Impact of right ventricular failure on the outcomes of acute inferior wall myocardial infarction.

Aim: Right ventricular failure (RVF) complicates 30-50% of cases with inferior wall myocardial infarctions (IWMI). Large-scale studies exploring the recent trends in morbidity and mortality of IWMI with RVF in the context of improved reperfusion strategies are currently lacking. Materials & methods: The International Classification of Diseases, Tenth Revision, Clinical Modification codes were used to query the National Inpatient Sample of 2018-2019 to yield IWMI admissions and stratified based on presence of RVF. The primary outcome was in-hospital mortality. Results: Out of the 182,485 weighed hospital admissions for IWMI, 1005 patients (0.6%) also had RVF. Patients with both IWMI and RVF had significantly higher mortality than patients with IWMI and no RVF (p < 0.001). Conclusion: RVF in patients with IWMI is an independent predictor of poor outcomes.

What is this article about? Right ventricular failure (RVF) refers to a condition in which the right ventricle is unable to pump blood to the left side of the heart. Up to 30­50% of patients with heart attacks, commonly known as acute myocardial infarction, affecting the back or the inferior wall of the heart (IWMI) can develop RVF. Research studies assessing the outcomes of patients with IWMI and RVF were done either in a small number of patients or done during the time when the current standard of acute myocardial infarction care was not the standard of care. Therefore, we conducted a study to assess the clinical outcomes of patients with IWMI and RVF in contemporary times.What are the results? We found that among all patients with IWMI, only about 0.6% had evidence of RVF. However, these patients were older and much more likely to have a higher burden of chronic medical problems and were less likely to have received angioplasty to open blocked arteries when compared with patients with IWMI and no RVF. Patients with IWMI and RVF were noticed to have a higher rate of death during hospitalization.What do the results mean? Patients with IWMI and RVF, when compared with patients with IWMI and no RVF, had significantly higher rates of various complications and death.

GPTFX: A Novel GPT-3 Based Framework for Mental Health Detection and Explanations.

This paper introduces a novel approach GPTFX, an AI-based mental detection with GPT frameworks. This approach leverages GPT embeddings and the fine-tuning of GPT-3. This approach exhibits superior performance in both classifying mental health disorders and generating explanations with accuracy of around 87% in classification and Rouge-L of around 0.75. We utilized GPT embeddings with machine learning models for the classification of mental health disorders. Additionally, GPT-3 was fine-tuned for generating explanations related to the predictions made by these machine learning models. Notably, the proposed algorithm proves well-suited for real-time monitoring of mental health by deploying in AI-IoMT devices, as it has demonstrated greater reliability when compared to traditional algorithms.

Polarity-Induced Morphological Transformation with Tunable Optical Output of Terpyridine-Phenanthro[9,10-d]imidazole-Based Ligand and Its Zn(II) Complexes with I-V Characteristics.

Self-assembled nanostructures obtained from various functional π-conjugated organic molecules have been able to draw substantial interest due to their inherent optical properties, which are imperative for developing optoelectronic devices, multiple-color-emitting devices with color-tunable displays, and optical sensors. These π-conjugated molecules have proven their potential employment in various organic electronic applications. Therefore, the stimuli-responsive fabrication of these π-conjugated systems into a well-ordered assembly is extremely crucial to tuning their inherent optical properties for improved performance in organic electronic applications. To this end, herein, we have designed and synthesized a functional π-conjugated molecule (TP) having phenanthro[9,10-d]imidazole with terpyridine substitution at the 2 position and its corresponding metal complexes (TPZn and (TP)2Zn). By varying the polarity of the self-assembly medium, TP, TPZn, and (TP)2Zn are fabricated into well-ordered superstructures with morphological individualities. However, this medium polarity-induced self-assembly can tune the inherent optical properties of TP, TPZn, and (TP)2Zn and generate multiple fluorescence colors. Particularly, this property makes them useful for organic electronic applications, which require adjustable luminescence output. More importantly, in 10% aqueous-THF medium, TPZn exhibited H-type aggregation-induced white light emission and behaved as a single-component white light emitter. The experimentally obtained results of the solvent polarity-induced variation in optical properties as well as self-assembly patterns were further confirmed by theoretical investigation using density functional theory calculations. Furthermore, we investigated the I-V characteristics, both vertical and horizontal, using ITO and glass surfaces coated with TP, TPZn, and (TP)2Zn, respectively, and displayed maximum current density for the TPZn-coated surface with the order of measured current density TPZn > TP > (TP)2Zn. This observed order of current density measurements was also supported by a direct band gap calculation associated with the frontier molecular orbitals using the Tauc plot. Hence, solvent polarity-induced self-assembly behavior with adjustable luminescence output and superior I-V characteristics of TPZn make it an exceptional candidate for organic electronic applications and electronic device fabrication.

Improved Charge Transport across Bovine Serum Albumin-Au Nanoclusters' Hybrid Molecular Junction.

Proteins, a highly complex substance, have been an essential element in living organisms, and various applications are envisioned due to their biocompatible nature. Apart from proteins' biological functions, contemporary research mainly focuses on their evolving potential associated with nanoscale electronics. Here, we report one chemical doping process in model protein molecules (BSA) to modulate their electrical conductivity by incorporating metal (gold) nanoclusters on the surface or within them. The as-synthesized Au NCs incorporated inside the BSA (Au 1 to Au 6) were optically well characterized with UV-vis, time-resolved photoluminescence (TRPL), X-ray photon spectroscopy, and high-resolution transmission electron microscopy techniques. The PL quantum yield for Au 1 is 6.8%, whereas that for Au 6 is 0.03%. In addition, the electrical measurements showed ∼10-fold enhancement of conductivity in Au 6 (8.78 × 10-3 S/cm), where maximum loading of Au NCs was predicted inside the protein matrix. We observed a dynamic behavior in the electrical conduction of such protein-nanocluster films, which could have real-time applications in preparing biocompatible electronic devices.

Impact of Pulmonary Hypertension in Patients With Hypertrophic Cardiomyopathy Presented With Cardiogenic Shock/Acute Decompensated Heart Failure.

There have been no studies focusing on how pulmonary hypertension (PH) affects inpatient outcomes in patients with hypertrophic cardiomyopathy (HCM) hospitalized for acute decompensated heart failure or cardiogenic shock. This study explores inpatient outcomes of patients with HCM, and concomitant PH compared to patients with HCM. Based on the National Inpatient Sample (NIS) 2016-2018, patients admitted with a primary diagnosis of acute decompensated heart failure or cardiogenic shock were selected. The patients diagnosed with concomitant HCM were identified and divided into 2 groups based on the presence or absence of PH. After propensity matching 1545 matched pairs were generated. Patients with PH had a higher prevalence of chronic kidney disease (P < 0.001), anemia (P < 0.001), coagulopathy (P < 0.001), atrial fibrillation (P = 0.031), and valvular disease (P < 0.001) (Table 1). The primary outcome (all-cause in-hospital mortality) occurred in 110 patients (2.6%) without PH and 95 patients (5.2%) with PH, which was not statistically significant after propensity matching (odds ratio [OR]:1.53; 95% confidence interval [CI]: 0.70-3.33; P = 0. 28) (Table 3). Patients with PH had a higher incidence of transient ischemic attack (TIA) (OR: 9.52; 95% CI: 3.38-26.78; P < 0.001)] and respiratory failure [(OR: 1.49; 95% CI:1.05-2.11; P = 0.027], although with no difference in requirement for mechanical ventilation (= 0.64), as compared to patients without PH. PH in patients with HCM is associated with increased morbidity, including increased risk of TIA and respiratory failure.

Selumetinib: the first ever approved drug for neurofibromatosis-1 related inoperable plexiform neurofibroma.

Plexiform neurofibroma (PN) is one of the most striking clinical features of neurofibromatosis 1. Growth of PN can occur at any stage of life but mostly in childhood and during hormonal changes. They arise from multiple nerve fascicles and may transform into malignant peripheral nerve sheath tumors. There was previously no approved medical therapy for tumor shrinkage or regression. Surgery is not always possible due to inaccessible location, involvement of vital tissue, optimal timing, and incomplete removal. Recently, the US Food and Drug Administration approved selumetinib for pediatric patients, 2 years of age and older, with neurofibromatosis type 1 who have symptomatic, inoperable tumor. Neurofibromin, a 2818 amino acid long cytoplasmic protein, is the product of the NF1 gene. It inhibits the activity of Ras GTPase proteins. Lack of functional neurofibromin in patients with NF1 leads to dysregulated Ras and tumorigenesis. RAS MAPK pathway is hyper activated in NF1. Selumetinib is an inhibitor of MEK1 and MEK2 proteins, which play an important role in the MAPK signaling pathway related to tumor growth. Approval was based on one pivotal, single-arm, phase II trial. 70% of participants experienced confirmed partial response of tumor shrinkage, and 68% also had improvement of related complications, and other studies have also shown beneficial responses. The major limitation of this molecule regarding its mechanism of action is the dose-dependent effect of MEK inhibition in growth of neurofibroma. Long-term safety and efficacy studies are to be done in the future to establish selumetininb as a useful medicine.

Newer Horizon for Treatment of Acute Attack of Migraine: Lasmiditan and Ubrogepant.

Migraine is characterized by severe, intermittent headache attacks with associated symptoms including nausea, vomiting, phonophobia, and photophobia. Still Triptans (selective 5-HT1B/D agonists) are considered as the first-line therapy in acute attack of migraine. Recently two new drugs Lasmiditan and Ubrogepant were approved by United States Food and Drug Administration in acute attack of migraine with or without aura in adults. Lasmiditan is a highly selective 5-HT1F receptor agonist which demonstrated superiority to placebo in the acute treatment of migraine in adults with moderate/severe migraine disability in two similarly designed phase-3 trials, SAMURAI and SPARTAN. Ubrogepant is a novel small molecule oral calcitonin gene-related peptide receptor antagonist. The approval was supported by two pivotal phase-3, randomized, double-blind, placebo-controlled trials (ACHIEVE I and ACHIEVE II) that evaluated the efficacy, safety, tolerability. Hopefully, these two drugs may soon be a new addition to the mounting armory of drugs against migraine and may fulfill a substantial unmet need.

A Randomized Controlled Trial to Compare the Efficacy, Safety and Tolerability of Asenapine versus Olanzapine in Management of Schizophrenia.

OBJECTIVE: : Schizophrenia is a serious disease characterized by impairment in the perception or expression of reality, leading to occupational and social dysfunction. The use of antipsychotic medication is now universal in the first-line treatment of schizophrenia. This study was undertaken to compare the efficacy of asenapine with a standard atypical antipsychotic, olanzapine in treating this disease. METHODS: It was designed as a single blind, randomized, controlled, parallel group, single centre Phase IV trial of a newer atypical antipsychotic, asenapine versus existing standard atypical antipsychotic, olanzapine. Total 80 subjects were enrolled as per eligibility criteria.Each recruited subject received daily treatment with the trial medication (Olanzapine 10 mg or Asenapine 10 mg daily) for duration of 12 weeks. BPRS, CGI-S, CGI-I, Laboratory parameters and compliance was assessed and analyzed. Continuous variables were compared by t test and non-parametric data was analyzed by Mann-Whitney U test and Wilcoxon signed rank test. Likely categorical variables were analyzed by chi-square test or Fisher's exact test, as appropriate. RESULTS: The duration of schizophrenia at presentation was comparable in both the treatment groups. There was significant reduction of BPRS score between any two visits of each treatment groups. The decline in CGI-S and CGI-I scores was statistically significant (p < 0.001) when compared between visits of any of the both treatment arms. Adherence to treatment was excellent for all patients. CONCLUSION: Newer atypical antipsychotic asenapine is more effective than standard olanzapine in reducing the symptoms of schizophrenia in this study and further larger studies are to be done.

Solid-State Protein Junctions: Cross- Laboratory Study Shows Preservation of Mechanism at Varying Electronic Coupling.

Successful integration of proteins in solid-state electronics requires contacting them in a non-invasive fashion, with a solid conducting surface for immobilization as one such contact. The contacts can affect and even dominate the measured electronic transport. Often substrates, substrate treatments, protein immobilization, and device geometries differ between laboratories. Thus the question arises how far results from different laboratories and platforms are comparable and how to distinguish genuine protein electronic transport properties from platform-induced ones. We report a systematic comparison of electronic transport measurements between different laboratories, using all commonly used large-area schemes to contact a set of three proteins of largely different types. Altogether we study eight different combinations of molecular junction configurations, designed so that Ageoof junctions varies from 105 to 10-3 µm2. Although for the same protein, measured with similar device geometry, results compare reasonably well, there are significant differences in current densities (an intensive variable) between different device geometries. Likely, these originate in the critical contact-protein coupling (∼contact resistance), in addition to the actual number of proteins involved, because the effective junction contact area depends on the nanometric roughness of the electrodes and at times, even the proteins may increase this roughness. On the positive side, our results show that understanding what controls the coupling can make the coupling a design knob. In terms of extensive variables, such as temperature, our comparison unanimously shows the transport to be independent of temperature for all studied configurations and proteins. Our study places coupling and lack of temperature activation as key aspects to be considered in both modeling and practice of protein electronic transport experiments.

Rainfall trends and variation in the Maasai Mara ecosystem and their implications for animal population and biodiversity dynamics.

Rainfall exerts a controlling influence on the availability and quality of vegetation and surface water for herbivores in African terrestrial ecosystems. We analyse temporal trends and variation in rainfall in the Maasai Mara ecosystem of East Africa and infer their implications for animal population and biodiversity dynamics. The data originated from 15 rain gauges in the Mara region (1965-2015) and one station in Narok Town (1913-2015), in Kenya's Narok County. This is the first comprehensive and most detailed analysis of changes in rainfall in the region of its kind. Our results do not support the current predictions of the International Panel of Climate Change (IPCC) of very likely increases of rainfall over parts of Eastern Africa. The dry season rainfall component increased during 1935-2015 but annual rainfall decreased during 1962-2015 in Narok Town. Monthly rainfall was more stable and higher in the Mara than in Narok Town, likely because the Mara lies closer to the high-precipitation areas along the shores of Lake Victoria. Predominantly deterministic and persistent inter-annual cycles and extremely stable seasonal rainfall oscillations characterize rainfall in the Mara and Narok regions. The frequency of severe droughts increased and floods intensified in the Mara but droughts became less frequent and less severe in Narok Town. The timings of extreme droughts and floods coincided with significant periodicity in rainfall oscillations, implicating strong influences of global atmospheric and oceanic circulation patterns on regional rainfall variability. These changing rainfall patterns have implications for animal population dynamics. The increase in dry season rainfall during 1935-2015 possibly counterbalanced the impacts of resource scarcity generated by the declining annual rainfall during 1965-2015 in Narok Town. However, the increasing rainfall extremes in the Mara can be expected to create conditions conducive to outbreaks of infectious animal diseases and reduced vegetation quality for herbivores, particularly when droughts and floods persist over multiple years. The more extreme wet season rainfall may also alter herbivore space use, including migration patterns.