COMPARISON OF DOCUMENTED PATIENT CARE BEFORE AND AFTER IMPLEMENTATION OF END OF LIFE CARE PATHWAY FOR TERMINALLY ILL PATIENTS AT SHAUKAT KHANUM MEMORIAL CANCER HOSPITAL AND RESEARCH CENTRE

Purpose: Shaukat Khanum Memorial Cancer Hospital and Research Cancer primarily deals with cancer patients and has various departments which provide best-integrated lifesaving care. However, when patients who have been given all possible medical and oncological treatment still progress their disease, they are then referred for best supportive care to palliative care department. The aim of this paper was to audit documented care for palliative patients before and after implementation of end of life care (ELC) pathway.Materials and Methods: We used a retrospective method to audit 45 terminally ill patients over a period of 3 months. Then, a re-audit was done over a period of 3 months and data were collected for patients who were started on SKM-ELC pathway.Results: Results show that the implementation of ELC pathway, 67% of the patients were not prescribed PRN medications for symptom control, 20% of the patients were not reviewed for the need of assisted nutrition and for 20% of the patient’s primary team were not even notified that the patient is dying. After the ELC pathway implementation, it was found that 100% of patients were reviewed for PRN medications and assisted nutrition. Oncologists were timely notified that the patient is dying.Conclusion: In summary, we can say that implantation of ELC pathway has significantly improved documented patients care in all aspects.Key words: Cancer, care for dying, end of life care, goals of care pathwa

Increased Depth of Cellular Imaging in the Intact Lung Using Far-Red and Near-Infrared Fluorescent Probes

Scattering of shorter-wavelength visible light limits the fluorescence imaging depth of thick specimens such as whole organs. In this study, we report the use of four newly synthesized near-infrared and far-red fluorescence probes (excitation/emission, in nm: 644/670; 683/707; 786/814; 824/834) to image tumor cells in the subpleural vasculature of the intact rat lungs. Transpelural imaging of tumor cells labeled with long-wavelength probes and expressing green fluorescent protein (GFP; excitation/emission 488/507 nm) was done in the intact rat lung after perfusate administration or intravenous injection. Our results show that the average optimum imaging depth for the long-wavelength probes is higher (27.8 ± 0.7  μm) than for GFP (20 ± 0.5  μm; p = 0.008; n = 50), corresponding to a 40% increase in the volume of tissue accessible for high-resolution imaging. The maximum depth of cell visualization was significantly improved with the novel dyes (36.4 ± 1  μm from the pleural surface) compared with GFP (30.1 ± 0.5  μm; p = 0.01; n = 50). Stable binding of the long-wavelength vital dyes to the plasma membrane also permitted in vivo tracking of injected tumor cells in the pulmonary vasculature. These probes offer a significant improvement in the imaging quality of in situ biological processes in the deeper regions of intact lungs

Experimental Performance Analysis Of Macrobending Loss Characteristics In Polymer Optical Fiber

An investigation of bending loss characteristics of a Polymer Optical Fiber is presented experimentally. Loss of optical power in an optical fiber due to bending has been investigated for a wavelength of 650 nm. Variations of bending loss with different lengths have been measured, with a number of radii of curvature. Bending Loss equations for short length POF is proposed, which shows the dependence of bending loss on the curvature radii. The equations can be an initial reference or aid in predicting the loss contributes by the polymer optical fiber

Anticoagulant-administered pulmonary embolism in post-cholecystectomy: choosing the lesser of the two evils

Introduction: Anticoagulant or blood thinning agents are well-established as the first line for pulmonary embolism treatment. It is vital in order to prevent the existing clot from enlarging and new clots from forming. It is known to increase the risk of bleeding, however not many cases have been reported to cause liver injury or hematoma. Case: We present a case of an 82-year-old male who underwent cholecystectomy for ruptured gallbladder empyema. Post-operative, he was complicated with multiple intra-abdominal collections and perihepatic infected hematoma. He also developed segmental pulmonary embolism which required anticoagulant. The dilemma occurred when he became hypotensive and dropping hemoglobin levels with repeated CT angiogram revealed new subcapsular hematoma with liver lacerations. Conclusion: Even though anti-coagulants rarely cause spontaneous liver hemorrhage, a thorough risk-benefit assessment needs to be performed in patients who underwent liver-related surgery since both liver haemorrhage and pulmonary embolism carries mortality risk to the patient. This is important to balance the need to prevent traumatic or possible spontaneous liver haemorrhage with the demand to treat the on-going pulmonary embolism

Source rock geochemical assessment and estimation of TOC using well logs and geochemical data of Talhar Shale, Southern Indus Basin, Pakistan

Assessment of organic carbon content (TOC) by geophysical logs has been a challenging task in the formation evaluation of shale gas. This research is conducted to estimate the unconventional hydrocarbon (shale-gas) potential of Talhar Shale in the Southern Indus Basin (SIB), Pakistan. In this study, total organic carbon content (%) was estimated through well logs by different methods and then correlated with well cuttings/core data to determine the best method for estimation of TOC content especially when well cuttings/core data are not available. The Talhar Shale’s thermal maturity, as well as the organic content, were assessed from geochemical analyses. Talhar Shale of Dangi-01 well has good to very good source potential whereas Chak7A-01 well has fair-good. According to Ven Krevalen cross-plot, Talhar Shale of Dangi-01 well has type III kerogen; it can only produce gas while Chak7A-01 has type II/III kerogen which produces both oil and gas. The TOC was estimated using two methods i.e., Schmoker’s and Hester’s and Multivariate Fitting methods. The estimated TOC is then correlated with well cuttings data and concluded that the Multivariate Fitting method is selected as an optimized method for estimation of TOC because it shows strong correlation values of 0.93 and 0.91 in both wells respectively for Talhar Shale SIB, Pakistan

TCT-545 Angiographic Features, Lesion, and Procedural Characteristics in Patients With Chronic Kidney Disease Undergoing Protected High-Risk Percutaneous Coronary Intervention

Background: Patients with chronic kidney disease (CKD) are at risk for accelerated atherosclerosis. There is a paucity of data regarding coronary lesion characteristics and procedural details of CKD patients, especially those on dialysis, undergoing high-risk percutaneous coronary intervention (HRPCI) with left ventricular support. Methods: We analyzed patients from the PROTECT III study who underwent Impella-supported HRPCI, stratified into 3 groups according to kidney function status based on history: 1) normal kidney function; 2) CKD not on dialysis; and 3) CKD on dialysis. Baseline characteristics, angiographic features, and procedural details were assessed. Results: The study population included 3,702 treated lesions in 1,223 patients with a mean age of 71 ± 11 years; 73% (893) were male, 68% (834) had normal kidney function (serum creatinine = 1 mg/dL [IQR: 0.9-1.2]), 23% (278) had CKD not on dialysis (serum creatinine = 1.6 mg/dL [IQR: 1.3-1.9]), and 9% (111) were on dialysis. Patients on dialysis were significantly younger and had more comorbidities, as well as a greater incidence of acute myocardial infarction as an indication for HRPCI compared with the other 2 groups (45.0 [dialysis] vs 30.1 [CKD not on dialysis] vs 36.0 [normal kidney function]; P = 0.03). There was no difference between groups in prevalence of 3-vessel disease (P = 0.63). Patients on dialysis had greater prevalence of severely calcified lesions and higher use of rotational and orbital atherectomy with greater number of passes (Table 1). Despite this, no significant differences were observed in post-PCI Thrombolysis In Myocardial Infarction flow, incidence of no-reflow, or dissection/perforation. Conclusion: In contrast to patients with normal kidney function, patients with CKD with or without dialysis treated with Impella had more comorbidities, higher prevalence of severely calcified lesions, and greater use of atherectomy with more passes. Despite the complexity of PCI, no significant differences in complications were observed. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP

TCT-99 Short- and Long-Term Outcomes of Patients With Chronic Kidney Disease Undergoing Protected High-Risk Percutaneous Coronary Intervention

Background: Patients with chronic kidney disease (CKD) and concomitant multivessel coronary artery disease (CAD) with or without left ventricular dysfunction often have high surgical risk and are declined for coronary artery bypass grafting. There is little data regarding clinical outcomes in these patients undergoing high-risk PCI (HRPCI) using Impella. Methods: We analyzed patients from the PROTECT III Study who underwent Impella-supported HRPCI and stratified them into 3 groups by kidney function status based on history: 1) normal kidney function, 2) CKD without dialysis, and 3) CKD with dialysis. We compared the composite incidence of major adverse cardiac and cerebrovascular events (MACCE) rate, defined as all-cause death, myocardial infarction (MI), stroke/transient ischemic attack (TIA), and repeat revascularization at 30 and 90 days. Results: We included 1,223 patients, aged 71 ± 11 years; 73% (893) were men, 68% (834) had normal kidney function (serum creatinine [Cr] 1.1 mg/dL, IQR 0.9-1.2), 23% (278) had CKD without dialysis (Cr 1.7 mg/dL, IQR 1.3-1.9), and 9% (111) were on dialysis. Patients on dialysis were younger with more comorbidities such as diabetes, heart failure, anemia, PVD and prior stroke. HRPCI status (urgent or elective), proportion of acute MI, and mean SYNTAX scores were similar. No significant differences in MACCE were shown between groups at 30 days or 90 days (Table). Patients with normal kidney function had comparable risks of 30-day and 90-day MACCE compared with CKD patients without dialysis with Cox proportional hazards analysis, and lower risk of 90-day MACCE compared to CKD patients with dialysis. Notably, CKD patients with or without dialysis also had similar 90-day MACCE risk (Table). Conclusion: Patients with CKD and dialysis undergoing HRPCI exhibit higher risk for 90-day MACCE compared to patients with normal kidney function. CKD patients without dialysis also had higher risk of MI at 90 days. Further research is needed. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP

Mathematical Modelling of a Static Concentrating Photovoltaic: Simulation and Experimental Validation

For the past twenty years, there has been increasing interest and investment in solar pho-tovoltaic (PV) technology. One particular area of interest is the development of concentrating PV (CPV), especially for use in building integration. Many CPV designs have been developed and investigated. This paper aims at producing a mathematical modelling using MATLAB programme to predict the current-voltage (I-V) and power-voltage (P-V) characteristics of a static CPV. The MATLAB programme could also simulate the angular response of the CPV designs-which has never been explored in the previous literature. In this paper, a CPV known as the rotationally asymmetrical dielectric totally internally reflecting concentrator (RADTIRC) was analysed. A specific RAD-TIRC design that has an acceptance angle of ±40° was investigated in this paper. A mathematical modelling was used to simulate the angular characteristics of the RADTIRC from −50° to 50° with an increment 5°. For any CPV, we propose that the value of opto-electronic gain, Copto-e needs to be included in the mathematical model, which were obtained from experiments. The range of incident angle (±50°) was selected to demonstrate that the RADTIRC is capable of capturing the sun rays within its acceptance angle of ±40°. In each simulation, the I-V and P-V characteristics were produced , and the short circuit current (Isc), the open-circuit voltage (Voc), the maximum power (Pmax), the fill factor (FF) and the opto-electronic gain (Copto-e) were determined and recorded. The results from the simulations were validated via experiments. It was found that the simulation model is able to predict the I-V and P-V characteristics of the RADTIRC as well as its angular response, with the highest error recorded for the Isc, Voc, Pmax, FF and Copto-e was 2.1229%, 5.3913%, 9.9681%, 4.4231% and 0.0000% respectively when compared with the experiment

Connexin-43 upregulation in micrometastases and tumor vasculature and its role in tumor cell attachment to pulmonary endothelium

<p>Abstract</p> <p>Background</p> <p>The modulation of gap junctional communication between tumor cells and between tumor and vascular endothelial cells during tumorigenesis and metastasis is complex. The notion of a role for loss of gap junctional intercellular communication in tumorigenesis and metastasis has been controversial. While some of the stages of tumorigenesis and metastasis, such as uncontrolled cell division and cellular detachment, would necessitate the loss of intercellular junctions, other stages, such as intravasation, endothelial attachment, and vascularization, likely require increased cell-cell contact. We hypothesized that, in this multi-stage scheme, connexin-43 is centrally involved as a cell adhesion molecule mediating metastatic tumor attachment to the pulmonary endothelium.</p> <p>Methods</p> <p>Tumor cell attachment to pulmonary vasculature, tumor growth, and connexin-43 expression was studied in metastatic lung tumor sections obtained after tail-vein injection into nude mice of syngeneic breast cancer cell lines, overexpressing wild type connexin-43 or dominant-negatively mutated connexin-43 proteins. High-resolution immunofluorescence microscopy and Western blot analysis was performed using a connexin-43 monoclonal antibody. Calcein Orange Red AM dye transfer by fluorescence imaging was used to evaluate the gap junction function.</p> <p>Results</p> <p>Adhesion of breast cancer cells to the pulmonary endothelium increased with cancer cells overexpressing connexin-43 and markedly decreased with cells expressing dominant-negative connexin-43. Upregulation of connexin-43 was observed in tumor cell-endothelial cell contact areas <it>in vitro </it>and <it>in vivo</it>, and in areas of intratumor blood vessels and in micrometastatic foci.</p> <p>Conclusion</p> <p>Connexin-43 facilitates metastatic 'homing' by increasing adhesion of cancer cells to the lung endothelial cells. The marked upregulation of connexin-43 in tumor cell-endothelial cell contact areas, whether in preexisting 'homing' vessels or in newly formed tumor vessels, suggests that connexin-43 can serve as a potential marker of micrometastases and tumor vasculature and that it may play a role in the early incorporation of endothelial cells into small tumors as seeds for vasculogenesis.</p