Association Between Sleeping Quality and Risk of Breast Cancer Among Women: A Case-Control Study From Pakistan.

BACKGROUND: This case-control study investigated the relationship between sleep duration and quality with the occurrence of breast cancer among women, both pre- and post-menopausal, in the northwest Khyber Pakhtunkhwa (KP) region of Pakistan. METHOD: This case-control research was carried in multiple tertiary care facilities. Newly diagnosed primary breast cancer patients were recruited as cases (n = 408), and 5+ years age-matched controls (n = 408) were randomly selected from the general population. Participants completed a Pittsburg sleeping quality index (PSQI) questionnaire that included questions on sleep characteristics. Statistical analysis included independent t-tests to compare mean sleep durations and quality scores between groups, and logistic regression to adjust for potential confounders. RESULTS: Sleep onset latency between cases and controls was not significantly associated with health outcomes, with a P-value of .142. However, sleep duration showed a significant association (P = .049). For sleep duration, the adjusted odds ratio for ≤6 h was 1.02 (95% CI: .5-2.1), while for 7-8 h the adjusted odds ratio was 1.0 (95% CI: .6-1.6). Self-reported sleep quality did not demonstrate significant associations, with the P-value for "very good" sleep quality being .561. Sleep duration of less than 6 h among women with triple-negative breast cancer (TNBC) was found to be strongly associated with a more aggressive type of breast cancer, with an adjusted odds ratio of 1.5 (95% CI: 1.02-2.3, P < .05). CONCLUSION: This study does not provide evidence to support an association between sleep duration or quality and the risk of breast cancer. However, it reports a significant association, with shorter sleep durations linked to an increased risk particularly in the context of aggressive breast cancer types such as TNBC.

Investigation of electronic, ferroelectric and local electrical conduction behavior of RF sputtered BiFeO3thin films.

Most of the applied research on BiFeO3(BFO) focuses on magnetoelectric and spintronic applications. This calls for a detailed grasp of multiferroic and conduction properties. BFO thin films with (100) epitaxial growth has been deposited on a LaNiO3(LNO) buffered Pt/Ti/SiO2/Si(100) substrate using RF magnetron sputtering. The film formed at 15 mTorr, 570 °C, and with Ar/O24:1 had a reasonably high degree of (100)-preferential orientation, the least surface roughness, and a densely packed structure. We obtained ferroelectric loops with strong polarization (150µC cm-2). The leakage current density is as low as 10-2A cm-2at 100 kV cm-1, implying that space-charge-limited bulk conduction (SCLC) was the primary conduction channel for carriers within BFO films. Local electrical conduction behavior demonstrates that at lower voltages, the grain boundary dominates electrical conduction and is linked to the displacement of oxygen vacancies in the grain boundary under external electric fields. We hope that a deeper understanding of the conduction mechanism will help integrate BFO into viable technologies.

Challenging Paradigm Limits of Retrograde Cerebral Perfusion During Lower Body Circulatory Arrest.

INTRODUCTION: Retrograde cerebral perfusion (RCP) is a safe and effective technique to augment cerebral protection during lower body circulatory arrest in patients undergoing elective hemiarch replacement. However, recommendations guiding optimal temperature, flow rate, and perfusion pressure are outdated and potentially overly limiting. We report our experience using RCP for elective hemiarch replacement with parameters that challenge the currently accepted paradigm. METHODS: This was a single-center, retrospective analysis of 319 adult patients who underwent elective hemiarch replacement between February 2010 and 2021 using hypothermic lower body circulatory arrest with RCP alone, RCP followed by antegrade cerebral perfusion (ACP), or ACP alone. Flow rates were adjusted to maintain cerebral perfusion pressure between 30 and 50 mm Hg for RCP and between 40 and 60 mm Hg for ACP. RESULTS: RCP was used in 22.6% (n = 72) of cases, whereas ACP alone was performed in 77.4% (n = 247) of cases. Baseline patient characteristics were similar between groups. Patients undergoing RCP demonstrated shorter cross-clamp time (97.0 min versus 100.0 min, P = 0.034) and shorter lower body circulatory arrest time (7.0 min versus 10.0 min, P < 0.0001) compared with ACP alone. Nadir bladder temperature was equivalent between groups (27.3°C versus 27.5°C, P = 0.752). There were no significant differences in postoperative complications, neurologic outcomes, or mortality. CONCLUSIONS: Moderate hypothermic lower body circulatory arrest combined with RCP at target perfusion pressures of 30-50 mm Hg in patients undergoing elective hemiarch replacement results in equivalent neurologic outcomes and overall morbidity to cases using ACP alone. These results challenge the currently accepted paradigm for RCP, which typically uses deep hypothermia while keeping perfusion pressures below 25 mm Hg.

Bioremediation of heavy metals polluted environment and decolourization of black liquor using microbial biofilms.

BACKGROUND: With increased urbanization and industrialization, modern life has led to an anthropogenic impact on the biosphere. Heavy metals pollution and pollutants from black liquor (BL) have caused severe effects on environment and living organisms. Bacterial biofilm has potential to remediate heavy metals and remove BL from the environment. Hence, this study was planned to investigate the potential of microbial biofilms for the bioremediation of heavy metals and BL polluted environments. METHODS AND RESULTS: Eleven biofilm forming bacterial strains (SB1, SB2, SC1, AF1, 5A, BC-1, BC-2, BC-3, BC-4, BC-5 and BC-6) were isolated and identified upto species level via 16S rRNA gene sequencing. Biofilm strains belonging to Bacillus and Lysinibacillus sphaericus were used to remediate heavy metals (Pb, Ni, Mn, Zn, Cu, and Co). Atomic absorption spectroscopy showed significantly high (P ≤ 0.05) bioremediation potential by L. sphaericus biofilm (1462.0 ± 0.67 µgmL-1) against zinc (Zn). Similarly, Pseudomonas putida biofilm significantly (P ≤ 0.05) decolourized (65.1%) BL. Fourier transform infrared (FTIR) analysis of treated heavy metals showed the shifting of major peaks (1637 & 1629-1647, 1633 & 1635-1643, and 1638-1633 cm-1) corresponding to specific amide groups due to C = O stretching. CONCLUSION: The study suggested that biofilm of the microbial flora from tanneries and pulp paper effluents possesses a strong potential for heavy metals bioremediation and BL decolourization. To our knowledge, this is the first report showing promising biofilm remediation potential of bacterial flora of tanneries and pulp-paper effluent from Kasur and Sheikhupura, Punjab, Pakistan, against heavy metals and BL.

Automatic Hybrid Access Control in SCADA-Enabled IIoT Networks Using Machine Learning.

The recent advancements in the Internet of Things have made it converge towards critical infrastructure automation, opening a new paradigm referred to as the Industrial Internet of Things (IIoT). In the IIoT, different connected devices can send huge amounts of data to other devices back and forth for a better decision-making process. In such use cases, the role of supervisory control and data acquisition (SCADA) has been studied by many researchers in recent years for robust supervisory control management. Nevertheless, for better sustainability of these applications, reliable data exchange is crucial in this domain. To ensure the privacy and integrity of the data shared between the connected devices, access control can be used as the front-line security mechanism for these systems. However, the role engineering and assignment propagation in access control is still a tedious process as its manually performed by network administrators. In this study, we explored the potential of supervised machine learning to automate role engineering for fine-grained access control in Industrial Internet of Things (IIoT) settings. We propose a mapping framework to employ a fine-tuned multilayer feedforward artificial neural network (ANN) and extreme learning machine (ELM) for role engineering in the SCADA-enabled IIoT environment to ensure privacy and user access rights to resources. For the application of machine learning, a thorough comparison between these two algorithms is also presented in terms of their effectiveness and performance. Extensive experiments demonstrated the significant performance of the proposed scheme, which is promising for future research to automate the role assignment in the IIoT domain.

Multi-Head Spatiotemporal Attention Graph Convolutional Network for Traffic Prediction.

Intelligent transportation systems (ITSs) have become an indispensable component of modern global technological development, as they play a massive role in the accurate statistical estimation of vehicles or individuals commuting to a particular transportation facility at a given time. This provides the perfect backdrop for designing and engineering an adequate infrastructural capacity for transportation analyses. However, traffic prediction remains a daunting task due to the non-Euclidean and complex distribution of road networks and the topological constraints of urbanized road networks. To solve this challenge, this paper presents a traffic forecasting model which combines a graph convolutional network, a gated recurrent unit, and a multi-head attention mechanism to simultaneously capture and incorporate the spatio-temporal dependence and dynamic variation in the topological sequence of traffic data effectively. By achieving 91.8% accuracy on the Los Angeles highway traffic (Los-loop) test data for 15-min traffic prediction and an R2 score of 85% on the Shenzhen City (SZ-taxi) test dataset for 15- and 30-min predictions, the proposed model demonstrated that it can learn the global spatial variation and the dynamic temporal sequence of traffic data over time. This has resulted in state-of-the-art traffic forecasting for the SZ-taxi and Los-loop datasets.

The Characterization and Study of Antibacterial, Free Radical Scavenging, and Anticancer Potential of Livistona chinensis-Mediated Silver Nanoparticles.

In the present research, Livistona chinensis leaf extracts were utilized as reductants to bio-fabricate silver nanoparticles (LC-AgNPs) and this was followed by the evaluation of their antioxidant, antibacterial, and anticancer potential. Multiple parameters were optimized for the formation and fidelity of LC-AgNPs. The color shift of the reaction mixture from yellow to dark brown confirmed the LC-AgNPs formation. UV/VIS spectroscopy exhibited a surface plasmon resonance (SPR) band at 436 nm. The Fourier transform infrared (FTIR) spectroscopy spectrum depicted phytochemicals in the plant extract acting as bio-reducers for LC-AgNPs synthesis. The XRD pattern confirmed the presence of LC-AgNPs by showing peaks corresponding to 2θ angle at 8.24° (111), 38.16° (200), 44.20° (220), and 64.72° (311). Zetasizer analysis exhibited size distribution by intensity of LC-AgNPs with a mean value of 255.7 d. nm. Moreover, the zeta potential indicated that the AgNPs synthesized were stable. The irregular shape of LC-AgNPs with a mean average of 38.46 ± 0.26 nm was found by scanning electron microscopy. Furthermore, the antioxidant potential of LC-AgNPs was examined using a DPPH assay and was calculated to be higher in LC-AgNPs than in leaf extracts. The calculated IC50 values of the LC-AgNPs and plant extract are 85.01 ± 0.17 and 209.44 ± 0.24, respectively. The antibacterial activity of LC-AgNPs was investigated against Escherichia coli, Pseudomonas aeruginosa, and Bacillus subtilis as well as Staphylococcus aureus, and maximum potential was observed after 24 h against P. aeruginosa. Moreover, LC-AgNPs exhibited maximum anticancer potential against TPC1 cell lines compared to the plant extract. The findings suggested that LC-AgNPs could be used as antioxidant, antibacterial, and anticancer agents for the cure of free-radical-oriented bacterial and oncogenic diseases.

Heavy metals contamination in vegetables irrigated with wastewater: a case study of underdeveloping regions of Pakistan.

Irrigation of food crops with untreated wastewater leads to the accumulation of heavy metals in their edible parts. Exposure to toxic elements through consumption of contaminated vegetables even at very low concentration is becoming a serious problem for human health in many countries. This issue of heavy metals contamination needs great attention especially in Pakistan where irrigation by wastewater has become a common practice in urban and periurban areas. The present study was conducted to assess the contamination of different heavy metals including nickel (Ni), cadmium (Cd), lead (Pb) and chromium (Cr) in vegetables irrigated with wastewater in different districts of Punjab (Pakistan) like, Faisalabad, Lahore, Gujranwala, Sargodha, Sahiwal, Multan, Rawalpindi and Bahawalpur during years 2016-2019. The maximum contamination factor (Ni, 1.39; Cd, 5.86; Pb, 3.99; Cr, 2.24), pollution load index (2.92) and degree of contamination (13.48) were observed in wastewater irrigated agricultural soils of district Gujranwala as compared to other districts. Mean metal concentration in vegetables grown with untreated wastewater and transfer factor varied with plant type, frequency of irrigation and soils types/series of different districts of Punjab. The highest metal contamination was observed in Gujranwala where 44% vegetable samples were contaminated with Ni, 87% with Cd, 97% with Pb and 88% with Cr. Radar analysis and hierarchical cluster analysis showed that mustard leaves, spinach and lettuce were more contaminated vegetables compared to other vegetables. This study contributes to the evidence-based conclusion that cultivation of vegetable with untreated wastewater should be prohibited and required treatment of wastewater is needed.

Metaheuristic Algorithms Based on Compromise Programming for the Multi-Objective Urban Shipment Problem.

The Vehicle Routing Problem (VRP) and its variants are found in many fields, especially logistics. In this study, we introduced an adaptive method to a complex VRP. It combines multi-objective optimization and several forms of VRPs with practical requirements for an urban shipment system. The optimizer needs to consider terrain and traffic conditions. The proposed model also considers customers' expectations and shipper considerations as goals, and a common goal such as transportation cost. We offered compromise programming to approach the multi-objective problem by decomposing the original multi-objective problem into a minimized distance-based problem. We designed a hybrid version of the genetic algorithm with the local search algorithm to solve the proposed problem. We evaluated the effectiveness of the proposed algorithm with the Tabu Search algorithm and the original genetic algorithm on the tested dataset. The results show that our method is an effective decision-making tool for the multi-objective VRP and an effective solver for the new variation of VRP.

Attention Autoencoder for Generative Latent Representational Learning in Anomaly Detection.

Today, accurate and automated abnormality diagnosis and identification have become of paramount importance as they are involved in many critical and life-saving scenarios. To accomplish such frontiers, we propose three artificial intelligence models through the application of deep learning algorithms to analyze and detect anomalies in human heartbeat signals. The three proposed models include an attention autoencoder that maps input data to a lower-dimensional latent representation with maximum feature retention, and a reconstruction decoder with minimum remodeling loss. The autoencoder has an embedded attention module at the bottleneck to learn the salient activations of the encoded distribution. Additionally, a variational autoencoder (VAE) and a long short-term memory (LSTM) network is designed to learn the Gaussian distribution of the generative reconstruction and time-series sequential data analysis. The three proposed models displayed outstanding ability to detect anomalies on the evaluated five thousand electrocardiogram (ECG5000) signals with 99% accuracy and 99.3% precision score in detecting healthy heartbeats from patients with severe congestive heart failure.

Postoperative Complications Are Not Elevated in Well-Compensated ESRD Patients Undergoing Cardiac Surgery: End-Stage Renal Disease Cardiac Surgery Outcomes.

BACKGROUND: Patients with end-stage renal disease (ESRD) are at high risk for cardiac disease requiring surgery, and have been shown to have increased surgical risks. There have been significant improvements in ESRD management, surgical techniques, and patient selection over the past 10 y. We evaluated rates of serious postoperative outcomes in stable, well-dialyzed patients with ESRD undergoing nonemergent cardiac surgery compared to the general cardiac surgery population. METHODS: In this propensity-score matched study, we evaluated 1451 adult patients who underwent nonemergent cardiac surgery at the University of Colorado Hospital (UCH) between 2011 and 2016. Patients with ESRD were compared to nonESRD patients. The primary outcome was a composite endpoint, including 30-d mortality, stroke, postoperative infection, and prolonged intensive care unit (ICU) length of stay (LOS). RESULTS: A total of 35 patients with ESRD met inclusion criteria. These select patients were younger with few comorbidities than the nonESRD population. There were no statistically significant differences in the composite outcome between ESRD and nonESRD patients in the propensity-matched analysis (OR 0.70, CI 0.29-1.72, P = 0.44). There were no significant differences or trends for in-hospital mortality, postoperative stroke, infection, ICU LOS, or hospital LOS between the patients with and without ESRD. CONCLUSIONS: Stable ESRD patients undergoing nonemergent surgery are not at increased risk of major postoperative complications when compared to those without ESRD. Well-compensated ESRD patients should not be excluded from surgical consideration.

Clinical predictors of in-hospital mortality in venoarterial extracorporeal membrane oxygenation.

INTRODUCTION: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is utilized as a life-saving procedure and bridge to myocardial recovery for patients in refractory cardiogenic shock. Despite technical advancements, VA-ECMO retains high mortality. This study aims to identify the clinical predictors of in-hospital mortality after VA-ECMO to improve risk stratification for this tenuous patient population. METHODS: The REgistry for Cardiogenic Shock: Utility and Efficacy of Device Therapy database is a multicenter, observational registry of ECMO patients. From 2013 to 2018, 789 patients underwent VA-ECMO. Bivariate analysis was performed on more than 300 variables regarding their association with in-hospital mortality. Logistic regression analyses were performed with variables chosen based upon clinical and statistical significance in the bivariate analysis. Tests were considered significant at a two-sided P < .05. RESULTS: Although 63.5% patients were successfully weaned from VA-ECMO, in-hospital mortality was 57.9%. Nonsurvivors were older (P < .0001), had higher body mass index (P = .01), higher rates of hypertension (P = .02), coronary artery disease (P = .02), chronic obstructive pulmonary disease (P = .02), chronic liver disease (P = .008), percutaneous coronary intervention (P = .02), and surgical revascularization (P = .02). Multivariate predictors for in-hospital mortality include older age (odds ratio [OR], 1.019; P = .007), cardiac arrest (OR, 2.76; P = .006), chronic liver disease (OR, 8.87; P = .04), elevated total bilirubin (OR, 1.093; P < .0001), and the presence of a left ventricular vent (OR, 2.018; P = .03). Pre-ECMO sinus rhythm was protective (OR, 0.374; P = .006). CONCLUSIONS: In a large study of recent VA-ECMO patients, in-hospital mortality remains significant, but acceptable given the severe pathology manifested in this population. Identification of pre-ECMO predictors of mortality helps stratify high-risk patients when deciding on ECMO placement, prolonged support, and prognosis.

Pilot scale production of recombinant hemicellulases and their saccharification potential.

Synergistic saccharification ability of hemicellulases (endo-xylanase and ß-xylosidase) was evaluated in this study for the bioethanol production from plant biomass. Endo-xylanase and ß-xylosidase genes from Bacillus licheniformis were cloned and expressed in Escherichia coli BL21 (DE3). Maximum endo-xylanase production was obtained at 200 rpm agitation speed, air supply rate 2.0 vvm, 70% volume of the medium, 20% dissolved oxygen level and with 3% inoculum size. The optimal conditions for maximum production of recombinant ß-xylosidase enzyme at pilot scale were 200 rpm agitation speed, 25% dissolved oxygen level, 2.5 vvm aeration rate, 70% volume of the medium with 2% inoculum size. Furthermore, the saccharification potential of these recombinant enzymes was checked for the production of xylose sugar by bioconversion of plant biomass by optimizing individually as well as synergistically by optimizing various parameters. Maximum saccharification (93%) of plant biomass was observed when both enzymes were used at a time with 8% sugarcane bagasse as a substrate and 200 units of each enzyme after incubation of 6 hr at 50 °C and 120 rpm. The results obtained in this study suggested these recombinant hemicellulases as potential candidates for the conversion of complex agricultural residues into simple sugars for ultimate use in the biofuel industry.

Synergetic Induction of NGF With Diazoxide and Erythropoietin Attenuates Spinal Cord Ischemic Injury.

BACKGROUND: Paraplegia remains a significant complication of thoracoabdominal aortic intervention. We previously reported that diazoxide (DZ), enhances the neuroprotective efficacy of erythropoietin (EPO). We hypothesized that DZ and EPO combined treatment attenuates spinal cord ischemic injury through upregulation of nerve growth factor (NGF). METHODS: DZ (pretreatment) was given to adult male C57/BL6 mice by oral gavage and EPO (before surgery) was intraperitoneally injected 32 h after administration of DZ. Spinal cords were harvested 0, 2, 4, and 6 h after injection of EPO. NGF expression was analyzed by western blot. After determining the optimal time, NGF expression was compared between DZ (pretreatment) + EPO (before surgery), DZ + PBS, PBS + EPO, and PBS + PBS (ischemic control). Four groups were studied to compare the motor function after ischemia: DZ + EPO (n = 11), ischemic control (n = 9), DZ + EPO + tropomyosin receptor kinase A receptor inhibitor (n = 9), and sham (without cross-clamp, n = 4). Spinal cord ischemia was induced by a 4-min thoracic aortic cross-clamp. Functional scoring (Basso Mouse Score) was done at 12-h intervals until 48 h, and spinal cords were harvested for evaluation of NGF expression and histological changes. RESULTS: NGF expression was significantly upregulated 4 h after administration of EPO. At 4 h after injection of EPO, NGF expression in the DZ + EPO group was significantly higher than that in the other groups. DZ + EPO significantly preserved motor function compared with all other groups. At 48 h after reperfusion, the level of NGF expression in the DZ + EPO group, was significantly higher than in all other groups. CONCLUSIONS: DZ + EPO attenuates spinal cord ischemic injury through upregulation of NGF. Better understanding of this mechanism may serve to further prevent ischemic complications for aortic intervention.

Predictors of Acute Kidney Injury Following Aortic Arch Surgery.

BACKGROUND: Acute kidney injury (AKI) following open aortic arch surgery is a frequent complication associated with increased morbidity and mortality. The primary purpose of this study was to evaluate risk factors for postoperative AKI in patients who underwent open aortic arch surgery utilizing hypothermic circulatory arrest (HCA). MATERIALS AND METHODS: Included were 295 patients undergoing surgery between January 2011 and March 2018. AKI was defined according to Kidney Disease: Improving Global Outcomes guidelines. Preoperative and intraoperative variables were stratified by no AKI versus any AKI, and bivariate analysis was performed. Multivariable logistic regression analysis used statistically and clinically significant characteristics from the bivariate analysis. RESULTS: Of the 295 patients, 93 (32%) developed AKI. In the bivariate analysis, significant predictors of AKI included the following: history of hypertension (P < 0.001), diabetes (P = 0.03), operative urgency (P = 0.009), cardiopulmonary bypass (CPB) time (P < 0.0001), HCA time (0.02), total intraoperative transfusions (P = 0.002), and concomitant procedures (coronary artery bypass grafting, or mitral/tricuspid interventions, P = 0.0009). In the multivariable analysis, significant predictors of AKI were history of hypertension (P = 0.03) and CPB time (P = 0.02). Age, operative urgency, circulatory arrest time, and any intraoperative transfusion were not significant in the multivariable analysis. CONCLUSION: In conclusion, given that CPB time is the only modifiable risk factor identified in the analysis, approaches to reducing bypass time should continue to be the focus of decreasing risk for postoperative AKI in HCA cases.

Data driven filtering of bowel sounds using multivariate empirical mode decomposition.

BACKGROUND: The analysis of abdominal sounds can help to diagnose gastro-intestinal diseases. Sounds originating from the stomach and the intestine, the so-called bowel sounds, occur in various forms. They are described as loose successions or clusters of rather sudden bursts. Realistic recordings of abdominal sounds are contaminated with noise and artifacts from which the bowel sounds must be differentiated. METHODS: The proposed intrinsic mode function-fractal dimension (IMF-FD) filtering utilizes the property of the multivariate empirical mode decomposition (MEMD) to behave as a series of band pass filters. The MEMD decomposes the abdominal signal into its different frequency components. The resulting intrinsic mode functions (IMFs) are modulated in amplitude and frequency where transient sonic events occur. Based on the complexity of the IMFs, measured by their fractal dimension (FD) in sliding windows, the information-carrying IMFs are selected. The filtered signal is formed as the superposition of all selected IMFs. The IMF-FD filter not only enhances the non-linear components of the original signal but also segments them from the rest. Another important aspect of this work is that typical artifacts that occur in the same frequency range as bowel sounds can be subsequently eliminated by heuristic rules. CONCLUSIONS: The method is tested on a realistic, contaminated data set with promising performance: close to 100% of the manually labeled bowel sounds are identified.

A qualitative study investigating perceived barriers to medication adherence in chronic illness patients of Karachi, Pakistan.

OBJECTIVE: The study aimed to perceived barriers to medication adherence in patients with chronic illnesses.. METHODS: A qualitative study was conducted in a tertiary care hospital in Karachi in September 2017, using grounded theory and inductive approach. Interviews were conducted using a checklist in Urdu language from patients of chronic illnesses determined based on medicines dispensed from the out-patient pharmacy in hospital. Interviews were recorded, transcribed verbatim, translated in English and validated. The translated quotations were analysed using a qualitative analysis software, and thematic analysis was conducted. Codes were generated and analysed by semantic linkages and network analysis using ATLAS.ti qualitative research software. RESULTS: Of the 16 patients interviewed, 8(50%) were males and 8(50%) were females. Barriers to medication adherence identified were patient behaviour (intentional and un-intentional non-adherence), comorbidity and pill burden, cost-related non-adherence, and low patient knowledge. The last barrier was associated with the rest. CONCLUSIONS: Counselling has the potential to increase patient knowledge regarding medication use, and active pharmacist-physician collaboration can improve medication adherence..

Correlates of diabetic retinopathy: A case study.

Prevalence of diabetes mellitus is increasing worldwide particularly in developing countries as according to International Diabetes Federation, globally a rise from 451 million diabetic people in 2017 to 693 million in 2045 is expected. Diabetic retinopathy is one of the major consequences of diabetes mellitus, so knowing its risk factors can be very helpful. For identifying the risk factors of the Diabetic Retinopathy (DR) in Faisalabad and to determine whether DR is more caused by type 1 or type 2 diabetes, a cross-sectional study was conducted at major hospitals in Faisalabad district during February-July 2016. Descriptive statistics were used for initial screening of the significant variables. Then binary logistic regression was applied to measure the influence of different factors on likelihood of DR. Using Odds Ratio (OR) from logistic regression as measure of influence, the problem of DR was found to be higher among males (OR=1.913; 95% C.I, 1.072~3.413), married patients (OR=5.678; 95% C.I=2.206~14.616), patients with type 1 diabetes (OR=2.195; 95% C.I=1.205~3.997), patients with obesity (OR=25.736; 95% C.I=11.033~60.031), patients using insulin treatment (OR=6.678; 95% C.I=2.330~10.138). The study demonstrated a high prevalence of DR in Faisalabad. Eye examination, social status of patients and duration of diabetes were also found as significant variables affecting DR.

Two novel forms of ERG oscillation in Drosophila: age and activity dependence.

Over an animal's lifespan, neuronal circuits and systems often decline in an inherently heterogeneous fashion. To compare the age-dependent progression of changes in visual behavior with alterations in retinal physiology, we examined phototaxis and electroretinograms (ERGs) in a wild-type D. melanogaster strain (Canton-S) across their lifespan. In aged flies (beyond 50% median lifespan), we found a marked decline in phototaxis, while motor coordination was less disrupted, as indicated by relatively stronger negative geotaxis. These aged flies displayed substantially reduced ERG transient amplitudes while the receptor potentials (RP) remained largely intact. Using a repetitive light flash protocol, we serendipitously discovered two forms of activity-dependent oscillation in the ERG waveforms of young flies: 'light-off' and 'light-on' oscillations. After repeated 500 ms light flashes, light-off oscillations appeared during the ERG off-transients (frequency: 50-120 Hz, amplitude: ∼1 mV). Light-on oscillations (100-200 Hz, ∼0.3 mV) were induced by a series of 50 ms flashes, and were evident during the ERG on-transients. Both forms of oscillation were observed in other strains of D. melanogaster (Oregon-R, Berlin), additional Drosophila species (D. funerbris, D. euronotus, D. hydei, D. americana), and were evoked by a variety of light sources. Both light-off and light-on oscillations were distinct from previously described ERG oscillations in the visual mutant rosA in terms of location within the waveform and frequency. However, within rosA mutants, light-off oscillations, but not light-on oscillations could be recruited by the repetitive light flash protocol. Importantly though, we found that both forms of oscillation were rarely observed in aged flies. Although the physiological bases of these oscillations remain to be elucidated, they may provide important clues to age-related changes in neuronal excitability and synaptic transmission.

Innominate Versus Axillary Artery Cannulation for the Hemiarch Repair.

BACKGROUND: Innominate artery cannulation has gained some popularity over the last decade as an alternative to axillary artery cannulation for providing selective antegrade cerebral perfusion during repair of the ascending aorta and arch. Innominate artery cannulation provides several advantages including avoidance of an additional incision and use of a larger caliber artery to provide less resistance to high flow during bypass and selective antegrade cerebral perfusion. We hypothesize that these advantages make innominate artery cannulation superior to axillary artery cannulation as it can decrease operative times and potentially decrease blood loss. METHODS: This was a single-center retrospective analysis of 206 patients who underwent hemiarch replacement between 2009 and 2017. All patients qualified including emergent cases. Groups were separated by mode of cannulation: axillary and innominate. Outcomes evaluated included cardiopulmonary bypass (CPB) time, cross-clamp time, circulatory arrest (CA) time, postoperative transfusions, intensive care unit length of stay, development of any neurological complications, end-organ failure, and mortality. Subgroup analysis was performed for elective and emergent cases. RESULTS: Axillary and innominate artery cannulation accounted for 37% (n = 77) and 67% (n = 129) of cases, respectively. There was no difference in patient characteristics except for a higher incidence of renal disease in the axillary group (16% versus 6%, P = 0.05). More emergent cases were performed in the axillary group (61% versus 17%, P < 0.001). Innominate cases had shorter CPB times (189 versus 150 min, P < 0.001) and CA (22.5 versus 11 min, P < 0.001) times overall. In the elective subgroup, CA times were shorter for the innominate cases. However, the emergent subgroup displayed no difference in operative times. Less transfusions were given in the innominate group including units of red blood cells (2 [0-6] versus 0 [0-2], P < 0.001), units of platelets (2 [1-3] versus 1 [0-2], P = 0.001), and units of plasma (6 [2-9] versus 2 [0-4], P < 0.001). A similar trend was observed in the elective subgroup. No difference in transfusions was observed in the emergent subgroup. There was no statistical difference in remaining outcomes between cases of axillary and innominate cannulation in the combined, elective, and emergent groups. CONCLUSIONS: Alternate cannulation strategies for open arch anastomoses are evolving with a trend toward using the innominate artery. These data suggest that innominate cannulation is at least equivalent to, and may be superior to, axillary cannulation. The innominate artery provides a larger conduit vessel for perfusion and this decrease in resistance to flow, allowing for faster cooling and rewarming, maybe why CPB times were lower in this group. Innominate cannulation is a safe and potentially advantageous technique for hemiarch repair.