Characterizing Chemical, Environmental, and Stimulated Subcellular Physical Characteristics of Size-Fractionated PMs Down to PM0.1.

Air pollution, especially particulate matter (PM), is a significant environmental pollution worldwide. Studying the chemical, environmental, and life-related cellular physical characteristics of size-fractionated PMs is important because of their different degrees of harmful effects on human respiratory tracts and organ systems, causing severe diseases. This study evaluates the chemical components of size-fractionated PMs down to PM0.1 collected during a biomass-burning episode, including elemental/organic carbon and trace elements. Single particle sizes and distributions of PM0.1, PM0.5-0.1, PM1.0-0.5, and PM2.5-1.0 were analyzed by scanning electron microscopy and Zeta sizer. Two commonly used cell lines, e.g., HeLa and Cos7 cells, and two respiratory-related cell lines including lung cancer/normal cells were utilized for cell cytotoxicity experiments, revealing the key effects of particle sizes and concentrations. A high-speed scanning ion conductance microscope explored particle-stimulated subcellular physical characteristics for all cell lines in dynamics, including surface roughness (SR) and elastic modulus (E). The statistical results of SR showed distinct features among different particle sizes and cell types while a E reduction was universally found. This work provides a comprehensive understanding of the chemical, environmental, and cellular physical characteristics of size-fractionated PMs and sheds light on the necessity of controlling small-sized PM exposures.

Standard medical ethnobotany of Kohistan, North Pakistan.

BACKGROUND: This study was exclusively focused on the documentation and cross-cultural evaluation of ethnomedicinal knowledge (EMK) within the diverse linguistic groups of Kohistan situated between the Himalayan and Hindukush Mountain ranges in the north Pakistan. METHODS: Data were gathered during the field survey (May 2022 to July 2023) through group conversations, semi-structured interviews, and on-site observation. Venn diagrams were employed to illustrate the comparative assessment of EMK, and different ethnobotanical indices were utilized to examine the data. RESULTS: A total of 96 wild medicinal plant species (MPs) belonging to 74 genera and 52 botanical families were documented. The most reported MPs belong to the family Polygonaceae (11 species), followed by Asteraceae (9 species) and Lamiaceae (8 species). The ethnomedicinal uses of Leontopodium himalayanum, Pedicularis oederi, Plocama brevifolia, Polypodium sibiricum, Pteridium esculentum, Sambucus wightiana, Solanum cinereum, Teucrium royleanum, Rhodiola integrifolia, Aconitum chasmanthum were reported for the first time in this region. Among the reported taxa herbaceous species were dominated (72%), followed by trees and shrubs (17% and 10%, respectively). Digestive problems (40 taxa and 114 use reports) and skin disorders (19 taxa and 549 use reports) were the most cited disease categories, whereas M. communis, M. longifolia, Ajuga integrifolia, Ziziphus jujuba, and Clematis grata exhibited the highest percentage fidelity levels. Out of 109 documented medicinal uses, a mere 12 were shared across all linguistic groups, and Bateri emerges as a notable outlier with the highest number of medicinal uses. In addition, a significant homogeneity was noted in the reported botanical taxa (61 species) among different linguistic groups. However, since the last decade biocultural heritage of Kohistan is facing multifaceted risks that need urgent attention. CONCLUSION: Our findings could be valuable addition to the existing stock of ethnomedicinal knowledge and may provide ethnopharmacological basis to novel drug discovery for preexisting and emerging diseases prioritizing detailed phytochemical profiling and the evaluation of bioactive potential.

Bridge the Gap: Addressing Rural End-of-Life Care Disparities and Access to Hospice Services.

Rural hospices face many obstacles in delivering palliative and end-of-life care in the United States. We aimed to identify these barriers and their potential solutions. Following a systematic approach, a comprehensive literature search using relevant keywords was conducted on online databases. Additionally, we conducted a manual search to include policy documents and white papers. Key challenges reported in the literature included limited geographic barriers and access issues, limited economic support, regulatory hindrances, and difficulty training and retaining palliative care staff. This contributes to inequitable access to hospice care in rural settings. We propose several potential solutions to overcome these hurdles and improve access. Advanced practice providers should be considered to serve as physician heads in rural hospices, which would expand resources in areas with physician shortages. A single per diem payment model should be implemented for rural hospices, regardless of the level of care provided, to help offset the higher cost of care. The Critical Access Hospital program and offering cost-based reimbursement for swing-bed stays could improve access to postacute care, including hospice services. Telehealth can improve the timeliness of care and reduce travel costs for patients and providers. Another solution to consider is simulation-based training to enhance the education of healthcare providers. In conclusion, there is a critical gap in end-of-life care access in rural communities. A multifaceted approach including policy changes, financial support, and technological innovations is essential to improve hospice care access in rural populations.

Constituents from leaves of Macaranga hemsleyana.

Objective: To study constituents of the leaves of Macaranga hemsleyana, and evaluate their inhibitory effects against NOD-like receptor thermal protein domain associated protein 3 (NLRP3) inflammasome activation, and antiproliferative activity. Methods: The constituents were isolated and purified by column chromatography on MCI gel CHP20P/P120, silica gel, Sephadex LH-20, and HPLC. The structures of compounds were determined by 1D, 2D NMR, and HR-ESI-MS data. The inhibitory effect of compounds on inflammasome activation was determined by lactate dehydrogenase (LDH) procedure. The antiproliferative activity was evaluated using MTT assay. Results: The study led to the isolation of 23 compounds, including one new compound, identified as (2Z)-3-[4-(ß-D-glucopyranosyloxy)-2'-hydroxy-5'-methoxyphenyl]-2-propenoic acid (1), together with 22 known compounds recognized as 1,4-dihydro-4-oxo-3-pyridinecarbonitrile (2), methyl 4-methoxynicotinate (3), 4-methoxynicotinonitrile (4), 1-(3-O-ß-D-glucopyranosyl-4,5-dihydroxyphenyl)-ethanone (5), neoisoastilbin (6), isoastilbin (7), aromadendrin (8), neoastilbin (9), astilbin (10), quercitrin (11), neoschaftoside (12), apigenin 6,8-bis-C-α-L-arabinoside (13), vitexin (14), bergenin (15), scopoletin (16), glucopyranoside salicyl (17), koaburside (18), benzyl ß-D-glucoside (19), icariside B5 (20), roseoside (21), loliolide (22), and adenosine (23). The tested compounds did not show LDH inhibition nor antiproliferative activity. Conclusion: Compound 1 was a new glycoside. Compounds 2 and 3 were obtained for the first time from natural source. The 22 known compounds constituted of alkaloids (2-4, 23), phenolics (5, 15, 17, 18), flavonoids (6-14), coumarin (16), benzyl glycoside (19), and norsesquiterpenes (20-22). All the compounds, 1-23, were revealed from M. hemsleyana for the first time. This is the initial uncovering of molecules 1-10, 12, 13, 17-19, and 23 from the genus Macaranga. The isolated compounds, 11, 14-16, and 20-22 established taxonomic classification of M. hemsleyana in Euphorbiaceae family. Flavonoids were outstanding as chemosystematic markers of Macaranga genus.

Antibiotic usage patterns in COVID-19 patients in five tertiary hospitals from Bangladesh: A countrywide picture.

Objectives: Irrational and injudicious use of antibiotics in COVID-19 patients could be detrimental in a tropical country with a weak antibiotic stewardship policy such as Bangladesh. This study aimed to focus on the antibiotic usage patterns in COVID-19 patients in Bangladesh. Methods: This prospective observational study was performed from July 2020 to June 2021 in five tertiary hospitals in Bangladesh. Data on demographic profile, disease severity, and antibiotic usage were collected directly from the patients' hospital documents. Results: A total of 3486 (94.4%) patients were treated with at least one antibiotic; 3261 (93.6%) patients received a single antibiotic, and 225 (6.5%) received multiple antibiotics. The most used antibiotics were ceftriaxone (37.3%), co-amoxiclav (26.3%), azithromycin (10.6%), and meropenem (10.3%). According to the World Health Organization AWaRe categorization, most (2260; 69.6%) of the antibiotics prescribed in this study belonged to the "Watch" group. Culture and sensitivity reports were available in 111 cases from one center. Only 18.9% of the patients were found to be co-infected with multi-drug-resistant bacteria (52.4% yield from sputum, 28.6% from urine, and 14.3% from blood). Conclusions: Strict antibiotic prescribing policy and antibiotic stewardship should be implemented immediately to limit the future threat of antimicrobial resistance in countries such as Bangladesh.

Impact of left ventricular assist devices on 30-day readmission and outcomes in non-variceal upper gastrointestinal bleeding: a nationwide analysis.

Introduction: Bleeding, especially non-variceal upper gastrointestinal bleeding (NVUGIB), remains the most common cause of readmission in left ventricular assist device (LVAD) patients. Any readmission after NVUGIB carries a worse prognosis. Aim: To compare readmission outcomes in NVUGIB patients with and without LVAD. Material and methods: We identified adult NVUGIB patients using the National Readmission Database 2018 employing International Classification of Diseases, Tenth Revision (ICD-10) codes. The patients were grouped based on LVAD history. Proportions were compared using the Fisher exact test, and multivariate Cox proportional regression analysis was used to compute adjusted p-values. We used Stata version 14.2 to perform analyses considering 2-sided p < 0.05 as statistically significant. Results: The analysis included 322,342 NVUGIB patients, 1403 had a history of LVAD (mean age 64.25 years). The 30-day all-cause readmission rate in NVUGIB with LVAD was higher (24.31% vs. 13.92%, p < 0.001). Gastrointestinal bleeding as a readmission cause was more prevalent in the LVAD group. In patients with LVAD, NVUGIB readmissions required more complex endoscopic procedures, either requiring intervention during endoscopy or enteroscopy. There was no difference in mortality in NVUGIB readmissions (1.51% vs. 4.49%, p = 0.36); however, the length and cost of stay were higher in the LVAD group. Additionally, we identified novel independent predictors of readmission from NVUGIB in patients with LVADs. Conclusions: Readmissions in NVUGIB patients after LVAD require complex haemostatic intervention and are associated with greater resource utilization. To reduce readmissions and associated healthcare costs, it is essential to identify high-risk patients.

Enhancing performance in the presence of outliers with redescending M-estimators.

In real-life situations, we have to analyze the data that contains the atypical observations, and the presence of outliers has adverse effects on the performance of ordinary least square estimates. In this situation, redescedning M-estimators, proposed by Huber (1964), are used to tackle the effects of outliers to increase the efficiency of least square estimates. In this study, we introduce a redescending M-estimator designed to generate robust estimates by mitigating the influence of outlier observations, even when the tuning constant is set to low values. This innovative estimator exhibits enhanced linearity at its core and maintains continuity throughout its range. Our proposed estimator stands out for its novelty, simplicity, differentiability, and practical applicability across real-world scenarios. The results of the proposed redescedning M-estimators are compared with existing robust estimators using an extensive simulation study. Two examples based on real-life data are also added to validate the performance of the suggested function. The formulated redescedning M-estimator produced efficient results as compared to all the considered redescedning M-estimators.

Stimuli-responsive glucuronoxylan polysaccharide from quince seeds for biomedical, food packaging, and environmental applications.

Mucilage is a gelatinous mixture of polysaccharides secreted from the seed coat and/or pericarp of many plant seeds when soaked in water. Mucilage affected seed germination while maintaining hydration levels during scarcity. Cydonia oblonga (quince) seeds are natural hydrocolloids extruding biocompatible mucilage mainly composed of polysaccharides. Quince seed mucilage (QSM) has fascinated researchers due to its applications in the food and pharmaceutical industries. On a commercial scale, QSM preserved the sensory and physiochemical properties of various products such as yogurt, desserts, cakes, and burgers. QSM is responsive to salts, pH, and solvents and is mainly investigated as edible coatings in the food industry. In tablet formulations, modified and unmodified QSM as a binder sustained the release of various drugs such as cefixime, capecitabine, diclofenac sodium, theophylline, levosulpiride, diphenhydramine, metoprolol tartrate, and acyclovir sodium. QSM acted as a reducing and capping agent to prepare nanoparticles for good antimicrobial resistance, photocatalytic characteristics, and wound-healing potential. The present review discussed the extraction optimization, chemical composition, stimuli-responsiveness, and viscoelastic properties of mucilage. The potential of mucilage in edible films, tissue engineering, and water purification will also be discussed.

Comparison of biosimilar filgrastim and originator filgrastim for peripheral blood stem cell mobilization for allogeneic hematopoietic stem cell transplantation.

BACKGROUND: Nivestym, a biosimilar granulocyte colony-stimulating factor (G-CSF) to the originator filgrastim (Neupogen), is now being used for the mobilization of peripheral blood stem cells (PBSC) in allogeneic hematopoietic stem cell transplantation (allo-HSCT). We aim to compare the efficacy of Nivestym and Neupogen for PBSC mobilization in healthy allogeneic donors. METHODS: We conducted a retrospective single-center study including 541 adult allo-HSCT donors receiving Nivestym (January 2013-July 2020), or Neupogen (July 2020-June 2023) for donor PBSC mobilization. Bivariate analysis was conducted using SPSS version 28. Statistical significance was determined at a p-value <.05. RESULTS: Our study included 541 allo-HSCT donors who received Neupogen (n = 345, 64%) or Nivestym (n = 196, 36%) for PBSC mobilization. The median age was 47 years (range 17-76). The median donor weight was 86 kg (95% confidence interval [CI]: 87-91). Donors receiving Neupogen had similar pre-G-CSF white blood cell count, CD34+ percentages, and circulating CD34+ count compared with donors receiving Nivestym. The Neupogen group had similar median PBSC product total neutrophil count, CD34+ percentage, absolute CD34+ count, and infused CD34+ dose compared with the Nivestym group. For donors aged 35 years or younger, the median CD34+ dose was higher in donors who received Neupogen compared with Nivestym (6.9 vs. 6.3 million cells/kg, p = .044). CONCLUSIONS: Nivestym demonstrated similar efficacy for PBSC mobilization compared with Neupogen among allo-HSCT donors. In donors aged 35 years or younger, a slightly lower PBSC product CD34+ count was noted with Nivestym compared with Neupogen.

Human gingival mesenchymal stem cells-lyosecretome attenuates adverse effect of hydrogen peroxide-induced oxidative stress on osteoblast cells.

Objective: To determine total protein content, antioxidant activity, and protective ability of lyophilized human gingival mesenchymal stem cells (hGMSCs)-secretome in hydrogen peroxide (H2O2) induced oxidative stress model. Methods: Human GMSCs were cultured to obtain a conditioned medium (secretome), then lyophilized to produce lyosecretome. Total protein was determined by bicinchoninic acid assay (BCA) and SDS-PAGE to improve protein measurements. Antioxidant concentration was measured by ABTS assay, while the protective ability of lyosecretome against oxidative stress was determined by the metabolic activity of osteoblast cells. The study group was divided into a control group (culture medium) and a lyosecretome treatment group (0.0; 0.157, 0.313, 0.625, 1.25, 2.5, 5, and 10 mg/mL + H2O2). Results: Lyosecretome had a protein concentration of 2086.00 ± 0.20 µg/ml, with a molecular weight of 174, 74, 61, 55, and 26 kDa, which are thought to facilitate cell migration, as well as bind cytokines and growth factors. Lyosecretome also provided the highest antioxidant activity of 93.51% at a concentration of 4.8 mg/ml, with an IC50 value of 2.08 mg/ml. The highest cell metabolic activity (79.53 ± 2.41%) was shown in the 1.25 mg/ml lyosecretome treatment group. All concentrations of hGMSC-lyosecretome attenuate the adverse effect of H2O2-induced oxidative stress. Conclusion: Lyosecretome obtained from hGMSCs can maintain metabolic activity in osteoblast cells as protection against H2O2 oxidative stress.

Shifting the Paradigm: How Stress Hyperglycemia Alters the Landscape of Heart Failure Management.

Background Acute decompensated heart failure (ADHF) significantly contributes to global morbidity. Stress hyperglycemia (SHGL), although commonly observed in non-diabetic ADHF patients, remains underexplored. This study investigates the predictive value of SHGL for major adverse cardiac events (MACEs) and its impact on coronary intervention outcomes. Methods In this prospective observational study at a tertiary care center, 650 non-diabetic ADHF patients admitted for coronary intervention between April 2021 and April 2022 were assessed. SHGL was defined by random blood sugar levels >140 mg/dl. We monitored the incidence of MACEs, including cardiac death, non-fatal myocardial infarction, and heart failure rehospitalization, alongside the success rates of coronary revascularizations over 12 months. Results SHGL was present in 54% of patients (n=352) and was significantly associated with increased MACEs (p<0.001), higher rehospitalization rates (p<0.01), and lower success in revascularization (p<0.05). Using logistic regression, SHGL, age >65, and prior heart failure hospitalization were identified as independent predictors of MACEs. Statistical analyses were performed using two-tailed Mann-Whitney U tests, with significance levels set at p<0.05 for noteworthy findings and p<0.01 or p<0.001 for highly significant findings. Conclusions SHGL significantly impacts coronary intervention outcomes and the future prognosis of heart failure in non-diabetic ADHF patients, identifying it as a critical, modifiable risk factor. These findings advocate integrating SHGL management into ADHF care, emphasizing the need for further research to develop standardized treatment protocols. Proper management of SHGL could potentially improve patient outcomes, highlighting the importance of metabolic control in heart failure management.

APPaRENT 3: Asthma Patients' and Physicians' Perspectives on the Burden and Management of Asthma in Seven Countries.

INTRODUCTION: Asthma management is strongly dependent on physician and patient beliefs and perceptions about the disease and its long-term treatment. The APPaRENT 3 study was conducted to explore factors influencing treatment choice and to understand patients' and physicians' attitudes and perspectives on the use of controller inhalers in regular versus flexible dosing for asthma management. METHODS: This cross-sectional survey of patients with asthma and treating physicians was conducted in seven countries: Indonesia, Malaysia, Philippines, Thailand, Vietnam (patient survey only), Saudi Arabia, and the United Arab Emirates. Assessment was carried out through an online/face-to-face questionnaire, where patients' viewpoints were focused on their attitudes and beliefs about asthma and treatment adherence, whereas physicians' viewpoints were gathered on their attitudes and beliefs about asthma management, knowledge of and adherence to asthma treatment guidelines, and asthma treatment regimens. RESULTS: Overall, 1400 patients (mean age, 34 years) and 599 physicians (mean age, 43 years) were included in the survey. Physicians similarly prioritised symptom control (39%) and exacerbation reduction (40%) in moderate asthma, whereas patients prioritised symptom control (41%) over exacerbation reduction (22%). Although both groups (physicians, 86%; patients, 84%) perceived asthma as well-controlled, poor management was evident based on Asthma Control Test (ACT) scores (mean, 15.7; standard deviation, 4.14; 82% had an ACT score < 20) and high symptom burden (39% reported nighttime awakenings or early mornings ≥ 2 nights/week). Most patients (76%) with moderate asthma were prescribed regular dosing, with the most common treatment being inhaled corticosteroid (ICS)/long-acting ß2-agonist (LABA) with as-needed inhaled short-acting ß2-agonist (SABA; 20%). Among patients on maintenance and reliever therapy, 93% of patients received a separate inhaled reliever. CONCLUSIONS: Despite high symptom burden, patients overestimated their level of asthma control. Physicians prioritised controlling symptoms and reducing exacerbations as treatment goals for moderate asthma, often prescribing regular dosing with ICS/LABA with as-needed inhaled SABA.

Managing asthma depends a lot on what doctors and patients think about the illness and its long-term treatment. This study looked into what influences treatment decisions and what patients and doctors think about using inhalers regularly or on an as-needed basis to manage asthma across seven countries (Indonesia, Malaysia, Philippines, Thailand, Vietnam [patient survey only], Saudi Arabia, and the United Arab Emirates). In this study, patients with asthma and doctors managing asthma completed an online/face-to-face questionnaire. The study aimed to understand what patients think about asthma and their treatment plan. Meanwhile, the doctors were asked what they think about managing asthma and how much they apply clinical guidelines for treating patients with asthma. Doctors believed it is equally important to control symptoms and prevent worsening of symptoms in patients with moderate asthma, while patients cared more about controlling symptoms than preventing worsening of symptoms. While doctors and patients both regarded asthma as well-controlled, many patients had low Asthma Control Test scores and experienced a lot of symptoms, suggesting that they are poor perceivers of asthma control. Most patients with moderate asthma were given regular treatment, usually with inhaled corticosteroid combined with long-acting ß₂-agonist along with as-needed short-acting ß₂-agonist as a reliever. Most patients who were prescribed the same inhaler for regular use and as a reliever also had a separate inhaler for quick relief of symptoms. This study shows the need for patients and doctors to have better conversations about asthma, its treatments, and what to expect from them.

An innovative approach to detect circulating tumor cells.

In cancer research, circulating tumor cells (CTCs) were identified as the main drivers of metastasis. They are vital for early detection and prevention of metastasis during cancer treatment. Even though continuous progress in research offers more and more tools to combat cancer, we still lack a proper arsenal of therapeutics. Especially in tumors with close to no targeting options, like triple-negative breast cancer, early detection is often the main difference between successful and failed therapy. When such tumors are detected too late, they may have already produced plenty of CTCs, likely causing metastasis, which is the primary reason for tumor-associated deaths. Detecting those CTCs early on could substantially impact therapy outcomes and the 5-year survival rate. In our study, we developed and evaluated a reliable and affordable CTC screening method based on flow cytometry and 5-aminolevulinic acid (5-ALA) staining. We successfully established a circulation model for 5-ALA and CTCs research and demonstrated that the method can detect an average of 11 ±â€¯3.3 CTCs out of 10,000 peripheral blood mononuclear cells, representing as low as approximately 0.1 % with a reasonable number of false positive events. Additionally, we present initial results on a theranostic approach using 5-ALA converted to protoporphyrin IX. The outcomes of this study might contribute significantly to the further development of CTC detection and the overall detection and treatment of cancer.

A Rare Case of Parotid Stone Adherence to the Facial Nerve.

This case report details a complex case of parotid gland sialolithiasis with stones adherent to the facial nerve, a scenario that presents a significant surgical challenge. Traditional sialendoscopy failed to address the condition in a 23-year-old female patient, leading to the adoption of a combined endoscopic transcutaneous approach. This method successfully resolved the condition without intraoperative complications, maintaining intact facial nerve function postoperatively. The case emphasizes the importance of individualized surgical strategy and expert technique in advanced parotid surgery, advocating this approach for similarly complex sialolithiasis cases.

Assessment of radiation-induced sterility, longevity, and reproductive characteristics of the Aedes aegypti (Diptera: Culicidae) strain of Swat: A step towards the implementation of SIT in Pakistan.

BACKGROUND OBJECTIVES: Biological approaches for vector mosquito control such as sterile insect technique (SIT) requires sterilization of male mosquitoes through specific radiation doses for sterility induction in males. Under the SIT program, the males used must be compatible with the wild males in vigor, flight and selection of mate. Much of this potential is determined by the diet provided in the larval stages and optimizing the irradiation doses that cause complete sterility but have very minimal effect on the lives of irradiated males. The current study is designed to evaluate gamma radiation doses for inducing sterility in male Aedes aegypti mosquitoes with a genomic background from Pakistan (Swat district) and to assess the effects of radiation exposure on the competency of irradiated males and other life traits of irradiated mosquitoes. METHODS: Sterilization of 17-hour-old male pupae (groups of 50 pupa/cup in three replicates) of the Ae. aegypti Swat strain was conducted using radiation doses of 30, 60, 70, 90, and 105 gray (Gy) from (Co60) at the Nuclear Institute for Food and Agriculture (NIFA) in Peshawar, Pakistan. Post-irradiated pupae were released in adult cages. Virgin females of the same cohort were released (1:1) to mate with the irradiated males. Mortality, longevity, mating competitiveness of males, and female fecundity were recorded. RESULTS: An average of 71 eggs per female was recorded in control with 86% hatch rate. Individual females mated with a 60 Gy treated males produced 60 ± 0.6 eggs per female with 17% hatch rate, and those mated with 70 Gy males produced 42 ± 0.01 eggs with a nil hatch rate, whereas females mated with males treated with ≥70 Gy doses did not reproduce to next generation. Females in groups of 50 mated with 60, 70 Gy treated males (equal pairs), produced 369±1.3 and 98±0.01 eggs with 15% and zero hatch rate. Significant dose dependent reduction in longevity was observed for >30 Gy doses. The matting competence of irradiated males was about half that of un-irradiated males. INTERPRETATION CONCLUSION: Aedes aegypti with a Pakistani genomic background treated with a ≥70 Gy dose of gamma radiation induced complete sterility in males and provided the first- step foundation for SIT application in Pakistan. Further extensive studies are required to optimize the SIT techniques so that fully sterile males with very minor quality changes can be produced on large scales for field trials.

Role of Anteromedial Cortical Support for Unstable Intertrochanteric Fractures Being Treated With Cephalomedullary Nails.

INTRODUCTION: Reduction quality is of paramount importance for an optimal outcome in unstable pertrochanteric fractures. The non-anatomical functional anteromedial buttress is proposed to prevent impending mechanical complications. We aimed to evaluate the role of anteromedial cortical support in preventing mechanical complications following fixation with the cephalomedullary nail. MATERIALS AND METHODS: A prospective, single-arm interventional study was conducted in the Orthopaedics Department of a Combined Military Hospital (CMH) in Rawalpindi. The duration of the study was 24 months. Patients were recruited by the purposive sampling technique as per inclusion/exclusion criteria. Preoperatively, the reduction was categorized as per Baumgartner's and Chang's criteria. Post-operatively, weight bearing as tolerated was advised. Radiographs prior to discharge for loss of reduction were evaluated. Follow-up radiographic measurements of neck length, neck shaft angle, and their loss as per protocol were done at three and six months. RESULTS: A total of 202 patients were operated on from October 21 until August 23. Mortality at six months in 39 patients (19.3%) and loss to follow-up in 31 patients (15.3%) resulted in 132 patients with complete follow-up and having developed complications in 12 patients (9.09%). The mean age was 76.3 ± 7.98 years; males were 105 (79.5%), and females were 27 (20.5%). Closed reduction was 58 (43.9%), and additional manoeuvres were required in 74 (56.1%). The mean tip apex distance (TAD) was 24.56 ± 2.76, and the Calcar gap was 5.16 ± 1.27. Cleveland zone centre-centre in 54 (40.9%), inferior-centre in 65 (49.2%), and inferior-posterior (9.9%) were statistically significant for mechanical complications (p≤0.001). There was a significant association between the grading of Chang's and Baumgartner's poor groups for the development of mechanical complications (p≤0.001). The mean time to full weight bearing without support was 21 ± 1.22 weeks. The mean Hip Harris score at six months was 69.27 ± 7.68. CONCLUSION: Results suggest that anteromedial cortical support can lead to fewer potential mechanical complications at six months. A higher Chang's grade drives surgeons to engage in additional manoeuvres. Anteromedial cortical support is worth consideration for unstable pertrochanteric fractures.

Max-mixed EWMA control chart for joint monitoring of mean and variance: an application to yogurt packing process.

The Max-Mixed EWMA Exponentially Weighted Moving Average (MM EWMA) control chart is a statistical process control technique used for joint monitoring of the mean and variance of a process. This control chart is designed to detect small and moderate shifts in the mean and variance of a process by comparing the maximum of two statistics, one based on the mean and the other on the variance. In this paper, we propose a new MM EWMA control chart. The proposed chart is compared with existing control charts using simulation studies, and the results show that the chart performs better in detecting small and moderate shifts in both the mean and variance. The proposed chart can be helpful in quality control applications, where joint monitoring of mean and variance is necessary to ensure a product's or process's quality. The real-life application of the proposed control chart on yogurt packing in a cup data set shows the outperformance of the MM EWMA control chart. Both simulations & real-life application results demonstrate the better performance of the proposed chart in detecting smaller shifts during the production process.

An adaptive Bayesian approach for improved sensitivity in joint monitoring of mean and variance using Max-EWMA control chart.

This article introduces an adaptive approach within the Bayesian Max-EWMA control chart framework. Various Bayesian loss functions were used to jointly monitor process deviations from the mean and variance of normally distributed processes. Our study proposes the mechanism of using a function-based adaptive method that picks self-adjusting weights incorporated in Bayesian Max-EWMA for the estimation of mean and variance. This adaptive mechanism significantly enhances the effectiveness and sensitivity of the Max-EWMA chart in detecting process shifts in both the mean and dispersion. The Monte Carlo simulation technique was used to calculate the run-length profiles of different combinations. A comparative performance analysis with an existing chart demonstrates its effectiveness. A practical example from the hard-bake process in semiconductor manufacturing is presented for practical context and illustration of the chart settings and performance. The empirical results showcase the superior performance of the Adaptive Bayesian Max-EWMA control chart in identifying out-of-control signals. The chart's ability to jointly monitor the mean and variance of a process, its adaptive nature, and its Bayesian framework make it a useful and effective control chart.

A support vector machine based drought index for regional drought analysis.

The increased global warming has increased the likelihood of recurrent drought hazards. Potential links between the frequency of extreme weather events and global warming have been suggested by earlier research. The spatial variability of meteorological factors over short distances can cause distortions in conclusions or limit the scope of drought analysis in a particular region when extreme values predominate. Therefore, it is challenging to make trustworthy judgments regarding the spatiotemporal characteristics of regional drought. This study aims to improve the quality and accuracy of regional drought characterization and the process of continuous monitoring. The new drought indicator presented in this study is called the Support Vector Machine based drought index (SVM-DI). It is created by adding different weights to an SVM-based X-bar chart that is displayed with regional precipitation aggregate data. The SVM-DI application site is located in Pakistan's northern area. Using the Pearson correlation coefficient for pairwise comparison, the study compares the SVM-DI and the Regional Standard Precipitation Index (RSPI). Interestingly, compared to RSPI, SVM-DI shows more pronounced regional characteristics in its correlations with other meteorological stations, with a significantly lower Coefficient of Variation. These results confirm that SVM-DI is a useful tool for regional drought analysis. The SVM-DI methodology offers a unique way to reduce the impact of extreme values and outliers when aggregating regional precipitation data.