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Understanding the adsorption dynamics of nanoparticles at solid-liquid interfaces is of paramount importance to engineer nanoparticles for a variety of applications. The nanoparticle surface chemistry is significant for controlling the adsorption dynamics. This study aimed to experimentally examine the adsorption of surface-modified round-shaped silica nanoparticles (with an average diameter of 12 nm), grafted with hydrophobic (propyl chains) and/or hydrophilic (polyethylene glycol chains) agents, at an aqueous solution-silica interface with spherical soda-lime glass beads (diameter of 3 mm) being used as adsorbents. While no measurable adsorption was observed for solely hydrophobic or hydrophilic nanoparticles, a considerable level of adsorption was detected for nanoparticles comprising both hydrophobic and hydrophilic agents. Various kinetic models were employed to model the adsorption dynamics of the responsive nanoparticles. The results demonstrated that the mixed diffusion-kinetics models could predict the dynamics better than the adsorption diffusion models, indicating that the dynamics is controlled by a combination of liquid film diffusion, intra-particle diffusion, and mass action. Additionally, the adsorption of the surface-modified silica nanoparticles onto a mineral silica surface was examined using molecular dynamics simulations. The interaction energy for nanoparticles comprising both hydrophobic and hydrophilic agents was evaluated to be more favorable than that of solely hydrophobic or hydrophilic nanoparticles.

Background: No evidence currently exists characterising global outcomes following major cancer surgery, including esophageal cancer. Therefore, this study aimed to characterise impact of high income countries (HIC) versus low and middle income countries (LMIC) on the outcomes following esophagectomy for esophageal cancer.Method: This international multi-center prospective study across 137 hospitals in 41 countries included patients who underwent an esophagectomy for esophageal cancer, with 90-day follow-up. The main explanatory variable was country income, defined according to the World Bank Data classification. The primary outcome was 90-day postoperative mortality, and secondary outcomes were composite leaks (anastomotic leak or conduit necrosis) and major complications (Clavien-Dindo Grade III - V). Multivariable generalized estimating equation models were used to produce adjusted odds ratios (ORs) and 95% confidence intervals (CI95%).Results: Between April 2018 to December 2018, 2247 patients were included. Patients from HIC were more significantly older, with higher ASA grade, and more advanced tumors. Patients from LMIC had almost three-fold increase in 90-day mortality, compared to HIC (9.4% vs 3.7%, p < 0.001). On adjusted analysis, LMIC were independently associated with higher 90-day mortality (OR: 2.31, CI95%: 1.17-4.55, p = 0.015). However, LMIC were not independently associated with higher rates of anastomotic leaks (OR: 1.06, CI95%: 0.57-1.99, p = 0.9) or major complications (OR: 0.85, CI95%: 0.54-1.32, p = 0.5), compared to HIC.Conclusion: Resections in LMIC were independently associated with higher 90-day postoperative mortality, likely reflecting a failure to rescue of these patients following esophagectomy, despite similar composite anastomotic leaks and major complication rates to HIC. These findings warrant further research, to identify potential issues and solutions to improve global outcomes following esophagectomy for cancer.

As firms are moving towards data-driven decision making, they are facing an emerging problem, namely, algorithmic bias. Accordingly, algorithmic systems can yield socially-biased outcomes, thereby ...

Endothelial injury and microvascular/macrovascular thrombosis are common pathophysiological features of coronavirus disease-2019 (COVID-19). However, the optimal thromboprophylactic regimens remain unknown across the spectrum of illness severity of COVID-19. A variety of antithrombotic agents, doses, and durations of therapy are being assessed in ongoing randomized controlled trials (RCTs) that focus on outpatients, hospitalized patients in medical wards, and patients critically ill with COVID-19. This paper provides a perspective of the ongoing or completed RCTs related to antithrombotic strategies used in COVID-19, the opportunities and challenges for the clinical trial enterprise, and areas of existing knowledge, as well as data gaps that may motivate the design of future RCTs.

Objective The aim of this study is to evaluate the feasibility, applicability and accuracy of artificial intelligence (AI) in the detection of normal versus carotid artery disease through greyscale static duplex ultrasound (DUS) images. Methods A prospective image acquisition of individuals undergoing duplex sonography for the suspicion of carotid artery disease at a single hospital was conducted. A total of n = 156 images of normal and stenotic carotid arteries (based on NASCET criteria) were evaluated by using geometry group network based on convolutional neural network (CNN) architecture. Outcome was reported based on sensitivity, specificity and accuracy of the network (artificial intelligence) for detecting normal versus stenotic carotid arteries as well as various categories of carotid artery stenosis. Results The overall sensitivity, specificity and accuracy of AI in the detection of normal carotid artery was 91%, 86% and 92%, respectively, and for any carotid artery stenosis was 87%, 82% and 90%, respectively. Subgroup analyses demonstrated that the network has the ability to detect stenotic carotid artery images (Conclusion This study demonstrates the feasibility, applicability and accuracy of artificial intelligence in the detection of carotid artery disease in greyscale static DUS images. This network has the potential to be used as a stand-alone software or to be embedded in any DUS machine. This can enhance carotid artery disease recognition with limited or no vascular experience or serve as a stratification tool for tertiary referral, further imaging and overall management.

With the ongoing trend toward miniaturization via system-on-chip (SoC), both radio-frequency (RF) SoCs and on-chip multi-sensory systems are gaining significance. This paper compares the inductance of a miniaturized on-chip near field communication (NFC) antenna versus the conventional screen-printed on-substrate ones that have been used for the transfer of sensory data from a chip to a cell phone reader. Furthermore, the transferred power efficiency in a coupled NFC system is calculated for various chip coil geometries and the results are compared. The proposed NFC antenna was fabricated via a lithography process for an application-specific integrated circuit (ASIC) chip. The chip had a small area of 2.4 × 2.4 mm2, therefore a miniaturized NFC antenna was designed, whereas the screen-printed on-substrate antennas had an area of 35 × 51 mm2. This paper investigates the effects of different parameters such as conductor thickness and materials, double layering, and employing ferrite layers with different thicknesses on the performance of the on-chip antennas using full-wave simulations. The presence of a ferrite layer to increase the inductance of the antenna and mitigate the interactions with backplates has proven useful. The best performance was obtained via double-layering of the coils, which was similar to on-substrate antennas, while a size reduction of 99.68% was gained. Consequently, the coupling factors and maximum achievable power transmission efficiency of the on-chip antenna and on-substrate antenna were studied and compared.

ObjectivesThe study evaluates the plausibility and applicability of prediction, pattern recognition and modelling of complications post-endovascular aneurysm repair (EVAR) by artificial intelligence for more accurate surveillance in practice.MethodsA single-centre prospective data collection on ( n = 250) EVAR cases with n = 26 preoperative attributes (factors) on endpoint of endoleak (types I–VI), occlusion, migration and mortality over a 13-year period was conducted. In addition to the traditional statistical analysis, data was subjected to machine learning algorithm through artificial neural network. The predictive accuracy (specificity and –1 sensitivity) on each endpoint is presented with percentage and receiver operative curve. The pattern recognition and model classification were conducted using discriminate analysis, decision tree, logistic regression, naive Bayes and support vector machines, and the best fit model was deployed for pattern recognition and modelling.ResultsThe accuracy of the training, validation and predictive ability of artificial neural network in detection of endoleak type I was 95, 96 and 94%, type II (94, 83, 90 and 82%) and type III was 96, 94 and 96%, respectively. Endpoints are associated with increase in weights through predictive modeling that were not detected through statistical analytics. The overall accuracy of the model was >86%.ConclusionThe study highlights the applicability, accuracy and reliability of artificial intelligence in the detection of adverse outcomes post-EVAR for an accurate surveillance stratification.

Social media has become a strategic tool for businesses and nonprofit organizations to connect with audiences. However, no comprehensive framework exists to support the continued improvement of soc...

This paper explores the competency of the time domain ultra-wideband (UWB)-circular synthetic aperture radar (CSAR) to image the breast and detect tumors. The image reconstruction is performed using a time domain global back projection technique adapted to the circular trajectory data acquisition. This paper also proposes a sectional image reconstruction method to compensate for the group velocity changes in different layers of a multilayer medium. Experiments on an advanced breast phantom examines the suitability of this technique for breast tumor imaging. The advanced breast phantom is designed based on a MRI of a real patient, fabricated using 3D printing technology, and filled with liquids that emulate normal and cancerous tissues. The measurement results, compared with MRI imaging of the phantom, demonstrate the suitability of the UWB-CSAR method for breast tumor imaging. This method can be a tool for early diagnosis as well as for treatment monitoring during chemotherapy or radiotherapy.

Focused on the assessment of the diphenhydramine hydrochloride (DPH) capabilities as an alternative to conventional and harmful industrial corrosion inhibitors, electrochemical techniques were employed. The optimum concentration of 1000 ppm was determined by molecular simulation and validated through electrochemical experiments. The results acquired from the electrochemical impedance spectroscopy (EIS) study showed that DPH at a concentration of 1000 ppm has a corrosion efficiency of 91.43% after 6 h immersion. The DPH molecules' orientation on the surface was assessed based on EIS predicting horizontal adsorption on the surface. Molecular simulations were done to explore the adsorption mechanism of DPH. The DPH molecules' orientation on the surface was also assessed based on computational studies confirming the horizontal adsorption predicted by EIS.

Doxorubicin (DOX) is a known anticancer drug which is widely used in cancer therapy. Carbon nanotubes (CNTs) are among the most promising platforms for smart drug delivery applications. However, due to the toxicity and their low sulubility their application is limited and their functionalization with wide range of biomolecules are suggested. Therefore, the functionalized carbon nanotubes (f-CNT) with carboxyl (CNT-COO) and folic acid (CNT-COO-FA) were investigated as drug-carrier.Molecular dynamics (MD) simulation along with the Density Functional Theory (DFT) methods are being used to study the drug loading process on functionalized carbon nanotubes.The results indicate that doxorubicin molecules interact more with CNT-COO-FA than CNT-COO. The embedded dipalmitoylphosphatidylcholine (DPPC) lipid bilayer with a folate receptor was considered a cancerous cell's representative model. Then the drug release from the f-CNTs near the lipid bilayer was simulated. The results showed that CNT-COO-FA with a pH and ligand-sensitive mechanism strongly interacts with cancerous cells, which led to higher drug release, in agreement with the experimental results. The conformational changes of the lipid bilayer and folate receptor during drug release were evaluated. The analysis showed that drug release from CNT-COO-FA has significantly changed lipid bilayer and receptor conformations. The obtained results were interpreted and justified by considering the molecular mechanisms which control the drug delivery in the studied systems.Based on the obtained results, CNT-COO-FA has a better performance during the drug release compared to CNT-COO in delivering doxorubicin. Both pH and ligand sensitive mechanisms are found to be responsible for higher drug delivery efficiency of CNT-COO-FA. In contrast, CNT-COO can only enhance drug delivery efficiently with a pH-sensitive mechanism.

Many advanced microfluidic Lab-on-disc (LOD) devices require an on-board power supply for powering active components. LODs with an on-board electrical power supply are called electrified-LODs (eLODs) and are the subject of the present review. This survey comprises two main parts. First, we discuss the different means of delivering electrical energy to a spinning disc including slip-ring, wireless power transmission, and on-board power supply. In the second part, we focus on utilizing electrical power on eLODs for three electrokinetic microfluidic processes: electrophoresis, electroosmotic flow, and dielectrophoresis. Electrokinetic phenomena enable propulsion, separation, and manipulation of different fluids and various types of microparticles/cells. We summarize the theoretical and experimental results for all three electrokinetic phenomena enacted on centrifugal platforms. While extensive numerical modeling and experimental research are available for electrokinetics on stationary platforms, there is a noticeable lack of development in this area when executed on rotating platforms. The review concludes by comparing the strengths and weaknesses of different electrokinetic techniques implemented on centrifugal platforms, and additionally, the most promising applications of electrokinetic-assisted eLOD devices are singled out.

BackgroundThe aim of this study is to establish and evaluate whether the use of prophylactic antibiotics in the creation of any autogenous arteriovenous fistula in hemodialysis patients is indicated, evidence-based and/or recommended.MethodsA systematic review and meta-aggregation of the literature from 1966 to August 2016 in the English language in Medline, Scopus, Embase and Cochrane Library was conducted.ResultsThe search produced a total of n=94 articles. Following the application of the recruitment criteria in accordance to PRISMA one (n=1) article was found eligible with a population of n=611 patients undergoing autogenous fistula formation. A total of n=136 patients received prophylactic antibiotics with no incidence of surgical site infection (SSI). The reported incidence of SSI in the group of patients (n=475) that did not receive prophylactic antibiotics was 0.2% (n=1). The quality of the article was assessed by the Oxford Critical Appraisal Skills Programme (CASP) and their recommendation for practice was evaluated through National Institute for Health and Care Excellence (NICE).ConclusionThe first systematic review of the literature demonstrates that the current use of prophylactic antibiotics in the creation of any autogenous AVF is not evidence-based and further research in this area is highly advocated.

The introduction of biologic and targeted immunomodulators is a significant breakthrough in the therapeutic area of various fields of medicine. The occurrence of serious infections, a complication of secondary immunosuppression associated with these agents, leads to increased morbidity and mortality. Implementing preventive strategies could minimize infection-related complications and improve therapeutic outcomes. The purpose of this review is to focus on current evident approaches regarding screening, monitoring, preventing (immunization and chemoprophylaxis), and management of infections in patients who are candidates for about 70 biologic and targeted immunomodulators. Recommendations are based on relevant guidelines, especially the ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document series published in 2018.

Purpose Fibrin sealant (Tisseel) is a human protein and thrombin soluble fibrinogen that has been indicated for reinforcement of gastro-intestinal anastomoses to prevent leakage. The objective of this study is to examine the impact of fibrin sealant regarding anastomotic leak, following Ivor-Lewis procedure. Methods This is a prospective comparative study on 2-stage oesophagectomy for cancer of the distal oesophagus or oesophagogastric junction. N = 57 individuals were randomly subjected; n = 22 patients to Tisseel in combination to surgical anastomosis versus n = 35 patients to surgical anastomosis alone. The test of probability was assessed through Chi-Square, independent samples paired T-Test and Log-Rank analysis. Results Of the 57 cases included, 56 underwent hybrid and 1 open oesophagectomy. In the Tisseel group, n = 5(22.7%) developed anastomotic leak comparing to n = 3(8.6%) of the control group. No statistically significant difference in leak rate was shown between the two groups; the test of probability was rejected. Conclusions Our results are not supportive of Tisseel tissue sealing property on the intrathoracic oesophago-gastric anastomosis and fibrin sealant's use cannot be justified.

Purpose To assess the sodium MRI signal loss resulting from typically used RF excitation pulses in human skeletal muscle, patellar cartilage, and skin. Methods A double flip-angle experiment was performed 3 times on the knees of 5 healthy volunteers with prescribed ω1 = γB1 of 1.67 kHz, 0.333 kHz, and 0.167 kHz. This was done to search for ω1 -dependent increased rates of sodium-23 central resonance flipping known to result from residual quadrupole splitting (ωQ ), as this flip-angle effect is associated with signal loss. This study facilitated in vivo regression of Gaussian-distributed residual quadrupole splitting SD (ωQ (SD) ) as well as T2fast and T2slow . Signal loss predicted from simulation was then compared with images acquired using 90° RF pulse lengths of 0.5 ms, 0.25 ms, and 0.15 ms. Results Sodium-23 central resonance flipping was significantly greater than prescribed (44% cartilage, 23% skin, 9% muscle) using ω1 = 0.167 kHz, but only 4% cartilage, 5% skin, and 2% muscle using ω1 = 1.67 kHz. Regression yielded ωQ (SD) = 420 ± 50 Hz for cartilage but no significant ωQ (SD) for skin or muscle. This points to rapid biexponential relaxation as the cause of the flip-angle effect for skin/muscle. The T2fast(60%) /T2slow(40%) values were 1.6 ± 0.8 ms/16.1 ± 2.5 ms for muscle, 2.7 ± 0.9 ms/18.4 ± 2.5 ms for cartilage, and 0.4 ± 0.1 ms/9.3 ± 1.7 ms for skin. Simulation predicted signal loss of 6% ± 3%, 3% ± 1%, and 2% ± 1% for muscle, 16% ± 3%, 6% ± 1%, and 3% ± 1% for cartilage, and 26% ± 7%, 15% ± 4%, and 10% ± 3% for skin when using 90° RF pulse lengths of 0.5 ms, 0.25 ms, and 0.15 ms, matching experiment. Conclusion High-power (short) RF pulses are necessary to reduce excitation-related signal loss, particularly for sodium-23 imaging of cartilage and skin.

Background/aim Circumferential resection margin involvement is an independent prognostic factor in patients with adenocarcinoma of the distal esophagus and esophago-gastric junction. However, there is currently no consensus on the extent and the technique of hiatal dissection. We describe a minimally invasive technique of circumferential hiatal dissection for adenocarcinoma of the distal esophagus and esophago-gastric junction with its related histopathological results. Patients and methods A prospective study of 40 consecutive patients undergoing hybrid (laparoscopic/thoracotomic) or totally minimally invasive Ivor-Lewis esophagogastrectomy over a period of 21 months was conducted. Dissection of the hiatus included peri-esophageal surrounding tissues in a cylindrical fashion maximizing the distance from the oesophageal wall. Crural muscle fibers and pleura bilaterally, pericardial fat anteriorly and pre-aortic tissue posteriorly were excised en bloc. Histopathological results particularly focused on involvement of the circumferential resection margin. Neoadjuvant chemotherapy was given to 24 (60%) patients. Results Complete histological clearance (R0) was achieved in 92.5% (n=37) according to the criteria of the College of American Pathologists and in 87.5% (n=35) according to those of the Royal College of Pathologists. In pT3 tumors (n=22), the circumferential resection margin was negative in 20 patients (91%) according to the College of American Pathologists, and in 17 (77%) according to the Royal College of Pathologists. Conclusion Adoption of this safe and reproducible technique might reduce the incidence of circumferential resection margin involvement and improve pathological outcomes. In addition, there may be positive implications for training and quality control.

Objective: The aim of this study is to examine the application of virtual artificial intelligence (AI) in the prediction of functional maturation (FM) and pattern recognition of factors in autogenous radiocephalic arteriovenous fistula (RCAVF) formation. Materials and Methods: A prospective database of 266 individuals over a four-year period with n=10 variables were used to train, validate and test an artificial neural network (ANN). The ANN was constructed to create a predictive model and evaluate the impact of variables on the endpoint of FM. Results: The overall accuracy of the training, validation, testing and all data on each output matrix at detecting FM was 86.4%, 82.5%, 77.5% and 84.5%, respectively. The results corresponded with their area under the curve for each output matrix at best sensitivity and at 1-specificity with the log-rank test p89%). AI has the ability of predicting with a high grade of accuracy FM and recognising patterns that influence it. Conclusion: AI is a replicable tool that could remain up to date and flexible to ongoing deep learning with further data feed ensuring substantial enhancement in its accuracy. AI could serve as a clinical decision-making tool and its application in vascular access requires further evaluation.

Summary Healthcare institutions including hospitals and clinics are increasingly using social media platforms, such as Twitter, to raise awareness in the community about health and wellness topics. In line with this trend, this study seeks to understand how three leading medical centers in the USA use Twitter to share educational content about medical conditions, treatments, preventive measures and other health-related topics. A sample of tweets posted by Cleveland Clinic, Johns Hopkins Hospital and Mayo Clinic during a 6-month timeframe was collected and thematically analyzed. The first analysis, which focused on eight popular health topics, showed that diet and cancer were consistently the most and diabetes was the least frequently used topics in the tweets. The second analysis, which drew upon the health belief model to understand the educational themes embedded into the tweets, revealed that the three institutions mainly provided general health advice and information in their tweets and paid less attention to causes and consequences of diseases, preventive strategies and patient success stories. Accordingly, it is recommended that healthcare institutions adjust their tweeting activities and align them with society’s health education needs. Such revised content strategies can help medical institutions achieve their health promotion goals more effectively.

Purpose: To elucidate the epidemiology, anatomical, presentation, classification, pathology, investigative modalities, management and prognosis of primary angiosarcoma of the aorta. Material and Methods: A systematic review of literature from the database inception to January 2021 in PubMed and Embase, CINAHL and Cochrane Library in accordance to PRISMA was conducted. Retrieval and extraction was performed by two independent reviewers. The hierarchy of the evidence was assessed through the National Institute for Health and Care Excellence Checklist. Data were subjected to pooled prevalence analysis, Kaplan–Meier survival and test of probability using log-rank analysis. This review is registered with International Prospective Register of Systematic Reviews: RD42021231314. Results: 82 studies with n = 123 cases met the inclusion criterion. Abdominal (45%) aorta was the commonest anatomical site with female predominance in ascending aorta (4:1) and aortic arch (2:1). The longest survival was in the ascending aorta and the shortest in the abdominal aorta [540 (interquartile range [IQR], 7–1560 days vs. 180 (IQR, 1–5730 days)], respectively. The overall median survival was 210 days (IQR, 1–5730 days) or 7 months. Lack of metastasis (47%) was a marker of longer survival ( p < 0.03) irrespective of other attributes. Conclusion: The pathophysiology appears to be a trend of increasing fatigue, fever and weight loss associated with segmental dysfunction of the aorta projecting occlusive or destructive phenotypes. Computed tomography angiography features of volume-occupying, bulky, polypoid (intraluminal), protrusive vegetation, hyper vascular without atherosclerotic lesions are extremely suggestive of PA of the aorta at 5th and 6th decades of life.

The rootstock GF677 is an interspecific hybrid with an important economic and horticultural value. In this research, the effect of indole butyric acid (IBA) in combination with putrescine (Put) and hydrogen peroxide (H2O2) on rooting of GF677 semi-hardwood stem cuttings in three cutting seasons (July, March and October) was investigated. Treatments as IBA (0, 1000, 2000 and 3000 mg L-1), Put (0, 800, 1600 and 3200 mg L-1) and H2O2 (1.5, 3 and 6% w/v) were included. The results showed that in July cuttings, the highest levels of callogenesis were observed in IBA treated cuttings in both concentrations of 1000 and 2000 mg L-1. The rooting was very low in July cuttings, while the highest percentage of rooting (14%) was observed in the combination of 2000 mg L-1 IBA+ 3% H2O2. In March, the cuttings treated by 1000 mg L-1 IBA+800 mg L-1 Put and 1000 mg L-1 IBA+1600 mg L-1 Put revealed the highest percentages of callus formation 83.31 and 83.33%, respectively. In these cuttings, the highest percentage of rooting (63.88%) was gained at 2000 mg L-1 IBA+3200 mg L-1 Put. The application of 1000 mg L-1 IBA+800 mg L-1 Put increased root fresh weight. In cuttings prepared in October, only 800 mg L-1 Put caused callus formation in more than 55% of the cuttings. The rooting of cuttings at this time was as low as the July cuttings, whereas the highest rooting percentage was observed in cuttings treated with IBA at a concentration of 1000 mg L-1. Overall, the experiment showed that the season of the cutting and the treatments with IBA+Put or H2O2 could improve rooting properties of the rootstock GF677. RESUMEN El portainjerto GF677 es un híbrido interespecífico con un importante valor económico y hortícola. En este estudio, se investigó el efecto del ácido indol butírico (IBA) en combinación con putrescina (Put) y peróxido de hidrógeno (H2O2) en el enraizamiento de esquejes de tallos de madera semidura GF677 en tres temporadas de corte (julio, marzo y octubre). Los tratamientos incluyeron IBA (0, 1000, 2000 y 3000 mg L-1), Put (0, 800, 1600 y 3200 mg L-1) y H2O2 (1.5, 3 y 6% p/v). Los resultados mostraron que en los esquejes de julio, la callogénesis más alta se observó en los esquejes tratados con IBA en ambas concentraciones de 1000 y 2000 mg L-1. El enraizamiento fue muy bajo en los esquejes de julio y el mayor porcentaje de enraizamiento (14%) se observó en la combinación de IBA 2000 mg L-1+H2O2 3%. En los esquejes de marzo, el mayor porcentaje de formación de callos se alcanzó en los tratados con IBA 1000 mg L-1+Put 800 mg L-1 e IBA 1000 mg L-1+Put 1600 mg L-1, 83.31 y 83.33%, respectivamente. En estos esquejes, el mayor porcentaje de enraizamiento (63.88%) se obtuvo con IBA 2000 mg L-1+Put 3200 mg L-1. La aplicación de IBA 1000 mg L-1+Put 800 mg L-1 aumentó el peso fresco de la raíz. En esquejes preparados en octubre, el Put solo a una concentración de 800 mg L-1 provocó la formación de callos en más del 55% de los esquejes. El enraizamiento de los esquejes en este momento era tan bajo como los esquejes de julio y el mayor porcentaje de enraizamiento se observó en los esquejes tratados con IBA a una concentración de 1000 mg L-1. En general, el experimento mostró que la temporada de corte y el tratamiento con IBA+Put o H2O2 podría mejorar las propiedades de enraizamiento de los esquejes de GF677.

Objective UK national guidelines recommend pancreatic enzyme replacement therapy (PERT) in pancreatic cancer. Over 80% of pancreatic cancers are unresectable and managed in non-surgical units. The aim was to assess variation in PERT prescribing, determine factors associated with its use and identify potential actions to improve prescription rates. Design RICOCHET was a national prospective audit of malignant pancreatic, peri-ampullary lesions or malignant biliary obstruction between April and August 2018. This analysis focuses on pancreatic cancer patients and is reported to STROBE guidelines. Multivariable regression analysis was undertaken to assess factors associated with PERT prescribing. Results Rates of PERT prescribing varied among the 1350 patients included. 74.4% of patients with potentially resectable disease were prescribed PERT compared to 45.3% with unresectable disease. PERT prescription varied across surgical hospitals but high prescribing rates did not disseminate out to the respective referring network. PERT prescription appeared to be related to the treatment aim for the patient and the amount of clinician contact a patient has. PERT prescription in potentially resectable patients was positively associated with dietitian referral (p = 0.001) and management at hepaticopancreaticobiliary (p = 0.049) or pancreatic unit (p = 0.009). Prescription in unresectable patients also had a negative association with Charlson comorbidity score 5–7 (p = 0.045) or >7 (p = 0.010) and a positive association with clinical nurse specialist review (p = 0.028). Conclusion Despite national guidance, wide variation and under-treatment with PERT exists. Given that most patients with pancreatic cancer have unresectable disease and are treated in non-surgical hospitals, where prescribing is lowest, strategies to disseminate best practice and overcome barriers to prescribing are urgently required.

Endothelial injury and microvascular/macrovascular thrombosis are common pathophysiologic features of coronavirus disease-2019 (COVID-19). However, the optimal thromboprophylactic regimens remain unknown across the spectrum of illness severity of COVID-19. A variety of antithrombotic agents, doses and durations of therapy are being assessed in ongoing randomized controlled trials (RCTs) that focus on outpatients, hospitalized patients in medical wards, and critically-ill patients with COVID-19. This manuscript provides a perspective of the ongoing or completed RCTs related to antithrombotic strategies used in COVID-19, the opportunities and challenges for the clinical trial enterprise, and areas of existing knowledge, as well as data gaps that may motivate the design of future RCTs.

Aim: Despite the similarities in the pathogenesis of the beta coronaviruses, the precise infective mechanisms of SARS-CoV-2 remain unclear. Objective: In this review, we aim to focus on the proposed theories behind the pathogenesis of SARS-CoV-2 and highlight the clinical complications related to coronavirus disease 2019 (COVID-19). Methods: We conducted a literature search in Pubmed, Scopus and Google Scholar for the relevant articles regarding clinical complications and pathogenesis of COVID-19. Results: Related articles were included and discussed. Conclusion: Respiratory system and the lungs are the most commonly involved sites of COVID-19 infection. Cardiovascular, liver, kidneys, gastrointestinal and central nervous systems are involved with different frequencies and degrees of severity.

Objective It has been hypothesized that a novel measurement technique of arteriovenous ratio (AVR) index obtained from inflow (radial artery diameter) to that of outflow (cephalic vein diameter) and its application through the Bernoulli effect has no impact on the primary functional maturation (FM) of autogenous radiocephalic arteriovenous fistula (RCAVF). Methods A prospective consecutive single-center cohort study with intention to treat of 324 patients undergoing RCAVF during a period of 4 years was conducted. Variables of demographics, anatomic factors, laterality, comorbidities, anesthesia type, presence of intraoperative thrill, angle of anastomosis, and AVR index were assessed through univariate and multivariate logistic regression analysis on the end point of FM. The AVR was subjected to three decimal points to ensure maximal accuracy for best sensitivity and 1 − specificity by receiver operating characteristic curve. The χ 2 (subgroup) analyses were undertaken to investigate the differences in FM incidence within different ranges of AVR. Test of probability ( P value) was considered to be significant with P Results Among all variables, the AVR index remained the only independent factor associated with FM (66%; n = 214/324) of RCAVFs ( P = .001; 95% confidence interval, 0.08-0.26). AVR of 1 to 1.06 was associated with 100% FM in RCAVFs. Decrease or increase of this index was associated with stepwise reduction in FM of RCAVFs ( P Conclusions The suggested novel measurement technique (AVR index) is an independent predictor of FM in RCAVFs. This study implies that minimal diameter (ie, inflow artery dimeter to outflow cephalic vein diameter) mismatch (AVR, 1-1.06) irrespective of other variables remains crucial for optimal hemodynamics (pressure and velocity) of RACVFs and their primary FM.

Placing dielectric pads adjacent to the imaging region is an effective method to increase the signal locally and also increase the radio frequency magnetic field homogeneity in magnetic resonance imaging. The use of local high permittivity pads is becoming more common, and this work focuses on the effect of larger dielectric pads on the transmit/receive performance of an array (e.g., coupling, efficiency and safety) having 8 channels, used to image a cylindrical phantom at 4.7T (200MHz). We investigate the effects of a dielectric liner surrounding the whole volume of interest both with and without an air gap. The simulations reveal that high permittivities are not recommended because they substantially degrade the longitudinal homogeneity, resulting in hot spots of specific absorption rate at the driven end of the array. Furthermore, high permittivities lead to dielectric resonances in the liner at frequencies close to the Larmor frequency, potentially degrading the performance of the array. Indeed, simulations and measurements confirm that a compromise must be made between improvements in field homogeneity and transmit performance, and that an optimal permittivity exists which is much lower than those commonly used in the literature. The optimal permittivity achieves minimal coupling (-23dB) between array elements, exhibits an intrinsic electromagnetic impedance equal to the geometric mean of those of the coil former and phantom and can be realized with inexpensive materials. For this permittivity the performance with an air gap of thickness equal to that of the liner is equivalent to that without the air gap.

Endovascular left gastric artery (LGA) embolisation has gained significant attention in the treatment of obesity/morbid obesity and reduction of ghrelin. The objective of this systematic review is to evaluate the recent literature, strengths, limitations and practical aspects of this new procedure in combination with its physiological and anatomical paradigm. A systematic electronic search of literature from 1966 to June 2017 in Medline, CINHAL, Embase, Scopus and Cochrane library in English language and adult subjects was conducted. This search was conducted in accordance with Preferred Reporting in Systematic Review and Meta-Analysis (PRISMA) guidelines. Quality assessment of the articles was performed, using Oxford critical appraisal skills programme (CASP), and their recommendation for practice was examined through National Institute for health Care Excellence (NICE). Inter-related reliability (Cronbach’s Alpha) was assessed between the two independent reviewers. A total of n = 62 individuals were subjected to LGA embolisation. At 1–3 months, 7–11% and, at 12 months, 2% weight reduction was associated with ghrelin concentration reduction of 36% at 6 months. There was Haemoglobin A1c reduction (7.4 to 6.3%) and improved quality of life (SF-36 questionnaire) at 6 months (9.5 points) (range, 3.2–17.2). Despite immediate epigastric pain and mucosal ulceration, no long-term adverse outcome was identified. The overall length of stay was 2–3 days. The outcome of this review (level of evidence 3) suggests LGA embolisation is feasible and effective and perhaps a safe procedure in the treatment of obesity and reduction of ghrelin. However, further trials are highly advocated.

Background: Esophagectomy in situs inversus is challenging. With long-segment supercharged reconstruction, it becomes more perplexing and multidisciplinary surgical skills are needed. Challenges met and the surgical technique used is presented in this case report. Methods: The case of a 49-year old patient with situs inversus abdominus and a locally advanced distal esophageal adenocarcinoma extending to the stomach is presented. Results: Following neoadjuvant chemotherapy and due to inability to use the stomach as a conduit, a thoracoscopic total esophagogastrectomy with long-segment reconstruction was performed. The conduit used was the left colon and was supercharged with venous and arterial anastomoses in the neck. Conduit perfusion, as assessed by the Spy system revealed marked improvement post supercharging. No anastomotic leak was noted and oral diet was started on day 4. On day 26 the patient developed pneumonia necessitating intubation that was declined. Organ support was withheld with patient death at day 29. Conclusion: In long-segment esophageal reconstruction with supercharged colon, although thoracoscopy is feasible, laparoscopy is found unsafe. Careful preoperative planning and colon assessment via computed tomography(CT) colonography/angiography and a multidisciplinary team approach is recommended. Adjuncts to assess conduit perfusion like the Spy system are helpful. Supercharging the long colonic conduit is a way of minimizing ischemia-related complications.

Introduction The objective of this study is to test the null hypothesis that an S-shaped surgical incision versus conventional (straight) skin incision in the creation of autogenous radiocephalic arteriovenous fistulas (RCAVFs) have no impact on the primary end-point of primary functional maturation and secondary end points of stenosis and thrombosis. Methods A prospective observational comparative consecutive study with intention-to-treat on individuals undergoing only radiocephalic arteriovenous fistula (RCAVFs) over a period of 12 months was conducted. Variables on patient's demographics, comorbidities, anesthesia type, mean arterial blood pressure, thrill, laterality, cephalic vein and radial artery diameter were collated. The test of probability was assessed through Chi-Square, Kaplan-Meier survival estimator and Log-Rank analysis. Results Total of n = 83 individuals with median age of 67 years (IQR, 20–89) and male predominance 83% during this period were subjected to RCAVF formation. Total of n = 45 patients in straight skin incision were compared to n = 38 individuals in S-shaped group. Despite equal prevalence of demographics, comorbidities, anesthesia type, mean arterial blood pressure (MAP), thrill, laterality, cephalic vein and radial artery diameter (p > 0.05) higher incidence of juxta-anastomotic stenosis was noted in the straight skin incision group (p = 0.029) in comparative and survival analysis (Log-Rank, p = 0.036). The maturation of the entire cohort was 69% (S-shaped 76% vs. straight group 62%) (p > 0.05). Conclusion The outcome of this study demonstrates that S-shaped surgical skin incision is associated with a lower incidence of stenosis in comparison to straight incision type in RCAVF formation., Highlights • S-shaped skin incision is an alternative to the conventional skin incision for creation of radiocephalic arteriovenous fistula (RCAVF). • This approach permits better exposure for both vessels and minimise the need for extensive mobilisation of cephalic vein. • S-shaped skin incision is associated with lower incidence of stenosis within the maturation period.

According to National Institute of Clinical Excellence guidelines, the ankle-brachial pressure index coupled with a full clinical evaluation has been the mainstay of detecting peripheral arterial disease on its suspicion. However, this technique is not free of its own limitations in calcified arteries, ulcerative and diabetic patients. We introduce a new, novel, and effective assessment device (BlueDop) with a minimal learning curve that could overcome such barriers and serve as a valid replacement in perihospital settings.

Introduction The aim of this study is to examine the role of five different operative salvage techniques with their long-term primary patency (PP) in an algorithmic manner in gaining primary functional maturation (FM) in radio cephalic arteriovenous fistulae (RCAVF) formation following their impairment. Methods A prospective consecutive data collection on 195 patients undergoing only autogenous RCAVF formation from July 2013 to December 2015 was conducted. Each non-maturing fistula was then exposed to a salvage technique by an algorithmic methodology and their FM and PP was prospectively recorded. Results Forty-two patients were exposed to five different salvages techniques, with a median age of 67 years (IQR, 27-90), cephalic vein diameter of 2 mm (IQR, 1.5-4 mm) and radial artery diameter of 1.8 mm (IQR, 1.2-2.1 mm), demonstrated 63.1% FM and cumulative primary patency of 15.2 months (95% CI, 12.5-17.9) over a 21-month follow-up period. Conclusions Operative salvage techniques play an important role in achieving assisted functional maturation and long-term patency in RCAVF as an alternative and/or in conjunction with other minimally invasive procedures. These procedures can maximize access outcome, minimize bridging procedures, decrease complications and optimize patient anatomical resources for longer access provisions in an era of aging population.

The aim of this study was to evaluate the collective and/or independent impact of patient demographics, comorbidities, anatomical factors, and peri-operative parameters on the primary functional maturation of RCAVFs. This study also aimed to identify the range and best cut off value for each variable and evaluate the likelihood, significance and percentage of primary functional maturation of RCAVFs.This was a prospective consecutive single centre cohort study over a 4 year period; it was conducted on patients with the intention-to-treat using a radiocephalic arteriovenous fistula (RCAVF) (Brescia-Cimino). During this period 548 vascular access procedures, inclusive of RCAVF, were performed. Variables included patient demographics (age, gender), anatomical variance (cephalic vein, radial artery diameter, laterality), comorbidities (diabetes mellitus, ischaemic heart disease, congestive cardiac failure, hypertension), aetiology of renal failure, and anaesthesia type (local versus general anaesthesia).Of the total, 324 patients, cephalic vein diameter1.5 mm (OR 4.57, 95% CI, 2.42-8.63, p .001) (non-augmented) and radial artery diameter 1.6 mm (OR 12.26, 95% CI, 6.27-23.97, p .001) were found to be independently associated with the primary functional maturation of 86% in the RCAVF formation.Of all the variables, cephalic vein and radial artery diameter are independently associated with the primary functional maturation of RCAVFs.

INTRODUCTION Oesophagectomy for oesophageal carcinoma carries a high risk of significant morbidity and mortality. Delayed gastric emptying is a relatively common complication following this procedure. A variety of medical, surgical and endoscopic strategies have been described to manage it. The vast majority of cases are related to post-operative pyloric dysfunction and are amenable to conventional management strategies. PATIENTS AND METHODS We present a new case of a patient with a duodenal hiatus hernia resulting in extrinsic gastroduodenal compression by the massively distended gastric conduit as a cause of gastric outlet obstruction following laparoscopic-assisted Ivor-Lewis oesophagectomy 2 years previously. RESULTS AND CONCLUSIONS Surgical repair of the hiatus hernia restored the post-oesophagectomy anatomy and resolved this patient's symptoms where conventional management of post-oesophagectomy gastric outlet obstruction had failed on multiple occasions. Most cases of delayed gastric emptying post-oesophagectomy occur as a result of pyloric dysfunction and can be managed using a combination of prokinetics, surgical intervention or more commonly, endoscopic dilatation. Other potential causes and therefore investigative and management strategies should be considered in patients who repeatedly fail conventional management. We offer an alternative diagnosis that may be considered in these patients and present a novel approach to their investigation and management.

Supplemental material, sj-pdf-1-vas-10.1177_1708538120949658 for Prediction, pattern recognition and modelling of complications post-endovascular infra renal aneurysm repair by artificial intelligence by Ali Kordzadeh, Mohammad A Hanif, Manfred J Ramirez, Nicholas Railton, Ioannis Prionidis and Thomas Browne in Vascular

Supplemental material, sj-pdf-1-vas-10.1177_1708538120949658 for Prediction, pattern recognition and modelling of complications post-endovascular infra renal aneurysm repair by artificial intelligence by Ali Kordzadeh, Mohammad A Hanif, Manfred J Ramirez, Nicholas Railton, Ioannis Prionidis and Thomas Browne in Vascular

Aim Three-dimensional laparoscopy improves the depth of perception during minimally invasive surgery, leading to better visibility and more precise dissection, and providing better clinical and surgical outcomes in complex surgical procedures. The aim of this study was to compare the pros and cons of the 3D technological systems available in our Unit for UGI surgery. Background & Methods In our Unit, we have two different 3D systems for abdominal and thoracic surgery. B Braun has the EinsteinVision 3D system with 0 and 30 degree fixed camera. Olympus produces an Endoeye Flex with an articulating tip 0 degree 3D camera as well as an Endoeye 3D 0 and 30 degree rotating camera. Advantages and disadvantages of the different 3D systems were evaluated on the basis of the experience of our senior surgeons performing routinely 3D operations. Results All surgeons agreed of the superiority of 3D vision compared to conventional 2D laparoscopy or thoracoscopy. The B Braun system is not available in an integrated operating theatre system and does not allow image rotation, but provides a full HD sharp resolution and has the advantage of a reusable camera with single use warming cover which could be used for unlimited procedures every day. The Olympus Endoeye Flex does not provide HD resolution and can be more difficult to manoeuvre, but has the advantage of the articulating tip. The Olympus Endoeye 30 degree rotating camera has a better HD resolution and the advantage of image rotation while maintaining the horizon. Conclusion Technology beyond 3D laparoscopic system has been evolving rapidly. Different products have their own strengths and weaknesses, and surgeons should be familiar with the system used.

The simulation of medical procedures through virtual reality (VR) system offers an opportunity to train medical students, paramedics and doctors across a range of specialists in a safe (risk-free), realistic and repeatable environment. It eliminates harmful consequences to patients and offers infinitely repeatable procedures. In this study, we developed an application of a "single Interrupted Suturing skill" that is used daily for various fields of surgery which is supervised by artificial intelligence (AI) algorithm. The automated graphical feedback and assessment procedures were simulated within the VR environment. The VR technologies for medical/clinical training has the potential to reduce service delivery costs significantly. The evaluation of the effectiveness and validity of the proposed system will be the focus of future research.

Gastrobronchial fistulae (GBF) following minimally invasive oesophagectomy (MIO) is a rare entity, with an estimated incidence of 0.3–1.5% according to the published literature. It could present with persistent cough (Ohno’s sign), chest pain, haemoptysis and recurrent pneumonia. Barium swallow examination remains the most sensitive investigation in 78% of the cases; the main stay of management is surgical and in some cases endoscopic (stent insertion). We report a rare case of a GBF 1 month after two-stage MIO for cancer of the gastro-oesophageal junction, which was successfully treated for the first time with an over-the-scope-clip.

BACKGROUND/AIM Surgical resection for esophageal cancer has remained the gold-standard therapy provided worldwide. Subcarinal lymph-nodes are classified as peri-esophageal nodes and their dissection may be performed during a 2- or 3-stage esophagectomy. The necessity and prognostic value of subcarinal lymphadenectomy is still debatable. The purpose of this study was to investigate the rate of invaded subcarinal lymph-nodes out of the total lymph-nodes resected. Detection of invaded nodes was correlated with clinical staging and tumor differentiation. PATIENTS AND METHODS This is a retrospective analysis of consecutive esophagectomies for cancer, performed in a UK tertiary center. The study was conducted over a 3-year period. RESULTS The rate of subcarinal lymph-node invasion was extremely low according to the results of our analysis. CONCLUSION Lymphadenectomy is not devoid of clinical impact on patients and therefore, the decision should actually be the outcome of a dynamic balance between complications and survival benefit.

To assess the sodium MRI signal loss resulting from typically used RF excitation pulses in human skeletal muscle, patellar cartilage, and skin.A double flip-angle experiment was performed 3 times on the knees of 5 healthy volunteers with prescribed ωSodium-23 central resonance flipping was significantly greater than prescribed (44% cartilage, 23% skin, 9% muscle) using ωHigh-power (short) RF pulses are necessary to reduce excitation-related signal loss, particularly for sodium-23 imaging of cartilage and skin.

We examined communicating personal health information (PHI) in virtual communities.Younger individuals are more concerned about their PHI privacy.Healthier individuals expect to receive less personal benefits of communicating PHI.Affective commitment will increase expected outcomes of communicating PHI. Over the past decade, social media technologies have become effective tools not only for entertainment, but also for online health communications. In virtual health communities (VHCs), the members often share their personal health information (PHI) with other members. These information exchanges provide benefits to both the information providers as well as the recipients. The PHI disclosure, however, may entail privacy concerns. Our study used the privacy calculus model to examine the trade-off between individuals' expected benefits and privacy concerns when disclosing PHI in social media environments. Our results showed that age, health status, and affective commitment influence the balance between the information disclosure drivers and barriers in the privacy calculus model. More specifically, we found that among members of VHCs, healthier people expect to receive fewer personal benefits of communicating PHI in social media environments. Moreover, individuals who are emotionally attached to online communities expect to both receive and provide more benefits while communicating PHI in those communities. We also observed that individuals who are familiar with but not members of VHCs, especially those who are young and healthy, are more concerned about their PHI privacy in online communities.

Objective Visceral artery aneurysms as a result of arterial degenerative disease are rare (0.1%-2%), and the superior mesenteric artery (SMA) accounts for 3.2% of all reported series. The current incidence of inferior mesenteric artery (IMA) aneurysm is unknown. However, infective causes (mycotic) of SMA and IMA aneurysm as a result of primary, secondary, and cryptogenic etiology remain a separate entity and attain fewer cases in the literature. Currently, there is no consensus on their presentation, diagnosis, and overall management. Methods A systematic review and meta-aggregation of literature from 1944 to March 2015 in the English language and of adult subjects in MEDLINE, Ovid, CINAHL, and the Cochrane database was conducted. Results The median age of patients with SMA aneurysm was 36 (range, 14-92) years, with a significant male predominance (73% vs 27%). In order of prevalence, abdominal pain (n = 25; 65%), low-grade fever (n = 23; 60%), malaise (n = 10; 26%), weight loss (n = 9; 23%), and nausea and vomiting (n = 8; 20%) were the most common presenting signs and symptoms. The most common microorganism was Streptococcus (n = 18; 47%), followed by Staphylococcus (n = 11; 28%). The investigative modality of choice was computed tomography (n = 22; 57.8%), followed by ultrasonography of the abdomen (n = 9; 23%). Primary etiology was noted in 5.4%, secondary in 71%, and cryptogenic in 13% of all cases. Aneurysmectomy alone was associated with bowel resection in four cases (10.5%), whereas aneurysmectomy with interposition vein grafting required no further intervention. The inpatient mortality after surgery was 7.8%, and the overall mortality was 15%. The median follow-up was 12 months (range, 2-120 months). The median age of patients with IMA aneurysm was 48 (range, 22-64) years, with a male predominance of 2:1 and abdominal pain in all cases (n = 3; 100%). The most common microorganism was Streptococcus (n = 2; 66.6%), and the operation of choice was aneurysmectomy (n = 2; 66.6%) after computed tomography scan (n = 3; 100%) as an investigative modality of choice. Conclusions The pentad of abdominal pain, pyrexia of unknown origin, malaise, weight loss, and nausea remains the most convincing presentation of mycotic aneurysms of the SMA and IMA. Computed tomography is the investigative modality of choice, and such patients are best served with aneurysmectomy alone in IMA aneurysms and interposition vein grafting in SMA aneurysms after initiation of antimicrobial therapy on suspicion of the diagnosis.