Prospective Study of the Effectiveness of Coping in Pediatric Patients

Findings about the influence of coping on psychological adjustment in children with different medical conditions are inconsistent and often based on cross-sectional data. This prospective study evaluated the effect of various coping strategies on children's post-traumatic stress symptoms and behavioral problems 1month and 1year after an accidental injury or the diagnosis of a chronic disease in 161 pediatric patients 6-15years of age. Only minor positive effects of coping on psychosocial adjustment were found: Religious coping reduced post-traumatic stress symptoms. Active coping strategies had negative effects on internalizing and externalizing behavioral problems. Support seeking strategies, distraction, and avoidance had no impact on long-term psychosocial adjustmen

Онтологическое описание киберфизических систем на производстве Индустрии 4.0

Предлагается схема организации взаимодействия компонентов киберфизических систем на производстве на основе онтологий. Рассматривается производственное предприятие Индустрии 4.0 типа умная фабрика. Основное внимание в статье уделено взаимодействию цифровых двойников оборудования и цифровых двойников технологических процессов с реальным оборудованием предприятия

Analyse de la migration d’huile dans les pompes à chaleur mono- et biétagées

The Laboratory of Industrial Energy systems has evaluated a series of high performance air-water heat pump concepts with the aim to retrofit existing fuel fired boilers for residential hydronic heating systems. The results are published within the framework of the Swiss Retrofit Heat Pump project, which is conducted by the Swiss Federal Office of Energy. The two-stage heat pump cycle has shown the best efficiency prospects. Oil migration between the upper stage and lower stage compressors is the main obstacle for commercialization in the low heat rate range. The oil mass concentration is measured by the Fourier Transform Infrared Spectrospopy (FTIR) method with an attenuated total reflection cell (ATR). This method was calibrated on a separated test loop and compared to measurements of mass-sampling and of density by a Coriolis effect densitymeter. Infrared analysis gives a precision of < 0.1% of oil concentration and the detection limit was identified at about 0.3%. Density measurements cannot be used in the ordinary temperature range of the liquid line in the heat pump. Mass sampling and the FT-IR measurements give corresponding results. An air-water heat pump (10 kWth, R-407C) was build in the laboratory to perform comparison tests in the single-stage and two-stage heating modes. The main elements of the heat pump are: two scroll type compressors, a brazed plate condenser, a finned tube evaporator, an economizer heat exchanger and two electronic expansion valves. Defrosting is done by cycle inversion with a 4-way reversing valve. Measured improvements on the two-stage heating mode of 30% for the COP and 24% for the heat output comparing to the corresponding test point (A-7/W50) in the single stage configuration have been shown. Important reductions of the maximum system temperature at the outlet of the compressors enable an extended range of application (including the point A-12/W65). In the two-stage heating mode an oil transfer rate of 5 - 10 g/min from the high pressure stage to the low pressure stage compressor was detected in all tested conditions, which is strongly limiting the continuous service of the heat pump. For long term running tests an additional balancing system composed of an oil pump and an oil vessel has been installed. The circulating oil concentration is between 0.2% and 0.4% for the two-stage configuration as measured with the FT-IR method. In single-stage mode the concentration is lower than 0.2% and only the mass sampling technique provided reliable results. Sensibility analysis in changing the regulation parameters did not give concluding results in order to design a stable configuration of the two-stage heat pump. In absence of integrated two-stage scroll compressors intermediate solutions have to be considered. These consist in the implementation of a booster compressor or the implementation of an oil separator at the outlet of the high pressure stage compressor coupled with a oil return management or a periodic shut down of the heat pump with external balancing of the oil level in the crankcase. An adapted heat transfer model for refrigerant-oil mixtures was developed, in order to investigate the theoretical impact of oil in the evaporator

Outcome of children with low-grade cerebellar astrocytoma: long-term complications and quality of life

Objects: To study the long-term outcome of surgically treated low-grade cerebellar astrocytomas in children. Materials and methods: We followed 31 consecutive patients under 16years of age who were diagnosed between 1980 and 2005 in a single institution. In 21 of 31 survivors (median follow-up time 7.9years; range 5.6-27.4years) who agreed to participate, tumor control, neurological and cognitive complications, and their impact on behavioral and emotional adjustment and health-related quality of life (HRQoL) were comprehensively assessed qualitatively and quantitatively. Results: Neurological sequelae were found in 43%. However, age-appropriate ability to perform daily life activities was normal in all patients. Remarkably, cognitive deficits leading to significant school problems occurred in 19% and behavioral and emotional adjustment disturbances in 27%. In comparison with healthy controls, the survivors rated their HRQoL similarly or even higher. Conclusion: Childhood low-grade cerebellar astrocytomas have an excellent cure rate by tumor surgery alone. When compared with other pediatric brain tumors, the risk of neurological, cognitive, emotional, and behavioral complications is relatively small. HRQoL is similar to that of healthy control

Aortic calcification and femoral bone density are independently associated with left ventricular mass in patients with chronic kidney disease

Background Vascular calcification and reduced bone density are prevalent in chronic kidney disease and linked to increased cardiovascular risk. The mechanism is unknown. We assessed the relationship between vascular calcification, femoral bone density and left ventricular mass in patients with stage 3 non-diabetic chronic kidney disease in a cross-sectional observational study. Methodology and Principal Findings A total of 120 patients were recruited (54% male, mean age 55±14 years, mean glomerular filtration rate 50±13 ml/min/1.73 m2). Abdominal aortic calcification was assessed using lateral lumbar spine radiography and was present in 48%. Mean femoral Z-score measured using dual energy x-ray absorptiometry was 0.60±1.06. Cardiovascular magnetic resonance imaging was used to determine left ventricular mass. One patient had left ventricular hypertrophy. Subjects with aortic calcification had higher left ventricular mass compared to those without (56±16 vs. 48±12 g/m2, P = 0.002), as did patients with femoral Z-scores below zero (56±15 vs. 49±13 g/m2, P = 0.01). In univariate analysis presence of aortic calcification correlated with left ventricular mass (r = 0.32, P = 0.001); mean femoral Z-score inversely correlated with left ventricular mass (r = −0.28, P = 0.004). In a multivariate regression model that included presence of aortic calcification, mean femoral Z-score, gender and 24-hour systolic blood pressure, 46% of the variability in left ventricular mass was explained (P<0.001). Conclusions In patients with stage 3 non-diabetic chronic kidney disease, lower mean femoral Z-score and presence of aortic calcification are independently associated with increased left ventricular mass. Further research exploring the pathophysiology that underlies these relationships is warranted

Reappraisal of putative glyoxalase 1-deficient mouse and dicarbonyl stress on embryonic stem cells in vitro

Glyoxalase 1 (Glo1) is a cytoplasmic enzyme with a cytoprotective function linked to metabolism of the cytotoxic side product of glycolysis, methylglyoxal (MG). It prevents dicarbonyl stress — the abnormal accumulation of reactive dicarbonyl metabolites, increasing protein and DNA damage. Increased Glo1 expression delays ageing and suppresses carcinogenesis, insulin resistance, cardiovascular disease and vascular complications of diabetes and renal failure. Surprisingly, gene trapping by the International Mouse Knockout Consortium (IMKC) to generate putative Glo1 knockout mice produced a mouse line with the phenotype characterised as normal and healthy. Here, we show that gene trapping mutation was successful, but the presence of Glo1 gene duplication, probably in the embryonic stem cells (ESCs) before gene trapping, maintained wild-type levels of Glo1 expression and activity and sustained the healthy phenotype. In further investigation of the consequences of dicarbonyl stress in ESCs, we found that prolonged exposure of mouse ESCs in culture to high concentrations of MG and/or hypoxia led to low-level increase in Glo1 copy number. In clinical translation, we found a high prevalence of low-level GLO1 copy number increase in renal failure where there is severe dicarbonyl stress. In conclusion, the IMKC Glo1 mutant mouse is not deficient in Glo1 expression through duplication of the Glo1 wild-type allele. Dicarbonyl stress and/or hypoxia induces low-level copy number alternation in ESCs. Similar processes may drive rare GLO1 duplication in health and disease

Selektive Lasertrabekuloplastik bei Patienten unter maximaler Lokaltherapie: eine retrospektive Analyse

Zusammenfassung: Hintergrund: Hauptziel der Glaukomtherapie ist nach wie vor die erfolgreiche Augendrucksenkung. Ziel dieser retrospektiven Studie war es, die Wirksamkeit der selektiven Lasertrabekuloplastik (SLT) bei Patienten unter maximaler Augendruck senkender Therapie zu untersuchen. Besonderes Augenmerk wurde in der Analyse darauf gelegt, ob präoperativ bekannte Faktoren einen Einfluss auf den IOD-senkenden Effekt haben. Material und Methode: Inkludiert wurden Patienten mit der Diagnose einer okulären Hypertension oder eines Offenwinkelglaukoms (primäres Offenwinkelglaukom, Pseudoexfoliationsglaukom, Pigmentdispersionsglaukom und Normaldruckglaukom), die im Zeitraum von 3/2008 bis 12/2010 aufgrund unzureichender Drucksenkung unter maximaler Lokaltherapie einer SLT unterzogen wurden und die einen Nachbeobachtungszeitraum von mindestens 3Monaten hatten. Die Datenanalyse erfolgte präoperativ, sowie einen Tag, einen Monat und drei Monate nach SLT und dann dreimonatlich bis zu 2,5 Jahre. Hauptmessparameter waren Ausmaß der IOD-Senkung sowie Erfolgsraten (³ 20% Augendruck-Senkung). Eine Re-SLT wurde nicht als Misserfolg gewertet. Resultate: Einhunderteinunddreißig Augen von 98 Patienten (58 Frauen, mittleres Alter 71,6 ± 11,2 Jahre, mittlerer Nachbeobachtungszeitraum 1,05 ± 0,67 Jahre) wurden inkludiert. Mittlerer Augendruck vor SLT war 19,6 ± 4,9mmHg. Bis 1,75 Jahre nach SLT war der Augendruck stets signifikant reduziert (16,6 ± 3,6; p = 0,044). Bis 2 Jahre nach SLT hatten Patienten mit höherem Ausgangs-Augendruck eine signifikant stärkere Drucksenkung (R2  = 0,358; p = 0,009). Es gab keinen signifikanten Unterschied in der Überlebensanalyse sowohl zwischen phaken bzw. pseudophaken Patienten als auch zwischen Patienten mit bzw. ohne Prostaglandintherapie (p = 0,671 und p = 0,994). Zwölf Augen hatten eine zweite SLT (mittlere Zeit bis zur Re-SLT 1,03 ± 0,55 Jahre). Fünfzehn Augen benötigten eine weitere Augendruck senkende Operation (mittlere Zeit bis zum Versagen der SLT 0,84 ± 0,52 Jahre). Schlussfolgerung: SLT kann auch bei Patienten unter maximaler Lokaltherapie noch eine signifikante Drucksenkung bewirken, wobei das Ausmaß der Drucksenkung über die Zeit abnimmt. Die Augendruck senkende Wirkung ist bei Patienten mit höherem präoperativen Augendruck stärker ausgepräg

Behaviour of non-donor specific antibodies during rapid re-synthesis of donor specific HLA antibodies after antibody incompatible renal transplantation

Background: HLA directed antibodies play an important role in acute and chronic allograft rejection. During viral infection of a patient with HLA antibodies, the HLA antibody levels may rise even though there is no new immunization with antigen. However it is not known whether the converse occurs, and whether changes on non-donor specific antibodies are associated with any outcomes following HLA antibody incompatible renal transplantation. Methods: 55 patients, 31 women and 24 men, who underwent HLAi renal transplant in our center from September 2005 to September 2010 were included in the studies. We analysed the data using two different approaches, based on; i) DSA levels and ii) rejection episode post transplant. HLA antibody levels were measured during the early post transplant period and corresponding CMV, VZV and Anti-HBs IgG antibody levels and blood group IgG, IgM and IgA antibodies were quantified. Results: Despite a significant DSA antibody rise no significant non-donor specific HLA antibody, viral or blood group antibody rise was found. In rejection episode analyses, multiple logistic regression modelling showed that change in the DSA was significantly associated with rejection (p = 0.002), even when adjusted for other antibody levels. No other antibody levels were predictive of rejection. Increase in DSA from pre treatment to a post transplant peak of 1000 was equivalent to an increased chance of rejection with an odds ratio of 1.47 (1.08, 2.00). Conclusion: In spite of increases or decreases in the DSA levels, there were no changes in the viral or the blood group antibodies in these patients. Thus the DSA rise is specific in contrast to the viral, blood group or third party antibodies post transplantation. Increases in the DSA post transplant in comparison to pre-treatment are strongly associated with occurrence of rejection

Exaggerated blood pressure response to dynamic exercise despite chronic refractory hypotension : results of a human case study

BACKGROUND: Chronic refractory hypotension is a rare but significant mortality risk in renal failure patients. Such aberrant physiology usually deems patient unfit for renal transplant surgery. Exercise stimulates the mechano-chemoreceptors in the skeletal muscle thereby modulating the sympathetic effects on blood pressure regulation. The haemodynamic response to dynamic exercise in such patients has not been previously investigated. We present a case with severe chronic hypotension who underwent exercise testing before and after renal transplantation, with marked differences in blood pressure response to exercise. CASE PRESENTATION: A 40-year old haemodialysis-dependent patient with a 2 year history of refractory hypotension (≤80/50 mmHg) was referred for living donor renal transplantation at our tertiary centre. Each dialysis session was often less than 2 h and 30 min due to symptomatic hypotension. As part of the cardiovascular assessment, she underwent haemodynamic evaluation with cardiopulmonary exercise testing. Blood pressure normalized during unloaded pedalling but was exaggerated at maximal workload whereby it rose from 82/50 mmHg to a peak of 201/120 mmHg. Transthoracic echocardiography, tonometric measure of central vascular compliance and myocardial perfusion scan were normal. She subsequently underwent an antibody-incompatible renal transplantation and was vasopressor reliant for 14 days during the post-operative period. Eight weeks following transplant, resting blood pressure was normal and a physiological exercise-haemodynamic response was observed during a repeat cardiopulmonary exercise testing. CONCLUSION: This case highlights the potential therapeutic role of unloaded leg cycling exercise during dialysis session to correct chronic hypotension, allowing patients to have greater tolerance to fluid shift. It also adds to existing evidence that sympathetic dysfunction is reversible with renal transplant. Furthermore chronic hypotension with preserved exercise-haemodynamic response and cardiovascular reserve should not preclude these patients from renal transplant surgery

The uremic toxin oxythiamine causes functional thiamine deficiency in end-stage renal disease by inhibiting transketolase activity

Decreased transketolase activity is an unexplained characteristic of patients with end stage renal disease (ESRD) and is linked to impaired metabolic and immune function. Herein we describe the discovery of a link to impaired functional activity of thiamine pyrophosphate co-factor through the presence, accumulation and pyrophosphorylation of the thiamine antimetabolite, oxythiamine, in renal failure. Plasma oxythiamine was increased 4-fold in patients receiving continuous ambulatory peritoneal dialysis (CAPD) and 15-fold in patients receiving haemodialysis (HD) immediately before a dialysis session: healthy controls 0.18 (0.11 – 0.22) nM, CAPD, 0.64 (0.48-0.94) nM and HD (2.73 (1.52-5.76) nM); P<0.001, Mann-Whitney U test. Oxythiamine was converted to the transketolase inhibitor oxythiamine pyrophosphate (OTPP). Red blood cell OTPP concentration was increased 4-fold in HD: healthy controls, 15.9 ± 10.4 nM and HD patients, 66.1 ± 26.7 nM; P<0.001, t-test. This accounted for the concomitant 41% loss of transketolase activity (mU/mg Hb): healthy controls, 0.410 ± 0.144 nM and HD, 0.240 ± 0.107 nM; P<0.01, paired t-test. This may be corrected by displacement with excess thiamine pyrophosphate and explain lifting of decreased transketolase activity by high dose thiamine supplementation in previous studies. Oxythiamine is likely of dietary origin, through cooking of acidic thiamine-containing foods. Trace level oxythiamine was not formed from thiamine degradation under physiological conditions but rather under acidic conditions at 100 oC. Monitoring of plasma oxythiamine concentration in renal failure and implementation of high dose thiamine supplements to counter it may help improve clinical outcome of patients with renal failure