Role of cardiopulmonary interactions in development of ventilator-induced lung injury-Experimental evidence and clinical implications

Ventilator-induced lung injury (VILI) impacts outcomes in ARDS and optimization of ventilatory strategies improves survival. Decades of research has identified various mechanisms of VILI, largely focusing on airspace forces of plateau pressure, tidal volume and driving pressure. Experimental evidence indicates the role of adverse cardiopulmonary interaction during mechanical ventilation, contributing to VILI genesis mostly by modulating pulmonary vascular dynamics. Under passive mechanical ventilation, high transpulmonary pressure increases afterload on right heart while high pleural pressure reduces the RV preload. Together, they can result in swings of pulmonary vascular flow and pressure. Altered vascular flow and pressure result in increased vascular shearing and wall tension, in turn causing direct microvascular injury accompanied with permeability to water, proteins and cells. Moreover, abrupt decreases in airway pressure, may result in sudden overperfusion of the lung and result in similar microvascular injury, especially when the endothelium is stretched or primed at high positive end-expiratory pressure. Microvascular injury is universal in VILI models and presumed in the diagnosis of ARDS; preventing such microvascular injury can reduce VILI and impact outcomes in ARDS. Consequently, developing cardiovascular targets to reduce macro and microvascular stressors in the pulmonary circulation can potentially reduce VILI. This paper reviews the role of cardiopulmonary interaction in VILI genesis

ETIOLOGICAL FACTORS, CLINICAL PRESENTATIONS AND TREATMENT OUTCOME OF CERVICAL LYMPHADENOPATHY: AN OBSERVATIONAL DESCRIPTIVE STUDY

Aim: To study various etiological factors, clinical presentations of cervical lymphadenopathy. To study the management and outcome of cervical lymphadenopathy Method: Proper clinical history was first noted, local and systemic examination was performed and a clinical diagnosis was made. Gender wise distribution, presenting symptoms, site distribution, and treatment outcome were noted. Result: Gender wise distribution of male and female was 52%, and 48%, commonest site of primary in cases of metastatic Secondaries was tongue followed by oesophagus and thyroid. After proper diagnosis confirmed by Histopathology (biopsy), treatment constituted properly- Cases of Tubercular Lymphadenitis (49 cases) were Started on Anti-tubercular treatment, all were showed improvement in symptoms. Cases of Reactive lymphadenitis (26 cases) started on antibiotics, all recovered well. Among 14 Cases of Metastatic secondaries, 5 cases were given Chemotherapy/Radiotherapy after expert oncologist opinion out of which 3 showed improved symptoms and 2 were expired, 6 cases were operated out of which 5 showed improved symptoms and 1 expired post operatively, 3 cases were referred to specialized oncological and oncosurgical center for further management. All 6 Lymphoma cases were started on chemotherapy after expert oncologist opinion showed improvement in symptoms. Conclusion: Commonest site of primary in cases of metastatic Secondaries was tongue followed by oesophagus and thyroid. Anti-tubercular treatment for tubercular lymphadenitis was highly satisfactory with improvement in almost all patients. Surgery was restricted as an adjuvant to chemotherapy, as diagnostic biopsy, for treatment of abscess/sinuses and for a lymph nodes that do not resolve with chemotherapy. Non-tuberculous non-neoplastic lesions can be best managed by conservatively. Keywords: Cervical lymphadenopathy; Clinical presentations; Treatment outcome

Optimal Sensor Location Design for Reliable Fault Detection in Presence of False Alarms

To improve fault detection reliability, sensor location should be designed according to an optimization criterion with constraints imposed by issues of detectability and identifiability. Reliability requires the minimization of undetectability and false alarm probability due to random factors on sensor readings, which is not only related with sensor readings but also affected by fault propagation. This paper introduces the reliability criteria expression based on the missed/false alarm probability of each sensor and system topology or connectivity derived from the directed graph. The algorithm for the optimization problem is presented as a heuristic procedure. Finally, a boiler system is illustrated using the proposed method

Shprintzen-Goldberg syndrome presenting as umbilical hernia in an Indian child

Shprintzen-Goldberg syndrome (S-G) is a rare connective tissue disorder characterised by craniosynostosis, craniofacial dysmorphism, skeletal, cardiovascular, neurological, and other abnormalities. We herein present a case of a 5-year-old Indian child who presented to our clinic with reducible umbilical hernia since birth, mental retardation, and delayed developmental milestones. After meticulous clinical examination with subsequent integration of clinical findings and investigations, we diagnosed her to possibly have Shprintzen-Goldberg syndrome. An attempt to compare the findings of our index case with the classical features as described by Greally et al. has been made. Given the rarity of this syndrome and the paucity of medical literature measuring the magnitude of this condition in the Indian population, this case serves to promote awareness of this rare entity

mTORC1 to AMPK switching underlies β-cell metabolic plasticity during maturation and diabetes.

Pancreatic beta cells (β-cells) differentiate during fetal life, but only postnatally acquire the capacity for glucose-stimulated insulin secretion (GSIS). How this happens is not clear. In exploring what molecular mechanisms drive the maturation of β-cell function, we found that the control of cellular signaling in β-cells fundamentally switched from the nutrient sensor target of rapamycin (mTORC1) to the energy sensor 5'-adenosine monophosphate-activated protein kinase (AMPK), and that this was critical for functional maturation. Moreover, AMPK was activated by the dietary transition taking place during weaning, and this in turn inhibited mTORC1 activity to drive the adult β-cell phenotype. While forcing constitutive mTORC1 signaling in adult β-cells relegated them to a functionally immature phenotype with characteristic transcriptional and metabolic profiles, engineering the switch from mTORC1 to AMPK signaling was sufficient to promote β-cell mitochondrial biogenesis, a shift to oxidative metabolism, and functional maturation. We also found that type 2 diabetes, a condition marked by both mitochondrial degeneration and dysregulated GSIS, was associated with a remarkable reversion of the normal AMPK-dependent adult β-cell signature to a more neonatal one characterized by mTORC1 activation. Manipulating the way in which cellular nutrient signaling pathways regulate β-cell metabolism may thus offer new targets to improve β-cell function in diabetes

Contact mechanism of a rock fracture subjected to normal loading and its impact on fast closure behavior during initial stage of fluid flow experiment

Fast closure of rock fractures has been commonly observed in the initial stage of fluid flow experiments at environmental temperatures under low or moderate normal stresses. To fully understand the mechanisms that drive this fast closure, the evolution of local stresses acting on contacting asperities on the fracture surfaces prior to fluid flow tests needs to be evaluated. In this study, we modeled numerically the asperity deformation and failure processes during initial normal loading, by adopting both elastic and elastic-plastic deformation models for the asperities on a real rock fracture with measured surface topography data, and estimated their impact on initial conditions for fluid flow test performed under laboratory conditions. Compared with the previous models that simulate the normal contact of a fracture as the approach of two rigid surfaces without deformations, our models of deformable asperities yielded smaller contact areas and higher stresses on contacting asperities at a given normal stress or normal displacement. The results show that the calculated local stresses were concentrated on the contacts of a few major asperities, resulting in crushing of asperity tips. With these higher contact stresses, however, the predicted closure rates by pressure solution are still several orders of magnitude lower than that of the experimental measurements at the initial stage of fluid flow test. This indicates that single pressure solution may not likely to be the principal compaction mechanism for this fast closure, and that the damages on contacting asperities that occur during the initial normal loading stage may play an important role

Berberine, a popular dietary supplement for human and animal health: Quantitative research literature analysis a review

Berberine is an alkaloid with a wide range of reported beneficial health effects. The current work provides an extensive literature analysis on berberine. Bibliometric data were identified by means of the search string TOPIC=(berberin* OR umbellatine*), which yielded 5,547 publications indexed in the Web of Science Core Collection electronic database. The VOSviewer software generated bubble maps to visualize semantic terms with citation results. The ratio of original articles to reviews was 13.6:1. The literature has been growing more quickly since the 2010s. Major contributing countries were China, the United States, India, Japan, and South Korea. Most of the publications appeared in journals specialized in pharmacology pharmacy, biochemistry molecular biology, chemistry, and plant science. Some of the frequently mentioned chemicals/chemical classes were alkaloid, palmatine, jatrorrhizine, coptisine, isoquinoline, and sanguinarine. The prevalent medical conditions under investigation included Alzheimers disease, cancer, diabetes, and obesity.Acknowledge the support by the Polish KNOW (LeadingNational Research Centre) Scientific Consortium “Healthy Animal-Safe Food,” decision of Ministry of Science and Higher Education No. 05-1/KNOW2/2015 and the European Union under the European Regional Development Fund (Homing/2017-4/41). Antoni Sureda has been supported by the Institute of Health Carlos III (Project CIBEROBN CB12/03/30038). Joanna Feder-Kubis was financed by the Polish Ministry of Science and Higher Education for the Faculty of Chemistry of Wrocław University of Science and Technology.info:eu-repo/semantics/publishedVersio