Does the revised cardiac risk index predict cardiac complications following elective lung resection?

Background: Revised Cardiac Risk Index (RCRI) score and Thoracic Revised Cardiac Risk Index (ThRCRI) score were developed to predict the risks of postoperative major cardiac complications in generic surgical population and thoracic surgery respectively. This study aims to determine the accuracy of these scores in predicting the risk of developing cardiac complications including atrial arrhythmias after lung resection surgery in adults. Methods: We studied 703 patients undergoing lung resection surgery in a tertiary thoracic surgery centre. Observed outcome measures of postoperative cardiac morbidity and mortality were compared against those predicted by risk. Results: Postoperative major cardiac complications and supraventricular arrhythmias occurred in 4.8% of patients. Both index scores had poor discriminative ability for predicting postoperative cardiac complications with an area under receiver operating characteristic (ROC) curve of 0.59 (95% CI 0.51-0.67) for the RCRI score and 0.57 (95% CI 0.49-0.66) for the ThRCRI score. Conclusions: In our cohort, RCRI and ThRCRI scores failed to accurately predict the risk of cardiac complications in patients undergoing elective resection of lung cancer. The British Thoracic Society (BTS) recommendation to seek a cardiology referral for all asymptomatic pre-operative lung resection patients with > 3 RCRI risk factors is thus unlikely to be of clinical benefit

Effect of Temperature and Strain rate on Flow behavior of Al0.3CoCrFeNi HEA

High-entropy alloys (HEAs) are currently attracting much interest because they offer unique properties and good ductility at low temperatures. These materials are of interest primarily because they contain five or more principal elements, with each element having a concentration between 5 and 35 at. %, and yet they have very simple structures based on solid solution phases. Super plasticity is major concern for forming industries to fabricate complex and curves components, to use in automotive, aerospace and other application. In addition to that, the materials used in automobile and other structural applications often encountered with shock loadings. Recent experiments have shown that the HEAs also have a potential for exhibiting superplastic property when testing at elevated temperatures. Since super-plasticity requires a very small grain size, typically < 10 μm, it is feasible to introduce significant grain refinement by thermomechanical processing. The main aim of this work is to develop Al0.3CoCrFeNi high entropy alloy with very fine equi-axed stable grain microstructure using proper thermomechanical treatment. Study the deformation behavior both at room and high temperature. Explore the possibility of super plasticity. Further, study the effect of temperature and strain rate on the deformation behavior

Chest wall mechanics before and after diaphragm plication

Background: Following diaphragmatic plication for unilateral paralysis, the effect on global chest wall function are unknown. Our hypothesis was that chest wall function would improve in both sides of the chest after plication of the paralysed side. Case Presentation: Using Optoelectronic Plethysmography, total and regional chest wall volumes were measured in one patient before and after left diaphragmatic plication. Volumes were recorded at quiet breathing. Respiratory capacity improved during quiet breathing when measured before and 6 months after surgery. These improvements occur at the abdominal-rib cage level in both operated and contralateral. Prior to surgery the abdominal rib cage motion was out of phase to the upper rib cage and abdominal compartment in both sides of the chest. Synchrony of all three compartments was restored after plication. Conclusion: This physiological study is the first published data in humans to show improvement in chest wall motion both in operated and contralateral side following diaphragmatic plication for unilateral paralysis

Buck-boost single-stage microinverter for building integrated photovoltaic systems

Microinverters for Building Integrated Photovoltaic (BIPV) systems must have had a small number of components, be efficient, and be reliable. In this context, a single-phase Buck-Boost Single-stage Microinverter (BBSM) for grid-connected BIPV systems is presented. The concept of topology is extracted from the buck-boost converter. The leakage current in the system is kept under control. It uses an optimal number of active and passive components to function at a high-efficiency level. The suggested topology provides a high level of reliability due to the absence of shoot-through problems. To validate the findings, a simulation in combination with an experimental system for a 70 W system is developed with the design approach. The efficiency of the microinverter, total harmonic distortion of the grid current are measured as 96.4% and 4.09% respectively. Finally, a comparison study has indicated the advantages and disadvantages of the suggested inverter

Video-assisted thoracoscopic lobectomy: which patients require postoperative physiotherapy?

Objectives: Following major thoracic surgery physiotherapy is recommended to improve reduced lung volume, aid secretion clearance, and improve mobility, however, in many centres physiotherapy provision is variable following minimally invasive video-assisted thoracoscopic surgery (VATS). The objective of this study was to observe frequency of problems potentially amenable to physiotherapy following VATS lobectomy, and to identify associated baseline factors of patients in whom physiotherapy may be beneficial. Methods: A prospective observational study was performed including all consecutive cancer patients undergoing VATS lobectomy in a regional centre over 4 years (2012–2016). Standard postoperative care included early mobilisation by nursing staff from postoperative day one (POD1). Physiotherapy assessment of all patients on POD1 determined presence of issues potentially amenable to physiotherapy intervention, and treatment was commenced. Outcome measures included postoperative pulmonary complication (PPC) development, hospital and high dependency unit (HDU) length of stay (LOS). Results: Of 285 patients, 209 (73%) received physiotherapy to assist/improve reduced mobility, of these 23 (8%) also received sputum clearance therapies and 65 (23%) specific therapy for lung volume loss. The remaining 76 (27%) patients had significantly lower hospital/HDU LOS (P &lt; 0.001) reflecting uncomplicated recovery. Chronic obstructive pulmonary disease (COPD), body mass index (BMI), preoperative mobility and age were independently associated with issues potentially amenable to physiotherapy (P = 0.013). Conclusion: Following VATS lobectomy a large proportion of patients demonstrated issues potentially amenable to physiotherapy. The authors recommend that patients receive routine physiotherapy assessment following this type of surgery to ensure that all issues are identified early. Screening of COPD, BMI, preoperative mobility and age will allow early identification of patients who may benefit most from postoperative physiotherapy and preoperative optimisation, however, these factors cannot predict the need for physiotherapy

Kimura’s Disease As Diagnostic Dilemma

Kimura’s disease is a chronic inflammatory disease of unknown aetiology. The classical triad includes painless subcutaneous mass in head and neck, eosinophilia and elevated serum immunoglobulin levels. Kimura’s disease is rare, besides can produce a diagnostic confusion as seen in our case deviating from its triad of presentation described in literature. A 14 year male child came with painless swelling over right post auricular region since 6 months. He had surgical excision for similar swelling at same site one year back. Complete surgical excision was done and sent for histopathology, which was reported, Kimura’s disease. After 3 years of follow up there was no recurrence. Our case showed Kimura’s disease can present with normal eosinophil count and serum immunoglobulin levels and histopathology alone is confirmatory. We also suggest surgery is the treatment of choice for Kimura’s disease either in primary or recurrence

Intelligent Energy Management across Smart Grids Deploying 6G IoT, AI, and Blockchain in Sustainable Smart Cities

© 2024 The Author(s). Licensee MDPI, Basel, Switzerland. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/In response to the growing need for enhanced energy management in smart grids in sustainable smart cities, this study addresses the critical need for grid stability and efficient integration of renewable energy sources, utilizing advanced technologies like 6G IoT, AI, and blockchain. By deploying a suite of machine learning models like decision trees, XGBoost, support vector machines, and optimally tuned artificial neural networks, grid load fluctuations are predicted, especially during peak demand periods, to prevent overloads and ensure consistent power delivery. Additionally, long short-term memory recurrent neural networks analyze weather data to forecast solar energy production accurately, enabling better energy consumption planning. For microgrid management within individual buildings or clusters, deep Q reinforcement learning dynamically manages and optimizes photovoltaic energy usage, enhancing overall efficiency. The integration of a sophisticated visualization dashboard provides real-time updates and facilitates strategic planning by making complex data accessible. Lastly, the use of blockchain technology in verifying energy consumption readings and transactions promotes transparency and trust, which is crucial for the broader adoption of renewable resources. The combined approach not only stabilizes grid operations but also fosters the reliability and sustainability of energy systems, supporting a more robust adoption of renewable energies.Peer reviewe

Acute Effects of Two Angiotensin Receptor Blockers on Vascular Hemodynamics, Arterial Stiffness, and Oxidative Stress in Patients with Mild to Moderate Hypertension: An Open Label Parallel Group Study

Introduction. We studied the acute effects of Olmesartan and Telmisartan at baseline and at the end of four weeks on indices of hemodynamics (heart rate HR, blood pressure BP), vascular (carotid femoral pulse wave velocity cf PWV, digital arterial tone expressed as Reflection index RI, and endothelial dependent vasodilator response EDVR), and oxidative stress (serum Malondialdehyde MDA) in hypertensive patients. Materials and Methods. The eligible patients were randomly allocated to either 20 mg Olmesartan or 40 mg Telmisartan. Results. 40 subjects received Olmesartan, and 29 received Telmisartan. After four weeks of treatment the mean changes from baseline in the Olmesartan group versus Telmisartan group are SBP -9.8±10 versus -6.3±12 mm Hg, P=0.24; DBP -6.1±11 versus -4.2±12.5 mm Hg, P=0.55; cf PWV -1.6±1.2 versus -0.9±1.4 m/s, P=0.04; EDVR -8.2±5.2 versus -5.2±5.7%, P=0.04; and MDA -1.9±1.1 versus -1.2±1.2 ηMol/mL, P=0.03. Conclusion. Olmesartan showed a better improvement in cf PWV, EDVR, and MDA than Telmisartan with an identical reduction in blood pressure.</jats:p

Allele-Specific HLA Loss and Immune Escape in Lung Cancer Evolution

Immune evasion is a hallmark of cancer. Losing the ability to present neoantigens through human leukocyte antigen (HLA) loss may facilitate immune evasion. However, the polymorphic nature of the locus has precluded accurate HLA copy-number analysis. Here, we present loss of heterozygosity in human leukocyte antigen (LOHHLA), a computational tool to determine HLA allele-specific copy number from sequencing data. Using LOHHLA, we find that HLA LOH occurs in 40% of non-small-cell lung cancers (NSCLCs) and is associated with a high subclonal neoantigen burden, APOBEC-mediated mutagenesis, upregulation of cytolytic activity, and PD-L1 positivity. The focal nature of HLA LOH alterations, their subclonal frequencies, enrichment in metastatic sites, and occurrence as parallel events suggests that HLA LOH is an immune escape mechanism that is subject to strong microenvironmental selection pressures later in tumor evolution. Characterizing HLA LOH with LOHHLA refines neoantigen prediction and may have implications for our understanding of resistance mechanisms and immunotherapeutic approaches targeting neoantigens. Video Abstract [Figure presented] Development of the bioinformatics tool LOHHLA allows precise measurement of allele-specific HLA copy number, improves the accuracy in neoantigen prediction, and uncovers insights into how immune escape contributes to tumor evolution in non-small-cell lung cancer

The Detection of Dysarthria Severity Levels Using AI Models: A Review

Dysarthria, a speech disorder stemming from neurological conditions, affects communication and life quality. Precise classification and severity assessment are pivotal for therapy but are often subjective in traditional speech-language pathologist evaluations. Machine learning models offer objective assessment potential, enhancing diagnostic precision. This systematic review aims to comprehensively analyze current methodologies for classifying dysarthria based on severity levels, highlighting effective features for automatic classification and optimal AI techniques. We systematically reviewed the literature on the automatic classification of dysarthria severity levels. Sources of information will include electronic databases and grey literature. Selection criteria will be established based on relevance to the research questions. The findings of this systematic review will contribute to the current understanding of dysarthria classification, inform future research, and support the development of improved diagnostic tools. The implications of these findings could be significant in advancing patient care and improving therapeutic outcomes for individuals affected by dysarthria