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Background: Interstitial lung disease (ILD) is a common complication of primary Sjögren’s syndrome (pSS). Because there is a paucity of literature on the management of pSS-associated ILD (pSS-ILD), this retrospective cohort study assessed the efficacy of azathioprine and mycophenolate therapy in adult patients with pSS-ILD. Methods: A retrospective cohort study was performed using electronic health records to identify adults meeting the 2016 American College of Rheumatology/European League Against Rheumatism classification criteria for pSS. The presence of pSS-ILD was confirmed by characteristic high-resolution computed tomography and/or histopathology findings. Sociodemographic, clinical, and pulmonary function test (PFT) data were abstracted for patients meeting the criteria and followed longitudinally from the date of their ILD diagnosis. PFT values were anchored on time of treatment start, and linear mixed-effects modeling was used to analyze changes in diffusion capacity for carbon monoxide (DLCO) and forced vital capacity (FVC) before and after treatment initiation. Results: We identified 19 subjects who had pSS-ILD, of whom seven were treated with azathioprine and seven were treated with mycophenolate. Within the azathioprine treated group, FVC% slope change trended toward improvement from a rate of -9.8% per month pre-treatment to 2.1% per month post-treatment (p = 0.13). Within the mycophenolate treated group, FVC% slope change improved from a rate of 1.5% per month pre-treatment to 4.3% per month post-treatment (p = 0.02) and DLCO% slope changed from a rate of -3.8% to –1.3% per month (p = 0.01) after therapy start. Conclusions: Mycophenolate treatment was associated with significant improvement in PFTs of pSS-ILD patients over time, and azathioprine treatment followed a similar non-significanttrend. Additional prospective studies are needed to further evaluate these findings. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (2): 136-147)

Reclamation in estuaries can greatly change the channel geometry and hydrodynamic conditions and these changes may have significant impacts on spatial and temporal distribution of the turbidity maximum zone. This study focuses on the effects of a large area of reclamation built in 2007–2018 and the behavior of the turbidity maximum zone along the North Channel of the Yangtze Estuary. Data were collected of bathymetry in the North Channel, tidal elevations at Sheshan Station, river discharge at Datong Station and turbidity, retrieved from six Landsat remote sensing images in the dry season from 2006 to 2019. In-situ measured data on flow velocity and suspended sediment concentration were obtained in the dry season of 2003 and 2018. Analysis of the data revealed that reclamations, which led to narrowing (0.86–2.74 km) and fixing of the channel, caused erosion of 0.19–3.72 m in the deep channel and deposition on the tidal flats. Furthermore, it was found that the length of the turbidity maximum zone decreased: its landward boundary shifted 5 km seaward during spring tide and 17 km seaward during neap tide in the dry season. The position of the seaward boundary wandered within a range of 3 km, being further downstream during neap tide than that during spring tide. A conceptual model of changes in the borders of the turbidity maximum zone in response to reclamation is proposed. After the reclamation works, the deeper and narrower channel intensified ebb-dominance of the flow velocity. The coarsening of bed sediment weakened resuspension and decreased the bottom tidally averaged suspended sediment concentration. These changes led to a significant decline in the depth-mean of tidally averaged suspended sediment concentration and caused the seaward movement of the landward boundary of the turbidity maximum zone.

Advances in nanotechnology provide plenty of exciting solutions to environmental issues affecting air, soil as well as water. To solve the water pollution problem caused by organics and microorganisms, development of a simple, environment-friendly, and cheap method for the synthesis of nanomaterials is of paramount importance. Herein, we prepared a novel nanocomposite (named Eggshell/Ag) using waste eggshell as a support and Cacumen platycladi extract as reducing and stabilizing agents in aqueous solutions at room temperature. Biogenic-stabilized Ag nanoparticles (Ag NPs) with an average diameter of 60 nm were well-dispersed on the surface of eggshells, exhibiting dual-functional properties of organics catalytic degradation and bacterial growth inhibition. Through five repeated assays, it was established that the reduction efficiency of the nanocomposite for 4-nitrophenol (4-NP) was high. The reduction could be completed rapidly at room temperature. Moreover, significant inhibition zones were observed for Staphylococcus aureus (S. aureus) agar plates and Escherichia coli (E. coli). Meanwhile, the minimum inhibition concentrations (MIC) were determined to be 0.08 and 0.04 mg mL−1, respectively, while the minimum bactericidal concentration (MBC) was measured as 0.64 mg mL−1. The biogenic Eggshell/Ag nanocomposites are promising candidates for a series of applications in the fields of biomedicine, environment as well as energy.

Background: Bleeding and thromboembolic events (TE) are common complications following HeartMate II (HMII) implantation. The aim of the study was to review our experience related to bleeding and TE events in patients with a HMII and identify factors associated with increased risk of these events. Methods: We retrospectively reviewed 70 consecutive patients who received a HMII between May 2006 and December 2011. The patients were followed for 12 months or until cardiac transplantation, device explantation or death. Major bleeding was defined by INTERMACS criteria with intracranial bleeding events added. Results: There were 48 bleeding events in 28 (40%) patients with gastrointestinal bleeding (54.2%) being most common. Patients with bleeding events had significantly higher average INR (p=0.04) and more chronic kidney disease (p=0.03), although 43.8% of bleeding events occurred at an INR Conclusion: Different factors are associated with bleeding and TE events. The appropriate target INR range for HMII patients should be chosen to balance the risk between bleeding and TE events based largely on patient factors.

Portopulmonary hypertension (PoPH) refers to pulmonary arterial hypertension associated with portal hypertension with or without evidence of an underlying liver disease. Despite the potential for curing PoPH with liver transplantation, the presence of moderate or severe PoPH is associated with increased morbidity and mortality and is, therefore, a contraindication to transplantation. Previous studies have predominantly used intravenous epoprostenol for treatment in order to qualify patients for liver transplantation. In this retrospective case series, we describe the clinical course of 11 patients whom we successfully treated (predominantly with oral sildenafil and subcutaneous treprostinil) in order to qualify them for liver transplantation. The mean pulmonary artery pressure significantly improved from 44 to 32.9 mm Hg, and the pulmonary vascular resistance decreased from 431 to 173 dyn second cm(-5) . There were significant improvements in the cardiac output and the transpulmonary gradient with these therapies as well. All 11 patients subsequently received liver transplants with a 0% mortality rate to date; the duration of follow-up ranged from 7 to 60 months. After transplantation, 7 of the 11 patients (64%) were off all pulmonary vasodilators, and only 2 patients required transiently increased doses of prostacyclins. In conclusion, an aggressive approach to the treatment of PoPH with sildenafil and/or treprostinil and subsequent liver transplantation may be curative for PoPH in some patients.

Progression of lung disease is a major event in children with cystic fibrosis (CF), but regional differences in its evolution are unclear. We hypothesized that regional differences occur beginning in early childhood. We examined this issue by evaluating 132 patients followed in the Wisconsin Neonatal Screening Project between 1985 and 2010. We scored chest x-rays obtained every 1–2 years with the Wisconsin chest x-ray system, in which we divided the lungs into quadrants, and gave special attention to ratings for bronchiectasis (BX) and nodular/branching opacities. We compared the upper and lower quadrant scores, and upper right and left quadrant scores, as patients aged using a multivariable generalized estimation equation (GEE) model. We did a confirmatory analysis for a subset of 81 patients with chest computerized tomography (CT) images obtained in 2000 and scored using the Brody scoring system. The chest x-ray analysis shows that the upper quadrants have higher BX (p

Introduction Telephone quitlines are an effective way to provide evidence-based tobacco dependence treatment services at the population level. Information about what services quitlines offer and how those services are used may improve their reach to the smoking population. Methods The North American Quitline Consortium surveyed state quitlines in 2005 and 2006 to get information about quitline services, funding, and use. We report changes between 2005 and 2006. Results By 2006, all 50 states, the District of Columbia, and Puerto Rico had quitlines, and annual mean reach was approximately 1% of US adult smokers (aged 18 years or older). Significant increases were seen in mean quitline reach, mean per capita funding for quitline services, and provision of free cessation medications; otherwise, few changes were seen in quitline services. Conclusions Quitlines have the potential to serve a large percentage of smokers. Between 2005 and 2006, gains in the number, reach, and per capita funding for quitline services in the United States were seen. Although this represents progress, further research and investment to optimize quitline service delivery and reach are required for quitlines to fulfill their potential of improving the health of the American population.

To correlate the severity of bronchiectasis in children with cystic fibrosis with clinical and microbiologic variables in order to clarify risk factors for the development of irreversible lung disease.