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To study the outcomes of noninvasive ventilation (NIV) administered through a tabletop device for coronavirus disease 2019 acute respiratory distress syndrome in the respiratory intermediate care unit (RIMCU) at a tertiary care hospital in India.We retrospectively studied a cohort of hospitalized patients deteriorating despite low-flow oxygen support who received protocolized management with positive airway pressure using a tabletop NIV device in the RIMCU as a step-up rescue therapy from July 30, 2020 to November 14, 2020. Treatment was commenced on the continuous positive airway pressure mode up to a pressure of 10 cm of HIn total, 246 patients were treated in the RIMCU during the study period. Of these, 168 received respiratory support via a tabletop NIV device as a step-up rescue therapy. Their mean age was 54 years, and 83% were men. Diabetes mellitus (78%) and hypertension (44%) were the commonest comorbidities. Treatment was successful with tabletop NIV in 77% (129/168) of the patients; of them, 41% (69/168) received treatment with continuous positive airway pressure alone and 36% (60/168) received additional increased inspiratory pressure via the bilevel positive air pressure mode.Respiratory support using the tabletop NIV device was an effective and economical treatment for coronavirus disease 2019 acute respiratory distress syndrome. Further studies are required to assess the appropriate time of initiation for maximal benefits and judicious utilization of resources.

Taking Venezuela’s complaint against the United States at the World Trade Organisation (“WTO”) as the inflection point, this article will explore whether a characterisation of cryptocurrencies as a ‘currency’ (similar to fiat currency) would ensure that cryptocurrencies are not covered by WTO disciplines on goods and services. Despite customary international law principles such as ius cudendae monetae and the persuasive argument that a ‘currency’ is neither a good or service - the article answers this question in the negative. In doing so, the article builds on the author’s blog post which was the first to analyse Venezuela’s complaint. It will divide issues that can arise during such a WTO dispute into three categories: threshold, substantive and compliance issues. Threshold issues would involve interpretative challenges to determine whether the General Agreement on Trade in Services (“GATS”) and General Agreement on Tariffs and Trade (“GATT”) regulate cryptocurrencies. Since the GATS Schedule of Commitments has historically been interpreted in a technologically neutral manner, identifying cryptocurrencies as a ‘service’ may not prove to be insurmountable. However, Howden’s claim that cryptocurrencies are barter goods that will be subject to disciplines of the GATT deserves critical scrutiny – more so because the GATT regulates tangible products and it also contains specific provisions relating to balance-of-payments. The article also undertakes a theoretical analysis of the heterodoxical nature of the cryptocurrency to evaluate whether it can be classified as a ‘security’ within the meaning of the GATS’ Annex on Financial Services. These threshold issues are, however, the tip of the iceberg. Once a WTO Panel commences its analysis, the substantive issues for consideration would involve determining whether a unique product such as cryptocurrencies has a ‘like product’ in the respondent member’s market. Further, the Panel’s analysis would involve a consideration relating to ‘general exceptions’ under Article XIV, GATS or Article XX, GATT which would entail an examination of whether the measure was necessary to achieve, amongst other regulatory objectives, either compliance with domestic regulations or the maintenance of public order. If the measure adversely impacting cryptocurrencies is determined to be WTO-inconsistent, issues of compliance and suspension of concessions are imminent. WTO Panels have historically estimated the quantum of suspensions of concessions by determining the trade volumes affected by the WTO-inconsistent measure and factoring it for a future time period. The decentralised nature of the distributed ledger technology underlying cryptocurrencies complicates any country-specific quantification of the impact on trade volumes of cryptocurrencies affected by the WTO inconsistent measure. Accordingly, determining suspensions of concessions in relation to cryptocurrencies would require significant judicial innovation by the arbitrator. The institutional perils of subjecting cryptocurrencies to WTO's disciplines highlighted in the article necessitate collective action by the WTO members to arrive at a normative framework to regulate cryptocurrencies at the WTO. The article concludes by arguing that the ongoing e-commerce negotiations between 76 member states at the WTO would be the most suitable forum for formulating such global rules. This is a Working Paper prepared for presentation at the conference on "International Economic Law in the Era of Distributed Ledger Technology" at the University of Turin, Italy on April 9, 2019. The full paper would soon be published in a leading journal.

The purpose of this study was to evaluate the efficacy of the enhanced PS femoral component design released in 2008 by DePuy. The patellar clunk syndrome has been reported in a significant number of patients following total knee arthroplasty. Design modifications of the implant have been made to reduce the incidence of the patellar clunk, especially in the posterior substituted designs.130 total knee replacements performed using the enhanced PS femoral components were followed-up with clinical and radiographic evaluations.Patellar clunk was seen in 3 of the 130 knees (2%). This is much less than the incidence of patellar clunk reported until now.Removal of the sharp ridge in the intercondylar groove in the newer implant seems to have been effective in reducing the incidence of the patellar clunk. It also indicates that the sharp ridge was the most probable cause of the clunk.

An essay based on the theme - "Digital Creativity: Culture Reimagined”. This was WIPO's theme for the 2016 World Intellectual Property Day.

Objectives: The aim of this report was to study the effect of chronic stretch reversal on the electrophysiological characteristics of the atria in humans.Background: Atrial stretch is an important ...

The principal cause of the clinical failure of bioprosthetic heart valves fabricated from glutaraldehyde-pretreated bovine pericardial valves is calcification. The present investigation describes the mineralization of glutaraldehyde-treated bovine pericardium (GBP), in an extra-circulatory environment and the possible methods of prevention via metal ions. Calcification was examined on GBP incubated in metastable solutions of calcium phosphate and the role of certain anesthetic drugs, ferric ions and magnesium ions in the media was evaluated. It seems that the addition of ethyl alcohol, pentothal and xylocaine in the calcium phosphate solutions, variably inhibited the GBP calcification. The metals like Fe3+ ions and Mg2+ ions and their combinations also substantially reduced the GBP mineralization. It is assumed that ferric ions may slow down or retard the calcification process by delaying the proper formation of hydroxyapatite while magnesium ions disrupt the growth of these crystals by replacing Ca2+. Hence, it is conceivable that a combination therapy-via local delivery of low levels of ferric ions and magnesium ions-may prevent the GBP-associated calcification. Further, a very low daily intake of alcohol appears to be beneficial to reduce the profile of calcium deposition at tissue interfaces.

Entrepreneurial firms, at their birth, have a high probability of failure due to the “liability of newness.” Even firms that surmount the initial challenges and get to the stage of issuing an initial pubic offering (IPO) still face a significant hazard rate. In this paper, we examine whether, in the post-IPO stage, strategic choice matters. We examine whether management actions following an IPO enhance the firm’s survival and, second, if they do, which actions really make a difference. We analyzed a sample of 104 internet-related firms that issued IPOs between 1995 and 1999, and find that management action in three areas - market expansion, entry into alliances, and expansion or reconfiguration of the top management team and/or board of directors - significantly enhance firm survival.

The hydrolytic and enzymic degradation of poly( l -lactic acid) (PLA) and poly(γ-benzyl l -glutamate) (PBGA) films, together with a series of surface treatments, were studied, as a function of exposure time. The degradation of these polymers was monitored by weight loss, contact angle, pH changes and tensile strength studies. Glutaraldehyde treatment retained the maximum strength of PLA in buffer, followed by carbodiimide, compared with control films. On the other hand, plasma glow reversed the effect. The ability of α-chymotrypsin, carboxypeptidase, ficin, esterase, bromelain and leucine aminopeptidase to modulate the degradation of PLA and PBGA was also investigated. Addition of these enzymes to the polymer-buffer system reduced the tensile strength of these polymers variably. Among the six enzymes studied, leucine aminopeptidase showed the highest enzymic effect on the degradation of the glutaraldehyde-treated and bare PLA or bare PBGA films. However, glutaraldehyde-cross-linked PLA demonstrated maximum stability in buffers or in all other enzyme systems studied compared with bare PLA. It is conceivable that surface treatments on these polymers might have altered their physical and chemical configuration and the subsequent degradation properties. Surface modifications may provide new ways of controlling the biodegradation of polymers for a variety of biomedical applications.

that irregular ventricular activation alters ion channel expression and cellular electrophysiology. Methods:mRNA expression of ion channels and accessory subunits was examined in neonatal rat ventricular myocytes (NVCMs) paced either regularly or irregularly for 24 hours to simulate ventricular activation in sinus rhythm (SR) and AF respectively. Relevant transmembrane currents were measured after 96 hours of regular vs irregular pacing using whole cell patch clamp approach. LV myocardium from end-stage heart failure (ESHF) patients in SR and chronic AF undergoing cardiac transplantation also underwent mRNA expression studies as guided by results from the NVCMmodel. Results: Irregular pacing induced a 48% increase in NVCMmRNA expression of KCNA4. However, there was no difference in Ito current density across pacing strategies. Irregular pacing induced trivial changes in NVCM mRNAexpression for theNa channel SCN5A (11% reduction), and the Ca channels CACNA1C (19% increase), and CACNA1H (8% decrease). No differences were observed for ion channels CACNA1G, KCNQ1, KCNH2, KCND3, KCNJ2, and KCNJ11; accessory subunits KCNE1, KCNE2, KCNIP2, and ABCC9; and gap junction subunits GJA1 and GJA5. There were no differences in mRNA expression of SCN5A, CACNA1C, CACNA1H, or KCNA4 in LV myocardium from ESHF patients in AF vs SR. Conclusion: In an acute model, irregular ventricular a i a a

The search for a nonthrombogenic membrane having high permselectivity to be used for hemodialysis applications continues to be a field of extensive investigation. A series of membranes was prepared by air drying the thin layers of albumin: chitosan [a (1 → 4)-2-amino-2-deoxy-β- d -glucan] blends in a ratio of 7:3 (chitosan:albumin). The albumin blended chitosan membranes showed high permeability properties for low molecular weight compounds. Nonthrombogenic albumin: chitosan blended membranes were derived by immobilizing bioactive molecules like PGE1, hirudin, heparin, or AT-III on liposome modified membranes, via the carbodiimide functional moiety. Such novel membranes demonstrated good permeability properties for small molecules and showed dramatic reduction in platelet attachment; though they exhibited variable degrees of wettability. The interfacial changes arising from surface modifications did not cause any significant interference with their permeability and mechanical properties.

In order to develop artificial materials for prolonged use in the vascular system, the complicated process of surface-induced thrombosis needs to be better understood. It seems lipids have a profound role toward the thrombosis and hemostasis mechanism, though adequate studies using lipids are not available to demonstrate its part in the thromboembolic phenomena that occur at the blood—foreign material interface. We have studied the interfacial phenomena of three lipids, namely, cholesterol, cephalin, and sphingosine, and their interaction with proteins and vitamin C toward an artificial surface using contact angle and trace labeling methods. Platelet adhesion and plasma recalcification time are also carried out for further understanding of the complex phenomena. The preliminary results suggest that lipids can be adsorbed to the polymer surface and can interact with proteins and platelets at the interface. Furthermore, the behavior of all lipids toward blood—polymer interaction is not similar and may change depending on the nature of lipid, net charge of the lipid—adsorbed surface, and the lipid—protein/lipid—platelet interaction at the interface. Possible interactions of lipid with platelets and proteins are suggested, including the interaction with an artificial surface.

Protein adsorption and platelet adhesion are two important biological processes arising at the blood-prosthetic interface. The effect of Vitamins and antiplatelet drugs to modulate the surface induced platelet adhesion to polycarbonate was investigated using washed calf platelets in presence and absence of fibrinogen. This study also demonstrated the effects of Vitamins and antiplatelet drugs towards protein adsorption to an artificial surface. It seems Vitamin B, Vitamin E, combinations of Aspirin-Persantine, Aspirin-Vitamin C, a synthetic Polyelectrolyte and Galactosamine reduced the fibrinogen (fg) surface concentration from a mixture of proteins. These antiplatelet agents also enhanced the albumin surface concentration. This itself may be one of the parameters to reduce the platelet adhesion towards an artificial surface. A combination of Aspirin Vitamin C-Vitamin B6-Vitamin E inhibited the fibrinogen surface binding, which might be beneficial to improve the blood compatibility of an artificial surface.

To develop artificial materials for prolonged use in the vascular system, the complicated process of surface-induced thrombosis needs to be better understood. Steroidal hormones have a profound role in thrombosis and haemostasis, although adequate studies are not available to demonstrate their part in the thromboembolic phenomena that occur at the blood-foreign material interface. We studied the interfacial phenomena of five steroid hormonal drugs, Sustanon, Menstrogen, Mixogen, Durabolin and Ovral and their interaction with proteins and platelets toward an artificial surface using contact angle, polyacrylamide gel electrophoresis, trace labelling methods, etc. This study demonstrates the effect of these hormones to modulate platelet-surface attachment in the presence of platelet inducers. The addition of steroid hormones to the polymer-protein system can inhibit the level of surface-bound albumin where the fibrinogen binding to an artificial surface has been enhanced or unaltered. Steroids also increase platelet-surface attachment to variable degrees. Prolonged use of steroids or the oestrogen-containing oral contraceptive agents may not be advisable for patients having an artificial implant in contact with blood.

The effects of glucosamine, galactosamine, and mannosamine on platelet adhesion and coagulation induced by an artificial surface were investigated. Glucosamine and galactosamine showed both antiplatelet and anticoagulant effects, but in case of mannosamine none of the above effects was found significant. The three analogs studied were having the same molecular weight and common molecular structure, however from our preliminary observations it could be suggested, that the spatial arrangement of functional groups in the glucopyranose ring at C2, C4 positions were important for it's activity.

An attempt is made here to crosslink different proteins using glutaraldehyde on polycarbonate surface and to evaluate how such surfaces may effect the blood compatibility of the polymer, by investigating the interfacial energies of the modified polymer surfaces using contact angle techniques. The plasma recalcification time and platelet adhesion studies were also carried out to develop an understanding further. It has been observed that the increased molecular weight of proteins seems to encourage thrombosis.

The platelet adhesion test using washed human platelets was employed to assess the affinity of bare polycarbonate surface as well as fibrinogen-induced platelet adhesion in the presence of l -ascorbic acid. The role of l -ascorbic acid to reduce the adhering platelets on the surface was discussed.