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The ideal method of operative fixation for unstable distal clavicle fractures remains controversial, with particular emphasis on the need to restore the normal coracoclavicular distance. Our preferred method of fixation includes open reduction and internal fixation with a distal clavicle locking plate in combination with a polydioxanone suture wrapped around the plate and coracoid to restore the coracoclavicular distance and offload the bony repair. The purpose of this study is to report clinical, radiographic, and functional outcomes in patients with unstable distal clavicle fractures treated with this method of fixation.

Molecular breast imaging (MBI) is an adjunctive screening tool that can be helpful in evaluating women with dense breasts or in high-risk patients. We present the case of a 43-year-old female who had markedly asymmetric uptake in one of her breasts on MBI study. Further evaluation with diagnostic mammogram and ultrasound did not demonstrate any suspicious findings in the affected breast. Discussion with the patient and additional clinical history revealed that the patient was exclusively breastfeeding from that side, accounting for the unilateral MBI findings.

Background: Infantile Ewing Sarcoma (ES) is an extremely rare disease with comparable outcomes on contemporary protocols. There is a paucity of data from India. Methods: Infants with proven ES diagnosed between January 2012 and December 2020 were retrospectively analyzed. The staging was performed using positron emission tomography-computerized tomography scan. Treated infants were administered weight-based chemotherapy. The local control was with surgery and/or radiotherapy. Results: There were 10 infants with ES with a male-to-female ratio of 2.3:1. The majority had extraosseous (90 %, n = 9) or axial primary (50 %, n = 5). Five patients with localized disease received treatment. Two died during induction chemotherapy (sepsis-1, cause unknown-1), and 3 are alive with no evidence of disease at a median follow-up of 8 years (range: 4–9). Two episodes of complicated febrile neutropenia were reported in 5 treated infants. Conclusions: ES in infants is rare and predominantly extraosseous with axial primary. Treated infants with non-metastatic disease tolerated chemotherapy well with good outcomes.

Copper (Cu) is highly sought for its excellent electrical and thermal conductivity. However, its limited mechanical strength hinders its wider application in demanding fields. This work explores the potential of graphene nanoplatelets (GNPs) as a strengthening agent for Cu. Cu-GNP composites with varying GNP content (0.1–1.5 wt%) were fabricated using a combined ball milling and powder metallurgy approach. The microstructure and mechanical properties of the composites were comprehensively analyzed using field emission scanning electron microscopy (FESEM), energy dispersive X-ray spectroscopy (EDS), X-ray diffraction (XRD), and Raman spectroscopy. Compared to pure Cu, the Cu-GNP composites showcased significantly improved mechanical performance. Notably, the Cu-1.0 wt% GNP composite exhibited a remarkable ∼27% and ∼53% enhancement in compressive strength and micro-hardness, respectively. This improvement is attributed to the effective load transfer between Cu and well-dispersed GNPs, which act as reinforcement elements and inhibit dislocation movement. These findings demonstrate the promising potential of Cu-GNP composites for applications requiring high strength.

Navigating clinical guidelines can be complex for real-time health care decision making. Our study evaluates the chat generative prerained transformer (ChatGPT)-4 in improving responses to clinical questions by integrating guidelines on Clostridioides difficile infection and colon polyp surveillance. We assessed ChatGPT-4’s responses to questions before and after guideline integration, noting a clear improvement in accuracy. ChatGPT-4 provided guideline-aligned answers consistently. Further analysis showed its ability to summarize information from conflicting guidelines, highlighting its utility in complex clinical scenarios. The findings suggest that large language models such as ChatGPT-4 can enhance clinical decision making and patient education by providing quick, conversational, and accurate responses. This approach opens a path for using artificial intelligence to deliver reliable responses in health care, supporting clinicians in real-time decision making and improving patient care.

Noniatrogenically acquired foreign bodies in the nipple-areola complex or breast skin are rare and can have variable imaging features, depending on the nature of the foreign material. We present the case of a 41-year-old female who had numerous apparent round and punctate calcifications in the right periareolar breast, predominantly within the skin. The biopsy showed multiple glass shards on a background of scar tissue. Further discussion with the patient confirmed that the glass shards were acquired during a motor vehicle accident several years earlier. We also review the types of foreign body material observed in the breast, the imaging appearance of glass foreign bodies in soft tissue, and methods of removal.

In the last four decades, survival in childhood cancer in India has improved significantly, however we increasingly face the question that has challenged providers in high-income countries: when care becomes futile and merely prolongs suffering, how should that be addressed? This position statement was prepared by a panel in the Pediatric Hematology-Oncology chapter of the Indian Academy of Pediatrics (IAP-PHO), with external experts, using a process endorsed by the Executive Committee of IAP-PHO. The panel consisted of providers and stakeholders who were committed to improving end-of-life care (EOLC) in children with cancer. Three case scenarios of terminally ill children with cancer were presented, and the various challenges of EOLC in each situation were brought up, including families who wanted everything possible done for their child and the fear of medicolegal issues by physicians. We emphasize the importance of involving palliative care services early in the process to ensure that families receive a consistent message about their child's outcome. With the recent Supreme Court of India decision, there is now a viable EOLC pathway to withdraw life-sustaining therapy (LST) from children who are terminally ill. We outline it and discuss the various barriers to the withdrawal of LST. Increased access to palliative medicine services, which currently exist sporadically across India, is a core necessity. IAP-PHO hopes to actively work with organizations representing colleagues in palliative care and intensive care, to see how we can improve EOLC in childhood cancer.

Summary: Clonal hematopoiesis involves the clonal expansion of hematopoietic cells, potentially progressing into hematological malignancies. Here, we present a protocol for the development and characterization of two mouse models designed to simulate clonal hematopoiesis and acute myeloid leukemia. We describe steps for model generation, monitoring clonal expansion, harvesting, fixation, and staining of bone marrow and spleen tissues. We specifically focus on the visualization and analysis of p53 mutant clonal expansions, providing a comprehensive protocol for studying these phenomena in mouse models.For complete details on the use and execution of this protocol, please refer to Pourebrahim et al.1 : Publisher’s note: Undertaking any experimental protocol requires adherence to local institutional guidelines for laboratory safety and ethics.

India’s higher education sector faces significant challenges in attracting international students, evidenced by hosting less than 1 % of globally mobile students despite substantial efforts to increase this number. This study explores critical barriers preventing international students from choosing India as their destination, including financial constraints, safety concerns, and cultural integration issues. It also assesses the impact of the COVID-19 pandemic on these decisions and examines the potential of online education as an alternative. Findings reveal that inadequate financial support and safety concerns are primary deterrents, with varying impacts across educational levels and regions. Recommendations include enhancing financial aid, improving safety measures, fostering cultural integration, and leveraging online education. Addressing these issues is crucial for India to align with global education trends and improve its international appeal.

The present study involves the use of combined network pharmacology and molecular modelling approach for identifying important phytoconstituents that could modulate the functions of multiple therapeutic targets in Alzheimer’s disease. A list of botanicals reported in the literature for their efficacy in Alzheimer’s disease, the phytochemicals present in the botanicals were identified with the help of network pharmacology approach. The pharmacokinetic properties like blood brain barrier penetration and Lipinski’s rule of five for the selected phytoconstituents were analyzed. The major targets involved in the pathogenesis of Alzheimer’s disease were collected from the DisGeNET database. The selected proteins were subjected to topological analysis using Cytoscape software to identify the important targets in the network. The top 7 phytoconstituents and 5 proteins were subjected to molecular docking, MM-GBSA and molecular dynamics studies. A total of 15 plants and 1443 phytoconstituents were identified through a literature survey and from several databases. The pharmacokinetics study revealed that 7 phytoconstituents - glycyrrhisoflavone, eugenol, ferulic acid, methyl jasmonate, geranyl formate, formononetin, and elemicin- exhibited favourable pharmacokinetic properties. Five targets, HMOX1, CNR1, STAT3, HDAC2, and MAOB were found to be important in the network of 3300 proteins based on degree centrality and betweenness centrality. Among the seven phytoconstituents, glycyrrhisoflavone exhibited good dock scores and free energy value. Based on this, the stability of glycyrrhisoflavone with the five selected targets were analyzed using molecular dynamics study. Glycyrrhisoflavone showed good stability with most of the selected therapeutic targets. The current study reveals that the selected phytoconstituents i.e glycyrrhisoflavone, eugenol, ferulic acid, methyl jasmonate, geranyl formate, formononetin, and elemicin could serve as good lead molecules in treatment and management of Alzheimer’s disease through modulation of multiple targets.

The food sustainability and safety issues are one of the biggest challenges that are faced by the developing countries as a result of the growing human population. Applications of nanotechnology enable a straightforward, alternative, and dependable technology for such issues. Various metal nanoparticles (NPs) have been shown in multiples research over the years to exhibit antibacterial and barrier capabilities, hence revolutionizing the packaging of various processed and fresh commodities. Additionally, improved outlook of metal nanomaterials has risen the availability of nanotechnology-based food items. Such an advancement in nanotechnology may provide a variety of solutions for issues associated with foods, their storage, shelf-life and may offer sustained economic, commercial and health benefits. Silver nano-particles (Ag NPs) in particular has a significant impact on sustainability and active & intelligent packaging due to their tunable physico-chemical, biological and enhanced biocidal properties. However, the challenges in assessing the safety of nanofoods and nano-packaging should be addressed in such a way so that socio-environmental interests are not compromised. Thus, this article presents a review, to provide scope of Ag NPs in food technology along with the recent advancements in food packaging industry.

One-pot open beaker green synthesis of silver nano-particles (Ag NPs) by ultrasound energy at room temperature is presented. Citrus fruit-mediated Ag NPs formation was monitored by observing surface plasmon resonance (SPR) by UV–Visible measurements. Orange juice extract played a dual role as it helped in the surface capping of Ag NPs while being a reducing agent to yield phase pure silver nanoparticles of less than 10 nm diameter. The phase purity and particle diameter were confirmed by X-ray diffraction (XRD) patterns and organic functionality was established by infra-red spectroscopy. The morphology was understood by AFM and SEM. Additionally, the study investigates the antioxidant activity and antimicrobial efficacy of so-synthesized Ag NPs against pathogenic microorganisms such as E. coli. and S. aureus. The study also assesses the anticancer activity of Ag NPs on four different cancer cell lines (A 2780, MDA-MB-231, A 375, and HepG2). The half maximal inhibitory concentration (IC50) of nano-silver sample SS-1 was about 5 μg against A 2780 and MDA-MB-231 cell lines.

Summary: The ability to sense and respond to osmotic fluctuations is critical for the maintenance of cellular integrity. We used gene co-essentiality analysis to identify an unappreciated relationship between TSC22D2, WNK1, and NRBP1 in regulating cell volume homeostasis. All of these genes have paralogs and are functionally buffered for osmo-sensing and cell volume control. Within seconds of hyperosmotic stress, TSC22D, WNK, and NRBP family members physically associate into biomolecular condensates, a process that is dependent on intrinsically disordered regions (IDRs). A close examination of these protein families across metazoans revealed that TSC22D genes evolved alongside a domain in NRBPs that specifically binds to TSC22D proteins, which we have termed NbrT (NRBP binding region with TSC22D), and this co-evolution is accompanied by rapid IDR length expansion in WNK-family kinases. Our study reveals that TSC22D, WNK, and NRBP genes evolved in metazoans to co-regulate rapid cell volume changes in response to osmolarity.

Summary: The intricate interplay between resident cells and the extracellular matrix (ECM) profoundly influences cancer progression. In triple-negative breast cancer (TNBC), ECM architecture evolves due to the enrichment of lysyl oxidase, fibronectin, and collagen, promoting distant metastasis. Here we uncover a pivotal transcription regulatory mechanism involving the epigenetic regulator UBR7 and histone methyltransferase EZH2 in regulating transforming growth factor (TGF)-β/Smad signaling, affecting the expression of ECM genes. UBR7 loss leads to a dramatic reduction in facultative heterochromatin mark H3K27me3, activating ECM genes. UBR7 plays a crucial role in matrix deposition in adherent cancer cells and spheroids, altering collagen content and lysyl oxidase activity, directly affecting matrix stiffness and invasiveness. These findings are further validated in vivo in mice models and TNBC patients, where reduced UBR7 levels are accompanied by increased ECM component expression and activity, leading to fibrosis-mediated matrix stiffness. Thus, UBR7 is a master regulator of matrix stiffening, influencing the metastatic potential of TNBC.

This research descibes a pioneering approach aimed at preparing zinc oxide nanoparticles (ZnO-NPs) with colchicine as the reducing and capping agent. Colchicine-loaded ZnO-NPs (CHZnO-NPs) were prepared by adding colchicine to the zinc sulfate heptahydrate solution. The CHZnO-NPs formulation was then characterized to determine the morphology, size, crystallinity, elemental composition and vibrational properties. Upon characterization, CHZnO-NPs were studied for their cytotoxic effect against the breast cancer cell line (MDA-MB-231). The successful biosynthesis of CHZnO-NPs was initially confirmed visually by the changes in the mixture color, from light-yellow to white cloudy. The best CHZnO-NPs formulation selected was F3, which possessed 10 mg/mL of colchicine. Formulation (F3) had the smallest mean particle diameter of 43.77 nm and the lowest zeta potential of −19.60 mV. It also had 92.21 ± 0.012 % encapsulation efficiency and 20.86 ± 0.005 % drug loading. Formulation (F3) displayed a hexagonal wurtzite structure with irregular morphology. The observation of colchicine peaks on the FTIR spectra of F3 proved the role of colchicine as a reducing and capping agent during the synthesis of ZnO-NPs. Besides, the in-vitro cell cytotoxicity study on the MDA-MB-231 cell line revealed a significant reduction in cell proliferation at the concentration of 25 μg of colchicine and F3. Further, studies on the cellular migration potential also demonstrated concentration-dependent activity. Overall, CHZnO-NPs were shown to be successfully synthesized via an environmental-friendly procedure and colchicine acted as a capping agent to regulate the particle size, and aggregation, in addition to its anticancer properties.

Summary: Background: The field of precision medicine endeavors to transform the healthcare industry by advancing individualised strategies for diagnosis, treatment modalities, and predictive assessments. This is achieved by utilizing extensive multidimensional biological datasets encompassing diverse components, such as an individual's genetic makeup, functional attributes, and environmental influences. Artificial intelligence (AI) systems, namely machine learning (ML) and deep learning (DL), have exhibited remarkable efficacy in predicting the potential occurrence of specific cancers and cardiovascular diseases (CVD). Methods: We conducted a comprehensive scoping review guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework. Our search strategy involved combining key terms related to CVD and AI using the Boolean operator AND. In August 2023, we conducted an extensive search across reputable scholarly databases including Google Scholar, PubMed, IEEE Xplore, ScienceDirect, Web of Science, and arXiv to gather relevant academic literature on personalised medicine for CVD. Subsequently, in January 2024, we extended our search to include internet search engines such as Google and various CVD websites. These searches were further updated in March 2024. Additionally, we reviewed the reference lists of the final selected research articles to identify any additional relevant literature. Findings: A total of 2307 records were identified during the process of conducting the study, consisting of 564 entries from external sites like arXiv and 1743 records found through database searching. After 430 duplicate articles were eliminated, 1877 items that remained were screened for relevancy. In this stage, 1241 articles remained for additional review after 158 irrelevant articles and 478 articles with insufficient data were removed. 355 articles were eliminated for being inaccessible, 726 for being written in a language other than English, and 281 for not having undergone peer review. Consequently, 121 studies were deemed suitable for inclusion in the qualitative synthesis. At the intersection of CVD, AI, and precision medicine, we found important scientific findings in our scoping review. Intricate pattern extraction from large, complicated genetic datasets is a skill that AI algorithms excel at, allowing for accurate disease diagnosis and CVD risk prediction. Furthermore, these investigations have uncovered unique genetic biomarkers linked to CVD, providing insight into the workings of the disease and possible treatment avenues. The construction of more precise predictive models and personalised treatment plans based on the genetic profiles of individual patients has been made possible by the revolutionary advancement of CVD risk assessment through the integration of AI and genomics. Interpretation: The systematic methodology employed ensured the thorough examination of available literature and the inclusion of relevant studies, contributing to the robustness and reliability of the study's findings. Our analysis stresses a crucial point in terms of the adaptability and versatility of AI solutions. AI algorithms designed in non-CVD domains such as in oncology, often include ideas and tactics that might be modified to address cardiovascular problems. Funding: No funding received.

Summary: The emergence of multidrug resistance in cancer cells necessitates the development of new therapeutic modalities. One way cancer cells orchestrate energy metabolism and redox homeostasis is through overloaded iron pools directed by iron regulatory proteins, including transferrin. Here, we demonstrate that targeting redox homeostasis using nitrogen-based heterocyclic iron chelators and their iron complexes efficiently prevents the proliferation of liver cancer cells (EC50: 340 nM for IITK4003) and liver cancer 3D spheroids. These iron complexes generate highly reactive Fe(IV)=O species and accumulate lipid peroxides to promote oxidative stress in cells that impair mitochondrial function. Subsequent leakage of mitochondrial cytochrome c activates the caspase cascade to trigger the intrinsic apoptosis pathway in cancer cells. This strategy could be applied to leverage the inherent iron overload in cancer cells to selectively promote intrinsic cellular apoptosis for the development of unique iron-complex-based anticancer therapeutics.

Purpose: To describe examination and findings in a case of mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) with particular focus on the ocular sequelae from diabetes. Observations: Neovascular glaucoma is not a common manifestation of MELAS. Conclusions and Importance: We present a rare case of neovascular glaucoma in a patient with MELAS with a history of diabetes, hearing loss, and macular dystrophy. MELAS should be suspected in patients with this constellation of symptoms.

The manuscript is a critical commentary on the article ‘Does blame always shift? Examining the impact of workplace safety communication language on post-accident blame attributions for multiple entities’. In this commentary, I find that the reasoning provided for the non-shifting of blame across entities in the causal chain is not adequate. I use a zero-sum game analogy for blame attributions to provide evidence for this inadequacy. In this commentary, I further point out that the focal article does not account for the similarities and dissimilarities between the people making the attributions and the people against whom attributions are being made.

We developed a well-characterized human induced pluripotent stem cell (iPSC) line obtained from healthy individuals' peripheral blood mononuclear cells (PBMC). The PBMCs were primed and reprogrammed using a non-integrating sendai viral vector, and the iPSC lines demonstrated complete differentiation capacity. This line, YBLi004-A, is available and registered in the human pluripotent stem cell registry. The line's legitimacy was validated using pluripotent marker expression, in vitro differentiation into three germ layers (ectoderm, mesoderm, and endoderm), karyotyping, and STR analysis. This iPSC line could be used as a healthy control for studies involving disease-specific-iPSCs, e.g. drug toxicity and efficacy testing.

In present study, a wall structure of SS309L was constructed through Gas metal arc welding based Wire-arc additive manufacturing process. The wall structure of SS309L underwent investigation for microstructure and mechanical properties at three positions along the horizontal deposition direction. Mechanical assessments, including microhardness testing, impact testing, tensile testing, and fractography, were conducted at three positions of walls. Microstructure study has shown a fine granular structure in addition to colony of columnar dendrites in bottom section, a columnar dendrites in middle section, and a mix of dendritic structure with even coarser structures in top section. The mean microhardness values were observed to be 159 ± 4.21 HV, 162 ± 3.89 HV, and 168 ± 5.34 HV for the top, middle, and bottom sections, respectively. Results of impact testing for the wall structure indicated greater strength compared to wrought SS309L. The tensile strength of the built structure showed average values of yield strength, ultimate tensile strength, and elongation to be 409.33 ± 7.66 MPa, 556.66 ± 6.33 MPa, and 39.66 ± 2.33 %, respectively. In comparison, wrought 309 L steel typically exhibits tensile strengths in the range of 360–480 MPa for yield strength, 530–650 MPa for ultimate tensile strength, and 35–45 % elongation. Thus, the obtained tensile strength results for the wall structure fall within the range of tensile strength observed in wrought 309 L steel. Fractography of the tensile and impact specimens, as obtained through Scanning Electron Microscopy, revealed the superior ductility of the fabricated component. This study contributes valuable insights into the manufacturing of wall structure and their analysis regarding mechanical characteristics.

The present work focuses on the impact of expanded graphite (EG) nano-powder along with spark-on-duration (Ton) and spark-off-duration (Toff), and current as factors on increasing material removal rate (MRR), reduction of surface roughness (SR), tool wear rate (TWR), dimensional deviation (DD), and surface defects for Ni55.8Ti. Taguchi’s design having 4 factors at 3 levels was employed to perform the experimental trials. ANOVA has successfully validated the developed regression equations. EDM factors of PC, Toff, current, and Toff were found to be the largest contributing factors with the involvement of 76.91 %, 38.40 %, 34.36 %, and 44.54 % for MRR, TWR, SR, and DD respectively. TLBO algorithm was used in the present work to tackle the conflicting situation and to optimize the response variables. The simultaneous optimization conducted through the Teaching-learning-based optimization technique has yielded optimal parameters setting of Ton at 7 µs, Toff at 5 µs, PC at 1.5 g/L, and current at 10 A by giving optimal response values at MRR of 42.82 mm3/min, TWR of 0.4039 mm3/min, SR of 3.71 µm, and DD of 92.65 µm. Lastly, Scanning electron microscopy was utilized to check EG nano-powder significance on the machined parts' surface morphology.

Metastases within breast usually occur due to a primary malignancy in the contralateral breast. Breast metastases from extra mammary malignancies are known to be very rare and the primary tumors are reported to be melanoma, lung cancer, gastro-intestinal primary tumors, neuroendocrine tumors, sarcomas, ovarian tumors and lymphomas. Breast lymphomas comprise 0.04%-0.7% of all cases of breast malignancies and may manifest either as a primary or a secondary variety. A primary breast lymphoma is known to be more infrequent than a secondary breast lymphoma. In patients with breast metastases the usual clinical presentation is with multiple palpable masses and imaging evaluation is the mainstay for initial diagnosis. We report the imaging features seen in 2 almost identical cases of secondary breast lymphoma. At mammography, multiple, round to elliptical, sharply circumscribed, high-density masses were seen, in which spiculation, calcification and architectural distortion were conspicuously absent. On sonography, these round /oval masses were homogenously hypoechoic, sharply circumscribed, showed a thin echogenic rim with posterior acoustic enhancement and were moderately to profusely vascular on color Doppler examination. These imaging features should suggest the possible diagnosis of metastases from a hematogenous malignancy and an ultrasound guided biopsy should be performed. Once the etiology of lymphoma is confirmed, a rigorous multi- modality imaging work up to identify the primary site, stage the disease and document other sites of dissemination is warranted.

Objectives: Elderly patients with hematologic malignancies face the highest risk of severe COVID-19 outcomes. The infection's impact on different age groups remains unstudied in detail. Methods: We analyzed elderly patients (age groups: 65-70, 71-75, 76-80, and >80 years old) with hematologic malignancies included in the EPICOVIDEHA registry between January 2020 and July 2022. Univariable and multivariable Cox regression models were conducted to identify factors influencing death in COVID-19 patients with hematological malignancy. Results: The study included data from 3,603 elderly patients (aged 65 or older) with hematological malignancy, with a majority being male (58.1%) and a significant proportion having comorbidities. The patients were divided into four age groups, and the analysis assessed COVID-19 outcomes, vaccination status, and other variables in relation to age and pandemic waves. The 90-day survival rate for patients with COVID-19 was 71.2%, with significant differences between groups. The pandemic waves had varying impacts, with the first wave affecting patients over 80 years old, the second being more severe in 65-70, and the third being the least severe in all age groups. Factors contributing to 90-day mortality included age, comorbidities, lymphopenia, active malignancy, acute leukemia, less than three vaccine doses, severe COVID-19, and using only corticosteroids as treatment. Conclusion: These data underscore the heterogeneity of elderly hematological patients, highlight the different impacts of COVID-19 waves and the pivotal importance of vaccination, and may help in planning future healthcare efforts.

Synthesis of highly stable green light emitting CdTe quantum dots in aq. medium is discussed. The absorption spectroscopy revealed formation of dots of the size about 4 nm. Effect of pH controlling reagents, capping agent and reaction time is studied. Highly stable CdTe of about 3 nm size with excellent fluorescence are synthesized in aqueous medium in about 30 min. The CdSe layer was successfully deposited around CdTe core to eventually isolate re-dispersible cubic CdTe/CdSe core/shell QDs.

Summary: Background: The COVID-19 pandemic heightened risks for individuals with hematological malignancies due to compromised immune systems, leading to more severe outcomes and increased mortality. While interventions like vaccines, targeted antivirals, and monoclonal antibodies have been effective for the general population, their benefits for these patients may not be as pronounced. Methods: The EPICOVIDEHA registry (National Clinical Trials Identifier, NCT04733729) gathers COVID-19 data from hematological malignancy patients since the pandemic's start worldwide. It spans various global locations, allowing comprehensive analysis over the first three years (2020–2022). Findings: The EPICOVIDEHA registry collected data from January 2020 to December 2022, involving 8767 COVID-19 cases in hematological malignancy patients from 152 centers across 41 countries, with 42% being female. Over this period, there was a significant reduction in critical infections and an overall decrease in mortality from 29% to 4%. However, hospitalization, particularly in the ICU, remained associated with higher mortality rates. Factors contributing to increased mortality included age, multiple comorbidities, active malignancy at COVID-19 onset, pulmonary symptoms, and hospitalization. On the positive side, vaccination with one to two doses or three or more doses, as well as encountering COVID-19 in 2022, were associated with improved survival. Interpretation: Patients with hematological malignancies still face elevated risks, despite reductions in critical infections and overall mortality rates over time. Hospitalization, especially in ICUs, remains a significant concern. The study underscores the importance of vaccination and the timing of COVID-19 exposure in 2022 for enhanced survival in this patient group. Ongoing monitoring and targeted interventions are essential to support this vulnerable population, emphasizing the critical role of timely diagnosis and prompt treatment in preventing severe COVID-19 cases. Funding: Not applicable.

The water issue has emerged as a significant barrier to agricultural productivity, particularly in dry and semiarid agro-ecologies, particularly during the winter season. Superabsorbent hydrogels have been identified as effective tools for improving crop and water productivity in arid locations by enhancing moisture retention. The application of hydrogel to soil is commonly done as a basal application, and its effectiveness is heavily influenced by the moisture level present in the soil. Therefore, a two-year field study was carried out to study the effects of various hydrogels and their application techniques and to assess the efficacy of recently developed cross–linked hydrogels (SPG 1118 and Pusa hydrogel) on soil water distribution (both spatial and temporal), water productivity and profitability of red cabbage. The experiment consisted of two irrigation regimes [full irrigation (100% ETc) and limited irrigation (75% ETc)] assisted in main plots, with two type of hydrogels (Pusa Hydrogel and SPG 1118) and two methods of application [root dipping and soil application of hydrogels and Control with no application of hydrogel] assisted in sub plots. The field experiment was conducted using spilt plot design with three replications. The analysis of soil water distribution patterns reveals that the utilization of hydrogels has resulted in a notable increase of 3–6% in soil water content (SWC) under full irrigation conditions, as compared to plots subjected to limited water conditions. In comparison to plots without hydrogel application, the plots treated with SPG 1118 and Pusa hydrogel exhibited enhanced soil water content of 5–6% and 2–4%, respectively. Additionally, the application of hydrogels in the root dipping showed increased water availability in the crop's root zone compared to soil application in throughout the crop season. Thus, hydrogels with reduced irrigation application resulted in significantly higher crop water productivity (14%) and irrigation water productivity (8 – 14%) compared to full irrigation levels. Likewise, root dipping of SPG 1118 led in considerable improvement in CWP (12–14%) and IWP (11–12%) over no hydrogel applied plots. In relation to profitability, the adoption of full irrigation in conjunction with SPG 1118 hydrogel resulted in an 8% increase in the benefit cost ratio compared to the control plots. Hence, the use of the unique SPG 1118 hydrogel through direct application to the roots, whether under conditions of full or limited irrigation, presents an inventive approach to address the growing issues of water shortages and sustainability in countries experiencing water stress.

Developing sustainable manufacturing methods that balance environmental and economic aspects is challenging. A comprehensive analysis of the economics of machining and carbon emissions is essential to encourage adopting sustainable practices. This work presents the machinability and comparative sustainability analysis of Nimonic 80 superalloy when it is machined utilizing a novel, environmentally friendly vegetable oil-based hybrid nanofluid-minimum quantity lubrication (MQL) and liquid carbon dioxide (LCO2) technique. The main objective is to comprehend the efficacy of the proposed approach on tool life, surface roughness, power consumption, total machining costs, and carbon emissions. Compared to other machining conditions, the use of hybrid nanofluid-MQL under 100 m/min cutting speed prevented rapid flank wear and considerably increased tool life by about 17–59 %. The change in cutting speed from 100 to 150 m/min has resulted in reduced tool life about 13–42 % under the selected environments. In addition, when compared to dry, flood, and MQL machining, the use of hybrid nanofluid-MQL and LCO2 reduced surface roughness by around 16–45 % at 150 m/min. Sustainability analysis revealed that machining at 150 m/min resulted in decreased costs ranging from 6.1 % to 36.4 % for selected cutting environments. Applying hybrid nanofluid-MQL lowered carbon emissions by 16.83 %, whereas LCO2 reduced carbon emissions by 14.6 % at 100 m/min. At 150 m/min, hybrid nanofluid-MQL and LCO2 lowered carbon emission by 22.3 % and 21.5 % at 150 m/min compared to dry machining. Compared to alternative cutting environments, hybrid nanofluid-MQL and LCO2 applications have longer tool lives, lower machining costs, and carbon emissions. As a result, they are economical and environmentally friendly.

Rationale & Objective: The incidence of arrhythmia varies by time of day. How this affects individuals on maintenance dialysis is uncertain. Our objective was to quantify the relationship of arrhythmia with the time of day and timing of dialysis. Study Design: Secondary analysis of the Monitoring in Dialysis study, a multicenter prospective cohort study. Settings & Participants: Loop recorders were implanted for continuous cardiac monitoring in 66 participants on maintenance dialysis with a follow up of 6 months. Exposure: Time of day based on 6-hour intervals. Outcomes: Event rates of clinically significant arrhythmia. Analytical Approach: Negative binomial mixed effects regression models for repeated measures were used to evaluate data from the Monitoring in Dialysis study for differences in diurnal patterns of clinically significant arrhythmia among those with end-stage kidney disease with heart failure and end-stage kidney disease alone. We additionally analyzed rates according to presence of heart failure, time of dialysis shift, and dialysis versus nondialysis day. Results: Rates of clinically significant arrhythmia peaked between 12:00 AM and 5:59 AM and were more than 1.5-fold as frequent during this interval than the rest of the day. In contrast, variations in atrial fibrillation peaked between 6:00 AM and 11:59 AM, but variations across the day were qualitatively small. Clinically significant arrhythmia occurred at numerically higher rate in individuals with end-stage kidney disease and heart failure (5.9 events/mo; 95% CI, 1.3-26.8) than those without heart failure (4.0 events/mo; 95% CI, 0.9-17.9). Although differences in overall rate were not significant, their periodicity was significantly different (P

We present one-pot colloidal synthesis of copper indium telluride (CITe) from respective metal salts with sodium tellurite in 1-octadecene with variation in surfactant and the reaction temperature between 200 and 300 °C. Oleic acid and/or oleyl amine are employed to initially, generate tellurides of individual element at intermediate stage. The tuning of reaction parameter including temperature variations play important role for the formation of phase-pure CuInTe2 nanocrystals with a band-gap of about 1.15 eV. The phase-purity was confirmed by XRD. EMI Shielding efficiency of CITe/PVA film can be enhanced to the tune of −8.84 dB by use of silver nano-particles. The composite can be suitable for X-band applications.

Background: pgaB associated biofilm formation in Acinetobacter baumannii enhances the virulence in concert with the high propensity of drug resistance. This research is thus aimed to characterize the pgaB gene molecularly and to examine its co-occurrence with MDR. Methodology: MDR strains of A. baumannii (N = 73) were selected to detect the formation of biofilms. Genomic DNA was extracted further and screened for pgaB followed by amplicon sequencing from the representative strains. Frequency of its distribution in different groups of drug resistant strains at a significant p-value of

Computer-aided diagnosis (CAD) systems play a vital role in modern research by effectively minimizing both time and costs. These systems support healthcare professionals like radiologists in their decision-making process by efficiently detecting abnormalities as well as offering accurate and dependable information. These systems heavily depend on the efficient selection of features to accurately categorize high-dimensional biological data. These features can subsequently assist in the diagnosis of related medical conditions. The task of identifying patterns in biomedical data can be quite challenging due to the presence of numerous irrelevant or redundant features. Therefore, it is crucial to propose and then utilize a feature selection (FS) process in order to eliminate these features. The primary goal of FS approaches is to improve the accuracy of classification by eliminating features that are irrelevant or less informative. The FS phase plays a critical role in attaining optimal results in machine learning (ML)-driven CAD systems. The effectiveness of ML models can be significantly enhanced by incorporating efficient features during the training phase. This empirical study presents a methodology for the classification of biomedical data using the FS technique. The proposed approach incorporates three soft computing-based optimization algorithms, namely Teaching Learning-Based Optimization (TLBO), Elephant Herding Optimization (EHO), and a proposed hybrid algorithm of these two. These algorithms were previously employed; however, their effectiveness in addressing FS issues in predicting human diseases has not been investigated. The following evaluation focuses on the categorization of benign and malignant tumours using the publicly available Wisconsin Diagnostic Breast Cancer (WDBC) benchmark dataset. The five-fold cross-validation technique is employed to mitigate the risk of over-fitting. The evaluation of the proposed approach's proficiency is determined based on several metrics, including sensitivity, specificity, precision, accuracy, area under the receiver-operating characteristic curve (AUC), and F1-score. The best value of accuracy computed through the suggested approach is 97.96%. The proposed clinical decision support system demonstrates a highly favourable classification performance outcome, making it a valuable tool for medical practitioners to utilize as a secondary opinion and reducing the overburden of expert medical practitioners.

At the moment, there is a growing interest in composite materials with matrices based on thermoplastic polymers; these materials are superior to traditional carbon fiber plastics due to higher fracture toughness and impact strength, low smoke generation during combustion, and high thermal and chemical resistance. The deformation behavior of such composite materials due to the high plastic deformation of the matrix differs from the behavior of traditional composites, which must be considered when performing calculations. In our study, as a model object, the features of the microstructure of single carbon thread impregnated with polysulfone were studied in order to evaluate the distribution of misorientation angles of elementary fibers, the degree of their damage, the thickness of the polymer matrix interlayers between elementary fibers in threads impregnated with more viscous thermoplastic binders. Statistical analysis of a large array of micrographs was carried out using specially developed algorithms for computer processing of electron microscopic images of a composite material. Algorithms for processing arrays of images using machine vision algorithms are proposed. Based on the analysis of the data array, the distributions of carbon fibers impregnated with polysulfone were plotted over the misorientation angle of the filaments and over the interfilament distance in the longitudinal and cross sections of the fiber. Using the machine learning method, an algorithm for detecting violations of the filament structure was implemented. The data obtained can be used to refine the calculations of the strength and deformation characteristics of composite materials with thermoplastic matrices.

Background: Despite successful mitral valve replacement (MVR), many patients remain in AF. Flecainide can be useful in these patients but has not been used because of underlying structural heart disease. Methods: We assessed oral flecainide for conversion and maintenance of SR in 25 patients of chronic rheumatic AF following MVR (age 34.4 yrs, mean AF duration: 3.6 yrs). Non-converters underwent DC cardioversion at 24 h and 4 weeks. Patients received flecainide and bb/diltiazem at discharge. Results: Single oral dose of Flecainide achieved SR in 6/25 (24%) while 19/25 achieved SR after DCC; at 24 h 21/25 (84%) were in SR. With mean flecainide dose (93.10 ± 9.40 mg), successful maintenance of SR at 6 months was seen in 16/23 (69.5%). No significant changes in PR interval, QRS duration or QTc were noted; flecainide was well tolerated. Patients in SR had significantly better functional status, QOL scores and higher LA strain at 6 months (25.25 vs 17.43%, p 21% for predicting SR were 87.5/71.43% and 100/85.71% respectively. Conclusion: Oral flecainide was safe and effective in post MVR rheumatic AF patients; maintenance of SR was achieved in 76% of initial converters and 64% of overall population, with better LA strain values. More studies are needed to validate these results.

Objectives: The presentation and outcomes of acute decompensated heart failure (ADHF) during COVID times (June 2020 to Dec 2020) were compared with the historical control during the same period in 2019. Methods: Data of 4806 consecutive patients of acute HF admitted in 22 centres in the country were collected during this period. The admission patterns, aetiology, outcomes, prescription of guideline-directed medical therapy (GDMT) and interventions were analysed in this retrospective study. Results: Admissions for acute heart failure during the pandemic period in 2020 decreased by 20% compared to the corresponding six-month period in 2019, with numbers dropping from 2675 to 2131. However, no difference in the epidemiology was seen. The mean age of presentation in 2019 was 61.75 (±13.7) years, and 59.97 (±14.6) years in 2020. There was a significant decrease in the mean age of presentation (p = 0.001). Also. the proportion of male patients decreased significantly from 68.67% to 65.84% (p = 0.037). The in-hospital mortality for acute heart failure did not differ significantly between 2019 and 2020 (4.19% and 4.,97%) respectively (p = 0.19). The proportion of patients with HFrEF did not change in 2020 compared to 2019 (76.82% vs 75.74%, respectively). The average duration of hospital stay was 6.5 days. Conclusion: The outcomes of ADHF patients admitted during the Covid pandemic did not differ significantly. The length of hospital stay remained the same. The study highlighted the sub-optimal use of GDMT, though slightly improving over the last few years.

Objectives: Ivabradine may have a role in rate control of atrial fibrillation (AF) due to effects on HCN channels in AV node. We studied role of Ivabradine in rate control of rheumatic AF. Methods: 80 patients, rheumatic AF, HR > 100 bpm (age 47 ± 11 yrs, AF duration 6.8 ± 2.9 years, rate 131 ± 16 bpm) on maximally tolerated ββ or CCB's, randomized to Ivabradine or escalated ββ/CCB. Ivabradine started @ 2.5 mg BD; increased to 5 mg BD if inadequate response at 1 week (failure to decrease HR 1 EHRA class; baseline 60% vs 17%3Better LA Strain (22.8 ± 2.8% vs 20.6 ± 2.5%)Ivabradine was well tolerated and there was no drug withdrawal. Conclusion: Our data suggest that Ivabradine can be an option for rate control in rheumatic AF.

Adoptive cell therapy of donor-derived, antigen-specific T cells expressing native T cell receptors (TCRs) is a powerful strategy to fight viral infections in immunocompromised patients. Determining the fate of T cells following patient infusion hinges on the ability to track them in vivo. While this is possible by genetic labeling of parent cells, the applicability of this approach has been limited by the non-specificity of the edited T cells. Here, we devised a method for CRISPR-targeted genome integration of a barcoded gene into Epstein-Barr virus-antigen-stimulated T cells and demonstrated its use for exclusively identifying expanded virus-specific cell lineages. Our method facilitated the enrichment of antigen-specific T cells, which then mediated improved cytotoxicity against Epstein-Barr virus-transformed target cells. Single-cell and deep sequencing for lineage tracing revealed the expansion profile of specific T cell clones and their corresponding gene expression signature. This approach has the potential to enhance the traceability and the monitoring capabilities during immunotherapeutic T cell regimens.

In most business and residential organizations, Diesel Generators (DG) is a viable supplementary power source for ensuring an undisturbed power supply. The DG is a hybrid machine that generates electrical energy using a Diesel Engine (DE) and an Electric Generator (EG). By routinely monitoring crucial machine parameters, alternative power source efficiency can be improved. Furthermore, Condition Monitoring Systems (CMS) based on the Internet of Things (IoT) have supplanted the traditional equipment maintenance method. Predictive maintenance is also an important building block of Industry 4.0, whose entire process and performance can be fully understood by using IoT-enabled Remote Monitoring (RM) schemes. Firstly, this paper introduces a remote monitoring and data acquisition scheme to realize the concept of predictive maintenance. Secondly, this article discusses a strategy for real-time observation of DG parameters as well as a comprehensive analysis of various metrics. Thirdly, this research article includes a monitoring and analysis scheme of crucial factors in a DG, like the speed of an engine, voltage output, the current produced, power factor, coolant required, fuel consumption, and battery health. Different mathematical models are formulated by correlating experimental data and estimating the coefficients. Finally, to create suitable real-time warnings under critical circumstances, a fuzzy logic-based Decision Support System (DSS) and web-based integration elements are presented.

Objective: To find out differences in the presentation, management and outcomes of COVID-19 infected STEMI patients compared to age and sex-matched non-infected STEMI patients treated during the same period. Methods: This was a retrospective multicentre observational registry in which we collected data of COVID-19 positive STEMI patients from selected tertiary care hospitals across India. For every COVID-19 positive STEMI patient, two age and sex-matched COVID-19 negative STEMI patients were enrolled as control. The primary endpoint was a composite of in-hospital mortality, re-infarction, heart failure, and stroke. Results: 410 COVID-19 positive STEMI cases were compared with 799 COVID-19 negative STEMI cases. The composite of death/reinfarction/stroke/heart failure was significantly higher among the COVID-19 positive STEMI patients compared with COVID-19 negative STEMI cases (27.1% vs 20.7% p value = 0.01); though mortality rate did not differ significantly (8.0% vs 5.8% p value = 0.13). Significantly lower proportion of COVID-19 positive STEMI patients received reperfusion treatment and primary PCI (60.7% vs 71.1% p value=< 0.001 and 15.4% vs 23.4% p value = 0.001 respectively). Rate of systematic early PCI (pharmaco-invasive treatment) was significantly lower in the COVID-19 positive group compared with COVID-19 negative group. There was no difference in the prevalence of high thrombus burden (14.5% and 12.0% p value = 0.55 among COVID-19 positive and negative patients respectively) Conclusions: In this large registry of STEMI patients, we did not find significant excess in in-hospital mortality among COVID-19 co-infected patients compared with non-infected patients despite lower rate of primary PCI and reperfusion treatment, though composite of in-hospital mortality, re-infarction, stroke and heart failure was higher.

Background: Atrial flutter (AFL) is a common arrhythmia associated with significant morbidity, yet the incremental burden of this condition has not been well documented. Objective: Using real-world data, we sought to evaluate the healthcare use and cost burden of incident AFL in the United States Methods: From 2017 to 2020, persons with an incident diagnosis of AFL were identified through Optum Clinformatics, a nationally representative administrative claims database of commercially insured individuals in the United States. We constructed 2 cohorts (AFL patient; non-AFL comparator) and used a matching weights method to balance covariates between cohorts. Using logistic regression and general linear models, 12-month all-cause and cardiovascular (CV)-related health care use (inpatient, outpatient, emergency room [ER] visits, and other) as well as medical expenditures were compared between the matched cohorts. Results: The matching weight sample sizes were 13,270 for AFL and 13,683 for the non-AFL cohorts. In the AFL cohort, ∼71% were at least 70 years of age, 62% identified as male, and 78% identified as White. The AFL cohort had significantly higher health care use, including all-cause (relative risk [RR] 1.14; 95% confidence interval [CI] 1.11–1.18) and CV-related ER visits (RR 1.60; 95% CI 1.52–1.70) compared with the non-AFL cohort. Mean total health care costs (per patient annually) were almost $21,783 (95% CI $18,967–$24,599) higher among patients with AFL compared to those without AFL ($71,201 vs $49,418, respectively; P

Primary monophasic synovial sarcoma of the lung is an extremely rare malignant mesenchymal tumor that can develop at any anatomic site. Synovial sarcoma is considered a high grade tumor with a poor prognosis. Metastatic pulmonary sarcoma is much more common. Hence primary lesion elsewhere in the body needs exclusion. No clinical or radiological features are specific for pulmonary sarcoma, often it is confused with bronchogenic carcinoma. Therefore biopsy is needed to establish the diagnosis of this rare tumor. We hereby present two cases of histologically proven primary monophasic synovial sarcoma of lung. The imaging features of this rare disease is reviewed.

Summary: Background: Infections are the main reason for mortality during acute leukaemia treatment and invasive aspergillosis (IA) is a major concern. Allogeneic stem cell transplantation (alloSCT) is a standard therapy and often is the only live-saving procedure in leukaemia patients. The profound immunodeficiency occurring after alloSCT led to high IA-associated mortality in the past. Therefore, patients with IA were historically considered transplant-ineligible. Recently, there has been improvement of anti-fungal management including novel anti-fungal agents. As a result, more leukaemia patients with IA are undergoing alloSCT. Outcome has not been prospectively assessed. Methods: We performed a prospective study in acute leukaemia patients undergoing alloSCT to analyse the impact of a prior history of probable or proven IA (pre-SCT IA). The primary endpoint was 1-year non-relapse mortality (NRM). Relapse free survival and overall survival were analysed as secondary endpoints. Findings: 1439 patients were included between 2016 and 2021. The incidence of probable or proven pre-SCT IA was 6.0% (n = 87). The cumulative incidence of 1-year NRM was 17.3% (95% CI 10.2–26.0) and 11.2% (9.6–13.0) for patients with and without pre-SCT IA. In multivariate analyses the hazard ratio (HR) for 1-year NRM was 2.1 (1.2–3.6; p = 0.009) for patients with pre-SCT IA. One-year relapse-free survival was inferior in patients with pre-SCT IA (59.4% [48.3–68.9] vs. 70.4 [67.9–72.8]; multivariate HR 1.5 [1.1–2.1]; p = 0.02). Consequently, 1-year overall survival was lower in patients with pre-SCT IA: (68.8% [57.8–77.4] vs. 79.0% [76.7–81.1]; multivariate HR 1.7 [1.1–2.5]; p = 0.01). Interpretation: Pre-SCT IA remains to be significantly associated with impaired alloSCT outcome. On the other hand, more than two thirds of patients with pre-SCT IA were alive at one year after alloSCT. IA is not anymore an absolute contraindication for alloSCT because the majority of patients with IA who undergo alloSCT benefit from this procedure. Funding: There was no external funding source for this study.