Clinical impact of forced vital capacity on exercise performance in patients with chronic obstructive pulmonary disease

BackgroundForced vital capacity (FVC) has been suggested to be a good biomarker for decreased exercise performance in patients with chronic obstructive pulmonary disease (COPD). However, as FVC is highly correlated with forced expiratory volume in 1 second (FEV₁), the relationship between FVC and exercise capacity should be assessed within the category of FEV1, i.e., COPD severity. However, this was not considered in previous studies. Thus, limited data are available on the association between reduced FVC and exercise capacity measured by 6-min walk distance (6MWD) based on COPD severity.MethodsWe performed a cross-sectional study using data from the Korean COPD Subgroup Study (KOCOSS) cohort. We evaluated 1,386 patients with moderate (n=895) and severe-to-very severe (n=491) COPD. Reduced FVC was defined as FVC <80% predicted and short 6MWD as <350 m. Multivariable logistic regression was used to evaluate the association between reduced FVC and short 6MWD.ResultsThere were no significant differences in respiratory symptoms and quality of life between the patients with reduced FVC and those with preserved FVC. However, patients with reduced FVC had shorter 6MWD (30.5 cm in moderate and 34.5 cm in severe-to-very severe COPD) and higher BODE index scores than those with preserved FVC. The cubic spline model revealed 6MWD peaked around 93% predicted of FVC in moderate COPD, whereas FVC showed a positive association with 6MWD in severe-to-very severe COPD. Multivariable analyses showed that reduced FVC was significantly associated with short 6MWD in both moderate [adjusted odds ratio (aOR) =1.44, 95% confidence interval (CI): 1.03–2.02] and severe-to-very severe (adjusted OR =1.55, 95% CI: 1.01–2.40) COPD.ConclusionsReduced FVC was significantly associated with shorter 6MWD in moderate-to-very severe COPD patients, suggesting that reduced FVC might be reflective of 6MWD-measured exercise capacity in moderate-to-very severe COPD.     

Prognostic impact of the ratio of preoperative CA19-9 to liver enzyme levels in pancreatic cancer patients with jaundice (predictability of combined CA19-9/AST and CA19-9/γ-GGT for jaundiced PDAC patients)

BackgroundCarbohydrate antigen 19–9 (CA19-9) has been reported as the most significant survival predictor of patients with pancreatic ductal adenocarcinoma (PDAC). However, the elevation of CA19-9 could interfere with obstructive jaundice and the predictive value of CA19-9 in PDAC patients with jaundice remains to be analyzed and elucidated to find possible adjustments.ObjectiveTo evaluate the predictability of preoperative CA19-9 and its adjustments for the overall survival (OS) of PDAC patients by analyzing the relationship between preoperative serum CA19-9 and total bilirubin (TBIL).MethodsA total of 563 consecutive patients who underwent surgery for primary pancreatic adenocarcinoma in our center between January 2015 and September 2018 were retrospectively reviewed. Clinicopathologic information was collected and preoperative parameters such as CA19-9, CEA, TBIL, γ-GGT, AST, ALT, and ALP were recorded as well as overall survival rates, which began from the date of operation to that of death or the last follow-up. Kaplan-Meier survival curves with log-rank test and Cox regression models were applied using SPSS and the survival and survminer packages in R software.ResultsUsing 39/390/1000 as the cut-off values for preoperative serum CA19-9, significant capability of OS stratification was found in the total cohort (p < 0.001, MST = 29.7/19.1/15.2/12.1 months) and patients with TBIL <102.6 μmol/L (p < 0.001, MST = 32.2/19.6/15.0/11.2 months). However, in the subgroup of TBIL≥102.6 μmol/L, this classification method was replaced by the combined scoring of CA19-9/AST and CA19-9/γ-GGT.ConclusionsAs an independent predictor of overall survival of PDAC patients, preoperative serum CA19-9 is defective in survival stratification when TBIL≥102.6 μmol/L but a positive survival prognosis could be achieved with the application of combined preoperative CA19-9/AST and CA19-9/γ-GGT.     

亚临床甲状腺功能减退症对非ST段抬高型心肌梗死患者心律失常事件的影响

目的探索亚临床甲状腺功能减退症(SH)对非ST段抬高型心肌梗死(NSTEMI)患者发生心律失常事件的影响。方法收集2016年1月至2018年8月就诊于河北省人民医院的NSTEMI患者。据患者甲状腺激素(TH)水平分组:甲状腺功能正常组(EU):促甲状腺素(TSH)、总甲状腺素(TT4)水平在正常范围内,n=237;SH组:TSH>4.2 mIU/L,TT4在正常范围内,n=28。比较两组患者基线资料、院内心律失常事件、院内终点事件发生情况。结果与EU组相比,SH组住院期间硝酸酯类药物使用(P=0.012)、天冬氨酸转移酶(P=0.022)、肌酸激酶(P=0.004)、红细胞计数(P=0.030)均较低,且左室收缩末期内径较小(P=0.020)。经多因素Logistic回归分析,SH组发生窦性心动过缓(OR=9.564,95%CI:1.634~55.989,P=0.012)、心房扑动(OR=7.824,95%CI:1.652~37.055,P=0.010)、房室交界区期前收缩(OR=4.940,95%CI:1.468~16.625,P=0.010)等心律失常事件风险仍较高。结论与EU组相比,SH组患者出现窦性心动过缓、心房扑动等心律失常风险增高。提前识别SH并监测NSTEMI患者的甲状腺功能有助于提前识别心律失常发作高危患者,从而使更多的患者获益。     

Comprehensive assessment of amino acid substitutions in the trimeric RNA polymerase complex of influenza A virus detected in clinical trials of baloxavir marboxil

BackgroundBaloxavir marboxil (BXM) is an approved drug that selectively targets cap‐dependent endonuclease on PA subunit in the RNA polymerase complex of influenza A and B viruses. Amino acid substitutions at position 38 in the PA subunit were identified as a major pathway for reduced susceptibility to baloxavir acid (BXA), the active form of BXM. Additionally, substitutions found at positions E23, A37, and E199 in the PA subunit impact BXA susceptibility by less than 10‐fold.MethodsWe comprehensively evaluated the impact of novel amino acid substitutions identified in PA, PB1, and PB2 subunits in BXM clinical trials and influenza sequence databases by means of drug susceptibility and replicative capacity.ResultsPA/I38N in A(H1N1)pdm09 and PA/I38R in A(H3N2) were newly identified as treatment‐emergent substitutions in the CAPSTONE‐2 study. The I38N substitution conferred reduced susceptibility by 24‐fold, whereas replicative capacity of the I38N‐substituted virus was impaired compared with the wild‐type. The I38R‐substituted virus was not viable in cell culture. All other mutations assessed in this extensive study did not significantly affect BXA susceptibility (< 2.4‐fold change).ConclusionThese results provide additional information on the impact of amino acid substitutions in the trimeric viral polymerase complex to BXA susceptibility and will further support influenza surveillance.     

Hydrogen Gas Phase and Electrochemical Hydriding of LaNi5−xMx (M = Sn,Co, Al) Alloys

Hydriding/dehydriding properties of a series of LaNi₅ based alloys were compared by applying both hydrogen gas phase and electrochemical hydrogen charge/discharge methods. The highest hydrogen absorption capacity of 1.4 wt.% H₂ was found for LaNi_4.3Co_0.4Al_0.3, although LaNi_4.8Sn_0.2 also reveals comparable hydrogen capacity (>1.3%). A significant difference in the hydriding kinetics was observed for all studied alloys before and after activation. The activated alloys (5 cycles at 65 °C, 40 atm. H₂) reach their maximum capacities after less than a minute, whereas the pure LaNi₅ alloy needs several minutes for complete hydriding. The electrochemical hydriding/dehydriding behavior of the alloys reveals superior performance of LaNi_4.3Co_0.4Al_0.3 and LaNi_4.8Sn_0.2 compared to the other compositions studied, as the capacity of LaNi_4.8Sn_0.2 decreases by only 10% for 60 charge/discharge cycles at a current density of 100 mA/g. Good agreement between the hydrogen sorption kinetics of the alloys obtained electrochemically and from hydrogen gas phase has also been observed.     

Physico-Chemical Investigation of Endodontic Sealers Exposed to Simulated Intracanal Heat Application: Hydraulic Calcium Silicate-Based Sealers

The aim of this study was to gain information about the effect of thermal treatment of calcium silicate-based sealers. BioRoot RCS (BR), Total Fill BC Sealer (TFBC), and Total Fill BC Sealer HiFlow (TFHF) were exposed to thermal treatment at 37 °C, 47 °C, 57 °C, 67 °C, 77 °C, 87 °C and 97 °C for 30 s. Heat treatment at 97 °C was performed for 60 and 180 s to simulate inappropriate application of warm obturation techniques. Thereafter, specimens were cooled to 37 °C and physical properties (setting time/flow/film thickness according to ISO 6876) were evaluated. Chemical properties (Fourier-transform infrared spectroscopy) were assessed after incubation of the specimens in an incubator at 37 °C and 100% humidity for 8 weeks. Statistical analysis of physical properties was performed using the Kruskal-Wallis-Test (P = 0.05). The setting time, flow, and film thickness of TFBC and TFHF were not relevantly influenced by thermal treatment. Setting time of BR decreased slightly when temperature of heat application increased from 37 °C to 77 °C (P < 0.05). Further heat treatment of BR above 77 °C led to an immediate setting. FT-IR spectroscopy did not reveal any chemical changes for either sealers. Thermal treatment did not lead to any substantial chemical changes at all temperature levels, while physical properties of BR were compromised by heating. TFBC and TFHF can be considered suitable for warm obturation techniques.     

Design and Evaluation of a New Resin-Filled GFRP Pipe Connection System for Butt Splicing of FRP Bars

Fiber-reinforced polymer (FRP) bars are one of the promising alternatives for steel bars used in concrete structures under corrosion or non-magnetic environments due to the unique physical properties of FRP materials. When compared with steel bars, FRP bars are difficult to be spliced in field application due to their anisotropy and low shear and compressive strengths. In view of this, the paper presents a new non-metallic connection system (i.e., resin-filled glass fiber-reinforced polymer (GFRP) pipe connection system) for the butt splicing of FRP bars. With the proposed connection system and a simplified trilinear interfacial bond-slip model, a set of design formulas were derived based on the requirement that the proposed connection system should provide a load transfer capacity beyond the tensile capacity of the spliced FRP bars (i.e., to fulfill the high tensile strength of FRP materials). Besides, considering the fabrication error-induced load transfer capacity reduction of the connection system in field application, a correction factor was introduced in the paper to compensate for the reduced load transfer capacity by increasing the FRP bar anchorage length. At last, to estimate the effectiveness of the proposed connection system and the derived design formulas, nine specimens were fabricated with a kind of commercially available basalt fiber-reinforced polymer (BFRP) bars and the designed connection system and tested under unidirectional tension to study their tensile performance. With the comparison between the tested and theoretical results, the effectiveness of the proposed connection system and the derived design formulas are verified.     

Ultimate Load-Carrying Ability of Rib-Stiffened 2024-T3 and 7075-T6 Aluminium Alloy Panels under Axial Compression

Stringer-stiffened panels made of aluminium alloys are often used as structural elements in the aircraft industry. The load-carrying capacity of this type of structure cannot relieve the reduction in strength in the event of local buckling. In this paper, a method of fabrication of rib-stiffened panels made of EN AW-2024-T3 Alclad and EN AW-7075-T6 Alclad has been proposed using single point incremental forming. Panels made of sheets of different thickness and with different values of forming parameters were tested under the axial compression test. A digital image correlation (DIC)-based system was used to find the distribution of strain in the panels. The results of the axial compression tests revealed that the panels had two distinct buckling modes: (i) The panels buckled halfway up the panel height towards the rib, without any appreciable loss of rib stability, and (ii) the rib first lost stability at half its height with associated breakage, and then the panel was deflected in the opposite direction to the position of the rib. Different buckling modes can be associated with the character of transverse and longitudinal springback of panels resulting from local interaction of the rotating tool on the surface of the formed ribs.     

Peak Cough Flow Fails to Detect Upper Airway Collapse During Negative Pressure Titration for Cough-Assist

ObjectiveTo study the ability of peak cough flow (PCF) and effective cough volume, defined as the volume exsufflated >3 L/s, to detect upper airway collapse during mechanical insufflation-exsufflation (MI-E) titration in neuromuscular patients.DesignProspective observational study.SettingRehabilitation hospital.ParticipantsPatients (N=27) with neuromuscular disease causing significant impairment of chest wall and/or diaphragmatic movement.InterventionsThe lowest insufflation pressure producing the highest inspiratory capacity was used. Exsufflation pressure was decreased from ?20 cm H₂O to ?60/?70 cm H₂O, in 10-cm H₂O decrements, until upper airway collapse was detected using the reference standard of flow-volume curve analysis (after PCF, abrupt flattening or flow decrease vs previous less negative exsufflation pressure).Main Outcome MeasuresPCF and effective cough volume profiles during expiration with MI-E.ResultsUpper airway collapse occurred in 10 patients during titration. Effective cough volume increased with decreasing expiratory pressure then decreased upon upper airway collapse occurrence. PCF continued to increase after upper airway collapse occurrence. In 5 other patients, upper airway collapse occurred at the initial ?20 cm H₂O exsufflation pressure, and during titration, PCF increased and effective cough volume remained unchanged at <200 mL. PCF had 0% sensitivity for upper airway collapse, whereas effective cough volume had 100% sensitivity and specificity.ConclusionOf 27 patients, 15 experienced upper airway collapse during MI-E titration. Upper airway collapse was associated with an effective cough volume decrease or plateau and with increasing PCF. Accordingly, effective cough volume, but not PCF, can detect upper airway collapse.     

充血性心力衰竭的容量监测护理进展

充血性心力衰竭（Congestive heart failure,CHF）是各种心脏疾病的终末期阶段,主要有体液潴留等临床表现,减轻充血是治疗基础,因此利尿剂的使用是心衰治疗中必不可少的部分,而容量监测管理是心力衰竭治疗评估的重中之重。尿量的增减、血压的高低、体重的变化、BNP/NT-proBNP水平的波动都是容量监测的主要内容,因此,我们对这些临床指标的监测进展做一综述。