Negative Delta Research Articles

Handgrip Evaluation Before and After Pulmonary Rehabilitation Therapy in Patients With Chronic Obstructive Pulmonary Disease (COPD).

Introduction Chronic Obstructive Pulmonary Disease (COPD) is a systemic disease characterized by skeletal muscle dysfunction, leading to increased morbidity and mortality and deteriorating quality of life. Pulmonary rehabilitation therapy improves symptoms and long-term adherence. This study aimed to evaluate how COPD patients respond to pulmonary rehabilitation therapy and its correlation with handgrip strength measurements. Materials and methods A prospective cohort study was conducted in patients over 45 years old with a spirometric diagnosis of COPD from a specialized reference center in Bucaramanga. Handgrip strength was measured before and after completing the pulmonary rehabilitation program. Patients with neurological or cognitive impairments, decompensated cardiovascular disease, nutritional diseases, or those in a telerehabilitation program were excluded. Results Seventy-one patients were included in the study, with 66.2% completing follow-up after the program. The average age was 73.38 years (SD ±7.77), 53.52% were women, and 60.56% had a history of smoking. After the follow-up, the average handgrip strength delta was 1.64 kg (SD ±3.48) p<0.001, 74.47% of them representing a positive result after pulmonary rehabilitation program. A higher Charlson index correlated with a positive delta, while a negative delta correlated with a lower Charlson index (p=0.01). A positive handgrip strength delta was associated with higher baseline quality of life scores. Conclusions Periodic handgrip strength measurements predict frailty and muscle dysfunction in COPD patients. Pulmonary rehabilitation therapy isa simple and cost-effective intervention that correlates with the improvement of indirect prognosis and survival indicators.

Effect of abdominal adipose tissue glucose uptake on brain aging.

Abdominal adipose tissue (AT) mass has adverse effects on the brain. This study aimed to investigate the effect of glucose uptake by abdominal AT on brain aging. Three-hundred twenty-five participants underwent total-body positron emission tomography scan. Brain age was estimated in an independent test set (n=98) using a support vector regression model that was built using a training set (n=227). Effects of abdominal subcutaneous and visceral AT (SAT/VAT) glucose uptake on brain age delta were evaluated using linear regression. Higher VAT glucose uptake was linked to negative brain age delta across all subgroups. Higher SAT glucose uptake was associated with negative brain age delta in lean individuals. In contrast, increased SAT glucose uptake demonstrated positive trends with brain age delta in female and overweight/obese participants. Increased glucose uptake of the abdominal VAT has positive influences on the brain, while SAT may not have such influences, except for lean individuals. Higher glucose uptake of the visceral adipose tissue was linked to decelerated brain aging. Higher glucose uptake of the subcutaneous adipose tissue (SAT) was associated with negative brain age delta in lean individuals. Faster brain aging was associated with increased glucose uptake of the SAT in female and overweight and obese individuals.

Delta troponin does not distinguish acute coronary syndrome in emergency department patients with renal impairment and an initial positive troponin.

In emergency department (ED) patients with renal impairment, troponin concentrations can be positive without myocardial ischemia. When there is clinical concern for acute coronary syndrome (ACS), guidelines recommend obtaining a delta troponin measurement to identify acute myocardial injury. However, evidence supporting the use of delta troponin to rule in or out ACS in patients with renal impairment and initial elevated troponin levels is limited. This retrospective, observational study assessed the diagnostic value of a 20% delta troponin cutoff in the prediction of ACS events in ED patients (estimated glomerular filtration rate [eGFR]<60mL/min/1.72 m2) with renal impairment, clinical concern for ACS, and an initial positive troponin concentration using either conventional troponin (cTnT) or high-sensitivity troponin (hsTnT). Clinical concern for ACS was based on initial ED physician-reported diagnoses. Patients with an initial diagnosis of ST-elevation myocardial infarction were not included. A positive initial troponin was identified at a threshold of ≥0.06ng/mL for cTnT and ≥52ng/L for hsTnT, and delta troponin measurements were obtained within 24h of the initial troponin. The primary composite outcome, termed ACS event, included (1) cardiac-related mortality, (2) coronary revascularization (or its recommendation), or a (3) clinically diagnosed type-1 myocardial infarction within 6 weeks of the ED presentation. Sensitivities, specificities, negative predictive values, positive predictive values, and negative and positive likelihood ratios were calculated for these 6-week ACS events. A total of 608 ED patients with renal impairment, an initial positive troponin, and clinical concern for ACS were included in the study. Of these patients, 234 had an initial positive cTnT (median eGFR 18mL/min/1.72 m2) and 374 had an initial positive hsTnT (median eGFR 25mL/min/1.72 m2). The overall ACS event rate was 38% in the cTnT group and 33% in the hsTnT group. In those with a negative delta, the 6-week ACS event rate was 32% when using cTnT, compared to 24% using hsTnT. Conversely, a positive delta was associated with an ACS event rate of 47% when cTnT was utilized versus 61% when hsTnT was utilized. In this study, approximately one-third of ED patients with renal impairment who had an initial positive troponin and clinical concern for ACS developed ACS events at 6 weeks. A delta troponin did not appear to provide clinically meaningful assistance in the prediction or exclusion of 6-week ACS events in this cohort.

Characteristics of Right-Sided Accessory Pathways Associated With Right Cardiac Veins.

The anatomy of myocardial fibers around the right cardiac veins (RCVs) and their roles in accessory pathways (APs) are rarely reported. Six RCV-APs were identified from 566 patients with right-sided APs. Mapping of retrograde atrial activation was performed using CARTO 3 system under orthodromic tachycardia or right ventricular pacing. Venography of RCVs was acquired at the earliest retrograde atrial activation. Patients enrolled had a median age of 30 (11-51) years, 5 of them were male. Venography of RCVs could be classified into 3 distinct patterns based on the identified ventricular branches, right marginal vein only (type I; n=3), both right marginal vein and anterior cardiac veins (type II; n=2), and anterior cardiac vein only (type III; n=1). Patients with type I venography had rS QRS pattern in lead V1, negative delta wave in lead III and negative or isoelectric delta wave in lead aVF. However, patients with type II and III venography had QS QRS patterns in lead V1 and variable patterns of delta wave in inferior leads. Earliest retrograde atrial activation was found at a median of 16.75 (14.60-20.00) mm away from the tricuspid annulus, all with A larger than V. At the earliest retrograde atrial activation, far-field ventricular electrogram was found 30 ms later than QRS onset in 1 patient under sinus rhythm. AP conduction was eliminated by mechanical pressure in 2 and by radiofrequency ablation in 4 at the ostium of the veins colocalizing with the earliest retrograde activation of the right atrium. No recurrence was observed during 36 (10-60) months follow-up. The RCV-AP is a rare form of right-sided APs characterized by atrial insertions distant from the annulus. ECG-speculated ventricular insertion sites conformed to the location of identified RCVs.

Enhancing Wind Turbine Stability and Performance: A Case Study on Speed Control and Maximum Power Point Tracking

Wind turbine performance is a critical aspect of renewable energy systems, and this study focuses on optimizing it through innovative strategies. It also discussed the different parts of WECS, such as wind turbines, generators, and control systems, to enhance their performance and efficiency. The research delves into the integration of speed control and Maximum Power Point Tracking (MPPT) mechanisms using a sophisticated Three-Phase Interleaved Buck-Boost Converter. The converter's unique topology, involving a back-to-back connection, shows a pivotal part in shaping the performance of the wind turbine. Furthermore, the near-zero implementation in MPPT strives to minimize oscillations and enhance photovoltaic panel and wind turbine efficiency. This technique, as explored in various studies, aims to achieve stable, efficient power output by reducing perturbations, ensuring optimal energy capture, and improving overall system reliability. This study investigates the transformation before and after near-zero implementation in various contexts. It explores the impact on energy efficiency with near-zero properties, and the performance of buildings, providing insights into the substantial changes brought about by near-zero initiatives. Additionally, the implementation of MPPT is explored, demonstrating that adjusting delta values can lead to faster stabilization times. By changing the negative delta value to -0.0005, the system achieves stabilization at the target power of 19 kW within 0.2 seconds. These findings emphasize the versatility of the Three-Phase Interleaved Buck-Boost Converter in enhancing both speed control and MPPT for wind turbines

Bexarotene-induced hypothyroidism and dyslipidemia; a nation-wide study.

Central hypothyroidism and dyslipidemia are well-known adverse events (AEs) of bexarotene therapy. Although hypothyroidism is known to cause dyslipidemia, no study has examined the association between hypothyroidism and dyslipidemia in patients undergoing bexarotene therapy. The aim of this study is to examine this association. A retrospective observational study was performed among 294 patients who initiated bexarotene therapy in Japan (nation-wide postmarketing complete surveillance). Jonckheere-Terpstra (one sided) test was performed to evaluate the effect of the bexarotene dose on lipid metabolisms, and regression analyses were performed to evaluate associations of bexarotene dose, free thyroxine (FT4), body mass index (BMI), and lipid metabolisms. Most patients developed hypothyroidism. Two-third of patients showed FT4 values below the lower limit at 1 week. Triglycerides (TG) increased in a bexarotene dose-dependent manner, and grade ≥3 AEs on hypertriglyceridemia was observed in 39% of the patients. Additionally, one-third of grade ≥3 AEs on hypertriglyceridemia occurred within 1 week. The delta_FT4 (difference in FT4 from baseline) negatively correlated with TG increase at 1 week (p = 0.012) but not with low density lipoprotein cholesterol (LDL-C) increase at any week. Bexarotene-induced hypothyroidism is almost inevitable and occurred quickly. Bexarotene-induced hypertriglyceridemia showed positive bexarotene dose dependency and negative delta_FT4 dependency. Prophylactic and appropriate thyroid hormone compensation therapy and starting bexarotene at low doses with subsequent titration while managing dyslipidemia may have a beneficial effect for the successful continuation of bexarotene therapy without severe endocrine and metabolic AEs.

Sedimentary evolution and lake level fluctuations of Urmia Lake (north‐west Iran) over the past 50 000 years; insights from Artemia faecal pellet records

AbstractA 25 m long sediment core from hypersaline Urmia Lake (north‐west Iran) was studied for the Late Quaternary depositional history and palaeoclimate variations using the abundance and compositional characteristics of Artemia faecal pellets. Sediment analysis is supported by scanning electron microscopy – energy dispersive X‐ray spectroscopy, organic and inorganic carbon content measurements, and stable isotopes (δ13C and δ18O) from faecal pellet carbonates. The imprecise chronology of the core back to 50 kyr bp is supported by ten radiocarbon ages from faecal pellets and bulk sediments. The palaeoenvironmental record is subdivided into four periods: (i) During much of Marine Isotope Stage 3, a period of lake level lowering is characterized by a decreasing amount of faecal pellets, and an increasing amount of coated grains, sulphate minerals and reworked shell fragments. (ii) During late Marine Isotope Stage 3 and early Marine Isotope Stage 2 a lake level lowstand and a lake floor exposure is interpreted based on the relatively low abundance of pellets, which are multicoloured and appear together with volcanic lithics and rounded sulphate minerals. (iii) During late Marine Isotope Stage 2 the record is devoid of pellets but dominated by large sulphate crystals suggesting a prolonged low lake level. (iv) During Marine Isotope Stage 1 a relative lake level highstand is rapidly established with sediments that are highly abundant in fresh pellets. The modern lake level lowstand is represented by a salt crust. The δ13C and δ18O records measured from faecal pellet carbonates suggest a link with the precipitation versus evaporation balance in the lake over time. From bottom to top the linear trend towards more negative delta values illustrates the increasing amount of precipitation arriving at the lake from the Late Pleistocene to the Holocene. Two prominent isotope minima during the Late Pleistocene and one prominent minimum in the early Holocene mark relative high lake levels, which can also be linked to Lake Van in Turkey.

Coronary sinus ablations in pediatric patients with supraventricular arrhythmias.

Intracoronary sinus ablations have been performed for various arrhythmical substrates. The aim of this study is to report our experience on pediatric patients of the safety and efficacy of ablations in the coronary sinus. This is a retrospective study of all patients who underwent ablations in the coronary sinus from October 2013 to October 2021 at a single center. Clinical presentation, type of arrhythmia causing tachycardia, ablation procedure, and outcome were recorded. A total of 27 patients were included in the study. Nineteen (69%) of those followed up received a diagnosis of Wolff-Parkinson-White syndrome (WPW), 4 (15%) were cases of supraventricular tachycardia with concealed accessory pathway (AP), 2 (8%) were cases of focal atrial tachycardia, and 2 (8%) were cases of permanent junctional reciprocating tachycardia. Negative delta wave was noteworthy especially in lead II in 11/19 (58%) cases and coronary sinus diverticulum was detected in the WPW cases. Of those with manifest AP (19 cases), 15 (79%) had a high-risk AP and the AP in all WPW cases was adenosine unresponsive. Radiofrequency (RF) catheter ablation was performed in 25/27 (93%) cases during the procedure, and 16/25 (64%) of these were irrigated RF catheters. No complications were observed in the follow-up, including coronary artery injury. Catheter ablation of supraventricular tachyarrhythmias can be accomplished effectively and potentially safely within the coronary sinus. Coronary sinus diverticula should be suspected in patients with manifest posteroseptal APs who have a previous failed ablation and typical electrocardiographic signs.

B-166 Effect of Urine Adulteration on Quantifying both Delta 8- and Delta 9-carboxy tetrahydrocannabinol using a New UPLC-tandem Mass Spectrometry Method

Abstract Background The legality and use of marijuana is a controversial topic. With increased prevalence of usage, cannabis detection for legal, medical, and workforce drug testing is on the rise. LC-MS/MS quantification of delta 9-carboxy tetrahydrocannabinol (delta 9-THC-COOH) in urine is accepted as the standard to detect marijuana use. One challenge faced by testing laboratories has been identifying adulterated samples. Many products/reagents can be used to manipulate the urine to avoid positive drug testing results. In this study, we developed a dilute-and-shoot strategy to separate and quantify both the delta 8- and 9-THC-COOH in urine samples and tested the effects of adulteration using a combination of nitrite and/or acids which can be used to mask cannabinoid use. Methods Five authentic delta 8- and 9-THC-COOH positive specimens, and one spiked sample were treated with strong acids (1N HCL or 10% TCA), 500 µg/mL nitrite, or a combination. After hydrolysis with sodium hydroxide, the analytes were quantified using a 6495 Mass Spectrometer coupled to a StreamSelect LC system (Agilent). LC separation was performed with a CORTECS T3 column utilizing a shallow gradient. In addition, twelve urine specimens with varying concentrations of delta 8- and 9-THC-COOH were treated with nitrite and screened using a delta 9-THC-COOH immunoassay on the Roche Cobas C501 and analyzed by LC-MS/MS. Results Nitrite did not change the physical appearance or the pH of the urine samples. Strong acid treatment also did not alter the appearance but did drop the urine pH ≤2. Pre-treated specimens with 1N HCL, 10% TCA, or 500 µg/mL of nitrite did not affect the delta 8- and 9-THC-COOH concentrations up to 6 days (refrigerated); however, specimens treated with strong acid combined with 500 µg/mL of nitrite for 30 min made both analytes undetectable. Additional experiments confirmed that 0.5 and 1 mol/L of nitrite lowered the concentration of all analytes, including internal standard, to undetectable levels in 48 h. Twelve additional specimens were collected, 3 with delta 8-THC-COOH, 3 with delta 9-THC-COOH, and 6 with both. All 12 samples screened positive using the Roche immunoassay and were quantified using the LC-MS/MS method. After treatment with 0.5 mol/L of nitrite, 10 of the 12 samples were negative using the immunoassay, but 2 samples remained positive. However, all nitrite treated specimens were negative (&amp;lt;LLOQ) using the LC-MS/MS method and the internal standard was eliminated. Later experiments confirmed that the delta 8- and 9-THC-COOH could be eliminated with as little as 0.1 mol/L nitrite for 30 min. Conclusion The unique dilute-and-shoot method can separate and quantify delta 8- and 9-THC-COOH. In addition, high concentrations of nitrite were shown to degrade both analytes along with the isotopically labeled internal standard. As a result, labs can distinguish true negative delta 8- and 9-THC-COOH (no analyte peaks) from nitrite adulterated specimens since the adulterated samples have no peaks for both the analytes and internal standard. A limitation of the study is that only sodium nitrite was tested. Other adulterants, such as potassium nitrite, pyridinium chlorochromate, peroxide etc. require further investigation.

Prognostic biomarkers in metastatic colorectal cancer: delta prognostic nutritional index, delta neutrophil to lymphocyte ratio, and delta platelet to lymphocyte ratio.

The aim of this study is to determine the prognostic value of the prognostic nutritional index (PNI), the neutrophil to lymphocyte ratio (NLR), and the platelet to lymphocyte ratio (PLR) and their dynamic changes on survival outcomes in metastatic colorectal cancers (mCRC). The data of 199 patients with mCRC were retrospectively analyzed. To evaluate the temporal relation between the PNI, NLR, and PLR values and survival, pre-chemotherapy PNI, NLR, and PLR levels were assessed from peripheral blood cell counts on admission; post-chemotherapy PNI, NLR, and PLR levels were assessed with follow-up blood cell counts within two weeks after chemotherapy; and the difference between pre-chemotherapy PNI, NLR, and PLR levels and post-chemotherapy PNI, NLR, and PLR levels was evaluated as delta PNI, delta NLR, and delta PLR. The median PNI, PLR, and NLR were 39.01, 150.2 and 2.53 before chemotherapy and 38.2, 146.6, and 3.31 after chemotherapy, respectively. The median OS was 23.7months (95%CI:17.8-29.7) and 28.9months (95%CI:24.8-33.08) for pre-chemotherapy PNI level < 39.01 vs. PNI level ≥ 39.01, respectively(p = 0.035) The positive delta PNI was significantly higher for OS than the negative delta PNI(p < 0.009). Delta PLR and delta NLR were not significant for OS and PFS(p > 0.05 for all). The results of this study clearly show that the negative delta PNI to be an independent predictor of poor OS and poor PFS in patients with colon cancer who received first line treatment. In addition, delta NLR and delta PLR were shown not to predict survival outcomes.

Two types of Tibetan Plateau vortex genesis in June and the associated mechanisms

The Tibetan Plateau vortex (TPV) is a key system triggering rainfall over the Tibetan Plateau (TP) during the boreal summer. The TPV genesis mechanisms are complicated and its classification is a great challenge. This study attempts to elucidate these aspects. By introducing the standardized index of 24-h increment of equivalent potential temperature Delta_{24h} theta_{{text{e}}} at 500 hPa, all the TPV cases generated in June between 1980 and 2016 are classified as either positive or negative. Composite analysis is subsequently applied to the extremes of these two types, i.e., the first and last fifth-percentile cases with extremely negative and positive standardized Delta_{24h} theta_{{text{e}}}, respectively. Results indicate that 70% of them occur in relatively warmer and wetter environments, with diabatic heating dominating the positive type and the dynamic effect of large-scale circulation dominating the negative type. For the extremely positive cluster, the geopotential-height increment over the TP exhibits a negative/west–positive/east dipole, which enhances the southerly flow over the western TP, while forming surface water–vapor convergence. Consequently, strong condensation heating occurs near the sub-cloud level, resulting in the development of potential vorticity below and eventually TPV genesis. For the negative cluster, local shear lines at 500 hPa and upstream troughs at 250 hPa occur at the TPV genesis location. In conjunction with anomalous westerlies, positive potential vorticity is generated in situ due to zonal advection. The retardation caused by the Kunlun Mountains on the impinging westerly flow associated with side-boundary friction also contributes to TPV genesis southeast of the mountains.

PO-03-142 ABLATION OF EPICARDIAL POSTEROSEPTAL ACCESSORY PATHWAYS IN CHILDREN

Epicardial posteroseptal accessory pathways (Epi-PSAPs) within the coronary sinus (CS) are a rarely reported ablation target in children. They are often associated with abnormal CS anatomy as well as risk of coronary artery (CA) injury. To assess characteristics associated with successful outcome of Epi-PSAP ablation in children. Retrospective cohort study at a tertiary care institution including all patients aged ≤18 years who underwent ablation of Epi-PSAP from 2000-2022. Clinical/electrophysiological characteristics and outcomes were analyzed. Epi-PSAP was targeted in 19 patients. Mean age at procedure was 13.4 (12.1-14.7) years, mean weight was 62.5 (47-78) kg. Prior ablations had been attempted in 7/19 patients. Ventricular preexcitation was present in 12/19 (63%) patients, with steep negative delta wave in lead II in all cases, and 8/12 (67%) demonstrating high risk antegrade conduction. CS angiogram to define the anatomy was performed in all patients. In 5/5 (100%) of cases where CS diverticulum was identified by CS angiogram, it proved to be the ablation target. CA angiogram to define arterial proximity (5mm cutoff) was obtained in 17/19 (90%). CA system was right dominant in 10/17 (59%), and closest arteries were ≥5mm away from the target in 11/17 (65%). Primary energy was RF in 12/19 (63%, artery ≥5mm) and cryo in 7/19 (37%, artery <5mm). Ablation was acutely successful in 18/19 (95%) patients, chronically successful in 15/18 (83%) of patients, over 98.2 (57.8-138.7) months of follow up.There was no apparent difference in outcome between ablation sites in 1) coronary vein; 2) CS diverticulum; or 3) floor of CS (FIG1.A.). The presence of a sharp unipolar accessory pathway potential (FIG1.B.) at the target site was significantly associated with acute (p=0.003) and chronic (p=0.005) success. Choice of energy was not significantly associated with outcome. Performance of CS angiogram (FIG1.C) was significantly associated with acute (p=0.04) and chronic (p=0.03) success when all ablation attempts were analyzed. There was no incidence of major adverse events. Majority of Epi-PSAP in children are manifest with high risk antegrade conduction properties. They can be ablated with RF energy when the coronary arteries are ≥5mm from ablation target, or alternatively with cryoablation. Localizing a sharp unipolar AP potential, identification of CS anatomy by CS angiogram, and delineation of arterial proximity by CA angiogram are associated with successful ablation.

Paraspinal muscles atrophy on both sides and at multiple levels after unilateral lumbar partial discectomy.

To identify the changes in cross-sectional areas (CSAs) and fatty infiltration of both sides of the paravertebral muscles and their associations with prognostic factors in patients who underwent unilateral lumbar discectomy. We retrospectively reviewed 27 patients who underwent magnetic resonance imaging before and after 1- or 2-level lumbar discectomy. The CSAs and functional cross-sectional areas of the paraspinal muscles were bilaterally measured from L1 to L2 to L5 to S1 based on T2-weighted axial images. These parameters were compared pre-and postoperatively. CSAs and functional cross-sectional areas decreased also in non-operative, non-surgical levels, not only in operated levels after discectomy. In the correlation analysis, the CSA of psoas major muscle at L1 to L2 was significantly decreased in patients with lower preoperative lordosis (r = 0.598, P = .040). The postoperative CSA of psoas major muscle at L4 to L5 was lower in those with the higher Pfirrmann grade (r = -0.590, P = .002); however, the CSA of quadratus lumborum muscle at L1 to L2 showed the opposite result (r = 0.526, P = .036). Similar results were also observed in the partial correlation adjusted for age and postoperative duration. Patients who underwent discectomy experienced overall paraspinal muscle atrophy in the lumbar region, including surgical and non-surgical sites. Such atrophic changes emphasized the need for core strengthening and lumbar rehabilitation from the early period after partial discectomy.

Behavior of the components of carbon-containing ash from the combustion of power coals under the conditions of chlorination roasting

On the basis of thermodynamic calculations of interaction reactions between mullite, oxides of titanium, iron, and Cl2 (gas) in the presence of carbon, the values of the Gibbs free energy are determined in the current work. It has been established that the probability of reactions occurring in the temperature range 1073&ndash;1473 K is very high. The most negative value &Delta;G&deg;Т = &ndash;1029.9 kJ/mol is typical for the titanium oxide reduction reaction at the roasting tem- perature (1100 &deg;С). The value of the Gibbs free energy of the destruction reaction of mullite (Al2SiO5), which is important for practice, is &Delta;G&deg;Т = &ndash;269.2 kJ/mol. This makes it possible to predict the complete decomposition of mullite from ash to easily soluble aluminum chloride under the conditions of chlorination roasting. The study of the behavior of carbon under the conditions of chlorination roasting of ash with CaCl2&nbsp;in an oxidizing atmosphere is also important. The results of the differential thermal analysis of the non-magnetic fraction of ash, previously separated from the TPP ash by magnetic separation, showed clearly defined manifestations on the DTA, DTG and TG curves, caused by the presence of various types of reactions in the system. Low-temperature (20&ndash;115 &deg;C) sample dehydration and ash dehydration were determined in the temperature range of 115&ndash;375 &deg;C. In the range of further heating of the sample (375&ndash;685 &deg;C), an exothermic projection was found on the DTA curve, which is characteristic of the oxidation of thermally active carbon present in the powder. The amount of carbon removed from the ash established as 6.75% by weight of the sample. The research was carried out within the framework of grant funding&nbsp;from the Committee of Science of the Ministry of Education and&nbsp;Science of the Republic of Kazakhstan for 2021&ndash;2023 in the priority&nbsp;area &ldquo;Geology, mining and processing of mineral and hydrocarbon raw&nbsp;materials, new materials, technologies, safe products and structures&rdquo;&nbsp;of project No. АР09259637 &ldquo;Development of a highly efficient wastefree&nbsp;technologies for the utilization of ash from coal combustion with the&nbsp;production of marketable products.

Predictive Ability of Coronary Artery Disease on Age Acceleration and Clinical Outcome in Adult Acute Myelogenous Leukemia

Background: Aging is strongly associated with hematologic malignancies. Chronological age (CA) fails to explain biological and clinical outcome differences among AML patients (pt) at same age. Phenotypic age (PA) has gained momentum to predict cause-specific mortality in individuals sharing similar CA. Age acceleration (AA), resulting from the difference between phenotypic or methylation age (MA) and CA correlates with all-cause mortality. Similarly, Clonal Hematopoiesis of indeterminate Prognosis (CHIP) is associated with AA [PMID: 34050697]. CHIP mutations (mut) may be inherited into AML from preexisting immortalized/transformed cells. Cells harboring CHIP induce inflammation and "accelerate" vascular complications [i.e coronary artery disease (CAD)]. In this study, we seek "proof of clinical concept" for an association between AA and AML outcome when accounting for the presence or not of CAD. Methods: After IRB approval, AML pt were selected to estimate PA based on "proposed score 9 clinical biomarker's score" [PMID: 29676998] including albumin, creatinine, glucose, c-reactive protein, lymphocyte percent, red cell mean cell volume, red distribution width, alkaline phosphatase, white blood count). PA was calculated at AML onset. Difference between PA and CA was recorded as Delta PA-CA. Positive and negative delta PA-CA were considered as AA vs rejuvenation. Given the association between inflammation, CAD and CHIP, we performed individual correlation survival analysis accounting for phenotypic age in AML pt with and without CAD. Descriptive statistics, univariate and multivariate analysis were performed using SAS software. Results: 81/253 (32%) AML pt were available. Pearson correlation revealed that in pt without CAD, PA negatively correlated with survival (R= -0.31, p= 0.04), an effect not observed among AML pt with established CAD (R= -0.10, p=0.52). With AML pt lacking CAD [42/81(51%)] representing our population of interest, median CA, PA and MA among pt with (N=31) or without (N=11) AA was 53 years (y) v 49, p=0.5, 84 v 44, p= 0.0001 and 79 v 44, p=0.0001. WBC was 27 K/uL v 32.4 K/uL, p=0.5, in pt with and without AA. Favorable (fav) ENL-2017 was 33% vs 18%, p=0.1, Int 11% vs 18%, p=NS and unfav 56% v 64%, p=NS in pt with and without AA. Overall survival (OS) was 439 d vs not reached (NR), in pt with and without AA, p=0.03, HR=6.5 CI 2.2-19.4. Multivariate cox regression considering ELN-2017 classification, age and PA revealed that only AA was independent predictor of outcome, p=0.03, HR-1.02, CI=1.002-1.03. Conclusions: AA is associated with inferior AML outcome without overt CAD. In our proof of concept cohort, and acknowledging small sample size, AA supersedes ENL-2017 classification and CA as predictors of inferior outcome in AML. Our study adds insight on how AA based on epigenetic clock estimation potentially influences not only leukemogesis, but also renders organ function inability to survive AML. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Could cardiac autonomic modulation be an objective method to identify hypobaric hypoxia symptoms at 25.000ft among Brazilian military airmen?

Hypobaric hypoxia during a flight can cause accidents, resulting in deaths. Heart rate variability may be more sensitive than self-reported hypoxia symptoms to the effects of HH. The level of physical fitness can contribute to efficient cardiac autonomic modulation. However, no studies have examined the association between fitness, heart rate variability, and the time of onset of hypobaric hypoxia symptoms. To analyze the influence of hypobaric hypoxia on cardiac autonomic function at the time of onset of the first symptoms and its association with physical fitness. Male airmen trained and belonging to the staff of the Brazilian Air Force (n = 23; 30 ± 6.7years) participated in a flight simulation in a 25.000ft hypobaric chamber. Heart rate variability was recorded with a Polar® cardiac monitor. Data were analyzed in the time-domain method using Kubios software. We evaluated pulse oximetry with the Mindray PM-60 oximeter. Physical fitness assessment test results were collected from the archive. At moments rest vs. hypoxia revealed a decrease in heart rate variability indices iRR and RMSSD (p < 0.001). The individual analysis of hypoxia-rest variation showed that 100% of the airmen had a negative delta for both iRR and RMSSD indices. The time of onset of hypoxia symptoms was not associated with body composition, physical fitness, oxygen saturation, and HRV indices. Also, we suggest that cardiac autonomic modulation seems to be more sensitive to the effects of hypobaric hypoxia at 25.000ft than the self-reported subjective perception of symptoms. Further devices that alert to a hypoxic condition during a flight should consider heart rate variability allowing more time and security to reestablish control of the flight.

Electrocardiographic criteria for localization of ventricular premature complexes from the inferior right ventricular outflow tract.

BackgroundThe ventricular premature complexes (PVCs) originating from the superior right ventricular outflow tract (RVOT) have high success rates by catheter ablation. It may not be the same when the origin is in the inferior RVOT.ObjectiveTo identify electrocardiographic (ECG) characteristics that predict the site for successful ablation of PVCs originating in the inferior RVOT.MethodsOf 309 consecutive patients with symptomatic PVCs despite medical therapy, 124 had PVCs originating from the RVOT, and 107 RVOT cases without structural heart disease and no bundle branch block in sinus rhythm were enrolled in the study. Among them, 74 have a superior RVOT origin, and 33 have an inferior RVOT origin.ResultsThe proportion with multiple morphologies of PVC was significantly higher in the inferior RVOT group than in the superior RVOT group (24.24 vs. 6.76%, P = 0.011). The QRS duration of PVCs with an inferior RVOT origin was more expansive than PVCs with a superior RVOT origin (162.42 ± 19.69 ms vs. 140.90 ± 11.30 ms; P < 0.001). Furthermore, the QRS wave in V1 in patients in the inferior RVOT group was more likely to have a negative delta wave at the onset of the QRS (27.27 vs. 1.39%, P < 0.001). We found that the areas under the receiver-operating characteristic curve (AUCs) for PVC diagnosis with an inferior RVOT origin ranged from 0.812 to 0.841 depending on ECG features, with the highest AUC for the QRS duration of PVCs and the amplitude of R waves in lead II. These ECG indices had good predictability for judging the origin of PVCs in the RVOT; the best threshold for the QRS duration of PVCs was 145 ms, and the best thresholds for the amplitude of R waves in leads II, III, and aVF were 1.35, 1.35, and 1.15 mV, respectively.ConclusionWhen evaluating a patient with PVCs, the source is likely to be the inferior RVOT if the ECG presentation conforms to the morphological characteristics of the RVOT, meanwhile, the QRS wave is relatively broad and polymorphic, and the main waves in limb leads (II, III, and aVF) are upward with low amplitude.

Therapeutic Effects of Modified Tempeh on Glycemic Control and Gut Microbiota Diversity in Diabetic Rats

Background: The role of the gut microbiota in improving glycemic control in diabetic patients is gaining attention. Tempeh is a fermented soy food from Indonesia that has antidiabetic and antidysbiotic effects. Interestingly, modification of tempeh processing by adding lactic acid bacteria has been reported to enhance the antidiabetic effect of tempeh. Aim: This study aimed to evaluate the effects of modified tempeh on serum glucose, insulin, and gut microbiota diversity of diabetic rats. Methods: Modified tempeh was developed by adding lactic acid bacteria from fermented cassava during tempeh processing. Diabetes was induced by injection of streptozotocin nicotinamide. Normal tempeh or modified tempeh was added to the diet and replaced 15% or 30% of casein. Serum glucose and insulin were analyzed before and after 30 days of intervention. At the end of the experiment, the appendix was sampled for gut microbiota analysis. Result: Modified tempeh has a significantly higher number of lactic acid bacteria (9.99 ± 0.09 versus 7.74 ± 0.07 log CFU, p &lt; 0.001) compared to normal tempeh. There was a significant difference (p &lt; 0.01) in serum glucose and insulin after treatment. Both tempeh supplements increased the diversity of the gut microbiota. Gut microbiota diversity has a strong negative correlation with delta glucose (r = -0.63, p &lt; 0.001) and delta insulin resistance index (r = -0.54, p = 0.003). Conclusion: Modified tempeh has potential therapeutic antidiabetic activity, possibly through increased diversity of the gut microbiota.

ABCL-007 Semiquantitative Measurements of Standard-Uptake-Value (ΔSUV) in Assessment of Patients Response and Outcomes in Aggressive Lymphomas

Positron emission tomography (PET) with 18-fluoro-2-deoxy-D-glucose ([18 F] FDG) is an essential tool for accurate staging, early, and late therapy response assessment in all FDG-avid lymphomas. To evaluate the accuracy of ΔSUV max in assessment of response to treatment in patients with lymphoma. This study was conducted between October 2019 and October 2021. Seventy-three patients diagnosed as high-grade lymphoma or Hodgkin disease (HD) were enrolled in the study. PET/CT examinations were performed at baseline (PET0), after the second, the fourth cycle of chemotherapy and at the end of treatment. PET-CT scans were analyzed according to the Deauville 5-point scale (5-PS). According to SUV-based assessment, PET/CT was considered negative when ΔSUV max at 2nd cycle (PET0-2) is more than 66% and ΔSUV max at 4th cycle (PET0-4) is more than 70%, respectively. The change in activity (ΔSUV) from initial (SUVmax1) to later scans (SUVmax2) was calculated as: SUV (%) = 100 x ([SUVmax2/SUVmax1] -1). Biopsy was taken if PET 2 or 4 is visually positive with negative delta SUV max, or in case of new lesions if other sites have improved. SUV uptake values at baseline were 16.30 ± 9.36 in NHL versus 12.55 ± 6.78 in HL. After 2 cycles of chemotherapy, (78.1%) had negative PET based on ΔSUV max raised to (86.3%) by the end of 4th cycle and this was different from 5PS where only (60.5%) raised to (74.4%) after the 4th cycle. In comparison with results of biopsy, ΔSUV0-2 has sensitivity 80%, specificity 94.1%, accuracy 90.91 % with P value (0.001) also, ΔSUV0-4 has sensitivity 80%, specificity 100%, accuracy 95.45 % with high agreement with P value (<0.001). On the contrary, the visual 5-PS analysis 0-2 specificity 17.65%, accuracy 36.36 with P value (<0.321). Also, the visual 5-PS analysis 0-4 specificity 41.18 %, accuracy 54.55% with P value (<0.082). After 4 cycles 22 patients needed to undergo biopsy because inconclusive results of PET. Comparison reveled that using ΔSUV max demonstrated higher specificity. ΔSUV max is comparable to biopsy and significantly more accurate than Deauville criteria in assessment of response to treatment.

Association between prehospital shock index variation and 28-day mortality among patients with septic shock

PurposeSeptic shock (SS) hyperdynamic phase is characterized by tachycardia and low-blood pressure reflecting the relative hypovolemia. Shock index (SI), the ratio between heart rate and systolic blood pressure, is a simple objective tool, usable for SS prognosis assessment.This study aims to evaluate the relationship between prehospital SI variation and 28-day mortality of SS patients initially cared for in prehospital setting by a mobile intensive care unit (mICU).MethodsFrom April 6th, 2016 to December 31st, 2020, 406 patients with SS requiring prehospital mICU were retrospectively analyzed. Initial SI, i.e. first measurement after mICU arrival to the scene, and final SI, i.e. last measurement of the prehospital stage, were used to calculate delta SI (initial SI—final SI) and to define positive and negative delta SI. A survival analysis after propensity score matching compared the 28-day mortality of SS patients with positive/negative delta SI.ResultsThe main suspected origins of infection were pulmonary (42%), digestive (25%) and urinary (17%). The 28-day overall mortality reached 29%.Cox regression analysis revealed a significant association between 28-day mortality and delta SI. A negative delta SI was associated with an increase in mortality (adjusted hazard ratio (HRa) of 1.88 [1.07–3.31] (p = 0.03)), whereas a positive delta SI was associated with a mortality decrease (HRa = 0.53 [0.30–0.94] (p < 10–3)).ConclusionPrehospital hemodynamic delta SI among SS patients cared for by a mICU is associated with 28-day mortality. A negative prehospital delta SI could help physicians to identify SS with higher risk of 28-day mortality.