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Abstract Background The majority of those diagnosed with aortic aneurysm in the UK are older, multi-morbid patients. Decision-making as to who may benefit from intervention (open or endovascular aneurysm repair) is highly variable across the NHS (as is the mode of intervention), in part because there are no detailed guidelines or consensus on preoperative assessment. Thus, there is likely to be significant variation in the pre-operative assessment and optimisation of these patients. Methods A survey was designed to understand current practice and attitudes of vascular surgeons and vascular anaesthetists in the UK regarding preoperative assessment and optimisation of patients undergoing elective aortic aneurysm repair. The survey was reviewed and validated by an expert panel, then distributed electronically to all vascular surgical and vascular anaesthetic leads in the UK. Results Overall, the response rate was 68%. The responses were varied between surgeons and anaesthetists, with differences reported in the preoperative assessment and optimisation of patients, the approach to shared decision-making, and the perioperative pathway. Conclusions Despite initiatives such as Getting It Right First Time (GIRFT) and National Institute for Health and Care Excellence (NICE) guidelines, variation still exists between centres with some differences in opinion observed between surgeons and anaesthetists. These differences may be leading to duplication of work in the perioperative pathway, inconsistencies in how risk is assessed and communicated with consequent variation in patient care. Addressing these issues requires awareness and implementation of existing guidelines, transdisciplinary working, efficient data-driven pathways, and structured aortic aneurysm multi-disciplinary team to promote meaningful shared decision-making.

Introduction Thoracic endovascular aortic repair (TEVAR) carries a 3%–6.1% stroke risk, including risk of ‘silent’ cerebral infarction (SCI). Stent-grafts are manufactured in room air and retain air. Instructions for use recommend saline flushing to ‘de-air’ the system prior to insertion, but substantial amounts of air are released when deploying them, potentially leading to downstream neuronal injury and SCI. Carbon dioxide (CO2) is more dense and more soluble in blood than air, without risk of bubble formation, so could be used in addition to saline to de-air stents. This pilot trial aims to assess the feasibility of a full-scale randomised controlled trial (RCT) investigating the neuroprotective benefit against SCI with the use of CO2-flushed aortic stent-grafts.Methods and analysis This is a multicentre pilot RCT, which is taking place in vascular centres in the UK, USA and New Zealand. Patients identified for TEVAR will be enrolled after informed written consent. 120 participants will be randomised (1:1) to TEVAR-CO2 or TEVAR-saline, stratified according to TEVAR landing zone. Participants will undergo preoperative neurocognitive tests and quality of life assessments, which will be repeated at 6 weeks, or first outpatient appointment, and 6 months. Inpatient neurological testing will be performed within 48 hours of return to level 1 care for clinical stroke or delirium. Diffusion-weighted MRI will be undertaken within 72 hours postoperatively (1–7 days) and at 6 months to look for evidence and persistence of SCI. Feasibility will be assessed via measures of recruitment and retention, informing the design of a full-scale trial.Ethics and dissemination The study coordination centre has obtained approval from the London Fulham Research Ethics Committee (19/LO/0836) and Southern Health and Disability Ethics Committee (NZ) and UK’s Health Regulator Authority (HRA). The study has received ethical approval for recruitment in the UK (Fulham REC, 19/LO/0836), New Zealand (21/STH/192) and the USA (IRB 019-264, Ref 378630). Consent for entering into the study will be taken using standardised consent forms by the local study team, led by a local PI. The results of the trial will be submitted for publication in an open access journal.Trial registration number NCT03886675

Pulswidth modulation (PWM) methods were developed to grant the voltage source inverter (VSI) output signal better quality measures. The PWM method that VSI relies on must consider the utilization of the direct current (DC) source, especially when the drive system works in the overmodulation region. In this paper, different zero-sequence harmonic injection PWM methods are proposed. Two essential objectives are optimized by minimizing total harmonic distortion and maximizing the DC bus utilization. All schemes’ results are compared with each other and with some of the commonly used PWM schemes. This paper concludes the usage of third, ninth, and fifteenth harmonic injections and any combination of them to reach a new PWM method that overtakes the disadvantages of other methods. Meanwhile, it provides a handy tool to operate VSI optimally. Ultimately, this work concludes to what extent is the zero-sequence injection is helpful. The work is evaluated experimentally, and the practical results match the simulation outcomes.

Objectives: Inadequate removal of the hemostatic agent can adversely affect the bond strength of restorations to the tooth structure. This study aimed to assess the effect of different cleansing protocols on the shear bond strength (SBS) of an etch-and-rinse adhesive to dentin contaminated with aluminum chloride hemostatic agent. Materials and Methods: In this experimental study, the mid-coronal dentin of 96 premolars was exposed. They were contaminated with a hemostatic agent (ViscoStat Clear) and then randomly divided into 7 groups (n=12). One group served as the control. The groups underwent various cleaning methods as follows: water spray, aluminum oxide particles (27µ diameter), a slurry of pumice with water, GC dentin conditioner (GCDC), sodium hypochlorite 2% (SHC), and chlorhexidine 2% (CHX). Composite cylinders were then fabricated and bonded to the surfaces using Scotchbond Multi-Purpose etch-and-rinse bonding agent. After thermocycling (10,000 cycles), the SBS was measured using a universal testing machine. Data were analyzed using one-way analysis of variance (ANOVA) and Tukey HSD (honestly significant difference) test, and the significance level was set at 0.05. Results: The SBS of the groups was significantly different (P=0.036). The SBS was the highest in the CHX and SHC groups, and the lowest SBS was related to the control group and GCDC groups. The difference between other groups was not significant (P=0.996). Conclusion: CHX and SHC yielded the highest bond strength among the tested modalities for cleansing the ViscoStat Clear from the tooth surface.

Starting from the perspective of the new social studies of childhood and their strong focus on agency of children this article follows the critical voices on the agency concept and reconceptualises children’s autonomy under conditions of vulnerability. Within the adult dominated field of sport the phenomenon of children’s vulnerability as well as children’s autonomy can be seen and discussed empirically. The authors analyse what and how children’s autonomy is enabled or limited e.g. through organisational aspects or through the superior position of adults. This leads to new findings concerning children’s emotional and physical vulnerability, children’s decisions about leisure time and adult-free spaces as well as the limitation of children’s autonomy. As a conclusion or in the sense of an outlook, thoughts towards theories of professionalism are considered.

In Islam, there are four fundamental factors of social development and change – personality, tradition, accident, and people. The Qur’an says: “Verily never will God change the condition of a people until they change it themselves [with their souls]. (Q-13:11). Therefore, the researcher’s aim is assessing the integration of slamic values in the teaching of martial arts in the youth for them be good followers of Islam thru inculcation in their minds and their behavior the real sense of a true Muslim. Essentially, this study is descriptive, which aimed mainly to serve as an exposition on the Religion, Traditional Culture, and History of the Muslims in the Philippines and their implication relevance to martial arts. The various data collected through in-depth study, interview and observation showed that Islam prepares people to be a fruitful citizen in the society. It also aimed for the total development of man not only in the religious aspect. Thus, Martial arts play a vital role in Islam not just as a means of self-defense, but as a system of ethics. Man and fighting are by nature intimately related; in fact, history shows that they are inseparable. Locally, the Bangsamoro has a very rich historical foundation in martial arts that is directly derivable from the roots of Islamic propagation. And as man became civilized, hand-to-hand fighting also became specialized and humanized and, gradually.

Muslim communities are known to be united, but every year, towards the start of Ramadhan, some of them argue which started to be divided over the issue on the determination of the start of the blessed month. This study aimed to investigate the different options proposed for the determination of the month of Ramadhan including local and global sighting; Number of witnesses required; Size of Matla'; and Saudi Sighting Process and its implications. Data were gathered through an in-depth study using the descriptive method. The objectives were to determine the universally accepted legal opinion on sighting the New Moon in connection with the elimination of differences that frequently surface and for ensuring the celebration of 'Eid on a single day in one lunar unit. Based on the findings, it is revealed that sighting the new moon must be conducted in each locality because there are Multiple Horizons (the time at which the moon rises, varies from place to place). Muslims must show unity during the month of Ramadhan and at the occasions of 'Eid at least locally if not nationally or internationally. This would be of great value and importance to the whole Muslim nation by fostering the initial steps towards united observance of Ramadhan.

One crucial barrier to progress in the treatment of cancer has been the inability to control the balance between cell proliferation and apoptosis: enter ceramide. Discoveries over the past 15 years have elevated this sphingolipid to the lofty position of a regulator of cell fate. Ceramide, it turns out, is a powerful tumour suppressor, potentiating signalling events that drive apoptosis, autophagic responses and cell cycle arrest. However, defects in ceramide generation and metabolism in cancer cells contribute to tumour cell survival and resistance to chemotherapy. This Review focuses on ceramide signalling and the targeting of specific metabolic junctures to amplify the tumour suppressive activities of ceramide. The potential of ceramide-based therapeutics in the treatment of cancer is also discussed. [ABSTRACT FROM AUTHOR]

Background: Repair bond strength of different composite resins has been assessed in few studies. In addition, reports on the efficacy of surface treatments are debated. Therefore, this in vitro study was conducted to evaluate the effect of three surface treatments on two nanocomposites versus a microhybrid composite. Materials and Methods: In this experimental study, 135 composite blocks (45 specimens per composite) of microhybrid (Filtek Supreme Z250, 3M ESPE, USA), nanohybrid (Filtek Supreme XT, 3M ESPE), and nanofilled (Filtek Supreme Z350, 3M ESPE) were thermocycled (5000 rounds) and then surface roughened (except in a control group of 9 specimens of three composite types). Each composite type was divided into three subgroups of surface treatments: (1) Bur abrading and phosphoric acid (PA) etching, (2) sandblasting and PA etching, and (3) hydrofluoric etching and silane application (n = 15 × 9, complying with ISO TR11405). Composite blocks were repaired with the same composite type but of a different color. Microtensile bond strength and modes of failure were analyzed statistically using two-way analyses of variance, Tukey and Chi-square tests (α = 0.05). Results: There were significant differences between three composite resins (P < 0.0001) and treatment techniques (P < 0.0001). Their interaction was nonsignificant (P = 0.228). The difference between nanofilled and nanohybrid was not significant. However, the microhybrid composite showed a significantly higher bond strength (Tukey P < 0.05). Sandblasting was significantly superior to the other two methods, which were not different from each other. Conclusion: Within the limitations of this in vitro study, it seems that microhybrid composite might have higher repair strengths than two evaluated nanocomposites. Among the assessed preparation techniques, sandblasting followed by PA etching might produce the highest bond strength.

This study evaluated the types of gene action governing the inheritance of resistance to Phytophthora nicotianae necrosis in populations derived from two crosses involving two susceptible (Beldi and Nabeul II) and one resistant (CM334) cultivars of pepper (Capsicum annuum L.). Populations, composed of Pr, Ps, F1,F2,BC1Pr, and BC1Ps generations, were inoculated with six P. nicotianae isolates. Generation means analysis indicated that an additive-dominance model was appropriate for P. nicotianae isolates PnKo1,PnKo2 and PnKr1, which showed low aggressiveness in the two crosses. For the more aggressive isolates PnBz1,PnBz2 and PnKr2, epistasis was an integral component of resistance in the two crosses. The presence of epistasis in the resistance of pepper to P. nicotianae was dependent on the level of aggressiveness of the isolates. Selection in pepper with less aggressive isolates was efficient, but not with more aggressive isolates; on the other hand, selection with more aggressive isolates was more stable. The minimum number of genes controlling resistance was estimated at up to 2.71. In the majority of cases, the additive variance was significant and greater than the environmental and dominance variance.

Le pseudo-Meigs syndrome comprend une tumeur pelvienne bénigne (en dehors des fibrothécomes ovariens) ou maligne associée à des épanchements, pleural et ou péritonéal, qui disparaissent après l'exérèse tumorale. Nous rapportons l'observation d'une patiente âgée de 47 ans, qui présentait une pleurésie droite associée à une ascite et une tumeur ovarienne maligne. L'évolution après l'exérèse chirurgicale de la masse tumorale même en l'absence d'une chimiothérapie montrait une disparition des épanchements. Le pseudo-Meigs syndrome est rare. Il nécessite des biopsies pleurales et péritonéales négatives, et la disparition des épanchements après l'exérèse chirurgicale de la tumeur, avant toute chimiothérapie. Une telle distinction est importante aussi bien sur le plan thérapeutique que pronostique.