Search results for: heart rate
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 8625

Search results for: heart rate

6315 Effective Apixaban Clearance with Cytosorb Extracorporeal Hemoadsorption

Authors: Klazina T. Havinga, Hilde R. H. de Geus

Abstract:

Introduction: Pre-operative coagulation management of Apixaban prescribed patients, a new oral anticoagulant (a factor Xa inhibitor), is difficult, especially when chronic kidney disease (CKD) causes drug overdose. Apixaban is not dialyzable due to its high level of protein binding. An antidote, Andexanet α, is available but expensive and has an unfavorable short half-life. We report the successful extracorporeal removal of Apixaban prior to emergency surgery with the CytoSorb® Hemoadsorption device. Methods: A 89-year-old woman with CKD, with an Apixaban prescription for atrial fibrillation, was presented at the ER with traumatic rib fractures, a flail chest, and an unstable spinal fracture (T12) for which emergency surgery was indicated. However, due to very high Apixaban levels, this surgery had to be postponed. Based on the Apixaban-specific anti-factor Xa activity (AFXaA) measurements at admission and 10 hours later, complete clearance was expected after 48 hours. In order to enhance the Apixaban removal and reduce the time to operation, and therefore reduce pulmonary complications, CRRT with CytoSorb® cartridge was initiated. Apixaban-specific anti-factor Xa activity (AFXaA) was measured frequently as a substitute for Apixaban drug concentrations, pre- and post adsorber, in order to calculate the adsorber-related clearance. Results: The admission AFXaA concentration, as a substitute for Apixaban drug levels, was 218 ng/ml, which decreased to 157 ng/ml after ten hours. Due to sustained anticoagulation effects, surgery was again postponed. However, the AFXaA levels decreased quickly to sub-therapeutic levels after CRRT (Multifiltrate Pro, Fresenius Medical Care, Blood flow 200 ml/min, Dialysate Flow 4000 ml/h, Prescribed renal dose 51 ml-kg-h) with Cytosorb® connected in series into the circuit was initiated (within 5 hours). The adsorber-related (indirect) Apixaban clearance was calculated every half hour (Cl=Qe * (AFXaA pre- AFXaA post/ AFXaA pre) with Qe=plasma flow rate calculated with Ht=0.38 and system blood flow rate 200 ml-min): 100 ml/min, 72 ml/min and 57 ml/min. Although, as expected, the adsorber-related clearance decreased quickly due to saturation of the beads, still the reduction rate achieved resulted in a very rapid decrease in AFXaA levels. Surgery was ordered and possible within 5 hours after Cytosorb initiation. Conclusion: The CytoSorb® Hemoadsorption device enabled rapid correction of Apixaban associated anticoagulation.

Keywords: Apixaban, CytoSorb, emergency surgery, Hemoadsorption

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6314 Single Stage “Fix and Flap” Orthoplastic Approach to Severe Open Tibial Fractures: A Systematic Review of the Outcomes

Authors: Taylor Harris

Abstract:

Gustilo-anderson grade III tibial fractures are exquisitely difficult injuries to manage as they require extensive soft tissue repair in addition to fracture fixation. These injuries are best managed collaboratively by Orthopedic and Plastic surgeons. While utilizing an Orthoplastics approach has decreased the rates of adverse outcomes in these injuries, there is a large amount of variation in exactly how an Orthoplastics team approaches complex cases such as these. It is sometimes recommended that definitive bone fixation and soft tissue coverage be completed simultaneously in a single-stage manner, but there is a paucity of large scale studies to provide evidence to support this recommendation. It is the aim of this study to report the outcomes of a single-stage "fix-and-flap" approach through a systematic review of the available literature. Hopefully, this better informs an evidence-based Orthoplastics approach to managing open tibial fractures. Systematic review of the literature was performed. Medline and Google Scholar were used and all studies published since 2000, in English were included. 103 studies were initially evaluated for inclusion. Reference lists of all included studies were also examined for potentially eligible studies. Gustilo grade III tibial shaft fractures in adults that were managed with a single-stage Orthoplastics approach were identified and evaluated with regard to outcomes of interest. Exclusion criteria included studies with patients <16 years old, case studies, systemic reviews, meta-analyses. Primary outcomes of interest were the rates of deep infections and rates of limb salvage. Secondary outcomes of interest included time to bone union, rates of non-union, and rates of re-operation. 15 studies were eligible. 11 of these studies reported rates of deep infection as an outcome, with rates ranging from 0.98%-20%. The pooled rate between studies was 7.34%. 7 studies reported rates of limb salvage with a range of 96.25%-100%. The pooled rate of the associated studies was 97.8%. 6 reported rates of non-union with a range of 0%-14%, a pooled rate of 6.6%. 6 reported time to bone union with a range of 24 to 40.3 weeks and a pooled average time of 34.2 weeks, and 4 reported rates of reoperation ranging from 7%-55%, with a pooled rate of 31.1%. A few studies that compared a single stage to a multi stage approach side-by-side unanimously favored the single stage approach. Outcomes of Gustilo grade III open tibial fractures utilizing an Orthoplastics approach that is specifically done in a single-stage produce low rates of adverse outcomes. Large scale studies of Orthoplastic collaboration that were not completed in strictly a single stage, or were completed in multiple stages, have not reported as favorable outcomes. We recommend that not only should Orthopedic surgeons and Plastic surgeons collaborate in the management of severe open tibial fracture, but they should plan to undergo definitive fixation and coverage in a single-stage for improved outcomes.

Keywords: orthoplastic, gustilo grade iii, single-stage, trauma, systematic review

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6313 Evaluation of Mito-Uncoupler Induced Hyper Metabolic and Aggressive Phenotype in Glioma Cells

Authors: Yogesh Rai, Saurabh Singh, Sanjay Pandey, Dhananjay K. Sah, B. G. Roy, B. S. Dwarakanath, Anant N. Bhatt

Abstract:

One of the most common signatures of highly malignant gliomas is their capacity to metabolize more glucose to lactic acid than normal brain tissues, even under normoxic conditions (Warburg effect), indicating that aerobic glycolysis is constitutively upregulated through stable genetic or epigenetic changes. However, oxidative phosphorylation (OxPhos) is also required to maintain the mitochondrial membrane potential for tumor cell survival. In the process of tumorigenesis, tumor cells during fastest growth rate exhibit both high glycolytic and high OxPhos. Therefore, metabolically reprogrammed cancer cells with combination of both aerobic glycolysis and altered OxPhos develop a robust metabolic phenotype, which confers a selective growth advantage. In our study, we grew the high glycolytic BMG-1 (glioma) cells with continuous exposure of mitochondrial uncoupler 2, 4, dinitro phenol (DNP) for 10 passages to obtain a phenotype of high glycolysis with enhanced altered OxPhos. We found that OxPhos modified BMG (OPMBMG) cells has similar growth rate and cell cycle distribution but high mitochondrial mass and functional enzymatic activity than parental cells. In in-vitro studies, OPMBMG cells showed enhanced invasion, proliferation and migration properties. Moreover, it also showed enhanced angiogenesis in matrigel plug assay. Xenografted tumors from OPMBMG cells showed reduced latent period, faster growth rate and nearly five folds reduction in the tumor take in nude mice compared to BMG-1 cells, suggesting that robust metabolic phenotype facilitates tumor formation and growth. OPMBMG cells which were found radio-resistant, showed enhanced radio-sensitization by 2-DG as compared to the parental BMG-1 cells. This study suggests that metabolic reprogramming in cancer cells enhances the potential of migration, invasion and proliferation. It also strengthens the cancer cells to escape the death processes, conferring resistance to therapeutic modalities. Our data also suggest that combining metabolic inhibitors like 2-DG with conventional therapeutic modalities can sensitize such metabolically aggressive cancer cells more than the therapies alone.

Keywords: 2-DG, BMG, DNP, OPM-BMG

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6312 The School-to-Work Transition: The Case of NEET Youths from Rural Areas

Authors: Anđelka Stojanović, Ivan Mihajlović, Ivica Nikolić

Abstract:

In the past years, due to the financial crisis and the tightening of conditions on the labor market, young people are facing great challenges in achieving financial independence and finding their place in society. Higher unemployment rates, poorer living conditions, separation from the labor market, and longer school-to-work transitions particularly affect rural youth and make significant differences between youth groups in rural and urban areas. Improving employability skills and development of instruments for further learning among young people “Not in Education, Employment, or Training” (NEET) should not be only the concerns of these people, already adequately be directed and supported by the institutions. According to the World Bank data, the share of youth not in education, employment or training (NEET), in the European Union in the past few years decreases but still shows a significant share in the total percentage of the youth population. In 2017 rate was 10.96% while in 2018 that value was 10.38%. When observing individual countries in Europe, especially those with lower incomes, this rate is much higher. It was concluded that this topic was not sufficiently elaborated and presented in the social and scientific environment. Therefore, the aim of this paper is to identify and systematize the problems of school-to-work transition among young NEETs living in rural areas as well as the initiatives for addressing their problems.

Keywords: NEET youth, risks and initiatives, rural youth, school-to-work transition

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6311 Implementation of a Lattice Boltzmann Method for Pulsatile Flow with Moment Based Boundary Condition

Authors: Zainab A. Bu Sinnah, David I. Graham

Abstract:

The Lattice Boltzmann Method has been developed and used to simulate both steady and unsteady fluid flow problems such as turbulent flows, multiphase flow and flows in the vascular system. As an example, the study of blood flow and its properties can give a greater understanding of atherosclerosis and the flow parameters which influence this phenomenon. The blood flow in the vascular system is driven by a pulsating pressure gradient which is produced by the heart. As a very simple model of this, we simulate plane channel flow under periodic forcing. This pulsatile flow is essentially the standard Poiseuille flow except that the flow is driven by the periodic forcing term. Moment boundary conditions, where various moments of the particle distribution function are specified, are applied at solid walls. We used a second-order single relaxation time model and investigated grid convergence using two distinct approaches. In the first approach, we fixed both Reynolds and Womersley numbers and varied relaxation time with grid size. In the second approach, we fixed the Womersley number and relaxation time. The expected second-order convergence was obtained for the second approach. For the first approach, however, the numerical method converged, but not necessarily to the appropriate analytical result. An explanation is given for these observations.

Keywords: Lattice Boltzmann method, single relaxation time, pulsatile flow, moment based boundary condition

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6310 Factors Influencing Health-related Quality of Life in Thai AMI Survivors

Authors: K. Masingboon, S. Duangpaeng, N. Chaiwong

Abstract:

Acute myocardial infarction (AMI) is the most common cause of death among Thai with coronary heart disease (CHD). Thai AMI survivors are most likely to have impaired health-related quality of life (HRQoL) due to their lifestyle, functional, and psychological problems. Guided by the Individual and Family Self-Management Theory, this study aimed to explore HRQoL and identify its predictors among Thai AMI survivors. 155 Thai AMI survivors were recruited by stratified random sampling from three hospitals located in eastern region of Thailand. HRQol was measured using the Short Form -12 Health Survey (SF-12). The Center for Epidemiologic studies Depression Scale (CES-D) was utilized to assess the presence of depression, and the Family Support questionnaire was administered to examine family support. Results revealed that 92 percent of Thai AMI survivors reported a generally high level of HRQoL and 80 percent of them reported higher level of HRQoL in physical health and mental health dimension. Depression and family support were significantly predicted HRQoL among Thai AMI survivors and accounted for 28.5 percent of variance (p < .001). Interestingly, depression was the most significant predictors of HRQoL (β = -.65, p < .001) In conclusion, depression is a significant predictor of HRQoL in Thai AMI survivors. Increasing awareness of depression among these survivors is important. Depressive symptoms in should be routinely assessed. In addition, intervention to improve HRQoL among Thai AMI survivors should be addressed through depressive symptom management and family collaboration.

Keywords: health-related quality of life, AMI survivors, predictors, collaboration

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6309 Performance of BLDC Motor under Kalman Filter Sensorless Drive

Authors: Yuri Boiko, Ci Lin, Iluju Kiringa, Tet Yeap

Abstract:

The performance of a BLDC motor controlled by the Kalman filter-based position-sensorless drive is studied in terms of its dependence on the system’s parameters' variations. The effects of system’s parameters changes on the dynamic behavior of state variables are verified. Simulated is a closed-loop control scheme with a Kalman filter in the feedback line. Distinguished are two separate data sampling modes in analyzing feedback output from the BLDC motor: (1) equal angular separation and (2) equal time intervals. In case (1), the data are collected via equal intervals Δθ of rotor’s angular position θᵢ, i.e., keeping Δθ=const. In case (2), the data collection time points tᵢ are separated by equal sampling time intervals Δt=const. Demonstrated are the effects of the parameters changes on the sensorless control flow, in particular, reduction of the torque ripples, switching spikes, torque load balancing. It is specifically shown that an efficient suppression of commutation induced torque ripples is achievable selection of the sampling rate in the Kalman filter settings above certain critical value. The computational cost of such suppression is shown to be higher for the motors with lower induction values of the windings.

Keywords: BLDC motor, Kalman filter, sensorless drive, state variables, torque ripples reduction, sampling rate

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6308 Controlled Release of Glucosamine from Pluronic-Based Hydrogels for the Treatment of Osteoarthritis

Authors: Papon Thamvasupong, Kwanchanok Viravaidya-Pasuwat

Abstract:

Osteoarthritis affects a lot of people worldwide. Local injection of glucosamine is one of the alternative treatment methods to replenish the natural lubrication of cartilage. However, multiple injections can potentially lead to possible bacterial infection. Therefore, a drug delivery system is desired to reduce the frequencies of injections. A hydrogel is one of the delivery systems that can control the release of drugs. Thermo-reversible hydrogels can be beneficial to the drug delivery system especially in the local injection route because this formulation can change from liquid to gel after getting into human body. Once the gel is in the body, it will slowly release the drug in a controlled manner. In this study, various formulations of Pluronic-based hydrogels were synthesized for the controlled release of glucosamine. One of the challenges of the Pluronic controlled release system is its fast dissolution rate. To overcome this problem, alginate and calcium sulfate (CaSO4) were added to the polymer solution. The characteristics of the hydrogels were investigated including the gelation temperature, gelation time, hydrogel dissolution and glucosamine release mechanism. Finally, a mathematical model of glucosamine release from Pluronic-alginate-hyaluronic acid hydrogel was developed. Our results have shown that crosslinking Pluronic gel with alginate did not significantly extend the dissolution rate of the gel. Moreover, the gel dissolution profiles and the glucosamine release mechanisms were best described using the zeroth-order kinetic model, indicating that the release of glucosamine was primarily governed by the gel dissolution.

Keywords: controlled release, drug delivery system, glucosamine, pluronic, thermoreversible hydrogel

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6307 Polymer Modification of Fine Grained Concretes Used in Textile Reinforced Cementitious Composites

Authors: Esma Gizem Daskiran, Mehmet Mustafa Daskiran, Mustafa Gencoglu

Abstract:

Textile reinforced cementitious composite (TRCC) is a development of a composite material where textile and fine-grained concrete (matrix) materials are used in combination. These matrices offer high performance properties in many aspects. To achieve high performance, polymer modified fine-grained concretes were used as matrix material which have high flexural strength. In this study, ten latex polymers and ten powder polymers were added to fine-grained concrete mixtures. These latex and powder polymers were added to the mixtures at different rates related to binder weight. Mechanical properties such as compressive and flexural strength were studied. Results showed that latex polymer and redispersible polymer modified fine-grained concretes showed different mechanical performance. A wide range of both latex and redispersible powder polymers were studied. As the addition rate increased compressive strength decreased for all mixtures. Flexural strength increased as the addition rate increased but significant enhancement was not observed through all mixtures.

Keywords: textile reinforced composite, cement, fine grained concrete, latex, redispersible powder

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6306 Real-Time Pedestrian Detection Method Based on Improved YOLOv3

Authors: Jingting Luo, Yong Wang, Ying Wang

Abstract:

Pedestrian detection in image or video data is a very important and challenging task in security surveillance. The difficulty of this task is to locate and detect pedestrians of different scales in complex scenes accurately. To solve these problems, a deep neural network (RT-YOLOv3) is proposed to realize real-time pedestrian detection at different scales in security monitoring. RT-YOLOv3 improves the traditional YOLOv3 algorithm. Firstly, the deep residual network is added to extract vehicle features. Then six convolutional neural networks with different scales are designed and fused with the corresponding scale feature maps in the residual network to form the final feature pyramid to perform pedestrian detection tasks. This method can better characterize pedestrians. In order to further improve the accuracy and generalization ability of the model, a hybrid pedestrian data set training method is used to extract pedestrian data from the VOC data set and train with the INRIA pedestrian data set. Experiments show that the proposed RT-YOLOv3 method achieves 93.57% accuracy of mAP (mean average precision) and 46.52f/s (number of frames per second). In terms of accuracy, RT-YOLOv3 performs better than Fast R-CNN, Faster R-CNN, YOLO, SSD, YOLOv2, and YOLOv3. This method reduces the missed detection rate and false detection rate, improves the positioning accuracy, and meets the requirements of real-time detection of pedestrian objects.

Keywords: pedestrian detection, feature detection, convolutional neural network, real-time detection, YOLOv3

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6305 UV Functionalised Short Implants as an Alternative to Avoid Crestal Sinus Lift Procedure: Controlled Case Series

Authors: Naira Ghambaryan, Gagik Hakobyan

Abstract:

Purpose:The study was to evaluate the survival rate of short implants (5-6 mm) functionalized with UV radiation placed in the posterior segments of the atrophied maxilla. Materials and Methods:The study included 47 patients with unilateral/bilateral missing teeth and vertical atrophy of the posterior maxillary area. A total of 64 short UV-functionalized implants and 62 standard implants over 10 mm in length were placed in patients. The clinical indices included the following parameters: ISQБ MBL, OHIP-G scale. Results: For short implants, the median ISQ at placement was 62.2 for primary stability, and the median ISQ at 5 months was 69.6 ISQ. For standart implant, the mean ISQ at placement was 64.3 ISQ, and ISQ after 5 months was 71.6 ISQ. Аfter 6 months mean MBL short implants 0.87 mm, after 1 year, 1.13 mm, after 5 year was 1.48 mm. Аfter 6 months, mean MBL standard implants 0.84 mm, after 1 year, 1.24 mm, after 5 year was 1.58 mm. Mean OHIP-G scores -patients satisfaction with the implant at 4.8 ± 0.3, satisfaction with the operation 4.6 ± 0.4; satisfaction with prosthetics 4.7 ± 0.5. Cumulative 5-year short implants rates was 96.7%, standard implants was 97.4%, and prosthesis cumulative survival rate was 97.2%. Conclusions: Short implants with ultraviolet functionalization for prosthetic rehabilitation of the posterior resorbed maxilla region is a reliable, reasonable alternative to sinus lift, demonstrating fewer complications, satisfactory survival of a 5-year follow-up period, and reducing the number of additional surgical interventions and postoperative complications.

Keywords: short implant, ultraviolet functionalization, atrophic posterior maxilla, prosthodontic rehabilitation

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6304 Effect of Quenching Medium on the Hardness of Dual Phase Steel Heat Treated at a High Temperature

Authors: Tebogo Mabotsa, Tamba Jamiru, David Ibrahim

Abstract:

Dual phase(DP) steel consists essentially of fine grained equiaxial ferrite and a dispersion of martensite. Martensite is the primary precipitate in DP steels, it is the main resistance to dislocation motion within the material. The objective of this paper is to present a relation between the intercritical annealing holding time and the hardness of a dual phase steel. The initial heat treatment involved heating the specimens to 1000oC and holding the sample at that temperature for 30 minutes. After the initial heat treatment, the samples were heated to 770oC and held for a varying amount of time at constant temperature. The samples were held at 30, 60, and 90 minutes respectively. After heating and holding the samples at the austenite-ferrite phase field, the samples were quenched in water, brine, and oil for each holding time. The experimental results proved that an equation for predicting the hardness of a dual phase steel as a function of the intercritical holding time is possible. The relation between intercritical annealing holding time and hardness of a dual phase steel heat treated at high temperatures is parabolic in nature. Theoretically, the model isdependent on the cooling rate because the model differs for each quenching medium; therefore, a universal hardness equation can be derived where the cooling rate is a variable factor.

Keywords: quenching medium, annealing temperature, dual phase steel, martensite

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6303 Using Coupled Oscillators for Implementing Frequency Diverse Array

Authors: Maryam Hasheminasab, Ahmed Cheldavi, Ahmed Kishk

Abstract:

Frequency-diverse arrays (FDAs) have garnered significant attention from researchers due to their ability to combine frequency diversity with the inherent spatial diversity of an array. The introduction of frequency diversity in FDAs enables the generation of auto-scanning patterns that are range-dependent, which can have advantageous applications in communication and radar systems. However, the main challenge in implementing FDAs lies in determining the technique for distributing frequencies among the array elements. One approach to address this challenge is by utilizing coupled oscillators, which are a technique commonly employed in active microwave theory. Nevertheless, the limited stability range of coupled oscillators poses another obstacle to effectively utilizing this technique. In this paper, we explore the possibility of employing a coupled oscillator array in the mode lock state (MLS) for implementing frequency distribution in FDAs. Additionally, we propose and simulate the use of a digital phase-locked loop (DPLL) as a backup technique to stabilize the oscillators. Through simulations, we validate the functionality of this technique. This technique holds great promise for advancing the implementation of phased arrays and overcoming current scan rate and phase shifter limitations, especially in millimeter wave frequencies.

Keywords: angle-changing rate, auto scanning beam, pull-in range, hold-in range, locking range, mode locked state, frequency locked state

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6302 Effects of Punicalagin on Some Productive and Reproductive Traits in Virgin Rabbit Does

Authors: Nada A. El-Shahaw, Anas A.Salem, M. Kobeisy, Hoda M. Shabaan

Abstract:

Reactive oxygen species (ROS) is collective term both oxygen radical, such superoxide (O₂•), hydroxyl(OH•), peroxyl (RO₂), and hydroperoxyl (HO₂•), and certain non-radical oxidizing agents, such as hydrogen peroxide (H₂O₂), hypochlorous acid (HOCL), and ozone (O₃), that can be convert easily to radical. The importance of antioxidants is shown here punicalagin. Punicalagin is preventing the harmful effect of (ROS) in all cells, specially gonadal cells. So, the aim of study was to investigate effects of punicalagin (PL) on maternal live body weight (MLBW), number of services/conception (NS), conception rate (CR), gestation length (GL), kindling rate (KR), total litter size (TLS), live litter size (LLS), kit weight (KW), progesterone (P4) and estradiol-17 (E2) concentrations at 1st and 2nd pregnancy of young does. A total of 28 healthy virgin does (6 months old) were divided into 2 equal groups. Group I, each doe, was injected IM with 100 ug PL twice/week pre-mating and one time 3 days post-mating. Group II, each doe was injected IM with sterilized water (control). Blood samples were taken at pre-mating, mating, post-mating, throughout pregnancy, and immediately post-kindling for assaying P4 and E2. All does were naturally mated with fertile bucks. Results revealed that PL displayed their significant impacts on MLBW, NS/conception, CR, GL, KR, TLS, LLS, KWs (birth and weaning), P4 and E2 concentrations either at 1ˢᵗ/2ⁿᵈ pregnancy or both of them. Conclusively, PL improved pregnancy outcomes of young do particularly at 2ⁿᵈ pregnancy and could be recommended in rabbit's farms.

Keywords: punicalagin, pregnancy, estradiol-17β, progesterone, does

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6301 Electricity Sector's Status in Lebanon and Portfolio Optimization for the Future Electricity Generation Scenarios

Authors: Nour Wehbe

Abstract:

The Lebanese electricity sector is at the heart of a deep crisis. Electricity in Lebanon is supplied by Électricité du Liban (EdL) which has to suffer from technical and financial deficiencies for decades and proved to be insufficient and deficient as the demand still exceeds the supply. As a result, backup generation is widespread throughout Lebanon. The sector costs massive government resources and, on top of it, consumers pay massive additional amounts for satisfying their electrical needs. While the developed countries have been investing in renewable energy for the past two decades, the Lebanese government realizes the importance of adopting such energy sourcing strategies for the upgrade of the electricity sector in the country. The diversification of the national electricity generation mix has increased considerably in Lebanon's energy planning agenda, especially that a detailed review of the energy potential in Lebanon has revealed a great potential of solar and wind energy resources, a considerable potential of biomass resource, and an important hydraulic potential in Lebanon. This paper presents a review of the energy status of Lebanon, and illustrates a detailed review of the EDL structure with the existing problems and recommended solutions. In addition, scenarios reflecting implementation of policy projects are presented, and conclusions are drawn on the usefulness of a proposed evaluation methodology and the effectiveness of the adopted new energy policy for the electrical sector in Lebanon.

Keywords: EdL Electricite du Liban, portfolio optimization, electricity generation mix, mean-variance approach

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6300 Trends of Agri-Food Production and Export Stimulating Economic Policy in Georgia

Authors: E. Kharaishvili, G. Erkomaishvili, M. Chavleishvili

Abstract:

The paper evaluates the natural and resource potential of agriculture, a traditional sector for Georgia. It is concluded that despite favorable conditions the rate of development of the sector is lower compared to other sectors of the economy, self-sufficiency rate for locally produced agricultural products is low; on average, import of food is 4 times higher compared to export, and the country faces considerable challenges in this regard. Tendencies of self-sufficiency rates are studied, and it is concluded that the indicators of export and import of agro-food products increase in accordance with the tendency of increasing production in agricultural sector. The paper substantiates stimulating impact of international trade on agricultural development. Two alternative strategies are assessed in this respect: 1) export stimulation, and 2) import replacement strategies. It is concluded that significant tendencies are observed in agro-food sector of Georgia; in particular, productivity is low; import volume significantly exceeds the export volume. It is considered that the growth of export will allow Georgia to overcome limited opportunities of local market and encourage increasing competitiveness. Various tools of economic policy are suggested for achieving these goals; in particular to subsidize export, optimize trade barriers, manage exchange rates effectively, offer special financial services, provide insurance for export, etc.

Keywords: agro-food sector, trend of production, export stimulation, economic policy

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6299 In vitro Evaluation of Capsaicin Patches for Transdermal Drug Delivery

Authors: Alija Uzunovic, Sasa Pilipovic, Aida Sapcanin, Zahida Ademovic, Berina Pilipović

Abstract:

Capsaicin is a naturally occurring alkaloid extracted from capsicum fruit extracts of different of Capsicum species. It has been employed topically to treat many diseases such as rheumatoid arthritis, osteoarthritis, cancer pain and nerve pain in diabetes. The high degree of pre-systemic metabolism of intragastrical capsaicin and the short half-life of capsaicin by intravenous administration made topical application of capsaicin advantageous. In this study, we have evaluated differences in the dissolution characteristics of capsaicin patch 11 mg (purchased from market) at different dissolution rotation speed. The proposed patch area is 308 cm2 (22 cm x 14 cm; it contains 36 µg of capsaicin per square centimeter of adhesive). USP Apparatus 5 (Paddle Over Disc) is used for transdermal patch testing. The dissolution study was conducted using USP apparatus 5 (n=6), ERWEKA DT800 dissolution tester (paddle-type) with addition of a disc. The fabricated patch of 308 cm2 is to be cut into 9 cm2 was placed against a disc (delivery side up) retained with the stainless-steel screen and exposed to 500 mL of phosphate buffer solution pH 7.4. All dissolution studies were carried out at 32 ± 0.5 °C and different rotation speed (50± 5; 100± 5 and 150± 5 rpm). 5 ml aliquots of samples were withdrawn at various time intervals (1, 4, 8 and 12 hours) and replaced with 5 ml of dissolution medium. Withdrawn were appropriately diluted and analyzed by reversed-phase liquid chromatography (RP-LC). A Reversed Phase Liquid Chromatography (RP-LC) method has been developed, optimized and validated for the separation and quantitation of capsaicin in a transdermal patch. The method uses a ProntoSIL 120-3-C18 AQ 125 x 4,0 mm (3 μm) column maintained at 600C. The mobile phase consisted of acetonitrile: water (50:50 v/v), the flow rate of 0.9 mL/min, the injection volume 10 μL and the detection wavelength 222 nm. The used RP-LC method is simple, sensitive and accurate and can be applied for fast (total chromatographic run time was 4.0 minutes) and simultaneous analysis of capsaicin and dihydrocapsaicin in a transdermal patch. According to the results obtained in this study, we can conclude that the relative difference of dissolution rate of capsaicin after 12 hours was elevated by increase of dissolution rotation speed (100 rpm vs 50 rpm: 84.9± 11.3% and 150 rpm vs 100 rpm: 39.8± 8.3%). Although several apparatus and procedures (USP apparatus 5, 6, 7 and a paddle over extraction cell method) have been used to study in vitro release characteristics of transdermal patches, USP Apparatus 5 (Paddle Over Disc) could be considered as a discriminatory test. would be able to point out the differences in the dissolution rate of capsaicin at different rotation speed.

Keywords: capsaicin, in vitro, patch, RP-LC, transdermal

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6298 Reduction of the Number of Traffic Accidents by Function of Driver's Anger Detection

Authors: Masahiro Miyaji

Abstract:

When a driver happens to be involved in some traffic congestion or after traffic incidents, the driver may fall in a state of anger. State of anger may encounter decisive risk resulting in severer traffic accidents. Preventive safety function using driver’s psychosomatic state with regard to anger may be one of solutions which would avoid that kind of risks. Identifying driver’s anger state is important to create countermeasures to prevent the risk of traffic accidents. As a first step, this research figured out root cause of traffic incidents by means of using Internet survey. From statistical analysis of the survey, dominant psychosomatic states immediately before traffic incidents were haste, distraction, drowsiness and anger. Then, we replicated anger state of a driver while driving, and then, replicated it by means of using driving simulator on bench test basis. Six types of facial expressions including anger were introduced as alternative characteristics. Kohonen neural network was adopted to classify anger state. Then, we created a methodology to detect anger state of a driver in high accuracy. We presented a driving support safety function. The function adapts driver’s anger state in cooperation with an autonomous driving unit to reduce the number of traffic accidents. Consequently, e evaluated reduction rate of driver’s anger in the traffic accident. To validate the estimation results, we referred the reduction rate of Advanced Safety Vehicle (ASV) as well as Intelligent Transportation Systems (ITS).

Keywords: Kohonen neural network, driver’s anger state, reduction of traffic accidents, driver’s state adaptive driving support safety

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6297 The Time-Frequency Domain Reflection Method for Aircraft Cable Defects Localization

Authors: Reza Rezaeipour Honarmandzad

Abstract:

This paper introduces an aircraft cable fault detection and location method in light of TFDR keeping in mind the end goal to recognize the intermittent faults adequately and to adapt to the serial and after-connector issues being hard to be distinguished in time domain reflection. In this strategy, the correlation function of reflected and reference signal is used to recognize and find the airplane fault as per the qualities of reflected and reference signal in time-frequency domain, so the hit rate of distinguishing and finding intermittent faults can be enhanced adequately. In the work process, the reflected signal is interfered by the noise and false caution happens frequently, so the threshold de-noising technique in light of wavelet decomposition is used to diminish the noise interference and lessen the shortcoming alert rate. At that point the time-frequency cross connection capacity of the reference signal and the reflected signal based on Wigner-Ville appropriation is figured so as to find the issue position. Finally, LabVIEW is connected to execute operation and control interface, the primary capacity of which is to connect and control MATLAB and LABSQL. Using the solid computing capacity and the bottomless capacity library of MATLAB, the signal processing turn to be effortlessly acknowledged, in addition LabVIEW help the framework to be more dependable and upgraded effectively.

Keywords: aircraft cable, fault location, TFDR, LabVIEW

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6296 Physico-Chemical Characteristics of Terminalia arjuna Encapsulated Dairy Drink

Authors: Sawale Pravin Digambar, G. R. Patil, Shaik Abdul Hussain

Abstract:

Terminalia arjuna (TA), an important medicinal plant in Indian System of Medicine, is specifically recognized for its recuperative effect on heart ailments. Alcoholic extract of TA (both free and encapsulated) was incorporated into milk to obtain functional dairy beverages. The respective beverages were appropriately flavored and optimized using response surface methodology to improve the sensory appeal. The beverages were evaluated for their compositional, anti-oxidative and various other physico-chemical aspects. Addition of herb (0.3%) extract to flavoured dairy drink (Drink 1) resulted in significantly lowered (p>0.05) HMF content and increased antioxidant activity, total phenol content as compared with control (Control 1). Subsequently, a significant (p>0.05) increase in acidity and sedimentation was also observed. Encapsulated herb (1.8%) incorporated drink (Drink 2) had significantly (P>0.05) enhanced HMF value and decreased antioxidant activity, phenol content as compared to herb added vanilla chocolate dairy drink (Drink 1). It can be concluded that addition of encapsulated TA extract and non-encapsulated TA extract to chocolate dairy drink at 0.3% concentration altered the functional properties vanilla chocolate dairy drink which could be related to the interaction of herb components such as polyphenol with milk protein or maltodextrin/ gum Arabic matrix.

Keywords: Terminalia arjuna, encapsulate, antioxidant activity, physicochemical study

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6295 Common Soccer Injuries and Its Risk Factors: A Systematic Review

Authors: C. Brandt, R. Christopher, N. Damons

Abstract:

Background: Soccer is one of the most common sports in the world. It is associated with a significant chance of injury either during training or during the course of an actual match. Studies on the epidemiology of soccer injuries have been widely conducted, but methodological appraisal is lacking to make evidence-based decisions. Objectives: The purpose of this study was to conduct a systematic review of common injuries in soccer and their risk factors. Methods: A systematic review was performed based on the Joanna Briggs Institute procedure for conducting systematic reviews. Databases such as SPORT Discus, Cinahl, Medline, Science Direct, PubMed, and grey literature were searched. The quality of selected studies was rated, and data extracted and tabulated. Plot data analysis was done, and incidence rates and odds ratios were calculated, with their respective 95% confidence intervals. I² statistic was used to determine the proportion of variation across studies. Results: The search yielded 62 studies, of which 21 were screened for inclusion. A total of 16 studies were included for the analysis, ten for qualitative and six for quantitative analysis. The included studies had, on average, a low risk of bias and good methodological quality. The heterogeneity amongst the pooled studies was, however, statistically significant (χ²-p value < 0.001). The pooled results indicated a high incidence of soccer injuries at an incidence rate of 6.83 per 1000 hours of play. The pooled results also showed significant evidence of risk factors and the likelihood of injury occurrence in relation to these risk factors (OR=1.12 95% CI 1.07; 1.17). Conclusion: Although multiple studies are available on the epidemiology of soccer injuries and risk factors, only a limited number of studies were of sound methodology to be included in a review. There was also significant heterogeneity amongst the studies. The incidence rate of common soccer injuries was found to be 6.83 per 1000 hours of play. This incidence rate is lower than the values reported by the majority of previous studies on the occurrence of common soccer injuries. The types of common soccer injuries found by this review support the soccer injuries pattern reported in existing literature as muscle strain and ligament sprain of varying severity, especially in the lower limbs. The risk factors that emerged from this systematic review are predominantly intrinsic risk factors. The risk factors increase the risk of traumatic and overuse injuries of the lower extremities such as hamstrings and groin strains, knee and ankle sprains, and contusion.

Keywords: incidence, prevalence, risk factors, soccer injuries

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6294 Kinetic Study of C₃N₄/CuWO₄: Photocatalyst towards Solar Light Inactivation of Mixed Populated Bacteria

Authors: Rimzhim Gupta, Bhanupriya Boruah, Jayant M. Modak, Giridhar Madras

Abstract:

Microbial contamination is one of the major concerns in the field of water treatment. AOP (advanced oxidation processes) is well-established method to resolve the issue of removal of contaminants in water. A Z-scheme composite g-C₃N₄/CuWO₄ was synthesized by sol-gel method for the photocatalytic inactivation of a mixed population of Gram-positive bacteria (S. aureus) and Gram-negative bacteria (E. coli). The photoinactivation was observed for different types of bacteria in the same medium together and individually in the absence of the nutrients. The lattice structures and phase purities were determined by X-ray diffraction. For morphological and topographical features, scanning electron microscopy and transmission electron microscopy analyses were carried out. The band edges of the semiconductor (valence band and conduction band) were determined by ultraviolet photoelectron microscopy. The lifetime of the charge carriers and band gap of the semiconductors were determined by time resolved florescence spectroscopy and diffused reflectance spectroscopy, respectively. The effect of weight ratio of C₃N₄ and CuWO₄ was observed by performing photocatalytic experiments. To investigate the exact mechanism and major responsible radicals for photocatalysis, scavenger studies were performed. The rate constants and order of the inactivation reactions were obtained by power law kinetics. For E. coli and S. aureus, the order of reaction and rate constants are 1.15, 0.9 and 1.39 ± 0.03 (CFU/mL)⁻⁰.¹⁵ h⁻¹, 47.95 ± 1.2 (CFU/mL)⁰.¹ h⁻¹, respectively.

Keywords: z-scheme, E. coli, S. aureus, sol-gel

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6293 An Assessment of Bathymetric Changes in the Lower Usuma Reservoir, Abuja, Nigera

Authors: Rayleigh Dada Abu, Halilu Ahmad Shaba

Abstract:

Siltation is a serious problem that affects public water supply infrastructures such as dams and reservoirs. It is a major problem which threatens the performance and sustainability of dams and reservoirs. It reduces the dam capacity for flood control, potable water supply, changes water stage, reduces water quality and recreational benefits. The focus of this study is the Lower Usuma reservoir. At completion the reservoir had a gross storage capacity of 100 × 106 m3 (100 million cubic metres), a maximum operational level of 587.440 m a.s.l., with a maximum depth of 49 m and a catchment area of 241 km2 at dam site with a daily designed production capacity of 10,000 cubic metres per hour. The reservoir is 1,300 m long and feeds the treatment plant mainly by gravity. The reservoir became operational in 1986 and no survey has been conducted to determine its current storage capacity and rate of siltation. Hydrographic survey of the reservoir by integrated acoustic echo-sounding technique was conducted in November 2012 to determine the level and rate of siltation. The result obtained shows that the reservoir has lost 12.0 meters depth to siltation in 26 years of its operation; indicating 24.5% loss in installed storage capacity. The present bathymetric survey provides baseline information for future work on siltation depth and annual rates of storage capacity loss for the Lower Usuma reservoir.

Keywords: sedimentation, lower Usuma reservoir, acoustic echo sounder, bathymetric survey

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6292 The Possibility of Using Somatosensory Evoked Potential(SSEP) as a Parameter for Cortical Vascular Dementia

Authors: Hyunsik Park

Abstract:

As the rate of cerebrovascular disease increases in old populations, the prevalence rate of vascular dementia would be expected. Therefore, authors designed this study to find out the possibility of somatosensory evoked potentials(SSEP) as a parameter for early diagnosis and prognosis prediction of vascular dementia in cortical vascular dementia patients. 21 patients who met the criteria for vascular dementia according to DSM-IV,ICD-10and NINDS-AIREN with the history of recent cognitive impairment, fluctuation progression, and neurologic deficit. We subdivided these patients into two groups; a mild dementia and a severe dementia groups by MMSE and CDR score; and analysed comparison between normal control group and patient control group who have been cerebrovascular attack(CVA) history without dementia by using N20 latency and amplitude of median nerve. In this study, mild dementia group showed significant differences on latency and amplitude with normal control group(p-value<0.05) except patient control group(p-value>0.05). Severe dementia group showed significant differences both normal control group and patient control group.(p-value<0.05, <001). Since no significant difference has founded between mild dementia group and patient control group, SSEP has limitation to use for early diagnosis test. However, the comparison between severe dementia group and others showed significant results which indicate SSEP can predict the prognosis of vascular dementia in cortical vascular dementia patients.

Keywords: SSEP, cortical vascular dementia, N20 latency, N20 amplitude

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6291 Technical, Environmental and Financial Assessment for Optimal Sizing of Run-of-River Small Hydropower Project: Case Study in Colombia

Authors: David Calderon Villegas, Thomas Kaltizky

Abstract:

Run-of-river (RoR) hydropower projects represent a viable, clean, and cost-effective alternative to dam-based plants and provide decentralized power production. However, RoR schemes cost-effectiveness depends on the proper selection of site and design flow, which is a challenging task because it requires multivariate analysis. In this respect, this study presents the development of an investment decision support tool for assessing the optimal size of an RoR scheme considering the technical, environmental, and cost constraints. The net present value (NPV) from a project perspective is used as an objective function for supporting the investment decision. The tool has been tested by applying it to an actual RoR project recently proposed in Colombia. The obtained results show that the optimum point in financial terms does not match the flow that maximizes energy generation from exploiting the river's available flow. For the case study, the flow that maximizes energy corresponds to a value of 5.1 m3/s. In comparison, an amount of 2.1 m3/s maximizes the investors NPV. Finally, a sensitivity analysis is performed to determine the NPV as a function of the debt rate changes and the electricity prices and the CapEx. Even for the worst-case scenario, the optimal size represents a positive business case with an NPV of 2.2 USD million and an IRR 1.5 times higher than the discount rate.

Keywords: small hydropower, renewable energy, RoR schemes, optimal sizing, objective function

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6290 A Study on the Relation among Primary Care Professionals Serving Disadvantaged Community, Socioeconomic Status, and Adverse Health Outcome

Authors: Chau-Kuang Chen, Juanita Buford, Colette Davis, Raisha Allen, John Hughes, James Tyus, Dexter Samuels

Abstract:

During the post-Civil War era, the city of Nashville, Tennessee, had the highest mortality rate in the country. The elevated death and disease among ex-slaves were attributable to the unavailability of healthcare. To address the paucity of healthcare services, the College, an institution with the mission of educating minority professionals and serving the under served population, was established in 1876. This study was designed to assess if the College has accomplished its mission of serving under served communities and contributed to the elimination of health disparities in the United States. The study objective was to quantify the impact of socioeconomic status and adverse health outcomes on primary care professionals serving disadvantaged communities, which, in turn, was significantly associated with a health professional shortage score partly designated by the U.S. Department of Health and Human Services. Various statistical methods were used to analyze the alumni data in years 1975 – 2013. K-means cluster analysis was utilized to identify individual medical and dental graduates into the cluster groups of the practice communities (Disadvantaged or Non-disadvantaged Communities). Discriminant analysis was implemented to verify the classification accuracy of cluster analysis. The independent t test was performed to detect the significant mean differences for clustering and criterion variables between Disadvantaged and Non-disadvantaged Communities, which confirms the “content” validity of cluster analysis model. Chi-square test was used to assess if the proportion of cluster groups (Disadvantaged vs Non-disadvantaged Communities) were consistent with that of practicing specialties (primary care vs. non-primary care). Finally, the partial least squares (PLS) path model was constructed to explore the “construct” validity of analytics model by providing the magnitude effects of socioeconomic status and adverse health outcome on primary care professionals serving disadvantaged community. The social ecological theory along with statistical models mentioned was used to establish the relationship between medical and dental graduates (primary care professionals serving disadvantaged communities) and their social environments (socioeconomic status, adverse health outcome, health professional shortage score). Based on social ecological framework, it was hypothesized that the impact of socioeconomic status and adverse health outcomes on primary care professionals serving disadvantaged communities could be quantified. Also, primary care professionals serving disadvantaged communities related to a health professional shortage score can be measured. Adverse health outcome (adult obesity rate, age-adjusted premature mortality rate, and percent of people diagnosed with diabetes) could be affected by the latent variable, namely socioeconomic status (unemployment rate, poverty rate, percent of children who were in free lunch programs, and percent of uninsured adults). The study results indicated that approximately 83% (3,192/3,864) of the College’s medical and dental graduates from 1975 to 2013 were practicing in disadvantaged communities. In addition, the PLS path modeling demonstrated that primary care professionals serving disadvantaged community was significantly associated with socioeconomic status and adverse health outcome (p < .001). In summary, the majority of medical and dental graduates from the College provide primary care services to disadvantaged communities with low socioeconomic status and high adverse health outcomes, which demonstrate that the College has fulfilled its mission.

Keywords: disadvantaged community, K-means cluster analysis, PLS path modeling, primary care

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6289 Pregnancy and Birth Outcomes of Single versus Multiple Embryo Transfer in Gestational Surrogacy Arrangements: A Systematic Review

Authors: Jutharat Attawet, Alex Y. Wang, Cindy M. Farquhar, Elizabeth A. Sullivan

Abstract:

Background: Adverse maternal and perinatal outcomes of multiple pregnancies resulting from multiple embryo transfers (ET) has become significant concerns. This is particularly relevant for gestational carriers since they usually do not have infertility issues. Single embryo transfer (SET) therefore has been encouraged to assist reproductive technology (ART) practice in order to reduce multiple pregnancies. Objectives: This systematic review aims to investigate the pregnancy and birth outcomes of SET and multiple ET in surrogacy arrangements. Search methods: This study is a systematic review. Electronic databases were searched from CINAHL, Medline, Embase, Scopus and ProQuest for studies from 1980 to 2017. Cross-references and national ART reports were also manual searchings. Articles without restriction of English language and study types were accessed. Carrier cycles involving in SET and multiple ET were identified in database searching. The main outcome measures including clinical pregnancy, live delivery and multiple deliveries per gestational carrier cycle were compared between SET and multiple ET. Mantel-Haenzel risk ratios (RRs) with 95% confidence intervals (CIs), using the numbers of outcome events in SET and multiple ET of each study were calculated suing RevMan5.3. Outcomes: The search returned 97 articles of which 5 met the inclusion criteria. Approximately 50% of carrier cycles were transferred a single embryo and 50% were transferred more than one embryo. The clinical pregnancy rate (CPR) was 39% for SET and 53% for multiple ET, which was not significantly different with RR = 0.83 (95% CI: 0.67-1.03). The live delivery rate was 33% for SET and 57% for multiple ET which was not significantly different with RR = 0.78 (95% CI: 0.61-1.00). The multiple delivery rate per carrier was greater risks in the multiple ET carrier cycles (RR =0.4, 95% CI: 0.01-0.26). There were 104 sets of twins (including one set of twins selectively reduced from triplets to twins) and 1 set of triples in the multiple ET carrier cycle. In the SET carrier cycles, there were 2 sets of twins. Significance of the study: SET should be advocated among surrogate carriers to prevent multiple pregnancies and subsequent adverse outcomes for both carrier and baby. Surrogacy practice should be reviewed and surrogate carriers should be fully informed of the risk of adverse maternal and birth outcome of multiple pregnancies due to multiple embryo transfers.

Keywords: assisted reproduction, birth outcomes, carrier, gestational surrogacy, multiple embryo transfer, multiple pregnancy, pregnancy outcomes, single embryo transfer, surrogate mother, systematic review

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6288 Plackett-Burman Design for Microencapsulation of Blueberry Bioactive Compounds

Authors: Feyza Tatar, Alime Cengiz, Dilara Sandikçi, Muhammed Dervisoglu, Talip Kahyaoglu

Abstract:

Blueberries are known for their bioactive properties such as high anthocyanin contents, antioxidant activities and potential health benefits. However, anthocyanins are sensitive to environmental conditions during processes. The objective of this study was to evaluate the effects of spray drying conditions on the blueberry microcapsules by Plackett-Burman experimental design. Inlet air temperature (120 and 180°C), feed pump rate (20% and 40%), DE of maltodextrin (6 and 15 DE), coating concentration (10% and 30%) and source of blueberry (Duke and Darrow) were independent variables, tested at high (+1) and low (-1) levels. Encapsulation efficiency (based on total phenol) of blueberry microcapsules was the dependent variable. In addition, anthocyanin content, antioxidant activity, water solubility, water activity and bulk density were measured for blueberry powders. The antioxidant activity of blueberry powders ranged from 72 to 265 mmol Trolox/g and anthocyanin content was changed from 528 to 5500 mg GAE/100g. Encapsulation efficiency was significantly affected (p<0.05) by inlet air temperature and coating concentration. Encapsulation efficiency increased with increasing inlet air temperature and decreasing coating concentration. The highest encapsulation efficiency could be produced by spray drying at 180°C inlet air temperature, 40% pump rate, 6 DE of maltodextrin, 13% maltodextrin concentration and source of duke blueberry.

Keywords: blueberry, microencapsulation, Plackett-Burman design, spray drying

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6287 Assessment of the Role of Plasmid in Multidrug Resistance in Extended Spectrum βEtalactamase Producing Escherichia Coli Stool Isolates from Diarrhoeal Patients in Kano Metropolis Nigeria

Authors: Abdullahi Musa, Yakubu Kukure Enebe Ibrahim, Adeshina Gujumbola

Abstract:

The emergence of multidrug resistance in clinical Escherichia coli has been associated with plasmid-mediated genes. DNA transfer among bacteria is critical to the dissemination of resistance. Plasmids have proved to be the ideal vehicles for dissemination of resistance genes. Plasmids coding for antibiotic resistance were long being recognized by many researchers globally. The study aimed at determining the antibiotic susceptibility pattern of ESBL E. coli isolates claimed to be multidrug resistance using disc diffusion method. Antibacterial activity of the test isolates was carried out using disk diffusion methods. The results showed that, majority of the multidrug resistance among clinical isolates of ESBL E. coli was as a result of acquisition of plasmid carrying antibiotic-resistance genes. Production of these ESBL enzymes by these organisms which are normally carried by plasmid and transfer from one bacterium to another has greatly contributed to the rapid spread of antibiotic resistance amongst E. coli isolates, which lead to high economic burden, increase morbidity and mortality rate, complication in therapy and limit treatment options. To curtail these problems, it is of significance to checkmate the rate at which over the counter drugs are sold and antibiotic misused in animal feeds. This will play a very important role in minimizing the spread of resistance bacterial strains in our environment.

Keywords: Escherichia coli, plasmid, multidrug resistance, ESBL, pan drug resistance

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6286 Correlation Between the Toxicity Grade of the Adverse Effects in the Course of the Immunotherapy of Lung Cancer and Efficiency of the Treatment in Anti-PD-L1 and Anti-PD-1 Drugs - Own Clinical Experience

Authors: Anna Rudzińska, Katarzyna Szklener, Pola Juchaniuk, Anna Rodzajweska, Katarzyna Machulska-Ciuraj, Monika Rychlik- Grabowska, Michał łOziński, Agnieszka Kolak-Bruks, SłAwomir Mańdziuk

Abstract:

Introduction: Immune checkpoint inhibition (ICI) belongs to the modern forms of anti-cancer treatment. Due to the constant development and continuous research in the field of ICI, many aspects of the treatment are yet to be discovered. One of the less researched aspects of ICI treatment is the influence of the adverse effects on the treatment success rate. It is suspected that adverse events in the course of the ICI treatment indicate a better response rate and correlate with longer progression-free- survival. Methodology: The research was conducted with the usage of the documentation of the Department of Clinical Oncology and Chemotherapy. Data of the patients with a lung cancer diagnosis who were treated between 2019-2022 and received ICI treatment were analyzed. Results: Out of over 133 patients whose data was analyzed, the vast majority were diagnosed with non-small cell lung cancer. The majority of the patients did not experience adverse effects. Most adverse effects reported were classified as grade 1 or grade 2 according to CTCAE classification. Most adverse effects involved skin, thyroid and liver toxicity. Statistical significance was found for the adverse effect incidence and overall survival (OS) and progression-free survival (PFS) (p=0,0263) and for the time of toxicity onset and OS and PFS (p<0,001). The number of toxicity sites was statistically significant for prolonged PFS (p=0.0315). The highest OS was noted in the group presenting grade 1 and grade 2 adverse effects. Conclusions: Obtained results confirm the existence of the prolonged OS and PFS in the adverse-effects-charged patients, mostly in the group presenting mild to intermediate (Grade 1 and Grade 2) adverse effects and late toxicity onset. Simultaneously our results suggest a correlation between treatment response rate and the toxicity grade of the adverse effects and the time of the toxicity onset. Similar results were obtained in several similar research conducted - with the proven tendency of better survival in mild and moderate toxicity; meanwhile, other studies in the area suggested an advantage in patients with any toxicity regardless of the grade. The contradictory results strongly suggest the need for further research on this topic, with a focus on additional factors influencing the course of the treatment.

Keywords: adverse effects, immunotherapy, lung cancer, PD-1/PD-L1 inhibitors

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