DYF-5/MAK-dependent phosphorylation promotes ciliary tubulin unloading.

Cilia are microtubule-based organelles that power cell motility and regulate sensation and signaling, and abnormal ciliary structure and function cause various ciliopathies. Cilium formation and maintenance requires intraflagellar transport (IFT), during which the kinesin-2 family motor proteins ferry IFT particles carrying axonemal precursors such as tubulins into cilia. Tubulin dimers are loaded to IFT machinery through an interaction between tubulin and the IFT-74/81 module; however, little is known of how tubulins are unloaded when arriving at the ciliary tip. Here, we show that the ciliary kinase DYF-5/MAK phosphorylates multiple sites within the tubulin-binding module of IFT-74, reducing the tubulin-binding affinity of IFT-74/81 approximately sixfold. Ablation or constitutive activation of IFT-74 phosphorylation abnormally elongates or shortens sensory cilia in Caenorhabditis elegans neurons. We propose that DYF-5/MAK-dependent phosphorylation plays a fundamental role in ciliogenesis by regulating tubulin unloading.

Acute kidney injury in infants with hypoxic-ischemic encephalopathy.

BACKGROUND: This study aimed to investigate the prevalence of acute kidney injury (AKI) in infants with varying degrees of hypoxic-ischemic encephalopathy (HIE) and its associated outcomes, including mortality and length of stay (LOS). METHODS: The study used the National Inpatient Sample (NIS) dataset from 2010 to 2018. Regression analysis was used to control confounding variables. RESULTS: Of 31,220,784 infants included in the study, 30,130 (0.1%) had HIE. The prevalence of AKI was significantly higher in infants with HIE (9.0%) compared to those without (0.04%), with an adjusted odds ratio (aOR) of 77.6 (CI:70.1-85.7, p < 0.001), with the highest prevalence of AKI in infants with severe HIE (19.7%), aOR:130 (CI: 107-159), p < 0.001). Infants with AKI had a higher mortality rate compared to those without AKI in those diagnosed with any degree of HIE (28.9% vs. 8.8%), aOR 3.5 (CI: 3.2-3.9, p < 0.001), particularly among those with severe HIE, aOR:1.4 (1.2-1.6, p < 0.001). CONCLUSIONS: HIE is associated with an increased prevalence of AKI. Infants with severe HIE had the highest prevalence of AKI and associated mortality. The study highlights the need for close monitoring and early detection of AKI in infants with HIE, particularly those with severe HIE, to ameliorate the associated adverse outcomes.

Reconstitution reveals motor activation for intraflagellar transport.

The human body represents a notable example of ciliary diversification. Extending from the surface of most cells, cilia accomplish a diverse set of tasks. Predictably, mutations in ciliary genes cause a wide range of human diseases such as male infertility and blindness. In Caenorhabditis elegans sensory cilia, this functional diversity appears to be traceable to the differential regulation of the kinesin-2-powered intraflagellar-transport (IFT) machinery. Here we reconstituted the first, to our knowledge, functional multi-component IFT complex that is deployed in the sensory cilia of C. elegans. Our bottom-up approach revealed the molecular basis of specific motor recruitment to the IFT trains. We identified the key component that incorporates homodimeric kinesin-2 into its physiologically relevant context, which in turn allosterically activates the motor for efficient transport. These results will enable the molecular delineation of IFT regulation, which has eluded understanding since its discovery more than two decades ago.

Prevalence and Outcomes of Gastrointestinal Anomalies in Down Syndrome.

OBJECTIVES: Our objective was to investigate the prevalence of small intestinal atresia and Hirschsprung's disease (HD) in infants with Down syndrome (DS) and its impact on outcomes. STUDY DESIGN: We analyzed the National Inpatient Sample dataset. We included infants with DS, small intestinal atresia, HD, and the concomitant occurrence of both conditions. Regression analysis was used to control clinical and demographic variables. RESULTS: A total of 66,213,034 infants were included, of whom, 99,861 (0.15%) had DS. The concomitant occurrence of small intestinal atresia and HD was more frequent in infants with DS compared with the general population, adjusted odds ratio (aOR): 122, 95% confidence interval (CI): 96-154, (p < 0.001). Infants with DS and concomitant small intestinal atresia and HD had higher mortality compared with those without these conditions, aOR: 8.59, 95% CI: 1.95-37.8. CONCLUSION: Infants with DS are at increased risk of concomitant small intestinal atresia and HD, and this condition is associated with increased mortality. KEY POINTS: · Infants with Down syndrome are at increased risk of congenital GI anomalies.. · Infants with Down syndrome are at increased risk of necrotizing enterocolitis.. · Increased mortality in Down syndrome infants with concomitant small intestinal atresia and Hirschsprung's disease..

Umbilical cord milking in nonvigorous infants: a cluster-randomized crossover trial.

BACKGROUND: Delayed cord clamping and umbilical cord milking provide placental transfusion to vigorous newborns. Delayed cord clamping in nonvigorous newborns may not be provided owing to a perceived need for immediate resuscitation. Umbilical cord milking is an alternative, as it can be performed more quickly than delayed cord clamping and may confer similar benefits. OBJECTIVE: We hypothesized that umbilical cord milking would reduce admission to the neonatal intensive care unit compared with early cord clamping in nonvigorous newborns born between 35 and 42 weeks' gestation. STUDY DESIGN: This was a pragmatic cluster-randomized crossover trial of infants born at 35 to 42 weeks' gestation in 10 medical centers in 3 countries between January 2019 and May 2021. The centers were randomized to umbilical cord milking or early cord clamping for approximately 1 year and then crossed over for an additional year or until the required number of consented subjects was reached. Waiver of consent as obtained in all centers to implement the intervention. Infants were eligible if nonvigorous at birth (poor tone, pale color, or lack of breathing in the first 15 seconds after birth) and were assigned to umbilical cord milking or early cord clamping according to their birth hospital randomization assignment. The baseline characteristics and outcomes were collected following deferred informed consent. The primary outcome was admission to the neonatal intensive care unit for predefined criteria. The main safety outcome was hypoxic-ischemic encephalopathy. Data were analyzed by the intention-to-treat concept. RESULTS: Among 16,234 screened newborns, 1780 were eligible (905 umbilical cord milking, 875 early cord clamping), and 1730 had primary outcome data for analysis (97% of eligible; 872 umbilical cord milking, 858 early cord clamping) either via informed consent (606 umbilical cord milking, 601 early cord clamping) or waiver of informed consent (266 umbilical cord milking, 257 early cord clamping). The difference in the frequency of neonatal intensive care unit admission using predefined criteria between the umbilical cord milking (23%) and early cord clamping (28%) groups did not reach statistical significance (modeled odds ratio, 0.69; 95% confidence interval, 0.41-1.14). Umbilical cord milking was associated with predefined secondary outcomes, including higher hemoglobin (modeled mean difference between umbilical cord milking and early cord clamping groups 0.68 g/dL, 95% confidence interval, 0.31-1.05), lower odds of abnormal 1-minute Apgar scores (Apgar ≤3, 30% vs 34%, crude odds ratio, 0.72; 95% confidence interval, 0.56-0.92); cardiorespiratory support at delivery (61% vs 71%, modeled odds ratio, 0.57; 95% confidence interval, 0.33-0.99), and therapeutic hypothermia (3% vs 4%, crude odds ratio, 0.57; 95% confidence interval, 0.33-0.99). Moderate-to-severe hypoxic-ischemic encephalopathy was significantly less common with umbilical cord milking (1% vs 3%, crude odds ratio, 0.48; 95% confidence interval, 0.24-0.96). No significant differences were observed for normal saline bolus, phototherapy, abnormal 5-minute Apgar scores (Apgar ≤6, 15.7% vs 18.8%, crude odds ratio, 0.81; 95% confidence interval, 0.62-1.06), or a serious adverse event composite of death before discharge. CONCLUSION: Among nonvigorous infants born at 35 to 42 weeks' gestation, umbilical cord milking did not reduce neonatal intensive care unit admission for predefined criteria. However, infants in the umbilical cord milking arm had higher hemoglobin, received less delivery room cardiorespiratory support, had a lower incidence of moderate-to-severe hypoxic-ischemic encephalopathy, and received less therapeutic hypothermia. These data may provide the first randomized controlled trial evidence that umbilical cord milking in nonvigorous infants is feasible, safe and, superior to early cord clamping.

Acute kidney injury in infants diagnosed with congenital diaphragmatic hernia.

BACKGROUND: To assess the association and outcomes of acute kidney injury (AKI) in infants diagnosed with congenital diaphragmatic hernia (CDH). METHODS: We analyzed the National Inpatient Sample dataset for the years 2010 through 2018. We evaluated the prevalence and outcomes associated with AKI in infants diagnosed with CDH. Outcomes were assessed using regression analysis while controlling for variables. RESULTS: A total of 32,042,481 term infants were identified, of them 10,804 had CDH. Prevalence of AKI in infants with CDH was 6.5% compared to 0.05% in those without CDH (aOR = 14.7, CI: 13.0-16.6). ECMO was utilized at 62% of CDH infants that had AKI compared to 17% in infants without AKI (aOR = 4.22, CI: 3.38-5.27). Mortality was greater in CDH infants who developed AKI when compared to those without AKI (57.3 vs. 16.7%, aOR = 3.65, CI: 2.99-4.46). The trend of mortality in CDH infants who developed AKI decreased overtime, p < 0.001, while the trends for mortality in the overall CDH infants and in CDH infants without AKI did not change during the study period, p = 0.12. CONCLUSION: AKI is not uncommon in infants diagnosed with CDH. ECMO utilization and mortality are substantially increased in CDH infants when they develop AKI. IMPACT: Mortality in infants diagnosed with congenital diaphragmatic hernia (CDH) is relatively high despite advances in neonatal care. Infants with CDH are potentially at increased risk of acute kidney injury (AKI). Within CDH population, infants diagnosed with AKI are at increased risk for ECMO use and mortality. This is the largest study to address the association and outcomes of AKI in term infants diagnosed with CDH.

Kidney replacement therapy in neonates: utilization trends and outcomes.

BACKGROUND: We aimed to assess prevalence and clinical characteristics of newborns receiving kidney replacement therapy (KRT). METHODS: We used the National Inpatient Sample (NIS) dataset for the years 2000-2017. Newborns treated with peritoneal dialysis (PD), hemodialysis (HD), and continuous KRT (CKRT) were included. Trend analysis using the Cochran-Armitage test was used to assess prevalence over the years. RESULTS: A total of 64,532,552 hospitalized newborns were included. Among the 4281 infants treated with KRT, 2501 (58.4%) were treated with PD, 997 (23.3%) had HD, and 783 (18.3%) used CKRT. Associated diagnoses included congenital kidney anomalies (37.4% vs. 15% vs. 9.5%), urinary tract anomalies (35% vs. 12.5% vs. 6.3%), and congenital heart disease (68% vs. 25.7% vs. 72.3%). Median length of stay was longest in PD patients (39 days vs. 18 days vs. 26 days), respectively. However, cost of hospitalization was greatest in CKRT patients (US $490,916 vs. US $218,514 vs. US $621,554), respectively. In the entire cohort, 54,424 newborns had acute kidney injury (AKI); of them 16,999 (31%) died. KRT was used in 2,688 (4.9%) of infants with AKI. Over the study period, trends for utilization of PD (from 0.042 to 0.06%) and CKRT (from 0.03 to 0.21%) increased whereas the hemodialysis trend decreased (from 0.021 to 0.013%). CONCLUSIONS: Congenital heart disease (CHD) and congenital anomalies of the kidneys and urinary tract (CAKUT) are the major diagnoses in newborns receiving KRT. Utilization of PD was greater than HD and CKRT. Trends of PD and CKRT utilization increased over time. Less than 5% of infants diagnosed with AKI received KRT.

Randomised feasibility trial of a virtual intervention to address infant car seat misuse.

BACKGROUND: Serious car seat installation errors occur at high rates in infants and children. These errors significantly increase the risk of child injury in a motor vehicle crash, and few interventions have addressed the challenge longitudinally. METHODS: This was a pilot randomised controlled feasibility trial of virtual car seat safety checks for caregivers of newborns recruited from an urban newborn nursery. The control (enhanced usual care (EUC)) group received an in-person car seat check as a newborn and virtual check at 9 months. The intervention group received two additional virtual checks at 3 and 6 months. Installation and infant positioning errors were documented and corrected by a child passenger safety technician (CPST). We measured feasibility and acceptability by tracking caregiver and CPST challenges, and caregiver retention. Group differences were tested for statistical significance using χ2 or Fisher's exact test for categorical variables, and two sample t-tests for continuous variables. RESULTS: 33 caregivers were randomised to the EUC and 28 to the intervention group. Virtual checks were feasible, with variable participation levels at each quarter. Wi-Fi and app challenges noted in 30%. There was satisfaction with the virtual car seat checks. At baseline, car seat installation and infant positioning errors occurred at equal frequency, and at 9 months the intervention group had a significantly lower mean proportion than the EUC group in all categories of errors. In summary, virtual seat checks are feasible and the optimal timing of repeat checks requires additional study. A larger study is needed to further evaluate the effect of longitudinal virtual checks on errors.

Cue-Based Feeding as Intervention to Achieve Full Oral Feeding in Preterm Infants Primarily Managed with Bubble CPAP.

OBJECTIVE: Cue-based feeding aims at matching introduction of per oral (PO) feeding with physiological readiness of preterm infants to facilitate PO intake and avoid oral aversion. It was claimed that cue-based feeding may lead to delay in the initiation or achieving full PO feeding in clinical setting primarily using bubble nasal continuous positive airway pressure (CPAP). The study aimed to examine the association of cue-based feeding with time of introduction and completing oral feeding in infants primarily managed with bubble CPAP. STUDY DESIGN: A retrospective analysis where outcomes of preterm infants ≤32 weeks' gestational age (GA) and ≤2,000 g birth weight (BW) were compared after a practice change from volume-based feeding advancement to cue-based feeding. Continuous variables were compared by using t-test and multilinear regression analysis to control for confounding variables. RESULTS: Of the 311 preterm infants who met inclusion and exclusion criteria, 194 were in the cue-based feeding group and 117 were in the volume-based advancement historical comparison group. There were no differences between groups regarding demographic or clinical variables. Postmenstrual age (PMA) of initial feeding assessment was less in the cue-based feeding group. Age of first PO feeding and when some PO was achieved every feed was mildly delayed in the cue-based feeding compared with comparison group, 34 (±1.3) versus 33.7 (±1.2) weeks, and 36.2 (±2.3) versus 36.0 (±2.4) weeks, (p < 0.01) respectively. However, the age of achieving full PO did not differ between groups, 36.8 (±2.2) versus 36.4 (±2.4) weeks (p = 0.13). There was no difference between groups regarding growth parameters at 36 weeks' PMA or at discharge. Similar results were obtained when examining subcategories of infants ≤1,000 g and 1,001 to 2,000 g. CONCLUSION: Cue-based feeding may not be associated with a delay in achieving full oral feeding or prolongation of the length of stay in preterm infants managed with CPAP. KEY POINTS: · Cue-based feeding matches introduction of PO feeding with physiological readiness.. · Cue-based feeding may not be associated with a delay in achieving full oral feeding in preterm infants.. · Cue-based feeding is not associated with prolongation of the length of stay in preterm infants.. · Cue based feeding in preterm infants managed with noninvasive bubble CPAP is examined..

An Innovative Cloud-Fog-Based Smart Grid Scheme for Efficient Resource Utilization.

Smart grids (SGs) enhance the effectiveness, reliability, resilience, and energy-efficient operation of electrical networks. Nonetheless, SGs suffer from big data transactions which limit their capabilities and can cause delays in the optimal operation and management tasks. Therefore, it is clear that a fast and reliable architecture is needed to make big data management in SGs more efficient. This paper assesses the optimal operation of the SGs using cloud computing (CC), fog computing, and resource allocation to enhance the management problem. Technically, big data management makes SG more efficient if cloud and fog computing (CFC) are integrated. The integration of fog computing (FC) with CC minimizes cloud burden and maximizes resource allocation. There are three key features for the proposed fog layer: awareness of position, short latency, and mobility. Moreover, a CFC-driven framework is proposed to manage data among different agents. In order to make the system more efficient, FC allocates virtual machines (VMs) according to load-balancing techniques. In addition, the present study proposes a hybrid gray wolf differential evolution optimization algorithm (HGWDE) that brings gray wolf optimization (GWO) and improved differential evolution (IDE) together. Simulation results conducted in MATLAB verify the efficiency of the suggested algorithm according to the high data transaction and computational time. According to the results, the response time of HGWDE is 54 ms, 82.1 ms, and 81.6 ms faster than particle swarm optimization (PSO), differential evolution (DE), and GWO. HGWDE's processing time is 53 ms, 81.2 ms, and 80.6 ms faster than PSO, DE, and GWO. Although GWO is a bit more efficient than HGWDE, the difference is not very significant.

Physical-Layer Security in Power-Domain NOMA Based on Different Chaotic Maps.

Nonorthogonal multiple access (NOMA) is a relevant technology for realizing the primary goals of next-generation wireless networks, such as high connectivity and stability. Because a rising number of users are becoming connected, user data security has become a critical issue. Many chaotic communication systems have been established to address this important issue via exhibition of affordable physical-layer-security solutions. In this study, we propose a chaotic downlink NOMA (C-DL-NOMA) system over the additive white Gaussian noise and Rayleigh-fading channels to enhance the security of the DL-NOMA system. The proposed algorithm is based on a coherent analog modulation technique that combines various chaotic maps for chaotic masking of encrypted data. On the transmitter, chaotic encryption was used for transmitted data with fixed power-allocation-level control, whereas on the receiver, successive interference-cancellation demodulation was utilized to detect multiple users, after which chaotic decryption was performed. Simulation results were evaluated based on security analyses, such as statistical analysis (histogram and correlation analyses and information entropy), bit-error-rate performance, and achievable-data-rate performance. According to these security analyses and numerical results, the proposed C-DL-NOMA system outperformed traditional unencrypted NOMA systems.

Neonatal hyperbilirubinemia and bilirubin neurotoxicity in hospitalized neonates: analysis of the US Database.

OBJECTIVE: The objective of this study was to assess the prevalence and trends for neonatal hyperbilirubinemia, and the development of bilirubin neurotoxicity in the USA. STUDY DESIGN: We used a de-identified national dataset for the years 2002-2017. The study included all newborn inpatients with postnatal age ≤28 days. Cochran-Armitage trend test was used for trend analyses. Regression analyses were performed and adjusted odds ratios (aOR) were reported. RESULTS: The study included 57,989,476 infants; of them 53,259,758 (91.8%) were term infants and 4,725,178 (8.2%) were preterm infants. Bilirubin neurotoxicity decreased over the years in term infants (Z = 0.36, p = 0.03) without change in preterm infants (Z = 42.5, p = 0.12). Black neonates were less likely to be diagnosed with hyperbilirubinemia than White neonates (aOR = 0.77, 95% confidence interval (CI): 0.77-0.78, p < 0.001) and more likely to develop bilirubin neurotoxicity than White neonates (aOR = 3.0.5, 95% CI: 2.13-4.36, p < 0.001). Bilirubin neurotoxicity rate in the overall population was 2.4 per 100,000 live births. CONCLUSIONS: Bilirubin neurotoxicity has significantly decreased in term infants and did not change in preterm infants. Despite the less diagnosis of hyperbilirubinemia in Black newborns, they are disproportionately at increased risk of developing bilirubin neurotoxicity when compared to White newborns. IMPACT: In this article, we analyzed the National Inpatient Database. This is the largest study of its kind using data on 57,989,476 neonates. The article has multiple novel findings: (1) it demonstrated that utilization of phototherapy has increased significantly over the years, (2) the rate of kernicterus for neonates decreased in term infants and did not change in preterm babies, (3) kernicterus was mostly encountered in infants without isoimmunization jaundice, and (4) there is a clear racial disparity in neonatal jaundice; although Black newborns have less neonatal jaundice, they are at increased risk of developing kernicterus.

Use of Rapid Molecular Polymerase Chain Reaction in Early Detection of Bacteremia in Neonates Prior to Blood Culture Positivity: A Pilot Study.

OBJECTIVE: There has been national strive to decrease the time needed to identify microorganisms in blood culture samples to reduce antibiotic use. This study evaluated rapid molecular polymerase chain reaction (PCR) use in identifying microorganisms in negative culture bottles from neonates with suspected bacterial blood stream infection at 20 to 24 hours of incubation. STUDY DESIGN: All blood specimens from neonates with suspected blood stream infection were included. Specimens were incubated using a standard blood culturing instrument that would flag positive if bacterial growth was detected. If the specimen was flagged positive at <20 hours, it was tested by PCR and plated for identification as per standard protocol. In our design, if specimen was not flagged at 20 hours of incubation, the bottle was sterilely accessed and a sample was obtained for PCR testing. The bottle would be returned for incubation for 120 hours or until flagged positive. RESULTS: A total of 192 blood specimens were included. Four specimens flagged positive at <20 hours and were all found to be positive by PCR. All other samples did not flag positive by 20 hours of incubation and were tested by PCR between 20 and 24 hours. One sample tested positive via PCR at 21.6 hours then flagged positive on the culturing instrument at 23.5 hours. All other specimens were negative by PCR and remained culture negative at 120 hours. The positive and negative predictive value of PCR verified by blood culture were both equal to 1.0. CONCLUSION: Using rapid molecular PCR on blood culture specimens at 20 to 24 hours of incubation provides 100% true negative results possibly allowing providers to discontinue antibiotics at 24 hours. KEY POINTS: · Antibiotic overuse leads to adverse neonatal outcomes.. · Molecular PCR may have true negative results.. · Larger study is needed to discontinue antibiotics earlier..

Length of Neuromuscular Re-education Therapy and Growth Parameters in Premature Infants.

OBJECTIVE: Neuromuscular re-education (NMRE) therapy including bracing, containment, facilitation techniques, joint compression, weight (WT) bearing, and myofascial release has been shown to improve neurodevelopmental maturation in premature infants. This study aimed to examine the association of NMRE with growth parameters including WT and length (L) at 36 weeks postmenstrual age (PMA) and at discharge. STUDY DESIGN: We analyzed data of infants <34 weeks gestational age (GA) or <1,800 g birth weight (BW) to examine the association of NMRE with growth parameters using correlation coefficient analysis. The effect of potential confounders was examined using multilinear regression models. RESULTS: Study includes 253 premature infants. Average GA was 300/7 weeks (±23/7) and BW was 1,315 g (±416), 49.8% were females and 65% were African Americans. NMRE has inverse correlation with WT at birth and at 36 weeks PMA, -0.66 (<0.001) and -0.21 (<0.001), respectively, but not at the time of discharge. NMRE has direct correlation with change in WT from birth to 36 weeks PMA and time of discharge, 0.50 (<0.001) and 0.62 (<0.001), respectively, and from the time of starting therapy to 36 weeks PMA or discharge, 0.25 (<0.001) and 0.51 (<0.001), respectively. There was no negative correlation between NMRE with daily WT gain from birth to 36 weeks PMA or to discharge, -0.05 (0.43) and -0.07 (0.23), respectively, or from the time of starting therapy to 36 weeks PMA, -0.09 (0.14). There was an inverse correlation between NMRE with average WT gain per day from the time of starting therapy to discharge, -0.26 (<0.001), Similar findings were found examining the correlation between NMRE and changes in L. Multilinear regression analysis examining the relationship while controlling for GA, BW, sex, and race; socioeconomic variables; and concurrent massage therapy and sensory integration revealed similar results. CONCLUSION: NMRE, aimed to enhance neurodevelopmental outcomes of premature infants, may not have a negative impact on their physical growth. KEY POINTS: · NMRE has been introduced in the care of premature infants to improve neurodevelopmental outcomes.. · It was hypothesized that NMRE may cause stress and lead to failure to thrive or suboptimal growth.. · The association of the duration of NMRE with length and weight gain in very low birth weight infants was examined, and there was no negative correlation..

A Dose-Limited Dexamethasone and Bubble Continuous Positive Airway Pressure in Ventilation-Dependent Extremely Premature Infants.

OBJECTIVE: Dexamethasone has been associated with early extubation and shorter duration of mechanical ventilation in preterm infants. High doses or prolonged courses of dexamethasone may be associated with poor neurodevelopmental outcomes. STUDY DESIGN: This is an observational cohort study assessing the efficacy of a low-dose short dexamethasone course combined with postextubation bubble continuous positive airway pressure (bCPAP) strategy on rates of successful extubation and reduction of the duration of invasive mechanical ventilation in extremely preterm infants. We compared the short-term outcomes of implementing such strategy on a group of infants with birth weight <750 g to a historical cohort. RESULTS: Among infants intubated for at least 10 days, median time to extubation from starting the dexamethasone course was 2 days (interquartile range: 1-3). Total duration of intubation was significantly shorter in infants who received dexamethasone compared with the control groups (21 ± 6 vs. 30 ± 10 days, p = 0.03), and although statistically nonsignificant, duration to wean to 21% bCPAP was shorter compared with the control group (48 ± 13 vs. 74 ± 29 days, p = 0.06). CONCLUSION: A low-dose short dexamethasone course combined with postextubation bCPAP intervention may be associated with successful early extubation and shorter duration of mechanical ventilation. KEY POINTS: · Noninvasive strategies may not succeed in infants < 750 g birth weight.. · Bubble CPAP has been shown to be associated with reduced complications including chronic lung disease.. · Postnatal dexamethasone therapy may succeed in conjunction with bubble CPAP to reduce reintubation..

An Automated CAD System for Accurate Grading of Uveitis Using Optical Coherence Tomography Images.

Uveitis is one of the leading causes of severe vision loss that can lead to blindness worldwide. Clinical records show that early and accurate detection of vitreous inflammation can potentially reduce the blindness rate. In this paper, a novel framework is proposed for automatic quantification of the vitreous on optical coherence tomography (OCT) with particular application for use in the grading of vitreous inflammation. The proposed pipeline consists of two stages, vitreous region segmentation followed by a neural network classifier. In the first stage, the vitreous region is automatically segmented using a U-net convolutional neural network (U-CNN). For the input of U-CNN, we utilized three novel image descriptors to account for the visual appearance similarity of the vitreous region and other tissues. Namely, we developed an adaptive appearance-based approach that utilizes a prior shape information, which consisted of a labeled dataset of the manually segmented images. This image descriptor is adaptively updated during segmentation and is integrated with the original greyscale image and a distance map image descriptor to construct an input fused image for the U-net segmentation stage. In the second stage, a fully connected neural network (FCNN) is proposed as a classifier to assess the vitreous inflammation severity. To achieve this task, a novel discriminatory feature of the segmented vitreous region is extracted. Namely, the signal intensities of the vitreous are represented by a cumulative distribution function (CDF). The constructed CDFs are then used to train and test the FCNN classifier for grading (grade from 0 to 3). The performance of the proposed pipeline is evaluated on a dataset of 200 OCT images. Our segmentation approach documented a higher performance than related methods, as evidenced by the Dice coefficient of 0.988 ± 0.01 and Hausdorff distance of 0.0003 mm ± 0.001 mm. On the other hand, the FCNN classification is evidenced by its average accuracy of 86%, which supports the benefits of the proposed pipeline as an aid for early and objective diagnosis of uvea inflammation.

An experience with a bubble CPAP bundle: is chronic lung disease preventable?

BACKGROUND: Continuous positive airway pressure (CPAP) is associated with marginal decrease in chronic lung disease (CLD). This study aims to report outcomes, with focus on CLD, of preterm infants managed with a bubble CPAP (b-CPAP) bundle of care. METHODS: Infants <1500 g were stratified into four groups depending on intubation status through first 3 days of life. The incidence of mortality, CLD and other morbidities were compared over four chronological epochs. Outcomes of the most recent epoch were compared to contemporaneous benchmarks from Vermont Oxford Network (VON). RESULTS: Of 773 infants (median GA = 28 weeks, average BW = 995 g), 24.5% were intubated in DR and 11.7% in the first day of life. Mechanical ventilation, bCPAP and oxygen days in survivors were 1.5, 29 and 14, respectively. Overall incidence of CLD was 6.4% that remained consistent in the four epochs (7.6%, 7.5%, 5.8% and 5%), respectively. In comparison to VON, CLD was significantly less (p < 0.001). Initial DR intubation was not associated with increased CLD compared to initial management with CPAP that required subsequent intubation. CONCLUSION: It is feasible and sustainable to administer a b-CPAP bundle of care to decrease CLD. Cluster randomized trials are needed to validate the reproducibility of this approach.

Myco-engineered gold nanoparticles from Jahnula aquatica coated with ampicillin/amoxicillin and their antibacterial and anticancer activity against cancer cells.

INTRODUCTION: Antibiotics play an important role in medical treatments. However, the multidrug resistance (MDR) bacteria impairs their functionality. Therefore, drug delivery represents the solution for this problem. Many techniques and methods are used in drug delivery, however nanoparticles conjugated drug is one of the most effective and promising techniques. The current work investigates a one-step method of extracellular biosynthesis of gold nanoparticles (AuNPs) and their biocompatibility in antibiotic delivery, where the synthesized AuNPs were loaded with Ampicillin/Amoxicillin. RESULTS: Both ampicillin and amoxicillin antibiotics are successfully conjugated with the Au NPs surface (the potential efficiency), especially, at the smaller particle size. Where, the Au NPs with particle size of 8 m size reveals a promising activity against cancer cells with 48 µg/mL inhibitory concentration (IC50) after 24 h of their exposure to HeLa cells, and induction of apoptosis was also noticed on HeLa treated cells. CONCLUSIONS: The bio-synthesised Au NPs using Jahnula. aquatica fungi show a promising nanocarrier biocompatibility drug delivery system in cancer clinical treatments, in particular for antibiotics delivery antibiotics in pharmaceutical applications with large-scale commercial production. To the best of our knowledge, freshwater fungi have never been exploited for AuNPs synthesis.

A Chaotic-Based Encryption/Decryption Framework for Secure Multimedia Communications.

Chaos-based encryption has shown an increasingly important and dominant role in modern multimedia cryptography compared with traditional algorithms. This work proposes novel chaotic-based multimedia encryption schemes utilizing 2D alteration models for high secure data transmission. A novel perturbation-based data encryption for both confusion and diffusion rounds is proposed. Our chaotification structure is hybrid, in which multiple maps are combined combines for media encryption. Blended chaotic maps are used to generate the control parameters for the permutation (shuffling) and diffusion (substitution) structures. The proposed schemes not only maintain great encryption quality reproduced by chaotic, but also possess other advantages, including key sensitivity and low residual clarity. Extensive security and differential analyses documented that the proposed schemes are efficient for secure multimedia transmission as well as the encrypted media possesses resistance to attacks. Additionally, statistical evaluations using well-known metrics for specific media types, show that proposed encryption schemes can acquire low residual intelligibility with excessive nice recovered statistics. Finally, the advantages of the proposed schemes have been highlighted by comparing it against different state-of-the-art algorithms from literature. The comparative performance results documented that our schemes are extra efficacious than their data-specific counterpart methods.

Comparative DFT Computational Studies with Experimental Investigations for Novel Synthesized Fluorescent Pyrazoline Derivatives.

A novel series of pyrazoline derivatives were synthesized and their spectral properties were characterized via FT-IR, 1H, and 13C NMR. The electronic transitions and fluorescence properties were tracked via UV-Vis and emission spectrometry. The density functional theory (DFT) calculations have been also computed to get spot onto the geometry, electronic transitions and spectroscopic properties theoretically that has been compared with the encountered experimental ones. Moreover, the dipole moment, optimized energy, HOMO - LUMO energies and band gaps were calculated for novel candidates pyrazoline derivatives with highly fluorescence quantum yield.