Disease Course, Treatments, and Outcomes of Children With Systemic Juvenile Idiopathic Arthritis-Associated Lung Disease.

OBJECTIVE: Systemic juvenile idiopathic arthritis-associated lung disease (SJIA-LD) is a life-threatening disease complication. Key questions remain regarding clinical course and optimal treatment approaches. The objectives of the study were to detail management strategies after SJIA-LD detection, characterize overall disease courses, and measure long-term outcomes. METHODS: This was a prospective cohort study. Clinical data were abstracted from the electronic medical record, including current clinical status and changes since diagnosis. Serum biomarkers were determined and correlated with presence of LD. RESULTS: We enrolled 41 patients with SJIA-LD, 85% with at least one episode of macrophage activation syndrome and 41% with adverse reactions to a biologic. Although 93% of patients were alive at last follow-up (median 2.9 years), 37% progressed to requiring chronic oxygen or other ventilator support, and 65% of patients had abnormal overnight oximetry studies, which changed over time. Eighty-four percent of patients carried the HLA-DRB1*15 haplotype, significantly more than patients without LD. Patients with SJIA-LD also showed markedly elevated serum interleukin-18 (IL-18), variable C-X-C motif chemokine ligand 9 (CXCL9), and significantly elevated matrix metalloproteinase 7. Treatment strategies showed variable use of anti-IL-1/6 biologics and addition of other immunomodulatory treatments and lung-directed therapies. We found a broad range of current clinical status independent of time from diagnosis or continued biologic treatment. Multidomain measures of change showed imaging features were the least likely to improve with time. CONCLUSION: Patients with SJIA-LD had highly varied courses, with lower mortality than previously reported but frequent hypoxia and requirement for respiratory support. Treatment strategies were highly varied, highlighting an urgent need for focused clinical trials.

Impact of electrochemical reducing power on homoacetogenesis.

Homoacetogenesis was performed in a microbial electrosynthesis single-chamber reactor at open and closed circuits modes. The aim is to investigate how an applied reducing power affects acetic acid synthesis and H2 gas-liquid mass transfer. At a cathode voltage of -175 mV vs. Ag/AgCl (3.0 NaCl), the acetic acid synthesis rate ramped up to 0.225 mmol L-1h-1 due to additional electrons and protons liberation from carbon-free sources such as water and ammonium via anodic oxidation. The study sets a new lowest benchmark that acetic acid can be bioelectrochemical synthesized at - 175 mV. The applied reducing power did not increase the H2 gas-liquid mass transfer because the direct electron transfer from cathode to microorganisms reduced the demand for H2 in the fermentation medium. Microbial analysis shows a high presence of Veillonellaceae spore-forming clostridia, which are identified as homoacetogens.

Hierarchical microstructure constructed with graphitic carbon-coated Ni3S2 nanoparticles anchored on N-doped mesoporous carbon nanoflakes for optimized sodium storage.

A hierarchical microstructure constructed with graphitic-carbon-coated Ni3S2 nanoparticles anchored on N-doped mesoporous carbon nanoflakes was fabricated using a nickel-based micro-nano structure as a precursor and polydopamine as a carbon source. By optimizing the microstructure, the obtained Ni3S2/carbon composite compounded with the thickest carbon nanoflakes delivers ultrafast and stable Na-ion storage performance, and can maintain a reversible charge capacity of 372 mA h g-1 at a current density of 5 A g-1 over 250 cycles, and 316 mA h g-1 even at a current density of 20 A g-1 for 2000 cycles. These remarkable electrochemical properties can be attributed to its hierarchical microstructure of graphitic-carbon-coated Ni3S2 particles and N-doped mesoporous carbon nanoflakes, which provide easy accessibility to the electrolyte, fast electron transport and Na+ diffusion, and even relieve the strain caused by the volume expansion upon cycling.

Chemically Roughened, Sputtered Au Films with Trace-Loaded Manganese Oxide for both On-Chip and Off-Chip High Frequency Supercapacitors.

High frequency supercapacitors (HFSCs) are promising in alternating current line filtering and adaptable storage of high-frequency pulse electrical energy. Herein, we report a facile yet integrated-circuit-compatible fabrication of HFSC electrodes by combining chemical roughening of the sputtered metal (Au) films and in situ trace loading of a pseudocapacitive material (MnO x ). The developed electrode fabrication route is versatile for different substrates, and is described with the application paradigms of both on-chip (with Si/SiO2 substrate) and off-chip (without Si/SiO2 substrate, with Ti substrate as an example in this study) HFSCs. With Au/MnO x films on Si/SiO2 substrates as the working electrodes, the derived on-chip HFSC displayed satisfactory performance in high frequency applications (i.e., an areal capacitance of 131.7 µF cm-2, a phase angle of -78°, and a RC time constant of 0.27 ms, at 120 Hz).

Nucleation and growth mechanism of a nanosheet-structured NiCoSe2 layer prepared by electrodeposition.

Ni-Co-Se layers have attracted a great deal of attention in the field of solar cells, electrocatalyst water splitting and supercapacitors. Electrodeposition is a simple, convenient and low-cost way to obtain Ni-Co-Se layers. However, until now, the electrochemical kinetics of the Ni-Co-Se system, including its growth and nucleation mechanisms, are still unclear. In present work a NiCoSe2 layer with a nanosheet structure was electrodeposited in a chloride bath. The electrochemical mechanisms of the Ni-Co-Se system were also studied. It is noted that the electrochemical kinetics of Ni-Co-Se electrodeposition can be influenced by both temperature and electrode material; however, temperature does not change the progressive nucleation process and mixed controlled growth mechanism of Ni-Co-Se. The diffusion coefficient D and charge-transfer coefficient α of the Ni-Co-Se system were calculated. The values of D obtained by cyclic voltammogram and chromoamperometry are close to each other at both 20 and 50 °C, respectively, and increase with the increase of temperature. Moreover, the activation energy E a was also calculated. Specially, a uniform 3D network-structure NiCoSe2 layer was electrodeposited on ITO glass at -0.9 V and 40 âˆ¼ 60 °C. The increased overpotential during deposition makes the NiCoSe2 layer more easily gather together; however, there is no significant effect on the surface morphology of the NiCoSe2 layer when the temperature is between 40 and 60 °C.

Determinants of airleak flow during humming V high-frequency oscillatory ventilation in an open-compartment ex-vivo model of airleak.

High-frequency oscillatory ventilation (HFOV) using small tidal volumes and maintaining sufficient end-expiratory lung volume may be beneficial in the treatment of airleak. However, few published guidelines exist to advise clinicians on appropriate ventilator settings in this clinical scenario. The present experiment aimed to determine the effect of frequency, stroke volume (SV) and mean airway pressure (MAP) on airleak from an isolated lung model ventilated with a Humming V HFOV. We performed a crossover non-randomized experiment using the repeated measurement method to test the hypothesis that MAP is the major determinate for airleak. The lungs of 13 healthy juvenile New Zealand white rabbits were isolated and ventilated with high peak pressure to create airleak. The dataset obtained was analyzed using the generalized estimating equation method. We found that airleak flow did not change as frequency was raised from 13 to 17 Hz (P = 0.463) with MAP and SV kept constant. SV was positively correlated to the amount of change in airleak (P < 0.01, coefficients +/- SEM = 1.2 +/- 0.1 ml/min/ml). Leakage flow increased significantly from 275 +/- 168 ml/min to 1,721 +/- 552 ml/min as MAP was increased from 5 cm H(2)O to 30 cm H(2)O (P < 0.001, coefficients +/- SEM = 56.1 +/- 3.0 ml/min/cm H(2)O) while inspiratory flow increased less and amplitude pressure remained about the same. We concluded that MAP (lung volume) was the main independent factor for airleak, whilst SV (tidal volume) exerted a lesser effect. Within the operational range of the Humming V, frequency did not affect airleak.

Measurement and validation of the voice handicap index in voice-disordered patients in Taiwan.

Voice disorders can cause problems for patients emotionally, physically, economically and functionally. Neither subjective nor objective voice examinations are able to evaluate such factors adequately. For this study, a retrospective analysis of 79 dysphonic cases was conducted using the voice handicap index (VHI) to gather comprehensive data across a variety of voice disorders. Of the 79 cases, 41 involved glottic insufficiency, 26 involved vocal polyps or mass, and 12 involved functional voice disorders. Cases were assessed with the VHI using physical (P), functional (F), emotional (E) parameters and a total (T) of the three. P, F, E and T variables were entered into a statistical programme and analysed using one-way analysis of variance (ANOVA). Mean +/-SE values for P, F, E and T, respectively, in glottic insufficiency cases were 31.61 +/- 1.10, 26.49 +/- 1.43, 26.06 +/- 1.54, and 84.20 +/- 4.21. Mean +/-SE values for P, F, E and T, respectively, in vocal mass cases were 30.69 +/- 1.73, 25.23 +/- 1.90, 23.96 +/- 1.82, and 79.88 +/- 5.08. The mean +/-SE values of P, F, E and T, respectively, in functional voice disorders were 20.92 +/- 2.06, 18.33 +/- 1.82, 16.83 +/- 1.86, and 56.08 +/- 5.23. We found the mean glottic insufficiency was significantly greater than functional voice disorders for each measure. There were significant differences between vocal mass and functional voice disorders means for P and T. Glottic insufficiency and vocal mass means were not significantly different for any measure. Problems in the physical realm were identified as the most severe amongst all patients. Glottic insufficiency patients were found to suffer the most in every VHI value. Although VHI is a relatively new method by which to measure discomfort in voice-disordered patients, it provides a mechanism for patients to define their discomfort and for therapists to better target recovery programmes to patient's needs.