Interventions to prevent hypothermia in extremely preterm low-weight infants undergoing cardiac catheterisation

BACKGROUND: In January 2019, a new device called the Amplatzer Piccolo Occluder was approved by the US Food and Drug Administration for percutaneous closure of patent ductus arteriosus in infants weighing more than 700 g and of postnatal age more than 3 days. Premature low-weight infants are predisposed to hypothermia when transported outside of the thermo-neutral environment. At our institution, 90% of extremely preterm low-weight infants developed transient moderate hypothermia in the cardiac catheterisation suite. METHODS: We conducted a study testing multiple hypotheses aimed at preventing hypothermia in the cardiac catheterisation suite. Interventions included increasing ambient room temperature, reducing exposure to cold environment and reducing overall time spent in the remote location. The primary outcome was the proportion of patients who developed transient hypothermia at the start of the procedure in the cardiac catheterisation suite. The secondary measures included mean core body temperature at four different instances, as well as anaesthesia time, procedure time and radiation exposure. RESULTS: During the study period, 10 patients were enrolled in each group. The postintervention group saw a reduction in transient hypothermia from 90% to 40% (absolute risk reduction 50%, p=0.02). Data analysis showed an improvement in mean core body temperature (35.4°C vs 36.4°C, p\u3c0.01) as well as a smaller percentage drop in temperature (4% vs 1.3%, p\u3c0.01) between the two groups, both of which were statistically significant. The anaesthesia time, procedure time and radiation exposure reduced between the two groups. CONCLUSION: The application of the interventions reduced hypothermia in this high-risk population. The implementation of a protocol with collaboration of a multidisciplinary team is indispensable in providing optimal care to extremely preterm infants

BUSINESS CENTERS: CLASSIFICATIONS, MAIN PROPERTIES AND REQUIREMENTS

Business centers are becoming one of the most important architectural components of modern cities; the need of such centers became a demand due to the concentration of high number of businesses and international businesses within big cities, which created the demand of an architectural cluster of business centers that facilitates running business between enterprises and keep the high concentration of financial flow within one zone.To understand this concept; the article will first note the most important business centers of our modern world, the percentage of companies present, and the medium rental cost. The financial components plays a huge role when it comes to business centers; as they always need funding to be realized, and to be funded they need to be able to produce an equivalent value and profit; in other terms they need to be self-independent buildings, to be able to understand that we need to take a look at the current examples in our world.Moreover, it’s very important to understand the different types of business centers, as they provide a variety of different services not to mention the importance of understanding location requisites depending on the type of business center. In this article the main classification of business centers is explained briefly with an example.Urban requirements and importance is discussed briefly as it is important to understand the concept of CBD (Central Business District) and how it reflects on the hosting cities in many different ways. As our urban formation is changing slowly and architectural demands are changing, it’s important to plan for our future cities to fulfill the objective and create flexibility and comfort, and avoid future complication and unnecessary waste of cost

ARCHITECTURE STUDY OF THENOLD CITY PART OF HOMS

The article is devoted to the study of the current situation in Syria in the city of Homs. The subject of analysis is urban, architectural and social status of Homs neighborhood. The authors aims to give a detailed study of a typical old-Homs neighborhood. An in-depth examination to modify part of the old city of Homs to rearrange and organize the spaces and the formation of fasades in an effort to preserve the architectural heritage scheme.The basis of the research is the comparative methods and collecting of current information and leading to the results.The results of the study are that the authors professional opinion that leads to a better status of the architecture and urban situation in the old city of Homs.The authors supposes that with minimal but well studied interventions to the urban and architecture structure of the old city of Homs we can keep its traditional face for closer link between the new generations and their ancestors.The results of the study can be applied in the sphere of urban planning and architectural design

Disease diagnosis in smart healthcare: Innovation, technologies and applications

To promote sustainable development, the smart city implies a global vision that merges artificial intelligence, big data, decision making, information and communication technology (ICT), and the internet-of-things (IoT). The ageing issue is an aspect that researchers, companies and government should devote efforts in developing smart healthcare innovative technology and applications. In this paper, the topic of disease diagnosis in smart healthcare is reviewed. Typical emerging optimization algorithms and machine learning algorithms are summarized. Evolutionary optimization, stochastic optimization and combinatorial optimization are covered. Owning to the fact that there are plenty of applications in healthcare, four applications in the field of diseases diagnosis (which also list in the top 10 causes of global death in 2015), namely cardiovascular diseases, diabetes mellitus, Alzheimer’s disease and other forms of dementia, and tuberculosis, are considered. In addition, challenges in the deployment of disease diagnosis in healthcare have been discussed

Study on value symbiosis and niche evolution of the corporate venture capital ecological community for innovation and knowledge

Within the context that global scientific and technological innovation continues to break through discipline constraints and achieve cross-domain group breakthrough development, large enterprises are constantly seeking new ways of opening and enabling. Corporate venture capital (CVC) has become an important way for large enterprises to seize knowledge, achieve symbiotic innovation, and explore external resources. By employing the bionics research method and focusing on the symbiosis mechanism between large enterprises and start-ups, this paper conducts an in-depth analysis on the symbiosis motivation, the composition of the symbiosis system, and the symbiosis environment, and explores the evolutionary simulation after the increase or decrease of resource capacity, the intrusion of the innovation population, or the equipotential integration into the innovation ecosystem when the external environmental factors change to verify the coordinated development within the enterprise population and between the enterprise population and the environment. The results show that: (1) The symbiosis, self-consistency, evolution, spillover, and other effects within the CVC ecological community fully realize the “positive sum game” process of both sides; (2) The large enterprise population and entrepreneurial enterprise population in the CVC ecological community form a two-dimensional symbiotic system; and (3) When the resource capacity of the innovation ecosystem changes, the innovation population invades the system with a strong jump in the queue, and the innovation population participates in the system with a weak allelic fusion. This paper points out the influence, interaction, and evolution development laws between enterprise species, enterprise groups, and the innovation system environment and enriches and expands the theory of the relationship between venture capital and enterprise innovation

Statistical analysis of the crowd dynamics in Al-Masjid Al-Nabawi in the city of Medina, Saudi Arabia

Purpose - The purpose of this study is to analyze the crowd dynamics of the visitors at Al-Masjid al-Nabawi during the most oversaturated period to characterize the most critical conditions and suggest technical solutions to accommodate visitors and provide them safe passage. Design/methodology/approach - In this study, the time of entrance from the Al-Salam Gate to the tomb and from the tomb to the exit from the Al-Baqi’ Gate has been collected in the most oversaturated period. To be precise and to model the worst case, important crowd measures of effectiveness data are collected in the two holiest times considered by Muslims, during the holy month of Ramadan and the month of Dhul-Hijjah and during the busiest hours of the day to consider safety factors while proposing future solutions. The conventional manual head-counting method has been adopted to determine the crowd density and to carry out actual counting of the visitors from the recorded videos and photos captured by the legitimate authority. Findings - The analyses revealed that the crowd dynamics in the month of Ramadan (peak) are statistically different from those for other times (off peak). In general, the crowd dynamics at all times on days other than Ramadan are almost identical. Originality/value - The results of crowd characterization from this study are expected to help optimize crowd management in the Masjid at the most critical location and time. The data collected in this study could be used for future research to simulate similar crowd scenes or for even different crowd management scenarios in case of emergencies such as fire hazards or evacuation process

The emerging role of virtual reality as an adjunct to procedural sedation and anesthesia: a narrative review

Over the past 20 years, there has been a significant reduction in the incidence of adverse events associated with sedation outside of the operating room. Non-pharmacologic techniques are increasingly being used as peri-operative adjuncts to facilitate and promote anxiolysis, analgesia and sedation, and to reduce adverse events. This narrative review will briefly explore the emerging role of immersive reality in the peri-procedural care of surgical patients. Immersive virtual reality (VR) is intended to distract patients with the illusion of “being present” inside the computer-generated world, drawing attention away from their anxiety, pain, and discomfort. VR has been described for a variety of procedures that include colonoscopies, venipuncture, dental procedures, and burn wound care. As VR technology develops and the production costs decrease, the role and application of VR in clinical practice will expand. It is important for medical professionals to understand that VR is now available for prime-time use and to be aware of the growing body in the literature that supports VR.info:eu-repo/semantics/publishedVersio

Treatment Outcomes in Patients With Metastatic Renal Cell Carcinoma With Sarcomatoid and/or Rhabdoid Dedifferentiation After Progression on Immune Checkpoint Therapy

BACKGROUND: Metastatic RCC with sarcomatoid and/or rhabdoid (S/R) dedifferentiation is an aggressive disease associated with improved response to immune checkpoint therapy (ICT). The outcomes of patients treated with VEGFR-targeted therapies (TT) following ICT progression have not been investigated. PATIENTS AND METHODS: Retrospective review of 57 patients with sarcomatoid (S), rhabdoid (R), or sarcomatoid plus rhabdoid (S + R) dedifferentiation who received any TT after progression on ICT at an academic cancer center. Clinical endpoints of interest included time on TT, overall survival (OS) from initiation of TT, and objective response rate (ORR) by RECIST version 1.1. Multivariable models adjusted for epithelial histology, IMDC risk, prior VEGFR TT, and inclusion of cabozantinib in the post-ICT TT regimen. RESULTS: 29/57 patients had S dedifferentiation and 19 had R dedifferentiation. The most frequently used TT was cabozantinib (43.9%) followed by selective VEGFR TT (22.8%). The median time on TT was 6.4 months for all, 6.1 months for those with S dedifferentiation, 15.6 months for R dedifferentiation, and 6.1 months for S + R dedifferentiation. Median OS from initiation of TT was 24.9 months for the entire cohort, and the ORR was 20.0%. Patients with R dedifferentiation had significantly longer time on TT than those with S dedifferentiation (HR 0.44, 95% CI, 0.21-0.94). IMDC risk was associated with OS. CONCLUSIONS: A subset of patients with S/R dedifferentiation derive clinical benefit from TT after they have progressive disease on ICT. Patients with R dedifferentiation appeared to derive more benefit from TT than those with S dedifferentiation

Primary angiitis of the central nervous system presenting with subacute and fatal course of disease: a case report

BACKGROUND: Primary angiitis of the central nervous system is an idiopathic disorder characterized by vasculitis within the dural confines. The clinical presentation shows a wide variation and the course and the duration of disease are heterogeneous. This rare but treatable disease provides a diagnostic challenge owing to the lack of pathognomonic tests and the necessity of a histological confirmation. CASE PRESENTATION: A 28-year-old patient presenting with headache and fluctuating signs of encephalopathy was treated on the assumption of viral meningoencephalitis. The course of the disease led to his death 10 days after hospital admission. Postmortem examination revealed primary angiitis of the central nervous system. CONCLUSION: Primary angiitis of the central nervous system should always be taken into consideration when suspected infectious inflammation of the central nervous system does not respond to treatment adequately. In order to confirm the diagnosis with the consequence of a modified therapy angiography and combined leptomeningeal and brain biopsy should be considered immediately

Factor XII and Upar Upregulate Neutrophil Functions to Influence Wound Healing

Coagulation factor XII (FXII) deficiency is associated with decreased neutrophil migration, but the mechanisms remain uncharacterized. Here, we examine how FXII contributes to the inflammatory response. In 2 models of sterile inflammation, FXII-deficient mice (F12–/–) had fewer neutrophils recruited than WT mice. We discovered that neutrophils produced a pool of FXII that is functionally distinct from hepatic-derived FXII and contributes to neutrophil trafficking at sites of inflammation. FXII signals in neutrophils through urokinase plasminogen activator receptor–mediated (uPAR-mediated) Akt2 phosphorylation at S474 (pAktS474). Downstream of pAkt2S474, FXII stimulation of neutrophils upregulated surface expression of αMβ2 integrin, increased intracellular calcium, and promoted extracellular DNA release. The sum of these activities contributed to neutrophil cell adhesion, migration, and release of neutrophil extracellular traps in a process called NETosis. Decreased neutrophil signaling in F12–/– mice resulted in less inflammation and faster wound healing. Targeting hepatic F12 with siRNA did not affect neutrophil migration, whereas WT BM transplanted into F12–/– hosts was sufficient to correct the neutrophil migration defect in F12–/– mice and restore wound inflammation. Importantly, these activities were a zymogen FXII function and independent of FXIIa and contact activation, highlighting that FXII has a sophisticated role in vivo that has not been previously appreciated