Patients with repaired Tetralogy of Fallot (rTOF) will develop dilation of the right ventricle (RV) from chronic pulmonary insufficiency and require pulmonary valve replacement (PVR). Cardiac MRI (cMRI) is used to guide therapy but has limitations in studying novel intracardiac flow parameters. This pilot study aimed to demonstrate feasibility of reconstructing RV motion and simulating intracardiac flow in rTOF patients, exclusively using conventional cMRI and an immersed-boundary method computational fluid dynamic (CFD) solver.
Four rTOF patients and three normal controls underwent cMRI including 4D flow. 3D RV models were segmented from cMRI images. Feature-tracking software captured RV endocardial contours from cMRI long-axis and short-axis cine stacks. RV motion was reconstructed via diffeomorphic mapping (Deformetrica, deformetrica.org), serving as the domain boundary for CFD. Fully-resolved direct numerical simulations were performed over several cardiac cycles. Intracardiac vorticity, kinetic energy (KE) and turbulent kinetic energy (TKE) was measured. For validation, RV motion was compared to manual tracings, results of KE were compared between CFD and 4D flow.
Diastolic vorticity and TKE in rTOF patients were 4.12 ± 2.42mJ/L and 115 ± 27/s, compared to 2.96 ± 2.16mJ/L and 78 ± 45/s in controls. There was good agreement between RV motion and manual tracings. The difference in diastolic KE between CFD and 4D flow by Bland-Altman analysis was -0.89910 to 2mJ/mL (95% limits of agreement -1.351 × 10
mJ/mL to 1.171 × 10
mJ/mL).
This CFD framework can produce intracardiac flow in rTOF patients. CFD has the potential for predicting the effects of PVR in rTOF patients and improve the clinical indications guided by cMRI.
This CFD framework can produce intracardiac flow in rTOF patients. CFD has the potential for predicting the effects of PVR in rTOF patients and improve the clinical indications guided by cMRI.Human protein disulfide isomerase (PDI), a protein containing 4 domains a, b, b', a', disordered x linker and C-terminus, plays critical roles in disulfide bond reactions and proper protein folding in the endoplasmic reticulum. The bb' domain contributes to client binding, the a, a' domain catalyse the rearrangement of the disulfide bonds. The x linker and a' domain were the main dynamics region for full-length PDI and the b'xa' construct has the minimum functional domain within full-length PDI. Herein, we report a new preparation strategy with 1, 6-hexandiol and backbone NMR chemical shift assignments for the monomer b'xa' domain.
Residential aged care facility (RACF) staff are well placed to identify opportunities for more appropriate prescribing. However, little is known about their views of polypharmacy, deprescribing and specific medications.
The objective of this study was to establish the beliefs and attitudes of RACF staff towards polypharmacy and medication use in residents.
A cross-sectional survey was conducted on RACF staff in metropolitan New South Wales, Australia using a self-administered questionnaire. The questionnaire was drafted based on the available literature and research team expertise and then piloted by a mixed group of 13 RACF staff. The final version of the questionnaire consisted of 28 questions. A total of 38 RACFs were contacted about the study. The questionnaire was distributed to eligible RACF staff between October 2017 and October 2019. The RACF staff were eligible if they provided direct patient care to residents or worked as a facility manager. Participants were excluded if they had insufficient inably optimise medication use in RACF residents, it is important to consider the variation in views of nurses and care staff.
To study the effectiveness, tolerability, and safety of oral nitrazepam in children with resistant West syndrome (WS).
This prospective observational study was conducted at a tertiary care hospital in North India from January 2019 to October 2020. Children with WS resistant to standard therapy were enrolled within 7 d of initiation of nitrazepam and prospectively followed-up for cessation of spasms and adverse events.
Forty-one children with resistant WS initiated on nitrazepam therapy were evaluated. The median age at onset of spasms was 6 mo (Q1, Q3 4, 8). There was a preponderance of male gender (71%) and structural causes (78%). More than half of the enrolled children had failed four or more antiseizure medications (ASM) for epileptic spasms. The study participants had a long lead-time-to-treatment (LTTT) for the initial standard therapy (median 2 mo; Q1, Q3 1, 5) and nitrazepam (median 11 mo; Q1, Q3 8, 16). Nitrazepam was instituted as monotherapy in 7 (17%) children and as an adjunct in the rest. Twenty-one (51%) children achieved persistent cessation of epileptic spasms. However, the electroclinical response was observed in 17 (42%) children. Drowsiness, sialorrhea, and decreased appetite were the most commonly observed adverse events. Most adverse events were mild to moderate in severity and did not require dose reduction or change of medication. There was no significant difference between the responders and nonresponders in terms of LTTT, age at onset, or etiology.
Nitrazepam is a safe and feasible treatment alternative in children with resistant WS resulting in persistent cessation of spasms and electroclinical response in nearly half of patients.
Nitrazepam is a safe and feasible treatment alternative in children with resistant WS resulting in persistent cessation of spasms and electroclinical response in nearly half of patients.Globally, the occurrence of biofilm associated infection has become an alarming menace to the medical fraternity because the thick exopolysaccharide layer encasing the biofilms makes the biofilm producing pathogens inherently resistant to antibiotics. Candida albicans, the most common pathogen among Candida spp. is the causative agent for superficial and invasive candidiasis. The morphological phase switching from yeast to hyphal form is one of the virulent traits of C. albicans critical for its pathogenicity. Owing to the emergence of antifungal resistance among this opportunistic fungus, there is a dire need for improvised alternative antifungal agents. In the present study, we have evaluated a biosurfactant from a marine bacterium for its biofilm disruption ability against C. 666-15 inhibitor research buy albicans. This biosurfactant had the potential to disrupt biofilms as well as to inhibit the morphological transition from yeast to hyphae. In addition, this biosurfactant showed enhance disruption of mixed species biofilms of C. albicans and Staphylococcus epidermidis when combined with DNase isolated from marine bacteria.666-15 inhibitor research buy
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