bluuebunny/crossref_metadata_2025 huggingface dataset:
Deep convolutional neural network for mixed random impulse and Gaussian noise reduction in digital images
Authors: Mafi Mehdi , Izquierdo Walter , Martin Harold , Cabrerizo Mercedes , Adjouadi Malek
Published: February 2021

This study utilises a deep convolutional neural network (CNN) implementing regularisation and batch normalisation for the removal of mixed, random, impulse, and Gaussian noise of various levels from digital images. This deep CNN achieves minimal loss of detail and yet yields an optimal estimation of structural metrics when dealing with both known and unknown noise mixtures. Moreover, a comprehensive comparison of denoising filters through the use of different structural metrics is provided to highlight the merits of the proposed approach. Optimal denoising results were obtained by using a 20‐layer network with 40 × 40 patches trained on 400 180 × 180 images from the Berkeley segmentation data set (BSD) and tested on the BSD100 data set and an additional 12 images of general interest to the research community. The comparative results provide credence to the merits of the proposed filter and the comprehensive assessment of results highlights the novelty and performance of this CNN‐based approach.
DeepInterpolation: fusion of multiple interpolations and CNN to obtain super‐resolution
Authors: Pandey Ram Krishna , Angarai Ganesan Ramakrishnan
Published: February 2021

The authors propose architectures that learn end‐to‐end mapping functions to improve the spatial resolution of the input natural images. The models are unique in forming non‐linear combinations of three image interpolation techniques using the convolutional neural network. Another proposed architecture uses a skip connection with nearest‐neighbour interpolation, achieving almost similar results. The architectures have been carefully designed to ensure that the reconstructed images lie precisely in the manifold of high‐resolution images, thereby preserving the high‐frequency components with fine details. They have compared with the state‐of‐the‐art and recent deep learning‐based natural image super‐resolution techniques and found that their methods can preserve the sharp details in the image, while also obtaining comparable or better peak‐signal‐to‐noise ratio values than them. Since their methods use image interpolations and a shallow convolutional neural network (CNN) with a fewer number of smaller filters, the computational cost is kept low. They have reported the results of the best two proposed architectures on five standard data sets for an upscale factor of 2. Their methods generalise well in most cases, which is evident from the better results obtained with increasingly complex data sets. For four times upscaling, they have designed similar architectures for comparing with other methods.
Efficient image structural similarity quality assessment method using image regularised feature
Authors: Li Yajing , Huang Baoxiang , Yang Huan , Hou Guojia , Zhang Pengfei , Duan Jinming
Published: February 2021

Image regularised features play a critical role in image processing domain, by integrating regularised feature and structural similarity, a new full‐reference image assessment method (IRF_SSIM) is proposed in this study. As well known, the gradient operator always be used to capture the edge information of the image, while the total variational regularised features can be adopted to calculate the detailed change information of image contrast and texture, as well as noise removal and edge retention. Therefore, the IRF_SSIM method extends the gradient features into the image regularised features to measure the structural changes in the image. In addition, image quality is also affected by variations of luminance and contrast. For a more comprehensive image quality assessment, the IRF_SSIM method considers the changes in structure, luminance and contrast simultaneously. In other words, the total image quality is estimated by structural similarity calculated by integrating the effects of image structure, luminance and contrast changes. Comparing with the representative methods, the experimental results illustrate that the IRF_SSIM method is highly consistent with the subjective assessment results.
Multimodal biometric recognition systems using deep learning based on the finger vein and finger knuckle print fusion
Authors: Daas Sara , Yahi Amira , Bakir Toufik , Sedhane Mouna , Boughazi Mohamed , Bourennane El‐Bay
Published: February 2021

Recognition systems using multimodal biometrics attracts attention because they improve recognition efficiency and high‐security level compared to the unimodal biometrics system. In this study, the authors present a secure multimodal biometrics recognition system based on the deep learning method that uses convolutional neural networks (CNNs). The authors propose two multimodal architectures using the finger knuckle print (FKP) and the finger vein (FV) biometrics with different levels of fusion: the features level fusion and scores level fusion. The features extraction for FKP and FV are performed using transfer learning CNN architectures: AlexNet, VGG16, and ResNet50. The key step aims to select separate features descriptors from each unimodal biometrics modality. After that, the authors combine them using the proposed fusion approaches were support vector machine or Softmax applies as classifiers to increase the proposed system security. The efficiency of the proposed algorithms is tested using publicly available biometrics databases. The experimental results show that the proposed fusion architectures achieve an accuracy of 99.89% and an equal error rate of 0.05%. The obtained results indicate that the biometrics recognition system using deep learning is secure, robust, and reliable.
Tumour growth prediction of follow‐up lung cancer via conditional recurrent variational autoencoder
Authors: Xiao Ning , Qiang Yan , Zhao Zijuan , Zhao Juanjuan , Lian Jianhong
Published: February 2021

The prediction of lung tumour growth is the key to early treatment of lung cancer. However, the lack of intuitive and clear judgments about the future development of the tumour often leads patients to miss the best treatment opportunities. Combining the characteristics of the variational autoencoder and recurrent neural networks, this study proposes a tumour growth prediction via a conditional recurrent variational autoencoder. The proposed model uses a variational autoencoder to reconstruct tumour images at different times. Meanwhile, the recurrent units are proposed to infer the relationship between tumour images according to the chronological order. The different tumour development varies in different patients, patients' condition is adopted to achieve personalised prediction. To solve the problem of blurred results, the authors add the total variation regularisation term into the object function. The proposed method was tested on longitudinal studies, National Lung Screening Trial and cooperative hospital dataset, with three points on lung tumours. The precision, recall, and dice similarity coefficient reach 82.22, 79.89 and 82.49%, respectively. Both quantitative and qualitative experimental results show that the proposed method can produce realistic tumour images.
CGGAN: a context‐guided generative adversarial network for single image dehazing
Authors: Zhou Zhaorun , Shi Zhenghao
Published: February 2021

Image haze removal is highly desired for the application of computer vision. This study proposes a novel context‐guided generative adversarial network (CGGAN) for single image dehazing. Of which, a novel new encoder–decoder is employed as the generator. In addition, it consists of a feature‐extraction net, a context‐extraction net, and a fusion net in sequence. The feature‐extraction net acts as an encoder, and is used for extracting haze features. The content‐extraction net is a multi‐scale parallel pyramid decoder and is used for extracting the deep features of the encoder and generating coarse dehazing image. The fusion net is a decoder and is used for obtaining the final haze‐free image. In order to get better dehazing results, multi‐scale information obtained during the decoding process of the context extraction decoder is used for guiding the fusion decoder. By introducing an extra coarse decoder to the original encoder–decoder, the CGGAN can make better use of the deep feature information extracted by the encoder. To ensure that the proposed CGGAN works effectively for different haze scenarios, different loss functions are employed for the two decoders. Experiments results show the advantage and the effectiveness of the proposed CGGAN, evidential improvements over existing state‐of‐the‐art methods are obtained.
New soft‐switched high gain three‐port DC–DC converter with coupled inductors
Authors: Zahedi Saadabad Neda , Hossein Hosseini Seyed , Nasiri Abolfazl , Sabahi Mehran
Published: February 2021

In this study, a new high step‐up non‐isolated three‐port DC–DC converter is proposed. A bidirectional buck–boost converter is used to interface photovoltaic battery and non‐isolated load port. Compared to the other three‐port converters, the presented topology has fewer component counts, which is the main merit of the proposed converter. The output voltage of the converter can be increased by using a three winding coupled inductor, a diode and a capacitor. Furthermore, since both main switches are turned on with zero voltage switching, switching losses is reduced and the efficiency of the converter is improved. Maximum power point tracking and maintaining the output voltage at a suitable level during the charging and discharging of the battery can be achieved by a simple controller. Moreover, according to the load power demand, three power flow paths will occur. The operation principle will be described in detail for three modes. Finally, the experiments with 400 W, 100 W, 40 V/400 V are implemented to verify the effectiveness of the converter.
Virtual space vector modulation strategy for common‐mode voltage reduction in three‐phase three‐level flying‐capacitor split‐source inverters
Authors: Brum Chaves Diego , Grigoletto Felipe B.
Published: February 2021

Transformerless systems play an important role in many applications, such as photovoltaic generation systems and motor drives, since they present reduced size and high efficiency. On the other hand, the flying‐capacitor split‐source inverter (FC‐SSI) merges the boost and the inverter stage in a single power conversion system. It is important to point out that conventional modulation strategies applied to the FC‐SSI can result in unacceptable common‐mode voltage (CMV) which is one of the main causes of leakage currents. To overcome this problem, this paper proposes a virtual space vector modulation technique for FC‐SSI. The proposed modulation strategy manipulates the switching vectors in order to result in constant CMV enabling the transformerless operation. Simulation and experimental results, as well as a comparative analysis with existing modulation techniques, are provided to show the good features of the proposed modulation strategy.
New Single‐Switch quadratic boost DC/DC converter with Low voltage stress for renewable energy applications
Authors: Hasanpour Sara , Siwakoti Yam , Blaabjerg Frede
Published: February 2021

In this paper, a novel non‐isolated Single‐Switch Quadratic Boost Coupled‐Inductor (SSQBCI) DC/DC converter with continuous input current and low voltage stress on the switching component is presented. The suggested structure is based on the traditional quadratic boost converter. In this new topology, to achieve an ultra‐high voltage gain without large duty cycle, a Coupled‐Inductor (CI) along with a Voltage Multiplier (VM) are employed. The magnetic energy stored in the leakage inductor of the CI is recycled by a regenerative passive clamp capacitor that is connected with the switch in parallel, which helps to limit the maximum voltage across the switch. Therefore, to reduce the switch conduction loss and improve the efficiency, a switch with the low static drain‐to‐source ON‐resistance can be used. Moreover, the low voltage stress on the output side diode alleviates the reverse recovery loss. The steady‐state operating principle, comparisons with other related topologies and also design considerations in Continuous Conduction Mode (CCM) will be analyzed in detail. Finally, the performance of the proposed SSQBCI is verified by experimental results using a prototype with 30V input and 200V ‐ 160 W output operation at a constant switching frequency 50 kHz.
Logic‐based space‐vector modulation for neutral‐point‐clamped multilevel inverter with DC‐link voltage balancing capability
Authors: Amini Jalal , Moallem Mehrdad
Published: February 2021

This study proposes a new simple and fast space‐vector modulation scheme with the capability of balancing capacitor voltages in neutral‐point‐clamped converters. In the first step, transformations from the commonly used reference frames to the 60°‐frame are discussed. Next, a new method is presented to generate an appropriate switching sequence based on the voltage of the clamp point and direction of the phase currents. The proposed method is computationally efficient and its algorithm only needs knowledge of the load current directions, leading to further simplification of the hardware. This method can easily be generalised to control diode‐clamped multilevel inverters with an arbitrary number of levels. The feasibility, effectiveness, and performance of the method are investigated through simulation and experimental studies under various load conditions.
Interactions between a half‐bridge MMC and a hybrid DC breaker during fault current interruption compared to a full‐bridge MMC
Authors: Döring David , Würflinger Klaus , Staudt Volker , Zeller Marcus , Ebner Günter
Published: February 2021

The large‐scale integration of remote renewable energy resources into existing AC grids is one of the main drivers for the construction of multi‐terminal direct current (MTDC) systems. Today, a few MTDC systems are already in execution stage or even in operation. However, with a growing number of extended MTDC systems, the probability of high‐voltage DC (HVDC) insulation faults is likely to increase and therefore, reliable solutions for handling of such disturbances are crucial in order to maintain high availability. Since most HVDC converters are realised by modular multilevel converters (MMC) converters are based on half‐bridge (HB) modules, they lack an inherent capability to control DC fault currents. Therefore, additional equipment like HVDC breakers needs to be installed as well. Among the various breaker types, the so‐called ‘hybrid’ DC circuit breaker (DCCB) is considered most popular. This contribution provides a more holistic view on the overall system behaviour, represented AC grid, MMC HVDC converter, DC reactor and DCCB altogether. It discusses the physical interactions of these main components in MTDC systems. In particular, the influence of the electrical parameters of the hybrid DCCB and its required DC reactors on the MMC converter's internal current and voltage conditions is outlined.
Backstepping control of flying capacitor multilevel inverter‐based active power filter
Authors: Manai Lazhar , Hakiri Donia , Besbes Mongi
Published: February 2021

In this work, the authors are considering the problem of compensation of harmonic current absorbed by a non‐linear load from a three‐phase grid voltage. The objective is twofold: the first is to reduce cost and control complexity by avoiding proportional–integral regulators and optimising measurement instrumentation while ensuring inverter capacitor voltage self‐balance and the second is to provide a robust control strategy against power grid problems. Without measuring current and capacitor voltages, the proposed control strategy generates accurate control signals able to ensure flying capacitor inverter self‐balance and full compensation of harmonics whatever the grid voltage problem. In this regard, the robustness of the proposed control against power grid problem such as sag, swell, grid voltage unbalance, and frequency variation have been tested while proving its efficiency to compensate for harmonic currents and ensuring capacitor voltage natural balance even in transient regimes. During balanced and unbalanced loads, the proposed method has exhibited an excellent transient response, represented by capacitor voltages tracking to their reference in the presence of large variation in the load. Finally, effectiveness of the proposed control strategy is verified by numerical simulations as well as realistic experiments, and its merits are showed in comparison with other methods.
Digitalisierung als therapeutische Ressource in transnationalen Familienbeziehungen
Authors: Borcsa Maria
Published: February 2021

Die Grundthese dieses Beitrages ist, dass sich psychologische und familiendynamische Prozesse im Zusammenhang von Mobilität, Migration, Flucht und Vertreibung durch das Vorhandensein von Informations- und Kommunikationstechnologien (IKTs) nicht mehr in der gleichen Art und Weise konzeptualisieren lassen wie vor der Digitalisierung.
Wie schulische Bildung Kinder und Familien stärken und belasten kann
Authors: Kroll Michael
Published: February 2021

Die Motivation der LehrerInnen, sich mit einem Kinderpsychiater auszutauschen, ist meist dadurch bedingt, der zunehmenden Unruhe an Schulen zu begegnen. Oft wird beklagt, dass Kinder „heutzutage“ vergleichsweise deutlich häufiger psychisch krank seien. Dieser verbreitete Eindruck lässt sich durch Studienergebnisse nicht objektivieren. Die allgemein wahrgenommene Unruhe an Schulen hat viele Gründe.
Familienberatungsstellen: Arbeiten an den Verbindungsstellen zwischen Unterstützung, Beratung und Therapie
Authors: Höfling Atilla , Schrappe Andreas
Published: February 2021

Familienberatungsstellen fördern das Wohl junger Menschen und stärken die Eltern. Fachkräfte im multidisziplinären Team helfen mit praktischer Unterstützung, Beratung und Psychotherapie. Die große Themenvielfalt erfordert eine enge Kooperation miteinander und mit anderen Hilfesystemen. Auch der routinierte Umgang mit komplexen Fallanliegen und Mehrpersonensettings ist gefragt. Systemisches Denken und Handeln ist hierfür eine hilfreiche Grundlage.
Step-clipping method can improve the detectability of the target lesion in colonic diverticular bleeding
Authors: Aoyama Taiki , Takemoto Hiroki , Takeuchi Yukari , Shigita Kenjiro , Asayama Naoki , Fukumoto Akira , Mukai Shinichi , Nagata Shinji
Published: February 2021

Background and study aims Despite the information regarding extravasation from contrast-enhanced computed tomography (CECT), the detectability of the target diverticulum by colonoscopy remains unsatisfactory in colonic diverticular bleeding (CDB). The lack of common signs recognizable on CT and endoscopic images makes it difficult to set a region of interest; however, this can be overcome with the “step-clipping” method, a strategic marking technique for revealing the target. We aimed to investigate the clinical performance of the step-clipping method in patients with CDB.

Patients and methods Eighty-seven patients diagnosed with CDB with extravasation using CECT who underwent colonoscopy between August 2007 and February 2020 were included. Patients were divided into two categories: the traditional group (those who underwent colonoscopy from August 2007 to May 2017, n = 54) and the step-clipping group (those who underwent colonoscopy from June 2017 to February 2020, n = 33).

Results The detection rate for the responsible diverticulum was significantly higher in the step-clipping group than in the traditional group (94 % vs 63 %; P = .0013). The step-clipping group had a shorter average search time during colonoscopy (9.6 vs 40.5 minutes; P < .0001) and lower re-bleeding rate after the initial colonoscopy (6 % vs 26 %; P = .02) than the traditional group, which facilitated earlier hospital discharge (5.4 vs 6.8 days; P = .027).

Conclusions Colonoscopy using the step-clipping method can improve the detectability of the target lesion within a shorter time, thus leading to lower re-bleeding rates and earlier hospital discharge.
Erfolgreiche Lösungen für Arthrose, Schmerz und Muskeln
Authors: Mosetter Kurt
Published: February 2021

Arthrose und Osteoporose sind keine degenerativen Prozesse, sondern eine Reaktion des Körpers auf zu geringe und falsche Belastungen („form follows function“). Schmerzen machen sich meist erst nach langer Zeit in der neuromuskulären Dekompensation bemerkbar. Gelenkentzündungen entstehen nicht von selbst, sondern meist gehen Magen-Darm-Beschwerden verschiedenster Formen voraus. Langlebigkeit und Remodeling der Knochen werden durch den Stoffwechsel sowie einen stabilen Hormonhaushalt koordiniert und erhalten. Mineralstoffe, D + Galaktose in Kombination mit Glukosamin und Omega-3-Fettsäuren sind wichtige Parameter einer erhaltenden Knochennahrung – denn nicht nur die Anspannung der Muskulatur beansprucht Energie, sondern ebenso die Entspannung. Diese Energie wird durch Glukose und Adenosintriphosphat bereitgestellt. Allerdings führt der Verbrauch von Adenosintriphosphat zur Entstehung von Ammoniak, was leistungsmindernd und toxisch wirkt. Daher gilt: Für gute knöcherne Strukturen ist eine stabile Energiebilanz erforderlich.
Naturheilkundliche Ansätze bei Gonarthrose
Authors: von Busch Beate , Langhorst Jost
Published: February 2021

Für die Behandlung der Gonarthrose steht im Klinikum am Bruderwald in Bamberg in der Abteilung für Integrative Medizin und Naturheilkunde ein multimodales Behandlungskonzept zur Verfügung, das im Wesentlichen aus den sieben Komponenten Ernährungstherapie, Bewegungstherapie, Hydrotherapie, Phytotherapie, Neuraltherapie, Akupunktur und Blutegeltherapie besteht. Ziel aller Maßnahmen ist eine Reduktion der proinflammatorischen Mediatoren in der Kniegelenksflüssigkeit, die eine Schmerzreaktion, eine Destruktion des Gelenkknorpels und eine Einschränkung der Beweglichkeit verursachen. Selbst schwere radiologische Verlaufsformen können mit den geschilderten Methoden erfolgreich therapiert werden. Gleichzeitig wird den Patienten durch selbstwirksames Handeln ein aktiver Umgang mit ihrer Erkrankung ermöglicht. Ein Zugewinn an Lebensqualität ist in vielen Fällen noch Monate nach den Interventionen nachweisbar.
Thrombotic Thrombocytopenic Purpura: When Basic Science Meets Clinical Research
Authors: Bécel Gaëlle , Faict Sylvia , Picod Adrien , Bouzid Raïda , Veyradier Agnès , Coppo Paul
Published: February 2021

The therapeutic landscape of thrombotic thrombocytopenic purpura (TTP) is rapidly changing with the recent availability of new targeted therapies. This progressive shift from empiricism to pathophysiology-based treatments reflects an intensive interaction between the continuous findings in the field of basic science and an efficient collaborative clinical research and represents a convincing example of the strength of translational medicine. Despite the rarity of TTP, national and international efforts could circumvent this limitation and shed light on the epidemiology, clinical presentation, prognosis, and long-term outcome of this disease. Importantly, they also provided high-quality results and practice changing studies for the benefit of patients. We report here the most recent therapeutic findings that allowed progressively improving the prognostic of TTP, both at the acute phase and through long-term outcome.
Endoscopic ‘suction room’ to treat complex enteral stump leaks after upper gastrointestinal surgery
Authors: Mutignani Massimiliano , Dioscoridi Lorenzo , Venezia Ludovica , Larghi Alberto , Pugliese Francesco , Cintolo Marcello , Bonato Giulia , Forti Edoardo
Published: February 2021

Leaks/dehiscence of the enteral stump associated with infected peri-enteric collections after upper gastrointestinal surgery are a life-threatening adverse event, not usually endoscopically treatable.

We describe a new endoscopic approach to treat complex entero-cutaneous fistulas (CECF) by creating a “suction room” through placement of multiple stents (enteral, biliary and/or pancreatic) and a large nose-enteral suction tube inside the enteral stent maintained on a continuous negative aspiration suction.Between January 2016 and December 2019, six consecutive patients referred to our unit with CECF of the enteral stump after failed redo surgeries underwent creation of a “suction room.” In five patients, enteral, biliary and pancreatic stents were positioned before a nose-to-stent or nose-to-collection large 18 Fr tube placement. In one patient, a pancreatic stent was not placed. Technical and clinical success were achieved in all patients. Mean and median times of aspiration were 49 and 27 days, respectively, with a mean hospital stay of 56 days after the endoscopic procedure. Stents were successfully removed. Mean post-procedural follow-up was 17.3 months.

Endoscopic creation of the “suction room” offers the unique possibility of treating complex entero-cutaneous fistulas in surgically altered sites, which are difficult to manage with standard endoscopic methods.
Clinical evaluation of physician-controlled guidewire manipulation during endoscopic ultrasound-guided hepaticogastrostomy (with video)
Authors: Nishiguchi Kyohei , Ogura Takeshi , Nishioka Nobu , Ueno Saori , Okuda Atsushi , Yamada Tadahiro , Yamada Masanori , Ueshima Kazuya , Higuchi Kazuhide
Published: February 2021

Background and study aims Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) may be most complex because of the EUS-guided biliary drainage procedure and variations in the course of the intrahepatic bile duct compared with the common bile duct (CBD). Appropriate guidewire insertion is essential. Physician-controlled guidewire manipulation (PCGW) might improve technical success rates of bile duct cannulation. The present study aimed to determine the technical feasibility and safety of PCGW during EUS-HGS.

Patients and methods A total of 122 consecutive patients who were scheduled to undergo EUS-HGS between October 2017 and April 2019 were prospectively registered. The primary endpoint was the technical success rate of guidewire insertion into the CBD or hepatic hilum. Guidewire insertion was considered to have failed if the HGS assistant failed to achieve manipulation.

Results The intrahepatic bile duct was successfully punctured in 120 of 122 patients. During guidewire insertion by the HGS assistant, guidewire fracture was observed in one patient. The guidewire was successfully inserted into the biliary tract and manipulated by the HGS assistant in 96 patients. PCGW was thus attempted for the remaining 23 patients. The guidewire was inserted by PCGW in all 23 patients, improving the technical success rate for guidewire insertion from 80 % to 100 %. After tract dilation, we deployed covered metal stents and plastic stents in 117 and two patients, respectively. The overall technical success rate for EUS-HGS was 97.5 % (119/122). Adverse events comprising bile peritonitis or leakage developed in five patients.

Conclusion PCGW might contribute to improving the success rate of EUS-HGS.
Prevalence of and risk factors for stent migration-induced duodenal perforation
Authors: Stassen Pauline M.C. , de Jong David M. , Poley Jan-Werner , Bruno Marco J. , de Jonge Pieter J.F.
Published: February 2021

Background and study aims The safety of transpapillary biliary drainage by stent placement through endoscopic retrograde cholangiography (ERC) may be compromised by the occurrence of stent migration-induced perforation of the duodenal wall (SMDP). We aimed to assess the prevalence rate, risk factors and clinical course of SMDP.

Patients and methods This retrospective cohort study included all patients who underwent an ERC with biliary plastic stent placement, between January 2014 and December 2018. Patients with an SMDP were identified from our endoscopy complication registry.

Results 1227 patients underwent an ERC, of whom 629 patients (51 %) with biliary plastic stent placement; in 304 patients (25 %) stents were placed for perihilar strictures. Thirteen patients with SMDP were identified. The prevalence was 2.1 % for patients with biliary plastic stent placement and 4.3 % for patients stented for a perihilar stricture. All SMDPs occurred in patients with a perihilar stricture and with stents ≥ 12 cm (range 12–20 cm). Another potential risk factor was stent insertion into the left liver lobe, which was present in 10 of 13 patients. In 10 of 13 patients, SMDP was clinically suspected. Three of 13 patients were asymptomatic and diagnosed at elective stent retrieval. Eight patients could be endoscopically treated with an over-the-scope clip. Four patients died due to abdominal sepsis despite repeated interventions.

Conclusion SMDP is a rare but potentially life-threatening complication of ERC after transpapillary drainage for perihilar biliary strictures. Stents ≥ 12 cm and stent insertion into the left liver lobe may be associated risk factors.
Antivirale Eigenschaften des Extrakts aus Cistus × incanus L. Pandalis bei SARS-CoV-2 in vitro nachgewiesen
Authors: Träder Jens-Martin
Published: February 2021

Da es noch keine zuverlässige Therapie gegen SARS-CoV-2 gibt, konzentriert sich die Forschung darauf, vielversprechende Substanzen zu finden, die bereits verfügbar sind. In dieser Studie soll untersucht werden, ob das pflanzliche Präparat Cystus Pandalis® in vitro antivirale Eigenschaften gegen SARS-CoV-2 aufweist, da es sich bereits gegen mehrere andere Viren als wirksam erwiesen hat. Am Fraunhofer Institut für Zelltherapie und Immunologie (IZI) wurden Zellkulturen unter Anwendung des Extrakts mit SARS-CoV-2 infiziert. Die Reduktion des Viruswachstums wurde durch den Vergleich von fokusbildenden Einheiten bewertet. Eine fast vollständige Hemmung des Viruswachstums durch den Extrakt wurde bei Konzentrationen von mehr als 15,6 µg/ml mit einer berechneten EC50 (mittlere effektive Konzentration) von 1,94 µg/ml beobachtet. Der Mechanismus dieses Extrakts beruht wahrscheinlich auf einer Wirkung der hochpolymeren Polyphenole. Man vermutet, dass der Extrakt bestimmte virale Strukturen umhüllt, wodurch diese Substanz als Eintrittsinhibitor wirkt. Aufgrund der hohen In-vitro-Aktivität erscheint es sinnvoll, den Extrakt als Prophylaxe gegen Infektionen mit SARS-CoV-2 einzusetzen.
Olfactory Performance among Hospital Residents
Authors: Rezende Gustavo Lara , Sarmet Max , Sousa Gabrielle Everton , Krier Felipe Carneiro , Parreira Diderot Rodrigues , Kuckelhaus Selma Aparecida
Published: February 2021

Introduction Smell plays an important role in the maintenance of health and quality of life of the general population. Health workers with olfactory impairment may not be able to help diagnose certain diseases, and subsequently increase the risk of hazardous events and mortality among those affected. ‘Odor learning’ requires repeated experiences with different smells to develop a discriminatory ability, and this is a process that takes years. Because of that, physicians of certain medical specialities have better odor detection than others.

Objective To study the olfactory performance and associated factors of otorhinolaryngology residents compared with residents of different medical specialities in a representative sample of a tertiary hospital.

Methods The University of Pennsylvania Smell Identification Test (UPSIT) was used to compare olfactory performance. Clinical and epidemiological data were collected among 42 hospital residents.

Results Otorhinolaryngology residents presented an average UPSIT score of 35.0, and the other residents, a score of 32.8 (p = 0.02) Of all the residents, 40.5% showed some grade of olfactory impairment. Half of the females students in the first year of residency showed olfactory dysfunction. The multivariate analyses found age (p = 0.03; 95% confidence interval for β = 0.33) to be an independent predictor of the UPSIT score.

Conclusion The present study demonstrated that otorhinolaryngology residents have greater olfactory capacity compared with other residents. Future studies should explore the relevant factors of olfactory impairment and its impact on quality of life in this population.
Análise de elementos finitos de um dispositivo de dinamização controlada para fixação circular externa
Authors: Faria Fernando Ferraz , Gruhl Carlos Eduardo Miers , Ferro Rafaela Rebonato , Rached Rodrigo Nunes , Soni Jamil Faissal , Trevilatto Paula
Published: February 2021

Objetivo Construir um protótipo virtual de um dispositivo de fixação circular externa para fraturas em ossos longos com dinamização controlada a partir de dois materiais diferentes e prever seu comportamento mecânico por meio da análise de elementos finitos AEF).

Método Modelos tridimensionais compostos de duas peças metálicas unidas por uma junta deslizante em rabo de andorinha e um amortecedor de silicone de alta densidade foram criados em um software. Análises de elementos finitos distintas foram simuladas considerando dois materiais (aço inoxidável ou titânio), modos (bloqueado ou dinamizado) e condições de carregamento (estático/pontual ou dinâmico/0,5 segundo) diferentes com carga axial uniforme de 150 kg na porção superior do dispositivo.

Resultados O modelo de elementos finitos (EFs) apresentou 81.872 nós e 45.922 elementos. Com aço inoxidável, o pico de tensão máxima (140,98 MPa) foi alcançado com o dispositivo bloqueado e sob carga estática, enquanto o maior deslocamento (2.415 × 10−3 mm) foi obtido com o dispositivo bloqueado e sob carga dinâmica. Com titânio, o pico de tensão máxima (141,45 MPa) ocorreu com o dispositivo bloqueado e sob carga estática, enquanto o maior deslocamento (3.975 × 10−3 mm) foi observado com o dispositivo bloqueado e sob carga dinâmica.

Conclusão O protótipo do dispositivo desempenhou o papel de suporte de tensão com deformação aceitável nos dois modos, bloqueado ou dinamizado, e pode ser fabricado com aço inoxidável ou titânio.
A Dual Gender Rare Case with 47,XY, + 18/46,XX Karyotype: Chimera or Mosaic?
Authors: Ankathil Ravindran , Eva Foong , Bakar Zulaikha Abu , Yunus Nazihah Mohd , Nawi Nurul Alia , Annuar Aziati , Ting Cheng Yi , Sulong Sarina
Published: February 2021

Our objective is to report one rare case of dual gender chimerism involving abnormal male trisomy 18 and normal female karyotype. The baby was born full term with birth weight of 1.8 kg, not vigorous with light meconium stained liquor and Apgar score of 51, 85 and 910. Parents are 40 years old and mother is G6P5 + 1. The baby had clinical features of Edwards syndrome, and a blood sample was sent to Human Genome Centre, Universiti Sains Malaysia, Malaysia for cytogenetic analysis. Conventional cytogenetic analysis results showed two distinct sex discordant genetic cell lines XY and XX in 90:10 ratio. The male genetic cell line XY also showed trisomy 18 (47,XY, + 18) consistent with clinical diagnosis of male Edwards syndrome, whereas the second genetic cell line showed normal 46,XX female. The present case was reported as dual gender chimera with chi 47,XY, + 18/46,XX karyotype pattern. To the best of available knowledge, dual gender chimerism with abnormal male trisomy 18 and normal female karyotype has not been reported so far, and this case is reported for its rarity and as the first report.
“Wings of a Butterfly” Technique in Modified Bentall's Procedure
Authors: Lee Seok In , Choi Chang Hyu , Park Kook Yang , Park Chul-Hyun
Published: February 2021

Many surgeons have modified the technique to reduce bleeding from anastomosis line since Bentall and De Bono introduced aortic root replacement using a composite graft. We present a new composite, butterfly wing–shaped, valve graft fixated using hand-made double sewing cuff. The “wings of a butterfly” technique is a method of reinforcement suturing between an added sewing cuff and residual aortic wall at the proximal stump and helps to reduce bleeding after the modified Bentall's procedure.
Managing Status Epilepticus in a Child with Dravet Syndrome: How Difficult It Could Be?
Authors: Badv Reza Shervin , Ghamari Azin , Ashrafi Mahmoud Reza , Mohammadi Mahmoud , Azizi Malamiri Reza , Heidari Morteza
Published: February 2021

Previously known as severe myoclonic epilepsy of infancy, Dravet syndrome is characterized by febrile or afebrile prolonged hemiconvulsive seizures or generalized status epilepticus in an infant with previously normal development. Immediate management of status epilepticus is critical in these patients. Early control of status epilepticus prevents further brain damage; however, there is no consensus regarding the management of status epilepticus in children with Dravet syndrome, as many conventional antiseizure medications that are recommended in the management of status epilepticus worsen the seizures in these patients. A 2.5-year-old girl child patient was referred due to status epilepticus which was refractory to antiseizure medications. Sodium valproate, nitrazepam, ketogenic diet, intravenous phenytoin, and midazolam continuous infusion were administered. After controlling status epilepticus, the probable diagnosis of Dravet syndrome was proposed and confirmed by a mutation in SCN1A. As previously stated in numerous case reports, phenytoin worsens seizures in patients with Dravet syndrome. Therefore, it seems logical that in every infant with status epilepticus and probable Dravet syndrome, the practicing physician considers administering intravenous valproate or even midazolam continuous infusion instead of intravenous phenytoin.
CYP2D6 rs35742686 and rs3892097 Gene Polymorphisms and Childhood Acute Lymphoblastic Leukemia: Relation to Disease Susceptibility in Kashmiri Children
Authors: Shapoo Nidha Sadiq , Masood Akbar , Bhat Javid R. , Bhatia A. S. , Shah Idrees A. , Ganai Bashir A.
Published: February 2021

CYP2D6 is one of the most widely investigated CYPs in relation to gene polymorphism. This study analyzed the relationship between CYP2D6 rs35742686 and rs3892097 single-nucleotide polymorphisms (SNPs) and potential risk factors in the development of acute lymphoblastic leukemia (ALL) in Kashmiri children. We recruited 300 cases and 600 controls for genotyping and risk factors assessment. Genotypes of rs35742686 and rs3892097 were analyzed by polymerase chain reaction-restriction fragment length polymorphism method. CYP2D6 expression analysis was done by quantitative reverse transcription polymerase chain reaction in ALL cases. Conditional logistic regression models were used to calculate odds ratios (OR) and 95% confidence intervals (CI). High risk of ALL was observed in cases who carried the mutant genotypes of rs35742686 (OR = 18.15; 95% CI = 4.13–79.66, p < 0.0001) or rs3892097 (OR = 24.06; 95% CI = 10.23–56.53, p < 0.0001). Significant interaction was observed between rs35742686 and rs3892097 SNPs (P interaction = 0.001). The risk associated with the variant genotypes of rs35742686 and rs3892097 was retained in the cases whose fathers were smokers or had maternal X-ray exposure (p < 0.001). Relative messenger ribonucleic acid expression across genotypes was significantly decreased in cases carrying rs357426863 (*3/*3) (n-fold = 0.37 ± 0.156, p < 0.0079) and rs3892097 SNPs (*4/*4) (n-fold = 0.02 ± 0.0075, p < 0.0001) suggesting these two events are independent in ALL cases. The study concluded that rs35742686 and rs3892097 SNPs are significantly associated with ALL risk in Kashmiri children.
The Effects of Virtual Reality on Upper Extremity in Patients with Obstetric Brachial Plexus Injury
Authors: Karas Havva Ezgi , Atıcı Emine , Aydın Gamze , Demirsöz Mert
Published: February 2021

The present study aimed to examine the effects of playing Nintendo Wii games on upper extremity functions compared with conventional physiotherapy, in children with obstetric brachial plexus injury (OBPI). Twenty-two patients with brachial plexus injuries were enrolled. The patients were divided into two groups by simple randomization. The control group (conventional physiotherapy group [CTG]: n = 11) received conventional physiotherapy for 6 weeks (40 minutes per day, for 4 days per week). The study group, called Nintendo Wii group (NWG; n = 11), received conventional physiotherapy as well as tennis, baseball, and boxing games with Nintendo Wii on days when there was no physical therapy. The upper extremity range of motion (ROM) was evaluated using a digital goniometer, motor function was assessed using the Active Movement Scale (AMS), and shoulder functions were assessed with the Mallet Scoring System (MSS). Virtual reality treatment had a positive effect on shoulder flexion, forearm pronation, wrist flexion, ROM, and functionality (p < 0.05). There was a significant improvement in shoulder abduction and shoulder external rotation in the CTG (p < 0.05). There was no significant difference in the MSS values of either groups (p > 0.05). As per the AMS, in the NWG, the shoulder internal rotation increased significantly (p < 0.05). Nintendo Wii treatment used in addition to conventional physiotherapy may be effective in increasing upper extremity functions in children with OBPI.
Method for estimating inoculum of the soilborne fungal pathogen Verticillium dahliae in Australian cotton soils
Authors: Young S. , Kirkby K. , Roser S. , Harden S.
Published: February 2021

The ability to quantify inoculum levels of the soilborne fungal pathogen Verticillium dahliae in field soil is essential for understanding potential disease pressure of Verticillium wilt in cotton and for making informed management decisions. Several semi-selective media and techniques for pathogen isolation have been developed for determining the inoculum levels of V. dahliae present in soil. The objective of this study was to gather data on soil plating techniques, media, sampling depths, and times of sampling for the detection and quantification of V. dahliae in field soils, in order to develop a V. dahliae isolation protocol for Australian cotton-growing soils. Two soil plating techniques (dilution plating or ‘wet plating’, and direct spreading by hand or ‘dry plating’) on four semi-selective media (Sorenson’s NP-10, potato dextrose agar, and acidified versions of each) were compared for their efficacy in quantifying soil inoculum as germinated microsclerotia propagules per gram soil. Soil was sampled from three depths to examine the vertical distribution of the fungus and so determine the ideal sampling depth. Field soil sampling was conducted pre-planting and post-harvest to examine differences in inoculum with sampling time. Based on the results of this study, a soil sampling protocol has been developed for Australian cotton farms that includes sampling soil before planting, at a depth of 2–24 cm, and using the direct dry plating method on Sorenson’s NP-10 media.
New holographic Weyl superconductors in Lifshitz gravity
Authors: Lu Jun-Wang , Wu Ya-Bo , Li Huai-Fan , Liao Hao , Zheng Yong , Dong Bao-Ping
Published: February 2021

We build holographic p-wave conductor(insulator)/superconductor models via the numerical method with a new form of Weyl coupling in five-dimensional Lifshitz gravity, and then investigate how the Weyl coupling parameter γ and the Lifshitz scaling parameter z affect the superconductor models. In the conductor/superconductor model, an increase in the Weyl correction (Lifshitz scaling) enhances (inhibits) the superconductor phase transition. Meanwhile, both the Weyl correction (when the Lifshitz parameter is large enough and fixed) and the Lifshitz scaling suppress the growth of the real part of the conductivity. The Weyl correction used here (CB
2) shows weaker effects on the critical value than the previous Weyl correction (CF
2). In the insulator/superconductor model, larger vaules of the Weyl parameter hinder the formation of condensate. However, in increase in the Lifshitz scaling enhances the appearance of condensate. In addition, the calculation suggests that a competitive relation may exist between the Weyl correction and the Lifshitz scaling.
Cleveland Clinic International IV Robotics Summit
Authors: Long Jordan , Calabrese Samuel , Al-jedai Ahmed , Boyd Anthony , Cotugno Michael , Dorn Mitchell , Fanikos John , Freudiger Michael J , Kraemer Irene , Lopez-Cabezas Carmen , Smith Abbi , de Stoppelaar Francine M , Usher Jerry , Yaniv Angela W , Knoer Scott
Published: February 2021

Purpose

The proceedings of an international summit on the current and desired future state of use of robotic systems to compound intravenous (IV) solutions are summarized.

The International IV Robotics Summit was held at the Cleveland Clinic main campus in Cleveland, OH, on April 29 and 30, 2019. The purpose of the summit was 2-fold: (1) to define the current state of robotic IV compounding and (2) to develop a guide for automation companies, pharmacy departments, and drug manufacturers to improve the technology and expand the use of IV robotics in health systems in the future. The first day of the summit included 45-minute presentations by each of the speakers. Each lecturer recounted a different hospital’s experience implementing and using IV robotics. On day 2 of the summit, an expert panel dedicated to mapping the future of IV robotics was convened to determine barriers to widespread adoption of IV robotics in health systems and offer potential solutions to remove these barriers. The expert panel targeted 3 specific audiences: robot manufacturers, drug manufacturers, and fellow pharmacy leaders.

Conclusion

It is the hope of the international faculty that the information that emerged from the summit can be used by others to successfully implement IV compounding robotics in their sterile products areas to maximize patient safety. The summit also served as a call to action for pharmacy leaders, drug manufacturers, and robotic companies to develop a safer, more efficient future for patients by working together to optimize the development and operation of IV robotics.
Improving isobutanol tolerance and titers through EMS mutagenesis in Saccharomyces cerevisiae
Authors: Su Yide , Shao Wenju , Zhang Aili , Zhang Weiwei
Published: February 2021

Improving yeast tolerance toward isobutanol is a critical issue enabling high-titer industrial production. Here, we used EMS mutagenesis to screen Saccharomyces cerevisiae with greater tolerance toward isobutanol. By this method, we obtained EMS39 with high-viability in medium containing 16 g/L isobutanol. Then, we metabolically engineered isobutanol synthesis in EMS39. About 2μ plasmids carrying PGK1p-ILV2, PGK1p-ILV3 and TDH3p-cox4-ARO10 were used to over-express ILV2, ILV3 and ARO10 genes, respectively, in EMS39 and wild type W303-1A. And the resulting strains were designated as EMS39-20 and W303-1A-20. Our results showed that EMS39-20 increased isobutanol titers by 49.9% compared to W303-1A-20. Whole genome resequencing analysis of EMS39 showed that more than 59 genes had mutations in their open reading frames or regulatory regions. These 59 genes are enriched mainly into cell growth, basal transcription factors, cell integrity signaling, translation initiation and elongation, ribosome assembly and function, oxidative stress response, etc. Additionally, transcriptomic analysis of EMS39-20 was carried out. Finally, reverse engineering tests showed that overexpression of CWP2 and SRP4039 could improve tolerance of S.cerevisiae toward isobutanol. In conclusion, EMS mutagenesis could be used to increase yeast tolerance toward isobutanol. Our study supplied new insights into mechanisms of tolerance toward isobutanol and enhancing isobutanol production in S. cerevisiae.