Background and Aims EUS-guided biliary drainage (EUS-BD) is increasingly used as an alternate therapeutic modality to percutaneous transhepatic biliary drainage (PTBD) for biliary obstruction in ...patients who fail ERCP. We conducted a systematic review and meta-analysis to compare the efficacy and safety of these 2 procedures. Methods We searched several databases from inception to September 4, 2016 to identify comparative studies evaluating the efficacy and safety of EUS-BD and PTBD. Primary outcomes of interest were the differences in technical success and postprocedure adverse events. Secondary outcomes of interest included clinical success, rate of reintervention, length of hospital stay, and cost comparison for these 2 procedures. Odds ratios (ORs) and standard mean difference were calculated for categorical and continuous variables, respectively. These were analyzed using random effects model of meta-analysis. Results Nine studies with 483 patients were included in the final analysis. There was no difference in technical success between 2 procedures (OR, 1.78; 95% CI, .69-4.59; I2 = 22%) but EUS-BD was associated with better clinical success (OR, .45; 95% CI, .23-.89; I2 = 0%), fewer postprocedure adverse events (OR, .23; 95% CI, .12-.47; I2 = 57%), and lower rate of reintervention (OR, .13; 95% CI, .07-.24; I2 = 0%). There was no difference in length of hospital stay after the procedures, with a pooled standard mean difference of –.48 (95% CI, –1.13 to .16), but EUS-BD was more cost-effective, with a pooled standard mean difference of –.63 (95% CI, –1.06 to –.20). However, the latter 2 analyses were limited by considerable heterogeneity. Conclusions When ERCP fails to achieve biliary drainage, EUS-guided interventions may be preferred over PTBD if adequate advanced endoscopy expertise and logistics are available. EUS-BD is associated with significantly better clinical success, lower rate of postprocedure adverse events, and fewer reinterventions.
Energy consumption for sustainable development has become a crucial issue in recent years. The anthropogenic effects of traditional energy sources (non-renewables) underscore the need for renewable ...energy and efforts to promote its adoption have comprised policy makers’ strategies to achieve sustainable development. At the same time, institutional stability is a necessary element needed to meet the goal of sustainable development via improved management of resources and technology diffusion. The literature shows some contradictory findings on this matter and this study aims to clarify. Thus, this research scrutinizes the contribution of renewable and non-renewable energies in sustainable development while also taking into account financial development and institutional quality in ASEAN countries from 1980 to 2018. To assess for co-integration, a pooled mean group (PMG) regression technique is employed and the findings from this technique are verified by using fully modified ordinary least square (FMOLS), dynamic ordinary least square (DOLS), and canonical cointegration regression (CCR) techniques in conjunction with other panel-based econometric procedures to evaluate the robustness of the model. The findings reveal a significantly positive influence for renewable energy and a significantly adverse impact for non-renewable energy with respect to sustainable development in ASEAN countries. In addition, the results indicate that institutional quality and financial development have adverse effects on sustainable development. Therefore, this research recommends sustainable management of non-renewables and greater promotion of renewables by strengthening institutional quality in ASEAN countries.
Diabetic retinopathy (DR) is a worldwide problem associated with the human retina. It leads to minor and major blindness and is more prevalent among adults. Automated screening saves time of medical ...care specialists. In this work, we have used different deep learning (DL) based 3D convolutional neural network (3D-CNN) architectures for binary and multiclass (5 classes) classification of DR. We have considered mild, moderate, no, proliferate, and severe DR categories. We have deployed two artificial data augmentation/enhancement methods: random weak Gaussian blurring and random shift along with their combination to accomplish these tasks in the spatial domain. In the binary classification case, we have found the performance of 3D-CNN architecture trained by deploying combined augmentation methods to be the best, while in the multiclass case, the performance of model trained without augmentation is the best. It is observed that the DL algorithms working with large volumes of data may achieve better performances as compared to the methods working with small volumes of data.
Piperine is a natural alkaloid that possesses a variety of therapeutic properties, including anti-inflammatory, antioxidant, antibacterial, and anticarcinogenic activities. The present study aims to ...assess the medicinal benefits of piperine as an anti-diarrheal agent in a chick model by utilizing in vivo and in silico techniques. For this, castor oil was administered orally to 2-day-old chicks to cause diarrhea. Bismuth subsalicylate (10 mg/kg), loperamide (3 mg/kg), and nifedipine (2.5 mg/kg) were used as positive controls, while the vehicle was utilized as a negative control. Two different doses (25 and 50 mg/kg b.w.) of the test sample (piperine) were administered orally, and the highest dose was tested with standards to investigate the synergistic activity of the test sample. In our findings, piperine prolonged the latent period while reducing the number of diarrheal feces in the experimental chicks during the monitoring period (4 h). At higher doses, piperine appears to reduce diarrheal secretion while increasing latency in chicks. Throughout the combined pharmacotherapy, piperine outperformed bismuth subsalicylate and nifedipine in terms of anti-diarrheal effects with loperamide. In molecular docking, piperine exhibited higher binding affinities towards different inflammatory enzymes such as cyclooxygenase 1 (-7.9 kcal/mol), cyclooxygenase 2 (-8.4 kcal/mol), nitric oxide synthases (-8.9 kcal/mol), and L-type calcium channel (-8.8 kcal/mol), indicating better interaction of PP with these proteins. In conclusion, piperine showed a potent anti-diarrheal effect in castor oil-induced diarrheal chicks by suppressing the inflammation and calcium ion influx induced by castor oil.
Plants are a major source of food for the world population. Plant diseases contribute to production loss, which can be tackled with continuous monitoring. Manual plant disease monitoring is both ...laborious and error-prone. Early detection of plant diseases using computer vision and artificial intelligence (AI) can help to reduce the adverse effects of diseases and also overcome the shortcomings of continuous human monitoring. In this work, we propose the use of a deep learning architecture based on a recent convolutional neural network called EfficientNet on 18,161 plain and segmented tomato leaf images to classify tomato diseases. The performance of two segmentation models i.e., U-net and Modified U-net, for the segmentation of leaves is reported. The comparative performance of the models for binary classification (healthy and unhealthy leaves), six-class classification (healthy and various groups of diseased leaves), and ten-class classification (healthy and various types of unhealthy leaves) are also reported. The modified U-net segmentation model showed accuracy, IoU, and Dice score of 98.66%, 98.5%, and 98.73%, respectively, for the segmentation of leaf images. EfficientNet-B7 showed superior performance for the binary classification and six-class classification using segmented images with an accuracy of 99.95% and 99.12%, respectively. Finally, EfficientNet-B4 achieved an accuracy of 99.89% for ten-class classification using segmented images. It can be concluded that all the architectures performed better in classifying the diseases when trained with deeper networks on segmented images. The performance of each of the experimental studies reported in this work outperforms the existing literature.
The calamity of the COVID-19 pandemic during the early half of 2020 not only caused a huge physical and economic loss but altered the social behavior of the whole world. The social and economic ...stagnation imposed in many countries and served as a major cause of perturbation in atmospheric composition. This paper utilized the relation between atmospheric composition and surface radiation and analyzed the impact of global COVID-19 lockdown on land surface solar and thermal radiation. Top of atmosphere (TOA) and surface radiation are obtained from the Clouds and Earth's Radiant Energy System (CERES) and European Reanalysis product (ERA5) reanalysis product. Aerosol Optical Depth (AOD) is obtained from Moderate Resolution Imaging Spectroradiometer (MODIS) while Nitrogen dioxide (NO2), and sulfur dioxide (SO2) are obtained from Ozone Monitoring Instrument (OMI). Observations of all mentioned parameters are studied for the global lockdown period of 2020 (from January to July) and compared with the corresponding months of the previous four years (2016–19) observations. Regarding surface radiation, April 2020 is the most affected month during the pandemic in which 0.2% increased net solar radiation (NSR), while 3.45% and 4.8% decreased net thermal radiation (NTR) and net radiation (NR) respectively was observed. Average radiative forcing during March–May 2020 was observed as 1.09 Wm−2, −2.19 Wm−2 and −1.09 Wm−2 for NSR, NTR and NR, respectively. AOD was reduced by 0.2% in May 2020 while NO2 and SO2 were reduced by 5.4% and 8.8%, respectively, in April 2020. It was observed that NO2 kept on reducing since January 2020 while SO2 kept on reducing since February 2020 which were the pre-lockdown months. These results suggest that a more sophisticated analysis is needed to explain the atmosphere-radiation relation.
•The impact of COVID-19 global lockdown on AOD, NO2 and SO2 and surface radiation is studied using remote sensing data.•Net solar radiations were increased while net thermal radiations and net radiations were reduced during the lockdown.•Reductions in all observed air pollutants were observed but NO2 showed an early decrease even before the lockdown period.•No perturbation in shortwave and longwave radiations was observed at top of the atmosphere.
Background and Aims The efficacy and safety of endoscopic gallbladder drainage (EGBD) performed via endoscopic retrograde cholangiography (ERC)-based transpapillary stenting or EUS-based transmural ...stenting are unknown. We aimed to conduct a proportion meta-analysis to evaluate the cumulative efficacy and safety of these procedures and to compare them with percutaneous gallbladder drainage (PGBD). Methods We searched several databases from inception through December 10, 2015 to identify studies (with 10 or more patients) reporting technical success and postprocedure adverse events of EGBD. Weighted pooled rates (WPRs) for technical and clinical success, postprocedure adverse events, and recurrent cholecystitis were calculated for both methods of EGBD. Pooled odds ratios (ORs) were also calculated to compare the technical success and postprocedure adverse events in patients undergoing EGBD versus PGBD. Results The WPRs with 95% confidence intervals (CIs) of technical success, clinical success, postprocedure adverse events, and recurrent cholecystitis for ERC-based transpapillary drainage were 83% (95% CI, 78%-87%; I2 = 38%), 93% (95% CI, 89%-96%; I2 = 39%), 10% (95% CI, 7%-13%; I2 = 27%), and 3% (95% CI, 1%-5%; I2 = 0%), respectively. The WPRs for EUS-based drainage for technical success, clinical success, postprocedure adverse events, and recurrent cholecystitis were 93% (95% CI, 87%-96%; I2 = 0%), 97% (95% CI, 93%-99%; I2 = 0%), 13% (95% CI, 8%-19%; I2 = 0%), and 4% (95% CI, 2%-9%; I2 = 0%), respectively. On proportionate difference, EUS-based drainage had better technical (10%) and clinical success (4%) in comparison with ERC-based drainage. The pooled OR for technical success of EGBD versus PGBD was .51 (95% CI, .09-2.88; I2 = 23%) and for postprocedure adverse events was .33 (95% CI, .14-.80; I2 = 16%) in favor of EGBD. Conclusions EGBD is an efficacious and safe therapeutic modality for treatment of patients with acute cholecystitis who cannot undergo surgery. EGBD shows a similar technical success as PGBD but appears to be safer than PGBD.
SARS-CoV-2 infections, commonly referred to as COVID-19, remain a critical risk to both human life and global economies. Particularly, COVID-19 patients with weak immunity may suffer from different ...complications due to the bacterial co-infections/super-infections/secondary infections. Therefore, different variants of alternative antibacterial therapeutic agents are required to inhibit those infection-causing drug-resistant pathogenic bacteria. This study attempted to explore these bacterial pathogens and their inhibitors by using integrated statistical and bioinformatics approaches. By analyzing bacterial 16S rRNA sequence profiles, at first, we detected five bacterial genera and taxa (
,
,
,
and
based on differentially abundant bacteria between SARS-CoV-2 infection and control samples that are significantly enriched in 23 metabolic pathways. A total of 183 bacterial genes were found in the enriched pathways. Then, the top-ranked 10 bacterial genes (
,
,
,
,
,
,
,
,
, and
) were selected as the pathogenic bacterial key genes (bKGs) by their protein-protein interaction (PPI) network analysis. Then, we detected bKG-guided top-ranked eight drug molecules (Bemcentinib, Ledipasvir, Velpatasvir, Tirilazad, Acetyldigitoxin, Entreatinib, Digitoxin, and Elbasvir) by molecular docking. Finally, the binding stability of the top-ranked three drug molecules (Bemcentinib, Ledipasvir, and Velpatasvir) against three receptors (
,
and
) was investigated by computing their binding free energies with molecular dynamic (MD) simulation-based MM-PBSA techniques, respectively, and was found to be stable. Therefore, the findings of this study could be useful resources for developing a proper treatment plan against bacterial co-/super-/secondary-infection in SARS-CoV-2 infections.
We report on the fabrication and study of bulk heterojunction (BHJ) solar cells based on a novel combination of a donor–acceptor ...poly(9,9-dioctylfluorenyl-2,7-diyl)-co-(N,N0-diphenyl)-N,N′di(p-butyl-oxy-pheyl)-1,4-diamino-benzene) (PFB) and 6, 6-phenyl-C61-butyric acid methyl ester (PCBM) blend composed of 1:1 by volume. indium tin oxide (ITO)/poly(3,4-ethylenedioxythiophene):poly(styrene sulfonate (PEDOT:PSS)/PFB–PCBM/Ag BHJ solar cells are fabricated by a facile cost-effective spin-coating technique. The thickness of the active film (PFB–PCBM) plays an important role in the efficiency of light absorption, exciton creation, and dissociation into free charges that results in higher power conversion efficiency (PCE). In order to optimize the PCE as a function of active layer thickness, a number of solar cells are fabricated with different thicknesses of PFB–PCBM films at 120, 140, 160, 180, and 200 nm, and their photovoltaic characteristics are investigated. It is observed that the device with a 180 nm thick film demonstrates a maximum PCE of 2.9% with a fill factor (FF) of 53% under standard testing conditions (STC) (25 °C, 1.5 AM global, and 100 mW/cm2). The current–voltage (I-V) properties of the ITO/PEDOT:PSS/PFB–PCBM/Ag BHJ devices are also measured in dark conditions to measure and understand different parameters of the heterojunction. Atomic force microscopy (AFM) and ultraviolet-visible (UV-vis) absorption spectroscopy for the PFB–PCBM film of optimal thickness (180 nm) are carried out to understand the effect of surface morphology on the PCE and bandgap of the blend, respectively. The AFM micrographs show a slightly non-uniform and rough surface with an average surface roughness (Ra) of 29.2 nm. The UV-vis measurements of the PFB–PCBM blend exhibit a reduced optical bandgap of ≈2.34 eV as compared to that of pristine PFB (2.88 eV), which results in an improved absorption of light and excitons generation. The obtained results for the ITO/PEDOT:PSS/PFB–PCBM (180 nm)/Ag BHJ device are compared with the ones previously reported for the P3HT–PCBM blend with the same film thickness. It is observed that the PFB–PCBM-based BHJ device has shown two times higher open circuit voltage (Voc) and, hence, enhanced the efficiency.
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