Management of a Patient With Ankylosing Spondylitis and Multiple Comorbidities Who Underwent a Percutaneous Nephrolithotomy Using an Innovative Positioning Strategy.

Ankylosing spondylitis (AS) is a chronic inflammatory disorder leading to bony ankylosis, ossification, and fibrosis of the spine. Airway management is difficult in these patients due to restricted head and neck movement as well as a stiff body posture. This also poses challenges in lying down supine as well as surgical positioning. We report a case of a patient with AS and multiple co-morbidities who underwent a percutaneous nephrolithotomy for renal calculi, and the customisations made in anaesthetic and surgical techniques to safely perform the procedure.

Improving 'Hand-Hygiene Compliance' among the Health Care Personnel in the Special Newborn Care Unit.

OBJECTIVES: To improve the hand-hygiene (HH) compliance among the health care personnel from 69 to 85% by 4 mo plan-do-study-act (PDSA) cycles, based on the WHO's five moments of hand hygiene and to study the impact of HH compliance upon the health care-associated infections (HAI) rate in the authors' special newborn care unit. METHODS: HH compliance study was undertaken based on the prioritization matrix. The barriers to HH compliance were identified and evaluated using fishbone analysis. An operational team was formed, and measures for improvement were chalked out. The baseline score was recorded through observation. A total of three PDSA cycles were carried out. Appropriate education and counseling regarding the WHO's five moments of hand hygiene were taught to the health care personnel. Interventions such as posters and supply of nonmedicated liquid hand soap, autoclaved paper towels, and alcohol-based hand sanitizer were provided. The effect of interventions on HH compliance was assessed at the end of each PDSA cycle. HAI data were collected and compared with the previous records. RESULTS: The HH compliance recorded during baseline, PDSA 1, PDSA 2, and PDSA 3 are respectively, as follows: 69% (16.75 ± 3.46), 74.58% (43.07 ± 7.50; p = 0.043), 63.75% (24.43 ± 5.16; p = 0.083), and 84.70% (47.45 ± 10.59; p = 0.014). The sum of HH scores from the three PDSA cycles when compared to the baseline is significant (p = 0.022). The HAI rate decreased from 13.81 to 1000 patient days to 10.43 per 1000 patient days (p = 0.566). CONCLUSION: HH compliance among health care personnel can be improved through information, education, and communication with constant monitoring.

Stochastic modeling and parameter estimation of turbogenerator unit of a thermal power plant under classical and Bayesian inferential framework.

The work reported in present study deals with the development of a novel stochastic model and estimation of parameters to assess reliability characteristics for a turbogenerator unit of thermal power plant under classical and Bayesian frameworks. Turbogenerator unit consists of five components namely turbine lubrication, turbine governing, generator oil system, generator gas system and generator excitation system. The concepts of cold standby redundancy and Weibull distributed random variables are used in development of stochastic model. The shape parameter for all the random variables is same while scale parameter is different. Regenerative point technique and semi-Markov approach are used for evaluation of reliability characteristics. Sufficient repair facility always remains available in plant as well as repair done by the repairman is considered perfect. As the life testing experiments are time consuming, so to highlight the importance of proposed model Monte Carlo simulation study is carried out. A comparative analysis is done between true, classical and Bayesian results of MTSF, availability and profit function.

A lightweight security framework for electronic healthcare system.

Electronic healthcare systems (EHS) are the most emerging field of today's digital world which is used for remote health monitoring, evidence-based treatment, disease prediction, modeling, etc. Many internet of things (IoT) devices and body sensors are involved in such systems for data collection. Every time a cloud-based solution is adopted to collect and preserve collected personal health information. Secure data transmission is a big challenge in such an environment as the devices are memory and power-constrained. This research focuses on a lightweight ciphering mechanism that can be used to secure an electronic healthcare system. Traditional cryptographic solutions are not suitable due to the operational complexity. Some popular lightweight block ciphers which includes SIMON, HEIGHT, LEA, etc. are used in IoT device to increase the speed. Hence, in this paper, we have proposed a lightweight security framework with a flexible key structure to protect the data in the electronic healthcare system. The proposed scheme increases the speed by minimum 4 % with compared to existing literature. Our experimental analysis shows that the proposed technique also have a low computational and communicational load. The brief security analysis using automated validation of internet security protocols and applications (AVISPA) tool shows that the proposed scheme can withstand all network attacks.

Polyvinylidene Fluoride-Added Ceramic Powder Composite Near-Field Electrospinned Piezoelectric Fiber-Based Low-Frequency Dynamic Sensors.

In this study, near-field electrospinning (NFES) is used to fabricate Ba x Sr1-x TiO3 (BST)/poly(vinylidene fluoride) (PVDF) piezoelectric fiber composites with excellent mechanical properties and chemical properties. BST ceramic powder is blended with PVDF solution uniformly to prepare a solution of appropriate conductance. The parameter for BST/PVDF fiber processing is based on PVDF fibers. Scanning electron microscopy, differential scanning calorimetry, microtensile testing, Fourier transform infrared spectroscopy, and electricity test of the blends of BST/PVDF fibers are incorporated. Mechanical properties of the fibers are then measured by microtensile testing. Effects of distinct ratios of Ba/Sr and the content of Ba0.7Sr0.3TiO3 ceramic powder on BST/PVDF piezoelectric fibers are discussed. Finally, BST/PVDF piezoelectric fiber composites are patterned on a poly(ethylene terephthalate) (PET)-based structure with an interdigital electrode as a BST/PVDF flexible energy harvester to capture ambient energy. The results show that the BST ceramic powder is ∼58-93 nm, and the diameters of piezoelectric fiber composites are ∼6.8-13.7 µm. The tensile strength of piezoelectric fiber composites is ∼74.92 MPa, and the Young's coefficient tensile strength is ∼3.74 GPa. Mechanical properties are 2-3 times higher than those of pure PVDF piezoelectric fibers. The maximum open-circuit voltage and closed-loop current of BST/PVDF fibers reached ∼1025 mV and ∼391 nA, respectively. The electromechanical energy conversion efficiency of the BST/PVDF energy harvester is found to be 1-2 times higher than that of the PVDF energy harvester. It is confirmed and validated that the addition of BST ceramic powder could effectively increase the piezoelectric constant of PVDF piezoelectric fibers.

Nanotheranostic Applications for Detection and Targeting Neurodegenerative Diseases.

Nanotechnology utilizes engineered materials and devices which function with biological systems at the molecular level and could transform the management of neurodegenerative diseases (NDs) by provoking, reacting to, and intermingling with target sites to stimulate physiological responses while minimizing side effects. Blood-brain barrier (BBB) protects the brain from harmful agents, and transporting drugs across the BBB is a major challenge for diagnosis, targeting, and treatment of NDs. The BBB provides severe limitations for diagnosis and treatment of Alzheimer's disease (AD), Parkinson's disease (PD), and various other neurological diseases. Conventional drug delivery systems generally fail to cross the BBB, thus are inefficient in treatment. Although gradual development through research is ensuring the progress of nanotheranostic approaches from animal to human modeling, aspects of translational applicability and safety are a key concern. This demands a deep understanding of the interaction of body systems with nanomaterials. There are various plant-based nanobioactive compounds which are reported to have applicability in the diagnosis and treatment of these NDs. This review article provides an overview of applications of nanotheranostics in AD and PD. The review also discusses nano-enabled drug delivery systems and their current and potential applications for the treatment of various NDs.

Corrigendum to "Joint Consensus Statement of the Indian National Association for Study of the Liver and Indian Radiological and Imaging Association for the Diagnosis and Imaging of Hepatocellular Carcinoma Incorporating Liver Imaging Reporting and Data System" [J Clin Expt Hepatol 9 (2019) 625-651].

[This corrects the article DOI: 10.1016/j.jceh.2019.07.005.].

Joint Consensus Statement of the Indian National Association for Study of the Liver and Indian Radiological and Imaging Association for the Diagnosis and Imaging of Hepatocellular Carcinoma Incorporating Liver Imaging Reporting and Data System.

Hepatocellular carcinoma (HCC) is the 6th most common cancer and the second most common cause of cancer-related mortality worldwide. There are currently no universally accepted practice guidelines for the diagnosis of HCC on imaging owing to the regional differences in epidemiology, target population, diagnostic imaging modalities, and staging and transplant eligibility. Currently available regional and national guidelines include those from the American Association for the Study of Liver Disease (AASLD), the European Association for the Study of the Liver (EASL), the Asian Pacific Association for the Study of the Liver, the Japan Society of Hepatology, the Korean Liver Cancer Study Group, Hong Kong, and the National Comprehensive Cancer Network in the United States. India with its large population and a diverse health infrastructure faces challenges unique to its population in diagnosing HCC. Recently, American Association have introduced a Liver Imaging Reporting and Data System (LIRADS, version 2017, 2018) as an attempt to standardize the acquisition, interpretation, and reporting of liver lesions on imaging and hence improve the coherence between radiologists and clinicians and provide guidance for the management of HCC. The aim of the present consensus was to find a common ground in reporting and interpreting liver lesions pertaining to HCC on imaging keeping LIRADSv2018 in mind.

Nanoparticles-mediated Brain Imaging and Disease Prognosis by Conventional as well as Modern Modal Imaging Techniques: a Comparison.

BACKGROUND: Multimodal imaging plays an important role in the diagnosis of brain disorders. Neurological disorders need to be diagnosed at an early stage for their effective treatment as later, it is very difficult to treat them. If possible, diagnosing at an early stage can be much helpful in curing the disease with less harm to the body. There is a need for advanced and multimodal imaging techniques for the same. This paper provides an overview of conventional as well as modern imaging techniques for brain diseases, specifically for tumor imaging. In this paper, different imaging modalities are discussed for tumor detection in the brain along with their advantages and disadvantages. Conjugation of two and more than two modalities provides more accurate information rather than a single modality. They can monitor and differentiate the cellular processes of normal and diseased condition with more clarity. The advent of molecular imaging, including reporter gene imaging, has opened the door of more advanced noninvasive detection of brain tumors. Due to specific optical properties, semiconducting polymer-based nanoparticles also play a pivotal role in imaging tumors. OBJECTIVE: The objective of this paper is to review nanoparticles-mediated brain imaging and disease prognosis by conventional as well as modern modal imaging techniques. CONCLUSION: We reviewed in detail various medical imaging techniques. This paper covers recent developments in detail and elaborates a possible research aspect for the readers in the field.

Deciphering the Biochemical Pathway and Pharmacokinetic Study of Amyloid ßeta-42 with Superparamagnetic Iron Oxide Nanoparticles (SPIONs) Using Systems Biology Approach.

Alzheimer's disease (AD) pathogenesis leads to the appearance of senile plaques due to the production and deposition of the ß-amyloid peptide (Aß). Superparamagnetic iron oxide nanoparticles (SPIONs) have potential role in the detection and imaging of Aß plaques in AD. SPIONs have shown appropriate potential in the diagnosis and treatment of AD. In the present study, the pharmacokinetics of SPIONs and its effect in the biochemical pathway of AD were analyzed using collected information. During analysis, the interaction of SPIONs with amyloid beta-42 (Aß42), a biomarker for AD progression, has been shown. Nodes represent the entities and edges represent the relation (interactions) of one node to another node. Aß42 and their interaction with other entities making up biochemical network are involved in AD mechanism in presence of SPION. The kinetic simulation was done to investigate pharmacokinetics of SPIONs for AD, where concentration was assigned of nanoparticles and other entities were applied as a kinetic irreversible simple Michaelis-Menten or mass action kinetics. Simulation was done in presence and absence of SPIONs to investigate pharmacokinetic effect in AD and explore the mechanism of Aß42 in presence of SPIONs. This study may lead to better understanding, which is required to target the metabolism of Aß42 peptide, a pivotal player in this pathology.

Current Perspective of Stem Cell Therapy in Neurodegenerative and Metabolic Diseases.

Neurodegenerative diseases have been an unsolved riddle for quite a while; to date, there are no proper and effective curative treatments and only palliative and symptomatic treatments are available to treat these illnesses. The absence of therapeutic treatments for neurodegenerative ailments has huge economic hit and strain on the society. Pharmacotherapies and various surgical procedures like deep brain stimulation are being given to the patient, but they are only effective for the symptoms and not for the diseases. This paper reviews the recent studies and development of stem cell therapy for neurodegenerative disorders. Stem cell-based treatment is a promising new way to deal with neurodegenerative diseases. Stem cell transplantation can advance useful recuperation by delivering trophic elements that impel survival and recovery of host neurons in animal models and patients with neurodegenerative maladies. Several mechanisms, for example, substitution of lost cells, cell combination, release of neurotrophic factor, proliferation of endogenous stem cell, and transdifferentiation, may clarify positive remedial results. With the current advancements in the stem cell therapies, a new hope for the cure has come out since they have potential to be a cure for the same. This review compiles stem cell therapy recent conceptions in neurodegenerative and neurometabolic diseases and updates in this field. Graphical Absract ᅟ.

Simple diagrammatic method to delineate male urethra in prostate cancer radiotherapy: an MRI based approach.

Stereotactic body radiotherapy (SBRT) is being increasingly utilized in the treatment of prostate cancer. With the advent of high-precision radiosurgery systems, it is possible to obtain dose distributions akin to high-dose rate brachytherapy with SBRT. However, urethral toxicity has a significant impact on the quality of life in patients with prostate cancer. Contouring the male urethra on a CT scan is difficult in the absence of an indwelling catheter. In this pictorial essay, we have used the MRI obtained for radiotherapy planning to aid in the delineation of the male urethra and have attempted to define guidelines for the same.

Nanoparticles in practice for molecular-imaging applications: An overview.

UNLABELLED: Nanoparticles (NPs) are playing a progressively more significant role in multimodal and multifunctional molecular imaging. The agents like Superparamagnetic iron oxide (SPIO), manganese oxide (MnO), gold NPs/nanorods and quantum dots (QDs) possess specific properties like paramagnetism, superparamagnetism, surface plasmon resonance (SPR) and photoluminescence respectively. These specific properties make them able for single/multi-modal and single/multi-functional molecular imaging. NPs generally have nanomolar or micromolar sensitivity range and can be detected via imaging instrumentation. The distinctive characteristics of these NPs make them suitable for imaging, therapy and delivery of drugs. Multifunctional nanoparticles (MNPs) can be produced through either modification of shell or surface or by attaching an affinity ligand to the nanoparticles. They are utilized for targeted imaging by magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT), positron emission tomography (PET), computed tomography (CT), photo acoustic imaging (PAI), two photon or fluorescent imaging and ultra sound etc. Toxicity factor of NPs is also a very important concern and toxic effect should be eliminated. First generation NPs have been designed, developed and tested in living subjects and few of them are already in clinical use. In near future, molecular imaging will get advanced with multimodality and multifunctionality to detect diseases like cancer, neurodegenerative diseases, cardiac diseases, inflammation, stroke, atherosclerosis and many others in their early stages. In the current review, we discussed single/multifunctional nanoparticles along with molecular imaging modalities. STATEMENT OF SIGNIFICANCE: The present article intends to reveal recent avenues for nanomaterials in multimodal and multifunctional molecular imaging through a review of pertinent literatures. The topic emphasises on the distinctive characteristics of nanomaterial which makes them, suitable for biomedical imaging, therapy and delivery of drugs. This review is more informative of indicative technologies which will be helpful in a way to plan, understand and lead the nanotechnology related work.