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ABSTRACT Background Nationwide US data on readmission rates for patients with cirrhosis admitted with hepatorenal syndrome (HRS) is lacking. We reviewed 30‐day readmission rates after HRS‐related hospitalizations, the associated predictors of readmissions, and their impact on resource utilization and mortality in the United States. Methods We identified all adults admitted with HRS between 2016 and 2019 using the Nationwide Readmission database of the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project. The primary outcome was all‐cause 30‐day readmission rate. Secondary outcomes were inpatient mortality rate, predictors of readmission, and resource utilization. Results We identified 245 850 hospitalizations of patients admitted for HRS in the United States from 2016 to 2019. Of these, 214 890 met the inclusion criteria. Mean age was 59.16 years, and 61.31% were males. Medicare was the most common primary payer (44.82%) followed by Medicaid (25.58%). The readmission rate was 24.6% within 30 days of discharge from index hospitalization. The most common cause of readmission was alcoholic cirrhosis with ascites (14.87%), followed by sepsis (9.32%) and unspecified hepatic failure (9%). The in‐hospital mortality rate for index hospitalization was 29.52% and 14.35% among those readmitted within 30 days. The mean length of stay (12.33 days vs. 7.15 days, p

The research aimed to outline the features of "new normal" communication behavior of young military leaders due to the COVID-19 pandemic influence. To study this critical problem we used some general scientific and empirical methods like literature analysis, synthesis and theoretical modelling, pedagogical experience, statistical data processing. The author found that the changes include development of closed and indirect forms, introduction of new lexical, grammatical, and stylistic units, fake information spread, misuse of information and communication technologies (ICT), periodical refusal to message with non-verbal tools. The findings show that professional discourse among young military leaders changes fast because of the COVID-19 pandemic. And the transformations involve different communication behavior, the more significant role of leaders in study group especially in the context of peer-to-peer learning, critical thinking development, independent production and comprehension of professional utterances, higher responsibility of a speaker. The experiment demonstrates that military officers and cadets are likely to cope with new "rules of the game" and they continue to carry out security tasks prioritizing discipline, considerable motivation, psychological readiness to high-risk conditions and adaptability to counteract dramatic challenges. The article is one of the early researches reviewing the features of young military leaders' discourse and describing its current transformations. The research can contribute to developement of recommendations for professional discourse improvements and, consequently, to enhance the efficiency of professional activities of military officers.

Abstract We previously reported the results of a randomized phase II trial (NCT02904954) in patients with early-stage non-small cell lung cancer (NSCLC) who were treated with either two preoperative cycles of the anti-PD-L1 antibody durvalumab alone or combined with immunomodulatory doses of stereotactic radiation (DRT). The trial met its primary endpoint of major pathological response, which was significantly higher following DRT with no new safety signals. Here, we report on the prespecified secondary endpoint of disease-free survival (DFS) regardless of treatment assignment and the prespecified exploratory analysis of DFS in each arm of the trial. DFS at 2 and 3 years across patients in both arms of the trial were 73% (95% CI: 62.1–84.5) and 65% (95% CI: 52.5–76.9) respectively. For the exploratory endpoint of DFS in each arm of the trial, three-year DFS was 63% (95% CI: 46.0–80.4) in the durvalumab monotherapy arm compared to 67% (95% CI: 49.6–83.4) in the dual therapy arm. In addition, we report post hoc exploratory analysis of progression-free survival as well as molecular correlates of response and recurrence through high-plex immunophenotyping of sequentially collected peripheral blood and gene expression profiles from resected tumors in both treatment arms. Together, our results contribute to the evolving landscape of neoadjuvant treatment regimens for NSCLC and identify easily measurable potential biomarkers of response and recurrence.

Professional training of border guards is closely connected with Ukraine's national development, its stability and economic prosperity. Due to emerging security threats, the training of future border guards in Ukraine has recently undergone radical changes including the reconsideration of professional competence. According to its reviewed profile, professional competence of border guards means integral unity of knowledge, skills, personal qualities, and values that help them perform their professional duties. Professional competence of border guards is the desired result of their training. The content of professional training for border guards is therefore an important aspect. Changes in the tasks facing the border agency has caused significant rethinking of training content for border guards, resulting in new subjects, sections, modules and topics. As information has to be transferred effectively to trainees, a range of teaching techniques was innovated in order to achieve the pedagogical intention. The innovative techniques include simulation technologies, horizontal learning, innovative lectures, training courses, information and communication technologies, interactive technologies, as well as game-based and project-based learning. These techniques are proven to be more effective in comparison to traditional methods. Despite some unresolved issues, the system of professional training for border guards in Ukraine has shown outstanding results. Further development and improvement will lead to the formation of professional competence of border guards at the desired high level.

The present study was conducted to determine health status and milk quality of goats reared under stall fed and free range grazing system. The research areas reported higher THI throughout the summer. Respiration rate (RR) and heart rate (HR) was significantly higher during summer in both the groups. Both groups had significantly increased neutrophils and eosinophils during the summer and increased Hb, PCV, and lymphocyte during the winter. Stall fed goats had significantly higher MDA during summer. The free range group had significantly higher levels of SOD and GSH in the summer and winter, respectively.Vitamins C and E levels declined during the summer. In both the groups, summer levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and plasma alkaline phosphatase (ALP) were significantly higher but remained within the reference range. During the summer, both groups of goats showed a significant decrease in plasma glucose, triglycerides, and cholesterol. Total proteins (TP) and Albumin both significantly declined during the winter in both the groups. Total immunoglobulins significantly increased during the winter in the free range group. Throughout the winter and the summer, respectively, the fat percentage increased in the milk of the stall-fed and free-range groups. Moreover, solid not fat (SNF) significantly declined in stall fed group during the winter. Also, there was no discernible difference in the amount of milk proteins between the groups; however, during the summer, it was discovered that stall-fed goats had more of them. The milk lactose significantly increased in both the groups in the time of summer though the increase was remarkable in stall fed goats. The present study indicated that stall fed and free range reared goats in winter and summer exhibit physiological variation in their health state, milk production, and composition.

Abstract Background The present study investigates if common missense functional variants p.I148M and p.E167K in PNPLA3 and TM6SF2 genes, respectively, associate with development of hepatic fibrosis and cirrhosis in a geographically novel cohort of Pakistani chronic hepatitis C (CHC) patients. Methods In total, 502 Pakistani CHC patients [242 males, median age 40 years, 220 with significant hepatic fibrosis, including 114 with cirrhosis] were genotyped for PNPLA3 and TM6SF2 variants using TaqMan genotyping assays. Associations between genotypes, biochemical and clinical parameters were evaluated. Results Genotypic distributions for PNPLA3 and TM6SF2 polymorphisms conformed to Hardy–Weinberg equilibrium and did not associate with fibrosis grades ≥ F2 or cirrhosis in any of the genetic models tested (all p = > 0.05). PNPLA3 and TM6SF2 variants did not modulate baseline characteristics and serum markers of liver injury in CHC patients. Similarly, increasing number of risk alleles of PNPLA3 and TM6SF2 polymorphisms had no trend effect on serum liver enzyme activities or proportion of CHC patients with significant or advanced fibrosis or cirrhosis (p = > 0.05). The same trend of no association with hepatic fibrosis or cirrhosis persisted in the multivariate logistic regression models adjusting for age, gender, body mass index and HCV viral load (p = > 0.05). Conclusions PNPLA3 and TM6SF2 variants do not appear to modulate development of hepatic fibrosis or cirrhosis in present CHC patients of Pakistani origin, and may be of more relevance in liver pathology involving abnormalities in hepatic fat accumulation. These results also reflect the divergent associations observed for different genetic modifiers of hepatic fibrosis and cirrhosis in distinct ethnicities.

Abstract The gaps between the complex nature of cancer and therapeutics have been narrowed down due to extensive research in molecular oncology. Despite gathering massive insight into the mysteries of tumor heterogeneity and the molecular framework of tumor cells, therapy resistance and adverse side effects of current therapeutic remain the major challenge. This has shifted the attention towards therapeutics with less toxicity and high efficacy. Myricetin a natural flavonoid has been under the spotlight for its anti-cancer, anti-oxidant, and anti-inflammatory properties. The cutting-edge molecular techniques have shed light on the interplay between myricetin and dysregulated signaling cascades in cancer progression, invasion, and metastasis. However, there are limited data available regarding the nano-delivery platforms composed of myricetin in cancer. In this review, we have provided a comprehensive detail of myricetin-mediated regulation of different cellular pathways, its implications in cancer prevention, preclinical and clinical trials, and its current available nano-formulations for the treatment of various cancers.

An entrepreneurial spirit is a crucial component of every nation's progress. For the majority of emerging nations, the biggest issue is unemployment. When it comes to lowering unemployment rates, entrepreneurs are crucial since they create jobs. Starting a business from scratch is not a picnic; it calls for meticulous preparation over the long haul. Expertise in creating and overseeing commercial ventures is also necessary. To achieve success as an entrepreneur, one must first understand his or her motivations and aspirations. Educated young people lack the necessary knowledge and skills to launch a new business. There are a lot of factors that influence students' entrepreneurial intents and attitudes while they are just starting out in the workforce, thus measuring students' intentions for starting a new firm is vital. An entrepreneur's desire to involve in an entrepreneurial action is defined by their level of commitment to the "Theory of Planned Behavior (TPB)." The sample size was 600 students, drawn from a variety of universities, both public and private, in Punjab. A student's entrepreneurial purpose was significantly impacted by their perceived control over their behavior and their attitude towards the activity, according to the results. Students' aspirations to start their own businesses might be bolstered by an industry interface and a start-up fund. Students lack the necessary information and expertise to launch a company, and many are unsure of how to create an organization plan for an entrepreneurial initiative. There was no statistically significant association between students' subjective norm and their intention to start their own business in this study. A person's social circle may not have the sway they need to make decisions in the face of societal shifts occurring at a rapid pace. [ABSTRACT FROM AUTHOR]

Background: Nationwide US data on readmission rates for patients with cirrhosis admitted with hepatorenal syndrome (HRS) is lacking. We reviewed 30‐day readmission rates after HRS‐related hospitalizations, the associated predictors of readmissions, and their impact on resource utilization and mortality in the United States. Methods: We identified all adults admitted with HRS between 2016 and 2019 using the Nationwide Readmission database of the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project. The primary outcome was all‐cause 30‐day readmission rate. Secondary outcomes were inpatient mortality rate, predictors of readmission, and resource utilization. Results: We identified 245 850 hospitalizations of patients admitted for HRS in the United States from 2016 to 2019. Of these, 214 890 met the inclusion criteria. Mean age was 59.16 years, and 61.31% were males. Medicare was the most common primary payer (44.82%) followed by Medicaid (25.58%). The readmission rate was 24.6% within 30 days of discharge from index hospitalization. The most common cause of readmission was alcoholic cirrhosis with ascites (14.87%), followed by sepsis (9.32%) and unspecified hepatic failure (9%). The in‐hospital mortality rate for index hospitalization was 29.52% and 14.35% among those readmitted within 30 days. The mean length of stay (12.33 days vs. 7.15 days, p < 0.01) and hospitalization costs ($44 903 vs. $22 353, p < 0.01) were higher for index hospitalizations than readmissions. Conclusions: Our study demonstrated that all‐cause 30‐day readmission and in‐hospital mortality rates after the development of HRS were strikingly high. This warrants health policies and interventions at the institutional level, including close post‐hospital discharge follow‐up, to decrease readmission rates, improve patient outcomes, and reduce cost burden. [ABSTRACT FROM AUTHOR]

Objectives: This study investigated the association of MSX1 gene variants rs3821949 and rs12532 with nonsyndromic cleft lip and/or palate (NSCL/P) in the Pakistani population. Design: Comparative cross-sectional study. Setting: Multicenter of CL/P malformation. Patients/Participants: Unrelated Non-Syndromic cleft Lip/Palate patients and healthy controls were enrolled. Methods: One hundred (n = 100) subjects with NSCL/P and n = 50 unrelated healthy controls were enrolled in a multicenter comparative cross-sectional study. A tetra amplification refractory mutation system (ARMS) polymerase chain reaction (PCR) was performed to analyze MSXI gene single nucleotide variants (SNVs). Results: Among 100 NSCL/P subjects, the majority were males (56%; male: female = 1.27: 1). Most of the cases (74%) had cleft lip and palate (CLP) compared to isolated clefts. Genotyping of MSX1 gene variant rs3821949 showed an increased risk for NSCL/P in various genetic models (P < 0.0001), and the A allele exhibited a more than 4-fold increased risk among cases (OR = 4.22: 95% CI = 2.16–8.22; P < 0.0001). Our investigation found no significant difference between the rs12532 variation and NSCL/P. Conclusion: Our study findings suggest that MSX1 gene variants may increase predisposition to NSCL/P in the Pakistani population. Further studies comprising large samples are required to identify the genetic aetiology of NSCL/P among our people. [ABSTRACT FROM AUTHOR]

Claudin-14 protein plays an essential role in regulating calcium ions in the kidney and ear. Two phenotypes, hearing loss and kidney stones, were reportedly associated with variations in the CLDN14 gene. This study aimed to understand CLDN14 mutations’ contribution to hearing loss and renal stone formation in a Pakistani cohort. We analyzed CLDN14 sequence variations in 100 patients, along with healthy individuals, to assess whether specific polymorphisms were associated with the disease. Also, we performed an in silico analysis using a mutation database and protein annotation. The rs219779’s genotype CT (p = 0.0020) and rs219780’s genotype AG (p = 0.0012) were significantly associated with kidney stones. We also found that a novel haplotype, “TA” associated with kidney stone formation, has moderate linkage disequilibrium. The TA haplotype was significantly correlated with a kidney stone risk formation of 3.76-fold (OR (CI 95%) = 3.76 (1.83–7.72)) and p = 0.0016 compared to other haplotypes. In silico analysis revealed that mutations associated with hearing loss were not correlated with renal stone formation but affected claudin-14 protein stability. We structurally mapped a novel TA haplotype of CLDN14 that, based on our analysis, likely contributes to the pathogenesis of renal stones.

The roles of educational online tools are very prevalent in the current time due to the advancement in technology, digital transformation, and the better speed of the internet. The digital platform is the most preferable and convenient platform to support advanced educational practices. Being a prominent study tool to manage the lectures, study materials, assignments and other necessary elements related to academics, the learning management system (LMS) has been implemented in most institutions, especially after the lockdown amid the COVID-19, pandemic. The purpose of this paper is to investigate the level of acceptance of the LMS in the North Indian regions of Punjab, Himachal Pradesh, and Haryana with the adoption of the Technology Acceptance Model (TAM) framework. To check the hypotheses (framed as per the TAM model), the structural equation model (SEM) has been applied which reveals that the acceptance level and the adoption of the LMS system is quite low across the chosen population. The complexity and the novelty of technology in addition to the alternative options of LMS can be the reason for the lower level of acceptance and adoption. The exact reason for the lower level of adoption can be explicitly understood from future research.

Rasmussen aneurysm is rare diagnosis occurring in patients with long-standing tuberculosis. TB-COVID-19 co-infection in the context of Rasmussen aneurysm is a rare occurrence, yet new cases are emerging. An elderly male was recently diagnosed with TB-COVID-19 co-infection and presented with sudden onset massive hemoptysis. The patient was diagnosed with Rasmussen aneurysm after being evaluated by computed tomography pulmonary angiogram due to a suggestive clinical presentation. Interventional radiologists planned for embolization of pulmonary artery, with an unidentifiable source. It was suspected that the patient's source of bleeding was hampered due to local tamponade effect or thrombosis of the aneurysm. The patient remained stable after 24 hours on computed tomography pulmonary angiogram. Our case emphasizes the importance of Rasmussen aneurysm as a differential diagnosis when presented with a TB-COVID-19 co-infection and sudden onset of hemoptysis symptomatically and radiologically. The timely diagnosis and management are key to improve mortality.

Abstract Background Coronavirus disease 2019, caused by the severe acute respiratory syndrome coronavirus 2, has a broad clinical spectrum, from asymptomatic to multi-organ dysfunction. Acute cerebrovascular events associated with coronavirus disease 2019 are mainly due to the severe acute respiratory syndrome coronavirus 2-induced prothrombotic state. Bilateral basal ganglia ischemia is rarely reported. Case presentation We report the case of a 64-year-old Asian (Pakistani) gentleman who presented initially with fever, cough, and shortness of breath, likely due to respiratory involvement by severe acute respiratory syndrome coronavirus 2. Later, he developed bilateral lower limb pain, followed by confusion and decreased level of consciousness. Accentuated large hypodense opacities were seen in the left and right basal ganglia, with mass effects on the left frontal horn. Conclusion This case demonstrates the importance of neuroimaging in the effective management of patients with neurological signs associated with coronavirus disease 2019.

Background: In this international multicenter study, we aimed to determine the independent risk factors associated with increased 30 day mortality and the impact of cancer and novel treatment modalities in a large group of patients with and without cancer with COVID-19 from multiple countries. Methods: We retrospectively collected de-identified data on a cohort of patients with and without cancer diagnosed with COVID-19 between January and November 2020 from 16 international centers. Results: We analyzed 3966 COVID-19 confirmed patients, 1115 with cancer and 2851 without cancer patients. Patients with cancer were more likely to be pancytopenic and have a smoking history, pulmonary disorders, hypertension, diabetes mellitus, and corticosteroid use in the preceding 2 wk (p≤0.01). In addition, they were more likely to present with higher inflammatory biomarkers (D-dimer, ferritin, and procalcitonin) but were less likely to present with clinical symptoms (p≤0.01). By country-adjusted multivariable logistic regression analyses, cancer was not found to be an independent risk factor for 30 day mortality (p=0.18), whereas lymphopenia was independently associated with increased mortality in all patients and in patients with cancer. Older age (≥65y) was the strongest predictor of 30 day mortality in all patients (OR = 4.47, p

We present the case of 30-year old primigravida female at 11 weeks’ gestation who was diagnosed to have ectopic pregnancy on obstetric ultrasound. An MRI pelvis was ordered to assess invasion into the posterior myometrium which confirmed a single right-sided broad ligament-extra uterine pelvic ectopic pregnancy with extrinsic mass effect on the right lower uterine segment without frank myometrial invasion. On an urgent basis, a uterine artery embolization (UAE) was performed by targeting the right femoral artery. Selective catheterization was performed of both uterine arteries and the right side showed a major feeder of the gestational sac. Supplied dose of methotrexate (95mg) was infused in the right uterine artery and both arteries were then embolized by gel foam slurry. Thus, prompt treatment reduced the risk of infertility and saved the patient from obstetrical emergency. Further exploration needs to be done in this field to explore conservative management options to preserve fertility.