Neonatal lupus erythematous – A report of three cases

Neonatal lupus erythematosus (NLE) is a rare acquired autoimmune disorder clinically characterized by skin lesions that resemble those of subacute or discoid lupus erythematosus and/or congenital heart bock. Skin and cardiac manifestations coexist only in 10% of the patients. It is caused by transplacental passage of maternal autoantibodies, usually anti-Ro/SS-A and /or anti-La/SS-B and less commonly anti-U1 ribonucleoprotein. Mothers of the infants with NLE are either asymptomatic or diagnosed with autoimmune disease. We describe 3 neonates with clinical and immunological findings compatible with NLE, their progress and outcome

Hydraulic anatomy affects genotypic variation in plant water use and shows differential organ specific plasticity to drought in Sorghum bicolor

Genotypic variability and plasticity in hydraulic anatomy are not well-understood in herbaceous monocots. In this study, we used Sorghum bicolor, a monocotyledonous, tropical grass model, to understand whether differential plant water use is associated with xylem anatomy and if whole-plant xylem anatomy responds to water stress, justifying differential genotypic sensitivity to drought. In a greenhouse environment, we studied four sorghum genotypes that are known to genetically differ in growth and exhibit differential sensitivity to drought. Under well-watered scenario, transpiration variability and plant growth traits correlated with xylem anatomical traits at both the leaf and stem level, including xylem area and predicted xylem-specific hydraulic conductivity. High water use genotypes had inherently higher hydraulic capacity, but under drought, their transpiration declined at higher fractions of transpirable soil water (FTSW) and they showed greater plasticity in hydraulic anatomy. However, lower FTSW thresholds and modest anatomical changes were identified in the low water use genotypes with inherently lower hydraulic conductivity. Drought, induced modular phenotypic plasticity in hydraulic anatomy, whereby plasticity in leaf xylem traits was remarkably higher than stem xylem, while root xylem showed a reverse nature of vascular modification. Xylem traits were in agreement with phloem anatomy, irrespective of water regime. Our study indicates that hydraulic anatomy can be critical for herbaceous monocots in determining limits to plant water use and genotypic response to drought with implications on whole-plant functions and habitat ecology

A Novel Approach for Shadow Detection and Removal from Image

Image processing has been one region of studies that draws the interest of extensive form of researchers. Surveillance structures are in big demand specially, for their packages in public areas, consisting of airports, stations, subways, front to buildings and mass events. Shadow occurs while objects consist of light from light source. Shadows offer wealthy information about the item shapes as well as light orientations. Shadow in picture reduces the reliability of many computer imaginative and prescient algorithms. Shadow regularly degrades the visual exceptional of an image. Shadow removal in an image is pre-processing step for computer imaginative and prescient algorithm and image enhancement. Shadow detection and removal in numerous actual lifestyles situations consisting of surveillance device and laptop vision machine remained a hard project. Shadow in visitors surveillance system might also misclassify the actual item, lowering the gadget overall performance

Risk Factors for Recurrent Exacerbations in the General-Practitioner-Based Swiss Chronic Obstructive Pulmonary Disease (COPD) Cohort.

BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) often suffer from acute exacerbations. Our objective was to describe recurrent exacerbations in a GP-based Swiss COPD cohort and develop a statistical model for predicting exacerbation. METHODS COPD cohort demographic and medical data were recorded for 24 months, by means of a questionnaire-based COPD cohort. The data were split into training (75%) and validation (25%) datasets. A negative binomial regression model was developed using the training dataset to predict the exacerbation rate within 1 year. An exacerbation prediction model was developed, and its overall performance was validated. A nomogram was created to facilitate the clinical use of the model. RESULTS Of the 229 COPD patients analyzed, 77% of the patients did not experience exacerbation during the follow-up. The best subset in the training dataset revealed that lower forced expiratory volume, high scores on the MRC dyspnea scale, exacerbation history, and being on a combination therapy of LABA + ICS (long-acting beta-agonists + Inhaled Corticosteroids) or LAMA + LABA (Long-acting muscarinic receptor antagonists + long-acting beta-agonists) at baseline were associated with a higher rate of exacerbation. When validated, the area-under-curve (AUC) value was 0.75 for one or more exacerbations. The calibration was accurate (0.34 predicted exacerbations vs 0.28 observed exacerbations). CONCLUSION Nomograms built from these models can assist clinicians in the decision-making process of COPD care

Feasibility, acceptability and effectiveness of integrated care for COPD patients: a mixed methods evaluation of a pilot community-based programme.

The aim of this study was to assess the feasibility, acceptability and effectiveness of a pilot COPD integrated care programme implemented in Valais, Switzerland. The programme was adapted from the self-management programme Living Well with COPD, and included the following elements: self-management patient-education group sessions, telephone and medical follow-ups, multidisciplinary teams, training of healthcare professionals, and evidence-based COPD care. A process and outcome evaluation of the pilot phase of the programme was conducted by means of qualitative and quantitative methods. Reach (coverage, participation rates), dosage (interventions carried out), fidelity (delivered as intended) and stakeholders' acceptance of the programme were evaluated through data monitoring and conduct of focus groups with patients and healthcare professionals. Effectiveness was assessed with pre-post analyses (before and after the intervention). The primary outcome measures were; (1) generic and disease-specific quality of life (36-Item Short Form Health Survey, Chronic Respiratory Questionnaire); and (2) hospitalisations (all-cause and for acute exacerbations) in the past 12 months. Secondary outcomes included self-efficacy, number of exacerbations and exercise capacity. Finally, controlled pre-post comparisons were also made with patients from the Swiss COPD Cohort for three common outcome measures (dyspnoea [mMRC score], number of exacerbations and smoking status). During the first 2 years of the programme, eight series of group-based education sessions were delivered to 57 patients with COPD in three different locations of the canton of Valais. Coverage objectives were achieved and attendance rate at the education sessions was high (83.6%). Patients' and healthcare professionals' reported a high degree of satisfaction, except for multidisciplinarity and transfer of information. Exploration of the effectiveness of this pilot programme suggested positive pre-post results at 12 months, with improvements in terms of health-related quality of life, self-efficacy, exercise capacity, immunisation coverage and Patient Assessment of Chronic Illness Care score. No other outcome, including the number of hospital admissions, differed significantly after 12 months. We observed no differences from the control group. The evaluation demonstrated the feasibility and acceptability of the programme and confirmed the relevance of mixed method process evaluation to adjust and improve programme implementation. The introduction of multidisciplinary teams in a context characterised by fragmentation of care was identified as the main challenge in the programme implementation and could not be achieved as expected. Despite this area for improvement, patients' feedback and early effectiveness results confirmed the benefits of COPD integrated care programmes emphasising self-management education

Incidental detection of an occult oral malignancy with autofluorescence imaging: a case report

BACKGROUND: Autofluorescence imaging is used widely for diagnostic evaluation of various epithelial malignancies. Cancerous lesions display loss of autofluorescence due to malignant changes in epithelium and subepithelial stroma. Carcinoma of unknown primary site presents with lymph node or distant metastasis, for which the site of primary tumour is not detectable. We describe here the use of autofluorescence imaging for detecting a clinically innocuous appearing occult malignancy of the palate which upon pathological examination was consistent with a metastatic squamous cell carcinoma. CASE DESCRIPTION: A submucosal nodule was noted on the right posterior hard palate of a 59-year-old white female during clinical examination. Examination of this lesion using a multispectral oral cancer screening device revealed loss of autofluorescence at 405 nm illumination. An excisional biopsy of this nodule, confirmed the presence of a metastatic squamous cell carcinoma. Four years ago, this patient was diagnosed with metastatic squamous cell carcinoma of the right mid-jugular lymph node of unknown primary. She was treated with external beam irradiation and remained disease free until current presentation. CONCLUSION: This case illustrates the important role played by autofluorescence tissue imaging in diagnosing a metastatic palatal tumour that appeared clinically innocuous and otherwise would not have been biopsied

The multi-stripe travelling salesman problem

In the classical Travelling Salesman Problem (TSP), the objective function sums the costs for travelling from one city to the next city along the tour. In the q-stripe TSP with q ≥ 1, the objective function sums the costs for travelling from one city to each of the next q cities along the tour. The resulting q-stripe TSP generalizes the TSP and forms a special case of the quadratic assignment problem. We analyze the computational complexity of the q-stripe TSP for various classes of specially structured distance matrices. We derive NP-hardness results as well as polyomially solvable cases. One of our main results generalizes a well-known theorem of Kalmanson from the classical TSP to the q-stripe TSP