ARTICLE | doi:10.20944/preprints202306.0467.v1
Subject: Medicine And Pharmacology, Cardiac And Cardiovascular Systems Keywords: cardiac magnetic resonance; T1 mapping; Late gadolinium enhancement; T2-STIR
Online: 6 June 2023 (14:48:58 CEST)
We sought to compare native T1 mapping to conventional Late gadolinium enhancement (LGE) and T2-STIR techniques in a cohort of consecutive patients undergoing cardiac MRI (CMR).. CMR was performed in 323 patients, 206 males (64%), mean age 54±8 years and in 27 age- and sex- matched healthy controls. At T2-STIR images myocardial hyperintensity suggesting edema was found in 41 patients (27%). LGE images were positive in 206 patients (64%). T1 mapping was abnormal in 171 (49%). In 206 patients (64%) a matching between LGE and native T1 was found. T1 was abnormal in 32 out of 41 (78%) with edema at T2-STIR. Overall, LGE and/or T2-STIR were abnormal in 209 patients, whereas native T1 in 154(52%). Conventional techniques and T1 mapping were concordant in 208 patients (64%). In 39 patients T1 mapping was positive despite negative conventional techniques (12%). T1 mapping was able in conditions with diffuse myocardial damage as cardiac amyloidosis, scleroderma and Fabry disease (additive role in 42%). On contrast, T1 mapping was less effective in cardiac disease with regional distribution of myocardial damage as myocardial infarction, HCM, myocarditis. In conclusion, conventional LGE/T2-STIR and T1 mapping are complementary techniques and should be used together in every CMR examination.
ARTICLE | doi:10.20944/preprints201703.0156.v2
Subject: Engineering, Electrical And Electronic Engineering Keywords: CBIR; , Late Fusion; SVM; BOVW
Online: 21 March 2017 (03:49:41 CET)
One of the challenges in Content-Based Image Retrieval (CBIR) is to reduce the semantic gaps between low-level features and high-level semantic concepts. In CBIR, the images are represented in the feature space and the performance of CBIR depends on the type of selected feature representation. Late fusion also known as visual words integration is applied to enhance the performance of image retrieval. The recent advances in image retrieval diverted the focus of research towards the use of binary descriptors as they are reported computationally efficient. In this paper, we aim to investigate the late fusion of Fast Retina Keypoint (FREAK) and Scale Invariant Feature Transform (SIFT). The late fusion of binary and local descriptor is selected because among binary descriptors, FREAK has shown good results in classification-based problems while SIFT is robust to translation, scaling, rotation and small distortions. The late fusion of FREAK and SIFT integrates the performance of both feature descriptors for an effective image retrieval. Experimental results and comparisons show that the proposed late fusion enhances the performances of image retrieval.
ARTICLE | doi:10.20944/preprints201907.0148.v1
Subject: Biology And Life Sciences, Horticulture Keywords: tomato; late blight; miRNA; overexpression; resistance
Online: 10 July 2019 (11:07:07 CEST)
Tomato is the highest-value fruit/vegetable crop worldwide. However, the quality and yield of tomatoes are severely affected by late blight. MicroRNA482s (miR482s) are involved in plant immune system. In this study, miR482c was transiently and stably overexpressed in tomatoes in transgenic plants to explore its mechanism in tomato resistance against late blight. Tomato in transgenic plants transiently overexpressed miR482c displayed larger lesion area than the control plants upon infection. Furthermore, compared with the WT tomato plants, the transgenic tomato plants stably overexpressing miR482c displayed decreased expression of target genes accompanied by lower POD, SOD, and PAL activity activities and higher MDA content, thereby leading to a decline in the ROS scavenging ability and aggravating the damage of lipid peroxidation product accumulation on the cell membrane, eventually enhancing plant susceptibility. This finding indicates that miR482c may act as a negative regulator in tomato resistance by regulating NBS-LRR expression levels and ROS levels.
Subject: Biology And Life Sciences, Biochemistry And Molecular Biology Keywords: Late blight; PVY; Ryadg; quality control; KASP
Online: 4 October 2021 (17:37:19 CEST)
Phytophthora infestans (Mont.) de Bary causing potato late blight (LB) and potato virus Y (PVY), are serious constraints to cultivated potatoes causing important yield reduction, and phenotyping for resistance is challenging. Breeding operations for vegetatively propagated crops can lead to genotype mislabeling that in turn reduces the genetic gain. Low-density and low-cost molecular marker assessment for phenotype prediction and quality control stands as a viable option for breeding programs. We report here the development of Kompetitive Allele Specific PCR (KASP) markers for LB and PVY resistance, and for quality control assessment, and their routine use in different breeding populations. Two KASP markers for LB resistance and two for PVY Ryadg were validated with an estimated assay power ranging between 0.65 and 0.88. Developed QC KASP markers demonstrated the power of tetraploid calls in discriminating the breeding material, including full sibs and half sibs. The routine implementation of developed markers in a breeding program will allow a better allocation of resources and a precise characterization of the breeding material, leading to an increased genetic gain.
ARTICLE | doi:10.20944/preprints201712.0064.v1
Subject: Social Sciences, Psychology Keywords: sex differences; suicide attempt; late life; depression; physical disability
Online: 11 December 2017 (13:04:01 CET)
Relatively little research attention has been paid to sex issues in late life suicidal behaviour. The aim was to compare clinical characteristics of women and men aged 70+ who were hospitalized after a suicide attempt. We hypothesized higher depression and anxiety scores in women, and we expected to find that men would more often attribute the attempt to health problems and compromised autonomy. Participants (56 women and 47 men, mean age 80) were interviewed by a psychologist. In addition to psychiatric and somatic health assessments, participants responded to an open-ended question concerning attributions of the attempt. There were no sex differences in depression and anxiety, but women were more likely to report that they found their situation hopeless (67.9% vs. 43.8%, p = 0.02). At least one serious physical disability was noted in 60.7% of the women and 53.2% of the men (p = 0.55). Proportions attributing their attempt to somatic illness did not differ (women, 14.5% vs. men 17.4%, p = 0.79), and similar proportions attributed the attempt to reduced autonomy (women, 21.8% vs. men, 26.1 %, p = 0.64). The unexpected lack of sex differences might be influenced by cultural context in which sex norms play a part.
ARTICLE | doi:10.20944/preprints202008.0367.v1
Subject: Social Sciences, Tourism, Leisure, Sport And Hospitality Keywords: Museums; special events; late opening; visitors' motivations; sustainability, touristic attractions
Online: 17 August 2020 (12:11:29 CEST)
The urban museum has become a multi-functional institution that transcends the functional display of artifacts. The museum has become, in cities, a hybrid institution that keeps its doors open late to support a wide variety of special events. This study explored London’s ‘Museum Lates’ programs and event characteristics, using museums’ theoretical views as cultural tourism attractions. Furthermore, the study applied the contextual model of learning to understand visitor attendance motivations. Authors employed an interpretive approach using interviews with two types of participants, event visitors, and event coordinators. Findings suggested that attendees possess a complex of personal, physical, and socio-cultural motivations for participating in museum lates events. The characteristics of late events – extraordinary quality and evening time atmosphere – produce different effects than current museum exhibitions held during regular operating hours. Museum lates events can contribute to achieving cultural sustainability, adding cultural construct to the traditional three-pillars of sustainability. Keywords: Museums; special events; late opening; visitors' motivations; sustainability, touristic attractions
ARTICLE | doi:10.20944/preprints201806.0378.v1
Subject: Physical Sciences, Astronomy And Astrophysics Keywords: stellar evolution; late stage stellar evolution; binarity; transients; planetary nebulae
Online: 25 June 2018 (10:30:21 CEST)
Intermediate-luminosity-optical-transients (ILOTs) are stellar outbursts with luminosity between those of classical novae and supernovae. They are divided into a number of sub-groups depending on the erupting progenitor and the properties of the eruption. Many of the ILOTs sit on the slanted Optical Transient Stripe (OTS) in the Energy-Time Diagram (ETD) that shows their total energy vs. duration of their eruption. We describe the different kinds of ILOTs that populate the OTS and other parts of the ETD. We also stand on similarities between Planetary Nebulae (PN) to ILOTs, and suggest that some PNe were formed in an ILOT event. The high energy part of the OTS is reserved to the supernova impostors -- giant eruption of very massive stars. We show results of 3D hydrodynamical simulations of supernova impostors that expose the mechanism behind these giant eruptions, and present new models for recent ILOTs. We stand on the connection between different kinds of ILOTs, and suggest that they are powered by a similar source of energy -- gravitational energy released by mass transfer.
ARTICLE | doi:10.20944/preprints202201.0284.v2
Subject: Arts And Humanities, Archaeology Keywords: urban; rural; millet; garden; orchard; Iberian Peninsula; High/Late Middle Ages
Online: 15 November 2022 (01:09:03 CET)
Towns emerged as dynamic economic and political centers during the Middle Ages, giving rise to the emergence of new social classes. As a result of these functions, a new relationship began to be forged with the rural world, which supplied towns with foodstuffs that satisfied new social demands. Archaeobotanical analysis (carpology) allows us to understand the flow of cash crops by tracing seeds and fruits produced in the countryside that were consumed in and redistributed from the towns. The study of waterlogged contexts from medieval archaeological sites in the Kingdom of Galicia (Santiago de Compostela, Padrón, and Pontevedra) has provided a set of species that played a crucial role in the economy of the urban dwellers and that possibly were related to differential access or food preferences. Evidence for fruits (grapes, chestnuts, figs, apples, and cherries, among others), garden crops (melon), and cereals (foxtail millet, rye, naked wheat, and oat) has been documented. Broomcorn millet is particularly abundant, demonstrating that it was important for subsistence. Some of the species found (medlar and turnip/grelo) are novel in the archaeobotanical literature of the medieval period in the Iberian Peninsula.
ARTICLE | doi:10.20944/preprints202209.0336.v1
Subject: Biology And Life Sciences, Horticulture Keywords: Walnut diversity; germplasm evaluation; late-leafing; pomological characteristics; superior geno-types
Online: 22 September 2022 (08:47:22 CEST)
Evaluating genetic diversity in walnut (Juglans regia L.) populations is a rapid approach used by walnut breeding programs to distinguish superior genotypes. The present study identified the Hamedan province walnut population as one of the richest, most genetically diverse regions in Iran during 2019-2020. After initial screening, 47 genotypes were selected for further evaluation of pomological and phenological traits based on International Plant Genetic Resources Institute (IPGRI) descriptors. Nut and kernel weights among the selected genotypes ranged between 7.15-21.05 g and 3.0-10.8 g, respectively. Principal component analysis (PCA) categorized genotypes into three distinct groups while cluster analysis (CA) further categorized genotypes into one of four groups. Spearman correlation analysis showed a positive correlation (P <0.01) between nut weight (NWT), nut size, and kernel weight (KW) while a negative correlation (P <0.01) between shell thickness (STH) and packing tissue thickness (PTT) with kernel percentage (KP) was observed. Lastly, 10 of 47 genotypes (TAL8, TAL9, TAL10, TAL14, TAL19, TAL22, TB2, TB4, TB6, and RDGH5) were considered superior. Superior genotypes were late-leafing (25-40 days after the standard) and displayed a lateral bearing (LB) habit with heavy nuts (12.52–16.82 g) and kernels (6.53–8.15 g), thin-shells (1.06–1.25 mm), and lightly-colored kernels. Cuttings of superior genotypes were then grafted in the orchard. Detecting superior and late-leafing genotypes in this investigation suggests cultivars resistant to late-spring frost may soon be isolated.
ARTICLE | doi:10.20944/preprints202008.0209.v1
Subject: Computer Science And Mathematics, Artificial Intelligence And Machine Learning Keywords: Sign Language Recognition; Multi-modality; Late Fusion; multi-sensor; Gesture Recognition
Online: 8 August 2020 (17:28:00 CEST)
In this work, we show that a late fusion approach to multi-modality in sign language recognition improves the overall ability of the model in comparison to the singular approaches of Computer Vision (88.14%) and Leap Motion data classification (72.73%). With a large synchronous dataset of 18 BSL gestures collected from multiple subjects, two deep neural networks are benchmarked and compared to derive a best topology for each. The Vision model is implemented by a CNN and optimised MLP and the Leap Motion model is implemented by an evolutionary optimised deep MLP topology search. Next, the two best networks are fused for synchronised processing which results in a better overall result (94.44%) since complementary features are learnt in addition to the original task. The hypothesis is further supported by application of the three models to a set of completely unseen data where a multi-modality approach achieves the best results relative to the single sensor method. When transfer learning with the weights trained via BSL, all three models outperform standard random weight distribution when classifying ASL, and the best model overall for ASL classification was the transfer learning multi-modality approach which scored 82.55% accuracy.
ARTICLE | doi:10.20944/preprints202305.0763.v1
Subject: Environmental And Earth Sciences, Geochemistry And Petrology Keywords: High Ba-Sr granitoids; Late Ordovician; Subduction; Proto-Tethys; North Qilian orogen
Online: 10 May 2023 (14:32:41 CEST)
The petrogenesis of high Ba-Sr granitoids provide a great significance to penetrate the Proto-Tethys evolution in the North Qilian orogenic belt. This paper presents a combination of zircon U-Pb age, whole-rock major and trace element concentrations, and Sr-Nd-Hf isotopic data for Caowa high Ba-Sr dioritic intrusion from the eastern part of the North Qilian orogenic belt, aiming to decipher its petrogenesis and tectonic setting. LA-ICP-MS zircon U-Pb dating yields an emplacement age of 447±3 Ma for the Caowa intrusion, indicating a magmatic activity of the late Ordovician. The Caowa quartz diorites contain moderate contents of SiO2, MgO, Mg# and resultant high concentrations of Na2O+K2O, Fe2O3T and Al2O3, displaying calc-alkaline and metaluminous characteristics. Their relatively elevated Ba (up to 1165 ppm) and Sr (561 to 646 ppm) contents, with obvious enrichment in LILEs (e.g. Ba、Th、U) and depletion in HFSEs (e.g. Nb、Ta、Ti) resemble those of typical high Ba-Sr granitoids in subduction zone. Together with enriched Sr-Nd isotopic compositons[(87Sr/86Sr)i=0.7082−0.7086, εNd(t)= -5.1 to -4.9], and relatively extensive εHf(t) values (-13.2 to +8.5) of zircons, it suggests that these high Ba-Sr quartz diorites were derived from a mixture magma source between the ancient crust materials and the enriched lithospheric mantle metasomatised by fluid was released from subducted oceanic crust or sediment. Taking into account the ophiolites, high pressure metamorphic rocks and arc magmatic rocks in the region, we infer that affected by the northward subduction of the Qilian Proto-Tethys ocean, the Laohushan oceanic crust of the North Qilian back-arc basin was subducted during the Late Ordovician and resulted in extensive metasomatism of lithospheric mantle by fluids derived from oceanic crust or sediments, and the Caowa high Ba-Sr quartz diorites generated in the process of crust-mantle interaction during the Late Ordovician.
REVIEW | doi:10.20944/preprints202210.0200.v1
Subject: Medicine And Pharmacology, Cardiac And Cardiovascular Systems Keywords: Fabry disease; Cardiac magnetic Resonance; T1 mapping; Late gadolinium enhancement; Feature tracking.
Online: 14 October 2022 (03:25:53 CEST)
Fabry disease (FD) is a X-linked inheritable storage disease caused by deficiency of al-pha-galactosidase causing lysosomal overload of sphingolipids. FD cardiomyopathy is character-ized by left ventricular (LV) hypertrophy and should be considered in differential diagnosis with all the other causes of LV hypertrophy. An early diagnosis of FD is very important because the enzyme replacement therapy (ERT) may change the fate of patients by blocking both cardiac and systemic involvement and improving prognosis. Diagnosis may be relatively easy in young patients with the typical signs ans symptoms of FD, but in male patients with late onset of disease and in females, diagnosis may be very challenging. Morphological and functional aspects are not specific for FD, which cannot be diagnosed or excluded by echocardiography. Cardiac magnetic resonance (CMR) with tissue characterization capability, is the preferred technique for the differential diagnosis of LV hypertrophy. The finding of decreased myocardial T1 value in LV hypertrophy is very specific for FD. Late gadolinium enhancement (LGE) is found in late stage of disease but it is useful to predict the cardiac response to ERT and to stratify the prognosis.
ARTICLE | doi:10.20944/preprints202001.0321.v1
Subject: Biology And Life Sciences, Agricultural Science And Agronomy Keywords: late blight; mating type; mefenoxam; metalaxyl; potato; SSR genotyping; race structure; tomato
Online: 27 January 2020 (07:28:44 CET)
Late blight caused by the oomycete pathogen Phytophthora infestans is a devastating disease of potato and tomato worldwide, including Israel. The population structure of this pathogen was monitored in potato and tomato fields in Israel during a 36-year period of 1983-2019. Isolates of the pathogen were tested for sensitivity to phenylamide fungicides, mating type, race structure, and genotype. The phenotypic and genotypic structure of the population from potato have changed greatly from one year to another, from one season to the next, within a season and within a single field. Major changes also occurred in the population collected from tomato crops. The mechanisms driving these multiple changes and the heterogeneous nature of the population in Israel are shown to derive from multiple migration events of the pathogen via seed tubers from Europe and from fitness-driven selection processes.
ARTICLE | doi:10.20944/preprints202306.0476.v2
Subject: Cardiac And Cardiovascular Systems, Medicine And Pharmacology Keywords: Late potentials; signal-averaged electrocardiogrhy; heart rate variability; fatal arrhyrthmia; sudden cardiac death
Online: 8 June 2023 (03:37:05 CEST)
Abstract: Background and Objectives: Holter-based late potentials (LPs) are useful for predicting lethal arrhythmias in organic cardiac diseases. Although Holter-based LPs exhibit diurnal varia-tion, no studies have evaluated the optimal timing of LP measurement over 24 h for predicting lethal arrhythmia that leads to sudden cardiac death. Thus, this study aimed to validate the most effective timing for Holter-based LP testing and to explore factors influencing diurnal variability of LP parameters. Materials and Methods: We retrospectively analyzed 126 patients with post-myocardial infarction (MI) status and 60 control participants who underwent high-resolution Holter electrocardiography. Among the 126 post-MI patients, 23 developed sustained ventricular tachycardia (VT) (the MI-VT group), while 103 did not (the MI-non-VT group) during the obser-vation period. Holter-based LPs were measured at 0:00, 4:00, 8:00, 12:00, 16:00, and 20:00, and heart rate variability analysis was simultaneously performed to investigate factors influencing diurnal variability of LP parameters. Results: Holter-based LP parameters showed diurnal variation with significant deterioration at night and improvement during the day. Assessment at the time with the longest duration of low-amplitude signals <40 μV in the filtered QRS complex terminus (LAS40) gave the highest receiver operating characteristics curve (area under the curve, 0.659) and the highest odds ratio (3.75; 95% confidence interval, 1.45–9.71; p=0.006) for predicting VT. In the multiple regression analysis, heart rate and noise were significant factors affecting LP parameters in the MI-VT and control groups. In the non-VT group, LP parameters were significantly influenced by noise and parasympathetic heart rate variability parameters such as logPNN50. Conclusions: For Holter-based LP measurements, test accuracy was higher when LP was measured at the time of the highest or worst value of LAS40. Changes in autonomic nervous system activity, including heart rate and noise levels, were factors influencing diurnal variability.
BRIEF REPORT | doi:10.20944/preprints202206.0324.v1
Subject: Medicine And Pharmacology, Pediatrics, Perinatology And Child Health Keywords: circadian clock; otitis media; late dinner; common cold; Mediterranean diet; oxidative stress; chronotype
Online: 23 June 2022 (10:37:16 CEST)
Running at odds with the timing imposed by the circadian clock plays an important role in the process that leads to communicable and non communicable diseases. The primary objective of this study was to analyse whether early dinner eater children were at lower risks of acute respiratory infections than late dinner eater children, during the COVID-19 pandemic. Methods: This cross sectional study was conducted from July to December 2020 on children attending Majorcan emergency services. Clinical data collected included timing, symptoms, laboratory tests and imaging studies of current illness. Each diagnosis was validated by general paediatricians. Our survey on dinner time habits was carried out by using self-administered questionnaires. Results: A total of 669 children under age 18 were included in the study. The median of dinner time was 8:30 pm. Late dinner eaters accounted for a higher proportion of acute otitis media than early dinner eaters (7% vs 3%; P=0.028). Other infectious diseases were not associated with dinner time habits. Conclusions: We make a preliminary estimate of the link between late dinner habits and acute otitis media in children. However, no conclusions about causality can be established due to the observational design of the study.
ARTICLE | doi:10.20944/preprints202202.0243.v1
Subject: Medicine And Pharmacology, Cardiac And Cardiovascular Systems Keywords: left ventricular noncompaction; cardiomyopathy; sinus bradycardia; HCN4 mutation; late gado-linium enhancement; children
Online: 21 February 2022 (03:16:22 CET)
Background: Left ventricular noncompaction (LVNC) is a genetically and phenotypically heterogeneous cardiomyopathy characterized by a two-layered myocardium consisting of compacted and noncompacted segments, prominent ventricular trabeculations, and intertrabecular recesses. Patients with LVNC are at increased risk to develop heart failure, atrial and ventricular arrhythmias, and/or systemic thromboembolic events. Familial forms of primary sinus bradycardia have been attributed to mutations in HCN4. There are very few reports about the association between HCN4 mutations and LVNC. The aim of our study was to characterize the clinical phenotype of families with LVNC and sinus bradycardia caused by mutation of the HCN4 gene. Methods: From March 2008 to July 2021 we prospectively enrolled 6 patients from 4 families with diagnosed isolated LVNC based on the clinical presentation, family history and echocardiographic and cardiovascular magnetic resonance (CMR) evidence of LVNC. Next generation sequencing (NGS) analysis was undertaken for evaluation of the molecular basis of the disease in each family. Results: A total of 6 children (median age 11 years) were enrolled and followed prospectively for the median of 12 years. All 6 patients were diagnosed with LVNC by echocardiography and 5 participants additionally by CMR. The presence of LGE was found in 3 children. Sinus bradycardia and dilation of the ascending aorta occurred in 5 studied patients. In 4 patients from 3 families the molecular studies demonstrated the presence of rare heterozygous HCN4 mutations. Conclusion: (1) The HCN4 mutation influences the presence of a complex LVNC phenotype, sinus bradycardia and dilation of the ascending aorta. (2) HCN4 mutation may be associated with the early presentation of clinical symptoms and the severe course of the disease. (3) It is particularly important to assess myocardial fibrosis not only within the ventricles, but also in the atria in patients with LVNC and sinus bradycardia.
ARTICLE | doi:10.20944/preprints201903.0098.v1
Subject: Chemistry And Materials Science, Organic Chemistry Keywords: Prebiotic chemistry, Late Heavy Bombardment, Hadean Eon, carbonaceous chondrites, primitive terrestrial atmosphere, viroids
Online: 7 March 2019 (13:54:30 CET)
Geochemists disagree whether or not prebiotic chemistry has existed already during the Hadean Eon and whether the then terrestrial atmosphere has been strongly or weakly reduced. Here I argue that cellular life has existed already just after the end of the Hadean Eon and that terrestrial life has survived a number of cataclysms during the Earth's history. I argue that although organic molecules have been detected in meteorites that most organic molecules required for the formation of macromolecules must have been formed on Earth. Finally, I argue that the primitive terrestrial atmosphere during the Hadean Eon has been weakly reduced, so that amino acids and small nucleic acids could have been formed. I suggest that the first self-replicable macromolecules have been similar to viroids.
ARTICLE | doi:10.20944/preprints201812.0338.v1
Subject: Medicine And Pharmacology, Cardiac And Cardiovascular Systems Keywords: severe aortic stenosis; longitudinal axis strain; late gadolinium enhancement; cardiac magnetic resonance imaging
Online: 28 December 2018 (07:12:57 CET)
To analyze the predictive ability and incremental value of left ventricular longitudinal axis strain (LAS) and late gadolinium enhancement (LGE) using standard cardiovascular magnetic resonance (CMR) imaging for the diagnosis and prognosis of severe aortic stenosis (AS) in patients with an indication for aortic valve replacement. We conducted a prospective study on 128 patients with severe AS and 52 volunteers. The evaluation protocol included standard biochemistry tests, novel biomarkers of myocardial fibrosis, 12-lead electrocardiograms and 24-hour Holter, the 6-minute walk test and extensive echocardiographic and CMR imaging studies. Outcomes were defined as the composite of major cardiovascular events (MACEs). Among AS patients, most (n = 17, 77.2%) of those who exhibited LGE at CMR imaging had MACEs during follow-up. Kaplan-Meier curves for event-free survival showed a significantly higher rate of MACEs in patients with LGE (p < 0.01) and decreased LAS (p < 0.001). In Cox regression analysis, only reduced LAS [hazard ratio 1.33, 95%CI (1.01 to 1.74), p < 0.01] and the presence of LGE [hazard ratio 11.3, 95%CI (1.82 to 70.0), p < 0.01] were independent predictors for MACEs. The predictive value increased if both LGE and reduced LAS were added to LVEF. None of the biomarkers of increased collagen turnover exhibited any predictive value for MACEs. LAS by CMR is an independent predictor of outcomes in patients with AS and provides incremental value beyond the assessment of LVEF and the presence of LGE.
ARTICLE | doi:10.20944/preprints202107.0438.v1
Subject: Medicine And Pharmacology, Immunology And Allergy Keywords: Preeclampsia; epidemiology; early onset preeclampsia; late onset preeclampsia; twin pregnancies; monozygotic twins; dizygotic twins
Online: 20 July 2021 (09:44:40 CEST)
Objectives: To develop a multivariate model for risk factors specific to early onset preeclampsia (EOP) and late onset preeclampsia (LOP) in our entire population (singleton and twin pregnancies). Material and methods: 20 year-observational population-based historical cohort study (2001-2020). All consecutive births delivered at the Centre Hospitalier Universitaire Hospitalier Sud Reunion’s maternity. A standardized validated epidemiological perinatal data base. Results: During the 20-year period, there were 81,834 pregnancies and 83,555 infants born, 1232 dichorionic and 350 monochorionic twin pregnancies. There were 2120 cases of preeclampsia, of which 2001preeclamptic singleton pregnancies and 119 twin pregnancies (incidence 7.5% in twin pregnancies vs 2.5% singletons, OR 3.0, p<0.001). Independent risk factors for EOP and LOP in a multivariate model (controlling for the two major confounders: namely maternal ages -both risks for EOP and LOP- and maternal pre-pregnancy BMI – specific risk factor for LOP) were: history of preeclampsia (aOR 11.7 for EOP, 7.8 for LOP, p < 0.0001), chronic hypertension (aOR 7.3 for EOP, 3.9 for LOP, p < 0.0001), history of perinatal death (aOR 2.2 for EOP, p < 0.0001 and 1.48 for LOP, p= 0.007), primipaternity (aOR 3.0 for EOP and 3.6 for LOP, p = 0.001), dizygotic twin pregnancies (aOR 3.7 for EOP, p < 0.0001 and 2.1 for LOP, p = 0.003), monozygotic twin pregnancies (aOR 3.98 for EOP, p = 0.003 and NS for LOP), ovulation induction (aOR 5.6 for EOP, p = 0.004 and NS for LOP), and in vitro fertilization (aOR 2.8 for EOP, p = 0.05 and NS for LOP). Specific to LOP and NS for EOP: renal diseases (aOR for LOP 2.9, p= 0.007) and gestational diabetes mellitus (aOR 1.2, p= 0.04). Conclusions: Maternal ages over 35 years, chronic hypertension , history of preeclampsia, ovulation induction, in vitro fertilizations, history of perinatal deaths and twin pregnancy (in our experience, especially mono zygotic twin pregnancies) are significant risk factors for EOP. New paternity is an independent factor for both EOP and LOP.
ARTICLE | doi:10.20944/preprints201806.0084.v1
Subject: Social Sciences, Cognitive Science Keywords: qualia; consciousness; emission theories; perception; event-related brain potentials; P600 or late posterior positivity; N400
Online: 6 June 2018 (10:51:03 CEST)
We take what we see, hear, smell and feel for the reality. However, as neuroscientists, we know that this reality, that is, our perceptual world, is in fact made up by the brain from the processing of the nerve impulses coming from receptors. Ancient Greeks used to think that this perceptual world, sometimes called our 3D movie (Chalmers), is emitted and has its own physical nature. Given how real the 3D movie looks to us, it is still difficult today to consider that all we would be dealing with would be patterns of brain activity The present study thus aimed at testing whether the perceptual world could have some physical existence in addition to that of the neural patterns responsible for it. To achieve that goal, we tried to see whether brains could be sensitive to the 3D movie of others. This, admittedly unusual, operational hypothesis was based on two assumptions. First, brains are sensitive to the 3D movie, as our experience includes reactions to our perceptual world. Second, the physicality at stake does not differ across individuals. We recorded the event-related brain potentials (ERPs) evoked by stimuli of the international affective picture system in pairs of closely-related participants. Most importantly, they could neither see the stimuli simultaneously presented to their partners nor their reactions to them. As in Bouten et al. (2015), around 400 ms after the onset of the stimuli, ERPs started being more positive in inconsistent conditions. Namely, when the two subjects of each pair were presented with the same stimulus whereas they were told it would be a different one and vice-versa (i.e., different-stimuli expected to be same). ERPs were less positive when the two subjects of a pair were presented with the same stimuli and were told they were the same and conversely (i.e., different-stimuli expected to be different). The same experiment was then run in pairs of strangers. No significant effect of consistency on ERPs was observed even though participants could, this time, see, in the very periphery of their visual field, the reactions of their partner to the stimuli. We thus use the results of both studies to support a new version of the emission theory of consciousness and to suggest that the sensitivity to the perceptual world of others may depend on their prior familiarity with it.
ARTICLE | doi:10.20944/preprints202105.0783.v1
Subject: Medicine And Pharmacology, Oncology And Oncogenics Keywords: cancer, cancer survivor, exercise, athletes, competition, long-term effects, late effects, living with and beyond cancer
Online: 31 May 2021 (14:02:13 CEST)
Athletes living with and beyond cancer can continue to train and, in some cases, compete during treatment. Following cancer treatment, athletes can return to competitive sport but need to learn to adapt their physical strength and training to lingering effects of cancer. It is critical for oncology healthcare providers to use the principles of assess, refer and advise to exercise oncology programs that are appropriate for the individual. Managing side effects of treatment is key to being able to train during and immediately following cancer treatment. Keen attention to fatigue is important at any point in the cancer spectrum to avoid overtraining and optimize the effects of training.
ARTICLE | doi:10.20944/preprints201902.0141.v1
Subject: Arts And Humanities, Archaeology Keywords: the Late Bronze Age; Bashkir Transurals; Srubnaya-Alacul type of monuments; interdisciplinary methods in archaeological investigation
Online: 15 February 2019 (11:16:37 CET)
The Late Bronze Age on the territory of Southern Transurals is represented by two major archeological cultures: Srubnaya and Andronovskaya (Alakul culture and Fyodorovskaya – type). Their interaction of constitutes a special mix of material cultures which preserves common features of two independent, Srubnaya and Andronovskaya cultures, but also creates novel local material features. These cultural groups are also known to have brought to the region the technology of bronze production. This is evidenced, amongst others, by the proximity of the largest copper mining in the region, Kargaly mines Chernykh (2002). New methods to produce ceramics and to work bones were also developed, combining two traditions, coming from Srubnaya and Andronovskaya cultures respectively. Importantly, the features of these cultures are commonly encountered together in a single cultural horizon across the distribution ares. These diffusion processes took place in a vast area (more than 120,000 km2) andwere reflected in archeological micro-district of the Urshak river basin. We present here the most recent results of the scientific examination of the Late Bronze Age settlements in southern Transurals and attempt to address a peculiar cultural co-habitation of two distinct cultural groups in this region. We also discuss their synchronism based on absolute dates and elaborate on this cultural syncretism in the entire territory of the Volga-Ural region.
ARTICLE | doi:10.20944/preprints202302.0014.v1
Subject: Biology And Life Sciences, Immunology And Microbiology Keywords: neonatal sepsis; blood culture; early-onset sepsis; late-onset sepsis; FilmArray® blood culture identification panel; neonates.
Online: 1 February 2023 (11:50:19 CET)
This prospective single-center study was designed to assess the clinical utility of the FilmArray® blood culture identification (BCID) panel for improving the diagnostic accuracy in neonatal sepsis. Results obtained using the FilmArray® BCID panel were correlated with results of blood culture in all consecutive neonates with suspicion of early-onset (EOS) and late-onset sepsis (LOS) attended in our service over a 2-year period. A total of 102 blood cultures from 92 neonates were included, 69 (67.5%) in cases of EOS and 33 (32.3%) in LOS. The FilmArray® BCID panel was performed in negative culture bottles at a median of 10 hours of blood culture incubation (range 7.5-20 hours), without differences by the type of sepsis. The FilmArray® BCID panel showed a 66.7% sensitivity, 100% specificity, 100% positive predictive value, and 95.7% negative predictive value. There were four false-negative cases, three of which of Streptococcus epidermidis in neonates with LOS and one case of Granulicatella adiacens in one neonate with EOS. We conclude that the use of the FilmArray® BCID panel in negative blood cultures from neonates with clinical suspicion of sepsis is useful in decision-making of starting or early withdrawal of empirical antimicrobials because of the high specificity and negative predictive values of this assay.
ARTICLE | doi:10.20944/preprints201810.0722.v1
Subject: Physical Sciences, Astronomy And Astrophysics Keywords: cosmology; Bianchi Type I; particle creation; open thermodynamic system; constant deceleration parameter; accelerated expansion; late time acceleration
Online: 30 October 2018 (09:36:05 CET)
A study of Bianchi Type I cosmological model is undertaken in the framework of creation of particles. To accommodate the creation of new particles, the universe is regarded as an Open thermodynamical system. The energy conservation equation is modified with the incorporation of a creation pressure in the energy momentum tensor. Exact solutions of the field equations are obtained (i) for a particular choice of the particle creation function and (ii) by considering the deceleration parameter to be constant. In the first model the behavior of the solution at late times is investigated. The physical aspects of the model have also been discussed. In the case of the second model we have restricted our analysis to the power law behaviour for the average scale factor. This leads to a particular form for the particle creation function. The behavior of the solution is investigated and the physical aspects of the model have also been discussed for the matter dominated era.
REVIEW | doi:10.20944/preprints202305.1327.v1
Subject: Biology And Life Sciences, Plant Sciences Keywords: Plum consumption; Consumer Quality Index; flesh breakdown; temperature management; critical bruising thresholds; maximum maturity; late harvest; firmness; SSC
Online: 18 May 2023 (10:25:20 CEST)
Plums are primarily marketed for fresh consumption, canning, freezing, jam and jelly. Unfortunately, plum consumption has remained steady or declined. Consumers complain about a lack of flavor quality but are willing to pay for higher quality. Thus, lack of flavor and cold storage disorders are the main barriers to consumption. Plum cultivars are susceptible to gel breakdown, flesh browning and ‘off flavors’. Consumer acceptance and postharvest life are highly dependent on genotype, quality attributes, harvest date and proper postharvest handling. A consumer quality index (CQI) based on soluble solids concentration (SSC) and minimum firmness is proposed to maximize flavor and postharvest life. In most cases, late harvest increases quality attributes. Our work and industry experience demonstrated that using critical bruising thresholds (CBT) based on minimum firmness measured at harvest acts as a reliable predictor of how late to harvest safely for maximum visual and sensory quality. Plums are well adapted to late harvest because of their low susceptibility to bruising damage, but proper postharvest temperature management and marketing within the potential market life are necessary to maintain flavor and avoid the onset of storage disorders. Thus, to maximize flavor and postharvest life, a CQI based on SSC and minimum firmness measured at consumption is proposed. This article provides guidance on using this CQI, combined with proper postharvest handling techniques such as correct harvest date determination and temperature management, to maintain quality and increase consumption.
ARTICLE | doi:10.20944/preprints202112.0407.v2
Subject: Medicine And Pharmacology, Pediatrics, Perinatology And Child Health Keywords: Parenteral fluids in premature infants; late premature infants; infections associated with the use of lines; early oral feeds
Online: 5 September 2022 (13:05:52 CEST)
Introduction: Some of the practices in medicine are carried out of habit without proven benefits. This is the case of premature babies from 30 to 34 weeks of gestation who are always given parenteral fluids, even though this practice has been associated with an increase incidence of infection. At the end of 2017, we started a protocol of rationalization in the use of parenteral fluid. To administer nutrition/fluids, we used oral fluids by suction if this was possible or otherwise by oral/nasogastric tube at volumes of 70-80 mL/Kg/day divided every 3 hours, with 5 mL increments every 12-24 hours until 200 mL/K/day was achieved, always using breast milk when possible. Material and methods: The present study sought to compare results before and after this new policy. For this work, we review all premature babies between 30-34 weeks of gestation in two time periods, the first from 01/01/2010 to 12/31/2017 and the second from 01/01/2018 to 08/15/2022. The number of cases with and without parenteral fluids (PF), the incidence of infection, the weight at admission and discharge, and the change in the weight Z score between birth and discharge were compared. Both the anthropometric and outcome variables were compared using the different statistical methods according to each variable. Results: were found 920 cases with the described characteristics. The groups before and after the intervention did not show significant differences in their general demographic characteristics. We observed a decrease use of PF in the second period, from 425 cases (82.0%) before to 297 (26.2%) after implementation, p <0.0001 and fewer days of use (4.1 days/average before vs 1.3 after, p <0.0001) of PF. The weight at discharge and the change in weight Z-score were the same in both groups. Infections went from nine cases before to two cases after but it was not statistically significant. There were no complications due to less use of PF. Discussion: This study showed that the use of PF is not associated with significant changes in outcomes of interest, which reinforces that its use does not generate any benefit for the patient. Larger number of cases is required to detect differences in low incidence events such as infections.
ARTICLE | doi:10.20944/preprints202003.0109.v1
Subject: Computer Science And Mathematics, Information Systems Keywords: Automated Fare Collection (AFC); Smart Card; Crowding; Practical Waiting Area; Subway Station Platform; Time-Varying; Late-Night Peak
Online: 6 March 2020 (09:02:01 CET)
Management of crowding at subway platform is essential to improving services, preventing train delays and ensuring passenger safety. Establishing effective measures to mitigate crowding at platform requires accurate estimation of actual crowding levels. At present, there are temporal and spatial constraints since subway platform crowding is assessed only at certain locations, done every 1~2 years, and counting is performed manually Notwithstanding, data from smart cards is considered real-time big data that is generated 24 hours a day and thus, deemed appropriate basic data for estimating crowding. This study proposes the use of smart card data in creating a model that dynamically estimates crowding. It first defines crowding as demand, which can be translated into passengers dynamically moving along a subway network. In line with this, our model also identifies the travel trajectory of individual passengers, and is able to calculate passenger flow, which concentrates and disperses at the platform, every minute. Lastly, the level of platform crowding is estimated in a way that considers the effective waiting area of each platform structure.
CASE REPORT | doi:10.20944/preprints202305.0182.v1
Subject: Medicine And Pharmacology, Neuroscience And Neurology Keywords: acute encephalopathy with biphasic seizures and late reduced diffusion; hypoxic encephalopathy; bright tree appearance; glutamate excitotoxicity; nonconvulsive status epilepticus
Online: 4 May 2023 (04:15:17 CEST)
Acute encephalopathy with biphasic seizures and reduced diffusion (AESD) is characterized by biphasic seizures following febrile viral infections and delayed reduced diffusion of the cerebral white matter on magnetic resonance imaging (MRI) diffusion-weighted imaging (DWI) (bright tree appearance, BTA). However, hypoxic encephalopathy with biphasic seizures and AESD-mimicking imaging findings has not been reported. Herein, we report an case of hypoxic encephalopathy due to suffocation with concomitant biphasic seizures and BTA, mimicking AESD. On day 1, a 5-month-old female was found face down with breathing cessation and deteriorating consciousness level. The electroencephalography (EEG) revealed periodic epileptic discharges, suggesting possible nonconvulsive status epilepticus. Despite the improvements in consciousness level and EEG abnormalities on day 2, her consciousness level deteriorated again with generalized tonic-clonic seizures on day 3, and head MRI-DWI revealed restricted diffusion predominantly in the subcortical areas, suggesting BTA. Treatment for acute encephalopathy resolved clinical sei-zures and EEG abnormalities. The persistence of abnormal EEG, reflecting abnormal excitation and accumulation of neurotoxic substances caused by hypoxia, may have contributed to the devel-opment of AESD-like findings. As hypoxic encephalopathy causes AESD-like biphasic seizures, monitoring the consciousness level, seizure occurrence, and EEG abnormalities even after acute symptoms have temporarily improved following hypoxia is essential.
ARTICLE | doi:10.20944/preprints201808.0102.v1
Subject: Environmental And Earth Sciences, Paleontology Keywords: global warming and environmental change; Late Quaternary paleoenvironments; Termination I; sea-water paleotemperature; marine microfossils; North Atlantic; stable isotopes
Online: 6 August 2018 (08:56:58 CEST)
The micropaleontological study (radiolarians and foraminifera) of the sediment core AMK-340, Reykjanes Ridge, North Atlantic, combined with the radiocarbon dating and Oxygen/Carbon isotopic record, provided data for the reconstruction of the summer paleotemperature on the water depth of 100 m, and paleoenvironments during the Termination I in the age interval of 14.5–8 ka. The response of the main microfossil species on the paleoceanographic changes within the Bølling-Allerød (BA) warming, the Younger Dryas (YD) cold event, and final transition to the warm Holocene was different. The BA warming was well reflected in the radiolarian and benthic but not planktic foraminiferal record. The high abundances of the cold-water radiolarian species Amphimelissa setosa as the Greenland/Iceland Sea indicator marked a cooling at the end of the BA and within the start of the YD at 13.2–12.3 ka. The micropaleontological and isotopic data together with the paleotemperature estimates for the Reykjanes Ridge at 60° N document that, after the warm BA, the middle YD ca. 12.5–12.2 ka was the next significant step toward the Holocene warming. Start of the Holocene interglacial conditions was reflected in abundant occurrence of the microfossils being indicators of the open boreal North Atlantic environments and lower oxygen isotope values indicating increasing warmth.
ARTICLE | doi:10.20944/preprints202107.0009.v1
Subject: Medicine And Pharmacology, Immunology And Allergy Keywords: Intensive care unit; percutaneous tracheostomy; COVID-19; early tracheostomy; late tracheostomy; ICU length of stay; health care workers; mechanical ventilation.
Online: 1 July 2021 (11:04:34 CEST)
(1) Background: Benefits and timing of percutaneous dilatational tracheostomy (PDT) in Intensive Care Unit (ICU) COVID-19 patients are still controversial. PDT is considered a high risk procedure for transmission of SARS CoV-2 to health care workers (HCWs). The present study analyzed optimal timing of PDT, clinical outcomes of patients undergoing PDT and safety of HCWs performing PDT. (2) Methods: 133 COVID-19 patients underwent PDT in our ICU from April 1, 2020 to March 31, 2021, 23 patients were excluded and 110 patients were enrolled. A trained medical team was dedicated to the PDT procedure. Demographic, clinical history and outcome data were collected. Patients who underwent PDT were stratified into two groups: early group, PDT ≤ 12 days from orotracheal-intubation (OTI) and late group, >12 days from OTI; HCW surveillance program was performed. (3) Results: Early group included 57 patients and late group included 53 patients. Early group patients showed shorter ICU length of stay and fewer days of mechanical ventilation than the late group (p<0.001). At day 7 after tracheostomy, early group patients required fewer intravenous anesthetic drugs and experienced an improvement of ventilation parameters, PaO2/FiO2-Ratio, PEEP and FiO2 (p<0.001). No difference in case fatality ratio between the two groups was reported. No SARS-CoV-2 infection was reported in HCWs performing PDT. (4) Conclusions: PDT was safe and effective for COVID-19 patients, since it improved respiratory support parameters, reduced ICU length of stay and duration of mechanical ventilation, and optimized the weaning process. The procedure was safe for all HCWs involved in the dedicated medical team. The development of standardized early PDT protocols should be implemented and PDT procedure could be considered as first line approach in ICU COVID-19 requiring prolonged mechanical ventilation.
ARTICLE | doi:10.20944/preprints202301.0071.v1
Subject: Physical Sciences, Astronomy And Astrophysics Keywords: Carrington event; craters; cratering; currents in plasma; electric discharge machining; geology; heliophysics; impact craters; Late Heavy Bombardment; piezoelectricity; transient crater; solar activity; Solar System
Online: 4 January 2023 (07:19:46 CET)
We consider an alternative hypothesis of crater formation -- through an electric discharge machining (EDM) of the celestial bodies' surfaces. The source of the energy and the current itself may lie in the plasma infalling on a celestial body (from an extremely strong solar outburst or a nearby supernova). This mechanism may have been even more important than impact cratering in the early Solar System, with potential implications to the history of the dynamics of the System itself and solar activity in particular. In this light, the conclusion that shocked and metamorphosed minerals found within crater sites are evidence of hypervelocity impacts might be reconsidered. There are ambiguities that remain among sources of mineralogical formations. This study is ongoing with details of investigations supporting a new approach to crater formation not yet exhausted. Apart from mineralogical analysis and theoretical considerations regarding the large scale crater formation, we present a description of experimental studies of EDM acting at low pressures. Experimental results are made with crude setups and could easily be replicated on a larger scale with valuable research potential, as there is a well understood relation between the crater size and the energy needed for its production.
ARTICLE | doi:10.20944/preprints202302.0404.v1
Subject: Arts And Humanities, History Keywords: sweating sickness; sudor anglicus; English Sweat; Picardy Sweat; febbre miliare; Tudor; England; EEBO; Early English Books Online; CQPWeb; corpus linguistics; history of medicine; history; early modern; late mediaeval
Online: 23 February 2023 (09:14:11 CET)
The first reports of the acute and often fatal illness known as the “English Sweat” are from 1485 and its last known outbreak was in 1551. During this period, the Sweat produced only five epidemic waves. Except for one outbreak which spread to the northern part of the continent of Europe in 1529, the Sweat was confined almost exclusively to England, with only anecdotal reports of isolated infections in other parts of the British Isles. The Sweat was thus only a minor component in the panorama of infectious disease affecting mediaeval and early modern Europe. Nevertheless, it continues to fascinate both medical historians and modern infectious disease biologists – the latter group now often engaged in competing exercises in retrospective diagnosis. This paper seeks to explore the reasons for such enduring interest, using the Early English Books Online (EEBO) text corpus to analyse the various contexts in which the Sweat was discussed up to 1700. EEBO shows that references to the Sweat occur repeatedly in astrological and religious discourses, especially from the mid-17th century onwards. Four salient examples are examined in detail. It is proposed that the cultural memory of the Sweat, in the 150 years following its disappearance, was kept disproportionately alive not so much by accounts of its alarming symptoms but more due to its metaphorical and illustrative utility in non-medical discourse.
REVIEW | doi:10.20944/preprints202103.0490.v1
Subject: Medicine And Pharmacology, Immunology And Allergy Keywords: Covid-19; Long Covid-19; Long Haulers Covid; Post Covid-19 Syndrome; Post-Acute Covid-19; Corona Virus; SARS-Cov-2; Novel Corona Virus 2019; Post-Acute SARS-CoV-2; PASC, Post-Acute Sequelae of COVID-19; Late Sequelae COVID-19
Online: 18 March 2021 (17:16:52 CET)
Introduction: Despite more than one year passed since the first cases of SARS-CoV-2 were reported, there is still no consensus on the definition and clinical management of post-acute-COVID-19. The condition has heterogeneously been named as Chronic COVID syndrome, Post COVID-19 Syndrome, post-acute sequela of SARS-CoV-2 (PASC), and the more familiar long COVID. Method: In order to capture all relevant published studies, we undertook a multi-step search with no language restriction. The following four-step search strategy was utilized: First, a preliminary (limited) search was conducted on January 20, 2021, in Google Scholar and PubMed to identify the appropriate keywords. Then, on January 30, 2021, we adopted a search strategy of electronic databases from Cochrane Library, PsycINFO, PubMed, Embase, Scopus, and Web of sciences, using those keywords. Then, after duplicate removal, we screened all titles, abstracts, and full texts. This resulted in 66 eligible studies. Subsequently, after a forward and backward search of their references and citations an additional 54 publications were found, resulting in a total of 120 publications that formed the basis of the present analysis. The titles, abstracts, and full-texts of non-English articles were translated using Google Translate for further evaluation. We conducted our scoping review based on the PRISMA-ScR Checklist.Results: We found only one randomized clinical trial in our search. Of the 67 original studies, 22 were cohort and 28 were cross-sectional studies totaling 74.6% of the original studies. Of the total of 120 publications, 59 (49.1%) focused on signs and symptoms, 28 (23.3%) were focused on management, and 13 (10.8%) focused on pathophysiology. Ten (9%) publications focused on imaging studies. Ninety-one percent of the original investigations came from high and upper-middle-income countries, highlighting the scarcity of reports originating from low-income and lower-middle-income countries.Conclusion: The predominant symptoms among those with the so-called “Long COVID” were: fatigue, breathlessness, arthralgia, sleep difficulties, and chest pain. Recent reports also point to the risk of long-term sequela with cutaneous, respiratory, cardiovascular, musculoskeletal, mental health, neurologic, and renal involvement in those who survive the acute phase of the illness. The ambiguity and controversies in its definition have impaired proper recognition and management of those requiring additional support following the resolution of the acute phase of this infection. This has resulted in long-standing distress for the patients and their families. Our findings highlight the need for a multidisciplinary approach, support, and rehabilitation for these patients in terms of long-term mental and physical health.