bluuebunny/crossref_metadata_2025 huggingface dataset:
Community Medicine in Ayushman Bharat Digital Mission: The Hidden Cornerstone
Authors: Samudyatha U.C , Kosambiya J.K. , Madhukumar Suwarna
Published: April 2023

Background:

India has launched Ayushman Bharat Digital Mission (ABDM), to provide an integrated digital health infrastructure. The success of digital health systems lies in their ability to achieve universal healthcare and incorporate all levels of disease prevention. The objective of this study was to develop an expert consensus on how Community Medicine (Preventive and Social Medicine) can be integrated into ABDM.

Methods:

A total of 17 and 15 participants, who were Community Medicine professionals with more than 10 years experience in the Public Health Sector and/or Medical Education in various parts of India, participated in round 1 and 2 of this Delphi study respectively. The study explored three domains: 1. Advantages and challenges of ABDM, and possible solutions; 2. Intersectoral convergence in Unified Health Interface (UHI) and 3. Way ahead in medical education and research.

Results:

Participants envisaged improved accessibility, affordability, and quality of care due to ABDM. However, awareness generation, reaching out to marginalized populations, human resource constraints, financial sustainability, and data security issues were anticipated challenges. The study identified plausible solutions addressing six broad challenges of ABDM and classified them based on the priority of implementation. Participants listed out nine key roles of Community Medicine professionals in digital health. The Study identified about 95 stakeholders who play direct and indirect roles in public health and can be connected to the general public through the Unified Health Interface of ABDM. Further, the study explored the future of medical education and research in the digital era.

Conclusion:

The Study contributes to broadening the scope of India’s digital health mission, with elements of Community Medicine in its cornerstone.
Financial Cost of Hypertension in Urban and Rural Tertiary Health Facilities in Southwest, Nigeria: A Comparative Cross-Sectional Study
Authors: Ipinnimo Tope Michael , Emmanuel Eyitayo Ebenezer , Ipinnimo Motunrayo Temidayo , Agunbiade Kehinde Hassan , Ilesanmi Oladipupo Adekunle
Published: April 2023

Background:

The financial cost of hypertension could result in serious economic hardship for patients, their households, and the community. To assess and compare the direct and indirect cost of care for hypertension in urban and rural tertiary health facilities.

Material and Methods:

A comparative cross-sectional study was carried out in two tertiary health facilities which are located in urban and rural communities of the southwest, Nigeria. Four hundred and six (204 urban, 202 rural) hypertensive patients were selected from the health facilities using a systematic sampling technique. A pretested semi-structured, interviewer-administered questionnaire adapted from that used in a previous study was used for data collection. Information on biodata, and direct and indirect costs was collected. Data entry and analysis were done using IBM SPSS Statistics for Windows, Version 22.0.

Results:

More than half of the respondents were females (urban, 54.4%; rural, 53.5%) and in their middle age (45-64 years) (urban, 50.5%; rural, 51.0%). The monthly cost of care for hypertension was significantly higher in urban than in rural tertiary health facilities (urban,

JOURNAL/ijcm/04.03/00659070-202348020-00023/320FF01/v/2023-04-07T113239Z/r/image-tiff

19,703.26 [$54.73]; rural,

JOURNAL/ijcm/04.03/00659070-202348020-00023/320FF01/v/2023-04-07T113239Z/r/image-tiff

18,448.58 [$51.25]) (P < 0.001). There was a significant difference in the direct cost (urban,

JOURNAL/ijcm/04.03/00659070-202348020-00023/320FF01/v/2023-04-07T113239Z/r/image-tiff

15,835.54 [$43.99]; rural,

JOURNAL/ijcm/04.03/00659070-202348020-00023/320FF01/v/2023-04-07T113239Z/r/image-tiff

14,531.68 [$40.37]) (P < 0.001), although the indirect cost (urban,

JOURNAL/ijcm/04.03/00659070-202348020-00023/320FF01/v/2023-04-07T113239Z/r/image-tiff

3,867.72 [$10.74]; rural,

JOURNAL/ijcm/04.03/00659070-202348020-00023/320FF01/v/2023-04-07T113239Z/r/image-tiff

3,916.91 [$10.88]) (P = 0.540) did not show much difference between the groups. The cost of drugs/consumables and investigations contributed more than half (urban, 56.8%; rural, 58.8%) of the cost in both health facilities.

Conclusion:

The financial cost of hypertension was higher in the urban tertiary health facility; therefore, more government support is needed in this health facility to close the financial gap.
Epidemiological Profile and Spatio-Temporal Pattern of Infant Deaths in a District of North India during 2016-2019
Authors: Sachdeva Aman , Verma Ramesh , Agrawal Ginni , Vinay  , Satija Jitesh
Published: April 2023

Background:

Infant mortality is an important health indicator of a population given its strong link to socioeconomic status, health service access, and quality and maternal health. The declining trend of Infant Mortality Rate has been observed in India where it reduced from 89 deaths per 1000 live births in 1990 to 28 deaths per 1000d live births in 2019. Most of the studies regarding the trend of infant mortality are state-based, however, state-level infant mortality has masked the intradistrict clustering of individual infant deaths. Hence, this study was planned with an objective to study the trend of infant mortality at the district level.

Material and Methods:

A retrospective study was conducted in the district Rohtak of Haryana using the data collected regarding infant deaths. The collected data regarding addresses were geocoded. The resulting layer was then analyzed using QGIS v3.10. The descriptive data was analyzed using SPSS v20.0.

Result:

In total, 1336 infant deaths during the study period were included. A declining trend of infant mortality was observed over the study period. The number of grids (25 km2) reduced from 18 in 2016 to 10 in 2019 depicting a reduction in the areas with more than expected count.

Conclusion:

This study emphasizes on the importance of using the geographic information science technique in identifying local hotspots within the district so as to find areas that need more support and observation.
Syringomyelia Secondary to Thoracic Intervertebral Disc Protrusion
Authors: Hui Soo Tze , Tharek Anas , Ibrahim Idris , Zakaria Mohd Hazeman
Published: April 2023

Spinal spondylosis is an extremely common problem among the middle-aged and elderly population. However, it is an extremely rare cause of syringomyelia in clinical practice. The differentiation between syringomyelia and hydromyelia is not always straightforward and rather exhaustive. Spinal cord compression and instability are the proposed mechanisms of injury-causing syringomyelia. Symptomatic presentation depends primarily on the location of the syrinx within the neuraxis, be it motor, sensory or autonomic disturbance. There were abundant of successful cases in the past, whereby surgical interventions can regress the appearance of syringomyelia in magnetic resonance imaging. However, there was a mixed result in terms of patients' symptom. There were only 6 reported articles of syringomyelia secondary to cervical spondylosis found worldwide. We describe a case of T11/T12 thoracic intervertebral disc protrusion causing long segment syringomyelia till conus medullaris.
The Influence of Digitalized Examination of the Histology Laboratory Course on Medical and Dental Students
Authors: Chiang Ming-Hsien , Lan Hsin-Chieh , Cheng Chia-Pi , Chen Jang-Yi , Yin Fon-Yi , Lin Gu-Jiun
Published: April 2023

Background:

Histology laboratory courses comprise the study of cell structures, tissues, and body organs, which are mainly examined using a microscope. Two types of examinations assess learning outcomes in these courses in Taiwan: the traditional, light microscope station (LMS) examination and the Microsoft PowerPoint (MS PPT) examination. Whether these examinations exhibit different influences on students' grade performances remains to be examined.

Aim:

The aim is to compare the grade performance and opinion of students in a medical center for the LMS and MS PPT examinations.

Methods:

We compared the grade performances of students who completed LMS (3 cohorts) or MS PPT (2 cohorts) examinations retrospectively and conducted a survey to investigate the students' learning attitude between these two types of examinations.

Results:

Grade performances in the MS PPT group were not significantly higher than those in the LMS group. The average scores of students who failed the LMS examination were significantly lower than those of students who failed the MS PPT examination. Questionnaire survey results showed that the MS PPT examination was easier for students and that they may spend less time studying for it. The LMS examination positively influenced learning attitudes among students with a rather low self-demand.

Conclusion:

Examination type may affect learning attitude, especially among students with a rather low self-demand. The MS PPT examination seems to be easier for students and was connected to remarks about less study time in the histology laboratory course, and for students with low self-demands, the traditional LMS examination may be a better option. We believe that with the advance of digital whole histology slide imaging, there is an opportunity to revolutionize both learning and evaluating for all medical school students.
Effect of Betahistine on Isolated Rats' Tracheal Smooth Muscles
Authors: Chou Ying-Liang , Wang Hsing-Won
Published: April 2023

Background:

Betahistine is used as an H3 antagonist. It has been used to treat balance disorders. During the administration of the drug, the trachea may be affected through oral intake.

Aim:

This study aimed to determine the effects of betahistine on the tracheal smooth muscle of rats in vitro.

Methods:

On a rat trachea that had been isolated and immersed in Krebs solution in a muscle bath, we evaluated the efficacy of betahistine. We examined how the application of parasympathetic mimetic agents altered tracheal contractility. The betahistine was evaluated using the following criteria: the drug's effects on tracheal smooth muscle contractions triggered by parasympathetic mimetic 10− 6 M methacholine, electrically induced tracheal smooth muscle contractions, and resting tracheal smooth muscle tension were listed below.

Results:

At preparation concentrations as high as 10− 4 M, betahistine produced a substantial relaxing response. The medication also prevented spike contraction brought by electrical field stimulation. However, betahistine alone had a negligible effect on the basal tension of the trachea at increasing concentrations.

Conclusion:

According to this study, excessive levels of betahistine might actually oppose cholinergic receptors and prevented the tracheal smooth muscles parasympathetic activity.
Extracorporeal Shockwave Therapy on Spasticity after Central Nervous System Injury
Authors: Chen Po-Huang , Ho Ching-Liang , Lee Cho-Hao
Published: April 2023

Background::

Spasticity is a disorder characterized by velocity dependently increasing in the tonic stretch reflexes (muscle tone). There were variable managements for spasticity. Treatment of spasticity depends on the severity, involved part, and patient's and families' preference. However, there were more trials completed in studying the efficacy of extracorporeal shockwave therapy (ESWT) in treating spasticity in different disease.

Aim:

The goal of our study is to evaluate the efficacy of ESWT in treating of spasticity after central nervous system lesions and to analyze the influences of related factors; we performed a systemic review to survey the effect.

Methods:

We performed a thoroughly systematic review and meta-analysis.

Results:

Totally 9 studies were included 4 studies examined the spasticity in stroke group, 4 studies were in cerebral palsy, and 1 study in multiple sclerosis. Regarding the effect of spasticity reduction in overall populations, the pooled effect showed that the modified Ashworth scale grade reduction compared with the baseline values were standardized mean difference (SMD): −4.07 (95% confidence interval (CI), −5.37– −2.76; P < 0.001) immediately after ESWT, SMD: −2.51 (95% CI, −3.40– −1.62; P < 0.001) after 4 weeks, and SMD: −1.44 (95% CI, −1.92– −0.95; P < 0.001) after 12 weeks. In terms of the disease types, the SMD in stroke patients was SMD: −4.03 (95% CI, −5.44– −2.61; Z = 5.57; P < 0.001) immediately after ESWT, SMD: −2.34 (95% CI, −3.01– −1.66; Z = 6.80; P < 0.001) after 4 weeks and SMD: −1.50 (95% CI, −2.06– −0.93; Z = 5.20; P < 0.001) after 12 weeks. No significant adverse events were found.

Conclusion:

The present meta-analysis revealed that ESWT effectively alleviates spasticity in patients after upper motor neuron lesions, regardless of disease type and parts treated. Both radial and focus ESWTs could decrease spasticity, regardless of the treatment session. The result could last for 12 weeks after treatment. Moreover, no serious side effects were observed after ESWT. Further studies with randomization and more parameters of ESWT were advised to setup to improve the clinical effectiveness.
Finding a Needle in the Haystack
Authors: Lin Hung-Yu , Peng Yi-Jen , Wu Yi-Ying , Chang Ping-Ying
Published: April 2023

The classical morphological features of follicular lymphoma (FL) are well-recognized. However, identifying some morphological variants, such as FL with hyaline-vascular Castleman disease (HVCD) like features (FL-HVCD), is challenging. Hence, we report a 57-year-old male with FL-HVCD who presented with nontender swelling of the bilateral lower limbs, caused by enlarged intra-abdominal lymph nodes with venous compression. The excised lymph nodes showed onionskin-like mantle zones and hyalinized blood vessels, which was consisted with HVCD. Oral medications were prescribed; however, the patient was lost to follow-up after 6 months and was readmitted with anemia, thrombocytopenia, and leukocytosis 3 years later. A bone marrow biopsy was done, and the patient was diagnosed as having overt FL with bone marrow involvement. Physicians should be careful if HCVD patients present with systemic symptoms or generalized lymphadenopathy. Excluding the possibility of lymphoma is necessary because the different treatment strategy and prognosis from HVCD.
Increased Cerebral Blood Flow Following L110 Acupuncture in Healthy Volunteers Observed with 99mTc-Ethyl Cysteine Dimer Single-Photon Emission Computed Tomography
Authors: Yeh Skye Hsin-Hsien , Lin Ching-Heng , Chang Ping-Ying , Lin Li-Fan , Tang Shin-En , Chiu Chuang-Hsin
Published: April 2023

Background::

Ischemic stroke is the second most common cause of death and a major cause of disability worldwide. Acupuncture is frequently advocated as an alternative treatment during stroke rehabilitation.

Aim:

The purpose of this study was to measure regional cerebral blood flow (rCBF) following acupuncture at LI-10 Shousanli in healthy volunteers using 99mTc-ethyl cysteine dimer (99mTc-ECD) single-photon emission computed tomography (SPECT).

Methods:

Fourteen healthy volunteers were enrolled in this study. A baseline brain SPECT was taken, and 3 months later, acupuncture was performed at LI-10 for 20 min, followed by a second SPECT. Statistical parametric mapping was used to analyze the changes in rCBF before and after acupuncture through a paired t-test.

Results:

Perfusion increased in the caudate, thalamus, hippocampus, and precuneus (P < 0.05) regions after acupuncture at LI-10 compared to baseline and decreased rCBF was observed in the frontal cortex, occipital cortex, and parietal regions compared to baseline. Differences between baseline and postacupuncture (PA) perfusion levels showed were highest in the hippocampus region, followed by the striatum, thalamus, and cerebellum regions.

Conclusion::

99mTC-ECD SPECT revealed significant increases in rCBF for specific region PA at LI-10. These results provide reference control group data for future longitudinal studies of stroke patients receiving acupuncture therapy as an alternative treatment to improve motor function and aid intensive rehabilitation.
Approach to Pulmonary Haemorrhage in Children
Authors: Nathan Anna Marie , Ying Hng Shih , Peng Eg Kah , Gowdh Nadia Fareeda Muhammad , de Bruyne Jessie
Published: April 2023

Pulmonary haemorrhage is rare in children but can be life-threatening. It is recognised as a triad of haemoptysis, drop in haemoglobin or iron-deficiency anaemia and radiographic evidence of pulmonary infiltrates. Although there can be a myriad of causes, careful history with consideration of co-morbid factors and radio imaging of the chest can help determine the most likely cause. This review will illustrate how to determine the aetiology, types of investigations to perform and management through real-life clinical vignettes.
Electronic medical records-based retrospective, longitudinal, observational study to understand the patient management of benign prostatic hyperplasia with alpha-blockers monotherapy in Indian population
Authors: Gupta Rahul , Trivedi Sameer , Vaddi Surya Prakash , Borgohain Mrinal , Mittal Rajan , Pandit Sucheta , Mane Amey
Published: April 2023

Objective:

The present retrospective study evaluates the effectiveness and tolerability of alpha-blockers as monotherapy in patients with benign prostatic hyperplasia associated with lower urinary tract symptoms (LUTS).

Materials and Methods:

A total of 335 male patients >50 years were categorized into four groups (Alfuzosin: 166, Silodosin: 67, Tamsulosin: 70, Prazosin: 32). The efficacy evaluated as a change in International Prostate Symptom Score (IPSS), peak flow rate (Qmax), residual urine volume, and relief from LUTS, and tolerability of the various alpha-blockers was assessed across the study group.

Results:

At baseline, most of the patients in alfuzosin (60%), silodosin (77%), and tamsulosin (90%) groups presented with severe IPSS (20–35), whereas patients in the prazosin group (69%) presented with a moderate score. At the end of the study, the mean IPSS gradually improved to moderate (41%, 62%, 66%, and 28%) and mild (59%, 38%, 28%, and 72%) in the alfuzosin, silodosin, tamsulosin, and prazosin groups, respectively (P = 0.004), with improvement in mean change in residual urine volume and complete relief from LUTS symptoms with no surgical or radiological interventions. Overall, 194 adverse events (AEs) were observed in 38.8% of patients. Of the total AEs, patients in the alfuzosin, silodosin, tamsulosin, and prazosin groups experienced 21%, 22%, 39%, and 18% of AEs, respectively.

Conclusion:

The nonselective alpha-adrenergic receptor antagonist, alfuzosin, emerged as noninferior in effectiveness and superior in tolerability than other selective alpha-blockers, silodosin, tamsulosin, and prazosin.
Seminal vesicle metastasis from hepatocellular carcinoma and renal cell carcinoma
Authors: Chan Marius Wai-Lok , Lau Wing-Hung , Kan Chi-Fai , Au Wing-Hang
Published: April 2023

We presented two rare cases of secondary seminal vesicle (SV) metastasis from hepatocellular carcinoma of the liver and renal cell carcinoma from the right kidney. Diagnosis of secondary SV metastasis should be made based on clinical history, radiological examination, histopathological examination, and, more importantly, the directed panel of immunohistochemistry. Via our experience in the investigation and diagnostic process, a better understanding of this unusual disease can be achieved.
The effect of percutaneous tract dilation technique on renal parenchymal trauma
Authors: Tsaturyan Arman , Adamou Constantinos , Pantazis Lampros , Kalogeropoulou Christina , Tzelepi Vasiliki , Apostolopoulos Dimitris , Pagonis Konstantinos , Peteinaris Angelis , Natsos Anastasios , Vrettos Theofanis , Al-Aown Abdulrahman , Liatsikos Evangelos , Kallidonis Panagiotis
Published: April 2023

Purpose:

The purpose of this study was to evaluate renal parenchymal trauma of two-step dilation compared to the conventional Amplatz gradual dilation during percutaneous nephrolithotomy on a porcine model.

Materials and Methods:

A nonpapillary percutaneous access tract was established under fluoroscopic guidance in both kidneys of four female pigs. On the right kidney of each pig, gradual dilation was performed using an Amplatz dilator set with a gradual dilation to 30 Fr, whereas on the left, a two-step dilation was utilized using only 16 Fr and 30 Fr dilators. Two of the animals were euthanized immediately after the procedure and the remaining two 1 month later. The pigs that were kept alive underwent a contrast-enhanced computed tomography immediately, 15, and 30 days postoperatively. A dimercaptosuccinic acid (DMSA) scintigraphy and single-photon emission computed tomography–computed tomography (CT) were also performed after the last CT and afterward, the pigs were sacrificed. All kidneys were harvested for pathohistological examination.

Results:

The follow-up radiologic imaging showed similar parenchymal damage caused by the compared dilation techniques and an expected reduction in scar size in the later scans. No scar was identified by DMSA in any kidney. Gross and microscopic examinations conducted both on the kidneys that were harvested immediately after the procedure and the ones from the animals that were left to heal, revealed no significant differences in tissue damage, grade of fibrosis, or inflammation depending on the dilation method.

Conclusions:

Our study showed no inferior outcomes caused by two-step dilation compared to gradual dilation regarding renal parenchymal damage following a nonpapillary puncture. In fact, postoperative imaging findings suggested a trend toward better healing and less scar tissue when the two-step method was used.
Recreational use of oral erectile dysfunction medications among male physicians - A cross-sectional study
Authors: Almannie Raed , Alzahrani Meshari A , Almuhaideb Mana , Abunohaiah Ibrahim , Habous Mohamad , Binsaleh Saleh
Published: April 2023

Introduction:

Erectile dysfunction (ED) is defined as the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance. Bypassing health-care providers and obtaining ED medications (EDM) without a prescription are an issue that is faced globally.

Aim:

We attempt to assess erectile function (EF) among a local sample of physicians, the psychological effects of recreational EDM use, and compare EF among different user groups.

Methods:

This is a cross-sectional study done solely on physicians in Saudi Arabia. A self-designed questionnaire including demographics, sexual characteristics, use of ED medication, sexual satisfaction, and the validated international index of EF (IIEF).

Outcome:

Physicians misused EDM.

Results:

A total of 503 physicians completed the questionnaire. Among participants reporting sexual problems, only 23% received counseling and 3.4% were professionally diagnosed with ED. Among users, 71.2% were using EDM recreationally, 14.4% prophylactically, and 14.4% were prescribed. Participants aged 20–29 IIEF-5 score was significantly lower than participants aged 30–39 years. Prescribed users had a lower IIEF-5 score compared to both recreational users and nonusers.

Clinical Implications:

Many healthy sexually active men use EDMs recreationally to increase sexual performance.

Strengths and Limitations:

One of the limitations of our study is that we did not use standardized tools to determine the diagnosis of some important disorders like premature ejaculation. Our study strengths include the very high response rate, with our results truly showing a nationwide self-assessment of sexual dysfunction.

Conclusion:

Recreational use of oral EDMs may adversely impact the psychological aspects of sexual function. In our study, physicians misused EDM. We recommend labeling EDMs as restricted medication that requires a prescription to use by a licensed physician.
Comparative effect of intraurethral clobetasol and tacrolimus in lichen sclerosus-associated urethral stricture disease
Authors: Choudhury Sunirmal , Khare Eeshansh , Pal Dilip Kumar
Published: April 2023

Background:

Management of urethral stricture related to lichen sclerosus (LS) is now gradually changing from surgical to nonsurgical due to availability of anti-inflammatory agents such as corticosteroids and calcineurin inhibitors. We determined the clinical impact of these agents in such patients on outpatient department basis in terms of improvement in symptoms on International Prostate Symptom Score (IPSS), external skin appearance, and maximum urinary flow rate (Qmax).

Materials and Methods:

Eighty patients of meatal stenosis and penile urethral stricture with histopathologically proven LS were divided into two groups, and clinical and predetermined parameters such as Qmax, IPSS, and changes in external appearance were compared between these groups after 3 months of topical and intraurethral application of clobetasol and tacrolimus with self-calibration.

Results:

A significant intragroup difference was noted in IPSS (P < 0.001) as well as Qmax (P < 0.001); postintervention intergroup difference in IPSS was not significant (P = 0.94) and however postintervention intergroup difference in Qmax was significant in favor of clobetasol (P = 0.007). A significantly increased number of additional procedures were done in the group receiving intraurethral tacrolimus (P = 0.0473) with significantly less number of skin complication in the group with topically applied clobetasol (P = 0.003).

Conclusion:

Though both clobetasol and tacrolimus, improved symptom score, Qmax and local external appearance yet topical and intra-urethral clobetasol application via urethral self calibration seems to be better option for lichen sclerosus related urethral stricture in terms cost and local complications.
Prospective evaluation of an intraoperative urodynamic stress test predicting urinary incontinence after robot-assisted laparoscopic radical prostatectomy
Authors: Mohr Mirjam Naomi , Uhlig Annemarie , Strauß Arne , Leitsmann Conrad , Ahyai Sascha A , Trojan Lutz , Reichert Mathias
Published: April 2023

Introduction:

Multiple factors influence postprostatectomy incontinence (PPI). This study evaluates the association between an intraoperative urodynamic stress test (IST) with PPI.

Materials and Methods:

This is an observational, single-center, prospective evaluation of 109 robot-assisted laparoscopic radical prostatectomies (RALPs) performed between July 2020 and March 2021. All patients underwent an intraoperative urodynamic stress test (IST) in which the bladder is filled up to an intravesical pressure of 40 cm H2O to evaluate whether the rhabdomyosphincter is capable of withstanding the pressure and ensure continence. Early PPI was evaluated using a standardized 1-h pad test performed the day after removal of the urinary catheter. The association of IST and PPI was evaluated using univariate and multivariable logistic regression models.

Results:

Nearly 76.6% of the patients showed no urine loss during the IST (“sufficient” population group). There was no significant correlation between this group and PPI after catheter removal (P = 0.5). Subgroup analyses of the “sufficient” patient population showed a 3.1 higher risk of PPI when no nerve sparing was performed (95% confidence interval: 1.05–9.70, P = 0.045).

Conclusion:

A sufficient IST, as a surrogate variable for a fully obtained rhabdomyosphincter, has no significant predictive value on its own but seems to be the optimal prerequisite for continence, since the data shows that the lack of neurovascular supply required for a functioning sphincter leads up to a 3.1 times higher risk for PPI.
P53 and survivin expression in renal cell carcinoma
Authors: Radovanović Milan , Petrović Miloš , Šantrić Veljko , Milojević Bogomir , Zubelić Aleksa , Isaković Aleksandra
Published: April 2023

Objective:

Mutation of p53 is detected in more than 50% of human cancers, expression of p53 has a potential prognostic value in patients with renal cell carcinoma (RCC). Survivin is a member of the inhibitor of apoptosis protein family, its overexpression is observed in many malignancies, including RCC. The aim of the study was to estimate a correlation between survivin and p53 expression in tumor samples and the histologic type of a tumor, tumor stage, tumor grade, and survival of patients.

Materials and Methods:

Tumor samples were collected from surgical specimens of 90 patients who underwent radical or partial nephrectomy for RCC between November 2017 and July 2020. Tumors were staged according to the UICC (The Union for International Cancer Control) TNM classification system and histopathologically graded according to Fuhrman nuclear grade system. Histopathological diagnosis was confirmed with standard light microscopic evaluation, using hematoxylin and eosin staining and standard p53 and survivin antibodies.

Results:

Positive p53 staining was observed in 36.7% of tumor specimens and 24.4% were survivin positive. There was a statistically significant correlation between p53 or survivin expression and histologic subtype of clear cell RCC as well as Type I and II of papillary RCC. There was a statistically significant correlation between p53 expression and tumor size, stage, and grade. The p53 or survivin expression was related to lower overall survival.

Conclusion:

The results of this study suggest that p53 overexpression and survivin positivity in RCC patients could be associated with poor prognosis. Thus, these proteins could be used as prognostic markers in RCC.
Comparative analysis of partial versus radical nephrectomy for renal cell carcinoma
Authors: Hakam Nizar , Heidar Nassib Abou , El-Asmar Jose , Khauli Mark , Degheili Jad , Al-Moussawy Mouhamad , Nasr Rami , El-Hajj Albert , Wazzan Wassim , Bulbul Muhammad , Khauli Raja B
Published: April 2023

Objectives:

Over the past 20 years, the utility of partial nephrectomy (PN), compared to radical nephrectomy (RN), for the management of localized renal cell carcinoma (RCC) has progressively increased, particularly for larger and more complex masses. We sought to compare the recurrence-free survival (RFS) outcomes of PN versus RN in a single-institution cohort.

Methods:

Between 2002 and 2017, 228 patients underwent RN or PN for lcT1a-T2b, N0M0 RCC at a single tertiary referral center, performed by five surgeons. The clinical end point result was (local or distant) RFS. Univariate and multivariate (cox regression) models were used to evaluate the association between type of surgery (PN vs. RN) and RFS, in the overall cohort and in a subgroup of patients with cT1b.

Results:

The median age was 59 (interquartile range [IQR] 48–66), and the median tumor size was 4.5 cm (IQR 3–7). There were 128 PN and 100 RN. Over a median follow-up of 4.2 years (IQR 2.2–6.9), the Kaplan–Meier analysis showed no significant RFS difference between PN and RN (logrank P = 0.53). On multivariate analysis, pathologic stage ≥T2a, Fuhrman Grade ≥3, and chromophobe histology were associated with a worse RFS. PN was not significantly associated with diminished RFS (Hazard ratio [HR] 1.78, 95% confidence interval [CI] 0.74–4.3, P = 0.199) in the overall cohort compared to RN. However, in the cT1b subgroup, PN was associated with a significant increase in recurrence compared to RN (HR = 12.4, 95% CI 1.45–133.4, P = 0.038).

Conclusions:

Our institutional data highlight the possibility of compromise in RFS for clinically localized RCC treated with PN compared to RN, particularly for larger and more complex masses. These data raise concern, especially in light of the nonproven association of survival benefit of PN over RN, warranting future randomized prospective studies for further evaluation.
Multi-objective Combination Optimization of Automobile Subframe Dynamic Stiffness
Authors: Ouyang Tao , Wu Jian , Chen Qiushi , Wu Guangqiang
Published: April 2023

Subframe is an important part of automobile chassis, which is connected with body, suspension control arm, powertrain mount, etc. The dynamic stiffness value of the connection point is an important performance index of the subframe, which affects the vibration of the vehicle body. This paper introduces the basic concept and related theory of dynamic stiffness, derives the theoretical formula of dynamic stiffness, and analyzes the frequency response of the key points of the subframe. In view of the fact that the dynamic stiffness of the subframe of a certain vehicle model is not up to the standard at some connection points, the dynamic stiffness CAE simulation analysis is carried out to determine the frequency range of insufficient dynamic stiffness and the connection points that need to be optimized. The combination optimization method combining size optimization and shape optimization is adopted, and genetic algorithm is used to set multiple mass constraints with multiple shape variables and size variables as design variables, so as to achieve the goal of optimizing the dynamic stiffness of the subframe. The simulation test shows that the dynamic stiffness of each key point of the subframe can basically meet the target requirements under the constraint of 15% increase in the mass of the subframe.
Vortex Drag Revisited
Authors: Howell Jeff , Butcher Daniel , Le Good Geoffrey
Published: April 2023

Some car shapes produce a substantial drag component from the generation of trailing vortices. This vortex (or lift dependent) drag is difficult to quantify for the whole vehicle, for reasons that are discussed. It has previously been shown that vortex drag may be assessed for some car features by consideration of the relationship between changes in drag and lift. In this paper this relationship is explored for some different vehicle shape characteristics, which produce positive and negative lift changes, and their combinations. Vortex drag factors are determined and vortex drag coefficients considered. An interference effect is identified between some of these features. For the simple bodies investigated the vortex drag contribution can be considerable.
A Comprehensive Study of the Impact of Tread Design on the Tire-Terrain Interaction using Advanced Computational Techniques
Authors: Ly Alfonse , El-Sayegh Zeinab , El-Gindy Moustafa , Oijer Fredrik , Johansson Inge
Published: April 2023

This paper investigates the impact of tread design on the tire-terrain interaction of two similar-sized truck tires with distinctly different tread designs running over various terrains and operating conditions using advanced computation techniques. The two truck tires used in the research are off-road tires sized 315/80R22.5 wide which were designed through Finite Element Analysis (FEA). The truck tire models were validated in static and dynamic domains using several simulation tests and measured data. The terrain includes a flooded surface and a snowed surface which were modelled using Smoothed-Particle Hydrodynamics (SPH) technique and calibrated using pressure-sinkage and direct shear tests. Both truck tire models were subjected to rolling resistance and cornering tests over the various flooded surface and snowed surface terrain conditions on the PAM-CRASH software. Other tire operating conditions included varying vertical loads, terrain depths, longitudinal speeds, and slip angles. The flooded surface depth was set up at 0%, 10%, and 25% sidewall height, and the snowed surface depth was set up at 10%, 35%, and 50% sidewall height. The truck tires were subjected to vertical loading of 13 kN, 27 kN, and 40 kN, longitudinal speeds of 10 km/h, 50 km/h, and 100 km/h, and slip angles of 2 degrees, 6 degrees, and 12 degrees. To study the impact of the different tread designs between the two similar-sized tires, the Rolling Resistance Coefficient (RRC), lateral force, self-aligning moment, and overturning moment were determined for both tires and compared.
Digital-Twin-Based Approaches and Applications for Improving Automotive Cybersecurity in Different Lifecycle Stages
Authors: Yu Jinghua , Lou Zeru , Hu Hongxing , Pu Geguang , Chen Mingsong
Published: April 2023

With the increasing connectivity and complexity of modern automobiles, cybersecurity has become one of the most important properties of a vehicle. Various strategies have been proposed to enhance automotive cybersecurity. Digital twin (DT), regarded as one of the top 10 strategic technology trends by Gartner in 2018 and 2019, establishes digital representations in a virtual world and raises new ideas to benefit real-life objects. In this paper, we explored the possibility of using digital twin technology to improve automotive cybersecurity. We designed two kinds of digital twin models, named mirror DT and autonomous DT, and corresponding environments to support cybersecurity design, development, and maintenance in an auto’s lifecycle, as well as technique training. The mirror DT, which displays the external behaviors of the physical object, collects, displays, and analyzes real-time data, for specific purposes like security analysis, anomaly detection, and so on. The autonomous DT models the internal logic of the real-world object, and is applicable for virtual design and debugging, system evaluation, and training in a purely virtual world. We proposed approaches for building the DT models, established a real-virtual interaction environment, and explored several feasible applications. Prototypes were developed to verify the effectiveness and expansibility of the proposed approaches and applications. In summary, DT technology helps engineers to improve work efficiency and effectiveness of cybersecurity design and management activities during the whole product lifecycle. Furthermore, the digital world is also ideal for professional training to help learners to better understand corresponding technics and do more exercises in the virtual world at a low cost.
Drivable Area Estimation for Autonomous Agriculture Applications
Authors: Alzu'bi Hamzeh , Varasquim Juliano , Taylor Elizabeth , Alrousan Qusay , Tasky Tom
Published: April 2023

Autonomous farming has gained a vast interest due to the need for increased farming efficiency and productivity as well as reducing operating cost. Technological advancement enabled the development of Autonomous Driving (AD) features in unstructured environments such as farms. This paper discusses an approach of utilizing satellite images to estimate the drivable areas of agriculture fields with the aid of LiDAR sensor data to provide the necessary information for the vehicle to navigate autonomously. The images are used to detect the field boundaries while the LiDAR sensor detects the obstacles that the vehicle encounters during the autonomous driving as well as its type. These detections are fused with the information from the satellite images to help the path planning and control algorithms in making safe maneuvers. The image and point cloud processing algorithms were developed in MATLAB®/C++ software and implemented within the Robot Operating System (ROS) middleware. Test results show that the presented approach was implemented successfully with robust detection of drivable areas in a farm environment.
Automated Vehicle Perception Sensor Evaluation in Real-World Weather Conditions
Authors: Goberville Nicholas A , Ahmed Sahil , Iliev Simeon , Pervan Boris
Published: April 2023

Perception in adverse weather conditions is one of the most prominent challenges for automated driving features. The sensors used for mid-to-long range perception most impacted by weather (i.e., camera and LiDAR) are susceptible to data degradation, causing potential system failures. This research series aims to better understand sensor data degradation characteristics in real-world, dynamic environmental conditions, focusing on adverse weather. To achieve this, a dataset containing LiDAR (Velodyne VLP-16) and camera (Mako G-507) data was gathered under static scenarios using a single vehicle target to quantify the sensor detection performance. The relative position between the sensors and the target vehicle varied longitudinally and laterally. The longitudinal position was varied from 10m to 175m at 25m increments and the lateral position was adjusted by moving the sensor set angle between 0 degrees (left position), 4.5 degrees (center position), and 9 degrees (right position). The tests were conducted on three days, one day representing the following weather conditions: clear, rain, and snow. The LiDAR performance was evaluated by comparing the return point count and return point power intensity from the target vehicle. The camera performance was quantified using a YOLOv5 model to perform object detection inference, tracking the detection confidence, inaccurate classification count (type I error), and misclassification count (type II error) of the target vehicle. Overall, LiDAR showed power intensity reduction by 22.42% and 29.30% in rain and snow, respectively, while camera confidence results were not impacted by the mild weather conditions.
Unstructured Road Region Detection and Road Classification Algorithm Based on Machine Vision
Authors: XIE Fei , Zhang Jian , Wang Chao , Liu Qiuzheng , Hong Ri , Yanchen Liu
Published: April 2023

Accurate sensing of road conditions is one of the necessary technologies for safe driving of intelligent vehicles. Compared with the structured road, the unstructured road has complex road conditions, and the response characteristics of vehicles under different road conditions are also different. Therefore, accurately identifying the road categories in front of the vehicle in advance can effectively help the intelligent vehicle timely adjust relevant control strategies for different road conditions and improve the driving comfort and safety of the vehicle. However, traditional road identification methods based on vehicle kinematics or dynamics are difficult to accurately identify the road conditions ahead of the vehicle in advance.

Therefore, this paper proposes an unstructured road region detection and road classification algorithm based on machine vision to obtain the road conditions ahead. Firstly, a vehicle data acquisition platform is built based on a Logitech HD camera, which is used to synchronously collect road image information and vehicle status signals. Secondly, aiming at the problem of unclear road edges of unstructured roads, threshold segmentation and connected domain analysis method are used to detect the road region in the image, and Canny operator is combined to realize road edge detection and road boundary fitting. Then, a road classification and post-processing algorithm based on vision and mileage information is proposed to resist the impact of sudden change of recognition results on continuous sections of complex unstructured roads.

Finally, the algorithm is tested and verified based on the collected real vehicle data playback. The results show that the designed unstructured road classification algorithm can accurately identify the changes of road categories, with an average accuracy of 94.57% on asphalt road, brick road, dirt road, and gravel road.
Optimizing Long Term Hydrogen Fueling Infrastructure Plans on Freight Corridors for Heavy Duty Fuel Cell Electric Vehicles
Authors: Siekmann Adam , Sujan Vivek
Published: April 2023

The development of a future hydrogen energy economy will require the development of several hydrogen market and industry segments including a hydrogen based commercial freight transportation ecosystem. For a sustainable freight transportation ecosystem, the supporting fueling infrastructure and the associated vehicle powertrains making use of hydrogen fuel will need to be co-established. This paper develops a long-term plan for refueling infrastructure deployment using the OR-AGENT (Optimal Regional Architecture Generation for Electrified National Transportation) tool developed at the Oak Ridge National Laboratory, which has been used to optimize the hydrogen refueling infrastructure requirements on the I-75 corridor for heavy duty (HD) fuel cell electric commercial vehicles (FCEV). This constraint-based optimization model considers existing fueling locations, regional specific vehicle fuel economy and weight, vehicle origin and destination (OD), vehicle volume by class and infrastructure costs to characterize in-mission refueling requirements for a given freight corridor. The authors applied this framework to determine the ideal long term public access locations for hydrogen refueling (constrained by existing fueling stations and dispensing technology), the minimal viable cost to deploy sufficient hydrogen fuel dispensers, and associated equipment, to accommodate a growing population of hydrogen fuel cell trucks. The framework discussed in this paper can be expanded and applied to additional electrified powertrains as well as a larger interstate system, expanded regional corridor, or other transportation networks.
In Line Nondestructive Testing for Sheet Metal Friction Stir Welding
Authors: Hunt Johnathon , Larsen Brigham , Hovanski Yuri
Published: April 2023

As automotive designs add more aluminum to lightweight their vehicles, friction stir welding (FSW) will likely become a principal joining process in the industry. FSW is a solid-state joining process which avoids many of the traditional problems of welding aluminum alloys such as hot cracking, porosity and solidification shrinkage. These attributes enable high preforming friction stir welded joints of cast, 5XXX, 6XXX, 7XXX or mixed aluminum alloy combinations. Although FSW technologies have advanced to support high volume applications and have been applied in current automotive parts, its inability for nondestructive evaluation (NDE) increases the cost to manufacture friction stir welded parts. Current state of the art NDE methods for FSW are either ultrasound or radiographic technologies which add complexity to manufacturing lines and additional costs to FSW production. Many have researched ways to reduce NDE costs by using measured forces of the FSW process. These methods have included trained neural networks (NN) that result in accurate defect predictions that can be applied in an industrial setting. Although NN provide an alternative solution to traditional NDE methods, they require large amounts of training and can only inspect welds that share exact welding parameters and machinery that were included in the training. An ideal FSW NDE method would reduce costs and be able to be applied on multiple welding machines and with a variety of parameters. The cost of a cited generalized force based stochastic NDE method in an industrial setting will be validated by an automotive production example here in.
Analysis of a Full-Stack Data Analytics Solution Delivering Predictive Maintenance
Authors: Hoyt Nathan , Smith Nathaniel , Tenny Joe , Hovanski Yuri
Published: April 2023

With the developments of Industry 4.0, data analytics solutions and their applications have become more prevalent in the manufacturing industry. Currently, the typical software architecture supporting these solutions is modular, using separate software for data collection, storage, analytics, and visualization. The integration and maintenance of such a solution requires the expertise of an information technology team, making implementation more challenging for small manufacturing enterprises. To allow small manufacturing enterprises to feasibly obtain the benefits of Industry 4.0 data analytics, a full-stack data analytics framework is presented, and its performance evaluated as applied in the common industrial analytics scenario of predictive maintenance. The predictive maintenance approach was achieved by using a full-stack data analytics framework comprised of the PTC Inc. Thingworx software suite. When deployed on a lab-scale factory, there was a significant increase in factory uptime in comparison with both preventive and reactive maintenance approaches. The predictive maintenance approach simultaneously eliminated unexpected breakdowns and extended the uptime periods of the lab-scale factory. This research concluded that similar or better results may be obtained in actual factory settings, since the only source of error on predictions in the testing scenario would not be present in real world scenarios. An analysis of the effect of downtime period durations and discussion on the cost of reactive maintenance and associated breakdowns is also presented.