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Abstract Gastrointestinal (GI) cancers are a significant global health concern with diverse etiologies and limited treatment options. Ellagic acid (EA), a natural polyphenolic compound, exhibits promising anticancer properties against various GI malignancies. In this article, we have reviewed recent research on the anticancer potential of EA across esophageal, gastric, colorectal, pancreatic, and liver cancers. In esophageal cancer, EA inhibits the formation of O6-methylguanine (O6-meGua) adducts induced by carcinogens like N-nitrosomethylbenzylamine (NMBA), thereby suppressing tumor growth. Additionally, EA inhibits STAT3 signaling and stabilizes tumor suppressor proteins, showing potential as an anti-esophageal cancer agent. In gastric cancer, EA regulates multiple pathways involved in cell proliferation, invasion, and apoptosis, including the p53 and PI3K-Akt signaling pathways. It also demonstrates anti-inflammatory and antioxidant effects, making it a promising therapeutic candidate against gastric cancer. In colorectal cancer (CRC), EA inhibits cell proliferation, induces apoptosis, and modulates the Wnt/β-catenin and PI3K/Akt pathways, suggesting its efficacy in preventing CRC progression. Furthermore, EA has shown promise in pancreatic cancer by inhibiting nuclear factor-kappa B, inducing apoptosis, and suppressing epithelial–mesenchymal transition. In liver cancer, EA exhibits radio-sensitizing effects, inhibits inflammatory pathways, and modulates the tumor microenvironment, offering potential therapeutic benefits against hepatocellular carcinoma. Studies on EA potential in combination therapies and the development of targeted delivery systems are required for enhanced efficacy against gastrointestinal cancers.

Grid-connected PV inverters require sophisticated control procedures for smooth integration with the modern electrical grid. The ability of FCS-MPC to manage the discrete character of power electronic devices is highly acknowledged, since it enables direct manipulation of switching states without requiring modulation techniques. This review discusses the latest approaches in FCS-MPC methods for PV-based grid-connected inverter systems. It also classifies these methods according to control objectives, such as active and reactive power control, harmonic suppression, and voltage regulation. The application of FCS-MPC particularly emphasizing its benefits, including quick response times, resistance to changes in parameters, and the capacity to manage restrictions and nonlinearities in the system without the requirement for modulators, has been investigated in this review. Recent developments in robust and adaptive MPC strategies, which enhance system performance despite distorted grid settings and parametric uncertainties, are emphasized. This analysis classifies FCS-MPC techniques based on their control goals, optimal parameters and cost function, this paper also identifies drawbacks in these existing control methods and provide recommendation for future research in FCS-MPC for grid-connected PV-inverter systems.

The major aim of this work is to analyze the thermophysical properties of hybrid nanoliquid inside a square lid driven enclosure under the effect of applied magnetic field and mixed convection. The Hybrid nanofluid is considered a suspension of Iron-oxide (Fe3O4) and Copper (Cu) nanoparticles into water. The cavity walls have varying properties such as top adiabatic wall is moving continuously while the lower wall is maintained at a high constant temperature, in addition, the vertical walls are kept at a low fixed temperature. The magnetic field is applied to the right vertical wall in a horizontal direction. Additionally, the effects of buoyancy forces caused by temperature gradients and shear forces caused by continuous lid motion are considered. The mathematical modelling of problem with all assumptions yields the nonlinear partial differential system. First this system is transferred into non-dimensional form and then transformed system is solved by using Galerkin finite element method (GFEM) along with Gaussian elimination method. Results for isotherms, streamlines and average Nusselt number are obtained versus Richardson number (0.1 ≤ Ri ≤ 15), Grashof number (10 ≤ Gr ≤ 10000), Hartmann number (0 ≤ Ha ≤ 100), volume fractions of solid nanoparticles (0.005 ≤ ϕ1 ≤ 0.02) and (0.005 ≤ ϕ2 ≤ 0.02). It is observed that the Richardson number and Grashof number have significant impacts on both flow velocity and temperature. In addition, concentration of hybrid nanoparticles improves the heat transfer performance. The obtained results may be crucial for thermal management in the cooling of electronics, heat exchangers, solar thermal collectors, industrial operations, medical equipment, HVAC systems, food processing, and renewable energy systems.

Abstract Rice brown spot is an important disease of rice worldwide that inflicts substantial yield losses. The antimicrobial potential of methanol, acetone and dimethyl sulfoxide (DMSO) extracts of different medicinal plants, viz., Syzygium aromaticum, Saussurea costus, Acorus calamus, Bergenia ciliate, Geranium pratense, Mentha longifolia, Inula racemosa, Podophyllum hexandrum, Heracleum candicans and Picrorhiza kurroa, against the brown spot pathogen Bipolaris oryzae in vitro was evaluated via mycelial growth inhibition and spore germination inhibition assays. Among the plant extracts tested, 100% mycelial inhibition was observed for the methanol extract of Syzygium aromaticum at all three concentrations (2000 ppm, 3000 ppm and 4000 ppm), followed by the methanol extract of Inula racemosa (90.33%) at 4000 ppm. A maximum conidial germination inhibition of 83.54% was exhibited by the Heracleum candicans leaf extract. Phytochemical profiling of Syzygium aromaticum and Inula racemosa through liquid chromatography and mass spectrometry (HR-LCMS) revealed the presence of several compounds, such as eugenol, ursolic acid, quercetin, chlorogenic acid, and noscapine. A molecular docking approach was used to identify key inhibitory molecules against B. oryzae. Among the compounds detected in S. aromaticum and Inula racemosa, ursolic acid and noscapine were found to have the greatest binding affinity for the Big Mitogen Activated Protein Kinase (BMK-1) enzyme present in B. oryzae. In conclusion, S. aromaticum and Inula racemosa are potent compounds that could serve as lead compounds for drug discovery in the future.

The quality of GNSS-based navigation services is highly influenced by the type of operating environment. The urban environments with buildings and structures pose substantial challenges for GNSS navigation accuracy. To address this challenge, we propose a data-driven approach Environment Adaptive Navigation (EAN) because complex mathematical models for GNSS environments are impractical for real-time use due to their processing load. This data-driven approach analyzes real-time GNSS data to understand how the environment affects performance and optimize receiver settings for each scenario. Keeping this in view, raw GNSS data was collected through field trials including the three environments: clear sky, partially degraded, and highly degraded. We then analyzed this data to pinpoint factors affecting accuracy, such as the number of available satellites and standard error measurements. The proposed solution, the EAN algorithm, tackles these limitations of the GNSS due to the urban environments and improves the navigation performance. This data-driven approach analyzes real-time GNSS data to identify the specific environment (clear, partially degraded, or highly degraded). Based on this assessment, EAN dynamically adjusts receiver settings, like tracking loop bandwidth, to achieve optimal performance under those conditions. Integrating the EAN model into GNSS receivers allows for real-time environment detection and adaptive configuration. This EAN-based GNSS receiver holds significant promise for safety-critical applications like Intelligent Transportation Systems (ITS). Precise navigation is crucial for functionalities within ITS, such as route optimization and autonomous vehicle operation. The effectiveness of the EAN-based receiver was validated through a field experiment demonstrating a notable increase in tracked satellites and a substantial reduction in outages within a highly degraded environment.

A new data-driven continuum model based on an artificial neural network is developed in this study for a new three-dimensional lattice-structured material design. The model has the capability to capture and predict the nonlinear elastic behaviour of the specific lattice-structured material in the three-dimensional continuum description after being trained through the appropriate dataset. The essential data as the input ingredients of the data-driven model are provided through a hybrid method including experimental and unit-cell level finite element simulations under comprehensive loading scenarios including uniaxial, biaxial, volumetric, and pure shear loading. Furthermore, the lattice-structured samples are also fabricated using SLA additive manufacturing technology and the experimental measurements are performed and used for validation of the model. This then illustrates that the current model/methodology is a robust and powerful numerical tool to conduct the homogenization in complex simulation cases and could be used to accelerate the analysis and optimization during the design process of new lattice-structured materials. The model could also easily be used for other engineered materials by updating the dataset and re-training the ANN model with new data.

Cervical cancer (CC) is the most common cancer in women and poses a serious threat to health. Despite familiarity with the factors affecting its etiology, initiation, progression, treatment strategies, and even resistance to therapy, it is considered a significant problem for women. However, several factors have greatly affected the previous aspects of CC progression and treatment in recent decades. miRNAs are short non-coding RNA sequences that regulate gene expression by inhibiting translation of the target mRNA. miRNAs play a crucial role in CC pathogenesis by promoting cancer stem cell (CSC) proliferation, postponing apoptosis, continuing the cell cycle, and promoting invasion, angiogenesis, and metastasis. Similarly, miRNAs influence important CC-related molecular pathways, such as the PI3K/AKT/mTOR signaling pathway, Wnt/β-catenin system, JAK/STAT signaling pathway, and MAPK signaling pathway. Moreover, miRNAs affect the response of CC patients to chemotherapy and radiotherapy. Consequently, this review aims to provide an acquainted summary of onco miRNAs and tumor suppressor (TS) miRNAs and their potential role in CC pathogenesis and therapy responses by focusing on the molecular pathways that drive them.

Peristaltic movement of fluid flows has significant applications in biomedical engineering, medicine, human physiology, etc. Specifically, it is very useful to understand and cure the very common intestinal diseases in human beings. A number of theoretical and empirical models are used to analyze peristaltic movement. In this work, the peristaltic movement of nanofluid is modeled with a non-Newtonian Ellis fluid model in a curved channel with compliant wall properties. The effects of Brownian motion, thermophoresis, and nonlinear radiations are considered in the heat transfer for better thermal analysis. The mathematical modeling of the physical problem yields the nonlinear partial differential equations with boundary conditions. First, the governing partial differential equations are non-dimensionalized, and then the resultant system is simplified by using the assumptions of a small Reynolds number and long wavelength. Then the obtained boundary value problem of differential equations is solved with the built-in Mathematica command NDSolve. The accuracy and reliability of the adopted procedure are verified by comparing the computed results with the reported literature. The impacts of the pertinent parameters (Brownian motion, thermal radiation, mixed convection, and thermophoresis phenomenon) on thermal energy, velocity, concentration, heat transfer rate, and stress at the lower wall are analyzed both in qualitative and quantitative manners. This study revealed some interesting facts, such as the peristaltic-driven motion of nanoliquid is strongly influenced by wall properties (i.e., wall elasticity, mass density, and wall damping). In addition, the flow experienced more resistance in the case of larger wall damping, but larger wall elasticity and mass density provide favorable movement for fluid motion. In addition, mixed convection plays a vital role in heat transfer and nanoparticle concentration in the curved domain. In addition, the curved channel walls have a higher stress factor than straight-plane channels. The results of the current study are very useful to understand many biological phenomena, such as the peristaltic movement of liquid during dialysis, food movement through the intestine, etc.

Key Clinical Message Tarlov cysts are uncommon causes of sacral radiculopathy, with particular predilection to second and third sacral roots, requiring timely diagnosis with lumbosacral MRI, and surgical management if symptomatic. Abstract Tarlov cysts or Type II meningeal cysts, are CSF‐filled sacs located in the extradural space of the sacral spinal canal, commonly originating at the dorsal root ganglion. While they were first documented by Tarlov in 1938, their etiology remains uncertain, with theories suggesting trauma‐induced bleeding or congenital abnormalities. These cysts, estimated to affect between 1% and 9% of the adult population, typically manifest as incidental findings but may lead to symptoms such as radiculopathies, sacral pain, and weakness in related sacral muscles. We present a case of a 63‐year‐old female presenting with recurrent left buttock pain and radiating leg discomfort. Physical examination revealed tenderness in the left buttock region, positive straight leg raise test, and minimal sensory deficits in the S1‐S2 dermatomes. A provisional diagnosis of radiculopathy was made, prompting further evaluation with MRI, revealing a Tarlov cyst and absence of lumbar spinal canal stenosis or neural foraminal compromise. The patient declined intervention and was managed conservatively. This case highlights the diagnostic challenges and therapeutic considerations in managing symptomatic Tarlov cysts, emphasizing the importance of tailored treatment strategies.

Background: The presence of perinatal asphyxia and its severity appear to correlate with increasing incidence of Acute kidney injury (AKI). The objective of this study is to determine the frequency of AKI and its outcome in birth asphyxia. Methods: This cross-sectional study was carried out in the Department of Pediatric Medicine from March 2019 to September 2019. A total of 111 newborns with birth asphyxia of gestational age 37–41 weeks were included. Neonates born to mothers having hypertension and diabetes mellitus, patients with congenital kidney anomalies like polycystic kidney disease and renal agenesis, and mothers taking nephrotoxic drugs or any other known cause of AKI like hypovolemic shock were excluded. Urine output (UOP) and final outcome of the patient were also noted. AKI was noted. Results: The mean gestational age was 38.29 ± 1.07 weeks. The mean weight of neonates was 3.08 ± 0.31 kg. The frequency of AKI in birth asphyxia was 20 (18.02%) neonates. Complete recovery in AKI patients was seen in 07 (35.0%) and death in 13 (65.0%) patients. Conclusion: This study has shown that the frequency of AKI in birth asphyxia was found in 18.02% neonates with complete recovery seen in 35.0% and death in 65.0% patients.

The correlation between epigenetic alterations and the pathophysiology of human infertility is progressively being elucidated with the discovery of an increasing number of target genes that exhibit altered expression patterns linked to reproductive abnormalities. Several genes and molecules are emerging as important for the future management of human infertility. In men, microRNAs (miRNAs) like miR-34c, miR-34b, and miR-122 regulate apoptosis, sperm production, and germ cell survival, while other factors, such as miR-449 and sirtuin 1 (SIRT1), influence testicular health, oxidative stress, and mitochondrial function. In women, miR-100-5p, miR-483-5p, and miR-486-5p are linked to ovarian reserve, PCOS, and conditions like endometriosis. Mechanisms such as DNA methylation, histone modification, chromatin restructuring, and the influence of these non-coding RNA (ncRNA) molecules have been identified as potential perturbators of normal spermatogenesis and oogenesis processes. In fact, alteration of these key regulators of epigenetic processes can lead to reproductive disorders such as defective spermatogenesis, failure of oocyte maturation and embryonic development alteration. One of the primary factors contributing to changes in the key epigenetic regulators appear to be oxidative stress, which arises from environmental exposure to toxic substances or unhealthy lifestyle choices. This evidence-based study, retracing the major epigenetic processes, aims to identify and discuss the main epigenetic biomarkers of male and female fertility associated with an oxidative imbalance, providing future perspectives in the diagnosis and management of infertile couples.

Clinical waste is a major source of infection amongst patients, hospital workers and the community. The Hospital Waste Management committee established in Dr. Ziauddin Hospital has active involvement of Nursing, Housekeeping and Infection Control departments. This multifaceted approach has brought about changes in the form of educational campaigns, involving training sessions and informational posters to improve awareness among hospital workers. This not only decreases the number of injuries and accidents occurring in relation to clinical waste disposal, but proper disposal of hazardous waste is beneficial for the community and the environment we live in. The first step is to target the areas which need the most attention and then to develop a tailor-made plan focusing on the major problems. Effective communication and teamwork help control the issue from all different angles and provide a pro-active approach to improve the waste management facilities of the hospital and serve the community as a whole.

Recent years have witnessed security as a great concern in vehicular networks (VANET). Particularly, Denial of Service (DoS) and Distributed Denial of Service (DDoS) attacks can jeopardize the network by broadcasting a storm of packets. Correspondingly, the network resources are jammed with malicious traffic. In this connection, the existing research presented various techniques to cope with DoS and DDoS attacks. Different from those traditional approaches, this study proposes an Intelligent Intrusion Detection System (IDS) by leveraging Machine Learning (ML). The proposed IDS utilizes a publicly available dataset on the application layer for mitigating DDoS attacks. The designed ML-based IDS relies on combining both the Random Projection (RP) and Randomized Matrix Factorization (RMF) methods to achieve the best results for enhancing the detection capabilities of the IDS. This amalgamation enhances the system's detection capabilities by extracting and analyzing meaningful features from network traffic data. Experimental validation of our approach involves a comprehensive evaluation of various ML models, including Extra Tree Classifier (ETC), Logistic Regression (LR), and Random Forest (RF). Remarkably, the combined accuracy of these models yields an average system accuracy of 0.98, surpassing existing methods. Unlike conventional approaches, our proposed IDS excels in efficiency and exhibits notable performance in detecting DoS and DDoS attacks in VANET. This proficiency ensures the integrity and safety of vehicle communications. Thus, our research substantially contributes to the vehicular network security field. The presented findings establish a foundation for future advancements in securing connected vehicles.

Complementary and alternative medicines (CAM) include conventional medical treatments. Patients worldwide use CAM at alarming rates; thus, reports of CAM-related DILI have been on the rise. The clinical presentations include asymptomatic liver test abnormalities, acute hepatitis with or without jaundice, acute cholestatic liver disease (bland or with hepatitis), acute liver failure, severe hepatitis with features of portal hypertension, and acute decompensation of known or unknown cirrhosis that can lead to acute-on-chronic liver failure. Acute hepatitis with or without necrosis, hepatocellular and canalicular cholestasis, herb-induced or CAM-triggered autoimmune hepatitis, granulomatous hepatitis, severe steatohepatitis, and vanishing bile duct syndrome are common liver biopsy findings in CAM-DILI. The presence of preexisting liver disease predicts severe liver injury, risk of progression to liver failure, and decreased transplant-free survival in patients with CAM-DILI. This review discusses global epidemiology and trends in CAM-DILI, clinical presentation, assessment and outcomes, commonly emerging threats in the context of hepatotoxic herbs, pragmatic assessment of “liver beneficial” herbs and health care myths, patient communication, regulatory framework, and future directions on research in CAM.

In recent years, the global business landscpae has witnessed a paradigm shift toward sustainable and responsible corporate practices. This transition has been particulalrly pronounced in the energy sector where companies are increasingly recongzing the importance of Non-Financial Reporting Initiatives (NFRI) in shaping their operational strategies. The current study endeavors to delive into the intricate relationship between NFRI and the Weighted Average Cost of Capital (WACC) for energy companies in Pakistan. The current study relied on Partial Least Square Structural Equation Modeling (PLS-SEM) technique to extract useful information about the study topic. The data collected for the period 1999 to 2020 from World Development Indicators. The findings of the study revealed that energy consuption factors are responsiblee for around 31.32% variations in WACC, while economic factors contribute 43.98% variations. The financial factors showed to have 35.72% variations in the WACC. The findings of current study revealed to implement policies fostering sustainable energy practices, robust economic growth, and prudent financial management to positively influence the Weighted Average Cost of Capital (WACC) for enhanced business competitiveness and investment attractiveness.

Key Clinical Message The presentation of a Morel‐Lavallée lesion in the lumbosacral region following a road traffic accident is an uncommon clinical entity. Knowledge of this rare site of occurrence can help in early diagnosis and proper management.

Abstract Apple cankers are extremely destructive diseases threatening the global apple industry through direct and indirect losses. The population structure of the pathogens is of paramount significance for the development of efficient management strategies. Therefore, phenotypic, pathogenic, and genetic diversity of Diplodia seriata causing black rot canker of apple was investigated in this study. All the isolates were included for investigating the in vitro mycelial growth, conidial dimensions, and pathogenic variability on two-year-old potted apple seedlings. The ISSR approach was used to investigate the molecular diversity of D. seriata. Mycelial growth rates were found to vary significantly amongst the isolates; however, there were no major variations seen between the different geographical groupings of isolates. Pathogenicity tests revealed variations in the size of cankers among the isolates indicating the presence of virulence variability. The isolates were segregated into three virulence groups based on canker length. The Bayesian analyses of ISSR data divided the isolates into two genetic clusters. The genetic clustering of the isolates revealed no relationship with geographical origin of the isolates. Furthermore, no direct relationship of genetic clustering was observed with morphological or pathogenic variability. The ISSR primers revealed very high level of variability in D. seriata; however, no distinct populations of the pathogen existed which is an indication of high level of gene flow between the diverse geographical populations. According to our knowledge, this is the first thorough investigation on the diversity of D. seriata associated with apple black rot canker in India.

As a country, Pakistan is mostly dependent on fossil fuels for fulfilling its energy demand, which is expensive, as well as being environmentally unfriendly. It is high time that the country decides to shift from fossil fuels to renewable energy resources like geothermal, wind, solar, etc., to cater for global warming issues. Pakistan has a lot of potential geothermal sites, as the location of Pakistan lies on several fault lines and hot springs, thus making it very easy to extract the temperature from deep inside the earth and harness it for Geothermal Energy. Also, a sound knowledge of ground temperature is essential to use geothermal energy, which is obtained by drilling boreholes and putting in sensors. However it becomes a very expensive and labor intensive procedure. Therefore, to avoid the huge cost for drilling boreholes, particularly for ground temperature analysis, a numerical approach has been considered for determining ground temperature. Furthermore, correlation charts between air and ground temperatures have been developed, as there were no proper studies on the ground temperature of Pakistan. Then, with the help of a boreholes drilled in the National University of Sciences and Technology, Islamabad, Pakistan, the actual ground and numerically calculated temperatures have been compared. The results show a temperature error margin in the range between 0.27% for higher depths of about 5.6 m and 7.3% near the surface of about 2.7 m. Thus, it is shown that the proposed method is easy to implement and better than large scale testing methods for the depths at which geothermal energy is extracted.

Introduction: Trigeminal neuralgia is a condition of craniofacial pain which is characterized by sudden, excruciating, and brief pain in the sensory distribution of one or more branches of the fifth cranial nerve resulting in decreased quality of life of the affected patient. In patient’s refractory to pharmacological or conservative treatment, the surgical procedure of choice is microvascular decompression. The aim of our study was to determine the outcome of retro mastoid suboccipital microvascular decompression technique for the trigeminal neuralgia. Material & Methods: This case series study was conducted in Department of Neurosurgery Prime Teaching Hospital and Irfan General Hospital Peshawar from January 2020 to January 2022. Consent from the ethical committee and patients were taken. All patients of trigeminal neuralgia were included. Those patients having mass lesion were excluded. All information were put in proforma. Results were analysed by SPSS version 20. Results: Total sample size of our study was 58 patients. Majority of the patients were female (n 34 59%). Mean age of the patients was 44+ 5 years (range 25-60 years). The common level of pain distribution was in maxillary and mandibular branches V2-V3, 39(67.8%). The most common aetiology of trigeminal neuralgia was superior cerebellar artery loop in 41(70.7%) patients. Surgical outcome in terms of pain relief was in 49 (84.5 %) patients, after 6-8 months follow-up, The most common complication of surgery was CSF leak in 3(5.2%) patients, followed by post operative Sub arachnoid haemorrhage in 1(1.8%) patient, mortality was reported in 2 (3.4%) patients. Conclusion: The results of our study concluded that microvascular decompression surgery is effective in reducing pain, improving patient satisfaction in trigeminal neuralgia patients who are refractory to conservative treatment options such as carbamazepine’s. The procedure also has some complications such as cerebrospinal fluid leakage and sub arachnoid haemorrhage.

Introduction: The cause of sciatica is not always discogenic and majority of patients are misdiagnosed as having discogenic sciatica while the underlying non discogenic causes are overlooked. This study aimed at evaluating the frequency of non-discogenic sciatica in patients presenting with lumber radiculopathy. Material & Methods: A prospective case series study was conducted from February 2022 to January 2023 at Ali Institute of Neurosciences, Irfan General Hospital Peshawar. Nonprobability convenience sampling technique was incorporated. A total of 624 patients were reported to the OPD with clinical presentations of sciatica out of which 81 patients were included after thorough subjective, objective, and radiological investigation. Data was analysed using SPSS version 26. Results: Five hundred forty-three (87%) patients were diagnosed with discogenic sciatica while 81(13%) patients were categorized under non discogenic disorders causing radicular symptoms. Majority of the patients 51(63%) were males as compared to females 30(37%) in the non-discogenic group. Out of 81 cases diagnosed with non-discogenic sciatica,26 cases (32%) were due to spinal tumours, facet dysfunction 10(12%), piriformis syndrome6(7%), cluneal nerve disorder2(2%), quadratus lumborum dysfunction4(5%), osteoarthritis of the hip3(4%), peripheral nerve disorders 8(10%), sacroiliac joint 3(4%) infections 10(13%),trauma to gluteal region 3(4%), pregnancy associated sciatica 2(2%), compressive neuropathy 4(5%). Conclusion: There are a number of non-discogenic disorders causing symptoms of lumber radiculopathy. Identifying the underlying non discogenic cause is still challenging. Considering the possible pathologies, detailed history taking and objective examination along with diagnostic tests and investigations can lead to the identification of underlying pathologies and their management.

Abstract It is essential to develop ultrasensitive biosensors for cancer detection and treatment monitoring. In the development of sensing platforms, metal-organic frameworks (MOFs) have received considerable attention as potential porous crystalline nanostructures. Core-shell MOF nanoparticles (NPs) have shown different diversities, complexities, and biological functionalities, as well as significant electrochemical (EC) properties and potential bio-affinity to aptamers. As a result, the developed core-shell MOF-based aptasensors serve as highly sensitive platforms for sensing cancer biomarkers with an extremely low limit of detection (LOD). This paper aimed to provide an overview of different strategies for improving selectivity, sensitivity, and signal strength of MOF nanostructures. Then, aptamers and aptamers-modified core-shell MOFs were reviewed to address their functionalization and application in biosensing platforms. Additionally, the application of core-shell MOF-assisted EC aptasensors for detection of several tumor antigens such as prostate-specific antigen (PSA), carbohydrate antigen 15-3 (CA15-3), carcinoembryonic antigen (CEA), human epidermal growth factor receptor-2 (HER2), cancer antigen 125 (CA-125), cytokeratin 19 fragment (CYFRA21-1), and other tumor markers were discussed. In conclusion, the present article reviews the advancement of potential biosensing platforms toward the detection of specific cancer biomarkers through the development of core-shell MOFs-based EC aptasensors.

The outbreak of a fatal black fungus infection after the resurgence of the cadaverous COVID-19 has exhorted scientists worldwide to develop a nutshell by repurposing or designing new formulations to address the crisis. Patients expressing COVID-19 are more susceptible to Mucormycosis (MCR) and thus fall easy prey to decease accounting for this global threat. Their mortality rates range around 32-70% depending on the organs affected and grow even higher despite the treatment. The many contemporary recommendations strongly advise using liposomal amphotericin B and surgery as first-line therapy whenever practicable. MCR is a dangerous infection that requires an antifungal drug administration on appropriate prescription, typically one of the following: Amphotericin B, Posaconazole, or Isavuconazole since the fungi that cause MCR are resistant to other medications like fluconazole, voriconazole, and echinocandins. Amphotericin B and Posaconazole are administered through veins (intravenously), and isavuconazole by mouth (orally). From last several years so many compounds are developed against invasive fungal disease but only few of them are able to induce effective treatment against the micorals. Adjuvant medicines, more particularly, are difficult to assess without prospective randomized controlled investigations, which are challenging to conduct given the lower incidence and higher mortality from Mucormycosis. The present analysis provides insight into pathogenesis, epidemiology, clinical manifestations, underlying fungal virulence, and growth mechanisms. In addition, current therapy for MCR in Post Covid-19 individuals includes conventional and novel nano-based advanced management systems for procuring against deadly fungal infection. The study urges involving nanomedicine to prevent fungal growth at the commencement of infection, delay the progression, and mitigate fatality risk.

Atypical Escherichia coli forms exhibit unusual characteristics compared to typical strains. The H2S-producing variants of some atypical E. coli strains cause a wide range of illnesses in humans and animals. However, there are sparse reports on such strains worldwide. We performed whole-genome sequencing (WGS) and detailed characterization of four H2S-producing E. coli variants from poultry and human clinical sources in Dhaka, Bangladesh. All four isolates were confirmed as E. coli using biochemical tests and genomic analysis, and were multidrug-resistant (MDR). WGS analysis including an additional Chinese strain, revealed diverse STs among the five H2S-producing E. coli genomes, with clonal complex ST10 being detected in 2 out of 5 genomes. The predominant phylogroup detected was group A (n = 4/5). The blaTEM1B (n = 5/5) was the most predominant extended-spectrum beta-lactamase (ESBL) gene, followed by different alleles of blaCTX-M (blaCTX-M -55,-65,-123; n = 3/5). Multiple plasmid replicons were detected, with IncX being the most common. One E. coli strain was classified as enteropathogenic E. coli. The genomes of all five isolates harbored five primary and four secondary function genes related to H2S production. These findings suggest the potential of these isolates to cause disease and spread antibiotic resistance. Therefore, such atypical E. coli forms should be included in differential diagnosis to understand the pathogenicity, antimicrobial resistance and evolution of H2S-producing E. coli.

Klebsiella aerogenes, a nosocomial pathogen, is increasingly associated with extensive drug resistance and virulence profiles. It is responsible for high morbidity and mortality. This report describes the first successfully treated case of community-acquired urinary tract infection (UTI) caused by Klebsiella aerogenes in an elderly housewife with Type-2 diabetes (T2D) from Dhaka, Bangladesh. The patient was empirically treated with intravenous ceftriaxone (500 mg/8 h). However, she did not respond to the treatment. The urine culture and sensitivity tests, coupled with bacterial whole-genome sequencing (WGS) and analysis, revealed the bacteria to be K. aerogenes which was extensively drug-resistant but was susceptible to carbapenems and polymyxins. Based on these findings, meropenem (500 mg/8 h) was administered to the patient, who then responded to the treatment and recovered successfully without having a relapse. This case raises awareness of the importance of diagnosis of not-so-common etiological agents, correct identification of the pathogens, and targeted antibiotic therapy. In conclusion, correctly identifying etiological agents of UTI using WGS approaches that are otherwise difficult to diagnose could help improve the identification of infectious agents and improve the management of infectious diseases.

Apple cultivation is one of the most significant means of subsistence in the Kashmir region of the northwestern Himalayas. It is considered as the backbone of the region's economy. Apple cultivation in the region is dominated by a late maturing cultivar “Red Delicious” which usually on maturity causes glut in the market. In order to bring new cultivars in the cultivation, and to expand the maturity season, it is necessary to evaluate the new cultivars on fruit physico-chemical attributes which ultimately decide the market rates before recommending to farmers for cultivars adoption. Therefore, the current study was carried out to evaluate thirteen apple cultivars on physico-chemical attributes over two years, 2017 and 2018 under agro-climatic conditions of Kashmir region The results revealed that cultivars differed significantly in terms of physico-chemical properties. Cultivars with the highest and lowest values for initial fruit set, fruit drop, final fruit retention, and fruit firmness in 2017 did not follow the same trend in 2018. During 2017 and 2018, cultivar Mollie's Delicious possessed the highest fruit length (72.39 mm and 81.45 mm), fruit diameter (81.18 mm and 84.14 mm), and fruit weight (205.85 g and 247.16 g), whereas cultivar Baleman's Cider had the lowest values (50.76 mm and 52.83 mm, 60.10 mm and 62.08 mm, and 71.46 g and 86.94 g), respectively. The harvesting dates were quite spread out during both years of study. Cultivar Mollie's Delicious was harvested the earliest in both years, on August 5th, 2017 and August 8th, 2018. Cultivar Fuji Zehn Aztec was the last cultivar harvested in 2017 on October 2 and in 2018 on October 5. The maximum number of seeds per fruit was noticed in the cultivar Mollie's Delicious (8.34 and 8.71) during both 2017 and 2018, respectively. Cultivar Starkrimson had the fewest seeds per fruit in 2017 (7.11) and 2018 (7.42). Cultivar Baleman's Cider had the highest acidity in 2017 (0.63%) and 2018 (0.52%). In both 2017 (0.25%) and 2018 (0.23%), the Adam's Pearmain cultivar was the least acidic. Cultivar Allington Pippin (16.13 °Brix) and Red Gold (16.73 °Brix) had the highest TSS in 2017 and 2018, respectively, whereas Vance Delicious (12.30 °Brix) and Top Red (10.78 °Brix) had the lowest TSS in 2017 and 2018, respectively. The cultivars Mollie's Delicious and Red Gold had the highest total sugars (11.33 and 11.40%) in 2017 and 2018, respectively. Cultivar Baleman's Cider had the lowest total sugars (9.82%) in 2017 while Top Red (9.78%) in 2018. The cultivar Vance Delicious had the highest ratio of leaves to fruits in 2017 (55.44) and for Shalimar Apple-2 in 2018 (49.65). In 2017, cultivars Fuji Zehn Aztec (29.26) and Silver Spur (24.51), had the fewest leaves per fruit. The highest leaf chlorophyll content was recorded in cultivar Shireen (3.50 and 3.57 mg g−1 fresh weight) during the years 2017 and 2018, respectively. Cultivar Baleman's Cider had the lowest leaf chlorophyll content (2.15 mg g−1 fresh weight) during 2017, while cultivar Allington Pippin (2.09 mg g−1 fresh weight) had the lowest leaf chlorophyll content in 2018. The cultivars Fuji Zehn Aztec, with a yield efficiency of 0.78 kg/cm2 and Silver Spur with a yield efficiency of 1.14 kg/cm2 were the most yield efficient during the years 2017 and 2018, respectively. Cultivar Shalimar Apple-2 was least performing with yield efficiencies of 0.05 and 0.07 kg/cm2 during 2017 and 2018, respectively.The findings suggest that cultivar Mollie's Delicious commercially matures first and has the highest fruit length, diameter, and weight; hence, it can be a good option for cultivation so as to fetch the maximum price in the market when other cultivars are still maturing. Shalimar Apple-2 is precluded for cultivation due to least yield efficiency, whereas cultivars Fuji Zehn Aztec and Silver Spur are recommended to farmers for their higher yield efficiency.

The advancement in cancer research using high throughput technology and artificial intelligence (AI) is gaining momentum to improve disease diagnosis and targeted therapy. However, the complex and imbalanced data with high dimensionality pose significant challenges for computational approaches and multi-omics data analysis. This study focuses on predicting skin cancer and analyzing overall survival probability. We employ the Kaplan–Meier estimator and Cox proportional hazards regression model, utilizing high-throughput machine learning (ML)-based ensemble methods. Our proposed ML-based ensemble techniques are applied to a publicly available dataset from the ICGC Data Portal, specifically targeting skin cutaneous melanoma cancers (SKCM). We used eight baseline classifiers, namely, random forest (RF), decision tree (DT), gradient boosting (GB), AdaBoost, Gaussian naïve Bayes (GNB), extra tree (ET), logistic regression (LR), and light gradient boosting machine (Light GBM or LGBM). The study evaluated the performance of the proposed ensemble methods and survival analysis on SKCM. The proposed methods demonstrated promising results, outperforming other algorithms and models in terms of accuracy compared to traditional methods. Specifically, the RF classifier exhibited outstanding precision results. Additionally, four different ensemble methods (stacking, bagging, boosting, and voting) were created and trained to achieve optimal results. The performance was evaluated and interpreted using accuracy, precision, recall, F1 score, confusion matrix, and ROC curves, where the voting method achieved a promising accuracy of 99%. On the other hand, the RF classifier achieved an outstanding accuracy of 99%, which exhibits the best performance. We compared our proposed study with the existing state-of-the-art techniques and found significant improvements in several key aspects. Our approach not only demonstrated superior performance in terms of accuracy but also showcased remarkable efficiency. Thus, this research work contributes to diagnosing SKCM with high accuracy.

Abstract Objectives The purpose of this study is to provide expert consensus recommendations to establish a global ultrasound curriculum for undergraduate medical students. Methods 64 multi-disciplinary ultrasound experts from 16 countries, 50 multi-disciplinary ultrasound consultants, and 21 medical students and residents contributed to these recommendations. A modified Delphi consensus method was used that included a systematic literature search, evaluation of the quality of literature by the GRADE system, and the RAND appropriateness method for panel judgment and consensus decisions. The process included four in-person international discussion sessions and two rounds of online voting. Results A total of 332 consensus conference statements in four curricular domains were considered: (1) curricular scope (4 statements), (2) curricular rationale (10 statements), (3) curricular characteristics (14 statements), and (4) curricular content (304 statements). Of these 332 statements, 145 were recommended, 126 were strongly recommended, and 61 were not recommended. Important aspects of an undergraduate ultrasound curriculum identified include curricular integration across the basic and clinical sciences and a competency and entrustable professional activity-based model. The curriculum should form the foundation of a life-long continuum of ultrasound education that prepares students for advanced training and patient care. In addition, the curriculum should complement and support the medical school curriculum as a whole with enhanced understanding of anatomy, physiology, pathophysiological processes and clinical practice without displacing other important undergraduate learning. The content of the curriculum should be appropriate for the medical student level of training, evidence and expert opinion based, and include ongoing collaborative research and development to ensure optimum educational value and patient care. Conclusions The international consensus conference has provided the first comprehensive document of recommendations for a basic ultrasound curriculum. The document reflects the opinion of a diverse and representative group of international expert ultrasound practitioners, educators, and learners. These recommendations can standardize undergraduate medical student ultrasound education while serving as a basis for additional research in medical education and the application of ultrasound in clinical practice.

Klebsiella pneumoniae is recognized as an urgent public health threat because of the emergence of difficult-to-treat (DTR) strains and hypervirulent clones, resulting in infections with high morbidity and mortality rates. Despite its prominence, little is known about the genomic epidemiology of K. pneumoniae in resource-limited settings like Bangladesh. We sequenced genomes of 32 K. pneumoniae strains isolated from patient samples at the International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b). Genome sequences were examined for their diversity, population structure, resistome, virulome, MLST, O and K antigens and plasmids. Our results revealed the presence of two K. pneumoniae phylogroups, namely KpI (K. pneumoniae) (97%) and KpII (K. quasipneumoniae) (3%). The genomic characterization revealed that 25% (8/32) of isolates were associated with high-risk multidrug-resistant clones, including ST11, ST14, ST15, ST307, ST231 and ST147. The virulome analysis confirmed the presence of six (19%) hypervirulent K. pneumoniae (hvKp) and 26 (81%) classical K. pneumoniae (cKp) strains. The most common ESBL gene identified was blaCTX-M-15 (50%). Around 9% (3/32) isolates exhibited a difficult-to-treat phenotype, harboring carbapenem resistance genes (2 strains harbored blaNDM-5 plus blaOXA-232, one isolate blaOXA-181). The most prevalent O antigen was O1 (56%). The capsular polysaccharides K2, K20, K16 and K62 were enriched in the K. pneumoniae population. This study suggests the circulation of the major international high-risk multidrug-resistant and hypervirulent (hvKp) K. pneumoniae clones in Dhaka, Bangladesh. These findings warrant immediate appropriate interventions, which would otherwise lead to a high burden of untreatable life-threatening infections locally.

Introduction:. Homeopathic remedies are highly diluted formulations without proven clinical benefits, traditionally believed not to cause adverse events. Nonetheless, published literature reveals severe local and non–liver-related systemic side effects. We present the first series on homeopathy-related severe drug-induced liver injury (DILI) from a single center. Methods:. A retrospective review of records from January 2019 to February 2022 identified 9 patients with liver injury attributed to homeopathic formulations. Competing causes were comprehensively excluded. Chemical analysis was performed on retrieved formulations using triple quadrupole gas chromatography-mass spectrometry and inductively coupled plasma atomic emission spectroscopy. Results:. Males predominated with a median age of 54 years. The most typical clinical presentation was acute hepatitis, followed by acute on chronic liver failure. All patients developed jaundice, and ascites were notable in one-third of the patients. Five patients had underlying chronic liver disease. COVID-19 prevention was the most common indication for homeopathic use. Probable DILI was seen in 77.8%, and hepatocellular injury predominated (66.7%). Four (44.4%) patients died (3 with chronic liver disease) at a median follow-up of 194 days. Liver histopathology showed necrosis, portal and lobular neutrophilic inflammation, and eosinophilic infiltration with cholestasis. A total of 29 remedies were consumed between 9 patients, and 15 formulations were analyzed. Toxicology revealed industrial solvents, corticosteroids, antibiotics, sedatives, synthetic opioids, heavy metals, and toxic phyto-compounds, even in ‘supposed’ ultra-dilute formulations. Conclusion:. Homeopathic remedies potentially result in severe liver injury, leading to death in those with underlying liver disease. The use of mother tinctures, insufficient dilution, poor manufacturing practices, adulteration and contamination, and the presence of direct hepatotoxic herbals were the reasons for toxicity. Physicians, the public, and patients must realize that Homeopathic drugs are not ‘gentle placebos.’

Abstract Background Colorectal cancer (CRC) consensus molecular subtypes (CMS) have different immunological, stromal cell, and clinicopathological characteristics. Single-cell characterization of CMS subtype tumor microenvironments is required to elucidate mechanisms of tumor and stroma cell contributions to pathogenesis which may advance subtype-specific therapeutic development. We interrogate racially diverse human CRC samples and analyze multiple independent external cohorts for a total of 487,829 single cells enabling high-resolution depiction of the cellular diversity and heterogeneity within the tumor and microenvironmental cells. Results Tumor cells recapitulate individual CMS subgroups yet exhibit significant intratumoral CMS heterogeneity. Both CMS1 microsatellite instability (MSI-H) CRCs and microsatellite stable (MSS) CRC demonstrate similar pathway activations at the tumor epithelial level. However, CD8+ cytotoxic T cell phenotype infiltration in MSI-H CRCs may explain why these tumors respond to immune checkpoint inhibitors. Cellular transcriptomic profiles in CRC exist in a tumor immune stromal continuum in contrast to discrete subtypes proposed by studies utilizing bulk transcriptomics. We note a dichotomy in tumor microenvironments across CMS subgroups exists by which patients with high cancer-associated fibroblasts (CAFs) and C1Q+TAM content exhibit poor outcomes, providing a higher level of personalization and precision than would distinct subtypes. Additionally, we discover CAF subtypes known to be associated with immunotherapy resistance. Conclusions Distinct CAFs and C1Q+ TAMs are sufficient to explain CMS predictive ability and a simpler signature based on these cellular phenotypes could stratify CRC patient prognosis with greater precision. Therapeutically targeting specific CAF subtypes and C1Q + TAMs may promote immunotherapy responses in CRC patients.

Abstract Background Second-generation androgen receptor inhibitors (ARIs) have been associated with adverse events (AEs) such as fatigue, falls, fractures, and rash in non-metastatic castration-resistant prostate cancer (nmCRPC) patients as identified in clinical trials. The objectives of this study were to describe the incidence and management of AEs in patients receiving apalutamide and enzalutamide. Methods This retrospective chart review study was conducted in nmCRPC-treating sites in the United States. Patients starting apalutamide or enzalutamide between February 1, 2018 and December 31, 2018 were included and any AEs they experienced were recorded. AEs, including those considered to be of special interest as defined in the pivotal clinical trials of the second-generation ARIs, were analyzed and grouped retrospectively in this study. Detailed chart data (patient demographics, clinical characteristics, treatment history, type of AE, outcomes, and resource utilization) were then collected for a randomly selected subset among patients with ≥1 AE to characterize AEs and their management. Descriptive results were summarized. Results Forty-three sites participated in the study. A total of 699 patients were included, of whom 525 (75.1%) experienced ≥1 AE. The most common AEs were fatigue/asthenia (34.3%), hot flush (13.9%), and arthralgia (13.6%). In the subset of 250 patients randomly selected from those who experienced ≥1 AE, patients were primarily White (72.0%), the mean age was 71 years, 86.0% had an Eastern Cooperative Oncology Group score of 0–1 at nmCRPC diagnosis, and the average prostate specific antigen (PSA) value at diagnosis was 23.2 ng/mL. PSA-doubling time

Pulmonary embolism in the neonate is a rare, life-threatening emergency. Risk factors for neonatal pulmonary embolism (PE) include sepsis, asphyxia, prematurity, and vascular catheterisation. We report the case of a preterm neonate with a massive saddle pulmonary thrombosis of unidentified etiology. Prompt diagnosis by cardiology allowed an emergent lifesaving open surgical thrombectomy, underscoring the importance of efficient multidisciplinary teamwork. Pediatric health-care professionals must be aware of this rare entity when initial oxygen desaturation management fails, even when obvious risk factors for PE are not apparent. We emphasise the importance of seamless multidisciplinary communication and proactive surgical consultation. Résumé: L’embolie pulmonaire chez le nouveau-né est une urgence rare qui met la vie en danger. Les facteurs de risque d’embolie pulmonaire néonatale comprennent la septicémie, l’asphyxie, la prématurité et le cathétérisme vasculaire. Nous rapportons le cas d’un nouveau-né prématuré présentant une thrombose pulmonaire en selle massive d’origine indéterminée. Un diagnostic rapide par le service de cardiologie a permis la réalisation d’urgence d’une thrombectomie chi-rurgicale ouverte salvatrice, soulignant ainsi l’importance d’un travail d’équipe multidisciplinaire efficace. Les professionnels de la santé en pédiatrie doivent être au fait de cette entité rare lorsque la prise en charge initiale de la désaturation en oxygène échoue, même quand les facteurs de risque évidents d'une embolie pulmonaire ne sont pas apparents. Nous insistons sur l’importance d’une communication multidisciplinaire en continu et d’une consultation chirurgicale proactive.

Unintentional islanding is a problem in electrical distribution networks; it happens when the central utility is unintentionally separated from the rest of the distributed power system. The islanding detection problem becomes severe in non-detection zones. We propose an intelligent islanding detection technique with zero non-detection zone for a hybrid distributed generation system. It is based on the computation of frequency spectrum variations over time using short-term Fourier transform and convolutional neural networks. For various islanding and non-islanding occurrences, the three-phase voltage at the point of common coupling is monitored, and time-series data is collected. Then computations for a set of multiple frequencies on scaled time-series data are carried out, and complex numbers are split into magnitude and phase values. To detect islanding and non-islanding occurrences, a modified convolutional neural network with forward propagation was utilized. For the IEC 61850-7-420 test system, several islanding and non-islanding scenarios are created and deployed to train the convolutional neural network for the proposed approach. The efficacy of the proposed islanding detection learning model is assessed using 5-fold cross-validation. The findings reveal that under normal and noisy conditions, the proposed methodology has zero non-detection zone with original dataset, excellent accuracy, selectivity, and sensitivity.

BACKGROUND: With growth of the use of point of care ultrasound (PoCUS) around the world, some medical schools have incorporated this skill into their undergraduate curricula. However, because of epidemiology of disease and regional differences in approaches to patient care, global application of PoCUS might not be possible. Before creating a PoCUS teaching course, it is critical to perform a needs analysis and recognize the training obstacles. MATERIALS AND METHODS: A validated online questionnaire was given to final-year medical students at our institution to evaluate their perceptions of the applicability of specific clinical findings, and their own capability to detect these signs clinically and with PoCUS. The skill insufficiency was assessed by deducting the self-reported clinical and ultrasound skill level from the perceived usefulness of each clinical finding. RESULTS: The levels of expertise and knowledge in the 229 students who participated were not up to the expected standard. The applicability of detection of abdominal aortic aneurysm (AAA) (3.9 ± standard deviation [SD] 1.4) was the highest. However, detection of interstitial syndrome (3.0 ± SD 1.1) was perceived as the least applicable. The deficit was highest in the detection of AAA (mean 0.95 ± SD 2.4) and lowest for hepatomegaly (mean 0.57 ± SD 2.3). Although the majority agreed that training of preclinical and clinical medical students would be beneficial, 52 (22.7%) showed no interest, and 60% (n = 136) reported that they did not have the time to develop the skill. CONCLUSION: Although medical students in Saudi Arabia claim that PoCUS is an important skill, there are significant gaps in their skill, indicating the need for PoCUS training. However, a number of obstacles must be overcome in the process.

Abstract One of the crucial challenges of the distribution network is the unintentionally isolated section of electricity from the power network, called unintentional islanding. Unintentional islanding detection is severed when the local generation is equal to or closely matches the load requirement. In this paper, both ensemble learning and canonical methods are implemented for the islanding detection technique of synchronous machine‐based distributed generation. The ensemble learning models for this study are random forest (RF) and Ada boost, while the canonical methods are multi‐layer perceptron (MLP), decision tree (DT), and support vector machine (SVM). The training and testing parameters for this technique are the total harmonic distortion (THD) of both current and voltage signals. THD is the most important parameter of power quality monitoring under islanding scenarios. The parameter and data extraction from the test system is executed in a MATLAB/Simulink environment, whereas the training and testing of the presented techniques are implemented in Python. Performance indices such as accuracy, precision, recall, and F 1 score are used for evaluation, and both ensemble learning models and canonical models demonstrate good performance. Ada‐boost shows the highest accuracy among all the five models with original data, while RF is robust and gives the best results with noisy data (20 and 30 dB) because of its ensemble nature.

BACKGROUND: Peripheral arterial disease (PAD) is more prevalent and often presents as more severe in patients with diabetes mellitus (DM) compared with those without DM. Although some patients may be asymptomatic, symptoms ranging from exertional leg heaviness and fatigue to acute limb loss are possible. PAD has significant physical and psychiatric health consequences, thus management with medical therapy and lifestyle changes are indicated. However, peripheral vascular intervention (PVI) is an increasingly popular method used in patients failing conservative management. The association of PVI with health status in diabetic patients has yet to be determined. METHODS: We analyzed the clinical response to PVI in DM (n=203, 52%) compared with non-DM patients (n=183, 48%), using the Peripheral Arterial Questionnaire (PAQ) for patients during baseline and a maximum 6 months after PVI. 502 patients participated with an exclusion of 116 patients from our analysis due to progression of acute limb ischemia and incomplete data collection. Our finalized study population comprised 386 consecutive patients with symptomatic PAD who had also received PVI treatment during the aforementioned time frame. Our patient population received PVI treatment in the year 2012 at the St. John Hospital and Medical Center in Detroit, MI. We used the PAQ summary score, which summarizes the patients’ level of physical and social function, patient symptoms, and overall quality of life before and after the procedure. This represented the PAD-related Quality of Health (QOH). Our score range is between 0 (lowest health quality) and 100 (highest health quality). RESULTS: Compared with non-DM patients, those with DM were more likely to have a history of prior PVI, an increased prevalence of PAD risk factors, and significantly lower QOH scores at baseline (32.7 +/- 20 vs 37.5 +/- 20.6, p=0.02). After adjustment for baseline confounding, neither the baseline, the change, nor the final summary scores were significantly different between groups. This suggests similar symptomatic and functional improvement in non-DM and DM patients post-PVI. CONCLUSIONS: Following PVI, PAD-specific health status showed a similar improvement in patients with and without DM, illustrating that use of this strategy among patients with multiple comorbidities or diffuse PAD as useful. Key Words: peripheral arterial disease, peripheral vascular intervention, diabetes mellitus, quality of life Figure or Table: Table 5. Comparison of the Summary Score of 6 PAQ Domains Using Median Scores from Mann Whitney U Test of DM and Non-DM Patients in Detroit, MI, USA PAQ domain DM Non-DM P-Value Physical limitation 16.6 (75.4) 25.0 (79.8) 0.06 Symptoms 23.6 (75.4) 27.7 (79.8) 0.24 Symptom stability 25.0 (75.4) 25.0 (79.8) 0.28 Social limitation 16.6 (75.4) 25.0 (79.8) 0.07 Treatment satisfaction 0.0 (75.4) 0.0 (79.8) 0.42 Quality of life 16.6 (75.4) 25.0 (79.8) 0.06 Summary score 18.7 (75.4) 26.0 (79.8) 0.049

Background: The COVID-19 pandemic has strained ICUs worldwide. To learn from our experience, we described the critical care response to the outbreak. Methods: This is a case study of the response of the Intensive Care Department (75-bed capacity) at a tertiary-care hospital to COVID-19 pandemic, which resulted in a high number of critically ill patients. Results: Between March 1 and July 31, 2020, 822 patients were admitted to the adult non-cardiac ICUs with suspected (72%)/confirmed (38%) COVID-19. At the peak of the surge, 125 critically ill patients with COVID-19 were managed on single day. To accommodate these numbers, the bed capacity of 4 ICUs was increased internally from 58 to 71 beds (+40%) by cohorting 2 patients/room in selected rooms; forty additional ICUs beds were created in 2 general wards; one cardiac ICU was converted to managed non-COVID-19 general ICU patients and one ward was used as a stepdown for COVID-19 patients. To manage respiratory failure, 53 new ICU ventilators, 90 helmets for non-invasive ventilation and 47 high-flow nasal cannula machines were added to the existing capacity. Dedicated medical teams cared for the COVID-19 patients to prevent cross-contamination. The nurse-to-patient and RT-to-patient ratio remained mostly 1:1 and 1:6, respectively. One-hundred-ten ward nurses were up-skilled to care for COVID-19 and other ICU patients using tiered staffing model. Daily executive rounds were conducted to identify patients for transfer and at least 10 beds were made available for new COVID-19 admissions/day. The consumption of PPE increased multiple fold compared with the period preceding the pandemic. Regular family visits were not allowed and families were updated daily by videoconferencing and phone calls. Conclusions: Our ICU response to the COVID-19 pandemic required almost doubling ICU bed capacity and changing multiple aspects of ICU workflow to be able to care for high numbers of affected patients.

Abstract Environmental protection agencies have begun imposing stringent regulations on the existing refineries to control the levels of gasoline additives. In this context, a novel compound, 2‐methoxy‐2‐methylheptane (MMH), had drawn attention as fuel additive for cleaner combustion. The conventional process of MMH production features three distillation columns in a direct sequence. These columns are used to maintain the required product purities and to utilize the unreacted reactants through recycling streams. The distillation system of the existing MMH plant can afford significant energy savings, leading to a reduction in the total annual costs (TAC). The aim of this investigation is to demonstrate that the reported conventional process can be significantly enhanced by modifying the design and operational parameters and by replacing two distillation columns with an intensified dividing wall column (DWC) configuration. The DWC design is further optimized using several algorithms such as the modified coordinate method (MCD), robust particle swarm paradigm (PSP), and firefly (FF) with nonlinear constraints. Compared to conventional process, the optimized DWC resulted in 24% and 11.5% savings in the plant operating and total annual costs, respectively.

Multi-resistant pathogenic strains of non-lactose fermenting Escherichia coli (NLF E. coli) are responsible for various intestinal and extraintestinal infections. Although several studies have characterised such strains using conventional methods, they have not been comprehensively studied at the genomic level. To address this gap, we used whole-genome sequencing (WGS) coupled with detailed microbiological and biochemical testing to investigate 17 NLF E. coli from a diagnostic centre (icddr,b) in Dhaka, Bangladesh. The prevalence of NLF E. coli was 10%, of which 47% (8/17) exhibited multi-drug resistant (MDR) phenotypes. All isolates (17/17) were confirmed as E. coli and could not ferment lactose sugar. WGS data analysis revealed international high-risk clonal lineages. The most prevalent sequence types (STs) were ST131 (23%), ST1193 (18%), ST12 (18%), ST501 (12%), ST167 (6%), ST73 (6%) and ST12 (6%). Phylogenetic analysis corroborated a striking clonal population amongst the studied NLF E. coli isolates. The predominant phylogroup detected was B2 (65%). The blaCTX-M-15 extended-spectrum beta-lactamase gene was present in 53% of isolates (9/17), whilst 64.7% (11/17) isolates were affiliated with pathogenic pathotypes. All extraintestinal pathogenic E. coli pathotypes demonstrated β-hemolysis. Our study underscores the presence of critical pathogens and MDR clones amongst non-lactose fermenting E. coli. We suggest that non-lactose fermenting E. coli be considered equally capable as lactose fermenting forms in causing intestinal and extraintestinal infections. Further, there is a need to undertake systematic, unbiased monitoring of predominant lineages amongst non-lactose fermenting E. coli that would help in better treatment and prevention strategies.

OBJECTIVES The aim of this study was to compare the effects of constrained induced movement therapy (CIMT) and BimanualIntensive Training (BIT) on functional outcomes of hemiplegic cerebral palsy children. METHODOLOGY Cerebral palsy children with age groups of 5 to 12 years were included with a total sample size of 38. Simplerandom sampling was done, and data was collected from Islamabad. Two groups were formed and named groupA: constrained induced movement therapy with 19% and group B: bimanual training with 19% respectively. Thefunctional outcome for the CIMPT and for the BIT group was assessed on the pretest and post-test scoreevaluation of QUEST and JTHF tests. RESULTS Statistically significant (p

Background: Extreme poverty is widespread among farm families in the rural areas of developing countries including India. Farmers toil hard in their fields to meet the growing demands of their families. Different techniques and technologies have been generated at different research institutes, experimental stations, and farm science centers. However the same technology is not properly disseminated to the farmers and the farmers usually follow traditional practices at their farms leading to low production, productivity, and yield of major crops grown worldwide, hence threatening the livelihoods and food security of the world population in a general and farming community in particular. Methods: The present study described the socio-personal characteristics, identified the stages and categories of technology adoption with help of multinomial logistic regression. A multistage sampling procedure was adopted to collect the data from the concerned apple growers. The study used mixed methods, combining focus group discussions, key informant interviews, and a household survey. Results: The study found that only nine out of fifteen technologies disseminated in the area have been fully adopted with a greater proportion (42.5 %) of the apple growers classified as early adopters of the recommended sustainable and intensified improved practices. The adoption of scientific technology is always the central focus of policymakers and planners in the developing world. Important to note is that the growers are in their active (42 years) farming age and have acquired 22 years’ experience which is long enough to understand that traditional practices are not as productive compared to the recently improved/recommended practices. The study also revealed that the determinants of technology adoption are age, experience, level of education, annual income, extension contact, and scientific orientation. Conclusion: The study, recommends that policymakers should capitalize on the determinants to design better programs relating to the adoption of sustainable improved technologies that will help in alleviation of poverty and ensure food security.

Biofuels are environmental friendly renewable fuels, that can be directly used in a diesel engine. However, a few shortcomings like a higher density, viscosity, a lower calorific value and increase in NOx emissions, has caused researchers to look for fuel additives to improve the physiochemical properties of these fuels and to enhance their performance and reduce harmful emissions. It is for this reason that modern research is focused on blending oxygenated additives such as alcohols and ethers with different generations of biodiesel. Since most studies have covered the effect of alcohol on biodiesel, there are few studies which have investigated the effect of oxygenated additives such as alcohols and ethers, especially related to second-generation biodiesel. Moreover, the details of their composition and molecular structure are still lacking. Hence, this study focuses on the performance and emission characteristics of biodiesel with the inclusion of oxygenated additives (alcohols and ethers) of non-edible-oil-based second-generation blends. The reviewed results showed that Neem biodiesel with methanol or diethyl ether reduced brake-specific fuel consumption by 10%, increased brake thermal efficiency by 25% and reduced CO and HC emissions due to a higher oxygen content. Diethyl ether reduced NOx emissions as well by producing a cooling effect, i.e., a reduced in-cylinder temperature. The addition of heptane, butanol and di ethyl ether to Jatropha biodiesel showed an improved brake thermal efficiency and an increment in brake-specific fuel consumption (5–20%), with reduced HC and CO2 (3–12%) emissions. Calophyllum inophyllum biodiesel also showed impressive results in terms of improving efficiency and reducing emissions with addition of butanol, pentanol, decanol and hexanol. Other factors that influenced emissions are the cetane number, viscosity, density and the latent heat of evaporation of tested biodiesel blends. This review would help the research community and the relevant industries to consider an efficient biodiesel blend for future study or its implementation as an alternate fuel in diesel engines.

Coal-fired power plants have been used to meet the energy requirements in countries where coal reserves are abundant and are the key source of NOx emissions. Owing to the serious environmental and health concerns associated with NOx emissions, much work has been carried out to reduce NOx emissions. Sophisticated artificial intelligence (AI) techniques have been employed during the past few decades, such as least-squares support vector machine (LSSVM), artificial neural networks (ANN), long short-term memory (LSTM), and gated recurrent unit (GRU), to develop the NOx prediction model. Several studies have investigated deep neural networks (DNN) models for accurate NOx emission prediction. However, there is a need to investigate a DNN-based NOx prediction model that is accurate and computationally inexpensive. Recently, a new AI technique, convolutional neural network (CNN), has been introduced and proven superior for image class prediction accuracy. According to the best of the author’s knowledge, not much work has been done on the utilization of CNN on NOx emissions from coal-fired power plants. Therefore, this study investigated the prediction performance and computational time of one-dimensional CNN (1D-CNN) on NOx emissions data from a 500 MW coal-fired power plant. The variations of hyperparameters of LSTM, GRU, and 1D-CNN were investigated, and the performance metrics such as RMSE and computational time were recorded to obtain optimal hyperparameters. The obtained optimal values of hyperparameters of LSTM, GRU, and 1D-CNN were then employed for models’ development, and consequently, the models were tested on test data. The 1D-CNN NOx emission model improved the training efficiency in terms of RMSE by 70.6% and 60.1% compared to LSTM and GRU, respectively. Furthermore, the testing efficiency for 1D-CNN improved by 10.2% and 15.7% compared to LSTM and GRU, respectively. Moreover, 1D-CNN (26 s) reduced the training time by 83.8% and 50% compared to LSTM (160 s) and GRU (52 s), respectively. Results reveal that 1D-CNN is more accurate, more stable, and computationally inexpensive compared to LSTM and GRU on NOx emission data from the 500 MW power plant.

Abstract Background Training in procedural skills is often suboptimal. The aim of this study was to quantify the needs of residents in internal medicine (IM), critical care (CC), and emergency medicine (EM) for instruction in ultrasound-guided procedures. Methods All IM, EM and CC residents (n = 200) at King Abdulaziz Medical City, Riyadh, Saudi Arabia, were invited to participate in a questionnaire-based survey to identify skill and experience gaps. The contribution of procedural skills to patient care (i.e. applicability) and proficiency in the sterile technique required to perform ultrasound-guided procedures were rated on Likert scales. Data on training, accreditation, and experience with and without ultrasound were collected. Results The overall response rate was 72% (IM 91%, CC 100%, EM 40%). Although the sample reported that procedural skills were very applicable, 19% (IM n = 25, EM n = 2) had not performed any procedures. However, five residents were accredited in point-of-care ultrasound, 61% of the sample had performed ultrasound-guided procedures and 65% had used landmark techniques. Whilst more internists had performed procedures using landmark techniques, CC and EM residents had performed more ultrasound-guided procedures. Whilst CC residents had not missed any opportunities to perform procedures because supervisors were less available, EM (6) and IM (89) residents had. Whilst skill gaps were only identified in the IM residency programme, experience gaps were present in all three residency programmes. The IM residency programme had larger experience gaps than the CC and EM programmes for all procedural skills. Discussion Residents in IM, CC and EM perceive that ultrasound-guided procedures are relevant to their practice. However, the IM residents performed fewer procedures than CC residents and EM residents at least partly because internists also lack skills in ultrasound. Training in ultrasound-guided procedures may reduce the use of landmark techniques and improve patient safety. Residents in IM, CC and EM therefore require training in ultrasound-guided procedures.

Background: Hyperglycemia-induced oxidative stress accelerates the process of apoptosis in tissues. Dilleniaindica (DI) is a medicinal plant, and its fruit contains many therapeutic properties. The therapeutic activity of the Methanolic Fruit Extract (MFE) of DI in attenuating oxidative stress and apoptosis in the liver and kidney tissues of alloxan-induced diabetic mice was analyzed in the present study. Methods: High-Performance Thin Layer Chromatography (HPTLC) profiling of MFE was conducted. GLUT4 protein expression analysis and lipid peroxidation assays were conducted to check for MFE effect by administering in diabetic mice. An ultrastructural study was conducted for both the tissues. In apoptotic studies, the TUNEL assay and apoptotic protein expression analysis was conducted. Results: High-Performance Thin Layer Chromatography (HPTLC) profiling of MFE showed the presence of two crucial antioxidants, ascorbic acid, and naringenin. In GLUT-4 protein expression analysis, MFE suppresses hyperglycemia by upregulating GLUT4 protein expression. Lipid peroxidation assay showed a decrease in malondialdehyde (MDA) upon MFE administration in diabetic mice. An ultrastructural study was conducted, and MFE was found to restore cellular alterations in diabetic tissues. In apoptotic studies, the TUNEL assay shows that MFE treatment showed fewer apoptotic cells than the diabetic group. The study also observed decreased caspase 3 protein expression and increased Bcl-2 protein expression. Conclusions: Therefore, it is inferred from the study that MFE can exert a protective effect by suppressing hyperglycemia and modulating oxidative stress and apoptosis in alloxan-administered diabetic mice.