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PURPOSE Evidence-based guidelines recommend cascade genetic counseling and testing for hereditary cancer syndromes, providing relatives the opportunity for early detection and prevention of cancer. The current standard is for patients to contact and encourage relatives (patient-mediated contact) to undergo counseling and testing. Direct relative contact by the medical team or testing laboratory has shown promise but is complicated by privacy laws and lack of infrastructure. We sought to compare outcomes associated with patient-mediated and direct relative contact for hereditary cancer cascade genetic counseling and testing in the first meta-analysis on this topic. MATERIALS AND METHODS We conducted a systematic review and meta-analysis in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO No.: CRD42020134276). We searched key electronic databases to identify studies evaluating hereditary cancer cascade testing. Eligible trials were subjected to meta-analysis. RESULTS Eighty-seven studies met inclusion criteria. Among relatives included in the meta-analysis, 48% (95% CI, 38 to 58) underwent cascade genetic counseling and 41% (95% CI, 34 to 48) cascade genetic testing. Compared with the patient-mediated approach, direct relative contact resulted in significantly higher uptake of genetic counseling for all relatives (63% [95% CI, 49 to 75] v 35% [95% CI, 24 to 48]) and genetic testing for first-degree relatives (62% [95% CI, 49 to 73] v 40% [95% CI, 32 to 48]). Methods of direct contact included telephone calls, letters, and e-mails; respective rates of genetic testing completion were 61% (95% CI, 51 to 70), 48% (95% CI, 37 to 59), and 48% (95% CI, 45 to 50). CONCLUSION Most relatives at risk for hereditary cancer do not undergo cascade genetic counseling and testing, forgoing potentially life-saving medical interventions. Compared with patient-mediated contact, direct relative contact increased rates of cascade genetic counseling and testing, arguing for a shift in the care delivery paradigm, to be confirmed by randomized controlled trials.

Medication administration errors (MAEs) are the most common and significant type of medication errors worldwide. This study aims to assess the prevalence, types, and severity of MAEs. Furthermore, this study attempts to determine the factors associated with the occurrence of MAEs.This cross-sectional study was conducted over a three-month interval in the internal medicine ward of a tertiary teaching hospital in Jordan. During the study period, 13 nurses were observed while they were preparing and administering medications using a direct disguised observation method. All the recorded observations about the preparation and administration were compared with the physician's orders in the medications' records to identify any possible MAEs.Having observed a total of 1,012 opportunities for errors, 910 MAEs were identified. Among these 910 errors, adherence errors were found to be the most frequent type (n = 364, 35.9%), followed by incorrect drug preparation (n = 247, 24.4%). None of the MAEs revealed any serious harm to patients or contributed to prolonged hospitalization. Antimicrobial drugs (n = 210, 23.0%) was the most common class associated with MAEs, followed by the class of cardiovascular (n = 157, 17.2%) medicines. Results have shown that the occurrence of MAEs was significantly higher in the non-intravenous medications in comparison to the intravenous medications (While this study revealed a high rate of MAEs, all the identified errors did not cause harm to the patients. Continuous awareness and education campaigns targeting the nurses about the importance of proper and safe drug administration are highly recommended.أخطاء إعطاء الدواء هي من بين أكثر أنواع الأخطاء الدوائية شيوعا وأهمية في جميع أنحاء العالم. هدفت هذه الدراسة إلى تقييم انتشار أخطاء إعطاء الدواء وأنواعها وشدتها، وتحديد العوامل المرتبطة بحدوث مثل هذه الأخطاء.أجريت هذه الدراسة المقطعية على مدى ثلاثة أشهر في جناح الطب الباطني في مستشفى تعليمي ثلاثي في الأردن. خلال فترة الدراسة، تمت ملاحظة ما مجموعه 13 ممرضة أثناء تحضير الأدوية وإعطائها باستخدام طريقة الملاحظة المقنعة المباشرة. تمت مقارنة جميع الملاحظات المسجلة المتعلقة بالتحضير والإدارة مع أوامر الطبيب في سجل الأدوية لتحديد أي أخطاء محتملة.لوحظ ما مجموعه 1012 فرصة للأخطاء، وتم تحديد 910 خطأ في إعطاء الأدوية. من بين هذه الأخطاء البالغ عددها 910، كانت أخطاء الالتزام هي النوع الأكثر شيوعا (العدد 364 ، 35.9٪)، يليها تحضير دواء غير صحيح (العدد 247، 24.4٪). لم يسفر أي من أخطاء إعطاء الأدوية عن ضرر جسيم للمرضى أو ساهم في البقاء في المستشفى لفترات طويلة. كانت الأدوية المضادة للميكروبات (العدد 210 ، 23.0٪) هي الفئة الأكثر شيوعا المرتبطة بـأخطاء إعطاء الأدوية، تليها أدوية أمراض القلب والأوعية الدموية (العدد 157 ، 17.2٪). أظهرت النتائج أن حدوث أخطاء إعطاء الأدوية كان أعلى بشكل ملحوظ في الأدوية غير الوريدية مقارنة بالأدوية الوريدية (القيمة الاحتمالية أقل من 0.001).كشفت هذه الدراسة عن وجود معدل مرتفع من أخطاء إعطاء الأدوية. على الرغم من أن جميع الأخطاء التي تم تحديدها لم تسبب أي ضرر للمرضى، إلا أن الأخطاء كانت موجودة دائما. يوصى بشدة بحملات التوعية والتثقيف المستمرة للممرضين والممرضات حول أهمية الإدارة السليمة والآمنة للأدوية.

Trauma is the number one cause of death among Americans between the ages of 1 and 46 years, costing more than $670 billion a year. Following death related to central nervous system injury, hemorrhage accounts for the majority of remaining traumatic fatalities. Among those with severe trauma that reach the hospital alive, many may survive if the hemorrhage and traumatic injuries are diagnosed and adequately treated in a timely fashion. This article aims to review the recent advances in pathophysiology management following a traumatic hemorrhage as well as the role of diagnostic imaging in identifying the source of hemorrhage. The principles of damage control resuscitation and damage control surgery are also discussed. The chain of survival for severe hemorrhage begins with primary prevention; however, once trauma has occurred, prehospital interventions and hospital care with early injury recognition, resuscitation, definitive hemostasis, and achieving endpoints of resuscitation become paramount. An algorithm is proposed for achieving these goals in a timely fashion as the median time from onset of hemorrhagic shock and death is 2 h.

Chronic myelomonocytic leukemia (CMML) is a rare but distinct hematological neoplasm with overlapping features of myelodysplastic syndrome (MDS) and myeloproliferative neoplasm (MPN). Individuals with CMML have persistent monocytosis and bone marrow dyspoiesis associated with various constitutional symptoms like fevers, unintentional weight loss, or night sweats. It is established that there is a strong association of CMML with preceding or coexisting autoimmune diseases and systemic inflammatory syndromes affecting around 20% of patients. Various molecular abnormalities like TET2, SRSF2, ASXL1, and RAS are reported in the pathogenesis of CMML, but no such mutations have been described to explain the strong association of autoimmune diseases and severe inflammatory phenotype seen in CMML. Germline mutation in SH2B adaptor protein 3 (SH2B3) had been reported before to affect a family with autoimmune disorders and acute lymphoblastic leukemia. In this report, we describe the first case of a female subject with many years of preceding history of multiple sclerosis before the diagnosis of CMML. We outline the evidence supporting the pathogenic role of SH2B3 p.E395K germline mutation, connecting the dots of association between autoimmune diseases and CMML genesis.

Rationale, aims, and objectives: This study provided a platform for electronic prescribing design features that may facilitate antimicrobial stewardship. This study aimed to identify software features within electronic prescribing systems and to assign priorities to these software features according to the opinions of the infection specialist health care professionals. Also, to identify any differences in priorities according to a professional group and experience in using electronic prescribing and communicate research findings to policy-makers and electronic prescribing manufacturers. Methods: The study was conducted in a large (600-bed) governmental tertiary and teaching hospital in Amman, Jordan. The survey was delivered by hand to antimicrobial prescribers (internists, surgeons, paediatricians, infectious diseases specialists, and critical care specialists) and non-prescribers (medical interns, clinical pharmacists, nurses, and other allied health care professionals) who filled out the survey face to face. The delivery of the survey started on March 15, 2020, and was closed on April 7, 2020. Results: Responses were received from 210 individuals. Interns represented more than one-third of respondents (n= 79, 37.6%), with 15.7% were internal medicine physicians. Among the healthcare professionals, around 44.7% (n= 94) are considered prescribers to antimicrobials, while others are considered non-prescribers (n= 116, 55.2%). The majority of respondents (n= 205, 97.6%) reported using an electronic prescribing and electronic health record system for part or all in their hospital, with 35.7% (n= 75) of them reported using these systems for more than one year. The prompt prescribing feature having the highest assigned priority was the allergy checker (n= 193, 91.9%) followed by the dose checker (n= 192, 91.4%). Conclusion: This study demonstrates the first attempt to describe views of healthcare professionals in Jordan about the potential significance of prescribing prompt and active prescription surveillance software features on clinical, microbiological and process outcomes to support antimicrobial stewardship. Findings from this study reveal considerable demand for additional software features expressed by the healthcare professionals charged with promoting rational use of antimicrobials and a consensus of anticipated positive impact on patient safety and efficiency outcomes.

Significance\ud \ud Communicating in ways that motivate engagement in social distancing remains a critical global public health priority during the COVID-19 pandemic. This study tested motivational qualities of messages about social distancing (those that promoted choice and agency vs. those that were forceful and shaming) in 25,718 people in 89 countries. The autonomy-supportive message decreased feelings of defying social distancing recommendations relative to the controlling message, and the controlling message increased controlled motivation, a less effective form of motivation, relative to no message. Message type did not impact intentions to socially distance, but people’s existing motivations were related to intentions. Findings were generalizable across a geographically diverse sample and may inform public health communication strategies in this and future global health emergencies.\ud \ud \ud \ud Abstract\ud \ud Finding communication strategies that effectively motivate social distancing continues to be a global public health priority during the COVID-19 pandemic. This cross-country, preregistered experiment (n = 25,718 from 89 countries) tested hypotheses concerning generalizable positive and negative outcomes of social distancing messages that promoted personal agency and reflective choices (i.e., an autonomy-supportive message) or were restrictive and shaming (i.e., a controlling message) compared with no message at all. Results partially supported experimental hypotheses in that the controlling message increased controlled motivation (a poorly internalized form of motivation relying on shame, guilt, and fear of social consequences) relative to no message. On the other hand, the autonomy-supportive message lowered feelings of defiance compared with the controlling message, but the controlling message did not differ from receiving no message at all. Unexpectedly, messages did not influence autonomous motivation (a highly internalized form of motivation relying on one’s core values) or behavioral intentions. Results supported hypothesized associations between people’s existing autonomous and controlled motivations and self-reported behavioral intentions to engage in social distancing. Controlled motivation was associated with more defiance and less long-term behavioral intention to engage in social distancing, whereas autonomous motivation was associated with less defiance and more short- and long-term intentions to social distance. Overall, this work highlights the potential harm of using shaming and pressuring language in public health communication, with implications for the current and future global health challenges.

Inorganic polymer materials (Geopolymers) are synthesized using alumino-silicate sources as solid components with an alkaline solution. This material is used as an alternative for building materials and provides thermal protection as foaming materials. This paper presents the preparation of these materials by the reaction between glass waste (from brown color bottles BP) with sodium hydroxide NaOH and sodium aluminum (AN5) solutions as alkali activators. For the preparation of mortars (BP-N5 and BP-AN5), sand was used as aggregate. The compressive strengths were assessed (24 and 6 MPa) respectively before heat treatment, the hydrolytic stability (PH and conductivity) tests were performed. Furthermore, hardened mortars have been heated at very high temperatures in the range of 200℃ to 800℃ within two hours. Based on the nature of the foaming behavior of such materials, various variables have changed; (80-140) % volume increase and porosity rise through the process of heat treatment, particularly at 600℃ and 800℃. On the other hand, (3.5-7) % mass reduction occurred. It can be said that the more significant porosity with different geometrical configurations (sizes and shapes) of such materials can be considered as acoustic insulation and thermal materials.

OBJECTIVE The aim of this study was to determine pharmacists' perceived knowledge and expertise required to deliver pharmaceutical care services to pediatric patients. METHODS Once ethical approval was obtained, a questionnaire was posted on local pharmacy groups. The questionnaire is composed of 4 domains: 1) Demographics, 2) Perceived knowledge of pediatric treatment and dosing, 3) Real-life pediatric cases, and 4) Future aspirations to enhance pediatric pharmacy. RESULTS A total of 200 questionnaires were completed and submitted online. Most participants (62.5%) practiced in a community setting. Most respondents (40%) reported that 41% to 60% of their patients were pediatrics. In general, respondents had a good perception of their knowledge and expertise to deliver pharmaceutical care services to pediatric patients. However, most respondents had a low knowledge score when faced with real-life pediatric cases. On a scale of 7 most respondents obtained the score of 2 (32%). CONCLUSIONS The present study sheds light on an alarming lack of knowledge in pediatric pharmaceutics among pharmacies in Jordan. Further training and educational programs should be put in place to address this gap in knowledge.

This study includes investigation and evaluation of the factors that affect the preparation and characterization of nanobinary ethosmal dispersion for flufenamic acid in comparison to liposomal dispersion to optimize its efficiency and produce prolong action. It is involved in the preparation of eighteen formulas of nanoethosomal dispersion and two conventional liposomal dispersions which are optimized by utilizing different methods of preparation and different concentrations of ethanol, propylene glycol (PG), phosphatidylcholine (PC), and cholesterol. The dispersions were characterized morphologically by transmission electronic microscopic (TEM), physical appearance, pH, ʓ-potential, particle size, polydispersity index (PDI), encapsulation efficiency percentage (EE%) and in vitro drug release. The selected optimized nanoethosomal formula (F8) demonstrated pH (6.53), EE% (85.24%), particle size (226.3 nm), PDI (0.010), ʓ-potential (-93.43 mV), sustained release of 94.52% after 24 h and exhibited acceptable stability for 4 weeks preferentially at refrigerated conditions. These results significantly outperformed the classical liposomal dispersion (F1), which demonstrated EE% (70.00%), vesicles size (635.4 nm), PDI (0.347), ʓ-potential (-9.76 mV) and in vitro release of 55.41% after 24 h' demonstrated the potential influence of ethanol and PG on improving the in vitro characterization of the vesicles dispersions. This work succeeded in preparing a well optimized and stable nanoethosomal dispersion for flufenamic acid that can be utilized to prepare a suitable topical preparation to penetrate deep into the epidermal and dermal tissues, giving its action up to 24 h upon single administration.

Background Understanding health care professionals' perceptions towards a Computerised Decision Support System (CDSS) may provide a platform for the determinants of successful adoption and implementation of CDSS. Therefore, this study examines health care professionals' perceptions of barriers and facilitators to adopting a CDSS for antibiotic prescribing in Jordanian hospitals. Methods This cross-sectional study was conducted among healthcare professionals in Jordan's two tertiary and teaching hospitals (n = 254). The survey was adapted from a previous study and comprised demographic items and scales to measure perceptions of healthcare professionals towards the barriers and facilitators to the adoption of CDSS for antibiotic prescribing were developed. In addition, Uni and multivariate logistic regression analyses were applied to screen for factors affecting participants' awareness of using electronic prescribing and electronic health record systems in AMS. Results The majority (n = 84, 72.4%) were aware that electronic prescribing and electronic health record systems could be used to facilitate antibiotic use prescribing. The essential facilitator made CDSS available in a portable format (n = 224, 88.2%). While, insufficient training to use CDSS was the most significant barrier (n = 175, 68.9%). The female providers showed significantly lower awareness (P = 0.006) and the nurses significantly higher awareness (P = 0.041) about using electronic prescribing and electronic health record systems. Conclusion This study examined health care professionals' perceptions towards adopting CDSS in AMS. Results provide insight into the perceived barriers and facilitators to adopting CDSS in AMS.

Community pharmacists (CPs) are among the frontline healthcare providers who have been exposed to a high risk of being infected with SARS-CoV-2 during the pandemic. Unfortunately, there have been limited studies in the Middle East that provide an occupational risk analysis among CPs. Therefore, this study aims to evaluate the risk of COVID-19 exposure among Middle Eastern CPs and to identify the infection predictors.A cross-sectional survey was conducted using an online, self-administered questionnaire that was distributed to CPs across KSA, Lebanon, and Jordan between November and December 2020. The bivariate logistic regression test was used to analyse the predictors associated with COVID-19.CPs were more susceptible to acquiring SARS-CoV-2 than the general public (12.9% vs. 1.5%). The significant predictors of infection included a family member with confirmed COVID-19 infection, age40 years, encountering patients in pharmacy without a protective glass-barrier, and contact with confirmed COVID-19 patients or colleagues with confirmed COVID-19 during practice. Additionally, the mean level of the respondents' expected rate of infection was 3.27 ± 1.04 (out of 5). This level was significantly higher among female pharmacists and Lebanese pharmacists.This study demonstrates that CPs are at a higher risk of acquiring COVID-19 compared with the general public. This is attributed to several occupational factors that increase the risk of exposure to COVID-19. Therefore, healthcare authorities are advised to enforce strict occupational guidelines for CPs.إن صيادلة المجتمع من ضمن مقدمي الرعاية الصحية العاملين في الخطوط الأمامية والمعرضين لخطر كبير للإصابة بفيروس كورونا المستجد أثناء الجائحة. ومن الملاحظ أن دراسات تحليل المخاطر المهنية الخاصة بصيادلة المجتمع في الشرق الأوسط محدودة. لذلك فقد هدفت هذه الدراسة إلى تقييم مخاطر تعرض هؤلاء الصيادلة لفيروس كورونا المستجد وعوامل التنبؤ بالإصابة بالعدوى.تم إجراء مسح مقطعي باستخدام استبانة عبر الإنترنت يتم تعبئتها ذاتيا وتم توزيعها على صيادلة المجتمع في المملكة العربية السعودية ولبنان والأردن خلال شهري نوفمبر وديسمبر 2020. وتم استخدام اختبار الانحدار اللوجستي ثنائي المتغير لتحليل المتنبئات المرتبطة بفيروس كورونا المستجد.كان صيادلة المجتمع أكثر عرضة للإصابة بعدوى فيروس كورونا المستجد من عامة المجتمع (١٢.٩٪ مقابل ١.٥٪). وكانت المؤشرات المهمة للعدوى هي وجود أحد أفراد العائلة مصابا بالعدوى، وكون السن أقل من ٤٠ عاما، ومقابلة المصابين في الصيدلية دون حاجز زجاجي واق، والاحتكاك بمصابين بالعدوى أثناء ممارسة المهنة، ووجود زميل مصاب. بالإضافة إلى ذلك، كان معدل توقع الإصابة بالعدوى لدى الصيادلة ٣.٢٧± ١.٠٤(من ٥). وكان المستوى أعلى بشكل ملحوظ بين الصيادلة الإناث والصيادلة اللبنانيين.أظهرت هذه الدراسة أن صيادلة المجتمع أكثر عرضة للإصابة بعدوى فيروس كورونا المستجد مقارنة بعامة المجتمع. ويعزى ذلك إلى عدة عوامل مهنية تزيد من خطر تعرضهم للفيروس. لذلك فإنه ينبغي للجهات الصحية المسؤولة أن تضع ضوابط توجيهية مهنية صارمة لصيادلة المجتمع مع مراقبة تطبيقها عن كثب.

The full array of cold-responsive cell types within white adipose tissue that drive thermogenic beige adipocyte biogenesis remains undefined. We demonstrate that acute cold challenge elicits striking transcriptomic changes specifically within DPP4+ PDGFRβ+ adipocyte precursor cells, including a β-adrenergic receptor CREB-mediated induction in the expression of the prothermogenic cytokine, Il33. Doxycycline-inducible deletion of Il33 in PDGFRβ+ cells at the onset of cold exposure attenuates ILC2 accumulation and beige adipocyte accrual. These studies highlight the multifaceted roles for adipocyte progenitors and the ability of select mesenchymal subpopulations to relay neuronal signals to tissue-resident immune cells in order to regulate tissue plasticity.

SUMMARYG protein-coupled receptor 84 (GPR84), a medium-chain fatty acid receptor, may be involved in various metabolic conditions but the mechanism remains unclear. We found that GPR84 is highly expressed and functions in brown adipose tissue (BAT). GPR84 knockout mice exhibited increased adiposity and vulnerability to cold exposure after aging, along with an increased BAT lipid content and decreased BAT activation compared to wild-type control mice.In vitro, primary brown adipocytes from GPR84 knockout mice showed reduced expression of thermogenic genes and lower O2consumption. The GPR84 agonist 6-OAU reversed these effects and restored brown adipocyte activation.In vivoandin vitroresults showed that BAT defects in GPR84 knockout mice were attributed to mitochondrial dysfunction. GPR84 activation greatly affected intracellular calcium efflux, further influencing mitochondrial respiration. GPR84 activates BAT by controlling the mitochondrial calcium content and respiration, suggesting a therapeutic target for activating BAT and treating metabolic diseases.HIGHLIGHTSHigh expression of GPR84 in brown adipocytes is induced by cold stimulation.Aged GPR84 knockout mice exhibit brown adipose tissue defects under cold exposure.GPR84 knockout mice show reduced mitochondrial function of brown adipocytes.GPR84 activation improves brown adipocyte functions.

Misalignment of feeding rhythms with the light-dark cycle leads to disrupted peripheral circadian clocks and obesity. Conversely, restricting feeding to the active period mitigates metabolic syndrome through mechanisms that remain unknown. We found that genetic enhancement of adipocyte thermogenesis through ablation of the zinc finger protein 423 (ZFP423) attenuated obesity caused by consumption of a high-fat diet during the inactive (light) period by increasing futile creatine cycling in mice. Circadian control of adipocyte creatine metabolism underlies the timing of diet-induced thermogenesis, and enhancement of adipocyte circadian rhythms through overexpression of the clock activator brain and muscle Arnt-like protein-1 (BMAL1) ameliorated metabolic complications during diet-induced obesity. These findings uncover rhythmic creatine-mediated thermogenesis as an essential mechanism that drives metabolic benefits during time-restricted feeding.

Purpose: Major salivary glands carcinoma (MSGC) comprises a morphologically diverse group of rare tumours with different clinical behaviours, and studies on epidemiology in the literature vary greatly depending on the geographic location. The aim of this study was to conduct a comprehensive analysis of the incidence rates, anatomical sites, and histological subtypes of different salivary gland malignancies in the population of Saudi Arabia. Methods: A retrospective cohort study included patients diagnosed with primary major salivary glands carcinoma (MSGC) in Saudi Arabia from 2008 to 2017, based on the demographic characteristics and histological data retrieved from the Saudi Cancer Registry (SCR) database. Malignant lesions were identified using the International Classification of Diseases for Oncology, Third Edition (ICD-O-3) Codes. Results: Salivary gland malignancies were diagnosed in 571 patients over 10 years (50.10% were males and 49.90% females). The parotid gland was the site of origin in 69.9% of cases. The most common histological type was mucoepidermoid carcinoma (29.1%). Over a decade, the incidence rate ranged from (0.15 to 0.24), with the highest overall in 2009. The peak incidence of salivary gland malignancies was observed in the fourth, fifth and sixth decade of life (17.5%, 18.2%, and 16.8%, respectively). Conclusion: Major salivary gland carcinomas (MSGC) are extremely rare in the Saudi population, with a low incidence rate of only 0.15 to 0.24 cases per 100,000 person-year compared to other parts of the world. However, the clinical findings of Salivary gland carcinoma were similar to those described worldwide.

The molecular origins of homochirality on Earth is not understood well, particularly how enantiomerically enriched molecules of astrobiological significance like sugars and amino acids might have been synthesized on icy grains in space preceding their delivery to Earth. Polycyclic aromatic hydrocarbons (PAHs) identified in carbonaceous chondrites could have been processed in molecular clouds by circularly polarized light prior to the depletion of enantiomerically enriched helicenes onto carbonaceous grains resulting in chiral islands. However, the fundamental low temperature reaction mechanisms leading to racemic helicenes are still unknown. Here, by exploiting synchrotron based molecular beam photoionization mass spectrometry combined with electronic structure calculations, we provide compelling testimony on barrierless, low temperature pathways leading to racemates of [5] and [6]helicene. Astrochemical modeling advocates that gas-phase reactions in molecular clouds lead to racemates of helicenes suggesting a pathway for future astronomical observation and providing a fundamental understanding for the origin of homochirality on early Earth.

Long noncoding RNAs (lncRNAs) have been recently recognized as key players of gene expression in cerebral pathogenesis. Thus, their potential use in stroke diagnosis, prognosis, and therapy is actively pursued. Due to the complexity of the disease, identifying stroke-specific lncRNAs remains a challenge. This study investigated the expression of lncRNAs HIF1A-AS2 and LINK-A, and their target gene hypoxia-inducible factor-1 (HIF-1) in Egyptian stroke patients. It also aimed to determine the molecular mechanism implicated in the disease. A total of 75 stroke patients were divided into three clinical subgroups, besides 25 healthy controls of age-matched and sex-matched. Remarkable upregulation of lncRNA HIF1A-AS2 and HIF1-α along with a downregulation of lncRNA LINK-A was noticed in all stroke groups relative to controls. Serum levels of phosphatidylinositol 3-kinase (PI3K), phosphorylated-Akt (p-Akt), vascular endothelial growth factor (VEGF), and angiopoietin-1 (ANG1) as well as their receptors, malondialdehyde (MDA), and total antioxidant capacity (TAC) were significantly increased, whereas brain-derived neurotrophic factor (BDNF) levels were significantly decreased particularly in hemorrhagic stroke versus ischemic groups. Eventually, these findings support the role of lncRNAs HIF1A-AS2 and LINK-A as well as HIF1-α in activation of angiogenesis, neovascularization, and better prognosis of stroke, especially the hemorrhagic type.

In dental accident cases the incidence of root fractures in permanent teeth are just 0.5-7% of the cases. Root fractures in the middle third are more frequently involved than the apical third fracture. Since their management may require an interdisciplinary/multidisciplinary approach to care, root fractures are clinically challenging. Thus, to ensure a good treatment plan and, therefore, the best possible prognosis, a clinician must strive for the right diagnosis of root fractures and have detailed knowledge of various therapeutic approaches. The present case highlights the use of the glass fiber post in the upper left lateral incisor, which is endodontically treated, demonstrating a complicated horizontal root fracture in the middle third of the root, stabilizing the fractured root fragments and monitoring the patient for one year, showing a well preserved assembly of the root fragments and the post. Keywords: Glass Fiber Post, Root Fracture, Horizontal Root Fracture.

Introduction: Immunohistochemistry plays an important but limited role in the diagnosis of primary bone tumors. Sometimes it is very difficult to differentiate osteosarcomas histologically from other tumors with similar morphology but with different malignant potential and treatment protocol. The correct diagnosis of OSA relies on identification of osteoid production by malignant cells which can be detected by the use of osteonectin. Materials and Methods: The present study was carried out on 200 patients of benign and malignant lesions of bone. After a detailed clinical history and local examination, paraffin section of resected specimens were studied by hematoxylin and eosin and immunohistochemical stain, osteonectin and matrix was graded on a four-tiered grading system with statistical analysis of osteonectin positivity in osteogenic bone tumours and tumour-like lesions. Results: Benign and malignant tumours accounted for 74.6% and 25.0% of the total cases. Osteoid production were seen in 36 cases (100.0%) of osteosarcomas, followed by fibrous dysplasia in 18 cases (100.0%) and osteoid osteoma in 10 cases (100.0%). Both polygonal and spindle shaped tumour cells in osteosarcoma showed Grade 4 positivity with osteonectin. Fibroblastic variant of osteosarcoma showed diffuse (Grade 4) and focal strong staining (Grade 2) alternating with negative areas. Chondroblastic variant of osteosarcoma showed Grade 4+ immunoreactivity in conventional osteosarcoma like areas, whereas chondrocyte- like tumour cells surrounded by chondro-osteoid –like matrix showed well- defined osteonectin staining. Conclusions: Osteonectin is a helpful osteogenic marker for establishing the diagnosis of osteoblastic origin of a tumour that produce no or scarcely any matrix. Keywords: Bone Tumors, Immunohistochemistry, Osteonectin.

Purpose The development and production of novel vaccine to prevent COVID-19 is an international imperative to human lives. For that purpose, clinical trials have to be carried out as per international ethical standards. The current study was undertaken to examine the willingness to participate in COVID-19 vaccine clinical trials and to determine factors that might affect their decision to participate. Patients and Methods A cross-sectional survey study was carried out among the public in Jordan. During the study period, a convenience sample of adults (aged 18 years or above) were asked to participate via an online self-administered survey that was designed to evaluate the willingness to participate in COVID-19 vaccine clinical trials and to determine factors affecting their decision to participate. Results Results showed that, among participants (n=1,287), 36.1% reported to be willing to participate in clinical trials of the vaccine. Additionally, a lower percentage (18.1%) were willing to allow their children to participate. Motivators that encourage participation were the desire to return to normal life (73.2%), followed by the desire to help in finding a treatment for COVID-19 infection (68.1%). Barriers towards the participation were not wanting to be challenged by the virus (54.7%), fear (40.7%), lack of time (40.4%), and mistrust in pharmaceutical companies (38.9%). Finally, results showed that higher educational level was associated with lower willingness to participate (P=0.001), whereas having a previous participation in clinical studies is associated with a significantly higher willingness to participate in COVID-19 vaccine clinical trials (P

The molecular mechanisms underlying obesity-induced increases in β cell mass and the resulting β cell dysfunction need to be elucidated further. Our study revealed that GPR92, expressed in islet macrophages, is modulated by dietary interventions in metabolic tissues. Therefore, we aimed to define the role of GPR92 in islet inflammation by using a high-fat diet-induced (HFD-induced) obese mouse model. GPR92-KO mice exhibited glucose intolerance and reduced insulin levels - despite the enlarged pancreatic islets - as well as increased islet macrophage content and inflammation level compared with WT mice. These results indicate that the lack of GPR92 in islet macrophages can cause β cell dysfunction, leading to disrupted glucose homeostasis. Alternatively, stimulation with the GPR92 agonist farnesyl pyrophosphate results in the inhibition of HFD-induced islet inflammation and increased insulin secretion in WT mice, but not in GPR92-KO mice. Thus, our study suggests that GPR92 can be a potential target to alleviate β cell dysfunction via the inhibition of islet inflammation associated with the progression of diabetes.

Chronic low-grade white adipose tissue (WAT) inflammation is a hallmark of metabolic syndrome in obesity. Here, we demonstrate that a subpopulation of mouse WAT perivascular (PDGFRβ+) cells, termed fibro-inflammatory progenitors (FIPs), activate proinflammatory signalling cascades shortly after the onset of high-fat diet feeding and regulate proinflammatory macrophage accumulation in WAT in a TLR4-dependent manner. FIPs activation in obesity is mediated by the downregulation of zinc-finger protein 423 (ZFP423), identified here as a transcriptional corepressor of NF-κB. ZFP423 suppresses the DNA-binding capacity of the p65 subunit of NF-κB by inducing a p300-to-NuRD coregulator switch. Doxycycline-inducible expression of Zfp423 in PDGFRβ+ cells suppresses inflammatory signalling in FIPs and attenuates metabolic inflammation of visceral WAT in obesity. Inducible inactivation of Zfp423 in PDGFRβ+ cells increases FIP activity, exacerbates adipose macrophage accrual and promotes WAT dysfunction. These studies implicate perivascular mesenchymal cells as important regulators of chronic adipose-tissue inflammation in obesity and identify ZFP423 as a transcriptional break on NF-κB signalling. PDGFRβ+ perivascular mesenchymal cells are shown to regulate chronic adipose-tissue inflammation in obesity through downregulation of ZFP423, a transcriptional corepressor of NF-κB.

Aim To investigate the relationship between maternal bonding and infant temperament during the first year of infant's life. Moreover, it also wanted to explore which perinatal factors could influence the quality of maternal attachment. Method A cross‐sectional study design was used to collect data from a sample of 277 mothers during the period of May–October 2018. The participants were asked to complete a three‐part survey that was developed to collect data on maternal attachment and infant temperament. Data was collected between March 2019–June 2019. Results The analysis of the data revealed that there was a significant relationship between infant temperament and maternal attachment [F(2, 95) = 6.783, p‐value = .001]. It also revealed that the factors that most influenced maternal attachment were infant temperament and planned pregnancy, which together explained 54% of the variance in maternal attachment (R 2 = 7.5). Conclusion Maternal attachment in Jordanian mothers can be explained by two significant factors: infant temperament and planning for pregnancy.

Background Pediatric pharmaceutical care is a new concept in the pharmacy profession. In Jordan, the knowledge of pediatric pharmaceutical care is limited, which may have negative consequences on pediatric pharmaceutical care and treatment efficacy and safety. Objectives The main objective of the present study is to assess parental needs for pediatric pharmaceutical care services and explore their current experiences of pharmaceutical services provided to their children. Setting Parental Facebook Groups in Jordan. Methods A descriptive, cross-sectional survey was designed and distributed online via Social Media networks, mainly Facebook. The validated survey contained 4 main sections addressing different themes related to pediatric pharmaceutical care services including: (1) parental perception of pediatric pharmaceutical care services. (2) Parental needs, wants, and expectations from the pharmacist when providing care to their children. (3) Parental awareness about pediatric pharmaceutical care, and parental satisfaction with current pediatric pharmaceutical care. Respondents who agreed to complete the survey signed and electronic informed consent form to access it. Main outcome measure The main outcomes measure was parental need for pediatric pharmaceutical care services. Results A total of 1104 respondents took part in the study. Of those 71% were female and 44% were 31-40 years old. The majority of respondents (78%) were not familiar with the pediatric pharmaceutical care term. The calculated overall mean perception score was 63.4%. The majority of respondents (89%) reported to need pediatric pharmaceutical care and the mean need score was 71.7%. Only 10.5% agreed/strongly agreed that their children were offered good pediatric pharmaceutical care services and respondents has a total mean satisfaction score of 65.7%. Conclusion The majority of the respondents reported that they need pharmaceutical care services for their children. Pharmacists in Jordan have to develop their role to incorporate pediatric pharmaceutical care services in their practice.

Objectives: To evaluate the role of angiogenesis by the assessment of mean vessel density and to quantify angiogenesis as an important variable in different benign and premalignant endometrial lesions. Materials and Methods: Endometrial biopsies and hysterectomy specimens were examined to evaluate and define any correlation between angiogenesis and different phases and premalignant diseased states of the endometrium. Microvessel counts were performed by examining the microvessels thoroughly in terms of count, morphology and density after staining the tissues by hematoxylin & eosin stain, reticulin stain and immunostain CD 34. Results: A total of 381cases of benign and premalignant endometrial lesions were included in the study. In 135 cases of simple hyperplasias, Microvessel Density (MVD) ranged from 2.4 - 6.7 and Mean MVD was 4.71 on H&E stain and MVD ranged from 2.8 - 8.3 with Mean MVD of 5.39 on reticulin stain. In 105 cases of complex hyperplasias, MVD ranged from 2.3 - 7.0 and Mean MVD was 4.93 on H &E satin and MVD ranged from 3.1-7.7 with Mean MVD of 5.68 on reticulin stain. In 67 cases of atypical hyperplasias, inbudding and outpouching of the glandular epithelium together with multilayering was appreciated with MVD from 4.5 - 8.8 and Mean MVD of 6.31 on H &E stain and MVD of 5.5 - 9.4 with Mean MVD of 7.19 on reticulin stain. A statistically significant difference was noted in all categories except in between simple and complex hyperplasia where the difference was not statistically significant. The role of angiogenesis becomes more significant with increasing severity of lesion, both in terms of hyperplasia and atypia when compared to normal endometrium. Although angiogenesis can be detected on immunostain more easily, it can be illustrated well by H and E or Reticulin stain. Conclusions: Role of angiogenesis becomes more significant with increasing severity of lesion, both in terms of hyperplasia and atypia when compared to normal endometrium. Although an

Background Tuberculosis remains a major health problem in the less developed nations and is now a major health problem in developed countries, owing to the emergence of human immunodeficiency virus (HIV) infection and (AIDS). However, despite the availability of effective chemotherapy, patient noncompliance with regimens is the most common reason for therapeutic failures. The aim of this study is to describe the cytological features of drug defaulters on lymph node fine-needle aspiration cytology (FNAC). Objective Due to the common problem of drug defaulters in developing countries like India, we had carried out a study to see the cytological features of drug defaulters on FNAC of the lymph node. Method Three hundred fifty tuberculosis cases, diagnosed based on Mantoux (Mx) test, acid-fast bacilli and/or culture, were followed up for drug compliance by cervical lymph node FNAC. Result Forty cases were found to be drug defaulters on detailed and meticulous follow-up. These patients were found to have splintered epithelioid cell granuloma with some viable epithelioid cells enmeshed in fibrous tissue elements. Other findings were degenerating epithelioid cells with or without surrounding eosinophilic infiltration and leaching of the degenerating lymphoid and epithelioid cells. Conclusion Lymph node FNAC can be used to identify tubercular drug defaulters, which may be time consuming and/or expensive by culture or other ancillary means.

One of the most lethal malignancies worldwide is colorectal cancer (CRC). Alterations in various signalling pathways, including PI3K-mTOR and NF-κB, have been reported in CRC with subsequent dysregulation of proliferation, apoptosis, angiogenesis and, questionably, autophagy processes. BEZ-235 (dactolisib) is a dual PI3K-mTOR inhibitor with potent anti-tumour activity. However, the observed toxicity of BEZ-235 necessitated the termination of its clinical trials. Hence, we aimed to evaluate the potential long-lasting anti-carcinogenic effects of adding diosmin (DIO, a natural NF-κB inhibitor) to BEZ-235 in HCT-116 CRC cells. The median inhibitory concentrations (IC50s) of BEZ-235 and/or DIO were evaluated in the HCT-116 CRC cell line. Caspase-3 activity was assessed colorimetrically, and p-Akt, NF-κB, CD1, VEGF and LC3B levels were assessed by ELISA. Additionally, LC3-II and P62 gene expression were assessed using qRT-PCR. The observed CIs (combination indices) and DRIs (dose reduction indices) confirmed the synergistic effect of DIO and BEZ-235. Co-administration of both drugs either in combination-1 (1 μM for BEZ-235, 250 μM for DIO) or in combination-2 (0.51 μM for BEZ-235 + 101.99 μM for DIO) inhibited the PI3K/Akt/mTOR/NF-κB axis, leading to the induction of apoptosis (via active caspase-3), and the inhibition of proliferation marker (CD1), angiogenesis marker (VEGF), autophagy protein (LC3B) and altered effects on LC3-IIandP62 gene expression. Our results reveal the synergistic chemotherapeutic effects of DIO combined with BEZ-235 in the HCT-116 CRC cell line and encourage future preclinical and clinical studies of this combination with reduced BEZ-235 concentrations to avoid its reported toxicity.

Introduction. Primary extrahepatic hydatid cysts are rare, and primary splenic hydatid cysts even rarer. Splenic hydatidosis constitutes 2% to 3.5% of all hydatid cysts. Aim. To present a case report of splenic hydatidosis with abdominal pain. Description of the case. We report here a case of isolated splenic hydatid cysts in a 23 year old female, who presented with dull dragging pain in the left hypochondrium. Diagnosis was made on computed tomography imaging of the abdomen and microscopic examination of the laminated hydatid cyst wall and supplemented with positive enzyme linked immunosorbent assay for hydatid antibodies. Conclusion. The incidence of splenic involvement by hydatid cysts is very low. Man is an accidental intermediate host, as entry of the larval forms into humans represents an end stage in its life cycle. Until recently the gold standard treatment for splenic hydatidosis was splenectomy, as medical therapy seems to be ineffective. However, the last two decades have shown a tendency towards splenic conservative surgery in suitable cases, to reduce opportunistic post splenectomy infection.

Background: Diabetes mellitus is a long-lasting metabolic disorder that hinders the capability of the body to utilize food properly and is affected day by day through our diet, exercise, infection and stress. Presently, the trend is more towards natural plant-based products containing potential bio-active components than towards conventional medicines. For the purpose, out of numerous herbs used in common medicines, the subfamily of Asphodelus tenuifolius, used for several ailments, anti-inflmmation, anti-hypertension and antidiuretics etc. Objective: The objective of the present study was to evaluate the therapeutic effect of Asphodelus tenuifolius against streptozotocin induced diabetic rats. Method: The current study was based on the in vitro and in vivo properties of Asphodelus tenuifolius. The in vivo study was conducted that includes the TPC, TFC & DPPH. The in vitro study was also administered that includes the body weight and glucose levels of the rats. The thirty rats were divided into six groups; normal control, disease control, drug control, extracts treatment at 250, 500 and 750 mg/kg respectively. Results: The results depicted that the maximum decline in blood glucose levels of the streptozotocin induced diabetic rats were observed in T5. However, the body weights of the diabetic rats were maintained. Conclusion: Conclusively, Asphodelus tenuifolius plants contain a bio-active component that help to reduce hyperglycemia, maintains body weights in streptozotocin induced diabetic rats.

This study investigated changes in the average grain size and hardness values of 253 MA austenitic stainless steel (ASS) and determined the grain growth kinetics as well as a hardness empirical model. A 35% multi-pass cold rolling process was employed to reduce the thickness of a 253 MA austenitic stainless steel pipe. Then, the rolled steel was annealed at 1100 °C for various soaking times of 0, 900, 1800, 2700, and 3600 s in a tubular furnace under a hydrogen atmosphere, followed by quenching to room temperature in the cool zone of the furnace. Then, micro-Vickers hardness measurements were done using a force of 0.3 N and the grain size changes were observed. A line intercept method was applied to measure the change of the 253 MA austenitic grain size. The results show that the average grain size of 253 MA ASS (austenitic stainless steel) increased with soaking time, while the hardness values decreased. Additionally, an equation modeling the predicted grain growth and hardness values was obtained.

Supplemental Material, sj-pdf-1-dos-10.1177_15593258221108280 for In-silico Studies Calculated a New Chitin Oligomer Binding Site Inside Vicilin: A Potent Antifungal and Insecticidal Agent by Ahsan Saeed, Zahra Rafiq, Muhammad Imran, Qamar Saeed, Muhammad Q. Saeed, Zahid Ali, Rana K. Iqbal, Saber Hussain, Binish Khaliq, Sohaib Mehmood and Ahmed Akrem in Dose-Response

Background: Corticosteroids play a significant role in managing the vast majority of inflammatory and immunologic conditions. To date, population-based studies on knowledge and attitudes concerning corticosteroids are scarce. This study aims to comprehensively assess knowledge, perception, experience and phobia toward corticosteroid use among the general population in the era of COVID-19. Methods: A cross-sectional self-administrated questionnaire was used to collect the data from 6 countries. Knowledge and corticophobia scores, descriptive statistics and logistic regression were computed. Results: A total of 2354 participants were enrolled in this study; the majority were females (61.6%) with an average age of 30. Around 61.9% had been infected previously with COVID-19, and about one-third of the participants had experience with corticosteroid use. The mean knowledge score was relatively satisfactory (8.7 ± 4.5 out of 14), and Corticophobia ranked a high score in all countries. Age, female gender, and history of COVID-19 were positively correlated with developing corticophobia. Conclusion: Our study highlights that the general knowledge about steroids was satisfactory. However, the phobia toward its use upon indication is high. Therefore, enhancing awareness and providing essential counseling regarding the rational use of corticosteroids may reduce corticophobia.

Neurofibromas of salivary gland are very rare and account for only 0.4% of all salivary gland neoplasms. Plexiform type of neurofibromas are predominantly seen in a scenario of neurofibromatosis-1 (NF-1) association, but solitary plexiform neurofibroma has also been occasionally reported. We present a report of this variant in a 17-year-old male who is presented with a slow-growing painless swelling in the right preauricular region for 8-month duration. Microscopic examination revealed multiple cell types including Schwann cells, perineurial cells, axons, lymphocytes, mast cells, and endoneurial fibroblasts. Immunostaining with S100 confirmed the neural origin. How to cite this article: Qadri S, Rabindranath D, Quadri S, et al. Facial Plexiform Neurofibroma as an Intraparotid Nodule: A Rare Case Presentation. Int J Otorhinolaryngol Clin 2020;12(1):8–10.

Trauma is the number one cause of death among Americans between the ages of 1 and 46, costing$670 billion a year. Blunt and penetrating trauma can lead to cardiac and aortic injuries, with the incidence of death varying upon the location of the damage. Among those who reach the hospital alive, many may survive if the hemorrhage and cardiovascular injuries are diagnosed and treated adequately in a timely fashion. Although echocardiography often is underused in the setting of cardiac trauma, it offers significant diagnosis and treatment potential because it is accessible in most settings, safe, relatively noninvasive, and can provide rapid and accurate trauma assessment in the hands of trained providers. This review article aims to analyze the pathophysiology of cardiac injuries in patients with trauma and the role of echocardiography for the accurate diagnosis of cardiac injury in trauma. This review, additionally, will offer a patient-centered, team-based, early management plan with a treatment algorithm to help improve the quality of care among these patients with cardiac trauma.

Energy-storing white adipocytes maintain their identity by suppressing the energy-burning thermogenic gene program of brown and beige adipocytes. Here, we reveal that the protein–protein interaction between the transcriptional coregulator ZFP423 and brown fat determination factor EBF2 is essential for restraining the thermogenic phenotype of white adipose tissue (WAT). Disruption of the ZFP423–EBF2 protein interaction through CRISPR–Cas9 gene editing triggers widespread “browning” of WAT in adult mice. Mechanistically, ZFP423 recruits the NuRD corepressor complex to EBF2-bound thermogenic gene enhancers. Loss of adipocyte Zfp423 induces an EBF2 NuRD-to-BAF coregulator switch and a shift in PPARγ occupancy to thermogenic genes. This shift in PPARγ occupancy increases the antidiabetic efficacy of the PPARγ agonist rosiglitazone in obesity while diminishing the unwanted weight-gaining effect of the drug. These data indicate that ZFP423 controls EBF2 coactivator recruitment and PPARγ occupancy to determine the thermogenic plasticity of adipocytes and highlight the potential of therapeutically targeting transcriptional brakes to induce beige adipocyte biogenesis in obesity.

Homeothermic vertebrates produce heat in cold environments through thermogenesis, in which brown adipose tissue (BAT) increases mitochondrial oxidation along with uncoupling of the electron transport chain and activation of uncoupling protein 1 (UCP1). Although the transcription factors regulating the expression of UCP1 and nutrient oxidation genes have been extensively studied, only a few other proteins essential for BAT function have been identified. We describe the discovery of FAM195A, a BAT-enriched RNA binding protein, which is required for cold-dependent thermogenesis in mice. FAM195A knockout (KO) mice display whitening of BAT and an inability to thermoregulate. In BAT of FAM195A KO mice, enzymes involved in branched-chain amino acid (BCAA) metabolism are down-regulated, impairing their response to cold. Knockdown of FAM195A in brown adipocytes in vitro also impairs expression of leucine oxidation enzymes, revealing FAM195A to be a regulator of BCAA metabolism and a potential target for metabolic disorders.

Papillary lesions of the breast include a broad spectrum of entities, many of which pose a diagnostic challenge for the pathologist. Papillary Carcinoma is a rare malignancy of the breast accounting for 0.5- 2% of all breast carcinomas. It occurs more frequently in post-menopausal women over the age of 60. The most common presentation is a painless, mobile mass with bloody nipple discharge. Mammography typically shows a large circumscribed mass with an irregular or nodular contour.We present a case of a 42-year-old-woman with a painless lump in the right breast for 11 months, diagnosed as encapsulated papillary carcinoma of breast with in-situ component. Keywords: Breast, Encapsulated papillary carcinoma, Histopathology.

Scrotal calcinosis is a rare benign disease, which presents as multiple, painless, hard nodular growth in the scrotum without any systemic metabolic disorder. Histologic features of the lesion are extensive dermal deposits of calcium, with associated lympho-histiocytic aggregates and focal foreign body giant cell reaction. The pathogenetic mechanisms could be either purely idiopathic or any form of dystrophic calcification of the lining epithelial cysts or any inflammatory process with subsequent rupture, calcification and obliteration of the cyst wall. We present a rare case report of a 23-year-old male, who presented to the general surgery clinic with complaints of multiple, firm to hard scrotal swellings for the last 6 months. Microscopic examination of the excised growth showed multiple cysts with foci of normal and inflamed lining, with luminal calcific material with foci of ‘naked’ calcium deposits in the dermis. Biochemical tests showed normal values of serum calcium and phosphorus levels in our patient. Keywords: Scrotum, Biochemical, Calcinosis, Histopathology.

Polycyclic aromatic hydrocarbons (PAHs) represent the link between resonance-stabilized free radicals and carbonaceous nanoparticles generated in incomplete combustion processes and in circumstellar envelopes of carbon rich asymptotic giant branch (AGB) stars. Although these PAHs resemble building blocks of complex carbonaceous nanostructures, their fundamental formation mechanisms have remained elusive. By exploring these reaction mechanisms of the phenyl radical with biphenyl/naphthalene theoretically and experimentally, we provide compelling evidence on a novel phenyl-addition/dehydrocyclization (PAC) pathway leading to prototype PAHs: triphenylene and fluoranthene. PAC operates efficiently at high temperatures leading through rapid molecular mass growth processes to complex aromatic structures, which are difficult to synthesize by traditional pathways such as hydrogen-abstraction/acetylene-addition. The elucidation of the fundamental reactions leading to PAHs is necessary to facilitate an understanding of the origin and evolution of the molecular universe and of carbon in our galaxy.