What Is Most Suitable for Children With Cystic Fibrosis—The Relationship Between Spirometry, Oscillometry, and Multiple Breath Nitrogen Washout

IntroductionIn cystic fibrosis (CF), pathological lung changes begin early in life. The technological progress currently gives many diagnostic possibilities. However, pulmonary function testing in children remains problematic.ObjectivesOur study aimed to correlate the results of impulse oscillometry (IOS) with those of multiple breath nitrogen washout (MBNW) in our pediatric CF population. We also compared those parameters between the groups with and without spirometric features of obturation.MethodsWe collected 150 pulmonary function test sets, including spirometry, IOS, and MBNW in patients with CF aged 12.08 ± 3.85 years [6–18]. The study group was divided into two subgroups: IA (without obturation) and IB (with obturation). We also compared Sacin, Scond, and oscillometry parameters of 20 patients aged 14–18 years who reached the appropriate tidal volume (VT) during MBNW.ResultsStatistical analysis showed a negative correlation between lung clearance index (LCI) and spimoetric parameters. Comparison of subgroups IA (n = 102) and IB (n = 48) indicated a statistically significant difference in LCI (p < 0.001) and FEV1z-score (p < 0.001), FEV1% pred (p < 0.001), MEF25z-score (p < 0.001), MEF50 z-score (p < 0.001), MEF75 z-score (p < 0.001), R5% pred (p < 0.05), and R20% pred (p < 0.01). LCI higher than 7.91 was found in 75.33% of the study group, in subgroup IB—91.67%, and IA−67.6%.ConclusionsLCI derived from MBNW may be a better tool than IOS for assessing pulmonary function in patients with CF, particularly those who cannot perform spirometry.

Pengaruh Media Leaflet Terhadap Pengetahuan dan Sikap Dalam Upaya Pencegahan Covid-19 Pada Pedagang di Pasar

Pengetahuan yang tepat dan memiliki sikap yang benar dapat mencegah penularan covid-19. Melalui media leafleat dalam upaya pencegahan dapat berdampak positif karena membentuk keyakinan orang untuk beriperilaku sesuai keyakinannya. Penelitian ini bertujuan mengetahui pengaruh media leaflet terhadap pengetahuan dan sikap dalam upaya pencegahan Covid-19 pada pedagang di Pasar Oesapa Kota Kupang. Jenis penelitian ini adalah penelitian analitik dengan pendekatan Pra Eksperimen. Jumlah sampel pada penelitian ini berjumlah 30 responden. Berdasarkan analisis univariat, responden lebih banyak usia 46-55 tahun (53.3%), Jenis kelamin perempuan lebih banyak (53.3%), pendidikan responden paling banyak adalah SMA (20%), jenis dagangan paling banyak adalah penjual ikan (26.7%). Rerata nilai pengetahuan responden sebelum mendapatkan penyuluhan adalah 44.66 dan sesudah pemberian penyuluhan melalui media leaflet adalah 94.22 yang artinya terjadi peningkatan rerata nilai sebelum dan sesudah pemberian leaflet. Hasil pengujian hipotesis menggunakan uji Wilcoxon,diperoleh nilai z-score sebesar 4.807 dengan nilai p value sebesar 0.000 yang artinya p<0.005 yang berarti Ada Pengaruh Peggunaan media leaflet terhadap Pengetahuan pedagang tentang Covid-19. Untuk variabel sikap, rerata nilai sikap responden sebelum mendapatkan penyuluhan adalah 72.85 dan sesudah pemberian penyuluhan melalui media leaflet adalah 97.46 yang artinya terjadi peningkatan rerata nilai sebelum dan sesudah pemberian leaflet. Hasil pengujian hipotesis menggunakan uji Wilcoxon,diperoleh nilai z-score sebesar 4.793 dengan nilai p value sebesar 0.000 yang artinya p<0.005 yang berarti Ada Pengaruh Peggunaan media leaflet terhadap Sikap pedagang tentang Covid-19. Oleh karena itu direkomendasikan Puskesmas Oesapa agar lebih meningkatkan frekuensi kunjungan pemberian edukasi kesehatan kepada pedagang pasar tradisional di Kelurahan Oesapa.

Associations of maternal plasma and infant umbilical cord blood plasma metabolomics profiles with anthropometric measures at birth: a prospective cohort study.

BackgroundThe metabolomics profiles of maternal plasma during pregnancy and cord plasma at birth might influence fetal growth and birth anthropometry. The objectives of this study are to examine how metabolites measured in maternal plasma samples collected during pregnancy and umbilical cord plasma samples collected at birth are associated with newborn anthropometric measures, a known predictor of future health outcomes.MethodsPregnant women between 24 and 28 weeks of gestation were recruited from prenatal clinics in New Hampshire as part of a prospective cohort study. Blood samples from 413 women at enrollment and 787 infant cord blood samples were analyzed using the Biocrates AbsoluteIDQ® p180 kit . Multivariable linear regression models were used to examine association of cord and maternal metabolites with infant anthropometry at birth.ResultsIn cord blood samples, several acylcarnitines, a phosphatidylcholine, and a custom metabolite indicator were negatively associated with birth weight Z-score, and lysophosphatidylcholines as well as three custom metabolite indicators were positively associated with birth weight Z-score. Acylcarnitine C5 was negatively associated with birth length Z-score, and several lysophosphatidylcholines and a custom metabolite indicator were positively associated with birth length Z-score. Maternal blood metabolites did not show significant associations with birth weight and length Z scores, however, a custom metabolite indicator, the ratio of kynurenine over tryptophan, was negatively associated with weight-for-length Z-score.ConclusionsSeveral cord blood metabolites associated with newborn weight and length Z-scores; in particular, consistent findings were observed for several acylcarnitines that play a role in utilization of energy sources, and a lysophosphatidylcholine that is part of oxidative stress and inflammatory response pathways. Fewer associations were observed with maternal metabolomic profiles.

Geometrical and Hemodynamic Variables for Thrombotic Risk Stratification in Kawasaki Disease

Objectives Thrombosis is a major adverse outcome for coronary artery aneurysms (CAA) in Kawasaki disease (KD). We investigated the geometric and hemodynamic abnormalities in patients with CAA and identified the risk factors for thrombosis by computational fluid dynamics (CFD) simulation. Methods We retrospectively studied 27 KD patients with 77 CAAs, including 20 CAAs with thrombosis in 12 patients. Patient-specific anatomic models obtained from cardiac magnetic resonance imaging (CMRI) were constructed to perform a CFD simulation. From the simulation results, we produced local hemodynamic parameters comprising of time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI) and relative resident time (RRT). The CAA’s maximum diameter (Dmax) and Z-score were measured on CMRI. Results Giant CAAs tended to present with more severe hemodynamic abnormalities. Thrombosed CAAs exhibited lower TAWSS (1.551 ± 1.535 vs. 4.235 ± 4.640dynes/cm2, p = 0.002), higher Dmax (10.905 ± 4.125 vs. 5.791 ± 2.826mm, p = 0.008), Z-score (28.301 ± 13.558 vs. 13.045 ± 8.394, p = 0.002), OSI (0.129 ± 0.132 vs. 0.046 ± 0.080, p = 0.01), and RRT (16.780 ± 11.982s vs. 9.123 ± 11.770s, p = 0.399) than the non-thrombosed group. An ROC analysis for thrombotic risk proved that all of the five parameters had area under the ROC curves (AUC) above 0.7, with Dmax delineating the highest AUC (AUCDmax = 0.871) and a 90% sensitivity, followed by Z-score (AUCZ−score = 0.849). Conclusions It is reasonable to combine the geometric index with hemodynamic information to establish a severity classification for KD cases.

Reference Values and the Z-Score Values of Tricuspid Annular Plane Systolic Excursion in Chinese Children

Objective To establish age-specific and body surface area (BSA)-specific reference values of Tricuspid Annular Plane Systolic Excursion (TAPSE) for children under 15 years old in China. Study design A retrospective study was conducted in Children's Hospital Attached to the Capital Institute of Pediatrics. A total of 702 cases were included in this research to establish reference values of TAPSE. SPSS 25.0 (IBM) was used for data analysis. Lambda-mu-sigma method was used to calculate and construct the age-specific and BSA-specific percentiles and Z-score curves of TAPSE. Results The mean value of TAPSE increased with age and BSA from 0 to 15 years in a nonlinear way and reached the adult level (17mm) until 1 year old. No difference could be observed in genders. Conclusions TAPSE values increased with age and BSA in Chinese children aged between 0-15 years and there was no difference between boys and girls. A multi-center study from different parts of China is supposed to be conducted in the future to reflect the whole spectrum of TAPSE in Chinese children.

Bone Mineral Density Changes in Long-Term Kidney Transplant Recipients: A Real-Life Cohort Study of Native Vitamin D Supplementation

Vitamin D insufficiency has been associated with reduced bone mineral density (BMD) in kidney transplant patients (KTRs). However, the efficacy of vitamin D supplementation on BMD remains poorly defined, especially for long-term KTRs. We aimed to investigate the effect of native vitamin D supplementation on the BMD of KTRs during a 2-year follow-up. Demographic, clinical, and laboratory data were collected. BMD was evaluated with standard DEXA that was performed at baseline (before vitamin D supplementation) and at the end of study period. BMD was assessed at lumbar vertebral bodies (LV) and right femoral neck (FN) by a single operator. According to WHO criteria, results were expressed as the T-score (standard deviation (SD) relative to young healthy adults) and Z-score (SD relative to age-matched controls). Osteoporosis and osteopenia were defined as a T-score ≤ −2.5 SD and a T-score < −1 and a > −2.5 SD, respectively. Based on plasma levels, 25-OH-vitamin D (25-OH-D) was supplemented as recommended for the general population. Data from 100 KTRs were analyzed. The mean study period was 27.7 ± 3.4 months. At study inception, 25-OH-D insufficiency and deficiency were recorded in 65 and 35 patients. At the basal DEXA, the percentage of osteopenia and osteoporosis was 43.3% and 18.6% at LV and 54.1% and 12.2% at FN, respectively. At the end of the study, no differences in the Z-score and T-score gains were observed. During linear mixed model analysis, native vitamin D supplementation was found to have a negative nitration with Z-score changes at the right femoral neck in KTRs (p < 0.05). The mean dose of administered cholecalciferol was 13.396 ± 7.537 UI per week; increased 25-OH-D levels were found (p < 0.0001). Either low BMD or 25-OH-vitamin D concentration was observed in long-term KTRs. Prolonged supplementation with 25-OH-D did not modify BMD, Z-score, or T-score.

Analysis of the Economic Sustainability of the Supply Chain Sector by Applying the Altman Z-Score Predictor

This paper fills the gap in the financial perspective of supply chain performance measurement, related to the lack of a bankruptcy probability indicator, and proposes a predictor which is the eighth-model of the Altman Z-Score Logistic Regression. Furthermore, a bankruptcy probability ranking is established for the companies’ supply chains, according to the industry to which they belong. Moreover, the values are set to establish three categories of companies according to predictor. The probability of bankruptcy is analysed and studied for the supply chain of different industries. The building industry is revealed to have the highest probability of bankruptcy.

Transcranial Direct Current Stimulation on Parkinson's Disease: Systematic Review and Meta-Analysis

Background: Clinical impact of transcranial direct current stimulation (tDCS) alone for Parkinson's disease (PD) is still a challenge. Thus, there is a need to synthesize available results, analyze methodologically and statistically, and provide evidence to guide tDCS in PD.Objective: Investigate isolated tDCS effect in different brain areas and number of stimulated targets on PD motor symptoms.Methods: A systematic review was carried out up to February 2021, in databases: Cochrane Library, EMBASE, PubMed/MEDLINE, Scopus, and Web of science. Full text articles evaluating effect of active tDCS (anodic or cathodic) vs. sham or control on motor symptoms of PD were included.Results: Ten studies (n = 236) were included in meta-analysis and 25 studies (n = 405) in qualitative synthesis. The most frequently stimulated targets were dorsolateral prefrontal cortex and primary motor cortex. No significant effect was found among single targets on motor outcomes: Unified Parkinson's Disease Rating Scale (UPDRS) III – motor aspects (MD = −0.98%, 95% CI = −10.03 to 8.07, p = 0.83, I2 = 0%), UPDRS IV – dyskinesias (MD = −0.89%, CI 95% = −3.82 to 2.03, p = 0.55, I2 = 0%) and motor fluctuations (MD = −0.67%, CI 95% = −2.45 to 1.11, p = 0.46, I2 = 0%), timed up and go – gait (MD = 0.14%, CI 95% = −0.72 to 0.99, p = 0.75, I2 = 0%), Berg Balance Scale – balance (MD = 0.73%, CI 95% = −1.01 to 2.47, p = 0.41, I2 = 0%). There was no significant effect of single vs. multiple targets in: UPDRS III – motor aspects (MD = 2.05%, CI 95% = −1.96 to 6.06, p = 0.32, I2 = 0%) and gait (SMD = −0.05%, 95% CI = −0.28 to 0.17, p = 0.64, I2 = 0%). Simple univariate meta-regression analysis between treatment dosage and effect size revealed that number of sessions (estimate = −1.7, SE = 1.51, z-score = −1.18, p = 0.2, IC = −4.75 to 1.17) and cumulative time (estimate = −0.07, SE = 0.07, z-score = −0.99, p = 0.31, IC = −0.21 to 0.07) had no significant association.Conclusion: There was no significant tDCS alone short-term effect on motor function, balance, gait, dyskinesias or motor fluctuations in Parkinson's disease, regardless of brain area or targets stimulated.

Corporate Social Responsibility Disclosure (CSRD) and Financial Distressed Risk (FDR): Does Institutional Ownership Matter?

This study aims to investigate the effect of corporate social responsibility disclosure (CSRD) on financial distressed risk (FDR) among firms listed on the Tehran Stock Exchange (TSE). This paper also examines whether there is a negative linkage between institutional ownership as a corporate governance mechanism and corporate bankruptcy. The final research purpose is to analyze if there is a moderating effect of institutional owners on the relationship between CSRD and FDR too. The study sample consists of 200 firms listed on the TSE between 2013 and 2018, and the statistical model is logistic regression. When FDR is assessed under both Article 141 of Iran’s business law and the Altman Z-score model, our results on the main research hypotheses are quite similar. Considering the social and cultural conditions and economic situation of the Iranian market, the results show that firms with a high level of CSR disclosure are not able to make themselves more creditworthy and do not have better access to financing, resulting in more financial insolvency. Our findings confirm institutional shareholders play a vital role in facilitating a firm’s emergence from bankruptcy. The results also demonstrate financial distress risk is less seen among companies with more institutional owners that disclose more CSR information. In other words, since the goals related to CSR are long-term and Iranian institutional investors have a long-term horizon towards the company, the presence of more institutional owners within a firm push managers to provide additional voluntary CSR disclosure so firms can maintain the trust of their shareholders at the highest possible level and prevent financial distress. Our additional analysis indicates there is a positive association between financial leverage and firm failure, whereas the current ratio and ROA are negatively connected with corporate bankruptcy. Finally, when FDR is assessed on the Altman Z-score model, our evidence supports a negative relation between purchase and sale-related party transactions and bankruptcy risk, which is consistent with the efficient transaction hypothesis.