bluuebunny/crossref_metadata_2025 huggingface dataset:
Prediabetes Is Associated with Increased Prevalence of Sleep-Disordered Breathing
Authors: Sánchez Enric , Sapiña-Beltrán Esther , Gavaldà Ricard , Barbé Ferran , Torres Gerard , Sauret Ariadna , Dalmases Mireia , López-Cano Carolina , Gutiérrez-Carrasquilla Liliana , Bermúdez-López Marcelino , Fernández Elvira , Purroy Francisco , Castro-Boqué Eva , Farràs-Sallés Cristina , Pamplona Reinald , Mauricio Dídac , Hernández Cristina , Simó Rafael , Lecube Albert ,   on behalf of the ILERVAS Project Collaborators
Published: March 2022

Type 2 diabetes leads to severe nocturnal hypoxemia, with an increase in apnea events and daytime sleepiness. Hence, we assessed sleep breathing parameters in the prediabetes stage. A cross-sectional study conducted on 966 middle-aged subjects without known pulmonary disease (311 patients with prediabetes and 655 controls with normal glucose metabolism) was conducted. Prediabetes was defined by glycated hemoglobin (HbA1c), and a nonattended overnight home sleep study was performed. Participants with prediabetes (n = 311) displayed a higher apnea–hypopnea index (AHI: 12.7 (6.1;24.3) vs. 9.5 (4.2;19.6) events/h, p < 0.001) and hypopnea index (HI: 8.4 (4.0;14.9) vs. 6.0 (2.7;12.6) events/h, p < 0.001) than controls, without differences in the apnea index. Altogether, the prevalence of obstructive sleep apnea was higher in subjects with prediabetes than in controls (78.1 vs. 69.9%, p = 0.007). Additionally, subjects with prediabetes presented impaired measurements of the median and minimum nocturnal oxygen saturation, the percentage of time spent with oxygen saturations below 90%, and the 4% oxygen desaturation index in comparison with individuals without prediabetes (p < 0.001 for all). After adjusting for age, sex, and the presence of obesity, HbA1c correlated with the HI in the entire population (r = 0.141, p < 0.001), and the presence of prediabetes was independently associated with the AHI (B = 2.20 (0.10 to 4.31), p = 0.040) as well as the HI (B = 1.87 (0.61 to 3.14), p = 0.004) in the multiple linear regression model. We conclude that prediabetes is an independent risk factor for an increased AHI after adjusting for age, sex, and obesity. The enhanced AHI is mainly associated with increments in the hypopnea events.
Oral Health-Related Quality of Life in Patients after Stroke—A Systematic Review
Authors: Schmalz Gerhard , Li Simin , Ziebolz Dirk
Published: March 2022

Objectives: Aim of this systematic review was to assess oral health-related quality of life (OHRQoL) of patients after stroke. Methods: The systematic literature search was performed on December 2021 based on PubMed, Medline, Web of Science, and Scopus, with the search terms: “oral health-related quality of life” AND stroke OR apoplexy OR ischemic stroke OR apoplectic insult. Articles exclusively examining patients after stroke and reporting a well-documented and valid OHRQoL measurement were included. Results: Out of 68 findings, 8 studies were included. The number of patients ranged between 31 and 549 individuals, mean age between 55.7 and 73.9 years, and 49–72% of individuals were male. Two studies included a healthy control group. Oral health parameters were rarely reported across studies. Five studies reported on the Oral Health Impact Profile (OHIP) 14 for OHRQoL, showing means between 2.87 and 33.0 in sum score. Three studies applied Geriatric Oral Assessment Index (GOHAI), with sum scores between 45.6 and 55.0. Only one study found worse OHRQoL in stroke patients compared to healthy controls. Two studies reported on an association between OHRQoL and general quality of life. Three studies found OHRQoL to be associated with different oral health parameters. Only one study found OHRQoL to be associated with stroke-related parameters. Conclusions: Patients after stroke show a reduced OHRQoL. Medical staff and caregivers should support oral hygiene and dental visits, to foster patients’ oral health and OHRQoL.
CXCL10/IP10 as a Biomarker Linking Multisystem Inflammatory Syndrome and Left Ventricular Dysfunction in Children with SARS-CoV-2
Authors: Başar Eviç Zeynep , Sönmez Hafize Emine , Uzuner Hüseyin , Karadenizli Aynur , Güngör Hüseyin Salih , Akgün Gökmen , Yetimakman Ayşe Filiz , Öncel Selim , Babaoğlu Kadir
Published: March 2022

Background: To investigate the diagnostic accuracy of CXCL10/IP10 for left ventricular (LV) dysfunction in multisystemic inflammatory syndrome (MIS-C). Methods: This cross-sectional, longitudinal study included 36 patients with MIS-C. Patients were classified as follows: (1) patients presenting with Kawasaki-like features (group I = 11); (2) patients presenting with LV systolic dysfunction (group II = 9); and (3) other presentations (group III = 3). CXCL10/IP10 levels were measured upon admission and on days 3 and 7 of treatment. Results: Twenty patients were male and 16 were female. The median age of patients at diagnosis was 7.5 (1.5–17) years. All patients had a fever lasting for a median of 4 (2–7) days. Ten patients had LV systolic dysfunction. The duration of hospitalization was longer in group II. Lymphocyte and platelet counts were lower, whereas NT-pro-BNP, troponin-I, D-dimer, and CXCL10/IP10 levels were higher in group II. Baseline levels of CXCL10/IP10 were weakly negatively correlated with ejection fraction (r = −0.387, p = 0.022). Receiver operator characteristic curve analysis yielded a cutoff value of CXCL10/IP10 to discriminate patients with LV dysfunction was 1839 pg/mL with sensitivity 88% and specificity 68% (Area under curve (AUC) = 0.827, 95% CI 0.682–0.972, p = 0.003). Conclusion: Having a good correlation with cardiac function, CXCL10/IP10 is a potential biomarker to predict LV dysfunction in MIS-C patients.
Morphological and Functional Changes of Meibomian Glands in Pediatric and Adult Patients with Allergic Conjunctivitis
Authors: Wu Yuqing , Jiang Hao , Zhou Xujiao , Zhai Zimeng , Yang Pei , Zhou Shuyun , Gu Hao , Xu Jianjiang , Hong Jiaxu
Published: March 2022

Allergic conjunctivitis (AC) is one of the most common ocular disorders in clinical practice and is associated with meibomian gland dysfunction. This study aimed to explore the morphological and functional changes of meibomian glands (MGs) in pediatric and adult patients with AC and to analyze their potential predictors. In our prospective, observational cohort study, a total of 59 patients with AC were enrolled, with 30 patients aged ≤16 years in the pediatric group and 29 patients in the adult group. All patients underwent examinations at baseline and last visit when the complete resolution of conjunctival papillae was identified. An automatic MG analyzer was used to measure the morphological and functional parameters of MGs, including their area ratio (GA), tortuosity index (TI), and signal index (SI). Two groups were comparable at baseline in terms of characteristics and MG parameters (p > 0.05). The morphological (length, square, and GA) and functional MG parameters (SI) of AC patients significantly improved in the pediatric group after treatment (all p < 0.05), but not in the adult group. The change in the GA correlated with age, sex, GA, TI, and SI at baseline (all p < 0.05). Age (p = 0.001) and GA (p < 0.001) at baseline were predictors of an improvement in the GA of MGs. The findings showed that the structure and function of MGs in pediatric patients with AC seem to improve after the conjunctival papillae disappear, but not in adult patients.
Cardiovascular Magnetic Resonance Detects Inflammatory Cardiomyopathy in Symptomatic Patients with Inflammatory Joint Diseases and a Normal Routine Workup
Authors: Markousis-Mavrogenis George , Bonou Maria , Vartela Vasiliki , Kolovou Genovefa , Venetsanopoulou Aliki , Markatseli Theodora , Skalkou Anastasia , Tziortzioti Zoi , Voulgari Paraskevi , Mavrogeni Sophie I.
Published: March 2022

Background. Patients with inflammatory joint diseases (IJD) are more likely to develop cardiovascular disease compared with the general population. We hypothesized that cardiovascular magnetic resonance (CMR) could identify cardiac abnormalities in patients with IJD and atypical symptoms unexplained by routine clinical evaluation. Patients-Methods. A total of 51 consecutive patients with IJD (32 with rheumatoid arthritis, 10 with ankylosing spondylitis, and 9 with psoriatic arthritis) and normal clinical, electrocardiographic and echocardiographic workups, were referred for CMR evaluation due to atypical chest pain, shortness of breath, and/or palpitations. Their CMR findings were compared with those of 40 non-IJD controls who were referred for the same reason. All participants were examined using either a 1.5 T or 3.0 T CMR system. For T1/T2 mapping, comparisons were performed separately for each field strength. Results. Biventricular systolic function was similar between groups. In total, 25 (49%) patients with IJD vs. 0 (0%) controls had replacement-type myocardial fibrosis (p < 0.001). The T2 signal ratio, early/late gadolinium enhancement, and extracellular volume fraction were significantly higher in the IJD group. Native T1 mapping was significantly higher in patients with IJD independent of the MRI field strength (p < 0.001 for both). T2 mapping was significantly higher in patients with IJD compared with controls only in those examined using a 1.5 T MR system—52.0 (50.0, 55.0) vs. 37.0 (33.5, 39.5), p < 0.001. Conclusions. In patients with IJD and a mismatch between cardiac symptoms and routine non-invasive evaluation, CMR uniquely identified a significant proportion of patients with myocardial inflammation. A CMR examination should be considered in patients with IJD in similar clinical settings.
Comparison of Long-Term Outcomes and Associated Factors between Younger and Older Rural Ischemic Stroke Patients
Authors: Chaudhary Durgesh , Anyaehie Michelle , Demiraj Francis , Bavishi Shreya , Shahjouei Shima , Li Jiang , Abedi Vida , Zand Ramin
Published: March 2022

Introduction: The rise of ischemic stroke among young adults has stressed the need to understand their risk profiles and outcomes better. This study aimed to examine the five-year ischemic stroke recurrence and survival probability among young patients in rural Pennsylvania. Methods: This retrospective cohort study included first-time ischemic stroke patients from the Geisinger Health System between September 2003 and May 2014. The outcomes included all-cause mortality and ischemic stroke recurrence at five years. Kaplan-Meier estimator, cumulative incidence function, Cox proportional hazards model, and Cause-specific hazard model were used to examine the association of independent variables with the outcomes. Results: A total of 4459 first-time ischemic stroke patients were included in the study, with 664 (14.9%) patients in the 18–55 age group and 3795 (85.1%) patients in the >55 age group. In the 18–55 age group, the five-year survival probability was 87.2%, and the cumulative incidence of recurrence was 8%. Patients in the 18–55 age group had significantly lower hazard for all-cause mortality (HR = 0.37, 95% CI 0.29–0.46, p < 0.001), and non-significant hazard for five-year recurrence (HR = 0.81, 95% CI 0.58–1.12, p = 0.193) compared to the >55 age group. Chronic kidney disease was found to be associated with increased mortality in the 18–55 age group. Conclusion: In our rural population, younger ischemic stroke patients were at the same risk of long-term ischemic stroke recurrence as the older ischemic stroke patients. Identifying the factors and optimizing adequate long-term secondary prevention may reduce the risk of poor outcomes among younger ischemic stroke patients.
Social Responsiveness and Psychosocial Functioning in Adults with Prader–Willi Syndrome
Authors: Fernández-Lafitte Meritxell , Cobo Jesus , Coronas Ramon , Parra Isabel , Oliva Joan Carles , Àlvarez Aida , Esteba-Castillo Susanna , Giménez-Palop Olga , Palao Diego J. , Caixàs Assumpta
Published: March 2022

Although various studies have investigated symptoms of autism spectrum disorder (ASD) in Prader–Willi syndrome (PWS), little is known about the consequences of these symptoms, especially in psychosocial function. We aimed to explore ASD symptoms in adults with PWS with special attention to psychosocial functionality. This cross-sectional study included 26 adults (15 women) with PWS who attended a reference unit for rare diseases. Participants’ primary caregivers completed the Social Responsiveness Scale (SRS), and clinicians assessed multidimensional functioning with the Personal and Social Performance Scale (PSP). Impaired social responsiveness was identified in 20 (76.9%) participants, and manifest to marked difficulties in social functioning were identified in 13 (50%). Participants with impaired social responsiveness (SRS ≥ 60) had significantly worse scores in functionality measured with the PSP (U = 12.5; p = 0.009) and with three of the four PSP main areas. Moreover, scores for the Social Cognition domain of the SRS correlated positively with the Socially useful activities (p < 0.05) and Personal and social relationships (p < 0.01) main areas of the PSP. These results suggest that difficulties in social skills should be assessed in all psychosocial evaluations of patients with PWS.
Clinical Outcomes of Neoadjuvant Therapy in Human Epidermal Growth Factor Receptor 2 Breast Cancer Patients: A Single-Center Retrospective Study
Authors: Hung Chih-Chiang , Tsai I-Chen , Hsu Chiann-Yi , Lin Hsin-Chen
Published: March 2022

(1) Background: Neoadjuvant therapy is widely used to treat locally advanced breast cancer. It has been recently shown that it can also improve the prognosis of patients during the early stages of breast cancer. In the past, advanced breast cancer with positive Human Epidermal growth factor Receptor 2 (HER2+) resulted in poor prognoses; however, outcomes have since changed after the introduction of HER2-targeting therapy. Achieving pathological Complete Response (pCR) is the most important aim, as it is a predictor of long-term outcomes in high-risk breast cancer subtypes. (2) Methods: We performed a retrospective review of all breast cancer patients who were treated with neoadjuvant therapy at Taichung Veterans General Hospital (VGHTC) between 2010 and 2018. A total of 147 HER2+ breast cancer patients who underwent neoadjuvant chemotherapy involving anthracycline and taxane-based regimens were enrolled. Within that population, 95 and 52 cases received single-blockade (Trastuzumab) and dual-blockade (Trastuzumab and Pertuzumab) neoadjuvant anti-HER2 therapy, respectively. (3) Results: The dual-blockade therapy group displayed a significantly higher pCR rate after surgery as compared to the single-blockade group (63.5% vs. 43.2%, p = 0.019). Advanced stage, larger tumor size, lymph node involvement and HER2 expression status were associated with the pCR rate. The 4-year OS was 85.2% and 100% in the single-blockage and dual-blockade therapy groups, respectively (p = 0.041). (4) Conclusion: Anthracycline, followed by taxane-based neoadjuvant chemotherapy combined with the dual HER2-blockade, had a higher pCR rate and better outcome when compared with the single HER2-blockade strategy in locally advanced HER2 breast cancer.
Blood Pressure Monitoring and Perinatal Outcomes in Normotensive Women with Gestational Diabetes Mellitus
Authors: Lara-Barea Almudena , Sánchez-Lechuga Begoña , Vidal-Suárez Álvaro , Arroba Ana , Bugatto Fernando , López-Tinoco Cristina
Published: March 2022

Alterations in ambulatory blood pressure detected by monitoring (ABPM) have been associated with perinatal complications in hypertensive pregnant women. Aim: To establish the relationships between the blood pressure (BP) profiles detected by ABPM and adverse perinatal outcomes in normotensive women with gestational diabetes mellitus (GDM). Methods: A prospective study of normotensive women in whom 24 h ABPM was performed at 28–32 weeks of pregnancy. The obstetric and perinatal outcomes were evaluated. Results: Two hundred patients were included. Thirty-seven women with GDM and obesity had significantly higher mean systolic BP (SBP) and nocturnal SBP and diastolic BP (DBP) compared to women with only GDM (n = 86). Nocturnal SBP (OR = 1.077; p = 0.015) and obesity (OR = 1.131; p = 0.035) were risk factors for the development of hypertensive disorders of pregnancy (HDPs). Mothers of newborns with neonatal complications (n = 27) had higher nocturnal SBP (103.8 vs. 100 mmHg; p = 0.047) and DBP (62.7 vs. 59.4; p = 0.016). Women who delivered preterm (n = 10) had higher BP and a non-dipper pattern (p = 0.005). Conclusions: Nocturnal SBP was a predictor of HDPs in normotensive women with obesity or GDM. Alterations in ABPM in these patients were associated with poor obstetric and perinatal outcomes.
Efficacy of Lenvatinib and Sorafenib in the Real-World First-Line Treatment of Advanced-Stage Hepatocellular Carcinoma in a Taiwanese Population
Authors: Lee Shou-Wu , Yang Sheng-Shun , Lien Han-Chung , Peng Yen-Chun , Ko Chung-Wang , Lee Teng-Yu
Published: March 2022

Aim: Currently, atezolizumab combined with bevacizumab is the standard first-line treatment for unresectable hepatocellular carcinoma (HCC), but lenvatinib or sorafenib are still recommended for these patients for some reasons. The aim of the study was to determine the outcomes of Taiwanese patients with advanced-stage HCC who received lenvatinib or sorafenib. Methods: Data on patients with BCLC stage C HCC who were receiving lenvatinib or sorafenib as the first-line therapy from May 2018 to August 2020 was collected. The individuals with lenvatinib and sorafenib were propensity score-matched at a ratio of 1:2. Results: A total of 22 patients with lenvatinib and 44 patients with sorafenib were enrolled. The ORR (36.4% vs. 11.4%, p = 0.023) and DCR (81.9% vs. 56.9%, p = 0.039) were both higher in the lenvatinib group compared with the sorafenib group. The median overall survival (OS) of the lenvatinib group and the sorafenib group was 9.36 months and 8.36 months, respectively. The best median OS was detected in patients receiving lenvatinib and having an objective tumor response (11.29 months), with a significant difference (p = 0.031) compared with the other groups. Conclusion: Lenvatinib, compared to sorafenib, had better ORR and DCR, but similar OS, in Taiwanese patients with advanced-stage HCC. The patients with an objective tumor response had a better OS.
Hyperuricemia Is Associated with Significant Liver Fibrosis in Subjects with Nonalcoholic Fatty Liver Disease, but Not in Subjects without It
Authors: Yen Pei-Chia , Chou Yu-Tsung , Li Chung-Hao , Sun Zih-Jie , Wu Chih-Hsing , Chang Yin-Fan , Lu Feng-Hwa , Yang Yi-Ching , Chang Chih-Jen , Wu Jin-Shang
Published: March 2022

Liver fibrosis is associated with liver-related outcomes, yet often remains underdiagnosed in primary care settings. Hyperuricemia is associated with non-alcoholic fatty liver disease (NAFLD), but the relationship between hyperuricemia and liver fibrosis remains unclear. Data on individuals without NAFLD is also limited. We investigated the association between hyperuricemia and liver fibrosis in subjects with and without NAFLD. This study recruited 11,690 relevant participants from a health-checkup center. NAFLD was based on ultrasonography. Hyperuricemia was defined as serum uric acid > 6.0 mg/dL in women and >7.0 mg/dL in men. Significant liver fibrosis was diagnosed with the aspartate aminotransferase to platelet ratio index ≥0.5. The following were positively associated with significant liver fibrosis: hyperuricemia (p = 0.001), age ≥ 65 years (p < 0.001), male gender (p < 0.001), obesity (p = 0.009), hypertension (p = 0.002), diabetes (p < 0.001), and NAFLD (p < 0.001) in the logistic regression. The positive association of hyperuricemia with significant liver fibrosis remained in subjects with NAFLD (p = 0.001), but not in subjects without NAFLD. In conclusion, hyperuricemia increased the associated risk of significant liver fibrosis. The positively associated risk existed in subjects with NAFLD, but not in those without it.
Association of Visual Impairment with Psychological Distress in Older Adults: A Survey of 105,092 Older People in Taiwan
Authors: Yen Chu-Yu , Fang I-Mo , Hu Hsiao-Yun , Weng Shih-Han
Published: March 2022

This study aimed to evaluate the association between visual impairment (VI) and psychological distress (PD) among older adults in Taiwan. The present cohort study included participants aged >65 years who participated in a physical examination program. Participants were divided into two groups on the basis of whether they had PD at baseline. The association between PD and VI with other variables was compared using the two-sample t-test for continuous variables and chi-squared test for discrete variables. Cox regression analyses were used to calculate the hazard ratio (HR). Cumulative incidence of PD was analyzed using the Kaplan-Meier method, and differences among participants with different severities of VI were analyzed using the two-tailed log-rank test. Subgroup analyses were performed to calculate the HR for PD among participants with different severities of VI. The PD group showed a significantly high percentage of VI. In addition, participants with VI showed a significantly higher HR and seven-year cumulative incidence rate of PD than those without VI. VI was independently and significantly associated with a higher incidence of PD among older Asian people. Therefore, identifying and treating correctible VI is important to prevent PD and improve the overall quality of life.
Postoperative Complications and Swallowing Function after Jejunal and Skin Flap Reconstruction for Hypopharyngeal Carcinoma—A Multicenter Retrospective Study
Authors: Tokashiki Kunihiko , Okamoto Isaku , Okada Takuro , Sato Hiroki , Yamashita Taku , Matsuki Takashi , Kondo Takahito , Fushimi Chihiro , Masubuchi Tatsuo , Miura Kouki , Omura Go , Tsukahara Kiyoaki
Published: March 2022

This study compared the incidence of perioperative complications and swallowing function between free jejunal flap reconstruction and cutaneous free tissue flap construction. We included 223 patients who underwent hypopharyngeal reconstruction using free flap. At discharge, +the free jejunal flap was associated with a Functional Oral Intake Scale (FOIS) score of 1–6 in 132 cases (70%) and a score of 7 in 56 cases (30%). Regarding the cutaneous free tissue flaps, FOIS scores of 1–6 were observed in 18 cases (51%), and a score of 7 was noted in 17 cases (49%). Donor site complications occurred in 12% of the patients who underwent free jejunal flap procedures and in none of the patients who underwent cutaneous free tissue flap procedures. We found that the free jejunal flap had a regular dietary intake rate in 56 patients (30%), whereas cutaneous free tissue flaps had a regular dietary intake rate in 17 patients (49%). Cutaneous free tissue flaps had a significantly higher regular dietary intake rate at discharge and a significantly lower incidence of donor site complications than free jejunal flaps. In conclusion, free-flap reconstruction may be a better method than free jejunal flap reconstruction for the treatment of hypopharyngeal cancer.
Buckling Analysis and Optimization of Stiffened Variable Angle Tow Laminates with a Cutout Considering Manufacturing Constraints
Authors: Zhao Wei , Kapania Rakesh K.
Published: March 2022

Variable angle tow laminates (VAT) and stiffeners are known to redistribute the in-plane load distribution and tailor the buckling mode shapes, respectively, for improving structural performance. To leverage the benefits of using VAT laminates in the practical applications, in the present paper, we discuss buckling load maximization conducted for a stiffened VAT laminated plate with a central cutout considering VAT laminate manufacturing constraints. Three representative boundary conditions as seen in the aerospace structures are considered: in-plane axial displacement, in-plane pure shear, and in-plane pure bending displacements. Two common manufacturing constraints, the one on the automatic fiber placement (AFP) manufacturing head turning radius and the other on the tow gap/overlap, while fabricating VAT laminates are considered in the laminate design. These two manufacturing constraints are modeled by controlling the fiber path radius of curvature and tape parallelism in optimizing the fiber path orientations for the VAT laminates. Stiffener layout and fiber path angle for the VAT laminated plates are both considered in the buckling load maximization study. To avoid using a fine mesh in modeling the stiffened VAT laminates with a cutout when employing the finite element analysis during the optimization, the VAT laminated plate and the stiffeners are modeled independently. The displacement compatibility is enforced at the stiffener–plate interfaces to ensure that the stiffeners move with the plate. Particle swarm optimization is used as the optimization algorithm for the buckling load maximization study. Optimization results show that, without considering AFP manufacturing constraints, the VAT laminates can increase the buckling loads by 21.2% and 12.4%, respectively, comparing to the commonly used quasi-isotropic laminates and traditionally straight fiber path laminates for the structure under the in-plane axial displacement case, 19.7% and 12.5%, respectively, for the in-plane shear displacement case, and 62.1% and 26.6%, respectively, for the in-plane bending displacement case. The AFP manufacturing constraints are found to have different impacts on the buckling responses for the VAT laminates, which cause the maximum buckling load to be 9.3–10.1%, 3.0–3.2%, and 23.2–29.8% less than those obtained without considering AFP manufacturing constraints, respectively, for the present studied model under in-plane axial, shear, and bending displacements.
The Direct Sandwich Composite Molding (D-SCM) Process: Sandwich Manufacturing and Characterization
Authors: Behnisch Felix , Brütsch Jonathan , Werner Henrik O. , Henning Frank
Published: March 2022

Sandwich structures benefit from the geometrical stiffening effect due to their high cross-sectional area moment of inertia. Transferred to carbon fiber-reinforced plastic (CFRP) components, the needed amount of carbon fiber (CF) material can be reduced and with it the CO2 footprint. The combination of a light foam core with continuous fiber-reinforced face sheets is a suitable material combination for lightweight design. Traditionally, CFRP sandwich structures with a foam core are manufactured in a two-step process by combining a prefabricated foam core with fiber-reinforced face sheets. However, in addition to the reduction in the used CFRP material, manufacturing processes with a high efficiency are needed. The objective of this paper is the sandwich manufacturing and characterization by using the Direct Sandwich Composite Molding (D-SCM) process for the one-step production of CFRP sandwich structures. The D-SCM process utilizes the resulting foaming pressure during the reactive polyurethane (PUR) foam system expansion for the impregnation of the CF-reinforced face sheets. The results of this work show that the production of sandwich structures with the novel D-SCM process strategy is feasible in one single manufacturing step and achieves good impregnation qualities. The foam density and morphology significantly influence the core shear properties and thus the component behavior under a bending load.
Benchmarking of 316L Stainless Steel Manufactured by a Hybrid Additive/Subtractive Technology
Authors: Sarafan Sheida , Wanjara Priti , Gholipour Javad , Bernier Fabrice , Osman Mahmoud , Sikan Fatih , Soost Josh , Amos Robert , Patnaik Prakash , Brochu Mathieu
Published: March 2022

This research study investigated the hybrid processing of 316L stainless steel using laser powder bed (LPB) processing with high-speed machining in the same build envelope. Benchmarking at four laser powers (160 W, 240 W, 320 W, and 380 W) was undertaken by building additively with machining passes integrated sequentially after every ten deposited layers, followed by the final finishing of select surfaces. The final geometry was inspected against the computer-aided design (CAD) model and showed deviations smaller than 280 µm for the as-built and machined surfaces, which demonstrate the good efficacy of hybrid processing for the net-shape manufacturing of stainless steel products. The arithmetic average roughness values for the printed surfaces, Ra (linear) and Sa (surface), were 11.4 um and 14.9 um, respectively. On the other hand, the vertical and horizontal machined surfaces had considerably lower roughness, with Ra and Sa values ranging between 0.33 µm and 0.70 µm. The 160 W coupon contained layered, interconnected lack of fusion defects which affected the density (7.84 g·cm−3), yield strength (494 MPa), ultimate tensile strength (604 MPa), Young’s modulus (175 GPa), and elongation at break (17.3%). By contrast, at higher laser powers, near-full density was obtained for the 240 W (7.96 g·cm−3), 320 W (7.94 g·cm−3), and 380 W (7.92 g·cm−3) conditions. This, combined with the isolated nature of the small pores, led to the tensile properties surpassing the requirements stipulated in ASTM F3184—16 for 316L stainless steel.
Nozzle Condition Monitoring System Using Root Mean Square of Acoustic Emissions during Abrasive Waterjet Machining
Authors: Kim Jeong-Uk , Kim Roh-Won , Kim Sung-Ryul , Kim Hyun-Hee , Lee Kyung-Chang
Published: March 2022

Machining of difficult-to-cut materials such as titanium alloys, stainless steel, Inconel, ceramic, glass, and carbon fiber-reinforced plastics used in the aerospace, automobile, and medical industries is being actively researched. One non-traditional machining method involves the use of an abrasive waterjet, in which ultra-high-pressure water and abrasive particles are mixed and then ejected through a nozzle, and the thin jet stream cuts materials. The nozzle greatly affects the machining quality, as does the cutting tool of general machining, so it is very important to monitor the nozzle condition. If the nozzle is damaged or worn, or if the bore size increases or the bore becomes clogged with abrasive, the material may not be cut, or the surface quality of the cut may deteriorate. Here, we develop a nozzle monitoring system employing an acoustic emission sensor that detects the nozzle condition in real time.
Influence of Swept Blades on the Performance and Hydrodynamic Characteristics of a Bidirectional Horizontal-Axis Tidal Turbine
Authors: Liu Siyuan , Zhang Jisheng , Sun Ke , Guo Yakun , Guan Dawei
Published: March 2022

Horizontal-axis tidal turbines (HATTs) have an acknowledged potential to extract a considerable amount of clean renewable energy from ocean tides. Among these, bidirectional HATTs (BHATTs) with bidirectional hydrofoils are thought to have higher economy than general HATTs. To improve the BHATTs, this study systemically investigated the influence of swept blades on the performance and hydrodynamics of the BHATT. A three-dimensional (3D) numerical model based on OpenFOAM was adopted to simulate a full-scale BHATT. The numerical framework was validated using two well-known experiments, and the mesh convergence was taken into consideration. The results indicate that the forward and backward swept blades have a limited impact on the performance and hydrodynamics of the BHATT. The upstream swept blade leads to a 4.3% decrease in the load on the rotor at design tip speed ratio (TSR) with a 2.0% decrease in the power. The BHATT with a downstream swept blade can produce 3.2% more energy at TSR = 6. Moreover, the swept blades have the opposite effect on the power of the BHATT at TSR = 6 and TSR = 9.
Vertical Distribution and Chemical Fractionation of Heavy Metals in Dated Sediment Cores from the Saronikos Gulf, Greece
Authors: Prifti Eleni , Kaberi Helen , Paraskevopoulou Vasiliki , Michalopoulos Panagiotis , Zeri Christina , Iliakis Stylianos , Dassenakis Manos , Scoullos Michael
Published: March 2022

The Saronikos Gulf is under a lot of anthropogenic pressure, such as the urban expansion of the metropolitan area of Athens, the port of Piraeus and marinas, industrial activities, and tourism. Heavy metal pollution has been a major environmental problem in the area for many decades. Sedimentary cores have proven to be an invaluable indicator of heavy metal pollution, as they can reveal not only the current metal inputs but also the evolution of pollution over time, and with the appropriate geochemical analyses, they can provide information on the potential toxicity of metals. In this study, the temporal evolution and the chemical speciation of eleven elements were examined in sediment cores from Elefsis Bay and the Inner Saronikos Gulf, with an emphasis on the emerging environmental hazards (V and Ag). The results showed extensive pollution of the sediments by Ni, Cr, Cu, Zn, As, Mo, Cd, and Pb from the 1910s and 1960s in Eastern and Western Elefsis Bay, respectively. A significant decrease of the sediment enrichment in V, Ni, Cr, Cu, Zn, As, Cd, Pb, and Ag since 2000 was observed in the part of the Inner Saronikos Gulf that is mainly influenced by the WWTP of Athens. However, a toxicity assessment using the metal contents of the surface sediments showed that most of the trace elements studied still pose a moderate to high risk of toxicity to benthic ecosystems. The present study highlighted the urgent need for focused research and the management of trace element inputs, particularly Ag in the Inner Saronikos Gulf, where severe sediment modification was evident.
Investigation into the Hydrodynamic Noise Characteristics of Electric Ducted Propeller
Authors: Chen Mengfei , Liu Jinfeng , Si Qiaorui , Liang Yun , Jin Zhongkun , Yuan Jianping
Published: March 2022

Ducted propeller is a kind of special propeller widely used in unmanned underwater vehicles, its flow characteristics and hydrodynamic noise are very important for marine environmental protection and equipment concealment. The hybrid techniques based on the acoustic analogy theory are adopted in the present study to calculate the unsteady flow field and sound field characteristics of a ducted propeller. The full scale flow filed and hydro-acoustic sources of the propulsion system are simulated by Detached-Eddy computational fluid dynamics (CFD) method. Hydrodynamic noise are calculated by FWH equation based on the CFD results. The frequency domain and directivity of sound pressure level at different sound field monitoring points are analyzed at four navigational speeds. The results show that the navigational speed that is in the inflow condition of the ducted propeller play important roles in the flow structure and underwater radiated noise. Under the fixed impeller rotational speed, the propulsion efficiency of ducted propeller increases first and then decreases with the raise of navigational speed. The maximum errors of thrust and power between simulation and experiment values are 0.5% and 0.1% respectively, which means that the adopted DES numerical simulation method has high credibility in calculating the acoustic source. At impeller rotational speed of 2000 r/min, the best state of flow field distribution is at the navigational speed of 1.54 m/s, which is corresponding to the highest propulsion efficiency condition. The propeller noise presents dipole characteristic in all working conditions, and at the obvious blade passing frequency, multiple characteristics are presented; most of the noise contribution is also concentrated below four times of the blade passing frequency. The total sound pressure level of the hydrodynamic noise is the smallest at the optimal efficiency condition (the navigational speed is 1.54 m/s). At high navigational speed, the low frequency characteristics below blade passing frequency increase and the amplitude becomes larger. This indicates that the component of turbulent noise becomes more important with the increase of navigational speed. The research focuses on analyzing the relationship between the energy loss of the ducted propeller wake field and the noise level, and it is found that the vortex at the tail makes a certain contribution to the noise. The research conclusions could provide some reference for the acoustic performance evaluation and noise reduction optimization of ducted propeller design as well as the improvement of UUV stealth performance.
Storm Tide and Wave Simulations and Assessment II
Authors: Hsiao Shih-Chun , Chiang Wen-Son , Chen Wei-Bo
Published: March 2022

The storm tides, surges, and waves that are associated with typhoons/tropical cyclones/hurricanes are the most severe threats to coastal zones, nearshore waters, and navigational safety [...]
An AUV Target-Tracking Method Combining Imitation Learning and Deep Reinforcement Learning
Authors: Mao Yubing , Gao Farong , Zhang Qizhong , Yang Zhangyi
Published: March 2022

This study aims to solve the problem of sparse reward and local convergence when using a reinforcement learning algorithm as the controller of an AUV. Based on the generative adversarial imitation (GAIL) algorithm combined with a multi-agent, a multi-agent GAIL (MAG) algorithm is proposed. The GAIL enables the AUV to directly learn from expert demonstrations, overcoming the difficulty of slow initial training of the network. Parallel training of multi-agents reduces the high correlation between samples to avoid local convergence. In addition, a reward function is designed to help training. Finally, the results show that in the unity simulation platform test, the proposed algorithm has a strong optimal decision-making ability in the tracking process.
Polymorphisms and Gene-Gene Interaction in AGER/IL6 Pathway Might Be Associated with Diabetic Ischemic Heart Disease
Authors: Liu Kuo , Xie Yunyi , Zhao Qian , Peng Wenjuan , Guo Chunyue , Zhang Jie , Zhang Ling
Published: March 2022

Background: Although the genetic susceptibility to diabetes and ischemic heart disease (IHD) has been well demonstrated, studies aimed at exploring gene variations associated with diabetic IHD are still limited; Methods: Our study included 204 IHD cases who had been diagnosed with diabetes before the diagnosis of IHD and 882 healthy controls. Logistic regression was used to find the association of candidate SNPs and polygenic risk score (PRS) with diabetic IHD. The diagnostic accuracy was represented with AUC. Generalized multifactor dimensionality reduction (GMDR) was used to illustrate gene-gene interactions; Results: For IL6R rs4845625, the CT and TT genotypes were associated with a lower risk of diabetic IHD than the CC genotype (OR = 0.619, p = 0.033; OR = 0.542, p = 0.025, respectively). Haplotypes in the AGER gene (rs184003-rs1035798-rs2070600-rs1800624) and IL6R gene (rs7529229-rs4845625-rs4129267-rs7514452-rs4072391) were both significantly associated with diabetic IHD. PRS was associated with the disease (OR = 1.100, p = 0.005) after adjusting for covariates, and the AUC were 0.763 (p < 0.001). The GMDR analysis suggested that rs184003 and rs4845625 were the best interaction model after permutation testing (p = 0.001) with a cross-validation consistency of 10/10; Conclusions: SNPs and haplotypes in the AGER and IL6R genes and the interaction of rs184003 and rs4845625 were significantly associated with diabetic IHD.
Traceable Features of Static Plantar Pressure Characteristics and Foot Postures in College Students with Hemiplegic Cerebral Palsy
Authors: Chow Tong-Hsien
Published: March 2022

Patients with cerebral palsy (CP) are characterized by disturbances of mobility with postural and foot deformities. Subsequent development of CP may lead to changes in plantar loading. This study examined the characteristics of foot types and relative loads associated with centers of gravity and foot posture in college students with left and right hemiplegic CP, as well as these differences between unaffected and hemiplegic limbs. A cross-sectional study of 45 hemiplegic college students with mild CP and 62 healthy students was conducted. Static plantar pressure was measured with a JC Mat. CP students exhibited low arches, and their plantar pressure distributions (PPDs) were mainly exerted on the left forefoot, as well as on the right forefoot and rearfoot. The weight shifted to the unaffected foot with dual plantar loading regions (forefoot and rearfoot), rather than the hemiplegic foot with a single region (forefoot). PPDs commonly increased at the medial metatarsals of both feet, and hemiplegic CP students presented the increased PPDs on the medial aspect of the hemiplegic foot accompanied by a rearfoot valgus posture pattern. The findings revealed a traceable feature to a possible connection among the pronated low arches, mild centers of gravity, metatarsal syndrome and rearfoot valgus of the hemiplegic limbs in CP patients.
A Fitness-Fatigue Model of Performance in Peripheral Artery Disease: Predicted and Measured Effects of a Pain-Free Exercise Program
Authors: Lamberti Nicola , Piva Giovanni , Businaro Federico , Caruso Lorenzo , Crepaldi Anna , Lòpez-Soto Pablo Jesùs , Manfredini Fabio
Published: March 2022

Banister impulse-response (IR) model estimates the performance in response to the training impulses (TRIMPs). In 100 patients with peripheral artery disease (PAD), we tested by an IR model the predictability of the effects of a 6-month structured home-based exercise program. The daily TRIMPs obtained from prescribed walking speed, relative intensity and time of exercise determined the fitness-fatigue components of performance. The estimated performance values, calculated from the baseline 6-min and pain-free walking distance (6MWD and PFWD, respectively) were compared with values measured at visits through regression models. Interval pain-free walking at controlled speed prescribed during circa-monthly hospital visits (5 ± 1) was safely performed at home with good adherence (92% of scheduled sessions, 144 ± 25 km walked in 50 ± 8 training hours). The mean TRIMP rose throughout the program from 276 to 601 a.u. The measured 6MWD and PFWD values increased (+33 m and +121 m, respectively) showing a good fit with those estimated by the IR model (6MWD: R2 0.81; PFWD: R2 0.68) and very good correspondence (correlation coefficients: 0.91 to 0.95), without sex differences. The decay of performance without training was estimated at 18 ± 3 weeks. In PAD, an IR model predicted the walking performance following a pain-free exercise program. IR models may contribute to design and verify personalized training programs.
Searching for New Molecular Targets for Oral Squamous Cell Carcinoma with a View to Clinical Implementation of Precision Medicine
Authors: Sasahira Tomonori , Kurihara-Shimomura Miyako , Shimojjukoku Yudai , Shima Kaori , Kirita Tadaaki
Published: March 2022

Head and neck cancer, including oral squamous cell carcinoma (OSCC), is the eighth most common malignancy globally and is characterized by local invasiveness and high nodal metastatic potential. The OSCC incidence is also increasing, and the number of deaths is also rising steadily in Japan. The development of molecular markers to eradicate OSCC is an urgent issue for humankind. The increase in OSCC despite the declining smoking rate may be due to several viral infections through various sexual activities and the involvement of previously unfocused carcinogens, and genetic alterations in individual patients are considered to be more complicated. Given this situation, it is difficult to combat OSCC with conventional radiotherapy and chemotherapy using cell-killing anticancer drugs alone, and the development of precision medicine, which aims to provide tailor-made medicine based on the genetic background of each patient, is gaining attention. In this review article, the current status of the comprehensive search for driver genes and biomarkers in OSCC will be briefly described, and some of the candidates for novel markers of OSCC that were found will be outlined.
Evaluation of CRC-Metastatic Hepatic Lesion Chemoembolization with Irinotecan-Loaded Microspheres, According to the Site of Embolization
Authors: Szemitko Marcin , Golubinska-Szemitko Elzbieta , Warakomski Marcin , Falkowski Aleksander
Published: March 2022

With the chemembolization of colorectal-cancer (CRC)-metastatic hepatic lesions by irinotecan-loaded microspheres, most researchers recommend slow embolizate delivery at the lobar-artery level to the entire liver parenchyma without obtaining visible stasis. An association has been reported between postoperatively visible embolizate stasis and lesion response to treatment. Possibly, in some cases, more selective administration might give greater benefit, particularly with previous systemic chemotherapy failure. Objective: Treatment response evaluation after chemoembolization of CRC-metastatic liver lesions with irinotecan-loaded microspheres, according to a hepatic-artery branch level of administration. Patients and methods: The analysis included 54 patients (24 females, 30 males) with large (median diameter > 5 cm) CRC-metastatic liver lesions, who underwent 196 chemoembolization procedures (mean 3.63 per patient) with irinotecan (100 mg)-loaded microspheres. Patients were divided into two groups according to initial embolizate-administration branch level: Group A (n = 26): at the segmental or subsegmental-vessel level; Group B (n = 28): at the lobar-branch level. Treatment response was assessed by computed-tomography (mRECIST criteria); overall survival (OS) and progression-free survival (PFS) were calculated using the Kaplan–Meier method and adverse effects were assessed according to the Common Terminology Criteria for Adverse Events (CTCAE; version 5.0). Results: There were statistically significant differences in the occurrence of partial response (PR): higher in Group A (42.3%) than Group B (17.9%) (p = 0.039) and occurrence of stable disease (SD): lower (p = 0.025) in Group A (11.5%) than Group B (39.4%). However, occurrence of disease progression (PD) was similar: Group A: 42.3%; Group B: 42.9% (p = 0.93). Patients in Group A presented with more favorable PFS (p = 0.029) and OS (p = 0.039) than Group B. Median survival times: Group A: 15.2 months; Group B: 13.1 months. There was no significant difference in complication incidence between groups (Group A: seven complications; Group B: six complications; p = 0.863). Conclusion: Superselective chemoembolizate administration to vessels supplying large CRC-metastatic liver lesions gave better response to treatment and extended patient survival time, without significantly increasing complication risk.
The COVID-19 Health Crisis and Its Impact on China’s International Relations
Authors: Cabestan Jean-Pierre
Published: March 2022

Using qualitative methods, this article focuses on the relationship between the COVID-19 health crisis and China’s foreign policy and foreign relations. My main argument is that since its outbreak in late 2019, the COVID-19 health crisis has deepened the tensions already existing between China and the United States, as well as China and the West in general. Other factors that appeared before the pandemic have also contributed to intensifying the Sino-US rivalry as well as Sino-European frictions. Nonetheless, Beijing’s proactive mask and vaccine diplomacy, its strict lockdown policy as well as its more aggressive nationalist and anti-western narrative have fed rather than alleviated these tensions. While China’s image in the Global South has remained largely positive, in the Global North, it has rapidly deteriorated. All in all, this paper demonstrates that the pandemic has been an aggravating factor contributing to the downward spiral of China’s relations with the outside world as well as its own isolation.