Safety of cold resection of non-ampullary duodenal polyps: Systematic review and meta-analysis.

Background and study aims Endoscopic resection has traditionally involved electrosurgical cautery (hot snare) to resect premalignant polyps. Recent data have suggested superior safety of cold resection. We aimed to assess the safety of cold compared with traditional (hot) resection for non-ampullary duodenal polyps. Methods We performed a systematic review ending in September 2022. The primary outcome of interest was the adverse event (AE) rate for cold compared with hot polyp resection. We reported odds ratios with 95% confidence intervals (CIs). Secondary outcomes included rates of polyp recurrence and post-polypectomy syndrome. We assessed publication bias with the classic fail-safe test and used forest plots to report pooled effect estimates. We assessed heterogeneity using I 2 index. Results Our systematic review identified 1,215 unique citations. Eight of these met inclusion criteria, seven of which were published manuscripts and one of which was a recent meeting abstract. On random effect modeling, cold resection was associated with significantly lower odds of delayed bleeding compared with hot resection. The difference in the odds of perforation (odds ratio [OR] 0.31 [95% confidence interval [CI] 0.05-2.87], P =0.2, I 2 =0) and polyp recurrence (OR 0.75 [95% CI 0.15-3.73], P =0.72, I 2 =0) between hot and cold resection was not statistically significant. There were no cases of post-polypectomy syndrome reported with either hot or cold techniques. Conclusions Cold resection is associated with lower odds of delayed bleeding compared with hot resection for duodenal tumors. There was a trend toward higher odds of perforation and recurrence following hot resection, but this trend was not statistically significant.

Risk Factors and Clinical Outcomes of Asymptomatic Bacteriuria in Pregnant Women: A Comprehensive Analysis.

Background Asymptomatic bacteriuria (ASB) in pregnant women poses risks to maternal and neonatal health. Understanding its prevalence and associated risk factors is crucial for effective management. This study aimed to determine the prevalence of ASB among pregnant women and identify associated risk factors. Methodology A cross-sectional study involving 294 pregnant women was conducted. ASB prevalence was determined, and bivariate analysis was performed to identify associated risk factors. Logistic regression analysis was employed to assess the significance of identified risk factors. Results The overall prevalence of ASB was 17.34%. Bivariate analysis revealed associations between ASB and maternal age (p > 0.05), socioeconomic status (p < 0.001), previous urinary tract infection (UTI) history (p < 0.001), diabetes mellitus (p = 0.00204), and anemia (p = 0.522). Multivariate logistic regression confirmed significant associations of ASB with maternal age (p = 0.008), parity (p = 0.001), previous UTI (p < 0.001), and diabetes mellitus (p < 0.001). Conclusion This study underscores the importance of screening for ASB during prenatal care, particularly among pregnant women with advanced maternal age, higher parity, previous urinary tract infection (UTI) history, and diabetes mellitus. Tailored screening strategies and prompt treatment can mitigate the risks associated with untreated ASB, improving maternal and neonatal outcomes. Healthcare providers should integrate these findings into routine antenatal care protocols to optimize maternal and fetal health.

Effect of Elevated Acetabular Cup on Contact and Failure Analysis in Hip Implants for Different Microseparations and Cup Inclinations Under Routine Gait Activities Using In Silico Approach.

Objectives: The acetabular cup design plays a critical role in reducing contact stress between femur head acetabular cup. Many studies used ellipsoidal and spheroidal geometry in acetabular cup design to effectively reduce contact stress. The present study focuses on elevated acetabular cup rim with round corner design to reduce contact stress with round corner geometry. Methods: The cobalt chromium femur head and cup are considered for finite element (FE) model of hip resurfacing. The gait loads of routine activities of humans like normal walking, stair ascending and descending and sitting down and getting up gait activities are applied to the developed 3D FE model. Five microseparations of 0.5, 1, 1.5, 2 and 2.5 mm are considered in the present study. The acetabular cup inclination angle considered for this study are 35°, 45°, 55°, 65° and 75°. The contact stress and von Mises stress plot for each gait activities under these microseparations are analyzed for betterment of longevity of implants. Results: Overall elevated cup rim design helped in reducing contact stress to a greater extent than conventional cup with different geometries. Also, the predicted von Mises stress for all the parameters considered in the current study are well within the yield strength of CoCr material. Therefore, elevated cup rim could be used as a better alternative to spline and, ellipsoidal and circular geometries of cup.

Public Health Crisis in Gaza-The Responsibility of US-Based Academic Medical Journals.

In this Viewpoint, the authors assert that US-based medical journals have an obligation to create space for discourse about the human costs of war and other political drivers of health.

Fuzzy analytic hierarchy process based generation management for interconnected power system.

Decision makers consistently face the challenge of simultaneously assessing numerous attributes, determining their respective importance, and selecting an appropriate method for calculating their weights. This article addresses the problem of automatic generation control (AGC) in a two area power system (2-APS) by proposing fuzzy analytic hierarchy process (FAHP), an multi-attribute decision-making (MADM) technique, to determine weights for sub-objective functions. The integral-time-absolute-errors (ITAE) of tie-line power fluctuation, frequency deviations and area control errors, are defined as the sub-objectives. Each of these is given a weight by the FAHP method, which then combines them into an single final objective function. This objective function is then used to design a PID controller. To improve the optimization of the objective function, the Jaya optimization algorithm (JOA) is used in conjunction with other optimization techniques such as sine cosine algorithm (SCA), Luus-Jaakola algorithm (LJA), Nelder-Mead simplex algorithm (NMSA), symbiotic organism search algorithm (SOSA) and elephant herding optimization algorithm (EHOA). Six distinct experimental cases are conducted to evaluate the controller's performance under various load conditions, with data plotted to show responses corresponding to fluctuations in frequency and tie-line exchange. Furthermore, statistical analysis is performed to gain a better understanding of the effectiveness of the JOA-based PID controller. For non-parametric evaluation, Friedman rank test is also used to validate the performance of the proposed JOA-based controller.

Gesture generation by the robotic hand for aiding speech and hard of hearing persons based on indian sign language.

Speech and hearing impairments are among the most common problems in Indian societies. It can affect anyone, whether children, adults, or more. Many different treatments can help to overcome hearing problems. Different types of hearing aids and cochlear implants help amplify sounds for better hearing. The type of language known as sign language is very scientific and has its grammar and syntax. Still, due to a need for more awareness among hard-of-hearing persons, they need to be made familiar with the institutions where they can learn and equip themselves for communication. This paper describes an approach to aid speech and hard-of-hearing persons so that they are free to communicate with persons who do not have speech and hearing disabilities based on the Indian Sign Language System. To find an appropriate solution, there is a need to develop a system that can act as an interpreter for speech and hard-of-hearing persons. The interpreter system is designed with the help of the Robotic hand model and is programmed using Raspberry Pi 4. Based on the experimental results, it can be observed that the robotic hands generated different signs of the alphabet corresponding to the speech commands uttered by an individual. Several experimental trials were conducted by ten persons who do not have any hearing disabilities. The results of the five experimental trials are shown in this paper. The estimation of performance parameters and statistical analysis are also carried out to analyze better and interpret the experimental results. Based on the experimental results, the proposed robotic hand interpreter system model accurately generates gestures corresponding to different alphabets used in the Indian Sign Language system, yielding an overall accuracy of 94 percent.

Dynamics of Single-Cell Protein Covariation during Epithelial-Mesenchymal Transition.

Physiological processes, such as the epithelial-mesenchymal transition (EMT), are mediated by changes in protein interactions. These changes may be better reflected in protein covariation within a cellular cluster than in the temporal dynamics of cluster-average protein abundance. To explore this possibility, we quantified proteins in single human cells undergoing EMT. Covariation analysis of the data revealed that functionally coherent protein clusters dynamically changed their protein-protein correlations without concomitant changes in the cluster-average protein abundance. These dynamics of protein-protein correlations were monotonic in time and delineated protein modules functioning in actin cytoskeleton organization, energy metabolism, and protein transport. These protein modules are defined by protein covariation within the same time point and cluster and, thus, reflect biological regulation masked by the cluster-average protein dynamics. Thus, protein correlation dynamics across single cells offers a window into protein regulation during physiological transitions.

Health care resource utilization and costs associated with diagnosed medication overuse headache and potential acute medication overuse in individuals with migraine.

OBJECTIVE: Estimate health care resource utilization and costs associated with medication overuse headache and potential acute medication overuse. METHODS: A retrospective analysis was conducted with Clinformatics Data Mart data (1 January 2019-31 December 2019) that included continuously enrolled commercially insured adults with migraine (International Classification of Diseases, Tenth Revision, Clinical Modification [ICD-10-CM] code G43.xxx). Medication overuse headache was defined as ≥1 inpatient or ≥2 outpatient claims with an ICD-10-CM code G44.41/40 (drug-induced headache). Potential acute medication overuse was defined as possessing sufficient medication for >10 mean treatment days/month for ergots, triptans, opioids, or combination analgesics or >15 mean cumulative days/month for simple prescription analgesics (e.g., acetaminophen, aspirin, other non-opioid analgesics) for >6 consecutive months. All-cause and migraine-related health care resource utilization and costs were compared after adjusting for demographic and clinical characteristics. RESULTS: Among 90,017 individuals with migraine, the frequency of medication overuse headache/potential acute medication overuse was 12.6% (diagnosed medication overuse headache: 0.6%; potential acute medication overuse: 12.1%). Adjusted all-cause total costs ($31,235 vs $21,486; difference: $9,749 [P < 0.001]) and adjusted migraine-related total costs ($9,770 vs $6,207; difference: $3,563 [P < 0.001]) were higher in the medication overuse headache/potential acute medication overuse group versus those without medication overuse headache/potential acute medication overuse. CONCLUSIONS: Individuals with diagnosed medication overuse headache/potential acute medication overuse had higher all-cause and migraine-related health care resource utilization and costs versus individuals without medication overuse headache/potential acute medication overuse, suggesting that improved migraine management is needed to reduce associated costs.

Dynamics of single-cell protein covariation during epithelial-mesenchymal transition.

Physiological processes, such as epithelial-mesenchymal transition (EMT), are mediated by changes in protein interactions. These changes may be better reflected in protein covariation within cellular cluster than in the temporal dynamics of cluster-average protein abundance. To explore this possibility, we quantified proteins in single human cells undergoing EMT. Covariation analysis of the data revealed that functionally coherent protein clusters dynamically changed their protein-protein correlations without concomitant changes in cluster-average protein abundance. These dynamics of protein-protein correlations were monotonic in time and delineated protein modules functioning in actin cytoskeleton organization, energy metabolism and protein transport. These protein modules are defined by protein covariation within the same time point and cluster and thus reflect biological regulation masked by the cluster-average protein dynamics. Thus, protein correlation dynamics across single cells offer a window into protein regulation during physiological transitions.

Sample Processing and Concentration Methods for Viruses from Foods and the Environment Prior to Detection.

Viruses are the leading cause of foodborne illness globally. Concentration of viruses from samples is important for detection because viral contamination of foods often occurs at low levels. In general, virus concentration methods can be classified as either nonspecific, exploiting the relatively homogeneous physicochemical properties of the virus to separate/concentrate it from the sample matrix, or specific, relying on recognition elements such as antibodies to specifically capture and separate viruses from foods. Numerous nonspecific and specific techniques for virus concentration have been reported, each with its own advantages and limitations. Factors to consider can include reagent and equipment costs, time-to-result, ease of use, and potential to eliminate matrix-associated inhibitors. The purpose of this review is to survey the different foodborne virus concentration techniques and their efficacy in various food and environmental matrices as well as discuss some emerging techniques for purification and concentration of viral pathogens from food samples. Expected final online publication date for the Annual Review of Food Science and Technology, Volume 15 is April 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Randomized trial of gastric and colorectal endoscopic submucosal dissection defect closure comparing a novel through-the-scope suturing system with an over-the-scope suturing system (with video).

BACKGROUND AND AIMS: Mucosal closure adds time but reduces adverse events associated with endoscopic submucosal dissection (ESD). We aimed to assess the closure time (CT), technical success, and cost-effectiveness between a novel through-the-scope helix tack suture system (TTSS) and the over-the-scope suturing system (OTSS). METHODS: In this single-center, prospective, randomized trial, all patients undergoing ESD with anticipated closure were randomized 1:1 to TTSS (study group) or OTSS (control group). Primary outcomes were CT and overall CT (OCT; CT + setup time). Secondary outcomes were rates of technical success, adverse events, and cost-effectiveness. RESULTS: Forty patients were randomized to OTSS (n = 20) or TTSS (n = 20). OTSS and TTSS groups were similar with respect to age, gender, proportion of colorectal polyps, proximal colon polyps, and mean size of the resected specimen (40.9 mm vs 40.4 mm). The mean CT was 18.4 minutes for OTSS and 23.3 minutes for TTSS (P = .36). The mean OCT was 32 minutes for OTSS and 39.5 minutes for TTSS (P = .36). Closure with a primary device was successful in 17 cases (85%) with OTSS and 18 cases (90%) with TTSS (P = .63). No closure-related intraprocedural adverse events or delayed perforations were noted. Mean cost of closure was significantly lower in the TTSS group for lesions <35 mm (P = .008). CONCLUSIONS: TTSS was not found to be superior to OTSS with respect to CT and technical and clinical success for closure of gastric and colorectal ESD defects. TTSS is more cost-effective for closure of lesions <35 mm. (Clinical trial registration number: NCT04925271.).

Use of Native-PAGE for the Identification of Epichaperomes in Cell Lines.

Epichaperomes are disease-associated pathologic scaffolds, composed of tightly bound chaperones, co-chaperones, and other factors. They mediate anomalous protein-protein interactions inside cells, which aberrantly affects the function of protein networks, and in turn, cellular phenotypes. Epichaperome study necessitates the implementation of methods that retain these protein complexes in their native cellular states for analysis. Here we describe a protocol for detection and composition analysis of epichaperomes in cell homogenates through native polyacrylamide gel electrophoresis.

Systems-level analyses of protein-protein interaction network dysfunctions via epichaperomics identify cancer-specific mechanisms of stress adaptation.

Systems-level assessments of protein-protein interaction (PPI) network dysfunctions are currently out-of-reach because approaches enabling proteome-wide identification, analysis, and modulation of context-specific PPI changes in native (unengineered) cells and tissues are lacking. Herein, we take advantage of chemical binders of maladaptive scaffolding structures termed epichaperomes and develop an epichaperome-based 'omics platform, epichaperomics, to identify PPI alterations in disease. We provide multiple lines of evidence, at both biochemical and functional levels, demonstrating the importance of these probes to identify and study PPI network dysfunctions and provide mechanistically and therapeutically relevant proteome-wide insights. As proof-of-principle, we derive systems-level insight into PPI dysfunctions of cancer cells which enabled the discovery of a context-dependent mechanism by which cancer cells enhance the fitness of mitotic protein networks. Importantly, our systems levels analyses support the use of epichaperome chemical binders as therapeutic strategies aimed at normalizing PPI networks.

Improved indirect instantaneous torque control based torque sharing function approach of SRM drives in EVs using hybrid technique.

This manuscript proposes an improved indirect instantaneous torque control (IITC) based torque sharing function (TSF) method of switched reluctance motor (SRM) drives in electric vehicles (EVs) using a hybrid system. The proposed hybrid techniques are joint performance of both Reptile Search Algorithm (RSA) and Honey Badger Algorithm (HBA), hence it is named as Enhanced RSA (ERSA) method. Here, an IITC method of SRMs for EVs is utilized. It achieves the requirements of the vehicle, like minimum torque ripple, improved speed range, high effectiveness, and maximal torque per ampere (MTPA). To precisely specify the switched reluctance motor and its magnetic features are measured by the proposed method. The modified Torque sharing function compensates the torque error along with incoming phase, which contains the minimal rate of change of flux linkage. Finally, the ERSA method is implemented to define the best control parameters. Then, the proposed ERSA system is performed on the MATLAB platform and the performance is compared to different existing systems. The MSE for case 1 and case 2 using proposed system attains 0.01093 and 0.01095. The voltage deviation for case 1 and case 2 using proposed system reaches 5 and 5. The power factor for case 1 and case 2 reaches a value of 50 and 40 using the proposed system.

Cardiomyocyte-specific deletion of TLR4 attenuates angiotensin II-induced hypertension and cardiac remodeling.

Toll-like receptor 4 (TLR4) is an integral factor in the initiation of the innate immune response and plays an important role in cardiovascular diseases such as hypertension and myocardial infarction. Previous studies from our lab demonstrated that central TLR4 blockade reduced cardiac TLR4 expression, attenuated hypertension, and improved cardiac function. However, the contribution of cardiac specific TLR4 to the development of hypertension and cardiac remodeling is unknown. Therefore, we hypothesized that cardiomyocyte specific knockdown of TLR4 would have beneficial effects on hypertension, cardiac hypertrophy, and remodeling. To test this hypothesis, cardiomyocyte-specific TLR4 knockdown (cTLR4KO) mice were generated by crossing floxed TLR4 mice with Myh6-Cre mice, and subjected to angiotensin II (Ang II, 1 µg/kg/min or vehicle for 14 days) hypertension model. Blood pressure measurements using radio telemetry revealed no differences in baseline mean arterial pressure between control littermates and cTLR4KO mice (103 ± 2 vs. 105 ± 3 mmHg, p > 0.05). Ang II-induced hypertension (132 ± 2 vs. 151 ± 3 mmHg, p < 0.01) was attenuated and cardiac hypertrophy (heart/body weight; 4.7 vs. 5.8 mg/g, p < 0.01) was prevented in cTLR4KO mice when compared with control mice. In addition, the level of myocardial fibrosis was significantly reduced, and the cardiac function was improved in cTLR4KO mice infused with Ang II. Furthermore, cardiac inflammation, as evidenced by elevated gene expression of TNF, IL-6, and MCP-1 in the left ventricle, was attenuated in cTLR4KO mice infused with Ang II. Together, this data revealed a protective role for cardiomyocyte-specific deletion of TLR4 against Ang II-induced hypertension and cardiac dysfunction through inhibition of proinflammatory cytokines.

Interpreting Iron Homeostasis in Congenital and Acquired Disorders.

Mammalian cells require iron to satisfy their metabolic needs and to accomplish specialized functions, such as hematopoiesis, mitochondrial biogenesis, energy metabolism, or oxygen transport. Iron homeostasis is balanced by the interplay of proteins responsible for iron import, storage, and export. A misbalance of iron homeostasis may cause either iron deficiencies or iron overload diseases. The clinical work-up of iron dysregulation is highly important, as severe symptoms and pathologies may arise. Treating iron overload or iron deficiency is important to avoid cellular damage and severe symptoms and improve patient outcomes. The impressive progress made in the past years in understanding mechanisms that maintain iron homeostasis has already changed clinical practice for treating iron-related diseases and is expected to improve patient management even further in the future.

A 3-Dimensional Evaluation of the Effects of Unilateral Vertical Mandibular Distraction Osteogenesis on Airway Volume Among Patients With Hemifacial Microsomia.

OBJECTIVE: The aim of this study was to evaluate the volumetric airway changes using three-dimensional images following unilateral vertical mandibular distraction osteogenesis (uVMD) among patients with hemifacial microsomia (HFM). DESIGN: This retrospective study analyzed cone-beam computed tomography (CBCT) scans of patients with HFM at three different timepoints; pretreatment (T0), posttreatment (T1), and at least 6 months post-distraction (T2). The individuals underwent uVMD between December 2018-Januaray 2021. The nasopharyngeal (NP) volume, oropharyngeal (OP) volume, and the area of maximum constriction (MC) were measured. Wilcoxon signed-rank test was used to compare the airway volumes between T0-T1, T1-T2, and T0-T2. RESULTS: Five patients met the inclusion criteria (mean age = 10.4 years; 1 female, 4 males). Intraclass correlation analysis showed excellent interrater reliability (r > .86, P < .001). Posttreatment, the OP airway volume exhibited a significant mean increase of 56% (P = .043) from T0 to T1, but decreased from T1-T2 by 13%. Likewise, the total airway volume presented with a significant mean increase of 48% between T0-T1 (P = .044), and a decrease of 7% from T1-T2. The changes in the NP airway volume and area of MC were not statistically significant (P > .05), but an increase in the mean values were observed. CONCLUSION: Surgical intervention with uVMD may significantly increase the OP airway volume and the total airway volume among patients with HFM immediately after distraction. However, the statistical significance diminished after six months post-consolidation, but the mean percent change may remain of clinical significance. The NP volume did not seem to show significant changes in response to uVMD.

Mucormycosis infection associated with global COVID-19 pandemic - an institutional histopathological study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) in the recent times have instilled signs of immunosuppression globally which has further precipitated increasing range of opportunistic infections. Mucormycosis is a distressing opportunistic fungal infection with a high incidence and is the third commonest acute invasive infection following candidiasis and aspergillosis. The aim of the present observational study is to delineate the enigmatic histopathological profile between mucormycosis cases seen prior to pandemic (PPM) and pandemic associated mucormycosis (PAM). MATERIAL AND METHODS: Tissue archives of 105 histopathologically diagnosed cases of mucormycosis were included and analysed for demographical details and histopathological parameters like fungal load and localization, granuloma formation, necrosis, inflammatory infiltrate and tissue invasion. RESULTS: 0ut of 105 included cases, 11/105 (10.48%) were reported PPM and 94/105 (89.52%) PAM. Among 94 cases of PAM, 51/94 (54%) cases also showed COVID-19 positivity, while 43/94 (46%) did not. Of all the histological variables, increased fungal load and necrosis were observed in PAM relative to PPM cases. CONCLUSIONS: The histopathological variables like fungal load, necrosis, granuloma formation and tissue invasion, could help the clinician in assessing the clinical status at the time of tissue diagnosis and improve the treatment accordingly.

Assessment of SARS-CoV-2 surrogate inactivation on surfaces and in air using UV and blue light-based intervention technologies.

The COVID-19 pandemic has created an urgent need to utilize existing and develop new intervention technologies for SARS-CoV-2 inactivation on surfaces and in the air. Ultraviolet (UV) technology has been shown to be an effective antimicrobial intervention. Here a study was conducted to determine the efficacy of commercially available UV and blue light-based devices for inactivating HCoV-229E, a surrogate of SARS-CoV-2. The results indicate that two UV devices designed for surface disinfection, with doses of 8.07 µJ/cm2 for the 254 nm device and 20.61 µJ/cm2 for the 275 nm device, were efficient in inactivating 4.94 logs of surface inoculated HCoV-229E. Additionally, a 222 nm UV device with intended ceiling-based operation was effective in inactivating 1.7 logs of the virus inoculated on surface, with a dose of 6 mJ/cm2. A ceiling-based device designed to emit blue light at 405 nm was found to produce 89% reduction in HCoV-229E inoculated on a surface for a dose of 78 J/cm2. Finally, the UV based 222 nm device was found to produce a 90% reduction in the concentration of airborne HCoV-229E, at a 55 µJ/cm2 dose. These results are indicative of the great potential of using UV based technology for the control of SARS-CoV-2.Implications: An important avenue of arresting COVID-19 and future pandemics caused by infectious pathogens is through environmental disinfection. To this effect, the study presented here evaluates commercially available UV and blue light based antimicrobial devices for their ability to kill the human coronavirus HCoV-229E, a surrogate of SARS-CoV-2, on surfaces and in air. The results indicate that two handheld UV devices produced complete inactivation of surface viral inoculum and a UVC ceiling based device produced 1 log reduction in HCoV-229E in air. These results imply the efficacy of UV technology as an antimicrobial tool, especially for rapid disinfection of indoor air.