Accuracy of rapid ultrasound in shock (RUSH) exam for diagnosis of shock in critically Ill patients

Background: Rapid ultrasound in shock (RUSH) is the most recent emergency ultrasound protocol, designed to help clinicians better recognize distinctive shock etiologies in a shorter time frame. Objectives: In this study, we evaluated the accuracy of the RUSH protocol, performed by an emergency physician or radiologist, in predicting the type of shock in critical patients. Patients and Methods: An emergency physician or radiologist performed the RUSH protocol for all patients with shock status at the emergency department. All patients were closely followed to determine their final clinical diagnosis. The agreement between the initial impression provided by RUSH and the final diagnosis was investigated by calculating the Kappa index. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of RUSH for diagnosis of each case. Results: We performed RUSH on 77 patients. Kappa index was 0.71 (P Value = 0.000), reflecting acceptable general agreement between initial impression and final diagnosis. For hypovolemic, cardiogenic and obstructive shock, the protocol had an NPV above 97 yet it had a lower PPV. For shock with distributive or mixed etiology, RUSH showed a PPV of 100 but it had low sensitivity. Subgroup analysis showed a similar Kappa index for the emergency physician and radiologist (0.70 and 0.73, respectively) in performing rush. Conclusions: This study highlights the role of the RUSH exam performed by an emergency physician, to make a rapid and reliable diagnosis of shock etiology, especially in order to rule out obstructive, cardiogenic and hypovolemic shock types in initial exam of shock patients. Copyright © 2015, Trauma Monthly

Accuracy of early rapid ultrasound in shock (RUSH) examination performed by emergency physician for diagnosis of shock etiology in critically ill patients

Background: Rapid Ultrasound in Shock (RUSH) is a recently reported emergency ultrasound protocol designed to help clinicians better recognize distinctive shock etiologies in a short time. We tried to evaluate the accuracy of early RUSH protocol performed by emergency physicians to predict the shock type in critically ill patients. Materials and Methods: Our prospective study was approved by the ethics committee of trauma research center, Baqiyatallah University of Medical Science, Iran. We enrolled 52 patients with shock state in the emergency department from April 2013 to October 2013. We performed early bed-side sonographic examination for participants based on RUSH protocol. Patients received all needed standard therapeutic and diagnostic interventions without delay and were followed to document their final diagnosis. Agreement (Kappa index) of initial impression provided by RUSH with final diagnosis, and also sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of RUSH for diagnosis of each shock type were calculated. Results: Fifty-two patients were enrolled in our study. Kappa index was 0.7 (P value = 0.000), reflecting acceptable general agreement between initial impression and final diagnosis. For hypovolemic and obstructive shocks, the protocol had sensitivity of 100 but had lower PPV. For shocks with distributive or mixed etiology, RUSH showed PPV of 100 but had low sensitivity. For cardiogenic shocks, all reliability indices were above 90. Conclusion: We highlight the role of RUSH examination in the hands of an emergency physician in making a rapid diagnosis of shock etiology, especially in ruling out obstructive, cardiogenic, and hypovolemic types

Mesenchymal stem cell-derived exosomes: A new therapeutic approach to osteoarthritis?

Degenerative disorders of joints, especially osteoarthritis (OA), result in persistent pain and disability and high costs to society. Nevertheless, the molecular mechanisms of OA have not yet been fully explained. OA is characterized by destruction of cartilage and loss of extracellular matrix (ECM). It is generally agreed that there is an association between pro-inflammatory cytokines and the development of OA. There is increased expression of matrix metalloproteinase (MMP) and "a disintegrin and metalloproteinase with thrombospondin motifs" (ADAMTS). Mesenchymal stem cells (MSCs) have been explored as a new treatment for OA during the last decade. It has been suggested that paracrine secretion of trophic factors, in which exosomes have a crucial role, contributes to the mechanism of MSC-based treatment of OA. The paracrine secretion of exosomes may play a role in the repair of joint tissue as well as MSC-based treatments for other disorders. Exosomes isolated from various stem cells may contribute to tissue regeneration in the heart, limbs, skin, and other tissues. Recent studies have indicated that exosomes (or similar particles) derived from MSCs may suppress OA development. Herein, for first time, we summarize the recent findings of studies on various exosomes derived from MSCs and their effectiveness in the treatment of OA. Moreover, we highlight the likely mechanisms of actions of exosomes in OA. © 2019 The Author(s)

Disulfide-induced self-assembled targets: A novel strategy for the label free colorimetric detection of DNAs/RNAs via unmodified gold nanoparticles

A modified non-cross-linking gold-nanoparticles (Au-NPs) aggregation strategy has been developed for the label free colorimetric detection of DNAs/RNAs based on self-assembling target species in the presence of thiolated probes. Two complementary thiol- modified probes, each of which specifically binds at one half of the target introduced SH groups at both ends of dsDNA. Continuous disulfide bond formation at 3′ and 5′ terminals of targets leads to the self-assembly of dsDNAs into the sulfur- rich and flexible products with different lengths. These products have a high affinity for the surface of Au-NPs and efficiently protect the surface from salt induced aggregation. To evaluate the assay efficacy, a small part of the citrus tristeza virus (CTV) genome was targeted, leading to a detection limit of about 5 × 10-9 mol.L-1 over a linear ranged from 20 × 10-9 to 10 × 10-7 mol.L-1. This approach also exhibits good reproducibility and recovery levels in the presence of plant total RNA or human plasma total circulating RNA extracts. Self-assembled targets can be then sensitively distinguished from non-assembled or mismatched targets after gel electrophoresis. The disulfide reaction method and integrating self-assembled DNAs/RNAs targets with bare AuNPs as a sensitive indicator provide us a powerful and simple visual detection tool for a wide range of applications

Chitosan/polyvinyl alcohol nanofibrous membranes: towards green super-adsorbents for toxic gases

Removal of hazardous gases from the atmosphere has become a big challenge for scientists and engineers alike. Eco-friendly nature of biopolymers has given a new dimension to the debate within the environmental science area but attempts mainly failed to cleanse the air stream of toxic gases as a consequence of design imperfections. In this work, green electrospun nanofibrous membranes based on chitosan (Cs)/polyvinyl alcohol (PVA) composite with a very high carbon monoxide adsorption capacity (much higher than the values one may expect from activated carbon and zeolite adsorbents, and also higher than that of the metal-organic framework) are developed. 2 k�1 factorial design, response surface and desirability function analyses are merged to optimize the electrospinning parameters for functional-based carbon monoxide elimination. The best Cs/PVA adsorbent obtained through multi-objective optimization has a very high desirability value level of 0.953. Optimized electrospinning parameters are: Voltage = 17 kV, spinning distance = 13 cm, flow rate = 0.2 mL/h, and PVA concentration = 6 wt.; and optimized properties are: maximum thermal stability = 329 °C, minimum fiber diameter = 9.8 nm, and maximum surface area = 2204 m 2 /g. This work opens a new era for taking the next steps towards the design and optimization of green super-adsorbents for gaseous contaminations. © 201

Radiosensitization of DNA in presence of Pt(II)-based compounds

X-ray irradiation of plasmid DNA in presence of platinum (II)-based compounds was carried out in order to assess the radiosensitization capabilities of these drugs. In present investigations pBR322 plasmid DNA was used to monitor effectiveness of chosen compounds in inducing strand breaks. Samples were incubated in presence of potential radiosensitisers: platinum (II) bromide and cis-diamminedibromoplatinum (II). The results were examined against a common cancer chemotherapy drug cis-diamminedichloroplatinum (II). It was found that platinum (II) bromide can greatly increase the levels of single- and double-strand break formation observed in the irradiated samples with respect to the samples containing platinum as a radiosensitizer only, possessing very little chemotherapeutic activity. The suggested drugs exhibit much higher level of radiosensitivity than widely used cisplatin and thus may be good candidates for cancer treatment

Radio- and photosensitization of DNA with compounds containing platinum and bromine atoms

Irradiations of plasmid DNA by both X-rays and UV light in the presence and absence of compounds containing platinum and bromine atoms were performed in order to asses the sensitization potential of these compounds. Plasmid DNA pBR322 was incubated with platinum (II) bromide, hydrogen hexabromoplatinate (IV), hydrogen hexahydroxyplatinate (IV) and sodium hexahydroxyplatinate (IV). Incubation was followed by X-ray or UV irradiations. It was found that amongst the sensitizers tested, during irradiations carried out in the presence of platinum (II) bromide, the highest levels of double strand breaks formation upon X-ray treatment were recorded. In contrast much less damage was induced by UV light. Data presented here suggests that this compound may be a promising radiosensitizer for cancer treatment

Clustering Algorithms: Their Application to Gene Expression Data

Gene expression data hide vital information required to understand the biological process that takes place in a particular organism in relation to its environment. Deciphering the hidden patterns in gene expression data proffers a prodigious preference to strengthen the understanding of functional genomics. The complexity of biological networks and the volume of genes present increase the challenges of comprehending and interpretation of the resulting mass of data, which consists of millions of measurements; these data also inhibit vagueness, imprecision, and noise. Therefore, the use of clustering techniques is a first step toward addressing these challenges, which is essential in the data mining process to reveal natural structures and iden-tify interesting patterns in the underlying data. The clustering of gene expression data has been proven to be useful in making known the natural structure inherent in gene expression data, understanding gene functions, cellular processes, and subtypes of cells, mining useful information from noisy data, and understanding gene regulation. The other benefit of clustering gene expression data is the identification of homology, which is very important in vaccine design. This review examines the various clustering algorithms applicable to the gene expression data in order to discover and provide useful knowledge of the appropriate clustering technique that will guarantee stability and high degree of accuracy in its analysis procedure

A hybrid GIS-assisted framework to integrate Dempster–Shafer theory of evidence and fuzzy sets in risk analysis: an application in hydrocarbon exploration

One of the most important reasons for the existence of geologic risk during the hydrocarbon exploration process is related to uncertainties in geospatial data and models employed for data fusion. This study proposes a geospatial information system-assisted approach integrated with soft computing methods to manage spatial uncertainties during the hydrocarbon exploration process. A framework was designed to illustrate the process of calculating the geologic risk interval of each hydrocarbon structure and its estimation of uncertainties. The model enhances the geologic risk analysis of a Dempster–Shafer data-driven method by a fuzzy logic approach. The resultant hybrid method showed high predictive power with the area under the success and predictive curves being 82.2 and 75.9%, respectively. According to the results, the proposed hybrid method has improved the quality of risk analysis