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Burn injuries are a constant threat in war. Aspects of the modern battlefield increase the risk of burn injuries and pose challenges for early treatment. The initial resuscitation of a severely burn-injured patient often exceeds the resources available in front-line medical facilities. This stems mostly from the weight and volume of the intravenous fluids required. One promising solution to this problem is enteral resuscitation with an oral rehydration solution. In addition to being logistically easier to manage, enteral resuscitation may be able to mitigate secondary injuries to the gut related to burn shock and systemic immunoinflammatory activation. This has been previously studied in burn patients, primarily using electrolyte solutions, with promising results. Modern ORS containing sodium, potassium, and glucose in ratios that maximize gut absorption may provide additional benefits as a resuscitation strategy, both in terms of plasma volume expansion and protection of the barrier and immune functions of the gut mucosa. While enteral resuscitation is promising and should be used when other options are not available, further research is needed to refine an optimal implementation strategy.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jss.2007.12.793 Byline: K. Vinay Kumar, V. Ravi, Mahil Carr, N. Raj Kiran Keywords: Software development effort; Software cost estimation; Wavelet neural networks; Threshold accepting based wavelet neural network Abstract: Software development has become an essential investment for many organizations. Software engineering practitioners have become more and more concerned about accurately predicting the cost and quality of software product under development. Accurate estimates are desired but no model has proved to be successful at effectively and consistently predicting software development cost. In this paper, we propose the use of wavelet neural network (WNN) to forecast the software development effort. We used two types of WNN with Morlet function and Gaussian function as transfer function and also proposed threshold acceptance training algorithm for wavelet neural network (TAWNN). The effectiveness of the WNN variants is compared with other techniques such as multilayer perceptron (MLP), radial basis function network (RBFN), multiple linear regression (MLR), dynamic evolving neuro-fuzzy inference system (DENFIS) and support vector machine (SVM) in terms of the error measure which is mean magnitude relative error (MMRE) obtained on Canadian financial (CF) dataset and IBM data processing services (IBMDPS) dataset. Based on the experiments conducted, it is observed that the WNN-Morlet for CF dataset and WNN-Gaussian for IBMDPS outperformed all the other techniques. Also, TAWNN outperformed all other techniques except WNN. Author Affiliation: Institute for Development and Research in Banking Technology, Castle Hills Road #1, Masab Tank, Hyderabad 500 057, AP, India Article History: Received 30 May 2007; Revised 28 December 2007; Accepted 28 December 2007

Background:Chronic obstructive pulmonary disease (COPD) is a common, preventable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases.AIM: To study the correlation of Six Minutes Walk distance with Spirometric and demographic parameters in COPD patients.Material and Methods:Study Design:Hospital based Retrospective observational study.Study area: Dept. of. Pulmonary Medicine. Study Period:1 year. Study population: Patients who had symptomatology COPD attending OPD or admitted in the Dept. of. Pulmonary Medicine. Sample size: study consisted a total of 50 patients. Sampling method: Simple Random sampling method. Study tools and Data collection procedure: The cases were selected after fulfilling the requirements as mentioned in the inclusion and the exclusion criteria. Secondary data was collected from the records maintained at the department.Statistical Analysis: The data was collected, compiled and compared statistically by frequency distribution and percentage proportion. Quantitative data variables were expressed by using Descriptive statistics (Mean ± SD). Qualitative data variables were expressed by using frequency and Percentage (%).To assess correlation of 6MWD with demographic and clinical parameters, Pearson correlation was used. Results:When tested for the correlation between 6MWD and other variables in the study population, FVC and Severity of the disease were found to be significantly correlated with 6MWD.6MWD was positively correlated with FVC (Forced Vital Capacity) and negatively correlated with severity of the disease in the study population. Other variables were had positive or negative correlation with 6MWD but statistical significance was not observed.Conclusion:As 6MWD has statistically significant correlation with FVC & COPD severity, it can be used to grade COPD especially in resource-limited settings as well as in patients who cannot perform spirometry. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus is considered as hypercoagulable state, where hypercoagulability of blood result in acceleration of atherosclerosis and diabetic microvascular complications. Three recognized diabetic microvascular complications include diabetic neuropathy, diabetic nephropathy and diabetic retinopathy. The aim of the present study was to evaluate association of plasma fibrinogen levels with other variables in patients with any of the three-recognized diabetic microvascular complications: diabetic neuropathy, diabetic retinopathy or diabetic nephropathy. Methods: 104 patients of T2DM from in Medical unit-II and ophthalmology ward, Services Hospital, Lahore from April to October 2017 were included in present study. The patients were divided into two groups of 52 patients each. Group 1 comprised of Type 2 Diabetes Mellitus patients without any diabetic microvascular complications and Group II: Type 2 Diabetes Mellitus patients with any of three recognized diabetic microvascular complications: diabetic neuropathy, diabetic nephropathy and diabetic retinopathy (52 patients). Plasma fibrinogen levels, blood sugar fasting (BSF), HbA1c and BMI were evaluated in all patients. Results: Spearman’s rank correlation coefficient, applied for measuring correlation of variables, showed statistically significant correlation (P < 0.05) of BSF r = 0.39; HbA1c r = 0.48 to plasma fibrinogen in patients with any of the three diabetic microvascular complications. Conclusion: Higher fibrinogen levels (Clotting factor I) in plasma contribute significantly to establishment of microvascular complications in type-II diabetes mellitus patients. Fibrinogen levels were positively correlated with HbA1c and blood sugar fasting.

Background: Educational environment (EE) plays a pivotal role in the academic growth of a medical student. The objective of the study was to compare the perception of a learning environment in Basic Health Sciences by first and second-year MBBS students of private and public medical colleges in Lahore, Pakistan during Covid-19 using a questionnaire. Methods: Data was collected from students (146) through a self-reported questionnaire via Google. dox after obtaining consent. A total score between 151 and 200 was considered excellent. A score between 101 and 150 indicated a positive approach while less than 100 was considered problematic. A score >3.5 for individual items indicate the presence of the specific aspect of the educational environment, whereas, 2.5). Teachers were helpful in stress management during the pandemic (>3). Proper counselors were employed by the private medical schools to cater to the needs of students who required assistance. Conclusion: A significantly high mean score was obtained from private-sector medical students regarding students’ perception of learning (SPL), students’ perception of teachers (SPT), and students’ academic self-perception (SASP), compared to public medical colleges. Keywords: Learning Environment; Questionnaire; Medical Students; Perception; Integrated.

Background: The polycystic ovarian syndrome (PCOS), a well-known endocrine-metabolic disease, is caused by the interaction of environmental, genetic and metabolic factors. A cross-sectional, comparative study was planned to evaluate high sensitivity C-reactive protein (hs-CRP), insulin and lipid profile in non-obese and obese PCOS patients. Methods: Seventy-two women diagnosed with PCOS as per Rotterdam criteria, were placed in three groups in accordance with the body mass index: Group 1 (normal weight), Group 11 (overweight), and Group 111 (obese). Blood glucose, hs-CRP, serum insulin, lipid profile was estimated and insulin resistance was calculated. Data was analyzed using version 20 of SPSS. Analysis of variance (ANOVA) was used to compare the numeric variables among three groups of PCOS women and p-value < 0.05 was considered statistically significant. Results: Significantly, higher levels of insulin (13.03 ± 0.22), triglyceride (1.74 ± 0.96) and hs-CRP (7.24±4.11) were detected in obese PCOS women. The levels of fasting blood glucose (4.61±0.54) were also raised. Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) (2.69±0.79) showed insulin resistance in obese PCOS women (p=0.004). The obese group had significantly lower HDL-Cholesterol levels (0.82±0.09). Levels of total cholesterol (4.69±0.97) and LDL-Cholesterol (3.08±0.64) were increased but results were non-significant. These results indicate obesity leads to insulin resistance, dyslipidemia with low grade inflammation in PCOS. Conclusion: Frequency of insulin resistance, dyslipidemia and low-grade inflammation was found significantly higher in young obese PCOS women. Obesity may have an important role in the aetiology as well as the complications associated with PCOS. Keywords: Polycystic Ovarian Syndrome; hs-CRP; Insulin Resistance; Dyslipidemia; Body Mass Index.

Statins are known to be anti-inflammatory, but the mechanism remains poorly understood. Here, we show that macrophages, either treated with statin in vitro or from statin-treated mice, have reduced cholesterol levels and higher expression of Jmjd3, a H3K27me3 demethylase. We provide evidence that lowering cholesterol levels in macrophages suppresses the adenosine triphosphate (ATP) synthase in the inner mitochondrial membrane and changes the proton gradient in the mitochondria. This activates nuclear factor kappa-B (NF-κB) and Jmjd3 expression, which removes the repressive marker H3K27me3. Accordingly, the epigenome is altered by the cholesterol reduction. When subsequently challenged by the inflammatory stimulus lipopolysaccharide (M1), macrophages, either treated with statins in vitro or isolated from statin-fed mice, express lower levels proinflammatory cytokines than controls, while augmenting anti-inflammatory Il10 expression. On the other hand, when macrophages are alternatively activated by IL-4 (M2), statins promote the expression of Arg1, Ym1, and Mrc1. The enhanced expression is correlated with the statin-induced removal of H3K27me3 from these genes prior to activation. In addition, Jmjd3 and its demethylase activity are necessary for cholesterol to modulate both M1 and M2 activation. We conclude that upregulation of Jmjd3 is a key event for the anti-inflammatory function of statins on macrophages.

Large language models (LLMs) have received considerable interest in the field of natural language processing (NLP) owing to their remarkable ability to generate clear, consistent, and contextually relevant materials. Among the numerous LLMs, ChatGPT (Generative Pre-trained Transformer for Chatbots) is emerging as a prominent prospective tool for developing conversational agents such as chatbots. However, there is a need for a clear conceptual understanding of ChatGPT's potential implications for the industry and its role in marketing. This study explores the adoption of ChatGPT in marketing and examines theories that may influence its adoption by marketers and consumers, as well as its implications for marketers. This study discusses how ChatGPT may allow for more personalized and engaging content, better customer experience, and improved ROI. However, adoption also brings challenges, including ethical considerations and the need for new skill development. This study also discusses future research opportunities for the adoption of ChatGPT and other generative artificial intelligence technologies in marketing. The goal is to provide insights for organizations that consider implementing these technologies, and to contribute to the literature on the adoption of Artificial Intelligence (AI) and the use of Generative AI in marketing.

Background and Aim: Although 80% of people with epilepsy live in low and lower-middle-income countries (LMIC), epilepsy surgery (ES) has reached very few of its potential beneficiaries in these nations. This imbalance could be overcome by telecollaboration ES, aided by the burgeoning digital penetration in LMIC. We aimed to propose a telecollaboration-mentorship model for resource-limited LMIC environs to initiate, sustain, and expand ES centers. We also aimed to assess the model's feasibility and provide a proof of concept. Materials and Methods: Five mentee centers (level 3 epilepsy centers) across three LMIC under the mentorship of a tertiary comprehensive epilepsy care center (level 4) were part of the telecollaboration-mentorship model. This model was used for surgical candidacy selection, intraoperative surgical support, and postoperative outcome assessment at the mentee centers, using both asynchronous and synchronous telecollaboration exchanges. Results: Nineteen patients across five centers and three LMIC underwent ES as part of the telecollaboration-mentorship program from 2018 to 2021. Sixty-eight telemedicine exchanges (average 3.5/patient), 42 asynchronous (email, text message, multimedia message), and 26 synchronous (phone call, video call, video conference) were made in the preoperative, intraoperative, and postoperative period. Worthwhile seizure outcome (Engel Class I, II) was achieved in 17 patients (89.4%) at a mean duration of follow-up of 13.5 months (standard deviation 10.9). Conclusion: The telecollaboration-mentorship model is a feasible, sustainable scalable, and replicable mechanism to expand the outreach of surgical care in epilepsy, especially in resource-constrained LMIC environs. It holds the potential to overcome the "ES divide" between LMIC and high-income countries and reduce the surgical treatment gap with acceptable surgical outcomes. [ABSTRACT FROM AUTHOR]

In this paper we obtain a sufficient condition for the absolute convergence of the double Fourier-Haar coefficients series of a function f whose continuous partial derivatives fx and fy are of bounded partial p-variation on the unit square. [ABSTRACT FROM AUTHOR]

SUMMARY Citral, a naturally occurring acyclic monoterpene aldehyde, is present in the essential oils of various plants, but only a few produce it in abundance. Despite its importance as a key aroma molecule, knowledge regarding the in‐planta biosynthesis of citral and its metabolic origin remains limited. Here, we have elucidated the functions of an alcohol dehydrogenase (CfADH1) and an aldoketo‐reductase (CfAKR2b) in citral biosynthesis in lemongrass (Cymbopogon flexuosus), one of the most cultivated aromatic crops for its citral‐rich essential oil. Expression of both CfADH1 and CfAKR2b showed correlation with citral accumulation in different developmental stages. Recombinant CfADH1 and CfAKR2b, despite their sequence unrelatedness, catalyzed citral formation from geraniol with NADP cofactor. Virus‐induced gene silencing in lemongrass and transient expression in lemon balm (Melissa officinalis) demonstrated the in‐planta involvement of CfADH1 and CfAKR2b in citral biosynthesis. While CfADH1 exhibited a dual cytosolic/plastidial localization, CfAKR2b was localized to the cytosol. This was supported by higher citral‐forming activity in the cytosolic fraction than in the chloroplast fraction of lemongrass leaf extract. Moreover, feeding lemongrass seedlings with inhibitors specific to the cytosolic mevalonate pathway and the plastidial methylerythritol phosphate pathway, combined with volatile profiling, supported the involvement of both pathways in citral formation. Taken together, our results indicate that high citral production has evolved in lemongrass through the recruitment of phylogenetically distant enzymes localized in both the cytosol and plastids. [ABSTRACT FROM AUTHOR]

Abstract In TP53 wild-type acute myeloid leukemia (AML), inhibition of MDM2 can enhance p53 protein expression and potentiate leukemic cell apoptosis. MDM2 inhibitor (MDM2i) monotherapy in AML has shown modest responses in clinical trials but combining options of MDM2i with other potent AML-directed agents like cytarabine and venetoclax could improve its efficacy. We conducted a phase I clinical trial (NCT03634228) to study the safety and efficacy of milademetan (an MDM2i) with low-dose cytarabine (LDAC)±venetoclax in adult patients with relapsed refractory (R/R) or newly diagnosed (ND; unfit) TP53 wild-type AML and performed comprehensive CyTOF analyses to interrogate multiple signaling pathways, the p53-MDM2 axis and the interplay between pro/anti-apoptotic molecules to identify factors that determine response and resistance to therapy. Sixteen patients (14 R/R, 2 N/D treated secondary AML) at a median age of 70 years (range, 23–80 years) were treated in this trial. Two patients (13%) achieved an overall response (complete remission with incomplete hematological recovery). Median cycles on trial were 1 (range 1–7) and at a median follow-up of 11 months, no patients remained on active therapy. Gastrointestinal toxicity was significant and dose-limiting (50% of patients ≥ grade 3). Single-cell proteomic analysis of the leukemia compartment revealed therapy-induced proteomic alterations and potential mechanisms of adaptive response to the MDM2i combination. The response was associated with immune cell abundance and induced the proteomic profiles of leukemia cells to disrupt survival pathways and significantly reduced MCL1 and YTHDF2 to potentiate leukemic cell death. The combination of milademetan, LDAC±venetoclax led to only modest responses with recognizable gastrointestinal toxicity. Treatment-induced reduction of MCL1 and YTHDF2 in an immune-rich milieu correlate with treatment response.

Boron Neutron Capture Therapy (BNCT) is a binary cancer therapy where a low energy neutron beam is incident upon a patient who has been administered a tumour-seeking 10B loaded compound. The neutron capture reaction on 10B results in the production of two short range particles, 7Li and 4He, that deposit all of their energies within the targeted cell. However, accurate, online dosimetry during BNCT is challenging as it requires knowledge of both the neutron fluence and 10B concentration in cells. An additional product in the neutron capture reaction on 10B is a 478 keV prompt gamma ray, and if the production vertices of these gamma rays could be imaged by an external camera, the density of the vertices could be used to infer the dose delivered to the patient. In this study, the feasibility of using an array of LaBr3 scintillators as a modified Compton camera for prompt gamma imaging during BNCT was investigated using Geant4 simulations. These simulations demonstrated that a phantom containing a 3 cm diameter region of 400 ppm 10B could be reconstructed using clinically relevant neutron fluences. This result opens up more possibilities for future research to improve dosimetry during BNCT.

Background. Cancer is one of the leading causes of death globally. The low and middle-income countries (LMICs) cover a major share of the global cancer burden; however, most of the LMICs including Nepal still lack national cancer control and prevention strategies. Since 1st January 2018, the Nepal Health Research Council (NHRC) started the population-based cancer registry (PBCR) in urban, suburban, and rural regions to support evidence-based cancer control intervention in each geographical region. Methods. Data regarding incidence and mortality was collected by the PBCR in Nepal. Indirect and direct methods were used to collect data from health facilities and communities, respectively. Registered cases of incidence and mortality from 1st January 2019 to 31st December 2019 were used. Each case was verified for correctness and duplication followed by residence confirmation via phone call. Guidelines and principles of the International Association of Cancer Registry were followed for the overall registration process including data quality control. Ethical approval was taken from the Ethical Review Board of the NHRC. Result. Age-adjusted incidence (AAR) and mortality rates in Nepal were found 65.6 and 29 per 100,000 people, respectively. Every 1 in 14 men and 1 in 13 women were at risk of getting, and 1 in 28 men and 1 in 33 women were dying of cancer before age 75 in Nepal. The highest risk was found for lung cancer (1 in 80) followed by stomach and mouth among men, and in women, breast cancer (1 in 76) was the commonest among all followed by lung and cervix. Conclusion. Cancer has been growing as one of the major public health burdens in Nepal. Screening with cost-effective technology, awareness, and vaccination against HPV should be a government priority including revision of treatment protocols for cancers that have higher mortality to prevent further preventable life loss from malignancies.