Search results for: hand dysfunction
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 4003

Search results for: hand dysfunction

3133 Influence of Bacterial Motility on Biofilm Formation

Authors: Li Cheng, Zhang Yilei, Cohen Yehuda

Abstract:

Two motility mechanisms were introduced into iDynoMiCs software, which adopts an individual-based modeling method. Based on the new capabilities, along with the pressure motility developed before, influence of bacterial motility on biofilm formation was studied. Simulation results were evaluated both qualitatively through 3D structure inspections and quantitatively by parameter characterizations. It was showed that twitching motility increased the biofilm surface irregularity probably due to movement of cells towards higher nutrient concentration location whereas free motility, on the other hand, could make biofilms flatter and smoother relatively. Pressure motility showed no significant influence in this study.

Keywords: iDynoMics, biofilm structure, bacterial motility, motility mechanisms

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3132 Your First Step to Understanding Research Ethics: Psychoneurolinguistic Approach

Authors: Sadeq Al Yaari, Ayman Al Yaari, Adham Al Yaari, Montaha Al Yaari, Aayah Al Yaari, Sajedah Al Yaari

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Objective: This research aims at investigating the research ethics in the field of science. Method: It is an exploratory research wherein the researchers attempted to cover the phenomenon at hand from all specialists’ viewpoints. Results Discussion is based upon the findings resulted from the analysis the researcher undertook. Concerning the results’ prediction, the researcher needs first to seek highly qualified people in the field of research as well as in the field of statistics who share the philosophy of the research. Then s/he should make sure that s/he is adequately trained in the specific techniques, methods and statically programs that are used at the study. S/he should also believe in continually analysis for the data in the most current methods.

Keywords: research ethics, legal, rights, psychoneurolinguistics

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3131 Aspects of Diglossia in Arabic Language Learning

Authors: Adil Ishag

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Diglossia emerges in a situation where two distinctive varieties of a language are used alongside within a certain community. In this case, one is considered as a high or standard variety and the second one as a low or colloquial variety. Arabic is an extreme example of a highly diglossic language. This diglossity is due to the fact that Arabic is one of the most spoken languages and spread over 22 Countries in two continents as a mother tongue, and it is also widely spoken in many other Islamic countries as a second language or simply the language of Quran. The geographical variation between the countries where the language is spoken and the duality of the classical Arabic and daily spoken dialects in the Arab world on the other hand; makes the Arabic language one of the most diglossic languages. This paper tries to investigate this phenomena and its relation to learning Arabic as a first and second language.

Keywords: Arabic language, diglossia, first and second language, language learning

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3130 NFTs, between Opportunities and Absence of Legislation: A Study on the Effect of the Rulings of the OpenSea Case

Authors: Andrea Ando

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The development of the blockchain has been a major innovation in the technology field. It opened the door to the creation of novel cyberassets and currencies. In more recent times, the non-fungible tokens have started to be at the centre of media attention. Their popularity has been increasing since 2021, and they represent the latest in the world of distributed ledger technologies and cryptocurrencies. It seems more and more likely that NFTs will play a more important role in our online interactions. They are indeed increasingly taking part in the arts and technology sectors. Their impact on society and the market is still very difficult to define, but it is very likely that there will be a turning point in the world of digital assets. There are some examples of their peculiar behaviour and effect in our contemporary tech-market: the former CEO of the famous social media site Twitter sold an NFT of his first tweet for around £2,1 million ($2,5 million), or the National Basketball Association has created a platform to sale unique moment and memorabilia from the history of basketball through the non-fungible token technology. Their growth, as imaginable, paved the way for civil disputes, mostly regarding their position under the current intellectual property law in each jurisdiction. In April 2022, the High Court of England and Wales ruled in the OpenSea case that non-fungible tokens can be considered properties. The judge, indeed, concluded that the cryptoasset had all the indicia of property under common law (National Provincial Bank v. Ainsworth). The research has demonstrated that the ruling of the High Court is not providing enough answers to the dilemma of whether minting an NFT is a violation or not of intellectual property and/or property rights. Indeed, if, on the one hand, the technology follows the framework set by the case law (e.g., the 4 criteria of Ainsworth), on the other hand, the question that arises is what is effectively protected and owned by both the creator and the purchaser. Then the question that arises is whether a person has ownership of the cryptographed code, that it is indeed definable, identifiable, intangible, distinct, and has a degree of permanence, or what is attached to this block-chain, hence even a physical object or piece of art. Indeed, a simple code would not have any financial importance if it were not attached to something that is widely recognised as valuable. This was demonstrated first through the analysis of the expectations of intellectual property law. Then, after having laid the foundation, the paper examined the OpenSea case, and finally, it analysed whether the expectations were met or not.

Keywords: technology, technology law, digital law, cryptoassets, NFTs, NFT, property law, intellectual property law, copyright law

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3129 Assessment of the State of Hygiene in a Tunisian Hospital Kitchen: Interest of Mycological and Parasitological Samples from Food Handlers and Environment

Authors: Bouchekoua Myriam, Aloui Dorsaf, Trabelsi Sonia

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Introduction Food hygiene in hospitals is important, particularly among patients who could be more vulnerable than healthy subjects to microbiological and nutritional risks. The consumption of contaminated food may be responsible for foodborne diseases, which can be severe among hospitalized patients, especially those immunocompromised. The aim of our study was to assess the state of hygiene in the internal catering department of a Tunisian hospital. Methodology and major results: A prospective study was conducted for one year in the Parasitology-Mycology laboratory of Charles Nicolle Hospital. Samples were taken from the kitchen staff, worktops, and cooking utensils used in the internal catering department. Thirty one employees have benefited from stool exams and scotch tape in order to evaluate the degree of infestation of parasites. 35% of stool exams were positive. Protozoa were the only parasites detected. Blastocystis sp was the species mostly found in nine food handlers. Its role as a human pathogen is still controversial. Pathogenic protozoa were detected in two food handlers (Giardia intestinalis in one person and Dientamoeba fragilis in the other one. Non-pathogenic protozoa were found in two cases; among them, only one had digestive symptoms without a statistically significant association with the carriage of intestinal parasites. Moreover, samples were performed from the hands of the staff in order to search for a fungal carriage. Thus, 25 employees (81%) were colonized by fungi, including molds. Besides, mycological examination among food handlers with a suspected dermatomycosis for diagnostic confirmation concluded foot onychomycosis in 32% of cases and interdigital intertrigo in 26%. Only one person had hand onychomycosis. Among the 17 samples taken from worktops and kitchen utensils, fungal contamination was detected in 13 sites. Hot and cold equipment were the most contaminated. Molds were mainly identified as belonging to five different genera. Cladosporium sp was predominant. Conclusion: In the view of the importance of intestinal parasites among food handlers, the intensity of fungi hand carriage among these employees, and the high level of fungal contamination in worktops and kitchen utensils, a reinforcement of hygiene measures is more than essential in order to minimize the alimentary contamination-risk.

Keywords: hospital kitchen, environment, intestinal parasitosis, fungal carriage, fungal contamination

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3128 Half Dose Tissue Plasminogen Activator for Intermediate-Risk Pulmonary Embolism

Authors: Macie Matta, Ahmad Jabri, Stephanie Jackson

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Introduction: In the absence of hypotension, pulmonary embolism (PE) causing right ventricular dysfunction or strain, whether confirmed by imaging or cardiac biomarkers, is deemed to be an intermediate-risk category. Urgent treatment of intermediate-risk PE can prevent progression to hemodynamic instability and death. Management options include thrombolysis, thrombectomy, or systemic anticoagulation. We aim to evaluate the short-term outcomes of a half-dose tissue plasminogen activator (tPA) for the management of intermediate-risk PE. Methods: We retrospectively identified adult patients diagnosed with intermediate-risk PE between the years 2000 and 2021. Demographic data, lab values, imaging, treatment choice, and outcomes were all obtained through chart review. Primary outcomes measured include major bleeding events and in-hospital mortality. Patients on standard systemic anticoagulation without receiving thrombolysis or thrombectomy served as controls. Patient data were analyzed using SAS®️ Software (version 9.4; Cary, NC) to compare individuals that received half-dose tPA with controls, and statistical significance was set at a p-value of 0.05. Results: We included 57 patients in our final analysis, with 19 receiving tPA. Patient characteristics and comorbidities were comparable between both groups. There was a significant difference between PE location, presence of acute deep vein thrombosis, and peak troponin level between both groups. The thrombolytic cohort was more likely to demonstrate a 60/60 sign and thrombus in transit finding on echocardiography than controls. The thrombolytic group was more likely to have major bleeding (17% vs 7.9%, p= 0.4) and in-hospital mortality (5.3% vs 0%, p=0.3); however, this was not statistically significant. Patients who received half-dose tPA had non-significantly higher rates of major bleeding and in-hospital mortality. Larger scale, randomized control trials are needed to establish the benefit and safety of thrombolytics in patients with intermediate-risk PE.

Keywords: pulmonary embolism, half dose thrombolysis, tissue plasminogen activator, cardiac biomarkers, echocardiographic findings, major bleeding event

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3127 Molecular Pathogenesis of NASH through the Dysregulation of Metabolic Organ Network in the NASH-HCC Model Mouse Treated with Streptozotocin-High Fat Diet

Authors: Bui Phuong Linh, Yuki Sakakibara, Ryuto Tanaka, Elizabeth H. Pigney, Taishi Hashiguchi

Abstract:

NASH is an increasingly prevalent chronic liver disease that can progress to hepatocellular carcinoma and now is attracting interest worldwide. The STAM™ model is a clinically-correlated murine NASH model which shows the same pathological progression as NASH patients and has been widely used for pharmacological and basic research. The multiple parallel hits hypothesis suggests abnormalities in adipocytokines, intestinal microflora, and endotoxins are intertwined and could contribute to the development of NASH. In fact, NASH patients often exhibit gut dysbiosis and dysfunction in adipose tissue and metabolism. However, the analysis of the STAM™ model has only focused on the liver. To clarify whether the STAM™ model can also mimic multiple pathways of NASH progression, we analyzed the organ crosstalk interactions between the liver and the gut and the phenotype of adipose tissue in the STAM™ model. NASH was induced in male mice by a single subcutaneous injection of 200 µg streptozotocin 2 days after birth and feeding with high-fat diet after 4 weeks of age. The mice were sacrificed at NASH stage. Colon samples were snap-frozen in liquid nitrogen and stored at -80˚C for tight junction-related protein analysis. Adipose tissue was prepared into paraffin blocks for HE staining. Blood adiponectin was analyzed to confirm changes in the adipocytokine profile. Tight junction-related proteins in the intestine showed that expression of ZO-1 decreased with the progression of the disease. Increased expression of endotoxin in the blood and decreased expression of Adiponectin were also observed. HE staining revealed hypertrophy of adipocytes. Decreased expression of ZO-1 in the intestine of STAM™ mice suggests the occurrence of leaky gut, and abnormalities in adipocytokine secretion were also observed. Together with the liver, phenotypes in these organs are highly similar to human NASH patients and might be involved in the pathogenesis of NASH.

Keywords: Non-alcoholic steatohepatitis, hepatocellular carcinoma, fibrosis, organ crosstalk, leaky gut

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3126 Reverse Logistics Information Management Using Ontological Approach

Authors: F. Lhafiane, A. Elbyed, M. Bouchoum

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Reverse Logistics (RL) Process is considered as complex and dynamic network that involves many stakeholders such as: suppliers, manufactures, warehouse, retails, and costumers, this complexity is inherent in such process due to lack of perfect knowledge or conflicting information. Ontologies, on the other hand, can be considered as an approach to overcome the problem of sharing knowledge and communication among the various reverse logistics partners. In this paper, we propose a semantic representation based on hybrid architecture for building the Ontologies in an ascendant way, this method facilitates the semantic reconciliation between the heterogeneous information systems (ICT) that support reverse logistics Processes and product data.

Keywords: Reverse Logistics, information management, heterogeneity, ontologies, semantic web

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3125 Employees' Attitude towards Corporate Governance without Unions

Authors: Bamidele Olufemi Ifenowo

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The study examined the practice of managing business organizations in Nigeria today without unions. It explored how this phenomenon evolved and became popular in the newly emerging mega banks in Nigeria. Attitudes of selected banks' employees to this phenomenon were surveyed.Simple statistical tools were used for data analysis. The findings revealed that most new employees who form the bulk of the sample never really cared about unionism. On the other hand, old and experienced employees were positively disposed towards unionism. This category of employees abhorred the current display of authoritarianism cum paternalism which seemed to characterize the managerial practice of most new generation banks in Nigeria today.

Keywords: authoritarianism, corporate governance, deunionisation, unionization, paternalism

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3124 Handling, Exporting and Archiving Automated Mineralogy Data Using TESCAN TIMA

Authors: Marek Dosbaba

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Within the mining sector, SEM-based Automated Mineralogy (AM) has been the standard application for quickly and efficiently handling mineral processing tasks. Over the last decade, the trend has been to analyze larger numbers of samples, often with a higher level of detail. This has necessitated a shift from interactive sample analysis performed by an operator using a SEM, to an increased reliance on offline processing to analyze and report the data. In response to this trend, TESCAN TIMA Mineral Analyzer is designed to quickly create a virtual copy of the studied samples, thereby preserving all the necessary information. Depending on the selected data acquisition mode, TESCAN TIMA can perform hyperspectral mapping and save an X-ray spectrum for each pixel or segment, respectively. This approach allows the user to browse through elemental distribution maps of all elements detectable by means of energy dispersive spectroscopy. Re-evaluation of the existing data for the presence of previously unconsidered elements is possible without the need to repeat the analysis. Additional tiers of data such as a secondary electron or cathodoluminescence images can also be recorded. To take full advantage of these information-rich datasets, TIMA utilizes a new archiving tool introduced by TESCAN. The dataset size can be reduced for long-term storage and all information can be recovered on-demand in case of renewed interest. TESCAN TIMA is optimized for network storage of its datasets because of the larger data storage capacity of servers compared to local drives, which also allows multiple users to access the data remotely. This goes hand in hand with the support of remote control for the entire data acquisition process. TESCAN also brings a newly extended open-source data format that allows other applications to extract, process and report AM data. This offers the ability to link TIMA data to large databases feeding plant performance dashboards or geometallurgical models. The traditional tabular particle-by-particle or grain-by-grain export process is preserved and can be customized with scripts to include user-defined particle/grain properties.

Keywords: Tescan, electron microscopy, mineralogy, SEM, automated mineralogy, database, TESCAN TIMA, open format, archiving, big data

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3123 Analyzing the Risk Based Approach in General Data Protection Regulation: Basic Challenges Connected with Adapting the Regulation

Authors: Natalia Kalinowska

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The adoption of the General Data Protection Regulation, (GDPR) finished the four-year work of the European Commission in this area in the European Union. Considering far-reaching changes, which will be applied by GDPR, the European legislator envisaged two-year transitional period. Member states and companies have to prepare for a new regulation until 25 of May 2018. The idea, which becomes a new look at an attitude to data protection in the European Union is risk-based approach. So far, as a result of implementation of Directive 95/46/WE, in many European countries (including Poland) there have been adopted very particular regulations, specifying technical and organisational security measures e.g. Polish implementing rules indicate even how long password should be. According to the new approach from May 2018, controllers and processors will be obliged to apply security measures adequate to level of risk associated with specific data processing. The risk in GDPR should be interpreted as the likelihood of a breach of the rights and freedoms of the data subject. According to Recital 76, the likelihood and severity of the risk to the rights and freedoms of the data subject should be determined by reference to the nature, scope, context and purposes of the processing. GDPR does not indicate security measures which should be applied – in recitals there are only examples such as anonymization or encryption. It depends on a controller’s decision what type of security measures controller considered as sufficient and he will be responsible if these measures are not sufficient or if his identification of risk level is incorrect. Data protection regulation indicates few levels of risk. Recital 76 indicates risk and high risk, but some lawyers think, that there is one more category – low risk/now risk. Low risk/now risk data processing is a situation when it is unlikely to result in a risk to the rights and freedoms of natural persons. GDPR mentions types of data processing when a controller does not have to evaluate level of risk because it has been classified as „high risk” processing e.g. processing on a large scale of special categories of data, processing with using new technologies. The methodology will include analysis of legal regulations e.g. GDPR, the Polish Act on the Protection of personal data. Moreover: ICO Guidelines and articles concerning risk based approach in GDPR. The main conclusion is that an appropriate risk assessment is a key to keeping data safe and avoiding financial penalties. On the one hand, this approach seems to be more equitable, not only for controllers or processors but also for data subjects, but on the other hand, it increases controllers’ uncertainties in the assessment which could have a direct impact on incorrect data protection and potential responsibility for infringement of regulation.

Keywords: general data protection regulation, personal data protection, privacy protection, risk based approach

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3122 Effects of Sensory Integration Techniques in Science Education of Autistic Students

Authors: Joanna Estkowska

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Sensory integration methods are very useful and improve daily functioning autistic and mentally disabled children. Autism is a neurobiological disorder that impairs one's ability to communicate with and relate to others as well as their sensory system. Children with autism, even highly functioning kids, can find it difficult to process language with surrounding noise or smells. They are hypersensitive to things we can ignore such as sight, sounds and touch. Adolescents with highly functioning autism or Asperger Syndrome can study Science and Math but the social aspect is difficult for them. Nature science is an area of study that attracts many of these kids. It is a systematic field in which the children can focus on a small aspect. If you follow these rules you can come up with an expected result. Sensory integration program and systematic classroom observation are quantitative methods of measuring classroom functioning and behaviors from direct observations. These methods specify both the events and behaviors that are to be observed and how they are to be recorded. Our students with and without autism attended the lessons in the classroom of nature science in the school and in the laboratory of University of Science and Technology in Bydgoszcz. The aim of this study is investigation the effects of sensory integration methods in teaching to students with autism. They were observed during experimental lessons in the classroom and in the laboratory. Their physical characteristics, sensory dysfunction, and behavior in class were taken into consideration by comparing their similarities and differences. In the chemistry classroom, every autistic student is paired with a mentor from their school. In the laboratory, the children are expected to wear goggles, gloves and a lab coat. The chemistry classes in the laboratory were held for four hours with a lunch break, and according to the assistants, the children were engaged the whole time. In classroom of nature science, the students are encouraged to use the interactive exhibition of chemical, physical and mathematical models constructed by the author of this paper. Our students with and without autism attended the lessons in those laboratories. The teacher's goals are: to assist the child in inhibiting and modulating sensory information and support the child in processing a response to sensory stimulation.

Keywords: autism spectrum disorder, science education, sensory integration techniques, student with special educational needs

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3121 The Different Ways to Describe Regular Languages by Using Finite Automata and the Changing Algorithm Implementation

Authors: Abdulmajid Mukhtar Afat

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This paper aims at introducing finite automata theory, the different ways to describe regular languages and create a program to implement the subset construction algorithms to convert nondeterministic finite automata (NFA) to deterministic finite automata (DFA). This program is written in c++ programming language. The program reads FA 5tuples from text file and then classifies it into either DFA or NFA. For DFA, the program will read the string w and decide whether it is acceptable or not. If accepted, the program will save the tracking path and point it out. On the other hand, when the automation is NFA, the program will change the Automation to DFA so that it is easy to track and it can decide whether the w exists in the regular language or not.

Keywords: finite automata, subset construction, DFA, NFA

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3120 The Dark Side of the Fight against Organised Crime

Authors: Ana M. Prieto del Pino

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As is well known, UN Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances (1988) was a landmark regarding the seizure of proceeds of crime. Depriving criminals of the profits from their activity became a priority at an international level in the fight against organised crime. Enabling confiscation of proceeds of illicit traffic in narcotic drugs and psychotropic substances, criminalising money laundering and confiscating the proceeds thereof are the three measures taken in order to achieve that purpose. The beginning of 21st century brought the declaration of war on corruption and on the illicit enjoyment of the profits thereof onto the international scene. According to the UN Convention against Transnational Organised Crime (2000), States Parties should adopt the necessary measures to enable the confiscation of proceeds of crime derived from offences (or property of equivalent value) and property, equipment and other instrumentalities used in offences covered by that Convention. The UN Convention against Corruption (2003) states asset recovery explicitly as a fundamental principle and sets forth measures aiming at the direct recovery of property through international cooperation in confiscation. Furthermore, European legislation has made many significant strides forward in less than twenty years concerning money laundering, confiscation, and asset recovery. Crime does not pay, let there be no doubt about it. Nevertheless, we must be very careful not to sing out of tune with individual rights and legal guarantees. On the one hand, innocent individuals and businesses must be protected, since they should not pay for the guilty ones’ faults. On the other hand, the rule of law must be preserved and not be tossed aside regarding those who have carried out criminal activities. An in-depth analysis of judicial decisions on money laundering and confiscation of proceeds of crime issued by European national courts and by the European Court of Human Rights in the last decade has been carried out from a human rights, legal guarantees and criminal law basic principles’ perspective. The undertaken study has revealed the violation of the right to property, of the proportionality principle legal and the infringement of basic principles of states’ domestic substantive and procedural criminal law systems. The most relevant ones have to do with the punishment of money laundering committed through negligence, non-conviction based confiscation and a too-far reaching interpretation of the notion of ‘proceeds of crime’. Almost everything in life has a bright and a dark side. Confiscation of criminal proceeds and asset recovery are not an exception to this rule.

Keywords: confiscation, human rights, money laundering, organized crime

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3119 Fast Track to the Physical Internet: A Cross-Industry Project from Upper Austria

Authors: Laura Simmer, Maria Kalt, Oliver Schauer

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Freight transport is growing fast, but many vehicles are empty or just partially loaded. The vision and concepts of the Physical Internet (PI) proposes to eliminate these inefficiencies. Aiming for a radical sustainability improvement, the PI – inspired by the Digital Internet – is a hyperconnected global logistic system, enabling seamless asset sharing and flow consolidation. The implementation of a PI in its full expression will be a huge challenge: the industry needs innovation and implementation support including change management approaches, awareness creation and good practices diffusion, legislative actions to remove antitrust and international commerce barriers, standardization and public incentives policies. In order to take a step closer to this future the project ‘Atropine - Fast Track to the Physical Internet’ funded under the Strategic Economic and Research Program ‘Innovative Upper Austria 2020’ was set up. The two-year research project unites several research partners in this field, but also industrial partners and logistics service providers. With Atropine, the consortium wants to actively shape the mobility landscape in Upper Austria and make an innovative contribution to an energy-efficient, environmentally sound and sustainable development in the transport area. This paper should, on the one hand, clarify the questions what the project Atropine is about and, on the other hand, how a proof of concept will be reached. Awareness building plays an important role in the project as the PI requires a reorganization of the supply chain and the design of completely new forms of inter-company co-operation. New business models have to be developed and should be verified by simulation. After the simulation process one of these business models will be chosen and tested in real life with the partner companies. The developed results - simulation model and demonstrator - are used to determine how the concept of the PI can be applied in Upper Austria. Atropine shall pave the way for a full-scale development of the PI vision in the next few decades and provide the basis for pushing the industry toward a new level of co-operation with more shared resources and increased standardization.

Keywords: Atropine, inter-company co-operation, Physical Internet, shared resources, sustainable logistics

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3118 Evaluation of Associated Risk Factors and Determinants of near Miss Obstetric Cases at B.P. Koirala Institute of Health Sciences, Dharan

Authors: Madan Khadka, Dhruba Uprety, Rubina Rai

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Background and objective: In 2011, around 273,465 women died worldwide during pregnancy, childbirth or within 42 days after childbirth. Near-miss is recognized as the predictor of the level of care and maternal death. The objective of the study was to evaluate the associated risk factors of near-miss obstetric cases and maternal death. Material and Methods A Prospective Observational Study was done from August 1, 2014, to June 30, 2015, in Department of Obstetrics and Gynecology at BPKIHS hospital, tertiary care hospital in Eastern Nepal, Dharan. Case eligible by the 5-factor scoring system and WHO near miss criteria were evaluated. Risk factors included severe hemorrhage, hypertensive disorders, and a complication of abortion, ruptured uterus, medical/surgical condition and sepsis. Results: A total of 9,727 delivery were attended during the study period from August 2014 to June 2014. There were 6307 (71.5%) vaginal delivery and 2777(28.5%) caesarean section and 181 perinatal death with a total of 9,546 live birth. A total of 162 near miss was identified, and 16 maternal death occurred during the study. Maternal near miss rate of 16.6 per 1000 live birth, Women with life-threatening conditions (WLTC) of 172, Severe maternal outcome ratio of 18.64 per 1000 live birth, Maternal near-miss mortality ratio (MNM: 1 MD) 10.1:1, Mortality index (MI) of 8.98%. Risk factors were obstetric hemorrhage 27.8%, abortion/ectopic 27.2%, eclampsia 16%, medical/surgical condition 14.8%, sepsis 13.6%, severe preeclamsia 11.1%, ruptured uterus 3.1%, and molar pregnancy 1.9%. 19.75% were prim gravidae, with mean age 25.66 yrs, and cardiovascular and coagulation dysfunction as a major life threatening condition and sepsis (25%) was the major cause of mortality. Conclusion: Hemorrhage and hypertensive disorders are the leading causes of near miss event and sepsis as a leading cause of mortality. As near miss analysis indicates the quality of health care, it is worth presenting in national indices.

Keywords: abortion, eclampsia, hemorrhage, maternal mortility, near miss

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3117 Evaluation of Existence of Antithyroid Antibodies, Anti-Thyroid Peroxidase and Anti-Thyroglobulin in Patients with Hepatitis C Viral Infections

Authors: Junaid Mahmood Alam, Sana Anwar, Sarah Sughra Asghar

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Chronic hepatitis or Hepatitis C viral (HCV) infection has been identified as one of the factors that could elicit autoimmune disease resulting in the development of auto-antibodies. Furthermore, HCV is implicated in contravening of forbearance to antigens, therefore, inciting auto-reactivity. In this regard, several near and past studies noted the prevalence of thyroid dysfunction and production of anti-thyroid antibodies (ATAb) such as anti-thyroid peroxidase (AntiTPO) and anti-thyroglobulin (AntiTG) in patients with HCV. Likewise, one of the etiologies of augmentation of thyroid disease is basically interferon therapy for HCV infections, for which a number of autoimmune diseases have been noted including Grave’s disease, Hishimoto thyroiditis. A prospectively case-control study was therefore carried out at department of clinical biochemistry lab services and chemical pathology in collaboration with department of clinical microbiology, at Liaquat National Hospital and Medical College, Karachi Pakistan for the period January 2015 to December 2017. Two control groups were inducted for comparison purpose, control group 1 = without HCV infection and with thyroid disorders (n = 20), control group 2 = with HCV infection and without thyroid disorders (n = 20), whereas HCV infected were n = 40 where more than half were noted to be positive for either of HCV IgG and Ag. In HCV group, patients with existing sub-clinical hypothyroidism and clinical hyperthyroidism were less than 5%. Analysis showed the presence of AntiTG in 12 HCV patients (30%), AntiTPO in 15 (37.5%) and both AntiTG and antiTPO in 10 patients (25%). Only 3 patients were found with the history of anti-thyroid auto-antibodies (7.5%) and one with parents and relatives with auto-immune disorders (2.5%). Patients that remained untreated were 12 (30%), under treatment 18 (45%) and with complete-course of treatment 10 (25%). As per review of the literature, meta-analysis of evident data and cross-sectional studies of selective cohorts (as studied in presented research), thyroid connection is designated as one of the most recurrent endocrine ailment associated with chronic HCV infection. Moreover, it also represents an extrahepatic disease in the continuum of HCV syndrome. In conclusion, HCV patients were more likely to encompass thyroid disorders especially related to development of either of ATAb or both antiTG and AntiTPO.

Keywords: Hepatitis C viral (HCV) infection, anti-thyroid antibodies, anti-thyroid peroxidase antibodies, anti-thyroglobulin antibodies

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3116 Comparative Study between Mesenchymal Stem Cells and Regulatory T-Cells in Macrophage Polarization for Organ Transplant Tolerance: In Vitro Study

Authors: Vijaya Madhuri Devraj, Swarnalatha Guditi, Kiran Kumar Bokara, Gangadhar Taduri

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Cell-based strategies may open therapeutic approaches that promote tolerance through manipulation of macrophages to increase long-term transplant survival rates and minimize side effects of the current immune suppressive regimens. The aim of the present study was, therefore, to test and compare the therapeutic potential of MSC and Tregs on macrophage polarization to develop an alternate cell-based treatment option in kidney transplantation. In the current protocol, macrophages from kidney transplant recipients with graft dysfunction were co-cultured with MSCs and Treg cells with and without cell-cell contact on transwell plates, further to quantitatively assess macrophage polarization in response to MSC and Treg treatment over time, M1 and M2 cell surface markers were used. Additionally, multiple soluble analytes were analyzed in cell supernatant by using bead-based immunoassays. Furthermore, to confirm our findings, gene expression analysis was done. MSCs induced the formation of M2 macrophages more than Tregs when macrophages M0 were cultured in transwell without cell contact. From this, we deduced the mechanism that soluble factors present in the MSCs condition media are involved in skewing of macrophages towards type 2 macrophages; similarly, in co-culture with cell-cell contact, MSCs resulted in more M2 type macrophages than Tregs. And an important finding of this study is the combination of both MSC-Treg showed significantly effective and consistent results in both with and without cell contact setups. Hence, it is suggestive to prefer MSCs over Tregs for secretome-based therapy and a combination of both for either therapy for effective transplantation outcomes. Our findings underline a key role of Tregs and MSCs in promoting macrophage polarization towards anti-inflammatory type. The study has great importance in prolongation of allograft and patient survival without any rejection by cell-based therapy, which induce self-tolerance and controlling infection.

Keywords: graft rejection, graft tolerance, macrophage polarization, mesenchymal stem cells, regulatory T cells, transplant immunology

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3115 Experimental Design in Extraction of Pseudomonas sp. Protease from Fermented Broth by Polyethylene Glycol/Citrate Aqueous Two-Phase System

Authors: Omar Pillaca-Pullo, Arturo Alejandro-Paredes, Carol Flores-Fernandez, Marijuly Sayuri Kina, Amparo Iris Zavaleta

Abstract:

Aqueous two-phase system (ATPS) is an interesting alternative for separating industrial enzymes due to it is easy to scale-up and low cost. Polyethylene glycol (PEG) mixed with potassium phosphate or magnesium sulfate is one of the most frequently polymer/salt ATPS used, but the consequences of its use is a high concentration of phosphates and sulfates in wastewater causing environmental issues. Citrate could replace these inorganic salts due to it is biodegradable and does not produce toxic compounds. On the other hand, statistical design of experiments is widely used for ATPS optimization and it allows to study the effects of the involved variables in the purification, and to estimate their significant effects on selected responses and interactions. The 24 factorial design with four central points (20 experiments) was employed to study the partition and purification of proteases produced by Pseudomonas sp. in PEG/citrate ATPS system. ATPS was prepared with different sodium citrate concentrations [14, 16 and 18% (w/w)], pH values (7, 8 and 9), PEG molecular weight (2,000; 4,000 and 6,000 g/mol) and PEG concentrations [18, 20 and 22 % (w/w)]. All system components were mixed with 15% (w/w) of the fermented broth and deionized water was added to a final weight of 12.5 g. Then, the systems were mixed and kept at room temperature until to reach two-phases separation. Volumes of the top and bottom phases were measured, and aliquots from both phases were collected for subsequent proteolytic activity and total protein determination. Influence of variables such as PEG molar mass (MPEG), PEG concentration (CPEG), citrate concentration (CSal) and pH were evaluated on the following responses: purification factor (PF), activity yield (Y), partition coefficient (K) and selectivity (S). STATISTICA program version 10 was used for the analysis. According to the obtained results, higher levels of CPEG and MPEG had a positive effect on extraction, while pH did not influence on the process. On the other hand, the CSal could be related with low values of Y because of the citrate ions have a negative effect on solubility and enzymatic structure. The optimum values of Y (66.4 %), PF (1.8), K (5.5) and S (4.3) were obtained at CSal (18%), MPEG (6,000 g/mol), CPEG (22%) and pH 9. These results indicated that the PEG/citrate system is accurate to purify these Pseudomonas sp. proteases from fermented broth as a first purification step.

Keywords: citrate, polyethylene glycol, protease, Pseudomonas sp

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3114 Wheat Production and Market in Afghanistan

Authors: Fayiz Saifurahman, Noori Fida Mohammad

Abstract:

Afghanistan produces the highest rate of wheat, it is the first source of food, and food security in Afghanistan is dependent on the availability of wheat. Although Afghanistan is the main producer of wheat, on the other hand, Afghanistan is the largest importers of flour. The objective of this study is to assess the structure and dynamics of the wheat market in Afghanistan, can compute with foreign markets, and increase the level of production. To complete this, a broad series of secondary data was complied with, group discussions and interviews with farmers, agricultural and market experts. The research findings propose that; the government should adopt different policies to support the local market. The government should distribute the seed, support financially and technically to increase wheat production.

Keywords: Afghanistan, wheat, production , import

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3113 Public-Private Partnership Projects in Canada: A Case Study Approach

Authors: Samuel Carpintero

Abstract:

Public-private partnerships (PPP) arrangements have emerged all around the world as a response to infrastructure deficits and the need to refurbish existing infrastructure. The motivations of governments for embarking on PPPs for the delivery of public infrastructure are manifold, and include on-time and on-budget delivery as well as access to private project management expertise. The PPP formula has been used by some State governments in United States and Canada, where the participation of private companies in financing and managing infrastructure projects has increased significantly in the last decade, particularly in the transport sector. On the one hand, this paper examines the various ways used in these two countries in the implementation of PPP arrangements, with a particular focus on risk transfer. The examination of risk transfer in this paper is carried out with reference to the following key PPP risk categories: construction risk, revenue risk, operating risk and availability risk. The main difference between both countries is that in Canada the demand risk remains usually within the public sector whereas in the United States this risk is usually transferred to the private concessionaire. The aim is to explore which lessons can be learnt from both models than might be useful for other countries. On the other hand, the paper also analyzes why the Spanish companies have been so successful in winning PPP contracts in North America during the past decade. Contrary to the Latin American PPP market, the Spanish companies do not have any cultural advantage in the case of the United States and Canada. Arguably, some relevant reasons for the success of the Spanish groups are their extensive experience in PPP projects (that dates back to the late 1960s in some cases), their high technical level (that allows them to be aggressive in their bids), and their good position and track-record in the financial markets. The article’s empirical base consists of data provided by official sources of both countries as well as information collected through face-to-face interviews with public and private representatives of the stakeholders participating in some of the PPP schemes. Interviewees include private project managers of the concessionaires, representatives of banks involved as financiers in the projects, and experts in the PPP industry with close knowledge of the North American market. Unstructured in-depth interviews have been adopted as a means of investigation for this study because of its powers to achieve honest and robust responses and to ensure realism in the collection of an overall impression of stakeholders’ perspectives.

Keywords: PPP, concession, infrastructure, construction

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3112 An Optimal Control Method for Reconstruction of Topography in Dam-Break Flows

Authors: Alia Alghosoun, Nabil El Moçayd, Mohammed Seaid

Abstract:

Modeling dam-break flows over non-flat beds requires an accurate representation of the topography which is the main source of uncertainty in the model. Therefore, developing robust and accurate techniques for reconstructing topography in this class of problems would reduce the uncertainty in the flow system. In many hydraulic applications, experimental techniques have been widely used to measure the bed topography. In practice, experimental work in hydraulics may be very demanding in both time and cost. Meanwhile, computational hydraulics have served as an alternative for laboratory and field experiments. Unlike the forward problem, the inverse problem is used to identify the bed parameters from the given experimental data. In this case, the shallow water equations used for modeling the hydraulics need to be rearranged in a way that the model parameters can be evaluated from measured data. However, this approach is not always possible and it suffers from stability restrictions. In the present work, we propose an adaptive optimal control technique to numerically identify the underlying bed topography from a given set of free-surface observation data. In this approach, a minimization function is defined to iteratively determine the model parameters. The proposed technique can be interpreted as a fractional-stage scheme. In the first stage, the forward problem is solved to determine the measurable parameters from known data. In the second stage, the adaptive control Ensemble Kalman Filter is implemented to combine the optimality of observation data in order to obtain the accurate estimation of the topography. The main features of this method are on one hand, the ability to solve for different complex geometries with no need for any rearrangements in the original model to rewrite it in an explicit form. On the other hand, its achievement of strong stability for simulations of flows in different regimes containing shocks or discontinuities over any geometry. Numerical results are presented for a dam-break flow problem over non-flat bed using different solvers for the shallow water equations. The robustness of the proposed method is investigated using different numbers of loops, sensitivity parameters, initial samples and location of observations. The obtained results demonstrate high reliability and accuracy of the proposed techniques.

Keywords: erodible beds, finite element method, finite volume method, nonlinear elasticity, shallow water equations, stresses in soil

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3111 Postpartum Female Sexual Dysfunctions in Hungary: A Cross-Sectional Study

Authors: Katalin Szöllősi, László Szabó

Abstract:

Introduction and purpose: Even though female sexual dysfunctions are common among women in the postpartum period, the profile of these disturbances has not been well investigated in Hungary yet. The aim of the study was to evaluate the postpartum female sexual functions in Hungary. This research sought to investigate the possible predictor factors which can influence postpartum female sexual functions. Method and sample: This was a cross-sectional study, including patients from two maternity clinics in Budapest. 113 women were recruited into our study 3 months after their childbirth. 53 had vaginal birth, 60 had a caesarian section. Data were collected from medical reports in addition by using self-developed questions and validated questionnaires in order to measure important predictors which may be responsible for postpartum sexual dysfunctions such as mode of delivery, parity, urinary incontinence and body image. Sexual functions were evaluated by the Hungarian version of the Female Sexual Function Index (FSFI). The Hungarian version of Body Image Questionnaire-Short Form14 (BSQ-SF14) was applied for assessing body image. Results: 82,3% of the participants began to have sexual intercourse within three months postpartum. 53,98% of the participants reported sexual dysfunctions (cut-off FSFI score 26,55). According to our results mode of delivery, parity, hemorrhoids, time of intercourse, resumption was not associated with female sexual dysfunctions. We found correlation at a tendential level between urinary incontinence and sexual dysfunctions (p=0,003, R=0,26). We found a negative correlation at a tendential level between the total score of BSQ-SF14 and FSFI (p=0,03, R=-0,269). Only 32,74% of women reported discussing sexual life with health care professionals. However, 67,25% of them would have had the need to be asked about their postpartum health issues. Conclusions and recommendations: The prevalence of female sexual dysfunctions were relatively high after childbirth. We found that incontinence and body image was associated with sexual dysfunctions; other risk factors remained unknown. Despite regular contact with health care professionals, women rarely get any information about postpartum sexual health issues. The high prevalence of dysfunctions indicates the need for further investigation to address other risk factors and proper counselling of women after childbirth.

Keywords: body image, postpartum, sexual dysfunction, urinary incontinence

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3110 Solving Fuzzy Multi-Objective Linear Programming Problems with Fuzzy Decision Variables

Authors: Mahnaz Hosseinzadeh, Aliyeh Kazemi

Abstract:

In this paper, a method is proposed for solving Fuzzy Multi-Objective Linear Programming problems (FMOLPP) with fuzzy right hand side and fuzzy decision variables. To illustrate the proposed method, it is applied to the problem of selecting suppliers for an automotive parts producer company in Iran in order to find the number of optimal orders allocated to each supplier considering the conflicting objectives. Finally, the obtained results are discussed.

Keywords: fuzzy multi-objective linear programming problems, triangular fuzzy numbers, fuzzy ranking, supplier selection problem

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3109 The Effect of Surgical Intervention on Pediatric and Adolescent Obstructive Sleep Apnea Syndrome

Authors: Ching-Yi Yiu, Hui-Chen Hsu

Abstract:

Objectives: Obstructive sleep apnea syndrome (OSAS) is a popular problem in the modern society. It usually leads to sleep disorder, excessive daytime sleepiness and associated with cardiovascular diseases, cognitive dysfunction and even death. The nonsurgical therapies include continuous positive airway pressure (CPAP), diet and oral appliances. The surgical approaches have nasal surgery, tonsillectomy, adenoidectomy, uvulopalatopharyngoplasty (UPPP) and transoral robotic surgery (TORS).We compare the impact of surgical treatments on these kinds of patients. Methods: Between January 2018 to September 2022, We have enrolled 125 OSAS patients including 82 male and 43 female in Chi Mei Medical Center, Liouying, Taiwan. The age distribution from 6 to 71 years old (y/o) with mean age 36.1 y/o. The averaged body mass index (BMI) is 25 kg/m2 in male and 25.5 kg/m2 in female. In this cohort, we evaluated their upper airway obstruction sites with nasopharyngoscopy and scheduled a planned surgery. Some of cases received polysomnography (PSG) preoperatively, the averaged apnea-hypopnea index (AHI) is 37.7 events/hour. We have 68 patients received tonsillectomy, 9 received UPPP, 42 received UPPP and septomeatoplasty (SMP) and 6 received adenoidectomy and tonsillectomy (A and T). The subjective daytime sleepiness was evaluated with the Epworth sleepiness scale (ESS). Results: In the 68 tonsillectomy group, the averaged BMI is 24.9 kg/m2. In the UPPP group, the averaged BMI is 28.9 kg/m2. In UPPP and SMP group, the averaged BMI is 27.9 kg/m2. In the A and T group, the averaged BMI is 17.2 kg/m2. The reduction of AHI less than 20 is 58% postoperatively. The ESS reduced from 10.9 to 4.9 after surgery. Conclusion: Obstructive sleep apnea syndrome is a common upper airway disturbance in the general population. The prevalence rate is ranging high depending on different regions, age, sex and race. It leads to severe morbidity and mortality including car accident, stroke, nocturnal desaand sudden death and should be considered to be a major public health problem. The CPAP is effective to improve daytime sleepiness but the long-term compliance is low. The surgical treatment with different modalities can produce 50% decrease in AHI and ESS after surgery in the 6 to 12 months short-term period.

Keywords: apnea-hypopnea index, obstructive sleep apnea syndrome, polysomnography, uvulopalatopharyngoplasty

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3108 Manufacturing and Calibration of Material Standards for Optical Microscopy in Industrial Environments

Authors: Alberto Mínguez-Martínez, Jesús De Vicente Y Oliva

Abstract:

It seems that we live in a world in which the trend in industrial environments is the miniaturization of systems and materials and the fabrication of parts at the micro-and nano-scale. The problem arises when manufacturers want to study the quality of their production. This characteristic is becoming crucial due to the evolution of the industry and the development of Industry 4.0. As Industry 4.0 is based on digital models of production and processes, having accurate measurements becomes capital. At this point, the metrology field plays an important role as it is a powerful tool to ensure more stable production to reduce scrap and the cost of non-conformities. The most extended measuring instruments that allow us to carry out accurate measurements at these scales are optical microscopes, whether they are traditional, confocal, focus variation microscopes, profile projectors, or any other similar measurement system. However, the accuracy of measurements is connected to the traceability of them to the SI unit of length (the meter). The fact of providing adequate traceability to 2D and 3D dimensional measurements at micro-and nano-scale in industrial environments is a problem that is being studied, and it does not have a unique answer. In addition, if commercial material standards for micro-and nano-scale are considered, we can find that there are two main problems. On the one hand, those material standards that could be considered complete and very interesting do not give traceability of dimensional measurements and, on the other hand, their calibration is very expensive. This situation implies that these kinds of standards will not succeed in industrial environments and, as a result, they will work in the absence of traceability. To solve this problem in industrial environments, it becomes necessary to have material standards that are easy to use, agile, adaptive to different forms, cheap to manufacture and, of course, traceable to the definition of meter with simple methods. By using these ‘customized standards’, it would be possible to adapt and design measuring procedures for each application and manufacturers will work with some traceability. It is important to note that, despite the fact that this traceability is clearly incomplete, this situation is preferable to working in the absence of it. Recently, it has been demonstrated the versatility and the utility of using laser technology and other AM technologies to manufacture customized material standards. In this paper, the authors propose to manufacture a customized material standard using an ultraviolet laser system and a method to calibrate it. To conclude, the results of the calibration carried out in an accredited dimensional metrology laboratory are presented.

Keywords: industrial environment, material standards, optical measuring instrument, traceability

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3107 The Representation of Young Sports Heroines in Cinema: Analysis of a Regressive Portrayal of Young Sportswomen on the Screen

Authors: David Sudre

Abstract:

Sport in cinema, like sport in society, has been mainly concerned with men and masculinity. Whether in the boxing ring, on the basketball playgrounds, or on the soccer fields, these films have mostly focused on the trials and tribulations of male athletes, for whom women have very generally played secondary, often devalued and devaluing roles, such as that of the loving and indispensable woman to the victorious athlete, that of the dangerous femme fatale, or that of the woman as a sexual object. For more than a century, this film genre has, on the contrary, symbolized the dominant values of patriotism, heroism and contributed at the same time to build an ideal of hegemonic masculinity. With the exception of films such as The Grand National (1944) and Million Dollar Baby (2004), the most commercially successful films tell the story of men's adventures in sports. Today, thanks in part to the struggles of the feminist movement and subsequent societal advances, we are seeing an increase in the number of women in increasingly prominent roles in sports films. Indeed, there seems to be a general shift in popular cinema toward women playing major characters in big-budget productions that have also achieved critical and commercial success. However, if, at first sight, the increase in the number of roles given to women suggests an evolution and a more positive image of them on the screen, it will be necessary to see how their representation is really characterized when they are young and occupy major roles in this type of film. In order to answer this question, we will rely on the results of research conducted on a corpus of 28 sports films in which a young woman plays the main role in the story. All of these productions are fictional (not documentary), mostly American, and distributed by major film studios. The chosen sports teen movies are among the biggest commercial successes of the genre and aim to make the maximum profit and occupy the most dominant positions within the "commercial pole" of the cinematic field. Therefore, this research will allow us, although a change has taken place in the last decades in the number of main roles granted to sportswomen, to decode the sociological subtext of these popular sports films for teenagers. The aim is to reveal how these sports films convey a conservative ideology that participates, on the one hand, in the maintenance of patriarchy and, on the other hand, in the dissemination of stereotyped, negative, and regressive images of young women athletes.

Keywords: cinema, sport, gender, youth, representations, inequality, stereotypes

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3106 Biomass For Energy In Improving Sustainable Economic Development

Authors: Dahiru Muhammad, Muhammad Danladi, Muhammad Yahaya, Adamu Garba

Abstract:

This paper put forward the potentialities of biomass for energy as divers means of sustainable economic development. The paper explains, in brief, the ways or methods that are used to generate energy from biomass, such as combustion, pyrolysis, anaerobic, and gasification, and also how biomass for energy can enhance the sustainable economic development of a Nation. Currently, the nation depends on fossil fuels as a sources of generating its energy which is finite and deflectable with time, while on the other hand, biomass is an alternative and endless product which consists of forest biomass, agricultural residues, and energy crops. Finally, recommendations and conclusion were made on the role of biomass for energy in improving sustainable economic development.

Keywords: biomass, energy, sustainability, economic

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3105 Human Lens Metabolome: A Combined LC-MS and NMR Study

Authors: Vadim V. Yanshole, Lyudmila V. Yanshole, Alexey S. Kiryutin, Timofey D. Verkhovod, Yuri P. Tsentalovich

Abstract:

Cataract, or clouding of the eye lens, is the leading cause of vision impairment in the world. The lens tissue have very specific structure: It does not have vascular system, the lens proteins – crystallins – do not turnover throughout lifespan. The protection of lens proteins is provided by the metabolites which diffuse inside the lens from the aqueous humor or synthesized in the lens epithelial layer. Therefore, the study of changes in the metabolite composition of a cataractous lens as compared to a normal lens may elucidate the possible mechanisms of the cataract formation. Quantitative metabolomic profiles of normal and cataractous human lenses were obtained with the combined use of high-frequency nuclear magnetic resonance (NMR) and ion-pairing high-performance liquid chromatography with high-resolution mass-spectrometric detection (LC-MS) methods. The quantitative content of more than fifty metabolites has been determined in this work for normal aged and cataractous human lenses. The most abundant metabolites in the normal lens are myo-inositol, lactate, creatine, glutathione, glutamate, and glucose. For the majority of metabolites, their levels in the lens cortex and nucleus are similar, with the few exceptions including antioxidants and UV filters: The concentrations of glutathione, ascorbate and NAD in the lens nucleus decrease as compared to the cortex, while the levels of the secondary UV filters formed from primary UV filters in redox processes increase. That confirms that the lens core is metabolically inert, and the metabolic activity in the lens nucleus is mostly restricted by protection from the oxidative stress caused by UV irradiation, UV filter spontaneous decomposition, or other factors. It was found that the metabolomic composition of normal and age-matched cataractous human lenses differ significantly. The content of the most important metabolites – antioxidants, UV filters, and osmolytes – in the cataractous nucleus is at least ten fold lower than in the normal nucleus. One may suppose that the majority of these metabolites are synthesized in the lens epithelial layer, and that age-related cataractogenesis might originate from the dysfunction of the lens epithelial cells. Comprehensive quantitative metabolic profiles of the human eye lens have been acquired for the first time. The obtained data can be used for the analysis of changes in the lens chemical composition occurring with age and with the cataract development.

Keywords: cataract, lens, NMR, LC-MS, metabolome

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3104 Associations between Surrogate Insulin Resistance Indices and the Risk of Metabolic Syndrome in Children

Authors: Mustafa M. Donma, Orkide Donma

Abstract:

A well-defined insulin resistance (IR) is one of the requirements for the good understanding and evaluation of metabolic syndrome (MetS). However, underlying causes for the development of IR are not clear. Endothelial dysfunction also participates in the pathogenesis of this disease. IR indices are being determined in various obesity groups and also in diagnosing MetS. Components of MetS have been well established and used in adult studies. However, there are some ambiguities particularly in the field of pediatrics. The aims of this study were to compare the performance of fasting blood glucose (FBG), one of MetS components, with some other IR indices and check whether FBG may be replaced by some other parameter or ratio for a better evaluation of pediatric MetS. Five-hundred and forty-nine children were involved in the study. Five groups were constituted. Groups 109, 40, 100, 166, 110, 24 children were included in normal-body mass index (N-BMI), overweight (OW), obese (OB), morbid obese (MO), MetS with two components (MetS2) and MetS with three components (MetS3) groups, respectively. Age and sex-adjusted BMI percentiles tabulated by World Health Organization were used for the classification of obesity groups. MetS components were determined. Aside from one of the MetS components-FBG, eight measures of IR [homeostatic model assessment of IR (HOMA-IR), homeostatic model assessment of beta cell function (HOMA-%β), alanine transaminase-to-aspartate transaminase ratio (ALT/AST), alanine transaminase (ALT), insulin (INS), insulin-to-FBG ratio (INS/FBG), the product of fasting triglyceride and glucose (TyG) index, McAuley index] were evaluated. Statistical analyses were performed. A p value less than 0.05 was accepted as the statistically significance degree. Mean values for BMI of the groups were 15.7 kg/m2, 21.0 kg/m2, 24.7 kg/m2, 27.1 kg/m2, 28.7 kg/m2, 30.4 kg/m2 for N-BMI, OW, OB, MO, MetS2, MetS3, respectively. Differences between the groups were significant (p < 0.001). The only exception was MetS2-MetS3 couple, in spite of an increase detected in MetS3 group. Waist-to-hip circumference ratios significantly differed only for N-BMI vs, OB, MO, MetS2; OW vs MO; OB vs MO, MetS2 couples. ALT and ALT/AST did not differ significantly among MO-MetS2-MetS3. HOMA-%β differed only between MO and MetS2. INS/FBG, McAuley index and TyG were not significant between MetS2 and MetS3. HOMA-IR and FBG were not significant between MO and MetS2. INS was the only parameter, which showed statistically significant differences between MO-MetS2, MO-MetS3, and MetS2-MetS3. In conclusion, these findings have suggested that FBG presently considered as one of the five MetS components, may be replaced by INS during the evaluation of pediatric morbid obesity and MetS.

Keywords: children, insulin resistance indices, metabolic syndrome, obesity

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