bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of vitamin D receptor gene polymorphisms and vitamin D levels with asthma and atopy in Cypriot adolescents: a case–control study
Authors: Papadopoulou Anna , Kouis Panayiotis , Middleton Nikos , Kolokotroni Ourania , Karpathios Themistokles , Nicolaidou Polyxeni , Yiallouros Panayiotis K.
Published: January 2020

Background: Polymorphisms in the vitamin D receptor (VDR) gene have been studied in immune-related disorders either as independent contributors or in combination with vitamin D concentration. Vitamin D and VDR have been independently linked to asthma susceptibility. We investigated whether VDR variants were associated independently or in relation to vitamin D levels with asthma in Cypriot adolescents.

Methods: We studied 190 current wheezers, 69 of which were categorized as active asthmatics and 671 healthy controls. We determined three VDR genotypes (BsmI, TaqI, ApaI) and measured serum 25(OH)D levels. Logistic regression and stratified analyses by the presence of hypovitaminosis D (≤20 ng/ml) were used to evaluate the association of the VDR variants with asthma.

Results: The distribution of TaqI genotypes was significantly different between controls and current wheezers (p = 0.030) or active asthmatics (p = 0.014). The tt genotype was over-represented in wheezers (19.2 %) and asthmatics (21.3 %) compared to respective controls (12.9 %). No difference was observed between controls, current wheezers and active asthmatics in the genotypic distribution of BsmI and ApaI polymorphic sites. After stratification by the presence of hypovitaminosis D, a significant association was detected between tt genotype of TaqI polymorphism with wheezing (OR: 1.97, 95 % CI: 1.12, 3.46) and asthma (OR: 2.37, 95CI%: 1.02, 5.52) only in those with normal vitamin D levels (>20 ng/ml) but not in subjects with low vitamin D.

Conclusions: The minor TaqI genotype of VDR is associated with asthma in Cypriot adolescents. This polymorphism may contribute to asthma susceptibility primarily under conditions of normal vitamin D levels (>20 ng/ml).
The role of iron in pulmonary pathology
Authors: Khiroya Heena , Turner Alice M.
Published: January 2020

Respiratory disease accounts for a large proportion of emergency admissions to hospital and diseaseassociated mortality. Genetic association studies demonstrate a link between iron metabolism and pulmonary disease phenotypes. IREB2  is a gene that produces iron regulatory protein 2 (IRP2), which has a key role in iron homeostasis. This review addresses pathways involved in iron metabolism, particularly focusing on the role of IREB2 . In addition to this, environmental factors also influence phenotypic variation in respiratory disease, for example inhaled iron from cigarette smoke is deposited in the lung and causes tissue damage by altering iron homeostasis. The effects of cigarette smoke are detailed in this article, particularly in relation to lung conditions that favour the upper lobes, such as emphysema and lung cancer. Clinical applications of iron homeostasis are also discussed in this review, especially looking at the pathophysiology of chronic obstructive pulmonary disease, lung cancer, pulmonary infections and acute respiratory distress syndrome. Promising new treatments involving iron are also covered.
Mental health, serum biomarkers and survival in severe COPD: a pilot study
Authors: Zilz Christian , Blaas Stefan H. , Pfeifer Michael , Jörres Rudolf A. , Budweiser Stephan
Published: January 2020

Background: Chronic obstructive pulmonary disease (COPD) impairs physical status and impacts on mental health. This prospective study was designed to assess associations between mental health and systemic biomarkers, and their combined relationship with long-term survival in stable severe COPD.

Methods: Forty-five patients with severe but stable COPD (forced expiratory volume in 1 s of 29.8 (quartiles: 22.6; 41.4) %predicted) were assessed using the Hospital Anxiety and Depression Scale (HADS), the Patient Health Questionnaire (PHQ), St. George’s Respiratory Questionnaire and the State-Trait Anxiety Inventory (STAI). The following serum biomarkers were measured: 25-OH-cholecalciferol, C-reactive protein, erythrocyte sedimentation rate, leucocyte number, serum amyloid-A (SA-A), N-terminal pro-brain natriuretic peptide, troponin I, glycosylated haemoglobin, haemoglobin (Hb), haematocrit (Hc), creatinine and thyroid-stimulating hormone. Patients were followed-up for 36 months. Associations between aspects of mental health and biomarkers, and their utility as predictors of 3-year survival were evaluated by regression analyses.

Results: The prevalence of anxiety (HADS-A: 89.9 %), depression (HADS-D: 58.8 %; PHQ: 60.6 %), somatisation (PHQ-15: 81.8 %) and psychosocial stress (PHQ-stress: 60.6 %) was high. There was a significant positive association between the leucocyte count and SA-A level with STAI-trait anxiety (p = 0.03 and p = 0.005, respectively), and between leucocytes and PHQ-stress (p = 0.043). Hb and Hc were significantly negatively associated with HADS-depression (p = 0.041 and p = 0.031, respectively). Univariate Cox regression analyses revealed that leucocyte count (hazard ratio (HR) 2.976, 95 % CI 1.059-8.358; p = 0.038), and stress (HR 4.922, 95 % CI 1.06–22.848; p = 0.042) were linked to long-term survival. In multivariate Cox regression analyses, including known risk factors for survival in COPD, PHQ-stress (HR 45.63, 95 % CI 1.72–1,208.48; p = 0.022) remained significantly associated with survival.

Conclusion: In this pilot study different dimensions of mental health were correlated to serum biomarkers, probably reflecting systemic effects of COPD. While leucocyte number and PHQ-stress were associated with long-term survival in univariate analyses, PHQ-stress remained in multivariate analyses as independent prognostic factor.
The effect of positive airway pressure therapy on neurocognitive functions, depression and anxiety in obesity hypoventilation syndrome
Authors: Baris Serap Argun , Tuncel Dilek , Ozerdem Cigdem , Kutlu Huseyin , Onyilmaz Tugba , Basyigit Ilknur , Boyaci Hasim , Yildiz Fusun
Published: January 2020

Background: The aim of this study is to evaluate the presence of neurocognitive dysfunctions, depression and anxiety and the effect of positive airway pressure (PAP) therapy on these alterations in Obesity Hypoventilation Syndrome (OHS) patients. Methods: Ten healthy normal and obese controls, 10 OHS and 10 OSAS patients were included in the study. Short form-36, Beck Depression Scale and State-Trade Anxiety Inventory (STAI 1-2) were performed. Wisconsin Card Sorting Test (WCST), Montreal Cognitive Assessment Scale (MOCA), Enhanced Cued Recall (ECR) and Mini Mental Test (MMT) were used for neurocognitive evaluation. All tests were repeated after one night PAP therapy in OHS and OSAS groups. Results: OHS patients had the lowest scores of physical (PF) and social functioning (SF) in SF-36. The total number of persistent errors and incorrect answers were the highest in OHS group in WCST. The scores of MOCA, ECR and MMT were lower; depression and anxiety scores were higher in OHS group than in controls (p = 0,00). There was a significant increase in the completed categories in OHS after PAP therapy (p = 0,03). There were also significant increases in MOCA, ECR and MMT scores and significant decreases in depression and anxiety scores with respect to PAP therapy. Conclusions: Cognitive dysfunction, depression and anxiety are important under-recognized comorbidities in OHS. It is suggested that short term PAP therapy had positive effects on neurocognitive functions, depression and anxiety but further multicentre, prospective studies with large number of cases are needed to evaluate the effect of long term PAP therapy on these parameters.
Hemothorax following lung transplantation: incidence, risk factors, and effect on morbidity and mortality
Authors: Hong Aria , King Christopher S. , Brown A. Whitney Walter , Ahmad Shahzad , Shlobin Oksana A. , Khandhar Sandeep , Bogar Linda , Rongione Anthony , Nathan Steven D.
Published: January 2020

Background: Hemothorax after lung transplantation may result in increased post-operative morbidity and mortality. Risk factors for developing hemothorax and the outcomes of patients who develop hemothorax have not been well studied. Methods: A retrospective chart review was performed on all patients who underwent lung transplantation at a single center between March 2009 and July 2014. Comparison was made between patients with and without hemothorax post-transplant. Results: There were 132 lung transplantations performed during the study period. Hemothorax was a complication in 17 (12.9 %) patients, occurring an average of 9 days after transplant. No difference was found between the hemothorax and non-hemothorax groups with respect to age, preoperative anticoagulation, lung allocation score, prior thoracotomy, coagulation profile, use of cardiopulmonary bypass, ischemic time, or postoperative P/F ratio. There was a trend towards a higher incidence of hemothorax in patients with underlying sarcoidosis and re-transplantation (p = 0.13 and 0.17, respectively). Hemothorax developed early (<48 h post-operatively) in 5 patients and presented in a delayed manner (≥48 h post-operatively) in 12 patients. Delayed hemothorax occurred primarily in the setting of anticoagulation (10 out of 12 patients). The hemothorax group had decreased ventilator-free days (p = 0.006), increased ICU length of stay (p = 0.01) and increased hospital length of stay (p = 0.005). Hemothorax was also associated with reduced 90-day survival (p = 0.001), but similar 1, 3, and 5-year survival (p = 0.63, p = 0.30, and p = 0.25), respectively). Conclusion: The development of hemothorax is associated with increased morbidity and decreased short-term survival. Hemothorax may present either within the first 48 h after surgery or in a delayed fashion, most commonly in the setting of anticoagulation.
Cost comparison of asthma treatments in 12-week study: caution about matching and short observational follow-up
Authors: Price David B. , Van Boven Job F.M. , Law Lisa M. , Cifra Alessandra , McQueen R. Brett
Published: January 2020

In the absence of randomisation, observational studies must take extra care to create treatment groups that are comparable in terms of key characteristics. Various matching methods exist which can create sound comparisons, minimising confounding where possible. A recent observational study by Dal Negro et al. carried out a cost analysis comparing two asthma medications. They report strong conclusions which favour one treatment over the other, however they include little discussion on the limitations of their study. The purpose of this letter is to comment on the weaknesses of the study design, including the level of matching used, and to urge readers to consider these issues alongside the interpretation of results.
The evidence on tiotropium bromide in asthma: from the rationale to the bedside
Authors: Radovanovic Dejan , Santus Pierachille , Blasi Francesco , Mantero Marco
Published: January 2020

Severe and poorly controlled asthma still accounts for a great portion of the patients affected. Disease control and future risk management have been identified by international guidelines as the main goals in patients with asthma. The need for new treatment approaches has led to reconsider anticholinergic drugs as an option for asthma treatment. Tiotropium is the first anticholinergic drug that has been approved for children and adults with poorly controlled asthma and is currently considered as an option for steps 4 and 5 of the Global Initiative for Asthma. In large randomized clinical trials enrolling patients with moderate to severe asthma, add-on therapy with tiotropium has demonstrated to be efficacious in improving lung function, decreasing risk of exacerbation and slowing the worsening of disease; accordingly, tiotropium demonstrated to be non inferior compared to long acting beta-agonists in the maintenance treatment along with medium to high inhaled corticosteroids. In view of the numerous ancillary effects acting on inflammation, airway remodeling, mucus production and cough reflex, along with the good safety profile and the broad spectrum of efficacy demonstrated in different disease phenotypes, tiotropium can represent a beneficial alternative in the therapeutic management of poorly controlled asthma. The present extensive narrative review presents the pharmacological and pathophysiological basis that guided the rationale for the introduction of tiotropium in asthma treatment algorithm, with a particular focus on its conventional and unconventional effects; finally, data on tiotropium efficacy and safety. from recent randomized clinical trials performed in all age categories will be extensively discussed.
Novel aspects in diagnostic approach to respiratory patients: is it the time for a new semiotics?
Authors: Smargiassi Andrea , Soldati Gino , Mariani Alberto A. , Inchingolo Riccardo
Published: January 2020

Medical approach to patients is a fundamental step to get the correct diagnosis. The aim of this paper is to analyze some aspects of the reasoning process inherent in medical diagnosis in our era. Pathologic signs (anamnestic data, symptoms, semiotics, laboratory and strumental findings) represent informative phenomena to be integrated for inferring a diagnosis. Thus, diagnosis begins with “signs” and finishes in a probability of disease. The abductive reasoning process is the generation of a hypothesis to explain one or more observations (signs) in order to decide between alternative explanations searching the best one. This process is iterative during the diagnostic activity while collecting further observations and it could be creative generating new knowledge about what has not been experienced before. In the clinical setting the abductive process is not only theoretical, conversely the physical exploitation of the patient (palpation, percussion, auscultation) is always crucial. Through this manipulative abduction, new and still unexpressed information is discovered and evaluated and physicians are able “to think through doing” to get the correct diagnosis. Abductive inferential path originates with an emotional reaction (discovery of the signs), step by step explanations are formed and it ends with another emotional reaction (diagnosis). Few bedside instruments are allowed to physicians to amplify their ability to search for signs. Stethoscope is an example. Similarities between ultrasound exploration and percussion can be found. Bedside ultrasonography can be considered an external amplifier of signs, a particular kind of percussion and represents a valid example of abductive manipulation. In this searching for signs doctors act like detectives and sometimes the discovering of a strategic, unsuspected sign during abductive manipulation could represent the key point for the correct diagnosis. This condition is called serendipity. Ultrasound is a powerful tool for detecting soft, hidden, unexpected and strategic signs.
The history and epidemiology of Middle East respiratory syndrome corona virus
Authors: Al-Osail Aisha M. , Al-Wazzah Marwan J.
Published: January 2020

Corona viruses cause common cold, and infections caused by corona viruses are generally self-resolving. During the last 4 years, corona viruses have become the most important viruses worldwide because of the occurrence of several recent deaths caused by corona viruses in Saudi Arabia. Spread of the infection occurred worldwide; however, most cases of mortality have occurred in the Middle East. Owing to the predominance of outbreaks in the Middle Eastern countries, the virus was renamed a Middle East respiratory syndrome corona virus (MERS-CoV) by the Corona virus Study Group. The Center for Diseases Control and Prevention and World Health Organization maintain a website that is updated frequently with new cases of MERS-CoV infection. In this review, we describe the history and epidemiology of this novel virus. Studies of the genetics and molecular mechanisms of this virus are expected to facilitate the development of vaccines in the future.
Effects of combination therapy indacaterol/ glycopyrronium versus tiotropium on moderate to severe COPD: evaluation of impulse oscillometry and exacerbation rate
Authors: Molino Antonio , Simioli Francesca , Stanziola Anna Agnese , Mormile Mauro , Martino Maria , D’Amato Maria
Published: January 2020

Background: Small airways are considered the major site of airflow limitation in COPD. Impulse oscillometry (IOS) is a forced oscillation technique, which provides passive measurement of lung mechanics. It can differentiate small airway from large airway obstruction and is more sensitive than spirometry for peripheral airway disease. In this study the efficacy of the combination of Indacaterol/Glycopirronium (IND/GLY) versus Tiotropium on airway resistance (R5, R20, R5–20), lung reactance (X) and resonant frequency in moderate to severe COPD patients has been evaluated. We also evaluated inspiratory capacity (IC), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), exacerbation rate and quality of life. Methods: Forty patients were monitored with forced oscillation technique and spirometry. Patients were randomized in 2 groups: 20 received fixed dose once daily Indacaterol/Glycopyrronium (Group A) and 20 received single Tiotropium (Group B). The oscillometry parameters were the measure of resistance in the airways at 5 Hz (R5), at 20 Hz (R20) and the lung reactance (X). Results: There was a statistically significant difference between pre-dosing at V1 and at follow up visits in R5, R20 and X values in patients receiving dual bronchodilation but not in control group. Pre-dosing IC value at follow up visits in patients receiving dual bronchodilation had a statistical significant variation. Conclusions: The “new” bronchodilator combination LABA/LAMA significantly reduces bronchial obstruction in small airways too. The oscillometry demonstrated greater sensitivity compared with spirometry for monitoring outcome measures of airway obstruction and the effect of long-term therapy.
Uneven distribution of professors and instructors in medical disciplines dealing with the four main chronic noncommunicable diseases: the case of the Italian Universities
Authors: Viegi Giovanni , Centanni Stefano , Blasi Francesco
Published: January 2020

Background: Chronic (non-communicable) diseases (NCD) – principally cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes – are leading causes of death and disability. There is the need to adopt a core University curriculum which let students be taught by teachers who are experts of the four main NCD, for reaching the public health goals proposed by the UN and the WHO. Methods: Our aim was to assess whether all medical students, regardless of the Italian university of enrolment, have an equal opportunity to be educated by an expert teacher in each of the four NCD. We have used the search engine http://cercauniversita.cineca.it/php5/docenti/cerca.php. Results: In January 2016, for each of the 43 universities with a school of medicine, we have assessed the presence of professors / instructors for each of the four academic disciplines corresponding to the four NCD: a) Respiratory medicine; b) Cardiovascular medicine; c) Oncology; d) Endocrinology. Comparing university personnel between Respiratory medicine and each of the other NCD academic sectors, there were negative differences, much wider with the sector Cardiovascular medicine, regarding individual (number of professors/instructors) and collective indicators (number of Universities with various kinds of professors/instructors). Conclusions: Both national societies and ERS should promote periodic analyses of the academic situation of respiratory medicine in the European countries for advocating the EU in order to have recommendations/suggestions for the Member States to get the proper recognition of respiratory medicine, at the same level as the other disciplines involved in preventing and managing the four main NCD.
Tuberculosis in South Asia: a tide in the affairs of men
Authors: Basnyat Buddha , Caws Maxine , Udwadia Zarir
Published: January 2020

Background: Tuberculosis (TB) remains the most common cause of infectious disease deaths worldwide. What is perhaps less appreciated is that the caseload of tuberculosis patients in South Asia is staggering. South Asia has almost 40% of the global TB burden with 4,028,165 cases in 2015. This region also has a disproportionate share of TB deaths (681,975 deaths, 38% of the global burden). Worldwide just 12.5% of TB cases are in HIV positive individuals, but much research and investment has focused on HIV-associated TB. Only 3.5% of patients with tuberculosis in South Asia have HIV co-infection. Not surprisingly with such a huge burden of disease, this region has an estimated 184,336 multi drug resistant (MDR) cases among notified TB cases which accounts for a third of global MDR burden. Crucially, at least 70% of the estimated MDR cases remain untreated in this region and MDR treatment success ranged from only 46% for India to 88% for Sri Lanka in the 2012 cohort that received treatment. This region represents many of the drivers of the modern TB epidemic: rapid urbanization and high density populations with dramatically rising incidence of diabetes, a burgeoning and largely unregulated private sector with escalating drug resistance and high air pollution both outdoor and household.

Conclusion: From bacterial biochemistry to policy implementation, we suggest ways in which South Asia can seize the opportunity lead global TB elimination by demonstrating feasibility in some of the world’s most densely populated cities and remotest reaches of the Himalayas. Clearly political will is essential, but we cannot defeat TB without understanding how to eliminate it in South Asia.
Management of severe acute exacerbations of COPD: an updated narrative review
Authors: Torres Antoni , Crisafulli Ernesto , Barbeta Enric , Ielpo Antonella
Published: January 2020

Background: Patients with chronic obstructive pulmonary disease (COPD) may experience an acute worsening of respiratory symptoms that results in additional therapy; this event is defined as a COPD exacerbation (AECOPD). Hospitalization for AECOPD is accompanied by a rapid decline in health status with a high risk of mortality or other negative outcomes such as need for endotracheal intubation or intensive care unit (ICU) admission. Treatments for AECOPD aim to minimize the negative impact of the current exacerbation and to prevent subsequent events, such as relapse or readmission to hospital. Main body: In this narrative review, we update the scientific evidence about the in-hospital pharmacological and non-pharmacological treatments used in the management of a severe AECOPD. We review inhaled bronchodilators, steroids, and antibiotics for the pharmacological approach, and oxygen, high flow nasal cannulae (HFNC) oxygen therapy, non-invasive mechanical ventilation (NIMV) and pulmonary rehabilitation (PR) as non-pharmacological treatments. We also review some studies of non-conventional drugs that have been proposed for severe AECOPD. Conclusion: Several treatments exist for severe AECOPD patients requiring hospitalization. Some treatments such as steroids and NIMV (in patients admitted with a hypercapnic acute respiratory failure and respiratory acidosis) are supported by strong evidence of their efficacy. HFNC oxygen therapy needs further prospective studies. Although antibiotics are preferred in ICU patients, there is a lack of evidence regarding the preferred drugs and optimal duration of treatment for non-ICU patients. Early rehabilitation, if associated with standard treatment of patients, is recommended due to its feasibility and safety. There are currently few promising new drugs or new applications of existing drugs.
Assessment of osteoporosis using the FRAX method and the importance of vitamin D levels in COPD patients
Authors: Anar Ceyda , Yavuz Melike Yüksel , Güldaval Filiz , Kalenci Dilek
Published: January 2020

Background: The aim of this paper was to evaluate the availability of FRAX for assessing osteoporosis risk, and to demonstrate the importance of vitamin D levels in COPD patients.

Methods: Fourty-six males who fulfilled the COPD diagnostic criteria defined by GOLD were included. Age, race, BMI, physical activity frequency, smoking and dietary habits, age at COPD diagnosis, disease duration, fractures history, and medications use were determined. Levels of 25(OH)D were detected. BMD was measured by DXA at lumbar spine, femoral neck, and entire femur, and classified according to ISCD. FRAX score was calculated. Control group was composed of 40 non-smoker individuals without previous history of pulmonary diseases.

Results: 25(OH)D levels were significantly different between patients and controls. In the COPD group, a statistically significant difference in vitamin D levels was detected among the A, B, C, and D grades, while no such significant differences in FRAX scores were detected. 25(OH)D levels were significantly low in COPD patients with disease exacerbations and hospitalizations in the previous one year. No correlation was detected between vitamin D levels and the FRAX score. A positive correlation was observed between vitamin D levels and T-score. FRAX scores were higher and vitamin D levels were lower in osteoporotic COPD patients than in non-osteoporotic COPD patients.

Conclusion: Using FRAX for assessing osteoporosis in COPD can reduce fracture risk and allow adequate treatment. Since vitamin D levels are related to exacerbations and hospitalizations, vitamin D supplementation may be needed in COPD patients, especially in those with high FRAX scores.
Motivation and response rates in bronchoscopy studies
Authors: Martinsen Einar M.H. , Eagan Tomas M.L. , Leiten Elise O. , Nordeide Eli , Bakke Per S. , Lehmann Sverre , Nielsen Rune
Published: January 2020

Background: Bronchoscopy is frequently used to sample the lower airways in lung microbiome studies. Despite being a safe procedure, it is associated with discomfort that may result in reservations regarding participation in research bronchoscopy studies. Information on participation in research bronchoscopy studies is limited. We report response rates, reasons for non-response, motivation for participation, and predictors of participation in a large-scale single-centre bronchoscopy study (“MicroCOPD”). Methods: Two hundred forty-nine participants underwent at least one bronchoscopy in addition to being examined by a physician, having lung function tested, and being offered a CT scan of the heart and lungs (subjects > 40 years). Each participant was asked an open question regarding motivation. Non-response reasons were gathered, and response rates were calculated. Results: The study had a response rate just above 50%, and men had a significantly higher response rate than women (56.5% vs. 44.8%, p = 0.01). Procedural fear was the most common non-response reason. Most participants participated due to perceived personal benefit, but a large proportion did also participate to help others and contribute to science. Men were less likely to give exclusive altruistic motives, whereas subjects with asthma were more likely to report exclusive personal benefit as main motive. Conclusion: Response rates of about 50% in bronchoscopy studies make large bronchoscopy studies feasible, but the fact that participants are motivated by their own health status places a large responsibility on the investigators regarding the accuracy of the provided study information.
Endotracheal metastasis of hepatocellular carcinoma: a case report
Authors: Ghinassi Giacomo , Imitazione Pasquale , Pecoraro Alfonso , Montella Luciano B.G. , Martucci Paola , Giacobbe Raffaella , Severo Campione , Aronne Domenico
Published: January 2020

We describe the case of a 75 years old patient with a history of hepatocellular carcinoma, with acute respiratory failure due to tracheal obstruction by metastasis, successfully treated with airway disobstruction with rigid bronchoscope.
Use of narrative medicine to identify key factors for effective doctor–patient relationships in severe asthma
Authors: Cappuccio Antonietta , Napolitano Silvia , Menzella Francesco , Pellegrini Guido , Policreti Alessandro , Pelaia Girolamo , Porpiglia Pasquale Alberto , Marini Maria Giulia
Published: January 2020

Background: In this project the authors use a narrative medicine (NM) approach to assess the promotion of trust in the relationship between physicians and their asthma patients. Methods: Following a NM educational course for physicians, a research was carried out in which at least 5 written narratives (parallel charts) for each participating physician were collected and qualitatively analysed according to Bury’s classification and the Grounded Theory. Results: The results of this study were of speculative and clinical interest. In particular, 66 participants wrote 314 narratives (246 on adult and 68 on paediatric patients). As a result of applying the NM approach, when the relationships remained problematic, many physicians wrote with a moral style about their adult (67%), and paediatric patients (33%) - especially in cases of asthmatic children’s or adolescents’ overprotective or absent families (40%) -. On the contrary, physicians who were able to listen to their patients with empathy (35%) made more shared decisions with patients, even with those they initially had a bad relationship. The used words of welcome, interest and acceptance were promoting patients’ trust that lead to restoring their activities in 45% of cases, according to physicians self-reporting. Conclusions: These approaches of NM are useful in daily clinical practice, with the goal of improving the quality of life (QOL) of patients with severe asthma, even in cases in which the doctor-patient relationship isn’t initially good.
Indoor exposure to particulate matter and volatile organic compounds in dwellings and workplaces and respiratory health in French farmers
Authors: Maesano Cara Nichole , Caillaud Denis , Youssouf Hassani , Banerjee Soutrik , Prud’Homme Julie , Audi Christelle , Horo Kigninlman , Toloba Yacouba , Ramousse Ollivier , Annesi-Maesano Isabella
Published: January 2020

Introduction: Few investigations have related objective assessments of indoor air pollutants to respiratory health in farmers, in spite of the many rural environmental hazards to which they are exposed. Chemical air pollution has been particularly neglected. Objective: We investigated the relationships of indoor exposure to particulate matter (PM) and volatile organic compounds (VOCs) to respiratory health in farmers. Methods: Nineteen VOCs (5 families) and PM (from ultrafine to total suspended particles (TSP)) were objectively assessed in dwellings and workplaces in 109 French farmers during a week. To take into account multiple exposures, scores of exposure were computed for total VOCs and VOCs families. Individuals filled a standardized questionnaire and underwent spirometry with bronchodilation test. Results: On average, VOCs concentrations were higher in dwellings than in workplaces. The reverse was observed for PM. When considering the mean concentrations of air pollutants for the whole farm (dwellings + workplaces), asthma (9.3%) was positively associated with elevated exposure to benzene (adjusted odds-ratio (ORa) = 6.64, 95%CI: 1.56–28.27), trichloroethylene (4.80, 1.00–23.30) and halogenated hydrocarbons score (2.9, 95% 1.3–6.8). Early airway obstruction (FEF25–75 < 80%, with normal FEV1 and FVC and FEV/FVC ≥ 70%) (29.8%) was related to elevated exposure to 2-butoxyetylacetate (11.49, 1.55–85.37) and glycol ethers score (2.0; 1.0–4.1) in the whole farm and to PM2.5 (ORa = 5.26, 95% CI: 1.09–25.28) in the granary/stable. The risk of Chronic Obstructive Pulmonary Diseases (FEV/FVC < 70%) (COPD) (4.26%) was found to be larger with elevated exposure to aldehydes (OR = 3.95, 1.09–14.26). Conclusion: Indoor chemical air pollution is detrimental to farmers’ respiratory health. More epidemiological investigations with detailed exposure assessments and clinical measures of respiratory effects are needed in rural settings to corroborate these findings.
Observational study of the effects of upper respiratory tract infection on hydration status
Authors: Eccles Ronald , Mallefet Pascal
Published: January 2020

Background: A frequent treatment recommendation during acute respiratory infection is to increase fluid intake. This is the first study to investigate whether upper respiratory tract infections (URTIs) such as common cold can lead to dehydration, as commonly believed by the public. Methods: This was an exploratory, noninterventional, observational, single-center study. Subjects made 2 visits to a UK study center for assessments of dehydration, once during URTI and then 2–3 weeks later when fully recovered. The primary endpoint was a comparison of serum osmolality during vs after URTI. Complete blood count, serum urea, serum electrolytes, urine parameters (eg, osmolality, specific gravity, color), body weight/BMI, subjective assessment of thirst, and physician assessment of dehydration were additional outcomes. Only descriptive statistics and shift tables were used. Results: Fifty-five otherwise healthy adults with moderate to severe URTI of < 120 h in duration were enrolled (63.6% female, 94.5% white, mean [SD] age 21.0 [6.8] years). There was no evidence of dehydration based on serum osmolality (mean [SD] 287.63 [4.83] mosm/kg during URTI; 288.60 [5.99] mosm/kg after recovery). With only a few exceptions, complete blood count, serum urea, serum electrolytes, urine specific gravity, urine color, and physician ratings of hydration remained stable. Body weight decreased > 1% in 34.0% of subjects and increased > 1% in 17.0% between visits, with similar changes in BMI. Urine osmolality varied: 14 subjects showed a decrease and 5 showed an increase, resulting in a higher mean [SD] urine osmolality during URTI (700.50 [231.59] vs 618.47 [320.29] mosm/kg). Subjects perceived greater thirst during URTI. Conclusions: In this pilot observational study, we found no evidence that URTIs such as common cold are associated with dehydration, contrary to popular belief.
Predictive factors for exacerbation and reexacerbation in chronic obstructive pulmonary disease: an extension of the Cox model to analyze data from the Swiss COPD cohort
Authors: Urwyler Pascal , Hussein Nebal Abu , Bridevaux Pierre O. , Chhajed Prashant N. , Geiser Thomas , Grendelmeier Peter , Zellweger Ladina Joos , Kohler Malcolm , Maier Sabrina , Miedinger David , Tamm Michael , Thurnheer Robert , Dieterle Thomas , Leuppi Joerg D.
Published: January 2020

Background: The Swiss COPD cohort was established in 2006 to collect data in a primary care setting. The objective of this study was to evaluate possible predictive factors for exacerbation and re-exacerbation. Methods: In order to predict exacerbation until the next visit based on the knowledge of exacerbation since the last visit, a multistate model described by Therneau and Grambsch was performed. Results: Data of 1,247 patients (60.4% males, 46.6% current smokers) were analyzed, 268 (21.5%) did not fulfill spirometric diagnostic criteria for COPD. Data of 748 patients (63% males, 44.1% current smokers) were available for model analysis. In order to predict exacerbation an extended Cox Model was performed. Mean FEV1/FVC-ratio was 53.1% (±11.5), with a majority of patients in COPD GOLD classes 2 or 3. Hospitalization for any reason (HR1.7; P = 0.04) and pronounced dyspnea (HR for mMRC grade four 3.0; P < 0.001) at most recent visit as well as prescription of short-acting bronchodilators (HR1.7; P < 0.001), inhaled (HR1.2; P = 0.005) or systemic corticosteroids (HR1.8; P = 0.015) were significantly associated with exacerbation when having had no exacerbation at most recent visit. Higher FEV1/FVC (HR0.9; P = 0.008) and higher FEV1 values (HR0.9; P = 0.001) were protective. When already having had an exacerbation at the most recent visit, pronounced dyspnea (HR for mMRC grade 4 1.9; P = 0.026) and cerebrovascular insult (HR2.1; P = 0.003) were significantly associated with re-exacerbation. Physical activity (HR0.6; P = 0.031) and treatment with long-acting anticholinergics (HR0.7; P = 0.044) seemed to play a significant protective role. In a best subset model for exacerbation, higher FEV1 significantly reduced and occurrence of sputum increased the probability of exacerbation. In the same model for re-exacerbation, coronary heart disease increased and hospitalization at most recent visit seemed to reduce the risk for re-exacerbation. Conclusion: Our data confirmed well-established risk factors for exacerbations whilst analyzing their predictive association with exacerbation and re-exacerbation. This study confirmed the importance of spirometry in primary care, not only for diagnosis but also as a risk evaluation for possible future exacerbations. Trial registration: Our study got approval by local ethical committee in 2006 (EK Nr. 170/06) and was registered retrospectively on ClinicalTrials.gov (NCT02065921, 19th of February 2014).
Beplanning van toekomstige ekonomiese ontwikkeling met besondere verwysing na kapitaalvorming, monetere beleid en werkgeleentheidskepping
Authors: Brand Simon S.
Published: January 2020

Planning future economic development with special reference to capital formation, monetary policy and the creation of job opportunities. Planning is discussed as centralized control of the rate and the direction of economic growth. Although such total central control does not exist, and is not pursued in South Africa, and the role of the free market mechanism is increasingly recognized, a certain degree of government participation in the country's economy is inevitable, particularly to help to realize the evolving national strategy. Short term objectives of economic policy focus on satisfactory growth in gross domestic product, price stability and external balance, while long term objectives aim at maintaining economic growth, employment opportunity, acceptable distribution of income, geographic spread of economic activities, adequate provision of collective goods and services and protection against external economic threat. Due to increasing unemployment creation of jobs is particularly important as a consideration for investment by both the private and public sectors. Three simulations done for the latest economic development programme for South Africa for the period 1978- 1987 and the implications of different outcomes are discussed. Even if the most favourable forecast applies, an unacceptably high unemployment rate can still be expected.Beplanning word bespreek as gesentraliseerde beheer van die koers en die rigting van ekonomiese groei. Alhoewel sodanige volkome sentrale beheer nie in Suid-Afrika bestaan of nagestreef word nie en nuwe klem val op die rol van die vrye markmeganisme, is 'n sekere mate van owerheidsdeelname in die landsekonomie onvermydelik, veral ook om die ontplooiende nasionale strategie te help verwesenlik. Doelwitte in ekonomiese beleid is op die korttermyn gerig op 'n bevredigende groeikoers in die bruto binnelandse produk, prysstabiliteit en eksterne ewewig, terwyl langtermyndoelstellings klem plaas op handhawing van ekonomiese groeikoers, werkvoorsiening, aanvaarbare verdeling van inkome, geografiese verspreiding van ekonomiese bedrywighede, voorsiening van voldoende kollektiewegoedere en dienste en versekering teen eksterne ekonomiese bedreigings. Weens stygende werkloosheid is veral werkvoorsiening van groot belang by investering deur sowel die private as die openbare sektore. Drie simulasies wat vir die jongste ekonomiese ontwikkelingsprogram vir Suid-Afrika oor die tydperk 1978-1987 en die implikasies van verskillende uitkomste gedoen is, word bespreek. Maar selfs as die gunstigste vooruitskatting geld, kan 'n onaanvaarbaar hoe werkloosheidskoers nog verwag word.
British images of trade relations with Japan
Authors: Marengo F. D.
Published: January 2020

In view of Western interest in learning from Japan, present knowledge of, and British attitudes to, the Japanese economy are critically reviewed through an analysis of press reports in 1977 and 1978. A variety of business people, financial Journalists, politicians and other interested parties in Britain, Japan, North America and Europe are quoted on issues such as the relative inferiority/superiority between EEC countries and Japan, attitudes and practices regarding marketing, the 'mysteriousness', cunning and determination of Japanese businessmen, and on differences between Japanese trade relations with the USA, and with EEC countries. Some recommendations are made on ways in which exchange of ideas and goods could be promoted, to mutual benefit of EEC countries and Japan.In die lig van Westerse belangstelling om meer van Japan te leer, word 'n kritiese oorsig gegee van huidige kennis van, en Britse houdings teenoor, die Japannese ekonomie, deur 'n ontleding van verslae in die Britse pers in 1977 en 1978. 'n Verskeidenheid van sakemense, finansiele verslaggewers, politici en ander belanghebbendes in Brittanje, Japan, Noord-Amerika en Europa word aangehaal oor sake soos die relatiewe meerderwaardigheid/minderwaardigheid tussen EEG lande en Japan, houdings en praktyke wat betref bemarking, die 'geheimsinnigheid', geslepenheid en doelgerigtheid van Japannese sakemanne, en oor verskille tussen Japannese handelsbetrekking met die VSA, en met EEG-lande. 'n Paar aanbevelings word genoem, oor maniere waarop wisseling van idees en van goedere bevorder kan word, tot wedersydse voordeel van EEG-lande en Japan.
Professional and organizational commitment of university research professors
Authors: Erwee Ronel
Published: January 2020

Professional commitment of university research professors is initially fostered by an internalized code of ethics, inculcated during an extensive training process, and further maintained by colleague authority. Professional commitment may however be eroded by current internal problems in the professions. Furthermore, the research professor functions within the constraints of the larger university system. The unique university research system, as well as the role of research administrators, may influence the development of the professor's organizational commitment. The relationship between the professor's professional organizational commitment is discussed. Blau and Scott's model of this particular relationship is criticized and alternate viewpoints are given.Die professlonele verbintenis van professore wat navorsing doen aan universiteite word in die eerste plek bevorder deur 'n geinternaliseerde etiese kode wat ingeprent is gedurende 'n intensiewe opleldingsproses en onderhou word deur kollegiale gesag. Professionele verbintenls mag egter ondermyn word deur huidige interne probleme wat deur die professies ondervind word. Verder funksioneer die navorsende professor ook binne die beperkinge van die groter universiteitstelsel. Hierdie unieke universiteitsnavorsingstelsel, sowel as die rol van die navorsingsadministreerders, mag die ontwikkeling van die professor se verbintenis ten opsigte van die instansie beinvloed. Die verwantskap tussen die professor se professionele verbintenis en die van die instansie word bespreek. Blau en Scott se model van hierdie besondere verwantskap word gekritiseer en ander sienings gegee.
Development of manpower and training facilities
Authors: Ward G. W.
Published: January 2020

No abstract available.
Changes in technology and the effects on the utilization of manpower in South Africa
Authors: Jacobs G. F.
Published: January 2020

Extracts from a speech by Professor G.F. Jacobs delivered to the National Congress for Manpower Utilization in South Africa.
Airway pressure changes during "bag squeezing"
Authors: Hack I. , Katz A. , Eales C.
Published: January 2020

Pressure data during controlled ventilation on a ventilator, "bagging” and slow “bagging” are reviewed. The technique for effective “bagging” is suggested.
The role of upper gastrointestinal endoscopy in bariatric procedure selection
Authors: Shetty Aashik , Nasta Amrit , Gupte Amit , Goel Ramen
Published: January 2020

Background:

Bariatric surgery leads to a significant improvement in obesity and associated comorbidities. Safe surgical outcomes are especially desirable in bariatric, as most patients perceive it as an aesthetic surgery, while an intestinal/gastric surgery may be associated with morbidity. A detailed pre-operative evaluation is required to avoid surgical surprises and post-operative complications. Besides other routine investigations, pre-surgery upper gastrointestinal (GI) endoscopy has always been a topic of debate. Some surgeons perform it routinely before the surgery, whereas others perform it selectively. It is mostly accepted that pre-operative diagnosis of gastro-oesophageal reflux disease could change the plan of surgery in favour of Roux-en-Y gastric bypass although similar consensus does not exist in favour of Sleeve gastrectomy if a gastric/duodenal pathology is detected pre-operatively in a planned roux-en-y gastric bypass patient.

Aim:

Through this case series, we want to highlight the role of routine pre-operative upper GI endoscopy in selecting the bariatric surgery.

Cases:

We present four cases, from amongst many others, where endoscopy changed the course of bariatric surgery.

Conclusion:

Upper GI endoscopy should be performed before bariatric surgery, even in asymptomatic patients, to avoid post-operative surprise/complication.
Automorphisms of surfaces: Kummer rigidity and measure of maximal entropy
Authors: Cantat Serge , Dupont Christophe
Published: January 2020

We classify complex projective surfaces

X

with an automorphism

f

of positive entropy for which the unique measure of maximal entropy is absolutely continuous with respect to the Lebesgue measure. As a byproduct, if

X

is a K3 surface and is not a Kummer surface, the periodic points of

f

are equidistributed with respect to a probability measure which is singular with respect to the canonical volume of

X

. The proof is based on complex algebraic geometry and Hodge theory, Pesin’s theory and renormalization techniques. A crucial argument relies on a new compactness property of entire curves parametrizing the invariant manifolds of the automorphism.
Automorphy of $m$-fold tensor products of GL(2)
Authors: Dieulefait Luis Victor
Published: January 2020

We prove that for any

m > 1

, given any

m

-tuple of Hecke eigenforms

f_i

of level

1

whose weights satisfy the usual regularity condition, there is a self-dual cuspidal automorphic form

\pi

of

{\rm GL}_{2^m}(\mathbb{Q})

corresponding to their tensor product, i.e., such that the system of Galois representations attached to

\pi

agrees with the tensor product of the ones attached to the cuspforms

f_i

.
The Chirka–Lindelöf and Fatou theorems for $\overline\partial_J$-subsolutions
Authors: Sukhov Alexandre
Published: January 2020

This paper studies boundary properties of bounded functions with bounded

\overline\partial_J

differential on strictly pseudoconvex domains in an almost complex manifold.
Insight on the microbial activity and microbiome in partial nitrification systems: CuO nanoparticles impact under different pH levels
Authors: Zhang Xiaojing , Zhang Nan , Zhou Yue , Delatolla Robert , Song Yali , Ma Yongpeng , Zhang Hongzhong
Published: January 2020

In this study, the effect of CuO nanoparticles (NPs) on partial nitrification (PN) process was investigated at various pH values. The shortand long-term experiments were carried out in six identical reactors, with or without CuO NPs, at pH values of 6.5, 8.0 and 10.0. The ammonia oxidation, reaction rates, copper content, and the microbial community were investigated. The results of this work suggested that CuO NPs inhibited the ammonia oxidation by aerobic ammonia-oxidizing bacteria (AOB), under both the acid and alkali conditions. AOB could resist the acid condition but was significantly suppressed when CuO NPs was fed, and the low pH did not aggravate the inhibition level. Almost all the bacteria lost bioactivity under the pH as 10.0, while anaerobic ammonia-oxidizing bacteria survived. The acid condition increased the Nitrosomonas relative abundance while the alkali condition lowered it. More than 60% of the supplied CuO NPs was discharged via effluent.