Intraoperative cardiopulmonary variables are well-known predictors of postoperative pulmonary complications (PPC), traditionally quantified by median values over the duration of surgery. However, it ...is unknown whether cardiopulmonary instability, or wider intra-operative variability of the same metrics, is distinctly associated with PPC risk and severity. We leveraged a retrospective cohort of adults (
n
= 1202) undergoing major non-cardiothoracic surgery. We used multivariable logistic regression to evaluate the association of two outcomes (1)moderate-or-severe PPC and (2)any PPC with two sets of exposure variables- (a)variability of cardiopulmonary metrics (inter-quartile range, IQR) and (b)median intraoperative cardiopulmonary metrics. We compared predictive ability (receiver operating curve analysis, ROC) and parsimony (information criteria) of three models evaluating different aspects of the intra-operative cardiopulmonary metrics:
Median-based:
Median cardiopulmonary metrics alone,
Variability-based:
IQR of cardiopulmonary metrics alone, and
Combined:
Medians and IQR. Models controlled for peri-operative/surgical factors, demographics, and comorbidities. PPC occurred in 400(33%) of patients, and 91(8%) experienced moderate-or-severe PPC. Variability in multiple intra-operative cardiopulmonary metrics was independently associated with risk of moderate-or-severe, but not any, PPC. For moderate-or-severe PPC, the best-fit predictive model was the Variability-based model by both information criteria and ROC analysis (area under the curve, AUC
Variability-based
= 0.74 vs AUC
Median-based
= 0.65,
p
= 0.0015; AUC
Variability-based
= 0.74 vs AUC
Combined
= 0.68,
p
= 0.012). For any PPC, the Median-based model yielded the best fit by information criteria. Predictive accuracy was marginally but not significantly higher for the Combined model (AUC
Combined
= 0.661) than for the Median-based (AUC
Median-based
= 0.657,
p
=
0.60) or Variability-based (AUC
Variability-based
= 0.649,
p
=
0.29) models. Variability of cardiopulmonary metrics, distinct from median intra-operative values, is an important predictor of moderate-or-severe PPC.
The nanostructured Bi-doped CdO thin films were prepared using sol–gel spin coating method. The morphology and optical properties were investigated using atomic force microscopy (AFM) and UV visible ...spectroscopy. The AFM results indicate that the CdO films are formed from the nanoparticles and the grain size of the films is changed with bismuth doping level. The optical band gap values of undoped and Bi-doped CdO films were determined by optical absorption method. The band gap value of undoped CdO film was found to be 2.589eV, on the other hand, the band gap values of Bi-doped CdO films were found to be in the range of 2.657–2.684eV. The band gap value of the CdO films is increased with the content of Bi dopant. It is evaluated that the optical band gap and grain size of the CdO film could be controlled by Bi-doping.
► Nanostructured Bi-doped CdO films were fabricated using sol–gel spin coating technique. ► The band gap of the CdO film was found to increase by Bi-doping. ► The observed increase in the band gap is explained on the basis of quantum size effects.
Flow cytometric (FCM) immunophenotyping is an important tool for generating diagnostic and prognostic information in plasma cell dyscrasias. This study aimed to evaluate the immunophenotype and ...ploidy status of plasma cells (PCs) in patients of myeloma and its correlation with other laboratory parameters. Bone marrow of 70 newly diagnosed cases of myeloma were subjected to FCM using a panel of antibodies; CD138, CD38, CD19, CD45, CD28, CD81, CD56, CD200, and CD229. FxCycle Violet (FCV) dye was used for the ploidy analysis of clonal PCs. Median age was 60 years with M:F ratio of 3.2:1. A positive correlation was noted between the morphological and FCM-based PC enumeration (r = 0.4,
p
= 0.001). Aberrant expression of CD56, CD200, CD28, CD117, CD81 and CD19 and was observed in 88.5%, 77%, 29%, 37%, 23% and 17% cases respectively. Two aberrant antigens were noted in all cases. CD81 + cases had a relatively higher quantity of monoclonal-protein (> 1 g/dl,
p
< 0.05) and renal insufficiency (Cr > 2 mg/dl,
p
< 0.05) as compared to the CD81- cases. CD229 was expressed in all the cases, with a median MFI in PCs significantly higher than other hematopoietic elements. Hyperdiploid PCs (median DI-1.59, range, 1.16–2.6) were noted in 80% cases (n = 48), diploid/ near-hyperdiploid PCs in 8% (n = 5) cases and hypodiploidy in 3% (n = 1) cases. Bright CD56/CD200 and CD45- can identify abnormal PC in the majority of the cases. CD81 appears to correlate with disease burden and might be useful as a prognostic marker. CD229 is a reliable gating marker for plasma cells. Ploidy analysis may be incorporated in routine workup to guide in the identification of patients with poor prognosis.
In vitro transdermal permeation of 5-fluorouracil (antineoplastic), a hydrophilic drug encapsulated in AOT/water/isopropylmyristate water-in-oil microemulsions (MEs), were studied using a modified ...Keshary and Chien diffusion cell. AOT (aerosol-OT or sodium bis(2-ethylhexyl) sulfosuccinate) is an anionic surfactant, which forms ‘water-in-oil’ ME in non-aqueous medium. The effect of water and AOT concentrations in MEs to the transdermal permeation of 5-fluorouracil through hairless mouse skin was investigated. MEs with 5:95 weight ratio of AOT:isopropylmyristate, containing 0.9, 1.8, 2.7 and 3.6% w/w of water have showed 1.68-, 2.36-, 3.58- and 3.77-fold increases in the skin flux of 5-fluorouracil (5-FU) respectively, compared to the aqueous solution of drug. The MEs with 5:95, 9:91 and 13:87 weight ratio of AOT:isopropyl myristate at fixed water content
W
0
=
15 (
W
0
=
H
2O/AOT) gave 3.58-, 5.04- and 6.3-fold enhancement of drug. In addition, attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy was used to examine the effect of ME on lipid alkyl chain, hydration level, and corneocyte cells of the stratum corneum (SC). Results reveal that the ME interacts with a component of the SC and perturbs its architectural structure. The extent of perturbation in the SC depends on the concentration of water and AOT in the ME. Preliminary dermal toxicity studies indicate that the AOT/water/isopropylmyristate ME be safe for the transdermal permeation of 5-FU.
The corrosion, microstructure, and hardness of nanocrystalline AA5083 were compared to that of conventional AA5083-H116 and consolidated gas atomized powder. The nanocrystalline AA5083 was produced ...by consolidating high-energy ball milled gas atomized powder with two methods: cold compaction and spark plasma sintering. Electrochemical impedance spectroscopy, cyclic potentiodynamic polarization, Mott-Schottky analysis, and immersion tests followed by surface analysis were used to evaluate the corrosion behavior in 0.6 M NaCl solution. Pitting corrosion resistance of the nanocrystalline AA5083 was superior to that of commercial AA5083-H116. The improved corrosion resistance was primarily attributed to the homogenous microstructure and significant grain refinement below 100 nm.
•Ball milling AA5083 caused nanocrystalline structure and homogenous microstructure.•Spark plasms sintering was effective in consolidation.•Simultaneous improvement in corrosion resistance and hardness by ball milling.•Improved passive film characteristics and corrosion resistance by ball milling.
Joining of dissimilar materials is always a global challenge. Sometimes it is unavoidable to execute multifarious activities by a single component. In the present investigation, 6061 aluminum alloy ...and 304 stainless steel were joined by friction stir welding (FSW) at different tool rotational rates. Welded joints were characterized in optical and scanning electron microscopes. Reaction products in the stirring zone (SZ) were confirmed through X-ray diffraction. Joint strength was evaluated by tensile testing. It was found that the increment in average heat input and temperature at the weld nugget (WN) facilitated iron enrichment near the interface. Enhancement in the concentration of iron shifted the nature of intermetallics from the Fe
2
Al
5
to Fe-rich end of the Fe-Al binary phase diagram. The peak microhardness and ultimate tensile strength were found to be maxima at the intermediate tool rotational rate, where Fe
3
Al and FeAl
2
appeared along with Fe
2
Al
5
.
The impact of human immunodeficiency virus (HIV) infection and CD4 count on the diagnosis of tuberculosis (TB) at population level is incompletely defined.
To determine how HIV infection and CD4 ...count affect disease site, sputum smear status and overall rate of laboratory confirmation (sputum smear microscopy or culture) of TB cases under routine programme conditions.
Retrospective analysis of the 2009 electronic TB register for Cape Town, South Africa.
Of 29,478 TB cases notified in 2009, HIV status was known for 25,744 (87.3%) cases, of whom 13,237 (51.4%) were HIV-positive. Of these, 61.2% had CD4 cell counts of <200 cells/μl and 82.7% had counts of <350 cells/μl. Laboratory confirmation of TB (by smear or culture) was obtained less frequently in HIV-infected than non-HIV-infected adult cases (53.9% vs. 74.3%, P< 0.001). HIV infection was associated with a higher proportion of sputum smear-negative and extra-pulmonary TB and lower grades of sputum smear positivity even among those with CD4 counts of ≥ 500 cells/μl. However, the relationship between the proportion of smear-positive cases and CD4 count was non-linear.
Much TB is not laboratory-confirmed in this setting despite good laboratory services. HIV-associated TB is more difficult to diagnose even at high CD4 cell counts of >500 cells/μl, suggesting early impact after HIV seroconversion.
The High Luminosity LHC (HL-LHC) project aims at accumulating 3000 fb -1 in the years 2023-2035, i.e., ten times more w.r.t. the nominal LHC performance expected for 2010-2021. One key element to ...reach this challenging performance is a new insertion region to reduce the beam size in the interaction point by approximately a factor two. This requires larger aperture magnets in the region spanning from the interaction point to the matching section quadrupoles. This aperture has been fixed to 150 mm for the inner triplet quadrupoles in 2012. In this paper, we give a first baseline of the interaction region. We discuss the main motivations that lead us to choose the technology, the combination of fields/gradients and lengths, the apertures, the quantity of superconductor, and the operational margin. Key elements are also the constraints given by the energy deposition in terms of heat load and radiation damage; we present the main features related to shielding and heat removal.
PDF
