This paper proposes fault tolerant algorithms for routing mobile agents in a single channel wireless sensor network which cover every node in the network. These algorithms use local knowledge (assume no knowledge of g...This paper proposes fault tolerant algorithms for routing mobile agents in a single channel wireless sensor network which cover every node in the network. These algorithms use local knowledge (assume no knowledge of global deployment or topology, etc). We propose the algorithms and show mathematical analysis to support our claims. The paper ends with simulation studies and discussion of results.展开更多
In this study, 32 black rice genotypes spanning diverse geographies in India were evaluated at both phenotypic and DNA sequence levels to gain insights into their genetic makeup. Significant variations were observed f...In this study, 32 black rice genotypes spanning diverse geographies in India were evaluated at both phenotypic and DNA sequence levels to gain insights into their genetic makeup. Significant variations were observed for 14 agro-morphological traits, showing correlations among several yield-related traits.展开更多
Cancer is a leading cause of death globally,with limited treatment options and several limitations.Chemotherapeutic agents often result in toxicity which long-term conventional treatment.Phytochemicals are natural con...Cancer is a leading cause of death globally,with limited treatment options and several limitations.Chemotherapeutic agents often result in toxicity which long-term conventional treatment.Phytochemicals are natural constituents that are more effective in treating various diseases with less toxicity than the chemotherapeutic agents providing alternative therapeutic approaches to minimize the resistance.These phytoconstituents act in several ways and deliver optimum effectiveness against cancer.Nevertheless,the effectiveness of phyto-formulations in the management of cancers may be constrained due to challenges related to inadequate solubility,bioavailability,and stability.Nanotechnology presents a promising avenue for transforming current cancer treatment methods through the incorporation of phytochemicals into nanosystems,which possess a range of advantageous characteristics such as biocompatibility,targeted and sustained release capabilities,and enhanced protective effects.This holds significant potential for future advancements in cancer management.Herein,this review aims to provide intensive literature on diverse nanocarriers,highlighting their applications as cargos for phytocompounds in cancer.Moreover,it offers an overview of the current advancements in the respective field,emphasizing the characteristics that contribute to favourable outcomes in both in vitro and in vivo settings.Lastly,clinical development and regulatory concerns are also discussed to check on the transformation of the concept as a promising strategy for combination therapy of phytochemicals and chemotherapeutics that could lead to cancer management in the future.展开更多
AIM: To assess the additive effect of lubiprostone on the quality of colon preparation in diabetics given single-dosed polyethylene glycol electrolyte(PEG)for colonoscopy.METHODS:This was an investigator-initiated,sin...AIM: To assess the additive effect of lubiprostone on the quality of colon preparation in diabetics given single-dosed polyethylene glycol electrolyte(PEG)for colonoscopy.METHODS:This was an investigator-initiated,singlecenter,single-blinded prospective trial comparing the efficacy of L+PEG to PEG alone on colon preparation quality in diabetics undergoing screening colonoscopy.The study was approved by our institution’s IRB.The PEG was given as a single-dose to address patientcompliance concerns voiced by our IRB with splitdosing.All patients received only clear liquids the day prior to colonoscopy.Experimental group(Grp L)received PEG+1 dose L 2 h prior to and 2 h after PEG completion.Control group(Grp C)received only PEG the evening prior to the colonoscopy.Patients were randomly assigned to one of the 2 groups.The endoscopist was blinded to which colon prep was given and all colonoscopies were complete.Upon colonoscopy completion,the endoscopist rated the colon prep-quality by a validated 5-point Likert scale(1-excellent to 5-inadequate).RESULTS:Sixty patients were enrolled in the study;30 Grp L and 30 Grp C.Overall,patients were excluded due to study non-completion in 12(41%)Grp L and 5(17%) Grp C,P=0.04.Average colon preparation score Grp L =2.47 and Grp C=3.00,P=0.09.Although this was not statistically significant,there was a trend towards improved colon prep in Grp L.Statistical significance may have been achieved if completion rates had been similar between both study groups.CONCLUSION:Use of 2-L capsules with PEG resulted in a trend towards improved colon prep over PEG alone in diabetic patients when given as a single-dose regimen.展开更多
BACKGROUND The severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)virus has become a pandemic for the last 2 years.Inflammatory response to the virus leads to organ dysfunction and death.Predicting the severit...BACKGROUND The severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)virus has become a pandemic for the last 2 years.Inflammatory response to the virus leads to organ dysfunction and death.Predicting the severity of inflammatory response helps in managing critical patients using serology tests IgG and IgM.AIM To investigate the correlation of the serology(IgM and IgG)with reverse transcriptase polymerase chain reaction(RT-PCR)status,disease severity[mild to critical],intensive care unit(ICU)admission,septic shock,acute kidney injury,and in-hospital mortality.METHODS We conducted a longitudinal study to correlate serum SARS-CoV-2 immunoglobulin M(IgM)and immunoglobulin G(IgG)serology with clinical outcomes in coronavirus disease 2019(COVID-19)patients.We analyzed patient data from March to December 2020 for those who were admitted at All India Institute of Medical Sciences Rishikesh.Clinical and laboratory data of these patients were collected from the e-hospital portal and analyzed.A correlation was seen with clinical outcomes and was assessed using MS Excel 2010 and SPSS software.RESULTS Out of 494 patients,the mean age of patients was 48.95±16.40 years and there were more male patients in the study(66.0%).The patients were classified as mild-moderate 328(67.1%),severe 131(26.8%),and critical 30(6.1%).The mean duration from symptom onset to serology testing was 19.87±30.53 d.In-hospital mortality was observed in 25.1%of patients.The seropositivity rate(i.e.,either IgG or IgM>10 AU)was 50%.IgM levels(AU/mL)(W=33428.000,P≤0.001)and IgG levels(AU/mL)(W=39256.500,P≤0.001),with the median IgM/IgG levels(AU/mL),were highest in the RT-PCR-Positive group compared to RT-PCR-Negative clinical COVID-19.There was no significant difference between the two groups in terms of all other clinical outcomes(disease severity,septic shock,ICU admission,mechanical ventilation,and mortality).CONCLUSION The study showed that serology levels are high in RT-PCR positive group compared to clinical COVID-19.However,serology can展开更多
OBJECTIVES To verify whether incomplete revascularisation(IR),quantified using the rSYNTAX(Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery)score andΔSYNTAX%score,could predict short-...OBJECTIVES To verify whether incomplete revascularisation(IR),quantified using the rSYNTAX(Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery)score andΔSYNTAX%score,could predict short-(in-hospital mortality)and long-term outcomes(12-month mortality)in octogenarians undergoing percutaneous coronary intervention(PCI).METHODS&RESULTS A retrospective analysis of 665 consecutive octogenarian patients presenting for PCI to a UK centre was performed.The baseline SYNTAX and rSYNTAX scores were assessed from angiographic images.ΔSYNTAX%score was calculated(ΔSYNTAX%=((SYNTAX-rSYNTAX)/SYNTAX)×100%))to measure the relative completeness of revascularisation.Kaplan-Meier analysis assessed survival at 12 months by tertiles of rSYNTAX andΔSYNTAX%scores.IncreasingΔSYNTAX%score was associated with reduced in-hospital mortality(P=0.017),and improved survival benefit(log rank 14.8,P=0.001)at 12 months.CONCLUSIONS Enhancing the completeness of revascularisation in octogenarians selected to undergo PCI is associated with a lower in-hospital mortality and a survival benefit at 12 months.展开更多
Like the Covid-19 pandemic,smallpox virus infection broke out in the last century,wherein 500 million deaths were reported along with enormous economic loss.But unlike smallpox,the Covid-19 recorded a low exponential ...Like the Covid-19 pandemic,smallpox virus infection broke out in the last century,wherein 500 million deaths were reported along with enormous economic loss.But unlike smallpox,the Covid-19 recorded a low exponential infection rate and mortality rate due to advancement inmedical aid and diagnostics.Data analytics,machine learning,and automation techniques can help in early diagnostics and supporting treatments of many reported patients.This paper proposes a robust and efficient methodology for the early detection of COVID-19 from Chest X-Ray scans utilizing enhanced deep learning techniques.Our study suggests that using the Prediction and Deconvolutional Modules in combination with the SSD architecture can improve the performance of the model trained at this task.We used a publicly open CXR image dataset and implemented the detectionmodelwith task-specific pre-processing and near 80:20 split.This achieved a competitive specificity of 0.9474 and a sensibility/accuracy of 0.9597,which shall help better decision-making for various aspects of identification and treat the infection.展开更多
Purpose:There are many infectious and inflammatory causes for elevated core-body temperatures,though they rarely pass 40℃(104℉).The term"quad fever"is used for extreme hyperpyrexia in the setting of acute ...Purpose:There are many infectious and inflammatory causes for elevated core-body temperatures,though they rarely pass 40℃(104℉).The term"quad fever"is used for extreme hyperpyrexia in the setting of acute cervical spinal cord injuries(SCIs).The traditional methods of treating hyperpyrexia are often ineffective and reported morbidity and mortality rates approach 100%.This study aims to identify the incidence of elevated temperatures in SCIs at our institution and assess the effectiveness of using a non-invasive dry water temperature management system as a treatment modality with mortality.Methods:A retrospective analysis of acute SCI patients requiring surgical intensive care unit admission who experienced fevers≥40℃(104℉)were compared to patients with maximum temperatures<40℃.Patients≥18 years old who sustained an acute traumatic SCI were included in this study.Patients who expired in the emergency department;had a SCI without radiologic abnormality;had neuropraxia;were admitted to any location other than the surgical intensive care unit;or had positive blood cultures were excluded.SAS 9.4 was used to conduct statistical analysis.Results:Over the 9-year study period,35 patients were admitted to the surgical intensive care unit with a verified SCI.Seven patients experienced maximum temperatures of≥40℃.Six of those patients were treated with the dry water temperature management system with an overall mortality of 57.1%in this subgroup.The mortality rate for the 28 patients who experienced a maximum temperature of≤40℃was 21.4%(p=0.16).Conclusion:The diagnosis of quad fever should be considered in patients with cervical SCI in the presence of hyperthermia.In this study,there was no significant difference in mortality between quad fever patients treated with a dry water temperature management system versus SCI patients without quad fever.The early use of a dry water temperature management system appears to decrease the mortality rate of quad fever.展开更多
CONSPECTUS:Catalyzing the oxygen evolution reaction(OER)is important for key energy-storage technologies,particularly water electrolysis and photoelectrolysis for hydrogen fuel production.Under neutral-to-alkaline con...CONSPECTUS:Catalyzing the oxygen evolution reaction(OER)is important for key energy-storage technologies,particularly water electrolysis and photoelectrolysis for hydrogen fuel production.Under neutral-to-alkaline conditions,first-row transitionmetal oxides/(oxy)hydroxides are the fastest-known OER catalysts and have been the subject of intense study for the past decade.Critical to their high performance is the intentional or accidental addition of Fe to Ni/Co oxides that convert to layered(oxy)hydroxide structures during the OER.Unraveling the role that Fe plays in the catalysis and the molecular identity of the true“active site”has proved challenging,however,due to the dynamics of the host structure and absorbed Fe sites as well as the diversity of local structures in these disordered active phases.In this Account,we highlight our work to understand the role of Fe in Ni/Co(oxy)hydroxide OER catalysts.We first discuss how we characterize the intrinsic activity of the first-row transition-metal(oxy)hydroxide catalysts as thin films by accounting for the contributions of the catalyst-layer thickness(mass loading)and electrical conductivity as well as the underlying substrate’s chemical interactions with the catalyst and the presence of Fe species in the electrolyte.We show how Fe-doped Ni/Co(oxy)hydroxides restructure during catalysis,absorb/desorb Fe,and in some cases degrade or regenerate their activity during electrochemical testing.We highlight the relevant techniques and procedures that allowed us to better understand the role of Fe in activating other first-row transition metals for OER.We find several modes of Fe incorporation in Ni/Co(oxy)hydroxides and show how those modes correlate with activity and durability.We also discuss how this understanding informs the incorporation of earthabundant transition-metal OER catalysts in anion-exchange-membrane water electrolyzers(AEMWE)that provide a locally basic anode environment but run on pure water and have advantages over the more-developed proton-excha展开更多
Hemodynamic monitoring has long formed the cornerstone of heart failure(HF) and pulmonary hypertension diagnosis and management. We review the long history of invasive hemodynamic monitors initially using pulmonary ar...Hemodynamic monitoring has long formed the cornerstone of heart failure(HF) and pulmonary hypertension diagnosis and management. We review the long history of invasive hemodynamic monitors initially using pulmonary artery(PA) pressure catheters in the hospital setting, to evaluating the utility of a number of implantable devices that can allow for ambulatory determination of intracardiac pressures. Although the use of indwelling PA catheters has fallen out of favor in a number of settings, implantable devices have afforded clinicians an opportunity for objective determination of a patient's volume status and pulmonary pressures. Some devices, such as the CardioM EMS and thoracic impedance monitors present as part of implantable cardiac defibrillators, are supported by a body of evidence which show the potential to reduce HF related morbidity and have received regulatory approval, whereas other devices have failed to show benefit and, in some cases, harm. Clearly these devices can convey a considerable amount of information and clinicians should start to familiarize themselves with their use and expect further development and refinement in the future.展开更多
Aorto-pulmonary artery fistula is a rare and lethal occurrence after thoracic surgery and aortic aneurysms. Here we present a rare occurrence of acute aorto-pulmonary artery fistula in outpatient department in a follo...Aorto-pulmonary artery fistula is a rare and lethal occurrence after thoracic surgery and aortic aneurysms. Here we present a rare occurrence of acute aorto-pulmonary artery fistula in outpatient department in a follow up patient of aortic valve replacement and discuss challenges faced in diagnosis, etiopathogenesis and management.展开更多
Compared with bare-metal stents (BMS),drug-eluting stems (DES)have shown better clinical outcomes for pa- tients undergoing percutaneous coronary intervention (PCI) by inhibition of neo-intirnal hyperplasia.[1]However...Compared with bare-metal stents (BMS),drug-eluting stems (DES)have shown better clinical outcomes for pa- tients undergoing percutaneous coronary intervention (PCI) by inhibition of neo-intirnal hyperplasia.[1]However,early- generation DES produced late thrombotic events,more than l-year,by delaying arterial healing of stented vessels,[2-5] New-generation DES have been developed'with thinner stent struts,more biocompatible polymer coatings for drug release,and a variety of antiproliferative agents with similar or superior anti-restenotic efficacy.[6]This development has led to a significant improvement in the efficacy and safety of new-generation DES,and consistently lower rates of very late stent thrombosis (VLST).[7,8]In fact,use of new-ge- neration DES is the standard treatment in contemporary PCI practice.[9]展开更多
Patients with acute kidney injury(AKI) in the intensive care unit(ICU) are often suitable for palliative care due to the high symptom burden. The role of palliative medicine in this patient population is not well defi...Patients with acute kidney injury(AKI) in the intensive care unit(ICU) are often suitable for palliative care due to the high symptom burden. The role of palliative medicine in this patient population is not well defined and there is a lack of established guidelines to address this issue. Because of this,patients in the ICU with AKI deprived of the most comprehensive or appropriate care. The reasons for this are multifactorial including lack of palliative care training among nephrologists. However,palliative care in these patients can help alleviate symptoms,improve quality of life,and decrease suffering. Palliative care physicians can determine the appropriateness and model of palliative care. In addition to shared decision-making,advance directives should be established with patients early on,with specific instructions regarding dialysis,and those advance directives should be respected.展开更多
OBJECTIVE To examine the trends in patient characteristics and clinical outcomes over a ten-year period and to analyse the predictors of mortality in octogenarians undergoing percutaneous coronary intervention(PCI)in ...OBJECTIVE To examine the trends in patient characteristics and clinical outcomes over a ten-year period and to analyse the predictors of mortality in octogenarians undergoing percutaneous coronary intervention(PCI)in our centre.METHODS A total of 782 consecutive octogenarians(aged 80 and above)were identified from a prospectively collected PCI database within our non-surgical,medium volume centre between 1st January 2007 and 31st December 2016.This represented 10.9%of all PCI procedures performed in our centre during this period.We evaluated the demographic and procedural character-istics of the cohort with respect to clinical outcomes(all-cause in-hospital and 1-year mortality,in-hospital complication rates,duration of hospital admission,coronary disease angiographic complexity and major co-morbidities).The cohort was further stratified into three chronological tertiles(January 2007 to July 2012,261 cases;August 2012 to May 2015,261 cases;June 2015 to December 2016,260 cases)to assess for differences over time.Predictors of mortality were identified through a multivariate re-gression analysis.RESULTS The number of octogenarians undergoing PCI increased nearly ten-fold over the studied period.Despite this,there were no significant differences in clinical outcomes or patient characteristics,except for the increased use of trans-radial vascular access[11.9%in first tertile vs.73.2%in third tertile(P<0.0001)].The all-cause in-hospital(5.8%vs.4.6%vs.3.8%,P=0.578)and 1-year mortality(12.4%vs.12.5%vs.14.4%,P=0.746)remained constant in all three tertiles respectively.Six independent predict-ors of mortality were identified-increasing age[HR=1.12(1.03−1.22),P=0.008],cardiogenic shock[HR=16.40(4.04-66.65),P<0.0001],severe left ventricular impairment[HR=3.52(1.69−7.33),P=0.001],peripheral vascular disease[HR=2.73(1.22−6.13),P=0.015],diabetes[HR=2.59(1.30−5.17),P=0.007]and low creatinine clearance[HR=0.98(0.96−1.00),P=0.031].CONCLUSION This contemporary observational study provides a useful insight into the real-w展开更多
Background Wilms tumor (WT) is the most common childhood kidney cancer worldwide, yet its incidence and clinical behavior vary according to race and access to adequate healthcare resources. To guide and streamline the...Background Wilms tumor (WT) is the most common childhood kidney cancer worldwide, yet its incidence and clinical behavior vary according to race and access to adequate healthcare resources. To guide and streamline therapy in the war-torn and resource-constrained city of Baghdad, Iraq, we conducted a first-ever molecular analysis of 20 WT specimens to characterize the biological features of this lethal disease within this challenged population. Methods Next-generation sequencing of ten target genes associated with WT development and treatment resistance (WT1, CTNNB1, WTX, IGF2, CITED1, SIX2, p53, N-MYC, CRABP2, and TOP2A) was completed. Immunohistochemistry was performed for 6 marker proteins of WT (WT1, CTNNB1, NCAM, CITED1, SIX2, and p53). Patient outcomes were compiled. Results Mutations were detected in previously described WT 'hot spots' (e.g., WT1 and CTNNB1) as well as novel loci that may be unique to the Iraqi population. Immunohistochemistry showed expression domains most typical of blastemal-predominant WT. Remarkably, despite the challenges facing families and care providers, only one child, with combined WT1 and CTNNB1 mutations, was confirmed dead from disease. Median clinical follow-up was 40.5 months (range 6–78 months). Conclusions These data suggest that WT biology within a population of Iraqi children manifests features both similar to and unique from disease variants in other regions of the world. These observations will help to risk stratify WT patients living in this difficult environment to more or less intensive therapies and to focus treatment on cell-specific targets.展开更多
Summary What is already known about this topic?Environmental factors such as temperature and humidity play important roles in the transmission of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)via droplets...Summary What is already known about this topic?Environmental factors such as temperature and humidity play important roles in the transmission of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)via droplets/aerosols.What is added by this report?Higher relative humidity(61%–80%),longer spreading time(120 min),and greater dispersal distance(1 m)significantly reduced SARS-CoV-2 pseudovirus loads.There was an interaction effect between relative humidity and spreading time.What are the implications for public health practice?The findings contribute to our understanding of the impact of environmental factors on the transmission of SARS-CoV-2 via airborne droplets/aerosols.展开更多
文摘This paper proposes fault tolerant algorithms for routing mobile agents in a single channel wireless sensor network which cover every node in the network. These algorithms use local knowledge (assume no knowledge of global deployment or topology, etc). We propose the algorithms and show mathematical analysis to support our claims. The paper ends with simulation studies and discussion of results.
文摘In this study, 32 black rice genotypes spanning diverse geographies in India were evaluated at both phenotypic and DNA sequence levels to gain insights into their genetic makeup. Significant variations were observed for 14 agro-morphological traits, showing correlations among several yield-related traits.
文摘Cancer is a leading cause of death globally,with limited treatment options and several limitations.Chemotherapeutic agents often result in toxicity which long-term conventional treatment.Phytochemicals are natural constituents that are more effective in treating various diseases with less toxicity than the chemotherapeutic agents providing alternative therapeutic approaches to minimize the resistance.These phytoconstituents act in several ways and deliver optimum effectiveness against cancer.Nevertheless,the effectiveness of phyto-formulations in the management of cancers may be constrained due to challenges related to inadequate solubility,bioavailability,and stability.Nanotechnology presents a promising avenue for transforming current cancer treatment methods through the incorporation of phytochemicals into nanosystems,which possess a range of advantageous characteristics such as biocompatibility,targeted and sustained release capabilities,and enhanced protective effects.This holds significant potential for future advancements in cancer management.Herein,this review aims to provide intensive literature on diverse nanocarriers,highlighting their applications as cargos for phytocompounds in cancer.Moreover,it offers an overview of the current advancements in the respective field,emphasizing the characteristics that contribute to favourable outcomes in both in vitro and in vivo settings.Lastly,clinical development and regulatory concerns are also discussed to check on the transformation of the concept as a promising strategy for combination therapy of phytochemicals and chemotherapeutics that could lead to cancer management in the future.
基金Supported by Sucampo Pharmaceuticals,Inc.,Bethesda,Maryland and Takeda PharmaceuticalsAmerica,Inc.,Deerfield,Illinois
文摘AIM: To assess the additive effect of lubiprostone on the quality of colon preparation in diabetics given single-dosed polyethylene glycol electrolyte(PEG)for colonoscopy.METHODS:This was an investigator-initiated,singlecenter,single-blinded prospective trial comparing the efficacy of L+PEG to PEG alone on colon preparation quality in diabetics undergoing screening colonoscopy.The study was approved by our institution’s IRB.The PEG was given as a single-dose to address patientcompliance concerns voiced by our IRB with splitdosing.All patients received only clear liquids the day prior to colonoscopy.Experimental group(Grp L)received PEG+1 dose L 2 h prior to and 2 h after PEG completion.Control group(Grp C)received only PEG the evening prior to the colonoscopy.Patients were randomly assigned to one of the 2 groups.The endoscopist was blinded to which colon prep was given and all colonoscopies were complete.Upon colonoscopy completion,the endoscopist rated the colon prep-quality by a validated 5-point Likert scale(1-excellent to 5-inadequate).RESULTS:Sixty patients were enrolled in the study;30 Grp L and 30 Grp C.Overall,patients were excluded due to study non-completion in 12(41%)Grp L and 5(17%) Grp C,P=0.04.Average colon preparation score Grp L =2.47 and Grp C=3.00,P=0.09.Although this was not statistically significant,there was a trend towards improved colon prep in Grp L.Statistical significance may have been achieved if completion rates had been similar between both study groups.CONCLUSION:Use of 2-L capsules with PEG resulted in a trend towards improved colon prep over PEG alone in diabetic patients when given as a single-dose regimen.
文摘BACKGROUND The severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)virus has become a pandemic for the last 2 years.Inflammatory response to the virus leads to organ dysfunction and death.Predicting the severity of inflammatory response helps in managing critical patients using serology tests IgG and IgM.AIM To investigate the correlation of the serology(IgM and IgG)with reverse transcriptase polymerase chain reaction(RT-PCR)status,disease severity[mild to critical],intensive care unit(ICU)admission,septic shock,acute kidney injury,and in-hospital mortality.METHODS We conducted a longitudinal study to correlate serum SARS-CoV-2 immunoglobulin M(IgM)and immunoglobulin G(IgG)serology with clinical outcomes in coronavirus disease 2019(COVID-19)patients.We analyzed patient data from March to December 2020 for those who were admitted at All India Institute of Medical Sciences Rishikesh.Clinical and laboratory data of these patients were collected from the e-hospital portal and analyzed.A correlation was seen with clinical outcomes and was assessed using MS Excel 2010 and SPSS software.RESULTS Out of 494 patients,the mean age of patients was 48.95±16.40 years and there were more male patients in the study(66.0%).The patients were classified as mild-moderate 328(67.1%),severe 131(26.8%),and critical 30(6.1%).The mean duration from symptom onset to serology testing was 19.87±30.53 d.In-hospital mortality was observed in 25.1%of patients.The seropositivity rate(i.e.,either IgG or IgM>10 AU)was 50%.IgM levels(AU/mL)(W=33428.000,P≤0.001)and IgG levels(AU/mL)(W=39256.500,P≤0.001),with the median IgM/IgG levels(AU/mL),were highest in the RT-PCR-Positive group compared to RT-PCR-Negative clinical COVID-19.There was no significant difference between the two groups in terms of all other clinical outcomes(disease severity,septic shock,ICU admission,mechanical ventilation,and mortality).CONCLUSION The study showed that serology levels are high in RT-PCR positive group compared to clinical COVID-19.However,serology can
文摘OBJECTIVES To verify whether incomplete revascularisation(IR),quantified using the rSYNTAX(Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery)score andΔSYNTAX%score,could predict short-(in-hospital mortality)and long-term outcomes(12-month mortality)in octogenarians undergoing percutaneous coronary intervention(PCI).METHODS&RESULTS A retrospective analysis of 665 consecutive octogenarian patients presenting for PCI to a UK centre was performed.The baseline SYNTAX and rSYNTAX scores were assessed from angiographic images.ΔSYNTAX%score was calculated(ΔSYNTAX%=((SYNTAX-rSYNTAX)/SYNTAX)×100%))to measure the relative completeness of revascularisation.Kaplan-Meier analysis assessed survival at 12 months by tertiles of rSYNTAX andΔSYNTAX%scores.IncreasingΔSYNTAX%score was associated with reduced in-hospital mortality(P=0.017),and improved survival benefit(log rank 14.8,P=0.001)at 12 months.CONCLUSIONS Enhancing the completeness of revascularisation in octogenarians selected to undergo PCI is associated with a lower in-hospital mortality and a survival benefit at 12 months.
文摘Like the Covid-19 pandemic,smallpox virus infection broke out in the last century,wherein 500 million deaths were reported along with enormous economic loss.But unlike smallpox,the Covid-19 recorded a low exponential infection rate and mortality rate due to advancement inmedical aid and diagnostics.Data analytics,machine learning,and automation techniques can help in early diagnostics and supporting treatments of many reported patients.This paper proposes a robust and efficient methodology for the early detection of COVID-19 from Chest X-Ray scans utilizing enhanced deep learning techniques.Our study suggests that using the Prediction and Deconvolutional Modules in combination with the SSD architecture can improve the performance of the model trained at this task.We used a publicly open CXR image dataset and implemented the detectionmodelwith task-specific pre-processing and near 80:20 split.This achieved a competitive specificity of 0.9474 and a sensibility/accuracy of 0.9597,which shall help better decision-making for various aspects of identification and treat the infection.
基金This research did not receive any specific grant from funding agencies in the public,commercial,or not-for-profit sectors.
文摘Purpose:There are many infectious and inflammatory causes for elevated core-body temperatures,though they rarely pass 40℃(104℉).The term"quad fever"is used for extreme hyperpyrexia in the setting of acute cervical spinal cord injuries(SCIs).The traditional methods of treating hyperpyrexia are often ineffective and reported morbidity and mortality rates approach 100%.This study aims to identify the incidence of elevated temperatures in SCIs at our institution and assess the effectiveness of using a non-invasive dry water temperature management system as a treatment modality with mortality.Methods:A retrospective analysis of acute SCI patients requiring surgical intensive care unit admission who experienced fevers≥40℃(104℉)were compared to patients with maximum temperatures<40℃.Patients≥18 years old who sustained an acute traumatic SCI were included in this study.Patients who expired in the emergency department;had a SCI without radiologic abnormality;had neuropraxia;were admitted to any location other than the surgical intensive care unit;or had positive blood cultures were excluded.SAS 9.4 was used to conduct statistical analysis.Results:Over the 9-year study period,35 patients were admitted to the surgical intensive care unit with a verified SCI.Seven patients experienced maximum temperatures of≥40℃.Six of those patients were treated with the dry water temperature management system with an overall mortality of 57.1%in this subgroup.The mortality rate for the 28 patients who experienced a maximum temperature of≤40℃was 21.4%(p=0.16).Conclusion:The diagnosis of quad fever should be considered in patients with cervical SCI in the presence of hyperthermia.In this study,there was no significant difference in mortality between quad fever patients treated with a dry water temperature management system versus SCI patients without quad fever.The early use of a dry water temperature management system appears to decrease the mortality rate of quad fever.
基金funded by National Science Foundation grant 1955106DOE EERE grant DE-EE0008841.
文摘CONSPECTUS:Catalyzing the oxygen evolution reaction(OER)is important for key energy-storage technologies,particularly water electrolysis and photoelectrolysis for hydrogen fuel production.Under neutral-to-alkaline conditions,first-row transitionmetal oxides/(oxy)hydroxides are the fastest-known OER catalysts and have been the subject of intense study for the past decade.Critical to their high performance is the intentional or accidental addition of Fe to Ni/Co oxides that convert to layered(oxy)hydroxide structures during the OER.Unraveling the role that Fe plays in the catalysis and the molecular identity of the true“active site”has proved challenging,however,due to the dynamics of the host structure and absorbed Fe sites as well as the diversity of local structures in these disordered active phases.In this Account,we highlight our work to understand the role of Fe in Ni/Co(oxy)hydroxide OER catalysts.We first discuss how we characterize the intrinsic activity of the first-row transition-metal(oxy)hydroxide catalysts as thin films by accounting for the contributions of the catalyst-layer thickness(mass loading)and electrical conductivity as well as the underlying substrate’s chemical interactions with the catalyst and the presence of Fe species in the electrolyte.We show how Fe-doped Ni/Co(oxy)hydroxides restructure during catalysis,absorb/desorb Fe,and in some cases degrade or regenerate their activity during electrochemical testing.We highlight the relevant techniques and procedures that allowed us to better understand the role of Fe in activating other first-row transition metals for OER.We find several modes of Fe incorporation in Ni/Co(oxy)hydroxides and show how those modes correlate with activity and durability.We also discuss how this understanding informs the incorporation of earthabundant transition-metal OER catalysts in anion-exchange-membrane water electrolyzers(AEMWE)that provide a locally basic anode environment but run on pure water and have advantages over the more-developed proton-excha
文摘Hemodynamic monitoring has long formed the cornerstone of heart failure(HF) and pulmonary hypertension diagnosis and management. We review the long history of invasive hemodynamic monitors initially using pulmonary artery(PA) pressure catheters in the hospital setting, to evaluating the utility of a number of implantable devices that can allow for ambulatory determination of intracardiac pressures. Although the use of indwelling PA catheters has fallen out of favor in a number of settings, implantable devices have afforded clinicians an opportunity for objective determination of a patient's volume status and pulmonary pressures. Some devices, such as the CardioM EMS and thoracic impedance monitors present as part of implantable cardiac defibrillators, are supported by a body of evidence which show the potential to reduce HF related morbidity and have received regulatory approval, whereas other devices have failed to show benefit and, in some cases, harm. Clearly these devices can convey a considerable amount of information and clinicians should start to familiarize themselves with their use and expect further development and refinement in the future.
文摘Aorto-pulmonary artery fistula is a rare and lethal occurrence after thoracic surgery and aortic aneurysms. Here we present a rare occurrence of acute aorto-pulmonary artery fistula in outpatient department in a follow up patient of aortic valve replacement and discuss challenges faced in diagnosis, etiopathogenesis and management.
文摘Compared with bare-metal stents (BMS),drug-eluting stems (DES)have shown better clinical outcomes for pa- tients undergoing percutaneous coronary intervention (PCI) by inhibition of neo-intirnal hyperplasia.[1]However,early- generation DES produced late thrombotic events,more than l-year,by delaying arterial healing of stented vessels,[2-5] New-generation DES have been developed'with thinner stent struts,more biocompatible polymer coatings for drug release,and a variety of antiproliferative agents with similar or superior anti-restenotic efficacy.[6]This development has led to a significant improvement in the efficacy and safety of new-generation DES,and consistently lower rates of very late stent thrombosis (VLST).[7,8]In fact,use of new-ge- neration DES is the standard treatment in contemporary PCI practice.[9]
文摘Patients with acute kidney injury(AKI) in the intensive care unit(ICU) are often suitable for palliative care due to the high symptom burden. The role of palliative medicine in this patient population is not well defined and there is a lack of established guidelines to address this issue. Because of this,patients in the ICU with AKI deprived of the most comprehensive or appropriate care. The reasons for this are multifactorial including lack of palliative care training among nephrologists. However,palliative care in these patients can help alleviate symptoms,improve quality of life,and decrease suffering. Palliative care physicians can determine the appropriateness and model of palliative care. In addition to shared decision-making,advance directives should be established with patients early on,with specific instructions regarding dialysis,and those advance directives should be respected.
文摘OBJECTIVE To examine the trends in patient characteristics and clinical outcomes over a ten-year period and to analyse the predictors of mortality in octogenarians undergoing percutaneous coronary intervention(PCI)in our centre.METHODS A total of 782 consecutive octogenarians(aged 80 and above)were identified from a prospectively collected PCI database within our non-surgical,medium volume centre between 1st January 2007 and 31st December 2016.This represented 10.9%of all PCI procedures performed in our centre during this period.We evaluated the demographic and procedural character-istics of the cohort with respect to clinical outcomes(all-cause in-hospital and 1-year mortality,in-hospital complication rates,duration of hospital admission,coronary disease angiographic complexity and major co-morbidities).The cohort was further stratified into three chronological tertiles(January 2007 to July 2012,261 cases;August 2012 to May 2015,261 cases;June 2015 to December 2016,260 cases)to assess for differences over time.Predictors of mortality were identified through a multivariate re-gression analysis.RESULTS The number of octogenarians undergoing PCI increased nearly ten-fold over the studied period.Despite this,there were no significant differences in clinical outcomes or patient characteristics,except for the increased use of trans-radial vascular access[11.9%in first tertile vs.73.2%in third tertile(P<0.0001)].The all-cause in-hospital(5.8%vs.4.6%vs.3.8%,P=0.578)and 1-year mortality(12.4%vs.12.5%vs.14.4%,P=0.746)remained constant in all three tertiles respectively.Six independent predict-ors of mortality were identified-increasing age[HR=1.12(1.03−1.22),P=0.008],cardiogenic shock[HR=16.40(4.04-66.65),P<0.0001],severe left ventricular impairment[HR=3.52(1.69−7.33),P=0.001],peripheral vascular disease[HR=2.73(1.22−6.13),P=0.015],diabetes[HR=2.59(1.30−5.17),P=0.007]and low creatinine clearance[HR=0.98(0.96−1.00),P=0.031].CONCLUSION This contemporary observational study provides a useful insight into the real-w
文摘Background Wilms tumor (WT) is the most common childhood kidney cancer worldwide, yet its incidence and clinical behavior vary according to race and access to adequate healthcare resources. To guide and streamline therapy in the war-torn and resource-constrained city of Baghdad, Iraq, we conducted a first-ever molecular analysis of 20 WT specimens to characterize the biological features of this lethal disease within this challenged population. Methods Next-generation sequencing of ten target genes associated with WT development and treatment resistance (WT1, CTNNB1, WTX, IGF2, CITED1, SIX2, p53, N-MYC, CRABP2, and TOP2A) was completed. Immunohistochemistry was performed for 6 marker proteins of WT (WT1, CTNNB1, NCAM, CITED1, SIX2, and p53). Patient outcomes were compiled. Results Mutations were detected in previously described WT 'hot spots' (e.g., WT1 and CTNNB1) as well as novel loci that may be unique to the Iraqi population. Immunohistochemistry showed expression domains most typical of blastemal-predominant WT. Remarkably, despite the challenges facing families and care providers, only one child, with combined WT1 and CTNNB1 mutations, was confirmed dead from disease. Median clinical follow-up was 40.5 months (range 6–78 months). Conclusions These data suggest that WT biology within a population of Iraqi children manifests features both similar to and unique from disease variants in other regions of the world. These observations will help to risk stratify WT patients living in this difficult environment to more or less intensive therapies and to focus treatment on cell-specific targets.
基金Supported by the Key Program of National Natural Science Foundation of China(No.92043201)the National Natural Science Foundation of China(No.52091544)+3 种基金the Capital’s Funds for Health Improvement and Research(No.2021-1G-2172)the Young Scholar Scientific Research Foundation of National Institute of Environmental Health(NIEH),Chinese Center for Disease Control and Prevention(China CDC,No.2020YSRF-03)the COVID-19 Emergency Funding from NIEH,China CDC(No.GWTX05)Bureau of Disease Prevention and Control,National Health Commission of China(No.WJW2102-01).
文摘Summary What is already known about this topic?Environmental factors such as temperature and humidity play important roles in the transmission of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)via droplets/aerosols.What is added by this report?Higher relative humidity(61%–80%),longer spreading time(120 min),and greater dispersal distance(1 m)significantly reduced SARS-CoV-2 pseudovirus loads.There was an interaction effect between relative humidity and spreading time.What are the implications for public health practice?The findings contribute to our understanding of the impact of environmental factors on the transmission of SARS-CoV-2 via airborne droplets/aerosols.
