Hepatitis B virus(HBV) infection is a global health problem. It is estimated there are more than 2 billion individuals exposed to the virus and 250 million are chronically infected. Hepatitis B is the cause of more th...Hepatitis B virus(HBV) infection is a global health problem. It is estimated there are more than 2 billion individuals exposed to the virus and 250 million are chronically infected. Hepatitis B is the cause of more than 600000 annual deaths due to cirrhosis and hepatocellular carcinoma. An effective vaccine exists and preventative initiatives center around universal vaccination especially in those at highest risk. Effective vaccination algorithms have led to a significant decline in the development of new infections and its devastating consequences. The vaccine is administered intramuscularly in three doses, with 95% showing long lasting serologic immunity. An additional fourth dose or a repeated higher dose three course regimen is given to those that fail to show immunity. Despite these additional regimens, some remain vulnerable to hepatitis B and are deemed nonresponders. Individuals with chronic disease states such as kidney disease, liver disease, diabetes mellitus, as well as those with a genetic predisposition, and those on immunomodulation therapy, have the highest likelihood of non-response. Various strategies have been developed to elicit an immune response in these individuals. These include increased vaccination dose, intradermal administration, alternative adjuvants, alternative routes of administration, co-administration with other vaccines, and other novel therapies. These alternative strategies can show improved response and lasting immunity. In summary, HBV vaccination is a major advance of modern medicine and all individuals at risk should be sought and vaccinated with subsequent adequate titers demonstrated.展开更多
Introduction: Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a rare disease of uncertain origin proposed to be secondary to viral or autoimmune causes. It presents as unilatera...Introduction: Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a rare disease of uncertain origin proposed to be secondary to viral or autoimmune causes. It presents as unilateral cervical lymphadenopathy and fever, typically resolving within a few months, however, it mimics malignant lymphoma, leading to extensive work-up fearing malignancy. Case History: A 33-year-old female with a history of Sjögren’s syndrome, rheumatoid arthritis (not on immunosuppressive therapy) and recent COVID-19 infection two months ago presented with episodes of flu-like symptoms;fever (101˚F), chills, and myalgias for two months. Upon evaluation, she had leukopenia (WBC 1.8 k/uL), neutropenia (1.0 k/uL), elevated CRP (134 mg/L), and CT neck demonstrated multiple enlarged cervical lymph nodes with necrosis. The patient was started on Cefdinir and doxycycline for a possible atypical infection given neutropenic fevers and the patient continued to have fevers. A biopsy showed focal necrosis with no evidence of malignancy, suggesting KFD that was likely triggered by a recent COVID infection. She was treated with Prednisone and naproxen, which led to an improvement in symptoms and recovery of her pancytopenia. Discussion: This case is unique since the patient’s recent infection with COVID-19 may have triggered the clinical manifestations of KFD. There have been a few case reports of children who were diagnosed with KFD after a COVID-19 infection and adults diagnosed with KFD following COVID vaccinations;however, this is the first case report involving a young adult in her thirties who was diagnosed with KFD two months after COVID-19.展开更多
As the differences of sensor＇s precision and some random factors are difficult to control,the actual measurement signals are far from the target signals that affect the reliability and precision of rotating machinery...As the differences of sensor＇s precision and some random factors are difficult to control,the actual measurement signals are far from the target signals that affect the reliability and precision of rotating machinery fault diagnosis.The traditional signal processing methods,such as classical inference and weighted averaging algorithm usually lack dynamic adaptability that is easy for trends to cause the faults to be misjudged or left out.To enhance the measuring veracity and precision of vibration signal in rotary machine multi-sensor vibration signal fault diagnosis,a novel data level fusion approach is presented on the basis of correlation function analysis to fast determine the weighted value of multi-sensor vibration signals.The approach doesn＇t require knowing the prior information about sensors,and the weighted value of sensors can be confirmed depending on the correlation measure of real-time data tested in the data level fusion process.It gives greater weighted value to the greater correlation measure of sensor signals,and vice versa.The approach can effectively suppress large errors and even can still fuse data in the case of sensor failures because it takes full advantage of sensor＇s own-information to determine the weighted value.Moreover,it has good performance of anti-jamming due to the correlation measures between noise and effective signals are usually small.Through the simulation of typical signal collected from multi-sensors,the comparative analysis of dynamic adaptability and fault tolerance between the proposed approach and traditional weighted averaging approach is taken.Finally,the rotor dynamics and integrated fault simulator is taken as an example to verify the feasibility and advantages of the proposed approach,it is shown that the multi-sensor data level fusion based on correlation function weighted approach is better than the traditional weighted average approach with respect to fusion precision and dynamic adaptability.Meantime,the approach is adaptable and easy to use,can be appl展开更多
BACKGROUND Alcohol-associated cirrhosis(AC)contributes to significant liver-related mortality in the United States.It is known to cause immune dysfunction and coagulation abnormalities.Patients with comorbid condition...BACKGROUND Alcohol-associated cirrhosis(AC)contributes to significant liver-related mortality in the United States.It is known to cause immune dysfunction and coagulation abnormalities.Patients with comorbid conditions like AC are at risk of worse clinical outcomes from coronavirus disease 2019(COVID-19).The specific association between AC and COVID-19 mortality remains inconclusive,given the lack of robust clinical evi-dence from prior studies.AIM To study the predictors of mortality and the outcomes of AC in patients hospitalized with COVID-19 in the United States.METHODS We conducted a retrospective cohort study using the National Inpatient Sample(NIS)database 2020.Patients were identified with primary COVID-19 hospitalizations based on an underlying diagnosis of AC.A matched comparison cohort of COVID-19 patients without AC was identified after 1:N propensity score matching based on baseline sociodemographic characteristics and Elixhauser comorbidities.Primary outcomes included median length of stay,median inpatient charges,and in-hospital mortality.Secondary outcomes included a prevalence of systemic complications.RESULTS A total of 1325 COVID-19 patients with AC were matched to 1135 patients without AC.There was no difference in median length of stay and hospital charges in COVID-19 patients with AC compared to non-AC(P>0.05).There was an increased prevalence of septic shock(5.7%vs 4.1%),ventricular fibrillation/ventricular flutter(0.4%vs 0%),atrial fibrillation(13.2%vs 8.8%),atrial flutter(8.7%vs 4.4%),first-degree atrioventricular nodal block(0.8%vs 0%),upper extremity venous thromboembolism(1.5%vs 0%),and variceal bleeding(3.8%vs 0%)in the AC cohort compared to the non-AC cohort(P<0.05).There was no difference in inpatient mortality in COVID-19 patients with non-AC compared to AC,with an odds ratio of 0.97(95%confidence interval:0.78-1.22,P=0.85).Predictors of mortality included advanced age,cardiac arrhythmias,coagulopathy,protein-calorie malnutrition,fluid and electrolyte disorders,septic shock,and upp展开更多
Platinum diselenide(PtSe_(2))is a promising two-dimensional(2D)material for the terahertz(THz)range as,unlike other transition metal dichalcogenides(TMDs),its bandgap can be uniquely tuned from a semiconductor in the ...Platinum diselenide(PtSe_(2))is a promising two-dimensional(2D)material for the terahertz(THz)range as,unlike other transition metal dichalcogenides(TMDs),its bandgap can be uniquely tuned from a semiconductor in the nearinfrared to a semimetal with the number of atomic layers.This gives the material unique THz photonic properties that can be layer-engineered.Here,we demonstrate that a controlled THz nonlinearity—tuned from monolayer to bulk PtSe_(2)—can be realized in wafer size polycrystalline PtSe_(2)through the generation of ultrafast photocurrents and the engineering of the bandstructure valleys.This is combined with the PtSe_(2)layer interaction with the substrate for a broken material centrosymmetry,permitting a second order nonlinearity.Further,we show layer dependent circular dichroism,where the sign of the ultrafast currents and hence the phase of the emitted THz pulse can be controlled through the excitation of different bandstructure valleys.In particular,we show that a semimetal has a strong dichroism that is absent in the monolayer and few layer semiconducting limit.The microscopic origins of this TMD bandstructure engineering are highlighted through detailed DFT simulations,and shows the circular dichroism can be controlled when PtSe_(2)becomes a semimetal and when the K-valleys can be excited.As well as showing that PtSe_(2)is a promising material for THz generation through layer controlled optical nonlinearities,this work opens up a new class of circular dichroism materials beyond the monolayer limit that has been the case of traditional TMDs,and impacting a range of domains from THz valleytronics,THz spintronics to harmonic generation.展开更多
BACKGROUND The incidence of diabetes mellitus type 1(DM1)has been rising worldwide because of improvements in diagnostic techniques and improved access to care in countries with lower socioeconomic status.A new anti-C...BACKGROUND The incidence of diabetes mellitus type 1(DM1)has been rising worldwide because of improvements in diagnostic techniques and improved access to care in countries with lower socioeconomic status.A new anti-CD4 antibody,Teplizumab,has been shown to delay the progression of DM1 and is the only medication approved for this indication.However,more information is needed about the safety profile of this drug.AIM To identify the odds ratios(OR)of systems-based adverse effects for Teplizumab when compared to Placebo.METHODS An extensive systematic review was conducted from the inception of the medication until December 31,2023.All clinical trials and studies that evaluated Teplizumab vs placebo were included in the initial review.The study protocol was designed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines guidelines and was registered in PROSPERO(ID:CRD42024496169).Crude OR were generated using RevMan Software version 5.4.RESULTS After screening and review,5 studies were selected to determine the risk of adverse effects of teplizumab compared to placebo.A total of 561 patients were included in the study population.Total adverse effects and system-based adverse effects were studied and reported.We determined that patients receiving Teplizumab had a higher risk of developing gastrointestinal(GI)(OR=1.60,95%CI:1.01-2.52,P=0.04),dermatological(OR=6.33,95%CI:4.05-9.88,P<0.00001)and hematological adverse effects(OR=19.03,95%CI:11.09-32.66,P<0.00001).These patients were also significantly likely to have active Epstein-Barr Virus infection(OR=3.16,95%CI:1.51-6.64,P<0.002).While our data showed that patients receiving Teplizumab did have a higher incidence of total adverse effects vs placebo,this finding did not reach statistical significance(OR=2.25,95%CI:0.80-6.29,P=0.12).CONCLUSION Our systematic review suggests that Teplizumab patients are at risk for significant adverse effects,primarily related to GI,dermatological,and hematological systems.The total adverse effect data is li展开更多
The intent of this paper is to schedule short-term hydrothermal system probabilistically considering stochastic operating cost curves for thermal power generation units and uncertainties in load demand and reservoir w...The intent of this paper is to schedule short-term hydrothermal system probabilistically considering stochastic operating cost curves for thermal power generation units and uncertainties in load demand and reservoir water inflows. Therefore, the stochastic multi-objective hydrothermal generation scheduling problem is formulated with explicit recognition of uncertainties in the system production cost coefficients and system load, which are treated as random variable. Fuzzy methodology has been exploited for solving a decision making problem involving multiplicity of objectives and selection criterion for best compromised solution. A real-coded genetic algorithm with arithmetic-average-bound-blend crossover and wavelet mutation operator is applied to solve short-term variable-head hydrothermal scheduling problem. Initial feasible solution has been obtained by implementing the random heuristic search. The search is performed within the operating generation limits. Equality constraints that satisfy the demand during each time interval are considered by introducing a slack thermal generating unit for each time interval. Whereas the equality constraint which satisfies the consumption of available water to its full extent for the whole scheduling period is considered by introducing slack hydro generating unit for a particular time interval. Operating limit violation by slack hydro and slack thermal generating unit is taken care using exterior penalty method. The effectiveness of the proposed method is demonstrated on two sample systems.展开更多
Artificial intelligence(AI)has impacted many areas of healthcare.AI in healthcare uses machine learning,deep learning,and natural language processing to analyze copious amounts of healthcare data and yield valuable ou...Artificial intelligence(AI)has impacted many areas of healthcare.AI in healthcare uses machine learning,deep learning,and natural language processing to analyze copious amounts of healthcare data and yield valuable outcomes.In the sleep medicine field,a large amount of physiological data is gathered compared to other branches of medicine.This field is primed for innovations with the help of AI.A good quality of sleep is crucial for optimal health.About one billion people are estimated to have obstructive sleep apnea worldwide,but it is difficult to diagnose and treat all the people with limited resources.Sleep apnea is one of the major contributors to poor health.Most of the sleep apnea patients remain undiagnosed.Those diagnosed with sleep apnea have difficulty getting it optimally treated due to several factors,and AI can help in this situation.AI can also help in the diagnosis and management of other sleep disorders such as insomnia,hypersomnia,parasomnia,narcolepsy,shift work sleep disorders,periodic leg movement disorders,etc.In this manuscript,we aim to address three critical issues about the use of AI in sleep medicine:(1)How can AI help in diagnosing and treating sleep disorders?(2)How can AI fill the gap in the care of sleep disorders?and(3)What are the ethical and legal considerations of using AI in sleep medicine?展开更多
We evaluated the growth and crown traits of 36 poplar clones at two distinct agro-climatic regions of Punjab （Ludhiana and Bathinda） in northwestern India, following randomized block design with three replications a...We evaluated the growth and crown traits of 36 poplar clones at two distinct agro-climatic regions of Punjab （Ludhiana and Bathinda） in northwestern India, following randomized block design with three replications and plot size of four trees. Significant differences among clones （p〈0.001） were observed for diameter at breast height （DBH）, tree height, volume, crown width and number of branches under both the site conditions. Clones ‘G-3’, ‘25-N’ and ‘41-N’ at Ludhiana and ‘G-3’, ‘RD-01’ and ‘S7C8’ at Bathinda were found to be superior for volume production. All growth and crown traits registered significantly higher values at Ludhiana in comparison to those at Bathinda. Clone site interaction was also significant （p〈0.001）. For volume, clones ‘L-62/84’, ‘113520’, ‘25-N’ and ‘S4C2’ witnessed huge fluctuations in ranking between sites. The correlations between growth traits were positive and highly significant （p〈0.001） at both sites. The clonal mean heritability was moderate for DBH and volume both at Ludhiana （0.61–0.66） and Bathinda （0.61–0.62）. Across sites, the genetic advance was the highest for volume （49.76%） and the lowest （6.50%） in case of height.展开更多
AIM:To identify the frequency of iron overload and study the three mutations in the HFE gene (C282Y,H63D,and S65C) in patients with chronic liver disorders (CLD) and controls. METHODS:To identify patients with iron ov...AIM:To identify the frequency of iron overload and study the three mutations in the HFE gene (C282Y,H63D,and S65C) in patients with chronic liver disorders (CLD) and controls. METHODS:To identify patients with iron overload (transferrin saturation > 45% in females and > 50% in males and serum ferritin > 1000 ng/mL) we evaluated 236 patients with CLD,including 59 with non-alcoholic steatohepatitis (NASH),22 with alcoholic liver disease (ALD),19 of cirrhosis due to viruses (HBV,HCV),and 136 with cryptogenic cirrhosis. Mutations of the HFE gene were analyzed by PCR-RE. hundred controls were screened for iron status and the mutations. RESULTS:Seventeen patients with CLD showed evidence of iron overload. Fifteen cases of iron overload had cryptogenic cirrhosis and two had ALD. None of the controls showed iron overload. We did not find any individual with 282Y or 65C either in the cases or in the controls. The prevalence of H63D heterozygosity was 12% in normal individuals,14.8% in 236 patients (16.9% in NASH,13.6% in ALD,26.3% in viral and 12.5% in cryptogenic cirrhosis) and the overall prevalence was 13.98%. Only two of the 17 patients with primary iron overload were heterozygous for H63D. One patient with NASH and one normal individual who were homozygous for H63D showed no iron overload.CONCLUSION:Primary iron overload in Indians is nonHFE type,which is different from that in Europeans and further molecular studies are required to determine the defect in various iron regulatory genes.展开更多
The use of fundamental modelocking to generate short terahertz(THz)pulses and THz frequency combs from semiconductor lasers has become a routine affair,using quantum cascade lasers(QCLs)as a gain medium.However,unlike...The use of fundamental modelocking to generate short terahertz(THz)pulses and THz frequency combs from semiconductor lasers has become a routine affair,using quantum cascade lasers(QCLs)as a gain medium.However,unlike classic laser diodes,no demonstrations of harmonic modelocking,active or passive,have been shown in THz QCLs,where multiple pulses per round trip are generated when the laser is modulated at the harmonics of the cavity’s fundamental round-trip frequency.Here,using time-resolved THz techniques,we show for the first time harmonic injection and mode-locking in which THz QCLs are modulated at the harmonics of the round-trip frequency.We demonstrate the generation of the harmonic electrical beatnote within a QCL,its injection locking to an active modulation and its direct translation to harmonic pulse generation using the unique ultrafast nature of our approach.Finally,we show indications of self-starting harmonic emission,i.e.,without external modulation,where the QCL operates exclusively on a harmonic(up to its 15th harmonic)of the round-trip frequency.This behaviour is supported by time-resolved simulations of induced gain and loss in the system and shows the importance of the electronic,as well as photonic,nature of QCLs.These results open up the prospect of passive harmonic modelocking and THz pulse generation,as well as the generation of low-noise microwave generation in the hundreds of GHz region.展开更多
A 21-year-old male with no significant past medical history, presented with right upper quadrant(RUQ) abdominal pain along with fevers and chills. Lab work revealed leukocytosis, anemia, and slightly elevated alkaline...A 21-year-old male with no significant past medical history, presented with right upper quadrant(RUQ) abdominal pain along with fevers and chills. Lab work revealed leukocytosis, anemia, and slightly elevated alkaline phosphatase. Viral serology for hepatitis B virus, hepatitis C virus, and human immunodeficiency virus were negative and he was immunocompetent.Computed tomography imaging revealed hepatic abscesses, the largest measuring 9.5 cm. Empiric antibiotics were started and percutaneous drains were placed in the abscesses. Anaerobic cultures from the abscesses grew Fusobacterium nucleatum. This is a gram negative anaerobic bacteria; a normal flora of the oral cavity. Fusobacterium is most commonly seen in Lemiere's disease, which is translocation of oral bacteria to the internal jugular vein causing a thrombophlebitis and subsequent spread of abscesses. Our patient did not have Lemiere's, and is the first case described of fusobacterium pyogenic liver abscess in a young immunocompetent male with good oral hygiene. This case was complicated by sepsis, empyema, and subsequent abscesses located outside the liver. These abscesses' have the propensity to flare abruptly and can be fatal. This case not only illustrates fusobacterium as a rare entity for pyogenic liver abscess, but also the need for urgent diagnosis and treatment. It is incumbent on physicians to diagnose and drain any suspicious hepatic lesions. While uncommon, such infections may develop without any overt source and can progress rapidly. Prompt drainage with antibiotic therapy remains the cornerstone of therapy.展开更多
In this paper,a monitoring and controlling system for the safety in production and environmental parameters of a small and medium-sized coal mine has been developed after analyzing the current domestic coal production...In this paper,a monitoring and controlling system for the safety in production and environmental parameters of a small and medium-sized coal mine has been developed after analyzing the current domestic coal production and security conditions. The client computer can convert the analog signal about the safety in production and environmental parameters detected from the monitoring terminal into digital signal,and then,send the signal to the coal mine safety monitoring centre. This information can be analyzed,judged,and diagnosed by the monitoring-management-controlling software for helping the manager and technical workers to control the actual underground production and security situations. The system has many advantages including high reliability,better performance of real-time monitoring,faster data communicating and good practicability,and it can effectively prevent the occurrence of safety incidents in coal mines.展开更多
Rice root-knot nematode(RRKN,Meloidogyne graminicola)and brown spot(BS,Drechslera oryzae)are serious constraints on the quality of rice grains,particularly under direct-seeded rice conditions in many parts of the worl...Rice root-knot nematode(RRKN,Meloidogyne graminicola)and brown spot(BS,Drechslera oryzae)are serious constraints on the quality of rice grains,particularly under direct-seeded rice conditions in many parts of the world.Developing rice varieties resistant to RRKN and BS will be the most effective and environmentally friendly management strategy.A total of 93 and 58 Oryza rufipogon accessions were screened against RRKN and BS,respectively,for two years under artificial inoculation conditions.Among the 93 O.rufipogon accessions。展开更多
The control of light–matter coupling at the single electron level is currently a subject of growing interest for the development of novel quantum devices and for studies and applications of quantum electrodynamics.In...The control of light–matter coupling at the single electron level is currently a subject of growing interest for the development of novel quantum devices and for studies and applications of quantum electrodynamics.In the terahertz(THz)spectral range,this raises the particular and difficult challenge of building electromagnetic resonators that can conciliate low mode volume and high quality factor.Here,we report on hybrid THz cavities based on ultrastrong coupling between a Tamm cavity and an LC circuit metamaterial and show that they can combine high quality factors of up to Q=37 with a deep-subwavelength mode volume of V=3.2×10^(-4)λ^(3).Our theoretical and experimental analysis of the coupled mode properties reveals that,in general,the ultrastrong coupling between a metamaterial and a Fabry–Perot cavity is an effective tool to almost completely suppress radiative losses and,thus,ultimately limit the total losses to the losses in the metallic layer.These Tamm cavity-LC metamaterial coupled resonators open a route toward the development of single photon THz emitters and detectors and to the exploration of ultrastrong THz light–matter coupling with a high degree of coherence in the few to single electron limit.展开更多
This study examines the construct validity and reliability of the Malay language questionnaire for urinary incontinence diagnosis (QUID) in women. Study Design: Random sampling design was used in this cross-sectional ...This study examines the construct validity and reliability of the Malay language questionnaire for urinary incontinence diagnosis (QUID) in women. Study Design: Random sampling design was used in this cross-sectional survey. Materials and Methods: The Americanized English language questionnaire was translated to the Malay language and distributed to community-dwelling Malaysian women living in various locations in Selangor. The construct validity was tested using exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA). The reliability was determined using Cronbach’s α. Results: A total of 111 women completed the Malay language QUID in this pilot study. The Keiser-Meyer-Olkin (KMO) measure of sampling adequacy of 0.675 and Bartlett’s test of sphericity (χ2 = 284.633, df = 15, p = 0.001) indicated that the EFA was possible. The total variance and the scree plot identified two factors above the initial eigenvalue of 1 while a third factor was just below it (0.758). The CFA output showed a recursive model with the solution being not admissible because two unobserved and exogenous variables had negative variance estimates. The following values of absolute fit indices showed an acceptable level of fit: 1) Chi-square test with χ2 = 4.997, df = 5, p = 0.416, indicated a smaller difference between the expected and observed covariance matrices;2) GFI = 0.986, AGFI = 0.939, RMR = 0.021 and CMIN/DF = 1.0 indicated acceptable level of fit;3) The baseline comparison values of NFI = 0.983 and CFI = 1.0 also indicated a good fit to the data;4) RMSEA = 0.000 was considered a perfect fit indicating that the hypothesized model was a good fit to the observed data. Under the hypothesis of “close fit”, the probability of getting a sample RMSEA as large as 0.000 was 0.567. The Cronbach’s α coefficient of 0.823 indicated good reliability. Conclusion: The Malay language QUID is a valid and reliable instrument for diagnosing female urinary incontinence in the Malaysian population.展开更多
Bile cast nephropathy is a condition of renal dysfunction in the setting of hyperbilirubinemia. There are very few cases of this condition reported in the last decade and a lack of established treatment guidelines. Wh...Bile cast nephropathy is a condition of renal dysfunction in the setting of hyperbilirubinemia. There are very few cases of this condition reported in the last decade and a lack of established treatment guidelines. While the exact etiology remains unknown, bile cast nephropathy is presumed to be secondary to multiple concurrent insults to the kidney including direct toxicity from bile acids, obstructive physiology from bile casts, and systemic hypoperfusion from vasodilation. Therapy directed at bilirubin reduction may improve renal function, but will likely need dialysis or plasmapheresis as well. We report our case of bile cast nephropathy and the therapeutic measures undertaken in a middle-aged male with chronic renal insufficiency that developed hyperbilirubinemia and drug-induced liver injury secondary to antibiotic use. He developed acute renal injury in the setting of rising bilirubin. He subsequently had a progressive decline in renal and hepatic function, requiring dialysis and plasmapheresis with some improvement, ultimately requiring transplantation.展开更多
文摘Hepatitis B virus(HBV) infection is a global health problem. It is estimated there are more than 2 billion individuals exposed to the virus and 250 million are chronically infected. Hepatitis B is the cause of more than 600000 annual deaths due to cirrhosis and hepatocellular carcinoma. An effective vaccine exists and preventative initiatives center around universal vaccination especially in those at highest risk. Effective vaccination algorithms have led to a significant decline in the development of new infections and its devastating consequences. The vaccine is administered intramuscularly in three doses, with 95% showing long lasting serologic immunity. An additional fourth dose or a repeated higher dose three course regimen is given to those that fail to show immunity. Despite these additional regimens, some remain vulnerable to hepatitis B and are deemed nonresponders. Individuals with chronic disease states such as kidney disease, liver disease, diabetes mellitus, as well as those with a genetic predisposition, and those on immunomodulation therapy, have the highest likelihood of non-response. Various strategies have been developed to elicit an immune response in these individuals. These include increased vaccination dose, intradermal administration, alternative adjuvants, alternative routes of administration, co-administration with other vaccines, and other novel therapies. These alternative strategies can show improved response and lasting immunity. In summary, HBV vaccination is a major advance of modern medicine and all individuals at risk should be sought and vaccinated with subsequent adequate titers demonstrated.
基金Project of Hunan Provincial Research Scheme(2007CK3054)Open Fund Project of Hunan Province Key Lab of Health Maintenance for Mechanical Equipment, Hunan University of Science and Technology(KFJJ0602)
文摘Introduction: Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a rare disease of uncertain origin proposed to be secondary to viral or autoimmune causes. It presents as unilateral cervical lymphadenopathy and fever, typically resolving within a few months, however, it mimics malignant lymphoma, leading to extensive work-up fearing malignancy. Case History: A 33-year-old female with a history of Sjögren’s syndrome, rheumatoid arthritis (not on immunosuppressive therapy) and recent COVID-19 infection two months ago presented with episodes of flu-like symptoms;fever (101˚F), chills, and myalgias for two months. Upon evaluation, she had leukopenia (WBC 1.8 k/uL), neutropenia (1.0 k/uL), elevated CRP (134 mg/L), and CT neck demonstrated multiple enlarged cervical lymph nodes with necrosis. The patient was started on Cefdinir and doxycycline for a possible atypical infection given neutropenic fevers and the patient continued to have fevers. A biopsy showed focal necrosis with no evidence of malignancy, suggesting KFD that was likely triggered by a recent COVID infection. She was treated with Prednisone and naproxen, which led to an improvement in symptoms and recovery of her pancytopenia. Discussion: This case is unique since the patient’s recent infection with COVID-19 may have triggered the clinical manifestations of KFD. There have been a few case reports of children who were diagnosed with KFD after a COVID-19 infection and adults diagnosed with KFD following COVID vaccinations;however, this is the first case report involving a young adult in her thirties who was diagnosed with KFD two months after COVID-19.
基金supported by National Hi-tech Research and Development Program of China (863 Program, Grant No. 2007AA04Z433)Hunan Provincial Natural Science Foundation of China (Grant No. 09JJ8005)Scientific Research Foundation of Graduate School of Beijing University of Chemical and Technology,China (Grant No. 10Me002)
文摘As the differences of sensor＇s precision and some random factors are difficult to control,the actual measurement signals are far from the target signals that affect the reliability and precision of rotating machinery fault diagnosis.The traditional signal processing methods,such as classical inference and weighted averaging algorithm usually lack dynamic adaptability that is easy for trends to cause the faults to be misjudged or left out.To enhance the measuring veracity and precision of vibration signal in rotary machine multi-sensor vibration signal fault diagnosis,a novel data level fusion approach is presented on the basis of correlation function analysis to fast determine the weighted value of multi-sensor vibration signals.The approach doesn＇t require knowing the prior information about sensors,and the weighted value of sensors can be confirmed depending on the correlation measure of real-time data tested in the data level fusion process.It gives greater weighted value to the greater correlation measure of sensor signals,and vice versa.The approach can effectively suppress large errors and even can still fuse data in the case of sensor failures because it takes full advantage of sensor＇s own-information to determine the weighted value.Moreover,it has good performance of anti-jamming due to the correlation measures between noise and effective signals are usually small.Through the simulation of typical signal collected from multi-sensors,the comparative analysis of dynamic adaptability and fault tolerance between the proposed approach and traditional weighted averaging approach is taken.Finally,the rotor dynamics and integrated fault simulator is taken as an example to verify the feasibility and advantages of the proposed approach,it is shown that the multi-sensor data level fusion based on correlation function weighted approach is better than the traditional weighted average approach with respect to fusion precision and dynamic adaptability.Meantime,the approach is adaptable and easy to use,can be appl
文摘BACKGROUND Alcohol-associated cirrhosis(AC)contributes to significant liver-related mortality in the United States.It is known to cause immune dysfunction and coagulation abnormalities.Patients with comorbid conditions like AC are at risk of worse clinical outcomes from coronavirus disease 2019(COVID-19).The specific association between AC and COVID-19 mortality remains inconclusive,given the lack of robust clinical evi-dence from prior studies.AIM To study the predictors of mortality and the outcomes of AC in patients hospitalized with COVID-19 in the United States.METHODS We conducted a retrospective cohort study using the National Inpatient Sample(NIS)database 2020.Patients were identified with primary COVID-19 hospitalizations based on an underlying diagnosis of AC.A matched comparison cohort of COVID-19 patients without AC was identified after 1:N propensity score matching based on baseline sociodemographic characteristics and Elixhauser comorbidities.Primary outcomes included median length of stay,median inpatient charges,and in-hospital mortality.Secondary outcomes included a prevalence of systemic complications.RESULTS A total of 1325 COVID-19 patients with AC were matched to 1135 patients without AC.There was no difference in median length of stay and hospital charges in COVID-19 patients with AC compared to non-AC(P>0.05).There was an increased prevalence of septic shock(5.7%vs 4.1%),ventricular fibrillation/ventricular flutter(0.4%vs 0%),atrial fibrillation(13.2%vs 8.8%),atrial flutter(8.7%vs 4.4%),first-degree atrioventricular nodal block(0.8%vs 0%),upper extremity venous thromboembolism(1.5%vs 0%),and variceal bleeding(3.8%vs 0%)in the AC cohort compared to the non-AC cohort(P<0.05).There was no difference in inpatient mortality in COVID-19 patients with non-AC compared to AC,with an odds ratio of 0.97(95%confidence interval:0.78-1.22,P=0.85).Predictors of mortality included advanced age,cardiac arrhythmias,coagulopathy,protein-calorie malnutrition,fluid and electrolyte disorders,septic shock,and upp
基金H2020 Future and Emerging Technologies,Grant/Award Number:964735H2020 Excellent Science,Grant/Award Number:881603+3 种基金Agence Nationale de la Recherche,Grant/Award Numbers:ANR-16-CE24-0023,ANR-2018-CE08-018-05National Research Foundation Singapore,Grant/Award Number:NRF-CRP26-2021-0004Region Ile de FranceEquipMeso,Grant/Award Number:ANR-10-EQPX-29-01。
文摘Platinum diselenide(PtSe_(2))is a promising two-dimensional(2D)material for the terahertz(THz)range as,unlike other transition metal dichalcogenides(TMDs),its bandgap can be uniquely tuned from a semiconductor in the nearinfrared to a semimetal with the number of atomic layers.This gives the material unique THz photonic properties that can be layer-engineered.Here,we demonstrate that a controlled THz nonlinearity—tuned from monolayer to bulk PtSe_(2)—can be realized in wafer size polycrystalline PtSe_(2)through the generation of ultrafast photocurrents and the engineering of the bandstructure valleys.This is combined with the PtSe_(2)layer interaction with the substrate for a broken material centrosymmetry,permitting a second order nonlinearity.Further,we show layer dependent circular dichroism,where the sign of the ultrafast currents and hence the phase of the emitted THz pulse can be controlled through the excitation of different bandstructure valleys.In particular,we show that a semimetal has a strong dichroism that is absent in the monolayer and few layer semiconducting limit.The microscopic origins of this TMD bandstructure engineering are highlighted through detailed DFT simulations,and shows the circular dichroism can be controlled when PtSe_(2)becomes a semimetal and when the K-valleys can be excited.As well as showing that PtSe_(2)is a promising material for THz generation through layer controlled optical nonlinearities,this work opens up a new class of circular dichroism materials beyond the monolayer limit that has been the case of traditional TMDs,and impacting a range of domains from THz valleytronics,THz spintronics to harmonic generation.
文摘BACKGROUND The incidence of diabetes mellitus type 1(DM1)has been rising worldwide because of improvements in diagnostic techniques and improved access to care in countries with lower socioeconomic status.A new anti-CD4 antibody,Teplizumab,has been shown to delay the progression of DM1 and is the only medication approved for this indication.However,more information is needed about the safety profile of this drug.AIM To identify the odds ratios(OR)of systems-based adverse effects for Teplizumab when compared to Placebo.METHODS An extensive systematic review was conducted from the inception of the medication until December 31,2023.All clinical trials and studies that evaluated Teplizumab vs placebo were included in the initial review.The study protocol was designed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines guidelines and was registered in PROSPERO(ID:CRD42024496169).Crude OR were generated using RevMan Software version 5.4.RESULTS After screening and review,5 studies were selected to determine the risk of adverse effects of teplizumab compared to placebo.A total of 561 patients were included in the study population.Total adverse effects and system-based adverse effects were studied and reported.We determined that patients receiving Teplizumab had a higher risk of developing gastrointestinal(GI)(OR=1.60,95%CI:1.01-2.52,P=0.04),dermatological(OR=6.33,95%CI:4.05-9.88,P<0.00001)and hematological adverse effects(OR=19.03,95%CI:11.09-32.66,P<0.00001).These patients were also significantly likely to have active Epstein-Barr Virus infection(OR=3.16,95%CI:1.51-6.64,P<0.002).While our data showed that patients receiving Teplizumab did have a higher incidence of total adverse effects vs placebo,this finding did not reach statistical significance(OR=2.25,95%CI:0.80-6.29,P=0.12).CONCLUSION Our systematic review suggests that Teplizumab patients are at risk for significant adverse effects,primarily related to GI,dermatological,and hematological systems.The total adverse effect data is li
文摘The intent of this paper is to schedule short-term hydrothermal system probabilistically considering stochastic operating cost curves for thermal power generation units and uncertainties in load demand and reservoir water inflows. Therefore, the stochastic multi-objective hydrothermal generation scheduling problem is formulated with explicit recognition of uncertainties in the system production cost coefficients and system load, which are treated as random variable. Fuzzy methodology has been exploited for solving a decision making problem involving multiplicity of objectives and selection criterion for best compromised solution. A real-coded genetic algorithm with arithmetic-average-bound-blend crossover and wavelet mutation operator is applied to solve short-term variable-head hydrothermal scheduling problem. Initial feasible solution has been obtained by implementing the random heuristic search. The search is performed within the operating generation limits. Equality constraints that satisfy the demand during each time interval are considered by introducing a slack thermal generating unit for each time interval. Whereas the equality constraint which satisfies the consumption of available water to its full extent for the whole scheduling period is considered by introducing slack hydro generating unit for a particular time interval. Operating limit violation by slack hydro and slack thermal generating unit is taken care using exterior penalty method. The effectiveness of the proposed method is demonstrated on two sample systems.
文摘Artificial intelligence(AI)has impacted many areas of healthcare.AI in healthcare uses machine learning,deep learning,and natural language processing to analyze copious amounts of healthcare data and yield valuable outcomes.In the sleep medicine field,a large amount of physiological data is gathered compared to other branches of medicine.This field is primed for innovations with the help of AI.A good quality of sleep is crucial for optimal health.About one billion people are estimated to have obstructive sleep apnea worldwide,but it is difficult to diagnose and treat all the people with limited resources.Sleep apnea is one of the major contributors to poor health.Most of the sleep apnea patients remain undiagnosed.Those diagnosed with sleep apnea have difficulty getting it optimally treated due to several factors,and AI can help in this situation.AI can also help in the diagnosis and management of other sleep disorders such as insomnia,hypersomnia,parasomnia,narcolepsy,shift work sleep disorders,periodic leg movement disorders,etc.In this manuscript,we aim to address three critical issues about the use of AI in sleep medicine:(1)How can AI help in diagnosing and treating sleep disorders?(2)How can AI fill the gap in the care of sleep disorders?and(3)What are the ethical and legal considerations of using AI in sleep medicine?
基金the funding agency ‘Forest Research Institute, Dehradun for providing necessary funds and supplying the clonesused in the study
文摘We evaluated the growth and crown traits of 36 poplar clones at two distinct agro-climatic regions of Punjab （Ludhiana and Bathinda） in northwestern India, following randomized block design with three replications and plot size of four trees. Significant differences among clones （p〈0.001） were observed for diameter at breast height （DBH）, tree height, volume, crown width and number of branches under both the site conditions. Clones ‘G-3’, ‘25-N’ and ‘41-N’ at Ludhiana and ‘G-3’, ‘RD-01’ and ‘S7C8’ at Bathinda were found to be superior for volume production. All growth and crown traits registered significantly higher values at Ludhiana in comparison to those at Bathinda. Clone site interaction was also significant （p〈0.001）. For volume, clones ‘L-62/84’, ‘113520’, ‘25-N’ and ‘S4C2’ witnessed huge fluctuations in ranking between sites. The correlations between growth traits were positive and highly significant （p〈0.001） at both sites. The clonal mean heritability was moderate for DBH and volume both at Ludhiana （0.61–0.66） and Bathinda （0.61–0.62）. Across sites, the genetic advance was the highest for volume （49.76%） and the lowest （6.50%） in case of height.
基金a grant from the Department of Biotechnology, India
文摘AIM:To identify the frequency of iron overload and study the three mutations in the HFE gene (C282Y,H63D,and S65C) in patients with chronic liver disorders (CLD) and controls. METHODS:To identify patients with iron overload (transferrin saturation > 45% in females and > 50% in males and serum ferritin > 1000 ng/mL) we evaluated 236 patients with CLD,including 59 with non-alcoholic steatohepatitis (NASH),22 with alcoholic liver disease (ALD),19 of cirrhosis due to viruses (HBV,HCV),and 136 with cryptogenic cirrhosis. Mutations of the HFE gene were analyzed by PCR-RE. hundred controls were screened for iron status and the mutations. RESULTS:Seventeen patients with CLD showed evidence of iron overload. Fifteen cases of iron overload had cryptogenic cirrhosis and two had ALD. None of the controls showed iron overload. We did not find any individual with 282Y or 65C either in the cases or in the controls. The prevalence of H63D heterozygosity was 12% in normal individuals,14.8% in 236 patients (16.9% in NASH,13.6% in ALD,26.3% in viral and 12.5% in cryptogenic cirrhosis) and the overall prevalence was 13.98%. Only two of the 17 patients with primary iron overload were heterozygous for H63D. One patient with NASH and one normal individual who were homozygous for H63D showed no iron overload.CONCLUSION:Primary iron overload in Indians is nonHFE type,which is different from that in Europeans and further molecular studies are required to determine the defect in various iron regulatory genes.
基金funding from the European Union FET-Open grant ULTRAQCL 665158the German Research Foundation(DFG)within the Heisenberg program(JI 115/4-2).
文摘The use of fundamental modelocking to generate short terahertz(THz)pulses and THz frequency combs from semiconductor lasers has become a routine affair,using quantum cascade lasers(QCLs)as a gain medium.However,unlike classic laser diodes,no demonstrations of harmonic modelocking,active or passive,have been shown in THz QCLs,where multiple pulses per round trip are generated when the laser is modulated at the harmonics of the cavity’s fundamental round-trip frequency.Here,using time-resolved THz techniques,we show for the first time harmonic injection and mode-locking in which THz QCLs are modulated at the harmonics of the round-trip frequency.We demonstrate the generation of the harmonic electrical beatnote within a QCL,its injection locking to an active modulation and its direct translation to harmonic pulse generation using the unique ultrafast nature of our approach.Finally,we show indications of self-starting harmonic emission,i.e.,without external modulation,where the QCL operates exclusively on a harmonic(up to its 15th harmonic)of the round-trip frequency.This behaviour is supported by time-resolved simulations of induced gain and loss in the system and shows the importance of the electronic,as well as photonic,nature of QCLs.These results open up the prospect of passive harmonic modelocking and THz pulse generation,as well as the generation of low-noise microwave generation in the hundreds of GHz region.
文摘A 21-year-old male with no significant past medical history, presented with right upper quadrant(RUQ) abdominal pain along with fevers and chills. Lab work revealed leukocytosis, anemia, and slightly elevated alkaline phosphatase. Viral serology for hepatitis B virus, hepatitis C virus, and human immunodeficiency virus were negative and he was immunocompetent.Computed tomography imaging revealed hepatic abscesses, the largest measuring 9.5 cm. Empiric antibiotics were started and percutaneous drains were placed in the abscesses. Anaerobic cultures from the abscesses grew Fusobacterium nucleatum. This is a gram negative anaerobic bacteria; a normal flora of the oral cavity. Fusobacterium is most commonly seen in Lemiere's disease, which is translocation of oral bacteria to the internal jugular vein causing a thrombophlebitis and subsequent spread of abscesses. Our patient did not have Lemiere's, and is the first case described of fusobacterium pyogenic liver abscess in a young immunocompetent male with good oral hygiene. This case was complicated by sepsis, empyema, and subsequent abscesses located outside the liver. These abscesses' have the propensity to flare abruptly and can be fatal. This case not only illustrates fusobacterium as a rare entity for pyogenic liver abscess, but also the need for urgent diagnosis and treatment. It is incumbent on physicians to diagnose and drain any suspicious hepatic lesions. While uncommon, such infections may develop without any overt source and can progress rapidly. Prompt drainage with antibiotic therapy remains the cornerstone of therapy.
基金supported by Technologies R&D of State Administration of Work Safety (06-399)Technologies R&D of Hunan Province ( No.05FJ4071)
文摘In this paper,a monitoring and controlling system for the safety in production and environmental parameters of a small and medium-sized coal mine has been developed after analyzing the current domestic coal production and security conditions. The client computer can convert the analog signal about the safety in production and environmental parameters detected from the monitoring terminal into digital signal,and then,send the signal to the coal mine safety monitoring centre. This information can be analyzed,judged,and diagnosed by the monitoring-management-controlling software for helping the manager and technical workers to control the actual underground production and security situations. The system has many advantages including high reliability,better performance of real-time monitoring,faster data communicating and good practicability,and it can effectively prevent the occurrence of safety incidents in coal mines.
文摘Rice root-knot nematode(RRKN,Meloidogyne graminicola)and brown spot(BS,Drechslera oryzae)are serious constraints on the quality of rice grains,particularly under direct-seeded rice conditions in many parts of the world.Developing rice varieties resistant to RRKN and BS will be the most effective and environmentally friendly management strategy.A total of 93 and 58 Oryza rufipogon accessions were screened against RRKN and BS,respectively,for two years under artificial inoculation conditions.Among the 93 O.rufipogon accessions。
基金Agence Nationale de la Recherche (ANR-19-CE24-0015,ANR-22-CE09-0018)European Research Council (820133)。
文摘The control of light–matter coupling at the single electron level is currently a subject of growing interest for the development of novel quantum devices and for studies and applications of quantum electrodynamics.In the terahertz(THz)spectral range,this raises the particular and difficult challenge of building electromagnetic resonators that can conciliate low mode volume and high quality factor.Here,we report on hybrid THz cavities based on ultrastrong coupling between a Tamm cavity and an LC circuit metamaterial and show that they can combine high quality factors of up to Q=37 with a deep-subwavelength mode volume of V=3.2×10^(-4)λ^(3).Our theoretical and experimental analysis of the coupled mode properties reveals that,in general,the ultrastrong coupling between a metamaterial and a Fabry–Perot cavity is an effective tool to almost completely suppress radiative losses and,thus,ultimately limit the total losses to the losses in the metallic layer.These Tamm cavity-LC metamaterial coupled resonators open a route toward the development of single photon THz emitters and detectors and to the exploration of ultrastrong THz light–matter coupling with a high degree of coherence in the few to single electron limit.
文摘This study examines the construct validity and reliability of the Malay language questionnaire for urinary incontinence diagnosis (QUID) in women. Study Design: Random sampling design was used in this cross-sectional survey. Materials and Methods: The Americanized English language questionnaire was translated to the Malay language and distributed to community-dwelling Malaysian women living in various locations in Selangor. The construct validity was tested using exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA). The reliability was determined using Cronbach’s α. Results: A total of 111 women completed the Malay language QUID in this pilot study. The Keiser-Meyer-Olkin (KMO) measure of sampling adequacy of 0.675 and Bartlett’s test of sphericity (χ2 = 284.633, df = 15, p = 0.001) indicated that the EFA was possible. The total variance and the scree plot identified two factors above the initial eigenvalue of 1 while a third factor was just below it (0.758). The CFA output showed a recursive model with the solution being not admissible because two unobserved and exogenous variables had negative variance estimates. The following values of absolute fit indices showed an acceptable level of fit: 1) Chi-square test with χ2 = 4.997, df = 5, p = 0.416, indicated a smaller difference between the expected and observed covariance matrices;2) GFI = 0.986, AGFI = 0.939, RMR = 0.021 and CMIN/DF = 1.0 indicated acceptable level of fit;3) The baseline comparison values of NFI = 0.983 and CFI = 1.0 also indicated a good fit to the data;4) RMSEA = 0.000 was considered a perfect fit indicating that the hypothesized model was a good fit to the observed data. Under the hypothesis of “close fit”, the probability of getting a sample RMSEA as large as 0.000 was 0.567. The Cronbach’s α coefficient of 0.823 indicated good reliability. Conclusion: The Malay language QUID is a valid and reliable instrument for diagnosing female urinary incontinence in the Malaysian population.
基金the University of Illinois College of Medicine, the departments of Graduate Medical Education, and the ROAPP fund for their assistance with the publication
文摘Bile cast nephropathy is a condition of renal dysfunction in the setting of hyperbilirubinemia. There are very few cases of this condition reported in the last decade and a lack of established treatment guidelines. While the exact etiology remains unknown, bile cast nephropathy is presumed to be secondary to multiple concurrent insults to the kidney including direct toxicity from bile acids, obstructive physiology from bile casts, and systemic hypoperfusion from vasodilation. Therapy directed at bilirubin reduction may improve renal function, but will likely need dialysis or plasmapheresis as well. We report our case of bile cast nephropathy and the therapeutic measures undertaken in a middle-aged male with chronic renal insufficiency that developed hyperbilirubinemia and drug-induced liver injury secondary to antibiotic use. He developed acute renal injury in the setting of rising bilirubin. He subsequently had a progressive decline in renal and hepatic function, requiring dialysis and plasmapheresis with some improvement, ultimately requiring transplantation.
