A Clinico-Epidemiological Study on Porokeratosis.

Porokeratosis (PK) is a chronic progressive disorder of keratinization characterized clinically by hyperkeratotic papules or plaques surrounded by a threadlike, elevated border that expands centrifugally. Pathogenesis involves heterozygous mutations in mevalonate kinase enzyme. The most common variants are disseminated superficial actinic porokeratosis (DSAP) and PK of Mibelli. All forms show a thin column of parakeratosis, the cornoid lamella, representing the active border. Dermoscopy reveals central brownish discoloration surrounded by a single hypopigmented band and a peripheral 'white track'. Long-standing cases of PK may undergo malignant transformation. UV-protection and topical agents, such as 5-fluorouracil, imiquimod, calcipotriol, tretinoin and oral retinoids are helpful. To study the clinical and epidemiological pattern of PK and the clinico-dermoscopic and histopathological correlation of PK. A prospective cross-sectional study was conducted on the patients attending the dermatology outpatient department (OPD) over 9 months with suspected features of PK. These patients were evaluated clinically and subjected to dermoscopy and histopathology. Statistical Package for the Social Sciences (SPSS) Of 11 patients, there were four (36.36%) males and seven (63.66%) females. The youngest was 18-year-old boy, and the eldest was 63-year-old man. The clinically most common type was PK of Mibelli with five (45.45%) cases. The most common dermoscopic feature observed was double-marginated, white peripheral border. The most common histopathological feature noted was cornoid lamella. PK is a rare skin disorder with a wide spectrum of clinical variants. Dermoscopy and histopathology aid in diagnosis, whereas dermoscopy plays a pivotal role in early and non-invasive diagnosis. Regular follow-up is mandatory to watch for the development of malignancies in a few variants.

Intraoperative hypoglycemia among adults with intraoperative glucose measurements: a cross-sectional multicentre retrospective cohort study.

PURPOSE: Intraoperative hypoglycemia is presumed to be rare, but generalizable multicentre incidence and risk factor data for adult patients are lacking. We used a multicentre registry to characterize adults with intraoperative hypoglycemia and hypothesized that intraoperative insulin administration would be associated with hypoglycemia. METHODS: We conducted a cross-sectional retrospective multicentre cohort study. We searched the Multicenter Perioperative Outcomes Group registry to identify adult patients with intraoperative hypoglycemia (glucose < 3.3 mmol·L-1 [< 60 mg·dL-1]) from 1 January 2015 to 31 December 2019. We evaluated characteristics of patients with intraoperative glucose measurements and with intraoperative hypoglycemia. RESULTS: Of 516,045 patients with intraoperative glucose measurements, 3,900 (0.76%) had intraoperative hypoglycemia. Diabetes mellitus and chronic kidney disease were more common in the cohort with intraoperative hypoglycemia. The odds of intraoperative hypoglycemia were higher for the youngest age category (18-30 yr) compared with the odds for every age category above 40 yr (odds ratio [OR], 1.57-3.18; P < 0.001), and were higher for underweight or normal weight patients compared with patients with obesity (OR, 1.48-2.53; P < 0.001). Parenteral nutrition was associated with lower odds of hypoglycemia (OR, 0.23; 95% confidence interval [CI], 0.11 to 0.47; P < 0.001). Intraoperative insulin use was not associated with hypoglycemia (OR, 0.996; 95% CI, 0.91 to 1.09; P = 0.93). CONCLUSION: In this large cross-sectional retrospective multicentre cohort study, intraoperative hypoglycemia was a rare event. Intraoperative insulin use was not associated with hypoglycemia.

RéSUMé: OBJECTIF: L'hypoglycémie peropératoire est présumée rare, mais il n'existe pas de données généralisables sur l'incidence multicentrique et les facteurs de risque chez la patientèle adulte. Nous avons utilisé un registre multicentrique pour caractériser les personnes adultes atteintes d'hypoglycémie peropératoire et émis l'hypothèse que l'administration peropératoire d'insuline serait associée à l'hypoglycémie. MéTHODE: Nous avons réalisé une étude de cohorte multicentrique rétrospective transversale. Nous avons effectué des recherches dans le registre du Multicenter Perioperative Outcomes Group afin d'identifier les patient·es adultes atteint·es d'hypoglycémie peropératoire (glucose < 3,3 mmol· L−1 [< 60 mg·dL−1]) du 1er janvier 2015 au 31 décembre 2019. Nous avons évalué les caractéristiques des patient·es présentant des mesures de glucose et une hypoglycémie peropératoires. RéSULTATS: Sur 516 045 patient·es ayant des mesures de glucose peropératoires, 3900 (0,76 %) ont présenté une hypoglycémie peropératoire. Le diabète sucré et l'insuffisance rénale chronique étaient plus fréquents dans la cohorte présentant une hypoglycémie peropératoire. Les risques d'hypoglycémie peropératoire étaient plus élevés pour la catégorie d'âge la plus jeune (18-30 ans) par rapport aux catégories d'âge au-dessus de 40 ans (rapport des cotes [RC], 1,57-3,18; P < 0,001), et étaient plus élevés chez les patient·es de poids insuffisant ou de poids normal par rapport aux patient·es obèses (RC, 1,48-2,53; P < 0,001). La nutrition parentérale était associée à une probabilité plus faible d'hypoglycémie (RC, 0,23; intervalle de confiance [IC] à 95 %, 0,11 à 0,47; P < 0,001). L'utilisation peropératoire d'insuline n'était pas associée à l'hypoglycémie (RC, 0,996; IC 95 %, 0,91 à 1,09; P = 0,93). CONCLUSION: Dans cette vaste étude de cohorte multicentrique rétrospective transversale, l'hypoglycémie peropératoire était un événement rare. L'utilisation peropératoire d'insuline n'était pas associée à l'hypoglycémie.

Association of Cardiopulmonary Hemodynamics and Outcomes in Pulmonary Hypertension Following Kidney Transplant: A Multicenter Retrospective Cohort Study.

BACKGROUND: Pulmonary Hypertension (PH) frequently complicates the evaluation of kidney transplant (KT) candidates, and is associated with increased adverse outcomes (mortality, delayed graft function (DGF), and major adverse cardiovascular events (MACE)) following KT. RESEARCH QUESTION: What is the relationship between cardiopulmonary hemodynamics and post-KT outcomes? STUDY DESIGN AND METHODS: We conducted a multicenter retrospective cohort study of adults undergoing KT between 10/1/11 and 10/1/21, who underwent right heart catheterization (RHC) to assess cardiopulmonary hemodynamics within a year of transplantation. Frailty models and logistic regression models were used to evaluate the association between cardiopulmonary hemodynamics and outcomes (mortality, DGF, MACE) following KT. RESULTS: A total of 117 patients were included in the final analysis, predominantly male (72%), with a median age of 57 years. PH, defined as mean pulmonary artery pressure (mPAP) > 20mmHg, was present in the majority of the cohort (N=93, 79%). The cohort was followed for a median of 29.9 months post-KT, during which about one-fourth experienced mortality (23%) or DGF (25%) events, and approximately one-third (34%) experienced MACE. Though echocardiographic measures of pulmonary artery pressure failed to identify post-KT outcomes, a mPAP of ≥ 30mmHg on RHC was associated with post-KT MACE (Hazard Ratio 2.60, 95% Confidence Interval [1.10, 6.10]) and more prevalent in those experiencing post-KT mortality (63% vs 32%, p=0.001). Pre-capillary pulmonary hypertension was also associated with post-KT mortality (Hazard Ratio 3.71, 95% Confidence Interval [1.07, 12.90]). INTERPRETATION: Pre-capillary pulmonary hypertension and a mPAP of ≥ 30mmHg on RHC, but not echocardiographic evidence of PH, was associated with mortality and MACE following KT. These data suggest that RHC hemodynamics are superior to echocardiographic measures of PH in associating with outcomes following KT, and RHC-derived mPAP in particular may have value in predicting MACE and mortality post-KT.

Retraction notice to "Performance and exergy analysis of an inclined solar still with baffle arrangements" [Heliyon 9 (2023) e14807].

[This retracts the article DOI: 10.1016/j.heliyon.2023.e14807.].

Metal organic framework anchored onto biowaste mediated carbon material (rGO) for remediation of chromium (VI) by the photocatalytic process.

Groundwater contaminated with hexavalent chromium Cr(VI) causes serious health concerns for the ecosystem. In this study, a hybrid amino functionalized MOF@rGO nanocatalyst was produced by utilization of a biowaste mediated carbon material (reduced graphene oxide; rGO) and its surface was modified by in situ synthesis of a nanocrystalline, mixed ligand octahedral MOF containing iron metal and NH2 functional groups and the prepared composite was investigated for Cr (VI) removal. The photocatalytic degradation of Cr(VI) in aqueous solutions was carried out under UV irradiation. Using a batch mode system, the effect of numerous control variables was examined, and the process design and optimization were carried out by response surface methodology (RSM). The photocatalyst, NH2-MIL(53)-Fe@rGO, was intended to be a stable and highly effective nanocatalyst throughout the recycling tests. XRD, SEM, EDS, FTIR examinations were exploited to discover more about surface carbon embedded with MOF. 2 g/L of NH2-MIL-53(Fe)/rGO was utilized in degrading 200 mg/L of Cr(VI) in just 100 min, implying the selective efficacy of such a MOF-rGO nanocatalyst. Moreover, the Eg determinations well agreed with the predicted range of 2.7 eV, confirming its possibility to be exploited underneath visible light, via the Tauc plot. Thus, MOF anchored onto biowaste derived rGO photo-catalyst was successfully implemented in chromium degradation.

AcumenTM hypotension prediction index guidance for prevention and treatment of hypotension in noncardiac surgery: a prospective, single-arm, multicenter trial.

BACKGROUND: Intraoperative hypotension is common during noncardiac surgery and is associated with postoperative myocardial infarction, acute kidney injury, stroke, and severe infection. The Hypotension Prediction Index software is an algorithm based on arterial waveform analysis that alerts clinicians of the patient's likelihood of experiencing a future hypotensive event, defined as mean arterial pressure < 65 mmHg for at least 1 min. METHODS: Two analyses included (1) a prospective, single-arm trial, with continuous blood pressure measurements from study monitors, compared to a historical comparison cohort. (2) A post hoc analysis of a subset of trial participants versus a propensity score-weighted contemporaneous comparison group, using external data from the Multicenter Perioperative Outcomes Group (MPOG). The trial included 485 subjects in 11 sites; 406 were in the final effectiveness analysis. The post hoc analysis included 457 trial participants and 15,796 comparison patients. Patients were eligible if aged 18 years or older, American Society of Anesthesiologists (ASA) physical status 3 or 4, and scheduled for moderate- to high-risk noncardiac surgery expected to last at least 3 h. MEASUREMENTS: minutes of mean arterial pressure (MAP) below 65 mmHg and area under MAP < 65 mmHg. RESULTS: Analysis 1: Trial subjects (n = 406) experienced a mean of 9 ± 13 min of MAP below 65 mmHg, compared with the MPOG historical control mean of 25 ± 41 min, a 65% reduction (p < 0.001). Subjects with at least one episode of hypotension (n = 293) had a mean of 12 ± 14 min of MAP below 65 mmHg compared with the MPOG historical control mean of 28 ± 43 min, a 58% reduction (p< 0.001). Analysis 2: In the post hoc inverse probability treatment weighting model, patients in the trial demonstrated a 35% reduction in minutes of hypotension compared to a contemporaneous comparison group [exponentiated coefficient: - 0.35 (95%CI - 0.43, - 0.27); p < 0.001]. CONCLUSIONS: The use of prediction software for blood pressure management was associated with a clinically meaningful reduction in the duration of intraoperative hypotension. Further studies must investigate whether predictive algorithms to prevent hypotension can reduce adverse outcomes. TRIAL REGISTRATION: Clinical trial number: NCT03805217. Registry URL: https://clinicaltrials.gov/ct2/show/NCT03805217 . Principal investigator: Xiaodong Bao, MD, PhD. Date of registration: January 15, 2019.

Peristaltic transport of Sutterby nanofluid flow in an inclined tapered channel with an artificial neural network model and biomedical engineering application.

Modern energy systems are finding new applications for magnetohydrodynamic rheological bio-inspired pumping systems. The incorporation of the electrically conductive qualities of flowing liquids into the biological geometries, rheological behavior, and propulsion processes of these systems was a significant effort. Additional enhancements to transport properties are possible with the use of nanofluids. Due to their several applications in physiology and industry, including urine dynamics, chyme migration in the gastrointestinal system, and the hemodynamics of tiny blood arteries. Peristaltic processes also move spermatozoa in the human reproductive system and embryos in the uterus. The present research examines heat transport in a two-dimensional deformable channel containing magnetic viscoelastic nanofluids by considering all of these factors concurrently, which is vulnerable to peristaltic waves and hall current under ion slip and other situations. Nanofluid rheology makes use of the Sutterby fluid model, while nanoscale effects are modeled using the Buongiorno model. The current study introduces an innovative numerical computing solver utilizing a Multilayer Perceptron feed-forward back-propagation artificial neural network (ANN) with the Levenberg-Marquardt algorithm. Data were collected for testing, certifying, and training the ANN model. In order to make the dimensional PDEs dimensionless, the non-similar variables are employed and calculated by the Homotopy perturbation technique. The effects of developing parameters such as Sutterby fluid parameter, Froude number, thermophoresis, ion-slip parameter, Brownian motion, radiation, Eckert number, and Hall parameter on velocity, temperature, and concentration are demonstrated. The machine learning model chooses data, builds and trains a network, and subsequently assesses its performance using the mean square error metric. Current results declare that the improving Reynolds number tends to increase the pressure rise. Improving the Hall parameter is shown to result in a decrease in velocity. When raising a fluid's parameter, the temperature profile rises.

Resonant ultrasound spectroscopy applications: Elastic moduli computation with x-ray computed tomography input for irregularly shaped objects.

Resonant ultrasound spectroscopy is a technique that uses a combination of experimentally measured resonant frequencies and physics-based computation of these frequencies to determine the entire set of single crystal elastic moduli of the material. Computation of the resonances is most often accomplished using the Rayleigh-Ritz energy minimization technique, and a basis function that requires sample with canonical geometry, such as a cylinder or a rectangular parallelepiped. Any deviation from canonical geometry can have a significant impact on the calculated resonance frequencies and the inverted elastic moduli. To overcome this limitation, this paper describes an approach that uses x-ray computed tomography data to generate accurate solid part model of components with complex geometry. The part model is then imported into an off-the-shelf finite element method (FEM) software to perform the forward problem. The FEM was combined with surrogate modeling for computation of resonance frequencies of both canonical and non-canonical samples, and ultimately, the inversion of elastic moduli.

Emerging aspects of metal ions-doped zinc oxide photocatalysts in degradation of organic dyes and pharmaceutical pollutants - A review.

In recent periods, a broad assortment of continual organic contaminants has been released into our natural water resources. Indeed, it is exceedingly poisonous and perilous to living things; thus, the elimination of these organic pollutants before release into the water bodies is vital. A variety of techniques have been utilized to remove these organic pollutants with advanced oxidation photocatalytic methods with zinc oxide (ZnO) nanoparticles being commonly used as a capable catalyst for contaminated water treatment. Nevertheless, its broad energy gap, which can be only stimulated under an ultraviolet (UV) light source, and high recombination pairs of electrons and holes limit their photocatalytic behaviors. However, numerous methods have been suggested to decrease its energy gap for visible regions. Including, the doping ZnO with metal ions (dopant) can be considered as an effectual route not only the reason for a movement of the absorption edges toward the higher (visible light) region but also to lower the electron-hole pair (e--h+) recombination. This review concentrated on the impact of dissimilar types of metal ions (dopants) on the advancement in the degradation performance of ZnO. So, this work demonstrates a vital review of contemporary attainments in the alteration of ZnO nanoparticles for organic pollutants eliminations. Besides, the effect of doping ions including transition metals, rare earth metals, and metal ions (substitutional and interstitial) concerning numerous types of altered ZnO are summarized. The photodegradation mechanisms for pristine and metal-modified ZnO nanoparticles are also conferred.

Investigations on the microstructure and properties of yttria and silicon carbide reinforced aluminium composites.

Powder Metallurgy (PM) was used to synthesize SiC (0, 5, 10, 15 & 20 wt%) and 1 wt% Yttria (Y2O3) reinforced aluminium (Al) metal matrix composites. The Al-SiC-Y2O3 hybrid composites samples were prepared for density (ρ), hardness (VHN), mechanical, tribological, and microstructural studies in accordance with ASTM standards. SEM images revealed an even spreading of SiC particles throughout the Al matrix and composition was verified by the characterization techniques. The addition of SiC and Y2O3 to their respective composites improved the VHN and 'ρ'. The compressive strength (CS) of Al-SiC-Y2O3 composites increased while increasing the SiC. The higher compression strength (405 MPa) was obtained for the Al - 1 wt% Y2O3-20 wt% SiC- hybrid composites. The thermal conductivity (K) of Al-SiC-Y2O3 samples diminishes, as the hard SiC particles are gradually added. Furthermore, it was observed that accumulative the wt% of SiC in the aluminium metal matrix (AMMC) results in a novel material with a decreased wear rate. The better properties was achieved for the samples contain 20 wt% of SiC content in Al - 1 wt% Y2O3 matrix.

Feasibility pilot trial for the Trajectories of Recovery after Intravenous propofol versus inhaled VolatilE anesthesia (THRIVE) pragmatic randomised controlled trial.

INTRODUCTION: Millions of patients receive general anaesthesia for surgery annually. Crucial gaps in evidence exist regarding which technique, propofol total intravenous anaesthesia (TIVA) or inhaled volatile anaesthesia (INVA), yields superior patient experience, safety and outcomes. The aim of this pilot study is to assess the feasibility of conducting a large comparative effectiveness trial assessing patient experiences and outcomes after receiving propofol TIVA or INVA. METHODS AND ANALYSIS: This protocol was cocreated by a diverse team, including patient partners with personal experience of TIVA or INVA. The design is a 300-patient, two-centre, randomised, feasibility pilot trial. Patients 18 years of age or older, undergoing elective non-cardiac surgery requiring general anaesthesia with a tracheal tube or laryngeal mask airway will be eligible. Patients will be randomised 1:1 to propofol TIVA or INVA, stratified by centre and procedural complexity. The feasibility endpoints include: (1) proportion of patients approached who agree to participate; (2) proportion of patients who receive their assigned randomised treatment; (3) completeness of outcomes data collection and (4) feasibility of data management procedures. Proportions and 95% CIs will be calculated to assess whether prespecified thresholds are met for the feasibility parameters. If the lower bounds of the 95% CI are above the thresholds of 10% for the proportion of patients agreeing to participate among those approached and 80% for compliance with treatment allocation for each randomised treatment group, this will suggest that our planned pragmatic 12 500-patient comparative effectiveness trial can likely be conducted successfully. Other feasibility outcomes and adverse events will be described. ETHICS AND DISSEMINATION: This study is approved by the ethics board at Washington University (IRB# 202205053), serving as the single Institutional Review Board for both participating sites. Recruitment began in September 2022. Dissemination plans include presentations at scientific conferences, scientific publications, internet-based educational materials and mass media. TRIAL REGISTRATION NUMBER: NCT05346588.

Agricultural waste biomass for sustainable bioenergy production: Feedstock, characterization and pre-treatment methodologies.

The worldwide trend in energy production is moving toward circular economy systems and sustainable availability of sources. Some advanced methods support the economic development of energy production by the utilization of waste biomass, while limiting ecological effects. The use of agro waste biomass is viewed as a major alternative energy source that expressively lowers greenhouse gas emissions. Agricultural residues produced as wastes after each step of agricultural production are used as sustainable biomass assets for bioenergy production. Nevertheless, agro waste biomass needs to go through a few cyclic changes, among which biomass pre-treatment contributes to the removal of lignin and has a significant role in the efficiency and yield of bioenergy production. As a result of rapid innovation in the utilization of agro waste for biomass-derived bioenergy, a comprehensive overview of the thrilling highlights and necessary advancements, in addition to a detailed analysis of feedstock, characterization, bioconversion, and contemporary pre-treatment procedures, appear to be vital. To this end, the current status in the generation of bioenergy from agro biomass through various pre-treatment procedures was examined in this study, along with presenting relevant challenges and a perspective for future investigations.

Progress and Prospective of the Industrial Development and Applications of Eco-Friendly Colorants: An Insight into Environmental Impact and Sustainability Issues.

Color is the prime feature directly associated with the consumer's attraction and choice of their food. The flavor, safety, and nutritional value of any food product are directly associated with the food color. Natural and synthetic colorants (dyes and pigments) have diversified applications in various sectors such as food, feed, pharmaceutical, textiles, cosmetics, and others. Concerning the food industry, different types of natural and synthetic colorants are available in the market. Synthetic food colorants have gained popularity as they are highly stable and cheaply available. Consumers worldwide prefer delightful foodstuffs but are more concerned about the safety of the food. After its disposal, the colloidal particles present in the synthetic colorants do not allow sunlight to penetrate aquatic bodies. This causes a foul smell and turbidity formation and gives a bad appearance. Furthermore, different studies carried out previously have presented the toxicological, carcinogenic effects, hypersensitivity reactions, and behavioral changes linked to the usage of synthetic colorants. Natural food colorings, however, have nutraceutical qualities that are valuable to human health such as curcumin extracted from turmeric and beta-carotene extracted from carrots. In addition, natural colorants have beneficial properties such as excellent antioxidant properties, antimutagenic, anti-inflammatory, antineoplastic, and antiarthritic effects. This review summarizes the sources of natural and synthetic colorants, their production rate, demand, extraction, and characterization of food colorants, their industrial applications, environmental impact, challenges in the sustainable utilization of natural colorants, and their prospects.

Performance and exergy analysis of an inclined solar still with baffle arrangements.

This study presents the details of performance and exergy investigations on an inclined solar still with baffle arrangements. The shortage of consumable water creates the transformation of accessible brackish water into consumable water an unavoidable one and this can be accomplished utilizing sun-oriented refining. To remove drinkable water from pungent water, sun-oriented still is broadly utilized. To build the contact season of the pungent water with sunlight-based brilliance, perplex course of action is set to expand the opposition in the stream. This prompts more vanishing of brackish water. Therefore, the objective of this study is to improve freshwater yield. The experimental study is performed for two different mass flow rates (mf1 = 0.0833 kg/min and mf2 = 0.166 kg/min). An increase in the mass flow of water directly deteriorates the yield of fresh water. Highest accumulated freshwater yield is achieved as 2.908 kg/m2 day during the month of May for mf1 = 0.0833 kg/min. The accumulated freshwater yield improved by 4.23% in comparison with inclined solar still designs. Moreover, the yield is better by 3.49%-61.56% in comparison with various solar still designs. Using RSM, a polynomial statistical model is specified to estimate as well as maximize the freshwater yield of ISSB. The exergy analysis for mf1 = 0.0833 kg/min shows a maximum hourly exergy efficiency of 6.82%.

Multicenter evaluation of the Quantra with the QStat Cartridge in adult patients undergoing liver transplantation.

Blood loss and transfusion of blood products are key concerns during liver transplantation. Whole-blood viscoelastic testing devices have been used to monitor hemostatic function and guide the transfusion of blood products in this patient population. The Quantra System with the QStat Cartridge is a new point-of-care, closed-system viscoelastic testing device that measures changes in clot stiffness during coagulation and fibrinolysis using ultrasound detection of resonance. The aim of this multicenter prospective observational study was to evaluate the Quantra System against the ROTEM delta device in monitoring coagulation and fibrinolysis in patients undergoing liver transplantation. One hundred twenty-five (125) adult subjects (above 18 y old) were enrolled across 5 medical centers in the US. Blood samples were collected at a minimum of 3-time points: preincision (baseline), during the anhepatic phase, and after the start of reperfusion. Performance was assessed as the correlation of equivalent measurements from the QStat Cartridge and ROTEM delta INTEM, EXTEM, and FIBTEM assays. In addition, a clinical concordance analysis was performed to assess the agreement between the 2 devices related to the detection of fibrinolysis. The correlation between the 2 viscoelastic testing devices was strong, with r -values ranging between 0.88 and 0.95, and the overall agreement with respect to detecting fibrinolysis was 90.3% (CI, 86.9%-93.2%). The results indicate that the Quantra with the QStat Cartridge provides comparable information as the ROTEM delta in the assessment of hemostatic function during a liver transplant. Quantra's simplicity of use and availability of rapid results may provide clinicians with a faster, more convenient means to assess coagulation and fibrinolysis status in the operating room and critical care setting.

Successful living donor liver transplantation in a patient with hemophilia A and factor VIII inhibitor: A case report with perioperative recommendations.

Liver transplantation in patients with end-stage liver disease and coexisting hemophilia A has been described. Controversy exists over perioperative management of patients with factor VIII inhibitor predisposing patients to hemorrhage. We describe the case of a 58-year-old man with a history of hemophilia A and factor VIII inhibitor, eradicated with rituximab prior to living donor liver transplantation without recurrence of inhibitor. We also provide perioperative management recommendations from our successful multidisciplinary approach.

Positron emission tomography myocardial perfusion imaging (PET MPI) findings predictive of post-liver transplant major adverse cardiac events.

Positron emission tomography myocardial perfusion imaging (PET MPI) is a noninvasive diagnostic test capable of detecting coronary artery disease, structural heart disease, and myocardial flow reserve (MFR). We aimed to determine the prognostic utility of PET MPI to predict post-liver transplant (LT) major adverse cardiac events (MACE). Among the 215 LT candidates that completed PET MPI between 2015 and 2020, 84 underwent LT and had 4 biomarker variables of clinical interest on pre-LT PET MPI (summed stress and difference scores, resting left ventricular ejection fraction, global MFR). Post-LT MACE were defined as acute coronary syndrome, heart failure, sustained arrhythmia, or cardiac arrest within the first 12 months post-LT. Cox regression models were constructed to determine associations between PET MPI variable/s and post-LT MACE. The median LT recipient age was 58 years, 71% were male, 49% had NAFLD, 63% reported prior smoking, 51% had hypertension, and 38% had diabetes mellitus. A total of 20 MACE occurred in 16 patients (19%) at a median of 61.5 days post-LT. One-year survival of MACE patients was significantly lower than those without MACE (54% vs. 98%, p =0.001). On multivariate analysis, reduced global MFR ≤1.38 was associated with a higher risk of MACE [HR=3.42 (1.23-9.47), p =0.019], and every % reduction in left ventricular ejection fraction was associated with an 8.6% higher risk of MACE [HR=0.92 (0.86-0.98), p =0.012]. Nearly 20% of LT recipients experienced MACE within the first 12 months of LT. Reduced global MFR and reduced resting left ventricular ejection fraction on PET MPI among LT candidates were associated with increased risk of post-LT MACE. Awareness of these PET-MPI parameters may help improve cardiac risk stratification of LT candidates if confirmed in future studies.

Modelling and optimization of thermophilic anaerobic digestion using biowaste.

Biowaste generation is considerably increasing multiple times recently due to various social and environmental changes like population growth, economic prosperity, globalisation etc. they contain different composition and generated at different stages of their life cycle. Though studies reported for recycle, reproduce and reuse of them, this investigation is unique by focussing to investigate the ideal circumstances for the production of biogas and methane from anaerobic digestion of vegetable waste using response surface methods and artificial neural networks with thermophilic temperature range. Thermophilic temperature of 20.78, organic loading rate of 0.2, pH of 8.81, agitation time of 5.8 and hydro retention time of 3 are the ideal input parameter values for the generation of biogas 3.03 m3 and methane% 186.08 with a desirability of 1. The Response surface model was surpassed by the Artificial Neural Network model.