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Visible light communication (VLC) is a promising communication technology that benefits from several advantages over other wireless communication techniques. However, the capacity of VLC systems is limited by the low modulation bandwidth of light-emitting diodes (LEDs) used as transmitters. To circumvent this bottleneck, non-orthogonal multiple access (NOMA) is popularly used in VLC systems. However, due to high inter-user interference at the receivers, NOMA suffers from poor outage performance, especially if the number of users is large. We propose to boost the outage performance of a NOMA-based VLC system by incorporating multi-user cooperative diversity over radio frequency (RF) links, thereby transforming it into a hybrid VLC-RF system. Such a system with cooperative NOMA (CoNOMA) has enhanced reliability compared to a conventional non-cooperative NOMA system. We formulate the expressions for the outage probability of the proposed system and analyze the outage performance for various power allocation schemes used in NOMA. We study the effects of increasing the number of users and the target data rate on the system’s overall outage performance. We also model the reliability of the multi-user CoNOMA system using Markov chains and evaluate the various reliability parameters for each user. We show that the outage performance and reliability of the VLC system are significantly enhanced by employing cooperative diversity using CoNOMA.

The relevance of subcortical structures and interhemispheric subcortical-cortical interactions among positive/negative affect and approach/withdrawal tendencies during resting-state are not fully understood. Gaining this knowledge may foster the know-how on their role in subsequent task-engagement and also on the interlinkage among affective measures and approach/withdrawal dichotomy. Here we performed a study based on Region of Interest (ROI)-based analysis and graph-theory estimates for global and subnetworks on a limited sample of healthy 50 male volunteers who recorded resting functional magnetic resonance imaging (fMRI) and self-reported measures of Positive and Negative Affect Schedule (PANAS) and BAS-BIS (Behavioral Activation System-Behavioral Inhibition System) scores. Our study's initial results of region of interest-to-region of interest (ROI-to-ROI) connectivity revealed the connectivity of subcortical neural substrates of PANAS and BAS-BIS scores with bilateralized cortical regions. However, on probing the lateralization of strength of degree measures of the cortical-regions vital for subcortical-cortical interaction, we found, for positive affect, a left-hemispheric proclivity. Further, higher connectivity within the left hemisphere was also observed for the left-lateralized critical cortical regions of negative affect. Our study also revealed the association of emotion and memory-related subcortical-cortical interactions in positive and negative affect. Right amygdala-right thalamus-frontotemporal cortical areas emanated in positive affect, and right putamen-left hippocampus-frontotemporal cortical regions network stemmed for negative affect. Then, we show the involvement of basal-ganglia structures in approach-withdrawal dichotomy with tight coupling of right-caudate, left-accumbens with anterior cingulate, and insular regions for withdrawal/inhibition system. Further, distinct involvement of the insula (posterior) in affective states while insula (anterior) in approach/withdrawal systems builds up for the existence of a feedback loop between affective and approach/withdrawal systems. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background/aim Advanced/recurrent breast cancer (ARBC) still has a poor prognosis; therefore, new treatment strategies are required. In this retrospective study, we aimed to investigate the efficacy of immune-cell therapy using T lymphocytes activated in vitro with or without dendritic cell vaccination in combination with standard therapies in terms of the survival of patients with ARBC. Patients and methods A total of 127 patients with ARBC were enrolled in this study. The correlation between overall survival and various clinical factors of each ARBC subset was examined by univariate and multivariate analyses. Results Multivariate analysis demonstrated that performance status (PS) 0, the absence of prior chemotherapy, liver/pleural metastasis, and the presence of combined surgery in ARBC and PS 0 or the absence of liver metastasis in the HR+/HER- subset are indications for immune-cell therapy. Conclusion A survival benefit could be potentially obtained by a combination of immune-cell therapy with other therapies in ARBC patients.

Introduction The increased use of new checkpoint inhibitors in cancer therapy has led to the discovery of new unconventional responses, like pseudoprogression and hyperprogression disease (HPD). The study documents imaging findings of HPD and analyzes the growth kinetics in advanced metastatic cancers patients treated with immunotherapy. Methods We retrospectively reviewed patients treated with anti-PD-1 (anti-progressive disease-1) antibody therapy (nivolumab) between January 2017 and December 2017 at our institute. The patients who exhibited early and rapid progression rates after initiation of immunotherapy were further analyzed for tumor growth kinetics (TGKs) and imaging findings. All prebaseline, baseline, and post nivolumab imaging were retrospectively reviewed to assess the TGKs, time to treatment failure (TTF), and rate of progression according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. Results Four patients with HPD had peculiar imaging appearance of unilateral circumferential nodular pleural thickening along with conglomerate pleural masses and effusions. Both primary and secondary sites progressed along with the appearance of new lesions in all these patients. The mean progression-free survival (PFS) was 32 days using Kaplan Meier analysis. Conclusion The unique and recurring imaging pattern of disease progression in patients with HPD as reported in our case series in addition to TGK ratio, and TTF may prove to be of additional help in early identification of this unique and ghastly outcome.

Introduction: Oral and dental health form an integral part of complete well being of an individual and society at large. Promoting oral health and societal progression go hand in hand. Aim: To investigate dentists' attitudes about pain and infection control while treating children and adolescents by assessing their recommendations of pre- and postoperative analgesics and antibiotics, and use of local anesthesia (LA) for definitive treatment in different clinical scenarios. Materials and Method: A total of 400 dentists, both general dental practitioners (GDPS) as well as specialist dentists, were surveyed over a period of 2 months by using a pre-tested close-ended questionnaire. The data was statistically analyzed using Pearson's Chi-square test and backward logistic regression analysis for analysis of categorical variables and independent variables, respectively. Level of significance was set at 5%. Results: It was found that there was a gross overuse of antibiotics and analgesics and under use of LA by GDPs compared to specialist dentists. Postoperative antibiotics and analgesics were used more commonly than preoperative antibiotics and analgesics. These strategies were used more often in permanent teeth than primary teeth except the use of LA, which was used with equal frequency in both primary as well as permanent dentition. Conclusion: Dependence on antibiotics and analgesics for achieving pain and infection control in children has to be minimized and focus has to be shifted on judicious definitive treatment involving use of LA, aseptic techniques, and behavior management techniques.

Kasabach Merritt syndrome (KMS) is a rare disease in which a benign vascular tumor that is hemangioma grows rapidly, entraps red blood cells, platelets, and coagulation factors leading to activation of coagulation cascade resulting in life-threatening disseminated intravascular coagulation and microangiopathic hemolytic anemia. KMS affects newborns and infants. Rarely can affect older children and adults with only a few cases reported in the existing literature. Clinically patients present with large cutaneous hemangioma usually involving the extremities however visceral organs may be involved in some cases along with anemia, thrombocytopenia, coagulopathy, and bleeding. We report a case of KMS in a 28-year-old female who presented with bilateral subdural hematoma, thrombocytopenia, and consumption coagulopathy. She was given seven days course of methylprednisolone to which she responded well.

Aim: The aim of this in vitro study is to compare the efficacy of three diagnostic methods, Direct visual method, Magnifying loupes and Dental operating microscope in recognising all the canals of the root canal system in maxillary first molars using CBCT and reference standard method. Materials and Methods: A total of 65 maxillary first molars were selected for this study. Teeth selected were evaluated by Periapical radiographs and CBCT. Access cavities of selected extracted human maxillary first molars were prepared, and the floor of the pulp chamber was then explored to locate the MB2 canal in five stages: Stage I (Direct Visual Method), Stage II (under ×3.5 Magnifying Loupes with light-emitting diode [LED] light), Stage III (Under Dental Operating Microscope), and Stage IV (Cross-sectioning was done below CEJ and the sections were evaluated using stereomicroscope at 10x magnification). Statistical Analysis: The descriptive statistics were tabulated using Chi square test to compare the efficacy between the diagnostic methods. Senstivity, specificity, Positive /Negative predictive values were calculated for each method. Results: The results obtained in this study showed that CBCT was most accurate with the dimensional accuracy of 96% followed by Dental operating microscope which performed better (with the diagnostic accuracy of 76%) than the magnifying loupes (with the diagnostic accuracy of 64%) direct visual method (with the diagnostic accuracy 60%). Conclusion: The dental operating microscope was most effective in the detection of MB2 canals followed by magnifying loupes and direct visual method. Additionally, CBCT could be used as a supplementary diagnostic tool in cases in which canals are not found using the methods available in the dental office. Keywords: Diagnostic methods, Direct visual method, Magnifying loupes, Dental operating microscope, CBCT, Cross-sectioning, Diagnostic accuracy.

Next generation sequencing (NGS) based technology has contributed enormously to our understanding of the biology of myeloid malignancies including acute myeloid leukaemia (AML) and myelodysplastic syndrome (MDS). Assessment of clinically important mutations by NGS is a powerful tool to define diagnosis, determine prognostic risk, monitor measurable residual disease and uncover predictive mutational markers/therapeutic targets, and is now a routine component in the workup and monitoring of haematological disorders. There are many technical challenges in the design, implementation, analysis and reporting of NGS based results, and expert interpretation is essential. It is vital to distinguish relevant somatic disease associated mutations from those that are known polymorphisms, rare germline variants and clonal haematopoiesis of indeterminate potential (CHIP) associated variants. This review highlights and addresses the technical and biological challenges that should be considered before the implementation of NGS based testing in diagnostic laboratories and seeks to outline the essential and expanding role NGS plays in myeloid malignancies. Broad aspects of NGS panel design and reporting including inherent technological, biological and economic considerations are covered, following which the utility of NGS based testing in AML and MDS are discussed. In current practice, patient care is now strongly shaped by the results of NGS assessment and is considered a vital piece of the puzzle for clinicians as they manage these complex haematological disorders.

BACKGROUND: Clinical data on patients admitted to hospital with coronavirus disease 2019 (COVID-19) provide clinicians and public health officials with information to guide practice and policy. The aims of this study were to describe patients with COVID-19 admitted to hospital and intensive care, and to investigate predictors of outcome to characterize severe acute respiratory infection. METHODS: This observational cohort study used Canadian data from 32 selected hospitals included in a global multisite cohort between Jan. 24 and July 7, 2020. Adult and pediatric patients with a confirmed diagnosis of COVID-19 who received care in an intensive care unit (ICU) and a sampling of up to the first 60 patients receiving care on hospital wards were included. We performed descriptive analyses of characteristics, interventions and outcomes. The primary analyses examined in-hospital mortality, with secondary analyses of the length of hospital and ICU stay. RESULTS: Between January and July 2020, among 811 patients admitted to hospital with a diagnosis of COVID-19, the median age was 64 (interquartile range [IQR] 53-75) years, 495 (61.0%) were men, 46 (5.7%) were health care workers, 9 (1.1%) were pregnant, 26 (3.2%) were younger than 18 years and 9 (1.1%) were younger than 5 years. The median time from symptom onset to hospital admission was 7 (IQR 3-10) days. The most common symptoms on admission were fever, shortness of breath, cough and malaise. Diabetes, hypertension and cardiac, kidney and respiratory disease were the most common comorbidities. Among all patients, 328 received care in an ICU, admitted a median of 0 (IQR 0-1) days after hospital admission. Critically ill patients received treatment with invasive mechanical ventilation (88.8%), renal replacement therapy (14.9%) and extracorporeal membrane oxygenation (4.0%); 26.2% died. Among those receiving mechanical ventilation, 31.2% died. Age was an influential predictor of mortality (odds ratio per additional year of life 1.06, 95% confidence interval 1.03-1.09). INTERPRETATION: Patients admitted to hospital with COVID-19 commonly had fever, respiratory symptoms and comorbid conditions. Increasing age was associated with the development of critical illness and death; however, most critically ill patients in Canada, including those requiring mechanical ventilation, survived and were discharged from hospital.

Fractures and wear tooth, poor dental position, trauma and dissatisfaction with aesthetics are the major causes why patients seek for dental treatment. This work aims to present a technique for treating cases with aesthetic requirements using guides, to restore teeth with a G.V. Black’s Class IV restoration. The combination of rising patient aesthetic demands and the desire for conservative dentistry, has resulted in development of intricate direct composite layering techniques. Direct restorations have good predictability, resistance load, longevity and compared with indirect restorations have greater preservation of dental tissues, low cost and fewer clinical sessions. This case report describes a systematic system to rebuild the lost anatomy of a maxillary central incisor with dental composites. Keywords: Composite resin restoration, Dental esthetics, Lingual putty technique.

Squamous cell carcinoma (SCC) of the nail bed is not encountered commonly although it is the most common primary malignancy at this site. In general, it has a low rate of spread, except for high risk types which carry a greater risk of spread. Screening for systemic tumours should be done in all cases especially in the elderly. We present the case of a 67 year old male who was otherwise healthy and presented with just nail discoloration associated with pain and occasional profuse bleeding with minor trauma which turned out to be SCC of nail bed on biopsy. Subsequently, he was screened for internal malignancies and was found to have clear cell Renal cell carcinoma of right kidney and a metastatic nodule in right lung. This presentation has not been previously described in literature.

Natural polysaccharides, as well as biopolymers, are now days widely developed for targeting colon cancer using various drug delivery systems. Currently, healing conformations are being explored that can efficiently play a multipurpose role. Owing to the capability of extravagance colonic diseases with the least adverse effects, biopolymers for site specific colon delivery have developed an increased curiosity over the past decades. Inulin (INU) was explored for its probable application as an entrapment material concerning its degradation by enzymes in the colonic microflora and its drug release behavior in a sustained and controlled manner. INU is a polysaccharide and it consists of 2 to 1 linkage having an extensive array of beneficial uses such as a carrier for delivery of therapeutic agents as an indicative/investigative utensil or as a dietary fiber with added well-being aids. In the main, limited research, as well as information, is available on the delivery of therapeutic agents using inulin specifically for colon cancer because of its capability to subsist in the stomach’s acidic medium. This exceptional steadiness and robustness properties are exploited in numerous patterns to target drugs securely for the management of colonic cancer, where they effectively act and kills colonic tumor cells easily. In this review article, recent efforts and inulin-based nano-technological approaches for colon cancer targeting are presented and discussed.

Background EGFR mutant NSCLC patients have leptomeningeal (LM) involvement in more than 9% cases. Material & methods We conducted a study evaluating the diagnostic utility of cfDNA EGFR testing in CSF using DdPCR while comparing it against MRI and CSF cytology. We also looked for known EGFR mutations in the CSF sample. These mutations were also tested in paired plasma samples. We further compared which constituent of CSF (pellet/supernatant) had better yield. Results 21 patients comprised the study. Of these 17 patients were diagnosed to have LM involvement based on conventional criteria. All modalities had 100 % specificity and positive predictive value. However, MRI and CSF cytology had a poor negative predictive value. cfDNA had the highest sensitivity (92.3 %), negative predictive value (75 %), accuracy (94.1 %), and net comparative benefit. Paired plasma samples were available for 19 patients. Primary EGFR mutation was detectable in the CSF sample in 16/19 patients; however, the plasma sample was positive only in 7/19 patients. 3 samples were negative for primary EGFR mutation in both CSF and plasma. None of the CSF samples showed positivity for T790M mutation which could however be observed in two patients in plasma samples. Both supernatant and pellet were analysed for cfDNA mutation analysis in 18/21 patients. The intraclass correlation coefficient regarding the percentage fraction tumor-derived DNA of cfDNA observed was 0.83(95 % CI 0.29 to 0.95) between both samples. Conclusion EGFR detection in CSF has a potential role in diagnosing LM involvement. T790 M resistance mutations are uncommon in CSF post first and second-generation TKIs. Both supernatant and pellet samples can be used for the extraction of cell-free DNA in CSF.

Viral diseases continue to emerge and represent a serious issue to public health. Since viral transmission occurs through respiratory droplets, most patients with coronavirus disease 2019 (COVID-19) predominantly have respiratory tract involvement. The clinical spectrum of COVID-19 ranges from asymptomatic to symptomatic with mild, moderate, and severe degrees of illnesses. There are no specific clinical features that can yet reliably distinguish COVID-19 from other viral respiratory infections. Unexplained worsening of underlying chronic illnesses and comorbidities should raise the suspicion of COVID-19. Beyond the life-threatening pulmonary complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the widespread organ-specific manifestations of COVID-19 are increasingly being appreciated. Given that angiotensin-converting enzyme 2, the entry receptor for the SARS-CoV-2, is expressed in multiple extrapulmonary tissues and that all might contribute to these extrapulmonary manifestations of COVID-19, here we review the pulmonary and extrapulmonary presentations for patients with COVID-19.

Background: Respiratory system involvement and fever are considered as a cardinal manifestation of Covid-19 infection for the screening of case detection. We (India) are into the fourth month of Covid-19 and cases are still rising, this could mean that fever and respiratory symptoms may not be the only initial symptoms. Therefore, we intend to investigate whether neurological symptoms can precede the cardinal symptoms. Methods: Totally, 391 Covid-19 RTPCR positive hospitalized patients were enrolled. All included subjects were presented with a questionnaire pertaining to systemic symptoms. For analysis of the chronology of symptoms, the study population was sub-grouped according to onset of their systemic involvement e.g., (1) Fever (2) Respiratory symptoms (3) Neurological symptoms (4) Gastrointestinal symptoms. Results: New-onset neurological symptoms were found in 106 (27.1%) out of 391 patients irrespective of their chronology to the onset of other symptoms. Of these 106 patients, altered taste (33.1%), altered smell (24.5%), and headache (22.6%) were the most common neurological symptoms. However, 38 (9.7%) subjects recognized neurological symptoms, as the initial manifestation of their illness. Mean duration of neurological symptoms before the onset of respiratory symptoms or fever was 2 ± 1.57 days. Conclusion: New-onset headache, altered taste, and smell were the most common neurological symptoms. In the context of the current pandemic, a high index of suspicion should be kept in patients presenting with these symptoms even in the absence of fever and respiratory symptoms. To the best of our knowledge, this is the first study from India comparing chronology of neurological symptoms with cardinal symptoms.

Mantle cell lymphoma (MCL) is an uncommon B-cell non-Hodgkin lymphoma (NHL) that is incurable with standard therapies. The genetic drivers of this cancer have not been firmly established, and the features that contribute to differences in clinical course remain limited. To extend our understanding of the biological pathways involved in this malignancy, we performed a large-scale genomic analysis of MCL using data from 51 exomes and 34 genomes alongside previously published exome cohorts. To confirm our findings, we resequenced the genes identified in the exome cohort in 191 MCL tumors, each having clinical follow-up data. We confirmed the prognostic association of TP53 and NOTCH1 mutations. Our sequencing revealed novel recurrent noncoding mutations surrounding a single exon of the HNRNPH1gene. In RNA-seq data from 103 of these cases, MCL tumors with these mutations had a distinct imbalance of HNRNPH1 isoforms. This altered splicing of HNRNPH1 was associated with inferior outcomes in MCL and showed a significant increase in protein expression by immunohistochemistry. We describe a functional role for these recurrent noncoding mutations in disrupting an autoregulatory feedback mechanism, thereby deregulating HNRNPH1 protein expression. Taken together, these data strongly imply a role for aberrant regulation of messenger RNA processing in MCL pathobiology.

Background/aim We aimed to investigate the efficacy of immune-cell therapy in terms of the survival of patients with neuroendocrine carcinoma of the uterine cervix (NECC), which lacks standardized therapeutic approaches. Patients and methods We identified 17 patients who were diagnosed as having NECC and treated with immune-cell therapy. The clinical characteristics of these patients were extracted from their records and their overall survival was measured. Results Of the 17 patients, two patients with early-stage NECC without recurrence and three patients with less than four treatments were excluded. The median survival times from the time of diagnosis and from the initial administration of immune-cell therapy were 49.7 and 24.4 months, respectively. The overall survival rates at 1, 2, and 5 years were 63.6%, 38.2%, and 25.5%, respectively. Long-term survival was observed in the patients with distant metastases. Conclusion The preliminary results of this retrospective study suggested the potential efficacy of immune-cell therapy for NECC.

Background/aim In this retrospective study, we aimed to investigate the efficacy of immune-cell therapy using T lymphocytes activated in vitro with or without dendritic cell vaccination in combination with standard therapies in terms of the survival of patients with advanced or recurrent endometrial and cervical cancers of the uterus. Patients and methods A total of 187 patients with advanced or recurrent uterine cancer were enrolled in this study. The correlation between overall survival and various clinical factors was examined by univariate and multivariate analyses. Results Univariate analysis revealed that the prognosis was improved in uterine cancer patients who received immune-cell therapy without prior chemotherapy or without distant metastasis. Multivariate analysis demonstrated that the absence of prior chemotherapy for endometrial cancer and liver/lung metastasis of cervical cancer are indications for immune-cell therapy. Conclusion Survival benefit in uterine cancer patients could be potentially obtained by a combination of immune-cell therapy with other therapies.

Background Immunotherapy for cancer patients has been the subject of attention in recent years. In this study, we investigated whether αβT‐cell therapy causes changes in the host's immune cell profile, and if so, the effect of these changes on prognosis. Methods Peripheral blood mononuclear cells (PBMCs) from 30 gastric cancer patients who had completed one course of αβT‐cell therapy were analyzed. The peripheral blood immune cell profile was established using PBMCs by counting the frequency of CD4+ helper T cells, CD8+ killer T cells, regulatory T cells (Tregs), and myeloid‐derived suppressor cells and measuring the expression of their surface markers. The changes after treatment and their association with response to treatment were investigated. Results Immune cell profiles changed greatly after treatment. The frequency of CD4+ helper T cells decreased, but that of CD8+ killer T cells increased. The frequency of programmed cell death 1 (PD‐1)+ effector Tregs increased significantly, but only in the non‐progressive disease (non‐PD) group, in which it was significantly higher compared with the PD group. Patients in whom the frequency of PD‐1+ effector Tregs increased had a significantly better prognosis than those in whom it decreased. Conclusion Our results suggested that αβT‐cell therapy changes the host's immune cell profile, and an increase in PD‐1+ effector Tregs may help improve prognosis., Our results suggested that αβT‐cell therapy changes the host's immune cell profile. An increase in PD‐1+ effector Tregs may help improve prognosis of advanced gastric cancer.

Background aims Activated γδT cells have been shown to exhibit cytotoxicity against tumor cells. However, the efficacy of γδT cell immunotherapy for a large number of patients with solid tumors remains unclear. In this study, we examined the efficacy of γδT cell immunotherapy using in vitro-activated γδT lymphocytes in combination with standard therapies in terms of the survival of patients with solid tumors, and determined prognostic factor for γδT cell immunotherapy. Methods 131 patients enrolled in this study received γδT cell immunotherapy with or without standard therapies. Their overall survival was analyzed by the Kaplan-Meier with log-rank test and Cox regression methods. Immunological analysis was performed by flow cytometry (FCM) before and after six cycles of γδT cell immunotherapy. Results Multivariable analysis revealed that patients who showed stable disease (SD) and partial response (PR) to γδT cell immunotherapy showed better prognosis than those with a progressive disease (PD) (P = 0.0269, hazard ratio [HR], 0.410, 95% confidence interval [CI], 0.190–0.901). Furthermore, when immunological parameters were examined by FCM, the high Vγ9/γδT ratio (i.e., the high purity of the Vγ9 cells within the adoptively transferred γδT cells) before treatment was found to be a good prognostic factor for γδT cell immunotherapy (P = 0.0142, HR, 0.328, 95% CI, 0.125–0.801). No serious adverse events were reported during γδT cell immunotherapy. Conclusion Thus, γδT cell immunotherapy might extend the survival of patients with solid tumors.

The assembly and disassembly of FtsZ play an essential role in bacterial cell division. Using single-cell imaging, we report that short exposure to BT-benzo-29 inhibits Z-ring formation in live Bacillus subtilis cells. Fluorescence recovery after photobleaching of the Z-ring in live bacteria demonstrated that BT-benzo-29 strongly suppressed the assembly dynamics of FtsZ in the Z-ring. Furthermore, B. subtilis cells expressing V275A-FtsZ resisted the antibacterial activity of BT-benzo-29 providing evidence that BT-benzo-29 inhibits bacterial proliferation by targeting FtsZ. In addition, a brief (8 min) exposure of BT-benzo-29 destroyed the Z-ring without perturbing the localization of a late cell division protein, DivIVA, the nucleoid segregation, and membrane permeability. BT-benzo-29, when used in combination with vancomycin and polymyxin B (PMB), produced a much stronger inhibitory effect on Bacillus subtilis and Escherichia coli cells, respectively. The combination index of BT-benzo-29 with vancomycin and PMB was determined to be

Background & Aims: The interaction between intestinal microbiota and the immune system plays a vital role in inflammatory bowel disease (IBD). Although numerous deep-sequencing studies have suggested dysbiosis in IBD, identifying specific bacteria from the stool or mucosa that are responsible for disease susceptibility or severity has remained a challenge. Lamina propria phagocytes ideally are localized to interact with bacteria that are in close proximity to, or have invaded, the tissue. Thus, we examined the microbial populations associated with the lamina propria phagocytes in 20 Crohn’s disease and 12 ulcerative colitis patients. Specifically, we aimed to address whether the phagocyte-associated microbiota differed from the mucosa-associated microbiota and whether this varied based on IBD type or the state of inflammation. Methods: 16S ribosomal RNA gene sequencing and innate immune gene expression profiling was done on CD11b+ lamina propria phagocytes isolated from the biopsies obtained from IBD patients. Results: Phagocyte-associated microbiota was enriched in bacterial species belonging to phylum Proteobacteria, whereas species belonging to phylum Bacteroidetes were enriched in the mucosal microbiota of IBD patients. Disease type was the most influential factor in driving differences in the microbiota of both the mucosa and the lamina propria phagocytes, irrespective of inflammation state o`r anatomic location. Crohn’s disease and ulcerative colitis specimens showed similar patterns of increased inflammatory gene expression in phagocytes isolated from inflamed areas compared with those isolated from uninflamed regions. Conclusions: This pilot study shows the feasibility of using lamina propria phagocytes to characterize the microbiota in IBD patients. The approach used in this study can narrow the spectrum of potentially dysbiotic bacterial populations and clinically relevant gene expression signatures in IBD patients. Keywords: Mucosa, Microbiota, Nanostring, Crohn’s Disease, Ulcerative Colitis

Background The optimal treatment duration for patients with bloodstream infection is understudied. The Bacteremia Antibiotic Length Actually Needed for Clinical Effectiveness (BALANCE) pilot randomized clinical trial (RCT) determined that it was feasible to enroll and randomize intensive care unit (ICU) patients with bloodstream infection to 7 versus 14 days of treatment, and served as the vanguard for the ongoing BALANCE main RCT. We performed this BALANCE-Ward pilot RCT to examine the feasibility and impact of potentially extending the BALANCE main RCT to include patients hospitalized on non-ICU wards. Methods We conducted an open pilot RCT among a subset of six sites participating in the ongoing BALANCE RCT, randomizing patients with positive non-Staphylococcus aureus blood cultures on non-ICU wards to 7 versus 14 days of antibiotic treatment. The co-primary feasibility outcomes were recruitment rate and adherence to treatment duration protocol. We compared feasibility outcomes, patient/pathogen characteristics, and overall outcomes among those enrolled in this BALANCE-Ward and prior BALANCE-ICU pilot RCTs. We estimated the sample size and non-inferiority margin impacts of expanding the BALANCE main RCT to include non-ICU patients. Results A total of 134 patients were recruited over 47 site-months (mean 2.9 patients/site-month, median 1.0, range 0.1–4.4 patients/site-month). The overall recruitment rate exceeded the BALANCE-ICU pilot RCT (mean 1.10 patients/site-month, p p = 0.0003). BALANCE-Ward patients were older, with lower Sequential Organ Failure Assessment scores, and higher proportions of infections caused by Escherichia coli and genito-urinary sources of bloodstream infection. The BALANCE-Ward pilot RCT patients had an overall 90-day mortality rate of 17/133 (12.8%), which was comparable to the 90-day mortality rate in the ICU pilot RCT (17/115, 14.8%) (p = 0.65). Simulation models indicated there would be minimal sample size and non-inferiority margin implications of expanding enrolment to increasing proportions of non-ICU versus ICU patients. Conclusion It is feasible to enroll non-ICU patients in a trial of 7 versus 14 days of antibiotics for bloodstream infection, and expanding the BALANCE RCT hospital-wide has the potential to improve the timeliness and generalizability of trial results. Trial registration Clinicaltrials.gov, NCT02917551. Registered on September 28, 2016.

In the present era due to over-industrialization and increase in pollution as well as changed life style, one can constantly meets with various pollutants; which ultimately results in weaken immune system and increased sensitivity toward allergens. This causes various types of allergic diseases. Urticaria is one of the most common allergic skin diseases characterized by erythematous and pruritic rashes. It affects 15-20% of the people at some point of their life. Highest incidence occurs at third decade of life. The discomfort and stress caused by urticarial can lead to serious impairment of quality life. In classics sheetpitta has almost similar symptomatology and causative factors as urticaria. In sheetpitta, vata and kapha are primarily disturbed and in combination of pitta they cause redness, swelling and itching on the skin. Although the diseases is not life-threatening, it makes the patient troubled due to its appearance, severe itching, and disturb the daily routine. In contemporary science there is no permanent cure, but only remission of the disease can be achieved by medicine. But these treatments can cause reoccurrence of the disease. So an effort has been made with Ayurvedic intervention. A male patient from Panchkarma OPD was treated with Virechana along with internal medication and dietary protocol. Significant relief in the symptoms is observed in the patient after Virechana and oral medication. Virechana may be better line of treatment for urticaria as it works on correcting the underlying root cause along with symptoms of the diseases.

The objective of the research was to assess the reproducibility of retinal nerve fiber layer (RNFL) and macular thickness using spectral domain optical coherence tomography and to establish whether the same investigator can get the same or similar results when performing the scan thrice in an hour, without reference to the previous scan and the repeat function. Materials and Methods. In this prospective observational study, 200 subjects who fulfilled the inclusion and exclusion criteria were scanned 3 times according to predefined guidelines at 0, 30 and 60 minutes on the same day, by the same investigator, using spectral domain optical coherence tomography for measurements of RNFL and macular thickness; observations were statistically analyzed and correlated. Results. In RNFL thickness, the temporal sector showed the worst reproducibility as compared to other sectors. RNFL was the greatest in the superior quadrant and the thinnest in the temporal quadrant. For macular thickness, the temporal sector (mid zone) showed the worst reproducibility, while in the outer zone, the inferior sector showed the worst reproducibility; macular thickness was the thinnest at the central zone (innermost 1-mm ring), the thickest within the inner 3-mm ring and diminished peripherally. Conclusions. RNFL and macular thickness measurements using spectral domain optical coherence tomography by the same observer at 0, 30 and 60 minutes were very reproducible, except for the sectors specifically mentioned. The greater the thickness of the RNFL in any sector the better was the reproducibility in that sector. For macular thickness, the temporal sector (mid zone) showed the worst reproducibility.

This case report describes the clinical procedures involved in the treatment of a complicated fracture in the maxillary left central incisor in a 35-year-old female patient, due to accidental fall. After clinical and radiograph examination Ellis class III fracture was diagnosed. Endodontic treatment was decided to restore the complicated crown fracture with fiber post and core followed by Porcelain fused to metal crown. & the tooth was satisfactory both esthetically and functionally. Keywords: Crown fracture, Traumatic dental injuries, Permanent tooth, Fiber Post.

Background: Ovarian malignancy is a common malignancy in women. Most malignancies are adenocarcinoma. However, adnexal metastases from squamous cell carcinoma (SCC) of the cervix are uncommon. Case...

Background The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P Interpretation This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men.

Background Traumatic Dental Injuries (TDI) have emerged as a very significant public health and social problem, especially among children and adolescents. The aim of this study was to investigate the prevalence and associated risk factors of traumatic dental injuries to permanent anterior teeth in school going children of Kolkata aged 7-14 years. Method A cross-sectional study was conducted among 3762 school going children attending various private and public schools of Kolkata aged 7–14 years. A multistage random clustering sampling technique was adopted to select the children.Type of trauma using Ellis and Davey classification of fractures along with Andresen’s Epidemiological Classification of Traumatic Injuries to Anterior Teeth, including WHO codes, was used. All values were considered statistically significant at P Results Prevalence of TDI to anterior teeth was found to be 9.89%. The mean age of children who presented with TDI was 11.06 ± 1.99.years. The most common place of occurrence of TDI was home. Falls were the most common causes of trauma. Children belonging to higher socioeconomic status were observed to have an increased prevalence of TDIs.The highest potential risk factor for the occurrence of trauma was a past history of trauma. Conclusion Present study found a prevalence of 9.89%, and a very low percentage of children had received treatment.

Considering the worldwide demand for colorants of natural origin, the utilization of ascomycete fungi as a prolific pigment producer unfolds a novel way to obtain these pigments for various applications, including food, cosmetic, and medical use. The presence of very few natural red pigment alternatives in the market also attracts research and industry priorities to unearth novel and sustainable red pigment producers. The present work is an attempt to identify a novel source of red color obtained from endophytic fungi isolated from terrestrial and marine habitats. Based upon the fungal capacity for pigment production, seven isolates of endophytic fungi were recognized as prospective pigment producers. Out of all, fungal isolate CPE04 was selected based upon its capacity to produce profuse extracellular red pigment. The isolate was identified as Talaromyces assiutensis, employing morphological features and phylogenetic characterization by internal transcribed spacer (ITS) sequences. To understand the chemical behavior of pigment molecules, an investigation of the chemical profile of fungal culture filtrate dried powder (CFDP) was performed using ultra-high-performance liquid chromatography-diode array detector-mass spectrometry (UPLC–DAD–MS). In total, eight compounds having pigment and pharmaceutical application were tentatively identified using UPLC–DAD–MS. Considering the commercial aspect of the stated work, an effort was also made for standardizing the upscaling of the pigment molecule. Investigations were performed for optimum medium and culturing conditions for maximum pigment production. CFDP was found to have a significant antibacterial activity against the bacterial pathogens Staphylococcus aureus (MTCC737), Vibrio cholerae (N16961), and methicillin-resistant S. aureus (MRSA) (ATCC BAA811). The CFDP showed a minimum inhibitory concentration at 64, 128, and 256 μg/ml against S. aureus, MRSA, and V. cholerae. A concentration-dependent (50–400 μg/ml) anticancer effect on HeLa cancer line was also observed, having a half-maximal inhibitory concentration (IC50) at 300 μg/ml. The antioxidant potential of CFDP has also been proven with the help of an antioxidant assay against 2,2′-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) radical (IC50, 32.01 μg/ml); DNA nicking assay and reactive oxygen species were generated in HeLa cancer line cells. The CFDP was also found to have no cytotoxicity toward HEK 293 T cell line using alamar blue (resazurin), a cell metabolic activity reagent.

Breast cancer persists as a diffuse source of cancer despite persistent detection and treatment. Flavonoids, a type of polyphenol, appear to be a productive option in the treatment of breast cancer, because of their capacity to regulate the tumor related functions of class of compounds. Plant polyphenols are flavonoids that appear to exhibit properties which are beneficial for breast cancer therapy. Numerous epidemiologic studies have been performed on the dynamic effect of plant polyphenols in the prevention of breast cancer. There are also subclasses of flavonoids that have antioxidant and anticarcinogenic activity. These can regulate the scavenging activity of reactive oxygen species (ROS) which help in cell cycle arrest and suppress the uncontrolled division of cancer cells. Numerous studies have also been performed at the population level, one of which reported a connection between cancer risk and intake of dietary flavonoids. Breast cancer appears to show intertumoral heterogeneity with estrogen receptor positive and negative cells. This review describes breast cancer, its various factors, and the function of flavonoids in the prevention and treatment of breast cancer, namely, how flavonoids and their subtypes are used in treatment. This review proposes that cancer risk can be reduced, and that cancer can be even cured by improving dietary intake. A large number of studies also suggested that the intake of fruit and vegetables is associated with reduced breast cancer and paper also includes the role and the use of nanodelivery of flavonoids in the healing of breast cancer. In addition, the therapeutic potential of orally administered phyto-bioactive compounds (PBCs) is narrowed because of poor stability and oral bioavailability of compounds in the gastrointestinal tract (GIT), and solubility also affects bioavailability. In recent years, creative nanotechnology-based approaches have been advised to enhance the activity of PBCs. Nanotechnology also offers the potential to become aware of disease at earlier stages, such as the detection of hidden or unconcealed metastasis colonies in patients diagnosed with lung, colon, prostate, ovarian, and breast cancer. However, nanoformulation-related effects and safety must not be overlooked. This review gives a brief discussion of nanoformulations and the effect of nanotechnology on herbal drugs.

Accurate classification of acute myeloid leukaemia (AML) has become increasingly reliant on molecular characterisation of this blood cancer. Throughout Australia and New Zealand massively parallel sequencing (MPS) is being adopted by diagnostic laboratories for the routine evaluation of patients with AML. This technology enables the surveying of many genes simultaneously, with many technical advantages over single gene testing approaches. However, there are many variations in wet and dry lab MPS procedures, which raises the prospect of discordant results between laboratories. This study compared the results obtained from MPS testing of ten diagnostic AML bone marrow aspirate samples sent to eight participating laboratories across Australasia. A reassuringly high concordance of 94% was observed with regard to variant detection and characterisation of pathogenicity. The level of discordance observed, although low, demonstrates the need for ongoing assessment of concordance between diagnostic testing laboratories through quality assurance programs. Refereed/Peer-reviewed

In recent years, the study of emotion has increased due to the interaction of human with machine as it is helpful to interpret human actions and to improve the relationship among humans and machines for developing the software that can understand the human states and can take action accordingly. This paper focuses on a preliminary study on emotion recognition using various psychological signals. Different researchers investigated various parameters which include facial expression, eye gaze, pupil size variation, eye movements using EEG, and deep learning techniques to extract the emotional features of humans. Diverse researchers have proposed a method for detecting emotions by using different psychological signals and achieved reliable accuracy. After a thorough analysis, it has been observed that the best accuracy achieved on the individual emotion detection was 90%. However, this experiment does not help to classify the specific emotion. To classify the specific emotion, the best accuracy achieved was 79.63%, which is a comparable accuracy.