Initiation Protocol Research Articles

Variability in temperature control practices amongst the Influence of Cooling duration on Efficacy in Cardiac Arrest Patients (ICECAP) trial

AimTemperature control is a complex bundled intervention; the synergistic impact of each individual component is ill defined and underreported. Resultantly, the influence of parameter optimization on temperature control’s overall neuroprotective effect remains poorly understood. To characterize variability in temperature control parameters and barriers to short pre-induction and induction times, we surveyed sites enrolling in an ongoing multicenter clinical trial. MethodsThis was a cross-sectional, survey study evaluating temperature control practices within the Influence of Cooling duration on Efficacy in Cardiac Arrest Patients (ICECAP) trial (NCT04217551). A 23-question web-based survey (Qualtrics) was distributed to the site principal investigators by email. Respondents were asked about site practices pertaining to the use of temperature control, including the request to upload individual institutional protocols. Open-ended responses were analyzed qualitatively by categorizing responses into identified themes. To complement survey level data, records pertaining to the quality of temperature control were extracted from the ICECAP trial database. ResultsThe survey response rate was 75% (n = 51) including 23.5% (n = 12) survey respondents who uploaded institutional protocols. Most sites reported having institutional protocols for temperature control (n = 41; 80%), including 62.5% (n = 32) who had separate protocols for initiation of temperature control in the emergency department (ED). Fewer sites had protocols specific to sedation or neuromuscular blockade (NMB) management (n = 35, 68.6%). Use of NMB during temperature control induction was variable; 61.7% (n = 29) of sites induced paralysis less than 20% of the time. While most institutional protocols (n = 11, 83.3%) commented on the importance of early initiation of temperature control, this was incongruent with the largest reported barrier, which was clinical nihilism regarding the importance of early temperature control initiation (n = 30, 62.5%). Within the ICECAP trial database, 1 in 2 patients were treated with NMB however, use of NMB and time to initiation of temperature control device varied widely between sites. ConclusionAmongst ICECAP trial sites, there was significant variability in resources, methods, and barriers for early temperature control initiation. Defining and standardizing high-quality temperature control must be prioritized, as it may impact the interpretation of past and current clinical trial findings.

Desirability of Outcome Ranking and Response Adjusted for Antibiotic Risk (DOOR/RADAR) Post Hoc Analysis Supports Equipoise for Antibiotic Initiation Strategies in Intensive Care Unit-Acquired Pneumonia.

Background: Pneumonia is the most common intensive care unit (ICU)-acquired infection and source of potential sepsis in ICU populations but can be difficult to diagnose in real-time. Despite limited data, rapid initiation of antibiotic agents is endorsed by society guidelines. We hypothesized that a post hoc analysis of a recent randomized pilot study would show no difference between two antibiotic initiation strategies. Patients and Methods: The recent Trial of Antibiotic Restraint in Presumed Pneumonia (TARPP) was a pragmatic cluster-randomized pilot of antibiotic initiation strategies for patients with suspected ICU-acquired pneumonia. Participating ICUs were cluster-randomized to either an immediate initiation protocol or a specimen-initiated protocol where a gram stain was required for initiation of antibiotics. Patients in the study were divided into one of seven mutually exclusive outcome rankings (desirability of outcome ranking; DOOR): (1) Survival, No Pneumonia, No adverse events; (2) Survival, Pneumonia, No adverse events; (3) Survival, No Pneumonia, ventilator-free-alive days ≤14; (4) Survival, Pneumonia, ventilator-free-alive days ≤14; (5) Survival, No Pneumonia, Subsequent episode of suspected pneumonia; (6) Survival, Pneumonia, Subsequent episode of suspected pneumonia; and (7) Death. These rankings were further refined using the duration of antibiotics prescribed for pneumonia (response adjusted for antibiotic risk; RADAR). Results: There were 186 patients enrolled in the study. After applying the DOOR analysis, a randomly selected patient was equally likely to have a better outcome in specimen-initiated arm as in the immediate initiation arm (DOOR probability: 50.8%; 95% confidence interval [CI], 42.7%-58.9%). Outcome probabilities were similar after applying the RADAR analysis (52.5%; 95% CI, 44.2%-60.6%; p = 0.31). Conclusions: We found that patients for whom antibiotic agents were withheld until there was objective evidence (specimen-initiated group) had similar outcome rankings to patients for whom antibiotic agents were started immediately. This supports the findings of the TARPP pilot trial and provides further evidence for equipoise between these two treatment strategies.

Through each other's eyes: initial results and protocol for the co-design of an observational measure of adolescent-parent interaction using first-person perspective

BackgroundCurrent observational methods to understand adolescent-parent interaction are limited in terms of ecological and content validity. We outline initial results and a protocol for future work from a programme of work to: (1) establish a new method for data capture of adolescent-parent interaction at home using wearable cameras and; (2) develop a new relevant and comprehensive observational micro-coding scheme. In Part 1, we report our completed preliminary work, comprised of an initial scoping review, and public engagement work. In Part 2, we present a protocol for the development of the new measure.MethodsPart 1—We searched Pubmed for existing observational measures of adolescent-parent interaction for the scoping review. We also undertook public engagement work utilising a mobile research van, taken to multiple locations around Bristol, UK to engage with a variety of populations through interactive methods. Part 2—Our protocol describes plans for: (1) A systematic review of the psychometric properties of observational measures of adolescent-parent interaction; (2) Focussed public engagement workshops; (3) Harmonisation of information from existing coding schemes and literature with information from public engagement with adolescents and parents; (4) A pilot study to assess the acceptability and feasibility of the method; (5) Development of a coding scheme in consultation with expert and lay panels, and through real-life application to recorded videos from a pilot sample.ResultsScoping review: we identified 21 adolescent-parent observational schemes, of which eight used micro-coding and 13 used globalcoding schemes. The majority of micro-coding schemes were not developed specifically for adolescents. Most studies used conflict or problem-solving tasks, which may not adequately capture positive adolescent-parent interactions. The mobile van event received views from 234 young people and/or parents. Families were positive about taking part in research using headcams. “Trust” and “understanding” were most frequently reported as important adolescent-parent relationship constructs.ConclusionsThis work represents the first attempt to truly co-design a method to assess parenting in adolescence. We hope to develop an observational measure using novel technological methods that can be used across a range of research and therapeutic settings.

Doubled haploidy methodology for three forage grasses [crested wheatgrass (Agropyron cristatum (L.) Gaertn.), hybrid bromegrass (Bromus riparius x B. inermis), and meadow bromegrass (Bromus riparius Rehm.)

Doubled haploidy (DH) methodology is used in many plant species to accelerate crop improvement and cultivar development; however not all species are amenable to the tissue culture technique. Experiments were undertaken to develop DH protocols for three perennial grasses [crested wheatgrass (Agropyron cristatum (L.) Gaertn.), hybrid bromegrass (Bromus riparius x B. inermis), and meadow bromegrass (Bromus riparius Rehm.)]. The initial experiment screened these forage grass species to established wheat (Triticum aestivum L.) microspore culture protocols. Following the initial screen, several factors influencing microspore embryogenesis were evaluated. These included genotype, donor plant conditions, developmental stage of the microspore, pretreatments, media composition, and culture conditions. For regeneration of the embryos to plants, media composition and culture conditions were assessed. Microspore-derived embryos/calli as well as green haploid/doubled haploid plants were regenerated from all three forage grasses. Differences were observed between species and genotypes within species in terms of embryogenic response. Modifications to the initial wheat DH protocol included the donor plant conditions, developmental stage of the microspore to late uninucleate to early binucleate and media composition. Regenerated plants were grown in the greenhouse.

Harvesting Silk Fibers from Plodia interpunctella: Role of Environmental Rearing Conditions in Fiber Production and Properties.

Silk fibers are produced by a wide variety of insects. The silkworm Bombyx mori (Bombyx) was domesticated because the physical properties of its silk fibers were amenable to the production of fine textiles. Subsequently, engineers have regenerated silk fibroin to form biomaterials. The monocular focus on Bombyx silk has underutilized the expanse of diverse silk proteins produced by more than 100,000 other arthropods. This vast array of silk fibers could be utilized for biomedical engineering challenges if sufficient rearing and purification processes are developed. Herein, we show that the moth, Plodia interpunctella (Plodia), represents an alternative silk source that is easily reared in highly regulated culture environments allowing for greater consistency in the silk produced. We controlled the temperature, resource availability (larvae/gram diet), and population density (larvae/mL) with the goal of increasing silk fiber production and improving homogeneity in Plodia silk proteins. We determined that higher temperatures accelerated insect growth and reduced life cycle length. Furthermore, we established initial protocols for the production of Plodia silk with optimal silk production occurring at 24 °C, with a resource availability of 10 larvae/gram and a population density of 0.72 larvae/mL. Population density was shown to be the most prominent driving force of Plodia silk mat formation among the three parameters assessed. Future work will need to link gene expression, protein production and purification, and resulting mechanical properties as a function of environmental cues to further transition Plodia silk into regenerated silk fibroin biomaterials.

Abstract WP283: Association of High-Risk Cardioembolic Sources on Cardiac CT With Acute Ischemic Stroke: A Case-Control Study

Background: Cardiac CT is increasingly used to detect a source of cardioembolism in stroke patients. We assessed the association between sources of embolism on cardiac CT, which were predefined as high-risk, and acute ischemic stroke. Methods: We analyzed data from Mind the Heart, a prospective, single-center, observational cohort study, and included consecutive patients with a suspected stroke who underwent ECG-gated cardiac CT during the initial stroke imaging protocol. Cases were patients with a final diagnosis of acute ischemic stroke (AIS), established by an adjudication committee. Controls were patients with stroke mimics (SMi). We excluded patients with a transient ischemic attack. Cardiovascular radiologists diagnosed structural high-risk sources of cardioembolism on cardiac CT according to predefined criteria. High-risk sources on cardiac CT were: cardiac thrombi, signs of endocarditis, recent myocardial infarction, prosthetic valve abnormalities, atrial myxomata and signs of rheumatic valvular disease. We used logistic regression, adjusting for age, sex, history of atrial fibrillation, and history of myocardial infarction. Results: Of 607 included patients, 452 had AIS (74%, median age 72, 59% male) and 155 had a SMi (26%, median age 70, 46% male). Diagnoses in the SMi group were: seizures (45/155, 29%) peripheral vestibulopathy (22/155, 14%), functional neurologic symptoms (16/155, 10%), benign headache disorder (8/155, 5%), intoxication (7/155, 5%), and other diagnoses (57/155, 37%). Cardiac CT detected a structural high-risk cardioembolic source in 52/452 AIS patients (12%) and in 5/155 SMi patients (3%, three patients with seizures, one with peripheral vestibulopathy and one with traumatic brain injury, aOR: 4.1, 95%CI 1.7-12.1). Cardiac thrombi were the most commonly observed high-risk sources of embolism and were detected in 38 (8%) AIS patients and in 2 (1%) SMi patients (aOR 7.0, 95%CI 2.1-43.9). Discussion and conclusion: A high-risk source of cardioembolism was detected on cardiac CT four times more often in patients with acute ischemic stroke than in patients with a stroke mimic. These data substantiate the clinical relevance of using acute CT to search for sources of cardioembolism in ischemic stroke patients.

Synthesis of surgeon and rehabilitation therapist treatment methods of bicipital tenosynovitis in dogs allows development of an initial consensus therapeutic protocol.

To compare the therapeutic approach of surgical specialists, sports medicine and rehabilitation specialists, and veterinarians with rehabilitation certification when treating bicipital tendon disease or tenosynovitis in dogs and to combine this information with existing research to develop a treatment algorithm that provides a framework for treating bicipital tenosynovitis. 223 respondents to an internet survey of board-certified veterinary surgeons, board-certified sports medicine and rehabilitation therapists, and veterinarians with rehabilitation certification. The survey was promoted via multiple listservs, specialist college newsletters, and private relevant social media sites. Answers were compiled and submitted for statistical analysis. Compared to rehabilitation therapists (RTh), surgeons placed less value on the stabilizing function of the biceps tendon and its role in preventing other shoulder morbidities. Similarly, compared to RTh, surgeons were more inclined to select surgery as the primary therapeutic approach and attributed a less optimistic prognosis to conservative therapy outcomes. There were multiple differences between surgeons and RTh in executing a conservative therapy program, with RTh more likely to recommend therapeutic exercise, extracorporeal shockwave, regenerative medicine, therapeutic ultrasound, exercise restriction, photobiomodulation, and pulsed electromagnetic field therapy. RTh were less likely to prescribe NSAIDS or inject corticosteroids. Despite the above noted differences, there were also multiple areas of agreement. Consensus agreement, combined with existing research, was used to create a treatment algorithm suggesting how to best address multiple manifestations of bicipital tendinopathy. Such guidelines can be considered to direct therapeutic strategies for this common condition.

Performance analysis: Securing SIP on multi-threaded/multi-core proxy server using public keys on Diffie-Hellman (DH) in single and multi-server queuing scenarios.

The rapid replacement of PSTN with VOIP networks indicates the definitive phase-out of the PBX/PABX with smartphone-based VOIP technology that uses WLAN connectivity for local communication; however, security remains a key issue, regardless of the communication coverage area. Session initiation protocol (SIP) is one of the most widely adopted VOIP connection establishment protocols but requires added security. On the Internet, different security protocols, such as HTTPS (SSL/TLS), IPSec, and S/MIME, are used to protect SIP communication. These protocols require sophisticated infrastructure and some pose a significant overhead that may deteriorate SIP performance. In this article, we propose the following: i) avoid using Internet bandwidth and complex Internet protocols for local communication within an organization, but harness WLAN connectivity, ii) use multi-threaded or multicore computer systems to handle concurrent calls instead of installing hardware-based SIP servers, and iii) run each thread in a separate core. Cryptography is a key tool for securely transmitting confidential data for long- and short-range communication, and the Diffie-Hellman (DH) protocol has consistently been a popular choice for secret key exchanges. Primarily, used for symmetric key sharing, it has been proven effective in generating public/private key pairs, sharing public keys securely over public channels, and subsequently deriving shared secret keys from private/public keys. This key exchange scheme was proposed to safeguard VOIP communication within WLANs, which rely on the SIP for messaging and multimedia communication. For ensuring an efficient implementation of SIP, the system was rigorously analyzed using the M/M/1 and M/M/c queuing models. We analyze the behavior of SIP servers with queuing models with and without end-to-end security and increase users' trust in SIP security by providing a transparent sense of end-to-end security as they create and manage their private and public keys instead of relying on the underlying SIP technology. This research implements instant messaging, voice conversation, and secret key generation over DH while implementing and observing the role of multi-threading in multiqueue systems that serve incoming calls. By increasing the number of threads from one to two, the SIP response time improved from 20.23809 to 0.08070 min at an arrival rate of 4250 calls/day and a service rate of three calls/min. Similarly, by adding one to seven threads, the queue length was reduced by four calls/min. Implementing secure media streaming and reliable AES-based signaling for session confidentiality and integrity introduces a minor 8-ms tradeoff in SIP service performance. However, the advantages of implementing added security outweigh this limitation.

The application of extracorporeal membrane oxygenation in emergent airway management - a single-center retrospective study

BackgroundEmergent airway occurrences pose a significant threat to patient life. Extracorporeal membrane oxygenation (ECMO) has been proven to be an effective method for managing emergent airways.MethodsA retrospective analysis was conducted on all patients receiving ECMO as an adjunct for emergent airway management from January 2018 to December 2022 at the People’s Hospital of Zhongshan City. We collected the basic information of the patients, their blood gas data before and after ECMO, the related parameters of ECMO, and the outcome and then analyzed and summarized these data.ResultsSix patients, with an average age of 51.0(28–66) years, received veno-venous (VV)- ECMO as an adjunct due to emergent airway issues. The average ECMO support duration was 30.5(11–48) hours. All six patients were successfully weaned off ECMO support, with five (83.3%) being successfully discharged after a hospital stay of 15.5(7–55) days. All six patients underwent VV-ECMO through femoral-internal jugular vein cannulation. Among these, five patients, whose airway obstruction was due to hemorrhage, underwent a non-anticoagulant ECMO strategy with no recorded thrombotic events.ConclusionsThe rapid establishment of ECMO support is aided by the establishment of a standardized ECMO initiation protocol and the formation of a multidisciplinary rapid-response ECMO team, which is particularly crucial for emergent airway management. When airway obstruction results from hemorrhagic factors, the early adoption of a non-anticoagulant ECMO strategy can be considered when implementing VV-ECMO.

A checklist for reporting, reading and evaluating Artificial Intelligence Technology Enhanced Learning (AITEL) research in medical education

Advances in Artificial Intelligence (AI) have led to AI systems’ being used increasingly in medical education research. Current methods of reporting on the research, however, tend to follow patterns of describing an intervention and reporting on results, with little description of the AI in the system, or the many concerns about the use of AI. In essence, the readers do not actually know anything about the system itself. This paper proposes a checklist for reporting on AI systems, and covers the initial protocols and scoping, modelling and code, algorithm design, training data, testing and validation, usage, comparisons, real-world requirements, results and limitations, and ethical considerations. The aim is to have a systematic reporting process so that readers can have a comprehensive understanding of the AI system that was used in the research.

Neutrophil-lymphocyte ratio and update conclusions from a 2-year double-blind rct testing fermented papaya preparation in healthy middle-aged/elderly subjects

Background:T his study represents the second part of a 2-year interventional study in middle-aged /elderly healthy subjects treated either with an antioxidant supplementation (200mg trans-resveratrol, 100mg Centella asiatica extract, 80mg ubiquinol, 50mg epigallo-cathechin-gallate, 20 mg anthocyanidins, 5mg zinc, and 200 IU vitamin E) or with a proprietary fermented papaya preparation (FPP). The choice of the fermented papaya preparation was based on over 12 years of experimental and clinical data proving its effectiveness on redox and immune regulation. The aim of this study was to complete a 24-month investigation of the potential beneficial effect of this functional food on key age-related immune system parameters.Methods: Study population: From a total of 106 subjects, we analyzed data collected from ninety-eight clinically stable, healthy community dwelling males and females aged 58 to 76 years. The investigation followed a double-blind methodology involving two groups, A and B. Group A received FPP® 4.5 grams, one sachet twice a day, coupled with a placebo capsule in the morning. Meanwhile, Group B was administered a papaya-flavored sachet twice a day, with an additional antioxidant mixture capsule in the morning, referred to as the AA group. Morning blood samples were collected and tested for: Asymmetric dimethylarginine (ADMA), apoptosis of PBMCs and blood including Neutrophil-Lymphocyte Ratio (NLR) after 12 months, i.e. corresponding to 24 months of the 2-year study (Visit VI of the initial protocol). Results: As compared to the first preliminary published year of the study, this further 12-month study enabled a more comprehensive analysis with a significant increase of analyzed overweight (≥25 and ≤29.9 kg/m2) subjects (58 vs 31, P<0.05). On the 24-month mark, AA-group showed a significant increase of NLR (P<0.05 vs entry level and FPP group), whereas FPP-group maintained a stable value. Urinary 8-OHdG values maintained, as in the preliminary study, a wide dispersion of data but both treatments equally reduced its value in over 27BMI/r over 70y old subjects, which as taken separately, had significantly elevated values (p<0.05 vs younger subjects). ADMA and frequency of apoptotic cells values were beneficially reduced only by FPP supplementation throughout all 24 months of the study (P<0.05 vs baseline and vs AA supplementation). A significant correlation between NLR and Apoptosis of PBMCs appeared in FPP-treated subjects and this was more pronounced in subjects with >27BMI or over 70 years of age.Conclusions: The novelty of the present work was the finding that FPP represents a substantial pharma-grade, non-GMO technological advancement over uncontrolled traditional plant extracts. This functional food affects oxi-inflammatory aging phenotype and NLR, a marker worth great attention for its preventive interventional potential in middle-age/elderly communities health care. Keywords: Fermented Papaya Preparation, NLR, ADMA, apoptosis, antioxidants, SARS-Cov19

Does a collecting system injury with grade iv renal blunt trauma always need urinary intervention?

This study aimed to identify the characteristics associated with the need for urinary intervention for a blunt renal injury with collection system involvement using a computed tomography (CT) protocol for trauma. Abdominal CT images of patients with blunt renal injuries from 2016 to 2020 were reviewed. Patients with low-grade renal trauma, non-collecting system involvement, American Association for the Surgery of Trauma grade V shattered kidney, and emergent nephrectomy were excluded. The largest perinephric mass thickness was measured in the axial view using CT, and a cutoff value was obtained using a receiver-operating characteristic curve analysis. Risk factors for further urinary intervention were analyzed. Among the 70 patients included in this study, those with perinephric mass thicknesses < 25mm (n = 36) had a significantly lower rate of urinary intervention than those with perinephric mass thicknesses ≥ 25mm (0 vs. 5; p = 0.023). There was no significant difference in the follow-up durations of the groups (19days vs. 38days; p = 0.198). More than 90% of the perinephric mass in the < 25mm group resolved within a median follow-up duration of 38days, whereas nearly half of the ≥ 25mm group had a residual perinephric mass during a median follow-up duration of 19days. The initial CT protocol for trauma was useful for predicting the need for further urinary interventions for collecting system injuries. A perinephric mass thickness < 25mm is predictive of a low likelihood of requiring urinary intervention.

A hybrid deep learning model for detecting DDoS flooding attacks in SIP-based systems

The Session Initiation Protocol (SIP) is widely used for multimedia communication as a signaling protocol to manage, establish, maintain, and terminate multimedia sessions among participants. However, SIP is vulnerable to attacks due to its text-based nature and the lack of adequate security measures. One of the most damaging attacks is the Distributed Denial of Service (DDoS) attack, which consumes resources and blocks legitimate users from accessing the available services. Although various machine learning-based schemes have been proposed to detect DDoS flooding attacks in SIP-based systems, most of them only address INVITE flooding attacks. REGISTER and ACK flooding attacks were not addressed. On the other hand, schemes based on statistical analysis are not sufficiently accurate. In this article, we propose a novel approach classifying DDoS flooding attacks in SIP-based systems using a combination of deep learning and entropy techniques. The proposed approach consists of two components: a hybrid deep learning model and an entropy-based model. The hybrid deep learning model combines convolutional neural networks and a stacked bidirectional long short-term memory network to extract features and classify traffic patterns. The entropy-based model measures the randomness and diversity of traffic flows using Shannon and Rényi entropies. To validate the proposed scheme, we built a balanced dataset of different types and intensities of DDoS flooding attacks. The results showed that the proposed scheme can effectively detect DDoS flooding attacks with high accuracy and low detection time for various attack intensities. Moreover, it surpasses other related schemes in terms of accuracy and detection time.

PhageBox: An Open Source Digital Microfluidic Extension With Applications for Phage Discovery.

Recent advancements demonstrate the significant role of digital microfluidics in automating laboratory work with DNA and on-site viral testing. However, since commercially available instruments are limited to droplet manipulation, our work addresses the need for accelerated integration of other components, such as temperature control, that can expand the application domain. We developed PhageBox-an accessible device that can be used as a biochip extension. At hardware level, PhageBox integrates temperature and electromagnetic control modules. At software level, PhageBox is controlled by embedded software containing a unique model for bio-protocol programming, and a graphical user interface for visual device feedback and operation. To evaluate PhageBox's efficacy for biomedical applications, we performed functional testing. Similarly, we validated the temperature control using thermography, obtaining a range of ±0.2[Formula: see text]. The electromagnets produced a magnetic force of 15 milliTesla, demonstrating precise immobilization of magnetic beads. We show the potential of PhageBox for bacteriophage research through three initial protocols: a universal framework for PCR, T7 bacteriophage restriction enzyme digestion, and concentrating ϕX174 RF genomic DNA. Our work presents an open-source hardware and software extension for digital microfluidics devices. This extension integrates temperature and electromagnetic modules, demonstrating efficacy in biomedical applications and potential for bacteriophage research. We developed PhageBox to be accessible: the components are off-the-shelf at a low cost ( ≤ $200), and the hardware designs and software code are open-source. With the long aim of ensuring reproducibility and accelerating collaboration, we also provide a DIY-build document.

Neuroblastoma estágio 4S e hepatomegalia maciça: relato de caso

Objective: To report a case of stage 4S neuroblastoma and massive hepatomegaly that worsened the disease prognosis. Case Description: A 3-month-old male infant presented with 7 days of worsening abdominal distension, significant sweating, incessant crying, and irritability. His abdomen was globular and exhibited massive hepatomegaly. Imaging examinations detected multiple nodules in the liver parenchyma and a hypoechoic nodule in the right adrenal gland. The lesions were biopsied, with findings revealing infiltrative neuroblastoma in the liver tissue. The patient was diagnosed with International Neuroblastoma Staging System stage 4S, and treatment was started according to the International Society of Paediatric Oncology - Paediatric Oncology in Developing Countries protocol. During the first chemotherapy cycle, his condition required prolonged mechanical ventilation and hemodialysis. It was then decided to switch to the POG 9341-Modified regimen in an emergency mode. A significant clinical improvement response was observed after the third chemotherapy cycle. Subsequent cycles were administered based on the initial proposed protocol. Complete remission was achieved after the eighth cycle. Comment: Stage 4S neuroblastoma usually has a good prognosis; however, when associated with massive hepatomegaly, the prognosis becomes unfavorable. Complications during the first chemotherapy cycle required a change in management to the POG 9341-Modified regimen, which resulted in a reduction in the number and size of hepatic and adrenal nodules. Owing to significant clinical improvement, the remaining cycles were performed using the initial protocol. Despite the uncommon association and the lack of consensus for a specific treatment, complete remission was achieved by combining therapeutic regimens.

Cell-Free Systems for the Production of Glycoproteins.

Cell-free protein synthesis (CFPS), whereby cell lysates are used to produce proteins from a genetic template, has matured as an attractive alternative to standard biomanufacturing modalities due to its high volumetric productivity contained within a distributable platform. Initially, cell-free lysates produced from Escherichia coli, which are both simple to produce and cost-effective for the production of a wide variety of proteins, were unable to produce glycosylated proteins as E. coli lacks native glycosylation machinery. With many important therapeutic proteins possessing asparagine-linked glycans that are critical for structure and function, this gap in CFPS production capabilities was addressed with the development of cell-free expression of glycoproteins (glycoCFE), which uses the supplementation of extracted lipid-linked oligosaccharides and purified oligosaccharyltransferases to enable glycoprotein production in the CFPS reaction environment. In this chapter, we highlight the basic methods for the preparation of reagents for glycoCFE and the protocol for expression and glycosylation of a model protein using a more productive, yet simplified, glycoCFE setup. Beyond this initial protocol, we also highlight how this protocol can be extended to a wide range of alternative glycan structures, oligosaccharyltransferases, and acceptor proteins as well as to a one-pot cell-free glycoprotein synthesis reaction.

Developing a new questionnaire of positive contributions to Chinese families by children with autism spectrum disorder.

A literature review of both Eastern and Western literature regarding families of children with autism spectrum disorder (ASD) revealed limited empirical research that examines ASD in China. Furthermore, most research in this area comes from a deficit model and there is a lack of research that comes from a strengths background. No previous study in China has looked at the positive contributions of children with ASD to their families. The present study came from a strengths-based perspective and aimed to develop a new questionnaire to evaluate the positive contributions made to families by children who have ASD in China and are raised by their respective families. It considered the severity level of the children's disorder and the impact this had on the parents. Besides examining the children's impairment levels, the study also examined positive contributions and their relationship with socio-demographic elements such as family income and employment status of the parents, which also seem to be related to the positive contributions experienced by the parents. First, based on the literature review, an initial qualitative interview protocol was developed and administered to 10 parents of children with ASD. Then, based on the analyses of the interviews, a quantitative questionnaire was developed to assess the positive contributions of children with ASD to their families. The questionnaire was then administered to 156 parents of children with ASD. The internal structure of the questionnaire was analyzed by factor analysis. The questionnaire's reliability and validity were also examined. The data were then analyzed with multiple correlation comparisons and an independent sample T-test. Six factors emerged for families of children with ASD. The results showed that the cumulative explanatory variance of the six dimensions of the questionnaire was 65.42%. The Cronbach's coefficient of each dimension was between 0.7 and 0.9, and the combined Cronbach's coefficient of the total questionnaire was 0.945. This study found that the overall average positive contribution to families by children with ASD was 3.32, which is at a medium level, and all six dimensions were at a medium-to-high level. This study also found that the family's monthly income contributed to the overall positive contribution, intimacy and happiness, and gaining more special knowledge through experience dimensions. Furthermore, it was found that moderate severity of ASD, high income, and parental employment were all associated with more positive contributions. This new questionnaire appears to have good reliability and validity and seems suitable for assessing the positive contributions to families by children with ASD in China. The present study may be helpful for the parents of children with ASD and will likely help them focus on the strengths of their children rather than their shortcomings. The study might also benefit counselors and researchers who would be able to use the new questionnaire to evaluate the positive contributions made to families by children who have ASD.

Desktop aplikacija za razmenu kriptozaštićenog govora

Introduction/purpose: All data exchanged over the Internet as well as other computer networks should be considered exposed to various types of security threats. In light of this, the transmission of voice over applications that do not use any type of crypto-protection allows anyone to discern the content of communication. Since voice transmission requires as little delay as possible, various protocols are used to enable crypto protected real-time communication. This paper presents one solution in a desktop application variant. Methods: The essence in voice exchange systems as well as in other systems where real-time communication is necessary is the establishment of a crypto-protected session which is a virtual secure channel for communication to which only the communicating parties have access. Voice sessions in the application are established with the SIP (Session Initiation Protocol) protocol. The sessions are further protected using the ZRTP (Zimmerman Real-time Transport Protocol) protocol. FusionPBX was used as the SIP server (registrar) for testing purpouses. The application is developed in C++ language using the Qt framework. Results: The final version of the application demostrates that ZRTP and SIP protocols are well suited for establishing crypto protected voice communications with low delay. Conclusion: This solution provides cryptographic functions for data secrecy and the management of cryptographic keys. Improving the solution with digital signatures and certificates will result in additional cryptographic functions: data integrity and personal identification. With this improvement, this solution will be able to withstand modern security threats with low delay.

Security Enhancement of SIP Protocol in VoIP Communication

In Voice over IP (VoIP) systems, calls are started, maintained, and ended using the Session Initiation Protocol (SIP). One of the SIP flaws is the lack of enough data to validate users, and its contents can be changed to fake the Caller Identification (CID). Fake CID can be used by hackers to trick receivers and obtain valuable materials. Existing solutions have a number of faults, including the use of more network resources, the use of insufficient data to identify fake CID, and high call setup delay for caller and callee during the validation process. This work presents an algorithm to enhance SIP protocol security to mitigate the flaws of the previous solutions that are used to address CID spoofing. By using the Media Access Control (MAC) address, the algorithm can validate the CID and warn the callee for the fake CID. The algorithm was developed and tested by using Mininet, Python based open source OpenFlow (POX) controller, SIPp simulator, Linphone softphone, and freePBX. All faked CID were detected and receivers were alerted on the linphone screen. Session setup delay obtained are within the 15.1 ms to 27.3 ms, which are within the acceptable Quality of Service (QoS) ranges.

Effect of albumin infusion on oxidative albumin modification and albumin binding capacity in chronic liver failure.

Oxidative albumin modification and impaired albumin binding function have been described both in chronic liver failure and for therapeutic albumin solutions. The aim of the present study was to evaluate the effect of albumin infusion on redox state and binding function of circulating albumin. We studied 20 patients with cirrhosis who routinely received albumin infusions for prevention of post-paracentesis circulatory dysfunction or treatment of hepatorenal syndrome. We measured albumin fractions by redox state of cysteine-34 and albumin binding properties using dansylsarcosine as site II ligand. Therapeutic albumin solutions showed high contents of human nonmercaptalbumin-1 and human nonmercaptalbumin-2, exceeding the respective values in our patients with decompensated cirrhosis. An initial protocol for the first nine patients sampled at baseline, 24 h and 48 h after albumin infusion revealed no significant changes of oxidized albumin species or albumin binding properties. However, a modified protocol for the remaining 11 patients sampled at baseline, <1h after and 24 h after albumin infusion revealed short-lived changes of oxidized albumin species while no changes in albumin binding properties were observed. In conclusion, therapeutic albumin infusion transiently changed albumin redox state but did not improve binding function of circulating albumin in chronic liver failure.