RESUMO
BACKGROUND: For patients with gastric cancer, the pathway from primary care (PC) clinician to gastroenterologist to cancer specialist (medical oncologist or surgeons) is referral dependent. The impact of clinician connectedness on disparities in quality gastric cancer care, such as at National Cancer Institute-designated cancer centers (NCI-CC), remains underexplored. This study evaluated how clinician connectedness influences access to gastrectomy at NCI-CC. METHODS: Maryland's All-Payer Claims Database was used to evaluate 667 patients who underwent gastrectomy for cancer from 2013 to 2018. Two separate referral linkages, defined as ≥9 shared patients, were examined: (1) PC clinicians to gastroenterologists at NCI-CC and (2) gastroenterologists to cancer specialists at NCI-CC. Multiple logistic regression models determined associations between referral linkages and odds of undergoing gastrectomy at NCI-CC. RESULTS: Only 15% of gastrectomies were performed at NCI-CC. Patients of gastroenterologists with referral links to cancer specialists at NCI-CC were more likely to be <65 years, male, White, and privately insured. Every additional referral link between PC clinician and gastroenterologist at NCI-CC and between gastroenterologist and cancer specialist at NCI-CC increased the odds of gastrectomy at NCI-CC by 71% and 26%, respectively. Black patients had half the odds as White patients in receiving gastrectomy at NCI-CC; however, adjusting for covariates including clinician-to-clinician connectedness attenuated this observation. CONCLUSION: Patients of clinicians with low connectedness and Black patients are less likely to receive gastrectomy at NCI-CC. Enhancing clinician connectedness is necessary to address disparities in cancer care. These results are relevant to policy makers, clinicians, and patient advocates striving for health equity.
RESUMO
AIM: To compare the acute healing outcomes of Biobrane® and Epiprotect® in paediatric partial thickness (PT) burns. METHODS: All paediatric patients (age <18 years) with PT burns managed using either Biobrane® or Epiprotect® over a 5-year period at our burns unit were included. The primary outcome was time to complete healing. Secondary outcomes included adherence, infection rates, length of hospital stay, duration of acute follow-up and return to the theatre. RESULTS: Among the 99 patients included, 38 received Epiprotect® and 61 received Biobrane®. The mean total body surface area (TBSA) was 6% (range 1%-15%) and median age was 21 months (range 5-169 months). Median time to healing in the Epiprotect® group was 19.5 days and 16 days in the Biobrane® group (P = .14). The median hospitalisation length was the same for both products (2 days, P = .85). Infection rate was lower in the Epiprotect® group (2.6% vs 16.4%, P = .048). There was no difference in adherence rate. These trends were preserved when depth sub-groups were analysed. Adherence and infection rates were not affected by post-operative antibiotics (P > .99 and P = .65, respectively) in either group. The rate of return to the theatre for further surgery was 13.2% for both products (P > .99). CONCLUSION: Our findings demonstrate that acute healing outcomes with Epiprotect® in paediatric PT burns are comparable to those with Biobrane®, with significantly lower infection rates for Epiprotect®. These results suggest that Epiprotect® is a viable alternative to Biobrane®. Nevertheless, further prospective randomised studies are required to investigate the short- and long-term outcomes.
Assuntos
Queimaduras , Materiais Revestidos Biocompatíveis , Cicatrização , Humanos , Queimaduras/terapia , Estudos Retrospectivos , Masculino , Feminino , Criança , Pré-Escolar , Lactente , Adolescente , Curativos Oclusivos , Tempo de Internação/estatística & dados numéricos , Resultado do TratamentoRESUMO
High-temperature flexible polymer dielectrics are critical for high density energy storage and conversion. The need to simultaneously possess a high bandgap, dielectric constant and glass transition temperature forms a substantial design challenge for novel dielectric polymers. Here, by varying halogen substituents of an aromatic pendant hanging off a bicyclic mainchain polymer, a class of high-temperature olefins with adjustable thermal stability are obtained, all with uncompromised large bandgaps. Halogens substitution of the pendant groups at para or ortho position of polyoxanorborneneimides (PONB) imparts it with tunable high glass transition from 220 to 245 °C, while with high breakdown strength of 625-800 MV/m. A high energy density of 7.1 J/cc at 200 °C is achieved with p-POClNB, representing the highest energy density reported among homo-polymers. Molecular dynamic simulations and ultrafast infrared spectroscopy are used to probe the free volume element distribution and chain relaxations pertinent to dielectric thermal properties. An increase in free volume element is observed with the change in the pendant group from fluorine to bromine at the para position; however, smaller free volume element is observed for the same pendant when at the ortho position due to steric hindrance. With the dielectric constant and bandgap remaining stable, properly designing the pendant groups of PONB boosts its thermal stability for high density electrification.
RESUMO
Diffusion in solids is a slow process that dictates rate-limiting processes in key chemical reactions. Unlike crystalline solids that offer well-defined diffusion pathways, the lack of similar structural motifs in amorphous or glassy materials poses great challenges in bridging the slow diffusion process and material failures. To tackle this problem, we propose an AI-guided long-term atomistic simulation approach: molecular autonomous pathfinder (MAP) framework based on deep reinforcement learning (DRL), where the RL agent is trained to uncover energy efficient diffusion pathways. We employ a Deep Q-Network architecture with distributed prioritized replay buffer, enabling fully online agent training with accelerated experience sampling by an ensemble of asynchronous agents. After training, the agents provide atomistic configurations of diffusion pathways with their energy profile. We use a piecewise nudged elastic band to refine the energy profile of the obtained pathway and the corresponding diffusion time on the basis of transition-state theory. With the MAP framework, we demonstrate atomistic diffusion mechanisms in amorphous silica with time scales comparable to experiments.
RESUMO
Acute viral hepatitis E (HEV) is the most common form of acute viral hepatitis in India. It is associated with self-limiting disease in most cases. However, the chronic form of HEV is also being increasingly recognized. Other viral infections like the hepatitis A virus (HAV) have been implicated in inciting autoimmune hepatitis. HEV infection has been associated with the formation of circulating liver-directed autoantibodies, however autoimmune liver disease following acute HEV infection has been rarely reported. Here we present a case of a 72-year-old diabetic lady who presented to us with an asymptomatic rise of liver enzymes. Investigations suggested metabolic dysfunction associated with steatotic liver disease. After three months of the diagnosis, she developed acute-on-chronic liver failure and her anti-HEV came out positive. She was managed accordingly. Afterwards patient had persistent high liver enzymes, so she underwent a liver biopsy. Her liver biopsy was compatible with autoimmune hepatitis.
RESUMO
The eigenvalue statistics are an important tool to capture localization to delocalization transition in physical systems. Recently, a ß-Gaussian ensemble is being proposed as a single parameter to describe the intermediate eigenvalue statistics of many physical systems. It is critical to explore the universality of a ß-Gaussian ensemble in complex networks. In this work, we study the eigenvalue statistics of various network models, such as small-world, Erdos-Rényi random, and scale-free networks, as well as in comparing the intermediate level statistics of the model networks with that of a ß-Gaussian ensemble. It is found that the nearest-neighbor eigenvalue statistics of all the model networks are in excellent agreement with the ß-Gaussian ensemble. However, the ß-Gaussian ensemble fails to describe the intermediate level statistics of higher order eigenvalue statistics, though there is qualitative agreement till n<4. Additionally, we show that the nearest-neighbor eigenvalue statistics of the ß-Gaussian ensemble is in excellent agreement with the intermediate higher order eigenvalue statistics of model networks.
RESUMO
The wound recovery phenomenon remains as one of the long challenging concerns worldwide. In search of user-friendly dressing materials, in this report, we fabricated a rational combinatorial strategy utilizing stereogenic harmony in a triphenylalanine fragment and appending it to δ-amino valeric acid at the N-terminus (hydrogelators I-VII) such that a potential scaffold could be fished out from the design. Our investigations revealed that all the hydrogelators displayed not only excellent self-healing performance as well as high mechanical strength at physiological pH but also mechanical stress-triggered gel-sol-gel transition properties. The structural and morphological investigation confirmed the presence of ß-sheet-like assemblies stabilized by intermolecular H-bonding and π-π interactions. Moreover, these scaffolds showed substantial antibacterial as well as antifungal efficacy against common wound pathogens, i.e, four Gram-positive bacteria (Staphylococcus aureus, Streptococcus mutans, B. subtilis, E. fecalis), four Gram-negative bacteria (Escherichia coli, Klebsiella pneumonia, P. aerugonosa, Proteus spp.), and two fungal strains (C. albicans and A. niger). The manifestation of consistent antioxidant properties might be due to the enhancement of amphiphilicity in hydrogelators, which has led to the generation of reactive oxygen species (ROS) in a facile manner, a probable mechanism to damage the microbial membrane, the driving force behind the antimicrobial efficacy. Also, the constructs exhibited proteolytic resistance and remarkable biocompatibility toward mammalian cells. Thus, based on the above benchmarks, the homochiral hydrogelator IV was seived out from a pool of seven, and we proceeded toward its in vivo evaluation using full-thickness excisional wounds in Wister rats. The scaffolds also accentuated the re-epithelialization as well in comparison to the negative control, thereby facilitating the wound closure process in a very short span of time (10 days). Overall, our in vitro and in vivo analysis certifies hydrogelator IV as an ideal dressing material that might hold immense promise for future wound care management.
Assuntos
Antibacterianos , Anti-Infecciosos , Ratos , Animais , Ratos Wistar , Antibacterianos/química , Staphylococcus aureus , Antioxidantes , MamíferosRESUMO
Deciphering the most promising strategy for the evolution of potential wound-healing therapeutics is one of the greatest challenging affairs to date. The development of peptide-based smart scaffolds with innate antimicrobial, anti-inflammatory, and antioxidant properties is an appealing way out. Aligned to the goal a set of Hydrogelators I-IV were developed utilizing the concept of chiral orchestration in diphenylalanine fragment, such that the most potent construct with all the bench marks namely mechanoresponsiveness, biocompatibility, consistent antimicrobial and antioxidant properties, could be fished out from the design. Interestingly, our inâ vitro Antifungal and Lipid peroxidation analysis identified the homochiral isomer Boc-δ-Ava-L-Phe-L-Phe-OH (Hydrogelator I), as an ideal candidate for the wound healing experiment, so we proceeded for the inâ vivo histopathological and antioxidant measurements in Wister rats. Indeed the wound images obtained from the different sets of animals on the 14th day of treatment demonstrated that with increased recovery time, hydrogelator I displayed a significant reduction in the lesion diameter compared to the marketed drug, and negative control. Even the histopathological measurements using H & E staining demonstrated diminished tissue destruction, neutrophil infiltration necrosis, and lymphatic proliferation in the hydrogelators, in comparison to others, backed by inâ vivo lipid peroxidation data. Overall our investigation certifies hydrogelator I as an effective therapeutic for managing the wound healing complication.
RESUMO
A dynamically tunable metal clad planar waveguide having 0.62PMN-0.38PT material is simulated and optimized for detection of cancer cells. Angular interrogation of the TE0 mode of waveguide shows that critical angle increases greater than the resonance angle with increasing of cover refractive index, which limits the detection range of waveguide. To overcome this limitation, proposed waveguide applies a potential on the PMN-PT adlayer. Although a sensitivity of 105.42 degree/RIU was achieved at 70 Volts in testing the proposed waveguide, it was found that the optimal performance parameters were obtained at 60 Volts. At this voltage, the waveguide demonstrated detection range 1.3330-1.5030, a detection accuracy 2393.33, and a figure of merit 2243.59 RIU-1 , which enabled the detection of the entire range of the targeted cancer cells. Therefore, it is recommended to apply a potential of 60 Volts to achieve the best performance from the proposed waveguide.
Assuntos
Metais , Neoplasias , Vibração , Neoplasias/diagnóstico por imagemRESUMO
Localization behaviors of Laplacian eigenvectors of complex networks furnish an explanation to various dynamical phenomena of the corresponding complex systems. We numerically examine roles of higher-order and pairwise links in driving eigenvector localization of hypergraphs Laplacians. We find that pairwise interactions can engender localization of eigenvectors corresponding to small eigenvalues for some cases, whereas higher-order interactions, even being much much less than the pairwise links, keep steering localization of the eigenvectors corresponding to larger eigenvalues for all the cases considered here. These results will be advantageous to comprehend dynamical phenomena, such as diffusion, and random walks on a range of real-world complex systems having higher-order interactions in better manner.
RESUMO
Ultrathin MoS2 has shown remarkable characteristics at the atomic scale with an immutable disorder to weak external stimuli. Ion beam modification unlocks the potential to selectively tune the size, concentration, and morphology of defects produced at the site of impact in 2D materials. Combining experiments, first-principles calculations, atomistic simulations, and transfer learning, it is shown that irradiation-induced defects can induce a rotation-dependent moiré pattern in vertically stacked homobilayers of MoS2 by deforming the atomically thin material and exciting surface acoustic waves (SAWs). Additionally, the direct correlation between stress and lattice disorder by probing the intrinsic defects and atomic environments are demonstrated. The method introduced in this paper sheds light on how engineering defects in the lattice can be used to tailor the angular mismatch in van der Waals (vdW) solids.
RESUMO
Effects of lateral compression on out-of-plane deformation of two-dimensional MoSe2 layers are investigated. A MoSe2 monolayer develops periodic wrinkles under uniaxial compression and Miura-Ori patterns under biaxial compression. When a flat MoSe2 monolayer is placed on top of a wrinkled MoSe2 layer, the van der Waals (vdW) interaction transforms wrinkles into ridges and generates mixed 2H and 1T phases and chain-like defects. Under a biaxial strain, the vdW interaction induces regions of Miura-Ori patterns in bilayers. Strained systems analyzed using a convolutional neural network show that the compressed system consists of semiconducting 2H and metallic 1T phases. The energetics, mechanical response, defect structure, and dynamics are analyzed as bilayers undergo wrinkle-ridge transformations under uniaxial compression and moiré transformations under biaxial compression. Our results indicate that in-plane compression can induce self-assembly of out-of-plane metasurfaces with controllable semiconducting and metallic phases and moiré patterns with unique optoelectronic properties.
RESUMO
Developmental dyscalculia is a neurodevelopmental disorder, influencing the learning of mathematics in developing children. In the last two decades, continuous growth of research has helped in the advancement of the state of knowledge of dyscalculia. This upsurge in the number of studies makes it relevant to conduct a systematic review, covering all the empirical evidence, but there is a dearth of review studies synthesizing findings of the studies in the recent past. Therefore, the current study aims to systematically review studies investigating the underlying cognitive causal factors associated with developmental dyscalculia in the last two decades. To investigate the underlying cognitive factors associated with dyscalculia, two prominent approaches have been used: domain-general and domain-specific. While the domain-general approach argues for the deficit in general cognitive abilities, the domain-specific approach argues for the deficit in core numerical abilities. In the present review, the PRISMA method is followed. Articles were searched using two methods: firstly, through database sources of Google Scholar, Web of Science, and ScienceDirect, 1738 abstracts were screened, of which 46 articles met the specific inclusion criteria; and secondly, through recently published systematic reviews and meta-analyses, 29 studies were included. A total of 75 studies, 48 studies from domain-general and 27 studies from domain-specific approaches, have been selected. This review discusses domain-general and domain-specific approaches of developmental dyscalculia, along with specific theories associated with both approaches. Based on the discussed findings, visuospatial working memory and symbolic number processing abilities emerged as the best predictor of math ability in children with dyscalculia.
RESUMO
Mucoceles are benign, encapsulated, expansible, locally invasive masses within a paranasal sinus filled with mucus and lined by epithelium. Sphenoid sinus mucoceles are relatively rare, accounting for only 1% of all paranasal sinus mucoceles. Usually presenting with headache but can rarely result in visual defect, diplopia and at times, ptosis. We present two cases of sphenoid sinus mucocele where patient presented with ophthalmoplegia, ptosis and/or sudden onset vision loss. With the help of imaging studies like CT scan and MRI of paranasal sinus diagnosis was made and immediate surgical intervention was planned which resulted in acceptable improvement of symptoms and vision.
RESUMO
BACKGROUND: Gastric cancer significantly contributes to cancer mortality globally. Gastric intestinal metaplasia (GIM) is a stage in the Correa cascade and a premalignant lesion of gastric cancer. The natural history of GIM formation and progression over time is not fully understood. Currently, there are no clear guidelines on GIM surveillance or management in the United States. AIM: To investigate factors associated with GIM development over time in African American-predominant study population. METHODS: This is a retrospective longitudinal study in a single tertiary hospital in Washington DC. We retrieved upper esophagogastroduodenoscopies (EGDs) with gastric biopsies from the pathology department database from January 2015 to December 2020. Patients included in the study had undergone two or more EGDs with gastric biopsy. Patients with no GIM at baseline were followed up until they developed GIM or until the last available EGD. Exclusion criteria consisted of patients age < 18, pregnancy, previous diagnosis of gastric cancer, and missing data including pathology results or endoscopy reports. The study population was divided into two groups based on GIM status. Univariate and multivariate Cox regression was used to estimate the hazard induced by patient demographics, EGD findings, and Helicobacter pylori (H. pylori) status on the GIM status. RESULTS: Of 2375 patients who had at least 1 EGD with gastric biopsy, 579 patients were included in the study. 138 patients developed GIM during the study follow-up period of 1087 d on average, compared to 857 d in patients without GIM (P = 0.247). The average age of GIM group was 64 years compared to 56 years in the non-GIM group (P < 0.001). In the GIM group, adding one year to the age increases the risk for GIM formation by 4% (P < 0.001). Over time, African Americans, Hispanic, and other ethnicities/races had an increased risk of GIM compared to Caucasians with a hazard ratio (HR) of 2.12 (1.16, 3.87), 2.79 (1.09, 7.13), and 3.19 (1.5, 6.76) respectively. No gender difference was observed between the study populations. Gastritis was associated with an increased risk for GIM development with an HR of 1.62 (1.07, 2.44). On the other hand, H. pylori infection did not increase the risk for GIM. CONCLUSION: An increase in age and non-Caucasian race/ethnicity are associated with an increased risk of GIM formation. The effect of H. pylori on GIM is limited in low prevalence areas.
RESUMO
The distribution of the ratios of consecutive eigenvalue spacings of random matrices has emerged as an important tool to study spectral properties of many-body systems. This article numerically investigates the eigenvalue ratios distribution of various model networks, namely, small-world, Erdos-Rényi random, and (dis)assortative random having a diagonal disorder in the corresponding adjacency matrices. Without any diagonal disorder, the eigenvalues ratio distribution of these model networks depict Gaussian orthogonal ensemble (GOE) statistics. Upon adding diagonal disorder, there exists a gradual transition from the GOE to Poisson statistics depending upon the strength of the disorder. The critical disorder (w_{c}) required to procure the Poisson statistics increases with the randomness in the network architecture. We relate w_{c} with the time taken by maximum entropy random walker to reach the steady state. These analyses will be helpful to understand the role of eigenvalues other than the principal one for various network dynamics such as transient behavior.
RESUMO
Collagenous gastritis and collagenous colitis are 2 rare gastrointestinal disorders in pediatric patients. Both of these disease processes exist on a clinical spectrum, and are extremely rare to be present together in the pediatric population. Due to the rarity and unknown etiology of these disease processes, standardized treatment protocols and objective clinical biomarkers of disease progression are missing. This is the first report to describe a 16 year old female with CG and CC who responded well to mesalamine therapy, evident by decreasing calprotectin levels after initiation of therapy.
RESUMO
BACKGROUND: Drain practices in minimally invasive retromuscular ventral hernia repairs have largely been transferred over from open surgery without significant review. We wished to evaluate the role of drains in these repairs. METHODS: Using the Abdominal Wall Reconstruction Surgical Collaborative (AWRSC) registry, patients with ventral hernias who underwent enhanced-view totally extraperitoneal (eTEP) repairs between February 2016 and September 2019 were evaluated. Patients with contamination or active infection within the surgical field, those who underwent an emergent or hybrid repair, or received a concomitant procedure were excluded. Propensity score matching based on the defect size, previous hernia repair status, and the use of posterior component separation (PCS) was used to match patients with drains to patients without drains. We evaluated 180-day outcomes in terms of SSIs, SSOs, and recurrence. RESULTS: 308 patients met the inclusion criteria. After propensity score matching, 48 patients with drains and 72 without drains were included in the analysis cohort. Those with drains were older with a greater likelihood of an incisional hernia, but were broadly similar for other relevant demographic and hernia-related variables. While there was no difference in the incidence of SSOs and SSIs between the two groups, we report a higher risk of SSOs needing procedural intervention (SSOPI) and recurrence, with a lengthened hospital stay in the cohort that received surgical drains. CONCLUSION: The use of surgical drains in "clean" eTEP repairs of ventral hernias appears to be common, with a selection bias for more complex cases. Based on our analysis, we found the use of drains was associated with longer hospital stays. The use of drains did not change the likelihood of suffering an SSI or SSO. However, the incidence of SSOPIs was higher despite the use of drains, which raises questions about their protective role in these repairs.
Assuntos
Hérnia Ventral , Hérnia Incisional , Músculos Abdominais/cirurgia , Hérnia Ventral/complicações , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Humanos , Hérnia Incisional/cirurgia , Estudos Retrospectivos , Telas Cirúrgicas/efeitos adversosRESUMO
OBJECTIVE: The disruption of bidirectional communication between neuroendocrine and immune components by stressors leads to mental problems. The immunomodulation therapy of neuroinflammation-led psychiatric illness is an emerging area of research. Therefore, the present study aimed to evaluate immune modulation efficacy of PD 149163 (PD) against the lipopolysaccharide (LPS)-induced neuroinflammation. MATERIALS AND METHODS: The Swiss albino mice (female/12 weeks) were divided into six groups (6 mice/group): (I) Control: 0.9% NaCl; (II) LPS: 1 mg/kg BW, for 5 days; (III) LPS + PD Low: LPS 1 mg/kg BW (for 5 days) after that PD 100 µg/kg BW (for 21 days); (IV) LPS + PD High: LPS 1 mg/kg BW (for 5 days) after that PD 300 µg/kg BW (for 21 days); (V) PD Low: PD 100 µg/kg BW (for 21 days); (VI) PD High: PD 300 µg/kg BW (for 21 days). All treatments were given intraperitoneal. RESULTS: The LPS-induced weight loss (body and brain) was normalized to control after PD treatment. The PD enhanced superoxide dismutase (SOD) activity while decreased lipid hydroperoxide (LOOH) level altered in LPS-exposed mice. The significantly increased pro-inflammatory cytokines (IL-6 and TNF-α) in LPS exposure were also decreased by PD. Likewise, the LPS-induced HPA axis activation was stabilized by PD. In the hippocampus, the pyramidal cell layer thickness, pyramidal neurons number and size of CA1 and CA3 regions were reduced along with misalignment, shrinkage, and impairment of cytoarchitecture. In the co-treated group, the LPS-induced hippocampus disruption was reversed after PD exposure. CONCLUSION: We suggested that the PD modulates the LPS-induced neuroinflammation and psychiatric illness in a dose-dependent manner.
Assuntos
Lipopolissacarídeos , Neurotensina , Animais , Feminino , Sistema Hipotálamo-Hipofisário , Inflamação/induzido quimicamente , Inflamação/tratamento farmacológico , Lipopolissacarídeos/toxicidade , Camundongos , Doenças Neuroinflamatórias , Neurotensina/efeitos adversos , Neurotensina/análogos & derivados , Sistema Hipófise-SuprarrenalRESUMO
Physiological and haplogroup studies performed to understand high-altitude adaptation in humans are limited to individual genes and polymorphic sites. Due to stochastic evolutionary forces, the frequency of a polymorphism is affected by changes in the frequency of a near-by polymorphism on the same DNA sample making them connected in terms of evolution. Here, first, we provide a method to model these mitochondrial polymorphisms as "co-mutation networks" for three high-altitude populations, Tibetan, Ethiopian and Andean. Then, by transforming these co-mutation networks into weighted and undirected gene-gene interaction (GGI) networks, we were able to identify functionally enriched genetic interactions of CYB and CO3 genes in Tibetan and Andean populations, while NADH dehydrogenase genes in the Ethiopian population playing a significant role in high altitude adaptation. These co-mutation based genetic networks provide insights into the role of different set of genes in high-altitude adaptation in human sub-populations.