NaYF4:Ho3+/Yb3+@NaGdF4 core@shell upconversion nanoparticles for contrast enhancement in bimodal in-vitro OCT imaging.

Contrast enhancement is explored in optical coherence tomography images using core NaYF4:Ho3+/Yb3+ and core@shell NaYF4:Ho3+/Yb3+@NaGdF4 nanoparticles. Under 980 nm excitation, core@shell nanoparticles exhibited 2.8 and 3.3 times enhancement at 541 nm and 646 nm emission wavelengths of Ho3+ ions compared to core nanoparticles. Photo-thermal conversion efficiencies were 32% and 20% for core and core@shell nanoparticles. In swept-source optical coherence tomography (SSOCT), core@shell nanoparticles have shown superior contrast, while in photo-thermal optical coherence tomography (PTOCT) core nanoparticles have excelled due to their higher photo-thermal conversion efficiency. The enhancement in contrast to noise ratio obtained is 58 dB. Comparative assessments of scattering coefficients and contrast-to-noise ratios were conducted, providing insights into nanoparticle performance for contrast enhancement in optical coherence tomography.

Exploring the Effect of Size Variability on Efficiency of Upconversion Nanoparticles as Optical Contrast Agents.

The current works explores the optical contrast property and nanaotheranostic capabilities of the rare earth based Upconversion nanoparticles. Optical coherence tomography (OCT) has been used to explore the particles ability to increase contrast and improve signal intensity. Photo thermal OCT, a function extension of OCT has been used to gauge the photo thermal potential of the nanoparticles. The nanoparticles successfully improved contrast and information from the deeper layers of the sample. The particles also showed excellent capability for use as photo thermal agents.

Probing multimodal light emission from Tb3+/Yb3+-doped garnet nanophosphors for lighting applications.

Herein we report the solution-combustion-method-synthesized Tb3+- and Tb3+/Yb3+-doped Gd3Ga5O12 nanophosphors, which possess luminescent and magnetic properties. The phase formation/crystal structure, and morphology of the prepared nanophosphors are studied using X-ray diffraction (XRD)/Raman spectroscopy and a field emission scanning electron microscope (FE-SEM), respectively. Tb3+/Yb3+-doped phosphor samples exhibit green emission with an intense band around 544 nm through downshifting (DS) and upconversion (UC) processes because of the 5D4 → 7F5 transition of Tb3+. In addition to this visible emission, these samples also show a NIR emission band around 1024 nm via the quantum cutting (QC) process due to the 2F5/2 → 2F7/2 transition of Yb3+. Emission decay measurements of the 5D4 → 7F5 transition of Tb3+ are performed to obtain the rate of energy transfer from Tb3+ to nearby Yb3+. Furthermore, using this energy transfer, the quantum cutting efficiencies were estimated. For their practical application, a selected sample was used to fabricate a LED device by combining the sample with a UV-C LED (274 nm). The obtained results, such as the activation energy (∼0.20 eV) and the high CRI value (78), suggest that the prepared sample can be utilized as a green-light-emitting agent in phosphor-coated (pc) WLEDs.

Boltzmann relation reliability in optical temperature sensing based on upconversion studies of Er3+ /Yb3+ co-doped PZT ceramics.

The fluorescence intensity ratio (FIR) of two thermally coupled levels with temperature follows the Boltzmann equation and shows an exponential nature to the temperature that is purely dependent on the energy difference between the levels. Despite the identical energy difference between the thermally coupled levels, researchers have observed varying sensitivities for various samples. In this article, the FIR and sensitivities were calculated using the Boltzmann equation by changing various parameters such as energy difference (ΔE) and the value of the constant C. The results were compared with various reports for Er3+ /Yb3+ ions. After analysis, a new polynomial fit equation was used to determine the temperature sensitivities for the Er3+ /Yb3+ co-doped PbZrTiO3 phosphor in lieu of the conventional Boltzmann equation. The polynomial fit equation eliminated the dependency of the sensitivity on the inverse of the FIR factor and a flat sensitivity curve was obtained with temperature.

A public-private partnership based model for regulating out-of-pocket expenditures to strengthen primary care system.

In developing countries like India, the cost of health care is largely borne by patient out-of-pocket payments. Recent studies have reported that patients skip public-funded clinics providing free consultation for distant private care providers. Some of the reasons identified for such behaviour include longer waiting times, perception regarding quality of care, etc. Therefore, optimal allocation of existing and new capacity is critical for a greater public interest. This article presents a decision-making framework towards this intent for strengthening the existing government primary healthcare network. In this article, a mixed-integer linear programing (MILP) model is developed for optimal reconfiguration of the existing government primary healthcare network to minimise patient out-of-pocket expenditures (OOPE). The model involves three types of facilities: Primary Health Centre (PHC), Community Health Centre (CHC), and Private OPD (outpatient department). Implementation of the proposed model can help in reducing out-of-pocket expenditures. The optimization model proposed in the article is unique as it incorporates for the first time, patient out-of-pocket expenditure, capacity reconfiguration, and public-private partnership decisions in the primary healthcare system. A solution algorithm is also proposed for the optimization model. The model would be useful for theory development and also in policy-making.

Incorporation of Zn(2+) ions into BaTiO3:Er(3+)/Yb(3+) nanophosphor: an effective way to enhance upconversion, defect luminescence and temperature sensing.

Ferroelectric BaTiO3 became a multifunctional material via doping of lanthanide ions (0.3 mol% Er(3+)/3.0 mol% Yb(3+)) and subsequently upconversion luminescence was enhanced by incorporation of Zn(2+) ions. Upconversion luminescence of BaTiO3:Er(3+)/Yb(3+) perovskite nanophosphor has been studied using 800 and 980 nm laser excitations. The emission dynamics is studied with respect to its dependence on input power and external temperature including lifetime. Based on time-resolved spectroscopy, it is inferred that two types of Er(3+) sites are present in the barium titanate lattice. The first one is a short lived component (minor species) present at 6-coordinated Ti-sites of low symmetry while the second one is a long lived component (major species), present at 12-coordinated Ba-sites with high symmetry. The influence of the introduction of Zn(2+) ions on the lifetime of (4)S3/2 and (4)F9/2 levels of Er(3+) ions is also investigated. Enhanced temperature sensing performance (120 K to 505 K) of the material is observed using the fluorescence intensity ratio technique, employing the emission from the thermally coupled, (2)H11/2 and (4)S3/2 energy levels of Er(3+) ions. The defect luminescence of the material is also found to increase upon Zn-doping.

Comparison of conventional infrainguinal versus modified proximal suprainguinal approach of Fascia Iliaca Compartment Block for postoperative analgesia in Total Hip Arthroplasty. A prospective randomized study.

Fascia Iliaca Compartment Block (FICB) has been widely used as a postoperative analgesic adjunct to opioids for total hip arthroplasty (THA), either by the conventional infrainguinal approach or the modified proximal suprainguinal approach irrespective of any specific advantage of one over the other. This study was conducted to compare the analgesic efficacy of the two techniques of FICB for postoperative analgesia. The 40 patients scheduled for THA were recruited for Intervention (s) and randomized to receive FICB either by suprainguinal approach (group S) or infrainguinal approach (group I) for postoperative analgesia with 40 ml of 0.2% bupivacaine, in addition to postoperative patient controlled analgesia (PCA) with morphine. Visual analogue scale (VAS) and PCA morphine consumption was used to assess the postoperative pain at 3, 6, 12 and 24 hours. The primary outcome was cumulative PCA morphine consumption in 24 hours. The pain intensity as measured by VAS scores showed significant reduction of intensity at 6 hours post block in group S as compared to group I (median [IQR]; 2[0-3]; 3[2.25-3]; p = 0.001) but, there was no significant difference in VAS at 12 and 24 hours. Postoperatively, there was significant difference in time to first PCA morphine demand (356.28 ± 33.32 vs 291.48 ± 37.17, p = < 0.001, respectively) in-group S vs. group I. The postoperative morphine consumption was also significantly less in group S compared to group I at 6, 12 and 24 hours and the cumulative morphine consumption in 24 hours (6.95 ± 2.14 vs 10.50 ± 2.24, p = < 0.001 respectively) was also less. In conclusion, in THA, suprainguinal approach of FICB has a superior postoperative analgesic efficacy compared to infrainguinal approach of FICB along with significantly less morphine consumption in first 24 hours.

Strong larvicidal potential of Artemisia annua leaf extract against malaria (Anopheles stephensi Liston) and dengue (Aedes aegypti L.) vectors and bioassay-driven isolation of the marker compounds.

Malaria and dengue are the two most important vector-borne human diseases caused by mosquito vectors Anopheles stephensi and Aedes aegypti, respectively. Of the various strategies adopted for eliminating these diseases, controlling of vectors through herbs has been reckoned as one of the important measures for preventing their resurgence. Artemisia annua leaf chloroform extract when tried against larvae of A. stephensi and A. aegypti has shown a strong larvicidal activity against both of these vectors, their respective LC50 and LC90 values being 0.84 and 4.91 ppm for A. stephensi and 0.67 and 5.84 ppm for A. aegypti. The crude extract when separated through column chromatography using petroleum ether-ethyl acetate gradient (0-100%) yielded 76 fractions which were pooled into three different active fractions A, B and C on the basis of same or nearly similar R f values. The aforesaid pooled fractions when assayed against the larvae of A. stephensi too reported a strong larvicidal activity. The respective marker compound purified from the individual fractions A, B and C, were Artemisinin, Arteannuin B and Artemisinic acid, as confirmed and characterized through FT-IR and NMR. This is our first report of strong mortality of A. annua leaf chloroform extract against vectors of two deadly diseases. This technology can be scaled up for commercial exploitation.

Sevoflurane and thoracic epidural anesthesia for trans-sternal thymectomy in a child with juvenile myasthenia gravis.

Literature on anesthetic management of juvenile myasthenia gravis (JMG) for thymectomy is limited. Recently, use of inhalational agents and total intravenous anesthesia with propofol and remifentanyl has been reported. All these techniques individually or in combination have been tried to avoid the use of muscle relaxant. We report successful use of sevoflurane as sole anesthetic agent for intubation and in combination with thoracic epidural anesthesia for intraoperative anesthetic management in a 5-year-old child with JMG.

In-situ oil-spill remediation by an electrodeposited superhydrophobic copper mesh.

The present study aims to combat the problem of oil in water pollution via its separation using a superhydrophobic copper mesh. An ecofriendly superhydrophobic copper mesh with a water contact angle of 166 ± 2° is developed by a facile two-step process (electrodeposition followed by coating). The coated mesh with mechanical robustness, chemical endurance and thermal stability is a promising choice for real-world conditions. Additionally, its resistance to corrosion in harsh chemical environments ensures its long-term durability. With a separation efficiency of 99.9 %, the coated mesh serves as an efficient medium for oil-water separation. It can be used as a reusable filtering medium with high separation efficiency in alkali and neutral environments. Besides, it is also competent for continuous oil-water separation and collection of oil from wastewater. Thus, the above study clearly manifests that the coated mesh holds tremendous potential for large-scale oil spill cleanup.

Assessment of NIR-triggered PEG-coated NaGdF4:Tm3+/Yb3+bio-compatible upconversion nanoparticles for contrast enhancement in OCT imaging and optical thermometry.

In this investigation, we embarked on the synthesis of polyethylene glycol coated NaGdF4:Tm3+/Yb3+upconversion nanoparticles (UCNPs), aiming to assess their utility in enhancing image contrast within the context of swept source optical coherence tomography (OCT) and photo-thermal OCT imaging. Our research unveiled the remarkable UC emissions stemming from the transitions of Tm3+ions, specifically the1G4→3H6transitions, yielding vibrant blue emissions at 472 nm. We delved further into the UC mechanism, meticulously scrutinizing decay times and the nanoparticles' capacity to convert radiation into heat. Notably, these nanoparticles exhibited an impressive photo-thermal conversion efficiency of 37.5%. Furthermore, our investigations into their bio-compatibility revealed a promising outcome, with more than 90% cell survival after 24 h of incubation with HeLa cells treated with UCNPs. The nanoparticles demonstrated a notable thermal sensitivity of 4.7 × 10-3K-1at 300 K, signifying their potential for precise temperature monitoring at the cellular level.

First indigenous transmission of Japanese Encephalitis in urban areas of National Capital Territory of Delhi, India.

OBJECTIVE: Until 2010, no Japanese encephalitis (JE) had been reported from Delhi. Upon report of four confirmed cases of JE in September 2011, detailed investigations were carried out to determine whether the cases were imported or indigenous. METHODS: Entomological surveys were carried out and all mosquito pools were tested for the detection of JE virus by ELISA method using specific monoclonal antibody. Human blood samples from contacts of the patients were tested by IgM-captured ELISA method. Pig's blood samples were also tested for the detection of JE virus. RESULTS: Culex tritaeniorhynchus, Culex vishnui and Culex pseudovishnui mosquitoes were found. In contrast to rural areas, their breeding habitats were different in the city. 19 pools were tested. JE virus was detected in two pools of Cx. tritaeniorhynchus females reared from field-collected larvae, indicating vertical transmission. One pool of Cx. vishnui was also positive. This is the first report for the detection of JE virus in mosquitoes from Delhi. JE IgM antibodies in five contacts/residents indicate recent infection. JE virus was also detected in pigs. CONCLUSION: Present analysis shows that of four reported JE cases, three were confirmed indigenous, indicating that the virus is multiplying in the city. Mapping of infected JE vector mosquitoes in the cities is required for preventive measures to contain further spread of the disease.

Power dependent photoacoustic and photoluminescence studies on a Ho3+/Yb3+ doped Y2O3 phosphor.

The Ho3+/Yb3+ doped Y2O3 phosphor samples were synthesized through a combustion method and then were annealed at 800 °C, 1000 °C, and 1200 °C. The cubic phase of the synthesized samples was confirmed by XRD analysis. The upconversion (UC) & photoacoustic (PA) spectroscopic studies were done on prepared samples and both spectra are compared. The samples have shown intense green upconversion emission at 551 nm due to the 5S2 → 5I8 transition of Ho3+ ion along with other bands. The maximum emission intensity is obtained for the sample annealed at 1000 °C for 2 hours. The authors have also measured the lifetime corresponding to 5S2 → 5I8 transition and found that lifetime values follow the trend of upconversion intensity. The maximum lifetime of 224 µs is observed for the sample annealed at 1000 °C. A photoacoustic cell & a pre-amplifier was fabricated and optimized for maximum sensitivity of the system. The PA signal was found to increase with increase of excitation power within the studied range, while UC emission was found to saturate after a certain pump power. The increase in PA signal is due to the increase in non-radiative transitions in the sample. The wavelength-dependent photoacoustic spectrum of sample has shown absorption bands around 445, 536, 649 and 945 (970) nm with maximum absorption at 945 (970) nm. This indicates its potential for photo-thermal therapy using infrared excitation.

Enhancement of photoacoustic and upconversion emission in Mg2+/Zn2+ codoped Gd2O3: Er3+/Yb3+ phosphor using 980 nm excitation.

In this work, Er3+/Yb3+ doped Gd2O3 phosphor samples were synthesized through a combustion method and then characterized through X-ray diffraction and FE-SEM techniques. The sample was studied for photoacoustic spectroscopy (PAS) and upconversion (UC) emission spectroscopy techniques using a frequency modulated 980 nm excitation source. A correlation between PA signal (produced due to non-radiative transitions) and UC emission intensity (produced due to radiative transition) is made in order to optimize the sample for both these properties. The phosphor was codoped with Mg2+ and Zn2+ ions to see enhancement in upconversion emission intensity and these ions have enhanced the upconversion emission. Studies show that the present phosphor is appropriate for producing strong upconversion emission intensity along with a strong photoacoustic signal which is beneficial for upconversion-imaging as well as photothermal therapy. The present sample has also shown its potential for detection of fingerprints.

Comparative studies of upconversion luminescence and optical temperature sensing in Tm3+/Yb3+ codoped LaVO4 and GdVO4 phosphors.

Tm3+/Yb3+ codoped LaVO4 and GdVO4 phosphors are successfully synthesized using solid state reaction methods and then upconversion emission studies are performed. X-ray diffraction has confirmed a pure monoclinic phase of LaVO4 and a tetragonal phase of GdVO4. Upconversion emission through 980 nm laser diode excitation has shown a strong blue band at 475 nm and two weak red bands at 647 and 700 nm originating from 1G4 → 3H6, 1G4 → 3F4 and 3F3 → 3H6 transitions of Tm3+ ions, respectively. Non-thermally coupled levels viz.3F3 (700 nm) and 1G4 (475 nm) in both the phosphors are used for fluorescence intensity ratio based optical thermometric studies and a comparison is made. The FIR data against temperature were fitted with polynomial and exponential fittings. The results show that polynomial fitting has a higher absolute sensitivity of 21.2 × 10-3 K-1 at 653 K for the LaVO4: Tm3+/Yb3+ phosphor than the exponential fitting sensitivity of 19.0 × 10-3 K-1 at 653 K, while in the case of the GdVO4: Tm3+/Yb3+ phosphor both fitting functions provided the same value of absolute sensitivity, that is 13.0 × 10-3 K-1 at 653 K. A comparison of the sensitivity values shows that the LaVO4: Tm3+/Yb3+ phosphor provides higher sensitivity than the GdVO4: Tm3+/Yb3+phosphor but the latter one is too high in upconversion emission.

Strategy to probe multimodal light emissions from Eu3+/Yb3+ activated garnet nanophosphors for LED devices and solar cell applications.

This study investigates multimodal light emission from an Eu3+/Yb3+ activated Y3Ga5O12 (YGG) nanophosphor synthesized using a low temperature solution combustion method. The prepared sample possesses a cubic phase and an Ia3̄d space group and this is confirmed with X-ray diffraction and Rietveld refinement analysis. The synthesized sample shows orange-red emission bands because of the f-f transitions of Eu3+ under UV (393 nm) and NIR (980 nm) excitations via downshifting (DS) and upconversion (UC) processes, respectively. Upon UV (393 nm) excitation of the sample, the Eu3+ ions absorb this energy and then transfer it to a neighboring pair of Yb3+ ions giving NIR emission (900-1100 nm) corresponding to the 2F5/2 → 2F7/2 transition of Yb3+. The energy transfer from a single Eu3+ ion to a pair of Yb3+ ions is possible because of the quantum cutting (QC) process and this energy transfer efficiency is found to increase with the increasing concentration of the Yb3+. The quantitative estimation of energy transfer and internal quantum cutting efficiency is determined by measuring the decay kinetics. An activation energy of 0.25 eV indicates the good thermal stability of the sample. Furthermore, samples are suitable for use in practical applications in lighting devices by combining them with the near-ultraviolet (NUV; InGaN) chip. The fabricated LED device shows stability with the driving current flow values. Studies indicate that the present nanophosphor could be useful for display devices, and in enhancing the spectral conversion efficiency of the solar cells.

Luminescence nanothermometry using a trivalent lanthanide co-doped perovskite.

This study investigates in detail the laser-mediated upconversion emission and temperature-sensing capability of (Ca0.99-a Yb0.01Er a )TiO3. Samples were prepared at different concentrations to observe the effect of erbium on upconversion while increasing its concentration and keeping all the other parameters constant. Doping is a widespread technological process which involves incorporating an element called a dopant in a lower ratio to the host lattice to derive hybrid materials with desired properties. The (Ca0.99-a Yb0.01Er a )TiO3 perovskite nanoparticles were synthesized via a sol-gel technique. The frequency upconversion was performed using a 980 nm laser diode excitation source. X-ray diffractometry (XRD) confirmed that the synthesized samples are crystalline in nature and have an orthorhombic structure. The temperature-sensing ability was examined using the fluorescence intensity ratio (FIR) algorithm of two emission bands (2H11/2 → 4I15/2 and 4S3/2 → 4I15/2) of the Er3+ ion. Temperature-dependent upconversion luminescence is observed over a broad temperature range of 298-623 K. The maximum sensor sensitivity obtained is 6.71 × 10-3 K-1 at 110°.

Deep learning based automated epidermal growth factor receptor and anaplastic lymphoma kinase status prediction of brain metastasis in non-small cell lung cancer.

Aim: The aim of this study was to investigate the feasibility of developing a deep learning (DL) algorithm for classifying brain metastases from non-small cell lung cancer (NSCLC) into epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) rearrangement groups and to compare the accuracy with classification based on semantic features on imaging. Methods: Data set of 117 patients was analysed from 2014 to 2018 out of which 33 patients were EGFR positive, 43 patients were ALK positive and 41 patients were negative for either mutation. Convolutional neural network (CNN) architecture efficient net was used to study the accuracy of classification using T1 weighted (T1W) magnetic resonance imaging (MRI) sequence, T2 weighted (T2W) MRI sequence, T1W post contrast (T1post) MRI sequence, fluid attenuated inversion recovery (FLAIR) MRI sequences. The dataset was divided into 80% training and 20% testing. The associations between mutation status and semantic features, specifically sex, smoking history, EGFR mutation and ALK rearrangement status, extracranial metastasis, performance status and imaging variables of brain metastasis were analysed using descriptive analysis [chi-square test (χ2)], univariate and multivariate logistic regression analysis assuming 95% confidence interval (CI). Results: In this study of 117 patients, the analysis by semantic method showed 79.2% of the patients belonged to ALK positive were non-smokers as compared to double negative groups (P = 0.03). There was a 10-fold increase in ALK positivity as compared to EGFR positivity in ring enhancing lesions patients (P = 0.015) and there was also a 6.4-fold increase in ALK positivity as compared to double negative groups in meningeal involvement patients (P = 0.004). Using CNN Efficient Net DL model, the study achieved 76% accuracy in classifying ALK rearrangement and EGFR mutations without manual segmentation of metastatic lesions. Analysis of the manually segmented dataset resulted in improved accuracy of 89% through this model. Conclusions: Both semantic features and DL model showed comparable accuracy in classifying EGFR mutation and ALK rearrangement. Both methods can be clinically used to predict mutation status while biopsy or genetic testing is undertaken.

Withaferin-A alleviates acute graft versus host disease without compromising graft versus leukemia effect.

Acute graft versus host disease (aGvHD) contributes to a significant proportion of non-relapse mortality and morbidity in patients undergoing allogeneic hematopoietic stem cell transplantation (alloHSCT). Withaferin-A (WA), a phytomolecule obtained from Withania somnifera (Ashwagandha), is known to have anti-inflammatory, anti-proliferative and immunomodulatory properties. The efficacy of WA for the prevention and treatment of aGvHD was evaluated using a murine model of alloHSCT. Prophylactic administration of WA to mice mitigated the clinical symptoms of aGvHD and improved survival significantly compared to the GvHD control [HR = 0.07 (0.01-0.35); P < 0.001]. Furthermore, WA group had better overall survival compared to standard prophylactic regimen of CSA + MTX [HR = 0.19 (0.03-1.1), P < 0.05]. At the same time, WA did not compromise the beneficial GvL effect. In addition, WA administered to animals after the onset of aGvHD could reverse the clinical severity and improved survival, thus establishing its therapeutic potential. Our findings suggest that WA reduced the systemic levels of Th1, Th2 and Th17 inflammatory cytokine and increased the anti-inflammatory cytokine IL-10 levels significantly (P < 0.05). WA also inhibited lymphocytes migration to gut, liver, skin and lung and protected these organs from damage. Ex-vivo, WA inhibited proliferation of human peripheral blood mononuclear cells (hPBMCs), modulated immune cell phenotype and decreased cytokine release. In addition, WA inhibited pJAK2 and pSTAT3 protein levels in mouse splenocytes and hPBMCs. In conclusion, our study demonstrates the utility of WA for the prevention and treatment of aGvHD, which should be further evaluated in a clinical setting.

Serological evidence of rickettsial infections in Delhi.

BACKGROUND & OBJECTIVES: Rickettsial infections remain under-diagnosed due to lack of diagnostic facilities in developing world. Here we present our experience at National Centre for Disease Control, Delhi, about a serosurvey done in Delhi for rickettsial disease with easy to perform low cost, low expertise Weil Felix test. METHODS: On the basis of cut-off titre obtained in healthy population, Weil Felix test results were interpreted along with clinical data. Entomological investigation was also carried out in select areas of Delhi. Rodents were trapped from houses and gardens and vector mites were collected. RESULTS: When serum samples were collected during initial 5 yr period from patients with fever of unknown origin, seropositivity was 8.2 per cent whereas when rickettsial infection was kept as one of the differential diagnosis by clinicians seropositivity increased to 33.3 per cent. Rickettsial infections detected were scrub typhus (48.2%) followed by spotted fever group (27.5%) and typhus group (6.8%) during 2005-2009. In preliminary entomological survey vector mite Leptotombidium deliense was found on rodents. INTERPRETATION & CONCLUSIONS: Our findings showed that results of Weil Felix test should not be disregarded, rather clinically compatible cases should be treated to save lives.