Venous Doppler flow patterns,venous congestion,heart disease and renal dysfunction:A complex liaison

The World Journal of Cardiology published an article written by Kuwahara et al that we take the pleasure to comment on.We focused our attention on venous congestion.In intensive care settings,it is now widely accepted that venous congestion is an important clinical feature worthy of investigation.Evaluating venous Doppler profile abnormalities at multiple sites could suggest adequate treatment and monitor its efficacy.Renal dysfunction could trigger or worsen fluid overload in heart disease,and cardio-renal syndrome is a well-characterized spectrum of disorders describing the complex interactions between heart and kidney diseases.Fluid overload and venous congestion,including renal venous hypertension,are major determinants of acute and chronic renal dysfunction arising in heart disease.Organ congestion from venous hypertension could be involved in the development of organ injury in several clinical situations,such as critical diseases,congestive heart failure,and chronic kidney disease.Ultrasonography and abnormal Doppler flow patterns diagnose clinically significant systemic venous congestion.Cardiologists and nephrologists might use this valuable,noninvasive,bedside diagnostic tool to establish fluid status and guide clinical choices.

Ultrasound unveiling:Decoding venous congestion in heart failure for precision management of fluid status

This editorial discusses the manuscript by Di Maria et al,published in the recent issue of the World Journal of Cardiology.We here focus on the still elusive pathophysiological mechanisms underlying cardio-renal syndrome(CRS),despite its high prevalence and the substantial worsening of both kidney function and heart failure.While the measure of right atrial pressure through right cardiac catheterization remains the most accurate albeit invasive and costly procedure,integrating bedside ultrasound into diagnostic protocols may substantially enhance the staging of venous congestion and guide therapeutic decisions.In particular,with the assessment of Doppler patterns across multiple venous districts,the Venous Excess Ultrasound(VExUS)score improves the management of fluid overload and provides insight into the underlying factors contributing to cardio-renal interactions.Integrating specific echocardiographic parameters,particularly those concerning the right heart,may thus improve the VExUS score sensitivity,offering perspective into the nuanced comprehension of cardio-renal dynamics.A multidisciplinary approach that consistently incorporates the use of ultrasound is emerging as a promising advance in the understanding and management of CRS.

Portal vein pulsatility:An important sonographic tool assessment of systemic congestion for critical ill patients

In this editorial we comment on the article by Kuwahara et al,published in the recent issue of the World Journal of Cardiology.In this interesting paper,the authors showed a correlation between portal vein pulsatility ratio,examined by bedside ultrasonography,and prognosis of hospitalized patients with acute heart failure.Systemic congestion is being notoriously underdetected in the acutely ill population with conventional methods like clinical examination,biomarkers,central venous pressure estimation and X-rays.However,congestion should be a key therapeutic target due to its deleterious effects to end organ function and subsequently patient prognosis.Doppler flow assessment of the abdominal veins is gaining popularity worldwide,as a valuable tool in estimating comprehensively congestion and giving a further insight into hemodynamics and patient management.

Real-Time Prediction of Urban Traffic Problems Based on Artificial Intelligence-Enhanced Mobile Ad Hoc Networks(MANETS)

Traffic in today’s cities is a serious problem that increases travel times,negatively affects the environment,and drains financial resources.This study presents an Artificial Intelligence(AI)augmentedMobile Ad Hoc Networks(MANETs)based real-time prediction paradigm for urban traffic challenges.MANETs are wireless networks that are based on mobile devices and may self-organize.The distributed nature of MANETs and the power of AI approaches are leveraged in this framework to provide reliable and timely traffic congestion forecasts.This study suggests a unique Chaotic Spatial Fuzzy Polynomial Neural Network(CSFPNN)technique to assess real-time data acquired from various sources within theMANETs.The framework uses the proposed approach to learn from the data and create predictionmodels to detect possible traffic problems and their severity in real time.Real-time traffic prediction allows for proactive actions like resource allocation,dynamic route advice,and traffic signal optimization to reduce congestion.The framework supports effective decision-making,decreases travel time,lowers fuel use,and enhances overall urban mobility by giving timely information to pedestrians,drivers,and urban planners.Extensive simulations and real-world datasets are used to test the proposed framework’s prediction accuracy,responsiveness,and scalability.Experimental results show that the suggested framework successfully anticipates urban traffic issues in real-time,enables proactive traffic management,and aids in creating smarter,more sustainable cities.

Congestive Heart Failure: Treatment of Symptoms or Causes

This paper is based on the author’s 20+ years of experience treating patients with congestive heart failure (CHF) as a cardiologist. In the 20+ years, 64 patients were treated, including both with reduced and preserved left ventricular function. Most patients had a 4 - 5 days hospitalization in their first admission with one readmission (1.6%) over seven years. This paper will help us understand the physiology and pathophysiology of congestive heart failure, especially how to use beta blockers and diuretics. It will shorten the length of hospitalization and lower the readmission rate and cost of CHF treatment. This paper will help us to open another research direction for CHF.

Sound waves and solutions:Point-of-care ultrasonography for acute kidney injury in cirrhosis

This article delves into the intricate challenges of acute kidney injury(AKI)in cirrhosis,a condition fraught with high morbidity and mortality.The complexities arise from distinguishing between various causes of AKI,particularly hemodynamic AKI,in cirrhotic patients,who experience hemodynamic changes due to portal hypertension.The term"hepatocardiorenal syndrome"is introduced to encapsulate the intricate interplay among the liver,heart,and kidneys.The narrative emphasizes the often-overlooked aspect of cardiac function in AKI assessments in cirrhosis,unveiling the prevalence of cirrhotic cardiomyopathy marked by impaired diastolic function.The conventional empiric approach involving volume expansion and vasopressors for hepatorenal syndrome is critically analyzed,highlighting potential risks and variable patient responses.We advocate for a nuanced algorithm for AKI evaluation in cirrhosis,prominently featuring point-of-care ultrasonography(POCUS).POCUS applications encompass assessing fluid tolerance,detecting venous congestion,and evaluating cardiac function.

Point-of-care ultrasonography spotlight:Could venous excess ultrasound serve as a shared language for internists and intensivists?

Point-of-care ultrasonography(POCUS),particularly venous excess ultrasound(VExUS)is emerging as a valuable bedside tool to gain real-time hemodynamic insights.This modality,derived from hepatic vein,portal vein,and intrarenal vessel Doppler patterns,offers a scoring system for dynamic venous congestion assessment.Such an assessment can be crucial in effective management of patients with heart failure exacerbation.It facilitates diagnosis,quantification of congestion,prognostication,and monitoring the efficacy of decongestive therapy.As such,it can effectively help to manage cardiorenal syndromes in various clinical settings.Extended or eVExUS explores additional veins,potentially broadening its applications.While VExUS demonstrates promising outcomes,challenges persist,particularly in cases involving renal and liver parenchymal disease,arrhythmias,and situations of pressure and volume overload overlap.Proficiency in utilizing spectral Doppler is pivotal for clinicians to effectively employ this tool.Hence,the integration of POCUS,especially advanced applications like VExUS,into routine clinical practice necessitates enhanced training across medical specialties.

Smart Parking Management System “MOTAH”

With a surge in the university’s student and staff population, parking problems and congestion have rapidly intensified. The recent inclusion of women drivers, particularly during official working hours, has exacerbated these challenges. This pressing issue underscores the critical necessity for a structured approach to managing university entries and overseeing parking at the gates. The proposed smart parking management system aims to address these concerns by introducing a design concept that restricts unauthorized access and provides exclusive parking privileges to authorized users. Through image processing, the system identifies available parking spaces, relaying real-time information to users via a mobile application. This comprehensive solution also generates detailed reports (daily, weekly, and monthly), aiding university safety authorities in future gate management decisions.

A Decision Framework for Automatic Guided Vehicle Routing Problem with Traffic Congestions

Automatic guided vehicles are widely used in various types of warehouses including the automated container terminals.This paper provides a decision framework for port managers to design and schedule automatic guided vehicle routing plans under time-varying traffic conditions.A large number of computational experiments on a grid graph are conducted to validate the efficiency of the proposed decision framework.We also proposed one efficient queueing rule in automatic guided vehicle routing scheduling.Although the complexity of the problem is high,computational results show that our proposed decision framework can provide high quality solutions within a relatively short computation time.

Congestion Control Algorithms for the Internet-A Secondary Publication

In the last five years,there has been a V-shaped recovery in the number of papers on congestion control algorithms on the Internet.In this paper,congestion problems on the Internet are discussed,such as congestion collapse and bufferbloat from the perspective of the necessity of congestion control algorithms.The typical congestion control algorithms are introduced,and the research areas and methods of congestion control algorithms are described.Recent research trends and future prospects of congestion control algorithms are also presented.

A Study on How Urban Rail Operators Can Secure New Growth Engines for the Future Approach: The Case of Underground Urban Logistics System

Seoul Metro is Seoul’s leading metro company, transporting up to 3 billion people annually. However, future ridership is expected to plummet due to an aging and shrinking population with one of the fastest declining total fertility rates in the world. The COVID-19 pandemic in 2019 accelerated this phenomenon. On the contrary, the e-commerce and home delivery industries have developed significantly since COVID-19. Seoul’s current logistics infrastructure cannot handle it. Under the inflection point of declining passenger transportation demand and increasing urban logistics demand, urban rail operators need new growth engines. Therefore, it is necessary to consider the introduction of an UULS (underground urban logistics system) that transports parcels instead of passengers through urban railways. If the UULS becomes a reality, it can be expected to secure scarce logistics land in cities, protect the environment and prevent traffic congestion by operating eco-friendly mass urban transportation, and acquire new revenue sources for urban rail operators. The UULS’s B/C ratio is 1.32. The sensitivity analysis shows that the ratio is above 1 in most cases where the unit cost of transportation is not significantly reduced.

An Effective Optimization Algorithm for Ant Colony Vehicular Congestion Management

Adaptability and dynamicity are special properties of social insects derived from the decentralized behavior of the insects. Authors have come up with designs for software solution that can regulate traffic congestion in a network transportation environment. The effectiveness of various researches on traffic management has been verified through appropriate metrics. Most of the traffic management systems are centered on using sensors, visual monitoring and neural networks to check for available parking space with the aim of informing drivers beforehand to prevent traffic congestion. There has been limited research on solving ongoing traffic congestion in congestion prone areas like car park with any of the common methods mentioned. This study focus however is on a motor park, as a highly congested area when it comes to traffic. The car park has two entrance gate and three exit gates which is divided into three Isle of parking lot where cars can park. An ant colony optimization algorithm (ACO) was developed as an effective management system for controlling navigation and vehicular traffic congestion problems when cars exit a motor park. The ACO based on the nature and movement of the natural ants, simulates the movement of cars out of the car park through their nearest choice exit. A car park simulation was also used for the mathematical computation of the pheromone. The system was implemented using SIMD because of its dual parallelization ability. The result showed about 95% increase on the number of vehicles that left the motor park in one second. A clear indication that pheromones are large determinants of the shortest route to take as cars followed the closest exit to them. Future researchers may consider monitoring a centralized tally system for cars coming into the park through a censored gate being.

Research of Fly over as a Solution to Congestion of Intersection Junction(Case Study:Jalan Jatingaleh Semarang)

In the next few years traffic will happen most of the time.This was triggered by the growing rate of vehicles against the road capacity which is not balance.All the time the congestion in the city of Semarang has been occurred at peak hours.Congestion also occurred in between Teuku Umar and Setia Budi road Jatingaleh because of a plot intersection(Kesatrian intersection,PLN intersection and Jatingaleh intersection)with the Toll Road.Jatingaleh is located in the southern city of Semarang which is a central meeting point between the upper and lower Semarang where the vehicle flows in through a combination of local current and regional traffic,and the flow of vehicles coming in and out from highway.The main cause of the problems that occurred in the area of Jatingaleh is due to the numbers of vehicles movement that occurs at the intersections.With the above issues,it is necessary to analyse the existing conditions and look into some solutions.Before carrying out an analysis a field surveys at peak hours for example morning(06:00 to 08:00 am)and for the afternoon(04:00 to 06:00 pm)should be conducted,then the number of vehicles is counted manually with“short-breakcounting”according to types of vehicles.From the analysis we found that the degree of saturation(DS)is 1.61 between Teuku Umar and Setia Budi road during the morning peak hours and 1.56 during the afternoon peak hours.This means that the capacity of the existing road is no longer able to accommodate the traffic flow.One of the solutions for the congestion that occurs at the intersection of Jatingaleh is to apply the efficiency of the intersection that is not in a plot with a Fly over,Underpass and the combination of Fly Over-Underpass.Base on the flow reduction calculation with 3 comparative modeling it shows that the Fly Over is the most technically efficient to be applied in this research.

Indices of Congested Areas and Contributions of Customers to Congestions in Radial Distribution Networks

Congestions are becoming a significant issue with an increasing number of occurrences in distribution networks due to the growing penetration of distributed generation and the expected development of electric mobility.Fair congestion management(CM)policies and prices require proper indices of congested areas and contributions of customer to congestions.This paper presents spatial and temporal indices for rapidly recognizing the seriousness of congestions from the perspectives of both magnitude violation and duration to prioritize the affected areas where CM procedures should be primarily activated.Besides,indices are presented which describe the contributions of customers to the congestions.Simulation tests on IEEE 123-bus and Australian 23-bus low-voltage distribution test feeders illustrate the calculation and capabilities of the proposed indices in balanced and unbalanced systems.

Clinical impact of portal vein pulsatility on the prognosis of hospitalized patients with acute heart failure

BACKGROUND Heart failure(HF)causes extracardiac organ congestion,including in the hepatic portal system.Reducing venous congestion is essential for HF treatment,but evaluating venous congestion is sometimes difficult in patients with chronic HF.The portal vein(PV)flow pattern can be influenced by right atrial pressure.Ultrasound images of the PV are quite easy to obtain and are reproducible among sonographers.However,the association between PV pulsatility and the condition of HF remains unclear.We hypothesize that PV pulsatility at discharge reflects the condition of HF.AIM To evaluate the usefulness of PV pulsatility as a prognostic marker for hospit-alized patients with acute HF.METHODS This observational study was conducted from April 2016 to January 2017 and April 2018 to April 2019 at Shinko Hospital.We enrolled 56 patients with acute HF,and 17 patients without HF served as controls.PV flow velocity was mea-sured by ultrasonography on admission and at discharge.We calculated the PV pulsatility ratio(PVPR)as the ratio of the difference between the peak and minimum velocity to the peak velocity.The primary endpoint was cardiac death and HF re-hospitalization.The observation period was 1 year from the first hospitalization.The Kaplan-Meier method was used to determine the stratified composite event-free rates,and the log-rank test was used for comparisons between groups.RESULTS On admission,the PVPR was significantly higher in patients with acute HF than controls(HF:0.29±0.20 vs controls:0.08±0.07,P<0.01).However,the PVPR was significantly decreased after the improvement in HF(admission:0.29±0.20 vs discharge:0.18±0.15,P<0.01)due to the increase in minimum velocity(admission:12.6±4.5 vs discharge:14.6±4.6 cm/s,P=0.03).To elucidate the association between the PVPR and cardiovascular outcomes,the patients were divided into three groups according to the PVPR tertile at discharge(PVPR-T1:0≤PVPR≤0.08,PVPR-T2:0.08<PVPR≤0.21,PVPR-T3:PVPR>0.21).The Kaplan-Meier analysis showed that patients with a higher PVPR at discharge had the worst prognosis among the groups.CONCLUSION PVPR at discharge reflects the condition of HF.It is also a novel prognostic marker for hospitalized patients with acute HF.

Impact of erythropoietin therapy on cardiorenal syndrome:A systematic review with meta-analysis

BACKGROUND Heart and kidney dysfunction frequently coexist in patients with acute heart failure due to the overlap between these two organ systems.Cardiorenal syndrome(CRS)results from pathology occurring in the heart and kidneys along with the consequences of dysfunction in one organ contributing to dysfunction in the other and vice versa.AIM To evaluate the use of erythropoietin(EPO)in patients with CRS and its effects on hemoglobin(Hb),major cardiovascular(CV)events,and hospitalization rates.METHODS On February 24,2022,searches were conducted using PubMed,MEDLINE,and EMBASE,and 148 articles were identified.A total of nine studies were considered in this systematic review.We assessed the included articles based on the National Heart,Lung,and Blood Institute quality assessment tools for controlled intervention and observational cohort or cross-sectional studies.An assessment of bias risk was conducted on the chosen studies,and data relevant to our review was extracted.RESULTS The systematic review of these studies concluded that most existing literature indicates that EPO improves baseline Hb levels and decreases myocardial remodeling and left ventricular dysfunction without reducing CV mortality.In addition,the effect of EPO on the hospitalization rate of patients with CRS needs to be further studied since this relationship is unknown.Future studies,such as randomized controlled clinical trials and prospective cohort studies,should be conducted to enhance the literature on the potential of EPO therapy in patients with CRS.CONCLUSION Our systematic review suggests that EPO therapy may have a significant role in managing CRS.The review highlights the potential benefits of EPO in improving baseline Hb levels,reducing the risk of major CV events,improving cardiac remodeling,myocardial function,New York Heart Association class,and B-type natriuretic peptide levels.However,the effect of EPO treatment on hospitalization remains unclear and needs further exploration.

Transcending boundaries:Unleashing the potential of multi-organ point-of-care ultrasound in acute kidney injury

Acute kidney injury(AKI)is a clinical syndrome characterized by a rapid increase in serum creatinine levels or a decrease in urine output or both.In spite of thorough history-taking,physical examination,and laboratory analysis,there are limitations in the diagnostic process and clinical monitoring of AKI.Point-of-care ultrasonography(POCUS),a limited ultrasound study performed by clinicians at the bedside,has emerged as a valuable tool in different clinical settings.In this discussion,we explore the potential of POCUS performed by nephrologists to address specific questions encountered in the diagnosis and management of AKI patients.POCUS not only aids in excluding hydronephrosis but also provides real-time insights into hemodynamics,enabling formulation of individualized treatment plans.Further studies are required to assess the impact of multi-organ POCUS on pragmatic patient outcomes related to AKI,as well as its potential in risk stratification and identification of different levels of AKI severity and pathophysiological signatures.

Point-of-care ultrasound in diagnosis and management of congestive nephropathy

Congestive nephropathy is kidney dysfunction caused by the impact of elevated venous pressures on renal hemodynamics.As a part of cardiorenal syndrome,the diagnosis is usually made based on history and physical examination,with findings such as jugular venous distension,a third heart sound,and vital signs as supporting findings.More recently,however,these once though objective measures have come under scrutiny for their accuracy.At the same time,bedside ultrasound has increased in popularity and is routinely being used by clinicians to take some of the guess work out of making the diagnosis of volume overload and venous congestion.In this mini-review,we will discuss some of the traditional methods used to measure venous congestion,describe the role of point-of-care ultrasound and how it can ameliorate a clinician’s evaluation,and offer a description of venous excess ultrasound score,a relatively novel scoring technique used to objectively quantify congestion.While there is a paucity of published large scale clinical trials evaluating the potential benefit of ultrasonography in venous congestion compared to gold standard invasive measurements,more study is underway to solidify the role of this objective measure in daily clinical practice.

Identification of key recovering node for spatial networks

Many networks in the real world have spatial attributes, such as location of nodes and length of edges, called spatial networks. When these networks are subject to some random or deliberate attacks, some nodes in the network fail, which causes a decline in the network performance. In order to make the network run normally, some of the failed nodes must be recovered. In the case of limited recovery resources, an effective key node identification method can find the key recovering node in the failed nodes, by which the network performance can be recovered most of the failed nodes. We propose two key recovering node identification methods for spatial networks, which are the Euclidean-distance recovery method and the route-length recovery method. Simulations on homogeneous and heterogeneous spatial networks show that the proposed methods can significantly recover the network performance.

Reducing congestion and emissions via roadside unit deployment under mixed traffic flow

It is expected that for a long time the future road trafc will be composed of both regular vehicles(RVs)and connected autonomous vehicles(CAVs).As a vehicle-to-infrastructure technology dedicated to facilitating CAV under the mixed trafc fow,roadside units(RSUs)can also improve the quality of information received by CAVs,thereby infuencing the routing behavior of CAV users.This paper explores the possibility of leveraging the RSU deployment to afect the route choices of both CAVs and RVs and the adoption rate of CAVs so as to reduce the network congestion and emissions.To this end,we frst establish a logit-based stochastic user equilibrium model to capture drivers’route choice and vehicle type choice behaviors provided the RSU deployment plan is given.Particularly,CAV users’perception error can be reduced by higher CAV penetration and denser RSUs deployed on the road due to the improved information quality.With the established equilibrium model,the RSU deployment problem is then formulated as a mathematical program with equilibrium constraints.An active-set algorithm is presented to solve the deployment problem efciently.Numerical results suggest that an optimal RSU deployment plan can efectively drive the system towards one with lower network delay and emissions.