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Purpose: Chemical dissolution of nickel-titanium (NiTi) files involves the application of a fluoride solution in direct contact with a damaged instrument, whereas electrochemical dissolution involves the application of an electrical current to the electrolyte, which accelerates fragment dissolution. This study aimed to determine the hardness and concentration of calcium and phosphorus (Ca and P) ions in dentinal walls following chemical and electrochemical dissolution of fractured ProTaper F2 files with a novel chemical solution.Materials & Methods: Thirty human maxillary first molar palatal roots with fractured ProTaper F2 files in the middle third (length, 2.5 mm were divided into three groups according to the treatment techniques used with a novel solution (NaF 12 g/L + NaCl2 60 g/L + MgCl2 60 g/L + CaCl2 60 g/L) at pH 5: Group 1: distilled water (control group), Group 2: electrochemical dissolution, and Group 3: chemical dissolution using the novel solution. The novel solution was placed for 10 min using an electrochemical technique, and for 30 min in contact with the separated instrument in the chemical group. The Vickers microhardness test was performed in three areas: at 3, 6, and 9 mm from the apex, and an energy-dispersive X-ray test for both Ca and P ions was performed. The analysis of variance (ANOVA) and Tukey's tests were used for statistical analysis. Results: According to the one-way ANOVA analysis, no difference was observed between the tested approaches (P > 0.05) in the three areas evaluated (3, 6, and 9 mm), with no difference in the Ca/P ratio between the tested groups. Conclusion: Compared to the control group, the use of chemical and electrochemical dissolution methods with the novel solution did not affect dentin hardness or dentinal structure in terms of the Ca/P ratio, thereby indicating promising results while saving time.

Background: Few Saudi studies have examined adverse drug reactions (ADRs) in patients with rheumatoid arthritis (RA) receiving intravenous (IV) originator biologics. Therefore, this study aimed to evaluate the prevalence, types, and predictors of ADRs following long-term IV originator biologic use in patients with RA. Patients and methods: This retrospective, single-center study included adult patients with RA who received IV originator biologics between 2015 and 2020. Medical records were reviewed and data regarding ADRs were collected and evaluated for causality using the Naranjo scale. Binary logistic regression analysis was performed to identify the odds for and factors associated with developing ADRs for each biologic. Results: A total of 129 patients (87.6% women) with a mean (standard deviation) age of 54 (13) years were included in this study. A total of 1963 doses of tocilizumab (38.76%), rituximab (38.76%), abatacept (13.95%), and infliximab (8.53%), were administered during the study period. ADRs with a Naranjo score ≥ 1 were experienced by 103 (78%) patients, with an average of 2.2 events per patient. Infection (26.6%) and skin and mucous membrane disorders (14.18%) were the most commonly reported ADRs. Abatacept was associated with a significantly higher risk of multiple ADRs than the other biologics (adjusted odds ratio: 3.145, 95% confidence interval 1.004–9.854, p = 0.049). Conclusion: There was a high prevalence of ADRs among patients with RA receiving biologics. Abatacept was associated with a greater risk of multiple ADRs than other biologics. Infection was the most common ADR. Future multicenter longitudinal studies are warranted.

Heat pipes are passive devices crucial for thermal management in various applications. However, conventional water-based fluids can limit their heat transfer capacity, especially in cold environments where freeze protection is necessary. This study investigates the potential of MgO-Al2O3 hybrid nanofluids to enhance heat transfer performance in cylindrical mesh heat pipes while addressing these limitations. The research demonstrates significant improvements in thermal performance compared to a water-ethylene glycol mixture. The MgO-Al2O3 hybrid nanofluid reduces thermal resistance by enhancing surface wettability in the evaporator section. Additionally, the formation of a nanofluid coating on the evaporator surface leads to a higher heat transfer coefficient. Furthermore, RSM successfully models the relationship between nanoparticle concentration, power input, and key thermal responses (thermal resistance and heat transfer coefficient). These findings highlight the effectiveness of MgO-Al2O3 hybrid nanofluids for augmenting heat transfer in heat pipes and provide valuable RSM models for predicting thermal behavior within the investigated range.

Introduction: It is still uncertain if higher thresholds on National Institute of Health Stroke Scale (NIHSS) are better predictors of large infarctions than the conventional 6-point cutoff., Methods: We used 6-point and higher NIHSS thresholds including 8, 9, and 10-point to predict relative infarct areas, expressed as percentage of the affected hemisphere on axial brain computed tomography images, beginning at 5% with 5% increments each time until reaching the 40% cutoff for large infarctions, or achieving 100% sensitivity. Results were compared using area under the receiver operating characteristic curves (AUROC)., Results: We enrolled 151 patients of acute ischemic stroke (Mean age: 62.88 years ± 12.71; Female: 48.34%). 77 patients (50.99%) exhibited left hemisphere strokes, while 74 (49%) had right hemisphere involvement. Sensitivity values of the 6-point for infarcts measuring 5%, 10%, 20%, 30%, and 40% were 62%, 64%, 77%, 82%, and 100%, respectively. At 40% infarct-size, 8-point achieved comparable results (52%, 55%, 69%, 76%, 100%), closely aligning with the 9-point (50%, 53%, 69%, 76%, 100%). The10-point was slightly trailing behind in sensitivity at 40% infarct-core (96%). Moreover, higher thresholds exhibited improved false-positive rates (FPR). At 40% infarct size, the FPRs of 6, 8, 9, and 10 points were 39%, 27%, 27%, and 21% respectively. Higher thresholds had augmented AUROC values (0.86, 0.86, 0.89) as compared to the 6-point (0.80). Logistic regression identified 14-point as definitive cutoff for large infarctions., Conclusion: Higher thresholds can better differentiate small and medium infarcts as true-negatives and substantially reduce false-positive referrals for mechanical thrombectomy., Competing Interests: Declaration of Competing Interest The authors of this article have no conflicts of interest with reference to the research, authorship, and publication., (Copyright © 2024 Elsevier B.V. All rights reserved.)

The current study analyzed the high heating values (HHVs) of various waste biomass materials intending to the effective management and more sustainable consumption of waste as clean energy source. Various biomass waste samples including date leaves, date branches, coconut leaves, grass, cooked macaroni, salad, fruit and vegetable peels, vegetable scraps, cooked food waste, paper waste, tea waste, and cardboard were characterized for proximate analysis. The results revealed that all the waste biomass were rich in organic matter (OM). The total OM for all waste biomass ranged from 79.39% to 98.17%. Likewise, the results showed that all the waste biomass resulted in lower ash content and high fixed carbon content associated with high fuel quality. Based on proximate analysis, various empirical equations (HHV=28.296-0.2887(A)-656.2/VM, HHV=18.297-0.4128(A)+35.8/FC and HHV=22.3418-0.1136(FC)-0.3983(A)) have been tested to predict HHVs. It was observed that the heterogeneous nature of various biomass waste considerably affects the HHVs and hence has different fuel characteristics. Similarly, the HHVs of waste biomass were also determined experimentally using the bomb calorimeter, and it was observed that among all the selected waste biomass, the highest HHVs (21.19 MJ kg -1 ) resulted in cooked food waste followed by cooked macaroni (20.25 MJ kg -1 ). The comparison revealed that experimental HHVs for the selected waste biomass were slightly deviated from the predicted HHVs. Based on HHVs, various thermochemical and biochemical technologies were critically overviewed to assess the suitability of waste biomass to energy products. It has been emphasized that valorizing waste-to-energy technologies provides the dual benefits of sustainable management and production of cleaner energy to reduce fossil fuels dependency. However, the key bottleneck in commercializing waste-to-energy systems requires proper waste collection, sorting, and continuous feedstock supply. Moreover, related stakeholders should be involved in designing and executing the decision-making process to facilitate the global recognition of waste biorefinery concept., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Purpose: The American College of Medical Genetics and Genomics emphasizes a "consistent and equitable approach for offering carrier screening." At our academic center, publicly insured prenatal patients underwent universal expanded carrier screening (ECS) to promote equitable care. The aim of the study was to evaluate rates, time, and barriers to complete ECS. This was defined as post-test counseling and partner testing after a patient was found heterozygous for a pathogenic variant., Methods: In this descriptive retrospective cohort study from 2018 to 2021, patients were offered ECS, consisting of 283 recessive and X-linked genes. Heterozygotes were contacted by genetic counselors (≤5 attempts) for education and partner testing. Rates of counseling, partner testing, diagnostic procedures, follow-up times, and barriers to completion were assessed., Results: During this time, 643 women underwent ECS. Of these 643 women, 462 were heterozygotes and 326 of 462 had undergone counseling. Two hundred twenty-two of 462 partners obtained testing, with a median of 32 days from patient to partner result. Approximately 21 couples were heterozygous for the same pathogenic variant. One patient pursued diagnostic testing., Conclusion: ECS offers useful information; however, this study highlights significant barriers to completion. There was suboptimal patient follow-up and low partner screening, perhaps from insufficient time to educate and counsel. Future directions include implementing quality measures to ensure optimal completion., Competing Interests: Conflict of Interest The authors declare no conflicts of interest., (Copyright © 2023 American College of Medical Genetics and Genomics. Published by Elsevier Inc. All rights reserved.)

Herein we report the fabrication of cationic functionalized cellulose nanofibers (c-CNF) having 0.13 mmol.g -1 ammonium content and its ionic crosslinking via the pad-batch process. The overall chemical modifications were justified through infrared spectroscopy. It is revealed that the tensile strength of ionic crosslinked c-CNF (z c -CNF) improved from 3.8 MPa to 5.4 MPa over c-CNF. The adsorption capacity of z c- -CNF was found to be 158 mg.g -1 followed by the Thomas model. Further, the experimental data were used to train and test a series of machine learning (ML) models. A total of 23 various classical ML models (as a benchmark) were compared simultaneously using Pycaret which helped reduce the programming complexity. However, shallow, and deep neural networks are used that outperformed the classic machine learning models. The best classical-tuned ML model using Random Forests regression had an accuracy of 92.6 %. The deep neural network made effective by early stopping and dropout regularization techniques, with 20 × 6 (Neurons x Layers) configuration, showed an appreciable prediction accuracy of 96 %., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Muhammad Muqeet reports equipment, drugs, or supplies was provided by Mehran University of Engineering & Technology. This manuscript contains only original data, which has not been published elsewhere, nor is submitted, in the press or under consideration simultaneously for publication elsewhere. All authors fully participated in the preparation of the manuscript and accept responsibility for the results being presented. The authors further declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. We declare no conflict of interest., (Copyright © 2023. Published by Elsevier B.V.)

Mitochondrial malfunction and cell senescence have been defined as the hallmarks of aging. Cell senescence leads to the loss of health allied with aging. While deciphering the complex association between mitochondria and cellular senescence, it is observed that senescence has a two-faced nature being beneficial and hazardous. This duality of cellular senescence is associated with circumstantial aspects. During the process of cellular senescence, dysfunctional mitochondria are accumulated, the efficiency of the oxidative phosphorylation process declines along with the enhanced synthesis of reactive oxygen species. It is suggested that reduction in the negative consequences of senescence throughout old age might be accomplished by targeting the mitochondria as all roads lead towards mitochondria. It is unclear how perturbation of mitophagy in senescence results in the accumulation of mitochondria, impairment of mitochondrial biogenesis and onset of diseases. Understanding this complex interplay will bring about a long yet healthy lifespan. But definitely casual and specific players contribute in the initiation and conservation of the cell senescence. Variations in metabolism, quality control and dynamics of mitochondria are observed during cell aging process. Several On-target and Off-target mechanisms can also cause side effects in cellular senescence. Translational research of these mechanisms may lead to effective clinical interventions. This chapter reviews the role of mitochondria, homeostatic mechanisms and mitophagy as drivers and effectors of cell senescence along with multiple signalling pathways that lead to the initiation, maintenance, induction and suppression of cellular aging process during health and disease., (Copyright © 2023. Published by Elsevier Inc.)

Percutaneous balloon mitral valvuloplasty (PBMV) is primarily performed for rheumatic mitral stenosis (MS). Therefore, limited data exist on PBMV in countries with a low incidence of rheumatic disease. Using the Nationwide Readmission Database, we examined trends in in-hospital mortality and 30-day readmission among patients who received PBMV for rheumatic and non-rheumatic MS. We also examined the change in 90-day hospitalization rate before vs after PBMV. Between 2016 and 2019, there were 1109 hospitalizations in which patients received PBMV for rheumatic (n = 955, 86.1%) vs non-rheumatic MS (n = 154, 13.9%). The all-cause in-hospital mortality for rheumatic and non-rheumatic MS did not change over time (0.9% → 2.0%, P = 0.94, and 5.9% → 9.5%, P = 0.09 respectively). Similarly, the 30-day readmission for patients with rheumatic and non-rheumatic MS did not change over time (12.4% → 9.9%, P = 0.26, and 4.4% → 10.5%, P = 0.30, respectively). The 90-day all-cause hospitalization rate remained the same before vs after PBMV for rheumatic and non-rheumatic MS (25.5% → 21.8%; P = 0.14, and 24.0% → 33.7%; P = 0.19, respectively). Although no statistically significant change was noted over time for trends in in-hospital mortality, 30-day readmission, or even in the change in 90-day all-cause hospitalizations before and after PBMV for both types of MS, among those with non-rheumatic MS, there was a signal of an increase in the in-hospital mortality, and 30-day readmission, even more, there was 29% relative increase in 90-day hospitalizations after PBMV. Future studies are needed to examine the role of PBMV in patients with non-rheumatic MS., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Aims: Breast cancer metastasis is the leading cause of mortality among breast cancer patients. Epithelial to mesenchymal transition (EMT) is a biological process that plays a fundamental role in facilitating breast cancer metastasis. The present study assessed the efficacy of parthenolide (PTL Tanacetum parthenium) on EMT and its underlying mechanisms in both lowly metastatic, estrogen-receptor positive, MCF-7 cells and highly metastatic, triple-negative MDA-MB-231 cells., Main Methods: MCF-7 and MDA-MB-231 cells were treated with PTL (2 μM and 5 μM). Cell viability was determined by MTT (3-(4,5-dimethy lthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) assay. Apoptosis was analyzed by the FITC (fluorescein isothiocyanate) annexin V apoptosis detection kit. The monolayer wound scratch assay was employed to evaluate cancer cell migration. Proteins were separated and identified by Western blotting. Gene expression was analyzed by quantitative real-time PCR., Key Findings: PTL treatment significantly reduced cell viability and migration while inducing apoptosis in both cell lines. Also, PTL treatment reverses the EMT process by decreasing the mesenchymal marker vimentin and increasing the epithelial marker E-cadherin compared to the control treatment. Importantly, PTL downregulates TWIST1 (a transcription factor and regulator of EMT) gene expression, concomitant with the reduction of transforming growth factor beta1 (TGFβ1) protein and gene expression in both cell lines. Additionally, molecular docking studies suggest that PTL may induce anticancer properties by targeting TGFβ1 in both breast cancer cell lines., Significance: Our findings provide insights into the therapeutic potential of PTL to mitigate EMT and breast cancer metastasis. These promising results demand in vivo studies., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Thoracic endovascular aortic repair (TEVAR) is a suitable alternative to open aortic surgery especially for older patients with poor general health and functional status. However, data on the benefit of TEVAR in elderly patients are limited. The aim of this study was to use a large national database to compare the outcomes of TEVAR in octogenarians vs nonoctogenarians in the treatment of thoracic aortic aneurysms and dissection., Methods: All patients who underwent TEVAR for nonruptured thoracic aneurysms or dissection (zones 1-5) between January 2014 and February 2019 were identified in the Vascular Quality Initiative database. The primary outcome was in-hospital mortality. Secondary outcomes included cardiac adverse events; neurologic events; respiratory complications; new-onset dialysis; leg compartment syndrome; postoperative hematoma in addition to spinal, bowel, arm, and leg emboli/ischemia; and return to the operating room. Outcomes were compared between octogenarians (age ≥80 years) and nonoctogenarians (age <80 years) using univariable and multivariable logistic regression models., Results: A total of 2042 patients were identified, including 390 octogenarians (19.1%). Compared with nonoctogenarians, octogenarians had higher percentages of females (49.5% vs 40.4%; P < .01) and White patients (75.9% vs 68.6%; P < .01) and were more likely to present with thoracic aneurysms (86.2% vs 64.3%; P < .001). They also had larger aortic diameters (maximum diameter, 60.3 ± 15.8 mm vs 53.4 ± 17.4 mm), less proximal disease zones (zone 1, 3.3% vs 5.5%; zone 2, 13.9% vs 24.1%; P < .001) and were more likely to undergo the procedure under local/regional anesthesia (5.4% vs 2.4%; P < .01) compared with patients less than 80 years of age. No association was observed between octogenarians and in-hospital mortality after TEVAR for aneurysms (5.1% vs 3.3%; odds ratio [OR], 1.38; 95% confidence interval [CI], 0.72-2.61; P = .33) or dissection (5.6% vs 4.9%; OR, 0.68; 95% CI, 0.14-3.32; P = .63). However, for thoracic aneurysm repair, octogenarians had a 44% higher adjusted odds of in-hospital complications (27.4% vs 20.7%; OR, 1.44; 95% CI, 1.04-1.98; P = .03) compared with their younger counterparts. In-hospital complications (27.8% vs 26.2%; P = .79; OR, 1.02; 95% CI, 0.50-2.11; P = .95) were similar in octogenarians undergoing endovascular repair for dissections of the thoracic aorta. Octogenarians were also associated with 1.74 times the mortality hazard compared with nonoctogenarians (adjusted hazard ratio, 1.74; 95% CI, 1.18-2.58; P = .01)., Conclusions: TEVAR is an acceptable treatment option for octogenarians who have aortic arch and descending aortic aneurysms or dissections (zones 1-5). However, in case of aneurysms, they might be at a higher risk of in-hospital complications. Octogenarians also had increased hazard of 1-year mortality; however, the exact cause of this mortality could not be deciphered. Our findings suggest that elderly patients should not be denied TEVAR based on age if they are medically and anatomically fit for this procedure., (Copyright © 2021. Published by Elsevier Inc.)

Human activity recognition (HAR) is a significant research area due to its wide range of applications in intelligent health systems, security, and entertainment games. Over the past few years, many studies have recognized human daily living activities using different machine learning approaches. However, the performance of a machine learning algorithm varies based on the sensing device type, the number of sensors in that device, and the position of the underlying sensing device. Moreover, the incomplete activities (i.e., data captures) in a dataset also play a crucial role in the performance of machine learning algorithms. Therefore, we perform a comparative analysis of eight commonly used machine learning algorithms in different sensor combinations in this work. We used a publicly available mobile sensors dataset and applied the k-Nearest Neighbors (KNN) data imputation technique for extrapolating the missing samples. Afterward, we performed a couple of experiments to figure out which algorithm performs best at which sensors' data combination. The experimental analysis reveals that the AdaBoost algorithm outperformed all machine learning algorithms for recognizing five different human daily living activities with both single and multi-sensor combinations. Furthermore, the experimental results show that AdaBoost is capable to correctly identify all the activities presented in the dataset with 100% classification accuracy., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Fructan based biopolymers have been extensively characterized and explored for their potential applications. Linear chained biopolymers, like levan-type fructan, have gained attention because they have exhibited unconventional stretchable and unbendable properties along with biodegradable and biocompatible nature. Current study deals with the chemical characterization and cytotoxic analysis of fructose based exopolysaccharide that was extracellularly produced by an indigenously isolated bacterial species (Zymomonas mobilis KIBGE-IB14). Maximum yield of exopolysaccharide (44.7 gL -1 ) was attained after 72 h of incubation at 30 °C under shaking conditions (180 rpm) when the culture medium was supplemented with 150.0 gL -1 of sucrose as a sole carbon source. This exopolysaccharide displayed high water solubility index (96.0%) with low water holding capacity (17.0%) and an intrinsic viscosity of about 0.447 dL g -1 . This biopolymer exhibited a characteristic linear homopolysaccharide structure of levan when characterized using Fourier Transform Infrared (FTIR), Nuclear Magnetic Resonance (NMR) spectroscopy ( 1 H, 13 C, TOCSY and NOESY) while, Atomic Force Microscopy (AFM) revealed its pointed and thorny structure. The decomposition temperature of levan was approximately 245 °C as revealed by Thermal Gravimetric Analysis (TGA). X-Ray Diffraction (XRD) results revealed its amorphous nature with crystalline phase. Cytotoxicity of different concentrations of levan was investigated against mouse fibroblast cell lines by measuring their cellular metabolic activity and it was noticed that a higher concentration of levan (2.0 mg ml -1 ) permitted the normal cell growth of NIH/3T3 cell lines. This non-cytotoxic and biocompatible nature suggests that this levan has the capability to be utilized in food and drug-based formulations as it exhibited biomedical potential., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Contrast enhancement in MRI using magnetization or saturation transfer techniques promises better sensitivity, and faster acquisition compared to T 1 or T 2 contrast. This work reports the synthesis and evaluation of 5-HT 1A targeted PARACEST MRI contrast agent using 1,4,7,10-tetraazacycloDOdecane-4,7,10-triacetAMide (DO3AM) as the bifunctional chelator, and 5-HT 1A -antagonist methoxyphenyl piperazine (MPP) as a targeting unit. The multi-step synthesis led to the MPP conjugated DO3AM with 60% yield. CEST-related physicochemical parameters were evaluated after loading DO3AM-MPP with paramagnetic MRI active lanthanides: Gadolinium (Gd-DO3AM-MPP) and Europium (Eu-DO3AM-MPP). Luminescence lifetime measurements with Eu-DO3AM-MPP and computational DFT studies using Gd-DO3AM-MPP revealed the coordination of one water molecule (q = 1.43) with metal-water distance (r M -H 2 O) of 2.7 Å and water residence time (τ m ) of 0.23 ms. The dissociation constant of K d 62 ± 0.02 pM as evaluated from fluorescence quenching of 5-HT 1A (protein) and docking score of -4.81 in theoretical evaluation reflect the binding potential of the complex Gd-DO3AM-MPP with the receptor 5-HT 1A . Insights of the docked pose reflect the importance of NH 2 (amide) and aromatic ring in Gd-DO3AM-MPP while interacting with Ser 374 and Phe 370 in the antagonist binding pocket of 5-HT 1A . Gd-DO3AM-MPP shows longitudinal relaxivity 5.85 mM -1 s -1 with a water residence lifetime of 0.93 ms in hippocampal homogenate containing 5-HT 1A . The potentiometric titration of DO3AM-MPP showed strong selectivity for Gd 3+ over physiological metal ions such as Zn 2+ and Cu 2+ . The in vitro and in vivo studies confirmed the minimal cytotoxicity and presential binding of Gd-DO3AM-MPP with 5-HT 1A receptor in the hippocampus region of the mice. Summarizing, the complex Gd-DO3AM-MPP can have a potential for CEST imaging of 5-HT 1A receptors., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The shipping industry is fairly volatile pertaining to shipment pricing. To handle this volatility, two types of pricing strategies are employed in the shipping sector, contract market pricing and spot pricing. The contract market offers a fixed shipment price for a known cargo task over a set period, with secured booking space in periods of high demand. The spot market has a fluctuating shipment price, where one can benefit from lower prices than contract rate shipment prices in the low season, but face escalating shipment prices and less certainty of being able to secure a booking on a particular vessel in peak season, as space is reserved for contracted customers. However, both the pricing strategies followed have no relationship between current shipment demand and available shipping capacity and shipment prices are quoted based on predefined price lists (hard copy). This paper addresses the research gap of optimal spot shipment price calculation based on current shipment demand and available shipping capacity. To do so, we have developed a model that utilizes historical data to calculate spot pricing for container shipments. The proposed model is capable of calculating shipment spot prices based on shipment demand and capacity. Data from various sources was gathered to generate a shipping dataset for three years (i.e. from 2016 until 2018). Regression and correlation analysis are used to quantify research outcomes. Results have shown that the proposed model significantly increases the correlation between shipment price and shipment demand from 0.33 to 0.88 and available capacity from - 0 . 12 to 0.35 respectively., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2020 Elsevier B.V. All rights reserved.)

Controlled drug delivery is a prime stratagem for minimizing both the frequency of therapeutic administration as well as systematic side effects with high drug content. One of the extensively studied approaches for controlling medicament delivery is the encapsulation of drug within polymer chains which sluggish the release on the basis of its crosslinked network. Recent advances in biomedical field have led to the fabrication of chitosan (CS) based biocompatible and biodegradable hydrogels for controlled delivery of encapsulated drug. In this study, CS-PVP based hydrogels are fabricated by varying the concentration of 3-glycidyloxypropyl trimethoxysilane (GPTMS) via solution casting technique. Swelling indices of prepared hydrogel samples were determined in different media including distilled water, different pH and electrolyte solutions. FTIR, TGA and WAXRD are conducted to evaluate the structural, thermal and crystalline properties of prepared hydrogels, respectively. Porosity (71%), hydrophilicity (55°) and mechanical properties (97.56 MPa of UTS and 85.23% E%) were investigated for the fabricated samples. Extensively in vitro biodegradation, antimicrobial performance and cytotoxicity were evaluated for these hydrogels. The drug release analysis was carried out to examine the release response of encapsulated iodopovidone at physiological conditions. These results tender a strategy for the design of structural hydrogel with different crosslinking mechanism like physical and covalent interactions. These insights obviate the demand for encapsulation and offer promising and translatable strategies for more effective release of drugs., Competing Interests: Declaration of competing interest There are no conflicts of interest to declare., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Few centers in the United States have the expertise to manage patients with a thoracoabdominal aortic aneurysm (TAAA). The purpose of this study is to use a nationally representative vascular database to assess the role of hospital volume on outcomes in patients undergoing endovascular repair for TAAA., Methods: All patients undergoing complex endovascular repair (cEVAR) for TAAA were identified in the Vascular Quality Initiative (VQI) database (2012-2018). The total mean number of cases per year was identified at each center and were used to group into three quantiles containing an equal number of patients (Low [LVH], Medium [MVH], High [HVH]). Standard univariate and multivariable (logistic regression) analyses were performed to evaluate the patient's characteristics and short-term outcomes., Results: A total of 2,115 patients from 118 centers (Low - 92, Medium - 19, High - 7) were identified in VQI from 2012 to 2018. The annual mean (S.D.) number of cases at HVH, MVH, LVH were 22.7 (4.7), 9.6 (3.0), 3.6 (1.4), respectively. The repair of Type III TAAA was slightly higher in HVH versus MVH versus LVH (22.5% vs. 21.0% vs. 15.1%), while Type I was more common among LVH versus MVH versus HVH (13.7% vs. 11.5% vs. 3.7%) (Both P < 0.001). Custom/modified devices were more likely to be used in HVH versus MVH versus LVH (67.9% vs. 27.6% vs. 27.2%) (P < 0.001). Additionally, HVH and MVH utilized fenestrated/branched or chimney/snorkel options more frequently, whereas surgical bypasses were common in LVH for revascularization of visceral arteries. In univariate analysis, HVH were associated with significantly lower mortality (2.2% vs. 5.1% and 6.5%), failure to rescue [FTR] (3.5% vs. 11.6% and 12.1%) and any complication (24.6% vs. 27.1% and 31.2%) compared to LVH and MVH (All P < 0.001). After adjusting for potential confounders, both LVH and MVH were associated with 2-4 fold increase in the odds of mortality [OR (95% CI): 2.30 (1.20-4.41) and 2.14 (1.16-3.93)] and FTR [OR (95% CI): 4.42 (1.86-10.54) and 4.08 (1.73-9.62)] compared to HVH., Conclusions: Our study demonstrates significantly lower morbidity and mortality in high volume hospitals performing cEVAR for TAAA, despite operating on older patients with more complex TAAA types. This is likely due to better rescue phenomenon in addition to more experienced operators. Complex endovascular repair of TAAA can be performed safely in high volume aortic centers of excellence., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Different plants can be used to prepare nanoparticles. This is termed as green technology. It is one of the best ecofriendly and low-cost method for the preparation of nanoparticles which has no harmful effects. PbO nanoparticles were prepared by green method using leaf extract of Datura Sternum plants. The preparation of Lead oxide was confirmed by color change from colorless to yellowish brown. UV-Visible peak obtained at 250 nm and XRD study clarified the formation of PbO NPs. These PbO nanoparticles were then applied for the preparation of Nano Composite Polymer Membranes (nCPMs). PbO-PVC nCPMs were prepared based on polyvinyl chloride (PVC) polymer and PbO filler with the help of solution casting method, using cyclohexanone as a solvent. Different percentage (5-35%) of filler was used. The physiochemical parameters studied were viscosity, water uptake (WU), perpendicular swelling (DT) in deionized water, density, porosity (ε), morphology, ion adsorption capacity (IAC) and electrical conductivity (σ). The values of all these parameters except viscosity and conductivity were increased on increasing filler percentage. Viscosity of the nCPMs solution was decreased from 171 to 46.21. The conductivity of nCPMs was first increased upto 25% filler and then decreased. The deformation in PVC structure was increased on enhancing PbO amount. The values of Density, porosity, water uptake, DT and IAC were found in range 1.15-5.02, 0.50-0.87, 72.01-141.30, 0.012-0.11, and 3.13 × 10 7 -8.60 × 10 7 respectively., Competing Interests: Declaration of competing interest All the authors have no conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Polymeric biocomposites (Polyaniline/sugarcane bagasse (Pan/SB), polypyrrole (PPy/SB), polyaniline/chitosan (PAn/Ch), polyaniline/starch (PAn/St) and polypyrrole/starch (PPy/St)) were prepared and applied for Acid Black-234 (AB-234) dye removal as a function of pH, reaction time, adsorbent dose, initial dye concentration and temperature. The optimum pH for the efficient adsorption for SB, PPy/SB, PAn/SB, PPy/Ch, PAn/Ch, PPy/St and PAn/St were 2, 3, 4, 4, 5, 3 and 3, respectively using adsorbent dose of 0.05 g for the reaction time of 60 min. The pseudo-first-order-kinetic model better explained the biosorption processes of SB, PAn/SB, PAn/Ch, PPy/St and PAn/St, while pseudo-second-order kinetic model better fitted to the kinetic data of PPy/SB and PPy/Ch. It was observed that the biosorption process of dye showed the satisfactory fitness for Langmuir isotherm for the biosorbents with maximum adsorption capacities 52.6, 100, 90.91, 90.0, 71.4, 66.6 and 62.5 for SB, PPy/SB, PAn/SB, PPy/Ch, PAn/Ch, PPy/St and PAn/St, respectively. The thermodynamic study revealed the exothermic nature of adsorption of dye on to biocomposites. Results revealed that polymeric biocomposites are efficient adsorbent and could possibly be used for the adsorption of dyes from textile wastewater., (Copyright © 2020 Elsevier B.V. All rights reserved.)

This study focusses on antibacterial properties and wound healing potential of curcumin cross-linked with chitosan-PVA membranes. The crude curcumin was extracted from the rhizome of (Curcumin longa) and chitosan-PVA 80 was also prepared separately. The synergistic potential 10, 20 and 30 mg of curcumin alone and in combination with chitosan-PVA was determined. The antibacterial, scavenging potential of free radical, total phenolic and total flavonoids contents were documented through spectrophotometric methods. Finally, the wound healing potential was tested on experimental animal (rabbits). Rabbits were divided into different groups; untreated (control), treated with 10, 20 and 30 mg of curcumin and its combination with chitosan-PVA80. Chitosan-PVA exhibited significant antibacterial property against bacterial pathogens. Wound healing trials on 2nd degree burns showed chitosan as substantial wound healing agent for wound bandages. Results have shown that chitosan wound gauzes augmented the granule and fibrous connective tissues formation., (Copyright © 2019 Elsevier B.V. All rights reserved.)

α-Glucosidase is considered as a therapeutic target for the treatment of type 2 diabetes mellitus (DM2). In current study, we synthesized pyrrolidine-2,5-dione (succinimide) and thiazolidine-2,4-dione derivatives and evaluated for their ability to inhibit α-Glucosidase. Pyrrolidine-2,5-dione derivatives (11a-o) showed moderate to poor α-glucosidase inhibition. Compound 11o with the IC 50 value of 28.3 ± 0.28 µM emerged as a good inhibitor of α-glucosidase. Thiazolidine-2,4-dione and dihydropyrimidine (TZD-DHPM) hybrids (22a-c) showed excellent inhibitory activities. The most active compound 22a displayed IC 50 value of 0.98 ± 0.008 µM. Other two compounds of this series also showed activity in low micromolar range. The in-vivo antidiabetic study of three compounds 11n, 11o and 22a were also determined using alloxan induced diabetes mice model. Compounds 11o and 22a showed significant hypoglycemic effect compared to the reference drug. In-vivo acute toxicity study showed the safety of these selected compounds. In-silico docking studies were carried out to rationalize the in-vitro results. The binding modes and bioassay results of TZD-DHPM hybrids showed that interactions with important residues appeared significant for high potency., (Copyright © 2019 Elsevier Inc. All rights reserved.)

This work presents the synthesis, structural characterization and biological affinity of the newly synthesized copper(II) complexes with the first antibacterial quinolone drug nalidixic acid (nal) or N-donor ligand 2,2'‑dipyridylamine (bipyam). [Cu(II)(nal)(bipyam)Cl], (2) reveals a distorted square pyramidal based geometry in Cu(II) atom confirmed by X-ray crystallography technique. The theoretical stabilities and optimized structures of the complex were obtained from DFT calculations. The ability of the complexes to bind with calf thymus DNA (CT DNA) were investigated by electronic absorption, fluorescence, circular dichroism, and viscosity measurements techniques. The experimental results reveal that the complexes strongly interact with CT DNA via intercalative mode but complex 2 exhibits the highest affinity giving K b =3.91±0.13×10 6 , M -1 . The fluorescence spectroscopy measurements show that both complexes have the superior ability to the replacement of EtBr from DNA-bound EtBr solution and bind to DNA through intercalative mode. Both complex also shows the superior affinity towards proteins with comparatively high binding constant values which have been further revealed by fluorescence spectroscopy measurements. Molecular docking analysis indicates that the interaction of the complexes and proteins are stabilized by hydrogen bonding and hydrophobic interaction. Furthermore, the results of in vitro cytotoxicity reveal that the complex 2 has excellent cytotoxicity than 1 against human breast cancer cell lines (MCF-7)., (Copyright © 2018. Published by Elsevier B.V.)

Hyaluronic acid (HA) plays multifaceted role in regulating the various biological processes such as skin repairmen, diagnosis of cancer, wound healing, tissue regeneration, anti-inflammatory, and immunomodulation. Owing to its remarkable biomedical and tissue regeneration potential, HA has been numerously employed as one of the imperative components of the cosmetic and nutricosmetic products. The present review aims to summarize and critically appraise recent developments and clinical investigations on cosmetic and nutricosmetic efficacy of HA for skin rejuvenation. A thorough analysis of the literature revealed that HA based formulations (i.e., gels, creams, intra-dermal filler injections, dermal fillers, facial fillers, autologous fat gels, lotion, serum, and implants, etc.) exhibit remarkable anti-wrinkle, anti-nasolabial fold, anti-aging, space-filling, and face rejuvenating properties. This has been achieved via soft tissue augmentation, improved skin hydration, collagen and elastin stimulation, and face volume restoration. HA, alone or in combination with lidocaine and other co-agents, showed promising efficacy in skin tightness and elasticity, face rejuvenation, improving aesthetic scores, reducing the wrinkle scars, longevity, and tear trough rejuvenation. Our critical analysis evidenced that application/administration of HA exhibits outstanding nutricosmetic efficacy and thus is warranted to be used as a prime component of cosmetic products., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: We report the first results of a new low-profile titanium locking plate for fixation of opening wedge high tibial osteotomy (OWHTO). Short spacer plates have been associated with a high hardware complication rate, whilst fixed angle locking plates have been associated with a high incidence of soft tissue irritation. This plate aims to achieve stable fixation whilst maintaining a low profile, allowing space for combined procedures., Methods: All patients undergoing OWHTO with the Activmotion plate were retrospectively reviewed. Patients were allowed to progress to full weight bearing after two weeks. Radiographic assessment included the medial proximal tibial angle (MPTA) and posterior tibial slope at six weeks and then three monthly until union. All complications were recorded., Results: Thirty-seven patients with 40 OWHTOs were included in the study. The mean MPTA increased from 85.2 preoperatively to 91.9 postop. Tibial slope changed from 5.2 to 4.2°. The correction was sustained until union with no loss of correction in the MPTA (median change 0.0, 95% CI for median (-0.25, 0.4)) or tibial slope (mean increase 0.32, 95% CI (-0.02, 0.67))., Conclusions: In this pilot study the Activmotion plate raised no safety concerns with regard to implant related adverse events or loss of initial correction. Early rehabilitation with immediate partial weight bearing was possible and all cases proceeded to osteotomy union with the exception of one case that needed to undergo bone grafting with implant retention. Premature removal of the implant was necessary in four cases due to symptomatic hardware irritation., (Copyright © 2018. Published by Elsevier B.V.)

An alkaline protease was produced by B. licheniformis with 132.43±3.4U/mL activity in LSF which was further enhanced by optimizing culture conditions. The optimum enzyme activity (148.9±4.1U/mL) was harvested at pH7.5; temperature, 40°C and inoculum, 1.5mL after 48h incubation. Alkaline protease was immobilization by forming cross linked enzyme aggregates (CLEAs) and the processes of CLEAs formation was also optimized. The protease CLEAs developed using 80% ammonium sulfate, 65mM glutaraldehyde and 0.11mM BSA showed best activity recovery (39.76%). Free protease and CLEAs were characterized and compared. It was observed that CLEAs of protease exhibited broad pH range with best activity at pH10. The immobilized protease was also thermo-tolerant with optimum activity at 65°C temperature. The V max and K m of protease-CLEAs were 125.5U/mL and 18.97μM, respectively as compared to 104.9U/mL and 29μM, respectively for free protease. It was concluded that immobilized enzyme in the form of CLEAs is a valuable catalyst for potential industrial applications., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Aims: This study examined the interaction between maternal high fructose diet and neonatal inflammation in neonates (P7), juveniles (P26-34) and adults on measures of anxiety-like behavior and cognition. The study aimed to assess the potential synergistic effects of these two forms of early-life inflammation., Main Methods: We fed Sprague-Dawley dams with high fructose (60%) diet or normal chow. Each litter was treated with either saline or lipopolysaccharide (LPS) on postnatal day (P)3 and P5 and two pups were tested for USVs after maternal separation on P7. Post-weaning, juveniles were tested on the elevated zero maze (EZM) and in a context-object discrimination (COD) task prior to tissue harvest. Adults were tested on the EZM and the COD task as well. Immunohistochemistry and ELISA were used to assess molecular and cellular changes in the offspring., Key Findings: This study demonstrates that maternal diet and neonatal inflammation altered peripheral inflammation in neonates, altered anxiety-like behavior in juveniles, and altered anxiety-like behavior in adulthood. Maternal diet and sex increased juvenile peripheral inflammation and altered memory on the context-discrimination task., Significance: Maternal diet has a profound impact on fetal and neonatal development, especially as obesity rates are on the rise worldwide. Together, these findings reveal enduring effects of maternal diet on offspring, support the findings on the effects of neonatal inflammation on anxiety-like behaviors in later-life periods, and add to the complex relationship between gestational and neonatal inflammation and anxiety., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Arsenic (As) is a naturally occurring metalloid and Class-A human carcinogen. Exposure to As via direct intake of As-contaminated water or ingestion of As-contaminated edible crops is considered a life threatening problem around the globe. Arsenic-laced drinking water has affected the lives of over 200 million people in 105 countries worldwide. Limited data are available on various health risk assessment models/frameworks used to predict carcinogenic and non-carcinogenic health effects caused by As-contaminated water. Therefore, this discussion highlights the need for future research focusing on human health risk assessment of individual As species (both organic and inorganic) present in As-contaminated water. Various conventional and latest technologies for remediation of As-contaminated water are also reviewed along with a discussion of the fate of As-loaded waste and sludge., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Use of free microbial enzymes for bioremediation and other industrial applications has several disadvantages like low stability and non-reusability in repeated batch operations. Immobilized enzymes are stable, recoverable and reusable in industrial processes. In this scenario G. lucidum IBL-05 LiP was entrapped in Ca-alginate beads using optimum concentrations of Na-alginate (4%), calcium chloride (0.2M) and glutraldehyde (0.02%). Optimum pH (pH 5) and temperature (55°C) for entrapped LiP were improved as compared to free LiP. Catalytic behavior of LiP also significantly enhanced, as K m value (0.25mM) decreased and V max value (868.6μmol/min) increased after ca-alginate entrapment of LiP. Decolorization efficiencies of Sandal reactive dyes after treating with immobilized LiP were in the range of 80-93%. A significant reduction was observed in water quality parameters including, BOD (66.44-98.22%), COD (81.34-98.82%) and TOC (80.21-97.77%) values. The cytotoxicity values for heamolytic and brine shrimp lethality of dye solutions treated with Ca-alginate immobilized LiP reduced up to 2.10-5.06% and 5.43-9.23%, respectively. On the basis of reduced toxicity and cytotoxicity values, it was concluded that Ca-alginate beads entrapped LiP may be an effective biocatalyst for bioremediation of dye based textile industry effluents., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Commercial immunoaffinity columns (IACs) are today available for all major mycotoxins. However, manufacturers give usually no or very limited information on the epitope, i.e. the specific part of the toxin molecule that binds to the antibody. 4-Deoxynivalenol (DON) is a trichothecene mycotoxin that is produced by plant pathogenic field fungi and is regulated in many countries worldwide. DON was shown to be biotransformed via different metabolic pathways, and thus many different biotransformation products may be found in different products or organisms. In addition, several structurally similar mycotoxins may co-occur with DON. We compared five commercial IACs for their retention of a range of DON derivatives modified in the C-3, C-8, C-10, C-13 or C-15 positions, as well as nivalenol (NIV) and T-2 tetraol. The DON-derivatives were deepoxy-DON, DON 3-, 8- and 15-O-β-d-glucuronides, 3- and 15-O-acetyl-DON, DON-3-O-β-d-glucoside, 10- and 13-cysteinyl-adducts of DON, and the 13-mercaptoethanol and 10,13-dimercaptoethanol adducts of DON. The C-3 derivatives and deepoxy-DON were retained by most of the columns. Only one of the five IACs retained C-15 and C-8 derivatives, but it did not retain C-3 derivatives or deepoxy-DON. The antibodies in two of the IACs bound C-10 conjugates, but C-13 derivatives were not retained by any of the columns. This study shows that all of the antibodies in commercial IACs bind a range of DON derivatives, especially those that are modified at C-3. NIV was retained by three of the columns, and T-2 tetraol was partially retained by one IAC., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Curcumin derivatives have been well-documented due to their natural antioxidant, antimicrobial and anti-inflammatory activities. Curcuminoids have also gained widespread recognition due to their wide range of other activities which include anti-infective, anti-mutagenic, anticancer, anti-coagulant, antiarthrititc, and wound healing potential. Despite of having a wide range of activities, the inherent physicochemical characteristics (poor water solubility, low bioavailability, chemical instability, photodegradation, rapid metabolism and short half-life) of curcumin derivatives limit their pharmaceutical significance. Aiming to overcome these pharmaceutical issues and improving therapeutic efficacy of curcuminoids, newer strategies have been attempted in recent years. These advanced techniques include polymeric nanoparticles, nanocomposite hydrogels, nanovesicles, nanofibers, nanohybrid scaffolds, nanoconjugates, nanostructured lipid carriers (NLCs), nanoemulsion, polymeric micelles and polymeric blend films. Incorporation of curcumin in these delivery systems has shown improved solubility, transmembrane permeability, long-term stability, improved bioavailability, longer plasma half-life, target-specific delivery, and upgraded therapeutic efficacy. In this review, a range of in vitro and in vivo studies have been critically discussed to explore the pharmaceutical significance and therapeutic viability of the advanced delivery systems to improve antioxidant, anti-inflammatory and antimicrobial efficacies of curcumin and its derivatives., (Copyright © 2017 Elsevier B.V. All rights reserved.)

New fluorescence switch-on meso-substituted free base meta-benziporphodimethenes were synthesized, characterized via acid catalyzed condensation reaction and metallated with Zn(2+). Their photophysical properties were also studied. The fluorescence spectra analysis demonstrates substituent's independent behaviour on emitting λmax. The average Stokes shift of 33nm was observed. Crystal structure of 8 was obtained and gave expected perturbed geometry., (Copyright © 2016 Elsevier B.V. All rights reserved.)

GSK-3 specific inhibitors are promising candidates for the treatment of devastating pathologies such as diabetes, neurodegenerative diseases and cancers. We have synthesized a library of pyrimidin-4-one-1,2,3-triazole conjugates using click-chemistry approach and evaluated them as glycogen synthase kinase-3β inhibitors. Compounds 3g, 3j, 3n and 3r were found to be most potent among the eighteen pyrimidin-4-one-1,2,3-triazole conjugates synthesized and they were further evaluated for their in vivo anti-depressant activity. Compound 3n (2-((1-(3,4-dimethylphenyl)-1H-1,2,3-triazol-4-yl)methylthio)-3-methyl-6-phenylpyrimidin-4(3H)-one) exhibited the most potent inhibitory activity against GSK-3β with IC50 value of 82nM and was also found to exhibit significant antidepressant activity at 50mg/kg, when compared with fluoxetine, a known antidepressant drug. The molecular docking studies were performed to elucidate the binding modes of the compounds with the GSK-3β target and two crucial interactions namely, hydrogen bond formation with Val 135 and Lys 183 residues in the active site of GSK-3β were observed., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Stroke is a leading cause of death and disability, especially in low-income and middle-income countries. We sought to quantify the importance of potentially modifiable risk factors for stroke in different regions of the world, and in key populations and primary pathological subtypes of stroke., Methods: We completed a standardised international case-control study in 32 countries in Asia, America, Europe, Australia, the Middle East, and Africa. Cases were patients with acute first stroke (within 5 days of symptom onset and 72 h of hospital admission). Controls were hospital-based or community-based individuals with no history of stroke, and were matched with cases, recruited in a 1:1 ratio, for age and sex. All participants completed a clinical assessment and were requested to provide blood and urine samples. Odds ratios (OR) and their population attributable risks (PARs) were calculated, with 99% confidence intervals., Findings: Between Jan 11, 2007, and Aug 8, 2015, 26 919 participants were recruited from 32 countries (13 447 cases [10 388 with ischaemic stroke and 3059 intracerebral haemorrhage] and 13 472 controls). Previous history of hypertension or blood pressure of 140/90 mm Hg or higher (OR 2·98, 99% CI 2·72-3·28; PAR 47·9%, 99% CI 45·1-50·6), regular physical activity (0·60, 0·52-0·70; 35·8%, 27·7-44·7), apolipoprotein (Apo)B/ApoA1 ratio (1·84, 1·65-2·06 for highest vs lowest tertile; 26·8%, 22·2-31·9 for top two tertiles vs lowest tertile), diet (0·60, 0·53-0·67 for highest vs lowest tertile of modified Alternative Healthy Eating Index [mAHEI]; 23·2%, 18·2-28·9 for lowest two tertiles vs highest tertile of mAHEI), waist-to-hip ratio (1·44, 1·27-1·64 for highest vs lowest tertile; 18·6%, 13·3-25·3 for top two tertiles vs lowest), psychosocial factors (2·20, 1·78-2·72; 17·4%, 13·1-22·6), current smoking (1·67, 1·49-1·87; 12·4%, 10·2-14·9), cardiac causes (3·17, 2·68-3·75; 9·1%, 8·0-10·2), alcohol consumption (2·09, 1·64-2·67 for high or heavy episodic intake vs never or former drinker; 5·8%, 3·4-9·7 for current alcohol drinker vs never or former drinker), and diabetes mellitus (1·16, 1·05-1·30; 3·9%, 1·9-7·6) were associated with all stroke. Collectively, these risk factors accounted for 90·7% of the PAR for all stroke worldwide (91·5% for ischaemic stroke, 87·1% for intracerebral haemorrhage), and were consistent across regions (ranging from 82·7% in Africa to 97·4% in southeast Asia), sex (90·6% in men and in women), and age groups (92·2% in patients aged ≤55 years, 90·0% in patients aged >55 years). We observed regional variations in the importance of individual risk factors, which were related to variations in the magnitude of ORs (rather than direction, which we observed for diet) and differences in prevalence of risk factors among regions. Hypertension was more associated with intracerebral haemorrhage than with ischaemic stroke, whereas current smoking, diabetes, apolipoproteins, and cardiac causes were more associated with ischaemic stroke (p<0·0001)., Interpretation: Ten potentially modifiable risk factors are collectively associated with about 90% of the PAR of stroke in each major region of the world, among ethnic groups, in men and women, and in all ages. However, we found important regional variations in the relative importance of most individual risk factors for stroke, which could contribute to worldwide variations in frequency and case-mix of stroke. Our findings support developing both global and region-specific programmes to prevent stroke., Funding: Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Health Research Board Ireland, Swedish Research Council, Swedish Heart and Lung Foundation, The Health & Medical Care Committee of the Regional Executive Board, Region Västra Götaland (Sweden), AstraZeneca, Boehringer Ingelheim (Canada), Pfizer (Canada), MSD, Chest, Heart and Stroke Scotland, and The Stroke Association, with support from The UK Stroke Research Network., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Takotsubo cardiomyopathy (TTC) mimics acute myocardial infarction on electrocardiography and is characterized by transient left ventricular dysfunction and positive cardiac biomarkers in the absence of significant coronary disease. In the majority of cases, TTC affects postmenopausal women and is commonly incited by a recent negative emotional stressor, although the pathophysiological mechanism of this process is incompletely understood. In contrast, we describe a case in which TTC developed after a recent positive emotional event in a postmenopausal woman., (Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

Objectives: This study reports the results a novel radiation reduction protocol (RRP) system for coronary angiography and interventional procedures and the determinants of radiation dose., Background: The cardiac catheterization laboratory is an important source of radiation and should be kept in good working order with dose-reduction and monitoring capabilities., Methods: All diagnostic coronary angiograms and percutaneous coronary interventions from a single catheterization laboratory were analyzed 2 months before and after RRP implementation. The primary outcome was the relative dose reduction at the interventional reference point. Separate analyses were done for conventional 15 frames/s (FPS) and at reduced 7.5 FPS post-RRP groups., Results: A total of 605 patients underwent coronary angiography (309 before RRP and 296 after RRP), with 129 (42%) and 122 (41%) undergoing percutaneous coronary interventions before and after RRP, respectively. With RRP, a 48% dose reduction (1.07 ± 0.05 Gy vs. 0.56 ± 0.03 Gy, p < 0.0001) was obtained, 35% with 15 FPS RRP (0.70 ± 0.05 Gy, p < 0.0001) and 62% with 7.5 FPS RRP (0.41 ± 0.03 Gy, p < 0.001). Similar dose reductions for diagnostic angiograms and percutaneous coronary interventions were noted. There was no change in the number of stents placed or vessels intervened on. Increased dose was associated with male sex, radial approach, increasing body mass index, cine runs, and frame rates. Using a multivariable model, a 48% relative risk with RRP (p < 0.001), 44% with 15 FPS RRP and 68% with 7.5 FPS RRP was obtained., Conclusions: We demonstrate a highly significant 48.5% adjusted radiation dose reduction using a novel algorithm, which needs strong consideration among interventional cardiology practice., (Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: There is no consensus in the literature on measures for evaluating the performance of general hospital Consultation-Liaison psychiatry services., Objective: The purpose of this study was to investigate what indicators might be used to this end., Methods: We surveyed United States Psychosomatic Medicine fellowship directors (n = 53) about the use of performance measures for their psychiatric consultation services. Results of this survey led to the construction of a second survey, which was distributed to the representatives of services calling for psychiatric consultations at our hospital (n = 21); this survey sought to determine the importance of various performance parameters to overall consultee satisfaction., Results: Sixty-three percent of responding psychiatric consult services do not use any of the parameters identified in the literature as performance measures. Consultee satisfaction was endorsed as a valuable performance indicator by 67.7% of them, but no satisfaction rating instrument was identified. The internal survey of consultees identified 11 of 16 candidate parameters as important or very important to consultee satisfaction, of which "consultant understands the core situation and the core question being asked" received the highest rating., Conclusions: Consultee satisfaction is perceived as a useful global measure of the effectiveness of a psychiatric consult service. We elicited parameters that can be used to create a measurement tool for consultee satisfaction with Consultation-Liaison services. The use of such a tool merits testing in a larger multicenter study., (Copyright © 2013 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.)

A convenient synthesis of oximes of steroidal chalcones (4a-4j) was performed and structural assignment of the products was confirmed on the basis of IR, (1)HNMR, (13)C NMR, MS and analytical data. The synthesized compounds were screened for in vitro antioxidant activity by using DPPH method and in vitro antimicrobial activity against different bacterial and fungal strains by agar diffusion method. The activity of the tested compounds against each microbe varied due to structural differences between them. Presence and position of different substituents on the benzene ring of the chalconyl pendent had a marked effect on the activity of the compounds. From the results it can be inferred that the compounds 4a-j showed significant antioxidant activity and antimicrobial activity against all microbial strains used for testing., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Introduction: Electrocardiographic (ECG) predictors of significant angiographic left main coronary artery stenosis (LMCS>50%) have been described in acute myocardial infarction using ST-segment elevation in lead aVR (aVR-STE). However, there is a paucity of data on its association with LMCS>50% in the setting of cardiogemic shock (CGS)., Methods: We investigated 210 consecutive, unselected, patients from Sept. 2002-2006 with CGS due to acute myocardial infarction undergoing cardiac catheterization. Of those, 191 patients with interpretable ECG tracings for aVR-STE analysis formed our study sample. aVR-STE was defined as ST-segment elevation≥1mm in aVR while LMCS>50% on coronary angiogram was defined as any left main lesion that demonstrated >50% lumen narrowing or equivalent by direct visualization or quantitative coronary angiography analysis., Results: There was 59% survival to discharge of this predominantly male cohort (median age 68±12years; 31% females). Fifty three (28%) cases had aVR-STE while 27 (14%) had LMCS>50%. Of those, 16 patients who had aVR-STE also had LMCS>50% (sensitivity 59%, specificity 77%, positive predictive value 30%, negative predictive value 92% for predicting LMCS>50%). Multivariate analysis revealed that aVR-STE was the only significant predictor of LMCS>50% was (p=0.014; Odds Ratio=3.06; 95% Confidence Interval 1.26-7.47)., Conclusion: In CGS due to acute myocardial infarction, aVR-STE>1mm proves to be an important predictor of LMCS>50%. Such data could be helpful in further risk stratification for optimal management during CGS., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Background: Guidelines for reperfusion in ST-elevation myocardial infarction (STEMI) were recently adopted by the Canadian Cardiovascular Society. We have developed a blended model of prehospital thrombolytic (PHL) therapy or primary percutaneous coronary intervention (PPCI) activation, in order to achieve guideline times., Methods: In our urban centre of 658,700 people, emergency medical services (EMS) were trained to perform and screen electrocardiograms (ECGs) for suspected STEMI. Suspected ECGs were transmitted to a physician's hand-held device. If the physician confirmed the diagnosis they coordinated initiation of either PHL or PPCI. In cases where physicians found the prehospital ECG negative for STEMI (PHENST), patients were transported to the closest emergency room., Results: From July 21, 2008 to July 21, 2010, the Cardiac Outcomes Through Digital Evaluation (CODE) STEMI project received 380 transmitted calls. There were 226 confirmed STEMI by the on-call physician, 158 (70%) received PPCI, 48 (21%) received PHL, and 20 (9%) had angiography but no revascularization. The PPCI, median time from first medical contact to reperfusion was 76 minutes (interquartile range [IQR], 64-93). For PHL, median time from first medical contact to needle was 32 minutes (IQR, 29-39). The overall mortality rate for the STEMI patients was 8% (PHL = 4 [8.3%], PPCI = 8 [5%], medical therapy = 7 [35%]). There were 154 PHENST patients, 44% later diagnosed with acute coronary syndrome. The mortality rate for PHENST was 14%., Conclusions: Through a model of EMS prehospital ECG interpretation, digital transmission, direct communication with a physician, and rapid coordinated service, we demonstrate that benchmark reperfusion times in STEMI can be achieved., (Copyright © 2012 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

Left ventricular free wall rupture (LVFWR) is one of the most lethal complications following myocardial infarction. It accounts for approximately 12% to 21% of all in-hospital deaths following myocardial infarction. The majority of patients die shortly after LVFWR from instantaneous pericardial tamponade and hemodynamic collapse. However, up to one-third of cases are subacute in nature, allowing limited time for emergent surgical repair to prevent sudden death. A high index of suspicion and timely use of diagnostic tests are important in recognizing cases. The present report describes the case of a 69-year-old man who initially presented with acute pericardial tamponade and was subsequently diagnosed with LVFWR in the operating room as the cause of his hemopericardium. The pathology, diagnosis and management of LVFWR are reviewed.