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Abstract Background The R wave in lead aVR, during the wide QRS complex tachycardia, is commonly observed in a ventricular tachycardia (VT) arising from certain locations in the ventricles. Objectives This was a retrospective and a proof of concept study to correlate the sites of origin of VT and premature ventricular contractions (PVCs) with the occurrence of R wave in lead aVR. Methods Patients with VT or high density of PVCs were included. Surface and intracardiac electrograms were recorded during the arrhythmia. VTs and PVCs arising from the inferior, inferolateral, or apical region of the ventricles were grouped into Zone 2. Those arising from the other areas of the ventricles were grouped into Zone 1. Results Sixty‐four patients were included in the study. The mean age was 57 years. There were 47 males. Among 64 patients with VT or PVCs, 28 patients had an R wave in aVR (43.7%), In 26 of 28 patients with an R wave in aVR, the site of origin of the arrhythmia was in Zone 2. The R wave in aVR was absent in 36 patients, 34 of whom had the origin of arrhythmia focus in Zone 1. The presence of an R wave in aVR correctly identified Zone 2 as a site of origin of the arrhythmia with high sensitivity (93%) and specificity (94%). Conclusions The presence of an R wave in aVR during wide QRS complex tachycardia or PVC is a valuable observation for identifying the site of origin of the arrhythmia and hence in distinguishing supraventricular tachycardia with aberrancy from VT.

In recent times, the continuous growth of construction and demolition (C&D) activities have resulted in increases in the utilization of natural resources as well as global C&D waste production. A major part of C&D waste produced is dumped in landfills worldwide although some countries have adopted good recycling and reuse facilities to generated C&D waste. Based on an extensive critical review of published literature on the topic including global C&D waste recycling statistics and composition of generated wastes, this paper identifies key physical, mechanical, and geotechnical characteristics of recycled C&D waste aggregates specific to use as pavement base or subbase materials. Recycled aggregates typically have sufficient CBR, abrasion resistance, compressive strength and resilient modulus in accordance with various road standard specifications, which enable their applications for pavement base and subbase layer construction. Recycled aggregates typically have higher water absorption and lower specific gravity values than virgin aggregates. Furthermore, this study evaluates the feasibility and effectiveness of recycled aggregates in pavement base and subbase layers based on the detailed laboratory investigations. Additionally, case studies involving large-volume utilization of recycled aggregates for field-scale pavement construction are presented facilitating the broader adoption of recycled materials in sustainable construction of road pavements. These studies document crucial insights into its real field performance in terms of strength, durability and longevity. Finally, authors have discussed the potential challenges, research gaps and future insights on the use of recycled aggregates in pavement construction. The use of recycled aggregates in pavement construction still has some barriers and challenges such as availability in bulk quantity especially at the field scale and absence of road standards for application, which require further research and practical developments to promote the sustainable use of these materials in the future.

Due to rapid population growth and urbanization, construction activities have increased worldwide resulting in generation of enormous volume of construction and demolition (C&D) waste. On one hand, C&D waste is generated during the construction, destruction, and rehabilitation of existing structures. While on the other, the transportation sector consumes large volumes of aggregates for pavement construction and maintenance. The extraction of finite natural aggregates causes potential damage to the environment. Recycled C&D waste, once converted into recycled aggregates, has the potential to be utilized in pavement layers due to its sound quality and composition; also resulting in lowering the landfill loads. This review article critically summarizes the environmental risks regarding chemical composition and leaching behavior of C&D wastes in pavements. Additionally, this review evaluates the environmental impacts of C&D waste aggregate production and application in pavements using life cycle assessment (LCA). Overall, the aim of this study is to investigate the environmental impacts and benefits of C&D waste to enable highway administrations to adopt and promote the use of C&D waste in development of sustainable road infrastructure. In this way, the review article attempts to promote a new era of sustainable road construction and achieve net zero waste goal.

An electrocardiogram showing atrial flutter in which varying ratios of AV conduction and the cyclical recurrence of varying QRS morphologies are observed is presented.

Abstract Differential diagnosis of wide QRS tachycardia (WQRST) on the electrocardiogram remains a challenging exercise. Correct diagnosis is important for prescribing appropriate therapy and determining prognosis. Differential diagnosis of wide QRS tachycardia revolves around differentiation between supraventricular tachycardia with aberrant conduction and ventricular tachycardia. Observations such as clinical history, findings of physical examination during tachycardia, AV dissociation, QRS morphology in lead V1 and lead V6, precordial concordance, RS complexes in precordial leads, contralateral bundle branch block during wide QRS tachycardia, R wave morphologies in lead aVR, and ventricular initial/terminal velocity of conduction ratio can help arrive at the correct diagnosis with reasonable accuracy. The observations described here can help arrive at the correct diagnosis of WQRST with both reasonable accuracy and confidence.

A 79-year-old Caucasian male was referred to cardiology clinic because the electrocardiogram showed premature atrial complexes and pre-excitation (delta waves) thought to be consistent with Wolff-Parkinson-White (WPW) syndrome. He did not report symptoms of palpitations or syncope. Careful analysis of the electrocardiogram revealed a fascicular-ventricular pathway (FVP) responsible for pre-excitation. Differentiating FVP from WPW syndrome is essential as the risk profile is different with each. Electrocardiographic observations that could help identify the presence of an FVP and its diagnostic, prognostic, and therapeutic implications are presented.

Introduction Pancreatic exocrine insufficiency (PEI) in patients with pancreatic malignancy is well documented in the literature and is known to negatively impact on overall survival and quality of life. A lack of consensus opinion remains on the optimal diagnostic test that can be adapted for use in a clinical setting for this cohort of patients. This study aims to better understand the prevalence of PEI and the most suitable diagnostic techniques in patients with advanced pancreatic malignancy.Methods and analysis This prospective observational study will be carried out in patients with pancreatic malignancy (including adenocarcinoma and neuroendocrine neoplasms). Consecutive patients with inoperable pancreatic malignancy referred for consideration of first-line chemotherapy will be considered for eligibility. The study comprises three cohorts: demographic cohort (primary objective to prospectively investigate the prevalence of PEI in patients with inoperable pancreatic malignancy); sample size 50, diagnostic cohort (primary objective to design and evaluate an optimal diagnostic panel to detect PEI in patients with inoperable pancreatic malignancy); sample size 25 and follow-up cohort (primary objective to prospectively evaluate the proposed PEI diagnostic panel in a cohort of patients with inoperable pancreatic malignancy); sample size 50. The following is a summary of the protocol and methodology.Ethics and dissemination Full ethical approval has been granted by the North West Greater Manchester East Research and Ethics Committee, reference: 17/NW/0597. This manuscript reflects the latest protocol V.8 approved 21 April 2020. Findings will be disseminated by presentation at national/international conferences, publication in peer-review journals and distribution via patient advocate groups.Trial registration number 194255, NCT0361643.

IntroductionThe misuse of antibiotics in poultry farming is a global issue.ObjectiveThe focus of this study was the health risk assessment of consumers from the determination of ciprofloxacin (CIP), tetracycline (TC), and oxytetracycline (OTC) in broiler chicken in the raw, frozen, and boiled stages using solid-phase extraction, high-performance liquid chromatography, and ultraviolet detection (SPE-HPLC-UV).Materials and methodsChromatographic separation was achieved using 0.3% metaphosphoric acid and acetonitrile (1:10, v/v) for CIP at 280 nm and oxalic acid (0.01 M) and acetonitrile (1:1, v/v) for TC and OTC at 355 nm with different retention times. The method had an acceptable precision with good linearity, specificity, limit of detection, limit of quantification, accuracy, and stability.ResultsAmong a total of 252 raw samples, approximately 68.25%, 25.4%, and 7.54% contained CIP, TC, and OTC, respectively. Out of the positive raw samples, CIP exceeded the maximum residual limit (MRL) in 3.6% muscle, 14.3% liver and 17.9% skin samples, whereas TC and OTC were below the MRLs. The residual concentrations of these antibiotics were almost unchanged in frozen samples. After boiling the chicken samples, the TC and OTC residues were reduced significantly compared to CIP. Although the concentrations of CIP in boiled samples were above the MRL set by the European Union, these did not exceed the hazard index 1.ConclusionBased on these results, the exposure levels to antibiotics in broiler chicken meats may be considered to have a low risk for human health.

Background: Brain metastases (BMs) in patients with extra-pulmonary neuroendocrine neoplasms (EP–NENs) are rare, and limited clinical information is available. The aim of this study was to detail the clinicopathological features, management and outcomes in patients with EP–NENs who developed BMs. Methods: A retrospective single-centre analysis of consecutive patients with EP–NENs (August 2004–February 2020) was conducted. Median overall survival (OS)/survival from BMs diagnosis was estimated (Kaplan–Meier). Results: Of 730 patients, 17 (1.9%) had BMs, median age 61 years (range 15–77); 8 (53%) male, unknown primary NEN site: 40%. Patients with BMs had grade 3 (G3) EP–NENs 11 (73%), G2: 3 (20%), G1: 1 (7%). Eight (53%) had poorly differentiated NENs, 6 were well-differentiated and 1 was not recorded. Additionally, 2 (13%) patients had synchronous BMs at diagnosis, whilst 13 (87%) developed BMs metachronously. The relative risk of developing BMs was 7.48 in patients with G3 disease vs. G1 + G2 disease (p = 0.0001). Median time to the development of BMs after NEN diagnosis: 15.9 months (range 2.5–139.5). Five patients had a solitary BM, 12 had multiple BMs. Treatment of BMs were surgery (n = 3); radiotherapy (n = 5); 4: whole brain radiotherapy, 1: conformal radiotherapy (orbit). Nine (53%) had best supportive care. Median OS from NEN diagnosis was 23.6 months [95% CI 15.2–31.3]; median time to death from BMs diagnosis was 3.0 months [95% CI 0.0–8.3]. Conclusion: BMs in patients with EP–NENs are rare and of increased risk in G3 vs. G1 + G2 EP–NENs. Survival outcomes are poor, and a greater understanding is needed to improve therapeutic outcomes.

Silver Nanoparticles (Ag-NPs) are progressively exercised as an antimicrobial agent among myriad applications. The rapid emergence of microbial resistance to conventional antibiotics by multidrug-resistant pathogens has become a threat to the global health community. Traditionally used herbal plants are good sources of bioactive phytochemicals and Galinsoga formosa is one of them. Thus, Ag-NPs are biologically synthesized, intending to evaluate the antibacterial activity of G. formosa. Disc diffusion assay was used to assess the antibacterial activity of leaf and flower crude extracts distinctly as well as of green synthesized Ag-NPs in vitro. The biosynthesis of Ag-NPs was primarily confirmed by brownish color solution and later by UV-Visible spectrophotometer. Ag-NPs synthesized from G. formosa leaf, and flower extract showed antibacterial activity against gram-positive (S. aureus, S. mutans, and S. epidermidis) and gram-negative (K. pneumoniae and P. aeruginosa) bacteria, where gram-negative bacteria were more sensitive than gram-positive bacteria. The highest zone of inhibition was observed against P. aeruginosa (13.33±0.58 mm) by applying Ag-NPs synthesized from G. formosa flower extract. In contrast, the lowest zone of inhibition was observed against S. epidermidis (6.33±0.58 mm). Antibacterial activity of Ag-NPs from flower and leaf extracts was considerably higher as compared to their respective crude extract. Further, Ag-NPs from the flower extract was exhibited more growth inhibitory response than the leaf extract. Hence, the findings of this research suggested that the synthesized Ag-NPs from G. formosa leaf and flower extract were exhibited antibacterial activity. Such synthesized Ag-NPs might help to develop new drug for combating against various diseases. [ J Adv Biotechnol Exp Ther 2021; 4(2.000): 178-186]

The pandemic situation of novel coronavirus disease 2019 (COVID-19) is a global threat on our current planet, with its rapid spread and high mortality rate. Sarcoidosis patients are at high risk to COVID-19 severity for having lung injuries as well as treating with immunosuppressive agents. So, physicians are in dilemma whether they should use immunosuppressive agents or not for the patients with sarcoidosis history and COVID-19 infection. Therefore, common factors should be identified to provide effective treatment. For determining the common genes between COVID-19 and sarcoidosis, GSE164805 and GSE18781 were retrieved from the Gene Expression Omnibus (GEO) database. Common upregulated genes were identified by using R language to investigate their involved pathways and gene ontologies (GO). With the aid of the STRING Cytoscape plugin tool, protein-protein interactions (PPIs) network was constructed. From the PPIs network, Hub genes and essential modules were detected by using Cytohubba, and MCODE respectively. For hub genes, TFs, TFs-miRNA, and drug, interaction networks were built through the NetworkAnalyst web platform. A total of 34 common upregulated genes were identified and among them, five hub genes, including TET2, MUC5AC, VDR, NFE2L2, and BCL6 were determined. In addition, a cluster having VDR and NFE2L2 was detected from the PPIs network. Moreover, 32 transcription factors and 9 miRNA were recognized for hub genes. Furthermore, vitamin D and some of its analogous compounds were obtained from the drug interaction network. In conclusion, hub genes identified in this study might have potential roles in modulating COVID-19 infection and sarcoidosis. However, further studies are required to corroborate this study.

Breast cancer (BC) is considered the second leading cause of cancer-related death in women. Accurate diagnosis is thus of utmost importance to avoid the burden of BC. Ankyrin 2 (ANK2) encodes the structural membrane adapter protein ankyrin-B, which is ubiquitously expressed in the human body. In this study, bioinformatics tools were used to determine whether ANK2 could be used as a diagnostic and prognostic biomarker in BC. ANK2 expression was analyzed using ONCOMINE, UALCAN, GEPIA2, and GENT2. Data from these servers showed the downregulated expression of ANK2 in BC relative to that in normal tissue. Further, downregulated ANK2 expression was found in such conditions as estrogen receptor-negative, human epidermal growth factor receptor 2-positive, positive nodal status, basal-like tumor, and triple-negative breast cancer, according to the data from the bc-GenExMiner v4.5 server. Analysis of 18 BC studies retrieved from the cBioPortal database revealed 88 missense mutations with 0.46%–5.09% copy number alterations in the ANK2 gene sequence. Additionally, a positive correlation between downregulated ANK2 expression and reduced survival probability of BC patients was revealed by a Kaplan–Meier plotter. Moreover, chordin-like 1, a tumor suppressor, was highly co-expressed with ANK2, as shown by the ONCOMINE, UCSC Xena, and GEPIA2 tools. The signaling pathways and gene ontologies of ANK2 and its co-expressed genes were identified using the Enrichr platform. The present results suggest that the ANK2 may serve as a biomarker for diagnosis, prognosis, and therapeutic purposes in BC.

Collagen isolated from the ribbon jellyfish (Chrysaora sp.) was hydrolysed using three different proteases (i.e. trypsin, alcalase and Protamex) to obtain bioactive peptides. Angiotensin-I-converting enzyme (ACE) inhibitory activity and antioxidant activities (i.e. ferric reducing antioxidant power (FRAP) and 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity) of the peptides were measured and compared, and the effect of the duration of hydrolysis on the bioactivity (ACE inhibitory and antioxidant activities) of peptides was also evaluated. FRAP activity was the highest in Protamex-induced (25–27mM) and trypsin-induced hydrolysates (24–26 mM) at 7 and 9 h, respectively. Conversely, hydrolysates produced by trypsin for 1 and 3 h showed the highest DPPH radical scavenging activities (94 and 92 %, respectively). Trypsin-induced hydrolysates (at 3 h) also showed the highest ACE inhibitory activity (89 %). The peptide sequences with the highest activities were identified using tandem mass spectrometry, and the results show that the hydrolysates had a high content of hydrophobic amino acids as well as unique amino acid sequences, which likely contribute to their biological activities.