bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of contamination on audible noise in AC transmission lines
Authors: Xie Lianke , Cui Xiangyu , Shi Xin , Hou Xiaobang , Hu Yanglin , Wei Qingquan
Published: May 2024

The objective of this study is to investigate the impact of accumulated pollutants on the surface of a 1000 kV AC transmission line in a specific location in China on its audible noise generation. The line with diatomaceous earth, kaolin, and other pollutants attached to it is modeled by using finite element software, and the study results indicate that the conductivity of the material plays a significant role in influencing the audible noise. In addition, diatomaceous earth has the least effect on the amplitude and lateral attenuation of audible noise, and sodium chloride and carbon powder have the greatest effect. The research in this paper can be used for the reason that dirt particles affect the magnitude of audible noise and these findings offer valuable insights for the management of audible noise.
Research on numerical simulation of tandem thrusters flow-induced noise
Authors: Ma Fuqiang , Xie Lixun , Liu Yansen
Published: May 2024

A tandem propeller is a kind of propulsion device that is installed on the outer axis and the inner axis with the same axis respectively and rotates positively and negatively. Taking DTMB tandem thrusters as an example, which consists of propeller3689 and propeller3849, the hydrodynamic characteristic simulation of the tandem thrusters is completed, using sound analogy theory. The simulation results are consistent with the experimental results. The speed distribution of the tandem thrusters and the hydrodynamic wake of the tandem thrusters are analyzed. Through the analysis of acoustic radiation characteristics, it can be concluded that the noise characteristics of tandem thrusters are more complex than those of ordinary propellers, and there are more line spectrum characteristics in them.
Development of an acoustic doppler flow profiler and flow testing
Authors: Zou Jun , Liu Yanping
Published: May 2024

The flow test with acoustic Doppler current profiler (ADCP) is a new flow test method developed and applied only in the last decade or so. However, because it involves many disciplines such as hydroacoustic physics, ultrasonic transducer technology, electronics, and signal processing, most of the ADCPs used at the present stage are imported, and the domestically produced high-precision ADCPs have a lot of space in the domestic market. This paper introduces the measurement principle of ADCP. Based on this principle, we have overcome the weak signal processing circuit and successfully developed a domestic horizontal fixed acoustic Doppler flow profiler. The instrument is used for flow tests in Yixing (South) Hydrological Station, and the results of the comparison and error analysis meet the requirements of the national first-class precision hydrological station in the “Hydrological Data Compilation Specification” to satisfy the needs of the daily test in the station. The “Horizontal Fixed Acoustic Doppler Profile Flow Rate System” was selected as one of the 100 typical cases of popularizing and applying the achievements of the Ministry of Water Resources in 2020, and it can replace the imported instruments.
Experimental study on cavitation water jet cleaning of marine fouling
Authors: Ji Zitao , Fang Zhenlong , Kang Ding
Published: May 2024

The accumulation of marine fouling on a ship’s hull can increase its fuel consumption, necessitating removal. The use of a cavitation water jet as an efficient method for cleaning marine fouling has been widely adopted. In the research, experiments are conducted on water jet cleaning of marine fouling to investigate the influence of water jet parameters on cleaning efficiency. The findings reveal that the surface damage to specimens was minimized when maintaining an erosion pressure of 16 MPa, employing a 25 mm standoff distance, and applying a 90° incidence angle. This research can provide theoretical guidance for subsequent optimization of cavitation water jet cleaning parameters.
Heat transfer mechanism of different vortex generators arrangements embedded in heat exchange tubes
Authors: Liu Kai , Guo Yangyang , Wang Jiangbo
Published: May 2024

Heat exchange is widely used in many fields to improve heat transfer efficiency and save energy, while longitudinal vortex generator (VG) is widely used in many heat transfer heat exchangers. In this work, the effect of VGs with different numbers and different pitch ratios (PR) on the heat transfer characteristics in the tube was studied numerically. The results show that when the fluid flows through the VG, the reflux region will be generated, and the fluid velocity in the reflux region will be inhibited, resulting in uneven temperature distribution and increased Nu. When multiple VGs are arranged in a row, the number of vortices is increased, and the area affected is increased. This improves the overall heat transfer performance. With the decrease of PR, the number of VG rows increases, and the heat transfer performance increases first and then decreases with the decrease of PR.
Study of long-term in-orbit pressure control of liquid krypton cryogenic storage tank
Authors: Chen Jidong , Zhu Jianbing , Chen Jie , Duan Luobin , Xu Guowen
Published: May 2024

Due to its high specific impulse, low toxicity, contamination, safety, and cost, krypton has gradually replaced other propellants as the primary choice for electric thrusters on deep-space exploration and large-orbit transfer missions with long-range, long-duration, and large-thrust requirements. However, due to the cryogenic propellant itself having a low boiling point, controlling the pressure change of krypton cryogenic propellant during the process of long-term cryogenic storage has emerged as one of the most important issues that must be resolved and proven to achieve non-destructive storage of cryogenic propellant. This paper examines the necessity and viability of a cryogenic gas propellant liquefaction storage scheme and quantifies the effectiveness of tank pressure control of the supercooled liquid krypton injection mixing scheme to solve the problem at present. Its purpose is to offer scheme examples for the design of a krypton thruster propellant storage unit and the in-tank pressure control during the long-term application process.
Optimization of sustainable distributed power generation in distribution networks: a comprehensive analysis of location, capacity, and environmental impact
Authors: Guo Guangchuan , Xu Limei , Maihemutijiang Maiheliya , Wang Yao
Published: May 2024

With the increasing integration of distributed generation (DG) into distribution networks, the impact of its output and configuration on the environment and overall benefits has become more pronounced. To enhance environmental benefits while minimizing costs, an optimization model for DG location and capacity considering environmental benefits (LCEB) is proposed. Initially, a mathematical model for DG location and capacity is established, with optimization objectives including voltage deviation, network loss, and environmental benefit. Subsequently, modified particle swarm optimization (MPSO) with a single-dimension search probability mutation is employed to solve this model, obtaining an optimized DG output and layout scheme. Finally, the feasibility and effectiveness of the proposed model are demonstrated through simulation and analysis by using the IEEE33 node system as an example. The results highlight the model’s capability to improve environmental and economic benefits, enhance voltage levels, and reduce network losses within the distribution network.
Current-sensorless model predictive control for DAB converter based on back-flow power optimization
Authors: Tang Kaile , Chen Quan , Ding Jinjin , Hui Hui , Zhang Qian
Published: May 2024

To solve problems such as high back-flow power, low system efficiency and poor dynamic properties of dual-active-full-bridge DC-DC converters in energy routers under traditional single-phase-shift modulation, the present paper introduces a current-sensorless-based model predictive control method combining back-flow power optimization based on Extended-Phase-Shift (EPS) modulation strategy. The transmission power model of the DAB converter is analyzed, taking into account the extended phase shift and the optimal shift comparison combination is found by the Lagrange multiplier method with the return power as the objective function. Then, the cost function is constructed to track the output voltage to achieve model predictive control without a current sensor. Finally, the accuracy and efficiency of the proposed strategy are verified by simulation. The results demonstrate the efficacy of this approach in mitigating system back-flow power and enhancing dynamic performance.
Reactive power optimization of distribution network with photovoltaic power based on sparrow search algorithm
Authors: He Beibei , Xiao Jianmei , Yi Puting , Gu Shuangnan
Published: May 2024

With the construction of new power systems centered around new energy, distributed photovoltaic power generation has been rapidly popularized. Photovoltaic power generation with volatility and randomness is connected to the distribution network, causing voltage fluctuations in the distribution network to exceed allowable values and an increase in system losses. The objective of this article is to establish a mathematical model for optimizing the distribution of reactive power using distributed photovoltaic power generation, to minimize system losses and voltage fluctuations. Using an improved sparrow search algorithm to solve the model and taking the IEEE30 node system as an example for simulation analysis, the feasibility of the model and algorithm is verified through case analysis.
An optimized design for power inspection
Authors: Fan Jiashu , Huang Qiaoliang
Published: May 2024

This paper realizes attitude tracking, speed tracking, fixed-point tracking, path tracking, and trajectory tracking by adjusting the relevant parameters of the UAV motor controller. In the practical application of UAVs, we will design some flight modes according to the actual use requirements, such as stabilization mode, fixed point mode, and mission mode. From the essence of control, these modes are to expect the state of the aircraft and allow it to fly in a given desired state. For example, in the stabilization mode, the remote control outputs pitch angle expectation, roll angle expectation, yaw rate expectation, and throttle expectation, and then the controller controls the above expectation by controlling the motor throttle.
A study of the performance of SPEEK electrolyte of a novel PEMFC
Authors: Awulachew S S , Nigussa K N
Published: May 2024

Analysis of performance of fuel cell is carried out by considering non-fluorinated electrolyte and variety of potential electrodes. The study spans low temperature regions and carried out MD investigation of transport of ions in a novel PEM fuel cell (PEMFC), which is composed of electrodes and SPEEK as a non-fluorinated electrolyte. Typical values of ion conductivity σ near room temperature are σ = 8.5 × 10−2 S cm−1 when Pt is used as electrode, σ = 26 × 10−2 S cm−1 when Pd3Ag is used as electrode, and σ = 0.34 × 10−2 S cm−1 when Pd is used as electrode. Thus, this study reveals a twofold implications. Firstly, the choice of electrolyte affects whether the traditional Pt electrode remains to be superior for the overall fuel cell performance. Secondly, using SPEEK electrolyte has a potential to yield a closely matching ion conductivity with the one obtained from the costly Nafion electrolyte.
Bioremediation potential of microalgae for copper ion from wastewater and its impact on growth and biochemical contents: equilibrium isotherm studies
Authors: Fawzy Mustafa A , Abdelsalam Shereen , Hafez Wafaa A , Fathi Adel A
Published: May 2024

The use of microalgae to remediate heavy metal-contaminated wastewater has attracted more and more interest. In this investigation, the green microalgae Chloroidium ellipsoideum and Desmodesmus subspicatus were used to study copper uptake from nutrient media and its effect on algal growth and metabolism. The growth of C. ellipsoideum and D. subspicatus generally decreased with increasing copper concentrations. There was a decrease in the carbohydrate content of C. ellipsoideum, but an increase was observed in D. subspicatus by treatment with various copper concentrations. Low concentrations of copper helped to increase the protein content of C. ellipsoideum, but a decline in protein content was reported for D. subspicatus. By increasing the copper concentrations, an increase in the free amino acids and a decrease in the total lipid content of C. ellipsoideum and D. subspicatus were recorded. At 0.1 mgl–1 copper concentration, pH of 6.8, and algal dose of 1 g L−1, the maximum biosorption capacity of C. ellipsoideum was 0.398 mg g−1, corresponding to the maximum reduction of 68.66% of Cu2+, and 0.396 mg/g for D. subspicatus, corresponding to the maximum reduction of 59.52%. The Langmuir, Freundlich, Temkin and Dubinin–Radushkevich models were applied to describe the isothermal biosorption of Cu2+ ions in studied algae. The Dubinin–Radushkevich model indicated that the copper biosorption mechanism was physical in nature. Cu2+ has a greater affinity for D. subspicatus than C. ellipsoideum, suggesting that C. ellipsoideum was relatively more resistant to Cu2+ toxicity than D. subspicatus. Moreover, FT-IR analysis revealed that carboxyl, amide, amino, carbonyl, hydroxyl, methyl and alkyl groups were the key groups responsible for the biosorption process. Therefore, D. subspicatus and C. ellipsoideum are efficient biosorbents for Cu2+ and can be used as biosorbents for heavy metals removal from wastewater.
Performance and stability of hybrid organic-inorganic perovskite photovoltaics in outdoor illuminations conditions
Authors: Meheretu Getnet M , Yihunie Moges T , Wubetu Getasew A
Published: May 2024

In this study, we conducted real-world outdoor performance and stability tests on two different configurations of perovskite solar cells in the climate conditions of Bahir Dar, Ethiopia. Under outdoor illumination with an incident power of 69 mW cm−2, this device demonstrated a power conversion efficiency (PCE) of 15% for an active area of 0.1 cm2. The maximum power generated, measured at a solar irradiance of 72 mW/ cm2, and was 1.23 mW. The second perovskite device has planar p-i-n configuration. This device achieved a PCE of 18% without masking, but the PCE dropped to 11% when the device was covered with circular aperture mask. Maximum power tracking and stability measurements of the device were conducted. Maximum power generation occurred at operating voltages ranging from 0.8 V to 1.2 V for a device with an active area of 0.095 to 0.1cm2. After 30 days of environmental exposure, the device maintained more than 90% of its initial PCE.
Building Partnerships
Authors: Williams Abiodun
Published: May 2024

Chapter 8 discusses the partnerships that Kofi Annan built with nongovernmental organizations, universities, think tanks, Nobel laureates, and other opinion shapers. He saw the potential of civil society as advocates and partners in achieving the goals of the UN. He believed that the engagement of civil society was a way to enhance the legitimacy, accountability, and transparency of intergovernmental decision-making. The chapter also examines his groundbreaking engagement with the business community and the creation of the Global Compact. Opening the UN to the private sector entailed risks and opportunities. The risk was that member states would see this form of engagement as a threat to their autonomy in economic governance. The opportunity derived from the fact that the private sector had enormous resources and expertise which could contribute to the UN’s work, especially on development. The chapter concludes with a discussion of Annan’s eponymous lecture series which he launched in 2002 as part of his goal to engage broader constituencies.
Lianas in tropical dry seasonal forests have a high hydraulic efficiency but not always a higher embolism resistance than lianas in rainforests
Authors: Gerolamo Caian S , Pereira Luciano , Costa Flavia R C , Jansen Steven , Angyalossy Veronica , Nogueira Anselmo
Published: May 2024

Background and Aims

Lianas have higher relative abundance and biomass in drier seasonal forests than in rainforests, but whether this difference is associated with their hydraulic strategies is unclear. Here, we investigate whether lianas of seasonally dry forests are safer and more efficient in water transport than rainforest lianas, explaining patterns of liana abundance.

Methods

We measured hydraulic traits on five pairs of congeneric lianas of the tribe Bignonieae in two contrasting forest sites: the wet ‘Dense Ombrophilous Forest’ in Central Amazonia (~2 dry months) and the drier ‘Semideciduous Seasonal Forest’ in the inland Atlantic Forest (~6 dry months). We also gathered a broader database, including 197 trees and 58 liana species from different tropical forests, to compare hydraulic safety between habits and forest types.

Key Results

Bignonieae lianas from both forests had high and similar hydraulic efficiency but exhibited variability in resistance to embolism across forest types when phylogenetic relationships were taken into account. Three genera had higher hydraulic safety in the seasonal forest than in the rainforest, but species across both forests had similar positive hydraulic safety margins despite lower predawn water potential values of seasonal forest lianas. We did not find the safety–efficiency trade-off. Merging our results with previously published data revealed a high variability of resistance to embolism in both trees and lianas, independent of forest types.

Conclusions

The high hydraulic efficiency of lianas detected here probably favours their rapid growth across tropical forests, but differences in hydraulic safety highlight that some species are highly vulnerable and may rely on other mechanisms to cope with drought. Future research on the lethal dehydration threshold and the connection between hydraulic resistance strategies and liana abundance could offer further insights into tropical forest dynamics under climatic threats.
Imagining the End of Official Social Work: Thinking Beyond the Possible and Probable
Authors: Brockmann Oliver
Published: May 2024

This article seeks to critically engage Chris Maylea’s 2020 provocative call to end official social work by suggesting that the debate it sparked has the potential to expand the contemporary social work discourse. This article explores the complexities and potential dangers of Maylea’s radical call, particularly its susceptibility to co-option by neo-conservative agendas. Whilst the idea of calling for the end of official social work may seem absurd, the article maintains that it might serve as an intellectual tool to overcome the ‘imaginary inertia’ that arguably plagues discussions about reforming the profession. Drawing on Michel Foucault’s concept of ‘episteme’ and Gaston Bachelard’s ‘categories of the real’, it suggests that Maylea’s call for abolition challenges the established boundaries of what is considered possible and probable in the critical social work discourse. This might open new avenues that might otherwise remain invisible to reimagine the future of the profession. Consequently, it is posited that imagining the end of official social work may align with and expand opposing calls for reformation of the profession.
Mapping interictal discharges using intracranial EEG-fMRI to predict postsurgical outcomes
Authors: Wilson William , Tehrani Negar , Pittman Daniel J , Dykens Perry , Mosher Victoria , Gill Laura , Peedicail Joseph , George Antis G , Beers Craig A , Goodyear Bradley , LeVan Pierre , Federico Paolo
Published: May 2024

Various subjective and objective methods have been proposed to identify which interictal epileptiform discharge (IED)-related EEG-functional MRI (fMRI) results are more likely to delineate seizure-generating tissue in patients with drug-resistant focal epilepsy for the purposes of surgical planning. In this intracranial EEG-fMRI study, we evaluated the utility of these methods to localize clinically relevant regions preoperatively and compared the extent of resection of these areas to postoperative outcome.

Seventy patients admitted for intracranial video-EEG monitoring were recruited for a simultaneous intracranial EEG-fMRI study. For all analyses of blood oxygen level-dependent responses associated with IEDs, an experienced epileptologist identified the most clinically relevant brain activation cluster using available clinical information. The maximum cluster (the cluster with the highest z-score) was also identified for all analyses and assigned to one of three confidence levels (low, medium or high) based on the difference of the peak z-scores between the maximum and second maximum cluster (the cluster with the second highest peak z-value). The distance was measured and compared between the peak voxel of the aforementioned clusters and the electrode contacts where the interictal discharge and seizure onset were recorded. In patients who subsequently underwent epilepsy surgery, the spatial concordance between the aforementioned clusters and the area of resection was determined and compared to postoperative outcome.

We evaluated 106 different IEDs in 70 patients. Both subjective (identification of the clinically relevant cluster) and objective (maximum cluster much more significant than the second maximum cluster) methods of culling non-localizing EEG-fMRI activation maps increased the spatial concordance between these clusters and the corresponding IED or seizure onset zone contacts. However, only the objective methods of identifying medium and high confidence maps resulted in a significant association between resection of the peak voxel of the maximum cluster and postoperative outcome. Resection of this area was associated with good postoperative outcomes but was not sufficient for seizure freedom. On the other hand, we found that failure to resect the medium and high confidence maximum clusters was associated with a poor post-surgical outcome (negative predictive value = 1.0, sensitivity = 1.0).

Methods to identify higher confidence EEG-fMRI results are needed to localize areas necessary for good postoperative outcomes. However, resection of the peak voxel within higher confidence maximum clusters is not sufficient for good outcomes. Conversely, failure to resect the peak voxel in these clusters is associated with a poor post-surgical outcome.
The Evergrande Story: A Look into Chinese Corporate Law and the Redefinition of Privately Owned Enterprises and Their Relationship to State-Owned Enterprises in the Chinese Economy
Authors: Chow Yun Kei
Published: May 2024

In December 2021, Evergrande, the second-largest private property developer in China, defaulted on its debt and became the most indebted firm in the world with over $300 billion in liabilities. Its default marked the beginning of a real estate crisis in China, one that is still in the process of being resolved. The Chinese State, through its State-owned enterprises (SOEs), has played an enormous role in mitigating the crisis. Had it not, it is very unlikely that Evergrande would remain in existence today, with huge ramifications for Chinese society and the national economy. This article undertakes a case study of Evergrande, a privately owned enterprise (POE) that exhibits SOE characteristics, to shed further light on the web of interactions between large enterprises in China. It reconsiders how ‘private’ some POEs are in the Chinese economy and argues that, at a certain level, both SOEs and POEs operate in a co-dependent manner. Not only does this challenge the conventional distinction between SOEs and POEs, but it also has wide-ranging implications for corporate governance in China. Indeed, SOEs find themselves having to bail out POEs and are exerting control over POEs in which they have no equity stake. SOEs are thus financially burdened with protecting all large enterprises including POEs, whereas POEs can operate in an unregulated fashion and receive rents from their close ties to SOEs. Altogether, this article’s analysis showcases the operation of various themes of Chinese corporate governance and contributes to the existing literature seeking to understand the unique role of the State in Chinese enterprises.
Adenosine kinase inhibition protects mice from abdominal aortic aneurysm via epigenetic modulation of VSMC inflammation
Authors: Xu Jiean , Liu Zhiping , Yang Qiuhua , Ma Qian , Zhou Yaqi , Cai Yongfeng , Zhao Dingwei , Zhao Guizhen , Lu Tammy , Ouyang Kunfu , Hong Mei , Kim Ha Won , Shi Huidong , Zhang Jifeng , Fulton David , Miller Clint , Malhotra Rajeev , Weintraub Neal L , Huo Yuqing
Published: May 2024

Aims

Abdominal aortic aneurysm (AAA) is a common, serious vascular disease with no effective pharmacological treatment. The nucleoside adenosine plays an important role in modulating vascular homeostasis, which prompted us to determine whether adenosine kinase (ADK), an adenosine metabolizing enzyme, modulates AAA formation via control of the intracellular adenosine level, and to investigate the underlying mechanisms.

Methods and results

We used a combination of genetic and pharmacological approaches in murine models of AAA induced by calcium chloride (CaCl2) application or angiotensin II (Ang II) infusion to study the role of ADK in the development of AAA. In vitro functional assays were performed by knocking down ADK with adenovirus-short hairpin RNA in human vascular smooth muscle cells (VSMCs), and the molecular mechanisms underlying ADK function were investigated using RNA-sequencing, isotope tracing, and chromatin immunoprecipitation quantitative polymerase chain reaction (ChIP-qPCR). The heterozygous deficiency of ADK protected mice from CaCl2- and Ang II-induced AAA formation. Moreover, specific knockout of ADK in VSMCs prevented Ang II-induced AAA formation, as evidenced by reduced aortic extracellular elastin fragmentation, neovascularization, and aortic inflammation. Mechanistically, ADK knockdown in VSMCs markedly suppressed the expression of inflammatory genes associated with AAA formation, and these effects were independent of adenosine receptors. The metabolic flux and ChIP-qPCR results showed that ADK knockdown in VSMCs decreased S-adenosylmethionine (SAM)-dependent transmethylation, thereby reducing H3K4me3 binding to the promoter regions of the genes that are associated with inflammation, angiogenesis, and extracellular elastin fragmentation. Furthermore, the ADK inhibitor ABT702 protected mice from CaCl2-induced aortic inflammation, extracellular elastin fragmentation, and AAA formation.

Conclusion

Our findings reveal a novel role for ADK inhibition in attenuating AAA via epigenetic modulation of key inflammatory genes linked to AAA pathogenesis.
Combined biomarker testing for the assessment of cardio-renal interactions among myocardial infarction patients
Authors: Shacham Y , Frydman S , Freund O , Abu Katash H , Banai S
Published: May 2024

Funding Acknowledgements

None.

Background

The utility of different biomarkers for the prediction of either renal or cardiovascular outcomes following ST-elevation myocardial infarction (STEMI) has been evaluated in several studies however, very few data exist on the prognostic value of combining biomarkers. Among numerous biomarkers examined, C-reactive protein (CRP) and Neutrophil gelatinase associated Lipocalin (NGAL) stand high in their utility to assess the cardiorenal crosstalk. The aim of this study was to assess the prognostic value of combined CRP and NGAL measurement for the assessment of renal and cardiovascular outcomes in reperfused STEMI patients.

Methods

Blood samples for plasma NGAL and CRP were drawn 24 hours after admission. High NGAL and CRP were defined as values within the 4th quartile (>75percentile). Patients were stratified into 4 study groups: Low NGAL/Low CRP, LOW NGAL/high CRO, High NGAL /low CRP and high NGAL/high CRP. Patients were assessed for the occurrence of in-hospital adverse clinical events (MACE). These included occurrence of acute kidney injury , 30-day mortality and their combination.

Results

A total of 311 patients were included (mean age 66 ± 14 years, 81% males).

According to the 4 study groups, there was a stepwise increase in the proportion of in hospital MACE ( 9% vs. 21% vs. 40% vs. 68% ;p,0.001,figure 1). In a multivariate regression model , compared to patients having low NGAL/low CRP we observed a graded, independent increase in the risk for MACE for low NGAL/high CRP , high NGAL/low CRP and high NGAL/high CRP levels( OR 2.89, p=0.02 vs. OR 3.29,p<0.001 vs. OR 17.6,p<0.001 respectively).

Peak concentrations showed significant areas under the curves (AUCs) for the prediction of MACE for both CRP AUC (0.692,95% CI 0.62-0.76) and NGAL ( AUC 0.778,95% CI 0.72-0.84). The combination of NGAL and CRP yielded a significant increase in AUC to 0.822 (95% CI 0.77 to 0.88) (combined biomarkers vs CRP: p<0.001 and combined vs. NGAL :p=0.02,figure 2).

Conclusions

In patients with reperfused STEMI, the combined assessment of NGAL and CRP provided incremental prognostic information for the prediction of in hospital MACE when compared with single-biomarker measurement.Proportion of in-hospital MACEAUC CR NGAL
Screening the influence of features for metabolic syndrome in occupational population based on Lasso and Elastic Net algorithms
Authors: Wang M
Published: May 2024

Funding Acknowledgements

None.

Objective

Screening features associated with metabolic syndrome (MetS) is essential for early detection in the occupational population. In this study, we utilized two machine learning algorithms to screen MetS features and compared the performance of models constructed from these screened features.

Method

A total of 3,077 workers’examination records were considered from our hospital. However, 233 records were excluded due to incompleteness and errors, resulting in a final dataset of 2,844 workers’examination records used for the study. We collected and analyzed available data to extract usable indicators initially. Then, we applied the Least Absolute Shrinkage and Selection Operator (Lasso) algorithm and Elastic Net algorithm to identify features related to MetS. Subsequently, different models, namely K-Nearest Neighbors (KNN), Logistic Regression (LR), Random Forest (RF), and Support Vector Machine (SVM),were established using these two groups of features to predict the probability of MetS in the occupational population. The performance of these models was evaluated using the Area Under the Receiver Operating Characteristic Curve (AUC), Calibration Curve, and Decision Curve Analysis (DCA).

Results

It was indicated that features screened by the Elastic Net algorithm were more stable and demonstrated better predictive performance compared to LASSO, particularly when the data had high dimensionality and correlations. Furthermore, this study presents the first application of the Elastic Net algorithm in screening features related to MetS and establishing a risk prediction model for routine physical examinations of the occupational population.

Conclusion

Notably, Elastic Net demonstrated improved stability when dealing with multiple indicators exhibiting high dimensional correlations. This enhanced stability allowed for a more accurate prediction of MetS, providing a basis for utilizing common universal indicators in health screening for the general occupational population.Study the basic characteristics of the p(a) AUC performance of 9 features screen
P2Y12 monotherapy versus standard dual antiplatelet therapy after percutaneous coronary intervention: a systematic review and meta-analysis
Authors: Buot B C J , David B J , Gaspar D C , Tanedo A N , Valencia A E , Castro R
Published: May 2024

Funding Acknowledgements

None.

Introduction

Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor after percutaneous coronary intervention (PCI) is the recommended therapy for lowering the ischemic risk among patients with acute coronary syndrome (ACS). However, the increased incidence of bleeding is a major concern. Monotherapy with a P2Y12 inhibitor after short-term DAPT to reduce adverse cardiovascular events and bleeding rates has not been fully established and remains uncertain. This meta-analysis aims to determine the effectiveness of P2Y12 inhibitor monotherapy after short-term DAPT in reducing cardiovascular and bleeding events.

Methods

A comprehensive search of randomized controlled trials (RCTs) examining the use of short-term DAPT followed by P2Y12 monotherapy in patients with ACS who underwent PCI was conducted. Outcome measures for all-cause mortality, myocardial infarction, and bleeding rates were analyzed using a random-effects model via Review Manager V5.4.

Results

A total of six randomized controlled trials (RCTs) with 36,724 subjects were analyzed. There were no significant differences in all-cause mortality (RR 0.89 [95% CI: 0.78-1.02], I² = 0%, p = 0.10) and myocardial infarction (RR 1.00 [95% CI: 0.88-1.14], I² = 0%, p = 0.72) between the P2Y12 inhibitor group and dual antiplatelet therapy (DAPT) group. There was a lower rate of major bleeding in the P2Y12 group compared to the DAPT group (RR 0.65 [95% CI: 0.49-0.88], I² = 76%, p = 0.002). The major sources of substantial heterogeneity are due to different intervals of de-escalation and baseline risk factors prior to PCI in each study.

Conclusion

P2Y12 monotherapy has similar rates of all-cause mortality and myocardial infarction. However, early de-escalation leads to a lower incidence of bleeding. P2Y12 monotherapy showed a 35% decreased risk of bleeding compared to the DAPT strategy. This suggests that P2Y12 monotherapy is a preferable antiplatelet strategy in patients undergoing PCI, especially in the high-risk bleeding population.
The biological equivalent and prognostic relevance of c-reactive protein (CRP) velocity in ST segment elevation myocardial infarction
Authors: Shacham Y , Banai S , Berliner S , Rogowski O , Brzezinski R
Published: May 2024

Funding Acknowledgements

None.

Background

The rate of increase, i.e. the velocity, of circulating C-reactive protein (CRP) concentrations during myocardial infarction has been associated with left ventricular dysfunction. However, the prognostic yield of this biomarker as well as the underlying biological process that links high CRP velocity (CRPv) with increased myocardial injury are not clear. Therefore, we sought to determine the associations between CRPv early during STEMI with short- and long-term mortality and its correlation to myocardial necrosis.

Methods

We retrospectively examined 1,155 patients with the diagnosis of acute STEMI, who had at least two successive CRP measurements (up to 48 hours apart) and at least one echocardiographic evaluation, all within the first 96 hours of admission. We calculated CRPv and examined its correlation with myocardial injury, measured by cardiac troponin and overall mortality over a median follow-up period of 5.2 years [IQR 3.7-6.5].

Results

Patients with high CRPv values (above 90th percentile, > 1 mg/L/h) had higher concentrations of cardiac troponin upon presentation regardless of their left ventricular systolic function (EF above or below 40%; Figure 1). Patients with high CRPv had increased 30-day and long-term mortality rates; OR= 4.6, 95% CI 2.3-9.2, p<0.001 for 30-day mortality and HR= 2.2, 95% CI 1.5-3.2, p<0.001 for long-term mortality. Furthermore, CRPv was associated with increased 30 –day and long term mortality rates even among patients with similar systolic function (EF above or below 40%; Figure 2).

Conclusions

High levels of CRPv early during STEMI are associated with increased mortality rates and elevated cardiac troponin release across all levels of left ventricular function. The higher mortality risk might be explained by an aggravated systemic inflammatory response to STEMI.CRP velocity and troponinCRP velocity and mortality
De-escalating treatments and transitioning care in a cardiac intensive care units network
Authors: Sacco A , Tavecchia G , Frea S , Sorini Dini C , Briani M , Bertaina M , Marini M , Trombara F , Ravera A , Colombo C , Villanova L , Tavazzi G , Pappalardo F , Morici N , Potena L
Published: May 2024

Funding Acknowledgements

None.

Background

Recent data (1) have shown that end-of-life (EOL) management of patients with acute decompensated heart failure (ADHF) in Cardiac Intensive Care Units (CICU) is aggressive, with late or no involvement of palliative care (PC) teams.

Purpose

To evaluate current PC and EOL practices in a contemporary multicenter registry of patients with ADHF who deteriorated to cardiogenic shock (CS).

Methods

A survey-based approach was used to collect data on PC and EOL management practices. We enrolled CS patients from 12 participating centers.

A subset of 153 patients with ADHF-CS, enrolled between March 2020 and March 2023, was analyzed. We asked participating centers to report their practice regarding de-escalating treatments and transitioning care in the context of EOL, focusing on 1) discussion of implantable cardioverter defibrillator (ICD) deactivation with patients, 2) documentation of do-not-resuscitate (DNR) orders in the patient's medical record, and 3) documentation of advance directives in the patient's medical record. We also examined early PC team involvement and ICD deactivation as indicators of de-escalating treatments and transitional care in ADHF-CS.

Results are presented as numbers and percentages (%) for categorical variables and medians (interquartile range, IQR) for continuous variables.

Results

Baseline characteristics of the population are shown in Table 1. Figure 1 describes the practices of the participating centers. DNR was routinely documented in the medical records in only 5 of 12 centers (41.7%). PC teams were involved in 21 of 153 enrolled ADHF-CS patients (13.7%). Of the 51 patients with an ICD, 17 died: 13 patients (76%) died in the hospital and 4 (24%) died within 6 months of discharge. ICD deactivation occurred in 6 of 17 deceased patients (35.3%). One patient had ICD deactivation supported by home PC services.

Conclusions

This study shows that the practice of de-escalating therapy, including ICD deactivation, is not routine in the participating centers. Our findings highlight the importance of integrating PC as a concurrent process with intensive care to effectively address the unmet needs of these patients and their families.
Use of Levosimendan in patients with INTERMACS 3 profile: weaning from inotropic support and short- to medium-term evolution
Authors: Enachi S , Bochaton T , Hayek A , Prieur C , Tomasevic D , Scheppler B , Bonnefoy Cudraz E , Jobbe Duval A
Published: May 2024

Funding Acknowledgements

None.

Introduction

Patients with advanced heart failure (HF) in cardiogenic shock (CS) present a markedly high mortality rate. For CS patients dependent on inotropes, management is difficult with few therapeutic options available, especially in the absence of a suitability for heart transplantation (HTX) or left ventricular assist device implantation (LVAD), thus associating an even worse prognosis.

Purpose

With our study we aim to analyse the rate of weaning from inotropic support when Levosimendan, a calcium sensitizer with positive inotropic effects, is used in INTERMACS 3 CS patients and their short to medium-term evolution. We then evaluate if the absence of right ventricular dysfunction, of renal dysfunction, non-ischemic aetiology and QRS width could be predicting factors of a successful weaning from inotropes.

Materials and methods

We conducted a monocentric retrospective analysis of patients from a tertiary cardiac intensive care unit that have received a 24 hours Levosimendan infusion in the context of INTERMACS 3 cardiogenic shock between August 2015 – April 2023.

Results

Of the 137 subjects included in the analysis, 62 patients received Levosimendan for INTERMACS 3 CS. The median age was 59±15.3 and 91.9% (n=57) were male. Baseline LVEF was 19±6%, cardiac index 1.67±0.4L/min/m2, median NTproBNP 13 378 ± 11 126ng/L. 51.6% (n=32) had ischemic heart disease and 40.3% (n=25) had dilated cardiomyopathy. After Heart Team discussion, only 37% (n=23) were considered eligible for HTX or LVAD.

Successful inotrope weaning was experienced in 68% (n=42). Amongst patients with weaning failure, most outcomes resulted in either death (45%), ambulatory continuous Dobutamine infusion (30%), or benefited from a HTX if eligible (15%). The weaning failure rates were similar amongst patients eligible and non-eligible to HTX or LVAD with different outcomes after weaning failure as shown in Figure 1. The overall survival rates at 1 month and 6 months were of 83.8% and 53.2% respectively, with a significant difference between survival rates according to inotrope weaning success or failure as shown in Figure 2. We found no clinical, biological, or echocardiographic parameter to be significantly associated with an increased probability of weaning.

Conclusion

Levosimendan use in INTERMACS 3 CS patients provides a good rate of success in weaning from inotropic support and could be a useful tool in allowing treatment optimization and stabilization in non HTX or LVAD eligible patients, as well as being a "bridge to transplantation" alternative. No predicting factors for successful weaning have been identified.
Risk of sepsis after extracorporeal cardiopulmonary resuscitation in patients with refractory cardiogenic shock from the RESCUE registry
Authors: Bae D , Oh K S , Kim M , Lee J H , Kim S M , Choi W G , Bae J W , Hwang K K , Kim D W , Cho M C , Yang J H , Gwon H C
Published: May 2024

Funding Acknowledgements

None.

Objectives

It is known that the incidence of sepsis is higher in patients receiving extracorporeal membranous oxygenation (ECMO). In particular, extracorporeal cardiopulmonary resuscitation (ECPR) is performed in emergency situations, which may increase the likelihood of non-aseptic management compared to routine procedures. So, we investigated the association of ECPR and incidence of sepsis in patients with refractory cardiogenic shock (CS).

Background

Pre- and post-ECPR sepsis are associated with increased mortality, and it is known that the occurrence of sepsis after ECPR is higher than in conventional cardiopulmonary resuscitation (CPR). However, it is not well known whether ECPR has a higher incidence of sepsis than ECMO insertion in non-CPR conditions.

Method

The SMART-RESCUE study is a multi-center, retrospective and prospective registry of patients that presented with CS. Between January 2014 and December 2018, 1,247 patients with CS were enrolled from 12 major centers in Korea. The incidence of sepsis was compared by dividing into two groups according to whether or not ECPR was performed. Patients with ECMO duration less than 48 hours were excluded.

Result

Total of 231 patients(mean age 59.46 years, men 67.70%, mead follow-up duration 136.5 days) were analyzed into ECPR group(n=95, 60.7 ± 13.0 years, men 75.8%) and non-ECPR group(n=136, 58.6 ± 15.5 years, men 65.4%) respectively. ECPR group showed lower SBP, lower DBP, lower HR, more shock caused by ischemia, more smoking, lower LVEF, higher Hb, higher serum Na, lower AST, higher Peak troponin I, higher vasoactive inotropic score, higher ICMP portion. After 1:1 propensity score matching corrected for height, SBP, DBP, Hb, initial pump flow, Na, ICMP, vasoactive inotropic score, difference remained in SBP, DBP, HR, cause of shock. Sepsis incidence was 7.4%. The risk for sepsis incidence was not different between two groups(7.4% vs 6.3%, adjusted OR 1.18, 95% CI 0.38-3.65, p=0.774).

Conclusion

ECPR procedure does not increase sepsis compared to ECMO insertion not in CPR state in patients with cardiogenic shock.

Keyword: Extracorporeal membrane oxygenation, cardiopulmonary resuscitation, sepsis, cardiogenic shockBaseline characteristicsAdjusted outcomes
ReDS to detect pulmonary congestion in the emergency department: reproducibility and effect of pulmonary comorbidities
Authors: Olesen A S , Miger K C , Fabricius-Bjerre A , Sajadieh A , Hoest N , Koeber N , Pedersen L , Schultz H H L , Abild-Nielsen A G , Grand J , Thune J J , Nielsen O W
Published: May 2024

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): This work was supported by the research fund of Bispebjerg University Hospital and Helsefonden.

Background

Remote Dielectric Sensing (ReDS) is a fast, non-invasive bedside method that estimates lung fluid content observer-independently. We previously described that ReDS has a moderate accuracy to detect acute heart failure in consecutive patients, and we hypothesise that unprecise ReDS estimates may arise from concomitant pulmonary diseases. Still, it is unknown how common comorbidities influence estimates of pulmonary congestion when using ReDS in the emergency department (ED).

Purpose

To examine the reproducibility of ReDS and the effect of pulmonary comorbidities in dyspnoeic patients in the ED.

Method

This prospective observational study included consecutive ED patients ≥50 years with acute dyspnoea. Upon admission, all patients were examined with a low-dose chest computed tomography (CT), an echocardiography and a ReDS examination. The default ReDS examination is performed with the ReDS device placed on the right hemithorax in sitting position. However, for reproducibility comparisons, we conducted three ReDS measurements on the right hemithorax after small adjustments, and in supine position (Picture 1: Scenario 1 and 2). Two blinded radiologists evaluated the CT scans for pulmonary congestion and other common pulmonary diseases.

Results

97 patients were included and had study examinations conducted within a median of 4.8 hours from admission. Reproducibility comparisons revealed coefficients of variations (CV) of 9.6%, 8.2%, and 8.3% for three ReDS measurements on the right hemithorax (Picture 1: Scenario 1). Similarly, CV was 9.5% for sitting versus supine positions (Picture 1: Scenario 2). For scenario 2, patients with CT verified pulmonary congestion had CV of 5.9%, while those without pulmonary congestion had CV of 10.3%.

In multivariate linear regression, we examined the relationship between pulmonary findings on CT and ReDS as a response variable (overall mean ReDS=31.6%, p<0.001). Lower ReDS estimates were observed in patients with pneumonia (-1.81, p=0.215, N=51) and emphysema (-5.44, p=0.001, N=26). Higher ReDS estimates were observed in fibrosis (5.58, p=0.032, N=8) and pulmonary congestion (5.79, p=0.002, N=17).

Conclusion

ReDS showed good reproducibility for patients with CT verified pulmonary congestion. However, the reproducibility was only moderate for consecutive patients with dyspnoea, who had a high prevalence of CT verified emphysema, lowering the ReDS estimates.Reproducibility comparisons