Socioeconomic status is an overlooked risk factor for cardiovascular disease (CVD). Low family income is a measure of socioeconomic status and may portend greater CVD risk. Therefore, we assessed the ...association of family income with cardiovascular risk factor and disease burden in American adults. This retrospective analysis included data from participants aged ≥ 20 years from the National Health and Nutrition Examination Survey (NHANES) cycles between 2005 and 2018. Family income to poverty ratio (PIR) was calculated by dividing family (or individual) income by poverty guidelines specific to the survey year and used as a measure of socioeconomic status. The association of PIR with the presence of cardiovascular risk factors and CVD as well as cardiac mortality and all-cause mortality was examined. We included 35,932 unweighted participants corresponding to 207,073,472 weighted, nationally representative participants. Participants with lower PIR were often female and more likely to belong to race/ethnic minorities (non-Hispanic Black, Mexican American, other Hispanic). In addition, they were less likely to be married/living with a partner, to attain college graduation or higher, or to have health insurance. In adjusted analyses, the prevalence odds of diabetes mellitus, hypertension, coronary artery disease (CAD), congestive heart failure (CHF), and stroke largely decreased in a step-wise manner from highest (≥ 5) to lowest PIR (< 1). In adjusted analysis, we also noted a mostly dose-dependent association of PIR with the risk of all-cause and cardiac mortality during a mean 5.7 and 5.8 years of follow up, respectively. Our study demonstrates a largely dose-dependent association of PIR with hypertension, diabetes mellitus, CHF, CAD and stroke prevalence as well as incident all-cause mortality and cardiac mortality in a nationally representative sample of American adults. Public policy efforts should be directed to alleviate these disparities to help improve cardiovascular outcomes in vulnerable groups with low family income.
Recently, multilevel converters (MLCs) have gained significant attention for stationary applications, including static compensators, industrial drives, and utility-grid interfaces for renewable ...energy sources. Compared to two-level voltage-source inverters (VSI) MLCs feature high-quality AC voltage with reduced harmonic content despite the lower switching frequency of the semiconductor devices. On the DC side, MLCs can integrate multiple isolated/non-isolated battery modules instead of a single battery pack. This helps to keep the system in service in case of a malfunction of one or more battery modules, as well as active balancing among the modules, a feature not possible with two-level VSI. In general, MLCs can be classified into two types: (i) two-port MLCs, which provide a single interface to connect with the battery pack, and (ii) multiport MLCs, which provide multiple interfaces to allow connection at the module or cell level. The classical topologies of both MLC types (e.g., neutral point clamped, flying capacitor, cascaded bridge) face limitations due to the high switch count. Consequently, many hybrid and reduced-switch topologies are reported in the literature. This paper presents a critical overview of both classical and recently reported MLC topologies and offers a better insight of MLC operation for grid-connected and standalone applications. In addition, the analysis thoroughly assesses various high-level control and modulation strategies while considering active balancing among the battery modules. Other salient features such as balancing speed during offtake/grid-injection mode and fault-ride-through capability are also incorporated. In conclusion, the key findings are summarized for a better understanding of the present and future integration of battery systems in stationary applications.
The research work focuses on investigating the effects of spacer group (varying aliphatic chain length=n) of co-crystal formers (oxalic acid (OA, n=0), (malonic acid (MA, n=1), (succinic acid (SA, ...n=2), (glutaric acid (GA, n=3), and (adipic acid (AA, n=4) on the physicochemical properties and oral bioavailability of praziquantel (PZQ) co-crystals. For this purpose, different co-crystals of PZQ with dicarboxylic acid co-crystal formers (OA, MA, SA, GA, and AA) were synthesized. These co-crystals were characterized by powder X-ray diffractometry (XRPD), differential scanning calorimetry (DSC), Fourier transform infrared spectroscopy (FT-IR), and thermogravimetry (TG) techniques. The in-vitro (solubility and dissolution) and in-vivo pharmacokinetic (P.K) studies were performed for PZQ co-crystals. Additionally, the effect of polymer hydroxypropyl cellulose (HPC) on the formation of PZQ co-crystals was also investigated. According to the study results, PZQ-SA co-crystal showed improved solubility, dissolution, and oral bioavailability. Overall, the solubility, dissolution, and oral bioavailability are consistent with each other. The order of improved solubility, dissolution, and oral bioavailability is observed as consistent like PZQ-SA > PZQ-AA > PZQ-GA > PZQ-OA > PZQ-MA > pure PZQ. Concerning HPC polymer effects, PZQ-OA, PZQ-MA, PZQ-GA, and PZQ-AA co-crystals were formed successfully in the presence of HPC polymer but the PZQ-SA co-crystal was inhibited.
The coronavirus disease 19 (COVID-19) is a highly transmittable and pathogenic viral infection caused by a novel evolutionarily divergent RNA virus, the severe acute respiratory syndrome coronavirus ...2 (SARS-CoV-2). The virus first emerged in Wuhan, China in December 2019, and subsequently spreaded around the world. Genomic analyses revealed that this zoonotic virus may be evolved naturally but not a purposefully manipulated laboratory construct. However, currently available data are not sufficient to precisely conclude the origin of this fearsome virus. Comprehensive annotations of the whole-genomes revealed hundreds of nucleotides, and amino acids mutations, substitutions and/or deletions at different positions of the ever changing SARS-CoV-2 genome. The spike (S) glycoprotein of SARS-CoV-2 possesses a functional polybasic (furin) cleavage site at the S1-S2 boundary through the insertion of 12 nucleotides. It leads to the predicted acquisition of 3-
-linked glycan around the cleavage site. Although real-time RT-PCR methods targeting specific gene(s) have widely been used to diagnose the COVID-19 patients, however, recently developed more convenient, cheap, rapid, and specific diagnostic tools targeting antigens or CRISPR-Cas-mediated method or a newly developed plug and play method should be available for the resource-poor developing countries. A large number of candidate drugs, vaccines and therapies have shown great promise in early trials, however, these candidates of preventive or therapeutic agents have to pass a long path of trials before being released for the practical application against COVID-19. This review updates current knowledge on origin, genomic evolution, development of the diagnostic tools, and the preventive or therapeutic remedies of the COVID-19. We also discussed the future scopes for research, effective management, and surveillance of the newly emerged COVID-19 disease.
Background Redo mitral valve surgery is required in up to one-third of patients and is associated with significant mortality and morbidity. Valve-in-valve transcatheter mitral valve replacement (ViV ...TMVR) is less invasive and could be considered in those at prohibitive surgical risk. Studies on comparative outcomes of ViV TMVR and redo surgical mitral valve replacement (SMVR) remain limited. Our study aimed to investigate the real-world outcomes of the above procedures using the National Inpatient Sample database. Methods and Results We analyzed National Inpatient Sample data using the
(
) from September 2015 to December 2018. A total of 495 and 2250 patients underwent redo ViV TMVR and SMVR, respectively. The patients who underwent ViV TMVR were older (77 versus 68 years,
<0.01). Adjusted mortality was higher in the redo SMVR group compared with the ViV TMVR group (7.6% versus <2.8%,
<0.01). Perioperative complications were higher among patients undergoing redo SMVR including blood transfusions (38% versus 7.6%,
<0.01) and acute kidney injury (36.7% versus 13.9%,
<0.01). Cost of care was higher (USD$57 172 versus USD$52 579,
<0.01), length of stay was longer (10 versus 3 days,
<0.01), and discharge to home was lower (20.3% versus 64.6%,
<0.01) in the SMVR group compared with the ViV TMVR group. Conclusions ViV TMVR is associated with lower mortality, periprocedural morbidity, and resource use compared with patients undergoing redo SMVR. ViV TMVR may be a viable option for some patients with mitral prosthesis dysfunction. Studies evaluating long-term outcomes and durability of ViV TMVR are needed. A patient-centered approach by the heart team, local institutional expertise, and careful preprocedure planning can help decision-making about the choice of intervention for the individual patient.
Abstract
Gallium nitride (GaN) is a promising wide-bandgap semiconductor, and new characterization tools are needed to study its local crystallinity, carrier dynamics, and doping effects. Terahertz ...(THz) emission spectroscopy (TES) is an emerging experimental technique that can probe the ultrafast carrier dynamics in optically excited semiconductors. In this work, the carrier dynamics and THz emission mechanisms of GaN were examined in unintentionally doped n-type, Si-doped n-type, and Mg-doped p-type GaN films. The photocarriers excited near the surface travel from the excited-area in an ultrafast manner and generate THz radiation in accordance with the time derivative of the surge drift current. The polarity of the THz amplitude can be used to determine the majority carrier type in GaN films through a non-contact and non-destructive method. Unique THz emission excited by photon energies less than the bandgap was also observed in the p-type GaN film.
SMARCA4-deficient undifferentiated tumor (SMARCA4-UT) is a highly malignant neoplasm with an undifferentiated or rhabdoid phenotype, posing a diagnostic challenge. This case report aims to create ...awareness about this rare neoplasm while dealing with cases presenting with undifferentiated morphology.
A 55-year-old gentleman with constitutional symptoms and lymphadenopathy. Imaging revealed a mass lesion in the right upper lobe of the lung. A biopsy of the cervical lymph node showed diffusely effaced architecture replaced by sheets of undifferentiated pleomorphic cells with vesicular nuclei, prominent nucleoli, eosinophilic cytoplasm, and multiple necrotic foci. An extensive immunohistochemistry (IHC) panel was applied, which showed positivity for synaptophysin, vimentin, and focal CD34 and EMA expression. Other markers like pan-cytokeratin, p40, TTF1, CD56, INSM1, calretinin, CD45, SOX10, S100, CD30, CD117, SMA, and Desmin were negative, with INI1 retained. The IHC panel excluded the morphological differentials of carcinoma, lymphoma, rhabdomyosarcoma, melanoma, and germ cell tumor. Further literature review led to the possibility of the SMARCA4-UT entity, which had a morphology and IHC profile similar to the present case. Testing for SMARCA4 (BRG-1) by IHC showed a complete loss in the tumor cells, favoring the diagnosis of Thoracic SMARCA4-deficient undifferentiated tumor (SMARCA4-UT).
SMARCA4-UTs are rare, highly aggressive, and poorly differentiated thoracic tumors. Recognizing them is vital as there is potential for therapeutic interventions such as immunotherapy and SMARCA4-targeted therapies, offering promising prospects for the future.
Novel coronavirus (SARS-CoV-2) causing COVID-19 disease has arisen to be a pandemic. Since there is a close association between other viral infection cases by epidemics and environmental factors, ...this study intends to unveil meteorological effects on the outbreak of COVID-19 across eight divisions of Bangladesh from March to April 2020. A compound Poisson generalized linear modeling (CPGLM), along with a Monte-Carlo method and random forest (RF) model, was employed to explore how meteorological factors affecting the COVID-19 transmission in Bangladesh. Results showed that subtropical climate (mean temperature about 26.6 °C, mean relative humidity (MRH) 64%, and rainfall approximately 3 mm) enhanced COVD-19 onset. The CPGLM model revealed that every 1 mm increase in rainfall elevated by 30.99% (95% CI 77.18%, − 15.20%) COVID-19 cases, while an increase of 1 °C of diurnal temperature (TDN) declined the confirmed cases by − 14.2% (95% CI 9.73%, − 38.13%) on the lag 1 and lag 2, respectively. In addition, NRH and MRH had the highest increase (17.98% (95% CI 22.5%, 13.42%) and 19.92% (95% CI: 25.71%, 14.13%)) of COVID-19 cased in lag 4. The results of the RF model indicated that TDN and AH (absolute humidity) influence the COVID-19 cases most. In the Dhaka division, MRH is the most vital meteorological factor that affects COVID-19 deaths. This study indicates the humidity and rainfall are crucial factors affecting the COVID-19 case, which is contrary to many previous studies in other countries. These outcomes can have policy formulation for the suppression of the COVID-19 outbreak in Bangladesh.
Objectives
To study trends of utilization, outcomes, and cost of care in patients undergoing undergoing transcatheter mitral valve repair (TMVr) with end‐stage renal disease (ESRD).
Background
Renal ...disease has been known to be a predictor of poor outcome in patients with mitral valve disease. Outcome data for patients with ESRD undergoing TMVr remains limited. Therefore, our study aims to investigate trends of utilization, outcomes, and cost of care among patients with ESRD undergoing TMVr.
Methods
We analyzed NIS data from January 2010 to December 2017 using the ICD‐9‐CM codes ICD‐10‐CM to identify patients who underwent TMVr. Baseline characteristics were compared using a Pearson 𝜒2 test for categorical variables and independent samples t‐test for continuous variables. Propensity matched analysis was done for adjusted analysis to compare outcomes between TMVr with and without ESRD. Markov chain Monte Carlo was used to account for missing values.
Results
A total of 15,260 patients (weighted sample) undergoing TMVr were identified between 2010 and 2017. Of these, 638 patients had ESRD compared to 14,631 patients who did not have ESRD. Adjusted in‐hospital mortality was lower in non‐ESRD group (3.9 vs. <1.8%). Similarly, ESRD patients were more likely to have non‐home discharges (85.6 vs. 74.9%). ESRD patients also had a longer mean length of stay (7.9 vs. 13.5 days) and higher mean cost of stay ($306,300 vs. $271,503).
Conclusion
ESRD is associated with higher mortality, complications, and resource utilization compared to non‐ESRD patients. It is important to include this data in shared decision‐making process and patient selection.
Rice blast poses a significant threat to food security in Bangladesh, particularly in irrigated lowland (boro rice), which constitutes over 50% of the country's total rice production. While using ...resistant varieties is an effective method to control rice blast, developing durable resistance is challenged by the pathogen's high variability. To address this, the current study examined the distribution of rice blast reaction types in the major rice‐growing ecosystem of Bangladesh, the irrigated lowland. Two surveys were conducted and 80 blast isolates were evaluated for pathogenicity against differential varieties (DVs). The results revealed that the high frequency of virulence (over 80%) for blast resistant genes, such as Pib, Pit, Pia, Pik‐s, Pi12(t), Pi19(t) and Pi20(t), whereas Pish, Pik‐m, Pi1, Pik‐h, Pi9 and Pita‐2 genes had the least virulence frequency. These low virulence frequency genes demonstrated promising potential for the development of blast resistant varieties in Bangladesh. The isolates were further categorized into two distinct cluster groups based on their reaction patterns to DVs, with theones coming from the eastern region predominantly in Cluster I, while the ones from the northern regions belonged mainly to Cluster II. Additionally, the isolates were classified based on five reaction types, namely U, i, k, z and ta, following a new designation system. Among these, U63, i0, k100, z06 and ta403 were the most dominant reaction types. Although these reaction types were prevalent across Bangladesh, their distribution frequency varied in different major rice‐growing regions. Furthermore, the study observed that early maturing varieties in the irrigated lowland ecosystem were highly susceptible to blast. The findings of this study will be crucial for developing a comprehensive and long‐lasting blast protection system in Bangladesh, focusing on broad‐spectrum resistance strategies.
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