Creating a flow restrictor in ductal stenting: a novel technique.

Ductal stenting has transformed the care of neonates with ductal-dependent critical CHD, especially in low-income countries. In small infants, a 3.5- or 4-mm stent may lead to too much pulmonary blood flow resulting in pulmonary oedema. We herein presented a novel technique to restrict ductal stent flow in a premature neonate with pulmonary atresia and intact ventricular septum following radiofrequency perforation of the pulmonary valve.

Towards an image-based brightness model for self-luminous stimuli.

Brightness is one of the most important perceptual correlates of color appearance models (CAMs) when self-luminous stimuli are targeted. However, the vast majority of existing CAMs adopt the presence of a uniform background surrounding the stimulus, which severely limits their practical application in lighting. In this paper, a study on the brightness perception of a neutral circular stimulus surrounded by a non-uniform background consisting of a neutral ring-shaped luminous area and a dark surround is presented. The ring-shaped luminous area is presented with 3 thicknesses (0.33 cm, 0.67 cm and 1.00 cm), at 4 angular distances to the edge of the central stimulus (1.2°, 6.4°, 11.3° and 16.1°) and at 3 luminance levels (90 cd/m2, 335 cd/m2, 1200 cd/m2). In line with the literature, the results of the visual matching experiments show that the perceived brightness decreases in presence of a ring and the effect is maximal at the highest luminance of the ring, for the largest thickness and at the closest distance. Based on the observed results, an image-based model inspired by the physiology of the retina is proposed. The model includes the calculation of cone-fundamental weighted spectral radiance, scattering in the eye, cone compression and receptive field post-receptor organization. The wide receptive field assures an adaptive shift determined by both the adaptation to the stimulus and to the background. It is shown that the model performs well in predicting the matching experiments, including the impact of the thickness, the distance and the intensity of the ring, showing its potential to become the basic framework of a Lighting Appearance Model.

Tunable Coupling Architecture for Fixed-Frequency Transmon Superconducting Qubits.

Implementation of high-fidelity 2-qubit operations is a key ingredient for scalable quantum error correction. In superconducting qubit architectures, tunable buses have been explored as a means to higher-fidelity gates. However, these buses introduce new pathways for leakage. Here we present a modified tunable bus architecture appropriate for fixed-frequency qubits in which the adiabaticity restrictions on gate speed are reduced. We characterize this coupler on a range of 2-qubit devices, achieving a maximum gate fidelity of 99.85%. We further show the calibration is stable over one day.

The tandem duplicator phenotype as a distinct genomic configuration in cancer.

Next-generation sequencing studies have revealed genome-wide structural variation patterns in cancer, such as chromothripsis and chromoplexy, that do not engage a single discernable driver mutation, and whose clinical relevance is unclear. We devised a robust genomic metric able to identify cancers with a chromotype called tandem duplicator phenotype (TDP) characterized by frequent and distributed tandem duplications (TDs). Enriched only in triple-negative breast cancer (TNBC) and in ovarian, endometrial, and liver cancers, TDP tumors conjointly exhibit tumor protein p53 (TP53) mutations, disruption of breast cancer 1 (BRCA1), and increased expression of DNA replication genes pointing at rereplication in a defective checkpoint environment as a plausible causal mechanism. The resultant TDs in TDP augment global oncogene expression and disrupt tumor suppressor genes. Importantly, the TDP strongly correlates with cisplatin sensitivity in both TNBC cell lines and primary patient-derived xenografts. We conclude that the TDP is a common cancer chromotype that coordinately alters oncogene/tumor suppressor expression with potential as a marker for chemotherapeutic response.

Validation of the Arabic Rowland Universal Dementia Assessment Scale (A-RUDAS) in elderly with mild and moderate dementia.

OBJECTIVES: Validated screening tests for dementia in Arabic are lacking. Given the low levels of education among elderly in the Middle East and North Africa region, the commonly used screening instrument, the Mini Mental State Examination, is not best suited. Alternatively, the Rowland Universal Dementia Assessment Scale (RUDAS) was especially designed to minimize the effects of cultural learning and education. The aim of this study was to validate the RUDAS in the Arabic language (A-RUDAS), evaluate its ability to screen for mild and moderate dementia, and assess the effect of education, sex, age, depression, and recruitment site on its performance. METHODS: A-RUDAS was administered to 232 elderly aged ≥65 years recruited from the communities, community-based primary care clinics, and hospital-based specialist clinics. Of these, 136 had normal cognition, and 96 had dementia. Clinicians diagnosed dementia according to the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) criteria. Interviewers, blind to the cognitive status of participants, administered A-RUDAS. The psychometric properties of A-RUDAS were examined for three cutoffs. RESULTS: At the cutoff of ≤22, A-RUDAS exhibited good sensitivity (83%) and specificity (85%) with an area under the receiver operating characteristic curve of 83.95%. Adjusting for age, sex, education, depression, and recruitment site, A-RUDAS score demonstrated a high level of accuracy in screening for mild and moderate dementia against DSM-IV diagnosis. CONCLUSION: The A-RUDAS is proposed for dementia screening in clinical practice and in research in Arabic-speaking populations with an optimal cutoff of ≤22.

Adaptations to water stress and pastoralism in the Turkana of northwest Kenya.

The Turkana people inhabit arid regions of east Africa-where temperatures are high and water is scarce-and they practice subsistence pastoralism, such that their diet is primarily composed of animal products. Working with Turkana communities, we sequenced 367 genomes and identified 8 regions putatively involved in adaptation to water stress and pastoralism. One of these regions includes a putative enhancer for STC1-a kidney-expressed gene involved in the response to dehydration and the metabolism of purine-rich foods such as red meat. We show that STC1 is induced by antidiuretic hormone in humans, is associated with urea levels in the Turkana themselves, and is under strong selection in this population (s∼0.041). This work highlights that partnerships with subsistence-level groups can lead to new models of human physiology with biomedical relevance.

Sarcoma Patients Admitted to the Intensive Care Unit (ICU): Predictive Relevance of Common Sepsis and Performance Parameters.

Purpose: Prognosis of sarcoma patients is improving, with a better understanding of sarcomagenesis revealing novel therapeutic targets. However, aggressive chemotherapy remains an essential part of treatment, bearing the risk of severe side effects that require intensive medical treatment. Available data on the characteristics and clinical outcome of sarcoma patients admitted to intensive care units (ICU) are sparse. Patients and Methods: We performed a retrospective analysis of sarcoma patients admitted to the ICU from 2005 to 2022. Patients ≥18 years with histologically proven sarcoma were included in our study. Results: Sixty-six patients were eligible for analysis. The following characteristics had significant impact on overall survival: sex (p=0.046), tumour localization (p=0.02), therapeutic intention (p=0.02), line of chemotherapy (p<0.001), SAPS II score (p=0.03) and SOFA score (p=0.02). Conclusion: Our study confirms the predictive relevance of established sepsis and performance scores in sarcoma patients. For overall survival, common clinical characteristics are also of significant value. Further investigation is needed to optimize ICU treatment of sarcoma patients.

Predictors of long-term mortality in octogenarian veterans following inguinal hernia repair.

BACKGROUND: While elective inguinal hernia repair (IHR) in octogenarians carries a low 30-day mortality rate, long-term outcomes are uncharted. If on average, veteran octogenarians are expected to succumb to pre-existing cardiopulmonary disease within a year of diagnosis, watchful waiting might be advisable. This study interrogated long-term mortality and its predictors following elective IHR in veteran octogenarians. MATERIALS AND METHODS: This is a retrospective analysis of 109 veterans (≥ 80 years of age), ten of which were nonagenarians who had an elective IHR. Data were dichotomized between deceased vs. non-deceased patients for univariable and multivariable analyses. Patient characteristics were also assessed in patients undergoing general (GA) vs. local (LA) anesthesia and corrected for unilateral repair and age. Kaplan-Meier curves were generated in corrected and uncorrected cohorts receiving GA vs. LA. RESULTS: At the time of analysis, 46 (45.0%) octogenarians were deceased. The average time to death following IHR was 3.7 ± 2.9 years [range (37 days-12.4 years)]. Univariable analysis showed renal disease (19.9% vs. 5.3%), operative time (67.9 ± 29.0 vs. 56.1 ± 14.4 min) and use of GA (73.0% vs. 34.8%) associated with long-term mortality (all p < 0.01). Renal disease [odds ratio (95% confidence intervals) 4.1 (1.2-13.8)] and use of GA [5.0 (2.0-10.0)] were independent predictors of mortality. Patients undergoing LA (n = 62) were older, were more likely to have cardiac disease, and had a higher ASA compared to patients receiving GA (n = 47). After correcting for age, cardiac disease and higher ASA remained more common in patients submitting to LA. Long-term mortality was significantly higher in both matched and unmatched octogenarians undergoing GA. CONCLUSION: Octogenarian veterans with a high burden of comorbid conditions are unlikely to experience short-term mortality because of their pre-existing conditions. Inguinal hernia repair should be offered to octogenarian veterans, but GA should be avoided whenever possible.

Over- and under-diagnosis of dementia in ethnic minorities: a nationwide register-based study.

OBJECTIVE: Among dementia professionals in several European countries, it is believed that dementia is under-diagnosed and under-treated to a greater extent among ethnic minorities than in the native population. It is unknown whether this belief holds true. The objective of this study was to compare the prevalence of register-based dementia diagnoses in the largest ethnic minority groups in Denmark with the prevalence of register-based dementia diagnoses in the general Danish population. METHODS: By linking the Danish hospital registers with the Danish Civil Registration System, nationwide dementia cases for three main ethnic minorities were identified. Age- and gender-specific prevalence rates for dementia were calculated and compared to previously published data for the general population. RESULTS: The study population consisted of 68 219 persons aged 20 and older. A total of 174 dementia cases were identified. The mean age at diagnosis was 57.7 years (SD = 16.2). Compared to the general population, there was a higher prevalence of dementia among those younger than 60 years, and a markedly lower prevalence of dementia among those 60 years and older. CONCLUSIONS: Dementia is under-diagnosed to a greater extent among ethnic minorities in the age group 60 years and older but is over-diagnosed in the age group younger than 60 years. Several factors may contribute to this pattern, including cultural differences in help-seeking behaviour, and problems in navigating the health-care system. Furthermore, cross-cultural assessment of dementia can be difficult because of language barriers and cultural differences.

Prolonged response to liposomal irinotecan in a patient with stage IV pancreatic/bile duct cancer previously treated with FOLFIRINOX and gemcitabine plus nab-paclitaxel.

At 9%, and 2% when diagnosed at advanced stage, the 5-year relative survival rate for pancreatic ductal adenocarcinoma (pdac) is the lowest of any cancer. The currently approved treatment options for metastatic pdac in the United States are folfirinox [irinotecan-fluorouracil (5fu)-leucovorin (lv)-oxaliplatin], gemcitabine-nab-paclitaxel, and liposomal irinotecan plus 5fu-lv. Liposomal irinotecan is a novel formulation of irinotecan encapsulated within a lipid bilayer, which favours local metabolic activation. The napoli-1 trial demonstrated the efficacy of liposomal irinotecan in combination with 5fu and lv for the treatment of advanced pdac after progression on gemcitabine-based chemotherapy. The 1-year survival in those patients was 25%; however, none had had irinotecan-refractory disease before treatment with liposomal irinotecan. Furthermore, the U.S. National Comprehensive Cancer Network guidelines recommend liposomal irinotecan plus 5fu-lv in patients who have received prior fluoropyrimidine-based therapy if no prior irinotecan therapy has been given. Here, we report a male patient with stage iv cancer of pancreas or bile duct (site unconfirmed) who experienced a prolonged (51 weeks) response to liposomal irinotecan plus 5fu-lv despite prior disease progression on irinotecan. Several factors have previously been associated with long-term survival in patients receiving liposomal irinotecan therapy: no prior irinotecan-based chemotherapy, high Karnofsky performance status score, age 65 years or less, serum carbohydrate antigen 19-9 less than 59 U/mL, neutrophil-to-lymphocyte ratio 5 or less, and absence of liver metastasis. The patient in the present report had none of those characteristics indicative of long-term survival, except his age at diagnosis-47 years.

Continuous physiological monitoring using wearable technology to inform individual management of infectious diseases, public health and outbreak responses.

Optimal management of infectious diseases is guided by up-to-date information at the individual and public health levels. For infections of global importance, including emerging pandemics such as COVID-19 or prevalent endemic diseases such as dengue, identifying patients at risk of severe disease and clinical deterioration can be challenging, considering that the majority present with a mild illness. In our article, we describe the use of wearable technology for continuous physiological monitoring in healthcare settings. Deployment of wearables in hospital settings for the management of infectious diseases, or in the community to support syndromic surveillance during outbreaks, could provide significant, cost-effective advantages and improve healthcare delivery. We highlight a range of promising technologies employed by wearable devices and discuss the technical and ethical issues relating to implementation in the clinic, focusing on low- and middle- income countries. Finally, we propose a set of essential criteria for the rollout of wearable technology for clinical use.

Host range and geographical distribution of Babesia sp. Mymensingh.

Bovine babesiosis represents a serious threat to the cattle industry in the tropics and subtropics. Although several Babesia species infect cattle, only B. bovis, B. bigemina and B. divergens are known to cause clinical babesiosis. However, our recent study demonstrated that the newly discovered Babesia sp. Mymensingh might be a virulent species capable of causing clinical babesiosis in cattle. The objective of this study was to determine the host range and geographical distribution of Babesia sp. Mymensingh on a global scale. A total of 2,860 archived DNA samples from 2,263 cattle in Sri Lanka (n = 672), the Philippines (n = 408), Vietnam (n = 460), Uganda (n = 409), Brazil (n = 164) and Argentina (n = 150); 419 buffalo in Sri Lanka (n = 327) and Vietnam (n = 92); and 127 goats and 51 sheep in Vietnam were screened using a Babesia sp. Mymensingh-specific PCR assay. Babesia sp. Mymensingh infection was detected in cattle, buffalo, sheep and goats. Cattle of all countries surveyed in this study except Brazil were found to be infected with Babesia sp. Mymensingh. The highest positive rates were recorded in cattle from the Philippines (11.3%) and Vietnam (9.6%), followed by Argentina (4.7%), Sri Lanka (1.5%) and Uganda (1.0%). Buffalo were found to be infected with this parasite in Sri Lanka (1.2%) and Vietnam (10.9%). Unexpectedly, Babesia sp. Mymensingh was also detected in sheep (2.0%) and goats (1.3%) from Vietnam. These findings were confirmed by PCR amplicon sequencing. In conclusion, our present findings indicate that Babesia sp. Mymensingh, which infects cattle, buffalo, sheep and goats, is endemic in Asia, Africa and South America.

Oxidized low-density lipoprotein (Oxidized LDL) and the risk of preeclampsia.

Oxidative stress plays an important role in the pathophysiology of preeclampsia. In a case-control study of 99 women with preeclampsia and 99 controls, we assessed maternal plasma oxidized low-density lipoprotein (oxidized LDL) in relation to preeclampsia risk. Logistic regression procedures were used to derive odds ratios (OR) and 95 % confidence intervals (CI). Plasma oxidized LDL was determined using enzyme immunoassay. Maternal plasma oxidized LDL was significantly positively correlated with lipids in both cases and controls. After adjusting for nulliparity, pre-pregnancy body mass index, physical inactivity, family history of chronic hypertension and plasma vitamin C concentrations, women who had elevated oxidized LDL concentrations ( > or = 50 U/l) experienced a 2.9-fold increased risk of preeclampsia when compared with women having lower oxidized LDL concentrations (95 % CI 1.4-5.9). The risk of preeclampsia was markedly increased in women who had both elevated oxidized LDL and elevated triglyceride concentrations (OR=8.9, 95 % CI 3.1-26.2). Women with both elevated oxidized LDL and low vitamin C concentrations experienced a 9.8-fold increased risk of preeclampsia (95 % CI 3.0-32.2). Our results confirm the role of oxidative stress in the pathogenesis of preeclampsia. Prospective studies are needed to determine if elevated oxidized LDL concentrations can predict the occurrence of preeclampsia.

Two-year outcome of first-line antiretroviral therapy among HIV-1 vertically-infected children in Hanoi, Vietnam.

A retrospective analysis of 86 HIV-1 vertically-infected Vietnamese children with a follow-up period >24 months after initiating antiretroviral therapy (ART) was performed from 2008 to 2012, to assess the outcome of first-line ART in resource-limited settings. Of the 86 children, 68 (79.1%) were treated successfully (plasma HIV-1 viral load [VL] <1000 copies/ml), and 63 (73.3%) had full viral suppression (VL <400 copies/ml) after 24 months of ART. No significant difference between successfully treated patients and failure groups was observed in VL, CD4(+) T-cell count or clinical stage at baseline; age at ART start; or ART regimen. All 14 children with VL >5000 copies/ml, one of four children with VL 1000-5000 copies/ml and none with VL <1000 copies/ml developed reverse transcriptase inhibitor (RTI)-resistance mutations by 24 months of ART. Y181C and M184V/I were the most dominant non-nucleoside and nucleoside RTI-resistance mutations, respectively (13/15, 86.7%). These findings suggest that VL testing after 24 months of ART can be used to efficiently differentiate ART failures among HIV-1 vertically-infected children in resource-limited settings.

Regulation of hepatic apolipoprotein B RNA editing in the genetically obese Zucker rat.

Hepatic apolipoprotein (apo) B RNA editing was examined in the genetically obese hyperinsulinemic and hypertriglyceridemic Zucker rat. In obese Zucker rats, apo B RNA editing was increased 42% relative to that in lean controls. Correspondingly, the proportion of serum triglyceride-rich lipoprotein containing apo B48 increased 4.7-fold in the obese Zucker rat. Quantification of hepatic total apo B mRNA showed no difference between obese Zucker and lean control rats. In contrast, the hepatic mRNA encoding APOBEC-1, the catalytic subunit of the RNA editing activity, demonstrated an increased abundance of 1.8-fold in obese Zucker rats versus lean controls.

Lipoprotein alterations in 10- and 20-week-old Zucker diabetic fatty rats: hyperinsulinemic versus insulinopenic hyperglycemia.

Lipoprotein and apolipoprotein parameters were studied in the male Zucker diabetic fatty (ZDF) rat at 10 and 20 weeks of age, corresponding to hyperinsulinemic and insulinopenic type 2 diabetes mellitus, respectively. At both ages, ZDF rats had elevated serum triglycerides, free fatty acids, and corticosterone, whereas 20-week ZDF rats had reduced thyroid hormones. At 10 weeks, the hyperlipidemia was confined to elevations in pre-beta triglyceride-rich (d < 1.006 g/mL) lipoproteins. By 20 weeks, all lipoprotein density fractions were increased compared with lean rats, with substantial increases in both low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol. In ZDF rats, there was a progressive increase in apolipoprotein B (apo B) from 1.9 times control at 10 weeks to three times control at 20 weeks. The increase in apo B was accompanied by a shift of apo B, particularly B100, from very-low-density lipoprotein (VLDL) into denser lipoproteins corresponding to intermediate-density lipoproteins plus LDLs (1.006 < d < 1.063 g/mL). In Zucker and 10-week ZDF rats, in the presence of hyperinsulinemia, the increase in serum apo B was predominantly apo B48 present in VLDL. By 20 weeks, when ZDF rats are insulinopenic, the mass ratio of B48:B100 shifted from 2.7 to 0.7. The shift was associated with a decrease in hepatic-edited apo B mRNA. Apo E increased in lean rats between 10 and 20 weeks of age. Although apo E also increased in ZDF rats, the increase by 20 weeks was less than that of lean rats. The molar ratio of apo E to B in VLDL was decreased in ZDF rats. In lean rats, greater than 50% of apo E was present in HDL, in contrast to ZDF rats, where less than 20% of apo E was present in HDL. VLDL apo E shifted to denser fractions by 20 weeks of age, similar to apo B. The apo C level was more than double compared with the level in lean rats and was redistributed from the HDL fraction to lipoprotein fractions containing apo B. Both apo A-I and apo A-IV levels more than doubled between 10 and 20 weeks in ZDF rats. The ZDF rat model may be useful in comparative studies of lipoproteins during diabetic progression from hyperinsulinemia to insulinopenia.

The effectiveness of traditional child psychotherapy.

This study used a randomized design to evaluate the effectiveness of child psychotherapy as typically delivered in outpatient settings. Overall results were similar to the results of nonrandomized studies of traditional child psychotherapy: Little support was found for its effectiveness, with treatment producing an overall effect size of -.08. Despite the lack of significant differences between treatment and control groups in regard to changes in child functioning, parents of children who received treatment reported higher levels of satisfaction with services than control group parents whose children received academic tutoring. Overall, the findings highlight the importance of developing, validating, and transporting effective treatments to clinical settings.

[Evaluation of the lithogenic risk in renal lithiasis. Value of urine density measurement]. / Evaluation du risque lithogène dans la lithiase rénale. Intérêt de la mesure de la densité urinaire.

OBJECTIVE: Measuring specific gravity of urine is a simple means of self-monitoring for urolithiasis patients. METHODS: We evaluated the reliability of two test strips (N-Multistix and Combur-Stix) and determined the relationship between urine specific gravity and crystal formation in first morning urine in 179 patients with calcium oxalate lithiasis. Urine hydrometry was used as the reference method. RESULTS: There was a good correlation between urine density read on the test strips and hydrometry (r = 0.733 for N-Multistix and 0.697 for Combur-Stix). Hydrometry showed little pH effect but the test strips gave results correlated with urine pH (r = 0.764 and 0.813 respectively). When urine pH was below 6.5, the specific gravity of the urine was overestimated; inversely for pH > 7, it was underestimated. Correction factors were obtained by comparing test strip values with specific gravity measurements for pH level between 4.5 and 8. There were crystals in 66% of the urine samples with a density > or = 1012 g/l. In contrast, 75% of the samples below this value were crystal free. There was a close relationship between 24-hour urine volume and specific gravity (n = 124; r = 0.778): a specific gravity of 1.012 corresponded to 2100 ml urine output. For 24% of the patients, specific gravity of the morning urine was > or = 1.012 despite a 24-h urine output > or = 2100 ml, indicating insufficient urine dilution during the night. CONCLUSION: Measurement of specific gravity with test strips with correction for pH can be a simple way to measure the specific gravity of urine and assess whether urine dilution is sufficient to reduce the risk of crystal formation, the main risk factor in urolithiasis patients.

A partial replication of Lippin (1990) using the Myers-Briggs type indicator with a sample of female prisoners.

A sample of 108 women incarcerated in a state prison who volunteered to participate in an employment seminar were given the Myers-Briggs Type Indicator. Comparison of the distribution of types here and in Myers and McCaulley's 1985 sample using a Selection Ratio Type Table for analysis indicated an overrepresentation of ISTJ, ISFJ, and ISTP. The ESFP and ESFJ types were underrepresented. Further analysis of the types and the relationship to criminal offense was not significant. Results are compared with those of Lippin from 1990.

Frequency - dependent advantage in wheat.

The effect of frequency-dependent advantage in wheat was investigated by growing F1. hybrid seeds of the crosses (Warimek X Halberd) and (Wariquam x Halberd) in a stand of Halberd at 5 frequencies: 4 %, 6.25 %, 11.11 %, 25 % and 50 %. A reduction of 35 % to 40 % in grain yield of individual plants was observed with both hybrids as their frequencies changed from 4% to 50 %. A similar trend with frequency was noted for several other plant characteristics, including total grain number, particularly with those measured towards the end of the growing season. Halberd plants did not show a corresponding increase as their frequency declined from 96 % to 50%. - The following season, 76 F4 lines from the cross (Warimek X Halberd) and 70 F4 lines from (Wariquam x Gabo) were grown at frequencies of 6.25% and 18.75% in machine sown stands of Wariquam and Halberd, respectively. Again grain yield decreased as genotypic frequency increased. Furthermore, there was a positive correlation between frequency-dependent advantage and relative grain yield, suggesting that high yielding genotypes show a greater advantage at low frequencies than lower yielding ones.