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1.
Artigo em Inglês | MEDLINE | ID: mdl-34822082

RESUMO

Water distillation by utilising free energy from the sun is one of the significant techniques for getting freshwater from salty and seawater. For the remote areas and small societies where freshwater is distant, solar distillation is one of the best explanations for freshwater creation. The main objective of this study is to evaluate the performance of the flat plate collector-assisted conventional solar still incorporating mirror wall and heat storage material, which was tested at Anchor institute of solar energy studies, Mehsana (23.5275311° latitude and 72.3881041° longitude), Gujarat. Moreover, the study captures average productivity with and without FPC which was 1.5 L and 1.0 L respectively during the day time for the entire period of experiments. In this study, the water depth is varied from 1 to 5 cm inside the single basin solar still to obtain the optimum depth. It was observed that when mirror augmented still was operated with the FPC, 3.6L/day productivity was achieved with 30% instantaneous efficiency, at solar radiation of 1122 W/m2 and ambient temperature of 24 °C. Also, the maximum productivity was observed at a water depth of 3 cm and 4 cm. Moreover, improvements in daily and yearly productivity were observed to be 51.515% and 56.6474% respectively, which were estimated on the basis of with and without FPC. An experiment was performed at Anchor Institute of Solar Energy, Mehsana located at the north part of Gujarat where the average annual rain was comparatively less compared to other regions, so this type of solar still can provide potable water to daily workers who work on site. Furthermore, economic study reveals 0.577 INR/litre cost of distiller output for conventional set-up and 0.477 INR/litre for the FPC assisted set-up.

2.
Altern Lab Anim ; : 2611929211061884, 2021 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-34836458

RESUMO

As non-animal alternatives gain acceptance, a need for harmonised testing strategies has emerged. Arguably the most physiologically-relevant model for assessing potential respiratory toxicants, that based on human precision-cut lung slices (hPCLS) has been utilised in many laboratories, but a variety of culture methodologies are employed. In this pilot study, combinations of three different hPCLS culture methods (dynamic organ roller culture (DOC), air-liquid interface (ALI) and submersion) and various media (based on E-199, DMEM/F12 and RPMI-1640) were compared. The hPCLS were assessed in terms of their viability and responsiveness to challenge. The endpoints selected to compare the medium-method (M-M) combinations, which included histological features and viability, were evaluated at day 14 (D14) and day 28 (D28); protein and adenylate kinase (AK) content, and cytokine response to immunostimulants (lipopolysaccharide (LPS) at 5 µg/ml; polyinosinic:polycytidylic acid (Poly I:C) at 15 µg/ml) were evaluated at D28 only. Based on the set of endpoints assessed at D28, it was clear that certain culture conditions significantly affected the hPCLS, with the tissue retaining more of its native features and functionality (in terms of cytokine response) in some of the M-M combinations tested more than others. This pilot study indicates that the use of appropriate M-M combinations can help maintain the health and functional responses of hPCLS, and highlights the need for the standardisation of culture conditions in order to facilitate effective inter-laboratory comparisons and encourage greater acceptance by the regulatory community.

3.
Artigo em Inglês | MEDLINE | ID: mdl-34774478

RESUMO

OBJECTIVES: The aim of this study was to evaluate the clinical impact of computed tomography (CT)-derived pulmonary artery dilatation (PAD) in patients undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND: Several studies have reported an association between pulmonary hypertension and cardiovascular events, but the prognostic value of PAD in patients undergoing TAVR remains unclear. METHODS: The preprocedural computed tomographic studies of patients who underwent TAVR at Cedars-Sinai Medical Center between November 2013 and December 2017 were analyzed. Patients were divided into 2 groups according to the presence of PAD assessed on CT (pulmonary artery [PA] diameter ≥29 mm). The primary endpoint was all-cause mortality at 2 years. RESULTS: A total of 895 patients were included (mean age 81.3 ± 8.5 years), with a mean Society of Thoracic Surgeons score of 4.8%. The median PA diameter was 28.0 mm, and PAD was observed in 369 patients (41.2%). Compared with the no-PAD group, the PAD group had higher Society of Thoracic Surgeons scores and higher rates of atrial fibrillation, chronic kidney disease, and chronic obstructive pulmonary disease. The PAD group had higher 2-year all-cause mortality than the no-PAD group (28.9% vs 12.8%; P < 0.001), and PAD was independently associated with mortality (adjusted hazard ratio: 2.21; 95% confidence interval: 1.44-3.39; P < 0.001). Furthermore, PAD had strong prognostic power in the subgroup analysis, stratified according to PA pressure (>36 mm Hg). CONCLUSIONS: CT-derived PAD is a significant prognostic factor in patients undergoing TAVR.

4.
JTCVS Open ; 6: 108-115, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34746874

RESUMO

You're driving along the freeway during rush hour. You're running late and find yourself in bumper-to-bumper traffic. You have 3 options: (1) do nothing, suffer with anguish inside; (2) find productive ways to pass the time, like listen to a podcast or talk on the phone; or (3) get off on the next exit and find an alternative, roundabout path to your destination. Similarly, patients suffering from coronary artery disease can opt to do nothing; stop progression and treat their symptoms with medical therapy; or undergo revascularization either percutaneously or surgically. There are few options, however, for those who develop chronic coronary artery disease without suitable revascularization strategies. They have missed their exit and are stuck in this metaphorical traffic jam, with no radio and no cell phone. These patients may experience refractory angina or develop ischemic cardiomyopathy and heart failure. Exploring solutions to this increasingly widespread problem is imperative. Chronic heart failure is rising, while the number of organs available for transplantation remains limited. Similarly, bridge therapies such as ventricular assist devices are resource intensive and are typically only performed at select, high-volume institutions. In the following article, the authors explore cardiac regenerative strategies to bridge this therapeutic gap. They delve into a so-called "biologic bypass," which aims to restore perfusion and functionality of ischemic myocardium. Specifically, they review published preclinical data and the potential clinical implementation of cardiac reprogramming of fibrotic tissue into functioning, contractile myocardium, as well as angiogenic therapies aimed at inducing angiogenesis. These innovative and forward-thinking approaches will be necessary to combat the challenges faced by the heart specialists of tomorrow.w Jordan Dozier, MD, and Nahush A. Mokadam, MD.

5.
J Neuroophthalmol ; 41(4): e806-e814, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34788250

RESUMO

BACKGROUND: Many potential surgical options exist to address large-angle deviations and head turns that result from various forms of paralytic strabismus. Muscle transposition surgeries serve as suitable alternatives to simple resection-recessions. Here, we report outcomes of augmented Hummelsheim and X-type transpositions for the correction of large-angle strabismus and provide insights for surgical planning. METHODS: We performed a retrospective chart review of 40 consecutive patients with strabismus who were treated with an augmented Hummelsheim or X-type transposition surgery at a single academic medical center. Etiologies included cranial nerve palsies (n = 26), monocular elevation palsy (n = 3), Duane syndrome (n = 1), traumatic extraocular muscle damage (n = 8), and chronic progressive external ophthalmoplegia (n = 2). All patients were followed for a minimum of 2 months postsurgery. Logistic regression analyses were performed to assess for predictors of surgical outcome. RESULTS: Forty consecutive patients were enrolled in our series. The median preoperative deviation was 46.5Δ (interquartile range [IQR] 35-70). The median postoperative deviation 2 months after surgery was 0.5Δ (IQR 0-9.5), which represented a significant improvement (P < 0.001). Thirty-three patients (82.5%) experienced an improvement in range and/or centration of binocular single vision (BSV). More patients who underwent an augmented Hummelsheim procedure and had a small overcorrection at postoperative day 3 had a favorable result on postoperative month 2 (79%) compared with those that were initially under-corrected (38%). Multiple logistic regressions found larger preoperative deviation (P < 0.005) and esotropia (P < 0.021) to be predictors of a less favorable surgical outcome (C-statistic = 0.83). Subgroup analysis revealed that less, favorable outcome after X-type transposition occurred most frequently in patients undergoing correction of an esodeviation. CONCLUSION: Augmented Hummelsheim transposition techniques offer effective treatment options for paralytic strabismus with esotropic deviations, whereas X-type transpositions are effective for exotropic deviations and deviations from severe inferior rectus damage. In addition to potentially providing a wider field of BSV, improved centration is often achieved.

6.
J Ayurveda Integr Med ; 12(4): 689-694, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34690043

RESUMO

BACKGROUND: Brass is a copper-zinc alloy that also contains additional elements, including lead. Industrial operations on brass produce dust and fumes that can be harmful to an individual's health. Ayurveda recommends Dadima Svarasa and Triphala Churna for the management of symptoms caused due to brass toxicity. OBJECTIVE: To obtain preliminary evidence on the efficacy of Triphala Churna (powder mixture of three myrobalans) and Dadima Svarasa (pomegranate juice) in the management of brass-associated high serum level of copper, zinc, lead, and their harms through an open-label single-arm pilot study. MATERIALS AND METHODS: A total of 20 workers with brass toxicity and increased level of one or more of the serum ions including copper, zinc and lead were prescribed. 5gm Triphala powder once daily and Dadima Svarasa 40 ml in two divided doses were administered daily for 28 days. Changes in serum concentration of heavy metals and common health problems like anorexia, headache, dizziness, weakness, nausea, nose irritation, eye irritation, epigastric pain, abdominal distention, chest pain, dyspnea, cough, lumbar pain, body ache, numbness, and occupational dermatitis were reported at baseline and end of the trial. RESULTS: Trial drugs were found to produce significant decrease in mean values of serum copper (p < 0.001) and serum lead (p < 0.001) whereas significant increase in mean values of serum zinc (p > 0.001) was observed. Significant relief was observed in nausea (p = 0.005), anorexia (p = 0.000), epigastric pain (p = 0.001), abdominal distention (p = 0.014), weakness (p = 0.005) and body ache (p = 0.005). CONCLUSION: Triphala Churna along with Dadima Svarasa are safe and effective in the management of brass-associated high serum levels of copper and lead and their health hazards.

8.
Materials (Basel) ; 14(20)2021 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-34683624

RESUMO

The prospect of using metal-cored wires instead of solid wires during gas metal arc welding (GMAW) of 2.25 Cr-1.0 Mo steels embraces several challenges. The in-service requirements for the equipment made up of these steels are stringent. The major challenge faced by the manufacturers is temper embrittlement. In the current study, the temper embrittlement susceptibility of the welded joint was ascertained by subjecting it to step cooling heat treatment. A 25 mm thick 2.25 Cr-1.0 Mo weld joint was prepared using a combination of the regulated metal deposition (RMD) and GMAW processes incorporating metal-cored wires. After welding the plates were exposed to post-weld heat treatment followed by a rigorous step cooling heat treatment prescribed by API standards. The temper embrittlement susceptibility of the weld joint was ascertained by Bruscato X-factor as well as by formulating ductile-to-brittle transition temperature (DBTT) curves by carrying out the impact toughness testing at various temperatures. Detailed microscopy and hardness studies were also carried out. It was established from the study that the X-factor value for the welded joint was 15.4. The DBTT for the weld joint was found to occur at -37 °C which was well below 10 °C. Optical microscopy and scanning electron microscopy indicated the presence of carbides and the energy dispersive X-ray spectrometry studies indicated the presence of chromium and manganese-rich carbides along with the presence of sulfur near the grain boundaries. This study establishes a base for the usage of metal-cored wires particularly in high temperature and pressure application of Cr-Mo steels.

9.
Respir Res ; 22(1): 275, 2021 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-34702270

RESUMO

BACKGROUND: Epidemiological data associate high levels of combustion-derived particulate matter (PM) with deleterious respiratory outcomes, but the mechanism underlying those outcomes remains elusive. It has been acknowledged by the World Health Organization that PM exposure contributes to more than 4.2 million all-cause mortalities worldwide each year. Current literature demonstrates that PM exacerbates respiratory diseases, impairs lung function, results in chronic respiratory illnesses, and is associated with increased mortality. The proposed mechanisms revolve around oxidative stress and inflammation promoting pulmonary physiological remodeling. However, our previous data found that PM is capable of inducing T helper cell 17 (Th17) immune responses via aryl hydrocarbon receptor (Ahr) activation, which was associated with neutrophilic invasion characteristic of steroid insensitive asthma. METHODS: In the present study, we utilized a combination of microarray and single cell RNA sequencing data to analyze the immunological landscape in mouse lungs following acute exposure to combustion derived particulate matter. RESULTS: We present data that suggest epithelial cells produce specific cytokines in the aryl hydrocarbon receptor (Ahr) pathway that inform dendritic cells to initiate the production of pathogenic T helper (eTh17) cells. Using single-cell RNA sequencing analysis, we observed that upon exposure epithelial cells acquire a transcriptomic profile indicative of increased Il-17 signaling, Ahr activation, Egfr signaling, and T cell receptor and co-stimulatory signaling pathways. Epithelial cells further showed, Ahr activation is brought on by Ahr/ARNT nuclear translocation and activation of tyrosine kinase c-src, Egfr, and subsequently Erk1/2 pathways. CONCLUSIONS: Collectively, our data corroborates that PM initiates an eTh17 specific inflammatory response causing neutrophilic asthma through pathways in epithelial, dendritic, and T cells that promote eTh17 differentiation during initial PM exposure.

11.
Ann Thorac Surg ; 2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34416227

RESUMO

BACKGROUND: Differences in left ventricular mass regression (LVMR) between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) have not been studied. We present clinical and echocardiographic data from veterans who underwent TAVR and SAVR, evaluating the degree of LVMR and its association with survival. METHODS: We retrospectively reviewed TAVR (n = 194) and SAVR (n = 365) procedures performed in veterans from 2011 to 2019. After 1:1 propensity matching, we evaluated mortality and secondary outcomes. Echocardiographic data (median follow-up 957 days, interquartile range 483-1652 days) were used to evaluate LVMR, its association with survival, and predictors of LVMR. RESULTS: There was no difference between SAVR and TAVR patients in mortality (for up to 8 years), stroke at 30 days, myocardial infarction, renal failure, prolonged ventilation, reoperation, or structural valve deterioration. SAVR patients (67.3% [101/150]) were more likely to have LVMR than TAVR patients (55.7% [44/79], p = 0.11). The magnitude of LVMR was greater for the SAVR patients (median = -23.3%) than for the TAVR patients (median = -17.8%, p = 0.062). SAVR patients with LVMR had a survival advantage over SAVR patients without LVMR (p = 0.016). However, LVMR was not associated with greater survival in TAVR patients (p = 0.248). CONCLUSIONS: SAVR patients were more likely to have LVMR and had a greater magnitude of LVMR than TAVR patients. LVMR was associated with better survival in SAVR patients, but not in TAVR patients.

13.
Am J Cardiol ; 157: 71-78, 2021 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-34373077

RESUMO

Several studies have shown that nutritional indexes are associated with cardiovascular events; however, limited studies have investigated the prognostic value of the Geriatric Nutritional Risk Index (GNRI) in patients undergoing transcatheter aortic valve implantation (TAVI). We aimed to evaluate the clinical impact of GNRI in patients undergoing TAVI. This single-center retrospective study analyzed consecutive patients treated with TAVI, stratified into groups according to their median baseline GNRI. The primary endpoint was 2-year all-cause mortality. In total, 968 patients with a mean age of 82.1 years and a median Society of Thoracic Surgeons (STS) score of 4.8% who underwent TAVI were included. The median GNRI was 103. Compared with the high-GNRI group (GNRI≥103, n = 451), the low-GNRI group (GNRI<103, n = 517) had higher STS scores and renal insufficiency rates. The 2-year all-cause mortality was significantly higher in the low-GNRI group than in the high-GNRI group (24.9% vs. 9.3%, p<0.001), despite no significant differences in procedural and clinical outcomes between the groups. On multivariable analysis, lower GNRI was independently associated with higher 2-year all-cause mortality (adjusted hazard ratio: 1.07; 95% confidence interval: 1.05-1.10; p<0.001). The GNRI retained its predictive value in subgroup analyses stratified by age (>75 vs. ≤75 years) and STS score (≥4 vs. <4). In conclusion, The GNRI is an important surrogate marker for predicting prognosis and mortality in patients undergoing TAVI.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Avaliação Geriátrica/métodos , Estado Nutricional , Medição de Risco/métodos , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/mortalidade , Causas de Morte/tendências , Feminino , Humanos , Masculino , Avaliação Nutricional , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia
14.
Ther Deliv ; 12(9): 651-670, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34374565

RESUMO

Background: The current study sought to formulate a dry powder inhalant (DPI) for pulmonary delivery of lipopolymeric nanoparticles (LPNs) consisting of cisplatin and siRNA for multidrug-resistant lung cancer. siRNA against ABCC3 gene was used to silence drug efflux promoter. Results & discussion: The formulation was optimized through the quality by design system by nanoparticle size and cisplatin entrapment. The lipid concentration, polymer concentration and lipid molar ratio were selected as variables. The DPI was characterized by in vitro deposition study using the Anderson cascade impactor. DPI formulation showed improved pulmonary pharmacokinetic parameters of cisplatin with higher residence time in lungs. Conclusion: Local delivery of siRNA and cisplatin to the lung tissue resulted into an enhanced therapeutic effectiveness in combating drug resistance.


Assuntos
Neoplasias Pulmonares , Nanopartículas , Administração por Inalação , Cisplatino , Inaladores de Pó Seco , Humanos , Pulmão , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/genética , Tamanho da Partícula , Pós , RNA Interferente Pequeno
15.
Mol Med ; 27(1): 79, 2021 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-34271850

RESUMO

BACKGROUND: High mobility group box 1 protein (HMGB1) is an alarmin following its release by immune cells upon cellular activation or stress. High levels of extracellular HMGB1 play a critical role in impairing the clearance of invading pulmonary pathogens and dying neutrophils in the injured lungs of cystic fibrosis (CF) and acute respiratory distress syndrome (ARDS). A heparin derivative, 2-O, 3-O desulfated heparin (ODSH), has been shown to inhibit HMGB1 release from a macrophage cell line and is efficacious in increasing bacterial clearance in a mouse model of pneumonia. Thus, we hypothesized that ODSH can attenuate the bacterial burden and inflammatory lung injury in CF and we conducted experiments to determine the underlying mechanisms. METHODS: We determined the effects of ODSH on lung injury produced by Pseudomonas aeruginosa (PA) infection in CF mice with the transmembrane conductance regulator gene knockout (CFTR-/-). Mice were given ODSH or normal saline intraperitoneally, followed by the determination of the bacterial load and lung injury in the airways and lung tissues. ODSH binding to HMGB1 was determined using surface plasmon resonance and in silico docking analysis of the interaction of the pentasaccharide form of ODSH with HMGB1. RESULTS: CF mice given 25 mg/kg i.p. of ODSH had significantly lower PA-induced lung injury compared to mice given vehicle alone. The CF mice infected with PA had decreased levels of nitric oxide (NO), increased levels of airway HMGB1 and HMGB1-impaired macrophage phagocytic function. ODSH partially attenuated the PA-induced alteration in the levels of NO and airway HMGB1 in CF mice. In addition, ODSH reversed HMGB1-impaired macrophage phagocytic function. These effects of ODSH subsequently decreased the bacterial burden in the CF lungs. In a surface plasmon resonance assay, ODSH interacted with HMGB1 with high affinity (KD = 3.89 × 10-8 M) and induced conformational changes that may decrease HMGB1's binding to its membrane receptors, thus attenuating HMGB1-induced macrophage dysfunction. CONCLUSIONS: The results suggest that ODSH can significantly decrease bacterial infection-induced lung injury in CF mice by decreasing both HMGB1-mediated impairment of macrophage function and the interaction of HMGB1 with membrane receptors. Thus, ODSH could represent a novel approach for treating CF and ARDS patients that have HMGB1-mediated lung injury.

16.
Can J Kidney Health Dis ; 8: 20543581211027759, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34290876

RESUMO

Background: The incidence of acute kidney injury (AKI) in patients with COVID-19 and its association with mortality and disease severity is understudied in the Canadian population. Objective: To determine the incidence of AKI in a cohort of patients with COVID-19 admitted to medicine and intensive care unit (ICU) wards, its association with in-hospital mortality, and disease severity. Our aim was to stratify these outcomes by out-of-hospital AKI and in-hospital AKI. Design: Retrospective cohort study from a registry of patients with COVID-19. Setting: Three community and 3 academic hospitals. Patients: A total of 815 patients admitted to hospital with COVID-19 between March 4, 2020, and April 23, 2021. Measurements: Stage of AKI, ICU admission, mechanical ventilation, and in-hospital mortality. Methods: We classified AKI by comparing highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) system. We calculated the unadjusted and adjusted odds ratio for the stage of AKI and the outcomes of ICU admission, mechanical ventilation, and in-hospital mortality. Results: Of the 815 patients registered, 439 (53.9%) developed AKI, 253 (57.6%) presented with AKI, and 186 (42.4%) developed AKI in-hospital. The odds of ICU admission, mechanical ventilation, and death increased as the AKI stage worsened. Stage 3 AKI that occurred during hospitalization increased the odds of death (odds ratio [OR] = 7.87 [4.35, 14.23]). Stage 3 AKI that occurred prior to hospitalization carried an increased odds of death (OR = 5.28 [2.60, 10.73]). Limitations: Observational study with small sample size limits precision of estimates. Lack of nonhospitalized patients with COVID-19 and hospitalized patients without COVID-19 as controls limits causal inferences. Conclusions: Acute kidney injury, whether it occurs prior to or after hospitalization, is associated with a high risk of poor outcomes in patients with COVID-19. Routine assessment of kidney function in patients with COVID-19 may improve risk stratification. Trial registration: The study was not registered on a publicly accessible registry because it did not involve any health care intervention on human participants.

17.
Am J Cardiol ; 153: 109-118, 2021 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-34210503

RESUMO

Multidetector computed tomography (MDCT) can provide valuable information for preprocedural planning of transcatheter mitral valve interventions. However, no data exists on pre-MDCT parameters predicting high transmitral pressure gradient (TMPG) post-MitraClip procedure. We analyzed the preprocedural MDCTs of 156 consecutive patients with mitral regurgitation undergoing MitraClip implantation at our institution. The mean TMPG was assessed by periprocedural transesophageal and pre-discharge transthoracic echocardiography. MDCT-derived mitral annulus area (MAA), anterior-posterior (AP) and medial-lateral (ML) mitral annulus diameters, and mitral valve orifice area (MVOA) were smaller in patients with mean TMPG ≥5 mmHg than those with mean TMPG <5 mmHg after 1-or 2-clip implantation. Small MAA, AP and ML diameters, and MVOA were moderately correlated with high TMPG post-MitraClip, in which MAA and MVOA had the highest degree of correlation after 1-clip (r = -0.46 both), whereas MAA and ML had the strongest degree of correlation after 2-clip (r = -0.39 both) and at discharge (r = -0.38 both). From the receiver-operating-characteristic curve analyses, no significant differences in the area under the curve were observed among these MDCT parameters for low TMPG after MitraClip implantation, except for those between MAA and AP diameter at discharge (p=0.026). For optimal cutoff values, MAA ≥1100 and ≥1300 mm2 had positive predictive values of 89% and 91%, while both MAA ≥750 and ≥900 mm2 had negative predictive values of 100%, for mean TMPG <5 mmHg after 1-and 2-clip implantation, respectively. In conclusion, in patients undergoing the MitraClip procedure, preprocedural MDCT parameters are useful to predict postprocedural mitral stenosis.


Assuntos
Cateterismo Cardíaco , Anuloplastia da Valva Mitral/efeitos adversos , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/epidemiologia , Valva Mitral/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia , Ecocardiografia Transesofagiana , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/etiologia , Tomografia Computadorizada Multidetectores , Complicações Pós-Operatórias/etiologia , Período Pré-Operatório , Medição de Risco
18.
Materials (Basel) ; 14(10)2021 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-34068107

RESUMO

In the current scenario of manufacturing competitiveness, it is a requirement that new technologies are implemented in order to overcome the challenges of achieving component accuracy, high quality, acceptable surface finish, an increase in the production rate, and enhanced product life with a reduced environmental impact. Along with these conventional challenges, the machining of newly developed smart materials, such as shape memory alloys, also require inputs of intelligent machining strategies. Wire electrical discharge machining (WEDM) is one of the non-traditional machining methods which is independent of the mechanical properties of the work sample and is best suited for machining nitinol shape memory alloys. Nano powder-mixed dielectric fluid for the WEDM process is one of the ways of improving the process capabilities. In the current study, Taguchi's L16 orthogonal array was implemented to perform the experiments. Current, pulse-on time, pulse-off time, and nano-graphene powder concentration were selected as input process parameters, with material removal rate (MRR) and surface roughness (SR) as output machining characteristics for investigations. The heat transfer search (HTS) algorithm was implemented for obtaining optimal combinations of input parameters for MRR and SR. Single objective optimization showed a maximum MRR of 1.55 mm3/s, and minimum SR of 2.68 µm. The Pareto curve was generated which gives the optimal non-dominant solutions.

19.
J Hand Ther ; 2021 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-34016518

RESUMO

STUDY DESIGN: Cross-sectional INTRODUCTION: Globally, diabetes is a leading cause of disability with an increased prevalence rate in the past three decades. Chronic diabetes has been shown to affect collagenous tissue which often leads to subsequent musculoskeletal complications. Despite increasing prevalence of musculoskeletal disorders, the proportion and distribution of types of upper extremity musculoskeletal disorders resulting in disabilities is poorly understood. PURPOSE OF THE STUDY: This cross-sectional study aims to gather data on the prevalence, proportion and distribution of upper extremity musculoskeletal disorders among individuals with Type 2 Diabetes Mellitus. Further, this study examines the relationship between common upper extremity disorders and the resulting disability among individuals with Type 2 Diabetes Mellitus. METHODS: 170 individuals diagnosed with Type 2 Diabetes Mellitus were recruited at a tertiary care hospital. Routine upper extremity assessments were performed to identify the presence of Frozen Shoulder (FS), Limited Joint Mobility (LJM), Trigger Finger, Carpal Tunnel Syndrome (CTS), and Dupuytren's Contracture. Disability was measured using the Disabilities of arm, shoulder, and hand (DASH) questionnaire. Descriptive statistics, one-way analysis of variance, Tukey's test, and Pearson's test were used to examine the prevalence, proportion and distribution of musculoskeletal disorders and disabilities among individuals with type 2 Diabetes Mellitus. RESULTS: 83(48.9%) participants had one or a combination of multiple musculoskeletal disorders of the upper extremity. The proportion of LJM, FS, CTS, Trigger Finger, and Dupuytren's Contracture were n = 46(27.1%); n = 43(25.3%); n = 16(9.4%); n = 8(4.7%); n = 5(2.9%) respectively. Disability scores on the DASH were 25.8 ± 14.5, 10.3 ± 11.9, and 10.6 ± 10.4 respectively for individuals with FS, LJM and Trigger Finger. DASH scores were highest in individuals with both CTS and FS, 29.8 ± 19.3. Duration of diabetes was significantly associated (r = 0 .19; P < .01) with the disability scores on DASH. CONCLUSION: The prevalence of musculoskeletal disorders in people with type 2 Diabetes mellitus remains high despite advances in medical management over the last two decades. The overall prevalence of hand disorders (LJM, CTS, Dupuytren's contracture, Trigger Finger) was higher than shoulder disorders (FS), e.g. frozen shoulder. People with a diabetes that had a diagnosed upper extremity conditon had more upper extremity disability, than those with diabetes but no diagnosed hand condition, Disability was highest for frozen shoulder and lowest for Dupuytren's diagnoses. Carpal tunnel syndrome was the most disabling hand condition. People with diabetes should be screened for upper extremity diagnoses that could limit their function. Poeple with disability resulting from hand disorders was lower than the shoulder disorders. A combination of hand and shoulder disorders resulted in greater disability.

20.
Am J Orthod Dentofacial Orthop ; 159(6): 774-778, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33952431

RESUMO

INTRODUCTION: This study aimed to compare patients' Salzmann Index scores for those who applied for Medicaid orthodontic coverage in Pennsylvania with their corresponding American Board of Orthodontics discrepancy index (DI) scores to assess if there is a correlation between Salzmann and DI scores. In addition, a threshold DI score was calculated that would correspond to Medicaid coverage approval. The study intended to answer the following questions: is there a correlation of 0.7 or greater between a patient's Salzmann Index and their DI? If so, is there a particular DI score that can be used as the minimum score for approving Medicaid orthodontic coverage in the state of Pennsylvania? METHODS: Salzmann Index scores, DI scores, and approval and disapproval results for Medicaid orthodontic coverage were obtained from 104 subjects aged between 10 and 17 years. A linear regression model was generated to assess if there was a correlation between the Salzmann scores and DI scores. If a correlation coefficient of 0.7 or greater were found, a threshold Salzmann Index score would be determined for subjects who were approved for Medicaid orthodontic coverage. The threshold Salzmann score would be used in the linear regression formula to find the corresponding DI score, which would be designated as the threshold DI score for approval for Medicaid orthodontic coverage in the state of Pennsylvania. RESULTS: A Pearson correlation of 0.453 was calculated between the 104 Salzmann scores and DI scores, demonstrating a moderate correlation. With the correlation coefficient being lower than 0.7, binary logistic regressions were calculated to assess the predictability between a given Salzmann score and approval and disapproval for Medicaid orthodontic coverage. The Salzmann score had an overall 68.3% success in predicting Medicaid orthodontic coverage approval/disapproval. Of the 58 subjects that were approved for Medicaid orthodontic coverage, 46.6% had Salzmann scores equal to or greater than 25. Of the 46 subjects that were disapproved for Medicaid orthodontic coverage, 78.3% had Salzmann scores equal to or less than 24. CONCLUSIONS: With the lack of high prediction rates seen from the results of the regression models, the current system of Medicaid does not appear to show consistency for assessing the need for orthodontic treatment coverage. Multiple insurance companies that participate under Medicaid require a Salzmann score of 25 or greater for approval; however, the results show the Salzmann score is arbitrary in terms of approval and disapproval. There appear to be underlying factors apart from the Salzmann score that the Pennsylvania Medicaid system uses to justify whether a patient was approved or denied for coverage.


Assuntos
Má Oclusão , Medicaid , Indexação e Redação de Resumos , Adolescente , Criança , Humanos , Ortodontia Corretiva , Índice de Gravidade de Doença , Estados Unidos
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