Experimental investigations of a single cylinder genset engine with common rail fuel injection system

Performance and emissions characteristics of compression ignition (CI) engines are strongly dependent on quality of fuel injection. In an attempt to improve engine combustion, engine performance and reduce the exhaust emissions from a single cylinder constant speed genset engine, a common rail direct injection (CRDI) fuel injection system was deployed and its injection timings were optimized. Results showed that 34°CA BTDC start of injection (SOI) timings result in lowest brake specific fuel consumption (BSFC) and smoke opacity. Advanced injection timings showed higher cylinder peak pressure, pressure rise rate, and heat release rate due to relatively longer ignition delay experienced

Mean platelet volume as short-term follow-up biomarker in children with celiac disease

Objective: To assess the mean platelet volume (MPV) as a short-term follow-up biomarker in celiac disease (CD) and to compare it with anti-tissue transglutaminase antibody (TTGA) assay in Indian children. Material and Methods: Newly diagnosed 35 children aged <12 years who were positive for TTGA and further confirmed by intestinal biopsy with histological Grade 2 and 3 based on modified Marsh Classification were enrolled. TTGA, MPV, and clinical parameters were assessed at enrollment and after 3 months of gluten free diet (GFD). Results: Short stature (94.3%) and diarrhea (80%) were the most common presenting features. 33 (94.3%) children were found to have anemia. MPV reduced significantly from 9.28±1.88 fl to 8.55±1.10 fl after 3 months of GFD, (p<0.001). The mean TTG level reduced from 166.80±59.23 U/ml to 86.45±39.67 U/ml (p<0.001) after 3 months of GFD. Conclusion: MPV is one of the biomarkers that can be used to monitor dietary transgressions in CD in short term

Systematic study of incomplete fusion reactions: Role of various entrance channel parameters

263-266The evaporation residues, populated through complete and incomplete fusion processes in the reaction of 18O+ 165Ho, have been analyzed via excitation function measurements at projectile energies ≈ 4-7 MeV/nucleon. The cross-sections measured experimentally have been compared with the predictions of the compound nucleus model code PACE-4 calculations which only considers complete fusion (CF) reaction cross-sections. The experimental cross-section of the reaction residues populated through xn and pxn channels matches well with the theoretical model code PACE-4 predictions. On the other hand, α-emitting channels show an enhancement in the measured cross-section over PACE-4 calculations which reveals the occurrence of incomplete fusion (ICF) at the studied energy range. The relative percentage of incomplete fusion has been calculated from the experimental data and its dependence on various entrance channel parameters like projectile energy, mass-asymmetry, α-Q value and Coulomb factor (ZPZT) has been studied. The strength of incomplete fusion function obtained in the 18O+ 165Ho interaction has been compared with the previously studied systems. Results of the present study indicate that 18O (two neutron excess) projectile shows more incomplete fusion contribution as compared to 12C,13C and 16O projectiles due to its relatively small negative α-Q value

Conversion from calcineurin inhibitor to belatacept-based maintenance immunosuppression in renal transplant recipients:A randomized phase 3b Trial

Significance Statement This randomized trial demonstrates the safety and efficacy of conversion from calcineurin inhibitor (CNI)? to belatacept-based maintenance immunosuppression in renal transplant recipients 6?60 months post-transplant. Patients converted to belatacept showed sustained improvement in renal function associated with an acceptable safety profile consistent with prior experience and a smaller treatment difference in acute rejection postconversion compared with that observed in earlier studies in de novo renal allograft recipients. These results favor the use of belatacept as an alternative to continued long-term CNI-based maintenance immunosuppression, which is particularly relevant for CNI-intolerant patients, including those who experience nephrotoxicity. These data help inform clinical practice guidelines regarding the conversion of such patients to an alternative immunosuppressive drug regimen.Background Calcineurin inhibitors (CNIs) are standard of care after kidney transplantation, but they are associated with nephrotoxicity and reduced long-term graft survival. Belatacept, a selective T cell costimulation blocker, is approved for the prophylaxis of kidney transplant rejection. This phase 3 trial evaluated the efficacy and safety of conversion from CNI-based to belatacept-based maintenance immunosuppression in kidney transplant recipients.Methods Stable adult kidney transplant recipients 6?60 months post-transplantation under CNI-based immunosuppression were randomized (1:1) to switch to belatacept or continue treatment with their established CNI. The primary end point was the percentage of patients surviving with a functioning graft at 24 months.Results Overall, 446 renal transplant recipients were randomized to belatacept conversion (n=223) or CNI continuation (n=223). The 24-month rates of survival with graft function were 98% and 97% in the belatacept and CNI groups, respectively (adjusted difference, 0.8; 95.1% CI, ?2.1 to 3.7). In the belatacept conversion versus CNI continuation groups, 8% versus 4% of patients experienced biopsy-proven acute rejection (BPAR), respectively, and 1% versus 7% developed de novo donor-specific antibodies (dnDSAs), respectively. The 24-month eGFR was higher with belatacept (55.5 versus 48.5 ml/min per 1.73 m(2) with CNI). Both groups had similar rates of serious adverse events, infections, and discontinuations, with no unexpected adverse events. One patient in the belatacept group had post-transplant lymphoproliferative disorder.Conclusions Switching stable renal transplant recipients from CNI-based to belatacept-based immunosuppression was associated with a similar rate of death or graft loss, improved renal function, and a numerically higher BPAR rate but a lower incidence of dnDSA. Clinical Trial registry name and registration number: A Study in Maintenance Kidney Transplant Recipients Following Conversion to Nulojix? (Belatacept)-Based, NCT01820572Nephrolog

Gallbladder reporting and data system (GB-RADS) for risk stratification of gallbladder wall thickening on ultrasonography:an international expert consensus

The Gallbladder Reporting and Data System (GB-RADS) ultrasound (US) risk stratification is proposed to improve consistency in US interpretations, reporting, and assessment of risk of malignancy in gallbladder wall thickening in non-acute setting. It was developed based on a systematic review of the literature and the consensus of an international multidisciplinary committee comprising expert radiologists, gastroenterologists, gastrointestinal surgeons, surgical oncologists, medical oncologists, and pathologists using modified Delphi method. For risk stratification, the GB-RADS system recommends six categories (GB-RADS 0–5) of gallbladder wall thickening with gradually increasing risk of malignancy. GB-RADS is based on gallbladder wall features on US including symmetry and extent (focal vs. circumferential) of involvement, layered appearance, intramural features (including intramural cysts and echogenic foci), and interface with the liver. GB-RADS represents the first collaborative effort at risk stratifying the gallbladder wall thickening. This concept is in line with the other US-based risk stratification systems which have been shown to increase the accuracy of detection of malignant lesions and improve management. Graphical abstract: [Figure not available: see fulltext.]

Utilization of mechanical power and associations with clinical outcomes in brain injured patients: a secondary analysis of the extubation strategies in neuro-intensive care unit patients and associations with outcome (ENIO) trial

Background: There is insufficient evidence to guide ventilatory targets in acute brain injury (ABI). Recent studies have shown associations between mechanical power (MP) and mortality in critical care populations. We aimed to describe MP in ventilated patients with ABI, and evaluate associations between MP and clinical outcomes. Methods: In this preplanned, secondary analysis of a prospective, multi-center, observational cohort study (ENIO, NCT03400904), we included adult patients with ABI (Glasgow Coma Scale ≤ 12 before intubation) who required mechanical ventilation (MV) ≥ 24 h. Using multivariable log binomial regressions, we separately assessed associations between MP on hospital day (HD)1, HD3, HD7 and clinical outcomes: hospital mortality, need for reintubation, tracheostomy placement, and development of acute respiratory distress syndrome (ARDS). Results: We included 1217 patients (mean age 51.2 years [SD 18.1], 66% male, mean body mass index [BMI] 26.3 [SD 5.18]) hospitalized at 62 intensive care units in 18 countries. Hospital mortality was 11% (n = 139), 44% (n = 536) were extubated by HD7 of which 20% (107/536) required reintubation, 28% (n = 340) underwent tracheostomy placement, and 9% (n = 114) developed ARDS. The median MP on HD1, HD3, and HD7 was 11.9 J/min [IQR 9.2-15.1], 13 J/min [IQR 10-17], and 14 J/min [IQR 11-20], respectively. MP was overall higher in patients with ARDS, especially those with higher ARDS severity. After controlling for same-day pressure of arterial oxygen/fraction of inspired oxygen (P/F ratio), BMI, and neurological severity, MP at HD1, HD3, and HD7 was independently associated with hospital mortality, reintubation and tracheostomy placement. The adjusted relative risk (aRR) was greater at higher MP, and strongest for: mortality on HD1 (compared to the HD1 median MP 11.9 J/min, aRR at 17 J/min was 1.22, 95% CI 1.14-1.30) and HD3 (1.38, 95% CI 1.23-1.53), reintubation on HD1 (1.64; 95% CI 1.57-1.72), and tracheostomy on HD7 (1.53; 95%CI 1.18-1.99). MP was associated with the development of moderate-severe ARDS on HD1 (2.07; 95% CI 1.56-2.78) and HD3 (1.76; 95% CI 1.41-2.22). Conclusions: Exposure to high MP during the first week of MV is associated with poor clinical outcomes in ABI, independent of P/F ratio and neurological severity. Potential benefits of optimizing ventilator settings to limit MP warrant further investigation