The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

Design and optimization of a transparent and flexible MIMO antenna for compact IoT and 5G applications

This work presents an optically transparent and flexible MIMO antenna that features two square patch elements placed in close proximity, aiming to meet the demands of compactness, flexibility, optical transparency, and visual appeal for IoT applications and future 5G wireless communication. The design includes a simple offset fed configuration to achieve the required isolation and impedance matching. It simplifies the process of creating closely spaced transparent MIMO antenna configurations. By optimizing and analyzing this structure, the antenna achieves better isolation and diversity gain performance, even when the patch elements are positioned very close to each other. To achieve optical transparency and flexibility, the antenna uses thin polyethylene terephthalate (PET) material as a substrate, which is a thermoplastic polymer resin from the polyester family. The wired metal mesh parameters for conducting parts of the MIMO antenna and offset position of the feed are carefully optimized to achieve required optical transparency, isolation, impedance matching and radiation performance without any complex decoupling or impedance matching network

Pharmacological inhibition of calpain-1 prevents red cell dehydration and reduces Gardos channel activity in a mouse model of sickle cell disease

ABSTRACT Sickle cell disease (SCD) is a globallydistributed hereditary red blood cell (RBC) disorder.One of the hallmarks of SCD is the presence ofcirculating dense RBCs, which are important in SCDrelatedclinical manifestations. In human dense sicklecells, we found reduced calpastatin activity and proteinexpression compared to either healthy RBCs or unfractionatedsickle cells, suggesting an imbalance betweenactivator and inhibitor of calpain-1 in favor of activatorin dense sickle cells. Calpain-1 is a nonlysosomal cysteineproteinase that modulates multiple cell functionsthrough the selective cleavage of proteins. To investigatethe relevance of this observation in vivo, weevaluated the effects of the orally active inhibitor ofcalpain-1, BDA-410 (30 mg/kg/d), on RBCs from SADmice, a mouse model for SCD. In SAD mice, BDA-410improved RBC morphology, reduced RBC density (D20;from 11060.001 to 11000.001 g/ml; P<0.05) andincreased RBC-K content (from 36410 to 42912.3mmol/kg Hb; P<0.05), markedly reduced the activityof the Ca2-activated Kchannel (Gardos channel), anddecreased membrane association of peroxiredoxin-2.The inhibitory effect of calphostin C, a specific inhibitorof protein kinase C (PKC), on the Gardos channelwas eliminated after BDA-410 treatment, which suggeststhat calpain-1 inhibition affects the PKC-dependentfraction of the Gardos channel. BDA-410 preventedhypoxia-induced RBC dehydration and K lossin SAD mice. These data suggest a potential role ofBDA-410 as a novel therapeutic agent for treatment ofSCD