A case of short QT-interval postventricular arrhythmia arrest from Torsade De Pointes, a new phenotype, or the result of tachycardia-mediated imbalance.

INTRODUCTION: We report the case of an 18-year-old female with recurrent syncope that was discovered to have congenital long QT syndrome (LQTS) and episodes of a transiently short QT interval after spontaneous termination of polymorphic ventricular tachycardia. METHODS & RESULTS: A cardiac event monitor revealed a long QT interval and initiation of polymorphic ventricular tachycardia by a premature ventricular complex on the preceding T-wave. After 1 minute of ventricular fibrillation, her arrhythmia spontaneously terminated with evidence of a short QT interval. CONCLUSIONS: A transient, potentially artificial, short QT interval following Torsades de Pointes can occur in patients with LQTS.

Accuracy of Patient-Specific, 3D-Printed Laminofacetal Based Trajectory-Guide for Pedicle Screw Placement in Subaxial Cervical and Thoracic Spine.

Background: Conventional methods of pedicle-screw placement have higher breach rates due to variations in pedicle trajectories. Objective: We studied the accuracy of patient-specific, three-dimensional (3D)-printed laminofacetal-based trajectory guide for pedicle-screw placement in the subaxial-cervical and thoracic spine. Materials and Methods: We enrolled 23 consecutive patients who underwent subaxial cervical and thoracic pedicle-screw instrumentation. They were divided into two groups: group A (cases without spinal deformity) and group B (cases with pre-existing spinal deformity). Patient-specific, 3D-printed laminofacetal-based trajectory guide for each instrumented level was designed. The accuracy of screw placement was assessed on postoperative computed tomography (CT) using the Gertzbein-Robbins grading. Results: A total of 194 pedicle screws (114 cervical and 80 thoracics) were placed using trajectory guides, of which 102 belonged to group B (34 cervical and 68 thoracics). Out of a total of 194 pedicle screws, 193 had clinically acceptable placement (grade A: 187; grade B: 6; and grade C: 1). In the cervical spine, 110 pedicle screws out of a total of 114 had grade A placement (grade B: 4). In the thoracic spine, 77 pedicle screws out of a total of 80 had grade A placement (grade B: 2; grade C: 1). Out of a total of 92 pedicle screws in group A, 90 had grade A placement, and the rest 2 had grade B breach. Similarly, 97 out of a total of 102 pedicle screws in group B were placed accurately, 4 had grade B and another had a grade C breach. Conclusions: Patient-specific, 3D-printed laminofacetal-based trajectory guide may help in accurate placement of subaxial cervical and thoracic pedicle screws. It may help reduce surgical time, blood loss, and radiation exposure.

Computational-sampling-moiré-based on-machine alignment for freeform optics.

The manufacturing and characterization of freeform optical surfaces are influenced by their high sensitivity to misalignments. In this work, the computational sampling moiré technique combined with phase extraction is developed for the precise alignment of freeform optics during fabrication and in metrology applications. This novel, to the best of our knowledge, technique achieves near-interferometry-level precision in a simple and compact configuration. This robust technology can be applied to industrial manufacturing platforms (such as diamond turning machines, lithography, and other micro-nano-machining techniques) as well as their metrology equipment. In a demonstration of computational data processing and precision alignment using this method, iterative manufacturing of freeform optical surfaces with a final-form accuracy of about 180 nm was accomplished.

Fluoride risk assessment from agricultural soils in India: a study based on vertical, spatial and geochemical distribution.

Fluoride (F) in agricultural soil is increasing continuously due to injudicious application of F-laden fertilizers, causing global concern about fluorosis disease. The objective of the study was to assess F risk in humans due to soil ingestion, dermal contact, and particulate inhalation during various agricultural activities. The study also emphasized chemical fractionation, distribution, and geochemical understanding of high F incidence. Agricultural surface soil was sampled randomly from 5 km × 5 km square grids besides soil profile samples for studying the vertical distribution of F. Various F fractions in soil (1:1 soil:water ratio, calcium chloride extractable F, hot water soluble F, exchangeable F, Fe-Mn oxide bound F, organic matter bound F, residual F, and total F) were estimated using the sequential fractionation method. Multivariate geochemical analysis and soil F risk were also assessed in humans. The water soluble F (F1:1) and CaCl2 extractable F (FCa) varied between 0.11 to 6.73 mg kg-1 and 1.02 to 6.94 mg F kg-1 soil, respectively. Total fluoride (TF) however, ranged between 115 to 456 mg F kg-1. A higher average of FCa/TF moving down the soil profile indicated a propensity for F endemicity. Weathering, ion-exchange, alkalinity, and clay were found to control the soil geochemistry of the area. The F contamination index explained > 82% variance of F contamination, but the hazard quotient of F for an adult was found < 1, indicating no potential fluorosis risk in the area. This study is the first of its kind in India, where ecological risk due to F from agricultural soil was assessed in humans and will be a benchmark for future researchers.

Conservation Tillage and Waste Crop Residue Based Zinc Fortification in Rice and Wheat under Reclaimed Sodic Soils: Progress toward Nutrient Circularity and Sustainability.

Nearly 50% of the population across the globe is at risk of malnutrition with respect to zinc (Zn) in areas where a cereal based dietary system dominates. The present study estimated daily Zn intake in humans through field experiments in reclaimed sodic soil, utilizing waste crop residue (CR) in conservation tillage where CR played a vital role in enhancing Zn uptake in rice and wheat grains. Zn dynamics, its bioavailability, interaction with soil properties, and plausible contribution in dietary intake were studied extensively to supplement the research. A higher mobility factor (2.70%) and plant available Zn resulted in its higher uptake in rice (58.2 mg kg-1) and wheat (67.2 mg kg-1) under zero tillage in rice followed by zero tillage in wheat where CR was retained on the surface (ZTR-ZTW+CR). Daily Zn intake was found to be maximum (0.651 mg kg-1 day-1) under ZTR-ZTW+CR, demonstrating zinc sufficiency. Thus, this study may help in formulating actionable policies for combating both nutritional security and environmental hazards due to CR burning.

Case Report of Novel, Automatic Shocking Vector Adjustment Algorithm: A Life-Saving Feature of a Modern Defibrillator.

BACKGROUND: Failed delivery of appropriate shocks against fatal dysrhythmias can be the result of low impedance on high-voltage leads. This malfunction might be missed on routine interrogation. We describe the case of a 66-year-old man with a high-voltage lead short circuit who was successfully rescued with the use of an overcurrent detection and automatic shocking vector adjustment algorithm. CASE REPORT: A 66-year-old man with severe nonischemic cardiomyopathy was admitted after receiving 2 shocks from his cardiac resynchronization therapy cardioverter-defibrillator. Interrogation of his defibrillator confirmed 2 consecutive episodes of ventricular fibrillation. For each episode, the initial shock therapy was aborted due to low impedance (<10 ohms) detected on the default shocking configuration: right ventricle to superior vena cava/implantable cardioverter generator. As a result, the device algorithm excluded the superior vena cava coil and immediately delivered a shock of 40 joules between the right ventricular coil and the cardiac resynchronization therapy cardioverter-defibrillator implantable cardioverter generator. This successfully terminated the ventricular fibrillation. All other lead measurements were normal. CONCLUSION: High-voltage lead malfunctions can lead to failed therapy of life-threatening dysrhythmias. Malfunctions like a low impedance of high-voltage leads may not be detected on routine interrogation. Fortunately, the overcurrent detection algorithm recognized the low impedance, and another shocking configuration was selected and successfully terminated the ventricular dysrhythmias. With these algorithms, overcurrent detection and automatic shocking vector adjustment, this patient was rescued. We suggest this feature be considered in all modern defibrillators.

Identification of discriminating chemical compounds in banana species and their odor characterization using GC-MS, statistical, and clustering analysis.

The study aims identification of discriminating chemical constituents in the banana odor grown in Philippines and Ecuador using GC-MS characterization. Ester is recognized as a major chemical class in selected banana odor. Odors discriminating compounds like, 2-hexenal, ethyl acetate, and hexanoic acid, ethyl ester, etc. have been identified. Besides, other odors generating chemical compounds (alcohols, esters, aldehydes, and ketones) have been recognized. Furthermore, principal component analysis (PCA) and hierarchical cluster analysis were implemented to differentiate banana odors. PCA achieved 100% discrimination of selected bananas odors using the peak area information about recognizing chemical compounds. Odor identity and discrimination of selected bananas have been achieved successfully. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13197-021-05298-9.

Beyond Ejection Fraction: Novel Clinical Approaches Towards Sudden Cardiac Death Risk Stratification in Patients with Dilated Cardiomyopathy.

Implantable Cardioverter-Defibrillator (ICD) therapy is indicated for patients at risk for sudden cardiac death due to ventricular tachyarrhythmia. The most commonly used risk stratification algorithms use Left Ventricular Ejection Fraction (LVEF) to determine which patients qualify for ICD therapy, even though LVEF is a better marker of total mortality than ventricular tachyarrhythmias mortality. This review evaluates imaging tools and novel biomarkers proposed for better risk stratifying arrhythmic substrate, thereby identifying optimal ICD therapy candidates.

A gradient boosting machine learning approach in modeling the impact of temperature and humidity on the transmission rate of COVID-19 in India.

Meteorological parameters were crucial and effective factors in past infectious diseases, like influenza and severe acute respiratory syndrome (SARS), etc. The present study targets to explore the association between the coronavirus disease 2019 (COVID-19) transmission rates and meteorological parameters. For this purpose, the meteorological parameters and COVID-19 infection data from 28th March 2020 to 22nd April 2020 of different states of India have been compiled and used in the analysis. The gradient boosting model (GBM) has been implemented to explore the effect of the minimum temperature, maximum temperature, minimum humidity, and maximum humidity on the infection count of COVID-19. The optimal performance of the GBM model has been achieved after tuning its parameters. The GBM results in the best accuracy of R2 = 0.95 for prediction of active cases in Maharashtra, and R2 = 0.98 for prediction of recovered cases of COVID-19 in Kerala and Rajasthan, India.

Evaluating toxicity impacts of environmental exposed chromium on small Indian mongoose (Urva auropunctatus) hematological, biochemical and histopathological functioning.

Sub-lethal toxic impacts of chromium on hematological, biochemical and histological parameters were analyzed in the female small Indian mongoose (Urva auropuctatus) residing contaminated environment of tannery industry. Chromium bioaccumulation in the blood, liver and kidney tissue of the exposed mongooses was found elevated compared to the control mongooses' tissues. Total body weight (75.7%), liver weight (83.6%) as well as HSI (68.1%), RSI (86.2%) and the platelets counts (59.7%) were found significantly elevated, with significantly reduced RBCs (59.6%), and WBCs (64%). LFT and RFT were also found abnormal, moreover, the histopathological injuries had been distinct inside the kidney (>75%) and hepatic (>75%) tissues of exposed animals. Shrinkage and vacuolization (>75%) inside the hepatocyte expanded sinusoidal spaces and nuclear pyknosis (>75%) was evident within the hepatic tissue. Hypertrophy of epithelial cells of renal tubules and inter-renal cells of the head kidney with a reduction in tubular lumens (>75%) and vacuolization of tubules were witnessed within the kidney section. Atrophy inside the kidney inter-renal cells, glomeruli compression within the Bowman's capsules (>75%) following the necrosis in hematopoietic tissues were found in exposed animals. The present findings indicate that chronic exposure to chromium induces severe anemia, decreased serum protein concentration, hepatic and renal tissue histopathology, impairing the vital capabilities of liver, metabolic regulation, excretion, and stress homeostasis maintenance of which within the long-run may posture a severe risk to animal well-being then distress their inhabitants.

Biological Management of Banana Fusarium Wilt Caused by Fusarium oxysporum f. sp. cubense Tropical Race 4 Using Antagonistic Fungal Isolate CSR-T-3 (Trichoderma reesei).

Fusarium wilt in bananas is one of the most devastating diseases that poses a serious threat to the banana industry globally. With no effective control measures available to date, biological control has been explored to restrict the spread and manage the outbreak. We studied the effective biological control potential of different Trichoderma spp. in the management of Fusarium oxysporum f. sp. cubense tropical race 4 (Foc TR4). Expression of the defense related genes and metabolites in banana plants inoculated with Foc TR4 and treated with effective Trichoderma sp interactions were also studied. The in vitro growth inhibition of Foc TR4 by Trichoderma reesei isolate CSR-T-3 was 85.19% indicating a higher antagonistic potential than other Trichoderma isolates used in the study. Further, in in vivo assays, the banana plants treated with the isolate CSR-T-3 T. reesei had a significant reduction in the disease severity index (0.75) and also had increased phenological indices with respect to Foc TR4 treated plants. Enhanced activity of defense enzymes, such as ß-1, 3-glucanase, peroxidase, chitinase, polyphenol oxidase, and phenylalanine ammonia lyase with higher phenol contents were found in the Trichoderma isolate CSR-T-3 treated banana plants challenge-inoculated with Foc TR4. Fusarium toxins, such as fusaristatin A, fusarin C, chlamydosporal, and beauveric acid were identified by LC-MS in Foc TR4-infected banana plants while high intensity production of antifungal compounds, such as ß-caryophyllene, catechin-o-gallate, soyasapogenol rhamnosyl glucoronide, peptaibols, fenigycin, iturin C19, anthocyanin, and gallocatechin-o-gallate were detected in T. reesei isolate CSR-T-3 treated plants previously inoculated with Foc TR4. Gene expression analysis indicated the upregulation of TrCBH1/TrCBH2, TrXYL1, TrEGL1, TrTMK1, TrTGA1, and TrVEL1 genes in CSR-T-3 treatment. LC-MS and gene expression analysis could ascertain the upregulation of genes involved in mycoparasitism and the signal transduction pathway leading to secondary metabolite production under CSR-T-3 treatment. The plants in the field study showed a reduced disease severity index (1.14) with high phenological growth and yield indices when treated with T. reesei isolate CSR-T-3 formulation. We report here an effective biocontrol-based management technological transformation from lab to the field for successful control of Fusarium wilt disease caused by Foc TR4 in bananas.

Ticagrelor or prasugrel vs. clopidogrel in combination with anticoagulation for treatment of acute coronary syndrome in patients with atrial fibrillation.

For patients with atrial fibrillation (AF) and acute coronary syndrome (ACS), it is often challenging to find the optimal balance between the risk for ischemic and hemorrhagic complication when using both antiplatelet therapy and oral anticoagulation (OAC) with vitamin K antagonist (VKA) or direct oral anticoagulants (DOACs). Current guidelines recommended: (I) double therapy with a P2Y12 inhibitor and dose adjusted VKA is reasonable post-stenting; (II) double therapy with clopidogrel and low-dose rivaroxaban (15 mg daily) may be reasonable post-stenting; (III) double therapy with a P2Y12 inhibitor and dabigatran 150 mg twice daily is reasonable post-stenting. In the AUGUSTUS trial, most patients were given clopidogrel as part a DAPT regimen, however prasugrel and ticagrelor use allowed albeit in a small percentage of the trial population, underestimating its effect. Ticagrelor and prasugrel are known to have a stronger antiplatelet effect compared to clopidogrel, however randomized studies have not been adequately powered to date allowing comparisons between ticagrelor, prasugrel and clopidogrel together in the setting of anticoagulation for the treatment of patients with ACS and AF. Careful consideration should be given to this scenario to avoid falling into the concept of sacrificing efficacy for safety.

Cardiac physiology in post myocardial infarction patients: the effect of cardiac rehabilitation programs-a systematic review and update meta-analysis.

Cardiac rehabilitation program (CRP) is a recognized non-pharmacological modality to decrease mortality after acute myocardial infarction (AMI) events. We aimed to evaluate the effect of CRP on the cardiac physiology in patients post myocardial infarction (MI). Online database search of PubMed, MEDLINE, EMBASE, SCOPUS, COCHRANE, and GOOGLE SCHOLAR were performed (1988-Mar 2016); key bibliographies were reviewed. Studies comparing post MI patients who were enrolled in a CRP to those who were not, were included. Standardized mean difference (SMD) with the corresponding 95% confidence intervals (CI) by random and fixed effects models of pooled data were calculated. Study quality was assessed using CONSORT criteria. Outcomes of interest measured included resting and maximum heart rate (HR), peak VO2, ejection fraction (EF%), wall motion score index (WMSI), left ventricular end diastolic volume (LVEDV) in cardiac rehabilitation patients versus control. Search strategy yielded 147 studies, 23 studies fulfilled the selection criteria, 19 of which were RCTs. These included a total of 1,683 patients; 827 were enrolled in a CRP while 855 did not receive the intervention. Median age was 58 years. There was no significant difference between the two groups in terms of age, comorbidities, severity of CAD, baseline EF or HR. Meta-analysis of data included demonstrated that CRP patients had lower post-intervention resting HR than non-CRP patients (SMD: -0.59; 95% CI: -0.73 to -0.46, fixed effect model P<0.05). EF% was significantly improved after CRP compared to control (SMD: 0.21; 95% CI: 0.02 to 0.40, P=0.03). Peak VO2 was significantly improved by CRP (SMD: 1.00; 95% CI: 0.56 to 1.45; P<0.0001). LVEDV was significantly less in CRP patients (SMD: -0.31; 95% CI: -0.59 to -0.02, fixed effect model P<0.05). WMSI was significantly less in CRP patients (SMD: -0.41; 95% CI: -0.78 to -0.05, P=0.024). CRP improves cardiac function in post MI patients. This may explain the reported improvement of functionality and mortality among those patients. Further randomized trials may help evaluate the long-term benefits of CRP.

Human health damages related to air pollution in China.

In recent years, air pollution in China has posed serious threats to human health. In this study, we investigate the relationship between air pollution and residents' health by nesting the household registration data of the China Migrant Dynamic Survey in 2014 with city characteristic data and pollution data. The results indicated that an increase in the concentration of air pollution significantly reduced residents' health levels. After using the instrumental variable (IV)-Oprobit model to solve endogenous problem, we have found that the negative impact of air pollution on residents' health remained significant. Moreover, the lag term of environmental indexes was introduced and found that air pollution significantly increased health risk. The results also demonstrated that the impact of air pollution on human health was heterogeneous. Men and urban residents were more sensitive to air pollution and more adversely affected. In addition to air pollution, the study found that, among the influencing factors at the individual level, males' health was better than females' health, and education positively impacted on residents' health. The health effects were consistent with the theoretical predictions of the Grossman model. The financial expenditure and medical input were negatively correlated with residents' health levels. Based on the results, we suggest the Chinese government should implement rigorous air pollution laws and regulations.

Multivariate statistical analysis for selecting optimal descriptors in the toxicity modeling of nanomaterials.

The present study is based on the application of a multivariate statistical analysis approach for the selection of optimal descriptors of nanomaterials with the objective of robust qualitative modeling of their toxicity. A novel data mining protocol has been developed for the selection of an optimal subset of descriptors of nanomaterials by using the well-known multivariate method principal component analysis (PCA). The selected subsets of descriptors were validated for qualitative modeling of the toxicity of nanomaterials in the PC space. The analysis and validation of the proposed schemes were based on five decisive nanomaterial toxicity data sets available in the published literature. Optimal descriptors were selected on the basis of the maximum loading criteria and using a threshold value of cumulative variance ≤90% on PC directions. A maximum inter-class separation(B) and the minimum intra-classes separation(A) were obtained for toxic vs. nontoxic nanomaterials in the PC space with the selected subsets of optimal descriptors compared to their other combinations for each of the datasets.

Double conduction through the atrioventricular node following acute medullary infarction: a case report.

Lateral medullary syndrome (LMS), also known as Wallenberg's syndrome, PICA syndrome, results from occlusion of the posterior inferior cerebellar artery, with associated infarction of parts of medulla oblongata, and cerebellum on the ipsilateral side. It often manifests as various patterns of sensory, motor, and autonomic deficits. While sensorimotor dysfunction presents as a predicted pattern of clinical signs and symptoms, autonomic dysfunction is usually less clinically apparent, and can be easily mistaken as a concomitant pathology in the end organ it affects. In this case, we present a case of an unusual pattern of cardiac arrhythmia as the first objective finding of LMS, caused by autonomic instability following infarction of vagus nerve nuclei in the medulla.

Opaque16, a high lysine and tryptophan mutant, does not influence the key physico-biochemical characteristics in maize kernel.

The enhancement of lysine and tryptophan in maize is so far basedon opaque2(o2) mutant, that along with the endosperm-modifiersled to development of Quality Protein Maize[QPM]. Though many mutants improving the endospermic protein quality were discovered, they could not be successfully deployed. Recently discovered opaque16 (o16)mutant enhances the lysine and tryptophan content in maize endosperm. In the present study, the influence of o16 on the endosperm modification was analyzed in four F2 populations, two each segregating for o16 allele alone and in combination with o2. The recessive o16o16 seed endosperm was found to be vitreousphenotypically similar to wild-O16O16. The mutant did not influence the degree of kernel opaqueness in o2o2 genetic background as opaqueness in o2o2/O16O16 and o2o2/o16o16 was similar. Grain hardness of o16o16 was comparable with the normal and QPM maize. The pattern of microscopic organization of proteinaceous matrix and starch granules, and zein profiling of the storage protein in o16o16 were found to be similar with normal maize endosperm, but distinct from the o2o2-soft genotype. The pattern in o2o2/o16o16 was unique and different from o2o2 and o16o16 as well. Here we demonstrated the effects of o16 on physico-biochemical characteristics of endosperm and report of o16 possessing negligible influence on kernel modification and hardness, which holds a great significance in maize quality breeding programme.

Evaluation of accuracy of virtual surgical planning for patient-specific pre-contoured plate in acetabular fracture fixation.

BACKGROUND: Acetabular fractures are amongst the most challenging fractures to treat because of complex anatomy. Open reduction and internal fixation remains the standard treatment for displaced acetabular fractures to achieve anatomical reduction as in any other intra-articular fracture. Patient-specific pre-contoured reconstruction plate template made by a pre-operative virtual surgical planning can be useful to respect patient's morphology, reduce surgical invasiveness and simplify the surgical procedure. Proper evaluation and surgical planning is necessary to achieve these goals. The goal of this study was to evaluate the outcomes of using virtual surgical planning and virtually pre-contoured plate template in comparison with the conventional method of intra-operative contouring of reconstruction plate for acetabular fracture fixation. METHODS: Twenty-five patients were categorized into group A and B by computerized randomization. In group A (12 patients), CT-based virtual surgical planning was done using Mimics and 3-Matic software to form virtually pre-contoured plates, which were 3D printed to act as templates over which 3.5 mm reconstruction plates were manually contoured pre-operatively and used for fixation. In group B (13 patient), conventional method of intra-operative contouring to adapt the plate to the fracture region was followed. Blood loss, surgical time, reduction on X-rays and post-operative computed tomography were compared between two groups. RESULTS: Duration of surgery and total blood loss were found to be less while reduction was found to satisfactory/anatomical in higher percentage of Group A than Group B patients. CONCLUSIONS: Virtual surgical planning, patient-specific virtually pre-contoured plate template and 3D printing technology improve the outcomes of acetabular fracture surgery by reducing duration and invasiveness of surgery and improving the quality of reduction. However, studies with larger sample size are required to further validate it.

Clinical outcomes of coronary occlusion following transcatheter aortic valve replacement: A systematic review.

BACKGROUND: Coronary occlusion (CO) is a rare but serious complication following transcatheter aortic valve replacement (TAVR) with limited published data. We sought to evaluate the immediate and short-term outcomes of CO complicating TAVR. METHODS: Studies, including case reports, case series and original articles published from 2002 to 2016 describing CO following TAVR were identified with a systematic electronic search using the PRISMA Statement. Only studies reporting data on demographic and procedural characteristics, management and follow up outcomes were analyzed. RESULTS: A total of 40 publications describing 96 patients (86 native, 10 bioprosthetic) were identified. Mean age was 83±7years and most (81%) were females. The mean logistic EuroSCORE and STS score was 23.5±14.6% and 9.1±3.2% respectively. TAVR access site was transfemoral in 73% and a balloon expandable valve was used in 78%. Among those with LCA occlusion, the mean LCA ostium height was 10.1±1.8mm while the mean RCA ostium height was 10.4±2.0mm among those with RCA occlusion. CO frequently involved the left main coronary artery (80%) and the most common mechanism was displacement of native valve leaflet (60%), and most cases occurred within 1-hour post-implantation (88%). Percutaneous coronary intervention was attempted in 82 patients and successful in 89%. Procedural death was 10.4%. CO following TAVR in native aortic valve stenosis was associated with a 30-day mortality rate of 35.3%. CONCLUSIONS: CO following TAVR is associated with a high procedural and 30-day mortality rate despite aggressive resuscitative measures including percutaneous coronary intervention.