Journal articles on the topic 'CIP failure'
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1
Prandoni, P., A. W. A. Lensing, H. R. Büller, M. Carta, M. Vigo, A. Cogo, S. Cuppini, and J. W. ten Cate. "Failure of Computerized Impedance Plethysmography in the Diagnostic Management of Patients with Clinically Suspected Deep-Vein Thrombosis." Thrombosis and Haemostasis 65, no. 03 (1991): 233–36. http://dx.doi.org/10.1055/s-0038-1647490.
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SummaryBefore a new diagnostic modality can be introduced in clinical medicine, the validity of both a normal and abnormal test result have to be assessed prospectively in an appropriate patient group. We have evaluated the clinical validity of. a new computerized impedance plethysmography (CIP) in the diagnostic management of 381 consecutive patients with clinically suspected venous thrombosis. In patients with serially normal CIP results, the diagnosis of venous thrombosis was refuted and, consequently, they were not treated with anticoagulant therapy and all were followed up for a period of 6 months to estimate the occurrence of symptomatic venous thromboembolism.The study was prematurely terminated by the safety monitoring committee because of an unacceptably high incidence of confirmed venous thromboembolism (10 patients, 3.2%; 95% confidence interval: 1.6% to 6%), including 4 episodes of fatal pulmonary embolism. In a subsequent explanatory study using ultrasonography in 29 other symptomatic patients who had at least 2 repeated normal CIP test results, the failure of CIP to detect proximal vein thrombosis was confirmed in 4 patients (14%). The reasons for this failure are probably related to the use of a modified device to measure impedance in the CIP apparatus, resulting in a lower ability to separate patients without venous thrombosis from those with the disease.We concluded that CIP is insensitive for the detection of proximal vein thrombosis and, therefore, not clinically useful in the diagnostic management of patients with suspected venous thrombosis.
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Lyu, Li-Hua, Wen-Di Liu, and Bao-Zhong Sun. "Electromagnetic Wave-Absorbing and Bending Properties of Three-Dimensional Honeycomb Woven Composites." Polymers 13, no. 9 (May 5, 2021): 1485. http://dx.doi.org/10.3390/polym13091485.
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To avoid the delamination of the traditional three-dimensional (3-D) honeycomb electromagnetic (EM) absorbing composites and improving the defects of low mechanical properties, the 3-D honeycomb woven fabrics were woven on the ordinary loom by practical design. The fabrication of 3-D honeycomb woven EM absorbing composites was based on carbon black/carbonyl iron powder/basalt fiber/carbon fiber/epoxy resin (CB/CIP/BF/CF/EP) by the vacuum-assisted resin transfer molding (VARTM) process. A CB/CIP composite absorbent study showed that CB/CIP composite absorbent belongs to a magnetic loss type absorbent. Adding CB/CIP significantly improved the absorption performance of composite, increased the absorption peak and the effective absorption bandwidth (EAB), but the bending performance decreased. The normalization analysis results showed that when the thickness was 15 mm, the mechanical properties and EM wave-absorbing properties of the 3-D honeycomb woven composite were the best matches. The morphological characteristics and displacement load curves of the composite after fracture were analyzed. The bending failure modes were brittle fracture of the fiber bundle, matrix cracking, and typical shear failure. Despite the above failure mechanism, the 3-D honeycomb woven EM absorbing composites still has good integrity without delamination.
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Wang, Guang Feng, and Tian Yu Wang. "Technology Research on Technical Innovation and Troubleshooting of Beer Production Equipment." Applied Mechanics and Materials 556-562 (May 2014): 6650–52. http://dx.doi.org/10.4028/www.scientific.net/amm.556-562.6650.
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This paper analyzes the shortcomings of traditional CIP cleaning and causes, proposing an improved method for CIP cleaning. It gives a general theoretical and practical discussion on production quality and efficiency of the weak links including squeezing bottles, conveyor’s recurring breakage, bottle washing machine frequently clogged and filter brewer's failure, etc..., which is of strong guidance in practice , appropriateness, effectiveness .
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Shepherd, Starane, Ayush Batra, and David P. Lerner. "Review of Critical Illness Myopathy and Neuropathy." Neurohospitalist 7, no. 1 (September 19, 2016): 41–48. http://dx.doi.org/10.1177/1941874416663279.
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Critical illness myopathy (CIM) and neuropathy are underdiagnosed conditions within the intensive care setting and contribute to prolonged mechanical ventilation and ventilator wean failure and ultimately lead to significant morbidity and mortality. These conditions are often further subdivided into CIM, critical illness polyneuropathy (CIP), or the combination—critical illness polyneuromyopathy (CIPNM). In this review, we discuss the epidemiology and pathophysiology of CIM, CIP, and CIPNM, along with diagnostic considerations such as detailed clinical examination, electrophysiological studies, and histopathological review of muscle biopsy specimens. We also review current available treatments and prognosis. Increased awareness and early recognition of CIM, CIP, and CIPNM in the intensive care unit setting may lead to earlier treatments and rehabilitation, improving patient outcomes.
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Mohd Shahar, Siti Fatimah, Saiful Amri Mazlan, Norhasnidawani Johari, Mohd Aidy Faizal Johari, Siti Aishah Abdul Aziz, Muntaz Hana Ahmad Khairi, Nur Azmah Nordin, and Norhiwani Mohd Hapipi. "Mechanical Properties and Microstructural Behavior of Uniaxial Tensile-Loaded Anisotropic Magnetorheological Elastomer." Actuators 11, no. 11 (October 26, 2022): 306. http://dx.doi.org/10.3390/act11110306.
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Magnetorheological elastomers (MREs) are well-known for their ability to self-adjust their mechanical properties in response to magnetic field influence. This ability, however, diminishes under high-strain conditions, a phenomenon known as the stress-softening effect. Similar phenomena have been observed in other filled elastomers; hence, the current study demonstrates the role of fillers in reducing the effect and thus maintaining performance. Anisotropic, silicone-based MREs with various carbonyl iron particle (CIP) concentrations were prepared and subjected to uniaxial tensile load to evaluate high-strain conditions with and without magnetic influence. The current study demonstrated that non-linear stress–strain behavior was observed in all types of samples, which supported the experimental findings. CIP concentration has a significant impact on the stress–strain behavior of MREs, with about 350% increased elastic modulus with increasing CIP content. Microstructural observations using field emission scanning electron microscopy (FESEM) yielded novel micro-mechanisms of the high-strain failure process of MREs. The magnetic force applied during tension loading was important in the behavior and characteristics of the MRE failure mechanism, and the discovery of microcracks and microplasticity, which was never reported in the MRE quasi-static tensile, received special attention in this study. The relationships between these microstructural phenomena, magnetic influence, and MRE mechanical properties were defined and discussed thoroughly. Overall, the process of microcracks and microplasticity in the MRE under tensile mode was primarily formed in the matrix, and the formation varies with CIP concentrations.
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Chen, Robert. "Electrophysiological Studies in the Critical Care Unit: Investigating Polyneuropathies." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 25, S1 (February 1998): S32—S35. http://dx.doi.org/10.1017/s0317167100034703.
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AbstractPolyneuropathies frequently contribute to ventilator dependency and prolonged stay in the intensive care unit. As clinical examination is often limited in critically ill patients, electrophysiological studies are invaluable in establishing the diagnosis of neuropathy, determining its pathophysiology, severity and in following the patients' progression. Guillain-Barré syndrome (GBS) developing before intensive care unit admission and critical illness polyneuropathy (CIP) developing as a complication of sepsis and multiorgan failure are the commonest causes of neuropathy. Electrophysiological findings in CIP are that of an axonal neuropathy whereas the findings in GBS are usually consistent with a demyelinating neuropathy. Axonal GBS can be distinguished from CIP by the preceding illnesses, slow nerve conduction velocity in some cases, lack of spontaneous activity on the initial needle electromyographic study and cerebrospinal fluid findings.
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Yang, Meng, Yanmin Jia, and Dongwei Liang. "Shaking Table Tests and Simulations of Grouting Sleeve Connecting Prefabricated Bridge Piers." Symmetry 14, no. 4 (March 23, 2022): 652. http://dx.doi.org/10.3390/sym14040652.
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To investigate the seismic performance of prefabricated piers with a grouting sleeve connection, two scaled model specimens of symmetrical prefabricated piers with different reinforcement anchorage lengths, and two cast-in-place (CIP) comparison symmetrical specimens, were designed and manufactured. The fabricated specimens were connected by a grouting sleeve, which was in the column of the pier. The height of the pier column of the test piece was 1.425 m, the diameter of the pier column was 0.25 m, and the size of the bearing platform was 0.85 m × 0.85 m × 0.5 m. Shake table tests were performed on the specimens to evaluate crack development, dynamic characteristics, acceleration response and relative displacement of the pier tops, as well as strain in the plastic hinge area. The results revealed the dominant failure mode of the test piers was bending failure, while the cracks were generally horizontal through-cracks. The failure location of the prefabricated specimens with the grouting sleeve was concentrated within one diameter of the pier in the upper sleeve region. Compared with the CIP specimens, the plastic hinge exhibited an obvious upward movement. Under a maximum test loading condition, the peak acceleration at the pier top of the fabricated pier was 11.0% smaller than that of the CIP specimen, the peak relative displacement was 34.2% smaller than that of the CIP specimen, and the peak tensile strain of the pier body was 46.8% smaller. The seismic performance of the prefabricated pier connected via the grouting sleeves was barely affected by changing the anchoring length of the reinforcements in the grouting sleeves. An ABAQUS finite element model was established for the specimens, with good agreement between the model and experimental results. When the seismic load was 0.65 g, the difference between the peak acceleration of the pier top in the X direction and the Y direction of the numerical simulation and the experimental data was less than 15%.
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Khosravi, S., S. Jafari, H. Zamani, and M. Nilkar. "Synergistic antimicrobial effects of atmospheric pressure non-thermal argon plasma and ciprofloxacin antibiotic against multi-drug resistant P. aeruginosa biofilm." Journal of Applied Physics 131, no. 21 (June 7, 2022): 213301. http://dx.doi.org/10.1063/5.0091001.
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Bacterial biofilm formation is regarded as the major cause of infection development, therapeutic failure, and antibiotic resistance. This study aimed to assess the synergistic antibiofilm potential of an atmospheric-pressure non-thermal argon plasma and ciprofloxacin (Cip) against multi-drug-resistant Pseudomonas aeruginosa. Bacterial biofilms were pre-treated with the non-thermal Ar-plasma and subsequently treated with Cip antibiotic. Then, the bacterial biofilm formation level and cell viability were investigated using crystal violet staining, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide, SEM, and fluorescence microscopy, respectively. It was found that a short-time (a few seconds) pretreating with Ar-plasma not only reduced bacterial biofilm formation but also significantly decreased the viability of the cells within the biofilm matrix. According to the results, treating with Cip alone reduced bacterial biofilms by 32%, while pretreatment with Ar-plasma for 5, 10, 30, 60, and 90 s and subsequent treatment with Cip reduced bacterial biofilms by 76%, 79%, 81%, 75%, and 88%, respectively. In addition, the viability of bacterial cells within the biofilm matrix reduced to 66% in Cip treated cells, while pretreating with Ar-plasma for 5, 10, 30, 60, and 90 s and then treating with Cip significantly decreased cell viability to 28%, 25%, 21%, 23%, and 15%, respectively. This concept opens a promising approach for the treatment of drug-resistant bacteria for decontamination of heat-sensitive materials and human tissues based on the combination of atmospheric-pressure non-thermal Ar-plasma and antibiotics.
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Latronico, Nicola, Frank A. Rasulo, Daniela Recupero, Andrea Beindorf, Paolo Liberini, Roberto Stefini, and Andrea Candiani. "Acute quadriplegia with delayed onset and rapid recovery." Journal of Neurosurgery 88, no. 4 (April 1998): 769–72. http://dx.doi.org/10.3171/jns.1998.88.4.0769.
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✓ The authors describe a patient with severe head injury and sepsis who became acutely quadriplegic 3 days postinjury because of a critical illness polyneuropathy (CIP) and critical illness myopathy (CIM), which resolved rapidly after treatment of the underlying infection. In only 3 days the patient developed septic shock together with flaccid quadriplegia and absent deep tendon reflexes with no clinical or radiological evidence of central nervous system deterioration. Neurophysiological studies showed an acute axonal sensorimotor polyneuropathy, whereas the clinical course strongly suggested a concurrent myopathy. A severe Staphylococcus epidermidis infection accompanied by bacteremia was treated and the patient recovered fully within a few days. Although the case described here is unique because of its very early onset and rapid resolution, CIP and CIM are frequent complications of sepsis and multiple organ failure. The authors suggest that severely head injured patients with sepsis should be evaluated for CIP and CIM when presenting with unexplained muscle weakness or paralysis.
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Kim, Bongyoung, Taul Cheong, and Jungmo Ahn. "How Does Antimicrobial Resistance Increase Medical Costs in Community-Acquired Acute Pyelonephritis?" Antimicrobial Stewardship & Healthcare Epidemiology 1, S1 (July 2021): s23. http://dx.doi.org/10.1017/ash.2021.42.
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Background: The proportion of antimicrobial-resistant Enterobacterales that are causative pathogens for community-acquired acute pyelonephritis (CA-APN) has been increasing. We examined the effect of antimicrobial resistance on medical costs in CA-APN. Methods: A single-center retrospective cohort study was conducted at a tertiary-care hospital in Korea between January 2018 to December 2019. All hospitalized patients aged ≥19 years who were diagnosed with CA-APN were recruited, and those with Enterobacterales as a causative pathogen were included. Comparisons between CA-APN caused by extended-spectrum β-lactamase (ESBL)–producing pathogens (ESBL+ group) and those by non–ESBL-producing organisms (ESBL– group) as well as CA-APN caused by ciprofloxacin-resistant pathogens (CIP-R group) and those by ciprofloxacin-sensitive pathogens (CIP-S group) were performed. Log-linear regression was performed to determine the risk factors for medical costs. Results: In total, 241 patients were included in this study. Of these, 75 (31.1%) had an ESBL-producing pathogen and 87 (36.1%) had a ciprofloxacin-resistant pathogen. The overall medical costs were significantly higher in the ESBL+ group compared with the ESBL− group (US$3,730.18 vs US$3,119.32) P <0.001) as well as in CIP-R group compared with CIP-S group (3,730.18 USD vs. 3,119.32 USD, P =0.005). In addition, length of stay was longer in ESBL+ group compared with ESBL-group (11 vs. 8 days, P <0.001) as well as in CIP-R group compared with CIP-S group (11 vs. 8 days, P <0.001). There were no significant difference in the proportion of clinical failure between ESBL+ and ESBL- groups; CIP-R and CIP-S groups. Based on the log-linear regression model, the costs associated with ESBL-producing Enterobacterales as the causative pathogen would be, on average, 27% higher or US$1,211 higher than its counterpart (P = .026). By the same token, a patient who is a year older would incur US$23 higher cost (P = .040). Having any structural problem in urinary tract would incur US$1,231 higher cost (P = .015). A unit increase in Pitt score would incur US$767 USD higher cost (P < 0.001) higher cost, all other things constant. Conclusions: Medical costs for hospitalized patients with CA-APN are increased by the existence of ESBL-producing Enterobacterales but not by the existence of ciprofloxacin-resistant Enterobacterales.Funding: NoDisclosures: None
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Anbar, Mohammad, and Deo P. Vidyarthi. "Maximizing the Flow Reliability in Cellular IP Network Using PSO." International Journal of Interdisciplinary Telecommunications and Networking 3, no. 1 (January 2011): 1–19. http://dx.doi.org/10.4018/jitn.2011010101.
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A Cellular IP (CIP) network involves a bulk of data transmission. It is highly reliable and guarantees the safe delivery of the packets required in such systems. Reliable traffic performance leads to efficient and reliable connectivity in Cellular IP network. CIP network, which consists of mobile hosts, base stations, and links, are often vulnerable and prone to failure. During the routing operation in the network, the base station, which works as router for the transmitted packets, may fail to perform. Reliable transmission is desirable, in terms of services of the base stations in the network, reliable routing, and processing the data. In this paper, the authors design a reliability model to increase the reliability of a flow, consisting of packets, passing through routers in a Cellular IP network. Particle Swarm Optimization (PSO) is able to solve a class of complex optimization problems. PSO is used to improve the reliability of the flow in CIP network. The proposed model studies the effects of packet processing rate (), packet arrival rate (), and the number of packets per flow on the reliability of the system. A simulation experiment is conducted and results reveal the effectiveness of the model.
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Rakhimov, R. T., I. N. Leyderman, and A. A. Belkin. "Respiratory Neuropathy as an Important Component of Critical Illness Polyneuromyopathy." Russian Sklifosovsky Journal "Emergency Medical Care" 9, no. 1 (October 20, 2020): 108–22. http://dx.doi.org/10.23934/2223-9022-2020-9-1-108-122.
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ABSTRACT. The attention of neurologists, neurosurgeons, intensive care physicians has been attracted recently by the new PICS (Post Intensive Care Syndrome) symptom complex (PIC) or PIC syndrome — Post Intensive Care Syndrome. One of the most severe options for PIT syndrome is critical illness polymyoneuropathy (CIP). Polyneuropathy (Critical illness polyneuropathies, or CIP) and myopathy (Critical illness myopathies, or CIM) are common complications of critical care. Several syndromes of muscle weakness are combined under the term «Intensive care unit-acquired weakness» or ICUAW. Respiratory neuropathy is a special case of PMCS, where respiratory failure is associated with damage to the neuromuscular apparatus of external respiration. The clinical consequence of respiratory neuropathy is an unsuccessful weaning from ventilator and a long stay of patients in ICU. This systematic review of the literature is an analysis of publications devoted to the main pathogenetic mechanisms of the development of CIP and respiratory neuropathy, diagnostic methods, new therapeutic approaches to the treatment of ICU patients with respiratory neuropathy. The special attention is given to the problem of acute muscle wasting, diagnosis and correction of proteinenergy metabolism disorders in patients with respiratory neuropathy.
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El-Chammas, Khalil, and Manu Sood. "Chronic Intestinal Pseudo-obstruction." Clinics in Colon and Rectal Surgery 31, no. 02 (February 25, 2018): 099–107. http://dx.doi.org/10.1055/s-0037-1609024.
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AbstractChronic intestinal pseudo-obstruction (CIP) is defined by either continuous or intermittent symptoms of bowel obstruction in the absence of fixed lumen excluding lesion. CIP includes a heterogeneous group of disorders which result either from diseases affecting the enteric neurons and smooth muscle lining or those involving the autonomic innervation of the bowel. Symptoms associated with CIP are nonspecific, which can sometimes contribute to the delay in recognizing the condition and making the correct diagnosis. The diagnostic workup should include imaging and manometry studies and, occasionally, full-thickness bowel biopsies for histopathological examination may be required. Multidisciplinary team approach for the management of these patients is recommended, and the team members should include a gastroenterologist, surgeon, chronic pain specialist, clinical nutritionist, and a psychologist. The treatment goals should include optimizing the nutritional status and preventing or delaying the development of intestinal failure. The majority of the patients require enteral or parenteral nutrition support, and chronic pain is a common and distressing symptom. Small bowel transplantation may be required if patients develop liver complications due to parenteral nutrition, have difficult central line access, or have poor quality of life and worsening pain despite aggressive medical management.
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Ostovar, Roya, Filip Schröter, Ralf-Uwe Kühnel, Martin Hartrumpf, and Johannes Maximilian Albes. "What Exactly Makes Age a Risk Factor for an Unfavorable Outcome after Mitral Valve Surgery?" Journal of Clinical Medicine 11, no. 23 (November 23, 2022): 6907. http://dx.doi.org/10.3390/jcm11236907.
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Objective: Age has an undeniable impact on perioperative mortality. However, it is not necessarily a predictor of frailty per se, as older patients have different outcomes. To verify specific conditions underlying frailty, we examined demographics, comorbidities, frequency, and distribution of postoperative complications influencing outcomes in a challenging cohort of patients undergoing mitral valve surgery. Methods: The study enrolled 1627 patients who underwent mitral valve surgery. Patients younger than 40 years who had been diagnosed with endocarditis were excluded. Patients were divided into three groups with ages ranging from 40–59 (n = 319), 60–74 (n = 795), and >75 years (n = 513). Baseline, comorbidities, postoperative complications, and mortality were recorded. Results: The older the patients were, the more frequently they suffered from pre- and postoperative renal insufficiency (p < 0.001). The likelihood of postoperative renal failure requiring dialysis was significantly higher with pre-existing renal failure. There was a significant association between postoperative renal insufficiency and the development of postoperative pleural or pericardial effusion (p < 0.001, p = 0.016). A significant decrease in BMI was observed in patients >75 years of age compared to the 60–74 years group (27.3 vs. 28.2 kg/m2, p = 0.007). The development of critical illnesses such as myopathy and neuropathy (CIP/CIM) was age-dependent and increased significantly with age (p = 0.04). Hospitalization duration and mortality also increased significantly with age (p = 0.013, p < 0.001). Conclusions: It appears that elderly patients with advanced renal failure have a significantly higher risk of mortality, postoperative renal failure, need for dialysis, and possibly the development of pleural and pericardial effusions in mitral valve surgery. In addition, more frequent CIP/CIM with concomitant decrease in BMI in the most advanced age group indicate sarcopenia and thus an additional feature of frailty besides renal failure.
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Han, Sun-Jin, Inwook Heo, Jae-Hyun Kim, Kang Su Kim, and Young-Hun Oh. "Experimental and Numerical Studies on the Structural Performance of a Double Composite Wall." Applied Sciences 11, no. 2 (January 6, 2021): 506. http://dx.doi.org/10.3390/app11020506.
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In this study, experiments and numerical analyses were carried out to examine the flexural and shear performance of a double composite wall (DCW) manufactured using a precast concrete (PC) method. One flexural specimen and three shear specimens were fabricated, and the effect of the bolts used for the assembly of the PC panels on the shear strength of the DCW was investigated. The failure mode, flexural and shear behavior, and composite behavior of the PC panel and cast-in-place (CIP) concrete were analyzed in detail, and the behavioral characteristics of the DCW were clearly identified by comparing the results of tests with those obtained from a non-linear flexural analysis and finite element analysis. Based on the test and analysis results, this study proposed a practical equation for reasonably estimating the shear strength of a DCW section composed of PC, CIP concrete, and bolts utilizing the current code equations.
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Xue, Wei Chen, Bin Zhang, and Yi Wang. "Static Performance of Reinforced Concrete U-Shaped Composite Beams Subjected to Positive Moment." Advanced Materials Research 368-373 (October 2011): 365–68. http://dx.doi.org/10.4028/www.scientific.net/amr.368-373.365.
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The reinforced concrete U-shaped composite beam which is composed of precast U-shaped beam, precast slabs and cast-in-place (CIP) concrete, is investigated in this paper. The performance of the reinforced concrete U-shaped composite beam and the cast-in-place concrete control specimen subjected to positive moment was evaluated in terms of failure pattern, flexural strength of normal section, ductility and slips based on the monotonic static loading tests. The results showed that both specimens behaved in ductile manner. The flexural strength of reinforced concrete U-shaped composite beam was about 11% lower than that of the control specimen. The displacement ductility and curvature ductility of the precast specimen were about 33% and 18% lower than those of corresponding control specimen, respectively. The slip between precast beam and precast slab and the slip between precast slab and CIP concrete were less than 0.16mm and 0.17mm, respectively. The results in this paper are useful to expand the application of reinforced concrete U-shaped composite beam in the field of civil engineering.
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Zhang, Huawei, Xinghai Zhou, Yuan Gao, Ying Wang, Yongping Liao, Liwei Wu, and Lihua Lyu. "Electromagnetic Wave-Absorbing and Bending Properties of Three-Dimensional Gradient Woven Composites with Triangular Sections." Polymers 14, no. 9 (April 25, 2022): 1745. http://dx.doi.org/10.3390/polym14091745.
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In order to solve defects such as poor integrity, delamination failure, and narrow absorption bandwidth, three-dimensional (3D) gradient honeycomb woven composites (GHWCs) with triangular sections were designed and prepared. Three-dimensional gradient honeycomb woven fabric was crafted with carbon fiber (CF) filaments and basalt fiber (BF) filaments as raw materials on an ordinary loom. Then, the 3D honeycomb woven fabric filled with rigid polyurethane foam was used as the reinforcement, and epoxy resin (EP) doped with carbon black (CB) and carbonyl iron powder (CIP) was conducted as the matrix. The 3D GHWC with triangular sections, which had both EM-absorbing and load-bearing functions, was prepared by the VARTM process. Through the macro test and micro characterization of 3D GHWCs with triangular sections, the overall absorbing properties and mechanical properties of the materials were analyzed. Moreover, the EM-absorbing mechanism and failure mode of the materials were clarified in this work. The results indicated that the CF filament reflective layer effectively improved the EM-absorbing and mechanical properties. Adding a CB/CIP-absorbing agent enhanced the overall EM-absorbing property but reduced the mechanical properties. The increasing number of gradient layers increased the maximum bending load, but the EM-absorbing performance first increased and then decreased. When the thickness was 15 mm, the maximum bending load was 3530 N, and the minimum reflection loss (RLmin) was −21.6 dB. The synergistic effects of EM-absorbing and mechanical properties were the best right now. In addition, this work provided a feasible strategy that adjusting the type of absorber and gradient aperture size ratio could meet the unique requirements of absorbing frequency and intensity, which has excellent application prospects in civil and military fields.
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Zhang, Huawei, Xinghai Zhou, Yuan Gao, Ying Wang, Yongping Liao, Liwei Wu, and Lihua Lyu. "Electromagnetic Wave-Absorbing and Bending Properties of Three-Dimensional Gradient Woven Composites with Triangular Sections." Polymers 14, no. 9 (April 25, 2022): 1745. http://dx.doi.org/10.3390/polym14091745.
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In order to solve defects such as poor integrity, delamination failure, and narrow absorption bandwidth, three-dimensional (3D) gradient honeycomb woven composites (GHWCs) with triangular sections were designed and prepared. Three-dimensional gradient honeycomb woven fabric was crafted with carbon fiber (CF) filaments and basalt fiber (BF) filaments as raw materials on an ordinary loom. Then, the 3D honeycomb woven fabric filled with rigid polyurethane foam was used as the reinforcement, and epoxy resin (EP) doped with carbon black (CB) and carbonyl iron powder (CIP) was conducted as the matrix. The 3D GHWC with triangular sections, which had both EM-absorbing and load-bearing functions, was prepared by the VARTM process. Through the macro test and micro characterization of 3D GHWCs with triangular sections, the overall absorbing properties and mechanical properties of the materials were analyzed. Moreover, the EM-absorbing mechanism and failure mode of the materials were clarified in this work. The results indicated that the CF filament reflective layer effectively improved the EM-absorbing and mechanical properties. Adding a CB/CIP-absorbing agent enhanced the overall EM-absorbing property but reduced the mechanical properties. The increasing number of gradient layers increased the maximum bending load, but the EM-absorbing performance first increased and then decreased. When the thickness was 15 mm, the maximum bending load was 3530 N, and the minimum reflection loss (RLmin) was −21.6 dB. The synergistic effects of EM-absorbing and mechanical properties were the best right now. In addition, this work provided a feasible strategy that adjusting the type of absorber and gradient aperture size ratio could meet the unique requirements of absorbing frequency and intensity, which has excellent application prospects in civil and military fields.
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Arnstadt, Benno, Christian Zillinger, Marcus Treitl, and Hans-Dieter Allescher. "Corona again? SSC after a severe COVID-disease." Zeitschrift für Gastroenterologie 59, no. 12 (October 19, 2021): 1304–8. http://dx.doi.org/10.1055/a-1647-3785.
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AbstractSecondary sclerosing cholangitis (SSC) is a severe complication of intensive care treatment in critically ill patients. It is characterized by rapid onset and severe chlolestasis with elevation of gGT. In contrast to primary sclerosing cholangitis, SSC-CIP has a distinct and timely well defined trigger and can have a rapid progress to cirrhosis and liver failure. In context of the COVID-19-pandemic, there are reports about patients, who developed SSC after a severe COVID-infection and intensive care treatment.We report on a 62-year old patient without any relevant pre-existing illnesses, who suffered from severe COVID-19 pneumonia with the need for long term ventilation. In the course of the disease he developed a critical-illness-polyneuropathy a pronounced cholestasis. After recovery from COVID-pneumonia, the PNP regressed but the cholestasis progressed. MRCP showed only irregular intrahepatic bile ducts, while EUS showed echogenic intraductal longitudinal structures characteristic for intraductal casts and for SSC-CIP. This was confirmed with ERC, where the complete necrotic bile ducts could be extracted and retrieved for histological and molecular analysis.The patient was included in a scheduled ERC-program to prevent a progress of SSC and the concomitant cirrhosis.SSC is an often missed diagnosis, which obviously can also occur in COVID-patients. In case of elevated liver function tests with cholestasis, EUS might be the key diagnostic method to characterize intraductal casts and identify those patients who should undergo ERC.
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Friedrich, O., M. B. Reid, G. Van den Berghe, I. Vanhorebeek, G. Hermans, M. M. Rich, and L. Larsson. "The Sick and the Weak: Neuropathies/Myopathies in the Critically Ill." Physiological Reviews 95, no. 3 (July 2015): 1025–109. http://dx.doi.org/10.1152/physrev.00028.2014.
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Critical illness polyneuropathies (CIP) and myopathies (CIM) are common complications of critical illness. Several weakness syndromes are summarized under the term intensive care unit-acquired weakness (ICUAW). We propose a classification of different ICUAW forms (CIM, CIP, sepsis-induced, steroid-denervation myopathy) and pathophysiological mechanisms from clinical and animal model data. Triggers include sepsis, mechanical ventilation, muscle unloading, steroid treatment, or denervation. Some ICUAW forms require stringent diagnostic features; CIM is marked by membrane hypoexcitability, severe atrophy, preferential myosin loss, ultrastructural alterations, and inadequate autophagy activation while myopathies in pure sepsis do not reproduce marked myosin loss. Reduced membrane excitability results from depolarization and ion channel dysfunction. Mitochondrial dysfunction contributes to energy-dependent processes. Ubiquitin proteasome and calpain activation trigger muscle proteolysis and atrophy while protein synthesis is impaired. Myosin loss is more pronounced than actin loss in CIM. Protein quality control is altered by inadequate autophagy. Ca2+dysregulation is present through altered Ca2+homeostasis. We highlight clinical hallmarks, trigger factors, and potential mechanisms from human studies and animal models that allow separation of risk factors that may trigger distinct mechanisms contributing to weakness. During critical illness, altered inflammatory (cytokines) and metabolic pathways deteriorate muscle function. ICUAW prevention/treatment is limited, e.g., tight glycemic control, delaying nutrition, and early mobilization. Future challenges include identification of primary/secondary events during the time course of critical illness, the interplay between membrane excitability, bioenergetic failure and differential proteolysis, and finding new therapeutic targets by help of tailored animal models.
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Olsson, Richard, Daniel Moreno Berggren, Olle Ringden, Jonas Mattsson, and Mats Remberger. "Graft Failure In Reduced Intensity Conditioning Allogeneic Hematopoietic Stem Cell Transplantation." Blood 122, no. 21 (November 15, 2013): 4559. http://dx.doi.org/10.1182/blood.v122.21.4559.4559.
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A decade ago reduced intensity conditioning (RIC) allogeneic hematopoietic stem cell transplantation (allo-HSCT) was successfully introduced to facilitate transplantation in patients with co-morbidities. In contrast to myeloablative conditioning regimens RIC transplants are associated with less toxicity and thus preferred in the elderly population. However, there are also disadvantages with RIC such as the increased risk of graft failure caused by rejection by remnant recipient T-cells at transplant, which often results in mixed chimerism during the first months post-transplant. Here, we present risk factors for graft failure in all first RIC allo-HSCTs performed at our center from 1995 to mid-2010 (n=357). Graft failure was defined as >95% recipient T-cells any time after engraftment or reinfusion of donor cells due to >50% recipient cells with no clinical or laboratory signs of relapse. Thirty-six patients (10%) experienced graft failure. The median age of the patients was 51 and 57% were males. In univariate analysis, graft failure was 3-fold increased in male compared to female patients (15% versus 4%; P<0.01). Furthermore, patients with non-malignant disorders (26% versus 2%; P<0.01) and solid tumors (20% vs. 2%; P<0.01) had an increased risk of graft failure when compared to acute leukemia. Graft versus host disease (GVHD) prophylaxis using cyclosporine A (CSA) in combination with mycophenolate mofetil (MMF) resulted in increased numbers of graft failure when compared to our standard regimen with CSA and methotrexate (18% vs. 5%; P<0.01). The graft failure rate was the lowest among HLA-identical sibling donors (6%), slightly higher in 8/8 matched unrelated donors (10%), and the highest in 6/6 matched unrelated donors (18%; P<0.01). Total nucleated cell (TNC) dose was also important with less graft failures when the TNC dose was >10 x 108/kg, whereas CD34+ cell dose had no impact on graft failure (P=0.15). Moreover, in univariate analyses year of transplant, donor sex, cell source, CMV mismatch, ABO mismatch, or pre-planned G-CSF did not influence graft failure rates (P>0.05). In multivariate analysis (Table 1), solid tumors were associated with markedly increased risk of graft failure (RR=10.95; P=0.03), whereas there was a tendency towards increased graft failure risk in non-malignant disorders (RR=8.01; P=0.05). Graft failures were also increased in male recipients (RR=3.27; P<0.01), in grafts with a TNC dose less than 10 x 108/kg (RR=2.17; P=0.03), when using MMF containing GVHD prophylaxis (RR=3.61; P<0.01), and in transplants with HLA match less than 8/8 (RR=4.94; P<0.01). In conclusion, graft failure is augmented in male recipients, and associated with diseases which usually do not receive high-dose chemotherapy pre-transplant such as solid tumors. HLA mismatch as well as TNC dose and GVHD prophylaxis were also important risk factors for graft failure in the present study.Table 1Multivariate analysis of risk factors for graft failure in reduced intensity conditioning allo-HSCT.CharacteristicsNRR95% CIP-valueNo of patients357Recipient sexFemale1531Male2043.271.35-7.93<0.01DiseaseAcute leukemiaa661CML276.810.70-66.310.10CLL225.380.55-52.630.15Lymphoma361.540.10-24.830.76MDS324.260.38-47.190.24MPD187.400.67-82.360.10Multiple myeloma2300-82.361Aplastic anemia382.540.25-26.210.43Non-malignant disorders348.010.96-66.800.05Solid tumors6110.951.34-89.170.03HLA matchHLA-identical sibling1561Unrelated donor 6/6454.941.84-13.24<0.01Unrelated donor 8/81232.160.90-5.180.09Other matched300-13.241Other mismatched303.301.18-9.240.02Total nucleated cell dose (x108/kg)0-58615-10920.540.24-1.220.1410-14870.370.15-0.940.04>14870.240.08-0.750.01GVHD profylaxisCSA+MTX2401CSA+Pred142.160.63-7.400.22CSA+MMF403.611.38-9.44<0.01Fk 506 +Rapamune451.320.43-4.080.63Other176.242.27-17.16<0.01aAML (n=60) and ALL (n=6). Disclosures: No relevant conflicts of interest to declare.
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AICHENBAUM, S. R., and H. RING. "Rehabilitation of a patient with critical illness polyneuropathy (CIP) following acute respiratory failure: a case report and review of literature." Disability and Rehabilitation 25, no. 6 (January 2003): 273–76. http://dx.doi.org/10.1080/0963828021000031214.
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Pereira, Filipe, Teresa Figueiredo, Rodrigo F. M. de Almeida, Catarina A. C. Antunes, Catarina Garcia, Catarina P. Reis, Lia Ascensão, Rita G. Sobral, and Patricia Rijo. "Unveiling the Mechanism of Action of 7α-acetoxy-6β-hydroxyroyleanone on an MRSA/VISA Strain: Membrane and Cell Wall Interactions." Biomolecules 10, no. 7 (June 30, 2020): 983. http://dx.doi.org/10.3390/biom10070983.
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The number of cases of failure in the treatment of infections associated with resistant bacteria is on the rise, due to the decreasing efficacy of current antibiotics. Notably, 7α-Acetoxy-6β-hydroxyroyleanone (AHR), a diterpene isolated from different Plectranthus species, showed antibacterial activity, namely against Methicillin-resistant Staphylococcus aureus (MRSA) strains. The high antibacterial activity and low cytotoxicity render this natural compound an interesting alternative against resistant bacteria. The aim of this study is to understand the mechanism of action of AHR on MRSA, using the MRSA/Vancomycin-intermediate S. aureus (VISA) strain CIP 106760, and to study the AHR effect on lipid bilayers and on the cell wall. Although AHR interacted with lipid bilayers, it did not have a significant effect on membrane passive permeability. Alternatively, bacteria treated with this royleanone displayed cell wall disruption, without revealing cell lysis. In conclusion, the results gathered so far point to a yet undescribed mode of action that needs further investigation.
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Haq, Ihteshamul, Mohsina Haq, Muhammad Farooq, Amber Javaid, Shafaq Zafar, Ashfaq Ahmad, Arbab Muhammad Kashif Khan, Mohammad Abbas, Bakht Biland Khan, and Momina Haq. "Multi-Drug Resistance of Escherichia coli (E.coli) Isolated from Clinical Isolates in District Peshawar Kp Pakistan." Pakistan Journal of Medical and Health Sciences 16, no. 1 (January 30, 2022): 830–35. http://dx.doi.org/10.53350/pjmhs22161830.
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Multidrug-resistant Escherichia coli have become a main public health distress in Pakistan and many countries, causing failure in treatment with the resultingenormous health burden. The current study was aimed to find the prevalence of E. coli among clinical isolates and their antibiotics susceptibility pattern using standard procedures. The Purpose of the present study to investigate the Prevalence and antibiotic susceptibility pattern of E. coli detected from clinical patients visiting Khyber teaching hospital Peshawar. In this study a total 415 sample were isolated from the patient of Khyber teaching hospital (KTH) Peshawar. The collected samples were processed for identification including Gram staining and biochemical test. Furthermore, the antibiotic susceptibility pattern of all the positive strains of E. coli was tested using selected antibiotic discs by disc diffusion method as per CLSI guidelines 2019.A total of 415 samples, 112 clinical isolates yielded the growth of E. coli using standard procedures. Out of 112 isolates, 52% were recovered from male patients while 60% were females. The positive samples were obtained from urine (58%), pus (14.3%), swab (8.9%), sputum (10.7%), and others 8.0% respectively. The highest sensitive drugs are FOS (99.1%), AK (98.2%), TZP (97.3%), MEM (93.8%), TGC (91.1%), CN (89.3%), SCF (78.6%), DO (65.2%), CT (60.7%), F (49.1%), ATM (27.7%) AMP (23.2%), CAZ (23.2%), CPM (22.3%) , CRO (19.6%) ,CTX (13.4%) and the lowest sensitive drug is CIP which is (7.1%) . The drugs which show high resistance are CIP (92.9%), CTX (86.6%), CRO (80.4%), CPM (77.7%), CAZ (76.8%), AMP (76.8%) , ATM (72.3%) , CT( 39.3%) , DO (34.8%), SCF (21.4%), CN(10.7%),TGC(8.9%), F(8.9%),MEM(6.3%) ,TZP(2.7%),AK (1.8%) ,and the lowest resistance drug is FOS (0.9%).Drug resistance monitoring and the epidemiological analysis of patient data are needed regularly and can be useful for the adequate management of antimicrobial resistance. Key words: Multidrug-resistant, Antimicrobial Resistance, Clinical Isolates, Bacteria, Peshawar
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Jin, Kelvin Chew Wai, Kam Dickson, and Ramesh Singh. "Mechanical Characterization of Zirconia Ceramic Composite." MATEC Web of Conferences 152 (2018): 02006. http://dx.doi.org/10.1051/matecconf/201815202006.
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In this day and age, zirconia ceramics are used widely in the medical field as biomaterials for the replacement of damaged body parts. This is because zirconia is one of the closest replacements for bone tissue. However, there were a few cases regarding the failure of zirconia ceramic hip transplants. To overcome this issue, composite materials are being studied as they are able to combine different properties which are not present in a material. This study of Y-TZP/stainless steel 316 composite is carried out with the idea of providing a solution for failure of zirconia implants and also an improvement in biomaterials which will benefit the biomedical world. The study aims to determine the effects on how the increasing of stainless-steel content in the composite will affect the relative density, Vickers hardness, fracture toughness and ageing resistance of the Y-TZP/stainless steel 316 composite. To carry out the research, the composite samples were prepared by mixing the powder of each samples according to their determined content with ethanol. After the powders were mixed, the powders were then pressed, followed by undergoing a Cold Isostatic Press process (CIP) and then it underwent sintering at its determined temperature. After sintering, the samples underwent grinding and polishing before being ready for testing. The outcomes of the research showed that as the sintering temperature and the content of stainless-steel increase in the composite, the fracture toughness and ageing resistance improved while the Vickers hardness and relative density decreased.
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Kim, Hong Bae, and Sang Hoon Kang. "Price Discovery and Transmission Mechanism between CDS and FX markets." Journal of Derivatives and Quantitative Studies 19, no. 1 (February 28, 2011): 37–58. http://dx.doi.org/10.1108/jdqs-01-2011-b0002.
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This study investigated the relationship between the CDS (credit default swap) market with the FX spot (FX swap) market, including the period of recent global financial crisis. A measure for market efficiency is the condition that the derivative markets dominate the asset market in price discovery. In our case, however, FX market should be leading the CDS market. We found FX (spot and Derivatives) market has co-integration relationship with CDS market. Looking at Gonzalo Granger (GG) and Hasbrouck's price discovery measure, we found the FX spot and derivatives market dominated CDS market in price discovery. This study has also examined the direction of shock spillover and volatility transmission between Korean CDS spread and Foreign exchange spot (FX swap) markets using the VECM bivariate GARCH approach. Our evidence suggested the presence of bi-directional shock volatility and volatility transmission between the CDS market and FX spot market partially exist. However, volatility spillover effects from CDS market to FX Swap market are stronger than in the reverse direction during the global financial crisis, indicating that the CDS spread signaling sovereign risk play a more important role in influencing the volatility of FX derivatives market. There are some particular features in FX market. The volatility and shock of CIP deviations reflecting arbitrage opportunities in FX swap market are influenced by those of CDS spread in tranquil period prior to Lehman failure. But after Lehman failure CDS played a crucial role in signaling credit risk in FX derivatives market. We found that higher liquidity and trading volume of market matters more in price discovery and information transmission.
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Wang, Chenyuan, Yigang He, Chuankun Wang, Lie Li, and Xiaoxin Wu. "Multi-Chip IGBT Module Failure Monitoring Based on Module Transconductance with Temperature Calibration." Electronics 9, no. 10 (September 23, 2020): 1559. http://dx.doi.org/10.3390/electronics9101559.
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The Insulated Gate Bipolar Transistor (IGBT) is the component with the highest failure rate in power converters, and its reliability is a critical issue in power electronics. IGBT module failure is largely caused by solder layer fatigue or bond wires fall-off. This paper proposes a multi-chip IGBT module failure monitoring method based on the module transconductance, which can accurately monitor IGBT module chip failures and bond wire failures. The paper first introduces the failure mechanism and module structure of the multi-chip IGBT module; then, it proposes a reliability model based on the module transconductance and analyzes the relationship between chip failure, bond wire failure, and the transmission characteristic curve of the IGBT module. Finally, the module transconductance under chip failure and bond wire failure is measured and calculated through simulation, and the temperature is calibrated, which can eliminate the influence of temperature on health monitoring. The results show that the method has a high sensitivity to chip failures and bond wire failures, can realize the failure monitoring of multi-chip IGBT modules, and is of great significance for improving the reliability of power converters.
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Wu, Xi, Meng-fu Wang, and Ze-long Liu. "Seismic Behavior of Innovative Precast Superimposed Concrete Shear Walls with Spiral Hoop and Bolted Steel Connections." Advances in Civil Engineering 2021 (May 15, 2021): 1–22. http://dx.doi.org/10.1155/2021/5525444.
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Owing to the desirable bond strength and excellent workability, spiral hoop and bolted steel connectors are introduced to enhance the connecting performance of superimposed reinforced concrete shear wall (SRCSW) system. In order to investigate the seismic performance of SRCSWs, applying such connecting methods under flexure-shear interaction and flexural dominated status, two groups of precast (PC) specimens were constructed: one-story and two-story specimens. Seismic behavior in terms of crack patterns, load-displacement response, ductility, stiffness degradation, strain response, and deformation results of SRCSWs is evaluated by the quasistatic cyclic test. It is shown that the wall specimens with the proposed connectors exhibited similar failure mode to that of the cast-in-place (CIP) walls and possessed adequate seismic performance such as lateral resistance, ultimate drift ratio, and lateral stiffness besides the ease of erection. The strain responses and deformation results of the PC specimens under reversed cyclic loading were presented to evaluate the effectiveness of the introduced connections. The test results indicated that the PC walls adopting bolted steel connectors behaved better in force transmission and exhibited greater integrity characteristic compared with the specimens having spiral hoop connectors. Lastly, simplified finite element models considering the nonlinear slip behavior within the connection joint of SRCSWs were established and verified, which could provide sufficient accuracy and efficiency to predict the seismic response of the proposed wall system.
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Mirotta, S., J. Guillot, V. Chevalier, and B. Biard. "Qualification and characterization of electronics of the fast neutron Hodoscope detectors using neutrons from CABRI core." EPJ Web of Conferences 170 (2018): 04016. http://dx.doi.org/10.1051/epjconf/201817004016.
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The study of Reactivity Initiated Accidents (RIA) is important to determine up to which limits nuclear fuels can withstand such accidents without clad failure. The CABRI International Program (CIP), conducted by IRSN under an OECD/NEA agreement, has been launched to perform representative RIA Integral Effect Tests (IET) on real irradiated fuel rods in prototypical Pressurized Water Reactors (PWR) conditions. For this purpose, the CABRI experimental pulse reactor, operated by CEA in Cadarache, France, has been strongly renovated, and equipped with a pressurized water loop. The behavior of the test rod, located in that loop in the center of the driver core, is followed in real time during the power transients thanks to the hodoscope, a unique online fuel motion monitoring system, and one of the major distinctive features of CABRI. The hodoscope measures the fast neutrons emitted by the tested rod during the power pulse with a complete set of 153 Fission Chambers and 153 Proton Recoil Counters. During the CABRI facility renovation, the electronic chain of these detectors has been upgraded. In this paper, the performance of the new system is presented describing gain calibration methodology in order to get maximal Signal/Noise ratio for amplification modules, threshold tuning methodology for the discrimination modules (old and new ones), and linear detectors response limit versus different reactor powers for the whole electronic chain.
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Liao, Y. W., W. T. Hung, Y. M. Chen, C. W. Hsieh, T. Y. Hsieh, Y. H. Chen, and W. N. Huang. "POS0741 HISTOPATHOLOGIC PATTERNS OF LUPUS NEPHRITIS PREDICT THE RISKS OF MORTALITY- A SINGLE-CENTER RETROSPECTIVE STUDY." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 622.1–622. http://dx.doi.org/10.1136/annrheumdis-2021-eular.2006.
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Background:Lupus nephritis is a significant complication of systemic lupus erythematosus and is associated with increased risks of end-stage kidney disease and mortality.Objectives:The retrospective observational study aims to investigate which component of the National Institutes of Health activity and chronic indices of lupus nephritis can predict mortality.Methods:We identified 528 SLE patients with biopsy-proven lupus nephritis between 2006 and 2019. Two patients with class VI lupus nephritis were excluded, and a total of 526 patients were analyzed. Serum creatinine, urine protein-to-creatinine ratio (UPCR), and serologic markers for SLE disease activity were measured at the time of the renal biopsy. The histopathologic findings of renal biopsies were classified by utilizing the International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification.Results:Among 526 patients enrolled, 64 expired, and 44 were female (68.8%, p=0.004). Class IV (± V) comprised the most (n= 39, 60.9%), followed by class V (n= 18, 29.7%). Lower eGFR was observed in the death group, compared with the survival group (median: 24.7 vs. 80.5, p<0.001). There were no significant differences in UPCR and serologic markers for SLE (dsDNA, C3, and C4). Total scores of chronicity index and the scores for each index were higher in the death group. Interestingly, although total scores of activity index in death and survival groups did not differ significantly, the scores for cellular crescents tended to be higher in the death group (1.38 ±1.77 vs. 0.72 ±1.24, p=0.002)In the univariable analysis, age, male sex, eGFR, activity index scores, cellular crescents, chronicity index scores, and all CI components (global obsolete glomeruli, tubular atrophy, interstitial fibrosis, fibrous crescents) and tubulointerstitial nephritis were significantly associated with an increased risk of death. When patient characteristics and NIH activity/ chronicity indices were jointly examined in a multivariable analysis, fibrous crescents were significantly associated with increased risk of death in females (HR 5.23 [95% CI: 1.51, 18.09]) (Table 1). In males, the risks of death increased with cellular crescents (HR 1.73 [95% CI: 1.10, 2.73]) but decreased with global obsolete glomeruli (HR 0.12 [95% CI: 0.02, 0.91]).Conclusion:In this single-center observational study, fibrous crescents in females and cellular crescents in males were significantly associated with increased risks of mortality.References:[1]Doria A, Iaccarino L, Ghirardello A, et al. Long-term prognosis and causes of death in systemic lupus erythematosus. Am J Med 2006; 119: 700–706.[2]Faurschou M, Starklint H, Halberg P, Jacobsen S. Prognostic factors in lupus nephritis: diagnostic and therapeutic delay increases the risk of terminal renal failure. J Rheumatol. 2006;33(8):1563-1569.[3]Chen YM, Hung WT, Liao YW, et al. Combination immunosuppressant therapy and lupus nephritis outcome: a hospital-based study. Lupus. 2019;28(5):658-666.Table 1.Logistic regression of predictors for mortality in patients with lupus nephritisUnivariableMultivariable (Female)Multivariable (Male)HR95% CIp valueHR95% CIp valueHR95% CIp valueAge1.03(1.01-1.05)0.0021.02(0.98-1.07)0.2671.01(0.95-1.08)0.670Male sex2.10(1.23-3.55)0.006UPCR1.02(0.95-1.09)0.616eGFR0.97(0.96-0.99)<0.0010.99(0.96-1.00)0.1830.98(0.96-1.00)0.086Activity Index1.06(1.01-1.11)0.027Cellular crescents1.29(1.12-1.50)<0.0011.03(0.63-1.67)0.9171.73(1.10-2.73)0.017Chronicity Index1.16(1.07-1.26)<0.001global obsolete glomeruli1.37(1.08-1.76)0.0111.24(0.55-2.77)0.6060.12(0.02-0.91)0.040Tubular atrophy1.65(1.28-2.13)<0.0010.41(0.06-2.82)0.3624.77(0.30-75.32)0.267Interstitial fibrosis1.71(1.32-2.23)<0.0013.70(0.52-26.24)0.1911.37(0.07-27.40)0.837Fibrous crescents2.38(1.40-4.03)0.0015.23(1.51-18.09)0.0090.00(0-extremely large)0.989Tubulointerstitial nephritis1.70(1.03-2.80)0.037Disclosure of Interests:None declared
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Cheung, Kevin, Alasdair Rathbone, Michel Melanson, Jessica Trier, Benjamin R. Ritsma, and Matti D. Allen. "Pathophysiology and management of critical illness polyneuropathy and myopathy." Journal of Applied Physiology 130, no. 5 (May 1, 2021): 1479–89. http://dx.doi.org/10.1152/japplphysiol.00019.2021.
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Critical illness-associated weakness (CIAW) is an umbrella term used to describe a group of neuromuscular disorders caused by severe illness. It can be subdivided into three major classifications based on the component of the neuromuscular system (i.e. peripheral nerves or skeletal muscle or both) that are affected. This includes critical illness polyneuropathy (CIP), critical illness myopathy (CIM), and an overlap syndrome, critical illness polyneuromyopathy (CIPNM). It is a common complication observed in people with critical illness requiring intensive care unit (ICU) admission. Given CIAW is found in individuals experiencing grave illness, it can be challenging to study from a practical standpoint. However, over the past 2 decades, many insights into the pathophysiology of this condition have been made. Results from studies in both humans and animal models have found that a profound systemic inflammatory response and factors related to bioenergetic failure as well as microvascular, metabolic, and electrophysiological alterations underlie the development of CIAW. Current management strategies focus on early mobilization, achieving euglycemia, and nutritional optimization. Other interventions lack sufficient evidence, mainly due to a dearth of large trials. The goal of this Physiology in Medicine article is to highlight important aspects of the pathophysiology of these enigmatic conditions. It is hoped that improved understanding of the mechanisms underlying these disorders will lead to further study and new investigations for novel pharmacologic, nutritional, and exercise-based interventions to optimize patient outcomes.
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Lee, Seungyub, Sueyeun Oak, Donghwi Jung, and Hwandon Jun. "Development of Failure Cause–Impact–Duration (CID) Plots for Water Supply and Distribution System Management." Water 11, no. 8 (August 18, 2019): 1719. http://dx.doi.org/10.3390/w11081719.
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Understanding the impact and duration (consequences) of different component failures (cause) in a water supply and distribution system (WSDS) is a critical task for water utilities to develop effective preparation and response plans. During the last three decades, few efforts have been devoted to developing a visualization tool to display the relationship between the failure cause and its consequences. This study proposes two visualization methods to effectively show the relationship between the two failure entities: A failure cause–impact–duration (CID) plot, and a bubble plot. The former is drawn for an effective snapshot on the range (extent) of failure duration and the impact of different failures, whereas the latter provides failure frequency information. A simple and practical failure classification system is also introduced for producing the two proposed plots effectively. To verify the visualization schemes, we collected records of 331 WSDS component failures that occurred in South Korea between 1980 and 2018. Results showed that (1) the proposed CID plot can serve as a useful tool for identifying most minor and major WSDS failures, and (2) the proposed bubble plot is useful for determining significant component failures with respect to their failure consequences and occurrence likelihoods.
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Khan, Bakht Umar, Fahad Khalid, Omer Aziz Mirza, Fayaz Ahmed Memon, Muhammad Shahid, and Muhammad Shehram. "Contrast-Induced Nephropathy Factors and Prevalence in Patients Getting Multi-Vessel Percutaneous Coronary Intervention." Pakistan Journal of Medical and Health Sciences 16, no. 5 (May 30, 2022): 1467–69. http://dx.doi.org/10.53350/pjmhs221651467.
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Objective: To assess the prevalence of contrast-induced nephropathy and its associated risk factors in patients undergoing multi-vessel percutaneous coronary intervention (PCI). Study Design: Observational/ Prospective study Place and Duration: Armed forces institute of cardiology & National Institute of heart diseases, Rawalpindi, during from the period September 2019 to Feb 2020. Methods: There were 112 patients of both genders with ages 18-75 years were presented in this study. Data on enrolled patients' age, gender, BMI, marital status and education level were collected after receiving written permission from each patient. This research included people who had undergone a percutaneous coronary intervention. Serum creatinine >0.5mg/dl from the baseline value was classified as contrast induced nephropathy. CIN-related risk factors were studied. Data was analyzed using SPSS 24.0. Results: The mean age of the patients was 51.6±9.53 years and had mean BMI 23.5±15.67 kg/m2. Majority were males 68 (60.7%) and 44 (39.3%) were females. There were 75 (66.96%) patients married and 55 (49.1%) patients were educated. Frequency of contrast induced nephropathy was among 25 (22.3%) cases. Most common risk factor of CIP was contrast volume 19 (76%) and hypertension found in 17 (68%) cases, followed by diabetes mellitus in 15 (60%) cases, age >65 years in 13 (52%) cases, CHF in 11 (44%) cases, smoking history in 9 (36%) cases and family history of CAD was 4 (16%). Conclusion: Patients undergoing PCI are at a considerable risk of developing contrast-induced nephropathy. Among the risk variables for CIN were anaemia (age >70 years), diabetes mellitus (contrast volume >150 ml), and heart failure. Keywords: Risk Factors, Contrast Induced Nephropathy, Percutaneous Coronary Intervention
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Khan, Bakht Umar, Fahad Khalid, Omer Aziz Mirza, Fayaz Ahmed Memon, Muhammad Shahid, and Muhammad Shehram. "Contrast-Induced Nephropathy Factors and Prevalence in Patients Getting Multi-Vessel Percutaneous Coronary Intervention." Pakistan Journal of Medical and Health Sciences 16, no. 5 (May 30, 2022): 1467–69. http://dx.doi.org/10.53350/pjmhs221651467.
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Objective: To assess the prevalence of contrast-induced nephropathy and its associated risk factors in patients undergoing multi-vessel percutaneous coronary intervention (PCI). Study Design: Observational/ Prospective study Place and Duration: Armed forces institute of cardiology & National Institute of heart diseases, Rawalpindi, during from the period September 2019 to Feb 2020. Methods: There were 112 patients of both genders with ages 18-75 years were presented in this study. Data on enrolled patients' age, gender, BMI, marital status and education level were collected after receiving written permission from each patient. This research included people who had undergone a percutaneous coronary intervention. Serum creatinine >0.5mg/dl from the baseline value was classified as contrast induced nephropathy. CIN-related risk factors were studied. Data was analyzed using SPSS 24.0. Results: The mean age of the patients was 51.6±9.53 years and had mean BMI 23.5±15.67 kg/m2. Majority were males 68 (60.7%) and 44 (39.3%) were females. There were 75 (66.96%) patients married and 55 (49.1%) patients were educated. Frequency of contrast induced nephropathy was among 25 (22.3%) cases. Most common risk factor of CIP was contrast volume 19 (76%) and hypertension found in 17 (68%) cases, followed by diabetes mellitus in 15 (60%) cases, age >65 years in 13 (52%) cases, CHF in 11 (44%) cases, smoking history in 9 (36%) cases and family history of CAD was 4 (16%). Conclusion: Patients undergoing PCI are at a considerable risk of developing contrast-induced nephropathy. Among the risk variables for CIN were anaemia (age >70 years), diabetes mellitus (contrast volume >150 ml), and heart failure. Keywords: Risk Factors, Contrast Induced Nephropathy, Percutaneous Coronary Intervention
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Yun, Yanchun, Jiafei Jiang, and Peng Chen. "Flexural Behavior of Lattice Girder Slabs with Different Connections: Experimental Study." Advances in Civil Engineering 2022 (December 27, 2022): 1–16. http://dx.doi.org/10.1155/2022/7722668.
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Lattice girder slab (LGS) is a precast composite slab that serves as an alternative to conventional concrete-in-place (CIP) slabs. The load-bearing capacity of joints for the LGSs is essential for large-span slabs with precast constructions, while limited connections could achieve both free-of-formwork construction and higher flexural bearing capacity. In order to enhance the flexural behavior of LGSs with free-of-formwork joints, the straight bar lapping connection away from the midspan, loop connection, and straight bar lapping connection within keyway for midspan joints were proposed in this study. Seven full-scale one-way LGSs with different transverse connections were tested under the four-point bending tests to investigate the joint behavior. The overall response and failure mode were observed during the test. The load versus midspan deflection, deflected shape, and characteristic load capacity were analyzed and discussed. The study showed that all the slabs’ deformability could reach as high as l/50 without load reduction. The LGS with the straight bar lapping connection in the midspan had the lowest flexural capacity (70% of the capacity for LGS without joints), while the flexural resistance of the slabs with other connections could be increased by 21.4% to 44.6% compared to LGSs with the traditional straight bar lapping connection in the midspan. The LGSs with the connections having keyways had the most significant improvement and could achieve high flexural capacity and 110% of deformability of the LGS without joints. The findings could enrich the connection types for LGSs for construction convenience and mechanical efficiency and further provide reference for the design of the two-way LGSs.
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Arevalo, A. B., H. Zala, P. Shah, M. Majmundar, and A. Ramirez Gomez. "POS0819 RACIAL DIFFERENCES IN CARDIOVASCULAR AND INFECTIOUS MORBIDITY AMONG PATIENTS WITH GIANT CELL ARTERITIS." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 700–701. http://dx.doi.org/10.1136/annrheumdis-2022-eular.4174.
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BackgroundGiant cell arteritis (GCA) is the most common primary vasculitis in adults. It presents with signs of vascular insufficiency of the extracranial arteries of the head, but may also affect the aorta and its primary and secondary branches. GCA is more prevalent in Caucasians of Scandinavian and Northern European descent, and is considered to be less common in African, Asian, Arab and Latin American populations.1,2 However, this may reflect a lack of formal epidemiological data in these populations rather than a true lower incidence. This is evidenced by extensive studies in white populations and a significant paucity of data in other ethnic groups. The most frequent causes of death in GCA are cardiovascular disease (CVD) (39%) followed by cerebrovascular disease (CVA) (14%), infection (13%), and malignancy (12%).3 Overall, the mortality rate is increased in the first two years and is associated with the disease severity, extent, ischemic, and treatment complications, particularly from glucocorticoids.4,5ObjectivesThe aim of this study was to compare the rate of cardiovascular and infectious complications in GCA patients among different ethnicities.MethodsIn this retrospective cohort study, we identified patients with biopsy proven GCA based on ICD-10 codes, using the Nationwide Inpatient Sample database (NIS) from 2016 to 2019. We included acute coronary syndrome (ACS), CVA, thoracic ascending aneurysm rupture (TAA), and infection (composite of UTI, sepsis and pneumonia) as our outcomes of interest and compared them between Caucasian, African American (AA), and Hispanic ethnicities. We implemented logistic regression analysis in the univariable and multivariable models. In the multivariable model, we adjusted all outcomes for potential confounders, including age, sex, obesity, hyperlipidemia, congestive heart failure, peripheral vascular diseases, diabetes, hypertension, renal failure, history of smoking or alcohol abuse, history of other drug abuse, prior history of MI, primary coronary intervention, or coronary artery bypass grafting, coagulopathy, liver disease, chronic pulmonary disease, ischemic cardiomyopathy, Elixhauser comorbidity index, type of insurance, bed size of hospital, history of defibrillator or pacemaker, and long-term use of steroids. The analysis was done using the STATA software, version 17.0 (MP2).ResultsWe identified 7,750 patients with GCA, of whom 5,710 (74%) were Caucasian, 1,335 (17%) were AA, and 705 (9%) were Hispanic. Our results showed that Hispanics had both a higher prevalence (16.30% vs 9.80% vs 7.50%, p-value = 0.017) and risk for infections (OR: 2.74; 95%-CI 1.4-5.5; p-value = 0.004) when compared to the other racial groups. There was no difference in the risk of ACS among Caucasians (OR: 2.72; 95%-CI 0.6-12.4; p-value = 0.2) and Hispanics (OR: 2.72; 95%-CI 0.4-17.4; p-value = 0.004) when compared to AA population. Similarly, risk of CVA was not different between racial groups (Caucasians: OR: 1.04; 95%-CI 0.6-1.7; p-value = 0.87; Hispanics: OR: 0.8; 95%-CI 0.4-1.7; p-value = 0.567). The prevalence for TAA was only reported in the Caucasian group (0.50%).ConclusionACS and CVA are known complications of GCA. There does not appear to be a difference in the risks of these common cardiovascular complications among racial groups. However, there was a significantly higher rate of infections in the Hispanic population. This may be explained by biologic differences in susceptibility and racial disparities in insurance coverage and access to care.References[1]Tehrani, R., et al. Seminar in Ophthalmology. 2008[2]Gruener, A., et al. JAMA Ophthalmol. 2019[3]Hill, C., et al. Semin Arthritis Rheum. 2017[4]Mackie S., et al. Nat Rev Rheumatol. 2014[5]Therkildsen, P., et al. Rheumatology (Oxford). 2021Table 1.Multivariable logistic regression comparing clinical outcomes across races*CaucasianHispanicOR95% CIP-valueOR95% CIP-valueACS2.720.6-12.40.22.720.4-17.40.291CVA1.040.6-1.70.870.80.4-1.70.567TAANANAInfection1.550.9-2.60.112.741.4-5.50.004*AA are taken as referenceDisclosure of InterestsNone declared
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Drivelegka, P., L. T. H. Jacobsson, U. Lindström, K. Bengtsson, and M. Dehlin. "OP0192 INCIDENT GOUT AND RISK OF FIRST-TIME ACUTE CORONARY SYNDROME: A PROSPECTIVE, POPULATION-BASED, COHORT STUDY IN SWEDEN." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 115.1–116. http://dx.doi.org/10.1136/annrheumdis-2021-eular.3256.
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Background:Gout is associated with an increased risk of cardiovascular disease (CVD), but it is not clear whether this risk is intrinsic to gout itself or to underlying comorbidities. Although the impact of gout on CVD has been studied previously, the results have been conflicting and studies from European countries are scarce.Objectives:To investigate the risk of first-time acute coronary syndrome (ACS) in patients with incident gout in western Sweden, compared to the general population.Methods:Using data from the population-based health care database VEGA, we identified all patients with incident gout diagnosis at either primary or specialized health care units in western Sweden, in the period 2007– 2017 (20,287 cases; mean age, 65.6 years; 67.4% males). Cases regarded as incident, if they did not have any recorded diagnosis of gout in the previous seven years. For each case, up to five controls matched on age, sex, and county at the date of first gout diagnosis were identified from the census register (84,240 controls). Cases and controls with prior history of ischemic heart disease were excluded. The follow-up began at the first diagnosis of gout, and ended at the earliest of an ACS event, emigration, death, or 31 December 2017. To estimate the risk of first-time ACS, we used incident rate (IR) and univariable and multivariable Cox regression analysis with adjustments for the following cardiovascular risk factors: the diagnoses of hypertension, diabetes, hyperlipidemia, obesity, renal disease, heart failure, cardiomyopathy, psoriasis, chronic obstructive pulmonary disease, alcoholism, cancer, cerebrovascular, and atherosclerotic disease, as well as for the dispensed prescriptions of statins, anticoagulants, anti-hypertensive, anti-diabetic, anti-hyperlipidemic, anti-obesity, and vasodilator drugs.Results:The IR of first-time ACS was 9.0 events per 1,000 person-years in the gout cohort, compared to 6.3 in the control cohort. The IRs were lower for women than men, both in the gout (IR, 8.2 vs 9.4) and in the control cohort (IR, 5.0 vs 7.0). Univariable analysis showed that patients with gout have a higher risk of first-time ACS, as compared to the general population (Figure 1, Table 1), but the increased risk is largely diminished after adjustments for cardiovascular risk factors (Table 1).Table 1.Risk of first-time ACS in patients with incident gout, as compared to the general population.Unadjusted HR95% CIp-valueAdjusted HR95% CIp-valueACS Overall1.431.32-1.55<.00011.151.05-1.240.0013 Men1.351.23-1.48<.00011.121.02-1.230.0230 Women1.631.41-1.89<.00011.211.03-1.410.0207Figure 1.Event-free survival curve for patients with gout and controls during the follow-up, where event is first-time acute coronary syndrome.Conclusion:Patients with incident gout have a 43% higher risk of first-time ACS, as compared to the general population. This increased risk is largely explained by the increased occurrence of comorbidities in gout, but there is still a modestly increased risk that may be due to gout related factors. Our results underline the importance of cardiovascular risk assessment and the need for appropriate management of the underlying cardiovascular risk factors in patients with gout.Disclosure of Interests:None declared
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Chew Wai Jin, Kelvin, Mervyn Marlon Anak Mathew Minggat, and Ramesh Singh. "Sintered Properties of Stainless Steel-doped Y-TZP Ceramics." MATEC Web of Conferences 152 (2018): 02012. http://dx.doi.org/10.1051/matecconf/201815202012.
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Yttria stabalised Tetragonal Zirconia Polycrystalline (Y-TZP) has been extensively renowned for its vast outstanding contribution in medical field such as primary function for implant biomaterial which acts as restoration of damaged body parts. Nonetheless in the past decades, there have been various reported cases that point the failure of hip transplants involving material of zirconia ceramic. This eventually leads to the birth of this research project where it studied the properties effects of Y-TZP as it was added or doped with stainless steel 316 (SS316). In this research project, the parameter of weight percentage for stainless steel 316 (SS316) to be doped with Y-TZP were as follows; 0 wt%, 0.1 wt%, 0.5 wt% and 1 wt%. The outcome of this experiment then were measured and analysed as according to properties of relative density, Vickers hardness and fracture toughness. The experiment was conducted by firstly mixed the Y-TZP and SS316 powders together as according to the weight percentage of SS316 as well as addition of ethanol solution that act for medium of enhancement. The mixture then underwent compacting pressure bench press as well as Cold Isostatic Pressure (CIP) in order to produce the green sample. After that, the green sample underwent sintering process via pressureless sintering method at mentioned ranges temperature of 1250°C, 1300°C, 1400°C and up to 1500°C. Subsequently, the sample then underwent grinding and polishing process before proceeding to the measurement and analysis process. The outcome of the measurement and analysis process revealed that as the content of SS316 doped with Y-TZP increases as well as the increased in sintering temperature, the relative density and fracture toughness profound to be increased while Vickers hardness indicated as decreased.
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Rúa-Figueroa, I., D. Rua-Figueroa, A. M. Anzola Alfaro, N. Pérez-Veiga, M. Galindo-Izquierdo, J. Calvo-Alén, A. Fernandez-Nebro, et al. "POS0721 ARE ANTIMALARIALS SAFE FOR THE HEART OF PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS? ANALYSIS OF FACTORS ASSOCIATED WITH THE DEVELOPMENT OF HEART FAILURE IN PATIENTS IN THE SPANISH SOCIETY OF RHEUMATOLOGY LUPUS REGISTRY (RELESSER)." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 610–11. http://dx.doi.org/10.1136/annrheumdis-2021-eular.1208.
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Background:Factors associated with the development of chronic heart failure (CHF) in systemic lupus erythematosus (SLE) have received little attention. On the other hand, recent data from the use of hydroxychloroquine in the treatment of SARS-CoV-2 infection during the COVID19 pandemic have cast some doubts on its cardiological safety.Objectives:To identify factors associated to CHF in SLE.Methods:Retrospective cross-sectional study, including all patients with SLE (≥4 ACR-1997 criteria) recruited in RELESSER registry. The objectives and methodology of the registry have been described previously (1). CHF was defined according to the Charlson index item. Patients with CHF before diagnosis of SLE were excluded. Cumulative damage was measured with the SLICC/ACR index, excluding cardiovascular (CV) items (mSDI). Multivariate analysis exploring factors associated with CHF was carried out.Results:117 patients (3% of the entire cohort) with SLE and CHF and 3,506 controls with SLE without CHF were included. 90% were women. Disease duration: mean (SD), 120.2 (87.7) months. CHF appeared after a median (P25-P75) of 9.40 (4.2-18.3) years from SLE diagnosis. Patients with CHF were older (59.8 ± 18.2 vs. 46.2 ± 4.3). In the bivariate analysis, the association of CHF with greater severity [Katz severity index: median (IQR): 4 (3-5) vs. 2 (1-3)], damage [mSDI: 3 (2-4) vs 0 (0-1)], comorbidity [modified Charlson- excluding CV items: 4 (3-6) vs 1(1-3)] and both CV (37.5% vs 6.7%) and overall mortality (43.2% vs 4.7%) (p<0.0001 for all comparisons). Also, CHF patients were more refractory to SLE treatments (33.3% vs 24%, p=0.0377) and were more frequently hospitalised due SLE [median 3 (1-5) vs 1(0-2), p<0.0001]. The results of the multivariable model are depicted in table 1.Table 1.Congestive heart failure associated factors (multivariable analysis)Odds Ratio95% CIP-valueSex (female)0.460.25 - 0.880.0147Ischaemic cardiopathy7.964.01 - 15.48<0.0001Cardiac arrhythmia7.384.00 - 13.42<0.0001Pulmonary hypertension3.711.84 - 7.250.0002Cardiac valvulopathy6.333.41 - 11.62<0.0001Hospitalization (due to SLE)3.741.81 - 8.650.0008Calcium or vitamin D5.292.07 - 16.860.0015Antimalarials0.280.17 - 0.45<0.0001mSDI *1.291.16 - 1.44<0.0001*mSDI = modified SLICC/ACR damage index (without cardiovascular items)Conclusion:- CHF is a rather late complication of SLE.- Patients with SLE and CHF have more severe SLE, with greater refractoriness to SLE treatments and higher overall mortality.- Treatment with antimalarials, as routinely used in SLE patients, is not only safe to heart, but even appears to have a cardioprotective effect.References:[1]Rúa-Figueroa I, López-Longo FJ, Calvo-Alén J, et al. National registry of patients with systemic lupus erythematosus of the Spanish Society of Rheumatology: objectives and methodology. Reumatol Clin. 2014;10(1):17-24.Acknowledgements:Research Unit of Spanish Society of RheumatologyDisclosure of Interests:None declared
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Kang, E., S. Hong, Y. G. Kim, C. K. Lee, J. S. Oh, B. Yoo, and S. M. Ahn. "POS0762 LONG-TERM RENAL OUTCOMES OF PATIENTS WITH NON-PROLIFERATIVE LUPUS NEPHRITIS." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 667–68. http://dx.doi.org/10.1136/annrheumdis-2022-eular.3393.
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BackgroundAlthough proliferative (class III or IV) lupus nephritis (LN) is the most common finding in the classification of LN, pure membranous (class V) or mesangial (class I or II) LN can occur as a form of LN. Even though non-proliferative LN (class I, II, or V) is a less severe form with good outcomes, data on long-term renal prognosis are limited.ObjectivesThis study investigated the long-term outcomes and prognostic factors in non-proliferative LN.MethodsWe retrospectively reviewed the medical records of patients with systemic lupus erythematosus who were diagnosed with LN class I, II, V or II+IV by kidney biopsy between 1997 and 2021 at a tertiary referral center. Clinical and laboratory data were compared between patients with and without poor renal outcomes. Poor renal outcome was defined as an estimated glomerular filtration rate (eGFR) of < 60 mL/min/1.73 m2 or death due to renal cause. Univariate and multivariate analyses were performed with the Cox proportional hazard model to identify the factors associated with poor renal outcomes.ResultsWe included 71 patients with non-proliferative LN (4: class I; 17: class II; 48: class V, 17; 2: class II+V). Median follow-up duration was 103 months (interquartile range 27–185) and the overall rate of poor renal outcomes at last follow-up was 29% (21/71), including end-stage renal disease (n=2) and renal death (n=1).Univariate analysis indicated that older age (HR 1.05; 95% CI: 1.00–1.09), low eGFR (HR 0.97; 95% CI: 0.95–0.99) and failure to reach complete remission at 6 months (HR 0.332; 95% CI: 0.12–0.92) were significantly associated with poor renal outcomes. Multivariate analysis revealed that low eGFR at 6 months (HR 0.97; 95% CI: 0.95–0.99) was significantly associated with poor renal outcomes.Figure 1.Renal outcomes at last follow upeGFR, estimated glomerular filtration rate (ml/min/1.73m2)Table 1.Univariate and multivariate Cox proportional hazard regression analyses of the factor associated with poor renal outcomesParameterUnivariate analysisMultivariate analysisHR95% CIp valueHR95% CIp valueClinical features Age1.0461.003-1.0910.0361.0020.960-1.0470.921 Sex1.6540.375-7.2980.506 SLEDAI1.0360.965-1.1120.327 Extra renal SLEDAI1.0380.971-1.110.272Renal profiles eGFR at LN diagnosis0.9930.976-1.0110.456 Proteinuria at LN diagnosis1.0001.000-1.0000.444 > 1g/24 hours0.6690.243-1.8410.437 > 3g/24 hours0.6240.229-1.6990.356 eGFR at 6M0.9670.948-0.9860.0010.9680.948-0.9880.002 eGFR at 12M0.9640.947-0.9810.000 Complete remission at 6M0.3320.119-0.9240.0350.5530.179-1.7070.303 Complete remission at 12M0.6670.232-1.9140.451 Transformation1.2460.423-0.7010.692Laboratory data Anti-dsDNA1.0010.999-1.0030.196 C31.0201.000-1.0410.051 C41.0270.969-1.0890.367 Albumin1.1800.661-2.1090.576ClassificationaClass I0.8020.102-6.3030.834Class II1.2980.412-4.0880.656Class V0.8870.308-2.5570.824Class II+V0.0480.000-16850.837Medicationsb ACEi/ARB1.6520.603-4.5280.329 Hydroxychloroquine1.3260.414-4.2420.635 Corticosteroid1.1860.154-9.1080.870 CNI2.4390.464-12.8240.292 MMF3.7880.959-14.9650.057 AZA0.5890.133-2.6110.486a LN classifications were based on the International Society of Pathology/Renal Pathology Society (ISN/RPS) classification.b Medications maintained at least one year since Lupus Nephritis diagnosis.HR, hazard ratio; 95% CI, 95% confidence interval; SLEDAI, systemic lupus erythematosus disease activity index; eGFR, estimated glomerular filtration rate; LN, lupus nephritis; anti-dsDNA, anti-double strand DNA; C3/C4; complement 3/4; ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; CNI, carcineurin inhibitor; MMF, mycophenolate mofetil; AZA, azathioprine.ConclusionPoor renal outcomes occurred in approximately 30% of patients with non-proliferative LN (class I, II or V) after long-term follow-up.Our findings suggest that more active management may be needed for non-proliferative LN, particularly in patients with low eGFR at 6 months.Disclosure of InterestsNone declared
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Chiu, Yi-Chung, Loren C. Chang, Chi-Kuang Chao, Tzu-Ya Tai, Kai-Lun Cheng, Hsin-Tzu Liu, Rong Tsai-Lin, et al. "Lessons Learned from IDEASSat: Design, Testing, on Orbit Operations, and Anomaly Analysis of a First University CubeSat Intended for Ionospheric Science." Aerospace 9, no. 2 (February 18, 2022): 110. http://dx.doi.org/10.3390/aerospace9020110.
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Given the pervasive use of satellite and over the horizon wireless communication technology in modern society, ionospheric disturbances that can disrupt such services are a crucial consideration. Ionospheric irregularities, plasma bubbles and other phenomena can have a great impact on satellite navigation and communications, impacting other systems reliant on such technologies. The Ionospheric Dynamics and Attitude Subsystem Satellite (IDEASSat) was a 3U developed by National Central University (NCU) to measure irregularities in the ionosphere, as well as to establish spacecraft engineering and operations capacity at NCU. The onboard Compact Ionospheric Probe (CIP) could measure high-resolution plasma parameters, which can be used for identifying ionospheric irregularities that can cause scintillation in satellite navigation and communications signals. Part of the spacecraft sub-systems were independently designed and developed by students, who were also responsible for integration, testing, and operations. IDEASSat was successfully launched into low Earth orbit on 24 January 2021, and then began mission operations. The spacecraft successfully demonstrated three-axis attitude stabilization and control, tracking, telemetry and command (TT&C), as well as flight software and ground systems that could support autonomous operation. The spacecraft experienced a critical anomaly 22 days after launch, followed by a 1.5-month communications blackout. The spacecraft briefly recovered from the blackout for long enough to replay flight data, which allowed for the cause of the blackout to be determined as an inability of the electrical power subsystem reset circuit to recover from an ionizing radiation induced single event latch-up. Although the mission was not completed, flight data obtained during the mission will help to improve the designs of future spacecraft in development at NCU. This paper will introduce IDEASSat’s final flight model design and implementation, integration, testing, environmental verification, and failure analysis, and will review the performance of the spacecraft during on-orbit operations. The results and experiences encountered in implementation and operations of the IDEASSat mission are presented here as a reference for other university small satellite teams.
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Hansson, Karin E., Anja Rosdahl, Mona Insulander, Sirkka Vene, Lars Lindquist, Sara Gredmark-Russ, and Helena H. Askling. "Tick-borne Encephalitis Vaccine Failures: A 10-year Retrospective Study Supporting the Rationale for Adding an Extra Priming Dose in Individuals Starting at Age 50 Years." Clinical Infectious Diseases 70, no. 2 (March 7, 2019): 245–51. http://dx.doi.org/10.1093/cid/ciz176.
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Abstract Background Southern Sweden is endemic for tick-borne encephalitis (TBE), with Stockholm County as one of the high-risk areas. Our aim in this study was to describe cases of vaccine failures and to optimize future vaccination recommendations. Methods Patients with TBE were identified in the notification database at the Department of Communicable Disease Control and Prevention in Stockholm County during 2006–2015. Vaccine failure was defined as TBE despite adherence to the recommended vaccination schedule with at least 2 doses. Clinical data were extracted from medical records. Results A total of 1004 TBE cases were identified, 53 (5%) were defined as vaccine failures. In this latter group, the median age was 62 years (6–83). Forty-three (81%) patients were aged >50 years and 2 were children. Approximately half of the patients had comorbidities, with diseases affecting the immune system accounting for 26% of all cases. Vaccine failures following the third or fourth vaccine dose accounted for 36 (68%) of the patients. Severe and moderate TBE disease affected 81% of the cases. Conclusions To our knowledge, this is the largest documented cohort of TBE vaccine failures. Vaccine failure after 5 TBE vaccine doses is rare. Our data provide rationale for adding an extra priming dose to those aged ≥50 years.
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Li, Susan. "Failure Analysis Challenges for Chip-Scale Packages." EDFA Technical Articles 15, no. 2 (May 1, 2013): 14–21. http://dx.doi.org/10.31399/asm.edfa.2013-2.p014.
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Abstract Chip-scale packages (CSPs) make efficient use of space on PCBs, but their small size, multilevel stacking arrangements, and complex interconnects present serious challenges when it comes to testing and failure analysis. This article describes some of the problems encountered when dealing with various types of CSPs and provides practical solutions based on the tools and techniques available in most FA labs. It discusses the causes and effects of package and die related failures and walks readers through the steps involved in decapsulating plastic FBGA packages using conventional etching, polishing, and milling techniques. It also includes a case study involving a failure caused by improper laser marking.
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Wang, Fei, Da Wang, and Hai Gang Yang. "A SAT-Based Pattern Generation Method for Diagnosis Multiple Scan Chain Faults." Advanced Materials Research 301-303 (July 2011): 989–94. http://dx.doi.org/10.4028/www.scientific.net/amr.301-303.989.
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Scan chain design is a widely used design-for-testability (DFT) technique to improve test and diagnosis quality. However, failures on scan chain itself account for up to 30% of chip failures. To diagnose root causes of scan chain failures in a short period is vital to failure analysis process and yield improvements. As the conventional diagnosis process usually runs on the faulty free scan chain, scan chain faults may disable the diagnostic process, leaving large failure area to time-consuming failure analysis. In this paper, a SAT-based technique is proposed to generate patterns to diagnose scan chain faults. The proposed work can efficiently generate high quality diagnostic patterns to achieve high diagnosis resolution. Moreover, the computation overhead of proving equivalent faults is reduced. Experimental results on ISCAS’89 benchmark circuits show that the proposed method can reduce the number of diagnostic patterns while achieving high diagnosis resolution.
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Feng, J. D., D. Tozzi, J. Liddell, M. Gleason, L. Pestic-Dragovich, and E. ElGabry. "Optimizing Run Control Performance in Tissue-Based Biomarker Testing: Experience of an Industry-Based CAP/CLIA Laboratory." American Journal of Clinical Pathology 156, Supplement_1 (October 1, 2021): S113—S114. http://dx.doi.org/10.1093/ajcp/aqab191.242.
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Abstract Introduction/Objective Introduction: In contrast to traditional labs, our CAP/CLIA Lab performs patient sample testing only for pharma-sponsored clinical trials. Very limited patient material is received, usually in the form of unstained slides rather than wet tissues. Strict run control (RC) quality measures are therefore essential to avoid repeat testing, exhaustion of patient material and/or delay of patient enrollment decisions. We describe methods to optimize RC staining performance and consistency. Methods/Case Report Methods: The RC failure rate was evaluated retrospectively and prospectively from January 2018 through March 2021. Specific failure modes were evaluated, including: 1) instrument-related (catastrophic mechanical failure, slide derailment, low temperature error), 2) stain-related (lighter or darker staining vs. reference), 3) tissue-related (tissue loss/fall-off). RC failures were also tracked by instrument and by individual biomarker. Results (if a Case Study enter NA) Results: 33,189 patient samples (84,130 slides) were tested from January 2018 through March 2021. Concurrently, 14,794 RC slides were tested across more than 115 biomarkers, including immunohistochemistry, multiplex immunofluorescence, and in situ hybridization assays. The RC failure rates by year were: 2018: 3.2 % (116 RCs), 2019: 3.8% (156 RCs), 2020: 1.9% (100 RCs), and 2021 (through March) 1.3% (21 RCs). The decrease in RC failure rate was a direct result of process changes addressing each of the failure modes, including, but not limited to: 1) improvement in slide storage conditions, 2) more selective RC tissue selection, and 3) more consistent interaction with on-site instrument support. Conclusion Process improvements addressing pre-analytic and analytic RC failure modes have resulted in a year-over-year decrease in RC failures. Consequently, our first-pass rates for immunohistochemical, immunofluorescence multiplex, and in-situ hybridization testing of patient samples have increased. Close monitoring of RC failure rates and near-real-time troubleshooting of individual RC failures are important components of successful operation in our unique laboratory setting, where patient material for testing is limited.
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Vanam, Kiran, Anthony Newman, Mori Poustinchi, and Stephen Stewart. "Quality Monitors and Inspection Criteria for Bare Die Flip Chip Ball Grid Array and Bare Die PoP Packages." International Symposium on Microelectronics 2014, no. 1 (October 1, 2014): 000533–36. http://dx.doi.org/10.4071/isom-wa61.
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Package form factor and cost are one of the key drivers in smart phone and tablet landscape. In order to meet these requirements hand held market has seen emergence of bare die flip chip ball grid array (BD FCBGA) and bare die package on package (BD PoP). As the name implies, these packages don't have a mold cap or heat spreader surrounding the silicon die resulting in lower cost and smaller form factor. Further package thickness reduction is possible by thinning of silicon die without significantly affecting high temperature (HT) warpage or coplanarity. One of the main concerns with aforementioned bare die package (BDP) configurations is die crack failure during assembly, testing, shipping or surface mount operation (SMT). The propensity of die crack failures further increases as thinner die is employed to meet overall package height requirements. This work focusses on evaluating various inspection tools for detecting gross die cracks to fine line cracks up to ~ 0.7 μm wide. Some of the key considerations for inspection tools, at assembly and test operations will be presented.
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Jones, Ronald N., Karen Krisher, and Deborah S. Bird. "Results of the Survey of the Quality Assurance for Commercially Prepared Microbiology Media." Archives of Pathology & Laboratory Medicine 127, no. 6 (June 1, 2003): 661–65. http://dx.doi.org/10.5858/2003-127-661-rotsot.
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Abstract Context.—Beginning in 1985, state-of-the-art surveys by the College of American Pathologists (CAP) led to M22-A guidelines by the National Committee for Clinical Laboratory Standards (NCCLS) for quality assurance (QA) of various commercially prepared isolation and diagnostic microbiology media. Some medium types were declared exempt from routine QA testing by each laboratory user, but manufacturer QA was maintained and specified in great detail. No update has occurred in more than 15 years as more complex media have been introduced into clinical microbiology practice. Objective.—To reassess the quality of commercially prepared microbiology media in the United States for the revision of NCCLS document M22-A2. Methods.—A questionnaire was designed to conform to that used by the CAP in 1985 and 1988, and was updated by lists of 52 recently introduced diagnostic media. Queries included details of laboratory QA in the last 12 months, such as number of lots tested, number of items in a lot, number of items in a quality control (QC) sample, number of lots failed, and reasons for lot failure. All CAP Microbiology Surveys participants received the document in late 2001. Results.—Data from nearly 300 000 media lots representing 32.7 million medium items were received from more than 3000 CAP Surveys subscribers. Lot raw data failure rates for all media ranged from 0.10% to 9.87% (average, 1.01%). Failures with media having a significant QC experience (≥1000 lots or ≥100 000 items) adjusted for QC strain-based failures (so-called extrapolated failure rate) ranged from 0.04% to 1.34% (average, 0.40%). The threshold rate for QA exemption from 1985 analyses was expanded to 0.50% or less and now allows exemption of 27 media evaluated in this study. Local laboratory QA must remain in force (M22-A2) for the other 25 products. Conclusions.—Generated QA failure results from the CAP Microbiology Surveys supplement recent results of the NCCLS M22 Subcommittee that will lead to more practical media QA guidelines and could significantly decrease costs for clinical microbiology laboratories through focusing QC on a smaller number of the most at-risk diagnostic products.
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Henry, Leo G., and Vijay Chowdhury. "Using Laboratory Simulation and Failure Analysis to Differentiate EOS and ESD Failures – An ISTFA ’99 Panel." EDFA Technical Articles 2, no. 2 (May 1, 2000): 23–24. http://dx.doi.org/10.31399/asm.edfa.2000-2.p023.
Full textAbstract:
Abstract At the ISTFA ’99 event, the organizers arranged for the first time a panel discussion on failure analysis related purely to EOS/ESD issues. Each panelist presented their area of expertise followed by two hours of lively exchange with the attendees and among attendees. The panel discussed how to differentiate EOS and ESD failures. These failures are more critical with the industry move to submicron geometries and newer interconnect materials and other processing technologies, such as copper and flip-chip processing.
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Fahey, K., R. Estrada, L. Mirkarimi, R. Katkar, D. Buckminster, and M. Huynh. "Applications of 3D X-Ray Microscopy for Advanced Package Development." International Symposium on Microelectronics 2011, no. 1 (January 1, 2011): 001078–83. http://dx.doi.org/10.4071/isom-2011-tha6-paper3.
Full textAbstract:
This paper describes the utilization of non-destructive imaging using 3D x-ray microscopy for package development and failure analysis. Four case studies are discussed to explain our methodology and its impact on our advanced packaging development effort. Identifying and locating failures embedded deep inside the package, such as a solder fatigue failure within a flip chip package, without the need for physical cross-sectioning is of substantial benefit because it preserves the package for further analysis. Also of utility is the ability to reveal the structural details of the package while producing superior quality 2D and volumetric images. The technique could be used not only for analysis of defects and failures, but also to characterize geometries and morphologies during the process and package development stage.
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Suvorova, Elena, Yuriy Sheynin, and Nadezhda Matveeva. "Fault Mitigation in Reconfigurable NoC Routers with Thin Design Rules." International Journal of Embedded and Real-Time Communication Systems 6, no. 1 (January 2015): 28–46. http://dx.doi.org/10.4018/ijertcs.2015010102.
Full textAbstract:
Modern networks-on-chip (NoC) for embedded systems are manufactured by thin design rules; they should be resistant to failures due to the specific aspects of the technology. In the paper we consider failure mitigation approaches, evaluate them for thin design rules. Most fault mitigation approaches are based on reconfiguration of NoC and its main components – routers. We suggest the methodology for development of reconfigurable routers with fault mitigation, estimate them using simulation that enables dynamic failure injection. The proposed method can be used for routers with different structures in NoC with various interconnection graphs.