Energy efficient gateway based routing with maximized node coverage in a UAV assisted wireless sensor network.

Ad-hoc wireless sensor networks face challenges of optimized node deployment for maximizing coverage and efficiently routing data to control centers in post disaster events. These challenges impact the outcome for extending the lifetime of wireless sensor networks. This study presents a uav assisted reactive zone based EHGR (energy efficient hierarchical gateway routing protocol) that is deployed in a situation where the natural calamity has caused communication and infrastructure damage to a major portion of the sensor network. EHGR is a hybrid multi layer routing protocol for large heterogeneous sensor nodes (smart nodes, basic nodes, user handheld devices etc.) EHGR is tailored to meet two important concerns for a disaster hit wsn ie. optimized deployment and energy efficient routing. The first part of EGHR focuses on maximized coverage during node deployments. Maximized coverage is an important aspect to be considered during the event of disaster since most of the nodes loose coverage and are detached from the wireless sensor network. The first part of EHGR uses state of the art game theory approach to build a model that maximizes the coverage of nodes during the deployment phase from all participating entities i.e. nodes and uavs. Rather than fixing the cluster head as is the case in traditional cluster-based approaches EHGR uses the energy centroid nodes. Energy centroid nodes evolve on the basis of aggregated energy of the zone. This approach is superior to simply electing cluster head nodes on the basis of some probability function. The nodes that fail to achieve any successful outcome from the game theory matching model fail to get any association. These nodes will use multi hop d2d relay approach to reach the energy centroid nodes. Gateway relay nodes used with the game theory approach during the deployment of the uav assisted wsn improves the overall coverage by 25% against traditional leach based hierarchical approaches. Once the optimum deployment phase is completed the routing phase is initiated. Aggregated data is sent by the energy centroid nodes from the ECN nodes to the servicing micro controller enabled un manned aerial vehicles. The routing process places partial burden of zone formation and data transmission to the control center for each phase on the servicing uavs. Energy centroid nodes engage only in the data aggregation process and transmission of data to servicing uav. Servicing-uavs reduce energy dissipated of the entire zone which result in gradual decrease of energy for the zone thus increasing the network lifetime. Node deployment phase and the routing phase of EHGR utilize the computations provide by the mirco controller enabled unmanned aerial vehicles such that the computationally intensive calculations are offloaded to the servicing uav. Experiment results indicate an increase in the first dead node report, half dead node report, and last dead node report. Network lifetime is extended to approximately 1800 rounds which is an increase by ratio of 100% against the traditional leach approach and increase by 50% percent against the latest approaches as highlighted in the literature.

Insights into the Value of Lyso-Gb1 as a Predictive Biomarker in Treatment-Naïve Patients with Gaucher Disease Type 1 in the LYSO-PROOF Study.

Gaucher disease (GD) is a rare autosomal recessive disorder arising from bi-allelic variants in the GBA1 gene, encoding glucocerebrosidase. Deficiency of this enzyme leads to progressive accumulation of the sphingolipid glucosylsphingosine (lyso-Gb1). The international, multicenter, observational "Lyso-Gb1 as a Long-term Prognostic Biomarker in Gaucher Disease"-LYSO-PROOF study succeeded in enrolling a cohort of 160 treatment-naïve GD patients from diverse geographic regions and evaluated the potential of lyso-Gb1 as a specific biomarker for GD. Using genotypes based on established classifications for clinical presentation, patients were stratified into type 1 GD (n = 114) and further subdivided into mild (n = 66) and severe type 1 GD (n = 48). Due to having previously unreported genotypes, 46 patients could not be classified. Though lyso-Gb1 values at enrollment were widely distributed, they displayed a moderate and statistically highly significant correlation with disease severity measured by the GD-DS3 scoring system in all GD patients (r = 0.602, p < 0.0001). These findings support the utility of lyso-Gb1 as a sensitive biomarker for GD and indicate that it could help to predict the clinical course of patients with undescribed genotypes to improve personalized care in the future.

Remote Health Monitoring Systems for Elderly People: A Survey.

This paper addresses the growing demand for healthcare systems, particularly among the elderly population. The need for these systems arises from the desire to enable patients and seniors to live independently in their homes without relying heavily on their families or caretakers. To achieve substantial improvements in healthcare, it is essential to ensure the continuous development and availability of information technologies tailored explicitly for patients and elderly individuals. The primary objective of this study is to comprehensively review the latest remote health monitoring systems, with a specific focus on those designed for older adults. To facilitate a comprehensive understanding, we categorize these remote monitoring systems and provide an overview of their general architectures. Additionally, we emphasize the standards utilized in their development and highlight the challenges encountered throughout the developmental processes. Moreover, this paper identifies several potential areas for future research, which promise further advancements in remote health monitoring systems. Addressing these research gaps can drive progress and innovation, ultimately enhancing the quality of healthcare services available to elderly individuals. This, in turn, empowers them to lead more independent and fulfilling lives while enjoying the comforts and familiarity of their own homes. By acknowledging the importance of healthcare systems for the elderly and recognizing the role of information technologies, we can address the evolving needs of this population. Through ongoing research and development, we can continue to enhance remote health monitoring systems, ensuring they remain effective, efficient, and responsive to the unique requirements of elderly individuals.

Bi-allelic loss-of-function variants in TMEM147 cause moderate to profound intellectual disability with facial dysmorphism and pseudo-Pelger-Huët anomaly.

The transmembrane protein TMEM147 has a dual function: first at the nuclear envelope, where it anchors lamin B receptor (LBR) to the inner membrane, and second at the endoplasmic reticulum (ER), where it facilitates the translation of nascent polypeptides within the ribosome-bound TMCO1 translocon complex. Through international data sharing, we identified 23 individuals from 15 unrelated families with bi-allelic TMEM147 loss-of-function variants, including splice-site, nonsense, frameshift, and missense variants. These affected children displayed congruent clinical features including coarse facies, developmental delay, intellectual disability, and behavioral problems. In silico structural analyses predicted disruptive consequences of the identified amino acid substitutions on translocon complex assembly and/or function, and in vitro analyses documented accelerated protein degradation via the autophagy-lysosomal-mediated pathway. Furthermore, TMEM147-deficient cells showed CKAP4 (CLIMP-63) and RTN4 (NOGO) upregulation with a concomitant reorientation of the ER, which was also witnessed in primary fibroblast cell culture. LBR mislocalization and nuclear segmentation was observed in primary fibroblast cells. Abnormal nuclear segmentation and chromatin compaction were also observed in approximately 20% of neutrophils, indicating the presence of a pseudo-Pelger-Huët anomaly. Finally, co-expression analysis revealed significant correlation with neurodevelopmental genes in the brain, further supporting a role of TMEM147 in neurodevelopment. Our findings provide clinical, genetic, and functional evidence that bi-allelic loss-of-function variants in TMEM147 cause syndromic intellectual disability due to ER-translocon and nuclear organization dysfunction.

Heartbeat Classification and Arrhythmia Detection Using a Multi-Model Deep-Learning Technique.

Cardiac arrhythmias pose a significant danger to human life; therefore, it is of utmost importance to be able to efficiently diagnose these arrhythmias promptly. There exist many techniques for the detection of arrhythmias; however, the most widely adopted method is the use of an Electrocardiogram (ECG). The manual analysis of ECGs by medical experts is often inefficient. Therefore, the detection and recognition of ECG characteristics via machine-learning techniques have become prevalent. There are two major drawbacks of existing machine-learning approaches: (a) they require extensive training time; and (b) they require manual feature selection. To address these issues, this paper presents a novel deep-learning framework that integrates various networks by stacking similar layers in each network to produce a single robust model. The proposed framework has been tested on two publicly available datasets for the recognition of five micro-classes of arrhythmias. The overall classification sensitivity, specificity, positive predictive value, and accuracy of the proposed approach are 98.37%, 99.59%, 98.41%, and 99.35%, respectively. The results are compared with state-of-the-art approaches. The proposed approach outperformed the existing approaches in terms of sensitivity, specificity, positive predictive value, accuracy and computational cost.

Millimeter-Wave Smart Antenna Solutions for URLLC in Industry 4.0 and Beyond.

Industry 4.0 is a new paradigm of digitalization and automation that demands high data rates and real-time ultra-reliable agile communication. Industrial communication at sub-6 GHz industrial, scientific, and medical (ISM) bands has some serious impediments, such as interference, spectral congestion, and limited bandwidth. These limitations hinder the high throughput and reliability requirements of modern industrial applications and mission-critical scenarios. In this paper, we critically assess the potential of the 60 GHz millimeter-wave (mmWave) ISM band as an enabler for ultra-reliable low-latency communication (URLLC) in smart manufacturing, smart factories, and mission-critical operations in Industry 4.0 and beyond. A holistic overview of 60 GHz wireless standards and key performance indicators are discussed. Then the review of 60 GHz smart antenna systems facilitating agile communication for Industry 4.0 and beyond is presented. We envisage that the use of 60 GHz communication and smart antenna systems are crucial for modern industrial communication so that URLLC in Industry 4.0 and beyond could soar to its full potential.

A disorder clinically resembling cystic fibrosis caused by biallelic variants in the AGR2 gene.

PURPOSE: We sought to describe a disorder clinically mimicking cystic fibrosis (CF) and to elucidate its genetic cause. METHODS: Exome/genome sequencing and human phenotype ontology data of nearly 40 000 patients from our Bio/Databank were analysed. RNA sequencing of samples from the nasal mucosa from patients, carriers and controls followed by transcriptome analysis was performed. RESULTS: We identified 13 patients from 9 families with a CF-like phenotype consisting of recurrent lower respiratory infections (13/13), failure to thrive (13/13) and chronic diarrhoea (8/13), with high morbidity and mortality. All patients had biallelic variants in AGR2, (1) two splice-site variants, (2) gene deletion and (3) three missense variants. We confirmed aberrant AGR2 transcripts caused by an intronic variant and complete absence of AGR2 transcripts caused by the large gene deletion, resulting in loss of function (LoF). Furthermore, transcriptome analysis identified significant downregulation of components of the mucociliary machinery (intraciliary transport, cilium organisation), as well as upregulation of immune processes. CONCLUSION: We describe a previously unrecognised autosomal recessive disorder caused by AGR2 variants. AGR2-related disease should be considered as a differential diagnosis in patients presenting a CF-like phenotype. This has implications for the molecular diagnosis and management of these patients. AGR2 LoF is likely the disease mechanism, with consequent impairment of the mucociliary defence machinery. Future studies should aim to establish a better understanding of the disease pathophysiology and to identify potential drug targets.

A Novel Hybrid Deep Learning Model for Human Activity Recognition Based on Transitional Activities.

In recent years, a plethora of algorithms have been devised for efficient human activity recognition. Most of these algorithms consider basic human activities and neglect postural transitions because of their subsidiary occurrence and short duration. However, postural transitions assume a significant part in the enforcement of an activity recognition framework and cannot be neglected. This work proposes a hybrid multi-model activity recognition approach that employs basic and transition activities by utilizing multiple deep learning models simultaneously. For final classification, a dynamic decision fusion module is introduced. The experiments are performed on the publicly available datasets. The proposed approach achieved a classification accuracy of 96.11% and 98.38% for the transition and basic activities, respectively. The outcomes show that the proposed method is superior to the state-of-the-art methods in terms of accuracy and precision.

Detection of malicious consumer interest packet with dynamic threshold values.

As a promising next-generation network architecture, named data networking (NDN) supports name-based routing and in-network caching to retrieve content in an efficient, fast, and reliable manner. Most of the studies on NDN have proposed innovative and efficient caching mechanisms and retrieval of content via efficient routing. However, very few studies have targeted addressing the vulnerabilities in NDN architecture, which a malicious node can exploit to perform a content poisoning attack (CPA). This potentially results in polluting the in-network caches, the routing of content, and consequently isolates the legitimate content in the network. In the past, several efforts have been made to propose the mitigation strategies for the content poisoning attack, but to the best of our knowledge, no specific work has been done to address an emerging attack-surface in NDN, which we call an interest flooding attack. Handling this attack-surface can potentially make content poisoning attack mitigation schemes more effective, secure, and robust. Hence, in this article, we propose the addition of a security mechanism in the CPA mitigation scheme that is, Name-Key Based Forwarding and Multipath Forwarding Based Inband Probe, in which we block the malicious face of compromised consumers by monitoring the Cache-Miss Ratio values and the Queue Capacity at the Edge Routers. The malicious face is blocked when the cache-miss ratio hits the threshold value, which is adjusted dynamically through monitoring the cache-miss ratio and queue capacity values. The experimental results show that we are successful in mitigating the vulnerability of the CPA mitigation scheme by detecting and blocking the flooding interface, at the cost of very little verification overhead at the NDN Routers.

New protocol for optimisation of polymer composition for imprinting of peptides and proteins.

We present here a novel screening tool for optimisation of polymerisation mixtures used in imprinting of peptides and proteins. To facilitate rapid synthesis and screening of a combinatorial library of polymers the solid-phase synthesis method developed by Piletsky and co-workers was scaled down to 50 mg of template-immobilised solid phase, allowing a single well of a 96-well microplate to function as an individual reaction vessel. In this way, 32 different polymer compositions containing N-isopropylacrylamide, acrylic acid, N-(3-aminopropyl)methacrylamide hydrochloride, and N-tert-butylacrylamide, were tested in imprinting of three peptides and three proteins. Utilising filtration microplates has allowed the elution and washing steps to be performed in a similar manner to the large-scale synthesis, whilst incorporation of a fluorescent monomer (N-fluoresceinylacrylamide) made it possible to analyse the binding of synthesised polymer nanoparticles to the solid phase with immobilised templates under different washing conditions. The experiment has proven that the variations in monomer compositions had an effect on the yield and affinity of synthesised molecularly imprinted polymers for the peptides, but not for the proteins. Imprinting in this way presents an ideal method for performing small-scale syntheses for testing polymerisation mixtures, as information regarding the molecularly imprinted polymers affinity can be assessed as part of the elution process, without a need for time-consuming analysis such as quartz crystal microbalance or surface plasmon resonance.

Two TCF7L2 Variants Associated with Type 2 Diabetes in the Han Nationality Residents of China.

OBJECTIVE: To determine the risk of type II diabetes (T2D) with two transcription factor 7-like 2 gene (TCF7L2) variants in the Han nationality population of Guangdong, China. STUDY DESIGN: Case control study. PLACE AND DURATION OF STUDY: International School, Clinical Laboratory of Over-sea Chinese Hospital, Department of Biochemistry, Medical School, Jinan University, China, from July 2014 to June 2016. METHODOLOGY: Two single nucleotide polymorphisms (SNPs) of gene TCF7L2 were genotyped by PCR amplification and sequencing of the specific DNA fragments, rs7903146 and rs12255372, by PCR amplification and sequencing of the specific DNA fragments in 339 T2D patients and 191 control subjects. Odds ratio was determined. RESULTS: The minor allele of the two variants was significantly associated with T2D; the risk to develop T2D for rs7903146 (IVS3C >T) was found to be greater than that for rs12255372 (IVS4G >T), with allelic odds ratio (OR) of 1.39 and 1.27 respectively. Furthermore, T2D risk associated with homozygosity of the minor alleles was found to be greater than that for heterozygosity. CONCLUSION: The two varients of the gene TCF7L2 are important genetic risk factors for the T2D development in the Han ethnic group in China.

Is Hepatovenocaval Syndrome a Different Entity from Budd-Chiari Syndrome in Children?

OBJECTIVE: To differentiate between clinical and demographic spectrum, and outcome in hepatovenocaval syndrome (HVCS) and Budd-Chiari syndrome (BCS). STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Division of Pediatric Gastroenterology, Hepatology and Nutrition, The Children Hospital, Lahore, from January 2014 to January 2017. METHODOLOGY: All children less than 18 years of age, presenting with ascites and visible veins over abdomen, flanks and back were enrolled in the study. Real time Doppler Ultrasonogram was performed in all children for documentation of intra- hepatic part of IVC obstruction along with or without hepatic venous obstruction. Children meeting inclusion criteria underwent liver profile, coagulation profile, diagnostic paracentesis for SAAG gradient, and Gadolinium enhanced multiphasic MR scan. Liver biopsy and venography was performed in selected patients. RESULTS: A total of 92 children presented with ascites, among them 58 children met our inclusion criteria. Intrahepatic IVC obliteration, i.e. HVCS, found in 67% (n=39) and hepatic venous outflow obstruction, i.e. BCS was found in 33% (n=19) children. Children with BCS were older than HVCS with mean age of 9.5 ±2.58 versus 4.12 ±0.977 years. HVCS group had 14 boys and 24 girls with a ratio of 1:1.8, while BCS had a ratio of 1:0.9 with 10 boys and 9 girls. No etiological factor was found for HVCS, while most of patients with BCS had a procoagulant disorder. Caudate lobe hypertrophy was a consistent feature in BCS, while IVC obstruction was found in HVCS persistently. Orthotopic liver transplant was needed in three cases (7.6%) of HVCS and four (20.96%) of BCS cases. Antibiotic therapy has a good role in HVCS, while anticoagulation and diuretics had good result in BCS. CONCLUSION: Hepatovenocaval syndrome (HVCS) mostly affected younger children, especially girls. BCS usually affected older age groups with pro-coagulant disorders who responded to anticoagulation and diuretic. Further studies are needed to compare both conditions.

Vitamin D Intoxication In 7-Month-Old Infant With Recommended Daily Intake Of Vitamin D.

Over the past decade there is increased use of vitamin D supplementation because of its benefits on bone health. It is a fat-soluble vitamin and cannot be excreted from the body. There is need for monitoring 25-hydroxyvitamin D levels in infants and children who receive long-term vitamin D supplementation at or above the upper level intake that is currently recommended. Vitamin D intoxication can present from mild ignorable to severe life-threatening symptoms. We present a 7- month-old infant with vitamin D intoxication at recommended daily doses of vitamin D.

A Randomized Control Trial of Preoperative Oral Antibiotics as Adjunct Therapy to Systemic Antibiotics for Preventing Surgical Site Infection in Clean Contaminated, Contaminated, and Dirty Type of Colorectal Surgeries.

BACKGROUND: Preoperative bowel preparation with or without oral antibiotics is controversial in terms of postoperative surgical site infections. OBJECTIVE: This study aimed to evaluate the efficacy of oral antibiotics as adjunct therapy to systemic antibiotics with mechanical bowel preparation for preventing surgical site infections in clean contaminated, contaminated, and dirty colorectal procedures. DESIGN: This was a single-center, prospective randomized study. SETTING: This study was conducted at the General Surgery Department at Jinling Hospital, Nanjing University, China, from July 15, 2014 to January 20, 2016. PATIENTS: Patients aged ≥18 years scheduled for abdominal surgery with clean-contaminated, contaminated, and dirty wounds were selected. INTERVENTIONS: Patients were randomly assigned to receive preoperative mechanical bowel preparation or mechanical bowel preparation with oral antibiotics. MAIN OUTCOMES: The primary outcome was the rate of surgical site infections. The secondary outcomes were extra-abdominal complications, duration of postoperative ileus, and readmission rate. RESULTS: Ninety-five patients were allocated to each group. Eight and 26 surgical site infections (8.42% vs 27.3 %, p = 0.004) occurred in the mechanical bowel preparation with oral antibiotics and mechanical bowel preparation groups. Thirteen extra-abdominal complications were reported: 6 in the mechanical bowel preparation with oral antibiotics group and 7 in the mechanical bowel preparation group (6.3% vs 7.3%, p = 0.77). Postoperative ileus duration did not differ between groups (p = 0.23). There were 4 readmissions in the mechanical bowel preparation group and none in the mechanical bowel preparation with oral antibiotics group (p = 0.04). On multivariable analysis, blood loss ≥500 mL (OR, 5.1; 95% CI, 1.27-20.4; p = 0.02), ASA score ≥3 (OR, 3.9; 95% CI, 1.2-12.5; p = 0.01), contaminated types (OR, 3.6; 95% CI, 1.5-8.6; p = 0.01), and administration of preoperative oral antibiotics (OR, 0.20; 95% CI, 0.06-0.60; p = 0.005) independently affected the incidence of surgical site infections. LIMITATIONS: This was a single-center study. CONCLUSION: Preoperative oral antibiotics, as adjunct therapy to systemic antibiotics and mechanical bowel preparation, significantly reduced surgical site infections and minimized the readmission rates in clean contaminated, contaminated, and dirty types of colorectal surgery. See Video Abstract at http://links.lww.com/DCR/A437.

Effect of Persistent Thrombocytopenia on Mortality in Surgical Critical Care Patients: A Retrospective Study.

Thrombocytopenia is common among surgical critically ill patients. The relationship between the duration of thrombocytopenia and mortality is not well studied. This retrospective 12-month cohort study was designed to evaluate the association between persistent thrombocytopenia and mortality among surgical critically ill patients to determine the risk factors for persistent thrombocytopenia. The study included adult patients consecutively admitted to the surgical intensive care unit (SICU) at our institution. Patients with a diagnosis of thrombocytopenia were identified from a prospective critical care database. We defined patients with persistent thrombocytopenia as those with thrombocytopenia lasting more than 7 consecutive days. The primary outcome of this study was 28-day mortality and the secondary outcomes were lengths of SICU stay and hospital stay. Fifty-one patients experienced persistent thrombocytopenia and 71 experienced nonpersistent thrombocytopenia. Among patients with persistent thrombocytopenia, mortality was significantly higher, and SICU and hospital stays were longer than those with nonpersistent thrombocytopenia. Risk factor analysis failed to predict which patients with thrombocytopenia would develop into persistent thrombocytopenia. Persistent thrombocytopenia is a clinically significant disorder and is associated with poorer outcomes. Future studies are needed to further define this process.

Spontaneous Perforation Of Bile Duct, Clinical Presentation, Laboratory Work Up, Treatment And Outcome.

BACKGROUND: Spontaneous perforation of bile duct (SPBD) is a rare and often misdiagnosed entity. Though rare, it is the second most common surgical cause of jaundice in infants, after biliary atresia. This study was planned to determine the clinical presentation, study different diagnostic modalities, treatment and outcome of patients with spontaneous perforation of bile duct. METHODS: This descriptive case series, comprising 22 patients with spontaneous perforation of bile duct over a period of 24 months. Clinical presentation, biochemical abnormalities, imaging details, treatment options and outcome were studied. RESULTS: Total 22 patients (12 Males and 10 Females) between ages of 1.5-36 months were studied. Associated anatomical defects included choledochal cyst in 7 (31.8%) while acquired biliary atresia in 1 (4.5%). Elevated liver enzymes (ALT and AST) were present in 16 patients (72.7%) and 5 (22.7%) had bilirubin above 3 mg/dl. Coagulopathy was seen in 8 (36.6%) patients. Abdominal USG showed presence of ascites in all 22 (100%), hydrocele in 2 (9.0%), inguinal hernia in 1 (4.5%), choledochal cyst in 7 (31.8%) and atretic gall bladder suggestive of acquired biliary atresia in one (4.5%) patient. HIDA scan was diagnostic in all 17 (77.27%) in which it was performed. MRCP was done in 3 (13.6%) patients. Mortality frequency was 3/22 (13.6%); one died of post-surgical sepsis second one was cirrhotic at time of presentation and didn't make It. Two were lost to follow up one which died at home while we lost contact with fourth patient. CONCLUSIONS: Spontaneous perforation of bile duct can present and should be suspected as an important cause of neonatal biliary ascites or peritonitis. Most patients can be managed with intravenous antibiotics, percutaneous drainage and ttube insertion while patients with choledochal cysts required cholecystectomy with roux en y choledochjejunostomy. Timely recognition and intervention is associated with favourable outcome.

Impact of Crohn's Disease on Marital Quality of Life: A Preliminary Cross-Sectional Study.

BACKGROUND AND AIMS: Quality of marriage exerts a great effect on quality of life [QOL] and health outcomes. Few data are available on the effects of Crohn's disease [CD] on quality of marriage. We aimed to clarify whether and how CD affected the marital relationship. METHODS: Web-based questionnaires were created including an ENRICH marital inventory, a general QOL survey [SF12], a short Inflammatory Bowel Disease Questionnaire [SIBDQ] and a modified Harvey-Bradshaw Index [HBI]. Married patients were enrolled through the outpatient registration system and diverse social media websites. Controls were subsequently enrolled and matched with the ratio of 1:1 through invitation emails and internet advertising. RESULTS: A total of 243 patients completed valid questionnaires and then 243 matched individuals were enrolled. Male patients were more affected, representing a significantly reduced total marital score. CD impaired the dimensions of idealistic distortion and marital satisfaction in both genders. There were correlations between quality of marriage, SF12, SIBDQ and HBI. Mental scale of SF12 correlated best with the marital relationship, indicating more significant involvement of mental adjustment. Multiple linear regression demonstrated that spouse's educational background, duration of marriage from disease onset, enteral nutrition, hospitalisation in past 12 months, and number of previous hospitalisations, independently impacted on quality of marriage. CONCLUSIONS: Certain aspects of the marital relationship were impaired in CD patients, especially in male subjects. In addition to medication, mental interventions should be given attention to improve the marriage of CD patients. Despite some novel findings in this study, this research orientation deserves more attention.

An elevated percentage of reticulated platelet is associated with increased mortality in septic shock patients.

Microcirculatory changes and coagulation disturbances are thought to play a key role in sepsis. Some evidence suggests that the percentage of reticulated platelets (RP%) may be a valuable and cost-effective sepsis screening parameter. This was a prospective study in surgical patients to investigate the potential value of RP% as a predictor of mortality in septic shock patients.This was a prospective study conducted in a surgical critical care center of a Chinese tertiary care hospital. Consecutive septic shock patients were enrolled at admission. Age- and sex-matched non-septic patients were recruited as control patients. RP% was determined by flow cytometry in 68 septic shock patients and 68 controls.Compared with survivors, septic patients who died presented with a significantly higher RP% (P < 0.001). The area under the receiver-operating characteristic curve for the RP% association with mortality was 0.867 (95 % CI 0.780-0.953, P < 0.001). Kaplan-Meier survival curves showed that mortality risk was significantly different when patients were stratified based on RP% (P < 0.001). This association was preserved in a multi-logistic regression analysis that included clinical confounders (P < 0.014).This prospective study demonstrates that increased RP% identifies septic shock patients who have a high risk of death. RP% has the potential to act as a marker for patient stratification in future clinical trials.

Diagnostic delay in Crohn's disease is associated with increased rate of abdominal surgery: A retrospective study in Chinese patients.

BACKGROUND: Diagnostic delay of Crohn's disease presents a challenge, and may increase the abdominal surgery rate. There have been no reports regarding diagnostic delay in Chinese patients. AIMS: We aimed to evaluate the impact of diagnostic delay on outcomes of Chinese Crohn's disease patients, and identify potential risk factors for the delay. METHODS: Altogether, 343 Crohn's disease patients from our hospital were retrospectively included. We assessed the effects of diagnostic delay on the outcomes, and identified the underlying risk factors. RESULTS: Diagnostic interval was defined as the interval between the first symptoms and the diagnosis of Crohn's disease. Diagnostic delay was defined according to the time interval in which the 76th to 100th percentiles of patients were diagnosed. The rates of subsequent surgery for diagnostic-delay and non-diagnostic-delay patients were 84.7% and 62.4%, respectively (odds ratio=1.108, P<0.0001). We found statistical differences between the two groups regarding age >40 years at diagnosis (35.3% versus 18.2%, P=0.004), basic educational level (48.2% versus 30.6%, P=0.005), and no family history of Crohn's disease (0 versus 1.6%, P=0.045). CONCLUSIONS: Diagnostic delay of Crohn's disease was significantly associated with increased rates of intestinal surgery. Risk factors for diagnostic delay were age >40 years at diagnosis, basic educational level, and no family history of Crohn's disease.

Surgical repair of an asymptomatic giant right coronary artery aneurysm.

Background Coronary artery aneurysm (CAA) is a rare finding, being mostly diagnosed on angiography or at autopsies. It is defined as being a dilation of the coronary artery that exceeds the diameter of the patient's largest coronary vessel by 1.5 to 2 times. Case Report We describe the operative correction of a giant right CAA measuring in excess of 10 cm. Conclusion Management of giant CAAs is not standardized and surgical strategy remains controversial. In our case, the patient has a successful surgical repair with no postoperative shunts on follow-up investigations.