bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Pilot Study on the Microclimate of a Multi-span Solar Energy Greenhouse
Authors: Ni Mengwei , Lan Dun , Shah Jahan Mohammad , Wang Jian , Guo Shirong 
Published: September 2019

Abstract. Extreme low and high temperature is the main obstacle to grow plants in an ambient environment. Due to climate change, these problems are getting worse day by day. To resolve this dilemma a new type of energy-saving greenhouse structure, a multi-span solar energy greenhouse (SEG), was designed and constructed in the Yangtze valley region of China. Using a multi-span plastic greenhouse as a control greenhouse (CG), the microclimate characteristics of the SEG were studied in winter and summer. The results showed that, because the SEG adopted the cooling way of the combination of external shading and natural ventilation in summer, on a sunny day and cloudy day, the average air temperature of the SEG were 3.9°C and 0.9°C lower than CG, respectively, the average solar transmittance were 40% and 18% lower than CG, respectively, indoor microclimate distribution was more uniform. In an acute temperature condition, the effect of natural ventilation on cooling inside the SEG was better than CG during the daytime. Additionally, during the winter season, on a sunny day and cloudy day, compared with CG, the average solar transmittances of the SEG were 24% and 12% lower than CG, respectively, at the same time, the average air temperature of the SEG were 2.1°C and 2.3°C higher than CG, respectively. During the nighttime, the soil surface as well as the film temperature of the SEG, was higher than CG, whether it was on a sunny or a cloudy day, the daily effective accumulated temperature in SEG was more than CG. A north wall was built inside the SEG could effectively improve indoor nighttime temperature, and per unit volume of the SEG could save 0.63 L of diesel per day in winter, thereby saving $0.53, and reducing carbon emissions by 1.74 kg. Taken together, considering all aspect we concluded that the indoor environment of the SEG was more suitable for plant growth and cost-effective for crop cultivation as well. Keywords: Energy-saving, Greenhouse, Microclimate characteristics, Solar energy, Thermal environment.
Macronutrient and calorie content in preterm and term human milk at first three week after delivery
Authors: Murty Dessy Shinta , Putra Hasriza Eka , Mulatsih Sri , Nurani Neti , Wibowo Tunjung 
Published: September 2019

Background The macronutrients in human milk change dynamically and vary among mothers. Evaluation of macronutrient content in human milk is needed to improve nutritional management in preterm infants.
Objective To measure the macronutrient content in preterm and full term human milk during three lactation periods in the first three weeks after delivery.
Methods We conducted a prospective study among 80 mothers of infants who were hospitalized in the Department of Perinatology/NICU at Sardjito Hospital, Yogyakarta. Carbohydrate, fat, protein, and caloric content were measured using a MIRIS human milk analyzer, once per week for three consecutive weeks after delivery. A single, daytime human milk specimen was collected in the morning by directly expressing from the breast.
Results Median protein, fat, carbohydrate, and caloric contents of mature milk in the preterm group were 1.40 (IQR 0.38), 3.25 (IQR 1.00), 5.70 (IQR 0.80) g/dL, and 60 kcal/dL, respectively. Median protein, fat, carbohydrate, and caloric contents of mature milk in the full term group were 1.40 (IQR 0.35), 3.30 (IQR 0.77), 5.80 (IQR 0.75) g/dL, and 62 kcal/dL, respectively, at the third week after delivery. In both groups, protein content in the first week was significantly higher than in the third week (P<0.001) after delivery. In contrast, fat content in the first week was significantly lower than in the third week (P< 0.05) after delivery, in both groups.
Conclusions There are no significant differences in macronutrient and caloric content between preterm and full term human milk during the first three weeks after delivery. However, there are significant changes in fat and protein content in both preterm and full term human milk during early lactation, between the first and third weeks.
Case report discussion of management of pink tetralogy of Fallot in VACTERL association
Authors: Putra Bayushi Eka , Hendrarto Toto Wisnu 
Published: September 2019

Tetralogy of Fallot (TOF) and VACTERL are considered rare entities requiring medical attention with regards to diagnosis and management. When TOF is associated with VACTERL association, case management might differ from a simple case of TOF.
Tetralogy of Fallot (TOF) is defined as a complex congenital cardiac abnormality characterized by ventricular septal defect, right outflow tract obstruction, right ventricular hypertrophy, and overriding aorta.1 The term was coined in 1888 by Fallot of Marseilles, even though the defect had been described in 1673 by Steno of Denmark. The entity was then studied extensively to deliver better care management through medical and surgical approaches.2
P: 1 Genetic Fingerprint of Hepatic Encephalopathy Risk in Liver Cirrhosis
Authors: Gil-Gómez Antonio , Ampuero Javier , Rojas Ángela , Gallego-Durán Rocío , Millán Raquel , Muñoz-Hernández Rocío , Francés Rubén , Soriano Germán , Romero-Gómez Manuel 
Published: September 2019

BACKGROUND:
To determine the impact of genetic factors on the development of hepatic encephalopathy (HE) in patients with liver cirrhosis.

METHODS:
Patients suffering from compensated liver cirrhosis [n = 434; estimation cohort (n = 294) and validation cohort (n = 140)] were included. Patients were followed up for five years until HE bouts, liver transplant, or death. Methods: Patients were genotyped for 62 candidate SNPs (genes involved in the pathophysiology of HE: inflammation, ammonia and glutamine metabolism, intestinal barrier integrity and oxidative stress) by using OpenArray custom plates. Likewise, a haplotype formed by four SNPs within GLS plus the length of a microsatellite in the promoter region of GLS were determined (Romero-Gómez et al. Ann Intern Med 2010). Statistical analysis was performed by Cox regression and Kaplan-Meier for continuous and categorical data. Significant variables, and those known as weighted prognostic indicators, were entered into multivariable models by competing risks, according to Fine and Gray's method.

RESULTS:
In the estimation cohort, competing risks analysis showed GLS mutations, FUT2-(rs601338), TLR9-(rs5743836), SLC1A3-(rs2562582) and SLC1A5-(rs313853), together with MELD, albumin, sodium and previous episodes of HE as variables independently associated to HE development. Those genes encode for proteins involved in maintenance of intestinal barrier integrity by host-microbial interactions (FUT2), pro-inflammatory response triggered by pathogens (TLR-9) and glutamine transport (SLC1A3 and SLC1A5). Combining these genetic factors according to number of alleles at risk, three levels of risk patients were defined: low, mid or high risk [sHR: 1; 6.5 (1.8–22.9) P = 0.004; 27.1 (7.5–96.8) P < 0.001, respectively] (C-index = 0.82). This regression model performed in a similar manner in the validation cohort [sHR: 1; 4.2 (1.2–14.3) P = 0.024; 10.0 (2.7–36.7) P < 0.001] (C-index = 0.78). Cumulative survival free of HE after 5 years was also influenced by this genetic fingerprint: 95.3%, 77.0% and 42.5% for the low, mid and high-risk groups (log-Rank 53.1; P < 0.001) in the estimation, and 85.2%, 56.0% and 40.0% (log-Rank 14.1; P < 0.001) in the validation cohort, respectively (Figure 1).

CONCLUSIONS:
Combination of unfavorable variants could predict HE. This genetic fingerprint could be implemented in clinical practice for decision making in the management of cirrhotic patients. Besides, this work emphasizes the role of these pathways in the pathophysiology of HE and brings out novel genes as potential therapeutic targets.
P: 8 Assessment of Cirrhotic Patients With Covert Hepatic Encephalopathy (HE) Through the EncephalApp (Stroop-Test) Based on Critical Flicker Frequency and PHES-Test
Authors: Neye R.M. , Kircheis G. , Hilger N. , Lüth S. 
Published: September 2019

BACKGROUND:
In daily clinical practice, the detection of HE is still less represented but strongly required. Therefore, we assessed the EncephalApp (Stroop-Test) in a German population by standard diagnostic procedures such as the Critical Flicker Frequency (CFF) and the PHES-Test (Psychometric Hepatic Encephalopathy Score). One of the purposes of the trial was finding a Cut-Off value for the EncephalApp in the German population.

METHODS:
81 patients with liver cirrhosis underwent the testing of the CFF, the PHES-Test and the EncephalApp. A control group of 25 healthy subjects were examined in the same manner. The CFF was considered pathological with <39 Hz and the PHES-Test with < - 4 value points. The On-plus-Off Time of the EncephalApp was compared to the results of the CFF and the PHES-Test. Different Cut-Offs of the On-plus-Off Time were analyzed. Within these HE groups, the mean values of the PHES-Test, the CFF and the On-plus-Off Time of the EncephalApp were compared and the ROC Analysis (receiver operating characteristic) was conducted. Laboratory parameters, clinical data, and further imaging techniques were also included and compared.

RESULTS:
The study group (n = 81) included 52 men and 29 women (62.8 years ± 12.5). For the evaluation of the EncephalApp, different Cut-Off values were determined and their specificity and sensitivity were calculated. The comparative parameter was the result of the PHES-Test. Through the creation of a ROC curve, the AUC (area under the curve) showed that the Cut-Off time of >224 sec with 0.803 is the most efficient with better sensitivity (79%) and specificity (82%). Other Cut-Off values showed lower sensitivities and higher false negative values.

CONCLUSIONS:
After evaluating the specificity, sensitivity and AUC the most efficient Cut-Off value for the On-plus-Off Time in the EncephalApp is >224 sec. In comparison with the CFF and the PHES testing, most of the patient withdrawals (especially in higher grade HE) within the study were registered by the EncephalApp. The EncephalApp is a valid and quick method to diagnose minimal HE but has its limitations in the grading between HE grade 1 and 2.
P: 13 The Role of Monocarboxylate Transporter-1 and Lactate Metabolism on the Development of Cognitive Deficits During NAFLD
Authors: Hadjihambi Anna , Hosford Patrick S , Jalan Rajiv , Pellerin Luc 
Published: September 2019

BACKGROUND:
Non-alcoholic fatty liver disease (NAFLD) is a major complication of obesity. Certain observations regarding NAFLD induced neuropsychiatric and neurochemical alterations have been reported but mechanisms are unknown (Seo, 2016). In this context, monocarboxylate transporter-1 (MCT1) haploinsufficient mice, which resist high fat diet (HFD) induced hepatic steatosis represent an interesting model (Carneiro, 2017). Using a mouse model of NAFLD (HFD+high fructose/high glucose in water [HF/HG]) we investigated the development of cognitive deficits and state of cerebral oxygenation and cerebrovascular reactivity.

METHODS:
Behavioural tests (open field/novel object recognition/forced swimming test [FST]) were performed in mice fed control diet (NC; WT + NC, MCT1 ± +NC) or HFD HF/HG (WT + HFD HF/HG, MCT1 ± +HFD HF/HG) for 16 weeks. Baseline PO2 (in somatosensory cortex) and in response to systemic hypercapnia (10% CO2) was monitored under anaesthesia by a fluorescence method (Oxylite™). Microelectrode biosensors were used for measurements of lactate release by cortical slices. EchoMRI was performed to assess lean/fat mass.

RESULTS:
Increased fat mass (not lean mass) was observed in WT and MCT1± mice (50% less) on HFD HF/HG compared to NC controls. Liver mass was only significantly higher in WT + HFD HF/HG mice compared to NC controls. Behavioural tests did not reveal any significant differences between groups except for FST, which indicated a depression-related behaviour in the WT + HFD HF/HG group compared to their controls. This was not observed with MCT1 ±+HFD HF/HG mice. WT+HFD HF/HG mice had a lower cerebral PO2 baseline and PO2 response induced by systemic hypercapnia compared to NC controls (although significance was not reached), while the MCT1± groups remained unchanged. Tonic lactate release was unaltered between all groups although the MCT1 ± +HFD HF/HG group indicated a trend of decreased lactate tone.

CONCLUSIONS:
Our results suggest that NAFLD is associated with a depression-related behaviour and a trend of decreased cerebral PO2 baseline. MCT1 haploinsufficient mice were resistant to the reported phenotypes, suggesting a link between liver metabolism and neuropathophysiological alterations in NAFLD.
P: 17 The Two-year Outcome in Patients With MHE and Sarcopenia on Mortality and the Development of OHE
Authors: Gupta Rohit , Thomas James , Anderson Greg , Rahman Tony 
Published: September 2019

BACKGROUND:
Hepatic encephalopathy is a significant complication of liver cirrhosis that is associated with a worse prognosis but also a poorer quality of life. The combination of sarcopenia and hepatic encephalopathy has a cascading and deleterious effect on both conditions. The aim of this study was to evaluate the long-term outcomes in patients who have minimal hepatic encephalopathy (MHE) and sarcopenia on mortality and the development of overt hepatic encephalopathy (OHE).

METHODS:
In this prospective trial, patients with liver cirrhosis at The Prince Charles Hospital were enrolled and followed for an average two years. An extensive exclusion criterion was used to reduce confounding factors; this included: active psychiatric condition, IVDU/drug use, neurological conditions, current significant alcohol intake, stroke, dementia, ongoing infection, language barrier, active malignancy, vision impairment, uncontrolled sleep apnoea, electrolyte disturbance and grade 1–4 encephalopathy. The diagnosis of MHE was Encephalapp Stroop test (Stroop) >190, Psychometric hepatic encephalopathy score (PHES) < −4 and Critical Flicker Frequency (CFF) <39. The diagnosis of sarcopenia was completed using hand grip strength comparing to standard deviation data based on sex and age. A subset of participants underwent a DEXA scan to assess for lean body mass. Participant's clinical and electronic notes were assessed to evaluate mortality and the development of OHE.

RESULTS:
A total of 187 patients with a diagnosis of cirrhosis were approached for recruitment in the trial. 98 patients were excluded, whilst 17 patients declined. A total of 72 participants were enrolled in the trial. 37 participants had MHE whilst 35 participants did not have MHE. 16 participants had sarcopenia and MHE, whilst 14 participants had sarcopenia with no MHE. Over the average two year follow up, participants who did not have MHE and were not sarcopenic did not develop overt hepatic encephalopathy. Whilst participants with MHE and Sarcopenia had a significantly higher risk of developing OHE and mortality as can be seen in Figure 1
P value <0.05. The Stroop test had the highest sensitivity 70% [CI 47%–86%] whilst the CFF had the highest specificity 78 % [CI 66%–87%] P value 0.005. In the subset analysis of patients who underwent a DEXA scan to assess lean body mass, this was not able to predict the risk of developing OHE.

CONCLUSIONS:
MHE and Sarcopenia assessment can be easily completed as a bedside clinical test to predict the long-term risk of mortality and the development of overt hepatic encephalopathy.
P: 21 Changes in Cerebral Hemodynamic Parameters in Patients With Acute Liver Failure
Authors: Pérez Juanita , López Viridiana , Cantú Carlos , Flores Fernando , Torre Aldo 
Published: September 2019

BACKGROUND:
Acute liver failure (ALF) is a clinical syndrome that results from severe and sudden loss of liver function in a patient without preexisting liver disease.1 High intracranial pressure (ICP) leads to loss of cerebral perfusion, brain herniation and irreversible brain damage in patients with acute liver failure (AHF).2 Transcranial Doppler ultrasound (TCD) is a non-invasive device that can continuously measure the speed of cerebral blood flow, producing a velocity-time waveform that indirectly monitors changes in cerebral hemodynamics, making it very useful in patients with ALF.3,4 Objetives Compare the cerebral hemodynamic parameters in patients with ALF using TCD before and after liver transplantation.

METHODS:
Retrospective and descriptive study. We searched patients with ALF during the period 2014–2018, who underwent TDC. For the descriptive analysis, medians of the quantitative variables and percentages of the qualitative variables were used. The comparison of medians was made using t student. Values were expressed as median and interquartile range, analyzed with Mann-Whitney U test. A value of P < 0.05 was considered statistically significant.

RESULTS:
We studied 10 patients (9 women, 1 man), with a median age of 29 years. The etiology of the liver failure was the following: 50% for autoimmune hepatitis, 20% undetermined, 10% hepatitis A and 10% pharmacological. We identified 4 deaths, 1 of which was during the post-transplant period. The following parameters were measured: systolic peak velocity (SPV), final diastolic velocity (FDV), médium veloctiy of the middle brain artery (VM), resistance index (RI) and pulsatility index (PI). There was changes in RI and PI, before transplant TDC: RI 0.69 (0.58–0.71) PI 1.29 (0.96–1.37) and after transplant TDC RI 0.51 (0.0–0.58), PI 0.78 (0.55–0.95) P value = 0.005 and 0.005 respectively.

CONCLUSIONS:
There was a significant decrease in the rates of pulsatility and resistance after liver transplantation.
P: 26 The Modification of Quantity and Quality of Muscle Mass Improves the Cognitive Impairment After TIPS
Authors: Gioia Stefania , Merli Manuela , Nardelli Silvia , Lattanzi Barbara , Ridola Lorenzo , Riggio Oliviero 
Published: September 2019

BACKGROUND:
Hepatic encephalopathy (HE) is the major complication of transjugular intrahepatic portosystemic shunt (TIPS). In cirrhotic patients, a correlation between sarcopenia and hepatic encephalopathy has been suggested.

AIM:
to evaluate the evolution of the skeletal muscle quantity and quality at CT scan and of the patients' cognitive impairment (both overt and minimal HE) before and after TIPS.

PATIENTS AND METHODS:
27 cirrhotic patients submitted to TIPS were studied. The modification of Skeletal Muscle Index (SMI), muscle attenuation, HE and plasma ammonia were evaluated before and after a mean follow-up of 9.8 ± 4 months after TIPS.

RESULTS:
During the follow-up, the mean SMI and muscle attenuation increased significantly, although not uniformly in all patients. PHES (Psychometric Hepatic Encephalopathy Score) and ammonia improved significantly in the patients with amelioration in SMI >10% (n = 16) and not in those without (n = 11) (PHES: −1.6 ± 2 vs −4.8 ± 2.1; P = 0.0005; ammonia: 48.5 ± 28.7 vs 96 ± 31.5 μg/dl; P = 0.0004). Moreover, the prevalence of minimal HE (12.5% vs 73%, P = 0.001) as well as the number of episodes of overt HE during the follow-up were significantly reduced in the patients with improved SMI. MELD remained stable or worsened after TIPS and was not significantly different between the groups with or without SMI improvement.

CONCLUSION:
The amelioration of muscle wasting and HE independent of liver function observed after TIPS supports the causal relationship between muscle wasting and HE.
P: 27 Evaluation of Neurocognitive Function in Patients With Compensated and Decompensed Cirrhosis
Authors: Mayorga Marín Tania , Delgadillo Aldo Torre 
Published: September 2019

BACKGROUND:
Cirrhosis is the end result of chronic liver damage caused by multiple entities. Up to 20%–60% of patients with cirrhosis are affected by a peculiar type of mild cognitive impairment related to selective attention and executive functions, visuomotor capacity, psychomotor speed, inhibition of response and selection of response that can only be detected by psychometry.

METHODS:
An observational, cross-sectional, analytical study was carried out. A total sample of 126 patients was established, 64 patients for each group. The NeuroPsi instrument was applied to determine the domains (Orientation, Attention, Visual Episodic Memory, Verbal Episodic Memory, Language, Reading Writing, Executive Conceptual Functions and Executive Motor Functions); With the transcranial Doppler, the hemodynamic parameters such as velocity, pulsatility index, resistance index, as well as the apnea index to assess cerebral vasoreactivity were evaluated.

RESULTS:
Up to now, 55 patients were studied, two groups were established: compensated cirrhotic 18 and decompensated, the gender ratio was 38% men and 62% women, with a median of 60 years. Compensated cirrhotics showed a higher percentage of patients without hepatic encephalopathy (HE) 65% vs 27.1%. The mean Child Pugh score was 7.47 ± 1.82. MELD Na mean for total patients was 12.98 ± 5.04. Of the masters, Reading Writing with 4.50 ± 0.89 for compensated and 4.85 ± 0.50 in decompensated (P = 0.07); in the domain of Executive Motor Functions with 5.69 ± 1.8 for compensated and 6.24 ± 0.89 decompensated (P = 0.16).

CONCLUSIONS:
This study could not find significant differences in the averages obtained in the 8 cognitive domains explored, between the compensated and decompensated cirrhotic patients, nor correlation between the Child Pugh score and the performance in the cognitive tests; It is considered relevant to increase the sample of this study to have more solid evidence. In the cerebral hemodynamic parameters assessed by transcranial Doppler, there were no significant differences between compensated and decompensated patients.