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0001). HIFU group tumor metastasis (27%) was lower than resected (33%) and control (67%) group metastasis. Ultrasound imaging, gross pathology and histology results supported these outcomes. HIFU procedures had no complications. Rabbit liver tumor ablation using a toroidal HIFU transducer under ultrasound imaging guidance might therefore be an effective intra-operative treatment for localized liver metastases.Innate immune cells can adopt long-term inflammatory phenotypes following brief encounters with exogenous (microbial) or endogenous stimuli. This phenomenon is named trained immunity and can improve host defense against (recurrent) infections. In contrast, trained immunity can also be maladaptive in the context of chronic inflammatory disorders, such as atherosclerosis. Key to future therapeutic exploitation of this mechanism is thorough knowledge of the mechanisms driving trained immunity, which can be used as pharmacological targets. AUNP-12 nmr These mechanisms include profound changes in intracellular metabolism, which are closely intertwined with epigenetic reprogramming at the level of histone modifications. Glycolysis, glutamine replenishment of the tricarboxylic acid cycle with accumulation of fumarate, and the mevalonate pathway have all been identified as critical pathways for trained immunity in monocytes and macrophages. In this review, we provide a state-of-the-art overview of how these metabolic pathways interact with epigenetic programs to develop trained immunity.
To examine prescription opioid claims among individuals with traumatic spinal cord injury (SCI) and to identify factors associated with both chronic opioid and chronic high-dose opioid use.
Retrospective cohort study using population-level administrative data.
Ontario, Canada.
Individuals (N=1842) with traumatic SCI between April 1, 2004 and March 31,2015.
Not applicable.
Proportion of cohort with chronic opioid use (≥90d supply) and proportion with chronic high-dose opioid use (≥90d supply exceeding 90 mg morphine equivalent) between April 1, 2016 and March 31, 2017 (observation period).
A total of 1842 individuals with traumatic SCI were identified (74% men), with a median age of 51 years (interquartile range [IQR], 34-64y) and median duration of injury of 6 years (IQR, 4-9y). During the observation period, 35% were dispensed at least 1 opioid and 19.8% received chronic opioids, 39% of whom received more than 90 mg daily (chronic high dose). The median daily morphine equivalent dose was 212 mged by the Canadian opioid guideline. Further research is needed to understand the risk factors associated with chronic, high-dose opioid use in this population.To optimize the operation and maintenance of nuclear power systems, this study presents a remaining useful life (RUL) prediction method for electric valves by combining convolutional auto-encoder (CAE) and long short term memory (LSTM). CAE can extract deeper features and LSTM is efficient in dealing with time-series data. Moreover, by designing a parallel structure between the outputs of CAE and the original data, features fed into the LSTM are enriched. Also, network structure and corresponding hyper-parameters are compared to obtain a more suitable model. Moreover, the accuracy of the proposed method is tested and compared with other machine learning algorithms. This work also serves as a critical innovation to enhance the safety and economic operation of nuclear plants and other complex systems.This paper investigates the observer-based output feedback control problem for cyber-physical systems against randomly occurring packet dropout and periodic Denial-of-Service (DoS) attacks. Two independent Bernoulli distribution are employed to model the randomly occurring packet dropout and periodic DoS attacks such that the considered system can be viewed as a stochastic system. Then, by stochastic analysis method, it proves that the closed-loop systems are still stochastically stable and satisfy a specified H∞ performance. The relationship between the disturbance rejection capacity and the success rate of a DoS attacker is also analyzed. Moreover, some novel inequalities and auxiliary matrices are adopted to remove the restrictive conditions on input matrix B and the diagonal structure of Lyapunov function. Finally, three examples are utilized to show the applicability of the proposed method.As unmanned aerial vehicles (UAVs) use global navigation satellite systems for positioning, the openness and weak security of satellite navigation signals make these systems easily falsifiable. By leveraging these characteristics, we propose a path following identification algorithm to gain control of UAVs using navigation spoofing as a countermeasure against illegal activities. Our contribution is threefold. First, we redefine the UAV kinematics model by treating the spoofing signal as wind. Subsequently, the relation between the spoofing signal and UAV heading angle is identified based on a path following algorithm, and the relation accuracy is experimentally verified. Finally, we propose the spoofing sparse A* search (SSAS) algorithm, whose effectiveness is verified by simulations of a UAV directed to a designated area while avoiding obstacles and forbidden areas.
Dyslipidemia is an important risk factor for cardiovascular disease (CVD). Statins are known to effectively reduce not only low-density lipoprotein cholesterol (LDL-C) level but also death and nonfatal myocardial infarction due to coronary heart disease. The risk for CVD from atherogenic dyslipidemia persists when elevated triglyceride (TG) and reduced high-density lipoprotein cholesterol (HDL-C) levels are not controlled with statin therapy. Therefore, statin/fenofibrate combination therapy is more effective in reducing CVD risk. Here, we assessed the efficacy and tolerability of pitavastatin/fenofibrate combination therapy in patients with mixed dyslipidemia and a high risk for CVD.
This multicenter, randomized, double-blind, parallel-group, therapeutic-confirmatory clinical trial evaluated the efficacy and tolerability of fixed-dose combination therapy with pitavastatin/fenofibrate 2/160mg in Korean patients with a high risk for CVD and a controlled LDL-C level (<100mg/dL) and a TG level of 150-500mofibrate was associated with a greater reduction in non-HDL-C compared with that with pitavastatin monotherapy, and a significantly improvement in other lipid levels. Moreover, the combination therapy was well tolerated, with a safety profile similar to that of statin monotherapy. Therefore, pitavastatin/fenofibrate combination therapy could be effective and well tolerated in patients with mixed dyslipidemia. ClinicalTrials.gov identifier NCT03618797.
There is a shortage of supplies for the protection of professionals during the COVID-19 pandemic. 3D printing offers the possibility to compensate for the production of some of the equipment needed. The objective is to describe the role of 3D printing in a health service during the COVID-19 pandemic, with an emphasis on the process to develop a final product ready to be implemented in the clinical environment.
A working group was formed between the healthcare administration, clinicians and other public and private institutions in Cantabria, Spain coordinated by the Valdecilla Virtual Hospital. The process included receiving the printing proposals, learning about the printing resources in the region, selecting the devices, creating a team for each project, prototyping, evaluation and redesign, manufacturing, assembly and distribution.
The following supplies are produced 1) devices that help protect providers face protection screens (2,400 units), personalized accessories for photophores (20 units) and ear-protection forks for face-masks (1,200 units); 2) products related to the ventilation of infected patients connectors for non-invasive ventilation systems; and 3) oral and nasopharyngeal swabs (7,500 units) for the identification of coronavirus carriers with the aim of designing action protocols in clinical areas.
3D printing is a valid resource for the production of protective material for professionals whose supply is reduced during a pandemic.
3D printing is a valid resource for the production of protective material for professionals whose supply is reduced during a pandemic.
A threshold Clinical Frailty Scale (CFS) of 5 (indicating mild frailty) has been proposed to guide ICU admission for UK patients with coronavirus disease 2019 (COVID-19) pneumonia. However, the impact of frailty on mortality with (non-COVID-19) pneumonia in critical illness is unknown. We examined the triage utility of the CFS in patients with pneumonia requiring ICU.
We conducted a retrospective cohort study of adult patients admitted with pneumonia to 170 ICUs in Australia and New Zealand from January 1, 2018 to September 31, 2019. We classified patients as non-frail (CFS 1-4) frail (CFS 5-8), mild/moderately frail (CFS 5-6),and severe/very severely frail (CFS 7-8). We evaluated mortality (primary outcome) adjusting for site, age, sex, mechanical ventilation, pneumonia type and illness severity. We also compared the proportion of ICU bed-days occupied between frailty categories.
1852/5607 (33%) patients were classified as frail, including1291/3056 (42%) of patients aged >65 yr, who would potentiallate frailty categories. These data do not support CFS ≥5 to guide ICU admission for pneumonia.
Existing genetic information can be leveraged to identify patients with susceptibilities to conditions that might impact their perioperative care, but clinicians generally have limited exposure and are not trained to contextualise this information. We identified patients with genetic susceptibilities to anaesthetic complications using a perioperative biorepository and characterised the concordance with existing diagnoses.
Adult patients undergoing surgery within Michigan Medicine from 2012 to 2017 were consented for genotyping. Genotypes were integrated with the electronic health record (EHR). We retrospectively characterised frequencies of variants associated with butyrylcholinesterase deficiency, factor V Leiden, and malignant hyperthermia, three pharmacogenetic factors with perioperative implications. We calculated the percentage homozygous and heterozygous for each that had been diagnosed previously and searched for EHR findings consistent with a predisposition.
Analysis of genetic data revealed thalinician use. We validated this application in a retrospective analysis for three conditions with well-characterised inheritance, and showed that not all genetic susceptibilities were documented in the EHR.
To assess the discrepancy rates (DR) for patients undergoing abdominopelvic computed tomography (CT) for acute non-traumatic abdominal pain who have a subsequent emergency laparotomy in a large university teaching hospital, in particular identifying the differences between subgroups of reporters, to assess factors that may influence the discrepancy rates, to examine the pathologies with the highest discrepancy rate, to identify learning points, and give recommendations on current practice.
The surgical data and CT reports of 1,176 patients who underwent urgent laparotomy after CT from 2014-2018 in a large university hospital were analysed retrospectively. A major discrepancy was defined as an error of fact in the radiology report, which led to incorrect management or patient harm.
Registrars have higher DR than consultants (6.86% versus 2.77%). The major DR for consultants met national standards (<5%). The major DRs for registrars met the national audit standard (<10%), but not the National Emergency Laparotomy Audit (NELA) standard (<5%).