Metastatic signet ring gastric adenocarcinoma presenting with microangiopathic hemolytic anemia.

Metastatic adenocarcinoma presenting as microangiopathic hemolytic anemia (MAHA) and leukoerythroblastic blood picture is rare. We report three patients who presented with MAHA as the initial symptom of metastatic signet ring cell gastric adenocarcinoma. One patient had past history of gastric ulcer. In all these patients the initial diagnosis was based on peripheral blood smear followed by bone marrow biopsy; upper GI endoscopy showed presence of gastric ulcers with focally scattered neo-plastic signet ring cells on histopathology. All patients died within a week of diagnosis

The frequency of heparin induced thrombocytopenia in patients undergoing elective cardiac bypass surgeries

OBJECTIVE: To determine the frequency of Heparin Induced Thrombocytopenia (HIT) in patients undergoing elective cardiac bypass surgeries and to observe the platelets evolution post surgically in these patients. METHOD: A prospective study was designed and 100 unselected consecutive patients undergoing elective cardiac bypass surgery were enrolled and evaluated. The clinical and laboratory details were noted before and after surgery. Their platelet counts were observed from day 0 (prior to surgery) to day 5 post operatively. Particle gel immunoassay was used to demonstrate the presence of antibodies against heparin-platelet factor 4 complexes. RESULTS: There were 86 males and 14 females with median age of 59 and 53.5 years respectively. Marked platelet count variation was detected during post operative period in all patients (n=100) ranging from 23 +/- SD 186.73 to 389 +/- 84.12 X 109/L. However, 20 patients showed \u3e50% drop on day 5 and seven of these also showed seroconversion. The clinical scoring for HIT was found to have a good negative predictive value. Thromboembolic complications were not observed in any of our patients. CONCLUSIONS: HIT is prevalent to a significant extent in patients after cardiac surgery in our clinical setting though it mostly remains undetected and is an under-diagnosed entity

Chromium removal from aqueous solution using bimetallic Bi\u3csup\u3e0\u3c/sup\u3e/Cu\u3csup\u3e0\u3c/sup\u3e-based nanocomposite biochar

Chromium (Cr), due to its greater contamination in aquifers and distinct eco-toxic impacts, is of greater environmental concern. This study aimed to synthesize nanocomposites of almond shells biochar (BC) with zerovalent bismuth and/or copper (Bi0/BC, Cu0/BC, and Bi0–Cu0/BC) for the removal of Cr from aqueous solution. The synthesized nanocomposites were investigated using various characterization techniques such as XRD, FTIR spectroscopy, SEM, and EDX. The Cr removal potential by the nanocomposites was explored under different Cr concentrations (25–100 mg/L), adsorbent doses (0.5–2.0 g/L), solution pH (2–8), and contact time (10–160 min). The above-mentioned advanced techniques verified successful formation of Bi0/Cu0 and their composite with BC. The synthesized nanocomposites were highly effective in the removal of Cr. The Bi0–Cu0/BC nano-biocomposites showed higher Cr removal efficiency (92%) compared to Cu0/BC (85%), Bi0/BC (76%), and BC (67%). The prepared nanocomposites led to effective Cr removal at lower Cr concentrations (25 mg/L) and acidic pH (4.0). The Cr solubility changes with pH, resulting in different degrees of Cr removal by Bi0–Cu0/BC, with Cr(VI) being more soluble and easier to adsorb at low pH levels and Cr(III) being less soluble and more difficult to adsorb at high pH levels. The experimental Cr adsorption well fitted with the Freundlich adsorption isotherm model (R 2 \u3e 0.99) and pseudo-second-order kinetic model. Among the prepared nanocomposites, the Bi0–Cu0/BC showed greater stability and reusability. It was established that the as-synthesized Bi0–Cu0/BC nano-biocomposite showed excellent adsorption potential for practical Cr removal from contaminated water

Coal bottom ash concrete: Mechanical properties and cracking mechanism of concrete subjected to cyclic load test

Coal waste has gained interest as an alternative aggregate for concrete production. Still, a topic that has been less researched is the serviceability of concrete containing coal waste, and the main concern is whether the namely coal bottom ash (CBA) aggregate affects the cracking of concrete beams. This research aims to elucidate the mechanical properties of concrete with the inclusion of CBA and its cracking mechanism on beams. Thus, concrete specimens were designed into four distinct combination replacements between half (50 %) and full (100 %) of coarse and fine CBA aggregate with the addition of 20 % fly ash to the cement amount. The beams were subjected to a cyclic load test to evaluate the cracking mechanism. The experimental results revealed that the compressive strength of all replacements achieved the targeted strength of 30 MPa at 28 days. However, the splitting tensile and flexural strengths decreased with the increment in volume of CBA in the design mixture. The cyclic load criteria with respect to deviation from linearity (DFL) was found promising to correlate to beam failure according to the deflection in each specific load cycle. Nonetheless, the cracking mechanism of the concrete beams was mainly influenced by the porous structure and high crushing index of coarse CBA, where all tested beams failed by flexural and shear cracks. Therefore, excessively increasing the coarse CBA replacement amount in a concrete mix produces a lower structural performance in beams under cyclic load

Coal bottom ash lightweight brick

100% and 50% replacement with coal ash. Reduce 40% of production cost. 20% less dense compare conventional brick

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570