Developing an Artificial Agent to play Games using Deep Reinforcement Learning

In Reinforcement Learning, Deep Q-Learning agents have seen great success with popular agents such as Alpha GO and Alpha Zero, these agents are constrained to discrete state space environments and are even prone to overestimation bias. To address these restrictions, we deployed Deep Deterministic Policy gradient and Soft Actor Critic off-policy algorithms in the Lunar Lander environment described in Zhao et al. (2020) research and compared their performance to Deep Q Networks. We observed that out of the three implemented algorithms, SAC outperformed both DQN and DDPG algorithms with a huge margin

The toxic tango: TKI and TCI cardiotoxicities

Abstract Background Immune checkpoint inhibitors (ICI) and Tyrosine kinase inhibitors (TKI) are effective for several types of cancers, but they can have several cardiotoxicity sides effects. We present a case of TKI-ICI toxicity resulting in multiorgan inflammatory syndrome with myocarditis and thrombotic STEMI that were successfully treated with high-dose steroids and PCI. Case presentation Seventy-two year-old man patient treated with on pembrolizumab 200 mg IV every 3 weeks and Axitinib 5 mg PO q12h for the past 5 months complained of acute shortness of breath, altered mental status, and chronic diarrhea. Coronary angiography demonstrated a thrombotic lesion in the right coronary artery (RCA) that was treated successfully with percutaneous coronary intervention (PCI). Despite PCI he continued to complain of shortness of breath further workup with Cardiac MRI (CMR) was obtained showed an ejection fraction of 38%, small pericardial effusion, and delayed gadolinium enhancement (DGE) in the inferior wall suggestive of myocarditis. An empirical trial of high-dose steroids improved all patient symptoms and ejection fraction; therefore, the chemotherapy regimen was changed. Conclusion This case report highlights the potential vasculogenic effects of Axitinib and immune-related myocarditis of pembrolizumab. Cardiologists and oncologists should be vigilant for the cardiotoxic effects of Axitinib and pembrolizumab

Outcome after Interlocking intramedullary nailing of humeral shaft fractures

Introduction: Management of fractures of humeral shaft is always a challenging problem to deal with as they are very frequently associated with multiple injuries, leading to complications. Interlocking intramedullary nails have gained popularity now a days for stabilization of humeral shaft fractures due to load sharing nature of implant, preservation of fracture haematoma, minimal exposure and rigid fixation with early mobilization. Material & Methods: A prospective clinical study on fifty patients of humeral shaft fractures was performed using antegrade locked intramedullary nailing in our hospital setting to evaluate the incidence of complications associated with this method of humeral shaft fracture fixation. Results: Superficial wound infection occurred in four cases (8%). Shortening of one cm was observed in one case (2%) and troublesome shoulder pain remained in two patients (4%). Persistent restriction of shoulder movements remained in twelve patients (24%) at 6 months, non-union occurred in two patients (4%), iatrogenic transient radial nerve palsy occurred in four patients (8%). Two patients (8%) developed myositis ossificans of shoulder joint and two patient (8%) developed hypertrophy of scar. Conclusion: A number of technical errors and complications, which we consider technique specific, were registered. The analysis and avoidance of these complications, related to intramedullary nailing of the humerus, will allow intramedullary nails to successfully bridge the gap between bracing and plating

Discussion and expostulations on postoperative worsening of hearing following middle ear surgeries

Abstract Background Hearing assessment after middle ear surgery has always been of interest to otologists for one of its major unavoidable and unpredictable complication is hearing loss. As the initial indication for operation is to treat precisely this problem, this complication poses a major dilemma for surgeons. We, thus, aimed to detect the proportion of postoperative worsening of hearing, causes, and risk factors in patients undergoing middle ear surgery. Method This retrospective descriptive study was conducted in the department of otolaryngology of a tertiary care center and data of medical records were retrieved from January 2016 until December 2020. This study included middle ear surgery patients with pre- and postoperative audiometric results. Those patients whose hearing worsened post-operatively (where bone conduction deteriorated > 10 dB) were noted and assessed accordingly. Results The medical records regarding morphological and audiological outcomes of 178 patients were available. We observed auditory degradation after surgery in eight patients (five primary cases and three revision cases), with an overall incidence rate of 4.49%. The mastoidectomy was performed in seven cases, either cortical (n = 5) and modified radical (n = 2). Modified radical mastoidectomy showed the greatest incidence of hearing loss (40%) among all surgical procedures. Except in one case, where sudden, profound loss occurred following otorrhoea on third day, hearing loss was progressive in rest of cases. Conclusion A patient with deteriorating hearing after middle ear surgery must be evaluated properly. There is an increased chance of hearing loss following surgery that involves more ossicular manipulation, drilling, extensive disease clearance, and revision. Utmost care must be taken while operating around ossicles and during disease clearance in key areas. Proper consent should be taken from such patients to avoid future litigations

Integrated Nutrient Management Improves the Productivity and Nutrient Use Efficiency of Lens culinaris Medik.

Enhancing nutrient use efficiencies (NUEs) is an important factor in achieving the long-term sustainability of a production system. Our two-year experiment was aimed at accessing the NUEs of the integration of macro- and micronutrient fertilization responses of three lentil (Lens culinaris) cultivars. Three cultivars were planted in the main plots, and ten nutrient combinations were used in the sub-plots: N1, control; N2, 100% recommended dose of fertilizers (RDF) (20:40—N:P2O5); N3, vermicompost (VC) at 2 t ha−1; N4, 50% recommended dose of nitrogen (RDN) + 100% recommended dose of phosphorus (RDP) + VC at 1 t ha−1; N5, RDF + 0.5% ZnSO4; N6, RDF + 0.5% FeSO4; N7, RDF + 0.5% ZnSO4 + 0.5% FeSO4; N8, 50% RDN + 100% RDP + VC at 1 t ha−1 + 0.5% ZnSO4; N9, 50% RDN + 100% RDP + VC at 1 t ha−1 + 0.5% FeSO4; and N10, 50% RDN + 100% RDP + VC at 1 t ha−1 + 0.5% ZnSO4 + 0.5% FeSO4. The results show that the cultivar HM-1 (1.59–1.61 Mg ha−1) recorded a significantly higher seed yield than cultivars Sapna (1.31–1.33 Mg ha−1) and Garima (both 1.30 Mg ha−1), while the cultivar Sapna had significantly more stover yield (1.86–1.90 Mg ha−1) than cultivar HM-1 (1.68–1.73 Mg ha−1). Cultivar HM-1 was more efficient in terms of partial factor productivity for N (77.5–78.5 kg kg−1), P (48.2–48.7 kg kg−1), K (143.6–145.5 kg kg−1), Zn (1336–1352 kg kg−1), and Fe (417–421 kg kg−1) than Sapna and Garima. Application of 50% N + 100% P + VC at 1.0 t ha−1 + 0.5% ZnSO4 + 0.5% FeSO4 resulted in higher seed yield (1.63–1.65 Mg ha−1) and agronomic efficiency for N (26.3–28.8 kg kg−1), P (12.42–13.63 kg kg−1), and K (52.3–57.4 kg kg−1) over other tested practices in both years. Hence, it could be concluded that considering the integrated nutrient management paradigm including 10 kg N ha−1 coupled with 40 kg P2O5 ha−1 through synthetic fertilizers, vermicomposting 1.0 t ha−1 as an organic source and foliar spray of 0.5% each of ZnSO4 and FeSO4 (N10) produced a 56.8% higher seed yield than the control, in addition to improving nutrient dynamics and NUEs for N, P, K, Zn, and Fe. Therefore, integrated fertilization coupled with cultivar selection could help to achieve the long-term food and nutritional sustainability targeted by the Sustainable Development Goals (SDGs)