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The pediatric International IgA Nephropathy (IgAN) Prediction Tool comprises two models with and without ethnicity and is the first method to predict the risk of a 30% decline in estimated glomerular filtration rate (eGFR) or kidney failure in children at the time of biopsy using clinical risk factors and Oxford MEST histology scores. However, it is unknown if the Prediction Tool can be applied after a period of observation post-biopsy. Using an international multi-ethnic cohort of 947 children with IgAN, 38% of whom were followed into adulthood, the Prediction Tool was updated for use one year after biopsy. Compared to the original pediatric Prediction Tool, the updated post-biopsy Prediction Tool had a better model fit with higher R2D(51%/50% vs 20%), significant increase in 4-year C-statistics (0.83 vs 0.73/0.69, ΔC 0.09 [95% confidence interval 0.07-0.10] and ΔC 0.14 [0.12-0.15]) and better 4-year calibration with lower integrated calibration indices (0.74/0.54 vs 2.45/1.01). Results were similar after internal validation and when the models were applied two years after biopsy. Trajectories of eGFR after a baseline one year post-biopsy were non-linear and those at higher predicted risk started with a lower eGFR and experienced a more rapid decline over time. In children, eGFR had a variable rate of increase until 15-18 years old and then decreased linearly with a more rapid decline in higher risk groups that was similar to young adults of comparable risk. Thus, the original pediatric Prediction Tool should be used in children at the time of biopsy, and the updated pediatric Prediction Tool should be used to re-evaluate risk one or two years after biopsy.

A reliable hemicellulose extraction method from oil palm empty fruit bunches (OPEFB) is required for subsequent investigations into its composition and participation in pyrolysis and anaerobic digestion processes. Previous hemicellulose OPEFB research only looked at yield, purity and functional characteristics. In this study, OPEFB extractives were removed followed by hemicellulose A (HA) and B (HB) isolation and characterisation using Fourier-transform infrared, thermogravimetric and ultimate analysis. Energy dispersive X-ray spectroscopy (EDS) was deployed on the extractive-free OPEFB ash. Ethanol-toluene removed 8.2 ± 0.1 wt% extractives from OPEFB, with ethanol only removing another 1.6 ± 0.1 wt% while water extracted a further 5.4 ± 1.1 wt%. Alkaline extraction of OPEFB with 3 M KOH at 40 °C and subsequent centrifugation yielded 28.6 wt% HA, while 8.0 wt% HB was obtained as a precipitate from the supernatant of HA using 95% ethanol. The empirical formula of commercial xylan, a hemicellulose surrogate, and HA and HB were C5H9.5O4.4, C5H9.4O4.1and C5H9.8O2.9, respectively. FTIR analysis suggests that xylose and arabinose were the main constituents of xylan, HA and HB. The ash content (AC) of HA and HB was ten times greater than xylan (2.7 wt%). EDS analysis suggests that the high AC of HA and HB is attributed to Ca, Mg and Si which could not be effectively removed during extractives removal. Thermogravimetry identified a common decomposition peak at 219 °C confirming the presence of hemicellulose in the isolated HA and HB. Further research is required to refine the extraction protocol to obtain purer OPEFB hemicellulose.

In this work, we assess the potential of computer vision techniques for age estimation of Gulf Menhaden Brevoortia patronusscales. Scales are the primary structure used for the age determination of Gulf Menhaden, and the ageing process can be labor intensive. Gulf Menhaden is the second‐largest fishery by weight in the United States, with average annual landings from 2018 to 2022 of 449,540 metric tons, and is assessed with age‐structured models that require information about the age structure of the catch and the stock. We used convolutional neural networks and deep neural networks to classify the age from images of Gulf Menhaden scales from three different sets of images of scales. The first set of data consists of images of scales from fish at ages 0 and 1 year. The second set of data consists of images of scales from fish at ages 0–4 years. The last set of data consists of images of scales from fish of ages 0, 1, and 2 years and includes only images of scales for which there is agreement by readers of age estimates derived from analyzing sagittal otoliths and scales from the same individual. The classification of ages was best when using a convolutional neural network model on the first data set. The poorest classification was for the model using deep neural networks with the second data set. Although we show that computer vision has promise for age determination from fish scale samples, our results indicate that considerable work must be done for wide adoption of the approach. With the continuous enhancements of computer vision models, improvements in the quality of scale images, and the accumulation of larger sets of scale images that can be used to train machine learning models, we believe that using computer vision can serve to reduce processing time and increase the accuracy of age estimates. Impact statementComputer vision techniques have been widely employed for image analysis but remain novel for fish age determination in a management context. In this work, we show that the approach has promise and document some of the hurdles that must be overcome prior to widespread use. Computer vision techniques have been widely employed for image analysis but remain novel for fish age determination in a management context. In this work, we show that the approach has promise and document some of the hurdles that must be overcome prior to widespread use.

Objective: FFA is a well-established investigation for the diagnosis of optic nerve abnormalities, requiring an intravenous cannula and extended imaging acquisition time. Cannulation can present a challenge in paediatric patients and whilst oral FFA has been used for decades, it has been limited by imaging technology and unconfirmed image acquisition timings. For years, we have used a modern ultra-widefield retinal camera, and established imaging time-points to demonstrate dynamic optic nerve head changes upon ingestion of fluorescein and collected a database of oFFA images for various presentations. Methods: Using an established protocol, optic nerve colour images were obtained, followed by oral administration of fluorescein dye. The optic nerves are then imaged at established intervals. An interpretation of oFFA tutorial was delivered to consultant ophthalmologists and trainees. Subsequently, these groups were assessed using a series of fifteen cases with the sensitivity and specificity of the test determined. Results: Our study presents a series of images and descriptions for common optic nerve abnormalities in paediatric populations. In the interpretation part of the study, overall sensitivity of 76.8% in the consultant group vs 63.3% in the combined consultant + trainees and specificity of 87.5% vs 68.4% in the combined group. Conclusions: This is the first study that describes characteristic features of several common, and serious, optic nerve abnormalities specifically for oFFA interpretation in a paediatric population. It also highlights the rapid accumulation of oFFA interpretation skills in non-specialist consultant and trainee ophthalmologists such as to obtain a high diagnostic accuracy with high sensitivity and specificity.

Abstract The outdoor advertising industry has undergone significant transformation. New proprietary information is promoted and sponsored by an industry trade organization comprised of advertisers, agencies, and media companies. The number [...]

Spinal pial arteriovenous fistulas (spAVFs) are rare, high-flow vascular malformations consisting of a single dilated pial artery connecting directly to an enlarged draining vein. This article describes the anatomic, clinical, and diagnostic features of spAVFs, to help clinicians to select the best treatment option. Both surgical and endovascular treatments are effective; microsurgery has a higher success rate. To maximize the exclusion rate, a multidisciplinary approach and adequate preoperative study are mandatory.

Solvent extraction is commonly used to extract oil from most seeds, including Moringa oleifera (MO). Oil extraction is a critical step in the production of cosmetics, pharmaceuticals, and other products that require the maximum amount of oil from the seed. On the other hand, MO as a coagulant need to be oil-free for coagulation performance. Therefore, optimization of oil yield is kept up to date. The extraction time, seed to solvent ratio, and particle size are the most optimised parameters reported on MO. Most Soxhlet extraction methodologies reported in the past mention a time range for extracting oil from the seed. Following the same extraction time, however, frequently results in variation in the yield of MO obtained. Because of this lack of reproducibility in oil yield, it has been demonstrated that using extraction time as a basis for monitoring the point at which maximum oil yield is achieved is not completely reliable. The range of ratios, solvent type, moisture content of the seed and the heating mantle vary from one to another. This study is focusing on oil extraction based on the number of siphons(8,16,24,32 siphons) using 2 different solvents (ethanol with a boiling point of and n-henaxe with a boiling point of) and shows that the optimum oil yield is at 16 siphons. It is also important to see when the extraction should stop for industrial scale to be cost effective. This method is then validated with two batches of MO seed for reproducibility. In addition, the use of polar solvents such as ethanol may also remove more protein and minerals from the seed, which can affect the quality and performance of the defatted MO seed in coagulation assays. Hence, EDS tests are included for preparing the suitable solvent used based on mineral removal.

Aureobasidin A (abA) is a natural depsipeptide that inhibits inositol phosphorylceramide (IPC) synthases with significant broad-spectrum antifungal activity. abA is known to have two distinct conformations in solution corresponding to trans-and cis-proline (Pro) amide bond rotamers. While the trans-Pro conformation has been studied extensively, cis-Pro conformers have remained elusive. Conformational properties of cyclic peptides are known to strongly affect both potency and cell permeability, making a comprehensive characterization of abA conformation highly desirable. Here, we report a high-resolution 3D structure of the cis-Pro conformer of aureobasidin A elucidated for the first time using a recently developed NMR-driven computational approach. This approach utilizes ForceGen’s advanced conformational sampling of cyclic peptides augmented by sparse distance and torsion angle constraints derived from NMR data. The obtained 3D conformational structure of cis-Pro abA has been validated using anisotropic residual dipolar coupling measurements. Support for the biological relevance of both the cis-Pro and trans-Pro abA configurations was obtained through molecular similarity experiments, which showed a significant 3D similarity between NMR-restrained abA conformational ensembles and another IPC synthase inhibitor, pleofungin A. Such ligand-based comparisons can further our understanding of the important steric and electrostatic characteristics of abA and can be utilized in the design of future therapeutics.

Background: Gene expression profiling data for human primary cutaneous melanomas are scarce because of the lack of retrospective collections of frozen tumors. To identify differentially expressed genes that may be involved in melanoma progression and prognosis, we investigated the relationship between gene expression profiles and clinical outcome in a cohort of patients with primary melanoma. Methods: Labeled complementary RNA (cRNA) from each tissue sample was hybridized to a pangenomic 44K 60-mer oligonucleotide microarray. Class comparison and class prediction analyses were performed to identify genes whose expression in primary melanomas was associated with 4-year distant metastasis-free survival among 58 patients with at least 4 years of follow-up, distant metastasis, or death. Results were validated immuno-histochemically at the protein level in 176 independent primary melanomas from patients with a median clinical follow-up of 8.5 years. Survival was analyzed with a Cox multivariable model and stratified log-rank test. All statistical tests were two-sided. Results: We identified 254 genes that were associated with distant metastasis-free survival of patients with primary melanoma. These 254 genes include genes involved in activating DNA replication origins, such as minichromosome maintenance genes and geminin. Twenty-three of these genes were studied at the protein level; expression of five (MCM4, P = .002; MCM3, P = .030; MCM6, P = .004; KPNA2, P = .021; and geminin, P = .004) was statistically significantly associated with overall survival in the validation set. In a multivariable Cox model adjusted for tumor thickness, ulceration, age, and sex, expression of MCM4 (hazard ratio [HR] of death = 4.04, 95% confidence interval ICI] = 1.39 to 11.76; P = .010) and MCM6 (HR of death = 7.42, 95% CI = 1.99 to 27.64; P = .003) proteins was still statistically significantly associated with overall survival. Conclusion: We identified 254 genes whose expression was associated with metastatic dissemination of cutaneous melanomas. These genes may shed light on the molecular mechanisms underlying poor prognosis in melanoma patients. [J Natl Cancer Inst 2006;98:472-82]

High dose methotrexate (HD-MTX) based chemoimmunotherapy is a central part of the standard approach to treatment of primary central nervous system lymphoma (PCNSL). Renal dysfunction leads to delayed MTX complete elimination and critical MTX concentration. Despite the recommendations, hemodialysis status should not exclude HD-MTX.

•The vertebral artery is in adults the main source of supply of the posterior fossa;•Its embryological development depends mostly on the longitudinal neural arteries;•Most of the adult’s variants can be explained through an embryological event.

Coronavirus disease 2019 (COVID-19) has become one of the biggest public health challenges of this century. Severe forms of the disease are associated with a thrombo-inflammatory state that can turn into thrombosis. Because tissue factor (TF) conveyed by extracellular vesicles (EVs) has been implicated in thrombosis, we quantified the EV-TF activity in a cohort of hospitalized patients with COVID-19 (n = 111) and evaluated its link with inflammation, disease severity, and thrombotic events. Patients with severe disease were compared with those who had moderate disease and with patients who had septic shock not related to COVID-19 (n = 218). The EV-TF activity was notably increased in patients with severe COVID-19 compared with that observed in patients with moderate COVID-19 (median, 231 [25th to 75th percentile, 39-761] vs median, 25 [25th to 75th percentile, 12-59] fM; P < .0001); EV-TF was correlated with leukocytes, D-dimer, and inflammation parameters. High EV-TF values were associated with an increased thrombotic risk in multivariable models. Compared with patients who had septic shock, those with COVID-19 were characterized by a distinct coagulopathy profile with significantly higher EV-TF and EV-fibrinolytic activities that were not counterbalanced by an increase in plasminogen activator inhibitor-1 (PAI-1). Thus, this article is the first to describe the dissemination of extreme levels of EV-TF in patients with severe COVID-19, which supports the international recommendations of systematic preventive anticoagulation in hospitalized patients and potential intensification of anticoagulation in patients with severe disease.

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Background:Previous studies of nurses' critical thinking skills that included demographic characteristics as determinants have been inconclusive. This study explored demographic determinants of critical thinking skills among nurses from public hospitals in Peninsular Malaysia.Method:This cross-sectional study included 549 nurses recruited via multistage cluster sampling. Nurses completed the demographic questionnaire and Health Sciences Reasoning Test (HSRT).Results:The majority of respondents failed to demonstrate critical thinking skills with a mean overall HSRT score of 13.8 (The majority of respondents failed to demonstrate critical thinking skills with a mean overall HSRT score of 13.8 (SD= 3.4). Educational qualifications (p= .003) and clinical specialties (p= .022) were significantly related to nurses' critical thinking skills. Years of clinical experience, age, and job ranking were not significantConclusion:The findings indicate a need to address the present curriculum in nursing education and to reinforce critical thinking skills in the nursing workforce. Future research on how nurses in Malaysia acquire critical thinking skills is needed. The findings indicate a need to address the present curriculum in nursing education and to reinforce critical thinking skills in the nursing workforce. Future research on how nurses in Malaysia acquire critical thinking skills is needed. [[J Contin Educ Nurs. 2020;51(3):109–117.]

Mankind’s quest to reduce its dependency on fossil fuel involves biomass as a promising alternative. However, direct application of raw biomass faces problems such as high moisture content, low heating value, and poor grindability. Pyrolysis is one of the pre-treatment methods to improve biomass properties particularly its energy density. This study is aimed at investigating the pyrolysis of oil palm trunk (OPT) into biocoal and its suitability for solid fuel applications in terms of slagging and fouling tendencies, bulk density, proximate and ultimate analysis, higher heating value, energy densification ratio, and mass and energy yield. The biocoal was produced using a top-lit, updraft reactor with a peak temperature of 550 °C and fixed air flowrate of 4.63 L/min. The bulk density of OPT biocoal was 87.7 kg/m3which is 4.63% lower than that of original OPT due to the increased porosity. The elemental composition of our biocoal resembles lignite. The volatile matter content decreased by a factor of 1.87 while the fixed carbon content and higher heating value (HHV) increased from 4.29 to 30.9% and from 14.5 to 19.6 MJ/kg, respectively. The HHV of biocoal increased by a factor of 1.36 relative to that of raw OPT; however, the resulting energy yield was low (37.6 ± 1.9%) due to a low biocoal yield of 27.8 ± 1.4%. The ash content increased by a factor of 1.5, resulting in an ash content of 27.8 wt% for biocoal. This increment may exacerbate the slagging and fouling propensity in furnaces and boilers as indicated by the slagging and bed agglomeration index which increased from 2.0 to 5.2 and from 0.4 to 0.7, respectively. Demineralization, a lower pyrolysis temperature and subsequent briquetting of OPT biocoal are suggested to improve its fuel properties for co-combustion in coal-firing power plants.

Device‐encapsulated human stem cell‐derived pancreatic endoderm (PE) can generate functional β‐cell implants in the subcutis of mice, which has led to the start of clinical studies in type 1 diabetes. Assessment of the formed functional β‐cell mass (FBM) and its correlation with in vivo metabolic markers can guide clinical translation. We recently reported ex vivo characteristics of device‐encapsulated human embryonic stem cell‐derived (hES)‐PE implants in mice that had established a metabolically adequate FBM during 50‐week follow‐up. Cell suspensions from retrieved implants indicated a correlation with the number of formed β cells and their maturation to a functional state comparable to human pancreatic β cells. Variability in metabolic outcome was attributed to differences in number of PE‐generated β cells. This variability hinders studies on processes involved in FBM‐formation. This study reports modifications that reduce variability. It is undertaken with device‐encapsulated human induced pluripotent stem cell‐derived‐PE subcutaneously implanted in mice. Cell mass of each cell type was determined on intact tissue inside the device to obtain more precise data than following isolation and dispersion. Implants in a preformed pouch generated a glucose‐controlling β‐cell mass within 20 weeks in over 60% of recipients versus less than 20% in the absence of a pouch, whether the same or threefold higher cell dose had been inserted. In situ analysis of implants indicated a role for pancreatic progenitor cell expansion and endocrine differentiation in achieving the size of β‐ and α‐cell mass that correlated with in vivo markers of metabolic control. Stem Cells Translational Medicine2019;8:1296&1305 Device‐encapsulated human induced pluripotent stem cell‐derived pancreatic endoderm can generate a glucose‐controlling β‐cell mass in immune‐compromised mice. For a dose of 5 × 106cells, this involves pancreatic progenitor cell differentiation as well as a cell mass increase following an initial cell loss. Measurement of these processes inside the device allows selection of conditions that help achieve metabolic control.