bluuebunny/crossref_metadata_2025 huggingface dataset:
Microorganisms and clinical outcomes of early- and late-onset ventilator-associated pneumonia at Srinagarind Hospital, a tertiary center in Northeastern Thailand
Authors: Arayasukawat Pavarit , So-ngern Apichart , Reechaipichitkul Wipa , Chumpangern Worawat , Arunsurat Itthiphat , Ratanawatkul Pailin , Chuennok Wanna
Published: January 2021

Background

Ventilator-associated pneumonia (VAP) is a common nocosomial infection in intensive care unit (ICU). Local microbiological surveillance of pathogens and resistance patterns for early-onset VAP (EOVAP) and late-onset VAP (LOVAP) will help to choose appropriate empiric antibiotics.

Objective

To compare the multi-drug resistant (MDR) pathogens, treatment outcomes, and factors associated with hospital mortality of VAP.

Method

A cross-sectional study between 1 January 2015 and 31 December 2017 at Srinagarind hospital, Khon Kaen University was conducted. The demographic data, causative pathogens, hospital length of stay (LOS), ICU LOS, mechanical ventilator (MV) days, and hospital mortality were retrospectively reviewed.

Results

One hundred and ninety patients were enrolled; 42 patients (22%) were EOVAP and 148 patients (78%) were LOVAP. Acinetobacter baumannii was the most common pathogen in both groups (50% EOVAP vs 52.7% LOVAP). MDR pathogens were significant greater in LOVAP (81.8%) than EOVAP (61.9%) (p = 0.007). The EOVAP had a significantly better ICU LOS [median (interquartile range, IQR) 20.0 (11.0, 30.0) vs. 26.5 (17.0, 43.0) days], hospital LOS [median (IQR) 26.5 (15.0, 44.0) vs. 35.5 (24.0, 56.0) days] shorter MV days [median (IQR) 14.0 (10.0, 29.0) vs. 23.0 (14.0, 35.5) days] and lower hospital mortality (16.7% vs 35.1%) than LOVAP (p < 0.05). The factor associated with hospital mortality was having simplified acute physiology (SAP) II score ≥ 40 with an adjusted odds ratio (aOR) of 2.22 [95% confidence interval (CI), 1.08–4.54, p = 0.02].

Conclusion

LOVAP had significantly higher MDR pathogens, MV days, ICU LOS, hospital LOS and hospital mortality than EOVAP. A broad-spectrum antibiotic to cover MDR pathogens should be considered in LOVAP. The factor associated with hospital mortality of VAP was a SAPII score ≥ 40.
Feasibility and effectiveness of a single-catheter approach for adrenal vein sampling in patients with primary aldosteronism
Authors: Wan Jindong , Ran Fei , Xia Siwei , Hou Jixin , Wang Dan , Liu Sen , Yang Yi , Zhou Peng , Wang Peijian
Published: January 2021

Background

Adrenal vein sampling (AVS) is the preferred method for subtyping patients with primary aldosteronism, while the procedure is technically challenging. This study evaluated the feasibility and effectiveness of a single-catheter approach for AVS.

Methods

A retrospective analysis of 106 consecutive patients who underwent AVS was performed to determine the procedural success and complication rates. Bilateral AVS procedures were performed using a single 5-Fr Tiger catheter with repeated manual reshaping.

Results

We successfully advanced the catheter into the bilateral adrenal veins of all patients and reached a 90.6% procedural success rate of AVS. The procedural period was 33.0 ± 8.2 min, the fluoroscopy period was 5.8 ± 1.7 min, and the diagnostic contrast used was 17.3 ± 5.5 ml. Only one patient (0.9%) had a hematoma at the femoral puncture site. No other complications were observed. The operation period gradually shortened as the cumulative number of operations increased. The number of procedures required to overcome the learning curve was about 33 cases.

Conclusions

The single-catheter approach is feasible and effective for AVS. Moreover, this approach required a relatively short learning curve for an inexperienced trainee.
Pedagogical foundations of cybercivility in health professions education: a scoping review
Authors: DE GAGNE Jennie C. , KOPPEL Paula D. , KIM Sang Suk , PARK Hyeyoung K. , RUSHTON Sharron
Published: January 2021

Background

Teaching cybercivility requires thoughtful attention to curriculum development and content delivery. Theories, models, and conceptual and theoretical frameworks (hereafter “tools”) provide useful foundations for integrating new knowledge and skills into existing professional practice and education. We conducted this scoping review to identify tools used for teaching cybercivility in health professions education.

Methods

Using Arksey and O’Malley’s scoping review framework, we searched six biomedical and educational databases and three grey literature databases for articles available in English published between January 1, 2000 and March 31, 2020. Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews), we screened and extracted relevant data, and reported the results of the search.

Results

The search resulted in 2272 articles, with 8 articles included in this review after inclusion criteria were applied. Four articles (50%) were peer-reviewed journal papers while the other 4 (50%) were dissertations. Eleven unique tools were identified by this review: (1) Transpersonal Caring Theory, (2) Theory of Workplace Incivility, (3) Conceptualization of Incivility, (4) Media Ecology Theory, (5) Principlism, (6) Salmon’s Five Stage Model of Online Learning, (7) Learner-Centered Educational Theory, (8) Gallant and Drinan’s 4-Stage Model of Institutionalization of Academic Integrity, (9) Theory of Planned Behavior, (10) Communication Privacy Management Theory, and (11) Moral Development Theory. Based on the tools analyzed in our scoping review, we determined three features of cybercivility pedagogy to which the tools provided a guide: (1) behavioral manifestations, (2) academic integrity, and (3) digital professionalism.

Conclusions

The reviewed tools provide a pedagogical foundation and guidance for teaching various properties of cybercivility. Future studies should be expanded to include a broader literature body and non-English literature to provide the global perspective and global skills needed by a diverse population of learners.
The Swedish version of the TeamSTEPPS® teamwork attitudes questionnaire (T-TAQ): A validation study
Authors: Hall-Lord Marie Louise , Bååth Carina , Ballangrud Randi , Nordin Anna
Published: January 2021

Background

Effective teamwork is essential for delivering safe health care. It is important to increase patient safety in healthcare by conducting interprofessional team training with both healthcare professionals and undergraduate students. Validated questionnaires that evaluate team training activities contribute to valuable knowledge regarding changes in attitudes toward teamwork. The aim of the study was to test the reliability and structural validity of the Swedish version of the TeamSTEPPS® Teamwork Attitudes Questionnaire (T-TAQ).

Methods

The study had a cross-sectional design. Four hospitals in three health care regions in Sweden participated in the study. In total, 458 healthcare professionals, response rate 39.4%, completed the questionnaire. The T-TAQ, which consists of 30 items and covers five dimensions (Team Structure, Leadership, Situation Monitoring, Mutual Support and Communication), was translated to Swedish. A paper version of the T-TAQ was distributed to healthcare professionals (physicians, registered nurses, midwives, nursing assistants and allied health professionals) from the hospitals. Reliability and validity were tested using Cronbach’s alpha and confirmatory factor analysis.

Results

Cronbach’s alpha was 0.70 for the total T-TAQ and ranged from 0.41 to 0.87 for the individual dimensions. The goodness-of-fit indexes in the confirmatory factor analysis (Model 2) revealed a normed chi-square of 2.96, a root mean square error of approximation of 0.068, a Tucker-Lewis index of 0.785 and a comparative fit index of 0.808.

Conclusions

The Swedish version of the T-TAQ has some potential to measure healthcare professionals’ general attitudes toward the core components of teamwork in hospital settings. Further validation studies of the Swedish version of the T-TAQ are required, with samples representing both healthcare professionals and students from various healthcare disciplines and educational levels.
Rural-urban and gender differences in the association between community care services and elderly individuals’ mental health: a case from Shaanxi Province, China
Authors: Yang Liu , Wang Lijian , Dai Xiuliang
Published: January 2021

Background

While community care services have been developing rapidly as a new way to meet the growing demands of elderly individuals in China, their health benefits are virtually unknown. Thus, the aim of this study was to examine the Chinese elderly individuals’ utilisation of community care services and its association with the mental health with comparing rural-urban and gender differences.

Methods

For this 2019 cross-sectional study, 687 elderly people from 7 counties (districts) of China’s Shaanxi province were enrolled. Respondents’ mental health level was assessed using a self-reported mental health measure. Four categories of community care services utilisation were examined: daily care services, medical care services, social and recreational services and spiritual comfort services. The binary logistic regression model was used in examining the association between community care services utilisation and mental health.

Results

Our results showed that there was a noted difference in mental health level between the male and female groups. Utilisation of medical care services and social and recreational services was significantly higher in the rural group than that in the urban group. Regression analysis showed that utilisation of daily care services (β = 0.809, p = 0.008) and social and recreational service (β = 0.526, p = 0.035) was significantly and positively associated with elderly individuals’ mental health level. Specifically, daily care services utilisation predicted a better mental health of the rural elderly (β = 1.051, p = 0.036) and the male elderly (β = 1.133, p = 0.053), while social and recreational services utilisation predicted a better mental health of the urban elderly (β = 0.927, p = 0.008) and the female elderly (β = 0.864, p = 0.007).

Conclusions

Our findings indicated varied levels of community care services utilisation and mental health are common among the elderly people in China. Community care services utilisation has a positive, albeit selective, association with elderly individuals’ mental health. Further policies should strengthen the equitable development of high-quality community care services in urban and rural areas to improve the mental health of elderly individuals, and focus more on gender differences in terms of community care services needs.
Effects of exercise-based pulmonary rehabilitation on adults with asthma: a systematic review and meta-analysis
Authors: Feng Zhenzhen , Wang Jiajia , Xie Yang , Li Jiansheng
Published: January 2021

Background

Pulmonary rehabilitation (PR) has been proposed as an effective method for many respiratory diseases. However, the effects of exercise-based PR on asthma are currently inconclusive. This review aimed to investigate the effects of exercise-based PR on adults with asthma.

Methods

The PubMed, Embase, Cochrane Library, Web of Science, International Clinical Trials Registry Platform and ClinicalTrials.gov databases were searched from inception to 31 July 2019 without language restriction. Randomized controlled trials (RCTs) investigating the effects of exercise-based PR on adults with asthma were included. Study selection, data extraction and risk of bias assessment were performed by two investigators independently. Meta-analysis was conducted by RevMan software (version 5.3). Evidence quality was rated by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.

Results

Ten literatures from nine studies (n = 418 patients) were identified. Asthma quality of life questionnaire total scores (MD = 0.39, 95% CI: 0.02 to 0.76) improved significantly in the experimental group compared to control group, including activity domain scores (MD = 0.58, 95% CI: 0.21 to 0.94), symptom domain scores (MD = 0.52, 95% CI: 0.19 to 0.85), emotion domain scores (MD = 0.53, 95% CI: − 0.03 to 1.09) and environment domain scores (MD = 0.56, 95% CI: 0.00 to 1.11). Both the 6-min walk distance (MD = 34.09, 95% CI: 2.51 to 65.66) and maximum oxygen uptake (MD = 4.45, 95% CI: 3.32 to 5.58) significantly improved. However, improvements in asthma control questionnaire scores (MD = − 0.25, 95% CI: − 0.51 to 0.02) and asthma symptom-free days (MD = 3.35, 95% CI: − 0.21 to 6.90) were not significant. Moreover, there was no significant improvement (MD = 0.10, 95% CI: − 0.08 to 0.29) in forced expiratory volume in 1 s. Nonetheless, improvements in forced vital capacity (MD = 0.23, 95% CI: 0.08 to 0.38) and peak expiratory flow (MD = 0.39, 95% CI: 0.21 to 0.57) were significant.

Conclusions

Exercise-based PR may improve quality of life, exercise tolerance and some aspects of pulmonary function in adults with asthma and can be considered a supplementary therapy. RCTs of high quality and large sample sizes are required.

Clinical trial registration: The review was registered with PROSPERO (The website is https://www.crd.york.ac.uk/prospero/, and the ID is CRD42019147107).
Hospital bed supply and inequality as determinants of maternal mortality in China between 2004 and 2016
Authors: Tian Fan , Pan Jay
Published: January 2021

Background

Driven by the government’s firm commitment to promoting maternal health, maternal mortality ratio (MMR) in China has achieved a remarkable reduction over the past 25 years. Paralleled with the decline of MMR has been the expansion of hospital bed supply as well as substantial reduction in hospital bed distribution inequalities, which were thought to be significant contributors to the reduction in MMR. However, evidences on the impact of hospital bed supply as well as how its distribution inequality has affected MMR remains scarce in China. Addressing this uncertainty is essential to understand whether efforts made on the expansion of healthcare resource supply as well as on improving its distribution inequality from a geographical perspective has the potential to produce measurable population health improvements.

Methods

Panel data of 31 provinces in China between 2004 and 2016 were extracted from the national statistical data, including China Statistical Yearbooks, China Health Statistical Yearbooks and other national publications. We firstly described the changes in hospital bed density as well as its distribution inequality from a geographical perspective. Then, a linear mixed model was employed to evaluate the impact of hospital bed supply as well as its distribution inequality on MMR at the provincial level.

Results

The MMR decreased substantially from 48.3 to 19.9 deaths per 100,000 live births between 2004 and 2016. The average hospital bed density increased from 2.28 per 1000 population in 2004 to 4.54 per 1000 population in 2016, with the average Gini coefficient reducing from 0.32 to 0.25. As indicated by the adjusted mixed-effects regressions, hospital bed density had a negative association with MMR (β = − 0.112, 95% CI: − 0.210--0.013) while every 0.1-unit reduction of Gini coefficient suggested 14.50% decline in MMR on average (β = 1.354, 95% CI: 0.123–2.584). Based on the mediation analysis, the association between hospital bed density or Gini coefficient with MMR was found to be significantly mediated by facility birth rate, especially during the period from 2004 to 2009.

Conclusions

This study provided empirical evidences on China’s impressive success in the aspect of reducing MMR which could be attributed to the expansion of hospital beds as well as the improvement in its distribution inequality from a geographical perspective. Such findings were expected to provide evidence-based implications for long-term policy-making procedures in order to achieve rational healthcare resource allocations as well as promoting the equity and accessibility to obtaining health care from a holistic perspective. Constant efforts should be made on improving the equity in healthcare resource allocations in order to achieve the penetration of universal healthcare coverage.
The quality of life in Chinese juvenile idiopathic arthritis patients: psychometric properties of the pediatric quality of life inventor generic core scales and rheumatology module
Authors: Wu Hua-hong , Wu Feng-qi , Li Yang , Lai Jian-ming , Su Gai-xiu , Cui Shu-hua , Chen Zheng , Li Hui
Published: January 2021

Background

Juvenile idiopathic arthritis (JIA) may seriously affects patients’ quality of life (QoL), but it was rarely focused and studied in China, so we explore JIA children’s QoL using Chinese version of the PedsQL4.0 Generic Core and PedsQL3.0 Rheumatology Module scale, and analyzed the psychometric properties of these two Scales among Chinese JIA children.

Methods

We recruited 180 JIA patients from Children's Hospital Affiliated to Capital Institute of Pediatrics and Hebei Yanda Hospital from July 2018 to August 2019. The questionnaires include information related on JIA, PedsQL4.0 generic core and PedsQL3.0 Rheumatology Module scales. According to the disease type, onset age of and course of JIA, we divided them into different groups, then compared the QoL status among different groups. Moreover, we analyzed the reliability and validity of these two scales in these 180 JIA children.

Results

The mean score of PedsQL4.0 generic core scale on these 180 patients was 82.85 ± 14.82, for these in active period was 72.05 ± 15.29, in remission period was 89.77 ± 9.23; the QoL score of systemic, polyarticular and oligoarticular JIA patients were 77.05 ± 19.11, 84.33 ± 12.46 and 87.12 ± 10.23. The mean score of PedsQL3.0 Rheumatology Module scale on 180 patients was 91.22 ± 9.45, for these in active period was 84.70 ± 11.37, in remission period was 95.43 ± 4.48; the QoL score of systemic, polyarticular and oligoarticular JIA patients were 89.41 ± 11.54, 89.38 ± 10.08 and 93.71 ± 6.92. In the PedsQL 4.0 Generic Core scale, the α coefficients of total scale and almost every dimension are all greater than 0.8 except for the school activity dimension of 0.589; the correlation coefficients of 22 items’ scores (total 23 items) with the scores of dimensions they belong to are greater than 0.5 (maximum value is 0.864), and the other one is 0.406. In PedsQL3.0 Rheumatology Module scale, except for the treatment and worry dimensions of 0.652 and 0.635, the α coefficients of other dimensions and the total scale are all greater than 0.7; the correlation coefficients of all items’ score were greater than 0.5 (the maximum is 0.933, the minimum is 0.515).

Conclusions

The QoL of Chinese JIA children is worse than their healthy peers, these in active period and diagnosed as systemic type were undergoing worst quality of life. The reliability and validity of PedsQL 4.0 Generic Core and PedsQL3.0 Rheumatology Module scale in Chinese JIA children are satisfactory, and can be used in clinical and scientific researches.
Application of discrete choice experiments to estimate value of life: a national study protocol in Iran
Authors: Mirzaee Negar , Takian Amirhossein , Farzadfar Farshad , Daroudi Rajabali , Kazemi Karyani Ali , Akbari Sari Ali
Published: January 2021

Background

Global concerns regarding the significant burden of non-communicable diseases and injuries (NCDIs) exist from both public health and economic perspectives. Our research focuses on the reduction of fatal risks due to NCDIs and the citizens’ preferences about health programs and intervention to reduce premature death due to NCDIs. Governments and health authorities need reliable evidence and information to prioritize the interests of their citizens. One crucial piece of evidence to justify the resources spent on NCDIs is the value derived from the interventions on prevention and NCDIs control. This concept is usually called “Value of Statistical Life” (VSL), meaning the monetary value that individuals place on changes in the risk levels of life- threatening events. To the best of our knowledge, for the first time, our study will estimate the statistical value of life for selected interventions for the prevention and control of NCDIs at both national and sub-national levels in the context of Iran. This paper reports the development of a national protocol through Discrete Choice Experiments (DCEs) method.

Methods and designs

Our study comprises several stages: (a) a literature review to identify the attributes and levels of the prevention programs and Willingness to Pay (WTP) for reducing the NCDI’s fatal risks; (b) experimental design to assessing, prioritizing, and finalizing the identified attributes and levels; (c) instrumental design to conduct face-to-face structured survey interviews of 3180 respondents aged 18–69 across the entire country; (d) statistical analysis to estimate the results through the Mixed Multinomial logit (MMNL) model.

Discussion

We anticipate that our findings will help build a stronger empirical basis for monetizing the value of small changes in selected fatality risks. It paves the way for other national or vast VSL estimates for NCDIs, as well as other major causes of morbidity and mortality in the context of Iran, and perhaps other low and middle-income countries (LMICs).
CooC11 and CooC7: the development and validation of age appropriate children’s perceived cooking competence measures
Authors: Dean Moira , Issartel Johann , Benson Tony , McCloat Amanda , Mooney Elaine , McKernan Claire , Dunne Laura , Brennan Sarah F. , Moore Sarah E. , McCarthy Danielle , Woodside Jayne V. , Lavelle Fiona
Published: January 2021

Background

Learning cooking skills during childhood and adolescence is associated with positive dietary outcomes in adulthood as well as being tracked from adolescence to adulthood. In addition studies have found that perceived competence to be a greater motivator to perform a behaviour than actual competence. However, a lack of validated tools that effectively measure behavioural and dietary changes including cooking confidence in children is a limitation. Therefore, this research aimed to develop and validate age-appropriate perceived cooking competence measures for younger and older primary school aged children.

Methods

Two measures of perceived Cooking Competence (CooC11 and CooC7) for older (8–12 years) and younger (6–7 years) children were developed from a critical evaluation of publically available recommendations and expert consultation. The cooking skills within the measures were illustrated by a graphic designer in consultation with a chef and reviewed in an iterative manner by the research team. The measures were piloted for clarity, ease of use and initial face validity. Multiple studies were used for both CooC11 and CooC7 to establish psychometric properties of the measures, temporal stability, internal consistency reliability, construct validity, as well as responsiveness to change for CooC11. Analysis included Exploratory Factor Analysis, Confirmatory Factor Analysis, Intraclass Correlation Coefficients, Pearson’s Correlations, ANOVAs and Cronbach’s Alphas.

Results

Both measures had high levels of face validity and received positive user feedback. Two factors were shown in both measures with the measures showing excellent temporal stability (ICC > 0.9) and good internal consistency (Cronbach’s Alphas > 0.7). Both measures showed initial discriminant validity, with significant differences (P< 0.001) between those who reported assisting their parents with dinner preparation and those who did not. Additionally, CooC11 was significantly correlated with an adult cooking measure and had a significant responsiveness to change (P< 0.01).

Conclusions

The CooC11 and CooC7 are the first validated age-appropriate measures for assessing children’s perceived Cooking Competence for ages 8–12 and 6–7 years respectively. They can be used to evaluate the efficacy of children’s cooking intervention studies or school nutrition education programmes.
Real-time monitoring of rhizosphere nitrate fluctuations under crops following defoliation
Authors: Capstaff Nicola M. , Domoney Claire , Miller Anthony J.
Published: January 2021

Background

Management regime can hugely influence the efficiency of crop production but measuring real-time below-ground responses is difficult. The combination of fertiliser application and mowing or grazing may have a major impact on roots and on the soil nutrient profile and leaching.

Results

A novel approach was developed using low-cost ion-selective sensors to track nitrate (NO3−) movement through soil column profiles sown with the forage crops, Lolium perenne and Medicago sativa. Applications of fertiliser, defoliation of crops and intercropping of the grass and the legume were tested. Sensor measurements were compared with conventional testing of lysimeter and leachate samples. There was little leaching of NO3− through soil profiles with current management practices, as monitored by both methods. After defoliation, the measurements detected a striking increase in soil NO3− in the middle of the column where the greatest density of roots was found. This phenomenon was not detected when no NO3− was applied, and when there was no defoliation, or during intercropping with Medicago.

Conclusion

Mowing or grazing may increase rhizodeposition of carbon that stimulates soil mineralization to release NO3− that is acquired by roots without leaching from the profile. The soil columns and sensors provided a dynamic insight into rhizosphere responses to changes in above-ground management practices.
Risk factors for femoral fracture in lateral decubitus direct anterior approach total hip arthroplasty using conventional stems: a retrospective analysis
Authors: Sun Guanjun , Yin Yi , Ye Yongjie , Li Qingshan
Published: January 2021

Objective

To provide guidelines for surgery and reduce the incidence of fracture, this study analyzed the relationship between femoral fracture and related factors in direct anterior approach (DAA) total hip arthroplasty (THA) in the lateral decubitus position.

Method

A retrospective series of 273 consecutive patients who underwent THA with the DAA in the lateral decubitus position was analyzed. Each surgery was performed by the same surgeon with a conventional operation bed and femoral stem. The correlations between the incidence of fracture and sex, age, body mass index (BMI), height, osteoporosis, the anterior superior iliac spine-greater trochanter distance (ASIS-GTD), and hip joint disease were analyzed by univariate analysis and logistic regression analysis.

Results

Among all hip arthroplasty procedures, 35 hips had femoral fractures, including 30 greater trochanter fractures, 4 proximal femoral splits, and 1 femoral perforation. The incidence of fracture was 12.82%. Univariate analysis showed no significant difference in the incidence of fracture by sex, BMI, or age. However, osteoporosis caused an increase in the incidence of fracture, while the incidence of fracture decreased as height and the ASIS-GTD increased. The incidence of femoral neck fracture was lower in cases of osteonecrosis of the femoral head than in cases of other diseases. Logistic regression showed a significant correlation between osteoporosis, the ASIS-GTD, and fractures. Patients with osteoporosis had a high possibility of fracture (OR = 2.414); the possibility of fracture decreased with increasing ASIS-GTD (OR = 0.938).

Conclusion

Lateral decubitus DAA THA can be successfully performed using a conventional operation bed and stem, effectively saving medical resources. Osteoporosis and a shorter ASIS-GTD were independent risk factors for femoral fracture.
The influence of near-field fluxes on seasonal carbon dioxide enhancements: results from the Indianapolis Flux Experiment (INFLUX)
Authors: Miles Natasha L. , Davis Kenneth J. , Richardson Scott J. , Lauvaux Thomas , Martins Douglas K. , Deng A. J. , Balashov Nikolay , Gurney Kevin R. , Liang Jianming , Roest Geoff , Wang Jonathan A. , Turnbull Jocelyn C.
Published: January 2021

Background

Networks of tower-based CO2 mole fraction sensors have been deployed by various groups in and around cities across the world to quantify anthropogenic CO2emissions from metropolitan areas. A critical aspect in these approaches is the separation of atmospheric signatures from distant sources and sinks (i.e., the background) from local emissions and biogenic fluxes. We examined CO2enhancements compared to forested and agricultural background towers in Indianapolis, Indiana, USA, as a function of season and compared them to modeled results, as a part of the Indianapolis Flux (INFLUX) project.

Results

At the INFLUX urban tower sites, daytime growing season enhancement on a monthly timescale was up to 4.3–6.5 ppm, 2.6 times as large as those in the dormant season, on average. The enhancement differed significantly depending on choice of background and time of year, being 2.8 ppm higher in June and 1.8 ppm lower in August using a forested background tower compared to an agricultural background tower. A prediction based on land cover and observed CO2fluxes showed that differences in phenology and drawdown intensities drove measured differences in enhancements. Forward modelled CO2enhancements using fossil fuel and biogenic fluxes indicated growing season model-data mismatch of 1.1 ± 1.7 ppm for the agricultural background and 2.1 ± 0.5 ppm for the forested background, corresponding to 25–29% of the modelled CO2enhancements. The model-data total CO2mismatch during the dormant season was low, − 0.1 ± 0.5 ppm.

Conclusions

Because growing season biogenic fluxes at the background towers are large, the urban enhancements must be disentangled from the biogenic signal, and growing season increases in CO2enhancement could be misinterpreted as increased anthropogenic fluxes if the background ecosystem CO2drawdown is not considered. The magnitude and timing of enhancements depend on the land cover type and net fluxes surrounding each background tower, so a simple box model is not appropriate for interpretation of these data. Quantification of the seasonality and magnitude of the biological fluxes in the study region using high-resolution and detailed biogenic models is necessary for the interpretation of tower-based urban CO2networks for cities with significant vegetation.
The relationship between quality of life and coping strategies of children with EB and their parents
Authors: Mauritz Petra J. , Bolling Marieke , Duipmans José C. , Hagedoorn Mariët
Published: January 2021

Background

Epidermolysis bullosa (EB) is a group of rare genetic skin disorders that primarily manifest as blisters and erosions following mild mechanical trauma. Despite the crucial role of the parents of children with EB in managing the disease, studies focusing on the parent–child relationship remain a gap in the literature. To address this gap, the current quantitative study, involving 55 children with all types of EB and 48 parents, assessed the relationship between their quality of life and coping strategies. Quality of life was measured with the Pediatric Quality of Life Inventory and TNO-AZL Questionnaire for Adult’s Health- related Quality of Life, and coping strategies were assessed with the Coping with a Disease Questionnaire. The majority of the analyses were descriptive and the results were interpreted qualitatively because of the small sample size.

Results

Overall, the quality of life of children with EB and that of their parents was somewhat lower compared with the quality of life of healthy children and adults. Children with EB who more frequently used emotional reactions and cognitive-palliative strategies to cope with the disease demonstrated lower levels of emotional and social functioning, while children who showed more acceptance and distancing showed higher levels of functioning on all domains. Parents who frequently demonstrated emotional reactions reported lower levels of social functioning and experienced more depressive emotions and anger. Parents who used more avoidance showed higher levels of positive emotions. Within parent–child dyads, acceptance, cognitive-palliative strategies and distancing were positively related. Children’s emotional and social functioning were negatively associated with their parents’ depressive emotions. Parents’ acceptance was linked to higher physical functioning in children, whereas children’s avoidance was linked to a lower level of anger in parents.

Conclusion

Children who are able to accept the disease or distance themselves from it appear to be better off in contrast to those who tend to engage in the cognitive-palliative strategies and expressing emotional reactions. Parents seem to be better off when they are able to use avoidance in contrast to those who tend to show emotional reactions. Further research is needed to substantiate these findings.
Quantitative assessment of left ventricular longitudinal function and myocardial deformation in Duchenne muscular dystrophy patients
Authors: Panovský Roman , Pešl Martin , Máchal Jan , Holeček Tomáš , Feitová Věra , Juříková Lenka , Masárová Lucia , Pešlová Eva , Opatřil Lukáš , Mojica-Pisciotti Mary Luz , Kincl Vladimír
Published: January 2021

Background

Duchenne muscular dystrophy (DMD) manifests in males mainly by skeletal muscle impairment, but also by cardiac dysfunction. The assessment of the early phases of cardiac involvement using echocardiography is often very difficult to perform in these patients. The aim of the study was to use cardiac magnetic resonance (CMR) strain analysis and mitral annular plane systolic excursion (MAPSE) in the detection of early left ventricular (LV) dysfunction in DMD patients.

Methods and results

In total, 51 male DMD patients and 18 matched controls were examined by CMR. MAPSE measurement and functional analysis using feature tracking (FT) were performed. Three groups of patients were evaluated: A/ patients with LGE and LV EF < 50% (n = 8), B/ patients with LGE and LVEF ≥ 50% (n = 13), and C/ patients without LGE and LVEF ≥ 50% (n = 30). MAPSE and global LV strains of the 3 DMD groups were compared to controls (n = 18).

Groups A and B had significantly reduced values of MAPSE, global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) in comparison to controls (p < 0.05). The values of MAPSE (11.6 ± 1.9 v 13.7 ± 2.7 mm) and GCS (− 26.2 ± 4.2 v − 30.0 ± 5.1%) were significantly reduced in group C compared to the controls (p < 0.05).

Conclusion

DMD patients had decreased LV systolic function measured by MAPSE and global LV strain even in the case of normal LV EF and the absence of LGE. FT and MAPSE measurement provide sensitive assessment of early cardiac involvement in DMD patients.
Initial predictors for short-term prognosis in anti-melanoma differentiation-associated protein-5 positive patients
Authors: Yang Qihua , Li Tianfang , Zhang Xin , Lyu Kunlong , Wu Shujun , Chen Yan , Liu Shengyun , Yu Zujiang
Published: January 2021

Background

Anti-melanoma differentiation-associated protein-5 (anti-MDA5) positive patients are characterized by the high mortality rate caused by interstitial lung disease (ILD). We conducted a retrospective study to summarize the clinical features and identify the initial predictors for death in anti-MDA5 positive patients.

Methods

We designed a retrospective cohort of anti-MDA5 positive patients. The demographic and clinical data recorded on first admission, as well as the outcomes during the first six months follow-up, were collected. Predictors of rapidly progressive ILD (RPILD) and poor outcomes were calculated using logistic regression models and Cox proportional hazard regression models, respectively.

Results

A total of 90 anti-MDA5 positive patients were included in this study. Eighty-one (90%) patients presented ILD on admission and 35 (38.9%) patients developed RPILD subsequently. During the first six months of follow-up, 22 (24.4%) patients died of respiratory failure at an average time of 6.6 ± 5.9 weeks. Factors including disease duration < 2 months (OR 6.1, 95% CI 1.7–22.4, P = 0.007), serum ferritin ≥ 1500 ng/ml (OR 12.3, 95% CI 3.1–49.6, P < 0.001), CRP ≥ 13 mg/L (OR 4.6, 95% CI 1.3–16.9, P = 0.021) and total GGO score ≥ 4 (OR 6.3, 95% CI 1.8–21.9, P = 0.003), were identified as independent predictors for RPILD. Cox regression model showed that total CT GGO score ≥ 4 (HR 4.8, 95% CI 1.3–17.9, P = 0.020), KL-6 > 1600 U/ml (HR 3.7, 95% CI 1.5–9.1, P = 0.004) and CRP > 5.8 mg/L (HR 3.7, 95% CI 1.0–12.8, P = 0.044) were poor prognostic risk factors, however initial combined treatment (HR 0.3, 95% CI 0.1–0.8, P = 0.019) predicted good prognosis in anti-MDA5 positive patients.

Conclusion

Anti-MDA5 positive patients demonstrated a high prevalence of ILD on admission, leading to a high short-term mortality rate. Higher total GGO score, higher levels of initial KL-6 and CRP predict poor outcome in anti-MDA5 positive patients. However, initial intensive treatment may improve the prognosis.
High clinical heterogeneity in a Chinese pedigree of retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations (RVCL-S)
Authors: Xie Nina , Sun Qiying , Yang Jinxia , Zhou Yangjie , Xu Hongwei , Zhou Lin , Zhou Yafang
Published: January 2021

Background

Being a newly defined disease, RVCL-S is underrecognized by clinicians globally. It is an autosomal dominantly inherited small vessel disease caused by the heterozygous C-terminal frameshift mutation in TREX1 gene. RVCL-S is featured by cerebral dysfunction, retinopathy, and vasculopathy in multiple internal organs. Misdiagnosis may cause devastating consequences in patients, such as iatrogenic PML caused by misuse of immunosuppressants. Thus, increasing awareness of this disease is in urgent need.

Results

We uncovered a large Chinese origin RVCL-S pedigree bearing the TREX1 mutation. A comprehensive characterization combining clinical, genetic, and neuropathological analysis was performed. The Intrafamilial comparison showed highly heterogeneous clinical phenotypes. Mutation carriers in our pedigree presented with retinopathy (8/13), seizures (2/13), increased intracranial pressure (1/13), mild cognitive impairment (3/13), stroke-like episode (3/13), mesenteric ischemia (1/13), nephropathy (9/13), ascites (3/13), hypertension (9/13), hyperlipidemia (3/8), hypoalbuminemia (3/8), normocytic anemia (3/8), subclinical hypothyroidism (1/8), hyperfibrinogenemia (1/8), hyperparathyroidism (2/8), and abnormal inflammatory markers (4/8). The constellation of symptoms is highly varied, making RVCL-S a challenging diagnosis. Comparison with reported RVCL-S pedigrees further revealed that the mesenteric ischemia is a novel clinical finding and the MRS pattern of brain lesions is emulating neoplasm and tumefactive demyelination.

Conclusion

Our reports characterize a highly heterogeneous RVCL-S pedigree, highlight the probability of misdiagnosis in clinical practice, and broaden the clinical spectrum of RVCL-S.
A new method for individual condylar osteotomy and repositioning guides used in patients with severe deformity secondary to condylar osteochondroma
Authors: Qi Lei , Cao Ningning , Ge Weiwen , Jiang Tengfei , Fan Linfeng , Zhang Lei
Published: January 2021

Background

Mandibular condylar osteochondroma (OC) could lead to facial morphologic and functional disturbances, such as facial asymmetry, malocclusion, and temporomandibular joint dysfunction. However, after condylar OC resection, the inaccurate reposition of the neocondyle still needs to be solved. The purpose of this study was to explore the feasibility of the condylar osteotomy and repositioning guide to reposition the neocondyle in the treatment of patients with severe deformity secondary to condylar OC.

Results

Three patients with severe deformity secondary to OC of the mandibular condyle were enrolled in this study. With the aid of condylar osteotomy and repositioning guide, condylar OC resection and repositioning were carried out, and the accuracy and stability of these guides were evaluated. All patients healed uneventfully, and no facial nerve injury and condylar ankylosis occurred. Compared with the computerized tomography scans in centric relation before surgery and 3 days after surgery, the results showed that the facial symmetry was greatly improved in all the patients. Also, after the superimposition of the condylar segments before surgery and 3 days after surgery, the postoperative reconstructed condyles had a high degree of similarity to the reconstruction of the virtual surgical planning. Observed from the sagittal and coronal directions, the measurements of condylar positions were very close to those of virtual surgical planning. Moreover, it also showed stable results after a 1-year follow-up.

Conclusions

For patients with severe deformity secondary to condylar OC, condylar osteotomy, and repositioning guide was expected to provide a new option for the improvement of facial symmetry and occlusal relationship.
Infiltrating immune cells in benign breast disease and risk of subsequent invasive breast cancer
Authors: Rohan Thomas E. , Arthur Rhonda , Wang Yihong , Weinmann Sheila , Ginsberg Mindy , Loi Sherene , Salgado Roberto
Published: January 2021

Background

It is well established that tumors are antigenic and can induce an immune response by the host, entailing lymphocytic infiltration of the tumor and surrounding stroma. The extent and composition of the immune response to the tumor, assessed through evaluation of tumor-infiltrating lymphocyte counts, has been shown in many studies to have prognostic and predictive value for invasive breast cancer, but currently, there is little evidence regarding the association between infiltrating immune cell counts (IICCs) in women with benign breast disease (BBD) and risk of subsequent invasive breast cancer.

Methods

Using a cohort of 15,395 women biopsied for BBD at Kaiser Permanente Northwest, we conducted a nested case-control study in which cases were women who developed a subsequent invasive breast cancer during follow-up and controls were individually matched to cases on age at BBD diagnosis. We assessed IICCs in normal tissue and in the BBD lesions, and we used unconditional logistic regression to estimate the multivariable odds ratios (OR) and 95% confidence intervals (CI) for the associations between IICCs and breast cancer risk.

Results

There was no association between the IICC in normal tissue (multivariable OR per 5% increase in IICC = 1.05, 95% CI = 0.96–1.16) or in the BBD lesion (OR per 5% increase in IICC = 1.06, 95% CI = 0.96–1.18) and risk of subsequent invasive breast cancer. Also, there were no associations within subgroups defined by menopausal status, BBD histology, BMI, and history of smoking.

Conclusion

The results of this study suggest that IICCs in BBD tissue are not associated with altered risk of subsequent invasive breast cancer.
Butanol production from lignocellulosic sugars by Clostridium beijerinckii in microbioreactors
Authors: Birgen Cansu , Degnes Kristin F. , Markussen Sidsel , Wentzel Alexander , Sletta Håvard
Published: January 2021

Background

Butanol (n-butanol) has been gaining attention as a renewable energy carrier and an alternative biofuel with superior properties to the most widely used ethanol. We performed 48 anaerobic fermentations simultaneously with glucose and xylose as representative lignocellulosic sugars by Clostridium beijerinckii NCIMB 8052 in BioLector® microbioreactors to understand the effect of different sugar mixtures on fermentation and to demonstrate the applicability of the micro-cultivation system for high-throughput anaerobic cultivation studies. We then compared the results to those of similar cultures in serum flasks to provide insight into different setups and measurement methods.

Results

ANOVA results showed that the glucose-to-xylose ratio affects both growth and production due to Carbon Catabolite Repression. The study demonstrated successful use of BioLector® system for the first time for screening several media and sugar compositions under anaerobic conditions by using online monitoring of cell mass and pH in real-time and at unprecedented time-resolution. Fermentation products possibly interfered with dissolved oxygen (DO) measurements, which require a careful interpretation of DO monitoring results.

Conclusions

The statistical approach to evaluate the microbioreactor setup, and information obtained in this study will support further research in bioreactor and bioprocess design, which are very important aspects of industrial fermentations of lignocellulosic biomass.
Cluster analysis of phenotypes of patients with Behçet’s syndrome: a large cohort study from a referral center in China
Authors: Zou Jun , Luo Jian-feng , Shen Yan , Cai Jian-fei , Guan Jian-long
Published: January 2021

Introduction

Behcet’s syndrome (BS) is a complex, heterogeneous disorder. However, classification of its subgroups is still debated. The purpose of this study was to investigate the clinical features and aggregation of patients with BS in China, based on manifestations and organ involvements.

Methods

This was a cross-sectional study of BS patients in Huadong Hospital of Fudan University between September 2012 and January 2020. We calculated relative risks (RRs) of clinical variables according to sex. Moreover, we conducted a hierarchical cluster analysis applied according to eighteen variables to determine subgroups of patients.

Results

A total of 860 BS patients were included. Male sex was associated with ocular involvement (RR 2.32, 95% CI 1.67, 3.22, P < 0.0001), vascular involvement (RR 2.00, 95% CI 1.23, 3.23, P = 0.004), cardiac lesion (RR 5.46, 95% CI 2.33, 12.77, P < 0.0001), and central nervous system involvement (RR 2.95, 95% CI 1.07, 6.78, P = 0.007) and was negatively associated with genital ulcers (RR 0.84, 95% CI 0.79, 0.91, P < 0.0001). Five clusters (C1–C5) were observed. C1 (n = 307) showed the skin and mucosa type. In C2 (n = 124), all had articular involvement, barely having major organ involvement except for 18 cases with intestinal lesions. In C3 (n = 156), the gastrointestinal type, 144 patients presented with intestinal involvement, and 36 patients with esophageal ulcers. In C4 (n = 142), all subjects presented with uveitis. C5 (n = 131) consisted of 44 patients with cardiac lesions, 58 with vascular involvement, and 26 cases having central nervous system involvement.

Conclusion

Our analysis confirmed sex differences in phenotypes of BS. Cluster analysis identified gastrointestinal, uveitis, and cardiovascular involvement cluster separately in different subsets, which represents the most commonly involved organs. Further research is required to replicate and clarify the patterns of phenotype in BS.