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Background: Asthma patients with atopic tendencies often experience airway inflammation and structural changes. Common triggers for asthma exacerbations include exercise, specific foods, and respiratory viral infections. Acupuncture has been investigated as a possible treatment for asthma management, but the efficacy of specific acupuncture points remains uncertain. Objective: This study aimed to evaluate the impact of stimulating specific acupuncture points along combined visceral meridians on asthma exacerbations triggered by various factors. It also assessed improvements in quality of life, focusing on symptoms, daily activities, environmental influences, and health-related quality of life (HRQoL) using the Mini Asthma Questionnaire. Method: The study included 50 patients with chronic persistent asthma who were randomly assigned and categorized based on the Global Initiative for Asthma (GINA) guidelines for asthma control. Over 5 weeks, participants underwent 12 laser acupuncture (LA) sessions targeting acupuncture points on the lung, heart, conception vessel, spleen, and stomach meridians. A low-level laser (780 nm wavelength, 800 mW output) was used to deliver 9.6 J/cm2 per acupoint in continuous mode. Outcomes were assessed at baseline and 5 weeks post-treatment using the Mini Asthma Questionnaire, Asthma Control Test (ACT), and Forced Expiratory Volume in 1 s (FEV1). Results: Following 5 weeks of laser acupuncture sessions, there was a significant improvement in exercise tolerance (p < 0.001) and a marked reduction in asthma exacerbations triggered by viral infections and food allergies (p < 0.001). The overall Mini Asthma Questionnaire scores were significantly increased from 37.08 ± 10.14 at baseline to 72.60 ± 9.97 post-treatment (p < 0.001). Spirometry findings demonstrated a significant improvement in FEV1 (p > 0.005). Conclusion: Laser acupuncture targeting combined visceral meridians shows promise in enhancing exercise tolerance and reducing asthma exacerbations caused by viral infections and food allergies. This approach significantly improves the quality of life for school-aged children with asthma. [ABSTRACT FROM AUTHOR]

While numerous studies have investigated demand management policies as a means of mitigating the impacts of climate change and population growth, little attention has been given to the interaction of spatial population patterns and water institutions that affect water shortages. In this article, we develop a methodology to evaluate how population location under alternative water institutions and climate scenarios impacts water demands, shortages, and derived economic values. We apply this methodology to the South Platte River Basin (SPRB) in Northeastern Colorado under three scenarios with ∼1,800 simulations. Results suggest that while water rights institutions have a negligible impact on total volumetric shortages relative to climate change, they have substantial distributional and economic implications. Results also suggest that continuous population growth in upstream cities yields the lowest water shortages if per capita use decreases with urbanization. However, if we assume that per capita demands do not decrease with population density, an equal distribution of population to upstream and downstream regions yields the lowest water shortage and highest economic value. These findings indicate the need that planning efforts must account for return flows and development patterns throughout a watershed in order to reduce water shortages and promote economic prosperity. Key Points: Water institutions have little effect on basin‐wide water shortages, but clearly determine who experiences shortagesThe location and density of population have significant effects on water shortages and economic valueEven distribution of population between regions in a basin provides lower shortages and higher values assuming constant per capita demand [ABSTRACT FROM AUTHOR]

Background: : Increasing student numbers and logistical challenges in pharmacy education limit patient counselling and clinical placement opportunities. Computer-based simulation (CBS) offers scalable, interactive learning but faces integration barriers. Objective: : To explore global perceptions of CBS implementation in pharmacy education among educators and students. Methods: An online cross-sectional survey was developed based on literature review and expert feedback. The survey was distributed globally through academic pharmacy organisations, social media, and the authors' networks. It included 20 questions targeting pharmacy educators and students. Results: : Responses from 152 educators across 38 countries and 392 students from 46 countries, spanning six WHO regions (AFRO, AMRO, EMRO, EURO, SEARO, and WPRO) were analysed using descriptive and inferential statistics. The majority of educators (90.1%, n = 137) and students (84.2%, n = 330) expressed comfort with using CBS and implementing it in their curriculum. Despite this, CBS was perceived as underutilised by 53.5% (n = 81) of educators and 63.7% (n = 250) of students. Students valued CBS for enhancing communication and problem-solving skills, while educators highlighted its relevance to community pharmacy practice. Both groups supported CBS use in assessments. All educators (100%) identified workload reduction as a key priority, hoped CBS could assist in this area. Educators also reported barriers such as financial constraints (56.6%, n = 86) and insufficient technical support (53.3%, n = 81). On the other hand, students were less optimistic about institutional support, with only a few (7.4%, n = 29) believed institutional leaders would actively support CBS adoption. Regional differences emerged, with SEARO (Southeast Asia) and AFRO (Africa) showing the lowest CBS usage rates. Educators in SEARO, AFRO, and EMRO (Eastern Mediterranean) raised concerns about technical support, while those in SEARO, AFRO, and WPRO (Western Pacific, including Australia, New Zealand, and Singapore) expressed financial concerns. Educators in AFRO and WPRO, however, reported being 100% comfortable with using CBS. Conclusion: : Both students and educators recognised the potential of CBS in pharmacy education, with strong support for its integration. Addressing barriers such as educator workload, financial constraints, and technical support is crucial for broader adoption. Improved resource allocation and targeted training for educators are essential to effectively incorporate CBS into the pharmacy curriculum. [ABSTRACT FROM AUTHOR]

Background: The results of several studies assessing the effect of the glutathione S-transferase class Mu 1 (GSTM1) null variant on the genetic susceptibility of tobacco-related cancers have been conflicting. In this work, we aim to identify the impact of the deletion of GSTM1 on lung cancer risk among smokers. Methods: This study was conducted on 20 patients diagnosed with primary lung cancer and 20 healthy individuals as a control group. They were subject to full medical history taking, complete clinical examination, and GSTM1 genotyping by PCR. Results: Both studied groups were matched for age, sex, and smoking status. No statistically significant difference was exhibited between the frequency of GSTM1 positive and GSTM1 null in the studied population. No risk of lung cancer associated with GSTM1 null genotype was demonstrated between the patients and control group (n = 14/20 cases) (p = 0.110, OR = 2.852, 95% CI 0.777–10.467). Additionally, there was no association between the risk of lung cancer and the presence of the gene either in smokers (p = 1, OR = 1.8 and 95% CI 0.124–26.196) or non-smokers; (p = 0.063, OR = 4.4 and 95% CI 0.889–21.78). No statistically significant risk was found between the frequencies of GSTM1 null and the various histopathological types of lung malignancy. Conclusion: The results of this work demonstrated no association between the occurrence of the GSTM1 null variant, even when stratified for smoking status, and the risk of lung cancer. [ABSTRACT FROM AUTHOR]

Background: The continuous positive airway pressure (CPAP) needed for the treatment of obstructive sleep apnea (OSA) can be determined after a manual titration study which is often expensive and time consuming. Hence, different predictive equations were suggested to simplify the treatment of OSA. The purpose of this work was to compare the CPAP identified with manual titration with that calculated using various equations in a cohort of patients with severe OSA. Methods: This work was conducted on patients diagnosed with severe OSA. Data collected included full medical history, demographic and anthropometric measures, polysomnography results, and the CPAP pressure obtained after manual titration which was further compared to 15 predictive equations retrieved from the literature. Results: A total of 166 patients [137 (82.5%) males and 29 (17.5%) females] with severe OSA were recruited in the study. Their mean age was 55.91 ± 12.64, and their baseline diagnostic apnea hypopnea index was 71.75 ± 23.70. The mean CPAP manual titration pressure was 11.31 ± 2.9 cmH2O. Non-significant statistical difference was found (p > 0.05) when the mean titration pressure was calculated by Eqs. 2 (11.36 ± 2), 3 (11.55 ± 1.68), 10 (11.51 ± 2.29), 11 (11.14 ± 2.04), and 14 (11.71 ± 2.06), whereas the mean titration pressure calculated by Eqs. 1, 4, 5, 6, 7, 8, 9, 12, 13, and 15 differed significantly from the manual titration pressure (p < 0.05). Conclusion: Predictive equations suggested to calculate CPAP pressure, albeit simple and easy to apply, yielded variable results and should be investigated carefully before their use into clinical practice. [ABSTRACT FROM AUTHOR]

Background: Analysis of free DNA molecules shed from tumour cells in plasma of patients referred as circulating tumour DNA (ctDNA) with reference to physiological circulating cell-free DNA (cfDNA) is nowadays exploited as liquid biopsy and is considered a new emerging promising biomarker for diagnosis, selection of proper treatment, and prognosis of cancer. DNA integrity index (DII) is assessed by calculating the ratio between the concentration of long cfDNA strands released from tumour cells (ALU247) and the short strands released from normal cells (ALU115). The aim of the current study was to evaluate DII as a potential diagnostic and prognostic biomarker of NSCLC. Methods: Our study included 48 NSCLC patients diagnosed as primary NSCLC before starting treatment, 30 COPD patients diagnosed clinically, radiologically, and subjected to chest high-resolution computerized tomography, and 40 healthy controls. cfDNA concentration and DII were measured by quantitative real-time polymerase chain reaction (qPCR). Results: ALU115, ALU247, and DII were significantly higher in NSCLC compared to COPD patients (p < 0.0001) and controls (p < 0.0001) and in COPD patients compared to control subjects (p < 0.0001). DII positively correlated with the stage of tumour (p = 0.01), tumour metastasis (p = 0.004), and with adenocarcinoma compared to other histopathological types (p = 0.02). To evaluate clinical utility of DII in NSCLC, ROC curve analysis demonstrated an AUC of 0.91 at a cut-off value of 0.44 with total accuracy = 85.6%, sensitivity = 90%, specificity = 83%, PPV = 78.1%, and NPV = 92.1%. Conclusion: cfDNA and DII represent a promising diagnostic and prognostic tool in NSCLC. This type of noninvasive liquid biopsy revealed its chance in the screening, early diagnosis, and monitoring of NSCLC. [ABSTRACT FROM AUTHOR]

In a study of DNA methylation changes in melatonin-deficient rice mutants, mutant plants showed premature leaf senescence during grain-filling and reduced grain yield. Melatonin deficiency led to transcriptional reprogramming, especially of genes involved in chlorophyll and carbon metabolism, redox regulation, and transcriptional regulation, during dark-induced leaf senescence. Hypomethylation of mCG and mCHG in the melatonin-deficient rice mutants was associated with the expression change of both protein-coding genes and transposable element-related genes. Changes in gene expression and DNA methylation in the melatonin-deficient mutants were compensated by exogenous application of melatonin. A decreased S-adenosyl-L-methionine level may have contributed to the DNA methylation variations in rice mutants of melatonin deficiency under dark conditions. [ABSTRACT FROM AUTHOR]

Background: The long-term post-COVID is a very complex pandemic phenotype disease. The persistence of manifestations had resulted in classifying COVID-19 infection into bipolar phase which is a post-COVID-19 subacute phase by which the ongoing symptoms extended for 4–12 weeks and chronic or long COVID-19 phase by which the associated symptoms and abnormalities were extending for more than 12 weeks even after the pandemic. Aim: Determining the percentage of patients who continued to suffer from different symptoms beyond 12 weeks of COVID-19 exposure and the use of different complementary modalities among patients with post-COVID. Patients and methods: The present study is a cross-sectional analytical observational study which was conducted through an online questionnaire using Google Forms with a total sample of 123 Egyptian patients older than 30 years old diagnosed with symptomatic and/or laboratory-confirmed COVID-19 infection with persistent health problems over 12 weeks prior to December 2021. Result: The findings revealed elevated percentages of persistent symptoms and unfavorable long-term consequences extending beyond 12 weeks post-infection, irrespective of vaccination status or hospitalization. These outcomes significantly affected individuals' health, finances, family dynamics, and lifestyle. Additionally, a notable proportion of cases sought relief through complementary medicine, particularly probiotics and herbal remedies. Conclusion: The questionnaire is an addition for a comprehensive long-term evaluation that might aid the clinician for follow-up of patient infected with COVID-19 and broaden the use of various complementary medical disciplines. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is a major public health problem. Covid-19 pandemic impacted all areas of daily life, including medical care. In particular, delivering care for patients with cancer or suspected cancer during the crisis was challenging given the competing risks of death from untreated cancer versus serious complications from SARS-CoV-2, and the likely higher lethality of Covid-19 in immunocompromised patients. This study aims to assess the efficacy and immunogenicity of SARS-COV-2 vaccines in breast cancer patients by evaluating antispike antibodies in vaccinated and non-vaccinated patients and also through assessing the infection with Covid-19 after vaccination in vaccinated patients and non-vaccinated patients. The study also aims to assess the safety of SARSCOV-2 vaccine in breast cancer patients (local and systemic toxicity). Methods: Our population consisted of 120 female patients diagnosed with early and locally advanced breast cancer (60 vaccinated and 60 unvaccinated against Covid-19), in the breast cancer unit, clinical oncology department, Ain Shams University Hospitals. All were on oncological systemic therapy (neoadjuvant or adjuvant treatment). The cutoff value of SARS COV-2 antibody is 50 AU/mL (= 50 seropositive, <50 seronegative). Results: Out of 120 patients, anti-SARS COV-2 antibody seropositivity was found to be 48 in non-vaccinated vs.58 in vaccinated patients (80% vs.96.7%), with p-value =0.0046, which was statistically significant. The median titre in both groups was found to be 1434.5 vs.2500, (p=0.0026). In the 120 patients, 26 patients had Covid-19 infection with a significant difference (p= 0.0004), with 21 (35%) non-vaccinated vs.5 (8.3 %) vaccinated. In the sixty vaccinated patients, mild local adverse events were reported such as warmness at site of injection in 17 (28.3%) patients, pain (11, 18.3%), swelling (11, 18.3%), itching (8, 13.3%), and redness (6, 10%) representing the least adverse event. The patients experienced mild systemic adverse events, the highest incidence was fatigue (28, 46.7%), then myalgia/arthralgia (17, 28.3%), headache (2, 3.3%), and fever (16, 26.7%). There was no statistical significance association between antispike Ab titre and age, stage, treatment types, and time since last vaccine. Conclusion: SARSCOV-2 vaccines are effective and safe in localized breast cancer patients on systemic therapy. [ABSTRACT FROM AUTHOR]

Background: End-stage renal disease (ESRD) patients on maintenance hemodialysis (MHD) are highly vulnerable to severe manifestations of coronavirus disease 2019 (COVID-19) as increased risk of thromboembolic disease and worsened neuropsychiatric status. Aim: To assess the long-term thrombotic and neuropsychiatric sequelae of severe acute respiratory syndrome corona virus 2 in post-COVID-19 ESRD patients on MHD. Patients and methods: We followed for 12 months, 35 clinically stable HD patients on MHD who were confirmed or highly suspected for COVID-19 by positive severe acute respiratory syndrome corona virus 2 RT-PCR and/or high probability on high-resolution computed tomography chest imaging. We recorded demographics, HD and COVID-19 related data, thromboembolic history, and psychiatric history. We recorded baseline and follow-up complete blood count with differential counts, D-dimer, prothrombin time, international normalized ratio, and high-resolution computed tomography chest findings. We assessed post-COVID-19 neuropsychiatric sequelae using the Arabic versions of Hamilton's depression rating scale and Taylor's manifest anxiety scale. Results: Total leukocytic count, lymphocytes, and platelets were significantly lower during infection than preinfection, 6 months, and 1-year postinfection (P <0.001, P =0.003, P =0.014, respectively). Six months after infection, d-dimer levels were higher than normal values. The incidence of vascular access thrombosis was 25.7%. The scores of Hamilton's depression rating scale and Taylor's manifest anxiety scale were high [25 (interquartile range; 17–28) and 26 (interquartile range; 19–33)], respectively, and the prevalence of depression and anxiety symptoms were 94.3 and 85.7%, respectively. Conclusions: During infection, ESRD patients showed significantly lower total leukocytic count, lymphocytes, and platelets than preinfection, 6 months, and 1-year postinfection. They had high levels of d-dimer 6 months postinfection and a high risk for vascular access thrombosis. Their psychological wellbeing was markedly impaired by the pandemic resulting in depression and anxiety. [ABSTRACT FROM AUTHOR]

Coronary artery disease (CAD) risk and plaque scores are often subjective and biased, particularly in mid-age asymptomatic women, whose CAD risk assessment has been historically underestimated. In this study, a new automatic ascending aorta time-to-peak-distention (TPD) analysis was developed for fast screening and as an independent surrogate for subclinical atherosclerosis in asymptomatic women. CCTA was obtained in 50 asymptomatic adults. Plaque burden segment involvement score (SIS) and automatic TPD were obtained from all subjects. Logistic regression analyses were performed to investigate the association between CAD risk scores and TPD with severe coronary plaque burden (SIS>5). TPD, individually, was found to be a significant predictor of SIS>5. Additionally, sex was a significant effect modifier of TPD, with a stronger statistically significant association with women. Four-dimensional aortic time-to-peak distention could supplement conventional CCTA analysis and offer a quick objective screening tool for plaque burden severity and CAD risk stratification, especially in women. [ABSTRACT FROM AUTHOR]

Textile dyes are one of the major water pollutants released into water in various ways, posing serious hazards for both aquatic organisms and human beings. Bioremediation is a significantly promising technique for dye decolorization. In the present study, the fungal strain Lasiodiplodia sp. was isolated from the fruiting bodies of Schizophyllum for the first time. The isolated fungal strain was examined for laccase enzyme production under solid-state fermentation conditions with wheat bran (WB) using ABTS and 2,6-Dimethoxyphenol (DMP) as substrates, then the fermented wheat bran (FWB) was evaluated as a biosorbent for Congo red dye adsorption from aqueous solutions in comparison with unfermented wheat bran. A Box–Behnken design was used to optimize the dye removal by FWB and to analyze the interaction effects between three factors: fermentation duration, pH, and dye concentration. Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), and scanning electron microscopy (SEM) were applied to study the changes in the physical and chemical characteristics of wheat bran before and after fermentation. An additional experiment was conducted to investigate the ability of the Lasiodiplodia sp. YZH1 to remove Congo red in the dye-containing liquid culture. The results showed that laccase was produced throughout the cultivation, reaching peak activities of ∼6.2 and 22.3 U/mL for ABTS and DMP, respectively, on the fourth day of cultivation. FWB removed 89.8% of the dye (100 mg L−1) from the aqueous solution after 12 h of contact, whereas WB removed only 77.5%. Based on the Box–Behnken design results, FWB achieved 93.08% dye removal percentage under the conditions of 6 days of fermentation, pH 8.5, and 150 mg L−1 of the dye concentration after 24 h. The fungal strain removed 95.3% of 150 mg L−1 of the dye concentration after 8 days of inoculation in the dye-containing liquid culture. These findings indicate that this strain is a worthy candidate for dye removal from environmental effluents. [ABSTRACT FROM AUTHOR]

Background: People living with HIV have an increased risk of cardiovascular disease (CVD). Although coronary endothelial function (CEF) is an early direct indicator of CVD, only a few studies have been able to interrogate CEF directly. Most studies have examined vascular endothelial function through indirect assessment of brachial flow‐mediated dilatation (FMD). However, peripheral arteries are significantly larger and manifest atherogenesis differently from the coronary arteries, and so produce conflicting results. Additionally, none of these studies focused on young adults who acquired HIV perinatally or in early childhood. Objective: The present study investigates CEF in a unique population of young adults with lifelong HIV using direct magnetic resonance imaging (MRI) of coronary FMD (corFMD) with an in‐house developed MRI‐integrated isometric handgrip exercise system with continuous feedback and monitoring mechanisms (fmIHE). Methods: Young adults who acquired HIV perinatally or in early childhood (n = 23) and group‐matched healthy participants (n = 12) completed corFMD‐MRI with fmIHE. CorFMD was measured as the coronary cross‐sectional area response to the fmIHE. Results: In univariable and multivariable regression analysis, HIV status was a significant risk modifier. CD8+ T‐cell count and smoking pack‐years and their interaction with HIV status were independently associated with impaired coronary artery response to fmIHE. In people living with HIV, corFMD was significantly inversely correlated with CD8+ T‐cells and smoking pack‐years. In a multivariable regression analysis adjusted for age and body mass index, CD8+ T‐cells and smoking and their interaction with HIV status remained significant independent predictors of coronary endothelial dysfunction. Discussion: In this unique population of young adults, HIV status was a significant risk modifier, and immune activation and smoking were associated with decreased CEF, directly measured from the coronary vascular response to fmIHE. Conclusions: Management of CVD risk factors such as smoking and developing strategies that target immune activation in people living with HIV are warranted. [ABSTRACT FROM AUTHOR]

Computer-based simulation (CBS) is an interactive pedagogical training method that has seen increased interest, especially in recent years. There is some evidence that CBS in pharmacy education is not as widely adopted compared to other healthcare disciplines. Pharmacy education literature to date has not specifically discussed the potential barriers which may cause this uptake challenge. In this systematic narrative review, we attempted to explore and discuss potential barriers that may impact the integration of CBS in pharmacy practice education and provide our suggestions to overcome them. We searched five major databases and used the AACODS checklist for grey literature assessment. We identified 42 studies and four grey literature reports, published between 1 January 2000 and 31 August 2022, which met the inclusion criteria. Then, the specific approach of Braun and Clarke for thematic analysis was followed. The majority of the included articles were from Europe, North America, and Australasia. Although none of the included articles had a specific focus on barriers to implementation, thematic analysis was used to extract and discuss several potential barriers, such as resistance to change, cost, time, usability of software, meeting accreditation standards, motivating and engaging students, faculty experience, and curriculum constraints. Ad- dressing academic, process, and cultural barriers can be considered the first step in providing guidance for future implementation research for CBS in pharmacy education. The analysis suggests that to effectively overcome any possible barriers to implementing CBS, different stakeholders must engage in careful planning, collaboration, and investment in resources and training. The review indicates that additional research is required to offer evidence-based approach and strategies to prevent overwhelming or disengaging users from either learning or teaching process. It also guides further research into exploring potential barriers in different institutional cultures and regions. [ABSTRACT FROM AUTHOR]

Computer-based simulations may represent an innovative, flexible, and cost-efficient training approach that has been underutilised in pharmacy practice education. This may need to change, with increasing pressure on clinical placement availability, COVID-19 restrictions, and economic pressures to improve teaching efficiency. This systematic narrative review summarises various computer-based simulations described in the pharmacy practice education literature, identifies the currently available products, and highlights key characteristics. Five major databases were searched (Medline, CINAHL, ERIC, Education Source and Embase). Authors also manually reviewed the publication section of major pharmacy simulator websites and performed a citation analysis. We identified 49 studies describing 29 unique simulators, which met the inclusion criteria. Only eight of these simulators were found to be currently available. The characteristics of these eight simulators were examined through the lens of eight main criteria (feedback type, grading, user play mode, cost, operational requirement, community/hospital setting, scenario sharing option, and interaction elements). Although a number of systems have been developed and trialled, relatively few are available on the market, and each comes with benefits and drawbacks. Educators are encouraged to consider their own institutional, professional and curriculum needs, and determine which product best aligns with their teaching goals. [ABSTRACT FROM AUTHOR]

Regional soft tissue mechanical strain offers crucial insights into tissue's mechanical function and vital indicators for different related disorders. Tagging magnetic resonance imaging (tMRI) has been the standard method for assessing the mechanical characteristics of organs such as the heart, the liver, and the brain. However, constructing accurate artifact-free pixelwise strain maps at the native resolution of the tagged images has for decades been a challenging unsolved task. In this work, we developed an end-to-end deep-learning framework for pixel-to-pixel mapping of the two-dimensional Eulerian principal strains ε p 1 and ε p 2 directly from 1-1 spatial modulation of magnetization (SPAMM) tMRI at native image resolution using convolutional neural network (CNN). Four different deep learning conditional generative adversarial network (cGAN) approaches were examined. Validations were performed using Monte Carlo computational model simulations, and in-vivo datasets, and compared to the harmonic phase (HARP) method, a conventional and validated method for tMRI analysis, with six different filter settings. Principal strain maps of Monte Carlo tMRI simulations with various anatomical, functional, and imaging parameters demonstrate artifact-free solid agreements with the corresponding ground-truth maps. Correlations with the ground-truth strain maps were R = 0.90 and 0.92 for the best-proposed cGAN approach compared to R = 0.12 and 0.73 for the best HARP method for ε p 1 and ε p 2 , respectively. The proposed cGAN approach's error was substantially lower than the error in the best HARP method at all strain ranges. In-vivo results are presented for both healthy subjects and patients with cardiac conditions (Pulmonary Hypertension). Strain maps, obtained directly from their corresponding tagged MR images, depict for the first time anatomical, functional, and temporal details at pixelwise native high resolution with unprecedented clarity. This work demonstrates the feasibility of using the deep learning cGAN for direct myocardial and liver Eulerian strain mapping from tMRI at native image resolution with minimal artifacts. [ABSTRACT FROM AUTHOR]

Background Most of the studies showed that the residual liver volume (the remaining liver tissue after partial hepatectomy) in living donor liver transplantation (LDLT) should be more than 35%, as it carries the best outcome for the donor after transplantation and the least incidence of complications. In this study, we compared the outcome of LDLT in case of residual volume between 30 and 34.9% versus residual liver volume above 35%, to increase the donor pool without affecting the safety of the donor. Objective To compare the outcome of LDLT with donors having residual liver volume between 30 and 34.9% versus residual liver volume above 35% regarding postoperative liver function tests (aspartate aminotransferase, alanine aminotransferase, bilirubin, and international normalized ratio), hospitals stay, and other postoperative complications. Patients and methods Type of study: a cohort retrospective study was conducted. Study setting: The study was conducted at Ain Shams University Hospital and Cairo Fatemic Hospital. Study population: A total of 40 donors were divided into two groups. Group A included 20 donors with residual liver volume 30–34.9%, and group B included 20 donors with residual liver volume more than 35%. Inclusion criteria were age between 18 and 35 years, BMI between 18 and 30, no hyperlipidemia, and on liver biopsy, steatosis was less than 10%. Exclusion criteria were age less than 18 or above 35 years, BMI was below 18 or above 30, presence of hyperlipidemia, and on liver biopsy, steatosis more than 10%. Results There was a nonsignificant difference between the groups in our study regarding grading of complications (I–V) according to modified Clavien system. There was a nonsignificant statistical difference between both groups in this study regarding peak aspartate aminotransferase, peak alanine aminotransferase, and peak international normalized ratio (P=0.494, 0.482, and 0.278, respectively). Peak total bilirubin, peak direct bilirubin, and peak creatinine were significantly higher among cases of group A (remnant liver volume 30–34.9%) in the current study. Mean peak total bilirubin, peak direct bilirubin, and peak creatinine were 4.82±3.01, 2.67±2.14, and 0.82±0.16, respectively, versus 2.83±1.60, 1.41±1.58, and 0.77±0.16, respectively, in control group (P=0.013, 0.041, and 0.032, respectively). There was a nonsignificant difference between both groups in our study regarding hospital stay. Conclusion Overall, 30–34.9% of residual liver volume in selected donors was as safe as above 35% of residual liver volume. [ABSTRACT FROM AUTHOR]

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Aim This study aimed to compare the visual outcomes and safety of femtosecond laser-assisted cataract surgery (FLACS) to conventional phacoemulsification (CP). Design This was a prospective nonrandomized interventional clinical study. Methodology Hundred eyes with nuclear cataract were divided into two groups: group A (50 eyes) underwent FLACS using the LenSx platform (Alcon Laboratories Inc., Fort Worth, Texas, USA) and group B (50 eyes) underwent CP surgery using the Centurion Vision System (Alcon Laboratories Inc., USA). Preoperative assessment included visual acuity (VA) testing, nuclear grading and specular microscopy. Ultrasound (US) total time, cumulative dissipated energy (CDE) and amount of irrigating fluid used were recorded. Postoperative assessment at 1 week, 1 month and 3 months included uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) and specular microscopy. Intra- or postoperative complications were recorded. Results There was no statistically significant difference in the US total time between both groups as a whole (P=0.248) and in each subgroup (P=0.379, 0.316 and 0.681 for NC grades 1, 2 and 3, respectively). CDE was statistically lower in FLACS with NC grade 2 (P=0.005) and 3 (P=0.006), with no significant difference with NC grade 1 (P=0.521). Irrigating fluid volume was significantly lower in the CP group as a whole (P≤0.001) and in each subgroup (P=0.004, <0.001 and <0.001 for grades 1, 2 and 3 NC). There was no significant difference between both groups in % endothelial cell loss (ECL), change in CCT, UCVA and BCVA at 1 week, 1 month and 3 months. No complications were recorded, except one case of incomplete capsulotomy with FLACS. Conclusion FLACS was associated with lower CDE than CP. However, visual outcomes were similar in both techniques. [ABSTRACT FROM AUTHOR]

Purpose: Roflumilast (Daliresp, Daxas) is a FDA-approved phosphodiesterase 4 (PDE4) inhibitor for the treatment of moderate-to-severe chronic obstructive pulmonary disease. In mice and in limited human studies, this oral medication can cause weight loss and improve insulin sensitivity. We set out to determine the mechanism of its effect on insulin sensitivity. Patients and methods: Eight adults with overweight/obesity and prediabetes received roflumilast for 6 weeks. Before and after roflumilast, subjects underwent tests of insulin sensitivity, mixed meal test, body composition, markers of inflammation, and mitochondria function. Dietary intake and physical activity were also assessed. Our primary outcome was the change in peripheral insulin sensitivity, as assessed by the hyper-insulinemic euglycemic clamp. Results: This study was underpowered for the primary outcome. Pre- and post-roflumilast mean peripheral insulin sensitivity were 48.7 and 70.0 mg/g fat free mass/minute, respectively, (P-value=0.18), respectively. Among the mixed meal variables, roflumilast altered glucagon-like peptide 1 (GLP-1) hormone the most, although the average effect was not statistically significant (P=0.18). Roflumilast induced a trend toward significance in 1) decreased energy intake (from 11,095 KJ to 8,4555 KJ, P=0.07), 2) decreased fat mass (from 34.53 to 32.97 kg, P=0.06), 3) decreased total and LDL cholesterol (P=0.06 for both variables), and 4) increased plasma free fatty acids (from 0.40 to 0.50 mEq/L, P=0.09) The interval changes in adiposity and free fatty acid were significantly associated with the subject's age (P-value range=<0.001 to 0.02 for the correlations). Inflammatory and adhesion markers, though unchanged, significantly correlated with one another and with incretin hormones only after roflumilast. Conclusion: We demonstrate, for the first time in humans, increasing percentage of fat mass loss from roflumilast with increasing age in adults with prediabetes and overweight/obesity. We also demonstrate novel associations among roflumilast-induced changes in incretin hormones, inflammatory markers, peripheral insulin sensitivity, and adiposity. We conclude that roflumilast's early effects on insulin sensitivity is indirect and likely mediated through roflumilast's prioritization of lipid over glucose handling. Clinical trials registration: NCT01862029. [ABSTRACT FROM AUTHOR]

The present work is devoted to study experimentally the effect of the vortex finder length to the cyclone height ratio (S/H), the air flow rate, and the biomass particles (diameters, feeding flow rates, and type) on the separation efficiency of the cyclone in cold tests. Results from the cold tests were taken as a base of the combustion tests in order to identify the optimum operating conditions. In addition, the combustion characteristics of the cyclone were studied. The experimental results showed that, by increasing the air flow rate, the biomass particles diameter and decreasing the biomass feeding flow rate, the separation efficiency increased. Also, by increasing the vortex finder length to the cyclone height ratio (S/H) the separation efficiency increased for vortex finder ratios greater than 8 % up to 16 % where the separation efficiency reached its maximum value. After that, the separation efficiency started to decrease by further increase of the vortex finder ratio. It is worth stating that, the fine biomass particles gave lower separation efficiency than the coarse particles at whole ranges of feeding flow rates. For all particles diameters, the maximum centerline axial temperatures were obtained at the top of the cyclone. For coarse particles diameters, the centerline axial temperature started to decrease until axial distance of y/D = 3. After that, the centerline axial temperature increased slightly until the exit of the cyclone. For fine particles diameters the centerline axial temperature decreased until the bottom of the cyclone. Finally, the combustion of LPG and biomass fuel mixture revealed higher values of radial temperatures than those obtained from the combustion of the LPG only at the same thermal load. [ABSTRACT FROM AUTHOR]

The purpose of this study is to investigate the use of fundamental rheological parameters as quantified by MR elastography (MRE) to measure liver fibrosis and inflammation simultaneously in humans. MRE was performed on 45 patients at 3 T using a vibration frequency of 56 Hz. Fibrosis and inflammation scores were obtained from liver biopsies. Biomechanical properties were quantified in terms of complex shear modulus G* as well as shear wave phase velocity c and shear wave attenuation α. A rheological fractional derivative order model was used to investigate the linear dependence of the free model parameters (dispersion slope y, intrinsic speed c0, and intrinsic relaxation time τ) on histopathology. Leave‐one‐out cross‐validation was then utilized to demonstrate the effectiveness of the model. The intrinsic speed c0 increases with hepatic fibrosis, while an increased relaxation time τ is reflective of more inflammation of the liver parenchyma. The dispersion slope y does not depend either on fibrosis or on inflammation. The proposed rheological model, given this specific parameterization, establishes the functional dependences of biomechanical parameters on histological fibrosis and inflammation. The leave‐one‐out cross‐validation demonstrates that the model allows identification, from the MRE measurements, of the histology scores when grouped into low−/high‐grade fibrosis and low−/high‐grade inflammation with significance levels of P = 0.0004 (fibrosis) and P = 0.035 (inflammation). The functional dependences of intrinsic speed and relaxation time on fibrosis and inflammation, respectively, shed new light onto the impact hepatic pathological changes on liver tissue biomechanics in humans. The dispersion slope y appears to represent a structural parameter of liver parenchyma not impacted by the severity of fibrosis/inflammation present in this patient cohort. This specific parametrization of the well‐established rheological fractional order model is valuable for the clinical assessment of both fibrosis and inflammation scores, going beyond the capability of the plain shear modulus measurement commonly used for MRE. [ABSTRACT FROM AUTHOR]

Noncirrhotic portal hypertension (NCPH) is a rare disease that may lead to serious clinical consequences. Currently, noninvasive tools for the assessment of NCPH are absent. We investigated the utility of spleen and liver volumetrics as a marker of the presence and severity of portal hypertension in this population. A cohort of NCPH patients evaluated between 2003 and 2015 was retrospectively studied. The association of spleen and liver volumes with the hepatic venous pressure gradient (HVPG) level was evaluated using locally weighted scatterplot smoothing curves. A cohort of patients with viral hepatitis‐related liver disease was used as controls. Of the 86 patients with NCPH evaluated during the study period, 75 (mean age, 35 ± 17; 73% males) were included in the final analysis. Patients with portal hypertension had significantly higher spleen and liver to body mass index (BMI) ratios compared to patients with HVPG <5 mm Hg (39.5 ± 27.9 versus 22.8 ± 10.6 cm3/kg/m2, P = 0.003; 91.1 ± 40.1 versus 71.4 ± 16.7 cm3/kg/m2, P = 0.014, for spleen/BMI and liver/BMI, respectively). In contrast to the patients with viral hepatitis, a positive linear correlation was observed in the NCPH cohort between spleen/BMI and liver/BMI (above a cutoff of 25 and 80 cm3/kg/m2, respectively) and HVPG level. Additionally, only in the NCPH cohort was an increase in spleen/BMI range quartile predictive of a higher prevalence of portal hypertension and clinically significant portal hypertension (trend, P = 0.014 and 0.031, respectively). Conclusion: Spleen and liver volumetrics may have utility in the assessment of NCPH as a noninvasive biomarker that can be performed using routine radiologic examinations. Further studies are needed to validate these findings. (Hepatology Communications 2018; 00:000‐000) [ABSTRACT FROM AUTHOR]

Background. Portal hypertension, an elevation in the hepatic venous pressure gradient (HVPG), can be used to monitor disease progression and response to therapy in cirrhosis. Since obtaining HVPG measurements is invasive, reliable noninvasive methods of assessing portal hypertension are needed. Methods. Noninvasive markers of fibrosis, including magnetic resonance elastography (MRE) shear wave velocity, were correlated with histologic fibrosis and HVPG measurements in hepatitis C (HCV) and/or HIV-infected patients with advanced liver disease enrolled in a clinical trial of treatment with simtuzumab, an anti-LOXL2 antibody. Results. This exploratory analysis includes 23 subjects: 9 with HCV monoinfection, 9 with HIV and HCV, and 5 with HIV and nonalcoholic steatohepatitis. Median Ishak fibrosis score was 4 (range 1–6); 11 subjects (48%) had cirrhosis. Median HVPG was 6 mmHg (range 3–16). Liver stiffness measured by MRE correlated with HVPG (r=0.64, p=0.01), histologic fibrosis score (r=0.71, p=0.004), noninvasive fibrosis indices, including APRI (r=0.81, p<0.001), and soluble LOXL2 (r=0.82, p=0.001). On stepwise multivariate regression analysis, MRE was the only variable independently associated with HVPG (R2=0.377, p=0.02). Conclusions. MRE of the liver correlated independently with HVPG. MRE is a valid noninvasive measure of liver disease severity and may prove to be a useful tool for noninvasive portal hypertension assessment. Trial Registration Number. This trial is registered with NCT01707472. [ABSTRACT FROM AUTHOR]

Background: Use of chronic blood transfusions as a treatment modality in patients with blood disorders places them at risk for iron overload. Since patients with β-thalassemia major (TM) are transfusion-dependent, most studies on iron overload and chelation have been conducted in this population. While available data suggest that compared to TM, patients with sickle cell disease (SCD) have a lower risk of extrahepatic iron overload, significant iron overload can develop. Further, previous studies have demonstrated a direct relationship between iron overload and morbidity and mortality rates in SCD. However, reports describing the outcome for patients with SCD and cardiac iron overload are rare.Study Design and Methods: We performed a retrospective analysis and identified two SCD patients with cardiac iron overload. We provide detailed descriptions of both cases and their outcomes.Results: Serum ferritin levels ranged between 17,000 and 19,000 μg/L. Both had liver iron concentrations in excess of 35 mg of iron per gram of dried tissue as well as evidence of cardiac iron deposition on magnetic resonance imaging. One patient died of an arrhythmia and had evidence of severe multiorgan iron overload via autopsy. On the other hand, after appropriate therapy, a second patient had improvement in cardiac function.Conclusion: Improper treatment of iron overload in SCD can lead to a fatal outcome. Alternatively, iron overload may potentially be prevented or reversed with judicious use of blood transfusions and early use of chelation therapy, respectively. [ABSTRACT FROM AUTHOR]

Background Chronic liver injury can result in fibrosis that may progress over years to end-stage liver disease. The most effective anti-fibrotic therapy is treatment of the underlying disease, however when not possible, interventions to reverse or slow fibrosis progression are needed. Aim The aim of this study was to study the safety and tolerability of simtuzumab, a monoclonal antibody directed against lysyl oxidase-like 2 ( LOXL2) enzyme, in subjects with hepatitis C virus ( HCV), human immunodeficiency virus ( HIV), or HCV- HIV co-infection and advanced liver disease. Methods Eighteen subjects with advanced liver fibrosis received simtuzumab 700 mg intravenously every 2 weeks for 22 weeks. Transjugular liver biopsies were performed during screening and at the end of treatment to measure hepatic venous pressure gradient ( HVPG) and to stage fibrosis. Results Treatment was well-tolerated with no discontinuations due to adverse events. No significant changes were seen in HVPG or liver biopsy fibrosis score after treatment. Exploratory transcriptional and protein profiling using paired pre- and post-treatment liver biopsy and serum samples suggested up-regulation of TGF-β3 and IL-10 pathways with treatment. Conclusion In this open-label, pilot clinical trial, simtuzumab treatment was well-tolerated in HCV- and HIV-infected subjects with advanced liver disease. Putative modulation of TGF-β3 and IL-10 pathways during simtuzumab treatment merits investigation in future trials. [ABSTRACT FROM AUTHOR]

A versatile pseudorandom bit sequence (PRBS)-based transmitter with the ability to mix the generated PRBS spectrum to arbitrary frequencies is presented. It incorporates a 2^11 -1 80-Gb/s PRBS generator, employing parallel architecture. The generator is optimized to provide a high bit rate as well as a long sequence length for low power consumption without any need of inductive peaking, compared with the PRBS generators reported in the literature. The PRBS generator is capable of generating bit rates ranging from 10 up to 80 Gb/s. The transmitter can shift the generated PRBS spectrum to arbitrary frequencies ranging from 20 to 60 GHz via a broadband mixer of a double sideband output spectrum of 80-GHz bandwidth. A radar is realized using the presented transmitter, where a range resolution of 7.5 mm could be achieved. The transmitter consumes power ranging from 576 mW to 1 W, depending on the output bit rate of the integrated PRBS generator. The proposed circuit was manufactured in an 0.35- \mu \textm SiGe technology with an ft of 200 GHz. [ABSTRACT FROM PUBLISHER]

In this paper, two proposed bandwidth (BW) extension techniques are discussed and analytically analyzed. The capabilities of the proposed feedback techniques are demonstrated with two design examples of different circuitry, supported by simulation and measurement results. The first design example is a broadband low-power active balun, employing one of the presented feedback techniques. It is capable of operating with a gain of 2.2 dB and BW of more than 70 GHz. The amplitude imbalance is less than 2.4 dB, while the phase imbalance is below 7^\circ up to 60 GHz and 14^\circ up to 70 GHz, consuming a low-power of 29.7 mW. The second design example is a differential three-stage amplifier, incorporating the two techniques, where their combined performance achieves a gain of 54 dB and a 3-dB BW of 25 GHz, resulting in a gain-BW product (GBP) of 12.5 THz, with a power consumption of 180 mW from a 3.3-V supply. The chips are fabricated in a 0.35-\mum SiGe:C bipolar technology with a f_t/ f\max of 200/250 GHz. [ABSTRACT FROM PUBLISHER]

Purpose An external driver-free MRI method for assessment of liver fibrosis offers a promising noninvasive tool for diagnosis and monitoring of liver disease. Lately, the heart's intrinsic motion and MR tagging have been utilized for the quantification of liver strain. However, MR tagging requires multiple breath-hold acquisitions and substantial postprocessing. In this study, we propose the use of a fast strain-encoded (FSENC) MRI method to measure the peak strain (S p) in the liver's left lobe, which is in close proximity and caudal to the heart. Additionally, we introduce a new method of measuring heart-induced shear wave velocity (SWV) inside the liver. Methods Phantom and in vivo experiments (11 healthy subjects and 11 patients with liver fibrosis) were conducted. Reproducibility experiments were performed in seven healthy subjects. Results Peak liver strain, S p, decreased significantly in fibrotic liver compared with healthy liver (6.46% ± 2.27% vs 12.49% ± 1.76%; P < 0.05). Heart-induced SWV increased significantly in patients compared with healthy subjects (0.15 ± 0.04 m/s vs 0.63 ± 0.32 m/s; P < 0.05). Reproducibility analysis yielded no significant difference in S p ( P = 0.47) or SWV ( P = 0.56). Conclusion Accelerated external driver-free noninvasive assessment of left liver lobe strain and SWV is feasible using strain-encoded MRI. The two measures significantly separate healthy subjects from patients with fibrotic liver. Magn Reson Med 74:106-114, 2015. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background. Persistent aminotransferase elevations are common in human immunodeficiency virus (HIV)-infected patients on antiretroviral therapy (ART), including those without hepatitis B or C coinfection, but their clinical significance is unknown. Methods. HIV-infected adults with aminotransferase levels elevated above the upper limit of normal for ⩾6 months while receiving ART, and without chronic viral hepatitis or other known causes of chronic liver disease, underwent a detailed metabolic assessment and liver biopsy. Results. Sixty-two HIV-infected subjects completed the study. Forty (65%) had clinically significant liver pathology, including 34 (55%) with nonalcoholic steatohepatitis (NASH) and 11 (18%) with bridging fibrosis, 10 of whom also had NASH. Nonspecific abnormalities alone were seen in 22 (35%) subjects, including mild steatosis, mild to moderate inflammation, and evidence of drug adaptation. Insulin resistance, obesity, and the presence of either of 2 minor alleles in the PNPLA3 gene were significantly associated with increased risk of NASH and fibrosis. NASH and/or fibrosis were not associated with duration of HIV infection or ART, specific antiretroviral drugs, history of opportunistic infection, immune status, or duration of aminotransferase elevation. Conclusions. HIV-infected adults with chronic aminotransferase elevations while receiving ART have a high rate of liver disease. Noninvasive testing can help identify liver disease in such patients, but liver biopsy is necessary to definitively identify those at risk for liver disease progression and complications. Longitudinal follow-up of this cohort will better characterize the natural history of aminotransferase elevations in this population and identify noninvasive biomarkers of liver disease progression. [ABSTRACT FROM AUTHOR]