bluuebunny/crossref_metadata_2025 huggingface dataset:
An Effect of 24-hour Temperature Change on Outpatient and Emergency and Inpatient Visits for Cardiovascular Diseases in Northwest China
Authors: Shi Qin , Wei Xingfu , Liu Yanli , Meng Xiangyan , Zhu Wenzhi , Wang Minzhen , Wang Yufeng , Kang Feng , Bai Yana , Nie Yonghong , zheng shan
Published: April 2021

Background: Some studies suggested 24-hour temperature change (TC24) was one of the potential risk factors for human health. However, evidence of the short-term effect of TC24 on outpatient and emergency department (O&ED) visits and hospitalizations for cause-specific cardiovascular diseases (CVDs) is still limited. Objective: To explore the short-term effects of TC24 on O&ED visits and hospitalizations for CVDs in northwest China which is an area with large temperature variation.Method: The O&ED visits records for CVDs of 3 general hospitals and the inpatient records for CVDs of 4 general hospitals were collected from January 1, 2013 to December 31, 2016, in Jinchang City, northwest China. Meteorological and air pollution data were also obtained during the same study period from local meteorological monitoring stations and environmental monitoring station, respectively. A generalized additive model (GAM) with Poisson regression was employed to analyze the effects of TC24 on O&ED visits and hospitalizations for CVDs. Results: V-shaped relationship were found between TC24 and O&ED visits and hospitalizations for CVDs including total CVD, hypertension, coronary heart disease (CHD) and stroke. Stratified analysis showed that men and patients over 65 years old were more susceptible to temperature changes. Whether heating may modify the effects of TC24 on O&ED visits and hospitalizations for CVDs.Conclusion: TC24 can affect the O&ED visits and hospitalizations for CVDs in this study. This study provides useful data for policy makers to better prepare local responses to the impact of changes in temperatures on population health.
Capturing the colloidal microplastics with plant-based nanocellulose networks
Authors: Leppänen Ilona , Lappalainen Timo , Lohtander Tiia , Jonkergouw Christopher , Arola Suvi , Tammelin Tekla
Published: April 2021

Microplastics accumulate to various aquatic organisms causing serious health issues, and they have raised concerns about human health by entering our food chain. The recovery techniques for the most challenging colloidal fraction even for the analytical purposes are limited. Here we show how hygroscopic nanocellulose network acts as an ideal capturing material even for the tiniest nanoplastic particles. We reveal that the entrapment of particles from the aqueous environment is a result of the network’s hygroscopic nature - a feature which is further intensified with the high surface area. We determine the nanoplastic binding mechanisms using surface sensitive methods, and interpret the results with the random sequential adsorption (RSA) model. The microplastic uptake does not rely on any specific interfacial interaction but rather on the water transport behavior of nanocellulose. These findings hold potential for the explicit quantification of the microplastics from different environments, and eventually, provide solutions to collect those directly on-site where they are produced.
Left Ventricular Strain and Left Atrial Strain Are Impaired During Hemodialysis in Children
Authors: Doan Tam T , Sriva Poyyapakkam , Liu Asela , Wilkes J. Kevin , Idrovo Alexandra , Akcan-Arikan Ayse , Swartz Sarah , Geer Jessica , Altman Carolyn A. , Ayres Nancy A. , Loar Robert W. , Pignatelli Ricardo
Published: April 2021

Purpose
We aimed to investigate intradialytic changes in ventricular and atrial function using speckle tracking echocardiography (STE) in pediatric hemodialysis (HD).
Methods
Children with HD vintage > 3 months were enrolled, and echocardiography was performed prior to, during, and after HD. STE was analyzed using GE EchoPAC. Left ventricular (LV) global longitudinal strain (GLS), strain rate (Sr), and mechanical dispersion index (MDI) were calculated as the average from 3 apical views; diastolic strain (Ds) and Sr from 4-chamber tracing; left atrial strain (LAS) and Sr from the 4- and 2-chamber views.
Results
A total of 15 patients were enrolled at a median age of 12 years (IQR 8, 16) and median HD vintage of 13 months (IQR 9, 25). GLS worsened during HD (-15.8 ± 2.2% vs -19.9 ± 1.9%, p < 0.001). Post-HD GLS was associated with BP decrease (coefficient = 0.62, p = 0.01). LV MDI and systolic Sr did not change. LV Ds progressively worsened (-8.4% (-9.2, -8.0) vs − 11.9% (-13.4, -10.3), p < 0.001). LAS changes at mid-HD returned to baseline post-HD. Ds, DSr, LAS, LASr were not associated with BV removal or BP decrease (p > 0.1).
Conclusions
Intradialytic LV strain and LAS changes consistent with subclinical systolic and diastolic dysfunction were observed during HD in children. Changes in Ds, DSr, LAS, and LASr were not associated with BP change or BV removal and may be related to the disease progression. Longitudinal study using these novel indices may unfold the effect of these subclinical changes on long-term cardiovascular health in children requiring chronic HD.
Congestion Control investigation into 5G V2V
Authors: CHIHI Houda , Boualegue Ridha
Published: April 2021

Congestion control is a hot research topic according to the continuous increase of traffic density together with great mobility of cars. In this context, in this survey we present an overview about the different vehicle to vehicle (V2V) communication enablers by describing the difference between them performing better driving assistance together with efficient congestion control ensuring driving safety. New radio (NR) 5G is the heuristic enabler which provides scalability and reliability towards vehicular communication. Indeed, NR 5G is the best solution supporing the great increase of network density. 5G technology is expected to allow much advanced services and application with a huge capacity of data exchange. Congestion occurance impacts the quality of service of vehicular network, for this accurate quantification is required. In our analysis we consider channel busy rate CBR as indicator of network density. Channel load control is mondatory to overcome traffic jam which could be highlighted by different metrics. The connectivity between cars is modeled with a game theory framework considering a non cooperative vehicular mobility. Each vehicle adjusts its transmitted power in dynamic way taking into account the traffic density measured by channel busy rate (CBR). Consequently, we follow a theoretical modeling to determine the efficient allocated power ensuring awareness messages exchange without saturating the communication channel under the respect of a fixed threshold. Therefore, channel saturation control is investigated following a theoretical analysis exploiting game theory under the assumption of a non cooperative strategy. Each vehicle acts as a player presenting a specific driving behavior different to the other cars participating into the same scenario. The optimization framework is about determining the optimal allocated power for congestion minimization.
Occurrence, Distribution, and Ecological Risk Assessment of Emerging and Legacy Contaminants in the Kadicha River in Lebanon
Authors: Merhabi Fatme , Gomez Elena , Amine Helmieh , Rosain David , Halwani Jalal , Fenet Hélène
Published: April 2021

The Kadicha river basin in Northern Lebanon is an illustrative example of multiple pressures encountered in the Mediterranean region: it is a small coastal river affected by rapid urbanization, population growth (drastically impacted by the influx of Syrian refugees), and a chronic default of wastewater treatment. In this context, multiple classes of contaminants may attain the river accumulating in sediment. However, very little information is available in the literature on the contamination status in such stressed Mediterranean contexts. This study proposed a first contamination evaluation of a small Mediterranean river submitted to multiple pressures. Two sediment sampling campaigns along sites impacted by increasing urban gradient within the Kadicha river basin were performed to determine the occurrence and the environmental risks of both emerging and legacy contaminants. The results revealed the detection of the 41 studied compounds. The highest concentrations were attained by PAHs and polycyclic musks (up to 311.79, 94.22, and 81.13 ng/g of dry weight for PAH, cashmeran, and galaxolide, respectively). The discontinuous urbanized upstream area and the estuary were the most contaminated areas of the river. An environmental risk assessment showed a hazard quotient (HQ) higher than 1 for both legacy and emerging compounds (EHMC and 4-MBC), indicating a potential risk to benthic species. Monitoring campaigns and implementation of wastewater treatment plants should be encouraged as the anthropogenic pressure on small Mediterranean rivers will increase over the years.
On Channel Estimation for Rician fading with the phase-shift in Cell-Free Massive MIMO system
Authors: Amadid Jamal , boulouird Mohamed , Belhabib Abdelfettah , Zeroual Abdelouhab
Published: April 2021

Channel estimation (CE) is a crucial phase in wireless communication systems, especially in cell-free (CF) massive multiple input multiple output (M-MIMO) since it is a dynamic wireless network. Therefore, this work is introduced to study CE for CF M-MIMO system in the uplink phase, wherein the performance of different estimators are evaluated, discussed, and compared in various situations. We assume the scenario in which each access point has prior knowledge of the channel statistics. The phase-aware-minimum mean square error (PA-MMSE) estimator, the non-phaseaware-MMSE (NPA-MMSE) estimator, and the least-squares estimator are the three
estimators which are exploited in this work. Besides, we consider the Rician fading channel in which the line-of-sight path is realized with a phase-shift that models the users’ mobility where the considered phase-shift follows a uniform distribution. On the other hand, the mean-squared error metric is employed in order to evaluate the performance of each estimator, where an analytical and simulated result is provided for the PA-MMSE estimator and the NPA-MMSE estimator in order to assert our numerical results.
MCDM Approach to Improve the Quality of Broadcasting Technique in Wireless Ad-hoc Networks
Authors: AHMAD NAEEM , Sethi Shuchi , Hasan Md Gulzarul , Barbhuiya Rejaul Karim
Published: April 2021

Contemporary research work in the field of Wireless Ad-hoc Networks (WANETs) are focused on most important issue of performance, minimize the congestion in the network. A number of research proposals have come up with innovative query transmission approaches in order to scale down congestion, route latency and energy consumption to the feasible extent. It has been shown experimentally that these approaches have mainly focused on checking propagation of route query using query broadcast repealing technique which unfortunately paves way to additional routing overhead. This leads to increased energy-consumption which offsets the benefits. This paper introduces a self-aware query-broadcast approach which is dynamic in nature and obtains desirable path in discovery phase without counterbalancing the advantages reaped from confining the request zones. The proposed approach relies on Analytic Hierarchy Process (AHP), which utilizes the routing metrics in estimating the weighing factors for combined weight metrics. For evaluation of the proposed technique, critical and analytical assessment is done in terms of query-diffusion, packet-delivery ratio and route-latency. The results reveal the proposed approach is ideal, optimal and highly practical for application in WANETs.
Application Based Performance Analysis of a Priority Flow Divider Valve Using Power Hydraulic Systems
Authors: Kumar Dharmendra , Mahato Anil C
Published: April 2021

Priority flow divider valve (PFDV) splits the flow in two different paths: Primary flow path and Secondary flow path. It can be used in twice applications: a system needs to perform dual functions against dual loads simultaneously and to obtain a stable flow by supplying a compensated flow from secondary flow line to the primary flow line using an energy storage device and a control valve. Two different hydraulic systems are identified to analyze the steady and dynamic performance of the PFDV. The first hydraulic system with PFDV is designed for automobile steering system with a load sensing control strategy in the presence of multiple actuators whereas second system is designed for wind turbine hydraulic power transmission to obtain stable power from it in the absence of generator. Both power hydraulic systems are modeled using bond graph technique and simulated in SYMBOLS SHAKTI software to analyze the PFDV performance.
Evaluation of Radiation Maculopathy after Treatment of Choroidal Melanoma with Ruthenium-106 using Optical Coherence Tomography Angiography
Authors: Torkashvand Ali , Riazi-Esfahani Hamid , Ghassemi Fariba , Pour Elias Khalil , Masoomian Babak , Zarei Mohammad , Fadakar Kaveh , Arjmand Mojtaba , Tayebi Freshteh , Ekradi Leila , Moghaddam Hamid Abrishami , Mahmoudi Tahereh , Daneshmand Reihaneh , Faghihi Hooshang
Published: April 2021

BACKGROUND: To assess the impact of brachytherapy on macular microvasculature utilizing optical coherence tomography angiography (OCTA) in treated choroidal melanoma.METHODS: In this retrospective observational case series, we reviewed the recorded data of the patients with choroidal melanoma treated with rheuthenium-106 (106Ru) plaque radiotherapy with follow-up period of more than 6 months. Automatically measured OCTA retinal parameters were analyzed after image processing. The non-irradiated fellow eye is considered as the control.RESULTS: Thirty-one eyes of 31 patients with the mean age of 51.1 years were recruited. Six eyes had no radiation maculopathy (RM). From 25 eyes with RM, nine eyes (36%) revealed a burnout macular microvasculature with imperceptible vascular details. Foveal and optic disc radiation dose had the highest value to predict the burnout pattern (ROC, AUC: 0.763, 0.727). Superficial and deep foveal avascular zone (FAZ) were larger in irradiated eyes in comparison to healthy eyes (1629 µm2 vs. 428 µm2, P =0.005; 1837 µm2 vs 268 µm2, P =0.021; respectively). Foveal and parafoveal vascular area density (VAD) and vascular skeleton density (VSD) in both superficial and deep capillary plexus (SCP and DCP) were decreased in all irradiated eyes in comparison with control eyes (P< 0.001). Compared with fellow healthy eyes, irradiated eyes without RM had significantly lower VAD and VSD at foveal and parafoveal DCP (all P<0.02). However, these differences at SCP were not statistically significant. CONCLUSION: The OCTA is a valuable tool for evaluating RM. Initial subclinical microvascular insult after 106Ru brachytherapy is more likely to occur in DCP. The deep FAZ area was identified as a more critical biomarker of BCVA than superficial FAZ in these patients.
A novel Double Tier Cryptographic System (nDTCS) to Reinforce Patients’ Privacy in Contemporary COVID-19 Telemedicine
Authors: BHOWMIK ANIRBAN , DEY JOYDEEP , KARFORMA SUNIL
Published: April 2021

In this modern COVID-19 telemedicine industry, privacy and security of patients’ information is the most open challenge to keep it intact. Considering the current legal regulations, every hospital must impose a prominent security technique to maintain a secure electronic health records system. The realization of telemedicine is another notable advancement in the field of medical sciences. The healthcare services have increased its throughput with the help of Internet based computing. Recently, security flaws on patient’s information have become a more significant challenge in electronic healthcare system. Electronics health record i.e. collection of health related patients’ information are extremely sensitive in nature. So, it is very relevant to impose an advanced security techniques in such systems. Here, we have focused on security issues likes of technical safeguards. A novel Double Tier Cryptographic System (nDTCS) have been proposed here. We had proposed a modified logistic map and linear congruence based security model for the secured telemedicine transactions with an authentication technique. For encryption and decryption purpose, two keys have been used which were intermediate key, and session key. The modified logistic map and secret sharing were the backbone of the proposed technique. This new approach of key generation provides newness as well as extra robustness in our proposed technique. The chaotic sequences in the ranges of I and n on the initial values , and t respectively were noted under this technique test. 264, 2256, 21024, 24096, 216384hand 265536 were the possibilities of combined key space volumes. The different types of mathematical experiments like randomness test, brute force, histogram analysis and their obtained results have guided that it is very secured and efficient for patients’ data transmission in health sectors.
TEMPO-Oxidized Cellulose Hydrogel Fiber Cell Load, a Cell Support System Proof of Concept 
Authors: Rios Mariana Alves , Barbugli Paula Aboud , Iemma Mônica Rosas Costa , Grande Rafael , Carvalho Antônio José Felix , Trovatti Eliane
Published: April 2021

The development of new cell carriers systems are crucial for application in regenerative medicine, once they deliver the cells to the injured tissue to trigger the repair and stimulate the regeneration of the new tissue, and so far various carrier systems have been investigated in this regard. Here we report on the synthesis and characterization of a new cell carrier system in fiber shape where the cells osteo-1 are incorporated into the oxidized cellulose nanofibers suspension and then complexed with calcium ions in a pulling process giving rise to the fiber loaded with cells. The microscopic images showed the success of the proposed method to incorporate the cells into the fibers. The results of the in-vitro viability tests indicated the capability of the fibers to keep the cells alive and to mineralize them, indicating that their osteogenic capability was not affected. In addition, the fiber disintegration studies showed the system is capable of releasing the cells, suggesting the potential of the fibers as a new assembled hydrogel carrier cell therapy.
Fine-grained Load Balancing with Traffic-aware Rerouting in DataCenter Networks
Authors: Zhang Tao , Lei Yasi , Zhang Qianqiang , Zou Shaojun , Huang Juan , Li Fangmin
Published: April 2021

Modern datacenters provide a wide variety of application services, which generate a mix of delay-sensitive short flows and throughput-oriented long flows, transmitting in the multi-path datacenter network. Though the existing load balancing designs successfully make full use of available parallel paths and attain high bisection network bandwidth, they reroute flows regardless of their dissimilar performance requirements. The short flows suffer from the problems of large queuing delay and packet reordering, while the long flows fail to obtain high throughput due to low link utilization and packet reordering. To address these inefficiency, we design a fine-grained load balancing scheme, namely TR (Traffic-aware Rerouting), which identifies flow types and executes flexible and traffic-aware rerouting to balance the performances of both short and long flows. Besides, to avoid packet reordering, TR leverages the reverse ACKs to estimate the switch-to-switch delay, thus excluding paths that potentially cause packet reordering. Moreover, TR is only deployed on the switch without any modification on end-hosts. The experimental results of large-scale NS2 simulations show that TR reduces the average and tail flow completion time for short flows by up to 60% and 80%, as well as provides up to 3.02x gain in throughput of long flows compared to the state-of-the-art load balancing schemes.
The Association Between Temperature and Cause-Specific Mortality in the Klang Valley, Malaysia
Authors: Yatim Ahmad Norazhar Mohd , Latif Mohd Talib , Sof Nurzawani Md , Ahamad Fatimah , Khan Md Firoz , Mahiyuddin Wan Rozita Wan , Sahani Mazrura
Published: April 2021

This study aims to examine the relationship between daily temperature and mortality in the Klang Valley, Malaysia over the period 2006 – 2015. A quasi-Poisson generalized linear model combined with a distributed lag non-linear model (DLNM) was used to estimate the association between mean temperature and mortality categories (natural, cardiovascular, and respiratory disease). Particulate matter with aerodynamic diameter below than 10 micrometer (PM10) and surface ozone (O3) has been adjusted as a potential confounding factor. Both cold and heat effects were associated with mortality categories. The relative risks of natural mortality associated with an extreme cold temperature (1st percentile of temperature, 25.2 °C) and an extreme hot temperature (99th percentile of temperature, 30.2 °C) relative to the minimum mortality temperature (28.2 °C) were 1.17 (95% confidence interval (CI): 0.97, 1.41) and 1.11 (95% CI: 0.93, 1.32) for lag 0-21, respectively. Heat effects were immediate whereas cold effects were delayed and lasted longer. People with respiratory diseases, the elderly and women were the most vulnerable groups when it came to the effects of extremely high temperatures. The extreme temperatures did not dramatically change the temperature-mortality risk estimates made before and after adjustments for air pollutant (PM10 and O3) levels.
Antiferromagnetic and Ferromagnetic Spintronics: Transport in the Two-dimensional Ferromagnet and the Role of In-chain and Inter-chain Interactions
Authors: Lima L. S.
Published: April 2021

Spin-transport and current-induced torques in ferromagnet heterostruc-tures given by a ferromagnetic domain wall are investigated. Furthermore , the continuum spin conductivity is studied in a frustrated spin system given by the two-dimensional Heisenberg model with ferromagnetic in-chain interaction J 1 < 0 between nearest neighbors and antiferromagnetic next-nearest-neighbor in-chain interaction J 2 > 0 with aim to investigate the effect of the phase diagram of the critical ion single anisotropy D c as a function of J 2 on conductivity. We consider the model with the moderate strength of the frustrating parameter such that in-chain spin-spin correlations that are predominantly ferromagnetic. In addition, we consider two inter-chain couplings J ⊥,y and J ⊥,z , corresponding to the two axes perpendicular to chain where ferromagnetic as well as antiferromagnetic interactions are taken into account.
Historical trends in Crop Water demand over Semi-Arid region of Syria
Authors: Homsi Rajab , Shahid Shamsuddin , Iqbal Zafar , Ali Atif Muhammad , Ziarh Ghaith Falah
Published: April 2021

Climate change has caused a shift in aridity, particularly in the dry regions of the world which may subsequently affect several sectors predominantly the agricultural and water resources. This research examined the climate change effects on crop water demand (CWD) in Syria over the period 1951–2010. Given the lack of observed data, this analysis relied on (GPCC) precipitation and (CRU) temperature data from 1951 to 2010. Potential Evapotranspiration (PET) at each grid was calculated using Penman-Monteith method and FAO-56 model was used to calculate the crop water demand (CWD). The analysis revealed that CWD in Syria increased from 1981 to 2010 when compared to 1951–1980.The increase in CWD has been found for all the crops except wheat, whereas the maximum changes are found during April, and May. The differences in CWD for Barley between the two periods were found to be in the range of -20 to 40 mm. A decrease in CWD observed in the south of the country. However, a rise in 0 to 20 mm range was also discovered in the north. The CWD for wheat was found to decline in most parts of the country. However, it was found to increase in the north. The increase in CWD for barley and wheat has increased agricultural water stress in the region. Several agriculture planning needs to be developed in accordance with the expected future climate changes in order to maintain the agricultural production in the region.
Prompt Extracorporeal Cardiopulmonary Resuscitation with Left Ventricular Unloading by IMPELLA Improves Outcome of Patients with Refractory Cardiac Arrest: A Single-Site Retrospective Cohort Study
Authors: Unoki Takashi , Tamura Yudai , Hirai Motoko , Suzuyama Hiroto , Inoue Masayuki , Yamamuro Megumi , Taguchi Eiji , Sawamura Tadashi , Nakao Koichi , Sakamoto Tomohiro
Published: April 2021

Background: Extracorporeal cardiopulmonary resuscitation (E-CPR) using venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a novel lifesaving method for refractory cardiac arrest (CA). However, VA-ECMO increases damaged left ventricular (LV) afterload. The percutaneous microaxial pump, Impella, can reduce LV preload with simultaneous circulatory support, which may have significant effect on clinical outcome by concomitant use of VA-ECMO and IMPELLA (ECPELLA). In the current retrospective cohort study, we assessed factors affecting outcome of CA patients who underwent E-CPR.Method: We retrospectively reviewed 149 consecutive CA patients with E-CPR from January 2012 through December 2020 in our institute. Patients were divided into three groups, ECEPLLA (n=29), IABP + VA-ECMO (n=78), and single VA-ECMO (n=42). We assessed 30-day survival and neurological outcome using the Cerebral Performance Categories (CPC). Results: There were no significant differences in age, gender, out of hospital CA, acute coronary syndrome among groups. The ECPELLA showed the highest cumulative 30-day survival (ECPELLA: 55%, IABP + VA-ECMO: 23%, VA-ECMO: 9.5; p=0.001) and the rates of CPC score 1 or 2 (ECPELLA: 31%, IABP + VA-ECMO: 13%, VA-ECMO: 7%; p=0.02). Multivariate analysis revealed that age (hazard ratio [HR], 1.30, 95% confidence interval [CI], 1.13-1.52, P=0.005) and Time from CA to ECMO support (HR, 1.22, 95%CI, 1.13-1.31, P<0.0001) and ECPELLA (HR, 0.46, 95%CI, 0.24-0.88, P=0.02) were significantly associated with the clinical outcome. Conclusion: Earlier initiation of E-CPR is critical to improve patient survival and neurological outcome. Additional Impella support, ECPELLA, appears to significantly improve the clinical outcome.
Feature Interaction in Smart Environments
Authors: Jesus Luis Emanuel Neves , Claro Daniela Barreiro , Rios Tatiane Nogueira
Published: April 2021

The Internet of Things (IoT) connects many devices daily together in the same environment. Each device may follow the set of rules from a static environment. A static environment is usually controlled by an expert who knows all the necessary rules to provide this environment. The violation of one rule can cause a feature interaction. A feature interaction occurs when two or more devices generate instability in an environment. In a dynamic environment like IoT, devices' inclusion, and exclusion make it impossible for an expert to maintain all these rules up-to-date. It is necessary to provide an automatic solution to avoid violating these rules and maintain the environment's good performance. Thus, this work introduces a new approach to detect a feature interaction in dynamic environments automatically. Almost all previous work provide static rules defined by an expert in a controlled environment to detect an interaction. However, this is not possible in dynamic environments because of the number of device interactions and the number of device connections in/out, which grow exponentially in IoT environments. We started with a lightweight systematic review to better position our research, and then we identified one gap to provide our solution. Thus, our method learns to detect the interactions based on data analysis and then automatically predict the device detections in IoT environments. Datasets were manually annotated. Experiments were performed, and results provide evidence that automatic detection of a set of device interactions is possible in similar or either in complementary domains.
Pre-Existing Cardiovascular Disease Increases Risk of Atrial Arrhythmia in Cancer Patients Treated with Ibrutinib
Authors: Avalon Juan Carlo , Fuqua Jacob , Miller Tyler , Deskins Seth , Wakefield Chelby , King Austin , Inderbitzin-Brooks Sonya , Bianco Christopher , Veltri Lauren , Fang Wei , Craig Michael , Kanate Abraham , Ross Kelly , Malla Midhun , Patel Brijesh
Published: April 2021

Background:

Ibrutinib is a Bruton’s tyrosine kinase inhibitor used in the treatment of hematological malignancies. The most common cardiotoxicity associated with ibrutinib is atrial arrhythmia (atrial fibrillation and flutter). It is known that patients with cardiovascular disease (CVD) are at an increased risk for developing atrial arrhythmia. However, the rate of atrial arrhythmia in patients with pre-existing CVD treated with ibrutinib is unknown.
Objective:

This study examined whether patients with pre-existing CVD are at a higher risk for developing atrial arrhythmias compared to those without prior CVD.
Methods:

A single-institution retrospective chart review of patients with no prior history of atrial arrhythmia treated with ibrutinib from 2012 to 2020 was performed. Patients were grouped into two cohorts: those with CVD (known history of coronary artery disease, heart failure, pulmonary hypertension, at least moderate valvular heart disease, or device implantation) and those without CVD. The primary outcome was incidence of atrial arrhythmia, and the secondary outcomes were all-cause mortality, risk of bleeding, and discontinuation of ibrutinib.
Results:

Patients were followed for a median of 1.1 years. Among 217 patients treated with ibrutinib, the rate of new-onset atrial arrhythmia was nearly threefold higher in the cohort with CVD compared to the cohort without CVD (17% vs 7%, p = 0.02). Patients with CVD also demonstrated increased adjusted all-cause mortality (OR 1.9, 95% CI 1.06–3.41, p = 0.01) and decreased survival probability (43% vs 54%, p = 0.04) compared to those without CVD over the follow-up period.
Conclusions:

Pre-existing cardiovascular disease was associated with significantly higher rates of atrial arrhythmia and mortality in patients with hematological malignancies managed with ibrutinib.
Prevalence and Patterns of Male Infertility Based on Semen Analysis in Patients Visiting Massawa Hospital; Eritrea: Cross-Sectional Study; 2020
Authors: Tesfai Berhe , Kibreab Fitsum , Gebremariam Hailemichael , Abraham Liwam
Published: April 2021

Background

Semen analysis is the first step to identify male factor infertility. World Health Organization estimates that male factor accounts for 50% of couple sub-fertility. The objective of this study was to determine the prevalence and patterns of male factor infertility based on semen analysis in patients visiting Massawa Hospital with infertility complaints.
Methods

It was a retrospective, descriptive cross sectional hospital based type of study with a census sampling method. Patient’s medical records and hospital laboratory register were used to retrieve semen analysis results of patients from June 2018 to June 2020. Ethical approval was obtained from the Ministry of Health Research and Ethical Review Committee. Confidentiality of patients records kept was secured and consent was obtained from study participants to use their data. Results were presented in frequency, tables and p value < 0.05 was considered significant.
Results

A total of 112 patients data was analyzed in the study with 49.1% were aged between 20 to 30 years. The prevalence of male factor infertility in these patients was found to be 42% and 79.5% of them had primary type of infertility. Of the study participants; 63 (56.3%), 72 (64.3%) and 70 (62.5%) had sperm count < 15 million sperms/ml, sperm motility < 40 % and morphology of < 60% respectively. One tenth, 15 (13.4%) of the patients had a semen volume of < 1.5ml/ejaculate, out of which 13(86.7%) had primary type of infertility. Moreover; 72 (64.3%) patients had total sperm count/ejaculate of < 39 million and 59 (82%) of these had primary type of infertility. In addition; 50.8% and 50% of patients aged 20 to 30 years had a sperm count < 15 million/ml and sperm motility of < 40% respectively.
Conclusion

The prevalence of male factor infertility was slightly higher and was dominated with primary infertility. Most patients had lower sperm count, sperm motility but higher semen volume, and majority of the patients with abnormal sperm results were aged between 20 to 30 years. Further prospective researches to determine the risk factors for male infertility and introducing assisted type of fertility in Eritrea are highly recommended.
A Realistic Greenland Ice Sheet and Surrounding Glaciers and Ice Caps Melting in a Coupled Climate Model
Authors: Devilliers Marion , Swingedouw Didier , Mignot Juliette , Deshayes Julie , Garric Gilles , Ayache Mohamed
Published: April 2021

Greenland ice sheet experienced an intensive melting in the last century, especially in the 1920s and over the last decades. The supplementary input into the ocean could disrupt the freshwater budget of the North Atlantic. Simultaneously, some signs of a recent weakening of the Atlantic Meridional Overturning Circulation (AMOC) have been reported. In order to better understand the possible impact of the increasing melting on the North Atlantic circulation, salinity and temperature trends, we construct an observation-based estimate of the freshwater fluxes spanning from 1840 to 2014. The estimate is based on runoff fluxes coming from Greenland ice sheet and surrounding glaciers and ice caps. Input from iceberg melting is also included and spatially distributed over the North Atlantic following an observed climatology. We force a set of historical simulations of the IPSL-CM6A-LR coupled climate model with this reconstruction from 1920 to 2014. The ten-member ensemble mean displays freshened and cooled waters around Greenland, which spread in the subpolar gyre, and then towards the subtropical gyre and the Nordic Seas. Over the whole period, the convection is reduced in the Labrador and Nordic Seas, while it is slightly enhanced in the Irminger Sea, and the AMOC is weakened by 0.32±0.35 Sv at 26°N. The multi-decadal trend of the North Atlantic surface temperature obtained with the additional freshwater forcing is slightly closer to observations than in standard historical simulations, although the two trends are only different at the 90% confidence level. Slight improvement of the Root Mean Square Error with respect to observations in the subpolar gyre region suggests that part of the surface temperature variability over the recent decades may have been forced by the release of freshwater from Greenland and surrounding regions since the 1920s. Finally, we highlight that the AMOC decrease due to Greenland melting remains modest in these simulations and can only explain a very small amount of the 3±1 Sv weakening suggested in a recent study.
What Determines the Final Place of Care of Advanced Cancer Patients Receiving Integrated Home-based Palliative Care?: a Retrospective Cohort Study
Authors: Tay RiYin , Choo Rozenne WK , Ong WahYing , Hum Allyn YM
Published: April 2021

Background Meeting patients' preferences for place of care at the end-of-life is an indicator of quality palliative care. Understanding the elements required for terminal care within an integrated model may inform policy and practice to increase the likelihood of meeting preferences. Hence, this study aims to identify factors associated with the final place of care of advanced cancer patients receiving integrated home-based palliative care.MethodsThis retrospective cohort study included deceased adult advanced cancer patients enrolled into the home-based service from January 2016-December 2018. Patients with <2 weeks enrolment or ≤1-week duration at the final place of care were excluded. Independent variables included patients’ and families’ characteristics, care preferences, healthcare utilization, functional status and symptom severity assessed using the Palliative Performance Scale (PPSv2) and the Edmonton Symptom Assessment System respectively. The dependent variable was the final place of care. Multivariate logistic regression identified independent determinants and Kappa value evaluated goal-concordance.ResultsOf the 359 eligible patients, home was the most common final place of care (58.2%), followed by inpatient hospice (23.7%) and hospital (16.7%). Single or divorced patients with older family caregivers had a 5.5 (95% CI:1.1-27.8) and 3.1 (95% CI:1.1-8.8) odds respectively of receiving terminal care in inpatient hospice. A PPSv2≥40% and pain score ≥2 increased the odds by 9.1 (95% CI:3.3-24.8) and 3.6 (95% CI:1.3-9.8) times respectively, while non-home death preference increased it by 23.8 (95% CI:5.4-105.1) times. In predicting hospitalization, males had a 3.2 (95% CI:1.0-9.9) odds while a PPSv2≥40% and pain score ≥2 increased the odds by 8.6 (95% CI:2.9-26.0) and 3.5 (95% CI:1.2-10.3) times respectively. Non-home death preference increased it by 9.8 (95% CI:2.1-46.3) times, all p<0.05. Goal-concordance was fair (72.6%, kappa=0.39).ConclusionsHigher functional status, greater pain intensity and non-home death preference predicted institutionalization as the final place of care. Additionally, single or divorced patients with older family caregivers were more likely to receive terminal care in inpatient hospice while males were more likely to be hospitalized. Despite an integrated care model, goal-concordance was suboptimal. More comprehensive community networks and resources, better pain control and personalized care planning discussions are recommended. Future research could examine factors in non-cancer patients.
Predictive Value of Sialidase in the Diagnosis of Sexually Transmitted Infections: a Cross-section Study Based on Vaginal Microecology Evaluation System
Authors: Liu Ying , Hao Jiatao , Zhao Haoyi , Wang Xiaowei , Wang Weihong , An Ruifang
Published: April 2021

Background: The purpose of this study was to determine whether any indexes of vaginal microecology evaluation system (VMES) could predict sexually transmitted infections (STIs).Methods: A total of 1032 women, who presented to Gynecology Outpatient Clinic of the First Affiliated Hospital of Xi'an Jiaotong University between November 2016 and November 2020, were included in the study. Incident STIs was defined as any case of Chlamydia trachomatis (CT), Mycoplasma genitalium (MG) and Neisseria gonorrhoeae (NG), and were confirmed using the RNA-based simultaneous amplification and testing (SAT) assay. VEMS is structured in two parts, one is the morphological characterizations encompassing bacterial density, flora diversity, predominant flora, pathogenic microorganisms and indicators of inflammation, the other is the functional indexes, including vaginal pH, cleanliness, hydrogen peroxide (H2O2), sialidase, β-glucuronidase, leukocyte esterase, and acetylglucosaminidase. Bacterial vaginosis (BV) was diagnosed by Gram stain (Nugent score). Associations were mainly assessed using logistic regression (LR).Results: SAT assay detected STIs in 64 (6.2%) of the 1032 samples tested and 136 (13.2%) women had a clinical BV diagnosis using Nugent score. Multivariate logistic regression analysis revealed that women with sialidase-positive were more likely to test positive for STIs (aOR=3.081, 95% CI=1.586-5.984, P=0.001). Of 896 women without clinical BV, significant association was also found for sialidase and STIs (aOR =4.133, 95% CI= 1.140-14.978, P=0.031).Conclusions: Sialidase may be a useful indicator to help clinicians identify these women who are at risk for STIs, especially in the absence of BV population.
Type I and Ii Pulmonary Atresia With Intact Ventricular Septum in Infants-10-year Experience in Initial Surgery at One Center
Authors: Song Hailong , Chen Ziying
Published: April 2021

Background: To explore the effect of initial surgery for type I and II pulmonary atresia with intact ventricular septum (PA/IVS). Methods: Patients with type I and II PA/IVS undergoing initial surgery were enrolled, including type I with systemic to pulmonary (BT) shunt+patent ductus arteriosus (PDA) ligation+mosaic surgery (surgical A), BT shunt+PDA ligation+pulmonary valve incision without extracorporeal circulation (surgical B), type II with BT shunt+PDA ligation+right ventricular outflow tract (RVOT) incision+transpulmonary annulus patch (TP) (surgical C), and BT shunt+PDA ligation+RVOT incision+TP+artificial pulmonary valve (surgical D). Mechanical ventilation time (MVT), length of ICU stay, mortality rate, tricuspid Z value (TZ), tricuspid regurgitation (TR), McGoon ratio, oxygen saturation (SpO2), pulmonary transvalvular pressure (PTP), pulmonary regurgitation (PR), survival rate and re-operation rate were compared between surgical A and B, and between surgical C and D.Results: After surgery, PR was greater by surgical A than by surgical B at 1 month (P<0.05); lower TZ and McGoon ratio and greater PR, PTP and TR at 3 months (P<0.05); lower SpO2 (P<0.05), greater PTP at 6 months (P<0.01); greater TR and PTP at 1 year (P<0.05). MVT and length of ICU stay were longer by surgical C than by surgical D (P<0.05). There was greater PR at discharge and 1 month (P<0.01); greater TR and PR, lower McGoon ratio and SpO2 at 3 months (P<0.05); lower TZ and PTP and greater PR and PTP at 6 months (P<0.05) and 1 year (P<0.01) respectively.Conclusion: Surgical B and D are superior to surgical A and C respectively.
Prognostic Nomogram for PJP Patients With HIV and NHIV
Authors: Feng Qiuyue , Hao Jingjing , Li Ang , Tong Zhaohui
Published: April 2021

Background: This study was to create nomogram models for precise prediction of mortality risk of NHIV-PJP and HIV-PJP cases.Methods: A retrospective study was performed over a 10-year period to evaluate the clinical characteristics and outcomes of NHIV-PJP at Beijing Chaoyang Hospital and HIV-PJP at Beijing Ditan Hospital in China from 2010 to 2019. Univariate and multivariate logistic regression analysis were used to screen out mortality risk factors for creating nomograms. Nomogram models were evaluated by using a bootstrapped concordance index, calibration plots and receiver operating characteristics (ROCs) curve.Results: A total of 167 NHIV-PJP cases and 193 HIV-PJP cases were included in the study. Pneumothorax, febrile days after admission, CD4+ T cells≤100cells/ul and sulfa combine CAS treatment were identified as independent risk factors that could be combined for accurate prediction of mortality result in NHIV-PJP group. We created a nomogram for mortality risk by using these variables. The area under the curve was 0.865 (95% confidence interval 0.799-0.931). The nomogram had a C-index of 0.865 and was well calibrated. Independent risk factors contained in the nomogram in HIV-PJP group included pneumothorax, PLT≤80×109/L, HGB≤90g/L, ALB, CMV co-infection and sulfa combine CAS treatment. The nomogram showed good discrimination, with a C-index of 0.904 and good calibration. The area under the curve was 0.910 (95% confidence interval 0.850-0.970). Conclusions: Our nomograms were useful tools for evaluating the poor prognosis in both NHIV-PJP and HIV-PJP cases.
Teleconsultation for Pediatric Patients With Type 1 Diabetes Mellitus During the COVID-19 Pandemic: Experience of a University Hospital in Brazil.
Authors: SANTANA YASMIN EUGENIA , Luciano Thais Milioni , Teodózio Ana Carolina Maia , de Santana Amanda Maria Barradas Monteiro , Ramos Letícia Rodrigues , Bastos Luiza Siqueira Rabelo , Cardoso Brena de Sá , Alves Marília Oliveira Barbosa , Atique Patricia Volpon Santos , Sarti Mariana Teresa Alves , Sader Soraya Lopes , Antonini Sonir Roberto Rauber , Stecchini Mônica Freire , Custódio Rodrigo José , Junior Raphael Del Roio Liberatore
Published: April 2021

Background: The SARS-CoV-2 pandemic expanded rapidly around the world in 2020 and health services needed to be reconfigured to meet the new demand and ensure the care of patients with chronic diseases, whether or not aggravated by this COVID-19 (disease caused by SARS-Cov-2). For patients with chronic diseases - such as diabetes mellitus - the teleconsultation stood out as a tool for clinical management in this period. This study aims to evaluate the impact of teleconsultation on glycemic control and prevention of acute complications related to diabetes mellitus in children and adolescents treated by the pediatric endocrinology team at Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo (HC-FMRP -USP) during the COVID-19 pandemic in 2020. Method: Descriptive study of data from pediatric diabetic patients who received teleconsultation via messages in the months of April to September 2020. Results: Regarding the patients evaluated (N = 143), there were 3.4 teleconsultations per patient in the studied period; requiring adjustment of insulin doses in 84.6% of cases. The hospital admission rate was 17.5% due to diabetic decompensation and / or the opening of diabetes mellitus. The dosage of glycosylated hemoglobin showed a worsening in 46% of the sample and an improvement in 37%. Conclusion: The teleconsultation was effective in ensuring health care for patients with DM1 during the COVID-19 pandemic.
A1 Reactive Astrocytes Activated by 2-chloroethanol Modulate M1 Microglia Polarization through Upregulating IL-1β and TNF-α
Authors: Wang Tong , Sun Qi , Tang Hongge , Wang Gaoyang , Zhao Fenghong , Chen Yuhua , Jin Yaping
Published: April 2021

Background1,2-Dichloroethane (1,2-DCE) is a synthetic organic chemical that causes brain edema under subacute poisoning. Our previous studies indicated that the neuroinflammation could be induced due to activation of both astrocytes and microglia during the course of brain edema in 1,2-DCE intoxicated mice. However, the crosstalk between the two glial cells in 1,2-DCE-induced neuroinflammation is unclear. In the current studies, we hypothesized that astrocytes are the first responder to the effects of 1,2-DCE in the brain, as they adhere to the cerebral capillaries, and they are an essential component of the blood-brain barrier (BBB).MethodsWe used primary cultured rat astrocytes and microglia, as well as a highly aggressively proliferating immortalized (HAPI) microglia cell line to study the effects of astrocytes on microglia polarization following exposure to 2-CE. ResultsFindings from the present studies demonstrated that treatment of primary rat astrocytes with 2-chloroethanol (2-CE), the intermediate metabolite of 1,2-DCE in vivo, can stimulate the activation of A1 reactive astrocytes (A1s) through p38 mitogen-activated protein kinase (p38 MAPK)/ nuclear factor-κB (NF-κB) and activator protein-1 (AP-1) signaling pathways by the reactive oxygen species (ROS) produced during 2-CE metabolism. A1s activated by 2-CE can upregulate the expression of interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and inducible nitric oxide synthase (iNOS), and stimulate the M1 polarization of microglia through IL-1β and TNF-α released by 2-CE activated A1s. Microglia are less sensitive to 2-CE than astrocytes, since treatment of primary rat microglia with 30 mM 2-CE alone failed to activate them, though this dose of 2-CE can activate A1s and in turn stimulate M1 polarization of microglia through the factors released by A1s. ConclusionThe neuroinflammation induced by 1,2-DCE in the brain of mice is most probably triggered by the activation of astrocytes. The understanding of the multidimensional roles of reactive astrocytes may further the development of new treatment strategies in reducing neuroinflammation and brain edema following 1,2-DCE-induced toxic encephalopathy.