bluuebunny/crossref_metadata_2025 huggingface dataset:
TSH Levels as an Independent Risk Factor for NAFLD and Liver Fibrosis in the General Population
Authors: Martínez-Escudé Alba , Pera Guillem , Costa-Garrido Anna , Rodríguez Lluís , Arteaga Ingrid , Expósito-Martínez Carmen , Torán-Monserrat Pere , Caballería Llorenç
Published: June 2021

Thyroid hormones may be a risk factor for the development of non-alcoholic fatty liver disease (NAFLD) and its progression to liver fibrosis. The aim of this study is to investigate the relationship between thyroid stimulating hormone (TSH) levels, NAFLD, and liver fibrosis in the general population. A descriptive cross-sectional study was performed in subjects aged 18–75 years randomly selected from primary care centers between 2012 and 2016. Each subject underwent clinical evaluation, physical examination, blood tests and transient elastography. Descriptive and multivariate logistic regression analyses were used to identify factors associated with NAFLD and fibrosis. We included 2452 subjects (54 ± 12 years; 61% female). Subjects with TSH ≥ 2.5 μIU/mL were significantly associated with obesity, atherogenic dyslipidemia, metabolic syndrome (MetS), hypertransaminasemia and altered cholesterol and triglycerides. The prevalence of NAFLD and liver fibrosis was significantly higher in subjects with TSH ≥ 2.5 (μIU/mL). We found a 1.5 times increased risk of NAFLD, 1.8 and 2.3 times increased risk of liver fibrosis for cut-off points of ≥8.0 kPa and ≥9.2 kPa, respectively, in subjects with TSH ≥ 2.5 μIU/mL compared with TSH < 2.5 μIU/mL (control group), independent of the presence of MetS. These findings remained significant when stratifying TSH, with values ≥ 10 μIU/mL.
Infectious Complications after Etomidate vs. Propofol for Induction of General Anesthesia in Cardiac Surgery—Results of a Retrospective, before–after Study
Authors: Weiss Björn , Schiefenhövel Fridtjof , Grunow Julius J. , Krüger Michael , Spies Claudia D. , Menk Mario , Kruppa Jochen , Grubitzsch Herko , Sander Michael , Treskatsch Sascha , Balzer Felix
Published: June 2021

Background: Etomidate is typically used as an induction agent in cardiac surgery because it has little impact on hemodynamics. It is a known suppressor of adrenocortical function and may increase the risk for post-operative infections, sepsis, and mortality. The aim of this study was to evaluate whether etomidate increases the risk of postoperative sepsis (primary outcome) and infections (secondary outcome) compared to propofol. Methods: This was a retrospective before–after trial (IRB EA1/143/20) performed at a tertiary medical center in Berlin, Germany, between 10/2012 and 01/2015. Patients undergoing cardiac surgery were investigated within two observation intervals, during which etomidate and propofol were the sole induction agents. Results: One-thousand, four-hundred, and sixty-two patients, and 622 matched pairs, after caliper propensity-score matching, were included in the final analysis. Sepsis rates did not differ in the matched cohort (etomidate: 11.5% vs. propofol: 8.2%, p = 0.052). Patients in the etomidate interval were more likely to develop hospital-acquired pneumonia (etomidate: 18.6% vs. propofol: 14.0%, p = 0.031). Conclusion: Our study showed that a single-dose of etomidate is not statistically associated with higher postoperative sepsis rates after cardiac surgery, but is associated with a higher incidence of hospital-acquired pneumonia. However, there is a notable trend towards a higher sepsis rate.
Impaired Iron Homeostasis and Haematopoiesis Impacts Inflammation in the Ageing Process in Down Syndrome Dementia
Authors: Raha-Chowdhury Ruma , Raha Animesh Alexander , Henderson James , Ghaffari Seyedeh Deniz , Grigorova Monika , Beresford-Webb Jessica , Allinson Kieren , Chakraborty Subhojit , Holland Anthony , Zaman Shahid H.
Published: June 2021

Down syndrome (DS) subjects are more likely to develop the clinical features of Alzheimer’s disease (AD) very early in the disease process due to the additional impact of neuroinflammation and because of activation of innate immunity. Many factors involved in the neuropathology of AD in DS, including epigenetic factors, innate immunity and impaired haematopoiesis, contribute significantly towards the pathophysiology and the enhanced ageing processes seen in DS and as a consequence of the triplication of genes RUNX1, S100β and OLIG2, together with the influence of proteins that collectively protect from cellular defects and inflammation, which include hepcidin, ferritin, IL-6 and TREM2. This study is aimed at determining whether genetic variants and inflammatory proteins are involved in haematopoiesis and cellular processes in DS compared with age-matched control participants, particularly with respect to neuroinflammation and accelerated ageing. Serum protein levels from DS, AD and control participants were measured by enzyme-linked immunosorbent assay (ELISA). Blood smears and post-mortem brain samples from AD and DS subjects were analysed by immunohistochemistry. RUNX1 mRNA expression was analysed by RT-PCR and in situ hybridisation in mouse tissues. Our results suggest that hepcidin, S100β and TREM2 play a critical role in survival and proliferation of glial cells through a common shared pathway. Blood smear analysis showed the presence of RUNX1 in megakaryocytes and platelets, implying participation in myeloid cell development. In contrast, hepcidin was expressed in erythrocytes and in platelets, suggesting a means of possible entry into the brain parenchyma via the choroid plexus (CP). The gene product of RUNX1 and hepcidin both play a critical role in haematopoiesis in DS. We propose that soluble TREM2, S100β and hepcidin can migrate from the periphery via the CP, modulate the blood–brain immune axis in DS and could form an important and hitherto neglected avenue for possible therapeutic interventions to reduce plaque formation.
Landscape of Preterm Birth Therapeutics and a Path Forward
Authors: Coler Brahm Seymour , Shynlova Oksana , Boros-Rausch Adam , Lye Stephen , McCartney Stephen , Leimert Kelycia B. , Xu Wendy , Chemtob Sylvain , Olson David , Li Miranda , Huebner Emily , Curtin Anna , Kachikis Alisa , Savitsky Leah , Paul Jonathan W. , Smith Roger , Adams Waldorf Kristina M.
Published: June 2021

Preterm birth (PTB) remains the leading cause of infant morbidity and mortality. Despite 50 years of research, therapeutic options are limited and many lack clear efficacy. Tocolytic agents are drugs that briefly delay PTB, typically to allow antenatal corticosteroid administration for accelerating fetal lung maturity or to transfer patients to high-level care facilities. Globally, there is an unmet need for better tocolytic agents, particularly in low- and middle-income countries. Although most tocolytics, such as betamimetics and indomethacin, suppress downstream mediators of the parturition pathway, newer therapeutics are being designed to selectively target inflammatory checkpoints with the goal of providing broader and more effective tocolysis. However, the relatively small market for new PTB therapeutics and formidable regulatory hurdles have led to minimal pharmaceutical interest and a stagnant drug pipeline. In this review, we present the current landscape of PTB therapeutics, assessing the history of drug development, mechanisms of action, adverse effects, and the updated literature on drug efficacy. We also review the regulatory hurdles and other obstacles impairing novel tocolytic development. Ultimately, we present possible steps to expedite drug development and meet the growing need for effective preterm birth therapeutics.
Effectiveness of Third-Class Biologic Treatment in Crohn’s Disease: A Multi-Center Retrospective Cohort Study
Authors: Albshesh Ahmad , Taylor Joshua , Savarino Edoardo V. , Truyens Marie , Armuzzi Alessandro , Ribaldone Davide G. , Shitrit Ariella Bar-Gil , Fibelman Morine , Molander Pauliina , Liefferinckx Claire , Nancey Stephane , Korani Mohamed , Rutka Mariann , Barreiro-de Acosta Manuel , Domislovic Viktor , Suris Gerard , Eriksson Carl , Alves Catarina , Mpitouli Afroditi , di Jiang Caroline , Tepeš Katja , Coletta Marina , Foteinogiannopoulou Kalliopi , Gisbert Javier P. , Amir-Barak Hadar , Attauabi Mohamed , Seidelin Jakob , Afif Waqqas , Marinelli Carla , Lobaton Triana , Pugliese Daniela , Maharshak Nitsan , Cremer Anneline , Limdi Jimmy K. , Molnár Tamás , Otero-Alvarin Borja , Krznaric Zeljko , Magro Fernando , Karmiris Konstantinos , Raine Tim , Drobne David , Koutroubakis Ioannis , Chaparro Maria , Yanai Henit , Burisch Johan , Kopylov Uri
Published: June 2021

Background: Multiple studies have described the effectiveness of ustekinumab (UST) and vedolizumab (VDZ) in patients with Crohn’s disease (CD) failing anti- Tumor necrosis factors (TNFs); however, the effectiveness of VDZ or UST as a third-class biologic has not yet been described. Aims and Methods: In this retrospective multicenter cohort study, we aimed to investigate the effectiveness of VDZ and UST as a third-class biologic in patients with CD. Results: Two-hundred and four patients were included; 156/204 (76%) patients received VDZ as a second- and UST as a third-class therapy (group A); the remaining 48/204 (24%) patients received UST as a second- and VDZ as a third-class therapy (group B). At week 16–22, 87/156 (55.5%) patients and 27/48 (56.2%) in groups A and B, respectively, responded to treatment (p = 0.9); 41/156 (26.2%) and 15/48 (31.2%) were in clinical remission (p = 0.5). At week 52; 89/103 (86%) patients and 25/29 (86.2%) of the patients with available data had responded to third-class treatment in groups A and B, respectively (p = 0.9); 31/103 (30%) and 47/29 (24.1%) were in clinical remission (p = 0.5). Conclusion: Third-class biological therapy was effective in more than half of the patients with CD. No differences in effectiveness were detected between the use of VDZ and UST as a third-class agent.
Identifying the Critical Threshold for Long-Term Pediatric Neurological Hospitalizations of the Offspring in Preterm Delivery
Authors: Zer Shiran , Wainstock Tamar , Sheiner Eyal , Miodownik Shayna , Pariente Gali
Published: June 2021

We opted to investigate whether a critical threshold exists for long-term pediatric neurological morbidity, and cerebral palsy (CP), in preterm delivery, via a population-based cohort analysis. Four study groups were classified according to their gestational age at birth: 24–27.6, 28–31.6, 32–36.6 weeks and term deliveries, evaluating the incidence of long-term hospitalizations of the offspring due to neurological morbidity. Cox proportional hazard models were performed to control for confounders. A Kaplan–Meier survival curve was used to compare the cumulative neurological morbidity incidence for each group. A total of 220,563 deliveries were included: 0.1% (118) occurred at 24–27.6 weeks of gestation, 0.4% (776) occurred at 28–31.6 weeks of gestation, 6% (13,308) occurred at 32–36.6 weeks of gestation and 93% (206,361) at term. In a Cox model, while adjusting for confounders, delivery before 25 weeks had a 3.9-fold risk for long-term neurological morbidity (adjusted HR (hazard ratio) = 3.9, 95% CI (confidence interval) 2.3–6.6; p < 0.001). The Kaplan–Meier survival curve demonstrated a linear association between long-term neurological morbidity and decreasing gestational age. In a second Cox model, adjusted for confounders, infants born before 25 weeks of gestation had increased rates of CP (adjusted HR = 62.495% CI 25.6–152.4; p < 0.001). In our population, the critical cut-off for long-term neurological complications is delivery before 25 weeks gestation.
Free Immunoglobulin Light Chains in Patients with Tick-Borne Encephalitis: Before and after Treatment
Authors: Gudowska-Sawczuk Monika , Czupryna Piotr , Moniuszko-Malinowska Anna , Pancewicz Sławomir , Mroczko Barbara
Published: June 2021

Background: Tick-borne encephalitis (TBE) is inflammation of the central nervous system (CNS) caused by a viral infection which may be associated with increased synthesis of immunoglobulins. It can lead to inter alia, breakdown of the blood-brain barrier (BBB), or even death and, unfortunately, treatment is only symptomatic. Therefore, the aim of the present study was assessment of the concentrations of free light chains (FLC) kappa (κ) and lambda (λ in the cerebrospinal fluid (CSF) and serum of patients with TBE. Methods: A total of 58 cerebrospinal fluid and serum sample pairs were analyzed. Samples were collected from patients with TBE before and after treatment. FLC were measured using the turbidimetric method. The values of κIgG-index, λIgG-index, κFLC-index and λFLC-index were calculated using relevant formulas. Results: Pre-treatment serum λFLC concentrations were higher in comparison to post-treatment levels. Moreover, it was observed that CSF λFLC, TBEV IgM, TBEV IgG, and serum TBEV IgG, as well as the values of λFLC-index, κFLC-index, and λIgG-index were elevated after treatment. In the total study group, the concentrations of CSF κFLC and λFLC, and values of four indexes: κFLC-index, λFLC-index, κIgG-index, and λIgG-index correlated with each other and with CSF TBEV IgM and IgG antibodies. The CSF level of TBEV IgG was also associated with serum IgG TBEV and CSF IgM TBEV antibodies. Additionally, serum κFLC correlated with serum and CSF λFLC. Conclusion: This is the first study that demonstrates statistically significant differences in serum and CSF λFLC, as well as in the calculated values of three algorithms: λIgG-index, κFLC-index, and λIgG-index prior to and following treatment of TBE. Our findings may indicate that these differences reflect the intrathecal synthesis of immunoglobulins and increased permeability of BBB in patients with TBE. Moreover, it could provide the basis for developing new therapeutic strategies.
Analysis of the Referral Rates of Newborn Hearing Screening Test According to Childbirth Delivery Methods in Neonatal Care Units
Authors: Seo Ganghyeon , Choi Hyo Geun , Jang Sookyung , Choi Sun , Lee Sa Ra , Park Su-Kyoung
Published: June 2021

It is known that neonates born by cesarean delivery (CD) may have higher referral rates than those born by vaginal delivery (VD) for newborn hearing screening (NHS). False-positive NHS results can increase costs and parental anxiety. This study analyzed the differences in NHS referral rates according to delivery methods in Level I, II, and III neonatal care units. A retrospective chart review was done for 2322 infants (4644 ears) with delivery records who underwent NHS between 2004 and 2017. The first NHS was performed immediately before discharge when the infant was in good condition via the automated auditory brainstem response (AABR) or automated otoacoustic emissions (AOAE). There were 98 neonates (196 ears) who underwent both AABR and AOAE simultaneously as the first NHS, 30 of which failed. We used a total of 4810 ears in this analysis. Of all enrolled ears, 2075 ears were of neonates born by CD, and 2735 ears were of neonates born by VD. A total of 2460 ears were from patients in Level III neonatal intensive care units (NICU) and 2350 ears were from Level I and II neonatal care units. The overall referral rate was higher in infants born via CD (4.5%) than VD (3.2%). In Level I and II neonatal intensive care units, the referral rate was significantly higher in those born via CD (3.0%) than via VD (1.4%). Further, based on the screening method, AABR (75.8%) was more frequently used than AOAE (24.2%), thereby revealing AABR’s higher referral rate in CD (2.9%) than in VD (1.2%). The referral rate of infants who underwent the NHS within three days of birth was higher in the CD group (3.0%) than in the VD group (1.3%). There was no significant difference in the referral rate depending on the delivery method when infants were hospitalized for more than four days or hospitalized in the NICU. The referral rate according to the delivery methods was significantly higher when the NHS test was performed for healthy newborns in the Level I and II neonatal care units born by CD within 72 h using AABR. Therefore, we recommend that the hearing screening test for newborns delivered by cesarean section be performed after 72 h of age. The results of this study may reduce the false-positive NHS results, unnecessary further tests, and parental anxiety.
A Systematic Review of the Efficacy and Safety of Direct Oral Anticoagulants in Atrial Fibrillation Patients with Diabetes Using a Risk Index
Authors: Acanfora Domenico , Ciccone Marco Matteo , Carlomagno Valentina , Scicchitano Pietro , Acanfora Chiara , Bortone Alessandro Santo , Uguccioni Massimo , Casucci Gerardo
Published: June 2021

Diabetes mellitus (DM) represents an independent risk factor for chronic AF and is associated with unfavorable outcomes. We aimed to evaluate the efficacy and safety of direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF), with and without diabetes mellitus (DM), using a new risk index (RI) defined as: RI =Rate of EventsRate of Patients at Risk. In particular, an RI lower than 1 suggests a favorable treatment effect. We searched MEDLINE, MEDLINE In-Process, EMBASE, PubMed, and the Cochrane Central Register of Controlled Trials. The risk index (RI) was calculated in terms of efficacy (rate of stroke/systemic embolism (stroke SEE)/rate of patients with and without DM; rate of cardiovascular death/rate of patients with and without DM) and safety (rate of major bleeding/rate of patients with and without DM) outcomes. AF patients with DM (n = 22,057) and 49,596 without DM were considered from pivotal trials. DM doubles the risk index for stroke/SEE, major bleeding (MB), and cardiovascular (CV) death. The RI for stroke/SEE, MB, and CV death was comparable in patients treated with warfarin or DOACs. The lowest RI was in DM patients treated with Rivaroxaban (stroke/SEE, RI = 0.08; CV death, RI = 0.13). The RIs for bleeding were higher in DM patients treated with Dabigatran (RI110 = 0.32; RI150 = 0.40). Our study is the first to use RI to homogenize the efficacy and safety data reported in the DOACs pivotal studies against warfarin in patients with and without DM. Anticoagulation therapy is effective and safe in DM patients. DOACs appear to have a better efficacy and safety profile than warfarin. The use of DOACs is a reasonable alternative to vitamin-K antagonists in AF patients with DM. The RI can be a reasonable tool to help clinicians choose between DOACs or warfarin in the peculiar set of AF patients with DM.
Dynamic Compilation for Transprecision Applications on Heterogeneous Platform
Authors: Dumas Julie , Charles Henri-Pierre , Mambu Kévin , Kooli Maha
Published: June 2021

This article describes a software environment called HybroGen, which helps to experiment binary code generation at run time. As computing architectures are getting more complex, the application performance is becoming data-dependent. The proposed experimental platform is helpful in programming applications that can be reconfigured at run time in order to be adapted for a new data environment. The HybroGen platform is adapted to heterogeneous architectures and can generate instructions for different targets. This platform allows to go farther than classical JIT compilation in many directions: the code generator is smaller by three orders of magnitude and faster by three orders of magnitude, compared to JIT (Just-In-Time) platforms, and allows making code transformation that is impossible in traditional compilation schemes, such as code generation for non von Neumann accelerators or dynamic code transformations for transprecision. The latter is illustrated in a code example: the square root with Newton’s algorithm. We also illustrate the proposed HybroGen platform with two other examples: a multiplication with a specialization on a value determined at run time, and a conversion of degrees Celsius to degrees Fahrenheit. This article presents a proof of concept of the proposed HybroGen platform in terms of its functionalities, and demonstrates the working status.
Tensile Performance of 3D-Printed Continuous Fiber-Reinforced Nylon Composites
Authors: Mohammadizadeh Mahdi , Fidan Ismail
Published: June 2021

Fused Filament Fabrication (FFF) is a promising technology for production of fiber-reinforced composite parts with complex geometries. Continuous Fiber Reinforced Additively Manufactured (CFRAM) parts are becoming more prominent due to their mechanical performance, light weight, and recyclability. CFRAM components are lighter, yet they are strong materials with a wide range of potential applications in the automotive industry, aerospace, medical tools, and sports goods. The wide range of applications of these novel materials justifies the need to study their properties. Tensile is one of the most important tests to evaluate the mechanical performance of CFRAM parts. In this paper, a comprehensive study is conducted on tensile properties of CFRAM components. The composite parts are printed using a dual nozzle 3D printing machine and their tensile performance is investigated. Furthermore, the effect of fiber type, fiber content, infill density, infill pattern, and layer thickness on tensile properties was studied. Nylon was used as the matrix and Carbon fiber (CF), fiberglass (FG), and Kevlar were used as reinforcing agents. Microstructural analysis was conducted to investigate the fracture mechanism, internal morphology, interlayer adhesion, and the printing quality of specimens. Finally, a comparative study is conducted on the price and printing time of CFRAM parts. It is observed that fiber inclusion increases the tensile strength up to 2200%; moreover, increasing the fiber content improves the tensile performance of composite. The results obtained demonstrate that CF-reinforced parts have better performance compared to FG and Kevlar-reinforced components. The results show that CFRAM parts have potential to replace metals and conventional composites for engineering applications like the automobile industry.
Median Polish Kriging and Sequential Gaussian Simulation for the Spatial Analysis of Source Rock Data
Authors: Varouchakis Emmanouil A.
Published: June 2021

In this technical note, a geostatistical model was applied to explore the spatial distribution of source rock data in terms of total organic carbon weight concentration. The median polish kriging method was used to approximate the “row and column effect” in the generated array data, in order for the ordinary kriging methodology to be applied by means of the residuals. Moreover, the sequential Gaussian simulation was employed to quantify the uncertainty of the estimates. The modified Box–Cox technique was applied to normalize the residuals and a cross-validation analysis was performed to evaluate the efficiency of the method. A map of the spatial distribution of total organic carbon weight concentration was constructed along with the 5% and 95% confidence intervals. This work encourages the use of the median polish kriging method for similar applications.
Short Term Forecast of Container Throughput: New Variables Application for the Port of Douala
Authors: Awah Penn Collins , Nam Hyungsik , Kim Sihyun
Published: June 2021

An accurate container throughput forecast is vital for any port. Since overall improvements in port performance and competitiveness can be derailed by port bottlenecks, ports need to find leverage to identify and prioritize measures to improve weak key performance indicators (KPIs) to attain growth opportunities. Prior studies had modeled container throughput from socio-economic and growth projection factors. This study aims to provide a practical method for forecasting the optimal container throughput a port can physically handle/attract given a certain level of terminal operation efficiency through random forest (RF) and multilayer perceptron (MLP) models. The study variables are derived from the port operations dimension and include ship turnaround time, vessel draft, container dwell time, berth productivity, container storage capacity, and custom declaration time. Evaluations are made based on the R-squared, NRMSE, MAE and MAPE. Model comparison is deduced with seven competing models in container throughput forecasting. The findings indicate that the RF model is a potential candidate for forecasting the engineering optimal throughput of Douala port. Model interpretation is provided through feature importance and partial dependence plots. The findings from this study will help reduce uncertainty and provide leverage for port management to spot bottlenecks and engage in better port planning and development projects which will strengthen their international competitive advantage.
Antimicrobial Activity of the Peptide LfcinB15 against Candida albicans
Authors: Chang Che-Kang , Kao Mou-Chieh , Lan Chung-Yu
Published: June 2021

Lactoferricin (Lfcin) is an amphipathic, cationic peptide derived from proteolytic cleavage of the N-lobe of lactoferrin (Lf). Lfcin and its derivatives possess broad-spectrum antibacterial and antifungal activities. However, unlike their antibacterial functions, the modes of action of Lfcin and its derivatives against pathogenic fungi are less well understood. In this study, the mechanisms of LfcinB15, a derivative of bovine Lfcin, against Candida albicans were, therefore, extensively investigated. LfcinB15 exhibited inhibitory activity against planktonic cells, biofilm cells, and clinical isolates of C. albicans and non-albicans Candida species. We further demonstrated that LfcinB15 is localized on the cell surface and vacuoles of C. albicans cells. Moreover, LfcinB15 uses several different methods to kill C. albicans, including disturbing the cell membrane, inducing reactive oxygen species (ROS) generation, and causing mitochondrial dysfunction. Finally, the Hog1 and Mkc1 mitogen-activated protein kinases were both activated in C. albicans cells in response to LfcinB15. These findings help us to obtain more insight into the complex mechanisms used by LfcinB15 and other Lfcin-derived peptides to fight fungal pathogens.
Risk Factors of 30-Day All-Cause Mortality in Patients with Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infection
Authors: Liu Keh-Sen , Tong Yao-Shen , Lee Ming-Tsung , Lin Hung-Yu , Lu Min-Chi
Published: June 2021

An optimal antimicrobial regimen for the treatment of patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infection (BSI) is currently unavailable. This study aimed to identify the appropriate antibiotics and the risk factors of all-cause mortality for CRKP BSI patients. This retrospective cohort study included the hospitalized patients with CRKP BSI. Primary outcome was 30-day all-cause mortality. Cox regression analysis was used to evaluate the risk factors of 30-day mortality. A total of 89 patients were included with a 30-day mortality of 52.1%. A total of 52 (58.4%) patients were treated with appropriate antimicrobial regimens and 58 (65.2%) isolates carried blaKPC-2 genes. Microbiologic eradication within 7 days (adjusted hazard ratio [HR] = 0.09, p < 0.001), platelet count (per 1 × 104/mm3, adjusted HR = 0.95, p = 0.002), and Pitt bacteremia scores (adjusted HR = 1.40, p < 0.001) were independently associated with 30-day all-cause mortality. No effective antimicrobial regimens were identified. In conclusion, risk factors of 30-day mortality in patients with CRKP BSI included microbiologic eradication > 7 days, lower platelet count, and a higher Pitt bacteremia score. These findings render a new insight into the clinical landscape of CRKP BSI.
Hybrid Verification Technique for Decision-Making of Self-Driving Vehicles
Authors: Al-Nuaimi Mohammed , Wibowo Sapto , Qu Hongyang , Aitken Jonathan , Veres Sandor
Published: June 2021

The evolution of driving technology has recently progressed from active safety features and ADAS systems to fully sensor-guided autonomous driving. Bringing such a vehicle to market requires not only simulation and testing but formal verification to account for all possible traffic scenarios. A new verification approach, which combines the use of two well-known model checkers: model checker for multi-agent systems (MCMAS) and probabilistic model checker (PRISM), is presented for this purpose. The overall structure of our autonomous vehicle (AV) system consists of: (1) A perception system of sensors that feeds data into (2) a rational agent (RA) based on a belief–desire–intention (BDI) architecture, which uses a model of the environment and is connected to the RA for verification of decision-making, and (3) a feedback control systems for following a self-planned path. MCMAS is used to check the consistency and stability of the BDI agent logic during design-time. PRISM is used to provide the RA with the probability of success while it decides to take action during run-time operation. This allows the RA to select movements of the highest probability of success from several generated alternatives. This framework has been tested on a new AV software platform built using the robot operating system (ROS) and virtual reality (VR) Gazebo Simulator. It also includes a parking lot scenario to test the feasibility of this approach in a realistic environment. A practical implementation of the AV system was also carried out on the experimental testbed.
The Role of Social Media in the Innovation and Performance of Kuwaiti Enterprises in the Food Sector
Authors: Alhaimer Rashed Salem
Published: June 2021

This study examined social media’s role in various levels of research, development, and performance within enterprises in Kuwait. The research incorporated four inductive case analyses in various sectors. The case studies epitomize the supply chain of Kuwaiti enterprises, including small and medium-sized enterprises (SMEs). Media richness theory and social exchange effectuation theory were utilized to create an effective theory and a theoretical framework. This study collected data via a questionnaire completed by 100 managers employed by Kuwaiti SMEs specialized in the food sector and interviews with eight managers. Numerical data were analyzed via SPSS software, while textual data were analyzed by applying thematic analysis. The results of this study suggest that Kuwaiti companies should adopt social media platforms and other novel, innovative outlets to publicize their organizations and maximize performance. Social media richness and openness tend to determine the supplier selection process in most Kuwaiti enterprises, leading to positive transactional and social impacts on entrepreneurship.
A New Classification of the Severity of Psoriasis: What’s Moderate Psoriasis?
Authors: Salgado-Boquete Laura , Carrascosa José Manuel , Llamas-Velasco Mar , Ruiz-Villaverde Ricardo , de la Cueva Pablo , Belinchón Isabel
Published: June 2021

The purpose of this study is to propose a ranking system for the severity of psoriasis. The consensus method of selecting the indices to include and the classification of real patient profiles by an expert panel to create a gold standard of severity were used. The performance of potential cut-offs was evaluated to create a ranking algorithm. The combined use of PASI, BSA, and sPGA may allow the classification of the severity of psoriatic patients. The final algorithm identifies severe patients in a single step (2 out 3 are met: PASI ≥ 11 or BSA ≥ 10 or sPGA ≥ 3), while two steps are required for mild ((2 out 3 are met: PASI ≤ 3 or BSA ≤ 5 or sPGA ≤ 2) and DLQI < 5) and moderate forms (the patient does not meet 2 out 3 (PASI ≥ 11 or BSA ≥ 10 or sPGA ≥ 3) but has a DLQI ≥ 5. A ranking algorithm is presented, consisting of different measures of disease which classifies psoriatic patients into three categories: mild, moderate, and severe.
Idiopathic Infertility as a Feature of Genome Instability
Authors: Puzuka Agrita , Alksere Baiba , Gailite Linda , Erenpreiss Juris
Published: June 2021

Genome instability may play a role in severe cases of male infertility, with disrupted spermatogenesis being just one manifestation of decreased general health and increased morbidity. Here, we review the data on the association of male infertility with genetic, epigenetic, and environmental alterations, the causes and consequences, and the methods for assessment of genome instability. Male infertility research has provided evidence that spermatogenic defects are often not limited to testicular dysfunction. An increased incidence of urogenital disorders and several types of cancer, as well as overall reduced health (manifested by decreased life expectancy and increased morbidity) have been reported in infertile men. The pathophysiological link between decreased life expectancy and male infertility supports the notion of male infertility being a systemic rather than an isolated condition. It is driven by the accumulation of DNA strand breaks and premature cellular senescence. We have presented extensive data supporting the notion that genome instability can lead to severe male infertility termed “idiopathic oligo-astheno-teratozoospermia.” We have detailed that genome instability in men with oligo-astheno-teratozoospermia (OAT) might depend on several genetic and epigenetic factors such as chromosomal heterogeneity, aneuploidy, micronucleation, dynamic mutations, RT, PIWI/piRNA regulatory pathway, pathogenic allelic variants in repair system genes, DNA methylation, environmental aspects, and lifestyle factors.
Effect of Increased Flexor Hallucis Longus Muscle Activity on Ground Reaction Force during Landing
Authors: Oku Kosuke , Kimura Daisuke , Ito Tomotaka , Matsugi Akiyoshi , Sugioka Tatsuya , Kobayashi Yusuke , Satake Hayato , Kumai Tsukasa
Published: June 2021

Repeated high-impact ground forces can lead to injury and decreased performance. While increasing flexor hallucis longus (FHL) muscle activity is known to increase stiffness and elasticity, it is unknown if this also decreases ground reaction forces by shock absorption during landing. This study aimed to determine whether increasing FHL muscle activity affects ground reaction force during landing in healthy subjects. Eight subjects performed single-leg steps onto a force platform for five trials, with and without flexion of the metatarsophalangeal (MTP) joint at the moment of landing. Integrated surface electromyography (sEMG) of the FHL and medial gastrocnemius (MG) and ground reaction forces (GRFs) were measured. sEMG and GRF during the 50 ms before and 100 ms following initial ground contact were analyzed and compared. Flexion of the MTP joint condition significantly decreased the vertical and mediolateral force peaks of GRF, and FHL muscle activity increased. Flexion of the MTP joint at the moment of landing reduces GRF in healthy subjects through force dissipation in the foot, by increased FHL muscle activity. The results suggest that this may contribute to injury prevention by reducing the impact force through flexing the MTP joint at the moment of landing.
Effect of the Membrane Composition of Giant Unilamellar Vesicles on Their Budding Probability: A Trade-Off between Elasticity and Preferred Area Difference
Authors: Miele Ylenia , Holló Gábor , Lagzi István , Rossi Federico
Published: June 2021

The budding and division of artificial cells engineered from vesicles and droplets have gained much attention in the past few decades due to an increased interest in designing stimuli-responsive synthetic systems. Proper control of the division process is one of the main challenges in the field of synthetic biology and, especially in the context of the origin of life studies, it would be helpful to look for the simplest chemical and physical processes likely at play in prebiotic conditions. Here we show that pH-sensitive giant unilamellar vesicles composed of mixed phospholipid/fatty acid membranes undergo a budding process, internally fuelled by the urea–urease enzymatic reaction, only for a given range of the membrane composition. A gentle interplay between the effects of the membrane composition on the elasticity and the preferred area difference of the bilayer is responsible for the existence of a narrow range of membrane composition yielding a high probability for budding of the vesicles.
Effect of Heat Input on the Ballistic Performance of Armor Steel Weldments
Authors: Savic Branko , Cabrilo Aleksandar
Published: June 2021

The purpose of this study is to examine the projectile penetration resistance of the base metal and heat-affected zones of armor steel weldments. To ensure the proper quality of armor steel welded joints and associated ballistic protection, it is important to find the optimum heat input for armor steel welding. A total of two armor steel weldments made at heat inputs of 1.29 kJ/mm and 1.55 kJ/mm were tested for ballistic protection performance. The GMAW welding carried out employing a robot-controlled process. Owing to a higher ballistic limit, the heat-affected zone (HAZ) of the 1.29 kJ/mm weldment was found to be more resistant to projectile penetration than that of the 1.55 kJ/mm weldment. The ballistic performance of the weldments was determined by analyzing the microstructure of weldment heat-affected zones, the hardness gradients across the weldments and the thermal history of the welding heat inputs considered. The result showed that the ballistic resistance of heat affected zone exist as the heat input was decreased on 1.29 kJ/mm. It was found that 1.55 kJ/mm does not have ballistic resistance.
Qualitative Comparison of 2D and 3D Atmospheric Corrosion Detection Methods
Authors: De Kerf Thomas , Hasheminejad Navid , Blom Johan , Vanlanduit Steve
Published: June 2021

In this article, we report the use of a Confocal Laser Scanning Microscope (CLSM) to apply a qualitative assessment of atmospheric corrosion on steel samples. From the CLSM, we obtain high-resolution images, together with a 3D heightmap. The performance of four different segmentation algorithms that use the high-resolution images as input is qualitatively assessed and discussed. A novel 3D segmentation algorithm based on the shape index is presented and compared to the 2D segmentation algorithms. From this analysis, we conclude that there is a significant difference in performance between the 2D segmentation algorithms and that the 3D method can be an added value to the detection of corrosion.
Hyaluronate Functionalized Multi-Wall Carbon Nanotubes Loaded with Carboplatin Enhance Cytotoxicity on Human Cancer Cell Lines
Authors: Leyva-González César Adrián , Salas-Treviño Daniel , Contreras-Torres Flavio Fernando , Loera-Arias María de Jesús , Gómez-Tristán Christian Alexis , Piña-Mendoza Edgar Iván , García-Rivas Gerardo de Jesús , Guillén-Meléndez Gloria Arely , Montes-de-Oca-Luna Roberto , Saucedo-Cárdenas Odila , Soto-Domínguez Adolfo
Published: June 2021

Cancer is a major global public health problem and conventional chemotherapy has several adverse effects and deficiencies. As a valuable option for chemotherapy, nanomedicine requires novel agents to increase the effects of antineoplastic drugs in multiple cancer models. Since its discovery, carbon nanotubes (CNTs) are intensively investigated for their use as carriers in drug delivery applications. This study shows the development of a nanovector generated with commercial carbon nanotubes (cCNTs) that were oxidized (oxCNTs) and chemically functionalized with hyaluronic acid (HA) and loaded with carboplatin (CPT). The nanovector, oxCNTs–HA–CPT, was used as a treatment against HeLa and MDA–MB-231 human tumor cell lines. The potential antineoplastic impact of the fabricated nanovector was evaluated in human cervical adenocarcinoma (HeLa) and mammary adenocarcinoma (MDA-MB-231). The oxCNTs–HA–CPT nanovector demonstrate to have a specific antitumor effect in vitro. The functionalization with HA allows that nanovector bio–directed towards tumor cells, while the toxicity effect is attributed mainly to CPT in a dose-dependent manner.
Investigation of the Relationship between Morphology and Thermal Conductivity of Powder Metallurgically Prepared Aluminium Foams
Authors: Gopinathan Arun , Jerz Jaroslav , Kováčik Jaroslav , Dvorák Tomáš
Published: June 2021

Among different promising solutions, coupling closed-cell aluminium foam composite panels prepared by a powder metallurgical method with pore walls interconnected by microcracks, with low thermal conductivity phase change materials (PCMs), is one of the effective ways of increasing thermal conductivity for better performance of thermal storage systems in buildings. The internal structure of the foam formation, related to the porosity which decides the heat transfer rate, plays a significant role in the thermal energy storage performance. The dependence of the heat transfer characteristics on the internal foam structure is studied numerically in this work. The foamable precursor of 99.7% pure aluminium powder mixed with 0.15 wt.% of foaming agent, TiH2 powder, was prepared by compacting, and extruded to a volume of 20 × 40 × 5 mm. Two aluminium foam samples of 40 × 40 × 5 mm were examined with apparent densities of 0.7415 g/cm3 and 1.62375 g/cm3. The internal porous structure of the aluminium foam samples was modelled using X-ray tomography slices through image processing techniques for finite element analysis. The obtained numerical results for the heat transfer rate and effective thermal conductivity of the developed surrogate models revealed the influence of porosity, struts, and the presence of pore walls in determining the heat flow in the internal structure of the foam. Additionally, it was found that the pore size and its distribution determine the uniform heat flow rate in the entire foamed structure. The numerical data were then validated against the analytical predictions of thermal conductivity based on various correlations. It has been found that the simplified models of Bruggemann and Russell and the parallel–series model can predict the excellent effective thermal conductivity results of the foam throughout the porosity range. The optimal internal foam structure was studied to explore the possibilities of using aluminium foam for PCM-based thermal storage applications.
Comprehensive Research and Analysis of a Coated Machining Tool with a New TiAlN Composite Microlayer Using Magnetron Sputtering
Authors: Michna Štefan , Hren Iryna , Novotný Jan , Michnová Lenka , Švorčík Václav
Published: June 2021

The application of thin monolayers helps to increase the endurance of a cutting tool during the drilling process. One such trendy coating is TiAlN, which guarantees high wear resistance and helps to “smooth out” surface defects. For this reason, a new type of weak TiAlN microlayer with a new composition has been developed and applied using the HIPIMs magnetron sputtering method. The aim of this study was to analyze surface-applied micro coatings, including chemical composition (EDX) and microstructure in the area of the coatings. Microstructural characterization and visualization of the surface structures of the TiAlN layer were performed using atomic force microscopy. To study the surface layer of the coatings, metallographic cross-sectional samples were prepared and monitored using light and electron microscopy methods. The microhardness of the test layer was also determined. Analyses have shown that a 2-to-4-micron thick monolayer has a microhardness of about 2500 HV, which can help increase the life of cutting tools.
The Influence of Polymer Composition on the Hydrolytic and Enzymatic Degradation of Polyesters and Their Block Copolymers with PDMAEMA
Authors: Kupczak Maria , Mielańczyk Anna , Neugebauer Dorota
Published: June 2021

Well-defined, semi-degradable polyester/polymethacrylate block copolymers, based on ε-caprolactone (CL), d,l-lactide (DLLA), glycolide (GA) and N,N′-dimethylaminoethyl methacrylate (DMAEMA), were synthesized by ring-opening polymerization (ROP) and atom transfer radical polymerization. Comprehensive degradation studies of poly(ε-caprolactone)-block-poly(N,N′-dimethylaminoethyl methacrylate) (PCL-b-PDMAEMA) on hydrolytic degradation and enzymatic degradation were performed, and those results were compared with the corresponding aliphatic polyester (PCL). The solution pH did not affect the hydrolytic degradation rate of PCL (a 3% Mn loss after six weeks). The presence of a PDMAEMA component in the copolymer chain increased the hydrolysis rates and depended on the solution pH, as PCL-b-PDMAEMA degraded faster in an acidic environment (36% Mn loss determined) than in a slightly alkaline environment (27% Mn loss). Enzymatic degradation of PCL-b-PDMAEMA, poly(d,l-lactide)-block-poly(N,N′-dimethylaminoethyl methacrylate) (PLA-b-PDMAEMA) and poly(lactide-co-glycolide-co-ε-caprolactone)-block-poly(N,N′-dimethylaminoethyl methacrylate) (PLGC-b-PDMAEMA) and the corresponding aliphatic polyesters (PCL, PLA and PLGC) was performed by Novozyme 435. In enzymatic degradation, PLGC degraded almost completely after eleven days. For polyester-b-PDMAEMA copolymers, enzymatic degradation primarily involved the ester bonds in PDMAEMA side chains, and the rate of polyester degradation decreased with the increase in the chain length of PDMAEMA. Amphiphilic copolymers might be used for biomaterials with long-term or midterm applications such as nanoscale drug delivery systems with tunable degradation kinetics.
Rheology of Cement Pastes with Siliceous Fly Ash and the CSH Nano-Admixture
Authors: Szostak Bartosz , Golewski Grzegorz Ludwik
Published: June 2021

The use of fly ash in cement composites adversely affects its mechanical properties during the first days of mixture curing. Modern technology, in the form of an admixture containing the hydrated calcium silicates, allows to accelerate the hardening and binding process of concrete. In this paper, studies on the influence of the admixture on properties of concretes with the ordinary Portland cements (OPC) containing the addition of siliceous fly ash (FA) have been carried out. As part of the experimental research, the authors conducted a series of studies for cement pastes modified with the addition of FA and the CSH nano-admixture (NA). In order to compare the mixtures, the following tests of cement pastes were carried out: the compressive and flexural strength, heat of hydration, SEM and rheological shrinkage. The mechanical parameters were tested after 4, 8, 12 and 24 h. The hydration heat test and microstructure analysis were carried out during the first 24 h of the concrete curing. All tests were carried out on the standard samples. On the basis of the heat of hydration test, much higher hydration heat was found in mixtures modified with the NA. During the shrinkage test, a positive effect of the NA was observed—the shrinkage during the first 28 days of mixture curing was lower than in the reference samples. The application of the CSH nano-admixture to cement pastes with the addition of FA has brought positive effects. Apart from a significant increase in strength in the first 24 h of mixture curing, a reduction in the rheological shrinkage was observed. The admixture can be successfully used in the ash concretes, in which a higher early strength is required.
Investigation of Ib-Values for Determining Fracture Modes in Fiber-Reinforced Composite Materials by Acoustic Emission
Authors: Jung Doyun , Yu Woong-Ryeol , Na Wonjin
Published: June 2021

This study analyzed failure behavior using Ib-values obtained from acoustic emission (AE) signals. Carbon fiber/epoxy specimens were fabricated and tested under tensile loads, during which AE signals were collected. The dominant peak frequency exhibited a specific range according to fracture mode, depending on the fiber structures. Cross-ply specimens, with all fracture modes, were used and analyzed using b- and Ib-values. The b-values decreased over the specimens’ entire lifetime. In contrast, the Ib-values decreased to 60% of the lifetime, and then increased because of the different fracture behaviors of matrix cracking and fiber fracture, demonstrating the usefulness of Ib-values over b-values. Finally, it was confirmed that abnormal conditions could be analyzed more quickly using failure modes classified by Ib-values, rather than using full AE data.