Design and fabrication of SU-8 polymer arrayed waveguide gratings based on flexible PDMS substrates.

We investigated and fabricated 1×8 and 1×16 traditional/saddle arrayed waveguide grating (AWG) wavelength division multiplexing devices on flexible substrates. The core layer was made of the negative epoxy photoresist SU-8, and polydimethylsiloxane (PDMS) material was selected for the cladding based on the high refractive index difference. A chemical modification method of PDMS was proposed to enhance the film-forming characteristics of the SU-8 core layer on PDMS substrates. After fabricating and characterizing the optical properties of the AWGs, the dimensions of the proposed 1×8 and 1×16 AWGs were 0.9×0.8cm2 and 1.1×0.9cm2, respectively. Experimental results showed that the saddle-type 1×8 and 1×16 AWGs had good signal transmission characteristics, and the insertion losses were only 5.1 dB and 6.8 dB, respectively, which were lower than those of traditional-type AWGs with the same dimensions and number of waveguides.

Genetics vs chronic corneal mechanical trauma in the etiology of keratoconus.

Both genetic and environmental factors have been considered to play a role in the etiology keratoconus. Eye rubbing, and more recently eye compression due to sleeping position, have been identified to be highly related to the condition, and are present in a high percentage of patients. Today, the predominant model is that these factors can provide the "second hit" necessary to generate the condition in a genetically susceptible individual. In addition, the extremely high prevalence in Arab populations, where endogamy could play a role, the high concordance rate in monozygotic twins, and the presence of family history of the condition between 5 and 23% of cases, support a genetic influence. Segregation analysis studies suggest that keratoconus is a complex non-Mendelian disease. Results from linkage analysis, next generation sequencing studies and genome-wide association studies also have suggested that genetic factors are involved in the condition. Recently, it has been proposed that mechanical trauma (i.e. eye rubbing or eye compression at night), is a sine quanon condition for the onset of keratoconus, and quite possibly its only cause. There are various arguments for and against this hypothesis. Indeed, it is possible, as initially suggested around 55 years ago, that the term "keratoconus" include diverse phenotypically similar conditions, which are actually of different etiology.

Artificial Intelligence-Enabled ECG Algorithm Based on Improved Residual Network for Wearable ECG.

Heart disease is the leading cause of death for men and women globally. The residual network (ResNet) evolution of electrocardiogram (ECG) technology has contributed to our understanding of cardiac physiology. We propose an artificial intelligence-enabled ECG algorithm based on an improved ResNet for a wearable ECG. The system hardware consists of a wearable ECG with conductive fabric electrodes, a wireless ECG acquisition module, a mobile terminal App, and a cloud diagnostic platform. The algorithm adopted in this study is based on an improved ResNet for the rapid classification of different types of arrhythmia. First, we visualize ECG data and convert one-dimensional ECG signals into two-dimensional images using Gramian angular fields. Then, we improve the ResNet-50 network model, add multistage shortcut branches to the network, and optimize the residual block. The ReLu activation function is replaced by a scaled exponential linear units (SELUs) activation function to improve the expression ability of the model. Finally, the images are input into the improved ResNet network for classification. The average recognition rate of this classification algorithm against seven types of arrhythmia signals (atrial fibrillation, atrial premature beat, ventricular premature beat, normal beat, ventricular tachycardia, atrial tachycardia, and sinus bradycardia) is 98.3%.

Chemotherapy-induced tubulopathy: a case report series.

Acquired tubulopathies are frequently underdiagnosed. They can be characterized by the renal loss of specific electrolytes or organic solutes, suggesting the location of dysfunction. These tubulopathies phenotypically can resemble Bartter or Gitelman syndrome). These syndromes are infrequent, they may present salt loss resembling the effect of thiazides (Gitelman) or loop diuretics (Bartter). They are characterized by potentially severe hypokalemia, associated with metabolic alkalosis, secondary hyperaldosteronism, and often hypomagnesemia. Tubular dysfunction has been described as nephrotoxic effects of platinum-based chemotherapy. We present 4 cases with biochemical signs of tubular dysfunction (Bartter-like/Gitelman-like phenotype) related to chemotherapy.

Ewing sarcoma of the cervix: an unusual site of presentation.

Ewing sarcoma is an exceedingly rare form of cancer that affects the cervix. It falls within the spectrum of neoplastic diseases known as Ewing's family of tumours, typically observed in osseous tissues. A woman in her 40s, experiencing symptoms of leucorrhoea and transvaginal bleeding that commenced 3 months before her consultation, was referred to our gynaecological oncology clinic with a preliminary diagnosis of ovarian teratoma. A colposcopy procedure was conducted unveiling a complete loss of cervical anatomy with friable and malodorous tissue. Pelvic ultrasound identified a lesion of uncertain origin in the cervix, suggestive of malignancy. Histopathological assessment of cervical biopsy specimens confirmed the presence of a small, round, blue cell neoplasm consistent with Ewing sarcoma. She underwent chemotherapy and pelvic radiotherapy, achieving complete remission 9 months after diagnosis, without experiencing any systemic adverse effects or sequelae.

Diagnostic Usefulness of Antibodies Against M-type Phospholipase A2 Receptor (aPLA2R) in Primary Membranous Nephropathy in the Mexican Population.

OBJECTIVE: This study aimed to determine the frequency and diagnostic performance of antibodies against M-type phospholipase A2 receptors (aPLA2R) in subjects with idiopathic membranous nephropathy (IMN). MATERIALS AND METHODS: A diagnostic test study was conducted in a cohort of 160 patients from the nephrology outpatient clinic over a period of eight years. Serum samples were taken and analyzed from patients with a histological diagnosis of IMN with proteinuria greater than and less than 1 g in 24 hours and other glomerular diseases other than IMN with aPLA2R measurement by enzyme-linked immunosorbent assay (ELISA) (Euroimmun, Luebeck, Germany). RESULTS: In 22 of 160 patients, an aPLA2R concentration >9 RU/mL was found, and all these cases had IMN. The prevalence of seropositivity in cases with active IMN was 78% (21/27). All these correlations were statistically significant with a p<0.001. The area under the receiver operating characteristic (ROC) curve (AB-ROC) of aPLA2R was 0.87 (95%, CI: 78-0.96). CONCLUSIONS: The aPLA2R has adequate diagnostic usefulness to diagnose IMN in the selected population, especially in subjects with proteinuria greater than 1 gr/day, with a sensitivity of 78% and a specificity of 99%.

Scleromyositis: A Novel Entity Beyond Systemic Sclerosis and Autoimmune Myositis.

Scleromyositis is a new clinical entity, which not only has clinical and histopathological components of systemic sclerosis and inflammatory myopathy but is also characterized by presenting unique characteristics, which may not be in the previously mentioned diseases. Up until now, there are no specific classification criteria proposed by the American College of Rheumatology or the European League Against Rheumatism (ACR/EULAR). This paper presents a case report of a female patient in her 60s who was admitted to our institution due to muscle weakness in her legs and dysphagia. Within her diagnosis approach, clinical characteristics compatible with autoimmune myopathy were found; however, she presented with anti-PM/Scl75 antibody-positive results. In this paper, we emphasized the clinical characteristics and forms of presentation of scleromyositis, additionally discussing the available treatment for this entity.

Advances in the Physiology of Transvascular Exchange and A New Look At Rational Fluid Prescription.

The Starling principle is a model that explains the transvascular distribution of fluids essentially governed by hydrostatic and oncotic forces, which dynamically allow vascular refilling according to the characteristics of the blood vessel. However, careful analysis of fluid physiology has shown that the principle, while correct, is not complete. The revised Starling principle (Michel-Weinbaum model) provides relevant information on fluid kinetics. Special emphasis has been placed on the endothelial glycocalyx, whose subendothelial area allows a restricted oncotic pressure that limits the reabsorption of fluid from the interstitial space, so that transvascular refilling occurs mainly from the lymphatic vessels. The close correlation between pathological states of the endothelium (eg: sepsis, acute inflammation, or chronic kidney disease) and the prescription of fluids forces the physician to understand the dynamics of fluids in the organism; this will allow rational fluid prescriptions. A theory that integrates the physiology of exchange and transvascular refilling is the "microconstant model", whose variables include dynamic mechanisms that can explain edematous states, management of acute resuscitation, and type of fluids for common clinical conditions. The clinical-physiological integration of the concepts will be the hinges that allow a rational and dynamic prescription of fluids.

Classification of electrocardiogram signals with waveform morphological analysis and support vector machines.

Electrocardiogram (ECG) indicates the occurrence of various cardiac diseases, and the accurate classification of ECG signals is important for the automatic diagnosis of arrhythmia. This paper presents a novel classification method based on multiple features by combining waveform morphology and frequency domain statistical analysis, which offer improved classification accuracy and minimise the time spent for classifying signals. A wavelet packet is used to decompose a denoised ECG signal, and the singular value, maximum value, and standard deviation of the decomposed wavelet packet coefficients are calculated to obtain the frequency domain feature space. The slope threshold method is applied to detect R peak and calculate RR intervals, and the first two RR intervals are extracted as time-domain features. The fusion feature space is composed of time and frequency domain features. A combination of support vector machine (SVM) with the help of grid search and waveform morphological analysis is applied to complete nine types of ECG signal classification. Computer simulations show that the accuracy of the proposed algorithm on multiple types of arrhythmia databases can reach 96.67%.

Cirrhosis etiology trends in developing countries: Transition from infectious to metabolic conditions. Report from a multicentric cohort in central Mexico.

Background: Cirrhosis is a public health threat associated with high mortality. Alcoholic Liver Disease (ALD) is the leading cause in Latin America and Metabolic Associated Fatty Liver Disease (MAFLD) in western countries. In Mexico, ALD and chronic Hepatitis C Virus infection (HCV) were the most frequent aetiologies during the past decades. We aimed to describe the trends in the aetiologies of cirrhosis in a middle-income country. Methods: We performed a retrospective cohort study including patients diagnosed with cirrhosis between 2000 and 2019 from six different tertiary care hospitals in central Mexico. We collected information regarding cirrhosis etiology, year of diagnosis, hepatocellular carcinoma development, liver transplantation, and death. We illustrated the change in the tendencies of cirrhosis aetiologies by displaying the proportional incidence of each etiology over time stratified by age and gender, and we compared these proportions over time using chi square tests. Findings: Overall, 4,584 patients were included. In 2019, MAFLD was the most frequent cirrhosis etiology (30%), followed by ALD (24%) and HCV (23%). During the study period, MAFLD became the leading etiology, ALD remained second, and HCV passed from first to fourth. When analysed by gender, ALD was the leading etiology for men and MAFLD for women. The annual incidence of HCC was 3·84 cases/100 persons-year, the median survival after diagnosis was 12·1 years, and seven percent underwent LT. Interpretation: Increased alcohol consumption and the obesity epidemic have caused a transition in the aetiologies of cirrhosis in Mexico. Public health policies must be tailored accordingly to mitigate the burden of alcohol and metabolic conditions in developing countries. Funding: None.

SOI Waveguide Bragg Grating Photonic Sensor for Human Body Temperature Measurement Based on Photonic Integrated Interrogator.

A waveguide Bragg grating (WBG) provides a flexible way for measurement, and it could even be used to measure body temperature like e-skin. We designed and compared three structures of WBG with the grating period, etching depth, and duty cycle. The two-sided WBG was fabricated. An experimental platform based on photonic integrated interrogator was set up and the experiment on the two-sided WBG was performed. Results show that the two-sided WBG can be used to measure temperature changes over the range of 35-42 °C, with a temperature measurement error of 0.1 °C. This approach has the potential to facilitate application of such a silicon-on-insulator (SOI) WBG photonic sensor to wearable technology and realize the measurement of human temperature.

Deferasirox nephrotoxicity-the knowns and unknowns.

In 2005, the oral iron chelator deferasirox was approved by the FDA for clinical use as a first-line therapy for blood-transfusion-related iron overload. Nephrotoxicity is the most serious and frequent adverse effect of deferasirox treatment. This nephrotoxicity can present as an acute or chronic decrease in glomerular filtration rate (GFR). Features of proximal tubular dysfunction might also be present. In clinical trials and observational studies, GFR is decreased in 30-100% of patients treated with deferasirox, depending on dose, method of assessment and population studied. Nephrotoxicity is usually nonprogressive and/or reversible and rapid iron depletion is one of several risk factors. Scarce data are available on the molecular mechanisms of nephrotoxicity and the reasons for the specific proximal tubular sensitivity to the drug. Although deferasirox promotes apoptosis of cultured proximal tubular cells, the trigger has not been well characterized. Observational studies are required to track current trends in deferasirox prescription, assess the epidemiology of deferasirox nephrotoxicity in routine clinical practice, explore the effect on outcomes of various monitoring and dose-adjustment protocols and elucidate the long-term consequences of the different features of nephrotoxicity. Deferasirox nephrotoxicity can be more common in the elderly; thus, specific efforts should be dedicated to investigate the effect of deferasirox use in this group of patients.

Renal damage associated with heavy metals: review work / Daño renal asociado a metales pesados: trabajo de revisión

Abstract Catheter-associated infection is an entity with multiple complications, a condition that alters the quality of life of all patients Chronic kidney disease (CKD) represents an important health problem in the entire global population, where knowledge of the environmental factors associated with this disease is currently essential for its prevention. Several heavy metals are recognized, including Cadmium (Cd), Lead (Pb), Arsenic (As) and Mercury (Hg), which are clearly associated with renal damage and progression of CKD. Studies in animals and humans primarily demonstrate a clear association between exposure to these metals and the presence of chronic renal damage, where the pathophysiology of each of these metals is important in understanding the mechanism of renal damage. The present review aims to analyze the pathophysiology and clinical manifestations of the nephrotoxicity associated with these metals, as well as the different studies in both humans and animals that have been performed.

Resumen La enfermedad renal crónica (ERC) representa un importante problema de salud en todo el globo. Actualmente, es esencial para su prevención el conocimiento de los factores ambientales asociados con la enfermedad. Se reconocen diversos metales pesados, entre los que destacan el cadmio (Cd), plomo (Pb), arsénico (As) y mercurio (Hg), que están claramente asociados con la lesión renal y la progresión de la ERC. Estudios en animales y humanos demuestran, principalmente, una clara asociación entre la exposición a estos metales y la presencia de daño renal crónico, donde la fisiopatologia de cada uno de ellos es importante para entender el mecanismo de daño renal. La presente revisión tiene como objetivo analizar, tanto la fisiopatología y manifestaciones clínicas de la nefrotoxicidad asociada a dichos metales, como los diferentes estudios que se han realizado en humanos y animales.