Background Non-Hodgkin Lymphoma (NHL) accounts for 5% of childhood cancers in children. Pediatric NHL patients achieve complete remission in high-income countries; however, mortality is high in low and middle-income countries due to complicated febrile neutropenia. Data published from our centre showed acute mortality of 19.7% and sepsis as the most common cause of death. Use of Granulocyte Colony Stimulating Factor (G-CSF) has shown to reduce the duration and severity of neutropenia and decrease the incidence of febrile neutropenia (FN). Therefore, our study aims to assess a reduction in acute mortality with the use of GCSF as primary prophylaxis in B-cell NHL and a reduction in hospital admission days with febrile neutropenia and delays in subsequent chemotherapy cycle. Methods This is a retrospective cohort study, performed at Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH) Lahore. All patients with diagnosis of B Cell NHL under 10 years of age from January 2018 to October 2021 were included. Data was collected on patient age, stage of disease, treatment regimen, day of start of GCSF, number of episodes of FN, duration of admission in hospital due to FN, day of count recovery and outcomes. Results Of the 106 patients, 45 (42.4%) were females and 61 (57.5%) were males and 60 patients (56.7%) were between 1-5 years of age. All patients were started on GCSF on 7 th day of COPADM regimen. Second cycle of induction chemotherapy was given on time at 21 st day in 57 (53.8%). 97 patients (91.5%) remained alive until end of induction and nine patients expired with mortality rate of (8.5%). Multi-drug resistant gram negative/positive bacteremia (32%) and invasive fungal infections (8.5%) remain the most frequent causes of prolonged febrile neutropenia in these patients. A total of 48 (45.4%) patients were discharged on 7 th day after 1 st cycle, 41 (38.6%) remained admitted for 8-15 days due to prolonged febrile neutropenia, and remaining 17 (16%) of patients remained admitted for more than 15 days due to prolonged FN. Conclusions Primary prophylactic use of GCSF in our patients helped reduce mortality to 8.5%, decreases number of FN episodes, decreases length of hospital stay, and improves count recovery. Therefore, the use needs to be promoted in pediatric cancer care centers especially in resource limited settings so that better outcomes can be achieved.

Chromatography is pivotal in separation and analysis, necessitating continuous performance enhancements. Yet, conventional methods exhibit limitations. This study introduces a novel approach by incorporating a second ligand, pushing chromatographic performance boundaries. Notably, this method can integrate with most optimization techniques, fostering synergy. Hydrophobic charge-induction chromatography (HCIC) serves as the focal point. Initially, an optimal resin, influenced by ligand density, was targeted. Various densities of the second ligand were coupled, assessing performance enhancement. Characterization, including scanning electron microscopy and BET analysis, was conducted. Subsequently, optimization effects under different pH, salt, and flow rate conditions were systematically studied, involving both static and dynamic adsorption experiments. Emphasis was placed on comparing the performance effects of the second ligand. Results showcase significant chromatographic enhancement with the second ligand, synergizing with optimization strategies, achieving breakthrough performance. In the final phase, the resin proves effective in the separation and purification of hIgG from human serum, achieving 96.6% purity and 91.6% recovery compared to the control, with increments of 10.6% and 20.4%, respectively. Meanwhile，the resin with the second ligand, exhibits commendable repeatability and stability. In conclusion, this study underscores how the addition of a suitable second ligand can elevate chromatographic performance, offering a novel strategy to augment existing ligand libraries and enhance chromatographic capabilities.

SGLT-2 inhibitors and high-dose acarbose as potential high-risk combinations for ketosis and ketoacidosis in Asian patients with T2DM：A case seriesWei Qiang1MD, Fei Yang1, 2MM, Ling Liu1, 3BS, Ruiqing Dong1BS, Yushi Sun1MD, Ahona Mondal , Hui Guo1*MD1Department of Endocrinology and Metabolism, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, P. R. China.2Department of Endocrinology, the First Affiliated Hospital of Xi’an Medical University, Xi’an 710077, P. R. China.3Department of Endocrinology, Chang Qing Oil Field Worker’s Hospital, Xi’an 710201 Xi’an 710061, P. R. China.

A novel enlarging fractional bandwidth (FBW) technique for acoustic-wave-lumped-element resonator (AWLR) -based bandpass filters is present. The new technique is based on a series of matching inductors that replace the parallel or series acoustic wave (AW) resonators of AW filters to beak the bandwidth constraint of the ladder-type structure. In addition, the transmission response analysis of the proposed AWLR-based filter is provided. A prototype of the AWLR-based filter is fabricated and tested to validate the proposed FBW widening technique. The measured insertion loss, FBW, and out-of-band rejection are 1.5dB, 1.63kt2 (kt2 is the electromechanical coupling coefficient of the AWR), and 38dB, respectively.

A document by Guanyu Liu. Click on the document to view its contents.

Flow and sediment sharing in a bifurcated channel are considered to be a very important issues in river engineering and flood management. The present study has been conducted based on the field bifurcation of the Kangsabati river bifurcates at Kapastikri, about 75 km downstream of Kangsabati reservoir of West Midnapore, West Bengal, India. A scaled physical model simulating bifurcation region was conducted on a fixed-bed model at the Laboratory of River Research Institute (RRI), West Bengal (WB), India. The model set-up has been run with a range of discharges, including low, moderate, and high with three different sets of bifurcation angles. Furthermore, three different sizes of sediment of varying densities have been used to find the transport capacity of sediment for individual bifurcated angle. A set of data have been collected for different conditions like varying discharge, angle of bifurcation, mean size of sediment ( d 50 ) particle and a comprehensive analysis have been done with respect to collected data to see how discharge and sediment load (bed-load) are distributed over the bifurcated branches. The present physical model study has determined the optimum discharge in the main channel for which the sediment and discharge get equally distributed over the bifurcated branches. The experimental data confirm that the distribution of bed load is dependent on the shape of the bifurcation and the sediment transport ratio ( s1/s2) is sensitive to the angle of bifurcation in which s1 & s2 represent sediment transport rate (kg/hr) in respective branches.

The achievement of optimum performance of a co-existing radar and communication (CRC) system is a challenging task when the channel state information (CSI) for the interference channels is imperfect, particularly when the power of the CRC system is restricted. To address this issue, this article proposes a robust CRC system design that considers CSI uncertainty. Specifically, the objective is to design a robust beamforming scheme to maximize the radar performance subject to the user signal-to-interference-plus-noise ratio （SINR）and the transmit power of the CRC system. Due to the infinite number of constraints that result from the CSI uncertainty of the interference channels, a loosely bound robust approach is developed, which employs the shrinkage method to convert the infinite number of constraints into a finite number of constraints. However, the performance of the loosely bound robust approach is not satisfactory. Therefore, this paper further proposes a sub-optimal robust approach that employs the S-procedure to transform the infinite number of inequality constraints into equivalent finite linear matrix inequalities (LMIs). The simulation results indicate that the design of the robust CRC system can significantly improve the system performance compared to the traditional design approach.

The fusion of renewable energy into power grid planning poses significant challenges. In this investigation, we assess planning strategies across eight key indicators encompassing economic, reliability, environmental, and adaptability considerations. Leveraging the Analytical Hierarchy Process (AHP) alongside the Entropy Weight Method, we ascertain both subjective and objective weights, subsequently synthesizing comprehensive weights with parsimonious discriminative data. Scores for planning strategies are then derived utilizing these weights. To illustrate and validate the efficacy of the proposed methodology, we apply it to four schemes within the IEEE-6 node system, incorporating wind and photovoltaic power plants.

ABSTRACT.Patients with vesical ureteral reflux (VUR) present with a wide range of severity. With an incidence of approximately 1%, Vesicoureteric reflux is a relatively common urological abnormality in children.Postnatal diagnosis of VUR is typically made following a diagnosis of a urinary tract infection (UTI) and less frequently following family screening. Voiding cystourethrograms remain the gold standard for diagnosing VUR. To preserve the kidney and prevent the need for potential renal replacement therapy, infants with a single kidney require significantly more assessment and prompt urine diversion decisions. Surgical correction is advised for patients with VUR grades IV and V, while VUR grades I, II, and III are managed conservatively.

This study aims to investigate the low cycle fatigue (LCF) behavior and fatigue life prediction method of an advanced solid solution strengthened nickel-based superalloy at various temperatures and stress concentrations. Cylindrical specimens as well as plates with three types of holes (including straight holes and inclined holes with different orientations) were designed and machined for fatigue tests. The test results revealed fatigue life decreases with the temperature increasing. Meanwhile, the fatigue lives of the plate specimens have decreased differently and are strongly dependent on the geometry and orientation of the holes. The key damage parameter related to the fatigue life was found on the strain gradient path. A criterion based on strain gradient is defined as the boundary of the damage process zone. The results show that the prediction was in good agreement with the experimental data, for the majority of the data is within a scatter band of ±2.

IntroductionCancer treatments can cause primary ovarian insufficiency (POI) and infertility1 which are associated with distress for patients and loved ones1–4. The American Society for Clinical Oncology and the American Society for Reproductive Medicine recommend early referral to reproductive specialists to discuss fertility preservation options prior to cancer therapy4,5.

This article introduces a Wasserstein distance-based distributionally robust optimization model to address the transmission expansion planning considering wind turbine-powered microgrids (MGs) under the impact of uncertainties. The primary objective of the presented methodology is to devise a robust expansion strategy that accounts for both short-term variability and long-term uncertainty over the planning horizon from the perspective of a central planner. In this framework, the central planner fosters the construction of appropriate transmission lines and the deployment of optimal MG-based generating units among profit-driven private investors. Short-term uncertainties, stemming from variations in load demands and production levels of stochastic units, are modeled through operating conditions. The Wasserstein distance uncertainty set is used to characterize the long-term uncertainty about the future load demand. To ensure the tractability of the proposed planning model, the authors introduce a decomposition framework embedded with a modified application of Bender’s method. To validate the efficiency and highlight the potential benefits of the proposed expansion planning methodology, two case studies based on simplified IEEE 6-bus and IEEE 118-bus systems are included. These case studies assess the effectiveness of the presented approach, its ability to navigate uncertainties, and its capacity to effectively optimize expansion decisions.

The vanishing inertia of synchronous generators in transmission systems requires the utilization of renewables for inertial support. These are often connected to the distribution system and their support should be coordinated to avoid violation of grid limits. To this end, this paper presents the Physics-informed Actor-Critic (PI-AC) algorithm for coordination of Virtual Inertia (VI) from renewable Inverter-based Resources (IBRs) in power distribution systems. Acquiring a model of the distribution grid can be difficult, since certain parts are often unknown or the parameters are highly uncertain. To favor model-free coordination, Reinforcement Learning (RL) methods can be employed, necessitating a substantial level of training beforehand. The PI-AC is a RL algorithm that integrates the physical behavior of the power system into the Actor-Critic (AC) approach in order to achieve faster learning. To this end, we regularize the loss function with an aggregated power system dynamics model based on the swing equation. Throughout this paper, we explore the PI-AC functionality in a case study with the CIGRE 14-bus and IEEE 37-bus power distribution system in various grid settings. The PI-AC is able to achieve better rewards and faster learning than the exclusively data-driven AC algorithm and the metaheuristic Genetic Algorithm (GA).

Objective: Retained placenta is a serious complication of vaginal birth. The ability to predict retained placenta may have positive effect on timely management. We aimed to evaluate the maternal and obstetric risk factors associated with retained placenta after singleton live vaginal birth Methods: A retrospective cohort of women who had retained placenta after singleton live vaginal birth ≥ 24 weeks, compared in 1:2 ratio with women who had normal vaginal delivery without complications. Study and control group were matched for maternal age, gestational age and parity. Multivariate regression analysis was performed to evaluate the potential risk factors for retained placenta including maternal and obstetrical characteristics Results: Fifteen thousand two hundred sixty women underwent vaginal delivery at our medical center between 2015-2022. One hundred seventy women (1.1%) were diagnosed with retained placenta. Ninety-nine women (0.65%) who met the inclusion criteria, were matched with 198 women (1.3%) as controls. Multivariate logistic regression revealed various potential risk factors not previously described as associated with retained placenta including: IVF pregnancy (OR 3.8, 95% CI [1.3- 11.7], P 0.018), preeclampsia (OR 4.5, 95% CI[1.1- 17.5 ],P 0.0315), women with large for gestational age fetus (OR 28.2, 95% CI [5.4- 148.5], P 0.0298),labor Induction (OR 21.8, 95%CI [5.5- 86.8],P <0.001), vacuum assisted vaginal delivery (OR 2.3 .95% CI [1.2- 4.5], P 0.011), and Duration of second stage > 3 hours (OR 3.9,95%CI [1- 15.1], P <0.001) Conclusion: Our study highlights unreported risk factors associated with retained placenta such as macrosomia , in vitro fertilization and endometriosis. This emphasis on early risk identification and the exploration of possible preventive measures holds promise for enhancing antenatal care practices, ultimately improving outcomes for both mothers and infants .

The regulation of emission color, emission efficiency and asymmetry factor is of great significance for the real applications of circularly polarized luminescent (CPL) materials. Herein, we develop a modular synthetic strategy toward full-color-tunable CPL materials based on chiral macrocyclic aggregation-induced emission (AIE) luminogens via delicate molecular engineering. Modular synthesis of chiral AIEgens with different acceptor moieties has afforded series of bright solid emitters with tunable emission colors. These chiral cyclic AIEgens have retained high solid state emission quantum yield and displayed CPL emission from blue to red as nano-aggregates, in liquid crystal matrix and polymer film. The strong acceptor units in the red-emitting chiral AIEgens RBTPE-2CN and SBTPE-2CN have rendered them twisted intramolecular charge transfer property and solvatochromic luminescence. And polymer matrix with different polarity further facilitates the tuning of CPL emission color from green to red emission. These results have paved a reliable approach toward constructing full-spectra solid-state CPL material.

Background: The estimated prevalence of tracheobronchomalacia (TBM) in children is about 1:2100. Tracheomalacia (TM) prevalence is higher in patients with chronic lung disease such as bronchiectasis and cystic fibrosis (CF) and may contribute to increased morbidity. Objective: To determine the prevalence and assess clinical features of TM, TBM and bronchomalacia (BM) in patients with primary ciliary dyskinesia (PCD). Methods: We performed a retrospective case-note review of all children with a confirmed or highly likely diagnosis of PCD attending Oslo University Hospital between 2000-2021. We selected those who had undergone flexible fiberoptic bronchoscopy (FB) and in whom the presence of TBM was assessed. We retrieved demographic and clinical data, including airway symptoms, PCD-diagnostic criteria, indication for bronchoscopy, the presence of lobar atelectasis, bacteriology and the descriptive and unblinded video-recorded results of FB. Complications occurring during and after bronchoscopy were noted. Results: Of 71 children with PCD, 32 underwent FB and were included in the review. The remaining 39 were included for TBM prevalence calculation only. Median age at FB was 6.0 y (3.1 – 11.9). Twenty-two children (69%) had intrathoracic airway malacia. Four (13%) had isolated TM, seven (22%) had TBM, and 11 (34%) had isolated BM affecting either main (n=4) or lobar bronchi (n=7) (LBM), including four with associated lobar atelectasis. FB related complications, one major, 12 minor, were documented in 13 children (41%). Conclusion: We found a high prevalence of TBM among children with PCD undergoing FB. This may represent a significant comorbidity and have implications for patient management.

A document by Mahdi Rezapour. Click on the document to view its contents.

A document by Mahdi Rezapour. Click on the document to view its contents.

A document by Mahdi Rezapour. Click on the document to view its contents.

A highly enantioselective palladium-catalyzed intramolecular Heck reaction of unactivated alkenes is developed, which provides a powerful route to access a broad range of chiral 3,3-disubstituted-2,3-dihydrobenzofurans bearing all-carbon quaternary stereocenter of interest in pharmaceutical research. Its salient features include high yield, excellent chemo- and enantioselectivity, mild condi-tions, a broad substrate scope as well as versatile transformations of the product.

A document by Mahdi Rezapour. Click on the document to view its contents.

Artificial Intelligence (AI) has garnered worldwide attention across public, academic, and technological sectors for its potential to revolutionize healthcare by improving cost and quality of care. This review critically examines the promises of AI-driven innovation in Otolaryngology (Ear, Nose, and Throat), a surgical specialty encompassing various subspecialties offering inpatient and outpatient services. The analysis focuses on AI's application in diagnostic support, precision medicine, image analysis, automation, and patient education, while also addressing the ethical and practical considerations. Despite the current high risks associated with AI use in clinical settings, there is significant potential for overcoming these challenges. The National Health Service (NHS) in the UK is adopting AI as part of its 'Long Term Plan' to enhance clinical practice and patient management. However, the adoption of AI in Otolaryngology requires a cautious approach to balance the risks of bias, reliability issues, and the 'black box' phenomenon. Proper education and training in AI for healthcare professionals are essential to ensure a knowledgeable workforce capable of utilizing these emerging technologies effectively.

In the previous work [6], we classified the solutions to a family of systems of Klein-Gordon equations with non-negative energy below the ground state into two parts: one blows up in finite time while the other extends to a global solution. In the present work, we strengthen this result, showing that these global solutions are indeed scattering in the energy space. Here we adapted Kenig-Merle’s concentration-compactness approach to the system.

Tissue levels of Alternaria allergen Alt a 1 reflect recurrence of refractory airway diseases.To the Editors,The quantification of Alternaria allergen in the local airway tissues is quite unknown, while Alternaria alternata is a widespread fungal species in the airway discharge and known to be one source of aeroallergens which contribute to development of asthma (1,2) and chronic rhinosinusitis (CRS) (3,4). We have recently been established the method for quantifying allergen in the local airway tissues (5). Since Alt a 1 is the main sensitizing allergen component and it is useful in diagnosis and immunotherapy (6), we have measured the levels of Alt a 1 in the local airway tissues and examined whether the quantification of Alt a 1 could reflect the allergic airway inflammation and recurrence of refractory allergic respiratory diseases.We obtained nasal polyp tissues from 64 patients with refractory CRS with nasal polyp (CRSwNP) and homogenized them. The tissue levels of Alt a 1, Alternaria specific IgE, IL-4, IL-5, IL-13, IL-33, galectin-10 in nasal polyp supernatant were measured. The tissue eosinophil numbers were also counted. We searched for the existence of postoperative nasal polyp for in the medical records in order to examine the usefulness of Alt a 1 as a predictor of nasal polyp recurrence after surgery.First, we measured the levels of Alt a 1 in airway tissues and ROC curve based on nasal polyp recurrence data was developed, with a cut-off value of 1.84 ng/g of local Alt a 1 (AUC = 0.75, Figure 1A). According to the presence or absence of nasal polyp recurrence, patients were divided into two groups and the levels of Alt a 1 were compared. The tissue levels of Alt a 1 were significantly higher in recurrence group. (p < 0.01, Figure 1B). Kaplan–Meier curves at the cut-off point of the local tissue Alt a 1 levels shows that of the recurrence-free rate in the low- Alt a 1 group is lower rate than that in the high- Alt a 1 group (p < 0.05, log-rank test, Figure 1C).We further measured Alternaria specific IgE level in the airway tissues in order to determine the sensitization to Alt a 1. The levels of Alt a 1 in nasal polyps had a significant positive correlation with the levels of Alternaria specific IgE (rs=0.56, p<0.0001, Figure 2A). We divided patients into two groups according to the local tissue levels of local Alt a 1, and compared the levels of Alternaria-specific IgE antibody between two groups. As result, the levels of Alternaria-specific IgE antibody were significantly higher in high- Alt a 1 group than those in low- Alt a 1 group. (p<0.0001, Figure 2B)Fungi induce alarmins which promote the development of type 2 response via increase in the number of eosinophils, accompanied by an increase in innate lymphoid cells (ILCs) and effector cells such as mast cells (7,8). We measured the level of type2 cytokines (IL-4, IL-5, IL-13) in the airway tissues and analyzed between high- and low- Alt a 1group respectively in order to assess the contribution of type2 inflammation to local allergic reaction to Alternaria alterna . Patients were divided into two groups according to the tissue levels of Alt a 1. The levels of IL-4 were significantly higher in high- Alt a 1 group than those in low- group. IL-4 plays an essential role in IgE class switching and production. The levels of IL-5 and IL-13 didn’t show significant difference but tended to be higher in the high- Alt a 1 group. (Figure 2C)Epithelial cells which activated by antigens induce proinflammatory responses due to the production of alarmins. Alternaria alternataexposure evokes IL-33 secretion and extracellular DNA from the airway epithelium, which functions as an alarmin to stimulate type 2 immunity in airway diseases (9). The levels of IL-33 in NPs were significantly higher in high- Alt a 1 group than those in the low- group (Figure 2C). Galectin-10 is relatively eosinophil specific protein which released from cytolytic cells is expected to be a biomarker for activated eosinophils in eosinophilic inflammatory diseases (10). The levels of galectin-10 in the airway tissues were significantly higher in high Alt a 1 group than low group. (Figure 2C)This is the first report to have quantified the levels of Alt a 1 in airway tissues and investigated the association to the type2 molecules of allergic reaction. Alternaria alterna is common fungi as an environmental antigen and the increase in the local tissue levels of Alt a 1 were associated with the recurrence of refractory CRSwNP. These results might explain the tissue levels of Alt a 1 can be a predictor of recurrence for refractory respiratory airway disease.