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Background: Little is known regarding the impact of socioeconomic factors on the use of evidence-based therapies and outcomes in patients with heart failure with reduced ejection fraction across Asia. Methods: We investigated the association of both patient-level (household income, education levels) and country-level (regional income level by World Bank classification, income disparity by Gini index) socioeconomic indicators on use of guideline-directed therapy and clinical outcomes (composite of 1-year mortality or HF hospitalization, quality of life) in the prospective multinational ASIAN-HF study (Asian Sudden Cardiac Death in Heart Failure). Results: Among 4540 patients (mean age: 60±13 years, 23% women) with heart failure with reduced ejection fraction, 39% lived in low-income regions; 34% in regions with high-income disparity (Gini ≥42.8%); 64.4% had low monthly household income (P interaction Conclusions: These findings highlight the importance of socioeconomic determinants among patients with heart failure in Asia and suggest that attention should be paid to address disparities in access to care among the poor and less educated, including those from wealthy regions. Registration: URL: https://clinicaltrials.gov ; Unique Identifier: NCT01633398.

AIMS Patients surviving an acute myocardial infarction (AMI) are at risk of developing symptomatic heart failure (HF) or premature death. We hypothesized that sacubitril/valsartan, effective in the treatment of chronic HF, prevents development of HF and reduces cardiovascular death following high-risk AMI compared to a proven angiotensin-converting enzyme (ACE) inhibitor. This paper describes the study design and baseline characteristics of patients enrolled in the Prospective ARNI vs. ACE inhibitor trial to DetermIne Superiority in reducing heart failure Events after Myocardial Infarction (PARADISE-MI) trial. METHODS AND RESULTS PARADISE-MI, a multinational (41 countries), double-blind, active-controlled trial, randomized patients within 0.5-7 days of presentation with index AMI to sacubitril/valsartan or ramipril. Transient pulmonary congestion and/or left ventricular ejection fraction (LVEF) ≤40% and at least one additional factor augmenting risk of HF or death (age ≥70 years, estimated glomerular filtration rate

There are times when a person is in an environment where they must focus on one conversation when multiple others are happening around them. This is referred to as the cocktail party phenomenon. Individuals with impaired hearing lack this ability. This paper gives insight into how the brain handles these situations and how it filters out what a person is not focusing on. Three video monitors were placed in front of the subject and each source played video and audio. The objective was to find any changes in the accuracy of classification when video stimuli are provided. Using a g. Nautilus headset and multiple audio and video sources, EEG is collected from a subject. This data is collected for each data source. Each dataset is used to train a single machine learning classifier which distinguishes the source of sound with a certain accuracy. The results yield an average accuracy of 94.28%

The life of a company depends upon the fine balance between its management led by Board of Directors and shareholder, and non-shareholder constituencies acting as the risk bearers. The Board of Directors therefore are subjected to fiduciary duties towards both these constituencies at all financial phase of the company – solvency, insolvency and borderline insolvency. The director liability framework in India is currently split with obligations enshrined under the Companies Act, 2013 during solvency and Insolvency and Bankruptcy Code, 2016 during insolvency and borderline stage. The lack of judicial interpretation and scholarly discourse on the insolvent and borderline insolvent director liability framework in India has resulted in several practical challenges. To understand parallels, the paper comparatively analyzes the liability framework as existing under the corporate and insolvency laws of the United States and the United Kingdom with Indian insolvency law. The paper suggests that there is a need to align the Indian corporate and insolvency law through statutory measures to increase the remedial protections available to creditors during borderline insolvency. The paper also highlights mitigation measures which can be undertaken by the management to reduce the scope for director liability, until legislative or judicial clarity is provided on the framework.

There are several scenarios where individuals must focus on one conversation while multiple conversations are happening around them. This phenomenon is commonly referred to as the cocktail party phenomenon. People with impaired hearing lack this ability. The research centers around finding a solution for this problem to eventually develop a hearing aid better suited for better directional intelligibility. A g.Nautilus headset is used in this study to obtain EEG data. In this study, training data is extracted from a headset placed on a test subject's head and is analyzed using a machine learning algorithm. In this study, two experiments were conducted, and data was gathered from eight test subjects. Results show a significant change in terms of accuracy depending upon the environment. The data gathered presents the test subject's ability to listen to one auditory stimulus over the other when directed to do so.

Background Data comparing outcomes in heart failure ( HF ) across Asia are limited. We examined regional variation in mortality among patients with HF enrolled in the ASIAN ‐HF (Asian Sudden Cardiac Death in Heart Failure) registry with separate analyses for those with reduced ejection fraction ( EF ; Methods and Results The ASIAN ‐ HF registry is a prospective longitudinal study. Participants with symptomatic HF were recruited from 46 secondary care centers in 3 Asian regions: South Asia (India), Southeast Asia (Thailand, Malaysia, Philippines, Indonesia, Singapore), and Northeast Asia (South Korea, Japan, Taiwan, Hong Kong, China). Overall, 6480 patients aged >18 years with symptomatic HF were recruited (mean age: 61.6±13.3 years; 27% women; 81% with HF and reduced r EF ). The primary outcome was 1‐year all‐cause mortality. Striking regional variations in baseline characteristics and outcomes were observed. Regardless of HF type, Southeast Asians had the highest burden of comorbidities, particularly diabetes mellitus and chronic kidney disease, despite being younger than Northeast Asian participants. One‐year, crude, all‐cause mortality for the whole population was 9.6%, higher in patients with HF and reduced EF (10.6%) than in those with HF and preserved EF (5.4%). One‐year, all‐cause mortality was significantly higher in Southeast Asian patients (13.0%), compared with South Asian (7.5%) and Northeast Asian patients (7.4%; P Conclusions This first multinational prospective study shows that the outcomes in Asian patients with both HF and reduced or preserved EF are poor overall and worst in Southeast Asian patients. Region‐specific risk factors and gaps in guideline‐directed therapy should be addressed to potentially improve outcomes. Clinical Trial Registration URL : https://www.clinicaltrials.gov/ . Unique identifier: NCT 01633398.

In the recent decades, biodegradable and biocompatible polyphosphoesters (PPEs) have gained wide attention in the biomedical field as relevant substitutes for conventional aliphatic polyesters. These amorphous materials of low glass transition temperature offer promise for the design of soft scaffolds for tissue engineering. Advantageously, the easy variation of the nature of the lateral pendant groups of PPEs allows the insertion of pendent unsaturations valuable for their further cross-linking. In addition, varying the length of the pendent alkyl chains allows tuning their hydrophilicity. The present work aims at synthesizing PPE networks of well-defined hydrophilicity and mechanical properties. More precisely, we aimed at preparing degradable materials exhibiting identical hydrophilicity but different mechanical properties and vice versa. For that purpose, PPE copolymers were synthesized by ring-opening copolymerization of cyclic phosphate monomers bearing different pendent groups (e.g., methyl, butenyl, and butyl). After UV irradiation, a stable and well-defined cross-linked material is obtained with the mechanical property of the corresponding polymer films controlled by the composition of the starting PPE copolymer. The results demonstrate that cross-linking density could be correlated with the mechanical properties, swelling behavior, and degradation rate of the polymers network. The polymers were compatible to human skin fibroblast cells and did not exhibit significant cytotoxicity up to 0.5 mg mL-1. In addition, degradation products appeared nontoxic to skin fibroblast cells and showed their potential as promising scaffolds for tissue engineering.

Medical diagnosis and treatment is a field where Artificial Intelligence (AI) has the potential to provide tremendous scope for targeted large-scale interventions. Trained on vast troves of digitized slides showing an enormous variety of tumors, AI systems will likely provide more accurate diagnoses than human pathologists, at least on fairly rote diagnostic tasks. To harness the power of deep learning using Convolutional Neural Networks (CNN), there arises a difficulty in training a CNN from scratch because it requires large amount of computing power and also large amount of training data. The latter aspect in training a CNN turns out to be an obstacle in the case of medical image analysis. Previous works have addressed this difficulty and have demonstrated that the use of pre-trained deep CNNs with sufficient training provide a performance better than training a CNN from scratch. In this paper, we provide a comparison of the results obtained by using weights pre-trained on medical images from CheXNet dataset with the results obtained by using weights pre-trained on the ImageNet dataset. We performed experiments on the Chest X-ray dataset obtained from Kaggle. A 121-layer DenseNet when trained on top of a finely tuned CheXNet model, a test accuracy of 88.78% was obtained with precision, recall and F1-score of 0.71, 0.97 and 0.81 respectively. Our experiments consistently demonstrated that: 1) A finely tuned deep CNN model when used as a base for training dataset of medical images provided better accuracy than the CNN model trained from scratch by generating initial random weights. 2) The use of deep CNN’s pre-trained weights on a medical image dataset provides better performance for medical image classification in terms of accuracy, precision and recall, than models trained on natural images like ImageNet dataset.

Cancer diagnosis and treatment is a field where AI has the potential to provide tremendous scope for targeted large scale interventions. NITI Aayog, Government of India, in its discussion paper, mentions that there are over 1 million new cases of cancer in India every year, a number which is likely to rise given the annual rise in population. However, the number of pathologists experienced in oncology are few, nearly as much as a thousandth of the patients suffering from cancer, which leads to delay in cancer diagnosis and treatment. Machine learning, when used with image digitization techniques that have progressed during the last decade, can help bridge this divide. Traditionally, the initial screening and diagnosis of cancer is done using morphological analysis, which can be automated using machine learning techniques. In our work, we attempt to illustrate the potential of Deep Learning, a sub domain of Machine Learning, in contributing to the automation of cancer diagnosis, by proposing a method to classify the subtypes of lymphoma, a cancer of the lymph nodes. We implement our method on an NIA curated dataset consisting of three labeled subtypes of lymphoma namely chronic lymphocytic leukemia, follicular lymphoma and mantle cell lymphoma. The method proposed in this work, which yields an accuracy of 97.33% on the NIA curated dataset shows that deep learning has the potential to aid an automated diagnosis for lymphoma.

The Cardiovascular TransRadialAccess Platform (Cardio-TRAP®) is a radiation protection technology to absorb incident radiation during right transradial percutaneous coronary intervention (PCI). Randomized, prospective, observational single center comparative study was conducted. Radiation doses at

Computer Vision has given a way for computers to see by interpreting the surrounding objects. Deep Learning is often used while training neural networks with image data. Many different models in Deep Learning are used to perform various tasks like classification and segmentation. To solve such tasks to give a better accuracy, the size and depth of modern deep learning models have been increasing. Thus transfer learning holds paramount importance as pre-trained weights can be used for further training and avoid expensive computation. Therefore, this can save a lot of expensive computing power. This paper aims to review such transfer learning models and compare their performances.

Optical coherence tomography (OCT) has revolutionized imaging of ocular structures and various disease conditions. Though it has been used in the clinic for some decades, the OCT has only recently found its way into the operating theater. Early attempts at intraoperative OCT, hand-held and microscope mounted, have already improved our understanding of the surgical pathology and the role it might play in surgical decision-making. The microscope-integrated OCT now allows seamless, high-resolution, real-time imaging of surgical maneuvers from the incision to wound closure. Visualization of instruments and intraoperative tissue manipulation are possible with this in vivo modality and, therefore, help improve the outcome of surgery. In this article, we describe the advantages it offers during various vitreoretinal procedures.

Indian government agency regulating prices, imposed highest price cap of INR 30000 ($464) in February 2017 on all drug eluting stents (DES) creating a stir in the global device industry. The impact of stent price reduction on selection for stent type and its associated outcomes was studied.

Drug coated balloon has emerged as a new therapeutic option to treat obstructive coronary artery disease(CAD) in percutaneous coronary intervention (PCI). In past Paclitaxel coated balloons have been used in coronary artery stenosis. This study sought to define the impact of Magictouch “Sirolimus

No or slow reflow following percutaneous coronary intervention (PCI), despite the presence of a patent epicardial vessel, is a serious complication resulting in increased morbidity and mortality. In the present study, we have evaluated the combination therapy of adenosine and sodium nitroprusside administered as sequential intracoronary (IC) boluses on no-reflow during PCI. Seventy-five high risk acute coronary syndrome patients who underwent PCI with evidence of initial less than TIMI (thrombolysis in myocardial infarction) III flow or developed deterioration in TIMI flow during the procedure were randomized to prophylactic administration of multiple boluses of IC saline solution, adenosine (12 µg/bolus) or the combination of adenosine (12 µg/bolus) and sodium nitroprusside (50 µg/bolus), sequentially. Assessment of TIMI and the TMP (tissue myocardial perfusion) grade was done and major adverse cardiac events (MACE) were assessed at the end of 6 months. Slow or no-reflow was persistent in 70% patients receiving saline solution, 31% patients receiving adenosine, and 4% patient receiving the combination. IC injection with saline solution did not produce improvement in TIMI flow or TMP grade. IC injection with combination resulted in greater improvement of TIMI flow and TMP grade. The crossover of patients with no-reflow in saline solution group or adenosine with combination treatment was associated with reestablishment of TIMI II in 4 and TIMI III in 20 patients. Our data suggest that combination therapy of adenosine and nitroprusside is safe and provides better improvement in coronary flow and MACE as compared with IC adenosine alone in cases of impaired flow during coronary interventions.

The percutaneous transradial approach for cardiac catheterization has been shown to be a safe alternative to femoral artery approach, owing to the favorable anatomical relation of the radial artery to surrounding structures and the dual blood supply to the hand. Selection of guide catheter is elementary but an issue of extreme importance in performance of percutaneous coronary interventions (PCI) and depends on the size of aorta, location of ostia on the aorta, the kind of back-up required and whether the artery arises from a normal origin or anomalously. Currently a variety of guiding catheters are available, each with a unique design and construction, which has vastly improved the technique of transradial PCI. However, much of the cause for procedural failure of the radial approach is associated with the need for higher technical skills and the difficulty in using femoral catheters in the smaller radial artery. There is a learning curve, and many interventionists are uncomfortable attempting a more technically challenging procedure. Nevertheless, it is a procedure that can be taught, and with the innovation of new catheters and devices made specifically for radial approach, it may become easier to adopt for interventionists with a sound knowledge of the anatomical considerations and skill on guiding catheters and hardwares. The current article provides a vivid insight on the various aspects of the learning curve for Transradial approach including proper patient selection, radial access assessment, troubleshooting arm vessel anomalies, guide catheter selection and engagement, augmentation of guide support, and adjunctive device selection.

The objective of the study was to demonstrate the effect of pioglitazone and pioglitazone in combination with statin on East Indian patients with hyperinsulinemia and hyperlipidemia. It was a randomized, placebo-controlled, double-blind study with a parallel-group design comprising 83 patients. Patients of either sex with cardiac complications, including hyperlipidemia and (or) diabetes mellitus with or without hyperinsulinemia, were enrolled. Patients over 70 years of age, with renal or hepatic failure, or with severe diabetes mellitus (total glucose >400 mg/dL) were excluded from the study. Enrolled patients were randomly assigned to 4 groups that received placebo, pioglitazone, atorvastatin, or both. Blood samples were collected before and after treatment for analysis of serum glucose, insulin, lipid profile, apolipoprotein (apo) A1, apo B, and fibrinogen. Data were compared with that of patients with normal insulin or hyperinsulinemia. The patients with hyperinsulinemia receiving only pioglitazone showed a significant decrease in insulin levels compared with those with normal insulin levels. These patients also showed a significant increase in HDL levels. However, no significant change was observed in patients treated with both atorvastatin and pioglitazone. Pioglitazone was also found to increase significantly the apo A1 levels in patients with hyperinsulinemia, but there was no significant increase in patients given both atorvastatin and pioglitazone. Our data suggests that pioglitazone should be given preferably to the patients with hyperinsulinemia and statin should not be coadministered.