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Objective: The evidence underlying the efficacy and safety of minimally invasive mitral valve surgery (MIMVS) is inconclusive. We conducted a meta-analysis to evaluate whether MIMVS improves clinical outcomes compared with conventional sternotomy. Methods: We searched MEDLINE (via PubMed), Embase, the Cochrane Library, and ClinicalTrials.gov from inception to January 2024 for all randomised controlled trials (RCTs), comparing MIMVS with conventional mitral valve surgery. RevMan 5.4 was used to analyse the data with risk ratio (RR) and mean difference (MD) as the effect measures. Results: Eight studies reporting data on 7 RCTs were included in our review. There was no significant difference in all-cause mortality, the number of patients requiring blood product transfusion, and the change from baseline in the SF-36 physical function scores between the MIMVS and conventional sternotomy groups. MIMVS reduced the length of hospital stay (MD -2.02 days, 95% CI: -3.66, -0.39) but did not affect the length of ICU stay, re-operation for bleeding, and the incidence of renal injury, wound infection, neurological events, and postoperative moderate or severe mitral regurgitation. MIMVS was associated with a trend toward lower postoperative pain scores (MD -1.06; 95% CI: -3.96 to 0.75). Conclusions: MIMVS reduced the number of days spent in the hospital and showed a trend toward lower postoperative pain scores, but it did not decrease the risk of all-cause mortality or the number of patients needing blood product transfusions. Further large-scale RCTs are required to inform definitive conclusions, particularly with regard to quality-of-life outcomes investigating functional recovery. Systematic Review Registration: PROSPERO (CRD42023482122).
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About 26 million people worldwide use the Saraiki language [1]. In the southern part of Punjab and Sindh, Saraiki language is extensively spoken. One of the most important Saraiki cultural hubs is Dera Ghazi Khan. In Dera Ghazi Khan, the Saraiki language is spoken by over 90 % of the population. Calligraphers use a sophisticated script to write this language. Despite the vast body of Optical Character Recognition (OCR) literature and research dedicated to other languages, a fully functional OCR system is still needed for Saraiki language [2,3]. This work presents a genuine dataset of Saraiki handwritten characters, consisting of 50,000 scanned photos, and makes it accessible to the public for use. All of the photographs include handwritten text contributed by teachers and students from Pak-Austria Fachhochschule for Applied Sciences and Technology, Pakistan. Around 1000 people, roughly half men and half women, contributed in writing this text. For scientific research, the dataset will be made accessible to the general public.
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Background: Malignant pheochromocytomas are rare and aggressive tumors that arise from the adrenal medulla and secrete catecholamines. Patients exhibit episodic symptoms of hypertension, headaches, sweating, and palpitations. The diagnosis is supported by elevated levels of urinary metanephrines, and imaging is used to determine the stage. Treatment involves surgical resection when possible. Case Report: A 57-year-old male presented with hematemesis and melena, and endoscopy revealed upper gastrointestinal bleeding. Imaging showed a malignant pheochromocytoma that had infiltrated the upper lobe of the right kidney and the right lobe of the liver, with a tumor thrombus extending into the hepatic inferior vena cava, the right atrium, and the right ventricle. The patient denied surgery and was treated with palliative medical therapy until he died 3 months later. Conclusion: Although rare, malignant pheochromocytomas may present with upper gastrointestinal bleeding. While metastasis to the liver is a typical manifestation of malignant pheochromocytomas, invasion of the inferior vena cava with infiltration to the right ventricle resulting in tricuspid valve malfunction is a rare finding.
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Cryptococcal meningitis represents a severe opportunistic fungal infection primarily observed in individuals with compromised immune systems. It frequently manifests in symptoms like headaches, vomiting, cranial nerve complications, and cognitive alterations. However, it's worth noting that up to 15% of cases may exhibit no discernible central nervous system-related symptoms. A 70-year-old male, previously diagnosed with pulmonary tuberculosis and undergoing treatment with anti-tubercular medications, was admitted due to changes in consciousness, sporadic low-grade fever, and cognitive impairment. An in-depth investigation revealed his HIV-negative and non-diabetic status, as well as his preserved immune competence. A plain CT head showed a communicating hydrocephalus and a lumbar puncture was positive for Cryptococcus neoformans. Treatment commenced with an induction regimen encompassing amphotericin and fluconazole, concurrently maintaining the anti-tubercular treatment course. The patient's condition displayed improvement, leading to a transition to a maintenance dosage of fluconazole. This case highlighted an extraordinary occurrence of Cryptococcal meningitis in an HIV-negative patient with no history of immunosuppressant use. Notably, Cryptococcal infection should be regarded as a primary consideration in patients afflicted by pulmonary tuberculosis who subsequently present with altered consciousness. The timely identification and proper management of such instances can substantially mitigate the risks of mortality and morbidity associated with this condition.
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Acute porphyria results from a deficiency of enzymes crucial for the heme synthesis process. This deficiency leads to elevated levels of intermediates, resulting in the characteristic symptoms of porphyrias such as abdominal and limb pain, neuropsychiatric issues, and sensitivity to light. In this report, we present the case of a 15-year-old male who experienced deteriorating motor neuropathy and recurrent bouts of abdominal pain. Numerous investigations were conducted, eventually leading to a diagnosis of acute porphyria. Despite attempts with hemin and glucose therapy, his motor neuropathy did not improve. However, significant progress was observed following plasmapheresis sessions. This case emphasizes the importance of considering acute porphyrias as a potential cause when managing patients with acute abdominal problems. By fostering a collaborative approach involving hematologists, physicians, neurologists, and surgeons, timely diagnosis and effective management of this condition can be achieved.
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We develop a probabilistic model for determining the location of dc-link faults in MT-HVdc networks using discrete wavelet transforms (DWTs), Bayesian optimization, and multilayer artificial neural networks (ANNs) based on local information. Likewise, feedforward neural networks (FFNNs) are trained using the Levenberg-Marquardt backpropagation (LMBP) method, which multi-stage BO optimizes for efficiency. During training, the feature vectors at the sending terminal of the dc link are selected based on the norm values of the observed waveforms at various frequency bands. The multilayer ANN is trained using a comprehensive set of offline data that takes the denoising scheme into account. This choice not only helps to reduce the computational load but also provides better accuracy. An overall percentage error of 0.5144% is observed for the proposed algorithm when tested against fault resistances ranging from 10 to 485 Ω. The simulation results show that the proposed method can accurately estimate the fault site to a precision of 485 Ω and is more robust.
Subject(s)
Algorithms , Neural Networks, Computer , Bayes Theorem , Computer Simulation , TimeABSTRACT
Purpose: To identify the iris morphology-related factors for prediction of outcomes of excessively low vault (< 100 µm) after Implantable Collamer Lens V4c (ICL V4c; STAAR Surgical) implantation. Methods: This retrospective case-control study included 81 eyes from 2,080 patients who underwent ICL implantation. Twenty-seven eyes of 27 patients with excessively low vault (< 100 µm) constituted the case group (excessively low vault group). Patients with vault (250 to 750 µm) were selected as the optimal vault group by matching anterior chamber depth, white-to-white distance and ICL size with cases with excessive low vault (< 100 µm) at a proportion of 1:2. The preoperative biometric parameters and postoperative vault were recorded. Multiple linear regression analysis was performed to assess the relationship between the postoperative vault and various variables. Conditional logistic regression analysis was used to estimate the risk factors for excessively low vault. Results: The postoperative vault was associated with preoperative pupil diameter (PD), crystalline lens rise, iris concavity and the ratio of the iris concavity to chord length (P < 0.05). The larger iris concavity increased risk of excessively low postoperative vault (< 100 µm) (OR = 81.10; 95%CI = 2.87 to 2296.58; P = 0.01). Conclusions: Eyes with obviously concave iris were associated with a higher rate of excessively low vault (< 100 µm). Evaluation of iris morphology may provide significant information for predicting excessive postoperative vault.
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Deep neural networks are efficient methods of recognizing image patterns and have been largely implemented in computer vision applications. Object detection has many applications in computer vision, including face and vehicle detection, video surveillance, and plant leaf detection. An automatic flower identification system over categories is still challenging due to similarities among classes and intraclass variation, so the deep learning model requires more precisely labeled and high-quality data. In this proposed work, an optimized and generalized deep convolutional neural network using Faster-Recurrent Convolutional Neural Network (Faster-RCNN) and Single Short Detector (SSD) is used for detecting, localizing, and classifying flower objects. We prepared 2000 images for various pretrained models, including ResNet 50, ResNet 101, and Inception V2, as well as Mobile Net V2. In this study, 70% of the images were used for training, 25% for validation, and 5% for testing. The experiment demonstrates that the proposed Faster-RCNN model using the transfer learning approach gives an optimum mAP score of 83.3% with 300 and 91.3% with 100 proposals on ten flower classes. In addition, the proposed model could identify, locate, and classify flowers and provide essential details that include flower name, class classification, and multilabeling techniques.
Subject(s)
Neural Networks, Computer , Software , FlowersABSTRACT
PURPOSE: To explore the feasibility of cyclophosphamide (CP) via a sub-Tenon micro-perfusion system (SMS) in rabbits, and assess its therapeutic efficacy in severe ocular inflammation. MATERIALS AND METHODS: Distribution and pharmacokinetics of CP were evaluated in vivo, and the concentrations of CP in plasma, vitreous humor, and retina/choroid were quantitated by ultra-high-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) at different time points. After induction of severe experimental uveitis, rabbits were divided into three groups (n=8 in each): the SMS group, subconjunctival injection (SI) group, and control group. Clinical inflammatory score was assessed in rabbits. Electroretinography and histopathology were performed on post-treatment day 8. Statistical analyses were performed using Mann-Whitney and Kruskal-Wallis tests. P-value less than 0.05 was considered significant. RESULTS: The concentrations of CP in vitreous humor and retina/choroid in the SMS group were significantly higher than that of the SI group at 3, 6, 10, and 24 hours (P<0.01), while plasmatic CP concentrations were comparable at all time points in the SMS group and SI group (P>0.05). The SMS group showed significantly less inflammation compared to the control group and SI group. Furthermore, the restoration of retinal structure and function were more obvious in the SMS group compared with conventional SI application. CONCLUSION: Sub-Tenon micro-perfusion of CP exhibited satisfied therapeutic efficacy in rabbits with severe ocular inflammation and may provide a promising alternative for controlling ocular inflammatory disease and immune-mediated ocular diseases.
Subject(s)
Anti-Inflammatory Agents/therapeutic use , Cyclophosphamide/therapeutic use , Inflammation/drug therapy , Ophthalmic Solutions/therapeutic use , Uveitis/drug therapy , Animals , Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents/analysis , Cyclophosphamide/administration & dosage , Cyclophosphamide/analysis , Disease Models, Animal , Female , Inflammation/pathology , Male , Ophthalmic Solutions/administration & dosage , Ophthalmic Solutions/analysis , Perfusion , Rabbits , Severity of Illness Index , Uveitis/pathologyABSTRACT
BACKGROUND: To calculate and evaluate the prevalence of reduced uncorrected distant visual acuity (UCDVA) in primary, middle and high schools in 6 districts of Changsha, Hunan, China. METHODS: A population-based retrospective study was conducted in 239 schools in 6 districts of Changsha. After routine eye examination to rule out diseases that can affect refraction, 250,980 eligible students from primary, middle and high schools were enrolled in the survey. Then the uncorrected distant and near visual acuity of each eye were measured. Categories of schools, districts, grades, eye exercises and sports time were also documented and analyzed. RESULTS: The overall prevalence of reduced UCDVA was 51.8% (95% confidence interval [CI]: 51.6-52.0%) in 6 districts of Changsha. Results of individual districts were as follows: Furong district 59.9%(95% CI: 57.9-61.8%), Tianxin district 62.3%(95% CI: 60.5-64.0%), Wangcheng district 47.8%(95% CI: 46.8-48.8%), Kaifu district 58.5%(95% CI: 58.0-58.9%), Yuhua district 47.0%(95% CI: 46.7-47.4%) and Yuelu district 52.6%(95% CI: 52.3-52.9%). The proportion of normal VA is seen to decrease from primary grade 3. The proportion of mildly reduced UCDVA is higher in primary grade 1 and 2. The proportion of moderately reduced UCDVA remains similar during 12 grades. The proportion of severely reduced UCDVA increases with grades. Multivariate analysis shows that the prevalence of reduced UCDVA is higher in key schools (risk ratio [RR] = 1.47, 95% CI 1.44-1.50) than non-key schools. CONCLUSIONS: According to the existing data analysis results, the prevalence of reduced UCDVA among primary, middle and high school students in Changsha is very high. Some effective measures need to be taken to prevent it.
Subject(s)
Schools , Adolescent , Child , China/epidemiology , Humans , Prevalence , Retrospective Studies , Visual AcuityABSTRACT
BACKGROUND: The aim of this study was to compare the distribution characteristics and ocular pharmacokinetics of norvancomycin (NVCM) in ocular tissues of the anterior segment between continuous topical ocular instillation and hourly administration of eye drop in rabbits. METHODS: Sixty rabbits were randomly divided into two groups: continuous topical ocular instillation drug delivery (CTOIDD) group and eye drop (control) group. In the CTOIDD group, NVCM solution (50 mg/mL) was perfused to the ocular surface using the CTOIDD system at 2 mL/h up to 10 h and the same solution was administered at one drop (50 µL) per hour for 10 h in the control group. Animals (N=6 per time-point per group) were humanely killed at 2, 4, 6, 10, and 24 h to analyze their ocular tissues and plasma. The concentrations of NVCM in the conjunctiva, cornea, aqueous humour, iris, ciliary body and plasma were measured by HPLC with photodiode array detector. The pharmacokinetic parameters were calculated by Kinetica 5.1. RESULTS: The highest concentrations of NVCM for the CTOIDD group and control group were 2105.45±919.89 µg/g and 97.18±43.14 µg/g in cornea, 3033.92±1061.95 µg/g and 806.99±563.02 µg/g in conjunctiva, 1570.19±402.87 µg/g and 46.93±23.46 µg/g in iris, 181.94±47.11 µg/g and 15.38±4.00 µg/g in ciliary body, 29.78±4.90 µg/mL and 3.20±1.48 µg/mL in aqueous humour, and 26.89±5.57 µg/mL and 1.90±1.87 µg/mL in plasma, respectively. The mean NVCM levels significantly increased at all time-points in cornea, iris, and ciliary body (p<0.05) in the CTOIDD group. The AUC0-24 values in the CTOIDD group were 27,543.70 µg·h/g in cornea, 32,514.48 µg·h/g in conjunctiva, 8631.05 µg·h/g in iris, 2194.36 µg·h/g in ciliary body and 343.9 µg·h/mL in aqueous humour, which were higher than for the eye drop group in all tissues. CONCLUSION: Since continuous instillation of NVCM with CTOIDD could reach significantly higher concentrations and was sustained for a longer period compared with hourly administration of eye drop, CTOIDD administered NVCM could be a possible method to treat bacterial keratitis.
Subject(s)
Eye/drug effects , Ophthalmic Solutions/pharmacokinetics , Vancomycin/analogs & derivatives , Administration, Topical , Animals , Dose-Response Relationship, Drug , Drug Delivery Systems , Eye/pathology , Molecular Conformation , Ophthalmic Solutions/administration & dosage , Rabbits , Structure-Activity Relationship , Tissue Distribution , Vancomycin/administration & dosage , Vancomycin/pharmacokineticsABSTRACT
PURPOSE: To evaluate the efficacy of dexamethasone (DXM) through sub-tenon sustained controllable drug delivery system (SSCDDS) for treating severe acute experimental uveitis. METHODS: Rabbits were treated with either DXM (treated group) or normal saline (control group) through SSCDDS. Clinical signs of uveitis were assessed at days 1, 3, 5, 7, and 14 after treatment. Histopathologic examinations were performed to evaluate inflammatory cell infiltration on posttreatment days 7 and 14. RESULTS: All signs of experimental uveitis were reduced by SSCDDS of DXM according to clinical criteria, and the treated group had significantly less inflammation than the control group (p<0.05). Histopathologic examinations showed severe inflammation and marked inflammatory cell infiltration in the control group, but minimal inflammation in the treated group. CONCLUSIONS: Sub-tenon sustained controllable delivery of DXM effectively suppresses severe acute inflammation in a rabbit model of uveitis. The proposed minimal invasive system might be a promising candidate for managing severe ocular diseases.
Subject(s)
Dexamethasone/administration & dosage , Disease Models, Animal , Drug Delivery Systems , Glucocorticoids/administration & dosage , Tenon Capsule/drug effects , Uveitis/drug therapy , Acute Disease , Animals , Delayed-Action Preparations , Female , Flow Cytometry , Male , Mycobacterium tuberculosis , Rabbits , Slit Lamp Microscopy , Uveitis/diagnosisABSTRACT
BACKGROUND: The changes in corneal biomechanical properties after LASIK remain an unknown but important topic for surgical design and prognostic evaluation. This study aims to observe the postoperative corneal biomechanical properties one month after LASIK with amount of corneal cutting (ACC) greater than 50% of the central corneal thickness (CCT). METHODS: FS-LASIK was performed in 10 left rabbit eyes with ACC being 60% (L60) and 65% (L65) of the CCT, while the right eyes (R) were the control. After 4 weeks, rabbits were executed and corneal strip samples were prepared for uniaxial tensile tests. RESULTS: At the same strain, the stresses of L65 and L60 were larger than those of R. The elastic moduli of L60 and L65 were larger than those of R when the stress was 0.02 MPa, while they began to be less than those of R when stress exceeds the low-stress region. After 10 s relaxation, the stress of specimens L65, L60, and R increased in turn. CONCLUSION: The elastic moduli of the cornea after FS-LASIK with ACC greater than 50% of the CCT do not become less under normal rabbit IOP. The limit stress grows with the rise of ACC when relaxation becomes stable.
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BACKGROUND: Flowers are admirable in scenic good looks and artistic beautification. These are also playing necessary roles in therapeutic preparations. Aphid is an important sucking pest of various flowers in ornamental territories and it is generally controlled by predators, so it was necessary to evaluate which aphid species affect the predator more or less. MATERIALS AND METHODS: Biocontrol agent Coccinella septempunctata was used against cosmos aphid (Aphis spiraecola, rose aphid (Macrosiphum rosea), gul e ashrafi aphid (Aphis fabae), kaner aphid (Aphis nerii), chandni aphid (Sitobion avenae), dahlia aphid (Myzus persicae) and annual chrysanthemum aphid (Macrosiphoniella sanborni). RESULTS: The grub of C. septempunctata consumed 283.8±9.04 M. rosea, 487.7±12.6 M. sanborni, 432.75±16.02 A. spiraecola, 478.2±8.07 A. fabae, 552.3±9.04 M. persicae, 142±1.32 A. nerii and 498.5±13.09 S. avenae in its whole larval life. The M. persicae and M. rosea consuming grubs showed 100% adult emergence while, M. sanborni, A. spiraecola, A. fabae and S. avenae showed 96.58, 89.02, 94.78 and 75.45% adult emergence, respectively. CONCLUSION: The C. septempunctata has significant predatory potential against A. spiraecola, M. rosea, A. fabae, S. avenae, M. persicae and M. sanborni except A. nerii. Thus, further studies are needed to find out alternate predator to control A. nerii on ornamentals.
Subject(s)
Aphids/classification , Biological Control Agents , Coleoptera/physiology , Feeding Behavior , Flowers/parasitology , Predatory Behavior , Animals , Coleoptera/growth & development , Larva/growth & development , Larva/physiologyABSTRACT
The antioxidant activity of fresh and rehydrated sea cucumber (Cucumaria frondosa) samples with/without internal organs was evaluated for the first time. In addition, their proximate, amino acid, and fatty acid compositions were examined. Rehydrated sea cucumber samples in distilled water were prepared from oven-dried products. All samples contained 83-90% moisture, but showed a significant difference among groups in their protein and lipid contents. Glutamic acid was the predominant amino acid in sea cucumber, followed by glycine and aspartic acid. Essential amino acids such as leucine and lysine were also present at high levels. The trend for free amino acid was different from that of total amino acids and varied among groups. Lipids in sea cucumber were dominated by eicosapentaenoic acid (EPA, C20:5n-3), ranging from 43.2 to 56.7% of the total fatty acids. Docosahexaenoic acid (DHA, C22:6n-3) was present at a much lower concentration of 2.0-5.8%. All sea cucumber samples exhibited radical scavenging property against 2,2'-azobis(2-aminopropane) dihydrochloride (AAPH) and 1,1-diphenyl-2-picrylhydrazyl (DPPH) radicals, with rehydrated samples, especially those with internal organs, possessing higher antioxidant activity than their fresh counterparts. No correlation existed between radical scavenging capacity and total phenolics content, suggesting that other components, in addition to phenolic compounds, contribute to the antioxidant activity of sea cucumber.
Subject(s)
Antioxidants/analysis , Cucumaria/chemistry , Food Handling/methods , Amino Acids/analysis , Animals , Fatty Acids/analysis , Phenols/analysisABSTRACT
This study examined (1) the effects of seasonal and annual environmental characteristics (temperature, chlorophyll content, salinity, microbial water quality, and algal lipid composition) in four aquaculture locations on the quality (meat content, shell size, and microbial and lipid compositions) of cultivated blue mussels and (2) the optimum harvest time for premium-quality mussels. Seasonal and annual temperature fluctuation of the seawater in the aquaculture sites significantly (P < 0.05) affected their salinity, microbial content, and algal fatty acid compositions, which in turn affected the quality attributes of cultivated mussels. The optimum growth period in terms of meat content (4-5 g) and shell size (50-60 mm) can be achieved within 1 year of cultivation. Because the cultivated mussels examined in this study never reached the maximum microbial load limits (10(5) or log 5 colony-forming units/g of meat), they can be harvested throughout the year. Meanwhile, no significant (P > 0.05) annual changes were observed in total omega-3 polyunsaturated fatty acids content of cultivated mussels. Nonetheless, the optimum harvest time may be April-June for eicosapentaenoic acid (EPA) rich mussels and September-October for docosahexaenoic acid (DHA) rich mussels in terms of fatty acid proportions; however, June may be the best month for the highest concentrations of both EPA and DHA.
Subject(s)
Aquaculture , Environment , Mytilus edulis , Quality Control , Shellfish , Animals , Fatty Acids/analysis , Mytilus edulis/chemistry , Mytilus edulis/growth & development , Mytilus edulis/microbiology , Seasons , TemperatureABSTRACT
To devise proper strategies to evaluate and maintain the quality of cultured blue mussels (Mytilus edulis) during storage on ice, this study examined the potential use of microbial growth, pH, lipid oxidation, and composition characteristics as quality indicators. It also evaluated the use of individual (i15:0, ai15:0, i16:0, ai16:0, i17:0, ai17:0, 17:0) and total bacterial fatty acid contents as a rapid method to examine the microbial quality of stored mussels. Linear regression analyses of the storage period of mussels vs various quality indicators indicated that the strongest correlation was between the storage period and microbial growth (r = 0.973, p < 0.0001) followed by the microbial fatty acid ai15:0 content (r = 0.903, p < 0.0001) and ash content (r = 0.819, p = 0.0002). All other correlations between the storage period and quality indicators were moderate (r = 0.500-0.700 and p < 0.05), poor (r < 0.500 and p > 0.05), or negative (r = -0.657 and p = 0.027).