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Abstract Neurodevelopmental disorders are currently one of the major complications faced by patients with congenital heart disease (CHD). Chronic hypoxia in the prenatal and postnatal preoperative brain may be associated with neurological damage and impaired long-term cognitive function, but the exact mechanisms are unknown. In this study, we find that delayed neuronal migration and impaired synaptic development are attributed to altered Atoh1 under chronic hypoxia. This is due to the fact that excessive Atoh1 facilitates expression of Kif21b, which causes excess in free-state α-tubulin, leading to disrupted microtubule dynamic stability. Furthermore, the delay in neonatal brain maturation induces cognitive disabilities in adult mice. Then, by down-regulating Atoh1 we alleviate the impairment of cell migration and synaptic development, improving the cognitive behavior of mice to some extent. Taken together, our work unveil that Atoh1 may be one of the targets to ameliorate hypoxia-induced neurodevelopmental disabilities and cognitive impairment in CHD.

Background/Objective: Multiple cases of postvaccination immune-related adverse events have been reported. We, hereby, present a patient who presented with new-onset type 1 diabetes mellitus (DM) after COVID-19 messenger RNA (mRNA) vaccination. Case Report: A 38-year-old Caucasian man presented with sudden onset of polyuria, polydipsia, and blurry vision for 1 month. The patient received the second dose of the COVID-19 mRNA vaccine (Pfizer-BioNTech) 4 weeks prior to symptom onset. Initial workup revealed glucosuria and hemoglobin A1c of 9.4%. Antibodies against multiple pancreatic beta cell autoantigens were detected. The patient was then initiated on insulin. Discussion: Hypothesized mechanisms for development of type 1 DM after COVID-19 mRNA vaccination include molecular mimicry, autoimmune/inflammatory syndrome induced by adjuvants, and possible interaction between the angiotensin-I converting enzyme-2 receptor on beta cells and viral mRNA. An initial high index of suspicion should be accompanied by early autoantibody testing and initiation of insulin, if indicated. Finally, if diagnosed with type 1 diabetes, patients must have long-term follow-up as there may be brief periods where glycemic control is maintained off insulin. Conclusion: New-onset type 1 DM has been reported after COVID mRNA vaccination. Clinicians should maintain a high index of suspicion and pursue early testing for the same to reduce adverse outcomes and improve long-term prognosis.

Abstract This literature review examines the impact of orthopaedic trauma on patient mental health. It focuses on patient outcomes, available resources, and healthcare provider knowledge and education. Orthopaedic trauma represents a significant physical and psychological burden for patients, often resulting in long-term disability, pain, and functional limitations. Understanding the impact of orthopaedic trauma on patient mental health is crucial for improving patient care, and optimizing recovery and rehabilitation outcomes. In this review, we synthesize the findings of empirical studies over the past decade to explore the current understanding of mental health outcomes in patients with orthopaedic trauma. Through this analysis, we identify gaps in existing research, as well as potential avenues for improving patient care and mental health support for patients with severe orthopaedic injuries. Our review reveals the pressing need for collaboration between healthcare providers, mental health professionals, and social support systems to ensure comprehensive mental care for patients with traumatic orthopaedic injuries.

Introduction: Cervical invasive carcinoma is one of the most frequent cancers in the world, and it can be prevented with screening. The papanicolaou (Pap) smear is the most common screening procedure. Pap staining, as it is now done, is costly, requires a large amount of alcohol, and takes a long time. Materials and Methods: A total of 170 patients were recruited. One hundred and sixty-six patients, considering eligibility criteria, undergoing Pap smear test. Eligibility criteria: Age: 18–49 years females, who did not have a total hysterectomy done, who consented to participate in the study. Each patient had two smears taken on glass slides. Standard Pap smears were fixed for at least 15 min in 95% ethanol. The other smear was air-dried before being fixed with alcohol formalin and stained with modified ultrafast Pap (MUFP) stain. A comparison of two different techniques was made on the basis of cytomorphological features. Results: In studied smears, a clean background was seen in 18.24% and 14.12% of the cases in Pap stain and MUFP, respectively. Kappa analysis found a good correlation between Pap stain and MUFP (kappa: 0.81, P < 0.01). Crisp chromatin was seen in 89.41% and 67.65% of MUFP and Pap staining, respectively. About 88.82% of MUFP stains showed optimal cytoplasmic details and the same was revealed by 81.18% of Pap stains. MUFP has a better quality index (QI) as compared to Pap staining as no case in MUFP had QI of < 0.80 with a statistically significant difference as P < 0.05. Conclusion: MUFP is a simple, user-friendly, affordable, and less time-consuming alternative in low-resource areas in comparison to the traditional technique for mass cervical cancer screening.

Abstract Nuclear power plants are aging around the world, and a precise assessment of irradiation damage in their components is needed. One key component, concrete, and specifically the silicates in its aggregates, can undergo significant expansion upon neutron radiation, which can lead to cracking and, ultimately, structural failure. However, assessing and predicting the extent of damage via neutron radiation is challenging due to reasons such as residual radioactivity and, most importantly, the high time involved. Here, we evaluate whether ion radiation can be a viable surrogate. Specifically, by employing Si2+ ion radiations and a comprehensive multi-modal imaging protocol, we report mineral-specific responses for key silicates such as quartz, albite, anorthite, and microcline. We find that 10 MeV Si2+ ions result in mineral expansions that are remarkably comparable to neutron radiation equivalent expansions (R2 = 0.86, RMSE = 1.29%), opening up pathways towards rapid assessment of silicates subject to irradiation.

Abstract We show that there are four chiral W $$ \mathcal{W} $$ -algebra extensions of so 2 3 $$ \mathfrak{so}\left(2,3\right) $$ algebra and construct them explicitly. We do this by a simple identification of each of the inequivalent embeddings of a copy of sl 2 ℝ $$ \mathfrak{sl}\left(2,\mathbb{R}\right) $$ in the so 2 3 $$ \mathfrak{so}\left(2,3\right) $$ algebra and the maximal subalgebra h $$ \mathfrak{h} $$ that commutes with it. Then using the standard 2d chiral CFT techniques we find the corresponding W $$ \mathcal{W} $$ -algebra extensions. Two of the four resultant W $$ \mathcal{W} $$ -algebras are new, one of which may be thought of as the conformal bms 3 $$ {\mathfrak{bms}}_3 $$ algebra valid for finite values of its central charge.

Objectives: The role of timing of coronary artery bypass grafting after acute myocardial infarction on early and late outcomes remains uncertain. Methods: We reviewed 1631 consecutive adult patients who underwent isolated coronary artery bypass grafting with information on timing of acute myocardial infarction. Early and late mortality were compared between patients receiving coronary artery bypass grafting within 24 hours after acute myocardial infarction, between 1 and 7 days after acute myocardial infarction, and more than 7 days after acute myocardial infarction. Sensitivity analyses were performed in subgroups of patients with ST-segment elevation myocardial infarction or non–ST-segment elevation myocardial infarction, and other high-risk groups. Results: A total of 124 patients (5.7%) underwent coronary artery bypass grafting within 24 hours, 972 patients (51.2%) received coronary artery bypass grafting between 1 and 7 days after acute myocardial infarction, and 535 patients (43.2%) underwent coronary artery bypass grafting more than 7 days after acute myocardial infarction. Overall operative mortality was 2.7% with comparable adjusted early mortality among 3 groups. Over a median follow-up of 13.5 years (interquartile range, 8.9-17.1), compared with patients receiving coronary artery bypass grafting between 1 and 7 days after acute myocardial infarction, those receiving coronary artery bypass grafting at 7 days had greater adjusted risk for late overall mortality (hazard ratio, 1.39, 95% CI, 1.16-1.67; P 7 days had a higher risk of late mortality [hazard ratio, 1.38, 95% CI, 1.14-1.67, P

Transesophageal echocardiography (TEE) has become an essential monitor for the management of most patients undergoing cardiothoracic surgery. TEE and central venous catheter placement are often used during cardiac surgeries. Here we conducted a study comparing TEE 3D probe as a surface probe with the ultrasound-guided (USG) vascular probe for guiding right internal jugular vein (IJV) catheterization. Context: USG vascular probe and TEE probe can help during central venous catheterization (CVC) and can confirm the location of guide wire in the neck vessels. We proposed this study, as there are only few studies comparing between TEE probe as surface probe and USG vascular probe for right IJV cannulation. Aims: To compare the TEE probe as a surface probe and USG vascular probe during right IJV catheterization in cardiac surgeries. Settings and Design: Prospective, comparative study. Methods and Material: One twenty-four patients of either sex posted for major elective cardiac surgery were included in this study. Patients were divided into two groups (TEE group and USG group) of 62 by assigning the study participants alternatively to each group. The goal of this study was to compare the puncture time, visualization of IJV to first successful puncture, quality of the imaging with needle tip positioning, and catheter positioning using both TEE probe and vascular probe. The primary outcome was comparison of time from visualization of the IJV to successful puncture using both TEE probe as a surface probe and vascular probe. Secondary outcome was to compare the quality of image with respect to needle tip positioning and compare quality of image with respect to catheter position using both probes. Statistical Analysis Used: Statistical analyses were performed by using a statistical software package SPSS, version 20.0. Results: The observation and results of our study clearly show the feasibility of TEE as surface probe for guiding central venous catheter in right IJV just like the vascular linear probe. There was no significant difference between the two groups (P > 0.05). No statistical differences were found in the puncture time, image quality, needle tip positioning, wire positioning, and catheter positioning between the two groups. All the P values were greater than 0.05. Conclusions: The TEE probe can be used as an alternative method to guide IJV puncturing and catheterization when the vascular probe is not available. It is feasible especially in cardiac surgeries where the TEE monitoring machine is a must in modern anesthesia and readily available than an ultrasound machine.

Abstract Background Evidence on the association between serum vitamin C (sVC) levels and obesity is limited. This study aimed to explore the relationship between sVC and body mass index (BMI) in adolescents aged 12 to 19 years. Methods We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2003–2006, with 3952 participants. sVC and BMI were independent variables and dependent variables, respectively. The associations of sVC with BMI were examined using multivariable linear regression models. Age, sex, and race/ethnicity were analyzed as subgroups. Then, we devised smooth curve fittings and saturation threshold analysis to address the nonlinear relationship. Results sVC had a negative correlation with BMI after adjusting for all covariates (β: -1.020, 95% CI: -1.359, -0.680). In the subgroup analysis by age, sex, and race/ethnicity, there was still a negative correlation between sVC and BMI (p

Abstract Background Spinal cord stimulation (SCS) has demonstrated multiple benefits in treating chronic pain and other clinical disorders related to sensorimotor dysfunctions. However, the underlying mechanisms are still not fully understood, including how electrode placement in relation to the spinal cord neuroanatomy influences epidural spinal recordings (ESRs). To characterize this relationship, this study utilized stimulation applied at various anatomical sections of the spinal column, including at levels of the intervertebral disc and regions correlating to the dorsal root entry zone. Method Two electrode arrays were surgically implanted into the dorsal epidural space of the swine. The stimulation leads were positioned such that the caudal-most electrode contact was at the level of a thoracic intervertebral segment. Intraoperative cone beam computed tomography (CBCT) images were utilized to precisely determine the location of the epidural leads relative to the spinal column. High-resolution microCT imaging and 3D-model reconstructions of the explanted spinal cord illustrated precise positioning and dimensions of the epidural leads in relation to the surrounding neuroanatomy, including the spinal rootlets of the dorsal and ventral columns of the spinal cord. In a separate swine cohort, implanted epidural leads were used for SCS and recording evoked ESRs. Results Reconstructed 3D-models of the swine spinal cord with epidural lead implants demonstrated considerable distinctions in the dimensions of a single electrode contact on a standard industry epidural stimulation lead compared to dorsal rootlets at the dorsal root entry zone (DREZ). At the intervertebral segment, it was observed that a single electrode contact may cover 20-25% of the DREZ if positioned laterally. Electrode contacts were estimated to be ~0.75 mm from the margins of the DREZ when placed at the midline. Furthermore, ventral rootlets were observed to travel in proximity and parallel to dorsal rootlets at this level prior to separation into their respective sides of the spinal cord. Cathodic stimulation at the level of the intervertebral disc, compared to an ‘off-disc’ stimulation (7 mm rostral), demonstrated considerable variations in the features of recorded ESRs, such as amplitude and shape, and evoked unintended motor activation at lower stimulation thresholds. This substantial change may be due to the influence of nearby ventral roots. To further illustrate the influence of rootlet activation vs. dorsal column activation, the stimulation lead was displaced laterally at ~2.88 mm from the midline, resulting in variances in both evoked compound action potential (ECAP) components and electromyography (EMG) components in ESRs at lower stimulation thresholds. Conclusion The results of this study suggest that the ECAP and EMG components of recorded ESRs can vary depending on small differences in the location of the stimulating electrodes within the spinal anatomy, such as at the level of the intervertebral segment. Furthermore, the effects of sub-centimeter lateral displacement of the stimulation lead from the midline, leading to significant changes in electrophysiological metrics. The results of this pilot study reveal the importance of the small displacement of the electrodes that can cause significant changes to evoked responses SCS. These results may provide further valuable insights into the underlying mechanisms and assist in optimizing future SCS-related applications.

Abstract Background Ventricular septal defect (VSD) is the most common congenital cardiac malformation, accounting for approximately 30% of congenital heart defects. Conventional surgical repair using cardiopulmonary bypass is invasive and associated with morbidities and prolonged hospital stay. With the advent of interventional approaches and availability of different occluding devices, the technique of perventricular device closure is evolving and being implemented successfully in larger groups of patients. We present herein, our initial experience of perventricular device closure for the ventricular septal defects in children to assess risks and benefits. Methods From March, 2023 to February, 2024, we have performed perventricular closure of ventricular septal defects in 13 children, under guidance of transesophageal echocardiography without cardiopulmonary bypass support. The median age at operation was 2 year (range 1.3–10 years) with the median body weight 11 kg (range 8.7–16.6 kg). Sixty-nine percent were males. The ventricular septal defect sizes ranged from 2.7 to 6 mm (mean 4.7 mm). Seven defects were perimembranous, four sub-aortic and two were muscular. One patient also underwent pulmonary artery de-banding with pulmonary artery balloon angioplasty and other one patent ductus arteriosus ligation, concomitantly. For defect closure, we used ventricular septal defect occlusion device (MemoPart™, Lepu Medical Technology Company, China) through a 3-cm skin incision in the lower- third of the sternum. The device sizes ranged from 5 to 8 mm (mean 6.9+-1.8 mm) and all patients except for two required symmetrical devices. Results All patients underwent device closure successfully. The procedural duration ranged between 32 and 52 min. None of the patients required cardiopulmonary bypass. The mean ventilation time and intensive care unit stay was 3 and 24 h, respectively. None of the patients required inotropic support or blood transfusions. Moreover, no patients developed any arrhythmias including heart block. The average length of hospital stay was 4.4 days. At the latest follow up, there were no residual shunts, conduction disturbances, device dislodgement or major aortic or tricuspid valve complications seen in any patients. There was no mortality. Conclusions Perventricular device closure of ventricular septal defects is a less invasive, extremely safe and effective method in children. It is associated with very fast recovery, shorter hospitalization time and better cosmetic incision. Moreover, it avoids cardiopulmonary bypass. The modifications and refinements in the design, material and implantation techniques will help in expanding the indications and prevent complications in the long-term.

No meta-analysis has holistically analysed and summarized the efficacy and safety of osilodrostat, a novel dual 11β-hydroxylase (cytochrome P450 family 11 subfamily B member 1 [CYP11B1]) and 18-hydroxylase (aldosterone synthase, CYP11B2) inhibitor in managing Cushing’s syndrome (CS). We undertook this meta-analysis to address this knowledge gap. Electronic databases were searched for randomized controlled trials (RCTs) involving patients with CS receiving osilodrostat in the intervention arm. The primary outcome was to evaluate changes in urine free cortisol (UFC) levels. Secondary outcomes were to evaluate alterations in cortisol levels, androgen levels, mineralocorticoid levels, and adverse events. From initially screened 109 articles, data from 2 RCTs involving 144 patients was analysed. After 8–12 weeks of therapy, the odds of achieving a normal 24-hour UFC was higher in patients receiving oslidrostat as compared to placebo. [odds ratio (OR) 21.94 (95% CI: 8.53–56.43); P < 0.00001; I2 = 0%]. The occurrence of adverse events [OR 1.35 (95% CI: 0.52–3.53); P = 0.54; I2 = 0%; low heterogeneity (LH); High certainty of evidence (HCE)], serious adverse events (SAEs) [OR 1.32 (95% CI: 0.30–5.79); P = 0.72; I2 = 0%; LH; HCE], adrenal insufficiency [OR 5.38 (95% CI: 0.91–31.78); P = 0.06; I2 = 0%; LH; HCE], headache [OR 0.98 (95% CI: 0.35–2.76); P = 0.97; I2 = 0%; LH; HCE], hyperandrogenism [OR 3.68 (95% CI: 0.59–22.80); P = 0.16; I2 = 0%; LH; HCE] and deaths [OR 0.32 (95% CI: 0.01–8.00); P = 0.48; I2 = 0%; LH; HCE] was comparable among the groups. The occurrence of nausea [OR 4.25 (95% CI: 1.26–14.30); P = 0.02; I2 = 0%; LH] and arthralgia [OR 6.54 (95% CI: 1.64–26.13); P = 0.008; I2 = 0%; LH; HCE] was significantly higher in the osilodrostat group as compared to placebo. Osilodrostat has good efficacy and safety in CS and was well tolerated over 48 weeks of use.

Background and Aim: Depression is a widespread mental health condition with a significant global impact. Recent research has explored the gut–brain axis, emphasizing the role of microbiota in neurotransmitter production. This study aims to explore the effectiveness of two complementary probiotic interventions: probiotic-rich curd and probiotic capsules, used in combination with the antidepressant escitalopram over 4 weeks. The primary objectives include assessing their impact on reducing the severity of depression, comparing their effectiveness, and discussing the clinical implications of findings. Materials and Methods: We conducted a 4-week prospective observational study at the Department of Psychiatry, MGM Medical College, and the associated Mental Hospital in Indore. Ninety individuals aged 18–60, diagnosed with depression (International Classification of Diseases-10) and assessed using the Hamilton Depression Rating Scale, participated. Subjects were divided into three groups: escitalopram 10 mg (n = 30), escitalopram 10 mg + 120 mL curd (n = 30), and escitalopram 10 mg + probiotic capsule (n = 30). Assessments were conducted on days 0, 14, and 28 using the Hamilton Depression Rating Scale. Results: All treatment groups exhibited a significant reduction in mean Hamilton Depression Rating Scale scores over the study duration (P < 0.001). Notably, the probiotic group showed a slightly greater reduction in scores between day 0 and day 28 compared to the curd and escitalopram-only groups. Conclusion: The study demonstrates the potential for slightly better outcomes with probiotic interventions alongside the antidepressant escitalopram over 4 weeks. Beyond symptom relief, this approach may offer lower side effects, potentially enhancing patient adherence. Future research should investigate long-term effects and specific probiotic strains in a larger, diverse population.

Background: The prevalence of human immunodeficiency virus (HIV) infection in the population of men who have sex with men (MSM) in India is higher than that of the general population, making them one of the high-risk population groups. This subgroup is also at a higher risk for mental disorders, substance use, and stigma due to their MSM status. There is a paucity of data about this in the Indian HIV-positive MSM subgroup. Aim: The study aimed to explore the understanding of “mental health” among MSM living with HIV and bring forth their unmet mental health needs. Methods: The study used a qualitative design with purposive sampling. Seven people living with HIV from a randomly selected antiretroviral therapy center in Mumbai, who identified as MSM, participated in the study. Data were collected through focus group discussion, audio recorded with consent, and then a thematic analysis of the transcript was done. Results: The responses were summarized into four broad categories – mental health problems, psychosocial and economic problems, philosophical conflicts, and coping strategies. The categories further generated multiple themes. Themes such as worries about the illness, fear of impending death, low self-esteem, stigma around HIV and homosexuality, and perceived and experienced discrimination were recurrent. Mental illness was perceived as an additional burden to their already existing health problem. Conclusion: This study provided a deeper understanding of the unmet mental health needs and psychosocial challenges faced by the HIV-infected Indian MSM. It may help the policymakers of the country to modify the existing health and social benefit schemes.

Background: Periodontal disease is associated with immune dysregulation, and cytokines released can add on to the coronavirus disease 2019 (COVID-19)-associated cytokine storm, further worsening the related adverse outcomes. Specific studies investigating cytokine levels in COVID-19 patients with periodontal disease are lacking. Examining the correlation between these conditions could aid in categorizing risk categories, determining referrals, and strengthening oral hygiene protocols. The current study sought to evaluate cytokine levels in the saliva of COVID-19-positive patients with and without periodontal disease. Materials and Methods: Twenty-six COVID-19-positive patients were subjected to periodontal examination, saliva collection, and assessment of cytokine levels through cytokine bead-based multiplex assay, using fluorescence-encoded beads with flow cytometry (BD FACS LSRFortessa). Eleven cytokines were assessed (interleukin [IL] 2, 4, 6, 10, 17A, and interferon-gamma (IFN-gamma), tumor necrosis factor-alpha (TNF-α), chemokine ligand 2 (CCL2/monocyte chemoattractant protein-1), C-X-C motif chemokine ligand (CXCL) 8/IL 8, CXCL 9/monokine-induced gamma interferon [MIG]), and CXCL 10 (chemokine IFN-gamma inducible protein 10 kDa). The cytokine levels of the recruited subjects were also compared graphically with the salivary cytokine levels reported in the literature for health, COVID-19, and periodontal disease alone. Results: Out of 26 COVID-19-positive patients, 17 had periodontal disease. Levels of all cytokines were raised in patients with both diseases when compared to values reported in literature for health, periodontal disease alone, or COVID-19 alone. However, there was no statistical difference among the recruited subjects for IL-2, IL-4, IL-6, IL-10, IL-17A, IFN-gamma, TNF-α, CCL2, CXCL 8, and CXCL 10. MIG levels were found to be higher in periodontally healthy, COVID-19-positive subjects (P = 0.01). Conclusions: Periodontal disease might contribute to the COVID-19-induced cytokine storm, potentially amplifying its impact.

The electron beam (EB) energy is one of the most crucial parameters of EB treatment applications. It governs the dose distribution inside the bulk of the product treated with an energetic EB. An online monitoring and robust system is proposed for EB energy monitoring for radio frequency (RF) linear accelerator (LINAC). Attenuation method using dosimeter films is applied to reproduce the range of electron beam in aluminum. In online monitoring system, two electrically isolated aluminum plates having identical shape but different thicknesses, as per full penetration thickness of electron beam, are used. The current constituted in each plate is measured by an oscilloscope with suitable resistors, by keeping the set up under the beam. The ratio of the current signal from the front plate to the sum of the signals from both plates is very sensitive to the beam energy. Here, an electron accelerator of 10 MeV is used to incorporate this device. Sensitivity and robustness are the key factors to make this device highly suitable for desirous applications of 10 MeV LINAC and also to meet the regulatory mandates related to energy limitations for industrial utilities.

Background: Goals of anesthesia in neurosurgery include stable cerebral hemodynamics and provide relaxed brain to surgeon. Dexmedetomidine and lignocaine as an adjuvant can fulfill these criteria but literature comparing the two are sparse. We compared the effects of intravenous infusion of dexmedetomidine or lignocaine on stress response, postoperative pain, and recovery in patients undergoing craniotomy for intracranial tumors. Methods: Approval was obtained from IEC, and the study was prospectively registered (CTRI/2022/11/047434). Written and informed consent was obtained from 105 patients fulfilling inclusion criteria, and they were divided into three groups. Group D received intravenous infusion of dexmedetomidine 1 mcg/kg over 15 minutes followed by infusion at rate of 0.5 mcg/kg/h, Group L received intravenous infusion of lignocaine 2 mg/kg over 15 minutes followed by infusion at rate of 1.5 mg/kg/h, and Group N received intravenous infusion of normal saline at the rate of 4–8 ml/h till skin suturing. SPSS v23 (IBM Corp.) was used for data analysis. Results: There was a significant difference between groups in terms of intraoperative hemodynamic variations, brain relaxation score, extubation criteria, postoperative pain, stress indicator response, and quality of recovery. Conclusions: Dexmedetomidine as an adjuvant to anesthetic drugs has a better profile than lignocaine in suppressing stress response and preventing hemodynamic variations at intubation, skull pin application, and surgical incision. Dexmedetomidine increases the duration of effective analgesia more than lignocaine, in postoperative period in patients undergoing craniotomy.

The three-point hitch, found on agricultural tractors, facilitates the raising and lowering of an attached implement. Some tractors include a rock shaft that comprises a physical shaft that interconnects and facilitates the raising and lowering of the lower arms of the three-point hitch in a synchronized manner. In this study, we deal with a hitch system with the lower arms actuated by two independent hydraulic cylinders. This innovative tractor hitch system design allows the implement to follow the terrain, instead of the tractor, about the fore–aft (roll) axis of the tractor. However, since the two lower arms are independent, a specialized controller is needed to move these arms in unison. First, we present a position controller for individual arms and a roll controller to move these arms together. Second, we present a unique algorithm to emulate a physical rock shaft while the implement is operating in float mode. The algorithm ensures that the implement does not roll around the fore–aft axis while making sure it moves up and down vertically to follow the terrain. We present experimental results from the step response of the hitch system’s height while tracking a velocity reference. With the roll of the implement defined as the difference between the left arm’s position in percentage and that of the right arm in percentage, we observe that the largest mean roll was 0.23% with a flail mower attached and 0.26% without any implement. We then present results from the implement’s position in the float mode when the software rock shaft was activated and compare them with the case without the software rock shaft. The experiments showed that, when the software rock shaft was turned on, the mean roll reduced from 4.64% to 0.58% with a seed drill implement and from −3.99% to −0.59% with a flail mower implement. The standard deviations in these two implement cases improved from 16.77% to 2.79% and 6.45% to 3.53%, respectively, proving the effectiveness of the software rock shaft and its potential to replace the physical rock shaft found on the traditional tractors.

Introduction: Enhanced recovery after surgery (ERAS) is a multidisciplinary approach to optimize patient care. The goal of this approach is to reduce the body’s reaction to surgical stress by optimizing the perioperative nutritional status, promoting analgesia without opioids, and early postoperative feeding. In pediatric patients, very limited literature is available for the application of ERAS protocol. This study was done to evaluate the application of ERAS protocol in pediatric hepatobiliary and pancreatic patients. Materials and Methods: This is a randomized prospective study conducted over a period of 2 years at a tertiary center in North India. A total of 40 hepatobiliary and pancreatic patients who were willing to participate in the study were included in the study. Patients were randomized by computer-generated method and data were collected regarding demography, clinical diagnosis, preoperative and postoperative workup, and peri-operative care including analgesia, pain scores, postoperative recovery, hospital stay, and complications. These patients were followed for 6 months postoperatively and the results were evaluated using SPSS software. Results: The study included 20 patients each in both the conventional and ERAS group with median ages of 11.5 years and 7.1 years, respectively. The data analysis showed that the ERAS group of patients had better outcomes in terms of hospital stay and drain removal time with significant statistical differences. Pain scores and complications are almost the same in both groups. Conclusion: Principles of ERAS can be safely applied in pediatric patients undergoing major surgery in the present era of emerging infections and also increasing patient burden without morbidity.

Abstract The proto-oncogene MYC encodes a nuclear transcription factor that has an important role in a variety of cellular processes, such as cell cycle progression, proliferation, metabolism, adhesion, apoptosis, and therapeutic resistance. MYC amplification is consistently observed in aggressive forms of several solid malignancies and correlates with poor prognosis and distant metastases. While the tumorigenic effects of MYC in patients with head and neck squamous cell carcinoma (HNSCC) are well known, the molecular mechanisms by which the amplification of this gene may confer treatment resistance, especially to immune checkpoint inhibitors, remains under-investigated. Here we present a unique case of a patient with recurrent/metastatic (R/M) HNSCC who, despite initial response to nivolumab-based treatment, developed rapidly progressive metastatic disease after the acquisition of MYC amplification. We conducted comparative transcriptomic analysis of this patient’s tumor at baseline and upon progression to interrogate potential molecular processes through which MYC may confer resistance to immunotherapy and/or chemoradiation and used TCGA-HNSC dataset and an institutional cohort to further explore clinicopathologic features and key molecular networks associated with MYC amplification in HNSCC. This study highlights MYC amplification as a potential mechanism of immune checkpoint inhibitor resistance and suggest its use as a predictive biomarker and potential therapeutic target in R/M HNSCC.

Abstract Background Ventricular tachycardia (VT) is the primary cause of sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM). However, the strategy for VT treatment in HCM patients remains unclear. This study is aimed to compare the effectiveness of catheter ablation versus antiarrhythmic drug (AAD) therapy for sustained VT in patients with HCM. Methods A total of 28 HCM patients with sustained VT at 4 different centers between December 2012 and December 2021 were enrolled. Twelve underwent catheter ablation (ablation group) and sixteen received AAD therapy (AAD group). The primary outcome was VT recurrence during follow-up. Results Baseline characteristics were comparable between two groups. After a mean follow-up of 31.4 ± 17.5 months, the primary outcome occurred in 35.7% of the ablation group and 90.6% of the AAD group (hazard ratio [HR], 0.29 [95%CI, 0.10–0.89]; P = 0.021). No differences in hospital admission due to cardiovascular cause (25.0% vs. 71.0%; P = 0.138) and cardiovascular cause-related mortality/heart transplantation (9.1% vs. 50.6%; P = 0.551) were observed. However, there was a significant reduction in the composite endpoint of VT recurrence, hospital admission due to cardiovascular cause, cardiovascular cause-related mortality, or heart transplantation in ablation group as compared to that of AAD group (42.9% vs. 93.7%; HR, 0.34 [95% CI, 0.12–0.95]; P = 0.029). Conclusions In HCM patients with sustained VT, catheter ablation reduced the VT recurrence, and the composite endpoint of VT recurrence, hospital admission due to cardiovascular cause, cardiovascular cause-related mortality, or heart transplantation as compared to AAD.

Abstract Vitamin A plays a pivotal role in health, particularly in regulating fat metabolism. Despite its significance, research into the direct relationship between vitamin A levels and obesity, especially among adolescents, is sparse. This study aims to explore this association within the adolescent population in the United States. This cross-sectional study analyzed the National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2006, with 8218 participants. The levels of vitamin A in the serum were determined based on utilizing high-performance liquid chromatography with photodiode array detection. The relationship between serum vitamin A concentrations and body mass index (BMI) was evaluated using weighted multiple linear regression models, incorporating subgroup analyses by sex and race/ethnicity to provide nuanced insights. A positive correlation was observed between serum vitamin A levels and BMI, with BMI increasing progressively across vitamin A quartiles (P

Pleural effusion is a common problem in our country, and most of these patients need invasive tests as they can’t be evaluated by blood tests alone. The simplest of them is diagnostic pleural aspiration, and diagnostic techniques such as medical thoracoscopy are being performed more frequently than ever before. However, most physicians in India treat pleural effusion empirically, leading to delays in diagnosis, misdiagnosis and complications from wrong treatments. This situation must change, and the adoption of evidence-based protocols is urgently needed. Furthermore, the spectrum of pleural disease in India is different from that in the West, and yet Western guidelines and algorithms are used by Indian physicians. Therefore, India-specific consensus guidelines are needed. To fulfil this need, the Indian Chest Society and the National College of Chest Physicians; the premier societies for pulmonary physicians came together to create this National guideline. This document aims to provide evidence based recommendations on basic principles, initial assessment, diagnostic modalities and management of pleural effusions.

Background Opioids administered as bolus doses or continuous infusions are widely used for major and daycare surgeries. Opioid-free anesthesia is multimodal anesthesia and analgesia that does not use opioids, benefiting patients from opioid-related adverse effects. We compared the postoperative analgesic requirements of patients scheduled for elective laparoscopic cholecystectomy under opioid-free and opioid-based anesthesia. Methods Study included 88 patients aged 18–60 years with American Society of Anesthesiologists physical status 1 and 2 who underwent elective laparoscopic cholecystectomy. Participants were randomly divided into two groups with 44 in each. The opioid-free group was administered an intravenous bolus of ketamine and dexmedetomidine, whereas fentanyl was used in opioid group. Primary outcome was to compare the total amount of fentanyl consumed by both groups during 6 h postoperative period. Episodes of postoperative nausea and vomiting (PONV) and vital signs were noted throughout the postoperative period to analyze the secondary outcomes. Results Both groups had similar demographic characteristics. The opioid-free group required lesser analgesia within the first 2 h (61.4 ± 17.4 vs. 79.0 ± 19.4 of fentanyl, P < 0.001), which was statistically significant. However, fentanyl consumption was comparable between the groups at 6 h (152 ± 28.2 vs. 164 ± 33.4, P = 0.061). Compared with 4.5% of the participants in the opioid-free group, 34% of those in the opioid-based group developed moderate PONV. Conclusions Opioid-free anesthesia in patients undergoing laparoscopic cholecystectomy reduced the requirement of analgesia in first two-hour postoperative period and was associated with decreased PONV.

Backgrounds and Aims: EUS-guided vascular intervention has expanded the horizons of diagnostic as well as therapeutic interventions for vascular pathology. EUS-guided embolization is a commonly performed technique for the treatment of gastric varices. However, there is a lack of data on the standardization of the technique. Here, we review the techniques and difficulties encountered during EUS-guided embolization of varices and pseudoaneurysms. Methods: This article and accompanying video describe the EUS-guided embolization techniques for various vascular lesions. EUS-guided embolization was achieved by combination therapy using coils and cyanoacrylate. Complete obliteration of the lesions was documented on follow-up. The existing literature of EUS-guided embolization therapy is also reviewed. Results: Patients with various vascular lesions, including gastric varices, ectopic duodenal varices, and splenic artery pseudoaneurysms, were successfully treated with EUS-guided coil plus cyanoacrylate injection. Patients with gastric varices underwent treatment with 2 EUS-guided techniques: (1) direct puncture of the varix and embolization and (2) feeder vessel embolization. Following embolization, the absence of Doppler flow within the varix and pseudoaneurysm was documented. Conclusions: Techniques of EUS-guided embolization of varices and pseudoaneurysms are demonstrated. Understanding the techniques and the challenges encountered during therapy is crucial to optimize outcomes and reduce adverse events.

ABSTRACT: Background: Root canal re-treatment (RCR) cases are considered some of the most challenging cases in the field of endodontics, as they are mostly associated with various iatrogenic errors such as ledge formation, incomplete biomechanical preparation, file separation, and incomplete obturation. These iatrogenic errors lead to defective niches within root canals that may act as reservoirs for various viable microorganisms. Such residual microbial niches may cause postoperative pain even after thorough debridement and reshaping the canals, ultimately leading to a poor prognosis for the tooth. Nowadays, prevention of postoperative pain in re-treatment cases and prognosis are effectively managed by photobiomodulation therapy (PBMT). Method: Relevant studies in the English language published before November 2022 were identified using electronic databases like PubMed, SCOPUS, and EBSCO to conduct bibliographic research. This systematic review is based on 3 studies that were found eligible as per the inclusion and exclusion criteria. This systematic review is in accordance with PRISMA guidelines. Results: The systematic review indicated a positive impact by significantly decreasing postoperative pain in RCR cases when treated with PBMT. The variation was statistically significant at 24 hours (P = .0002), 48 hours (P = .03), and 72 hours (P = .02). The mean difference at 24 hours was 0.65 (95% CI, 0.32–0.99), at 48 hours was 0.46 (95% CI, 0.05–0.87), and at 72 hours was 0.40 (95% CI, 0.07–0.74). There was no statistical heterogenicity at 24 hours (P > .05), but a medium heterogenicity was observed at 48 hours and 72 hours. Practical implication: PBMT or low-level laser therapy has shown superior results as compared to the conventional pharmacologic approach in postoperative pain management in RCR cases.

Introduction: Varicose Veins (VV) are enlarged, convoluted, and elongated veins that primarily affect the superficial veins in the lower limbs and are one of the most prevalent indications of vascular diseases. The reasons for elevated venous pressure are understood, but the inflammatory cytokines that initiate the ultimate pathways of tissue destruction and are in charge of the clinical characteristics of Chronic Venous Insufficiency (CVI) are yet unknown. Although inflammation plays a crucial role in the process of tissue apoptosis, it also plays a crucial role in tissue repair and regeneration. Aim: To investigate changes in blood markers of varicose vein inflammation and endothelial damage and compare them with systemic markers in VV patients and conclude that they are increased in VV blood. Materials and Methods: The comparative cross-sectional study was conducted in the Department of Biochemistry on 70 patients with primary VV who were scheduled for Outpatient Sclerotherapy at Nootan Medical College and Research Centre, Sankalcahnd Patel Vidyadham in Visnagar, Gujarat, India from April 2021 to June 2023. Chronic lower extremity Venous Disease (CVD) was categorised using the Clinical Aetiology Anatomy Pathophysiology (CEAP) classification method. Blood samples were obtained above the knee from the tortuous and dilated varicose tributaries of the great saphenous vein (local) and from the antecubital (systemic) vein by standard venipuncture. Erythrocytes, leukocytes, platelets, haemoglobin, and haematocrit were determined using an automatic haematology analyser. D-dimer and High sensitivity C-reactive Protein (hsCRP) were determined by an immune turbidimetric assay. IL-6 and von Willebrand factor (vWF) were measured by Enzyme Linked Immunosorbent Assay (ELISA) using commercially available kits according to the manufacturers’ instructions. An Independent samples t-test was used to compare group difference, and p-value ≤0.05 were considered significant in all two-sided statistical tests. Results: Basic haematologic test results {systemic versus (vs) varicose blood samples} were comparable. In VV, the following parameters were significantly increased compared to systemic blood: Haemoglobin (12.85±1.81 g/dL vs. 15.82±1.57 g/dL, p

Objective: This study aims to know the surgical treatment of electrical injuries, perineum, and scrotum. Case(s) Presentation: A 55-year-old male sustained electric burns to the back, perineum and scrotum. The patient failed to void following removal of the catheter 6 weeks later, hence the patient was referred to the urology department for further management. was counselled for a two-phase urethral surgery. Discussion: In our case, the patient had sustained perineal and scrotal burns when he sat over a live wire. This led to the loss of skin and soft tissues, needing massive musculoskeletal and skin grafts. Our patient underwent a number of revision surgeries leading to repeated scarring of the perineal tissues and skin. Conclusion: Electrical injuries to the perinium and genitalia are rare. Hence the surgical strategy of electrical injuries requires a step-wise approach. Initially, conservative debridement needs to performed so as to preserve any tissue of questionable viability and ensure subsequent adequate soft-tissue coverage. The reconstructive surgical procedures bring about satisfactory outcomes. Keywords: Electrical injury, perineum, scrotum, surgical strategy.

Multiple Input and Output-Orthogonal Time–Frequency Selective (MIMO-OTFS) is considered one of the leading candidates for the beyond fifth generation (B5G) radio framework. The signal detection process is complex due to the large number of antennas, which also increases the framework’s latency. Signal detection algorithms such as Recurrent Neural Networks (RNNs), Neural Networks (NNs), Support Vector Machines (SVMs), Minimum Mean Square Error (MMSE), Maximum Likelihood Detection (MLD), Expectation-Maximization (EM), and Zero-Forcing Equalization (ZFE) are analyzed for Rayleigh and Rician channels. Currently available methods involve intricate identification and receivers with lower spectral efficiency. Experimental results indicate that RNNs, NNs, and SVM detectors, which have lower complexity, are recommended to improve the bit error rate (BER) and power spectral density (PSD) of the MIMO-OTFS system. It is also noted that RNNs offer diversity in received data, achieving a significant gain of 5 dB to 7 dB compared to existing OTFS systems across different MIMO frameworks. Furthermore, the utilization of machine learning algorithms significantly obtained a gain of −305 and −330 (RNNs) for the Rayleigh and Rician channels, respectively. These findings underscore the benefits of integrating sophisticated detection methods in B5G communication channels, indicating a valuable direction for future research and advancements in this area.

Diet significantly affects reproductive outcomes across species, yet the precise effects of macronutrient compositions beyond caloric intake on reproductive aging are understudied. Existing literature presents conflicting views on the fertility impacts of nutrient-rich versus nutrient-poor developmental diets, underscoring a notable research gap. This study addresses these gaps by examining effects of isocaloric diets with varied protein-to-carbohydrate ratios during both developmental and adult stages on reproductive aging of a large, outbred Drosophila melanogaster population (n = ∼2100). Our results clearly demonstrate an age-dependent dietary impact on reproductive output, initially dominated by the developmental diet, then by a combination of developmental and adult diets in early to mid-life, and ultimately by the adult diet in later life. Importantly, we found that the effects of developmental and adult diets on reproductive output are independent, with no significant interaction. Further investigations into the mechanisms revealed that the effect of developmental diet on fecundity is regulated via ovarioles formation and vitellogenesis; while, the effect of adult diet on fecundity is mostly regulated only via vitellogenesis. These insights resolve disputes in the literature about dietary impacts on fertility and offer valuable perspectives for optimizing fertility strategies in improving public health and conservation efforts in this changing world.

There is a growing need for a more streamlined and automated method of refining biofuels, as there are currently no universally applicable process inspection instruments on the market. All process variables in bio-oil upgrading operations are maintained according to the offline specifications of the products and intermediates. Failure of the process and loss of resources can result from batch-wise monitoring not having real-time product standards. Consequently, in order to cut down on waste and lessen the chances of process failure, a quick and accurate tool for specifying intermediates and products is required. To resolve this issue, we created a model using response surface methodology and an artificial neural network that can increase the bio-oil yield involving parameters, i.e., biomass particle size (mm), temperature (°C), and residence time (min). The maximum bio-oil production (47.0883%) was achieved at 3 mm particle size, 523°C temperature, and 20 min residence time. All results are “better” for root mean squared error (∼1), and the highest coefficient of regression for bio-oil production is in the range of 0.97–0.99. Temperature is the most significant factor in bio-oil yield, followed by particle size and residence time. Based on physicochemical properties, bio-oil has the maximum kinematic viscosity (11.3 Cst) and water content (18.7%). Making bio-oil precious compounds allows it to be used as boiler feedstock and steam generation fuel.

Hydatidosis or echinococcosis is an endemic parasitic disease caused by the ingestion of eggs of echinococcal species worldwide. In India, the annual incidence varies from 1 to 200 per one 100,000 hab., with the highest prevalence reported in the Indian states of Andhra Pradesh and Tamil Nadu. The dog is the definitive host, while humans, sheep, and cattle are intermediate hosts. The disease usually involves the liver and lungs, with the kidney and other organs rare involvement. Cardiac hydatidosis is still further rare, seen in 0.2% to 2% of the patients who remain asymptomatic until the development of its complications. Sudden deaths in cardiac echinococcosis are mostly attributed to cardiac arrhythmias, coronary artery diseases, valvular diseases, cardiomyopathies, pericarditis, and cardiac tamponade. We, herein, report a rare case of cardiac hydatid cyst incidentally found during the autopsy of a 26-year-old male who died due to electrical injuries. A single greyish-white cystic mass measuring 1.5cm X 1.2cm was detected on the left anterior ventricular wall 4 cm above the apex and was confirmed microscopically as a hydatid cyst. The cause of death was attributed to external injury.

Background: Ewings sarcoma is relatively rare and accounts for a 3–4% of childhood cancer. The data of Ewings sarcoma is scarce in North India and so the study was planned to find out the demographics, outcome and prognostic factors of Ewings sarcoma. Methods: This is a retrospective study conducted in the Department of Pediatrics, Pediatric Oncology unit at a tertiary care centre (KGMC, Lucknow) in North India. All patients of age 1–16 years with biopsy and IHC proven Ewings sarcoma during 2015–2020 were included in the study. Parameters were noted and follow up was done till December 2021. Statistical analysis was done by Microsoft Excel and GraphPad Prism 10. Overall survival was assessed using Kaplan Meir Survival Analysis. P value

Penile strangulation secondary to utilization of a constrictive ring is a rare urologic emergency that requires urgent decompression to prevent prolonged vascular obstruction resulting in necrosis and gangrene. Current literature is mainly comprised of case presentations that focus on management in the acute setting via removal of the ring. Herein, we describe surgical management of a patient who presents in delayed fashion after self-removal of the constrictive ring. We discuss our penectomy-sparing technique of debridement and split thickness skin graft.

One of the most feasible approaches to reduce the carbon footprint of concrete, a critical contributor to global CO2 emissions, is to consider the high-volume replacement of cement with supplementary cementitious materials (SCMs). However, this approach currently has two issues: 1) low early-age strength, 2) inconsistent carbon accounting. To address these issues, we investigate the micro- and macro-scale performance of a series of low-carbon concrete mixes and analyze their global warming potential (GWP) using 5 unique LCA tools. We report that the cumulative heat, when normalized to the total water content, exhibits correlations with key performance metrics such as open porosity (R2 = 0.83) and compressive strength (R2 = 0.92). In addition, all LCA tools suggest that high-SCM mixes (55–70% replacement), broadly, can reduce the GWP values for concrete by ∼50% (from ∼450 to ∼240 kg CO2-eq/m3). However, depending on the mix and the LCA tool used, for GWP values, the relative variation can be as high as 30% (∼50–80 kg CO2-eq/m3). Finally, we normalize the compressive strength to the GWP metric using an ‘Integrated Strength Eco-Efficiency’ (I-SEE) coefficient, which can be a potential parameter for simultaneously assessing concrete’s performance and environmental impact.

Objective: To do a cross-cultural adaptation and validation of the translated Hindi version with Indian modification of the Japanese Orthopedic Association (In-mJOA-H) score for cervical myelopathy. Background: Indian modification of the Japanese Orthopedic Association (In-mJOA-H) score has never been translated and studied in any vernacular language. This is one of the biggest limitations in assessing disease severity where most of the population is speaking Hindi or other regional languages. Materials and Methods: A cross-sectional study of 193 patients, from November 2020 to May 2021, with cervical myelopathy or neck pain with radiculopathy was done. The acceptability, validity, responsiveness, reproducibility, and cross-cultural adaptation were evaluated for the Hindi version (In-mJOA-H). Results: A strong correlation was found between In-mJOA-H with the English version and its individual component of the English version Indian modification of the JOA scale (In-mJOA-E). Conclusion: Good acceptability, validity, responsiveness, and reproducibility were established for the Hindi version (In-mJOA-H) with Indian modifications and its correlation to the English version Indian modification of the JOA scale (In-mJOA-E).

Peripartum cardiomyopathy and hypertensive disorders of pregnancy are not very uncommon in routine practice, but when associated with abruptio placentae and significant hypotension, survival of both child and mother becomes challenging. We report a case of a 20-year-old primigravida who presented in the gynecology emergency unit of our hospital with an ejection fraction of < 20%, severe preeclampsia with abruptio placentae leading to fetal demise, and renal failure in the immediate postoperative period. Challenges faced during decision making regarding the mode of delivery and grave concerns during intraoperative and postoperative periods are discussed. In this case, prompt termination of pregnancy, various point-of-care sonographic measurements, and post-operative emergency dialysis played vital roles in the complete recovery of this patient with a failing heart and grossly jeopardized hemodynamics. Hence, multidisciplinary team-based management is crucial for managing such cases to prevent maternal mortality and morbidity.

Gout is a metabolic disorder that leads to elevated serum uric acid levels and deposition of urate crystals in the joints. The disease is usually confined to the joint space and leads to pain and limitation of jaw opening. The case describes a 45-year-old female patient with a chief complaint of ‘occasional pain in the left temporal muscle region’. The case disclosed a gout manifestation in the temporomandibular joint (TMJ) after physical and radiographic findings. Gout manifestation in the TMJ is an unusual presentation and a few reports in the English literature address the subject. Gout in the TMJ should be included as a differential diagnosis for joint disorders because of its rarity. A clinician may overlook gout involving the TMJ in the differential diagnosis of facial pain even when the patient has received a diagnosis of gout in other joints.

Background Preoperative anxiety in neurosurgical patients is high due to life-threatening illness and uncertainty of the surgical outcome. This study assessed preoperative anxiety and its influencing factors in patients undergoing intracranial tumor surgeries utilizing the Amsterdam Preoperative Anxiety and Information Scale (APAIS).

Introduction: Efficient cold chain and vaccine logistics management are made possible by the health system's processes, practices, and policies, which are evaluated by Effective Vaccine Management, a diagnostic tool. A significant number of urban Jabalpur children receive vaccinations from a government health facility. The aim of the study was to Assess the cold chain maintenance and vaccine management practices at urban government Cold Chain Points of Jabalpur district. Methods: A cross-sectional study was carried out at all of 13 urban government Cold Chain Points across Jabalpur district. Globally validated World Health Organization - United Nations International Children's Emergency Fund Effective Vaccine Management tool was used for this study. Criteria wise and Consolidated Effective Vaccine Management scores were calculated as per World Health Organization guidelines. Results: All the urban service point stores or cold chain points scored more than the target 80% in two criteria: storage capacity and building. The consolidated criteria score of all the cold chain points in urban Jabalpur, criteria like maintenance, stock management, management information system, and supportive functions, were lagging behind the 80% mark. Low scores in maintenance, stock management, and management information system and supportive functions criteria are somehow a setback for all the preparation and hard work done towards optimal vaccine management and supply chain in the area. Conclusion: The overall performance of the urban cold chain points in Jabalpur district was far better as compared to the state-level effective vaccine management assessment done in Madhya Pradesh in 2011 and 2016. Planned preventive maintenance for buildings and equipment needs to be strengthened. Issues like Lack of information for stock management, need for periodic refresher trainings are to be emphasized.

Abstract Alteration of gut microbiota can affect chronic lung diseases, such as asthma and chronic obstructive pulmonary disease, through abnormal immune and inflammatory responses. Previous studies have shown a feasible connection between gut microbiota and bronchopulmonary dysplasia (BPD) in preterm infants. However, whether BPD can be ameliorated by restoring the gut microbiota remains unclear. In preterm infants with BPD, we found variance in the diversity and structure of gut microbiota. Similarly, BPD rats showed gut dysbiosis, characterized by a deficiency of Lactobacillus, which was abundant in normal rats. We therefore explored the effect and potential mechanism of action of a probiotic strain, Lactobacillus plantarum L168, in improving BPD. The BPD rats were treated with L. plantarum L168 by gavage for 2 weeks, and the effect was evaluated by lung histopathology, lung function, and serum inflammatory markers. Subsequently, we observed reduced lung injury and improved lung development in BPD rats exposed to L. plantarum L168. Further evaluation revealed that L. plantarum L168 improved intestinal permeability in BPD rats. Serum metabolomics showed altered inflammation-associated metabolites following L. plantarum L168 intervention, notably a marked increase in anti-inflammatory metabolites. In agreement with the metabolites analysis, RNA-seq analysis of the intestine and lung showed that inflammation and immune-related genes were down-regulated. Based on the information from RNA-seq, we validated that L. plantarum L168 might improve BPD relating to down-regulation of TLR4 /NF-κB /CCL4 pathway. Together, our findings suggest the potential of L. plantarum L168 to provide probiotic-based therapeutic strategies for BPD.

Abstract The death toll and monetary damages from landslides continue to rise despite advancements in predictive modeling. These models’ performances are limited as landslide databases used in developing them often miss crucial information, e.g., underlying movement types. This study introduces a method of discerning landslide movements, such as slides, flows, and falls, by analyzing landslides’ 3D shapes. By examining landslide topological properties, we discover distinct patterns in their morphology, indicating different movements including complex ones with multiple coupled movements. We achieve 80-94% accuracy by applying topological properties in identifying landslide movements across diverse geographical and climatic regions, including Italy, the US Pacific Northwest, Denmark, Turkey, and Wenchuan in China. Furthermore, we demonstrate a real-world application on undocumented datasets from Wenchuan. Our work introduces a paradigm for studying landslide shapes to understand their underlying movements through the lens of landslide topology, which could aid landslide predictive models and risk evaluations.

Abstract Smart hospitals are poised to greatly enhance life quality by offering persistent health monitoring capabilities. Remote healthcare and surgery, which are highly dependent on low latency, have seen a transformative improvement with the advent of 5G technology. This has facilitated a new breed of healthcare services, including monitoring and remote surgical procedures. The enhanced features of 5G, such as Enhanced Mobile Broadband (eMBB) and Ultra-Reliable Low Latency Communications (URLLC), have enabled the development of advanced healthcare systems. These systems reduce the need for direct patient contact in hospitals, which is especially pertinent as 5G becomes more widespread. This research presents novel hybrid detection algorithms, specifically QR decomposition with M-algorithm maximum likelihood-minimum mean square error (QRM-MLD-MMSE) and QRM-MLD-ZF (zero forcing), for use in Massive MIMO (M-MIMO) technology. These methods aim to decrease the latency in MIMO-based Non-Orthogonal Multiple Access (NOMA) waveforms while ensuring optimal bit error rate (BER) performance. We conducted simulations to evaluate parameters like BER and power spectral density (PSD) over Rician and Rayleigh channels using both the proposed hybrid and standard algorithms. The study concludes that our hybrid algorithms significantly enhance BER and PSD with lower complexity, marking a substantial improvement in 5G communication for smart healthcare applications.

Abstract The challenge of urban growth and land use land cover (LULC) change is particularly critical in developing countries. The use of remote sensing and GIS has helped to generate LULC thematic maps, which have proven immensely valuable in resource and land-use management, facilitating sustainable development by balancing developmental interests and conservation measures. The research utilized socio-economic and spatial variables such as slope, elevation, distance from streams, distance from roads, distance from built-up areas, and distance from the center of town to determine their impact on the LULC of 2016 and 2019. The research integrates Artificial Neural Network with Cellular Automta to forecast and establish potential land use changes for the years 2025 and 2040. Comparison between the predicted and actual LULC maps of 2022 indicates high agreement with kappa hat of 0.77 and a percentage of correctness of 86.83%. The study indicates that the built-up area will increase by 8.37 km2 by 2040, resulting in a reduction of 7.08 km2 and 1.16 km2 in protected and agricultural areas, respectively. These findings will assist urban planners and lawmakers to adopt management and conservation strategies that balance urban expansion and conservation of natural resources leading to the sustainable development of the cities.

Background: Cardiac involvement is common in children with multisystem inflammatory syndrome associated with the COVID-19 pandemic. A majority of children have significantly raised levels of NT pro-BNP, ferritin, D-dimers, and cardiac troponin in addition to high C-reactive protein and procalcitonin levels. Cardiac involvement may include rhythm disturbance, depressed myocardial function, valvar regurgitation, and/or coronary artery inflammation. This hospital-based prospective study was aimed to evaluate cardiovascular manifestations in cases of multisystem inflammatory syndrome in children (MIS-C). Subjects and Methods: The current study was a prospective observational study that included 100 children admitted to the pediatric intensive care unit after getting the requisite clearance from the institutional ethics committee; informed written consent of parents was taken before the start of the study. Results: The mean age of the study participants was 8.9 ± 3.9 years with 62% male children. Ninety-four percentage had MIS-C with KD phenotype while only 6% of kids developed shock. Abnormal electrocardiography (ECG) was found in 41%, pericardial effusion in 16%, left ventricular dysfunction (LVD) in 42%, and coronary lesions found in 30% of patients. Abnormal NT-proBNP (>125 pg/ml) was noted in 90% of children. Abnormal cTnT was seen in 89%, and 91% of children had abnormal BNP. The present study found a mortality of 6%. Conclusions: MIS-C with KD phenotype is the most common presentation with raised cardiac injury markers. Abnormal ECG LVD and coronary lesions are transient common cardiac abnormalities which get resolved within 3 months of treatment.

Abstract Background Supra aortic obstruction in children is uncommon and is seen in certain unique conditions. While intraluminal obstruction due to heavy calcification is seen in older populations, it is not described in pediatric populations. The coral reef aorta is a rare and distinct calcifying disease causing luminal obstruction of the suprarenal aorta in adults. The definition of this diagnosis relies entirely on the unique aspects and consistency of the lesions, which are rock-hard, irregular, gritty plaques with a white luminal surface resembling a coral reef. However, no such case has been described in children. Case presentation We present an adolescent boy who presented with a heavily calcified ascending aortic lesion associated with aortopathy and hypertension, 12 years after an aortic coarctation repair. The investigations included echocardiography, magnetic resonance and computer-tomographic imaging. A 3-D model was printed in order to visualize and plan surgical steps in advance for safe placement of clamps and defining the extent of resection. In addition, it provided an idea about tissue quality, thickness, spatial relationship, and orientation in relation to surrounding structures. Successful resection and replacement of the diseased segment of the aorta were achieved on cardiopulmonary bypass support. Post-operative recovery was uneventful, and at 6-month follow-up, the patient is doing well. In this report, various aspects of such lesions have been discussed, including clinical presentations, complications, planning and conduct of a safe cardiopulmonary bypass, and precautions during surgery for a successful outcome. Conclusion Complicated obstructive aortic lesions in children require careful assessment, appropriate advanced imaging, and the use of 3-D printing technology in order to plan and perform safe and effective surgical management. The etiology of severe calcified aorta in children may be related to metabolic factors, previous surgery, use of a homograft, or an inflammatory process. However, it has yet to be proven.