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Key Clinical Message Button battery ingestion has been a common condition encountered by otorhinolaryngologists. Impaction in the esophagus can lead to serious and fatal complications such as tracheoesophageal fistula. Management involves a multidisciplinary team and varies from supportive therapy to surgical intervention. Abstract Ingestion of button batteries has been seen with increasing frequency over the past decade. In several small numbers of reported cases, their impaction in the esophagus has led to severe, sometimes fatal, complications. The management of these cases has varied from expectant, supportive therapy to early surgical intervention. We report a case of button battery ingestion that was diagnosed late and resulted in a complication of tracheoesophageal fistula with migration to the thorax which was managed by open surgery.

Abstract The presence of stone cells in pears is recognized as a problem for the pear processing industry. Bacillus and mold can degrade stone cells because of their potential to digest cellulose and lignin, but they cannot be used for the degradation test of pear stone cells. In this study Lactoplantibacillus plantarum JYLP‐326 was used in single culture or in the mixed culture with Saccharomyces cerevisiae Y2 to study their potential to degrade stone cells during fermentation and the mechanism of degradation was further explored. Synergy in cellulase activity was observed in the mixed‐culture where the maximum activity was observed at 96th hour of fermentation. Activities of endoglucanase, exoglucanase and β‐glucosidase were 1.75, 4.58, and 2.31. The degradation rate of stone cells in the mixed‐culture was 37.67%, which was significantly higher than that the results obtained for single cultures. The results of scanning electron microscopy (SEM) showed that the surface of the cultured stone cells became rough. Metabolomics studies confirmed the presence of specific metabolites related to the degradation of stone cells after the fermentation. It was concluded that the mixed‐culture fermentation using the above‐mentioned strains could be exploited by the pear processing industry to degrade stone cells.

Abstract Background and Aims Antibiotic resistance (ABR) is a global public health emergency which has seen an uptick in low‐ to middle‐income countries in recent times due to a plethora of aggravating factors and has led to a whole host of setting‐specific pathogens registering high rates of resistance, causing outbreaks with graver mortality and morbidity. This review analyzes available literature to determine the causes and effects of ABR and recommend solutions to the problem in a Pakistani setting. Methods Sources for this narrative review were identified via electronic databases using keyword search methods. The information was retrieved using databases such as PubMed and Science Direct. Additionally, websites such as CDC and World Health Organization were used to attain pertinent information. All the sources were selected as per their relevance and appropriateness toward the purpose of this review. Results This review details the causes by dividing them into three primary strata, namely (1) under‐regulation, (2) over‐prescription and self‐medication, and (3) lack of medical stewardship. This is made much graver when the COVID‐19 pandemic and the subsequent erratic treatment response is considered, with the pandemic augmenting already high levels of consumption. These factors have led a cascade of effects including, but not limited to, a considerable increase in ABR in pathogens to first‐line drugs Conclusion ABR is a serious and growing issue which will result in undesirable personal, local, and national consequences if unchecked. Mitigation and reversal of this trend is necessary by developing existing programs and investing in novel therapies and pharmaceutical research and strengthening regulatory policies and mechanisms.

Abstract Background Biliary atresia (BA) is rare liver disease of unknown etiology, and is a major indication for liver transplant (LT). Previous data indicate improved outcomes with early referral for Kasai portoenterostomy (KPE). Objective Evaluate the long‐term outcomes in BA, with particular focus on those transitioned to adult care with native livers. Subjects and Methods Patients with BA treated between1980 and 2012 were identified. Data were collected from the time of referral, transition to adult care, and the most recent clinic notes, from which patient and native liver survival were calculated. Results Four hundred and fifty‐four patients with BA were identified, who were followed up for median of 16.4 years from birth; 74 died (41 of whom had a LT), giving a 20‐year survival rate of 83.6%. Two hundred and seventy‐two patients received an LT, with the median native liver survival being 35 months. Of patients who transitioned to adult care, 54 of 180 (30.0%) retained their native liver. Of these, 72% (39 of 54) had evidence of chronic liver disease at transition, of whom 8 were subsequently lost to follow‐up, 9 were transplanted, and 22 remained stable with compensated liver disease. Of the 15 of 54 patients (28%) with no evidence of chronic disease in their native liver disease at transition, 3 were subsequently lost to follow‐up; none received transplants, although 3 patients developed new‐onset liver disease. All patients transitioned to adult care completed secondary school education (N = 180), with 49% having attended college/university and 87% being in employment or education at the last follow‐up. Of female patients, 34% had at least one pregnancy (27 children in 21 women), while 22% of males had fathered a child. Conclusion Long‐term outcomes in BA are good, with patients surviving into adult life. Progression of chronic liver disease and associated morbidity is common in those who retained their native livers, suggesting that these patients require monitoring of liver disease throughout adult life, and early recognition of the need for LT.

The Prunus armeniaca L. (bitter apricot) is an apricot fruit tree categorized on the basis of the bitter taste of its seed kernel. In this study, the functional, medicinal, and therapeutic potential of bitter apricot seed kernel oil (BASKO) was evaluated. The qualitative screening of BASKO was performed using standard methodologies. The chemical profile of the oil was analyzed with the help of Fourier transform infrared (FTIR) and gas chromatography and mass spectrometry (GC-MS). Results revealed the presence of different phytochemical constituents comprising steroids, flavonoids, terpenoids, alkaloids, and cardiac glycosides. The antioxidant activity of the oil was determined by a 2,2,diphenyl-1picrylhydrazyl (DPPH) radical inhibition essay. Total phenolic and flavonoid contents were 10.6±1.32 mg GAE/g and 4.75±0.11 mg QE/g, respectively. DPPH inhibition of 89.5% was achieved at 1000 μg/mL of BASKO, with IC50=90.44 μg/mL (83.47–96.67 μg/mL with 95% CI). The antimicrobial potential of the BASKO revealed the inhibition of Escherichia coli (20.3±2.08 mm), Salmonella typhi (19.3±2.51 mm), Klebsiella pneumoniae (16.6±1.52 mm), Pseudomonas aeruginosa (17±2 mm), and Staphylococcus aureus (25±1.01 mm). The minimum inhibitory concentration (MIC) value was 250 μL/mL for K. pneumoniae, S. typhi, P. aeruginosa, and S. aureus, whereas 62.5 μL/mL for E. coli. Moreover, BASKO showed antifungal potential against Trichophyton tonsurans (77.3±2.08%), Epidermophyton floccosum (69.6±3.51%), Aspergillus niger (74.3±2.56%), Aspergillus flavus (90±3%), and Mucor mucedo (78.3±2.51%). Antileishmanial activity of oil was evaluated against Leishmania major by MTT assay, and an IC50 value of 89.75 μg/mL was observed. The study revealed that BASKO is a good source of biologically active compounds to be used as functional, therapeutical, and antimicrobial agents in food and pharmaceutical products.

Soils exhibit structural heterogeneity across diverse spatio-temporal scales, yielding myriad of microhabitats, highlighting the need for a nuanced understanding of the intricate interactions within the soil matrix. At the nanometer scale, the interplay among organic matter (OM), mineral particles, and microbiota intricately govern the long-term destiny of soil carbon (C), nutrient cycling, and the fate of both organic and inorganic pollutants. Notably, the sorption of soil organic matter (SOM) onto smaller clay particles and its entrapment in microaggregates further contribute to this complex dynamic. Understanding these processes depends on recognizing their scale-dependent nature, necessitating sophisticated techniques for investigation. Although various methods are employed across scales, the current set of techniques still lacks the requisite sensitivity and resolution for microscale data collection. To address this limitation, the adoption of novel microscopic and spectroscopic techniques capable of probing molecular, isotopic, and elemental patterns at the micro to nano scale becomes imperative. Among these cutting-edge methodologies, the nano-scale secondary ion mass spectrometer (NanoSIMS) emerges as a paradigm-shifting tool. Representing the latest evolution in ion microprobes, NanoSIMS seamlessly integrates high-resolution microscopy and isotopic analysis, maintaining unparalleled signal transmission and spatial resolution, reaching as fine as 50 nm. Its capabilities extend beyond conventional applications in science, as evidenced by recent breakthroughs in utilizing NanoSIMS to study biophysical interfaces in soils. This article underscores the pressing need to advance the incorporation of NanoSIMS as a pioneering instrumentation technique in soil studies. Furthering the implementation of this novel instrumentation technique in soil studies will pave avenues and aid in the advancement of future research.

Introduction The Centers for Disease Control and Prevention (CDC) issued a health advisory in response to an outbreak of Fusarium meningitis from exposure to spinal anesthesia for cosmetic surgery performed in Mexico between Jan 1 to May 13, 2023. This paper outlines the neuroendovascular and neurosurgical observations and management of this outbreak at our Comprehensive Stroke Center with a focus on angio‐invasive disease. Methods A retrospective chart review was performed for fungal meningitis patients that presented between April and July 2023. Results There were a total of 12 patients who were found to have fungal meningitis, 11 of whom were included in the final analysis with angio‐invasive Fusarium solani. The mean age was 31.7 ± 7.15. 92% of patients were female. CT and MRI were initially normal in two‐thirds of patients. No cases demonstrated positive growth on fungal cultures. Only (1→3)‐β‐D‐Glucan assays were positive in all patients who were tested. After several patients in this series developed subarachnoid hemorrhage from a ruptured mycotic aneurysm, we proceeded to institute weekly cerebral angiography protocol. This detected moderate to severe vasospasm in 75%, and aneurysms in 58%, with the most common site being the basilar artery. The aneurysms were seen exclusively in the posterior circulation. The average size of aneurysms when first detected was 5.0 ± 3.8 mm. Patients with brain aneurysms were treated with flow diversion in 57% of cases, primary coiling was performed in 14%, and the remaining expired prior to treatment. 14% in our series actually developed another episode of subarachnoid hemorrhage after treatment from a new angiographically confirmed aneurysm. All patients who presented with subarachnoid hemorrhage from mycotic aneurysms have passed or withdrawn care. With regard to vasospasm treatment, 80% had treatment with intra‐arterial verapamil and 40% underwent mechanical angioplasty. We did not perform balloon angioplasty in any case due to concern for rupture of the weakened compromised vessel walls. Finally with regard to cerebrospinal fluid (CSF) diversion; 67% underwent ventriculostomy, and a minority were converted to ventriculoperitoneal shunts. All but one patient received dual antifungal therapy with Amphotericin B and Voriconazole, and 42% were started on every other day intrathecal Amphotericin B. Conclusion We have found that in patients with fusarium meningitis that weekly angiographic surveillance for aneurysms and vasospasm should be performed. Conventional angiography is preferred to computed tomography angiography due to the smaller size of aneurysms. Aneurysms should be primarily coiled prior before flow diversion is attempted, and vasospastic vessels may be mechanically dilated in the setting of vessel wall necrosis.

Introduction There is a higher prevalence of diabetes mellitus type 2 in Hispanics as compared to other ethnic groups in the United States. Diabetes is a risk factor for acute ischemic stroke and also a poor predictor of outcome for many interventional surgeries. We performed this retrospective cohort analysis to assess the impact of poorly controlled diabetes, defined as HbA1C of 9.0% or greater, on the functional and procedural outcomes of Hispanic patients with acute ischemic stroke undergoing mechanical thrombectomy. Methods We conducted a retrospective review of a prospectively maintained patient database at a large volume comprehensive stroke center. Patients included were of Hispanic origin presenting between 2012 and 2022 who underwent thrombectomy for acute ischemic stroke. Baseline patient demographics and clinical characteristics recorded include age, gender, HbA1C level, National Institutes of Health Stroke Scale (NIHSS) at admission, manual CT ASPECTS and stroke risk factors (hypertension, atrial fibrillation, coronary artery disease, congestive heart failure, LDL, smoking, history of stroke/TIAs). Patients were separated into two groups depending on the presence poorly controlled diabetes defined as an HbA1C of 9.0% or greater. Outcomes evaluated include modified Rankin scale at 3 months, symptomatic intracranial hemorrhage, mass effect, 90‐day mortality, and whether any stenting or angioplasty was required during mechanical thrombectomy. Results 495 patients met the inclusion criteria out of which 69 had HbA1c of 9% or greater. Patients with poorly controlled diabetes were significantly younger (median age 63 vs 72, p

Introduction Hemorrhagic transformation is a major complication of large vessel occlusion (LVO) recanalization after mechanical thrombectomy in acute ischemic stroke. We investigated whether computed tomography perfusion (CTP) derived hypoperfusion index ratio correlates with the rate of hemorrhagic transformation. Methods We conducted a retrospective cohort analysis of a prospectively maintained patient database. Included patients underwent mechanical thrombectomy for large vessel ischemic stroke from January 2019 to December 2022. Patients were separated into 2 groups depending on whether or not hemorrhagic transformation developed. Hypoperfusion index ratio on admission CTP was determined using VizAI software. Data were analyzed using Chi‐square and Mann‐Whitney U tests. Results Among the 289 patients included (median age, 72.5; 41.5% female), 55 (19%) had hemorrhagic transformation. Patients with hemorrhagic transformation had a significantly higher hypoperfusion index ratio (median, 0 vs 0.2; P= 0.004) compared with those with no hemorrhagic transformation. Multivariable analysis showed that for every 0.1 increase in the hypoperfusion index ratio, there was a significant 4.64‐fold increase in hemorrhagic transformation (OR 4.64; 95% CI 1.40 to 15.18; p=0.011). Conclusion In patients with LVO who underwent mechanical thrombectomy, a higher hypoperfusion index ratio on admission CTP was associated with an increased rate of hemorrhagic transformation. This suggests that the hypoperfusion index ratio could be used as a predictor for hemorrhagic transformation after mechanical thrombectomy.

Abstract Studies of the impacts of solar geoengineering have mostly ignored tropospheric chemistry. By decreasing the sunlight reaching Earth's surface, geoengineering may help mitigate anthropogenic climate change, but changing sunlight also alters the rates of chemical reactions throughout the troposphere. Using the GEOS‐Chem atmospheric chemistry model, we show that stratospheric aerosol injection (SAI) with sulfate, a frequently studied solar geoengineering method, can perturb tropospheric composition over a span of 10 years, increasing tropospheric oxidative capacity by 9% and reducing methane lifetime. SAI decreases the overall flux of shortwave radiation into the troposphere, but increases flux at certain UV wavelengths due to stratospheric ozone depletion. These radiative changes, in turn, perturb tropospheric photochemistry, driving chemical feedbacks that can substantially influence the seasonal and spatial patterns of radiative forcing beyond what is caused by enhanced stratospheric aerosol concentrations alone. For example, chemical feedbacks decrease the radiative effectiveness of geoengineering in northern high latitude summer by 20%. Atmospheric chemical feedbacks also imply the potential for net global public health benefits associated with stratospheric ozone depletion, as the decreases in mortality resulting from SAI‐induced improvements in air quality outweigh the increases in mortality due to increased UV radiation exposure. Such chemical feedbacks also lead to improved plant growth. Our results show the importance of including fuller representations of atmospheric chemistry in studies of solar geoengineering and underscore the risk of surprises from this technology that could carry unexpected consequences for Earth's climate, the biosphere, and human health.

Abstract Objective Chronic obstructive airway disease (COPD) is characterized by airflow limitation due to airway and/or alveolar abnormalities with significant extra‐pulmonary manifestations. Bone health impairment is an extra‐pulmonary complication of COPD which is less well studied in India. Moreover, it can contribute to significant morbidity and mortality. Hence, we aim to estimate the prevalence of osteoporosis and metabolic parameters of adverse bone health in patients with COPD. Methods In this case control study, male subjects aged 40–70 years with COPD attending the respiratory outpatient clinic in a tertiary care hospital were recruited over a period of 2 years and the control population were derived from the historical cohort who were apparently healthy with no obvious diseases. Metabolic parameters of bone health measured from fasting blood samples were calcium, albumin, alkaline phosphatase, phosphorous, parathormone, creatinine, 25‐hydroxy vitamin D, and testosterone. Bone mineral density (BMD) was estimated using DXA scan and the World Health Organization (WHO) criteria was used to categorize into osteoporosis, osteopenia, and normal BMD based on the T‐score at femoral neck, lumbar spine and distal forearm. Pulmonary function tests and 6 minute walk test were performed if they had not been done in the previous 3 months. The associations of COPD with osteoporosis were analyzed using linear regression analysis and effect size are presented as beta with 95% confidence interval. Results Of the 67 participants with COPD enrolled in the study, osteoporosis was present in 61% (41/67) and osteopenia in an additional 33% (22/67) of the cases, which was higher when compared to the control population (osteoporosis 20% [50/252] and osteopenia 58% [146/252]). In regression modeling, there was a trend toward adverse bone health with advanced age, low body mass index, low forced expiratory volume in 1 second and testosterone deficiency in COPD. Conclusion Individuals with COPD have a substantially higher prevalence of osteoporosis and osteopenia, up to almost twice that of the general population, with a significant number demonstrating at least one parameter of adverse metabolic bone health on assessment. Hence, bone health assessment should be a part of comprehensive COPD care to prevent adverse consequences due to poor bone health.

Abstract The United States Federal Emergency Management Agency (FEMA) provides funding to state and local governments as well as tribes and territories (SLTTs) through its Flood Mitigation Assistance (FMA) grant program to engage in flood risk management efforts. Although all communities are susceptible to flooding, flooding does not impact communities equally. This article contributes to FEMA's goal of addressing equity concerns by examining whether the FMA program is distributed equitably in counties located in eight coastal states in the United States. Using secondary data from OpenFEMA, the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, and parcel‐level flood risk data from First Street Foundation from 2016 to 2020, results indicate that socially vulnerable counties are less likely to receive FMA funding, and counties with greater average flood risk are more likely to receive FMA funding. The findings suggest that there is an opportunity for FEMA to improve the FMA program so that funding can be more equitably distributed, such as providing grant writing and application training and support to socially vulnerable communities, educating socially vulnerable communities about the benefits of the FMA program, and extending the application deadline for socially vulnerable communities impacted by flood events.

Abstract Introduction Covid‐19 is linked with the development of cardio‐metabolic disorders, including dyslipidemia, dysregulation of high‐density lipoprotein (HDL), and low‐density lipoprotein (LDL). Furthermore, SARS‐Co‐2 infection is associated with noteworthy changes in lipid profile, which is suggested as a possible biomarker to support the diagnosis and management of Covid‐19. Methods This paper adopts the literature review method to obtain information about how Covid‐19 affects high‐risk group patients and may cause severe and critical effects due to the development of acute lung injury and acute respiratory distress syndrome. A narrative and comprehensive review is presented. Results Reducing HDL in Covid‐19 is connected to the disease severity and poor clinical outcomes, suggesting that high HDL serum levels could benefit Covid‐19. SARS‐CoV‐2 binds HDL, and this complex is attached to the co‐localized receptors, facilitating viral entry. Therefore, SARS‐CoV‐2 infection may induce the development of dysfunctional HDL through different mechanisms, including induction of inflammatory and oxidative stress with activation of inflammatory signaling pathways. In turn, the induction of dysfunctional HDL induces the activation of inflammatory signaling pathways and oxidative stress, increasing Covid‐19 severity. Conclusions Covid‐19 is linked with the development of cardio‐metabolic disorders, including dyslipidemia in general and dysregulation of high‐density lipoprotein and low‐density lipoprotein. Therefore, the present study aimed to overview the causal relationship between dysfunctional high‐density lipoprotein and Covid‐19.

Abstract Sclerosing epithelioid fibrosarcoma (SEF) is a rare and distinctive variant of fibrosarcoma. To date, about 100 cases only have been documented. Histopathologically, it resembles a variety of benign, pseudosarcomatous and other malignancies. Early diagnosis and treatment are vital for improving the treatment outcomes.

Abstract Aim This study aimed to explore the perception of other healthcare professionals, including the doctors, physiotherapists and perfusionists, about the nurses' role and competencies in veno‐venous extracorporeal membrane oxygenation. Background Extracorporeal membrane oxygenation is considered as a challenging clinical activity that requires critical decision and rapid response from nurses, particularly in emergencies. It was observed that nurses are primarily responsible for bedside management of these patients, and teamwork was found helping the nurses to manage this high‐acuity care. However, little is known on the perception of other healthcare professionals about the nurses' roles and competencies, which would contribute to further improvements in quality extracorporeal membrane oxygenation care. Design This was a qualitative descriptive study. Methods One‐to‐one in‐depth interviews were conducted with nine healthcare professionals working in extracorporeal membrane oxygenation care in an adult intensive care unit of a general hospital in Kuwait. Results Participants reported that nurses play critical and multiple roles and responsibilities in the insertion, maintenance, weaning, and retrieval of extracorporeal membrane oxygenation, plus providing general nursing care, and performed their roles competently. Heavy workload, less recognition and support, and individual differences in competence were reported as possible barriers to the nurses' performance. Conclusion Other healthcare professionals recognize continuous training, having experience, teamwork, and increased staffing as measures that can promote the nurses' role in extracorporeal membrane oxygenation.

Abstract Background and Aims The burden of noncommunicable diseases is increasing in developing countries and in settings with an existing communicable burden. The study aim was to identify the disease pattern, length of stay, and clinical outcome of medical admissions. Methods A retrospective observational study of patients admitted to medical wards between 1st July 2019 and 30th June 2020, excluding those admitted for chemotherapy. The outcome measures were the pattern of disease, length of stay, and clinical outcome. Results A total of 3930 patients were analyzed. A total of 53.5% were males, and 42.9% were aged 51–75 years, with a median age of 57 years (IQR 41–71). A total of 41.3% had health insurance, 21.7% died, and the median length of stay was 6 days (IQR 4–9). Cardiovascular diseases were the most common diagnosis (26.8%) on admission and cause of death (27.9%). The common causes of death were stroke (15.1%), chronic kidney disease (11.1%), and heart failure (9.0%). Noninsured patients had a high mortality risk (odds ratios [OR] 1.67, 95% confidence interval [CI] 1.42–1.96), which was also seen among patients aged more than 75 years (OR 1.3, 95% CI 1.08–1.57), patients with communicable diseases (OR 1.44, 95% CI 1.23–1.68), and weekend admissions (OR 1.29, 95% CI 1.08–1.55). The 72‐h admission window is critical due to a very high mortality risk (OR 3.03, 95% CI 2.58–3.56). Conclusion Cardiovascular diseases are the leading cause of hospital admissions and deaths in a tertiary hospital in Northern Tanzania. Lifestyle modification, health education, and community resources are needed to combat the growing burden of cardiovascular and renal disease.

Abstract This paper proposes an adaptive real‐time energy scheduling method (RT‐EMS) for a microgrid, using a Lyapunov optimization‐based real‐time approach. Inaccuracy in day‐ahead predictions can result in non‐optimal solutions to the energy scheduling problem. Although the real‐time optimization method eliminates the need to deal with the prediction uncertainties, it ignores the valuable statistical information used in day‐ahead stochastic approaches and provides suboptimal solutions to the problem. The proposed adaptive approach combines the advantages of both the stochastic day‐ahead and the RT‐EMS and reduces the real‐time operational cost of the microgrid. The proposed method moves the RT‐EMS solution towards the optimal solution, by adding a penalty term to the objective function. Numerical results are provided to demonstrate the improved performance of the proposed adaptive method.

Abstract Transportation sector is one of the core parts of modern civilization. Proper utilization of energy and exergy in this sector is necessary to ensure energy loss and environmental sustainability. Increasing exergy efficiency will reduce carbon emissions from this sector. Since 1970, Reistad estimates have been widely used to determine the energy and exergy efficiencies of this sector. However, the modern transport sector has undergone significant changes in recent decades. Hence, it is necessary to apply new Reistad estimates in determining the energy and exergy efficiencies. This is the first study to apply updated Reistad estimates to explore the energy and exergy efficiencies in the transportation sector of Bangladesh based on the data from 2000 to 2017. The overall exergy efficiency is significantly lower than the energy efficiencies as it ranges from 27.7% to 30.0%. Efficiencies are lower as the maximum portion of input exergy is lost to the environment. The road subsector needs major improvements as it is responsible for major amount of exergy loss. A comparison is made between conventional and updated estimates which highlights that the updated estimates provide more accurate results. Thus, it is recommended to apply updated Reistad estimates in determining the energy and exergy efficiencies of the transport sector.

Abstract A hybrid multiple pulse amplitude and position modulation (H‐MPAPM) scheme based on gradual multi‐pulse pulse‐position modulation (G‐MPPM) and multi‐level pulse amplitude modulation (M‐PAM) schemes is proposed for deep‐space optical communication. In this scheme, transmitted information is conveyed by different combinations of the positions and amplitudes of multiple optical pulses. The performance of the proposed scheme with multi‐pulse pulse‐position modulation (MPPM), G‐MPPM and multiple pulse amplitude and position modulation (M‐PAPM) schemes in terms of the number of transmitted symbols, data rate, symbol error rate (SER), bit error rate (BER), bandwidth utilization efficiency and power requirements are studied in this work. Our results reveal that, at the same frame size, the proposed scheme allows much more symbols per frame transmission, achieves higher transmission energy and further enhance the bandwidth utilization efficiency of MPPM, G‐MPPM and M‐PAPM schemes. Moreover, compared to the MPPM and G‐MPPM, the proposed scheme achieves lower levels of SERs but at the expense of peak power levels. Furthermore, the proposed scheme outperforms G‐MPPM and MPPM schemes by approximately 1 and 2 dB at a BER of 10−6, respectively. In addition, the analytical expressions for the BER and SER of the proposed scheme are validated using Monte Carlo (MC) simulations.

Abstract Extra‐uterine leiomyoma (EUL) is extremely rare and due to its unusual location, results into diagnostic dilemma and due to its unusual location may lead to surgical complication as in this case. We present a case of large broad ligament leiomyoma in a 40‐year‐old premenauposal that was excised with challenges.

Abstract Background and Aims Frail older adults are more than twice as likely to experience postoperative complications. Preoperative exercise may better prepare these patients through improved stamina and mobility experienced in the days following surgery. We measured the impact of a walking intervention using an activity tracker and coaching on postoperative stamina, and mobility in older adults with frailty traits. Methods We included patients aged 60+ and scoring 4+ on the Edmonton Frailty Scale. We then randomized patients to intervention versus control stratified by anticipated hospital stay (1 night vs. 2+ night) and baseline stamina (i.e., 6‐min walk distance [6MWD]). Intervention patients received an activity tracker and linked smart phone. An athletic trainer (AT) prescribed a daily step count goal and titrated this up after checking in with patients during weekly telephone calls. Controls received general walking recommendations. We then measured postoperative 6MWD 1–3 days after surgery. We also assessed postoperative mobility by measuring steps walked the day after surgery using a thigh‐worn monitor. Because many patients could not walk postoperatively, we compared intervention‐control difference in both 6MWD and steps using Wilcoxon rank testing and Tobit and ordinal logistic regression adjusting for several patient characteristics. Results We randomized 104 eligible patients; 80 patients remained for final analysis. There was no difference in intervention versus control postoperative 6MWD (median 72 vs. 74 m Wilcoxon p = 0.54) or postoperative steps taken (median 128 vs. 51 steps Wilcoxon p = 0.76). Analysis adjusting for patient characteristics was consistent with these findings. Conclusion Our intervention consisting of goal setting with an activity tracker and telephonic coaching by an AT did not appear to improve stamina or mobility measured in the days after surgery. Small sample size limited our ability to examine this impact in subsets defined by surgical specialty or baseline stamina.

Abstract Young adults with HCC tend to have a poor prognosis because of advanced disease despite preserved liver function. Screening and early diagnosis for HCC are needed for young adults to demonstrate an improved prognosis, especially in HBsAg positive patients.

Abstract In a young patient with systemic lupus erythematosus presenting with status epilepticus and neurological deficits, early brain imaging, risk factor identification and prompt treatment of underlying lupus flare‐up and cerebral venous sinus thrombosis could significantly improve the management and prognosis.

AZD9567 is a potent and selective nonsteroidal oral glucocorticoid receptor modulator. It is developed as an anti‐inflammatory drug with improved safety profile compared with steroids like prednisolone. Throughout the clinical development of AZD9567, dose selection and data interpretation require a method for determining doses with the same anti‐inflammatory effect as prednisolone. Equipotent doses of AZD9567 and prednisolone were defined by the same average inhibition of TNFα release, a biomarker of anti‐inflammatory effect, measured in a lipopolysaccharide‐stimulated whole blood ex vivo assay. Based on pharmacokinetic‐pharmacodynamic models, TNFα dose‐response relationships for AZD9567 and prednisolone were established. A comparison of the dose‐response curves enabled estimation of an equipotency relationship. Specifically, 20 mg prednisolone was estimated to be equipotent to 40 mg AZD9567 (95% confidence interval: 29–54 mg). Static concentration‐response analyses showed that the relative potencies for inhibition of TNFα release of AZD9567 and prednisolone were well aligned with several other pro‐inflammatory cytokines.

Abstract Irregular pericardial wall thickening, mediastinal lymph nodes, and pericardial fluid analysis are helpful to identify metastasis to the pericardium though it is a marker of advanced disease and poor prognosis.

Background Atrial fibrillation (AF) commonly occurs in the setting of acute conditions. We aimed to identify the acute conditions associated with secondary AF (AF precipitants) including pneumonia/sepsis, pneumothorax, respiratory failure, myocarditis, pericarditis, alcohol intoxication, thyrotoxicosis, cardiothoracic surgery, other surgery in patients with newly diagnosed AF and determine their association with subsequent oral anticoagulant use. Methods and Results We assembled a cohort of patients in the UMass Memorial Healthcare system with a new diagnosis of AF with and without AF precipitants. We used combinations of International Classification of Diseases, Tenth Revision (ICD‐10) codes, Current Procedural Terminology codes, laboratory values, imaging reports, and physician notes including discharge summary texts to identify AF precipitants. We then manually reviewed the individual charts to validate presence of AF precipitants. The study sample consisted of 185 patients with and 172 patients without AF precipitants. Pneumonia/sepsis, myocardial infarction, respiratory failure, and cardiothoracic surgery were the most common precipitants identified. In multivariable analyses adjusting for age, sex, patient comorbidities, left atrial enlargement, left ventricular ejection fraction, and antiplatelet use, patients with AF precipitants were less likely to receive subsequent anticoagulation therapy at 30 days after the initial AF diagnosis (odds ratio, 0.31; 95% CI, 0.19–0.52). The association was persistent after excluding men with CHA2DS2‐VASc score

Abstract Spontaneous aortic thrombosis is rare, and prompt diagnosis is needed whenever encountering a case of unexplained abdominal pain. The cause of the thrombosis needs to be evaluated thoroughly to rule out any underlying thrombophilias.

Background Cardiac manifestations in COVID-19 are multifactorial and are associated with increased mortality. The clinical utility and prognostic value of echocardiography in COVID-19 inpatients is not clearly defined. We aim to identify echocardiographic parameters that are associated with 30-day clinical outcomes secondary to COVID-19 hospitalization. Methods This retrospective cohort study was conducted in a large tertiary hospital in New York City during the COVID-19 pandemic. It included 214 adult inpatients with a laboratory-confirmed diagnosis of COVID-19 by reverse transcriptase polymerase chain reaction assay (RT-PCR) for SARS-CoV-2 on nasopharyngeal swab and had a transthoracic echocardiogram performed during the index hospitalization. Primary outcome was 30-day all-cause inpatient mortality. Secondary outcomes were 30-day utilization of mechanical ventilator support, vasopressors, or renal replacement therapy. Results Mild right ventricular systolic dysfunction (odds ratio (OR): 3.51, 95% confidence interval (CI): 1.63–7.57, p = 0.001), moderate to severe right ventricular systolic dysfunction (OR: 7.30, 95% CI: 2.20–24.25, p = 0.001), pulmonary hypertension (OR: 5.39, 95% CI: 1.96–14.86, p = 0.001), and moderate to severe tricuspid regurgitation (OR: 3.92, 95% CI: 1.71–9.03, p = 0.001) were each associated with increased odds of 30-day all-cause inpatient mortality. Pulmonary hypertension and moderate to severe right ventricular dysfunction were each associated with increased odds of 30-day utilization of mechanical ventilator support and vasopressors. Conclusions Right ventricular dysfunction, pulmonary hypertension, and moderate to severe tricuspid regurgitation were associated with increased odds for 30-day inpatient mortality. This study highlights the importance of echocardiography and its clinical utility and prognostic value for evaluating hospitalized COVID-19 patients.