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Background: In kidney transplantation, concerns have been raised regarding increased incidence of viral opportunistic infections in hepatitis C virus (HCV) nucleic acid test (NAT)‐negative (‐) recipients who received HCV NAT‐positive (+) donor kidneys, specifically BK polyomavirus (BKPyV), cytomegalovirus (CMV), and Epstein‐Barr virus (EBV). The purpose of this study was to determine the incidence of these three viral opportunistic infections in HCV NAT‐ recipients who have undergone kidney transplantation with HCV NAT+ donor kidneys at our institution. Methods: This was an Institutional Review Board‐approved, single‐center, retrospective case‐control study of HCV NAT‐ kidney transplant recipients with HCV NAT+ donors from 2018 to 2021. The primary outcome was the cumulative incidence of viral infections of BKPyV, CMV, and/or EBV within 1 year following kidney transplantation. Results: A total of 231 patients were included, 77 in the exposed (donor HCV NAT+) group and 154 in the control (donor HCV NAT‐) group. The adjusted cumulative incidence of viremia within 1 year did not statistically differ between groups (77% exposed group versus 66% for the control group, hazard ratio 1.34, 95% confidence interval 0.95–1.89). In addition, no statistically significant differences were observed for secondary outcomes with the exception of CMV viremia (62% exposed versus 49% control, p = 0.021). However, there were more patients in the exposed group at high risk for CMV viremia based on serostatus (CMV Donor+/Recipient‐, D+/R‐). Conclusion: Among patients who received HCV NAT+ donor kidneys, no clear association was observed between exposure to HCV NAT+ donor kidneys and viral infections of BKPyV, CMV, or EBV. [ABSTRACT FROM AUTHOR]

Growing worldwide waste management challenges have prompted research efforts for sustainable solutions, especially in green energy technologies. This study highlights robotics' critical role in modern waste management by putting forth a novel strategy incorporating cutting‐edge technologies. The research aims to create an effective waste monitoring system to measure the amounts of methane gas and organic waste at disposal sites. The main component of this method is a 3D‐printed spider robot driven by a servo motor with solid and flexible claws. This robotic system communicates gas level readings to the ThingSpeak platform on the Internet of Things, while it navigates waste disposal sites autonomously. The study also investigates how to develop robotic systems more economically and efficiently by using a portable, low‐power microcontroller, such as the Arduino Nano. The study uses a rigorous testing methodology to assess the performance and viability of the microcontroller and robotic system. The results are expected to emphasise a practical and economic development approach while offering insightful information on developing sustainable waste management technologies. [ABSTRACT FROM AUTHOR]

Acute abdominal pain in the adolescent or young adult can be due to many causes, some of which are considered in this discussion. The key to an accurate diagnosis is a meticulous medical history, careful physical examination repeated over time, and judicious use of laboratory and/or imaging studies. The medical history may present red flags that alert the astute clinician to which causes are benign and which ones indicate serious pathology. Particularly important is the location of the pain and how it may change over time. The challenging features presented by acute abdominal pain in the adolescent and young adult include findings such as guarding or rigidity signifying acute appendicitis or peritonitis versus negative palpatory findings that are non-specific with minimal clinical value. Appropriate follow-up over time is a valued tool in the clinician's armamentarium in the evaluation and management of acute abdominal pain. [ABSTRACT FROM AUTHOR]

Power quality is the main problem with the power system network. Poor electricity quality may cause disruptions and financial challenges for consumers. Additionally, it could cause electronic gadgets to overheat, be damaged, or operate inadvertently. Transformers and other components of the power distribution system may also overheat and experience core saturation. This study investigates potential problems with the quality of the electricity in a photovoltaic linked power system. This paper suggests a new optimization method for day-ahead trading and control in DC microgrid power management (MG). The goal of the multiobjective optimization dispatch (MOOD) problem is to lower overall operational costs as well as the costs associated with power loss in efficient conservation systems and exhaust emission quantities such as nitrogen oxides, sulphur dioxide, and carbon dioxide. Using the weighted sum approach, the multiobjective optimization problem is reduced to a single optimization problem. The analytical hierarchy process (AHP) method is then used to calculate the weight coefficients while accounting for each objective function's preferences. Power balancing, high levels of renewable energy penetration, the most effective scheduling of battery charging and discharging, control of load curtailment, and the technical limitations of the system are all taken into account when evaluating the system's performance in both grid-connected and standalone operation modes. The ant lion optimizer (ALO) technique is taken into account to tackle MOOD, comparing the effectiveness of the proposed method to other well-known heuristic optimization techniques. The simulation's results demonstrate how effectively the proposed strategy can address the coordinated control and optimization dispatch difficulties. They also found that operating the MG system economically in grid-connected mode can save overall costs by roughly 4.70% compared to doing it in independent mode. [ABSTRACT FROM AUTHOR]

In a solar power plant, a solid phase transformer and an optimization coordinated controller are utilized to improve transient responsiveness. Transient stability issues in a contemporary electrical power system represent one of the difficult tasks for an electrical engineer due to the rise in uncertain renewable energy sources (RESs) as a result of the need for green energy. The potential for terminal voltage to be adversely impacted by this greater RES raises the possibility of electrical device damage. It is possible to use a solid state transformer (SST) or smart transformer to address a transient response issue. These devices are frequently employed to interact between RES and a power grid. SST features a variety of regulated converters to maintain the necessary voltage levels. This method can therefore simultaneously lessen power fluctuations and transient responsiveness. In order to improve the quality of RES power injections and the electrical system's transient stability, this work provides a controller design for a solar photovoltaic (SPV) system that is connected to the grid by SST. The optimization of a controller model is proposed by modifying a PI controller taken from a commercial one. With the use of IEEE 39 standard buses, the proposed controller is tested. When evaluating the effectiveness of a suggested controller, it is important to take into account a variety of solar radiation patterns as well as a time delay uncertainty that can range from 425 ms to 525 ms. According to simulation results, the proposed controller can be employed to lessen power fluctuation brought on by unpredictable RES. Additionally, the proposed coordinated regulation of SPV and SST can prevent catastrophic damage in the event of substantial disturbances like a circuit breaker collapsing to expand a power line due to a fault by inhibiting significant voltage cycles within an electronic appliance's rated voltage limit. The results indicate that a transitory stability issue in a modern power system caused by an unforeseen increase in RES may be addressed utilizing the suggested controllers as alternatives. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to compare characteristics of erupted and impacted third molars in the mandible and the maxilla using quantitative measurements and determine any relationship between the eruption/impaction pattern of third molars in both jaws with available eruption space and tooth inclination. Material and Methods: Patients who visited to the Department of Oral and Maxillofacial Surgery at tertiary care institute of India were screened for eligibility to join our study. The eruption status of the third molars in both jaws were examined on orthopantomographs by measuring the distance from the line tangent to the highest points of occlusal cusps of the third molar to that of the adjacent second molar. The presence of available space for the eruption was determined by the ratio of the mesiodistal length of the third molar crown to the length of the alveolar arch distal to second molars. Results: There was sufficient space for the eruption of third molars in 17.6% of the cases in the mandible as opposed to 61.7% of the cases in the maxilla. In the mandible, 37.7% of third molars were in vertical position, 37.1% were in mesioangular position, and 19.9% were in distoangular position. In the maxilla, 62.5% of third molars were in vertical position and 33.12% were in distal inclination. The presence of favorable parameters does not warrant full eruption of third molars in both jaws. Conclusion: Removal of impacted third molars is the most commonly employed procedure in oral surgery practice. Pain and pericoronitis were the most common symptoms usually associated with level A impaction and vertical position. [ABSTRACT FROM AUTHOR]

While a bidirectional positive link between palatable food intake and alcohol drinking has been suggested, several rodents studies report reduced alcohol drinking following palatable diets exposure. These studies utilized purified rodents' diets high in sugar/fat; however, the effects of hyper-palatable food (HPF) rich in fat and sugar on alcohol drinking remain unclear. Furthermore, neural substrates involved in HPF-mediated changes in alcohol consumption are poorly understood. Therefore, the present study evaluated the effects of patterned feeding of a hyper-palatable food (Oreo cookies) on alcohol drinking as well as dopamine (DA) and serotonin (5-HT) content in rat's mesocorticolimbic (medial-prefrontal cortex, orbitofrontal cortex, amygdala, and nucleus accumbens) circuitry. Male Long Evans rats received 8-weeks of intermittent (Mon, Tue, Wed) Oreo cookies access, which induced a patterned feeding, in which rats in the Oreo group overconsumed calories on HPF days whereas underconsumption was observed on chow only (Thu, Fri) days. Following HPF exposure, alcohol consumption was evaluated while patterned feeding continued. Alcohol intake in the Oreo group was significantly lower as compared to the chow controls. However, alcohol intake in the Oreo group increased to the levels seen in the group receiving chow following the suspension of patterned HPF feeding. Finally, DA levels in the nucleus accumbens were significantly greater, whereas its metabolite (DOPAC) levels were lower in the Oreo group compared to the chow controls. Surprisingly, 5-HT levels remained unaltered in all tested brain areas. Together, these data suggest that HPF-associated increased DA availability and reduced DA turnover within mesocorticolimbic circuitry may regulate alcohol drinking following patterned HPF feeding. [ABSTRACT FROM AUTHOR]

Moderate to severe pain occurs in many cancer patients during their clinical course and may stem from the primary pathology, metastasis, or as treatment side effects. Uncontrolled pain using conservative medical therapy can often lead to patient distress, loss of productivity, shorter life expectancy, longer hospital stays, and increase in healthcare utilization. Various publications shed light on strategies for conservative medical management for cancer pain and a few international publications have reviewed limited interventional data. Our multi-institutional working group was assembled to review and highlight the body of evidence that exists for opioid utilization for cancer pain, adjunct medication such as ketamine and methadone and interventional therapies. We discuss neurolysis via injections, neuromodulation including targeted drug delivery and spinal cord stimulation, vertebral tumor ablation and augmentation, radiotherapy and surgical techniques. In the United States, there is a significant variance in the interventional treatment of cancer pain based on fellowship training. As a first of its kind, this best practices and interventional guideline will offer evidenced-based recommendations for reducing pain and suffering associated with malignancy. [ABSTRACT FROM AUTHOR]

Craniopharyngiomas are the most commonly presented nonglial tumors in child patients. They cause significant morbidity and mortality, both before and after surgery. The most common immediate postsurgery complications are attributable to pituitary insufficiency. Neurovascular complications account for only 2.7 to 2.9% surgical cases, and usually involve the vessels of the Circle of Willis. Thrombosis or vasospasm of the vessels of posterior circulation is unheard of. Here, we are reporting a unique case of a child with craniopharyngioma who developed acute spontaneous basilar artery thrombosis and posterior circulation stroke 6 days after surgery. [ABSTRACT FROM AUTHOR]

Craniopharyngiomas are the most commonly presented nonglial tumors in child patients. They cause significant morbidity and mortality, both before and after surgery. The most common immediate postsurgery complications are attributable to pituitary insufficiency. Neurovascular complications account for only 2.7 to 2.9% surgical cases, and usually involve the vessels of the Circle of Willis. Thrombosis or vasospasm of the vessels of posterior circulation is unheard of. Here, we are reporting a unique case of a child with craniopharyngioma who developed acute spontaneous basilar artery thrombosis and posterior circulation stroke 6 days after surgery. [ABSTRACT FROM AUTHOR]

Introduction  Ventriculoperitoneal shunt (VPS) is the most common procedure used for cerebrospinal fluid (CSF) diversion in hydrocephalus. Over the years, many technical, procedural, and instrument-related advancements have taken place which have reduced the associated complication rates. Shunt block is a very common complication irrespective of the shunt system used. The abdominal end of the shunt tube gets blocked usually due to plugging of omentum onto the shunt catheter. We describe a technique of catheter fixation and placement under vision coupled with omentopexy done laparoscopically to prevent this complication. Materials and Methods  This technique was used in 23 patients (11 female, 12 male; range 16–73 years) afflicted with hydrocephalus from June 2016 and December 2019 after obtaining an informed consent, and the outcomes were noted in terms of shunt patency, complications, if any, and the need for revision. Results  The median operation time was 90 minutes (range 35–160 minutes). All shunt catheters were still functional after a mean follow-up of 16.5 months (range 1–34 months) and none required revision. Conclusion  Laparoscopic placement of shunt tube along with omental folding is a safe and effective technique for salvaging the abdominal end of VPS and may be helpful in reducing shunt blockage. [ABSTRACT FROM AUTHOR]

Due to ongoing pandemic, majority of the academic teaching is executed on online platforms, leading to extended screen time. Anecdotal evidence suggests long-term ophthalmic impact of extended screen time. Present study was carried out to document eye related problems amongst adult university/college students undertaking online classes to document the effects of online teaching. An online survey method was undertaken in the month of July, 2020 amongst university/ college students of Gujarat using google form. All possible social media platforms were used to collect the data from students of Gujarat. Epi Info and SPSS were used and both descriptive and inferential analysis was performed. A total of 620 students from the various streams participated in the study where around 56.5% were female respondents. The majority of students (88% of participants) had noticed eye problems out of that 39.1% of participants felt that online teaching as a reason. Headache (54.0%) was the most common problem experienced by the participants followed by Pain in eyes (34%) and Watering (26.3%). To conclude online teaching has led to increased eye strain and other eye-related problems in university/college going students and risk factors for severity included sessions attended per day, the distance at device kept, and the enjoyment level. In spite of the high incidence of ophthalmic issues, none of the respondents contacted any ophthalmologist for the same. [ABSTRACT FROM AUTHOR]

Background. Pediatric endodontics is a field with constant evolution, resulting in the shifting of paradigms from the use of conventional hand files to rotary files for biomechanical preparation in primary teeth. Biomechanical preparation plays a crucial role in the success of root canal treatment. Primary teeth need special attention since they differ from permanent teeth in root canal morphology. Cleaning and shaping of the canals damage the root dentin, leading to dentinal cracks. Newer techniques for root canal preparation, including Ni-Ti rotary files and SAF system, have been developed for use in pediatric endodontics to overcome the drawbacks of conventional methods. The present study compared dentinal defects formed by rotary systems in primary teeth. Methods. Eighty primary teeth were included. The teeth were decoronated with a diamond disc. All the roots were inspected for any pre-existing cracks or craze lines under transmitted light under a stereomicroscope. The specimens were then divided into four groups (n=20): group 1: control, group 2: hand files (HF), group 3: ProTaper files, and group IV: SAF files. The samples were instrumented according to the group they were assigned to. Results. The HF and SAF groups exhibited fewer microcracks. Dentinal microcracks were observed in roots prepared with rotary ProTaper files. There were significant differences between HF/SAF and rotary files (P < 0.05). Conclusion. Stainless steel hand K-files and SAF instruments resulted in fewer dentinal damage than the ProTaper Universal files. SAF exhibited satisfactory results with minimal or no crack formation. [ABSTRACT FROM AUTHOR]

Background The Transit Care Hub (TCH) is an inpatient ward traditionally used as a waiting area for patients who require transport to return home. In July 2018, a six-month pilot of a TCH pharmacist was funded to improve the flow of patients through the hospital. Setting Major Australian teaching hospital. Objective(s) To determine the effect that the TCH pharmacist had on patient flow within the hospital and on the time saved for other clinical pharmacists, as well as estimating cost savings. Methods A service delivery framework for the TCH pharmacist was developed and tested. This involved a proactive approach to patient discharge with ward-based staff. Data were collected from July to November 2018, 20 weeks prior to and 20 weeks after the commencement of the pilot. Main outcome measure Measurements included the number of best possible medication histories (BPMHs) completed during admission, improvements in arrival time to TCH from inpatient wards and cost savings. Results During the pilot study period (20 weeks), 791 patients were discharged by the TCH pharmacist, arriving an average of 70 minutes earlier than other patients discharging through TCH. There was a 16% increase in patients discharging through TCH which released ward beds. The TCH pharmacist increased the number of BPMHs on day of admission by 14%. There was an estimated annual saving of AU$252,008 for the hospital. Conclusions The TCH pharmacist service enhanced patient flow by coordinating earlier discharges, increasing the timely completion of BPMHs, and saving ward pharmacist time. Significant cost savings supported a permanently funded position. [ABSTRACT FROM AUTHOR]

Background and Aims: Epidural analgesia is believed to be the most difficult technique to learn for a trainee. The reason for this is not only inexperience of the provider and the complexity of the technique but also patient factors like obesity, spinal deformity and others which makes the epidural placement difficult. The aim of this study was to evaluate some of the common risk factors for difficult epidural placement as perceived by the anesthesia providers during training, with varying level of experience. Material and Methods: This prospective observational study includes patients who received epidural placement for labor analgesia. Data recorded on these patients included age, height, weight, body mass index (BMI), ease of palpation of the spinous process, level of epidural placement, number of attempts, time taken for epidural placement and experience of the provider. The association between the variables were assessed using logistic regression for first attempt success and Cox proportional hazard ratio for time to epidural placement. Results: A total of 373 patients received epidural placement for labor analgesia. The mean BMI at the time of placement was 34. The first attempt success rate for the placement of epidural was 67% (n = 273). Women with well palpable spinous process were 3.3 times more likely to have a successful first attempt placement irrespective of the provider experience or BMI [3.39 (1.77-6.51), P < 0.001]. The time to placement was shorter in patients with good anatomical landmarks [1.58 (1.20-2.07), P < 0.001) and when performed by a trainee who had performed a minimum of 20 epidural procedures [1.57 (1.26-1.94), P < 0.001). Conclusion: Inability to palpate the spinous process contributes to multiple attempts at epidural placement when performed by a trainee. [ABSTRACT FROM AUTHOR]

Summary: Li‐ion cells suffer from significant safety and performance problems due to overheating and thermal runaway. Effective thermal management can lead to increased energy conversion efficiency and energy storage density. Critical needs towards these goals include the capability to predict thermal behavior in extreme conditions and determine thermal management requirements to prevent thermal runaway. This paper presents an experimentally validated theoretical model to predict the temperature distribution in a cell in response to nonlinear heat generation rate that is known to occur during thermal runaway. This problem is solved by linearization of the nonlinear term over successive time intervals. Experimental measurements carried out on a thermal test cell in conditions similar to thermal runaway show good agreement with the theoretical model. Experimental measurements and model predictions indicate strong dependence of the fate of the cell on its reaction kinetics, thermal properties, and ambient conditions. Specifically, a sudden change in thermal runaway behavior is predicted once the ambient temperature crosses a certain threshold, consistent with past experimental observations. The impact of increasing cell thermal conductivity on improved thermal runaway performance is quantified. Results presented here provide a fundamental understanding of thermal runaway, and may lead to improved performance and safety of Li‐ion–based energy conversion and storage systems. Develops an analytical thermal runaway model to predict Li‐ion cell temperature under abuse conditions.Presents experimental validation for a wide variety of parameters.Experimentally demonstrates enhanced safety with increase in thermal conductivity.Analyzes effect of different heat transfer and reaction kinetics parameters on cell safety. [ABSTRACT FROM AUTHOR]

Purpose. There are limited resources for long-term specialist follow-up after bariatric surgery. In selected centres, patients can access a postoperative support group, but there is no clear evidence to guide their delivery. Materials and Methods. A retrospective study of bariatric surgery patients (n = 152) who had been discharged from specialist follow-up (mean time since surgery 5.5 years), covering weight history, physical and psychosocial comorbidities, and the need for a postoperative bariatric support group. Results. Fifty-eight percent wanted a postbariatric surgery patient support group. This was not associated with operation type or the amount of weight lost or regained. However, those who wanted a support group were significantly more likely to be struggling to keep the weight off, to be unhappy with the way they look, or to be experiencing difficulties returning to work. Conclusions. These data point to an unmet patient requirement for a postoperative support group that is independent of weight loss success. More research is required to ascertain how such a group should be delivered, but our data would suggest that supporting patients with weight loss maintenance, body image, and return to work is an important part of postoperative care, and these needs extend well beyond the immediate period of specialist follow-up. [ABSTRACT FROM AUTHOR]

Background:Physostigmine has long been recognized as an antidote to reverse anticholinergic delirium. However, its effectiveness, safety profile, and dosing have been disputed. Objectives:To describe effectiveness, adverse events, and dosing associated with the use of physostigmine to reverse anticholinergic delirium. Methods:A retrospective cohort study of hospitalized patients reported to a regional poison center system between 2003 and 2012 who received physostigmine to reverse an anticholinergic toxidrome. Data extraction ofa prioridefined variables were recorded with concurrence of investigators. The cases were stratified by the primary ingestant as the presumed causative agent and associations for response were performed using odds ratios (ORs), 95% confidence intervals (CI’s), andpvalues. Results:Of the 1422 cases identified, 191 met the inclusion criteria. Patients exposed to non-diphenhydramine antihistamines (n = 14), antipsychotics (n = 4), and tricyclic antidepressants (n = 3) had 100% response to physostigmine, whereas anticholinergic plants (n = 46/67; 68.7%, OR: 0.70; CI: 0.36–1.35), diphenhydramine (n = 43/56; 64.2%, OR: 1.30; CI: 0.63–2.68), and combination products (n = 8/10; 80%, OR: 1.48; CI: 0.30–7.24) had partial response rates. Of the included patients, 142 (74.3%) were treated with physostigmine alone, and 16 (8.4%) of these patients were discharged directly from the emergency department (ED). Discussion:Most patients, 182 (95.3%), had no documented adverse effects. Four patients (2.1%) experienced emesis, two experienced QTc prolongation (1.0%), and two experienced seizures (1.0%). There was a single fatality 6 h after physostigmine administration. Average initial total doses of physostigmine ranged from 1.0 to 1.75 mg. Most patients were admitted to the ICU (n = 110; 57.6%), however, 36 (18.8%) patients were discharged directly from the ED. Conclusions:In this retrospective cohort study, physostigmine administration to reverse anticholinergic delirium had a good safety profile, and often improved or resolved anticholinergic delirium when administered in doses less than 2 mg. [ABSTRACT FROM PUBLISHER]

Gastrointestinal (GI) microbiota are known to play paramount role in inflammatory bowel disease (IBD). Innovative sequencing methods have radically expanded our ability to analyze the intestinal microbiome. However, alterations of the GI microbiome in IBD have not yet been fully evaluated. Irregular colonization of the gut has been implicated in chronic intestinal inflammation. Faecal microbiota transplantation (FMT) is a procedure which aims to restore microbial disturbances to the individual's gut microbiome. The success of FMT in Clostridium difficile infection (CDI) has inspired studies to explore transplantation in other conditions such as IBD. Ulcerative colitis (UC) and Crohn's disease (CD), the two principal manifestations of IBD, are emerging as a worldwide epidemic and are multifactorial in aetiology. There have been various case series in the past looking at the use of FMT in IBD, with a large number of them focusing on UC; however, two new randomized controlled trials shed up-to-date light on the complex interactions between the GI microbiome and patients. Regardless of these new studies, much more remains unknown about the efficacy and safety profile of FMT in IBD, ultimately casting a shadow over its use as a therapeutic intervention in conditions other than CDI. Further researches are necessary to fully evaluate the role of FMT as a management option in IBD. In this review, we discuss and summarize the functions of FMT in IBD, and the relationship between IBD and the GI microbial variations present. [ABSTRACT FROM AUTHOR]

The genetic diversity of Human Immunodeficiency Virus type-1(HIV-1) has been shown to affect the performance of Nucleic Acid Testing (NAT) of Human Immunodeficiency Virus type-1. Although, majority NAT assays were designed to detect the conserved regions of HIV-1 mutations at the primer or probe binding regions may lead to false negatives. In this study, we evaluated the feasibility of detecting two genomic targets for enhanced sensitivity. A total of 180 tests using HIV-1 VQA RNA quantitation standard, 240 tests using EQAPOL HIV-1 viral diversity subtype panel, and 30 clinical plasma samples from Cameroon were evaluated. The analysis was based on probit and hit rate. The genomic targets LOD estimated by PROBIT for the gag target was 118 cps/ml (95%CI 64 cps/ml lower bound), Pol or POL/LTR was at 40 cps/ml (95%CI 17, 16 cps/ml), LTR 45 cps/ml (95%CI 20 cps/ml lower bound), and Gag/LTR at 67.8 cps/ml (95%CI 32 cps/ml lower bound). For HIV-1 subtypes the overall reactivity was 55-100% when tested at 100 and 1000 cps/ml and combination of genomic targets detection increased the reactivity to 100%. The plasma samples evaluation showed LTR or pol/LTR combination yielded higher sensitivity for patients with lower viral load (<40 cps/ml). We conclude that detection of two HIV-1 genomic targets improved sensitivity for detection of genetically diverse HIV-1 strains. J. Med. Virol. 88:1092-1097, 2016. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Backgound: Intracranial cerebral aneurysms in the pediatric population are infrequent, and those occurring in infants less than 1 year old are extremely rare. Of intracranial aneurysms in children, dissecting aneurysms are the most common type seen. While spontaneous dissecting aneurysms usually present with ischemia, hemorrhage can also occur. Methods: A retrospective review of our patients revealed that from July 1, 2007 to June 30, 2012, four infants were treated for ruptured distal dissecting intracranial aneurysms at Texas Children's Hospital. Mycotic aneurysms and collagen vascular disorder were excluded in all four cases. All patients presented in our series presented with subarachnoid hemorrhage, and three had intraventricular hemorrhage. All patients underwent conventional catheter angiography for diagnosis. All patients in this series were managed in the acute or subacute period with surgical or endovascular trapping without distal bypass procedures. All four patients tolerated sacrifice of the parent vessels feeding these distal aneurysms well. Case report and review of literature: We describe the presentation and management of these rare cases and then review the current literature on the management of these dissecting aneurysms in infants. [ABSTRACT FROM AUTHOR]

A 75-year-old man with history of metastatic bladder cancer (4/2015) status post chemotherapy and thymoma (9/2015) status post resection, currently undergoing treatment with pembrolizumab, presented with fever, fatigue, and acute onset pancytopenia. Work-up revealed elevated ferritin, low fibrinogen, splenomegaly, elevated soluble CD25, and decreased natural killer cell activity. Bone marrow biopsy was performed to evaluate for hemophagocytic lymphohistiocytosis (HLH). Biopsy showed a normocellular bone marrow with histiocytic hyperplasia and hemophagocytosis confirming the presumed diagnosis of HLH. He was started on treatment accordingly. It was later found that the patient had coexistent Epstein-Barr virus (EBV) reactivation. Pembrolizumab is a monoclonal antibody used as first-line treatment for patients with certain tumors shown to have high PD-L1 expression on neoplastic cells. It is a second-line treatment for patients that have evidence of disease progression on or after platinum containing chemotherapy. This antibody specifically binds to PD-L1 receptors on T-cells (an inhibitory immune checkpoint molecule) effectively blocking tumor cells with PD-L1 ligands from inactivating T-cells. Adverse side effects of pembrolizumab include immune-mediated infections along with thyroid dysfunction, colitis, and type 1 diabetes mellitus; however, there has been no report of its association with HLH. HLH is characterized by impaired T-cell and NK response during episodes of persistent and excessive activation of macrophages. The pathogenesis of HLH is related to defects in the regulatory pathways responsible for normal termination of the inflammatory response. The clinical signs and symptoms result from production of proinflammatory cytokines, mediated by uncontrolled activation of T-cells and antigen-presenting cells. The most common infectious trigger for HLH is viral infection. In this case, EBV was likely the primary cause, but the effects of concurrent PD-L1 inhibitor may have perpetuated the inappropriately prolonged T-cell activation, thereby facilitating the development of HLH. [ABSTRACT FROM AUTHOR]

We have previously shown that 6 weeks of intermittent high-fat diet (Int-HFD) pre-exposure significantly reduced alcohol drinking in rats, providing preliminary evidence of the effectiveness of a dietary intervention in reducing alcohol intake. However, the functional framework and underlying neurobiological mechanisms of such dietary intervention are unknown. Here, we examined the impact of Int-HFD pre-exposure duration on alcohol drinking, plasma feeding peptides, and central neurotransmitter receptors gene expression. Male Long Evans rats (n = 6–7/group) received no pre-exposure, 1 or 2 weeks pre-exposure to Int-HFD and alcohol drinking (two-bottle choice) was evaluated. We observed HFD pre-exposure-dependent decrease in alcohol drinking, with a significant decrease observed following 2 weeks of Int-HFD pre-exposure. No significant between-group differences in plasma feeding peptides (i.e., ghrelin, leptin, insulin) were detected. A PCR array revealed that the expression of several neurotransmitter receptors was significantly (p < 0.05 and ≥2-fold) altered in the striatum and ventral tegmental area compared to controls. These data suggest that pre-exposure to a palatable diet is critical to reduce alcohol drinking in rats, possibly through genetic alterations in the brain reward circuitry. Importantly, the present study is a step forward in identifying the critical framework needed to evaluate the therapeutic potential of nutritional contingency in the management of alcoholism. [ABSTRACT FROM AUTHOR]

California has some of the key agricultural regions in the United States. One of these key regions, San Joaquin Valley, frequently experiences severe droughts leading to shortage of irrigation water. This has a significant impact on the agricultural based economy of the region. It is imperative to develop new strategies to reduce overall water consumption in agriculture without affecting crop yield. A large fraction of irrigation water is lost due to the evapotranspiration (ET) process in the crops and the soil. The classical Penman-Monteith model has been used in the present work to analyze the effect of different environmental variables and water saving strategies on the ET. Some of the scenarios considered show potential for significant water savings without much reduction in the amount of sunlight available to facilitate crop growth. The central idea considered in this study is the use of canopy shading to cover the crop field resulting in reduction in the ET. Among the strategies considered, the most promising strategy is to partially cover the crop field for a certain part of the day by employing a partially covering retractable canopy. Based on numerical calculations, total reduction in ET is calculated to be 37% from June to August for the partially covering retractable canopy. [ABSTRACT FROM AUTHOR]