Hepatocellular carcinoma (HCC) is primary hepatic malignancy with a high incidence of recurrence. The risk of recurrence directly correlates to patient’s overall prognosis. Management of advanced HCC ...involves a combination of surgical resection, locoregional therapy, and systemic treatment. Distant metastases are rare, and intraventricular cardiac metastases are even more infrequent. This brief review details an illustrative case of cardiac metastasis after curative treatment of primary HCC and then summarizes the literature on risk factors, treatment options, and patient prognosis in the setting of distant metastases from HCC. Prognosis of metastasis to the heart is generally poor, and available evidence emphasizes the importance of maintaining regular posttreatment screening for metastases in patients with HCC. Given the variable presentation and high risk of recurrence, it is critical to have individualized multimodality treatment plans.
Stargardt disease is a progressive retinal disorder caused by bi-allelic mutations in the ABCA4 gene that encodes the ATP-binding cassette, subfamily A, member 4 transporter protein. Over the past ...few years, we and others have identified several pathogenic variants that reside within the introns of ABCA4, including a recurrent variant in intron 36 (c.5196+1137G>A) of which the pathogenicity so far remained controversial. Detailed clinical characterization of this variant confirmed its pathogenic nature, and classified it as an allele of intermediate severity. Moreover, we discovered several additional ABCA4 variants clustering in intron 36. Several of these variants resulted in aberrant splicing of ABCA4, i.e., the inclusion of pseudoexons, while the splicing defects caused by the recurrent c.5196+1137G>A variant strongly increased upon differentiation of patient-derived induced pluripotent stem cells into retina-like cells. Finally, all splicing defects could be rescued by the administration of antisense oligonucleotides that were designed to specifically block the pseudoexon insertion, including rescue in 3D retinal organoids harboring the c.5196+1137G>A variant. Our data illustrate the importance of intronic variants in ABCA4 and expand the therapeutic possibilities for overcoming splicing defects in Stargardt disease.
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Khan et al. report on the clinical characterization of patients harboring a recurrent deep-intronic variant in ABCA4 underlying retinal disease and demonstrate that this, and other variants close by, lead to splicing defects that can be rescued by antisense oligonucleotides.
This article proposes highly efficient asymmetric boost half-bridge diode-clamped dc/dc converter that can accommodate a wide input voltage range. The proposed converter uses a boost half-bridge ...structure at the primary side and an active diode-clamped cell at the secondary side along with small size primary-side/secondary-side capacitors. Thus, this circuit is small and can be developed at low cost, but it experiences different resonance combinations during the first half and remaining half switching periods. By incorporating an active diode-clamped cell and asymmetric resonance, the proposed converter accomplishes nearly zero-voltage-switching turn- off at the upper secondary-side switch and turn- off at the voltage closed to half of the output voltage at the lower secondary-side switch regardless of variation in input voltage. This helps to reduce switching losses at the secondary-side switches. We identified the accurate voltage gain of the proposed converter and obtained its detailed design guideline taking the asymmetric resonance into account. Furthermore, the currents flowing through the output diodes are unbalanced due to the asymmetric resonance, but can be balanced by applying different secondary-side duty ratios. A 400-W rated prototype that converts 48-72 V input to a 380-V output is designed and tested to validate the concept. The prototype demonstrates 95.9% peak efficiency and enhanced efficiency performance over the wide input voltage range.
Pancreatic cancer is one of the common cancers in US and is associated with high mortality and morbidity. The objectives of our study were to look at the recent trends in the number of ...hospitalizations with pancreatic cancer.
We identified patients with a discharge diagnosis of pancreatic cancer in the National Inpatient Sample from 2007 to 2011 using International Classification of Diseases-Clinical Modification, 9th revision (ICD-9-CM) codes. We looked at the yearly trend in the hospitalizations with pancreatic cancer and the outcomes which included length of stay (LOS), hospital charges and in-hospital mortality. We also performed multivariate analysis to look for the predictors of mortality.
There were 450, 414 patients with discharge diagnosis of pancreatic cancer. There was 18% increase in hospitalizations with pancreatic cancer in 2011 compared to 2007. Most of the patients were Caucasian (63%) with the mean age of 68 ± 0.14 years, had Medicare (57%) as primary insurance, were from Southern region (35%) and had higher Charlson Comorbidity Index (CCI) (87% with CCI > = 5). 6% underwent Whipple's procedure in the index hospitalization. After the adjustment for inflation, the mean hospital charges increased from $ 47,331 in 20007 to $ 53, 854 in 2011 (p = 0.01). LOS decreased from 7.31 ± 0.11 days in 2007 to 6.70 ± 0.09 days in 2011 (<0.001). Despite the increase in the number of hospitalizations of patients with pancreatic cancer, mortality decreased from 9.8% in 2007 to 8.1% in 2011 (p<0.001). On multivariate analysis, the independent factors associated with higher mortality were older age, male sex African-American race, insurance status other than Medicare, higher CCI and enrollment in palliative care. There was regional variation in mortality. Whipple's procedure conferred lower mortality.
Our study showed downward trends in LOS and in-hospital mortality despite increasing hospitalizations with pancreatic cancer.
Purpose of review
Hepatitis C (HCV) is the most common cause of viral hepatitis in elderly individuals. This patient population previously experienced suboptimal outcomes with interferon-based ...regimens. Unfortunately, patients aged 65 years and older were underrepresented in phase 2 and 3 clinical trials with newer direct acting antiviral (DAA) therapies. Since the advent of second-generation DAA in 2013, numerous robust real-world experiences highlighting the efficacy and safety of DAA in the elderly have been published. This review article summarizes the cascade of care for hepatitis C from diagnosis to cure from an evidence-based perspective of the aging population.
Recent finding
In a large study from the Veterans Affairs Healthcare System, the overall sustained virologic response (SVR) of 15,884 patients treated with DAA regimens was 91.2%. These newer therapies remained highly effective in the subset of patients aged 65 years and older with SVR rates above 90%. A Spanish National Registry reported outcomes in patients ≥ 65 years old treated for HCV with oral DAA regimens over a 2-year period. The overall SVR was 94% in the study of 1252 subjects.
Summary
Current real-world data imply DAA treatment regimens remain highly effective and safe in elderly patients when compared to the general population.
Over 15% of probands in a large cohort of more than 1500 inherited retinal degeneration patients present with a clinical diagnosis of Stargardt disease (STGD1), a recessive form of macular dystrophy ...caused by biallelic variants in the ABCA4 gene. Participants were clinically examined and underwent either target capture sequencing of the exons and some pathogenic intronic regions of ABCA4, sequencing of the entire ABCA4 gene or whole genome sequencing. ABCA4 c.4539 + 2028C > T, p.= ,Arg1514Leufs*36 is a pathogenic deep intronic variant that results in a retina-specific 345-nucleotide pseudoexon inclusion. Through analysis of the Irish STGD1 cohort, 25 individuals across 18 pedigrees harbour ABCA4 c.4539 + 2028C > T and another pathogenic variant. This includes, to the best of our knowledge, the only two homozygous patients identified to date. This provides important evidence of variant pathogenicity for this deep intronic variant, highlighting the value of homozygotes for variant interpretation. 15 other heterozygous incidents of this variant in patients have been reported globally, indicating significant enrichment in the Irish population. We provide detailed genetic and clinical characterization of these patients, illustrating that ABCA4 c.4539 + 2028C > T is a variant of mild to intermediate severity. These results have important implications for unresolved STGD1 patients globally with approximately 10% of the population in some western countries claiming Irish heritage. This study exemplifies that detection and characterization of founder variants is a diagnostic imperative.
Summary
Enhancement of network performance is a big challenge today for the emerging technology based on IEEE 802.16. Wireless technology is an alternate solution to wired technology. Network ...availability all the way is an important challenge in day‐to‐day life. Due to the huge population, the availability of the network is again a big challenge. Also, it becomes more difficult to capture the network if considering rural areas, hilly, lakes, and seashores today. This work proposed relay stations in WiMAX (Worldwide Interoperability for Microwave Access) networks along with various bandwidth allocation algorithms to increase the signal strength over the long distance using retransmission of the original signal by relay station and extend the coverage with a higher data rate and higher user capacity. The availability of WiMAX networks for the channel bandwidth assignment to users for data and service is very important in today's scenario. This paper focuses on evaluating the performance of bandwidth allocation algorithms in light WiMAX networks with and without relay stations. The performance evaluation is done by increasing the number of nodes with various bandwidth allocation techniques with and without relay stations. In this work the round robin and strict priority algorithms are used for channel bandwidth allocation in a light WiMAX network and performance is analyzed through throughput, goodput, and packet drop rate, which will help to implement and configure the suggested optimal parameters in the production environment. This work enhanced the throughput and goodput and reduce the dropout rate, and the user capacity also increased.
This article focuses on evaluating the performance of bandwidth allocation algorithms in light WiMAX networks with and without relay stations utilizing round robin and strict priority algorithms.
The performance assessment is carried out by increasing the number of nodes with various bandwidth allocation techniques with and without relay stations. Performance analysis carried out using throughput, goodput, and packet drop rate.
The outcome enhanced the throughput, goodput and reduce the dropout rate and increased the user capacity.
Transgender and gender nonconforming (TGNC) people are a marginalized set of the population that continues to experience health care inequalities. This study aimed to assess oral health parameters ...including Candida growth and intensity among TGNC adults.
This cross-sectional study recruited two subgroups: 40 transgender and 40 control adults. Consented participants were interviewed and clinically examined. Data using the WHO oral health assessment forms were obtained. Samples for Candida growth and intensity analysis were collected from the dorsum surface of the tongue.
27.5% of the transgender group was HIV seropositive. Oral nicotine stomatitis and leukoplakia are reported to be the most prevalent intra-oral lesions showing a prevalence of 27.5% and 20%, respectively. The dental and periodontal health parameters of the transgender group were worse than those of the control group. The intensity of Candida colonies was significantly higher in the test group (p = 0.014).
Poor oral health and significant oral mucosal disorders were reported in transgender adults that have shown a higher rate of behavioral risk factors such as tobacco and alcohol consumption. Further longitudinal studies in different world regions are warranted to understand the barriers to good oral health in transgender adults and how to implement effective prevention and management strategies.
Internet connectivity in WiMAX networks, along with various applications, is increasing rapidly, so the connectivity of internet and data transfer speed are always challenges for effective data ...transmission in wireless networks. Several factors affect the performance of networks. One important factor is to choose a suitable frame period for effective data transmissions. The performance of different frame periods with Round Robin and Strict Priority is evaluated in this work. A frame period in Round Robin performs better than a Strict Priority in terms of throughput, but a Strict Priority performs better in terms of drop rates. This paper also demonstrates that an effective frame period, when combined with a proper bandwidth allocation algorithm, yields better results. This work gives the analysis that Round Robin performs 83.8847% better while Strict Priority performs 86.0020% better than the earliest deadline first algorithms for 10 subscriber stations in terms of throughput. This work is helpful to researchers and industrialists for actual implementations in WiMAX networks.
Background Severe aortic stenosis causes recurrent mucosal bleeds, mainly from angiodysplasias and acquired von Willebrand deficiency (vWD) which is corrected after aortic valve replacement, either ...transcatheter (TAVR) or surgical (SAVR). Occurrence of GI bleed pre-TAVR was significantly associated with mortality following valve replacement in patients who had coronary artery disease (CAD) but not in those without CAD (table).
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