bluuebunny/crossref_metadata_2025 huggingface dataset:
Nonlinear model predictive acceleration synchronization technique for rigid-model-based tracking control of multi-DOF flexible systems
Authors: Yaqubi S , Homaeinezhad MR
Published: April 2020

In this paper, the problem of stabilization and tracking control of uncertain flexible multivariable continuum mechanism systems with additional appendage considering boundedness of undesired vibrational effects are investigated. It is proposed that rather than controlling the entire dynamical system through installation of additional actuators on appendage, it is more desirable to stabilize the core system while considering undesired vibrational effect in the appendage as optimization cost. To this end, the nonlinear programming problem corresponding to a predictive control scheme is presented based on a cost defined according to magnitude of accelerations of undesired vibrations in the appendage. Stabilization of control algorithm is conducted based on demonstration of existence of feasible Lyapunov functions. Candidate Lyapunov functions are defined based on sliding functions analysis. The associated sliding functions are defined for core subsystems which correspond to degrees of freedom of dynamical system that are associated with reference signals. Undesired vibrations caused by other degrees of freedom corresponding to appendage are considered as segments of control cost in the optimization problem. To ensure the feasibility of control model in real-time applications, the control algorithm is obtained in discrete-time basis. Based on investigation of monotonically decreasing Lyapunov functions and expression of sliding functions as a combination of dynamical terms, reference inputs and control input terms, stabilizing constraints of closed-loop system are calculated. Similarly, based on combination of sliding surfaces with considered control and vibrational constraints, additional constraints for boundedness of vibrational terms in nonlinear programming problem are obtained. Numerical comparisons with a sliding control algorithm for core mechanical system and a reaching law method indicate improvements regarding reduction of undesired vibrational effects in appendage. Furthermore, regulation of appendage dynamics is conducted without installation of additional actuators, which reduces the implementation cost in comparison with a full-control scheme for core system and appendage.
Studies on cold metal transfer welding of aluminium alloy 6061-T6 using ER 4043
Authors: Pramod R , Shanmugam N Siva , Krishnadasan CK
Published: April 2020

Aluminium alloy 6061-T6 is utilized in aerospace industry for developing pressure vessel liner. Cold metal transfer is a promising welding process used in fabricating aluminium structures. The present work is focussed to achieve an optimum welding parameter for joining a 3.5-mm thick pressure vessel and to examine the mechanical properties and metallurgical nature of the weldment. The welded joint was evaluated as defect free using radiography test. The joint efficiency (66.61%) and measured microhardness of weldment (59.78 HV) exhibited promising results. The effect of grain coarsening in the heat affected zone (HAZ) and weld zone is attributed to the thermal gradients during welding. Dissipation of small amounts of strengthening elements Si and Mg during welding leads to reduction in mechanical properties. X-ray diffraction peaks revealed the presence of intermetallic Al–Si and Fe–Si in the weld zone. Fractography examination confirms the ductile type of failure in the fractured surface of the tensile samples.
Impact of diabetes as a risk factor in patients undergoing subcutaneous implantable cardioverter defibrillator implantation: A single-centre study
Authors: Kaya Elif , Siebermair Johannes , Vonderlin Nadine , Hadjamu Nino , Azizy Obayda , Rassaf Tienush , Wakili Reza
Published: April 2020

Introduction:

Patients with diabetes mellitus are known to carry an increased risk for surgical site infections and perioperative complications. The subcutaneous implantable cardioverter defibrillator is an established treatment option in patients at risk for sudden cardiac death especially with an increased risk for infection over time.

Methods and Results:

Forty-eight patients (mean age = 55.0 ± 21.3 years, 31.3% patients with diabetes mellitus, 75% male) who underwent consecutive subcutaneous implantable cardioverter defibrillator surgery between February 2016 and May 2019 were retrospectively analysed. Overall adverse events including relevant bleeding complications, any surgical wound problems and infections requiring reoperation or device malfunction were evaluated as primary combined safety endpoint. Patients with diabetes mellitus tended to be older with a higher body mass index compared to non-diabetes mellitus. Procedure duration and postsurgery hospital days were not different in diabetes mellitus versus non-diabetes mellitus patients. Analysis of the primary combined endpoint showed no significant difference but a trend towards higher event rates in the diabetes mellitus group (diabetes mellitus vs non-diabetes mellitus: 20% vs 12.1%, p = 0.119).

Conclusion:

Diabetes mellitus is a frequent and relevant variable in patients undergoing subcutaneous implantable cardioverter defibrillator implantation represented by 31.3% in this consecutive cohort. Our results suggest that diabetes mellitus is not associated with a prolonged hospital stay or increased rate of periprocedural adverse events.
Replacing LNT: The Integrated LNT-Hormesis Model
Authors: Kaminski Cara Y. , Dattoli Michael , Kaminski Joseph M.
Published: April 2020

Many scientists and regulators utilize the linear no-threshold (LNT) relationship to estimate the likelihood of carcinogenesis. The LNT model is incorrect and was adopted based upon false pretenses. The use of the model has been corrupted by many to claim that even the smallest ionizing radiation dose may initiate carcinogenesis. This claim has resulted in societal harm.
Pregnancy complications in women of Russian, Somali, and Kurdish origin and women in the general population in Finland
Authors: Bastola Kalpana , Koponen Päivikki , Härkänen Tommi , Luoto Riitta , Gissler Mika , Kinnunen Tarja I
Published: April 2020

Objective:

We compared the prevalence of gestational diabetes and hypertensive disorders in the most recent pregnancy among women of Russian, Somali, and Kurdish origin and women in the general population in Finland.

Methods:

The study groups were selected from population-based samples of 18- to 64-year-old women. The women were of Russian (n = 318), Somali (n = 583), and Kurdish (n = 373) origin or from the general population (n = 243), and had given birth in Finland between 2004 and 2014. The data were obtained from the National Medical Birth Register and the Hospital Discharge Register. Data on gestational diabetes and hypertensive disorders were extracted based on relevant International Classification of Diseases, Tenth Revision codes. The main statistical methods were logistic regression analyses adjusted for age, parity, body mass index, socioeconomic status, and smoking.

Results:

The prevalence of gestational diabetes was 19.1% in Kurdish, 14.4% in Somali, 9.3% in Russian, and 11.8% in the general population. The prevalence of hypertensive disorders was 5.4% in the general population, 3.8% in Somali, 3.1% in Kurdish, and 1.7% in Russian. When adjusted for confounders, Kurdish women had two-fold odds for gestational diabetes (odds ratio = 1.98; 95% confidence interval = 1.20–3.32) compared with the general population, but the odds for hypertensive disorders did not differ between groups.

Conclusion:

Women of Kurdish origin were more likely to develop gestational diabetes. Studies with larger samples are required to confirm these findings to develop prevention strategies for later development of type 2 diabetes. Future research including other migrant groups is recommended to identify differences in pregnancy complications among the women in migrant and general population.
Peace journalism in times of ‘war risks’: Coverage of the hydrocarbons conflict in Turkish Cypriot and Greek Cypriot newspapers
Authors: Ciftcioglu Vasvi , Shaw Ibrahim Seaga
Published: April 2020

The Mediterranean island of Cyprus, the last divided country in Europe, faced a grave risk of plunging into war in September 2011. The reason behind this danger was represented as the confrontation over the excavation of hydrocarbon reserves found in the Eastern Mediterranean Sea. The main goal of this article is to explore the extent to which peace journalism was practiced, or not, by analysing the front-page stories of the prominent Turkish Cypriot and Greek Cypriot newspapers about this conflict. A review of peace journalism research reveals that researchers have mainly focused on war reporting. In order to address this deficit in peace journalism research, this article focuses on a case study where there was a risk for military confrontation. The combined sample drawn from six newspapers in the respective communities indicates a strong preference towards war journalism. As the analysis further shows, the newspapers from both sides failed to discuss peaceful solutions to the hydrocarbons conflict and they also failed to discuss the negative repercussions of a possible war related to the hydrocarbons conflict.
Handheld ultrasound in training – The future is getting smaller!
Authors: Wilkinson Jonathan N , Saxhaug Lars Mølgaard
Published: April 2020

Traditional ultrasound teaching is normally delivered using large, costly and often quite advanced cart-based systems. These carts are often large systems on wheels, usually limited to the departments that own them i.e. clinics, wards or radiology. Portability has been further improved by the development of laptop style systems, which are easier to wheel in-between patients/departments. In our experience and anecdotally, many of these systems can be intimidating to the novice and can lead to early attrition or poor uptake of ultrasound into clinical practice. Carts can also restrict the amount of training deliverable to practitioners, as they are limited in number due to cost and can take quite some time to boot up, reducing convenience.

This dogma is being progressively changed with the advent of smaller handheld devices, some clearly within the financial grasps of most practitioners, and even to the point of medical schools offering students their own personal device.1,2 This relative inexpensiveness can lead to the purchase of these devices for novelty and convenience, over need. Obvious caution is needed in these circumstances, but with increased ease of purchase, better availability and inbuilt simplicity, ultrasound learning can be seamlessly integrated into day-to-day practice.

This review discusses how one of the most disruptive innovations in modern medicine is changing ultrasound from a classic imaging modality to become integrated as the fifth pillar of clinical examination, and how these new devices can serve as springboards to more advanced ultrasound training. In fact, within what has become a bigger area of clinical examination, things are getting smaller.
Usefulness of the advanced monoenergetic image reconstruction in dual-energy computed tomography for detecting the perforator vein of lower extremity varix
Authors: Matsumae Hidekazu , Nakagawa Motoo , Ozawa Yoshiyuki , Asano Miki , Shimohira Masashi , Shibamoto Yuta
Published: April 2020

Background

Identification of the perforator vein is important for treating lower extremity varix.

Purpose

We evaluated the ability of 40-keV advanced monoenergetic images to depict the perforator vein in patients with lower extremity varix.

Material and Methods

Thirty-three patients aged 52–86 years were examined with contrast-enhanced dual-energy computed tomography (CT) and advanced virtual monoenergetic images (40 keV) were reconstructed. For evaluating enhancement of a lower extremity vein and the difference in CT number between the vein and muscle, we set the region of interest on the popliteal vein (PV). We also evaluated the ability of 100-kVp and 40-keV volume-rendering (VR) images to depict the perforator veins.

Results

The mean CT numbers of the PV at 100 kVp and 40 keV were 113 ± 16 and 321 ± 63 HU, respectively ( P < 0.01). In 40-keV transverse images of 33 patients, 84 of the perforator veins were detected. In those 84 veins, 70 (83%) were depicted and 14 (17%) were not depicted on VR images that were reconstructed from 40-keV transverse images. At 100 kVp, 10 (12%) of the perforator veins could be depicted in VR images because the muscles buried them or the PVs were blurred due to insufficient enhancement.

Conclusion

The advanced monoenergetic reconstruction technique is useful for evaluating the perforator vein in patients with lower extremity varix.
A Misdiagnosed Case of Double Outlet Right Atrium Associated With Hypoplastic Right Ventricle
Authors: Raso Irene , Quarti Andrea , Chessa Massimo , Basile Domenica Paola , Saracino Antonio , D’Aiello Angelo Fabio , Raineri Claudia , Carminati Mario , Giamberti Alessandro
Published: April 2020

Double outlet right atrium (DORA) is a rare congenital heart disease in which the right atrium opens into both ventricles. The reduced leftward motion of the interventricular septum causes a malalignment between the atrial and the ventricular septum at the cardiac crux, which is the pathognomonic feature of this heart defect. We describe a case of significant exertional desaturation in an adult patient who was diagnosed with DORA, restrictive right ventricle, and anomalous tricuspid valve. Subsequently, the patient underwent one-and-a-half ventricular palliation.
Single-Stage Repair of Interrupted Aortic Arch With Aortopulmonary Window and Bovine-Type Aortic Arch Complicated by Left Subclavian Artery Origin Stenosis—A Case Report
Authors: Patel Agastya , Mohanty Smruti Ranjan , Kundan Simran , Kulkarni Snehal , Rao Suresh G.
Published: April 2020

An aortopulmonary window is known to be associated in 5% of interrupted aortic arch cases. The combination of these lesions with a bovine-type aortic arch is much more uncommon. We report its embryological explanation and successful single-stage surgical repair in a three-month-old infant.
Improvement in Protein-Losing Enteropathy in a Patient With Fontan Circulation After Cardiac Rehabilitation and Prescriptive Exercise
Authors: Broda Christopher R. , Castellanos Daniel A. , Pham Tam Dan N. , Dreyer W. Jeff , Opina Angeline D. , Ermis Peter R. , Lam Wilson W.
Published: April 2020

Fontan-associated protein-losing enteropathy is difficult to treat and associated with poor prognosis. Cardiac rehabilitation and exercise are thought to have beneficial effects for patients with Fontan circulation. We report the case of a young adult patient palliated to Fontan circulation, with a decade-long history of symptoms related to protein-losing enteropathy. At age 23 years, he appreciated an improvement in symptoms and laboratory values after cardiac rehabilitation and prescriptive exercise.
Novel Multidisciplinary Management of Acute Kidney Injury After Infant Orthotopic Heart Transplantation
Authors: Wang Billy C. , Gordon Brent M. , Chau Peter , Martens Timothy P. , Lion Richard P.
Published: April 2020

Acute kidney injury following orthotopic heart transplantation in pediatric recipients is often multifactorial, requiring balance of immune suppression, nephrotoxic medication exposure, nutrition, and fluid status. Therapeutic options are often limited by patient size and hemodynamic stability. We describe a four-month, 4.9-kg female bridged by mechanical circulatory support to transplant after failed stage 1 palliation secondary to recurrent aortic stenosis and severe ventricular dysfunction. Posttransplant, kidney injury was managed by transcatheter relief of central obstruction from an anastomotic stricture and continuous renal replacement therapy, allowing uninterrupted immune suppression, medication, and nutrition delivery until sufficient recovery of renal function.
Use of Intracardiac Echocardiography in the Evaluation and Management of Iatrogenic Aortopulmonary Communication After Percutaneous Intervention in Postoperative Patients With Congenital Heart Disease
Authors: Broda Christopher R. , Mulukutla Venkatachalam , Bansal Manish , Penny Daniel J. , Mullins Charles E. , Qureshi Athar M.
Published: April 2020

Iatrogenic aortopulmonary communications (IAPCs) are an uncommon but important complication after percutaneous intervention in postoperative patients. Iatrogenic aortopulmonary communications typically occur after balloon angioplasty or other interventions of the pulmonary outflow tract in certain anatomic configurations in which there is a denuded tissue plane between the pulmonary artery and aorta. They can present with signs and symptoms ranging from subtle clues which are difficult to recognize to near immediate hemodynamic instability. Once recognized, these lesions can become management dilemmas, and intraprocedural interventions can be complicated by complex anatomy and inadequate visualization by standard imaging techniques. We report cases where intracardiac echocardiography (ICE) was integral in the evaluation and management of IAPC as complications of prior transcatheter interventions. We found using ICE safely and effectively identified IAPCs and reduced the technical difficulty of intervention after IAPC discovery.
A National Survey: Current Clinical Practice in Pediatric Anesthesia for Congenital Heart Surgery
Authors: Baehner Torsten , Kiefer Nicholas , Ghamari Shahab , Graeff Ingo , Huett Christopher , Pflugradt Stefan , Sendzik Bjoern , Heinze Ingo , Mueller Matthias , Schindler Ehrenfried , Duerr Georg Daniel , Ellerkmann Richard , Velten Markus
Published: April 2020

Background:

Providing anesthesia for pediatric patients undergoing congenital cardiac surgery is complex and requires profound knowledge and clinical experience. Prospective studies on best anesthetic management are missing, partially due to different standards. The aim of the present study was to survey the current standard practice in anesthetic management in pediatric cardiac surgical centers in Germany.

Methods:

All 78 cardiac surgical centers in Germany were reviewed for a congenital cardiac surgery program. Centers with an active program for congenital cardiac surgery were interviewed to participate in the present online questionnaire to assess their current anesthetic practice.

Results:

Twenty-seven German centers running an active program for congenital heart surgery were identified, covering more than 3,000 pediatric cardiac surgeries annually. Of these centers, 96.3% (26/27) participated in our survey. Standard induction agents were etomidate in 26.9% (7/26), propofol in 19.2% (5/26), a combination of benzodiazepines and ketamine in 19.2% (5/26), and barbiturates in 11.5% (3/26). General anesthesia was preferentially maintained using volatile agents, 61.5% (16/26), with sevoflurane being the most common volatile agent within this group, 81.2% (13/16). Intraoperative first-choice/first-line inotropic drug was epinephrine, 53.8% (14/26), followed by milrinone, 23.1% (6/26), and dobutamine 15.4% (4/26). Fast-track programs performing on-table extubation depending on the type of surgical procedure were established at 61.5% (16/26) of the centers.

Conclusion:

This study highlights the diversity of clinical standards in pediatric cardiac anesthesia for congenital cardiac surgery in Germany.
Transposition of the Great Arteries Associated With Non-Kommerell Diverticulum: Lessons From Two Cases
Authors: Nguyen Truong Ly Thinh , Tran Vinh Quang
Published: April 2020

Vascular ring malformations usually occur as an isolated lesion. d-Transposition of the great arteries (d-TGA) associated with vascular ring malformations has seldom been reported in the literature. In this report, we describe two unusual cases of d-TGA associated with non-Kommerell diverticulum resulting in vascular ring. Our approach for the diagnosis and surgical management of this unusual combination of congenital heart lesions is described.
Tricuspid Valve Endocarditis Following a Scorpion Sting: A Case Report
Authors: Zouizra Zahira , Benbakh Soukaina , Karimi Salwa El , Boumzebra Drissi
Published: April 2020

Scorpion sting envenoming is a common pediatric emergency in the Moroccan southern areas. Cardiomyopathy is the most common cardiovascular manifestation of envenoming, resulting from the stimulation of the sympathetic nervous system by the venom or from the direct effect of the venom toxins on the myocardium. Rare cases of infective endocarditis following a scorpion sting have been reported in the literature. We report a case of tricuspid valve infective endocarditis following a scorpion sting in a previously healthy eight-year-old child. The patient initially was managed medically before undergoing tricuspid valve replacement with a bioprosthesis. The postoperative course was uneventful with a full recovery.
Utility of CT Angiography for the Prediction of Coronary Artery Compression in Patients Undergoing Transcatheter Pulmonary Valve Replacement
Authors: Rinaldi Elizabeth , Sadeghi Soraya , Rajpal Saurabh , Boe Brian A. , Daniels Curt , Cheatham John , Sinha Sanjay , Levi Daniel S. , Aboulhosn Jamil
Published: April 2020

Objectives:

We aimed to evaluate the utility of computed tomography angiography (CTA) for coronary compression (CC) prediction in patients with congenital heart disease undergoing balloon-expandable transcatheter pulmonary valve replacement (TPVR).

Background:

Coronary compression is a serious complication of TPVR, but the value of preprocedural CTAs to assess CC risk is largely unexplored.

Methods:

In all, 586 patients underwent TPVR between January 2009 and July 2018. Adults with a pre-TPVR CTA and children with a CTA performed less than one year prior to TPVR were included. Patients with poor CTA image quality or with aborted cases due to reasons other than CC were excluded. Sixty-six patients were finally included. Cardiac anatomy was assessed via multiplanar reconstruction of CTAs.

Results:

Coronary compression occurred in 9 (14%) of the 66 patients who underwent TPVR. Most CC cases (seven of nine) occurred in patients with conduits. Proximity of the right ventricular outflow tract (RVOT) landing zone to the coronary arteries and to the chest wall was a significant risk factor for compression ( P < .001 and P = .019, respectively). Compression risk increased significantly if patients had an RVOT to coronary artery distance of ≤3 mm ( P < .001) and an RVOT to chest wall distance of ≤8 mm ( P = .026). Anomalous course of coronary arteries was another significant univariate risk factor ( P = .003).

Conclusions:

Right ventricular outflow tract landing zone distance of ≤3 mm to a coronary artery, landing zone distance of ≤8 mm to the chest wall, and anomalous coronary arteries are associated with increased CC risk. Electrocardiogram gating may not be necessary if coronary arteries are opacified on CTAs. Larger studies are needed to explore and confirm these coronary artery compression risk factors.
Does Previous Cardiac Surgery Predict Impaired Quality of Life in Adults With Congenital Heart Disease?
Authors: Wang Qi Feng , Rouse Sarah , Hay Margaret , Menahem Samuel
Published: April 2020

Background:

Improved survival of children with congenital heart disease (CHD) into adult life has led to further study of their quality of life (QoL) and its determinants. The QoL including the symptoms of anxiety and depression of adults with CHD was analyzed to determine the relationship, if any, between prior cardiac surgery and QoL.

Methods:

Adults with CHD who were recruited from a single community-based cardiology practice completed self-reported questionnaires on their QoL, which included symptoms of anxiety and depression. Standard linear regression analysis was used to determine whether prior cardiac surgery predicted lower QoL scores.

Results:

One hundred forty-nine adult patients with CHD were sent QoL questionnaires. Completed questionnaires were received from 135 patients: 71 (53%) males and 64 (47%) females, with a mean age of 26.3 years (standard deviation: 7.8, min: 17, max: 49). Respondents were assigned to two groups: those who had (n = 89, 66%) or had not (n = 46, 34%) previously undergone one or more cardiac surgical interventions. Results from standard linear regression analyses revealed no predictive relationship between history of previous cardiac surgery, whether one or more operations, and QoL.

Conclusions:

Among adult patients with CHD who completed QoL questionnaires, we observed no association between a patient’s history of prior cardiac surgery and self-reported QoL measures. This welcome and important finding may be a reflection of the good functional capacity of both groups (postsurgical and nonsurgical) irrespective of the original CHD diagnosis and need for surgical intervention.
Predictors of Acute Kidney Injury After Hip Fracture in Older Adults
Authors: Braüner Christensen Julie , Aasbrenn Martin , Sandoval Castillo Luana , Ekmann Anette , Giver Jensen Thomas , Pressel Eckart , Haxholdt Lunn Troels , Suetta Charlotte , Palm Henrik
Published: April 2020

Introduction:

This study aimed to investigate the prevalence of acute kidney injury (AKI) following hip fracture surgery in geriatric patients and to identify predictors for development of AKI with a focus on possible preventable risk factors.

Methods:

In this retrospective cohort study, we reviewed electronic medical records of all patients above 65 years of age who underwent hip fracture surgery at Copenhagen University Hospital, Bispebjerg, Denmark, in 2018. Acute kidney injury was assessed according to the Kidney Disease Improving Global Outcomes guidelines. Multivariate logistic regression analyses were used to identify independent risk factors for AKI.

Results:

Postoperative AKI developed in 28.4% of the included patients (85/299). Acute kidney injury was associated with increased length of admission (11.3 vs 8.7 days, P < .001) and 30-day mortality (18/85 vs 16/214, P = .001). In multivariable analysis, higher age (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.01-1.08, P = .004), heart disease (OR: 1.78, 95% CI: 1.01-3.11, P = .045), and postoperative blood transfusion (OR: 1.84, 95% CI: 1.01-3.36, P = .048) were associated with AKI. Moreover, a higher postoperative C-reactive protein (199.0 ± 99.9 in patients with AKI, 161.3 ± 75.2 in patients without AKI) and lower postoperative diastolic blood pressure were observed in patients developing AKI.

Discussion and Conclusion:

Acute kidney injury was common following hip fracture surgery and associated with longer admissions and increased mortality. Patients developing AKI were older and showed several postoperative similarities, including higher C-reactive protein, lower postoperative diastolic pressure, and the need for blood transfusion.
Angina Bullosa Hemorrhagica: Post-traumatic Swelling in the Oral Cavity—A Case Report
Authors: Peters Jeroen P. M. , van Kempen Pauline M. W. , Robijn Sybren M. M. , Thomeer Hans G. X. M.
Published: April 2020

Angina bullosa hemorrhagica (ABH) is a rare, benign disorder characterized by one or multiple blood-filled blisters in the oral cavity (mainly soft palate, and sometimes oropharynx) with a sudden onset, that may lead to a potentially threatened airway. The most common hypothesis of its unknown origin is mild trauma. This lesion can easily be confused with other mucosal diseases or hematological disorders. Knowledge of the condition is important for correct diagnosis and treatment. Incision of the bulla, intubation, or even tracheotomy may be indicated. Here we present a case of 35-year-old woman with a complaint of dysphagia without dyspnea. During oral examination, a blue and/or purple blister on the soft palate was present. On endoscopic examination, an edematous uvula was observed, without other abnormalities. Eventually, the blister ruptured spontaneously and healed within one week without any sequelae.
Variations in the Delivery of Primary Diabetes Care in Malaysia: Lessons to Be Learnt and Potential for Improvement
Authors: Mustapha Feisul Idzwan , Aagaard-Hansen Jens , Lim Shiang Cheng , Nasir Nazrila Hairizan , Aris Tahir , Bjerre-Christensen Ulla
Published: April 2020

Background:

The article describes variations in the organization of clinical services for diabetes patients in 10 public primary health clinics in Malaysia with the view to learn from current innovations and improve diabetes service provision.

Methods:

This study combined the use of secondary data and a qualitative multicase study approach applying observations in 10 randomly selected Ministry of Health (MOH) health clinics in Kuala Lumpur and Selangor and semistructured interviews of the family medicine specialists from the same clinics.

Results:

Although there are specific MOH guidelines for diabetes care, some clinics had introduced innovations for diabetes care such as the novel ‘personalized care’, ‘one-stop-centre’ and utilization of patients’ waiting time for health education. Analysis showed that there was room for improvement in terms of task shifting to free precious time of staff with specialized functions, streamlining appointments for various examinations, increasing continuity of consultations with same doctors, and monitoring of performance.

Conclusion:

We contend that there is a potential for increased effectiveness and efficiency of primary diabetes care in Malaysia without increasing the resources – a potential that may be tapped into by systematic learning from ongoing innovation.
Revisiting China’s Social Volcano: Attitudes toward Inequality and Political Trust in China
Authors: Lei Ya-Wen
Published: April 2020

Existing literature suggests that despite rising inequality in China, Chinese people tend to tolerate inequality, so it would be unlikely that rising inequality would cause sociopolitical instability. Few studies, however, have systematically explained Chinese people’s attitudes toward inequality, analyzed attitudinal changes over time, or examined the relationship between such attitudes and political trust. The author’s analysis of national surveys in 2004, 2009, and 2014 yields three findings. First, critical attitudes toward inequality consistently correlate with a structural understanding of inequality and skepticism of procedural or institutional justice. Second, Chinese people’s attitudes toward inequality changed little between 2004 and 2009, but between 2009 and 2014, there was increasing criticality of both inequality and its seeming disjuncture with China’s socialist principles. Third, people who are discontent with income inequality in China are more likely than others to distrust the local government, and those who draw on socialism to critique inequality are also more likely to distrust the central and local governments. Together, these findings suggest rising inequality could have political ramifications.
Ambedkar’s Proposal to Safeguards Minorities Against Communal Majority in Democracy
Authors: Thorat Sukhadeo
Published: April 2020

As early as in 1909, the British had accepted the principle of political representation in the central and provincial legislatures for religious minorities in British India. In 1909, the Muslims were given representation in the central and provincial legislatures through nominations. Other small minorities were also accorded political representation through separate electorate and/or through nomination. Later, in the 1935 Act, political representation through separate electorates was retained for Muslims, Sikhs, Indian Christians, Anglo-Indians and Europeans. The 1935 Act also accorded separate electorate to the Scheduled Castes (SCs). However, in case of the SCs, the separate electorate was replaced by a ‘joint’ electorate method under pressure from Gandhiji’s fast unto death. In the new Constitution of India in 1950, the political reservation was withdrawn for most of the minorities except the SC and Scheduled Tribes (STs). SCs and STs were awarded political reservation through the ‘joint electorate’ method. However, Ambedkar had proposed a comprehensive scheme for the political representation for social and religious minorities based on the principal of balanced representation, rule of unanimity and principal of faith and confidence.
High occurrence of impaired emotion recognition after ischemic stroke
Authors: Aben Hugo P , Visser-Meily Johanna MA , Biessels Geert Jan , de Kort Paul LM , Spikman Jacoba M ,   on behalf of the PROCRAS study group
Published: April 2020

Introduction

Deficits of emotion recognition after ischemic stroke are often overlooked by clinicians, and are mostly not spontaneously reported by patients. However, impaired emotion recognition after stroke negatively affects the ability to return to work and the quality of life. It is still unknown how often impairments of emotion recognition occur shortly after ischemic stroke. We aimed to estimate the occurrence of impaired emotion recognition after ischemic stroke and to characterise these patients with impaired emotion recognition.

Patients and methods

Two hundred thirty patients were included, derived from a prospective study of cognitive recovery. Five weeks after ischemic stroke a neuropsychological assessment was performed, including an emotion recognition task (i.e. Ekman 60-faces test). Emotion recognition was regarded as impaired if the total score was below the fifth percentile for a large independent reference sample.

Results

Emotion recognition was impaired in 33.5% of patients. Patients with impaired emotion recognition were more likely to have an abnormal Montreal Cognitive Assessment during hospitalisation, and 5 weeks after their stroke, a higher proportion of them had a vascular cognitive disorder (VCD). Even 20% of patients without VCD had impaired emotion recognition. Discussion: Emotion recognition was often impaired after ischemic stroke. This is clinically relevant, since impaired emotion recognition negatively impacts social functioning. Conclusion: Even when there was no cognitive disorder in traditional cognitive domains, emotion recognition was impaired in 1 out of 5 patients. Clinicians should systematically ask patients and their caregivers about deficits in emotion recognition, and, if needed, test for these deficits.
Tissue Expander Use for Reconstruction of Scalp Soft Tissue Sarcoma Wide Resection Defects
Authors: Strode Matthew A. , Lohman Robert F. , Salerno Kilian E. , Kane John M.
Published: April 2020

The potentially curative treatment for soft tissue sarcomas is wide resection. When located on the scalp, this can require removal of significant volumes of adjacent soft tissues as well as the skull periosteum. Consequently, reconstruction of the surgical defect is challenging. For patients receiving preoperative radiation or chemotherapy, gradual tissue expansion through the placement of a preoperative tissue expander can allow for primary closure of the wide resection defect, typically with hair-bearing scalp.
A probabilistic seismic hazard model for Mainland China
Authors: Rong Yufang , Xu Xiwei , Cheng Jia , Chen Guihua , Magistrale Harold , Shen Zheng-Kang
Published: April 2020

We construct a probabilistic seismic hazard model for mainland China by integrating historical earthquakes, active faults, and geodetic strain rates. We delineate large seismic source zones based on geologic and seismotectonic characteristics. For each source zone, a tapered Gutenberg–Richter (TGR) distribution is used to model the total seismic activity rates. The TGR a- and b-values are calculated using a new earthquake catalog, while corner magnitudes are constrained using the seismic moment rate inferred from a geodetic strain rate model. For hazard calculations, the total TGR distribution is split into two parts, with smaller ( MW < 6.5) earthquakes being distributed within the zone using a smoothed seismicity method, and larger earthquakes put both onto active faults, based on fault slip rates and dimensions, and into the zone as background seismicity. We select ground motion models by performing residual analysis using ground motion recordings. Site amplifications are considered based on a site condition map developed using geology as a proxy. The resulting seismic hazard is consistent with the fifth-generation national seismic hazard model for most major cities.
Emerging trends in poly(methyl methacrylate) containing carbonaceous reinforcements—Carbon nanotube, carbon black, and carbon fiber
Authors: Kausar Ayesha
Published: April 2020

Poly(methyl methacrylate) is an important acrylic thermoplastic polymer. Poly(methyl methacrylate) is a transparent and rigid synthetic plastic. There has been growing interest in developing high performance poly(methyl methacrylate)-based nanocomposites. This article reviews a few important poly(methyl methacrylate)-based nanocomposites and composites. An extended account of the poly(methyl methacrylate) nanocomposites with carbonaceous nanofillers and fillers is given. The physical properties and how to manufacture poly(methyl methacrylate)/carbon nanotube, poly(methyl methacrylate)/carbon black, and poly(methyl methacrylate)/carbon fiber materials are appraised. The research so far shows that the mechanical, thermal, conducting, and microstructural performances improved compared with pure poly(methyl methacrylate). In order to further enhance the poly(methyl methacrylate) material performance, chemically modifying the carbonaceous fillers and chemical affinity with the polymer matrix are necessary. The main challenges here are to obtain well-dispersed, aligned, and easily processable poly(methyl methacrylate)-based composites. Poly(methyl methacrylate)-based nanocomposite applications are also reviewed in an attempt to facilitate progress in this emerging area. These materials are potential candidates in electromagnetic interference shielding, gas sensors, separation membranes, tissue engineering, and drug delivery applications.
EPCR deficiency or function-blocking antibody protects against joint bleeding–induced pathology in hemophilia mice
Authors: Magisetty Jhansi , Pendurthi Usha R. , Esmon Charles T. , Rao L. Vijaya Mohan
Published: April 2020

We recently showed that clotting factor VIIa (FVIIa) binding to endothelial cell protein C receptor (EPCR) induces anti-inflammatory signaling and protects vascular barrier integrity. Inflammation and vascular permeability are thought to be major contributors to the development of hemophilic arthropathy following hemarthrosis. The present study was designed to investigate the potential influence of FVIIa interaction with EPCR in the pathogenesis of hemophilic arthropathy and its treatment with recombinant FVIIa (rFVIIa). For this, we first generated hemophilia A (FVIII−/−) mice lacking EPCR (EPCR−/−FVIII−/−) or overexpressing EPCR (EPCR++ FVIII−/−). Joint bleeding was induced in FVIII−/−, EPCR−/−FVIII−/−, and EPCR++FVIII−/− mice by needle puncture injury. Hemophilic synovitis was evaluated by monitoring joint bleeding, change in joint diameter, and histopathological analysis of joint tissue sections. EPCR deficiency in FVIII−/− mice significantly reduced the severity of hemophilic synovitis. EPCR deficiency attenuated the elaboration of interleukin-6, infiltration of macrophages, and neoangiogenesis in the synovium following hemarthrosis. A single dose of rFVIIa was sufficient to fully prevent the development of milder hemophilic synovitis in EPCR−/−FVIII−/− mice. The development of hemophilic arthropathy in EPCR-overexpressing FVIII−/− mice did not significantly differ from that of FVIII−/− mice, and 3 doses of rFVIIa partly protected against hemophilic synovitis in these mice. Consistent with the data that EPCR deficiency protects against developing hemophilic arthropathy, administration of a single dose of EPCR-blocking monoclonal antibodies markedly reduced hemophilic synovitis in FVIII−/− mice subjected to joint bleeding. The present data indicate that EPCR could be an attractive new target to prevent joint damage in hemophilia patients.
Phase 1 study of lenzilumab, a recombinant anti–human GM-CSF antibody, for chronic myelomonocytic leukemia
Authors: Patnaik Mrinal M. , Sallman David A. , Mangaonkar Abhishek A. , Heuer Rachel , Hirvela Jeffery , Zblewski Darci , Al-Kali Aref , Binder Moritz , Balasis Maria E. , Newman Hannah , Letson Christopher , Kruer Traci L. , Gangat Naseema , Komrokji Rami S. , Tefferi Ayalew , Lo Adrian , Shih Ted , Durrant Cameron , List Alan F. , Padron Eric
Published: April 2020

In this phase 1 trial, inhibition of granulocyte-macrophage colony-stimulating factor (GM-CSF) was associated with clinically meaningful responses in 5 of 15 patients with relapsed or refractory chronic myelomonocytic leukemia (CMML). Preliminary data suggest that this approach may be tractable in CMML bearing activating NRAS mutations.
OsSLC1 Encodes a Pentatricopeptide Repeat Protein Essential for Early Chloroplast Development and Seedling Survival
Authors: Lv Jun , Shang Lianguang , Chen Yun , Han Yao , Yang Xiaoyan , Xie Shuzhang , Bai Wenqin , Hu Mingyu , Wu Hong , Lei Kairong , Yang Ya’nan , Ge Shengzhen , Trinh Hai Phuong , Zhang Yi , Guo Longbiao , Wang Zhongwei
Published: April 2020

Background

The large family of pentatricopeptide repeat (PPR) proteins is widely distributed among land plants. Such proteins play vital roles in intron splicing, RNA editing, RNA processing, RNA stability and RNA translation. However, only a small number of PPR genes have been identified in rice.

Results

In this study, we raised a mutant from tissue-culture-derived plants ofOryza sativa subsp. japonica‘Zhonghua 11’, which exhibited a lethal chlorosis phenotype from germination to the third-leaf stage. The mutant was designatedseedling-lethal chlorosis 1(slc1). Theslc1mutant leaves showed extremely low contents of photosynthetic pigments and abnormal chloroplast development, and were severely defective in photosynthesis. Map-based cloning ofOsSLC1revealed that a single base (G) deletion was detected in the first exon ofOs06g0710800in theslc1mutant, which caused a premature stop codon. Knockout and complementation experiments further confirmed thatOsSLC1is responsible for the seedling-lethal chlorosis phenotype in theslc1mutant.OsSLC1was preferentially expressed in green leaves, and encoded a chloroplast-localized PPR protein harboring 12 PPR motifs. Loss-of-function ofOsSLC1affected the intron splicing of multiple group II introns, and especially precluded the intron splicing ofrps16, and resulted in significant increase in the transcript levels of 3 chloroplast ribosomal RNAs and 16 chloroplast development-related and photosynthesis-related genes, and in significant reduction in the transcript levels of 1 chloroplast ribosomal RNAs and 2 chloroplast development-related and photosynthesis-related genes.

Conclusion

We characterized a novel chloroplast-localized PPR protein, OsSLC1, which plays a vital role in the intron splicing of multiple group II introns, especially therps16intron, and is essential for early chloroplast development and seedling survival in rice.
Study on the influence mechanism of underground mineral element Fe(II) on Cr(VI) transformation under subsurface and groundwater interaction zones
Authors: Zheng Yiru , Liu Shuguang , Dai Chaomeng , Duan Yanping , Makhinov Aleksei Nikolavich , Hon Leong Kah , Araruna Júnior José Tavares
Published: April 2020

Background

With the acceleration of urbanization, heavy metal contamination in subsurface water and groundwater is becoming more and more serious, and the interaction between surface water and underground water is an important factor that cannot be ignored. Based on the change of oxygen content in surface water and groundwater environment, this research mainly studied the influencing factors and mechanism of underground mineral element Fe(II) on the morphological transformation of heavy metal Cr(VI) under the condition of surface–groundwater interaction, and simulates the interaction process of subsurface–groundwater by changing the dissolved oxygen content in the redox reaction system of dissolved Fe(II) and Cr(VI). The influence mechanism of pH, Fe(II):Cr(VI), groundwater hardness ion and humic acid on the morphological transformation of Cr(VI) was investigated.

Results

The results showed that the content of DO did affect the conversion of Cr(VI) by Fe(II). pH had a great influence on the redox reaction: while pH = 3–5, the reaction rate of Fe(II) and Cr(VI) and the removal rate of Cr(VI) decreased with the increase of pH; while pH = 6–8, the reaction rate and the removal of Cr(VI) increased with the increase of pH. When Fe(II):Cr(VI) = 3:1, the reaction of Fe(II) and Cr(VI) is affected by DO; when Fe(II):Cr(VI) is 1:1, 2:1, 4:1 and 5:1, DO has no obvious effect on the reaction. Groundwater hardness ions can greatly promote the redox reaction. When humic acid exists in the reaction system, the Fe(III) formed by the oxidation of Fe(II) by Cr(VI) will once again be converted into soluble Fe(II), the reduction of humic acid further promotes the redox reaction between Fe(II) and Cr(VI), and promotes the conversion of Cr(VI) by Fe(II) more effectively. Moreover, the higher the concentration of humic acid, the higher the removal rate of Cr(VI).

Conclusions

The research results have practical guiding significance for groundwater contamination prediction, pollution control and remediation, integrated water resources management and the construction of sponge city in China.
Reconstruction of a gene regulatory network of the induced systemic resistance defense response in Arabidopsis using boolean networks
Authors: Timmermann Tania , González Bernardo , Ruz Gonzalo A.
Published: April 2020

Background

An important process for plant survival is the immune system. The induced systemic resistance (ISR) triggered by beneficial microbes is an important cost-effective defense mechanism by which plants are primed to an eventual pathogen attack. Defense mechanisms such as ISR depend on an accurate and context-specific regulation of gene expression. Interactions between genes and their products give rise to complex circuits known as gene regulatory networks (GRNs). Here, we explore the regulatory mechanism of the ISR defense response triggered by the beneficial bacterium Paraburkholderia phytofirmans PsJN in Arabidopsis thaliana plants infected with Pseudomonas syringae DC3000. To achieve this, a GRN underlying the ISR response was inferred using gene expression time-series data of certain defense-related genes, differential evolution, and threshold Boolean networks.

Results

One thousand threshold Boolean networks were inferred that met the restriction of the desired dynamics. From these networks, a consensus network was obtained that helped to find plausible interactions between the genes. A representative network was selected from the consensus network and biological restrictions were applied to it. The dynamics of the selected network showed that the largest attractor, a limit cycle of length 3, represents the final stage of the defense response (12, 18, and 24 h). Also, the structural robustness of the GRN was studied through the networks’ attractors.

Conclusions

A computational intelligence approach was designed to reconstruct a GRN underlying the ISR defense response in plants using gene expression time-series data of A. thaliana colonized by P. phytofirmans PsJN and subsequently infected with P. syringae DC3000. Using differential evolution, 1000 GRNs from time-series data were successfully inferred. Through the study of the network dynamics of the selected GRN, it can be concluded that it is structurally robust since three mutations were necessary to completely disarm the Boolean trajectory that represents the biological data. The proposed method to reconstruct GRNs is general and can be used to infer other biologically relevant networks to formulate new biological hypotheses.