Search

Background Aim Methods Results Conclusion Fabry disease is a rare X‐linked multisystem disease, with progressive proteinuric kidney disease contributing significantly to morbidity and mortality of these patients. Evidence shows that sodium‐glucose cotransporter 2 inhibitors (SGLT2Is) can reduce proteinuria and slow progression to end‐stage kidney disease in both diabetic and non‐diabetic kidney disease.Evaluate the effects of SGLT2I on kidney function and albuminuria in patients with Fabry disease.Single‐centre real‐world case series reviewing electronic medical records of patients with Fabry disease who initiated therapy with dapagliflozin or empagliflozin (n = 11). Changes in urine albumin–creatinine ratio (uACR) and creatinine before and after treatment with SGLT2I were analysed using Wilcoxon signed‐rank test. Two‐tailed P‐values <0.05 were considered significant.Eleven patients were followed for up to 19 months after commencement of SGLT2I. An overall significant reduction in albuminuria (P = 0.05) was seen with SGLT2I use in the Fabry cohort. Median uACR before SGLT2I was 76 mg/mmol (interquartile range (IQR) 47–141) and after SGLT2I was 39 mg/mmol (IQR 18–95) (P = 0.05). All patients with uACR >100 mg/mmol had reduction in albuminuria over the study period. SGLT2Is were well tolerated overall, with only one case resulting in cessation of treatment due to adverse effects.These results suggest SGLT2Is can significantly reduce albuminuria in a portion of patients with Fabry‐related kidney disease and offer additional treatment for Fabry nephropathy. Given the nature of the study design and small case numbers, further long‐term controlled studies are required to evaluate the long‐term efficacy of this medication class in both cardiac and renal outcomes in Fabry disease. [ABSTRACT FROM AUTHOR]

The article in the Journal of Magnetic Resonance Imaging discusses the reliability and agreement of manual region of interest (ROI) segmentation methods in tissue sodium magnetic resonance imaging (23Na MRI). The study found good to excellent inter-rater and intrarater reliability for skin, leg muscle, tibial bone, and whole leg tissue segmentation. However, there was a clinically unacceptable bias in mean sodium concentration when comparing different skin segmentation methods. The research highlights the importance of establishing standards in ROI segmentation methods for wider clinical use of 23Na MRI technology. [Extracted from the article]

Objectives: To investigate the approach taken by clinicians involved in the diagnosis and management of individuals with Differences of Sex Development (DSD), particularly with regard to genomic testing, and identify perceived gaps/strengths/barriers in current practice. Design and Methods: An anonymous online survey was developed, with questions exploring demographics, perceptions of genomic testing, availability of genetics services and opinions on the role and utility of genomic testing in DSD. All responses were anonymous. Clinicians involved in the diagnosis and management of individuals with DSD were recruited from relevant societies and departments across Australia and New Zealand. Results: 79 eligible clinicians commenced the survey, with 63 completing it and 16 providing a partial response. The perceived benefit of having a genetic diagnosis for DSD was almost unanimous (97%). Almost half (48%) of respondents reported barriers in genomic testing. 81% of respondents reported they order genomic tests currently. Approaches to genomic testing when faced with four different clinical scenarios varied across respondents. Clinicians perceived genomic testing to be underutilised (median 36 on sliding scale from 0 to 100). Conclusions: Despite 97% of respondents reporting benefit of a genetic diagnosis for individuals with DSD, this was not reflected throughout the survey with regard to clinical implementation. When faced with clinical scenarios, the recommendations for genomic testing from respondents was much lower, indicating the discrepancy between perception and clinical practice. Genomic testing in the context of DSD is seen as both beneficial and desired, yet there are multiple barriers impacting its integration into standard clinical care. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 pandemic highlighted the need for more rapid and routine application of modeling approaches such as quantitative microbial risk assessment (QMRA) for protecting public health. QMRA is a transdisciplinary science dedicated to understanding, predicting, and mitigating infectious disease risks. To better equip QMRA researchers to inform policy and public health management, an Advances in Research for QMRA workshop was held to synthesize a path forward for QMRA research. We summarize insights from 41 QMRA researchers and experts to clarify the role of QMRA in risk analysis by (1) identifying key research needs, (2) highlighting emerging applications of QMRA; and (3) describing data needs and key scientific efforts to improve the science of QMRA. Key identified research priorities included using molecular tools in QMRA, advancing dose–response methodology, addressing needed exposure assessments, harmonizing environmental monitoring for QMRA, unifying a divide between disease transmission and QMRA models, calibrating and/or validating QMRA models, modeling co‐exposures and mixtures, and standardizing practices for incorporating variability and uncertainty throughout the source‐to‐outcome continuum. Cross‐cutting needs identified were to: develop a community of research and practice, integrate QMRA with other scientific approaches, increase QMRA translation and impacts, build communication strategies, and encourage sustainable funding mechanisms. Ultimately, a vision for advancing the science of QMRA is outlined for informing national to global health assessments, controls, and policies. [ABSTRACT FROM AUTHOR]

Purpose: Uncorrected refractive error is the leading cause of vision impairment globally; however, little attention has been given to equity and access to services. This study aimed to identify and prioritise: (1) strategies to address inequity of access to refractive error services and (2) population groups to target with these strategies in five sub‐regions within the Western Pacific. Methods: We invited eye care professionals to complete a two‐round online prioritisation process. In round 1, panellists nominated population groups least able to access refractive error services, and strategies to improve access. Responses were summarised and presented in round 2, where panellists ranked the groups (by extent of difficulty and size) and strategies (in terms of reach, acceptability, sustainability, feasibility and equity). Groups and strategies were scored according to their rank within each sub‐region. Results: Seventy five people from 17 countries completed both rounds (55% women). Regional differences were evident. Indigenous peoples were a priority group for improving access in Australasia and Southeast Asia, while East Asia identified refugees and Oceania identified rural/remote people. Across the five sub‐regions, reducing out‐of‐pocket costs was a commonly prioritised strategy for refraction and spectacles. Australasia prioritised improving cultural safety, East Asia prioritised strengthening school eye health programmes and Oceania and Southeast Asia prioritised outreach to rural areas. Conclusion: These results provide policy‐makers, researchers and funders with a starting point for context‐specific actions to improve access to refractive error services, particularly among underserved population groups who may be left behind in existing private sector‐dominated models of care. [ABSTRACT FROM AUTHOR]

Phase change materials (PCMs) can absorb, store, and release substantial latent heat within a specific temperature range during phase transition and have gained huge attention due to environmental concerns and energy crises. However, PCMs have a significant downside in energy storage due to their relatively lower thermal conductivity, leading to inadequate heat transfer (HT) performance. The foremost aim of the research is to synthesize an eco‐friendly coconut shell biochar (CSB) dispersed with organic A46 PCM in the temperature range of 44°C to 46°C to form a green nanocomposite. A two‐step approach is adopted to formulate the nanocomposites with different weight concentrations (0.2% and 0.8%) of green CSB particles. The developed nanocomposite's thermal conductivity and chemical stability were examined using a thermal properties analyzer and a Fourier transforms infrared spectrometer. The developed biochar composites have excellent thermal conductivity (0.39 W/m K) compared with base PCM (0.22 W/m K). Also, the developed nanocomposites were physically mixed together; there were no additional functional groups formed compared to pristine PCM, and the prepared materials were composite. Furthermore, a numerical analysis was performed using two‐dimensional energy modeling software to ascertain the HT rate of A46 composites. These thermally energized green nanocomposites show great promise for thermal energy storage and thermal management applications like battery thermal management, photovoltaic thermal systems, desalination systems, electronic cooling, building applications, and textiles. [ABSTRACT FROM AUTHOR]

Objective: To determine surgical outcomes and stone‐free rates (SFRs) when offering upfront retrograde intrarenal surgery (RIRS) to patients with asymptomatic incidental renal stones (AIRS), as active surveillance, shockwave lithotripsy or upfront intervention in patients with AIRS is still a debate among urologists. Patients and Methods: This retrospective FLEXible Ureteroscopy Outcomes Registry (FLEXOR), supported by the Team of Worldwide Endourological Researchers (TOWER), examines adult patients who underwent RIRS. We analysed a subset of asymptomatic patients with renal stones on imaging who were treated with RIRS. Data includes patient characteristics, stone specifications, anaesthesia type, perioperative details, complications, and SFR. A multivariable logistic regression analysis was performed to assess factors associated with the SFR. Results: Among 679 patients with AIRS, 640 met the inclusion criteria. The median age was 55 years, with 33.4% being female. In all, 22.1% had positive urine cultures. The median stone diameter was 12 mm, commonly in lower and interpolar locations. RIRS was preferentially performed under general anaesthesia using a reusable scope in 443 cases. Prophylactic antibiotics were administered to 314 patients. The median operation time was 58 min and the median laser time was 24 min. The SFR was 68.8%. The use of holmium laser (odds ratio [OR] 0.21, 95% confidence interval [CI] 0.06–0.63; P < 0.01) and multiple stones (OR 0.38, 95% CI 0.19–0.76; P < 0.01) were factors associated with lower odds of being stone free. Overall complications were minimal, with sepsis in 1.6% of patients. Re‐interventions were performed in 76 cases (11.8%), with RIRS being the most common in 67 cases (10.6%). Conclusion: Our multicentre real‐world study is the first of its kind that highlights the pros and cons of offering RIRS to patients with AIRS and demonstrates a favourable SFR with acceptable complications. Pre‐emptively discussing potential re‐intervention helps patients make informed decisions, particularly in cases involving large and multiple stones. [ABSTRACT FROM AUTHOR]

Aim: Patients with metabolic dysfunction‐associated steatotic liver disease (MASLD) are at increased risk of incident cardiovascular disease. However, the clinical characteristics and prognostic importance of MASLD in patients presenting with acute myocardial infarction (AMI) have yet to be examined. Methods: This study compared the characteristics and outcomes of patients with and without MASLD presenting with AMI at a tertiary centre in Singapore. MASLD was defined as hepatic steatosis, with at least one of five metabolic criteria. Hepatic steatosis was determined using the Hepatic Steatosis Index. Propensity score matching was performed to adjust for age and sex. The Kaplan‐Meier curve was constructed for long‐term all‐cause mortality. Cox regression analysis was used to investigate independent predictors of long‐term all‐cause mortality. Results: In this study of 4446 patients with AMI, 2223 patients with MASLD were matched with patients without MASLD using propensity scores. The mean follow‐up duration was 3.4 ± 2.4 years. The MASLD group had higher rates of obesity, diabetes and chronic kidney disease than their counterparts. Patients with MASLD had early excess all‐cause mortality (6.8% vs. 3.6%, p <.001) at 30 days, with unfavourable mortality rates sustained in the long‐term (18.3% vs. 14.5%, p =.001) compared with those without MASLD. After adjustment, MASLD remained independently associated with higher long‐term all‐cause mortality (hazard ratio 1.330, 95% confidence interval 1.106‐1.598, p =.002). Conclusion: MASLD embodies a higher burden of metabolic dysfunction and is an independent predictor of long‐term mortality in the AMI population. Its early identification may be beneficial for risk stratification and provide therapeutic targets for secondary preventive strategies in AMI. [ABSTRACT FROM AUTHOR]

Computational target fishing plays an important role in target identification, particularly in drug discovery campaigns utilizing phenotypic screening. Numerous approaches exist to predict potential targets for a given ligand, but true targets may be inconsistently ranked. More advanced simulation methods may provide benefit in such cases by reranking these initial predictions. We evaluated the ability of binding pose metadynamics to improve the predicted rankings for three diverse ligands and their six true targets. Initial predictions using pharmacophore mapping showed no true targets ranked in the top 50 and two targets each ranked within the 50–100, 100–150, and 250–300 ranges respectively. Following binding pose metadynamics, ranking of true targets improved for four out of the six targets and included the highest ranked predictions overall, while rankings deteriorated for two targets. The revised rankings predicted two true targets ranked within the top 50, and one target each within the 50–100, 100–150, 150–200, and 200–250 ranges respectively. The findings of this study demonstrate that binding pose metadynamics may be of benefit in refining initial predictions from structure‐based target fishing algorithms, thereby improving the efficiency of the target identification process in drug discovery efforts. [ABSTRACT FROM AUTHOR]

The optimization of nanomaterial synthesis using numerous synthetic variables is considered to be an extremely laborious task because conventional combinatorial explorations are prohibitively expensive. In this work, an autonomous experimentation platform developed for the bespoke design of metal nanoparticles (NPs) with targeted optical properties is reported. This platform operates in a closed‐loop manner between the batch synthesis module of metal NPs and the UV–vis spectroscopy module, based on the feedback of the AI optimization modeling. With silver (Ag) NPs as a representative example, it is demonstrated that the Bayesian optimizer implemented with the early stopping criterion can efficiently produce Ag NPs at room temperature precisely possessing the desired absorption spectra within only 200 iterations (when optimizing among five aqueous synthetic reagents). In addition to the outstanding material developmental efficiency, the analysis of synthetic variables further reveals a novel chemistry involving the quantitative effects of citrate in Ag NP synthesis. The amount of citrate is key to controlling the competition between spherical and plate‐shaped NPs and, as a result, affects the shapes of the absorption spectra as well. This study highlights both capabilities of the platform to enhance search efficiencies and to provide novel chemical knowledge by analyzing datasets accumulated from autonomous experimentations. [ABSTRACT FROM AUTHOR]

This article provides an overview of the immunophenotypic characteristics of acute myeloid leukemia (AML) with UBTF tandem duplications (TD). The study found that AML cases with UBTF-TDs often exhibit loss or decreased expression of certain antigens, such as CD34 and HLA-DR, while cross-lineage expression of CD4 or CD7 is common. These immunophenotypic abnormalities can complicate the assessment of minimal residual disease (MRD), but it is crucial to analyze the CD34+ population. The article emphasizes the importance of comprehensive laboratory evaluation and combined molecular and flow cytometry MRD assessment for this specific subgroup of AML. [Extracted from the article]

Microalgal biofuel is a promising solution to replace fossil fuel as a renewable and environmental‐friendly energy source, thereby contributing to the United Nations (UN) Sustainable Development Goals (SDGs), in particular SDG‐7, or Affordable and Clean Energy. Unlike energy crops (like oil palm and sugar cane), microalgae benefit from faster growth rate, higher lipid content, smaller land area required, ability to flourish using waste or brackish water, and posing zero competition with food crops. Microalgae‐derived biofuels (like biodiesel, bioethanol, biomethane, and biohydrogen) are sustainable energy sources that can be produced using well‐developed techniques (e.g., transesterification, fermentation, anaerobic digestion, and Fisher–Tropsch process). To prevent dire climate conditions resulting from the global temperature rise of 1.5°C and resolve worldwide energy security issue, our generation will need to establish and implement renewables on a global scale. To improve the industrial production of microalgal biofuel, the efficiencies of biomass and metabolite production to post‐cultivation biofuel synthesis processes must be enhanced. For the cultivation step, there exist three key techniques that can directly change the traits, structure, and behavior of microalgal cells, and induce them to accumulate targeted metabolites rapidly and in large amounts. These techniques are genetic engineering, chemical modulation, and nanomaterial approach. Genetic engineering commonly alters the chloroplast DNA of microalgae to overexpress or down‐regulate key genes in various metabolic pathways so that the cells accumulate more lipids. Chemicals can also be used to modulate microalgal growth and lipid accumulation by inducing oxidative stress or prevent conversion of lipid molecules. Nanomaterials and nanoparticles can also enhance microalgal lipid production by microenvironmental stress induction, vitamin supplementation, and light backscattering. Therefore, in this review, the recent progress as well as the pros and cons of genetic engineering, chemical modulation, and nanomaterial approach in achieving greater biofuel production from microalgae are comprehensively examined. [ABSTRACT FROM AUTHOR]

Background: Early access program (formerly cohort Temporary Authorization for Use) was granted for trastuzumab deruxtecan (T‐DXd) in France based on DESTINY‐Breast01 trial which demonstrated its efficacy and safety in HER2‐positive metastatic/unresectable breast cancer after ≥2 anti‐HER2‐based regimens received at metastatic stage. Method s : This multicenter real‐world early access program included HER2‐positive metastatic/unresectable breast patients pretreated with at least two lines of anti‐HER2 regimens who received T‐DXd 5.4 mg/kg intravenously in monotherapy every 3 weeks. Results: Four hundred and fifty‐nine patients (median age, 58 years; hormone receptor‐positive, 67%; brain metastases, 28.1%) received T‐DXd. Before inclusion, 81.7% of patients had radiation therapy and 76.5% had undergone surgery. Median number of prior metastatic treatment lines was four (range, 2–22); 99.8% patients had received trastuzumab, 94.8% trastuzumab emtansine and 79.3% pertuzumab. Follow‐up was performed from September 30, 2020 to March 30, 2021; when the early access program stopped, the median duration of T‐DXd treatment was 3.4 (range, 0–7.8) months. In 160 patients with available tumor assessment, objective response rate was 56.7% and 12.1% had progression. In 57 patients with available brain tumor assessment, complete or partial intracranial response was reported for 35.7% patients and 5.4% had progression. A total of 17 (3.7%) patients with interstitial lung disease (ILD) was reported with no cases of ILD‐related death. Conclusions: In this early access program in patients with heavily pretreated HER2‐positive metastatic/unresectable breast cancer, T‐DXd had antitumor activity with a similar response to that reported in previous clinical studies. T‐DXd was well tolerated and no new safety signals were observed. [ABSTRACT FROM AUTHOR]

The identification of the synthetic cannabinoids receptor agonists (SCRAs) has always posed a great challenge to drug testing laboratories with slight structural modifications aimed at evading drug legislation. In addition, the most prevalent synthetic cannabinoids have valine and tert‐leucine amino acid moieties where re‐arrangement of the carbon chains can result in structural isomers that are very similar to the parent synthetic cannabinoids. This makes their analysis and identification challenging, and the problem is compounded with the difficulty in purchasing reference standards quickly and a lack of literature for comparison. Therefore, in this investigation, four series of synthetic cannabinoids (AB‐PINACA, AB‐CHMINACA, MMB‐FUBINACA and 5‐fluoro‐MDMB‐PINACA) and their alkyl chain structural isomers at the amino acid moieties were synthesized and characterized using various analytical techniques—gas chromatography–mass spectrometry (GC–MS), gas chromatography–infrared detection (GC–IRD) and nuclear magnetic resonance (NMR) spectroscopy to evaluate the ability of each analytical technique to differentiate the respective isomers for their identification. A total of 12 isomers were synthesized and analysed together with the four parent synthetic cannabinoids. NMR was able to differentiate between all the compounds, whereas GC–IRD was able to discern between most of the synthetic cannabinoids and their isomers. GC–MS had the least discriminating power and was not able to differentiate some of the compounds that has very similar mass spectra. The results from this work will be useful to other drug testing laboratories that are facing the identification of related synthetic cannabinoids. [ABSTRACT FROM AUTHOR]

Introduction: Clinical outcomes of long‐term ventricular septal pacing (VSP) without His‐Purkinje capture remain unknown. This study evaluated the differences in clinical outcomes between conduction system pacing (CSP), VSP, and right ventricular pacing (RVP). Methods: Consecutive patients with bradycardia indicated for pacing from 2016 to 2022 were prospectively followed for the clinical endpoints of heart failure (HF)‐hospitalizations and all‐cause mortality at 2 years. VSP was defined as septal pacing due to unsuccessful CSP implant or successful CSP followed by loss of His‐Purkinje capture within 90 days. Results: Among 1016 patients (age 73.9 ± 11.2 years, 47% female, 48% atrioventricular block), 612 received RVP, 335 received CSP and 69 received VSP. Paced QRS duration was similar between VSP and RVP, but both significantly longer than CSP (p <.05). HF‐hospitalizations occurred in 130 (13%) patients (CSP 7% vs. RVP 16% vs. VSP 13%, p =.001), and all‐cause mortality in 143 (14%) patients (CSP 7% vs. RVP 19% vs. VSP 9%, p <.001). The association of pacing modality with clinical events was limited to those with ventricular pacing (Vp) > 20% (pinteraction <.05). Adjusting for clinical risk factors among patients with Vp > 20%, VSP (adjusted hazard ratio [AHR]: 4.74, 95% confidence interval [CI]: 1.57–14.36) and RVP (AHR: 3.08, 95% CI: 1.44‐6.60) were associated with increased hazard of HF‐hospitalizations, and RVP (2.52, 95% CI: 1.19–5.35) with increased mortality, compared to CSP. Clinical endpoints did not differ between VSP and RVP with Vp > 20%, or amongst groups with Vp < 20%. Conclusion: Conduction system capture is associated with improved clinical outcomes. CSP should be preferred over VSP or RVP during pacing for bradycardia. [ABSTRACT FROM AUTHOR]

Aims: Heart failure (HF) is a growing health problem, yet there are limited data on patients with HF in Malaysia. The Malaysian Heart Failure (MY‐HF) Registry aims to gain insights into the epidemiology, aetiology, management, and outcome of Malaysian patients with HF and identify areas for improvement within the national HF services. Methods and results: The MY‐HF Registry is a 3‐year prospective, observational study comprising 2717 Malaysian patients admitted for acute HF. We report the description of baseline data at admission and outcomes of index hospitalization of these patients. The mean age was 60.2 ± 13.6 years, 66.8% were male, and 34.3% had de novo HF. Collectively, 55.7% of patients presented with New York Heart Association (NYHA) Class III or IV; ischaemic heart disease was the most frequent aetiology (63.2%). Most admissions (87.3%) occurred via the emergency department, with 13.7% of patients requiring intensive care, and of these, 21.8% needed intubation. The proportion of patients receiving guideline‐directed medical therapy increased at discharge (84.2% vs. 93.6%). The median length of stay (LOS) was 5 days, and in‐hospital mortality was 2.9%. Predictors of LOS and/or in‐hospital mortality were age, NYHA class, estimated glomerular filtration rate, and comorbid anaemia. LOS and in‐hospital mortality were similar regardless of ejection fraction. Conclusions: The MY‐HF Registry showed that the HF population in Malaysia is younger, predominantly male, and ischaemic‐driven and has good prospects with hospitalization for optimization of treatment. These findings suggest a need to reassess current clinical practice and guide resource allocation to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Summary: Flow cytometry (FC) incorporating the T‐cell receptor β constant chain‐1 (TRBC1) has been recently proposed as a new standard in T‐cell clonality assessment. While early studies demonstrated high sensitivity in samples with conspicuous tumour burden, performance in real‐world samples, including those with low tumour burden and correlation with molecular methods has been limited. We evaluated TRBC1‐FC performance and correlated the results with high‐throughput TRB sequencing and a targeted next‐generation sequencing gene panel. Our cohort consisted of 90 evaluable samples from 57 patients. TRBC1‐FC confirmed T‐cell clonality in 37 out of 38 samples (97%) that were involved in a mature T‐cell neoplasm (MTCN). T‐cell clonality was also identified in nine samples from patients lacking a current or prior diagnosis of MTCN, consistent with the emerging entity T‐cell clonality of uncertain significance. TRBC‐FC was polyclonal in all samples and negative for disease involvement by standard pathology assessment. However, correlation with TRB sequencing in 17 of these samples identified two cases that harboured the known clonal sequence from index testing, indicating the presence of measurable residual disease not otherwise detected. Our study provides real‐world correlative validation of TRBC1‐FC, highlighting the strengths and limitations pertinent to its increasing implementation by general diagnostic laboratories. [ABSTRACT FROM AUTHOR]

Two main disadvantages of starch‐based biofilms are their low mechanical strength and high hydrophobicity. This work investigated incorporation of cellulose microfibers (CMF) with a range of CMF loading (i.e., 0, 0.5, and 1.0 wt% of CMF) as fillers to improve the mechanical properties of starch‐based biofilm. CMFs (average diameter = 75 μm) were isolated from midrib of Musa Saba' banana residue using chemical treatments of steam explosion alkaline treatment, acid‐chlorite treatment, and acid hydrolysis. The starch‐based biofilm showed improved tensile strength (32.5%), Young's Modulus (55.4%), opacity (23.7%), crystallinity (54.2%), and reduction in elongation (27%) with 1.0 wt% CMF loading compared with biofilm without CMF. The film's mechanical properties improvement is further supported by the even filler dispersion within the film matrix shown in field emission scanning electron microscope micrographs. Active packaging containing the antimicrobial compound of myricetin was incorporated into the 1.0 wt% CMF reinforced film to produce SC1M, which showed the fastest release of myricetin in 95% ethanol (fatty acid simulant), followed by 3% acetic acid (acidic simulant) and slowest in distilled water (aqueous simulant). CMF derived from banana midrib residue can be a viable bioreinforcement component for developing biofilms for fatty food packaging, which protects against humidity, oxygen, temperature, and light‐induced deterioration. [ABSTRACT FROM AUTHOR]

Objectives: Southeast Asia (SEA) is a rapidly ageing and a diversely populated region that requires strategies to maintain its populations' physical activity and sense of well‐being. While the benefits of group exercise programs are known, the characteristics and types of exercises in terms of their effectiveness for physical function and fidelity of the programs have yet to be defined within this population. Methods: Ovid, MEDLINE, Scopus, PEDro (Physiotherapy Evidence Database), EBSCOHOST, Cochrane library and Open Grey databases were searched to identify relevant studies. Methodological quality was assessed using the PEDro Scale and the Newcastle Ottawa Scale (NOS). Meta‐analysis was undertaken when the same outcome measures were reported in a minimum of two studies with appropriate data. (PROSPERO: CRD42020177317). Results: Eleven studies with 900 participants were included, out of which 395 participants were allocated to group exercise programs and 383 completed the program. Culturally adapted Thai dance programs and multicomponent exercise programs were the most‐commonly reported group exercises. The Timed Up and Go test (TUG) and attendance rates were the most‐frequently reported outcomes. Meta‐analysis demonstrated significant improvement in physical function assessed using the Timed Up and Go test (Random effect model −1.27 s, 95% CI −1.65, −0.88, I2 = 74%). In two studies, adherence (81% and 94%) and dropout rates (4% and 19%) were reported. Conclusions: Group‐based exercise programs in Southeast Asia consisting mostly of culturally adapted Thai dance programs and multicomponent exercise programs appear to have positive effects on physical function. However, better descriptions of fidelity, including adherence, are required in future studies. [ABSTRACT FROM AUTHOR]

Objective: To perform a systematic review and meta‐analysis to evaluate the impact of body mass index (BMI) on oncological (primary) and surgical (secondary) outcomes of patients who underwent nephrectomy, as obesity or high BMI is a known risk factor for renal cell carcinoma (RCC) and predictor of poorer outcomes. Methods: Studies were identified from four electronic databases from database inception to 2 June 2021, according to the Preferred Reporting Items for Systematic Review and Meta‐analysis statement. The review protocol was registered in the International Prospective Register of Systematic Reviews with the identification number: CRD42021275124. Results: A total of 18 studies containing 13 865 patients were identified for the final meta‐analysis. Regarding oncological outcomes, higher BMI predicted higher overall survival (BMI >25 vs BMI <25 kg/m2: hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.58–0.85), cancer‐specific survival (BMI >25 vs BMI <25 kg/m2: HR 0.60, 95% CI 0.50–0.73; BMI 25–30 vs BMI <25 kg/m2: HR 0.46, 95% CI 0.23–0.95; BMI >30 vs BMI <25 kg/m2: HR 0.50, 95% CI 0.36–0.69), and recurrence‐free survival rates (BMI >25 vs BMI <25 kg/m2: HR 0.72, 95% CI 0.63–0.82; BMI 25–30 vs BMI <25 kg/m2: HR 0.59, 95% CI 0.42–0.82). Those with a lower BMI fared better in surgical outcomes, such as operation time and warm ischaemic time, although the absolute difference was minimal and unlikely to be clinically significant. There was no difference between groups for length of hospital stay, intraoperative or postoperative complications, blood transfusion requirements, and conversion to open surgery. Conclusion: Our study suggests that a higher BMI is associated with improved long‐term oncological survival and similar perioperative outcomes as a lower BMI. More research into the underlying biological and physiological mechanisms will enable better understanding of the effect of BMI, beyond mere association, on post‐nephrectomy outcomes. [ABSTRACT FROM AUTHOR]

A major cause of premature catalyst deactivation in the catalytic hydrogenation of fatty acids is the presence of impurities in the feedstock. With more oleochemical plants shifting to opportunistic crude palm oil (CPO) as their feedstock, the feedstock quality becomes an important factor in their procurement process. For CPO, the impurities level can be coarsely estimated by the deterioration of bleaching index (DOBI). A high DOBI value (e.g. DOBI > 2.99) indicates good quality CPO and ease in processing, while low DOBI value implies low level of carotene and/or high level of oxidised sludge oil, both of which could be detrimental to the processing of CPO. In our work, unsplit CPO feedstocks with varying DOBI value were directly hydrogenated in a laboratory‐scale pressure reactor with the presence of commercial nickel catalysts. Experimental results showed that catalyst deactivation was linked to DOBI value, where decreasing DOBI led to faster catalyst deactivation. For example, iodine value (IV) < 1.0 can be achieved for CPO with high DOBI value (2.97) after 150 min, and IV of 5–7 and IV > 20 were achieved for medium DOBI value (2.57–2.68) and low DOBI value (2.24), respectively. For CPO with low DOBI value (2.24), doubling the catalyst dosage ensured that the hydrogenated product met the low IV specification. This work showed that identifying the CPO with DOBI value presents an indicator to the manufacturer to find the right CPO tailored to the existing processes to maximise profitability. [ABSTRACT FROM AUTHOR]

Mediated through hierarchical domestic institutions and a global system of jurisprudence that tends to view older jurisdictions as more authentic or authoritative legal sources, the language of common law is seldom explored through a world Englishes lens, but Malaysian law has opened up possibilities for indigenised and pluricentric common law by its use of Malay alongside English. While some studies have examined bilingualism in Malaysian public courtrooms, few have looked into the less accessible spaces of law office practice. This study investigates bilingual legal practice through the experiences of law students undertaking professional internships at various institutions nationwide. Although some sectors lean toward one language more than the other, most students reported intense and dynamic patterns of bilingualism. The findings offer scope for research specifically into Malaysian legal English from a language contact perspective. [ABSTRACT FROM AUTHOR]

Variant acute promyelocytic leukaemia with novel NAB2::RARA fusion shows clinical all-trans retinoic acid and arsenic trioxide sensitivity Acute promyelocytic leukaemia (APL) is characterised by reciprocal translocation between the promyelocytic leukaemia ( I PML i ) gene at chromosome 15q24 and the retinoic acid receptor alpha ( I RARA i ) gene at chromosome 17q21. (E) Metaphase FISH using PML:RARA dual fusion translocation probe (Metasystems), which is negative for PML:RARA fusion but displays 3 RARA (green) signals, indicating the presence of a variant RARA translocation. [Extracted from the article]

Key Clinical Message: The high‐risk "Shark Fin" electrocardiogram (ECG) pattern has been associated with transmural ischemia but can also result from electrolyte anomalies. Therefore, the decision for invasive coronary catheterization requires a detailed history and dedicated biochemical tests. Pseudo‐infarction ECG pattern resembling "Shark Fin" was demonstrated in a 76‐year‐old lady with a previous total thyroidectomy who presented with unspecific symptoms. An incidental finding of hypokalemia and hypocalcemia was thought to be related to delayed onset hypoparathyroidism. Potential etiologies like coronary vasospasm and catecholamine‐associated myocardial injury were suggested. [ABSTRACT FROM AUTHOR]

Introduction: The benefits of cardiac resynchronization therapy (CRT) with biventricular pacing (BiV) is significantly lower when applied to heart failure (HF) patients with non‐left bundle branch block (LBBB) conduction delay. We investigated clinical outcomes of conduction system pacing (CSP) for CRT in non‐LBBB HF. Methods: Consecutive HF patients with non‐LBBB conduction delay undergoing CSP were propensity matched for age, sex, HF‐etiology, and atrial fibrillation (AF) in a 1:1 ratio to BiV from a prospective registry of CRT recipients. Echocardiographic response was defined as an increase in left ventricular ejection fraction (LVEF) by ≥10%. The primary outcome was the composite of HF‐hospitalizations or all‐cause mortality. Results: A total of 96 patients were recruited (mean age 70 ± 11years, 22% female, 68% ischemic HF and 49% AF). Significant reductions in QRS duration and LV dimensions were seen only after CSP, while LVEF improved significantly in both groups (p < 0.05). Echocardiographic response occurred more frequently in CSP than BiV (51% vs. 21%, p < 0.01), with CSP independently associated with four‐fold increased odds (adjusted odds ratio 4.08, 95% confidence interval [CI] 1.34–12.41). The primary outcome occurred more frequently in BiV than CSP (69% vs. 27%, p < 0.001), with CSP independently associated with 58% risk reduction (adjusted hazard ratio [AHR] 0.42, 95% CI 0.21–0.84, p = 0.01), driven by reduced all‐cause mortality (AHR 0.22, 95% CI 0.07–0.68, p < 0.01), and a trend toward reduced HF‐hospitalization (AHR 0.51, 95% CI 0.21–1.21, p = 0.12). Conclusions: CSP provided greater electrical synchrony, reverse remodeling, improved cardiac function and survival compared to BiV in non‐LBBB, and may be the preferred CRT strategy for non‐LBBB HF. [ABSTRACT FROM AUTHOR]

Aim: To examine the prevalence and prognosis of hepatic steatosis and fibrosis in post‐acute myocardial infarction (AMI) patients. Methods: Patients presenting with AMI to a tertiary hospital were examined from 2014 to 2021. Hepatic steatosis and advanced hepatic fibrosis were determined using the Hepatic Steatosis Index and fibrosis‐4 index, respectively. The primary outcome was all‐cause mortality. Cox regression models identified determinants of mortality after adjustments and Kaplan–Meier curves were constructed for all‐cause mortality, stratified by hepatic steatosis and advanced fibrosis. Results: Of 5765 patients included, 24.8% had hepatic steatosis, of whom 41.7% were diagnosed with advanced fibrosis. The median follow‐up duration was 2.7 years. Patients with hepatic steatosis tended to be younger, female, with elevated body mass index and an increased metabolic burden of diabetes, hypertension and hyperlipidaemia. Patients with hepatic steatosis (24.6% vs. 20.9% mortality, P <.001) and advanced fibrosis (45.6% vs. 32.9% mortality, P <.001) had higher all‐cause mortality rates compared with their respective counterparts. Hepatic steatosis (adjusted hazard ratio 1.364, 95% CI 1.145‐1.625, P =.001) was associated with all‐cause mortality after adjustment for confounders. Survival curves showed excess mortality in patients with hepatic steatosis compared with those without (P =.002). Conclusions: Hepatic steatosis and advanced fibrosis have a substantial prevalence among patients with AMI. Both are associated with mortality, with an incrementally higher risk when advanced fibrosis ensues. Hepatic steatosis and fibrosis could help risk stratification of AMI patients beyond conventional risk factors. [ABSTRACT FROM AUTHOR]

The bearing capacity of a square footing on an unstabilised and geogrid-stabilised granular layer over clay is estimated using finite element techniques in ABAQUS (a commercial finite element software). The model incorporates a range of soil parameters and layer thicknesses. The two-layered soil system in the model assumes a strong upper granular layer and a weak lower clay layer. The parametric results of the finite element analyses are used to develop design curves with dimensionless parameters in terms of linear gradient and the ratio of the undrained shear strength of clay to the effective vertical stress of the granular layer. The design curves are compared with the published results in the literature and found to be promising. The developed design curves are applied to estimate the minimum thickness of the granular layer and are compared with other existing methods. This application illustrates the simplicity of the proposed technique and reveals that the proposed approach yields a reasonable prediction for the bearing capacity when compared with other established methods. [ABSTRACT FROM AUTHOR]

Congenital disorders of glycosylation (CDG) are a clinically and biochemically heterogeneous subgroup of inherited metabolic disorders. Most CDG with abnormal N‐glycosylation can be detected by transferrin screening, however, MOGS‐CDG escapes this routine screening. Combined with the clinical heterogeneity of reported cases, diagnosing MOGS‐CDG can be challenging. Here, we clinically characterize ten MOGS‐CDG cases including six previously unreported individuals, showing a phenotype characterized by dysmorphic features, global developmental delay, muscular hypotonia, and seizures in all patients and in a minority vision problems and hypogammaglobulinemia. Glycomics confirmed accumulation of a Glc3Man7GlcNAc2 glycan in plasma. For quantification of the diagnostic Glcα1‐3Glcα1‐3Glcα1‐2Man tetrasaccharide in urine, we developed and validated a liquid chromatography‐mass spectrometry method of 2‐aminobenzoic acid (2AA) labeled urinary glycans. As an internal standard, isotopically labeled 13C6‐2AA Glc3Man was used, while labeling efficiency was controlled by use of 12C6‐2AA and 13C6‐2AA labeled laminaritetraose. Recovery, linearity, intra‐ and interassay coefficients of variability of these labeled compounds were determined. Furthermore, Glc3Man was specifically identified by retention time matching against authentic MOGS‐CDG urine and compared with Pompe urine. Glc3Man was increased in all six analyzed cases, ranging from 34.1 to 618.0 μmol/mmol creatinine (reference <5 μmol). In short, MOGS‐CDG has a broad manifestation of symptoms but can be diagnosed with the use of a quantitative method for analysis of urinary Glc3Man excretion. [ABSTRACT FROM AUTHOR]

The amount of HbH has been shown to correlate with the size of the I ATRX i clone.[6] In the Oxford ATMDS Registry, one patient demonstrated an I ATRX i clone size of 35% and 1.5% at two different time-points, corresponding to 25% and <1% HbH-containing cells by supravital staining respectively. Keywords: genetic analysis; myeloid leukaemia; red blood cell disorders; somatic mutation; thalassaemia EN genetic analysis myeloid leukaemia red blood cell disorders somatic mutation thalassaemia e13 e16 4 12/22/22 20230101 NES 230101 Acquired -thalassaemia is a rare disorder that can arise in patients with myelodysplastic syndrome ( -thalassaemia myelodysplastic syndrome, ATMDS).[1] In contrast to I cis- i acting variants of the -gene cluster in inherited thalassaemia, ATMDS is caused by somatic variants in the X-linked I ATRX i gene that encodes a I trans- i acting chromatin-associated protein.[[2]] Consistent with this, germline I ATRX i variants cause the inherited ATR-X syndrome characterised by severe mental retardation and mild -thalassaemia in males.[[4]] Despite advances in understanding ATRX protein function, the exact mechanism of -globin gene repression is unknown, and several clinical observations remain unresolved: (1) the haematologic phenotype for a given variant is more severe in ATMDS compared to ATR-X syndrome, (2) the proportion of HbH can fluctuate with time, and (3) the -thalassaemia often resolves after leukaemic transformation. Acquired somatic ATRX mutations in myelodysplastic syndrome associated with alpha thalassemia (ATMDS) convey a more severe hematologic phenotype than germline ATRX mutations. [Extracted from the article]

Verheij syndrome (VRJS) is a rare craniofacial spliceosomopathy presenting with craniofacial dysmorphism, multiple congenital anomalies and variable neurodevelopmental delay. It is caused by single nucleotide variants (SNVs) in PUF60 or interstitial deletions of the 8q24.3 region. PUF60 encodes a splicing factor which forms part of the spliceosome. To date, 36 patients with a sole diagnosis of VRJS due to disease‐causing PUF60 SNVs have been reported in peer‐reviewed publications. Although the depth of their phenotyping has varied greatly, they exhibit marked phenotypic heterogeneity. We report 10 additional unrelated patients, including the first described patients of Khmer, Indian, and Vietnamese ethnicities, and the eldest patient to date, with 10 heterozygous PUF60 variants identified through exome sequencing, 8 previously unreported. All patients underwent deep phenotyping identifying variable dysmorphism, growth delay, neurodevelopmental delay, and multiple congenital anomalies, including several unique features. The eldest patient is the only reported individual with a germline variant and neither neurodevelopmental delay nor intellectual disability. In combining these detailed phenotypic data with that of previously reported patients (n = 46), we further refine the known frequencies of features associated with VRJS. These include neurodevelopmental delay/intellectual disability (98%), axial skeletal anomalies (74%), appendicular skeletal anomalies (73%), oral anomalies (68%), short stature (66%), cardiac anomalies (63%), brain malformations (48%), hearing loss (46%), microcephaly (41%), colobomata (38%), and other ocular anomalies (65%). This case series, incorporating three patients from previously unreported ethnic backgrounds, further delineates the broad pleiotropy and mutational spectrum of PUF60 pathogenic variants. [ABSTRACT FROM AUTHOR]

Background: Surgical parathyroidectomy may be required for severe and refractory secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease (CKD). Parathyroidectomy is associated with long-term survival benefit despite an increase in short-term morbidity and mortality. Global variation in practice exists, with limited Australian data on outcomes following parathyroidectomy. Aim: To evaluate clinical outcomes of patients with chronic kidney disease undergoing surgical parathyroidectomy for secondary hyperparathyroidism. Methods: We conducted a retrospective study of patients who underwent parathyroidectomy for SHPT between January 2010 and December 2019 at a single tertiary referral centre in Melbourne, Australia. Biochemical markers and medications were assessed 12 months pre- and post-surgery. Clinical outcomes, including hospital readmission, cardiovascular events and mortality were assessed following surgery. Results: During the 10-year study period, 129 patients underwent parathyroidectomy for SHPT (mean age 50.7 ± 15 years; 109 (85%) on dialysis). Significant immediate post-operative complications were seen in eight (6%) patients, requiring admission to the intensive care unit (n = 6) or return to theatre (n = 2). Within the first 6 months, 24 (19%) patients required hospital readmission. Within 12 months post-parathyroidectomy, 100 (78%) and 103 (80%) patients experienced at least one episode of hypercalcaemia (corrected calcium >2.6 mmol/L) or hypocalcaemia (corrected calcium <2.1 mmol/L) respectively. Over a 12-month period, there were six (5%) deaths and eight (6%) patients experienced a major cardiovascular event. Conclusion: Significant fluctuations in serum calcium levels are common post-parathyroidectomy; however, long-term morbidity and mortality in our cohort were lower than previously reported, highlighting that parathyroidectomy in a carefully selected cohort is safe for severe SHPT refractory to medical treatment. [ABSTRACT FROM AUTHOR]

Developing a bio‐based polyol polyurethane foam with the desired properties for use as growing media for green vertical walls could be beneficial in the quest to create a more sustainable urban living. In this work, palm kernel oil‐based polyol (PKOP) was mixed with petroleum‐based polyol (PP) at different ratios in synthesizing polyurethane foam. The impacts of PKOP/PP formulation on the density, cell morphology, water absorption, water retention, swelling behavior, and their chemical functional groups were evaluated. It was determined that replacing PP with low levels of PKOP could reduce the water absorption ability due to the introduction of hydrophobic plant‐based fatty acids. On the contrary, polyurethane foam containing more than 30% PKOP has improved the water absorbing ability and retention properties. Fourier‐transform infrared (FTIR) spectrum indicates that the synthesized foams are isocyanate‐free and stable toward pH changes. The trial planting attempt was a success where the plants were grown from seeds using the synthesized foam media. It was proposed that 50% PKOP is most suitable for use as a growing media, based on its water absorbing and retention properties. The findings of this study highlight the potential for the use of bio‐based polyol polyurethane foam for more sustainable growing media in urban gardens. [ABSTRACT FROM AUTHOR]

Sexual disinhibition in dementia is a distressing and embarrassing behaviour. Currently, there are no guideline‐directed management aims to address this behaviour in patients with dementia. This case report highlights a combined non‐pharmacological and pharmacological approach for managing dementia in a patient who showed marked sexual disinhibition. [ABSTRACT FROM AUTHOR]

BACKGROUND: The maturity of honey has a great impact on its quality and contents. Additionally, stingless bee honey contains high moisture, which allows microorganisms to survive and ferment, contributing to honey's variable flavor and physicochemical properties. Therefore, there is a need for better quality control of the honey process, especially the harvest time of honey. RESULTS: We gathered honey from the nest of stingless bees Heterotrigona itama and Tetrigona binghami over different time periods, i.e. 15, 30, and 45 days. The results show harvest time considerably affects the physicochemical properties, antioxidant activity, and antimicrobial activity of honey. Good antioxidant activity and antimicrobial activity can be found in honey produced from a longer harvest time. Compared with 15‐day harvest time, at 30‐ or 45‐day harvest time water, trehalulose, and protein content and total acidity increased, and the content of reducing sugars, fructose and glucose, and pH values, decreased in both types of honey. Moreover, compared with 15‐day harvest time, the sum of six organic acids in the 45‐day honey of H. itama fluctuated between 2.78 to 4.12 g 100 g−1 and in the 45‐day honey of T. binghami increased from 1.66 to 3.61 g 100 g−1, respectively. CONCLUSION: Honey harvest time had a significant effect on the physicochemical properties, antioxidant activity, and antimicrobial activity of stingless bee honey (H. itama or T. binghami). This study provides a reference for beekeepers to adjust harvest time to obtain honey with suitable physicochemical parameters. © 2022 Society of Chemical Industry. [ABSTRACT FROM AUTHOR]

Background: Emphysematous pyelonephritis (EP) is a severe necrotizing infection of the renal parenchyma which is associated with significant case mortality. We sought to identify the incidence and predictive risk factors associated with EP mortality. Methods: Two electronic databases, PubMed and Web of Science, were searched from their inception until June 06, 2021 for relevant articles. Two independent teams reviewed abstracts and extracted data from the selected manuscripts. A meta-analysis has been reported in line with PRISMA 2020 and AMSTAR Guidelines. Results: Of the 1080 retrieved abstracts, 79 underwent full-text review and 45 studies were included in the final analysis, comprising a total cohort of 1303 patients and 177 mortalities. The pooled prevalence of mortality among the patients with EP disease was 13%. Our analysis found a significantly decreasing trend in mortality rates, an increasing trend in minimally invasive intervention and decreasing trends in emergency nephrectomy in the EP studies from 1985 to 2020. Significant risk factors that were associated with a negative impact on survival of EP patients included sepsis (OR = 15.99), shock (OR = 15.57), disturbance of consciousness (OR = 12.11), thrombocytopenia (OR 7.85), acute renal failure (OR = 5.41), Wan classification I (OR = 4.57), emergency nephrectomy (OR = 3.73), Huang–Tseng classification III–IV (OR = 2.4) and medical management alone (OR = 2.04). Female sex (OR = 0.52) and minimally invasive intervention (OR = 0.47) (percutaneous nephrostomy or ureteral stent placement) were associated with decreased mortality rates. Conclusions: Our study results demonstrated several significant risk factors that could help guide treatment to reduce the mortality risk of EP patients. Clinically, early treatment with a combination of minimally invasive intervention and appropriate medical management may be protective for reducing mortality risk in EP patients. [ABSTRACT FROM AUTHOR]

Respiratory diseases (RDs), such as chronic obstructive pulmonary disease, cystic fibrosis, asthma, and pneumonia, are associated with significant morbidity and mortality. Treatment usually consists of antibiotics and steroids. Relevant published literature reviews, studies, and clinical trials were accessed from institutional and electronic databases. The keywords used were respiratory diseases, steroids, antibiotics, and combination of steroids and antibiotics. Selected articles and literature were carefully reviewed. Antibiotics are often prescribed as the standard therapy to manage RDs. Types of causative respiratory pathogens, spectrum of antibiotics activity, route of administration, and course of therapy determine the type of antibiotics that are prescribed. Despite being associated with good clinical outcome, treatment failure and recurrence rate are still high. In addition, antibiotic resistance has been widely reported due to bacterial mutations in response to the use of antibiotics, which render them ineffective. Nevertheless, there has been a growing demand for corticosteroids (CS) and antibiotics to treat a wide variety of diseases, including various airway diseases, due to their immunosuppressive and anti‐inflammatory properties. The use of CS is well established and there are different formulations based on the diseases, such as topical administration, tablets, intravenous injections, and inhaled preparations. Both antibiotics and CS possess similar properties in terms of their anti‐inflammatory effects, especially regulating cytokine release. Thus, the current review examines and discusses the different applications of antibiotics, CS, and their combination in managing various RDs. Drawbacks of these interventions are also discussed. [ABSTRACT FROM AUTHOR]

Segmental infantile hemangiomas affecting the upper body are associated with PHACE(S) (Posterior fossa anomalies, Hemangioma, Arterial anomalies, Cardiac anomalies, Eye anomalies, and Sternal defects) syndrome, whereas segmental infantile hemangiomas affecting the lower body are the cutaneous hallmark of LUMBAR (Lower body hemangioma and other skin defects, Urogenital anomalies and Ulceration, Myelopathy, Bony deformities, Anorectal malformations and Arterial anomalies, and Renal anomalies) syndrome. We present two individuals with concurrent features of both PHACE and LUMBAR syndromes demonstrating an overlap phenotype. The overlapping features seen in our patients suggest that these syndromes occur on the same phenotypic spectrum and derive from a common embryonic pathophysiology. [ABSTRACT FROM AUTHOR]

Introduction: To determine the downstream utilisation of Computed Tomography Coronary Angiography (CTCA) in a single Australian tertiary centre. Methods: A single‐centre retrospective study analysed 1460 patients undergoing CTCA between 1st January 2015 to 31st December 2018 at a tertiary hospital in Victoria, Australia, with a catchment area of 500,000 people. The coronary stenosis grading, plaque characteristics and coronary calcium score were identified. The downstream impact was assessed by measuring the number of stress echocardiograms, myocardial perfusion scans (MPS), invasive coronary angiograms and subsequent revascularisations. Results: The number of CTCA's performed steadily increased from 59 in 2015 to 395, 461 and 545 in 2016, 2017 and 2018 respectively. Seven hundred and fifty‐seven (52%) were females, and 703 (48%) males with 724 (50%) normal CTCA studies. The number of downstream stress echocardiogram performed each year was 2, 60, 46 and 16, respectively, accompanied by MPS numbers of 0, 21, 29, and 18. There were 9, 37, 57 and 64 invasive coronary angiograms with 1, 13, 19 and 22 corresponding revascularisations. Despite small increases in absolute numbers of patients presenting with chest pain (from 2678 in 2015 to 3660 in 2018), there was a significant increase in downstream further testing from 11 in 2015 to 98 in 2018. Conclusion: The use of CTCA expansion has resulted in an increase in downstream testing. Therefore, resource planning with regards to CTCA expansion will have to account for increased rates of functional testing, invasive angiography and revascularisation. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the initial use of label‐free second harmonic generation (SHG) imaging with two‐photon excitation (2PE) auto‐fluorescence in multiphoton microscopy (MPM) for the quantification of collagen/fibrosis on preimplantation biopsies of extended criteria donors (ECD). Materials and methods: Twenty preimplantation core biopsies were extracted from 10 donor kidney samples, of which originated from seven donors. Kidney Donor Profile Index (KDPI) and Remuzzi scores of biopsies were calculated. Collagen parameters measured included quantification by the Collagen Area Ratio in Total Tissue (CART) and qualitative measurements by Collagen Reticulation Index (CRI). Results: Biopsies classified with > 85% KDPI scores had significantly higher CART (p =.011) and lower CRI values (p =.025) than biopsies with ≤ 85% KDPI scores. Increase in CRI values correlated significantly with rise in recipient creatinine levels 1‐year post‐transplant (p =.027; 95% CI: 4.635‐66.797). Conclusion: MPM is an evolving technology that enables the quantification of the amount (CART) and quality (CRI) of collagen deposition in unstained preimplantation biopsies of donor kidneys stratified by KDPI scores. This initial evaluation found significant differences in both parameters between donor kidneys with more or less than 85% KDPI. [ABSTRACT FROM AUTHOR]

Introduction: Pacing leads with extendable‐retractable helix (EHL) are alternatives to fixed‐helix leads (FHL) for conduction system pacing (CSP), but data on handling characteristics are limited. This study evaluated a dual‐center experience of lead handling and performance during CSP. Methods and Results: Consecutive patients with His‐bundle pacing (HBP) or left bundle branch pacing (LBBP) were evaluated for the primary outcome of lead failure, defined as structural damage to the lead necessitating lead replacement. Differences in pacing characteristics were compared. Among 280 patients (mean age 74 ± 11 years, 44% male, 50% LBBP), 246 (88%) received FHL and 34 (12%) received EHL. Of 299 leads used, lead failure occurred more frequently among patients with EHL than FHL (29% vs. 2%, p <.001), regardless of CSP modality. Majority of damaged leads (89%) in the form of helix deformation were successfully removed, with failure occurring in only two patients, both EHL, leading to helix fracture and retention within the septal myocardium. EHL, compared to FHL, was associated with 25‐fold increased odds of lead failure (odds ratio: 25.21, 95% confidence interval: 7.35–86.51), and persisted after adjustment in turn for age, pacing modality and indication. CSP implant success rates did not differ by lead design (FHL 80% vs. EHL 71%, p =.18), with similar pacing thresholds at implant and follow‐up. Conclusion: Helix deformation and fracture were more frequent with EHL in CSP despite similar implant success. These findings have significant implications for lead selection during CSP and raises concerns about the long‐term extractability of EHL in CSP. [ABSTRACT FROM AUTHOR]

Background: Cardiac amyloidosis is a protein misfolding disorder involving deposition of amyloid fibril proteins in the heart. The associated fibrosis of the conduction tissue results in conduction abnormalities and arrhythmias. "Classical" electrocardiogram (ECG) findings in cardiac amyloidosis include that of low voltage complexes with increased left ventricular wall thickness on echocardiography. However, this "classical" finding is neither sensitive nor specific. As cardiac amyloidosis is associated with a generally poor prognosis, the need for early recognition of this disease is important given the availability of new treatment options. In this review, we highlight 3 cases of patients with cardiac amyloidosis. Although presenting with typical clinical signs and symptoms, ECG for all 3 patients was not consistent with the classical findings described. They underwent further diagnostic tests which clinched the diagnosis of cardiac amyloidosis, allowing patients to receive targeted treatment. Through the review of the literature, we will highlight the different ECG patterns in patients with different types of cardiac amyloidosis and clinical scenarios, as well as the pitfalls of using ECG to identify the condition. Lastly, we also emphasize the current paradigms in diagnosing cardiac amyloidosis through the non‐invasive methods of echocardiography, cardiac magnetic resonance imaging, and nuclear technetium‐pyrophosphate imaging. Conclusions: Electrocardiogram is often the first investigation used in evaluating many cardiac disorders, including cardiac amyloidosis. However, classical features of cardiac amyloidosis on ECG are often not present. A keen understanding on the ECG features of cardiac amyloidosis and knowledge of the diagnostic workflow is important to diagnose this condition. [ABSTRACT FROM AUTHOR]

Background: Health responses associated with occupational exposures can vary between men and women. Aims: This study reviewed the work injury and disability risks associated with similar types of occupational exposures for men and women within and across occupations. Materials & Methods: A systematic review was undertaken of observational studies published between 2009 and 2019. Studies were required to empirically compare men and women for associations between occupational exposures and work injury or disability outcomes. Included studies were appraised for methodological quality and medium to high rated studies were compared for risk differences between men and women. Results: Of 14,006 records identified, 440 articles were assessed for methodological quality, and 33 medium to high rated studies were included and reviewed. Among all occupations, the association between physical exposures, job demands, noise, and repetitive tasks, and injury risk were stronger among men. The relationship between repetitive tasks and sickness absence was stronger among women. Most studies examining psychological exposures found no risk differences for men and women across occupations. Men were at higher injury risk in certain occupations in primary and secondary industry sectors involving physical exposures and some chemical/biological exposures. Women were at higher injury risk for the physical demands and repetitive tasks of health care and aluminum production occupations. Conclusion: This review found that men and women can have different work injury and disability risks, both across and within the same occupations, for some physical exposures and to a lesser extent for some chemical and biological exposures. These differences might be a result of occupation‐specific task differences. [ABSTRACT FROM AUTHOR]