Box-whisker Plots Research Articles

Comparison of two techniques of administering the Valsalva manoeuvre in patients under general anaesthesia: A randomised controlled study.

Surgeons often request a Valsalva manoeuvre (VM) at the end of surgery (head-neck surgery, craniotomy) to check haemostasis and to unmask covert venous bleeders. We aimed to compare an anaesthesia machine-generated objective technique for delivering VM under pressure-control (PC) mode with the traditional subjective technique of delivering VM in manual mode. This randomised controlled study included 60 adult patients randomised to manual (Group M) and controlled ventilation (Group C) groups. Our primary outcome measure was internal jugular vein (IJV) diameter at pre-determined time points (T0 = baseline, T1 = VM initiation, T2 = 20 s after VM initiation, T3 = immediately after VM release, and T4 = 1 min, T5 = 2 min and T6 = 5 min post-VM release). Secondary outcome measures included mean arterial pressure (MAP), heart rate, time to desired plateau airway pressure, number of patients with bleeders unmasked and surgeon satisfaction. Independent/paired sample t-tests were applied. Results are expressed as mean (standard deviation), mean difference (95% confidence interval), dotted box-whisker plots and trendlines. P <0.05 is considered statistically significant. Mean differences in diameter changes in IJV (in centimetres) in the mediolateral and anteroposterior directions between Group C and Group M were -0.136 (-0.227, -0.044) and -0.073 (-0.143, -0.002), respectively. VM in the PC mode produced more significant IJV dilatation (P = 0.004, P = 0.044). MAP at T0 and T1 was comparable. At T2 and T3, there was a more significant fall in MAP in Group C versus Group M (P = 0.018 and P = 0.021, respectively). At T4, T5 and T6, MAP was comparable. Performing VM in PC mode is a better technique based on IJV diameter, haemodynamics, bleeder unmasking and surgeon satisfaction.

Assessing current and future available resources to supply urban water demands using a high-resolution SWAT model coupled with recurrent neural networks and validated through the SIMPA model in karstic Mediterranean environments

Hydrological simulation in karstic areas is a hard task due to the intrinsic intricacy of these environments and the common lack of data related to their geometry. Hydrological dynamics of karstic sites in Mediterranean semiarid regions are difficult to be modelled mathematically owing to the existence of short wet episodes and long dry periods. In this paper, the suitability of an open-source SWAT method was checked to estimate the comportment of a karstic catchment in a Mediterranean semiarid domain (southeast of Spain), which wet and dry periods were evaluated using box-whisker plots and self-developed wavelet test. A novel expression of the Nash–Sutcliffe index for arid areas (ANSE) was considered through the calibration and validation of SWAT. Both steps were completed with 20- and 10-year discharge records of stream (1996–2015 to calibrate the model as this period depicts minimum gaps and 1985–1995 to validate it). Further, SWAT assessments were made with records of groundwater discharge and relating SWAT outputs with the SIMPA method, the Spain’s national hydrological tool. These methods, along with recurrent neural network algorithms, were utilised to examine current and predicted water resources available to supply urban demands considering also groundwater abstractions from aquifers and the related exploitation index. According to the results, SWAT achieved a “very good” statistical performance (with ANSE of 0.96 and 0.78 in calibration and validation). Spatial distributions of the main hydrological processes, as surface runoff, evapotranspiration and aquifer recharge, were studied with SWAT and SIMPA obtaining similar results over the period with registers (1980–2016). During this period, the decreasing trend of rainfalls, characterised by short wet periods and long dry periods, has generated a progressive reduction of groundwater recharge. According to algorithms prediction (until 2050), this declining trend will continue reducing groundwater available to meet urban demands and increasing the exploitation index of aquifers. These results offer valuable information to authorities for assessing water accessibility and to provide water demands in karstic areas.

Diagnostic Accuracy in Detecting Fungal Infection with Ultra-Low-Dose Computed Tomography (ULD-CT) Using Filtered Back Projection (FBP) Technique in Immunocompromised Patients.

Purpose: To compare the accuracy of ultra-low-dose (uLDCT) to standard-of-care low-dose chest CT (LDCT) in the detection of fungal infection in immunocompromised (IC) patients. Method and Materials: One hundred IC patients had paired chest CT scans performed with LDCT followed by uLDCT. The images were independently reviewed by three chest radiologists who assessed the image quality (IQ), diagnostic confidence, and detection of major (macro nodules, halo sign, cavitation, consolidation) and minor (4-10 mm nodules, ground-glass opacity) criteria for fungal disease using a five-point Likert score. Discrepant findings were adjudicated by a fourth chest radiologist. Box-whisker plots were used to analyze IQ and diagnostic confidence. Inter-rater reliability was assessed using interclass correlation coefficients (ICCs). The statistical difference between LDCT and uLDCT results was assessed using Wilcoxon paired test. Results: Lung reconstructions had IQ and diagnostic confidence scores (mean ± std) of 4.52 ± 0.47 and 4.63 ± 0.51 for LDCT and 3.85 ± 0.77 and 4.01 ± 0.88 for uLDCT. The images were clinically acceptable except for uLDCT in obese patients (BMI ≥ 30 kg/m2), which had an IQ ranking from poor to excellent (scores 1 to 5). The accuracy in detecting major and minor radiological findings with uLDCT was 96% and 84% for all the patients. The inter-rater agreements were either moderate, good, or excellent, with ICC values of 0.51-0.96. There was no significant statistical difference between the uLDCT and LDCT ICC values (p = 0.25). The effective dose for uLDCT was one quarter that of LDCT (CTDIvol = 0.9 mGy vs. 3.7 mGy). Conclusions: Thoracic uLDCT, at a 75% dose reduction, can replace LDCT for the detection of fungal disease in IC patients with BMI < 30.0 kg/m2.

TRACE METAL ANALYSIS IN GROUNDWATER OF THE HANDRI RIVER BASIN, KURNOOL DISTRICT, ANDHRA PRADESH, INDIA

Quantitative analysis of trace metals in the groundwater of the Handri river basin was conducted using Inductively Coupled Plasma Optical Emission Spectroscopy (ICP-OES). Descriptive statistics, box whisker plots, and GIS assessed their spatial distribution in South India. The elements arsenic, cadmium, and iron were the most abundant, with iron having the highest concentration and copper the lowest. Chromium, copper, nickel, and zinc complied with BIS and WHO standards for drinking water. In certain locations of the Handri river basin, elevated concentrations of arsenic, cadmium, iron, lead, and manganese were found to be polluting and endangering the water. A comprehensive analysis revealed that, out of 41 water quality sites, copper, chromium, nickel, and zinc were within acceptable limits, while arsenic and cadmium exceeded the limits. Twenty groundwater sites showed elevated iron content, revealed by a spatial distribution map. Excessive manganese and lead levels were observed in specific stations, such as Gorantla, Bondi Madugula, Ramachandrapuram, Konganapadu, and Tangaradona. The study suggests that population growth and industrialization contribute to resource depletion and environmental deterioration. The cohesive findings from descriptive models, box whisker plots, and spatial analyses aim to guide decision-makers in developing adaptive groundwater trace element monitoring strategies for the Handri basin in Kurnool district, India.

Comparison of Ketamine-Dexmedetomidine Combination with Fentanyl-Dexmedetomidine Combination for Procedural Sedoanalgesia during CT-Guided Interventional Radiology Procedures: A Randomized Controlled Study

Background: The quest for an ideal sedoanalgesic-combination exhibiting the triad of efficacy, safety and patient comfort has led to administration of several permutations and combinations of drugs (midazolam, fentanyl, remifentanil, dexmedetomidine, propofol, ketamine, pethidine, pentazocine). The ideal sedoanalgesic for CT-guided core-biopsy of spine, radiofrequency/microwave ablation of hepatic/pulmonary lesions, has hitherto been elusive. In the absence of any guidelines, we compared a ketamine-dexmedetomidine combination (Group-K) with fentanyl-dexmedetomidine (Group-F).&#x0D; Methods: This prospective, interventional, single-centric, parallel-armed, randomized controlled study included 60 patients (ASA physical state I-II, either gender, aged 18-75y, weighing 35-85kg), undergoing CT-guided core biopsy/radiofrequency/microwave ablation in remote location, allocated to Group-K and Group-F. Independent/paired-sample t-tests were utilized and data expressed as box-whisker plots and trendlines, p-value&lt;0.05 being statistically significant.&#x0D; Results: There was a significant difference in intraprocedural pain-scores between both groups (p-values 0.0001, 0.0011, 0.0092 and 0.0201 at 0-10mins, 10-20mins, 20-30mins and 30-40mins respectively). More patients in Group-F required rescue-analgesic with reduced interventionist-satisfaction score versus Group-K. In Group-K, mean arterial pressure and heart rate (95.1mmHg;79.6/min) increased after initial ketamine bolus, but were maintained/decreased at intervention-initiation (93.2mmHg;79.4/min) and at 10min and 30min thereafter. In Group-F, MAP and HR decreased after initial fentanyl bolus (83.5mHg;71.9/min), increased with intervention-initiation (90.1mmHg;77/min), progressively decreasing at every time-point thereafter. VAS-scores (resting; on coughing) were lower in Group-K.&#x0D; Conclusion: A ketamine-dexmedetomidine combination technique demonstrated a superior sedoanalgesic effect with reduced intra-procedural bradypnea, bradycardia, rescue-drug requirement and post-procedural complications with enhanced interventionist-satisfaction and may emerge as the ideal procedural sedoanalgesic for patients undergoing CT-guided core-biopsy, radiofrequency/microwave ablation.

Use of Explainable AI Algorithm Revealing Longitudinal Changes in Practice Patterns and Toxicity Models

Dosimetric constraints evolve as clinicians implement practice changes, requiring modeling approaches to be dynamic. We applied a semi-automated explainable artificial intelligence (eAI) algorithm and dashboard visualizations to model dysphagia and xerostomia for head and neck cancer patients. We coupled a large, comprehensive, "real-world" database to the eAI for discovery of features with the strongest combined statistical and machine learning based evidence and to identify clinically actionable thresholds. Cohort included 758 patients treated 2017-2021 for HN cancer with conventional fractionation. Features included age, sex, diagnosis, staging, chemotherapy, smoking and alcohol status, BMI, weight loss, re-simulation, DVH curves, PTV and OAR volumes. Patients were scored for toxicity within 2 yrs of RT for dysphagia grade ≥ 3 and xerostomia grade ≥ 2. Bootstrap resampling of thresholds, ROC-AUC, PR-ROC, SN, SP, F1 and diagnostic odds ratio was used to statistically profile strength of evidence for candidate features. XGBoost models with 10-fold cross validation were repeated (n = 20) to identify mean and CIs for statistical measures of predictions. DVH metrics included standard template values and those with highest statistical evidence and low cross correlation with other features. Backward feature selection was used to identify the most relevant feature subset, where the least informative feature is iteratively removed from the model. This workflow was repeated by year and overall. Annual incidence of dysphagia averaged 0.13 ± 0.02 overall years. Xerostomia incidence decreased from 0.32 to 0.12 (2017-2021). Box-whisker plots by year showed consistent reductions in standard practice toxicity linked DVH metric values. Median dose to superior constrictors (PCM), contralateral parotid and contralateral submandibular gland (SMG) declined from 2017 to 2021 by 48 to 33 Gy, 17 to 10 Gy, and 28 to 22 Gy respectively. Statistics of XGBoost models of dysphagia for all years were ROC-AUC = 0.72 ± 0.05. Strongest overall years predictors were Oral Cavity (OC) D50%[Gy] < 32, inferior PCM Max [Gy] < 60, contralateral SMG D10%[Gy] < 53 and use of Paclitaxel. Xerostomia models were less predictive with ROC-AUC = 0.65 ± 0.05. Strongest predictors over each year were ipsilateral parotid D30%[Gy] < 35, contralateral SMG D96%[Gy] < 18.4, and overall staging < II. Predictive features varied substantially by year for both, showing the most consistency for SMG doses. For example, OC D50%[Gy] < 27 and contralateral SMG D96%[Gy] < 18 dominated xerostomia model in 2017 but not in 2021 when practice norms shifted to lower doses. As OAR doses were systematically reduced, statistical and AI models evidence highlighted contralateral SMG dose as important to both dysphagia and xerostomia for clinical practice change. The "real-world" database + eAI + visualization dashboards provided a method for continuous learning as clinical practice changes.

Unrevealing the role of miRNA in successful TNBC treatment: A pilot study to explore the chemotherapy drugs for timely treatment of TNBC

Objectives: Worldwide, breast cancer is the most prevalent and common type of cancer. Physical examination and mammography with a range of sensitivities are currently used as screening methods. Triple-negative breast cancer (TNBC) lacks estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER-2) gene expression. MicroRNAs (miRNA) as potential prognostic and diagnostic biomarkers, miRNA 125, 200c, 221, 21, and 34a were selected for study. Materials and Methods: Here, 25 consenting TNBC patients with negative ER/PR/HER-2 status and compatible history were accrued from the Department of Oncosurgery, All India Institutes of Medical Sciences (AIIMS) Bhopal. Serum from participants and 25 controls was collected for quantitative estimation of miRNA by quantitative real-time polymerase chain reaction. After being treated with epirubicin, capecitabine, and paclitaxel, the MDA-MB-231 cell line’s expression of these miRNA subtypes was also examined. Statistical Analysis: All statistical analyses, pie charts, dot plots, and box-whisker plots were performed using EZR (Easy R), R Commander version 2.7-1. Bar graphs were created using Microsoft Excel 2019 software. Heat map graphics were produced using Graph Prism Version 9. Results: miRNA125 (p&lt; 0.0001) and miRNA21 (p&lt; 0.05) were found to be statistically significant. miR125 (DCt [cycle threshold] 2.77) was seen to be upregulated and miR21 (DCt -1.61) was seen to be downregulated in TNBC patients. Epirubicin treatment caused miR125 to be downregulated, but capecitabine treatment caused miR125 to be upregulated. Paclitaxel was seen to downregulate miR21. All three chemotherapeutic agents were seen to downregulate miR34a. Conclusion: miRNAs can be developed into a reliable biomarker and prognostic tool with more research. They can also help develop and improve pharmaco-therapeutic strategies.

Molecular analysis and clinical significance of hemoglobin Quong Sze in Huizhou city, Southern China.

Hemoglobin Quong Sze (Hb QS) is one of the most common non-deletional α-thalassemia (α-thal), which is prevalent in the Southern Chinese population. However, there are still few comprehensive researches on the molecular characterization of Hb QS. So it is important to find out appropriate diagnosis and characterization of Hb QS carrier for genetic counseling. A hematological screening including hematological indices and hemoglobin analysis was performed in 113,400 individuals from Huizhou city, Southern China. Then, suspected thalassemia carriers were detected by a suspension-array system and DNA sequencing for α- and β-thal. In our study, we identified 521 subjects who were Hb QS carriers, including fourteen different genotypes. Among them, 445 Hb QS heterozygotes showed a decrease in the mean corpuscular hemoglobin (MCH), 16 compound heterozygotes for Hb QS/α+-thal presented mild thalassemia, 28 Hb QS in combination with --SEA/αα manifested as Hb H disease, varying clinical symptoms from only moderate anemia to severe anemia and requiring blood transfusion, and 29 double heterozygotes for Hb QS and β-thal behaved as β-thal trait. The mean corpuscular volume (MCV) and MCH were significantly reduced and no Hb H peak could be detected in one patient with Hb H-Hb QS and β-thal. Meanwhile, we identified two homozygous Hb QS carriers, who showed mild to moderate anemia and increased Hb A2 level but negative results from a sequencing analysis for the first time. Additionally, Comparison of hematological parameters among the major four genotype groups showed significant differences in most box-whisker plots. People who originated from Huizhou city showed many genotypes and diversity in the clinical manifestations of Hb QS carriers. This study enlarges the mutation spectrum of α-thal and emphasizes that reliable detection of the gene mutations is important for genetic counseling. It also strengthens the prevention and control of thalassemia.

Solvent-free microwave extraction of essential oil and hydrosol from fresh leaves of Cinnamomum burmannii (Nees et T. Nees) Blume after screw extrusion treatment and evaluation of pancreatic lipase inhibitory activities in vitro compared to its main components

One of the most significant sources of commercial camphor oil is the essential oil of Cinnamomum burmannii (Nees et T. Nees) Blume leaves, which has been manufactured using a variety of distillation techniques, including hydrodistillation and microwave-assisted hydrodistillation. In this study, we employed solvent-free microwave extraction (SFME) to recover hydrosol and essential oil from fresh C. burmannii leaves that had undergone screw extrusion. An optimum yield of 12.35 ± 0.62 mL/kg DW of essential oil was obtained by optimizing the major SFME contributing parameters using a face-centered central composite design (FCCCD). By using SFME, the influence of microwave irradiation power on the yield and quality of the essential oil of fresh leaves of C. burmannii was examined. With the aid of first- and second-order kinetic equations, SFME was contrasted with hydrodistillation and dry distillation. A total of 32 components were detected in the essential oil, and 22 components were detected in the hydrosol obtained by SFME under the optimized conditions. The main components of the essential oil were 1,8-cineole (21.67%), borneol (17.37%) and α-terpineol (7.45%), in descending order, and the main components of the hydrosol were trans-2-hydroxycinnamic acid (21.45%), borneol (22.07%), 1,8-cineole (13.65%) and α-terpineol (11.93%). 1,8-Cineole and borneol were the two components with the highest influence on hierarchical clustering, according to principal component analysis and heatmap analysis. Moreover, box-whisker plots were used to determine and compare the inhibitory activities of the essential oil and its three primary constituents against pancreatic lipase. The outcomes demonstrated that 1,8-cineole played a critical role in the essential oil's ability to inhibit pancreatic lipase, and they also demonstrated a positive correlation between the concentration and the amount of inhibition activity.

Left atrial appendage anatomical changes following radiofrequency-based ostial isolation

Abstract Funding Acknowledgements Type of funding sources: None. Background Left atrial appendage (LAA) electrical isolation (ei) may be achieved via radiofrequency (RF) energy applications at the level of the appendage ostium targeting the sites of earliest activation recorded by a mapping catheter. Notably, RF has long been used in vascular, orthopedic, and aesthetic surgery to promote thermal-induced collagen matrix contraction, fibrosis, and tissue retraction. LAA anatomical changes associated to RF-induced tissue retraction have never been reported. Purpose To quantify the anatomical changes of the LAA ostium following RF-based LAAei. Methods Thirty-four consecutive patients requiring AF ablation with LAAei underwent transesophageal echocardiography (TEE) within 7 days before (baseline TEE) and apx 6 months after (follow-up TEE) ablation. The diameter of LAA orifice and landing zone were measured at 4 different views (0°, 45°, 90°, 135°). Measurements were performed by two independent reviewers blinded to the patient’s identity. Results Among 43 AF patients (67±6yrs, 72.1% males), the LAA morphology was classified as chicken wing in 19 (44.2%) patients, windsock in 12 (27.9%), cactus in 8 (18.6%), and cauliflower in 4 (9.3%). At baseline TEE, the mean maximum and mean minimum ostial diameters were 25±4mm and 22±4mm, respectively. The mean maximum and mean minimum diameters of the landing zone were 26±4mm and 23±3mm, respectively. On average, LAAei was achieved after 17±6 minutes of RF at a power of 45W. Follow-up TEE was performed 294±136 days after LAAei. The median LAA contraction velocity was 0.1 m/s (IQR: 0.02-0.18) and was significantly impaired in all patients. At follow-up TEE, the mean maximum and mean minimum ostial diameters were 19±4mm and 17±3mm, respectively. The mean maximum and mean minimum diameters of the landing zone were 20±4mm and 18±4mm, respectively. The mean relative reduction of the ostium and the landing zone was -24.4% and -22.5%, respectively. Box-Whisker plots of the maximum and minimum ostial diameters before and after LAAei are reported in Fig.1. Conclusion RF led to a &amp;gt;20% reduction of the diameters of the ostium and the landing zone. These changes may have important implications for a successful percutaneous occlusion procedure and justify a staged approach of isolation and occlusion.

Assessment of stress response due to C-Mac D-blade guided videolaryngoscopic endotracheal intubation and docking of da Vinci surgical robot using perfusion index in patients undergoing transoral robotic oncosurgery.

Clinical utility of perfusion index (PI) has entered a new realm as a non-invasive, quantitative index of stress response to endotracheal intubation. Transoral robotic surgery (TORS) involves F-K retractor aided docking of the surgical robot producing haemodynamic and stress responses akin to laryngoscopy. We compared the stress response to videolaryngoscopy with that due to docking of da Vinci surgical robot using PI, heart rate and mean arterial pressure evaluated at specific time points post-laryngoscopy and post-docking. Twenty-six adult patients, scheduled for TORS under general endotracheal anaesthesia were included in this prospective, observational, single-centric cohort study. Statistical analysis included paired samples t-test, dotted box-whisker plots, trendlines and correlograms for comparative analysis of two stressors, laryngoscopy and docking. Baseline PI was 4.14. PI values increased post-midazolam (4.23), 1min (5.69) and 3min (6.25) post anaesthetic-induction, plummeted at laryngoscopy (3.24), remained low at 1min (3.68), 3min (4.69) thereafter, and were highest at 10min (6.17) post-laryngoscopy and predocking (6.84). Docking witnessed a fall in PI (4.1), which remained low at 1min (4.02), 3min (4.31) and 10min (4.79) post-docking. PI was significantly higher at laryngoscopy compared with PI at docking (p = 0.0044). At 1min and 3min post-laryngoscopy and post-docking, respectively, the differences in PI were statistically insignificant. PI at 10min post-laryngoscopy was significantly lower than PI at 10min post-docking (p < 0.0001). As non-invasively quantified by PI, videolaryngoscopic stress response is more intense but shorter-lived versus that due to docking. PI displays a negative correlation with haemodynamic variables. PI at laryngoscopy is a good predictor of PI at docking, enabling pre-emptive measures (fentanyl bolus; deepening of volatile anaesthesia from MAC-maintenance to MAC-intubation) anticipating the docking-induced stress response.Trial registration http://ctri.nic.in ; Identifier: CTRI/2019/11/022091.

Predicting Hydroxychloroquine Clearance in Healthy and Diseased Populations Using a Physiologically Based Pharmacokinetic Approach.

Hydroxychloroquine (HCQ), a congener of chloroquine, is widely used in prophylaxis and the treatment of malaria, and also as a cure for rheumatoid arthritis, systemic lupus erythematosus, and various other diseases. Physiologically based pharmacokinetic modeling (PBPK) has attracted great interest in the past few years in predicting drug pharmacokinetics (PK). This study focuses on predicting the PK of HCQ in the healthy population and extrapolating it to the diseased populations, i.e., liver cirrhosis and chronic kidney disease (CKD), utilizing a systematically built whole-body PBPK model. The time vs. concentration profiles and drug-related parameters were obtained from the literature after a laborious search and in turn were integrated into PK-Sim software for designing healthy intravenous, oral, and diseased models. The model's evaluation was performed using observed-to-predicted ratios (Robs/Rpre) and visual predictive checks within a 2-fold error range. The healthy model was then extrapolated to liver cirrhosis and CKD populations after incorporating various disease-specific pathophysiological changes. Box-whisker plots showed an increase in AUC0-t in liver cirrhosis, whereas a decrease in AUC0-t was seen in the CKD population. These model predictions may assist clinicians in adjusting the administered HCQ doses in patients with different degrees of hepatic and renal impairment.

Rapid seismic fragility curves assessment of eccentrically braced frames through an output-only nonmodel-based procedure and machine learning techniques

A nonmodel and output-only-based framework incorporating an Auto-Regressive model and roof absolute acceleration response are hired in this study to compute a robust wavelet-based damage-sensitive feature (rDSF) and estimate engineering demand parameters (EDPs) of buildings with eccentrically braced frames (EBFs). A large database is recruited to estimate the peak and residual story drift ratios and peak floor absolute accelerations as EDPs. The database comprises cmorfb-fc wavelet-based rDSF, number of stories, building heights, and EDPs of the 4- and 8-story EBF archetypes, resulting from 44 far-field ground motions through incremental dynamic analysis. The capability of both the closed-form equations and machine learning (ML) techniques is investigated to estimate the EDPs. The predictive equations are constructed using ordinary least squares linear regression, Symbolic and Bayesian regressions. To have a more accurate estimation of EDPs, 12 renowned ML-based regression algorithms are also implemented for training, validation, and test datasets. Sensitivity analysis using box-whisker plots on the validation dataset shows that Extreme Gradient Boosted Trees (ExGBT) ensemble has a remarkable efficiency to predict the EDPs and leads to the highest 10-fold correlation coefficient and the lowest root-mean-square error. Moreover, ExGBT has the lowest median absolute relative deviation in different damage states and consequently is selected as the best surrogate algorithm. The predicted EDPs can be further exploited to map rDSF-based fragility curves, a conditional probability at each defined damage state given the value of rDSF. The comparative results for the test data approve that the predicted fragility curves approximately match with those obtained from observed data and can be used for early decision-making in emergency operations.

Rituximab, a Safer Option for Rheumatoid Arthritis: A Comparison of the Reported Adverse Events of Approved Monoclonal Antibodies

Monoclonal antibodies (mAbs), which are commonly used to treat rheumatoid arthritis (RA), have been linked to a variety of adverse events (AEs). The objective of the study was to compare the safety profiles of six FDA approved mAbs (sarilumab, tocilizumab, adalimumab, golimumab, infliximab, and rituximab) marketed for the treatment of RA. A systematic review of the literature was conducted using the databases PubMed, Cochrane Library, and Science Direct. The manuscript comprised a total of 23 clinical studies. The percentage of patients who had AEs was calculated and presented using box-whisker and forest plots. Infections and infestations were found to be the most common AEs in RA patients treated with mAbs. Raised alanine aminotransferase (ALT), aspartate aminotransferase (AST), upper respiratory tract infection (URTI), and nasopharyngitis were frequently reported. The most common AEs were reported with adalimumab. The highest percentage of patients reporting AEs was associated with golimumab (52%), while rituximab had the fewest AEs (4.9%). In conclusion, rituximab appears to be a safer treatment option for RA as it is found to be associated with a lower risk of AEs, particularly respiratory infections.

Development and Evaluation of a Physiologically Based Pharmacokinetic Model of Labetalol in Healthy and Diseased Populations.

Labetalol is a drug that exhibits both alpha and beta-adrenergic receptor-blocking properties. The American Heart Association/American Stroke Association (AHA/ASA) has recommended labetalol as an initial treatment option for the management of severe hypertension. The physiologically based pharmacokinetic (PBPK) model is an in silico approach to determining the pharmacokinetics (PK) of a drug by incorporating blood flow and tissue composition of the organs. This study was conducted to evaluate the primary reasons for the difference in PK after intravenous (IV) and oral administration in healthy and diseased (renal and hepatic) populations. A comprehensive literature search was done using two databases, PubMed and Google Scholar. Various PK parameters were screened for the development of the PBPK model utilizing a population-based PK-Sim simulator. Simulations were performed after creating building blocks firstly in healthy individuals and then in diseased patients after IV and oral administration. The disposition of labetalol after IV and oral administration occurring in patients with the hepatic and renal disease was predicted. The model was evaluated by calculating the Robs/pred ratio and average fold error (AFE), which was in the two-fold error range. Moreover, Box-whisker plots were made to compare the overall concentration of the drug in the body at various stages of disease severity. The presented model provides useful quantitative estimates of drug dosing in patients fighting against severe chronic diseases.

Machine learning-based simulation for proton exchange membrane electrolyzer cell

This paper presents two systematic machine learning (ML) approaches for predicting the hydrogen production rate and cell current density for proton exchange membrane electrolyzer cells (PEMEC) as a function of different design parameters. Management of the hydrogen production rate and current density remains an important research topic for many technologies, including PEM water electrolysis cells, which are the focus of this study; therefore, two applications of ML were proposed to simulate the hydrogen production rate and current density for PEMEC. In this study, five different ML models were trained and tested for each simulation i.e., artificial neural networks, polynomial regression, support vector machine regressor, K-nearest neighbor regressor, and decision tree regressor, using 15 different input parameters and single output parameters. Box and whisker data analysis was applied to obtain the highest activation materials for the current density in the dataset. The box whisker plots revealed that Nafion115 and Nafion117 for the membrane type, titanium for the electrode type (cathode and anode), platinum (Pt) as the cathode catalyst, Pt and ruthenium as anode catalysts, and deionized water and methanol as the electrolyte (catholyte and anolyte) were the highest activation materials for current density. The performance comparison of the ML models was given by calculating the mean absolute error for the training and test data for each model. For both simulations, the ANN model showed the best performance, with a mean absolute error of 5.0006 for training and 6.4383 for testing for hydrogen production simulation, and 0.03819 for training and 0.04036 for testing for the current density simulation. Both applications have minimal error values, which means that the proposed methods simulate the real PEM cell performance well. This study paves the way for a significant method to reduce the cost, effort, and time required to fabricate PEMEC.

P4 LEFT ATRIAL APPENDAGE ANATOMICAL CHANGES FOLLOWING RADIOFREQUENCY–BASED OSTIAL ISOLATION

Abstract Background Left atrial appendage (LAA) electrical isolation (ei) may be achieved via radiofrequency (RF) energy applications at the level of the appendage ostium targeting the sites of earliest activation recorded by a mapping catheter. Notably, RF has long been used in vascular, orthopedic, and aesthetic surgery to promote thermal–induced collagen matrix contraction, fibrosis, and tissue retraction. LAA anatomical changes associated to RF–induced tissue retraction have never been reported. Objective To quantify the anatomical changes of the LAA ostium following RF–based LAAei. Methods Thirty–four consecutive patients requiring AF ablation with LAAei underwent transesophageal echocardiography (TEE) within 7 days before (baseline TEE) and &amp;gt;6 months after (follow–up TEE) ablation. The diameter of LAA orifice and landing zone were measured at 4 different views (0°, 45°, 90°, 135°). Measurements were performed by two independent reviewers blinded to the patient’s identity. Results Among 34 AF patients (68±7yrs, 73.5% males), the LAA morphology was classified as chicken wing in 15 (44%) patients, windsock in 10 (29%), cactus in 6 (18%), and cauliflower in 3 (9%). At baseline TEE, the mean maximum and mean minimum ostial diameters were 25±4mm and 22±4mm, respectively. The mean maximum and mean minimum diameters of the landing zone were 26±4mm and 23±3mm, respectively. On average, LAAei was achieved after 16±7 minutes of RF at a power of 45–47W. Follow–up TEE was performed 257±148 days after LAAei. The median LAA contraction velocity was 0.1 m/s (IQR: 0.04–0.18) and was significantly impaired in all patients. At follow–up TEE, the mean maximum and mean minimum ostial diameters were 19±4mm and 17±3mm, respectively. The mean maximum and mean minimum diameters of the landing zone were 20±4mm and 18±4mm, respectively. The mean relative reduction of the ostium and the landing zone were –24.4% and –22.5%, respectively. Box–Whisker plots of the maximum and minimum ostial diameters before and after LAAei are reported in Fig. 1. Conclusion RF led to a &amp;gt; 20% reduction of the diameters of the ostium and the landing zone. These changes may have important implications for a successful percutaneous occlusion procedure and justify a staged approach of isolation and occlusion.

PO-696-07 LEFT ATRIAL APPENDAGE ANATOMICAL CHANGES FOLLOWING RADIOFREQUENCY-BASED OSTIAL ISOLATION

Left atrial appendage (LAA) electrical isolation (ei) may be achieved via radiofrequency (RF) energy applications at the level of the appendage ostium targeting the sites of earliest activation recorded by a mapping catheter. Notably, RF has long been used in vascular, orthopedic, and aesthetic surgery to promote thermal-induced collagen matrix contraction, fibrosis, and tissue retraction. LAA anatomical changes associated to RF-induced tissue retraction have never been reported. To quantify the anatomical changes of the LAA ostium following RF-based LAAei. Thirty-four consecutive patients requiring AF ablation with LAAei underwent transesophageal echocardiography (TEE) within 7 days before (baseline TEE) and >6 months after (follow-up TEE) ablation. The diameter of LAA orifice and landing zone were measured at 4 different views (0°, 45°, 90°, 135°). Measurements were performed by two independent reviewers blinded to the patient’s identity. Among 34 AF patients (68±7yrs, 73.5% males), the LAA morphology was classified as chicken wing in 15 (44%) patients, windsock in 10 (29%), cactus in 6 (18%), and cauliflower in 3 (9%). At baseline TEE, the mean maximum and mean minimum ostial diameters were 25±4mm and 22±4mm, respectively. The mean maximum and mean minimum diameters of the landing zone were 26±4mm and 23±3mm, respectively. On average, LAAei was achieved after 16±7 minutes of RF at a power of 45-47W. Follow-up TEE was performed 257±148 days after LAAei. The median LAA contraction velocity was 0.1 m/s (IQR: 0.04-0.18) and was significantly impaired in all patients. At follow-up TEE, the mean maximum and mean minimum ostial diameters were 19±4mm and 17±3mm, respectively. The mean maximum and mean minimum diameters of the landing zone were 20±4mm and 18±4mm, respectively. The mean relative reduction of the ostium and the landing zone was -24.4% and -22.5%, respectively. Box-Whisker plots of the maximum and minimum ostial diameters before and after LAAei are reported in Fig.1. RF led to a >20% reduction of the diameters of the ostium and the landing zone. These changes may have important implications for a successful percutaneous occlusion procedure and justify a staged approach of isolation and occlusion.

Evaluation of Physicochemical Characteristics of Coastal Waters of Nellore, Southeast Coast of India, by a Multivariate Statistical Approach

The Swarnamukhi river estuary (SRE), and the surrounding sea in Nellore, southeast coast of India, is one of the least studied marine environments, notably for physicochemical characteristics. Seawater samples were collected from five stations every month from 2014 to 2017 to assess physicochemical characteristics. The open sea (OS) station was significantly different from the inner stations, according to non-metric multidimensional scaling and cluster analysis. The variability was shown by strong factor loadings of atmospheric temperature (0.87), water temperature (0.84), biochemical oxygen demand (0.77), ammonia (0.85), and total nitrogen (0.78). Furthermore, one-way ANOVA and box-whisker plots facilitated simplifying and corroborating multivariate results that showed high concentration in the inner stations. Based on the N/P and Si/N ratios, nitrate and silicate were the key limiting factors in this study. The findings are critical for establishing reference conditions for comparison studies with other comparable ecosystems in the tropical region for better environmental conservation and management.

Using Microbial Responses Viewer and a Regression Approach to Assess the Effect of pH, Activity of Water and Temperature on the Survival of Campylobacter spp.

This study aimed at developing a model for evaluating the survival of various Campylobacter jejuni strains under different conditions in culture media and poultry data from ComBase. Campylobacter data of culture media (116) and poultry (19) were collected from Microbial Responses Viewer, an additional tool of ComBase. The Weibull equation was selected as a suitable model for the analysis of survival data because of the nonlinearity of survival curves. Then, the fitting parameters (first reduction time and shape parameter) were analysed through a Kruskall–Wallis test and box-whisker plots, thus pointing out the existence of two classes of temperature (0–12 °C and 15–25 °C) and pH (4–6.5 and 7–7.5) acting on the viability of C. jejuni. Finally, a general regression model was used to build a comprehensive function; all factors were significant, but temperature was the most significant variable, followed by pH and water activity. In addition, desirability and prediction profiles highlighted a negative correlation of the first reduction time with temperature and a positive correlation with pH and water activity.