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OBJECTIVES: Metabolic syndrome is known to predict outcomes in COVID-19 acute respiratory distress syndrome (ARDS) but has never been studied in non-COVID-19 ARDS. We therefore aimed to determine the association of metabolic syndrome with mortality among ARDS trial subjects. DESIGN: Retrospective cohort study of ARDS trials' data. SETTING: An ancillary analysis was conducted using data from seven ARDS Network and Prevention and Early Treatment of Acute Lung Injury Network randomized trials within the Biologic Specimen and Data Repository Information Coordinating Center database. PATIENTS: Hospitalized patients with ARDS and metabolic syndrome (defined by obesity, diabetes, and hypertension) were compared with similar patients without metabolic syndrome (those with less than three criteria). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was 28-day mortality. Among 4288 ARDS trial participants, 454 (10.6%) with metabolic syndrome were compared with 3834 controls (89.4%). In adjusted analyses, the metabolic syndrome group was associated with lower 28-day and 90-day mortality when compared with control (adjusted odds ratio [aOR], 0.70 [95% CI, 0.55-0.89] and 0.75 [95% CI, 0.60-0.95], respectively). With each additional metabolic criterion from 0 to 3, adjusted 28-day mortality was reduced by 18%, 22%, and 40%, respectively. In subgroup analyses stratifying by ARDS etiology, mortality was lower for metabolic syndrome vs. control in ARDS caused by sepsis or pneumonia (at 28 d, aOR 0.64 [95% CI, 0.48-0.84] and 90 d, aOR 0.69 [95% CI, 0.53-0.89]), but not in ARDS from noninfectious causes (at 28 d, aOR 1.18 [95% CI, 0.70-1.99] and 90 d, aOR 1.26 [95% CI, 0.77-2.06]). Interaction p = 0.04 and p = 0.02 for 28- and 90-day comparisons, respectively. CONCLUSIONS: Metabolic syndrome in ARDS was associated with a lower risk of mortality in non-COVID-19 ARDS. The relationship between metabolic inflammation and ARDS may provide a novel biological pathway to be explored in precision medicine-based trials.
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Lesão Pulmonar Aguda , Síndrome Metabólica , Pneumonia , Síndrome do Desconforto Respiratório , Humanos , Síndrome Metabólica/complicações , Estudos RetrospectivosRESUMO
BACKGROUND: The global spread of coronavirus disease 2019 (COVID-19) continues in several jurisdictions, causing substantial strain to health care systems. The purpose of our study was to predict the effect of the COVID-19 pandemic on patient outcomes and use of hospital resources in Ontario, Canada. METHODS: We developed an individual-level simulation to model the flow of patients with COVID-19 through the hospital system in Ontario. We simulated different combined scenarios of epidemic trajectory and hospital health care capacity. Our outcomes included the number of patients who needed admission to the ward or to the intensive care unit (ICU) with or without the need for mechanical ventilation, number of days to resource depletion, number of patients awaiting resources and number of deaths. RESULTS: We found that with effective early public health measures, hospital system resources would not be depleted. For scenarios with late or ineffective implementation of physical distancing, hospital resources would be depleted within 14-26 days, and in the worst case scenario, 13 321 patients would die while waiting for needed resources. Resource depletion would be avoided or delayed with aggressive measures to increase ICU, ventilator and acute care hospital capacities. INTERPRETATION: We found that without aggressive physical distancing measures, the Ontario hospital system would have been inadequately equipped to manage the expected number of patients with COVID-19 despite a rapid increase in capacity. This lack of hospital resources would have led to an increase in mortality. By slowing the spread of the disease using public health measures and by increasing hospital capacity, Ontario may have avoided catastrophic stresses to its hospitals.
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Infecções por Coronavirus/epidemiologia , Recursos em Saúde , Necessidades e Demandas de Serviços de Saúde , Hospitais , Unidades de Terapia Intensiva , Pneumonia Viral/epidemiologia , Capacidade de Resposta ante Emergências , Ventiladores Mecânicos , Betacoronavirus , COVID-19 , Controle de Doenças Transmissíveis , Simulação por Computador , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/prevenção & controle , Número de Leitos em Hospital , Humanos , Ontário/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/mortalidade , Pneumonia Viral/prevenção & controle , SARS-CoV-2RESUMO
Relocation of large numbers of critically ill patients between hospitals is sometimes necessary and the risks associated with relocation may be high. In the setting of adherence to an interhospital intensive care unit (ICU) relocation protocol, we aimed to determine whether the interhospital relocation of all ICU patients in a single day is associated with changes in vital signs, device removal, and worse clinical outcomes. We conducted a prospective, observational, cohort study of all critically ill adults admitted to a tertiary medical center's ICUs on the day of a planned hospital relocation and exposed to interhospital ICU relocation compared with unexposed critically ill adults. Changes in vital signs were evaluated by the before-and-after interhospital relocation measurement of vital signs, and clinical outcomes were collected for all patients. A total of 699 patients were admitted to the ICU during the observation period, 24 of whom were exposed to interhospital ICU relocation on a single day. The median interhospital transport duration was 28 minutes (interquartile range: 24-35) and 29% of patients were receiving invasive mechanical ventilation. Patients exposed to interhospital ICU relocation had no significant change in any vital sign measurement and no devices were unintentionally removed. Inhospital mortality was similar (8.3%) to patients not exposed to interhospital ICU relocation (9.2%, P > .99). In the setting of adherence to an ICU relocation protocol, the interhospital ICU relocation of all critically ill adults during a single day is not associated with changes in vital signs, device removal, or worse clinical outcomes.
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Cuidados Críticos/métodos , Estado Terminal/mortalidade , Unidades de Terapia Intensiva/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Adulto , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Estudos ProspectivosRESUMO
BACKGROUND: Oilseed Brassica represents an important group of oilseed crops with a long history of evolution and cultivation. To understand the origin and evolution of Brassica amphidiploids, simple sequence repeat (SSR) markers were used to unravel genetic variations in three diploids and three amphidiploid Brassica species of U's triangle along with Eruca sativa as an outlier. RESULTS: Of 124 Brassica-derived SSR loci assayed, 100% cross-transferability was obtained for B. juncea and three subspecies of B. rapa, while lowest cross-transferability (91.93%) was obtained for Eruca sativa. The average % age of cross-transferability across all the seven species was 98.15%. The number of alleles detected at each locus ranged from one to six with an average of 3.41 alleles per primer pair. Neighbor-Joining-based dendrogram divided all the 40 accessions into two main groups composed of B. juncea/B. nigra/B. rapa and B. carinata/B. napus/B. oleracea. C-genome of oilseed Brassica species remained relatively more conserved than A- and B-genome. A- genome present in B. juncea and B. napus seems distinct from each other and hence provides great opportunity for generating diversity through synthesizing amphidiploids from different sources of A- genome. B. juncea had least intra-specific distance indicating narrow genetic base. B. rapa appears to be more primitive species from which other two diploid species might have evolved. CONCLUSION: The SSR marker set developed in this study will assist in DNA fingerprinting of various Brassica species cultivars, evaluating the genetic diversity in Brassica germplasm, genome mapping and construction of linkage maps, gene tagging and various other genomics-related studies in Brassica species. Further, the evolutionary relationship established among various Brassica species would assist in formulating suitable breeding strategies for widening the genetic base of Brassica amphidiploids by exploiting the genetic diversity present in diploid progenitor gene pools.
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Evolução Biológica , Brassica/genética , Repetições de Microssatélites , Filogenia , Alelos , Brassica/classificação , Mapeamento Cromossômico , Marcadores Genéticos , Variação GenéticaRESUMO
The goal of this study was to understand safety climate in the United States (U.S.) fire service, which responded to more than 31 million calls to the 9-1-1 emergency response system in 2013. The majority of those calls (68 %) were for medical assistance, while only 4 % of calls were fire-related, highlighting that the 9-1-1 system serves as a critical public health safety net. We conducted focus groups and interviews with 123 firefighters from 12 fire departments across the United States. Using an iterative analytic approach supported by NVivo 10 software, we developed consensus regarding key themes. Firefighters concurred that the 9-1-1 system is strained and increasingly called upon to deliver Emergency Medical Services (EMS) in the community. Much like the hospital emergency department, EMS frequently assists low-income and elderly populations who have few alternative sources of support. Firefighters highlighted the high volume of low-acuity calls that occupy much of their workload, divert resources from true emergencies, and lead to unwarranted occupational hazards like speeding to respond to non-serious calls. As a result, firefighters reported high occupational stress, low morale, and desensitization to community needs. Firefighters' called for improvements to the 9-1-1 system-the backbone of emergency response in the U.S.-including better systems of triage, more targeted use of EMS resources, continuing education to align with job demands, and a strengthened social safety net to address the persistent needs of poor and elderly populations.
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Sistemas de Comunicação entre Serviços de Emergência/estatística & dados numéricos , Bombeiros , Adulto , Despacho de Emergência Médica/estatística & dados numéricos , Auxiliares de Emergência/psicologia , Feminino , Bombeiros/psicologia , Incêndios , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Estados UnidosRESUMO
CONTEXTE: La propagation à l'échelle planétaire de la maladie à coronavirus 2019 (COVID-2019) se poursuit dans plusieurs pays, mettant à rude épreuve les systèmes de santé. Cette étude avait pour but de prédire les répercussions de la pandémie sur les issues des patients et l'utilisation des ressources hospitalières en Ontario (Canada). MÉTHODES: Nous avons conçu un modèle de simulation axé sur les personnes illustrant le flux de patients atteints de la COVID-19 dans les hôpitaux ontariens. Nous avons simulé diverses combinaisons de trajectoires épidémiques et de capacités de soins hospitaliers. Les paramètres à l'étude étaient le nombre de patients devant être admis au service d'hospitalisation ou à l'unité des soins intensifs (USI) avec ou sans respirateur mécanique , le nombre de jours jusqu'à l'épuisement des ressources, le nombre de patients en attente de ressources et le nombre de décès. RÉSULTATS: Nous avons constaté que la mise en place rapide de mesures de santé publique efficaces éviterait l'épuisement des ressources hospitalières. Les simulations dans lesquelles les mesures d'éloignement sanitaire étaient inefficaces ou adoptées tardivement ont montré que l'épuisement des ressources prendrait de 14 à 26 jours et qu'il y aurait, dans le pire des cas, 13 321 décès de personnes en attente de ressources. Cet épuisement pourrait être évité ou retardé par la mise en place de mesures rigoureuses visant à améliorer la capacité des hôpitaux en matière de soins intensifs, de respirateurs mécaniques et de soins hospitaliers. INTERPRÉTATION: Sans l'adoption de mesures d'éloignement sanitaire rigoureuses, le système de santé ontarien n'aurait pas eu les ressources nécessaires pour prendre en charge le nombre attendu de patients atteints de la COVID-19, même en cas d'augmentation rapide de sa capacité hospitalière. Les pénuries auraient fait augmenter le taux de mortalité. En ralentissant la transmission de la maladie par la mise en place de mesures de santé publique et l'augmentation de la capacité des hôpitaux, l'Ontario a probablement évité que ces derniers subissent une pression catastrophique.
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First time compared the different metals doped ZnS nanoparticles for antibacterial and liver cancer cell line. In this study, copper, aluminum and nickel doped ZnS NPs were synthesized via co-precipitation method. The XRD analysis was confirmed the presence of cubic crystal structure and crystallite size decreased from 6 to 3 nm with doping elements. While as SEM micro-grains were revealed slightly irregular and agglomerated morphology with the presence of dopant elements. The presence of different dopant elements such as Cu, Al and Ni in ZnS NPs was identified via EDX analysis. The FTIR results demonstrate various vibrational stretching and bending modes attached to the surface of ZnS nanomaterials. After that the well diffusion method was used to conduct in-vitro bioassays for evaluation of antibacterial and anticancer activities against E.coli and B.cereus, as well as HepG2 liver cancer cell line. Our findings unveil exceptional results with maximum inhibition zone of approximately 9 to 23 mm observed against E.coli and 12 to 27 mm against B.cereus, respectively. In addition, the significant reduction in cell viability was achieved against the HepG2 liver cancer cell line. These favorable results highlight the potential of Ni doped ZnS NPs for various biomedical applications. In future, the doped ZnS nanomaterials will be suitable for hyperthermia therapy and wound healing process.
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Alumínio , Antibacterianos , Antineoplásicos , Cobre , Escherichia coli , Níquel , Sulfetos , Compostos de Zinco , Humanos , Níquel/química , Antibacterianos/farmacologia , Antibacterianos/química , Sulfetos/química , Sulfetos/farmacologia , Cobre/química , Antineoplásicos/farmacologia , Antineoplásicos/química , Alumínio/química , Compostos de Zinco/química , Escherichia coli/efeitos dos fármacos , Células Hep G2 , Nanopartículas Metálicas/química , Sobrevivência Celular/efeitos dos fármacos , Bacillus cereus/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Nanopartículas/químicaRESUMO
Finding new catalysts and pyrolysis technologies for efficiently recycling wasted plastics into fuels and structured solid materials of high selectivity is the need of time. Catalytic pyrolysis is a thermochemical process that cracks the feedstock in an inert gas environment into gaseous and liquid fuels and a residue. This study is conducted on microwave-assisted catalytic recycling of wasted plastics into nanostructured carbon and hydrogen fuel using composite magnetic ferrite catalysts. The composite ferrite catalysts, namely, NiZnFe2O4, NiMgFe2O4, and MgZnFe2O4 were produced through the coprecipitation method and characterized for onward use in the microwave-assisted valorization of wasted plastics. The ferrite nanoparticles worked as a catalyst and heat susceptor for uniformly distributed energy transfer from microwaves to the feedstock at a moderate temperature of 450°C. The type of catalyst and the working parameters significantly impacted the process efficiency, gas yield, and structural properties of the carbonaceous residue. The tested process took 2-8 minutes to pulverize feedstock into gas and carbon nanotubes (CNTs), depending on the catalyst type. The NiZnFe2O4-catalyzed process produced CNTs with good structural properties and fewer impurities compared to other catalysts. The NiMgFe2O4 catalyst performed better in terms of hydrogen evolution by showing 87.5% hydrogen (H2) composition in the evolved gases. Almost 90% of extractable hydrogen from the feedstock evolved during the first 2 minutes of the reaction.
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Utilizing waste heat to drive thermodynamic systems is imperative for improving energy efficiency, thereby improving sustainability. A combined cooling and power systems (CCP) utilizes heat from a temperature source to deliver both power and cooling. However, CCP systems utilizing LNG cold energy suffers from low second law efficiency due to significant temperature differences. To address this, an "Advanced Power and Cooling with LNG Utilization (ACPLU)" system is proposed, integrating a cascaded transcritical carbon dioxide (TCO2)-LNG cycle with an Organic Rankine cycle (ORC) for improved power generation and an absorption refrigeration system (ARS) for simultaneous cooling. This study evaluates the second law efficiency, net work output, and exergy destruction performance through a sensitivity analysis, optimizing variables such as heat source temperature, superheater temperature difference, ORC and CO2 turbine inlet and condenser pressures, evaporator temperature, and pinch point temperatures of heat exchangers and generator. Compared to previous studies on CCP systems, the ACPLU shows a superior performance, with a second law efficiency of 27.3 % and a net work output of 11.76 MW. Cyclopentane as an ORC working fluid resulted in the highest second law efficiency of 29.06 % and net work output of 12.27 MW. Parametric analysis suggested that heat source temperature significantly impacts net power output. The exergy analysis concluded that a high-pressure ratio and good thermal match between the heat exchangers enhance overall performance. Utilizing artificial neural network (ANN) to produce a multiple-input-multiple-output (MIMO) objective function and performing multi-objective optimization (MOO) using genetic algorithm (GA), an improved second law efficiency and net power output by 28.11 % and 14.16 MW respectively, with pentane as the working fluid, is demonstrated. An average cost rate of 9.121 $/GJ was observed through a thermo-economic analysis. The ACPLU system is promising for medium temperature waste heat recovery, such as, pharmaceutical manufacturing plants.
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The current research is related to the synthesis of different concentrations (0, 3, and 7 wt %) Zn doped TiO2-NPs by using the coprecipitation method. The rutile, anatase crystal structure appeared on different diffracted peaks in TiO2-NPs, and the crystallite size (12 to 24 nm) was calculated by using XRD analysis. The spherical, irregular, porous grain-like surface morphology was observed by SEM analysis, and the identification of different functional modes such as hydroxyl, -C-O, -C-O-C, and Ti-O-Ti attached on the surface of the spectrum was examined via FTIR analysis. After that, the increased absorbance of TiO2-NPs by increasing the Zn concentration in TiO2-NPs was observed by UV-visible analysis. After that, the well diffusion method was performed to measure antibacterial activity, and the MTT assay was used to investigate anticancer activity against the HepG2 cell line. It was observed that the inhibition zone of S. aureus and E. coli increased by increasing the concentration of Zn-doped TiO2-NPs from 2 to 32 mm. The 7 wt % Zn-doped TiO2-NPs provided significant anticancer activity against the liver cancer cell line and antibacterial activity. In the future, Zn doped TiO2-NPs can be used for in vitro analysis against different microbial and animal models for the treatment of cancer.
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PURPOSE: The 'Improved White Ponni' (IWP) rice variety, which is susceptible to lodging, leading to yield losses. Our primary goal is to develop new rice lines with non-lodging traits, enhancing stem strength and resistance to adverse conditions. Additionally, we aim to improve yield-contributing agronomic traits, benefiting farmers, food security, and the environment. Our work contributes to scientific knowledge and addresses a significant issue in Southern Indian rice cultivation. MATERIALS AND METHODS: In the present study, early and semi-dwarf early mutants of IWP were developed without altering the native grain quality traits using gamma ray-mediated mutagenesis. The seeds (500) were irradiated with γ-rays after fixing the Lethal Dose 50 (LD50), and selection for semi-dwarfism and earliness was imposed on a large M2 population. The selected traits were confirmed by evaluating the M3 lines at morpho-physiological, biochemical, and molecular levels. RESULTS: The response of mutants to gibberellic acid has been studied, which identified responsive mutants as well as slow-responding mutant lines including IWP-11-2, IWP-48-2, IWP-50-11, and IWP-33-2. Agar plate assay indicated low α- amylase content in IWP-50-11, IWP-33-2, IWP-43-1, IWP-47-2, and IWP-18-1. The scanning electron microscopy demonstrated that the mutants displayed an increased cellular dimension in comparison to the wild type. In dwarf mutants, null alleles were observed for the SD1 gene-specific primers which depicts gene undergone mutation. Further sequencing revealed the presence of single nucleotide polymorphisms in the SD1 gene resulting in semi-dwarfism in the mutant IWP-D-1. CONCLUSIONS: The impact of a defective gibberellic acid-mediated signaling pathway in mutants to produce a novel high-yielding and early maturing semi-dwarf rice variety.
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Nanismo , Giberelinas , Oryza , Sindactilia , Oryza/genética , Raios gama , Polimorfismo de Nucleotídeo Único , FenótipoRESUMO
The post-pandemic energy crisis and ever-increasing environmental degradation necessitate researchers to scrutinize refrigeration systems, major contributors to these issues, for minimal environmental impact and maximum performance. Thus, this study aims to comprehensively examine a triple cascade refrigeration system (TCRS) equipped with hydrocarbon refrigerants (1-butene/Heptane/m-Xylene). This system is specifically designed for ultra-low temperature applications, including vaccine storage, quick-freezing, frozen food preservation, cryogenic processes, and gas liquefaction. The investigation integrates conventional thermodynamic analysis with economic and environmental impact assessments, and finally multi-objective optimization (MOO) to ascertain optimal operating conditions for the system. The effect of (1) evaporator temperature, Tevap (2) condenser temperature, Tcond (3) Lower Temperature Circuit (LTC) condenser temperature, TLTC (4) Mid Temperature Circuit (MTC) condenser temperature, TMTC and (5) Cascade Condenser temperature difference, Δ T on three objective functions (COP, exergy efficiency, and overall plant cost) have been investigated employing a parametric analysis. Subsequently, quadratic equations for these objective functions are generated using the Box-Behnken method, and MOO utilizing the Genetic algorithm has been performed to maximize COP and exergy efficiency while minimizing the overall cost rate. The decision-making techniques TOPSIS and LINMAP are used to retrieve a unique solution from the Pareto Front, and the system performance has been assessed at the optimal point. The optimization result demonstrates that for the 10-kW capacity TCRS, COP, exergy efficiency, and total plant cost are 0.71, 0.51, and 38262.05 $/year respectively, at optimum condition (Tevap = -101.023 °C , Tcond = 36.545 °C , TLTC = - 69.047 °C and TMTC = - 34.651 °C ). Exergy analysis identifies HTC compressor (19.3 %) and throttle valve (15.5 %) as key contributors to total exergy destruction, while economic analysis underscores capital and maintenance costs (72 %) as the primary contributors to the overall cost, with evaporator (43 %) and condenser (20 %) accounting for 63 % of this cost.
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In this study, NiZnFe2O4 composite was synthesized using a sol-gel route and subjected to nonthermal plasma treatment for tailoring their cations' distribution and physicochemical, magnetic, and photocatalytic properties. Microwave plasma treatment was given to the composites for 60 min in support of postsynthesis sintering at 700 °C for 5 h. X-ray diffraction (XRD) analysis was conducted on pre- and postplasma-modified ferrite composites to identify phase-pure cubic spinel structure and cations' distribution. The cation distributions were measured from the ratio of XRD intensity peaks corresponding to (220), (311), (422) and (440) planes. The intensity ratio of plasma-treated ferrite composites decreased compared to that of pristine composites. The crystallite size and lattice constant were increased on plasma treatment of the composite. The morphological analysis showed nanoflower-like structures of the particles with an increased surface area in the plasma-treated composites. The plasma oxidation and sputtering effects caused a reduction in the nanoflower size. The energy bandgap increased with a decrease in particle size due to plasma treatment. The rhodamine B dye solution was then irradiated with a light source in the presence of the nanocomposites. The dye degradation efficiency of the composite photocatalyst increased from 80 to 96% after plasma treatment.
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BACKGROUND: Post-cataract endophthalmitis has increased after introduction of clear cornea incisions (CCI). Laboratory models suggested that these incisions might not be competent at certain changes in intraocular pressure (IOP). Considering that side-port incisions (SPI) might behave similarly, the purpose of the present study was to determine the most stable side-port incision configuration. METHODS: Using four cadaveric human eyes, four different side-port incisions (SPI) were created in each cornea: 1.5 mm and 2.5 mm squared tunnel, 1.5 mm and 2.5 mm stab tunnel. Fluorescein was placed on the eye, and the IOP varied from 10 to 80 mmHg. IOP at which each SPI started leaking was recorded. In the second part of the study, India ink was applied to the corneal surface at normal IOP, and then rinsed with balanced salt solution (BSS). The ink influx was recorded by planimetry. IOP was elevated to 80 mmHg, ink was reapplied, and IOP was dropped to 0 mmHg. Ink influx was measured again. Histological examination was used to visualize ink inflow into each incision. RESULTS: There was no statistically significant difference in the IOP levels at which the different incisions leaked (p = 0.52). A significant increase in the length of India ink ingress in all incision types was measured after IOP variation (p < 0.05). The 2.5 mm squared incision showed the least increase in ink inflow in this test. CONCLUSION: All incision types of SPIs tested exhibited similar resistance to leakage after IOP variation. Good resistance to wound leakage may not predict adequate resistance to the inflow of bacterial-sized particles into the wound.
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Carbono/metabolismo , Extração de Catarata/métodos , Córnea/metabolismo , Córnea/cirurgia , Corantes Fluorescentes/metabolismo , Deiscência da Ferida Operatória/metabolismo , Câmara Anterior/metabolismo , Técnicas de Diagnóstico Oftalmológico , Endoftalmite/metabolismo , Humanos , Pressão Intraocular/fisiologia , Modelos Biológicos , Permeabilidade , Complicações Pós-Operatórias , Doadores de Tecidos , CicatrizaçãoRESUMO
BACKGROUND: Corneal collagen cross-linking (CXL), a technique that combines riboflavin administration with long-wave ultraviolet light irradiation, was primarily developed to increase the biomechanical strength of collagen fibrils of the cornea to avoid the progression of keratoconus. Recently, this method has been proposed to treat selected cases of infectious keratitis. METHODS: To test the protocol used for progressive keratoconus in infectious keratitis, Candida albicans, and Fusarium solani, strains were exposed to irradiation using a wavelength of 365 nm at a power density of 3 mW/cm(2) for 30 min in the presence of riboflavin photosensitizer. All experiments were performed in triplicate. Qualitative and quantitative measurements of fungal viability used plate cultures and an automated trypan blue dye exclusion method respectively. Fungal cell diameter was also assessed in all groups. Statistical analyses were performed using the triplicate values of each experimental condition. RESULTS: Experimental findings of photodynamic therapy applied to the cell inactivation of both yeasts and filamentous fungi were compared with control groups. Qualitative results were corroborated with quantitative findings which showed no statistical significance between challenged samples (experimental groups) and the control group (p-value = 1). In comparison with a control group of live cells, statistical significance was observed when riboflavin solution alone had an effect on the morphologic size of filamentous fungi, while ultraviolet light irradiation alone showed a slight decrease in the cell structure of C. albicans. CONCLUSIONS: The impact of long-wave ultraviolet combined with riboflavin photosensitizer showed no antifungal effect on C. albicans and F. solani. The significant decrease in cell morphology of both filamentous fungi and yeasts submitted to photosensitizing riboflavin and exposure to ultraviolet light, respectively, may be promising in the development and standardization of alternatives for fungal cell inactivation, because of their minimal cytotoxic effects on the corneal surface. The methodological improvement in the preparation and application of individual chemical compounds, such as riboflavin, or physical systems, such as a long-wave light source, as antifungal agents may also assist in establishing promising therapeutic procedures for keratomycosis.
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Candida albicans/efeitos dos fármacos , Candida albicans/efeitos da radiação , Fusarium/efeitos dos fármacos , Fusarium/efeitos da radiação , Fármacos Fotossensibilizantes/farmacologia , Riboflavina/farmacologia , Raios Ultravioleta , Candida albicans/crescimento & desenvolvimento , Contagem de Colônia Microbiana , Fusarium/crescimento & desenvolvimento , Viabilidade MicrobianaRESUMO
PURPOSE: To present the first 3 cases of Acanthamoeba keratitis (AK), unresponsive to medical treatment, that were successfully treated with a novel adjunctive therapy using ultraviolet light A (UVA) and riboflavin (B2). DESIGN: Interventional case series. PARTICIPANTS: Two patients with confirmed AK and 1 patient with presumptive AK, which were all refractive to multidrug conventional therapy. INTERVENTION: Two treatment sessions involving topical application of 0.1% B2 solution to the ocular surface combined with 30 minutes of UVA irradiation focused on the corneal ulcer. MAIN OUTCOME MEASURES: Clinical examination by slit lamp, confocal microscopy, and histopathology, when available. RESULTS: All patients in these series showed a rapid reduction in their symptoms and decreased ulcer size after the first treatment session. The progress of the clinical improvement began to slow after 1 to 3 weeks of the first application and was then renewed after the second application. All ancillary signs of inflammation mostly resolved after the second treatment session. The ulcers in all patients continued to decrease and were closed within 3 to 7 weeks of the first application. Two patients developed dense central corneal scars, and penetrating keratoplasty was performed for visual rehabilitation. Histopathologic examination of the excised tissue revealed no Acanthamoeba organisms. The remaining patient had no symptoms or signs of infection, both clinically and by confocal microscopy, and was left with a semitransparent eccentric scar that did not affect visual acuity. CONCLUSIONS: The adjunctive use of UVA and B2 therapy seems to be a possible alternative for selected cases of medication-resistant AK.
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Ceratite por Acanthamoeba/tratamento farmacológico , Úlcera da Córnea/tratamento farmacológico , Fotoquimioterapia , Fármacos Fotossensibilizantes/uso terapêutico , Riboflavina/uso terapêutico , Raios Ultravioleta , Ceratite por Acanthamoeba/parasitologia , Adulto , Antiprotozoários/uso terapêutico , Benzamidinas/uso terapêutico , Biguanidas/uso terapêutico , Quimioterapia Adjuvante , Clorexidina/análogos & derivados , Clorexidina/uso terapêutico , Lentes de Contato Hidrofílicas/parasitologia , Úlcera da Córnea/parasitologia , Quimioterapia Combinada , Humanos , Masculino , Microscopia Confocal , Pessoa de Meia-Idade , Acuidade Visual/fisiologiaRESUMO
ARDS is a clinically heterogeneous syndrome, rather than a distinct disease. This heterogeneity at least partially explains the difficulty in studying treatments for these patients and contributes to the numerous trials of therapies for the syndrome that have not shown benefit. Recent studies have identified different subphenotypes within the heterogeneous patient population. These different subphenotypes likely have variable clinical responses to specific therapies, a concept known as heterogeneity of treatment effect. Recognizing different subphenotypes and heterogeneity of treatment effect has important implications for the clinical management of patients with ARDS. This review presents studies that have identified different subphenotypes and discusses how they can modify the effects of therapies evaluated in trials that are commonly considered to have shown no overall benefit in patients with ARDS.
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Heterogeneidade Genética , Síndrome do Desconforto Respiratório , Variação Biológica da População , Humanos , Medicina de Precisão/métodos , Síndrome do Desconforto Respiratório/genética , Síndrome do Desconforto Respiratório/terapia , Resultado do TratamentoRESUMO
In this paper, we detect the occurrence of epileptic seizures in patients as well as activities namely stand, walk, and exercise in healthy persons, leveraging EEG (electroencephalogram) signals. Using Hilbert vibration decomposition (HVD) on non-linear and non-stationary EEG signal, we obtain multiple monocomponents varying in terms of amplitude and frequency. After decomposition, we extract features from the monocomponent matrix of the EEG signals. The instantaneous amplitude of the HVD monocomponents varies because of the motion artifacts present in EEG signals. Hence, the acquired statistical features from the instantaneous amplitude help in identifying the epileptic seizures and the normal human activities. The features selected by correlation-based Q-score are classified using an LSTM (Long Short Term Memory) based deep learning model in which the feature-based weight update maximizes the classification accuracy. For epilepsy diagnosis using the Bonn dataset and activity recognition leveraging our Sensor Networks Research Lab (SNRL) data, we achieve testing classification accuracies of 96.00% and 83.30% respectively through our proposed method.
Assuntos
Epilepsia , Vibração , Epilepsia/diagnóstico , Atividades Humanas , Humanos , Convulsões , CaminhadaRESUMO
Importance: Resurgent COVID-19 cases have resulted in the reinstitution of nonpharmaceutical interventions, including school closures, which can have adverse effects on families. Understanding the associations of school closures with the number of incident and cumulative COVID-19 cases is critical for decision-making. Objective: To estimate the association of schools being open or closed with the number of COVID-19 cases compared with community-based nonpharmaceutical interventions. Design, Setting, and Participants: This decision analytical modelling study developed an agent-based transmission model using a synthetic population of 1â¯000â¯000 individuals based on the characteristics of the population of Ontario, Canada. Members of the synthetic population were clustered into households, neighborhoods, or rural districts, cities or rural regions, day care facilities, classrooms (ie, primary, elementary, or high school), colleges or universities, and workplaces. Data were analyzed between May 5, 2020, and October 20, 2020. Exposures: School reopening on September 15, 2020, vs schools remaining closed under different scenarios for nonpharmaceutical interventions. Main Outcomes and Measures: Incident and cumulative COVID-19 cases between September 1, 2020, and October 31, 2020. Results: Among 1â¯000â¯000 simulated individuals, the percentage of infections among students and teachers acquired within schools was less than 5% across modeled scenarios. Incident COVID-19 case numbers on October 31, 2020, were 4414 (95% credible interval [CrI], 3491-5382) cases in the scenario with schools remaining closed and 4740 (95% CrI, 3863-5691) cases in the scenario for schools reopening, with no other community-based nonpharmaceutical intervention. In scenarios with community-based nonpharmaceutical interventions implemented, the incident case numbers on October 31 were 714 (95% CrI, 568-908) cases for schools remaining closed and 780 (95% CrI, 580-993) cases for schools reopening. When scenarios applied the case numbers observed in early October in Ontario, the cumulative case numbers were 777 (95% CrI, 621-993) cases for schools remaining closed and 803 (95% CrI, 617-990) cases for schools reopening. In scenarios with implementation of community-based interventions vs no community-based interventions, there was a mean difference of 39â¯355 cumulative COVID-19 cases by October 31, 2020, while keeping schools closed vs reopening them yielded a mean difference of 2040 cases. Conclusions and Relevance: This decision analytical modeling study of a synthetic population of individuals in Ontario, Canada, found that most COVID-19 cases in schools were due to acquisition in the community rather than transmission within schools and that the changes in COVID-19 case numbers associated with school reopenings were relatively small compared with the changes associated with community-based nonpharmaceutical interventions.