4th Symposium Research Articles

A RETROSPECTIVE STUDY OF RED CELL DISTRIBUTION WIDTH AND RIGHT VENTRICULAR SYSTOLIC PRESSURE IN PULMONARY HYPERTENSION

SESSION TITLE: Pulmonary Vascular Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Red Cell Distribution Width (RDW), a measure that reflects the non-homogeneity in sizes of red cells, is a cheap and readily available parameter that has been correlated to various cardiac hemodynamic variables. The 6th World Symposium on Pulmonary Hypertension (PH) recently redefined PH to include all patients with a mean pulmonary artery pressure (mPAP) of greater than 20 mm Hg. Right Ventricular Systolic Pressure (RVSP) on transthoracic echocardiography is usually the first measured parameter when evaluating a patient for PH. We aimed to study the correlation between RDW and RVSP, so as to assess the potential role of RDW as a risk-stratifying aid for PH. METHODS: Patients who underwent right heart catheterization (RHC) at our center between November 2014 and November 2019 were included in this retrospective study. Exclusion criteria included patients under the age of 18, active malignancy, known hemoglobinopathy, blood transfusion within one month of laboratory testing, and lack of RDW measurement within 3 months of the RHC. Hemodynamic parameters obtained on RHC, as were hemoglobin and RDW values from the closest CBC obtained within 3 months of the RHC. Student’s t-test was used to compare RDW between patients with elevated RDW (> 14.5%) and normal RDW (≤ 14.5%). RDW was also compared between various cutoffs of RVSP. RESULTS: 342 patients were included in this study. A significantly higher RVSP was noted in the group with elevated RDW (> 14.5%, n = 130), as opposed to the group with normal RDW (≤ 14.5%, n = 212) (50.57 vs 41.39 mm Hg, p < 0.0001). Mean RDW was compared between high RVSP and non-elevated RSVP groups. When an RVSP > 35 mm Hg was used as the cutoff, there was a significant difference in RDW between the elevated (n = 233) and the normal (n = 109) groups (14.79 vs 13.82%, p < 0.0001). This held true when the cutoff was changed to an RSVP > 20 mm Hg; the elevated RSVP group (n = 336) tended to have a higher RVSP than the normal RVSP group (n = 6) (14.51 vs 12.9%, p = 0.0001). CONCLUSIONS: This study indicates a correlation between RDW and RVSP. This correlation may be a consequence of the association between RDW and mean pulmonary artery pressure (mPAP) in the setting of PH, which has been demonstrated in other previous studies. While the mechanism for this association is unknown, it is hypothesized to be a consequence of the nature of RDW to correlate to the level of inflammatory cytokines; PH is a disease with a significant inflammatory component. Alternatively, RDW may be tied to the level of subclinical hypoxia or hemolysis associated with microvascular disruption in PH. CLINICAL IMPLICATIONS: The measurement of RVSP is usually the first step in the evaluation of a patient with suspected PH. RDW, being a conveniently measured parameter on complete blood counts, appears to correlate with RVSP, and may have a role in pre-test risk stratification for PH. DISCLOSURES: No relevant relationships by Syed Haider, source=Admin input No relevant relationships by Pius Ochieng, source=Web Response No relevant relationships by Divya Ravi, source=Web Response No relevant relationships by NISHANT SHARMA, source=Web Response No relevant relationships by Metlapalli Venkata Sravanthi, source=Web Response No relevant relationships by Pandi Todhe, source=Web Response

RED CELL DISTRIBUTION WIDTH CORRELATES WITH NT-PROBNP IN PULMONARY HYPERTENSION

SESSION TITLE: Pulmonary Vascular Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: N-terminal pro-brain-type natriuretic peptide (NT-proBNP) is an established biomarker for pulmonary hypertension (PH), as an indicator of disease severity, and a predictor of mortality and morbidity. Red Cell Distribution Width (RDW), the measure of anisocytosis amongst red cells, is increasingly being realized to be a biomarker for various conditions. The purpose of this study was to assess the correlation between RDW and NT-proBNP in the setting of the new definition of PH as per the 6th World Symposium, which includes all patients with a mean pulmonary artery pressure (mPAP) of over 20 mm Hg. METHODS: Patients who underwent right heart catheterization (RHC) at our hospital system between November 2014 and November 2019 were included in this retrospective study. Exclusion criteria included patients under the age of 18, active malignancy, known hemoglobinopathy, blood transfusion within one month of laboratory testing, and a lack of RDW or NT-proBNP measured within 3 months of RHC. Hemodynamic parameters obtained on RHC were documented. The closest RDW and NT-proBNP values obtained within 3 months of the RHC were noted. Student’s t-test was used to compare NT-proBNP between patients with elevated RDW (> 14.5%) and normal RDW (≤ 14.5%). Secondly, mean RDW was compared between elevated BNP (≥ 300 pg/mL) and normal BNP (< 300 pg/mL). RESULTS: 231 patients were included in this study. 176 of them had RHC-proven PH. Amongst PH patients, there was a statistically significant significant difference in the mean NT-proBNP between the elevated RDW (> 14.5%, n = 90) and the non-elevated RDW (≤ 14.5%, n = 86) groups (7401.57 vs 3663.83 pg/mL, p = 0.0076). Patients with elevated NT-proBNP (≥ 300 pg/mL, n = 142) tended to have a higher RDW than those with normal BNP (< 300 pg/mL, n = 34) (15.03 vs 14.36%, p = 0.0264). These relationships held true when generalized to include patients without PH. The elevated RDW group (n = 100) had a significantly higher NT-proBNP than the normal RDW group (n = 131) (6866.19 vs 3136.6 pg/mL, p = 0.002). The elevated NT-proBNP group (n = 172) also had a higher RDW than the normal NT-proBNP group (n = 69) (14.84 vs 13.96%, p = 0.0003). CONCLUSIONS: NT-proBNP has previously been shown to be a valid biomarker for assessing disease severity, and to predict mortality and morbidity in patients with PH. The correlation between RDW and NT-proBNP in the setting of PH implies that RDW may also be a useful surrogate marker for disease severity in PH. CLINICAL IMPLICATIONS: RDW is a relatively cheap marker that could be used alongside other biomarkers such as NT-proBNP to measure the severity of disease in PH. Further studies are required to directly validate this relationship. DISCLOSURES: No relevant relationships by Syed Haider, source=Admin input No relevant relationships by Pius Ochieng, source=Web Response No relevant relationships by Divya Ravi, source=Web Response No relevant relationships by NISHANT SHARMA, source=Web Response No relevant relationships by Metlapalli Venkata Sravanthi, source=Web Response No relevant relationships by Pandi Todhe, source=Web Response

CORRELATION BETWEEN PULMONARY VASCULAR RESISTANCE AND RED CELL DISTRIBUTION WIDTH IN PULMONARY HYPERTENSION

SESSION TITLE: Pulmonary Vascular Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Red Cell Distribution Width (RDW) is a mathematically derived value, used to evaluate the size variation of red cells. It can be elevated in situations of recent blood loss or transfusion, renal dysfunction, etc. A literature review shows that RDW has been correlated with various cardiac hemodynamic parameters in the setting of pulmonary hypertension (PH). The 6th World Symposium on Pulmonary Hypertension (PH) recently defined pre-capillary PH to include PH patients with a pulmonary vascular resistance (PVR) of over 3 Woods Units (WU). The purpose of this study was to determine the presence of a correlation between RDW and PVR. METHODS: Patients who underwent right heart catheterization (RHC) at our center between November 2014 and November 2019 were included in this retrospective study. Exclusion criteria included patients under the age of 18, active malignancy, known hemoglobinopathy, blood transfusion within one month of laboratory testing, and patients without an RDW measured within 3 months of RHC. Hemodynamic parameters obtained on RHC were documented, along with RDW values from the closest CBC obtained within 3 months of the RHC. Student’s t-test was used to compare PVR between patients with elevated RDW (> 14.5%) and normal RDW (= 14.5%). Additionally, RDW was compared between patients with elevated PVR (> 3 WU) and those without. RESULTS: 306 patients were included in this study. The elevated RDW group (> 14.5%, n = 117) tended to have a higher PVR than normal RDW group (= 14.5%, n = 189), and this was found to be statistically significant (3.02 vs 2.43 WU, p = 0.495). On the other hand, patients with an elevated PVR (= 3 WU, n = 71) were also found to higher RDW than the non-elevated PVR (< 3 WU, n = 235) group, in a statistically significant fashion (15.05 vs 14.31%, p = 0.0369). CONCLUSIONS: This study implies that a statistically significant correlation exists between PVR and RDW. The elevation of RDW in the setting of an elevated PVR could be due to the fact that RDW is tied to the severity of inflammatory state. PH likely has an inflammatory component; there have been studies demonstrating increased expression of C-reactive protein receptor lectin-like oxidized low-density lipoprotein receptor-1 the pulmonary vasculature cells of patients with CTEPH. Furthermore, endothelial dysfunction, inflammation, and smooth muscle proliferation is causative of elevations in PVR. CLINICAL IMPLICATIONS: Given the importance of PVR in the classification of PH, a cheap biomarker to predict the PVR in patients with PH would be of utility. RDW could serve useful in this setting, however, larger studies are needed to validate this association. DISCLOSURES: No relevant relationships by Syed Haider, source=Admin input No relevant relationships by Pius Ochieng, source=Web Response No relevant relationships by Divya Ravi, source=Web Response No relevant relationships by NISHANT SHARMA, source=Web Response No relevant relationships by Metlapalli Venkata Sravanthi, source=Web Response No relevant relationships by Pandi Todhe, source=Web Response

The Critical Role of Pulmonary Artery Wedge Pressure Saturation In The Standardization of Pulmonary Artery Wedge Pressure Measurement

Introduction Inadequate balloon occlusion while measuring pulmonary artery wedge pressure (PAWP) during right heart catheterization (RHC) may lead to inaccurate measures and clinically relevant misdiagnosis of disease. Following the 6th World Symposium on Pulmonary Hypertension (PH) recommendations, we instituted a standard of care clinical protocol at the Medical University of South Carolina that required obtaining a PAWP saturation (sat) to confirm complete occlusion whenever initially measured PAWP is >15 mmHg. We sought to determine: 1) The difference between initial and lowest reported PAWP 2) The frequency in which this practice leads to a change in PH classification 3) The overall success rate in obtaining a PAWP sat. Methods After IRB approval, investigators not performing the RHC procedure prospectively collected demographic, echocardiographic and hemodynamic data. Subjects undergoing routine post-transplant RHC were excluded. After the initial PAWP measurement (as determined by the RHC operator), a PAWP sat was drawn to confirm occlusion (defined as >90% or within 5% of the systemic arterial oxygen saturation). If the PAWP sat did not confirm occlusion, the balloon was deflated and up to two additional attempts were made to re-measure the PAWP and confirm with a PAWP sat. PAWP were recorded at the same point in the respiratory cycle with each attempt. Repeated measures were compared using Signed Rank Test. Results We enrolled 75 subjects (age 58.3 +/- 13.3 years, 60% men, 59% with LVEF 15 mmHg. Despite apparent confirmation of PAWP position by fluoroscopy and/or typical hemodynamic waveforms, an occlusive PAWP sat was unable to be confirmed in 39 (52%) of subjects during the first attempt. In these subjects, the mean difference between initial and lowest PAWP was -4.1 +/- 7.7 mmHg (p 5 mmHg. Three of the 4 subjects referred for PH with preserved EF were ultimately reclassified as having pre-capillary PH. Eight of the 16 referred for advanced heart failure evaluation were re-classified as combined post- and pre-capillary PH with PVR > 3 WU, which then required vasodilator testing. With additional attempts, a PAWP sat was confirmed in 83% of subjects. There were no observed complications during additional PAWP attempts. Conclusion The practice of requiring a PAWP sat resulted in significantly lower PAWP, higher PVR and clinically relevant disease reclassification. A PAWP sat is a simple and safe technique to verify an elevated PAWP during RHC.

Large Granular Lymphocyte Leukemia and Precapillary Pulmonary Hypertension

Large Granular Lymphocyte Leukemia and Precapillary Pulmonary Hypertension

Mitigating Curtailment and Carbon Emissions through Load Migration between Data Centers

Summary As the share of variable renewable energy (VRE) grows in the electric grid, so does the risk of curtailment. While energy storage and hydrogen production have been proposed as solutions to the curtailment problem, they often pose technological and economic challenges. Here, we analyze the potential of data center load migration for mitigating curtailment and greenhouse gas (GHG) emissions. Using historical hourly electricity generation, curtailment, and typical data center server utilization data, we simulate the effect of migrating data center workloads from the fossil-fuel-heavy PJM to the renewable-heavy CAISO. The results show that load migration within the existing data center capacity during the curtailment hours in CAISO has the potential to reduce 113–239 KtCO2e per year of GHG emissions and absorb up to 62% of the total curtailment with negative abatement costs in 2019. Our study demonstrates the overlooked role that data centers can play for VRE integration and GHG emissions mitigation.

Evaluation and management of pulmonary arterial hypertension

Pulmonary arterial hypertension is a devastating progressive disease mediated by different pathophysiologic pathways that result in progressive increase in pulmonary vascular resistance along with right ventricular failure and eventually premature death. Despite significant advances in the understanding of the underlying mechanisms and development of a number of targeted therapies, pulmonary arterial hypertension remains a challenging condition with high morbidity and mortality. New therapies are being actively sought, and early recognition remains of paramount importance. In an effort to improve the detection and management of pulmonary hypertension, the 6th World Symposium on Pulmonary Hypertension came up with most recent statements in 2018. The goal of this review is to summarize some key updates from the proceedings of the Symposium pertaining to different aspects of evaluation and management of patients with pulmonary arterial hypertension.

Pulmonary Hypertension Roundtable: Drug Development and Negative Clinical Trial Results

Pulmonary Hypertension Roundtable: Drug Development and Negative Clinical Trial Results

Editorial DISCRETE proceedings

Eberhard Widmann Stefan-Meyer-Institute for Subatomic Physics (SMI), Austrian Academy of Science, Boltzmanngasse 27, 1090, Vienna, AustriaE-mail: e.widmann@oeaw.ac.atThis volume contains the proceedings of the 6th Symposium on Prospects in the Physics of Discrete Symmetries, DISCRETE 2018. The symposium was held in Vienna from 26th to the 30th of November 2018, organized by the Stefan Meyer Institute for subatomic Physics of the Austrian Academy of Sciences. The topics of the DISCRETE conference series evolved from the previous meetings in Valencia (2008), Rome (2010), Lisbon (2012), London (2014) and Warsaw (2016), and covered in 2018

Current Aspects of Definition and Diagnosis of Pulmonary Hypertension

At the 6th World Symposium on Pulmonary Hypertension (WSPH), which took place from February 27 until March 1, 2018 in Nice, scientific progress over the past 5 years in the field of pulmonary hypertension (PH) was presented by 13 working groups. The results of the discussion were published as proceedings towards the end of 2018. One of the major changes suggested by the WSPH was the lowering of the diagnostic threshold for PH from ≥ 25 to > 20 mmHg mean pulmonary arterial pressure, measured by right heart catheterization at rest. In addition, the pulmonary vascular resistance was introduced into the definition of PH, which underlines the importance of cardiac output determination at the diagnostic right heart catheterization.In this article, we discuss the rationale and possible consequences of a changed PH definition in the context of the current literature. Further, we provide a current overview on non-invasive and invasive methods for diagnosis, differential diagnosis, and prognosis of PH, including exercise tests.

How low should we go? Potential benefits and ramifications of the pulmonary hypertension hemodynamic definitions proposed by the 6th World Symposium.

The 6th World Symposium on Pulmonary Hypertension (WSPH) proposed lowering the mean pulmonary artery pressure (mPAP) threshold that defines pulmonary hypertension from ≥ 25 to > 20 mmHg. The historical context and evolution of the pulmonary hypertension definition and the data used to rationalize recent changes are reviewed here. There are accumulating data on the clinical significance of mildly elevated mPAPs (21-24 mmHg). Studies have demonstrated lower exercise capacity and an increased risk of progression to overt pulmonary hypertension (mPAP ≥ 25 mmHg) in specific at-risk patient populations. Further, large registries across diverse pulmonary hypertension populations have identified increased mortality in patients with mPAPs 21-24 mmHg. Although the clinical sequelae of lowering the mPAP threshold remain unclear, this uncertainty has fueled recent debates within the pulmonary hypertension community. The changes to the pulmonary hypertension definition proposed by the 6th WSPH are supported by normative hemodynamic data in healthy individuals as well as studies demonstrating an association between mPAPs above this normal range and increased mortality. Whether the higher mortality observed in patients with mildly elevated mPAPs is directly attributable to pulmonary vascular disease that is amenable to therapeutic intervention remains to be determined.

Current Aspects of Definition and Diagnosis of Pulmonary Hypertension

At the 6th World Symposium on Pulmonary Hypertension (WSPH), which took place from February 27 until March 1, 2018 in Nice, scientific progress over the past 5 years in the field of pulmonary hypertension (PH) was presented by 13 working groups. The results of the discussion were published as proceedings towards the end of 2018. One of the major changes suggested by the WSPH was the lowering of the diagnostic threshold for PH from ≥ 25 to > 20 mmHg mean pulmonary arterial pressure, measured by right heart catheterization at rest. In addition, the pulmonary vascular resistance was introduced into the definition of PH, which underlines the importance of cardiac output determination at the diagnostic right heart catheterization.In this article, we discuss the rationale and possible consequences of a changed PH definition in the context of the current literature. Further, we provide a current overview on non-invasive and invasive methods for diagnosis, differential diagnosis, and prognosis of PH, including exercise tests.

Anyone can do it: Noise, punk and the ethics/politics of transgression

Anyone can do it: Noise, punk and the ethics/politics of transgression

Risk stratification and prognostic factors in patients with pulmonary arterial hypertension and comorbidities a cross-sectional cohort study with survival follow-up

BackgroundThe objective of this study was to analyze prognostic factors and risk stratification in patients with pulmonary arterial hypertension (PAH) and comorbidities.MethodsPatients with invasively diagnosed PAH were included in the analysis. Comorbidities were clinically diagnosed as proposed in the 6th World Symposium of pulmonary hypertension. Uni- and multivariate analysis were employed for identification of factors predicting survival and time to first clinical worsening (TTCW). Risk stratification was based on parameters from ESC/ERS-guidelines 2015.ResultsIn total 142 patients were enrolled in the study, 90 of them were diagnosed as PAH without and 52 with comorbidities. All patients received targeted PAH therapy and were followed for 3.3 ± 2.4 years. In PAH patients without comorbidities survival and TTCW were significantly associated with reduced 6-min walking distance (6MWD), elevated N-terminal pro brain natriuretic peptide (NT-proBNP), WHO-functional class (WHO-FC) and right atrial (RA) area. In the multivariate analysis, 6MWD was an independent predictor for survival (p = 0.002) and WHO-FC for TTCW (p = 0.001). In patients with PAH and comorbidities these parameters had no significant association with survival and TTCW. Average risk score was significantly associated with survival (p = 0.001) and TTCW (p = 0.013) in PAH but not in PAH with comorbidities (both p > 0.05; figure 1).ConclusionRisk stratification based on ESC/ERS-guidelines could only be confirmed in patients without comorbidities, but not in patients with PAH and comorbidities. The data of this study suggest, that a different risk stratification needs to be applied to PAH patients with comorbidities. Further studies are needed to confirm these results.Trial registrationNot applicable, retrospective registry.

Клінічний випадок легеневої гіпертензії, асоційованої з рідкісною хворобою легень

У статті проаналізовано клінічний випадок легеневої гіпертензії (ЛГ), асоційованої з рідкісним захворюванням легень – лімфангіолейоміоматозом. Висвітлюються питання: критерії діагностики цього захворювання, поширеність, основні шляхи патогенезу, зокрема механізми розвитку ЛГ, клінічні вияви, методи лікування. Зроблено висновки щодо особливостей цього випадку, а саме: це рідкісне захворювання легень, яке можливо діагностувати лише за наявності досвіду; захворювання діагностовано у відносно пізньому віці, що є нетиповим (як правило, більшість жінок з таким діагнозом – дітородного віку); за помірних змін функції легень спостерігалася значна ЛГ, яка потребувала додаткового обстеження в спеціалізованому центрі; незважаючи на діагностоване ураження легень та загальні рекомендації не призначати специфічну терапію при цій формі ЛГ, як виняток, простагландини були застосовані, що поліпшувало клінічний стан пацієнтки. Спираючись на останні рекомендації 6-го Всесвітнього симпозіуму із легеневої гіпертензії (Ніцца, 2018), розглядаються особливості діагностики та лікування ЛГ, пов’язані з гіпоксією і хворобами легень (група 3), та їх відмінності від легеневої артеріальної гіпертензії (група 1). Особливий наголос робиться на необхідності індивідуального підходу до призначення специфічної терапії ЛГ пацієнтам із захворюванням легень і підвищенням тиску в легеневій артерії та проведення клінічних досліджень із вивчення її впливу на перебіг захворювання.

Abstracts from the 4th Annual Symposium on Musculoskeletal and Neuromuscular Diseases (2019)

Abstracts from the 4th Annual Symposium on Musculoskeletal and Neuromuscular Diseases (2019)

Diagnostic accuracy of CT pulmonary angiography in suspected pulmonary hypertension

ObjectivesComputed tomography (CT) pulmonary angiography is widely used in patients with suspected pulmonary hypertension (PH). However, the diagnostic and prognostic significance remains unclear. The aim of this study was to (a) build a diagnostic CT model and (b) test its prognostic significance.MethodsConsecutive patients with suspected PH undergoing routine CT pulmonary angiography and right heart catheterisation (RHC) were identified. Axial and reconstructed images were used to derive CT metrics. Multivariate regression analysis was performed in the derivation cohort to identify a diagnostic CT model to predict mPAP ≥ 25 mmHg (the existing ESC guideline definition of PH) and > 20 mmHg (the new threshold proposed at the 6th World Symposium on PH). In the validation cohort, sensitivity, specificity and compromise CT thresholds were identified with receiver operating characteristic (ROC) analysis. The prognostic value of the CT model was assessed using Kaplan-Meier analysis.ResultsBetween 2012 and 2016, 491 patients were identified. In the derivation cohort (n = 247), a CT model was identified including pulmonary artery diameter, right ventricular outflow tract thickness, septal angle and left ventricular area. In the validation cohort (n = 244), the model was diagnostic, with an area under the ROC curve of 0.94/0.91 for mPAP ≥ 25/> 20 mmHg respectively. In the validation cohort, 93 patients died; mean follow-up was 42 months. The diagnostic thresholds for the CT model were prognostic, log rank, all p < 0.01.DiscussionIn suspected PH, a diagnostic CT model had diagnostic and prognostic utility.Key Points• Diagnostic CT models have high diagnostic accuracy in a tertiary referral population of with suspected PH.• Diagnostic CT models stratify patients by mortality in suspected PH.

「物理学者の社会的責任」第11回シンポジウム : SDIと物理学者

「物理学者の社会的責任」第11回シンポジウム : SDIと物理学者

The 11th Australian Rural and Remote Mental Health Symposium Communiqué.

The 11th Australian Rural and Remote Mental Health Symposium Communiqué.

Preface

The 10th Asian-Pacific Conference on Aerospace Technology and Science (APCATS’2019) & The 4th Asian Joint Symposium on Aerospace Engineering (AJSAE’2019) were held jointly during August 28-31, 2019. APCATS being an important technical event in the Asia-Pacific area is convened every two years while AJSAE every year. Both APCATS and AJSAE are important events, which have been devoted to the research and development in all aspects of aerospace technologies and science, in the community of aerospace and aeronautical engineering. These two conferences when jointly held together can become a platform for the delegates from different countries to meet and gain fruitful results.In the joint conference of APCATS’2019 & AJSAE’2019, over 200 experts and researchers in the fields related to aerospace technologies and science attended the conference to share their innovative ideas, discuss the state-of-art methods, exchange their experiences, and establish beneficial collaborations. Delegates from Taiwan, Hong Kong, China, Japan, Korea, Australia, Indonesia, and Philippines enjoyed the good time they had in the conference. There were 102 papers presented orally in the conference and among them 30 papers were selected for publication after peer review. The papers collected for publication are of high quality and related to different areas of aerospace and aeronautical engineering. The conference ended successfully and all the delegates looked forward to attending the next meeting in India in 2021.The success of the joint conference has relied on many people’s efforts and contributions. Many thanks are extended to the colleagues and students of the Mechanical Engineering Department, National Chiao Tung University, for their assistance in organizing the conference. The guidance of the Honorary Co-chairs and Regional Representatives are gratefully appreciated. The reviewers have helped not only review the papers but also provide valuable comments to improve the quality of the papers. Their efforts and assistance are prominent in making the conference a success. Last, but not the least, many thanks to those who have helped chair the sessions, construct the conference website or make arrangements for the conference. The success of the conference is a natural outcome of their contributions and assistance.