bluuebunny/crossref_metadata_2025 huggingface dataset:
Empowering Commercial Vehicles through Data-Driven Methodologies
Authors: Bethaz Paolo , Cavaglion Sara , Cricelli Sofia , Liore Elena , Manfredi Emanuele , Salio Stefano , Regalia Andrea , Conicella Fabrizio , Greco Salvatore , Cerquitelli Tania
Published: September 2021

In the era of “connected vehicles,” i.e., vehicles that generate long data streams during their usage through the telematics on-board device, data-driven methodologies assume a crucial role in creating valuable insights to support the decision-making process effectively. Predictive analytics allows anticipation of vehicle issues and optimized maintenance, reducing the resulting costs. In this paper, we focus on analyzing data collected from heavy trucks during their use, a relevant task for companies due to the high commercial value of the monitored vehicle. The proposed methodology, named TETRAPAC, offers a generalizable approach to estimate vehicle health conditions based on monitored features enriched by innovative key performance indicators. We discussed performance of TETRAPAC in two real-life settings related to trucks. The obtained results in both tasks are promising and able to support the company’s decision-making process in the planning of maintenance interventions.
Energy Savings Results from Small Commercial Building Retrofits in the US
Authors: Sherman Rachael , Naganathan Hariharan , Parrish Kristen
Published: September 2021

Small commercial buildings, or those comprising less than 50,000 square feet of floor area, represent 94% of U.S commercial buildings by count and consume approximately 8% of the nation’s primary energy; as such, they represent a largely unexploited opportunity for energy savings. Small commercial buildings also represent a large economic market—the National Institute of Building Sciences (NIBS) estimated the small commercial retrofit market at USD 35.6 billion. Despite the prominence of small commercial buildings and the economic opportunity for energy retrofits, many energy efficiency programs focus on large commercial buildings, and create efficiency solutions that do not meet the needs of the small commercial market. This paper presents an analysis of 34 small commercial case study projects that implemented energy efficiency retrofits. This paper contributes to the existing building retrofit body of knowledge in the following ways: (1) it identifies the decision criteria used by small commercial building stakeholders that decided to complete an energy retrofit; (2) it identifies the most commonly implemented efficiency measures in small commercial buildings, and discusses why this is the case; and (3) it provides empirical evidence about the efficacy of installing single energy efficiency measures (EEMs) compared to packages of EEMs in small commercial buildings by reporting verified energy savings. To the authors’ knowledge, this paper is the first to catalog decision criteria and energy savings for the existing small commercial buildings market, and this research illustrates that small commercial building decision-makers seem most motivated to retrofit their spaces by energy cost savings and operational concerns. Furthermore, small commercial building decision-makers opted to implement single-system retrofits in fifteen (15) of the thirty-four cases studied. Finally, this research documents the improved savings, in the small commercial buildings market, associated with a more integrated package of EEMs compared to a single-system approach, achieving approximately 10% energy savings for a single-system approach and more than 20% energy savings for integrated approaches. These savings translate to CO2 savings of 1,324,000 kgCO2/year to 2,647,000 kgCO2/year, respectively, assuming small commercial buildings are retrofit at a rate of 0.95% of the stock annually.
Modular Multilevel Converters for Large-Scale Grid-Connected Photovoltaic Systems: A Review
Authors: Alotaibi Saud , Darwish Ahmed
Published: September 2021

The use of photovoltaic (PV) systems as the energy source of electrical distributed generators (DG) is gaining popularity, due to the progress of power electronics devices and technologies. Large-scale solar PV power plants are becoming the preferable solution to meet the fast growth of electrical energy demand, as they can be installed in less than one year, as compared to around four years in the case of conventional power plants. Modular multilevel inverters (MMIs) are the best solution to connect these large-scale PV plants to the medium-voltage (MV) grid, due to their numerous merits, such as providing better power quality, having higher efficiency, providing better reliability, and their scalability. However, MMIs are still progressing and need some improvement before they can be implemented safely in the industrial, medium, and high voltage networks. The main purpose of this paper is to review the present MMIs topologies when used in PV applications. The review aims to present a comprehensive study of the various recent submodule circuits associated with MMI topologies. Maximum power point tracking (MPPT) control schemes for PV inverters will be explored extensively. Then, the different control strategies of PV MMIs will be presented and compared to give a holistic overview of the submodules balancing techniques, ranges, and capabilities under balanced and unbalanced grid conditions. In addition, the paper will discuss the future of PV MMIs systems in electricity networks.
Multi-Parameter Optimization of Efficiency, Capital Cost and Mass of Ferris Wheel Turbine for Low Wind Speed Regions
Authors: Adeyeye Kehinde A. , Ijumba Nelson , Colton Jonathan S.
Published: September 2021

The design and development of wind turbines in low-wind-speed areas involves several technical and financial challenges related to maximizing conversion efficiency and minimizing cost. Unfortunately, much of the African continent is dominated by low-wind-speed resources. In this study, a multi-parameter optimization method is used to explore the design of a novel Ferris wheel wind turbine (FWT) technology, which has an 800-kW generation capability. We used the tip speed ratio, lift-to-drag ratio and power coefficient to determine the optimal efficiency by varying the number of blades and rim diameters. The capital cost estimates, as affected by rim diameter and the number of blades, are presented. This paper studies FWTs at their rated wind speeds because wind turbines have their maximum performance at the rated wind speeds, and this allows one to observe the effects of changing the rim diameter and the number of blades without the need to consider the location of the turbine. The results show that reducing the number of spokes by half (from 64 to 32) on the four rim diameters studied decreases the efficiency by less than 0.19%, while reducing the acquisition cost by 42%, installation cost by 42% and mass by 28%. Reducing the number of spokes to a quarter (i.e., from 32 to 16) decreases the efficiency by less than 0.31%, reduces the acquisition and installation costs by 36% and 35.5%, respectively, and the mass by 19.2%, of the four rim diameters studied. The reduction of the number of blades has a significant effect on the efficiency and capital cost with varying rim diameters. This paper shows the potential for Ferris-wheel-based wind turbines for low-wind-speed conditions, such as those that prevail in parts of Africa.
A Novel Single-Inductor Bipolar-Output DC/DC Boost Converter for OLED Microdisplays
Authors: Casallas Ingrid , Urbina Robert , Paez-Rueda Carlos-Ivan , Correa-Flórez Carlos Adrián , Vuelvas José , Parraga Manuel , Hay Abdel-Karim , Fajardo Arturo , Perilla Gabriel
Published: September 2021

In this paper, a novel SIBO (Single-Inductor Bipolar-Output) DC/DC Boost converter is proposed to power OLED (Organic Light-Emitting Diode) microdisplays. The proposed topology merges a conventional SISO (Single-Inductor Single-Output) DC/DC Boost converter and a switched capacitor inverter to produce a SIBO converter without both the cross-regulation effect and the unbalanced output voltages. Moreover, its control circuit and efficiency are almost the same as the conventional SISO Boost converter. Therefore, the novel converter maintains the power density, the small form factor, and the high efficiency of its conventional counterpart. The proposed converter was analyzed under continuous-conduction mode operation using the moving average operator and charge conservation principle. As a result, the authors proposed an equation set with the main averages and ripples of the circuit variables expressed as analytical functions of the circuit components, the input voltage, and the duty cycle. Both the functionality of the proposed converter and the accuracy of the developed equation set were analyzed by extensive simulations. The simulation performed using ideal components was characterized by a mean absolute percentage error of 0.774% with a standard deviation of 1.566%. These results confirm the high accuracy of the proposed equation set. Furthermore, the non-ideal model simulation confirms the functionality of the proposed converter in “real” operation conditions. Under simulation with non-ideal components, the result statistics were a mean absolute percentage error of 7.36% with a standard deviation of 6.91%. Therefore, the converter design using the proposed ideal model could be a good start point of a converter optimization process based on more complex component models and assisted by computer-aided design tools.
Battery Model Identification Approach for Electric Forklift Application
Authors: da Silva Cynthia Thamires , Dias Bruno Martin de Alcântara , Araújo Rui Esteves , Pellini Eduardo Lorenzetti , Laganá Armando Antônio Maria
Published: September 2021

Electric forklifts are extremely important for the world’s logistics and industry. Lead acid batteries are the most common energy storage system for electric forklifts; however, to ensure more energy efficiency and less environmental pollution, they are starting to use lithium batteries. All lithium batteries need a battery management system (BMS) for safety, long life cycle and better efficiency. This system is capable to estimate the battery state of charge, state of health and state of function, but those cannot be measured directly and must be estimated indirectly using battery models. Consequently, accurate battery models are essential for implementation of advance BMS and enhance its accuracy. This work presents a comparison between four different models, four different types of optimizers algorithms and seven different experiment designs. The purpose is defining the best model, with the best optimizer, and the best experiment design for battery parameter estimation. This best model is intended for a state of charge estimation on a battery applied on an electric forklift. The nonlinear grey box model with the nonlinear least square method presented a better result for this purpose. This model was estimated with the best experiment design which was defined considering the fit to validation data, the parameter standard deviation and the output variance. With this approach, it was possible to reach more than 80% of fit in different validation data, a non-biased and little prediction error and a good one-step ahead result.
A Power Grid Fault Diagnosis Method in the Case of Alarm Information Loss Based on the Top-k Skyline Query Algorithm
Authors: Jin Lei , Chen Qing , Ji Jinjie , Zhou Xiaotong
Published: September 2021

After the failure of the power system, a large amount of alarm information will flood into the dispatching terminal instantly. At the same time, there are inevitable problems, such as the abnormal operation of the protection and the circuit breaker, the lack of alarm information, and so on. This kind of uncertainty problem brings great trouble to the fault diagnosis algorithm. As a data processing algorithm for an uncertain information set, Top-k Skyline query algorithm can eliminate the data points that do not meet the requirements in the information set, and then output the final K results in order. Based on this background, this paper proposes a power grid fault diagnosis method based on the Top-k Skyline query algorithm considering alarm information loss. Firstly, the fault area is determined by using the information of the electrical quantity and switching value. Then, backward reasoning Petri nets are established for the nodes in the fault area to form the data set of fault hypotheses. Then, the Top-k Skyline query algorithm is used to sort the hypotheses and choose the hypothesis with higher reliability. Finally, an IEEE 39-bus system example is given to verify the reliability of the proposed method.
Dynamic Response Characteristics Analysis and Energy, Exergy, and Economic (3E) Evaluation of Dual Loop Organic Rankine Cycle (DORC) for CNG Engine Waste Heat Recovery
Authors: Yao Baofeng , Ping Xu , Zhang Hongguang
Published: September 2021

Frequent fluctuations of CNG engine operating conditions make the waste heat source have uncertain, nonlinear, and strong coupling characteristics. These characteristics are not conducive to the efficient recovery of the DORC system. The systematic evaluation of the CNG engine waste heat source and the comprehensive performance of the DORC system is conducive to the efficient use of waste heat. Based on the theory of internal combustion (IC) engine thermal balance, this paper analyzes the dynamic characteristics of compressed natural gas (CNG) engine waste heat energy under full operating conditions. Then, based on the operating characteristics of the dual loop organic Rankine cycle (DORC) system, thermodynamic models, heat transfer models, and economic models are constructed. The dynamic response characteristics analysis and energy, exergy, and economic (3E) evaluation of the DORC system under full operating conditions are carried out. The results show that the maximum values of net power output, heat exchange area, and the minimum values of EPC (electricity production cost) and PBT (payback time) are all obtained under rated condition, which are 174.03 kW, 25.86 kW, 37.54 kW, 24.76 m2, 0.15 $/kW·h and 3.46 years. Therefore, the rated condition is a relatively ideal design operating point for the DORC system. The research in this paper not only provides a reliable reference for the comprehensive analysis and evaluation of the performance of the DORC system, but also provides useful guidance for the selection of appropriate DORC system design operating points.
Maintaining the Balance of Intestinal Flora through the Diet: Effective Prevention of Illness
Authors: Zhang Li , Zhang Zhenying , Xu Lei , Zhang Xin
Published: September 2021

The human body is home to a complex community of dynamic equilibrium microbiota, including bacteria, fungi, parasites, and viruses. It is known that the gut microbiome plays a crucial role in regulating innate and adaptive immune responses, intestinal peristalsis, intestinal barrier homeostasis, nutrient uptake, and fat distribution. The complex relationship between the host and microbiome suggests that when this relationship is out of balance, the microbiome may contribute to disease development. The brain–gut–microbial axis is composed of many signal molecules, gastrointestinal mucosal cells, the vagus nerve, and blood–brain barrier, which plays an essential role in developing many diseases. The microbiome can influence the central nervous system function through the brain–gut axis; the central nervous system can also affect the composition and partial functions of the gut microbiome in the same way. Different dietary patterns, specific dietary components, and functional dietary factors can significantly affect intestinal flora’s structure, composition, and function, thereby affecting human health. Based on the above, this paper reviewed the relationship between diet, intestinal flora, and human health, and the strategies to prevent mental illness through the dietary modification of intestinal microorganisms.
DNA Damage Response and Cell Cycle Regulation in Pluripotent Stem Cells
Authors: Chen Andy Chun Hang , Peng Qian , Fong Sze Wan , Lee Kai Chuen , Yeung William Shu Biu , Lee Yin Lau
Published: September 2021

Pluripotent stem cells (PSCs) hold great promise in cell-based therapy because of their pluripotent property and the ability to proliferate indefinitely. Embryonic stem cells (ESCs) derived from inner cell mass (ICM) possess unique cell cycle control with shortened G1 phase. In addition, ESCs have high expression of homologous recombination (HR)-related proteins, which repair double-strand breaks (DSBs) through HR or the non-homologous end joining (NHEJ) pathway. On the other hand, the generation of induced pluripotent stem cells (iPSCs) by forced expression of transcription factors (Oct4, Sox2, Klf4, c-Myc) is accompanied by oxidative stress and DNA damage. The DNA repair mechanism of DSBs is therefore critical in determining the genomic stability and efficiency of iPSCs generation. Maintaining genomic stability in PSCs plays a pivotal role in the proliferation and pluripotency of PSCs. In terms of therapeutic application, genomic stability is the key to reducing the risks of cancer development due to abnormal cell replication. Over the years, we and other groups have identified important regulators of DNA damage response in PSCs, including FOXM1, SIRT1 and PUMA. They function through transcription regulation of downstream targets (P53, CDK1) that are involved in cell cycle regulations. Here, we review the fundamental links between the PSC-specific HR process and DNA damage response, with a focus on the roles of FOXM1 and SIRT1 on maintaining genomic integrity.
Intergenerational Narrative Learning to Bridge the Generation Gap in Humanistic Care Nursing Education
Authors: Kuo Yu-Lun , Lee Jian-Tao , Yeh Mei-Yu
Published: September 2021

Background: The development of nursing students’ ability to practice humanistic care is extremely important. Methods: This study explored students’ learning experience when providing humanistic care for older adults with chronic diseases while employing intergenerational narrative learning. An exploratory descriptive qualitative study design was adopted. Results: We analyzed evaluations from 35 students who completed the course, in which intergenerational narrative learning was employed. Evaluations contained open-ended questions that asked students to reflect upon their experiences and describe their perceptions, thoughts, and feelings after the course. Three main themes were revealed by thematic analysis: direct interaction supersedes knowledge in books, the framework for improving humanistic caring, and internalization of the importance of humanistic care in nursing. Conclusion: An awareness of patients’ perspectives inspired the students in their development toward a more profound caring attitude. The intergenerational narrative learning teaching strategy could foster professional and humanistic-centered care in nursing students.
Remote Management of Patients after Total Joint Arthroplasty via a Web-Based Registry during the COVID-19 Pandemic
Authors: Ulivi Michele , Orlandini Luca , Meroni Valentina , D’Errico Mario , Fontana Arianna , Viganò Marco , Mangiavini Laura , D’Anchise Roberto , Parente Franco , Pozzoni Roberto , Sansone Valerio , Zagra Luigi , Peretti Giuseppe M.
Published: September 2021

Background: In 2020, due to the outbreak of the COVID-19 (Coronavirus Disease 2019) pandemic, patients who underwent total joint arthroplasty were not able to undergo the proper postoperative surgical and rehabilitative care. This study aims to evaluate the potential of a web-cloud-based database on patients’ follow-up in extraordinary situations, when a traditional in-person follow-up cannot be warranted. Methods: Patients who underwent joint arthroplasty at our Institute between 21 February and 16 March 2020 were included in the study group and were matched to a similar population undergoing joint arthroplasty in February/March 2019. All patients routinely complete questionnaires before and after treatment, including patient-reported outcome measures such as the Visual Analogues Scale (VAS), Knee/Hip Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS/HOOS-PS) and Short-Form Health Survey (SF-12) for the monitoring of clinical improvements. Results: 56 (study group) and 144 (control group) patients were included in the study. Both groups demonstrated significant improvements at 3 months. HOOS-PS improvement was significantly reduced in the 2020 group compared to 2019 (21.7 vs. 33.9, p < 0.001). This reduction was related to intense physical activities. Similarly, the functional score improvement related to these activities was reduced for patients undergoing knee replacement (8 vs. 10, p < 0.05). Conclusions: The web-based Institute Registry emerged as a meaningful and sensitive tool during an extraordinary situation such as the COVID-19 pandemic to monitor patients’ progression after total joint arthroplasties. Thanks to this tool, it was possible to observe that the prevention of usual postoperative care due to pandemic-related restrictions did not alter the benefits observed after joint replacement surgeries, even if this condition reduced the postoperative improvements in the most burdensome physical activities. A broader use of this kind of tool would improve and potentially reduce the burden and costs of postoperative patients’ monitoring in standard and extraordinary conditions. In addition, the systematic remote collection of data would allow for the identification of relevant differences in clinical outcomes in specific conditions or following the modification of treatment and rehabilitation protocols.
Corporate Social Practices and Firm Financial Performance: Empirical Evidence from France
Authors: Boukattaya Sonia , Omri Abdelwahed
Published: September 2021

The present work aimed to examine the association between Corporate Social performance (CSP) and corporate financial performance (CFP) taking into account corporate social irresponsibility. Here, we used a sample of French non-financial firms listed on SBF 120 between 2011 and 2016. Our findings provided evidence that corporate social responsibility (CSR) and corporate social irresponsibility (CSI) exert opposite effects on the CFP. Using an estimation of the vector autoregressive (VAR) model for panel data, we showed that the CSI has a greater and more lasting impact on CFP than CSR.
Topic Modeling for Amharic User Generated Texts
Authors: Neshir Girma , Rauber Andreas , Atnafu Solomon
Published: September 2021

Topic Modeling is a statistical process, which derives the latent themes from extensive collections of text. Three approaches to topic modeling exist, namely, unsupervised, semi-supervised and supervised. In this work, we develop a supervised topic model for an Amharic corpus. We also investigate the effect of stemming on topic detection on Term Frequency Inverse Document Frequency (TF-IDF) features, Latent Dirichlet Allocation (LDA) features and a combination of these two feature sets using four supervised machine learning tools, that is, Support Vector Machine (SVM), Naive Bayesian (NB), Logistic Regression (LR), and Neural Nets (NN). We evaluate our approach using an Amharic corpus of 14,751 documents of ten topic categories. Both qualitative and quantitative analysis of results show that our proposed supervised topic detection outperforms with an accuracy of 88% by SVM using state-of-the-art-approach TF-IDF word features with the application of the Synthetic Minority Over-sampling Technique (SMOTE) and with no stemming operation. The results show that text features with stemming slightly improve the performance of the topic classifier over features with no stemming.
Successful Eradication of the Asian Longhorn Beetle, Anoplophora glabripennis, from North-Eastern Italy: Protocol, Techniques and Results
Authors: Marchioro Matteo , Faccoli Massimo
Published: September 2021

The Asian Longhorn Beetle (ALB), Anoplophora glabripennis (Coleoptera: Cerambycidae), is an important and extremely polyphagous wood-boring beetle native to Asia. In the 1990s, ALB was accidentally introduced into North America and Europe. In 2009, a large ALB infestation was found in the Veneto Region (north-eastern Italy), in the municipality of Cornuda (Treviso province). Eradication actions were immediately undertaken, based on delimitation of infested and buffer zones, tree visual inspections, felling and chipping of infested trees, trapping protocols, and citizen alerts. A total of 36,361 trees, belonging to 16 genera, were surveyed twice a year over an area of 7594 hectares. In 2020, after 11 years of eradication measures, the ALB population of Cornuda was declared eradicated. Overall, 2361 trees belonging to 8 genera were felled and destroyed, of which 1157 were found to be infested by ALB. This paper describes all the actions carried out and the procedures applied in order to eradicate ALB from north-eastern Italy, providing a useful example for current and future ALB eradication programs.
Bioactivity of Carlina acaulis Essential Oil and Its Main Component towards the Olive Fruit Fly, Bactrocera oleae: Ingestion Toxicity, Electrophysiological and Behavioral Insights
Authors: Rizzo Roberto , Pistillo Marco , Germinara Giacinto Salvatore , Lo Verde Gabriella , Sinacori Milko , Maggi Filippo , Petrelli Riccardo , Spinozzi Eleonora , Cappellacci Loredana , Zeni Valeria , Canale Angelo , Benelli Giovanni
Published: September 2021

Among botanical insecticides based on essential oils (EOs) or their main components, Carlina acaulis EO and the aromatic polyacetylene carlina oxide, constituting more than 90% of its EO, were recently proven to be effective against the larvae and adults of some insect vectors and pests. In this study, the toxicity of C. acaulis EO and carlina oxide were tested on Bactrocera oleae adults using a protein bait formulation. The LC50 values of the C. acaulis EO and carlina oxide were 706 ppm and 1052 ppm, respectively. Electroantennographic (EAG) tests on B. oleae adults showed that both carlina EO and oxide elicited EAG dose-dependent responses in male and female antennae. The responses to the EO were significantly higher than those to carlina oxide, indicating that other compounds, despite their lower concentrations, can play a relevant role. Moreover, Y-tube assays carried out to assess the potential attractiveness or repellency of carlina oxide LC90 to B. oleae adults showed that it was unattractive to both males and females of B. oleae, and the time spent by both sexes in either the control or the treatment arm did not differ significantly. Overall, this study points out the potential use of C. acaulis EO and carlina oxide for the development of green and effective “lure-and-kill” tools.
Iron Replacement Therapy with Oral Ferric Maltol: Review of the Evidence and Expert Opinion
Authors: Schmidt Carsten , Allen Stephen , Kopyt Nelson , Pergola Pablo
Published: September 2021

Iron deficiency is the most common cause of anemia globally and is frequently reported in patients with underlying inflammatory conditions, such as inflammatory bowel disease (IBD) and chronic kidney disease (CKD). Ferric maltol is a new oral iron replacement therapy designed to optimize iron absorption while reducing the gastrointestinal adverse events associated with unabsorbed free iron. Ferric maltol has been studied in clinical trials involving almost 750 adults and adolescents with iron-deficiency anemia associated with IBD, CKD, and other underlying conditions, and it has been widely used in clinical practice. It is approved for the treatment of adults with iron deficiency with or without anemia, independent of the underlying condition, and is commercially available in Europe and the United States. We review the published evidence for ferric maltol, which demonstrates consistent and clinically meaningful improvements in hemoglobin and measures of iron availability (ferritin and transferrin saturation) and shows that it is well-tolerated over long-term treatment for up to 64 weeks—an important consideration in patients with chronic underlying conditions such as IBD and CKD. We believe that ferric maltol is an effective, convenient, and well-tolerated treatment option for iron deficiency and iron-deficiency anemia, especially when long-term management of chronic iron deficiency is required. Writing support was provided by Shield Therapeutics (Gateshead, UK).
Post-Surgical Ablative or Adjuvant Radioiodine Therapy Has No Impact on Outcome in 1–4 cm Differentiated Thyroid Cancers without Extrathyroidal Extension
Authors: De Leo Simone , Trevisan Matteo , Colombo Carla , Gazzano Giacomo , Palazzo Sonia , Vicentini Leonardo , Persani Luca , Fugazzola Laura
Published: September 2021

Whether to conduct remnant ablation or adjuvant radioactive iodine (RAI) therapy in patients with intrathyroidal differentiated thyroid carcinoma (DTC), sized 1.1–4 cm, is debated. We evaluated the impact of RAI on outcome in this category of DTCs. We retrospectively enrolled 308 patients submitted to total thyroidectomy: 198 had tumors sized 1.1–2 cm (Group 1) and 110 of 2.1–4 cm (Group 2). Both groups were divided into patients receiving and not receiving RAI after surgery. RAI+ and RAI− patients did not significantly differ, regarding several clinical and pathological features. Final outcome was defined according to dynamic risk stratification. Remission was observed in the majority of Group 1 and Group 2 patients and outcome did not significantly differ between RAI+ and RAI− patients: respectively, 95.8% vs. 93.7% in Group 1, and 87.7% vs. 86.5% in Group 2. The majority of persistent cases, either RAI+ or RAI−, received therapeutic RAI administration, and about 50% of RAI− cases had an excellent response at final follow up, whereas no RAI+ persistent patients had a beneficial effect. Our findings demonstrate that patients with an intrathyroidal DTC sized 1.1–4 cm do not benefit from RAI. The outcome of these patients remains favorable, and the few patients with persistent diseases can be treated with RAI during follow up.
Prospective Evaluation of a Standardized Screening for Atrial Fibrillation after Ablation of Cavotricuspid Isthmus Dependent Atrial Flutter
Authors: Krisai Philipp , Roten Laurent , Zeljkovic Ivan , Pavlovic Nikola , Ammann Peter , Reichlin Tobias , Auf der Maur Eric , Streicher Olivia , Knecht Sven , Kühne Michael , Osswald Stefan , Novak Jan , Sticherling Christian
Published: September 2021

Aims: We aimed to prospectively investigate the effectiveness of a standardized follow-up for AF-detection after common atrial flutter (cAFL) ablation. Methods: A total of 309 patients after cAFL ablation without known AF, from 5 centers, and at least one completed, standardized follow-up at 3, 6 and 12 months, including a 24 h Holter-electrocardiogram (ECG), were included. The primary outcome was incident atrial fibrillation (AF), or atrial tachycardia (AT). Predictors were investigated by Cox proportional-hazards models. Results: The mean age was 67.9 years; 15.2% were female and the mean CHA2DS2-VASc (Congestive heart failure, Hypertension, Age, Diabetes, Stroke, Vascular disease, Sex category) score was 2.4 points. The great majority of patients (90.3%) were anticoagulated. Over a mean follow-up of 12.2 months with a standardized approach, AF/AT was detected in 73 patients, corresponding to 11.7% at 3 months, 18.4% at 6 months and 28.2% at 12 months of follow-up. AF was found in 64 patients, AT in 9 and both in 2 patients. Occurrence of AF was recorded in 40 (60.6%) patients by Holter-ECG and in the remaining 26 (39.4%) by clinical follow-up only. There was no difference in male versus female (p = 0.08), or in younger versus older patients (p = 0.96) for AF/AT detection. Only coronary artery disease (hazard ratio [95% confidence intervals] 1.03 [1.01–1.05], p = 0.01) was associated with the primary outcome. Conclusions: AF or AT was detected in a large proportion of cAFL patients after cavotricuspid-isthmus (CTI) ablation, using a standardized follow-up over 1 year. This standardized screening can be easily implemented with high patient acceptance. The high proportion of post-ablation AF needs to be taken into consideration when deciding on long-term oral anticoagulation.
Effects of Probiotics, Prebiotics, and Synbiotics on Uremic Toxins, Inflammation, and Oxidative Stress in Hemodialysis Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Nguyen Thi Thuy Uyen , Kim Hyeong Wan , Kim Won
Published: September 2021

The dysbiosis of gut microbiota may cause many complications in patients with end-stage renal disease, which may be alleviated by probiotic, prebiotic, and synbiotic supplementation. The aim of this systematic review and meta-analysis was to assess the effects of these supplementations on circulatory uremic toxins, biomarkers of inflammation, and oxidative stress in hemodialysis patients. We searched the EMBASE, MEDLINE, Web of Science, and Cochrane Library databases until 8 August 2021. Randomized controlled trials evaluating adult patients receiving hemodialysis were included. The pooled results from 23 studies with 931 hemodialysis patients indicated that interventions significantly decreased the circulating levels of p-cresyl sulfate (standardized mean difference (SMD): 0.38; 95% CI: −0.61, −0.15; p = 0.001), endotoxins (SMD: −0.58; 95% CI: −0.99, −0.18; p = 0.005), malondialdehyde (SMD: −1.16; 95% CI: −1.81, −0.52; p = 0.0004), C-reactive proteins (CRP) (SMD: −0.61; 95% CI: −0.99, −0.23; p = 0.002), and interleukin 6 (SMD: −0.92; 95% CI: −1.51, −0.33; p = 0.002), and improved the total antioxidant capacity (SMD: 0.89; 95% CI: 0.49, 1.30; p < 0.0001) and glutathione (SMD: 0.40; 95% CI: 0.14, 0.66; p = 0.003) when compared to the placebo group. Our results suggest that treatment with probiotics, prebiotics, and synbiotics may help alleviate uremic toxin levels, oxidative stress, and the inflammatory status in hemodialysis patients.
Should We Quantify Valvular Calcifications on Cardiac CT in Patients with Infective Endocarditis?
Authors: Chevance Virgile , Valter Remi , Nouri Mohamed Refaat , Sifaoui Islem , Moussafeur Amina , Lepeule Raphael , Bergoend Eric , Mule Sebastien , Tacher Vania , Huguet Raphaelle , Folliguet Thierry , Canoui-Poitrine Florence , Lim Pascal , Deux Jean-François
Published: September 2021

Background: Evaluate the impact of valvular calcifications measured on cardiac computed tomography (CCT) in patients with infective endocarditis (IE). Methods: Seventy patients with native IE (36 aortic IE, 31 mitral IE, 3 bivalvular IE) were included and explored with CCT between January 2016 and April 2018. Mitral and aortic valvular calcium score (VCS) were measured on unenhanced calcium scoring images, and correlated with clinical, surgical data, and 1-year death rate. Results: VCS of patients with mitral IE and no peripheral embolism was higher than those with peripheral embolism (868 (25–1725) vs. 6 (0–95), p < 0.05). Patients with high calcified mitral IE (mitral VCS > 100; n = 15) had a lower rate of surgery (40.0% vs.78.9%; p = 0.03) and a higher 1-year-death risk (53.3% vs. 10.5%, p = 0.04; OR = 8.5 (2.75–16.40) than patients with low mitral VCS (n = 19). Patients with aortic IE and high aortic calcifications (aortic VCS > 100; n = 18) present more frequently atypical bacteria on blood cultures (33.3% vs. 4.8%; p = 0.03) than patients with low aortic VCS (n = 21). Conclusion: The amount of valvular calcifications on CT was associated with embolism risk, rate of surgery and 1-year risk of death in patients with mitral IE, and germ’s type in aortic IE raising the question of their systematic quantification in native IE.
Impact of Preoperative Total Knee Arthroplasty on Radiological and Clinical Outcomes of Spinal Fusion for Concurrent Knee Osteoarthritis and Degenerative Lumbar Spinal Diseases
Authors: Kim Hong Jin , Yang Jae Hyuk , Chang Dong-Gune , Suh Seung Woo , Jo Hoon , Kim Sang-Il , Song Kwang-Sup , Cho Woojin
Published: September 2021

Concurrent knee osteoarthritis (KOA) and degenerative lumbar spinal disease (LSD) has increased, but the total knee arthroplasty (TKA) effect on degenerative LSD remains unclear. The aim of this study was to retrospectively analyze to compare radiological and clinical outcomes between spinal fusion only and preoperative TKA with spinal fusion for the patients with concurrent KOA and degenerative LSD. A total of 72 patients with concurrent KOA and degenerative LSDs who underwent spinal fusion at less than three levels were divided in two groups: non-TKA group (n = 50) and preoperative TKA group (n = 22). Preoperative lumbar lordosis (LL) was significantly lower in the preoperative TKA group than the non-TKA group (p < 0.05). Significantly higher preoperative pelvic incidence (PI), PI/LL mismatch, and pelvic tilt (PT) occurred in preoperative TKA group than non-TKA group (all p < 0.05). There was significant improvement of postoperative Oswestry Disability Index and leg Visual Analog Scale in the preoperative TKA group (all p < 0.01). Preoperative TKA could be a benefit for in proper correction of sagittal spinopelvic alignment by spinal fusion. Therefore, preoperative TKA could be considered a preceding surgical option for patients with severe sagittal spinopelvic parameters in concurrent KOA and degenerative LSD.
Left Atrial Fibrosis after Single Shot Guided Pulmonary Vein Isolation
Authors: Mathew Shibu , Saboukh Islam , Singh Parminder , Fries Bastian , Johnson Victoria , Schneider Nikita , Fraebel Christian , Chasan Ritvan , Hamm Christian W. , Schmitt Jörn
Published: September 2021

Cryoballoon (CB)-based pulmonary vein isolation (PVI) is an effective treatment modality for patients with atrial fibrillation (AF) with encouraging acute and long-term outcome data. However, the size of collaterally created lesion sets adjacent to the pulmonary veins (PVs) remains unclear, especially when CB ablation is performed with individualized time-to-isolation (TTI) protocols. This study seeks to investigate the extension of lesions at the posterior wall and the roof of the left atrium (LA). Thirty patients with paroxysmal or persistent AF underwent ablation with a fourth-generation CB. The individual freeze-cycle duration was set at TTI + 120 s. A total of 120 PVs were identified, and all were successfully isolated. A three-dimensional electroanatomical high-density (HD) mapping of the LA was performed in every patient before and after PVI. The surface areas of the posterior wall and LA roof were measured and compared with lesion extension after PVI. After CB ablation, 65.6 ± 16.9% of the posterior wall and 75.4 ± 18.4% of the LA roof remained unablated. In addition, non-antral lesion formation was observed in every patient in at least one PV. After CB ablation, anterior antral parts of the superior PVs showed the greatest unablated areas compared with the other antral areas. HD re-mapping after CB-based PVI demonstrated that major regions of the posterior wall and roof remained electrically normal and unaffected. Unablated antral areas were localized predominantly in the anterior segments of the superior PVs and may be partly responsible for AF recurrence.
A Network Analysis of Drug Combinations Associated with Acute Generalized Exanthematous Pustulosis (AGEP)
Authors: Martinez-De la Torre Adrian , van Weenen Eva , Kraus Mathias , Weiler Stefan , Feuerriegel Stefan , Burden Andrea M.
Published: September 2021

Acute generalized exanthematous pustulosis (AGEP) is a rare skin adverse drug reaction. The pathophysiology and causative drugs associated with AGEP are poorly understood, with the majority of studies in AGEP focusing on a single-drug-outcome association. We therefore aimed to explore and characterize frequently reported drug combinations associated with AGEP using the WHO pharmacovigilance database VigiBase. In this explorative cross-sectional study of a pharmacovigilance database using a data-driven approach, we assessed individual case safety reports (ICSR) with two or more drugs reported to VigiBase. A total of 2649 ICSRs reported two or more drugs. Cardiovascular drugs, including antithrombotics and beta-blockers, were frequently reported in combination with other drugs, particularly antibiotics. The drug pair of amoxicillin and furosemide was reported in 57 ICSRs (2.2%), with an O/E ratio of 1.3, and the combination of bisoprolol and furosemide was recorded 44 times (1.7%), with an O/E ratio of 5.5. The network analysis identified 10 different communities of varying sizes. The largest cluster primarily consisted of cardiovascular drugs. This data-driven and exploratory study provides the largest real-world assessment of drugs associated with AGEP to date. The results identify a high frequency of cardiovascular drugs, particularly used in combination with antibiotics.
The Impact of a Preterm Baby Arrival in a Family: A Descriptive Cross-Sectional Pilot Study
Authors: Jiménez-Palomares María , Fernández-Rejano María , Garrido-Ardila Elisa María , Montanero-Fernández Jesús , Oliva-Ruiz Petronila , Rodríguez-Mansilla Juan
Published: September 2021

Background: The rate of premature births is increasing every day, with an estimated 15 million premature babies born worldwide each year. When a child is born prematurely, he or she is transferred to a Neonatal Intensive Care Unit (NICU), requiring special care on an ongoing basis. The admission of the newborn to these units can negatively affect the family routine as it generates changes and requires adaptation to new roles. Objectives: The objective of the present study was to understand the effect of the arrival of a premature baby on the family, based on the parents’ perception. Methods: A cross-sectional descriptive observational study conducted by means of a self-administered online ad-hoc questionnaire which collected information related to the situation of the relatives of premature infants in the region of Extremadura (Spain). The questionnaire consisted of a total of 35 questions, divided into three sections: ‘family environment’, ‘stay in hospital’ and ‘return home’. Results: Among the 53 responses obtained from fathers and mothers, 44 were from mothers. 53.6% of the respondents felt a delay in the acquisition of their parental role and 86.8% were afraid for their baby. During hospital stay, most of the parents had to modify their routines (94.3%), 69.8% suffered from sleep disturbances, 84.9% changed their eating habits and 88.5% referred to loss of time for themselves. Once at home, the time it took to recover their family normality ranged from 4 to 11 months, while 84.9% of respondents neglected their personal appearance and more than half had to give up or reduce their working hours. Conclusion: The arrival of a premature baby has a strong impact on the parents’ family environment, altering their daily routines and occupations both in hospital and at home. If preterm care programmes take into account these possible occupational imbalances, it will not only meet the needs of the parents but also provide family-centred care.
Pregnancy Outcomes among Women with Graves’ Hyperthyroidism: A Retrospective Cohort Study
Authors: Harn-a-morn Panwad , Dejkhamron Prapai , Tongsong Theera , Luewan Suchaya
Published: September 2021

Objective: The primary objectives of this study are to compare the rates of preterm birth; fetal growth restriction and low birth weight between the following groups: (1) pregnant women treated for thyrotoxicosis and low-risk pregnancies; (2) between pregnant women with thyrotoxicosis with no need of medication and low-risk pregnancies; and (3) between those treated with MMI and PTU. Methods: The medical records of singleton pregnancies with thyrotoxicosis were comprehensively reviewed. Low-risk pregnancies matched for age and parity were randomly recruited as controls. The obstetric outcomes were compared between both groups; the outcomes of various subgroups of the thyrotoxicosis group were also compared. Results: A total of 408 pregnant women with thyrotoxicosis were recruited. Compared with the controls; the women of the thyrotoxicosis group had significantly higher rates of low birth weight (LBW) (23.7% vs. 17.7%; p: 0.036), preterm birth (19.3% vs. 12.3%; p: 0.007), preeclampsia (8.5% vs. 4.4%; p: 0.019) and cesarean section (21.5% vs. 16.0%; p: 0.046). In the thyrotoxicosis group; 67; 127; and 158 patients were treated with MMI; PTU and no anti-thyroid drug (ATD), respectively. All obstetric outcomes were comparable between the women treated with PTU and those with MMI; and between the controlled and uncontrolled groups. However, women who needed ATD had significantly higher rates of LBW and preterm birth than those without medications. Conclusions: Thyrotoxicosis, whether treated or not needing ATDs, was significantly associated with an increased risk of adverse pregnancy outcomes. Also, active disease, indicated by the need for ATD significantly increased the risk of such adverse outcomes; whereas the patients treated with MMI or PTU had comparable adverse outcomes.
Association of Novel Advanced Glycation End-Product (AGE10) with Complications of Diabetes as Measured by Enzyme-Linked Immunosorbent Assay
Authors: Bronowicka-Szydełko Agnieszka , Krzystek-Korpacka Małgorzata , Gacka Małgorzata , Pietkiewicz Jadwiga , Jakobsche-Policht Urszula , Gamian Andrzej
Published: September 2021

Advanced glycation end-products (AGEs) contribute to vascular complications and organ damage in diabetes. The unique AGE epitope (AGE10) has recently been identified in human serum using synthetic melibiose-derived AGE (MAGE). We aimed at developing ELISA for AGE10 quantification, determining whether AGE10 is present in diabetic patients (n = 82), and evaluating its association with diabetic complications. In a competitive ELISA developed, the reaction of synthetic MAGE with anti-MAGE was inhibited by physiological AGE10 present in serum. In this assay, new murine IgE anti-MAGE monoclonal antibodies, which do not recognize conventional AGEs, a synthetic MAGE used to coat the plate, and LMW-MAGE (low molecular mass MAGE) necessary to plot a standard curve were used. AGE10 was significantly higher in patients with microangiopathy, in whom it depended on treatment, being lower in patients treated with aspirin. AGE10 levels were positively correlated with estimated glomerular filtration rate (eGFR) and negatively with creatinine. As a marker of stage ≥3 chronic kidney disease or microangiopathy, AGE10 displayed moderate overall accuracy (respectively, 69% and 71%) and good sensitivity (82.6% and 83.3%) but poor specificity (58.1% and 57.8%). In conclusion, newly developed immunoassay allows for AGE10 quantification. AGE10 elevation is associated with microangiopathy while its decrease accompanies stage ≥3 chronic kidney disease.
Prehabilitation Program in Elderly Patients: A Prospective Cohort Study of Patients Followed Up Postoperatively for Up to 6 Months
Authors: Malot Claire , Durand-Bouteau Astrid , Barizien Nicolas , Bizard Antoine , Kennel Titouan , Fischler Marc , Minnella Enrico , Le Guen Morgan
Published: September 2021

The preoperative period may be an opportune period to optimize patients’ physical condition with a multimodal preoperative program. The impact of a “prehabilitation” program on elderly patients is discussed. This mono-center observational cohort study included consecutively 139 patients planned for major abdominal and thoracic surgery, with 44 in the control group (age < 65) and 95 in the elderly group (age > 65). All patients followed a “prehabilitation” program including exercise training, nutritional optimization, psychological support, and behavioral change. Seventeen patients in the control group and 45 in the elderly group completed the study at six months. The 6-minute walk test (6 MWT) increased in both groups from the initial evaluation to the last (median value of 80 m (interquartile range 51) for those under 65 years; 59 m (34) for the elderly group; p = 0.114). The 6 MWT was also similar after one month of prehabilitation for both populations. The rate of postoperative complications was similar in the two groups. Prehabilitation showed equivalence in patients over 65 years of age compared to younger patients in terms of increase in functional capabilities and of postoperative evolution. This multimodal program represents a bundle of care that can benefit a frailer population.