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Objectives: An estimated 125 million workers are exposed to asbestos worldwide. Asbestos is classified by the International Agency for Research on Cancer as a Group 1 carcinogen. The association between occupational asbestos exposure and kidney cancer is not well established however. This study aimed to determine the mortality and incidence of kidney cancer in workers who have been exposed to asbestos. We performed a systematic review and meta-analysis to evaluate the association between occupational asbestos exposure and kidney cancer., Methods: Medline, EMBASE, and Web of Science were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for articles on occupational asbestos exposure and kidney cancer. The studies reported the standardized mortality ratio (SMR) or standardized incidence ratio (SIR) of kidney cancer in workers exposed to asbestos. SMRs or SIRs with its 95% confidence interval (CI) were pooled using a fixed-effect model., Results: Forty-nine cohort studies involving 335 492 workers were selected for analysis. These studies included 468 kidney cancer deaths and 160 incident cases. The overall pooled-SMR of kidney cancer was 0.95 (95% CI: 0.86-1.05), with no significant heterogeneity (PQ = 0.09, I2 = 24.87%). The overall pooled-SIR of kidney cancer was 0.95 (95% CI: 0.79-1.11), with no significant heterogeneity (PQ = 0.68, I2 = 0.00%). Subgroup analysis did not find any increased association with occupational asbestos exposure. There was no evidence of publication bias with Egger's test P values of 0.08 for mortality studies and 0.99 for incidence studies., Conclusions: This systematic review and meta-analysis did not show evidence of association between occupational asbestos exposure and kidney cancer mortality or incidence., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.)

Renal complications are long-term effect of diabetes mellitus where glucose is excreted in urine. Therefore, reliable glucose detection in urine is critical. While commercial urine strips offer a simple way to detect urine sugar, poor sensitivity and low reliability limit their use. A hybrid glucose oxidase (GOx)/horseradish peroxidase (HRP) assay remains the gold standard for pathological detection of glucose. A key restriction is poor stability of HRP and its suicidal inactivation by hydrogen peroxide, a key intermediate of the GOx-driven reaction. An alternative is to replace HRP with a robust inorganic enzyme-mimic or NanoZyme. While colloidal NanoZymes show promise in glucose sensing, they detect low concentrations of glucose, while urine has high (mM) glucose concentration. In this study, a free-standing copper NanoZyme is used for the colorimetric detection of glucose in human urine. The sensor could operate in a biologically relevant dynamic linear range of 0.5-15 mM, while showing minimal sample matrix effect such that glucose could be detected in urine without significant sample processing or dilution. This ability could be attributed to the Cu NanoZyme that for the first time showed an ability to promote the oxidation of a TMB substrate to its double oxidation diimine product rather than the charge-transfer complex product commonly observed. Additionally, the sensor could operate at a single pH without the need to use different pH conditions as used during the gold standard assay. These outcomes outline the high robustness of the NanoZyme sensing system for direct detection of glucose in human urine. Graphical abstract.

Context: An important element of the diagnosis of polycystic ovary syndrome is hyperandrogenism., Objective: To determine the distribution of modified Ferriman-Gallwey (mF-G) scores, as a measure of facial and body hair growth, and associations between the mF-G scores and serum androgen concentrations, including 11-oxygenated androgens., Design: Cross-sectional study of non-health-care-seeking women, aged 18 to 39 years, recruited from the eastern states of Australia from November 2016 to July 2017., Participants and Measurements: Participants provided an mF-G self-assessment that corresponded to their appearance when not using treatment for excess hair. Androgens were measured in 710 women by liquid chromatography and tandem mass spectrometry., Results: The distribution of the mF-G scores was right-skewed. The median (range) mF-G score of all participants (73.1% Caucasian) was 5 (0-36). The mF-G scores were negatively associated with age (rs = 0.124; P < 0.0001) and positively associated with body mass index (BMI) (rs = 0.073; P < 0.0001). Only androstenedione remained significantly associated with mF-G scores when controlling for age and BMI. Cluster analysis identified 2 groups with mF-G score of < 10 and ≥ 10. Repeating the cluster analysis using the combined vector of mF-G score and androstenedione returned a similar cluster structure, and again separated the 2 groups at a mF-G score < 10 versus ≥ 10., Conclusions: A self-assessed mF-G score ≥ 10 is indicative of excess body hair. Androstenedione, as well as testosterone, should be measured when hyperandrogenism is being evaluated. The lack of association between mF-G scores and the 11-oxygenated androgens highlights the need for a better understanding of these steroids., (© Endocrine Society 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction and Hypothesis: Pelvic floor disorders (PFDs), including urinary incontinence (UI), faecal incontinence (FI) and pelvic organ prolapse (POP), are common debilitating conditions globally, with considerable variation of prevalence reported in low and middle-income countries (LMICs). It was hypothesised that the variation could be due to both random and non-random errors. The aim was to determine the pooled prevalence estimates of PFDs among community-dwelling women in LMICs and to examine possible reasons for the variations of prevalence reported., Methods: A systematic search of MEDLINE, EMBASE, PsycINFO, CINAHL and Maternity & Infant Care was conducted to retrieve eligible studies. A meta-analysis with a random effects model and a meta-regression were performed. The manuscript was structured using the PRISMA checklist ., Results: A total of 49 studies were included. The overall pooled prevalence of PFDs in LMICs was 25% (95% CI 22-29%). The pooled prevalence of UI, FI and POP was 30% (95% CI 25-35%), 8% (95% CI 4-11%) and 15% (95% CI 10-20%), respectively. A significant difference in the prevalence of UI was found between studies conducted in low and lower middle-income and upper middle-income countries and for FI between studies that used validated and non-validated questionnaires. Other methodological features did not show any effect on the variation of prevalence estimates of UI, FI and POP., Conclusions: PFDs affect a substantial proportion of women in LMICs. Since methodological heterogeneity was unexplained, this review suggests the need for large nationally representative population-based surveys to provide reliable estimates of the prevalence of PFDs in LMICs.

Background: People with renal disease have a markedly higher risk of cardiovascular disease as well as morbidity and mortality after cardiac surgery. Little is known regarding the post-operative adverse outcomes following isolated coronary artery bypass graft (CABG) in the Australian population with renal disease., Objectives: The aim of this study was to examine the effect of different stages of renal disease on patients' risk of post-operative mortality and complications following isolated CABG in an Australian cohort., Methods: Using the ANZSCTS (Australian and New Zealand Society of Cardiac and Thoracic Surgeons) registry, data from 44,968 patients who underwent isolated CABG between 2001 and 2014 were used. The effect of renal disease stages on short- and long-term outcomes were examined using multivariable logistic and Cox's regression methods respectively., Results: Three of 4 Australian patients (74.6%) who underwent isolated CABG had some degree of renal disease: 50.2% mild; 20.9% moderate; 2.1% severe; and 1.6% dialysis-dependent. Adjusted risk of 30-day mortality increased with deteriorating renal disease from mild (1.6-fold) to dialysis-dependent (4.6-fold). Worsening renal disease was also associated with higher risk of post-operative complications. Hazard ratio for long-term survival shows steady increase of mortality risk with worsening renal disease categories from 1.1-fold for mild to 3.9-fold for patients on dialysis., Conclusions: Pre-existing renal disease is significantly associated with 30-day and long-term mortality, length of intensive care unit and hospital stay as well as several other post-operative complications., (Copyright © 2019 World Heart Federation (Geneva). Published by Elsevier B.V. All rights reserved.)

Aims: The objective of this study was to identify the determinants of glycaemic control among people with type 2 diabetes mellitus in Bangladesh. A cross-sectional study was carried out during March to September 2017, and 1253 adult patients with type 2 diabetes mellitus were recruited from six hospitals. Data were collected from patients via face-to-face interview, and their medical records were reviewed. Multiple logistic regression analysis was performed. Among the participants, 53.2% were male. Mean (±SD) age was 54.1 (±12.1) years and mean (±SD) duration of diabetes was 9.9 (±7.2) years. About 82% participants had inadequate glycaemic control (HbA1c ≥ 7%) and 54.7% had very poor control (HbA1c ≥ 9%). Low education level, rural residence, unhealthy eating habits, insulin use, infrequent follow up check-ups and history of coronary artery diseases found associated with inadequate and very poor controls. Being female and smokeless tobacco consumer appeared to be associated with inadequate control however cognitive impairment was associated with very poor control only. Prevalence of inadequate glycaemic level was very high in Bangladesh. Having understood relatable lifestyle modification factors, demographics and co-morbidities among people with type 2 diabetes, health care providers in conjunction with patients should work together to address the glycaemic control.

Background: Countercurrent saccharification is a promising way to minimize enzyme loading while obtaining high conversions and product concentrations. However, in countercurrent saccharification experiments, 3-4 months are usually required to acquire a single steady-state data point. To save labor and time, simulation of this process is necessary to test various reaction conditions and determine the optimal operating point. Previously, a suitable kinetic model for countercurrent saccharification has never been reported. The Continuum Particle Distribution Modeling (CPDM) satisfactorily predicts countercurrent fermentation using mixed microbial cultures that digest various feedstocks. Here, CPDM is applied to countercurrent enzymatic saccharification of lignocellulose., Results: CPDM was used to simulate multi-stage countercurrent saccharifications of a lignocellulose model compound (α-cellulose). The modified HCH-1 model, which accurately predicts long-term batch saccharification, was used as the governing equation in the CPDM model. When validated against experimental countercurrent saccharification data, it predicts experimental glucose concentrations and conversions with the average errors of 3.5% and 4.7%, respectively. CPDM predicts conversion and product concentration with varying enzyme-addition location, total stage number, enzyme loading, liquid residence time (LRT), and solids loading rate (SLR). In addition, countercurrent saccharification was compared to batch saccharification at the same conversion, product concentration, and reactor volume. Results show that countercurrent saccharification is particularly beneficial when the product concentration is low., Conclusions: The CPDM model was used to simulate multi-stage countercurrent saccharification of α-cellulose. The model predictions agreed well with the experimental glucose concentrations and conversions. CPDM prediction results showed that the enzyme-addition location, enzyme loading, LRT, and SLR significantly affected the glucose concentration and conversion. Compared to batch saccharification at the same conversion, product concentration, and reactor volume, countercurrent saccharification is particularly beneficial when the product concentration is low., Competing Interests: Competing interestsThe authors declare that they have no competing interests.

Background: Enzymatic hydrolysis is a major step for cellulosic ethanol production. A thorough understanding of enzymatic hydrolysis is necessary to help design optimal conditions and economical systems. The original HCH-1 (Holtzapple-Caram-Humphrey-1) model is a generalized mechanistic model for enzymatic cellulose hydrolysis, but was previously applied only to the initial rates. In this study, the original HCH-1 model was modified to describe integrated enzymatic cellulose hydrolysis. The relationships between parameters in the HCH-1 model and substrate conversion were investigated. Literature models for long-term (> 48 h) enzymatic hydrolysis were summarized and compared to the modified HCH-1 model., Results: A modified HCH-1 model was developed for long-term (> 48 h) enzymatic cellulose hydrolysis. This modified HCH-1 model includes the following additional considerations: (1) relationships between coefficients and substrate conversion, and (2) enzyme stability. Parameter estimation was performed with 10-day experimental data using α-cellulose as substrate. The developed model satisfactorily describes integrated cellulose hydrolysis data taken with various reaction conditions (initial substrate concentration, initial product concentration, enzyme loading, time). Mechanistic (and semi-mechanistic) literature models for long-term enzymatic hydrolysis were compared with the modified HCH-1 model and evaluated by the corrected version of the Akaike information criterion. Comparison results show that the modified HCH-1 model provides the best fit for enzymatic cellulose hydrolysis., Conclusions: The HCH-1 model was modified to extend its application to integrated enzymatic hydrolysis; it performed well when predicting 10-day cellulose hydrolysis at various experimental conditions. Comparison with the literature models showed that the modified HCH-1 model provided the best fit.

Background: Despite epidemiological studies worldwide have documented erectile dysfunction (ED) as a major complication of type 2 diabetes Mellitus (T2DM) in men, only limited research reported on determinants of ED in this population. The study aimed at examining the association of ED with dyslipidaemia in T2DM patients., Methods: The study enrolled 813 consecutive eligible adult male T2DM patients attending the endocrinology departments of a tertiary teaching hospital in Bangladesh. Sexual function was assessed using modified International Index of Erectile Function (IIEF) in face-to-face interview and collected along with sociodemographic information. Diabetes and lipid profile and treatment history were collected from patient's treatment records. Association of ED with dyslipidaemia was assessed using multivariable logistic regression adjusting for potential confounders., Result: Prevalence of ED among the T2DM patients was very high (72.7%), of which around half had moderated-to-severe ED. Odds of having dyslipidaemia among T2DM patients with ED is 2.3 times higher than those without. The odds increased by approximately 3 fold for an abnormal High Density Lipoprotein level and by 2.7 fold for abnormal Low Density Lipoprotein., Conclusion: Dyslipidaemia was associated with increased ED risk among T2DM. Abnormal lipoprotein level particularly were found to pose greater risk., (Copyright © 2018 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Enzyme-mimicking catalytic nanoparticles, more commonly known as NanoZymes, have been at the forefront for the development of new sensing platforms for the detection of a range of molecules. Although solution-based NanoZymes have shown promise in glucose detection, the ability to immobilize NanoZymes on highly absorbent surfaces, particularly on free-standing substrates that can be feasibly exposed and removed from the reaction medium, can offer significant benefits for a range of biosensing and catalysis applications. This work, for the first time, shows the ability of Ag nanoparticles embedded within the 3D matrix of a cotton fabric to act as a free-standing peroxidase-mimic NanoZyme for the rapid detection of glucose in complex biological fluids such as urine. The use of cotton fabric as a template not only allows high number of catalytically active sites to participate in the enzyme-mimic catalytic reaction, the absorbent property of the cotton fibres also helps in rapid absorption of biological molecules such as glucose during the sensing event. This, in turn, brings the target molecule of interest in close proximity of the NanoZyme catalyst enabling accurate detection of glucose in urine. Additionally, the ability to extract the free-standing cotton fabric-supported NanoZyme following the reaction overcomes the issue of potential interference from colloidal nanoparticles during the assay. Based on these unique characteristics, nanostructured silver fabrics offer remarkable promise for the detection of glucose and other biomolecules in complex biological and environmental fluids., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objectives: To develop a model for predicting long-term survival following coronary artery bypass graft surgery., Methods: This study included 46 573 patients from the Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZCTS) registry, who underwent isolated coronary artery bypass graft surgery between 2001 and 2014. Data were randomly split into development (23 282) and validation (23 291) samples. Cox regression models were fitted separately, using the important preoperative variables, for 4 'time intervals' (31-90 days, 91-365 days, 1-3 years and >3 years), with optimal predictors selected using the bootstrap bagging technique. Model performance was assessed both in validation data and in combined data (development and validation samples). Coefficients of all 4 final models were estimated on the combined data adjusting for hospital-level clustering., Results: The Kaplan-Meier mortality rates estimated in the sample were 1.7% at 90 days, 2.8% at 1 year, 4.4% at 2 years and 6.1% at 3 years. Age, peripheral vascular disease, respiratory disease, reduced ejection fraction, renal dysfunction, arrhythmia, diabetes, hypercholesterolaemia, cerebrovascular disease, hypertension, congestive heart failure, steroid use and smoking were included in all 4 models. However, their magnitude of effect varied across the time intervals. Harrell's C-statistics was 0.83, 0.78, 0.75 and 0.74 for 31-90 days, 91-365 days, 1-3 years and >3 years models, respectively. Models showed excellent discrimination and calibration in validation data., Conclusions: Models were developed for predicting long-term survival at 4 time intervals after isolated coronary artery bypass graft surgery. These models can be used in conjunction with the existing 30-day mortality prediction model., (© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Introduction: Many risk prediction models are currently in use for predicting short-term mortality following coronary artery bypass graft (CABG) surgery. This review critically appraised the methods that were used for developing these models to assess their applicability in current practice setting as well as for the necessity of up-gradation., Evidence Acquisition: Medline via Ovid was searched for articles published between 1946 and 2016 and EMBASE via Ovid between 1974 and 2016 to identify risk prediction models for CABG. Article selection and data extraction was conducted using the CHARMS checklist for review of prediction model studies. Association between model development methods and model's discrimination was assessed using Kruskal-Wallis one-way analysis of variance and Mann-Whitney U-test., Evidence Synthesis: A total of 53 risk prediction models for short-term mortality following CABG were identified. The review found a wide variation in development methodology of risk prediction models in the field. Ambiguous predictor and outcome definition, sub-optimum sample size, inappropriate handling of missing data and inefficient predictor selection technique are major issues identified in the review. Quantitative synthesis in the review showed "missing value imputation" and "adopting machine learning algorithms" may result in better discrimination power of the models., Conclusions: There are aspects in current risk modeling, where there is room for improvement to reflect current clinical practice. Future risk modelling needs to adopt a standardized approach to defining both outcome and predictor variables, rational treatment of missing data and robust statistical techniques to enhance performance of the mortality risk prediction.

Objective: The objective of this study was to examine the strength and consistency of the relationship between depression and diabetes in Bangladeshi population., Methods: The study was conducted at the medicine department of Bangabandhu Shiekh Mujib Medical University (BSMMU) during May 2012 to May 2013. Equal number of type 2 diabetes mellitus (T2DM) patients and non-diabetic subjects (patient attendants) were recruited from outpatient department matching for age (±2 years) and gender. Demographic and anthropometric data were collected from all the subjects. Depression was assessed using, Hospital Anxiety and Depression Scale (HADS) questionnaire. A subject with a score above 8 was considered as depressive. Baseline characteristics of diabetic and non-diabetic participants were compared using chi square test. Multivariable logistic regression was performed to assess the association between diabetes and depression adjusting for all plausible confounders in the model., Results: 24.8% non-diabetic and 56.2% diabetic subjects were found to have depression. Statistically significant difference was found in income, waist-to-hip ratio between diabetic and non-diabetic subjects (P<0.001). Diabetic patients show 7-fold greater odds of having depression in comparison to their non-diabetic counterpart [OR 7.0, 95% CI (3.4, 14.3)]. Female gender appeared as significant predictor of depression [OR 4.3, 95% CI (2.1, 8.9)]., Conclusions: In Bangladeshi population, people with diabetes are 7 times more likely to have co-existing depression in comparison to non-diabetic subjects. Further studies are required to establish the nature of the relationship between depression and T2DM., (Copyright © 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Muscle loss and arterial stiffness share common risk factors and are commonly seen in the elderly. We aimed to synthesise the existing literature on studies that have examined this association. We searched electronic databases for studies reporting correlations or associations between a measure of muscle tissue and a measure of arterial stiffness. Meta-analysis was conducted using Fisher's Z-transformed r-correlation (r Z ) values. Pooled weighted r Z and 95% confidence intervals were calculated in an inverse-variance, random-effects model. Heterogeneity was assessed by the inconsistency index (I 2 ). Study quality was assessed on a checklist using items from validated quality appraisal guidelines. 1195 records identified, 21 satisfied our inclusion criteria totalling 8558 participants with mean age 52±4 years (range 23-74). Most studies reported an inverse relationship between muscle tissue and arterial stiffness. Eight studies had data eligible for meta-analysis. Muscle tissue was inversely associated with pulse wave velocity in healthy individuals [r Z =-.15 (95% CI -0.24, -0.07); P=.0006; I 2 =85%; n=3577] and in any population [r Z =-.18 (-0.26, -0.10); P<.0001; I 2 =81%; n=3930]. In a leave-one-out sensitivity analysis, the results remained unchanged. Lower muscle tissue was associated with arterial stiffness. Studies were limited by cross-sectional design. Cardiovascular risk monitoring may be strengthened by screening for low muscle mass and maintaining muscle mass may be a primary prevention strategy., (© 2017 John Wiley & Sons Australia, Ltd.)

Projections on the profitability of the pharmaceutical industry predict a large amount of growth in the coming years. Stagnation over the last 20 years in product development has led to the search for new processing methods to improve profitability by reducing operating costs or improving process productivity. This work proposes a novel multifeed bioreactor system composed of independently controlled feeds for substrate(s) and media used that allows for the free manipulation of the bioreactor supply rate and substrate concentrations to maximize bioreactor productivity and substrate utilization while reducing operating costs. The optimal operation of the multiple feeds is determined a priori as the solution of a dynamic optimization problem using the kinetic models describing the time-variant bioreactor concentrations as constraints. This new bioreactor paradigm is exemplified through the intracellular production of beta-carotene using a three feed bioreactor consisting of separate glucose, ethanol and media feeds. The performance of a traditional bioreator with a single substrate feed is compared to that of a bioreactor with multiple feeds using glucose and/or ethanol as substrate options. Results show up to a 30% reduction in the productivity with the addition of multiple feeds, though all three systems show an improvement in productivity when compared to batch production. Additionally, the breakeven selling price of beta-carotene is shown to decrease by at least 30% for the multifeed bioreactor when compared to the single feed counterpart, demonstrating the ability of the multifeed reactor to reduce operating costs in bioreactor systems. © 2017 American Institute of Chemical Engineers Biotechnol. Prog., 33:902-912, 2017., (© 2017 American Institute of Chemical Engineers.)

Few-layer black phosphorous (BP) has emerged as a promising candidate for next-generation nanophotonic and nanoelectronic devices. However, rapid ambient degradation of mechanically exfoliated BP poses challenges in its practical deployment in scalable devices. To date, the strategies employed to protect BP have relied upon preventing its exposure to atmospheric conditions. Here, an approach that allows this sensitive material to remain stable without requiring its isolation from the ambient environment is reported. The method draws inspiration from the unique ability of biological systems to avoid photo-oxidative damage caused by reactive oxygen species. Since BP undergoes similar photo-oxidative degradation, imidazolium-based ionic liquids are employed as quenchers of these damaging species on the BP surface. This chemical sequestration strategy allows BP to remain stable for over 13 weeks, while retaining its key electronic characteristics. This study opens opportunities to practically implement BP and other environmentally sensitive 2D materials for electronic applications., (© 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Introduction: Pelvic floor disorders (PFDs) including urinary incontinence, faecal incontinence and pelvic organ prolapse are common debilitating conditions among women in high-income countries. However, PFDs in women in low/middle-income countries (LMICs) have not been studied extensively. We aim to conduct a systematic review and meta-analysis of the available literature to determine the prevalence of, and/or risk factors for, PFDs in women in LMIC., Methods and Analysis: We will search electronic databases including MEDLINE, EMBASE, PsycINFO, CINAHL, Maternity & Infant Care and Google Scholar for eligible studies. Inclusion criteria will be observational studies of healthy women, which have collected data using validated or non-validated tools, are published in English and were conducted in community women in LMICs, defined by the World Bank. A standardised data extraction form will be developed and piloted, based on the template of the Cochrane good practice data extraction form. All included studies will be assessed based on a risk-of-bias tool specifically developed for prevalence studies. Pooled prevalence estimates of PFDs will be generated using RevMan V.5.2.1 software. Forest plots will be generated to display the overall random-effects pooled estimates with CIs. A metaregression will be conducted to identify sources of between-study heterogeneity in the pooled prevalence estimates. We will quantify heterogeneity using the I 2 measure and its CI. We will use funnel plots to detect potential reporting biases and small-study effects. We will also conduct a sensitivity analysis to verify the robustness of the study conclusions, assessing the impact of methodological quality, study design, sample size and the effect of missing data., Ethics and Dissemination: Our review is entirely based on published data. Thus, an ethics committee approval or written informed consent will not be required for this study as primary data will not be collected. The results will be disseminated by publication of the manuscript in a peer-reviewed journal and/or will be presented at relevant conferences., Prospero Registration Number: CRD42016043881., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objective: To compare the impact of different variable selection methods in multiple regression to develop a parsimonious model for predicting postoperative outcomes of patients undergoing cardiac surgery., Methods: Data from 84,135 patients in the Australian and New Zealand Society of Cardiac and Thoracic Surgeons registry between 2001 and 2014 were analyzed. Primary outcome was 30-day-mortality. Mixed-effect logistic regressions were used to build the model. Missing values were imputed by the use of multiple imputations. The following 5 variable selection methods were compared: bootstrap receiver-operative characteristic (ROC), bootstrap Akaike information criteria, bootstrap Bayesian information criteria, and stepwise forward and stepwise backward methods. The final model's prediction performance was evaluated by the use of Frank Harrell's calibration curve and using a multifold cross-validation approach., Results: Stepwise forward and backward methods selected same set of 21 variables into the model with the area under the ROC (AUC) of 0.8490. The bootstrap ROC method selected 13 variables with AUC of 0.8450. Bootstrap Bayesian information criteria and Akaike information criteria respectively selected 16 (AUC: 0.8470) and 23 (AUC: 0.8491) variables. Bootstrap ROC model was selected as the final model which showed very good discrimination and calibration power., Conclusions: Clinical suitability in terms of parsimony and prediction performance can be achieved substantially by using the bootstrap ROC method for the development of risk prediction models., (Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

This study aimed to investigate factors affecting fruit and vegetables (FAVs) intake among Bangladeshi adults. Dietary data of 9275 adults from the Bangladesh Noncommunicable Disease Risk Factor Survey 2010 were analyzed. The mean age of the respondents was 42.4 (±13.5) years. Multistage cluster sampling was applied to identify samples. Demographics, personal habits, physical activity, diet, and anthropometric data were collected using the WHO-STEPs questionnaire. Average daily intake of <5 servings of FAVs combined was considered to be low FAV consumption, and its prevalence was 82.8%. A mixed-effect logistic regression model was fitted to assess association of factors with low FAV intake. Higher educational attainment, greater wealth, female sex, low physical activity, body mass index >25 kg/m 2 , and smokeless tobacco consumption were significantly associated with higher FAV consumption. Frequency of low FAV intake increased with increasing age and decreased with increasing educational attainment. Programs targeting people at risk of low FAV consumption are needed to promote consumption.

To feed a growing population, alternative sources of animal feed (e.g., lignocellulose) are needed to replace grains (e.g., corn). Oxidative lime pretreatment (OLP) increases lignocellulose digestibility by removing lignin and hemicellulose acetyl content. Adding a mechanical pretreatment (e.g., ball milling) further improves digestibility. This study determines the effectiveness of OLP and ball milling to enhance the ruminant digestibility of lignocellulose. For forage sorghum, the 48-h in vitro TDN were 40, 64, and 84 g nutrients digested/100 g organic matter (OM) for raw, short-term OLP, and short-term OLP + ball milling, respectively. In terms of compositional changes, OLP increases NDF and decreases non-fiber carbohydrate (NFC) and crude protein (CP), all of which would normally be associated with a decrease in digestibility. However, because OLP and ball milling beneficially change composition (lignin removal) and structural features (reduced crystallinity), digestibility actually increases. Although ball milling increases digestibility according to standard laboratory assays, it reduces particle size possibly allowing fine particles to escape from the rumen before they are digested, thus limiting its practical application. Nonetheless, this study indicates that mechanical pretreatment greatly increases digestibility, and therefore it is desirable to identify an effective mechanical treatment that retains fiber integrity.

Oxidative lime pretreatment (OLP) increases lignocellulose digestibility by removing lignin and hemicellulose acetyl content. Digestibility is improved further by adding mechanical shock treatment, which subjects aqueous slurry of biomass to an explosive pressure pulse. Shock treatment mechanically disrupts the microscopic structure while maintaining the macroscopic integrity of the biomass particle. This study determined the effectiveness of these pretreatments to enhance the ruminant digestibility of corn stover. In terms of compositional changes, OLP and shock treatment should negatively affect the feed value of corn stover; however, digestibility analysis provides a significantly different conclusion. With corn stover, shock + OLP improved the 48-h neutral detergent fiber digestibility (NDFD) to 79.0 g neutral detergent fiber (NDF) digested/100 g NDF fed, compared to 49.3 for raw corn stover. The 48-h in vitro total digestible nutrients (TDNom, g nutrients digested/100 g OM) was 51.9 (raw), 59.7 (OLP), and 72.6 (shock + OLP). Adding extracted corn stover solubles to shock + OLP increased TDNom to 74.9. When enough solubilized chicken feathers were added to match the protein content of corn grain, TDNom increases to 75.5, which is only 12.6 less than corn grain.

Background: The aim of this study was to evaluate the impact of missing values on the prediction performance of the model predicting 30-day mortality following cardiac surgery as an example., Methods: Information from 83,309 eligible patients, who underwent cardiac surgery, recorded in the Australia and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) database registry between 2001 and 2014, was used. An existing 30-day mortality risk prediction model developed from ANZSCTS database was re-estimated using the complete cases (CC) analysis and using multiple imputation (MI) analysis. Agreement between the risks generated by the CC and MI analysis approaches was assessed by the Bland-Altman method. Performances of the two models were compared., Results: One or more missing predictor variables were present in 15.8% of the patients in the dataset. The Bland-Altman plot demonstrated significant disagreement between the risk scores (p<0.0001) generated by MI and CC analysis approaches and showed a trend of increasing disagreement for patients with higher risk of mortality. Compared to CC analysis, MI analysis resulted in an average of 8.5% decrease in standard error, a measure of uncertainty. The MI model provided better prediction of mortality risk (observed: 2.69%; MI: 2.63% versus CC: 2.37%, P<0.001)., Conclusion: 'Multiple imputation' of missing values improved the 30-day mortality risk prediction following cardiac surgery., (Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)

Background: The presence of cervical lymph node metastasis is an important prognostic factor for patients with head and neck squamous cell carcinomas (HNSCC). Accurate assessment of lymph node metastasis in these patients is essential for appropriate prognostic and management purposes. Here, we evaluated the effectiveness of the maximum standardized uptake value (SUV max ) on positron emission tomography (PET) in assessing lymph node metastasis in HNSCC prior to surgery., Methods: A retrospective review of 74 patients with HNSCC who underwent PET/CT prior to neck dissection were examined. Pre-operative PET/CT scans were reviewed by two experienced nuclear medicine physicians and SUV max of the largest node in each nodal basin documented. These were compared with the histology results of the neck dissection., Results: A total of 359 nodal basins including 86 basins with metastatic nodes were evaluated. A nodal SUV max ≥3.16 yielded a sensitivity of 74.4 % and specificity of 84.9 % in detecting metastatic nodes. The nodal SUV max /Liver SUV max ratio was found on receiver operating characteristic (ROC) to be effective in detecting metastatic nodes with an area under ROC curve of 0.90. A nodal SUV max /Liver SUV max ratio ≥0.90 yielded a sensitivity of 74.1 % and specificity of 93.4 %. By comparison, visual inspection yielded sensitivities of 66.3 and 61.6 % in observers 1 and 2 respectively. The corresponding specificities were 77.7 and 86.5 %., Conclusions: Nodal SUV max and nodal SUV max /liver SUV max are both useful in the pre-operative detection of metastatic nodes with the latter being superior to visual inspection. The ratio is likely to be more useful as it corrects for inter-scanner variability.

Background: Many patients classified as "urgent" in Australia New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) registry contradict the prescribed definition (surgery within 72hours of angiogram or unplanned admission). The aim was to examine the impacts of this misclassification on the prediction of 30-day mortality following cardiac surgery., Methods: The 'reported clinical status' was compared with a 'corrected clinical status' following reclassification based on the standard definition calculated from raw data. Observed-to-predicted risk ratios (OPRs) of 30-day mortality were calculated for the model using reported status and corrected status and compared. A Bland-Altman plot was generated to examine the level of agreement between the two OPRs., Results: Of 18496 cases reported as urgent, 49.9% were operated after 72hours, leading to misclassification of 14.6% in the registry. Misclassified patients had significantly higher mortality (3.5%) than true urgent patients (2.9%). Underweight (OR:1.6,CI:1.2-2.1), dialysis (OR:1.4,CI:1.1-1.7), endocarditis (OR:2.1,CI:1.7-2.5), shock (OR:1.6,CI:1.3-2.0) and poor ejection fraction (OR:1.2,CI:1.1-1.4) were significant predictors of misclassification. Bland- Altman plot demonstrates significant disagreement between two risk estimates (P<0.001). Misclassification results in overestimation of risk by 9.1%. Observed-to-predicted risk increased with corrected definition (0.8975 vs 0.9875), suggesting poorer calibration with reported status., Conclusions: In the ANZSCTS database, misclassification prevalence is 14.6%. Misclassification compromises the discrimination capacity and calibration of the model and results in overestimation of mortality risk., (Copyright © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)

Background: Nationally representative data on noncommunicable disease (NCD) risk factors are lacking in Bangladesh. This study was done to determine the prevalence of common risk factors for major NCDs among men and women of rural and urban areas of Bangladesh., Materials and Methods: This survey was done with 9,275 individuals aged 25 years or older randomly drawn from all over the country. Information on diet, physical activity, tobacco and alcohol, and treatment history for hypertension and diabetes were collected. Height, weight, waist circumference, and blood pressure (BP) were measured., Results: There were 4,312 men and 4,963 women with the mean age of 42 years (standard deviation 13 years). Half of them (54%) used tobacco in some form, <1% consumed alcohol within the past 30 days, 92% did not consume adequate fruit and vegetables (five servings or more), and 35% had low physical activity level [<600 metabolic equivalent (MET) min per week]. Documented diabetes was found in 4% of the participants. Seventeen percent were overweight [body mass index (BMI) ≥25 kg/m 2 and 21% had abdominal obesity (men ≥94, women ≥80 cm). Overall, 21% people had hypertension (blood pressure ≥140/90 mmHg or medication). Physical inactivity, alcohol intake, hypertension, obesity, and diabetes were more prevalent in urban areas, as opposed to tobacco. Tobacco intake showed a decreasing gradient, but hypertension, obesity, diabetes, and low physical activity showed an increasing gradient across the wealth quartiles., Conclusion: Risk factors are widely prevalent in Bangladeshi people across sexes and across both rural and urban areas of residences. NCD prevention through risk factor control, and early detection and treatment of hypertension and diabetes are warranted.

Background: Non-communicable diseases (NCDs) have already become major killers in Bangladesh. Once NCDs are developed, they become chronic health and economic problems. Their primary prevention is linked to their common risk factors. This study was conducted to determine the prevalence of NCD risk factors with a focus on their clustering in Bangladeshi adults., Methods: This nationally representative study was done in 4,073 (1,812 men and 2,261 women) adults aged 25 years or older selected from rural and urban households. Multistage cluster sampling design was used. Selected variables were in line with steps I and II of WHO stepwise surveillance except alcohol., Results: Forty-four percent used tobacco in any form. Almost 93% did not consume adequate fruit and vegetables (5 servings or more). Thirty eight percent had low physical activity level (<600 MET-minutes/week). One-quarter (26%) were overweight (body mass index > =25 kg/m^2). Twenty-one percent had hypertension (blood pressure > =140/90 mmHg or medication) and about 5% had documented diabetes. Upon examination of risk factor clustering, we observed that 38% had at least three risk factors. After this threshold, clustering suddenly dropped down to a fairly low level. Using this threshold as a cut-off, clustering of risk factors was associated with age, male gender, urban residence, educational levels and quality of house in multivariate analysis., Conclusion: Prevalence of NCD risk factors is fairly high in Bangladeshi adults with a tendency of clustering. If a risk factor such as hypertension is detected, a closer look for other risk factors has to be given in both at clinical and public health settings. Clustering raises risk by more than a summation of risk factors. Our findings, therefore, suggest that Bangladesh could expect a significant increase in NCDs in near future.

Background and Objective: Body-mass-index (BMI) is widely accepted as an indicator of nutritional status in adults. Mid-upper-arm-circumference (MUAC) is another anthropometric-measure used primarily among children. The present study attempted to evaluate the use of MUAC as a simpler alternative to BMI cut-off <18.5 to detect adult undernutrition, and thus to suggest a suitable cut-off value., Methods: A cross-sectional study in 650 adult attendants of the patients of Dhaka-Hospital, of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) was conducted during 2012. Height, weight and MUAC of 260 male and 390 female aged 19-60 years were measured. Curve estimation was done to assess the linearity and correlation of BMI and MUAC. Sensitivity and specificity of MUAC against BMI<18.5 was determined. Separate Receiver-operating-characteristic (ROC) analyses were performed for male and female. Area under ROC curve and Youden's index were generated to aid selection of the most suitable cut-off value of MUAC for undernutrition. A value with highest Youden's index was chosen for cut-off., Results: Our data shows strong significant positive correlation (linear) between MUAC and BMI, for males r = 0.81, (p<0.001) and for females r = 0.828, (p<0.001). MUAC cut-off <25.1 cm in males (AUC 0.930) and <23.9 cm in females (AUC 0.930) were chosen separately based on highest corresponding Youden's index. These values best correspond with BMI cut-off for under nutrition (BMI <18.5) in either gender., Conclusion: MUAC correlates closely with BMI. For the simplicity and easy to remember MUAC <25 cm for male and <24 cm for female may be considered as a simpler alternative to BMI cut-off <18.5 to detect adult undernutrition.

Injuries are a focus of public health practice because they pose a serious health threat, occur frequently and are preventable. The evidence regarding injury, its contributing factor and its consequence in rural population of Bangladesh is scarce. Present study aimed to assess the epidemiology of injury in a rural area. The study was conducted in the 'Bairag' Union of Anwara upazilla in Chittagong district of Bangladesh. Data of 6256 individuals were collected from 1016 households. Three structured and standardized questionnaires were used for data collection. The questionnaires were pretested and validated prior to final survey. Severity of injury was assessed based on the number of days with restricted activity and consequences of injury were considered as a measure of severity of injury. A total of six people died due to injury in last one year in the survey, the death tolls to 0.096% (95% CI 0.037%-0.199%). A total of 392 experienced an injury that at least hampered one day's routine activity. Crude prevalence of injury over last one year is calculated to be 6.27% (95% CI 5.69%-6.89%). Of injured subject's majority (77.2%) were aged between 10 to 59 years, 73% were male, 55.6% were of lower class and among them 7.9 % suffered multiple injuries. More than 80% of the incident leading to injury happened during the day, (8 am to 6 pm). Daytime injury mostly occurs in afternoon. The mechanism of injury of 30% subjects were road accident, of 29.5% subjects was slip, trip or fall. In 17.9% victims' mechanism of injury was collision with a person or object. Around 10% had deep cut, 1.4% had superficial cut, and 3.3% patient had burn through contact with heat. Among the injured only 19.2% escaped any physical consequence, 27.2% suffered from decrease in work capacity, 48.1% developed temporary disability, 3.8% developed permanent disability, and 1.2% suffered disfiguration.

The risk factor profiles, management and outcome have significant difference between stroke subsets. Aim of this study was to investigate the risk for the two most common subtypes of stroke in Bangladeshi population. Seventy cases of hemorrhagic stroke (HS) and 105 cases of confirmed ischemic stroke (IS) were recruited from the Shaheed Suhrawardy Medical College Hospital (ShSMCH) and Dhaka Medical College Hospital between January-June 2011. Total 171 age, sex matched controls were selected from the hospitalized patients with history of no stroke ever. Average hemorrhagic stroke patients (60.4 ± 12.3 years) were younger than both ischemic strokes (63.5 ± 13 years). Family history of premature cardiovascular death was found more in HS patients (p = 0.001). Multivariate logistic regression showed, in IS model 'less fruit consumption (OR 4.6), table salt intake (OR 8.15), psychosocial stress (OR 3.5), abnormal ECG (OR 3.6) and Increased WHR (OR 6.9) appeared as significant predictors adjusted for all potential candidate confounders. In HS model less fruit consumption (OR 5.0), table salt intake (OR 9.9), Stress (OR 4.1), family history of cardiovascular disease (CVD) death (OR 11.3), hypertension (OR 43), aspirin intake (OR 4.5) and increased WHR (OR 3.7) remained as significant predictors.

Furfural is an important platform chemical with a wide range of applications. However, due to the low concentration of furfural in the hydrolysate, the conventional methods for furfural recovery are energy-intensive and environmentally unfriendly. Considering the disadvantages of pervaporation (PV) and distillation in furfural separation, a novel energy-efficient 'green technique', gas stripping assisted vapor permeation (GSVP), was introduced in this work. In this process, the polydimethylsiloxane (PDMS) membrane was prepared by employing water as solvent. Coking in pipe and membrane fouling was virtually non-existent in this new process. In addition, GSVP was found to achieve the highest pervaporation separation index of 216200 (permeate concentration of 71.1 wt% and furfural flux of 4.09 kg m(-2) h(-1)) so far, which was approximately 2.5 times higher than that found in pervaporation at 95°C for recovering 6.0 wt% furfural from water. Moreover, the evaporation energy required for GSVP decreased by 35% to 44% relative to that of PV process. Finally, GSVP also displayed more promising potential in industrial application than PV, especially when coupled with the hydrolysis process or fermentation in biorefinery industry.

A novel amperometric biosensor for catechol was developed using the layer-by-layer (LbL) self-assembly of positively charged hexadecyltrimethylammonium stabilized gold nanocubes (AuNCs), negatively charged poly(sodium 4-styrenesulfonate) and tyrosinase on a screen printed carbon electrode (SPCE). A carboxylic acid terminated alkanethiol assembled on electrochemically deposited Au nanoparticles on a SPCE was used as a platform for LbL assembly. Each SPCE sensor surface was terminated with tyrosinase and the electrocatalytic response due to the tyrosinase reaction with catechol was measured using cyclic voltammetry and square wave voltammetry (SWV). The effect of introducing AuNCs into the LbL assembly to further enhance the catechol detection performance was then investigated by comparing the SWV results to those from biosensors created using both the tyrosinase modified LbL assembly in the absence of NCs and the covalent attachment of tyrosinase. A wide dynamic range from 10nM to 80 µM of catechol with an excellent sensitivity of 13.72 A/M and a detection limit of 0.4 nM were both achieved alongside a good selectivity and reproducibility for the AuNC-modified electrodes. As a demonstration, the optimized biosensor design was applied to determine catechol concentrations in tea samples., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Dyslipidemia is a major risk factor for macro-vascular complications in patients with type 2 diabetes mellitus (T2DM). Present study explored pattern and predictors of dyslipidemia in Bangladeshi T2DM patients. The cross-sectional study is conducted among 366 consecutive eligible T2DM patients aged >30 years, BIRDEM diabetic hospital, during July-to-December 2010. Physical examination, diabetic profile, lipid profile and serum createnine was performed. Adjusted odds ratio and confidence limit were generated through binary logistic regression. Most frequent form (59.3%) of dyslipidemia is low HDL. Duration of T2DM is significantly correlated with TC (P<0.05), HDL (P<0.05) and LDL (P<0.05) in both male and female. Glycemic control in terms of HbA1c >7% appeared as predictor of dyslipidemia (P<0.01). Duration T2DM is associated with increased risk of having higher TC (P<0.05), LDL (P<0.05) and lower HDL (P<0.01) and does not seem to affect triglyceride (P>0.05). T2DM with comorbid hypertension seems to predict hyper tri-glyceridemia and lower HDL. Both TC-HDL ratio and LDL-HDL ratio appeared as good predictor of all four parameters of dyslipidemia (P<0.01). The characteristic features of diabetic dyslipidemia are low HDL, high triglyceride and LDL cholesterol level. Low HDL level is the most frequent type of abnormality. Poor glycemic control, prolonged duration, coexisting hypertension predicts dyslipidemia in T2DM., (Copyright © 2013 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Poly(phthalazinone-ether-sulfone) (PPES) polymer is a relatively newly developed material with a bis(4-fluorodiphenyl) sulfone group. The formation of the PPES membrane by wet-phase inversion can proceed according to a slow or fast gelation method. These formation mechanisms were studied experimentally. The resulting membrane morphology was investigated using both optical and scanning electron micrography. The effects of PPES concentration and two additives, polyvinylpyrrolidone (PVP) and oxalic acid (OA), on the apparent viscosity and gelation rate of PPESK/NMP solutions and membrane performance have also been investigated. It was found that the gelation rate is important to obtain a sponge-like membrane structure, however favored by a fast gelation rate. The membrane obtained by a fast gelation rate showed a high pure water flux and rejection of bovine serum albumin (BSA), contrary to previous findings. On the basis of the experimental results, the actual membrane structure and pure water flux were related, and in agreement with the optical micrograph and gelation rate, respectively. The current results provide a fundamental insight in this novel copolymer, useful in future applications, especially in the membrane formation process.

Not all cases of rheumatic fever (RF) end up as rheumatic heart disease (RHD). The fact raises the possibility of existence of a subgroup with characteristics that prevent RF patients from developing the RHD. The present study aimed at exploring the risk factors among patients with RHD. The study assessed the risk of RHD among people both with and without RF. In total, 103 consecutive RHD patients were recruited as cases who reported to the National Centre for Control of Rheumatic Fever and Heart Disease, Dhaka, Bangladesh. Of 309 controls, 103 were RF patients selected from the same centre, and the remaining 206 controls were selected from Shaheed Suhrawardy Medical College Hospital, who got admitted for other non-cardiac ailments. RHD was confirmed by auscultation and colour Doppler echocardiography. RF was diagnosed based on the modified Jones criteria. An unadjusted odds ratio was generated for each variable, with 95% confidence interval (CI), and only significant factors were considered candidate for multivariate analysis. Three separate binary logistic regression models were generated to assess the risk factors of RF, risk factors of RHD compared to non-rheumatic control patients, and risk factors of RHD compared to control with RF. RF and RHD shared almost a similar set of risk factors in the population. In general, age over 19 years was found to be protective of RF; however, age of the majority (62.1%) of the RHD cases was over 19 years. Women [odds ratio (OR) = 2.2, 95% CI 1.1-4.3], urban resident (OR = 3.1, 95% CI 1.2-8.4), dwellers in brick-built house (OR = 3.6, 95% CI 1.6-8.1), having > 2 siblings (OR = 3.1, 95% CI 1.5- 6.3), offspring of working mothers (OR = 7.6, 95% CI 2.0-24.2), illiterate mother (OR = 2.6, 95% CI 1.2-5.8), and those who did not brush after taking meals (OR = 2.5, 95% CI 1.0-6.3) were more likely to develop RF. However, more than 5 members in a family showed a reduced risk of RF. RHD shared almost a similar set of factors in general. More than three people sharing a room also showed an increased risk of RHD (OR = 1.9, 95% CI 1.0-3.4), in addition to the risk factors of RF. Multivariate model also assessed the factors that may perpetuate RHD among RF patients. Overcrowding (OR = 2.4, 95% CI 1.2-4.7) and illiteracy (OR = 2.4, 95% CI 1.1-5.2) posed the risk of RHD in the RF patients. The study did not find new factors that might pose an increased risk, rather looked for the documented risk factors and how these operate in the population of Bangladesh.

Background: The aim of the present study was to estimate the incidence of diabetic retinopathy (DR) among type 2 diabetic (T2D) subjects in Bangladesh., Methods: A random sample of 977 patients with T2D was recruited retrospectively in 2008 from newly diagnosed T2D patients who had attended the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorder (BIRDEM) in 1993. Baseline information for the cohort was collected for 1993 from hospital records. The mean time until development of DR in newly diagnosed T2D patients was calculated using survival analysis. Cox's proportional hazards model was used to assess factors affecting the time until development of DR., Results: The cumulative incidence of DR over the 15-year period was 50.6% (95% confidence interval [CI] 47.5%-53.8%). The incidence density (per 100 person-years) of DR was similar in the overall cohort (4.1; 95% CI 3.7-4.5) and in men (4.2; 95% CI 3.7-4.7) and women (4.1; 95% CI 3.6-4.6) separately. The mean time (in years) until development of DR in the cohort was 9.72 (95% CI 9.38-10.06), with similar times in men (9.8; 95% CI 9.3-10.3) and women (9.6; 95% CI 9.5-10.1) analyzed separately. Age, sex, hypertension, lipid profile, HbA1c, and serum creatinine were entered into the hazards model simultaneously. However, only age (hazard ratio [HR] 0.75; 95% CI 0.61-0.92) and HbA1c (HR 0.52; 95% CI 0.33-0.82) had a significant effect on the time until development of DR., Conclusions: Glucose deregulation is the most important factor in the development of DR., (© 2012 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.)

We investigated growth kinetics of microalgae, Chlorella vulgaris, in immobilized arrays of nanoliter-scale microfluidic drops. These static drop arrays enabled simultaneous monitoring of growth of single as well as multiple cells encapsulated in individual droplets. To monitor the growth, individual drop volumes were kept nearly intact for more than a month by controlling the permeation of water in and out of the microfluidic device. The kinetic growth parameters were quantified by counting the increase in the number of cells in each drop over time. In addition to determining the kinetic parameters, the cell-size distribution of the microalgae was correlated with different stages of the growth. The single-cell growth kinetics of C. vulgaris showed significant heterogeneity. The specific growth rate ranged from 0.55 to 1.52 day(-1) for different single cells grown in the same microfluidic device. In comparison, the specific growth rate in bulk-scale experiment was 1.12 day(-1). It was found that the average cell size changes significantly at different stages of the cell growth. The mean cell-size increased from 5.99 ± 1.08 to 7.33 ± 1.3 µm from exponential to stationary growth phase. In particular, when multiple cells are grown in individual drops, we find that in the stationary growth phase, the cell size increases with the age of cell suggesting enhanced accumulation of fatty acids in older cells., (Copyright © 2012 Wiley Periodicals, Inc.)

Background & Objectives: Transmission of dengue virus depends on the presence of Aedes mosquito. Mosquito generation and development is known to be influenced by the climate. This study was carried out to examine whether the climatic factors data can be used to predict yearly dengue cases of Dhaka city, Bangladesh., Methods: Monthly reported dengue cases and climate data for the years 2000-2008 were obtained from the Directorate General of Health Services (DGHS) and Meteorological Department of Dhaka, Bangladesh, respectively. Data for the period 2000 to 2007 were used for development of a model through multiple linear regressions. Retrospective validation of the model was done with 2001, 2003, 2005 and 2008 data. Log transformation of the dependent variable was done to normalize data for linear regression. Average monthly humidity, rainfall, minimum and maximum temperature were used as independent variables and number of dengue cases reported monthly was used as dependent variable. Accuracy of the model for predicting outbreak was assessed through receiver operative characteristics (ROC) curve., Results: Climatic factors, i.e. rainfall, maximum temperature and relative humidity were significantly correlated with monthly reported dengue cases. The model incorporating climatic data of two-lag month explained 61 per cent of variation in number of reported dengue cases and this model was found to predict dengue outbreak (≥ 200 cases) with considerable accuracy [area under ROC curve = 0.89, 95%CI = (0.89-0.98)]., Interpretation & Conclusions: Our results showed that the climate had a major effect on the occurrence of dengue infection in Dhaka city. Though the prediction model had some limitations in predicting the monthly number of dengue cases, it could forecast possible outbreak two months in advance with considerable accuracy.

Aims: To determine the risk factors associated with diabetic retinopathy (DR) in Bangladeshi type 2 diabetic subjects., Methods: A cohort of 977 type-2 diabetic patients was recruited retrospectively based on hospital records in 2008, who were naïve type-2 diabetes during 1993. Data on diabetes and lipid profile with serum creatinine and biophysical measures were obtained at baseline, 5, 10 and 15 years. DR was diagnosed by retinal color photography. Generalized linear models were used to assess the associations of clinical, biochemical and anthropometric variables with retinopathy at three follow-up. Cumulative exposures were determined based on average exposure to individual attribute. IRR and 95% CI were generated through Poisson regression model, adjusting for age-at-diagnosis of diabetes, baseline BMI, end-line waist-to-hip ratio and present physical activity status., Results: DR patients had significantly poorer glycemic control at all three follow-ups. Age, residence, physical activity, serum creatinine and hypertension appeared as independent risk factors for DR in all three follow-up points. Poisson regression model identified glucose deregulation (IRR 1.8; CI 1.5-2.1), hypertension (IRR 1.5; CI 1.2-1.8) and raised serum creatinine (IRR 1.9; CI 1.5-2.3) as significant predictors for DR adjusted for possible confounders. Work related moderate-to-heavy physical activity (IRR 0.2; CI 0.1-0.3) appeared as protective., Conclusions: Along with poor glycemic control, hypertension, nephropathy are independent risk factor retinopathy., (Copyright © 2012. Published by Elsevier Ltd.)

In this research, a recombinant whole cell biocatalyst was developed by expressing three cellulases from Clostridium cellulolyticum--endoglucanase (Cel5A), exoglucanase (Cel9E), and β-glucosidase--on the surface of the Escherichia coli LY01. The modified strain is identified as LY01/pRE1H-AEB. The cellulases were displayed on the surface of the cell by fusing with an anchor protein, PgsA. The developed whole cell biocatalyst was used for single-step ethanol fermentation using the phosphoric acid-swollen cellulose (PASC) and the dilute acid-pretreated corn stover. Ethanol production was 3.59 ± 0.15 g/L using 10 g/L of PASC, which corresponds to a theoretical yield of 95.4 ± 0.15%. Ethanol production was 0.30 ± 0.02 g/L when 1 g/L equivalent of glucose in the cellulosic fraction of the dilute sulfuric acid-pretreated corn stover (PCS) was fermented for 84 h. A total of 0.71 ± 0.12 g/L ethanol was produced in 48 h when the PCS was fermented in the simultaneous saccharification and co-fermentation mode using the hemicellulosic (1 g/L of total soluble sugar) and as well as the cellulosic (1 g/L of glucose equivalent) parts of PCS. In a control experiment, 0.48 g/L ethanol was obtained from 1 g/L of hemicellulosic PCS. It was concluded that the whole cell biocatalyst could convert both cellulosic and hemicellulosic substrates into ethanol in a single reactor. The developed C. cellulolyticum-E. coli whole cell biocatalyst also overcame the incompatible temperature problem of the frequently reported fungal-yeast systems.

As a first step toward understanding the energetics of removal of cello-oligomers from the cellulose surface, we have performed umbrella sampling calculations to determine the free energy required for separation of repeating units of cellulose and hemicellulose from each other. Molecular dynamics (MD) simulations were performed for both the stacked and non-stacked arrangements of the cellobiose pair system and the xylobiose pair system. These stacked and non-stacked arrangements were taken as representative systems for the crystalline and amorphous domains in cellulose and hemicellulose. In addition, similar calculations were also carried out to determine the energetics involved in the separation of the cellobiose-xylobiose molecule pair in the non-stacked arrangement. The potential of mean force profiles exhibit a single minimum in all cases and are qualitatively similar. Our results show that the location of the minimum as well as the depth of the well can be correlated with the size of the disaccharide molecules., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Molecular-imprinted membranes of Puerarin were prepared by phase inversion technique with acrylonitrile-acrylic acid copolymer (P (AN-co-AA)). To characterize P (AN-co-AA), ubbelohde viscometer was used to measure its viscosity-molecular weight. P (AN-co-AA) with different molecular weight was used to prepare membranes. The copolymer-dimethyl sulfoxide solution with Puerarin (PU) template was coagulated in water at various temperatures. The increase in P (AN-co-AA) molecular weight and the decrease in coagulation temperature caused an increase in PU recognition property of the resultant membrane. The PU imprinted membrane prepared with P (AN-co-AA) showed good selective ability to PU. The purity of PU increased from 56.51 to 98.41 wt%. Surface and cross-section morphology of the membranes were analyzed by using scanning electron micrograph. High-performance liquid chromatography was used for the quantification of Puerarin in isolated fraction., (Copyright © 2011 Wiley Periodicals, Inc.)

Despite the advances in modern antimicrobial treatment, paranasal sinus disease remains relatively common. A case of chronic inflammatory frontal sinus disease presented with unilateral recurrent eyelid swelling. Clinical features and management in conjunction with ENT are discussed. An extensive literature search has shown only one other similar case reported in Russian language whose management details however are not available., (© JSCR.)

Purpose: Early detection of ovarian malignancy is of great clinical importance. The high mortality rate is due to the difficulties with the early detection of ovarian cancer. Current research attempted to assess the accuracy of Color Doppler Sonography and serum CA-125 level as diagnostic tool of ovarian tumor., Materials and Methods: In this cross-sectional study, 60 consecutive patients with ovarian tumor attending the Department of Obstetrics and Gynecology of BSMMU were recruited. Of the study participants 23.3% belong to 16-25 year age group, 20% belong to 26-35 years age group and 23.30% each were of 46-55 years and > 55 years age group. All the patients recruited were from in-patient department and had undergone surgery. Following excision, routine histopathology revealed 43.30% malignant (n=26) and 56.7% (n=34) benign ovarian lesion. Data were collected from the clinical history form and bimanual pelvic examination, serum CA 125 levels, estimation of Resistance index (RI), Pulsatility Index (PI), Novel Index by CDS and post-operative histo-pathological findings were then recorded. Sensitivity, specificity, accuracy, positive and negative predictive value of the diagnosis made by CDS, CA125, in the discrimination of the benign and malignant ovarian tumors was calculated. Using Receiver operative characteristics analysis the accuracy of RI, PI, CA 125 and Novel Index in the diagnosis of ovarian tumor (benign or malignant) were assessed., Results: With the Cut-off of < .5, Resistance Index is found to be capable of detecting 92% of malignant cases (sensitivity 91.7), and could detect 89% (specificity 88.9) of benign cases correctly which translates in to 90% accuracy in the diagnosis of ovarian tumor. Predictive values for positive (84.6) and negative (94.1) tests were also found to be quite high. Pulsatility index was found to be moderate accuracy (63.3%) with cutoff <1 for malignancy, however low predictive value for a positive test (38.5) questions its use. Both CA-125 and Novel Index showed similar level of sensitivity and specificity. Although Novel Index is derivative of CA125, Novel Index demonstrated better diagnostic accuracy and negative predictive value. The cutoff for CA 125 was mandated as 83.58. With the value the sensitivity is 76.9% and the specificity is 94.1%. RI is found to be more sensitive in detection of positive cases (Malignant) and CA125 is found to be more accurate in detection of negative cases (Benign). However a combination could be tried to make a better detection., Conclusion: Color Doppler ultra-sonography and CA125 excels in different tasks, the study concludes in favor of concurrent use of the methods for improving efficacy and thus early detection of ovarian malignancy.

While many kinetic models have been developed for the enzymatic hydrolysis of cellulose, few have been extensively applied for process design, optimization, or control. High-solids operation of the enzymatic hydrolysis of lignocellulose is motivated by both its operation decreasing capital costs and increasing product concentration and hence separation costs. This work utilizes both insights obtained from experimental work and kinetic modeling to develop an optimization strategy for cellulose saccharification at insoluble solids levels greater than 15% (w/w), where mixing in stirred tank reactors (STRs) becomes problematic. A previously developed model for batch enzymatic hydrolysis of cellulose was modified to consider the effects of feeding in the context of fed-batch operation. By solving the set of model differential equations, a feeding profile was developed to maintain the insoluble solids concentration at a constant or manageable level throughout the course of the reaction. Using this approach, a stream of relatively concentrated solids (and cellulase enzymes) can be used to increase the final sugar concentration within the reactor without requiring the high initial levels of insoluble solids that would be required if the operation were performed in batch mode. Experimental application in bench-scale STRs using a feed stream of dilute acid-pretreated corn stover solids and cellulase enzymes resulted in similar cellulose conversion profiles to those achieved in batch shake-flask reactors where temperature control issues are mitigated. Final cellulose conversions reached approximately 80% of theoretical for fed-batch STRs fed to reach a cumulative solids level of 25% (w/w) initial insoluble solids.

The rates and extents of enzymatic cellulose hydrolysis of dilute acid pretreated corn stover (PCS) decline with increasing slurry concentration. However, mass transfer limitations are not apparent until insoluble solids concentrations approach 20% w/w, indicating that inhibition of enzyme hydrolysis at lower solids concentrations is primarily due to soluble components. Consequently, the inhibitory effects of pH-adjusted pretreatment liquor on the enzymatic hydrolysis of PCS were investigated. A response surface methodology (RSM) was applied to empirically model how hydrolysis performance varied as a function of enzyme loading (12-40 mg protein/g cellulose) and insoluble solids concentration (5-13%) in full-slurry hydrolyzates. Factorial design and analysis of variance (ANOVA) were also used to assess the contribution of the major classes of soluble components (acetic acid, phenolics, furans, sugars) to total inhibition. High sugar concentrations (130 g/L total initial background sugars) were shown to be the primary cause of performance inhibition, with acetic acid (15 g/L) only slightly inhibiting enzymatic hydrolysis and phenolic compounds (9 g/L total including vanillin, syringaldehyde, and 4-hydroxycinnamic acid) and furans (8 g/L total of furfural and hydroxymethylfurfural, HMF) with only a minor effect on reaction kinetics. It was also demonstrated that this enzyme inhibition in high-solids PCS slurries can be approximated using a synthetic hydrolyzate composed of pure sugars supplemented with a mixture of acetic acid, furans, and phenolic compounds, which indicates that generally all of the reaction rate-determining soluble compounds for this system can be approximated synthetically.

The theory of heterogeneous catalysis in chemical reactors is employed to simulate laminar flow through tubes at large mass transfer Peclet numbers in which anchorage-dependent cells (i) adhere to a protein coating on the inner surface at r=R(wall), (ii) receive nutrients and oxygen from an aqueous medium via transverse diffusion toward the active wall, and (iii) proliferate in the presence of viscous shear at the cell/aqueous-medium interface. This process is modeled as convective diffusion in cylindrical coordinates with chemical reaction at the boundary, where chemical reaction describes the rate of nutrient consumption. The formalism of irreversible thermodynamics is employed to describe an unusual coupling between viscous shear, or velocity gradients at the cell/aqueous-medium interface, and rates of nutrient consumption. Linear transport laws in chemically reactive systems that obey Curie's theorem predict the existence of cross-phenomena between fluxes (i.e., scalar reaction rates) and driving forces (i.e., 2nd-rank velocity gradient tensor) whose tensorial ranks differ by an even integer-in this case, two. This methodology for stress-dependent chemical reactions yields an additional zeroth-order contribution, via the magnitude of the velocity gradient tensor, to heterogeneous kinetic rate expressions because nutrient consumption and cell proliferation are stress-sensitive. Computer simulations of nutrient consumption suggest that bioreactor designs should consider stress-sensitive reactions when the shear-rate-based Damköhler number (i.e., defined for the first time in this study as the stress-dependent zeroth-order rate of nutrient consumption relative to the rate of nutrient diffusion toward active cells adhered to the tube wall) is greater than 10-20% of the stress-free Damköhler number. Models of bioreactor performance are presented for simple 1st-order, simple 2nd-order, and complex chemical kinetic rate expressions, where the latter considers adsorption/desorption equilibria via the Fowler-Guggenheim modification of the Langmuir isotherm for cell-protein docking on active sites, accompanied by cell-cell attraction. Stress sensitivity is magnified in physically realistic cell-based tubular bioreactors with complex stress-free kinetic rate expressions relative to simulations with simple 1st- and 2nd-order kinetics.

The cytotoxicity of fullerene C60 particles on two mammalian cell lines, i.e. the Chinese hamster ovary (CHO) cells and the Madin-Darby canine kidney (MDCK) cells, has been investigated. Although innate fullerene particles have a very low solubility in deionized (DI) water, these particles can be dissolved in the tetrahydrofuran (THF) solvent at a great value. Further, the dissolved fullerene particles in the THF solvent could be extracted into a DI water solution at a significantly increased solubility. The formation of fullerene particle aggregates is believed to be the cause of the increased solubility. Results presented here show that once the concentration of the fullerene aggregates reaches a certain level, the cells start to die. The lethal dosage LD50, which is defined as the lowest fullerene concentration that results in a 50% cell death within 24 h, has been determined. Furthermore, the percentage of cell mortality increased with increasing fullerene concentration and incubation time yielding a negative effect on cell viability. These results, illustrated by atomic force microscopy (AFM), dynamic light scattering (DLS) and other microscopic techniques, will help to better understand the side effects of fullerene particles in mammalian cells.

A model was developed for novel prediction of N-linked glycan branching pattern classification for CHO-derived N-linked glycoproteins. The model consists of 30 independent recurrent neural networks and uses predicted quantities of secondary structure elements and residue solvent accessibility as an input vector. The model was designed to predict the major component of a heterogeneous mixture of CHO-derived glycoforms of a recombinant protein under normal growth conditions. Resulting glycosylation prediction is classified as either complex-type or high mannose. The incorporation of predicted quantities in the input vector allowed for theoretical mutant N-linked glycan branching predictions without initial experimental analysis of protein structures. Primary amino acid sequence data were effectively eliminated from the input vector space based on neural network prediction analyses. This provided further evidence that localized protein secondary structure elements and conformational structure may play more important roles in determining glycan branching patterns than does the primary sequence of a polypeptide. A confidence interval parameter was incorporated into the model to enable identification of false predictions. The model was further tested using published experimental results for mutants of the tissue-type plasminogen activator protein [J. Wilhelm, S.G. Lee, N.K. Kalyan, S.M. Cheng, F. Wiener, W. Pierzchala, P.P. Hung, Alterations in the domain structure of tissue-type plasminogen activator change the nature of asparagine glycosylation. Biotechnology (N.Y.) 8 (1990) 321-325].