Search

Abstract Introduction Delays exist at each stage of the chronic limb‐threatening ischaemia (CLTI) care pathway, but there is little known about patient factors influencing delay to diagnosis of CLTI. This study explores the experiences and perceptions of patients recently diagnosed with CLTI. Methods A qualitative interview study was conducted. Sixteen participants underwent semi‐structured interviews. Reflexive thematic analysis was performed on the data, aiming to understand factors which can influence delay in the CLTI care pathway. Results Five interrelated themes were developed: CLTI is a devastating condition; Reluctance to ask for help; When we are empowered we get better care; Luck plays a role in the process to diagnosis; and Vascular units can do better, comprising sub‐themes of information transfer—consider communication and arterial versus non‐arterial centres—proximity isn't everything. Conclusions The five themes generated from the interview data describe factors relevant to delay given meaning by participants who have lived experience of CLTI. Theme content should be noted by clinicians, commissioners and providers looking to improve care pathways for patients with CLTI. The importance of awareness for the public, patients and clinicians linked ideas in some themes and interventions to raise awareness should be considered.

Abstract Introduction Patients in the community with suspected Chronic limb‐threatening ischaemia (CLTI) should be urgently referred to vascular services for investigation and management. The Theoretical Domains Framework (TDF) allows identification of influences on health professional behaviour in order to inform future interventions. Here, the TDF is used to explore primary care clinicians' behaviours with regards to recognition and referral of CLTI. Methods Semi‐structured interviews were conducted with 20 podiatrists, nurses and general practitioners in primary care. Directed content analysis was performed according to the framework method. Utterances were coded to TDF domains, and belief statements were defined by grouping similar utterances. Relevance of domains was confirmed according to belief frequency, presence of conflicting beliefs and the content of the beliefs indicating relevance. Results Nine TDF domains were identified as relevant to primary care clinicians: Knowledge, Environmental context and resources, Memory, Decision and attention processes, Beliefs about capabilities, Skills, Emotions, Reinforcement and Behavioural regulation. Relationships across domains were identified, including how primary care clinician confidence and working in a highly pressurized environment can affect behaviour. Conclusion We have identified key barriers and enablers to timely recognition and referral behaviour. These beliefs identify targets for theory‐driven behaviour change interventions to reduce delays in CLTI pathways.

Recently, convolution neural networks (CNNs) have attracted a great deal of attention due to their remarkable performance in various domains, particularly in image and text classification tasks. However, their application to tabular data classification remains underexplored. There are many fields such as bioinformatics, finance, medicine where non-image data are prevalent. Adaption of CNNs to classify non-image data remains highly challenging. This paper investigates the efficacy of CNNs for tabular data classification, aiming to bridge the gap between traditional machine learning approaches and deep learning techniques. We propose a novel framework fuzzy convolution neural network (FCNN) tailored specifically for tabular data to capture local patterns within feature vectors. In our approach, we map feature values to fuzzy memberships. The fuzzy membership vectors are converted into images that are used to train CNN model. The trained CNN model is used to classify unknown feature vectors. To validate our approach, we generated six complex noisy data sets. We used randomly selected seventy percent samples from each data set for training and thirty percent for testing. The data sets were also classified using the state-of-the-art machine learning algorithms such as the decision tree (DT), support vector machine (SVM), fuzzy neural network (FNN), Bayes’ classifier, and Random Forest (RF). Experimental results demonstrate that our proposed model can effectively learn meaningful representations from tabular data, achieving competitive or superior performance compared to existing methods. Overall, our finding suggests that the proposed FCNN model holds promise as a viable alternative for tabular data classification tasks, offering a fresh prospective and potentially unlocking new opportunities for leveraging deep learning in structured data analysis.

Rosmarinus officinalis L. commonly known as Rosemary is a well-known genus belongs to Lamiaceae family, which is one of the major plant families with a high concentration of essential oils. Rosemary is well known to produce herbal essential oils owing to the presence of therapeutic and medicinal elements in the plant’s by-products. In the present study, rosemary essential oil (REO) was extracted from Rosmarinus officinalis and it was evaluated for its phytochemicals, antioxidant, antibacterial, antifungal, anti-diabetic and anti-inflammatory activities. GC-FID analysis and fingerprint analysis was performed. Different antioxidant assays were performed like DPPH (1,1-diphenyl-2-picrylhydrazyl), ABTS (2,2-azinobis-3-ethylbenzothiazoline-6-sulphonic acid), nitric oxide radical, hydroxyl radical, iron reducing potential, iron chelating activity. Anti-bacterial activity was observed by the disk diffusion method against Gram-positive (G+), Gram-negative (G−) bacteria. Anti-diabetic and anti-inflammatory activities were also performed. Antifungal activity against Aspergillosis and Mucormycosis causing fungal strains was also evaluated. GC-FID revealed the presence of vertocitral, α-pinene andhumulene oxidemajor component of REO along with other bioactive components. The IC50 value (µl/ml) for various assays was observed in the following order: OH- (16.6118), iron chelating (32.0115), iron reducing (92.534), DPPH (101.929), and ABTS (172.2765). The best antimicrobial activity was against Bacillus subtilis (MTCC 121), with an inhibition zone of 2.5 cm. REO showed strong anti-inflammatory and anti-diabetic potential and can be employed as an anti-diabetic agent due to its inhibitory effect on α-amylase activity. Based on these findings it was concluded that REO can be widely employed across a variety of sectors, including food, aromatherapy, herbal and allopathic medicine, cosmetics, and as a natural biocide, fungicide, and preservative.

Background Delays in the pathway from first symptom to treatment of chronic limb-threatening ischaemia (CLTI) are associated with worse mortality and limb loss outcomes. This study examined the processes used by vascular services to provide urgent care to patients with suspected CLTI referred from the community.Methods Vascular surgery units from various regions in England were invited to participate in a process mapping exercise. Clinical and non-clinical staff at participating units were interviewed, and process maps were created that captured key staff and structures used to create processes for referral receipt, triage and assessment at the units.Results Twelve vascular units participated, and process maps were created after interviews with 45 participants. The units offered multiple points of access for urgent referrals from general practitioners and other community clinicians. Triage processes were varied, with units using different mixes of staff (including medical staff, podiatrists and s) and this led to processes of varying speed. The organisation of clinics to provide slots for ‘urgent’ patients was also varied, with some adopting hot clinics, while others used dedicated slots in routine clinics. Service organisation could be further complicated by separate processes for patients with and without diabetes, and because of the organisation of services regionally into vascular networks that had arterial and non-arterial centres.Conclusions For referred patients with symptoms of CLTI, the points of access, triage and assessment processes used by vascular units are diverse. This reflects the local context and ingenuity of vascular units but can lead to complex processes. It is likely that benefits might be gained from simplification.

Air-core inductors are key components in power converters and measurement equipment. To optimally design inductors, their self-resonant frequency (SRF) as a result of inherent stray capacitance should be accurately estimated. This paper presents optimal design procedures for air-core inductors, considering constraints such as SRF and inductor volume. To this end, a methodology is proposed to estimate the variability of stray capacitances, accounting for various uncertainty factors. Specifically, for single-layer air-core inductors, an empirical expression is adopted and experimentally verified to provide better predictions compared to the commonly used physical-based approach. For multi-layer air-core inductors, an enhanced analytical approach based on the energy-conservation method is proposed, which considers the impact of five influence factors. Two key factors (the proximity effect and the variation of turn length) are investigated by FEM simulations and incorporated into the enhanced models. The other three factors (the effective permittivity of the wire insulation coating, the winding tightness, and the electric field path assumption) are taken into account as uncertainty factors, leading to statistical estimates of the stray capacitance and SRF. Finally, two samples are fabricated for single- and multi-layer air-core inductors, which agree well with the design specifications, proving the effectiveness of the proposed design methodology.

Background High-quality surgical care is vital to deliver the excellent outcomes patients deserve following surgical treatment. Quality improvement collaboratives (QICs) are based on a multicentre model for improving healthcare. They are increasingly used but their effectiveness in the context of surgical services is unclear. This review assessed effectiveness of QICs in National Health Service (NHS) surgical settings, and identified factors that influenced implementation.Methods A systematic search of MEDLINE and EMBASE, as well as grey literature, was conducted in January 2022 to identify evaluations of QICs in NHS surgical settings. Data were extracted on the intervention, setting, study results and factors that were identified as facilitators or barriers. These were coded using the Consolidated Framework for Implementation Research (CFIR). The quality of study reports was assessed using Quality Improvement Minimum Criteria Set.Results Fifteen reports on 10 QICs met inclusion criteria. The evaluations used study designs of different strength, with one using a stepped-wedge randomised controlled trial (RCT). Eight studies reported the QIC had been successful in achieving their principal aims, which covered a mix of patient outcomes and process indicators. The study based on the RCT found the QIC was not successful (no improvement in patient outcomes). Each article reported a range of facilitators and barriers to effectiveness of implementation of the QIC, which were spread across the CFIR domains (intervention, outer setting, inner setting, individuals and process). There were few barriers reported in the intervention domain that related to the QIC. There was no clear relationship between numbers of facilitators and barriers reported and effectiveness.Conclusions Studies have reported QICs to be effective in increasingly complex contexts, but their results must be treated with caution. The evaluations often used weak study designs and the quality of reports was variable. Evaluation with strong study design should be integral to future QICs.PROSPERO registration number CRD42022324970.

Abstract There is limited understanding of the inter‐compartmental progression and treatment outcomes of primary central nervous system lymphoma (PCNSL). In this multicenter retrospective cohort study on 234 patients with PCNSL (median age: 62.5 years [18–92]; median follow‐up 35 months [0.1–237.0]) from 2000 till 2018 were divided into group 1 (ocular, 44 patients): 1A and 1B without and with CNS progression and group 2 (CNS, 190 patients): 2A and 2B without and with ocular progression, respectively. In group 1 (44 patients), 33 patients received local treatment, and 11 patients received systemic treatment. In group 2 (15 patients), six patients received combination treatment, while seven patients received only systemic treatment. A complete response was observed in 19 (43%) and 91 (48%) patients in groups 1 and 2, respectively. The 2‐year progression‐free survival (PFS) was 35% (95% CI: 0.23, 0.54) and 56% (95% CI: 0.49, 0.63) for groups 1 and 2, respectively (p

Abstract Background Chronic limb‐threatening ischaemia (CLTI) is a condition associated with significant risks of lower limb loss and mortality, which increase with delays in management. Guidance recommends urgent referral and assessment, but delays are evident at every stage of the CLTI patient pathway. This study uses qualitative methods to explore hospital clinicians' experiences and perceptions of the existing CLTI pathway. Methods A qualitative interview study was conducted. Semi‐structured interviews were undertaken with 13 clinicians involved in the assessment of patients referred to hospital with suspected CLTI, identified via purposive sampling from English vascular surgery units. Clinicians included podiatrists, vascular specialist nurses and doctors. Reflexive thematic analysis was performed on the data from a critical realist position. Results The need for speed was the single overarching theme identified. Four linked underlying themes were also identified; 1. Vascular surgery as the poor relation (compared to cancer and other specialties), with a sub‐theme of CLTI being a challenging diagnosis. 2. Some patients are more equal than others, with sub‐themes of diabetes vs. non‐diabetes, hub vs. spoke and frailty vs. non‐frail. 3. Life in the National Health Service (NHS) is tough, with sub‐themes of lack of resource and we're all under pressure. 4. Non‐surgeons can help. Conclusions The underlying themes generated from the rich interview data describe barriers to timely referral, assessment and management of CLTI, as well as the utility of non‐surgical roles such as podiatrists and vascular specialist nurses as a potential solution for delays. The overarching theme of the need for speed highlights the meaning given to adverse consequences of delays in management of CLTI by clinicians involved in its assessment. Future improvement projects aimed at the CLTI pathway should take these findings into account.

Summary: Background: Many studies evaluating care in hospitals in England use the Hospital Episode Statistics (HES) administrative database. The aim of this study was to explore whether the International Classification of Diseases 10th Revision (ICD-10) system used by HES supported the evaluation of care received by patients with peripheral arterial disease (PAD) who had revascularisation. Methods: This retrospective cohort study used records on patients who had revascularisation for PAD between 1st January 2017 and 31st December 2019 in England, collected prospectively in the National Vascular Registry (NVR) and linked to HES. Patients were excluded if their NVR record did not have a match in HES, due to lack of consent or different admission and procedure dates. Agreement between different presentations of PAD recorded in the NVR and the ICD-10 diagnostic codes recorded in HES was evaluated using the unweighted Kappa statistic and sensitivity and specificity. Agreement between the NVR and HES was also assessed for gender, age, comorbidities, mode of admission, and procedure type and side. Findings: In total, 20,603 patients who had 24,621 admissions were included in the study. Agreement between NVR and HES on patient gender (Kappa = 0.98), age (Kappa = 0.98), mode of admission (Kappa = 0.80), and procedure type and side (Kappa = 0.92 and 0.87, respectively) was excellent. When all diagnostic fields in HES were explored, substantial agreement was observed for chronic ischaemia with tissue loss (Kappa = 0.63), but it was lower for chronic ischaemia without tissue loss (Kappa = 0.32) and acute limb ischaemia (Kappa = 0.15). Agreement on comorbidities was mixed; excellent for diabetes (Kappa = 0.82), moderate for chronic lung disease (Kappa = 0.56), chronic kidney disease (Kappa = 0.56), and ischaemic heart disease (Kappa = 0.45) and fair for chronic heart failure (Kappa = 0.35). Interpretation: The diagnostic ICD-10 codes currently used in HES cannot accurately differentiate between stages of PAD. Therefore, studies using HES to examine patterns of care and outcomes for patients with PAD are likely to suffer from misclassification bias. Adopting an extended ICD-10 system or the ICD-11 version released to the World Health Organisation member states in 2022, may overcome this problem. Funding: Healthcare Quality Improvement Partnership (HQIP).

Purpose: To describe a patient with bilateral peripapillary astrocytic hamartomas with exudation of subretinal fluid into the macula and loss of vision without evidence of choroidal neovascularization. The patient rapidly responded to intravitreal bevacizumab injections resulting in reduced subretinal fluid and clinical improvement. Observation: A 70-year-old female presented with worsening vision in her left eye due to subretinal fluid exudation from a peripapillary astrocytic hamartoma. The patient was treated with two doses of bevacizumab with rapid improvement in vision and resolution of subretinal fluid. Genetic testing was negative for common pathogenic variants for tuberous sclerosis and neurofibromatosis, which are highly associated with bilateral optic nerve and retinal astrocytic hamartomas. Conclusion: Astrocytic hamartomas with exudation may be responsive to bevacizumab suggesting a dependence of these lesions on vascular endothelial growth factor (VEGF) independent of secondary choroidal neovascularization. Furthermore, this case describes a patient with bilateral astrocytic hamartomas without genetic or clinical confirmation of associated phakomatoses, such as tuberous sclerosis and neurofibromatosis.

Purpose: The objective of this study was to identify the diagnostic features of optic nerve head melanocytoma (ONH-MCT) on spectral domain optical coherence tomography (SD OCT) and OCT angiography (OCT-A). Methods: Retrospective study of 11 patients for their demographic, clinical features and imaging including SD OCT (tumour location, extent and interface) and OCT-A (surface and intrinsic vascularity) were reviewed. Flow rate percentage (FR %) was calculated over the lesion and compared to fellow eye and similar pigmented lesions. Results: The average age was 52.8 ± 10.9 years. ONH-MCT tumors occupied 3-tissue spaces- optic disc (n = 2), retinal layer (n = 5) and retina-choroidal layers (n = 4). SD OCT (11 eyes) showed elevated hyper reflective disorganized retinal layers with posterior shadowing (9 eyes) and hyper reflective dots within the tumor (all eyes). Microvascular features on OCT-A (8 eyes) in radial peripapillary capillary slab showed surface vascularization (7 eyes) and intrinsic vascularity in choroidal slab (8 eyes) with surrounding hypo reflective boundary. The mean FR % was higher at 65.1 ± 3.77% (CI: 61.9-68.2) compared to mean FR at 60.4 ± 1.06% (CI: 59.5-61.2) in the fellow eye (p = 0.01). Comparison with nevus and melanoma SD OCT showed a high reflective choroidal layer with normal or irregular outer retinal layers respectively; OCT-A showed hypo reflective area at the center with hyper reflective boundary and iso reflective area at center with hyper reflective boundary respectively. Conclusion: SD OCT and OCT-A features may help to differentiate ONH-MCT from clinically similar looking pigmented lesions like nevus and melanoma.

The prevalence of Huanglongbing (HLB) in Florida has forced growers to search for new management strategies to optimize fruit yield in young orchards and enable earlier economic returns given the likelihood of HLB-induced yield reductions during later years. There has been considerable interest in modifying orchard architecture design and fertilizer and irrigation management practices as strategies for increasing profitability. Our objectives were to evaluate how different combinations of horticultural practices including tree density, fertilization methods, and irrigation systems affect growth, foliar nutrient content, fruit yield, and fruit quality of young ‘Valencia’ sweet orange [Citrus sinensis (L.) Osbeck] trees during the early years of production under HLB-endemic conditions. The study was conducted in Fort Pierce, FL, from 2014 to 2020 on a 1- to 7-year-old orchard and evaluated the following treatments: standard tree density (358 trees/ha) and controlled-release fertilizer with microsprinkler irrigation (STD_dry_MS), high tree density (955 trees/ha) with fertigation and microsprinkler irrigation (HDS_fert_MS), and high tree density with fertigation and double-line drip irrigation (HDS_fert_DD). Annual foliar nutrient concentrations were usually within or higher than the recommended ranges throughout the study, with a tendency for decreases in several nutrients over time regardless of treatment, suggesting all fertilization strategies adequately met the tree nutrient demand. During fruit-bearing years, canopy volume, on a per-tree basis, was higher under STD_dry_MS (6.2–7.2 m3) than HDS_fert_MS (4.3–5.3 m3) or HDS_fert_DD (4.9–5.9 m3); however, high tree density resulted in greater canopy volume on an area basis, which explained the 86% to 300% increase in fruit yield per ha that resulted in moving from standard to high tree density. Although fruit yields per ha were generally greatest under HDS_fert_MS and HDS_fert_DD, they were lower than the 10-year Florida state average (26.5 Mg·ha−1) for standard tree density orchards, possibly due to the HLB incidence and the rootstock chosen. Although tree growth parameters and foliar nutrient concentrations varied in response to treatments, management practices that included high tree density and fertigation irrespective of irrigation systems produced the highest fruit yields and highest yield of solids. Soluble solids content (SSC) and titratable acidity (TA) were lower, and the SSC-to-TA ratio was highest under STD_dry_MS in 2016–17, with no treatment effects on quality parameters detected in other years. Both drip and microsprinkler fertigation methods sufficiently met tree nutrient demand at high tree density, but additional research is needed to determine optimal fertilization rates and better rootstock cultivars in young high-density sweet orange orchards under HLB-endemic conditions in the Indian River Citrus District.

Huanglongbing (HLB), or citrus greening disease, affects practically all fruit-bearing trees in commercial citrus orchards in Florida with no cure identified yet. High-density plantings and enhanced nutritional programs such as application of controlled-release fertilizer (CRF) with higher micronutrient levels can mitigate disease symptoms and extend the tree life span of sweet oranges (Citrus sinensis). The objective of this study was to evaluate the effects of tree planting density and application of CRF blends differing in N to K ratio and micronutrient content on grapefruit (Citrus paradisi) plant health, canopy volume, fruit yield, and fruit quality in an HLB-affected orchard. A study was conducted in Florida for two growing seasons (2017–18 and 2018–19) to evaluate the response of ‘Ray Ruby’ grapefruit on Kuharske citrange (Citrus sinensis × Poncirus trifoliata) to three planting densities (300, 440, and 975 trees per ha) and two CRF blends [12 nitrogen (N)–1.31 phosphorus (P)–7.47 potassium (K) and 16N–1.31P–16.6K] with different nutrient sources and composition. According to quantitative real-time polymerase chain reaction testing, all sampled trees tested positive for Candidatus Liberibacter asiaticus, the pathogen associated with HLB. Trees planted at 975 trees per ha had 33% lower canopy volume per tree but 160% greater fruit yield per hectare and 190% higher yield of solids compared with 300 trees per ha. Fruit produced in high-density planting (975 trees per ha) was 18% more acidic with higher soluble solid compared with low-density planting (300 trees per ha). The use of a CRF blend with higher amounts of micronutrients along with lower K increased canopy volume in both seasons and resulted in 24% and 29% reduction in fruit yield per hectare and yield of solids, respectively, in 2017–18. Our results indicate that high-density plantings increase fruit yield per area, and regardless of the N to K ratio, the use of CRF blends supplemented with micronutrients may not increase fruit yield in HLB-affected grapefruit.

Since the arrival of Huanglongbing (HLB) disease in Florida, several management approaches, including modification of orchard architecture design and nutritional therapy, have been explored. High-density plantings anticipate early economic returns from HLB-affected orchards. With no cure available for HLB, balanced nutrient application through soil and foliar spraying can mitigate the disease. A 2-year study was conducted to investigate the effects of three grapefruit (Citrus paradisi) planting densities [single-row (300 and 440 trees per ha), and double-row high-density (975 trees per ha)], two controlled-release fertilizer (CRF) blends, and foliar-applied micronutrients (FAM) (a blend of B, Mn, and Zn at 0, 1.5, 3, and 6 times the recommended rates) on grapefruit growth and fruit yield, physiological parameters, and foliar nutrient concentrations in an HLB-affected orchard. All the trees tested positive for HLB based on real-time quantitative polymerase chain reaction (qPCR) test. The highest planting density resulted in the lowest trunk diameter and canopy volume. Despite lower yield per tree in 2019–20, 975 trees per ha planting induced the greatest fruit and solid yields per ha. Also, the fruit produced from 975 trees per ha planting tended to be acidic with the deposition of more soluble solids. Use of CRF with higher micronutrients increased canopy volume with the expense of reduced fruit number in 2019–20. FAM did not affect cycle threshold (Ct) value and tree growth parameters. Fruit yield, photosynthesis rate, and stomatal conductance (gS) decreased, and all leaf nutrient concentrations except B increased in 2019–20 with all FAM rates tested. In conclusion, our study showed that high-density planting optimizes yield under HLB-endemic conditions. In addition, supplemental soil and foliar micronutrient application do not enhance yield of HLB-affected trees over a 2-year timeframe, warranting further research for confirmation of results.

Worldwide use of chemical pesticides is on rise which is creating a big problem to environment and human health. Hence great interest has been generated to find out botanical leads having anti-pest properties from medicinal plants. The objective of this work was to evaluate the insecticidal potential of Eucalyptus globulus waste hydrosol obtained after essential oil distillation. Samples of Eucalyptus globulus genus were collected from near-by areas of study, and were hydro-distilled and their by-product ‘hydrosol was analyzed for phenolics and tannin determination. UV-VIS, FT-IR and fluorescent study was also conducted of by-product hydrosol. In addition, insecticidal activity of by-product hydrosol was also monitored against mealy bug. Substantial amount of phenolics and tannins were detected in the by-product hydrosol. UV and fluorescent spectroscopy revealed the presence of secondary metabolites. Significantly higher insecticidal activity was observed of by-product hydrosol against mealy bug. The results suggested that by-product hydrosol from Eucalyptus globulus essential oil distillation can be considered as potential candidates for bio-control of pests.

PurposeThe long-term survival of uveal melanoma patients in the US is not known. We compared long-term survival estimates using relative survival, excess absolute risk (EAR), Kaplan-Meier (KM), and competing risk analyses.SettingPopulation based cohort study.Study populationPooled databases from Surveillance, Epidemiology, and End Results data (SEER, SEER-9+SEER-13+SEER-18).Main outcome measureOverall Survival (OS), Metastasis Free Survival (MFS) and relative survival, computed directly or estimated via a model fitted to excess mortality.ResultsThere were 10678 cases of uveal melanoma spanning a period of 42 years (1975-2016). The median age at diagnosis was 63 years (range 3-99). Over half the patients were still alive at the end of 2016 (53%, 5625). The KM estimates of MFS were 0.729 (0.719, 0.74), 0.648 (0.633, 0.663), and 0.616 (0.596, 0.636) at 10, 20, and 30 years, respectively. The cumulative probabilities of melanoma metastatic death at 10, 20 and 30 years were 0.241 (0.236, 0.245), 0.289 (0.283, 0.294), and 0.301 (0.295, 0.307). In the first 5 years since diagnosis of uveal melanoma, the proportion of deaths attributable to uveal melanoma were 1.3 with rapid fall after 10 years. Death due to melanoma were rare beyond 20 years. Relative survival (RS) plateaued to ~60% across 20 to 30 years. EAR parametric modeling yielded a survival probability of 57%.ConclusionsRelative survival methods can be used to estimate long term survival of uveal melanoma patients without knowing the exact cause of death. RS and EAR provide more realistic estimates as they compare the survival to that of a normal matched population. Death due to melanoma were rare beyond 20 years with normal life expectancy reached at 25 years after primary therapy.

SARS-CoV-2 (COVID-19), member of corona virus family, is a positive single stranded RNA virus. Due to lack of drugs it is spreading its tentacles across the world. Being associated with cough, fever, and respiratory distress, this disease caused more than 15% mortality worldwide. Mpro/3CLpro has recently been regarded as a suitable target for drug design due to its vital role in virus replication. The current study focused on the inhibitory activity of eucalyptol (1,8 cineole), an essential oil component from eucalyptus oil, against Mpro/3CLprofrom SARS-CoV-2. Till date there is no work is undertaken on in-silico analysis of this compound against Mpro/3CLproof SARS-CoV-2. Molecular docking studies were conducted by using 1-click dock tool and Patchdock analysis. In-silico absorption, distribution, metabolism, excretion and toxicity (ADMET) profile were also studied. The calculated parameters such as docking score indicated effective binding of eucalyptol to COVID-19 Mpro protein. Active site prediction revealed the involvement of active site residues in ligand binding. Interactions results indicated that, Mpro/3CLpro/eucalyptol complexes forms hydrophobic interactions. ADMET studies provided guidelines and mechanistic scope for identification of potent anti-COVID 19 drug. Therefore, eucalyptol may represent potential herbal treatment to act as COVID-19 Mpro/3CLproinhibitor, a finding which must be validated in vivo.

A series of low band gap, planar conjugated polymers, P1 (PFDTBT), P2 (PFDTDFBT) and P3 (PFDTTBT), based on fluorene and benzothiadiazole, was synthesized. The effect of fluorine substitution and fused aromatic spacers on the optoelectronic and photovoltaic performance was studied. The polymer, derived from dithienylated benzothiodiazole and fluorene, P1, exhibited a highest occupied molecular orbital (HOMO) energy level at −5.48 eV. Density functional theory (DFT) studies as well as experimental measurements suggested that upon substitution of the acceptor with fluorine, both the HOMO and lowest unoccupied molecular orbital (LUMO) energy levels of the resulting polymer, P2, were lowered, leading to a higher open circuit voltage and short circuit current with an overall improvement of more than 110% for the photovoltaic devices. Moreover, a decrease in the torsion angle between the units was also observed for the fluorinated polymer P2 due to the enhanced electrostatic interaction between the fluorine substituents and sulfur atoms, leading to a high hole mobility. The use of a fused π-bridge in polymer P3 for the enhancement of the planarity as compared to the P1 backbone was also studied. This enhanced planarity led to the highest observed mobility among the reported three polymers as well as to an improvement in the device efficiency by more than 40% for P3.

Undifferentiated thyroid carcinoma is a relatively uncommon highly malignant tumor originating from the follicular cells of thyroid gland having poor prognosis. It accounts for 2%–5% of all thyroid carcinomas and patients typically present with a rapidly growing anterior neck mass with aggressive symptoms. A 70-year-old female presented with diffuse neck swelling measuring 6 cm × 5 cm for 1-month duration which was associated with mild dyspnea. Fine needle aspiration cytology (FNAC) from the swelling revealed a cellular smear comprising of highly pleomorphic follicular epithelial cells arranged in clusters and singly scattered with a background of bizarre tumor giant cells and inflammatory cells.

Introduction To evaluate WHO chest radiograph interpretation processes during a pneumococcal vaccine effectiveness study of children aged 3–35 months with suspected pneumonia in Sylhet, Bangladesh.Methods Eight physicians masked to all data were standardised to WHO methodology and interpreted chest radiographs between 2015 and 2017. Each radiograph was randomly assigned to two primary readers. If the primary readers were discordant for image interpretability or the presence or absence of primary endpoint pneumonia (PEP), then another randomly selected, masked reader adjudicated the image (arbitrator). If the arbitrator disagreed with both primary readers, or concluded no PEP, then a masked expert reader finalised the interpretation. The expert reader also conducted blinded quality control (QC) for 20% of randomly selected images. We evaluated agreement between primary readers and between the expert QC reading and the final panel interpretation using per cent agreement, unadjusted Cohen’s kappa, and a prevalence and bias-adjusted kappa.Results Among 9723 images, the panel classified 21.3% as PEP, 77.6% no PEP and 1.1% uninterpretable. Two primary readers agreed on interpretability for 98% of images (kappa, 0.25; prevalence and bias-adjusted kappa, 0.97). Among interpretable radiographs, primary readers agreed on the presence or absence of PEP in 79% of images (kappa, 0.35; adjusted kappa, 0.57). Expert QC readings agreed with final panel conclusions on the presence or absence of PEP for 92.9% of 1652 interpretable images (kappa, 0.75; adjusted kappa, 0.85).Conclusion Primary reader performance and QC results suggest the panel effectively applied the WHO chest radiograph criteria for pneumonia.

In contrast to other cancers, the presence of tumor-infiltrating lymphocytes (TILs) in uveal melanoma is associated with a poor prognosis. However, how TILs may promote disease progression and what regulates their infiltration has not yet been established. To address these clinically relevant outstanding questions, T cell, immune regulatory, and chemokine gene expression profiles of 57 enucleated uveal melanoma tumors were compared, encompassing 27 with TILs and 30 without,. Tumors with infiltrating lymphocytes expressed more CD8A mRNA, as well as IFNG, TGFB1, and FOXP3 transcripts. Other T helper associated cytokines and T helper transcription factors were not differentially expressed, nor were mediators of lymphocyte cytotoxicity. The immune inhibitors INDO, PDCA1, CTLA4, and LAG3, and the non-classical MHC Class I target of CD8+ T regulatory cells, HLA‑E, were significantly higher in tumors with TILs. FAS was also significantly higher. The C-C chemokine ligands CCL4, CCL5, and CCL20 were higher in tumors with TILs. Levels of CCL5 were most strongly correlated with levels of CD8A. Chemokine receptors were not differentially expressed. Molecular profiling of uveal melanoma tumors with TILs supports the existence of an immunosuppressive tumor microenvironment and suggests roles for CD8+ regulatory T cells, as well as specific chemokines, in fostering uveal melanoma disease progression.

Purpose: To describe a case of diffuse conjunctival papilloma in an immunocompromised individual on tacrolimus that was refractory to treatment with interferon α-2b, but responded to topical mitomycin-c. Observations: A 79-year-old Caucasian female with a history of a liver transplant twenty years ago, who was immunosuppressed with tacrolimus (2 mg daily) presented with a diffuse conjunctival and corneal squamous papilloma. Following treatment with four weekly subconjunctival interferon-α2b injections (3 million units/0.5 mL) and 3 months of topical interferon-α2b therapy (1 million units/mL), four times daily, slow progression was documented. The patient was switched to topical mitomycin-c drops (0.04%) administered four times daily (one week on and one week off) with dramatic regression of the tumor. Conclusion: and Importance. In cases of conjunctival squamous papilloma that do not respond readily to topical interferon, topical mitomycin-c is an alternate therapeutic option. We hypothesize that use of tacrolimus may have contributed to the lack of response to topical interferon-α2b.

Conventionally managed citrus orchards can be modified to incorporate advanced horticultural practices such as higher plant density and efficient water and fertilizer application known as open hydroponics system (OHS) to increase productivity under Huanglongbing (HLB) endemic conditions. A field study was conducted from 2013 to 2018 to evaluate the effect of an OHS on “Ray Ruby” grapefruit (RR) production under HLB-endemic conditions. We tested a combination of different rootstocks [Sour orange (RR/SO) and US-897 (RR/897)], tree planting densities [standard (STD, 358 trees per ha) and high density staggered (HDS, 953 trees per ha)], fertilization methods (dry granular—dry and fertigation—fert), and irrigation systems (double driplines—DD and microsprinkler—MS), arranged in five treatments: RR/SO_STD_dry_MS, RR/SO_HDS_fert_DD, RR/897_HDS_fert_MS, RR/897_HDS_fert_DD, and RR/SO_HDS_fert_MS. All trees were infected by Candidatus Liberibacter asiaticus five years after planting. Trunk diameter and canopy volume increased over time and were higher under RR/SO_STD_dry_MS compared to other treatments. Total fruit number increased in 2016/17 compared to other seasons; however, 65% of fruit were classified as small (

Ultrasound-guided intraarticular hip corticosteroid injections may be useful for emergency care providers treating patients with painful exacerbations of osteoarthritis of the hip. Corticosteroid injection is widely recommended as a first-line treatment for painful osteoarthritis of the hip. Bedside ultrasound is readily available in most emergency departments; however, using ultrasound to guide therapeutic hip injections has not yet been described in emergency practice. Herein, we present the first description of a successful emergency physician-performed ultrasound-guided hip injection of local anesthetic and corticosteroid for pain control in a patient with an acute exacerbation of osteoarthritis. [West J Emerg Med. 2013;14(5):505–508.]

Objective: The objective of this study was to conduct feasibility study of phase III breast and lung cancer clinical trials in India. Materials and Methods: Study synopsis and feasibility questionnaire were mailed to 300 oncologists for each indication. Criteria of selection were enrolment of ≥2 patients per month, frequency of Ethics Committee (EC) meeting ≤4 weeks, dropout rate

Introduction: Ageing of the population along with changes in the family structure and shifts in intergenerational relations has brought into focus issues pertaining to health status across all domains, which in turn reflect the quality of life of elderly in India. This study was carried out with an objective to assess and compare the quality of life among elderly, residing in old age homes and in the community. Methodology: This study was carried out in the field practice area of PESIMSR, Kuppam, during June and November 2013. A total of 112 elderly were included in the study. Quality of life was assessed in four domains using WHO QOL (BREF) and the data was analyzed using SPSS software ver19. Results: Overall quality of life was low in both the groups. However, in the physical domain, institutional elderly had higher QOL (50.47 vs 47.18) and in the social domain, non institutional elderly had higher QOL (47.63 vs 33.60). Overall, 21.42% rated their QOL as good and 24.1% rated their health as satisfied. Socio-demographic variables were significantly related to QOL in social domain. Conclusion: Quality of life depends on multiple dimensions of well being which needs comprehensive assessment and multidimensional approach to improve.

Background: Tobacco and alcohol consumption are the leading cause of preventable death. Fewer studies have focused on tobacco and alcohol use among rural elderly. Objective of the study was to find out the prevalence of tobacco and alcohol use among rural el- derly population and its association with various sociodemo- graphic factors. Method: Cross-sectional community based study was conducted in the rural area of V.Kota mandal of Chittoor district, Andhra Pra- desh. Studyparticipants were selected using multistage random sampling method. Results: The prevalence of current tobacco users was 40.5%, among them 37.2% men and 1.4% women were current smokers. Among tobacco chewers 37.3% were women and 17.3% were men.Alcohol consumption was seen in 28.7% of the men compared with 0.9% of the women.Tobacco and alcohol use was significantly associated with age, education, economic status, marital status and living ar- rangements. Conclusion: There is a high prevalence of smoking and alcohol consumption among men in this rural elderly population which needs to addressed immediately to prolong health living years.

Uveal melanoma is the most common malignancy of the adult eye. The overall mortality rate is high because this aggressive cancer often metastasizes before ophthalmic diagnosis. Quantitative proteomic analysis of primary metastasizing and non-metastasizing tumors was pursued for insights into mechanisms and biomarkers of uveal melanoma metastasis.Eight metastatic and 7 non-metastatic human primary uveal melanoma tumors were analyzed by LC MS/MS iTRAQ technology with Bruch's membrane/choroid complex from normal postmortem eyes as control tissue. Tryptic peptides from tumor and control proteins were labeled with iTRAQ tags, fractionated by cation exchange chromatography, and analyzed by LC MS/MS. Protein identification utilized the Mascot search engine and the human Uni-Prot/Swiss-Protein database with false discovery ≤ 1%; protein quantitation utilized the Mascot weighted average method. Proteins designated differentially expressed exhibited quantitative differences (p ≤ 0.05, t-test) in a training set of five metastatic and five non-metastatic tumors. Logistic regression models developed from the training set were used to classify the metastatic status of five independent tumors.Of 1644 proteins identified and quantified in 5 metastatic and 5 non-metastatic tumors, 12 proteins were found uniquely in ≥ 3 metastatic tumors, 28 were found significantly elevated and 30 significantly decreased only in metastatic tumors, and 31 were designated differentially expressed between metastatic and non-metastatic tumors. Logistic regression modeling of differentially expressed collagen alpha-3(VI) and heat shock protein beta-1 allowed correct prediction of metastasis status for each of five independent tumor specimens.The present data provide new clues to molecular differences in metastatic and non-metastatic uveal melanoma tumors. While sample size is limited and validation required, the results support collagen alpha-3(VI) and heat shock protein beta-1 as candidate biomarkers of uveal melanoma metastasis and establish a quantitative proteomic database for uveal melanoma primary tumors.