Status Epilepticus: Etiology, Outcome and Predictors of Mortality

ObjectiveThis study was designed to determine the etiology of status epilepticus (SE) andits relation to mortality.Materials and MethodsThis descriptive study was carried out based on the medical records of 40 patients with diagnosis of SE discharged from pediatric hospital of Bandar Abbas between March 2002 and March 2004. Multivariant analysis was pereformed to determine the prevalence of the disorder and the relation between SE and other factors such as gender, age, response to treatment, and mortality. We classified the etiology according to international league against epilepsy (ILAE) classification and also uses another classification regarding underlying causes such as fever (non-CNS infection), central nervous system infection, hypoxia, and metabolic causes.ResultsStatus epilepticus was responsible for 0.3% of all hospital  dmissions during the study period. Based on the ILAE classification, frequencies for acute symptomatic, febrile, progressive encephalopathic, remote, and cryptogenic SE were 42.5%, 32.5%, 10%, 7.5%, and 7.5%, respectively.The most common underlying causes resulting in SE were fever (45%), metabolic disorders (15%), CNS infection (12.5%), chronic neurologic diseases (7.5%), idiopathic (7.5%), hypoxia (5%), drug withdrawal (2.5%), CNS hemorrhage (2.5%), neurodegenerative disease (2.5%), brain abscess (2.5%), and post DPT (Diphteria,Pertusis,Tetanus) vaccination (2.5%). Mortality rate was 25% (80% in the patients younger than 5 years and 40% in those aged less than 1 year). Occurrence of SE and its mortality was found to be related to age (p< 0.05).ConclusionFor SE, if seizures continue for more than 5 minutes, treatment must beinitiated. The outcome is determined by etiology, age, seizure duration and management; however, all we can do is enhance the management and increase its effectiveness

99mTc-MIBI Lung Scintigraphy in the Assessment of Pulmonary Involvement in Interstitial Lung Disease and Its Comparison With Pulmonary Function Tests and High-Resolution Computed Tomography: A Preliminary Study

The differentiation of active inflammatory processes from an inactive form of the disease is of great value in the management of interstitial lung disease (ILD). The aim of this investigation was to assess the efficacy of 99mTc-methoxy-isobutyl-isonitrile (99mTc-MIBI) scans in distinguishing the severity of the disease compared to radiological and clinical parameters.In total, 19 known cases of ILD were included in this study and were followed up for 1 year. Five patients without lung disease were considered as the control group. The patients underwent pulmonary function tests (PFTs) and high-resolution computed tomography scans, followed by 99mTc-MIBI scanning. The 99mTc-MIBI scans were analyzed either qualitatively (subjectively) or semiquantitatively.All 19 ILD patients demonstrated a strong increase in 99mTc-MIBI uptake in the lungs compared to the control group. The 99mTc-MIBI scan scores were higher in the patient group in both the early phase (0.240.19-0.31 vs 0.110.10-0.15, P 0.14). The 99mTc-MIBI scan scores were not significantly correlated with the PFT findings (P > 0.05). In total, 5 patients died and 14 patients were still alive over the 1-year follow-up period. There was also a significant difference between the uptake intensity of 99mTc-MIBI and the outcome in the early phase (dead: 0.320.29-0.43 vs alive: 0.210.18-0.24, P < 0.05) and delayed phase (dead: 0.270.22-0.28 vs alive: 0.100.07-0.19, P < 0.05).The washout rate was ~40 min starting from 20 min up to 60 min and this rate was significantly different in our 2 study groups (ILD: 46.6115.61-50.39 vs NL: 70.9127.09-116.36, P = 0.04).The present study demonstrated that 99mTc-MIBI lung scans might distinguish the severity of pulmonary involvement in early views, which were well correlated with HRCT findings. These results also revealed that 99mTc-MIBI lung scans might be used as a complement to other diagnostic and clinical examinations in terms of functional information in ILD; however, further investigations are strongly required

Building change detection by W-shape resunet++ network with triple attention mechanism

Building change detection in high resolution remote sensing images is one of the most important and applied topics in urban management and urban planning. Different environmental illumination conditions and registration problem are the most error resource in the bitemporal images that will cause pseudochanges in results. On the other hand, the use of deep learning technologies especially convolutional neural networks (CNNs) has been successful and considered, but usually causes the loss of shape and detail at the edges. Accordingly, we propose a W-shape ResUnet++ network in which images with different environmental conditions enter the network independently. ResUnet++ is a network with residual blocks, triple attention blocks and Atrous Spatial Pyramidal Pooling. ResUnet++ is used on both sides of the network to extract deeper and discriminator features. This improves the channel and spatial inter-dependencies, while at the same time reducing the computational cost. After that, the Euclidean distance between the features is computed and the deconvolution is done. Also, a dual loss function is designed that used the weighted binary cross entropy to solve the unbalance between the changed and unchanged data in change detection training data and in the second part, we used the mask–boundary consistency constraints that the condition of converging the edges of the training data and the predicted edge in the loss function has been added. We implemented the proposed method on two remote sensing datasets and then compared the results with state-of-the-art methods. The F1 score improved 1.52 % and 4.22 % by using the proposed model in the first and second dataset, respectively

Free volume variation with molecular weight of polymers

Free volume measurements were made in several molecular weight fractions of two different geometries of poly(arylene ether ketone)s. Free volumes were measured using positron lifetime spectroscopy. It has been observed that the free volume cell size V(sub f) varies with the molecular weight M of the test samples according to an equation of the form V(sub f) = AM(B), where A and B are constants. The molecular weights computed from the free volume cell sizes are in good agreement with the values measured by gel permeation chromatography

The effect of fractal-like mechanical ventilation on vital signs in a rat model of acute-on-chronic liver failure

OBJECTIVE: The network of interactions between different organs is impaired in liver cirrhosis. Liver cirrhosis is associated with multi-system involvement, which eventually leads to multiple organ failure. This process is accelerated by a precipitating factor such as bacterial infection, which leads to respiratory distress, circulatory shock, neural dysfunction and very high mortality. Cirrhotic patients often have blunted respiratory sinus arrhythmia and impaired cardio-respiratory variability. Fractal-like mechanical ventilation is reported to enhance respiratory sinus arrhythmia and attenuate respiratory distress in experimental models. In the present study we hypothesise that fractal-like mechanical ventilation may improve the outcome of cirrhotic rats with multiple organ failure. APPROACH: Cirrhosis was induced by chronic biliary obstruction in rats. Acute multiple organ failure was induced by intraperitoneal injection of bacterial endotoxin in cirrhotic rats. The effect of conventional mechanical ventilation (with constant tidal volume and respiratory rate) or fractal-like ventilation (with the same average but variable tidal volume and respiratory rate) were assessed on vital signs, oxygen saturation and plasma alanine aminotransferase in anaesthetised cirrhotic rats. MAIN RESULTS: We demonstrated that fractal-like mechanical ventilation was accompanied by improved oxygen saturation, reduced heart rate and decreased liver injury following injection of bacterial endotoxin. Moreover, variable mechanical ventilation in cirrhotic rats reduced mortality and prevented a fall in short-term heart rate variability following endotoxin challenge in comparison with rats with constant mechanical ventilation. Significance: We suggest further investigations into the beneficial effects of fractal-like ventilation strategy in critically ill patients with liver failure requiring organ support and mechanical ventilation

Empirical constraints on the origin of fast radio bursts: volumetric rates and host galaxy demographics as a test of millisecond magnetar connection

The localization of the repeating FRB 121102 to a low-metallicity dwarf galaxy at $z=0.193$, and its association with a quiescent radio source, suggests the possibility that FRBs originate from magnetars, formed by the unusual supernovae in such galaxies. We investigate this via a comparison of magnetar birth rates, the FRB volumetric rate, and host galaxy demographics. We calculate average volumetric rates of possible millisecond magnetar production channels such as superluminous supernovae (SLSNe), long and short gamma-ray bursts (GRBs), and general magnetar production via core-collapse supernovae. For each channel we also explore the expected host galaxy demographics using their known properties. We determine for the first time the number density of FRB emitters (the product of their volumetric birthrate and lifetime), $R_{\rm FRB}\tau\approx 10^4$Gpc$^{-3}$, assuming that FRBs are predominantly emitted from repetitive sources similar to FRB 121102 and adopting a beaming factor of 0.1. By comparing rates we find that production via rare channels (SLSNe, GRBs) implies a typical FRB lifetime of $\approx$30-300 yr, in good agreement with other lines of argument. The total energy emitted over this time is consistent with the available energy stored in the magnetic field. On the other hand, any relation to magnetars produced via normal core-collapse supernovae leads to a very short lifetime of $\approx$0.5yr, in conflict with both theory and observation. We demonstrate that due to the diverse host galaxy distributions of the different progenitor channels, many possible sources of FRB birth can be ruled out with $\lesssim 10$ host galaxy identifications. Conversely, targeted searches of galaxies that have previously hosted decades-old SLSNe and GRBs may be a fruitful strategy for discovering new FRBs and related quiescent radio sources, and determining the nature of their progenitors

Anti-melanocortin-4 receptor autoantibodies in obesity

Background: The melanocortin-4 receptor (MC4R) is part of an important pathway regulating energy balance. Here we report the existence of autoantibodies (autoAbs) against the MC4R in sera of obese patients. Methods: The autoAbs were detected after screening of 216 patients' sera by using direct and inhibition ELISA with an N-terminal sequence of the MC4R. Binding to the native MC4R was evaluated by flow cytometry and pharmacological effects by measuring adenylyl cyclase activity. Results: Positive results in all tests were obtained in patients with overweight or obesity (prevalence: 3.6%) but not in normal weight patients. The selective binding properties of anti-MC4R autoAbs were confirmed by surface plasmon resonance and by immunoprecipitation with the native MC4R. Finally it was demonstrated that these autoAbs increased food intake in rats after passive transfer via intracerebroventricular injection. Conclusion: These observations suggest that inhibitory anti-MC4R autoAbs might contribute to the development of obesity in a small subpopulation of patients