Human immunodeficiency virus(HIV)modifies CD4-positive cells,resulting in immunodeficiency and a wide range of gastrointestinal(GI)manifestations.The burden of HIV-related GI illnesses has significantly evolved with t...Human immunodeficiency virus(HIV)modifies CD4-positive cells,resulting in immunodeficiency and a wide range of gastrointestinal(GI)manifestations.The burden of HIV-related GI illnesses has significantly evolved with the widespread use of antiretroviral therapy(ART).While ART has effectively reduced the occurrence of opportunistic infections,it has led to an increase in therapy-related GI illnesses.Common esophageal conditions in HIV patients include gastroesophageal reflux disease,idiopathic esophageal ulcers,herpes simplex virus,cytomegalovirus(CMV),and candidal esophagitis.Kaposi’s sarcoma,a hallmark of acquired immunodeficiency syndrome,may affect the entire GI system.Gastritis and peptic ulcer disease are also frequently seen in patients with HIV.Diarrhea,often linked to both opportunistic infections and ART,requires careful evaluation.Bloody diarrhea,often a sign of colitis caused by bacterial infections such as Shigella or Clostridium difficile,is prevalent.Small bowel lymphoma,although rare,is increasing in prevalence.Anorectal disorders,including proctitis,fissures,and anal squamous cell carcinoma,are particularly relevant in homosexual men,underlining the importance of timely diagnosis.This review comprehensively explores the epidemiology,pathogenesis,and treatment considerations for the various GI disorders associated with HIV,highlighting the importance of accurate diagnosis and effective treatment to improve outcomes for HIV-infected patients.展开更多
Liver transplantation(LT)is the definitive treatment for end-stage liver disease,acute liver failure,and liver cancer.Although advancements in surgical techniques,postoperative care,and immunosuppressive therapies hav...Liver transplantation(LT)is the definitive treatment for end-stage liver disease,acute liver failure,and liver cancer.Although advancements in surgical techniques,postoperative care,and immunosuppressive therapies have significantly improved outcomes,the long-term use of immunosuppression has increased the risk of complications,including infections,cardiovascular disease,and cancer.Among these,de novo malignancies(DNMs)are a major concern,accounting for 20%-25%of deaths in LT recipients surviving beyond the early post-transplant period.Non-melanoma skin cancers,particularly squamous cell carcinoma are the most prevalent DNMs.Other significant malignancies include Kaposi's sarcoma,post-transplant lymphoproliferative disorders,and various solid organ cancers,including head and neck cancers.Compared to the general population,LT patients face a twofold increase in solid organ malignancies and a 30-fold increase in lymphoproliferative disorders.Risk factors for DNM include chronic immunosuppression,alcohol or tobacco use,viral infections,and underlying liver disease.Emerging evidence emphasizes the importance of tailored cancer screening and prevention strategies,including regular dermatological examinations,targeted screenings for high-risk cancers,and patient education on lifestyle modifications.Early detection through enhanced surveillance protocols has been shown to improve outcomes.Management of DNMs involves a combination of standard oncological therapies and adjustments to immunosuppressive regimens,with promising results from the use of mTOR inhibitors in select patients.The review highlights the critical need for ongoing research to refine risk stratification,optimize screening protocols,and improve treatment approaches to mitigate the burden of DNMs in LT recipients.By implementing personalized preventive and therapeutic strategies,we can enhance long-term outcomes and quality of life for this vulnerable population.展开更多
Obstacle avoidance becomes a very challenging task for an autonomous underwater vehicle(AUV)in an unknown underwater environment during exploration process.Successful control in such case may be achieved using the mod...Obstacle avoidance becomes a very challenging task for an autonomous underwater vehicle(AUV)in an unknown underwater environment during exploration process.Successful control in such case may be achieved using the model-based classical control techniques like PID and MPC but it required an accurate mathematical model of AUV and may fail due to parametric uncertainties,disturbance,or plant model mismatch.On the other hand,model-free reinforcement learning(RL)algorithm can be designed using actual behavior of AUV plant in an unknown environment and the learned control may not get affected by model uncertainties like a classical control approach.Unlike model-based control model-free RL based controller does not require to manually tune controller with the changing environment.A standard RL based one-step Q-learning based control can be utilized for obstacle avoidance but it has tendency to explore all possible actions at given state which may increase number of collision.Hence a modified Q-learning based control approach is proposed to deal with these problems in unknown environment.Furthermore,function approximation is utilized using neural network(NN)to overcome the continuous states and large statespace problems which arise in RL-based controller design.The proposed modified Q-learning algorithm is validated using MATLAB simulations by comparing it with standard Q-learning algorithm for single obstacle avoidance.Also,the same algorithm is utilized to deal with multiple obstacle avoidance problems.展开更多
Surface modification for improving corrosion resistance of Mg alloys is highly demanded for degradable orthopedic and cardiovascular devices.The research reports the design and development of TiO_(2)–HA composite and...Surface modification for improving corrosion resistance of Mg alloys is highly demanded for degradable orthopedic and cardiovascular devices.The research reports the design and development of TiO_(2)–HA composite and novel TiO_(2)–HA–PCL hybrid coating belonging to the unique class of inorganic organic hybrid with striking features that are explored for the first time in the corrosion resistance of Mg alloys.Sol–gel dip coating combined with non-solvent induced phase separation is used to create the hybrid coating.TiO_(2)–HA–PCL hybrid coating introduces strong hydrogen bonding between TiO_(2)–HA inorganic matrix and PCL organic layer in addition to the Vander wall electrostatic interaction of the later with the Mg substrate which in turn enhance adhesion strength to about 1.5 times of TiO_(2)–HA coating.The corrosion potentials for TiO_(2)–HA–PCL and TiO_(2)–HA were found to be-0.407 V and-1.017 V(vs Ag/Ag Cl),respectively.The current densities of TiO_(2)–HA–PCL and TiO_(2)–HA were found to be 7.31×10^(-8)A/cm^(2)and 4.03×10^(-4)A/cm^(2)respectively.The corrosion resistance of coatings was confirmed by immersion testing by weight loss,pH changes and H_(2)evolution measurements at interval of 7 days till 28 days.The present TiO_(2)–HA–PCL coating in comparison to TiO_(2)–HA coating demonstrate nearly 6%less weight loss.The outcome of the present work was compared with the similar coatings in recent past.The work done ingresses enhancing the corrosion resistance of Mg alloys,which fulfill the dreams of future degradable orthopedic and cardiovascular devices.展开更多
BACKGROUND Lifetime psychotic symptoms are present in over half of the patients with bipolar disorder(BD)and can have an adverse effect on its course,outcome,and treatment.However,despite a considerable amount of rese...BACKGROUND Lifetime psychotic symptoms are present in over half of the patients with bipolar disorder(BD)and can have an adverse effect on its course,outcome,and treatment.However,despite a considerable amount of research,the impact of psychotic symptoms on BD remains unclear,and there are very few systematic reviews on the subject.AIM To examine the extent of psychotic symptoms in BD and their impact on several aspects of the illness.METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed.An electronic literature search of six English-language databases and a manual search was undertaken to identify published articles on psychotic symptoms in BD from January 1940 to December 2021.Combinations of the relevant Medical Subject Headings terms were used to search for these studies.Articles were selected after a screening phase,followed by a review of the full texts of the articles.Assessment of the methodological quality of the studies and the risk of bias was conducted using standard tools.RESULTS This systematic review included 339 studies of patients with BD.Lifetime psychosis was found in more than a half to two-thirds of the patients,while current psychosis was found in a little less than half of them.Delusions were more common than hallucinations in all phases of BD.About a third of the patients reported first-rank symptoms or mood-incongruent psychotic symptoms,particularly during manic episodes.Psychotic symptoms were more frequent in bipolar type I compared to bipolar type II disorder and in mania or mixed episodes compared to bipolar depression.Although psychotic symptoms were not more severe in BD,the severity of the illness in psychotic BD was consistently greater.Psychosis was usually associated with poor insight and a higher frequency of agitation,anxiety,and hostility but not with psychiatric comorbidity.Psychosis was consistently linked with increased rates and the duration of hospitalizations,switching among patients with depression,and poorer outcomes with mood-incongruent symptoms.In contrast,psychosis was less likely to be accompanied by a rapid-cycling course,longer illness duration,and heightened suicidal risk.There was no significant impact of psychosis on the other parameters of course and outcome.CONCLUSION Though psychotic symptoms are very common in BD,they are not always associated with an adverse impact on BD and its course and outcome.展开更多
A novel PCL/HA/TiO_(2)hybrid coating on ZM21 Mg alloy substrate has been investigated for corrosion resistance, biocompatibility and mechanical integrity loss in terms of bending, compressive and tensile strength in p...A novel PCL/HA/TiO_(2)hybrid coating on ZM21 Mg alloy substrate has been investigated for corrosion resistance, biocompatibility and mechanical integrity loss in terms of bending, compressive and tensile strength in physiological media. The prepared hybrid coating was dip coated over ZM21 from HA/TiO_(2)and PCL solutions followed by creating a microporous PCL layer by utilizing Non-solvent Induced Phase Separation(NIPS) technique. The electrochemical measurement and in-vitro degradation study in SBF after 28 days showed that the PCL/HA/TiO_(2) hybrid coating reduced H2 evolution rate, weight loss, and corrosion rate by 64, 116 and 118 times respectively, as compared to uncoated ZM21 samples. The surface studies carried out using SEM-EDX, FTIR and XRD revealed formation of highly stable 3d flower-like HA crystals with Ca/P ratio of 1.60 in the PCL micropores. This dense apatite growth effectively protected the PCL/HA/TiO_(2)hybrid coated samples to maintain the good mechanical integrity even after 28 days of immersion as compared to HA/TiO_(2)composite coated, As-polished(A/P) and As-machined(A/M) samples. The failure analysis of samples under mechanical loading were performed using SEM-BSE-EBSD.The in-vitro cellular viability of L929 fibroblast cells on PCL/HA/TiO_(2)hybrid coating was found 50.47% higher with respect to control group,whereas bacterial viability was supressed by 57.15 and 62.35% against gram-positive Staphylococcus aureus and gram-negative Escherichia coli bacterial models. The comprehensive assessment indicates PCL/HA/TiO_(2)hybrid coating as a suitable candidate to delay early degradation and mechanical integrity loss of Mg-based alloys for devising biodegradable orthopaedic implant.展开更多
Mg and its alloys evince strong candidature for biodegradable bone implants,cardiovascular stents,and wound closing devices.However,their rapid degradation rate causes premature implant failure,constraining clinical a...Mg and its alloys evince strong candidature for biodegradable bone implants,cardiovascular stents,and wound closing devices.However,their rapid degradation rate causes premature implant failure,constraining clinical applications.Bio-functional surface coatings have emerged as the most competent strategy to fulfill the diverse clinical requirements,besides yielding effective corrosion resistance.This article reviews the progress of biodegradable and advanced surface coatings on Mg alloys investigated in recent years,aiming to build up a comprehensive knowledge framework of coating techniques,processing parameters,performance measures in terms of corrosion resistance,adhesion strength,and biocompatibility.Recently developed conversion and deposition type surface coatings are thoroughly discussed by reporting their essential therapeutic responses like osteogenesis,angiogenesis,cytocompatibility,hemocompatibility,anti-bacterial,and controlled drug release towards in-vitro and in-vivo study models.The challenges associated with metallic,ceramic and polymeric coatings along with merits and demerits of various coatings have been illustrated.The use of multilayered hybrid coating comprising a unique combination of organic and inorganic components has been emphasized with future perspectives to obtain diverse bio-functionalities in a facile single coating system for orthopedic implant applications.展开更多
文摘Human immunodeficiency virus(HIV)modifies CD4-positive cells,resulting in immunodeficiency and a wide range of gastrointestinal(GI)manifestations.The burden of HIV-related GI illnesses has significantly evolved with the widespread use of antiretroviral therapy(ART).While ART has effectively reduced the occurrence of opportunistic infections,it has led to an increase in therapy-related GI illnesses.Common esophageal conditions in HIV patients include gastroesophageal reflux disease,idiopathic esophageal ulcers,herpes simplex virus,cytomegalovirus(CMV),and candidal esophagitis.Kaposi’s sarcoma,a hallmark of acquired immunodeficiency syndrome,may affect the entire GI system.Gastritis and peptic ulcer disease are also frequently seen in patients with HIV.Diarrhea,often linked to both opportunistic infections and ART,requires careful evaluation.Bloody diarrhea,often a sign of colitis caused by bacterial infections such as Shigella or Clostridium difficile,is prevalent.Small bowel lymphoma,although rare,is increasing in prevalence.Anorectal disorders,including proctitis,fissures,and anal squamous cell carcinoma,are particularly relevant in homosexual men,underlining the importance of timely diagnosis.This review comprehensively explores the epidemiology,pathogenesis,and treatment considerations for the various GI disorders associated with HIV,highlighting the importance of accurate diagnosis and effective treatment to improve outcomes for HIV-infected patients.
文摘Liver transplantation(LT)is the definitive treatment for end-stage liver disease,acute liver failure,and liver cancer.Although advancements in surgical techniques,postoperative care,and immunosuppressive therapies have significantly improved outcomes,the long-term use of immunosuppression has increased the risk of complications,including infections,cardiovascular disease,and cancer.Among these,de novo malignancies(DNMs)are a major concern,accounting for 20%-25%of deaths in LT recipients surviving beyond the early post-transplant period.Non-melanoma skin cancers,particularly squamous cell carcinoma are the most prevalent DNMs.Other significant malignancies include Kaposi's sarcoma,post-transplant lymphoproliferative disorders,and various solid organ cancers,including head and neck cancers.Compared to the general population,LT patients face a twofold increase in solid organ malignancies and a 30-fold increase in lymphoproliferative disorders.Risk factors for DNM include chronic immunosuppression,alcohol or tobacco use,viral infections,and underlying liver disease.Emerging evidence emphasizes the importance of tailored cancer screening and prevention strategies,including regular dermatological examinations,targeted screenings for high-risk cancers,and patient education on lifestyle modifications.Early detection through enhanced surveillance protocols has been shown to improve outcomes.Management of DNMs involves a combination of standard oncological therapies and adjustments to immunosuppressive regimens,with promising results from the use of mTOR inhibitors in select patients.The review highlights the critical need for ongoing research to refine risk stratification,optimize screening protocols,and improve treatment approaches to mitigate the burden of DNMs in LT recipients.By implementing personalized preventive and therapeutic strategies,we can enhance long-term outcomes and quality of life for this vulnerable population.
基金the support of Centre of Excellence (CoE) in Complex and Nonlinear dynamical system (CNDS), through TEQIP-II, VJTI, Mumbai, India
文摘Obstacle avoidance becomes a very challenging task for an autonomous underwater vehicle(AUV)in an unknown underwater environment during exploration process.Successful control in such case may be achieved using the model-based classical control techniques like PID and MPC but it required an accurate mathematical model of AUV and may fail due to parametric uncertainties,disturbance,or plant model mismatch.On the other hand,model-free reinforcement learning(RL)algorithm can be designed using actual behavior of AUV plant in an unknown environment and the learned control may not get affected by model uncertainties like a classical control approach.Unlike model-based control model-free RL based controller does not require to manually tune controller with the changing environment.A standard RL based one-step Q-learning based control can be utilized for obstacle avoidance but it has tendency to explore all possible actions at given state which may increase number of collision.Hence a modified Q-learning based control approach is proposed to deal with these problems in unknown environment.Furthermore,function approximation is utilized using neural network(NN)to overcome the continuous states and large statespace problems which arise in RL-based controller design.The proposed modified Q-learning algorithm is validated using MATLAB simulations by comparing it with standard Q-learning algorithm for single obstacle avoidance.Also,the same algorithm is utilized to deal with multiple obstacle avoidance problems.
基金funded under the research grant(File no.EMR/2016/001581)sponsored by SERB,DST,India
文摘Surface modification for improving corrosion resistance of Mg alloys is highly demanded for degradable orthopedic and cardiovascular devices.The research reports the design and development of TiO_(2)–HA composite and novel TiO_(2)–HA–PCL hybrid coating belonging to the unique class of inorganic organic hybrid with striking features that are explored for the first time in the corrosion resistance of Mg alloys.Sol–gel dip coating combined with non-solvent induced phase separation is used to create the hybrid coating.TiO_(2)–HA–PCL hybrid coating introduces strong hydrogen bonding between TiO_(2)–HA inorganic matrix and PCL organic layer in addition to the Vander wall electrostatic interaction of the later with the Mg substrate which in turn enhance adhesion strength to about 1.5 times of TiO_(2)–HA coating.The corrosion potentials for TiO_(2)–HA–PCL and TiO_(2)–HA were found to be-0.407 V and-1.017 V(vs Ag/Ag Cl),respectively.The current densities of TiO_(2)–HA–PCL and TiO_(2)–HA were found to be 7.31×10^(-8)A/cm^(2)and 4.03×10^(-4)A/cm^(2)respectively.The corrosion resistance of coatings was confirmed by immersion testing by weight loss,pH changes and H_(2)evolution measurements at interval of 7 days till 28 days.The present TiO_(2)–HA–PCL coating in comparison to TiO_(2)–HA coating demonstrate nearly 6%less weight loss.The outcome of the present work was compared with the similar coatings in recent past.The work done ingresses enhancing the corrosion resistance of Mg alloys,which fulfill the dreams of future degradable orthopedic and cardiovascular devices.
文摘BACKGROUND Lifetime psychotic symptoms are present in over half of the patients with bipolar disorder(BD)and can have an adverse effect on its course,outcome,and treatment.However,despite a considerable amount of research,the impact of psychotic symptoms on BD remains unclear,and there are very few systematic reviews on the subject.AIM To examine the extent of psychotic symptoms in BD and their impact on several aspects of the illness.METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed.An electronic literature search of six English-language databases and a manual search was undertaken to identify published articles on psychotic symptoms in BD from January 1940 to December 2021.Combinations of the relevant Medical Subject Headings terms were used to search for these studies.Articles were selected after a screening phase,followed by a review of the full texts of the articles.Assessment of the methodological quality of the studies and the risk of bias was conducted using standard tools.RESULTS This systematic review included 339 studies of patients with BD.Lifetime psychosis was found in more than a half to two-thirds of the patients,while current psychosis was found in a little less than half of them.Delusions were more common than hallucinations in all phases of BD.About a third of the patients reported first-rank symptoms or mood-incongruent psychotic symptoms,particularly during manic episodes.Psychotic symptoms were more frequent in bipolar type I compared to bipolar type II disorder and in mania or mixed episodes compared to bipolar depression.Although psychotic symptoms were not more severe in BD,the severity of the illness in psychotic BD was consistently greater.Psychosis was usually associated with poor insight and a higher frequency of agitation,anxiety,and hostility but not with psychiatric comorbidity.Psychosis was consistently linked with increased rates and the duration of hospitalizations,switching among patients with depression,and poorer outcomes with mood-incongruent symptoms.In contrast,psychosis was less likely to be accompanied by a rapid-cycling course,longer illness duration,and heightened suicidal risk.There was no significant impact of psychosis on the other parameters of course and outcome.CONCLUSION Though psychotic symptoms are very common in BD,they are not always associated with an adverse impact on BD and its course and outcome.
基金CSIR-IMTECH laboratory for providing the technical support in biocompatibility testing。
文摘A novel PCL/HA/TiO_(2)hybrid coating on ZM21 Mg alloy substrate has been investigated for corrosion resistance, biocompatibility and mechanical integrity loss in terms of bending, compressive and tensile strength in physiological media. The prepared hybrid coating was dip coated over ZM21 from HA/TiO_(2)and PCL solutions followed by creating a microporous PCL layer by utilizing Non-solvent Induced Phase Separation(NIPS) technique. The electrochemical measurement and in-vitro degradation study in SBF after 28 days showed that the PCL/HA/TiO_(2) hybrid coating reduced H2 evolution rate, weight loss, and corrosion rate by 64, 116 and 118 times respectively, as compared to uncoated ZM21 samples. The surface studies carried out using SEM-EDX, FTIR and XRD revealed formation of highly stable 3d flower-like HA crystals with Ca/P ratio of 1.60 in the PCL micropores. This dense apatite growth effectively protected the PCL/HA/TiO_(2)hybrid coated samples to maintain the good mechanical integrity even after 28 days of immersion as compared to HA/TiO_(2)composite coated, As-polished(A/P) and As-machined(A/M) samples. The failure analysis of samples under mechanical loading were performed using SEM-BSE-EBSD.The in-vitro cellular viability of L929 fibroblast cells on PCL/HA/TiO_(2)hybrid coating was found 50.47% higher with respect to control group,whereas bacterial viability was supressed by 57.15 and 62.35% against gram-positive Staphylococcus aureus and gram-negative Escherichia coli bacterial models. The comprehensive assessment indicates PCL/HA/TiO_(2)hybrid coating as a suitable candidate to delay early degradation and mechanical integrity loss of Mg-based alloys for devising biodegradable orthopaedic implant.
文摘Mg and its alloys evince strong candidature for biodegradable bone implants,cardiovascular stents,and wound closing devices.However,their rapid degradation rate causes premature implant failure,constraining clinical applications.Bio-functional surface coatings have emerged as the most competent strategy to fulfill the diverse clinical requirements,besides yielding effective corrosion resistance.This article reviews the progress of biodegradable and advanced surface coatings on Mg alloys investigated in recent years,aiming to build up a comprehensive knowledge framework of coating techniques,processing parameters,performance measures in terms of corrosion resistance,adhesion strength,and biocompatibility.Recently developed conversion and deposition type surface coatings are thoroughly discussed by reporting their essential therapeutic responses like osteogenesis,angiogenesis,cytocompatibility,hemocompatibility,anti-bacterial,and controlled drug release towards in-vitro and in-vivo study models.The challenges associated with metallic,ceramic and polymeric coatings along with merits and demerits of various coatings have been illustrated.The use of multilayered hybrid coating comprising a unique combination of organic and inorganic components has been emphasized with future perspectives to obtain diverse bio-functionalities in a facile single coating system for orthopedic implant applications.
