Search results for: toxicity assessment

Authors: Carlos Riascos, Peter Thomson

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Real-time hybrid simulation (RTHS) is a modern cyber-physical technique used for the experimental evaluation of complex systems, that treats the system components with predictable behavior as a numerical substructure and the components that are difficult to model as an experimental substructure. Therefore it is an attractive method for evaluation of the response of civil structures under earthquake, wind and anthropic loads. Another practical application of RTHS is the evaluation of control systems, as these devices are often nonlinear and their characterization is an important step in the design of controllers with the desired performance. In this paper, the response of three-story shear frame controlled by a tuned liquid column damper (TLCD) and subject to base excitation is considered. Both passive and semi-active control strategies were implemented and are compared. While the passive TLCD achieved a reduction of 50% in the acceleration response of the main structure in comparison with the structure without control, the semi-active TLCD achieved a reduction of 70%, and was robust to variations in the dynamic properties of the main structure. In addition, a RTHS was implemented with the main structure modeled as a linear, time-invariant (LTI) system through a state space representation and the TLCD, with both control strategies, was evaluated on a shake table that reproduced the displacement of the virtual structure. Current assessment measures for RTHS were used to quantify the performance with parameters such as generalized amplitude, equivalent time delay between the target and measured displacement of the shake table, and energy error using the measured force, and prove that the RTHS described in this paper is an accurate method for the experimental evaluation of structural control systems.

Keywords: structural control, hybrid simulation, tuned liquid column damper, semi-active sontrol strategy

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Authors: G. Medkour Ishak-Boushaki, A. Taibi, M. Allab

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Quantitative environmental radioactivity measurements are needed to determine the level of exposure of a population to ionizing radiations and for the assessment of the associated risks. Gamma spectrometry remains a very powerful tool for the analysis of radionuclides present in an environmental sample but the basic problem in such measurements is the low rate of detected events. Using large environmental samples could help to get around this difficulty but, unfortunately, new issues are raised by gamma rays attenuation and self-absorption. Recently, a new method has been suggested, to detect and identify without quantification, in a short time, a gamma ray of a low count source. This method does not require, as usually adopted in gamma spectrometry measurements, a pulse height spectrum acquisition. It is based on a chronological record of each detected photon by simultaneous measurements of its energy ε and its arrival time τ on the detector, the pair parameters [ε,τ] defining an event mode sequence (EMS). The EMS serials are analyzed sequentially by a Bayesian approach to detect the presence of a given radioactive source. The main object of the present work is to test the applicability of this sequential approach in radioactive environmental materials detection. Moreover, for an appropriate health oversight of the public and of the concerned workers, the analysis has been extended to get a reliable quantification of the radionuclides present in environmental samples. For illustration, we consider as an example, the problem of detection and quantification of 238U. Monte Carlo simulated experience is carried out consisting in the detection, by a Ge(Hp) semiconductor junction, of gamma rays of 63 keV emitted by 234Th (progeny of 238U). The generated EMS serials are analyzed by a Bayesian inference. The application of the sequential Bayesian approach, in environmental radioactivity analysis, offers the possibility of reducing the measurements time without requiring large environmental samples and consequently avoids the attached inconvenient. The work is still in progress.

Keywords: Bayesian approach, event mode sequence, gamma spectrometry, Monte Carlo method

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Authors: Maysam Mard-Soltani, Mohamad Javad Rasaee, Saeed Khalili, Abdol Karim Sheikhi, Mehdi Hedayati

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Production of specific antibody responses against hTSH is a cumbersome process due to the high identity between the hTSH and the other members of the glycoprotein hormone family (FSH, LH and HCG) and the high identity between the human hTSH and host animals for antibody production. Therefore, two polyclonal antibodies were purified against two recombinant proteins. Four possible ELISA tests were designed based on these antibodies. These ELISA tests were checked against hTSH and other glycoprotein hormones, and their sensitivity and specificity were assessed. Bioinformatics tools were used to analyze the immunological properties. After the immunogen region selection from hTSH protein, c terminal of B hTSH was selected and applied. Two recombinant genes, with these cut pieces (first: two repeats of C terminal of B hTSH, second: tetanous toxin+B hTSH C terminal), were designed and sub-cloned into the pET32a expression vector. Standard methods were used for protein expression, purification, and verification. Thereafter, immunizations of the white New Zealand rabbits were performed and the serums of them were used for antibody titration, purification and characterization. Then, four ELISA tests based on two antibodies were employed to assess the hTSH and other glycoprotein hormones. The results of these assessments were compared with standard amounts. The obtained results indicated that the desired antigens were successfully designed, sub-cloned, expressed, confirmed and used for in vivo immunization. The raised antibodies were capable of specific and sensitive hTSH detection, while the cross reactivity with the other members of the glycoprotein hormone family was minimum. Among the four designed tests, the test in which the antibody against first protein was used as capture antibody, and the antibody against second protein was used as detector antibody did not show any hook effect up to 50 miu/l. Both proteins have the ability to induce highly sensitive and specific antibody responses against the hTSH. One of the antibody combinations of these antibodies has the highest sensitivity and specificity in hTSH detection.

Keywords: hTSH, bioinformatics, protein expression, cross reactivity

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Authors: Jarmila Štěpánová, Martin Kudláček, Lukáš Jakubec

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The people with spinal cord injury are one of the least sport active members of our society. Their hypoactivity is determined by primary injury, i.e., the loss of motor function, the injured part of the body is connected with health complications and social handicap. Study performs one part of the standardization process of semi-structured interview PARA-SCI.CZ (Czech version of the Physical Activity Recall Assessment for People with Spinal Cord Injury), which measures the type, frequency, duration, and intensity of physical activity of people with spinal cord injury. The study focused on persons with paraplegia who use a wheelchair as their primary mode of mobility. The aim of this study was to perform a process to determine the criterion validity of PARA-SCI.CZ. The actual physical activity of wheelchair users was monitored during three days by using accelerometers Actigraph GT3X fixed on the non-dominant wrist, and semi-structured interview PARA-SCI.CZ. During the PARA-SCI.CZ interview, participants were asked to recall activities they had done over the past 3 days, starting with the previous day. PARA-SCI.CZ captured frequency, duration, and intensity (low, moderate, and heavy) of two categories of physical activity (leisure time physical activity and activities of a usual day). Accelerometer Actigraph GT3X captured duration and intensity (low and moderate + heavy) of physical activity during three days and nights. The study presented three potential recalculations of measured data. Standardization process of PARA-SCI.CZ is essential to critically approach issues of health and active lifestyle of persons with spinal cord injury in the Czech Republic. Standardized PARA-SCI.CZ can be used in practice by physiotherapists and sports pedagogues from the field of adapted physical activities.

Keywords: physical activity, lifestyle, paraplegia, semi-structure interview, accelerometer

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Authors: Ryan Villafuerte Lansangan

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Assessing students’ understanding in the microscopic level of an abstract subject like chemistry poses a challenge to teachers. Literature reveals that the use of representations serves as an essential avenue of measuring the extent of understanding in the discipline as an alternative to traditional assessment methods. This undertaking explored the representational competence profile of high school students from the University of Santo Tomas High School in understanding selected chemical principles and correlate this with their academic profile in chemistry based on their performance in the academic achievement examination in chemistry administered by the Center for Education Measurement (CEM). The common misconceptions of the students on the selected chemistry principles based on their representations were taken into consideration as well as the students’ views regarding their understanding of the role of chemical representations in their learning. The students’ level of representation task instrument consisting of the main lessons in chemistry with a corresponding scoring guide was prepared and utilized in the study. The study revealed that most of the students under study are unanimously rated as Level 2 (symbolic level) in terms of their representational competence in understanding the selected chemical principles through the use of chemical representations. Alternative misrepresentations were most observed on the students’ representations on chemical bonding concepts while the concept of chemical equation appeared to be the most comprehensible topic in chemistry for the students. Data implies that teachers’ representations play an important role in helping the student understand the concept in a microscopic level. Results also showed that the academic achievement in the chemistry of the students based on the standardized CEM examination has a significant association with the students’ representational competence. In addition, the students’ responses on the students’ views in chemical representations questionnaire evidently showed a good understanding of what a chemical representation or a mental model is by drawing a negative response that these tools should be an exact replica. Moreover, the students confirmed a greater appreciation that chemical representations are explanatory tools.

Keywords: chemical representations, representational competence, academic profile in chemistry, secondary students

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Authors: Amizawati Mohd Amir, Ruhanita Maelah, Zaidi Mohd Noor

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As part of the Malaysia Higher Institutions' Strategic Plan in promoting high-quality research and education, the Ministry of Higher Education has introduced various instrument to assess the universities performance. The aims are that university will produce more commercially-oriented research and continue to contribute in producing professional workforce for domestic and foreign needs. Yet the spirit of the success lies in the commitment of university particularly the academic staff to translate the vision into reality. For that reason, the element of fairness and justice in assessing individual academic staff performance is crucial to promote directly linked between university and individual work goals. Focusing on public research universities (RUs) in Malaysia, this study observes at the issue through the practice of university contemporary performance measurement system. Accordingly management control theory has conceptualized that contemporary performance measurement consisting of three dimension namely strategic, comprehensive and dynamic building upon equity theory, the relationships between contemporary performance measurement system and organizational justice and in turn the effect on academic staff work performance are tested based on online survey data administered on 365 academic staff from public RUs, which were analyzed using statistics analysis SPSS and Equation Structure Modeling. The findings validated the presence of strategic, comprehensive and dynamic in the contemporary performance measurement system. The empirical evidence also indicated that contemporary performance measure and procedural justice are significantly associated with work performance but not for distributive justice. Furthermore, procedural justice does mediate the relationship between contemporary performance measurement and academic staff work performance. Evidently, this study provides evidence on the importance of perceptions of justice towards influencing academic staff work performance. This finding may be a fruitful input in the setting up academic staff performance assessment policy.

Keywords: comprehensive, dynamic, distributive justice, contemporary performance measurement system, strategic, procedure justice, work performance

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Authors: Roike Iwan Montolalu, Henny Adeleida Dien, Feny Mentang, Kristhina P. Rahael, Tomy Moga, Ayub Meko, Siegfried Berhimpon

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In the last 20 years, packaging materials derived from petrochemicals polymers were widely used as packaging materials. This due to various advantages such as flexible, strong, transparent, and the price is relatively cheap. However, the plastic polymer also has various disadvantages, such as the transmission monomer contamination into the material to be packed, and waste is non-biodegradable. Edible film (EF) is an up to date materials, generated after the biodegradable packaging materials. The advantages of the EF materials, is the materials can be eat together with food, and the materials can be applied as a coating materials for a widely kind of foods especially snack foods. The aims of this research are to produce and to analyze the characteristics of smoked EF made from carrageenan, myofibril and collagen of Black Marlin (Makaira indica) industrial waste. Smoked EF made with an addition of 0.8 % smoke liquid. Three biopolymers i.e. carrageenan, myofibril, and collagen were used as treatments, and homogenate for 1 hours at speed of 1500 rpm. The analysis carried out on the pH and physical properties i.e. thickness, solubility, tensile strength, % elongation, and water vapor transmission rate (WVTR), as well as on the sensory characteristics of texture i.e. wateriness, firmness, elasticity, hardness, and juiciness of the coated products. The result shown that the higher the concentration the higher the thickness of EF, where as for myofibril proteins appeared higher than carrageenan and collagen. Both of collagen and myofibril shown that concentration of 6% was most soluble, while for carrageenan were in concentration of 2 to 2.5%. For tensile strength, carrageenan was significantly higher than myofibril and collagen; while for elongation, collagen film more elastic than carragenan and myofibril protein. Water vapor transmission rate, shown that myofibril protein film lower than carrageenan and collagen film. From sensory assessment of texture, carrageenan has a high elasticity and juiciness, while collagen and myofibril have a high in firmness and hardness.

Keywords: edible film, collagen, myofibril, carrageenan

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Authors: Alexander A. Tokmakov

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Cell-free protein synthesis is widely used to synthesize recombinant proteins. It allows genome-scale expression of various polypeptides under strictly controlled uniform conditions. However, only a minor fraction of all proteins can be successfully expressed in the systems of protein synthesis that are currently used. The factors determining expression success are poorly understood. At present, the vast volume of data is accumulated in cell-free expression databases. It makes possible comprehensive bioinformatics analysis and identification of multiple features associated with successful cell-free expression. Here, we describe an approach aimed at identification of multiple physicochemical and structural properties of amino acid sequences associated with protein solubility and aggregation and highlight major correlations obtained using this approach. The developed method includes: categorical assessment of the protein expression data, calculation and prediction of multiple properties of expressed amino acid sequences, correlation of the individual properties with the expression scores, and evaluation of statistical significance of the observed correlations. Using this approach, we revealed a number of statistically significant correlations between calculated and predicted features of protein sequences and their amenability to cell-free expression. It was found that some of the features, such as protein pI, hydrophobicity, presence of signal sequences, etc., are mostly related to protein solubility, whereas the others, such as protein length, number of disulfide bonds, content of secondary structure, etc., affect mainly the expression propensity. We also demonstrated that amenability of polypeptide sequences to cell-free expression correlates with the presence of multiple sites of post-translational modifications. The correlations revealed in this study provide a plethora of important insights into protein folding and rationalization of protein production. The developed bioinformatics approach can be of practical use for predicting expression success and optimizing cell-free protein synthesis.

Keywords: bioinformatics analysis, cell-free protein synthesis, expression success, optimization, recombinant proteins

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Authors: Magdalena Bury-Kaminska, Aneta Szudy-Szczyrek, Aleksandra Nowaczynska, Olga Jankowska-Lecka, Marek Hus, Klaudia Kot

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Introduction: The aim of the research was to determine the changes in cognitive functioning in patients with plasma cell myeloma by comparing patients’ state before the treatment and during chemotherapy as well as to determine the biological factors that can be used to predict patients’ cognitive state. Methods: The patients underwent the research procedure twice: before chemotherapy and after 4-6 treatment cycles. A psychological test and measurement of the following biological variables were carried out: TNF-α (tumor necrosis factor), IL-6 (interleukin 6), IL-10 (interleukin 10), BDNF (brain-derived neurotrophic factor). The following research methods were implemented: the Montreal Cognitive Assessment (MoCA), Battery of Tests for Assessing Cognitive Functions PU1, experimental and clinical trials based on the Choynowski’s Memory Scale, Stroop Color-Word Interference Test (SCWT), depression measurement questionnaire. Results: The analysis of the research showed better cognitive functions of patients during chemotherapy in comparison to the phase before it. Moreover, neurotrophin BDNF allows to predict the level of selected cognitive functions (semantic fluency and execution control) already at the diagnosis stage. After 4-6 cycles, it is also possible to draw conclusions concerning the extent of working memory based on the level of BDNF. Cytokine TNF-α allows us to predict the level of letter fluency during anti-cancer treatment. Conclusions: It is possible to presume that BDNF has a protective influence on patients’ cognitive functions and working memory and that cytokine TNF-α co-occurs with a diminished execution control and better material grouping in terms of phonological fluency. Acknowledgment: This work was funded by the National Science Center in Poland [grant no. 2017/27/N/HS6/02057.

Keywords: chemobrain, cognitive impairment, non−central nervous system cancers, hematologic diseases

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Authors: Mersha Tewodros Getnet, Mengistu Ketema, Bamlaku Alemu, Girma Demilew

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The availability of forest products determines the possibilities for forest-based livelihood options. Plantation forest is a widespread economic activity in highland areas of the Amhara regional state, owing primarily to degradation and limited access to natural forests. As a result, tree plantation has become one of the rural livelihood options in the area. Therefore, given the increasing importance of smallholder plantations in highland areas of Amhara Regional States, the aim of this research was to evaluate the extent of smallholder plantations and their socio-economic impact. To address the abovementioned research, a sequential embedded mixed research design was employed. This qualitative and quantitative information was gathered from both primary and secondary sources. Primary data were collected from 385 sample households, which were chosen using a three-stage, multi-stage sampling method based on the Cochran sample size formula. Both descriptive and inferential statistics were used to analyze the data. Smallholder eucalyptus plantations in the study area were discovered to be common, and they are now part of the livelihood portfolio for meeting both household wood consumption and generating cash income. According to the PSM model's ATT results, income from selling farm forest products certainly contributes more to total household income, farm expenditure per cultivated land, and education spending than non-planter households. As a result, the government must strengthen plantation practices by prioritizing specific intervention areas while implementing measures to counteract the plantation's inequality-increasing effect through a variety of means, including progressive taxation.

Keywords: smallholder plantation, Eucalyptus, propensity score matching, average treatment effect and income

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Authors: Rakan Hassan M. Alzahrani, Ziyad Alzahrani, Bader Bashrahil, Abdulrahman Elyasi, Abdullah a Ghaddaf, Rayan Alzahrani, Mohammed Alkathlan, Nawaf Alghamdi, Dakheelallah Almutairi

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Background: Corticosteroid irrigations, which regularly involve the off-label use of budesonide mixed with normal saline in high volume Sino-nasal irrigations, have been more commonly used in the management of post-operative chronic rhinosinusitis (CRS). Objective: This article attempted to measure the efficacy of post-operative budesonide nasal irrigation compared to normal saline-alone nasal irrigation in the management of chronic rhinosinusitis (CRS) through a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: The databases PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched by two independent authors. Only RCTs comparing budesonide irrigation to normal saline alone irrigation for CRS with or without polyposis after functional endoscopic sinus surgery (FESS) were eligible. A random effect analysis model of the reported CRS-related quality of life (QOL) measures and the objective endoscopic assessment scales of the disease was done. Results: Only 6 RCTs met the eligibility criteria, with a total number of participants of 356. Compared to normal saline irrigation, budesonide nasal irrigation showed statically significant improvements in both the CRS-related quality of life (QOL) and the endoscopic findings (MD= -4.22 confidence interval [CI]: -5.63, -2.82 [P < 0.00001]), (SMD= -0.50 confidence interval [CI]: -0.93, -0.06 [P < 0.03]) respectively. Conclusion: Both intervention arms showed improvements in CRS-related QOL and endoscopic findings in post-FESS chronic rhinosinusitis with or without polyposis. However, budesonide irrigation seems to have a slight edge over conventional normal saline irrigation with no reported serious side effects, including hypothalamic-pituitary-adrenal (HPA) axis suppression.

Keywords: Budesonide, chronic rhinosinusitis, corticosteroids, nasal irrigation, normal saline

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Authors: Elizabeth Malebogo Mosepele

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Road transport has become increasingly common in the world; people rely on road networks for transportation purpose on a daily basis. However, environmental impact of roads on surrounding landscapes extends their potential effects even further. This study investigates the impact of road network on natural vegetation. The study will provide baseline knowledge regarding roadside vegetation and would be helpful in future for conservation of biodiversity along the road verges and improvements of road verges. The general hypothesis of this study is that the amount and condition of road side vegetation could be explained by road network conditions. Remote sensing techniques were used to analyze vegetation conditions. Landsat 8 OLI image was used to assess vegetation cover condition. NDVI image was generated and used as a base from which land cover classes were extracted, comprising four categories viz. healthy vegetation, degraded vegetation, bare surface, and water. The classification of the image was achieved using the supervised classification technique. Road networks were digitized from Google Earth. For observed data, transect based quadrats of 50*50 m were conducted next to road segments for vegetation assessment. Vegetation condition was related to road network, with the multinomial logistic regression confirming a significant relationship between vegetation condition and road network. The null hypothesis formulated was that 'there is no variation in vegetation condition as we move away from the road.' Analysis of vegetation condition revealed degraded vegetation within close proximity of a road segment and healthy vegetation as the distance increase away from the road. The Chi Squared value was compared with critical value of 3.84, at the significance level of 0.05 to determine the significance of relationship. Given that the Chi squared value was 395, 5004, the null hypothesis was therefore rejected; there is significant variation in vegetation the distance increases away from the road. The conclusion is that the road network plays an important role in the condition of vegetation.

Keywords: Chi squared, geographic information system, multinomial logistic regression, remote sensing, road side vegetation

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Authors: D. Ramajo, S. Corzo, M. Nigro

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A Multi-dimensional computational fluid dynamics (CFD) two-phase model was developed with the aim to simulate the in-core coolant circuit of a pressurized heavy water reactor (PHWR) of a commercial nuclear power plant (NPP). Due to the fact that this PHWR is a Reactor Pressure Vessel type (RPV), three-dimensional (3D) detailed modelling of the large reservoirs of the RPV (the upper and lower plenums and the downcomer) were coupled with an in-house finite volume one-dimensional (1D) code in order to model the 451 coolant channels housing the nuclear fuel. Regarding the 1D code, suitable empirical correlations for taking into account the in-channel distributed (friction losses) and concentrated (spacer grids, inlet and outlet throttles) pressure losses were used. A local power distribution at each one of the coolant channels was also taken into account. The heat transfer between the coolant and the surrounding moderator was accurately calculated using a two-dimensional theoretical model. The implementation of subcooled boiling and condensation models in the 1D code along with the use of functions for representing the thermal and dynamic properties of the coolant and moderator (heavy water) allow to have estimations of the in-core steam generation under nominal flow conditions for a generic fission power distribution. The in-core mass flow distribution results for steady state nominal conditions are in agreement with the expected from design, thus getting a first assessment of the coupled 1/3D model. Results for nominal condition were compared with those obtained with a previous 1/3D single-phase model getting more realistic temperature patterns, also allowing visualize low values of void fraction inside the upper plenum. It must be mentioned that the current results were obtained by imposing prescribed fission power functions from literature. Therefore, results are showed with the aim of point out the potentiality of the developed model.

Keywords: PHWR, CFD, thermo-hydraulic, two-phase flow

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Authors: Efthimios Kokkotos, Kostakis Marios, Beis Alexandros, Angelos Patakas, Antonios Avgeris, Vassilios Triantafyllidis

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H, C, and O stable isotope ratios were measured in different olive oils and table olives originating from different regions of Greece. In particular, the stable isotope ratios of different olive oils produced in the Lakonia region (Peloponesse – South Greece) from different varieties, i.e., cvs ‘Athinolia’ and ‘koroneiki’, were determined. Additionally, stable isotope ratios were also measured in different table olives (cvs ‘koroneiki’ and ‘kalamon’) produced in the same region (Messinia). The aim of this study was to provide sufficient isotope ratio data regarding each variety and region of origin that could be used in discriminative studies of oil olives and table olives produced by different varieties in other regions. In total, 97 samples of olive oil (cv ‘Athinolia’ and ‘koroneiki’) and 67 samples of table olives (cvs ‘kalmon’ and ‘koroneiki’) collected during two consecutive sampling periods (2021-2022 and 2022-2023) were measured. The C, H, and O isotope ratios were measured using Isotope Ratio Mass Spectrometry (IRMS), and the results obtained were analyzed using chemometric techniques. The measurements of the isotope ratio analyses were expressed in permille (‰) using the delta δ notation (δ=Rsample/Rstandard-1, where Rsample and Rstandardis represent the isotope ratio of sample and standard). Results indicate that stable isotope ratios of C, H, and O ranged between -28,5+0,45‰, -142,83+2,82‰, 25,86+0,56‰ and -29,78+0,71‰, -143,62+1,4‰, 26,32+0,55‰ in olive oils produced in Lakonia region from ‘Athinolia’ and ‘koroneiki ‘varieties, respectively. The C, H, and O values from table olives originated from Messinia region were -28,58+0,63‰, -138,09+3,27‰, 25,45+0,62‰ and -29,41+0,59‰,-137,67+1,15‰, 24,37+0,6‰ for ‘Kalamon’ and ‘koroneiki’ olives respectively. Acknowledgments: This research has been co-financed by the European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship and Innovation, under the call RESEARCH—CREATE—INNOVATE (Project code: T2EDK-02637; MIS 5075094, Title: ‘Innovative Methodological Tools for Traceability, Certification and Authenticity Assessment of Olive Oil and Olives’).

Keywords: olive oil, table olives, Isotope ratio, IRMS, geographical origin

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Authors: Cleto J. Sauer Jr., Rita C. Sauer, Chaider G. Andrade, Dóris F. Rabelo

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Some patients with COVID-19 disease and difficult airway characteristics undergo to endotracheal intubation (ETI) procedure. The tracheal introducer, known as the bougie guide, can aid ETI in patients with difficult airway pattern. Realistic simulation (RS) is a methodology utilized for healthcare professionals training. To improve skills in using the bougie guide of physicians from Recôncavo da Bahia region in Brazil, during COVID-19 outbreak, RS training was carried out. Simulated scenario included the Nasco Lifeform realistic simulator for ETI and a bougie guide introducer. Training was a capacitation program organized by the Health Department of Bahia State. Objective: To report effects in participants´ self-confidence perception for using bougie guide after a RS based training. Methods: Descriptive study, secondary data extracted from questionnaires. Priority workplace and previous knowledge about bougie were reported on a preparticipation formulary. Participants also completed pre- and post-training qualitative self-assessment (10-point Likert scale) regarding to self-confidence in using bougie guide. Distribution analysis for qualitative data was performed with Wilcoxon Signed Rank Test, and self-confidence increase analysis in frequency contingency tables with Fisher's exact test. Results: From May to June 2020 a total of 36 physicians participated of training, 25 (69%) from primary care setting, 32 (89%) with no previous knowledge about the bougie guide utilization. For those who had previous knowledge about bougie pre-training self-confidence median was 6,5, and 2 for participants who had not. In overall there was an increase in self-confidence median for bougie utilization. Median (variation) before and after training was 2.5 (1-7) vs. 8 (4-10) (p <0.0001). Among those who had no previous knowledge about bougie (n = 32) an increase in self-confidence greater than 3 points for bougie utilization was reported by 31 vs. 1 participants (p = 0.71). Conclusions: Most of participants had no previous knowledge about using the bougie guide. RS training contributed to self-confidence increase for using bougie for ETI procedure. RS methodology can contribute for training in using the bougie guide for ETI procedure during COVID-19 outbreak.

Keywords: bougie, confidence, COVID-19, endotracheal intubation, realistic simulation

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Authors: Gampel Alexander, Mazzuchi Thomas, Sarkani Shahram

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The cybersecurity landscape is constantly evolving, and organizations must adapt to the changing threat environment to protect their assets. The implementation of the NIST Risk Management Framework (RMF) has become critical in ensuring the security and safety of industrial control and automation systems. However, cybersecurity professionals are facing challenges in implementing RMF, leading to systems operating without authorization and being non-compliant with regulations. The current approach to RMF implementation based on business practices is limited and insufficient, leaving organizations vulnerable to cyberattacks resulting in the loss of personal consumer data and critical infrastructure details. To address these challenges, this research proposes a Model-Based Systems Engineering (MBSE) approach to implementing cybersecurity controls and assessing risk through the RMF process. The study emphasizes the need to shift to a modeling approach, which can streamline the RMF process and eliminate bloated structures that make it difficult to receive an Authorization-To-Operate (ATO). The study focuses on the practical application of MBSE in industrial control and automation systems to improve the security and safety of operations. It is concluded that MBSE can be used to solve the implementation challenges of the NIST RMF process and improve the security of industrial control and automation systems. The research suggests that MBSE provides a more effective and efficient method for implementing cybersecurity controls and assessing risk through the RMF process. The future work for this research involves exploring the broader applicability of MBSE in different industries and domains. The study suggests that the MBSE approach can be applied to other domains beyond industrial control and automation systems.

Keywords: authorization-to-operate (ATO), industrial control systems (ICS), model-based system’s engineering (MBSE), risk management framework (RMF)

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Authors: Dawit Chankaye

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Background: Azadirachta indica is the most versatile medicinal plant known as “the village pharmacy”. The plant is known for its broad spectrum of biological activity in India and various countries throughout history by many different human cultures. The present study was undertaken to determine the antimalarial and antidiabetic properties of the leaf extracts of A. indica grown in Ethiopia when treated in vivo. This work has also been concerned with determining essential oil composition and the antimicrobial activity of the plant in vitro. Methods: Leaf extracts were prepared using three different selected solvents. Standard and clinical isolates were treated with extracts of the leaves of A. indica using the agar well diffusion method. The antimalarial and antidiabetic tests were conducted in vivo in mice. Phytochemical screening was done using various chemical tests, and the volatile oil constituents were determined using gas chromatography-mass spectrometry (GC/MS). Results: In vivo antimalarial activity studies showed 85.23%, 69.01%, and 81.54% suppression of parasitemia for 70% ethanol, acetone, and water extracts, respectively. The extracts collected from the leaves also showed reduced blood sugar levels in alloxan-induced diabetic mice. In addition, the solvent extracts were shown to have an inhibitory effect on the growth of microorganisms under the study. The minimum inhibitory concentration (MIC) ranged from 850 to 1050 µg/ml. Notably, the phytochemical investigation of the ethanol extracts showed the presence of secondary metabolites. Seventeen compounds (mainly sesquiterpenes) that represent 75.45% of the essential oil were characterized by GC/MS analysis. Conclusion: Extracts examined in this study indicated that the leaf of A. indica grown in Ethiopia retained the biological activities demonstrating the extent equivalent to when it was grown in its natural habitat. In addition, phytochemical investigation and GC/MS analysis of volatile oil constituents showed comparable results to those presented in India and elsewhere.

Keywords: Azadirachta indica, vivo, antimalarial activity, antidiabetic activity, alloxan, mice, phytochemical

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Authors: Zaka Nisa, Farooq Sher

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Adverse drug reactions (ADRs) underreporting is a great challenge to Pharmacovigilance. Health care professionals have to consider ADR reporting as their professional obligation, an effective system of ADR reporting is important to improve patient health care and safety. The present study is designed to assess the knowledge, attitude, practice and factors associated with ADR reporting by health care professionals (physicians and pharmacists) in public and private hospitals of Pakistan. A pretested questionnaire was administered to 384 physicians and pharmacists in public and private hospitals. Respondents were evaluated for their knowledge, attitude, and practice related to ADR reporting. The data was analyzed using the SPSS statistical software, the factors which encourage and discourage respondents in reporting ADRs were determined. Most of the respondents have shown a positive attitude towards ADR reporting. The response rate was 95.32%. Of the 367 questionnaires, including 333 (86.5%) physicians and 34 (8.8%) pharmacists with the mean age 28.34 (SD= 6.69), most of the respondents showed poor ADR reporting knowledge (83.1%). The majority of respondents (78.2%) showed positive attitude towards ADR reporting and only (12.3%) hospitals have good ADR reporting practice. Knowledge of respondents in public hospitals (8.6%) was less as compare to those in the private hospitals (29.7%) (P < 0.001). Attitude of respondents in private hospitals was more positive (92.4%) than those in public hospitals (68.8%) (P < 0.001). No significant difference was observed in practicing of ADR reporting in public (11.8%) and private hospitals (13.1%) (P value 0.89). Seriousness of ADR, unusualness of reaction, new drug involvement and confidence in diagnosis of ADR were the factors which encourage respondents to report ADR, however, lack of knowledge regarding where and how to report ADR, lack of access to ADR reporting form, managing patients was more important than reporting ADR, legal liability issues were the factors which discourage respondents to report ADR. The study reveals poor knowledge and practice regarding ADR reporting. However positive attitude was seen regarding ADR reporting. There is a need of educational training for health care professionals as well as genuine and continuous efforts are required by Government and health authorities to ensure the proper implementation of ADR reporting system in all of the hospitals.

Keywords: adverse drugs reactions (ADR), pharmacovigilance, spontaneous ADR reporting, knowledge of ADR, attitude of health care profesionals, practice of ADR reporting

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Authors: Muhammad Tayyab Afzal, Muhammad Arslan, Mirza Muhammad Waqar

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One of the key components of the water cycle is evapotranspiration (ET), which represents water consumption by vegetated and non-vegetated surfaces. Conventional techniques for measurements of ET are point based and representative of the local scale only. Satellite remote sensing data with large area coverage and high temporal frequency provide representative measurements of several relevant biophysical parameters required for estimation of ET at regional scales. The objective is of this research is to exploit satellite data in order to estimate evapotranspiration. This study uses Surface Energy Balance System (SEBS) model to calculate daily actual evapotranspiration (ETa) in Larkana District, Sindh Pakistan using Landsat TM data for clouds-free days. As there is no flux tower in the study area for direct measurement of latent heat flux or evapotranspiration and sensible heat flux, therefore, the model estimated values of ET were compared with reference evapotranspiration (ETo) computed by FAO-56 Penman Monteith Method using meteorological data. For a country like Pakistan, agriculture by irrigation in the river basins is the largest user of fresh water. For the better assessment and management of irrigation water requirement, the estimation of consumptive use of water for agriculture is very important because it is the main consumer of water. ET is yet an essential issue of water imbalance due to major loss of irrigation water and precipitation on cropland. As large amount of irrigated water is lost through ET, therefore its accurate estimation can be helpful for efficient management of irrigation water. Results of this study can be used to analyse surface conditions, i.e. temperature, energy budgets and relevant characteristics. Through this information we can monitor vegetation health and suitable agricultural conditions and can take controlling steps to increase agriculture production.

Keywords: SEBS, remote sensing, evapotranspiration, ETa

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Authors: Wen-Ting Wang, Wei-An Tsai, Rong-Hong Hsieh

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Long term taking high fat diet can lead to over production of energy, result in accumulation of body fat, dyslipidemia and increased lipid metabolism in the body. Over metabolism of lipid results in excessive reactive oxygen species and oxidative stress, may also cause mitochondrial dysfunction and cell death. Krill oil, fish oil and linseed oil are good sources of n-3 polyunsaturated fatty acids (PUFA). The present study investigated the effect of high fat diet and various oil rich of n-3 fatty acids on mitochondrial function and cell membrane composition. Six-weeks old male Spraque-Dawley rats were randomly divided into 8 groups including: control group, high fat diet group, low dosage and high dosage krill oil group, low dosage and high dosage fish oil group, and low dosage and high dosage linseed oil group. After 12 weeks of experimental period, the low dosage krill oil, fish oil group and linseed oil group with different dosage prevented mitochondrial dysfunction caused by high fat diet. The supplementation of different oils increased plasma, erythrocyte and mitochondrial n-3/n-6 ratio and further increased the proportion of PUFA in erythrocyte and mitochondrial membrane. It also decreased serum triglyceride (TG) and low density lipoprotein cholesterol (LDL-C) concentration. However, there was no significant change in serum total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), biomarker of liver function, glucose, insulin, homeostasis model assessment-insulin resistance (HOMA-IR) and plasma malonadialdehyde (MDA) concentration when compared with high fat diet group. The supplementation of different sources of n-3 PUFA can maintain mitochondrial function and modulate cell membrane fatty acid composition in high fat diet conditions, and there is a positive relationship between mitochondrial function and mitochondrial membrane composition.

Keywords: fish oil, linseed oil, mitochondria, n-3 PUFA

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Authors: Gulnaz Erkomaishvili

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Introduction. One of the most important issues of state economic policy in the 21st century is the problem of environmental protection. The Georgian government considers the green economy as one of the most important means of sustainable economic development and takes the initiative to implement voluntary measures to promote sustainable development. In this context, it is important to promote the development of ecosystem services, clean production, environmental education and green jobs.The development of the green economy significantly reduces the inefficient use of natural resources, waste generation, emissions into the atmosphere and the discharge of untreated water into bodies of water.It is, therefore, an important instrument in the environmental orientation of sustainable development. Objectives.The aim of the paper is to analyze the current status of the green economy in Georgia and identify effective ways to improve the environmental, economic policy of sustainable development. Methodologies: This paper uses general and specific methods, in particular, analysis, synthesis, induction, deduction, scientific abstraction, comparative and statistical methods, as well as experts’ evaluation. bibliographic research of scientific works and reports of organizations was conducted; Publications of the National Statistics Office of Georgia are used to determine the regularity between analytical and statistical estimations. Also, theoretical and applied research of international organizations and scientist-economists are used. Contributions: The country should implement such an economic policy that ensures the transition to a green economy, in particular, revising water, air and waste laws, strengthening existing environmental management tools and introcing new tools (including economic tools). Perfecting the regulatory legal framework of the environmental impact assessment system, which includes the harmonization of Georgian legislation with the requirements of the European Union. To ensure the protection and rational use of Georgia's forests, emphasis should be placed on sustainable forestry, protection and restoration of forests.

Keywords: green economy, environmental protection, environmental protection economic policy, environmental protection policy challanges

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Authors: I. Gusti Agung Aditya Surya Wibawa, Andri Syafriya, Beiruny Syam

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Gumai Formation which acts as regional seal for Talang Akar Formation becomes one of the most prolific reservoir in South Sumatra Basin and the primary exploration target in this area. Marine conditions were eventually established during the continuation of transgression sequence leads an open marine facies deposition in Early Miocene. Marine clastic deposits where calcareous shales, claystone and siltstones interbedded with fine-grained calcareous and glauconitic sandstones are the domination of lithology which targeted as the hydrocarbon reservoir. All this time, the main objective of PetroChina’s exploration and production in Betara area is only from Lower Talang Akar Formation. Successful testing in some exploration wells which flowed gas & condensate from Gumai Formation, opened the opportunity to optimize new reservoir objective in Betara area. Limitation of conventional wireline logs data in Gumai interval is generating technical challenge in term of geological approach. A utilization of Gas While Drilling indicator initiated with the objective to determine the next Gumai reservoir candidate which capable to increase Jabung hydrocarbon discoveries. This paper describes how Gas While Drilling indicator is processed to generate potential and non-potential zone by cut-off analysis. Validation which performed by correlation and comparison with well logs, Drill Stem Test (DST), and Reservoir Performance Monitor (RPM) data succeed to observe Gumai reservoir in Betara Complex. After we integrated all of data, we are able to generate a Betara Complex potential map and overlaid with reservoir characterization distribution as a part of risk assessment in term of potential zone presence. Mud log utilization and geophysical data information successfully covered the geological challenges in this study.

Keywords: Gumai, gas while drilling, classification, reservoir, potential

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Authors: Norzaliza Md. Nor, Sh-Hussain Salleh, Mahyar Hamedi, Hadrina Hussain, Wahab Abdul Rahman

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Motivational factor is mainly the students’ desire to involve in learning process. However, it also depends on the goal towards their involvement or non-involvement in academic activity. Even though, the students’ motivation might be in the same level, but the basis of their motivation may differ. In this study, it focuses on the intrinsic motivational factor which student enjoy learning or feeling of accomplishment the activity or study for its own sake. The intrinsic motivational factor of students in learning mathematics and science has found as difficult to be achieved because it depends on students’ interest. In the Program for International Student Assessment (PISA) for mathematics and science, Malaysia is ranked as third lowest. The main problem in Malaysian educational system, students tend to have extrinsic motivation which they have to score in exam in order to achieve a good result and enrolled as university students. The use of electroencephalogram (EEG) signals has found to be scarce especially to identify the students’ intrinsic motivational factor in learning science and mathematics. In this research study, we are identifying the correlation between precursor emotion and its dynamic emotion to verify the intrinsic motivational factor of students in learning mathematics and science. The 2-D Affective Space Model (ASM) was used in this research in order to identify the relationship of precursor emotion and its dynamic emotion based on the four basic emotions, happy, calm, fear and sad. These four basic emotions are required to be used as reference stimuli. Then, in order to capture the brain waves, EEG device was used, while Mel Frequency Cepstral Coefficient (MFCC) was adopted to be used for extracting the features before it will be feed to Multilayer Perceptron (MLP) to classify the valence and arousal axes for the ASM. The results show that the precursor emotion had an influence the dynamic emotions and it identifies that most students have no interest in mathematics and science according to the negative emotion (sad and fear) appear in the EEG signals. We hope that these results can help us further relate the behavior and intrinsic motivational factor of students towards learning of mathematics and science.

Keywords: EEG, MLP, MFCC, intrinsic motivational factor

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Authors: Pinna Beatrice., Laini Alex, Negro Giovanni, Burgazzi Gemma, Viaroli Pierluigi, Vezza Paolo

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Habitat models rarely consider macroinvertebrates as ecological targets in rivers. Available approaches mainly focus on single macroinvertebrate species, not addressing the ecological needs and functionality of the entire community. This research aimed to provide an approach to model the habitat of the macroinvertebrate community. The approach is based on the recently developed Flow-T index, together with a Random Forest (RF) regression, which is employed to apply the Flow-T index at the meso-habitat scale. Using different datasets gathered from both field data collection and 2D hydrodynamic simulations, the model has been calibrated in the Trebbia river (2019 campaign), and then validated in the Trebbia, Taro, and Enza rivers (2020 campaign). The three rivers are characterized by a braiding morphology, gravel riverbeds, and summer low flows. The RF model selected 12 mesohabitat descriptors as important for the macroinvertebrate community. These descriptors belong to different frequency classes of water depth, flow velocity, substrate grain size, and connectivity to the main river channel. The cross-validation R² coefficient (R²𝒸ᵥ) of the training dataset is 0.71 for the Trebbia River (2019), whereas the R² coefficient for the validation datasets (Trebbia, Taro, and Enza Rivers 2020) is 0.63. The agreement between the simulated results and the experimental data shows sufficient accuracy and reliability. The outcomes of the study reveal that the model can identify the ecological response of the macroinvertebrate community to possible flow regime alterations and to possible river morphological modifications. Lastly, the proposed approach allows extending the MesoHABSIM methodology, widely used for the fish habitat assessment, to a different ecological target community. Further applications of the approach can be related to flow design in both perennial and non-perennial rivers, including river reaches in which fish fauna is absent.

Keywords: ecological flows, macroinvertebrate community, mesohabitat, river habitat modeling

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Authors: Afaf Manzoor, Abdul Hameed

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Children with hearing impairment face several challenges in accessing primary and secondary education in general and higher education in particular in Pakistan. A large number of these children are excluded from formal education system through segregated special institutions. The enrollment rate of these children at school level is very low and it continues decreasing as they move on the ladder of education. Negligible number of students with hearing impairment gets any chance to be enrolled at tertiary or higher education institutes. The segregated system of education at primary and secondary level makes it even more difficult to adjust in an inclusive classroom at a higher level not only for students with hearing impairment but for their teachers and peers as well. A false belief of teachers and parents about low academic profile of students with hearing impairment is one of the major challenges to overcome for their participation at higher education. This case study was conducted to document an innovative step taken by the Department of Special Education Needs, University of Management & Technology, Lahore Pakistan. The prime objective of this study was to assess the satisfaction level of students with hearing impairment in BS 4 Years and MA Special Education programs at Lahore campus. Structured interviews were of 40 students with hearing impairment to assess the satisfaction on service delivery (admission process, classroom pedagogy, content, assessment/results, access to other services centers i.e. library, cafeteria, hostel, co-curricular activities) and campus life. Their peers without disabilities were also interviewed to assess their acceptance level. The findings of the study revealed positive results about their educational as well as social inclusion in the university. The students also shared their fears at the time of admission and how fear eventually faded out with the passage of time due to the proper academic support system. The findings of the study will be shared in detail with the audience during the presentation.

Keywords: students with hearing impairment, higher education, inclusive education, marginalization

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Authors: Apoorva Bamal, Agnieszka Indiana Olbert

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Floods are known to be one of the most devastating hydro-climatic events, impacting a wide range of stakeholders in terms of environmental, social and economic losses. With difference in inundation durations and level of impact, flood hazards are of different degrees and strength. Amongst various set of domains being impacted by floods, environmental degradation in terms of water quality deterioration is one of the majorly effected but less highlighted domains across the world. The degraded water quality is caused by numerous natural and anthropogenic factors that are both point and non-point sources of pollution. Therefore, it is essential to understand the nature and source of the water pollution due to flooding. The major impact of floods is not only on the physico-chemical water quality parameters, but also on the biological elements leading to a vivid influence on the aquatic ecosystem. This deteriorated water quality is impacting many water categories viz. agriculture, drinking water, aquatic habitat, and miscellaneous services requiring an appropriate water quality to survive. This study identifies, reviews, evaluates and assesses multiple researches done across the world to determine the impact of floods on water quality. With a detailed statistical analysis of top relevant researches, this study is a synopsis of the methods used in assessment of impact of floods on water quality in different geographies, and identifying the gaps for further abridgement. As per majority of the studies, different flood magnitudes have varied impact on the water quality parameters leading to either increased or decreased values as compared to the recommended values for various categories. There is also an evident shift of the biological elements in the impacted waters leading to a change in its phenology and inhabitants of the specified water body. This physical, chemical and biological water quality degradation by floods is dependent upon its duration, extent, magnitude and flow direction. Therefore, this research provides an overview into the multiple impacts of floods on water quality, along with a roadmap of way forward to an efficient and uniform linkage of floods and impacted water quality dynamics.

Keywords: floods, statistical analysis, water pollution, water quality

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Authors: Ramin Zargarbashi, Hamid Rabie, Behnam Panjavi, Hooman Kamran, Seyedarad Mosalamiaghili, Zohre Erfani, Seyed Peyman Mirghaderi, Maryam Salimi

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Background: Posterior shoulder dislocation is one of the disabling complications of brachial plexus birth injury (BPBI), and various treatment options, including capsule and surrounding muscles release for open reduction, humeral derotational osteotomy, and tendon transfers, have been recommended to manage it. In the present study, we aimed to determine the clinical outcome of open reduction with soft tissue release, tendon transfer, and glenoid osteotomy inpatients with BPBI and posterior shoulder dislocation or subluxation. Methods: From 2018 to 2020, 33 patients that underwent open reduction, glenoid osteotomy, and tendon transfer were included. The glenohumeral deformity was classified according to the Waters radiographic classification. Functional assessment was performed using the Mallet grading system before and at least two years after the surgery. Results: The patients were monitored for 26.88± 5.47 months. Their average age was 27.5±14 months. Significant improvement was seen in the overall Mallet score (from 13.5 to 18.91 points) and its segments, including hand to mouth, hand to the neck, global abduction, global external rotation, abduction degree, and external rotation degree. Hand-to-back score and the presence of trumpet sign were significantly decreased in the post-operation phase (all p values<0.001). The above-mentioned variables significantly changed for both infantile and non-infantile dislocations. Conclusion: Our study demonstrated that open reduction along with glenoid osteotomy improves retroversion, and muscle strengthening with different muscle transfers is an effective technique for BPBI.

Keywords: birth injuries, nerve injury, brachial plexus birth palsy, Erb palsy, tendon transfer

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Authors: Vivianne Aggestam

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Purpose: Organic dairy products have steadily increased with consumer popularity in recent years in Sweden, permitting more transport activities. The main aim of this study was to compare the transport costs and the environmental emissions made by the organic and conventional dairy production in Sweden. The objective was to evaluate differences and environmental impacts of transport between the two different production systems, allowing a more transparent understanding of the real impact of transport within the supply chain. Methods: A partial attributional Life Cycle Assessment has been conducted based on a comprehensive survey of Swedish farmers, dairies and consumers regarding their transport needs and costs. Interviews addressed the farmers and dairies. Consumers were targeted through an online survey. Results: Higher transport inputs from conventional dairy transportation are mainly via feed and soil management on farm level. The regional organic milk brand illustrate less initial transport burdens on farm level, however, after leaving the farm, it had equal or higher transportation requirements. This was mainly due to the location of the dairy farm and shorter product expiry dates, which requires more frequent retail deliveries. Organic consumers tend to use public transport more than private vehicles. Consumers using private vehicles for shopping trips primarily bought conventional products for which price was the main deciding factor. Conclusions: Organic dairy products that emphasise its regional attributes do not ensure less transportation and may therefore not be a more “climate smart” option for the consumer. This suggests that the idea of localism needs to be analysed from a more systemic perspective. Fuel and regional feed efficiency can be further implemented, mainly via fuel type and the types of vehicles used for transport.

Keywords: supply chains, distribution, transportation, organic food productions, conventional food production, agricultural fossil fuel use

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Authors: S. P. Rana

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Objectives: For the manufacture of a very thin strip or a strip with a high-quality finish, the stainless steel sheet that is called billet is re-rolled in re-rolling mill to make stainless steel sheet of 18 gauges. The rolls of re-rolling mill exert tremendous pressure over the sheet and there is likely chance of breaking of stainless steel strip from the sheet. The objective of the study was to minimise the number of accidents in steel re-rolling mills due to ejection of stainless steel strip and to minimize the pollution caused by the pickling process used in these units. Methods: Looking into the high rate of frequency and severity of accidents as well as pollution hazard in re-rolling and pickling mills, it becomes essential to make necessary arrangements for prevention of accidents in such type of industry. The author carried out survey/inspections of a large number of re-rolling and pickling mills and allied units. During the course of inspection, the working of these steel re-rolling and pickling mills was closely studied and monitored. A number of accidents involving re-rolling mills were investigated and subsequently remedial measures to prevent the occurrence of such accidents were suggested. Assessment of occupational safety and health system of these units was carried out and compliance level of the statutory requirements was checked. The workers were medically examined and monitored to ascertain their health conditions. Results: Proper use of safety gadgets by workers, machine guarding and regular training brought down the risk to an acceptable level and discharged effluent pollution was brought down to permissible limits. The fatal accidents have been reduced by 83%. Conclusions: Effective enforcement and implementation of the directions/suggestions given to the managements of such units brought down the no. of accidents to a rational level. The number of fatal accidents has reduced by 83% during the study period. The effective implementation of pollution control device curtailed the pollution level to an acceptable level.

Keywords: re-rolling mill, hazard, accident, health hazards

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Authors: Ali A. Bazzi, Ameer Hamza, Riley O’Hara, Kimberly Kado, Karen H. Hagglund, Lamia Fathallah, Robert T. Morris

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Introduction: Endometrial Cancer is a common gynecologic malignancy primarily treated with complete surgical staging, which may include complete pelvic and para-aortic lymphadenectomy. The role of lymphadenectomy is controversial, especially the intraoperative indications for the procedure. Three factors are important in decision to proceed with lymphadenectomy: Myometrial invasion, maximum tumor dimension, and histology. Many institutions incorporate these criteria in varying degrees in the decision to proceed with lymphadenectomy. This investigation assesses the use of intraoperatively measured MTD with and without pre-operative histologic grade. Methods: This study compared retrospectively EEC patients with intraoperatively measured MTD ≤2 cm to those with MTD >2 cm from January 1, 2002 to August 31, 2017. This assessment compared those with MTD ≤ 2cm with endometrial biopsy (EB) grade 1-2 to patients with MTD > 2cm with EB grade 3. Lymph node metastasis (LNM), recurrence, and survival were compared in these groups. Results: This study reviewed 222 patient cases. In tumors > 2 cm, LNM occurred in 20% cases while in tumors ≤ 2 cm, LNM was found in 6% cases (p=0.04). Recurrence and mean survival based on last follow up visit in these two groups were not statistically different (p=0.78 and 0.36 respectively). Data demonstrated a trend that when combined with preoperative EB International Federation of Gynecology and Obstetrics (FIGO) grade, a higher proportion of patients with EB FIGO Grade 3 and MTD > 2 cm had LNM compared to those with EB FIGO Grade 1-2 and MTD ≤ 2 cm (43% vs, 11%, p=0.06). LNM was found in 15% of cases in which lymphadenectomy was performed based on current practices, whereas if the criteria of EB FIGO 3 and MTD > 2 cm were used the incidence of LNM would have been 44% cases. However, using this criterion, two patients would not have had their nodal metastases detected. Compared to the current practice, the sensitivity and specificity of the proposed criteria would be 60% and 81%, respectively. The PPV and NPV would be 43% and 90%, respectively. Conclusion: The results indicate that MTD combined with EB FIGO grade can detect LNM in a higher proportion of cases when compared to current practice. MTD combined with EB FIGO grade may eliminate the need of frozen section sampling in a substantial number of cases.

Keywords: endometrial cancer, FIGO grade, lymphadenectomy, tumor size

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