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Examination of red blood cell (RBC) morphology in peripheral blood smears can help diagnose hematologic disease, even in resource-limited settings, but this analysis remains subjective and semi-quantitative with low throughput. Prior attempts to develop automated tools have been hampered by poor reproducibility and limited clinical validation. Here, we present a novel, open-source machine-learning approach (denoted the 'RBC-diff') to quantify abnormal RBCs in peripheral smear images and generate an RBC morphology differential. RBC-diff cell counts showed high accuracy for single-cell classification (mean AUC: 0.93) and quantitation across smears (mean R2: 0.76 compared to experts, inter-experts R2: 0.75). RBC-diff counts were concordant with clinical morphology grading for 300,000+ images and recovered expected pathophysiologic signals in diverse clinical cohorts. Criteria using RBC-diff counts distinguished thrombotic thrombocytopenic purpura and hemolytic uremic syndrome from other thrombotic microangiopathies, providing greater specificity than clinical morphology grading (72% vs. 41%, p < 0.001), while maintaining high sensitivity (94-100%). Elevated RBC-diff schistocyte counts were associated with increased 6-month all-cause mortality in a cohort of 58,950 inpatients (9.5% mortality for schist. > 1%, vs. 4.7% for schist. < 0.5%, p < 0.001) after controlling for comorbidities, demographics, clinical morphology grading, and blood count indices. The RBC-diff also enabled estimation of single-cell volume-morphology distributions, providing insight into morphology influences on routine blood count measures. Our codebase and expert-annotated images are included here to spur further advancements. These results illustrate that computer vision can enable rapid and accurate RBC morphology quantitation, which may provide value in both clinical and research contexts.

Shale inhibition solutions that are commonly used in water-based fluids employ chemical systems that are not universally applicable. For example, kaolinite rich shales, can lose strength when exposed to KCl through cation exchange with potassium. In the United States, government regulations prohibit the disposal of greater than 3,000 ppm chloride on lease or 1,000 ppm chloride off lease. The hazardous nature of choline chloride restricts its use as shale inhibitor for water-based fluids.Nanosilica Based Shale Inhibitor (NSBSI) has been developed to mitigate the difficulties in clay stabilization in particularly challenging formations. NSBSI is used when drilling with low solids, non-dispersed muds, such as polymer and PAC muds. It can be used as an alternative to polyamine-based shale inhibitors and silicate-based shale inhibitors. Field trials were conducted in three wells. Commonly used shale inhibitor (polyamine based) were replaced by NSBSI in mud formulations in order to complete the field trials. Trouble-free drilling through problematic shale sections with no changes in mud properties, and no indications of lack of inhibition were experienced.Further addressing field requirements for shale inhibition in water-based muds, we have also developed a second shale-inhibiting product which is functionalized nanoplatelets composed of amine functionalities anchored on the nanometer-thick magnesium silicates (LMS-NH2). A facile synthetic approach was employed to synthesize lab-scale quantity of LMS-NH2 through combination of sol-gel and precipitation techniques. The structural characterization was conducted using powder X-ray diffraction (XRD), Fourier transformed infrared spectroscopy (FTIR), and thermogravimetric analysis (TGA) to evaluate generation of anticipated LMS-NH2. Shale stabilization characteristics of LMS-NH2 were tested and compared with other commercial shale inhibitors. Clay swelling and clay dispersion tests were performed to demonstrate the effectiveness of the impermeable coating of nano-platelets on to the clay-rich shales. The LMS-NH2 have demonstrated 87% recovery of swellable shales after dispersion tests. The microscopic study conducted on the treated shales reveals the formation of inorganic film on the shales, which provide impervious coating to protect the water susceptible clays. The linear swelling measurements were also performed to understand the effectiveness of LMS-NH2 over 72 hours demonstrating minimized the hydration and subsequent swelling of clay-rich shales.The newly developed inhibitor in the current study has outperformed conventional shale inhibitors wherein the presence of inorganic constituents aids stronger film formation compared to solely organic inhibitors. Comparative studies have been carried out against commercially used shale inhibitors using linear swell meter, dispersion test and pore pressure penetration test and the results will be presented.

Background. Upper tract urothelial carcinoma remains an uncommon disease that is clinically difficult to identify early and surveil. Open nephroureterectomy is the gold standard for patients with high-grade disease, especially for patients in whom surveillance is complicated such as those with prior cystectomies/ileal conduits. This report presents a case of a patient with a history of radical cystectomy and ileal conduit construction who underwent a successful minimally invasive robotic surgery for treatment of upper tract urothelial carcinoma. Case Presentation. The patient is a 72-year-old Caucasian male with a history of recurrent superficial bladder tumors treated with cystoscopies with fulguration, Bacillus Calmette-Guerin, and a robot-assisted cystectomy with ileal conduit diversion presenting with recurrent urinary tract infections and hematuria secondary to a ureteral stricture. The patient was admitted previously for urosepsis during which time a percutaneous nephrostomy tube was inserted on the right side. Upon presentation, imaging revealed a lesion extending from the lower pole of the right kidney into the renal pelvis. The presence of a nephrostomy and urostomy allowed the surgical team to utilize a minimally invasive approach to remove the diseased kidney and ureter with visualization enhanced by indocyanine green. Conclusion. Minimally invasive robot-assisted approaches to treating upper tract urothelial carcinomas may offer an alternative to the open cases typically employed in cases of patients with prior ileal conduit. Furthermore, utilizing indocyanine green may expand the applicability of such approaches to uro-oncologic cases with greater complexity.

Background and aims Early goal-directed therapy (EGDT) provides preset goals to be achieved by intravenous fluid therapy and inotropic therapy with earliest detection of change in the hemodynamic profile. Improved outcome in cardiac surgery patients has been shown by perioperative volume optimization, while postoperative intensive care unit (ICU) stay can be decreased by improving oxygen delivery. Our aim of this study was to study the outcome of EGDT in patients undergoing elective cardiac surgery. Materials and methods This is a prospective single institute study involving a total of 478 patients. Patients were divided into group I, who received standard hospital care, and group II, who received EGDT. Postoperatively, patients were observed in ICU for 72 hours. Hemodynamics, laboratory data, fluid bolus, inotrope score, complication, ventilatory time, and mortality data were collected. Results Postoperative ventilatory period (11.12 ± 10.11 vs 9.45 ± 8.87, p = 0.0719) and frequency of change in inotropes (1.900 ± 0.9 vs 1.19 ± 0.61, p = 0.0717) were lower in group II. Frequency of crystalloid boluses (1.33 ± 0.65 vs 1.75 ± 1.09, p = 0.0126), and quantity of packed cell volume (PCV) used (1.63 ± 1.03 vs 2.04 ± 1.42, p = 0.0364) were highly significant in group II. Use of colloids was higher in group II and was statistically significant (1.98 ± 1.99 vs 3.05 ± 2.17, p = 0.0012). The acute kidney injury (AKI) rate was (58 (23.10%) vs 30 (13.21%), p = 0.007) lower and statistically significant (p = 0.007) in group II. Conclusion Early goal-directed therapy reduces the postoperative ventilatory period, frequency of changes in inotropes, and incidence of AKI, and decreases ventilation hours, number of times inotropes changed, and AKI. How to cite this article Patel H, Parikh N, Shah R, Patel R, Thosani R, Shah P, et al. Effect of Goal-directed Hemodynamic Therapy in Postcardiac Surgery Patients. Indian J Crit Care Med 2020;24(5):321–326.

Industrial multistage spray drying systems often have limited in situ process measurements to provide sufficient information for computational fluid dynamics (CFD) simulations of the primary drying chamber. In this case study on the spray dryer at Davis Dairy Plant (South Dakota State University), uncertainties were encountered in specifying the outlet boundary conditions of the spray drying chamber with two outlets: the side outlet and the bottom outlet leading to the second stage external vibrating bed. Using the available data on the vacuum pressure of the chamber, a numerical framework was introduced to approximate suitable outlet boundary conditions for the drying chamber. The procedure involved analyzing the ratio of the airflow rate between the two outlets and using a pseudo-tracer inert particle injection analysis. The goal of this approach was to determine a suitable range of outlet vacuum pressure that will lead to realistic particle movement behaviors during the actual plant operation. ...

IP traceback approaches have an important role to play in mitigating the attacks based on IP spoofing like Denial of service/Distributed denial of service attacks. Due to the obvious significance of such attacks, numerous approaches have been proposed in the literature. However, as per our observations, there is still a scope to improve the IP traceback techniques especially in terms of reducing the number of false-positives, reducing the number of packets required at the victim node and the requirement of an upstream router map. Motivated by this observation, in this paper, we propose a novel Light-weight Packet Marking (LPM) that is a probabilistic packet marking (PPM) approach, to trace back the sources of an attack. LPM improves upon the existing PPM approaches in the number of packets required by the victim to reconstruct the attack paths, reduced false-positives and support incremental deployment. It does not even require an upstream router map. LPM also authenticates the marking that enables a victim to detect the attackers attempts to forge the marking. LPM uses multiple hash functions to reduce the false positives further to zero. We carry out experimental analysis as well as security analysis of LPM considering attacker and compromised routers in our attacker model.

Most of the CFD simulations of spray dryers reported in the literature utilizes a fixed air inlet temperature numerical framework. In this paper, a numerical framework was introduced to model spray drying as an outlet air temperature controlled process. A P-controller numerical framework was introduced which allows the inlet temperature to be automatically adjusted based on the required outlet temperature set point. This numerical framework was evaluated with a simulation of a two-stage pilot scale spray drying system at the Davis Dairy Plant (South Dakota State University) which is used for commercial contract spray drying operation. Keywords: CFD simulation; Multi-Stage Spray Drying; P-Controller

BACKGROUND: After cardiac surgery acute kidney injury (AKI) is a common and serious condition carrying significant costs and is independently associated with increased morbidity and mortality. During cardiopulmonary bypass (CPB) surgery, modifiable factors may contri bute to post - operative AKI. Their prevention might be a potential target for nephroprotection and any other morbidity after cardiac surgery. METHODS AND MATERIAL : The objective of the present study was to identify and determine whether intraoperative hypot ension or any other cofactor are independent risk factors for postoperative AKI defined by the RIFLE (renal Risk, Injury, Failure, Loss of renal function and End - stage renal disease). On basis of this patients were divided into two groups according to rise in serum creatinine >0.3 mg/dl till 72 hrs postoperatively. Group B patients have developed AKI (n=34) and the remaining patients were in Group A. RESULT : In our study we have found that mean arterial pressure during CPB were less in group B patients compare to group A patients which was statistically significant (p

Traditionally most protein ingredients are sold as a powder due to transport ease and longer shelf life. Many high-protein powder ingredients such as milk protein concentrate with 85% protein and micellar casein concentrate have poor rehydration properties (e.g., solubility) after storage, which might limit their use. An alternative to the production of dried protein ingredients is the option to use liquid protein ingredients, which saves the cost of spray drying, but may also improve flavor and offer different functional properties. The objective of this study was to determine the effect of spray drying on the flavor and functionality of high-protein ingredients. Liquid and dried protein ingredients (whey protein concentrate with 80% protein, whey protein isolate, milk protein concentrate with 85% protein, and micellar casein concentrate) were manufactured from the same lot of milk at the North Carolina State University pilot plant. Functional differences were evaluated by measurement of foam stability and heat stability. Heat stability was evaluated by heating at 90°C for 0, 10, 20, and 30 min followed by micro-bicinchoninic acid and turbidity loss measurements. Sensory properties were evaluated by descriptive analysis, and volatile compounds were evaluated by gas chromatography-mass spectrometry. No differences were detected in protein heat stability between liquids and powders when spray dried under these conditions. Whey protein concentrate with 80% protein (liquid or spray dried) did not produce a foam. All powders had higher aroma intensity and cooked flavors compared with liquids. Powder proteins also had low but distinct cardboard flavor concurrent with higher relative abundance of volatile aldehydes compared with liquids. An understanding of how spray drying affects both flavor and functionality may help food processors better use the ingredients they have available to them.

Introduction: Improving tissue oxygenation is one of most important tasks in management of low cardiac output. Central venous oxygen saturation (ScvO2 ) and lactate are established criteria for monitoring the adequacy of tissue oxygenation. The venous-to-arterial carbon dioxide difference [P(v-a)CO2 ] is inversely associated with cardiac output. Aim: To study the use of P(v-a)CO2 /C(a-v)O2 ratio as a marker of low cardiac output during Cardiopulmonary Bypass (CPB) in paediatric cardiac surgical patients. Materials and Methods: The present study was a prospective observational study conducted over a period of nine months from 1st August 2015 to 30th April 2016. A total of 110 children were enrolled, who underwent CPB during cardiac surgery. The CPB time, Mean Arterial Pressure (MAP), flow rate, cross clamp time, were recorded for all the patients as well as Arterial Blood Gas (ABG) and Venous Blood Gas (VBG) were checked at four different points of time: 1) Before CPB, 2) 10 minutes after initiation of CPB, 3) 30 minutes on CPB and 4) off CPB. Results: The results indicated that Receiver Operating Characteristic curve (ROC curve) at 30 minute of CPB time P(v-a)CO2 /C(a-v)O2 was more specific and sensitive than lactate to detect anaerobic metabolism. Decrease platelet count was significant on second postoperative day. Conclusion: The present study suggests the use of P(v-a) CO2 /C(a-v)O2 ratio as a marker to detect low flow on CPB. Our study was single centric and with a small size, studies involving large population and multiple centers are required to support the recent findings.

Background and Aims: Central venous catheter placement is an important procedure for ICU (Intensive Care Unit) patients. We studied the usefulness of ultrasonography for placement of central venous catheter by in-experienced anesthetists. Materials and Methods: A prospective observational study of 32 patients requiring central venous access (CVA) in surgical ICU (SICU). Data collected were patient's demographics, indication, type of catheter, success rate, attempts, complication rate and access time were recorded and compared with other studies. Result: The overall success rate was 89.5% in the IJV (Internal Jugular Vein) and 92.3% for SCV (Subclavian Vein) group. The success rates for insertion at first, second, and third attempt were 52.6%, 31.6%, and 5.2% for IJV and 46.2% and 53.8% for SCV. Average number of attempts made for IJV cannulation was 1.74 +/- 1.04 and 1.54 +/- 0.51 for SCV. The total time taken for IJV access was 858.78 +/- 381.9 sec, whereas in the SCV group, it was 984 +/- 328.98 seconds. In our study, overall rate of complication was 21.05% (4/19 patients) for IJV and 23.07% (3/13 patients) for SCV insertion. Incidence of various complications like arterial puncture, misplacement of CVC, hematoma, pneumothorax, and hemothorax were also noted. Conclusion: This study concludes that real time ultrasound guidance during IJV and SCV cannulation can achieve higher success rate, fewer complications, number of attempts, and failure rate among inexperienced anesthetists.

1031Background: In MA.31 the lapatinib-taxane combination led to shorter PFS than trastuzumab-taxane in HER2+ metastatic breast cancer. We previously reported the positive prognostic utility of pre...

Purpose: This article summarizes data submitted to the U.S. Food and Drug Administration for marketing approval of azacitidine as injectable suspension (Vidaza, Pharmion Corporation, Boulder, CO) for treatment of patients with myelodysplastic syndrome. Experimental Design: In one phase 3 controlled trial, 191 study subjects were randomized to treatment with azacitidine or to observation; an additional 120 patients were treated with azacitidine in two phase 2 single arm studies. The primary efficacy end point was the overall response rate, defined as complete or partial normalization of peripheral blood counts and bone marrow blast percentages for at least 4 weeks. Results: In the controlled trial, the overall response rate was 15.7% in the azacitidine treatment group; there were no responders in the observation group (P < 0.0001). Response rates were similar in the two single arm studies. During response patients stopped being red cell or platelet transfusion dependent. Median duration of responses was at least 9 months. An additional 19% of azacitidine-treated patients had less than partial responses, most becoming transfusion independent. The most common adverse events attributed to azacitidine were gastrointestinal, hematologic, local (injection site), and constitutional. There were no azacitidine-related deaths. Conclusions: On May 19, 2004 the U.S. Food and Drug Administration approved azacitidine as injectable suspension for treatment of patients with the following myelodysplastic syndrome subtypes: refractory anemia or refractory anemia with ringed sideroblasts (if accompanied by neutropenia or thrombocytopenia or requiring transfusions), refractory anemia with excess blasts, refractory anemia with excess blasts in transformation, and chronic myelomonocytic leukemia. Full prescribing information is available at http://www.fda.gov/cder/foi/label/2004/050794lbl.pdf. Azacitidine is the first agent approved for treatment of myelodysplastic syndrome.

Milk protein concentrates (MPCs) are complete dairy proteins (containing both caseins and whey proteins) that are available in protein concentrations ranging from 42% to 85%. As the protein content of MPCs increases, the lactose levels decrease. MPCs are produced by ultrafiltration or by blending different dairy ingredients. Although ultrafiltration is the preferred method for producing MPCs, they also can be produced by precipitating the proteins out of milk or by dry-blending the milk proteins with other milk components. MPCs are used for their nutritional and functional properties. For example, MPC is high in protein content and averages approximately 365 kcal/100 g. Higher-protein MPCs provide protein enhancement and a clean dairy flavor without adding significant amounts of lactose to food and beverage formulations. MPCs also contribute valuable minerals, such as calcium, magnesium, and phosphorus, to formulations, which may reduce the need for additional sources of these minerals. MPCs are multifunctional ingredients and provide benefits, such as water binding, gelling, foaming, emulsification, and heat stability. This article will review the development of MPCs and milk protein isolates including their composition, production, development, functional benefits, and ongoing research. The nutritional and functional attributes of MPCs are discussed in some detail in relation to their application as ingredients in major food categories.

With the growing concerns on the information security and the capabilities of an attacker, Denial of Service (DoS) attacks have become one of the most serious and potent form of network security attacks. The attackers target the protocols to exhaust resources by either disabling the servers or disrupting the protocol exchange. In fact, almost all the communication protocols including TCP, HIP, etc. are vulnerable to resource exhaustion attacks. One of the ways of dealing with the DoS attacks is to carry out a cost analysis of the impact of the DoS attacks and ensure that the impact of the same is minimized to the extent possible. We illustrate the applicability of the same to analyze the Internet Key Exchange (IKE) version2 protocol. IKEv2 is one of the significant protocol of IPSec suite. It establishes the security association between source and destination before IPSec connection establishes. In this paper, we analyze IKEv2 protocol to show that IKE v2 is susceptible to DoS attacks.To the best of our knowledge, although IKE v1 has been analyzed for susceptibility to the DoS attacks, IKE v2 has not yet been. We also propose a new variant of IKE v2 protocol using model given by Stebila and et al. to ensure mitigation of DoS attacks in IKEv2.

Many studies show an association between ageing and mean telomere length in DNA isolated from peripheral blood mononuclear cells, few studies have examined less accessible tissues. This study has two objectives: (i) to define the best method to prepare rodent DNA for telomere length measurement by Southern blotting and (ii) to determine whether there are differential rates of telomere attrition in different rodent tissues. We found that the use of agarose plugs for DNA isolation was essential for the accurate measurement of rodent telomere length. Tissue was collected from neonatal (3 days) or aged (18-24 months) male Wistar rats and terminal restriction fragment (TRF) length was measured by Southern blotting. Cardiac tissue from aged rats showed a 38% loss of TRF length compared with newborn animals (p

Snake bites have remained India's most neglected tropical predicament despite of high mortality rates. The reasons behind such high mortality are usually unaware and uneducated rural population, lack of availability of early and proper treatment, doctors in dilemma, unavailability of antivenins in highly prone areas, high reaction rates to antivenin treatment and many more. This article may help the readers to update their knowledge with pros and cons of newer researches that have been carried out in various countries of the world with a motive to reduce snake bite related morbidity and mortality to minimum. Here, an effort has also been made to draw some attention of health authorities of India on recent advances that can help to curb mortality due to snake bites if bed side tests are made cost effective.

Background: Medullary hypoxia is a critical initiating event in the development of multiple forms of acute kidney injury (AKI), and the urinary PO2 provides an index of medullary oxygenation. This biomarker has the potential to aid in the management of patients at risk of AKI and, so, to possibly prevent development of AKI. Objective: To evaluate the effect of cardiopulmonary bypass (CPB) on urine oxygen tension (PO2) and determine whether perioperative PO2 can predict postoperative renal dysfunction in patients undergoing cardiac surgery. Materials and Methods: This prospective, observational study has enrolled a total of 63 patients who were undergoing on-pump cardiac surgery. On the basis of the AKI guideline, the patients were distributed into two groups. Group A patients did not develop AKI (n = 45), and the remaining patients developed AKI: group B (n = 12). Preoperative renal data and intraoperative and postoperative data were collected. Result: Urine PO2 data were recorded for 63 patients from blood gas analyzer. Prebypass and postbypass urine PO2 was similar up to 24-h postoperative in all patients. Even in patients who develop AKI, we did not find any difference in urine PO2 prebypass and postbypass. Conclusion: These results suggest the possibility of PO2 detecting an early stage of renal dysfunction in cardiac surgery although further studies will be required to substantiate it.

The CO2 uptake capacity and CO2/N2 selectivity of Troger's base-bridged nanoporous covalent organic polymers (TB-COPs) were investigated. The TB-COPs were synthesized by reacting the terminal amines of tetrahedral monomers – namely, tetraanilyladamantane and tetraanilylmethane – with dimethoxymethane in a one-pot reaction under relatively mild conditions. Interestingly, these two tetrahedral monomers formed nanoporous polymers with substantially different surface areas. While the polymer resulting from the Trogerization of the tetraanilyladamantane monomer (TB-COP-1) exhibited a high surface area of 1340 m2 g−1, that from the tetraanilylmethane monomer (TB-COP-2) was found to be only 0.094 m2 g−1. This unusual phenomenon can be explained by the proximity of the amino moieties to each other within the monomeric unit. A shorter distance between the amino groups enables intramolecular as well as intermolecular cyclization, thus resulting in a much lower porosity. TB-COP-1 exhibited significant CO2 uptake capacities of up to 5.19 and 3.16 mmol g−1 at 273 and 298 K under ambient pressure, and CO2/N2 selectivities of 79.2 and 68.9 at 273 and 298 K at 1 bar for a gas mixture of CO2 : N2 at a ratio of 0.15 : 0.85. It is noteworthy that TB-COP-1 showed remarkable selectivity retention when increasing the temperature from 273 to 298 K.

Application of solid sorbents for CO2 capture and separation has been under consideration since last decades owing to the promising feature of repeatable use, low cost of regeneration and thermo physical stability. However, the capturing capacity, selectivity and the overall performance of adsorbents at different temperatures and pressures still require further investigation to make these materials capable of replacing the mono-ethanol system. Here in we report synthesis, characterization and application of covalent organic polymers. Capturing capacity of COPs at low temperature and pressure has been experimented for two COPs materials (namely COP-9, COP-10) for CO2 and N2 adsorption. Materials were also characterized with BET and TGA. Copyright 2017 American Institute of Chemical Engineers. All rights reserved. This paper was made possible by the support of Qatar National Research Fund, National Priorities Research Program grant (NPRP# 5-499-1-088) and (NPRP# 6-330-2-140). The statements made herein are solely the responsibility of the authors. Scopus