Utilization of extracorporeal membrane oxygenation during the COVID-19 pandemic.

The ongoing outbreak of severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2, or coronavirus disease 2019 (COVID-19)] was declared a pandemic by the World Health Organization on March 11, 2020. Worldwide, more than 65 million people have been infected with this SARS-CoV-2 virus, and over 1.5 million people have died due to the viral illness. Although a tremendous amount of medical progress has been made since its inception, there continues to be ongoing research regarding the pathophysiology, treatments, and vaccines. While a vast majority of those infected develop only mild to moderate symptoms, about 5% of people have severe forms of infection resulting in respiratory failure, myocarditis, septic shock, or multi-organ failure. Despite maximal cardiopulmonary support and invasive mechanical ventilation, mortality remains high. Extracorporeal membrane oxygenation (ECMO) remains a valid treatment option when maximal conventional strategies fail. Utilization of ECMO in the pandemic is challenging from both resource allocation and ethical standpoints. This article reviews the rationale behind its use, current status of utilization, and future considerations for ECMO in critically ill COVID-19 patients

An Investigation of Temperature and Wind Impact on ACSR Transmission Line Sag and Tension

Power transmission is mainly based on overhead transmission lines with conductors being supported by transmission towers. Transmission lines are subjected to environmental stress (temperature changes, winds, snow etc), have an impact on the surrounding areas (visual pollution, building restrictions) and experience heavy losses due to resistive, magnetic and capacitive effects. Thus, proper modeling and installation of these conductors are necessary. The conductors are generally installed in a catenary shape to minimize the capacitive effects and to balance the tension. This paper presents an investigation on the sag and tension behavior under different temperature and wind of ACSR (Aluminum Conductor-Steel Reinforced) lines. Four different cases of temperature and wind are tested to calculate sag and tension. Simulation setup is done in ETAP (electrical transient and analysis program). Results are recorded and discussed

Chromosomal deletions on 16p11.2 encompassing SH2B1 are associated with accelerated metabolic disease.

New approaches are needed to treat people whose obesity and type 2 diabetes (T2D) are driven by specific mechanisms. We investigate a deletion on chromosome 16p11.2 (breakpoint 2-3 [BP2-3]) encompassing SH2B1, a mediator of leptin and insulin signaling. Phenome-wide association scans in the UK (N = 502,399) and Estonian (N = 208,360) biobanks show that deletion carriers have increased body mass index (BMI; p = 1.3 × 10 <sup>-10</sup> ) and increased rates of T2D. Compared with BMI-matched controls, deletion carriers have an earlier onset of T2D, with poorer glycemic control despite higher medication usage. Cystatin C, a biomarker of kidney function, is significantly elevated in deletion carriers, suggesting increased risk of renal impairment. In a Mendelian randomization study, decreased SH2B1 expression increases T2D risk (p = 8.1 × 10 <sup>-6</sup> ). We conclude that people with 16p11.2 BP2-3 deletions have early, complex obesity and T2D and may benefit from therapies that enhance leptin and insulin signaling

Engineering of Phenylboronic Acid Based Glucose-Sensitive Microgels with 4-Vinylpyridine for Working at Physiological pH and Temperature

Glucose-sensitive p(NIPAM-4-VP-PBA) microgels with different 4-VP content are synthesized by the functionalization of p(NIPAM-4-VP-AA) microgels with 3-aminophenylboronic acid. The glucose-, pH-, and thermosensitive behavior of the microgels are investigated using DLS. The feeding content of the hydrophilic 4-VP group increases the hydrodynamic radius and volume phase transition temperature of the resultant microgel. The effect of 4-VP content on hydrodynamic radius and volume phase transition is systematically studied at different pH values. The effect of 4-VP content on the glucose sensitivity is studied at physiological pH and temperature. The Lewis base moiety 4-VP adjusts the working pH of the PBA-based glucose-responsive microgel to physiological values

Human west nile virus disease outbreak in Pakistan, 2015–2016

Like most of the world, Pakistan has seen an increase in mosquito-transmitted diseases in recent years. The magnitude and distribution of these diseases are poorly understood as Pakistan does not have a nation-wide system for reporting disease. A cross-sectional study to determine which flaviviruses were causing of arboviral disease in Pakistan was instituted. West Nile virus (WNV) is a cause of seasonal fever with neurotropic findings in countries that share borders with Pakistan. Here, we describe the active and persistent circulation of WNV in humans in the southern region of Pakistan. This is the first report of WNV causing neurological disease in human patients in this country. Of 997 enrolled patients presenting with clinical features suggestive of arboviral disease, 105 were positive for WNV IgM antibodies, and 71 of these patients possessed WNV-specific neutralizing antibodies. Cross-reactivity of WNV IgM antibodies with Japanese encephalitis virus(JEV) occurred in 75 of these 105 patients. WNV co-infections with Dengue viruses were not a contributing factor for the severity of disease. Nor did prior exposure to dengue virus contribute to incidence of neurological involvement in WNV-infected patients. Patients with WNV infections were more likely to present with altered mental status, seizures, and reduced Glasgow Coma scores when compared with JEV-infected patients. Human WNV cases and vector numbers exhibited a temporal correlation with climate

Predicting the effect of voids on mechanical properties of woven composites.

An accurate yet easy to use methodology for determining the effective mechanical properties of woven fabric reinforced composites is presented. The approach involves generating a representative unit cell geometry based on randomly selected 2D orthogonal slices from a 3D X-ray micro-tomographic scan. Thereafter, the finite element mesh is generated from this geometry. Analytical and statistical micromechanics equations are then used to calculate effective input material properties for the yarn and resin regions within the FE mesh. These analytical expressions account for the effect of resin volume fraction within the yarn (due to infiltration during curing) as well as the presence of voids within the composite. The unit cell model is then used to evaluate the effective properties of the composite.DelPHE 780 Project funded by UK Department of International Development (DFID), through British Council managed DelPHE scheme

Hepatocellular carcinoma in Pakistan: where do we stand?

Context: From the 1970s till the mid 1990s, hepatitis B was the most common etiological factor for hepatocellular carcinoma (HCC) in Pakistan. Afterwards, a shift in HCC etiology was observed with a steady rise in hepatitis C virus (HCV) related HCC cases. HCV-3a, which is the most prevalent genotype, is also most frequent in HCV related HCC. There was an increase in the proportion of non-B non-C (NBNC) HCC cases as well, which might be attributed to an increase in non-alcoholic fatty liver disease. Evidence Acquisition: The age-standardized rate for HCC is 7.64/100 000 in males and 2.8/100 000 in females. Male to female ratio is 3.6:1. Usual age of presentation is in the fifth and sixth decade. Most patients present with advanced disease, as they are not in a regular surveillance program. This is more so for patients with NBNC chronic liver disease. As many sonologists in Pakistan are practicing without sufficient training to pick up early lesions, alpha-fetoprotein is still recommended to compliment ultrasound in the surveillance of HCC. Results: Majority of HCC patients present with nonresectable disease. Interventions such as transarterial chemoembolization, radiofrequency ablation, resection and chemotherapy including sorafenib are available in selected centers. Pakistan appears to be in an area of intermediate endemicity for HCC. There is a need for population based epidemiological studies to estimate the exact disease burden. Conclusions: Measures to prevent the spread of hepatitis C and B can slow down the epidemic rise in the incidence of HCC in the coming decades. There is a need to implement a proper surveillance program to identify HCC cases at an early stage

Exploring the potential of four medicinal plants for antioxidant enzymes activity, proximate and nutritional composition

A study was conducted to evaluate the antioxidant enzymes activity, proximate and nutritional composition of four medicinal plants, which may contribute to folk pharmacological use in the treatment of different diseases. Plant samples were extracted and antioxidant enzymes like superoxide dismutase (SOD), peroxidase (POD), polyphenol oxidase (PPO) and ascorbate peroxide (APX) activity were estimated. Medicinal plants were also analysed for moisture, ash, protein, fibre, carbohydrate, and fats contents. Plant samples were wet digested and mineral composition in terms of nitrogen (N), phosphorus (P), potassium (K), calcium (Ca), magnesium (Mg), and sodium (Na) was determined. The results revealed that antioxidant activity, proximate and nutritional composition differs significantly among tested medicinal plants extract. The leaves of medicinal plants showed more proximate composition (moisture contents, crude protein, fats contents), nutrient accumulation (N, P, K, Ca, Mg and Na), and antioxidant enzymes (POD, PPO, and APX activity). Among medicinal plants, Tribulus terrestris L. showed the highest amount of crude protein, crude fibre, gross energy, and N and Ca contents. Maximum K, Mg, Na contents, POD, PPO and APX activity was observed in Cenchrus ciliaris L. The ash, fats, phosphorus and SOD activity was more in Euphorbia hirta L. While, Cyperus rotundus L. produced maximum carbohydrates concentration among the tested plants. It is concluded that the target medicinal species had emerged as a good source of the antioxidant and nutritive source, which could play an important role in human nutrition. The extracts of these plants parts can be used in the synthesis of mineral and antioxidant-containing drugs and medicines. This study will provide a baseline for the pharmacology industry

From monogenic to polygenic obesity: recent advances

The heritability of obesity and body weight in general is high. A small number of confirmed monogenic forms of obesity—the respective mutations are sufficient by themselves to cause the condition in food abundant societies—have been identified by molecular genetic studies. The elucidation of these genes, mostly based on animal and family studies, has led to the identification of important pathways to the disorder and thus to a deeper understanding of the regulation of body weight. The identification of inborn deficiency of the mostly adipocyte-derived satiety hormone leptin in extremely obese children from consanguineous families paved the way to the first pharmacological therapy for obesity based on a molecular genetic finding. The genetic predisposition to obesity for most individuals, however, has a polygenic basis. A polygenic variant by itself has a small effect on the phenotype; only in combination with other predisposing variants does a sizeable phenotypic effect arise. Common variants in the first intron of the ‘fat mass and obesity associated’ gene (FTO) result in an elevated body mass index (BMI) equivalent to approximately +0.4 kg/m² per risk allele. The FTO variants were originally detected in a genome wide association study (GWAS) pertaining to type 2 diabetes mellitus. Large meta-analyses of GWAS have subsequently identified additional polygenic variants. Up to December 2009, polygenic variants have been confirmed in a total of 17 independent genomic regions. Further study of genetic effects on human body weight regulation should detect variants that will explain a larger proportion of the heritability. The development of new strategies for diagnosis, treatment and prevention of obesity can be anticipated