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To examine the effects of a cognitive-motor rehabilitation program consisting of treadmill training (TT) augmented by virtual reality (TT+VR) on frailty in people with multiple sclerosis (pwMS). Secondary analysis from a multicenter randomized controlled trial investigating the effects of TT+VR, compared with TT only, on measures of mobility and cognitive function in pwMS. Four university research laboratories in 3 countries. A total of 124 pwMS were randomized into the parent trial. Here, we studied a subset of n = 83 participants (mean age, 49.4±9.3y; 73.5% female; expanded disability status scale range, 2.0-6.0), who completed the intervention and had complete preintervention and postintervention frailty data. Participants were randomly allocated to TT+VR (n=44) or TT (n=39). Both groups trained 3 times a week for 6 weeks. Frailty was assessed using a 40-item frailty index (FI) through standard validated procedures and represented the primary study outcome. Two exploratory frailty indices were also computed by isolating health-related deficits involving the cognitive (FI-physical) or physical (FI-cognitive) domains from the main FI. The assessments were performed at baseline and after 6 weeks, upon intervention completion. The mean FI of study participants at baseline was 0.33±0.13, indicating a moderate average level of frailty. FI scores improved in both TT+VR and TT groups participants (pooled mean ΔFI, 0.024; 95% CI, 0.010-0.038; F=10.49; P=.002; η p 2=0.115), without any group-by-time interaction (F=0.82; P=.367; η p 2=0.010). However, a significant group-by-time interaction was found for pretraining and posttraining changes in FI-cognitive (F=5.74; P=.019; η p 2=0.066), suggesting a greater improvement for TT+VR group participants than for TT group participants. TT with or without virtual reality can reduce frailty levels in pwMS. While both TT and TT+VR had a positive effect on overall frailty, only TT+VR improved cognitive aspects of frailty and may represent an appropriate strategy for counteracting frailty in pwMS. [ABSTRACT FROM AUTHOR]

[Display omitted] • Non-thermal atmospheric pressure plasma (NTP) has anti-melanoma effects. • miRNA sequencing identifies NTP-induced, differentially regulated miRNAs. • NTP exposure upregulated several miRNAs, especially miR-200b-3p and miR-215-5p. • miR-200b-3p and miR-215-5p upregulation decreased cell viability and migration. • NTP dysregulated PI3K-AKT-ZEB1 axis-related miRNAs in melanoma cells in vitro. Melanoma is a rare but highly malignant form of skin cancer. Although recent targeted and immune-based therapies have improved survival rates by 10–15%, effective melanoma treatment remains challenging. Therefore, novel, combinatorial therapy options such as non-thermal atmospheric pressure plasma (NTP) are being investigated to inhibit and prevent chemoresistance. Although several studies have reported the apoptotic and inhibitory effects of reactive oxygen species produced by NTP in the context of melanoma, the intricate molecular network that determines the role of microRNAs (miRNAs) in regulating NTP-mediated cell death remains unexplored. This study aimed to explore the molecular mechanisms and miRNA networks regulated by NTP-induced oxidative stress in melanoma cells. Melanoma cells were exposed to NTP and then subjected to high-throughput miRNA sequencing to identify NTP-regulated miRNAs. Various biological processes and underlying molecular mechanisms were assessed using Alamar Blue, propidium iodide (PI) uptake, cell migration, and clonogenic assays followed by qRT-PCR and flow cytometry. NTP exposure for 3 min was sufficient to modulate the expression of several miRNAs, inhibiting cell growth. Persistent NTP exposure for 5 min increased differential miRNA regulation, PI uptake, and the expression of genes involved in cell cycle arrest and death. qPCR confirmed that miR-200b-3p and miR-215-5p upregulation contributed to decreased cell viability and migration. Mechanistically, inhibiting miR-200b-3p and miR-215-5p in SK-2 cells enhanced ZEB1, PI3K, and AKT expression, increasing cell proliferation and viability. This study demonstrated that NTP exposure for 5 min results in the differential regulation of miRNAs related to the PI3K-AKT-ZEB1 axis and cell cycle dysregulation to facilitate melanoma suppression. [ABSTRACT FROM AUTHOR]

Cloud computing has revolutionized the way businesses and individuals access and utilize computing resources. Efficient virtual machine placement is a critical aspect of optimizing resource utilization, reducing operational costs, energy consumption, service level agreement and minimum virtual machine migrations, execution time, and ensuring the overall performance of cloud services. This manuscript introduces a novel approach that combines the creative problem-solving capabilities of brainstorming with the computational power of Artificial Neural Networks (ANN) to address the virtual machine placement problem in cloud environments. In this study, we propose a hybrid technique that leverages the collective intelligence of human brainstorming to generate a diverse set of placement strategies. These strategies are then evaluated, refined, and optimized using an ANN model trained on historical cloud resource allocation workload logs. By integrating the human creative process with the data-driven predictive capabilities of ANN, our approach aims to overcome the limitations of traditional virtual machine placement algorithms, which often struggle to adapt to dynamic workloads and changing resource requirements. The manuscript provides a detailed description of the hybrid technique, including the process of brainstorming for generating placement strategies, data collection and preprocessing, ANN model development, and the integration of these components into an efficient placement system. We present experimental results demonstrating the effectiveness of our approach in optimizing resource allocation, improving service performance, and optimizing resource utilization, reducing energy consumption, service level agreement and minimum virtual machine migrations, reducing execution time compared to existing static, and meta-heuristic methods. The proposed Brain Storming with ANN based Hybrid Technique offers a promising solution for enhancing the efficiency of virtual machine placement in cloud computing environments. BSO-ANN outperforms the existing techniques using performance metrics (energy consumption(Kwh), execution time(ms), SLA violations, and number of migrations). It combines human ingenuity with data-driven insights to adapt to the ever-changing dynamics of cloud workloads. This manuscript contributes to the ongoing research in cloud resource management, offering a practical approach for cloud service providers and organizations to better utilize their resources and enhance the overall quality of cloud-based services. © 2012 Published by Elsevier Ltd. Selection and/or peer-review under responsibility of Global Science and Technology Forum Pte Ltd. [ABSTRACT FROM AUTHOR]

Coronary artery occlusion (CO) during transcatheter aortic valve replacement (TAVR) is a devastating complication. The objective of this study was to assess the clinical impact of a computational predictive modeling algorithm for CO during TAVR planning. From January 2020 to December 2022, 116 patients (7.6%) who underwent TAVR evaluation were deemed to be at increased risk of CO on the basis of traditional criteria. Patients underwent prospective computational modeling (DASI Simulations) to assess their risk of CO during TAVR; procedural modifications and clinical results were reviewed retrospectively. Of the 116 patients at risk for CO by traditional methodology, 53 had native aortic valve stenosis (45.7%), 47 had undergone previous surgical AVR (40.5%), and 16 had undergone previous TAVR (13.8%). Transcatheter valve choice, size, or implantation depth was modeled for all patients. Computational modeling predicted an increased risk of CO in 39 of 116 (31.9%) patients. Within this subcohort, 29 patients proceeded with TAVR. Procedural modifications to augment the risk of CO included bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction during TAVR (n = 10), chimney coronary stents (n = 8), and coronary access without stents (n = 3). There were no episodes of coronary artery compromise among patients after TAVR, either for those predicted to be at high risk of CO (with procedural modifications) or those predicted to be at low risk (standard TAVR). The use of preoperative simulations for TAVR in patient-specific geometry through computational predictive modeling of CO is an effective enhancement to procedure planning. [ABSTRACT FROM AUTHOR]

Stenotrophomonas maltophilia , an environmentally ubiquitous microbe, is a challenging opportunistic pathogen in the hospital setting. Neonates are particularly vulnerable to infection with Stenotrophomonas but information on presentation, therapeutic response and outcome of such infection in this population is limited. To expand this knowledge, we report here a series of five cases. All the five neonates having S. maltophilia sepsis, were preterms (27–32 weeks), very low birth weight, with clinical presentation within three weeks of life, with respiratory involvement presenting as respiratory distress due to pulmonary haemorrhage, non-specific features like lethargy, altered blood sugar levels and haemodynamic instability. The microbe was sensitive to amikacin, ceftazidime, cotrimoxazole, gentamycin, levofloxacin and minocycline except in two cases showing levofloxacin resistance. All but one neonate survived with morbidities like retinopathy of prematurity, bronchopulmonary dysplasia and metabolic bone disease. [ABSTRACT FROM AUTHOR]

The evaluation of mediastinal lymphadenopathy and masses poses a diagnostic challenge because of a myriad of possible etiologic causes; their proximity to numerous vital structures and the difficulty of access for biopsy. Computed tomography is an excellent modality for the initial evaluation of mediastinal lymph nodes (LNs). Tissue diagnosis is of paramount importance to confirm the diagnosis of mediastinal lymphadenopathy. Of various modalities including CT-guided biopsy, mediastinoscopy is considered a gold standard for tissue acquisition, but it is associated with considerable morbidity. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive method of sampling of mediastinal LNs and its role has been established in malignant cause of LN enlargement. However, its role in diagnosing benign diseases has not been studied much. In a cross-sectional observational study, we performed EBUS-TBNA of 116 patients, and the sample was evaluated by various pathological modalities. Most common LN sampled was subcarinal (68%). MTB gene Xpert was positive in 45 cases, and resistance was detected in 3 cases. Most common diagnosis was tuberculous lymphadenitis (67.9%). Only five of our patients had post-operative bronchospasm, while four had peri-operative hypoxia, which was managed with oxygen therapy. EBUS-TBNA is an excellent modality for sampling mediastinal LNs, which is very safe and can be done on an OPD basis. [ABSTRACT FROM AUTHOR]

The longitudinal relation between coronary artery disease (CAD) polygenic risk score (PRS) and long-term plaque progression and high-risk plaque (HRP) features is unknown. The goal of this study was to investigate the impact of CAD PRS on long-term coronary plaque progression and HRP. Patients underwent CAD PRS measurement and prospective serial coronary computed tomography angiography (CTA) imaging. Coronary CTA scans were analyzed with a previously validated artificial intelligence–based algorithm (atherosclerosis imaging–quantitative computed tomography imaging). The relationship between CAD PRS and change in percent atheroma volume (PAV), percent noncalcified plaque progression, and HRP prevalence was investigated in linear mixed-effect models adjusted for baseline plaque volume and conventional risk factors. A total of 288 subjects (mean age 58 ± 7 years; 60% male) were included in this study with a median scan interval of 10.2 years. At baseline, patients with a high CAD PRS had a more than 5-fold higher PAV than those with a low CAD PRS (10.4% vs 1.9%; P < 0.001). Per 10 years of follow-up, a 1 SD increase in CAD PRS was associated with a 0.69% increase in PAV progression in the multivariable adjusted model. CAD PRS provided additional discriminatory benefit for above-median noncalcified plaque progression during follow-up when added to a model with conventional risk factors (AUC: 0.73 vs 0.69; P = 0.039). Patients with high CAD PRS had an OR of 2.85 (95% CI: 1.14-7.14; P = 0.026) and 6.16 (95% CI: 2.55-14.91; P < 0.001) for having HRP at baseline and follow-up compared with those with low CAD PRS. Polygenic risk is strongly associated with future long-term plaque progression and HRP in patients suspected of having CAD. [Display omitted] [ABSTRACT FROM AUTHOR]

• ASM pricing data from November 2013 to July 2023 was analyzed. • Average brand-name ASM prices increased from $8.71 to $15.43; generics decreased from $1.39 to $1.26. • Generic IR ASM formulations were 5728.99–7751.20 % cheaper than ER. • Each new generic labeler reduced generic prices by 5.45 % but brand-name prices increased by 2.46 %. • Share of brand-generic ASM pairs with a price difference over 10,000 % rose from 16.44 % to 20 % (2013–2016 to 2020–2023). The median cost of anti-seizure medications (ASM) in the United States (U.S.) nearly doubled per person between 2006 and 2021. This increase, combined with shifts in ASM usage and the impact of the COVID-19 pandemic on drug supply chains amid rising inflation, underscored the urgent need to scrutinize ASM pricing dynamics. This study aimed to analyze the complex dynamics of ASM pricing in the U.S. over the past decade (2013–2023); this included how the entry of generic ASMs influenced the pricing of brand-name counterparts and what impacted price variations across different ASM formulations (e.g., significant inflation, the COVID-19 pandemic). This study utilized National Average Drug Acquisition Cost (NADAC) data from November 2013 to July 2023. We adjusted ASM prices for inflation using the Consumer Price Index for Medicinal Drugs - Seasonally Adjusted (CPI-MDS). Statistical analyses included fixed effects regressions and multivariable regression analysis to evaluate the impact of inflation, the number of medication labelers, and the COVID-19 pandemic on ASM prices. Our study analyzed 23 ASMs approved by the U.S. Food and Drug Administration (FDA), which encompassed 223 oral formulations:112 brand-name and 111 generics. From 2013–2016 to 2020–2023, accounting for standard deviations (SD), the average price of brand-name ASMs increased from $8.71 (SD 5.9) to $15.43 (SD 10.7), while generic ASMs saw a slight decrease from $1.39 (SD 1.8) to $1.26 (SD 1.6). Consequently, the price gap between brand-name and generic ASMs surged from 1452.39 % to 3399.26 %. The proportion of matched brand-name and generic ASMs with a price difference of 1000 %–9999 % increased from 32.88 % (2013–2016) to 41.43 % (2020–2023), while those exceeding 10,000 % rose from 16.44 % to 20 % in the same period. Generic immediate-release (IR) formulations were significantly less expensive than extended-release (ER) or delayed-release (DR) counterparts, with cost differences reaching up to 7751.20 %. The number of medication labelers was inversely related to generic ASM prices, which decreased by 5.45 % (p = 0.001) with each additional generic labeler, while brand-name ASM prices increased by 2.46 % (p < 0.001) with each additional generic labeler. The COVID-19 pandemic led to a 24.4 % increase in brand-name ASM prices and a 23.1 % decrease in generic ASM prices. The findings reveal an expanding price disparity between brand-name and generic oral ASMs. An inverse relationship was observed between the number of medication labelers and generic ASM prices, with additional labelers driving down generic prices. However, introducing more generic labelers led to a significant increase in brand-name ASM prices. Furthermore, following patent expirations, brand-name ASM prices rose—a trend explained by the "generics paradox," where, contrary to expectations, brand prices do not decrease and may even increase when generics enter the market. These findings underscore the need for targeted interventions in drug pricing policies to manage the rising costs associated with epilepsy treatment. To ensure equitable access to ASMs, stakeholders must understand and address the factors driving these pricing dynamics. [ABSTRACT FROM AUTHOR]

The transport sector is experiencing a notable transition towards sustainability, propelled by technological progress, innovative materials, and a dedication to environmental preservation. This study explicitly examines the incorporation of electric vehicles (EVs) into the power grid, with a particular emphasis on passenger automobiles. Our analysis emphasises the vital importance of updated transport infrastructure in decreasing greenhouse gas emissions and aiding carbon reduction efforts in electricity networks. The analysis uncovers that adopting electric vehicles offers significant advantages, including enhanced grid efficiency and decreased emissions. However, it also brings issues concerning the design and operation of power systems at both the transmission and distribution levels. Key players are crucial in tackling these difficulties to improve electric vehicle integration into the grid. The study determines the most effective ways for distributing and providing electric vehicle charging infrastructure, and investigates the efforts made to establish common standards in order to solve current challenges. This research contributes to the advancement of sustainable mobility and energy systems by conducting a thorough examination of the impact of electric vehicles on power systems and offering appropriate integration solutions. [ABSTRACT FROM AUTHOR]

As a mega-biobank linked to a national healthcare system, the Million Veteran Program (MVP) can directly improve the health care of participants. To determine the feasibility and outcomes of returning medically actionable genetic results to MVP participants, the program launched the MVP Return of Actionable Results (MVP-ROAR) Study, with familial hypercholesterolemia (FH) as an exemplar actionable condition. The MVP-ROAR Study consists of a completed single-arm pilot phase and an ongoing randomized clinical trial (RCT), in which MVP participants are recontacted and invited to receive clinical confirmatory gene sequencing testing and a telegenetic counseling intervention. The primary outcome of the RCT is 6-month change in low-density lipoprotein cholesterol (LDL-C) between participants receiving results at baseline and those receiving results after 6 months. The pilot developed processes to identify and recontact participants nationally with probable pathogenic variants in low-density lipoprotein receptor (LDLR) on the MVP genotype array, invite them to clinical confirmatory gene sequencing, and deliver a telegenetic counseling intervention. Among participants in the pilot phase, 8 (100%) had active statin prescriptions after 6 months. Results were shared with 16 first-degree family members. Six-month ΔLDL-C (low-density lipoprotein cholesterol) after the genetic counseling intervention was −37 mg/dL (95% CI: −12 to −61; P =.03). The ongoing RCT will determine between-arm differences in this primary outcome. While underscoring the importance of clinical confirmation of research results, the pilot phase of the MVP-ROAR Study marks a turning point in MVP and demonstrates the feasibility of returning genetic results to participants and their providers. The ongoing RCT will contribute to understanding how such a program might improve patient health care and outcomes. Clinical Trial Registration: ClinicalTrials.gov ID NCT04178122. [ABSTRACT FROM AUTHOR]

The relative efficacy of 532 nm subthreshold micropulse laser in comparison to the 810 nm subthreshold micropulse laser, in the treatment of central serous chorioretinopathy is not known. This randomized controlled trial included 99 eyes each in groups A and B. Key inclusion criteria were: (i) vision loss for minimum three months due to persistent central serous chorioretinopathy; (ii) focal leaks (upto two leaks) on fundus fluorescein angiography. Key exclusion criteria were: (i) history of prior treatment for central serous chorioretinopathy; (ii) absence of any leak/ presence of diffuse leaks/ >2 leaks on fundus fluorescein angiography; (iii) chronic central serous chorioretinopathy. All eyes were treated with subthreshold micropulse laser (group A: 532 nm green laser; group B: 810 nm diode laser). Best-corrected visual acuity, autofluorescence, spectral domain optical coherence tomography, and fundus fluorescein angiography, were evaluated at baseline and at 1, 3, and 6 months. Laser was repeated in nor-responders at 3 months. There was a statistically significant improvement in BCVA in both groups six months post laser. Between the two groups, a comparable proportion of eyes showed complete resolution of subretinal fluid at one month, three months and at six months. No adverse effect of laser was observed in either group. Both 532 nm STMP laser and 810 nm STMP laser have comparable structural and functional outcomes in the treatment of non-resolving CSC. There are no adverse effects related to either of the two wavelengths. [ABSTRACT FROM AUTHOR]

Iris fixated intraocular lens (IOLs) have been used for Aphakia and capsular bag instability. The IOLs cause a postoperative non dilating pupil in most cases. We encountered such a case which presented with rhegmatogenous retinal detachment. We describe a novel technique of operating for retinal reattachment in such a case using iris hooks passing in the potential plane between the IOL optic and the iris. The technique had advantages of obviating the need for IOL explantation, associated large corneal entry wound, allowing silicone oil tamponade by retaining an IOL-iris diaphragm, early visual rehabilitation, reduced surgical time, and avoiding multiple surgeries. [ABSTRACT FROM AUTHOR]

Hydrogen has enormous potential for sustainable future mobility. However, current challenges include high production costs and storage issues, necessitating further engineering advancements. Compressed Natural Gas is also a viable alternative, as it is easily produced and stored but suffers from slow flame speed-related issues. Improving its combustion characteristics by enrichment using a small fraction of hydrogen holds significant promise. Inducting hydrogen directly into the combustion chamber improves the engine's volumetric efficiency, eliminating the backfire issues. However, it is crucial to understand the test fuel's jet and mixing characteristics before engine investigations. This study aims to analyse the macroscopic jet characteristics of hydrogen, compressed natural gas and hydrogen-enriched compressed natural gas in realistic engine-like conditions in a constant volume spray chamber at various fuel injection pressures and varying ambient pressures and temperatures. Fuel injection pressures for hydrogen and CNG were varied at 16, 32, and 48 bar, and ambient pressures in the constant volume spray chamber were set at 4- and 8-bar and ambient temperatures at 25 and 100 °C. The results showed hydrogen exhibited ∼2% shorter jet penetration length than compressed natural gas. Depending on the test conditions, hydrogen showed a ∼1–3% higher jet area than CNG due to its higher diffusivity and faster mixing. This higher jet area improved fuel-air mixing of hydrogen with air compared to CNG. The effect of hydrogen enrichment with CNG on their jet characteristics was also analysed for 8 bar FIP. 10% (v/v), 20%, and 40% hydrogen-enriched compressed natural gas did not significantly alter the macroscopic jet characteristics from baseline compressed natural gas. [Display omitted] • Macroscopic spray characterization of hydrogen and CNG in CVSC using Schlieren. • FIP for hydrogen and CNG was varied at varying ambient pressures/temperatures. • Hydrogen exhibited a ∼2% shorter spray jet penetration length than CNG. • Hydrogen showed a larger spray area than CNG. • Hydrogen enrichment of CNG didn't alter macroscopic spray characteristics. [ABSTRACT FROM AUTHOR]

Optimizing the heat transmission rate of the flow through the statistically designed chain of experiments has major applications in product designing and improvising. Here, statistic design is framed by implementing response surface optimization methodology to contemplate the flow of dual non-Newtonian fluids allowed to flow over non-linear stretched geometry. The fluid flow model is designed under Cattaneo-Christov diffusion theory over a magnetized-radiative surface. The boundary condition is enriched with the slip regime and Newtonian heating. Numerical computations are acquired by employing the shooting technique approach in association with Runge-Kutta Fehlberg numerical scheme. Statistical and numerical consequences disclose that non-linear stretching index causes a depletion in velocity and temperature. When the Eckert number and the heat generating parameter are both large, the heat transfer rate is also large. Mass transport rate is lowest for higher ratios of diffusion coefficients. The 0.265365 is the maximum possible heat transport rate attained for the 8th experimental run with the key elements: Eckert number, heat source and radiation parameter. The critical point claimed by the Pareto chart shows that the slightest manipulation of the radiation parameter is critical for the heat transport rate, whereas the heat source parameter and Eckert number have almost similar influences on the response. [ABSTRACT FROM AUTHOR]

Fluoridated mouth rinses improve anti-cariogenic environment but decrease oral pH below critical value, affecting orthodontic bracket surface topography and causing corrosive changes over prolonged use. This invitro study aimed to quantitatively and qualitatively assess the surface topography and metallic ion release of the stainless steel (SS) brackets at varying acidic and alkaline pH. Forty unused SS brackets were divided into four groups (Group A, B, C, D) and immersed for 48- hours in solutions of artificial saliva and sodium fluoride (0.2 %) mouth rinse at varying pH of 5.5,6.7,7 and 8. The surface morphologic changes were analyzed under scanning electron microscope (SEM) at 50×, 150×, and 500× magnification. The changes in slot area were scored using the customized scale. The Energy Dispersive Xray Spectroscopy Analysis (EDAX) was used to estimate the probed elements' atomic and weight percentage. The mean score of the scale was 3.4 for the brackets immersed in the acidic solution which was statistically significant (p = 0.00)and for alkaline and neutral solutions (p = 0.00). Chromium was found to be significantly higher in the alkaline solution (p = 0.016) followed by the neutral solution. Carbon was found excess in acidic solution than the neutral and alkaline solution. Quantitative and qualitative analysis of the ion release in stainless steel brackets using SEM and EDAX revealed the corrosive effect of fluoride ion causing maximum surface changes in acidic medium and chromium release in alkaline pH. [Display omitted] [ABSTRACT FROM AUTHOR]

Microbubbles (MBs) are gas or vapor-filled cavities inside liquids with sizes ranging from 2 to 3 µm. Recently, MBs have shown great promise in nanomedicine owing to their high encapsulation efficiency, targeted drug release, improved biocompatibility, and longer blood circulation. Furthermore, they are more suitable for focusing on particular body regions and are safer and non-invasive. MBs generators are used to create bubbles in fluid dynamics, chemistry, medicine, agriculture, and the environment. Drug delivery using MBs increases penetration without causing systemic toxicity. In this study, we examined whether the use of microbubbles as a local drug-delivery mechanism increases tubular penetration of endodontic medications and irrigant. An Enterococcus faecalis culture was added to 38 dentin cylinders of single-rooted teeth. Samples were divided into the experimental and control groups that received a triple antibiotic paste with and without MB infusion (n = 19 in each group), respectively. After 14 days, the number of live bacteria in the samples was determined using confocal laser scanning microscopy. After 14 days of contact with the medication, the percentages of live and dead bacteria were assessed. Results show that Group 2 (Triple antibiotic infused micro bubble) showed significantly (P < 0.05) higher antibacterial efficacy than Group 1 (TAP). In this study, the antibacterial efficacy was significantly higher in the experimental group than in the control group. Therefore, within the limitations of the study it can be said that MB infusion is a viable technique to improve root canal disinfection. Hence, it can be considered as a novel technique for local drug delivery systems in endodontic management. [ABSTRACT FROM AUTHOR]

The sensory-collapse test (formerly the scratch-collapse test) is a physical examination finding describing a momentary inhibition of external shoulder rotation following light stimulation of an injured nerve in the ipsilateral limb. Similar to other physical examination tests designed to interrogate nerve compression, such as the Phalen or Tinel tests, its test characteristics demonstrate variation. There remains speculation about the test's existence and anatomic basis. The literature of mammalian reflex physiology was reviewed with an emphasis on the sensory pathways from the upper extremity, the extrapyramidal system, and newly discovered pathways and concepts of nociception. A clear reflex pathway is described connecting the stimulus within an injured nerve through the afferent pathways in the fasciculus cuneatus in the spinal cord directly to the lateral reticulospinal tract, resulting in the inhibition of extensor muscles in the proximal limb (eg, shoulder) and activation of the limb flexors by acting upon alpha and gamma motor neurons. The sensory-collapse test represents a reflex pathway that teleologically provides a mechanism to protect an injured nerve by withdrawal toward the trunk and away from the noxious environment. [ABSTRACT FROM AUTHOR]

Our objective was to compare the impact of patient-prosthesis mismatch (PPM) for 2 years after surgical aortic valve replacement within the prospective, randomized Placement of Aortic Transcatheter Valves (PARTNER) trials. Surgical aortic valve replacement patients from the PARTNER 1, 2, and 3 trials were included. PPM was classified as moderate (indexed effective orifice area ≤0.85 cm2/m2) or severe (indexed effective orifice area ≤0.65 cm2/m2). The primary endpoint was the composite of all-cause death and heart failure rehospitalization at 2 years. By the predicted PPM method (PPM P), 59.1% had no PPM, 38.8% moderate PPM, and 2.1% severe PPM; whereas by the measured PPM method (PPM M), 42.4% had no PPM, 36.0% moderate, and 21.6% severe. Patients with no PPM P (23.6%) had a lower rate of the primary endpoint compared with patients with moderate (28.2%, P =.03) or severe PPM P (38.8%, P =.02). Using the PPM M method, there was no difference between the no (17.7%) and moderate PPM M groups (21.1%) in the primary outcome (P =.16). However, those with no PPM M or moderate PPM M were improved compared with severe PPM M (27.4%, P <.001 and P =.02, respectively). Severe PPM analyzed by PPM P was only 2.1% for surgical aortic valve replacement patients. The PPM M method overestimated the incidence of severe PPM relative to PPM P , but was also associated with worse outcome. There was higher all-cause mortality in patients with severe PPM, thus surgical techniques to minimize PPM remain critical. [ABSTRACT FROM AUTHOR]

RAM cannula is used as interface for delivering nasal continuous positive airway pressure (nCPAP) in many neonatal care units though the bench to bedside evidence for its use in clinical settings in lacking. In this prospective cohort study from tertiary care neonatal care unit, the primary objective was to determine the rate of CPAP failure using RAM interface, within 72 h of starting of therapy and secondary objective was to look for the incidence and severity of nasal trauma with the use of RAM interface for CPAP delivery. All inborn preterm neonates between 28 and 32 weeks of gestation and weight more than 1000 g who required non-invasive respiratory support within 6 h of life were included in the study. The enroled cohort of 250 neonates had mean gestational age of 30.73 ± 1.32 weeks and mean birth weight of 1410 ± 210 g. CPAP failure rate with the use of RAM interface was 31.2% (78/250) in the overall cohort. The failure rate was higher in subgroup of gestation between 28 and 30 week (52.1%) in comparison with the 31–32-week gestation (18.2%; p-value = 0.0001). Nasal trauma was present in 36 (14%) neonates; of whom 33 (91%) had mild and 2 (6%) and 1 (3%) had moderate and severe, respectively. On multivariate analysis, birth weight less than 1250 g, incomplete antenatal steroids, need for PEEP more than 5 cm & FiO2 > 30% at onset of distress and administration of surfactant were found be statistically significantly associated with CPAP failure with RAM interface. The clinical outcomes with the use of RAM interface for CPAP administration are comparable to those with other interfaces with lesser incidence of nasal injury. The results of this study warrant future randomized trials to compare different CPAP interfaces for clinical outcomes and nasal injuries from the developing countries. [ABSTRACT FROM AUTHOR]

The P2X7 receptor, a member of the P2X receptor family, plays a crucial role in various physiological processes, particularly pain perception. Its expression across immune, neuronal, and glial cells facilitates the release of pro-inflammatory molecules, thereby influencing pain development and maintenance, as evidenced by its association with pulpitis in rats. Notably, P2X receptors such as P2X3 and P2X7 are pivotal in dental pain pathways, making them promising targets for novel analgesic interventions. Leveraging graph neural networks (GNNs) presents an innovative approach to model graph data, aiding in the identification of drug targets and prediction of their efficacy, complementing advancements in genomics and proteomics for therapeutic development. In this study, 921 drug-gene interactions involving P2X receptors were accessed through https://www.probes-drugs.org/. These interactions underwent meticulous annotation, preprocessing, and subsequent utilization to train and assess GNNs. Furthermore, leveraging Cytoscape, the CytoHubba plugin, and other bioinformatics tools, gene expression networks were constructed to pinpoint hub genes within these interactions. Through analysis, SLC6A3, SLC6A2, FGF1, GRK2, and PLA2G2A were identified as central hub genes within the context of P2X receptor-mediated drug-gene interactions. Despite achieving a 65 percent accuracy rate, the GNN model demonstrated suboptimal predictive power for gene-drug interactions associated with oral pain. Hence, further refinements and enhancements are imperative to unlock its full potential in elucidating and targeting pathways underlying oral pain mechanisms. [ABSTRACT FROM AUTHOR]

This paper delves into the increasingly complex domain of Optimal Power Flow (OPF) within modern power systems, enhanced by the integration of unpredictable renewable energy sources. The research originally integrates stochastic photovoltaic and wind energy sources, along with a suite of Flexible AC Transmission System (FACTS) components – including thyristor-controlled series compensators, static VAR compensators, and thyristor-controlled phase shifters. The primary objective is to solve the OPF problem by reducing generation costs while accommodating the variable nature of renewable energy sources and load demands. This study prioritizes the examination of both constant and fluctuating load requirements. The inherent variability of PV and wind energy, along with load demand, is captured through the modelling of probability density functions. This approach enables a more detailed optimization process, incorporating not just the cost of thermal energy generation but also the scheduling costs of renewable sources and associated penalty costs. Moreover, the study examines the strategic placement and sizing of FACTS components, an aspect essential in minimizing the overall cost of power production. Employing both single- and multi-objective optimization algorithms, the research addresses the OPF problem in a modified IEEE-30 bus system through various case studies. The application of the recently developed flow direction algorithm, including its multi-objective variant with an ε -based constraint-handling mechanism to OPF problem is the primary contributions of this work. The results, benchmarked against several advanced metaheuristic algorithms, reveal the proposed algorithm's superior performance. This comprehensive study not only underscores the potential of integrating renewable energy sources into the grid but also highlights the efficacy of intelligent optimization strategies in managing the complexities of modern power systems. • In a RESs integrated network, the OPF problem is assessed considering FACTS devices. • The placement and sizing of such devices are augmented, considering uncertainties. • Stochastic PV and wind power and uncertain load demand are included in OPF. • Formulation of multi-objective flow direction algorithm and constraint handling mechanism for the said problem. • Performance comparison among various well-known algorithms. [ABSTRACT FROM AUTHOR]

Adequate valve performance after surgical mitral valve repair with an annuloplasty ring is not always sustained over time. The risk of repeat mitral valve surgery may be high in these patients. Transcatheter mitral valve-in-ring (MViR) is emerging as an alternative for high-risk patients. The authors sought to assess contemporary outcomes of MViR using third-generation balloon-expandable aortic transcatheter heart valves. Patients who underwent MViR and were enrolled in the STDS/ACC TVT (Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy) Registry between August 2015 and December 2022 were analyzed. A total of 820 patients underwent MViR at 236 sites, mean age was 72.2 ± 10.4 years, 50.9% were female, mean STS score was 8.2% ± 6.9%, and most (78%) were in NYHA functional class III to IV. Mean left ventricular ejection fraction was 47.8% ± 14.2%, mean mitral gradient was 8.9 ± 7.0 mm Hg, and 75.5% had ≥ moderate mitral regurgitation. Access was transseptal in 93.9% with 88% technical success. All-cause mortality at 30 days was 8.3%, and at 1 year, 22.4%, with a reintervention rate of 9.1%. At 1-year follow-up, 75.6% were NYHA functional class I to II, Kansas City Cardiomyopathy Questionnaire score increased by 25.9 ± 29.1 points, mean mitral valve gradient was 8.4 ± 3.4 mm Hg, and 91.7% had ≤ mild mitral regurgitation. MViR with third-generation balloon-expandable aortic transcatheter heart valves is associated with a significant reduction in mitral regurgitation and improvement in symptoms at 1 year, but with elevated valvular gradients and a high reintervention rate. MViR is a reasonable alternative for high-risk patients unable undergo surgery who have appropriate anatomy for the procedure. (STS/ACC TVT Registry Mitral Module [TMVR]; NCT02245763) [Display omitted] [ABSTRACT FROM AUTHOR]

Mirroring the experience with colonic resections, cold snare-based techniques have been recently proposed for non-ampullary duodenal lesions to reduce the risk of adverse events (AEs). As the duodenal wall is thinner and more vascularized than in the colon, electrocautery-related AEs are relevant issues in this setting. We performed a systematic review with pooled-analysis to evaluate the efficacy and safety of this technique. Electronic databases (Medline, Scopus, EMBASE) were searched up to January 2023. Full articles including patients with duodenal lesions resected by cold-snare technique were eligible. The adverse events (i.e., bleeding, perforation, stricture), complete resection, and recurrence rates were pooled using a random model. Eleven studies were eligible, providing data on 3137 lesions removed from 233 patients. The overall AE rate for cold snaring was 0.25% (95% CI, 0.19%-0.69%). Among the three studies comparing cold- and hot-snare approaches, procedure-related bleeding rate was significantly lower with cold approach (OR 1.21, 0.51–2.85; p = 0.66). The complete resection rate was 99.40% (95% CI, 98.60%-100%), with a residual/recurrence rate of 12.95% (95% CI, 4.75%-21.16%). On univariate meta-regression, lesion size significantly affected both the adverse events and recurrence risk. Cold-snare resection appears effective and extremely safe for resecting non-ampullary duodenal lesions. [ABSTRACT FROM AUTHOR]

For the root canal treatment to be successful, the root canal system must be cleaned and shaped, and must be gradually widened from the apical to the coronal region in order to preserve dentin thickness. ProFit S3 (Profit Dental, India) patented rotary file with variable taper design preserves dentin. The study employs ultra-high-resolution nano-computed tomography to assess the volumetric changes of two new rotary files in permanent mandibular premolars. Based on inclusion and exclusion criteria, this in-vitro investigation used extracted premolars. Before the pre-operative scan, samples were made and the working length was determined using a high-precision nano-CT (SkyScan 2214, Bruker, Kontich, Belgium). A single skilled pediatric dentist used ProFit S3 (Profit Dental, India) and Protaper Gold (PTG; Dentsply, Tulsa Dental Specialties, Tulsa, OK, USA) to prepare the canals. Post-op scans were similar to pre-ops. For 3D root canal visualization and analysis, NRecon software was used to rebuild images. Profit S3 has a mean value of 0.65500 and Protaper gold 1.38800, indicating a significant range. Protaper gold followed Profit S3 in canal volume differential. The two rotating file systems differed significantly (p 0.05). ProFit S3 maintained mesiodistal and buccolingual dentin thickness at 4 mm, 8 mm, and 12 mm, followed by Protaper Gold. ProFit S3 exhibited the lowest mean canal volume difference compared to Protaper gold. Unlike Protaper Gold, ProFit S3 offers a variable taper design that preserves root canal anatomy, peri cervical dentin, and dentin thickness. [ABSTRACT FROM AUTHOR]

• Limited manufacturing facilities for parenteral antiseizure meds risk shortages. • India's antiseizure med production dominance risks supply chain. • Lack of data on medication supply chain highlights the need for better transparency. • Multi-medication manufacturing facilities pose bottleneck risks in the supply chain. Generic drug manufacturing has shifted away from the U.S. in the last few decades. The medication supply chain, from manufacturers to resellers, has become increasingly globalized and complex. This has led to bottlenecks in their manufacture resulting in medication shortages. Review of this process as it pertains to antiseizure medications (ASM) shows gaps in our comprehension of its complexities. Understanding these processes will be essential for preventing medication shortages. The aim of this research is to examine the generic ASM supply with an emphasis on production, labeling, and repackaging. Data from the United States Food and Drug Administration (FDA) and the National Library of Medicine (NLM) website DailyMed was used to evaluate supply chain details to gather information on antiseizure medication formulations, manufacturing locations, and labeling. Out of 3142 ASM-related active National Drug Code (NDC-9) codes, 2663 NDC-9 codes with Abbreviated New Drug Application (ANDA) status were included in the analysis. Most (94.8 %) were enteral, with only 5.2 % being parenteral (intravenous and intramuscular route). We identified the manufacturing country for 82 % of these codes, corresponding to 306 unique ANDA numbers. 119 manufacturing sites in 12 countries produce generic ASM Finished Dosage Forms (FDF): 103 for enteral and 21 for parenteral. India is the main producer of enteral ASM FDFs with 49 sites, followed by the US with 36. Regarding parenteral formulation, five countries had 21 unique manufacturing locations. 42 % of the 103 enteral ASM FDFs manufacturing sites produced multiple ASM FDFs, with one facility making eight distinct ASMs. 34.4 % of facilities were associated with over 3 ANDAs, and 15.1 % with more than 5. 22.7 % of ANDAs lacked a manufacturing facility identifier. Repackaged ASM FDFs constituted 48 % of NDC-9 s. Gabapentin and pregabalin were the most common oral ASMs. India is the major source for generic ASM FDFs manufacturing, leading to concerns about overall supply dependency on that country. There is a paucity of facilities for the global supply of parenteral ASM FDFs. There is missing data for many NDC-9 codes emphasizing urgency for transparency in the supply chain. [ABSTRACT FROM AUTHOR]

Federated learning (FL) is a collaborative learning paradigm where multiple clients are used to build the model without sharing data and preserving privacy. An FL-based linear regression model is designed to predict the length of stay for patients at hospitals using the low-power Arduino Nano 33 BLE Sense microcontroller unit (MCU). FL uses a distributed learning technique that allows model building from decentralized data sources. The Arduino Nano 33 BLE Sense is a compact and energy-efficient MCU providing an ideal platform for implementing FL in resource-constrained environments. FL algorithms aggregate model parameters from multiple Arduino clients and collectively train and build a predictive model to estimate the length of stay at the hospital by patients. Experiments were conducted to understand the performance of FL on clients with data of equal and varying sizes and heterogeneous data from multiple sources. The performance of the algorithm is evaluated based on Mean Absolute Error (MAE), Percentage Decrease in Training error (PDTE), and Percentage Difference with Optimal Testing (PDOT) value. Experimental results show that the number of local epochs and FL rounds affects the convergence of clients to the optimal value. The experimental results demonstrate the applicability of FL on low-power MCUs, preserving privacy which is a core requirement for healthcare solutions. [ABSTRACT FROM AUTHOR]

Using a time-varying parameter SVAR model over the period 1994 to 2021, this paper provides estimates of exchange rate pass-through (ERPT) to both producer and consumer prices for nine emerging Asian economies. We also examine the role of four global shocks as propagation channels to both producer and consumer price ERPT, specifically via oil prices, global output, US monetary policy, and the VIX. Our main findings are: (i) ERPT is incomplete and mostly higher for ERPT to producer than consumer prices; (ii) longer-term ERPT to producer and consumer prices is mostly greater in magnitude than shorter-term ERPT; (iii) ERPT has been declining for most Asian EMEs since around 2010; (iv) oil price and global output shocks mostly affect longer-term producer price ERPT in emerging Asia; and (v) US monetary policy and VIX shocks mostly affect longer-term consumer price ERPT in emerging Asia. [ABSTRACT FROM AUTHOR]

Psychological morbidities are one of the emerging global health problems. It affects a considerable number of ante-natal women leading to consequences during the postnatal period as well. We conducted this research to study the magnitude and determinants of psychological morbidities during pregnancy. In this study, we included 650 pregnant women from an established cohort of 2500 pregnant women and assessed the psychological morbidities among them using the GMHAT/PC tool. The overall prevalence of psychological morbidities during pregnancy was 14.6%, with anxiety and depression being the leading ones. Low education levels, lower socio-economic status, unintended pregnancy, complicated previous pregnancy, lack of family and social support, and domestic violence increased the odds of psychological morbidity. On Multivariate logistic regression, Low education levels increased the odds to more than twice [illiterate/primary schooling OR: 4.00, p = 0.026; secondary schooling OR: 2.64, p = 0.034; high school OR: 2.60, p = 0.033] unintended pregnancy [OR: 1.91, p = 0.043] and lack of family support [OR: 7.19, p < 0.001] increased the odds of psychological morbidity among pregnant women. Bringing these issues to the mainstream and addressing them by developing interventions to address them during the lifecycle of a female will help to prevent episodes of psychological stress and morbidity among pregnant females. [ABSTRACT FROM AUTHOR]

In this article, we define the tensor product V ⊗ W of a representation V of a quiver Q with a representation W of an another quiver Q ′ , and show that the representation V ⊗ W is semistable if V and W are semistable. We give a relation between the universal representations on the fine moduli spaces N 1 , N 2 and N 3 of representations of Q , Q ′ and Q ⊗ Q ′ respectively over arbitrary algebraically closed fields. We further describe a relation between the natural line bundles on these moduli spaces when the base is the field of complex numbers. We then prove that the internal product Q ̃ ⊗ Q ′ ̃ of covering quivers is a sub-quiver of the covering quiver Q ⊗ Q ′ ˜. We deduce the relation between stability of the representations V ⊗ W ˜ and V ̃ ⊗ W ̃ , where V ̃ denotes the lift of the representation V of Q to the covering quiver Q ̃. We also lift the relation between the natural line bundles on the product of moduli spaces N 1 ̃ × N 2 ̃ . [ABSTRACT FROM AUTHOR]

Estimating the cover and management factor (C -factor) for Universal Soil Loss Equation (USLE) that varies spatially and temporally within a watershed is time-consuming and resource-intensive. The Normalized Difference Vegetation Index (NDVI) approach can offer a potential alternative for this process. The current study examines nine NDVI models to compare and evaluate their performance in estimating the C -factor values for an agricultural watershed in southwestern Ontario, Canada. Satellite imagery from 2013 to 2020 was used to analyze the models' similarities and differences on a detailed spatial and temporal scale. The results showed different C- factor values for each model, reflecting that they were developed for different geographical areas and purposes. While the Karaburun model differed from all other models on an annual basis, a detailed combined analysis of different spatial and temporal scales revealed that it was similar to other models. Seasonal analysis was found to be adequate for the current study, as it reduced the resources required and provided an overall view of the vegetation situation. However, a detailed monthly analysis may be necessary when investigating a specific season. The current analysis found that the summer months of June, July, and August have similar trends when comparing different models for different land uses and individual months, which aligns with the seasonal analysis. In conclusion, the current study highlights the importance of incorporating spatial and temporal scales in hydrological modeling and provides valuable insight into the applicability of different NDVI models for estimating the C- factor for southwestern Ontario watersheds. These findings can help inform future research and aid in developing accurate models for estimating soil erosion in this region. The results also emphasize that the NDVI approach has the potential for estimating the USLE C- factor and improving the estimation of soil erosion from agricultural watersheds by incorporating a variable C- factor over time and space. However, further research is needed to validate each model and determine which model best suits the study area. [ABSTRACT FROM AUTHOR]

Increasing infectious rate estimates and low microbiological surveillance affect safety of gastrointestinal endoscopy globally. Single use endoscopes and accessories have been claimed to improve safety, but there is lack of data on their indication and sustainability. We aimed to identify a series of best practice recommendations for the use of single use endoscopes and accessories using a modified Delphi. Consensus statements for the use of single use endoscopy and accessories were developed using a modified Delphi process, utilizing an international endoscopist expert panel of 62 experts from 33 nations. The main steps in the process were selecting the consensus group, conducting systematic literature reviews, developing statements, and anonymous voting on the statements until consensus was reached. High-risk patients were defined as those with multi-drug-resistant infections, immunosuppressive medication or chemotherapy, post-transplantation, or with severe neutropenia. Of the 26 statements that were voted upon through two rounds, 17 statements reached consensus. Category 1: single use accessories (8 statements), related to defining recommendations for the use of single use accessories in all patient populations or high-risk patients. Category 2: clinical indication for single use endoscopes (9 statements), including indications to high-risk patients, protecting the endoscope apparatus and contamination measures in endoscopy units. Category 3: technical factors (4 statements), related to superior performance and technical specifications with the new innovation. Category 4: environmental issues (2 statements), concerning mechanisms that reduce the detrimental burden to the environment. Category 5: financial implications (3 statements), related to healthcare policies, cost neutrality and other financial associations of single use endoscopy. This is the first international initiative in determining clinical indications for single use endoscopy and accessories. The study's findings should serve as a framework for future physicians to guide future research and aid the proper evidence-based indications for the implementation of single use endoscopes in clinical practice. [ABSTRACT FROM AUTHOR]

• Advancements in spark plasma sintering (SPS) for Mg and its alloys are introduced. • Effects of processing/material conditions on structural features are presented. • Particle nanostructuring and composites for controlling degradation are explored. • An overview of the latest industrial advancements of SPS Mg is thoroughly reviewed. Within the past ten years, spark plasma sintering (SPS) has become an increasingly popular process for Mg manufacturing. In the SPS process, interparticle diffusion of compressed particles is rapidly achieved due to the concept of Joule heating. Compared to traditional and additive manufacturing (AM) techniques, SPS gives unique control of the structural and microstructural features of Mg components. By doing so, their mechanical, tribological, and corrosion properties can be tailored. Although great advancements in this field have been made, these pieces of knowledge are scattered and have not been contextualized into a single work. The motivation of this work is to address this scientific gap and to provide a groundwork for understanding the basics of SPS manufacturing for Mg. To do so, the existing body of SPS Mg literature was first surveyed, with a focus on their structural formation and degradation mechanisms. It was found that successful Mg SPS fabrication highly depended on the processing temperature, particle size, and particle crystallinity. The addition of metal and ceramic composites also affected their microstructural features due to the Zener pinning effect. In degradative environments, their performance depends on their structural features and whether they have secondary phased composites. In industrial applications, SPS'd Mg was found to have great potential in biomedical, hydrogen storage, battery, automotive, and recycling sectors. The prospects to advance the field include using Mg as a doping agent for crystallite size refinement and using bulk metallic Mg-based glass powders for amorphous SPS components. Despite these findings, the interactions of multi-composites on the processing-structure-property relationships of SPS Mg is not well understood. In total, this work will provide a useful direction in the SPS field and serve as a milestone for future Mg-based SPS manufacturing. [ABSTRACT FROM AUTHOR]

• Advancements in laser shock peening (LSP) for Mg and its alloys are introduced. • Process-microstructure relationships of LSP and Mg alloys are presented. • Relationship of LSP on residual stress and surface roughness formation is discussed. • LSP on mechanical, tribological, corrosion and wear-corrosion behaviors are studied. • Ongoing advances, scientific gaps, and suggestions for future trends are provided. Among the existing series of softer metals, magnesium (Mg) has attracted much attention due to its impressive strength-to-weight ratio. However, due to its ease of deformability, Mg tends to suffer from rapid degradation in a wide variety of abrasive and electrochemical environments. One method of improving its surface properties is through surface modification techniques. Among the existing techniques, laser shock peening (LSP) has been one of the most widely utilized processes due to its surface-hardening-like effects. Despite this understanding, a comprehensive review has yet to exist that encapsulates the strengthening mechanism of LSP for Mg and its influence in degradation environments. This review aims to encapsulate the existing research around the LSP field for Mg. Specifically, an understanding of the surface-strengthening effects in relation to its mechanical, tribological, corrosion, and tribo-corrosion characteristics is elucidated. Additionally, the feasibility of LSP for Mg materials in critical industries is also discussed. Through this work, a novel understanding of LSP for Mg can be understood, which can provide a future direction for research in this field. [ABSTRACT FROM AUTHOR]

Multimodal imaging techniques have furthered our understanding of how different aspects of Alzheimer's disease (AD) pathology relate to one another. Diffusion tensor imaging (DTI) measures such as mean diffusivity (MD) may be a surrogate measure of the changes in gray matter structure associated with AD. Positron emission tomography (PET) imaging of synaptic vesicle glycoprotein 2A (SV2A) has been used to quantify synaptic loss, which is the major pathological correlate of cognitive impairment in AD. In this study, we investigated the relationship between gray matter microstructure and synaptic density. DTI was used to measure MD and [11C]UCB-J PET to measure synaptic density in 33 amyloid–positive participants with AD and 17 amyloid–negative cognitively normal (CN) participants aged 50–83. Univariate regression analyses were used to assess the association between synaptic density and MD in both the AD and CN groups. Hippocampal MD was inversely associated with hippocampal synaptic density in participants with AD (r = −0.55, p <0.001, df = 31) but not CN (r = 0.13, p = 0.62, df = 15). Exploratory analyses across other regions known to be affected in AD suggested widespread inverse associations between synaptic density and MD in the AD group. In the setting of AD, an increase in gray matter MD is inversely associated with synaptic density. These co-occurring changes may suggest a link between synaptic loss and gray matter microstructural changes in AD. Imaging studies of gray matter microstructure and synaptic density may allow important insights into AD-related neuropathology. • What is the primary question addressed by this study? What is the relationship between gray matter microstructure measured with diffusion tensor imaging and synaptic density measured with positron emission tomography in participants with Alzheimer's disease and normal cognition? • What is the main finding of this study? Higher gray matter mean diffusivity is significantly associated with lower synaptic density in participants with Alzheimer's disease but not normal cognition. This inverse correlation is present across many brain regions that are commonly affected in AD. • What is the meaning of the finding? Synaptic loss in AD is highly related to microstructural changes that can be measured via MRI. [ABSTRACT FROM AUTHOR]

This study investigated torque expression in maxillary incisors using two passive self-ligating bracket types (Damon Q and Pitts 21) placed at different heights using the Finite element method. Two passive self-ligating brackets, Damon Q (Ormco, USA) and Pitts 21 (OC Orthodontics, USA) were 3D modeled using micro-computed tomography. Damon Q (0.022ˮ x 0.028″ slot size) and Pitts 21 (0.021ˮ x 0.021″ slot size) brackets were placed on a maxillary central incisor at predetermined vertical heights. Arch wires of size 0.019ˮ x 0.025″ stainless steel (Damon Q) and 0.020ˮ x 0.020" Titanium Molybdenum (Pitts 21) were placed in the bracket slots. Pitts 21 brackets showed higher torquing moments at all bonding heights as compared to Damon Q brackets. The minimum torquing moment was 9.03Nmm at 5 mm for Damon Q and the maximum torquing moment was 14.92Nmm for Pitts 21 at a bracket bonding height of 8 mm. Total deformation for Pitts 21 at a height of 5 mm from the incisal edge was 0.61 × 10−6mm as compared to that of Damon Q which was 0.41 × 10−6mm. Lowest Von Mises stress values were at 27.07 MPa in Damon Q brackets at a bracket height of 5 mm from the incisal edge. Highest Von Mises stress values were 36.80 MPa for Pitts 21 brackets at a bracket height of 8 mm from the incisal edge. Pitts 21 brackets exhibited superior torquing characteristics compared to Damon Q. Total deformation in Pitts 21 was higher than Damon Q at all tested bracket bonding heights. [Display omitted] [ABSTRACT FROM AUTHOR]

The CLASP IID (Edwards PASCAL TrAnScatheter Valve RePair System Pivotal Clinical) trial is the first randomized controlled trial comparing the PASCAL system and the MitraClip system in prohibitive risk patients with significant symptomatic degenerative mitral regurgitation (DMR). This study sought to report primary and secondary endpoints and 1-year outcomes for the full cohort of the CLASP IID trial. Prohibitive-risk patients with 3+/4+ DMR were randomized 2:1 (PASCAL:MitraClip). The 1-year assessments included secondary effectiveness endpoints (mitral regurgitation [MR] ≤2+ and MR ≤1+), and clinical, echocardiographic, functional, and quality-of-life outcomes. Primary safety (30-day composite major adverse events [MAEs]) and effectiveness (6-month MR ≤2+) endpoints were assessed for the full cohort. A total of 300 patients were randomized (PASCAL: n = 204; MitraClip: n = 96). At 1 year, differences in survival, freedom from heart failure hospitalization, and MAE were nonsignificant (P > 0.05 for all). Noninferiority of the PASCAL system compared with the MitraClip system persisted for the primary endpoints in the full cohort (for PASCAL vs MitraClip, the 30-day MAE rates were 4.6% vs 5.4% with a rate difference of −0.8% and 95% upper confidence bound of 4.6%. The 6-month MR ≤2+ rates were 97.9% vs 95.7% with a rate difference of 2.2% and 95% lower confidence bound (LCB) of −2.5%, respectively). Noninferiority was met for the secondary effectiveness endpoints at 1 year (MR ≤2+ rates for PASCAL vs MitraClip were 95.8% vs 93.8% with a rate difference of 2.1% and 95% LCB of −4.1%. The MR ≤1+ rates were 77.1% vs 71.3% with a rate difference of 5.8% and 95% LCB of −5.3%, respectively). Significant improvements in functional classification and quality of life were sustained in both groups (P < 0.05 for all vs baseline). The CLASP IID trial full cohort met primary and secondary noninferiority endpoints, and at 1 year, the PASCAL system demonstrated high survival, significant MR reduction, and sustained improvements in functional and quality-of-life outcomes. Results affirm the PASCAL system as a beneficial therapy for prohibitive-surgical-risk patients with significant symptomatic DMR. [Display omitted] [ABSTRACT FROM AUTHOR]

Ocular tear film and the ocular surface together represent a dynamic playground of various protective factors against environmental influencers. Surrounding environment and geoclimatic milieu are the pertinent and continuous influencing factors. Prevalence study of Dry eye disease (DED) in various climatic conditions and professions provides an insight into this peculiar aspect of DED and human geography. This was a hospital based, cross-sectional, comparative, analytical observational study. 1840 young soldiers between 25 and 45 years of age were studied. Divided in five climate groups based on Köppen–Geiger climate classification system the subjects were sub-grouped into professions exposed to known aggravating environmental factors. The ocular surface was examined for signs and symptoms of DED and its prevalence and risk ratio for different climates and professions were calculated. Highest prevalence of DED was found in cold desert climate and among visual display unit (VDU) users. Least prevalence was seen in highland type of climate and among people involved in professional exposed to high temperature. Prevalence of DED based upon the signs and ocular surface disease index (OSDI) was calculated and stratified with risk ratio for climatic conditions and professions. Different climatic conditions and professions had different prevalence of signs, symptoms of OSD and DED which indicated its influence on prevalence of the disease. [ABSTRACT FROM AUTHOR]

• Surgery was effective in a majority of children with epilepsy from a genetic cause. • Surgery improved seizure frequency despite diffuse or multifocal MRI or EEG findings. • Seizure freedom was achieved in ⅓ of this cohort; median follow-up 11 months. • >50 % seizure reduction was present in ⅔ of children; median follow-up of 11 months. • There is a long latency between recognizing drug resistance and referral for surgery. This study assesses current practices and outcomes of epilepsy surgery in children with a genetic etiology. It explores the pre-surgical workup, types of surgeries, and post-surgical outcomes in a broad array of disorders. Patients ≤18 years who completed epilepsy surgery and had a known genetic etiology prior to surgical intervention were extrapolated from the Pediatric Epilepsy Research Consortium (PERC) surgery database, across 18 US centers. Data were assessed univariably by neuroimaging and EEG results, genetic group (structural gene, other gene, chromosomal), and curative intent. Outcomes were based on a modified International League Against Epilepsy (ILAE) outcome score. Of 81 children with genetic epilepsy, 72 % had daily seizures when referred for surgery evaluation, which occurred a median of 2.2 years (IQR 0.3, 5.2) after developing drug resistance. Following surgery, 68 % of subjects had >50 % seizure reduction, with 33 % achieving seizure freedom [median follow-up 11 months (IQR 6, 17). Seizure freedom was most common in the monogenic structural group, but significant palliation was present across all groups. Presence of a single EEG focus was associated with a greater likelihood of seizure freedom (p=0.02). There are meaningful seizure reductions following epilepsy surgery in the majority of children with a genetic etiology, even in the absence of a single structural lesion and across a broad spectrum of genetic causes. These findings highlight the need for expedited referral for epilepsy surgery and support of a broadened view of which children may benefit from epilepsy surgery, even when the intent is palliative. [ABSTRACT FROM AUTHOR]

The majority of high-power, high-voltage, and high-power medium-voltage electronic applications now need multi-level inverters (MLIs), which are becoming a required technology. MLIs may provide a wide range of output levels designed to meet the diverse requirements of high voltage/power applications. In addition to the increased output levels, MLI can mitigate the total harmonic distortion (THD) and perform the function of voltage stress (dv/dt) reduction across the power switches. The overwhelming development of new MLI topologies on existing ones multiplies its potential to stimulate more output levels with fewer components. Moreover, the most recent MLI topologies use symmetrical dc sources to produce comparable output levels with fewer semiconductor switches, decreasing capital costs and improving system reliability. In essence, asymmetrical DC source values can be obtained from various unconventional energy sources, including solar, wind, etc. As a result, the various topologies were proposed with an asymmetrical structure for balancing the unequal DC voltage sources and converting them into AC voltages with balanced conditions. This comprehensive review will provide an in-depth analysis of various MLI setups based on switch count, switching methods, symmetric structures, asymmetric topologies, and hybrid configurations. [ABSTRACT FROM AUTHOR]

Nowadays, the use of electric vehicles (EVs) is increasing as the charging infrastructure for these EVs is necessary. The highly rapid loading technology can charge cars and looks like refilling fuel in vehicles. This article covers the review of sophisticated loading infrastructure, several topologies of converters, and quick-charging technologies to meet future requirements. Specifically designed for AC/DC front-end stage and non-isolated and isolated DC/DC converters are suitable for Fast Charging Stations (FCS) and their applications that meet automotive battery isolation requirements. In addition, evaluate the benefits of converting the medium voltage to low voltage at the FCS by substituting a Solid-State Transformer (SST). Also, this paper presents a topological survey of available charging stations. The performance of various topologies of charging stations is discussed based on grid support, modularity, power density, and other factors. [ABSTRACT FROM AUTHOR]

To characterize patterns of prescription opioid use among individuals with multiple sclerosis (MS) and identify risk factors associated with chronic use. Retrospective longitudinal cohort study examining US Department of Veterans Affairs electronic medical record data of Veterans with MS. The annual prevalence of prescription opioid use by type (any, acute, chronic, incident chronic) was calculated for each study year (2015-2017). Multivariable logistic regression was used to identify demographics and medical, mental health, and substance use comorbidities in 2015-2016 associated with chronic prescription opioid use in 2017. US Department of Veterans Affairs, Veteran's Health Administration. National sample of Veterans with MS (N=14,974). Chronic prescription opioid use (≥90 days). All types of prescription opioid use declined across the 3 study years (chronic opioid use prevalence=14.6%, 14.0%, and 12.2%, respectively). In multivariable logistic regression, prior chronic opioid use, history of pain condition, paraplegia or hemiplegia, post-traumatic stress disorder, and rural residence were associated with greater risk of chronic prescription opioid use. History of dementia and psychotic disorder were both associated with lower risk of chronic prescription opioid use. Despite reductions over time, chronic prescription opioid use remains common among a substantial minority of Veterans with MS and is associated with multiple biopsychosocial factors that are important for understanding risk for long-term use. [ABSTRACT FROM AUTHOR]

Skin tears are classed as traumatic wounds mainly caused by shearing and frictional forces. Incidences of skin tears are noted to be significant mostly in the elderly population and those with fragile and vulnerable skin. Individuals undergoing mammography are susceptible to skin tears due to factors associated with skin breakdown such as thinning of the epidermis, use of steroids, presence of moisture, but this, when compounded with the procedure of mammography can increase the risk further. Mammography, an x-ray imaging method, which exerts adequate compression force on the breast tissue for the mammographer to obtain a high-quality image for diagnostic purposes. However, when compression force is applied during mammography resulting incidences of cutaneous skin tears can occur. Lack of and under reporting of skin tears during mammography makes it difficult to ascertain the extent of this problem and scale of its incidence. Therefore, the purpose of this narrative review is to focus on providing an overview of skin tears associated with mammography and a discussion of the current literature with regards to its incidence and diagnosis. In addition, the review will also discuss the theoretical and contextual perspective of the prevention and management strategies associated with skin tears. • Skin tears are classified as traumatic wounds linked to elderly population and those with fragile skin. • Mammography an x-ray imaging method applies compression force that can lead to the occurrence of skin tears. • Lack of under reporting makes it difficult to ascertain the extent of the problem. • From limited data around 4.7% of people undergoing mammography procedures develop skin tears. • Prospective research to determine the prevalence of skin damage and tears in mammography is required. [ABSTRACT FROM AUTHOR]

Automated surgical video analysis promises improved healthcare. We propose novel spatial context aware combined loss function for end-to-end Encoder-Decoder training for Surgical Phase Classification (SPC) on laparoscopic cholecystectomy (LC) videos. Proposed loss function leverages on fine-grained class activation maps obtained from fused multi-layer Layer-CAM for supervised learning of SPC, obtaining improved Layer-CAM explanations. Post classification, we introduce graph theory to incorporate known hierarchies of surgical phases. We report peak SPC accuracy of 96.16%, precision of 94.08% and recall of 90.02% on public dataset Cholec80, with 7 phases. Our proposed method utilizes just 73.5% of parameters as against existing state-of-the-art methodology, achieving improvement of 0.5% in accuracy, 1.76% in precision with comparable recall, with an order less standard deviation. We also propose DNN based surgical skill assessment methodology. This approach utilizes surgical phase prediction scores from the final fully-connected layer of spatial-context aware classifier to form multi-channel temporal signal of surgical phases. Time-invariant representation is obtained from this temporal signal through time- and frequency-domain analyses. Autoencoder based time-invariant features are utilized for reconstruction and identification of prominent peaks in dissimilarity curves. We devise a surgical skill measure (SSM) based on spatial-context aware temporal-prominence-of-peaks curve. SSM values are expected to be high when executed skillfully, aligning with expert assessed GOALS metric. We illustrate this trend on Cholec80 and m2cai16-tool datasets, in comparison with GOALS metric. Concurrence in the trend of SSM with respect to GOALS metric is obtained on these test videos, making it a promising step towards automated surgical skill assessment. [ABSTRACT FROM AUTHOR]