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Sonothrombolysis induces clot breakdown using ultrasound waves to excite microbubbles. Despite the great potential, selecting optimal ultrasound (frequency and pressure) and microbubble (radius) parameters remains a challenge. To address this, a computational model was developed to investigate the bubble behaviour during sonothrombolysis. The blood and clot were assumed to be non-Newtonian and porous, respectively. The effects of ultrasound and microbubble parameters on flow-induced shear stress on the clot surface during stable and inertial cavitation were investigated. It was found that microbubble translation towards the clot and the shear stress on the clot surface during stable cavitation were significant when the bubble was about to undergo inertial cavitation. While insonation of large microbubble (radius of 1. 65 μ m) at low frequency (0.50 MHz) produced the highest shear stress during stable cavitation, selection of these parameters is not as intuitive for inertial cavitation due to the strong competing effect between jet velocity and translational distance. An increase in jet velocity is always accompanied by a decrease in the translational distance and vice versa. Therefore, a right balance between the jet velocity and the translational distance is critical to maximise the shear stress on the clot surface. A jet velocity of 303 m/s and a distance travelled of 5. 12 μ m at an initial bubble-clot separation of 10 μ m produced the greatest clot surface shear stress. This is achievable by insonating a 0. 55 μ m microbubble using 0.50 MHz and 600 kPa ultrasound. • A bubble dynamics model during sonothrombolysis was developed. • Large bubble at low ultrasound frequency is preferred for stable cavitation. • Competing effect between distance travelled by bubble and the jet velocity. • Effective inertial cavitation requires a right balance from this effect. [ABSTRACT FROM AUTHOR]

[Display omitted] Impaired interferon response and allergic sensitization may contribute to virus-induced wheeze and asthma development in young children. Plasmacytoid dendritic cells (pDCs) play a key role in antiviral immunity as critical producers of type I interferons. pDCs also express the high-affinity IgE receptor through which type I interferon production may be negatively regulated. Whether antiviral function of pDCs is associated with recurrent episodes of wheeze in young children is not well understood. We sought to evaluate the phenotype and function of circulating pDCs in children with a longitudinally defined wheezing phenotype. We performed multiparameter flow cytometry on PBMCs from 38 children presenting to the emergency department with an acute episode of respiratory wheeze and 19 controls. RNA sequencing on isolated pDCs from the same individuals was also performed. For each subject, their longitudinal exacerbation phenotype was determined using the Western Australia public hospital database. We observed a significant depletion of circulating pDCs in young children with a persistent phenotype of wheeze. The same individuals also displayed upregulation of the FcεRI on their pDCs. Based on transcriptomic analysis, pDCs from these individuals did not mount a robust systemic antiviral response as observed in children who displayed a nonrecurrent wheezing phenotype. Our data suggest that circulating pDC phenotype and function are altered in young children with a persistent longitudinal exacerbation phenotype. Expression of high-affinity IgE receptor is increased and their function as major interferon producers is impaired during acute exacerbations of wheeze. [ABSTRACT FROM AUTHOR]

Although many countries have banned tobacco advertising on traditional media platforms, the tobacco industry actively promotes their products via online channels. Adolescents are at high risk of exposure due to spending substantial time online. We examined the prevalence of adolescent exposure to online tobacco advertisements and promotions. We analyzed data from the Global Youth Tobacco Surveys (GYTS; 2013–2018; average response rate = 76.8%). We included 15 countries in four regions that measured self-reported exposure to tobacco advertising on the internet in the past month (N = 111,356, adolescents aged 11–18): Region of the Americas (Argentina, Costa Rica, Cuba, Ecuador, Panama, Paraguay, Peru), African (Mauritius, Zimbabwe), European (Czech Republic, Turkey), and the Western Pacific (Micronesia, Macao, Papua New Guinea, Samoa). We calculated the prevalence of online exposure to tobacco advertising by past-month cigarette use. Prevalence of adolescent exposure to online advertisements for tobacco products ranged from 18.2%–34.3% and 12.3%–34.4% for tobacco advertisements that "looked fun or cool". Exposure to online tobacco product advertisements was prevalent across countries, including those with advertising bans in place, and included adolescents who have never smoked (14.4%–28.4% exposed to any, 9.1%–31.0% exposed to fun or cool advertisements). Reporting seeing tobacco advertising online that looked fun or cool was positively associated with the prevalence of past-month smoking (r = 0.64, p =.010). A substantial proportion of adolescents in countries that have banned tobacco advertising are still exposed to advertisements for tobacco products online. Internet tobacco advertising needs better enforcement to prevent adolescent tobacco use and uptake worldwide. [ABSTRACT FROM AUTHOR]

A robust instrument for measuring the educational environment in a pharmacy patient care setting is currently lacking. The authors aimed to develop a person-reported outcome measure to gauge trainee pharmacists' perceptions of their clinical workplace-based educational environment. This paper reports the various sources of validity evidence. A preliminary, three-domain (system, relationship, and personal), 36-item measurement instrument was developed by incorporating results from literature review, focus group interviews, iterative discussions among educators, and cognitive interviews. The preliminary instrument, together with the Dundee Ready Educational Environment Measure (DREEM) and Orientation to Happiness Scale (OHS), were administered to trainee pharmacists recruited from one pharmacy school and one healthcare cluster in Singapore. Rasch analysis was conducted on the overall instrument as well as three domains: System, Relationship, and Personal. The 36-item instrument was administered to 145 learners, of which 66 were trainee pharmacists and 79 undergraduate interns. Upon removal of the middle "neutral" category to resolve poorly functioning categories and removal of five poorly functioning items, the overall instrument and its domains generally showed good fit with the Rasch model. Moreover, the overall 31-item Singapore Pharmacy Educational Environment Questionnaire (SPEEQ) and its three domains showed moderate to high convergent correlation with all the five DREEM domains and low to non-significant divergent correlation with the OHS Pleasure of Life subscale. Among one sample of pharmacy trainees, the 31-item SPEEQ and its three component domains demonstrated notable validity evidence to gauge trainees' perceptions of their learning environment. [ABSTRACT FROM AUTHOR]

The amount of SARS-CoV-2 detected in the upper respiratory tract (URT viral load) is a key driver of transmission of infection. Current evidence suggests that mechanisms constraining URT viral load are different from those controlling lower respiratory tract viral load and disease severity. Understanding such mechanisms may help to develop treatments and vaccine strategies to reduce transmission. Combining mathematical modelling of URT viral load dynamics with transcriptome analyses we aimed to identify mechanisms controlling URT viral load. COVID-19 patients were recruited in Spain during the first wave of the pandemic. RNA sequencing of peripheral blood and targeted NanoString n Counter transcriptome analysis of nasal epithelium were performed and gene expression analysed in relation to paired URT viral load samples collected within 15 days of symptom onset. Proportions of major immune cells in blood were estimated from transcriptional data using computational differential estimation. Weighted correlation network analysis (adjusted for cell proportions) and fixed transcriptional repertoire analysis were used to identify associations with URT viral load, quantified as standard deviations (z-scores) from an expected trajectory over time. Eighty-two subjects (50% female, median age 54 years (range 3–73)) with COVID-19 were recruited. Paired URT viral load samples were available for 16 blood transcriptome samples, and 17 respiratory epithelial transcriptome samples. Natural Killer (NK) cells were the only blood cell type significantly correlated with URT viral load z-scores (r = −0.62, P = 0.010). Twenty-four blood gene expression modules were significantly correlated with URT viral load z-score, the most significant being a module of genes connected around IFNA14 (Interferon Alpha-14) expression (r = −0.60, P = 1e-10). In fixed repertoire analysis, prostanoid-related gene expression was significantly associated with higher viral load. In nasal epithelium, only GNLY (granulysin) gene expression showed significant negative correlation with viral load. Correlations between the transcriptional host response and inter-individual variations in SARS-CoV-2 URT viral load, revealed many molecular mechanisms plausibly favouring or constraining viral replication. Existing evidence corroborates many of these mechanisms, including likely roles for NK cells, granulysin, prostanoids and interferon alpha-14. Inhibition of prostanoid production and administration of interferon alpha-14 may be attractive transmission-blocking interventions. [Display omitted] • SARS-CoV-2 upper respiratory viral z-scores were correlated with host response. • Negative correlation between viral load and blood NK cells and IFN-α14 module. • Positive correlation between blood prostanoid module and viral load. • Nasal granulysin expression negatively correlated with viral load z-score. • Identifies putative mechanisms favouring and restricting SARS-CoV-2 replication. [ABSTRACT FROM AUTHOR]

The cornea is the major contributor to the refractive power of the eye, and corneal diseases are a leading cause of reversible blindness. The main treatment for advanced corneal disease is keratoplasty: allograft transplantation of the cornea. Examples include lenticule implantation to treat corneal disorders (e.g. keratoconus) or correct refractive errors. These procedures are limited by the shelf-life of the corneal tissue, which must be discarded within 2-4 weeks. Electron-beam irradiation is an emerging sterilisation technique, which extends this shelf life to 2 years. Here, we produced lenticules from fresh and electron-beam (E-beam) irradiated corneas to establish a new source of tissue for lenticule implantation. In vitro, in vivo , and ex vivo experiments were conducted to compare fresh and E-beam-irradiated lenticules. Results were similar in terms of cutting accuracy, ultrastructure, optical transparency, ease of extraction and transplantation, resilience to mechanical handling, biocompatibility, and post-transplant wound healing process. Two main differences were noted. First, ∼59% reduction of glycosaminoglycans resulted in greater compression of E-beam-irradiated lenticules post-transplant, likely due to reduced corneal hydration—this appeared to affect keratometry after implantation. Cutting a thicker lenticule would be required to ameliorate the difference in refraction. Second, E-beam-sterilised lenticules exhibited lower Young's modulus which may indicate greater care with handling, although no damage or perforation was caused in our procedures. In summary, E-beam-irradiated corneas are a viable source of tissue for stromal lenticules, and may facilitate on-demand lenticule implantation to treat a wide range of corneal diseases. Our study suggested that its applications in human patients are warranted. Corneal blindness affects over six million patients worldwide. For patients requiring corneal transplantation, current cadaver-based procedures are limited by the short shelf-life of donor tissue. Electron-beam (E-beam) sterilisation extends this shelf-life from weeks to years but there are few published studies of its use. We demonstrated that E-beam-irradiated corneas are a viable source of lenticules for implantation. We conducted in vitro, in vivo , and ex vivo comparisons of E-beam and fresh corneal lenticules. The only differences exhibited by E-beam-treated lenticules were reduced expression of glycosaminoglycans, resulting in greater tissue compression and lower refraction suggesting that a thicker cut is required to achieve the same optical and refractive outcome; and lower Young's modulus indicating extra care with handling. [Display omitted] [ABSTRACT FROM AUTHOR]

Plant sterols (PS) have been shown to lower blood lipid-lipoproteins concentrations and may serve as a potential functional ingredient for cardiovascular disease (CVD) risk management. However, there are limited studies examining this effect in individuals with metabolic syndrome (MetS). The aim of this study was to evaluate the effects of PS-enriched food consumption as part of a healthy dietary pattern (HDP) on blood pressure and endothelial function in Singaporean adults with MetS. This was a 12-week, crossover, randomized controlled trial with a 4-week washout period. Thirteen subjects were instructed to consume an HDP diet either with normal soy milk (control group) or with PS (2 g/day)-enriched soy milk (PS group) for 4 weeks. Blood lipid-lipoproteins and glucose concentrations, blood pressure, and endothelial function-related indicators (flow-mediated dilation, total plasma nitrate/nitrite and endothelin-1, circulating endothelial progenitor cells) were assessed before and after the intervention. Systolic blood pressure [mean change, PS group: -4.0 ± 3.7 mmHg; control group: 5.9 ± 2.5 mmHg (P Interaction = 0.01)] and long-term CVD risk [mean change, PS group: -0.2 ± 1.0 %; control group: 2.7 ± 1.3 % (P Interaction = 0.03)] decreased following PS consumption. No changes were observed in the other endothelial function-related outcomes. Consumption of PS-enriched food with an HDP diet may lower blood pressure and long-term CVD risk in adults with MetS. NCT03723330, https://clinicaltrials.gov/. • Consumption of PS-enriched food with an HDP diet improved blood pressure regulation in individuals with MetS. • Consumption of PS-enriched food with an HDP diet favorably affected long-term cardiovascular disease risk. • No effect of PS consumption was observed on endothelial function in individuals with MetS. [ABSTRACT FROM AUTHOR]

The study investigates the integration of remote sensing data and machine learning (ML) techniques in streamflow simulation and forecasting in Klang River Basin. The motivation behind the research lies in the need for improved accuracy in streamflow prediction to support effective water resource management and flood control in Malaysia. Five ML models, including K-Nearest Neighbours (KNN), Support Vector Machines (SVM), Random Forests (RF), Artificial Neural Network (ANN), and Long Short-Term Memory (LSTM) were tested, with 25 different model configurations trained on datasets from Malaysia's Department of Irrigation and Drainage (DID) and climate data from NASA's Giovanni Portal. Among the models, RF − III showed the best performance with SMAPE , MdAPE and Lp values of 0.36 and 0.37 and 0.908, respectively. Further analysis underscores air temperature's substantial impact on streamflow prediction, deviating significantly from the benchmark value. The findings contribute to advancements in streamflow forecasting, offering potential applications in flood management and water resource planning for the region. [ABSTRACT FROM AUTHOR]

• The optimal surgical treatment for symptomatic recurrent Rathke's cleft cysts (RCCs) is unclear. • This study compared cyst wall resection, drainage with intrasellar stent insertion, and resection with intracystic bleomycin. • Cyst wall resection was associated with the highest risk of symptomatic recurrence at 58.8% • There were no significant differences in postoperative complication rates between the treatment arms. The optimal management of symptomatic recurrent Rathke's cleft cysts (RCCs) is unclear. Here, we compared the outcomes of various surgical approaches for symptomatic recurrent RCCs. PubMed and Embase were systematically reviewed for studies that reported individual-participant data on outcomes after surgical treatment for symptomatic recurrent RCCs presenting with headache and/or visual field defect. The primary outcome was symptomatic recurrence, and the secondary outcome was postoperative complications. Subgroup analyses were performed based on the number of recurrences, duration since initial surgery, previous treatment, and symptoms of recurrence. Of the 713 studies screened, 14 studies (30 recurrences in 24 patients) were included in the meta -analysis. Cyst wall resection was the most common treatment (n = 17, 56.7 %), followed by drainage with intrasellar stent insertion (n = 7, 23.3 %) and resection with intracystic bleomycin (n = 6, 20.0 %). Most of the cases were first recurrences (56.7 %, n = 17). The mean (SD) duration between the initial treatment and onset of symptomatic recurrence was 3.0 (3.6) years. Over a median [IQR] follow-up period of 1.2 [0.4, 2.5] years, patients who underwent cyst wall resection had a significantly higher incidence of symptomatic recurrence at 58.8 %, compared to a 0 % symptomatic recurrence rate in patients treated with drainage and intrasellar stent insertion or resection with intracystic bleomycin (p = 0.014). Patients who underwent cyst wall resection also had the highest risk of symptomatic recurrence on subgroup analysis, though this was statistically significant only among patients who underwent cyst wall resection as their preceding treatment (p = 0.021). There were no significant differences in postoperative complication rates between the treatment arms. In conclusion, for patients with symptomatic recurrent RCCs presenting with headache and/or visual field defects, drainage with intrasellar stent insertion and intracystic bleomycin may be superior to cyst wall resection alone. This approach may reduce the risk of another symptomatic recurrence within one year. [ABSTRACT FROM AUTHOR]

Fluorescence imaging with indocyanine green is increasingly being used in colorectal surgery to assess anastomotic perfusion, and to detect sentinel lymph nodes. In this 2-round, online, Delphi survey, 35 international experts were asked to vote on 69 statements pertaining to patient preparation and contraindications to fluorescence imaging during colorectal surgery, indications, technical aspects, potential advantages/disadvantages, and effectiveness versus limitations, and training and research. Methodological steps were adopted during survey design to minimize risk of bias. More than 70% consensus was reached on 60 of 69 statements, including moderate-strong consensus regarding fluorescence imaging's value assessing anastomotic perfusion and leak risk, but not on its value mapping sentinel nodes. Similarly, although consensus was reached regarding most technical aspects of its use assessing anastomoses, little consensus was achieved for lymph-node assessments. Evaluating anastomoses, experts agreed that the optimum total indocyanine green dose and timing are 5 to 10 mg and 30 to 60 seconds pre-evaluation, indocyanine green should be dosed milligram/kilogram, lines should be flushed with saline, and indocyanine green can be readministered if bright perfusion is not achieved, although how long surgeons should wait remains unknown. The only consensus achieved for lymph-node assessments was that 2 to 4 injection points are needed. Ninety-six percent and 100% consensus were reached that fluorescence imaging will increase in practice and research over the next decade, respectively. Although further research remains necessary, fluorescence imaging appears to have value assessing anastomotic perfusion, but its value for lymph-node mapping remains questionable. [ABSTRACT FROM AUTHOR]

Mirum Pharmaceuticals, Inc. Cerebrotendinous xanthomatosis (CTX) is a rare metabolic disorder of bile acid synthesis caused by biallelic pathogenic variants in the CYP27A1 gene, encoding the sterol 27-hydroxylase enzyme, which leads to abnormal bile acid synthesis and toxic accumulation of cholestanol, bile alcohols and other metabolites. Chenodeoxycholic acid (CDCA) treatment is considered the standard-of-care for CTX. We evaluated the efficacy and safety of CDCA on biomarkers of CTX in the first Phase 3, randomized withdrawal, double-blind (DB), placebo (PBO)-controlled, two-period x two-treatment cross-over study with rescue medication (RESTORE). A 24-week randomized withdrawal, DB, crossover study with a 30-day safety follow-up was conducted in adult patients (≥16 years of age) with CTX who received 250 mg CDCA TID for two 8-week open label (OL) periods of the study and either blinded CDCA or PBO for two 4-week DB periods. Eligible participants had a clinical diagnosis of CTX with biochemical confirmation, no known malabsorption or GI conditions, and not on cholic acid and/or medication impacting bile acid absorption. The primary endpoint was change in the urinary bile alcohol biomarker 5β-cholestane-3α,7α,12α,23S,25-pentol (23S-pentol) from Baseline (BL) to the end of each DB treatment period. Key secondary efficacy endpoints included: percent changes in plasma cholestanol and 7α-hydroxy-4-cholesten-3-one (7αC4) at end of each DB period and proportion of patients requiring rescue medication (CDCA) during the DB periods. Safety parameters were also assessed. The analysis included 14 participants with a median (min, max) age at enrollment of 41.5 (16, 55) years, the majority were white males, and all had a clinical diagnosis of CTX with biochemical confirmation. CDCA withdrawal after the OL treatment period resulted in a statistically significant 20-fold increase (95% CI: 10.3, 43.5 p<0.0001) in urine 23S-pentol (ng/mL), a 2.8-fold increase (95% CI: 1.5, 5.2; p=0.0083) in plasma cholestanol (µg/mL), and a 50-fold increase (95% CI: 25.0, 66.7; p<0.0001) in plasma 7αC4 (ng/mL; placebo relative to CDCA). A significant proportion of participants on PBO (61.5% [95% CI: 31.6, 86.1]; p=0.0006) required blinded rescue medication during the DB withdrawal periods. Most commonly reported TEAEs on CDCA were diarrhea (n=5) and headache (n=3) with the majority mild to moderate in severity and not considered treatment related. Withdrawal of CDCA treatment led to significant increases in CTX biomarkers. CDCA treatment is well-tolerated and can effectively suppress abnormal bile acid synthesis in CTX, preventing accumulation of cholestanol and bile alcohols. This underscores the potential for CDCA to help CTX patients avoid disease progression. [ABSTRACT FROM AUTHOR]

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Gas hydrate formation is a very challenging problem in the oil and gas industry. The chemical inhibition method is the best practicable hydrate mitigation method by injecting hydrate inhibitors such as Thermodynamic Hydrate Inhibitors (THIs) and Kinetic Hydrate Inhibitors (KHIs) into the pipeline. However, the hydrate inhibitors' biodegradability and limited data on dual functional inhibitor mixtures raise concerns in this study. This study aims to investigate and compare thermodynamic and kinetic inhibition on CO 2 hydrate by using biodegradable amino acid inhibitor mixtures of Glycine and Alanine. In this study, the inhibitor mixtures were prepared by mixing Glycine and Alanine in 3 different mixture ratios, followed by the Thermodynamic and Kinetic inhibition tests. Thermodynamic Inhibition Test was conducted by using 10 wt% of inhibitor mixtures in a CO 2 -water system under pressure of 4.0, 3.5, 3.0 and 2.5 MPa, while Kinetic Inhibition Test was carried out by using 1 wt% of the sample in the CO 2 -water system at a constant pressure of 4.0 MPa and temperatures at 274.15K. The analysis methods for the Thermodynamic Inhibition Test were Hydrate Liquid-Vapor Equilibrium (HLVE) Curve, Average Depression Temperature and Molar Dissociation Enthalpy, while the Induction Time method, the number of CO 2 moles consumed, the formation rate of CO 2 gas hydrate and RIP were used in the Kinetic Inhibition Test. In this study, all inhibitor mixtures exhibit dual functional inhibition on the CO 2 hydrate. For THI, 50% Gly: 50% Ala shows the best thermodynamic inhibition strength with an average depression temperature of 2.42 K. All the inhibitor mixtures for THI have the dissociation enthalpies within the CO 2 hydrate enthalpy range, which show that the inhibition is due to the influence on the water molecules' interaction only. For KHI, 75% Gly: 25% Ala shows the highest kinetic inhibition strength on CO 2 formation with the longest induction time of 115.2 min and the highest RIP of 0.40. In the KHI experiment, there is a drop in the CO 2 uptake capacity with the presence of inhibitors used, where the highest difference of CO 2 moles consumed is 0.0057 mol. A synergistic effect of inhibitor mixtures was observed in this study on 50% Gly: 50% Ala for THI and 75% Gly: 25% Ala for KHI. However, the "degradation" effect was also exhibited on 75% Gly: 25% Ala and 25% Gly: 75% Ala for THI and 50% Gly: 50% Ala and 25% Gly: 75% Ala for KHI, where the performance of the inhibitor mixtures is poorer than the concentrated amino acids. The "degradation" effect of the inhibitor mixtures at certain ratios was not covered in this study and it requires a further understanding of the chemistry behind the inhibition mechanism. • Application of the synergic effect of amino acids for CO 2 Hydrate Formation and Dissociation. • Performance evaluation of Mix amino acids compared to the Pure amino acids as THIs and KHIs on CO 2 gas hydrate. • Compare the Phase equilibrium modeling results with the experimental study results. [ABSTRACT FROM AUTHOR]

The heavy metal load in coral reefs of Singapore has not been comprehensively assessed since 1994. Here, we repeated the surveys conducted 27 years ago to quantify the levels of Cd, Cu, Cr, Fe, Pb, Ti, Zn in sediment and the sea urchin Diadema setosum from seven reefs. Cu and Cd showed significant reductions, Pb and Cr remained stable, while Fe, Ti and Zn had increased significantly. Overall, based on the Pollution Load Index (PLI), Singapore's reefs would not be considered polluted. Nevertheless, elevated concentrations of Cu, Pb and Zn were detected in sediment, with Cu and Pb exceeding the Threshold Effect Level. The spatial distribution of metal loads between sediment and sea urchin tissues were decoupled, underscoring the complexity of metal uptake and bioavailability. We reveal a mixed temporal trend among the heavy metals examined, each presenting different toxicity potentials and hence risks to local marine assemblages. [Display omitted] • Heavy metals in coral reef sediment and sea urchin tissues were compared to 1994 levels. • A mixed temporal trend was revealed, with varying toxicity potentials among metals. • Heavy metals in sea urchin tissues showed distinct spatial and temporal trends. • Urchin gonads exhibited significant Cd bioaccumulation. • Sex and reproductive status significantly affected metal accumulation in sea urchin gonads. [ABSTRACT FROM AUTHOR]

Nanotechnology holds immense promise for transforming the aquaculture sector by offering significant advancements in disinfection, water quality monitoring, and wastewater treatment. As the global demand for seafood continues to escalate, traditional fishing methods alone are unable to meet this rising need, necessitating the sustainable and regulated expansion of aquaculture practices. However, the industry faces multifaceted challenges, including supply demands for seeds, feed, and fertilizers, frequent disease outbreaks impacting production, competition for resources like land and water, and the imperative to ensure the quality of fish produced. Moreover, aquaculture activities contribute to declining water quality, further exacerbated by other pollutants from agricultural and industrial sources. In this context, our review explores pioneering research utilizing nanotechnology to address these pressing challenges. The major points covered are as follows: 1) The innovative and recent use of nanoparticles for efficient disinfection and water quality regulation; 2) The deployment of advanced nanosensors for precise monitoring of water conditions and combating microbial threats; 3) The strategic application of nanomaterials for wastewater remediation to prevent environmental pollution; 4) The exploration of cutting-edge nanotechnology solutions for comprehensive aquaculture management; 5) The discussion of potential challenges to overcome barriers to the commercialization of nanotechnology in the aquaculture industry. This review serves as a vital contribution by offering a thorough examination of the diverse applications of nanomaterials throughout all facets of aquaculture operations, providing a cohesive viewpoint for both researchers and industry professionals aiming to capitalize on the extensive benefits of nanotechnology in bolstering sustainability and productivity within aquaculture systems. [Display omitted] • Nanoparticles have enormous potential in disinfecting waterborne microbes. • Use of nanosensors enhances pathogen detection, specificity, and applicability. • Nanocoating creates a fouling-resistant barrier, reducing environmental impact. • Nanotechnology offers cost-effective and efficient wastewater treatment solutions. • Comprehending the environmental fate of nanoparticles is essential for application. [ABSTRACT FROM AUTHOR]

Coral-reef type aortic occlusions are uncommon conditions that can result in intermittent claudication. Many claudicants also have concomitant neurogenic aetiologies and revascularization alone may not be beneficial. These cases can prove to be a diagnostic challenge. We present a case of worsening bilateral calf claudication in a patient with previously asymptomatic coral-reef type aorta, anxiety, and spinal stenosis presents. Investigations were unable to differentiate between a neurogenic and vascular cause. The patient opted for aortic stenting before spinal surgery, after extensive discussion. Initial attempts at crossing the occluded segments were unsuccessful and the patient was offered the option to either resume conservative therapy, perform an open axillo-bifemoral bypass or repeat aortic stenting. After discussion, a repeat aortic stenting was performed. This time, the stenting attempt was successful, with completion angiogram showing brisk antegrade flow and strong distal pulses returned. Post-surgery, the patient's symptoms improved vastly. Differentiation of vascular claudication from neurogenic claudication is diagnostically challenging. Decision to treat the aorta or the spinal issue first depend on the patient's constellation of symptoms. Endovascular aortic stenting is well accepted with good results and lower morbidity than open surgery. A repeat attempt is always a possible option. • A 69-year-old with anxiety, significant spinal stenosis and a "coral-reef" type heavily calcified aorta presents with worsening bilateral calf claudication. • The treatment of claudication can be challenging when more than one aetiology exists. Deciding which is more likely requires experience. • Despite an unsuccessful first attempt, the eventual repeat endovascular stenting was successfully performed • Endovascular aortic stenting is now well accepted with fairly good results and lower morbidity than open surgery. A repeat attempt is always a possible option. [ABSTRACT FROM AUTHOR]

Circadian patterns in ST-segment elevation myocardial infarction (STEMI) patients have been previously reported, but little is known about the impact of time dependence of symptom onset on long-term prognosis. Our study population consisted of 11,731 STEMI patients treated by primary percutaneous coronary intervention (PPCI), enrolled in the Singapore Myocardial Infarction Registry (SMIR). Analysis of STEMI incidence trends over the 24-hour period showed the highest rate of symptom onset in the morning, with the peak incidence at 09:00 am. Patients with symptom onset in between 00:00 am-5:59 am showed the highest prevalence of diabetes (P = .010) and anterior STEMI (P < .001) and had the longest ischemic time (P < .001). After adjusting for confounders, we found an association between time of symptom onset of STEMI and rehospitalization for heart failure (HF) at 1 year, with symptom onset between 06:00 pm-11:59 pm and 00:00 am-05:59 am having an estimated 30% to 50% higher risk of rehospitalization for HF at 1 year. Moreover, symptom onset remained a predictor of worse prognosis only in the subgroup of patients with symptoms lasting longer than 120 minutes. The results of this study demonstrate for the first time that rehospitalization for HF in STEMI patients treated with PPCI has a dependence on the time of onset of symptoms, with prolonged ischemia time playing a pivotal role. This may be an additional risk factor to identify those who warrant closer monitoring and more rigorous optimization of their treatment at follow-up, to improve their outcomes. [ABSTRACT FROM AUTHOR]

The role of laparoscopic rectal cancer resection remains controversial. Thus, we aimed to conduct a one-stage meta-analysis with reconstructed patient-level data using randomized trial data to compare long-term oncologic efficacy of laparoscopic and open surgical resection for rectal cancer. Medline, EMBASE and Scopus were searched for articles comparing laparoscopic with open surgery for rectal cancer. Primary outcome was disease free survival (DFS) while secondary outcome was overall survival (OS). One-stage meta-analysis was conducted using patient-level survival data reconstructed from Kaplan-Meier curves with Web Plot Digitizer. Shared-frailty and stratified Cox models were fitted to compare survival endpoints. Seven randomized trials involving 1767 laparoscopic and 1293 open resections for rectal cancer were included. There were no significant differences between both groups for DFS and OS with respective hazard ratio estimates of 0.91 (95% CI: 0.78–1.06, p = 0.241) and 0.86 (95% CI:0.73–1.02, p = 0.090). Sensitivity analysis for non-metastatic patients and patients with mid and lower rectal cancer showed no significant differences in OS and DFS between both surgical approaches. In the laparoscopic arm, improved DFS was noted for stage II (HR: 0.73, 95% CI:0.54–0.98, p = 0.036) and stage III rectal cancers (HR: 0.74, 95% CI:0.55–0.99, p = 0.041). This meta-analysis concludes that laparoscopic rectal cancer resection does not compromise long-term oncologic outcomes compared with open surgery with potential survival benefits for a minimal access approach in patients with stage II and III rectal cancer. [ABSTRACT FROM AUTHOR]

Background/purpose: Taiwan set up disaster medical assistance teams (DMATs) after the Chi-Chi earthquake, but these teams lack unified standards.Methods: This study was divided into two phases. Phase I was a Delphi study conducted in 2019 with 26 experts who were invited to establish Taiwan's DMAT standards by modifying the World Health Organization Emergency Medical Team (WHO EMT) type I fixed standards. Phase II was a cross-sectional study conducted in 2020. A questionnaire was used to evaluate the disaster preparedness of DMATs by standards set in phase I.Results: In phase I, Taiwan's DMAT standards were established after three rounds of Delphi consensus, with a response rate of 88.5%. The major departures from the WHO EMT standards were the exclusion of obstetric care, mental health, rehabilitation, and laboratory and blood transfusion standards and the addition of an ultrasound standard. During phase II, a total of 32 teams were invited, and the response rate was 96.9%. The overall standard achievement rate was 56.9%, and the three lowest achievement rates corresponded to sanitation (22.6%), medical malpractice insurance (25.8%), and pharmacy and drug supply (25.8%). The national DMATs, official DMATs, DMATs funded by government, and DMATs with ≥10 years of experience had significantly higher achievement rates for partial or overall standards.Conclusion: Using localized standards to evaluate the disaster preparedness of each team, DMATs were found to have many shortcomings mainly due to the lack of unified government announcement standards, legal protection, and adequate financial support. [ABSTRACT FROM AUTHOR]

The opinion on the mechanisms underlying the pathogenesis of preeclampsia still divides scientists and clinicians. This common complication of pregnancy has long been viewed as a disorder linked primarily to placental dysfunction, which is caused by abnormal trophoblast invasion, however, evidence from the previous two decades has triggered and supported a major shift in viewing preeclampsia as a condition that is caused by inherent maternal cardiovascular dysfunction, perhaps entirely independent of the placenta. In fact, abnormalities in the arterial and cardiac functions are evident from the early subclinical stages of preeclampsia and even before conception. Moving away from simply observing the peripheral blood pressure changes, studies on the central hemodynamics reveal two different mechanisms of cardiovascular dysfunction thought to be reflective of the early-onset and late-onset phenotypes of preeclampsia. More recent evidence identified that the underlying cardiovascular dysfunction in these phenotypes can be categorized according to the presence of coexisting fetal growth restriction instead of according to the gestational period at onset, the former being far more common at early gestational ages. The purpose of this review is to summarize the hemodynamic research observations for the two phenotypes of preeclampsia. We delineate the physiological hemodynamic changes that occur in normal pregnancy and those that are observed with the pathologic processes associated with preeclampsia. From this, we propose how the two phenotypes of preeclampsia could be managed to mitigate or redress the hemodynamic dysfunction, and we consider the implications for future research based on the current evidence. Maternal hemodynamic modifications throughout pregnancy can be recorded with simple-to-use, noninvasive devices in obstetrical settings, which require only basic training. This review includes a brief overview of the methodologies and techniques used to study hemodynamics and arterial function, specifically the noninvasive techniques that have been utilized in preeclampsia research. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is one of the most prevalent and life-threatening cancer among the world. Accumulated somatic mutations during malignant transformation process endow cancer cells with increased growth, invasiveness and immunogenicity. These highly immunogenic cancer cells develop multiple strategies to evade immune attack. Through post-transcriptional regulation, microRNAs (miRNAs) not only participate in cancer development and progression but also manipulate anti-cancer immune response. This study aims to identify miRNAs associated with the colorectal cell malignant transformation process and their association with immune cell population using synchronous adjacent normal, polyp and CRC specimens. We conducted a Low Density Array to compare the miRNA expression profile of synchronous colorectal adenoma, adenocarcinoma and adjacent normal colon mucosa collected from 8 patients, in order to identify candidate miRNAs involved in CRC progression. These findings were further validated in 14 additional patients and GEO dataset GSE41655. The relative abundance of dendritic cells, natural killer cells, neutrophil and macrophage was determined and correlated with dysregulated miRNA levels. MicroRNA microarray identified 39 miRNAs aberrantly expressed during the colorectal cell transformation process. Seven novel miRNAs were shortlisted, and dysregulation of miR-149-3p, miR-192-3p, miR-335-5p and miR-425 were further validated by the qPCR validation experiment and data retrieved from the GEO dataset. Furthermore, these miRNAs demonstrated certain associations with level of dendritic cells, natural killer cells, neutrophil and macrophage within the polyp or CRC specimens. This study revealed miRNA dysregulated during stepwise malignant transformation of colorectal mucosal cells and their association with immune cell population. [ABSTRACT FROM AUTHOR]

Upper gastrointestinal Crohn's disease (UGI-CD) is an important subclassification of Crohn's Disease (CD). We performed a systematic review and meta-analysis to evaluate the prevalence, risk factors, and clinical outcomes associated with UGI-CD. We searched Embase and Medline for articles reporting the clinical information of UGI-CD in CD patients, through 27 October 2020. Disease location and phenotype were coded according to the Montreal classification, and results were pooled with random effects by DerSimonian and Laird model. 26 articles were included. The prevalence of UGI-CD was 13%. UGI-CD was most commonly found in the stomach (56%) and was associated with concurrent ileocolonic involvement (54%). Non-stricturing, non-penetrating UGI-CD was the most common behavioral phenotype (61%). L4-jejunal disease was associated with the highest rates of surgery. Region of origin did not significantly influence the location and phenotype of UGI-CD. Young, male patients presenting with erythema nodosum, aphthous ulcers and stricturing-phenotype are more likely to have UGI-CD, which in turn is linked to increased risk of hospitalization and surgery. UGI-CD is present in 13% of patients with CD, and patients with L4-jejunal disease are more likely to require surgery. Further studies examining the effect of ethnicity and region on UGI-CD are needed. [ABSTRACT FROM AUTHOR]

Adrenalectomy cures unilateral primary aldosteronism, and it improves or cures hypertension. However, a significant proportion of patients are classified with absent clinical success postsurgery, suggesting that surgery was ineffective. We assessed all patients 6 to 12 months post-surgery for clinical outcomes using Primary Aldosteronism Surgical Outcomes (PASO), AVIS-2, and CONNsortium criteria. We estimated blood pressure changes after adjustment for changes in defined daily dosages of antihypertensive medications. We also reassessed all patients using PASO at their recent clinical visit. A total of 104 patients with unilateral primary aldosteronism underwent adrenalectomy at 2 tertiary centers from 2000 to 2019; 24 (23%), 31 (30%), and 54 (52%) patients were classified with absent clinical success using PASO, AVIS-2, and CONNsortium criteria, respectively. Among 24 patients with absent clinical success using PASO criteria, 10 had complete biochemical cure, 3 partial, 2 absent, and 9 had resolution of hypokalemia. On multivariable analysis, absent clinical success was associated with presence of hyperlipidemia, diabetes mellitus, and lower defined daily dosages at baseline. After adjustment for changes in defined daily dosages, 7 of 24 patients showed blood pressure improvement ≥20/10 mm Hg post-surgery. After a follow-up of mean 5.6 years, 12 of 24 patients showed partial or complete clinical success when reassessed using PASO criteria. Only 6 of 104 (5.8%) patients failed to show clinical improvement post-surgery using any of the 3 mentioned criteria or using PASO criteria at their recent clinical visit. Although some patients may be classified with absent clinical success post-surgery, the assessment of clinical outcomes remains subject to many variables. In patients with unilateral primary aldosteronism, evidenced by lateralization on AVS, unilateral adrenalectomy should remain the recommended treatment. [ABSTRACT FROM AUTHOR]

Facial expressions are important social communicators. In addition to communicating social information, the specific muscular movements of expressions may serve additional functional roles. For example, recalibration theory hypothesizes that the anger expression exaggerates facial cues of strength, an indicator of human fighting ability, to increase bargaining power in conflicts. Supporting this theory is evidence that faces displaying one element of an angry expression (e.g. lowered eyebrows) are perceived to be stronger than faces with opposite expression features (e.g. raised eyebrows for fear). The present study sought stronger evidence that more natural manipulations of facial anger also enhance perceived strength. We used expression aftereffects to bias perception of a neutral face towards anger and observed the effects on perceptions of strength. In addition, we tested the specificity of the strength-cue enhancing effect by examining whether two other expressions, fear and happy, also affected perceptions of strength. We found that, as predicted, a face biased to be perceived as angrier was rated as stronger compared to a baseline rating, whereas a face biased to be more fearful was rated as weaker, consistent with the purported function of fear as an act of submission. Interestingly, faces biased towards a happy expression were also perceived as stronger, though the effect was smaller than that for anger. Overall, the results supported the recalibration theory hypothesis that the anger expression enhances cues of strength to increase bargaining power in conflicts, but with some limitations regarding the specificity of the function to anger. [ABSTRACT FROM AUTHOR]

Several workflow changes were implemented in a large academic interventional radiology practice, including separation of inpatient and outpatient services, early start times, and using an adaptive learning system to predict case length tailored to individual physicians. Metrics including procedural volume, on-time start, accuracy at predicting case length, and room shutdown time were assessed before and after the intervention. Considerable improvements were seen in accuracy of first case start times, predicting block times, and last case encounter ending times. It is proposed that with improved role clarity, interventional radiologists can regain control over their schedules, utilize work hours more efficiently, and improve work-life balance. [ABSTRACT FROM AUTHOR]

Airway involvement, such as airway invasion, compression, and tracheobronchoesophageal fistula (TEF), in esophageal cancer is associated with significant morbidity. However, the risk factors and outcomes of airway complications remain unclear, with limited evidence to guide management. This retrospective analysis included 804 patients with a diagnosis of esophageal cancer from 1998 to 2018 at a tertiary care medical center (Singapore General Hospital, Singapore). Patients' demographics, treatment details, and airway involvement, as determined by bronchoscopic evaluation or computed tomographic imaging, were recorded and analyzed to determine risk factors and outcomes of airway involvement. The incidence of airway involvement and TEF was 36.6% and 13.1%, respectively. Airway involvement was associated with reduced survival from the time of diagnosis (hazard ratio, 1.52; 95% confidence interval [CI], 1.30 to 1.79) and increased hospitalizations per year (4.53 ± 4.80 vs 2.75 ± 3.68; P <.001). On multivariate analysis, midesophageal tumors (odds ratio [OR], 11.0; 95% CI, 6.3 to 19.0) and upper esophageal tumors (OR, 8.5; 95% CI, 4.7 to 15.6), previous treatment with esophageal stenting (OR, 17.8; 95% CI, 4.1 to 77.6), and chemotherapy or radiotherapy were associated with development of airway involvement. In patients with TEF, treatment with chemotherapy (OR, 0.34; 95% CI, 0.20 to 0.60) and combined airway and esophageal stenting (OR, 0.48; 95% CI, 0.25 to 0.91) were independently associated with improved survival. Airway involvement and TEF are common and are associated with increased morbidity and poorer survival. Clinicians should remain vigilant for airway complications after treatment with esophageal stenting, chemotherapy, or radiotherapy, especially in patients with midesophageal and upper esophageal cancers. In patients with TEFs, survival is improved when they are treated with airway stenting, esophageal stenting, or chemotherapy. [ABSTRACT FROM AUTHOR]

Fournier's gangrene is a urological emergency associated with high mortality and morbidity. Severe gangrene resulting in pelvic bone and lower limb involvement are extremely rare. We report a rare case of Fournier's gangrene that is complicated by necrotising fasciitis of the lower limb and osteomyelitis of the pelvic bone, in a patient with previous prostatic adenocarcinoma. The patient was promptly resuscitated, started on broad spectrum antibiotics and then underwent an emergent surgical debridement, followed by multiple relook debridement and definitive reconstruction. Throughout the patient's hospitalisation, he was managed in a multidisciplinary team involving surgeons from different specialities, physicians and allied health staff. Extension of Fournier's gangrene into distant structures is rare but serious complications. To date, there is only one other case reported in literature. The relationship between prior prostatic malignancy and Fournier's gangrene can be explored in subsequent studies. We present a rare case of Fournier's gangrene with pelvic and distal limb involvement. We highlight the possible yet devastating complications of this disease and discuss treatment options available for the holistic management of patients with Fournier's gangrene. • A 66-year-old male with previous high grade mucinous-type adenocarcinoma with signet cells of the prostatic urothelium that was previously treated with radiation therapy, presented with extensive perineal gangrene and painful swelling of the right lower limb for 2 weeks duration. • Intraoperative findings revealed extensive fournier's gangrene, pelvic bone osteomyelitis and pus tracking along the iliotibial tract into the lateral aspect of the right calf. Cultures results were polymicrobial and fungal. • The patient underwent multiple perineal and right lower limb debridements, and was treated with antibiotics and antifungals. Definitive reconstructions of the perineal, sacral and right lower limb wounds were eventually performed. • To our knowledge, this is the second case of Fournier's gangrene with extension into the lower limb. • The contribution of a previous prostatic malignancy to the development of Fournier's gangrene could be explored in subsequent studies. [ABSTRACT FROM AUTHOR]

Carbon quantum dots (CQDs) offer significant promise across industries due to their distinctive optical properties and strong biocompatibility. However, conventional synthesis methods frequently need more precision in controlling nanoparticle size, shape, and uniformity, limiting their versatility in diverse applications. Therefore, this study introduced an innovative approach to synthesising CQDs by combining electrochemical techniques with carbon dioxide (CO 2) nanobubbles, circumventing the need for conventional surfactant-based exfoliation. According to the findings, the synthesised CQDs exhibited remarkable properties, including a high quantum yield of 26.17% and an average particle size of 2.24 ± 1.07 nm. Such characteristics render them exceptionally suitable for portable sensors for heavy metal detection in wastewater. Moreover, the investigation revealed the outstanding selectivity of the synthesised CQDs, particularly towards iron (Fe3+) ions, but demonstrated limited reactivity towards lead (Pb2+) and copper (Cu2+) ions. The novel approach also generated non-toxic CQD under the supply of CO 2 nanobubbles, which offers a scalable avenue for developing advanced materials for various applications, including sensors for heavy metal ion detection in wastewater. The conventional synthesis method that relied on sodium dodecyl sulphate (SDS) surfactants without CO 2 nanobubbles yielded CQDs with a significantly lower quantum yield of 11.2%. In short, incorporating CO 2 nanobubbles with electrochemical techniques enhanced quantum yield and superior control over the size and shape of the synthesized CQDs. This novel method successfully produced CQDs with scalable distinct morphologies and provided a new understanding of the CQD synthesis mechanism, with potential applications in portable sensing for environmental monitoring and water quality management. [Display omitted] • Synthesis of carbon quantum dots via CO 2 nanobubbles enhanced electrolysis. • Fabrication of 3D-printed mobile sensor for Fe3+ ions detection. • Exposition of graphite's exfoliation mechanism in the presence of CO 2 nanobubbles. [ABSTRACT FROM AUTHOR]

Arthrocentesis and arthroscopy are relatively safe treatments for arthrogenic temporomandibular disorders. Hands-on training in both procedures is essential for surgeons to become competent. In this study, a three-dimensional (3D) temporomandibular joint (TMJ) prototype was developed at a relatively low cost, and arthrocentesis and arthroscopy were performed successfully on the model. Despite its limitations, this model is a viable adjunct to TMJ surgical training and can be fabricated easily by any training centre with a 3D printer. [ABSTRACT FROM AUTHOR]

The pandemic of Covid-19 has caused a shift of paradigm of education, from face-to-face to e-learning. E-learning leads to an escalation in digitalization of handwritten documents because it requires submission of homework and assignments through online. To help teachers in checking digitalized handwritten homework, this paper proposes an automatic checking system based on a convolutional neural network (CNN) for handwritten numeral recognition. The CNN is used to recognize four arithmetic operations in mathematical questions consisting of addition, deduction, multiplication and division. The performance CNN in handwritten numeral recognition have been optimized in terms of activation function and gradient descent algorithm. The proposed CNN is also trained and tested with the MNIST handwritten data set. The experimental results show that the recognition accuracy the improved CNN improves to a certain extent as compared to before optimization. [ABSTRACT FROM AUTHOR]

• Recurrence requiring reoperation occurred in 10.8% of patients. • Thrombotic events occurred in 8.6% of patients. • Time to resumption did not significantly affect recurrence. • Recurrence rates were similar for patients restarted before and after 14 to 84 days. • Early resumption can be safe for patients with a high thromboembolic risk. The decision to resume antithrombotic therapy after surgical evacuation of chronic subdural hematoma (CSDH) requires judicious weighing of the risk of bleeding against that of thromboembolism. This study aimed to investigate the impact of time to resumption of antithrombotic therapy on outcomes of patients after CSDH drainage. Data were obtained retrospectively from three tertiary hospitals in Singapore from 2010 to 2017. Outcome measures analyzed were CSDH recurrence and any thromboembolic events. Logistic and Cox regression tests were used to identify associations between time to resumption and outcomes. A total of 621 patients underwent 761 CSDH surgeries. Preoperative antithrombotic therapy was used in 139 patients. 110 (79.1%) were on antiplatelets and 35 (25.2%) were on anticoagulants, with six patients (4.3%) being on both antiplatelet and anticoagulant therapy. Antithrombotic therapy was resumed in 84 patients (60.4%) after the surgery. Median time to resumption was 71 days (IQR 29 – 201). Recurrence requiring reoperation occurred in 15 patients (10.8%), of which 12 had recurrence before and three after resumption. Median time to recurrence was 35 days (IQR 27 – 47, range 4 – 82 days). Recurrence rates were similar between patients that were restarted on antithrombotic therapy before and after 14, 21, 28, 42, 56, 70 and 84 days, respectively. Thromboembolic events occurred in 12 patients (8.6%), of which five had the event prior to restarting antithrombosis. Time to antithrombotic resumption did not significantly affect CSDH recurrence. Early resumption of antithrombotic therapy can be safe for patients with a high thromboembolic risk. [ABSTRACT FROM AUTHOR]

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To determine the variation in practices on meticillin-resistant Staphylococcus aureus (MRSA) surveillance and management of MRSA-colonized patients amongst 17 acute healthcare facilities in Singapore, the Ministry of Health convened a sharing session with Infection Prevention and Control Leads. All hospitals practised close to universal MRSA entry swabbing in keeping with national policy. There were, however, major variations in the response to both positive and negative surveillance swabs across facilities including the role of routine antiseptic bathing and MRSA decolonization. Most undertaking decolonization considered its role to be in 'bioburden reduction' rather than longer-term clearance. [ABSTRACT FROM AUTHOR]

Conventional colectomy, and the Japanese Society for Cancer of the Colon and Rectum (JSCCR) D2 Lymphadenectomy (LND2), are currently considered standard of care for surgical management of colon cancer. Colectomy with complete mesocolic excision (CME) and JSCCR D3 Lymphadenectomy (LND3) are more radical alternative approaches and provide a greater degree of lymph nodal clearance. However, controversy exists over the long-term benefits of CME/LND3 over non-CME colectomies (NCME)/LND2. In this study, we performed a systematic review and meta-analysis to compare the surgical, pathological, and oncological outcomes of CME/LND3 with NCME/LND2. Embase, Medline and CENTRAL databases were searched from inception until May 15, 2020, in accordance with PRISMA guidelines. Studies were included if they compared curative intent CME/LND3 with NCME/LND2. Weighted mean differences (WMD) and odds ratios (OR) were estimated for continuous and dichotomous outcomes respectively. Out of 1310 unique citations, 106 underwent full-text review, and 30 were included for analysis. In total, 21,695 patients underwent resection for colon cancer. 11,625 received CME/LND3, and 10,070 underwent NCME/LND2. No significant differences were found in post-operative morbidity and mortality. Both overall and disease-free survival favored CME/LND3 (5-year OS: OR = 1.29; 95% CI 1.02 to 1.64, p = 0.03; 5-year DFS: OR = 1.61; 95% CI 1.14 to 2.28; p = 0.007). This is the first systematic review and meta-analysis to demonstrate that CME/LND3 has superior long-term survival outcomes compared to NCME/LND2. [ABSTRACT FROM AUTHOR]

The adoption of low-carbohydrate diets can lead to weight loss in many patients. However, these now widespread diets also have the potential to exacerbate hypercholesterolemia. The objective of this study is to display the potentially harmful effects of the ketogenic diet on cholesterol levels in patients with or without underlying hyperlipidemia. We describe 5 patients who developed marked increases in plasma cholesterol on ketogenic diets and assessed whether they had a well-described underlying genetic hyperlipidemia. Three out of 5 patients had extraordinary increases of blood cholesterol levels to over 500 mg/dL. The other 2 patients more than doubled their low-density lipoprotein cholesterol levels on a ketogenic diet. One patient had an APOE E2/E2 genotype. A higher burden of common genetic polymorphisms was found in 2 patients, with no major mutations found. No potential genetic cause was seen in a fourth patient, and the fifth patient had no genetic testing. Three patients, including the one who was most hypercholesterolemic, had a marked reduction in cholesterol after reverting to a more liberal diet. One refused to change his diet but had a satisfactory low-density lipoprotein cholesterol reduction on ezetimibe. These cases should serve as a caution that high-fat low-carbohydrate diets have the potential to exacerbate or cause hypercholesterolemia in patients with or without underlying genetic hyperlipidemia. • Low-carb diets can lead to weight loss, but can exacerbate hypercholesterolemia. • Hypercholesterolemia can develop with or without underlying genetic hyperlipidemia. • This article describes patients who developed marked increases in plasma cholesterol. [ABSTRACT FROM AUTHOR]

• A generic mathematical model for the retrofit of water networks is developed. • The model is applicable to both direct reuse/recycling and regeneration schemes. • The model considers adding new pipes and modifying existing pipes. • Single- and multi-objective optimisation scenarios were presented with a case study. • Trade-offs among freshwater use, retrofit cost and modified pipes are explored. This work develops a generic mathematical model for process engineers and designers to retrofit existing water networks in process plants for water savings. The model is applicable to both direct reuse/recycling and regeneration schemes, with single- and multi-objective optimisation scenarios. The objectives of the model may include minimum water flowrates, minimum extent of retrofits and/or a reasonable payback period. A literature case study involving an existing water network in a pulp and paper mill is solved to elucidate the newly proposed model. The results of single-objective optimisation show maximum annual cost savings of $4,027,919 in the direct reuse/recycling scheme (with a 57.2% freshwater saving) and $4,420,975 in the regeneration scheme (with an 84.5% freshwater saving). For multi-objective optimisation, the use of the constraint method in the direct reuse/recycling scheme generates a range of Pareto optimal solutions for selection by the decision-maker. It was found that 88.1% of the freshwater saving can be achieved with 44.2% of the piping retrofit cost. Although the compromise solution obtained using fuzzy optimisation in the regeneration scheme achieves only 66.6% of the freshwater saving with 86% of the total retrofit cost, the number of new and modified connections is reduced by more than half. [ABSTRACT FROM AUTHOR]

Panton-Valentine Leukocidin (PVL), is one of the virulence gene expressed by Methicillin Resistant Staphylococcus aureus (MRSA) and is known to be associated with severe form of community acquired MRSA infection. The aim of this study is to investigate its prevalence in our setting and patient's clinical outcome. A cross sectional study involve retrospective record review were done involving 90 MRSA positive isolates between November 2016 and October 2017. Multiplex PCR was performed to detect fem A , mec A and PVL genes. Clinical presentation and outcomes of patients were reviewed and presented as descriptive analysis. All of the 90 MRSA isolates included in this study were positive for fem A and mec A genes following PCR. PVL gene was detected in 20% (n = 18) of the isolates of which 61.1% (n = 11) were community acquired infections and 38.8% (n = 7) were hospital acquired. Case distribution from community acquired infections include patients with skin and soft tissue infections (33.3%, n = 6), infected diabetic foot ulcers (16.7%, n = 3), and one patient each (5.5%, n = 1) for community acquired pneumonia and meningitis. Half of the PVL positive MRSA cases (50%, n = 9) were having sepsis and four of them succumbed to death due to severe infection. This study shows a high prevalence of PVL positive MRSA infection in our population. Skin and soft tissue infections accounting for the major sources. In addition, the presence of the PVL gene is associated with increased risk for developing sepsis. [ABSTRACT FROM AUTHOR]

Growing populations, increasing standards of living, and reliance on advancing technologies are resulting in an emerging abundance of electronic waste. Automating disassembly of these electronic products is a vital part of improving end-of-life product treatment where hazardous chemicals and materials are present. Furthermore, non-destructive disassembly is ideal to preserve the embodied energy in components from manufacturing. This requires the removal, and hence detection, of fasteners like screws in a disassembly environment. Crosshead screws are a common fastener type used in LCD monitors. This paper proposes a method of screw detection for disassembly and presents results of detection of crosshead screws on components of various models of LCD monitors in a disassembly cell. The system first applies gamma correction to standardize brightness––or luminance–– of images. Generic knowledge about screw features in the form of a deep learning model is then used to visually detects screws. The results are analyzed against common screw location combinations on product components in order to logically reason about possible undetected screws that are also likely to exist. Finally, true negative detections are collected as new training data and the deep learning model is re-trained on these missed detections to improve performance; tailoring and adapting to the environment of the specific disassembly cell. [ABSTRACT FROM AUTHOR]

• Bilateral chronic subdural hematoma is frequently drained unilaterally. • Unilateral drainage achieves similar outcomes as bilateral drainage in select cases. • Use of anticoagulants predicts reoperation for contralateral hematoma growth. • Maximum axial width ≤9 mm predicts complete resolution of contralateral hematoma. • Our prognostic score predicts risk of reoperation for contralateral hematoma. Bilateral chronic subdural hematoma (bCSDH) is frequently drained unilaterally when the contralateral CSDH is small and asymptomatic. However, reoperation rates for contralateral CSDH growth can be high. We aimed to develop a prognostic scoring system to guide the selection of suitable patients for unilateral drainage of bCSDH. Data were collected retrospectively across three tertiary hospitals from 2010 to 2017 on all consecutive bCSDH patients aged 21 or above. Predictors of reoperation were identified using multivariable logistic regression. A prognostic score was developed and internally validated. 240 bCSDH patients were analyzed. 98 (40.8%) underwent unilateral and 142 (59.2%) underwent bilateral evacuation. Clinical outcomes were comparable between the unilateral and bilateral evacuation groups. Within the unilateral evacuation group, 4 (4.1%) had a reoperation for contralateral CSDH growth. Reoperation for contralateral CSDH was predicted by preoperative use of anticoagulants (OR = 15.0, 95% CI: 1.49–169.15, p = 0.017). Complete resolution of contralateral CSDH was predicted by its preoperative maximum width, with a cut-off of 9 mm producing the highest sensitivity and specificity (OR = 4.17 for ≤9 mm, 95% CI: 1.54–11.11, p = 0.004). Using our prognostic score, reoperation rate for contralateral CSDH was 1.6%, 3.6%, 16.7%, and 50.0% in low-risk, moderate-risk, high-risk and very high-risk patients, respectively. With each increase of 1 in the prognostic score, patients were 4 times as likely to undergo reoperation for contralateral CSDH (OR = 3.98, 95% CI: 1.36–13.53, p = 0.013). Our proposed risk score may be used as an adjunct in clinical decision making for bCSDH patients undergoing unilateral evacuation. [ABSTRACT FROM AUTHOR]

Evolutionary theories suggest that humans prefer sexual dimorphism in faces because masculinity in men and femininity in women may be an indicator of immune function during development. In particular, the immunocompetence handicap hypothesis proposes that sexual dimorphism indicates good immune function during development because the sex hormones, particularly testosterone in men, required for the development of sexually dimorphic facial features also taxes the immune system. Therefore, only healthy males can afford the high level of testosterone for the development of sexually dimorphic traits without compromising their survival. Researchers have suggested that a similar mechanism via the effects of oestrogen might also explain male preferences for female femininity. Despite the prominence of the immunocompetence handicap hypothesis, no studies have tested whether immune function during development predicts adult facial sexual dimorphism. Here, using data from a longitudinal public health dataset, the Western Australian Pregnancy Cohort (Raine) Study (Generation 2), we show that some aspects of immune function during early adolescence (14 years) positively predict sexually dimorphic 3D face shape in both men and women. Our results support a fundamental assumption that facial sexual dimorphism is an indicator of immune function during the development of facial sexual dimorphism. [ABSTRACT FROM AUTHOR]

In previous work, we presented a web-based graph database engine to enable companies to find pathways to convert their wastes to resource to enable industrial symbiosis (IS). In this paper, we extend the database to include water streams, and cost and carbon footprint (CFP) of pathways for waste-to-resource conversion. To support companies' decision making for waste-to-resource conversion pathways, we enhanced the database query processor based on a graph algorithm to identify eco-efficient pathways to convert waste to resource based on user's preference. We demonstrate the application of this methodology using a case study of wastewater to water resource. [ABSTRACT FROM AUTHOR]

The application of robotic disassembly or disassembly automation in industry is currently limited due to technological constraints on handling uncertainties in end-of-life product variation and condition. As a result, extensive research focuses on closing the gap between the need for robotic disassembly and the technological capabilities needed to deliver it. A multi-head tool utilizing a screwdriver, hole saw, and angle grinder has been developed and tested for the application of robotic disassembly of LCD screens. Each of the three tools is mounted on the wrist of an ABB IRB 140 industrial robot arm orthogonal to each other such that the robot need only rotate to apply a different tool head. The system builds upon a previous system which used only destructive and semi-destructive cutting methods, by introducing a force/torque sensor to guide force control for the non-destructive unscrewing skill and the less destructive drilling skill as options for the removal of screws. These alternative actions allow the system to deal with variations and unexpected outcomes of disassembly such as failures to disestablish a fastener with a particular skill, and if all alternative actions are exhausted, user demonstration is called upon. [ABSTRACT FROM AUTHOR]

Singapore imports more than 90% of the food consumed with the remaining being produced in farms locally. With Singapore's commitment to achieving the United Nations' sustainable development goals and the recently announced "30 by 30" goal of raising the current food production levels from the current 10–30% of the nation's food needs by 2030, there is an emphasis to raise productivity, strengthen climate resilience and also tackle resource constraints. This work presents the current trend analysis of Singapore's food supply and consumption through the lens of life cycle environmental impacts. With this as a baseline, multiple future scenarios are presented based on different anticipated shifts as a comparison. Based on the "30 by 30" goal, these future scenario analyses describe shifts towards optimal health diet and plant-based diet through alternative plant-based meats, and will be further discussed to derive insights on how they may affect future outcomes in terms of environmental impacts and what they mean for decision-making or policy-making. [ABSTRACT FROM AUTHOR]