bluuebunny/crossref_metadata_2025_split huggingface dataset:
Design and Implementation of High Performance PPSK demodulator in Biomedical Implant
Authors: Katikala Hima Bindu , Murthy G.Ramana , Nath Yatavakilla Amarendra 
Published: April 2021

Abstract
The important challenge for the realization of hearing aids is small size, low cost, low power consumption and better performance, etc. Keeping these requirements in view this work concentrates on the VLSI (Very Large Scale Integrated) implementation of analog circuit that mimic the PPSK (Passive Phase Shift Keying) demodulator with low pass filter. This research deals with RF Cochlear implant circuits and their data transmission. A PPSK modulator is used for uplink data transmission in biomedical implants with simultaneous power, data transmission This paper deals about the implementation of PPSK demodulator with related circuits and low pass filter which are used in cochlear implants consumes low power and operates at 14MHz frequency. These circuits are designed using FINFET 20nm technology with 0.4v DC supply voltage. The performance of proposed design over the previous design is operating at low threshold voltage, reduces static leakage currents and often observed greater than 30 times of improvement in speed performance
National Trauma System Establishment Based on Implementation of Regional Trauma Centers Improves Outcomes of Trauma Care; A Follow-up Observational Study in South Korea
Authors: Jung Kyoungwon , Kwon Junsik , Huh Yo , Moon Jonghwan , Hwang Kyungjin , Cho Hyun Min , Kim Jae Hun , Park Chan Ik , Yun Jung-Ho , Kim Oh Hyun , Lee Kee-Jae , Kim Sunworl , Lim Borami , Kim Yoon 
Published: April 2021

Abstract
Background: Although Korea is a high-income country, its trauma system is comparable to low- and middle-income countries with high preventable trauma death rates (> 30%). Since 2012, Korea has established a national trauma system based on the implementation of regional trauma centers and improvement of the transfer system; this study aimed to evaluate its effectiveness.Methods: We compared the national preventable trauma death rates, transfer patterns, and outcomes between 2015 and 2017. The review of preventable trauma deaths was conducted by multiple panels and a severity-adjusted logistic regression model was created to identify factors influencing the preventable trauma death rate. We also compared the number of trauma patients transferred to emergency medical institutions and mortality in models adjusted with injury severity scores.Results: The preventable trauma death rate decreased from 2015 to 2017 (30.5% vs. 19.9%, p < 0.001). In the severity-adjusted model, the preventable trauma death risk had a lower odds ratio (0.68, 95% confidence interval: 0.53–0.87, p = 0.002) in 2017 than in 2015. Regional trauma centers received 1.6 times more severe cases in 2017 (according to the International Classification of Diseases Injury Severity Score [ICISS]; 23.1% vs. 36.5%). In the extended ICISS model, the overall trauma mortality decreased significantly from 2.1% (1008/47806) to 1.9% (1062/55057) (p = 0.041).Conclusions: Establishment of the national trauma system was associated with significant improvements in performance and outcomes of trauma care. This was mainly because of the implementation of regional trauma centers and because more severe patients were transferred to regional trauma centers. This study might be a good model for low- and middle-income countries, which lack a trauma system.
Crossing Empirical Trend Analysis (CETA) At Risk Levels In Hydro-Meteorological Time Series
Authors: Sen Zekai 
Published: April 2021

Abstract
Trend identification procedures are employed to determine the systematic monotonic trend lines in a given hydro-meteorological time series records for depiction of time dependent changes in the form of increase or decrease. Different methodologies are proposed for such identifications, but most of them require restrictive assumptions such as the normal (Gaussian) probability distribution, serial independence and long sample sizes. In order to relieve especially the serial independence requirement pre-whitening and over-whitening procedures are suggested, but they cannot render a serially dependent series into completely independent structure. In this paper, a new trend methodology is proposed on the basis of crossing features along any given straight-line within the given time series and the one with the maximum crossing number is the searched trend component. This approach does not require any restrictive assumption. Contrary to the previous trend algorithms, the suggested crossing empirical trend analysis (CETA) yields not a single trend, but a set of trends at different levels within the variation range of hydro-meteorological time series records. In this paper for the sake of brevity only three levels are considered at 10%, 50% and 90% risk levels. The comparison of the CETA approach is presented with the classical and frequently used method of Mann-Kendall (MK) trend identification procedure based on the Sen’s slope calculation. For small serial correlation coefficients and normal probability distribution (PDF) function cases CETA and classical technique yield almost the same trend line within +5% error band limits. The application of this methodology is presented for monthly and annual discharge records of Danube River and annual precipitation records from seven geographical regions of Turkey.
Large Bending Deformation of Piezoelectric Nanobeam with Surface Energy Model
Authors: Yang Fan , Li Chengbo 
Published: April 2021

Abstract
In the present paper, we analyze the influence of surface effect on the nonlinear bending behavior of piezoelectric nanobeams by Euler-Bernoulli model and surface energy model. Based on the principle of minimum potential energy and the electromagnetic theory, the nonlinear governing equation as well as the boundary conditions is deducted incorporated surface effects and piezoelectric effects. The effect of surface effect on bending deformation and induced charge of piezoelectric beams under different boundary conditions is discussed under the condition of small deformation and large deformation. The results show that, under the condition of small deformation, the surface effect reduces the bending deformation and the inductive charge, under the condition of large deformation, the surface effect has little effect on the bending deformation of piezoelectric nanobeams. Furthermore, the external constraints and cross-section width b of the piezoelectric nanobeam have significant effect on the bending deformation stiffness. these conclusions have important guiding significance for the design and correction of nanobeams-based nanomechanical systems and piezoelectric nanofunctional devices.
Efficacy and Complications of Regional Citrate Anticoagulation During Continuous Renal Replacement Therapy in Critically Ill Patients with COVID-19
Authors: Khadzhynov Dmytro , Berge Uwe von dem , Muench Frédéric , Karaivanov Stoyan , Koerner Roland , Kruse Jan M. , Zickler Daniel , Budde Klemens , Eckardt Kai-Uwe , Lehner Lukas J. 
Published: April 2021

Abstract
Background: Enhanced coagulation in coronavirus disease 2019 (COVID-19) patients is considered a major obstacle for continuous renal replacement therapy (CRRT), but systematic analyses are sparse. We compared filter survival and citrate-induced complications during CRRT with regional citrate anticoagulation (RCA) in COVID-19 and Non-COVID-19 patients.Methods: In this retrospective study we included all consecutive adult patients (n=97) with acute kidney injury (AKI) treated with RCA-CRRT at seven ICUs of a tertiary university hospital over the tree month period. Medical data were collected to compare the efficacy and complications of RCA-CRRT between COVID-19 (n=44) and Non-COVID-19 patients (n=53).Results: There was no significant difference in the number of CRRT filters used per patient in COVID-19 vs. Non-COVID-19 patients (median 5 vs 3 filters, p=0.103). Mean filter run-time was significantly higher in COVID-19 patients compared to Non-COVID-19 patients (68.4 (95%CI 67.0-69.9) vs. 65.2 (95%CI 63.2-67.2) hours, respectively; log-rank 0.014). COVID-19 patients showed significantly higher activated partial thromboplastin time (aPTT) throughout the CRRT due to systemic anticoagulation compared to Non-COVID-19 patients (54 (IQR 45 – 61) vs. 47 (IQR 41 - 58) seconds, respectively; p<0.001). A significantly higher incidence of combined metabolic disturbances (metabolic alkalosis, hypercalcemia and hypernatremia), consistent with reduced filter patency and citrate overload during RCA, was observed in COVID-19 patients compared to Non-COVID-19 patients (19.1% vs. 12.7%, respectively; p=0.04). These metabolic disarrangements were resistant to per-protocol adjustments and disappeared after replacement of the CRRT-filter. Conclusions: In contrast to initial concerns, adequate filter life-span can be achieved with RCA during CRRT in COVID-19 patients. However, close monitoring of the acid-base balance appears warranted, as these patients tend to develop reduced filter patency leading to a higher incidence of citrate overload and metabolic disturbances. Trial Registration (local authority): EA1/285/20 (Ethikkommission der Charité - Universitätsmedizin Berlin); date of registration 08.10.2020.
Squamous Differentiation in pT1 Low-Grade Bladder Urothelial Carcinoma is Associated with High Risk of Recurrence
Authors: Wei Wanqing , Zhang Jianwei , Wang Keruo , Xia Shunlin , Shang Zhiqun , Li Gang , Niu Yuanjie 
Published: April 2021

Abstract
Background A large number of studies have confirmed that squamous differentiation is closely related to the prognosis of bladder cancer, and studies also showed that it is an independent predictor for the prognosis of such disease. However, the role of squamous differentiation in pT1 low-grade bladder cancer (LGBC) has not been reported yet. This study mainly intends to explore the clinical significance of squamous differentiation in pT1 LGBC.Methods The clinicopathological data of 582 patients with pT1 LGBC from April 2007 to December 2018 were retrospectively analyzed, including 51 cases pathologically diagnosed as pT1 LGBC with squamous differentiation, and 531 cases as pT1 LGBC without squamous differentiation. The clinicopathological characteristics and prognosis of patients in the two groups were compared.Results 51 cases (8.7%) were pathologically diagnosed as pT1 LGBC with squamous differentiation. As compared with non-squamous differentiation, squamous differentiation was closely related to the age of patients (P=0.009) and postoperative recurrence (P<0.001). Further studies on the pT1 LGBC recurrence group showed that the patients in the squamous differentiation group were more prone to multiple recurrences (P=0.033) and invasive recurrence (P<0.001) after surgery. The Kaplan-Meier analysis indicated that pT1 LGBC patients with squamous differentiation had shorter recurrence-free survival (RFS) time. The Cox proportional hazard analysis confirmed that squamous differentiation was an independent predictor of RFS time in patients with pT1 LGBC.Conclusions Squamous differentiation is closely related to postoperative recurrence of pT1 LGBC, especially multiple recurrences and invasive recurrence after surgery. Squamous differentiation is an independent predictor of the RFS time in patients with pT1 LGBC.
Low Lactic Acid and Hypercholesterolemia Reduce 90-day Mortality in Patients Suffering From Septic Shock According to the Sepsis-3 Definition
Authors: Wang Dong , Sun Yali , Liu Huan , Zhang Xiaojuan , Ding Xianfei , Liu Shaohua , Han Bing , Wang Haixu , Duan Xiaoguang , Sun Tongwen 
Published: April 2021

Abstract
Background: Dyslipidemia and lactic acid levels are associated with poor prognosis of septic shock. After the revised definition of sepsis and septic shock (Sepsis-3) in 2016, data on the prognostic value of lactic acid levels and hypocholesterolemia were lacked. This study aimed to evaluate whether lactic acid and cholesterol can be used to predict mortality in ICU patients suffering from septic shock.Methods: Prospective observational study, 349 patients suffering from septic shock as defined by Sepsis-3. The COX model and the binary logistic regression model evaluate the correlation between lactic acid or total cholesterol and death from septic shock, and are adjusted according to the demographics, chronic diseases, and biomarkers of the participants.Results: Total cholesterol, total protein, and albumin levels were significantly lower, and lactic acid, acute physiology, and chronic health assessment (APACHE II) were significantly higher in the surviving group compared to those in the non-surviving group. Lactate levels < 4.4 mmol/L and total cholesterol levels < 2.42 mmol/L were associated with mortality after adjusting for confounders (odd ratio, 3.06 [95% CI, 1.78-5.27] and 1.99 [95% CI, 1.15-3.46]). In multivariate analysis, urogenital origin, albumin levels < 25 g/L, age < 60 years, and APACHE II < 20 were independent risk factors for death from septic shock.Conclusions: In those suffering from septic shock, increased blood lactate levels and decreased total cholesterol levels were associated with higher mortality. Furthermore, it was found that lactic acid and total cholesterol are sensitive markers of mortality in an ICU setting.
An Iranian patient affected by autosomal recessive hypercholesterolemia due to a novel variant in the LDLRAP1 gene
Authors: Nikasa Parisa , Rabbani Bahareh , Hejazi Mohammad Saeid , Firouzi Ata , Baharvand Hossein , Totonchi Mehdi , Mahdieh Nejat 
Published: April 2021

Abstract
Background: Autosomal recessive hypercholesterolemia (ARH) is a rare monogenic disorder resulting from mutations of the LDLRAP1 gene, which leads to elevated LDL-C levels. Here, using whole exome sequencing (WES), we describe a 22-year-old Iranian female who carries a novel nonsense mutation in LDLRAP1. Methods: Genetic investigations were performed for the patient and her family. She showed LDL-C level of 720 mg/dL since the age of 11 years. At the age of 13 years old, aortic valve repair surgery was performed due to severe aortic valve stenosis (AVS). At the age of 17, along with prescription of rosuvastatin plus ezetimibe, coronary angiography displayed the presence of serious stenotic lesions of the coronary arteries and also aortic valve, making the patient eligible for coronary artery bypass grafting (CABG) and aortic valve replacement (AVR).Results: Genetic analysis showed the presence of a previously unreported homozygous LDLRAP1 gene variant, c.649G>T, generating a nonsense mutation at amino acid 217, shortening the ARH protein from 308 to 217 amino acid, which removes AP-2 binding domain of ARH, as an important part in LDL uptake.Conclusion: During a 10-year treatment, we observed a 74% reduction in LDL-C level. Despite the treatment with maximal dose of rosuvastatin plus ezetimibe, the results of coronary angiography demonstrated severe supravalvular aortic stenosis (SVAS) resulted in significant stenotic lesions of the coronary arteries and aortic valve. This highlights the importance of WES in early diagnosis of ARH, and it is proposed to prevent or at least delay the onset of the cardiovascular events.
Risk factors for acute kidney injury after unilateral radical nephrectomy and inferior vena cava thrombectomy under cardiopulmonary bypass: a retrospective study
Authors: Zhang Qi , Li Ming , Fu Dongmei , Wang Dongxin , Diao Shiqi 
Published: April 2021

Abstract
In patients with renal cell carcinoma (RCC) and cancer-related thrombosis in the inferior vena cava (IVC) or right atrium (AT), it is still unknown whether nephrectomy, anesthesia, and surgical trauma can cause postoperative acute kidney injury (AKI) and what are the risk factors for AKI. To examine the incidence and risk factors of postoperative AKI in patients who underwent unilateral radical nephrectomy and cardiopulmonary bypass (CPB)-assisted thrombectomy in the IVC and/or atrial AT due to RCC complicated with cancer-associated thrombosis. This retrospective study included patients who underwent unilateral radical nephrectomy and CPB-assisted thrombectomy in the inferior vena cava and/or atrial pulmonary artery due to RCC, under general anesthesia, from December 2011 to June 2015, at Peking University First Hospital. Among 31 patients, 15 (48.4%) had postoperative AKI. Compared with the non-AKI group (n = 16), patients in the AKI group (n = 15) were older (59.0 ± 8.7 vs. 48.5 ± 12.9 years, P = 0.012) had smaller intraoperative urine volume (1225 ± 639 vs. 1685 ± 597 mL, P = 0.048). There were no differences in preoperative creatinine clearance. Age (OR = 1.10, 95%CI: 1.02–1.20, P = 0.020) was independently associated with AKI occurrence. The patients undergoing unilateral radical nephrectomy and CPB-assisted IVC thrombectomy have a high rate of AKI. Older ones are at a higher risk of postoperative AKI.
Impact of COVID-19 on Academic Activities of Final Year Nursing Students in Zambia: Evidence from Zambia
Authors: Mwila Kennedy , Kalolo Florence , Mudenda Steward , Hikaambo Christabel Nang’andu 
Published: April 2021

Abstract
Background: The novel coronavirus disease 2019 (COVID-19) has had many impacts on the education sector. The pandemic has had negative impacts on the academic activities of nursing students globally. Therefore, we assessed the impact of the COVID- 19 on the academic activities of final year nursing students in Lusaka and Mufulira Districts of Zambia. Materials and methods: This was a cross-sectional study that employed quantitative methods using a structured questionnaire among 196 final year nursing students. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 21. Results: A female predominance (67.9%) and a response rate of 95.14% were achieved. Many students strongly agreed (32.7%) and agreed (20.4%) that they did not complete their course work resulting in some concepts being poorly taught, 86.1% strongly agreed that they had delayed final examinations, and 51.5% strongly agreed that they did not do their clinical attachments. Students strongly disagreed (40.3%) that the e-library and wireless facilities in their school were well-stocked. Hence, this resulted in some students (40.3%) missing class lessons and assessments. Conclusion: The COVID-19 epidemic has negatively affected the academic activities of nursing students in Zambia. Ministries responsible for education must put in place measures that will mitigate the impact of COVID-19 on the education sector. Schools must adapt to the changes in the way of conducting learning and assessment sessions. Finally, schools must improve on their e-library and wireless facilities to effectively support online learning.
Rapid Resolution of severe feline infectious peritonitis using natural products
Authors: Zhang Yue , Zhang Yuanfeng , Zhu Lili , Lu Fang , Du Xin , Zhao Xin , Lu Tao 
Published: April 2021

Abstract
This is the first report of a successful treatment of a severe feline infectious peritonitis (FIP) case using Lianhuaqingwen (LH) capsule, a Chinese patent medicine （natural products）and it has been used for the treatment of coronavirus disease 2019. A 1-year-old cat was diagnosed FIP and presented with severe ascites, aphagia, inflammation, breathing difficulties and weight loss. Within 22 days of LH capsule treatment, all indicators of the cat eventually returned to normal, and the ascites gradually disappeared. This case report is the first description of the clinical recovery features of a cat with a systemic FCoV infection using LH capsules.
Cautious Addition of Targeted Therapy to PD-1 Inhibitors after Initial Progression of BRAF Mutant Metastatic Melanoma on Checkpoint Inhibitor Therapy
Authors: Samlowski Wolfram , Adajar Camille 
Published: April 2021

Abstract
Background: Virtually all metastatic melanoma patients who progress after initial treatment with PD-1 or CTLA-4 directed antibodies will die of their disease. Salvage options are urgently needed. It is theoretically attractive to combine immunotherapy with targeted agents in progressing patients with BRAF mutation positive melanoma, but the toxicity of combined treatment has proven challenging. We have observed striking responses with the cautious addition of low doses of targeted therapy to PD-1 antibody treatment at the time of disease progression following initial immunotherapy. This allowed conversion of a significant number of rapidly progressing patients to durable complete responses in BRAF mutant melanoma. Results: We therefore performed a retrospective analysis of our large patient database and identified 23 patients who progressed on initial checkpoint inhibitor treatment, who subsequently had cautious addition of BRAF±MEK inhibitor therapy to PD-1 antibody treatment. We found an objective response rate of 55% in second line therapy, with a median progression-free survival of 33.4 months and median overall survival of 34.1 months, with 40% of patients in remission over 3 years. Ten of 12 responding patients were able to discontinue all therapy and continue in unmaintained remission. Toxicity of this approach was generally manageable (only 21.7 % grade 3-5 toxicity). There was 1 early sudden death for unknown reasons in a responding patient. Conclusions: Our results suggest that 2nd line therapy with PD-1 inhibitors plus BRAF±MEK inhibitors has substantial activity and manageable toxicity. This treatment can induce additional durable complete responses after failure of initial immunotherapy of metastatic melanoma. These remarkable results suggest further evaluation be performed of sequential checkpoint inhibitor therapy with cautious addition of targeted therapy in appropriate patients.
Identification of The Potential Signature Genes Between Lung Adenocarcinoma and Lung Squamous Cell Carcinoma
Authors: Li Xue , wang zhenni , Xie Jun , Zhu Naishuo 
Published: April 2021

Abstract
Objectives:The purpose of this study was to identify and compare the potential signature genes along with the key pathways related to the pathogenesis of lung adenocarcinoma and lung squamous cell carcinoma through bioinformatics analysis.Methods:The differential expressions of miRNAs (DEmiRNAs) and mRNAs (DEmRNAs) in lung adenocarcinoma (AD) and lung squamous cell carcinoma (SC) were identified using the microarray data of 2miRNA and 6 mRNA from the Gene Expression Omnibus (GEO) database. The interaction between the DEmiRNAs and DEmRNAs was explored, followed by the KEGG pathway enrichment, Gene Ontology annotation (GO) enrichment analysis, DEmiRNA-gene interactive network, and protein-protein interaction (PPI) network to predict the hub genes and identify the key pathways. The sequencing data was then downloaded from The Cancer Genome Atlas (TCGA) to validate the hub genes, perform survival analysis, construct the ROC curve along with identifying the regulatory networks of mRNA-miRNA-lncRNA. Finally, the resulting signature genes and significant regulatory networks in AD and SC were filtrated across these analyses.Results:The DEmiRNAs and DEmRNAs were found to be significantly enriched in the phagosomes, human T-cell leukemia virus 1 infection, and ECM-receptor interaction in the AD, whereas in SC, they were enriched in the cell cycle and p53 signaling pathways. Furthermore, we found that the hsa-miR-21-5p, hsa-miR-200a-5p, and COL1A1 may act as potential meaningful biomarkers for the AD while hsa-miR-141-3p, hsa-miR-429, hsa-miR-130b-3p, hsa-miR-205-5p, and FRMD6 may play an important role in SC. The HMGA1/hsa-miR-424-5p/PVT1 maybe a significant regulatory network of AD while KIF11/hsa-miR-30d-5p/DLEU2, CCNE2/hsa-miR-30d-5p/DLEU2, and SPTBN1/hsa-miR-218-5p/MAGI2-AS3 may be the useful networks in regulating the SC progression.Conclusion: This study provided the signature targets and theoretical basis for further research on the biomarkers and molecular mechanisms of the SC, AD, and NSCLC.