bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification of Building Architectural Work Construction Safety Risks
Authors: Aurellina Dinda Syafryn , Machfudiyanto Rossy Armyn
Published: July 2023

In Indonesia, the rate of workplace accidents in the construction industry is still relatively high. Unsupervised work activities, which result in the disregard of risk control for these work activities, are one of the factors contributing to the high rate of workplace accidents. Therefore, if WBS can be used to design construction safety planning, then all dangerous operations can be monitored. This study will employ the quantitative technique as its methodology. The WBS for architectural construction safety planning will be developed through case study work on the High Prosecutor's Office Building for DKI Jakarta Province and based on the Minister of Public Works and Public Housing Regulation No. 10 of 2021. This study aims to identify the risks in each architectural work activity using the WBS and produce a good construction safety management strategy in the form of a risk assessment for each architectural work activity to improve construction safety performance (K2) in building construction projects in Indonesia.
Durability Study of Rubberized Lightweight Concrete Using Nano-Silica
Authors: Antony Minu , Roy Rony George
Published: July 2023

Lightweight concrete (LWC) is used in the construction of partition and panel walls in framed structures because it reduces the dead load acting on the structure. Rubberized lightweight aggregate concrete is made by using waste rubber tyre chips as a partial replacement of coarse aggregate which increases the ductility, and toughness and minimizes the impact effect of concrete. The presence of rubber content decreases the compressive strength and bond strength, which affects the durability of concrete. Nowadays, nanomaterials' application has received much attention to enhance concrete properties. Due to the nano-filler effect and the pozzolanic reaction, the microstructure becomes more homogeneous and less porous, especially at the interfacial transition zone (ITZ), which leads to reduced permeability. Among the nano-materials, nano-silica has gained particular attention compared to conventional mineral addition due to its better performance in concrete. Incorporating a small number of nanoparticles in concrete can modify the nano-structure of cementitious materials, thus producing high strength and durability. This study is to investigate the durability properties of rubberized LWC containing nano-silica at dosages of 1%, 3%, and 5% by replacement of cement, respectively. Durability under a marine environment is to be analysed based on compressive strength, bond strength, and resistance to the penetration of chloride ions for 28 and 56 days.
Comparative study on durability of concrete using recycled and natural aggregate
Authors: Kumar Kamlesh , Kumar Pankaj
Published: July 2023

This research provides insight of experimental study on performance of concrete produced from natural and recycled aggregates. The strength of recycled aggregate concrete and its durability is still questionable as compared to the concrete with natural aggregates. The intention of this research was to assess the longevity and durability of concrete specimens composed of both conventional and recycled aggregates. This experiment involved preparing concrete specimens with recycled aggregate at 0%, 50% and 100% using a M25 mix design. The physical and mechanical characteristics of the concrete specimens such as compressive test, UPV test and split tensile strength test were assessed over a period of 28 days. The water absorption is very crucial as it can lead to concrete degradation and reduced durability over time. The results of this study indicate that strength of concrete using recycled aggregates along with silica fume and metakaolin shows enhanced mechanical properties. Therefore, recycled aggregates may be a viable and ecologically acceptable and substitute to natural aggregates in the preparation of concrete.
Corrosion of steel rebars embedded in One-part Alkali activated concrete mixes
Authors: Reddy Bijivemula Kiran Kumar , Narasimhan Mattur C.
Published: July 2023

To reduce CO2 emissions and turn a variety of industrial/agricultural wastes into valuable cementitious products, alkali-activated materials (AAM) are recognized as suitable substitutes for regular Portland cement (OPC). However, the concentrated aqueous alkali solutions used in conventional two-part alkali activated materials are highly corrosive, viscous, and are difficult to handle in direct field applications. As a result, the potential for developing so-called "just add water" type one-part AAMs, as compared to traditional two-part AAM, is being explored, particularly in cast-in-situ applications. In the present study on corrosion of reinforcing steel bars in fly ash-slag (FA-GGBS) based one-part AAC mixtures, three parameters—the total binder content, the relative proportions of GGBS and Fly-ash and the percentage of sodium oxide (Na2O) - are recognized as the key factors in determining the strength and durability performance (including corrosion of rebars embedded in it) of a given AAC mix. Accordingly, experiments were conducted on AAC mixes with three binder contents (440, 460, and 480 kg/m3), three Slag/FA ratios (80/20, 70/30 and 60/40, by volume) and three alternate Na2O percentages (5, 6, and 7%, by weight of total binder content). Prismatic cylindrical test specimens of reinforced geopolymer concrete were prepared and half-cell potential and corrosion rate measurements were made after 28-, 56-, and 90 days of continuous exposure to 3% of NaCl solution, to accelerate the corrosion process. Measured corrosion current density and corrosion rates using a Electro-chemical Corrosion Analyser have indicated that the AAC mixture having a total binder content 440 kg/m3, GGBS/FS ratio of 70/30 and 6% Na2O content, exhibits best corrosion resistance amongst the various mixes tested herein, as measured up to the end of 90-days.
Utilizing Rice Hull Ash as Partial Replacement for Cement in Producing Soil-Cement: Materials for Deep Mix Soil Stabilization
Authors: Daarol Michelle , Delos Reyes Clib James , Sales Showna Lee
Published: July 2023

Stabilization of residual soils is studied chemically using cement and Rice Hull Ash (RHA). The investigation includes the evaluation of the physical properties of the soil and its classification. Furthermore, changes in the unit weight, the specific gravity of non-treated and treated with 5-25% RHA partially replacing soil-cement samples, and the moisture content of non-treated and treated soil before and after curing (21 days) were also examined. Moreover, ultimately, an investigation as to what percentage of RHA in partially replacing cement would produce the largest compressive strength and shear strength has also been done in this study. Tests showed that the soil was CL (Low Plasticity Clay) and that it has been found out the unit weight increases as the treatment of percentage increases. The specific gravity also increases with the further addition of cement but decreases when the amount of RHA is noticeable in the mix. As to moisture content, it has been found that there were always changes in the water content before and after curing for hydration. Moreover, the Unconsolidated Undrained Triaxial test was also employed to determine the changes in the strength of non-treated and untreated soil. It has been found that the maximum deviator stress peaked at 20 % RHA replacement, as do the internal friction angle and cohesion value, hence the maximum shear strength, for all confining pressures. These parameters have proved that RHA 20% partial replacement has the potential to Deep Mix Method (DMM) in strength and economics.
Radar Based Precipitation Nowcasting Prediction by Using Deep Learning Techniques
Authors: Imran Shaik , Anuradha T. , Bharat Ratnala
Published: July 2023

Nowcasting is an emerging area in meteorology that focuses on accurately anticipating the severity of short-term rainfall for a particular location. It is essential to many facets of society. Owing to its significance, researchers are experimenting to predict short term rainfall using neural network approaches. This study analyses proposes a novel method of merging Convolutional Neural Network and Long Short-Term Memory neural networks on a radar echo dataset. The model was tested against a synthetic moving mnist dataset before applying on actual radar image dataset. Given the previous radar images, the model could successfully find future image sequences and obtained an accuracy of more than 90%.
Delineation of safe groundwater aquifers in a Fluoride contaminated region: Walwa Taluka, Maharashtra
Authors: Sathe Sandip S. , Patil Kranti , Chavan Rohit , Jadhav Vaishnavi , Kamble Shubham , Bhan Uday
Published: July 2023

Groundwater aquifer contamination has leads health problems in village areas of Maharashtra, India. In this study, groundwater analysis was carried out for different groundwater parameters along with fluoride to delineate the high and low contaminated fluoride region in the Walwa taluka, Maharashtra. A distinct contaminated regions for high and low F‒ contaminated regions were identified in the collected post monsoon groundwater samples (n = 144). In total 98% samples are unsuitable for consumption. Hydro-geochemistry of the region showed highest anion concentration for bicarbonate (1880 mg/L), whereas highest cation concentration for calcium was measured as 118 mg/L. It is main cause for alkaline groundwater condition in this region. The 2D ordinary kriging results are well corborated with the obtained hydrogeochemistry results. The low F‒ concentration region was found near the Krishna River, whereas high concentration regions were found near the agricultural and high land region. The primary hydrogeochemistry of the region suggests that the geogenic source of F‒ minerals in the region. The practice of fertiliser, herbicides and pesticides on agricultural field suggests that these are the secondary source for groundwater F‒ contamination. The applied numerical groundwater modelling software, provided technically viable and effective decision making-tool for identification of safe region in the study area.
A case study of air quality data of Ernakulam district
Authors: Saraswathy R. , Sathidevi C.
Published: July 2023

The main objective of an economist is to predict the future of any problem concerning the common man. Considering the human health in India, air pollution becomes a matter of major concern. The present study analyses the air quality data of Ernakulam district in Kerala by assessing various atmospheric pollutants and meteorological factors. The air pollution analysis of southern state, says that Ernakulam district has not been able to sustain the air quality gains of 2020 in the year 2021. As per 2021 air quality categorisation of analysis of days, it is seen that the number of days with worse air quality index has increased two times compared to previous year. The study comes to the conclusion that the meteorological factors have a great impact on the atmospheric pollutants and increasing humidity help to improve pollution. Also, the particulate matters are the major contributer for the increase in air quality index level. The most recent XLSTAT version and python programming were used to infer the results in this study. The researcher contends that, steps are to be taken to reduce the impact of solar radiations which helps in reducing the air quality level.
ANN in forecasting Missing Rainfall Data
Authors: Agrawal Jagottam Das
Published: July 2023

ANN has been used to estimate rainfall data by analysing patterns and mapping the correlation between historical data and weather patterns. ANNs are a type of machine learning algorithm that is modelled on the structure of the human brain, which makes them particularly effective for solving complex problems that involve large amounts of data. Overall, the use of ANNs for estimating rainfall data is a promising area of research that has the potential to provide valuable insights into weather patterns and their impacts on the environment and human society. The potential of ANN in the estimation of missing precipitation values has been investigated in detail. This study proposes to compare the performance of conventional methods as well as different algorithms of the Artificial Neural Network method to predict missing rainfall in the Upper Tapi catchment area in the West region of India. It was found that the ANN method has an edge over the conventional methods and proved to be a better method of finding the missing rainfall data values.
Phytoremediation of Wastewater through Implemented Wetland – A Review
Authors: Bilgaiyan Purti , Shivhare Niharika , Gowripathi Rao N.R.N.V.
Published: July 2023

Contrary to the typical treatment system, built wetland systems have become high-performance wastewater treatment technology in recent years. In India as well, this technology is becoming more important for reducing water pollution. A built wetland is essentially a tank that has been planted with plants tolerant of waterlogged conditions and filled with a substrate. In this method, wastewater is treated by plants through phytoremediation. A manmade wetland's plant species is crucial in maintaining the temperature needed for a variety of biological and physiological processes necessary for the efficient treatment of wastewater. Hydraulic retention time (HRT), plant type, and bed material make up a built wetland's key elements. Generally, gravels and sand are used as the bed media and the plant species used are grasses like typha grass, canna indica, para grass, etc. Environmental-related parameters that are taken into consideration are pH, COD, BOD, TSS, NH3-N, PO4, nitrate, and Fecal coliform count in one complete macrophyte life cycle. The present paper gives information about the different types of constructed wetlands, pollutants removal mechanism by microphytes, engineering design used, and application of implemented wetlands.
Environmental sustainability during machining of hardened steel using nanofluid: A case study
Authors: Khatai Saswat , Sahoo Ashok Kumar , Kumar Ramanuj , Panda Amlana
Published: July 2023

The positive effects of nanofluid-assisted minimum quantity lubrication include improved performance during machining and environmental sustainability. In the present study two cutting parameters levels such as feed rate of 0.05 (mm/rev)- depth of cut of 0.1(mm)-cutting speed of 80(m/min) and feed rate of 0.15(mm/rev)-depth of cut of 0.3(mm)-cutting speed of 200(m/min) has been used in the hard turning of D2 steel. It was determined that the 0.3% ZrO2 wt% observed to be improved machinability as compared to dry and Minimum Quantity Lubrication (MQL) environment. Finally, the sustainability assessment through the Pugh Matrix Assessment (PMA) presented the potential of nanofluid-MQL for improvement of machinability of hardened D2 steel for cleaner production.
Plasma Free Hemoglobin Generation Using the EOS PMP™Oxygenator and the CentriMag®Blood Pump
Authors: Hodge Ashley B. , Deitemyer Matthew A. , Duffy Victoria L. , Tumin Dmitry , Garbin Dorothy A. , Nicol Kathleen K. , Hayes Don , Cismowski Mary J. , Yates Andrew R.
Published: July 2023

Hemolysis is a known consequence of extracorporeal membrane oxygenation (ECMO) resulting from shear force within the different components of the extracorporeal circuit. The primary aim of this study was to evaluate the EOS PMP™oxygenator for generation of plasma free hemoglobin (PfHg) over 24 hours at nominal operating range flow rates. The EOS ECMO™(LivaNova, Inc.; formerly Sorin, Arvada, CO) is equipped with a plasma tight polymethylpentene (PMP) hollow fiber oxygenator. We hypothesized that PfHg generation would be elevated in circuits with higher flow rates, because of the significant pressure drop across the oxygenator according to manufacturer provided flow charts. Generated PfHg concentrations were compared with PfHg concentrations from blood not exposed to an ECMO circuit. The secondary aim was to evaluate circuit flow-rate-induced changes in platelet count and platelet function over 24 hours. Circuits contained a CentriMag®(St. Jude Medical, St. Paul, MN) blood pump and an EOS ECMO PMP™oxygenator. Circuits in triplicate were run continuously for 24 hours at three flow rates [1, 3, and 5 liters per minute {LPM}]. PfHg was analyzed at baseline, 6, 12, 18, and 24 hours. Platelet count and function were measured at baseline and 24 hours. Concentrations of PfHg at baseline for circuits operating at 1, 3, and 5 LPM were 24.4 ± 4.0, 38.4 ± 28.6, and 26.7 ± 6.9 mg/dL, respectively. PfHg concentrations after 24 hours were statistically compared for the three flow rates using analysis of variance; PfHg concentrations at 1 LPM (181.4 ± 29.1 mg/dL), 3 LPM (145.9 ± 8.7 mg/dL), and 5 LPM (100.1 ± 111.3 mg/dL) circuits. TheF-test was not statistically significant (p= .632), indicating that PfHg generation at 24 hours was similar among the three flow rates. Excessive hemolysis using PfHg levels in the EOS PMP™membrane oxygenator was not observed.
Technique of Complete Heart Isolation with Continuous Cardiac Perfusion During Cardiopulmonary Bypass: New Opportunities for Gene Therapy
Authors: Katz Michael G. , Fargnoli Anthony S. , Yarnall Charles , Perez Angel , Isidro Alice , Hajjar Roger J. , Bridges Charles R.
Published: July 2023

Cardiopulmonary bypass (CPB) featuring complete heart isolation and continuous cardiac perfusion is a very promising approach for solving the problem of efficient gene delivery. In the technique presented here, separate pumps are used for the systemic and cardiac circuits. This system permits continuous isolated arrested heart perfusion through optimizing a number of delivery parameters including temperature, flow rate, driving pressure, ionic composition, and exposure time to the cardiac vessels. During complete cardiac isolation, the blood vector concentration trended from 11.51 ± 1.73 log genome copies (GCs)/cm3 to 9.84 ± 1.65 log GC/cm3 (p > .05). Despite restructuring a very high concentration to the heart, GCs were detectable in the systemic circuit. These values over time were near negligible by comparison but detectable 1.66 ± .26 during 20 minutes of recirculation and did not change (p > .05). After the completion of the recirculation interval and subsequent washing procedure, the initial systemic blood vector GC concentration slightly increased to 2.08 ± .38 log GCs/cm3 (p > .05). During the recirculation period, we supported flow via the cardiac circuit around 300 mL/min. In this technique of heart isolation with continuous cardiac perfusion, >99% of the vector remains in coronary circulation during recirculation period. The animal’s non recirculation blood, or that in the system, was routinely tested during and after recirculation to contain much less than 1% of the original dose obtained via logging concentration of therapeutic over time. All of the sheep in this group recovered from anesthesia and received critical postoperative care, including all organ function, in the first 24–36 hours. Twenty-one sheep (84%) survived to euthanasia at 12 weeks. Average CPB time was 107 ± 19.0 minutes and cross-clamp time was 49 ± 7.9 minutes. This technology readily provides multiple pass recirculation of genes through the heart with minimal side effects of collateral expression of other organs.
Predictors of Oxygenator Exchange in Patients Receiving Extracorporeal Membrane Oxygenation
Authors: Basken Robyn , Cosgrove Rick , Malo Joshua , Romero Andrew , Patanwala Asad , Finger Jacqueline , Kazui Toshinobu , Khalpey Zain , Mosier Jarrod
Published: July 2023

Thrombosis within the membrane oxygenator (MO) during extracorporeal membrane oxygenation (ECMO) can lead to sudden oxygenator dysfunction with deleterious effects to the patient. The purpose of this study was to identify predictors of circuit exchange during ECMO. This is a single-center, retrospective study of all patients who received ECMO at our institution from January 2010 to December 2015. Changes in potential markers were compared on Day 3 vs. Day 0 before MO exchange. Of the 150 patients who received ECMO, there were 58 MO exchanges in 35 patients. Mean ECMO duration was 21.1 (±12.7) days. D-dimer (DD) (μg/mL) (mean difference −2.6; 95% confidence interval [CI]: −4.2 to −1.1;p= .001) increased significantly in the 3 days leading up to MO exchange, whereas fibrinogen (mg/dL) (mean difference 90.7; 95% CI: 41.8–139.6;p= .001), platelet (PLT) count (1,000/μL) (mean difference 23.3; 95% CI: 10.2–36.4;p= .001), and heparin dose (units/h) (mean difference 261.7; 95% CI: 46.3–477.1;p= .02) decreased. Increasing DD or decreasing fibrinogen, PLT count, or heparin dose may indicate an impending need for MO exchange in patients receiving ECMO. Early identification of these changes may help prevent sudden MO dysfunction.
Management Strategies during a VA ECMO Run in a Neonate with E. Coli Septic Shock Masquerading as Hypoxic Ischemic Encephalopathy
Authors: Quinones Cardona Vilmaris , Menkiti Ogechukwu
Published: July 2023

Advances in neonatal care for hypoxic respiratory failure, with high-frequency ventilation and inhaled nitric oxide, have led to a decreased need for extracorporeal membrane oxygenation (ECMO). However, neonates resistant to such therapies are more complex and at higher risk of mortality. One such population includes those with hypoxic ischemic encephalopathy (HIE) undergoing controlled hypothermia (CH). We present a challenging case of a full-term neonate with inotrope-resistant Escherichia coli septic shock, profound coagulopathy, hypoxic respiratory failure, and HIE requiring CH and venoarterial (VA) ECMO. We illustrate that family-centered decision-making, ECMO, primary team, and subspecialist support is critical to success. In addition, we share the strategic medical interventions concomitantly used with VA ECMO to aid in the survival of this high-risk infant such as continuous veno-venous hemofiltration with AN69 membrane for cytokine and fluid removal, prostaglandin use to relieve right ventricular strain in malignant pulmonary hypertension, and cautious use of bronchoscopy to assist in lung recruitment.
Impact of Pre-bypass Autologous Blood Collection on Blood Transfusion Rates
Authors: Crosby Amanda D. , Sistino Joseph J.
Published: July 2023

Pre-bypass acute autologous donation (PAAD) is a method of blood conservation that reduces exposure of blood to the cardiopulmonary bypass (CPB) circuit and may prevent the contact activation of platelets and clotting factors. The purpose of this study was to evaluate the impact of PAAD on product transfusion rates in cardiac surgical patients. This is a retrospective study of patients undergoing cardiac surgery between 2015 and 2017 for either a coronary artery bypass (CABG), valve replacement, or a combined valve/CABG procedure. PAAD was performed by removing blood from the venous line of the bypass circuit immediately before the institution of CPB. The amount of PAAD volume was determined during the surgical time-out. This was based on patient size, baseline hemoglobin, and type of case. Poisson logistic regression was used to determine whether PAAD was a significant predictor for blood product transfusion. After obtaining institutional review board approval, we reviewed 236 records on (n = 154, 65.3%) who received PAAD and (n = 82, 34.7%) with no blood withdrawal before CPB. The median PAAD volume in the PAAD group was 750 mL. Patients undergoing PAAD had a 14.3% red blood cell (RBC) transfusion rate (.27 ± .91 units), and without PAAD, the RBC transfusion rate was 62.2% (1.56 ± 1.79 units). The significant (p< .05) odds ratios (ORs) for RBC transfusion were as follows: baseline hemoglobin .617 (.530–.719), PAAD .998 (.997–.999), CPB time 1.009 (1.003–1.015), age 1.034 (1.013–1.055), and BSA odds ratio (OR) .326 (.124–.857). PAAD could not be used in all patients. However, using the OR in the Poisson logistic regression model, a one-unit reduction in RBC transfusion is predicted for each 500 mL of PAAD. PAAD was also associated with a significant reduction in fresh frozen plasma and platelet transfusion.
Perfusion Methods and Modifications to the Cardiopulmonary Bypass Circuit for Midline Unifocalization Procedures
Authors: Margetson Tristan D. , Sleasman Justin , Kollmann Sami , McCarthy Patrick J. , Jahadi Ozzie , Sheff Don , Shuttleworth Paul , Mainwaring Richard D. , Hanley Frank L.
Published: July 2023

Pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries (PA/VSD/MAPCAs) is a rare form of congenital heart disease. The midline unifocalization procedure has been developed for the treatment of PA/VSD/MAPCAs. These are complex and very lengthy procedures that require an entirely different method of perfusion. The purpose of this study was to review our perfusion modifications to support these unifocalization procedures. Sixty-four unifocalization procedures have been performed at our institution during the past 3 years. The median age was 4.1 months (range 1 month–3.5 years) and the median weight at surgery was 4.5 kg (range 3.5–19 kg). The median duration of cardiopulmonary bypass was 352 minutes (range 128–629 minutes), and the median duration of cross-clamp was 24 minutes (range 14–72 minutes). The conduct of surgery included cooling to a rectal perfusion temperature of 25° and a flow rate of 100 mL/kg/min. A pH-stat strategy and del Nido cardioplegia were used. Modifications to the cardiopulmonary bypass circuit include upsizing the oxygenator, reservoir, cannulae, vent catheter, and tubing. All circuits were modified to include the capability of performing an intraoperative flow study. This study is used to determine whether the VSD can be closed during surgery. A collateral flow study circuit is also set up for first-time operations to measure the residual collateral flow after all of the MAPCAs have been harvested. Patients who require midline unifocalization will invariably require very lengthy periods of support on cardiopulmonary bypass. We have adapted our perfusion circuitry to prepare for the demands on the bypass circuit to meet the requirements of this patient population. Our institution has developed a systematic approach for the conduct of perfusion to best serve our patients presenting with PA/VSD/MAPCAs.
Lactated Ringer’s as a Base Solution for del Nido Cardioplegia
Authors: Kantathut Narongrit , Cherntanomwong Piya , Khajarern Siam , Leelayana Parinya
Published: July 2023

Unavailability of Plasma-Lyte A precludes the utility of traditional del Nido cardioplegia in many countries. This observational study aimed to evaluate myocardial preservation and clinical outcomes when using lactated Ringer’s solution as the base solution for del Nido cardioplegia as compared with our institute’s standard blood cardioplegia strategy. Eighty-nine adult patients underwent cardiac surgery for acquired heart disease from February 2017 to November 2017 either with del Nido cardioplegia (n = 44) or blood cardioplegia (n = 45). Clinical data and outcomes were compared. Patient characteristics were similar between groups. Troponin T release was lower in the del Nido group on postoperative day 1 (.632 [.437, .907] vs. .827 [.599, 1.388] ng/mL;p= .009) and day 2 (.363 [.250, .451] vs. .549 [.340, .897] ng/mL;p= .002). The del Nido group exhibited lower total volume of cardioplegia administered (1,075 [1,000, 1,250] vs. 3,400 [2,700, 3,750] mL;p< .0001), fewer doses (1.6 ± .7 vs. 4.6 ± 1.3;p< .0001), and a decreased incidence of ventricular fibrillation after aortic cross-clamp removal (9.09 vs. 31.11%;p= .01). The del Nido group had shorter intensive care unit stays (2 [1, 2] vs. 3 [2, 4] days;p< .0001), hospital stays (7 [6, 10] vs. 9 [7, 10] days;p= .0002), less vasopressor and inotropic support (1 [1, 1] vs. 1 [1, 2] days;p= .0001), and lower incidence of postoperative atrial fibrillation/flutter (25 vs. 46.7%;p= .033). No mortality occurred and clinical outcomes were similar. The use of traditional del Nido cardioplegia ingredients added to lactated Ringer’s as the base solution provided either similar or superior myocardial protection than our blood cardioplegia strategy depending on the outcome measure analyzed. The use of lactated Ringer’s as a base solution may be an option for centers that do not have access to Plasma-Lyte. Further investigation and follow-up are warranted after this observational study.
Die Rechtsfrage: Inwiefern darf ich Therapiemittel bewerben?
Authors: Schlegel Thomas
Published: July 2023

„Ich habe für meine Praxis ein teures robotikgestütztes Therapiesystem für die Neurologie angeschafft. Die Nutzung des Geräts müssen Patient*innen selbst bezahlen. Damit sich die Anschaffung lohnt, sollten wir das System in der Praxis möglichst häufig nutzen. Deshalb möchte ich die Therapie damit bewerben. In welcher Form darf ich dies tun und was muss ich beachten?“

Therapeutin aus Niedersachsen
Psychosomatisch erkrankte Menschen – eine besondere Herausforderung für Pflegende in der Psychiatrie?
Authors: Jansen Wolfgang
Published: July 2023

Psychiatrisch Pflegende müssen sowohl die somatischen als auch die psychischen Beschwerden der Patient*innen erkennen und in den psychosomatischen Kontext einordnen. Was bei dieser ganzheitlichen Behandlungsstrategie zu beachten ist, erläutert unser Autor.
Progression and Relapse of Pediatric Soft Tissue Sarcoma:
Individualized Approach of Treatment – Experience from a Major Pediatric
Cancer Center in Europe
Authors: Barnbrock Anke Elisabeth , Luckowitsch Marie , Schmidt Stanislaw , Buus-Gehrig Constanze , Koscher Leila , Becker Martina , Vokuhl Christian , Klingebiel Thomas , Lehrnbecher Thomas , Bochennek Konrad
Published: July 2023

BackgroundThe outcome of children with refractory or relapsed soft tissue
sarcoma (STS) is extremely poor. Whereas larger clinical trials evaluated
specific treatment modalities, real-life data on individual multimodal
therapeutic strategies, given alone or in combination, are scarce.

Patients and Methods We retrospectively analyzed the clinical course of 18
pediatric patients with progression of or relapsed STS treated between 2008 and
2018 in our institution.

Results A total of 18 patients (median age 12.4 years) suffered from
progression or relapse of alveolar (n=7), embryonal (n=5),
undifferentiated (n=2) rhabdomyosarcoma or desmoplastic small round cell
tumor (n=4). 14 patents had an initial stage IV disease. All but one
patient died. Median survival was 12.5 months. Shortest survival was seen in
patients with systemic progression of the disease, longest in patients with
local relapse. Patients with an Oberlin score<2 at the time of relapse
had a significant longer time of survival than those with a score≥2. No
significant advantage of a specific therapeutic modality was observed.

Discussion We critically analyzed the clinical course in the real-life
setting, in which various treatment options were applied to an individual
patient according to the best of available data. We observed that some patients
died within a short period of time despite multiple treatment modalities, which
underlines the need for better prognostic parameters.

Conclusion In addition to well characterized clinical factors such as
local or systemic relapse, the Oberlin score could be helpful in counselling
patients and their families for choosing the best strategy of care.
Zur Koinzidenz von Normaldruckhydrocephalus und Alzheimer-Demenz:
therapeutische Implikationen und offene Fragen
Authors: Beeke Max , Homeyer Patricia , Brandt Moritz D. , Donix Markus , Haußmann Robert
Published: July 2023

Der Normaldruckhydrocephalus (NPH) ist im höheren Lebensalter
häufig, eine klinische Unterversorgung von Patienten wahrscheinlich.
Nicht selten besteht eine komorbide Alzheimererkrankung. Die häufige
Koinzidenz lässt pathophysiologische Überschneidungen vermuten,
welche bislang aber unzureichend verstanden sind. Cerebrale
Komorbiditäten scheinen das therapeutische Ansprechen auf eine
ventrikuloperitoneale Shuntversorgung erheblich zu beeinflussen. Ihre
Würdigung im diagnostischen Prozess ist daher von großer
Bedeutung, um dem häufig hochvulnerablen Patientenklientel wenig
erfolgsversprechende operative Prozeduren zu ersparen.
Psychiatrisch-psychotherapeutische und psychosoziale Bedarfe in der
ambulanten Suchthilfe: Implikationen für eine integrierte
Suchtbehandlung
Authors: Salas David Gurrea , Neuenschwander Hans Jürg , Schwilk Michael , Lüddeckens Thomas , Pichler Eva-Maria , Scherbaum Norbert , Roser Patrik
Published: July 2023

Ziel der Studie Der psychiatrisch-psychotherapeutische und psychosoziale
Hilfebedarf in der ambulanten Suchthilfe wurde im Rahmen eines integrierten
Versorgungskonzepts mit Beteiligung von Einrichtungen der Suchtberatung und
Suchtbehandlung ermittelt.

Methodik Die prospektive Datenerhebung erfolgte zwischen dem 01.03.2020
und dem 30.04.2021 im Rahmen der erstmaligen Vorstellung in den beteiligten
Einrichtungen der Suchtberatung und Suchtbehandlung. Die Erfassung der
psychischen Belastung bei den teilnehmenden Personen, die sich in einer
Suchtberatung vorstellten (N=234), erfolgte mit Hilfe der
Brief-Symptom-Checklist (BSCL). Die psychosoziale Belastung bei den
teilnehmenden Personen, die sich in einem suchtmedizinischen Ambulatorium
vorstellten (N=198), wurde mit Hilfe des Kurzassessments zur Indikation
der psychosozialen Suchtberatung erfasst. In beiden Versorgungsstrukturen wurden
zudem soziodemografische und klinische Daten erhoben.

Ergebnisse 1.) In den Einrichtungen der Suchtberatung zeigte sich bei etwa
55% der Klient:innen eine klinisch auffällige psychische
Belastung. Diese Klient:innen hatten zudem häufiger Probleme mit
mehreren Substanzen sowie häufiger psychische Begleiterkrankungen,
insbesondere affektive Störungen. 2.) In den Einrichtungen der
Suchtbehandlung wiesen etwa 52% der Patient:innen eine Unzufriedenheit
bezüglich der finanziellen Situation und etwa 44%
bezüglich der Beschäftigungs- und Alltagssituation auf. Die
Unzufriedenheit mit der sozialen Situation und der Wohnsituation war mit jeweils
etwa 25% geringer ausgeprägt.

Schlussfolgerung Der psychiatrisch-psychotherapeutische und psychosoziale
Hilfebedarf ist in beiden Versorgungsstrukturen hoch und erfordert ein
integriertes Versorgungssystem mit dem routinemäßigen Einsatz
standardisierter Assessments und einer koordinierten Zuweisungspraxis zwischen
Suchtberatung und Suchtbehandlung.
Der bewusste Blick nach innen – Gesunde Selbstführung
Authors: Holtmeier Lisa
Published: July 2023

Wer andere führen will, muss sich selbst führen lernen. Handelt es sich bei diesem Satz um eine Phrase oder steckt doch mehr dahinter? Was bedeutet (gesunde) Selbstführung und wie kann sie im stressigen Alltag gelingen? Das und vieles mehr erfahren Sie in diesem Beitrag.
Massive Localized Abdominal Lymphedema: A Case Report with Literature Review
Authors: Gogia Badri , Chekmareva Irina , Leonova Anastasiia , Alyautdinov Rifat , Karmazanovsky Grigory , Glotov Andrey , Kalinin Dmitry
Published: July 2023

Massive localized lymphedema (MLL) is a rare disease caused by the obstruction of lymphatic vessels with specific clinical morphological and radiological characteristics. People with morbid obesity are mainly affected by MLL. Lymphedema is easily confused with soft tissue sarcoma and requires differential diagnosis, both the possibility of an MLL and also carcinoma manifestations in the soft tissues. The possible causes of massive lymphedema include trauma, surgery, and hypothyroidism. This report is the first case of MLL treated surgically in the Russian Federation. Detailed computed tomography (CT) characteristics and an electron microscope picture of MLL are discussed. A 50-year-old woman (body mass index of 43 kg/m2) with MLL arising from the anterior abdominal wall was admitted to the hospital for surgical treatment. Its mass was 22.16 kg. A morphological study of the resected mass confirmed the diagnosis of MLL. We review etiology, clinical presentation, diagnosis, and treatment of MLL. We also performed an electron-microscopic study that revealed interstitial Cajal-like cells telocytes not previously described in MLL cases. We did not find similar findings in the literature. It is possible that the conduction of an ultrastructural examination of MLL tissue samples will further contribute to the understanding of MLL pathogenesis.
Determinants of Inadequate Cardioprotection in Adult Patients with Left Ventricular Dysfunction
Authors: Sanetra Krzysztof , Gerber Witold , Buszman Piotr Paweł , Mazur Marta , Milewski Krzysztof , Kaźmierczak Paweł , Bochenek Andrzej
Published: July 2023

Background Perioperative cardioprotection is essential for achieving satisfactory clinical outcomes in heart failure patients. It is important to understand the factors affecting perioperative cardioprotection.

Methods The institutional database was searched for patients with reduced ejection fraction (EF, < 40%) who underwent surgery with cardioplegia-induced arrest. Patients were divided into del Nido cardioplegia (DN) and cold blood cardioplegia (CB) groups. The relationships between age, preoperative blood parameters, creatinine, cross-clamp time (CCT), extracorporeal circulation time (ECT), and postoperative troponin values at 12 hours or deterioration of EF (≥5%) were evaluated. Baseline characteristics, operative parameters, and outcomes were analyzed.

Results There were 508 patients with reduced EF (331 DN and 177 CB). In the entire cohort, anemic patients had greater troponin values (p = 0.004) as well as in the DN group (p = 0.002). However, this was not detected in the CB group (flat regression line; p = 0.674). Patients with high leukocyte values had greater troponin release (entire cohort: p < 0.001; DN group: p < 0.001; CB group: steep regression line with p = 0.042). Longer CCT and ECT were associated with greater troponin release (entire cohort; both groups) and greater risk of fall in EF. In a direct comparison, fewer patients had significant deterioration of EF in the DN group than CB group (3.9 vs. 11.9%; p < 0.001).

Conclusion The use of CB cardioplegia may be beneficial in anemic patients, whereas the use of DN cardioplegia may be beneficial for expected long CCT and high leukocytosis.
“I don't have Huntington's disease”: the boundaries between acceptance and understanding
Authors: Franklin Gustavo Leite , Teive Hélio A. Ghizoni , Cardoso Francisco Eduardo
Published: July 2023

Huntington's disease (HD) is an inherited disease that leads to an inexorable progression of motor, cognitive and psychiatric disturbances. In the initial stages, the symptoms are not clearly disabling, and the patient may present a lack of awareness about the symptoms themselves, which we call anosognosia. However, anosognosia might not justify all passivity of the HD patient in face of the diagnosis. Patients may also experience the denial of illness, as a stage of grief, expected to happen in the face of the diagnosis of any neurodegenerative disorder. In addition, people with HD tend to be more apathetic, and more silent, in regular consultations. In the present article, the authors express a point of view, discussing the behavior of the HD patient, in which there is a multifactorial passivity, in the face of the diagnosis and of the disease itself. Having the proper knowledge of this situation may prepare the neurologist to better understand the patient and the evolution of the disease.
Shared Genes and Molecular Mechanisms between Nonalcoholic Fatty Liver Disease and Hepatocellular Carcinoma Established by WGCNA Analysis
Authors: He Juan , Zhang Xin , Chen Xi , Xu Zongyao , Chen Xiaoqi , Xu Jiangyan
Published: July 2023

Background Hepatocellular carcinoma (HCC) is one of the leading causes of death from cancer worldwide. The histopathological features, risk factors, and prognosis of HCC caused by nonalcoholic fatty liver disease (NAFLD) appear to be significantly different from those of HCC caused by other etiologies of liver disease.

Objective This article explores the shared gene and molecular mechanism between NAFLD and HCC through bioinformatics technologies such as weighted gene co-expression network analysis (WGCNA), so as to provide a reference for comprehensive understanding and treatment of HCC caused by NAFLD.

Methods NAFLD complementary deoxyribonucleic acid microarrays (GSE185051) from the Gene Expression Omnibus database and HCC ribonucleic acid (RNA)-sequencing data (RNA-seq data) from The Cancer Genome Atlas database were used to analyze the differentially expressed genes (DEGs) between NAFLD and HCC. Then, the clinical traits and DEGs in the two disease data sets were analyzed by WGCNA to obtain W-DEGs, and cross-W-DEGs were obtained by their intersection. We performed subsequent Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genome (KEGG) enrichment analyses of the cross-W-DEGs and established protein–protein interaction networks. Then, we identified the hub genes in them by Cytoscape and screened out the final candidate genes. Finally, we validated candidate genes by gene expression, survival, and immunohistochemical analyses.

Results The GO analysis of 79 cross-W-DEGs showed they were related mainly to RNA polymerase II (RNAP II) and its upstream transcription factors. KEGG analysis revealed that they were enriched predominantly in inflammation-related pathways (tumor necrosis factor and interleukin-17). Four candidate genes (JUNB, DUSP1, NR4A1, and FOSB) were finally screened out from the cross-W-DEGs.

Conclusion JUNB, DUSP1, NR4A1, and FOSB inhibit NAFLD and HCC development and progression. Thus, they can serve as potential useful biomarkers for predicting and treating NAFLD progression to HCC.
Impact of Obesity and Hyperglycemia on Pregnancy-specific Urinary Incontinence
Authors: Vesentini Giovana , Piculo Fernanda , Marini Gabriela , Barbosa Angélica Mércia Pascon , Corrente José Eduardo , Rudge Marilza Vieira Cunha
Published: July 2023

Objective The lack of data on the impact of hyperglycemia and obesity on the prevalence of pregnancy-specific urinary incontinence (PSUI) led us to conduct a cross-sectional study on the prevalence and characteristics of PSUI using validated questionnaires and clinical data.

Methods This cross-sectional study included 539 women with a gestational age of 34 weeks who visited a tertiary university hospital between 2015 and 2018. The main outcome measures were the prevalence of PSUI, the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and the Incontinence Severity Index (ISI) questionnaires. The women were classified into four groups: normoglycemic lean, normoglycemic obese, hyperglycemic lean, and hyperglycemic obese. The differences between groups were tested using descriptive statistics. Associations were estimated using logistic regression analysis and presented as unadjusted and adjusted odds ratios.

Results Prevalence rates of PSUI were no different between groups. However, significant difference in hyperglycemic groups worse scores for severe and very severe PSUI. When adjusted data for confound factors was compared with normoglycemic lean group, the hyperglycemic obese group had significantly higher odds for severe and very severe forms of UI using ICIQ-SF (aOR 3.157; 95% CI 1.308 to 7.263) and ISI (aOR 20.324; 95% CI 2.265 to 182.329) questionnaires and highest perceived impact of PSUI (aOR 4.449; 95% CI 1.591 to 12.442).

Conclusion Our data indicate that obesity and hyperglycemia during pregnancy significantly increase the odds of severe forms and perceived impact of PSUI. Therefore, further effective preventive and curative treatments are greatly needed.
Treatment and Management Experience of Idiopathic Granulomatous Mastitis in a Low-income Country
Authors: Llancari Pedro Antonio , Ortiz Antonio , Becerra Juan , Muñoz Ricardo , Valeriano Christiam , Novoa Rommy Helena
Published: July 2023

Objective Reporting our experience of the management and treatment of Idiopathic granulomatous mastitis (IGM) in a low-income country by describing patients characteristics and therapy with emphasis on conservative surgical excision and postoperative care as the cornerstone of treatment.

Methods A retrospective cohort of women with histopathological diagnosis of IGM from 2014 to 2018 at Instituto Nacional Materno Perinatal in Lima, Peru. Patients' characteristics, clinical presentation, treatment, management, postoperative care, and follow-up were analyzed.

Results Thirty-eight patients with histopathological diagnosis of IGM were identified. Their average age was 35.9 years and 23 (60.5%) reported previous use of hormonal contraceptives. Nine (23.7%) patients had chronic mastitis with previous treatment. The time from the onset of symptoms to the first clinic consult was 5.1 months on average. Twenty-one (55.3%) patients had the lesion in the right breast, with a mean size of 6.9 cm. Conservative surgical excision was performed in all patients. Additionally, 86.8% required corticosteroids and 78.9% were treated with antibiotics. Complete remission was obtained at 141 days on average (range 44 to 292 days). Six (15.8%) women reported ipsilateral recurrence and 5 (13.2%), contralateral. The latency time was 25.5 months on average.

Conclusion The conservative surgical treatment demonstrated and close follow-up made for a high cure rate, but with recurrence similar to that reported in the literature. Use of gloves is an alternative to manage post operative wounds in a low-income country. The most frequent adverse effect was breast surgical scar.
Developing a trusted human-AI network for humanitarian benefit
Authors: Devitt S. Kate , Scholz Jason , Schless Timo , Lewis Larry
Published: July 2023

Artificial intelligences (AI) will increasingly participate digitally and physically in conflicts yet there is a lack of trusted communications with humans for humanitarian purposes. For example, in disasters and conflicts messaging and social media are used to share information, however, international humanitarian relief organisations treat this information as unverifiable and untrustworthy. Furthermore, current AI implementations can be brittle, with a narrow scope of application and wide scope of ethical risks. Meanwhile, human error can cause significant civilian harms even by combatants committed to compliance with international humanitarian law. AI offers an opportunity to help reduce the tragedy of war and better deliver humanitarian aid to those who need it. However, to be successful, these systems must be trusted by humans and their information systems, overcoming flawed information flows in conflict and disaster zones that continue to be marked by intermittent communications, poor situation awareness, mistrust and human errors. In this paper, we consider the integration of a communications protocol (the ‘Whiteflag protocol’), distributed ledger ‘blockchain’ technology, and information fusion with artificial intelligence (AI), to improve conflict communications called “Protected Assurance Understanding Situation & Entities” (PAUSE). Such a trusted human-AI communication network could provide accountable information exchange regarding protected entities, critical infrastructure, humanitarian signals and status updates for humans and machines in conflicts. Trust-based information fusion provides resource-efficient use of diverse data sources to increase the reliability of reports. AI can catch human mistakes and complement human decision making, while human judgment can direct and override AI recommendations. We examine several realistic potential case studies for the integration of these technologies into a trusted human-AI network for humanitarian benefit including mapping a conflict zone with civilians and combatants in real time, preparation to avoid incidents and using the network to manage misinformation. We finish with a real-world example of a PAUSE-like network, the Human Security Information System (HSIS), being developed by USAID, that uses blockchain technology to provide a secure means to better understand the civilian environment.