Serum levels of tumor necrosis factor-alpha and vascular endothelial growth factor as markers of disease activity in patients with axial spondyloarthritis

Background: Assessment of disease activity in axial spondyloarthritis (axSpA) has remained a challenge. This study aims to investigate the role of vascular endothelial growth factor (VEGF) and tumor necrosis factor-alpha (TNF-α) as markers of disease activity in patients with axSpA. Methods: A total of 40 patients with axSpA were included in this study. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)/Bath Ankylosing Spondylitis Functional Index (BASFI), serum TNF-α, and VEGF levels were assessed at baseline and the same parameters were assessed after 24 weeks of therapy with either etanercept or NSAIDs (20 patients in each group). Twenty healthy age- and sex-matched controls were also recruited for the study. Results: Patients with axSpA had higher levels of serum TNF-α (mean 341 pg/ml) and VEGF (mean 791 pg/ml) as compared with healthy controls (mean 72.5 pg/ml, P < 0.001 and mean 269 pg/ml, P < 0.001). There was significant reduction in serum TNF-α and VEGF levels after 24 weeks of treatment with etanercept (mean 161 pg/ml, P < 0.001 and mean 442 pg/ml, P < 0.001, respectively) but not with NSAID (P = 0.29, P = 0.25). Both TNF-α and VEGF had a positive correlation with BASDAI (r = 0.57, P < 0.01 and r = 0.44, P < 0.01) and BASFI (r = 0.61, P < 0.01 and r = 0.33, P = 0.03) at baseline. The levels of TNF-α and VEGF showed no correlation with ESR and CRP (P = 0.48, P = 0.07 and P = 0.21, P = 0.06, respectively) at baseline. There was no correlation between BASDAI and levels of ESR, CRP (P = 0.27 and P = 0.49, respectively). Conclusion: Serum levels of TNF-α and VEGF serve as better markers of disease activity as compared with ESR and CRP in axSpA

Channel&ndash;Spatial Segmentation Network for Classifying Leaf Diseases

Agriculture is an important resource for the global economy, while plant disease causes devastating yield loss. To control plant disease, every country around the world spends trillions of dollars on disease management. Some of the recent solutions are based on the utilization of computer vision techniques in&nbsp;plant science which helps to monitor crop industries such as tomato, maize, grape, citrus, potato and cassava, and other crops. The attention-based CNN network has become effective in plant disease prediction. However, existing approaches are less precise in detecting minute-scale disease in the leaves. Our proposed Channel&ndash;Spatial segmentation network will help to determine the disease in the leaf, and it consists of two main stages: (a) channel attention discriminates diseased and healthy parts as well as channel-focused features, and (b) spatial attention consumes channel-focused features and highlights the diseased part for the final prediction process. This investigation forms a channel and spatial attention in a sequential way to identify diseased and healthy leaves. Finally, identified leaf diseases are divided into Mild, Medium, Severe, and Healthy. Our model successfully predicts the diseased leaves with the highest accuracy of 99.76%. Our research study shows evaluation metrics, comparison studies, and expert analysis to comprehend the network performance. This concludes that the Channel&ndash;Spatial segmentation network can be used effectively to diagnose different disease degrees based on a combination of image processing and statistical calculation

Abstracts of 1st International Conference on Machine Intelligence and System Sciences

This book contains the abstracts of the papers presented at the International Conference on Machine Intelligence and System Sciences (MISS-2021) Organized by the Techno College of Engineering, Agartala, Tripura, India &amp; Tongmyong University, Busan, South Korea, held on 1–2 November 2021. This conference was intended to enable researchers to build connections between different digital technologies based on Machine Intelligence, Image Processing, and the Internet of Things (IoT). Conference Title: 1st International Conference on Machine Intelligence and System SciencesConference Acronym: MISS-2021Conference Date: 1–2 November 2021Conference Location: Techno College of Engineering Agartala, Tripura(w), IndiaConference Organizer: Techno College of Engineering, Agartala, Tripura, India &amp; Tongmyong University, Busan, South Korea

Effect of Intraoperative High Positive End-Expiratory Pressure (PEEP) With Recruitment Maneuvers vs Low PEEP on Postoperative Pulmonary Complications in Obese Patients: A Randomized Clinical Trial (vol 321, pg 2292, 2019)

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Effect of Intraoperative High Positive End-Expiratory Pressure (PEEP) With Recruitment Maneuvers vs Low PEEP on Postoperative Pulmonary Complications in Obese Patients: A Randomized Clinical Trial.

IMPORTANCE An intraoperative higher level of positive end-expiratory positive pressure (PEEP) with alveolar recruitment maneuvers improves respiratory function in obese patients undergoing surgery, but the effect on clinical outcomes is uncertain

Effect of intraoperative high Positive End-Expiratory Pressure (PEEP) with recruitment maneuvers vs low PEEP on postoperative pulmonary complications in obese patients : a randomized clinical trial

IMPORTANCE An intraoperative higher level of positive end-expiratory positive pressure (PEEP) with alveolar recruitment maneuvers improves respiratory function in obese patients undergoing surgery, but the effect on clinical outcomes is uncertain. OBJECTIVE To determine whether a higher level of PEEP with alveolar recruitment maneuvers decreases postoperative pulmonary complications in obese patients undergoing surgery compared with a lower level of PEEP. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial of 2013 adults with body mass indices of 35 or greater and substantial risk for postoperative pulmonary complications who were undergoing noncardiac, nonneurological surgery under general anesthesia. The trial was conducted at 77 sites in 23 countries from July 2014-February 2018; final follow-up: May 2018. INTERVENTIONS Patients were randomized to the high level of PEEP group (n = 989), consisting of a PEEP level of 12 cm H2O with alveolar recruitment maneuvers (a stepwise increase of tidal volume and eventually PEEP) or to the low level of PEEP group (n = 987), consisting of a PEEP level of 4 cm H2O. All patients received volume-controlled ventilation with a tidal volume of 7 mL/kg of predicted body weight. MAIN OUTCOMES AND MEASURES The primary outcomewas a composite of pulmonary complications within the first 5 postoperative days, including respiratory failure, acute respiratory distress syndrome, bronchospasm, new pulmonary infiltrates, pulmonary infection, aspiration pneumonitis, pleural effusion, atelectasis, cardiopulmonary edema, and pneumothorax. Among the 9 prespecified secondary outcomes, 3 were intraoperative complications, including hypoxemia (oxygen desaturation with SpO(2) 1 minute). RESULTS Among 2013 adults who were randomized, 1976 (98.2%) completed the trial (mean age, 48.8 years; 1381 [69.9%] women; 1778 [90.1%] underwent abdominal operations). In the intention-to-treat analysis, the primary outcome occurred in 211 of 989 patients (21.3%) in the high level of PEEP group compared with 233 of 987 patients (23.6%) in the low level of PEEP group (difference, -2.3%[95% CI, -5.9% to 1.4%]; risk ratio, 0.93 [95% CI, 0.83 to 1.04]; P =.23). Among the 9 prespecified secondary outcomes, 6 were not significantly different between the high and low level of PEEP groups, and 3 were significantly different, including fewer patients with hypoxemia (5.0% in the high level of PEEP group vs 13.6% in the low level of PEEP group; difference, -8.6%[95% CI, -11.1% to 6.1%]; P <.001). CONCLUSIONS AND RELEVANCE Among obese patients undergoing surgery under general anesthesia, an intraoperative mechanical ventilation strategy with a higher level of PEEP and alveolar recruitment maneuvers, compared with a strategy with a lower level of PEEP, did not reduce postoperative pulmonary complications

High PEEP with recruitment maneuvers versus Low PEEP During General Anesthesia for Surgery -a Bayesian individual patient data meta-analysis of three randomized clinical trials

Background: The influence of high positive end-expiratory pressure (PEEP) with recruitment maneuvers on the occurrence of postoperative pulmonary complications after surgery is still not definitively established. Bayesian analysis can help to gain further insights from the available data and provide a probabilistic framework that is easier to interpret. Our objective was to estimate the posterior probability that the use of high PEEP with recruitment maneuvers is associated with reduced postoperative pulmonary complications in patients with intermediate-to-high risk under neutral, pessimistic, and optimistic expectations regarding the treatment effect. Methods: Multilevel Bayesian logistic regression analysis on individual patient data from three randomized clinical trials carried out on surgical patients at Intermediate-to-High Risk for postoperative pulmonary complications. The main outcome was the occurrence of postoperative pulmonary complications in the early postoperative period. We studied the effect of high PEEP with recruitment maneuvers versus Low PEEP Ventilation. Priors were chosen to reflect neutral, pessimistic, and optimistic expectations of the treatment effect. Results: Using a neutral, pessimistic, or optimistic prior, the posterior mean odds ratio (OR) for High PEEP with recruitment maneuvers compared to Low PEEP was 0.85 (95% Credible Interval [CrI] 0.71 to 1.02), 0.87 (0.72 to 1.04), and 0.86 (0.71 to 1.02), respectively. Regardless of prior beliefs, the posterior probability of experiencing a beneficial effect exceeded 90%. Subgroup analysis indicated a more pronounced effect in patients who underwent laparoscopy (OR: 0.67 [0.50 to 0.87]) and those at high risk for PPCs (OR: 0.80 [0.53 to 1.13]). Sensitivity analysis, considering severe postoperative pulmonary complications only or applying a different heterogeneity prior, yielded consistent results. Conclusion: High PEEP with recruitment maneuvers demonstrated a moderate reduction in the probability of PPC occurrence, with a high posterior probability of benefit observed consistently across various prior beliefs, particularly among patients who underwent laparoscopy