Scholarly

An Overview of Technology Availability to Support Remote Decentralized Clinical Trials

Year: 2021 Volume: 15 Issue: 9 228 - 234 Pages

Abstract: Developing new medicine and health solutions and improving patient health currently rely on the successful execution of clinical trials, which generate relevant safety and efficacy data. For their success, recruitment and retention of participants are some of the most challenging aspects of protocol adherence. Main barriers include: i) lack of awareness of clinical trials; ii) long distance from the clinical site; iii) the burden on participants, including the duration and number of clinical visits, and iv) high dropout rate. Most of these aspects could be addressed with a new paradigm, namely the Remote Decentralized Clinical Trials (RDCTs). Furthermore, the COVID-19 pandemic has highlighted additional advantages and challenges for RDCTs in practice, allowing participants to join trials from home and not depending on site visits, etc. Nevertheless, RDCTs should follow the process and the quality assurance of conventional clinical trials, which involve several processes. For each part of the trial, the Building Blocks, existing software and technologies were assessed through a systematic search. The technology needed to perform RDCTs is widely available and validated but is yet segmented and developed in silos, as different software solutions address different parts of the trial and at various levels. The current paper is analyzing the availability of technology to perform RDCTs, identifying gaps and providing an overview of Basic Building Blocks and functionalities that need to be covered to support the described processes.

Titanium Dioxide Modified with Glutathione as Potential Drug Carrier with Reduced Toxic Properties

Year: 2021 Volume: 15 Issue: 10 141 - 144 Pages

Abstract: The paper presents a process to obtain glutathione-modified titanium oxide nanoparticles. The processes were carried out in a microwave radiation field. The influence of the molar ratio of glutathione to titanium oxide and the effect of the fold of NaOH vs. stoichiometric amount on the size of the formed TiO2 nanoparticles was determined. The physicochemical properties of the obtained products were evaluated using dynamic light scattering (DLS), transmission electron microscope- energy-dispersive X-ray spectroscopy (TEM-EDS), low-temperature nitrogen adsorption method (BET), X-Ray Diffraction (XRD) and Fourier-transform infrared spectroscopy (FTIR) microscopy methods. The size of TiO2 nanoparticles was characterized from 30 nm to 336 nm. The release of titanium ions from the prepared products was evaluated. These studies were carried out using different media in which the powders were incubated for a specific time. These were: water, SBF and Ringer's solution. The release of titanium ions from modified products is weaker compared to unmodified titanium oxide nanoparticles. The reduced release of titanium ions may allow the use of such modified materials as substances in drug delivery systems.

Performance Evaluation of Minimum Quantity Lubrication on EN3 Mild Steel Turning

Year: 2021 Volume: 15 Issue: 10 344 - 348 Pages

Abstract: Lubrication, cooling and chip removal are the desired functions of any cutting fluid. Conventional or flood lubrication requires high volume flow rate and cost associated with this is higher. In addition, flood lubrication possesses health risks to machine operator. To avoid these consequences, dry machining and minimum quantity are two alternatives. Dry machining cannot be a suited alternative as it can generate greater heat and poor surface finish. Here, turning work is carried out on a Lathe machine using EN3 Mild steel. Variable cutting speeds and depth of cuts are provided and corresponding temperatures and surface roughness values were recorded. Experimental results are analyzed by Minitab software. Regression analysis, main effect plot, and interaction plot conclusion are drawn by using ANOVA. There is a 95.83% reduction in the use of cutting fluid. MQL gives a 9.88% reduction in tool temperature, this will improve tool life. MQL produced a 17.64% improved surface finish. MQL appears to be an economical and environmentally compatible lubrication technique for sustainable manufacturing.

Software Product Quality Evaluation Model with Multiple Criteria Decision Making Analysis

Year: 2020 Volume: 14 Issue: 12 549 - 565 Pages

Authors:
C. Ardil

Abstract: This paper presents a software product quality evaluation model based on the ISO/IEC 25010 quality model. The evaluation characteristics and sub characteristics were identified from the ISO/IEC 25010 quality model. The multidimensional structure of the quality model is based on characteristics such as functional suitability, performance efficiency, compatibility, usability, reliability, security, maintainability, and portability, and associated sub characteristics. Random numbers are generated to establish the decision maker’s importance weights for each sub characteristics. Also, random numbers are generated to establish the decision matrix of the decision maker’s final scores for each software product against each sub characteristics. Thus, objective criteria importance weights and index scores for datasets were obtained from the random numbers. In the proposed model, five different software product quality evaluation datasets under three different weight vectors were applied to multiple criteria decision analysis method, preference analysis for reference ideal solution (PARIS) for comparison, and sensitivity analysis procedure. This study contributes to provide a better understanding of the application of MCDMA methods and ISO/IEC 25010 quality model guidelines in software product quality evaluation process.

Sustainable Balanced Scorecard for Kaizen Evaluation: Comparative Study between Egypt and Japan

Year: 2021 Volume: 15 Issue: 10 779 - 788 Pages

Abstract: Continuous improvement activities are becoming a key organizational success factor; those improvement activities include but are not limited to kaizen, six sigma, lean production, and continuous improvement projects. Kaizen is a Japanese philosophy of continuous improvement by making small incremental changes to improve an organization’s performance, reduce costs, reduce delay time, reduce waste in production, etc. This research aims at proposing a measuring system for kaizen activities from a sustainable balanced scorecard perspective. A survey was developed and disseminated among kaizen experts in both Egypt and Japan with the purpose of allocating key performance indicators for both kaizen process (critical success factors) and result (kaizen benefits) into the five sustainable balanced scorecard perspectives. This research contributes to the extant literature by presenting a kaizen measurement of both kaizen process and results that will illuminate the benefits of using kaizen. Also, the presented measurement can help in the sustainability of kaizen implementation across various sectors and industries. Thus, grasping the full benefits of kaizen implementation will contribute to the spread of kaizen understanding and practice. Also, this research provides insights on the social and cultural differences that would influence the kaizen success. Determining the combination of the proper kaizen measures could be used by any industry, whether service or manufacturing for better kaizen activities measurement. The comparison between Japanese implementation of kaizen, as the pioneers of continuous improvement, and Egyptian implementation will help recommending better practices of kaizen in Egypt and contributing to the 2030 sustainable development goals. The study results reveal that there is no significant difference in allocating kaizen benefits between Egypt and Japan. However, with regard to the critical success factors some differences appeared reflecting the social differences and understanding between both countries, a single integrated measurement was reached between the Egyptian and Japanese allocation highlighting the Japanese experts’ opinion as the ultimate criterion for selection.

Technological Applications in Automobile Manufacturing Sector: A Case Study Analysis

Year: 2021 Volume: 15 Issue: 10 339 - 343 Pages

Authors:
Raja Kannusamy

Abstract: The research focuses on the applicable technologies in the automobile industry and their effects on the productivity and annual revenue of the industry. A study has been conducted on six major automobile manufacturing industries represented in this research as M1, M2, M3, M4, M5 and M6. The results indicate that M1, which is a pioneer in technological applications, remains the market leader, followed by M5 and M2 taking the second and third positions, respectively. M3, M6 and M4 are the followers and are placed next in positions. It has also been observed that M1 and M2 have entered into an agreement to share the basic structural technologies and they maintain long-term and trusted relationships with their suppliers through the Keiretsu system. With technological giants such as Apple, Microsoft, Uber and Google entering the automobile industry in recent years, an upward trend is expected in the futuristic market with self-driving cars to dominate the automobile sector. To keep up with the market trend, it is essential for automobile manufacturers to understand the importance of developing technological capabilities and skills to be competitive in the marketplace.

Additive Friction Stir Manufacturing Process: Interest in Understanding Thermal Phenomena and Numerical Modeling of the Temperature Rise Phase

Year: 2021 Volume: 15 Issue: 9 311 - 316 Pages

Abstract: Additive Friction Stir Manufacturing, or AFSM, is a new industrial process that follows the emergence of friction-based processes. The AFSM process is a solid-state additive process using the energy produced by the friction at the interface between a rotating non-consumable tool and a substrate. Friction depends on various parameters like axial force, rotation speed or friction coefficient. The feeder material is a metallic rod that flows through a hole in the tool. There is still a lack in understanding of the physical phenomena taking place during the process. This research aims at a better AFSM process understanding and implementation, thanks to numerical simulation and experimental validation performed on a prototype effector. Such an approach is considered a promising way for studying the influence of the process parameters and to finally identify a process window that seems relevant. The deposition of material through the AFSM process takes place in several phases. In chronological order these phases are the docking phase, the dwell time phase, the deposition phase, and the removal phase. The present work focuses on the dwell time phase that enables the temperature rise of the system due to pure friction. An analytic modeling of heat generation based on friction considers as main parameters the rotational speed and the contact pressure. Another parameter considered influential is the friction coefficient assumed to be variable, due to the self-lubrication of the system with the rise in temperature or the materials in contact roughness smoothing over time. This study proposes through a numerical modeling followed by an experimental validation to question the influence of the various input parameters on the dwell time phase. Rotation speed, temperature, spindle torque and axial force are the main monitored parameters during experimentations and serve as reference data for the calibration of the numerical model. This research shows that the geometry of the tool as well as fluctuations of the input parameters like axial force and rotational speed are very influential on the temperature reached and/or the time required to reach the targeted temperature. The main outcome is the prediction of a process window which is a key result for a more efficient process implementation.

Method for Tuning Level Control Loops Based on Internal Model Control and Closed Loop Step Test Data

Year: 2021 Volume: 15 Issue: 9 424 - 431 Pages

Authors:
Arnaud Nougues

Abstract: This paper describes a two-stage methodology derived from IMC (Internal Model Control) for tuning a PID (Proportional-Integral-Derivative) controller for levels or other integrating processes in an industrial environment. Focus is ease of use and implementation speed which are critical for an industrial application. Tuning can be done with minimum effort and without the need of time-consuming open-loop step tests on the plant. The first stage of the method applies to levels only: the vessel residence time is calculated from equipment dimensions and used to derive a set of preliminary PI (Proportional-Integral) settings with IMC. The second stage, re-tuning in closed-loop, applies to levels as well as other integrating processes: a tuning correction mechanism has been developed based on a series of closed-loop simulations with model errors. The tuning correction is done from a simple closed-loop step test and application of a generic correlation between observed overshoot and integral time correction. A spin-off of the method is that an estimate of the vessel residence time (levels) or open-loop process gain (other integrating process) is obtained from the closed-loop data.

Optimization of Hemp Fiber Reinforced Concrete for Mix Design Method

Year: 2021 Volume: 15 Issue: 9 309 - 313 Pages

Abstract: The purpose of this study is to evaluate the incorporation of hemp fibers (HF) in concrete. Hemp fiber reinforced concrete (HFRC) is becoming more popular as an alternative for regular mix designs. This study was done to evaluate the compressive strength of HFRC regarding mix procedure. HF were obtained from the manufacturer and hand processed to ensure uniformity in width and length. The fibers were added to concrete as both wet and dry mix to investigate and optimize the mix design process. Results indicated that the dry mix had a compressive strength of 1157 psi compared to the wet mix of 985 psi. This dry mix compressive strength was within range of the standard mix compressive strength of 1533 psi. The statistical analysis revealed that the mix design process needs further optimization and uniformity concerning the addition of HF. Regression analysis revealed that the standard mix design had a coefficient of 0.9 as compared to the dry mix of 0.375 indicating a variation in the mixing process. While completing the dry mix, the addition of plain HF caused them to intertwine creating lumps and inconsistency. However, during the wet mixing process, combining water and HF before incorporation allows the fibers to uniformly disperse within the mix hence the regression analysis indicated a better coefficient of 0.55. This study concludes that HRFC is a viable alternative to regular mixes however more research surrounding its characteristics needs to be conducted.

Incorporating Lexical-Semantic Knowledge into Convolutional Neural Network Framework for Pediatric Disease Diagnosis

Year: 2021 Volume: 15 Issue: 9 87 - 93 Pages

Abstract: The utilization of electronic medical record (EMR) data to establish the disease diagnosis model has become an important research content of biomedical informatics. Deep learning can automatically extract features from the massive data, which brings about breakthroughs in the study of EMR data. The challenge is that deep learning lacks semantic knowledge, which leads to impracticability in medical science. This research proposes a method of incorporating lexical-semantic knowledge from abundant entities into a convolutional neural network (CNN) framework for pediatric disease diagnosis. Firstly, medical terms are vectorized into Lexical Semantic Vectors (LSV), which are concatenated with the embedded word vectors of word2vec to enrich the feature representation. Secondly, the semantic distribution of medical terms serves as Semantic Decision Guide (SDG) for the optimization of deep learning models. The study evaluates the performance of LSV-SDG-CNN model on four kinds of Chinese EMR datasets. Additionally, CNN, LSV-CNN, and SDG-CNN are designed as baseline models for comparison. The experimental results show that LSV-SDG-CNN model outperforms baseline models on four kinds of Chinese EMR datasets. The best configuration of the model yielded an F1 score of 86.20%. The results clearly demonstrate that CNN has been effectively guided and optimized by lexical-semantic knowledge, and LSV-SDG-CNN model improves the disease classification accuracy with a clear margin.

A Numerical Study of the Interaction between Residual Stress Profiles Induced by Quasi-Static Plastification

Year: 2021 Volume: 15 Issue: 9 306 - 310 Pages

Abstract: One of the most relevant phenomena in manufacturing is the residual stress state development through the manufacturing chain. In most cases, the residual stresses have their origin in the heterogenous plastification produced by the processes. Although a few manufacturing processes have been successfully approached by numerical modeling, there is still lack of understanding on how these processes' interactions will affect the final stress state. The objective of this work is to analyze the effect of the grinding procedure on the residual stress state generated by a quasi-static indentation. The model consists in a simplified approach of shot peening, modeling four cases with variations in indenter size and force. This model was validated through topography, measured by optical 3D focus-variation. The indentation model configured with two loads was then exposed to two grinding procedures and the result was analyzed. It was observed that the grinding procedure will have a significant effect on the stress state.

An E-Maintenance IoT Sensor Node Designed for Fleets of Diverse Heavy-Duty Vehicles

Year: 2021 Volume: 15 Issue: 9 299 - 305 Pages

Abstract: E-maintenance is a relatively recent concept, generally referring to maintenance management by monitoring assets over the Internet. One of the key links in the chain of an e-maintenance system is data acquisition and transmission. Specifically for the case of a fleet of heavy-duty vehicles, where the main challenge is the diversity of the vehicles and vehicle-embedded self-diagnostic/reporting technologies, the design of the data acquisition and transmission unit is a demanding task. This is clear if one takes into account that a heavy-vehicles fleet assortment may range from vehicles with only a limited number of analog sensors monitored by dashboard light indicators and gauges to vehicles with plethora of sensors monitored by a vehicle computer producing digital reporting. The present work proposes an adaptable internet of things (IoT) sensor node that is capable of addressing this challenge. The proposed sensor node architecture is based on the increasingly popular single-board computer – expansion boards approach. In the proposed solution, the expansion boards undertake the tasks of position identification, cellular connectivity, connectivity to the vehicle computer, and connectivity to analog and digital sensors by means of a specially targeted design of expansion board. Specifically, the latter offers a number of adaptability features to cope with the diverse sensor types employed in different vehicles. In standard mode, the IoT sensor node communicates to the data center through cellular network, transmitting all digital/digitized sensor data, IoT device identity and position. Moreover, the proposed IoT sensor node offers connectivity, through WiFi and an appropriate application, to smart phones or tablets allowing the registration of additional vehicle- and driver-specific information and these data are also forwarded to the data center. All control and communication tasks of the IoT sensor node are performed by dedicated firmware.

Study of Eatable Aquatic Invertebrates in the River Dhansiri, Dimapur, Nagaland, India

Year: 2021 Volume: 15 Issue: 9 83 - 86 Pages

Authors:
Dilip Nath

Abstract: A study has been conducted on the available aquatic invertebrates in the river Dhansiri at Dimapur site. The study confirmed that the river body composed of aquatic macroinvertebrate community in two phyla viz., Arthropods and Molluscs. Total ten species have been identified from there as the source of alternative protein food for the common people. Not only the protein source they are also the component of aquatic food chain and indicators of aquatic ecosystem. Proper management and strategies to promote the edible invertebrates can be considered as the alternative protein and alternative income source for the common people for sustainable livelihood improvement.

Physicochemical and Thermal Characterization of Starch from Three Different Plantain Cultivars in Puerto Rico

Year: 2021 Volume: 15 Issue: 9 223 - 227 Pages

Abstract: Plantain contains starch as the main component and represents a relevant source of this carbohydrate. Starches from different cultivars of plantain and bananas have been studied for industrialization purposes due to their morphological and thermal characteristics and their influence in food products. This study aimed to characterize the physical, chemical, and thermal properties of starch from three different plantain cultivated in Puerto Rico: Maricongo, Maiden and FHIA 20. Amylose and amylopectin content, color, granular size, morphology, and thermal properties were determined. According to the amylose content in starches, FHIA 20 presented lowest content of the three cultivars studied. In terms of color, Maiden and FHIA 20 starches exhibited significantly higher whiteness indexes compared to Maricongo starch. Starches of the three cultivars had an elongated-ovoid morphology, with a smooth surface and a non-porous appearance. Regardless of similarities in their morphology, FHIA 20 exhibited a lower aspect ratio since its granules tended to be more elongated. Comparison of the thermal properties of starches showed that initial starch gelatinization temperature was similar among cultivars. However, FHIA 20 starch presented a noticeably higher final gelatinization temperature (87.95°C) and transition enthalpy than Maricongo (79.69°C) and Maiden (77.40°C). Despite similarities, starches from plantain cultivars showed differences in their composition and thermal behavior. This represents an opportunity to diversify plantain starch use in food-related applications.

A 3D Numerical Environmental Modeling Approach for Assessing Transport of Spilled Oil in Porous Beach Conditions under a Meso-Scale Tank Design

Year: 2021 Volume: 15 Issue: 9 181 - 188 Pages

Abstract: Shorelines are vulnerable to significant environmental impacts from oil spills. Stranded oil can cause potential short- to long-term detrimental effects along beaches that include injuries to ecosystem, socio-economic and cultural resources. In this study, a three-dimensional (3D) numerical modeling approach is developed to evaluate the fate and transport of spilled oil for hypothetical oiled shoreline cases under various combinations of beach geomorphology and environmental conditions. The developed model estimates the spatial and temporal distribution of spilled oil for the various test conditions, using the finite volume method and considering the physical transport (dispersion and advection), sinks, and sorption processes. The model includes a user-friendly interface for data input on variables such as beach properties, environmental conditions, and physical-chemical properties of spilled oil. An experimental meso-scale tank design was used to test the developed model for dissolved petroleum hydrocarbon within shorelines. The simulated results for effects of different sediment substrates, oil types, and shoreline features for the transport of spilled oil are comparable to that obtained with a commercially available model. Results show that the properties of substrates and the oil removal by shoreline effects have significant impacts on oil transport in the beach area. Sensitivity analysis, through the application of the one-step-at-a-time method (OAT), for the 3D model identified hydraulic conductivity as the most sensitive parameter. The 3D numerical model allows users to examine the behavior of oil on and within beaches, assess potential environmental impacts, and provide technical support for decisions related to shoreline clean-up operations.

User’s Susceptibility Factors to Malware Attacks: A Systemic Literature Review

Year: 2021 Volume: 15 Issue: 9 403 - 414 Pages

Abstract: Users’ susceptibility to malware attacks have been noticed in the past few years. Investigating the factors that make a user vulnerable to those attacks is critical because they can be utilized to set up proactive strategies such as awareness and education to mitigate the impacts of those attacks. Demographic, behavioral, and cultural vulnerabilities are the main factors that make users susceptible to malware attacks. It is challenging, however, to draw more general conclusions based on those factors due to the varieties in the type of users and different types of malware. Therefore, we conducted a systematic literature review (SLR) of the existing research for user susceptibility factors to malware attacks. The results showed that all demographic factors are consistently associated with malware infection regardless of the users' type except for age and gender. Besides, the association of culture and personality factors with malware infection is consistent in most of the selected studies and for all types of users. Moreover, malware infection varies based on age, geographic location, and host types. We propose that future studies should carefully take into consideration the type of users because different users may be exposed to different threats or targeted based on their user domains’ characteristics. Additionally, as different types of malware use different tactics to trick users, taking the malware types into consideration is important.

The Effects of an Online Career Intervention on University Students’ Levels of Career Adaptability

Year: 2021 Volume: 15 Issue: 9 725 - 732 Pages

Authors:
Anna Veres

Abstract: People’s ability to adapt to a constantly changing environment is essential. Career adaptability is central to Career Construction Theory, where proper adaptation to new situations, changing environments, and jobs require adequate career development. Based on current career theories and the possibilities offered by digital technology, the primary goal of this study is to develop career adaptability through an online tool. Its secondary goal is to apply for an online career intervention program and explore its developmental possibilities. A total of 132 university students from the bachelor program took part in the study, from which 65 students received a four-week online career intervention, while 67 participants formed the control group. Based on the results, it can state that career adaptability can be developed, and there is a great demand and interest from university students to use career-related programs on online platforms. Career interventions should be performed online as well if there is suitable software and a well-constructed program. Limitations and further implications are discussed.

Verification of Space System Dynamics Using the MATLAB Identification Toolbox in Space Qualification Test

Year: 2021 Volume: 15 Issue: 8 250 - 257 Pages

Authors:
Y. V. Kim

Abstract: This article presents an approach with regards to the Functional Testing of Space System (SS) that could be a space vehicle (spacecraft-S/C) and/or its equipment and components – S/C subsystems. This test should finalize the Space Qualification Tests (SQT) campaign. It could be considered as a generic test and used for a wide class of SS that, from the point of view of System Dynamics and Control Theory, may be described by the ordinary differential equations. The suggested methodology is based on using semi-natural experiment laboratory stand that does not require complicated, precise and expensive technological control-verification equipment. However, it allows for testing totally assembled system during Assembling, Integration and Testing (AIT) activities at the final phase of SQT, involving system hardware (HW) and software (SW). The test physically activates system input (sensors) and output (actuators) and requires recording their outputs in real time. The data are then inserted in a laboratory computer, where it is post-experiment processed by the MATLAB/Simulink Identification Toolbox. It allows for estimating the system dynamics in the form of estimation of its differential equation coefficients through the verification experimental test and comparing them with expected mathematical model, prematurely verified by mathematical simulation during the design process. Mathematical simulation results presented in the article show that this approach could be applicable and helpful in SQT practice. Further semi-natural experiments should specify detail requirements for the test laboratory equipment and test-procedures.

Associations among Fetuin A, Cortisol and Thyroid Hormones in Children with Morbid Obesity and Metabolic Syndrome

Year: 2021 Volume: 15 Issue: 8 203 - 206 Pages

Abstract: Obesity is a disease with an ever-increasing prevalence throughout the world. The metabolic network associated with obesity is very complicated. In metabolic syndrome (MetS), it becomes even more difficult to understand. Within this context, hormones, cytokines, and many others participate in this complex matrix. The collaboration among all of these parameters is a matter of great wonder. Cortisol, as a stress hormone, is closely associated with obesity. Thyroid hormones are involved in the regulation of energy as well as glucose metabolism with all of its associates. Fetuin A has been known for years; however, the involvement of this parameter in obesity discussions is rather new. Recently, it has been defined as one of the new generation markers of obesity. In this study, the aim was to introduce complex interactions among all to be able to make clear comparisons, at least for a part of this complicated matter. Morbid obese (MO) children participated in the study. Two groups with 46 MO children and 43 with MetS were constituted. All children included in the study were above 99th age- and sex-adjusted body mass index (BMI) percentiles according to World Health Organization criteria. Forty-three morbid obese children in the second group also had MetS components. Informed consent forms were filled by the parents of the participants. The institutional ethics committee has given approval for the study protocol. Data as well as the findings of the study were evaluated from a statistical point of view. Two groups were matched for their age and gender compositions. Significantly higher body mass index (BMI), waist circumference, thyrotropin, and insulin values were observed in the MetS group. Triiodothyronine concentrations did not differ between the groups. Elevated levels for thyroxin, cortisol, and fetuin-A were detected in the MetS group compared to the first group (p > 0.05). In MO MetS- group, cortisol was correlated with thyroxin and fetuin-A (p < 0.05). In the MO MetS+ group, none of these correlations were present. Instead, a correlation between cortisol and thyrotropin was found (p < 0.05). In conclusion, findings have shown that cortisol was the key player in severely obese children. The association of this hormone with the participants of thyroid hormone metabolism was quite important. The lack of association with fetuin A in the morbid obese MetS+ group has suggested the possible interference of MetS components in the behavior of this new generation obesity marker. The most remarkable finding of the study was the unique correlation between cortisol and thyrotropin in the morbid obese MetS+ group, suggesting that thyrotropin may serve as a target along with cortisol in the morbid obese MetS+ group. This association may deserve specific attention during the development of remedies against MetS in the pediatric population.

Relationship between Hepatokines and Insulin Resistance in Childhood Obesity

Year: 2021 Volume: 15 Issue: 8 199 - 202 Pages

Abstract: Childhood obesity is an important clinical problem, because it may lead to chronic diseases during the adulthood period of the individual. Obesity is a metabolic disease associated with low-grade inflammation. The liver occurs at the center of metabolic pathways. Adropin, fibroblast growth factor-21 (FGF-21) and fetuin A are hepatokines. Due to the immense participation of the liver in glucose metabolism, these liver derived factors may be associated with insulin resistance (IR), which is a phenomenon discussed within the scope of obesity problems. The aim of this study is to determine the concentrations of adropin, FGF-21 and fetuin A in childhood obesity, to point out possible differences between the obesity groups and to investigate possible associations among these three hepatokines in obese and morbid obese children. A total of 132 children were included in the study. Two obese groups were constituted. The groups were matched in terms of mean±SD values of ages. Body mass index values of the obese and morbid obese groups were 25.0±3.5 kg/m2 and 29.8±5.7 kg/m2, respectively. Anthropometric measurements including waist circumference, hip circumference, head circumference, and neck circumference were recorded. Informed consent forms were taken from the parents of the participants and the Ethics Committee of the institution approved the study protocol. Blood samples were obtained after an overnight fasting. Routine biochemical tests including glucose- and lipid-related parameters were performed. Concentrations of the hepatokines (adropin, FGF-21, fetuin A) were determined by enzyme-linked immunosorbent assay. Insulin resistance indices such as homeostasis model assessment for IR (HOMA-IR), alanine transaminase-to aspartate transaminase ratio (ALT/AST), diagnostic obesity notation model assessment laboratory index, diagnostic obesity notation model assessment metabolic syndrome index as well as obesity indices such as diagnostic obesity notation model assessment-II index, and fat mass index were calculated using the previously derived formulas. Statistical evaluation of the study data as well as findings of the study were performed by SPSS for Windows. Statistical difference was accepted significant when p < 0.05. Statistically significant differences were found for insulin, triglyceride, high density lipoprotein cholesterol levels of the groups. A significant increase was observed for FGF-21 concentrations in the morbid obese group. Higher adropin and fetuin A concentrations were observed in the same group in comparison with the values detected in the obese group (p > 0.05). There was no statistically significant difference between the ALT/AST values of the groups. In all of the remaining IR and obesity indices, significantly increased values were calculated for morbid obese children. Significant correlations were detected between HOMA-IR and each of the hepatokines. The highest one was the association with fetuin A (r = 0.373, p = 0.001). In conclusion, increased levels observed in adropin, FGF-21 and fetuin A have shown that these hepatokines possess increasing potential going from the obese to morbid obese state. Out of the correlations found with IR index, the most affected hepatokine was fetuin A, the parameter possibly used as the indicator of the advanced obesity stage.

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