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Lactose hydrolyzed skim milk powder has the potential to become a staple value-added ingredient in snack and frozen foods because 70% of the population suffers from lactose intolerance. However, the flow behavior of lactose hydrolyzed skim milk concentrates and their resulting products need to be understood. The aim of this study was to compare two rheological modeling methods and determine which method is best for predicting rheological behavior in lactose hydrolyzed and unhydrolyzed skim milk concentrates and reconstituted powder samples. The two methods compared are the combined temperature-concentration multiple-linear regression model and the shear rate-temperature-concentration superposition principle master curve model. Prior to fitting the data to the two models, the effect of temperature was determined via the Arrhenius relationship and the effect of concentration was determined via the Exponential relationship. The combined temperature-concentration method resulted in a single logarithmic model for each concentrate type which yields the consistency coefficient at any temperature and concentration input. The master curve method resulted in a single Power law type model for each concentrate type that describes the overall rheological behavior of the samples. When the predicted consistency coefficients from each method were compared to the raw data, both the master curve (r = 0.973, P < 0.0001) and the combined (r = 0.940, P < 0.0001) methods showed a strong correlation to the raw data. When the results were examined by concentrate type, the master curve model had a stronger fit (P < 0.01) for the reconstituted samples compared to the combined model which did not show a statistically significant correlation to the raw data (P < 0.075). The results of this study indicate that the master curve method is superior for predicting the rheological behavior of concentrated milk samples prepared from varying methods within our tested ranges. [ABSTRACT FROM AUTHOR]

The precise segmentation of skin lesion in dermoscopic images is essential for the early detection of skin cancer. However, the irregular shapes of the lesions, the absence of sharp edges, the existence of artifacts like hair follicles, and marker color make this task difficult. Currently, fully connected networks (FCNs) and U-Nets are the most commonly used techniques for melanoma segmentation. However, as the depth of these neural network models increases, they become prone to various challenges. The most pertinent of these challenges are the vanishing gradient problem and the parameter redundancy problem. These can result in a decline in Jaccard index of the segmentation model. This study introduces a novel end-to-end trainable network designed for skin lesion segmentation. The proposed methodology consists of an encoder-decoder, a region-aware attention approach, and guided loss function. The trainable parameters are reduced using depth-wise separable convolution, and the attention features are refined using a guided loss, resulting in a high Jaccard index. We assessed the effectiveness of our proposed RA-Net on four frequently utilized benchmark datasets for skin lesion segmentation: ISIC 2016, ISIC 2017, ISIC 2018, and PH2. The empirical results validate that our method achieves state-of-the-art performance, as indicated by a notably high Jaccard index. [ABSTRACT FROM AUTHOR]

The development of efficient methods for the synthesis of mechanically interlocked compounds is currently considered a major challenge in supramolecular chemistry. Twofold vinylogous fumaramides, a class of conjugated bis(enaminones), successfully achieve the assembly of hydrogen-bonded amide-based rotaxanes, with a templating ability comparable to that of their parent fumaramide-based systems, showcasing full conversions and impressive yields up to 92%. Computational calculations offer a compelling explanation for the remarkable efficiency of these bis(enaminones) in driving the synthesis of unprecedented rotaxanes. The reactivity of these interlocked species was thoroughly investigated, revealing that a one-step double stopper-exchange process can be successfully performed while preserving the mechanical bond. This approach facilitates the formation of controllable rotaxanes, including a three-station molecular shuttle, whose assembly via a clipping methodology is highly unselective. The internal translational motion of this latter species has been successfully controlled in a reversible way by means of a cycloaddition/retrocycloaddition sequence. Many templates for accessing hydrogen-bonded amide-based rotaxanes have resulted in modest yields, but a novel templating method has shown significant promise. Conjugated bis(enaminones) serve as an effective template for the formation of rotaxanes, and a post-synthetic double stopper-exchange method further enables the preparation of versatile and complex rotaxane structures. [ABSTRACT FROM AUTHOR]

This review critically analyzes the incidence of trastuzumab-induced left ventricular systolic dysfunction and congestive heart failure (CHF), distinguishing between cases with and without prior anthracycline exposure. It highlights the fact that the elevated risk of trastuzumab-induced cardiotoxicity is closely associated with prior anthracycline exposure. In the absence of prior anthracycline exposure, the incidence rates of trastuzumab-induced cardiotoxicity, particularly CHF (ranging from 0% to 0.5%), are largely comparable with those reported in the general population, especially when reversibility is taken into account. Current cardiac surveillance recommendations during trastuzumab treatment have not yet adapted to the increasing adoption of nonanthracycline treatment strategies and the associated low risk of cardiotoxicity. We propose a refined monitoring protocol to reduce the frequency of cardiac evaluations for low-risk to moderate-risk patients, especially those receiving nonanthracycline treatments. By focusing on patients at high risk or those with prior anthracycline exposure, this strategy seeks to optimize the cost-effectiveness of cardiac care in oncology. Our review reevaluates trastuzumab-induced cardiotoxicity, advocating for tailored cardiac surveillance on the basis of anthracycline exposure and risk factors. A step toward cost-effective care in cardio-oncology. [ABSTRACT FROM AUTHOR]

Introduction: Breast cancer (BC) is the second most common cancer in Saudi women. Therefore, understanding BC and its related risk factors, symptoms, and screening is critical for early detection and intervention. The current study was meant to explore the knowledge, awareness, and attitude (KAA) gap in BC: risk factors, symptoms, and screening. Material and Methods: This cross‑sectional investigation was carried out with Health Professions Students (HPS) using a predesigned and validated study questionnaire to examine HPS knowledge and attitudes concerning BC and associated risk factors, symptoms, and screening. Results: A total of 277 female students responded to the survey. The frequency of correct answers for the BC knowledge questions varied from the lowest of 27.8% to the highest of 88.8%, with only 5 out of 15 questions (33.3%) answered correctly by more than 60% of the participants, displaying poor knowledge and awareness of BC. A majority (>60%) of the participants identified only 7 of the 18 risk factors of BC correctly, whereas 11 of the 13 early warning signs of BC were identified correctly by the majority (>60%) of the participants. Among the participants, only 26.4% were aware of the breast cancer screening center, but 94.6% of them agreed that early detection of breast cancer is important and 82.7% agreed to participate in the screening program if offered. Conclusion: Participants’ knowledge and awareness of BC were found to be relatively low; however, their attitudes towards BC screening were positive. As a result, it is critical to develop effective education programs, curricular activities, and awareness campaigns to address the lack of awareness of BC and to have an appropriate response to screening to reduce disease burden. [ABSTRACT FROM AUTHOR]

Animal welfare is the state of an animal's body and mind and the level to which its requirements are satisfied. Animal welfare is affected by human decisions and actions. Numerous decisions concerning animals are driven by human desires to enhance their own lives, and some of these decisions may be influenced by self-interest or a strong emphasis on economic factors. How to assess the welfare state of animals is a central issue in animal welfare science. Two critical questions can be used to address animal welfare: first, is the animal healthy, and second, does the animal have what it needs? Both of these questions can potentially be answered using the study of animal behavior. The development of behavioral methodologies is crucial for evaluating welfare in contexts where concern for animal welfare is often highest, such as on intensive modern farms and sites where working animals are used. Herein, we discuss animal welfare by focusing on some of its major concepts and explanations. Later, to illustrate key aspects of animal welfare, we chose to examine the information that is available for some 'neglected' livestock species, which are commercially important on a global basis and found in large numbers: buffaloes (Bubalus bubalis), camels (Camelus dromedarius), donkeys (Equus asinus), mules (Equus asinus × Equus caballus), and lumpfish (Cyclopterus lumpus). We chose these species because there are major ongoing concerns about their welfare, and more research is required to help solve the various problems. Overall, there are strong imbalances in terms of the species that are usually studied in terms of animal welfare research, and we call for greater attention to those that have traditionally been neglected. [ABSTRACT FROM AUTHOR]

Background: Surgery-first approach is the current standard of care for resectable pancreatic ductal adenocarcinoma (PDAC), and a proportion of these cases will require venous resection. This study aimed to identify parameters on staging computed tomography (CT) that predict the need for venous resection during pancreaticoduodenectomy (PD) for resectable PDAC. Methods: We conducted a retrospective analysis of prospectively collected data on patients who underwent PD for resectable staged PDAC (as per NCCN criteria) between 2011 and 2020. Staging CTs were independently reviewed by two specialist radiologists blinded to the clinical outcomes. Univariate and multivariate risk analyses were performed. Results: In total, 296 PDs were included. Venous resection was performed in 62 (21%) cases. There was a higher rate of resection margin positivity in the vein resection group (72.6% vs. 48.7%, p = 0.001). Tumour at the neck of the pancreas, superior mesenteric vein involvement of ≥10 mm and pancreatic duct dilatation were identified as independent predictors for venous resection. Discussion: Staging CT parameters can predict the need for venous resection during PD for resectable cases of PDAC. This may assist in surgical planning, patient selection and counselling. Future efforts should concentrate on validating these results or identifying additional predictors in a multicentre and prospective setting. [ABSTRACT FROM AUTHOR]

Summary: Background: Gut‐directed hypnotherapy is effective for patients with irritable bowel syndrome (IBS). Despite its considerable evidence base, gut‐directed hypnotherapy is not widely available and remains a limited resource. This emphasises the need to select patients who are most likely to benefit. Aim: To determine whether baseline patient characteristics were predictive of response to gut‐directed hypnotherapy in patients with IBS Methods: We conducted a secondary analysis of outcomes of 448 patients with refractory Rome III IBS who participated in a randomised study confirming non‐inferiority of 6 compared to 12 sessions of gut‐directed hypnotherapy. We compared baseline patient characteristics, including age, sex, IBS subtype, quality of life and IBS‐Symptom Severity Scale (IBS‐SSS), non‐colonic symptom score and Hospital Anxiety and Depression (HAD) score between responders and non‐responders. We defined response as ≥50‐point decrease in IBS‐SSS or ≥30% reduction in pain severity scores. Results: Overall, 76.3% achieved ≥50‐point decrease in IBS‐SSS. Responders had a higher baseline non‐colonic symptom score (p = 0.005). Those who achieved ≥30% improvement in abdominal pain scores (59.8%) had higher baseline IBS‐SSS (p = 0.03), and lower baseline HAD‐depression score (p = 0.012). Fifty‐four patients (12%) dropped out of gut‐directed hypnotherapy. Compared to completers, dropouts had higher baseline HAD‐anxiety score (p = 0.034). Conclusions: These data suggest that patients with a higher burden of gastrointestinal and extraintestinal symptoms are most likely to benefit from gut‐specific behavioural intervention for refractory IBS. Clinical assessment of gastrointestinal, somatic and psychological symptom profiles may play a role in selecting patients for gut‐directed hypnotherapy. [ABSTRACT FROM AUTHOR]

Vitamin D3 (VD3) and iron‐blend granules were blended with corn and lentil composite flour (75/25, w/w) and fed into a pilot‐scale twin‐screw extruder to produce ready‐to‐eat snacks. The morphology and microstructure of extruded snacks were examined using scanning electron microscopy with energy‐dispersive X‐ray (SEM–EDX), X‐ray powder diffraction, and FT‐IR. Differential scanning calorimetry and thermogravimetric analysis measured the melting temperature and thermal stability of the extrudates. SEM and FT‐IR analysis demonstrate that micronutrients are mixed well in formulations used in extrudates at high shear and high temperatures. The SEM–EDX exhibited the presence of iron, whereas high performance liquid chromatography measurements confirmed the significant retention of VD3 in the extruded snacks. The interaction between VD3 and human osteoblast cells was studied using live imaging and the MMT assay. Overall, for the first time, VD3 and Fe2+ blend granules have been used in an extrusion platform, which has significant potential for the intervention of VD3 and iron deficiencies. Practical Application: For the first time, we reported the use of VD3/iron‐blend granules in extruded products. The findings of this work demonstrated the thermal stability and capability of providing adequate quantities of VD3 and iron in corn flour/lentil flour/VD3‐iron blend extruded snacks. Furthermore, the interaction of VD3 with osteoblast cells highlights the potential health benefits of the extrudates. [ABSTRACT FROM AUTHOR]

Introduction The important association between hematological disorders and cardiovascular system originates within multiple points of interface, ranging from heart and its structural constituents, coronary arteries and veins, cerebrovascular, pulmonary and peripheral vasculature. Any anomaly of either of the blood components can severely affect the blood flow and blood viscosity which finally leads to thrombosis. Objective This study will help clinicians to evaluate those patients having hematological abnormality and are having potential prothrombotic state due to abnormal hemostasis. Rationale Introducing cardiac health screening in patients with any hematological disease can improve the quality of life of these patients. Material and methods This cross sectional analytical study was conducted in hematology Department of Peshawar institute of Cardiology after approval from hospital ethical and research committee. Study duration was 6 months. All patients were subjected to detailed history, clinical examination. Demographic (Age, Gender) and relevant clinical information. Investigation like CBC, coagulation profile, hemolytic profile, Chest X-ray, ECG, Echo, Angiography findings were used to monitor patient’s clinical status. Results Out of 43 patients, 08 cases (18.60%) presented were of benign hematological disorder and the rest 35 cases (81.40%) presented with malignant hematological disorders. A significant P- value of (0.000) was observed in patients with malignant hematological disorder in association with benign hematological disorders. Conclusion From our study findings, several local and international platforms data, it can be concluded that those hematological abnormalities which have direct or indirect association with thromboembolic events can present with cardiac manifestation in the form of chest pain or acute myocardial injury at any stage of disease process. Therefore, clinicians must evaluate patients having hematological abnormality and are having potential prothrombotic state due to abnormal hemostasis for cardiac manifestation of the disease as well. [ABSTRACT FROM AUTHOR]

Introduction. In the United States, the hepatitis C virus (HCV) is a leading contributor to liver-related illnesses and fatalities. Despite effective antiviral medications, acute infections have increased in recent years, likely due to IV drug use and the opioid epidemic. Previous guidelines recommended one-time screening for individuals born between 1945 and 1965. The CDC now recommends screening all adults over 18 unless there is a low prevalence in the area. Accurate measurement of HCV prevalence is essential for targeted prevention. In New York, over 100,000 individuals have HCV. We present data on HCV screening at a safety net hospital in Long Island, NY. Objective. To identify screening rates for hepatitis C and the exposure prevalence and specific demographics of a community in Long Island, NY. Methods. We performed a review of all patients seen in our hospital from 2012 to 2019. We identified patients born in the years 1945 to 1965 using our electronic medical record (EMR) system and subsequently analyzed those who were anti-HCV positive. We reviewed their demographics, including age, gender, and ethnicity, as well as their history of intravenous drug use and HIV coinfection status. Basic statistical analysis was used. Results. Our study identified 21,722 patients born between 1945 and 1965 and found that only 8.5% or 1,858 individuals were screened for hepatitis C. Among them, we found that 5.9% (109) tested positive for HCV antibody, with 3.0% (56) having an active infection. Demographic characteristics of those with HCV antibodies included 70.6% male, 53.2% Caucasian, 33.9% Black, and 15.6% persons who inject drugs (PWID). Conclusion. Our study findings suggest that a significant portion of patients in our community had missed opportunities for screening in our hospital. Our community had an estimated 5.9% prevalence, higher than the national and state averages. Caucasian men had higher prevalences. This study suggests the need for broader screening initiatives and more focused resource allocation, perhaps to safety net institutions, to decrease the burden of HCV. [ABSTRACT FROM AUTHOR]

Oblique orientation of vocal cord demands strict compliance, by technicians and clinicians, to the recommended parallel plane CT scan of larynx. Repercussions of non-compliance has never been investigated before. We aimed to observe influence of non-parallel vocal cord plane CT scan on qualitative and quantitative glottic parameters, keeping parallel plane CT as a standard for comparison. Simultaneous identification of potential suboptimal imaging sequelae as a result of unformatted CT plane was also identified. In this study we included 95 normal adult glottides and retrospectively analyzed their anatomy in two axial planes, non-parallel plane ① and parallel to vocal cord plane ②. Qualitative (shape, structures at glottic level) and quantitative (anterior commissure ACom, vocal cord width VCw, anteroposterior AP, transverse Tr, cross-sectional area CSA) glottic variables were recorded. Multivariate statistical analysis was used to predict pattern and their impact on glottic anatomy. Plane ① displayed supraglottic features in glottis; adipose (90.5%) and split thyroid laminae (70.6%). Other categorical variables: atypical shape, submental structures and multilevel vertebral crossing were also in majority. All glottic dimensions varied significantly between two planes with most in ACom (-5.8mm) and CSA (-15.0 mm2). In contrast, plane ② manifested higher VCw (>73%), Tr (66.3%), CSA (64.2%) and AP (44.2%) measurements. On correlation analysis, variation in ACom, CSA, Tr was positively associated with VC or plane obliquity (p<0.05). This variability was more in obese and short necked subjects. Change in one parameter also modified other significantly i.e., ACom versus AP and CSA versus Tr. Results indicated statistically significant change in subjective and objective anatomical parameters of glottis on non-application of appropriate CT larynx protocol for image analysis hence highlighting importance of image reformation. [ABSTRACT FROM AUTHOR]

Simple Summary: Mutations in head and neck cancer result in abnormal tumor cell growth, increase the risk of distant metastasis, and lead to therapeutic failure. Progenitor cells, head and neck cancer stem cells, and bulk tumor cells may all harbor these mutations, and identifying the mutations in stem cells may facilitate stratifying patients who are likely to benefit from treatment. Patients with head and neck cancer whose tumor exhibits Keap1/Nrf2 mutations in their stem cells are significantly more likely to develop rapid lung metastasis and fail treatment. Our findings suggest a molecular genotyping of head and neck cancer stem cells, which may facilitate personalized treatment strategies and assist in identifying patients who would benefit from chemotherapy, radiotherapy, and targeted therapies. Mutations in Keap1/Nrf2 in head and neck cancer result in abnormal cell growth. Progenitor cells, bulk tumor cells, and head and neck cancer stem cells (HN-CSCs) may all harbor these mutations. Nevertheless, whether Keap1/Nrf2 mutations in HN-CSCs have an impact on clinical outcomes is unknown. Cancerous HN-CSCs and benign stem cells were obtained from freshly resected head and neck cancer patients (n = 50) via flow cytometry cell sorting and tested for Keap1/Nrf2 mutations. The existence of Keap1/Nrf2 mutations in HN-CSCs, as well as their correlations with tumor mutations, pathologic tumor stage, tumor histologic grades, lung metastasis, treatment outcomes, and the patient's age and conditions, are assessed at the last follow-up visit. Thirteen tumors were found to have Keap1/Nrf2 mutations in their HN-CSCs. More than half of the lung metastases and disease progression occurred in HN-CSCs with mutations. Patients whose tumors carried Keap1/Nrf2 mutations in their HN-CSCs had significantly shorter progression-free survival, overall survival, and time of treatment failure than their non-HN-CSC counterparts. These associations were partly driven by HN-CSCs, in which Keap1/Nrf2 mutations were overrepresented in fast progressors and associated with an increased risk of disease progression. Our findings suggest that molecular genotyping of HN-CSCs may facilitate personalized treatment strategies and assist in identifying patients who are likely to benefit from chemotherapy. [ABSTRACT FROM AUTHOR]

Objective. To develop real-time 4D MRI using MR signature matching (MRSIGMA) for volumetric motion imaging in patients with pancreatic cancer on a 1.5T MR-Linac system. Approach. Two consecutive MRI scans with 3D golden-angle radial stack-of-stars acquisitions were performed on ten patients with inoperable pancreatic cancer. The complete first scan (905 angles) was used to compute a 4D motion dictionary including ten pairs of 3D motion images and signatures. The second scan was used for real-time imaging, where each angle (275 ms) was processed separately to match it to one of the dictionary entries. The complete second scan was also used to compute a 4D reference to assess motion tracking performance. Dice coefficients of the gross tumor volume (GTV) and two organs-at-risk (duodenum-stomach and small bowel) were calculated between signature matching and reference. In addition, volume changes, displacements, center of mass shifts, and Dice scores over time were calculated to characterize motion. Main results. Total imaging latency of MRSIGMA (acquisition + matching) was less than 300 ms. The Dice coefficients were 0.87 ± 0.06 (GTV), 0.86 ± 0.05 (duodenum-stomach), and 0.85 ± 0.05 (small bowel), which indicate high accuracy (high mean value) and low uncertainty (low standard deviation) of MRSIGMA for real-time motion tracking. The center of mass shift was 3.1 ± 2.0 mm (GTV), 5.3 ± 3.0 mm (duodenum-stomach), and 3.4 ± 1.5 mm (small bowel). The Dice scores over time (0.97 ± [0.01–0.03]) were similarly high for MRSIGMA and reference scans in all the three contours. Significance. This work demonstrates the feasibility of real-time 4D MRI using MRSIGMA for volumetric motion tracking on a 1.5T MR-Linac system. The high accuracy and low uncertainty of real-time MRSIGMA is an essential step towards continuous treatment adaptation of tumors affected by real-time respiratory motion and could ultimately improve treatment safety by optimizing ablative dose delivery near gastrointestinal organs. [ABSTRACT FROM AUTHOR]

Introduction: Intraoperative consultation examinations are required by surgeons from pathologists for immediate important decisions regarding the optimal extent of surgery. Surgeons particularly want to know whether a lesion is malignant or not. Both frozen section (FS) and touch impression cytology serve this purpose well. Both provide accurate results in minutes while the patient is under anesthesia. The surgeon then modifies his surgical plan based on the intraoperative consultation from pathologist. Objectives: The objective of this study is to access the role of imprint cytology (IC) and FS in diagnosis of tumors of different organs, to correlate IC and FS findings with histopathological diagnosis and to determine their diagnostic accuracy. Materials and Method: This present prospective cross-sectional study was done in the pathology department of BKL Walawalkar Rural Medical College, Dervan, Chiplun, for a period of one and a half year. A total of 161 surgical specimens from various organs were studied using IC and FS. The results of both the techniques were compared with the gold standard histopathological diagnosis. Results: Statistical correlation of IC and FS with histopathology shows that true positive cases on IC are 88.7% and on FS are 85.1%. Sensitivity, specificity, and diagnostic accuracy of IC and FS are 95.7%, 81.8%, 94.7% and 93.2%, 78.9%, 92%, respectively. Combined diagnostic accuracy is 93.5%. Conclusion: IC and FSs are interdependable intraoperative diagnostic modalities. IC is a simple, accurate, rapid, and cost-effective diagnostic tool, intraoperatively. FS preserves crisp cellular and nuclear detail and also closely approximates permanent histopathology sections. Thus, a combination of IC and FS helps in achieving high diagnostic accuracy rates and in distinguishing benign and malignant lesions. [ABSTRACT FROM AUTHOR]

Staphylococcus sciuri (also currently Mammaliicoccus sciuri) are anaerobic facultative and non-motile bacteria that cause significant human pathogenesis such as endocarditis, wound infections, peritonitis, UTI, and septic shock. Methicillin-resistant S. sciuri (MRSS) strains also infects animals that include healthy broilers, cattle, dogs, and pigs. The emergence of MRSS strains thereby poses a serious health threat and thrives the scientific community towards novel treatment options. Herein, we investigated the druggable genome of S. sciuri by employing subtractive genomics that resulted in seven genes/proteins where only three of them were predicted as final targets. Further mining the literature showed that the ArgS (WP_058610923), SecY (WP_058611897), and MurA (WP_058612677) are involved in the multi-drug resistance phenomenon. After constructing and verifying the 3D protein homology models, a screening process was carried out using a library of Traditional Chinese Medicine compounds (consisting of 36,043 compounds). The molecular docking and simulation studies revealed the physicochemical stability parameters of the docked TCM inhibitors in the druggable cavities of each protein target by identifying their druggability potential and maximum hydrogen bonding interactions. The simulated receptor-ligand complexes showed the conformational changes and stability index of the secondary structure elements. The root mean square deviation (RMSD) graph showed fluctuations due to structural changes in the helix-coil-helix and beta-turn-beta changes at specific points where the pattern of the RMSD and root mean square fluctuation (RMSF) (< 1.0 Å) support any major domain shifts within the structural framework of the protein–ligand complex and placement of ligand was well complemented within the binding site. The β-factor values demonstrated instability at few points while the radius of gyration for structural compactness as a time function for the 100-ns simulation of protein–ligand complexes showed favorable average values and denoted the stability of all complexes. It is assumed that such findings might facilitate researchers to robustly discover and develop effective therapeutics against S. sciuri alongside other enteric infections. [ABSTRACT FROM AUTHOR]

A study published in the journal Ultrasound in Obstetrics & Gynecology aimed to validate the accuracy of the "amniotic sac sign" in diagnosing early miscarriage. The study involved 1897 pregnancies from 1890 women across five centers. The results showed that the presence of an amniotic sac without a live embryo had 100% specificity for the diagnosis of miscarriage. Implementing this sign could potentially reduce the number of follow-up visits for pregnancies of uncertain viability by 10%, providing benefits in terms of patient anxiety and financial costs. [Extracted from the article]

Key Points: Question: Does 1 year of treatment with atorvastatin, 40 mg/d, started prior to anthracycline-based chemotherapy among patients with lymphoma, reduce the chance of a significant decrease in left ventricular ejection fraction (LVEF) compared with placebo? Findings: In this randomized trial of 300 adult patients with lymphoma, the percentage of patients with a decrease in cardiac function (≥10% absolute decline in LVEF from prior to chemotherapy to a final value of <55% over the 12-month study period), among those randomized to atorvastatin was 9% compared with a rate of 22% among patients randomized to placebo. This difference met statistical significance. Meaning: Atorvastatin reduced cardiac functional impairment in patients with lymphoma treated with anthracyclines. This finding may support the use of atorvastatin in patients with lymphoma at risk of cardiac dysfunction due to anthracycline treatment. Importance: Anthracyclines treat a broad range of cancers. Basic and retrospective clinical data have suggested that use of atorvastatin may be associated with a reduction in cardiac dysfunction due to anthracycline use. Objective: To test whether atorvastatin is associated with a reduction in the proportion of patients with lymphoma receiving anthracyclines who develop cardiac dysfunction. Design, Setting, and Participants: Double-blind randomized clinical trial conducted at 9 academic medical centers in the US and Canada among 300 patients with lymphoma who were scheduled to receive anthracycline-based chemotherapy. Enrollment occurred between January 25, 2017, and September 10, 2021, with final follow-up on October 10, 2022. Interventions: Participants were randomized to receive atorvastatin, 40 mg/d (n = 150), or placebo (n = 150) for 12 months. Main Outcomes and Measures: The primary outcome was the proportion of participants with an absolute decline in left ventricular ejection fraction (LVEF) of ≥10% from prior to chemotherapy to a final value of <55% over 12 months. A secondary outcome was the proportion of participants with an absolute decline in LVEF of ≥5% from prior to chemotherapy to a final value of <55% over 12 months. Results: Of the 300 participants randomized (mean age, 50 [SD, 17] years; 142 women [47%]), 286 (95%) completed the trial. Among the entire cohort, the baseline mean LVEF was 63% (SD, 4.6%) and the follow-up LVEF was 58% (SD, 5.7%). Study drug adherence was noted in 91% of participants. At 12-month follow-up, 46 (15%) had a decline in LVEF of 10% or greater from prior to chemotherapy to a final value of less than 55%. The incidence of the primary end point was 9% (13/150) in the atorvastatin group and 22% (33/150) in the placebo group (P =.002). The odds of a 10% or greater decline in LVEF to a final value of less than 55% after anthracycline treatment was almost 3 times greater for participants randomized to placebo compared with those randomized to atorvastatin (odds ratio, 2.9; 95% CI, 1.4-6.4). Compared with placebo, atorvastatin also reduced the incidence of the secondary end point (13% vs 29%; P =.001). There were 13 adjudicated heart failure events (4%) over 24 months of follow-up. There was no difference in the rates of incident heart failure between study groups (3% with atorvastatin, 6% with placebo; P =.26). The number of serious related adverse events was low and similar between groups. Conclusions and Relevance: Among patients with lymphoma treated with anthracycline-based chemotherapy, atorvastatin reduced the incidence of cardiac dysfunction. This finding may support the use of atorvastatin in patients with lymphoma at high risk of cardiac dysfunction due to anthracycline use. Trial Registration: ClinicalTrials.gov Identifier: NCT02943590 This randomized trial assesses the effect of 12 months of atorvastatin vs placebo on development of cardiac dysfunction among patients with lymphoma undergoing anthracycline-based chemotherapy. [ABSTRACT FROM AUTHOR]

Working donkeys (Equus asinus) support human living standards globally. However, there is little information on the effect of human perceptions of emotion and pain on the welfare of working donkeys. We interviewed donkey owners (nD332) in Pakistan to determine the relationship between human perspectives on donkey sentience: emotions and the ability to feel pain, and the routine working practices that could impact donkey welfare. The majority of donkey owners used padding under the saddle (n D 211; 63.6%; 95% CI (58.3%-68.9%)) and provided access to food (n D 213; 64.2%; 95% CI (58.9%-69.3%)) and water (nD195; 58.7%; 95% CI (53.4%-64.1%)) during the working day. Owners reported that at some point in their donkey's life, 65.3% (95% CI (60.2%-70.5%)) had load-associated injuries, of which 27.7% (nD92; 95% CI (22.8%- 32.5%)) were wounds, 20.5% (n D 68; 95% CI (16.1%-24.8%)) were lameness and 7.2% (nD24; 95% CI 4.4%-10.0%) were back pain. In total, 81.3% (95% CI 77.1%- 85.5%; nD270) of owners believed that their donkeys felt pain, and 70.2% (95% CI (65.2%-75.1%; nD233) of owners believed that their donkeys had emotions. Multiple correspondence analysis (MCA) was used to understand the relationship between owners' recognition of emotions and pain in donkeys and their working practices. The MCA factor map revealed two clusters, named positive and negative clusters. The positive cluster included owner's recognition of donkey pain and emotions, the availability of food and water, use of padding under the saddle, absence of injuries along with the willingness to follow loading guidelines. The negative cluster represented practices that did not benefit donkey welfare, such as using saddles without padding and a lack of food and water during work. The presence of injuries, owners not recognizing that donkeys feel pain and emotion along with an unwillingness to follow loading guidelines were also found in the negative cluster. We show that the owners who recognized sentience in their donkeys were more likely to use practices that are good for donkey welfare. The ability of owners to identify sentience in donkeys, along with their willingness to follow welfare guidelines, are important factors in improving the lives of working donkeys. [ABSTRACT FROM AUTHOR]

Grape and apple pomace powders, a good source of dietary fiber and nutrients, were incorporated in formulations containing milk protein concentrate with over 81% milk protein (MPC-81) to produce puffed products using supercritical fluid extrusion (SCFX). The cellular structure and cell nucleation dynamics in the extruded samples were evaluated as function of pressure drop and supercritical CO2 (SCCO2) injection rates. Results showed that SCFX generated pomace-based extruded products had an expansion ratio up to 12.3 and microcellular structure (ranging in cell size from 278 to 540 µm) and cell density of the order of 104–105 cells/cm3. The general trend of increased cell density and decreased cell size of extrudates was observed by increasing pressure drop rate and SCCO2 content and exhibited a uniform cellular architecture when the injected SCCO2 level was close its saturation solubility in the aqueous phase of the dough, and the pressure drop rate was high, up to 141.04 MPa/s. Beyond these values, some structural collapse was observed in both extrudates. Although the extrudates had the same level of expansion, their hardness values gradually decreased, indicating that the textural qualities and microcellular structure in extrudates can be controlled by regulating the SCCO2 injection and pressure drop rates. It is thus reasonable to suggest that the SCFX technology provides a unique strategy to control cellular morphology, expansion, and physicochemical characteristics of nutritionally superior extruded products. [ABSTRACT FROM AUTHOR]

Background Cardiovascular events have been reported to occur in one in five patients receiving chimeric antigen receptor T-cell (CAR-T) therapy. Commonly reported effects including cardiomyopathy, heart failure, myocardial infarction (MI), and arrhythmia. Here, we present a novel case of a patient who developed acute ST segment elevations during CAR-T cell infusion. Case summary A 76-year-old man with diffuse large B cell lymphoma was admitted for an investigational CD-19 directed, autologous CAR-T cell therapy. Less than 5 min into the CAR-T cell infusion, he developed severe chest pain, dyspnea, flushing, hypotension, and tachycardia. Electrocardiogram (EKG) showed inferior ST elevations and reciprocal lateral ST depressions. Emergent coronary angiography revealed mild non-obstructive coronary disease. ST segment changes and patient symptoms resolved after catheterization. Discussion Given the complete resolution of symptoms and EKG abnormalities in the context of non-obstructive coronary artery disease, this clinical presentation was thought to be most consistent with ST elevation MI due to coronary vasospasm. The mechanism of this vasospasm is as yet not understood and may be related to an anaphylactic reaction or a cardiotoxicity related to the cell therapy agent. As the use of CAR-T therapy continues to expand, there is a need to further characterize the full spectrum of its cardiotoxic effects. [ABSTRACT FROM AUTHOR]

Background: Although expanded access is an increasingly used pathway for patients to access investigational medicine, little is known on the magnitude and content of published scientific research collected via expanded access. Methods: We performed a review of all peer-reviewed expanded access publications between January 1, 2000 and January 1, 2022. We analyzed the publications for drugs, diseases, disease area, patient numbers, time, geographical location, subject, and research methodology (single center/multicenter, international/national, prospective/retrospective). We additionally analyzed endpoints reported in all COVID-19-related expanded access publications. Results: We screened 3810 articles and included 1231, describing 523 drugs for 354 diseases for 507,481 patients. The number of publications significantly increased over time ( p < 0.001 ). Large geographical disparities existed as Europe and the Americas accounted for 87.4% of all publications, whereas Africa only accounted for 0.6%. Oncology and hematology accounted for 53% of all publications. Twenty-nine percent of all expanded access patients (N = 197,187) reported on in 2020 and 2021 were treated in the context of COVID-19. Conclusions: By summarizing characteristics of patients, diseases, and research methods described in all scientific literature published on expanded access, we provide a unique dataset for future research. We show that published scientific research on expanded access has surged over the past decades, partly due to COVID-19. However, international collaboration and equity in geographic access remain an issue of concern. Lastly, we stress the need for harmonization of research legislation and guidance on the value of expanded access data within real-world data frameworks to improve equity in patient access and streamline future expanded access research. [ABSTRACT FROM AUTHOR]

Aims Chimeric antigen receptor T-cell therapy (CAR-T) harnesses a patient's immune system to target cancer. There are sparse existing data characterizing death outcomes after CAR-T-related cardiotoxicity. This study examines the association between CAR-T-related severe cardiovascular events (SCE) and mortality. Methods and results From a multi-centre registry of 202 patients receiving anti-CD19 CAR-T, covariates including standard baseline cardiovascular and cancer parameters and biomarkers were collected. Severe cardiovascular events were defined as a composite of heart failure, cardiogenic shock, or myocardial infarction. Thirty-three patients experienced SCE, and 108 patients died during a median follow-up of 297 (interquartile range 104–647) days. Those that did and did not die after CAR-T were similar in age, sex, and prior anthracycline use. Those who died had higher peak interleukin (IL)-6 and ferritin levels after CAR-T infusion, and those who experienced SCE had higher peak IL-6, C-reactive protein (CRP), ferritin, and troponin levels. The day-100 and 1-year Kaplan–Meier overall mortality estimates were 18% and 43%, respectively, while the non-relapse mortality (NRM) cumulative incidence rates were 3.5% and 6.7%, respectively. In a Cox model, SCE occurrence following CAR-T was independently associated with increased overall mortality risk [hazard ratio (HR) 2.8, 95% confidence interval (CI) 1.6–4.7] after adjusting for age, cancer type and burden, anthracycline use, cytokine release syndrome grade ≥ 2, pre-existing heart failure, hypertension, and African American ancestry; SCEs were independently associated with increased NRM (HR 3.5, 95% CI 1.4–8.8) after adjusting for cancer burden. Conclusion Chimeric antigen receptor T-cell therapy recipients who experience SCE have higher overall mortality and NRM and higher peak levels of IL-6, CRP, ferritin, and troponin. [ABSTRACT FROM AUTHOR]

Despite decades of genetic studies on late-onset Alzheimer's disease, the underlying molecular mechanisms remain unclear. To better comprehend its complex etiology, we use an integrative approach to build robust predictive (causal) network models using two large human multi-omics datasets. We delineate bulk-tissue gene expression into single cell-type gene expression and integrate clinical and pathologic traits, single nucleotide variation, and deconvoluted gene expression for the construction of cell type-specific predictive network models. Here, we focus on neuron-specific network models and prioritize 19 predicted key drivers modulating Alzheimer's pathology, which we then validate by knockdown in human induced pluripotent stem cell-derived neurons. We find that neuronal knockdown of 10 of the 19 targets significantly modulates levels of amyloid-beta and/or phosphorylated tau peptides, most notably JMJD6. We also confirm our network structure by RNA sequencing in the neurons following knockdown of each of the 10 targets, which additionally predicts that they are upstream regulators of REST and VGF. Our work thus identifies robust neuronal key drivers of the Alzheimer's-associated network state which may represent therapeutic targets with relevance to both amyloid and tau pathology in Alzheimer's disease. A network analysis on deconvoluted bulk transcriptomic data from human Alzheimer's disease cohorts identifies several potential key disease drivers, including JMJD6. [ABSTRACT FROM AUTHOR]

Manual assessment of biomedical imaging based diagnostics is limited as it is time-consuming and subjective. Bio-inspired diagnostics applications on embedded and mobile devices are becoming more popular as they overcome these limitations and aid in early detection and diagnosis. The neural theory of visual attention puts forward that the processing resources are dedicated to more important information, for resource saving and performance improvement. Moreover, adversarial learning can potentially alleviate the various biases of the human cognitive system. The limited performance of the current lightweight network approaches can be attributed to the absence of above-mentioned properties of the human cognition. Accordingly, we introduce GLAN, a lightweight attention based network that is particularly well suited to embedded and mobile devices. GLAN's design follows lightweight architecture design principles for encoder-decoder design. To improve performance a twofold novel strategy is adopted. Firstly, we equip the encoder and the decoder with lightweight attention mechanisms to increase their focus and improve segmentation performance. Secondly, adversarial learning is employed with augmentation to increase the generalization ability of the lightweight attention network. e have evaluated our GLAN on three different applications including lung segmentation, digestive tract polyp segmentation and optic disc segmentation. GLAN is quite competitive in terms of segmentation performance while comprehensively outperforming recent alternatives in terms of computational requirements. Specifically, GLAN requires 94.17%, 78.18%, 80.95% and 67.56% less computational parameters as compared with four recent lightweight alternatives. This advocates its application in real-time biomedical imaging diagnostics on embedded and mobile devices in clinical settings. [ABSTRACT FROM AUTHOR]

Gut‐directed hypnotherapy (GDH) is a highly effective brain‐gut behavioral therapy which is recommended in international guidelines for the treatment of irritable bowel syndrome (IBS). There is increasing recognition of the value of GDH as part of integrated care alongside medical and dietary approaches. This has led to recent innovations to widen access to GDH to meet the increasing demand. Recent advances include streamlined courses of individualized GDH, group therapy, and remote delivery. In this issue of Neurogastroenterology and Motility, Peters et al. retrospectively report outcomes of smartphone app‐delivered GDH in a population with self‐reported IBS. While adherence was low, those that completed smart phone‐delivered GDH‐achieved symptom benefit. This mini‐review summarizes the current evidence‐base for available modalities of GDH and discusses the current and future utility and development of mobile health applications in the digital therapeutics' era. [ABSTRACT FROM AUTHOR]

Knee osteoarthritis patient phenotyping is relevant to developing targeted treatments and assessing the treatment efficacy of total knee arthroplasty (TKA). This study aimed to identify clusters among TKA candidates based on demographic and knee mechanic features during gait, and compare gait changes between clusters postoperatively. TKA patients underwent 3D gait analysis 1‐week pre (n = 134) and 1‐year post‐TKA (n = 105). Principal component analysis was applied to frontal and sagittal knee angle and moment waveforms, extracting major patterns of variability. Age, sex, body mass index, gait speed, and frontal and sagittal pre‐TKA angle and moment PC scores previously identified as relevant to TKA outcomes were standardized (mean = 0, SD = 1, [134 × 15]). Multidimensional scaling and machine learning‐based hierarchical clustering were applied. Final clusters were validated by examining intercluster differences pre‐TKA and gait feature changes (PostPCscore – PrePCscore) by k‐way Χ2 and ANOVA tests. Four TKA candidate phenotypes yielded optimum clustering metrics, interpreted as higher and lower functioning clusters that were predominantly male and female. Higher functioning clusters pre‐TKA (clusters 1 and 4) had more dynamic sagittal flexion moment (p < 0.001) and frontal plane adduction moment (p < 0.001) loading/un‐loading patterns during stance. Post‐TKA, higher functioning clusters demonstrated less knee mechanic improvements during gait (flexion angle p < 0.001; flexion moment p < 0.001). TKA candidates can be characterized by four clusters, predominately separated by sex and knee joint biomechanics. Post‐TKA knee kinematics and kinetics improvements were cluster‐specific; lower functioning clusters experienced more improvement. Cluster‐based patient profiling may aid in triaging and developing OA management and surgical strategies meeting group‐level function needs. [ABSTRACT FROM AUTHOR]

The Khairi Murat-Kauliar area lies between the Salt Range Thrust (SRT) in the south whereas Main Boundary Thrust (MBT) in the north which is the part of the Potwar Sub Basin. Eocene to Recent rock succession is exposed in the study area. The selected siliciclastic Siwalik Group display various facies in a fluviatile environment, with different lithologies, and sedimentary features. The petrographic studies of Siwalik Group delineate different microfacies including feldspathic litharenite, litharenite and sub arkose. The provenance study of sandstones depicted the terrane of dissected arc and recycled orogeny, indicating that the detritus was received from sedimentary, metamorphic, plutonic and volcanic rocks from the northern domain of Indian Plate, Karakoram Ranges and Kohistan Island arc. The Siwalik sandstone also contains heavy mineral assemblage such as tourmaline, garnet, epidote, hornblende and chlorite. This heavy detritus assemblage depicted that the deposits were received from metamorphic and igneous origin. A modified dynamic depositional stages of the Siwalik Group with respect to Himalayan orogeny is further built using outcrop data, microfacies and heavy minerals analysis. According to this concept, the group was deposited along Himalayan uprising and thrusting, on the depository in targeted area. The Siwalik Group depicted different phase of Himalayan tectonics and these molasse sequence were deposited in a subsiding foreland basin under the conditions of rapid erosion and quick deposition. [ABSTRACT FROM AUTHOR]

Recent progress in encoder–decoder neural network architecture design has led to significant performance improvements in a wide range of medical image segmentation tasks. However, state-of-the-art networks for a given task may be too computationally demanding to run on affordable hardware, and thus users often resort to practical workarounds by modifying various macro-level design aspects. Two common examples are downsampling of the input images and reducing the network depth or size to meet computer memory constraints. In this paper, we investigate the effects of these changes on segmentation performance and show that image complexity can be used as a guideline in choosing what is best for a given dataset. We consider four statistical measures to quantify image complexity and evaluate their suitability on ten different public datasets. For the purpose of our illustrative experiments, we use DeepLabV3+ (deep large-size), M2U-Net (deep lightweight), U-Net (shallow large-size), and U-Net Lite (shallow lightweight). Our results suggest that median frequency is the best complexity measure when deciding on an acceptable input downsampling factor and using a deep versus shallow, large-size versus lightweight network. For high-complexity datasets, a lightweight network running on the original images may yield better segmentation results than a large-size network running on downsampled images, whereas the opposite may be the case for low-complexity images. [ABSTRACT FROM AUTHOR]

Objectives: Fibrinolytic therapy can be effective for management of complex pleural effusions. Tissue plasminogen activator (tPA, 10 mg) and deoxyribonuclease (DNAse) every 12 h with a dwell time of one hour is a common strategy based on published data. We used a simpler protocol of tPA (4 mg) without DNAse but with a longer dwell time of 12 h, repeated daily. We reviewed our results.Methods: Charts were reviewed and demographics, clinical data and treatment information were abstracted. Outcomes were assessed based on radiographic findings and need for surgery.Results: Two hundred and fifteen effusions in 207 patients (8 bilateral) were identified. 85% were either infectious or malignant. Two hundred and forty nine chest tubes were used: 84% were 10 Fr or 12 Fr and 7% were PleurX®. Five hundred and thirty one doses of tPA were given. The median number of doses per effusion was 2 (range 1-10), and 84% of effusions were treated with three or fewer doses. There were no significant bleeding complications. Median time to chest tube removal was 6 days (range 1 to 98, IQR 4 to 10). Drainage was considered complete for 78% of effusions, while 6% required decortication.Conclusions: Low dose tPA daily with a 12 h dwell time may be as effective as the standard regimen of tPA and DNAse twice daily with one hour dwell. For most patients only three doses were required, and small pigtail catheters were sufficient. This regimen uses less medication and is logistically much easier than the current standard. [ABSTRACT FROM AUTHOR]

In recent years, convolutional neural network architectures have become increasingly complex to achieve improved performance on well-known benchmark datasets. In this research, we have introduced G-Net light, a lightweight modified GoogleNet with improved filter count per layer to reduce feature overlaps, hence reducing the complexity. Additionally, by limiting the amount of pooling layers in the proposed architecture, we have exploited the skip connections to minimize the spatial information loss. The suggested architecture is analysed using three publicly available datasets for retinal vessel segmentation, namely DRIVE, CHASE and STARE datasets. The proposed G-Net light achieves an average accuracy of 0.9686, 0.9726, 0.9730 and F 1 - s c o r e of 0.8202, 0.8048, 0.8178 on DRIVE, CHASE, and STARE datasets, respectively. The proposed G-Net light achieves state-of-the-art performance and outperforms other lightweight vessel segmentation architectures with fewer trainable number of parameters. [ABSTRACT FROM AUTHOR]

Herein, zinc oxide nanoparticles (ZnO NPs) were greenly synthesized from Tridax procumbens aqueous leaf extract (TPE) and characterized physically (e.g., Fourier-transform infrared (FTIR) spectroscopy and scanning electron microscopy (SEM)) and biologically (test of their anti-diabetic activity). Anti-diabetic activities of TPE and TPE-derived ZnO NPs have been carried out in a streptozotocin (STZ)—induced diabetic rat model. Diabetes mellitus (DM) was induced with a single intraperitoneal dosage of the glucose analogue STZ (55 mg/Kg) known to be particularly toxic to pancreatic insulin-producing beta-cells. TPE and TPE-derived ZnO NPs were administered orally, once every day for 21 days in diabetic rats, at 100 and 200 mg/Kg, respectively. The standard antidiabetic medication, glibenclamide, was used as a control at a dose of 10 mg/Kg. Various parameters were investigated, including bodyweight (bw) variations, glycemia, lipidaemia, glycated hemoglobin (HbA1c), and histopathological alterations in the rat's liver and pancreas. The TPE-mediated NPs were small, spherical, stable, and uniform. Compared to TPE and, to a lesser extent, glibenclamide, TPE-derived ZnO NPs lowered blood glucose levels considerably (p < 0.05) and in a dose-dependent manner while preventing body weight loss. Further, positive benefits for both the lipid profile and glycated hemoglobin were also noticed with TPE-derived ZnO NPs. The histopathological assessment revealed that synthesized TPE-derived ZnO NPs are safe, non-toxic, and biocompatible. At 200 mg/Kg/day, TPE-derived ZnO NPs had a more substantial hypoglycemic response than at 100 mg/Kg/day. Thus, in this first reported experimental setting, ZnO NPs biosynthesized from the leaf extract of Tridax procumbens exert more potent anti-diabetic activity than TPE and glibenclamide. We conclude that such a greenly prepared nanomaterial may be a promising alternative or complementary (adjuvant) therapy, at least to the current Indian's traditional medicine system. Translational findings are prompted in human populations to determine the efficacy of these NPs. [ABSTRACT FROM AUTHOR]

This study elucidated the reactive role of the supercritical fluid extrusion (SCFX) process along with calcium chelation by added sodium hexametaphosphate (SHMP) in altering the physicochemical properties of milk protein concentrate (MPC) with added sucrose (MPC‐S) to make expanded extrudates of defined microstructure that self‐disintegrate in the mouth. Calcium chelation by SHMP and temporarily induced acidity (pH 4.75) due to the formation of carbonic acid via SC‐CO2 incorporation during SCFX prevented protein–protein interactions involving calcium bridging and disulfide bonding in MPC‐S extrudates. The electrophoretic patterns demonstrated increased solubility of caseins in MPC‐S‐SHMP extrudates when compared to MPC‐S‐control. MPC‐S‐SHMP extrudates absorbed three times more water than MPC‐S‐control extrudates after 30 s of hydration. Textural analysis demonstrated that the compression strength of MPC‐S‐SHMP extrudates reduced by 93% on hydration as compared to 31% for MPC‐S‐control samples. During hydration, increased water absorption by MPC‐S‐SHMP extrudates resulted in weakened extrudate structure and decreased mechanical strength contributing to self‐disintegration in less than 30 s in the mouth which was confirmed by sensory evaluation. Practical Applications: The developed and demonstrated process led to the manufacture of nutritious, milk protein‐based convenient and quick in‐mouth disintegrating puffs that can be used as a valuable replacement for starch‐based first finger foods intended for toddlers. They also provide the opportunity to practice baby led weaning along with being rich in protein and essential amino acids. Additionally, the developed product should be suitable for consumption by elderly as well as for patients with other conditions such as dysphagia. [ABSTRACT FROM AUTHOR]

BAckground and Aims: Respiratory complications are one of the biggest challenges following cardiac surgery, which can lead to hypoxia and acute respiratory failure (ARF). The aim of this study to identify the factors led to BiPAP application for postoperative respiratory complications and its effectiveness as the main outcome measures after cardiac surgery. Methods: It was a retrospective cohort study with consecutive sampling technique. A total of 335 postcardiac surgery patients medical record was reviewed who were underwent for surgery from November 1, 2018 to November 30, 2019. 265 patients were finalized for the recruitment, five patients were excluded before the final analysis. Data of 260 patients were analyzed for compiling of results. Results: The mean age was 59 years. 196 (75.4%) patients were males and females were 64 (24.6%). Mean weight was 72 kg and mean body mass index (BMI) 26.67 kg/m2. BiPAP application was in 38 (14.6%) patients and significantly high in with high BMI, (p < 0.05). There are significant associations of BiPAP application patients with COPD (p < 0.05). Patients with positive fluid balance, cardiac dysfunction, and required inotropic support were significantly associated with BiPAP need (p < 0.05), respectively. Conclusion: BiPAP is effective to treat ARF and other respiratory complications after adult cardiac surgeries. High BMI, atelectasis, and pneumonia are also the independent factors causing ARF. BiPAP can be a successful tool for preventing the adverse effects of postoperative pulmonary complications after cardiac surgery. [ABSTRACT FROM AUTHOR]

Flexible radiofrequency coils for magnetic resonance imaging (MRI) have garnered attention in research and industrial communities because they provide improved accessibility and performance and can accommodate a range of anatomic postures. Most recent flexible coil developments involve customized conductors or substrate materials and/or target applications at 3 T or above. In contrast, we set out to design a flexible coil based on an off-the-shelf conductor that is suitable for operation at 0.55 T (23.55 MHz). Signal-to-noise ratio (SNR) degradation can occur in such an environment because the resistance of the coil conductor can be significant with respect to the sample. We found that resonating a commercially available RG-223 coaxial cable shield with a lumped capacitor while the inner conductor remained electrically floating gave rise to a highly effective "cable coil." A 10-cm diameter cable coil was flexible enough to wrap around the knee, an application that can benefit from flexible coils, and had similar conductor loss and SNR as a standard-of-reference rigid copper coil. A two-channel cable coil array also provided good SNR robustness against geometric variability, outperforming a two-channel coaxial coil array by 26 and 16% when the elements were overlapped by 20–40% or gapped by 30–50%, respectively. A 6-channel cable coil array was constructed for 0.55 T knee imaging. Incidental cartilage and bone pathologies were clearly delineated in T1- and T2-weighted turbo spin echo images acquired in 3–4 min with the proposed coil, suggesting that clinical quality knee imaging is feasible in an acceptable examination timeframe. Correcting for T1, the SNR measured with the cable coil was approximately threefold lower than that measured with a 1.5 T state-of-the-art 18-channel coil, which is expected given the threefold difference in main magnetic field strength. This result suggests that the 0.55 T cable coil conductor loss does not deleteriously impact SNR, which might be anticipated at low field. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES Locally advanced lung cancers present a significant challenge to minimally invasive thoracic surgeons. An increasing number of centres have adopted robotic-assisted thoracoscopic surgeries for these complex operations. In this study, we compare surgical margins achieved, conversion rates to thoracotomy, perioperative mortality and 30-day readmission rates for robotic and video-assisted thoracoscopic surgery (VATS) lobectomy for locally advanced lung cancers. METHODS Using the National Cancer Database, we identified patients with non-small-cell lung cancer who received neoadjuvant chemotherapy/radiotherapy, had clinical N1/N2 disease or in the absence of these 2 features had a tumour >5 cm treated with either robotic or VATS lobectomy between 2010 and 2016. Perioperative outcomes and conversion rates were compared between robotic and VATS lobectomy. RESULTS A total of 9512 patients met our inclusion criteria with 2123 (22.3%) treated with robotic lobectomy and 7389 (77.7%) treated with VATS lobectomy. Comparable R0 resections, 30- and 90-day mortality and 30-day readmission rates were observed for robotic and VATS lobectomy while a higher rate of conversion to thoracotomy was observed for VATS (aOR = 1.99, 95% confidence interval = 1.65, 2.39, P  < 0.001). CONCLUSIONS Our analysis of the National Cancer Database suggests that robotic lobectomy for complex lung resections achieves similar perioperative outcomes and R0 resections as VATS lobectomy with the exception of a lower rate of conversion to thoracotomy. [ABSTRACT FROM AUTHOR]

While hippocampal atrophy and its regional susceptibility to Alzheimer's disease (AD) are well reported at late stages of AD, studies of the asymptomatic stage of AD are limited but could elucidate early stage pathophysiology as well as provide predictive biomarkers. In this study, we performed multi-modal magnetic resonance imaging (MRI) to estimate morphometry, functional connectivity, and tissue microstructure of hippocampal subfields in cognitively normal adults including those with asymptomatic AD. Highresolution resting-state functional, diffusion and structural MRI, cerebral spinal fluid (CSF), and neuropsychological evaluations were performed in healthy young adults (HY: n = 40) and healthy older adults with negative (HOff: n = 47) and positive (HOC: n = 25) CSF biomarkers of AD. Morphometry, functional connectivity, and tissue microstructure were estimated from the structural, functional, and diffusion MRI images, respectively. Our results indicated that normal aging affected morphometry, connectivity, and microstructure in all hippocampal subfields, while the subiculum and CA1-3 demonstrated the greatest sensitivity to asymptomatic AD pathology. Tau, rather than amyloid-b, was closely associated with imaging-derived synaptic and microstructural measures. Microstructural metrics were significantly associated with neuropsychological assessments. These findings suggest that the subiculum and CA1-3 are the most vulnerable in asymptomatic AD and tau level is driving these early changes. [ABSTRACT FROM AUTHOR]