A remarkable response to palliative treatment in metastatic breast cancer: A case report and comprehensive literature review.

The case report describes a patient with stage IV breast cancer which metastasized to the lungs. The patient's initial computed tomography (CT) scan revealed a malignant lesion in the upper outer quadrant of the left breast and multiple pulmonary nodules, suggesting pulmonary metastasis. After starting palliative chemotherapy with intravenous paclitaxel and subcutaneous injections of Herceptin, a follow-up CT scan 3 months after the initiation of treatment showed the disappearance of metastasis, and her cancer regressed to stage II breast cancer that could be surgically resected. This case report highlights the importance of timely and appropriate palliative treatment measures, which can lead to unexpected outcomes, such as the regression of metastatic lesions and the possibility of curative treatment in such advanced cancer.

Experimental and Analytical Studies on Low-Cost Glass-Fiber-Reinforced-Polymer-Composite-Strengthened Reinforced Concrete Beams: A Comparison with Carbon/Sisal Fiber-Reinforced Polymers.

This study presents an experimental framework with seventeen beams to investigate the impact of loading type, configuration, and through-bolt anchorage on LC-GFRP (Low-Cost Glass-Fiber-Reinforced Polymer) confinement performance. Beams underwent three-point and four-point bending, with LC-GFRP applied in various ways, including U-shaped, side-bonded, and fully wrapped, with and without anchors. The performance of LC-GFRP was compared to CFRP (Carbon-Fiber-Reinforced Polymer) and sisal wraps. LC-GFRP in side-bonded and U-shaped configurations without anchors under three-point bending showed no shear failure, while those under four-point bending without anchors experienced shear failure. With anchors, U-shaped configurations successfully prevented shear failure. The side-bonded, U-shaped, and U-shaped configurations along the full span with anchors demonstrated peak capacity enhancements of 72.11%, 43.66%, and 68.39% higher improvements than the corresponding configurations without anchors, respectively. Wrapping all sides of the beam with LC-GFRP or CFRP prevented shear failure without additional anchors, with complete wrapping being the most efficient method. When anchors were used, significant capacity enhancements were observed. Existing shear strength prediction models were evaluated, highlighting the need for more tailored expressions for LC-GFRP confinement, especially for non-U-shaped configurations.

Performance Prediction of Hybrid Bamboo-Reinforced Concrete Beams Using Gene Expression Programming for Sustainable Construction.

The building and construction industry's demand for steel reinforcement bars has increased with the rapid growth and development in the world. However, steel production contributes to harmful waste and emissions that cause environmental pollution and climate change-related problems. In light of sustainable construction practices, bamboo, a readily accessible and eco-friendly building material, is suggested as a viable replacement for steel rebars. Its cost-effectiveness, environmental sustainability, and considerable tensile strength make it a promising option. In this research, hybrid beams underwent analysis through the use of thoroughly validated finite element models (FEMs), wherein the replacement of steel rebars with bamboo was explored as an alternative reinforcement material. The standard-size beams were subjected to three-point loading using FEMs to study parameters such as the load-deflection response, energy absorption, maximum capacity, and failure patterns. Then, gene expression programming was integrated to aid in developing a more straightforward equation for predicting the flexural strength of bamboo-reinforced concrete beams. The results of this study support the conclusion that the replacement of a portion of flexural steel with bamboo in reinforced concrete beams does not have a detrimental impact on the overall load-bearing capacity and energy absorption of the structure. Furthermore, it may offer a cost-effective and feasible alternative.

Behavior of non-prismatic RC beams with conventional steel and green GFRP rebars for sustainable infrastructure.

This study presents an experimental and finite element analysis of reinforced concrete beams with solid, hollow, prismatic, or non-prismatic sections. In the first part, a total of six beams were tested under four-point monotonic bending. The test matrix was designed to provide a comparison of structural behavior between prismatic solid and hollow section beams, prismatic solid and non-prismatic solid section beams, and prismatic hollow and non-prismatic hollow section beams. The intensity of shear was maximum in the case of prismatic section beams. The inclusion of a tapered section lowered the demand for shear. In the second part, Nonlinear Finite Element Modeling was performed by using ATENA. The adopted modeling strategy resulted in close agreement with experimental crack patterns at ultimate failure. However, the ultimate failure loads predicted by nonlinear modeling were generally higher than their corresponding experimental results. Whereas in the last part, the developed models were further extended to investigate the effect of the strength of concrete and ratio of longitudinal steel bars on the ultimate load-carrying capacity and cracking behavior of the reinforced concrete beams with solid, hollow, prismatic, or non-prismatic sections. The ultimate loads for each beam predicted by the model were found to be in close agreement with experimental results. Nonlinear modeling was further extended to assess the effects of concrete strength and longitudinal reinforcement ratio on failure patterns and ultimate loads. The parametric study involved beams reinforced with glass fiber-reinforced polymer (GFRP) bars against shear and flexural failure. In terms of ultimate load capacities, diagonal cracking, and flexural cracking, beams strengthened with GFRP bars demonstrated comparable performance to the beams strengthened with steel bars.

Load-Bearing Performance of Non-Prismatic RC Beams Wrapped with Carbon FRP Composites.

This study investigated the influence of CFRP composite wrapping techniques on the load-deflection and strain relationships of non-prismatic RC beams. A total of twelve non-prismatic beams with and without openings were tested in the present study. The length of the non-prismatic section was also varied to assess the effect on the behavior and load capacity of non-prismatic beams. The strengthening of beams was performed by using carbon fiber-reinforced polymer (CFRP) composites in the form of individual strips or full wraps. The linear variable differential transducers and strain gauges were installed at the steel bars to observe the load-deflection and strain responses of non-prismatic RC beams, respectively. The cracking behavior of unstrengthened beams was accompanied by excessive flexural and shear cracks. The influence of CFRP strips and full wraps was primarily observed in solid section beams without shear cracks, resulting in enhanced performance. In contrast, hollow section strengthened beams exhibited minor shear cracks alongside the primary flexural cracks within the constant moment region. The absence of shear cracks was reflected in the load-deflection curves of strengthened beams, which demonstrated a ductile behavior. The strengthened beams demonstrated 40% to 70% higher peak loads than control beams, whereas the ultimate deflection was increased up to 524.87% compared to that of the control beams. The improvement in the peak load was more prominent as the length of the non-prismatic section increased. A better improvement in ductility was achieved for the case of CFRP strips in the case of short non-prismatic lengths, whereas the efficiency of CFRP strips was reduced as the length of the non-prismatic section increased. Moreover, the load-strain capacity of CFRP-strengthened non-prismatic RC beams was higher than the control beams.

Prediction of Stress-Strain Curves for HFRP Composite Confined Brick Aggregate Concrete under Axial Load.

Recently, hemp-fiber-reinforced polymer (HFRP) composites have been developed to enhance the strength and ductility of normal and lightweight aggregate concrete along with recycled brick aggregate concrete. In addition, both experimental and analytical investigations have been performed to assess the suitability of the existing strength and strain models. However, the theoretical and analytical expressions to predict the stress-strain curves of HFRP-confined concrete were not developed. Therefore, the main objective of this study was to develop analytical expressions to predict the stress-strain curves of HFRP-confined waste brick aggregate concrete. For this purpose, a new experimental framework was conducted to examine the effectiveness of HFRP in improving the mechanical properties of concrete constructed with recycled brick aggregates. Depending on the strength of the concrete, two groups were formed, i.e., Type-1 concrete and Type-2 concrete. A total of sixteen samples were tested. The ultimate compressive strength and strain significantly increased due to HFRP confinement. Improvements of up to 272% and 457% in the ultimate compressive strength and strain were observed due to hemp confinement, respectively. To predict the ultimate compressive strength and strain of HFRP-confined concrete, this study investigated several existing analytical stress-strain models. Some of the strength models resulted in close agreement with experimental results, but none of the models could accurately predict the ultimate confined strain. Nonlinear regression analysis was conducted to propose expressions to predict the ultimate compressive strength and strain of HFRP-confined concrete. The proposed expressions resulted in good agreement with experimental results. An analytical procedure was proposed to predict the stress-strain curves of hemp-confined concrete constructed by partial replacement of natural coarse aggregates by recycled fired-clay brick aggregates. A close agreement was found between the experimental and analytically predicted stress-strain curves.

Low-Cost Fiber Chopped Strand Mat Composites for Compressive Stress and Strain Enhancement of Concrete Made with Brick Waste Aggregates.

Given the excessive demolition of structures each year, the issues related to the generated structural waste are striking. Bricks being a major constituent in the construction industry, also hold a significant proportion of the construction waste generated annually. The reuse of this brick waste in new constructions is an optimal solution considering cost-effectiveness and sustainability. However, the problems related to the substandard peak stress and ultimate strain of concrete constructed with recycled brick aggregates (CRAs) limit its use in non-structural applications. The present study intends to improve the unsatisfactory mechanical characteristics of CRAs by utilizing low-cost glass fiber chopped strand mat (FCSM) sheets. The efficacy of FCSM sheets was assessed by wrapping them around CRA specimens constructed with different concrete strengths. A remarkable increase in the peak compressive stress and the ultimate strain of the CRA specimens were observed. For low, medium, and high strength CRAs, the ultimate strain improved by up to 320%, 308%, and 294%, respectively, as compared to the respective control specimens. Several existing analytical models were utilized to predict the peak compressive stress and ultimate strain of the CRAs strengthened using FCSM sheets. None of the considered models reproduced experimental results accurately. Therefore, equations were formulated using regression predicting the peak stress and ultimate strain of the CRAs confined with FCSM sheets. The predicted values were found to correlate well with the experimental values.

Distributed uplink cache for improved energy and spectral efficiency in B5G small cell network.

The advent of content-centric networks and Small Cell Networks (SCN) has resulted in the exponential growth of data for both uplink and downlink transmission. Data caching is considered one of the popular solutions to cater to the resultant challenges of network congestion and bottleneck of backhaul links in B5G networks. Caching for uplink transmission in distributed B5G scenarios has several challenges such as duplicate matching of contents, mobile station's unawareness about the cached contents, and the storage of large content size. This paper proposes a cache framework for uplink transmission in distributed B5G SCNs. Our proposed framework generates comprehensive lists of cache contents from all the Small Base Stations (SBSs) in the network to remove similar contents and assist uplink transmission. In addition, our framework also proposes content matching at a Mobile Station (MS) in contrast to an SBS, which effectively improves the energy and spectrum efficiency. Furthermore, large size contents are segmented and their fractions are stored in the distributed cache to improve the cache hit ratio. Our analysis shows that the proposed framework outperforms the existing schemes by improving the energy and spectrum efficiency of both access and core networks. Compared to the existing state of the art, our proposed framework improves the energy and spectrum efficiency of the access network by 41.28% and 15.58%, respectively. Furthermore, the cache hit ratio and throughput are improved by 9% and 40.00%, respectively.

Safety evaluation study of lincomycin and spectinomycin hydrochloride intramuscular injection in chickens.

This study aimed to investigate the nonclinical safety of lincomycin and spectinomycin hydrochloride (LC-SPH) intramuscular (i.m) doses on target animals (chickens) to provide guidelines for dose level design and side effect monitoring in clinical trials. A total of 80 healthy Arbor Acres plus broiler chicks were completely randomized and blindly divided into four treatment groups (control, one-time dose, three-time dose, and five-time dose) of 20 chicks each (20 chickens per group). At the age of day 15, all chickens (except the control group) were administered LC-SPH intramuscularly (chest muscles) at different doses of 20 mg/kg.bw, 60 mg/kg.bw, and 100 mg/kg.bw respectively for 9 consecutive days recommended by veterinary international cooperation on harmonization (VICH) guidelines. The chickens had ad libitum access to antibiotic-free feed and water. Feeding chickens were observed twice a day throughout the study. The drug safety was evaluated by complete blood count, biochemical parameters, histopathological, clinical signs, body weight gain, and feed conversion ratio (FCR). Hence, considering the minor toxicity of 60 mg/kg, our results reveal that intramuscular injection of at least 20 mg/kg body weight has no effects on growth performance, clinical blood parameters, organ coefficient, and histopathological parameters. Thus, a combination of LC-SPH 20 mg/kg body weight i.m injection investigated safe followed daily administration for nine consecutive days in healthy chickens. It is concluded that the experimental results support the safety of 20 mg/kg body weight in combination for the further clinical research study.

The Therapeutic Application of Tamarix aphylla Extract Loaded Nanoemulsion Cream for Acid-Burn Wound Healing and Skin Regeneration.

Background and Objectives: Nanomedicine is a constantly growing field for the diagnosis and treatment of various diseases as well as for regenerative therapy. Nanotechnology-based drug-delivery systems improve pharmacological and pharmacokinetic profiles of plants based biologically active molecules. Based on traditional claims, leaves of the Tamarix aphylla (TA) were investigated for their potential healing activity on burn wounds. Materials and Methods: In this study, TA-based nanoemulsion was prepared. The nanoemulsion was characterized for size, zeta potential, pH, viscosity, and stability. The nanoemulsion containing plant extract was converted into cream and evaluated for its efficacy against acid-burn wounds inflicted in the dorsum of rabbits. The animals were classified into four main groups: Group A as a normal control group, Group B as a positive control (treated with cream base + silver sulfadiazine), Group C as a standard drug (silver sulfadiazine), and Group D as a tested (treated with nanoemulsion cream containing TA extract). The prepared system could deliver TA to the target site and was able to produce pharmacological effects. On days 0, 7, 14, 21, 28, and 35, wound contraction rate was used to determine healing efficacy. The wound samples were collected from the skin for histological examination. Results: Based on statistical analysis using wound-healing time, Group D showed a shorter period (21.60 ± 0.5098) (p < 0.01) than the average healing time of Group C (27.40 ± 0.6002) (p < 0.05) and Group B (33.40 ± 0.8126) (p < 0.05). The histopathological assessment showed that burn healing was better in Group D compared with Group C and Group B. The nanoemulsion cream had a non-sticky texture, low viscosity, excellent skin sensations, and a porous structure. By forming a protective layer on the skin and improving moisture, it enhanced the condition of burnt skin. Conclusions: According to the findings of this study, nanoemulsion cream containing TA extract has great potential in healing acid-burn wounds

Prevalence of Micronutrient Deficiencies among Preschool and School-Going Children in Flood-Hit Areas of Pakistan.

There is minimal literature regarding micronutrient deficiencies in flood-affected regions. In our study, we aimed to find the prevalence of micronutrient deficiencies (vitamin A, calcium, zinc, iron, and iodine) among preschool and school-age children in flood-hit areas of Khyber Pakhtunkhwa, Pakistan. In this cross-sectional study, a multi-stage sampling technique was used for the selection of 656 households. Serum micronutrient status was detected in the targeted population in the affected districts. The least significant difference test was used with analysis of variance to determine significant differences in nutrient contents in different areas. Of the total respondents, 90.8% of the children were calcium deficient, 88.3% were zinc deficient, 26.7% were iron deficient, 53.5% were vitamin A deficient, and 39.5% were had an iodine deficiency in flood-affected areas. A significant difference (P < 0.05) was found in different age groups of children for zinc (5.7-42.63 µg/dL) and urinary iodine (69.6-85.4 µg/L). The 10- to 12-year-old age group had a lower serum zinc concentration (5.7 µg/dL), whereas the 1- to 3-year-old age group had a lower urinary iodine concentration (69.6 µg/L) than other groups. There was no significant difference (P > 0.05) between male and female children and various age groups for calcium and iron status. Vitamin A levels were significantly (P < 0.05) different among different age groups (high in age group 4-6 years) and districts. Vitamin A concentration was lower in the Nowshera District, whereas serum iron and zinc were lower in the Dera Ismail Khan District. All the important micronutrients in the population of children were deficient in the flood-affected areas of Pakistan. Therefore, policymakers should implement potential prevention strategies, such as food security, school health nutrition, food fortification, nutrition in the first 1,000 golden days, nutrition knowledge, and awareness of the local population, to reduce the burden of micronutrients deficiencies in flood-affected areas.

Correlates of mothers' nutritional status in developing economies: Evidence from demographic and health surveys.

The study investigates the determinants of the nutritional status of mothers in developing countries. For a panel of 38 developing countries, data were obtained from the nationally representative Demographic and Health Surveys (DHS). Married women of reproductive age group (15 to 45 years), currently living with their husbands were selected as the target population. Body mass index was used as a proxy measure to gauge the nutritional status. Both bivariate and multivariate statistical analyses were employed to assess the socioeconomic determinants of mothers' nutritional status. The findings from both descriptive and probability analyses identified the mothers' poor educational status, early marriage, high fertility rate, low birth interval, low women empowerment status, household poverty, and belonging to rural areas as the main determinants of poor nutritional status of mothers in developing countries; hence, there is a need to focus more on this group in order to stop the sustained transmission of intergenerational malnutrition.

RETRACTED: A Multicentre Randomized Controlled Trial Comparing Plating with Intramedullary Nailing for Extra-articular Distal Tibial Fractures.

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). Injury was alerted to concerns regarding similarities of the data of this study to those published in the FixDIT UK trial.1 The investigators were invited to reply to the issues raised and were also asked to provide their original dataset available to the Editor-in-Chief. After several communications, the authors were not in a position to submit their original dataset to the Journal. Consequently, this article has been retracted at the request of the Editor-in-Chief due to serious scientific and ethical concerns relating to the integrity of the data collected and included in this study. 1. Costa ML, Achten J, Griffin J, Petrou S, Pallister I, Lamb SE, Parsons NR; FixDT Trial Investigators Effect of Locking Plate Fixation vs Intramedullary Nail Fixation on 6-Month Disability Among Adults With Displaced Fracture of the Distal Tibia: The UK FixDT Randomized Clinical Trial. .JAMA. 2017 Nov 14;318(18):1767-1776.

Fixation of distal radius fractures using wide-awake local anaesthesia with no tourniquet (WALANT) technique: A randomized control trial of a cost-effective and resource-friendly procedure.

AIMS: We hypothesized that the wide-awake local anaesthesia with no tourniquet (WALANT) technique is cost-effective, easy to use, safe, and reproducible, with a low learning curve towards mastery, having a high patient satisfaction rate. Furthermore, WALANT would be a suitable alternative for the austere and developing nation environments where lack of funds and resources are a common issue. METHODS: This was a randomized control trial of 169 patients who required surgery for closed isolated distal radius fractures. The study was performed between March 2016 and April 2019 at a public sector level 1 trauma centre. General anaesthesia was used in 56 patients, Bier's block in 58 patients, and WALANT in 55 patients. Data were collected on pre-, peri-, and postoperative parameters, clinical outcome, hospital costs, and patient satisfaction. One-way analysis of variance (ANOVA) was used with a p-value of 0.05 being significant. RESULTS: Operations with WALANT proceeded sooner, and patients recovered faster, resulting in mean fewer missed working days (7.8 (SD 1.67)) compared with general anaesthesia (20.1 (SD 7.37)) or Bier's block (14.1 (SD 7.65)) (p < 0.001). The WALANT patients did not develop complications, while the other patients did (p < 0.04). Clinical outcomes did not differ, nor did surgeon qualification affect clinical outcomes. Mean hospital costs were lower for WALANT ($428.50 (SD 77.71)) than for general anaesthesia ($630.63 (SD 114.77)) or Bier's block ($734.00 (SD 37.54)) (p < 0.001). Patient satisfaction was also higher (p < 0.001). CONCLUSION: WALANT for distal radius fractures results in a faster recovery, is more cost-effective, has similar clinical outcomes, and has fewer complications than general anaesthesia or Bier's block. This makes WALANT an attractive technique in any setting, but especially in middle- and low-income countries.Cite this article: Bone Joint Res 2020;9(7):429-439.

Factors associated with the quality of Antenatal Care (ANC) services use in Bahawalpur.

A cross sectional study was conducted from October 2016 to February 2017 with the aim to examine the factors affecting the quality of antenatal care (ANC) services being used in Bahawalpur district. Data was collected using the Stratified cluster sampling technique from 1,650 married women of reproductive age (15-49 years) who had given birth to at least one child in four preceding years. Information regarding socioeconomic aspects and the ANC services used during pregnancy were recorded through interviews. The quality of ANC services being used was measured through constructing an index. The results from multivariate ordered logistic regression analysis revealed that longer birth interval, gender of the eldest child (female), birth order of the child (as first or second child), number of living sons, the woman's knowledge about complications of pregnancy, her prior history of neonatal mortality, her socioeconomic empowerment, and wealth status of her family translate into the use of quality ANC services in district Bahawalpur.

Revealing heterogeneous causal links among financial development, construction industry, energy use, and environmental quality across development levels.

This work investigates the dynamic heterogeneous causal links among financial development, construction industry, energy use, and environmental quality across the development levels, for 30 Chinese provinces during the period 2001-2016. For this purpose, a model of environmental quality has been constructed introducing the financial development and construction industry as endogenous factors. A Pedroni's cointegration is employed and found the long-run cointegrating mechanism among the variables of interest. The dynamic common correlated effects mean group approach (DCCEMGA) is adopted to estimate the impact elasticities. Moreover, for robustness check, a sensitivity analysis is conducted employing common correlated effects mean group approach (CCEMGA). The main results are first, a two-way positive causal bridge is existent between gross domestic product (GDP) and energy use, construction industry and GDP, and financial development and GDP. In terms of the contribution of the construction industry to economic performance, construction industry-driven growth acceleration impact is observed. Second, a one-way positive causal link is identified running from financial development (both the banking sector and stock market) to the construction industry and is termed as finance-driven construction promotion effect. Also, a one-sided positive causal connection is operating from financial development and construction industry to energy use and carbon dioxide emissions. Finally, a standard environmental Kuznets curve (EKC), financial development-augmented EKC, and construction industry-augmented EKC hypotheses are found valid in the whole country and eastern region of China. Based on empirics, a regional heterogeneity has been observed in terms of the degree of impact and statistical significance while comparing the regional panels. The sensitivity analysis proved the empirical results to be robust and reliable. Moreover, based on the findings, policy recommendations are documented. Graphical abstract.