Liver transplantation and resection in patients with hepatocellular cancer and portal vein tumor thrombosis: Feasible and effective?

Patients with locally advanced hepatocellular cancer(HCC)and portal vein tumor thrombosis(PVTT)have a dismal prognosis since limited treatment options are available for them.In recent years,effective systemic therapy,and advances in the understanding of technicalities and effectiveness of ablative therapies especially radiotherapy,have given some hope to prolong survival in them.This review summarized recent evidence in literature regarding the possible role of liver resection(LR)and liver transplantation(LT)in patients with locally advanced HCC and PVTT with no extrahepatic disease.Downstaging therapies have helped make curative resection or LT a reality in selected patients.This review emphasizes on the key points to focus on when considering surgery in these patients,who are usually relegated to palliative systemic therapy alone.Meticulous patient selection based on tumor biology,documented downstaging based on imaging and decrease in tumor marker levels,and an adequate waiting period to demonstrate stable disease,may help obtain satisfactory long-term outcomes post LR or LT in an intention to treat strategy in patients with HCC and PVTT.

Alignment Techniques in Total Knee Arthroplasty:Where do We Stand Today?

Achieving optimal alignment in total knee arthroplasty(TKA)is a critical factor in ensuring optimal outcomes and long-term implant survival.Traditionally,mechanical alignment has been favored to achieve neutral post-operative joint alignment.However,contemporary approaches,such as kinematic alignments and hybrid techniques including adjusted mechanical,restricted kinematic,inverse kinematic,and functional alignments,are gaining attention for their ability to restore native joint kinematics and anatomical alignment,potentially leading to enhanced functional outcomes and greater patient satisfaction.The ongoing debate on optimal alignment strategies considers the following factors:long-term implant durability,functional improvement,and resolution of individual anatomical variations.Furthermore,advancements of computer-navigated and robotic-assisted surgery has augmented the precision in implant positioning and objective measurements of soft tissue balance.Despite ongoing debates on balancing implant longevity and functional outcomes,there is an increasing advocacy for personalized alignment strategies that are tailored to individual anatomical variations.This review evaluates the spectrum of various alignment techniques in TKA,including mechanical alignment,patient-specific kinematic approaches,and emerging hybrid methods.Each technique is scrutinized based on its fundamental principles,procedural techniques,inherent advantages,and potential limitations,while identifying significant clinical gaps that underscore the need for further investigation.

Systematic review with expert consensus on use of extracorporeal hemoadsorption in septic shock:An Indian perspective

BACKGROUND Septic shock is a severe form of sepsis characterised by deterioration in circulatory and cellular-metabolic parameters.Despite standard therapy,the outcomes are poor.Newer adjuvant therapy,such as CytoSorb®extracorporeal haemoadsorption device,has been investigated and shown promising outcome.However,there is a lack of some guidance to make clinical decisions on the use of CytoSorb®haemoadsorption as an adjuvant therapy in septic shock in Indian Setting.Therefore,this expert consensus was formulated.AIM To formulate/establish specific consensus statements on the use of CytoSorb®haemoadsorption treatment based on the best available evidence and contextualised to the Indian scenario.METHODS We performed a comprehensive literature on CytoSorb®haemoadsorption in sepsis,septic shock in PubMed selecting papers published between January 2011 and March 20232021 in English language.The statements for a consensus document were developed based on the summarised literature analysis and identification of knowledge gaps.Using a modified Delphi approach combining evidence appraisal and expert opinion,the following topics related to CytoSorb®in septic shock were addressed:need for adjuvant therapy,initiation timeline,need for Interleukin-6 levels,duration of therapy,change of adsorbers,safety,prerequisite condition,efficacy endpoints and management flowchart.Eleven expert members from critical care,emergency medicine,and the intensive care participated and voted on nine statements and one open-ended question.RESULTS Eleven expert members from critical care,emergency medicine,and the intensive care participated and voted on nine statements and one open-ended question.All 11 experts in the consensus group(100%)participated in the first,second and third round of voting.After three iterative voting rounds and adapting two statements,consensus was achieved on nine statements out of nine statements.The consensus expert panel also recognised the necessity to form an association or society that can keep a registry regarding the use of CytoSorb®for all indications in the open-ended question(Q10)focusing on“future recommendations for CytoSorb®therapy”.CONCLUSION This Indian perspective consensus statement supports and provides guidance on the use of CytoSorb®haemoadsorption as an adjuvant treatment in patients with septic shock to achieve optimal outcomes.

Sentiment Analysis with Tweets Behaviour in Twitter Streaming API

Twitter is a radiant platform with a quick and effective technique to analyze users’perceptions of activities on social media.Many researchers and industry experts show their attention to Twitter sentiment analysis to recognize the stakeholder group.The sentiment analysis needs an advanced level of approaches including adoption to encompass data sentiment analysis and various machine learning tools.An assessment of sentiment analysis in multiple fields that affect their elevations among the people in real-time by using Naive Bayes and Support Vector Machine(SVM).This paper focused on analysing the distinguished sentiment techniques in tweets behaviour datasets for various spheres such as healthcare,behaviour estimation,etc.In addition,the results in this work explore and validate the statistical machine learning classifiers that provide the accuracy percentages attained in terms of positive,negative and neutral tweets.In this work,we obligated Twitter Application Programming Interface(API)account and programmed in python for sentiment analysis approach for the computational measure of user’s perceptions that extract a massive number of tweets and provide market value to the Twitter account proprietor.To distinguish the results in terms of the performance evaluation,an error analysis investigates the features of various stakeholders comprising social media analytics researchers,Natural Language Processing(NLP)developers,engineering managers and experts involved to have a decision-making approach.

Investigating the Hubble Tension Through Hubble Parameter Data

The Hubble constant(H_0),which represents the expansion rate of the universe,is one of the most important cosmological parameters.The recent measurements of H0using the distance ladder methods such as type Ia supernovae are significantly greater than the CMB measurements by Planck.The difference points to a crisis in the standard model of cosmology termed Hubble tension.In this work we compare different cosmological models,determine the Hubble constant and comment on the Hubble tension using the data from differential ages of galaxies.The data we use are free from systematic effects as the absolute age estimation of the galaxies is not needed.We apply the Bayesian approach along with the commonly used maximum likelihood method to estimate H_0 and calculate the AIC scores to compare the different cosmological models.The non-flat cosmological model provides a higher value for matter density as well as the Hubble constant compared to the flatΛCDM model.The AIC score is smaller for the flatΛCDM cosmology compared to the non-flat model indicating the flat model a better choice.The best-fit values of H_0 for both these models are 68.7±3.1 km s^(-1)Mpc^(-1)and 72.2±4km s^(-1)Mpc^(-1),respectively.Our results are consistent with the CCHP measurements.However,the flat model result does not agree with the SH0ES result,while the non-flat result is inconsistent with the Planck value.

A high Q terahertz metamaterial absorber using concentric elliptical ring resonators for harmful gas sensing applications

A nearly perfect metamaterial absorber is proposed that can find utility in terahertz sensing applications.The design consists of two concentric elliptical ring resonators(ERRs)whose parameters are appropriately set to achieve dual band absorption with near perfect absorption.The first absorption band at 3.62 THz having a Q-factor of 51.7 was caused due to the currents in the outer and inner ERR.The second absorption peak at 3.814 THz having a Q factor of 1411.11 was a consequence of currents flowing across the gap between the two concentric resonators.Furthermore,it is observed that the absorption bands are sensitive to the variation in refractive index of the surrounding medium.The sensitivity's in the absorption bands are 3 THz/RIU and 3.59 THz/RIU respectively.A sensor is proposed based on this design to detect harmful gases,which is demonstrated for detection of Methane and Chloroform.High Q-factor and high sensitivity of the narrow band makes the design an excellent sensor for detecting variations in the refractive index.

Preventing breast cancer in LMICs via screening and/or early detection: The real and the surreal

To review the present status of breast cancer(BC) screening/early detection in low- and middle-income countries(LMICs) and identify the way forward, an open focused search for articles was undertaken in Pub Med, Google Scholar and Google, and using a snowball technique, further articles were obtained from the reference list of initial search results. In addition, a query was put up on Research Gate to obtain more references and find out the general opinion of experts on the topic. Experts were also personally contacted for their opinion. Breast cancer(BC) is the most common cancer in women in the world. The rise in incidence is highest in LMICs where the incidence has often been much lower than high-income countries. In spite of more women dying of cancer than pregnancy or childbirth related causes in LMICs, most of the focus and resources are devoted to maternal health. Also, the majority of women in LMICs present at late stages to a hospital to initiate treatment. A number of trials have been conducted in various LMICs regarding the use of clinical breast examination and mammography in various combinations to understand the best ways of implementing a population level screening/early detection of BC; nevertheless, more research in this area is badly needed for different LMIC specific contexts. No-tably, very few LMICs have national level programs for BC prevention via screening/early detection and even stage reduction is not on the public health agenda. This is in addition to other barriers such as lack of awareness among women regarding BC and the presence of stigma, inappropriate attitudes and lack of following proper screening behavior, such as conducting breast self-examinations. The above is mixed with the apathy and lack of awareness of policy makers regarding the fact that BC prevention is much more cost-effective and humane than BC treatment. Implementation of population level programs for screening/early detection of BC, along with use of ways to improve awareness of women regarding BC, can prove critical in stemming the increasing burden of BC in LMICs. Use of newer modalities such as ultrasonography which is more suited to LMIC populations and use of m Health for awareness creation and increasing screening compliance are much needed extra additions to the overall agenda of LMICs in preventing BC.

A Novel Enzymatic Method for Preparation and Characterization of Collagen Film from Swim Bladder of Fish Rohu (<i>Labeo rohita</i>)

A novel enzymatic method for extraction and preparation of fish collagen from swim bladder revealed the occurrence of α, β and γ bands with approximately 12.1 g/100g collagen corresponding to 89% of collagen and thus confirmed the nativity and purity of the fish collagen. FT-IR studies confirmed the retention of all three amide bands of I, II and III, and triple helixcity. UN-crosslinked and UV-crosslinked fish collagen membrane records a very high temperature of helix denaturation at 197℃ and 215℃, shrinkage temperature at 50℃ ± 3.2℃ and 62℃ ± 2.7℃ and tensile strength at 16.89 ± 2.5 and 120.02 ± 1.0 Kg/cm2 respectively. Fish collagen matrix promoted NIH 3T3 and L6 cellular growth and proliferation. The study indicates that availability of pure fish collagen could replace bovine collagen in tissue engineering applications.

High Incidence of Pulmonary Tuberculosis in ART Naive Remunerated Blood Donors with Human Immunodeficiency Virus Type-1 Infection: Possible Role of Iron Overload

Iron overload is reported to be associated with immune alterations and increased susceptibility to infections. HIV infection is characterized by progressive immunodeficiency leading to invasion by opportunistic pathogens. It was of interest to find out if disease course in HIV type-1 infection could have any relation with alteration in body iron status among individuals with history of oral iron intake. A follow-up study of immunologic and virologic markers in relation to disease progression was undertaken on asymptomatic HIV-1 positive blood donors with history of oral iron intake (subgroup I) compared to those without such history (subgroup II). High serum iron was associated with elevated levels of Th2 category of cytokines, heightened immune activation, faster decline in CD4 + T lymphocyte count and higher viral set point. Pulmonary tuberculosis (PT) was the most common AIDS related illness (ARI) (>70%) recorded among subgroup I compared to non-PT category of ARI. Median ARI free duration (months) was shorter among those who developed PT compared to those developing non-PT category of ARI i.e. 30 (95% CI as 26,32) versus 67(95% CI as 60,71) in subgroup I and 47 (95% CI as 42,49) versus 80 (95% CI as 72,87) in subgroup II (P P < 0.001 for PT versus non-PT in both subgroups). The present study indicates that body iron overload resulting from excess intake of iron may be associated with qualitative defects in cell mediated immunity at early stage of HIV-1 infection that may facilitate subsequent acquisition of pulmonary tuberculosis, shorter ARI free duration and reduced survival.

Endoscopic ultrasound guided drainage of pancreatic fluid collections: Assessment of the procedure, technical details and review of the literature

Endoscopic ultrasound(EUS) guided drainage of pancreatic fluid collections(PFC) has become increasingly popular and become first line management option in many centers. Use of therapeutic echoendoscopes has greatly increased the applicability of EUS guided transmural drainage. Drainage is indicated in symptomatic PFCs, PFC related infection, bleed, luminal obstruction, fistulization and biliary obstruction. EUS guided transmural drainage of PFCs is preferred in patients with non bulging lesions, portal hypertension, bleeding tendency and in those whom conventional drainage has failed. In the present decade significant progress has been made in minimally invasive endoscopic techniques. There are newer stent designs, access devices and techniques for more efficient drainage of PFCs. In this review, we discuss the EUS guided drainage of PFCs in acute pancreatitis.

Heat Pipe for Aerospace Applications—An Overview

The paper presents an overview of heat pipes, especially those used in different space missions. Historical perspectives, principles of operations, types of heat pipes are discussed. Several factors have contributed to the science and technology of the present state-of-Art heat pipe leading to the development of loop heat pipes, micro and miniature heat pipes and micro loop heat pipes. The paper highlights the advancement of heat pipe for hypersonic cruise vehicles, loop heat pipes with higher conductance in 10 K range, heat pipe switches for temperature control of the spacecraft electronics.

The Unexplored Role of Probiotics on the Parasitic Pathogens

The beneficial bacteria coined as probiotics are used as therapeutics to the host and evidences are there to demonstrate to treat bacterial and viral respiratory infections, gastrointestinal diseases, eczema, inflammation, H. pylori infection, irritable bowel syndrome and allergic symptoms etc. In recent past, probiotics has been reported for the control of intestinal parasite infections as well as few non-gut infections spread among human and veterinary animals. Animal models and in vitro culture systems have been studied regarding cellular interactions between probiotics and pathogens or relevant host cells, though the underlying molecular mechanisms mediating the beneficial effects have not yet fully discovered. Hence, more evidence based studies are warranted to correlate whether probiotics through multiple mechanisms might indeed provide a strain-specific protection against parasites to use it as therapeutics. This article has described the effect of probiotics in some of the intestinal as well as non-gut parasites and suggested the scope of exploring the benefit for protozoan parasite Leishmania, as India is planning for the elimination of the disease.

Identification of Oxidative Degradation Products of Lansoprazole by Using High Resolution Mass Spectrometry Spectral Data

The study focused on the application of high-resolution mass spectrometry for the identification of impurities in pharmaceutical small molecules. A high-performance liquid chromatography (HPLC) coupled high resolution mass spectrometer (HRMS) was used for identification of oxidative degradation impurities (DIs) of lansoprazole. The utilization of HRMS facilitates to determine the accurate mass of impurities and their fragment/product ions. A fast mass spectrometer (MS) compatible reverse phase chromatography method was used to investigate the oxidative stressed impurities. HPLC column;C18 (50 × 4.6 mm, 3.5 μm) was used with gradient elution. Spectral data acquired using information dependent acquisition (IDA) with real time dynamic background subtraction algorithm (DBS). Three oxidative impurities: DI-I (m/z 386.0781), DI-II (m/z 402.0734) and DI-III (m/z 386.0785), was observed during this study;interpretation of high resolution spectral data of all three impurities was carried out;elemental composition and molecular structure was proposed for major fragments. In this study mass error was found ≤7.7 parts per million (ppm).

Systematic review and meta-analysis of the impact of deviations from a clinical pathway on outcomes following pancreatoduodenectomy

BACKGROUND Enhanced recovery after surgery is steadily gaining importance in patients undergoing pancreatic surgery,including pancreatoduodenectomy(PD).While clinical pathways targeting enhanced-recovery can achieve their intended outcome in reducing length of stay,compliance to these pathways,and their relevance is poorly understood.The aim of this systematic review was to assess the impact of deviations from/non-compliance to a clinical pathway on post-PD outcomes.AIM To assess the impact of deviations from/non-compliance to a clinical pathway on post-PD outcomes.METHODS A systematic review of major reference databases was undertaken,according to preferred reporting items for systematic reviews and meta-analysis guidelines,between January 2000 and November 2020 relating to compliance with clinical pathways and its impact on outcomes in patients undergoing PD.A meta-analysis was performed using fixed-effects or random-effects models.RESULTS Eleven studies including 1852 patients were identified.Median overall compliance to all components of the clinical pathway was 65.7%[interquartile range(IQR):62.7%-72.3%]with median compliance to post-operative parameters of the clinical pathway being 44%(IQR:34.5%-52.25%).Meta-analysis using a fixed-effects model showed that≥50%compliance to a clinical pathway predicted significantly fewer post-operative complications[pooled odds ratio(OR):9.46,95%confidence interval(CI):5.00-17.90;P<0.00001]and a significantly shorter length of hospital stay[pooled mean difference(MD):4.32,95%CI:-3.88 to-4.75;P<0.0001].At 100%compliance which was associated with significantly fewer post-operative complications(pooled OR:11.25,95%CI:4.71-26.84;P<0.00001)and shorter hospital stay(pooled MD of 4.66,95%CI:2.81-6.51;P<0.00001).CONCLUSION Compliance to post-PD clinical pathways remains low.Deviations are associated with an increased risk of complications and length of hospital stay.Understanding the relevance of deviations to clinical pathways post-PD presents pancreatic surgeons with opportunities to actively pursue an enhanced-recovery of their patients.

Liquid chromatography tandem mass spectrometry method for the estimation of lamotrigine in human plasma:Application to a pharmacokinetic study

A reliable,selective and sensitive liquid chromatography tandem mass spectrometry method was developed and validated for the quantification of lamotrigine in human plasma using lamotrigine13C3,d3 as an internal standard.Analyte and internal standard were extracted from human plasma by solid-phase extraction and detected in positive ion mode by tandem mass spectrometry with electrospray ionization（ESI） interface.Chromatographic separation was performed on a Chromolith s SpeedROD;RP-18e column（50-4.6 mm i.d.） using acetonitrile：570.1 mM ammonium formate solution（90：10,v/v） as the mobile phase at a flow rate of 0.500 mL/min.The calibration curves were linear over the range of 5.02-1226.47 ng/mL with the lower limit of quantitation validated at 5.02 ng/mL.The analytes were found stable in human plasma through three freeze（-20℃）-thaw（ice-cold water bath） cycles and under storage on bench-top in ice-cold water bath for at least 6.8 h,and also in the mobile phase at 10℃ for at least 57h.The method has shown good reproducibility,as the intra-and inter-day precisions were within 3.0%,while the accuracies were within 76.0% of nominal values.The validated LC-MS/MS method was applied for the evaluation of pharmacokinetic and bioequivalence parameters of lamotrigine after an oral administration of 50mg lamotrigine tablet to thirty-two healthy adult male volunteers.

A Detailed Study of the Role of Fermi Energy in Determining Properties of Superconducting NbN

The recent concern with the role of Fermi energy (EF) as a determinant of the properties of a superconductor (SC) led us to present new EF-dependent equations for the effective mass (m*) of superconducting electrons, their critical velocity, number density, and critical current density, and also the results of the calculations of these parameters for six SCs the Tcs of which vary between 3.72 and 110 K. While this work was based on, besides an idea due to Pines, equations for Tc and the gap at T = 0 that are explicitly EF-dependent, it employed an equation for the dimensionless construct that depends on EF only implicitly;k in this equation is the Boltzmann constant, θ is the Debye temperature, and P0 is the critical momentum of Cooper pairs. To meet the demand of consistency, we give here derivation of an equation for y that is also explicitly EF-dependent. The resulting framework is employed to (a) review the previous results for the six SCs noted above and (b) carry out a study of NbN which is the simplest composite SC that can shed further light on our approach. The study of NbN is woven around the primary data of Semenov et al. For the additional required inputs, we appeal to the empirical data of Roedhammer et al. and of Antonova et al.

Demand and Capacity Modelling in Healthcare Using Discrete Event Simulation

The NHS is right now confronting huge pressures relating to demand and capacity in radiology. The purpose of this research has been to provide information about MRI usage, details of operational aspects of MRI services, and to ascertain the planning intentions of NHS radiology services to keep up and create MRI capacity. The report expands on using Discrete Event Simulation (DES) to inspect and plan the utilisation of NHS hospital resources for the radiology department to help a 24 hr service that is available to outpatients which will help with diminishing patient waiting time, better resource usage, understanding the capacity and demand. Consequently, this research examines to adjust staff and resources with the demand of the MRI. The research was investigated using DES in various scenarios to find which resources are inactive;patients are treated slowly. DES helped in discovering resource utilisation and outpatient throughout the system. It additionally helped in distinguishing the bottlenecks in patient flow. The DES simulation results demonstrated that time for the outpatient in the system is less and more outpatients have been treated too. There is a higher level of outpatient patients leaving the system under 120 minutes. The report uncovered an MRI report interpretation time. Reception room time and MRI waiting room time are decreased significantly. It additionally exhibited with an expanded outflow of outpatients, resources, for example, MRI capacity and radiographer utilisation expanded.

Understanding cashless payments in India

Background:This paper analyzes India’s gradual transition towards a cashless economy.Methods:We present a theoretical model that evaluates decisions by consumers and sellers to adopt cashless payments.We then use data from surveys conducted in 2011 and 2014(from World Bank’s Global Findex),as well as household and enterprise surveys conducted in 2009-2010 to estimate the amount of cashless transactions prevalent in India and identify the avenues that are successful and those that are not.We analyze instruments(cards versus point-of-sale versus mobile),micro units(individuals versus households versus retailers),and sectors to identify and estimate the enablers and bottlenecks.Results:We find that the most crucial enabler of cashless payments are inflows of funds into the accounts.Conclusion:Based on our findings,we suggest possible policy interventions.

Efficacy of Haemocoagulase as a Topical Haemostatic Agent after Minor Oral Surgical Procedures—A Prospective Study

Purpose: Haemocoagulase is a topical haemostatic agent which provides the adequate haemostasis after minor oral surgical procedures and it has also been proved to be beneficial in promoting wound healing. The aim of this study was to check the efficacy of haemocoagulase in stopping the bleeding and its effect over wound healing after the minor oral surgical procedure. Material & Method: This study is comprised of 150 surgical sites in 75 patients. The subjects were divided into 2 groups in which Group 1 consists of 50 surgical sites in 25 patients and Group II consists of 100 surgical sites in 50 patients. Group I comprised of the group of simple extraction. In these patients one tooth socket was selected as haemocoagulase site and the other socket was the control group in which no drug was used to control haemorrhage. Group II comprised of the group of patients with bilateral impactions. 50 sockets and surgical sites were sprinkled with Haemocoagulase, and 50 sockets and surgical sites were used as control side in which no drug was used to control haemorrhage. Results: In Group I bleeding was stopped with the average time of 1.35 minutes, while at control side bleeding was stopped with the average time of 2.25 minutes. In Group II bleeding was stopped with average time for haemostasis being 1.46 minutes, while at control side the bleeding was stopped in an average time of 2.43 minutes. Conclusion: Haemocoagulase after minor oral surgery not only provides faster haemostasis but also enhances healing.

Impaired <i>in Vitro</i>Macrophage Function in HIV-1 Infected Remunerated Blood Donors with History of Oral Iron Intake

Both HIV-1 infection and iron overload are independently associated with infection by Mycobacterium tuberculosis due to impaired macrophage function. A prospective study of in vitro assessment of macrophage function was undertaken in a group of asymptomatic HIV-1 infected remunerated (professional) blood donors with (n = 54) or without (n = 54) prevalent practice of oral iron intake (subgroups I and II respectively). The assessment was carried out at enrolment as well as at the point of development of AIDS related illness (ARI). The subgroup I showed higher levels of pro-inflammatory cytokines viz. IL-1β, IL-6 and IL-8, but lowered levels of IL-12p70 in serum as well as in supernatant of monocyte derived macrophage (MDM) cultures both at enrolment and at the point of development of ARI in the subset of cases that developed pulmonary tuberculosis (PT) on follow up compared to the subset that developed categories of ARI other than pulmonary tuberculosis (non-PT) on follow up. The subgroup II of HIV-1 positive donors did not show any such alterations at enrolment or at the point of development of PT or non-PT categories of ARI on follow up. There was significant depression of nitrite level in serum as well as that produced by MDM culture at enrolment in subgroup I regardless of category of ARI developed on follow up while in subgroup II there was significant elevation in these levels at enrolment, more among cases developing PT than those developing non-PT category of ARI. The subgroup I demonstrated increased production of superoxide at enrolment. The present study suggested that depressed production of nitrite and IL-12p70 by macrophages induced by iron overload may be responsible for greater susceptibility of HIV-1 positive donors to M. tuberculosis while superoxide may be a less powerful anti-mycobacterial tool.