A Case of COVID-19 Pneumonia Leading to Acute Respiratory Distress Syndrome (ARDS) and Multi-organ Failure Requiring Extracorporeal Membrane Oxygenation (ECMO) for Six Months and an Associated Critical Limb Ischemia.

This article presents the case of a 57-year-old woman with a history of rheumatoid arthritis who developed severe coronavirus disease 2019 (COVID-19) pneumonia that progressed to acute respiratory distress syndrome (ARDS) and multi-system organ failure. Despite initial slow progression and multiple hospital readmissions, her condition rapidly deteriorated, leading to full respiratory failure requiring intubation and ventilation. She was transferred to a specialized center where she underwent extracorporeal membrane oxygenation (ECMO) and hemodialysis for acute renal failure. Unfortunately, she remained dependent on ECMO for an extended period of six months. Although she made a gradual recovery, the prolonged critical care treatment resulted in critical ischemia of multiple extremities, necessitating a below-knee amputation (BKA) of her left lower extremity and transmetatarsal amputations of her right hand. This case reports one of the longest ECMO treatments for COVID-19 and associated comorbidities in the literature. Clinicians could include a longer duration of treatment and potential associated disabilities in the informed consent.

Computing the effects of temperature and osmotic stress on the seed germination of Helianthus annuus L. by using a mathematical model.

An extremely important oil crop in the world, Helianthus annuus L. is one of the world's most significant members of the Asteraceae family. The rate and extent of seed germination and agronomic features are consistently affecting  by temperature (T) and changes in water potential (ψ). A broad hydrothermal time model with T and ψ components could explain sunflower responses over suboptimal T and ψ. A lab experiment was performed using the HTT model to discover both T and ψ and their interactive effects on sunflower germination and also to figure  out the cardinal Ts values. The sunflower seeds were germinated at temperatures (15 °C, 20 °C, 25 °C and 30 °C); each Ts had five constant ψs of 0, 0.3, 0.6, 0.9, and 1.2 MPa via PEG 6000 as osmotic stress inducer. The results revealed that highest germination index was found in seed grown at 20 °C in distilled water (0 MPa) and the lowest at 30 °C with osmotic stress of (- 1.2 MPa). The highest value of germination rate index was found in seed grown at 20 °C in distilled water (0 MPa) and the lowest at 15 °C with an osmotic stress of (- 1.2 MPa). In conclusion, water potential, temperature, and their interactions have a considerable impact on seed germination rate, and other metrics (GI, SVI-I, GRI, GE, SVI-II, and MGT). Seeds sown  at 20 °C with zero water potential showed high germination metrics such as GE, GP, GRI, and T50%. The maximum value to TTsub noted at 30 °C in - 0.9 MPa osmotic stress and the minimum value was calculated at 15 °C in - 1.2 MPa osmotic stress. The result of TTsupra recorded highest at 15 °C in  controlled group (0 MPa). Moreover, θH was  highest at 30 °C in controlled condition (0 MPa) and minimum value was observed at  20 °C under - 1.2 MPa osmotic stress. The value of θHTT were  maximum at  30 °C in controlled group (0 MPa) and minimum value was  recorded at 15 °C under - 1.2 MPa osmotic potential. The base, optimum and ceiling temperatures for sunflower germination metrics in this experiment were noted  6.8, 20 and 30 °C respectively.

Hospital Readmission Rates for Patients Receiving In-Person vs. Telemedicine Discharge Follow-Up Care.

INTRODUCTION: Unplanned readmissions can be avoided by standardizing and improving the coordination of care after discharge. Telemedicine has been increasingly utilized; however, the quality of this care has not been well studied. Standardized measures can provide an objective comparison of care quality. The purpose of our study was to compare quality performance transitions of care management in the office vs telemedicine. METHODS: The Epic SlicerDicer tool was used to compare the percentage of encounters that were completed via telemedicine (video visits); or via in-person for comparison, Chi-squared tests were used. RESULTS: A total of 13,891 patients met the inclusion criteria during the study time frame. There were 12,846 patients in the office and 1,048 in the telemedicine cohort. The office readmission rate was 11.9% with 1,533 patients out of 12,846 compared with telemedicine with the rate of readmission at 12.1% with 126 patients out of 1,045 patients. The P-value for the Chi-squared test between the prepandemic and study time frame was 0.15 and 0.95, respectively. Demographic comparability was seen. DISCUSSION: Our study found a comparable readmission rate between patients seen via in-office and telemedicine for Transitions of Care Management (TCM) encounters. The findings of this study support the growing body of evidence that telemedicine augments quality performance while reducing cost and improving access without negatively impacting HEDIS performance in health care systems. CONCLUSION: Telemedicine poses little threat of negatively impacting HEDIS performance and might be as effective as posthospitalization traditional office care transitions of care management.

Insight into soft chemometric computational learning for modelling oily-wastewater separation efficiency and permeate flux of polypyrrole-decorated ceramic-polymeric membranes.

Reliable modeling of oily wastewater emphasizes the paramount importance of sustainable and health-conscious wastewater management practices, which directly aligns with the Sustainable Development Goals (SDG) while also meeting the guidelines of the World Health Organization (WHO). This research explores the efficiency of utilizing polypyrrole-coated ceramic-polymeric membranes to model oily wastewater separation efficiency (SE) and permeate flux (PF) based on established experimental procedures. In this area, computational simulation still needs to be explored. The study developed predictive regression models, including robust linear regression (RLR), stepwise linear regression (SWR) and linear regression (LR) for the ceramic-polymeric porous membrane, aiming to interpret its complex performance across diverse conditions and, thus, develop its utility in oily wastewater treatment applications. Subsequently, a novel, simple average ensemble paradigm was explored to reduce errors and improve prediction skills. Prior to the development of the model, stability and reliability analysis of the data was conducted based on Philip Perron tests with the Bartlett kernel estimation method. The accuracy of the SE exhibited a high consistency, averaging 99.92% with minimal variability (standard deviation of 0.026%), potentially simplifying its prediction compared to PF. The modes were validated and evaluated using metrics like MAE, RMSE, Speed, and MSE, in addition to 2D graphical and cumulative distribution function graphs. The LR model emerged as the best with the lowest RMSE =0.21951, indicating superior prediction accuracy, followed closely by RLR with an RMSE = 0.22359. SWLR, while having the highest RMSE = 0.34573, marked its dominance in prediction speed with 110 observations per second. Notably, the RLR model justified a reduction in error by approximately 35.29% compared to SWLR. Moreover, the training efficiency of the LR model exceeded, demanding a mere 2.9252 s, marking a reduction of about 32.54% compared to SWLR. The improved simple ensemble learning proved merit over the three models regarding error accuracy. This study emphasizes the essential role of soft-computing learning in optimizing the design and performance of ceramic-polymeric membranes.

A CMIP6 multi-model based analysis of potential climate change effects on watershed runoff using SWAT model: A case study of kunhar river basin, Pakistan.

The hydrological regimes of watersheds might be drastically altered by climate change, a majority of Pakistan's watersheds are experiencing problems with water quality and quantity as a result precipitation changes and temperature, necessitating evaluation and alterations to management strategies. In this study, the regional water security in northern Pakistan is examined about anthropogenic climate change on runoff in the Kunhar River Basin (KRB), a typical river in northern Pakistan using Soil and Water Assessment tool (SWAT) and flow durarion curve (FDC). Nine general circulation models (GCMs) were successfully utilized following bias correction under two latest IPCC shared socioeconomic pathways (SSPs) emission scenarios. Correlation coefficients (R2), Nash-Sutcliffe efficiency coefficients (NSE), and the Percent Bias (PBIAS) are all above 0.75. The conclusions demonstrate that the SWAT model precisely simulates the runoff process in the KRB on monthly and daily timescales. For the two emission scenarios of SSP2-4.5 and SSP5-8.5, the mean annual precipitation is predicted to rise by 3.08 % and 5.86 %, respectively, compared to the 1980-2015 baseline. The forecasted rise in mean daily high temperatures is expected to range from 2.08 °C to 3.07 °C, while the anticipated increase in mean daily low temperatures is projected to fall within the range of 2.09 °C-3.39 °C, spanning the years 2020-2099. Under the two SSPs scenarios, annual runoff is estimated to increase by 5.47 % and 7.60 % due to climate change during the same period. Future socioeconomic growth will be supported by a sufficient water supply made possible by the rise in runoff. However, because of climate change, there is a greater possibility of flooding because of increases in both rainfall and runoff. As a result, flood control and development plans for KRB must consider the climate change's possible effects. There is a chance that the peak flow will move backwards relative to the baseline.

Shining insights: Deciphering the biogenic synthesis of Ajuga bracteosa-mediated gold nanoparticles with advanced microscopy techniques.

In this study, gold nanoparticles (AuNPs) were bioreduced from Ajuga bracteosa, a medicinal herb known for its therapeutic properties against various diseases. Different fractions of the plant extract were used, including the methanolic fraction (ABMF), the n-hexane fraction (ABHF), the chloroform fraction (ABCF), and the aqueous extract for AuNPs synthesis. The characterization of AuNPs was performed using UV-Vis spectrophotometry, FT-IR, XRD, EDX, and TEM. UV-Vis spectroscopy confirmed the formation of AuNPs, with peaks observed at 555 nm. FT-IR analysis indicated strong capping of phytochemicals on the surface of AuNPs, which was supported by higher total phenolic contents (TPC) and total flavonoid contents (TFC) in AuNPs. XRD results showed high crystallinity and a smaller size distribution of AuNPs. TEM analysis revealed the spherical shape of AuNPs, with an average size of 29 ± 10 nm. The biologically synthesized AuNPs exhibited superior antibacterial, antioxidant, and cytotoxic activities compared to the plant extract fractions. The presence of active biomolecules in A. bracteosa, such as neoclerodan flavonol glycosides, diterpenoids, phytoecdysone, and iridoid glycosides, contributed to the enhanced biological activities of AuNPs. Overall, this research highlights the potential of A. bracteosa-derived AuNPs for various biomedical applications due to their remarkable therapeutic properties and effective capping by phytochemicals. RESEARCH HIGHLIGHTS: This research underscores the growing significance of herbal medicine in contemporary healthcare by exploring the therapeutic potential of Ajuga bracteosa and gold nanoparticles (AuNPs). The study highlights the notable efficacy of A. bracteosa leaf extracts and AuNPs in treating bacterial infections, demonstrating their bactericidal effects on a range of strains. The anti-inflammatory properties of plant extracts and nanoparticles are evidenced through paw edema method suggesting their applicability in managing inflammatory conditions. These findings position A. bracteosa and AuNPs as potential candidates for alternative and effective approaches to modern medication.

Pancreatic ductal adenocarcinoma: exploring clinicopathological trends and racial disparities in a comprehensive U.S. population-based study.

INTRODUCTION: Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy about 50% of PDAC are metastatic at presentation. In this study, we evaluated PDAC demographics, annual trend analysis, racial disparities, survival rate, and the role of different treatment modalities in localized and metastatic disease. METHODS: A total of 144,824 cases of PDAC were obtained from the SEER database from 2000 to 2018. RESULTS: The median age was 69 years, with a slightly higher incidence in males (52%) and 80% of all cases were white. Among cases with available data, 43% were grade III tumors and 57% were metastatic. The most common site of metastasis was the liver (15.7%). The annual incidence has increased steadily from 2000 to 2018. The overall observed (OS) 5-year survival rate was 4.4% (95% CI 4.3-4.6%), and 5 years cause-specific survival (CSS) was 5% (95% CI 5.1-5.4%). The 5-year survival with multimodal therapy (chemotherapy, surgery, and radiation) was 22% (95% CI 20.5-22.8%). 5-year CSS for the blacks was lower at 4.7% (95% CI 4.2-5.1%) compared to the whites at 5.3% (95% CI 5.1-5.4%). Multivariate analysis found male gender and black race associated with worse prognosis. Kaplan-Meier survival analysis found multimodal therapy to have the best outcomes in all three stages. CONCLUSION: PDAC is an aggressive malignancy with male gender and black race are associated with a poor prognosis. Surgery with chemoradiation was associated with the best overall survival. With steadily increasing rates of PDAC, improved treatment modalities are paramount to improving survival in these patients.

Multi-Omics Approaches Provide New Insights into the Identification of Putative Fungal Effectors from Valsa mali.

Pathogenic fungi secrete numerous effectors into host cells to manipulate plants' defense mechanisms. Valsa mali, a necrotrophic fungus, severely impacts apple production in China due to the occurrence of Valsa canker. Here, we predicted 210 candidate effector protein (CEP)-encoding genes from V. mali. The transcriptome analysis revealed that 146 CEP-encoding genes were differentially expressed during the infection of the host, Malus sieversii. Proteome analysis showed that 27 CEPs were differentially regulated during the infection stages. Overall, 25 of the 146 differentially expressed CEP-encoding genes were randomly selected to be transiently expressed in Nicotiana benthamiana. Pathogenicity analysis showed that the transient expression of VM1G-05058 suppressed BAX-triggered cell death while the expression of VM1G-10148 and VM1G-00140 caused cell death in N. benthamiana. In conclusion, by using multi-omics analysis, we identified potential effector candidates for further evaluation in vivo. Our results will provide new insights into the investigation of virulent mechanisms of V. mali.

Colorectal Adenosquamous Carcinoma: Demographics, Tumor Characteristics, and Survival Benefits of Surgery with Chemoradiation.

BACKGROUND: Colorectal adenosquamous carcinoma (ASC) is a rare subtype of colorectal carcinoma. This study presents findings from a large database query to highlight the demographic, clinical, and pathological factors, prognosis, and survival of colorectal ASC. METHODS: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients with colorectal ASC diagnosed between 2000 and 2020 and assess factors associated with overall survival (OS) and cause-specific survival (CSS). RESULTS: Among 284 identified cases, the median age of diagnosis was 64 years. The majority of patients were White (69.0%), with income ≤ $70,000 ( 62.3%), and lived in metropolitan areas (85.6%). Regarding tumor characteristics, the majority of tumors were poorly differentiated (49.6%), regional stage (39.8%), size of > 4.0 cm ( 41.5%), and had a negative lymph node status (47.2%). Primary sites were the rectum (35.2%) and colon ( 64.8%). In patients with primary site to the rectum, the majority of treatment modality was multimodal therapy (40.0%). The main treatment modality for the primary site to the colon was surgery only (46.2%), followed by surgery + chemotherapy (34.2%). The overall 5-year survival was 31.3 (95% C.I. 28.4-34.2) and the 5-year cause-specific survival (CSS) was 40.1% (95% C.I. 36.9-43.3). Multivariate analysis showed age ≥ 60 years, regional stage, and distant stage were negative prognostic factors. An income of > $70,000, multimodal therapy, and surgery with chemotherapy were positive prognostic factors. CONCLUSION: Colorectal adenosquamous carcinomas are more common in the non-Hispanic White populations and appear more frequently later in life (based on the median age of diagnosis at 64). Factors that contributed to a worse prognosis were an age of diagnosis ≥ 60 years, regional stage, and distant stage.

Circulation of foot-and-mouth disease serotypes, risk factors, and their effect on hematological and biochemical profiles among cattle and buffalo in Quetta, Balochistan, Pakistan.

Background and Aim: Foot-and-mouth disease (FMD) is an infectious disease of cloven-hoofed animals, including buffalo, cattle, sheep, goats, and pigs, causing major economic losses to the local farmers and, overall, to the national economy of the country. This study aimed to detect FMDV serotypes in year-round FMD outbreaks, hematological and biochemical changes, and oxidative stress in FMDV-infected cattle and buffaloes in the district of Quetta, Balochistan, Pakistan, and the socioeconomic impact of FMD outbreaks on farmers. Materials and Methods: We conducted a cross-sectional study in the district of Quetta, Balochistan, Pakistan, where FMD virus (FMDV) serotypes were detected by enzyme-linked immunosorbent assay (ELISA). Hematological, biochemical, and oxidative analyses were performed by analyzing the blood of FMDV-infected and non-infected animals. Information on the associated risk factors was obtained through a structured questionnaire by interviewing farmers in each FMD-affected farm. Results: Thirty-four out of 38 farms (89%, 95% confidence interval [CI]: 75%-97%) were positive for FMD by ELISA. Higher FMD infection was detected in farms with a herd size of <50 animals (50%, 17/34), followed by >100 animals (32%, 11/34) and 51-100 animals (18%, 6/34). Fifty-seven percent (114/200, 95% CI: 50%-64%) of animals were positive for FMD. Of these, 61% (69/114) were cattle and 39% (45/114) were buffalo. FMD positivity was higher in females (86%, 98/114) than in males (14%, 16/114) and higher in animals older than 2 years of age (52%, 59/114). On average, farmers lose U.S. dollars 3000 annually due to FMD outbreaks. Animals infected with FMDV had significantly (p ≤ 0.05) white blood cell counts and significantly (p ≤ 0.05) lower hemoglobin and total protein concentrations in buffalo and cattle, whereas infected cattle showed significantly (p ≤ 0.05) lower albumin levels. Globulin levels were lower in buffaloes infected. Alanine aminotransferase levels were lower in infected cattle (p ≤ 0.05). Creatinine levels were higher in infected buffalo (p ≤ 0.05). Urea and phosphorus concentrations were higher in FMDV-infected cattle and buffalo (p ≤ 0.05). Calcium levels were lower in infected cattle and buffalo (p ≤ 0.05). Catalase enzyme activity in infected cattle and buffaloes was significantly lower (p < 0.05). Lipid peroxidation was significantly higher in FMDV-infected cattle and buffalo (p ≤ 0.05). Conclusion: This study confirmed serotype O circulation among cattle and buffalo in year-long FMD outbreaks in the Quetta District of Balochistan. Blood analysis identified a parameter deviated from the normal level due to FMDV infection. In addition, the outbreak of FMD has a significant negative economic impact on livestock farmers.

Genomic characterization and expression profiling of the lytic polysaccharide monooxygenases AA9 family in thermophilic fungi Thermothelomyces fergusii in response to carbon source media.

Enhancing enzyme activity and stability in biomass degradation can improve substrate saccharification and, increases biorefinery efficiency. For the first time, we identified 20 lytic polysaccharide monooxygenases (LPMOs) AA9 genes in the genome of Thermothelomyces fergusii. Our results showed that TfAA9 was categorized into LPMOs1, LPMOs2, and LPMOs3 subgroups based on protein diversity. Protein- 3D structure analysis showed strong interactions between Myceliophthora thermophila AA9 proteins and 17 TfAA9 proteins. Gene ontology analysis indicated a high enrichment of cellulase activity in TfAA9 genes. KEGG pathways analysis revealed the role of TfAA9 proteins in the endohydrolysis of 1,4-beta-D-glucosidic linkages in cellulose. Numerous TfAA9s gene transcripts were up-regulated on avicel, cellobiose, and glucose, with a higher proportion on avicel. Protein concentration, endoglucanase, and cellulase activity were also boosted on avicel. However, limited fungal biomass was observed on avicel, despite the abundance of AA9 LPMOs in the T. fergusii genome. These findings expand our understanding of fungal AA9 genes and their role in lignocellulolytic degradation. The disparity between biomass and enzymatic activity suggests screening TfAA9 genes for highly active enzymes and redundant genes via heterologous expression. In short, functional characterization of these genes could contribute to improving the saccharification process of industrial raw materials.

Consanguineous Marriages and the Perception of Wife-Beating Justification in Pakistan: An Application of Fairlie Decomposition Analysis.

Pakistan has a significant occurrence of both consanguineous marriages and intimate partner violence (IPV), which may be interlinked. The practice of consanguineous marriages could potentially influence women to rationalize and accept instances of IPV. Such attitudes perpetuate a culture of violence against women, creating difficulties for victims to reject or escape from it. Pakistan has high prevalence rate of consanguineous marriages and IPV. However, no research has been done to explain the difference in acceptance of IPV between women in consanguineous and non-consanguineous marriages. This study used Pakistan Demographic and Health Survey data and applied association tests, logistic regression, and the Fairlie decomposition analysis. The Fairlie decomposition helps us identify the relative contribution of different socioeconomic factors in the inequalities in IPV between the two types of marriages. Five dimensions of wife-beating justification are used as outcome variables. Age, education, and empowerment of women, husband education, woman witness parental violence, region, place of residence, and household wealth status are used as independent variables. The logistic regression results indicated that women in consanguineous marriages of younger age and who witnessed parental violence are more likely to justify wife-beating than those who belong to wealthy households and enjoy more empowerment. Compared to the Punjab province, women residing in Sindh and Baluchistan are less likely and in the Khyber Pakhtunkhwa province are more likely to justify wife-beating. The Fairlie decomposition analysis shows that household wealth status, woman education, and empowerment are the main contributors in explaining the gap between the wife-beating justification of the two groups. The IPV gap can be reduced up to 77% if the distribution of women in different wealth quantiles of the consanguineous marriage group is identical to the non-consanguineous marriage group. Furthermore, woman education level is the second highest contributor. Consanguineous marriages are a prevalent cultural practice in Pakistan and are associated with several negative health and social outcomes. Addressing this issue requires a sustained and comprehensive effort by the government, civil society, and international partners, with a particular focus on women from poor households with less education.

Fitness difference between two synonymous mutations of Phytophthora infestans ATP6 gene.

BACKGROUND: Sequence variation produced by mutation provides the ultimate source of natural selection for species adaptation. Unlike nonsynonymous mutation, synonymous mutations are generally considered to be selectively neutral but accumulating evidence suggests they also contribute to species adaptation by regulating the flow of genetic information and the development of functional traits. In this study, we analysed sequence characteristics of ATP6, a housekeeping gene from 139 Phytophthora infestans isolates, and compared the fitness components including metabolic rate, temperature sensitivity, aggressiveness, and fungicide tolerance among synonymous mutations. RESULTS: We found that the housekeeping gene exhibited low genetic variation and was represented by two major synonymous mutants at similar frequency (0.496 and 0.468, respectively). The two synonymous mutants were generated by a single nucleotide substitution but differed significantly in fitness as well as temperature-mediated spatial distribution and expression. The synonymous mutant ending in AT was more common in cold regions and was more expressed at lower experimental temperature than the synonymous mutant ending in GC and vice versa. CONCLUSION: Our results are consistent with the argument that synonymous mutations can modulate the adaptive evolution of species including pathogens and have important implications for sustainable disease management, especially under climate change.

Knowledge and Behavior of Primary Care Physicians Regarding Utilization of Standardized Tools in Screening and Assessment of Anxiety, Depression, and Mood Disorders at a Large Integrated Health System.

INTRODUCTION: Standardized screening, objective evaluation, and management of behavioral health conditions are major challenges in primary care. The Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire (PHQ-9), and Mood Disorder Questionnaire (MDQ) provide standardized screening and symptom management tools for generalized anxiety disorder (GAD), major depressive disorder (MDD), and Mood Disorders (MD), respectively. This study explores family physicians' knowledge, attitudes, and practices regarding the utilization of GAD-7, PHQ-9, and MDQ in outpatient primary care offices. METHODS: The study method was a cross-sectional electronic and paper survey utilizing a self-administered questionnaire that assessed primary care physicians' demographics, knowledge, attitudes, and practices in rural and urban outpatient clinical settings regarding GAD-7, PHQ-9, and MDQ. Statistical software SAS 9.4 was used for descriptive and Chi-Square statistics. RESULTS: Out of 320 total participants,145 responded (45.3%). Responding family physicians demonstrated a high level of familiarity with the GAD-7 (97.9%), PHQ-9 (97.9%), and MDQ (81.3%) assessment tools. However, the reported utilization rates were relatively lower than knowledge, with 62.7%, 73.1%, and 31.9% extremely likely or likely to utilize the GAD-7, PHQ-9, and MDQ as screening and monitoring tools, respectively. Less than a quarter of the total respondents use the objective score for the future management of GAD, with significantly more residents utilizing the score for GAD-7 compared to attendings (P < .05). There was no statistical significance difference between residents and attendings for the objective evaluation of Major Depressive Disorder (P = .26) and Mood Disorders (P = .05). CONCLUSIONS: Despite being knowledgeable of the utility of GAD-7, PHQ-9, and MDQ, the primary care physicians in a large integrated health system in Central Pennsylvania and Northern Maryland report inconsistent utilization in their practice. Further studies are needed to determine the underlying factors contributing to the suboptimal usage of these screening tools and ways to increase it.

68 Ga-Pentixafor PET/CT for In Vivo Imaging of CXCR4 Receptors in Glioma Demonstrating a Potential for Response Assessment to Radiochemotherapy: Preliminary Results.

PURPOSE: The aim of this study was to evaluate the diagnostic potential of 68 Ga-pentixafor PET/CT for in vivo CXCR4 receptors imaging in glioma and its possible role in response assessment to radiochemotherapy (R-CT). METHODS: Nineteen (12 men, 7 women) patients with glioblastoma multiforme (GBM) underwent 68 Ga-pentixafor PET/CT, contrast-enhanced MR, and MR spectroscopy. Patients were divided in to 2 groups, that is, group I was the presurgical (n = 9) group in which the scanning was done before surgery, and PET findings were correlated with CXCR4 receptors' density. The group II was the postsurgical (n = 10) group in which the scanning was done before and after R-CT and used for treatment response evaluation. The quantitative analysis of 68 Ga-pentixafor PET/CT evaluated the mean SUV max , SUV mean , SUV peak , and T/B values. MR spectroscopy data evaluated the ratios of tumor metabolites (choline, NAA, creatine). RESULTS: 68 Ga-Pentixafor uptake was noted in all (n = 19) the patients. In the group I, the mean SUV max , SUV mean , SUV peak , and T/B values were found to be 4.5 ± 1.6, 0.60 ± 0.26, 1.95 ± 0.8, and 6.9 ± 4.6, respectively. A significant correlation ( P < 0.005) was found between SUV mean and choline/NAA ratio. Immunohistochemistry performed in 7/9 showed CXCR4 receptors' positivity (intensity 3 + ; stained cells >50.0%). In the group II, the mean SUV max at baseline was 4.6 ± 2.1 and did not differ (4.4 ± 1.6) significantly from the value noted at post-R-CT follow-up PET/CT imaging. At 6 months' clinical follow-up, 4 patients showed stable disease. SUV max and T/B ratios at follow-up imaging were lower (3.70 ± 0.90, 2.64 ± 1.35) than the corresponding values (4.40 ± 2.8; 2.91 ± 0.93) noted at baseline. Six (6/10) patients showed disease progression, and the mean SUV max , and T/B ratio in these patients were significantly ( P < 0.05) higher than the corresponding values at baseline and also higher than that noted in the stable patients. CONCLUSIONS: 68 Ga-Pentixafor PET/CT can be used for in vivo mapping of CXCR4 receptors in GBM. The technique after validation in a large cohort of patients may have added diagnostic value for the early detection of GBM recurrence and for treatment response evaluation.

Hybrid multimodule DC-DC converters accelerated by wide bandgap devices for electric vehicle systems.

In response to the growing demand for fast-charging electric vehicles (EVs), this study presents a novel hybrid multimodule DC-DC converter based on the dual-active bridge (DAB) topology. The converter comprises eight modules divided into two groups: four Insulated-Gate Bipolar Transistor (IGBT) modules and four Metal-Semiconductor Field-Effect Transistor (MESFET) modules. The former handles high power with a low switching frequency, while the latter caters to lower power with a high switching frequency. This configuration leverages the strengths of both types of semiconductors, enhancing the converter's power efficiency and density. To investigate the converter's performance, a small-signal model is developed, alongside a control strategy to ensure uniform power sharing among the modules. The model is evaluated through simulation using MATLAB, which confirms the uniformity of the charging current provided to EV batteries. The results show an impressive power efficiency of 99.25% and a power density of 10.99 kW/L, achieved through the utilization of fast-switching MESFETs and the DAB topology. This research suggests that the hybrid multimodule DC-DC converter is a promising solution for fast-charging EVs, providing high efficiency, power density, and switching speed. Future studies could explore the incorporation of advanced wide bandgap devices to handle even larger power fractions.

Journey into tomorrow: cardiovascular wellbeing transformed by nano-scale innovations.

Worldwide, cardiovascular diseases (CVDs) account for the vast majority of deaths and place enormous financial strains on healthcare systems. Gold nanoparticles, quantum dots, polymeric nanoparticles, carbon nanotubes, and lipids are innovative nanomaterials promising in tackling CVDs. In the setting of CVDs, these nanomaterials actively impact cellular responses due to their distinctive properties, including surface energy and topographies. Opportunities to more precisely target CVDs have arisen due to recent developments in nanomaterial science, which have introduced fresh approaches. An in-depth familiarity with the illness and its targeted mechanisms is necessary to use nanomaterials in CVDs effectively. We support the academic community's efforts to prioritize Nano-technological techniques in addressing risk factors linked with cardiovascular diseases, acknowledging the far-reaching effects of these conditions. The significant impact of nanotechnology on the early detection and treatment of cardiovascular diseases highlights the critical need for novel approaches to this pressing health problem, which is affecting people worldwide.

Technology in Medicine: Improving Clinical Documentation.

The association between electronic health record (EHR) documentation and physician burnout is well-known. A combination of insufficient time to complete tasks, clinical documentation burden, and electronic inbox overload comprises the definition of documentation-related burnout. Burnout mitigation strategies related to clinical documentation include use of targeted EHR training for documentation, use of medical scribes, and institutional documentation redesign. Mitigation strategies related to electronic inbox overload include assigning designated administrative time for inbox management, tailoring of message content to decrease length, and a team-based approach to clinical workflows. Best practices for improving the efficiency of clinical documentation in the EHR include use of automation tools (eg, macros, templates), physician note optimization, and use of team-based documentation. Clinical documentation aids such as medical scribes, speech recognition software, and artificial intelligence (AI)-based software are popular and often considered a necessary resource in health care. For most practices, decisions regarding which aid to use will likely be determined by cost. Speech recognition software is the lowest cost option. AI-based software and medical scribes are more costly.

Technology in Medicine: Telemedicine.

Telemedicine is defined as the provision of clinical services via telephone or video and is a type of telehealth. Telehealth is defined as the use of electronic information and telecommunications technologies for the delivery of health care, health education, and health information. During the COVID-19 pandemic, telemedicine availability and use of telehealth care significantly increased. The integral role of telemedicine during this time prompted the unprecedented integration of telehealth as a quasi-standard of care. Recent studies have shown telemedicine can achieve comparable or superior quality performance compared with in-office visits for a range of clinical areas in large primary care populations. Implementation of telemedicine at the practice level depends on use of strong clinical workflows across the medical team. Effective telemedicine visits rely on adaptation to a digital environment and patient cooperation for virtual physical examinations. There are subtle differences in coding for billing telemedicine visits (mainly for audio-only visits), and many add-on codes for preventive care are eligible for telehealth. Concerns exist about the ethical implications of virtual care, especially regarding privacy and access. The future success of telehealth will depend on a balance of patient autonomy and health outcomes in the context of health equity.

Technology in Medicine: Remote Patient Monitoring.

Remote patient monitoring (RPM) provides real-time clinical patient data to the medical team. The foundational element of RPM is communication, including data processing and integration in the electronic health record and communication of data between patients and clinicians. Patient portals are integral to this communication and their use can result in improved health outcomes and patient safety. Patient portals promote engagement of patients in their care, increase access to the medical team, and integrate RPM system data. RPM systems can monitor a spectrum of parameters related to chronic conditions, from vital signs (eg, heart and respiration rates, blood pressure, blood oxygen and glucose levels) to advanced cardiovascular measures. Some RPM systems are capable of automated monitoring. Health care insurance coverage of RPM systems varies widely, which has health equity implications, particularly for high-risk patients with endocrine and cardiovascular conditions. Additional challenges to widespread adoption of RPM include its contribution to administrative burden for physicians, patient data privacy issues, and variable effectiveness of RPM systems in the management of different chronic conditions.