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Weixing Zhang,1 Zhangzhi Li,2 Muhammad Safwan Akram,3 Muhammad Fayyaz Ur Rehman,4 Nazeer Hussain Khan,5,6 Dan Hu,7 Muhammad Mustaqeem,8 Yuanyuan Zeng,1 Fariha Kanwal9 1Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, People’s Republic of China; 2Department of Hematology, Taihe Hospital, Hubei University of Medicine, Hubei, 442000, People’s Republic of China; 3School of Health and Life Sciences, Teesside University, Middlesbrough, TS1 3BX, UK; 4Institute of Chemistry, University of Sargodha, Sargodha, 40100, Pakistan; 5Henan International Key Laboratory of Nuclear Protein, School of Life Sciences, Henan University Kaifeng, Henan, 475004, People’s Republic of China; 6Laboratory of Animal and Human Physiology, Department of Biological Sciences, Quaid I Azam University, Islamabad, 45320, Pakistan; 7Department of Neurology, The Central Hospital of Xiaogan, Hubei, 432100, People’s Republic of China; 8Department of Chemistry, University of Sargodha, Sub Campus Bhakkar, Bhakkar, 30000, Pakistan; 9Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People’s Republic of ChinaCorrespondence: Fariha Kanwal; Yuanyuan Zeng Email fariha@sjtu.edu.cn; yuanyuanzeng@aliyun.comObjective: To evaluate the Li’s and Japanese scoring methods scoring for screening early gastric cancer in a healthy population.Methods: During January 2016–December 2018, profiles of the healthy people participated in a physical examination in the first people’s Hospital of Shanghai were collected. A total of 342 volunteers, including 137 males and 205 females ageing 40– 74, were enrolled. After recording the basic information, all volunteers were scored using the Japan scoring method and the new gastric cancer screening score (ie, Li’s score). The subjects’ work characteristics (ROC curve) were drawn according to the patient’s endoscopic pathological examination to indicate early gastric cancer, to determine the best cut-off point for the diagnosis of early gastric cancer by Japanese scoring and Li’s scoring, respectively. The sensitivity and specificity of both scoring methods were calculated as well.Results: The area under the ROC curve of Japanese and Li’s score, in the diagnosis of early gastric cancer, was 0.763 and 0.837, respectively. Japanese and Li’s score ≥ 14 were considered as the best cut-off point. The sensitivity and specificity of Li’s scoring were 63.60% and 91.10%, respectively. The sensitivity and specificity of the Japanese score were 54.50% and 87.50%, respectively. The area under the ROC curve in Li’s scoring is more significant than that in Japanese scoring, and there was a substantial difference in the two methods (P< 0.05).Conclusion: Both Li’s scoring and Japanese scoring have shown good screening value for early gastric cancer in a healthy population, but Li’s scoring is more sensitive/specific than Japanese scoring.Keywords: Li’s scoring, Japanese scoring, early gastric cancer

Background and aimsThere are guidelines for the medical management of cirrhosis and associated quality indicators (QIs), but QIs focusing on standards for palliative aspects of care are needed.MethodsWe convened a 9-member, multidisciplinary expert panel and used RAND/UCLA modified Delphi methods to develop palliative care quality indicators for patients with cirrhosis. Experts were provided with a report based on a systematic review of the literature that contained evidence concerning the proposed candidate QIs. Panelists rated QIs prior to a planned meeting using a standard 9-point RAND appropriateness scale. These ratings guided discussion during a day-long phone conference meeting, and final ratings were then provided by panel members. Final QI scores were computed and QIs with a final median score of greater than or equal to 7, and no disagreement was included in the final set.ResultsAmong 28 candidate QIs, the panel rated 19 as valid measures of quality care. These 19 quality indicators cover care related to information and care planning (13) and supportive care (6).ConclusionsThese QIs are evidence-based process measures of care that may be useful to improve the quality of palliative care. Research is needed to better understand the quality of palliative care provided to patients with cirrhosis.

In situ monitoring of bone regeneration enables timely diagnosis and intervention by acquiring vital biological parameters. However, an existing gap exists in the availability of effective methodologies for continuous and dynamic monitoring of the bone tissue regeneration process, encompassing the concurrent visualization of bone formation and implant degradation. Here, we present an integrated scaffold designed to facilitate real-time monitoring of both bone formation and implant degradation during the repair of bone defects. Laponite (Lap), CyP-loaded mesoporous silica (CyP@MSNs) and ultrasmall superparamagnetic iron oxide nanoparticles (USPIO@SiO2) were incorporated into a bioink containing bone marrow mesenchymal stem cells (BMSCs) to fabricate functional scaffolds denoted as C@M/GLU using 3D bioprinting technology. In both in vivo and in vitro experiments, the composite scaffold has demonstrated a significant enhancement of bone regeneration through the controlled release of silicon (Si) and magnesium (Mg) ions. Employing near-infrared fluorescence (NIR-FL) imaging, the composite scaffold facilitates the monitoring of alkaline phosphate (ALP) expression, providing an accurate reflection of the scaffold's initial osteogenic activity. Meanwhile, the degradation of scaffolds was monitored by tracking the changes in the magnetic resonance (MR) signals at various time points. These findings indicate that the designed scaffold holds potential as an in situ bone implant for combined visualization of osteogenesis and implant degradation throughout the bone repair process.

Objective: The current study aimed to observe hypertension educational intervention's effect on general physicians (GPs) to improve blood pressure control and patient outcomes indirectly. Methods: This randomized control trial includes 42 GPs divided into 2 groups. GPs in group 1 receive face-to-face education with structured educational material on hypertension management strategies by a senior cardiologist. GPs in group 2 receive the print version of education material. The data was collected from six major cities in Pakistan. GPs with at least three years of experience in the broad primary care disciplines, with ages above 18 years, were included in the study. Results: A total of 42 physicians (21 from each group) completed questionnaires, while out of 420 hypertension patients, 105 newly diagnosed and already diagnosed patients enrolled under physicians of both groups. The educational material did just as well at informing clinicians as the face-to-face group intervention did and both the interventions had a significant effect on knowledge and BP control. Conclusion: After the 3-month follow-up, both interventions, including face-to-face and educational approaches, demonstrated significant effectiveness in improving knowledge and blood pressure control. Innovation: The study shows that hypertension educational intervention's effect on general physicians indirectly improves blood pressure control and patient outcomes. And emphasize for developing a hypertension educational program targeted at general physicians.

Skin cancer is a pervasive and potentially life-threatening disease. Early detection plays a crucial role in improving patient outcomes. Machine learning (ML) techniques, particularly when combined with pre-trained deep learning models, have shown promise in enhancing the accuracy of skin cancer detection. In this paper, we enhanced the VGG19 pre-trained model with max pooling and dense layer for the prediction of skin cancer. Moreover, we also explored the pre-trained models such as Visual Geometry Group 19 (VGG19), Residual Network 152 version 2 (ResNet152v2), Inception-Residual Network version 2 (InceptionResNetV2), Dense Convolutional Network 201 (DenseNet201), Residual Network 50 (ResNet50), Inception version 3 (InceptionV3), For training, skin lesions dataset is used with malignant and benign cases. The models extract features and divide skin lesions into two categories: malignant and benign. The features are then fed into machine learning methods, including Linear Support Vector Machine (SVM), k-Nearest Neighbors (KNN), Decision Tree (DT), Logistic Regression (LR) and Support Vector Machine (SVM), our results demonstrate that combining E-VGG19 model with traditional classifiers significantly improves the overall classification accuracy for skin cancer detection and classification. Moreover, we have also compared the performance of baseline classifiers and pre-trained models with metrics (recall, F1 score, precision, sensitivity, and accuracy). The experiment results provide valuable insights into the effectiveness of various models and classifiers for accurate and efficient skin cancer detection. This research contributes to the ongoing efforts to create automated technologies for detecting skin cancer that can help healthcare professionals and individuals identify potential skin cancer cases at an early stage, ultimately leading to more timely and effective treatments.

The development of advanced Intelligent Transportation Systems has been made possible by the rapid expansion of autonomous vehicles (AVs) and networking technology (ITS). The in-vehicle users' increased data needs from AVs put the vehicle's trajectory data in danger and make it more susceptible to security threats. In this paper, Autonomous vehicles (AVs) transform the intelligent transportation system by exchanging real-time and seamless data with other AVs and the network (ITS). Transportation that is automated has many advantages for people. However, worries about safety, security, and privacy continue to grow. The AVs need to exchange sensory data with other AVs and with their own for navigation and trajectory planning. When an unreliable sensor-equipped AV or one that is malicious enters connectivity in such circumstances, the results could be disruptive. To effectively detect anomalies and mitigate cyberattacks in AVs, this study suggests the Efficient Anomaly Detection (EAD) method. The EAD technique finds and isolates rogue AVs using the Multi-Agent Reinforcement Learning (MARL) algorithm, which operates over the 6G network to thwart modern cyberattacks and provide a quick and accurate anomaly detection mechanism. The expected outcomes demonstrate the value of EAD and have an accuracy rate that is 8.01% greater than that of the current systems.

Abstract Multicenter studies in pediatric cardiovascular magnetic resonance (CMR) improve statistical power and generalizability. However, a structured process for identifying important research topics has not been developed. We aimed to (1) develop a list of high priority knowledge gaps, and (2) pilot the use of a wiki survey to collect a large group of responses. Knowledge gaps were defined as areas that have been either unexplored or under-explored in the research literature. High priority goals were: (1) feasible and answerable from a multicenter research study, and (2) had potential for high impact on the field of pediatric CMR. Seed ideas were contributed by a working group and imported into a pairwise wiki survey format which allows for new ideas to be uploaded and voted upon ( https://allourideas.org ). Knowledge gaps were classified into 2 categories: ‘Clinical CMR Practice’ (16 ideas) and ‘Disease Specific Research’ (22 ideas). Over a 2-month period, 3,658 votes were cast by 96 users, and 2 new ideas were introduced. The 3 highest scoring sub-topics were myocardial disorders (9 ideas), translating new technology & techniques into clinical practice (7 ideas), and normal reference values (5 ideas). The highest priority gaps reflected strengths of CMR (e.g., myocardial tissue characterization; implementation of technologic advances into clinical practice), and deficiencies in pediatrics (e.g., data on normal reference values). The wiki survey format was effective and easy to implement, and could be used for future surveys.

Objective: To determine the frequency of infections in cardiac implantable Electronic device patients, identify risk factors, and look for optimization in reducing Cardiac Implantable Electronic Device infections, with a resultant decrease in mortality and morbidity, decrease in hospital stay, and total expenditure. Study Design: Cross-sectional study. Place and Duration of Study: Electrophysiology Department of National Institute of Cardiovascular Diseases, Karachi Pakistan, from Jul 2019 to Jun 2020. Methodology: The study was conducted on the patients with cardiac implantable devices. Adult patients of either gender with cardiac implantable Electronic device and infection were included. Epicardial leads and surgical site infections within six weeks were excluded. Results: One thousand and forty-six (1046) patients were enrolled in the study. There were 596(57%) male patients. 385(36.8%) patients were implanted with single chamber pacemakers, 390(37.3%) with dual chamber pacemakers, 146(14%) single chamber ICD (implantable cardiac defibrillator), 67(6.4%) dual-chamber cardiac implantable Electronic device, 46(4.4%) CRT-D, 12(1.1%) TPM, 134(12.8%) Re-do, 114(10.9%), 114(10.9%) generator change, 20(1.9%) leads revision, 26(2.5%) patients had extraction. The rate of CIED infection was 34(2.1%). The association of the study parameters with infection rate revealed that type of device (p=0.002), extraction, suture type, and post-procedure hematoma (p

Computer viruses, malicious, and other hostile attacks can affect a computer network. Intrusion detection is a key component of network security as an active defence technology. Traditional intrusion detection systems struggle with issues like poor accuracy, ineffective detection, a high percentage of false positives, and an inability to handle new types of intrusions. To address these issues, we propose a deep learning-based novel method to detect cybersecurity vulnerabilities and breaches in cyber-physical systems. The proposed framework contrasts the unsupervised and deep learning-based discriminative approaches. This paper presents a generative adversarial network to detect cyber threats in IoT-driven IICs networks. The results demonstrate a performance increase of approximately 95% to 97% in terms of accuracy, reliability, and efficiency in detecting all types of attacks with a dropout value of 0.2 and an epoch value of 25. The output of well-known state-of-the-art DL classifiers achieved the highest true rate (TNR) and highest detection rate (HDR) when detecting the following attacks: (BruteForceXXS, BruteForceWEB, DoS_Hulk_Attack, and DOS_LOIC_HTTP_Attack) on the NSL-KDD, KDDCup99, and UNSW-NB15 datasets. It also maintained the confidentiality and integrity of users’ and systems’ sensitive information during the training and testing phases.

Objectives: Tricuspid valve (TV) surgery remains understudied and little data exist describing the surgical indications, outcomes, and prognostic factors for pediatric patients with non-Ebstein 2-ventricle congenital TV lesions. This study aims to describe early and late outcomes of pediatric patients with non-Ebstein congenital TV lesions undergoing isolated TV procedures at a single institution. Methods: All patients who underwent TV surgery for non-Ebstein congenital TV disease between 2006 and 2018 were included. Patients who had missing preoperative data, patients with single-ventricle physiology, congenitally corrected transposition of the great arteries, and patients undergoing TV intervention as part of repair of an atrioventricular canal defect were excluded. The primary end point was the occurrence of TV reintervention or TV regurgitation (TR) ≥ moderate. Results: A total of 85 patients were included. The tricuspid lesion was isolated TR in 80 (94.1%), isolated tricuspid stenosis in 3 (3.5%) and mixed disease in 2 (2.4%) patients. Median age at surgery was 33 years (interquartile range, 12-53 years). TV repair and TV replacement were performed in 66 (77.6%) and 19 (22.4%) patients, respectively. One (1.2%) patient underwent TV reoperation during the same admission. There was no in-hospital mortality. Median follow-up was 3.3 years (interquartile range, 0.1-4.7 years). The overall cumulative incidence of TV reintervention or TR deemed moderate or greater at 1, 3, and 5 years was 3% ± 2%, 11% ± 4%, and 20% ± 8%. In multivariable analysis, age younger than 12 years (P = .04) and mitral valve regurgitation deemed moderate or greater (P = .01) were independent risk factors for TV reintervention or recurrent TR deemed to be moderate or greater at last follow-up. Conclusions: TV surgery in patients with non-Ebstein congenital TV disease can be performed with good outcomes. TV reintervention or TR deemed moderate or greater occurred in 20% of patients on midterm follow-up. Patients younger than age 12 years are at higher risk for recurrent TR or TV reintervention, whereas preoperative MR deemed moderate or greater increases this risk, especially in patients older than age 12 years. There was no difference in outcomes between TV replacement and repair.

Co/SnO2, Ni/SnO2, and Ni-Co/SnO2 nanocatalysts have been synthesized by microwave mediated co-precipitation method, and characterized by FT-IR, XRD, EDX, SEM. Their catalytic properties were studied in the reduction of 4-nitrophenol with NaBH4. FT-IR spectra contain peaks in the region of 480–650 cm-1 due to the stretching vibrations of the metal–oxygen bond (Ni–O, Sn–O, and Co–O). The XRD analysis showed the characteristic peaks of SnO2 (tetragonal rutile structural type), become broader after doping with Ni and Co and suggested the formation of Ni–Co/SnO2 nanocatalyst having particle size in range of 4–6 nm. It is clear from EDX analysis that weight concentrations of Co, Ni, and Sn were close to nominal concentrations in the doped sample of Ni–Co/SnO2. The SEM images showed that particle size of nanocatalysts lay in nanoscale. Catalytic evaluation of prepared catalysts in the reduction of 4-nitrophenol was investigated by UV–Vis spectrophotometery. Ni–Co/SnO2 is an effective nanocatalyst for 4‑nitrophenol reduction to 4-aminophenol, with 90.5% conversion. The calculated rate constant (k) value of this catalyzed reaction is 1 × 10–2 s–1, following pseudo-first-order kinetic model. [ABSTRACT FROM AUTHOR]

Background: To date, no optimal way of organizing and delivering care to hypertensive patients at the primary carer level has been identified, due to which a significant number of patients fail to meet the treatment goals. The current study aims to observe hypertension educational intervention's effect on general physicians (GPs) to indirectly improve blood pressure control and patient outcomes. Methodology: In this randomized control trial, GPs will be divided into 2 groups and both groups will be asked to fill hypertension awareness questionnaire at baseline and, after randomization. GPs of the group I will receive (1 day) face-to-face education with structured educational material on hypertension management strategies. GPs of group II will receive the print version of educational material (structured educational material) on strategies of structured hypertension management. Both groups of GPs will recruit 10 (5 newly diagnosed + 5 already diagnosed patients) from the study site. The patient will be asked to fill hypertension awareness questionnaire at baseline and share a 12-hour blood pressure measurement. GPs and patients will be reassessed after 3 months of intervention. Discussion: The purpose of designing this study is to observe the effect of hypertension educational intervention for general physicians to improve blood pressure control and patient outcomes indirectly. Results of this study may provide a basis for developing a hypertension educational program targeted at general physicians. Trial registration: The trial was registered with ClinicalTrials.gov NCT05038774.

Summary: Background: The introduction of oral direct‐acting antivirals (DAAs) has dramatically changed the landscape of HCV treatment. However, a small percentage of patients fail to achieve sustained virologic response (SVR). Understanding the number of people who fail on DAAs and require re‐treatment is important for budget impact and disease burden projections. Aim: To quantify the number of HCV patients who fail to achieve SVR on oral DAAs (NS5A vs. non‐NS5A) and require re‐treatment. Methods: We used a mathematical model to simulate clinical management of HCV in the USA, which included the implementation of HCV screening, treatment, and disease progression. We simulated different waves of DAA treatment and used real‐world data to extract SVR rates and market shares of available therapies. Results: Our model projected that the number of people living without viraemia (i.e. cured) would increase from 0.70 million in 2014 to 1.78 million by 2020. Between 2014 and 2020, 1.50 million people would receive treatment with DAAs, of whom 124 000 (8.3%) are projected to fail to achieve SVR. Among those treatment failures, 66 600 (53.7%) patients would fail treatment with NS5A inhibitors and 69 600 (56.1%) would have cirrhosis. During the same period, 34 200 people would progress to decompensated cirrhosis and 27 300 would develop hepatocellular carcinoma after failing to achieve SVR. Conclusions: Even in the era of highly effective DAAs, a significant number of patients will fail to achieve SVR and will require re‐treatment options. Timely and effective re‐treatment is essential to prevent the long‐term sequelae of HCV. [ABSTRACT FROM AUTHOR]

Background: One of the most frequently observed valvular heart lesions is Mitral stenosis (MS), characterized by left ventricular inflow tract obstruction at the mitral valve level caused by different etiologies. Early detection of symptomatic mitral stenosis with a thrombus in LAA, not responding to anticoagulation in due course of time are sent for Mitral valve replacement rather than undergoing PTMC. The current study aims to see the anticoagulation response in different types of left atrial appendages so that non-responders can be referred for surgery on the first TEE and Cardiac CT. Methodology: The current study will observe the frequency of left atrial appendage (LAA) thrombus resolution after three months of anticoagulation in patients with severe MS. It will assess the response rate in different morphologies of LAA so that non-responders can be referred for surgery on the very first TEE and Cardiac CT. Consecutive MS patients with thrombus in LAA detected via transesophageal echocardiography will be included in the study. According to the standard procedure, TEE followed by Cardiac CT will be performed after obtaining informed consent from the patients. Discussion: Detecting the anticoagulation response using follow-up TEE in different types of left atrial appendages might be helpful for the non-responders that can be referred for surgery after TEE and Cardiac CT on first examination and TEE only at the end of three months. Trial registration number: The trial was registered on ClinicalTrials.gov (NCT05186649).

Higher education institutes have integratede-learning systems (ELS)in their educational infrastructure. The development and implementation of ELS needs continuous quality evaluation and assessment to attract more learners.A conceptual model consisting of system, service and information qualities was evaluated to measure the user satisfaction. Data was collected from 356 learners including Post Graduate (52%) and Graduate (48%)students of Virtual University, Pakistan. To investigate the research hypotheses, Structural Equation Modelling (SEM) was employed. The empirical analysis indicated that information quality (0.38, p<0.05), service quality (0.14, p<0.05)and system quality(0.48, p<0.01) were the positive and significant indicators for user satisfaction. The variance explained by the model is 71% that showed the significance of model. [ABSTRACT FROM AUTHOR]

The chronic hepatitis C ( CHC) cohort in the United States is getting older. Elderly patients with CHC may be at a high risk of cirrhosis and hepatocellular carcinoma ( HCC), but also other nonhepatic comorbidities that negatively impact their likelihood of receiving or responding to antiviral treatment. There is little information on the clinical epidemiology or outcomes of CHC and its treatment in the elderly. We conducted a retrospective cohort study of 1 61 744 patients with a positive Hepatitis C virus RNA in the Veterans Health Administration Hepatitis C Clinical Case Registry to examine the association between age subgroups (20-49, 50-64, 65-85 years) and risk of cirrhosis, HCC or death using Cox proportional hazards models. We also examined the effect of treatment with a sustained viral response ( SVR) on these outcomes in each age subgroup. The age distribution was 36.8% 20- to 49-year-olds, 57.6% 50- to 64-year-olds and 5.6% 65- to 85-year-olds (i.e. elderly). Risk of cirrhosis, HCC and death was significantly elevated in elderly patients [ HR cirrhosis = 1.14 (1.00-1.29), HR HCC = 2.44 (1.99-2.99); HR death 2.09 (1.98-2.22)] compared with younger patients. The incidence of HCC was than 8.4 per 1000 PY in the elderly compared with 2.6 per 1000 PY and 5.7 per 1000 PY, among the 20-49 and 50-64 age groups, respectively. Elderly patients were significantly less likely to receive antiviral treatment (3.8% vs 14.8% and 19.1%, P < 0.0001), but among those who received treatment SVR was not different among the age groups (33.5% vs 33.2% and 32.1%). In an analysis limited to those who received treatment, SVR compared to treatment receipt with no SVR was associated with a reduction in risk of developing cirrhosis ( HR = 0.34; 0.18-0.66) and HCC ( HR = 0.60; 0.22-1.61) and all-cause mortality risk ( HR = 0.52, 0.33-0.82). Elderly patients with CHC are more likely to develop HCC than younger patients but have traditionally received less antiviral treatment than younger patients. However, receipt of curative treatment is associated with a benefit in reducing cirrhosis, HCC and overall mortality, irrespective of age. [ABSTRACT FROM AUTHOR]

Background: Longstanding severe rheumatic mitral stenosis (MS) is associated with changes in the atrial chamber dimensions. It is not known whether there is an increased thickness of the inter-atrial septum (IAS) in patients with severe rheumatic mitral stenosis. The objective of this study was to evaluate pre-procedural IAS thickness by echocardiography in patients with moderate to severe rheumatic mitral stenosis undergoing percutaneous balloon mitral valvuloplasty (PBMV). Methods: The thickness of the IAS was measured by transesophageal echocardiography (TEE) in 86 patients between 14 and 65 years of age. Patients with moderate to severe rheumatic mitral stenosis undergoing percutaneous mitral balloon valvuloplasty (PMBV) at the National Institute of Cardiovascular Diseases (NICVD), Karachi were recruited for this study. IAS thickness was measured by TEE using standard views and 3 different phases of cardiac cycles were evaluated. Results: Out of 86 patients, almost three fourths (73.3%) were between 14 and 29 years of age and two thirds (62.8%) were females. Mean IAS thickness was 2.56 (SD 0.92) mm at anterior region (AR), 1.89 (SD 0.75) mm at fossa ovalis (FO), and 2.95 (SD 0.97) mm at posterior region (PR). None of the demographic and clinical groups showed any statistically significant difference in IAS thickness. Conclusions: Inter-atrial septum (IAS) thickness measurement does not change in the presence of moderate to severe rheumatic mitral stenosis as compared to the reported normal values of IAS thickness in cadaveric hearts. Keywords: Inter-atrial septum thickness, Percutaneous mitral balloon valvuloplasty, Transesophageal echocardiography

Conducting composites of polyaniline have successfully synthesised with different weight percentages of aluminium oxide (0-40%) dispersed during polymerisation of polyaniline. These composites were characterised by X-ray diffraction analysis, UV-visible absorption spectroscopy, scanning electron microscopy and standard two probe method to study the influence of doping on their structure, effect of band gap energy and surface morphology on conductivity of polyaniline. It was perceived that dispersion of aluminium oxide in polyaniline matrix has introduced good structural and conducting properties. The percolation threshold for conductivity was observed at 10 wt-% of metal oxide content in polyaniline matrix owing to semicrystalline behaviour, small band gap energy, homogeneous dispersion and reduction in grain boundary volume as inferred from X-ray diffraction, ultraviolet and scanning electron microscopy studies. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the angiographic profile and outcome of primary percutaneous coronary intervention in female patients with acute myocardial infarction. Method: The cross-sectional study was conducted at the National Institute of Cardiovascular Diseases, Karachi, from July 1, 2017, to March 31, 2018, and comprised female patients presenting with acute myocardial infarction who underwent primary percutaneous coronary intervention and got enrolled in the National Cardiovascular Data Registry. Follow-up calls were made 1 year post-intervention and outcomes were noted. Data was analysed using SPSS 21. Results: Of the 522 female patients with a mean age of 57.41±11.14 years, 334(64%) were hypertensive, 202(38.7%) diabetic, 16(3.1%) had a family history of coronary artery disease, and 9(1.7%) were smokers. Single-vessel disease was observed in 183(35.1%) patients, and three-vessel disease in 144(27.6%). Post-procedure thrombolysis in myocardial infarction flow (0-II) was observed in 29(5.6%) patients, bleeding in 2(0.4%), and in-hospital mortality was in 22(4.2%). Telephonic follow-up was successfully conducted in 436(87.5%) of the discharged patients, and, of them 15(3.4%) had expired and recurrence was reported by 10(2.3%) patients and 8(80%) of them underwent re-intervention. Conclusion: More than half the female patients had multi-vessel disease and bifurcation lesion was observed in more than three-fourth of the sample. Key Words: Coronary artery disease, Women, Percutaneous coronary intervention, Acute myocardial infarction, Angiography, Pakistan. Continuous...

The study aims to investigate the interference of mother tongue in the English pronunciation of Pothohari speakers. The distinctive features of English pronunciation of Pakistani Pothohari speakers are analyzed keeping focus on selected vowels, diphthongs and /r/ sound. A set of nine phonemes: diphthongs ɪə,ɑɪ,eɪ, əʊ, ɔɪ, vowels ɒ, ɜː, æ and /r/ phoneme are focused. The study has foregrounded, in distinctive features, theory for theoretical considerations. Twenty native Pothohari speakers participated in the study. A list of eighteen sentences with the target sounds is used for data collection purpose. The utterances of sample participants are recorded and analyzed to realizd the objectives of the study. Both quantitative and qualitative approaches are utilized to analyze the recorded data. Received Pronunciation (RP) is used as a reference tool to determine the differences. The findings identified certain distinctive features in English pronunciation of the Pothohari speakers marked by the influence of the mother tongue.

Background: Surveillance for hepatocellular carcinoma (HCC) is recommended for patients with hepatitis C virus (HCV) infection and cirrhosis. However, whether surveillance is being done as recommended is unknown. Objective: To examine the prevalence and determinants of HCC surveillance among HCV-infected patients with cirrhosis in Veterans Affairs (VA) health care facilities in the United States. Design: Retrospective cohort study of HCV-infected patients using data obtained from the national VA Hepatitis C Clinical Case Registry. Setting: 128 VA medical centers. Patients: HCV-infected patients with cirrhosis diagnosed between fiscal years 1998 and 2005. Measurements: Abdominal ultrasonography and measurement of [alpha]-fetoprotein for HCC surveillance were identified from administrative data by using a previously validated algorithm. Patients were categorized as having routine (tests done during at least 2 consecutive years in the 4 years after cirrhosis diagnosis), inconsistent (at least 1 test, but not routine), or no surveillance in the 4 years after cirrhosis diagnosis. Predictors of surveillance were identified by using hierarchical random-effects regression. Results: 126 670 patients with HCV were identified; 13 002 (10.1%) had cirrhosis. Approximately 42.0% of patients with cirrhosis received 1 or more HCC surveillance tests within the first year after the cirrhosis index date; however, a decline in receipt of surveillance was observed in the following 2 to 4 years. Among patients with cirrhosis and at least 2 years of follow-up, routine surveillance occurred in 12.0%, inconsistent surveillance in 58.5%, and no surveillance in 29.5%. Lower medical and psychological comorbid conditions, presence of varices, and the absence of decompensated liver disease were associated with a higher likelihood of receiving routine surveillance. Limitations: Hepatocellular carcinoma surveillance tests were indirectly identified from registry data. Physician recommendations could not be captured. Conclusion: Few HCV-infected veterans with cirrhosis received routine HCC surveillance. New strategies are needed to improve the implementation of HCC surveillance in clinical practice. Primary Funding Source: Houston Veterans Affairs Health Services Research and Development Center of Excellence and the National Cancer Institute. [ABSTRACT FROM AUTHOR]

BACKGROUND: Medicare has proposed quality-of-care indicators for chronic hepatitis C virus (HCV) infection. The extent to which these standards are met in practice is largely unknown. OBJECTIVE: To evaluate the quality of health care that patients with HCV receive and the factors associated with receipt of quality care. DESIGN: Retrospective cohort study. SETTING: Nationwide U.S. health insurance company research database. PARTICIPANTS: 10 385 patients with HCV enrolled in the database between 2003 and 2006. Patients were included if they were eligible for at least 1 quality indicator. MEASUREMENTS: Quality of HCV care received by patients, as measured by 7 explicit quality indicators included in Medicare's 2009 Physician Quality Reporting Initiative. RESULTS: Proportions of patients meeting quality indicators varied, ranging from 21.5% for vaccination to 79% for the HCV genotype testing indicator. Overall, 18.5% of patients (95% CI, 18% to 19%) received all recommended care. Older age and presence of comorbid conditions were associated with lower quality, whereas elevated liver enzyme levels, cirrhosis, and HIV infection were associated with higher quality. Patients who saw both generalists and specialists received the best care (odds ratio of receiving care for which a patient is eligible: specialists alone, 0.79 [CI, 0.66 to 0.95]; primary care physician alone, 0.44 [CI, 0.40 to 0.48]). LIMITATIONS: The study had an observational retrospective design, used a convenience sample, and had no information on patient ethnicity. It may be that the indicators or the reporting of the indicators of HCV care--and not the care itself--is suboptimum. CONCLUSION: Health care quality, based on Medicare criteria, is suboptimum for HCV. Care that included both specialists and generalists is associated with the best quality. Our results support the development of specialist and primary care collaboration to improve the quality of HCV care. PRIMARY FUNDING SOURCE: Saint Louis University Liver Center. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of spontaneous hemorrhage and its effect on mortality rate among electric burn injury patients. Materials and Methods: It is a retrospective review of the consecutive patients with electric injuries who were managed at Burn Centre, Karachi over a 4 year period spanning from January 2008- December 2011. Data were extracted regarding age of patient; site involved in electric burn, artery involved in spontaneous hemorrhage, surgical intervention, recurrence of hemorrhage and associated mortality. Results: Electric burn constituted 1.42% of admissions in our burn Centre (n=208). Frequency of spontaneous hemorrhage was found in 25% (n=52) of cases. Frequent site of injury involved in spontaneous hemorrhage was upper limbs (44.25%), followed by lower limbs and anterior trunk. Most common vessel involved in spontaneous hemorrhage was axillary artery (19.23%, n=10) followed by radial artery (11.53%, n=6) and popliteal artery (11.53%, n=6). Surgical procedures carried out were primary ligation and amputation. Bleeding recurred in 23.07% of cases. Total mortality in electric burns cases was 13.46 % (n=28/208), however out of these 28 cases, mortality rate due to spontaneous hemorrhage was 32.14% (n=9/28). Conclusion: Prompt and timely institution of appropriate surgical interventions among electric burn injury patients has the potential to reduce the frequency of life-threatening episodes of spontaneous hemorrhage and improve the outcome in terms of morbidity and survival.

Saccharomyces cerevisiae does not contain a p53 homolog. Utilizing this yeast as an in vivo test tube model, our aim was to investigate if a yeast protein would show p53 DNA binding homology. Electrophoretic mobility shift analyses revealed the formation of specific DNA-protein complexes consisting of S. cerevisiae nuclear protein(s) and oligonucleotides containing p53 DNA binding sites. A S. cerevisiae p53 binding site factor (Scp53BSF) bound to a p53 synthetic DNA-consensus sequence (SCS) and a p53 binding-site sequence from the MDM2 oncogene. The complexes were of comparable size. Like mammalian p53, the affinity of Scp53BSF for the SCS oligonucleotide was higher than for the MDM2 oligonucleotide. Binding of Scp53BSF to the SCS and MDM2 oligonucleotides was strongly competed by unlabeled oligonucleotides containing mammalian p53 sites, but very little by a mutated site oligonucleotide. Importantly, Scp53BSF-DNA binding activity was significantly induced in extracts from cells with DNA damage. This resulted in dose-dependent coordinated activation of transcription when using p53-binding site reporter constructs. An ancient p53-like DNA binding protein may have been found, and activation of DNA-associated factors to p53 response elements may have functions not yet determined.

Background: To compare the immediate induction (within 06 hours) versus late induction (after 24 hours) in terms of mean pre-labour rupture of membranes (PROM) to delivery interval in females presenting with term PROM. Methods ; In this randomized controlled trial, 100 patients were enrolled per inclusion and exclusion criteria and randomly assigned to two groups. For Group A, induction of labor was immediately started with prostaglandin E2 vaginal tablet, whereas for Group B it was done 24 hours later. The PROM to delivery time for both groups was noted down, whether delivered vaginally or by caesarean section. The SPSS Version 17 was used to analyse the collected data. Quantitative variables like age, gestational age, parity and PROM to delivery interval were assessed by calculating mean and SD. Comparison of PROM to delivery interval between the two groups was done by using independent t test. p- Value

Objective: To evaluate the usefulness of the Alvarado scoring system in reducing the percentage of negative appendectomy in our unit. Materials and methods: A cross-sectional study was conducted, comprising 110 patients, admitted to Surgical Unit I, Civil Hospital, Karachi, in 2011 with a preliminary diagnosis of acute appendicitis. Patients of both sexes and all age groups except younger than 10 years were included in the study and their Alvarado scores calculated, on the basis of which patients were divided into two groups: Group A (Alvarado score

Background and Aims: There are guidelines for the medical management of cirrhosis and associated quality indicators (QIs), but QIs focusing on standards for palliative aspects of care are needed.Methods: We convened a 9-member, multidisciplinary expert panel and used RAND/UCLA modified Delphi methods to develop palliative care quality indicators for patients with cirrhosis. Experts were provided with a report based on a systematic review of the literature that contained evidence concerning the proposed candidate QIs. Panelists rated QIs prior to a planned meeting using a standard 9-point RAND appropriateness scale. These ratings guided discussion during a day-long phone conference meeting, and final ratings were then provided by panel members. Final QI scores were computed and QIs with a final median score of greater than or equal to 7, and no disagreement was included in the final set.Results: Among 28 candidate QIs, the panel rated 19 as valid measures of quality care. These 19 quality indicators cover care related to information and care planning (13) and supportive care (6).Conclusions: These QIs are evidence-based process measures of care that may be useful to improve the quality of palliative care. Research is needed to better understand the quality of palliative care provided to patients with cirrhosis. [ABSTRACT FROM AUTHOR]

The article discusses antiviral regimens for chronic hepatitis B virus infection. Hepatitis B is an inflammation of the liver that is caused by a virus. The virus spreads through contact with infected body fluids. Most people who get hepatitis B recover within a few months, but some develop chronic infection. Chronic infection increases the risk for liver failure and liver cancer. Persons with chronic infection often have virus-related protein substances in their blood for many years. Doctors often treat patients with chronic hepatitis B virus infections with powerful antiviral drugs.