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Introduction and Objectives: Clinical data for older patients with advanced liver disease are limited. This post hoc analysis evaluated the efficacy and safety of terlipressin in patients aged ≥65 years with hepatorenal syndrome using data from 3 Phase III, randomized, placebo-controlled studies (OT-0401, REVERSE, CONFIRM). Patients and Methods: The pooled population of patients aged ≥65 years (terlipressin, n = 54; placebo, n = 36) was evaluated for hepatorenal syndrome reversal—defined as a serum creatinine level ≤1.5 mg/dL (≤132.6 μmol/L) while receiving terlipressin or placebo, without renal replacement therapy, liver transplantation, or death—and the incidence of renal replacement therapy (RRT). Safety analyses included an assessment of adverse events. Results: Hepatorenal syndrome reversal was almost 2-times higher in terlipressin-treated patients compared with patients who received placebo (31.5% vs 16.7%; P = 0.143). Among surviving patients, the need for RRT was significantly reduced in the terlipressin group, with an almost 3-times lower incidence of RRT versus the placebo group (Day 90: 25.0% vs 70.6%; P = 0.005). Among 23 liver-transplant-listed patients, significantly fewer patients in the terlipressin versus placebo group needed RRT by Days 30 and 60 (P = 0.027 each). Fewer patients in the terlipressin group needed RRT post-transplant (P = 0.011). More terlipressin-treated patients who were listed for and received a liver transplant were alive and RRT-free by Day 90. No new safety signals were revealed in the older subpopulation compared with previously published data. Conclusions: Terlipressin therapy may lead to clinical improvements in highly vulnerable patients aged ≥65 years with hepatorenal syndrome. Clinical trial numbers: OT-0401, NCT00089570; REVERSE, NCT01143246; CONFIRM, NCT02770716

Patients with hepatitis C virus (HCV) often have elevated serum markers and histologic features of autoimmune hepatitis (AIH). We evaluated an HCV‐positive (HCV+) study group that had elevated serum markers of AIH before starting direct‐acting antiviral (DAA) therapy (n = 21) and compared them to an HCV+ control group that did not have laboratory studies suggesting AIH (n = 21). Several patients in the study (17/21) and control (11/21) groups had liver biopsies before DAA treatment, and many were biopsied due to elevated serum markers of AIH. Evaluation of pre‐DAA treatment liver biopsies showed histologic features suggestive of AIH in 64.7% (11/17) of the study group and 45.5% (5/11) of the control group. Patients who were HCV+ with elevated serum markers of AIH had significantly increased hepatitis activity (P

A two-year study was conducted on integrated weed management in maize under different tillage regimes at Agricultural Research Station Swabi Khyber Pakhtunkhwa, Pakistan during Spring 2014 and subsequently repeated in 2015. The experiment was laid out at silt loam soil in Randomized complete block design (RCBD) with a split plot arrangement having three replications. Tillage regimes ((minimum, conventional and deep tillage) were kept in main plots (Factor A) and allelopathic plant residues (sorghum, sunflower and parthenium) as surface mulched in various combinations and their water extracts @ 15L each + atrazine @ ?th of recommended dose were assigned to the sub-plots (Factor B), for weed management in maize. Data during both years (2014 and 2015) were recorded and analyzed for dry biomass of weeds 30 DAS, kernels ear-1, ear length (cm), kernel yield (kg ha-1) and cost benefit ratio. Foliar application of Sorghum + parthenium water extracts at 15 L integrated with a quarter recommended dose of atrazine (pre emergence) under conventional tillage regimes suppressed total weed dry biomass by 34 and 42% at 30 DAS during 2014 and 2015, respectively which increased maize kernel yield by 52 % over the weedy check and was almost equivalent to the label dose of atrazine (0.50 kg a.i ha-1) and also had the highest CBR (1:20.4). Among the soil mulch treatments, Sorghum + sunflower +parthenium each at 4 Mg ha-1 under deep tillage regimes suppressed weed dry biomass by 69 and 75 % at 30 DAS during 2014 and 2015 respectively, pooled data of both years (2014 and 2015) indicated increase in maize kernel yield by 54 % over control with CBR (1:15:2). However, the mulch treatments and the cost of deep tillage were uneconomical. Hand weeding under deep tillage regimes increased maize kernel yield by 46 % as compared to the weedy check. Based on current studies, it is concluded that foliar application of Sorghum + parthenium aqueous extract integrated with reduced atrazine dose are economical and eco-friendly having the highest CBR. Consequently, reliance on atrazine could be reduced by 75% resulting in environmental safety and sustainability, however further studies are suggested to fine tune our findings. [ABSTRACT FROM AUTHOR]

In current article, convective Poiseuille boundary layer flow of ethylene glycol (C2H6O2)-based nanofluid with suspended aluminum oxide (Al2O3) nanoparticles through a porous wavy channel has been examined. The impact of thermal radiation, Ohmic dissipation, electric field, and magnetic fields are also considered. The flow is due to constant pressure gradient in a wavy frame of reference. The governed momentum and thermal boundary layer equations is system of PDE’s, which are converted to system of ODE’s via suitable similarity transformations. The homotopy analysis method is applied to solve the governed flow problem. Convergence of series solutions is inspected through h-curves and residual errors norm, whereas the optimal value of convergence control parameter is obtained by means of genetic algorithm Nelder-Mead approach. The influence of numerous involving parameters like Hartmann number, Grashof number, Eckert number, electric parameter, radiation parameter, and porosity parameter on flow, heat transfer, skin friction coefficient and Nusselt number are illustrated through graphs and discussed briefly. [ABSTRACT FROM AUTHOR]

Photocatalytic reduction of CO2 into solar fuel such as methane and methanol, is an attractive approach to simultaneously solve the energy crisis and global warming problem. Herein, comparative photocatalytic activity of graphene oxide nanosheets have been investigated for photocatalytic reduction of CO2 into methane and methanol in continuous gas and liquid phase photoreactor system. The graphene oxide sheets were prepared according to Tour's method. The chemical composition and optical properties was evaluated through XPS and UV-vis spectroscopy. Graphene oxide nanosheets exhibited maximum amount of 224.87 μmol/g.h methanol and 14.8 μmol/g.h methane in liquid and gas phase system, respectively. Higher yield of methanol in liquid phase compared to methane in gaseous system can be attributed to dispersion of graphene oxide sheets in water. Hence, graphene oxide nanosheets are efficient photocatalyst for CO2 reduction into methanol. Nevertheless, further research is essential to improve the photostability of graphene oxide sheets for real application of photocatalytic CO2 reduction. [ABSTRACT FROM AUTHOR]

Mixed convection flow of two layers nanofluid in a vertical enclosure is studied. The channel consists of two regions. Region I is electrically conducting while Region II is electrically non-conducting. Region I is filled with base fluid water with copper oxides nanoparticles and Region II is filled with base fluid kerosene oil with iron oxides. The simultaneous effects of electro-magnetohydrodynamics and Grashof number are also taken into account. The governing flow problem consists of nonlinear coupled differential equations which is tackled using analytical technique. Analytical results have been obtained by the homotopy analysis method (HAM). The results for the leading parameters, such as the Hartmann numbers, Grashof numbers, ratio of viscosities, width ratio, volume fraction of nanoparticles, and the ratio of thermal conductivities for three different electric field scenarios under heat generation/absorption were examined. It is found that the effect of the negative electric load parameter assists the flow while the effect of the positive electric load parameter opposes the flow as compared to the case when the electric load parameter is zero. All outcomes for significant parameters on velocity and temperature are discussed graphically., (© 2023 IOP Publishing Ltd.)

Thermoelectric technology holds great promise as a green and sustainable energy solution, generating electric power directly from waste heat. Herein, we investigate the thermoelectric properties of SiPGaS/As van der Waals heterostructures by using computations based on density functional theory and semiclassical Boltzmann transport theory. Our results show that both models of SiPGaS/As van der Waals heterostructures have low lattice thermal conductivity at room temperature (300 K). Applying 4% tensile strain to the models leads to a significant enhancement in the figure of merit ( ZT ), with model-I and model-II exhibiting ZT improvements of up to 24.5% and 14.8%, respectively. Notably, model-II outperforms all previously reported heterostructures in terms of ZT value. Additionally, we find that the maximum thermoelectric conversion efficiency ( η ) for model-II at 4% tensile strain reaches 23.98% at 700 K. Our predicted ZT avg > 1 suggests that these materials have practical potential for thermoelectric applications over a wide temperature range. Overall, our findings offer valuable insights for designing better thermoelectric materials.

Two-dimensional van der Waals heterostructures (vdWHs) with tunable band alignment have the potential to be benignant in the development of minimal multi-functional and controllable electronics, but they have received little attention thus far. It is crucial to characterize and control the band alignment in semiconducting vdWHs, which determines the electronic and optoelectronic properties. The future success of optoelectronic devices will require improved electronic property control techniques, such as using an external electric field or strain engineering, to change the electronic structures directly. Herein, we review heterostructures fabricated as transition metal dichalcogenides (TMDCs) as one of their constituent monolayers with other notable 2D materials that can transfer from type-II to type-III (type-III > type-II) band alignment when a biaxial strain or electric field is applied., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Objective: The objective of this systematic review is to determine the fate of spinal implants when patients develop postoperative wound infection after posterior instrumental fusion in a degenerative spine., Methods: A systematic review of the English-language literature (published between January 2001 and July 2020) was undertaken to identify articles documenting the management strategy for surgical site infections (SSIs) after posterior lumbar spinal fusion. Studies on pedicle screw fixation after trauma, immunocompromised, metastatic spine disease, and combined anterior/posterior approach were excluded. Two independent reviewers assessed the level of evidence quality using the criteria set by the North American Spine Society, and disagreements were resolved by consensus., Results: Of the 3071 citations identified, 49 met the criteria to undergo full-text review. Outcomes after SSIs were studied from a combined pool of 1150 patients who had undergone instrumental spinal fusion. The collected data showed that 456 patients (39.97%) had undergone spinal implant removal after SSI while 694 patients (60.03%) had their implants retained until the resolution of SSI. There was an absolute risk reduction (ARR) of 29% (-0.292) and a relative risk reduction (RRR) of 50.3% (-0.503) of implant removal if the patient underwent wound debridement following SSI. The number needed to treat (NNT) for wound debridement was calculated at 3.31 from our pooled cohort. The ARR in implant removal following vacuum-assisted closure (VAC) therapy was 16.6% and RRR was noted at 40.4%. This led to a high value of NNT at 6.0 patients. There was an ARR of 33.5% and a RRR of 70.7% was estimated in patients undergoing continuous irrigation., Conclusions: Our review of the literature suggests that surgeons prefer early wound debridement with or without negative pressure wound therapy under antimicrobial coverage for eradication of SSI after posterior lumbar spinal fusion. Implant removal is generally reserved for cases refractory to the other treatment modalities., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Low cost and highly efficient two dimensional materials as photocatalysts are gaining much attention to utilize solar energy for water splitting and produce hydrogen fuel as an alternative to deal with the energy crisis and reduce environmental hazards. First principles calculations are performed to investigate the electronic, optical and photocatalytic properties of novel two dimensional transition metal dipnictide XP 2 (X = Ti, Zr, Hf) monolayers. The studied single layer XP 2 is found to be dynamically and thermally stable. TiP 2 , ZrP 2 and HfP 2 systems exhibit semiconducting nature with moderate indirect band gap values of 1.72 eV, 1.43 eV and 2.02 eV, respectively. The solar light absorption is found to be in energy range of 1.65-3.3 eV. All three XP 2 systems (at pH = 7) and the HfP 2 monolayer (at pH = 0) that straddle the redox potentials, are promising candidates for the water splitting reaction. These findings enrich the two dimensional family and provide a platform to design novel devices for emerging optoelectronic and photovoltaic applications., Competing Interests: There is no conflict of interest., (This journal is © The Royal Society of Chemistry.)

Objective: To determine diagnostic accuracy of human chorionic gonadotropins stimulation test in differentiating androgen insensitivity syndrome and 5-alpha reductase deficiency, keeping testosterone to dihydrotestosterone ratio as the gold standard., Methods: The cross-sectional study was conducted at the Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from January to December, 2016, and comprised patients aged 01 day to 20 years having XY chromosomes on karyotyping and with a spectrum of phenotypes. Blood samples were collected from each subject for basal serum testosterone, serum luteinizing hormone and serum follicular stimulating hormone level. Human chorionic gonadotropins stimulation test was performed in every subject as per the protocol. Sandwich chemiluminescence immunoassay technique was used to analyse serum samples. Serum dihydrotestosterone level was also detected to determine testosterone and dihydrotestosterone ratio. Data was analysed using SPSS 24. ., Results: Of the 104 subjects with a mean age of 1.78}0.95 years,96(92.3%) were diagnosed as cases of androgen insensitivity syndrome on the basis of human chorionic gonadotropins stimulation response level, which was 2-9 times of basal serum testosterone level. Also, 8(7.7%) subjects were diagnosed to have 5-alpha reductase deficiency syndrome. In such subjects, post-human chorionic gonadotropins response level of serum testosterone was more than 10 times of the basal level., Conclusions: The human chorionic gonadotropins stimulation test was found to be comparable to testosterone-to dihydrotestosterone ratio in differentiating between case of androgen insensitivity syndrome and 5-alpha reductase deficiency.

The internal average energy loss caused by entropy generation for steady mixed convective Poiseuille flow of a nanofluid, suspended with titanium dioxide (TiO 2 ) particles in water, and passed through a wavy channel, was investigated. The models of thermal conductivity and viscosity of titanium dioxide of 21 nm size particles with a volume concentration of temperature ranging from 15 °C to 35 °C were utilized. The characteristics of the working fluid were dependent on electro-magnetohydrodynamics (EMHD) and thermal radiation. The governing equations were first modified by taking long wavelength approximations, which were then solved by a homotopy technique, whereas for numerical computation, the software package BVPh 2.0 was utilized. The results for the leading parameters, such as the electric field, the volume fraction of nanoparticles and radiation parameters for three different temperatures scenarios were examined graphically. The minimum energy loss at the center of the wavy channel due to the increase in the electric field parameter was noted. However, a rise in entropy was observed due to the change in the pressure gradient from low to high.

In this paper, an analytical study of internal energy losses for the non-Darcy Poiseuille flow of silver-water nanofluid due to entropy generation in porous media is investigated. Spherical-shaped silver (Ag) nanosize particles with volume fraction 0.3%, 0.6%, and 0.9% are utilized. Four illustrative models are considered: (i) heat transfer irreversibility (HTI), (ii) fluid friction irreversibility (FFI), (iii) Joule dissipation irreversibility (JDI), and (iv) non-Darcy porous media irreversibility (NDI). The governing equations of continuity, momentum, energy, and entropy generation are simplified by taking long wavelength approximations on the channel walls. The results represent highly nonlinear coupled ordinary differential equations that are solved analytically with the help of the homotopy analysis method. It is shown that for minimum and maximum averaged entropy generation, 0.3% by vol and 0.9% by vol of nanoparticles, respectively, are observed. Also, a rise in entropy is evident due to an increase in pressure gradient. The current analysis provides an adequate theoretical estimate for low-cost purification of drinking water by silver nanoparticles in an industrial process.

Operating room (OR) turnaround time (TAT) is the minimal essential time required for cleaning of OR and preparation for the next case. The TAT inversely affects OR efficiency. Several factors related to personnel, equipment and scheduling have been identified as causes of increased TAT. We conducted the study to identify factors that affect OR TAT and to propose recommendations for its reduction. The retrospective study, conducted at Aga Khan University Hospital, Karachi, comprised TAT records related to March 2014. Of the 88 cases, 22(25%) showed a delay. Upon Pareto analysis it was found that in 8(36.6%) cases there was a delay of 70% related to scheduling of OR list and 5(22.7%) related to movement of patients from wards to OR. As such, improvement in these two broad areas can take care of majority of delays. We also recommend documentation of all processes as part of continuous improvement.