315 research outputs found

    Exploring the Etiology of Referred Otalgia: A Comprehensive Study

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    Background: Ear pain, known as otalgia, has diverse origins, spanning from benign to severe conditions. Accurate diagnosis and treatment require an understanding of its etiology. Otalgia can be categorized as primary (ear-related) or referred (originating elsewhere). Referred otalgia poses unique challenges, as pain is perceived in the ear despite non-ear origins. Aim: The aim of present study is to investigate the potential causes of referred otalgia involving cranial and cervical nerves, and to explore the interplay between ear and distant body structures. Materials & Methods: A prospective study from March 2023 to June 2023 in an ENT OPD of Sharda Hospital, Greater Noida involved 360 patients. Evaluations encompassed dental, nasal, and head & neck assessments. Data included age, gender, side affected, and underlying cause statistical analysis was conducted using SPSS version. Results: Out of 360 patients, 16.1% had referred otalgia. Most were female (67.2%), and right-sided involvement was predominant (47%). Toothache (31.6%) and pharyngitis (29.1%) were the most common leading causes. Other causes included Gastroesophageal reflux disease, sinusitis, temporomandibular joint disease, cervical spine arthritis, and Bell's palsy. Two cases (0.5%) were associated with supraglottic and base of tongue malignancies. Conclusion: This study provides insights into referred otalgia's diverse origins, stressing the importance of comprehensive clinical evaluation for accurate diagnosis and tailored treatment. Collaboration among medical specialists is vital. Further research and clinical cooperation are needed to enhance our understanding of this complex condition

    Optimization of forest harvest scheduling at the operational level, considering precedence relationship among harvesting activities

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    The competitiveness of forest companies is strongly affected by the costs associated with getting the raw material to the mills. As harvesting costs contribute significantly to this cost, mathematical programming models were developed to optimize the scheduling of harvest activities within and between cut blocks to reduce the overall cost. However, the precedence relationship between harvesting activities occurring concurrently across multiple cut blocks has not been considered in the existing literature. In this paper, a mixed-integer linear programming model is developed to optimize the scheduling of harvesting activities, considering the precedence relationship among harvesting activities. The objective of the model is to minimize the total costs. The model determines the start time and end time of each harvesting activity at each cut block, considering the movement time of machines between cut blocks. The model is applied to the case of a large forest company in British Columbia, Canada. The model’s harvesting cost is only 1.37% higher than the lowest possible harvesting cost, and only 3 assigned machines have an idle time. The detailed harvesting schedule is generated based on the start time, the end time, and the operating time for each activity at each cut block.ISSN:1494-2119ISSN:1913-222

    Taxonomy of hybridly polarized Stokes vortex beams

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    Structured beams carrying topological defects, namely phase and Stokes singularities, have gained extensive interest in numerous areas of optics. The non-separable spin and orbital angular momentum states of hybridly polarized Stokes singular beams provide additional freedom for manipulating optical fields. However, the characterization of hybridly polarized Stokes vortex beams remains challenging owing to the degeneracy associated with the complex polarization structures of these beams. In addition, experimental noise factors such as relative phase, amplitude, and polarization difference together with beam fluctuations add to the perplexity in the identification process. Here, we present a generalized diffraction-based Stokes polarimetry approach assisted with deep learning for efficient identification of Stokes singular beams. A total of 15 classes of beams are considered based on the type of Stokes singularity and their associated mode indices. The resultant total and polarization component intensities of Stokes singular beams after diffraction through a triangular aperture are exploited by the deep neural network to recognize these beams. Our approach presents a classification accuracy of 98.67% for 15 types of Stokes singular beams that comprise several degenerate cases. The present study illustrates the potential of diffraction of the Stokes singular beam with polarization transformation, modeling of experimental noise factors, and a deep learning framework for characterizing hybridly polarized beam

    Spatial transcriptomics reveals distinct and conserved tumor core and edge architectures that predict survival and targeted therapy response

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    Abstract The spatial organization of the tumor microenvironment has a profound impact on biology and therapy response. Here, we perform an integrative single-cell and spatial transcriptomic analysis on HPV-negative oral squamous cell carcinoma (OSCC) to comprehensively characterize malignant cells in tumor core (TC) and leading edge (LE) transcriptional architectures. We show that the TC and LE are characterized by unique transcriptional profiles, neighboring cellular compositions, and ligand-receptor interactions. We demonstrate that the gene expression profile associated with the LE is conserved across different cancers while the TC is tissue specific, highlighting common mechanisms underlying tumor progression and invasion. Additionally, we find our LE gene signature is associated with worse clinical outcomes while TC gene signature is associated with improved prognosis across multiple cancer types. Finally, using an in silico modeling approach, we describe spatially-regulated patterns of cell development in OSCC that are predictably associated with drug response. Our work provides pan-cancer insights into TC and LE biology and interactive spatial atlases ( http://www.pboselab.ca/spatial_OSCC/ ; http://www.pboselab.ca/dynamo_OSCC/ ) that can be foundational for developing novel targeted therapies

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

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    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‚Äďcritically 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‚ÄČ=‚ÄČ257), ARB (n‚ÄČ=‚ÄČ248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n‚ÄČ=‚ÄČ10), or no RAS inhibitor (control; n‚ÄČ=‚ÄČ264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support‚Äďfree 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‚Äďfree days among critically ill patients was 10 (‚Äď1 to 16) in the ACE inhibitor group (n‚ÄČ=‚ÄČ231), 8 (‚Äď1 to 17) in the ARB group (n‚ÄČ=‚ÄČ217), and 12 (0 to 17) in the control group (n‚ÄČ=‚ÄČ231) (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‚Äďfree 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

    Asia‚ÄďPacific association for study of liver guidelines on management of ascites in liver disease

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    The development of ascites is a landmark event in the natural history of cirrhosis. This guidance statement by the Asia‚ÄďPacific Association for Study of Liver (APASL) provides an evidence-based approach to managing ascites and its complications in patients with chronic liver disease. These guidelines extensively review the differential diagnosis, diagnostic evaluation, and management of ascites, hyponatremia, hepatic hydrothorax and hepatorenal syndrome (HRS) in patients with cirrhosis and acute-on-chronic liver failure (ACLF). A panel of international experts was invited to formulate the guidelines. The opinions of the experts were collected using two sets of Delphi questionnaires. Then, an online meeting of all the experts was held to discuss the evidence and formulate the final recommendations by consensus. The guidelines were developed using the GRADE system for analysing the level of evidence and strength of recommendation (Table 1). All authors have gone through the guidance document and endorse the same.In this document, we have also covered the grey areas which have been underexplored in previous guidelines and some of the issues which are relatively peculiar to the Asia‚ÄďPacific region. Given the high burden of tuberculosis in some of the countries of the Asia‚ÄďPacific region, mixed ascites is not uncommon in these patients with liver disease. We discuss the diagnostic approach to mixed ascites and the role of ascitic fluid adenosine deaminase (ADA) and other tests for tuberculosis. In addition, many countries in the Asia‚ÄďPacific region are low-middle-income countries, and financial constraints are an essential barrier to liver transplants and other costly therapies like albumin. Hence, we have discussed the role of low-dose albumin in the prevention of paracentesis-induced circulatory dysfunction (PICD) after large-volume paracentesis (LVP) and the prevention of acute kidney injury (AKI) in patients with spontaneous bacterial peritonitis (SBP). We have also reviewed the current evidence of outpatient albumin in managing patients with ascites and have made practical recommendations. We also highlight the timing of albumin infusion concerning LVP. To decrease adverse events and improve patient compliance with diuretic therapy, the guidelines emphasize initiating low-dose diuretics and gradually increasing the dose to the maximum tolerable dose. Non-alcoholic fatty liver disease (NAFLD), also referred to as Metabolic associated fatty liver disease (MAFLD) by some societies has become a significant cause of chronic liver disease worldwide [1]. Many patients with NAFLD/MAFLD related cirrhosis are on angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) when they present to a hepatologist or gastroenterologist with ascites. For the first time, we provide guidance statements regarding the use of these drugs in patients with cirrhosis and ascites. For refractory ascites, we have now defined renal dysfunction following the International Club of Ascites (ICA) recommendations on AKI. Lastly, we have highlighted the gaps in our knowledge and have provided directions for future research

    Continuous Shoulder Activity Tracking after Open Reduction and Internal Fixation of Proximal Humerus Fractures

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    Postoperative shoulder activity after proximal humerus fracture treatment could influence the outcomes of osteosynthesis and may depend on the rehabilitation protocol. This multi-centric prospective study aimed at evaluating the feasibility of continuous shoulder activity monitoring over the first six postoperative weeks, investigating potential differences between two different rehabilitation protocols. Shoulder activity was assessed with pairs of accelerometer-based trackers during the first six postoperative weeks in thirteen elderly patients having a complex proximal humerus fracture treated with a locking plate. Shoulder angles and elevation events were evaluated over time and compared between the two centers utilizing different standard rehabilitation protocols. The overall mean shoulder angle ranged from 11¬į to 23¬į, and the number of daily elevation events was between 547 and 5756. Average angles showed longitudinal change <5¬į over 31 ¬Ī 10 days. The number of events increased by 300% on average. Results of the two clinics exhibited no characteristic differences for shoulder angle, but the number of events increased only for the site utilizing immediate mobilization. In addition to considerable inter-patient variation, not the mean shoulder angle but the number of elevations events increased markedly over time. Differences between the two sites in number of daily events may be associated with the different rehabilitation protocols

    A second update on mapping the human genetic architecture of COVID-19