Insufficient Material Research Articles

Biomarker testing in non-small cell lung cancer in routine care: Analysis of the first 3,717 patients in the German prospective, observational, nation-wide CRISP Registry (AIO-TRK-0315)

ObjectivesAn increasing number of treatment-determining biomarkers has been identified in non-small cell lung cancer (NSCLC) and molecular testing is recommended to enable optimal individualized treatment. However, data on implementation of these recommendations in the “real-world” setting are scarce. This study presents comprehensive details on the frequency, methodology and results of biomarker testing of advanced NSCLC in Germany. Patients and methodsThis analysis included 3,717 patients with advanced NSCLC (2,921 non-squamous; 796 squamous), recruited into the CRISP registry at start of systemic therapy by 150 German sites between December 2015 and June 2019. Evaluated were the molecular biomarkers EGFR, ALK, ROS1, BRAF, KRAS, MET, TP53, RET, HER2, as well as expression of PD-L1. ResultsIn total, 90.5 % of the patients were tested for biomarkers. Testing rates were 92.2 % (non-squamous), 70.7 % (squamous) and increased from 83.2 % in 2015/16 to 94.2% in 2019. Overall testing rates for EGFR, ALK, ROS1, and BRAF were 72.5 %, 74.5 %, 66.1 %, and 53.0 %, respectively (non-squamous). Testing rates for PD-L1 expression were 64.5 % (non-squamous), and 58.5 % (squamous). The most common testing methods were immunohistochemistry (68.5 % non-squamous, 58.3 % squamous), and next-generation sequencing (38.7 % non-squamous, 14.4 % squamous). Reasons for not testing were insufficient tumor material or lack of guideline recommendations (squamous). No alteration was found in 37.8 % (non-squamous), and 57.9 % (squamous), respectively. Most common alterations in non-squamous tumors (all patients/all patients tested for the respective biomarker): KRAS (17.3 %/39.2 %), TP53 (14.1 %/51.4 %), and EGFR (11.0 %/15.1 %); in squamous tumors: TP53 (7.0 %/69.1 %), MET (1.5 %/11.1 %), and EGFR (1.1 %/4.4 %). Median PFS (non-squamous) was 8.7 months (95 % CI 7.4–10.4) with druggable EGFR mutation, and 8.0 months (95 % CI 3.9–9.2) with druggable ALK alterations. ConclusionTesting rates in Germany are high nationwide and acceptable in international comparison, but still leave out a significant portion of patients, who could potentially benefit. Thus, specific measures are needed to increase implementation.

Increased Current Density of a Redox Flow Battery with a Carbon Paper Partially Modified by Porous Carbon Nanofibers

One of the technical issues of vanadium redox flow batteries with a carbon paper electrode and interdigitated flow channel is the relatively low current density due to insufficient active material transport downstream in the electrode and low reaction interface area. In this study, we propose a new composite electrode structure, i.e., a porous carbon nanofiber layer that is partially added on the carbon paper. The current density of the composite electrode was higher than that of the unloaded carbon paper electrode due to the lower internal resistances of the battery. In addition, the discharge capacity and voltage efficiency during the charge-discharge operation were improved by the composite structure.

Desafios do trabalho de educadoras sociais em casas de acolhimento

Este estudo analisa as vivências de prazer e sofrimento no trabalho de educadoras sociais em Casas de Acolhimento no Pantanal Sul-Mato-Grossense. Baseado na teoria da Psicodinâmica do Trabalho, foi analisado o sofrimento derivado do choque entre as normatizações organizacionais e as situações laborais reais experienciadas no atendimento a crianças e adolescentes. Nove profissionais de duas instituições públicas foram entrevistadas, cujas narrativas foram ponderadas através da Análise de Sentido. Os resultados apontam para o uso constante de inteligência prática diante de condições materiais e capacitações insuficientes, relações institucionais desrespeitosas, falta de suporte emocional-afetivo e autoaceleração pela sobrecarga de trabalho imposta. A identificação com as tarefas socioeducativas e a satisfação com o desenvolvimento dos acolhidos foram os aspectos citados propulsores de realização. Conclui-se ser necessário o reconhecimento da profissão e da importância da educação social para a reintegração segura dos acolhidos na família de origem ou lar adotivo.

Prolonged nucleic acid conversion and false-negative RT-PCR results in patients with COVID-19: A case series

BackgroundProlonged nucleic acid conversion and false-negative real-time polymerase chain reaction (RT-PCR) results might occur in COVID-19 patients rather than infection recurrence. Presentation of casesWe reported four cases who had negative RT-PCR results, in addition to the last two consecutive negative results. Patient-1 had negative RT-PCR results twice (the 6th and 8th) from a total of 11 swabs. Patient-2 had negative RT-PCR results once (the 5th) from a total of 8 swabs. Patient-3 showed negative results of RT-PCR twice (the 4th and 6th) from a total of 11 swabs. Patient-4 had negative RT-PCR results twice (the 2nd and 10th) from a total of 14 swabs. DiscussionThe fluctuating trend of our RT-PCR results in our cases might be due to insufficient viral material in the specimen, laboratory errors during sampling, restrictions on sample transportation, or mutations in the primary and probe target regions in the SARS-CoV-2 genome. Several factors might affect the occurrence of prolonged nucleic acid conversion, including older age, comorbidities, such as diabetes and hypertension, and impaired immune function. ConclusionHere, we confirmed the occurrence of prolonged nucleic acid conversion and the possibility of false negative RT-PCR results in COVID-19 patients.

Performance of Online Classes in Lahore, Pakistan During Covid‐19

The outbreak of pandemic throughout the world has paralyzed all activities including the education system. As physical academic sessions have completely ceased so quickly it has been shifted to emergency remote teaching. The purpose of present research is to highlight the challenges and problems associated with taking online classes in developing a country like Pakistan during Covid-19. This study is mainly related to exploring the socioeconomic, health, and educational impacts of E-learning on students of Lahore, an important city of Pakistan. For this, qualitative data was collected by online google questionnaire as reported by 1,263 students of different institutes in Lahore. Pearson's chi- square tests were applied to test the associations and correlation among targeted variables by using SPSS. To better analyze the percentage share of different variables in terms of impacts of online classes spatial interpolation technique with pie charts was used through Arc GIS 10.6. The outcomes of the current research clearly show that there are many problems a student faces to attend an online class. The main problems are including improper study environment, inequality in the availability of gadgets, insufficient online study material, no access or slow internet speed, and load shedding. The above said challenges are negatively influencing the study of students in terms of minimum or no participation of students and proxy attendance in online class. Moreover, student's health is also reported as badly affected by attending online classes. Weak eyesight, overweight, sleep deprivation, and behavioral issues among students are found to be higher in this lockdown era. In the context of this research, it is recommended to reduce the timings of online class, training of students, easy availability of gadgets, and cost-effective student internet packages can be introduced to encourage the students and to make effective online classes.

Creating the Impossible: Lenin’s Legacy

ABSTRACT The 150th anniversary of the birth of Lenin provides an occasion for rethinking his legacy. Rethinking and employing it is critically to understand and change modern capitalism. The author shows that all his theoretical elaborations and practice make up an integral system of scientific achievements and political acts. Lenin’s elaboration of the development and limits of capitalism, including the contradictions of monopoly capital, allowed him to distinguish the system’s motive forces and pathways of change, and to outline the main steps of constructing a new society. His analysis of imperialism and approach to capitalism as an integrated world system is the basis for his conclusion that the initial impulse leading to a breakthrough from this system to socialism would occur at the “weakest link.” His use of the dialectical method solved Russia’s crisis in 1917 through a revolutionary course with insufficient material preconditions, but whose victory might lead to the simultaneous resolving of both bourgeois-democratic and socialist tasks. His theory of social creativity helps identify the forces capable of carrying through the revolution and of retaining power. His decisiveness and responsibility in accomplishing theoretically validated actions allowed him to find the only true solutions in critical situations, and to triumph.

Desafios da gestão nas escolas das águas

School management is related to both general administration issues and pedagogical aspects. This article aims to present the work of school management in the “Schools of Waters” (School in riverside areas), located in the Pantanal of Mato Grosso do Sul (Brazil). For its development, the qualitative perspective was adopted, with a study of documentation, observation and interviews with the school’s managers. The data were systematized and organized in two topics: a) Characterization and Functioning of the Schools of Waters; and b) Curricular Proposal and Monitoring of Pedagogical Work. It was found that the necessary autonomy to carry out the management work is hampered by the insufficient material conditions for work closer to the community.

A review of the genus Chrastoblatta Saussure et Zehntner, 1895 (Dictyoptera: Ectobiidae: Blattellinae)

This paper gives a review of the insufficiently studied genus Chrastoblatta Saussure et Zehntner, 1895. The genus Chrastoblatta was described from Madagascar (environs of Antananarivo) and includes two species: Ch. tricolor Saussure et Zehntner, 1895 and Ch. dimidiata (Saussure, 1863). This contribution is based on the study of a series of paralectotypes of Ch. tricolor and syntypes of Ch. dimidiata from The Muséum d’histoire naturelle in Geneva. Additional specimens of Ch. tricolor were found in the collection of the Zoological Institute of the Russian Academy of Sciences in Saint Petersburg. Detailed morphological description of the type species, Ch. tricolor, is given. Particular attention is paid to the structure of the male and female genitalia, which are described for the first time. Chrastoblatta dimidiata is briefly described due to insufficient and damaged material, but it is probably closely related to the type species. The genus Chrastoblatta is characterized by a peculiar structure of the wide and flat head, hind tibiae with concavity at the apex, a distinctly reduced 4th segment of the tarsi, an asymmetrical hypandrium, and robust, curved styli. The presence of not inverted genitalia suggests the placement of Chrastoblatta in the subfamily Blattellinae. At the present time, the differential diagnosis of the genus Chrastoblatta based on characters of the male and female genitalia cannot be compiled due to insufficient knowledge of other Madagascan ectobiid.

Diagnostic Accuracy of Next Generation Sequencing Panel using Circulating Tumor DNA in Patients with Advanced Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis.

Background/ObjectivesUntil now, no meta-analysis has been published to evaluate the diagnostic performance of next-generation sequencing (NGS) panel using circulating tumor (ctDNA) in patients with advanced non-small cell lung cancer (aNSCLC). The aim of the study was to carry out a systematic review and a meta-analysis in order to determine the accuracy of NGS of ctDNA to detect six oncogenic driver alterations: epidermal growth factor receptor (EGFR); anaplastic lymphoma kinase (ALK); ROS proto-oncogene 1, receptor tyrosine kinase (ROS-1); serine/threonine-protein kinase B-RAF (BRAF); RET proto-oncogene (RET); and MET proto-oncogene, receptor tyrosine kinase (MET) exon 14 in patients with aNSCLC.MethodsMEDLINE/PubMed, Cochrane Library, Latin American and Caribbean Health Sciences Literature (LILACS), and Centre for Reviews and Dissemination databases and articles obtained from other sources were searched for relevant studies that evaluate the accuracy (sensitivity and specificity) of NGS using ctDNA in patients with aNSCLC. The studies were eligible when NGS of ctDNA was compared with tissue tests to detect at least one of the six oncogenic driver alterations. Diagnostic measures (sensitivity and specificity) were pooled with a bivariate diagnostic random effect. All statistical analyses were performed with software R, v.4.0.0.ResultsTen studies were eligible for data extraction. The overall pooled estimates of sensitivity and specificity were 0.766 (95% CI: 0.678–0.835); 0.999 (95% CI: 0.990–1.000), respectively.ConclusionsThe analysis has demonstrated that the NGS panel using ctDNA has a high accuracy to identify the six actionable oncogenic driver alterations in patients with aNSCLC. Therefore, it can be considered a reliable alternative to guide the patients with aNSCLC to the right treatment who cannot undergo an invasive procedure or have insufficient tissue material for molecular tests.

Simplified Submucosal Tunneling Biopsy Using Clip-With-Line Traction and Closure for Gastric Subepithelial Lesion.

Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) has emerged as a standard and convenient method for the sampling of subepithelial lesions (SELs). Immunohistological analysis is required to definitively distinguish mesenchymal tumors; however, EUS-FNA provides insufficient material to achieve this, especially for small SELs < 2 cm. We therefore previously reported a novel submucosal tunneling biopsy (STB) technique that utilizes endoscopic submucosal dissection (ESD) for sampling SELs. However, unresolved advanced technical issues have hindered its widespread application. Currently, a counter-traction technique is used to facilitate ESD. We here describe a technically simplified STB technique using clip-with-line traction for gastric SELs.

PD-1 blockade in recurrent or metastatic cervical cancer: Data from cemiplimab phase I expansion cohorts and characterization of PD-L1 expression in cervical cancer

ObjectivesTo characterize the safety, tolerability, and anti-tumor activity of cemiplimab as monotherapy or in combination with hypofractionated radiation therapy (hfRT) in patients with recurrent or metastatic cervical cancer. To determine the association between histology and programmed death-ligand 1 (PD-L1) expression. MethodsIn non-randomized phase I expansion cohorts, patients (squamous or non-squamous histology) received cemiplimab 3 mg/kg intravenously every 2 weeks for 48 weeks, either alone (monotherapy cohort) or with hfRT during week 2 (combination cohort). Due to insufficient tissue material, PD-L1 protein expression was evaluated in commercially purchased samples and mRNA expression levels were analyzed from The Cancer Genome Atlas (TCGA). ResultsTwenty patients enrolled in both cohorts in total; 10 had squamous histology. The most common adverse events of any grade were diarrhea, fatigue, and hypokalemia, occurring in 35%, 25%, and 25%, respectively. Objective response rate was 10% in each cohort; responders had squamous histology. Duration of response was 11.2 months and 6.4 months for the responder in the monotherapy and combination cohort, respectively. Irradiated lesions were not included in the response assessments. In separate archived specimens (N = 155), PD-L1 protein expression in tumor and immune cells was negative (<1%) more commonly in adenocarcinoma than in squamous tumors. PD-L1 mRNA levels were lower in adenocarcinoma than squamous cell tumors (1.2 vs 5.0 mean transcripts per million, respectively) in TCGA. ConclusionsCemiplimab has activity in cervical squamous cell carcinoma. The phase I results, combined with results from other anti–PD-1 trials in cervical cancer and our biomarker analyses have informed the design of the ongoing phase III trial, with the primary overall survival hierarchical analyses being done first in patients with squamous histology.

Atuação profissional frente à pandemia de COVID-19: dificuldades e possibilidades

Objetivo: O presente estudo tem por objetivo relatar a experiência de profissionais que atuam em cenários diferentes ante ao enfrentamento da pandemia de COVID-19. Metodologia: Trata-se de um relato de experiência acerca da vivência de 4 profissionais de saúde, 3 enfermeiras e 1 psicóloga, que atuam em diferentes regiões do Estado do Rio de Janeiro, em diferentes cenários de trabalho: Estratégia de Saúde da Família; Unidade de Pronto Atendimento; Instituição privada de ensino técnico e superior e Consultório clínico, no período pandêmico de março a abril de 2020, local de atuação profissional das participantes do estudo. Resultados: Como resultados, apresentaram-se as principais dificuldades e potencialidades ante o enfrentamento à pandemia, na área de ensino e na assistência, quais foram: Necessidade de adaptação às novas ferramentas tecnológicas; Dificuldade na adaptação rápida à transição do ensino presencial para o ensino online; Insuficiência de recursos humanos e materiais e de qualificação, além de danos psicológicos; porém foi relatado o desenvolvimento da capacidade de resiliência e união profissional. Considerações Finais: Pode-se concluir que os danos psicológicos enfrentados por esses profissionais são preocupantes, necessitando assim, de condutas de autocuidado e apoio entre os membros da equipe a fim de assegurarem sua saúde mental.

477P Genomically-matched therapy in refractory CRC according to ESCAT

Next Generation Sequencing (NGS) emerges as an actionability-searching strategy in the molecularly heterogeneous context of colorectal cancer (CRC)1, but its clinical impact remains unknown in a refractory setting. We aim to determine the value of NGS in terms of enrolment in genomically-guided clinical trials (gCT) in a cohort of metastatic CRC (mCRC) patients (pts) according to ESMO Scale for Clinical Actionability of Molecular Targets (ESCAT[E]) 2. 1Muzny et al, Nature 2012; 2Mateo et al, Ann Oncol 2018. Target population are pts with refractory mCRC included in NGS program (DNA seq for mutations [mut], amplifications [amp] or deletions [del] and RNA seq for fusions [fus]) for therapeutic purposes from 2015-2019. 159 pts have been identified, 122 left-sided (LC) vs 37 right-sided (RC). Basal molecular profile locally performed showed: 80 pts RAS WT (E IA), all treated with anti-EGFR; 9 pts BRAF V600E (E IA), 6/9 received BRAF-inhibitors; 3 pts MSI (E IB), 2/3 received immunotherapy. NGS (149 mut panel, 29 amp/del panel, 27 fus panel) was performed on archival FFPE samples of primary tumors (85%) and metastases (15%) of 113 LC and 36 RC. 10 pts have insufficient material. NGS unveiled druggable alterations different from basal profile in 24 pts (16%): 2 ERBB2 amp (EIB), 6 KRAS G12C mut (EIIIA), 3 ERBB2 mut (EIIIA), 5 PIK3CA mut in RAS –BRAF WT (EIVA), 3 BRAF nonV600E mut (EIVA), 4 RNF43 mut (EIVA), 1 MET amp (EIVA), distributed as 7 RC (19%) and 17 LC (15%). Only 4 pts were included in gCT, 5 deteriorated clinically and 15 were enrolled in other unmatched trials or received SoC because lack of slots in gCT. NGS unravels 16% of ESCAT-defined druggable alterations with final inclusion rate in gCT of 4/159 pts. Further data is needed to better define the value of NGS in mCRC, considering the evolving landscape of gCT and biomarkers, as well as basal tumor biology and clonal selection.

Isotopically distinct terrestrial planets via local accretion

Combining isotopic constraints from meteorite data with dynamical models of planet formation proves to be advantageous in identifying the best model for terrestrial planet formation. Prior studies have shown that the probability of reproducing the distinct isotopic compositions of the Earth and Mars for both classical and Grand Tack models is very low. In the framework of the Grand Tack model, for Mars to be isotopically different from the Earth, it had to form under very specific conditions. Here, we subjected a fairly new and unexplored model—the depleted disc model—to the test. It presupposes that the region in the inner protoplanetary disc from Mars’ orbit and beyond is depleted in mass such that Mars is left with insufficient material to grow to a larger size. Our aim is to test the whether the distinct isotopic compositions of the Earth and Mars are a natural outcome of this model. We found that the terrestrial planets accrete material mostly locally and have feeding zones that are sufficiently distinct. The Earth and Mars, and by extension, Venus, can have distinct isotopic compositions if there is an isotopic gradient in the terrestrial planet region of the protoplanetary disc. Our results suggest that the material in the inner Solar System most likely did not undergo substantial mixing that homogenised the potential isotopic gradient, in contrast to the Grand Tack model where the feeding zones of the terrestrial planets are nearly identical due to the mixing of material by Jupiter’s migration.

Abstract 5368: A multiparameter assay for HER2 protein detection on circulating tumor cells in non-small cell lung cancer

Abstract Lung cancer biopsy can be difficult to perform successfully; it has a 30% adverse event risk and often provides insufficient material to test. Therefore, a liquid biopsy method to analyze the tumor is advantageous. Analysis of circulating tumor cells (CTCs) by multiparameter immunofluorescence (IF) microscopy allows non-invasive characterization of cancer cell biomarker expression. HER2 is a well-known therapeutic target in breast cancer and studies have shown that HER2 status on CTCs may provide prognostic information about response to anti-HER2 therapies. Less is understood about its frequency and clinical importance in non-small cell lung cancer (NSCLC). The RareCyte platform is uniquely suited for CTC identification and phenotypic characterization with a sensitive, accurate, simple and repeatable workflow from blood collection to CTC characterization and single-cell isolation. We developed an assay for detecting HER2 expression on lung CTCs using the RareCyte platform and validated the assay on model CTC spike-in samples with high (BT-474), medium (MDA-MB-453), low (H1650 and OVCAR-3) and absent (MDA-MB-468) HER2 protein levels. Blood was processed to slides using the AccuCyte Sample Preparation System and stained with anti-HER2 together with the RarePlex Kit for CTC identification (nuclear dye, anti-CD45 to exclude WBC, and anti-cytokeratin/EpCAM for CTCs). The spike-in samples showed the expected trend in per-cell HER2 mean fluorescence intensity values. The percentage of HER2-positive cells was &amp;gt; 90% for the HER2-high, medium and low cell lines, and &amp;lt; 5% for the HER2-negative cell line. The assay was applied to 10 advanced stage (III or IV) post-treatment NSCLC patient samples. At least 1 CTC was found in 6 samples (range 0-2043) and HER2 expression was confirmed in 5 out of the 6 samples, indicating this assay is useful for characterizing HER2 expression in CTCs in NSCLC. Citation Format: Edward Lo, Daniel Campton, Lillian Costandy, Heather Itamoto, Ryan Huston, Braden Gardner, Steve Reese, Arturo Ramirez, Eric P. Kaldjian, Tad George, I-Ming Wang, Steven Pirie-Shepherd. A multiparameter assay for HER2 protein detection on circulating tumor cells in non-small cell lung cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5368.

Development Strategy of Marine Sports Tourism: A Perspective of Cost Theory

Li, Z.-J. and Niu, Y.-Z., 2020. Development strategy of marine sports tourism: a perspective of cost theory. In: Qiu, Y.; Zhu, H., and Fang, X. (eds.), Current Advancements in Marine and Coastal Research for Technological and Sociological Applications. Journal of Coastal Research, Special Issue No. 107, pp. 17-20. Coconut Creek (Florida), ISSN 0749-0208.The strategy of “one belt, one road” has become one of the important ways to communicate with Asian and African countries. This is a concept and initiative of cooperative development. Therefore, one belt, one road initiative “, we can better realize the new development mode of Hainan's global tourism. Hainan is rich in marine sports tourism resources, which can establish a marine sports tourism circle composed of a variety of sports tourism projects, including leisure, folk customs, events, exploration, etc. With the diversification of sports tourism projects in Hainan, there are still many problems in marine sports tourism resources, such as insufficient development and publicity, insufficient material infrastructure, and less prominent brand. Therefore, with one belt, one road strategy, Hainan should build a global tourism demonstration area, which will enhance the sports tourism in Asian and African countries. By playing the role of society and government, we can improve the physical infrastructure of marine sports tourism, which will promote the integration of “point, line and area” of Hainan marine sports tourism. Through the “one belt, one road”, Hainan can better build a marine sports tourism circle. First, this paper analyzes the definition of related concepts. Then, this paper analyzes the current situation of Hainan's tourism development model. Finally, this paper constructs the Hainan marine sports tourism circle from the perspective of tourism.

Delirium and encephalopathy in severe COVID-19: a cohort analysis of ICU patients

BackgroundNeurotropism of SARS-CoV-2 and its neurological manifestations have now been confirmed. We aimed at describing delirium and neurological symptoms of COVID-19 in ICU patients.MethodsWe conducted a bicentric cohort study in two French ICUs of Strasbourg University Hospital.All the 150 patients referred for acute respiratory distress syndrome due to SARS-CoV-2 between March 3 and May 5, 2020, were included at their admission. Ten patients (6.7%) were excluded because they remained under neuromuscular blockers during their entire ICU stay. Neurological examination, including CAM-ICU, and cerebrospinal fluid analysis, electroencephalography, and magnetic resonance imaging (MRI) were performed in some of the patients with delirium and/or abnormal neurological examination. The primary endpoint was to describe the incidence of delirium and/or abnormal neurological examination. The secondary endpoints were to describe the characteristics of delirium, to compare the duration of invasive mechanical ventilation and ICU length of stay in patients with and without delirium and/or abnormal neurological symptoms.ResultsThe 140 patients were aged in median of 62 [IQR 52; 70] years old, with a median SAPSII of 49 [IQR 37; 64] points. Neurological examination was normal in 22 patients (15.7%). One hundred eighteen patients (84.3%) developed a delirium with a combination of acute attention, awareness, and cognition disturbances. Eighty-eight patients (69.3%) presented an unexpected state of agitation despite high infusion rates of sedative treatments and neuroleptics, and 89 (63.6%) patients had corticospinal tract signs. Brain MRI performed in 28 patients demonstrated enhancement of subarachnoid spaces in 17/28 patients (60.7%), intraparenchymal, predominantly white matter abnormalities in 8 patients, and perfusion abnormalities in 17/26 patients (65.4%). The 42 electroencephalograms mostly revealed unspecific abnormalities or diffuse, especially bifrontal, slow activity. Cerebrospinal fluid examination revealed inflammatory disturbances in 18/28 patients, including oligoclonal bands with mirror pattern and elevated IL-6. The CSF RT-PCR SARS-CoV-2 was positive in one patient. The delirium/neurological symptoms in COVID-19 patients were responsible for longer mechanical ventilation compared to the patients without delirium/neurological symptoms. Delirium/neurological symptoms could be secondary to systemic inflammatory reaction to SARS-CoV-2.Conclusions and relevanceDelirium/neurological symptoms in COVID-19 patients are a major issue in ICUs, especially in the context of insufficient human and material resources.Trial registrationNA.

Effect of Weld Parameters on the Microstructure of Aluminum-Copper Joints Produced by Flash Welding

The effects of operational conditions on dissimilar Al-Cu flash welded joint quality have been studied using a series of industrial welding experiments. Macro- and microstructural analyses of dissimilar aluminum-copper joints produced by flash butt welding are performed in the present work. Various process conditions including standard and non-standard operational conditions were assessed during the welding experiments. Optical and scanning electron microscopy and electron dispersive x-ray spectroscopy are used to investigate and assess the metallurgical joints created through this process. For suboptimal process conditions, voids (5 mm wide, 1 mm deep) were observed at the joint interface. Some of the voids contained remnants of molten metal while some were empty. Al-Cu intermetallic compounds at the joint area were investigated, and their chemical compositions are determined. The profile of the joint interface was observed to be wavy which is attributed to the voids on the copper side and insufficient material flow of the copper during the upset. The effects of welding parameters on the waviness of the interfaces are investigated. The results show that the waviness of the interface increases with increasing the heat intensity (heat/joint area). No correlation was observed between the flashing speed and the waviness of the interfaces.

Breast fine needle aspiration biopsy cytology reporting using international academy of cytology Yokohama system: A single institution experience

Background/Objectives: 1) To categorize the Breast Fine Needle Aspiration Biopsy (FNAB) samples according to this new system of reporting. 2) To assess the diagnostic accuracy, sensitivity and specificity of breast FNA and calculate the risk of malignancy (ROM) for each category. Methods: This retrospective study included all patients who underwent Breast fine needle aspiration biopsy cytology (FNAB) obtained between January 2019 to December 2019 and were reclassified according to the newly proposed IAC Yokohama reporting system. Only cases for which histopathological reports were available were included in the study. The risk of malignancy (ROM) for each category was determined. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were evaluated based on a three-category approach. Results: A total of 63 women were included in the study. The samples were distributed as follows: insufficient material 0, benign 34.9%, atypical 3.18%, suspicious for malignancy 7.9%, and malignant 53.9%. The respective ROM for each category was 0% for category 1 (insufficient material), 4.5% for category 2 (benign), 50% for category 3 (atypical), 100% for category 4 (suspicious for malignancy), and 100% for category 5 (malignant). When calculating diagnostic accuracy and predictive values where only malignant cases were considered positive tests, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 94.40%, 100%, 100%, 91.66% and 96.55%, respectively. Conclusion: Categorization of the Breast FNAB cytology according to the newly proposed IAC Yokohama system of reporting helps pathologists in achieving diagnostic clarity and guides clinicians in appropriate patient management. IAC Yokohama system of reporting breast cytopathology can serve as a bridge between pathologists and clinicians in effective stratification of breast lesions.

Development of an additive and subtractive hybrid manufacturing process planning strategy of planar surface for productivity and geometric accuracy

The directed energy deposition (DED) process enables the production of near net shape parts in the starting form of either powder or wire melted by a focused energy source, such as laser. The target geometry is then built layer by layer. In theory, engineering components with complex shapes can be fabricated with a single setup using a hybrid CNC machine tool, which has capabilities of both DED and traditional subtractive machining processes. However, the issue of inaccurate DED deposited geometry and insufficient material deposition results in the repetition of the hybrid process to achieve the goal geometric dimension. This paper presents a generalized strategy for different materials that plan DED toolpath for the planar geometric feature to achieve its required final geometric dimension by using only a single hybrid manufacturing cycle based on simulated results and validate the strategy experimentally by using a hybrid CNC machine.