•TNBC represents the most aggressive phenotype of breast cancer.•Conventional therapy prescribed for breast cancer is not effective in treatment of TNBC.•Specific therapeutic targets must be ...identified in TNBC.•The PI3K/Akt/Mtor (PAM) pathway is an important signaling pathway of TNBC.•Drug molecules targeting the PAM pathway could emerge as promising therapeutics.
Triple-negative breast cancer (TNBC) is a highly malignant subtype of breast cancer associated with poor prognosis. Although conventional chemotherapy regimens have shown some effectiveness in early TNBC cases, the outcome in advanced stages is poor. The PI3K/AKT/mTOR pathway is one of the important and active pathways involved in chemoresistance and survival of TNBC. This pathway is speculated to play an important part in malignant transformation and has been considered as a potential molecular target for the design of therapeutic agents to treat TNBC. This review discusses the potentials and drug discovery perspectives of PI3K/AKT/mTOR as a therapeutic target for effective management of TNBC with anticipated challenges.
Purpose
Due to the increasing demand of customer and competitive market pressure, manufacturing organizations should be modernized in strategies, production operations, processes and its procedures ...to remain competitive. So, a flexible manufacturing system (FMS) was adopted by the manufacturing system to fight with competitive pressure. The purpose of this paper is to enhance the performance of manufacturing system, with a focus on its factors.
Design/methodology/approach
In this research, the ranking of the performance factor of FMSs is done by using multiple attribute decision-making (MADM) methods as multi-objective optimization on the basis of ratio analysis (MOORA) and preference selection index (PSI). Weights of attributes are defined by the AHP method.
Findings
Ranking of performance factor is done on the basis of six variables which affect three elements of performance of FMS, i.e. productivity, flexibility and quality. MOORA is applied in three ways such as the ratio-based, reference point and full multiplicative method. In the MOORA method, ranking was done considering weights of attributes and also without it. A PSI method is used to find the best factor among the factors. The results of these methodologies, i.e. MOORA and PSI, are same, i.e. productivity is the primary factor in the manufacturing system. The ranking is validated by the result of different methodology used in this research.
Practical implications
This research has evaluated the important factors and performance variables which can enhance the performance of manufacturing organizations. So, the manufacturing persons can focus on these to enhance its performance.
Originality/value
Combined MADM methods, i.e. MOORA and PSI methodologies, are used in this paper to deal with the ranking of performance factors of the FMS considering qualitative characteristics. These approaches show the conversion of a qualitative attribute to quantitative attributes by using fuzzy logic.
Recently, breast cancer has reached the highest incident rate amongst all the reported cancers, and one of its variants, known as triple-negative breast cancer (TNBC), is deadlier compared to the ...other types of breast cancer due to a lack of feasible diagnostic techniques. Advancements in nanotechnology have paved the way to formulate several nanocarriers with the ability to deliver anticancer drugs effectively and selectively to cancer cells with minimum side effects to non-cancerous cells. Nanotheranostics is a novel approach that can be used in the diagnosis of disease along with therapeutic effects. Currently, various imaging agents, such as organic dyes, radioactive agents, upconversion nanoparticles, various contrasting agents, quantum dots, etc., are being explored for the imaging of internal organs or to examine drug distribution. Furthermore, ligand-targeted nanocarriers, which have the potential to target cancer sites, are being used as advanced agents for cancer theranostic applications, including the identification of various metastatic sites of the cancerous tumor. This review article discusses the need for theranostic application in breast cancer with various imaging techniques, the latest nanotheranostic carriers in breast cancer, and related safety and toxicity issues, as well as highlights the importance of nanotheranostics in breast cancer, which could be helpful in deciphering questions related to nanotheranostic systems.
Purpose
Medical tourism encourages the traveling of patients, expert healthcare professionals and promotes cross-border trade in healthcare services. The Indian medical tourism sector is facing new ...challenges as well as certain ethical and legal issues because of continuous market changes and patient’s requirements while at the same time advancements in current health services have also been observed. It is therefore very important to understand and address the issues of the medical tourists. The purpose of this paper is to evaluate the important factors which can make India an affordable medical tourism destination.
Design/methodology/approach
In this paper, the factors influencing Indian medical tourism sector have been explored by conducting literature review, they are ranked according to the results of a questionnaire-based survey and further analyzed by using the interpretive structural modeling (ISM) approach. The mutual relationships between these factors were identified to develop an ISM model so as to find out the important factors which can make India an affordable place for medical tourism.
Findings
The results of the survey and the model show that cost of medical procedures, facilitation, and care, the infrastructure of Indian hospitals, clinical excellence and the competence of doctors and staff are the top level factors.
Practical implications
It is very important to address the concerns of the patients coming to a developing country like India for availing medical services. This research has evaluated the important factors which can make India an affordable medical tourism destination.
Originality/value
This research assesses the effects of globalization on delivery of healthcare services in India by conducting critical analysis of the medical tourism industry by collecting original data from the international patients coming to India for different types of medical procedures so that a comprehensive model can be prepared which will help the hospitals and policymakers to improve the processes related to medical tourism.
Background: This study examines quality of life (QOL) of a sample of police officers in India. The concept of QOL includes well-being, social obligations, relationships of a person, and his ...association with environment. The study examines the factors on which QOL of police officers depend and their relationships with each other. The issues linked with QOL are important because they directly affect the individual's ability to maintain a healthy lifestyle and affect organizational performance in the long run. This study explores relevant factors that have an impact on the QOL of the employees of police department in India. Method: In this paper, literatures review, ISM, MICMAC, and DEMATEL methodology have established eleven factors that impact the QOL of police officers in India. Mutual relations between factors have been established using the ISM approach to develop a model to represent these relationships. DEMATEL methodologies were used to analyze these factors. Results: Results indicate that "fair compensation, work overload, workplace safety, and job stress" are the top-level factors that affect QOL of police officers. Conclusion: The identification of factors and their mutual relationships that affect QOL are important for police officers and have to be dealt with according to their order of importance. The research model developed in this study shows how the factors of police officers' QOL are interrelated and presents the interrelationships among these factors. A comprehensive model depicting the relationships among these factors has been established, so that the QOL of police officers can be improved.
Introduction
Clinically measured Quadriceps angle (Q-angle) has low reliability. Measurement of angle between femoral shaft and patellar tendon (FSPT angle) on routine knee MRI was described in this ...study to represent the lateral vector forces of quadriceps mechanism. The cross-sectional study was designed to compare this angle between subjects with objective patellofemoral instability (PFI) versus those without PFI, to assess its reliability, and to assess its validity in terms of its ability to differentiate between PFI and non-PFI subjects using the “Receiver Operating Characteristic” (ROC) curve.
Materials and methods
MRI scans of 20 subjects with PFI and 20 without PFI were obtained. FSPT angle was measured in each MRI by three different raters. In addition, the clinical Q-angle was also measured in the control group.
Results
The FSPT angle was significantly higher in PFI group as compared with the non-PFI group (
p
< 0.001). It had substantial inter-rater reliability of 0.82 (95% CI = 0.67–0.92) in the non-PFI group and 0.89 (95% CI = 0.78–0.95) in the PFI group. Test-retest reliability was more than 0.90. The AUC for the ROC curve was 0.86 (95% CI = 0.74–0.97). The clinical Q-angle measured in non-PFI subjects had inter-rater reliability of only 0.48 (95% CI = 0.21–0.72), and showed a fair correlation of 0.58 with the MRI angle.
Conclusion
Measurement of FSPT angle was described on MRI with substantial intra-rater and inter-rater reliability. The angle was significantly higher in PFI versus non-PFI subjects and also showed a good ability to differentiate between these two groups in the ROC curve.
Introduction
Survival following lung transplant is low. With limited donor lung availability, predicting post-transplant survival is key. We investigated the predictive value of pre-transplant CT ...biomarkers on survival.
Methods
In this single-center retrospective cohort study of adults in a diverse, underserved, urban lung transplant program (11/8/2017–5/20/2022), chest CTs were analyzed using TeraRecon to assess musculature, fat, and bone. Erector spinae and pectoralis muscle area and attenuation were analyzed. Sarcopenia thresholds were 34.3 (women) and 38.5 (men) Hounsfield Units (HU). Visceral and subcutaneous fat area and HU, and vertebral body HU were measured. Demographics and pre-transplant metrics were recorded. Survival analyses included Kaplan–Meier and Cox proportional hazard.
Results
The study cohort comprised 131 patients, 50 women, mean age 60.82 (SD 10.15) years, and mean follow-up 1.78 (SD 1.23) years. Twenty-nine percent were White. Mortality was 32.1%. Kaplan–Meier curves did not follow the proportional hazard assumption for sex, so analysis was stratified. Pre-transplant EMR metrics did not predict survival. Women without sarcopenia at erector spinae or pectoralis had 100% survival (
p
= 0.007). Sarcopenia did not predict survival in men and muscle area did not predict survival in either sex. Men with higher visceral fat area and HU had decreased survival (
p
= 0.02). Higher vertebral body density predicted improved survival in men (
p
= 0.026) and women (
p
= 0.045).
Conclusion
Pre-transplantation CT biomarkers had predictive value in lung transplant survival and varied by sex. The absence of sarcopenia in women, lower visceral fat attenuation and area in men, and higher vertebral body density in both sexes predicted survival in our diverse, urban population.
Background There is no standardized system to grade pleural effusion size on CT scans. A validated, systematic grading system would improve communication of findings and may help determine the need ...for imaging guidance for thoracentesis. Methods CT scans of 34 patients demonstrating a wide range of pleural effusion sizes were measured with a volume segmentation tool and reviewed for qualitative and simple quantitative features related to size. A classification rule was developed using the features that best predicted size and distinguished among small, moderate, and large effusions. Inter-reader agreement for effusion size was assessed on the CT scans for three groups of physicians (radiology residents, pulmonologists, and cardiothoracic radiologists) before and after implementation of the classification rule. Results The CT imaging features found to best classify effusions as small, moderate, or large were anteroposterior (AP) quartile and maximum AP depth measured at the midclavicular line. According to the decision rule, first AP-quartile effusions are small, second AP-quartile effusions are moderate, and third or fourth AP-quartile effusions are large. In borderline cases, AP depth is measured with 3-cm and 10-cm thresholds for the upper limit of small and moderate, respectively. Use of the rule improved interobserver agreement from κ = 0.56 to 0.79 for all physicians, 0.59 to 0.73 for radiology residents, 0.54 to 0.76 for pulmonologists, and 0.74 to 0.85 for cardiothoracic radiologists. Conclusions A simple, two-step decision rule for sizing pleural effusions on CT scans improves interobserver agreement from moderate to substantial levels.
Purpose
Prevalence and sex differences of non-traumatic hemoperitoneum in the Emergency Department has not been studied in the literature.
Methods
Following IRB approval, multiple keyword searches ...were used to identify all cases of hemoperitoneum over a 55-month period. Cases were reviewed to confirm and quantify the hemoperitoneum. Maximum attenuation was used to grade blood density. Medical records were reviewed to determine cause, interventions and outcomes in each patient.
Results
Of the 171 verified cases of non-traumatic hemoperitoneum, 76% of cases were in women. CT exams in women were positive for hemoperitoneum 0.25% of the time, while 0.13% were positive in men. Regarding size, 25.7% were large, 24.5% were moderate and 49.7% were small. Contrast-enhanced studies had HU values of 103 ± 19 (range 47–146) which were significantly higher than for non-enhanced studies with values of 82 ± 19 (range 43–121,
p
< 0.001). The most common cause of non-traumatic hemoperitoneum was ruptured ovarian cyst which was found in 58% of women (76 cases). Of these, 69 patients received observation, 6 patients underwent surgery and 1 patient received Vitamin K. For the 95 non-ovarian cyst cases, 65% patients were admitted and then discharged, 22% were discharged from the ED, 12% expired and 1% were transferred to a different hospital. Post-procedure hemorrhage was the second to most common cause in women (24/130 = 18%) and the most common etiology in men (14/41 = 34%).
Conclusions
In women, ovarian cyst rupture was the most common etiology of hemoperitoneum. Post-procedure hemorrhage was second in women and the most common etiology in men. Although unusual causes of hemoperitoneum will be encountered, understanding the most common causes of hemoperitoneum can provide a reasonable starting point when attempting to determine the most likely etiology of hemoperitoneum in any individual patient.
Healthcare workers (HCW) are most vulnerable to contracting COVID-19 infection. Understanding the extent of human-to-human transmission of the COVID-19 infection among HCWs is critical in managing ...this infection and for policy making. We did this study to estimate new infection by seroconversion among HCWs in recent contact with COVID-19 and predict the risk factors for infection.
A cohort study was conducted at a tertiary care COVID-19 hospital in New Delhi during the first and second waves of the COVID-19 pandemic. All HCWs working in the hospital during the study period who came in recent contact with the patients were our study population. The data was collected by a detailed face-to-face interview, serological assessment for anti- COVID-19 antibodies at baseline and end line, and daily symptoms. Potential risk factors for seroprevalence and seroconversion were analyzed by logistic regression keeping the significance at p<0.05.
A total of 192 HCWs were recruited in this study, out of which 119 (62.0%) were seropositive. Almost all were wearing Personal protective equipment (PPE) and following Infection prevention and control (IPC) measures during their recent contact with a COVID-19 patient. Seroconversion was observed among 36.7% of HCWs, while 64.0% had a serial rise in the titer of antibodies during the follow-up period. Seropositivity was negatively associated with being a doctor (odds ratio OR 0.35, 95% Confidence Interval CI 0.18-0.71), having COVID-19 symptoms (OR 0.21, 95% CI 0.05-0.82), having comorbidities (OR 0.14, 95% CI 0.03-0.67), and received IPC training (OR 0.25, 95% CI 0.07-0.86), while positively associated with partial (OR 3.30, 95% CI 1.26-8.69), as well as complete vaccination for COVID-19 (OR 2.43, 95% CI 1.12-5.27). Seroconversion was positively associated with doctor as a profession (OR 13.04, 95% CI 3.39-50.25) and with partially (OR 4.35, 95% CI 1.07-17.65), as well as fully vaccinated for COVID-19 (OR 6.08, 95% CI 1.73-21.4). No significant association was observed between adherence to any IPC measures and PPE adopted by the HCW during the recent contact with COVID-19 patients and seroconversion.
Almost all the HCW practiced IPC measures in these settings. High seropositivity and seroconversion are most likely due to concurrent vaccination against COVID-19 rather than recent exposure to COVID-19 patients. Further studies using anti-N antibodies serology may help us find the reason for the seropositivity and seroconversion among HCWs.
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