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The electrocardiogram (ECG) is a crucial diagnostic tool in the Emergency Department (ED) for assessing patients with Acute Coronary Syndrome (ACS). Despite its widespread use, the ECG has limitations, including low sensitivity of the STEMI criteria to detect Acute Coronary Occlusion (ACO) and poor inter-rater reliability. Emerging ECG features beyond the traditional STEMI criteria show promise in improving early ACO diagnosis, but complexity hinders widespread adoption. The potential integration of Artificial Neural Networks (ANN) holds promise for enhancing diagnostic accuracy and addressing reliability issues in ECG interpretation for ACO symptoms. Ovid MEDLINE, CINAHL, EMBASE, Cochrane, PubMed and Scopus were searched from inception through to 8th of December 2023. A thorough search of the grey literature and reference lists of relevant articles was also performed to identify additional studies. Articles were included if they reported the use of ANN for ECG interpretation of Acute Coronary Syndrome in the Emergency Department patients. The search yielded a total of 244 articles. After removing duplicates and excluding non-relevant articles, 14 remained for analysis. There was significant heterogeneity in the types of ANN models used and the outcomes assessed, making direct comparisons challenging. Nevertheless, ANN appeared to demonstrate higher accuracy than physician interpreters for the evaluated outcomes and this proved independent of both specialty and years of experience. The interpretation of ECGs in patients with suspected ACS using ANN appears to be accurate and potentially superior when compared to human interpreters and computerised algorithms. This appears consistent across various ANN models and outcome variables. Future investigations should emphasise ANN interpretation of ECGs in patients with ACO, where rapid and accurate diagnosis can significantly benefit patients through timely access to reperfusion therapies. • Artificial neural networks are a promising adjunct to interpret ECGs • Artificial neural networks may be as accurate as experienced physicians • There is significant heterogeneity within the current published literature • Further research should focus on ECGs of patients with an acute coronary occlusion [ABSTRACT FROM AUTHOR]

Implantable loop recorders (ILRs) are increasingly used to evaluate patients with unexplained syncope. Identification of all predictors of bradycardic syncope and consequent permanent pacemaker (PPM) insertion is of substantial clinical interest as patients in the highest risk category may benefit from upfront pacemaker insertion. We performed a systematic review and meta-analysis to identify risk predictors for PPM insertion in ILR recipients with unexplained syncope. An electronic database search (MEDLINE, Embase, Scopus, Cochrane) was performed in June 2023. Studies evaluating ILR recipients with unexplained syncope and recording risk factors for eventual PPM insertion were included. A random effects model was used to calculate the pooled odds ratio (OR) for clinical and electrocardiographic characteristics with respect to future PPM requirement. Eight studies evaluating 1007 ILR recipients were included; 268 patients (26.6%) underwent PPM insertion during study follow-up. PPM recipients were older (mean age, 70.2 ± 15.4 years vs 61.6 ± 19.7 years; P <.001). PR prolongation on baseline electrocardiography was a significant predictor of PPM requirement (pooled OR, 2.91; 95% confidence interval, 1.63–5.20). The presence of distal conduction system disease, encompassing any bundle branch or fascicular block, yielded a pooled OR of 2.88 for PPM insertion (95% confidence interval, 1.53–5.41). Injurious syncope and lack of syncopal prodrome were not significant predictors of PPM insertion. Sinus node dysfunction accounted for 62% of PPM insertions, whereas atrioventricular block accounted for 26%. Approximately one-quarter of ILR recipients for unexplained syncope require eventual PPM insertion. Advancing age, PR prolongation, and distal conduction disease are the strongest predictors for PPM requirement. [Display omitted] [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has gained significant attention to the intersection of public health crises and environmental challenges, particularly in the context of marine pollution. This paper examines the various impacts of the pandemic on marine environments, focusing on the pollution attributed to single-use plastics (SUPs) and personal protective equipment (PPE). Drawing on a comprehensive analysis of literature and case studies, the paper highlights the detrimental effects of increased plastic waste on marine ecosystems, biodiversity, and human health. Statistical data and graphical representations reveal the scale of plastic pollution during the pandemic, emphasizing the urgent need for mitigation strategies. The study evaluates innovative monitoring techniques and future recommendations, emphasizing stakeholder collaboration in sustainable waste management. By broadening geographic examples and comparative analyses, it provides a global perspective on the pandemic's impact, highlighting the importance of international cooperation for safeguarding marine ecosystems. [Display omitted] • COVID-19 reshapes marine pollution dynamics. • Surge in medical waste affects marine ecosystems • Pandemic disrupts shipping, impacts environmental integrity. • Innovative mitigation strategies proposed • Urgency for holistic approaches in post-pandemic era [ABSTRACT FROM AUTHOR]

Polysomnography (PSG) is the reference standard of sleep measurement, but is burdensome for the participant and labor intensive. Affordable electroencephalography (EEG)-based wearables are easy to use and are gaining popularity, yet selecting the most suitable device is a challenge for clinicians and researchers. In this systematic review, we aim to provide a comprehensive overview of available EEG-based wearables to measure human sleep. For each wearable, an overview will be provided regarding validated population and reported measurement properties. A systematic search was conducted in the databases OVID MEDLINE, Embase.com and CINAHL. A machine learning algorithm (ASReview) was utilized to screen titles and abstracts for eligibility. In total, 60 papers were selected, covering 34 unique EEG-based wearables. Feasibility studies indicated good tolerance, high compliance, and success rates. The 42 included validation studies were conducted across diverse populations and showed consistently high accuracy in sleep staging detection. Therefore , the recent advancements in EEG-based wearables show great promise as alternative for PSG and for at-home sleep monitoring. Users should consider factors like user-friendliness, comfort, and costs, as these devices vary in features and pricing, impacting their suitability for individual needs. [ABSTRACT FROM AUTHOR]

Knowledge of morphology of the maxillary arch is important in many spacialities of dentistry. This retrospective cross-sectional study was performed using 109 randomly selected maxillary CBCT images of patients in the age range of 18–60 from the archives in Faculty of Dental Sciences, University of Peradeniya, Sri Lanka. EzDent software was used for measurements. Measurements related to the width were acquired from coronal sections while the measurements related to antero-posterior dimensions were performed on axial sections. A majority had an oval shaped maxillary arch (64.8%) followed by V shaped one.(29.2%). The mean height of the alveolar ridge at the upper canine position was 8.9 mm and the mean height of the alveolar ridge at the first molar level was 20.1 mm. Mann Whitney U test was used to compare measurements of variables between males and females. Difference in the height of alveolar ridge at the junction of soft and hard palate, width of the alveolar ridge at the canine, first molar and second molar and also the antero-posterior distance of the arch at the inter canine distance and junction between the hard and soft palate were statistically significant. Kruskal Wallis test was used to compare the differences between age groups. Chisquare values didnot indicate significant differences of measurements according to the age group of the participants. In conclusion, there is a significant difference in all maxillary arch parameters between the different genders. No significant differences in arch parameters were observed among the different age groups. [ABSTRACT FROM AUTHOR]

Contrast-induced acute kidney injury is not uncommon after percutaneous coronary intervention, particularly in high-risk patients. Pharmacologic approaches have not demonstrated significant benefit, and numerous device-based approaches exist targeting a variety of pathways. In this review, we summarize the most recent interventions and the evidence behind them. [ABSTRACT FROM AUTHOR]

Background: Female gender is associated with an increased recurrence of atrial fibrillation (AF) after catheter ablation (CA). Although AF is more common in men, women constitute a significant proportion with persistent atrial fibrillation (PsAF).Objective: The purpose of this study was to determine whether multiple ablation procedures improves arrhythmia outcomes in females with PsAF compared to men.Methods: We performed a multicenter observational study to determine long-term arrhythmia outcomes in patients undergoing >1 CA for PsAF. CA involved pulmonary vein (PV) isolation with additional ablation including linear, posterior wall isolation, electrogram-guided, or a combination of these.Results: A total of 281 patients had >1 ablation procedure for PsAF and were included in this analysis (mean age 58.7 ± 9.3 years; 86 [30.6%] female; left atrial [LA] area 27.0 ± 5.3 cm2; PsAF duration 1.7 ± 1.7 years). At mean follow-up of 45.5 ± 31.8 months, freedom from recurrent AF was present in 148 patients(52.7%) after 2.2 ± 0.5 procedures. After multivariate analysis, female gender (hazard ratio [HR] 2.10; P <.001) and enduring PV isolation (HR 1.64; P = .01) were independently associated with AF recurrence. Enduring PV isolation was significantly higher in women than in men (33.7% vs 19.5%; P = .01).Conclusion: Female gender was independently and strongly associated with arrhythmia recurrence in patients undergoing multiple procedures for PsAF. PV reconnection was less likely, and fewer reconnected PVs occurred in women. Further studies are required to better understand the mechanisms responsible for AF in females to assist in closing the gender gap in the success of CA. [ABSTRACT FROM AUTHOR]

To determine the size and position of the Greater Palatine Foramen using CBCT GPF was evaluated on 50 CBCT's which were obtained at the Division of Oral Medicine and Radiology, FDS, University of Peradeniya, The distance of each GPF to the mid maxillary suture (MMS), Anterior Nasal Spine (ANS), relationship of the GPF to the molar teeth and diameter were measured in different orthogonal planes using measurement tools integrated to the CBCT software. Mean diameter of the GPF in females and males were 3.72 mm for the right and 3.31 mm for the left and 4.56 mm and 4.30 mm. The antero-posterior distance measured from the ANS to mid GPF in axial sections among females was 45.70 mm and 44.81 mm for the right and left respectively whereas for males it was 48.37 mm and 47.6 mm. The distances in axial sections were 14.82 and 15.14 mm for right and left sides in females whereas in males it was 15.50 and 15.67 mm from the MMS. The same measurement in the coronal plane was 14.93 mm and 15.22 mm for females for the right and left GPF and was 15.63 mm and 15.49 mm in males respectively. There was a significant difference between the distance of ANS to the GPF on both sides and the diameters of GPF in both males and females (p < 0.005). A significant difference was seen between the mean distance from the ANS to the GPF in left and right sides and the diameter of the GPF on the sides among the genders. [ABSTRACT FROM AUTHOR]

• There was no evidence on Cd, Pb or As contamination in rice or drinking water in CKDu affected areas in Sri Lanka. • Urine, hair and renal tissue analysis did not demonstrate features of Cd or As toxicity in CKDu patients. • There was no evidence to support direct contribution of As, Cd or Pb in pathogenesis of CKDu. Chronic kidney disease of uncertain etiology (CKDu) in areas in and around Sri Lanka's North Central Province has been identified as a major non-communicable disease due to its high prevalence and the burden on the public health system. Controversial evidence relating to the etiology and risk factors of CKDu has been reported. The most debated is the role of trace elements such as Cd and As in the pathogenesis of CKDu. Urine and hair samples collected from CKDu patients and healthy controls were measured for the concentration of different elements including Cd and As. To assess the possible environmental exposures, drinking water and rice samples collected from the affected areas as well as unaffected areas in the country were analyzed. Transmission electronic microscopic analysis of renal biopsies from CKDu patients was also performed. Analysis of drinking water and rice samples indicated that the levels of all minerals and trace elements analyzed including Cd and As were within the levels recommended by World Health Organization and Sri Lanka drinking water guidelines and did not suggest any form of contamination. Analysis of biological samples, including urine, hair and renal tissue, did not provide evidence to support Cd or As toxicity in CKDu patients. Overall, the observations of this integrated, comprehensive study, which included biological, environmental and pathological investigations, strongly support our previous reports on the absence of Cd and As toxicity in areas with high prevalence of CKDu. Further, these observations do not provide evidence on the involvement of Cd and As in pathogenesis of CKDu in Sri Lanka. [ABSTRACT FROM AUTHOR]

Abstract Objective The objectives of this study were to evaluate the normal radiographic length of the styloid process (SP), prevalence and type of elongation, and angulation of the styloid process in relation to sex and side on digital panoramic radiographs in a Sri Lankan population. Methods A total of 100 digital panoramic images selected from the database at the Division of Oral Medicine and Radiology, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka were evaluated for the radiological features of the styloid process. Lengths greater than 30 mm were consider as elongated. Elongated styloid processes were also classified into three types based on Langlais classification (elongated, pseudo articulated; and segmented). Results The mean radiological length of the SP on the right and left side was 25.8 mm ± 7.5 mm and 23.2 mm ± 9.0 mm respectively. The prevalence of elongated styloid process in males and female were 34.9% and 24.6%. The maximum length observed on right and left sides were 43.2 mm and 41 mm respectively. However, the differences between the genders and the sides were statistically not significant (P = 0.199). The most frequently observed type of elongation was type I (elongated) according to the Langlais classification. Conclusion This study provides valuable knowledge of the anatomical variations of the SP which may help clinicians from various specialties to diagnose the Eagle syndrome. [ABSTRACT FROM AUTHOR]

• People who had both type 2 diabetes (T2DM) and hypertension had larger volumes of perivascular spaces (PVS) in their white matter visible on MRI. • In people with hypertension, PVS mediated associations between T2DM and small vessel disease (SVD) markers, and SVD progression over 1 year. • PVS may be a target to mitigate the impact of T2DM and hypertension on the small cerebral vessels. Type 2 diabetes mellitus (T2DM) and hypertension are risk factors for cerebral small vessel disease (SVD); however, few studies have characterised their relationships with MRI-visible perivascular spaces (PVS). MRI was used to quantify deep (d) and periventricular (p) white matter hyperintensities (WMH), lacunes, PVS in the white matter (wmPVS) or basal ganglia (bgPVS), and diffusion metrics in white matter. Patients with T2DM had greater wmPVS volume and there were greater wmPVS volumes in patients with T2DM and hypertension together. Counterfactual moderated mediation models found indirect effects of T2DM on volumes of other SVD and diffusion markers that were mediated by wmPVS: pWMH, dWMH, periventricular lacunes, and deep lacunes, and progression of deep lacunes over 1 year, in patients with hypertension, but not in patients without hypertension. Studying the regulation of cortical perivascular fluid dynamics may reveal mechanisms that mediate the impact of T2DM on cerebral small vessels. [ABSTRACT FROM AUTHOR]

Background: Systemic hemodynamic characteristics of patients with suspected acute ischemic stroke are poorly described. The objective of this study was to identify baseline hemodynamic characteristics of emergency department (ED) patients with suspected acute stroke.Methods: This was a planned analysis of the stroke cohort from a multicenter registry of hemodynamic profiling of ED patients. The registry prospectively collected non-invasive hemodynamic measurements of patients with suspicion for acute stroke within 12h of symptom onset. K-means cluster analysis identified hemodynamic phenotypes of all suspected stroke patients, and we performed univariate hemodynamic comparisons based on final diagnoses.Results: There were 72 patients with suspected acute stroke, of whom 38 (53%) had a final diagnosis of ischemic stroke, 10 (14%) had hemorrhagic stroke, and 24 (33%) had transient ischemic attack (TIA). Analysis defined three phenotypic clusters based on low or normal cardiac index (CI) and normal or high systemic vascular resistance index (SVRI). Patients with TIA had lower mean CI (2.3L/min/m2) compared to hemorrhagic or ischemic stroke patients (p<0.01).Conclusions: The study demonstrates the feasibility of defining hemodynamic phenotypes of ED patients with suspected stroke. [ABSTRACT FROM AUTHOR]

Background: There is little known about the baseline hemodynamic (HD) profiles (beyond pulse/blood pressure) of patients presenting to the Emergency department (ED) with acute heart failure (AHF). Assessing these baseline parameters could help differentiate underlying HD phenotypes which could be used to develop specific phenotypic specific approaches to patient care.Methods: Patients with suspected AHF were enrolled in the PREMIUM (Prognostic Hemodynamic Profiling in the Acutely Ill Emergency Department Patient) multinational registry and continuous HD monitoring was initiated on ED presentation using noninvasive finger cuff technology (Nexfin, BMEYE, Edwards Lifesciences, Irvine, California). Individuals with clinically suspected and later confirmed AHF were included in this analysis and initial 15minute averages for available HD parameters were calculated. K-means clustering was performed to identify out of 23 HD variables a set that provided the greatest level of inter-cluster discrimination and intra-cluster cohesions.Results: A total of 127 patients had confirmed AHF. The final model, using mean normalized patient baseline HD values was able to differentiate these individuals into 3 distinct phenotypes. Cluster 1: normal cardiac index (CCI) and systemic vascular resistance index (SVRI); cluster 2: very low CI and markedly increased SVRI: and cluster 3: low CI and an elevated SVRI. These clusters were not differentiated using clinically available ED information.Conclusions: Three distinct clusters were defined using novel noninvasive presenting HD monitoring technology in this cohort of ED AHF patients. Further studies are needed to determine whether phenotypic specific therapies based on these clusters can improve outcomes. [ABSTRACT FROM AUTHOR]

Exposure to excess fluoride is a controversial public health concern as it can cause dental/skeletal fluorosis as well as renal toxicity. The study intended to evaluate the synergistic interaction of clay intercalation and thermochemical modification on corncob biochar to remove fluoride from aqueous solutions. Layered double hydroxide was assorted with thermally activated (torrefaction and pyrolysis) corncob biochar at 1:1 (w/w) ratio to obtain composites called LDH-CCBC250 and LDH-CCBC500. Physicochemically characterized adsorbents were assessed against the pH (3–9), reaction time (up to 12 h) and initial fluoride concentration (0.5–10 mg L−1) for defluoridation. The porous structure of biochar was found to be richer compared to biocharcoal. The adsorption performance of LDH-CCBC500 was 6-fold higher compared to LDH-CCBC250 signifying the pronounced effect of thermal activation. Fluoride adsorption was pH dependent, and the best pH was in the range of pH 3.5–5.0 and there was no ionic strength dependency. Fluoride uptake by LDH-CCBC500 follows pseudo-second order and Elovich kinetic models, which suggests a chemisorption process followed by physisorption. The most expected way to eliminate fluoride by LDH-CCBC500, which had a maximum adsorption capacity of 7.24 mg g−1, was cooperative chemical adsorption upon the Langmuir and Hills isotherm (r2 = 0.99) parameters. Layered double hydroxide intercalated corncob biochar derived from slow pyrolysis is best performing in acidic waters. [Display omitted] • Fluoride removal by thermochemically produced corncob biochars were examined. • Thermal activation provides improvement towards adsorption performance. • A high removal of F− of 7.24 mg g−1 was observed for LDH-CCBC500 at pH 4. • Cooperative chemisorption followed by physisorption governs the F− removal mechanism. [ABSTRACT FROM AUTHOR]

Objectives: To derive distinct clusters of septic emergency department (ED) patients based on their presenting noninvasive hemodynamic (HD) measurements and to determine if any clinical parameters could identify these groups.Methods: Prospective, observational, convenience study of individuals with confirmed systemic infection. Presenting, pretreatment noninvasive HD parameters were compiled using Nexfin (Bmeye/Edwards LifeSciences) from 127 cases. Based on normalized parameters, k-means clustering was performed to identify a set of variables providing the greatest level of intercluster discrimination and intracluster cohesion.Results: Our best HD clustering model used 2 parameters: the cardiac index (CI [L/min per square meter]) and systemic vascular resistance index (SVRI [dynes·s/cm5 per square meter]). Using this model, 3 different patient clusters were identified. Cluster 1 had high CI with normal SVRI (CI, 4.03 ± 0.61; SVRI, 1655.20 ± 348.08); cluster 2 low CI with increased vascular tone (CI, 2.50 ± 0.50; SVRI, 2600.83 ± 576.81); and cluster 3 very low CI with markedly elevated SVRI (CI, 1.37 ± 0.81; SVRI, 5951.49 ± 1480.16). Cluster 1 patients had the lowest 30-day overall mortality. Among clinically relevant variables available during the initial patient evaluation in the ED age, heart rate and temperature were significantly different across the 3 clusters.Conclusions: Emergency department patients with confirmed sepsis had 3 distinct cluster groupings based on their presenting noninvasively derived CI and SVRI. Further clinical studies evaluating the effect of early cluster-specific therapeutic interventions are needed to determine if there are outcome benefits of ED HD phenotyping in these patients. [ABSTRACT FROM AUTHOR]

Infectious diseases remain a major health concern in many parts of the developing world, where access to adequate health care and modern diagnostic tools are absent. Current diagnostic technologies like ELISA and PCR require large sample volumes, bulky, expensive instrumentation, highly trained personnel, long experimental time, and a modern infrastructure that developing countries lack. Hence, portable, low cost tools would be a huge first step towards making accurate diagnostics available to a wider range of patients worldwide. In this work, we present a portable, microfluidic platform, controlled via a smartphone application, that requires no external pumping and is capable of rapid (within 18 minutes) 6-step colorimetric detection of an array of vaccinia virus proteins spotted on a nitrocellulose pad. We envision this platform as a first step to a fully integrated, portable immunoassay that can be used to expand global healthcare. [ABSTRACT FROM AUTHOR]

The directional and nondirectional associations of periodontitis with chronic kidney disease: A systematic review and meta-analysis of observational studies. Zhao D, Khawaja AT, Jin L, Li K–Y, Tonetti M, Pelekos G. J Perio Res 2018; 53(5):682-704. The authors' own institution, University of Hong Kong. Systematic review with meta-analysis of data. [ABSTRACT FROM AUTHOR]

Abstract: Acoustic methods have been developed and used to detect insects in concealed habitats. The larvae of red palm weevil, Rynchophorus ferrugineus (Olivier), a serious pest of the coconut palm, Cocos nucifera L. feed on the soft tissues inside the stem and bud region. Detection of infested coconut palms in the early stages by the conventional method of checking for external symptoms is time consuming, labour intensive and costly. This paper describes the development of a portable and efficient acoustic device and its potential in detection of infested palms in the field. The device comprises a sensor to mount on the palm and to acquire the sounds of red palm weevil larvae, an electronic unit that processes the acquired sounds and a set of headphones to receive the output sound by the listener. It is light weight, user-friendly and powered by batteries. The highest accuracy of identifying infested palms was obtained when the palm was checked at four positions; either side of palm base and bases of the two lowermost leaves. The infested palms were detected with over 97% accuracy, while the probability of not detecting uninfested palms was over 92%. A second check increased the rate of accuracy. Many difficulties encountered with conventional methods could be overcome by the use of this device. [Copyright &y& Elsevier]

Can 4% Articaine Buccal Infiltration Replace Inferior Alveolar Nerve Block (IANB) with 2% Xylocaine for Pulp Therapy in Primary Mandibular Molars? A Systematic Review. Sunny P Tirupathi, Srinitya Rajasekhar, Mayuri Ganesh, Abhishek Vamshi, David Tyro, Int J Clin Pediatr Dent. 2021;14(3):420–425. The authors did not state any funding support. Systematic review. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) is associated with an increased incidence of cardiovascular disease (CVD). The Anti-oxidant Therapy In Chronic Renal Insufficiency (ATIC) Study showed that a multistep treatment strategy improved carotid intima-media thickness, endothelial function, and microalbuminuria in patients with stages 2 to 4 CKD. Increased plasma concentrations of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, have been linked to greater CVD risk in patients with CKD. The aim of this study is to assess effects of the multistep intervention on plasma ADMA concentrations in the ATIC Study.Study Design: Secondary analysis of a randomized double-blind placebo-controlled trial.Setting& Participants: 93 patients with creatinine clearance of 15 to 70 mL/min/1.73 m(2) (according to the Cockcroft-Gault equation) from 7 outpatient clinics in Amsterdam, The Netherlands.Intervention: The treatment group received sequential treatment consisting of pravastatin, 40 mg/d. After 6 months, vitamin E, 300 mg/d, was added, and after another 6 months, homocysteine-lowering therapy (folic acid, 5 mg/d; pyridoxine, 100 mg/d; and vitamin B(12), 1 mg/d, all in 1 tablet) were added and continued for another year. The control group received matching placebos.Outcome& Measures: Plasma ADMA levels.Results: 36 participants (77%) in the treatment group and 38 (83%) in the placebo group completed the study. Mean ADMA and symmetric dimethylarginine concentrations in the total study population were 0.53 +/- 0.07 (SD) and 1.14 +/- 0.46 mumol/L, respectively. After 24 months, there was no overall effect of the treatment strategy on ADMA concentrations (beta = -0.006; P = 0.27). Analysis of separate treatment effects suggested that vitamin E significantly decreased ADMA levels by 4% in the treatment group compared with the placebo group (multiple adjusted P = 0.02).Limitations: The study was a secondary analysis, power calculation was based on the primary end point of carotid intima-media thickness, mean plasma ADMA levels were relatively low.Conclusion: Overall, a multistep treatment strategy consisting of pravastatin, vitamin E, and B vitamins had no effect on plasma ADMA levels in a stage 2 to 4 CKD population. This suggests that the beneficial effects of the intervention were not mediated by changes in ADMA levels. Possible ADMA-lowering effects of vitamin E deserve further attention. [ABSTRACT FROM AUTHOR]

Rodrigues RP, Vidigal MT, Vieira WA, Nascimento GG, Sabino-Silva R, Blumenberg C, Siqueira MF, Siqueira WL, Paranhos LR. Salivary changes in chronic kidney disease and in patients undergoing hemodialysis: a systematic review and meta-analysis. Journal of Nephrology. 2022 Mar 2:1-29. The work has been partially funded by CAPES—Finance Code 001. The authors have also acknowledged The Brazilian National Council for Scientific and Technological Development (CNPq) and Minas Gerais State Agency for Research and Development, Brazil (FAPEMIG) for the support. Systematic review with meta-analysis of data. [ABSTRACT FROM AUTHOR]

There is evidence that children in residential care institutions (RCI) have higher rates of psychological problems, suicide and criminal behaviour. There is only one study in Sri Lanka which has examined the psychological well-being of children in RCIs. Further evidence is needed to formulate policies related to the mental health of institutionalized children in the local context. A cross sectional descriptive study was carried out in a selected RCI, in Colombo, Sri Lanka. All children (> 4 years) and adolescents who have been in the institution for more than 3 months were included. The caregiver rated version of the Strength and Difficulties Questionnaire (SDQ) was used to assess the extent of emotional and behavioural problems. The sample included 103 children and adolescents, between 5-17years. Majority (51.5%) were females. Mean age at entering care was 6.48 years. The mean score for externalizing problems was 6.72 (SD=3.702) and the mean score for internalizing problems was 4.12 (SD=2.312). Peer problems (23.4 %) and conduct problems (21.5 %) were the commonest problems encountered. Only 40 % of the children having clinically significant levels of problems were in contact with mental health services. A quarter of the participants had elevated levels of emotional and behavioural problems. Routine screening programmes should be carried out at regular intervals in the RCI's for early detection of children with psychological problems in institutionalized children. • Peer problems and conduct problems were the commonest psychological problems encountered. • Children who were transferred from other centers had higher externalizing problems and total difficulties. • Hyperactivity, conduct problems and emotional problems were higher in those living at the current institution for <5 years. • 40 % of the children having clinically significant levels of difficulties were in contact with mental health services. • 25 % with conduct problems and 27.7 % with hyperactivity were in contact with mental health services. • None of the children having clinically significant levels of emotional problems were in contact with mental health services. [ABSTRACT FROM AUTHOR]

Background Female genital mutilation (FGM) has serious health consequences, including adverse obstetric outcomes and significant physical, sexual and psychosocial complications for girls and women. Migration to Australia of women with FGM from high-prevalence countries requires relevant expertise to provide women and girls with FGM with specialised health care. Midwives, as the primary providers of women during pregnancy and childbirth, are critical to the provision of this high quality care. Aim To provide insight into midwives’ views of, and experiences working with, women affected by FGM. Methods A descriptive qualitative study was undertaken using focus group discussions with midwives from four purposively selected antenatal clinics and birthing units in three hospitals in urban New South Wales. The transcripts were analysed thematically. Findings Midwives demonstrated knowledge and recalled skills in caring for women with FGM. However, many lacked confidence in these areas. Participants expressed fear and a lack of experience caring for women with FGM. Midwives described practice issues, including the development of rapport with women, working with interpreters, misunderstandings about the culture of women, inexperience with associated clinical procedures and a lack of knowledge about FGM types and data collection. Conclusion Midwives require education, training and supportive supervision to improve their skills and confidence when caring for women with FGM. Community outreach through improved antenatal and postnatal home visitation can improve the continuity of care provided to women with FGM. [ABSTRACT FROM AUTHOR]

Objective: to identify how midwives in low and middle income countries (LMIC) and high income countries (HIC) care for women with female genital mutilation (FGM), their perceived challenges and what professional development and workplace strategies might better support midwives to provide appropriate quality care. Design: an integrative review involving a narrative synthesis of the literature was undertaken to include peer reviewed research literature published between 2004 and 2014. Findings: 10 papers were included in the review, two from LMIC and eight from HIC. A lack of technical knowledge and limited cultural competency was identified, as well as socio-cultural challenges in the abandonment process of the practice, particularly in LMIC settings. Training in the area of FGM was limited. One study reported the outcomes of an education initiative that was found to be beneficial. Key conclusions: professional education and training, a working environment supported by guidelines and responsive policy and community education, are necessary to enable midwives to improve the care of women with FGM and advocate against the practice. Implications for practice: improved opportunities for midwives to learn about FGM and receive advice and support, alongside opportunities for collaborative practice in contexts that enable the effective reporting of FGM to authorities, may be beneficial and require further investigation. [ABSTRACT FROM AUTHOR]

Humic substances (HS) are heterogeneous organic polymers that show monotonous properties. HS are present at different proportions in the terrestrial environment, and they implicate the performance of water desalination plants. Recently electrodialysis self-reversal (EDR) technology has been used to treat excess salinity, hardness and fluoride in HS rich groundwater in Sri Lanka (~3 mg L−1, dissolved C). Due to the high organic content of HS in groundwater, the EDR ion exchange membranes are prone to fouling. To unravel the fouling mechanisms, humic acid (HA) and fulvic acid (FA) fractions were isolated and fractionated from the groundwater and characterized spectroscopically. All membrane fouling experiments were conducted for HA and FA contaminated water using a lab-scale EDR setup operated under batch mode. Sequential desorption experiments were carried out using distilled water, 2% (w/w) NaCl, and 0.3% (w/w) sodium dodecyl sulfate to probe variations among two fouling mechanisms. Similarities were found in aromatic and aliphatic carbon contents, humification degree, and molecular weight of humic substances. Higher proportions of carboxylic and phenolic groups were found in FA compared to HA. Ester groups in HA facilitate P, S, and Si migration within organic moieties. The molecular environs in the vicinity of carboxyl functional groups led different fouling mechanisms. HA fouling was found irreversible compared to FA fouling. The subtle differences between fouling mechanisms will help implement appropriate pretreatments to ensure the durability of EDR membranes. [Display omitted] • Phosphates, sulfates, and silicates are ester bonded only with a humic fraction. • Fouling anion exchange membranes by fulvic and humic fractions differ markedly. • Membrane functionality deteriorates by humic fraction fouling. [ABSTRACT FROM AUTHOR]

Sukriti KC. Wang XZ, Gallagher JE. Diagnostic sensitivity and specificity of host-derived salivary biomarkers in periodontal disease amongst adults: Systematic review. J Clin Periodontol 2020;47(3):289–308. doi: 10.1111/jcpe.13218. Information not available. Systematic review. [ABSTRACT FROM AUTHOR]

Effectiveness of Intracanal Cryotherapy in Root Canal Therapy: A Systematic Review and Meta-analysis of Randomized Clinical Trials. Durre Sadaf, Muhammad Zubair Ahmad, Igho J Onakpoya, J Endod. 2020 Dec;46(12):1811–1823.e1. The authors did not claim any funding support. Systematic review with meta-analysis. [ABSTRACT FROM AUTHOR]

Abstract: The Active Straight Leg Raise (ASLR) is an important test in diagnosing pelvic girdle pain (PGP). It is difficult to understand what happens normally during the ASLR, let alone why it would be impaired in PGP. In the present study, healthy subjects performed the ASLR under normal conditions, with weight added above the ankle, and while wearing a pelvic belt. Activity of the abdominal muscles, rectus femoris (RF), and biceps femoris (BF) was recorded with surface electromyography (EMG), and transversus abdominis (TA) with fine wire EMG. RF was ipsilaterally active, BF contralaterally, and the abdominal muscles bilaterally. All muscle activity was higher with weight, and abdominal muscle activity was lower with the pelvic belt. In both these conditions, TA and obliquus abdominis internus (OI) were more asymmetrically active than obliquus externus. The abdominal muscles engage in multitasking, combining symmetric and asymmetric task components. Hip flexion causes an unwanted forward pull on the ipsilateral ilium, which is counteracted by contralateral BF activity. To transfer this contralateral force toward ipsilateral, the lateral abdominal muscles press the ilia against the sacrum (“force closure”). Thus, problems with the ASLR may derive from problems with force closure. Also abdominal wall activity counteracts forward rotation of the ilium. Moreover, contralateral BF activity causes transverse plane rotation of the pelvis, often visible as an upward movement of the contralateral anterior superior iliac spine. Such transverse plane rotation is countered by ipsilateral TA and OI. The present study facilitates the understanding of what normally happens during the ASLR. [Copyright &y& Elsevier]

Abstract: The invasion of biological organisms via ballast water has created threats to the environment and human health. In this study, a cost-effective electrochemical disinfection reactor was developed to inactivate Escherichia coli, one of the IMO-regulated indicator microbes, in simulated ballast water. The complete inactivation of E. coli could be achieved within a very short time (150, 120, or 60s) with an energy consumption as low as 0.0090, 0.0074 or 0.0035kWh/m3 for ballast water containing E. coli at concentrations of 108, 107 and 106 CFU/100mL, respectively. Electrochemical chlorination was the major disinfection mechanism in chloride-abundant electrolytes, whereas oxidants such as ozone and free radicals contributed to 20% of the disinfection efficiency in chloride-free electrolytes. Moreover, a disinfection kinetics model was successfully developed to describe the inactivation of E. coli. [Copyright &y& Elsevier]

Abstract: Ballast water is essential in maintaining the balance and structural integrity of ships during voyage. However, it has created biological invasion threats to the ocean environment. An innovative electrochemical technology was developed in this study. The microorganisms regulated by the International Maritime Organization (D2) were used as the target organisms. It was found that the required energy to meet the D2 was below 0.006kWh/m3. The size of disinfector (m3) was about 0.5% of treatment flow rate (m3/h). The complete disappearance of chlorine in seawater was achieved after three days. The ballast tank corrosion was not worsened due to the application of technology. The ecotoxicity studies showed no toxic effect on fish, invertebrate, and algae. Finally, the environmental risk assessment showed the treated water did not pose threats to the environment. It can therefore be concluded that the technology provides a cost-effective and environmental friendly solution to ballast water management. [Copyright &y& Elsevier]

: BackgroundConventional coronary bypass surgery is associated with substantial morbidity caused by cardiopulmonary bypass (CPB) and median sternotomy. This report describes an innovative technique to perform complete revascularization through a lateral thoracotomy without CPB (thoraCAB).: MethodsFrom February 2000 to April 2001 a total of 200 patients underwent thoraCAB. The patient is positioned with the left side elevated to 45 degrees. A 5- to 6-inch incision is made over the left fourth or fifth intercostal space from just medial to the nipple to the anterior axillary line. The left internal thoracic artery is harvested as a pedicle graft under vision. Proximal anastomoses are first completed on the ascending aorta, followed by the distal coronary anastomoses on the beating heart using a stabilizer. Intercostal nerve freezing is done using a cryoprobe.: ResultsComplete revascularization was achieved in all patients. The number of grafts averaged 2.9 ± 1.08 per patient. One patient (0.5%) died of renal failure. Two patients (1%) were converted to CPB. No strokes were observed. Three patients (1.5%) required prolonged ventilation (>48 hours). Five patients (2.5%) had postoperative bleeding requiring reexploration. Of the patients, 16 (8%) developed new-onset postoperative atrial fibrillation.: ConclusionsThoraCAB has been feasible in the vast majority of patients requiring coronary bypass surgery. The prevalence of postoperative atrial fibrillation was low. Postoperative pain maybe lessened with intercostal nerve freezing. [Copyright &y& Elsevier]

Water treatment based on electrocoagulation (EC) is attractive since required chemicals and colloids are produced in-situ. However, optimisation of EC operation parameters is necessary to enhance its efficiency. We optimised EC cell parameters by the response surface method (RSM). The optimal removal efficiencies of hardness (63%) and fluoride (97%) were achieved at 1.98 kW h/m3. With the removal of divalent cations, some anionic species concurrently remove via an energetically feasible route to adjust the charge balance. When simulated water is used (450 mg/L TDS, 580 mg/L CaCO 3 , 10 mg/L fluorides and pH 6.50), 83% hardness and 99% fluoride are removed with 0.69 kW h/m2 energy consumption. The chemical species in the solution matrix, particularly SO 4 2, significantly affect the hardness and fluoride removal efficiencies. The contaminated EC sludge resulted from feed water is characterised by spectroscopic methods to probe hardness and fluoride removal mechanisms. In the presence of Mg2+, F- interacts with Al-sludge sites forming ≡ MgF − OH. When Ca2+ and F- are present, both ≡ CaF − OH and ≡ CaF are formed. In Ca2+, Mg2+ and F- treated Al-sludge dominates CaF−OH and ≡ CaF over ≡ MgF − OH. [Display omitted] • We optimised electrocoagulation cell parameters to remove excess hardness in water by a response surface method. • Maximal fluoride removal in the same water occurs by charge balancing. • In the sludge, CaF 2 and MgF 2 phases are formed via chemically subtle routes. • Matrix ions in water affect hardness and fluoride removal efficiencies. [ABSTRACT FROM AUTHOR]

Ruksakiet K, Hanák L, Farkas N, Hegyi P, Sadaeng W, Czumbel LM, Sang-Ngoen T, Garami A, Mikó A, Varga G, Lohinai Z. Antimicrobial Efficacy of Chlorhexidine and Sodium Hypochlorite in Root Canal Disinfection: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Endod. 2020 Aug;46(8):1032-1041.e7. doi: 10.1016/j.joen.2020.05.002. Epub 2020 May 12. PMID: 32413440. The Hungarian Human Resources Development Operational Program, the Higher Education Excellence Program of the Hungarian Ministry of Human Capacities to the Therapy Research Module of Semmelweis University, National Research, Development and Innovation Office, Hungarian Scientific Research Fund and the Economic Development and Innovation Operative Programme Grant. Systematic review with meta-analysis. [ABSTRACT FROM AUTHOR]

• Wood quality attributes of mature radiata pine are described. • Nutrient removal from harvesting practices did not adversely affect wood quality. • In some cases, negative consequences resulted from repeated fertiliser addition. • This knowledge will help forest managers design forest nutrition programmes. With intensification of forest management, there has been increasing focus on the impacts of harvest residue removal on tree growth and long-term site productivity. The intensity of harvest removals, which has a direct impact on the available nutrient pools, influences tree growth and are also likely to impact the quality of wood formed. This study focused on the effects of harvesting residue removal practices (whole tree + forest floor, whole tree and stem only) at the end of the previous rotation and repeated fertiliser addition during the current rotation on selected wood quality attributes. Growth, wood density and standing tree acoustic velocity data were collected from almost 600 radiata pine (Pinus radiata D. Don) trees from long term site productivity trials across New Zealand (Woodhill, Tarawera and Berwick Forests). A sample of 116 trees were felled to obtain detailed wood quality measurements on logs and cross-sectional discs at different heights along the stem. There was little or no effect of different levels of harvesting removal on any of the measures of wood quality. However, repeated fertiliser addition throughout the course of the rotation (up to 3200 kg N ha−1 at Woodhill Forest) did result in adverse impacts on wood density, stiffness, branch size and heartwood content. The degree to which these affect returns to forest growers and end-product performance will depend on the market segment that logs are being sold into. It is recommended that nutritional strategies aimed at increasing forest productivity should incorporate studies to evaluate their potential adverse impacts on wood quality. [ABSTRACT FROM AUTHOR]

Colloidal halide perovskite nanocrystals or quantum dots (QDs) show similar defect tolerance as thin film perovskite materials with added nanoscale phenomena. Perovskite QD solar cells have demonstrated efficiencies of 16.6%, greater than that of any other QD material system. While the efficiency lags behind the best thin-film perovskite devices, these solar cells could have advantages over the thin-film versions in terms of processability, phase stability, and high open-circuit voltages. However, some operating principles behind perovskite quantum dot device stacks and the associated electric field properties are still unknown. Here, we characterize the junction structure within perovskite QD solar cells, by exposing functioning cross-sections and using nanometer-scale Kelvin probe force microscopy to offer insight into the selection and performance of charge selective contacts. We also evaluated various solar cell device architectures with different selective contacts to isolate the role of each junction in device performance. We show that in high-performance n-i-p architectures, both electron- and hole-transport layer (HTL) interfaces possess a strong electric field, but in the case of the inverted p-i-n architecture, we find that high interfacial recombination at the HTL/QD junction is responsible for subpar device performance. Perovskite QD and thin film materials can synergistically be combined to offer more design flexibility in PV devices, and here we demonstrate that the interface between perovskite thin films and QDs are relatively benign and amenable for synergistic device design. Image 1 • Operating principles & electric field properties of perovskite quantum dot cells with various architectures. • n-i-p cell performance and junction characteristics with modified charge-selective contacts. • Identified weakness of PTAA/perovskite junction in p-i-n cell. • Hybrid thin-film perovskite/quantum dot perovskite eliminates interface problem in p-i-n cell. [ABSTRACT FROM AUTHOR]

Efficacy of Corticosteroids on Postoperative Endodontic Pain: A Systemic Review and Meta-analysis. Shamszadeh S, Shirvani A, Eghbal MJ, Asgary S. J Endod 2018;44(7):1057-1065. The authors' own institution, Shahid Beheshti University of Medical Sciences. Systematic review with meta-analysis of data. [ABSTRACT FROM AUTHOR]

Vitex negundo L. is used as an anti-inflammatory agent in Ayurveda and Sri Lankan traditional medicine. Here, the anti-inflammatory effects of an aqueous leaf extract (ALE) of V. negundo L. was investigated. The inhibitory effects of freeze-dried ALE (15.7–500 μg/mL) against interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumour necrosis factor-α (TNFα) secretion by human mononuclear cells, phagocytic activity of human neutrophils, and reactive oxygen species (ROS) and nitric oxide (NO) production by human leukocytes were tested in vitro. The inhibitory effects were dose dependent, and the strongest effect was observed at 500 μg/mL (P < 0.05). ALE caused 58.0 ± 1.0 % and 26.1 ± 2.0 % inhibition of IL-6 and TNFα secretion, respectively, whereas the positive control, Andrographis paniculata , caused complete inhibition. Phagocytic activity and ROS production were inhibited by 55 ± 4.5 % and 58.6 ± 8.6 %, respectively, whereas the positive controls, Ixora coccinea and diphenyleneiodonium chloride, caused 100 ± 4.4 % and 80 ± 6.4 % inhibition, respectively. ALE markedly inhibited NO production (87.5 ± 17.7 %), and the effect was comparable to that of the positive control, N-monomethyl- l -arginine (95.0 ± 1.0 %). The membrane-stabilizing activity of ALE (0.01–100 μg/mL) was assessed using heat-induced lysis of human erythrocytes. The highest membrane stabilizing activity (91 %) was observed at 0.01 μg/mL and was comparable with that of aspirin (positive control; 86.6 ± 0.51 %). These inhibitory effects may be the mechanisms through which V. negundo L. elicits its anti-inflammatory activities and support the traditional use of V. negundo L. as an anti-inflammatory agent. [ABSTRACT FROM AUTHOR]