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Aim: This article presents a novel approach to automate the segmentation of organ at risk (OAR) for high-dose-rate brachytherapy patients using three deep learning models combined with ensemble learning techniques. It aims to improve the accuracy and efficiency of segmentation. Materials and Methods: The dataset comprised computed tomography (CT) scans of 60 patients obtained from our own institutional image bank and 10 patients from the other institute, all in Digital Imaging and Communications in Medicine format. Experienced radiation oncologists manually segmented four OARs for each scan. Each scan was preprocessed and three models, Double U-Net (DUN), Bi-directional ConvLSTM U-Net (BCUN), and Transformer Networks (TN), were trained on reduced CT scans (240 × 240 × 128) due to memory limitations. Ensemble learning techniques were employed to enhance accuracy and segmentation metrics. Testing and validation were conducted on 12 patients from our institute (OID) and 10 patients from another institute (DID). Results: For DID test dataset, using the ensemble learning technique combining Transformer Network (TN) and BCUN, i.e., TN + BCUN, the average Dice similarity coefficient (DSC) ranged from 0.992 to 0.998, and for DUN and BCUN (DUN + BCUN) combination, the average DSC ranged from 0.990 to 0.993, which reflecting high segmentation accuracy. The 95% Hausdorff distance (HD) ranged from 0.9 to 1.2 mm for TN + BCUN and 1.1 to 1.4 mm for DUN + BCUN, demonstrating precise segmentation boundaries. Conclusion: The proposed method leverages the strengths of each network architecture. The DUN setup excels in sequential processing, the BCUN captures spatiotemporal dependencies, and transformer networks provide a robust understanding of global context. This combination enables efficient and accurate segmentation, surpassing human expert performance in both time and accuracy.

Abstract Objective The aim of this study was to investigate whether pre‐operative comorbidity status measured by the Charlson comorbidity index (CCI) or cardiopulmonary exercise testing (CPET) is associated with postoperative complications and length of stay (LOS) in patients undergoing robot‐assisted radical cystectomy and intracorporeal urinary diversion (RARC‐ICUD). Patients and methods We conducted a retrospective study of a prospectively maintained database of 428 consecutive patients who underwent RARC‐ICUD at a tertiary referral centre between 2011 and 2019. CCI was correlated with peri‐operative outcomes including postoperative LOS, Clavien–Dindo (CD) complications and survival. A planned subgroup analysis was performed to evaluate the relationship between pre‐operative CPET, and the same outcomes utilising the threshold of anaerobic threshold (AT) ≥ 11/

A field experiment was conducted during summer 2018 and 2019 to study the performance of maize (Zea mays L.) genotypes under drip and furrow irrigation regimes at the Main Agriculture Research Station, University of Agricultural Sciences, Dharwad, Karnataka. The experiment was laid out in strip plot design with 3 replications. Treatments included 4 irrigation levels (drip irrigation at 0.6 ETc, 0.8 ETc and 1.0 ETc and furrow irrigation at 0.8 IW/CPE ratio) and 4 maize genotypes. The data indicated that, furrow irrigation at 0.8 IW/CPE ratio and drip irrigation at 1.0 ETc recorded significantly higher and on par growth and yield parameters, grain yield (75.8 q/ha and 71.4 q/ha, respectively) and economic returns. Drip irrigation at 1.0 ETc consumed 28.6% less water but recorded significantly higher water productivity over furrow irrigation. Among the genotypes, NK-6240 found superior over rest of the genotypes. The combination of furrow irrigation with NK-6240 recorded significantly higher growth and yield attributes as well as grain yield and economics over rest of the combinations. However, this treatment remained statistically non-significant with drip irrigation at 1.0 ETc with NK-6240 and furrow irrigation with CP-818.

Abstract The intercropping of legumes with cereals help to achieve sustainable intensification by their mutual complementarity at efficiently using radiation, nutrients, etc. Several studies indicated such beneficial effects on the other component crop however, little research has been conducted to quantify their effects on the subsequent crop in a cropping system. In this study, the effect of the legume intercropping on the entire cropping system, particularly the maize + legume-wheat system was studied. Four legumes intercropped to maize followed by wheat crop were studied for intensification measures such as wheat equivalent yield (WEY), land equivalent ratio (LER), sustainable value index (SVI), and economic returns. N saving effect of legumes on the subsequent wheat crop was quantified with two N levels. Maize + cowpea-wheat combination was the most productive and economic intercrop combination (LER = 1.71, SVI = 0.96) with an increase in net economic return (43.63%) with a B:C ratio of 1.94. An additional 25% N (37.5 kg ha−1) was saved in the wheat crop when the legume intercropping was undertaken with maize. The results suggest that intercropping is the key to diversification and reduces the risk of crop failures by enhancing land-use efficiency, soil fertility, and economic returns under weather vagaries. This will be beneficial to small and marginal farmers of many countries.

COVID-19 has resulted in the deferral of major surgery for genitourinary (GU) cancers with the exception of cancers with a high risk of progression. We report outcomes for major GU cancer operations, namely radical prostatectomy (RP), radical cystectomy (RC), radical nephrectomy (RN), partial nephrectomy (PN), and nephroureterectomy performed at 13 major GU cancer centres across the UK between March 1 and May 5, 2020. A total of 598 such operations were performed. Four patients (0.7%) developed COVID-19 postoperatively. There was no COVID-19–related mortality at 30 d. A minimally invasive approach was used in 499 cases (83.4%). A total of 228 cases (38.1%) were described as training procedures. Training case status was not associated with a higher American Society of Anesthesiologists (ASA) score (p = 0.194) or hospital length of stay (LOS; p > 0.05 for all operation types). The risk of contracting COVID-19 was not associated with longer hospital LOS (p = 0.146), training case status (p = 0.588), higher ASA score (p = 0.295), or type of hospital site (p = 0.303). Our results suggest that major surgery for urological cancers remains safe and training should be encouraged during the ongoing COVID-19 pandemic provided appropriate countermeasures are taken. These real-life data are important for policy-makers and clinicians when counselling patients during the current pandemic. Patient summary: We collected outcome data for major operations for prostate, bladder, and kidney cancers during the COVID-19 pandemic. These surgeries remain safe and training should be encouraged during the ongoing pandemic provided appropriate countermeasures are taken. Our real-life results are important for policy-makers and clinicians when counselling patients during the COVID-19 pandemic.

We analyzed the spectrum of biopsy-proven renal disease in a single tertiary care center in North India from 2007 to 2016. A total of 420 biopsies were analyzed. Patients were excluded if clinical details were unavailable or if either the histopathology core or the IF core was inadequate. In the final analysis, 359 biopsies were included. All clinical, laboratory, histopathological, and immunofluorescence (IF) findings were recorded in each case. The usefulness of IF in reaching a definitive diagnosis was also analyzed. The patients were in the age range of 2–94 years; 23.1% were children and 76.9% were adults. Males (60.4%) outnumbered females (39.6%) in all the disease categories except lupus nephritis (LN). Primary glomerular diseases (PGDs) (n = 297, 82.7%) were more common than secondary glomerular diseases (SGDs) (n = 46, 12.8%) and tubulointerstitial diseases (n = 16, 4.5%). The most common PGD was focal segmental glomerulosclerosis (FSGS) (23.4%), followed by minimal change disease (17%) and membranous nephropathy (12.5%), whereas the most common SGD was LN, seen in 9.2%. In the present study, IF helped in reaching the final diagnosis in 44.3%. The entities in which IF was most useful in reaching the final diagnoses were FSGS (31.5%) and IgA nephropathy (14.5%). The final pathological diagnosis correlated with the first clinical possibility in 207 of 359 (57.7%) cases. This 10-year study provides descriptive data and highlights the changing pattern of renal disease possibly due to an increased awareness and referral to higher centers.

The development of organic—inorganic hybrids or nanocomposite films is increasingly becoming attractive in light of their emerging applications. This research focuses on the formation of a unique nanocomposite film with enhanced elasticity suitable for many biomedical applications. The physical property measurement system and transmission electron microscopy were used to analyze Pt–Fe3O4 hybrid nanoparticles. These nanohybrids exhibited magnetic effects. They were further exploited to prepare the nanocomposite films in conjunction with a chitosan-g–glycolic acid organic fraction. The nanocomposite films were then examined using standard techniques: thermogravimetric analysis, X-ray diffraction, Fourier transform infrared spectroscopy, and atomic force microscopy. Tensile strength testing demonstrated a significantly greater elastic strength of these nanocomposite films than pure chitosan films. The water absorption behavior of the nanocomposites was evaluated by measuring swelling degree. These nanocomposites were observed to have substantially improved physical properties. Such novel nanocomposites can be extended to various biomedical applications, which include drug delivery and tissue engineering.

Previously synthesized novel chalcone oxime ethers (COEs) were evaluated for inhibitory activities against monoamine oxidases (MAOs) and acetylcholinesterase (AChE). Twenty-two of the 24 COEs synthesized, except COE-17 and COE-24, had potent and/or significant selective inhibitory effects on MAO-B. COE-6 potently inhibited MAO-B with an IC50 value of 0.018 µM, which was 105, 2.3, and 1.1 times more potent than clorgyline, lazabemide, and pargyline (reference drugs), respectively. COE-7, and COE-22 were also active against MAO-B, both had an IC50 value of 0.028 µM, which was 67 and 1.5 times lower than those of clorgyline and lazabemide, respectively. Most of the COEs exhibited weak inhibitory effects on MAO-A and AChE. COE-13 most potently inhibited MAO-A (IC50 = 0.88 µM) and also significantly inhibited MAO-B (IC50 = 0.13 µM), and it could be considered as a potential nonselective MAO inhibitor. COE-19 and COE-22 inhibited AChE with IC50 values of 5.35 and 4.39 µM, respectively. The selectivity index (SI) of COE-22 for MAO-B was higher than that of COE-6 (SI = 778.6 vs. 222.2), but the IC50 value (0.028 µM) was slightly lower than that of COE-6 (0.018 µM). In reversibility experiments, inhibitions of MAO-B by COE-6 and COE-22 were recovered to the levels of reference reversible inhibitors and both competitively inhibited MAO-B, with Ki values of 0.0075 and 0.010 µM, respectively. Our results show that COE-6 and COE-22 are potent, selective MAO-B inhibitors, and COE-22 is a candidate of dual-targeting molecule for MAO-B and AChE.

The rice−wheat cropping system being the backbone of food security in South-Asia has resulted in soil health deterioration, declining water table, and air pollution affecting livability index of the region. The effect of rice residue retention (RRR), irrigation levels and foliar application of K on wheat grain yield (GY), water use efficiency (WUE) and profitability was tested over three years. RRR increased wheat GY (5224 kg ha−1), above-ground biomass (AGBM = 11.9 t ha−1), tillers per square meter (TPM = 469) and grains per meter square (GrPMS = 13,917) significantly. Relative water content (RWC = 93.8) and WUE (2.45 k gm−3) were also increased significantly by RRR. Consequently, profitability (Net return = 624.4 $ and Benefit to cost (B:C) ratio) was enhanced. Foliar application of K enhanced GY (5151 kg ha−1), AGBM (12 t ha−1), RWC (94.1), SPAD (52.2), WUE (2.40 kg m−3), net returns (625.2 $) and BC ratio (1.62) significantly. RRR increased GY (15.66%) and WUE (17.39%) with additional revenue of 151 $ with only one irrigation at the CRI stage (ICS). RRR adopted over 10% of the area can earn 187 million-US$ annually. RRR if adopted over existing practice on a large area would reduce environmental degradation with an enhanced income to small and marginal farmers.

Background: Imatinib, a tyrosine kinase inhibitor, causes growth failure in children with chronic myeloid leukemia probably by targeting the growth hormone (GH)/insulin like growth factor-1 (IGF-1) axis. We aim to explore the imatinib targets expression in pituitary adenomas and study the effect of imatinib on GH secretion in somatotropinoma cells and GH3 cell line.Materials and Methods: The expression pattern of imatinib's targets (c-kit, VEGF, and PDGFR-α/β) was studied using immunohistochemistry and immunoblotting 157 giant (≥4 cm) pituitary adenomas (121 non-functioning pituitary adenomas, 32 somatotropinomas, and four prolactinomas) and compared to normal pituitary (n = 4) obtained at autopsy. The effect imatinib on GH secretion, cell viability, immunohistochemistry, electron microscopy, and apoptosis was studied in primary culture of human somatotropinomas (n = 20) and in rat somato-mammotroph GH3 cell-line. A receptor tyrosine kinase array was applied to human samples to identify altered pathways.Results: Somatotropinomas showed significantly higher immunopositivity for c-kit and platelet-derived growth factor receptor-β (PDGFR-β; P < 0.009 and P < 0.001, respectively), while staining for platelet-derived growth factor receptor-α (PDGFR-α) and vascular endothelial growth factor (VEGF) revealed a weaker expression (P < 0.001) compared to normal pituitary. Imatinib inhibited GH secretion from both primary culture (P < 0.01) and GH3 cells (P < 0.001), while it did not affect cell viability and apoptosis. The receptor tyrosine kinase array showed that imatinib inhibits GH signaling via PDGFR-β pathway.Conclusion: Imatinib inhibits GH secretion in somatotropinoma cells without affecting cell viability and may be used as an adjunct therapy for treating GH secreting pituitary adenomas.

Background and Aims: Swapping of the endotracheal tube with laryngeal mask airway (LMA) before emergence from anaesthesia is one of the methods employed for attenuation of pressor response at extubation. We decided to compare the placement of ProSeal ™ LMA (PLMA) before endotracheal extubation versus conventional endotracheal extubation in controlled hypertensive patients scheduled for elective surgeries under general anaesthesia. Methods: Sixty consenting adult patients were randomly allocated to two groups of thirty each; Group E in whom extubation was performed using standard technique and Group P in whom PLMA was inserted before endotracheal extubation (Bailey manoeuvre). The primary outcome parameter was heart rate (HR). The secondary outcomes were systolic, diastolic and mean blood pressure (MBP), electrocardiogram, oxygen saturation and end-tidal carbon dioxide. Two-tailed paired Student's t-test was used for comparison between the two study groups. The value of P< 0.05 was considered as statistically significant. Results: The patient characteristics, demographic data and surgical procedures were comparable in the two groups. A statistically significant decrease was observed in HR in Group P as compared to Group E. Secondary outcomes such as systolic, diastolic and MBP depicted a statistically insignificant difference. Conclusion: Bailey manoeuvre was not effective method to be completely relied upon during extubation when compared to standard extubation.

Hashimoto encephalopathy remains a Rubik′s cube for the present generation of clinical research. Myriad presentations have been noted, and observations recorded in few subgroups of patients have gone on only to be trashed by a second group of patients with a completely different clinical profile. Steroids have been traditionally held to be the treatment for this condition, but long-term side effects associated with it limits its use. Although multiple drugs have been tried, yet there exists no data for their long-term efficacy in maintaining remission. No radiological findings have been consistently associated with this condition. We report the use of azathioprine in maintaining long-term remission in one such patient with Hashimoto encephalopathy and the presence of lactate peak in magnetic resonance spectroscopy of the patient, which showed dramatic regression with institution of immunosuppression.

Pernicious anemia is a common cause of vitamin B12 deficiency. Here, we discuss a case of a young woman who presented with severe anemia along with a history of iron deficiency anemia. After a review of her clinical presentation and laboratory data, we identified an autoimmune hemolytic anemia and a concomitant pernicious anemia. The concurrence of both these hematological diagnoses in a patient is rare.

Background: Central nervous system (CNS) infections caused by Mycobacterium tuberculosis (MTB) are the most severe forms of extrapulmonary TB (EPTB) due to high levels of mortality and neurological morbidity. Limited studies are available on CNS-TB animal-model development, despite the steady rise in cerebral-TB cases in India over the past decade. This study describes the development of a murine model of CNS-TB using a clinical strain (C3) isolated from the cerebrospinal fluid (CSF) of CNS-TB patients. Methods: Groups of mice were infected intravenously with an MTB C3 strain isolated from the CSF of CNS-TB patients in order to mimic the dynamics of actual infection. Brain and lung tissue were evaluated for bacterial burden, as well as histopathology and surrogate markers of TB infection at 30- and 50-days post-infection. Results: Mice infected intravenously with MTB C3 strains showed progressive development of CNS disease, with high bacillary burden in the lungs during the initial stage (30 days), which eventually disseminated to the brain at a later stage (50 days). All C3-infected mice showed elevated levels of mycobacterial antigens and antibodies, as well as increased T cell adenosine deaminase activity in brain homogenates, which explicitly correlated with mycobacterial load in the brain and chronic brain pathology. High mortality rates (60%) were associated with mice infected with the C3 strain as compared to those of controls. Conclusion: Our findings demonstrated the design of a novel murine model of CNS-TB using a C3 strain and that replicated events of EPTB dissemination. This model will promote efforts to understand the pathogenesis CNS-TB infection for development of improved therapeutic interventions in the future.

Aim: This article presents a novel approach to automate the segmentation of organ at risk (OAR) for high-dose-rate brachytherapy patients using three deep learning models combined with ensemble learning techniques. It aims to improve the accuracy and efficiency of segmentation. Materials and Methods: The dataset comprised computed tomography (CT) scans of 60 patients obtained from our own institutional image bank and 10 patients from the other institute, all in Digital Imaging and Communications in Medicine format. Experienced radiation oncologists manually segmented four OARs for each scan. Each scan was preprocessed and three models, Double U-Net (DUN), Bi-directional ConvLSTM U-Net (BCUN), and Transformer Networks (TN), were trained on reduced CT scans (240 × 240 × 128) due to memory limitations. Ensemble learning techniques were employed to enhance accuracy and segmentation metrics. Testing and validation were conducted on 12 patients from our institute (OID) and 10 patients from another institute (DID). Results: For DID test dataset, using the ensemble learning technique combining Transformer Network (TN) and BCUN, i.e., TN + BCUN, the average Dice similarity coefficient (DSC) ranged from 0.992 to 0.998, and for DUN and BCUN (DUN + BCUN) combination, the average DSC ranged from 0.990 to 0.993, which reflecting high segmentation accuracy. The 95% Hausdorff distance (HD) ranged from 0.9 to 1.2 mm for TN + BCUN and 1.1 to 1.4 mm for DUN + BCUN, demonstrating precise segmentation boundaries. Conclusion: The proposed method leverages the strengths of each network architecture. The DUN setup excels in sequential processing, the BCUN captures spatiotemporal dependencies, and transformer networks provide a robust understanding of global context. This combination enables efficient and accurate segmentation, surpassing human expert performance in both time and accuracy. [ABSTRACT FROM AUTHOR]