Abstract
Sepsis is a life-threatening condition and understanding the disease pathophysiology through the use of host immune response biomarkers is critical for patient stratification. Lack of ...accurate sepsis endotyping impedes clinicians from making timely decisions alongside insufficiencies in appropriate sepsis management. This work aims to demonstrate the potential feasibility of a data-driven validation model for supporting clinical decisions to predict sepsis host-immune response. Herein, we used a machine learning approach to determine the predictive potential of identifying sepsis host immune response for patient stratification by combining multiple biomarker measurements from a single plasma sample. Results were obtained using the following cytokines and chemokines IL-6, IL-8, IL-10, IP-10 and TRAIL where the test dataset was 70%. Supervised machine learning algorithm naïve Bayes and decision tree algorithm showed good accuracy of 96.64% and 94.64%. These promising findings indicate the proposed AI approach could be a valuable testing resource for promoting clinical decision making.
The purpose of this study was to develop a better understanding of the pathophysiology of the condition, we studied the patterns by which the septum primum (SP) and septum secundum (SS) fuse.
A ...patent foramen ovale (PFO) is a communication across the interatrial septum between a nonadherent SP and SS and is considered to be a risk factor for serious clinical syndromes.
We examined the interatrial septum in 94 randomly selected autopsied hearts, with a focus on the SP and SS and the patterns by which the 2 structures fuse.
Of the 94 specimens that were suitable for analysis, 26 (27.66%) had a PFO. Of the remaining 68 hearts, complete fusion of the SP and SS along the entire zone of overlap was seen in 27 (28.7%) hearts. In the remaining 41 hearts (60.29%), a PFO was absent, but incomplete fusion of the SP and SS was seen. Of 41 hearts, 37 (90%) had a septal pouch that opened into the left atrial (LA) cavity. Four hearts (10%) had a pouch accessible from the right atrium. Hearts with left-sided pouches tended to be younger (50 +/- 18 years of age) than hearts where there was complete fusion (age 63 +/- 23 years) (p = 0.06).
Our data suggest that when a foramen ovale closes spontaneously, the SP and SS fuse initially at the caudal limit of the zone of overlap of the 2 structures. This incomplete fusion results in a pouch that, in the majority of instances, communicates with the LA cavity.
This study investigates the lateral displacement of the oesophagus at the level of the left atrium (LA) in 11 cadavers.
The study was conducted using human cadavers. An endotracheal stylet probe was ...inserted into the eosphagus. The pericardium overlying the posterior LA was fixed in place. The lateral movement of the oesophagus from side to side was recorded. The initial study method had the stylet probe extending to the gastroesophageal (GE) junction. A revised protocol had the distal end of the endotracheal stylet probe ∼4 cm cranial to the GE junction. In six cadavers using the initial study method, the oesophagus was displaced a mean of 1.8 ± 0.35 cm to the right and 2 ± 0.48 cm to the left. In five cadavers, using the revised method, the oesophagus was displaced by a mean of 2.26 ± 0.27 cm to the right and 2.3 ± 0.66 cm to the left.
Mediastinal anatomy, specifically the presence of a loose connective tissue that attaches the oesophagus to the parietal pericardium overlying the posterior LA wall will allow for a lateral displacement of the oesophagus. This should decrease or eliminate the likelihood of thermal injury of the oesophagus. Using an endotracheal stylet, we investigated the lateral displacement of the oesophagus in 11 human cadavers. In six with the stylet extending to the GE junction, the oesophagus was displaced a mean of 3.8 cm. In five, with stylet 4 cm cranial to the junction, the displacement was 4.56 cm.
Abstract
Staphylococcus
aureus is a common pathogen causing infections in humans with various degrees of severity, with pneumonia being one of the most severe infections. In as much as staphylococcal ...pneumonia is a disease driven in large part by α-hemolysin (Hla) and Panton-Valentine leukocidin (PVL), we evaluated whether active immunization with attenuated forms of Hla (HlaH35L/H48L) alone, PVL components (LukS-PVT28F/K97A/S209A and LukF-PVK102A) alone, or combination of all 3 toxoids could prevent lethal challenge in a rabbit model of necrotizing pneumonia caused by the USA300 community-associated methicillin-resistant S. aureus (MRSA). Rabbits vaccinated with Hla toxoid alone or PVL components alone were only partially protected against lethal pneumonia, whereas those vaccinated with all 3 toxoids had 100% protection against lethality. Vaccine-mediated protection correlated with induction of polyclonal antibody response that neutralized not only α-hemolysin and PVL, but also other related toxins, produced by USA300 and other epidemic MRSA clones.
Biomaterials play a significant role in revolutionizing human life in terms of implants and medical devices. These materials essentially need to be highly biocompatible and inert to the human ...physiological conditions. This paper provides an in-depth, critical and analytical review on the previous research work and studies conducted in the field of metals and alloys used as implant materials including stainless steel, titanium and its alloys, cobalt chromium and others. Since the manufacturing of medical implants relies on selected grades of biomaterials, metals play a significant role in biomaterials market. This paper focuses on highlighting some basic principles of manufacturing implant materials underlying composition, structure and properties of these materials. Finally, attention is also given to the role of these implant materials on the betterment of human life in terms of their failures by critically analysing these materials.
Prolongation of the QTc Interval Is Seen Uniformly During Early Transmural Ischemia David N. Kenigsberg, Sanjaya Khanal, Marcin Kowalski, and Subramaniam C. Krishnan Methods: To understand ...electrocardiographic changes accompanying early ischemia, ECGs recorded at 20-s intervals during angioplasty were analyzed with 2 automated systems: MUSE (n-74) and Interval Editor (IE) (n-50). Results: Ischemia prolonged Bazett’s QTc interval uniformly (100%). With MUSE, QTc interval prolonged from 423 ± 25 to 455 ± 34 ms (p < 0.001). With IE, QTc interval prolonged from 424.0 ± 27 to 458 ± 33 ms (p < 0.001). Time to maximal QTc interval prolongation, change in T-wave polarity, ST-segment elevation, and ST-segment depression were 22, 24, 29 and 35 s, occurring in 100%, 7%, 15%, and 7% respectively. Conclusion: QTc interval prolongs uniformly in ischemia. Compared with other ECG indexes, it is also the earliest.
Our limited understanding of the pathophysiological mechanisms that operate during sepsis is an obstacle to rational treatment and clinical trial design. There is a critical lack of data from low- ...and middle-income countries where the sepsis burden is increased which inhibits generalized strategies for therapeutic intervention. Here we perform RNA sequencing of whole blood to investigate longitudinal host response to sepsis in a Ghanaian cohort. Data dimensional reduction reveals dynamic gene expression patterns that describe cell type-specific molecular phenotypes including a dysregulated myeloid compartment shared between sepsis and COVID-19. The gene expression signatures reported here define a landscape of host response to sepsis that supports interventions via targeting immunophenotypes to improve outcomes.
Background Venous phlebotomy performed by trained personnel is critical for patient diagnosis and monitoring of chronic disease, but has limitations in resource-constrained settings, and represents ...an infection control challenge during outbreaks. Self-collection devices have the potential to shift phlebotomy closer to the point of care, supporting telemedicine strategies and virtual clinical trials. Here we assess a capillary blood micro-sampling device, the Tasso Serum Separator Tube (SST), for measuring blood protein levels in healthy subjects and non-hospitalized COVID-19 patients. Methods 57 healthy controls and 56 participants with mild/moderate COVID-19 were recruited at two U.S. military healthcare facilities. Healthy controls donated Tasso SST capillary serum, venous plasma and venous serum samples at multiple time points, while COVID-19 patients donated a single Tasso SST serum sample at enrolment. Concentrations of 17 protein inflammatory biomarkers were measured in all biospecimens by Ella multi-analyte immune-assay. Results Tasso SST serum protein measurements in healthy control subjects were highly reproducible, but their agreements with matched venous samples varied. Most of the selected proteins, including CRP, Ferritin, IL-6 and PCT, were well-correlated between Tasso SST and venous serum with little sample type bias, but concentrations of D-dimer, IL-1B and IL-1Ra were not. Self-collection at home with delayed sample processing was associated with significant concentrations differences for several analytes compared to supervised, in-clinic collection with rapid processing. Finally, Tasso SST serum protein concentrations were significantly elevated in in non-hospitalized COVID-19 patients compared with healthy controls. Conclusions Self-collection of capillary blood with micro-sampling devices provides an attractive alternative to routine phlebotomy. However, concentrations of certain analytes may differ significantly from those in venous samples, and factors including user proficiency, temperature control and time lags between specimen collection and processing need to be considered for their effect on sample quality and reproducibility.
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