bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental Analysis of Temperature Influence on Waste Tire Pyrolysis
Authors: Čepić Zoran , Mihajlović Višnja , Đurić Slavko , Milotić Milan , Stošić Milena , Stepanov Borivoj , Ilić Mićunović Milana
Published: August 2021

Pyrolysis is an optimal thermochemical process for obtaining valuable products (char, oil, and gas) from waste tires. The preliminary research was done on the three groups of samples acquired by cutting the same waste tire of a passenger vehicle into cylindrical granules with a base diameter of 3, 7, and 11 mm. Each batch weighed 10 g. The heating rate was 14 °C/min, and the final pyrolysis temperature was 750 °C, with 90 s residence time. After the pyrolysis product yields were determined for all of the three sample groups, further research was performed only on 3 mm granules, with the same heating rate, but with altered final pyrolytic temperatures (400, 450, 500, 550, 600, 650, 700, and 750 °C). The results of this study show that thermochemical decomposition of the waste tire sample takes place in the temperature range of 200–500 °C, with three distinct phases of degradation. The highest yield of the pyrolytic oil was achieved at a temperature of 500 °C, but further heating of volatile matters reduced the oil yield, and simultaneously increased the yield of gas, due to the existence of secondary cracking reactions. The analysis of pyrolytic oil and char showed that these products can be used as fuel.
Effects of All-Night Driving on Selective Attention in Professional Truck Drivers: A Preliminary Functional Magnetic Resonance Study
Authors: Gazdzinski Stefan P. , Binder Marek , Bortkiewicz Alicja , Baran Paulina , Dziuda Łukasz
Published: August 2021

Fatigue affects multiple aspects of cognitive performance among drivers. However, even after fatigue builds up, some are still able to maintain the level of behavioral performance. To evaluate these adaptations on the neural network level, we utilized functional magnetic resonance imaging (fMRI). Seventeen male professional drivers underwent two fMRI sessions, once while rested and once in a fatigued condition after 10-h of overnight driving. The cognitive task used in the study involved the detection of visual feature conjunctions, namely the shape and the color. There were no significant differences in the task performance between the conditions except for longer reaction times in the fatigued condition. However, we observed substantial differences in the activation patterns during the cognitive task involving selective attention between the conditions. On the global level, we observed a general decrease in activation strength in the fatigued condition, which appeared to be more pronounced in the left hemisphere. On the local level, we observed a (spatially) extended activation of the medial prefrontal regions in the fatigued condition, which reflected increased cognitive control mechanisms compensating for the diminished efficiency of mechanisms involved in meeting task demands.
Decline in Share Prices of Energy and Fuel Companies on the Warsaw Stock Exchange as a Reaction to the COVID-19 Pandemic
Authors: Bieszk-Stolorz Beata , Markowicz Iwona
Published: August 2021

Many factors influence the prices of energy commodities and the value of energy and fuel companies. Among them there are the following factors: economic, social, environmental and political, and recently also the COVID-19 pandemic. The aim of the paper is to examine what the probability and intensity of a decrease in the prices of shares of energy and fuel companies listed on the Warsaw Stock Exchange (Poland) was during the first wave of the pandemic in the first quarter of 2020. The study used the survival analysis methods: the Kaplan-Meier estimator, the test of equality of duration curves and the Cox non-proportional hazards model. The analysis showed that the probability and intensity of price decline of energy and fuel companies in the initial period was the same as that of other companies. The differences become apparent only after 50 days from the established maximum of their value. The risk of price declines in energy and fuel companies increased significantly. This situation was related both to a temporary reduction in demand for energy and fuels, pandemic restrictions introduced in individual countries and the behaviour of stock market investors.
Verification and Validation of COMSOL Magnetohydrodynamic Models for Liquid Metal Breeding Blankets Technologies
Authors: Alberghi Ciro , Candido Luigi , Testoni Raffaella , Utili Marco , Zucchetti Massimo
Published: August 2021

Liquid metal breeding blankets are extensively studied in nuclear fusion. In the main proposed systems, the Water Cooled Lithium Lead (WCLL) and the Dual Coolant Lithium Lead (DCLL), the liquid metal flows under an intense transverse magnetic field, for which a magnetohydrodynamic (MHD) effect is produced. The result is the alteration of all the flow features and the increase in the pressure drops. Although the latter issue can be evaluated with system models, 3D MHD codes are of extreme importance both in the design phase and for safety analyses. To test the reliability of COMSOL Multiphysics for the development of MHD models, a method for verification and validation of magnetohydrodynamic codes is followed. The benchmark problems solved regard steady state, fully developed flows in rectangular ducts, non-isothermal flows, flow in a spatially varying transverse magnetic field and two different unsteady turbulent problems, quasi-two-dimensional MHD turbulent flow and 3D turbulent MHD flow entering a magnetic obstacle. The computed results show good agreement with the reference solutions for all the addressed problems, suggesting that COMSOL can be used as software to study liquid metal MHD problems under the flow regimes typical of fusion power reactors.
Empirical Correlations between the Hydraulic Properties Obtained from the Geoelectrical Methods and Water Well Data of Arak Aquifer
Authors: Khalilidermani Mitra , Knez Dariusz , Zamani Mohammad Ahmad Mahmoudi
Published: August 2021

A number of empirical correlations have been achieved between the hydraulic properties measured through geoelectrical methods and water well data of Arak Aquifer located in Markazi province, Iran. The geoelectrical method of Vertical Electrical Sounding (VES) technique was used to calculate the hydraulic properties of the aquifer. Through the VES technique, the pivotal hydraulic properties such as porosity, hydraulic conductivity, and specific yield of the layers were calculated. The results of VES technique were compared with the data obtained from seven observation water wells that were already drilled as exploratory coring boreholes in the region. The results demonstrate that as the porosity and hydraulic conductivity of the water-bearing layer increase, the results of VES technique appear much identical to the water well records. Furthermore, the specific yield was calculated as 4.6% that was very close to the value of 3.5% measured through the previous pumping tests. Moreover, VES technique predicted the water table of the aquifer very close to the water level monitored in the observation water wells. The obtained correlations can be used as an alternative for drilling of new observation wells that are inefficient in time and expense, and may encounter environmental limitations of drilling and site construction.
Annual Thermal Performance of an Industrial Hybrid Direct–Indirect Solar Air Heating System for Drying Applications in Morelos-México
Authors: Álvarez-Sánchez Francisco , Flores-Prieto Jassón , García-Valladares Octavio
Published: August 2021

A theoretical–experimental annual analysis of a hybrid industrial direct–indirect solar air heating system performance for drying was conducted considering temperatures, useful energy Qu, efficiency η, and solar fraction SF. The direct solar air heating system located in Morelos, México, has flat-plate solar air collectors, and the indirect system has flat-plate solar water collectors, a thermal storage tank, a cross-flow fin, and a tube heat exchanger. A validated TRNSYS program modeled the process; the validation was carried out by comparing each component outlet temperature and useful energy with the respective experimental field data. The analysis considered annual usage over seven days a week, nine hours a day (from 09:00 to 18:00 h), and three operation modes. For the direct, indirect, and hybrid operation modes, the Qu values were 31.60, 55.19, and 75.18 MWh/yr; the annual η values were 0.44, 0.41, and 0.42; and the annual SF values were 0.45, and 0.73 for the indirect and hybrid mode, respectively. The hybridization of the direct–indirect solar air heating system increased annual performance by up to 58% in Qu and 42% in SF. The parametric analysis showed that a characteristic working nomogram of the hybrid system could be achieved, correlating the useful energy, efficiency, solar fraction, and operation temperature at a specified mass flow rate, and working temperature.
Selected Determinants of Sustainable Transport in the Context of the Development of a Low-Carbon Economy in Poland
Authors: Godzisz Karolina , Dzikuć Maciej , Kułyk Piotr , Piwowar Arkadiusz , Kuryło Piotr , Szufa Szymon
Published: August 2021

Road transport is one of the key elements of economic development that helps build social and territorial cohesion. The economic development that has taken place in Poland over the last three decades has led to an improvement in road infrastructure throughout the country. Construction of new roads and improvement of existing ones promotes economic development. However, as the number of cars increases, so does the level of air emissions. In reducing pollutant emissions, the analysis of the technological possibilities used and the improvement of their efficiency with the simultaneous minimization of generated pollution is also of particular importance. The purpose of the publication is to present development trends in road transport in Poland and the possibility of reducing emissions in this respect. The method of analysing strategic documents and statistical data was used to achieve this goal. Moreover, the article shows perspectives for reducing the level of emissions from road transport and refers to the assumptions related to the modernization of the transport sector and reducing its share in carbon emissions and its sustainable development in cities.
A Review of Fully Integrated and Embedded Power Converters for IoT
Authors: Richelli Anna , Salem Mohamed , Colalongo Luigi
Published: August 2021

The Internet of Things (IoT) has found application in many components of implantable medical devices, wearable smart devices, monitoring systems, etc. The IoT devices are conventionally battery powered, even though, in several low power applications, they can also be powered using energy harvesting technology. Independently of the power sources (if batteries or environment), efficient and robust power converters must be designed to provide the small and distributed energy required by such IoT devices. This review paper will first provide an overview about the power consumption in IoT devices; second, it will discuss the most recent research and advance in the field of fully-integrated or embedded DC/DC converters, starting from high-performance integrated charge pumps or embedded inductive boost converters for specific harvesting sources (temperature, solar, and so on), to novel DC/DC converters for multiple energy sources.
Construction Time Estimation Function for Canadian Utility Scale Power Plants
Authors: Kabanda Herve , Romard Alex , Yurtsever Fuze , Wadhera Anjali , Andrews Joshua , Merrett Craig
Published: August 2021

Construction time and time overruns for infrastructure projects have been frequently studied; however, the construction time of power plants has not been studied. This lack of study is problematic, as more renewable energy power plants, such as wind and solar, are planned for many jurisdictions. Accurately estimating the construction time of a power plant will assist construction planning, budget estimates, and policy development encouraging the use of more renewable sources. The construction times of utility scale power plants in Canada were studied using publicly available data. Multiple linear regression analysis techniques were applied to the data to generate construction time estimation functions for all power plants together, and for individual technologies. The analyses reveal that construction time is sensitive to jurisdiction and the decade of construction, indicating that decisions made by individual Canadian provincial governments at different times had statistically significant impacts on construction time. The analyses also indicated that construction time is a strong function of installed capacity, independent of technology. This finding suggests that large solar or wind energy facilities will encounter longer construction times similar to large hydroelectric facilities.
Bidirectional Nitrogen Transfer and Plant Growth in a Mixed Plantation of N2-Fixing Species and Eucalyptus urophylla × E. grandis under Different N Applications
Authors: Yao Xianyu , Goodale Uromi Manage , Yang Mei , Liao Liangning , Yu Sufang , Wang Shengqiang , Ye Shaoming
Published: August 2021

N2-fixing species play a crucial role in mixed-plantations as they improve stand productivity. To quantify the N transfer from N2-fixing species to Eucalyptus (Eucalyptus urophylla × E. grandis) in N2-fixing species/Eucalyptus plantations, we established a pot experiment and confirmed the occurrence of this process under natural conditions. The 15N was traced in labeled species as well as in neighboring tree species after labeling, and the growth was evaluated in short-term natural trials. Our results showed that a bidirectional N transfer occurred. The amount of net N transfer was 21.8–127.0 mg N plant−1, which was equal to 1.5–21.2% of the total nitrogen (TN) that accumulated in Eucalyptus plants under pot conditions, was transferred from Dalbergia odorifera to Eucalyptus. The amount of N transferred significantly decreased with the increasing N application rate but increased with time after labeling. Compared with the results for the Eucalyptus monocrop, the soil N concentration (including NO3−-N and NH4+-N) greatly improved when D. odorifera was introduced together with Eucalyptus under both field and pot conditions. Furthermore, the results under field conditions were consistent with the results of the pot experiment. The dry matter (DM) yield (14.5–16.4%) and the N content (5.1–9.6%) in Eucalyptus increased when mixed together with D. odorifera, but the N content in and DM yield of D. odorifera slightly decreased. It is concluded that the N transfer between Eucalyptus and D. odorifera is a much more important dynamic process than previously recognized, and Eucalyptus and legume intercropping is a successful management practice because N transfer provides a significant amount of N required for Eucalyptus productivity.
Overexpression of SgGH3.1 from Fine-Stem Stylo (Stylosanthes guianensis var. intermedia) Enhances Chilling and Cold Tolerance in Arabidopsis thaliana
Authors: Jiang Ming , Ma Long-Long , Huang Huai-An , Ke Shan-Wen , Gui Chun-Sheng , Ning Xin-Yi , Zhang Xiang-Qian , Zhong Tian-Xiu , Xie Xin-Ming , Chen Shu
Published: August 2021

Stylosanthes (stylo) species are commercially significant tropical and subtropical forage and pasture legumes that are vulnerable to chilling and frost. However, little is known about the molecular mechanisms behind stylos’ responses to low temperature stress. Gretchen-Hagen 3 (GH3) proteins have been extensively investigated in many plant species for their roles in auxin homeostasis and abiotic stress responses, but none have been reported in stylos. SgGH3.1, a cold-responsive gene identified in a whole transcriptome profiling study of fine-stem stylo (S. guianensis var. intermedia) was further investigated for its involvement in cold stress tolerance. SgGH3.1 shared a high percentage of identity with 14 leguminous GH3 proteins, ranging from 79% to 93%. Phylogenetic analysis classified SgGH3.1 into Group Ⅱ of GH3 family, which have been proven to involve with auxins conjugation. Expression profiling revealed that SgGH3.1 responded rapidly to cold stress in stylo leaves. Overexpression of SgGH3.1 in Arabidopsis thaliana altered sensitivity to exogenous IAA, up-regulated transcription of AtCBF1-3 genes, activated physiological responses against cold stress, and enhanced chilling and cold tolerances. This is the first report of a GH3 gene in stylos, which not only validated its function in IAA homeostasis and cold responses, but also gave insight into breeding of cold-tolerant stylos.
Surgical Management of Hereditary Breast Cancer
Authors: Berger Elizabeth R. , Golshan Mehra
Published: August 2021

The identification that breast cancer is hereditary was first described in the nineteenth century. With the identification of the BRCA1 and BRCA 2 breast/ovarian cancer susceptibility genes in the mid-1990s and the introduction of genetic testing, significant advancements have been made in tailoring surveillance, guiding decisions on medical or surgical risk reduction and cancer treatments for genetic variant carriers. This review discusses various medical and surgical management options for hereditary breast cancers.
Recent Advancements in the Medical Treatment of Diabetic Retinal Disease
Authors: Szymanska Maja , Mahmood Daanyaal , Yap Timothy E. , Cordeiro Maria F.
Published: August 2021

Diabetic retinal disease remains one of the most common complications of diabetes mellitus (DM) and a leading cause of preventable blindness. The mainstay of management involves glycemic control, intravitreal, and laser therapy. However, intravitreal therapy commonly requires frequent hospital visits and some patients fail to achieve a significant improvement in vision. Novel and long-acting therapies targeting a range of pathways are warranted, while evidence to support optimal combinations of treatments is currently insufficient. Improved understanding of the molecular pathways involved in pathogenesis is driving the development of therapeutic agents not only targeting visible microvascular disease and metabolic derangements, but also inflammation and accelerated retinal neurodegeneration. This review summarizes the current and emerging treatments of diabetic retinal diseases and provides an insight into the future of managing this important condition.
P2ISE: Preserving Project Integrity in CI/CD Based on Secure Elements
Authors: Muñoz Antonio , Farao Aristeidis , Correia Jordy Ryan Casas , Xenakis Christos
Published: August 2021

During the past decade, software development has evolved from a rigid, linear process to a highly automated and flexible one, thanks to the emergence of continuous integration and delivery environments. Nowadays, more and more development teams rely on such environments to build their complex projects, as the advantages they offer are numerous. On the security side however, most environments seem to focus on the authentication part, neglecting other critical aspects such as the integrity of the source code and the compiled binaries. To ensure the soundness of a software project, its source code must be secured from malicious modifications. Yet, no method can accurately verify that the integrity of the project’s source code has not been breached. This paper presents P2ISE, a novel integrity preserving tool that provides strong security assertions for developers against attackers. At the heart of P2ISE lies the TPM trusted computing technology which is leveraged to ensure integrity preservation. We have implemented the P2ISE and quantitatively assessed its performance and efficiency.
Challenges of Cochlear Implantation in Intralabyrinthine Schwannoma Patients: Surgical Procedures and Auditory Outcome
Authors: Häussler Sophia Marie , Szczepek Agnieszka J. , Gräbel Stefan , Olze Heidi
Published: August 2021

Intralabyrinthine schwannoma (ILS) is a rare benign tumor of the inner ear potentially causing unilateral sensorineural hearing loss and vertigo. This study evaluated the outcome of one surgical session comprising microsurgical ILS resection and cochlear implantation in terms of surgical feasibility, complications, and auditory outcome. Ten clinically and histologically confirmed ILS patients included in this study (three women and seven men; mean age 56.4 ± 8.6) underwent surgery between July 2015 and February 2020. Eight patients had intracochlear tumor location; the remaining two had vestibulocochlear and intravestibular ILS. One of the three following methods was used for tumor removal: an extended cochleostomy, subtotal cochleoectomy, or a translabyrinthine approach. Although negligible improvement was observed in two of the patients, two patients were lost to follow-up, and one opted out from using CI, the speech perception of the five remaining ILS patients improved as per the Freiburg Monosyllable Test (FMT) from 0% before surgery to 45– 50% after the implantation. Our study supports the presented surgical approach’s feasibility and safety, enabling tumor removal and hearing restoration shortly after surgery.
Body Composition According to Spinal Cord Injury Level: A Systematic Review and Meta-Analysis
Authors: Raguindin Peter Francis , Bertolo Alessandro , Zeh Ramona Maria , Fränkl Gion , Itodo Oche Adam , Capossela Simona , Bally Lia , Minder Beatrice , Brach Mirjam , Eriks-Hoogland Inge , Stoyanov Jivko , Muka Taulant , Glisic Marija
Published: August 2021

The level of injury is linked with biochemical alterations and limitations in physical activity among individuals with spinal cord injury (SCI), which are crucial determinants of body composition. We searched five electronic databases from inception until 22 July 2021. The pooled effect estimates were computed using random-effects models, and heterogeneity was calculated using I2 statistics and the chi-squared test. Study quality was assessed using the Newcastle–Ottawa Scale. We pooled 40 studies comprising 4872 individuals with SCI (3991 males, 825 females, and 56 sex-unknown) in addition to chronic SCI (median injury duration 12.3 y, IQR 8.03–14.8). Individuals with tetraplegia had a higher fat percentage (weighted mean difference (WMD) 1.9%, 95% CI 0.6, 3.1) and lower lean mass (WMD −3.0 kg, 95% CI −5.9, −0.2) compared to those with paraplegia. Those with tetraplegia also had higher indicators of central adiposity (WMD, visceral adipose tissue area 0.24 dm2 95% CI 0.05, 0.43 and volume 1.05 L 95% CI 0.14, 1.95), whereas body mass index was lower in individuals with tetraplegia than paraplegia (WMD −0.9 kg/mg2, 95% CI −1.4, −0.5). Sex, age, and injury characteristics were observed to be sources of heterogeneity. Thus, individuals with tetraplegia have higher fat composition compared to paraplegia. Anthropometric measures, such as body mass index, may be inaccurate in describing adiposity in SCI individuals.
The Level of Stress and Coping Strategies in Patients with Multiple Sclerosis and Their Relationships with the Disease Course
Authors: Kotas Roman , Nowakowska-Kotas Marta , Budrewicz Sławomir , Pokryszko-Dragan Anna
Published: August 2021

Objectives: Stress is supposed to be linked with a background of multiple sclerosis (MS) and the disease course. Design: The study aimed to assess the level of stress and coping strategies in MS patients within a year of follow-up and to investigate the relationships between these aspects and factors related—or not—to MS. Methods: In 65 patients with MS, the Perceived Stress Scale (PSS-10), Type D Scale (DS14) and Coping Orientations to Problems Experienced (COPE) were performed at baseline and after a year. Baseline PSS-10, DS-14 and COPE scores were analyzed with regard to demographics, MS duration, treatment, indices of disability and self-reported stressful events (SEs). Final PSS-10 and COPE results were analyzed with reference to MS activity and SE within a year of follow-up. Results: Initially, 67% of patients reported a moderate or high level of stress and 31% met Type-D personality criteria. Diverse coping strategies were preferred, most of which were problem-focused. The negative affectivity DS-14 subscore (NEG) was correlated with disability level. Non-health-related SEs were associated with higher PSS-10 and NEG scores. After a year, the mean PSS-10 score decreased, while COPE results did not change significantly. Non-health-related SEs were associated with a higher PSS-10 score and less frequent use of acceptance and humor strategies. Those with an active vs. stable MS course during the follow-up did not differ in terms of PSS-10 and COPE results. Conclusions: MS patients experienced an increased level of stress. No significant relationships were found between stress or coping and MS course within a year. Non-health-related factors affected measures of stress more than MS-related factors.
Liver Transplantation in Patients with Hepatocellular Carcinoma beyond the Milan Criteria: A Comprehensive Review
Authors: Toniutto Pierluigi , Fumolo Elisa , Fornasiere Ezio , Bitetto Davide
Published: August 2021

The Milan criteria (MC) were developed more than 20 years ago and are still considered the benchmark for liver transplantation (LT) in patients with hepatocellular carcinoma (HCC). However, the strict application of MC might exclude some patients who may receive a clinical benefit of LT. Several expanded criteria have been proposed. Some of these consider pretransplant morphological and biological variables of the tumor, others consider post-LT variables such as the histology of the tumor, and others combine pre- and post-LT variables. More recently, the HCC response to locoregional treatments before transplantation emerged as a surrogate marker of the biological aggressiveness of the tumor to be used as a better selection criterion for LT in patients beyond the MC at presentation. This essential review aims to present the current data on the pretransplant selection criteria for LT in patients with HCC exceeding the MC at presentation based on morphological and histological characteristics of the tumor and to critically discuss those that have been validated in clinical practice. Moreover, the role of HCC biological markers and the tumor response to downstaging procedures as new tools for selecting patients with a tumor burden outside of the MC for LT is evaluated.
Characterisation of Non-Pathogenic Premutation-Range Myotonic Dystrophy Type 2 Alleles
Authors: Radvanszky Jan , Hyblova Michaela , Radvanska Eva , Spalek Peter , Valachova Alica , Magyarova Gabriela , Bognar Csaba , Polak Emil , Szemes Tomas , Kadasi Ludevit
Published: August 2021

Myotonic dystrophy type 2 (DM2) is caused by expansion of a (CCTG)n repeat in the cellular retroviral nucleic acid-binding protein (CNBP) gene. The sequence of the repeat is most commonly interrupted and is stably inherited in the general population. Although expanded alleles, premutation range and, in rare cases, also non-disease associated alleles containing uninterrupted CCTG tracts have been described, the threshold between these categories is poorly characterised. Here, we describe four families with members reporting neuromuscular complaints, in whom we identified altogether nine ambiguous CNBP alleles containing uninterrupted CCTG repeats in the range between 32 and 42 repeats. While these grey-zone alleles are most likely not pathogenic themselves, since other pathogenic mutations were identified and particular family structures did not support their pathogenic role, they were found to be unstable during intergenerational transmission. On the other hand, there was no observable general microsatellite instability in the genome of the carriers of these alleles. Our results further refine the division of CNBP CCTG repeat alleles into two major groups, i.e., interrupted and uninterrupted alleles. Both interrupted and uninterrupted alleles with up to approximately 30 CCTG repeats were shown to be generally stable during intergenerational transmission, while intergenerational as well as somatic instability seems to gradually increase in uninterrupted alleles with tract length growing above this threshold.
Bone Marrow Microenvironment Interplay and Current Clinical Practice in Multiple Myeloma: A Review of the Balkan Myeloma Study Group
Authors: Bila Jelena , Katodritou Eirini , Guenova Margarita , Basic-Kinda Sandra , Coriu Daniel , Dapcevic Milena , Ibricevic-Balic Lejla , Ivanaj Arben , Karanfilski Oliver , Zver Samo , Beksac Meral , Terpos Evangelos , Dimopoulos Meletios Athanassios
Published: August 2021

The course of multiple myeloma (MM) is influenced by a variety of factors, including the specificity of the tumour microenvironment (TME). The aim of this review is to provide insight into the interplay of treatment modalities used in the current clinical practice and TME. Bortezomib-based triplets are the standard for MM first-line treatment. Bortezomib is a proteasome inhibitor (PI) which inhibits the nuclear factor kappa B (NF-κB) pathway. However, bortezomib is decreasing the expression of chemokine receptor CXCR4 as well, possibly leading to the escape of extramedullary disease. Immunomodulatory drugs (IMiDs), lenalidomide, and pomalidomide downregulate regulatory T cells (Tregs). Daratumumab, anti-cluster of differentiation 38 (anti-CD38) monoclonal antibody (MoAb), downregulates Tregs CD38+. Bisphosphonates inhibit osteoclasts and angiogenesis. Sustained suppression of bone resorption characterises the activity of MoAb denosumab. The plerixafor, used in the process of stem cell mobilisation and harvesting, block the interaction of chemokine receptors CXCR4-CXCL12, leading to disruption of MM cells’ interaction with the TME, and mobilisation into the circulation. The introduction of several T-cell-based immunotherapeutic modalities, such as chimeric-antigen-receptor-transduced T cells (CAR T cells) and bispecific antibodies, represents a new perspective in MM treatment affecting TME immune evasion. The optimal treatment approach to MM patients should be adjusted to all aspects of the individual profile including the TME niche.
High Central Venous Pressure after Cardiac Surgery Might Depict Hemodynamic Deterioration Associated with Increased Morbidity and Mortality
Authors: Schiefenhövel Fridtjof , Trauzeddel Ralf F. , Sander Michael , Heringlake Matthias , Groesdonk Heinrich V. , Grubitzsch Herko , Kruppa Jochen , Berger Christian , Treskatsch Sascha , Balzer Felix
Published: August 2021

Background: Cardiac surgery patients represent a high-risk cohort in intensive care units (ICUs). Central venous pressure (CVP) measurement seems to remain an integral part in hemodynamic monitoring, especially in cardio-surgical ICUs. However, its value as a prognostic marker for organ failure is still unclear. Therefore, we analyzed postoperative CVP values after adult cardiac surgery in a large cohort with regard to its prognostic value for morbidity and mortality. Methods: All adult patients admitted to our ICUs between 2006 and 2019 after cardiac surgery were eligible for inclusion in the study (n = 11,198). We calculated the median initial CVP (miCVP) after admission to the ICU, which returned valid values for 9802 patients. An ROC curve analysis for optimal cut-off miCVP to predict ICU mortality was conducted with consecutive patient allocation into a (a) low miCVP (LCVP) group (≤11 mmHg) and (b) high miCVP (HCVP) group (>11 mmHg). We analyzed the impact of high miCVP on morbidity and mortality by propensity score matching (PSM) and logistic regression. Results: ICU mortality was increased in HCVP patients. In addition, patients in the HCVP group required longer mechanical ventilation, had a higher incidence of acute kidney injury, were more frequently treated with renal replacement therapy, and showed a higher risk for postoperative liver dysfunction, parametrized by a postoperative rise of ≥ 10 in MELD Score. Multiple regression analysis confirmed HCVP has an effect on postoperative ICU-mortality and intrahospital mortality, which seems to be independent. Conclusions: A high initial CVP in the early postoperative ICU course after cardiac surgery is associated with worse patient outcome. Whether or not CVP, as a readily and constantly available hemodynamic parameter, should promote clinical efforts regarding diagnostics and/or treatment, warrants further investigations.
Unconventional Therapy with IgY in a Psoriatic Mouse Model Targeting Gut Microbiome
Authors: Surcel Mihaela , Munteanu Adriana , Isvoranu Gheorghita , Ibram Alef , Caruntu Constantin , Constantin Carolina , Neagu Monica
Published: August 2021

Psoriasis has a multifactorial pathogenesis and recently it was shown that alterations in the skin and intestinal microbiome are involved in the pathogenesis of psoriasis. Therefore, microbiome restoration becomes a promising preventive/therapy strategy in psoriasis. In our pre-clinical study design using a mice model of induced psoriatic dermatitis (Ps) we have tested the proof-of-concept that IgY raised against pathological human bacteria resistant to antibiotics can alleviate psoriatic lesions and restore deregulated immune cell parameters. Besides clinical evaluation of the mice and histology of the developed psoriatic lesions, cellular immune parameters were monitored. Immune cells populations/subpopulations from peripheral blood and spleen cell suspensions that follow the clinical improvement were assessed using flow cytometry. We have quantified T lymphocytes (CD3ε+) with T-helper (CD4+CD8−) and T-suppressor/cytotoxic (CD8a+CD4−) subsets, B lymphocytes (CD3ε−CD19+) and NK cells (CD3ε−NK1.1+). Improved clinical evolution of the induced Ps along with the restoration of immune cells parameters were obtained when orally IgY was administered. We pin-point that IgY specific compound can be used as a possible pre-biotic-like alternative adjuvant in psoriasis.
Poor Prognosis of Diffuse Large B-Cell Lymphoma with Hepatitis C Infection
Authors: Tsai Yu-Fen , Liu Yi-Chang , Yang Ching-I , Chuang Tzer-Ming , Ke Ya-Lun , Yeh Tsung-Jang , Gau Yuh-Ching , Du Jeng-Shiun , Wang Hui-Ching , Cho Shih-Feng , Hsu Chin-Mu , Wu Pey-Fang , Huang Ching-I , Huang Chung-Feng , Yu Ming-Lung , Dai Chia-Yen , Hsiao Hui-Hua
Published: August 2021

Background: Hepatitis C virus (HCV) in diffuse large B-cell lymphoma (DLBCL) is associated with a higher prevalence and distinctive clinical characteristics and outcomes. Methods: A retrospective analysis of adult DLBCL patients from 2011 to 2015 was studied. Results: A total of 206 adult DLBCL were enrolled with 22 (10.7%) HCV-positive patients. Compared to HCV-negative patients, the HCV-positive group had a poor performance status (p = 0.011), lower platelet count (p = 0.029), and higher spleen and liver involvement incidences (liver involvement, p = 0.027, spleen involvement, p = 0.026), and they received fewer cycles of chemotherapy significantly due to morbidity and mortality (p = 0.048). Overall survival was shorter in HCV-positive DLBCL (25.3 months in HCV-positive vs. not reached (NR), p = 0.049). With multivariate analysis, poor performance status (p < 0.001), advanced stage (p < 0.001), less chemotherapy cycles (p < 0.001), and the presence of liver toxicity (p = 0.001) contributed to poor OS in DLBCL. Among HCV-positive DLBCL, the severity of liver fibrosis was the main risk factor related to death. Conclusion: Inferior survival of HCV-positive DLBCL was observed and associated with poor performance status, higher numbers of complications, and intolerance of treatment, leading to fewer therapy. Therefore, anti-HCV therapy, such as direct-acting antiviral agents, might benefit these patients in the future.
Mobile Health, Disease Knowledge, and Self-Care Behavior in Chronic Kidney Disease: A Prospective Cohort Study
Authors: Tsai Yi-Chun , Hsiao Pei-Ni , Kuo Mei-Chuan , Wang Shu-Li , Chen Tzu-Hui , Kung Lan-Fang , Hsiao Shih-Ming , Lin Ming-Yen , Hwang Shang-Jyh , Chen Hung-Chun , Chiu Yi-Wen
Published: August 2021

Mobile health (mHealth) management is an emerging strategy of care for patients with chronic diseases. However, the effect of mHealth management on clinical outcomes of patients with chronic kidney disease (CKD) has not been well-studied. The aim of this study was to investigate the additional influence of mHealth on disease knowledge and self-care behavior in CKD patients who had received traditional education. We designed and developed a new healthcare mobile application, called iCKD, which has several major features, including home-based physiological signal monitoring, disease health education, nutrition analysis, medication reminder, and alarms and a warning system. Trained nurses interviewed patients with CKD using structured questionnaires of disease knowledge and self-care behavior. After propensity score matching, we analyzed 107 patients who used iCKD and traditional education, and 107 who received traditional education. The patients who used iCKD had higher disease knowledge scores than those who received traditional education. In multivariate analysis, iCKD was significantly and positively associated with disease knowledge scores. Patients with high education levels could have greater disease knowledge through using mHealth. There was no significant difference in total scores of self-care behavior between the two groups. In conclusion, mHealth can significantly increase disease knowledge in patients with CKD.
Simple and Reliable Method for Gastric Subepithelial Tumor Localization Using Endoscopic Tattooing before Totally Laparoscopic Resection
Authors: Wang Sheng-Fu , Cheng Hao-Tsai , Hsu Jun-Te , Wu Chi-Huan , Chen Chun-Wei , Lin Chun-Jung , Sung Kai-Feng
Published: August 2021

Background: Totally laparoscopic surgery for early gastric cancer and subepithelial tumors has been popularized worldwide, yet localization of early or small-sized tumors is a persistent challenge due to difficulty being identified with the lack of manual tactile sensation. Thus, accurate localization with tattooing before the surgery would help improve efficiency during surgery. There are multiple methods to localize tumors before laparoscopy, each with varying advantages and disadvantages. The use of endoscopic tattooing with dye has been carried out for several decades due to its safety, lower cost, and convenience. However, there is a lack of studies on endoscopic tattooing before totally laparoscopic resection. Aims: To evaluate the effect of endoscopic tattooing with dye for gastric subepithelial tumors localization before laparoscopic resection and to evaluate the tattooing effect on different locations of tumors in stomach. Method: We retrospectively collected data of patients with gastric subepithelial tumors who underwent endoscopic tattooing before totally laparoscopic resection from 2017 to 2020 in a university affiliated medical center. All patients were analyzed for preoperative characteristics and then categorized into two groups based on tumor locations concerning the difficulty of laparoscopic surgery. The independent t test and Chi-square test were performed to compare perioperative outcome and complications between these two groups. Result: A total of 19 patients were included retrospectively at our center. The individuals were 5 male and 14 female patients with a mean age of 58.2 years old. Most patients had no symptoms, and the tumors were found incidentally in 12 patients (63%). All tumors were identified clearly during laparoscopic resection. The mean tumor size was 2.3 cm. The surgeries took an average of 111 min and a mean of 7 mL blood loss was found. All tumors had negative resection margins with no recurrence during follow-up. Gastrointestinal stromal tumor was the major pathologic diagnosis, found in 12 patients (63%), followed by the leiomyoma in 5 patients (26%). Only three patients had mild adverse effects after surgery and the symptoms were self-limited. Our analysis found no significant difference in preoperative patient characteristics and perioperative outcomes between patients with differing tumor locations. Conclusion: This study is the first and largest report on endoscopic tattooing with dye before laparoscopic resection of gastric subepithelial tumor resection. Our results emphasize that endoscopic tattooing with dye is a safe and reliable method for localizing subepithelial tumors in the stomach prior to totally laparoscopic resection, with no correlation to where the tumor is located.
Evaluation of Plaque Vulnerability via Combination of Hemodynamic Analysis and Simultaneous Non-Contrast Angiography and Intraplaque Hemorrhage (SNAP) Sequence for Carotid Intraplaque Hemorrhage
Authors: Lee Ui Yun , Kwak Hyo Sung
Published: August 2021

The purpose of this study was to assess the vulnerability of plaque using a combination of simultaneous non-contrast angiography, intraplaque hemorrhage (SNAP) sequence, and local hemodynamic analysis in an intraplaque hemorrhage (IPH), and to evaluate the association between morphological and hemodynamic factors and IPH by comparing the IPH (presence of IPH) and non-IPH (plaque with absence of IPH) groups. In total, 27 IPH patients and 27 non-IPH patients were involved in this study, and baseline characteristics were collected. For morphological factors, diameters, and areas of the internal carotid artery (ICA), external carotid artery, and common carotid artery were measured, and bifurcation angle (α) and ICA angle (β) were also measured for comparison between the IPH group and non-IPH group. For hemodynamic factors, time-averaged wall shear stress (WSS), minimum WSS, maximum WSS, and oscillatory shear index were calculated using computational fluid dynamics (CFD) simulations. For the qualitative analysis, cross-sectional images with analyzed WSS and SNAP sequences were combined to precisely assess local hemodynamics. Bifurcation angle (α) was significantly different between the IPH and non-IPH groups (39.47 degrees vs. 47.60 degrees, p = 0.041). Significantly higher time-averaged WSS, minimum WSS, and maximum WSS were observed in the IPH group compared to the non-IPH group. In the IPH group, when using the combined analysis with SNAP sequences and WSS, the WSS of the region with IPH was significantly higher than the region without IPH (2.32 vs. 1.21 Pa, p = 0.005). A smaller bifurcation angle (α) and higher time-averaged WSS, minimum WSS, and maximum WSS were associated with IPH. The combined analysis of SNAP sequences and WSS might help to evaluate the risk of carotid IPH.
Identifying Clinicopathological Factors Associated with Oncotype DX® 21-Gene Recurrence Score: A Real-World Retrospective Cohort Study of Breast Cancer Patients in Quebec City, Canada
Authors: Gagnet Simon , Diorio Caroline , Provencher Louise , Mbuya-Bienge Cynthia , Lapointe Julie , Morin Claudya , Lemieux Julie , Nabi Hermann
Published: August 2021

Gene expression profiling tests such as the Oncotype DX (ODX) 21-gene recurrence score (RS) assay is increasingly used in clinical practice to predict the risk of recurrence and support treatment planning for early-stage breast cancer (BC). However, this test has some disadvantages such as a high cost and a long turnaround time to get results, which may lead to disparities in access. We aim to identify clinicopathological factors associated with ODX RS in women with early-stage BC. We conducted a retrospective cohort study of women identified in the medical database of the Deschênes-Fabia Breast Disease Center of Quebec City University, Canada. Our sample consists of 425 women diagnosed with early-stage BC who have obtained an ODX RS between January 2011 and April 2015. The ODX RS has been categorized into three levels as originally defined: low (0–17), intermediate (18–30), and high (>30). The mean RS was 17.8 (SD = 9.2). Univariate analyses and multinomial logistic regressions were performed to identify factors associated with intermediate and high RS compared with low RS. A total of 237 (55.8%) patients had low RS, 148 (34.8%) had intermediate RS, and 40 (9.4%) had high RS. Women with progesterone receptor (PR)-negative (ORs ranging from 3.51 to 10.34) and histologic grade II (ORs ranging from 3.16 to 23.04) tumors were consistently more likely to have intermediate or high RS than low RS. Similar patterns of associations were observed when the RS was categorised using redefined thresholds from (i.e., from the TAILORx study or dichotomized). This study provides evidence suggesting that histologic grade and PR status are predictive factors for intermediate or high RS in women with early-stage BC. If these results are confirmed in future studies, considering these clinicopathological factors could spare women the need to get such a test before the beginning of a possible adjuvant therapy. This option could be considered in settings where the cost of testing is an issue.
Clinical Evaluation of Pathognomonic Salivary Protease Fingerprinting for Oral Disease Diagnosis
Authors: Koller Garrit , Schürholz Eva , Ziebart Thomas , Neff Andreas , Frankenberger Roland , Bartsch Jörg W.
Published: August 2021

Dental decay (Caries) and periodontal disease are globally prevalent diseases with significant clinical need for improved diagnosis. As mediators of dental disease-specific extracellular matrix degradation, proteases are promising analytes. We hypothesized that dysregulation of active proteases can be functionally linked to oral disease status and may be used for diagnosis. To address this, we examined a total of 52 patients with varying oral disease states, including healthy controls. Whole mouth saliva samples and caries biopsies were collected and subjected to analysis. Overall proteolytic and substrate specific activities were assessed using five multiplexed, fluorogenic peptides. Peptide cleavage was further described by inhibitors targeting matrix metalloproteases (MMPs) and cysteine, serine, calpain proteases (CSC). Proteolytic fingerprints, supported by supervised machine-learning analysis, were delineated by total proteolytic activity (PepE) and substrate preference combined with inhibition profiles. Caries and peridontitis showed increased enzymatic activities of MMPs with common (PepA) and divergent substrate cleavage patterns (PepE), suggesting different MMP contribution in particular disease states. Overall, sensitivity and specificity values of 84.6% and 90.0%, respectively, were attained. Thus, a combined analysis of protease derived individual and arrayed substrate cleavage rates in conjunction with inhibitor profiles may represent a sensitive and specific tool for oral disease detection.
Grey and White Matter Volume Changes after Preterm Birth: A Meta-Analytic Approach
Authors: Schmitz-Koep Benita , Haller Bernhard , Coupé Pierrick , Menegaux Aurore , Gaser Christian , Zimmer Claus , Wolke Dieter , Bartmann Peter , Sorg Christian , Hedderich Dennis M.
Published: August 2021

Cross-sectional studies have reported lower brain grey matter volumes (GMV) and white matter volumes (WMV) in preterm (PT) born individuals. While large MRI studies in the normative population have led to a better understanding of brain growth trajectories across the lifespan, such results remain elusive for PT born individuals since large, aggregated datasets of PT born individuals do not exist. To close this gap, we investigated GMV and WMV in PT born individuals as reported in the literature and contrasted it against individual volumetric data and trajectories from the general population. Systematic database search of PubMed and Web of Science in March 2021, and extraction of outcome measures were conducted by two independent reviewers. Individual data on full-term (FT) controls was extracted from freely available databases. Mean GMV, WMV, total intracranial volume (TIV), and mean age at scan were the main outcome measures. Of 532 identified records, nine studies were included with 538 PT born subjects between 1.1 and 28.5 years of age. Reference data was generated from 880 FT controls between 1 and 30 years of age. GMV was consistently lower in PT born individuals from infancy to early adulthood with no evidence for catch-up growth. While GMV changes followed a similar trajectory as FT controls, WMV was particularly low in adolescence after PT birth. Results demonstrate altered brain volumes after PT birth across the first half of lifespan. Future studies should address this issue in large aggregated datasets of PT born individuals.