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During the past decade there has been a revolution in cancer therapeutics by the emergence of antibody-based and cell-based immunotherapies that modulate immune responses against tumors. These new therapies have extended and improved the therapeutic efficacy of chemo-radiotherapy and have offered treatment options to patients who are no longer responding to these classic anti-cancer treatments. Unfortunately, tumor eradication and long-lasting responses are observed in a small fraction of patients, whereas the majority of patients respond only transiently. These outcomes indicate that the maximum potential of immunotherapy has not been reached due to incomplete knowledge of the cellular and molecular mechanisms that guide the development of successful anti-tumor immunity and its failure. In this review, we discuss recent discoveries about the immune cellular composition of the tumor microenvironment (TME) and the role of key signaling mechanisms that compromise the function of immune cells leading to cancer immune escape.

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The composition of the tumor immune microenvironment (TIME) is considered a key determinant of patients’ response to immunotherapy. The mechanisms underlying TIME formation and development over time are poorly understood. Glioblastoma (GBM) is a lethal primary brain cancer for which there are no curative treatments. GBMs are immunologically heterogeneous and impervious to checkpoint blockade immunotherapies. Utilizing clinically relevant genetic mouse models of GBM, we identified distinct immune landscapes associated with expression of EGFR wild-type and mutant EGFRvIII cancer driver mutations. Over time, accumulation of polymorphonuclear myeloid-derived suppressor cells (PMN-MDSC) was more pronounced in EGFRvIII-driven GBMs and was correlated with resistance to PD-1 and CTLA-4 combination checkpoint blockade immunotherapy. We determined that GBM-secreted CXCL1/2/3 and PMN-MDSC–expressed CXCR2 formed an axis regulating output of PMN-MDSCs from the bone marrow leading to systemic increase in these cells in the spleen and GBM tumor-draining lymph nodes. Pharmacologic targeting of this axis induced a systemic decrease in the numbers of PMN-MDSC, facilitated responses to PD-1 and CTLA-4 combination checkpoint blocking immunotherapy, and prolonged survival in mice bearing EGFRvIII-driven GBM. Our results uncover a relationship between cancer driver mutations, TIME composition, and sensitivity to checkpoint blockade in GBM and support the stratification of patients with GBM for checkpoint blockade therapy based on integrated genotypic and immunologic profiles.

Supplementary Table 1

The composition of the tumor immune microenvironment (TIME) is considered a key determinant of patients’ response to immunotherapy. The mechanisms underlying TIME formation and development over time are poorly understood. Glioblastoma (GBM) is a lethal primary brain cancer for which there are no curative treatments. GBMs are immunologically heterogeneous and impervious to checkpoint blockade immunotherapies. Utilizing clinically relevant genetic mouse models of GBM, we identified distinct immune landscapes associated with expression of EGFR wild-type and mutant EGFRvIII cancer driver mutations. Over time, accumulation of polymorphonuclear myeloid-derived suppressor cells (PMN-MDSC) was more pronounced in EGFRvIII-driven GBMs and was correlated with resistance to PD-1 and CTLA-4 combination checkpoint blockade immunotherapy. We determined that GBM-secreted CXCL1/2/3 and PMN-MDSC–expressed CXCR2 formed an axis regulating output of PMN-MDSCs from the bone marrow leading to systemic increase in these cells in the spleen and GBM tumor-draining lymph nodes. Pharmacologic targeting of this axis induced a systemic decrease in the numbers of PMN-MDSC, facilitated responses to PD-1 and CTLA-4 combination checkpoint blocking immunotherapy, and prolonged survival in mice bearing EGFRvIII-driven GBM. Our results uncover a relationship between cancer driver mutations, TIME composition, and sensitivity to checkpoint blockade in GBM and support the stratification of patients with GBM for checkpoint blockade therapy based on integrated genotypic and immunologic profiles.

Polymer and biomaterial 3D printing is an innovative technology that can construct any 3D entity by depositing material layer by layer with current research interpreting towards enlarged use in the medical sector. The different materials like concrete, ceramic, metals, and polymers are usually used for 3D printing. With the purpose of making 3D printing sustainable, scholars are working on the use of diverse bio-derived materials for 3D printing. Polymer and biomaterial printing is beneficial in the medical sector because it empowers the 3D printing of affordable functional parts with good properties and proficiencies. In this review, we highlight current research developments for biomaterial and polymer printing using Fused Deposition Modeling (FDM) for the medical sector. Explicitly, the composition, characteristics, and properties of bio-polymers are discussed. Further, the application of bio-polymers in the medical sector like dental implants, drug delivery systems, and safety equipment and polymers containing bio-fillers are discussed too. Keywords: Polymer, Bio-material, 3D printing, Dental implants, Safety equipment

This research paper aims to examine the various aspects of cryptocurrencies, from their inception to their current status in the financial market, using a multidisciplinary approach that incorporates mathematical and psychological methods to explore the factors that contribute to the success of celebrity endorsements and the potential risks associated with them. The first section (1.1) of this research paper will provide an overview of cryptocurrencies, exploring their history, functionality, and impact on the global financial market. This will involve examining the technical details behind cryptocurrencies, such as blockchain technology, and the differences between various types of virtual assets. The research will also discuss the potential advantages and disadvantages of investing in cryptocurrencies, as well as the regulatory challenges they face. The second section (2.1) of the research paper will focus on the psychological aspect of cryptocurrency investing, analyzing the connection between personality traits and the likelihood of purchasing a cryptocurrency based on a celebrity endorsement. This will involve investigating Howard Gardner's theory of multiple intelligences to understand the qualities that make people more susceptible to investing in a cryptocurrency without prior knowledge (Gardner, 1983). The third section (3.1) of the research paper will delve into the mathematical side of cryptocurrency investing, examining the factors that contribute to the success of celebrity endorsements and the artificial growth of cryptocurrencies. This will involve developing software to calculate the artificial growth of a cryptocurrency over a 24-hour period and analyzing the data to understand the underlying factors driving its value. By taking a multidisciplinary approach, this research will shed light on the complexities of investing in virtual assets and help inform investors of the potential risks and benefits of investing in cryptocurrencies through qualitative and quantitative analyses and through the use of a Multi-Level Latent Class Analysis (LCA).

Objectives This study sought to identify electrocardiographic (ECG) and clinical predictors of sudden cardiac arrest (SCA) in sarcoidosis. Background Sudden cardiac death (SCD) is the leading cause of death in cardiac sarcoidosis (CS) and may be the earliest manifestation of disease. Widespread or repeated advanced imaging is a challenging solution to this problem. ECG is an affordable and widely accessible modality that could help guide diagnostic approaches and risk stratification. Methods Data were obtained from the National Inpatient Sample (2005–2017) using International Classification of Diseases-9th Revision and -10th Revision-Clinical Modification. The primary outcome was to identify predictors of SCA, whereas predictors of SCA in young individuals and those with normal ventricular function served as secondary measures. Furthermore, temporal trends in sarcoidosis as well as SCA were also analyzed. Logistic regression analysis was used to calculate odds ratios, following which a multivariable regression was used to adjust for potential confounders. Results Electrocardiographic markers of AV node dysfunction or bundle branch block are associated with substantially increased risk of SCA in a limited proportion of patients (8.6%). This association is also observed among younger patients ( Conclusions ECG evidence of AV nodal dysfunction or distal conduction disease should raise suspicion for cardiac involvement in patients with sarcoidosis and are associated with increased risk of SCA. ECG markers could help identify patients who would benefit from advanced imaging. The sensitivity of ECGs is, however, limited and presence of a normal ECG does not reflect a low risk of SCA.

The adoption of assistive lower limb exoskeletons in built environments is reliant on the further development of these devices to handle the varied conditions experienced in everyday life. The required development includes more varied and flexible gait patterns, but also appropriate user interfaces to enable fluid gait. This work explores the properties of an algorithm used to predict user intent based on sensors onboard a user-balanced robotic exoskeleton system. Specifically, classification algorithms built with different input data sets are compared - with varying detail of the interaction forces between the crutches and the ground, and the duration of the data sample used to make the prediction. Data were collected with one able-bodied participant using an exoskeleton, training three independent classifiers corresponding to different exoskeleton states. The results indicate the value of including information about the interaction forces between the crutches and the ground in improving prediction accuracy, with increasing prediction window also generally resulting in an increase in prediction accuracy. Whilst no categorical recommendation can be made with respect to either parameter, these results provide a baseline which can be used in conjunction deliberate consideration of the costs associated with implementation.

In 2009, the first cryptocurrency was created by an anonymous user known as Satoshi Nakomato. Since January 2009, when the pioneer cryptocurrency, Bitcoin, was developed, there are estimated to be 19,000 new virtual assets. Cryptocurrencies have been in circulation for quite some time, however, have just recently drawn a great deal of attention over these last years (2018-2022). Due to this, research in the industry is still quite limited prohibiting people from understanding the stage of development of these assets and allowing them to properly deem investment in these currencies as reliable and a solid form of passive income. This paper aims to provide a brief yet in-depth analysis of the cryptocurrency industry and its artificial growth from celebrities and other factors. In additionto this, providingan analysis regarding the perception of these endorsements and factors making them more or less effective.&nbsp

Therapeutic hypothermia (TH) is one of the few proven neuroprotective modalities in clinical practice. However, current methods to achieve TH are suboptimal. We investigated a novel esophageal device that utilizes high-flow transesophageal dry air to achieve TH via evaporating cooling. Seven Yorkshire pigs (

Objectives This study sought to explore the long-term arrhythmic outcomes of bilateral cardiac sympathetic denervation (BCSD). Background BCSD has been associated with improved arrhythmic outcomes in patients with refractory ventricular arrhythmias. However, whether BCSD antiarrhythmic effects are sustained long after the procedure is still uncertain. Methods We included consecutive patients who underwent BCSD because of refractory ventricular tachycardia (VT) and had at least 18 months of follow-up. VT recurrence after BCSD was evaluated to assess arrhythmic outcomes. The occurrence of VT episodes within the first 12 weeks after the procedure was assessed to explore the impact of early VT recurrence on late arrhythmia-free survival. Results Twenty patients (42 ± 16 years; 55% male) were included in the analysis. Nineteen (95%) patients had structural heart disease (left ventricular ejection fraction: 0.46 ± 0.14). Class I or class III drugs failed for all patients, and the mean number of VT ablation procedures was 2.5 ± 1.6. Over a mean follow-up of 1,300 ± 321 days (median: 1,276 days [Interquartile range (IQR): 1,181 to 1,480 days), 11 (55%) patients remained VT free after sympathectomy. Freedom from sustained VT or implantable cardioverter-defibrillator shock was 60% (95% confidence interval: 0.35 to 0.77) and 54.5% (95% confidence interval: 0.31 to 0.73) after BCSD at 1 and 4 years. Early VT recurrence was not associated with worse late arrhythmia-free survival rates. Conclusions BCSD was associated with longstanding antiarrhythmic effects in patients with refractory ventricular arrhythmias. The occurrence of VT episodes early after the procedure was not associated with worse late arrhythmic outcomes.

There has been tremendous growth in recent years in the sector of IOE and its applications. One such application is RFID. RFID stands for Radio Frequency Identification. There are many use cases being practiced in day to day lives of RFID such as in transportation, shopping malls, agriculture, factories, health-care and many more. Another application is a smart attendance system. The current traditional attendance system has many limitations which can be overcome with the help of RFID based attendance systems. This system consists of RFID scanners also called tags and RFID readers to offer more efficient and accurate information gathering of the students. This paper focuses on developing an RFID based Attendance System using microcontroller, some sensors, RFID tags, readers and other basic electrical components. RFID based attendance system provides the most modern approach to track user check-in and checkout status., {"references":["Jadhav, A., Dutonde, S., Todarmal, A., Patil, A..(2020). IoT Based Biometric Attendance System for Smart Classroom. 8(4):58-67.","Joshi, A., Ahmad, A., Saxena, A., & Juneja, P. (2021). RFID Based Attendance System.","Joshi, A., Ahmad, A., Saxena, A., Juneja, P.(2016). Smart Attendance System Using RFID In IOT.5(4):1155-1159","Yadu, N., & Uma, K. A Review on Real Time IOT Based advanced Eattendance System.","Chand, M. V. V., Meeran, M. S., & Prabaharan, V. (2015). Secured Attendance Management System Using RFID Technology. International Research Journal of Engineering and Technology (IRJET), 2(8).","Arulogun, O. T., Olatunbosun, A., Fakolujo, O. A., & Olaniyi, O. M. (2013). RFID-based students attendance management system.","Qureshi, M. (2020). The proposed implementation of RFID based attendance system. International Journal of Software Engineering & Applications (IJSEA), 11(3).","Al-mansor, M. J., & Ali, F. Z.(2020) Student Attendance Using RFID System,. 22(12):253-264, 2020."]}

High-resolution scar characterization using late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMR) is useful for guiding ventricular arrhythmia (VA) treatment. However, imaging study quality may be degraded by breath-holding difficulties, arrhythmias, and implantable cardioverter-defibrillators (ICDs). We evaluated the effect of image quality on left ventricle (LV) base to apex scar interpretation in pre-VA ablation LGE-CMR. 43 consecutive patients referred for VA ablation underwent gradient-recalled-echo LGE-CMR. In ICD patients (n = 24), wide-bandwidth inversion-recovery suppressed ICD artifacts. In non-ICD patients, single-shot steady-state free-precession LGE-CMR could also be performed to reduce respiratory motion/arrhythmia artifacts. Study quality was assessed for adequate/limited scar interpretation due to cardiac/respiratory motion artifacts, ICD-related artifacts, and image contrast. 28% of non-ICD patients had studies where image quality limited scar interpretation in at least one image compared to 71% of ICD patient studies (p = 0.012). A median of five image slices had limited quality per ICD patient study, compared to 0 images per non-ICD patient study. Poorer quality in ICD patients was largely due to motion-related artifacts (54% ICD vs 6% non-ICD studies, p = 0.001) as well as ICD-related image artifacts (25% of studies). In VA ablation patients with ICDs, conventional CMR protocols frequently have image slices with limited scar interpretation, which can limit whole-heart scar assessment. Motion artifacts contribute to suboptimal image quality, particularly in ICD patients. Improved methods for motion and ICD artifact suppression may better delineate high-resolution LGE scar features of interest for guiding VA ablation.

Inducing normothermia with surface cooling temperature modulating devices (TMDs) is cumbersome and often associated with significant shivering. We tested the safety and feasibility of a novel transnasal evaporative cooling device to induce and maintain normothermia in febrile patients following ischemic and hemorrhagic stroke. A single-center study utilizing the CoolStat® transnasal cooling device was used to achieve core temperature reduction in mechanically ventilated stroke patients with fever (T ≥ 38.3 C) refractory to acetaminophen by inducing an evaporative cooling energy exchange in the nasal turbinates thru a high flow of dehumidified air into the nasal cavity and out through the mouth. Continuous temperature measurements were obtained from tympanic and core (esophageal or bladder) temperature monitors. Safety assessments included continuous monitoring for hypertension, tachycardia, and raised intracranial pressure (when monitored). Otolaryngology (ENT) evaluations were monitored for any device-related nasal mucosal injury with a pre- and post-visual examination. Shivering was assessed every 30 min using the Bedside Shivering Assessment Scale (BSAS). Duration of device use was limited to 8 h, at which time patients were transitioned to routine care for temperature management. Ten subjects (median age: 54 years, BMI: 32.5 kg/m2, 60% men) were enrolled with normothermia achieved in 90% of subjects. One subject did not achieve normothermia and was later refractory to other TMDs. Median baseline temperature was 38.5 ± 0.1 C, with a reduction noted by 4 h (38.5 ± 0.1 vs 37.3 ± 0.8, P

Background Cardiac sympathetic denervation (CSD) is an important adjunctive option for patients with refractory ventricular arrhythmias (VAs). Reports of efficacy of CSD in patients with structural heart disease (SHD) and refractory VA vary widely in literature. Objective The purpose of this study was to conduct a systematic review of arrhythmic outcomes and complications in patients with SHD who underwent CSD due to recurrent VAs. Methods Electronic databases (Google Scholar and PubMed) were searched to identify reports on CSD in SHD using appropriate medical subject terms. No sample size restriction was applied. All patients with known channelopathies were excluded. Baseline demographic and surgical data, arrhythmic outcomes, and procedural complications were evaluated. Results A total of 13 studies and 173 patients were included. Of the 173 patients (121 [70%] male); pooled mean age 54.6 [95% confidence interval 52.6–56.7] years), 48 (28%) had ischemic cardiomyopathy, and 141 (82%) underwent bilateral CSD. Overall freedom from events ranged from 58% to 100%. Complications were reported in 49 patients(28%). Transient hypotension (9%), pneumothorax (5%), neuropathic pain (skin sensitivity) (4%), Horner syndrome (3%), sweating pattern changes (3%), and hemothorax (2%) were the most common complications. No procedure-related deaths were reported. Conclusion CSD reduced the number of VA events in patients with SHD, and the benefit from the intervention seemed to be independent of the underlying SHD. Although overall rate of postprocedural complications was high, most of the complications were temporary. Major postprocedural complications after CSD were infrequent.

Background We have previously developed an intraprocedural automatic arrhythmia‐origin localization (AAOL) system to identify idiopathic ventricular arrhythmia origins in real time using a 3‐lead ECG. The objective was to assess the localization accuracy of ventricular tachycardia (VT) exit and premature ventricular contraction (PVC) origin sites in patients with structural heart disease using the AAOL system. Methods and Results In retrospective and prospective case series studies, a total of 42 patients who underwent VT/PVC ablation in the setting of structural heart disease were recruited at 2 different centers. The AAOL system combines 120‐ms QRS integrals of 3 leads (III, V2, V6) with pace mapping to predict VT exit/PVC origin site and projects that site onto the patient‐specific electroanatomic mapping surface. VT exit/PVC origin sites were clinically identified by activation mapping and/or pace mapping. The localization error of the VT exit/PVC origin site was assessed by the distance between the clinically identified site and the estimated site. In the retrospective study of 19 patients with structural heart disease, the AAOL system achieved a mean localization accuracy of 6.5±2.6 mm for 25 induced VTs. In the prospective study with 23 patients, mean localization accuracy was 5.9±2.6 mm for 26 VT exit and PVC origin sites. There was no difference in mean localization error in epicardial sites compared with endocardial sites using the AAOL system (6.0 versus 5.8 mm, P =0.895). Conclusions The AAOL system achieved accurate localization of VT exit/PVC origin sites in patients with structural heart disease; its performance is superior to current systems, and thus, it promises to have potential clinical utility.

Innovation assumes a basic part in all day-by-day exercises of the current day. One of these requirements is to make an automated home that controls activity and turns off electronic gadgets through a cell phone. This execution can be carried out viably utilizing bundle following programming that incorporates IoT capacities to control and reproduce an automated home. IoT innovation can be applied to some genuine issues, for example, schoolwork, treatment, grounds, office, and so forth. In this paper, the emphasis is on a protected home framework that incorporates gadgets, for example, cooling, alert, lighting, and entryways and carport that is a portion of the everyday issues. The point of this exploration is to come up with such a simulation or recreation of smart gadgets that can be constrained by the end-client smart gadget distantly and afterward show the idea called automated home. Utilization of Cisco Packet Tracer Features Simulated automated home and IoT gadgets are observed. These results which are gathered from the simulation show that these smart gadgets can be associated with the home entry and items can be effectively checked which prompts the possibility of luxurious and safe home automation system., {"references":["Alexandria, A. (2014). Enabling communication between wireless sensor networks and the internet of things-ACOAP communication stacks. International journal of Science and Engineering,5. 6-7.","Abdi, A. (2018). Designing Smart Campus Using Internet of Things. International Journal of Computer Science Trends and Technology (IJCST),6 I 3.109-116.","Hoque, E., Dickerson, R. F., Preum, S. M., Hanson, M., Barth, A., & Stankovic, J. A. (2015, June). Holmes: A comprehensive anomaly detection system for daily in-home activities. International Conference on Distributed Computing in Sensor Systems. 40-51. IEEE.","Boyanov, L., & Minchev, Z. (2014). Cyber Security Challenges in Smart Homes. Cyber Security and Resiliency Policy Framework, 38. IOS Press Ebooks.","Pal, D., Triyason, T., & Funikul, S. (2017, December). Smart homes and quality of life for the elderly: a systematic review. In 2017 IEEE International Symposium on Multimedia (ISM) (pp. 413-419). IEEE. Palaniappan, S., Hariharan, N., T Kesh, N., & Deborah S, A. (2015). Home automation systems-A study. International Journal of Computer Applications, 116(11), 11-18.","Palaniappan, S., Hariharan, N., T Kesh, N., & Deborah S, A. (2015). Home automation systems-A study. International Journal of Computer Applications, 116(11), 11-18.","Hossain, N., Hossain, M. A., Sultana, R., & Lima, F. A. (2018). A Security Framework for IOT based Smart Home Automation System. Global Journal of Computer Science and Technology.","Pujaria, U., Patil, P., Bahadure, P., & Asnodkar, M. (2020). Internet of Things based Integrated Smart Home Automation System. Available at SSRN 3645458."]}

Peroxisome proliferator activated receptors (PPARs) are transcription factors that belong to nuclear hormone superfamily, with three distinct types identified: PPARapha (PPARα), PPARgamma (PPARγ), and PPARbeta/delta (PPARβ/δ). The role of PPARγ in the immune system has been mainly studied in macrophages, where it is known to mediate M2 polarization. Synthetic ligands for activating PPARγ ameliorate disease outcomes in various models of inflammation and autoimmunity. Here, we investigated how PPARγ affects antigen-specific effector and memory responses of CD8+ T cells using OT-I TCR transgenic mice and OT-I mice with T cell-specific PPARγ deletion. During CD8+ T effector differentiation in vitro by IL-2 culture following stimulation with cognate antigen, PPARγ deletion resulted in a rapid and enhanced T effector cell expansion and activation. However, PPARγ deficient OTI cells were more prone to exhaustion. This effect coincided with decreased mitochondrial fitness and spare respiratory capacity, high ROS levels and a significant increase in oxidized lipids. During generation of T effector cells in vivo, PPARγ deletion resulted in similar outcomes. At the memory phase there were no numerical differences in the T memory subsets in vivo, but upon rechallenge in vitro, PPARγ-deficient antigen-specific T cells had impaired capacity for effector differentiation. Our findings uncover a new role of PPARγ in CD8+ T responses and indicate that PPARγ has an indispensable role in regulating metabolism-mediated cues that imprint T cell differentiation and long-term effector capacity. Supported by RO1CA212605, RO1CA229784-01, RO1CA238263 (to VAB)

Background Intranasal high flow of dehumidified (dry) air results in evaporative cooling of nasal passages. In this randomized clinical trial, we investigated the effect of dry gas induced nasal cooling on migraine headaches. Methods In this single-blind study, acute migraineurs were randomized to either nasal high-flow dry oxygen, dry air, humidified oxygen or humidified air (control) at 15 L/min for 15 min. All gases were delivered at 37°C. Severity of headache and other migraine associated symptoms (International Classification for Headache Disorders, 3rd edition criteria) were recorded before and after therapy. The primary endpoint was change in pain scores, while changes in nausea, photosensitivity and sound sensitivity scores served as secondary endpoints. A linear regression model was employed to estimate the impact of individual treatment components and their individual interactions. Results Fifty-one patients (48 ± 15 years of age, 82% women) were enrolled. When compared to the control arm (humidified air), all therapeutic arms showed a significantly greater reduction in pain scores (primary endpoint) at 2 h of therapy with dry oxygen (−1.6 [95% CI −2.3, −0.9]), dry air (−1.7 [95% CI −2.6, −0.7)]), and humidified oxygen (−2.3 [95% CI −3.5, −1.1]). A significantly greater reduction in 2-h photosensitivity scores was also noted in all therapeutic arms (−1.8 [95% CI −3.2, −0.4], dry oxygen; −1.7 [95% CI −2.9, −0.4], dry air; (−2.1 [95% CI −3.6, −0.6], humidified oxygen) as compared to controls. The presence of oxygen and dryness were independently associated with significant reductions in pain and photosensitivity scores. No adverse events were reported. Conclusion Trans-nasal high-flow dry gas therapy may have a role in reducing migraine associated pain. Clinical Trial registration: NCT04129567

The developing air and sound contamination is one of the major issues nowadays. This huge measure of expanding contamination has made human life inclined to huge number of infections. Subsequently, it has now gotten important to control the contamination to guarantee solid work and better future. The Air and Sound Pollution Monitoring gadget can be gotten to by the specialists and the average folks having a place with the zone. The gadget will be introduced through a portable application which will show the live updates of the contamination level of the region. This framework chips away at the strategies for IOT which is a rising innovation dependent on the combination of gadgets and software engineering. The implanted sensors in the framework help to identify significant air contaminating gases, for example, CO2, SO2 and CO and level of sound contamination., {"references":["Singh, A., Pathak, D., Pandit, P., Patil, S., & Golar, P. C. (2017). IOT based Air and Sound Pollution Monitoring System. International Journal of Advanced Research in Electrical, Electronics and Instrumentation Engineering, 6(3).","Chandana, P. S., Sreelekha, K., Reddy, A. M. L., Reddy, M. A. K., & Senthamilselvan, R. Iot Air and Sound Pollution Monitoring System.(2017). IJAET,3(1),18-21.","Pan, M. S., & Tseng, Y. C. (2007). ZigBee and their applications. In Sensor Networks and Configuration (pp. 349-368). Springer, Berlin, Heidelberg.","Ghayvat, H., Mukhopadhyay, S., Gui, X., & Suryadevara, N. (2015). WSNand IOT-based smart homes and their extension to smart buildings. Sensors, 15(5), 10350- 10379.","https://www.scribd.com/document/37 3367641/AllAbout-Arduino-Boards.","Murty, R. N., Mainland, G., Rose, I., Chowdhury, A. R., Gosain, A., Bers, J., & Welsh, M. (2008, May). Citysense: An urban-scale wireless sensor network and testbed. In 2008 IEEE conference on technologies for homeland security (pp. 583-588). IEEE.","Barrenetxea, G., Ingelrest, F., Schaefer, G., Vetterli, M., Couach, O., & Parlange, M. (2008, April). Sensorscope: Out-of-the-box environmental monitoring. In 2008 International Conference on Information Processing in Sensor Networks (ipsn 2008) (pp. 332-343). IEEE.","Rao, B. P., Saluia, P., Sharma, N., Mittal, A., & Sharma, S. V. (2012, December). Cloud computing for Internet of Things & sensing based applications. In 2012 Sixth International Conference on Sensing Technology (ICST) (pp. 374-380). IEEE."]}

BACKGROUND Cardiac sympathetic denervation (CSD) is a useful therapeutic option in patients with structural heart disease (SHD) and ventricular tachycardia (VT) who are otherwise refractory to standard antiarrhythmic drug (AAD) therapy or catheter ablation (CA). In this study, we sought to retrospectively analyze the long-term outcomes of CSD in patients with refractory VT and/or VT storm with a majority of the patients being taken up for CSD ahead of CA. METHODS We included consecutive patients with SHD who underwent CBD from 2010 to 2019 owing to refractory VT. A complete response to CSD was defined as a greater than 75% reduction in the frequency of ICD shocks for VT. RESULTS A total of 65 patients (50 male, 15 female) were included. The underlying VT substrate was ischemic heart disease (IHD) in 30 (46.2%) patients while the remaining 35 (53.8%) patients had other nonischemic causes. The mean duration of follow-up was 27 ± 24 months. A complete response to CSD was achieved in 47 (72.3%) patients. There was a significant decline in the number of implantable cardioverter-defibrillator (ICD) or external defibrillator shocks post-CSD (24 ± 37 vs. 2 ± 4, p

BACKGROUND: We previously developed an intraprocedural automated site of origin localization system to identify the origin of early left ventricular (LV) activation using 12-lead ECGs. However, it has limitations, as it could not identify the site of origin in the right ventricle (RV), and relied on acquiring a complete electroanatomic map (EAM). OBJECTIVE: The objective of this study was to present a new system, the Automatic Arrhythmia Origin Localization (AAOL) system, which utilized incomplete EAM for localization of idiopathic ventricular arrhythmia (IVA) origin on the patient-specific geometry of LV, RV and neighboring vessels. The accuracy of the system in localizing IVA source sites on cardiac structures where pace-mapping is challenging was assessed. METHODS: Twenty patients undergoing IVA catheter ablation had a 12-lead ECG recorded during clinical arrhythmia and during pacing at various locations identified on EAM geometries. The new system combined 3-lead (III, V2, V6) 120-ms QRS integrals and patient-specific EAM geometry with pace mapping to predict the site of earliest ventricular activation. The predicted site was projected onto EAM geometry. RESULTS: Twenty-three IVA origin sites were clinically identified by activation mapping and/or pace mapping (8 RV; 15 LV, including 8 from the posteromedial papillary muscle; 2 from the aortic root; and 1 from the distal coronary sinus). The new system achieved a mean localization accuracy of 3.6 mm for the 23 mapped IVAs. CONCLUSIONS: The new intraprocedural AAOL system achieved accurate localization of IVA origin in ventricles and neighbouring vessels, which could facilitate ablation procedures for patients with IVAs. Key Words: Idiopathic ventricular arrhythmias (IVA); Premature ventricular complexes (PVCs); idiopathic ventricular tachycardia (IVT); Pace mapping; Activation mapping; Radiofrequency (RF) Ablation; ECG.

Introduction: Few intraprocedural localization systems have been developed to predict idiopathic ventricular arrhythmia (IVA) source sites. However, an accurate and bi-ventricular patient-specific automated site of origin localization system remains elusive. To address this issue, we have developed a new automatic arrhythmia origin localization (AAOL) system that determines the sites of earliest activation in both ventricles and provides superior accuracy. Hypothesis: We hypothesized that the AAOL system can use electroanatomic mapping (EAM) geometry and accurately localize IVA source sites on patient-specific geometry of LV, RV and neighboring vessels using 3-lead ECGs. Methods: Twenty patients undergoing IVA catheter ablation had a 12-lead ECG recorded during clinical arrhythmia and during pacing at various locations identified on EAM geometries. The AAOL system combined 3-lead (III, V2, V6) 120-ms QRS integrals and patient-specific EAM geometry with intracardiac pacing to predict the site of earliest ventricular activation. The predicted site was projected onto the EAM geometry using the EAM triangular-mesh site nearest to the tip of the predicted site. Results: Twenty-three IVA source sites were clinically identified by activation mapping and/or pace mapping (8 RV, 15 LV, including 8 from the posteromedial papillary muscle; 2 from the aortic root; and 1 from the distal coronary sinus). The new system achieved a mean localization accuracy of 3.6 mm for the 23 mapped IVAs (Figure 1D), better than that achieved by previous systems. Conclusions: The new AAOL system offers highly accurate localization of IVA source sites in both ventricles and neighboring vessels, which could facilitate ablation procedures for patients with IVAs.

Catheter ablation has become an important element in the management of atrial fibrillation. Several technical advances allowed for better safety profiles and lower recurrence rates, leading to an increasing number of ablations worldwide. Despite that, major complications are still reported, and esophageal thermal injury remains a significant concern as atrioesophageal fistula (AEF) is often fatal. Recognition of the mechanisms involved in the process of esophageal lesion formation and the identification of the main determinants of risk have set the grounds for the development and improvement of different esophageal protective strategies. More sensitive esophageal temperature monitoring, safer ablation parameters and catheters, and different energy sources appear to collectively reduce the risk of esophageal thermal injury. Adjunctive measures such as the prophylactic use of proton-pump inhibitors, as well as esophageal cooling or deviation devices, have emerged as complementary methods with variable but promising results. Nevertheless, as a multifactorial problem, no single esophageal protective measure has proven to be sufficiently effective to eliminate the risk, and further investigation is still warranted. Early screening in the patients at risk and prompt intervention in the cases of AEF are important risk modifiers and yield better outcomes.

There has been a rise in the number of patients suffering from major depression over the past decade. Most of the patients are reluctant and do not open up for councelling services. Conversational applications such as chatbots have been found efficient in overcoming alcohol addiction. Effective treatments can tackle depression, but only 10% of affected patients are able to avail such treatments mainly due to lack of resources and social stigma associated with mental disorders. We propose CARO, a chatbot app, which is capable of performing empathetic conversations and providing medical advice for people with major depression. CARO will be able to sense the conversational context, its intent and the associated emotions.

Peroxisome proliferator activated receptors (PPARs) are transcription factors that belong to nuclear hormone superfamily, with three distinct types identified: PPARapha (PPARα), PPARgamma (PPARγ), and PPARbeta/delta (PPARβ/δ). PPARs possess a critical role in the regulation of lipid metabolism, and thus play critical roles in the differentiation and fate of immune cells. PPARα is involved in lipid and carbohydrate metabolism and PPARα agonists, such as fibrates, have been used for the treatment of hypertriglyceridemia and cardiovascular diseases. PPARα has an anti-inflammatory role during infection, and similar to PPARγ, affects the polarization of macrophages. In acute myelogenous leukemia (AML), PPARα mutations correlate with chemoresistance, poor treatment outcomes and unfavorable prognosis. In experimental tumor models, it has been proposed that PPARα agonists might enhance anti-tumor T cell responses during PD-1 blocking immunotherapy. To dissect the mechanistic role of PPARα in tumor immunity, we used mice with global deletion of PPARα and examined tumor growth and profile of the immunological landscape, using various syngeneic tumor models. Significantly larger B16-F10 melanoma and MC-17 fibrosarcoma tumors were observed in PPARα KO mice compared with wild-type control, suggesting that PPARα deletion attenuated the immunological response against cancer. To dissect the role of PPARα in key populations of the innate and adaptive immune system involved in anti-tumor responses, we analyzed the immunological landscape of tumor, tumor draining lymph nodes (TDLN) and spleen, 14-16 days after tumor implantation. Assessment of CD4 + and CD8 + T cells, CD11b +F4/80 + tumor-associated macrophages (TAMs), CD11b +Ly6C hiLy6G - monocytic myeloid derived suppressor cells (M-MDSC), and CD11b +Ly6C loLy6G + polymorphonuclear myeloid derived suppressor cells (PMN-MDSC), by using flow cytometry, showed no quantitative differences between the two experimental groups. Functionally, MDSC from PPARα KO and WT mice showed comparable immunosuppressive properties as determined by suppression assay using splenocytes from OTI transgenic mice. However, PPARα KO TAMs demonstrated a less activated state, as determined by the lower expression levels of MHC-II that is critical for antigen presentation, and CD86 that is critical for T cell costimulation and prevention of T cell anergy and exhaustion. In agreement with these properties of TAMs, CD4 + T cells from TDLN of PPARα KO mice had diminished expression of activation markers, including PD-1, PD-L1 and ICOS, and numerically decreased central memory-like CD4 + T cells (T CM), compared to control tumor bearing mice. Furthermore, CD69, an emerging marker of T cell exhaustion, was significantly upregulated in CD4 + and CD8 + T cells from the TDLN of PPARα KO mice. To determine whether PPARα ablation altered the cell intrinsic properties of myeloid cells and/or T cells resulting in impaired anti-tumor function, we examined in vitro responses of isolated populations. In response to activation via TCR/CD3 and CD28, PPARα deficient T cells had no significant differences in expansion and cytokine production compared to control. In contrast, PPARα deficient Ly6C + monocytes isolated from the bone marrow displayed diminished responses to TLR-mediated signaling as determined by production of IL-6 and TNFα. Our in vitro and in vivo findings reveal a dominant role of PPARα in regulating the fate of innate immune cells thereby altering T cell responses and anti-tumor function. Our findings have implications for the development of new therapeutic approaches to enhance innate immune cell function for the improvement of cancer immunotherapy. Disclosures No relevant conflicts of interest to declare.

BackgroundCardiac sympathetic denervation (CSD) has been shown to reduce the burden of implantable cardioverter-defibrillator (ICD) shocks in small series of patients with structural heart disease (SHD) and recurrent ventricular tachyarrhythmias (VT).ObjectivesThis study assessed the value of CSD and the characteristics associated with outcomes in this population.MethodsPatients with SHD who underwent CSD for refractory VT or VT storm at 5 international centers were analyzed by the International Cardiac Sympathetic Denervation Collaborative Group. Kaplan-Meier analysis was used to estimatefreedom from ICD shock, heart transplantation, and death. Cox proportional hazards models were used to analyze variables associated with ICD shock recurrence and mortality after CSD.ResultsBetween 2009 and 2016, 121 patients (age 55 ± 13 years, 26% female, mean ejection fraction of 30 ± 13%) underwent left or bilateral CSD. One-year freedom from sustained VT/ICD shock and ICD shock, transplant, and death were 58%and 50%, respectively. CSD reduced the burden of ICD shocks from a mean of 18 ± 30 (median 10) in the year before study entry to 2.0 ± 4.3 (median 0) at a median follow-up of 1.1 years (p< 0.01). On multivariable analysis, pre-procedure New York Heart Association functional class III and IV heart failure and longer VT cycle lengths were associated with recurrent ICD shocks, whereas advanced New York Heart Association functional class, longer VT cycle lengths, and a left-sided-only procedure predicted the combined endpoint of sustained VT/ICD shock recurrence, death, and transplantation. Of the 120 patients taking antiarrhythmic medications before CSD, 39 (32%) no longer required them at follow-up.ConclusionsCSD decreased sustained VT and ICD shock recurrence in patients with refractory VT. Characteristics independently associated with recurrence and mortality were advanced heart failure, VT cycle length, and a left-sided-only procedure.