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Objectives: This study aimed to investigate the protective activity of brown seaweed, the ethanolic and water extracts of Sargassum binderi (S. binderi) were examined. Anticancer drug, cisplatin is normally used for the treatment of solid tumors that cause acute kidney damage after assemblage in the renal tubules., Material and Methods: It was an acute nephrotoxicity study, animals were divided into several groups randomly, cisplatin (7mg/kg i.p.) and normal saline were used as positive and negative control respectively. The S. bindari ethanolic and water extract were given orally in a dose of 200mg/kg for 5days. Various biomarkers were assessed to observe the nephroprotective potential, while antioxidant activities were investigated using reduced glutathione, catalase and malondialdehyde as oxidative stress. GCMS was performed to validate the presence of important therapeutic moieties., Results: The current result justified that pretreatment with S. binderi inhibited the elevation of antioxidant parameters and also showed protection against lipid peroxidation, induced by cisplatin challenge. The overall impact was the nephroprotection, which has been revealed from the results. GCMS evaluation of hexanes fraction revealed the presence of therapeutically important compounds including heptasiloxane, 3,7,11,15-tetramethyl-2-hexadecen-1-ol, hexadecamethyl, cyclooctasiloxane, and hexadecamethyl. These compounds have been reported for their antioxidant, antibacterial, anticancer, and antifungal activities., Conclusion: S. binderi showed reno-protective effect by checking their well-known biochemical parameters probably due to the antioxidant activity as confirmed by the presence of compounds., (Copyright © 2024 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.)

We present a case of a three-month-old Hispanic female seen in the clinic for atopic dermatitis (AD) along with a rare incidence of associated cephalocervical lymphadenitis. The patient had a three-month history of redness, irritation, inflammation, and pruritus of the scalp, face, torso, and lymph nodes. The history and examination originally indicated seborrheic dermatitis with AD, impetigo, and folliculitis on the differential. Due to the rarity of this presentation, it is crucial to increase clinical recognition and awareness of this combination among physicians to improve patient outcomes. Recognizing this unusual presentation can lead to more accurate diagnoses and tailored treatment plans, ultimately benefiting the patient while also advancing our understanding of similar cases., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Sohail et al.)

The application of artificial intelligence (AI) in education and clinical medicine has shown tremendous growth. The primary explanation for this application is AI's ability to integrate efficient and tailored methods for screening, using diagnostics, and enhancement of patient and medical education. AI's wide scope of utility can be seen through its ability to improve efficiency in clinical settings through scheduling, charting, diagnostics, and screening tools, ultimately allowing physicians to spend more focused time on patient care. AI has also had a tangible impact on promoting patient education through its ability to provide patients with preliminary information regarding their diagnoses before followup and to further discussion with their physician. AI's application in medical education is promising due to its ability to provide immediate and interactive feedback to the learner, which allows for meaningful reinforcement of knowledge. AI can therefore be recognized as a tool that can provide incredible enhancement in the areas of clinical medicine and education, with meaningful opportunities for integration and application., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2024. Published by Elsevier Inc.)

Same day cancellations of surgery have adverse effects on both patients and health care systems. To date, the majority of research has evaluated reasons for same day cancellation, and relatively little is known about risk factors for cancellation. The aim of this study is to develop and evaluate the accuracy of a model for preoperatively predicting which patients are at risk for experiencing same day cancellation. While accurately predicting which patients are likely to experience same day cancellation remains challenging, predictive models may aid in the early identification of patients at risk for cancellation. Future studies are required to assess whether the use of predictive analytics leads to reduced cancellation rates in practice.

Background: Urolithiasis is one of the most prevalent urological diseases and is associated with a substantial economic burden. Its prevalence varies according to geographical location. Qatar is a Middle Eastern country located in the Afro-Asian Stone Belt. It has a dry and hot climate, which may predispose individuals working in these environments to form kidney stones (KSs)., Methods: A population sample of 4204 patients was categorized into five occupational classes. The frequencies and correlations of these occupations with KS formation were calculated., Results: Among the total cases, 2000 presented with KSs, with the majority being of Asian descent (49%), followed by individuals of Middle Eastern descent (35.1%). Technicians accounted for 35.15% of KS cases followed by clerks (29.2%) and executives (14.6%). Among KS cases, 44% had a single stone, 30% had multiple stones, and 26% had two stones. In comparing both KS and non-KS groups, age, gender, occupation, and race were significantly associated with KS formation (p<0.05), while BMI did not show any significant correlation (p>0.05). Asian males aged 31-40, working as technicians, were significantly more prone to urolithiasis. In comparing age, BMI, and gender with stone characteristics, only age was found significantly associated with stone size (p<0.05). Occupation showed an impact on all studied stone characteristics. Clerks and technicians presented more frequently with stones within the 11-15 mm range, while executives more frequently presented with smaller stones (p<0.001). Stone density was more frequently <500 HU in workers, technicians and housewives and >500 HU in executives and clerks (p<0.001)., Conclusions: Our findings revealed an elevated risk of urolithiasis among certain occupational groups, particularly technicians, who frequently work outdoors in high-temperature environments. Alternatively, the sedentary nature of clerical and executive positions can also contribute to the risk of urolithiasis.

Acetaminophen (AAP) is an analgesic-antipyretic drug which is considered safe at recommended dose, but its overuse may induce renal and hepatic injuries. Marine macro algae have great potential against drug-induced renal and hepatic dysfunctions. The present study described the reno-protective and hepato-protective effects of the ethanol extract of an edible green alga Ulva fasciata and its fractions (n-hexane, chloroform and methanol) against AAP toxicity. In the 1 st set of experiment, rats were divided into five groups. Of which two were treatment groups beside three controls, the first treatment group was given ethanol extract of U. fasciata alone and the second group was given the same extract with AAP. In the 2 nd set of experiment, rats were divided into nine groups, of which three treatment groups administered n -hexane, chloroform and methanol fractions of ethanol extract of U. fasciata respectively while other three treatment groups received the same fractions individually with AAP. On the 11 th day, rats were decapitated after 12 h of fasting from both sets, blood samples were collected for assessment of biochemical parameters and kidney tissues were used for determination of oxidants and antioxidants. Histopathological assessment was also done in kidney tissues. A single dose of AAP (600 mg/kg) affected kidney markers including creatinine, urea and blood urea nitrogen (BUN) and hepatic enzymes. Ethanolic extract of U. fasciata normalized kidney and liver markers in AAP intoxicated rats. AAP also reduced glutathione (GSH) in kidney tissues and altered kidney architecture, which were improved by ethanolic extract and chloroform soluble fraction of U. fasciata. A total of 14 polyunsaturated fatty acids were identified from chloroform soluble fraction of U. fasciata by GC-MS and assumed these may be involved in protective activities of U. fasciata .

Introduction: Delirium is associated with a three-fold increase in frequency of 6-mo mortality following intensive care unit admission. Outside of mortality, it has been linked with severe morbidity including long-term cognitive decline, loss of autonomy, and increased risk of institutionalization. There is a paucity of literature regarding delirium and geriatric trauma patients. The aim of our study is to determine predictive factors of delirium in geriatric trauma patients., Methods: This is a retrospective review of all geriatric (>65 y) trauma patients with a documented frailty score at a Level I Trauma Center from 1/2019 to 9/2021. Univariate and multivariate logistic regressions were performed. Geriatric patients with delirium (D) and those without delirium (ND) were compared. Patients were excluded if they did not have a documented frailty score or died before admission., Results: One thousand three hundred and seventeen patients met criteria; 40 (3%) patients developed delirium. Neither age nor gender was different between the two groups. Frailty scores were not different between the two groups. Patients with documented delirium had a higher incidence of a positive drug screen on admission (85% versus 62.2%, P = 0.0034), higher median injury severity score (10 versus 9, P = 0.0088), and longer hospital (7 d versus 3 d, P < 0.001) and intensive care unit (1 d versus 0 d, P < 0.001) length of stay (LOS) than their ND counterparts. The D group had a higher frequency of benzodiazepine (47.5% versus 19.3%, P < 0.001) and narcotic use (77.5% versus 56.5%, P = 0.0085). Tethers nor bedrest orders were significantly associated with delirium. Incidence of urinary tract infection (12.5% versus 1%, P < 0.001) and restraint use (P < 0.001) were significantly associated with increased risk of delirium. Additionally, those with a diagnosis of delirium were more often discharged to a skilled nursing facility than those in the ND group (45% versus 30.8%, P = 0.0006)., Conclusions: We aimed to identify key predictive factors of delirium in our study population and found that certain factors correlated with higher frequencies of delirium in our geriatric trauma patients. Preadmission and early controlled substance use were significantly associated with delirium, as were the presence of urinary tract infection and extended intensive care unit LOS. By recognizing some of these modifiable factors, LOS may decrease while increasing the likelihood of discharge home., (Copyright © 2023 Elsevier Inc. All rights reserved.)

There are recent reports that Ramadan fasting (RF) results in weight gain instead of weight loss. In addition, the data on the efficacy of brief nutrition education on healthy eating practices in Ramadan for better health are scarce. Therefore, a study was conducted to investigate the effects of brief nutrition education before the start of RF on healthy eating practices during RF. For this purpose, a prospective observational study focused on "Dietary Education and Awareness for Ramadan (DEAR)" as an intervention was carried out. The participants ( n  = 74) were recruited and divided into two groups, i.e., intervention and control groups ( n  = 37 each). As an intervention, nutrition education lessons were given before and during RF month. The control group did not attend these nutrition education lessons. Data on anthropometrics, dietary intake, and other parameters were collected at three time points: before, in the end, and 4 weeks after RF. Weight was measured in kg; height, waist circumference (WC), and hip circumference (HC) were measured in cm; and body mass index (BMI) was calculated. Waist-to-hip ratio (WHR) was calculated by dividing the waist value by the hip value. Body composition analysis was performed by the body composition analyzer (BF-907). Blood pressure (BP) was measured using a validated automated blood pressure. A 3-5 ml of venous blood was collected, and plasma and serum were separated. Serum and plasma samples were processed for general blood chemistry (blood lipid profile, glucose, and CRP) within 2 h. CRP was determined by the immunoturbidimetry method using an auto-analyzer. An enzyme-linked immunosorbent assay (ELISA) was used to determine cytokine/chemokines. Adherence to nutrition education (intervention) was assessed. The results show that nutrition education has positive effects on overall nutrition. Significant improvement in dietary adherence to dietary advice in the intervention group was noted. Significant BW loss (mean loss: 1.21 kg) in the intervention group was observed. The majority (63.3%) had lost BW ≥ 1.0 kg. Other changes observed as a result of the intervention included improvements in blood glucose, cholesterol, CRP levels, and systolic and diastolic BP. There was a notable shift in pro- and anti-inflammatory cytokine concentrations: IL-7, IL-4, and TGF-α decreased, while IL-2, TNF-α and resistin, IL-1 RA, IL-17 A, and sCD40 increased. In conclusion, RF resulted in a loss in mean BW and an improvement in related blood chemistry and cytokine profiles. Furthermore, nutrition education before RF resulted in better nutrition practices during RF and a desirable healthy BW, blood lipid, and cytokine profiles., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Gul, Khan, Alam, Almajwal, Hussain, Sohail, Hussain, Cena, Shafiq and Aftab.)

Metacells are cell groupings derived from single-cell sequencing data that represent highly granular, distinct cell states. Here we present single-cell aggregation of cell states (SEACells), an algorithm for identifying metacells that overcome the sparsity of single-cell data while retaining heterogeneity obscured by traditional cell clustering. SEACells outperforms existing algorithms in identifying comprehensive, compact and well-separated metacells in both RNA and assay for transposase-accessible chromatin (ATAC) modalities across datasets with discrete cell types and continuous trajectories. We demonstrate the use of SEACells to improve gene-peak associations, compute ATAC gene scores and infer the activities of critical regulators during differentiation. Metacell-level analysis scales to large datasets and is particularly well suited for patient cohorts, where per-patient aggregation provides more robust units for data integration. We use our metacells to reveal expression dynamics and gradual reconfiguration of the chromatin landscape during hematopoietic differentiation and to uniquely identify CD4 T cell differentiation and activation states associated with disease onset and severity in a Coronavirus Disease 2019 (COVID-19) patient cohort., (© 2023. The Author(s).)

Sacubitril/valsartan is a drug commonly prescribed for the management of hypertension. However, the complete understanding of its efficacy and safety as an antihypertensive agent remains a subject of ongoing investigation. To address this gap, a meta-analysis was conducted to assess and compare the efficacy and safety of sacubitril/valsartan in relation to olmesartan, an angiotensin receptor blocker (ARB). A thorough search of PubMed, Google Scholar, and Cochrane databases was performed to identify relevant randomized controlled trials (RCTs) and observational studies that could contribute to this meta-analysis. The selected studies were evaluated for their efficacy and safety parameters, including mean sitting and ambulatory blood pressure measurements, common side effects, adverse events, and drug discontinuation rates. A total of eight studies, involving 4488 hypertensive patients, were included in this analysis. Among the participants, 63.5% were administered sacubitril/valsartan, while 36.5% received olmesartan. The analysis revealed significant changes in mean sitting systolic blood pressure (MsSBP), mean sitting diastolic blood pressure (MsDBP), and mean sitting pulse pressure (MsPP) favoring sacubitril/valsartan, with p-values <0.00001, 0.07, and <0.00001, respectively. Additionally, sacubitril/valsartan demonstrated a significant reduction in mean ambulatory systolic blood pressure (MaSBP), mean ambulatory diastolic blood pressure (MaDBP), and mean ambulatory pulse pressure (MaPP) with p-values of 0.001, 0.001, and 0.02, respectively. However, it is important to note that safety outcomes indicated that sacubitril/valsartan was associated with slightly less favorable results compared to olmesartan. This meta-analysis highlights that sacubitril/valsartan exhibits superior efficacy in reducing blood pressure parameters compared to olmesartan in hypertensive patients. Nevertheless, its safety profile appears to be slightly less favorable. To reinforce these findings and provide more robust evidence, further studies with larger sample sizes should be conducted in the future. This comprehensive review serves as a valuable resource for healthcare professionals and researchers seeking to make informed decisions regarding antihypertensive treatment options., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Raja et al.)

Background: The role of sexual intercourse as an alternative treatment approach for ureteral stones (UTSs) is a recent area of investigation with only small sample-sized studies. This study aims to evaluate the role of sexual intercourse in the spontaneous passage of distal or intramural UTSs via a larger sample size., Materials and Methods: The study population included cases that had either a distal ureteric or an intramural radiopaque stone. The patients were divided into two groups; group A was instructed to engage in sexual intercourse two to three times per week while also receiving symptomatic treatment for 4 weeks. Group B received symptomatic treatment alone and was instructed to abstain from sexual intercourse or masturbation for the same period., Results: A total of 160 male patients were enrolled in this study. The ages of the patients ranged from 21 to 58 years. The rate of stone expulsion after 2 weeks was 68.18% in group A and 53% in group B ( P =0.053). The expulsion rate after 4 weeks was 80% in group A and 68.4% in group B ( P =0.072). The mean expulsion time was 13.9±5.4 days for the experimental group and 15.2±6.7 days for the control group ( P =0.179). The experimental group required fewer analgesic injections in comparison to the control group ( P <0.05)., Conclusion: While the role of sexual intercourse in facilitating the passage of distal or intramural UTSs cannot be fully established, it may aid to some extent. However, it should not be relied upon as a standalone treatment modality., Competing Interests: There are no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

The membrane bioreactor (MBR) is an efficient technology for the treatment of municipal and industrial wastewater for the last two decades. It is a single stage process with smaller footprints and a higher removal efficiency of organic compounds compared with the conventional activated sludge process. However, the major drawback of the MBR is membrane biofouling which decreases the life span of the membrane and automatically increases the operational cost. This review is exploring different anti-biofouling techniques of the state-of-the-art, i.e., quorum quenching (QQ) and model-based approaches. The former is a relatively recent strategy used to mitigate biofouling. It disrupts the cell-to-cell communication of bacteria responsible for biofouling in the sludge. For example, the two strains of bacteria Rhodococcus sp. BH4 and Pseudomonas putida are very effective in the disruption of quorum sensing (QS). Thus, they are recognized as useful QQ bacteria. Furthermore, the model-based anti-fouling strategies are also very promising in preventing biofouling at very early stages of initialization. Nevertheless, biofouling is an extremely complex phenomenon and the influence of various parameters whether physical or biological on its development is not completely understood. Advancing digital technologies, combined with novel Big Data analytics and optimization techniques offer great opportunities for creating intelligent systems that can effectively address the challenges of MBR biofouling.

Endophytic fungi live inside plant tissues but do not cause any disease. Several reports have now revealed that they have great influence on host. In this study, the beneficial role of endophytic fungi is highlighted and explored. Endophytic fungi isolated from healthy plants were identified as Aspergillus terreus, Curvularia lunata, C. hawaiiensis, Macrophomina phaseolina, Fusarium solani, Talaromyces assiutensis, and T. trachyspermus using 18S rRNA gene sequencing. In vitro, fungi evaluated for antimicrobial activity, showed significant activity. These fungi were tested in field application by exploring their broad spectrum. Talaromyces assiutensis and T. trachyspermus were applied in pots and field plot experiments using sunflower as test plants, along with endophytic Cephalosporium sp., and Chaetomium sp. Endophytic fungi showed significant activity against root rot pathogens affecting sunflower and improved plant biomass. They also improved production of plant defense biochemical markers (polyphenolic content and salicylic acid) with improvement in antioxidant potential. These fungi are used as biological control agents, so their culture filtrates are used to check the presence of metabolites by GC-MS. Several new compounds were isolated from T. assiutensis. The major bioactive compounds are Coumarin, 3,4-dihydro-6-methoxy-4,4-dimethyl, 1-Monolinoleoylglycerol trimethylsilyl ether, 1,2-Propanediol, 3-(octadecyloxy), Ethyl iso-allocholate, and 1H-Pyrazole, which possess antioxidant, antitumor, antibacterial, anticancer, and antimicrobial properties. These findings will lead to further in-depth research toward the potential use of these endophytic fungi for their possible use in agriculture and drug formation., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The most prominent homozygous deletions in cancer affect chromosome 9p21.3 and eliminate CDKN2A/B tumor suppressors, disabling a cell-intrinsic barrier to tumorigenesis. Half of 9p21.3 deletions, however, also encompass a type I interferon (IFN) gene cluster; the consequences of this co-deletion remain unexplored. To functionally dissect 9p21.3 and other large genomic deletions, we developed a flexible deletion engineering strategy, MACHETE (molecular alteration of chromosomes with engineered tandem elements). Applying MACHETE to a syngeneic mouse model of pancreatic cancer, we found that co-deletion of the IFN cluster promoted immune evasion, metastasis and immunotherapy resistance. Mechanistically, IFN co-deletion disrupted type I IFN signaling in the tumor microenvironment, leading to marked changes in infiltrating immune cells and escape from CD8 +  T-cell surveillance, effects largely driven by the poorly understood interferon epsilon. These results reveal a chromosomal deletion that disables both cell-intrinsic and cell-extrinsic tumor suppression and provide a framework for interrogating large deletions in cancer and beyond., (© 2022. The Author(s).)

Background: Given their mostly rural/suburban locations, level II trauma centers (TCs) may offer greater exposure to and experience in managing geriatric trauma patients. We hypothesized that geriatric patients would have improved outcomes at level II TCs compared to level I TCs., Methods: The Pennsylvania Trauma Outcome Study (PTOS) database was retrospectively queried from 2003 to 2017 for geriatric (age ≥65 years) trauma patients admitted to level I and II TCs in Pennsylvania. Patient demographics, injury severity, and clinical outcomes were compared to assess differences in care between level I and II TCs. A multivariate logistic regression model assessed the adjusted impact of care at level I vs II TCs on mortality, complications, and functional status at discharge (FSD). The National Trauma Data Bank (NTDB) was retrospectively queried for geriatric (age ≥65 years) trauma admissions to state-accredited level I or level II TCs in 2013., Results: 112 648 patients met inclusion criteria. The proportion of geriatric trauma patients across level I and level II TCs were determined to be 29.1% and 36.2% ( P <.001), respectively. In adjusted analysis, there was no difference in mortality (adjusted odds ratio [AOR]: 1.13; P = .375), complications (AOR: 1.25; P = .080) or FSD (AOR: 1.09; P = .493) when comparing level I to level II TCs. Adjusted analysis from the NTDB (n = 144 622) also found that mortality was not associated with TC level (AOR: 1.04; P = .182)., Discussion: Level I and level II TCs had similar rates of mortality, complications, and functional outcomes despite a higher proportion (but lower absolute number) of geriatric patients being admitted to level II TCs. Future consideration for location of centers of excellence in geriatric trauma should include both level I and II TCs.

Aims: The efficacy of three isolates of endophytic Penicillium species that have shown significant suppressive effect on root rotting fungi in our previous study were further evaluated in pots and field plot experiments for their effect on root diseases of okra, induction of systemic resistance and physiochemical properties of okra fruit., Methods and Results: Aqueous suspensions of endophytic Penicillium and Pseudomonas monteilii were applied in pots and field plots using okra as test plant. Data on the fungal infection of roots, plant growth, plant resistance markers like polyphenol, salicylic acid and antioxidant status of plant were determined. These isolates significantly suppressed root diseases and induced systemic resistance via increasing level of resistance markers, polyphenol and salicylic acid besides improving antioxidant activity of Penicillium and P. monteilii-treated plants as compared to control plants. GC-MS analysis of n-hexane extract of mycelium of P. nigricans revealed the presence of 15 different volatile compounds., Conclusions: Endophytic Penicillium and P. monteilii have potential against root-infecting fungi of okra and can improve plant growth and yield., Significance and Impact of the Study: Endophytic Penicillium species and P. monteilii can suppress root rotting fungi by direct mechanism or induction of systemic resistance in plants., (© 2020 The Society for Applied Microbiology.)

Cisplatin is widely used in anticancer therapy, but a substantial percentage of patients who receive the therapeutic dose of cisplatin develop nephrotoxicity. Hepatotoxicity may also develop after a single dose or low repeated doses of cisplatin. Ulva fasciata is an edible seaweed, commonly known as sea lettuces have also been shown various biological activities. In this study, ethanol extract and its solvent fractions (n-hexane and chloroform) of U. fasciata were given (orally) to different groups of rats for 10 days. Injury to the kidney was induced by administrating cisplatin, intraperitoneally (i.p.) to rats at a dose of 7 mg/kg body weight (b.w.) dissolved in 1 mL saline, at 5th day of the experiment. At 10th day rats were sacrificed and kidney parameters (creatinine, urea, and blood urea nitrogen (BUN)) and electrolyte balance (Ca ++ , Mg ++ , K+, and Na + ) in serum were determined, while oxidative stress markers glutathione (GSH), catalase (CAT) and malondialdehyde (MDA), and inflammatory cytokines, tumor necrosis factor (TNF α), and interleukin (IL-6) were determined in kidney tissues. Histological examination of the kidney was also performed to examine the changes in kidney tissues. Cisplatin caused adverse effects on blood parameters, antioxidants, and inflammatory markers with severe renal tubular injury in kidney tissues. Ethanol extract of U. fasciata and its fractions effectively improved these disorders and diminished the renal dysfunction. However, ethanol extract was found more effective in attenuating the adverse effect of cisplatin than its fractions. n-Hexane-soluble fraction that was subjected to GC-FID and GC-MS analysis revealed the presence of several compounds and some of them are new from this source. It could be concluded that the U. fasciata possesses nephroprotective effect and can attenuate cisplatin-induced renal dysfunction. Since U. fasciata is an edible seaweed, it may be used as a diet supplement.

This study critically reviews the recent developments and future opportunities pertinent to the conversion of CO 2 as a potent greenhouse gas (GHG) to fuels and valuable products. CO 2 emissions have reached an alarming level of around 410 ppm and have become the primary driver of global warming and climate change leading to devastating events such as droughts, hurricanes, torrential rains, floods, tornados and wildfires across the world. These events are responsible for thousands of deaths and have adversely affected the economic development of many countries, loss of billions of dollars, across the globe. One of the promising choices to tackle this issue is carbon sequestration by pre- and post-combustion processes and oxyfuel combustion. The captured CO 2 can be converted into fuels and valuable products, including methanol, dimethyl ether (DME), and methane (CH 4 ). The efficient use of the sequestered CO 2 for the desalinization might be critical in overcoming water scarcity and energy issues in developing countries. Using the sequestered CO 2 to produce algae in combination with wastewater, and producing biofuels is among the promising strategies. Many methods, like direct combustion, fermentation, transesterification, pyrolysis, anaerobic digestion (AD), and gasification, can be used for the conversion of algae into biofuel. Direct air capturing (DAC) is another productive technique for absorbing CO 2 from the atmosphere and converting it into various useful energy resources like CH 4 . These methods can effectively tackle the issues of climate change, water security, and energy crises. However, future research is required to make these conversion methods cost-effective and commercially applicable., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Biofouling is unwanted accumulation of microbial population on the membrane surface which limits the use of membrane bioreactor (MBR) in the market. Disruption of the biofilm formation by Quorum Quenching (QQ) by using cell entrapping beads (CEBs) is an approach with great potential to control membrane biofouling as the beads used provide not only mitigating effect on biofilm formation, by interfering Quorum Sensing, but also physical forces to detach the biofilm from the membrane surface. This research aimed to develop QQ-CEB with locally available chemicals in Pakistan and its application to evaluate the QQ effect together with physical and chemical cleaning. Various CEBs were made of different mixtures of sodium alginate and polyvinyl alcohol (PVA) and their quality was tested considering physical and biological aspects. Rhodococcus sp. BH4 and Pseudomonas putida were entrapped in the CEBs and then introduced in MBR as one of biofouling control methods along with standard backwash and chemical backwash. The CEBs made of specific concentration of PVA were proven to be more durable and helpful in mitigating biofouling as compared to that of sodium alginate. An MBR operated with PVA-alginate QQ CEBs together with chemical backwash showed the best performance without deterioration of effluent quality.

Solvent fractions (n-hexane, cholorofrom, methanol) and fractions containing sterols of Jolyna laminarioides was evaluated in triton-induced and high-fat-diet induced hyperlipidemic rats. Oral administration of J. laminarioides significantly reduced the elevated level of serum total cholesterol, triglycerides and LDL-c, both in triton induced and high fat diet induced hyperlipidemic rat models with increased serum HDL-c. Chloroform: methanol fraction (2:1) and n-hexane fraction containing sterol showed promising results in reducing LDL-c. The methanol fraction showed hypolipidemic effect by increasing HDL-c (90%). The extracts and fractions of the seaweed also decreased the increased level of cardiac and hepatic marker enzymes beside lowering lipid profile. J. laminarioides exhibited high anti-hyperlipidemic effects both in triton induced and high fat diet induced hyperlipidemic rats.

Alchemical free energy calculations have made a dramatic impact upon the field of structure-based drug design by allowing functional group modifications to be explored computationally prior to experimental synthesis and assay evaluation, thereby informing and directing synthetic strategies. In furthering the advancement of this area, a series of 21 β-secretase 1 (BACE1) inhibitors developed by Janssen Pharmaceuticals were examined to evaluate the ability to explore large substituent perturbations, some of which contain scaffold modifications, with multisite λ-dynamics (MSλD), an innovative alchemical free energy framework. Our findings indicate that MSλD is able to efficiently explore all structurally diverse ligand end-states simultaneously within a single MD simulation with a high degree of precision and with reduced computational costs compared to the widely used approach TI/MBAR. Furthermore, computational predictions were shown to be accurate to within 0.5-0.8 kcal/mol when CM1A partial atomic charges were combined with CHARMM or OPLS-AA-based force fields, demonstrating that MSλD is force field independent and a viable alternative to FEP or TI approaches for drug design.

Cisplatin is considered one of the best anticancer medications often used for the treatment of various cancers even with its adverse effects. Acetaminophen (paracetamol) is a widely used analgesic-antipyretic drug that causes hepatotoxicity at higher than the effective doses. The present study assesses the nephroprotective and hepatoprotective effects of two seaweeds against cisplatin and acetaminophen toxicity in rats. Damage to the liver and kidney was induced by administering a single intraperitoneal dose of acetaminophen (600 mg/kg) or cisplatin (7 mg/kg) to groups of rats. The damage to the liver and kidney was assessed by the elevated liver (ALT, AST, ALP, LDH, electrolytes) and kidney (urea, creatinine) biomarkers. The ethanol extract of brown seaweed reversed the elevated levels of kidney and liver biomarkers along with triglycerides, cholesterol, and glucose. Among the two seaweeds, Sargassum ilicifolium showed better nephroprotective and hepatoprotective effects than the standard drug N-Acetyl-cysteine, Halymenia porphyroides showed only limited protection. Findings of this study provide evidence of nephroprotective and hepatoprotective effects of S. ilicifolium. Seaweed could be a beneficial dietary supplement to attenuate nephrotoxicity and hepatotoxicity.

Background: Renal stone disease is a very common medical problem in general population. As with invent of newer therapeutic modalities, ESWL is already losing its popularity. But we believe it as an effective way of treating renal stones. This study was conducted to evaluate any improvement in success rate of ESWL therapy for treating renal stones with latest shockwave lithotripsy machines., Methods: Study conducted from June 2016 until November 2017 in Alkhor hospital, Hamad Medical Corporation, Qatar. All patients undergoing ESWL for renal stones in mentioned period were included. Total 197 patients underwent ESWL using newer machines. Factors already studied to affect the success rate like stone size, location, consistency (measured by Hounsfield units on CT), presence of stent were taken in consideration. After a period of 3 months either complete stone clearance or stone fragments smaller than 4 mm were considered as a treatment success. These results were compared to the results from literature., Results: Patients were followed until 3 months after treatment. 170 patients (86.29%) had complete stone clearance. Eleven patients (5.58%) had residual stone less than 4 mm, thus achieving an overall success of 181 patients (91.88%). 42 patients (21.32%) needed repeat session of ESWL with a maximum number of 3 sessions. 16 patient's (8.12%) required auxiliary procedures like flexible ureteroscopy. Post-ESWL complications were recorded in 12 patients (6.09%). Success rate was affected mainly by stone size with negligible effect of stone location. Presence of stent affected the number of sessions but has no impact on stone clearance.., Conclusions: Although the stone size and to a negligible extent, the stone location and presence of stent may affect the stone clearance, nevertheless a significant improvement in success rate has been observed by use of new shockwave lithotripsy machines.

Little is known about the spectrum of mitochondrial DNA (mtDNA) mutations across pediatric malignancies. In this study, we analyzed matched tumor and normal whole genome sequencing data from 616 pediatric patients with hematopoietic malignancies, solid tumors, and brain tumors. We identified 391 mtDNA mutations in 284 tumors including 45 loss-of-function mutations, which clustered at four statistically significant hotspots in MT-COX3 , MT-ND4 , and MT-ND5 , and at a mutation hotspot in MT-tRNA-MET . A skewed ratio (4.83) of nonsynonymous versus synonymous (dN/dS) mtDNA mutations with high statistical significance was identified on the basis of Monte Carlo simulations in the tumors. In comparison, opposite ratios of 0.44 and 0.93 were observed in 616 matched normal tissues and in 249 blood samples from children without cancer, respectively. mtDNA mutations varied by cancer type and mtDNA haplogroup. Collectively, these results suggest that deleterious mtDNA mutations play a role in the development and progression of pediatric cancers. SIGNIFICANCE: This pan-cancer mtDNA study establishes the landscape of germline and tumor mtDNA mutations and identifies hotspots of tumor mtDNA mutations to pinpoint key mitochondrial functions in pediatric malignancies., (©2019 American Association for Cancer Research.)

The quest for a sustainable environment and combating global warming, carbon capture, and storage (CCS) has become the primary resort. A complete shift from non-renewable resources to renewable resources is currently impossible due to its major share in energy generation; making CCS an imperative need of the time. This study, therefore, aims to examine the reckoning of carbon dioxide (CO 2 ), measurement methods, and its efficient capture and storage technologies with an ambition to combat global warming and achieve environmental sustainability. Conventionally, physical, geological and biological proxies are used to measure CO 2 . The recent methods for CO 2 analyses are spectrometry, electrochemical gas sensors, and gas chromatography. Various procedures such as pre, post, and oxyfuel combustion, and use of algae, biochar, and charcoal are the promising ways for CO 2 sequestration. However, the efficient implementation of CCS lies in the application of nanotechnology that, in the future, could provide a better condition for the environment and economic outlooks. The captured carbon can be stored in the earth crust for trillions of years, but its leakage during storage can raise many issues including its emissions in the atmosphere and soil acidification. Therefore, global and collective efforts are required to explore, optimize and implement new techniques for CCS to achieve high environmental sustainability and combat the issues of global warming., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Patent ductus arteriosus (PDA) usually presents during childhood, less frequently in adolescence, and rarely in late adulthood. The usual mode of presentation is left ventricular failure and respiratory symptoms. Here is a case of a female with patent ductus arteriosus, who was apparently in quite good state of health and gave birth to six offsprings without herself having any problem. At the age of 40, she presented with infected vegetations at the site of PDA, causing fever and clinical signs of PDA, confirmed by echocardiography.

Background: Endoscopic sutured gastroplasty (ESG) has evolved over time. With the advent of full-thickness endoscopic suturing, an efficient technique for ESG was developed and refined., Methods: This prospective first-in-man trial started in April 2012 and represents the first use of full-thickness endoscopic suturing for primary obesity therapy. The trial focused on procedure development, reproducibility, safety, and short-term efficacy. The trial was performed at centers in five countries, in three phases. Phase I was evaluation of safety and technical feasibility of various procedure techniques; stitch patterns and sequences were assessed for efficiency, safety, and feasibility. Phase II entailed continued procedure refinement to establish a standardized technique. Phase III entailed evaluation of technical feasibility and weight loss outcomes in 77 patients; the procedure was performed using the standardized technique, and there was no procedure development. Data were prospectively collected into a registry., Results: In Phase I, the procedure was created and modified to improve time efficiency. Safety and technical feasibility were established, and short-term weight loss was demonstrated. In Phase II, a number of stitch patterns were attempted, and the stitch pattern was modified and finalized. 22 patients were included, and 1-year total weight loss was 17.3 ± 2.6%. In Phase III, conformity with the final technique was high. 77 patients were included, with a mean BMI of 36.1 ± 0.6 kg/m 2 . Mean weight loss was 16.0 ± 0.8% at 6 months and 17.4 ± 1.2% at 12 months (n = 44). Postprocedural nausea, vomiting, and epigastric pain were frequently reported; there were no reported significant adverse events post-procedure or during the follow-up period., Conclusions: Following a methodical procedure development phase, ESG demonstrated safety and short-term efficacy in this trial. The procedure also achieved meaningful weight loss during the follow-up period.

Objectives: To assess the outcomes of performing percutaneous nephrolithotomy (PCNL) in a modified supine position, more feasible for surgeons, anaesthetists, and operating theatre staff, as well as for the patient himself, and evaluating it in comparison to the standard prone position., Patient and Methods: A retrospective, case-control study was conducted between January 2011 and December 2015. In all, 197 patient's records were reviewed. The initial 101 patients were operated upon in prone position. From mid-2013, 96 patients were operated upon in a complete supine, flank-free position. The groups were compared in terms of operation time, calculated from positioning the patient after anaesthesia induction, insertion of ureteric catheter, puncture of renal system, until the end of procedure; stone-free rate; hospital stay; and postoperative complications, such as transfusion rate, fever, and urinary leakage., Results: There were two significant differences between the groups. Firstly, the operation time was a mean (SD) 32.3 (6.6) min shorter for the supine versus the prone position ( P  < 0.001). Secondly, hospital stay was a mean (SD) 1.2 (0.75) days shorter for the supine vs the prone position ( P  < 0.001). The complete stone clearance rate (85.4% for supine vs 79.2% for prone; P  = 0.2) and postoperative complications (7.3% for supine vs 17.8% for prone; P  = 0.02) were comparable in both groups., Conclusion: Supine PCNL is a feasible procedure with similar outcomes in terms of stone-free rate as well as postoperative complications, to the standard prone PCNL. It reduces unnecessary delay that occurs during change of position resulting in significant shortening of the total operation time and surgeons can perform supine PCNL whilst sitting.

Objective: To determine the relationship of stress and academic performance in first year medical students and to identify sources of stress, levels of stress and relevant coping strategies., Study Design: Mixed method sequential., Place and Duration of Study: Allama Iqbal Medical College, Lahore, from March to December 2010., Methodology: Survey questionnaire and in-depth interviews were carried out in the first year students with their consent. Two hundred and fifty students were surveyed, out of whom 120 students responded. Twelve students with their consent were interviewed. Non-probability purposive sampling was employed for both types of data collection. SPSS version 20 was used. The qualitative data generated through structured in-depth interviews, were analyzed by content analysis., Results: Low level of stress was found in 7.5% (score ‹150), moderate level of stress was present in 71.67% (score between 150 and 300), and high level of stress was observed in 20.83% (score ›300) of the students. There is moderate negative (-0.583) and significant (p < 0.01) correlation between academic performance and sources of stress. Similarly there is moderate negative (-0.478) and significant (p < 0.01) correlation between academic performance and levels of stress. There was strong positive (0.799) and significant (p < 0.01), correlation between stress level and number of stress sources., Conclusion: The study showed a diversity of stress sources and a high level of stress in the medical students. The results also show that higher level of stress is associated with poor academic performance.

Background: Plastic stents are routinely placed in the pancreaticobiliary system to facilitate drainage. A second endoscopy is often required for stent removal. We have developed magnetic pancreaticobiliary stents that can be removed by using an external hand-held magnet, thereby obviating the need for a second endoscopy., Objective: To develop and test magnetic pancreaticobiliary stents and retrieval system in ex-vivo and in-vivo porcine models., Setting: Animal laboratory., Design: Benchtop and animal study., Animals: 5 pigs., Interventions: Design: Computer simulations determined both the optimal design of cylindrical magnets attached to the distal aspect of existing plastic stents and the optimal design of the external hand-held magnet. Benchtop ex-vivo experiments measured magnetic force to validate the design. In-vivo analysis: In 5 Yorkshire pigs, magnetic stents were deployed into the common bile duct by using a conventional duodenoscope. An external hand-held magnet was applied for stent removal. Stent insertion and removal times were recorded., Main Outcome Measurements: Technical feasibility., Results: Magnetic stents of varying lengths and calibers were successfully created. In ex-vivo testing, the capture distance was 10.0 cm. During in-vivo testing, the magnetic stents were inserted and removed easily. The mean insertion and removal times were 3.2 minutes and 33 seconds, respectively., Limitations: Animal study, small numbers., Conclusions: Magnetic pancreaticobiliary stents and associated retrieval system were successfully designed and tested in the acute porcine model. An external, noninvasive means of stent removal potentially obviates the need for a second endoscopy, which could represent a major gain both for patients and in health care savings., (Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.)

Although trigger finger is a condition commonly treated by orthopedic surgeons, we have not found sufficient studies in the literature addressing the treatment of trigger finger that persists following A1 pulley release. We identified 12 fingers in 11 patients with symptoms of trigger finger following A1 pulley release who subsequently underwent resection of 1 or both slips of the flexor digitorum superficialis tendon. Ten patients (11 fingers) presented for follow-up at a mean of 21 months after surgery. All patients had resolution of their symptoms with a mean visual analog score of 1.5 and a mean DASH score of 17. Grip and pinch strength were comparable to the contralateral side. Mean total active range of motion of the affected digit was 252°. Resection of 1 or both slips of the flexor digitorum superficialis is an effective method for treatment of recalcitrant trigger finger.

Background: Early recurrent hemorrhage after endoscopic intervention for acute upper GI bleeding (UGIB) can approach 20% and leads to increased morbidity and mortality. Little has changed over the past several decades regarding immediate posthemorrhage surveillance, and there has likewise been no significant improvement in outcomes., Objective: To develop and test an endoscopically implantable wireless biosensor for real-time detection of fluorescein-labeled blood in ex vivo and in vivo porcine models of UGIB., Setting: Animal laboratory., Design: Benchtop and acute animal studies., Subjects: Five pigs., Interventions: UGIB models were surgically created in living pigs. Biosensors were endoscopically deployed in the stomach using standard endoscopic clips. The ability to detect acute UGIB and estimated blood loss leading to biosensor activation were recorded. Feasibility of wireless data transmission out of the body to an external computer and cell phone was assessed., Main Outcome Measurements: Technical feasibility and immediate complications., Results: A porcine UGIB model was successfully created. Biosensors were able to detect all acute bleeding events and wirelessly transmit out of the body, and successfully sent an emergency text message to the intended cell phone in all cases. Average estimated blood loss leading to biosensor activation was 30 mL (10-75 mL)., Limitations: Animal study; small numbers., Conclusions: An endoscopically implantable wireless biosensor successfully detected acute hemorrhage in a porcine UGIB model and sent an emergency cell-phone alert in real time., (Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.)

Background: Gastrojejunostomy is important for palliation of malignant gastric outlet obstruction and surgical obesity procedures. A less-invasive endoscopic technique for gastrojejunostomy creation is conceptually attractive. Our group has developed a compression anastomosis technology based on endoscopically delivered self-assembling magnets for endoscopy (SAMSEN) to create an instant, large-caliber gastrojejunostomy., Objective: To develop and evaluate an endoscopic means of gastrojejunostomy creation by using SAMSEN., Setting: Developmental laboratory and animal facility., Design: Animal study and human cadaveric study., Subjects: Yorkshire pigs (7 cadaver, 5 acute); human (1 cadaver)., Interventions: A transoral procedure for SAMSEN delivery was developed in porcine and human cadaver models. Subsequently, gastrojejunostomy creation by using SAMSEN was performed in 5 acute pigs. The endoscope was advanced into the peritoneal cavity through the gastrotomy, and a segment of the small bowel was grasped and pulled closer to the stomach. An enterotomy was created, and a custom overtube was advanced into the small bowel for deployment of the first magnetic assembly. Next, a reciprocal magnetic assembly was deployed in the stomach. The 2 magnetic systems were mated under fluoroscopic and endoscopic guidance. Contrast studies assessed for gastrojejunostomy leak. Immediate necropsies were performed., Main Outcome Measurements: Technical feasibility and complications., Results: Gastrojejunostomy creation by using SAMSEN was successful in all 5 animals. Deep enteroscopy was performed through the stoma without difficulty. No leaks were identified on contrast evaluation. At necropsy, the magnets were properly deployed and robustly coupled together, resistant to vigorous tissue manipulation., Limitations: Acute animal study., Conclusions: Endoscopic creation of immediate gastrojejunostomy by using SAMSEN is technically feasible., (Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.)

Clinical endoscopic intervention of the pancreaticobiliary tree [endoscopic retrograde cholangiopancreatography (ERCP)] often concludes with the insertion of a temporary plastic stent to reduce the risk of post-ERCP complications by promoting continued flow of bile and pancreatic fluids. This stent is later removed once the patient has fully recovered, but today this necessitates a second endoscopic intervention. The final goal of this work is to obviate the second intervention. This is to be achieved by adding a magnetic ring to the stent such that the stent is removed using a hand-held magnet, held in a suitable position ex vivo . This paper details the design, optimization, and both ex vivo and in vivo testing of the magnetized stent and hand-held magnet, which has been accomplished to date. The optimized design for the hand-held magnet and the modified stent with a magnetic attachment performs in line with simulated expectations, and successful retrieval is achieved in the porcine ex vivo setting at 9-10 cm separation. This is comparable to the mean target capture distance of 10 cm between the entry point to the biliary system and the closest cutaneous surface, determined from random review of clinical fluoroscopies in ten human patients. Subsequently, the system was successfully tested in vivo in the acute porcine model, where retrieval at an estimated separation of 5-6 cm was captured on endoscopic video. These initial results indicate that the system may represent a promising approach for the elimination of a second endoscopic procedures following placement of pancreatic and biliary stents.

Natural orifice translumenal surgery (NOTES) has garnished significant attention from surgeons and gastroenterologists, due to the fusion of flexible endoscopy and operative technique. Preliminary efforts suggest that NOTES holds potential for a less invasive approach with certain surgical conditions. Many of the hurdles encountered during the shift from open to laparoscopic surgery are now being revisited in the development of NOTES. Physician directed efforts, coupled with industry support, have brought about several NOTES specific devices and platforms to help address limitations with current instrumentation. This review addresses current flexible platforms and their attributes, advantages, disadvantages and limitations.

Background: Natural Orifice Transluminal Endoscopic Surgery (NOTES) is a developing, minimally invasive surgical approach whose potential benefits are being investigated. Little is known about secure access site closure and early healing kinetics of transvisceral access., Study Design: Transvisceral access incisions were created in the colon (C-NOTES, n = 8) and stomach (G-NOTES, n = 8) for peritoneal exploration. Incisions were closed primarily with endoloops, endoclips, or t-tags. Macroscopic and histologic analyses performed on postoperative day 7 assessed gross appearance, granulation tissue, inflammation, ulceration, and complications., Results: Macroscopically, incisions appeared closed without intraperitoneal spillage. Incisions closed by endoloop and t-tags showed intense granulation tissue fill of defect despite partial (G-NOTES, n = 3) and transmural ulceration (C-NOTES, n = 8; G-NOTES, n = 3). Of the 30 t-tags applied, 40% broke or deployed into the peritoneal cavity. Endoclip closures (C-NOTES, n = 1; G-NOTES, n = 1) did not show histologic mucosal continuity. Healing complications included transmural necrosis (C-NOTES, n = 1; G-NOTES, n = 1), foreign body material (C-NOTES, n = 3; G-NOTES, n = 2), and microabscesses (G-NOTES, n = 1)., Conclusions: This study provides a reproducible model to assess noninvasive repair of planned visceral perforations. Of investigated technologies, endoloop closure was favored for transcolonic incisions, and t-tags with omental patch for transgastric incisions, although these have significant limitations. Endoclips were inadequate for primary closure, but may be useful as an adjunctive closure modality. Additional studies are needed to examine visceral repair at later time points, as they will help determine the quality and kinetics of repair of a variety of incision closure strategies. This study demonstrates the need for improved technologies to more reliably close visceral transluminal defects., (Copyright (c) 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: High-quality bowel preparation is essential for successful outpatient colonoscopy. Currently, the rate of adequate bowel preparation for outpatient colonoscopy in the USA is low. Patients often fail to adhere to recommended preparation instructions. Limited literature exists on evaluating educational intervention as a means of improving the quality of bowel preparation prior to outpatient colonoscopy., Objective: Our objective was to determine the effect of an educational intervention on the quality of outpatient colonoscopy preparation. The secondary objective was to determine whether the quality of bowel preparation improves overall colonoscopy outcomes as measured by rate of polyp detection and caecal intubation time., Methods: A single-blinded, prospective, randomised, controlled trial was conducted in two inner-city gastroenterology clinics in the USA. One hundred and sixty-four subjects were enrolled and randomly assigned to one of two groups. The control group subjects received verbal and written instructions for colonoscopy. The intervention group subjects received the same instructions and were then asked to answer a questionnaire. The subjects' responses were reviewed and an additional explanation of the preparation process provided. An attending gastroenterologist determined the quality of each bowel preparation at the time of colonoscopy using the Universal Preparation Assessment Scale., Results: The educational intervention had no impact on the overall quality of bowel preparation (P=0.12). However, the type of food (liquid vs solid) consumed during the 24 hours prior to the procedure (P=0.04) and the time since the last solid meal (P=0.03) did have an impact on preparation quality. Other significant factors included elapsed time to first bowel movement from the initiation of bowel preparation (P=0.05) and age younger than 55 (P=0.02). Adequate bowel preparation was associated with shorter total procedure (P=0.001) and caecal intubation (P=0.01) times., Conclusion: Our study failed to demonstrate any effect of an educational intervention on the quality of colonoscopy preparation. However, adherence to simple dietary instructions did have a significant impact on the quality of bowel preparation. Adequate bowel preparation was associated with shorter procedure time and caecal intubation time.

Background: Birth fractures of the humeral diaphysis are encountered at most pediatric medical centers and pediatric orthopaedic practices. The treatment strategy of these fractures is uniformly nonoperative. However, we have not found sufficient studies in the literature demonstrating the extent to which remodeling is possible and therefore how much deformity is acceptable in the treatment of these fractures., Methods: We reviewed the records of our institution's Orthopaedic Surgery Clinic and identified all children seen for birth fractures of the humerus from 2001 to 2005. The angulation and displacement at presentation and at follow-up were measured., Results: All patients were treated nonoperatively, and most were managed by swaddling. In 9 patients with more than 4 months of radiographic follow-up, the mean initial angulation was 26 degrees in the coronal plane and 25 degrees in the sagittal plane. The mean angulation at final follow-up was 5 degrees in the coronal plane and 7 degrees in the sagittal plane. The maximum angulation at presentation was 66 degrees, which remodeled to 5 degrees at 7.3 months' follow-up., Conclusions: Our findings suggest that attempts to obtain an anatomical reduction or the use of more than the simplest immobilization methods are not necessary given the tremendous capacity for remodeling of these fractures in infants.