bluuebunny/crossref_metadata_2025 huggingface dataset:
Research on Intelligent Substation Simulation Modelling Technology Based on Data Acquisition Technology
Authors: Zhang Kexin , Tan Long , Xu Minhu , Han Siwei , Zhang Dewen , Chen Shiyu
Published: September 2020

The introduction of intelligent substation process layer network has caused great changes in the data source and transmission method of relay protection, and its action performance and reliability are increasingly dependent on the communication network. The data flow of the relay protection in the intelligent substation and the communication mechanism of each message are analysed. Based on the IEC61850 standard, the process layer network and the relay protection IED device are modelled on the OPNET simulation software to realize the MU of the relay protection in the intelligent substation the whole process simulation of data collection, SV message, GOOSE message, protection algorithm and protection export. Combined with the example of current protection, the principle and realization mechanism of modelling and simulation are explained, and its feasibility and effectiveness are verified, which provides a new effective research tool for the quantitative analysis of relay protection in smart substations.
Integrated Metric Learning Based Multiple Object Tracking Method under Occlusion in Substations
Authors: Zhang Pengfei , Chen Zhongyang , Zhang Xinyue , Yang Zhongguang , Shi Wenbin
Published: September 2020

Nowadays most of background subtraction based algorithms lack the robustness to handle tracking multiple objects with specific situations such as heavy occlusion in intelligent video surveillance system. This paper proposed an integrated metric learning based multiple object tracking method in smart substations. First tracks personnel obtaining bounding box, then integrates obtained mahalanobis distance and cosine distance of personnel. When occlusion occurs, proposed method compares the integrated metric vale with threshold so as to track personnel in different frames. Experiments in the smart substation confirm that our method can track multiple personnel under occlusion effectively and reliably.
Research on Key Techniques for Negative Line Loss Rectification of Interprovincial Transmission Lines
Authors: Li Ning , Zhang Wei , Wang Yongchao , Sun Guodong , Li Peng , Su Linhao
Published: September 2020

Carry out in-depth research on the causes, mechanisms, and key remediation technologies of abnormal line losses across transmission lines, study transmission line loss and line impedance, network topology, line flow, line insulation, corona discharge, environmental temperature and humidity conditions, and measurement devices relationship between influencing factors such as errors. Establish a theoretical model of the multi-parameter error influencing factors of line loss under special conditions of inter-provincial transmission line routes. Based on the causes and mechanisms of abnormal line losses, research and propose efficient and comprehensive management methods and techniques for negative line losses. The lean management and evaluation system lays the technical foundation.
Application of BIM and RFID Technologies in Power Construction Industry
Authors: Gan Yupeng , Yin Hang , Chen Xiaolei
Published: September 2020

Although Building Information Modeling (BIM) and Radio Frequency Identification (RFID) technologies have been widely used in the civil construction industry, they are rarely used in the power construction industry. BIM offers the possibility of full life-cycle management for property owners, and RFID facilitates delicacy management in different time stages. The main objective of this paper is to present a review of BIM and RFID applications in the construction industry, and then to disclose the development possibilities and prospects of BIM and RFID in the power construction industry. In this paper, BIM and RFID technologies are discussed to apply in three main phases: pre-construction phase, construction phase, and post-construction phase. Besides, concerning power construction, a substation case is also exhibited. This paper revealed that BIM and RFID technologies are suitable for the power construction industry, and they can bring considerable economic and social benefits.
Research on Substation Comprehensive Information Automation System Based on Ubiquitous Power Internet of Things Technology
Authors: Yuan Hui , Zhuang Yan , Hu Yaodong , Liang Yuan , Xu Ning , Zhu Guowei , Gao Hang , Zhang Yintie
Published: September 2020

The rapid development of society has made the production and living requirements of electrical energy supply higher and higher. Large-scale data collection and analysis of people’s lives and social production, and making corresponding judgments based on the results, are of great significance for optimizing power planning, saving energy and reducing emissions, facilitating residents’ lives, and coordinating social production. State Grid Co., Ltd. proposes to build “three types of two networks”, in which the ubiquitous power Internet of Things shoulders the existing power grid and further communicates the tasks of the user side and the generation, transmission and distribution side. In terms of function, the ubiquitous power IoT can be basically divided into four structures: perception layer, network layer, node centre and dispatch layer. According to the role of each structure, the development and construction are targeted. The system coordinates the construction of the ubiquitous power Internet of Things based on the overall structure, so that things are connected and characters interact, and a shared energy interconnection ecosystem is built.
Effect of Entry Conditions on Performance of a Proton Exchange Membrane Fuel Cell with Interdigitated Flow Fields
Authors: Wang Yixiang , Shen Ruibo , Sun Zhe , Wu Mingge
Published: September 2020

A three-dimensional two-phase mathematical model is used to investigate the entry conditions effects on performance of proton exchange membrane fuel cells (PEMFC) with an interdigitated flow field. Analogy with parallel and serpentine flow fields, interdigitated is better than the other two in comprehensive, and should be preferred. Comparison of different relate humidity (RH) indicates that RH significantly affect cell performance, while RH of cathode affect more. Current density increases with increased hydrogen flow of RH 100%, however, slightly reduces with that of oxygen.
Grid-connected Inverter Control Strategy Based on Capacitor Voltage Error Inertia Feedback
Authors: Xing Ning , Huang Hongquan , Chen Yanming
Published: September 2020

Firstly, the mathematical model of single-phase grid connected inverter is established.Then, the mathematical derivation is carried out accord to the state space model, and the control strategy of grid-connected inverter based on capacitor voltage error inertia feedback is proposed. In this strategy, the first-order inertial feedback of capacitor voltage error is adopted to suppress the resonance peak of LCL filter, the feedforward of capacitor reference voltage is adopted to improve the tracking performance of the system, and the proportional feedforward of grid-connected voltage is used to suppress the harmonic of power grid. In addition, Simulation verify the feasibility and effectiveness of the proposed control strategy.
Wind Water and Solar Complementary Power Generation System Based on Particle Swarm Optimization and Neural Network Algorithm
Authors: Yu Tengfei , Tao Jun
Published: September 2020

Wind and light energy are volatile and need to be predicted to provide the basis for the next control strategy. this system uses the neural network algorithm to carry on the short time forecast to the wind energy, the solar energy, Under the condition of high accuracy and based on the predicted results, particle swarm optimization (PSO) is adopted to make decisions. In this way, it can decide how to do today, like when should it charge/discharge the battery to maintain the stability of system rather than just analysis feasibility of system only bases on the history data. By regulating each energy use strategy at different times, the purpose of complementary output is achieved, and the output is guaranteed to be stable as far as possible.
Multi Model Robust PID Control of Main Steam Temperature based on Gap Metric
Authors: Ma Zenghui , Xu Huiyi , Dong Fang
Published: September 2020

In order to adapt to the current construction of smart power plants, thermal power plants put forward higher requirements for the main steam temperature control. The traditional cascade PID control scheme is difficult to achieve satisfactory control quality. In this paper, several models of the main steam temperature plant are classified according to the gap metric, and then the corresponding robust PID controller is designed for different models. The simulation results show that the multi model robust PID control based on gap metric can effectively solve the large delay and nonlinearity of the main steam temperature plant, and the control performance is better than the cascade PID control, which is worth popularizing in engineering application.
Effects of Chronic and State Loneliness on Heart Rate Variability in Women
Authors: Roddick Charlotte M , Chen Frances S
Published: September 2020

Background

Loneliness, the subjective experience of social isolation, represents one of the largest risk factors for physical illness and early death in humans. However, the mechanisms by which loneliness leads to adverse health outcomes are not well understood.

Purpose

In this study, we examined altered parasympathetic nervous system function as a potential pathway by which chronic loneliness and state loneliness may “get under the skin” to impact cardiovascular physiology.

Methods

In a controlled laboratory setting, vagally mediated resting heart rate variability (HRV), HRV reactivity to an induction of state loneliness, and HRV reactivity to a cognitive challenge task were assessed in a sample of 316 healthy women (18–28 years).

Results

Greater chronic loneliness in women predicted lower resting HRV, an independent risk factor for cardiovascular disease and all-cause mortality, after controlling for demographic, psychosocial, and health behavior covariates. Furthermore, women higher in chronic loneliness experienced significantly larger increases in HRV to state loneliness and reported significantly higher levels of negative affect immediately following state loneliness, compared with their less chronically lonely counterparts. Chronic loneliness also predicted blunted HRV reactivity—a maladaptive physiological response—to cognitive challenge.

Conclusions

The current findings provide evidence that chronic loneliness is associated with altered parasympathetic function (both resting HRV and HRV reactivity) in women, and that the immediate experience of state loneliness is linked to a proximate increase in HRV among chronically lonely women. Results are discussed in terms of implications for cardiovascular health and the evolutionary functions of loneliness.
Understanding Between-Person Interventions With Time-Intensive Longitudinal Outcome Data: Longitudinal Mediation Analyses
Authors: Berli Corina , Inauen Jennifer , Stadler Gertraud , Scholz Urte , Shrout Patrick E
Published: September 2020

Background

Mediation analysis is an important tool for understanding the processes through which interventions affect health outcomes over time. Typically the temporal intervals between X, M, and Y are fixed by design, and little focus is given to the temporal dynamics of the processes.

Purpose

In this article, we aim to highlight the importance of considering the timing of the causal effects of a between-person intervention X, on M and Y, resulting in a deeper understanding of mediation.

Methods

We provide a framework for examining the impact of a between-person intervention X on M and Y over time when M and Y are measured repeatedly. Five conceptual and analytic steps involve visualizing the effects of the intervention on Y, M, the relationship of M and Y, and the mediating process over time and selecting an appropriate analytic model.

Results

We demonstrate how these steps can be applied to two empirical examples of health behavior change interventions. We show that the patterns of longitudinal mediation can be fit with versions of longitudinal multilevel structural equation models that represent how the magnitude of direct and indirect effects vary over time.

Conclusions

We urge researchers and methodologists to pay more attention to temporal dynamics in the causal analysis of interventions.
Identification of seminal proteins related to the inhibition of mate searching in female crickets
Authors: Moschilla Joe A , Tomkins Joseph L , Simmons Leigh W
Published: September 2020

In response to the reduction in fitness associated with sperm competition, males are expected to evolve tactics that hinder female remating. For example, females often display a postmating reduction in their sexual receptivity that has been shown to be mediated by proteins contained in a male’s seminal fluid (sfps). However, although there has been comprehensive research on sfps in genetically well-characterized species, few nonmodel species have been studied in such detail. We initially confirm that female Australian field crickets, Teleogryllus oceanicus, do display a significant reduction in their mate-searching behavior 24 h after mating. This effect was still apparent 3 days after mating but was entirely absent after 1 week. We then attempted to identify the sfps that might play a role in inducing this behavioral response. We identified two proteins, ToSfp022 and ToSfp011, that were associated with the alteration in female postmating behavior. The knockdown of both proteins resulted in mated females that displayed a significant increase in their mate-searching behaviors compared with females mated to males having the full compliment of seminal fluid proteins in their ejaculate. Our results indicate that the female refractory period in T. oceanicus likely reflects a sperm competition avoidance tactic by males, achieved through the action of male seminal fluid proteins.
ABCModeller: an automatic data mining tool based on a consistent voting method with a user-friendly graphical interface
Authors: Zhang Pengyi , Wu Jiangpeng , Zhai Honglin , Li Shuyan
Published: September 2020

In order to extract useful information from a huge amount of biological data nowadays, simple and convenient tools are urgently needed for data analysis and modeling. In this paper, an automatic data mining tool, termed as ABCModeller (Automatic Binary Classification Modeller), with a user-friendly graphical interface was developed here, which includes automated functions as data preprocessing, significant feature extraction, classification modeling, model evaluation and prediction. In order to enhance the generalization ability of the final model, a consistent voting method was built here in this tool with the utilization of three popular machine-learning algorithms, as artificial neural network, support vector machine and random forest. Besides, Fibonacci search and orthogonal experimental design methods were also employed here to automatically select significant features in the data space and optimal hyperparameters of the three algorithms to achieve the best model. The reliability of this tool has been verified through multiple benchmark data sets. In addition, with the advantage of a user-friendly graphical interface of this tool, users without any programming skills can easily obtain reliable models directly from original data, which can reduce the complexity of modeling and data mining, and contribute to the development of related research including but not limited to biology. The excitable file of this tool can be downloaded from http://lishuyan.lzu.edu.cn/ABCModeller.rar.
Two Neural Networks for Laughter: A Tractography Study
Authors: Gerbella M , Pinardi C , Di Cesare G , Rizzolatti G , Caruana F
Published: September 2020

Laughter is a complex motor behavior occurring in both emotional and nonemotional contexts. Here, we investigated whether the different functions of laughter are mediated by distinct networks and, if this is the case, which are the white matter tracts sustaining them. We performed a multifiber tractography investigation placing seeds in regions involved in laughter production, as identified by previous intracerebral electrical stimulation studies in humans: the pregenual anterior cingulate (pACC), ventral temporal pole (TPv), frontal operculum (FO), presupplementary motor cortex, and ventral striatum/nucleus accumbens (VS/NAcc). The primary motor cortex (M1) and two subcortical territories were also studied to trace the descending projections. Results provided evidence for the existence of two relatively distinct networks. A first network, including pACC, TPv, and VS/NAcc, is interconnected through the anterior cingulate bundle, the accumbofrontal tract, and the uncinate fasciculus, reaching the brainstem throughout the mamillo-tegmental tract. This network is likely involved in the production of emotional laughter. A second network, anchored to FO and M1, projects to the brainstem motor nuclei through the internal capsule. It is most likely the neural basis of nonemotional and conversational laughter. The two networks interact throughout the pre-SMA that is connected to both pACC and FO.
Neurofunctional Components of Simple Calculation: A Magnetoencephalography Study
Authors: Salillas Elena , Piccione Francesco , di Tomasso Silvia , Zago Sara , Arcara Giorgio , Semenza Carlo
Published: September 2020

Our ability to calculate implies more than the sole retrieval of the correct solution. Essential processes for simple calculation are related to the spreading of activation through arithmetic memory networks. There is behavioral and electrophysiological evidence for these mechanisms. Their brain location is, however, still uncertain. Here, we measured magnetoencephalographic brain activity during the verification of simple multiplication problems. Following the operands, the solutions to verify could be preactivated correct solutions, preactivated table-related incorrect solutions, or unrelated incorrect solutions. Brain source estimation, based on these event-related fields, revealed 3 main brain networks involved in simple calculation: 1) bilateral inferior frontal areas mainly activated in response to correct, matching solutions; 2) a left-lateralized frontoparietal network activated in response to incorrect table-related solutions; and (3) a strikingly similar frontoparietal network in the opposite hemisphere activated in response to unrelated solutions. Directional functional connectivity analyses revealed a bidirectional causal loop between left parietal and frontal areas for table-related solutions, with frontal areas explaining the resolution of arithmetic competition behaviorally. Hence, this study isolated at least 3 neurofunctional networks orchestrated between hemispheres during calculation.
Advances in Separation and Purification of Bioactive Polysaccharides through High-speed Counter-Current Chromatography
Authors: Yang Yu , Khan Bilal Muhammad , Zhang Xiping , Zhao Yongjie , Cheong Kit-Leong , Liu Yang
Published: September 2020

Polysaccharides, with an extensive distribution in natural products, represent a group of natural bioactive substances having widespread applications in health-care food products and as biomaterials. Devising an efficient system for the separation and purification of polysaccharides from natural sources, hence, is of utmost importance in the widespread applicability and feasibility of research for the development of polysaccharide-based products. High-speed counter-current chromatography (HSCCC) is a continuous liquid–liquid partitioning chromatography with the ability to support a high loading amount and crude material treatment. Due to its flexible two-phase solvent system, HSCCC has been successfully used in the separation of many natural products. Based on HSCCC unique advantages over general column chromatography and its enhanced superiority in this regard when coupled to aqueous two-phase system (ATPS), this review summarizes the separation and purification of various bioactive polysaccharides through HSCCC and its coupling to ATPS as an aid in future research in this direction.
Typhoid and Paratyphoid Cost of Illness in Nepal: Patient and Health Facility Costs From the Surveillance for Enteric Fever in Asia Project II
Authors: Mejia Nelly , Abimbola Taiwo , Andrews Jason R , Vaidya Krista , Tamrakar Dipesh , Pradhan Sailesh , Shakya Rajani , Garrett Denise O , Date Kashmira , Pallas Sarah W
Published: September 2020

Background

Enteric fever is endemic in Nepal and its economic burden is unknown. The objective of this study was to estimate the cost of illness due to enteric fever (typhoid and paratyphoid) at selected sites in Nepal.

Methods

We implemented a study at 2 hospitals in Nepal to estimate the cost per case of enteric fever from the perspectives of patients, caregivers, and healthcare providers. We collected direct medical, nonmedical, and indirect costs per blood culture–confirmed case incurred by patients and their caregivers from illness onset until after enrollment and 6 weeks later. We estimated healthcare provider direct medical economic costs based on quantities and prices of resources used to diagnose and treat enteric fever, and procedure frequencies received at these facilities by enrolled patients. We collected costs in Nepalese rupees and converted them into 2018 US dollars.

Results

We collected patient and caregiver cost of illness information for 395 patients, with a median cost of illness per case of $59.99 (IQR, $24.04–$151.23). Median direct medical and nonmedical costs per case represented ~3.5% of annual individual labor income. From the healthcare provider perspective, the average direct medical economic cost per case was $79.80 (range, $71.54 [hospital B], $93.43 [hospital A]).

Conclusions

Enteric fever can impose a considerable economic burden on patients, caregivers, and health facilities in Nepal. These new estimates of enteric fever cost of illness can improve evaluation and modeling of the costs and benefits of enteric fever–prevention measures.
Typhoid and Paratyphoid Cost of Illness in Pakistan: Patient and Health Facility Costs From the Surveillance for Enteric Fever in Asia Project II
Authors: Mejia Nelly , Qamar Farah , Yousafzai Mohammad T , Raza Jamal , Garrett Denise O , Date Kashmira , Abimbola Taiwo , Pallas Sarah W
Published: September 2020

Background

The objective of this study was to estimate the cost of illness from enteric fever (typhoid and paratyphoid) at selected sites in Pakistan.

Methods

We implemented a cost-of-illness study in 4 hospitals as part of the Surveillance for Enteric Fever in Asia Project (SEAP) II in Pakistan. From the patient and caregiver perspective, we collected direct medical, nonmedical, and indirect costs per case of enteric fever incurred since illness onset by phone after enrollment and 6 weeks later. From the health care provider perspective, we collected data on quantities and prices of resources used at 3 of the hospitals, to estimate the direct medical economic costs to treat a case of enteric fever. We collected costs in Pakistani rupees and converted them into 2018 US dollars. We multiplied the unit cost per procedure by the frequency of procedures in the surveillance case cohort to calculate the average cost per case.

Results

We collected patient and caregiver information for 1029 patients with blood culture–confirmed enteric fever or with a nontraumatic terminal ileal perforation, with a median cost of illness per case of US $196.37 (IQR, US $72.89–496.40). The median direct medical and nonmedical costs represented 8.2% of the annual labor income. From the health care provider perspective, the estimated average direct medical cost per case was US $50.88 at Hospital A, US $52.24 at Hospital B, and US $11.73 at Hospital C.

Conclusions

Enteric fever can impose a considerable economic burden in Pakistan. These new estimates of the cost of illness of enteric fever can improve evaluation and modeling of the costs and benefits of enteric fever prevention and control measures, including typhoid conjugate vaccines.
Characteristics, Comorbidities, and Outcomes in a Multicenter Registry of Patients With Human Immunodeficiency Virus and Coronavirus Disease 2019
Authors: Dandachi Dima , Geiger Grant , Montgomery Mary W , Karmen-Tuohy Savannah , Golzy Mojgan , Antar Annukka A R , Llibre Josep M , Camazine Maraya , Díaz-De Santiago Alberto , Carlucci Philip M , Zacharioudakis Ioannis M , Rahimian Joseph , Wanjalla Celestine N , Slim Jihad , Arinze Folasade , Kratz Ann Marie Porreca , Jones Joyce L , Patel Shital M , Kitchell Ellen , Francis Adero , Ray Manoj , Koren David E , Baddley John W , Hill Brannon , Sax Paul E , Chow Jeremy
Published: September 2020

Background

People living with human immunodeficiency virus (HIV) may have numerous risk factors for acquiring coronavirus disease 2019 (COVID-19) and developing severe outcomes, but current data are conflicting.

Methods

Health-care providers enrolled consecutively, by nonrandom sampling, people living with HIV (PWH) with lab-confirmed COVID-19, diagnosed at their facilities between 1 April and 1 July 2020. Deidentified data were entered into an electronic Research Electronic Data Capture (REDCap) system. The primary endpoint was a severe outcome, defined as a composite endpoint of intensive care unit (ICU) admission, mechanical ventilation, or death. The secondary outcome was the need for hospitalization.

Results

There were 286 patients included; the mean age was 51.4 years (standard deviation, 14.4), 25.9% were female, and 75.4% were African American or Hispanic. Most patients (94.3%) were on antiretroviral therapy, 88.7% had HIV virologic suppression, and 80.8% had comorbidities. Within 30 days of testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 164 (57.3%) patients were hospitalized, and 47 (16.5%) required ICU admission. Mortality rates were 9.4% (27/286) overall, 16.5% (27/164) among those hospitalized, and 51.5% (24/47) among those admitted to an ICU. The primary composite endpoint occurred in 17.5% (50/286) of all patients and 30.5% (50/164) of hospitalized patients. Older age, chronic lung disease, and hypertension were associated with severe outcomes. A lower CD4 count (<200 cells/mm3) was associated with the primary and secondary endpoints. There were no associations between the ART regimen or lack of viral suppression and the predefined outcomes.

Conclusions

Severe clinical outcomes occurred commonly in PWH with COVID-19. The risks for poor outcomes were higher in those with comorbidities and lower CD4 cell counts, despite HIV viral suppression.

Clinical Trials Registration

NCT04333953.
Mobile Networked Creativity: Developing a Theoretical Framework for Understanding Creativity as Survival
Authors: de Souza e Silva Adriana , Xiong-Gum Mai Nou
Published: September 2020

Mobile networked creativity is an emergent practice that arises from the ongoing relationships among people and people with technologies—or networked resources. In this article, we propose a concept of creativity as emerging from networked connections, (im)mobility, and situations of hardship. We, thus, make a connection between mobility and space as networked elements of creativity as opposed to individual agent models. We focus on how unplanned or emergent uses of digital technologies reveal how creative practices emerge, particularly in the context of mobile technology use where people are physically mobile and yet connected via the Internet. We define the concept of creativity as a constant process of becoming, a “recursive organization” that can be seen in groups such as migrants, or people living in disenfranchised communities that survive in make-shift locations such refugee camps or slums. Contrary to the affluent and capitalistic-embedded traditional ideas of creativity, mobile networked creativity is a practice that is found mostly in situations of economic hardship, power imbalances, and (im)mobilities.
Epidemiology and Natural History of Elderly-onset Inflammatory Bowel Disease: Results From a Territory-wide Hong Kong IBD Registry
Authors: Mak Joyce Wing Yan , Lok Tung Ho Carmen , Wong Kylie , Cheng Tsz Yan , Yip Terry Cheuk Fung , Leung Wai Keung , Li Michael , Lo Fu Hang , Ng Ka Man , Sze Shun Fung , Leung Chi Man , Tsang Steven Woon Choy , Shan Edwin Hok Shing , Chan Kam Hon , Lam Belsy C Y , Hui Aric Josun , Chow Wai Hung , Ng Siew Chien
Published: September 2020

Background

Elderly-onset inflammatory bowel disease [IBD], defined as age ≥60 at diagnosis, is increasing worldwide. We aimed to compare clinical characteristics and natural history of elderly-onset IBD patients with those of adult-onset IBD patients.

Methods

Patients with a confirmed diagnosis of IBD from 1981 to 2016 were identified from a territory-wide Hong Kong IBD registry involving 13 hospitals. Demographics, comorbidities, clinical features, and outcomes of elderly-onset IBD patients were compared with those of adult-onset IBD patients.

Results

A total of 2413 patients were identified, of whom 270 [11.2%] had elderly-onset IBD. Median follow-up duration was 111 months (interquartile range [IQR]: 68–165 months). Ratio of ulcerative colitis [UC]: Crohn’s disease [CD] was higher in elderly-onset IBD than in adult-onset IBD patients [3.82:1 vs 1.39:1; p <0.001]. Elderly-onset CD had less perianal involvement [5.4% vs 25.4%; p <0.001] than adult-onset CD. Elderly-onset IBD patients had significantly lower cumulative use of immunomodulators [p = 0.001] and biologics [p = 0.04]. Elderly-onset IBD was associated with higher risks of: cytomegalovirus colitis (odds ratio [OR]: 3.07; 95% confidence interval [CI] 1.92–4.89; p <0.001); herpes zoster [OR: 2.42; 95% CI 1.22–4.80; p = 0.12]; and all cancer development [hazard ratio: 2.97; 95% CI 1.84–4.79; p <0.001]. They also had increased number of overall hospitalisations [OR: 1.14; 95% CI 1.09–1.20; p <0.001], infections-related hospitalisation [OR: 1.87; 95% CI 1.47–2.38; p <0.001], and IBD-related hospitalisation [OR: 1.09; 95% CI 1.04- 1.15; p = 0.001] compared with adult-onset IBD patients.

Conclusions

Elderly-onset IBD was associated with increased risk of infections and cancer development, and increased infection- and IBD-related hospitalisations. Specific therapeutic strategies to target this special population are needed.
Risk of Relapse in Patients With Ulcerative Colitis With Persistent Endoscopic Healing: A Durable Treatment Endpoint
Authors: Jangi Sushrut , Holmer Ariela K , Dulai Parambir S , Boland Brigid S , Collins Angelina E , Pham Lysianne , Sandborn William J , Singh Siddharth
Published: September 2020

Background

Deep remission in patients with UC has relied on initial achievement of biochemical, endoscopic, and/or histological remission. We evaluated persistent symptomatic remission and endoscopic healing (EH: Mayo endoscopy score [MES] 0 or 1) on consecutive endoscopic examinations as a durable treatment endpoint.

Methods

In a retrospective cohort study, we estimated and compared cumulative risk of clinical relapse in patients with persistent EH, with and without persistent histological remission and depth of EH, among adults with active UC treated-to-target of symptomatic remission and EH who achieved and maintained symptomatic remission and EH over two serial endoscopic assessments. We also explored risk of relapse in patients with persistent EH whose therapy was de-escalated.

Results

Of 270 patients who initially achieved EH with treatment-to-target, 89 maintained symptomatic remission and EH on follow-up endoscopy [interval between EH1 and EH2, 16 months]. On follow-up after EH2 [median, 19 months], 1-year cumulative risk of relapse in patients with persistent EH was 11.5%, and with persistent histological remission was 9.5%. Seventeen patients with persistent EH, who underwent de-escalation of therapy, did not have an increased risk of relapse as compared with patients who continued index therapy [5.3% vs 14%, p = 0.16].

Conclusions

Patients with active UC treated-to-target of clinical remission, who achieve and maintain symptomatic remission and EH over consecutive endoscopies, have a low risk of relapse, particularly in a subset of patients who simultaneously achieve histological remission. Persistent EH should be examined as a treatment endpoint suggestive of deep remission.
Intestinal Receptor of SARS-CoV-2 in Inflamed IBD Tissue Seems Downregulated by HNF4A in Ileum and Upregulated by Interferon Regulating Factors in Colon
Authors: Verstockt Bram , Verstockt Sare , Abdu Rahiman Saeed , Ke Bo-jun , Arnauts Kaline , Cleynen Isabelle , Sabino João , Ferrante Marc , Matteoli Gianluca , Vermeire Séverine
Published: September 2020

Background

Patients with inflammatory bowel disease [IBD] are considered immunosuppressed, but do not seem more vulnerable for COVID-19. Nevertheless, intestinal inflammation has shown to be an important risk factor for SARS-CoV-2 infection and prognosis. Therefore, we investigated the role of intestinal inflammation on the viral intestinal entry mechanisms, including ACE2, in IBD.

Methods

We collected inflamed and uninflamed mucosal biopsies from Crohn’s disease [CD] [n = 193] and ulcerative colitis [UC] [n = 158] patients, and from 51 matched non-IBD controls for RNA sequencing, differential gene expression, and co-expression analysis. Organoids from UC patients were subjected to an inflammatory mix and processed for RNA sequencing. Transmural ileal biopsies were processed for single-cell [sc] sequencing. Publicly available colonic sc-RNA sequencing data, and microarrays from tissue pre/post anti-tumour necrosis factor [TNF] therapy, were analysed.

Results

In inflamed CD ileum, ACE2 was significantly decreased compared with control ileum [p = 4.6E-07], whereas colonic ACE2 was higher in inflamed colon of CD/UC compared with control [p = 8.3E-03; p = 1.9E-03]. Sc-RNA sequencing confirmed this ACE2 dysregulation and exclusive epithelial ACE2 expression. Network analyses highlighted HNF4A as key regulator of ileal ACE2, and pro-inflammatory cytokines and interferon regulating factors regulated colonic ACE2. Inflammatory stimuli upregulated ACE2 in UC organoids [p = 1.7E-02], but not in non-IBD controls [p = 9.1E-01]. Anti-TNF therapy restored colonic ACE2 regulation in responders.

Conclusions

Intestinal inflammation alters SARS-CoV-2 coreceptors in the intestine, with opposing dysregulations in ileum and colon. HNF4A, an IBD susceptibility gene, seems an important upstream regulator of ACE2 in ileum, whereas interferon signalling might dominate in colon.
Independent and incremental prognostic value of semiquantitative measures of tricuspid regurgitation severity in heart failure with preserved ejection fraction
Authors: Harada Tomonari , Obokata Masaru , Omote Kazunori , Iwano Hiroyuki , Ikoma Takahiro , Okada Kenya , Yoshida Kuniko , Kato Toshimitsu , Kurosawa Koji , Nagai Toshiyuki , Negishi Kazuaki , Anzai Toshihisa , Kurabayashi Masahiko
Published: September 2020

Aims

This study sought to determine the independent and incremental prognostic value of semiquantitative measures of tricuspid regurgitation (TR) severity over right heart remodelling and pulmonary hypertension (PH) in heart failure with preserved ejection fraction (HFpEF).

Methods and results

Echocardiography was performed on 311 HFpEF patients. TR severity was defined by the semiquantitative measures [i.e. vena contracta width (VCW) and jet area] and by the guideline-based integrated qualitative approach (absent, mild, moderate, or severe). All-cause mortality or heart failure hospitalization occurred in 101 patients over a 2.1-year median follow-up. There was a continuous association between TR severity and the composite outcome with a hazard ratio (HR) of 1.17 per 1 mm increase of VCW [95% confidence interval (CI) 1.08–1.26, P < 0.0001]. Compared with patients with the lowest VCW category (≤1 mm), RV-adjusted HRs for the outcome were 1.99 (95% CI 1.05–3.77), 2.63 (95% CI 1.16–5.95), and 5.00 (95% CI 1.60–15.7) for 1–3, 3–7, and ≥7 mm VCW categories, respectively. TR severity as defined by the guideline-based approach showed a similarly graded association, but it was no longer significant in models including PH. In contrast, VCW remained independently and incrementally associated with the outcome after adjusting for established prognostic factors, as well as RV diameter and PH (fully adjusted HR 1.14 per 1 mm, 95% CI 1.02–1.27, P = 0.02; χ2 58.8 vs. 51.5, P = 0.03).

Conclusion

The current data highlight the potential value of the semiquantitative measures of TR severity for the risk stratification in patients with HFpEF.
Myocardial ischaemia caused by bilateral coronary ostial stenosis from pseudointimal membranes in a full root freestyle valve: a case report
Authors: Bekke Kirstine , Dagnegård Hanna , Sigvardsen Per E , Smerup Morten
Published: September 2020

Background

Coronary artery ostial stenosis is a rare but well-known complication to aortic root replacement. The occurrence of this complication in patients with the Medtronic Freestyle bioprosthesis is poorly described. We report a case of late bilateral coronary ostial stenosis due to pseudointimal membranes within a Medtronic Freestyle bioprosthesis, resulting in acute coronary syndrome.

Case summary

In 2013, a 43-year-old male patient received a Medtronic Freestyle bioprosthesis as a full aortic root implantation due to endocarditis with root abscess. Preoperative coronary angiography was normal. The patient, who had no previous symptoms of coronary ischaemia, presented with severe chest pain and acute coronary syndrome in 2017. Coronary angiography and electrocardiogram-gated contrast-enhanced cardiac computed tomography showed bilateral coronary ostial stenosis. The patient was successfully treated with coronary artery bypass grafting. Intraoperative inspection revealed pseudointimal membranes covering the coronary ostia. Histology showed fibro-intimal thickening with areas of inflamed granulation tissue.

Discussion

Bilateral coronary ostial stenosis is a severe, potentially life-threatening condition, and a possible complication to implantation of the Medtronic Freestyle bioprosthesis as a full root. The phenomenon may occur late and should be distinguished from arteriosclerotic coronary artery disease.
The role of intracoronary thrombolysis in selected patients presenting with ST-elevation myocardial infarction: a case series
Authors: Barua Sumita , Geenty Paul , Deshmukh Tejas , Ada Cuneyt , Tanous David , Cooper Mark , Fahmy Peter , Denniss Alan Robert
Published: September 2020

Background

Primary percutaneous coronary intervention (PCI) is the cornerstone of management for ST-elevation myocardial infarction (STEMI). However, large intracoronary thrombus burden complicates up to 70% of STEMI cases. Adjunct therapies described to address intracoronary thrombus include manual and mechanical thrombectomy, use of distal protection device and intracoronary anti-thrombotic therapies.

Case summary

This series demonstrates the use of intracoronary thrombolysis in the setting of large coronary thrombus, bifurcation lesions with vessel size mismatch, diffuse thrombosis without underlying plaque rupture, and improving coronary flow to allow vessel wiring and proceeding to definitive revascularization.

Discussion

Larger intracoronary thrombus burden correlates with greater infarct size, distal embolization, and the associated no-reflow phenomena, and propagates stent thrombosis, with subsequent increase in mortality and major adverse cardiac events. Intracoronary thrombolysis may provide useful adjunct therapy in highly selected STEMI cases to reduce intracoronary thrombus and facilitate revascularization.
The role of four-dimensional computed tomography in transcatheter aortic valve replacement prosthesis endocarditis with concurrent leaflet thrombosis: a case report
Authors: Khav Nancy , Rashid Hashrul N , Brown Adam J
Published: September 2020

Background

Transcatheter aortic valve replacement (TAVR) is becoming increasingly utilized for the treatment of severe aortic valvular heart disease. Infective endocarditis of TAVR is rare but associated with higher mortality and morbidity. The potential for leaflet thrombosis following TAVR is also becoming increasingly recognized. Diagnosis of these conditions on echocardiography can be challenging due to prosthesis artefact.

Case summary

An 84-year-old man with a previous transcatheter aortic valve replacement presented with a febrile illness and bacteraemia. Transthoracic and transoesophageal echocardiography demonstrated high transvalvular gradients with features of prosthesis endocarditis, though leaflet morphology could not be fully assessed due to prosthesis artefact. Four-dimensional computed tomography revealed hypo-attenuated leaflet thickening with reduced leaflet motion, consistent with prosthesis leaflet thrombosis. The patient was successfully treated with antibiotics and anticoagulation, with resolution of the infection and normalization of the transvalvular gradient after 6 weeks.

Discussion

Echocardiography should be the first-line investigation for assessing leaflet morphology in suspected prosthetic valve endocarditis or leaflet thrombosis but its accuracy may be limited by artefact. Our case highlights that four-dimensional computed tomography provides further evaluation of prosthesis leaflet morphology/motion, providing valuable diagnostic information.
Right atrial thrombus in a patient with COVID-19 pneumonia: a case report
Authors: Shamsah Mohammed A , Bitar Zouheir Ibrahim , Alfoudri Huda
Published: September 2020

Background

Significant coagulopathy and hyperinflammation are found in patients with coronavirus disease 2019 (COVID-19). Expert consensus has recommended prophylactic anticoagulation in COVID-19 patients due to the risk of thrombo-embolism. However, the use of therapeutic anticoagulation in these patients is still a matter of debate.

Case summary

We describe a patient with COVID-19 pneumonia and a clinical hyperinflammatory state. He developed early respiratory depression and required ventilation, and he subsequently developed haemodynamic instability. Point-of-care echocardiography demonstrated a right atrial thrombus and right ventricular dysfunction suggestive of acute massive pulmonary embolism. He was managed with veno-arterial extracorporeal membrane oxygenation and local thrombolysis.

Discussion

Critical cases of COVID-19 pneumonia are associated with hypercoagulation, and these patients should be monitored closely for complications. Therapeutic anticoagulation may play a role in the management and prevention of thrombo-embolism.
Potentially inappropriate prescriptions in heart failure with reduced ejection fraction: ESC position statement on heart failure with reduced ejection fraction-specific inappropriate prescribing
Authors: El Hadidi Seif , Rosano Giuseppe , Tamargo Juan , Agewall Stefan , Drexel Heinz , Kaski Juan Carlos , Niessner Alexander , Lewis Basil S , Coats Andrew J S , Savarese Gianluigi
Published: September 2020

Heart failure (HF) is a chronic debilitating and potentially life-threatening condition. HF patients are usually at high risk of polypharmacy and consequently, potentially inappropriate prescribing leading to poor clinical outcomes. Based on the published literature, a comprehensive HF-specific prescribing review tool is compiled to avoid medications that may cause HF or harm HF patients and to optimize the prescribing practice of HF guideline-directed medical therapies. Recommendations are made in line with the last versions of European Society of Cardiology (ESC) guidelines, ESC position papers, scientific evidence, and experts’ opinions.
Short dual antiplatelet therapy followed by P2Y12 inhibitor monotherapy vs. prolonged dual antiplatelet therapy after percutaneous coronary intervention with second-generation drug-eluting stents: a systematic review and meta-analysis of randomized clinical trials
Authors: Giacoppo Daniele , Matsuda Yuji , Fovino Luca Nai , D’Amico Gianpiero , Gargiulo Giuseppe , Byrne Robert A , Capodanno Davide , Valgimigli Marco , Mehran Roxana , Tarantini Giuseppe
Published: September 2020

Aims

After percutaneous coronary intervention (PCI) with second-generation drug-eluting stent (DES), whether short dual antiplatelet therapy (DAPT) followed by single antiplatelet therapy (SAPT) with a P2Y12 receptor inhibitor confers benefits compared with prolonged DAPT is unclear.

Methods and results

Multiple electronic databases, including PubMed, Scopus, Web of Sciences, Ovid, and ScienceDirect, were searched to identify randomized clinical trials comparing ≤3 months of DAPT followed by P2Y12 inhibitor SAPT vs. 12 months of DAPT after PCI with second-generation DES implantation. The primary and co-primary outcomes of interest were major bleeding and stent thrombosis 1 year after randomization. Summary hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by fixed-effect and random-effects models. Multiple sensitivity analyses including random-effects models 95% CI adjustment were applied. A sensitivity analysis comparing trials using P2Y12 inhibitor SAPT with those using aspirin SAPT was performed. A total of five randomized clinical trials (32 145 patients) were available. Major bleeding was significantly lower in the patients assigned to short DAPT followed by P2Y12 inhibitor SAPT compared with those assigned to 12-month DAPT (random-effects model: HR 0.63, 95% 0.45–0.86). No significant differences between groups were observed in terms of stent thrombosis (random-effects model: HR 1.19, 95% CI 0.86–1.65) and the secondary endpoints of all-cause death (random-effects model: HR 0.85, 95% CI 0.70–1.03), myocardial infarction (random-effects model: HR 1.05, 95% CI 0.89–1.23), and stroke (random-effects model: HR 1.08, 95% CI 0.68–1.74). Sensitivity analyses showed overall consistent results. By comparing trials testing ≤3 months of DAPT followed by P2Y12 inhibitor SAPT vs. 12 months of DAPT with trials testing ≤3 months of DAPT followed by aspirin SAPT vs. 12-month of DAPT, there was no treatment-by-subgroup interaction for each endpoint. By combining all these trials, regardless of the type of SAPT, short DAPT was associated with lower major bleeding (random-effects model: HR 0.63, 95% CI 0.48–0.83) and no differences in stent thrombosis, all-cause death, myocardial infarction, and stroke were observed between regimens.

Conclusion

After second-generation DES implantation, 1–3 months of DAPT followed by P2Y12 inhibitor SAPT is associated with lower major bleeding and similar stent thrombosis, all-cause death, myocardial infarction, and stroke compared with prolonged DAPT. Whether P2Y12 inhibitor SAPT is preferable to aspirin SAPT needs further investigation.