bluuebunny/crossref_metadata_2025 huggingface dataset:
Energy Control Strategy for Parallel Hybrid Electric Vehicle Based on Terminal Neural Network
Authors: Yan Haitao , Xu Yongzhi
Published: November 2021

Energy control strategy is a key technology of hybrid electric vehicle, and its control effect directly affects the overall performance of the vehicle. The current control strategy has some shortcomings such as poor adaptability and poor real-time performance. Therefore, a transient energy control strategy based on terminal neural network is proposed. Firstly, based on the definition of instantaneous control strategy, the equivalent fuel consumption of power battery was calculated, and the objective function of the minimum instantaneous equivalent fuel consumption control strategy was established. Then, for solving the time-varying nonlinear equations used to control the torque output, a terminal recursive neural network calculation method using BARRIER functions is designed. The convergence characteristic is analyzed according to the activation function graph, and then the stability of the model is analyzed and the time efficiency of the error converging to zero is deduced. Using ADVISOR software, the hybrid power system model is simulated under two typical operating conditions. Simulation results show that the hybrid electric vehicle using the proposed instantaneous energy control strategy can not only ensure fuel economy but also shorten the control reaction time and effectively improve the real-time performance.
Investing in Renewable Energy and Energy Efficiency in Palestinian Territories: Barriers and Opportunities
Authors: Yasin Aysar , Camporeale Cecilia , Alsayed Mohammed , Del Ciello Roberto , Yaseen Basel
Published: November 2021

The main objective of this paper is to identify the renewable energy (RE) and energy efficiency (EE) policy and regulatory risks and barriers in the Palestinian Territories (PT). An accurate insight into the market structure and normative frameworks for RE and EE investments in the PT is performed. For this purpose, a survey has been conducted through two questionnaires and interviews addressed to public decision-makers and local and foreign sectoral companies to study the market confidence in the field of renewable energy sources (RES) and EE. The questionnaire was designed to investigate the attractiveness of RE and EE in the country by directly involving the various market players and to identify what could encourage or hinder investment. RE and EE are, in fact, a valid response to the needs of the PT to guarantee independence and security of supply, ensure access to energy throughout the territory, and reduce emissions. The climate-related issues are listed in the Palestinian political agenda. National subsidies and grants are offered for investment in RES and EE but are still the main barriers. Developments towards further utilization of RES are in progress continually. Marketing campaigns are stimulating the production of RE and EE promotion. RES and EE laws and regulations are continually issued.
Challenges of Diagnosing Severe Ehrlichiosis in Orthotopic Liver Transplant Recipients
Authors: Parkinson Melissa , Vuyyuru Spandana , Patel Jay , Animalu Chinelo
Published: November 2021

In recent solid organ transplant recipients, acute febrile illness is usually a source of grave concern and a diagnostic dilemma, especially if no response is noted after initiation of broad antimicrobial therapy. Human Monocytic Ehrlichiosis (HME) is a tick-borne illness caused by Ehrlichia chaffeensis and is not considered an opportunistic infection in immunocompromised patients such as solid organ transplant patients. Ehrlichiosis in immunocompromised patients can be life-threatening, and a strong index of suspicion is needed, especially in patients who live in endemic areas, for proper treatment initiation with doxycycline. We report a case of a 40-year-old male who received an orthotopic liver transplant six months earlier secondary to primary sclerosing cholangitis, on chronic immunosuppressive medication, who presented with complaints of sudden onset fever associated with nausea, vomiting, and diarrhea. Initial extensive infectious workup was negative and no response to empiric antimicrobials. There was suspicion for ehrlichiosis prompting empiric doxycycline use. Subsequently, E. chaffeensis polymerase chain reaction (PCR) was positive, and the antibiotic regimen was de-escalated to only doxycycline with complete resolution of his symptoms and progressive improvement in previously abnormal biochemical indices.
Robustness of Supersaturated Design to Study the Causes of Medical Errors
Authors: Abdulrahman Alanazi Talal , Alshammari Abdalwahab Omar , Alhur Anas , Alhur Afrah Ali
Published: November 2021

Background. In the modern contemporary, there are obvious demands for accurate interpretations of the worldwide problem, which is medication errors (MEs) due to various serious negative events that effect patient health. Most parts of the world considered health as significant issue for centuries. Recently, investigators have examined the effects of writing physician orders from the nurse’s viewpoint and represent that 100% of ambiguous writing of doctor orders related directly to MEs. Objective. The aim of our work is to investigate the major causes of (MEs) in the Saudi Arabia population from multiple aspects. Methods. An online review gave quantitative information from 450 members. Respondents were heedlessly parceled into two conditions (Yes+, No−) and mentioned to respond to one of two plans of the explanations behind the medical errors. Fourteen determining factors in the predesign have been chosen. Entire data were collected relevant to the study purpose and the content of the questionnaire written suitably to the participants with no ambiguous terms to analyze obtained data accurately using supersaturated plans and regression methods utilizing the SPSS program to decide the real causes of the medical errors. Results. The findings indicated that often failures in the care process can be traced back to poor documentation and a lack or inadequacy of procedures; the limitations of integrated health systems between the doctor and pharmacists, human problems when standards of care, policies, processes, or procedures are not properly or effectively followed, inadequate use of technology in healthcare facilities, and unclear line of prescription from the doctor are factors that contributed to the medical errors. Conclusion. The Saudi Arabian government needs to foster a functional arrangement to examine these reasons for medical errors and make a move. Future investigations could break down the information utilizing edge plans technique.
Potential Therapeutic Effect of Citronellal on Diabetic Cardiomyopathy in Experimental Rats
Authors: Lu Jun-Xiu , Qiu Yue , Guo Li-Juan , Song Ping , Xu Jian , Wan Guang-Rui , Wang Shuang-Xi , Yin Ya-Ling , Li Peng
Published: November 2021

Diabetic cardiomyopathy (DCM), a cardiovascular complication of patients with diabetes, is a special cardiomyopathy that is independent of coronary heart disease, hypertension, and valvular disease. Citronellal (CT) is a monoterpene compound generated by the secondary metabolism of plants. In this work, the therapeutic effect and mechanism of CT in DCM were investigated. Experimental diabetic rat models were constructed through a high-fat and high-carbohydrate diet combined with low-dosage streptozotocin (STZ) treatment. CT was intragastrically administered at the dosage of 150 mg/kg/day. The cardiac functions of the rats were evaluated via cardiac Doppler ultrasound. Changes in myocardial structure were analyzed through histopathology. Changes in the representative indices of oxidative stress, namely, superoxide dismutase (SOD) activity and malondialdehyde (MDA) content were detected on the basis of a biochemical test. Related protein levels were assayed via immunofluorescence and Western blot analyses. The DCM rats in the nontreatment group experienced diastolic and systolic dysfunctions, associated with myocardial hypertrophy, fibrosis, and cardiomyocyte apoptosis. Moreover, this condition was concurrent with metabolic disorders, the degradation of SOD activity in myocardial tissues, the increase in MDA content, the abnormal activation of sodium–hydrogen exchanger 1 (NHE1), and the aggravation of cell apoptosis (Bax levels were elevated, whereas Bcl-2 levels decreased). Myocardial hypertrophy, fibrosis, oxidative stress, and cell apoptosis were obviously inhibited after treatment with CT (150 mg/kg/day). The abnormal activation of NHE1 was recovered under the action of CT. Our study results showed that CT might play a protective role in the treatment of DCM by repressing the abnormal activation of NHE1.
The Role of Apolipoprotein E ε4 in Early and Late Mild Cognitive Impairment
Authors: Luo Yulin , Tan Li , Therriault Joseph , Zhang Hua , Gao Ying ,   and the Alzheimer’s Disease Neuroimaging Initiative
Published: November 2021

Background: Apolipoprotein E (APOE) ε4 is highly associated with mild cognitive impairment (MCI). However, the specific influence of APOE ε4 status on tau pathology and cognitive decline in early MCI (EMCI) and late MCI (LMCI) is poorly understood. Our goal was to evaluate the association of APOE ε4 with cerebrospinal fluid (CSF) tau levels and cognition in EMCI and LMCI patients in the Alzheimer’s Disease Neuroimaging Initiative database, and whether this association was mediated by amyloid-β (Aβ). Methods: Participants were 269 cognitively normal (CN), 262 EMCI, and 344 LMCI patients. They underwent CSF Aβ42 and tau detection, APOE ε4 genotyping, Mini-Mental State Examination, (MMSE), and Alzheimer’s disease assessment scale (ADAS)-cog assessments. Linear regressions were used to examine the relation of APOE ε4 and CSF tau levels and cognitive scores in persons with and without Aβ deposition (Aβ+ and Aβ−). Results: The prevalence of APOE ε4 is higher in EMCI and LMCI than in CN (p < 0.001 for both), and in LMCI than in EMCI (p = 0.001). APOE ε4 allele was significantly higher in Aβ+ subjects than in Aβ− subjects (p < 0.001). Subjects who had a lower CSF Aβ42 level and were APOE ε4-positive experienced higher levels of CSF tau and cognitive scores in EMCI and/or LMCI. Conclusions: An APOE ε4 allele is associated with increased CSF tau and worse cognition in both EMCI and LMCI, and this association may be mediated by Aβ. We conclude that APOE ε4 may be an important mediator of tau pathology and cognition in the early stages of AD.
MRI-Derived Fetal Weight Estimation in the Midpregnancy Fetus: A Method Comparison Study
Authors: Matthew Jacqueline , Skelton Emily , Story Lisa , Davidson Alice , Knight Caroline L. , Gupta Chandni , Pasupathy Dharmintra , Rutherford Mary
Published: November 2021

Objectives: The aim of this study was to compare the standard ultrasound (US) estimated fetal weight (EFW) and MRI volume-derived methods for the midtrimester fetus. Methods: Twenty-five paired US and MRI scans had the EFW calculated (gestational age [GA] range = 20–26 weeks). The intra- and interobserver variability of each method was assessed (2 operators/modality). A small sub-analysis was performed on 5 fetuses who were delivered preterm (mean GA 29 +3 weeks) and compared to the actual birthweight. Results: Two MRI volumetry EFW formulae under-measured compared to US by −10.9% and −14.5% in the midpregnancy fetus (p < 0.001) but had excellent intra- and interobserver agreement (intraclass correlation coefficient = 0.998 and 0.993). In the preterm fetus, the mean relative difference (MRD) between the MRI volume-derived EFW (MRI-EFW) and actual expected birthweight (at the scan GA) was −13.7% (−159.0 g, 95% CI: −341.7 to 23.7 g) and −17.1% (−204.6 g, 95% CI: −380.4 to −28.8 g), for the 2 MRI formulae. The MRD was smaller for US at 5.3% (69.8 g, 95% CI: −34.3 to 173.9). Conclusions: MRI-EFW results should be interpreted with caution in midpregnancy. Despite excellent observer agreement with MRI volumetry, refinement of the EFW formula is needed in the second trimester, for the small and for the GA and preterm fetus to compensate for lower fetal densities.
IgA Nephropathy Secondary to Ipilimumab Use
Authors: Dougherty Sean C. , Desai Nisa , Cathro Helen P. , Renaghan Amanda
Published: November 2021

Ipilimumab is a human monoclonal antibody targeting cytotoxic T-lymphocyte-associated protein 4 approved for the treatment of non-small-cell lung cancer (NSCLC) and other malignancies. Despite a high prevalence of other immune-related adverse events (irAEs), checkpoint inhibitor (CPI)-related nephrotoxicity has been reported less frequently. In this clinical case report, we describe the evaluation of a 70-year-old female with stage IV NSCLC who presented with nephrotic range proteinuria 4 weeks after receiving her first cycle of ipilimumab. She underwent a renal biopsy and was found to have IgA nephropathy that was presumed to be secondary to ipilimumab use, given recent initiation of therapy and clinical history. Unfortunately, despite prompt initiation of corticosteroids, her acute kidney injury progressed and she required hemodialysis, later transitioning to hospice. To our knowledge, this is one of few reported cases of IgA nephropathy secondary to CPI use. With increasing use of CPIs, this case further emphasizes the need for continued surveillance for irAEs, which can occur at any point in a patient’s treatment course.
Increase in Chondroitin Sulfate and Decline in Arylsulfatase B May Contribute to Pathophysiology of COVID-19 Respiratory Failure
Authors: Tzankov Alexandar , Bhattacharyya Sumit , Kotlo Kumar , Tobacman Joanne K.
Published: November 2021

Introduction: The potential role of accumulation of chondroitin sulfates (CSs) in the pathobiology of COVID-19 has not been examined. Accumulation may occur by increased synthesis or by decline in activity of the enzyme arylsulfatase B (ARSB; N-acetylgalactosamine-4-sulfatase) which requires oxygen for activity. Methods: Immunostaining of lung tissue from 28 patients who died due to COVID-19 infection was performed for CS, ARSB, and carbohydrate sulfotransferase (CHST)15. Measurements of mRNA expression of CHST15 and CHST11, sulfotransferase activity, and total sulfated glycosaminoglycans (GAGs) were determined in human vascular smooth muscle cells following angiotensin (Ang) II treatment. Results: CS immunostaining showed increase in intensity and distribution, and immunostaining of ARSB was diminished in COVID-19 compared to normal lung tissue. CHST15 immunostaining was prominent in vascular smooth muscle cells associated with diffuse alveolar damage due to COVID-19 or other causes. Expression of CHST15 and CHST11 which are required for synthesis of CSE and chondroitin 4-sulfate, total sulfated GAGs, and sulfotransferase activity was significantly increased following AngII exposure in vascular smooth muscle cells. Expression of Interleukin-6 (IL-6), a mediator of cytokine storm in COVID-19, was inversely associated with ARSB expression. Discussion/Conclusion: Decline in ARSB and resulting increases in CS may contribute to the pathobiology of COVID-19, as IL-6 does. Increased expression of CHSTs following activation of Ang-converting enzyme 2 may lead to buildup of CSs.
Dissociative-Traumatic Dimension and Triple Network: An EEG Functional Connectivity Study in a Sample of University Students
Authors: Carbone Giuseppe Alessio , Imperatori Claudio , Bersani Francesco Saverio , Massullo Chiara , Orlando Egle Maria , Farina Benedetto
Published: November 2021

Aims: We investigated the association among triple network electroencephalographic (EEG) functional connectivity, dissociative symptoms, and childhood trauma (CT) in a sample of university students. Sampling and Methods: Seventy-six participants (30 males and 46 females; mean age 22.12 ± 2.35) completed self-report measures investigating dissociative symptoms, CT, and depressive symptoms. Participants also performed an eyes-closed resting-state EEG recording. EEG analyses were conducted through the exact low-resolution electromagnetic tomography (eLORETA) software. Results: A 2-step cluster analysis revealed 2 groups: participants (N = 23) with high dissociative-traumatic dimension symptoms (DTD+) and participants (N = 53) with low DTD symptoms (DTD−). Compared to DTD− subjects, DTD+ participants showed decreased theta connectivity between the salience network (SN) and central executive network (CEN), specifically between the right anterior insula and the left posterior parietal cortex. No significant correlation was detected between EEG data and clinical variables. Conclusion: Our results raise the possibility of a dysfunctional connectivity pattern occurring between the SN and CEN in individuals with high DTD symptoms. Such connectivity pattern might reflect the neuropsychophysiological disintegration related to pathological dissociation.
Association between Genetic Polymorphisms of MIR3142HG and the Risk of Steroid-Induced Osteonecrosis of the Femoral Head in the Population of Northern China
Authors: Wang Tiantian , Wu Huiqiang , Sun Menghu , Liu Tingting , An Feimeng , Dong Qiumei , Wang Jianzhong
Published: November 2021

Background: Steroid-induced osteonecrosis of the femoral head (ONFH) is aseptic necrosis of the femoral head caused by glucocorticoid use. Once necrotic femoral head necrosis occurs, it irreversibly affects the quality of life seriously. Studies have shown that the susceptibility to steroid-induced ONFH is likely to be related to the variation of miRNA-coding genes. Therefore, this study aimed was to investigate the effect of MIR3142HG on steroid-induced ONFH. Methods: Agena MassARRAY was used to genotype MIR3142HG gene rs1582417, rs2431689, rs7727155, and rs17057846 in 199 patients and 725 healthy people. A genetic model and haplotype analysis were used to evaluate the relationship between the MIR3142HG polymorphism and the risk of steroid-induced ONFH. The odds ratio and 95% confidence intervals were obtained through logistic regression to assess the influence of gene polymorphisms on the occurrence of steroid-induced ONFH. Results: The consequences show that rs7727115 is a protective factor, it could reduce the risk of steroid-induced ONFH, and rs1582417 could increase the risk of steroid-induced ONFH. In the genetic model, rs1582417 was associated with increased risk of alcohol-induced ONFH in dominant model and log-additive model. rs7727115 showed a decreased risk in codominant model, dominant model, and log-additive model. In addition, rs2431689 is related to HDL-C (p = 0.012) and ApoA1 (p = 0.010) levels, and rs17057846 (p = 0.024) is related to ApoB levels. Thelinkage analysis indicated 3 single-nucleotide polymorphisms (rs2431689, rs7727115, and rs17057846) in MIR3142HG with significant chain imbalance. In addition, haplotype “GGG” of MIR3142HG was found out and is harmful for steroid-induced ONFH. Conclusion: Our results first confirm that the genetic polymorphism of MIR3142HG is associated with steroid-induced ONFH susceptibility in Chinese Han population.
What Are the Key Points of Treatment for Cases of Mild Cognitive Impairment? Based on the Evaluation of Cognitive Function Tasks in the ADASJcog
Authors: Yoshii Yoshihiko , Takahashi Akiko , Ishizawa Miyuki
Published: November 2021

Background/Aims: The aims of this study were to identify the degree of atrophy of the hippocampus in image findings and which cognitive function items should be focused on when treating mild cognitive impairment. Methods: A total of 66 cases with mild cognitive impairment were included in the study over a 1.5-year observation period. MR images were used to assess hippocampal atrophy, and cognitive function was assessed by the ADASJcog test. Results: In the mild dementia group, there was a hierarchical difference in the 4 cognitive impairments in which each degree was significantly higher hierarchically. In the normally improved group, memory and act dysfunction was significantly improved, and in deteriorated cases, memory, orientation, and act dysfunction increased significantly. The normally improved group tended to have lighter hippocampal atrophy than the deteriorating group. Discussion: In early treatment of mild cognitive impairment, it is important to focus on which cognitive items to treat, but there are no reports that present them numerically. Because it is not clear, there may be a risk that dementia may progress due to stunned treatment. It became clear that it was meaningful to show it, and it was the orientation and act function. Conclusion: It was suggested that hippocampal atrophy should be kept within the normal range and that the key treatment was mainly to improve memory and act dysfunction without reducing orientation function.
Design and Validation of an Expanded Disability Status Scale Model in Multiple Sclerosis
Authors: Barreiro-González Antonio , Sanz Maria T. , Carratalà-Boscà Sara , Pérez-Miralles Francisco , Alcalá Carmen , Carreres-Polo Joan , España-Gregori Enrique , Casanova Bonaventura
Published: November 2021

Introduction: We aimed to develop and validate an Expanded Disability Status Scale (EDSS) model through clinical, optical coherence tomography (OCT), and magnetic resonance imaging (MRI) measures. Methods: Sixty-four multiple sclerosis (MS) patients underwent peripapillary retinal nerve fiber layer and segmented macular layers evaluation through OCT (Spectralis, Heidelberg Engineering). Brain parenchymal fraction was quantified through Freesurfer, while cervical spinal cord (SC) volume was assessed manually guided by Spinal Cord Toolbox software analysis. EDSS, neuroradiological, and OCT assessment were carried out within 3 months. OCT parameters were calculated as the average of both nonoptic neuritis (ON) eyes, and in case the patient had previous ON, the value of the fellow non-ON eye was taken. Brain lesion volume, sex, age, disease duration, and history of disease-modifying treatment (1st or 2nd line disease-modifying treatments) were tested as covariables of the EDSS score. Results: EDSS values correlated with patient’s age (r = 0.543, p = 0.001), SC volume (r = −0.301, p = 0.034), and ganglion cell layer (GCL, r = −0.354, p = 0.012). Using these correlations, an ordinal regression model to express probability of diverse EDSS scores were designed, the highest of which was the most probable (Nagelkerke R2 = 43.3%). Using EDSS cutoff point of 4.0 in a dichotomous model, compared to a cutoff of 2.0, permits the inclusion of GCL as a disability predictor, in addition to age and SC. Conclusions: MS disability measured through EDSS is an age-dependent magnitude that is partly conditioned by SC and GCL. Further studies assessing paraclinical disability predictors are needed.
Effects of Increased Central Cholinergic Activity on the Metabolic Challenge Induced by Submaximal Exercise in Rats: Adrenomedullary Secretion Influences
Authors: Rodrigues Alex Guazzi , Campos Helton Oliveira , Drummond Lucas Rios , Marubayashi Umeko , Coimbra Cândido Celso
Published: November 2021

Aim: The aim of this study was to assess the influence of adrenomedullary secretion on the plasma glucose, lactate, and free fatty acids (FFAs) during running exercise in rats submitted to intracerebroventricular (i.c.v.) injection of physostigmine (PHY). PHY i.c.v. was used to activate the central cholinergic system. Methods: Wistar rats were divided into sham-saline (sham-SAL), sham-PHY, adrenal medullectomy-SAL, and ADM-PHY groups. The plasma concentrations of glucose, lactate, and FFAs were determined immediately before and after i.c.v. injection of 20 μL of SAL or PHY at rest and during running exercise on a treadmill. Results: The i.c.v. injection of PHY at rest increased plasma glucose in the sham group, but not in the ADM group. An increase in plasma glucose, lactate, and FFAs mobilization from adipose tissue was observed during physical exercise in the sham-SAL group; however, the increase in plasma glucose was greater with i.c.v. PHY. Moreover, the hyperglycemia induced by exercise and PHY in the ADM group were blunted by ADM, whereas FFA mobilization was unaffected. Conclusion: These results indicate that there is a dual metabolic control by which activation of the central cholinergic pathway increases plasma glucose but not FFA during rest and exercise, and that this hyperglycemic response is dependent on adrenomedullary secretion.
A Scoping Review of Alternative Anticoagulation Strategies for Hemodialysis Patients with a Mechanical Heart Valve
Authors: Thomson Benjamin K.A. , Pilkey Nathan G. , Monteith Bethany , Holden Rachel M.
Published: November 2021

Introduction: Patients with end-stage renal disease (ESRD) have high rates of cardiac valvulopathy but can develop contraindications for vitamin K antagonist (VKA) therapy. We explored the evidence for alternative anticoagulation strategies in patients with ESRD with a contraindication for VKA therapy. Methods: A scoping review was completed, searching MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Conference abstracts from inception to March 30, 2021. The study population was patients with ESRD who were on VKA therapy and developed a contraindication to VKA therapy use. All data regarding studies, patient characteristics, anticoagulation strategy, and clinical outcomes were summarized. Results: Twenty-three articles met inclusion criteria. These articles included 57 patients. Contraindications to VKA therapy included calcific uremic arteriolopathy (CUA) (n = 55) and warfarin-induced skin necrosis (n = 2). All studies were either case reports or case series. There were 10 anticoagulation strategies identified. Continuation of VKA therapy was associated with increased death and decreased rates of CUA resolution (80.0% and 10.0%, respectively), compared to apixaban (24.0% and 70.8%), subcutaneous (SC) low-molecular-weight heparin (LMWH) (14.3%, 85.7%), and SC unfractionated heparin (0.0%, 100.0%). While only 5 patient cases were reported with mechanical heart valves, SC LMWH use has been reported in this context with good outcomes. Conclusions: In patients with ESRD who develop a contraindication to VKA therapy, several alternative anticoagulation strategies have been reported with superior outcomes to VKA continuation. While outcomes appear superior to continuation of VKA therapy, more data are required before definitive recommendations can be made for the patient with ESRD and a mechanical heart valve.
Evaluation of Fetal Renal Artery Doppler Indices in Pregnancies Complicated with Preeclampsia
Authors: Kaya Serdar , Kaya Basak
Published: November 2021

Objective: Preeclampsia, characterized by endothelial dysfunction, is associated with maternal and fetal Doppler alterations. This study aimed to evaluate fetal renal artery Doppler indices in pregnancies complicated with preeclampsia and compare them with normotensive pregnancies. Design: This cross-sectional study enrolled 46 pregnancies complicated with preeclampsia between weeks 24 and 37 of gestation as the study group and 48 normotensive pregnancies as the control group. Materials and Methods: The abdominal aorta, its bifurcation, and the renal arteries were visualized in the coronal view of the fetal abdomen using color Doppler. Renal artery Doppler indices were measured after arising from the abdominal aorta. The angle of insonation was ≤30° from the direction of blood flow, and the sample volume was 2 mm. Fetal renal artery pulsatility index, resistance index, systolic/diastolic ratio, and peak systolic velocity (PSV) were measured. All Doppler measurements were performed in the absence of fetal movements. Moreover, demographic characteristics and the perinatal outcome data of patients were recorded. Results: The values of fetal renal artery pulsatility and resistance indices were found to be significantly lower in the study group than those in the control group (p < 0.001 and p = 0.013, respectively). The fetal renal artery systolic/diastolic ratio and PSV values were also significantly lower in the study group compared with those in the control group (p = 0.007 and p < 0.001, respectively). Renal artery pulsatility and resistance indices were negatively correlated with mean arterial pressure (r = −0.381, p < 0.001 and r = −0.267, p = 0.009, respectively). The renal artery systolic/diastolic ratio was also significantly negatively correlated with the mean arterial pressure (r = −0.257, p = 0.013). Limitations: The main limitations of this study are its cross-sectional design and the small number of participants. Another limitation of the study is that preeclamptic pregnancies complicated with fetal growth restriction were not included. Conclusion: The observed decrease in fetal renal artery Doppler impedance may be caused by the unique response of the fetal renal artery to the factors involved in the etiopathogenesis of preeclampsia than other fetal peripheral vessels. These changes in fetal renal artery indices in pregnancies complicated with preeclampsia could be taken into account in the assessment of fetal health.
Efficacy of Fovea-Sparing Internal Limiting Membrane Peeling for Epiretinal Membrane Foveoschisis
Authors: Sekine Reio , Kogo Jiro , Jujo Tatsuya , Sato Keiji , Arizono Ibuki , Kawagoe Tatsukata , Tokuda Naoto , Kitaoka Yasushi , Takagi Hitoshi
Published: November 2021

Introduction: The aim of the study was to investigate the outcomes of vitrectomy with fovea-sparing internal limiting membrane (ILM) peeling (FSIP) for epiretinal membrane (ERM) foveoschisis based on new optical coherence tomography definitions. Methods: Twenty-three eyes of 22 patients (69.7 ± 9.9 years old) who underwent vitrectomy with FSIP without gas tamponade for ERM foveoschisis were analyzed. All patients underwent follow-up examinations for at least 12 months. In the FSIP technique, the ILM is peeled off in a donut shape, preserving the foveal ILM. The logarithm of the minimal angle of resolution best-corrected visual acuity (BCVA), central macular thickness (CMT), and surgical complications were examined. Results: The BCVA at 12 months improved significantly from baseline (p < 0.001). Baseline ellipsoid zone defects were found in 2 eyes (9%), and all defective eyes had recovered at 12 months. CMT decreased significantly from baseline (p < 0.001). Acute macular edema, full-thickness macular hole, and recurrence of ERM were not observed during follow-up. Discussion/Conclusion: FSIP achieved good visual outcome and retinal morphological change. Moreover, FSIP might avoid acute macular edema in ERM foveoschisis surgery.
Beyond Front-Line Therapy for Unresectable Gastroesophageal Adenocarcinoma: Are There Differences in Subsequent Therapy Sequencing?
Authors: Rogers Jane E. , Wang Xuemei , Trail Allison , Ajani Jaffer A.
Published: November 2021

Background: Platinum + fluoropyrimidine is a standard front-line therapy for unresectable gastroesophageal adenocarcinoma (GA). Subsequent therapy recommendations are ramucirumab + paclitaxel (RAM/PAC), taxane, irinotecan, or trifluridine-tipiracil. RAM/PAC is the preferred second-line choice; however, patients can have a contraindication due to cumulative neuropathy. Our study assessed varied sequencing of second-line and third-line therapies comparing RAM/PAC followed by fluoropyrimidine + irinotecan (FOLFIRI/CAPEIRI) versus the opposite sequence. Methods: We retrospectively analyzed metastatic GA patients who received at least 3 lines of therapy. Two cohorts were studied. Group A: RAM/PAC second-line with FOLFIRI/CAPEIRI third-line or group B: FOLFIRI/CAPEIRI second-line followed by RAM/PAC. Primary outcome was overall survival (OS). Results: Ninety-four patients were available for analysis (51 pts group A: 43 pts group B). No difference was observed in median OS from the start of second-line therapy (group A = 10.5 months vs. group B = 11.1 months, p = 0.97) or median OS from metastatic disease diagnosis (group A = 19.8 months vs. group B = 19.4 months, p = 0.73). Conclusions: Our study, examining a practical issue of how to sequence second- and third-line therapies, documents that one sequence versus the other does not compromise patient outcomes and overall, our patients had an outstanding OS of beyond 19 months when they receive third-line therapy.
Termos da agricultura familiar em Libras
Authors:   Instituto Federal do Pará, Magalhães Claudia do Socorro Azevedo , Neves Miranilde Oliveira ,   Neves, Suzuki Júlio César ,   Universidade de São Paulo. Faculdade de Filosofia, Letras e Ciências Humanas
Published: November 2021

Os autores mostram que as palavras nascem, modificam-se e são recriadas a partir de um novo contexto. Na Língua Brasileira de Sinais não é diferente, sobretudo no momento em que novos termos se fazem necessários, e, como a Libras é considerada nossa segunda Língua, evidentemente que a comunidade surda, assim como todas as Pessoas Surdas precisam da oferta de sinais ainda não constituídos . Enfatiza-se as palavras Pessoas Surdas com iniciais maiúsculas, para diferenciar surdas/surdos que fazem uso da língua de sinais e constroem sua identidade baseada em um corpo diferente e não deficiente, além de usar a simbolização do mundo a partir da língua de sinais construída nas estruturas dos estudos surdos. O livro oferece a oportunidade de acessar-se termos, que, de acordo com pesquisas realizadas, ainda não foram catalogados oficialmente e disponibilizados. A obra também apresenta alguns sinais diferentes que facilitarão o processo formativo da Pessoa Surda e ampliarão suas redes de contato e de comunicação. Ressalta-se que o reconhecimento da Libras no Brasil como segundo idioma oficial só se estabeleceu em 2002 e o fato de este livro ter sido elaborado a partir da realidade local na qual se insere o Campus Castanhal do IFPA, com cursos que valorizam o Desenvolvimento Rural Sustentável, a Agropecuária, Aquicultura, Meio Ambiente, Agroindústria, Floresta, Agronomia, Engenharia de Pesca, dentre outros.
Effects of Arterial Stiffness and Carotid Intima-Media Thickness Progression on the Risk of Overweight/Obesity and Elevated Blood Pressure/Hypertension: a Cross-Lagged Cohort Study
Authors: Agbaje Andrew O. , Barker Alan R. , Tuomainen Tomi-Pekka
Published: November 2021

We examined the temporal longitudinal associations of carotid-femoral pulse wave velocity (cfPWV), a measure of arterial stiffness, and carotid intima-media thickness (cIMT) with the risk of overweight/obesity and elevated blood pressure (BP)/hypertension. We studied 3862 adolescents aged 17.7 years from the Avon Longitudinal Study of Parents and Children, followed-up for 7 years. cfPWV and cIMT were measured by ultrasound. Total and trunk fat mass and lean mass were assessed by dual-energy X-ray absorptiometry. Body mass index and BP were measured. Data were analyzed using logistic regression, linear mixed-effect, and cross-lagged structural equation models, with covariate adjustments. Among 1719 male and 2143 female participants, higher cfPWV at 17.7 years was associated with the risk of elevated systolic BP/hypertension (odds ratio, 1.20 [1.02–1.41];
P
=0.026), elevated diastolic BP/hypertension (1.77 [1.32–2.38];
P
<0.0001), body mass index-overweight/obesity (1.19 [1.01–1.41];
P
=0.041), and trunk fat mass overweight/obesity (1.24 [1.03–1.49];
P
=0.023) at 24.5 years. Higher cIMT at 17.7 years had no associations with obesity and elevated BP at follow-up. cfPWV progression was directly associated with 7-year increase in systolic BP (effect estimate 16 mm Hg [9–24];
P
<0.0001) and diastolic BP (28 mm Hg [23–34];
P
<0.0001). cIMT progression was directly associated with the 7-year increase of all adiposity measures and diastolic BP. In the temporal analysis, baseline cfPWV was directly associated with follow-up systolic and diastolic BP, however, baseline BP was unassociated with follow-up cfPWV. cfPWV but not cIMT was bidirectionally associated with adiposity. Obesity and hypertension prevention from adolescence may require developing novel approaches to mitigate arterial stiffness.
Performance of the RACE Prehospital Triage Score During Working and Nonworking Hours
Authors: Salahuddin Hisham , Castonguay Alicia C. , Hitomi Emi , Zaidi Syed F. , Shawver Julie , Korsnack Andrea , Burgess Richard , Kung Vieh , Jumaa Mouhammad
Published: November 2021

Background

Prehospital triage scores aim to identify large vessel occlusions (LVOs) in the field; however, their real‐world performance and accuracy across a 24‐hour period remains unknown. In this study, we compare the positive predictive value of the prehospital Rapid Arterial occlusion Evaluation (RACE) score for the detection of LVO during working hours and nonworking hours.

Methods

We performed a retrospective review of all patients presenting with a RACE score of ≥5 at one comprehensive and one thrombectomy‐capable hospital between July 2015 and December 2019. Patients were dichotomized to those presenting during “working hours” (7:00
am
to 6:00
pm
on weekdays) or “nonworking hours” (6:01
pm
to 6:59
am
on weekdays or anytime during weekends). The primary outcome was diagnosis of LVO. Secondary outcomes included diagnosis of acute neurovascular syndromes, door‐to‐treatment time metrics, and a modified Rankin Scale of ≤2 in those undergoing mechanical thrombectomy.

Results

Of the 701 patients with RACE score ≥5, 687 patients were included (355 nonworking hours and 332 working‐hours cohorts). Mean age was 71 and 72 years in the nonworking hours and working hours groups, respectively (
P
=0.13). Median National Institutes of Health Stroke Scale and baseline demographics were comparable between the 2 groups. There was no significant difference in the diagnosis of LVO (36.3% versus 34.6%;
P
=0.69) or final discharge diagnosis. The positive predictive value of the RACE score for the detection of an acute neurovascular syndrome (transient ischemic attack and stroke) was improved during nonworking hours (76.3% versus 67.8%;
P
=0.01). In patients undergoing mechanical thrombectomy, rates of good clinical outcome were similar (44.7% versus 48%;
P
=0.76), despite the shorter door‐to‐groin‐puncture and revascularization times during working hours.

Conclusions

The RACE score shows a consistent positive predictive value in determining LVO during working and nonworking hours. However, it is more accurate in determining acute neurovascular syndromes during nonworking hours, which is driven by a decrease in stroke mimics during this time.
‘We Are Soldiers in God’s Army’: Spiritual Warfare and Adoption of Military trope in Pentecostal Charismatic Churches in Southern Africa
Authors: Gukurume Simbarashe , Taru Josiah
Published: November 2021

Spiritual warfare is an important part of everyday life and rituals in Pentecostal churches in Africa and beyond. In Pentecostal parlance, the world is constructed and construed as a battleground between born-again Christians and Satanic forces. This article examines the ways in which Pentecostal Charismatic Churches in Southern Africa adopt and utilise military metaphors and trope in their everyday rituals and practices of spiritual warfare. Drawing on qualitative ethnographic fieldwork and in-depth interviews among three Pentecostal churches in Zimbabwe and South Africa, we argue that militarised metaphors are deployed as important symbolic and material weapons in the spiritual warfare against the devil and demonic forces. In the fight against the demonic, Pentecostal prophets and pastors cast themselves as the commanders, general and majors, leading an army of Christ. This army’s role is to defeat Satan and his demonic forces and expand the kingdom of God before the second coming of Christ.
The Windowless Room of the Present: Rereading David Harlan
Authors: Paul Herman
Published: November 2021

This essay unearths the guiding question of David Harlan’s 1997 book, The Degradation of American History. While most commentators have focused their attention on Harlan’s biting criticism of the historical profession, this essay argues that Harlan’s diatribe against historical scholarship pursued “for its own sake” stems from a deep concern about the moral education of citizens in an age that François Hartog and others typify as “presentist.” Although Harlan’s remedies against presentism are found wanting, the essay argues that the question raised in The Degradation of American History is a relevant, timely, and still unresolved one, now even more than at the time of the book’s original publication.
microRNA-265 Regulates Bone Marrow Mesenchymal Stem Cells Differentiation and Promotes Sepsis Lung Injury Repair via Transforming Growth Factor Beta 1
Authors: Tan Lian , Wang Xiongxiong , Chen Danqi , Xu Li , Xu Yudong , Hu Dongjun
Published: November 2021

Our study investigates whether miR-265 regulates the differentiation of rat bone marrow mesenchymal stem cells (BMSCs) into alveolar type II epithelial cells (ATII) through TGF-β1 and promotes lung injury repair in rats with sepsis, thereby inhibiting sepsis progression.
25 patients with sepsis admitted to the Respiratory and Critical Care Medicine Department of the hospital and 17 normal controls were included. TGF-β1 level was measured by ELISA. miR-265 level was measured by qRT-PCR and AT II-related genes and proteins expression was analyzed
by western blot and qRT-PCR. miR-265 expression was significantly higher in sepsis patients than normal group. Progenitor BMSCs were long and shuttle-shaped after 1 and 3 days of growth. Cultured MSCs had low expression of the negative antigen CD34 (4.32%) and high expression of the positive
antigen CD44 (99.87%). TGF-β1 level was significantly increased with longer induction time, while miR-265 expression was significantly decreased in cell culture medium. miR-265 interference significantly decreased TGF-β1 expression. In conclusion, miR-265 inhibits BMSC
differentiation to AT II via regulation of TGF-β1, thereby inhibiting sepsis progression.
In Vitro and In Vivo Degradation, Mechanical Properties, and Histocompatibility of Weft-Knitted Silk Mesh-Like Grafts
Authors: Tang Liang , Zhao Si-Yu , Yang Ya-Dong , Yang Geng , Zhang Wen-Yuan , Li Yue-Zhong
Published: November 2021

To investigate the degradation, mechanical properties, and histocompatibility of weft-knitted silk mesh-like grafts, we carried out the In Vitro and In Vivo silk grafts degradation assay. The In Vitro degradation experiment was performed by immersing the silk grafts
in simulated body fluid for 1 year, and the results showed that the degradation rate of the silk mesh-like grafts was very slow, and there were few changes in the mechanical properties and quality of the silk mesh-like graft. In Vivo degradation assay was taken by implantation of the
silk mesh-like grafts into the subcutaneous muscles of rabbits. At 3, 6, and 12 months postoperation, the rate of mass loss was 19.36%, 31.84%, and 58.77%, respectively, and the maximum load was 63.85%, 34.63%, and 10.76%, respectively of that prior to degradation. The results showed that
the degradation rate of the silk graft and the loss of mechanical properties In Vivo were faster than the results obtained in the In Vitro experiments. In addition, there were no significant differences in secretion of serum IL-6 and TNF-α between the experimental
and normal rabbits (P >0.05), suggesting no obvious inflammatory reaction. The findings suggest that the weft-knitted silk mesh-like grafts have good mechanical properties, histocompatibility, and In Vivo degradation rate, and therefore represent a candidate material for artificial
ligament
Shallow Cumulus Properties as Captured by Adiabatic Fraction in High-Resolution LES Simulations
Authors: Eytan Eshkol , Khain Alexander , Pinsky Mark , Altaratz Orit , Shpund Jacob , Koren Ilan
Published: November 2021

Shallow convective clouds are important players in Earth’s energy budget and hydrological cycle, and are abundant in the tropical and subtropical belts. They greatly contribute to the uncertainty in climate predictions due to their unresolved, complex processes that include coupling between the dynamics and microphysics. Analysis of cloud structure can be simplified by considering cloud motions as a combination of moist adiabatic motions like adiabatic updrafts and turbulent motions leading to deviation from adiabaticity. In this work, we study the sizes and occurrence of adiabatic regions in shallow cumulus clouds during their growth and mature stages, and use the adiabatic fraction (AF) as a continuous metric to describe cloud processes and properties from the core to the edge. To do so, we simulate isolated trade wind cumulus clouds of different sizes using the System of Atmospheric Modeling (SAM) model in high resolution (10 m) with the Hebrew University spectral bin microphysics (SBM). The fine features in the clouds’ dynamics and microphysics, including small near-adiabatic volumes and a thin transition zone at the edge of the cloud (∼20–40 m in width), are captured. The AF is shown to be an efficient measure for analyzing cloud properties and key processes determining the droplet-size distribution formation and shape during the cloud evolution. Physical processes governing the properties of droplet size distributions at different cloud regions (e.g., core, edge) are analyzed in relation to AF.

Significance Statement

1) This study investigates the evolution of cumulus clouds (Cu) using a 10-m-resolution LES model with spectral bin microphysics. 2) The study improves the understanding of the mutual effects of adiabatic updrafts and lateral entrainment and mixing. 3) The study demonstrates the existence of an adiabatic core in nonprecipitating Cu. 4) Shapes of the droplet size distributions are closely related to the adiabatic fraction values. 5) Utilization of high resolution reveals the existence of physically significant small features in the cloud structure, such as a narrow cloud interface zone and small adiabatic volumes.
Using SEEPS with a TRMM-Derived Climatology to Assess Global NWP Precipitation Forecast Skill
Authors: North Rachel C. , Mittermaier Marion P. , Milton Sean F.
Published: November 2021

Monitoring precipitation forecast skill in global numerical weather prediction (NWP) models is an important yet challenging task. Rain gauges are inhomogeneously distributed, providing no information over large swathes of land and the oceans. Satellite-based products, on the other hand, provide near-global coverage at a resolution of ∼10–25 km, but limitations on data quality (e.g., biases) must be accommodated. In this paper the stable equitable error in probability space (SEEPS) is computed using a precipitation climatology derived from the Tropical Rainfall Measuring Mission (TRMM) TMPA 3B42 V7 product and a gauge-based climatology and then applied to two global configurations of the Met Office Unified Model (UM). The representativeness and resolution effects on an aggregated SEEPS are explored by comparing the gauge scores, based on extracting the nearest model grid point, with those computed by upscaling the model values to the TRMM grid and extracting the TRMM grid point nearest the gauge location. The sampling effect is explored by comparing the aggregate SEEPS for this subset of ∼6000 locations (dictated by the number of gauges available globally) with all land points within the TRMM region of 50°N and 50°S. The forecast performance over the oceanic areas is compared with performance over land. While the SEEPS computed using the two different climatologies should never be expected to be identical, using the TRMM climatology provides a means of evaluating near-global precipitation using an internally consistent dataset in a climatologically consistent way.