Assessment of early bronchiectasis in young children with cystic fibrosis is dependent on lung volume

Objective: The aim of this study was to determine whether assessment of early CT scan-detected bronchiectasis in young children with cystic fibrosis (CF) depends on lung volume. Methods: This study, approved by the hospital ethics committee, included 40 young children with CF from a newborn screened population contributing paired volume-controlled inspiratory and expiratory volumetric chest CT scans acquired under general anesthesia while clinically stable. Bronchiectasis was assessed with a semiquantitative CT scan score in inspiration and expiration, and the sensitivity of the expiratory CT scan to detect bronchiectasis was compared with the inspiratory CT scan by sensitivity and intraclass correlation coefficient analysis and Bland-Altman plots. Matched inspiratory and expiratory airway-vessel measurements were obtained in a subset of 10 children, and the relationship between lung volume and airway:vessel ratio after adjusting for age and vessel size was examined with the use of a linear regression model with generalized estimating equations. The number of visible airways in inspiration and expiration was compared in all 40 children by Wilcoxon signed rank test. Results: Expiratory scans had poor sensitivity (0.46) to detect bronchiectasis, underestimating disease extent (P < .001). Airway:vessel ratios were consistently higher in inspiration, independent of age and vessel size (P < .001), with significantly more airways visible in inspiration than in expiration, independent of age (median, 71 vs 28, respectively; P < .001). Conclusions: In young children with CF, radiologic assessment of early bronchiectasis with chest CT scan depends on lung volume; thus, expiratory scans may not be appropriate for evaluating bronchiectasis in this population. Lung volume during CT image acquisition should be standardized to evaluate airway dimensions in young children

A screening tool to identify risk for bronchiectasis progression in children with cystic fibrosis

Background The marked heterogeneity in cystic fibrosis (CF) disease complicates the selection of those most likely to benefit from existing or emergent treatments. Objective We aimed to predict the progression of bronchiectasis in preschool children with CF. Methods Using data collected up to 3 years of age, in the Australian Respiratory Early Surveillance Team for CF cohort study, clinical information, chest computed tomography (CT) scores, and biomarkers from bronchoalveolar lavage were assessed in a multivariable linear regression model as predictors for CT bronchiectasis at age 5-6. Results Follow-up at 5-6 years was available in 171 children. Bronchiectasis prevalence at 5-6 was 134/171 (78%) and median bronchiectasis score was 3 (range 0-12). The internally validated multivariate model retained eight independent predictors accounting for 37% (adjusted R-2) of the variance in bronchiectasis score. The strongest predictors of future bronchiectasis were: pancreatic insufficiency, repeated intravenous treatment courses, recurrent lower respiratory infections in the first 3 years of life, and lower airway inflammation. Dichotomizing the resulting prediction score at a bronchiectasis score of above the median resulted in a diagnostic odds ratio of 13 (95% confidence interval [CI], 6.3-27) with positive and negative predictive values of 80% (95% CI, 72%-86%) and 77% (95% CI, 69%-83%), respectively. Conclusion Early assessment of bronchiectasis risk in children with CF is feasible with reasonable precision at a group level, which can assist in high-risk patient selection for interventional trials. The unexplained variability in disease progression at individual patient levels remains high, limiting the use of this model as a clinical prediction tool.Development and application of statistical models for medical scientific researc

Non-sustained ventricular tachycardia in patients with congenital heart disease: An important sign?

BACKGROUND: Sustained ventricular tachycardia (susVT) and ventricular fibrillation (VF) are observed in adult patients with congenital heart disease (CHD). These dysrhythmias may be preceded by non-sustained ventricular tachycardia (NSVT). The aims of this study are to examine the 1] time course of ventricular tachyarrhythmia (VTA) in a large cohort of patients with various CHDs and 2] the development of susVT/VF after NSVT. METHODS: In this retrospective study, patients with VTA on ECG, 24-hour Holter or ICD-printout or an out-of-hospital-cardiac arrest due to VF were included. In patients with an ICD, the number of shocks was studied. RESULTS: Patients (N=145 patients, 59% male) initially presented with NSVT (N=103), susVT (N=25) or VF (N=17) at a mean age of 40+/-14years. Prior to VTA, 58 patients had intraventricular conduction delay, 14 an impaired ventricular dysfunction and 3 had coronary artery disease. susVT/VF rarely occurred in patients with NSVT (N=5). Fifty-two (36%) patients received an ICD; appropriate and inappropriate shocks, mainly due to supraventricular tachycardia (SVT), occurred in respectively 15 (29%) (NSVT: N=1, susVT: N=9, VF: N=5) and 12 (23%) (NSVT: N=4, susVT: N=5, VF: N=3) patients. CONCLUSIONS: VTA in patients with CHD appear on average at the age of 40years. susVT/VF rarely developed in patients with only NSVT, whereas recurrent episodes of susVT/VF frequently developed in patients initially presenting with susVT/VF. Hence, a wait-and-see treatment strategy in patients with NSVT and aggressive therapy of both episodes of VTA and SVT in patients with susVT/VF seems justified

Workplace spirituality and job satisfaction

In order to obtain an improved understanding of behaviour at work, employees should be studied from physical, psychological, and spiritual dimensions. Although the physical and psychological dimensions of individuals at work have been studied extensively, the spiritual dimension has been neglected for many years. The objective of the current research was to determine the relationship between workplace spirituality and a positive attitude related to work, that is, job satisfaction. A cross-sectional study was conducted with a sample of 600 white-collar workers, chosen from two organizations in different industries in South Africa. The research results indicate that there is a positive relationship between workplace spirituality and job satisfaction. These findings deepen the understanding of personal spirituality, organizational spirituality, and job satisfaction. They bring new insights into the significant role which spirituality plays in the context of the workplace. To survive in the 21st century, organizations need to be spiritually based. This, in turn, will lead to workers being satisfied with their entire work experience.http://www.tandf.co.uk/journals/titles/09540261.asp2015-07-31hb201

Capacidade de enraizamento de estacas de Maytenus muelleri Schwacke com a aplicação de ácido indol butírico relacionada aos aspectos anatômicos Rooting capacity of Maytenus muelleri Schwacke cuttings with indolebutyric acid application related to anatomical aspects

A espinheira-santa (Maytenus muelleri - Celastraceae) é a planta medicinal nativa do Sul do Brasil, cujas folhas são tradicionalmente utilizadas pela medicina popular para o tratamento de úlceras e outros problemas gástricos. Existem poucos trabalhos publicados sobre a produção de mudas e técnicas de propagação vegetativa da espécie. A propagação de espinheira-santa por estaquia poderia ser um método eficiente para obtenção de material homogêneo, com características genéticas desejáveis, produzido a partir de plantas matrizes selecionadas. O presente trabalho teve por objetivo estudar os efeitos da aplicação de ácido indol butírico (AIB), em solução e em pó, no enraizamento de estacas de espinheira-santa coletadas nas quatro estações do ano (abril/2005 a janeiro/2006), bem como averiguar, por meio de análises anatômicas e histoquímicas das estacas, a presença de possíveis impedimentos à iniciação do enraizamento adventício. Estacas provenientes de ramos de plantas matrizes de seis anos cultivadas da Estação Experimental do Canguiri, Pinhais, PR, foram coletadas e tratadas com AIB (0, 1500, 3000 mg L-1 ou mg kg-1), em solução alcoólica (50% v/v) e em talco. Aos 365 dias foram avaliadas as porcentagens de estacas enraizadas e mortas, número e comprimento médio de raízes formadas por estaca. Análises anatômicas e histoquímicas com lugol e cloreto férrico foram realizadas. A estação mais promissora para o enraizamento foi o verão/2006 com 62,50% para o tratamento controle, devido à menor lignficação dos ramos no período de intenso crescimento vegetativo. O número médio de raízes formadas por estaca foi de 6,94 (solução) e o comprimento médio de raízes formadas/estaca chegou a 4,82 cm nesta mesma estação. As concentrações de AIB aplicadas não foram eficientes na indução radicial, independentemente do modo de aplicação. Foi detectada a presença de uma camada quase contínua de fibras e braquiesclereídes, a qual constitui barreira anatômica à indução radicial. Os testes histoquímicos revelaram a presença de amido e de compostos fenólicos nas estacas, em todas as estações do ano. A dificuldade ou demora no enraizamento não pode ser justificada pela falta de reservas de amido nos tecidos das estacas, mas pode ser justificada pela presença de compostos fenólicos, possivelmente do grupo dos monofenóis, que causam a degradação do AIA, interferindo negativamente na indução do enraizamento.<br>"Espinheira-santa" (Maytenus muelleri - Celastraceae) is a medicinal plant native to Southern Brazil, the leaves of which are traditionally used in popular medicine for the treatment of stomach ulcers and other gastric problems. There are few published studies about seedling production and vegetative propagation techniques for this species. The propagation of "espinheira-santa" by cuttings could be an efficient method to obtain homogeneous material, with desirable genetic characteristics, produced from selected mother plants. This paper aimed to study the effects of indolebutyric acid (IBA) application, in solution and in powder, on the rooting of "espinheira-santa" cuttings, collected in four seasons (April/2005 to January/2006), as well as to investigate, by means of cutting anatomical and histochemical analyses, the presence of possible impediments to adventitious rooting initiation. Cuttings from branches of six-year mother plants grown at "Estação Experimental do Canguiri", Pinhais, Paraná State, Brazil, were collected and treated with IBA (0, 1500, 3000 mg L-1 or mg kg-1) in alcoholic solution (50% v/v) and in powder. After 365 days, the percentages of rooted and dead cuttings, the number and mean length of roots/cutting were evaluated. Anatomical and histochemical analyses were performed with lugol and ferric chloride. The most promising season for rooting was Summer/2006, with 62.50% of rooting for the control treatment, due to the lesser lignification degree of branches in intense vegetative growth period. The mean number of roots/cutting was 6.94 (solution) and the mean length of roots/cutting was 4.82 cm in that same season. The applied IBA concentrations were not efficient in inducing root growth, regardless of the application method. An almost continuous layer of fibers and stone cells was detected, constituting an anatomical barrier for rooting induction. The histochemical tests revealed the presence of starch and phenolic compounds in cuttings, in all seasons. The difficulty or delay in rooting cannot be justified by the absence of starch reserve in the cutting tissues but by the presence of phenolic compounds, possibly of the group of monophenols, which cause IAA degradation, negatively affecting rooting induction