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Background: Heart failure (HF) is a debilitating disease affecting >64 million people worldwide. In addition to impaired cardiovascular performance and associated systemic complications, most patients with HF suffer from depression and substantial cognitive decline. Although neuroinflammation and brain hypoperfusion occur in humans and rodents with HF, the underlying neuronal substrates, mechanisms, and their relative contribution to cognitive deficits in HF remains unknown. Methods: To address this critical gap in our knowledge, we used a well-established HF rat model that mimics clinical outcomes observed in the human population, along with a multidisciplinary approach combining behavioral, electrophysiological, neuroanatomical, molecular and systemic physiological approaches. Results: Our studies support neuroinflammation, hypoperfusion/hypoxia, and neuronal deficits in the hippocampus of HF rats, which correlated with the progression and severity of the disease. An increased expression of AT1aRs (Ang II [angiotensin II] receptor type 1a) in hippocampal microglia preceded the onset of neuroinflammation. Importantly, blockade of AT1Rs with a clinically used therapeutic drug (Losartan), and delivered in a clinically relevant manner, efficiently reversed neuroinflammatory end points (but not hypoxia ones), resulting in turn in improved cognitive performance in HF rats. Finally, we show than circulating Ang II can leak and access the hippocampal parenchyma in HF rats, constituting a possible source of Ang II initiating the neuroinflammatory signaling cascade in HF. Conclusions: In this study, we identified a neuronal substrate (hippocampus), a mechanism (Ang II–driven neuroinflammation) and a potential neuroprotective therapeutic target (AT1aRs) for the treatment of cognitive deficits in HF.

Introduction: While global responses to the COVID-19 pandemic have been subject to intense empirical scrutiny, the role of particular actors as part of government responses has been less documented. Objective: This article fills such a gap by reviewing the World Banks social protection responses to the early stages of the pandemic.Materials and methods: It does so by presenting results from portfolio data, anonymized surveys, and key informant interviews within the organization. Results: Taken together, these sources point to an unprecedented operational scale-up by the organization as it strived to support countries dealing with widespread needs and pervasive uncertainty. Yet questions remain on whether such significant response would lead to game-changing reforms in the configuration of national social protection systems.

Background: Chronic hypertension can lead to the development of heart failure (HF), a debilitating disease affecting ~65 million people worldwide. In addition to impaired cardiovascular performance and associated systemic complications, most patients with HF suffer from depression and/or cognitive decline. Although neuroinflammation and brain hypoperfusion occur in humans and rodents with heart failure (HF), the underlying neuronal substrates, mechanisms, and their relative contribution to cognitive deficits in HF remains unknown. Methods: To address this critical gap in our knowledge, we used a well-established HF rat model that mimics clinical outcomes observed in humans, along with a multidisciplinary approach combining behavioral, electrophysiological, neuroanatomical, molecular and systemic physiological approaches. Results: Our studies support neuroinflammation, hypoperfusion/hypoxia and neuronal deficits in the hippocampus of HF rats, which correlated with the progression and severity of the disease. An increased expression of angiotensin II AT1a receptors (AngII-AT1aRs) in hippocampal microglia preceded the onset of neuroinflammation. Importantly, blockade of AT1Rs with a clinically used therapeutic drug (losartan) efficiently reversed neuroinflammatory endpoints (but not hypoperfusion/hypoxia ones), resulting in turn in improved cognitive performance in HF rats. Finally, we show than circulating AngII leaks and access the hippocampal parenchyma in HF rats, constituting a likely source initiating the neuroinflammatory cascade. Conclusions: We provide compelling evidence for a novel mechanism that contributes to cognitive deficits in HF. We identified a neuronal substrate (hippocampus), a novel mechanism (Angiotensin II-driven neuroinflammation) and a potential novel neuroprotective therapeutic target (AngII-AT1aRs) for the treatment of cognitive deficits in HF. DFG Postdoc Fellowship AL 2466/1-1 to FA; National Heart, Lung, and Blood Institute Grant NIH HL090948 to JES, National Institute of Neurological Disorders and Stroke Grant NIH NS094640 to JES and funding provided by the Center for Neuroinflammation and Cardiometabolic Diseases (CNCD) at Georgia State University. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

The geochemical and texture of forests soil on different aspects have been widely studied, but the adverse effects of environmental degradation poses deterioration on mangroves forest soil of different mangroves species has not been broadly in the literature. The aim of the research was to find out the reasons for the change in forests density along with the extinction of mangroves species and to determine the detrimental impacts of forest soil on mangroves of Keti Bunder, Indus delta, Pakistan. The field study of the Indus delta has been conducted during the year 2021-22. The soil samples were collected from each root zone at different depths (25, 50, and 70 cm) of mangroves species (A.marina, R.mucronata, C.tagal, and A.corniculatum) that presently exist in Pakistan. To evaluate the soil quality, some physical and chemical parameters (pH, Salinity, TDS, TOC, Calcium, Magnesium, Sodium, Potassium, Nitrate, Phosphate, Iron, and Chromium) were used to evaluate the adversity of the pollution. The statistical results have also been calculated by using Descriptive and Principal Component Analysis to find out the level of parameters dispersed in soil and their effects that may cause extinction of mangroves species from Pakistan. Keywords: Species extinction, Adverse impacts, Soil quality, Physico-chemical, Indus delta

In recent years, number of elderly people in population has been increased because of the rapid advancements in the medical field, which make it necessary to take care of old people. Accidental fall incidents are life-threatening and can lead to the death of a person if first aid is not given to the injured person. Immediate response and medical assistance are necessary in case of accidental fall incidents to elderly people. The research community explored various fall detection systems to early detect fall incidents, however, still there exist numerous limitations of the systems such as using expensive sensors, wearable sensors that are hard to wear all the time, camera violates the privacy of person, and computational complexity. In order to address the above-mentioned limitations of the existing systems, we proposed a novel set of integrated features that consist of melcepstral coefficients, gammatone cepstral coefficients, and spectral skewness. We employed a decision tree for the classification performance of both binary problems and multi-class problems. We obtained an accuracy of 91.39%, precision of 96.19%, recall of 91.81%, and F1-score of 93.95%. Moreover, we compared our method with existing state-of-the-art methods and the results of our method are higher than other methods. Experimental results demonstrate that our method is reliable for use in medical centers, nursing houses, old houses, and health care provisions.

The overlapping displacement fields among closely spaced piles termed as pile-to-pile interactions, increase the overall settlement of pile groups. Resultantly, under static loading, these interactions invariably decrease the group stiffness of piles than the collective stiffnesses of corresponding single piles. Whereas under dynamic loading, the group stiffness may increase or decrease than the cumulative stiffnesses of single piles depending on the loading frequency. As soil exhibits nonlinear behaviour under strong motions, in addition to the consideration for soil nonlinearity to obtain the response of piles, nonlinearity generated at the interface between the soil and pile needs to be appropriately considered as it can significantly change the response of piles. To assess the influence of mentioned nonlinearities on the vertical pile-to-pile interaction factors, a scale model test on closely spaced piles is carried out under 1 g conditions. At very low loading amplitudes wherein soil exhibits close-to-elastic behaviour, the experimental interactions are drastically smaller than those obtained from closed-form solutions assuming soil as an elastic material, highlighting the influence of soil-pile interface nonlinearity. Under higher loading amplitudes, results indicate that the increased nonlinearities strengthen the amplitude dependency of interactions. To minutely assess the effects of soil-pile interface nonlinearity on the response, three-dimensional nonlinear finite element modelling (FEM) is carried out. Results obtained from FEM considering soil and soil-pile interface nonlinearities validate the experimental results well. Whereas, assuming soil as an elastic material leads to a noticeable reduction in interactions due to stiffnesses of neighbouring piles; interactions get further reduced when the number of adjacent piles increases.

Objective: Assessment of the outcome of esophageal dilatation in patients with esophageal stricture formation due to corrosive intake experienced at a tertiary healthcare facility in order to devise a better management plan for such patients. Study design: Retrospective Study Study setting: Sheikh Zayed Medical College/Hospital, Rahim Yar Khan. Study duration: January 2018-June 2021 Methodology: A total of 19 subjects who presented with esophageal stricture formation due to corrosive intake were taken as study subjects. The location of involved mucosa, number of dilatation sessions done, level of symptomatic relief and recurrence rates were assessed for these study subjects. Then the data was gathered and analyzed with the help of SPSS Version. 21. Results: This study comprising of 19 patients who had esophageal stricture formed due to corrosive intake and they underwent esophageal dilatation for it. The age range for the subjects came out to be 5-40 years (Mean= 2.89±8.81). Male to female ratio came out to be 7(36.8%) vs 12(63.2%) respectively. Among these study subjects, 15(78.9%) subjects gave history of an acid ingestion while only 4(21.1%) had a history of alkali ingestion. Majority of them showed relief in response to esophageal dilatation and with low recurrence rates. Conclusion: Esophageal dilatation with bougies is one of the safest, less invasive, and efficient method for the effective management of esophageal stenosis/ stricture formation after corrosive intake that needs to be emphasized specially in healthcare centers which lack specialized departments dealing with more invasive surgical procedure and facilities. Keywords: Esophagus, Dilatation, Corrosive, Stricture, Acid, Alkali

YOLOv7 algorithm have taken the object detection domain by the storm as its real-time object detection capabilities out ran all other previous algorithms both in accuracy and speed [1]. YOLOv7 advances the state of the art results in object detection by inferring more quickly and accurately than its contemporaries. In this paper, we are going to present our work of implementing this SOTA deep learning model on a soccer game play video to detect the players and football. As the result, it detected the players, football and their movement in real time. We also analyzed and compared the YOLOv7 results against its previous versions including YOLOv4, YOLOv5 and YOLO-R. The code is available at: https://github.com/RizwanMunawar/YOLO-RX57-FPS-Comparision

Objective: To analyse the experience of empyema thoracis management using video-assisted thoracoscopic surgery. Method: The retrospective study was conducted at the Combined Military Hospitals, Rawalpindi and Lahore, Pakistan, and comprised data of empyema thoracis cases who underwent thoracoscopic decortications by the same consultant surgeon between January 2009 and 2018. Uniportal or multiportal video-assisted thoracoscopic decortications was done. Histopathology and microbiological sampling were done in all cases. Results: of the 162 cases, 114(70.4%) were done on males and 48(29.6%) on females. The overall mean age was 44±16.37 years. Three ports were utilised in 58(36%) patients. Hospital stay of 122(75.3%) patients was

Objective To compare the effectiveness of open thoracotomy and video assisted thoracic surgery (VATS) for empyema thoracis in paediatric population. Study design Observational study. Place and duration of study This observational study was conducted at Department of Thoracic Surgery, CMH, Lahore, from October 2013 to August 2018. Methodology Medical record of children up to the age of 14 years who were operated for empyema thoracis was reviewed. Patients were divided into two groups: Open thoracotomy, and VATS; and compared for etiology, preoperative treatment, grade of empyema, procedure performed; histopathology and complications, e.g. post-thoracotomy neuralgia, surgical site infection, recurrence over 6 months. Results A total of 61 paediatric patients were operated for empyema thoracis. Age ranged between 1 to 14 years (mean = 10.25 ±3.30 years). Most common etiology of empyema was tuberculosis in 24 (39.3%) cases, followed by pneumonia in 22 (36.1%). Surgical treatment consisted of open thoracotomy in 40 (65.5%) cases, while 21 (34.5%) underwent VATS. Postoperative X-ray was satisfactory in 38 (95%) cases undergoing open thoracotomy as compared to 21 (100%) cases undergoing VATS (p=value 0.29). There was no recurrence in either of the two groups over a follow-up period of six months. Overall complication rate was 32.5% (13 cases) in cases undergoing open thoracotomy, while 33.3% (7 cases) in VATS group (p=value 0.95). There was one (2.5%) mortality in open thoracotomy group, while no death occurred in VATS group. Conclusion Early surgical treatment, both open as well as VATS, gives satisfactory results in management of paediatric empyema. VATS is a safe alternative to open thoractomy with good success rate and less incidence of complications.

Objective: To analyze the outcome of Video assisted Thoracoscopy (Vats) in Primary Spontaneous Pneumothorax (PSP). Methods: This case series was carried out from Jan 2010 to Jan 2017 in Dept of Thoracic Surgery CMH Rawalpindi and Lahore. A total of 98 patients underwent Video-assisted thoracoscopic for PSP. Inclusion criteria were physiologically fit patients with PSP for recurrent attacks, occupational hazards and prolonged air leak. Exclusion criteria included secondary spontaneous pneumothorax, previous pleurodesis and physiologically unfit patient for general anesthesia. Vanderschueren's thoracoscopic classification was used for macroscopic staging. A 3-port technique was used for apical stapling with partial pleurectomy up to 6th rib. Parietal pleura and diaphragm was also abraded. Results: Occupational hazard was the commonest indication for surgery, n= 39 (39.7%). This was followed by recurrent pneumothorax n=37 (37.7%), persistent air leak n= 19 (19.38%), and contra lateral pneumothorax n=4 (4.08). Mean age was 22.8 years ± 6.5. Majority of the cases were in stage 3 of Vanderschueren’s classification, n=69 (70.4%). Stage 4 were n= 18 and stage 2 were n=7. Mean operative time was 51minutes ±14.4. Postoperative prolonged air leak occurred in 3 patients and post-operative neuralgia occurred in 8 patients. Mean follow-up was 22 months ± 5.5, range 5-24 months for all patients. One had generalized recurrence and 2 patients have subpulmonic trapping of air. Conclusions: Video-assisted thoracoscopic stapling and pleurectomy is an effective definitive treatment for primary spontaneous pneumothorax when indicated with minimal recurrence. Keywords: Video-assisted thoracoscopy, blebs, pneumothorax. Continuous...

The supply chain monitored in real-time using the sensors makes supply chain flow efficient and reliable. The Coronavirus Disease of 2019 (COVID-19) pandemic has added pressure on the federal and provincial governments to identify appropriate vaccine distribution solutions. In order to reduce the losses of the vaccines throughout the supply chain, such a solution was needed to notify the supply chain stakeholders to take action if the temperature or humidity of a batch of vaccines begin to cross its threshold level and also to allow the stakeholders to view the location of a specific batch of vaccines while in transit. There has been a great loss of vaccines in transit which is resulting in an expensive overhead for the supply chain. So, there is a need for cloud computing based monitoring of vaccine shipment using sensors embedded into the shipping container to track the location, temperature, and humidity of vaccine batches during transportation. Since these sensitive properties will be monitored in real-time which would ultimately lead to fewer losses of the vaccines. The simulation of sensor data is done to achieve the real-world condition for vaccine movement. The cloud computing services architecture is used to make the working of supply chain efficient and transfer of ownership between the entities involved in delivering the vaccines in a trusted way. The data generated through this transfer of ownership is immutable and it would generate the efficient trust of entities in the supply chain. This would build a reliable supply chain and provide the visibility to take timely actions to prevent the vaccines from getting damaged. Reliability would build trust in the supply chain from the immutability of the database. As a result of visibility, timely action should be taken to prevent vaccines from getting damaged by the environmental conditions through which it is being transported.

Chest wall tuberculosis is a rare disease, and although incidence has decreased further with advances in antituberculosis chemotherapy, it remains prevalent in developing countries. Diagnosis is difficult because pus smears or bacterial cultures of aspirate frequently fail to yield tuberculous bacilli. To discuss the characteristics of this rare disease and suggest an optimal strategy for management, we share our experience with 32 patients managed surgically and with antituberculosis chemotherapy.In this descriptive case series we retrospectively reviewed the medical records of 32 patients managed from May 2006 to May 2016.Out of 32 cases of chest wall tuberculosis, 59.4% (n=19) patients had a current or previous history of tuberculosis. Presenting complaints were chest pain, a palpable mass and pus discharge in most patients. A preoperative bacteriologic diagnosis was positive in only 3 patients. Generous abscess debridement was done in 21 (65.63%) cases, abscess debridement and partial rib resection in 11 (34.38%), abscess debridement and partial sternum excision in 7 (21.88%), and clavicle excision in 2 (6.25%) patients. Postoperative wound infection was noted in 1 (3.13%) patient. There were no recurrences.Chest wall tuberculosis requires generous debridement of diseased tissue including under lying bone, meticulous obliteration of residual dead space by vascular muscle flap, and negative suction drainage in addition to antituberculosis chemotherapy for good post-operative results with acceptable morbidity and mortality.

Underwater wireless communication technologies are gaining immense popularity due to their wide applications ranging from sea surveillance to climate recording, oil production control, and autonomous vehicles. Acoustic communication is the most commonly adopted technique for this purpose as it offers the least attenuation, high speed, and longer range compared to other communication techniques. But the composition of the sea is not uniform, and the behavior of acoustic wave varies as we move from shallow water to deep sea. This paper gives a comparison of acoustic wave propagation in two different channels of the Arabian Sea and the propagation characteristics of high frequency and low-frequency acoustic signal for each channel. The paper also discusses a comparative analysis of transmission losses incurred in both channels for given frequencies and thus becoming a useful tool for choosing the appropriate frequency for reliable underwater wireless communication.

This study was conducted to assess the water quality of the lower Indus Basin, Pakistan. Eighty- two water samples were collected from forty-one locations of lower Indus Basin (Kashmore to Keti-Bander) during pre and post monsoon seasons. The variation pattern in the water quality has been observed in both seasons. The samples were analysed for physical quality (temperature, pH, turbidity, dissolved oxygen, total dissolved solids, salinity and conductivity), chemical quality (chloride, total alkalinity, total hardness, sulphate, potassium, sodium, iron, zinc, lead, mercury, copper, cadmium and nitrate) and biological quality (coliform bacteria). The study reveals that the concentrations of lead, mercury, and cadmium in water samples during both seasons were slightly higher than the permissible limits, whereas, all other parameters were within WHO guidelines. The higher concentration of heavy metals must be rectified by the concerned authorities in order to protect human health.

Forty-seven infants with ventricular septum (n=19), tetralogy of Fallout (n=8) and transposition of the great(n=28) who underwent "corrective" surgery in their first year of life were examined for their birth weight and their pre- and post-operative status. postoperative growth. The average birth weight for each group was lower than that of the standard population. Our current research was conducted at Sir Ganga Ram Hospital, Lahore from March 2019 to April 2020. There was a decrease in the growth rate in preoperative period which was reversed after the operation. At follow-up, 13-1 9 months later (mean), Most of the infants had regained at least their birth weight percentile, while the group with ventricular communication exceeded it. The pathophysiological mechanisms contributing to these observations are considered. Keywords: Cardiovascular surgery, first year of life, weight gain of children with congenital heart defects.

Recently, there has been increasing evidence that immunotherapy could be an incredible weapon against malignancies. Unlike conventional medical procedures such as chemotherapy or radiotherapy, immunotherapy targets malignant cells more explicitly, offering patients the opportunity for higher response rates and greater personal satisfaction and even cure the infection. Disease immunizations could target tumor-related antigens, germline antigens for malignant growth, infection-related antigens or explicit tumor antigens, which are also called neoantigens. Our current research was conducted at Mayo Hospital, Lahore from May 2019 to April 2020. Malignant growth antibodies could be cell-based (for example, evidence of immunization of dendritic cells focusing on corrosive phosphatase for metastatic prostate disease), peptide/protein-based, or quality-related, with different types of adjuvants. Neoantigens are explicit for tumors and could be introduced by MHC particles and perceived by T lymphocytes, which is the ideal focus to extend the specificity of the remedy and reduce the danger of a wave of autoimmunity. By focusing on common antigens and private epitopes, the malignancy antibody can eventually treat the disease. Similarly, personalized immunotherapies based on neoantigens are emerging. In this article, we review the drafting and evidence of the scope and use of malignancy antibodies. We summarize the new clinical preliminaries of neoantigens-based malignant growth immunizations that have been planned by the melanoma close to the patient's home. With the rapid advances in personalized immunotherapy, it is recognized that tumors could be productively controlled and treated in the new period of accuracy medication. Keywords: Latest production and therapeutic, cancer vaccine.

Upper cervical oesophageal and hypo-pharyngeal malignancies pose significant challenges in surgical management. In advanced tumours total laryngopharyngeal esophagectomy (TLPO) and gastric pull up provides excellent result.It is a descriptive case series and was conducted from Jan 2010 to Jan 2017. Thirty-five patients underwent TLPO. The inclusion criteria were; tumours of hypo-pharynx which allow tumour free resection margins and cervical oesophageal tumours not involving mediastinal trachea. There were no clinically palpable cervical lymph nodes. Patients with locoregional advanced disease and poor performance status were excluded. All cases underwent standard one stage TLPO with bilateral inter-jugular lymph nodal clearance. Minimal invasive techniques used in three cases.Out of 35 patients, n=21 (60%) of patient had lesion of hypopharynx with post cricoid involvement, n=13 (37.1%) had primary tumour of cervical oesophagus abutting pharynx and cricoid and only one patient had a tumour of hypopharynx with perforation. Histopathological conformation of diagnosis done in all patients preoperatively which showed Well differentiated Squamous cell in n=19 (54.28%), moderately differentiated squamous cell in 28.57% (n=10). Post-operative staging of the patients 74.28% (n=26) fall in stage 3. Operative time was less than 3 hours in 17 patients with two team technique, between 3-4 hours in 8 patients and more than 4 hours in 3 patients. SVT in 14.28% (n=5), Atrial Fibrillation in 5.71% (n=2). Chest complications including pneumothorax in 11.43% (n=4), basal atelectasis in 22.86% (n=8), pulmonary embolism in 2.85% (n=1), aspiration in 8.57% (n=3) and tracheal stenosis in n=1, 5.71% (n=2) cases had anastomotic leak. Postop 28 days mortality was 8.57% (n=3).TLPO with stomach pull up offer good results in patients with resectable disease with acceptable morbidity and mortality in operable patients.

To ascertain the outcome of primary resection anastomosis in patients of post-intubation tracheal stenosis (PITS) and the associated morbidity.A case series.Department of Thoracic Surgery, Combined Military Hospital, (CMH) Rawalpindi, Lahore and Multan from January 2010 to August 2018.Patients with tracheal stenosis due to prolonged intubation with functional were included. Exclusion criteria were patients having stenosis due to malignant cause, trauma and glottic stenosis involving vocal cords. Clinical examination, computerised tomography (CT) of neck plus chest and fiberoptic bronchoscopy were done in all the patients, while virtual bronchoscopy were done in 35 cases. Sharp dissection, aided by loupes, was the preferred technique. Thyroid tissue and strap muscle were used as flap for high cricoid lesion. Guardian stitch was applied to all cases. Postoperative elective bronchoscopy was performed after a fortnight.Among 43 patients, [26 (60.5%) men and 17 (39.5) women] 18 patients were intubated for days10 ,18 for10 and 7 for3 days. Thirty-four (79.1%) patients were under 40 years of age, while 23 patients had tracheostomy incorporated in surgery. Bronchoscopy evaluation of distance from vocal cords showed involvement of the first ring in six patients, 1st ring normal in 1, 2 rings normal in 17, while 3 or more rings spared in 19 patients. Length of stenotic segment was2 cm in 17, between 2-3 cm in 21, and between 3-5 cm in five patients. All patients were successfully extubated. Two patients had twin lesions. Seven patients required hyoid bone excision and release. There was one recurrent stenosis managed successfully with dilatation and granulation removal.Post-intubation tracheal stenosis (PITS) is curable disease. Primary resection and anastomosis remain the gold standard with acceptable morbidity and mortality. Key Words: Tracheal stenosis, Intubation, Resection, Primary anastomosis.

Objective: Attractive reverberation imaging allows non-invasive perception of PO2 changes between air and oxygen respiration by measuring the attractive longitudinal run time T1. The variations in PO2 correspond to changes in longitudinal flow rate DR1 (where DR1 = 1/T1Oxygen _ 1/T1air). Information on this response may suggest medical mediations by means of parental oxygen organization during the prenatal period to cure fetal developmental confinement. Researchers present in vivo estimates of fetal-placental unit reply to maternal hyperoxia. Test: Ten women with a generally safe pregnancy (22-34 weeks incubation) and six non-pregnant adults. Methods: Our current research was conducted at Mayo Hospital, Lahore from October 2017 to September 2018. Throughout imaging, mothers' air supply was different from restorative air (21% oxygen) to therapeutic oxygen (100% oxygen), and T1 was observed after some time in placenta and fetal brain using an imaging group with intermittently rephased attractive reverberation. To show that the strategy could identify a mental reply, the brain responses of five typical adult volunteers were estimated using the comparative imaging convention. The basic results amount changes in T1 subsequent an oxygenation test. Results: Not any critical DR1 (P = 0.43, paired t-trial) was detected in fetal minds. The critical placental DR1 (P = 0.0003, paired t-test) of 0.03 _ 0.02/s (average _ SD) was observed at all times in similar limbs. In the minds of non-pregnant adults, a huge DR1 (P = 0.02, combined t-test) of 0.006 _ 0.003/s was detected. Conclusion: The organization of short-term parental oxygen does not improve oxygenation of the fetal mind, unlike the reaction seen in adult brain. Keywords: Brain, fetus, longitudinal relaxation rate, magnetic character imaging, oxygen, placenta, pregnancy.

Non-union of scaphoid bone fractures, though an uncommon occurance, are a signficant cause of morbidity in young patients. This review outlines the current understanding of vascularised bone grafts and non-union, and examines the most current clinical literature regarding the role of these procedures in modern orthopaedic practice. Composite evidence from level III studies would support using osseous grafts on a vascular pedicle for patients with non-union of the proximal end of the scaphoid with associated avascular necrosis and in cases of revision surgery where a previous non-vascularised graft has failed to achieve bony union.

Our understanding of the full range of natural variability in streamflow, including how modern flow compares to the past, is poorly understood for the Upper Indus Basin (UIB) because of short instrumental gauge records. To help address this challenge, we use Hierarchical Bayesian Regression (HBR) with partial pooling to develop six centuries long (1394–2008 C.E.) streamflow reconstructions at three UIB gauges (Doyian, Gilgit, and Kachora), concurrently demonstrating that HBR can be used to reconstruct short records with interspersed missing data. At one gauge (Partab Bridge), with a longer instrumental record (47 years), we develop reconstructions using both Bayesian Regression (BR) and the more conventionally used Principal Components Regression (PCR). The reconstructions produced by PCR and BR at Partab Bridge are nearly identical and yield comparable reconstruction skill statistics, highlighting that the resulting tree-ring reconstruction of streamflow is not dependent on the choice of statistical method. Reconstructions at all four reconstructions indicate flow levels in the 1990s were higher than mean flow for the past six centuries. While streamflow appears most sensitive to accumulated winter (January-March) precipitation and summer (MJJAS) temperature, with warm summers contributing to high flow through increased melt of snow and glaciers, shifts in winter precipitation and summer temperatures cannot explain the anomalously high flow during the 1990s. Regardless, the sensitivity of streamflow to summer temperatures suggests that projected warming may increase streamflow in coming decades, though long-term water risk will additionally depend on changes in snowfall and glacial mass balance.

Primary tumours of the trachea are rare. Adenoid cystic carcinoma (ACC) constitutes less than 1% of these tumours. They occasionally masquerade as asthma. We are presenting a case of a young female, who had been treated for 3 years as asthma. She presented in emergency with severe respiratory difficulty, stridor and decreasing saturation of 85% on room air. Two weeks back, she had a CT scan in a local hospital, but they did not notify the tracheal mass. Her clinical picture and CT scan helped us diagnose the case. She was treated in emergency with primary resection of tracheal mass and anastomosis. The tumor was diagnosed as ACC. Postoperative recovery was uneventful. Continuity of the trachea was restored and adjuvant radiotherapy was given.

Background: Patients who were helped with a helpful complaint technique for scoliosis of the spine are usually ventilated a short time later in today's practice. Postoperative mechanical ventilation and the subsequent stretching of the emergency section are associated with extended restorative use and versatility, e.g. ventilator-induced pneumonia. The clear evaluation of components that can contribute to PMV and their modification can spread the benefits. The present assessment was performed to identify preoperative and intraoperative parts associated with an introductory PMV as a therapeutic framework for scoliosis a short time later. Methods: One hundred and ten progressive cases that performed a scoliosis change between May 2018 and May 2019 were treated very well at Services Hospital Lahore. Among the PMV cases were respondents who did not remain extubated in the workroom and were committed to mechanical ventilation. Among the preoperative and intraoperative variables studied were age, sex, weight, cardiorespiratory work, proximity of kyphosis, number and stature of vertebrae, cautious care, low consideration of thoracoplasty, range of reconstruction system, blood reversal, fluids and blood transfusions, hypothermia, additional use of antifibrinolytics. Results: The standard time of cases was 16.34±5.81 years with female strength (60.7%). The univariate study showed that logically drawn mixtures of vertebrae (more than 9), blood accidents, number of mixed gems, blood transfusions and hypothermia were broadly associated by PMV (P Conclusion: Producers saw that continuously expanded mixtures and hypothermia were free hazards for the start of PMV. By using activities to turn away from hypothermia, a reduction in PMV can be achieved. Keywords: Postoperative mechanical ventilation, risk factors, scoliosis surgery.

In aerial robotics, intelligent control has been a buzz for the past few years. Extensive research efforts can be witnessed to produce control algorithms for stable flight operation of aerial robots using machine learning. Supervised learning has the tendency but training an agent using supervised learning can be a tedious task. Moreover, the data gathering could be expensive and always prone to inaccuracies due to parametric variations and system dynamics. An alternative approach is to ensure the stability of the aerial robots with the help of Deep Re-inforcement Learning (DRL). This paper deals with the intelligent control of quad-copter using deterministic policy gradient algorithms. In this research, state of the art Deep Deterministic Policy Gradient (DDPG) and Distributed Distributional Deep Deterministic Policy Gradient (D4PG) algorithms are employed for attitude control of quad-copter. An open source simulation environment GymFC is used for training of quad-copter. The results for comparative analysis of DDPG & D4PG algorithms are also presented, highlighting the attitude control performance.

10-15 % of trauma patient has chest injuries. There is a paradigm shift in the last two decades towards rib fixation from conservative management. Rib fixation results in immediate pain reduction in patients. Although rib fixation shows promising results, conservative management is still preferred.The study was carried out in CMH Lahore from Jan 2017 to March 2018. It was a Controlled Prospective study. Convenient sampling was used. 43 patients are included in the study. Patients with four or more fracture ribs were included. Patients followed at one, two and three months with spirometry/X-ray /clinical response. Rib fixation was done in 21 patients while 22 were managed conservatively. Patients were given choice of both the management options and treated as per their choice resulting in two groups.Mean age of patients is 51.35 years. Majority of them were males (86.05%), had haemothorax as confirmed with CT scan (69.80%) and unilateral fracture (79.10%). 7.40% have flail segment. Operative group shows statistically significant improvement in the recovery to work and less post-operative pain when compared to control group. There were no statistical differences among variables such as pre-operative severity and pain index, length of hospital stay, number of days for ventilator support and post op FEV1. There is statistically significant reduction in pneumonia (p0.05), Acquired respiratory distress syndrome (ARDS) (p0.05), ventilatory support greater than 1 day (p0.05) but there is no statistically significant reduction in.Rib fixation should be performed early after trauma as it decreases pain, lessens complications and facilitate early recovery to work.

Objective To analyse the outcome and morbidity associated with decortication in empyema thoracis. Study design A case series. Place and duration of study Departments of Surgery, Combined Military Hospitals (CMH) of Rawalpindi, Quetta and Lahore, from January 2006 to March 2018. Methodology This is a retrospective study of 812 cases of open and VATS (video-assisted thoracic surgery) decortication for empyema thoracis, operated by the same consultants. Only patients with established empyema were included. Those who were unfit for one-lung ventilation, undergoing local anesthesia procedures like rib resection, clagget window or tube windows, with clotted hemothorax and malignant pathology were excluded. Posterolateral serratus sparing thoracotomy was used in open decortications. Multiportal or uniport VATS was employed for video-assisted thoracoscopic decortications (VATD). Histopathology and microbiological sampling was also done in all cases. Results There were 537 (66.1%) males and 275 (33.9%) females. Age ranged from 1 to 80 years with a mean of 37 years. Open decortication was done in 650 (80%), standard decortication with posterolateral thoracotomy in 458 (56.4%), minithoracotomy was done in 69 (8.4%) patients with loculated empyema, thoracotomy and open decortication with conventional thoracoplasty was done in 21 patients. Twenty-two patients required open decortications with tailored thoracoplasty and muscle flap. Open decortication with intercostal muscle (ICM) flap or primary closure of bronchopleural fistula was performed in 55 patients. VATD was done in 162 cases, out of which 120 were early empyema, and 42 were of chronic empyema; of which 22 required a further utility thoracotomy. Decortication with lung resection and muscle flap reinforcement to bronchial stump was done in 25 patients. Blood transfusion was required in 331 (40.7%). Twenty-six (3.4%) patients developed residual space and collection requiring intervention; and 384 (47.3%) patients had a histopathology diagnostic for tuberculosis. There were 11 (1.3%) deaths. Conclusion Open decortication is still one of the preferred procedures in developing countries. VATD is also increasingly utilised for empyema.

As 360-degree videos grow dramatically in popularity, more applications demand the ability to stream 360-degree videos to wirelessly connected devices, such as smartphone headsets. However, the limited capacity and the unstable network conditions make wireless networks ill-suited to the requirements of 360-degree videos--high resolution and low delay. One common approach is to take advantage of the fact that the viewer only watches a small portion of the video around the field of view (FOV). This allows for better allocation of network bandwidth by prioritizing content the viewer actually watches. Previous efforts on 360-degree videos have largely focused on adapting the encoded bitrate to optimize video quality in the time-varying FOV. This paper follows the general FOV-aware approach but uses a different technique. Rather than adapting bitrate, we explore the opportunities of a custom underlying transport protocol for 360-degree videos. In particular, we make a case for using Forward Error Correction (FEC) coding over UDP to reduce video streaming delay (a key limitation of all TCP-based approaches). We present Dante, an FOV-aware UDP-based video streaming protocol that adapts to changing network conditions by dynamically choosing FEC redundancy levels based on how close the video content is to the FOV region. Experimental results show that Dante improves video quality (PSNR) by 20% to 30% over traditional UDP-based video streaming protocols and 40% over FOV-aware DASH.