Survival Outcomes of Cytoreductive Surgery with HIPEC in Gastric Adenocarcinoma: A National Cancer Database Study.

BACKGROUND: This study aimed to assess the impact of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) on the survival outcomes for patients with gastric cancer and peritoneal carcinomatosis (PC). METHODS: A retrospective analysis of the National Cancer Database from 2004 to 2020 identified patients with topography and histology codes consistent with gastric adenocarcinoma who underwent CRS/HIPEC. The exclusion criteria ruled out known other distant metastasis and missing key data. The study compared the CRS/HIPEC group with patients who had stage IV disease (with the same exclusions for distant metastases) and received systemic chemotherapy but no surgery to the primary site. RESULTS: The study included 148 patients who underwent CRS/HIPEC. Their median age was 57 years (interquartile range [IQR], 47-66 years), with 57.4% of the patients identifying as male and 73.6% identifying as white. Most of the CRS/HIPEC patients had locally advanced disease, with 33.8% having pT4 disease and 23% patients having pN3 status. The Charlson-Deyo scores were 0 for 77% and 1 for 16.9% of the patients. The overall survival (OS) among the stage IV patients managed with CRS/HIPEC was significantly longer than for the patients receiving only systemic chemotherapy (median survival, 18.1 vs 9.3 months; p < 0.001), and the 1-year OS was 72.6% versus 38.8% (p < 0.05)). Among the stage IV patients, CRS/HIPEC showed better survival than systemic chemotherapy (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.44-0.73; p < .001) when control was used for the Charlson Deyo score, histology, age, and sex. CONCLUSIONS: These results suggest the association of CRS/HIPEC with improved survival for selected patients with gastric adenocarcinoma and peritoneal disease. Some of this difference may have been due to selection bias, but the differences in the survival curves are robust.

Coupling Effects of Electrostatic Interactions and Salt Concentration Gradient in Polymer Translocation through a Nanopore: A Coarse-Grained Molecular Dynamics Simulations Study.

We study the influence of polymer pore interactions and focus on the role played by the concentration gradient of salt in the translocation of polyelectrolytes (PE) through nanopores explicitly using coarse-grained Langevin dynamics simulations. The mean translocation time is calculated by varying the applied voltage, the pH, and the salt concentration gradient. Changing the pH can alter the electrostatic interaction between the protein pore and the polyelectrolyte chain. The polymer pore interaction is weakened by the increase in the strength of the externally applied electric field that drives translocation. Additionally, the screening effect of the salt can reduce the strong charge-charge repulsion between the PE beads which can make translocation faster. The simulation results show there can be antagonistic or synergistic coupling between the salt concentration-induced screening effect and the drift force originating from the salt concentration gradient thereby affecting the translocation time. Our simulation results are explained qualitatively with free energy calculations.

Multivalent Salt-Induced Self-Assembly of Amphiphilic Polyelectrolytes of Different Charge Fractions: A Coarse-Grained Molecular Dynamics Simulation Study.

Amphiphilic polymers with both hydrophobic and hydrophilic blocks are of great interest for their potential applications in drug delivery. Their self-assembly behavior in response to environmental factors like ion charge and multivalent salt concentration has been the subject of recent investigation. Our study utilizes coarse-grained molecular dynamics simulations to investigate the aggregation behavior of amphiphilic copolymers upon introducing tetravalent salt at varying charge fractions. We identify a critical concentration, Cs*, where the aggregation number reaches its maximum for each charge fraction, followed by a subsequent decrease at the excessive salt regime. This study reveals distinct morphological transitions in response to increasing salt concentration and decreasing charged fractions, namely, (i) stable dispersed micelles, (ii) a singular micelle comprising all copolymer chains, and (iii) redispersed micelles, particularly evident at lower charged fractions. Our study highlights the significant influence of tetravalent salt and charge fractions of polyelectrolyte chains on the self-assembly behavior of polyelectrolyte copolymers.

Aerosols and black carbon variability using OMI and MERRA-2 and their relationship to near-surface air temperature.

An extinction of incoming solar radiation is taking place by absorption and scattering by dust, water droplets, and gaseous molecules. Such phenomena are responsible for altering meteorological variables. In the present study, temporal analysis of the aerosol optical thickness (AOT) and black carbon (BC) surface mass concentration was undertaken using an ozone monitoring instrument (OMI) and modern-era retrospective analysis for research and applications, version 2 (MERRA-2) satellite from the year 2018 to 2022. The study was mainly focused on the western states of India which are Rajasthan, Gujarat, and Maharashtra. The correlation of AOT and BC surface mass concentration with near-surface temperature (2m above ground level) was analyzed. BC and temperature shows strong negative correlation as BC is known for its absorption of radiation. It accumulates in the atmosphere and contributes to atmospheric warming while simultaneously bringing down the near-surface air temperature due to the reduced sunlight reaching the ground. Also, seasonal analysis was conducted for winter, summer, monsoon, and post-monsoon, which shows the higher values of AOT in monsoon; however, seasonal average BC surface mass concentration was found high in winter in each year for all three states. AERONET data from Jaipur, Rajasthan, and Pune, Maharashtra for the year 2021 was used to further evaluate the AOT generated from OMI. The results demonstrated a significant connection, with R2 values of 0.62 and 0.69, respectively. The temperature retrieved from MERRA-2 was also validated with ground truth data of the Continuous Ambient Air Quality Monitoring Station (CAAQMS) at both stations showing high agreement with R2 > 0.70.

Cost-effectiveness of portable-automated ABR for universal neonatal hearing screening in India.

The World Health Organization considers Universal Neonatal Hearing Screening (UNHS) essential to global public health. Rashtriya Bal Swasthya Karyakram has included newborn hearing screening in India since 2013. The program faces human, infrastructure, and equipment shortages. First-line hearing screening with improved diagnostic accuracy is needed. The Portable Automated Auditory Brainstem Responses (P-AABR) can be used in remote areas for UNHS due to its low infrastructure needs and diagnostic accuracy. This study evaluated the cost-effectiveness of P-AABR in UNHS. We employed an analytical model based on decision trees to assess the cost-effectiveness of Otoacoustic Emission (OAE) and P-AABR. The total cost to the health system for P-AABR, regardless of true positive cases, is INR 10,535,915, while OAE costs INR 7,256,198. P-AABR detects 262 cases, whereas OAE detects 26 cases. Portable Automated ABR costs INR 97 per case detection, while OAE costs INR 67. The final ICER was 97407.69. The P-AABR device is cost-effective, safe and feasible for UNHS Rashtriya Bal Swasthya Karyakram (RBSK) programs. Beyond reducing false referrals and parent indirect costs, it detects more hearing-impaired infants. Even in shortages of skilled workers, existing staff can be trained. Thus, this study suggests integrating this device into community and primary health centers to expand UNHS coverage.

Dinitrogen Binding and Activation: Bonding Analyses of Stable V(III/I)-N2-V(III/I) Complexes by the EDA-NOCV Method from the Perspective of Vanadium Nitrogenase.

The FeVco cofactor of nitrogenase (VFe7S8(CO3)C) is an alternative in the molybdenum (Mo)-deficient free soil living azotobacter vinelandii. The rate of N2 reduction to NH3 by FeVco is a few times higher than that by FeMoco (MoFe7S9C) at low temperature. It provides a N source in the form of ammonium ions to the soil. This biochemical NH3 synthesis is an alternative to the industrial energy-demanding production of NH3 by the Haber-Bosch process. The role of vanadium has not been clearly understood yet, which has led chemists to come up with several stable V-N2 complexes which have been isolated and characterized in the laboratory over the past three decades. Herein, we report the EDA-NOCV analyses of dinitrogen-bonded stable complexes V(III/I)-N2 (1-4) to provide deeper insights into the fundamental bonding aspects of V-N2 bond, showing the interacting orbitals and corresponding pairwise orbital interaction energies (ΔE orb(n)). The computed intrinsic interaction energy (ΔE int) of V-N2-V bonds is significantly higher than those of the previously reported Fe-N2-Fe bonds. Covalent interaction energy (ΔE orb) is more than double the electrostatic interaction energy (ΔE elstat) of V-N2-V bonds. ΔE int values of V-N2-V bonds are in the range of -172 to -204 kcal/mol. The V → N2 ← V π-backdonation is four times stronger than V ← N2 → V σ-donation. V-N2 bonds are much more covalent in nature than Fe-N2 bonds.

Generic and vision related quality of life associated with different types of cataract surgeries and different types of intraocular lens implantation.

OBJECTIVES: To assess the effects of different types of cataract surgeries and intraocular lenses on generic as well as vision related quality of life of cataract patients, using EQ-5D and IND-VFQ 33 instruments respectively. METHODS: An observational, longitudinal study of patients undergoing cataract surgery was carried out at three ophthalmology centres. Patients were prospectively admitted for surgery for age-related cataract. Generic quality of life was assessed by using Euroqol's EQ5D-5L questionnaire and vision related quality of life was assessed by the IND-VFQ-33 questionnaire. Data pertaining to vision function and quality of life were collected pre surgery and 4 weeks after the surgery. RESULTS: Out of total patients (n = 814) recruited for the study, 517 patients were interviewed for both pre-surgery and post-surgery for EQ5D and 519 patients were interviewed for both pre-surgery and post-surgery for IND VFQ 33 tool. The combined data from all three centres showed that Quality Adjusted Life Year (QALY) gains observed in patients undergoing phacoemulsification with foldable lens implantation (2.25 QALY) were significantly higher (0.57 QALY) as compared to Small Incision Cataract Surgery (SICS) with PMMA lens implantation (1.68 QALY). Highest improvement however, in all three subscales of IND-VFQ-33 tool were clearly observed for SICS with PMMA lens implantation. CONCLUSIONS: The study has elicited the Health related and vision related Quality of Life scores for cataract surgeries and subsequent lens implantation. This study also offers Health State Utility Values along with visual outcomes for different surgical procedures, lenses and for the combination of surgery with lens implantation for cataract procedures providing a useful resource for future economic evaluation studies.

Effects of cataract surgery and intra-ocular lens implantation on visual function and quality of life in age-related cataract patients: a systematic review protocol.

BACKGROUND: Cataract is the leading cause of blindness and low vision worldwide. Presently, cataract surgery is the only treatment for cataract and is very effective in restoring sight. In cataract surgery, the natural lens of the eye that becomes clouded is removed and replaced with an artificial intraocular lens. There are multiple techniques for removal of lens as well as many types of intraocular lenses available for implantation. For this reason, it becomes imperative to monitor the impact of different surgical techniques and different intraocular lenses on health-related quality of life (HRQoL) of the patients. This systematic review aims to evaluate HRQoL evidences on effects of different types of cataract surgeries and intraocular lenses on visual function and quality of life in age-related cataract patients. METHOD: Databases like Cochrane, EMBASE, SCOPUS, NHS Economic Evaluation Database (NHS EED), Health Technology Assessment (HTA) database, MEDLINE, ClinicalTrials.gov , Current Controlled Trials and World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) will be searched systematically. Two reviewers will independently screen studies using predefined inclusion and exclusion criteria along with the extraction of data, and assessment of methodological quality using a standard checklist. DISCUSSION: This systematic review will help in understanding how different types of cataract surgeries and intraocular lenses make a difference on quality of life of age-related cataract patients in terms of visual function and health-related quality of life. As the review attempts to bring together all the cataract-related HRQoL evidences pertaining to different cataract surgical techniques, different intraocular lenses and cataract-related complications, it will also identify gaps in evidence. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018092377.

Pulmonary artery-to-left atrial fistula discovered after the closure of atrial septal defect: A rare clinical scenario.

A case of the right pulmonary artery-to- left atrial fistula with atrial septal defect (ASD) is presented. The fistula was detected after the patient developed desaturation following surgical closure of the ASD. It was managed with a transcatheter (trans-RPA route) closure of the fistula using a 12-mm Amplatzer ventricular septal defect closure device.