bluuebunny/crossref_metadata_2025 huggingface dataset:
Input voltage controlled full‐bridge series resonant converter for LED driver application
Authors: Kolla Hemasundara Rao , Vishwanathan Neti , Murthy Bhagwan K.
Published: February 2021

In this study, a phase shift controlled full‐bridge series resonant converter (SRC) integrated with buck converters for light‐emitting diode (LED) driver application is proposed. This LED driver supplies four LED loads simultaneously. The current through LED loads is controlled by phase shift control of the SRC, and its output is added to the input voltage. Zero‐voltage switching (ZVS) switching of all the switches is achieved by operating the SRC at lagging power factor for all input voltage variations. As the only part of the output power is processed through the SRC and all the switches operating with ZVS, the efficiency of the converter is 95.7%, which is high. A 142 W LED driver is designed, and its performance is tested with PSPICE simulations and experimental prototype.
Design and parameter configuration of modular multilevel dynamic DC transformer for renewable energy sources
Authors: Li Bin , Lyu Huijie , He Jiawei , Zhang Weixin , Wu Tonghua , Dai Wei , Li Xindong
Published: February 2021

DC transformer plays a significant role in DC distributed network. This study proposes a modular multilevel dynamic DC transformer (MMDT), which can realise smooth control of transformer ratio, multi‐level voltage conversion, and reliable fault isolation without high‐frequency transformers and extra loss. The inner circuit, formed by the capacitors, not only realises the energy exchange between different sides but also provides the capability of fault isolation. In the proposed MMDT, the voltage transforming is realised by switching to different numbers of control units (CUs) on each side. To realise multi‐level voltage transforming, the multi‐port MMDT is developed. Furthermore, this study offers analyses of the current and voltage characteristics in steady‐state and investigates the parameter design method in detail. Finally, the simulation and experiment tests are conducted to verify the feasibility and superiority of the proposed MMDT.
Design of highly compact short‐time duty power inductors for supercapacitor charging applications
Authors: Zhang Xinsheng , Wang Ruitian , Xiao Fei , Fan Xuexin , Yang Guorun , Yang Beichao
Published: February 2021

For medium‐voltage, large‐capacity, multi‐output supercapacitor charging applications, power inductors play an important role in filtering and energy storage. For a short‐time duty power inductor, the major design challenge is accurate transient thermal prediction, which goes beyond the scope of the empirical method. A transient thermal model that considers water‐cooling plates was constructed to predict thermal performance. On this basis, this study presents a novel multi‐objective optimisation design method, where the analytical method and the finite‐element method were combined through programming control to balance accuracy and efficiency. Furthermore, a short‐time duty 400 kW/182 A/2 kHz/15 kV power inductor prototype was designed and manufactured. Compared with the results of the 30‐minute thermal experiment, the calculation error is no >7.0%, which is significant for the accurate and highly compact design of the short‐time duty power inductor.
Estimation of electric and magnetic fields in a 230 kV electrical substation using spatial interpolation techniques
Authors: Fontgalland Glauco , de Andrade Humberto D. , de Figueiredo Ana L. , Queiroz Idalmir de S. , De Oliveira Alexandre H. S. , Paiva José L. S. , Sousa Matheus E. T.
Published: February 2021

This study presents the estimation of the electric and magnetic fields level inside a 400 MVA electrical substation. Located in the northeast region of Brazil, the power plant operates with 230 and 69 kV at 60 Hz frequency. The on‐site measurements were performed at previously selected locations covering the whole courtyard and followed the international and national regulatory standards. The electrical and magnetic fields 2‐D contour maps over the entire courtyard are presented, which allow better visualisation and analysis of the exposure levels around all equipment. By using the GoldenSurfer V.13 tool, eight interpolation methods were applied to predict unsampled locations. The plots were made using the method that best fit the sampled dataset after the cross‐validation technique is used. The measurements were taken during six days during a period of 16 h on 741 locations. For this electrical substation, the maps validate the high electric field level close to breakers and switches at 230 kV and high magnetic field close to equipment operating at 69 kV. The comparison between the exposure levels and those established in current guidelines indicate that the electromagnetic environment on this substation is safe for the occupational population as well as for the general public.
Data reduction algorithm for correlated data in the smart grid
Authors: Pourmirza Zoya , Walker Sara , Brooke John
Published: February 2021

Smart grids are intelligent electrical networks that incorporate information and communication technology (ICT) to provide data services for the power grid. In this paper, the ICT requirements for monitoring and control of the neighbourhood area network level of the smart grid, with particular emphasis on making the ICT infrastructure energy efficient, are analysed. One approach to provide energy efficiency in the communication system is to develop a data reduction algorithm to reduce the volume of data prior to transmission. Thus, a data compression technique called DRACO (data reduction algorithm for correlated data) that shows a reasonable compression ratio while using network resources efficiently is designed and developed. DRACO can be applied to data with a high data sampling rate, and can transmit the essential information with compression ratios of 70%–99%. The results of applying DRACO on real data collected by devices located in the University of Manchester campus are discussed, followed by the evaluation and validation of DRACO by comparing it with other available techniques. Finally, it is concluded that DRACO is suitable for smart grid applications since it optimizes the network resource consumption and reduces the communication energy cost while maintaining the integrity and quality of data.
Pitch-angle distribution of accelerated electrons in 3D current sheets with magnetic islands
Authors: Zharkova V. , Xia Q.
Published: February 2021

Aims. This research aims to explore variations of electron pitch-angle distributions (PADs) during spacecraft crossing of reconnecting current sheets (RCSs) with magnetic islands. Our results can benchmark the sampled characteristic features with realistic PADs derived from in situ observations.

Methods. Particle motion is simulated in 2.5D Harris-type RCSs using the particle-in-cell method and considering the plasma feedback to electromagnetic fields induced by accelerated particles. We evaluate particle energy gains and PADs in different locations with virtual spacecraft passing the current sheet while moving in the different directions. The RCS parameters are comparable to heliosphere and solar wind conditions.

Results. The energy gains and the PADs of particles would change depending on the specific topology of the magnetic fields. In addition, the observed PADs also depend on the crossing paths of the spacecraft. When the guiding field is weak, the bi-directional electron beams (strahls) are mainly present inside the islands and are located just above or below the X-nullpoints in the inflow regions. The magnetic field relaxation near the X-nullpoint alters the PADs towards 90°. As the guiding field becomes larger, the regions with bi-directional strahls are compressed towards small areas in the exhausts of RCSs. Mono-directional strahls are quasi-parallel to the magnetic field lines near the X-nullpoint due to the dominant Fermi-type magnetic curvature-drift acceleration. Meanwhile, the high-energy electrons confined inside magnetic islands create PADs of around 90°.

Conclusions. Our results link the electron PADs to local magnetic structures and the directions of spacecraft crossings. This can help to explain a variety of the PAD features reported in recent observations in the solar wind and the Earth’s magnetosphere.
Infrared action spectroscopy of doubly charged PAHs and their contribution to the aromatic infrared bands
Authors: Banhatti S. , Palotás J. , Jusko P. , Redlich B. , Oomens J. , Schlemmer S. , Brünken S.
Published: February 2021

The so-called aromatic infrared bands (AIBs) are attributed to emission of polycyclic aromatic hydrocarbons (PAHs). The observed variations toward different regions in space are believed to be caused by contributions of different classes of PAH molecules, that is to say with respect to their size, structure, and charge state. Laboratory spectra of members of these classes are needed to compare them to observations and to benchmark quantum-chemically computed spectra of these species. In this paper we present the experimental infrared (IR) spectra of three different PAH dications, naphthalene2+, anthracene2+, and phenanthrene2+, in the vibrational fingerprint region 500–1700 cm−1. The dications were produced by electron impact ionization of the vapours with 70 eV electrons, and they remained stable against dissociation and Coulomb explosion. The vibrational spectra were obtained by IR predissociation of the PAH2+ complexed with neon in a 22-pole cryogenic ion trap setup coupled to a free-electron infrared laser at the Free-Electron Lasers for Infrared eXperiments (FELIX) Laboratory. We performed anharmonic density-functional theory calculations for both singly and doubly charged states of the three molecules. The experimental band positions showed excellent agreement with the calculated band positions of the singlet electronic ground state for all three doubly charged species, indicating its higher stability over the triplet state. The presence of several strong combination bands and additional weaker features in the recorded spectra, especially in the 10–15 μm region of the mid-IR spectrum, required anharmonic calculations to understand their effects on the total integrated intensity for the different charge states. These measurements, in tandem with theoretical calculations, will help in the identification of this specific class of doubly-charged PAHs as carriers of AIBs.
Experimental study of loop shape using 0.025-inch ERCP guidewires (with videos)
Authors: Ogura Takeshi , Ueno Saori , Okuda Atsushi , Nishioka Nobu , Yamada Tadahiro , Yamada Masanori , Ueshima Kazuya , Matsuno Jun , Yamamoto Yoshitaro , Higuchi Kazuhide
Published: February 2021

Background and study aims Duct penetration by the guidewire sometimes occurs during endoscopic retrograde cholangiography, which might lead to adverse events such as acute pancreatitis. To prevent duct penetration, making a loop shape with the guidewire might provide a useful technique. The aim of this experimental study was thus to evaluate which types of guidewire can most easily form a loop shape.

Methods This experimental study evaluated six guidewires (0.025-inch, angle type): MICHISUJI; VisiGlide 2; Jagwire; Pathcorse; RevoWave-α UltraHard 2; and M-through. Flexibility of the tip, shaft stiffness, and the ability to form a loop were evaluated for each type in an ex vivo model. Deformation behavior was also recorded on video, and factors suitable for making a loop shape in each guidewire were evaluated.

Results Flexibility and stiffness of each guidewire differed significantly. During an experimental study regrading deformation behavior before forming a loop shape, maximum load was lower for MICHISUJI (6.8 g) than for other guidewires (Jagwire [11.3 g], M-through [12.9 g], VisiGlide 2 [12.9 g], Revowave [21 g], and Pathcorse [25.4 g]). Mean time required to achieve a loop shape was as follows: MICHISUJI, 6.2 seconds; M-through, 8.7 seconds; VisiGlide 2, 11.0 seconds; and Revowave, 7.1 seconds.

Conclusion In conclusion, characteristics of flexibility and stiffness among guidewires were significantly different in the ex-vivo study. In the experimental study regrading deformation behavior until achieving a loop shape, maximum load also differed. To evaluate whether guidewires easily form a loop shape, clinical study is needed.
Outpatient ESD for challenging colorectal lesions: Is it feasible and safe for western countries?
Authors: Pecere Silvia , Barbaro Federico , Petruzziello Lucio , Papparella Luigi Giovanni , Napoli Marco , Boskoski Ivo , Costamagna Guido
Published: February 2021

Background and study aims The need for hospital beds during the COVID-19 pandemic almost overwhelmed the health care systems all over the world. Therefore, elective non-life-saving procedures were postponed. We decided to perform all colorectal endoscopic mucosal dissections (ESDs) for challenging lesions as outpatient procedures, organizing an ad hoc path to management of any delayed post-procedural complications. The aim of the present study was to retrospectively evaluate the feasibility and safety of outpatient ESD for colorectal tumors.

Patients and methods From March 2020 to May 2020, outpatient colorectal ESDs were performed for 15 challenging lesions. We retrospectively investigated feasibility and safety of the procedures, rates of en bloc resection, and complications rates.

Results The mean age of the patients was 66.5 years and 40 % of the them were on antiplatelet/anticoagulation therapy. Median size of removed lesions was 45 mm (range 32–77) and 38 mm (range 24 to 55) Five patients (33 %) had rectal tumors extending to the dentate line and four (26.6 %) were recurrences on a scar of previous endoscopic or surgical local resections. All complications, such as bleeding or visible microperforation, were managed endoscopically and no delayed perforations occurred. One patient had fever (37.5 °C), while three patients complained of anal pain after ESD for a rectal tumor that extended to the dentate line (RTDL); all patients were managed conservatively.

Conclusion Outpatient colorectal ESD is feasible and safe for challenging lesions. It reduces costs of hospitalization but direct access to the endoscopy service to manage potential post-ESD complications should always be guaranteed.
Checklist feasibility and impact in gastrointestinal endoscopy: a systematic review and narrative synthesis
Authors: Bitar Véronique , Martel Myriam , Restellini Sophie , Barkun Alan , Kherad Omar
Published: February 2021

Background and study aim Checklists prevent errors and have a positive impact on patient morbidity and mortality in surgical settings. Despite increasing use of checklists in gastrointestinal endoscopy units across many countries, a summary of cumulated experience is lacking. The aim of this study was to identify and evaluate the feasibility of successful checklist implementation in gastrointestinal endoscopy units and summarise the evidence of its impact on the commitment in safety culture.

Methods A comprehensive literature search was performed identifying the use of a checklist or time-out in endoscopy units from 1978 to January 2020 using OVID MEDLINE, EMBASE, and ISI Web of Knowledge databases, with search terms related to checklist and endoscopy. We summarised overall adherence to checklists from included studies through a narrative synthesis, characterizing barriers and facilitators according to nurse and physician perspectives, while also summarizing safety endpoints.

Results The seven studies selected from 673 screened citations were highly heterogeneous in terms of methodology, context, and outcomes. Across five of these, checklist adherence rates post-intervention varied for both nurses (84 % to 96 %) and physicians (66 % to 95 %). Various facilitators (education, continued reassessment) and barriers (lack of safety culture, checklist completion time) were identified. Most studies did not report associations between checklist implementation and clinical outcomes, except for better team communication.

Conclusion Implementation of a gastrointestinal endoscopy checklist is feasible, with an understanding of relevant barriers and facilitators. Apart from a significant increase in the perception of team communication, evidence for a measurable impact attributable to gastrointestinal checklist implementation on endoscopic processes and safety outcomes is limited and warrants further study.
Incidence of Retinal Detachment after Macular Surgery
Authors: Grajewski Luise , Grajewski Olaf , Carstens Jens , Krause Lothar
Published: February 2021

Macular surgery has become an increasingly atraumatic procedure for the eye with the surgical methods that have been further developed in recent years. The most common complications include cystoid macular oedema and retinal detachment, more rarely endophthalmitis. The aim of this retrospective study is to record the number of retinal detachments following elective macular surgery. In this study we included all patients who underwent pars plana vitrectomy (ppV, 20 or 25 gauge) in the years 2009 – 2016. We then identified the patients who were hospitalised again because of retinal detachment. For the affected patients, the rate of retinal detachment, functional outcomes and possible risk factors were recorded. A total of 904 eyes were identified, of which 667 had surgery for epiretinal membrane, 188 for macular hole, and 49 for vitreomacular traction with a 20 or 25 gauge ppV. Of these 904, retinal detachment occurred in 17 (1.88%) cases. The mean time between first ppV
and second ppV with retinal detachment was 248 days (3 – 1837 days). Two of the 17 patients had at least one retinal break before or during surgery. The retinal break was located inferior in six cases, superior in four; in four cases PVR retinal detachment and in three cases the foramina were distributed. Mean visual acuity was 0.27 (decimal) before macular surgery and 0.28 at the time of last presentation. Modern vitrectomy techniques reduce the complications in elective macular surgery, but do not replace the surgeonʼs experience.
Evaluation of the Significance of Tear Ferning Patterns in beta-Thalassemia Patients
Authors: Fagehi Raied , Abbadi Ibrahim M. , Abusharha Ali , Alanazi Mana A. , Malhan Hafiz , El-Hiti Gamal A. , Masmali Ali M.
Published: February 2021

Aim This study was designed to evaluate the tear film in beta-thalassemia patients using tear ferning (TF) and phenol red thread (PRT) tests.

Methods Forty beta-thalassemia patients, aged 18 – 38 years (25.7 ± 6.0 years), along with a control group of 40 age-matched subjects with healthy eyes completed the study. All subjects completed the ocular surface disease index (OSDI) first, followed by the TF and PRT tests with a 5-minute gap between the tests.

Results Significant differences (Wilcoxon test, p < 0.05) were observed between the beta-thalassemia and control groups in all scores. Among beta-thalassemia patients, OSDI scores indicated eye dryness in 35 subjects (87.5%). PRT showed dryness in 31 subjects (77.5%) in the right and left eyes, and the TF grades were ≥ 2 for the tears collected from 35 subjects (87.5%). There was a strong correlation (r = 0.851, p = 0.001) between the PRT measurements in the right and left eyes. There was a medium correlation between OSDI and TF scores (r = 0.309, p = 0.026) and between OSDI and age (r = 0.365, p = 0.010). Age had a moderate negative correlation (r = − 0.328, p = 0.019) with the PRT obtained from the right eye.

Conclusion Significant ocular dryness symptom was observed in beta-thalassemia patients, based on the scores collected from TF and PRT tests. Beta-thalassemia patients develop dry eyes, possibly due to several factors, including reduced tear secretion. Therefore, it is important to regularly evaluate both the quality and quantity of tears in patients with beta-thalassemia.
Eletromiografia do músculo peitoral maior após reconstrução cirúrgica da ruptura crônica do tendão
Authors: Ejnisman Benno , Andreoli Carlos Vicente , Belangero Paulo Santoro , Komatsu William Ricado , Hipolide Debora Cristina , Pochini Alberto de Castro
Published: February 2021

Objetivo Avaliar a atividade eletrofisiológica do músculo peitoral maior (PM) lesionado de pacientes operados que realizam halterofilismo, mais especificamente exercícios de supino, especialmente a atividade das porções clavicular e esternocostal do PM.

Métodos Todos os atletas no estudo I (10 pacientes) tiveram rupturas completas unilaterais durante o exercício de supino, e tinham histórico de uso de esteroides anabolizantes, associação descrita em até 86,7% das rupturas tendinosas do PM. O grupo controle incluiu 10 homens sem lesão no tendão do PM que não realizaram exercícios de supino. Descrição do projeto transversal. Os valores de p foram obtidos por múltiplas comparações com a correção de Bonferroni.

Resultados Na comparação entre o grupo controle (C) e os halterofilistas durante o pós-operatório (POS), não foram encontradas diferenças nas medidas obtidas nas porções clavicular e esternocostal do músculo PM: nível médio clavicular (p = 0,847); desvio padrão (DP) clavicular (p = 0,777); área clavicular (p = 0,933); mediana da clavícula (p = 0,972); nível médio esternocostal (p = 0,633); DP esternocostal (p = 0,602); área esternocostal (p = 0,931); e mediana esternocostal (p = 0,633).

Conclusão Neste estudo, a atividade eletromiográfica do músculo PM em atletas de halterofilismo (exercício de supino) que foram submetidos a cirurgia esteve dentro dos parâmetros normais para as porções claviculares e esternocostais estudadas.
Barrier for Particle Dispersion Control During Mastoidectomy
Authors: Muniz Camila Rêgo , Pena Carlos Felype Oliveira , da Fonseca Marcio Ribeiro Studart , de Freitas Marcos Rabelo
Published: February 2021

Introduction The China Health Authority alerted the World Health Organization (WHO) of several cases of pneumonia, and the WHO has declared the novel coronavirus (COVID-19) a global pandemic. Mastoidectomy is a high-risk aerosol generating procedure with the potential to expose the surgeon to infectious particles.

Objective Aim to develop a low-cost prototype for a barrier device that can be used during mastoidectomy.

Methods Describe the steps involved during otological emergency, requiring immediate surgical procedure, in untested patients. The Otorhinolaryngology Surgical Team of Walter Cantídio Hospital developed the barrier for particle dispersion presented here.

Results During surgery, the prototype did not compromise visualization of the surgical field and instrumentation. Microscope repositioning was not compromised or limited by tent Instrumentation and instrument pouch under the Microscope-Tent (MT) performed surgery. After surgery, the plastic sheet was removed simply, without requiring strength. Bone dust and irrigation droplets were collected on the tent.

Conclusion Our team developed and practiced, in an otologic emergency, a low-cost and reproducible barrier device that can be used in mastoidectomy in COVID-19 patients. Further tests on efficacy may be necessary.
Correlation between Serum Interleukin-17 level and Serum Reactive Oxygen Species levels among Children experiencing Otitis Media with Effusion
Authors: Abdelhafeez Marwa , Mohamed Noura Mostafa
Published: February 2021

Introduction The detection of inflammatory mediators in the serum of children with have otitis media with effusion (OME) and their correspondence with clinical considerations may enable the use of a modern nonsurgical curative treatment for OME.

Objective To determine the relation between interleukin-17 (IL-17) serum level and reactive oxygen species (ROS) serum levels in children suffering from OME and to disclose if any variation occurs in the level of IL-17 Will affect the ROS and antioxidant equilibrium in the serum, which indicates the entire body's reaction to OME.

Methods The present study was a case-control study. A total of 24 children experienced OME, and 24 healthy controls were recruited.

All participants in the study were subjected to a systematic clinical investigation including otoscopic, audiometric, and tympanometric examination. Also, venous blood samples were collected from all children to determine the levels of IL-17 and ROS.

Results The mean ± standard deviation (SD) age ranges of the patients and the control group were 6.8 ± 2.7 and 6.2 ± 3.4 years, respectively. A stylistically significant difference in the levels of serum nitric oxide (NO), catalase (CT), myeloperoxidase (MPO), and malondialdehyde (MDA) (p < 0.05) was detected between OME and control patients. No significant difference was found in serum levels of superoxide dismutase (SOD) and glutathione peroxidase (GPX) between OME and control patients. The serum levels of MDA, NO, and MPO positively correlated with the serum levels of IL-17 in OME patients.

Conclusion In the present study, there is a reasonable role of the IL-17 pathway in OME pathogenesis through an increase in ROS levels.
Challenges in Management of Tracheobronchial Foreign Bodies with Delayed Presentation: An Institutional Experience
Authors: Kaushal Darwin , Goyal Amit , Soni Kapil , Choudhury Bikram , Nair Nithin Prakasan , Kumar Prawin , Vaithankalath Sameema V.
Published: February 2021

Introduction Airway foreign bodies are emergencies involving multidisciplinary departments like Pediatrics, Aneasthesiology and Otorhinolaryngology. It is always a challenge to diagnose and manage patients who present late to our emergencies.

Objective In the present study, we aim to analyze the various challenges faced during the management of tracheobronchial foreign bodies with delayed presentation.

Methods A retrospective hospital record-based analysis of patients who presented to us with tracheobronchial foreign bodies from January 2017 to February 2020 was performed. All patients until the age of 16 years old were included in the present study. We assessed the demographics, preoperative, intraoperative and postoperative data of the patients.

Results Seventeen patients were analyzed in the study. Among these, 44.4% of the patients had delayed presentation (> 1 month). The majority of the patients had an organic foreign body (Supari or betel nut). All patients underwent rigid bronchoscopy, followed by optical forceps-assisted removal of the foreign body. A total of 82% of the patients had granulations around the foreign body.

Conclusion Management of delayed presentation tracheobronchial foreign body is a big challenge for Otorhinolaryngologists. The key factors for preventing complications in the definitive management of tracheobronchial foreign bodies are preoperative planning, multi-discipline teamwork, surgeon expertise and technique.
The Associations of Tonsillectomy with Adenoidectomy with Pneumonia and Appendicitis Based on National Sample Cohort Data from the Korean National Health Insurance Service
Authors: Jeong Junhui , Choi Jung Kyu , Choi Hyun Seung , Hong Chang Eui , Shin Hyang Ae , Chang Jung Hyun
Published: February 2021

Introduction The association between tonsillectomy with adenoidectomy (T&A) with appendicitis is controversial, and the association of T&A with pneumonia has not been investigated.

Objective To investigate the associations of T&A with pneumonia and appendicitis using data from the Korean National Health Insurance Service National Sample Cohort.

Methods We selected patients between the ages of 3 and 10 years who had undergone T&A in 2005 and were monitored since the performance of the T&A until 2013. The control group was established to have similar propensities for demographic characteristics compared to the T&A group. For eight years after the T&A, the number of patients with a diagnosis of pneumonia, patients who were admitted due to pneumonia, and those who underwent appendectomy were analyzed. The risk factors for pneumonia and appendectomy were analyzed.

Results The number of pneumonia diagnoses was significantly higher in the T&A group than in the control group (p = 0.023), but there were no significant differences in the number of admissions due to pneumonia between the 2 groups (p = 0.155). Younger age and T&A were significant risk factors for the development of pneumonia. There were no significant differences in the number of appendectomies between the T&A and the control groups (p = 0.425), neither were there significant risk factors for appendectomy.

Conclusion Tonsillectomy with adenoidectomy was associated with an increase in pneumonia diagnoses, but it was not associated with the number of appendectomies. The associations of T&A with pneumonia and appendicitis were analyzed in this population-based study.
Factors Associated with Tobacco Cessation in Primary Health Care
Authors: Melnick Ricardo , Rech Gabriela Soares , Rech Rafaela Soares , Faustino-Silva Daniel Demétrio
Published: February 2021

Introduction Cigarettes are the main cause of preventable death in the world, and primary health care services can contribute to the management of this habit.

Objective To describe and analyze the factors associated with tobacco cessation in groups of smokers in primary health care.

Methods The present is a cross-sectional study conducted in 12 primary health care units from July 2016 to May 2017. We investigated sociodemographic and health variables, as well as smoking characteristics and different interventions for tobacco cessation, with the outcome being studied and analyzed after the fourth group care session.

Results We evaluated 329 smokers, of which 182 quit smoking after the fourth interview. Most of the individuals who quit smoking were women (n = 121, 66.5%), with a monthly income of 2 to 5 minimum wages (n = 88, 77.9%). After the multivariable analysis, we observed that tobacco cessation was significantly associated with depression (prevalence ratio [PR] = 1.11; 95% confidence interval [95%CI] = 1.02 to 1.22), as well as with belonging to the groups which used as approaches motivational interviewing (PR = 1.21; 95%CI = 1.13 to 2.01), patches (PR = 1.36; 95%CI = 1.24 to 1.48), and bupropion (PR = 1.16; 95%CI = 1.03 to 1.31).

Conclusion Primary health care is the ideal site for the reduction of smoking rates, given that different technologies may be applicable and useful for tobacco cessation. The comprehensiveness and longitudinal care offered in primary care may provide opportunities for health professionals to understand which is the best technology for each health system user, thus contributing to personalized care.
Cervical Vestibular-Evoked Myogenic Potentials and Balance Testing in Children with Down Syndrome
Authors: Kaya Sule , Bas Banu , Er Serap , Keseroglu Kemal , Korkmaz Hakan
Published: February 2021

Introduction Vestibular otolith function plays a major role in balance control.

Objective To investigate the saccular and balance functions of children with Down syndrome (DS).

Methods In total, 15 children with DS aged between 9 and 11 years were included. An age- and gender-matched control group (CG) composed of 15 normal participants was also included. The subjects with DS had trisomy 21, without hearing or organic problems, and they had independence in stance. The saccular function among the children with DS and among the controls was tested using air-conduction cervical vestibular-evoked myogenic potentials (cVEMPs). In addition, the static and dynamic balance statuses were evaluated using the following assessments; the Pediatric Balance Scale (PBS), the modified Clinical Test of Sensory Interaction on Balance (mCTSIB), the Romberg test, and the Timed Up and Go (TUG) test.

Results In the present study, the results of the saccular function test showed that there was a significant difference between children with and without DS (p < 0.05). The DS subjects had significantly earlier N1 latancy and lower amplitude of the cVEMPs (< 70 μV) compared with the control subjects. The static-dynamic balance ability was statistically and significantly different in children with DS compared with the controls (p < 0.05).

Conclusion These results revealed that saccular function seems to be affected in DS subjects. The dysfunction in static and dynamic balance abilities of the children with DS may be attributed to vestibular dysfunction as well as low gross motor skills. This knowledge should be taken into account when assessing motor performance in those subjects. Additional larger studies testing other dimensions of the vestibular system in children with DS are needed.
Differences in Correlation between Subjective and Measured Olfactory and Gustatory Dysfunctions after Initial Ear, Nose and Throat Evaluation
Authors: Nørgaard Hans Jacob , Fjaeldstad Alexander Wieck
Published: February 2021

Introduction Subjective chemosensory function can differ from measured function. Previous studies on olfactory assessment have found a positive correlation between subjective and measured scores. However, information on gustatory correlation between measured and subjective functions is sparse in patients who have undergone an initial ear, nose and throat (ENT) evaluation.

Objectives To evaluate the correlation between subjective and measured olfactory and gustatory dysfunctions in a population complaining of taste and/or smell dysfunction after an initial ENT evaluation without chemosensory testing. Furthermore, we aimed to assess the need for chemosensory testing depending on the type of subjective chemosensory dysfunction.

Methods A case series in which subjective chemosensory function was assessed through a questionnaire and measured chemosensory function was assessed by validated clinical tests.

Results In total, 602 patients with complaints of olfactory and/or gustatory dysfunction were included. We found that 50% of the patients with normal gustatory function and an olfactory impairment classified their olfactory impairment as a subjective taste disorder. Furthermore, 98% of the patients who rated their olfactory function as absent did have a measurable olfactory impairment, but only 64% were anosmic.

Conclusion Subjective gustatory dysfunction was poorly correlated with measured gustatory dysfunction, and was often found to reflect olfactory dysfunction. Contrarily, subjective olfactory dysfunction was positively correlated with measurable olfactory dysfunction. Although subjective anosmia was a strong indicator of measured anosmia or hyposmia, the existence of remaining olfactory function was frequently found in these patients. Validated chemosensory testing should be performed in patients with perceived olfactory or gustatory deficits, as this could help ensure increased diagnostic precision and a relevant treatment.
Effectiveness and Adverse Effects of Tranexamic Acid in Bleeding during Adenotonsillectomy: A Randomized, Controlled, Double-blind Clinical Trial
Authors: Fornazieri Marco Aurélio , Kubo Henrique Kazuo Lima , de Farias Lisandra Coneglian , da Silva Adriano Morita Fernandes , Garcia Ellen Cristine Duarte , Santos Gustavo de Alcântara Lopes dos , Pinna Fábio de Rezende , Voegels Richard Louis
Published: February 2021

Introduction Intra and postoperative bleeding are the most frequent and feared complications in adenotonsillectomy (AT). Tranexamic acid (TXA), which is known for its antifibrinolytic effects, has a proven benefit in reducing bleeding in hemorrhagic trauma and cardiac surgery; however, the effectiveness and timing of its application in AT have not yet been established.

Objectives We aimed to evaluate the efficacy of TXA in controlling bleeding during and after AT and assess its possible adverse effects in children.

Methods The present randomized, controlled, double-blind clinical trial included 63 children aged 2 to 12 years. They were randomly assigned to receive either intravenous TXA (10 mg/kg) or placebo 10 minutes before surgery. The volume of intraoperative bleeding, presence of postoperative bleeding, and adverse effects during and 8 hours after the surgery were assessed.

Results No difference in bleeding volume was noted between the 2 groups (mean, 122.7 ml in the TXA group versus 115.5 ml in the placebo group, p = 0.36). No intraoperative or postoperative adverse effects were noted because of TXA use. Furthermore, no primary or secondary postoperative bleeding was observed in any of the participants.

Conclusion In our pediatric sample, TXA (10 mg/kg) administration before AT was safely used, without any adverse effects. It did not reduce the bleeding volume in children during this type of surgery. Future studies should assess the use of higher doses of TXA and its administration at other time points before or during surgery.
Clinical Pathways of Patients Denied Total Knee Arthroplasty Due to an Institutional BMI Cutoff
Authors: Wilson Charlie D. , Lundquist Kathleen F. , Baruch Nathan H. , Gaddipati Ravindra , Hammonds Kendall A.P. , Allen Bryce C.
Published: February 2021

Out of concern for the increased risk of complications with morbid obesity, institutional body mass index (BMI) cutoffs for total knee arthroplasty (TKA) have become commonplace. We sought to answer the questions: what percentage of morbidly obese patients with knee osteoarthritis who present to an arthroplasty clinic will, within 2 years, undergo TKA at (1) a BMI less than 40 kg/m2 or (2) at a BMI greater than 40 kg/m2? Of those who do not undergo surgery, (3) what percentage lose enough weight to become TKA-eligible, and (4) what percentage do not? We performed an observational study of 288 patients, of which 256 had complete follow-up. Institutional electronic medical record review and patient follow-up by telephone were conducted to determine which patients underwent surgery, and at what BMI. For those that did not undergo TKA, BMI was examined to see if the patient ever lost enough weight to become TKA eligible. Twelve of 256 patients (4.7%) underwent TKA at a BMI less than 40 kg/m2, 64 patients (25%) underwent TKA at a BMI greater than 40 kg/m2, and 7 patients (2.7%) underwent surgery at an outside hospital. The average BMI at the time of surgery was 42.3 kg/m2. Thirty-seven of 256 patients (14.4%) lost enough weight to become TKA-eligible within 2 years of the initial visit but did not undergo surgery, while 136 patients (53.1%) neither underwent TKA nor became eligible. Strict enforcement of a BMI cutoff for TKA is variable among surgeons. In the absence of weight loss protocols, 19.1% of morbidly obese patients may be expected to reach the sub-40 kg/m2 BMI milestone.
Subchondral Bone Condition and Intraoperative Grading of Cartilage Degeneration Underneath Patella Unrelated to the Clinical Outcome after TKA with Unresurfaced Patella
Authors: Park Hyung Jun , Chang Moon Jong , Kim Tae Woo , Chang Chong Bum , Kang Kee Soo , Kang Seung-Baik
Published: February 2021

The degree of cartilage degeneration assessed intraoperatively may not be sufficient as a criterion for patellar resurfacing in total knee arthroplasty (TKA). However, single-photon emission tomography/computed tomography (SPECT/CT) is useful for detecting osteoarthritic involvement deeper in the subchondral bone. The purpose of the study was to determine whether SPECT/CT reflected the cartilage lesion underneath the patella in patients with end-stage osteoarthritis (OA) and whether clinical outcomes after TKA without patellar resurfacing differed according to the severity of patellofemoral (PF) OA determined by visual assessment and SPECT/CT findings. This study included 206 knees which underwent TKA. The degree of cartilage degeneration was graded intraoperatively according to the International Cartilage Repair Society grading system. Subjects were classified into low and high uptake groups according to the degree of bone tracer uptake (BTU) on SPECT/CT in the PF joint. The Feller's patella score and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were assessed preoperatively and postoperative 1 and 2 years. The increased BTU in the PF joint was associated with more severe degenerative cartilage changes underneath the patella (p < 0.001). The risk for the presence of denudated cartilage was greater in the high uptake group (odds ratio = 5.89). There was no association between clinical outcomes and visual grading of patellar cartilage degeneration or the degree of BTU on SPECT/CT. The visual assessment of the degree of cartilage degeneration underneath the patella and preoperative SPECT/CT evaluation of the PF joint were not predictive of clinical outcome after TKA with unresurfaced patella.
Role of Inferior Vena Cava Parameters as Predictors of Fluid Responsiveness in Pediatric Septic Shock: A Prospective Study
Authors: EL-Nawawy Ahmed Ahmed , Omar Omneya Magdy , Hassouna Hadir Mohamed
Published: February 2021

Fluid resuscitation is the initial therapy for septic shock worldwide. Prediction of fluid responsiveness is essential for optimizing fluid administration. Only few pediatric studies have evaluated the role of inferior vena cava (IVC) as a reliable predictor of fluid responsiveness. The aim of this study was to evaluate the role of IVC parameters as predictors of fluid responsiveness in children (under the age of 5 years) having septic shock at different times from admission. A prospective observational study included 51 children having septic shock. It was conducted in the nine-bedded pediatric intensive care unit of a university hospital from January 1, 2018, to the August 31, 2018. Echocardiography was used to assess minimal and maximal IVC diameters and its distensibility index with simultaneous assessment of stroke volume (SV), at 1, 6, and 24 hours from admission. The decision to give fluid in these children was thereby based on the presence of at least one sign of inadequate tissue perfusion. SV was reassessed directly after administration of a fluid bolus of 10 mL/kg over 10 minutes. Fluid responsiveness was considered adequate when there was ≥ 10% increase in SV after fluid bolus. Minimal IVC diameter indexed to body surface area and its distensibility index can be predictors of fluid responsiveness at all times: 1 hour (area under curve [AUC] = 0.88; 95% confidence interval [CI] = 0.77–0.96), 6 hours (AUC = 0.86; 95% CI = 0.67–0.97), and 24 hours (AUC = 0.77; 95% CI = 0.6–0.95). IVC distensibility index can also predict fluid responsiveness at 1 hour (AUC= 0.87; 95% CI = 0.74–0.95), 6 hours (AUC = 0.86; 95% CI = 0.73–0.94), and 24 hours (AUC = 1; 95% CI = 0.77–1). The cutoff points of each parameter differed from time to time (contradicts with previous statement that says it is predictor at all times). The maximum IVC diameter could not predict fluid responsiveness at any time from admission. Minimal IVC diameter and its distensibility index were feasible noninvasive surrogates of fluid responsiveness in pediatric septic shock at different times from admission.
Lowe Syndrome: A Complex Clinical Diagnosis with a Novel Mutation in the OCRL Gene
Authors: Parikh Akanksha C. , Gadgil Pradnya
Published: February 2021

Lowe syndrome (LS) is a rare X-linked condition having a clinical triad of congenital cataracts, intellectual disability, and progressive tubular nephropathy. Although the easily recognizable symptom complex usually evolves by infancy, a unifying diagnosis is often missed. We present a young boy with a prolonged history of multisystem affection, finally leading to the clinical suspicion of LS. The diagnosis was confirmed on genetic analysis as well as a previously unreported mutation in the OCRL gene was discovered. A 9-year-old boy with intellectual disability and recent onset seizures was referred for the evaluation of rickets. In addition, there was a significant past history of neonatal cataracts, infantile glaucoma, persistent albuminuria, and severe short stature with growth hormone deficiency. The characteristic involvement of eyes, brain, and kidneys along with a family history of a maternal uncle being similarly affected led to the clinical suspicion of LS. A whole exome sequencing was performed, which not only confirmed a nonsense mutation, c.2530C > T, in exon 23 of the Lowe gene (OCRL) but also revealed it to be a novel pathogenic variant. This case highlights the importance of piecing together the different facets of a complex clinical syndrome in reaching a challenging diagnosis. Also, LS must be kept as a differential in any child with neonatal cataracts and intellectual disability. Genetic confirmation of LS in our patient partly relieved the parental anxiety, and the child continued to remain under follow-up with multiple specialists, only now with a definite diagnosis.
The 30-Minute Sprint: Recognizing Intrapartum Prematurity Counseling Limitations
Authors: Georgescu Abigail , Muthusamy Anbu , Basir Mir A.
Published: February 2021

Describe the characteristics and content of intrapartum counseling provided to women hospitalized for premature birth between 23 and 34 weeks' gestation age (GA). The study was conducted between April and December 2009 in two teaching hospitals with labor and delivery units and level 3 neonatal intensive care units. Counselors completed a postcounseling survey. From 60 sessions, 46 surveys were collected. The median counseling duration was 30 minutes; this was not associated with gestational age. The support-person was not present for most (57%) counseling sessions. There was a positive correlation (p = 0.001) between the number of maternal questions and her education. There was no difference in counseling content across the 23 to 34 weeks' GA regarding delivery room care, physical/mental disability, and vision problems. This study of characteristics and content of premature birth counseling for birth between 23 and 34 weeks' GA found that the duration of most sessions is 30 minutes; the father of the baby is not present during counseling for most premature births, and the topics discussed by counselors are fairly similar and extensive irrespective of the GA. These findings highlight the existing contrast between the recommended counseling practices and the actual practice reported by counselors.
Acute Fulminant Cerebral Edema: A Case Series at a Large Pediatric Tertiary Center
Authors: Hardy Duriel , Gentile Carlyn Patterson , Beslow Lauren A. , Santi Mariarita , Agarwal Sonika
Published: February 2021

Acute fulminant cerebral edema is a poorly understood but serious neurologic condition resulting in profound neurologic disability or mortality. Here we presented a case series of four children that presented to our institution with new neurologic dysfunction and neuroimaging evidence of cerebral edema. Ages ranged from 2 to 7 years with the most common presenting features being altered mental status, vomiting, and/or seizure. Two patients had normal head computed tomography, but follow-up imaging performed within 15 hours demonstrated fulminant edema. One patient was positive for influenza, and one had neuropathology consistent with acute hemorrhagic leukoencephalitis. Two had no identified cause. Treatments included broad-spectrum antibiotics and acyclovir, hyperosmolar agents, intravenous steroids, and decompressive craniectomy. Only one patient survived. Acute encephalopathy complicated by fulminant cerebral edema is a rapidly evolving and often fatal neurologic condition. Early identification with neuroimaging and intervention may improve outcomes. Repeat neuroimaging should be considered if initial imaging is normal but there is persistent or progressive unexplained encephalopathy. Further studies are required to determine optimal diagnostic and management strategies.