Results of a Pilot Study on the Safety and Early Efficacy of Novel Polymethyl Methacrylate Microspheres and a Hyaluronic Acid Device for the Treatment of Low Back Pain Caused by Degenerative and Diseased Intervertebral Discs of the Lumbar Spine.

Background Low back pain (LBP) costs the healthcare system billions of dollars each year. Intervertebral disc (IVD) degeneration is a significant cause of LBP, due to structural defects, biomechanical instability, and inflammation. First-line therapy for patients with LBP includes physical therapy, medication, and steroid injections. DiscSealTM was developed to provide patients who are refractory to first-line therapy with a minimally invasive treatment alternative to invasive surgical procedures. The product is a combination of poly-methyl methacrylate (PMMA) microspheres in hyaluronic acid (HA) that is injected under modified discography into the IVD. Methods Two pain specialist centers in Australia recruited eligible participants who were followed up for 180 days post-procedure. The procedure was conducted using a modified discography technique. Low back and leg pain was reported using the Visual Analogue Scale (VAS) while other endpoints included were Oswestry Disability Index (ODI), Clinician and Patient Global Impact of Change, and Patient Rating of Overall Health Status. The general analytical approach for all endpoints was descriptive in nature and 95% confidence intervals of means were estimated. Results The pilot study achieved its primary objective which was an absence of peri-treatment or post-treatment device-related Serious Adverse Events (SAE) during the first 90 days. There were no device-related serious adverse events recorded throughout the study. The mean LBP percentage change from baseline at 90 and 180 days was -27.0% and -42.3% respectively. The mean ODI percentage change from baseline at 90 and 180 days was -22.3 and -14.2% respectively. End of study improvements shows a 67.8% (20.83) increase in Overall Health Status, as well as positive results for Participant and Clinician Global Impact of Change. These results were achieved based on treating one diseased IVD, although 83.3% of patients were diagnosed with multiple diseased IVDs. Conclusions The results from this pilot study showed that DiscSealTM is safe and well-tolerated. Early efficacy shows that DiscSealTM may be a promising treatment option for people suffering from discogenic LBP that have not responded to first-line treatment options. A larger, statistically powered study where all diseased discs are treated should be completed to validate the promising results from this early feasibility study.

Early Stage Machine Learning-Based Prediction of US County Vulnerability to the COVID-19 Pandemic: Machine Learning Approach.

BACKGROUND: The rapid spread of COVID-19 means that government and health services providers have little time to plan and design effective response policies. It is therefore important to quickly provide accurate predictions of how vulnerable geographic regions such as counties are to the spread of this virus. OBJECTIVE: The aim of this study is to develop county-level prediction around near future disease movement for COVID-19 occurrences using publicly available data. METHODS: We estimated county-level COVID-19 occurrences for the period March 14 to 31, 2020, based on data fused from multiple publicly available sources inclusive of health statistics, demographics, and geographical features. We developed a three-stage model using XGBoost, a machine learning algorithm, to quantify the probability of COVID-19 occurrence and estimate the number of potential occurrences for unaffected counties. Finally, these results were combined to predict the county-level risk. This risk was then used as an estimated after-five-day-vulnerability of the county. RESULTS: The model predictions showed a sensitivity over 71% and specificity over 94% for models built using data from March 14 to 31, 2020. We found that population, population density, percentage of people aged >70 years, and prevalence of comorbidities play an important role in predicting COVID-19 occurrences. We observed a positive association at the county level between urbanicity and vulnerability to COVID-19. CONCLUSIONS: The developed model can be used for identification of vulnerable counties and potential data discrepancies. Limited testing facilities and delayed results introduce significant variation in reported cases, which produces a bias in the model.

One-pot photoassisted synthesis, in situ photocatalytic testing for hydrogen generation and the mechanism of binary nitrogen and copper promoted titanium dioxide.

For the sustainable production of hydrogen by photocatalysis, the use of renewable resources such as water, organic compounds from plant biomass and earth abundant metal promoters is desired. We herein describe the previously not reported "one-pot" photoassisted synthesis of a binary metal-nitrogen promoted Cu(0)-N-TiO2 photocatalyst from a N-TiO2 precursor by photodeposition of copper directly in the photocatalytic suspension. The N-TiO2 contains nanocrystalline anatase as found by XRD and Raman spectroscopy. X-ray Photoelectron Spectroscopy (XPS) and Electron Spin Resonance (ESR) spectroscopy indicate that a nitrogen promoter is present as a substitutional site. The scheme of relaxation of a photoexcited charge through a substitutional nitrogen induced midgap states in N-TiO2 is proposed. The binary promoted Cu(0)-N-TiO2 photocatalyst prepared from N-TiO2 by "one-pot" photodeposition of copper in the suspension showed a high activity in the in situ hydrogen generation under near-UV/visible light with glycerol in water, up to 675 µmol g-1 h-1. The "one-pot" photoassisted synthesis and mechanism of operation of the Cu(0)-N-TiO2 photocatalyst are studied by the complementary in situ spectroscopic methods.

A Synergistic Role of Myeloperoxidase and High Sensitivity Troponin T in the Early Diagnosis of Acute Coronary Syndrome.

Aim of this study was to evaluate the role of Myeloperoxidase (MPO) and high sensitive Troponin T in the early diagnosis of acute coronary syndrome (ACS). This was a cross sectional study that comprised of 120 individuals of which 75 were cases and 45 healthy controls. On the basis of clinical history and 12 lead electrocardiogram initial diagnosis of ACS was made in the cases. MPO and high sensitive Troponin T (hs-cTnT) was measured in all the individuals. Levels of MPO were significantly higher in patients of ACS as compared to those in control group [medians: 15.40 (95 % CI 11.06-20.84) vs 5.84 (95 % CI 5.50-6.44)]. By taking the cut off as >11.87 U/mL for MPO, its sensitivity was 87 % (95 % CI 73.7-95.1), specificity was 97.3 % (95 % CI 90.6-99.7), positive predictive value was 94.6 % and negative predictive value was 92.6 %. Positive likelihood ratio was 33.0 while negative likelihood ratio was 0.13, whereas the corresponding values in case of hs-cTnT were 95.6 % (95 % CI 85.2-99.5), 61.3 % (95 % CI 49.5-72.6), 59.7 %, 95.8 %, 2.47 and 0.07 by taking cut off as >14 pg/ml. The area under the ROC curves (AUC) of MPO and hscTnT at 0-6 h were 0.971 (95 % CI 0.92-0.99, P < 0.001) and 0.797 (95 % CI 0.71-0.86, P < 0.001) respectively. The logistic model combining the two markers yielded sensitivity, specificity, positive predictive value and negative predictive value of 95.7, 97.3, 98.2 and 93.7 % respectively. It was concluded that MPO and hs-cTnT may be useful tools for risk stratification of ACS and can be used together with better accuracy in the early diagnosis of ACS.

Self-Exfoliated Guanidinium-Based Ionic Covalent Organic Nanosheets (iCONs).

Covalent organic nanosheets (CONs) have emerged as functional two-dimensional materials for versatile applications. Although π-π stacking between layers, hydrolytic instability, possible restacking prevents their exfoliation on to few thin layered CONs from crystalline porous polymers. We anticipated rational designing of a structure by intrinsic ionic linker could be the solution to produce self-exfoliated CONs without external stimuli. In an attempt to address this issue, we have synthesized three self-exfoliated guanidinium halide based ionic covalent organic nanosheets (iCONs) with antimicrobial property. Self-exfoliation phenomenon has been supported by molecular dynamics (MD) simulation as well. Intrinsic ionic guanidinium unit plays the pivotal role for both self-exfoliation and antibacterial property against both Gram-positive and Gram-negative bacteria. Using such iCONs, we have devised a mixed matrix membrane which could be useful for antimicrobial coatings with plausible medical benefits.

A synergistic role of ischemia modified albumin and high-sensitivity troponin T in the early diagnosis of acute coronary syndrome.

AIM: The aim was to evaluate the role of high sensitivity troponin T and ischemia modified albumin (IMA) and in the early diagnosis of acute coronary syndrome (ACS). MATERIALS AND METHODS: This was a cross-sectional study that comprised of 120 individuals of which 75 were cases and 45 healthy controls. On the basis of clinical history and 12-lead electrocardiogram, initial diagnosis of ACS was made in the cases. High sensitive cardiac troponin T (hs-cTnT) and IMA were measured in all the individuals. RESULTS: Levels of IMA were significantly higher in patients of ACS as compared to those in control group (means: 101.83 [95% confidence interval (CI): 91.96-111.70] vs. 41.11 [95% CI: 38.55-43.67]). By taking the cut-off as >65.23 U/mL for IMA, which was obtained from receiver operating characteristic (ROC) curve, the sensitivity was 91.3%, specificity was 81.1%, positive predictive value (PPV) was 74.4%, and negative predictive value (NPV) was 93.9%. Positive likelihood ratio was 4.83 while negative likelihood ratio was 0.11, whereas the corresponding values in case of hs-cTnT were 95.6% (95% CI: 85.2-99.5), 61.3% (95% CI: 49.5-72.6), 59.7%, 95.8%, 2.47 and 0.07 by taking cut-off as >14 pg/mL. The area under the ROC curves (AUC) of IMA and hs-cTnT at 0-6 h were 0.932 (95% CI: 0.87-0.97, P < 0.001) and 0.797 (95% CI: 0.71-0.86, P < 0.001), respectively. The logistic model combining the two markers yielded sensitivity, specificity, PPV, and NPV of 95.7%, 81.1%, 88.6%, and 92.5% respectively. CONCLUSION: hs-cTnT and IMA may be useful tools for risk stratification of ACS and can be used together with better accuracy in the early diagnosis of ACS.

Production of hydrogen by glycerol photoreforming using binary nitrogen-metal-promoted N-M-TiO(2) photocatalysts.

The need for renewable energy focuses attention on hydrogen obtained by using sustainable and green methods. The sustainable compound glycerol can be used for hydrogen production by heterogeneous photocatalysis. A novel approach involves the promotion of the TiO2 photocatalyst with a binary combination of nitrogen and transition metal. We report the synthesis and spectroscopic characterization of the new N-M-TiO2 photocatalysts (M=none, Cr, Co, Ni, Cu), and the photocatalytic reforming of glycerol to hydrogen under ambient conditions and near-UV or visible light versus benchmark P25 TiO2 . In units of activity µmol m(-2) h(-1) , N-Ni-TiO2 is five-fold more active than P25, and N-Cu-TiO2 is 44-fold more active. The photocatalytic activity of N-M-TiO2 increases from Cr to Co and Ni, whereas the photoluminescence decreases; the change in activity is due to the modulation of charge recombination.