Transcranial volumetric imaging using a conformal ultrasound patch.

Accurate and continuous monitoring of cerebral blood flow is valuable for clinical neurocritical care and fundamental neurovascular research. Transcranial Doppler (TCD) ultrasonography is a widely used non-invasive method for evaluating cerebral blood flow1, but the conventional rigid design severely limits the measurement accuracy of the complex three-dimensional (3D) vascular networks and the practicality for prolonged recording2. Here we report a conformal ultrasound patch for hands-free volumetric imaging and continuous monitoring of cerebral blood flow. The 2 MHz ultrasound waves reduce the attenuation and phase aberration caused by the skull, and the copper mesh shielding layer provides conformal contact to the skin while improving the signal-to-noise ratio by 5 dB. Ultrafast ultrasound imaging based on diverging waves can accurately render the circle of Willis in 3D and minimize human errors during examinations. Focused ultrasound waves allow the recording of blood flow spectra at selected locations continuously. The high accuracy of the conformal ultrasound patch was confirmed in comparison with a conventional TCD probe on 36 participants, showing a mean difference and standard deviation of difference as -1.51 ± 4.34 cm s-1, -0.84 ± 3.06 cm s-1 and -0.50 ± 2.55 cm s-1 for peak systolic velocity, mean flow velocity, and end diastolic velocity, respectively. The measurement success rate was 70.6%, compared with 75.3% for a conventional TCD probe. Furthermore, we demonstrate continuous blood flow spectra during different interventions and identify cascades of intracranial B waves during drowsiness within 4 h of recording.

Complete agenesis of dorsal pancreas: A rare cause of insulin-dependent diabetes mellitus.

ABSTRACT: We report a 16-year-old boy who presented with abdominal pain and severe hyperglycemia. His random blood glucose on admission was above 300 mg/dL, without ketosis. Urine examination revealed mild ketonuria. Renal function tests were normal. Antibodies to glutamate acid decarboxylase (anti-GAD) and islet tyrosine phosphatase 2 (anti-IA2) were negative. Findings on enhanced abdominal computed tomography scan were compatible with complete dorsal pancreatic agenesis. The body and tail of the pancreas were not visualized. Additionally, ectopic and malrotated left kidney was detected. Magnetic resonance cholangiopancreatography confirmed the absence of the dorsal pancreatic duct. The patient was treated with multiple subcutaneous insulin injections and attained good glycemic control. He is currently doing well on follow-up. The present case is a rare combination of complete agenesis of the dorsal pancreas with an ectopic, malrotated kidney. Clinical awareness of this rare association will help improve patient management.

Survival analysis on subchondral bone length for total knee replacement.

OBJECTIVE: Use subchondral bone length (SBL), a new MRI-derived measure that reflects the extent of cartilage loss and bone flattening, to predict the risk of progression to total knee replacement (TKR). METHODS: We employed baseline MRI data from the Osteoarthritis Initiative (OAI), focusing on 760 men and 1214 women with bone marrow lesions (BMLs) and joint space narrowing (JSN) scores, to predict the progression to TKR. To minimize bias from analyzing both knees of a participant, only the knee with a higher Kellgren-Lawrence (KL) grade was considered, given its greater potential need for TKR. We utilized the Kaplan-Meier survival curves and Cox proportional hazards models, incorporating raw and normalized values of SBL, JSN, and BML as predictors. The study included subgroup analyses for different demographics and clinical characteristics, using models for raw and normalized SBL (merged, femoral, tibial), BML (merged, femoral, tibial), and JSN (medial and lateral compartments). Model performance was evaluated using the time-dependent area under the curve (AUC), Brier score, and Concordance index to gauge accuracy, calibration, and discriminatory power. Knee joint and region-level analyses were conducted to determine the effectiveness of SBL, JSN, and BML in predicting TKR risk. RESULTS: The SBL model, incorporating data from both the femur and tibia, demonstrated a predictive capacity for TKR that closely matched the performance of the BML score and the JSN grade. The Concordance index of the SBL model was 0.764, closely mirroring the BML's 0.759 and slightly below JSN's 0.788. The Brier score for the SBL model stood at 0.069, showing comparability with BML's 0.073 and a minor difference from JSN's 0.067. Regarding the AUC, the SBL model achieved 0.803, nearly identical to BML's 0.802 and slightly lower than JSN's 0.827. CONCLUSION: SBL's capacity to predict the risk of progression to TKR highlights its potential as an effective imaging biomarker for knee osteoarthritis.

Ocular screening for chronic graft-versus-host disease in patients with allogeneic hematopoietic stem cell transplant.

OBJECTIVE: This study investigates ocular manifestations of graft-versus-host disease in patients following allogeneic hematopoietic stem cell transplantation (HSCT) at the University of Texas Medical Branch (UTMB). Preferred practice pattern guidelines are proposed for ocular graft-versus-host disease (oGHVD) detection. METHODS: The Epic electronic medical record database at UTMB was screened using International Classification of Diseases, Tenth Revision (ICD-10), codes for bone marrow transplants, stem cell transplants, and complications of bone marrow transplants and stem cell transplants. We identified 50 patients with the ICD-10 codes that were seen at UTMB between 2000 and 2021. Patients who received an HSCT and follow-up care with UTMB were included in this study. Thirty-eight patients met the inclusion criteria, whereas 12 patients were excluded because they had no diagnosis of HSCT or did not follow-up with UTMB. RESULTS: Of the 38 patients in our cohort, 23.7% (n = 9) were noted to have oGVHD. As many as 89% of the patients with oGVHD presented with an ocular surface disease including keratoconjunctivitis sicca, meibomian gland dysfunction, and dry eye syndrome. Systemic GVHD also was found in 44% of the patients with oGVHD. Only 29% (n = 11) of the study population had referrals to ophthalmology. Most referrals (55%) were made within 1 year of getting the HSCT. None of the patients in our cohort received an ocular screening before HSCT. CONCLUSIONS: Many post-HSCT patients lack routine ophthalmic care. Regularly assessing post-HSCT patients for early signs and symptoms of oGVHD may limit adverse outcomes. Management of oGVHD should involve a multidisciplinary team approach.

Evaluation of the Surface Roughness and Color Stability of Two Types of Milled Zirconia Before and After Immersion in Alcoholic Beverages: An In Vitro Study.

Objective This study aims to evaluate the effects of immersion in alcoholic beverages on the surface roughness and color stability of two types of milled zirconia. Materials and methods The sample size included 60 cuboid-shaped samples of two types of zirconia (Z1 and Z2), 30 in each group. Zirconia was milled and sintered at 1,500°C for eight hours. The samples were immersed in artificial saliva (control), red wine, and whiskey three times a day over a 30-day period. After each post-immersion cycle, samples were cleaned ultrasonically. Surface roughness and color parameters were measured using an atomic force microscope (AFM) and spectrophotometer before and after immersion. The collected data was organized into tables, and statistical analysis was conducted using the Statistical Package for the Social Sciences (SPSS) version 27 software (IBM SPSS Statistics, Armonk, NY). For surface roughness, a paired t-test was conducted, while for color change, one-way analysis of variance (ANOVA) and Tukey's honestly significant difference (HSD) tests were done. Results The mean values of pre- and post-immersion values reveal that whiskey causes the highest difference in surface roughness for Z1 (137.09 nm) and Z2 (86.15 nm) groups, while red wine causes maximum discoloration in both Z1 (2.41) and Z2 (1.94) groups. The paired t-test revealed significant surface roughness changes in Z1 with artificial saliva and red wine, while whiskey (p<0.05), although showing changes, lacked statistical significance (p>0.05). The whiskey group demonstrated a moderate linear association (0.599) between pre- and post-immersion values. For Z2, artificial saliva, red wine, and whiskey (p<0.05) induced statistically significant surface roughness alterations. ANOVA tests indicated significant color changes post-immersion in all three subgroups of Z1 and Z2 (p<0.05 for both). Tukey's HSD test showed significant differences between artificial saliva and red wine (p<0.05), as well as artificial saliva and whiskey (p<0.05) in Z1 and Z2. However, no significant difference was found between red wine and whiskey in both Z1 and Z2 groups (p>0.05). Conclusion Whiskey, red wine, and artificial saliva increased zirconia's surface roughness. Alcoholic solutions altered zirconia's colorimetric parameters, with no significant differences among them.

Comparing physiological impacts of positive pressure ventilation versus self-breathing via a versatile cardiopulmonary model incorporating a novel alveoli opening mechanism.

Mathematical models can be used to generate high-fidelity simulations of the cardiopulmonary system. Such models, when applied to real patients, can provide valuable insights into underlying physiological processes that are hard for clinicians to observe directly. In this work, we propose a novel modelling strategy capable of generating scenario-specific cardiopulmonary simulations to replicate the vital physiological signals clinicians use to determine the state of a patient. This model is composed of a tree-like pulmonary system that features a novel, non-linear alveoli opening strategy, based on the dynamics of balloon inflation, that interacts with the cardiovascular system via the thorax. A baseline simulation of the model is performed to measure the response of the system during spontaneous breathing which is subsequently compared to the same system under mechanical ventilation. To test the new lung opening mechanics and systematic recruitment of alveolar units, a positive end-expiratory pressure (PEEP) test is performed and its results are then compared to simulations of a deep spontaneous breath. The system displays a marked decrease in tidal volume as PEEP increases, replicating a sigmoidal curve relationship between volume and pressure. At high PEEP, cardiovascular function is shown to be visibly impaired, in contrast to the deep breath test where normal function is maintained.

Remarkable enhancement of the adsorption and diffusion performance of alkali ions in two-dimensional (2D) transition metal oxide monolayers via Ru-doping.

Transition metal oxides (TMO) are the preferred materials for metal ion battery cathodes because of their high redox potentials and good metal-ion intercalation capacity, which serve as an outstanding replacement for layered sulphide. In this work, using first-principles calculations based on Density functional theory approach, we explored the structural and electronic properties which comprise of adsorption and diffusion behaviour along with the analysis of voltage profile and storage capacity of Ru doped two-dimensional transition metal oxide [Formula: see text], [Formula: see text], and [Formula: see text] monolayers. The adsorption of alkali ions (Li, Na) to the surface of TMOs is strengthened by Ru-atom doping. Ru doping enhanced the adsorption energy of Li/Na-ion by 25%/11% for [Formula: see text], 8%/13% for [Formula: see text], and 10%/11% [Formula: see text] respectively. The open circuit voltage (OCV) also increases due to the high adsorption capacity of doped Monolayers. Ru doping makes the semiconducting TMOs conduct, which is suitable for battery application. As alkali ion moves closer to the dopant site, the adsorption energy increases. When alkali ions are close to the vicinity of doping site, their diffusion barrier decrease and rises as they go further away. Our current findings will be useful in finding ways to improve the storage performance of 2D oxide materials for application in energy harvesting and green energy architecture.

An all phosphorene lattice nanometric spin valve.

Phosphorene is a unique semiconducting two-dimensional platform for enabling spintronic devices integrated with phosphorene nanoelectronics. Here, we have designed an all phosphorene lattice lateral spin valve device, conceived via patterned magnetic substituted atoms of 3d-block elements at both ends of a phosphorene nanoribbon acting as ferromagnetic electrodes in the spin valve. Through First-principles based calculations, we have extensively studied the spin-dependent transport characteristics of the new spin valve structures. Systematic exploration of the magnetoresistance (MR) of the spin valve for various substitutional atoms and bias voltage resulted in a phase diagram offering a colossal MR for V and Cr-substitutional atoms. Such MR can be directly attributed to their specific electronic structure, which can be further tuned by a gate voltage, for electric field controlled spin valves. The spin-dependent transport characteristics here reveal new features such as negative conductance oscillation and switching of the sign of MR due to change in the majority spin carrier type. Our study creates possibilities for the design of nanometric spin valves, which could enable integration of memory and logic elements for all phosphorene 2D processors.

Decisions With Patients, Not for Patients: Shared Decision-Making in Allergy and Immunology.

Shared decision-making (SDM) is an increasingly implemented patient-centered approach to navigating patient preferences regarding diagnostic and treatment options and supported decision-making. This therapeutic approach prioritizes the patient's perspectives, considering current medical evidence to provide a balanced approach to clinical scenarios. In light of numerous recent guideline recommendations that are conditional in nature and are clinical scenarios defined by preference-sensitive care options, there is a tremendous opportunity for SDM and validated decision aids. Despite the expansion of the literature on SDM, formal acceptance among clinicians remains inconsistent. Surprisingly, a significant disparity exists between clinicians' self-reported adherence to SDM principles and patients' perceptions of its implementation during clinical encounters. This discrepancy underscores a fundamental issue in the delivery of health care, where clinicians may overestimate their integration of SDM, while patients' experiences suggest otherwise. This review critically examines the factors contributing to this inconsistency, including barriers within the health care system, clinician attitudes and behaviors, and patient expectations and preferences. By elucidating these factors in the fields of food allergy, asthma, eosinophilic esophagitis, and other allergic diseases, this review aims to provide insights into bridging the gap between clinician perception and patient experience in SDM. Addressing this discordance is crucial for advancing patient-centered care and ensuring that SDM is not merely a theoretical concept but a tangible reality in the.

Thiazine-derived compounds in inhibiting efflux pump in Staphylococcus aureus K2068, mepA gene expression, and membrane permeability alteration.

Staphylococcus aureus is a bacterium responsible for resistance to multiple drugs and the efflux system is widely studied among the resistance mechanisms developed by this species. The present study evaluates the inhibition of the MepA efflux pump by thiadiazine-derived compounds. For this purpose, thiadiazine-derived compounds (IJ-14 to IJ-20) were tested against S. aureus K2068 strains. Microdilution tests were initially conducted to assess the Minimum Inhibitory Concentration (MIC) of the compounds and their efflux pump inhibition activity. In addition, fluorimetry tests were performed using BrEt emission and tests were conducted to inhibit the expression of the mepA gene. This involved comparing the bacterial gene expression with the antibiotic alone to the gene expression after combining compounds (IJ-17 and IJ-20) with the antibiotic. Furthermore, membrane permeability assessment tests and in silico molecular docking tests were performed. It was observed that the IJ17 and IJ20 compounds exhibited direct activity against the tested strain. The IJ17 compound produced significant results in the gene inhibition tests, which was also evidenced through the membrane permeability alteration test. These findings suggest that thiadiazine-derived compounds have promising effects against one of the main resistance mechanisms, with the IJ17 compound presenting observable mechanisms of action.

Evaluación del estado nutricional de adultos mayores que viven en un centro geriátrico en Caracas, basada en técnicas de despistaje de desnutrición Mini Nutritional Assessment (MNA) / Evaluation of the nutritional status of older adults living in a geriatric center in Caracas, based on malnutrition screening techniques Mini Nutritional Assessment (MNA)

La valoración del estado nutricional constituye un aspecto clave en la atención de la población adulta mayor, aunque no existe una herramienta de referencia que permita definir de forma inequívoca la situación nutricional de un paciente, la intervención nutricional a través del diagnóstico-planificación-acción-evaluación, mejora la calidad de vida y garantiza la salud. Con el propósito de realizar diagnostico nutricional de 66 adultos mayores, que se encuentran viviendo en un centro geriátrico de larga estancia de Caracas, se elaboró y aplicó un formato de historia nutricional que incluiría la encuesta MNA y otros parámetros de interés. Este instrumento detectó de forma rápida, sencilla, económica y poco invasiva 25,76% casos de malnutrición y 40,91% riesgo de malnutrición en los evaluados, así como las posibles condiciones que las generan como demencia senil tipo Alzheimer, hipertensión arterial que requiere polimedicación y discapacidad motora. La evaluación antropométrica permitió detectar que el 70,59% de la malnutrición es de tipo calórica protéica. La dificultad para vivir sólos, el envejecimiento y la poca ingesta de alimentos, especialmente de aceite de oliva y frutos secos, influyen en el deterioro de la salud de estos pacientes. Un IMC promedio inferior a 23 kg/m² y la circunferencia de pantorrilla inferior a 31cm, demuestran un socavado estado nutricional y un déficit protéico. La información obtenida, permitió realizar un informe nutricional individualizado que se incluyó en la historia médica de cada paciente, que podrían ser utilizada en un futuro para realizar cambios al menú, recomendaciones, suplementación e interconsultas médicas a quienes requirieran mayor intervención de acuerdo a cada caso.

The assessment of nutritional status is a key aspect in the care of older adults, although there is no reference tool that can unmistakenly define the nutritional status of a patient, nutritional intervention through diagnosis-planning-actionevaluation improves the quality of life and guarantees health. In order to perform nutritional diagnosis to 66 older adults, who are living in a long stay nursing home in Caracas, a format of nutritional history was developed and applied, which included the MNA survey and other factors of interest. This method detected in a quick, simple, inexpensive and minimally invasive manner 25.76% cases of malnutrition and 40.91% cases of malnutrition at risk within the assessed, as well as the possible conditions that generate them such as senile dementia (Alzheimer’s type), high blood pressure which requires multiple medication, and motor disabilities. The anthropometric assessment allowed us to detect that 70.59% of malnutrition is of a protein calorie kind. The difficulty of living alone, aging and a low intake of food, particularly olive oil and nuts, influence the deteriorating health of these patients. An average BMI below 23 kg/m² and the circumference of less than 31cm calf, show an undercut nutritional status and a protein deficit. The information obtained allowed an individualized nutritional report that was included in the medical history of each patient, one which could be used in the future to make changes to the menu, to give recommendations, supplementation and medical interconsultations to those who require greater intervention according to each case.

Mulheres e HIV/Aids: informação, ação e recursos relativos as mulheres e HIV/Aids, saúde reprodutiva e relações sexuais

Manual de informações dirigido especialmente para pais, estudantes, professores e agentes multiplicadores de informações. O manual traz informações sobre comportamentos sexuais, o conhecimento do corpo humano e o seu funcionamento, a sexualidade em diferentes fases, os principais problemas sexuais, todos métodos anticoncepcionais, as diferentes formas de manisfestação da sexualidade e os fatores que podem melhorar o prazer sexual

User Acceptability of the female condom in Zimbabwe

Zimbabwe has experienced a rapid rise in HIV seroprevalence in the past five years. Current estimates of infection rates among urban adults arebetween 10-15 percent. The male condom; currently the mainstay of prevention strategies; is limited by the fact that it is not widely used and depends on male initiative as well as consent. The female condom offers an alternative method that may provide women with more options to reduce their risk of infection. The proposed project will examine the acceptability of the female condom among female volunteers form four different groups: urban outpatient clinicic attendets; urbannurses; rural hospital attenders and commercial sex workers. Where possible; male partners will also be interviewed. Eligible women in these settings who meet inclusion criteria (principally that they be currently sexually active and free of sexually transmitted disease) and following a supervised fitting of the condom will be invited ot participate in a two week trial of the female condom. At completion; they will be interviewed to determine the acceptability of the condom to themselves and their partners. Group discussions will aim to determine the beliefs; feelings and knowledge of women experienced in female condom use. The discussions will determine informational needs as well as messages which may be usedin future promotional materials. The study will not examine effectiveness of thefemale condom

Consequences of smallpox vaccination in leprosy patients

This study illustrates the consequences of smallpox revaccination in 45 lepromatous, 28 tuberculoid, and 47 normal individuals. Results obtained with leprosy were associated with a relative anergy against the vaccinia virus, the anergy being minimal in the tuberculoid leprosy but marked in the cases with lepromatous leprosy.