Self-adaptive moth flame optimizer combined with crossover operator and Fibonacci search strategy for COVID-19 CT image segmentation

The COVID-19 is one of the most significant obstacles that humanity is now facing. The use of computed tomography (CT) images is one method that can be utilized to recognize COVID-19 in early stage. In this study, an upgraded variant of Moth flame optimization algorithm (Es-MFO) is presented by considering a nonlinear self-adaptive parameter and a mathematical principle based on the Fibonacci approach method to achieve a higher level of accuracy in the classification of COVID-19 CT images. The proposed Es-MFO algorithm is evaluated using nineteen different basic benchmark functions, thirty and fifty dimensional IEEE CEC'2017 test functions, and compared the proficiency with a variety of other fundamental optimization techniques as well as MFO variants. Moreover, the suggested Es-MFO algorithm's robustness and durability has been evaluated with tests including the Friedman rank test and the Wilcoxon rank test, as well as a convergence analysis and a diversity analysis. Furthermore, the proposed Es-MFO algorithm resolves three CEC2020 engineering design problems to examine the problem-solving ability of the proposed method. The proposed Es-MFO algorithm is then used to solve the COVID-19 CT image segmentation problem using multi-level thresholding with the help of Otsu's method. Comparison results of the suggested Es-MFO with basic and MFO variants proved the superiority of the newly developed algorithm.

Trends in rifampicin and isoniazid resistance in patients with presumptive TB

BACKGROUND: Early diagnosis of drug-resistant TB (DR-TB) is crucial in preventing the spread of the disease in the community. Introduction of upfront decentralised drug susceptibility testing to district-level as part of universal drug susceptibility testing (UDST) policy increased the feasibility of rapid and early testing for drug resistance closer to the patient and has resulted in reduced circumstances for transmission. The introduction of the first-line line-probe assay (FL-LPA), GenoType^® MTBDRplus v2, has had an extensive impact on the management of multidrug-resistant TB (MDR-TB) in India.MATERIALS and METHODS: Sputum samples of patients with presumptive TB and DR-TB from selected districts of Tamil Nadu received through National TB Elimination Programme (NTEP) were subjected to FL-LPA as per programme guidelines. In this study, we present trends in genotypic resistance to isoniazid (INH) and rifampicin (RIF) during the 4 years (2016-2019) among these patients. Band patterns were analysed as per the updated GLI (Global Laboratory Initiative) LPA interpretation and reporting guidelines.RESULTS: A total of 26,349 samples were received during the study period. Smear-positive samples (n = 20231) were directly subjected to FL-LPA; smear-negative samples were cultured in liquid media and M. tuberculosis-positive cultures were tested using FL-LPA. A total of 18,441 were MTB-positive on FL-LPA. INH monoresistance, RIF monoresistance and MDR-TB was observed in respectively 8.7%, 1.1% and 3.3% of the samples. There was a decreasing trend in all types of resistance observed particularly after 2017 (P < 0.001). MDR-TB showed a steady decrease from 5.6% to 1.8%. S531L (19.5%) and S315T (61.1%) were the most common mutations identified in the rpoB and katG genes, respectively. The percentage of inhA-c-15t promoter mutation, indicating low-level INH resistance, showed a consistent increase (P < 0.001).CONCLUSION: The impact of the UDST policy on the NTEP may have led to this decreasing trend in RIF and INH resistance observed in the study period. The increase in low-level INH resistance mutation inhA-c-15t may be associated with ethionamide/prothionamide resistance, and this should be taken into account when designing DR-TB regimen.

Enhanced chaotic JAYA algorithm for parameter estimation of photovoltaic cell/modules

Parameters for defining photovoltaic models using measured voltage-current​ characteristics are essential for simulation, control, and evaluation of photovoltaic-based systems. This paper proposes an enhanced chaotic JAYA algorithm to classify the parameters of various photovoltaic models, such as the single-diode and double-diode models, accurately and reliably. The proposed algorithm introduces a self-adaptive weight to regulate the trend to reach the optimal solution and avoid the worst solution in various phases of the search space. The self-adaptive weight capability also allows the proposed technique to reach the best solution at the earliest phase, and later, the local search process starts, which also increase the ability to explore. A three different chaotic process, including sine, logistics and tent map, is proposed to optimize the consistency of each generation's best solution. The proposed algorithm and its variants proposed are used to solve the parameter estimation problem of various PV models. To show the proficiency of the suggested algorithm and its variants, an extensive simulation is carried out using MATLAB/Simulink software. Two statistical tests are conducted and compared with the latest techniques for validating the performance of the suggested algorithm and its variants. Comprehensive analysis and experimental results display that the suggested algorithm can achieve highly competitive efficiency in terms of accuracy and reliability compared to other algorithms in the literature. This research will be backed up with extra online service and guidance for the paper's source code at https://premkumarmanoharan.wixsite.com/mysite.

Incidence of spontaneous intestinal perforations exceeds necrotizing enterocolitis in extremely low birth weight infants fed an exclusive human milk-based diet: A single center experience

BACKGROUND

Spontaneous intestinal perforation (SIP) and necrotizing enterocolitis (NEC) are complications of extremely low birth weight (ELBW, ≤1000 g) infants. ELBW infants at Texas Children's Hospital receive an exclusive human milk-based diet, which has been associated with a reduction of NEC.

OBJECTIVES

1) Assess incidence of SIP and NEC (Stage II or greater) in ELBW infants receiving 100% human milk-based diet, 2) Describe mortality rates of ELBW infants with SIP and NEC.

METHODS

Prospective single-center observational cohort study of ELBW infants born between 2010 and 2014 with SIP or NEC (exclusion: congenital anomalies and death within 48 h).

RESULTS

Of 379 ELBW infants, 345 were eligible. Of these, 28 (8.1%) had SIP and 8 (2.3%) had NEC (medical n = 1, surgical n = 7). SIP infant mortality was 32% (n = 9) compared to 63% (n = 5) for NEC patients. Of SIP infants with PD (n = 25), 52% required subsequent exploratory laparotomy (LAP). Of NEC infants with peritoneal drainage (PD) (n = 2), both required subsequent LAP.

CONCLUSION

Using an exclusive human milk-based diet, the incidence of SIP exceeds NEC in ELBW infants at our institution. This shows a changing trend in the incidence of these two diagnoses in the era of human milk, as NEC had previously been more prevalent in ELBW infants. More than half of infants who initially received PD later required LAP. There were no differences in survival outcomes in both SIP and NEC groups based on surgical management.

Parenteral lipids shape gut bile acid pools and microbiota profiles in the prevention of cholestasis in preterm pigs

Multi-component lipid emulsions, rather than soy-oil emulsions, prevent cholestasis by an unknown mechanism. Here, we quantified liver function, bile acid pools, and gut microbial and metabolite profiles in premature parenterally fed pigs given a soy-oil lipid emulsion, Intralipid (IL), a multi component lipid emulsion, SMOFlipid (SMOF), a novel emulsion with a modified fatty-acid composition [experimental emulsion (EXP)], or a control enteral diet (ENT) for 22 days. We assayed serum cholestasis markers, measured total bile acid levels in plasma, liver, and gut contents, and analyzed colonic bacterial 16S rRNA gene sequences and metabolomic profiles. Serum cholestasis markers (i.e., bilirubin, bile acids, and γ-glutamyl transferase) were highest in IL-fed pigs and normalized in those given SMOF, EXP, or ENT. Gut bile acid pools were lowest in the IL treatment and were increased in the SMOF and EXP treatments and comparable to ENT. Multiple bile acids, especially their conjugated forms, were higher in the colon contents of SMOF and EXP than in IL pigs. The colonic microbial communities of SMOF and EXP pigs had lower relative abundance of several gram-positive anaerobes, including Clostridrium XIVa, and higher abundance of Enterobacteriaceae than those of IL and ENT pigs. Differences in lipid and microbial-derived compounds were also observed in colon metabolite profiles. These results indicate that multi-component lipid emulsions prevent cholestasis and restore enterohepatic bile flow in association with gut microbial and metabolomic changes. We conclude that sustained bile flow induced by multi-component lipid emulsions likely exerts a dominant effect in reducing bile acid-sensitive gram-positive bacteria.

New generation lipid emulsions increase brain DHA and improve body composition, but not short-term neurodevelopment in parenterally-fed preterm piglets

New generation, multicomponent parenteral lipid emulsions provide key fatty acids for brain growth and development, such as docosahexaenoic acid (DHA) and arachidonic acid (AA), yet the content may be suboptimal for preterm infants. Our aim was to test whether DHA and AA-enriched lipid emulsions would increase activity, growth, and neurodevelopment in preterm piglets and limit brain inflammation. Cesarean-delivered preterm pigs were given three weeks of either enteral preterm infant formula (ENT) or TPN with one of three parenteral lipid emulsions: Intralipid (IL), SMOFlipid (SMOF) or an experimental emulsion (EXP). Activity was continuously monitored and weekly blood sampling and behavioral field testing performed. At termination of the study, whole body and tissue metrics were collected. Neuronal density was assessed in sections of hippocampus (HC), thalamus, and cortex. Frontal cortex (FC) and HC tissue were assayed for fatty acid profiles and expression of genes of neuronal growth and inflammation. After 3 weeks of treatment, brain DHA content in SMOF, EXP and ENT pigs was higher (P < 0.01) in FC but not HC vs. IL pigs. There were no differences in brain weight or neuron density among treatment groups. Inflammatory cytokine TNFα and IL-1β expression in brain regions were increased in IL pigs (P < 0.05) compared to other groups. Overall growth velocity was similar among groups, but IL pigs had higher percent body fat and increased insulin resistance compared to other treatments (P < 0.05). ENT pigs spent more time in higher physical activity levels compared to all TPN groups, but there were no differences in exploratory behavior among groups. We conclude that a soybean oil emulsion increased select brain inflammatory cytokines and multicomponent lipid emulsions enriched with DHA and AA in parenteral lipids results in increased cortical DHA and improved body composition without affecting short term neurodevelopmental outcomes.

A dataset of the study on design parameters for the solar photovoltaic charge controller

This set of data is being used to calculate the design parameters of the solar photovoltaic (PV) charge controller. The data presented in this paper are used to design an advanced charge control with higher capacity and more possible real-time applications. This design parameters of the controller will be useful for the off-grid systems, automatic street light, and signs control, etc., which requires the medium-level power, and more reliable operation. The design set of parameters such as inductance, switching frequency, duty cycle, power loss, and the efficiency are given in this paper for the rating of the 500 W charge controller. The data captured are compared with the various power level selection along with the different power semiconductor switches.

Microvesicles in hepatic and peripheral vein can predict nonresponse to corticosteroid therapy in severe alcoholic hepatitis

BACKGROUND

Severe alcoholic hepatitis patients have high mortality and limited response to corticosteroids. Microvesicles reflect cellular stress and disease conditions.

AIMS

To investigate whether microvesicles are associated with severity, response to steroid therapy and inflammation in severe alcoholic hepatitis.

METHODS

Microvesicles originating from different cells were studied pre-therapy in 101 patients; (71 responder to corticosteroid therapy and 30 nonresponders) and 20 healthy controls. Microvesicles and cells were determined in peripheral and hepatic vein samples using flow cytometry and correlated with outcomes. Inflammatory signalling pathways and functional alterations of immune cells after stimulation with microvesicles were also investigated.

RESULTS

Microvesicles mean levels were higher in nonresponders for T cells (CD3⁺ CD4⁺ ; 10.1 MV/μL vs 5.4; P = 0.06), macrophages (CD68⁺ CD11b⁺ ; 136.5 vs 121.9 MV/μL; P = 0.01), haematopoietic stem-cells (CD45⁺ CD34⁺ ; 116.8 vs 13.4 MV/μL; P = 0.0001) and hepatocytes (ASGPR⁺ ; 470 vs 361 MV/μL; P = 0.01); the latter two predicting steroid nonresponse in 94% patients at baseline in peripheral plasma. Microvesicle levels correlated with histological and liver disease severity indices. Whereas, in non-responders hepatic vein CD34+ cells were lower (P = 0.02), the CD34+ microvesicles there from were higher (P = 0.04), thus suggesting impaired regeneration. Also, microvesicles of 0.2-0.4 μm size were higher in nonresponders (P < 0.03) at baseline. Microvesicles from patients trigger more (P = 0.04) ROS generation, TNF-α production (P = 0.04) and up-regulate pro-inflammatory cytokine related genes in neutrophils in vitro.

CONCLUSIONS

Pre-therapy peripheral plasma levels of CD34⁺ and ASGPR⁺ microvesicles are reliable non-invasive markers of steroid nonresponse and mortality in patients with severe alcoholic hepatitis.

Emerging Clinical Benefits of New-Generation Fat Emulsions in Preterm Neonates

Soybean oil-based intravenous fat emulsions (IVFEs) have been the predominant parenteral nutrition IVFE used in the United States for neonates over the past 45 years. Even though this emulsion has proven useful in supplying infants with energy for growth and essential fatty acids, there have been concerns over its composition in the development of several morbidities, ranging from sepsis to liver disease, bronchopulmonary dysplasia, and impaired neurodevelopment and growth. The exact mechanisms that drive these morbidities in preterm infants are multifactorial, but potential contributors include high ω-6 (n-6) fatty acid composition, low docosahexaenoic acid and antioxidant supplementation, and the presence of potentially harmful nonnutritive components (eg, phytosterols). To address these issues, new-generation IVFEs with various types and amounts of fat have been developed containing greater amounts of the medium-chain fatty acids, long-chain polyunsaturated fatty acid, docosahexaenoic acid, lower concentrations of ω-6 polyunsaturated fatty acids, supplemental vitamin E, and low or negligible amounts of phytosterols. This review examines the clinical outcomes associated with different morbidities of parenteral nutrition in neonates who have received either soybean oil-based or new-generation IVFEs and addresses whether the proposed benefits of new-generation IVFEs have improved outcomes in the neonatal population.

Avascular osteonecrosis of femoral head in a postoperative patient of pituitary Cushing's disease

We describe a rare association of Cushing's disease causing avascular osteonecrosis of the femoral head in a patient with operated pituitary macroadenoma. Avascular necrosis of the femoral head (AVN) is not a common cause of musculoskeletal disability. Though AVN of the hip is a well-recognized complication of steroid treatment, it is rare in cases of endogenous hypercortisolism. To our knowledge, only 16 patients with AVN, associated with endogenous Cushing's syndrome (CS), have been documented in the medical literature. AVN associated with glucocorticoid use is more likely to manifest as bilateral disease than either idiopathic AVN or ethanol-associated AVN. We describe a 26-year-old woman who was diagnosed with Cushing's disease in 2007 and operated in the same year for an ACTH secreting pituitary adenoma, who was consequently given replacement dose steroid therapy for post operative panhypopituitarism. During follow up, she complained of bilateral hip pain and difficulty in ambulation. Magnetic resonance imaging showed multiple bony infarcts in the proximal femur and distal femur with femoral head collapse fractures bilaterally, consistent with AVN. She further underwent decompression surgery on bilateral hip joints. This case illustrates that AVN, an orthopaedic emergency, can be an alarming manifestation of Cushing's disease.

Ventilatory strategies for the extremely premature infant

Bronchopulmonary dysplasia (BPD), which has long-term adverse outcomes, is common following extremely premature birth. BPD has a multifactorial etiology, including a high level or prolonged use of mechanical ventilation. Numerous research studies, therefore, have attempted to identify ventilatory techniques which reduce the likelihood of baro/volutrauma and hence BPD; these have been critically examined in this review, particularly with regard to their relevance to the extremely prematurely born infant. This has highlighted that few randomized studies of ventilatory strategies have concentrated exclusively on those high-risk infants. Overall, in prematurely born infants, advantages have been suggested by the results of studies examining pressure support, proportional assist and volume-targeted ventilation. In addition, High-Frequency Oscillatory Ventilation (HFOV) may reduce the deterioration seen in lung function of prematurely born infants over the first year after birth. In conclusion, more randomized studies are required which concentrate exclusively on the extremely prematurely born population who are at highest risk of BPD. It is essential in such studies that long-term follow-up assessment is inbuilt so that the benefits/adverse effects can be appropriately identified.

Novel thieno oxazine analogues as antihyperglycemic and lipid modulating agents

A series of phenyl acetic acid and alpha-hydroxy propionic acid derivatives were synthesized. In vivo studies of the compounds indicated compound 2c as the most potent in one of the series, which has both glucose and lipid lowering properties. The syntheses and biological studies have been discussed.

Free leucine dissociates homo- and heterodimers formed between proteins containing leucine heptad repeats

A highly specific method for the dissociation of protein dimers has been developed. The method involves exposure of the dimers to free leucine at a concentration ranging between 3 and 10 mM. Using this method it has been possible to dissociate goat uterine oestrogen receptor homodimers, heterodimers formed between the non-activated oestrogen receptor (naER) and the oestrogen receptor activation factor (E-RAF) of the goat uterus, c-jun homodimers derived from bovine bone marrow and also glucocorticoid receptor homodimers isolated from rat liver cytosol. The pattern of dimer dissociation by leucine clearly differentiates two classes of proteins. The first is represented by steroid hormone receptors where dimerization is apparently contributed by both coiled-coil dimerization interfaces and the conserved heptad repeats of leucine. The second is represented by oncoproteins like c-fos and c-jun which dimerize through the exclusive involvement of leucine zippers. The patterns of dissociation of these two groups of proteins from the concerned affinity columns are distinctly different. This indicates a possibility that the elution pattern may be used as a yardstick to determine whether two proteins dimerize through the exclusive involvement of leucine zippers or whether coiled-coil interfaces are also involved in the dimerization process.

Euglycemic and hypolipidemic activity of PAT5A: a unique thiazolidinedione with weak peroxisome proliferator activated receptor gamma activity

The euglycemic and hypolipidemic activities of PAT5A, a novel pyridine analog of thiazolidinedione, have been evaluated in different animal models. Administration of PAT5A to db/db mice resulted in dose-dependent decreases in plasma glucose, triglyceride, and insulin levels, and an improved glucose tolerance. The glucose-lowering activity of PAT5A was better than that of troglitazone and comparable to that of rosiglitazone. In addition, PAT5A showed better lipid-lowering activity than troglitazone or rosiglitazone. A similar profile was seen in ob/ob mice. In high-fat-fed Sprague Dawley rats, PAT5A treatment reduced plasma triglyceride and total cholesterol levels. An in vitro peroxisome proliferator activated receptor gamma (PPARgamma) transactivation assay in HEK-293 cells showed poor transactivation for PAT5A compared with rosiglitazone. PAT5A did not show any PPARalpha- or PPARdelta-activating properties. Ex vivo study in db/db mice treated with PAT5A showed decreased activity of liver glucose 6-phosphatase, a key enzyme in gluconeogenesis. A 28-day probe toxicity study in Wistar rats did not show any treatment-related alterations in hematologic and biochemical parameters, nor any macroscopic and microscopic changes in the vital organs, whereas rosiglitazone treatment increased liver and heart weights. Our results indicate that PAT5A is a potent insulin sensitizer and hypolipidemic compound with a weak PPARgamma activation potential. Both in vivo and in vitro results suggest that PAT5A improves glucose kinetics and lipid levels through mechanisms not related to PPAR activation.