Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Acute liver failure following paracetamol overdose.

Acute liver failure is a rare syndrome comprising a coagulopathy of liver origin, jaundice and encephalopathy in a patient with no prior history of liver disease. Paracetamol overdose is the leading cause of acute liver failure in the United Kingdom and often presents with extrahepatic organ dysfunction requiring critical care. We present the case of a patient with hyper acute liver failure secondary to paracetamol overdose. Management focused on ensuring the correct diagnosis had been made, administering N-acetyl cysteine, fluid resuscitation and broad spectrum antimicrobials. Early intubation and transfer to a transplant centre were undertaken following development of hepatic encephalopathy. Neuroprotective measures and hypertonic saline were instituted to reduce the risk of intracranial hypertension. High dose haemofiltration was also started to help reduce ammonia levels. Aggressive critical care therapies with specialised input results in good outcomes for patients admitted with paracetamol induced hyper acute liver failure. Liver transplant is reserved for those patients unlikely to survive with medical treatment alone

An Improved Strategy for Task Scheduling in the Parallel Computational Alignment of Multiple Sequences

Task scheduling in parallel multiple sequence alignment (MSA) through improved dynamic programming optimization speeds up alignment processing. The increased importance of multiple matching sequences also needs the utilization of parallel processor systems. This dynamic algorithm proposes improved task scheduling in case of parallel MSA. Specifically, the alignment of several tertiary structured proteins is computationally complex than simple word-based MSA. Parallel task processing is computationally more efficient for protein-structured based superposition. The basic condition for the application of dynamic programming is also fulfilled, because the task scheduling problem has multiple possible solutions or options. Search space reduction for speedy processing of this algorithm is carried out through greedy strategy. Performance in terms of better results is ensured through computationally expensive recursive and iterative greedy approaches. Any optimal scheduling schemes show better performance in heterogeneous resources using CPU or GPU

A computational classification method of breast cancer images using the VGGNet model

Cancer is one of the most prevalent diseases worldwide. The most prevalent condition in women when aberrant cells develop out of control is breast cancer. Breast cancer detection and classification are exceedingly difficult tasks. As a result, several computational techniques, including k-nearest neighbor (KNN), support vector machine (SVM), multilayer perceptron (MLP), decision tree (DT), and genetic algorithms, have been applied in the current computing world for the diagnosis and classification of breast cancer. However, each method has its own limitations to how accurately it can be utilized. A novel convolutional neural network (CNN) model based on the Visual Geometry Group network (VGGNet) was also suggested in this study. The 16 layers in the current VGGNet-16 model lead to overfitting on the training and test data. We, thus, propose the VGGNet-12 model for breast cancer classification. The VGGNet-16 model has the problem of overfitting the breast cancer classification dataset. Based on the overfitting issues in the existing model, this research reduced the number of different layers in the VGGNet-16 model to solve the overfitting problem in this model. Because various models of the VGGNet, such as VGGNet-13 and VGGNet-19, were developed, this study proposed a new version of the VGGNet model, that is, the VGGNet-12 model. The performance of this model is checked using the breast cancer dataset, as compared to the CNN and LeNet models. From the simulation result, it can be seen that the proposed VGGNet-12 model enhances the simulation result as compared to the model used in this study. Overall, the experimental findings indicate that the suggested VGGNet-12 model did well in classifying breast cancer in terms of several characteristics