bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of vitamin D on the onset and progress of Kawasaki disease
Authors: Okazaki Natsumi , Ikeda Hiroyuki , Honda Takafumi , Tsuno Kazuma , Inoue Fumiya , Takahashi Satoko , Sakurai Ayako , Ueki Hideaki , Noguchi Yasushi , Hamada Hiromichi , Igarashi Shunji 
Published: March 2022

AbstractBackgroundThe seasonal epidemic of Kawasaki disease (KD) in winter in Japan suggests that low vitamin D status may affect KD through the immune system. We aimed to evaluate the effect of vitamin D on the onset and clinical course of KD.MethodsWe conducted a case‐control study to compare 25‐hydroxyvitamin D (25(OH)D) levels in KD patients admitted to our hospital between March 2018 and June 2021, with those in healthy controls from published Japanese data. In patients with KD, we evaluated the association of 25(OH)D levels with intravenous immunoglobulin resistance and coronary artery lesions.ResultsWe compared 290 controls and 86 age‐group‐adjusted patients with KD. The 25(OH)D levels in KD patients were lower than those in the controls (median: 17 vs. 29 ng/mL, P < 0.001). In winter, 25(OH)D levels in KD patients were lower than those in summer (median: 13 vs. 19 ng/mL). The adjusted odds ratios for the onset of KD were 4.9 (95% CI: 2.5–9.6) for vitamin D insufficiency (25(OH)D: 12–20 ng/mL) and 29.4 (95% CI: 12.5–78.2) for vitamin D deficiency (25(OH)D < 12 ng/mL). Among 110 KD patients, 25(OH)D levels at diagnosis of KD were not associated with intravenous immunoglobulin resistance or coronary artery lesions.ConclusionsThe 25(OH)D levels in patients with KD were lower than those in the controls, especially in winter. Lower 25(OH)D levels in winter were associated with an increased risk of KD onset. It remains to be elucidated whether the observed association has a causal relationship.
Association of pediatric inguinal hernia contents with patient age and sex
Authors: Ohkura Takahiro , Kumori Koji , Kawamura Toshihiko , Manako Junko , Ishibashi Shuichi , Funabashi Narimasa , Tajima Yoshitsugu 
Published: March 2022

AbstractBackgroundAlthough pediatric inguinal hernia (IH) is a very common disease, systematic reviews of herniated organs are scarce. The current study aims to clarify the contents of pediatric IH using preoperative ultrasonography (US) in association with patient age, sex, and risk for developing irreducible/strangulated hernia.MethodsThe medical records of pediatric IH patients who underwent inguinal US examination prior to surgery between 2014 and 2019 were reviewed. Hernia contents were categorized into four groups based on US findings: bowel, omentum, ovary with or without fallopian tube, and ascites.ResultsA total of 524 IH lesions found in 220 men and 304 women were analyzed. The most common hernia content in patients under 12 months of age was the bowel (91.0%) in males and ovaries (89.5%) in females. The omentum became the most common herniated organ in both men (78.6%) and women (88.0%) aged 2 years and older. Emergency operations were performed in 3 patients (0.57%) due to irreducible IH, where 2 patients with irreducible ovaries, 5 and 7 months old, developed ovarian torsion and needed to undergo emergent salpingo‐oophorectomy.ConclusionsThe contents of pediatric IH depended on patient age and sex. Herniated ovaries in infants can twist in the hernia sac and become strangulated. It is important for clinicians to expect the herniated organ and take appropriate measures in the pediatric primary care setting.
Repertoire of glycan‐binding placenta‐associated antibodies in healthy pregnancy and in pre‐eclampsia
Authors: Ziganshina Marina M. , Shilova Nadezhda V. , Khasbiullina Nailia R. , Terentyeva Anastasia V. , Dolgopolova Elena L. , Nokel Alexey Yu , Yarotskaya Ekaterina L. , Shmakov Roman G. , Bovin Nicolai V. , Sukhikh Gennady T. 
Published: March 2022

AbstractA possible mechanism of the immune tolerance in pregnancy is production of blocking antibodies which reside in placenta and protect foetal allogeneic cells from the mother's immune system. Their epitope specificity, as well as the nature of the biomolecules masked by them, is unknown. For better understanding of this phenomenon, we attempted to characterize the specificity of antibodies isolated from placentas of women with healthy pregnancy and pre‐eclampsia (PE). It was found that: (1) the repertoire of placental antibodies is significantly less variable and qualitatively different from the peripheral blood; (2) with PE, the repertoire of placental antibodies is narrower than in healthy pregnancy; (3) some antibodies are found almost exclusively in the placenta, and some – only in the placenta of healthy women.
Effect of extracorporeal carbon dioxide removal on respiratory quotient measured by indirect calorimetry: Unravelling the mystery
Authors: Ghijselings Idris E. , Bockstael Brecht , De Waele Elisabeth , Jonckheer Joop 
Published: March 2022

New Findings
What is the main observation in this case?
Several studies have reported progressive hypoxaemia once extracorporeal carbon dioxide removal is started in patients with hypercapnic respiratory failure, possibly attributable to an altered respiratory quotient.
What insights does it reveal?
In this quality control report, we show that the respiratory quotient exhibits only minimal alteration when extracorporeal carbon dioxide removal is started and assume that the progressive hypoxaemia is attributable to an increase in intrapulmonary shunt.
AbstractThe use of extracorporeal carbon dioxide removal (ECCO2R) has been proposed in patients with acute respiratory distress syndrome to achieve lung‐protective ventilation and in patients with selective hypercapnic respiratory failure. However, several studies have reported progressive hypoxaemia, as expressed by a need to increase the inspired oxygen fraction (FiO2) to maintain adequate oxygenation or by a decrease in the ratio of arterial oxygen tension (PaO2) to FiO2 once ECCO2R is started. We present the case of a patient who was admitted to the intensive care unit for a coronavirus disease 2019 pneumonia and who was intubated because of hypercapnic respiratory insufficiency. Extracorporeal carbon dioxide removal was started, and the patient subsequently developed progressive hypoxaemia. To test whether the hypoxaemia was attributable to the ECCO2R, blood samples were taken in different settings: (1) ‘no ECCO2R’, blood flow 150 ml/min with a ECCO2R gas flow of 0 L/min; and (2) ‘with ECCO2R’, blood flow 400 ml/min with gas flow 12 L/min. We measured PaO2, alveolar oxygen tension, PaO2/FiO2, alveolar–arterial oxygen tension difference, arterial carbon dioxide tension and the respiratory quotient (RQ) by indirect calorimetry in each setting. The RQ was 0.60 without ECCO2R and 0.57 with ECCO2R. The alveolar oxygen tension was 220.4 mmHg without ECCO2R and increased to 240.3 mmHg with ECCO2R, whereas PaO2/FiO2 decreased from 177 to 171. Our study showed only a minimal change in RQ when ECCO2R was started. We were the first to measure the RQ directly, before and after the initiation of ECCO2R, in a patient with hypercapnic respiratory failure.
The Effects of Incoming Vortex and Wake on the Aerodynamics of an Intermediate Turbine Duct
Authors: Zhou Chao , Dong Fan , Hou Jiangdong 
Published: March 2022

Abstract
In a high bypass ratio aircraft engine, the high-pressure and low-pressure turbines are connected by an intermediate turbine duct (ITD). The aerodynamic performance of the ITD is affected by the incoming flow from the high-pressure turbine. This paper investigates the effects of an incoming wake or/and a near casing streamwise vortex on the flow field and loss of an ITD. For the case with only an incoming wake, the wake interacts with the boundary layer (BL), forming a pair of vortices and causing additional loss. With an incoming streamwise vortex, the casing boundary layer interacts with it and a loss core forms near the casing. When both a wake and a streamwise vortex are present at the inlet, apart from interacting with the boundary layer, the wake and the streamwise vortex could interact with each other. It is found that the distance between the wake and streamwise vortex has a major effect on the flow pattern and aerodynamic loss of ITD. Three different distances between the wake and the incoming streamwise vortex are investigated. When the distance between the wake and incoming streamwise vortex is large, the two flow structures develop relatively independently and the combined effect is small. As the distance between them reduces, the flow structure induced by the wake interacts with the incoming streamwise vortex and suppresses the loss production. However, for the case with the shortest distance, the interaction enhances the loss generation. A simplified analytical model is proposed to explain this loss mechanism.
Influence of Supersonic Nozzle Design Parameters on the Unsteady Stator–Rotor Interaction in Radial-Inflow Turbines for Organic Rankine Cycles
Authors: Cappiello Alessandro , Tuccillo Raffaele 
Published: March 2022

Abstract
The use of radial-inflow turbine (RIT) for organic Rankine cycle (ORC) plant sizes below 100 kW is promising, although the application remains challenging. In fact, the single-stage arrangement imposed by economic constraints and hence the large expansion ratio, together with the large molecular weight, which characterizes organic fluids, usually result in highly supersonic flows, so making the use of transonic stators often mandatory.
Particularly, the influence of RIT stator design parameters on losses and the level of unsteadiness seen by the subsequent rotor is still scarcely addressed in published literature.
The present work investigates the effect of the convergent–divergent stators design parameters and the resulting downstream flow field non-uniformity on the unsteady stator–rotor interaction and loss generation in ORC RIT.
To this end, two stator and rotor configurations which differ by the stator design parameters (i.e., discharge metal angle and number of vanes) have been tested by means of three-dimensional (3D) unsteady CFD calculations accounting for real-gas properties.
The results show that larger stator–rotor interaction is present for the case featuring higher vane count and lower outlet metal, which also features the largest fluctuations of power output and pressure force on blade, together with a substantially lower average total-to-static efficiency, as a result of a larger stator downstream pitchwise non-uniformity.
Ultimately, the results indicate that only aiming for optimal stator efficiency during the stator design phase might lead to highly suboptimal configurations from the whole turbine stage point of view.
Optimization of a Tip Appendage for the Control of Tip Leakage Vortices in Axial Flow Fans
Authors: Meyer Thomas O. , van der Spuy Sybrand J. , Meyer Christiaan J. , Corsini Alessandro 
Published: March 2022

Abstract
This paper presents the numerical optimization of a tip appendage design for the passive control of tip leakage vortices in subsonic axial flow cooling fans. The studied class of fan was designed in the conventional manner without the consideration of tip clearance effects. As such, the objective of this investigation is the improvement of the aerodynamic performance characteristics of the datum fan through consideration of the blade tip geometry. Based on previous studies involving fan performance enhancement using various tip end-plate configurations, the most promising end-plate geometry which is found to best improve the fan’s performance characteristics is selected for further development through optimization. Before the optimization process can begin, initialization of the chosen end-plate’s design space using the design of experiments (DoEs) technique is performed. Formulation of the response surface is based on a multi-objective multi-point objective function which considers the fan’s various performance metrics. Considering the optimization process, the design and analysis of computer aided experiments method is used in the development of the Kriging-based surrogate model’s database. The resulting database is coupled with an efficient global optimization algorithm which completes the workflow of the optimization routine. The Pareto-front of non-dominated solutions is used to guide the optimal design selection, on which the experimental evaluations are based. The experimental results of the optimized design indicate improved fan performance characteristics at greater than peak efficiency flowrates. This design is found to increase the datum fan’s design point performance characteristics by a value of 32.90% in total-to-static pressure rise and a 7.66 percentage point increase in total-to-static efficiency at the fan’s design speed of 722 rpm.
Assessment of mitochondrial toxicity in newborns and infants with congenital cytomegalovirus infection treated with valganciclovir
Authors: Ortiz-Gracia Alba , Ríos María , Tobías Ester , Noguera-Julian Antoni , García-García Francesc Josep , Cantó-Santos Judith , Valls-Roca Laura , Garrabou Glòria , Grau Josep Maria , Cardellach Francesc , Sánchez Emilia , Morén Constanza , Fortuny Clàudia 
Published: March 2022

BackgroundGanciclovir/valganciclovir is currently indicated during the first 6 months of life in symptomatic children with congenital cytomegalovirus (CMV) infection. However, this treatment may have the potential to induce mitochondrial toxicity due to off-target inhibition of DNA-polymerases. Similar anti-HIV drugs have been associated with mitochondrial toxicity but this has never been explored in CMV.ObjectiveTo determine the potential mitochondrial toxicity profile at the genetic, functional and biogenesis level in peripheral blood mononuclear cells from a cohort of newborns and infants with symptomatic congenital CMV infection (treated with valganciclovir, untreated and uninfected controls).DesignLongitudinal, observational and controlled study.Setting and patientsSubjects were recruited at the tertiary referral Hospital Sant Joan de Déu and experiments were conducted at IDIBAPS-Hospital Clínic of Barcelona, Spain. CMV-infected newborns underwent comprehensive monthly clinical follow-up.MethodsMitochondrial parameters, audiometry and neurological assessment were measured at baseline, 3–6 and 12 months after inclusion in the study. The Kruskal-Wallis test for k-independent samples and Friedman tests for repeated measurements were applied.ResultsComplex IV, citrate synthase enzymatic activities and mtDNA remained preserved in congenital CMV-infected infants treated with valganciclovir compared with controls (p>0.05 in all cases).ConclusionsNo evidence of mitochondrial toxicity was found in infants treated with valganciclovir for congenital CMV.
Quantitative analysis of optical coherence tomography imaging in patients with different severities of hydroxychloroquine toxicity
Authors: Membreno Raul F , De Silva Tharindu , Agrón Elvira , Keenan Tiarnan DL , Cukras Catherine A 
Published: March 2022

PurposeTo determine the diagnostic validity of quantitative measures derived from optical coherence tomography (OCT) images in their ability to discriminate between cohorts of eyes unaffected by hydroxychloroquine (HCQ) and those with a range of toxicity severities, including mild toxicity.MethodsProspective, single-centre, case–control study conducted between August 2010 and May 2017. Participants were exposed to HCQ for at least 5 years (mean±SD =14±7.2 years) and classified into affected and unaffected cohorts based on the American Academy of Ophthalmology’s 2016 recommendations. For affected eyes, severity (groups 1–4) was assigned based on the extent of ellipsoid zone loss. For all eyes, spectral domain-OCT scans were analysed quantitatively to compute inner retinal thickness (IRT), outer retinal thickness (ORT), and minimum signal intensity (MI) and compared across toxicity groups.ResultsOf the 85 participants (mean age 59±12 years, 93% female), 30 had retinal toxicity. Significant differences in ORT and MI were observed between each affected severity group and unaffected eyes. Significant differences in IRT were observed for groups 3–4 but not groups 1–2. ORT and MI were each able to discriminate between unaffected and group 1 eyes with the highest discrimination at the inner subfields (areas under the curve, AUC=0.96 for ORT and AUC=0.93 for MI).ConclusionsQuantitative analysis of OCT scans revealed significant differences between eyes with and without toxicity in two different measures. Each individual metric could discriminate between the unaffected and the lowest severity category, suggesting their potential utility in screening for HCQ toxicity in patients at risk.
Associations of long-term physical activity trajectories with coronary artery calcium progression and cardiovascular disease events: results from the CARDIA study
Authors: Gao Jing-Wei , Hao Qing-Yun , Lu Liu-Yi , Han Jia-Jin , Huang Fei-Fei , Vuitton Dominique A. , Wang Jing-Feng , Zhang Shao-Ling , Liu Pin-Ming 
Published: March 2022

ObjectiveThe study aimed to assess the associations of physical activity (PA) trajectories across a 25-year span with coronary artery calcium (CAC) progression, and subsequent risk of cardiovascular disease (CVD) events.MethodsWe included 2497 participants from the Coronary Artery Disease Risk Development in Young Adults study who had computed tomography-assessment of CAC at baseline (year 15: 2000–2001) and follow-up (year 20 or 25) and at least three measures of PA from year 0 to year 25. Long-term PA trajectories were determined by latent class modelling using a validated questionnaire.ResultsAmong the included participants, 1120 (44.9%) were men, 1418 (56.8%) were white, and the mean (SD) age was 40.4 (3.6) years. We identified three distinct PA trajectories based on PA average levels and change patterns: low (below PA guidelines, n=1332; 53.3%); moderate (meeting and slightly over PA guidelines, n=919; 36.8%) and high (about three times PA guidelines or more, n=246; 9.9%). During a mean (SD) follow-up of 8.9 (2.1) years, 640 (25.6%) participants had CAC progression. Participants in the high PA trajectory group had a higher risk of CAC progression than those in the low PA trajectory group after adjustment for traditional cardiovascular risk factors (HR 1.51; 95% CI 1.18 to 1.94). However, high PA trajectory was not associated with an increased risk of incident CVD events (HR 1.01; 95% CI 0.44 to 2.31) and the incidence of CVD events in participants with CAC progression was similar across all three PA trajectory groups (p=0.736).ConclusionLong-term PA about three times the guidelines or more is independently associated with CAC progression; however, no additional risk of incident CVD events could be detected.
Comparison of diabetic and idiopathic sensory polyneuropathies with respect to nerve fibre affection and risk factors
Authors: Itani Mustapha , Gylfadottir Sif , Krøigård Thomas , Gaist Laura , Holbech Jakob Vormstrup , Kristensen Alexander Gramm , Karlsson Pall , Möller Sören , Tankisi Hatice , Gaist David , Jensen Troels S , Finnerup Nanna Brix , Sindrup Søren Hein 
Published: March 2022

Background and purposeChronic distal sensory or sensorimotor polyneuropathy is the most common pattern of polyneuropathy. The cause of this pattern is most often diabetes or unknown. This cross-sectional study is one of the first studies to compare the demographics, cardiovascular risk factors and clinical characteristics of diabetic polyneuropathy (DPN) with idiopathic polyneuropathy (IPN).MethodsPatients with DPN were included from a sample of 389 patients with type 2 diabetes mellitus (T2DM) enrolled from a national cohort of patients with recently diagnosed T2DM (Danish Centre for Strategic Research in Type 2 Diabetes cohort). Patients with IPN were included from a regional cohort of patients with symptoms of polyneuropathy referred for workup at a combined secondary and tertiary neurological centre (database cohort).ResultsA total of 214 patients with DPN were compared with a total of 88 patients with IPN. Patients with DPN were older (67.4 vs 59 years) and had a longer duration of neuropathy symptoms. Patients with DPN had greater body mass index (32 vs 27.4 kg/m2) and waist circumference (110 cm vs 97 cm); higher frequency of hypertension diagnosis (72.9% vs 30.7%); lower total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol levels; and a higher prevalence of use of statins (81.8% vs 19.3%). DPN was associated with a slightly higher autonomic score and total score on the Neuropathy Symptom Score; lower frequency of hyperalgesia, allodynia and decreased vibration on quantitative sensory testing; lower intraepidermal nerve fibre density count and higher frequency of small-fibre neuropathy.ConclusionDPN and IPN showed clear differences in neuropathy characteristics, indicating that these two entities are to be regarded as aetiologically and pathogenetically distinct.
Impact of ‘4+7’ volume-based drug procurement on the use of policy-related original and generic drugs: a natural experimental study in China
Authors: Wang Jing , Yang Ying , Xu Luxinyi , Shen Yuan , Wen Xiaotong , Mao Lining , Wang Quan , Cui Dan , Mao Zongfu 
Published: March 2022

ObjectiveTo evaluate the impact of the first round of the National Centralized Drug Procurement pilot (so-called ‘4+7’ policy) on the use of policy-related original and generic drugs.MethodsA retrospective natural experimental design was adopted. Drug procurement data from the China Drug Supply Information Platform database were used, involving 9 ‘4+7’ pilot cities in intervention group and 12 non-pilot provinces in control group. ‘4+7’ policy-related drugs were selected as study samples, including 25 drugs in the ‘4+7’ procurement list and their alternative drugs that have not yet been covered by the policy. ‘4+7’ List drugs were divided into bid-winning and non-winning products according to the bidding results. Included drugs were sorted into original and generic products. Difference-in-difference method was employed to estimate the net effect of policy impact.ResultsAfter policy intervention, the DDDs (defined daily doses) of ‘4+7’ List original drugs significantly reduced (β=−39.10, p<0.001), while generic drugs increased (β=40.43, p<0.01). 17.08% of the original drugs in DDDs were substituted by generic drugs. Prominent reduction was observed in the monthly expenditure of ‘4+7’ List drugs (¥726.40 million) and overall policy-related drugs (¥654.47 million). The defined daily drug cost (DDDc) of bid-winning original and generic drugs, as well as non-winning original drugs, decreased by 44.44%, 79.00% and 15.10% (all p<0.01), while the DDDc of non-winning generic drugs increased by 64.81% (p<0.001). The use proportion of higher-quality drugs raised prominently from 39.66% to 91.93%.Conclusions‘4+7’ policy is conducive to generic substitution, drug price reduction and pharmaceutical cost-containment in China. The overall quality level of drug use of the Chinese population increased after policy intervention, especially in primary healthcare settings. However, the increased DDDc of non-winning generic drugs and alternative drugs should draw the importance of further policy monitoring.