bluuebunny/crossref_metadata_2025 huggingface dataset:
Driving cycle prediction based on Markov chain combined with driving information mining
Authors: Li Ling , Sun Haochen , Tao Fazhan , Fu Zhumu
Published: May 2023

Driving cycle prediction (DCP) is of great importance for vehicle’s awareness of surrounding environment and optimization of control strategy. It has won much attention around the world. However, the used driving database could not reflecting the great diversity in multi driving cycles in real world. The characteristic parameters could not represent the complex and diverse driving conditions. Therefore, DCP models’ adaptability and generalization ability are limited. Moreover, prediction methods in existing researches always take large computation burden, difficult to apply in practice. To tackle these issues, the present research focus on DCP based on Markov chain combined with driving information mining (DIM). Firstly, many standard test cycles and real cycles are collected to construct an database of great diversity. Secondly, DIM technologies are studied to extract the optimal parameter set reflecting driving characteristics and determine the driving cycle categories. Thirdly, prediction method based on recursive self-learning Markov chain is proposed. Recursive equation of Markov state transition probability matrix (TPM) is deduced to save computation time. The key parameter of prediction method is adjusted to achieve optimal prediction performance. Synthesized standard test driving cycles (SSTDC) and real driving cycles (RDC) in database, as well as a new real driving cycle (NRDC) are tested. Driving pattern prediction accuracy of the proposed method is 99.25% for SSTDC, 100.00% for RDC, and 99.84% for NRDC, respectively. Compared with the benchmark method, the prediction accuracy is improved by 18.87% for SSTDC, 10.07% for RDC and 23.51% for NRDC, respectively. In addition, processing time of the prediction program is significantly reduced by 2.23 s (36.14%) for SSTDC, 12.30 s (51.25%) for RDC and 3.99 s (52.16%) for NRDC, respectively. It can be verified that the proposed method has high precision, short response time, as well as good adaptability and charming generalization ability for new cycles.
Research on simulated operational path analysis applied to structure-borne road noise
Authors: Li Xiaolong , Lu Chihua , Zhu Yawei , Sun Yi , Chen Wan , Cheng Can
Published: May 2023

The accurate identification of noise sources inside vehicles is the basis of optimizing structure-borne noise problems, and transfer path analysis (TPA) is one of the most commonly used methods. The load-response type TPA represented by the classical TPA has high accuracy but low experimental efficiency. The response-response type TPA represented by the Operational TPA (OTPA) has high efficiency but cannot guarantee its accuracy when the relevant excitation sources act on the system simultaneously or there is a strong coupling between the transfer paths. In this paper, a novel response-response type TPA, simulated operational path analysis (SOPA), balancing efficiency and accuracy is proposed and tested. Without severing the connection between the source and receiver, the system is decoupled by running the simulated loads separately, and the proposed inverse transmissibility matrix method is used to cancel the crosstalk between reference signals, thus solving the problems of path cross-coupling and path neglection of OTPA in multi-input systems. For validation purpose, a four-shaker bench test is analysed, it is found that SOPA is more accurate than OTPA in path contributions analysis. Finally, SOPA is applied to the transfer path analysis of structure-borne road noise inside the vehicle, and it is also shown that the noise can be well predicted. Therefore, the proposed method may be an alternative method in addition to the traditional source-path-contribution analysis.
Coping strategies among older adults living with HIV/AIDS with history of childhood sexual abuse
Authors: Amoatika Daniel A , Brown Monique J , Addo Prince N O , Kaur Amandeep
Published: May 2023

Background: Childhood sexual abuse (CSA) may be a risk factor for poor mental health in adulthood. Survivors may experience emotions detrimental to their social and mental wellbeing. Some of these emotions may include anger, fear, rage, helplessness, guilt, shame, which may impact their coping strategies. The aim of this study was to determine the association between CSA and coping among older adults living with HIV (OALH). Method: Data were obtained from 91 OALH via convenience sampling. The participants were recruited from an immunology clinic and were at least 50 years or older and living with HIV. CSA was operationalized using questions from the Adverse Childhood Experiences Questionnaire. Coping was assessed using the Brief COPE Inventory. Crude and adjusted linear regression models, controlling for age, sex, race, gender, and income were used to determine the association between CSA and each coping subscale. The analyses were conducted in SAS version 9.4. Results: Crude analyses showed statistically significant associations between CSA and specific coping strategies: humor (β = 1.244; p = 0.0018), religion (β = 1.122; p = 0.0291), Self-blame (β = 1.103; p = 0.0154), planning β = 1.197; p = 0.0196), venting (β = 1.218; p = 0.0063), substance use (β = 0.828; p = 0.0335) and instrumental support (β = 0.949; p = 0.0416) After adjusting for sociodemographic characteristics, there was a statistically significant association between CSA and humor (β = 1.321; p = 0.0048) and self-blame (β = 1.046; p = 0.0382). Conclusion: OALH with a history of CSA were more likely to use humor and self-blame as coping strategies. Trauma-informed interventions should be geared towards decreasing self-blame for OALH who are CSA survivors.
Psychological Momentum
Authors: Honey Christopher J. , Mahabal Abhijit , Bellana Buddhika
Published: May 2023

Our mental experience is largely continuous on the scale of seconds and minutes. However, this continuity does not always arise from a volitional carrying forward of ideas. Instead, recent actions, thoughts, dispositions, and emotions can persist in mind, continually shaping our later experience. Aspects of this fundamental property of human cognition— psychological momentum—have been studied under the rubrics of mindset, mood, memory, task set, and mind wandering. Reviewing these largely independent threads of research, we argue that psychological momentum needs to be understood from an integrated perspective as an adaptation that, although sometimes costly, carries forward thoughts and dispositions that respond to the current and future environment.
The Nexus Between IT Capabilities and Firm Innovation Performance: The Mediating Effect of Supply Chain Agility
Authors: Khan Kashif Ullah , Atlas Fouzia , Ali Wajahat , Ghani Usman , Khan Farhan
Published: May 2023

This study investigates the impact of IT capabilities on firm innovation performance. Further, it examines the mediating role of supply chain agility (SCA) as well as the moderating effect of innovation orientation (IO). The proposed conceptual model draws on resource-based view (RBV) theory. Dataset of 335 responses was analysed with process MACRO using SPSS 24.0 and AMOS. The findings show that IT capabilities positively affect firm innovation performance and SCA mediates the relationship of IT capabilities and firm innovative performance. Finally, results also confirm the moderating effect of IO between the IT capabilities and SCA.
Effectiveness of Telephone-Based Interpersonal Psychotherapy on Antenatal Depressive Symptoms: A Prospective Randomized Controlled Trial in The Kingdom of Jordan
Authors: Abujilban Sanaa , Al-Omari Hasan , Issa Esra’a , ALhamdan Ayat , Al-nabulsi Lama , Mrayan Lina , Mahmoud Khadejah F. , Kernohan W. George
Published: May 2023

Background:

Jordanian pregnant women report high prevalence of antenatal depressive symptoms, compared to their counterparts internationally. One potential nonpharmacological intervention is Interpersonal Psychotherapy (IPT), accessed by telephone.

Aim:

The aim of this study is to compare the depressive symptom level(s) among Jordanian pregnant women who received IPT treatment with those who received routine antenatal care.

Methods:

A prospective randomized controlled trial design was used. Following ethical approval, a sample of 100 pregnant women (50 in each group) at 24 to 37 weeks gestation, was drawn from one governmental public hospital. Seven sessions (each half an hour) of telephone-based IPT were offered twice weekly to those assigned to the intervention arm: one pretherapy orientation, five intermediates, and one closing session. The Edinburgh Postnatal Depression Scale was administered before and after the intervention. Analysis of covariance was used to detect the intervention effect. The two groups were matched based on demographic and health characteristics.

Results:

Compared to the control group, pregnant women who received the intervention reported fewer depressive symptoms.

Conclusions:

Midwives and general nurses should screen all pregnant women for symptoms of depression. The effectiveness of IPT treatment in alleviating depressive symptoms indicates the importance of using such supportive interventions by midwives and general nurses, who are trained in psycho-educational counseling techniques. Moreover, data provided by this study may encourage policymakers to legislate policies that make psychotherapists available and accessible in antenatal care units and ensure that staff have adequate training via continuing education programs to screen for antenatal depressive symptoms.
Study of antibiotic resistance and virulence genes in Escherichia coli isolated from urinary tract infection patients in Tanta University Hospitals
Authors: Helmy Aya A , Abdel Ghafar Muhammad T , Okda Hanaa I , Abo-Elenein Amany M
Published: May 2023

This study aimed to investigate the prevalence of antibiotic resistance genes CTX-M and Qnr, as well as the virulence genes HlyA, Pap, CNF1, and Afa, in uropathogenic Escherichia coli ( UPEC) isolates from the Egyptian population. In this cross-sectional study, a total of 50 E. coli isolates were collected from urine samples from patients with urinary tract infections (UTIs) admitted to Tanta University Hospital from December 2020 to November 2021. The isolates were cultured, identified, and tested for antibiotic susceptibility by the disc diffusion method. The CTX-M, Qnr ( QnrA, B, and S), Pap, CNF1, HlyA, and Afa genes were detected by polymerase chain reaction in UPEC isolates. The Pap, CNF1, HlyA, and Afa genes were found to be positive in 18%, 12%, 10%, and 2% of the isolates, respectively. In addition, CTX-M and QnrS were found to be positive in 44% and 8% of the isolates, while QnrA and B were not detected. Furthermore, positive Pap, CNF1, and HlyA genes were significantly associated with both upper and lower UTIs, increased frequency, urgency, and dysuria, and complicated UTIs, as well as pyuria over 100 white blood cells per high-power field. In conclusion, the prevalence of virulence and antibiotic resistance genes varies by population. At our hospital, the Pap gene is the most prevalent virulence gene and was strongly associated with complicated UTIs, while the CTX-M and QnrS genes were the most prevalent and related to antibiotic resistance. Our findings, however, should be interpreted with caution due to the small sample size.
How Prior Experience With Automated Technology Impacts Perceptions of Autonomous Vehicles Among Midwestern U.S. Farmers
Authors: Hazelton-Boyle Josephine K. , Piatkowski Daniel
Published: May 2023

Autonomous Vehicles (AVs) are widely considered to be the future of surface transportation in the United States, but little is understood about how people will interact with these vehicles, what they will use them for, and how they will impact our roads. However, farmers have been interacting with some degree of AV technology, primarily auto-guidance, in the Midwestern U.S. for at least the last 10 years. We use in-depth qualitative interviews to understand farmers’ experiences with using highly automated technology in order to inform adoption and diffusion patterns of AVs. The findings include implications for on-road AVs for technology adoption, infrastructure, AV users, and public policy which each hold relevance for engineers, planners, and policy-makers seeking to be proactive in preparing for AVs.
Children and adolescents’ mental health in pandemics and confinement: A scoping review of vulnerability factors and repercussions
Authors: Montreuil Marjorie , Camden Chantal , Genest Christine , Gilbert Elsa , Laberge-Perrault Emilie , Piché Geneviève , Rassy Jessica , Bogossian Aline , Gendron-Cloutier Lauranne , Barbo Geneveave
Published: May 2023

Children and adolescents are a population at particular risk of experiencing adverse mental health repercussions related to pandemics. To understand vulnerability factors and repercussions of pandemics and related sanitary measures on children and adolescents’ mental health, we performed a scoping review to examine and synthesize literature. In total, 66 articles were included. Results present: (1) factors that increase vulnerability to adverse mental health repercussions (e.g., having a pre-existing mental health condition, social isolation, low socio-economic status, parental distress, and overexposure to media content) and (2) specific mental health repercussions (e.g., anxiety, fear, depression, and externalizing behaviors). Addressing concerns underlined in this review could contribute to preventing further negative mental health repercussions of pandemics for children and adolescents and better prepare governments and professionals to address these highly challenging situations. Recommendations for practice include enhancing healthcare professionals’ awareness about possible detrimental repercussions pandemics and sanitary measures have on children and adolescents’ mental health, assessing changes for those with pre-existing mental health conditions, allocating funding for telehealth research, and providing greater support to healthcare providers.
An artificial neural network approach for rational decision-making in borderline orthodontic cases: A preliminary analytical observational in silico study
Authors: Kapoor Shanya , Shyagali Tarulatha R , Kuraria Amit , Gupta Abhishek , Tiwari Anil , Goyal Payal
Published: May 2023

Introduction:

Artificial intelligence (AI) technology has transformed the way healthcare functions in the present scenario. In orthodontics, expert systems and machine learning have aided clinicians in making complex, multifactorial decisions. One such scenario is an extraction decision in a borderline case.

Objective:

The present in silico study was planned with the intention of building an AI model for extraction decisions in borderline orthodontic cases.

Design:

An observational analytical study.

Setting:

Department of Orthodontics, Hitkarini Dental College and Hospital, Madhya Pradesh Medical University, Jabalpur, India.

Methods:

An artificial neural network (ANN) model for extraction or non-extraction decisions in borderline orthodontic cases was constructed based on a supervised learning algorithm using the Python (version 3.9) Sci-Kit Learn library and feed-forward backpropagation method. Based on 40 borderline orthodontic cases, 20 experienced clinicians were asked to recommend extraction or non-extraction treatment. The decision of the orthodontist and the diagnostic records, including the selected extraoral and intra-oral features, model analysis and cephalometric analysis parameters, constituted the training dataset of AI. The built-in model was then tested using a testing dataset of 20 borderline cases. After running the model on the testing dataset, the accuracy, F1 score, precision and recall were calculated.

Results:

The present AI model showed an accuracy of 97.97% for extraction and non-extraction decision-making. The receiver operating curve (ROC) and cumulative accuracy profile showed a near-perfect model with precision, recall and F1 values of 0.80, 0.84 and 0.82 for non-extraction decisions and 0.90, 0.87 and 0.88 for extraction decisions.

Limitation:

As the present study was preliminary in nature, the dataset included was too small and population-specific.

Conclusion:

The present AI model gave accurate results in decision-making capabilities related to extraction and non-extraction treatment modalities in borderline orthodontic cases of the present population.
Emotion-focused dyadic coping styles used by family carers of people with dementia during the COVID-19 pandemic
Authors: Colclough Carmen , Miles Eleanor , Rusted Jennifer , Perach Rotem , Hicks Ben , Dixon Josie , Dangoor Margaret , Gridley Kate , Birks Yvonne , Donaghy Paul , Mcardle Riona , Moseley Elen , Sondh Harsharon K , Banerjee Sube ,   for the DETERMIND team
Published: May 2023

Emotional wellbeing of family carers and people with dementia is associated with not only how each individual copes with stress and conflict, but also by how they cope together. Finding ways to positively cope together was particularly important during COVID-19 lockdown restrictions, when other avenues of emotional support were less available. We explored how carers experienced and used emotion-focused dyadic coping styles during the COVID-19 pandemic. In-depth qualitative interviews were conducted during the pandemic with 42 family carers, supplemented by quality of life scores collected both pre- and during the pandemic and household status. Abductive thematic analysis identified five styles of emotion-focused dyadic coping: common, supportive, hostile, disengaged avoidance and protective. The COVID-19 pandemic left many dyads unsupported. While many carers adapted, reporting increases in quality of life and enjoying the extra time with the person with dementia, others experienced dyadic conflict and reductions in quality of life. This variation was associated with dyadic coping styles, including challenges in using ‘positive’ styles and the protective use of ‘negative’ disengaged avoidance in the right situations. Dyadic coping styles also differed as a function of whether the dyad lived together. As many people with dementia are supported by an informal carer, considering how they cope together could help us to better support them. We make suggestions for dyadic interventions tailored by co-residency status that could help dyads identify and communicate coping needs, reconnect following avoidance coping, and replenish their coping resources through social support.
Damage detection with ultrasonic guided waves using machine learning and aggregated baselines
Authors: Nerlikar Vivek , Mesnil Olivier , Miorelli Roberto , D’Almeida Oscar
Published: May 2023

In guided wave (GW)-based structural health monitoring (SHM), ultrasonic elastic waves are used to detect damages in structures by comparing the acquired signals with those acquired before defect formation. Making the SHM system automatic, especially for similar structures, such as turbine blades, is rather challenging. The high sensitivity of GWs to environmental and operational conditions, the variabilities due to sensor positioning, sensor coupling, and material variability in composites limit the baseline application. This work presents a machine learning (ML)-based damage detection method using aggregated baselines independent of their damaged states to enhance the generalization capability of ML algorithms by considering similar structures’ variabilities. The methodology relies on feature extraction from raw GW signals and training classification algorithms (e.g., kernel machines, ensemble methods, and neural networks). Two experimental data sets on composite panels are used. The first experimental data set of 45 composite panels is used to validate the approach by considering the aforementioned inter-specimen variabilities. Half of the 45 panels provide pristine data, and the rest provide damaged data so that the same sample is present in the training or test set but never in both. High classification performance is obtained, demonstrating that the classifier has successfully learned to recognize defect signatures despite the influence of the variabilities linked to the multiple instrumented specimens. The second experimental data set of 1 composite panel with temperature variation is used. Good classification performance is obtained without using baseline correction methods.
Effects of thermoplastic poly(ether-ester) elastomer and bentonite on properties of recycled poly(ethylene terephthalate)
Authors: Chaiwutthinan Phasawat , Phetreung Chalermkiat , Larpkasemsuk Amnouy
Published: May 2023

The synergistic effects of thermoplastic poly(ether-ester) elastomer (TPEE) and bentonite nanoclay on mechanical, morphological, thermal, and dynamic mechanical properties of recycled poly(ethylene terephthalate) (R-PET) were investigated. The efficiency of TPEE as impact modifier for the R-PET was evidenced by a significant increase in the impact strength and elongation at break with increasing TPEE contents (from 10 to 30 wt%), while the tensile strength and Young’s modulus exhibited an opposite trend. The 70/30 (wt%/wt%) R-PET/TPEE blend was selected as an optimum formulation for further blending with a very low loading of bentonite (1−5 parts per hundred of resin, phr) using the same processing techniques (extruding and injection molding). X-ray diffraction and transmission electron microscopy revealed that the 1 phr bentonite nanocomposite exhibited an exfoliated structure with the highest improvement in the mechanical properties compared with other nanocomposites and the unfilled blend. Meanwhile, the nanocomposites with 2, 3, and 5 phr bentonite formed tactoid or agglomerated bentonite morphology. Differential scanning calorimetry, thermogravimetric and dynamic mechanical analyses demonstrated a noticeable increase in the crystallization temperature, a comparable thermal stability, and a slight increase in the glass transition temperature, respectively, of all nanocomposites when compared with those of the neat R-PET.
Study of the corporate social responsibility in the leather tanning sector
Authors: Pons Adrià , Rius Josep , Vintró Carla , Lopez Sergi
Published: May 2023

Reasons to adopt Corporate Social Responsibility reporting by leather tanning companies must primarily be sought in the specific nature of the industry, where leather is a material from renewable sources, however part of its manufacture process might pose one of the gravest environmental hazards in the world. The tanning industry appears, therefore, as a sector compiling CSR reports expected to confirm its environment-friendly actions. The purpose of this research is to examine and understand CSR roles and diffusion in the small and medium enterprises of the leather tanning industry in Catalonia (Spain), especially in relation with the adoption of other management systems. It identifies the most distinguished CSR practices, procedures and metrics and the profiles of companies more prone to adopt them. We used a qualitative approach to fulfill this aim. Results show that leather companies are familiar with CSR practices, but there is further scope for improvement in terms of formalization of CSR procedures and measurement systems. Results show that the majority of socially responsible practices are related to environmental issues and consequently there is a relation between CSR and the application of environmental management systems. The analysis reveals that the management of CSR activities improves with the diffusion of knowledge on CSR practices.
Primary aortoenteric fistula after intravesical instillation of Bacillus Calmette-Guérin for bladder cancer
Authors: Lorenzo Javier Fernández , López Arquillo Irene María , Rey Jorge Vidal
Published: May 2023

Objective

Primary aortoenteric fistulas (PAEFs) are a rare entity with high morbidity, and their relationship with Bacillus Instillation of Calmette-Guérin is anecdotal.

Methods/Results

We present a 68-year-old male with a primary aortoenteric fistula after instillation of Bacillus Calmette-Guérin (BCG) for a non-muscle-invasive bladder cancer. Diagnosis was made by CT angiography, subsequently confirmed by intraoperative findings and results of anatomopathological studies of aortic wall samples. We performed an in-situ reconstruction with a silver prosthesis impregnated in rifampicin with satisfactory evolution at one year.

Conclusions

Primary aortoenteric fistula is an extremely rare complication, and although its relationship with intravesical BCG therapy is anecdotal, it should be considered in patients with gastrointestinal bleeding who have previously undergone this treatment. Its diagnosis requires clinical suspicion, and its treatment should be carried out without delay. Long-term targeted anti-biotherapeutic treatment is a fundamental pillar for its management. Reconstruction with an antibiotic-impregnated silver prosthesis is a valid option in cases of controlled infection.
Cardiac function in women receiving dual anti-Her2 antibodies (trastuzumab and pertuzumab) combined with chemotherapy for breast cancer
Authors: Zekri Jamal , Rasool Haleem , Rizvi Syed Azhar J , Eldeeb Hany , Al-Gahmi Aboelkhair , Farag Kamel , Rasmy Ayman
Published: May 2023

Background:

Chemotherapy regimens containing a combination of anti-Her2 antibodies are effective but can be associated with cardiac toxicity.

Objectives:

We evaluate the outcome with a particular focus on the cardiac function of patients with Her2 over-expressed breast cancer receiving Chemotherapy regimens combined with Trastuzumab and Pertuzumab in routine clinical practice settings.

Design and methods:

The initial cohort of patients who started Chemotherapy regimens in combination with Trastuzumab and Pertuzumab before September 2019 in four cancer units were reviewed retrospectively. All patients had regular measurements of left ventricular ejection fraction by Doppler ultrasound.

Results:

Sixty-seven patients were identified. Chemotherapy regimens in combination with Trastuzumab and Pertuzumab treatment were administered in the neoadjuvant and palliative settings in 28 (41.8%) and 39 (58.2%) patients, respectively. All patients underwent left ventricular ejection fraction assessment prior to starting Chemotherapy regimens in combination with Trastuzumab and Pertuzumab treatment and at 3 and 6 months later. Subsequently, left ventricular ejection fraction was measured at 9, 12, 15, 18, 21, and 24 months as long as patients are still receiving any of the treatment components. Compared to baseline, the mean left ventricular ejection fraction was not significantly different at any of the subsequent time points (range; decrease by 0.936% to increase by 1.087%: T-test P value not statistically significant for all comparisons). Trastuzumab and Pertuzumab administration was withheld temporarily for two patients due to clinically suspected cardiac toxicity which was excluded upon further investigations. In the neoadjuvant cohort, 82.3% of patients were relapse free at 3 years. The median progression-free survival was 20 months, and the median overall survival was 41 months in the palliative cohort.

Conclusion:

In this cohort describing our limited initial experience, dual anti-Her2 antibodies (Trastuzumab and Pertuzumab) combined with chemotherapy is effective and not associated with significant cardiac toxicity when the left ventricular ejection fraction is measured every 3 months. This may suggest that previous concerns about cardiotoxicity may have been overemphasized. Further studies investigating less frequent left ventricular ejection fraction monitoring may be warranted.
Quantification of risk dilution induced by correlation parameters in dynamic probabilistic risk assessment of nuclear power plants
Authors: Kubo Kotaro , Tanaka Yoichi , Ishikawa Jun
Published: May 2023

Nuclear power plants are critical infrastructures that produce electricity. However, accidents in nuclear power plants can cause considerable consequences such as the release of radioactive materials. Therefore, appropriately managing their risk is necessary. Various nuclear regulatory agencies employ probabilistic risk assessment (PRA) to effectively evaluate risks in nuclear power plants. Dynamic PRA has gained popularity because it allows for more realistic assessment by reducing the assumptions and engineering judgments related to time-dependent failure probability and/or human-action reliability in the conventional PRA methodology. However, removing all assumptions and engineering judgments is difficult; thus, the risk analyst, for example, the regulator, must understand their effects on the assessment results. This study focuses on “risk dilution,” which emerges from the assumptions about uncertainty. Dynamic PRA of a station blackout sequence in a boiling-water reactor was performed using the dynamic PRA tool, namely, Risk Assessment with Plant Interactive Dynamics (RAPID) and the severe-accident code Thermal–Hydraulic Analysis of Loss of Coolant, Emergency Core Cooling, and Severe Core Damage version 2 (THALES2), which altered the correlation parameters among the uncertainties of the events that occurred in sequence. The results demonstrated that the conditional core-damage probability and mean value of the core-damage time varied from 0.27 to 0.47 and from 7.1 to 8.7 h, respectively. When the dynamic PRA results are used for risk-informed decision making, the decision maker should adequately consider the effect of risk dilution.
Role of clinical biomarkers in predicting the effectiveness of omalizumab
Authors: Zhang Qing , Li Chunxiao , Wan Jingxuan , Zhang Mengyuan , Nong Ying , Lin Jiangtao
Published: May 2023

Objective:

To explore whether baseline clinical biomarkers and characteristics can be used to predict the responsiveness of omalizumab.

Methods:

We retrospectively analyzed a cohort of patients with severe asthma who received omalizumab treatment and collected their baseline data and relevant laboratory examination results along with case records of omalizumab treatment responsiveness after 16 weeks. We compared the differences in variables between the group of patients that responded to omalizumab therapy and the non-responder group, and then performed univariate and multivariate logistic regression. Finally, we analyzed the difference in response rate for subgroups by selecting cut-off values for the variables using Fisher’s exact probability method.

Results:

This retrospective, single-center observational study enrolled 32 patients with severe asthma who were prescribed daily high-dose inhaled corticosteroids and long-acting β2 receptor agonists on long-acting muscarinic receptor antagonists with or without OCS. Data on age, sex, BMI, bronchial thermoplasty, FeNO, serum total IgE, FEV1, blood eosinophils, induced sputum eosinophils, blood basophils, and complications were not significantly different between the responder and non-responder groups. In the univariate and multivariate logistic regression, all the variants were not significant, and we were unable to build a regression model. We used normal high values and the mean or median of variables as cut-off values to create patient subgroups for the variables and found no significant difference in the omalizumab response rate between the subgroups.

Conclusion:

The responsiveness of omalizumab is not associated with pretreatment clinical biomarkers, and these biomarkers should not be used to predict the responsiveness of omalizumab.
Early transmural healing and its predictors assessed by magnetic resonance enterography in patients with Crohn’s disease receiving ustekinumab
Authors: Zhou Longyuan , Hu Cicong , Zhang Ruonan , Qiu Yun , Wang Yu , Liu Zishan , Chen Baili , He Yao , Zeng Zhirong , Li Xuehua , Mao Ren , Chen Minhu
Published: May 2023

Background:

Transmural healing (TH) is a potential therapeutic goal of Crohn’s disease (CD) and is associated with better clinical outcomes. However, few studies have described early TH and its predictors.

Objectives:

We aimed to evaluate early TH and its predictors using magnetic resonance enterography (MRE) in patients with CD receiving ustekinumab (UST).

Design:

This was a retrospective observational study.

Methods:

Patients with active CD treated with UST and their intestinal segments with bowel wall thickness (BWT) ⩽ 3 mm at baseline were included. Clinical characteristics, laboratory indicators, endoscopic manifestations, and MRE indices were evaluated at baseline and week 26 (W26) of the therapy. The following MRE parameters were assessed: BWT, edema, apparent diffusion coefficient (ADC), Clermont score, Magnetic Resonance Index of Activity score, fat stranding, comb sign, and stricture. TH was defined as BWT ⩽ 3 mm without any signs of inflammation (i.e., ulceration, edema, diffusion-weighted hyperintensity, and increased contrast enhancement) at W26.

Results:

The study included 37 patients with 106 intestinal segments (including 15 proximal small intestines, 33 terminal ilea, and 58 colons). Clinical features, laboratory indicators, endoscopic results, and MRE parameters at W26 were significantly improved after UST treatment in both patient-based and intestinal segment-based analysis. Seven (18.9%) patients and 26 (24.5%) intestinal segments achieved TH at W26. Baseline BWT [odds ratio (OR) = 0.287, 95% confidence interval (CI), 0.090–0.918, p = 0.035] and ADC (OR = 2.997, 95% CI, 1.009–8.908, p = 0.048) predict TH of patients at W26. Baseline ADC (OR = 2.857, 95% CI, 1.285–6.349, p = 0.010) and presence of stenosis (OR = 0.196, 95% CI, 0.052–0.735, p = 0.016) were associated with TH of segments at W26.

Conclusion:

Early TH assessed by MRE was observed in nearly one-fifth of patients with CD and intestinal segments after UST treatment for 26 weeks. Baseline MRE indices such as BWT and presence of stenosis might negatively predict TH, while ADC might positively predict early TH.
Free antibodies-to-infliximab are biomarker for predicting the effect of dose intensification in pediatric Crohn’s disease patients with secondary loss of response
Authors: Kim Eun Sil , Kwon Yiyoung , Choe Yon Ho , Kim Mi Jin
Published: May 2023

Background:

Immunogenicity to antitumor necrosis factor alpha agents, such as infliximab (IFX), may lead to therapeutic failure.

Objectives:

This study evaluated the relationship between free and total antibodies-to-infliximab (ATIs), trough levels (TLs) of IFX, and the response to dose intensification.

Design:

We performed a prospective, observational study including pediatric patients with Crohn’s disease (CD) receiving IFX maintenance therapy without dose intensification.

Methods:

We compared clinical and laboratory outcomes according to the presence of free and total ATIs. Factors associated with response to IFX dose intensification were investigated by analyzing IFX TLs and free and total ATIs.

Results:

Of the 98 patients, 9 patients had detectable free ATIs and 38 patients had total ATIs. Patients with free ATIs had significantly lower TLs (0.7 versus 5.1 µg/mL, p < 0.001) than patients without free ATIs. However, there was no difference in the IFX TLs according to the presence of total ATIs ( p = 0.2523). Analysis of the 38 samples with total ATIs showed that response to dose intensification was significantly lower in patients with free ATIs than those without free ATIs (22.2% versus 65.5%, p < 0.001). In addition, free ATIs were the only factor with poor response to dose intensification [odds ratio (OR): 14.15, 95% confidence interval (CI): 1.31–151.97, p = 0.0140]. According to the receiver operating characteristic analysis, the optimal cutoff level indicating non-response to IFX dose intensification was 30.0 AU/mL for free ATIs concentration (area under curve, 0.792; 95% CI: 0.590–0.942; sensitivity, 60.0%; specificity, 96.7%; p = 0.0241).

Conclusion:

Free ATIs, but not total ATIs, have a negative impact on the course of CD. Free ATIs are potential reliable biomarker for predicting the effect of dose intensification in patients with loss of response to IFX. Future studies based on serial and proactive therapeutic drug monitoring are required in the future.
Effects of visceral adipose tissue on anti-tumour necrosis factor-α in Crohn’s disease
Authors: Li Kangrong , Gong Pan , Zhang Yongbin , Liu Minji , Zhang Zinan , Yu Xiaoyu , Ye Mingmei , Tian Li
Published: May 2023

Background:

It remains unclear whether visceral adipose tissue (VAT) can predict the response of patients with Crohn’s disease (CD) to anti-tumour necrosis factor-α (anti-TNF-α) therapy.

Objectives:

This study aimed to investigate whether VAT predicts the efficacy of infliximab (IFX) for different sites of CD and its relationship with serum TNF-α levels and IFX serum trough concentration.

Design:

This is a multicentre retrospective study.

Methods:

Patients with CD treated with IFX from January 2014 to January 2021 were included. The perimeter of the visceral adipose area was obtained by a Computed Tomography (CT) scan. Participants were classified according to the lesion site (L1, L2, and L3) and visceral fat area. The participants were divided into colon-uninvolved non-visceral obesity (L1-VATL), colon-uninvolved visceral obesity (L1-VATH), colon-involved non-visceral obesity (L2 + L3-VATL), and colon involved visceral obesity (L2 + L3-VATH) groups. The end points of this study were set as disease remission status at 6 and 12 months.

Results:

The final cohort included 140 patients. Regarding efficacy at 6 and 12 months, there was a significant difference between L1-VATL (73.8% versus 36.8%, p = 0.006) and L1-VATH (81.0% versus 47.4%, p = 0.008) groups. In the analysis of serum TNF-α levels and IFX serum trough concentrations, there was a significant difference between L1-VATL and L1-VATH (59.5 pg/mL versus 236.0 pg/mL, pTNF-α = 0.006), (10.0 μg/mL versus 0.4 μg/mL, pIFX = 0.000), and L1-VATH and L2 + L3-VATH (78.7 pg/mL versus 118.6 pg/mL, pTNF-α = 0.031), (0.4 μg/mL versus 6.40 μg/mL, pIFX = 0.017).

Conclusion:

In L1 patients, the VAT level predicted the efficacy of IFX, with high VAT values indicating poor efficacy. The VAT level may be a useful radiological marker to predict the efficacy of IFX in patients with various types of CD.
Concurrent radical cystectomy and nephroureterectomy indications and outcomes: a systematic review and comparative analysis
Authors: Zein Marwan , Nasrallah Ali A. , Abou Heidar Nassib F. , Najdi Jad , Hneiny Layal , El Hajj Albert
Published: May 2023

Introduction:

Urothelial carcinoma can arise from the urinary bladder or from the upper urinary tract. In some instances, urinary bladder cancer (UBC) and upper tract urothelial carcinoma (UTUC) can be concurrently diagnosed, necessitating a combined radical cystectomy (RC) with radical nephroureterectomy (RNU). A systematic review was done on the combined procedure exploring outcomes and indications, in addition to a comparative analysis between the combined procedure and cystectomy alone.

Methods:

For the systematic review, three databases (Embase, PubMed, and Cochrane) were queried, selecting only studies that included intraoperative and perioperative data. For the comparative analysis, using the NSQIP database, CPT codes for RC and RNU were used to identify two cohorts, one with RC and RNU and one with RC alone. A descriptive analysis was performed on all preoperative variables, and propensity score matching (PSM) was performed. Postoperative events were then compared between the two matched cohorts.

Results:

For the systematic review, 28 relevant articles were included amounting to 947 patients who underwent the combined procedure. The most common indication was synchronous multifocal disease, the most common approach was open surgery, and the most common diversion technique was using an ileal conduit. Almost 28% of patients required blood transfusion and remained in the hospital for an average of 13 days. The most common postoperative complication was prolonged paralytic ileus. For the comparative analysis, 11,759 patients were included of which 97.5% underwent RC only and 2.5% underwent the combined procedure. After PSM, the cohort that had undergone the combined procedure showed an increased risk of renal injury, increased readmission rates, and increased reoperation rates. Whereas the cohort that had undergone RC only showed an increased risk of deep venous thrombosis (DVT), sepsis, or septic shock.

Conclusion:

A combined RC and RNU is a treatment option for concurrent UCB and UTUC that should be cautiously utilized as it is associated with high morbidity and mortality. Patient selection, discussion of the risks and benefits of the procedure, and explanation of the available treatment options remain the most important pillars in managing patients with this complex disease.
Accuracy of Continuous Glucose Monitoring in an Insulin-Treated Population Requiring Haemodialysis
Authors: Horne Christopher , Cranston Iain , Amos Mark , Flowers Katey
Published: May 2023

Background:

Continuous glucose monitoring (CGM) is revolutionizing diabetes care by giving both patients and the healthcare professionals unprecedented insights into glucose variability and patterns. It is established in National Institute for Health and Care Excellence (NICE) guidance as a standard of care for type 1 diabetes and diabetes in pregnancy under certain conditions. Diabetes mellitus (DM) is recognized as an important risk factor for chronic kidney disease (CKD). Around a third of patients receiving in-center haemodialysis as renal replacement therapy (RRT) have diabetes, either as a direct cause of renal failure or as an additional co-morbidity. Evidence of poor compliance with the current standard of care (self-monitoring of blood glucose [SMBG]) and overall greater morbidity and mortality, suggests this patient population as an ideal target group for CGM. However, there exists no strong published evidence showing the validity of CGM devices in insulin-treated diabetes patients requiring haemodialysis.

Methods:

We applied a Freestyle Libre Pro sensor to 69 insulin-treated diabetes haemodialysis (HD) patients on a dialysis day. Interstitial glucose levels were obtained, and time matched within 7 minutes to capillary blood glucose testing and any plasma blood glucose levels sent. Data cleansing techniques were applied to account for rapidly correcting hypoglycaemia and poor SMBG technique.

Results:

Clarke-error grid analysis showed 97.9% of glucose values in an acceptable range of agreement (97.3% on dialysis days and 99.1% on non-dialysis days).

Conclusions:

We conclude that the Freestyle Libre sensor is accurate in measuring glucose levels when compared to glucose as measured by capillary SMBG testing and laboratory obtained serum glucose in patients on HD.
CENtral blood pressure Targeting: a pragmatic RAndomized triaL in advanced Chronic Kidney Disease (CENTRAL-CKD): A Clinical Research Protocol
Authors: Goupil Rémi , Nadeau-Fredette Annie-Claire , Prasad Bhanu , Hundemer Gregory L. , Suri Rita S. , Beaubien-Souligny William , Agharazii Mohsen
Published: May 2023

Background:

Emerging data favor central blood pressure (BP) over brachial cuff BP to predict cardiovascular and kidney events, as central BP more closely relates to the true aortic BP. Considering that patients with advanced chronic kidney disease (CKD) are at high cardiovascular risk and can have unreliable brachial cuff BP measurements (due to high arterial stiffness), this population could benefit the most from hypertension management using central BP measurements.

Objective:

To assess the feasibility and efficacy of targeting central BP as opposed to brachial BP in patients with CKD G4-5.

Design:

Pragmatic multicentre double-blinded randomized controlled pilot trial.

Setting:

Seven large academic advanced kidney care clinics across Canada.

Patients:

A total of 116 adults with CKD G4-5 (estimated glomerular filtration rate [eGFR] < 30 mL/min) and brachial cuff systolic BP between 120 and 160 mm Hg. The key exclusion criteria are 1) ≥ 5 BP drugs, 2) recent acute kidney injury, myocardial infarction, stroke, heart failure or injurious fall, 3) previous kidney replacement therapy.

Methods:

Double-blind randomization to a central or a brachial cuff systolic BP target (both < 130 mm Hg) as measured by a validated central BP device. The study duration is 12 months with follow-up visits every 2 to 4 months, based on local practice. All other aspects of CKD management are at the discretion of the attending nephrologist.

Outcomes:

Primary Feasibility: Feasibility of a large-scale trial based on predefined components. Primary Efficacy: Carotid-femoral pulse wave velocity at 12 months. Others: Efficacy (eGFR decline, albuminuria, BP drugs, and quality of life); Events (major adverse cardiovascular events, CKD progression, hospitalization, mortality); Safety (low BP events and acute kidney injury).

Limitations:

May be challenging to distinguish whether central BP is truly different from brachial BP to the point of significantly influencing treatment decisions. Therapeutic inertia may be a barrier to successfully completing a randomized trial in a population of CKD G4-5. These 2 aspects will be evaluated in the feasibility assessment of the trial.

Conclusion:

This is the first trial to evaluate the feasibility and efficacy of using central BP to manage hypertension in advanced CKD, paving the way to a future large-scale trial.

Trial registration:

clinicaltrials.gov (NCT05163158)
“You Can Change the World With a Haircut”: Evaluating the Feasibility of a Barber-led Intervention for Men of Black and Ethnic Minority Heritage to Manage High Blood Pressure
Authors: Thomas Nicola , Ewart Catriona , Lewinson Roberts Debi , Brown Andrew
Published: May 2023

Background:

People of Black, Asian and minority ethnic (BAME) heritage have a higher-than-average incidence of, and mortality from hypertension and stroke. Therefore, it is important to identify new settings for engaging people at risk of high blood pressure (BP).

Aim:

This feasibility study aimed to evaluate if barbers in a London borough can support and educate men of BAME heritage to manage their BP. Following UK Medical Research Council guidance, the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework was used to guide study objectives and feasibility outcomes.

Methods:

We collaborated with 8 barbers who were part of an existing BAME barber network. Barbers were trained online (1.5 h) and face-to-face (3 h) to provide BP healthcare advice and take customers BP readings. Qualitative field notes were collected to assess how best to recruit and train barbers, and to understand how to maintain motivation and retention of barbers. BP readings were recorded between June 2021 and March 2022.

Results:

Both online and face-to-face training were effective, however, greater focus on how to start conversations about BP with clients was needed. We found that motivation, incentivization and regular contact with barbers were important for recruitment, retention, and sustained BP measurement. Obtaining BP readings was challenging due to client concerns about recording their data and the impracticalities of recording results. We captured 236 BP recordings, of which 39 (16.53%) were over 140/90 mmHg; of these, 5 were over 180/100 mmHg.

Conclusion:

The combined data showed that educating barbers to take BP readings and deliver healthcare advice about BP is a viable intervention for rollout in a large-scale study. It has demonstrated the need to identify strategies to motivate barbers for sustained recruitment and retention, as well as further efforts to build trust among customers for long-term BP surveillance.