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Purpose: The aim of this retrospective observational study is to compare C-reactive protein to albumin ratio and CURB-65 score in the emergency department in terms of predicting mortality in patients over the age of 18 who were hospitalized for COVID-19 pneumonia.Materials and Methods: The study includes 613 patients hospitalized between March 15 and April 30, 2020 due to COVID-19 pneumonia detected on thorax computed tomography at the emergency department pandemic area. Hospitalized patients were divided into groups according to positive and negative real-time polymerase chain reaction results. Results: While 73.1% (n: 448) of 613 patients included in the study were hospitalized in the ward, 26.9% (n: 165) were hospitalized in intensive care. 8.6% (n: 53) of the total patients died. In non-survivors patients the mean CURB 65 score was 4±1 (and C-Reactive Protein to Albumin Ratio was 5.6±4.2 Multivariate logistic regression analysis showed that CURB 65 and high C-Reactive Protein to Albumin Ratio are independent risk factors for COVID-19 pneumonia. Conclusion: The C-reactive protein to albumin ratio is as sensitive as CURB 65 and can guide the clinician in the early detection of patients with poor prognosis COVID-19 pneumonia., Amaç: Bu retrospektif gözlemsel çalışmanın amacı, COVID-19 pnömonisi nedeniyle hastaneye yatırılan 18 yaş üstü hastalarda mortaliteyi öngörme açısından acil serviste bakılan C-reaktif protein/albumin oranı ile CURB-65 skorunun karşılaştırılmasıdır.Gereç ve Yöntem: Çalışma 15 Mart-30 Nisan 2020 tarihleri arasında acil servis pandemi alanında toraks bilgisayarlı tomografisinde COVID-19 pnömonisi tespit edilerek hastaneye yatırılan 613 hastayı kapsamaktadır. Hastanede yatan hastalar pozitif ve negatif gerçek zamanlı polimeraz zincir reaksiyonu sonuçlarına göre gruplara ayrıldı.Bulgular: Çalışmaya dahil edilen 613 hastanın %73,1'i (n:448) serviste yatarken, %26,9'u (n:165) yoğun bakımda yatmaktaydı. Toplam hastaların %8,6'sı (n:53) öldü. Ölen hastalarda CURB 65 skoru ortalama 4±1 ve C-reaktif protein/albümin oranı 5.6±4.2 idi.. Çok değişkenli lojistik regresyon analizi, CURB 65 skorunu) ve yüksek C-reaktif protein/albümin oranı olduğunu gösterdi.) COVID-19 pnömonisi için bağımsız risk faktörleri olarak göstermiştir.Sonuç: C-reaktif protein/albumin oranı, kötü prognozlu COVID-19 pnömonisi olan hastaların erken tespitinde CURB 65 kadar duyarlı olup klinisyene yol gösterebilir.

Online news blogs and websites are becoming influential to any society as they accumulate the world in one place. Aside from that, online news blogs and websites have efficient strategies in grabbing readers’ attention by the headlines, that being so to recognize the sentiment orientation or polarity of the news headlines for avoiding misinterpretation against any fact. In this study, we have examined 3383 news headlines created by five different global newspapers. In the interest of distinguishing the sentiment polarity (or sentiment orientation) of news headlines, we have trained our model by seven machine learning and two deep learning algorithms. Finally, their performance was compared. Among them, Bernoulli naïve Bayes and Convolutional Neural Network (CNN) achieved higher accuracy than other machine learning and deep learning algorithms, respectively. Such a study will help the audience in determining their impression against or for any leader or governance; and will provide assistance to recognize the most indifferent newspaper or news blogs.

PurposeThis paper aims to examine how the quality of work-life (QWL) factors influence job satisfaction and tests if organization type moderates this relationship.Design/methodology/approachThe study adopts a quantitative cross-sectional research design using survey administration among resident doctors used in the Indian health-care sector. Drawing on the person-environment fit theory, leader-member exchange theory and action learning theory, the authors discuss the results.FindingsResults depicted that in addition to the direct relationship between QWL and job satisfaction, this association is moderated by organization type.Practical implicationsThe study provides critical information for health-care managers to prioritize three QWL attributes, namely, meaningful development, supervision, working conditions to enhance job satisfaction among resident doctors.Originality/valueThe study contributes to the limited empirical scholarly research adding a deeper understanding of pertinent factors influencing resident doctor’s QWL-job satisfaction relationship.

This study conducted an in-depth analysis combining computational and experimental verifications of the deleterious missense mutations associated with the SLC29A4 protein. The functional annotation of the non-synonymous single nucleotide polymorphism (nsSNPs), followed by structure-function analysis, revealed 13 single nucleotide polymorphisms (SNP) as the most damaging. Among these, six mutants P429T/S, L144S, M108V, N86H, and V79E, were predicted as structurally and functionally damaging by protein stability analysis. Also, these variants are located at evolutionary conserved regions, either buried, contributing to the structural damage, or exposed, causing functional changes in the protein. These mutants were further taken for molecular docking studies. When verified via experimental analysis, the SNPs M108V (rs149798710), N86H (rs151039853), and V79E (rs17854505) showed an association with type 2 diabetes mellitus (T2DM). Minor allele frequency for rs149798710 (A G) was 0.23 in controls, 0.29 in metformin responders, 0.37 in metformin non-responder, for rs151039853 (A C) was 0.21 in controls, 0.28 in metformin responders, 0.36 in metformin non-responder and for rs17854505 (T A) was 0.20 in controls, 0.25 in metformin responders, 0.37 in metformin non-responder. Hence, this study concludes that SLC29A4 M108V (rs149798710), N86H (rs151039853), and V79E (rs17854505) polymorphisms were associated with the increased risk of T2DM as well as with the increased risk towards the failure of metformin therapeutic response in T2DM patients of Pakistan. Communicated by Ramaswamy H. Sarma.

Objective: To compare the efficacy of 2% diltiazem gel with 0.2% glyceryl trinitrate in patients presenting with chronic anal fissure at Tertiary Care Hospital, Larkana. Methodology: This prospective comparative Study was conducted at department of Surgery ward-II Chandka Medical Hospital, Larkana from 14-01-19 to 14-07-19. A total of 130 patients who were treated as OPD cases were included in this study. Each patient detailed history & clinical examination, details of symptomatology was recorded in a epically diagnosed proforma. These patients were randomly divided in two equal groups i-e group A 65 patients and group B 65 patients. Group A patients were treated with 02% glyceryl trinitrate and group B patients were treated with diltiazem gel 02%. All the patients of group A & B were followed up to 02 months after start of leadema as a OPD cases. Results: A total of 130 patients (65 each in 2% diltiazem gel with 0.2% glyceryl trinitrate group) were included. Mean age in both groups was 42.56±3.91 and 41.71±4.01. 46 (70.8%) and 19 (29.2%) were male and female in Group A and 39 (60%) and 26 (40%) were male and female in Group B. Efficacy of 2% diltiazem gel with 0.2% glyceryl trinitrate in patients presenting with chronic anal fissure was 76.9% and 50.8% respectively. Conclusion: DTZ (2%) and GTN (0.2%) are equally effective in healing anal fissures. DTZ is better than GTN as it causes less side effects, low recurrence rate, healing rate and therefore better compliance.

Severe acute respiratory syndrome coronavirus 2 causes coronavirus disease 2019 (Covid-19), which has been declared as a pandemic by the World Health Organization. The aim of the study described here was to determine the severity of pneumonia and the clinical parameters related to a modified lung ultrasound score (mLUS) in patients with COVID-19 pneumonia. The study included 44 patients with proven COVID-19 pneumonia. Patients were divided into three groups on the basis of pneumonia severity: mild/moderate pneumonia (group I), severe pneumonia (group II) and critically ill patients (group III). It was determined that mLUS values in groups I–III were 6.51 ± 4.12, 23.5 ± 5.9 and 24.7 ± 3.9, respectively. mLUS values were significantly higher in group II and III patients than in group I patients. There was a positive relationship between mLUS and age and N-terminal pro-brain natriuretic peptide level and a negative relationship with PaO2/FiO2 (p = 0.032, β = 0.275 vs. p = 0.012, β = 0.315 vs. p = 0.001, β = –0.520, respectively). In patients with COVID-19 pneumonia, mLUS increases significantly with the severity of the disease.

Objective: Using non-invasive methods, such as BMI and CT LAIto suggest a prediction model for hepatic steatosis, examine the CT liver attenuation index and body mass index (BMI)association for pathological steatosis in living liver donors. Histological analysis remains the standard reference. Study Design: Retrospective study Place and Duration of Study: Liver Transplantation Department, Bahria International Hospital Orchard, Lahore from 1st June 2017 to 31st December 2018. Methodology: Fifty-nine donors were included with a median age of 23.00 years, as well as the potential donors for LDLT who experienced evaluation as a potential liver donor. Donors who underwent CT scan and histological liver evaluation were part of this study. Results: Of the donors, forty-eight (81.35%) had a CT LAI ≥1. The median BMI was 22.1 (range: 17.00–33.4). Twenty eight (47.5%) of the patients had undergone liver biopsy for screening in the pre-transplant period whereas 31 (52.5%) of the total evaluated donors underwent biopsy during the transplant. Thirty four (57.62%) out of 59 evaluated living liver donors underwent hepatectomy. Non-significant association (P=0.719) between different categories of BMI as the steatosis increases histologically, whereas significant association (P

Background: Female pattern hair loss is also observed in women without increased androgen levels. Vitamin D is a factor that has recently been considered in dealing with these patients. Deficiency of Vitamin D might be correlated with diffuse hair loss. Objective: To determine the frequency of serum levels of Vitamin D3 in patients with female pattern of hair loss (FPHL) at tertiary care hospital Karachi. Methodology: This cross-sectional research was conducted upon a sample of 163 female patients (chosen via non-probability – consecutive sampling) presenting to the Dept. of Dermatology, Abbasi Shaheed Hospital, Karachi from 29th July 2018 to 28 th January 2019, with a clinical diagnosis of FPHL. Data was recorded onto a structured questionnaire containing inquiries pertaining to basic biodata, sociodemographic details, and inferences obtained from blood tests (CBC, serum ferritin, TSH level and vitamin D level). Serum 25 OH Vitamin D level < 20 was taken as deficient, 21-29 was insufficient and over 30 was sufficient. Data was analyzed using SPSS. v. 21.0. Results: The mean age was 30.39±6.36 years. Mean FPHL duration was 5.85±2.89 months. Total 63.2% patients were classified as mild, 26.45% patients were classified as moderate and 10.4% patients were classified as severe. Total 73% patients were found as vitamin D deficient, 22.1% as vitamin D insufficient and 4.9% as vitamin D sufficient. Significant association of vitamin D deficiency was observed with education status, vitamin D intake since past 6 months, and socio economic status. Conclusion: Results showed high vitamin D3 deficiency (73.0%) among patients with female pattern of hair loss (FPHL).

Purpose: To evaluate iron deficiency anemia and other concomitant risk factors among pregnant women in a tertiary care hospital in Sargodha District of Pakistan. Methods: An observational cross-sectional study on pregnant women over a six-month period from December 2016, was conducted in the gynaecology and obstetrics department of the District Headquarters Hospital, Sargodha, Pakistan. All women with renal failure, heart disease and surgical history were excluded from the study, while all pregnant women visiting the out-patient department (OPD) were included in the investigation. Blood sampling and analysis were performed, following standard laboratory operating procedures to determine the haemoglobin (Hb) levels of the patients. Results: Fifty pregnant women were enrolled in this study. They had a mean age of 27.85 ± 4.99 years with a range of 20 – 46 years. Almost half, i.e., 26 (52 %), were aged 20 – 30 years; 18 (36 %) 31 – 40 years and six (12 %) > 40 years of age. Regarding occupational status, 45 (90 %) of the respondents were housewives. In total, 86 % of the women were anemic, while the remaining 14 % were non-anemic and had an Hb level slightly > 11 g/dL. Among the anemic women, 13 (26 %) had mild anemia, 33 (66 %) moderate anemia, and 4 (8 %) were severely anemic. Conclusion: Iron deficiency and anemia have major health impacts on pregnant women. Steps should be taken during ante-natal care to monitor Hb levels in pregnant women and apply appropriate remedy where necessary. Other biomarkers and related risk factors such as total iron binding capacity (TIBC) and total blood count (TBC) have previously been found to be linked to anemia

Reduction in isometric strength of the scapulohumeral muscles is a commonly seen impairment in overhead athletes afflicted with shoulder impingement syndrome (SIS). The purpose of this study was to compare the effects of two different treatment programs: progressive resistance exercises plus manual therapy (PRE plus MT) and motor control exercises (MCE), on isometric strength of upper trapezius (UT), middle trapezius (MTr), lower trapezius (LT), serratus anterior (SA), supraspinatus (Supr.), anterior deltoid (A.D), and latissimus dorsi (LD). 80 male university-level overhead athletes clinically diagnosed with SIS were randomly allocated into either of the two groups: PRE plus MT and MCE group. Athletes in the PRE plus MT group underwent graduated exercises with resistance elastic band, stretching exercises, and mobilization of the thoracic and shoulder joints. MCE group was submitted to motor control exercises in varied planar positions. Athletes in both groups underwent management 3 times a week for 8 weeks. Isometric strength of UT, MTr, LT, Supr, A.D, SA, and LD was measured at three-time points: baseline, 4th week, and 8th week. Relative to baseline, both interventions were found to be effective in increasing and optimizing the isometric strength of muscles ( p < 0.05 ) except for supraspinatus in the MCE group ( p > 0.05 ). However, athletes in PRE plus MT group presented a more pronounced increase in isometric strength than those in the MCE group. Between groups analysis found the largest isometric strength improvement in PRE plus MT group for A.D, followed by Supr. and UT muscles ( p < 0.05 ; effect size: 0.39 to 0.40). The study concluded that compared to MCE, PRE plus MT provides greater improvement in the isometric strength of scapulohumeral muscles.

Swertia chirata (S chirata), (Family Gentianaceae) is a well-known herbaceous plant. It is very popular in traditional systems of medicine like Unani, Ayurveda, and Siddha. It is commonly used in Unani medicine, for several pharmacological effects including Musaffi-i-Dam (blood purifier), Muqawwi-i-Mida (stomachic), Muhallil-i-Awram (anti-inflammatory), Muqawwi-i-Qalb wa Jigar (tonic to heart and liver), Mulattif (demulcent), Mudir (diuretic), Mulliyin (laxative) properties. It is used for chronic fever, malaria, anemia, liver disorders, hypertension, dyspepsia, gastritis, ulcers, constipation, and skin diseases, and is included in many pharmacopoeial and non-pharmacopoeial preparations. The entire plant contains ophelic acid, two bitter glycosides chiratin, and amarogentin. It also contains resins, tannin, gum, carbonate, and phosphate of potash, lime, and magnesia. Extensive studies on S. chirata have been carried out by various researchers and a wide spectrum of its pharmacological actions have been explored which includes anti-inflammatory, anti-diabetic, antimicrobial, and antioxidant properties. The present review is an effort to provide a detailed survey of the literature, scientific researches of pharmacognostical characteristics, chemical composition, and pharmacological activities of this plant.

Background In patients with melanoma and asymptomatic brain metastases (MBM), nivolumab plus ipilimumab provided an intracranial response rate of 55%. Here, we present the first report for patients who were symptomatic and/or required corticosteroids and updated data for asymptomatic patients. Methods Patients with measurable MBM, 0.5-3.0 cm, were enrolled into Cohort A (asymptomatic) or Cohort B (stable neurologic symptoms and/or receiving corticosteroids). Nivolumab, 1 mg/kg, and ipilimumab, 3 mg/kg, were given intravenously every 3 weeks ×4, followed by nivolumab, 3 mg/kg, every 2 weeks until progression, unacceptable toxicity, or 24 months. The primary endpoint was intracranial clinical benefit rate (CBR; complete response [CR], partial response [PR], or stable disease ≥6 months). Results Symptomatic patients (N = 18) received a median of one nivolumab and ipilimumab combination dose and had an intracranial CBR of 22.2%. Two of 12 patients on corticosteroids had CR; 2 responded among the 6 not on corticosteroids. Median intracranial progression-free survival (PFS) and overall survival (OS) were 1.2 and 8.7 months, respectively. In contrast, with 20.6 months of follow-up, we confirmed an intracranial CBR of 58.4% in asymptomatic patients (N = 101); median duration of response, PFS, and OS were not reached. No new safety signals were observed. Conclusions Nivolumab plus ipilimumab provides durable clinical benefit for asymptomatic patients with MBM and should be considered for first-line therapy. This regimen has limited activity in MBM patients with neurologic symptoms and/or requiring corticosteroids, supporting the need for alternative approaches and methods to reduce the dependency on corticosteroids. Clinical trial registration. ClinicalTrials.gov, NCT02320058.

Aims and Objectives: To study the expression of immunomarker CD 44 and evaluate its diagnostic and prognostic significance and its correlation with clinicopathological variables in Breast Carcinoma. Materials and Methods: 50 diagnosed cases of breast carcinoma, presenting clinically with breast lumps were processed routinely for histopathological diagnosis of breast cancer and immunoexpression of CD 44 was performed. The immunoexpression of CD44 was detected mainly at the membrane of tumour cells and the scoring was performed. Results: 217 (98.2%) were females and 4(1.8%) males. Most common subtype involved was invasive carcinoma (NST) in 205(92.8%) cases. Out of 29 cases of grade 2 tumor, 07 (14.0%) showed 1+ score, 10(20.0 %) showed 2+ score and 12 (24.0%) cases showed 3+ immunoexpression. Out of 25 cases of T2 (2-5cm) size, 07(14.0%) showed 1+ score, 09(18.0%) case each showed 2+ score and 3+ immunoexpression. Out of 26 cases of stage III, 04(8.0%) showed 1+ score, 09(18.0%) showed 2+ score and 13(26.0%) cases showed 3+ immunoexpression. Out of 05 cases of N3, 02(4.0%) showed 2+ score and 03(6.0%) showed 3+ immunoexpression. Out of 21 cases of basal cell type, 03(6.0%) showed 1+ score, 07(14.0 %) showed 2+ score and 11(22.0%) cases showed 3+ immunoexpression. Out of 11 (50.0%) cases with weak to moderate expression of CD44, 7(31.8%) cases were stable and alive while 4(18.2%) died due to distant metastasis to various sites. Conclusions: CD 44 is associated with disease progression, recurrence, advanced metastasis and reduced disease free survival and can be used in future to predict early diagnosis of advanced disease. Keywords: Breast carcinoma, CD 44, Immunohistochemistry, Prognosis.

A binary neural network (BNN) chip explores the limits of energy efficiency and computational density for an all-digital deep neural network (DNN) inference accelerator. The chip intersperses data storage and computation using computation near memory (CNM) to reduce interconnect and data movement costs. It performs wide inner product operations to leverage parallelism inherent in DNN computations. The BNN chip leverages lightweight pipelining at a near-threshold voltage (NTV) to reduce the overhead of sequential elements. It employs optimized data access patterns to reduce memory accesses for convolutional operation with pooling layers. The combination of these techniques enables the BNN chip to achieve a peak energy efficiency of 617 TOPS/W. The digital BNN chip approaches the energy efficiency of analog in-memory techniques while also ensuring deterministic, scalable, and bit-accuracy operation. Moreover, the all-digital design leverages process scaling and does not require additional memory transistors or passive devices to attain a peak compute density of 418 TOPS/mm2 and a memory density of 414 KB/mm2. The binary design is extended to enable bit-serial integer precision operation with a reconfigurable 1-b multiplication circuit and element-wise partial sum shift and accumulate. This technique allows for fine-grain mixed precision and retains energy efficiency by exploiting parallelism inherent in DNNs. The bit-serial binary operation allows for bit-accurate operation and high DNN accuracy that multibit analog compute-in-memory designs struggle to attain. It provides favorable energy tradeoffs compared with small-integer digital DNN accelerators.

Learning outcomes After a thorough analysis of the case, students will be able to do the following: understand the building blocks of incentive structure in an organizational setting. Review the existing incentive structure at WINFORT. Develop effective incentive approaches to motivate employees at workplace. Illustrate the importance of performance management review to motivate employees. Case overview/synopsis The case explores the motivational state of a talent acquisition executive or talent scout working for a staffing firm, WINFORT Services in New Delhi, India. The two main characters in the cast are Helena Stacy, the Lead Talent Scout at WINFORT and Sofia Williams, the Talent scout. There was a meeting conducted between Helena and Sofia regarding the latter’s performance review held annually. However, to Sofia’s surprise, she could to get any salary hike this time as she failed to achieve her given targets. This led to a serious altercation between the two and resulted in Sofia started thinking of looking for alternate job opportunities. Complexity academic level The case is suitable for any postgraduate course, in particular MBA or MBA executive development program on human resource management, talent management, compensation and benefits, and as a module on motivation in organizational behavior. Subject code CSS 6: Human Resource Management. Supplementary materials In addition, there are more resources available to augment the understanding of the business operations of staffing firms in India. Interested instructors and students are advised to go through these resources to better understand the routine operations of a staffing organization. https://talentcorner.in/how-recruitment-industry-generates-wealth/ https://wowidea.in/how-recruitment-agencies-in-india-works/ https://www.michaelpage.be/about-us/our-recruitment-process?fbclid=iwar0ftzztbzm5afvdwv_oyvp1f1p8zgpuflrbt8z6yg9zakm5c0kaoaom6ha

Epithelial ovarian cancer normally spreads transcoelomically via the peritoneal cavity and then, in more advanced stages, to the intra-abdominal lymph nodes and the liver and lung parenchyma. Bone metastasis is an extremely rare initial presentation in patients with primary carcinoma of the ovary and is associated with poor prognosis. Herein we report a rare case of femoral metastasis of papillary carcinoma of the ovary in a 49-year-old female, who presented to the orthopaedics clinic with complaints of pain and swelling around the left knee joint since 2 months. X ray and MRI of left leg showed a diffuse soft tissue swelling and osteolytic lesions in the lower femur around the condyles with focal cortical destruction. Fine needle aspiration biopsy of the lesion was suggestive of metastatic adenocarcinoma. Subsequent ultrasonography of the lower abdomen showed a hypoechoic shadow in the left ovary. Local surgical excision with left oopherectomy was performed. After histopathologic and immunohistochemical examination from both the sites, a final diagnosis of primary papillary adenocarcinoma of the ovary with femoral metastasis was given. She was treated with 6 cycles of adjuvant combination chemotherapy of Paclitaxel 150 mg/m2and Cisplatin 50 mg/m2 and a good response was seen. This case is unique in presentation of bony femoral metastasis with silent epithelial ovarian carcinoma. Keywords: Bone, Femur, Metastasis, Ovarian cancer, Immunohistochemistry.

Background: In chronic hepatitis diseases the liver impairment results in imbalance in glucose homeostasis and metabolism resulting in type 2 diabetes Aim: To estimate the frequency of type 2 diabetes in chronic hepatitis B and C patients. Study Design: Cross sectional analytical study Place and Duration of Study: Department of Medicine, Chandka Medical College Hospital, Larkana 1st October 2020 to 31st March 2021. Methodology: One hundred patients of hepatitis were recruited. Fifty patients of hepatitis B and 50 patients of hepatitis C age 20-65 years were enrolled. Their fasting blood sugar and HbA1C levels were analyzed and correlated with their clinical symptoms. Results: 20% hepatitis B and 26% hepatitis patients had asymptomatic type 2 diabetes. There were more men affected from hepatitis than women and type 2 diabetic respectively. Conclusion: Asymptomatic type 2 diabetics need suffering from hepatitis B and hepatitis C need to be screened for better treatment plan. Keyword: Hepatitis B, Hepatitis C, Type 2 diabetes

Purpose The purpose of this paper is to broaden the link between workplace flexibility (WF) and job engagement (JE) while considering quality of work life (QWL) as mediator and the use of knowledge sharing (KS) as moderator. While numerous studies have focused solely on the importance of WF, QWL, KS and JE only exclusively, this study integrates them to delineate their association and to empirically assess the relationships. To advance an in-depth knowledge of these aspects, the study goes beyond the conventional findings. Design/methodology/approach In total, 378 employees from software firms in India participated in the questionnaire-based survey. It is a cross-sectional study. The proposed conceptual model and hypothesis were analyzed and tested by structural equation modeling and process macro. Drawing on the person environment (P-E) fit theory and social exchange theory, the authors discuss how QWL mediates and KS moderates the association between WF and JE. Findings Results indicate a positive association between WF and JE. Furthermore, it was found that QWL mediated and KS moderated this association. Practical implications Findings of the study will help the management to comprehend the significance QWL interventions in increasing their JE. This paper may encourage HR managers in the Information Technology (IT) industry to perceive the importance of KS. Moreover, the study accentuates flexible work options as essential phenomenon to positively impinge on the JE of employees in the IT sector. Originality/value The present study tries to enrich the extant research on WF and JE while it demonstrates the use of QWL interventions and KS as vital constructs that may significantly and positively influence JE.

Nonalcoholic fatty liver disease is very common in patients with polycystic ovary syndrome (PCOS). In patients with PCOS, the clinical use of liver stiffness (LS) and whether LS increases or decreases are still unclear. The purpose of this study was to determine the parameters related to LS and whether there is an increase in LS in patients with PCOS compared with healthy controls. Thirty-eight women diagnosed with PCOS according to Rotterdam criteria and 28 healthy age- and sex-matched controls were included in this study. In addition to routine follow-up parameters for all patients, serum homeostatic model assessment of insulin resistance (HOMA-IR) and complement C1q/tumor necrosis factor-related protein 3 (CTRP3) levels were measured, and point shear wave elastography was performed. Body mass index; waist circumference; systolic blood pressure; serum glucose, alanine aminotransferase, highly sensitive C-reactive protein, and dehydroepiandrosterone sulfate, testosterone, and HOMA-IR levels; and luteinizing hormone/follicle-stimulating hormone ratio were higher in PCOS group compared with healthy controls (P < 0.05). Serum CTRP3 levels were lower in patients with PCOS (P < 0.05). Liver stiffness value was significantly higher in PCOS group than healthy controls (P < 0.001). Positive correlation was found between LS and waist circumference as well as calcium, dehydroepiandrosterone sulfate, testosterone, and HOMA-IR levels (P < 0.05 for each one). Negative correlation was found between LS and CTRP (P < 0.01 for each one). In linear regression analysis, only CTRP3 level was found to be related to LS (P < 0.001 and β = 0.734). Liver stiffness value obtained by point shear wave elastography increases in patients with PCOS compared with healthy controls and is closely and negatively related to serum CTRP3 levels.

Spindle cell carcinoma of the salivary gland is very rare. Spindle cell carcinoma is a variant of squamous cell carcinoma with an aggressive course. We present a rare case of spindle cell carcinoma of the parotid in a 54-year-old male, who presented with a rapidly enlarging mass in the right parotid gland. Histopathologically, the tumour was composed of foci of squamous cell carcinoma with sheets of malignant squamoid cells and spindle cell sarcoma with scattered pleomorphic, plump to spindle- shaped cells with foci of bone formation. Immunohistochemical studies revealed cytokeratin positivity and vimentin negativity in the squamous cell carcinoma component with focal positivity for epithelial membrane antigen and negative expression of cytokeratin and vimentin positivity in the sarcomatoid component. A final diagnosis of primary spindle cell carcinoma of the parotid gland was given. Our patient is alive and well with no clinical or radiological evidence of recurrence or metastatic disease after 12 months of follow up period. Keywords: Salivary gland, Spindle cell carcinoma, Histopathology, Immunohistochemistry.

Background:Reactive aldehydes are involved in diseases associated with oxidative stress, including diabetes. Human salivary aldehyde dehydrogenase (hsALDH) presumably protects us from many toxic ingredient/contaminant aldehydes present in food.Objective:This study aimed to probe the activity of hsALDH in patients with diabetes and than to correlate it with various oxidative stress markers in the saliva.Methods:The saliva samples were collected from total 161 diabetic patients from Rajiv Gandhi Centre for Diabetes, Jawaharlal Nehru Medical College (JNMC), AMU, Aligarh, (India). HsALDH activity and markers of oxidative stress [8-hydroxydeoxyguanosine (8-OHDG), malondialdehyde (MDA) and advanced glycation end products (AGEs)] were measured in the saliva samples.Results:Patients with early stage of diabetes had higher activity of hsALDH when compared with the control group. As the history of diabetes increases, the activity of the enzyme decreases and also higher oxidative stress markers (8-OHDG, MDA and AGEs) are detected in the saliva samples. Negative significant correlation between hsALDH activity and oxidative stress markers were observed (p Conclusion:The activity of hsALDH increases in early stages of diabetes most probably to counter the increased oxidative stress associated with diabetes. However, in later stages of diabetes, the activity of the enzyme decreases, possibly due to its inactivation resulting from glycation.

Background The coarse F waves on the 12‐lead surface electrocardiogram (ECG) in patients with atrial fibrillation (AF) are known as atrial viability and contractility indicator. Our aim in this study was to investigate the effect of coarse F wave on thromboembolism in patients with permanent AF. Methods In our study, 328 patients with permanent AF were included. Routine laboratory, echocardiographic and electrocardiographic parameters were examined. Cerebrovascular event (CVE) or acute artery occlusion was considered a thromboembolic event. Results In our study, 46 (14.0%) of the patients were found to have thromboembolic events and 282 (86%) of them were found without thromboembolic events. In the group with thromboembolic event, the number of patients with hypertension (HT) (P, The coarse F waves may be seen on electrocardiogram in permanent atrial fibrillation patients. This wave may be related to thromboembolism and morbidity.

INTRODUCTION Fine needle aspiration cytology (FNAC), along with thyroid ultrasound, is an important tool in evaluation of thyroid nodules that helps in further management of these patients in making a decision of surgical intervention vs follow-up. The Bethesda System for Reporting Thyroid Cytopathology category III of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) has risk of malignancy (ROM) ranging from 5% to 15%. The aim of the present study was to describe the frequency of AUS/FLUS in thyroid gland FNACs and the surgical outcomes of these cases. METHODS The integrated laboratory management system retrieved the thyroid FNACs from 2010 to 2018 and subsequent surgical pathology specimens. For the AUS/FLUS cases, data regarding patient demographics, cytology and histological diagnoses were recorded. The results were tabulated as the overall frequency of AUS/FLUS in thyroid FNACs, cytohistological correlation (benign and malignant) and ROM. RESULTS Over a period of 9 years, 256 (10.9%) cases out of 2342 thyroid FNACs were reported as AUS/FLUS at our institution. Mean age was 43.5 years. The majority (70.3%) of patients were female. Seventy-two of 104 resection specimens (69.2%) were reported as benign and 32 cases (30.7%) had malignant diagnosis. Upper-bound ROM was 30.7% (32 cases with malignant diagnosis out of 104 resection specimens). Lower-bound ROM was calculated as 12.5% (32 cases with malignant diagnosis out of 256 total AUS diagnosis). CONCLUSION The AUS/FLUS category of thyroid cytology and associated ROM remain an evolving area. Individual institutions should monitor the frequency and include ROM in the dashboard indicators to remain within the recommended range.

Purpose To evaluate the changes in intraocular pressure (IOP), central corneal thickness (CCT), axial length, and ocular surface in patients with end-stage renal failure after single-session hemodialysis treatment and to examine the correlation of these findings with systemic hemodynamic parameters. Patients and Methods A total of 112 eyes of 112 patients enrolled in a hemodialysis treatment program for three times a week (approximately four hours per session) for at least three months in our hospital between December 2019 and March 2020 were included in the study. Approximately 30 minutes before and after hemodialysis, the best-corrected visual acuity measurement, slit-lamp examination, IOP measurement, and dilated fundus examination with the Goldmann applanation tonometer were performed in all patients. The axial length measurement was undertaken by ultrasonic biometry, and the CCT measurement by ultrasonic pachymetry. The ocular surface evaluation was performed based on the tear breakup time (BUT), basal secretion time (BST) and keratoepitheliopathy score. Blood pressure, serum osmolarity, and body weight were measured before and after hemodialysis. Results The mean IOP decreased from 12.2 ± 3.5 to 10.8 ± 2.2 mmHg, and the mean decrease was 1.4 ± 2 mmHg, indicating statistical significance (p

Sheehan's syndrome (SS) is known as pituitary insufficiency that develops after bleeding and hypovolemia at birth or after birth. The pathological and clinical findings of SS were first described by Harold L. Sheehan. Due to improvements in obstetric care, the frequency of the disease has declined worldwide. Sheehan syndrome is a rare cause of hypopituitarism in developed countries.. However, it is more common in underdeveloped and developing countries. Small sella size enlargement of the pituitary gland, autoimmunity also play a role in the pathogenesis of the disease. Depending on the pituitary damage, symptoms may appear immediately or years later. It may be presented as isolated hormone deficiency or pan hypopituitarism. For diagnosis, it is important to have a history of excessive hemorrhage at birth, amenorrhea and inability to breastfeed. Lymphocytic hypophysitis should be remembered in differential diagnosis. In this review, a patient with serious post-partum hemorrhage, followed by a history of 3 pregnancies is presented with a slow developing and pan hypopituitarism-causing SS and current physio pathological data in SS are presented.

Background and Objective: In patients older than 65 years of age, fractures of the Proximal humerus are the second most common in incidence pertaining upper extremity fracture and are only the third most overall common fracture, after hip fractures and the distal radial fractures. It is well known that Most of the minimally displaced fractures of proximal humerus can be treated conservatively. For displaced fractures, many surgical techniques have been described but no single technique is considered to be the standard care. Optimal reduction and fixation of three and four part fractures of proximal humerus remains a challenge well known. Also in most of the surgical techniques and conservative treatments of proximal humerus fractures, post-operative stiffness due to long periods of immobilization remains a challenging issue, even after fruitful union of the fractures. Our study was undertaken to evaluate the functional outcome of the proximal humerus fractures treated with JESS fixators followed by early range of motion exercises post operatively, to curtail the occurrence of stiff shoulder due to longer immobilization periods of other fixation modalities. The final results of the study was then compared to the data of retrospective studies of different modalities of treating proximal humerus fractures and the incidence of frozen shoulder in their studies. Method: It was a Prospective study of 12months duration including 50 adult patients (>18 yrs) with fractures of the proximal humerus admitted to Hospital, and treated by Joshi’s External Stabilization System(JESS) with early mobilization and start of range of motion and pendulum exercises, from post op day 3. Consequently the patients were evaluated till 2 month post-pin removal period, using Murley shoulder score at the time of Pin removal followed by a gap of two months and were followed up at the outpatient clinic. Results: 50 patients were included in the study. The study had 15 (30%) females and 35 (70%) males. out of total 50 cases 18 (36%) patients had left side involvement and 32 (64%) had right side involvement. In 20 (40%) patients the injury to surgery interval was 1-3 days, in 15 (30%) patients the injury to surgery interval was 4-7 days and in 15 (30%) patients the injury to surgery interval was more than 7 days. Neer’s classification was used for classifying the proximal humerus fractures in our study and 3 part fracture was the most common followed by 2 part fracture. Murley score 2 months after implant removal in relation to final outcome was 50.50 ± 5.62 days in excellent outcome group, 55.65 ± 5.69 days in good outcome group, 64.27 ± 7.93 days in fair outcome group and 71.00 ± 11.27 days in poor outcome group. As the duration of complete pin removal increased the final outcome shifted from excellent to poor. Conclusion: In our study we found that proximal humeral fractures can be satisfactorily treated with JESS fixator which is a simpler and affordable method of proximal humerus fracture fixation, which also provides easy early shoulder mobilization and good gain of functionality in about four months since injury. Early mobilization and proper follow-ups with scheduled exercise regimes are of pivotal importance in bringing a better functionality and to decrease the post-operative incidence of frozen shoulder and these factors can be achieved by our modality.

Background: The frequency of premature ventricular contractions (PVCs) increases in patients with poor sleep quality (PSQ). Aims: The aim of this study was to evaluate PSQ in patients referred for radiofrequency catheter ablation (RFA) due to PVCs and to determine the effect of RFA on PSQ. Methods: A total of 207 patients who were diagnosed with the PVC burden greater than 10% and underwent 3-dimensional RFA in our center were included in this cross -sectional study. Self -reported sleep quality was assessed in all patients in addition to a 24-hour Holter electrocardiogram before ablation and at 3-month follow -up. The effect of RFA on self -reported sleep quality in patients with PVCs was evaluated. Results: Before RFA, 87% of the study patients had PSQ. In those with PVCs, subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, daytime dysfunction, and the global Pittsburgh Sleep Quality Index (PSQI) improved after RFA (P

Low back pain (LBP) has been found to profoundly increase in athletes in the last decade. There are numerous treatment options available for LBP of which retrowalking seems to be a promising option for these patients; however, its potential utility in athletes is not known yet. To investigate the effect of addition of retrowalking to conventional exercises on pain, range of motion, muscle fatigability, and balance in collegiate athletes with chronic mechanical LBP. Subjects were screened using Oswestry Disability Index (ODI) and those having mild-to-moderate disability were included in the study. A sample of 30 athletes were randomly assigned into two groups, retrowalking + conventional exercise (n = 15) and conventional exercise (n = 15). Pain, flexion range of motion, balance, and muscle fatigability were examined before and after 4 weeks of the intervention. Retrowalking group performed retrowalk on a treadmill at self-paced speed for 15 min/day for 3 days per week for 4 weeks along with the conventional exercises for back pain, whereas participants in the control group performed conventional exercises alone for the same duration. Significant differences were observed in pain (p = 0.003) and balance (p = 0.003) between the groups after the intervention period, signifying greater improvement in the retrowalking group. No significant group differences were observed for flexion range of motion (p = 0.97) and muscle fatigability (p > 0.05). Main findings of the present study suggest that retrowalking when added to conventional exercises may be helpful in reducing chronic mechanical LBP and improving dynamic balance. Whereas retrowalking when combined with conventional exercises has no additional effect in improving the flexion range of motion and reducing muscle fatigability.

Stressor (biotic as well as abiotic) generally hijack the plant growth and yield characters in hostile environment leading to poor germination of the plants and yield. Among the plant growth promoting rhizobacteria, Azotobacter spp. (Gram-negative prokaryote) are considered to improve the plant health. Various mechanisms are implicated behind improved plant health in Azotobacter spp. inoculated plants. For example, acceleration of phytohormone like Indole-3-Acetic Acid production, obviation of various stressors, nitrogen fixation, pesticides and oil globules degradation, heavy metals metabolization, etc. are the key characteristics of Azotobacter spp. action. In addition, application of this bacteria has also become helpful in the reclamation of soil suggesting to be a putative agent which can be used in the transformation of virgin land to fertile one. Application of pesticides of chemical origin are being put on suspension mode as the related awareness program is still on. As far as the limitations of this microbe is concerned, commercial level formulations availability is still a great menace. Present review has been aimed to appraise the researchers pertaining to utility of Azotobacter spp. in the amelioration of plant health in sustainable agroecosystem. The article has been written with the target to gather maximum information into single pot so that it could reach to the dedicated researchers.

Objectives: To evaluate the role of angiogenesis by the assessment of mean vessel density and to quantify angiogenesis as an important variable in different benign and premalignant endometrial lesions. Materials and Methods: Endometrial biopsies and hysterectomy specimens were examined to evaluate and define any correlation between angiogenesis and different phases and premalignant diseased states of the endometrium. Microvessel counts were performed by examining the microvessels thoroughly in terms of count, morphology and density after staining the tissues by hematoxylin & eosin stain, reticulin stain and immunostain CD 34. Results: A total of 381cases of benign and premalignant endometrial lesions were included in the study. In 135 cases of simple hyperplasias, Microvessel Density (MVD) ranged from 2.4 - 6.7 and Mean MVD was 4.71 on H&E stain and MVD ranged from 2.8 - 8.3 with Mean MVD of 5.39 on reticulin stain. In 105 cases of complex hyperplasias, MVD ranged from 2.3 - 7.0 and Mean MVD was 4.93 on H &E satin and MVD ranged from 3.1-7.7 with Mean MVD of 5.68 on reticulin stain. In 67 cases of atypical hyperplasias, inbudding and outpouching of the glandular epithelium together with multilayering was appreciated with MVD from 4.5 - 8.8 and Mean MVD of 6.31 on H &E stain and MVD of 5.5 - 9.4 with Mean MVD of 7.19 on reticulin stain. A statistically significant difference was noted in all categories except in between simple and complex hyperplasia where the difference was not statistically significant. The role of angiogenesis becomes more significant with increasing severity of lesion, both in terms of hyperplasia and atypia when compared to normal endometrium. Although angiogenesis can be detected on immunostain more easily, it can be illustrated well by H and E or Reticulin stain. Conclusions: Role of angiogenesis becomes more significant with increasing severity of lesion, both in terms of hyperplasia and atypia when compared to normal endometrium. Although an

Aim:In patients with acute appendicitis (AA), the number of monocytes increase and the level of high-density lipoprotein cholesterol (HDL-C) decrease. The monocyte/HDL-C ratio (MHR) has recently been used as a diagnostic and prognostic marker for acute inflammation. As far as we research in the literatures, there is no information about the use or alteration of MHR in patients with AA. The aim of this study was to investigate the MHR change in patients with AA and its utility for this disease.Methods:This cross-sectional study includes 206 patients with AA and 57 healthy controls that are similar in age and sex. Serum lipid panel was measured in all patients in addition to routine history, physical examination and laboratory evaluations. Patients were divided into two groups with and without AA and all data were compared.Results:MHR was significantly higher in patients with AA (17.5±9.9 vs 8.5±1.6 and p

The purpose of this study is to investigate the relation between residual SYNTAX score (rSS) and contrast-induced nephropathy (CIN) development in patients with non-ST segment elevation myocardial infarction (NSTEMI) with normal or near-to-normal left ventricular ejection fraction (LVEF) who underwent percutaneous coronary intervention (PCI). A total of 306 patients who underwent PCI with NSTEMI were included in our study. SYNTAX scores were calculated for the periods before and after PCI. Patients were divided into 2 groups as developed CIN following PCI (CIN +) and patients did not (CIN −). Fifty-four (17.6%) of patients who were included in the study developed CIN. Age ( P = .001) and rSS ( P = .002) were significantly higher and LVEF was lower ( P = .034) in the CIN (+) group. Age ( P = .031, odds ratio [OR]: 1.031, 95% CI, 1.003-1.059) and rSS ( P = .04, OR: 1.036, 95% CI, 1.002-1.071) were independent predictors for CIN. In receiver operating characteristic analyses, when the cutoff value of rSS was taken as 3.5, it determined CIN with 79% sensitivity and 65% specificity. Contrast-induced nephropathy may develop more frequently in patients with increased rSS value. The rSS may be useful to follow-up these patients for CIN development.

Ebstein anomaly can be managed by single ventricular, bi-ventricular and one and a half ventricular repairs. We present midterm results of Comprehensive Tricuspid Valve repair (CTVR) with bi-directional cavo-pulmonary shunt (BCPS). In this prospective observational study (Jan2012–July2018), 69 patients underwent surgery for Ebstein anomaly. In Group I (n = 48; 69.6%), all patients got CTVR and a BCPS (one and a half ventricle repair). Group II (n = 15; 21.8%) consisted of a similar repair without BCPS (bi-ventricle repair). All patients were echocardiographed at six monthly intervals. Median age of the cohort was 17 years (range 1–68). 12 (17.4%) patients were Carpentier type B, 51 (73.9%) were type C and 6 (8.7%) were type D. There were two early mortalities (2.89%). At a mean follow up of 3.2 ± 1.2 years, there were no late deaths and one delayed repair-failure in each group. Group I had significantly lower mean TR grade (1.2 ± 0.4vs1.6 ± 0.5, p = 0.03) as compared to Group II without a significant difference in the mean gradients (1.5 ± 0.5vs1.6 ± 0.6, p = 0.4). Mean indexed TAPSE (15.0 ± 6.7vs.16.6 ± 5.6 mm/m2, p = 0.21), NYHA class (1.2 ± 0.4vs1.3 ± 0.4) and six-minute walk distance (506 vs 507 m, p = 0.7) was similar in both groups. One and a half ventricle repair of Ebstein anomaly gives a more functionally competent, non-stenotic and durable tricuspid valve as compared to a two-ventricle repair. BCPS doesn’t result in facial swelling or AV malformations. Preload reduction by BCPS may allow the myopathic ventricle to remodel.

National heritage buildings are considered as the memory of the cities and its civilization’s legacy. Such buildings are receiving more attention these days especially from architectures who are trying to restore them by using the proper techniques to bring them back to their former appearance to serve the community in the present time. From that point, the general goal of this research is to concentrate on the used techniques of restoring national heritage buildings by using the proper materials for the damaged or the collapsed parts as the restoration process differs from a building to another. All these points should be done according to the laws and protocols of UNSCO and ICOMOS to keep the authentic features of the building and pass it on to the next generations. This research deals specifically and practically with restoring the Qishla building in Kirkuk as a restoration sample. Some parts of that building collapsed recently and the research aims to save that building by studying the techniques of restoring it using the materials and building techniques of the era the building was built in. This research rises an important point, which is finding a general prospective of scientific and technical ways in restoring cultural heritage buildings which are made from stone specifically. From all that above the main issue that this research deals with is “The unclear techniques of restoring cultural heritage buildings in general and the restoration process of Qishla building with stone in specific”. Accomplishing the aim of this research lies in two points: First: Studying the rules which govern the restoration process of cultural heritage buildings. Second: Studying the restoration process of Qishla building and that includes; the restoration process with stone should be done by examining the chemical and physical features of the stone, durability of the used stone, conducting chemical tests in international labs as (ACMAE ANALYSES/ Canada) and the last step is to analyze and discuss the results to take final decisions.

To prepare for radioactive iodine therapy in post total thyroidectomy patients with well-differentiated thyroid cancer (WDTC), either thyroid hormone withdrawal (THW) or administration of recombinant human thyrotropin (rhTSH) can be performed. Our objective is to compare quality of life (QoL) parameters using the SF-36v2 questionnaire (Short Form health survey) and a self-evaluated item, and the hypothyroid status using modified Billewicz scores in an Asian population undergoing either THW or rhTSH for remnant ablation or adjuvant treatment following total thyroidectomy for WDTC. We will also assess the proportion of patients achieving TSH level of >30 mU/L after 4 weeks of thyroid hormone withdrawal. Patients in the rhTSH group were better in the QoL domains of physical functioning, role functioning/physical and bodily pain, while patients in THW group were better in mental health. This was however, not statistically significant. Modified Billewicz scores were higher in patients in THW group as compared with rhTSH group and statistically significant. A total of 96.3% of patients achieved TSH level >30 mU/L after 4 weeks of THW. Clinical symptoms and signs of hypothyroidism as assessed with modified Billewicz scores were statistically significantly higher in the THW group. However, there was no statistically significant difference in QoL in the rhTSH group.

The apelinergic system plays an important role in the modulation of the cardiovascular system via the apelin peptide and the apelin receptor (APJ receptor). Apelin and elabela, also known toddler, are peptide ligands for the apelin receptor. These two peptides show similar biological actions, such as vasodilatation, increased myocardial contractility, angiogenesis, and energy metabolism. However, the serum levels of elabela in patients with hyperthyroidism are not well known. The aim of this study was to investigate the changes in serum elabela levels in patients with hyperthyroidism and its association with hypertension. This cross-sectional study included 74 patients with newly diagnosed hyperthyroidism due to Graves' disease and 20 healthy individuals. Serum elabela levels were measured by enzyme-linked immunosorbent assay. The patients were divided into two groups: hyperthyroid patients without hypertension (n = 51) and those with hypertension (n = 23). Basal heart rate, serum glucose and high-sensitive C reactive protein were significantly higher in hyperthyroid patients with and those without hypertension than in healthy controls (p < 0.05 for each). Serum elabela levels were significantly elevated in hyperthyroid patients compared with healthy controls, with higher serum elabela levels found in hyperthyroid patients with hypertension than those without hypertension. Linear regression analysis showed that serum elabela levels were correlated with systolic blood pressure (p < 0.001). In conclusion, serum elabela levels were significantly increased in patients with hyperthyroidism, especially in hyperthyroid patients with hypertension. Elevation in serum elabela levels may contribute to alleviation of cardiovascular complications of hyperthyroidism and hypertension.

In certain pathologies, mitral valve repair is complicated by a paucity of tissue caused by fibrosis or destruction. Utilization of autologous pericardium for leaflet augmentation may be the only option to repair these valves. We present the midterm results of mitral valve leaflet augmentation with glutaraldehyde-fixed autologous pericardium. One hundred thirty consecutive patients undergoing mitral valve repair with glutaraldehyde-fixed pericardial augmentation of leaflets were followed up clinically and by echocardiography at 6-month intervals. Mean age was 24.8 years (range 2-64). The etiology was rheumatic in 75.3%, indeterminate in 8.4%, and other in 16.1%. Out of the rheumatics, 57.1%, 24.4%, and 18.3% had combined mitral stenosis and mitral regurgitation, isolated mitral regurgitation, and mitral stenosis, respectively. About 21.5% had a recent history of rheumatic activity. Eight were operated emergently for intractable heart failure. Majority of the patients required repair of multiple components of the mitral valve apparatus. Leaflet peeling was done in 52.3%. Pericardial patch augmentation of anterior mitral leaflet, posterior mitral leaflet, or both were carried out in 61.5%, 34.6%, and 3.8% patients respectively. Sixty percent got chordal procedures, while 92.3% got annuloplasty. There were no deaths during the mean follow-up period of 28 months. Ninety-three percent of our patients were in New York Heart Association class I and II on follow-up. There were 11 repair failures. Seven patients underwent a reoperation, while 4 patients are being managed conservatively (reoperation rate 5.38%). Augmentation of mitral valve leaflets with autologous pericardium allows many significantly fibrosed and destroyed valves to be reliably repaired with good midterm durability and hemodynamics.

Neuroblastoma (NB) is the most common extracranial solid tumor in infants and children, and imposes significant morbidity and mortality in this population. The aggressive chemoradiotherapy required to treat high-risk NB results in survival of less than 50%, yet is associated with significant long-term adverse effects in survivors. Boosting efficacy and reducing morbidity are therefore key goals of treatment for affected children. We hypothesize that these may be achieved by developing strategies that both focus and limit toxic therapies to the region of the tumor. One such strategy is the use of targeted image-guided drug delivery (IGDD), which is growing in popularity in personalized therapy to simultaneously improve on-target drug deposition and assess drug pharmacodynamics in individual patients. IGDD strategies can utilize a variety of imaging modalities and methods of actively targeting pharmaceutical drugs, however in vivo imaging in combination with focused ultrasound is one of the most promising approaches already being deployed for clinical applications. Over the last two decades, IGDD using focused ultrasound with “microbubble” ultrasound contrast agents (UCAs) has been increasingly explored as a method of targeting a wide variety of diseases, including cancer. This technique, known as sonopermeation, mechanically augments vascular permeability, enabling increased penetration of drugs into target tissue. However, to date, methods of monitoring the vascular bioeffects of sonopermeation in vivo are lacking. UCAs are excellent vascular probes in contrast-enhanced ultrasound (CEUS) imaging, and are thus uniquely suited for monitoring the effects of sonopermeation in tumors. Methods: To monitor the therapeutic efficacy of sonopermeation in vivo, we developed a novel system using 2D and 3D quantitative contrast-enhanced ultrasound imaging (qCEUS). 3D tumor volume and contrast enhancement was used to evaluate changes in blood volume during sonopermeation. 2D qCEUS-derived time-intensity curves (TICs) were used to assess reperfusion rates following sonopermeation therapy. Intratumoral doxorubicin (and liposome) uptake in NB was evalauted ex vivo along with associated vascular changes. Results: In this study, we demonstrate that combining focused ultrasound therapy with UCAs can significantly enhance chemotherapeutic payload to NB in an orthotopic xenograft model, by improving delivery and tumoral uptake of long-circulating liposomal doxorubicin (L-DOX) nanoparticles. qCEUS imaging suggests that changes in flow rates are highly sensitive to sonopermeation and could be used to monitor the efficacy of treatment in vivo. Additionally, initial tumor perfusion may be a good predictor of drug uptake during sonopermeation. Following sonopermeation treatment, vascular biomarkers show increased permeability due to reduced pericyte coverage and rapid onset of doxorubicin-induced apoptosis of NB cells but without damage to blood vessels. Conclusion: Our results suggest that significant L-DOX uptake can occur by increasing tumor vascular permeability with microbubble sonopermeation without otherwise damaging the vasculature, as confirmed by in vivo qCEUS imaging and ex vivo analysis. The use of qCEUS imaging to monitor sonopermeation efficiency and predict drug uptake could potentially provide real-time feedback to clinicians for determining treatment efficacy in tumors, leading to better and more efficient personalized therapies. Finally, we demonstrate how the IGDD strategy outlined in this study could be implemented in human patients using a single case study.

Resumo Fundamento Os níveis de Proteína 3 relacionada ao fator de necrose tumoral/complemento sérico C1q (CTRP3) e a relação com a fibrilação atrial (FA) na doença arterial coronária estável (DAC) não estão claros atualmente. Objetivos O objetivo deste estudo foi investigar a mudança nos níveis séricos de CTRP3 e sua relação com a FA paroxística em DAC estável. Método O estudo incluiu 252 pacientes com DAC e 50 controles saudáveis com idade/sexo compatíveis. Os níveis séricos de CTRP3 foram medidos, além da anamnese de rotina, exame físico, exames laboratoriais e ecocardiograma. Os pacientes foram divididos em grupos com e sem DAC e indivíduos com DAC com e sem FA paroxística. Os valores eram estatisticamente significativos quando p

Purpose: In our article, we aimed to identify whether there is an increase in intima-media thickness (IMT) measured from the abdominal aorta in patients with acromegaly and to identify the parameters closely related to the aortic IMT (AIMT).Materials and Methods: 52 patients with acromegaly and 46 healthy controls were included. For all participants, all the necessary laboratory tests were done for acromegaly. On vascular ultrasound examination, the internal carotid IMT, common-carotid IMT, and aortic IMT (AIMT) were measured. The study population was divided into 3 different groups; control group (Group I), acromegaly patients in remission (Group II) and acromegaly patients with active disease (group-III). Results: The incidence of hypertension, diabetes, and smoking was higher in Group-II-III than Group I. Insulin-like growth factor-1 (IGF-1) levels were increased from Group I to III and there was a significant difference between all groups. Common-carotid IMT and internal carotid IMT values were not significantly different between the groups. The AIMT value in Group III patients was statistically higher than the other two groups. The AIMT was similar between Groups I to II. Only the IGF-1 level was found to be independently associated with AIMT. Conclusion: In patients with active acromegaly disease, AIMT is significantly elevated without elevation of carotid IMT, and AIMT is independently associated with serum IGF-1 levels. AIMT could be a useful study to show the presence of early subclinical atherosclerosis in acromegaly patients.

Code review turns into a progressively mainstream method to detect early defects in the codebase. These days experts are rushing towards peer-investigating the codebases written by any co-located team members or other authors from distributed or dispersed teams. Chipping away at a circulated or scattered team, reviewing a codebase is required to inspect the patches before consolidating. Code looking into can likewise be a structure of approving practical and non-useful necessities. In certain circumstances, analysts do not invest enough time to comment in an organized manner, which turns into a bottleneck to other developers for tackling the discoveries or recommendations remarked by the peer-reviewers. To make the review process more progressively successful and well-organized, productive remarks are compulsory. We have extricated 2185 human code review comments of five marketed projects by mining respective projects’ repositories. Six machine learning classifiers have been utilized to train our model. Stochastic Gradient Descent (SGD) vector machine accomplishes a higher accuracy of 63.89% among the others. This work will assist the specialists with building up organized and viable code review culture among worldwide programmers or software engineers by categorizing code review comments.

Yield is one of the most important agronomic traits for the breeding of rapeseed (Brassica napus L), but its genetic dissection for the formation of high yield remains enigmatic, given the rapid population growth. In the present review, we review the discovery of major loci underlying important agronomic traits and the recent advancement in the selection of complex traits. Further, we discuss the benchmark summary of high-throughput techniques for the high-resolution genetic breeding of rapeseed. Biparental linkage analysis and association mapping have become powerful strategies to comprehend the genetic architecture of complex agronomic traits in crops. The generation of improved crop varieties, especially rapeseed, is greatly urged to enhance yield productivity. In this sense, the whole-genome sequencing of rapeseed has become achievable to clone and identify quantitative trait loci (QTLs). Moreover, the generation of high-throughput sequencing and genotyping techniques has significantly enhanced the precision of QTL mapping and genome-wide association study (GWAS) methodologies. Furthermore, this study demonstrates the first attempt to identify novel QTLs of yield-related traits, specifically focusing on ovule number per pod (ON). We also highlight the recent breakthrough concerning single-locus-GWAS (SL-GWAS) and multi-locus GWAS (ML-GWAS), which aim to enhance the potential and robust control of GWAS for improved complex traits.

Sumbul, G., De Wall, A., Kreuziger, T., Marcelino, F., Costa, H., Benevides, P., Caetano, M., Demir, B., & Markl, V. (2021). BigEarthNet-MM: A Large-Scale, Multimodal, Multilabel Benchmark Archive for Remote Sensing Image Classification and Retrieval [Software and Data Sets]. IEEE Geoscience and Remote Sensing Magazine, 9(3), 174-180. https://doi.org/10.1109/MGRS.2021.3089174 This article presents the multimodal BigEarthNet (BigEarthNet-MM) benchmark archive consisting of 590,326 pairs of Sentinel-1 and Sentinel-2 image patches to support deep learning (DL) studies in multimodal, multilabel remote sensing (RS) image retrieval and classification. Each pair of patches in BigEarthNet-MM is annotated with multilabels provided by the CORINE Land Cover (CLC) map of 2018 based on its thematically most detailed level-3 class nomenclature. Our initial research demonstrates that some CLC classes are challenging to accurately describe by considering only (single-date) BigEarthNet-MM images. In this article, we also introduce an alternative class nomenclature as an evolution of the original CLC labels to address this problem. This is achieved by interpreting and arranging the CLC level-3 nomenclature based on the properties of BigEarthNet-MM images in a new nomenclature of 19 classes. In our experiments, we show the potential of BigEarthNet-MM for multimodal, multilabel image retrieval and classification problems by considering several state-of-the-art DL models. authorsversion published