Relationship between Serum Bortezomib Concentration and Emergence of Diarrhea in Patients with Multiple Myeloma and/or AL Amyloidosis

(1) Background: multiple myeloma patients have benefited from bortezomib therapy, though it has often been discontinued owing to diarrhea. The objective of this study was to verify serum bortezomib concentration in the emergence of diarrhea. (2) Methods: this prospective, observational case-control, and monocentric study was performed with an approval by the Ethics Committee of Kumamoto University Hospital in 2015 (No. 1121) from February 2015 to April 2017. (3) Results: twenty-four patients with bortezomib therapy were recruited; eight patients (33.3%) developed diarrhea at day 3 as median. Median measured trough bortezomib concentration at 24 h after first or second dose for patients with or without diarrhea was 0.87 or 0.48 ng/mL, respectively (p = 0.04, Wilcoxon signed rank test). Receiver operation characteristic (ROC) analysis produced the cut-off concentration of 0.857 ng/mL (area under the ROC curve of 0.797, sensitivity of 0.625, specificity of 0.875). The survival curves between patients with and without diarrhea were similar (p = 0.667); those between patients with higher and lower concentration than median value (0.61 ng/mL) were also similar (p = 0.940). (4) Conclusions: this study indicated the possible involvement of serum bortezomib concentration in the emergence of diarrhea in bortezomib therapy in patients with multiple myeloma.

Detection of poststroke oropharyngeal dysphagia with swallowing screening by ultrasonography

There are currently no standard evaluation tools for poststroke neurogenic oropharyngeal dysphagia. We previously suggested calculating the relative movements of the hyoid bone and larynx by ultrasonography to evaluate swallowing movement. Swallowing movement is altered in neurogenic oropharyngeal dysphagia. Therefore, the present study aimed to verify whether an ultrasonographic evaluation of swallowing movement facilitates the detection of neurogenic oropharyngeal dysphagia. Eighteen healthy male elderly participants (the healthy group) and 18 male stroke patients diagnosed with neurogenic oropharyngeal dysphagia (the dysphagia group) were enrolled. Participants swallowed 5 mL of liquid and water with an adjusted viscosity and the movements of the hyoid bone and larynx were visualized by ultrasonography. The results obtained revealed significant differences in laryngeal duration (static phase), laryngeal displacement (elevation phase), and the hyoid bone–laryngeal motion ratio (HL motion ratio) between the two groups. A multiple regression analysis was performed to adjust for confounding factors, and laryngeal duration (static phase) and the HL motion ratios were identified as factors affecting dysphagia. In the receiver operation characteristic curve of the two variations, the area under the curve for laryngeal duration (static phase) was 0.744 and the cut-off was 0.26 sec with 72.2% sensitivity and 88.9% specificity; the area under the curve for the HL motion ratio was 0.951 and the cut-off was 0.56 with 88.9% sensitivity and 88.9% specificity. Therefore, the objective evaluation of hyoid bone and larynx movements during swallowing by ultrasonography facilitated the detection of neurogenic oropharyngeal dysphagia.

Wideband Circularly Polarized Antenna Based on a Non-Uniform Metasurface

This paper presents a non-uniform metasurface (MS)-based circularly polarized (CP) antenna that is able to perform with a wideband operation characteristic. A squared patch with truncated corners was chosen as a radiating CP source. Then, unlike the conventional CP MS antennas with a uniform MS, the proposed design employed a non-uniform MS placed above the driven patch. Apart from increasing the impedance bandwidth, the non-uniform MS was also capable of generating two additional CP bands in the high-frequency region, which contributed to significantly increasing the antenna’s overall performance. For demonstration, an antenna prototype was fabricated and experimentally tested. The measured operating bandwidth of the fabricated antenna was about 30% and the broadside gain within this band was around 6.6 dBic. Compared to the other reported CP MS antennas in the open literature, the proposed design has the advantages of very wideband operation with a comparable size and gain.

Do low TB prevalence and lack of BCG Vaccinations Contribute to Emergence Multisystem Inflammatory Syndrome in Children?

Background: Emergence of new multisystem inflammatory syndrome in children (MIS-C) is thought to be associated with COVID-19 pandemic. Covid-19 morbidity and mortality variances among countries have been suggested by previous works to be influenced by BCG and previous latent TB infection (which is reflected by TB prevalence) possibly through inducing heterogeneous immunity against SARS-CoV-2. Aim: To examine influence of BCG status and TB prevalence on variances among countries which report new multisystem inflammatory syndrome in children (MIS-C). Methods: We choose all countries which report MIS-C till 23/6/2020, number of cases for each 10 million inhabitants was examined among 3 categories of countries classified according to BCG program status. TB prevalence, MIS-C no. / 10 million (M) population and Covid- 19 deaths/M are taken as markers. Receiver operation characteristic - (ROC) curve, with some relative indicators such as (sensitivity and specificity rates), estimation area of trade - off between sensitivity and specificity, and cutoff points are used with different studied markers for discriminating different three pairs of countries (which have different BCG practices). Results: BCG vaccinations and high TB prevalence are found to be associated with decrease MIS-C no. and COVID-19 deaths Conclusions: Findings might explain variances in MIS-C incidence and in COVID-19 mortality among countries worldwide. Further studies to confirm this relation and to confirm possible similar relations in Kawasaki disease(KD) in previous epidemics is recommended.

Energy transformation without using filter on high resistive load

In this paper, 9-level, 17-level, 19-level, 21-level, 27-level, and 39- level inverters with SPWM are presented. According to a switching function, the high-multilevel inverter design has been described since a new multi-level inverter structure is considered. The multilevel inverter structure is designed with placing switches and sources on levels. Pulse width modulation, controlling switches in the inverter structure, is also produced by comparison between triangles and sinus signals. Operating sequences of the switches are given in the table in order to demonstrate the inverter operation characteristic with the produced signals. Then, mathematical equations are formed by considering an operation of switches on the load. In simulations and experiments, the 9-level, 17- level, 19-level, 21-level, 27-level, and 39-level inverters are performed on the resistance (R) and inductance (L) loads with different resistance, because it is difficult to generate current and voltage with an acceptable harmonic distortion on the impedances which have high ohmic values. After applications of experimentation and simulation, the obtained results are compared with other published papers of results and the international IEEE standard, which is 5% for harmonic distortions of creating currents and voltages.