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Greater adherence to plant-based diets is associated with a lower risk of incident chronic kidney disease (CKD). Metabolomics can help identify blood biomarkers of plant-based diets and enhance understanding of underlying mechanisms.Using untargeted metabolomics, we aimed to identify metabolites associated with 4 plant-based diet indices (PDIs) (overall PDI, provegetarian diet, healthful PDI, and unhealthful PDI) and incident CKD in 2 subgroups within the Atherosclerosis Risk in Communities study.We calculated 4 PDIs based on participants' responses on an FFQ. We used multivariable linear regression to examine the association between 4 PDIs and 374 individual metabolites, adjusting for confounders. We used Cox proportional hazards regression to evaluate associations between PDI-related metabolites and incident CKD. Estimates were meta-analyzed across 2 subgroups (n1 = 1762; n2 = 1960). We calculated C-statistics to assess whether metabolites improved the prediction of those in the highest quintile compared to the lower 4 quintiles of PDIs, and whether PDI- and CKD-related metabolites predicted incident CKD beyond the CKD prediction model.We identified 82 significant PDI-metabolite associations (overall PDI = 27; provegetarian = 17; healthful PDI = 20; unhealthful PDI = 18); 11 metabolites overlapped across the overall PDI, provegetarian diet, and healthful PDI. The addition of metabolites improved prediction of those in the highest quintile as opposed to the lower 4 quintiles of PDIs compared with participant characteristics alone (range of differences in C-statistics = 0.026-0.104; P value ≤ 0.001 for all tests). Six PDI-related metabolites (glycerate, 1,5-anhydroglucitol, γ-glutamylalanine, γ-glutamylglutamate, γ-glutamylleucine, γ-glutamylvaline), involved in glycolysis, gluconeogenesis, pyruvate metabolism, and γ-glutamyl peptide metabolism, were significantly associated with incident CKD and improved prediction of incident CKD beyond the CKD prediction model (difference in C-statistics for 6 metabolites = 0.005; P value = 0.006).In a community-based study of US adults, we identified metabolites that were related to plant-based diets and predicted incident CKD. These metabolites highlight pathways through which plant-based diets are associated with incident CKD.

Purpose To evaluate the long-term effect of subthreshold nanosecond laser (SNL) treatment on progression to late age-related macular degeneration (AMD). Design Observational extension study of a randomized, sham-controlled trial. Participants Two hundred twelve participants with bilateral large drusen. Methods The Laser Intervention in the Early Stages of AMD (LEAD) study was a 36-month trial where participants were randomized to receive SNL or sham treatment in 1 eye at 6-monthly intervals up to 30 months. After the completion of the LEAD study, the 2 largest recruiting sites offered remaining participants an opportunity to enroll in a 24-month observational extension study. This study thus examined all participants from these 2 sites who were enrolled in the LEAD study at baseline, including the additional observational data. Main Outcome Measures Time to develop late AMD, defined on multimodal imaging, between those randomized the SNL or sham treatment. Results Overall, no significant difference was found in the rate of progression over a 60-month period in those randomized to the SNL compared with the sham group (adjusted hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.36–1.09; P = 0.098), similar to the findings at 36 months in the LEAD Study. However, evidence of treatment effect modification continued to emerge based on the coexistence of reticular pseudodrusen (RPD; P = 0.007, adjusted interaction). Namely, progression was slowed significantly with SNL treatment for those without coexistent RPD (adjusted HR, 0.34; 95% CI, 0.16–0.71; P = 0.004), but it was not significantly different for those with RPD (adjusted HR, 1.81; 95% CI, 0.67–4.88; P = 0.239). Conclusions A 24-month observational extension study to the LEAD Study confirmed that SNL treatment did not significantly reduce the overall rate of progression to late AMD in a cohort with intermediate AMD. However, the persistence of a potential beneficial treatment effect in those without coexistent RPD over a longer follow-up duration of an additional 24 months without additional treatment is encouraging. These findings provide further justification for future trials to examine the potential value of SNL treatment for slowing progression in intermediate AMD.

To report clinical and patient-reported outcome measures (PROMs) in patients undergoing revision surgery after diagnosis of anchor-induced arthropathy.Patients who underwent revision arthroscopic shoulder surgery and were diagnosed with post-instability glenohumeral arthropathy performed from January 2006 to May 2018 were included in the current study. Patients were excluded if they underwent prior open shoulder procedures, if glenoid bone loss was present, or if prerevision imaging and records were incomplete or not available. Data included initial diagnosis and index procedure performed, presenting arthropathy symptoms including duration, exam findings before revision surgery, and surgical intervention. PROMs were prospectively collected before surgery and at minimum 2-year follow-up.Fourteen patients were included with a mean (± standard deviation) age at presentation of 35.2 ± 12.1 years (range 16 to 59). The follow-up rate was 86%, with a mean follow-up of 3.8 years (range 1.1 to 10.6). Mean time to development of arthropathy symptoms was 48.2 months (range1 month to 13.8 years), all presenting with pain and decreased range of motion on exam. At time of revision surgery, all patients underwent either open or arthroscopic removal of previous implants, including anchors and suture material. Six patients underwent additional revision stabilization procedures, 1 underwent total shoulder arthroplasty, and 7 underwent arthroscopic intraarticular debridement, capsular release, and chondroplasty with or without microfracture. Pain significantly improved in 79% of patients (P = .05). Significant improvements in all PROMs were observed, including 12-item Short Form (43.8 to 54.8, P.01); Disabilities of the Arm, Shoulder, and Hand, shortened version (31.8 to 8.4, P.01); Single Assessment Numeric Evaluation (47.0 to 84.5, P.05); and American Shoulder and Elbow Surgeons (61.6 to 92.1, P.01). Average external rotation significantly improved, from 31° ± 22° to 52° ± 24° (P = .02).Rapid intervention after diagnosis, through either revision arthroscopic or open debridement and stabilization, can lead to significant improvement in range of motion, pain, and overall patient function and satisfaction.IV, retrospective case series.

The purpose of this study was to investigate the role of preoperative bone marrow lesion (BML) size and location on (1) postoperative patient reported outcomes and (2) postoperative failure and time to failure after osteochondral allograft (OCA) transplantation.Consecutive patients from 2 senior surgeons who underwent isolated OCA transplantation to the knee from 2009-2018 were identified for the case series. Preoperative magnetic resonance imaging (MRI) was evaluated for BMLs based on 2 classification systems (Welsch et al. and Costa-Paz et al.) by 2 independent graders. BMLs associated with minimum 1-year postoperative outcomes were evaluated, and the effect of BML classification on survivorship was investigated with Kaplan-Meier curves.The 77 patients who underwent isolated OCA transplantation (mean follow-up: 39.46 ± 22.67 months) and had preoperative MRIs were included. Within this cohort, 82% of patients demonstrated a BML. The preoperative Costa-Paz et al. classification was significantly positively correlated with the postoperative Visual Analog Scale, International Knee Documentation Committee and Veterans RAND 12-Item Health Survey raw scores for both graders (P0.05). Failure occurred in 5 of 65 (8%) patients at a mean of 22.86 ± 12.04 months postoperatively. The presence of BML alone did not significantly affect survival (P = 0.780). However, for 1 grader, the Welsch et al. classification was associated with increased risk of graft failure (P = 0.031).Preoperative subchondral BMLs were present in 82% of patients undergoing OCA transplantation. We found that more severe BMLs based on the Costa-Paz classification, with increasing involvement in the juxta-articular surface, were correlated with higher postoperative patient-reported functional outcomes after OCA. BMLs may be associated with an increase in graft failure, but their role in this remains unclear.IV, Retrospective Case Series.

The hip capsule and acetabular labrum are critical structures that function to protect and stabilize the hip joint. As the use of hip arthroscopy increases, there is increasing interest in the integrity of the hip capsule and labrum in optimizing postoperative function and outcomes. In this report, we describe the surgical technique for capsular reconstruction with dermal allograft and labral augmentation with tibialis anterior allograft for the treatment of gross instability after hip arthroscopy. This technique may be applied in situations with large capsular defects and deficient labral tissue., Technique Video Video 1 Intraoperative assessment of the central compartment revealed labral insufficiency with residual femoroacetabular impingement syndrome pathology. Viewing from the MMAP, the first suture anchor is placed at the 10-o’clock position via the AL portal. The suture from the suture anchor is used to measure the length of labral insufficiency, which was 4.2 cm. The remaining 3 suture anchors are placed up to the 4-o’clock position through the DALA portal. Two double-loaded suture anchors are placed adjacent to the head of the rectus femoris tendon along the acetabulum for capsular reconstruction. The labral allograft is passed through the DALA portal using the Kite technique and knotted down anteromedially to posterolaterally. Upon plication of the vertical limb of the capsulotomy, a 2.0 × 2.5-cm defect remained. Sutures from the double-loaded anchors are passed through the distal lateral and distal medial T-capsulotomy leaflets in a mattress fashion and knotted. One suture from the proximal anchor and one suture from the distal anchor is retrieved through the DALA portal and passed through the proximal and distal corners of the capsular allograft, respectively. The graft is then shuttled through the DALA portal using the Kite technique and each corner is knotted down in a simple fashion. A dynamic examination is then performed to evaluate graft placement. (AL, anterolateral; DALA, distal anterior lateral accessory; MMAP, modified mid-anterior portal.)

BACKGROUND: High diet quality is associated with a lower risk of chronic diseases. Metabolomics can be used to identify objective biomarkers of diet quality. OBJECTIVES: We used metabolomics to identify serum metabolites associated with 4 diet indices and the components within these indices in 2 samples from African Americans and European Americans. METHODS: We studied cross-sectional associations between known metabolites and Healthy Eating Index (HEI)-2015, Alternative Healthy Eating Index (AHEI)-2010, the Dietary Approaches to Stop Hypertension Trial (DASH) diet, alternate Mediterranean diet (aMED), and their components using untargeted metabolomics in 2 samples (n(1) = 1,806, n(2) = 2,056) of the Atherosclerosis Risk in Communities study (aged 45–64 y at baseline). Dietary intakes were assessed using an FFQ. We used multivariable linear regression models to examine associations between diet indices and serum metabolites in each sample, adjusting for participant characteristics. Metabolites significantly associated with diet indices were meta-analyzed across 2 samples. C-statistics were calculated to examine if these candidate biomarkers improved prediction of individuals in the highest compared with lowest quintile of diet scores beyond participant characteristics. RESULTS: Seventeen unique metabolites (HEI: n = 6; AHEI: n = 5; DASH: n = 14; aMED: n = 2) were significantly associated with higher diet scores after Bonferroni correction in sample 1 and sample 2. Six of 17 significant metabolites [glycerate, N-methylproline, stachydrine, threonate, pyridoxate, 3-(4-hydroxyphenyl)lactate)] were associated with ≥1 dietary pattern. Candidate biomarkers of HEI, AHEI, and DASH distinguished individuals with highest compared with lowest quintile of diet scores beyond participant characteristics in samples 1 and 2 (P value for difference in C-statistics

Background Agricultural production in controlled indoor farming offers a reliable alternative to food and nutrition supply for densely populated cities and contributes to addressing the impending food insecurity. Leafy vegetables, rich in vitamins, minerals, fibres and antioxidants, account for over half of the indoor farming operations worldwide. Light is the foremost environmental factor for plant growth and development, and the success of indoor farming largely depends on lighting qualities. The energy efficient light-emitting diode (LED) has been increasingly used in indoor farming systems. Scope and approach Here we provide an updated overview of the current indoor vertical farming systems, the mechanisms of light perception by photoreceptors, and the effects of LED spectra or intensity on growth and phytonutrient accumulation of leafy greens. We also outline the challenges in interpreting and applying the research findings in the field and highlight issues to be addressed. Key findings and conclusions Lighting quality and quantity can be manipulated to improve yield and phytonutrient contents of leafy greens. As responses of leafy greens to light are dependent on genotype and developmental stage, light recipe targeting different developmental stages should be formulated for different species for maximizing yield. While it has been known that blue wavelength has a more prominent positive impact on phytonutrient accumulation than red, little is known for other wavelengths. Moreover, recent findings that green wavelength inhibits plant growth in a blue-wavelength-dependent manner highlight the need for future research to investigate interactive effects of different wavelengths on modulating plant growth and metabolism.

The Latarjet procedure to treat instability was first described by the eponymous surgeon in 1954. Long-term results from this procedure have been favorable. In 2007, Lafosse et al. first described an all-arthroscopic technique for the Latarjet procedure. In the United States, the Latarjet procedure is most predictably indicated by surgeons in cases of significant glenoid bone loss, revision instability, and patients engaging in high-risk sport. In some European centers, the Latarjet has broader indications and is often also used as a first-line surgical intervention when conservative treatment has failed, including for those without bone loss or with multidirectional instability. • Achieve exposure of the inferior pole of coracoid and anterior glenoid rim; • coracoid is prepared; axillary nerve and brachial plexus are exposed; • coracoid portal is created; • coracoid is drilled and osteotomy is made; • coracoid transferred to anterior glenoid rim through split in subscapularis; • the bone graft is fixed in place with screws. Arthroscopic Latarjet can have a difficult learning curve compared with the open procedure. Both arthroscopic and open Latarjet have similar complication rates. The most common complications include graft fracture, non-union, and infection and are less than 2%. Arthroscopic Latarjet is reported to be less painful initially, but this equalizes by 1 month. Studies have shown that arthroscopic Latarjet results in excellent graft position. Recurrent instability for arthroscopic Latarjet ranges from 0.3% to 4.8% and is comparable with open Latarjet procedures. In summary, the arthroscopic Latarjet procedure results in less pain early, excellent coracoid graft position, and has a similar complication rate to open Latarjet.

Procyanidins (PCs) are polyphenols highly accumulated in litchi fruit (Litchi chinensis). Despite their bioactivity, the molecular composition of native and oxidized procyanidins is little understood. In this paper, polyphenols from litchi pericarp were extracted using two solvents (methanol and acetone). The mean degree of polymerization (mDP) of native and identification of oxidized PCs were carried out by phloroglucinolysis– and thioglycolysis–HPLC–ESI–MS/MS, respectively. About 60% of extracted polyphenols corresponded to procyanidins from litchi pericarp. Native PCs were mainly oligomeric procyanidins (mDP 4). Only (−)-epicatechin was detected as terminal and extension units in PCs. Thioglycolysis–HPLC–ESI–MS identified five oxidation markers of PCs with [M−H]− m/z 575, 593, 609, 679 and 863. Intra- and intermolecular modifications of A and B-type procyanidins were identified. The method used for the characterization of PCs from litchi pericarp allowed understanding of the structural composition of its native and oxidized tannins.

Digital imaging technology and refined software programs have significantly improved a clinician's ability to assess and evaluate anatomic structures and quantify both defect size and required graft volume. This article summarizes the computed tomography-based technology used in these applications to illustrate their current use as exemplified by computer-assisted planning and treatment of severe maxillofacial atrophy treated using both interpositional and mesh-onlay grafting methodology.

Summary Introduction Extracellular vesicles (EVs) are cell-secreted packages that deliver cargo to target cells to effect functional and phenotypic changes. They are secreted by many different cell types, including adipose-derived stem cells (ADSCs), which are a promising field of study in regenerative medicine. Our aim was to perform a systematic review of the literature to summarize the scientific work that has been conducted on ADSC EVs to date. Methods The Pubmed database was queried with keywords (and variations of) “adipose derived stem cell,” “stromal vascular fraction,” and “extracellular vesicles.” We excluded review papers, then manually screened articles based on title and abstract. Full-text articles were assessed for eligibility to include in final review. Results While an extensive body of research exists on EVs, a much smaller proportion of that is original research on ADSC EVs. Of 44 manuscripts that met our database search criteria, 21 articles were selected for our systematic review. Conclusion ADSC EVs were found to exert effects on angiogenesis, cell survival and apoptosis, inflammation, tissue regeneration, and reduction of disease pathology. Further studies examine characteristics of ADSC EVs. Future work should aim to further detail the safety profiles of ADSC EVs given their potential for cell-based therapies. The body of research studies characterizing ADSC EVs continues to expand, and much work remains to be done before human pilot studies can be considered. To our knowledge, we offer the first systematic review summarizing the research on ADSC EVs and their determined roles to date.

International audience; Brain data recorded with electroencephalography (EEG), magnetoencephalography (MEG) and related techniques often have poor signal-to-noise ratios due to the presence of multiple competing sources and artifacts. A common remedy is to average responses over repeats of the same stimulus, but this is not applicable for temporally extended stimuli that are presented only once (speech, music, movies, natural sound). An alternative is to average responses over multiple subjects that were presented with identical stimuli, but differences in geometry of brain sources and sensors reduce the effectiveness of this solution. Multiway canonical correlation analysis (MCCA) brings a solution to this problem by allowing data from multiple subjects to be fused in such a way as to extract components common to all. This paper reviews the method, offers application examples that illustrate its effectiveness, and outlines the caveats and risks entailed by the method.

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Osteochondral defects present a unique clinical challenge due to their combination of phenotypically distinct cartilage and bone, which require specific, stratified biochemical cues for tissue regeneration. Furthermore, the articular cartilage exhibits significantly worse regeneration than bone due to its largely acellular and avascular nature, prompting significant demand for regenerative therapies. To address these clinical challenges, we have developed a bilayered, modular hydrogel system that enables the click functionalization of cartilage- and bone-specific biochemical cues to each layer. In this system, the crosslinker poly(glycolic acid)-poly(ethylene glycol)-poly(glycolic acid)-di(but-2-yne-1,4-dithiol) (PdBT) was click conjugated with either a cartilage- or bone-specific peptide sequence of interest, and then mixed with a suspension of thermoresponsive polymer and mesenchymal stem cells (MSCs) to generate tissue-specific, cell-encapsulated hydrogel layers targeting the cartilage or bone. We implanted bilayered hydrogels in rabbit femoral condyle defects and investigated the effects of tissue-specific peptide presentation and cell encapsulation on osteochondral tissue repair. After 12 weeks implantation, hydrogels with a chondrogenic peptide sequence produced higher histological measures of overall defect filling, cartilage surface regularity, glycosaminoglycan (GAG)/cell content of neocartilage and adjacent cartilage, and bone filling and bonding compared to non-chondrogenic hydrogels. Furthermore, MSC encapsulation promoted greater histological measures of overall defect filling, cartilage thickness, GAG/cell content of neocartilage, and bone filling. Our results establish the utility of this click functionalized hydrogel system for in vivo repair of the osteochondral unit.

Research indicates that discrepancies between a need to belong and relationship satisfaction relate to negative well-being (i.e., loneliness, depression, low self-esteem) in adolescents. We extend these findings to adults and to more intense forms of relationship satisfaction (i.e., love-mattering) and negative well-being (i.e., suicidality). Belongingness needs did not relate to suicidality, but discrepancies between high belongingness needs and low love associated with greater suicidality. For those with a high need to belong, love-mattering may potentially mitigate the link between a need to belong and suicidality.

Background Mental health conditions are associated with poor outcomes in patients with chronic disease as well as various orthopedic conditions. The purpose of this study was to describe the relationship between mental health, preoperative disability, and postoperative outcomes in patients undergoing shoulder arthroplasty. Methods Data, including mental health diagnoses, were prospectively collected from patients undergoing total shoulder arthroplasty or reverse total shoulder arthroplasty from 2009 to 2015 at a single academic institution. Shoulder range of motion, visual analog scale, 12-Item Short Form Health Survey, and American Shoulder and Elbow Surgeons scores were collected preoperatively and at 1 and 2 years postoperatively. Data were analyzed using multivariate mixed-effect regression analysis. Results The study included 280 patients, 105 (37.5%) of whom had a mental health diagnosis of depression, anxiety, schizophrenia, or bipolar disorder. Both groups of patients had similar shoulder range of motion, pain, and function before shoulder arthroplasty. Hospital length of stay, discharge destination, and readmissions were similar for both groups. There were similar improvements in pain, function, and range of motion after shoulder arthroplasty in patients with and without diagnosed mental health conditions. Conclusions Overall, the presence of a psychiatric diagnosis was not predictive of outcomes. Although psychiatric conditions are often considered surgical comorbidities, mental health diagnoses should not be a barrier to performing clinically indicated shoulder arthroplasty, because both groups of patients appear to benefit from pain relief and improved shoulder function.

2, 3, 7, 8-Tetrahydroxy-chromeno [5, 4, 3-cde] chromene-5, 10-dione, commonly named ellagic acid was successfully separated by size-exclusion chromatography (SEC) from pomegranate husk ellagitannins purified by solid-state fermentation. Recovery of metabolites from fermented mash was carried out by the addition of ethanol and manual pressing. Culture extracts were loaded on a Sephadex LH-20 column, three fractions were separated, and second fraction was identified and evaluated by high performance liquid chromatography followed by electro spray ionization and mass spectrometry (HPLC/ESI/MS). It was possible to obtain a yield of 47 mg/g of pomegranate husk polyphenols. The analysis of HPLC/ESI/MS allowed to identify punicalagin (1082.97 m/z), punicalin (780.99 m/z) and ellagic acid (300.80 m/z). After the fermentation process, the main compound was ellagic acid. The present study describes a rapid and effective fermentation/chromatographic separation process for ellagic acid production.

The present work describes the monitoring of CO2 production by Aspergillus niger GH1 in a bioprocess for the production of ellagitannase (EAH) and ellagic acid by solid state fermentation. Pomegranate ellagitannins, mainly punicalagin, were used as carbon source and EAH inducer. A second condition, using ellagitannins and maltose as growth promoting carbon source, was tested. The ellagic acid production was quantified and the EAH activity was assayed. The accumulated metabolites were identified by HPLC-ESI-MS/MS. Higher CO2 production (7.79mg/grams of dry material) was reached in media supplemented with maltose. Short-time lag phase (7.79h) and exponential phase (10.42h) were obtained using only ellagitannins, despite its lower CO2 production (3.79mg/grams of dry material). Without the use of maltose lower ellagic acid (11.85mg/L/h) and EAH (21.80U/L/h) productivities were reached. The use of maltose enhances the productivity of EA (33.18mg/L/h) and EAH (33.70U/L/h). Besides of punicalin and ellagic acid, two unknown compounds with mass weight of 702 and 290g/mol (ions 701 and 289m/z in negative mode, respectively) were identified and characterized by HPLC-ESI-MS/MS analysis.

Background With experience, certain psychomotor skills should translate from standard laparoscopy to single-incision laparoscopy (SIL). We proposed to compare all surgical postgraduate year (PGY) levels and determine if experience translated to improved SIL skills. Methods Surgical residents of all PGY levels (1-5) at our institution were included. Baseline surveys were obtained to determine resident level of exposure to both SIL and standard laparoscopic cases. Participants performed the following tasks: running of the bowel, endoloop placement, extracorporeal suture tying, and intracorporeal suture tying. Tasks were performed on a commercially provided simulated inanimate organ model. Participants were given 5 min to complete each task. Data were collected and analyzed by an impartial-certified Fundamentals of Laparoscopic Surgery proctor. Results A total of 31 residents participated in the study. Overall, there was minimal SIL exposure among all residents. As expected, PGY level correlated with increased ability to complete assigned tasks within the allotted time. There was a statistically significant difference in the number of individuals able to complete a task based on PGY level for all given tasks ( P = 0.005). With increased difficulty, the percentage of higher level residents able to complete the task decreased (100% PGY5 completed running of bowel versus 0% intracorporeal knot tying). Conclusions Certain psychomotor skills did appear to translate to SIL skills. However, further dedicated SIL training may help to better develop certain laparoscopic skills devoted to SIL.

Purpose This article aims to introduce the novel technique of utilization of a custom 3D titanium printed reconstruction combined with in-situ tissue engineering for the reconstruction and dental rehabilitation of an infected severely atrophic mandible. Technique A 3-staged approach was used to remove the failing implants and debride the mandible, eradicating the infection, followed by reconstruction of the severely atrophic mandible using tissue engineering supported by a customized 3D-printed titanium undercarriage and reconstruction plate for vertical and horizontal augmentation. Finally, a CAD/CAM 3D-printed surgical guide was used for optimal placement of 4 dental implants. Conclusion A predictable and satisfactory reconstruct of a severely infected mandible with failing hardware to full dental rehabilitation and aesthetics was achieved by utilizing an amalgamation of state-of-the-art technology and tissue engineering.

In this study, an ultrasound-assisted extraction (UAE) of ellagic acid (EA) from pomegranate husk was studied according to a central composite design (CCD) matrix and analyzed under response surface methodology (RSM). Effect of several factors such as temperature (26–93 °C), sonication time (4–55 min), concentration of solvent (aqueous ethanol, 24%–75%), and solid–liquid ratio (3–16​ g/mL) were evaluated. EA yield was determined by high performance liquid chromatography (HPLC) analysis and then CCD model was validated. The best extraction conditions were at 93.60 °C of extraction temperature for 55.23 min using 75.23 % of aqueous ethanol and liquid/solid ratio of 3.27 mL/g of vegetal material obtaining a recovery of EA of 19.47 mg/g. In addition, four experiments were conducted to evaluate the extent to which the individual impact of sonication and temperature on EA extraction from pomegranate husk. A positive effect combined both factors was observed. On the other hand, the results could suggest that UAE has no effect on purified ellagitannins hydrolysis under conditions used in this study, indicating that increase in the EA yield is attributed only to the cell rupture. The optimal conditions of EA extraction from pomegranate husk established in this research could be applicable in the food and pharmaceutical industry due to the UAE method presents many advantages in comparison with conventional technologies.

RNA modifications constitute an essential layer of gene regulation in living organisms. As the most prevalent internal modification on eukaryotic mRNAs, N6-methyladenosine (m6A) exists in many plant species and requires the evolutionarily conserved methyltransferases, demethylases, and m6A binding proteins for writing, erasing, and reading m6A, respectively. In plants, m6A affects many aspects of mRNA metabolism, including alternative polyadenylation, secondary structure, translation, and decay, which underlies various plant developmental processes and stress responses. Here, we discuss the recent progress in understanding the roles of m6A modification in mRNA metabolism and their mechanistic link with plant development and stress responses. We also highlight some outstanding questions and provide an outlook on future prospects of m6A research in plants.

Metal Additive Manufacturing (AM) has begun its revolution in various high value industry sectors through enabling design freedom and alleviating laborious machining operations during the production of geometrically complex components. The use of powder bed fusion (PBF) techniques such as Selective Laser Melting (SLM) also promotes material efficiency where unfused granular particles are recyclable after each forming operation in contrast to conventional subtractive methods. However, powder characteristics tend to deviate from their pre-process state following different stages of the process which could affect feedstock behaviour and final part quality. In particular, primary feedstock characteristics including granulometry and morphology must be tightly controlled due to their influence on powder flow and packing behaviour as well as other corresponding attributes which altogether affect material deposition and subsequent laser consolidation. Despite ongoing research efforts which focused strongly on driving process refinement steps to optimise the SLM process, it is also critical to understand the level of material sensitivity towards part forming due to granulometry changes and tackle various reliability as well as quality issues related to powder variation in order to further expand the industrial adoption of the metal additive technique. In this review, the current progress of Metal AM feedstock and various powder characteristics related to the Selective Laser Melting process will be addressed, with a focus on the influence of powder granulometry on feedstock and final part properties.

This paper demonstrates a simple, minimally-invasive method of estimating the gold recovery rate of gravitational separation equipment used by artisanal and small-scale miners at alluvial gold sites in the Guianas, South America. A local ASM group mining an alluvial gold deposit agreed to allow the research team to collect eight samples of ore material immediately before it was to be processed by their sluice and eight samples taken immediately upon exit from their sluice. Each sample was sieved into three grain size portions ( 500 μm) and each portion assayed for gold content. The results indicate that the sluice at this site is capturing approximately 91% of the gold that enters the sluicing system, and the grain size distribution of the gold particles suggests that mercury amalgamation methods employed by the miners post sluicing are likely to be very efficient as well. Although this study and sample size is extremely small, and should not be taken as a full replacement of more elaborate geologic sampling and metallurgical analysis, this method could provide a useful tool for practitioners who want to quickly evaluate ASM gold processing methods and consider the effectiveness of introducing alternative processing technologies, especially those that aim to reduce mercury emissions from ASM.

Cesarean delivery is the most common surgical procedure performed in the USA. We evaluated the postoperative analgesic properties of neuraxial hydromorphone compared to neuraxial morphine for post-cesarean delivery analgesia.A retrospective chart review was performed of women who underwent cesarean delivery and received neuraxial anesthesia from March to November 2011 and from March to November 2012. A total of 450 patients received intrathecal morphine 200μg and 387 patients received intrathecal hydromorphone 60μg. Eighty-one patients received epidural morphine 3mg and 102 patients received epidural hydromorphone 0.6mg.Median time to first opioid after intrathecal morphine was 17.0h versus 14.6h after intrathecal hydromorphone (P0.0001). Patients who received intrathecal hydromorphone consumed more opioids in the first 24h; 37.0mg versus 26.4mg oral morphine equivalents (P0.001). The side effect profile between the intrathecal groups was similar. Median time to first opioid with epidural morphine was 20.1h versus 13.0h with epidural hydromorphone (P=0.0007). Total opioid consumption was not significantly different between the epidural groups. The side effect profiles were similar.Hydromorphone is a reasonable alternative to morphine for post-cesarean delivery analgesia. With the dosing used in our study, analgesia from morphine lasted longer than hydromorphone via intrathecal and epidural routes; however, neuraxial hydromorphone remains a reasonable option for long-acting analgesia post cesarean delivery.