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Backgrounds/aims: Metastatic lesions of the pancreas (PMET) account for 1%-5% of all malignant solid pancreatic lesions (SPL). In this study we evaluated the utility of endoscopic ultrasonography with fine needle aspiration (EUS-FNA) in diagnosing PMET., Methods: Patients who underwent EUS-FNA at a community referral center between 2011-2017 for SPL were identified. Clinical, radiologic, and EUS-FNA features of those with PMET were compared to those with primary solid tumors of the pancreas: pancreatic adenocarcinoma (PDAC) and neuroendocrine tumors (PNET)., Results: A total of 191 patients were diagnosed with solid pancreatic malignancy using EUS-FNA: 156 PDAC, 27 PNET, and eight (4.2%) had PMET. Patients with PMET were less likely to have abdominal pain (25.0% vs. 76.3% vs. 48.2%; p < 0.01) or obstructive jaundice (37.5% vs. 58.3% vs. 0%; p < 0.01) compared to PDAC and PNET. Those with PMET were more likely to have mass lesions with/without biliary or pancreatic ductal dilatations (100% vs. 86.5% vs. 85.2%; p < 0.01) and lower CA19-9 (82.5 ± 43.21 U/mL vs. 4,639.30 ± 11,489.68 U/mL vs. 10.50 ± 10.89 U/mL; p < 0.01) compared to PDAC and PNET. Endosonographic features were similar among all groups. Seven (87.5%) patients with PMET had a personal history of malignancy prior to PMET diagnosis. The primary malignancy was renal cell carcinoma in five PMET., Conclusions: PMET are exceedingly rare, comprising less than 5% of SLP. Patients with PMET are less likely to present with symptoms and mostly identified by surveillance imaging for the primary malignancy.

Extensive use of halogenated flame retardants (HFRs) and organophosphate esters (OPEs) has generated great concern about their adverse effects on environmental and ecological safety and human health. As well as emissions during use of products containing such chemicals, there are mounting concerns over emissions when such products reach the waste stream. Here, we review the available data on contamination with HFRs and OPEs arising from formal waste treatment facilities (including but not limited to e-waste recycling, landfill, and incinerators). Evidence of the transfer of HFRs and OPEs from products to the environment shows that it occurs via mechanisms such as: volatilisation, abrasion, and leaching. Higher contaminant vapour pressure, increased temperature, and elevated concentrations of HFRs and OPEs in products contribute greatly to their emissions to air, with highest emission rates usually observed in the early stages of test chamber experiments. Abrasion of particles and fibres from products is ubiquitous and likely to contribute to elevated FR concentrations in soil. Leaching to aqueous media of brominated FRs (BFRs) is likely to be a second-order process, with elevated dissolved humic matter and temperature of leaching fluids likely to facilitate such emissions. However, leaching characteristics of OPEs are less well-understood and require further investigation. Data on the occurrence of HFRs and OPEs in outdoor air and soil in the vicinity of formal e-waste treatment facilities suggests such facilities exert a considerable impact. Waste dumpsites and landfills constitute a potential source of HFRs and OPEs to soil, and improper management of waste disposal might also contribute to HFR contamination in ambient air. Current evidence suggests minimal impact of waste incineration plants on BFR contamination in outdoor air and soil, but further investigation is required to confirm this., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objective: Clonazepam (CP) is a potent long-acting nitrobenzodiazepine derivative that could be used for targeting peripheral benzodiazepine receptors. Phospholipid magnesome is a new vesicular nanosystem recently developed for brain targeting. Improving the uptake of 131 I-CP to the brain might be effective for the diagnosis and/or radiotherapy of certain brain diseases and/or tumors., Methods: CP was radiolabeled with 131 I using direct electrophilic substitution reaction. Quality control of 131 I-CP was performed using different techniques. Different formulas of 131 I-CP were prepared and characterized according to particle size and polydispersity index. The structural features of the optimized formula were then interpreted using transmission electron microscopy and scanning electron microscopy, whereas pharmacokinetic and in vivo behaviors were estimated using the intravenous and intranasal delivery routes., Results: The heart and blood demonstrated lower uptake of 131 I-CP, which inevitably decreased the nontarget effects of radioiodine. Intranasally administered 131 I-CP-loaded magnesomes (INMg) had noticeably higher brain uptake (7.1 ± 0.09%ID/g) with rapid onset of action within 5 min and effective pharmacokinetic behavior. INMg had a drug targeting efficiency and nose-to-brain direct transport percentage of 121.1% and 94.6%, respectively as well as a relative bioavailability of 441.04 ± 75.5%., Conclusion: The present study showed that 131 I-CP-loaded magnesomes can be a beneficial brain-targeting approach for improving the diagnosis and/or radiotherapy of certain brain diseases., (Copyright © 2021. Published by Elsevier B.V.)

Background: An adaptive seating system is a basic rehabilitation need for children and youth with cerebral palsy (CP) as it supports the structure and function of the musculoskeletal system and can positively affect their activities and participation. Despite the importance of adaptive seating systems, there is limited access to such systems in low-income countries., Objectives: To determine the percentage of children and youth between 4 and 18 years of age with CP in Egypt whose activity level and sitting ability suggest the need for an adaptive seating system., Study Design: Observational cross-sectional study., Methods: One hundred ninety-three participants were included after fulfilling the criteria of the Surveillance of Cerebral Palsy of Europe. Their level of activity was assessed by a physical therapist using the Gross Motor Function Classification System (GMFCS), and their sitting ability was evaluated using the Level of Sitting Scale (LSS). Participants were considered to require an adaptive seating system if they scored GMFCS level IV or V and LSS level 1-5 concurrently., Results: Approximately 44% of the study participants were classified as GMFCS level IV or V and LSS level 1-5, suggesting that they were in need of an adaptive seating system., Conclusions: There is a large percentage of children and youth with CP in Egypt who need an adaptive seating system to be integrated into their rehabilitation., (Copyright © 2021 International Society for Prosthetics and Orthotics.)

Transdisciplinary solutions are needed to achieve the sustainability of ecosystem services for future generations. We propose a framework to identify the causes of ecosystem function loss and to forecast the future of ecosystem services under different climate and pollution scenarios. The framework (i) applies an artificial intelligence (AI) time-series analysis to identify relationships among environmental change, biodiversity dynamics and ecosystem functions; (ii) validates relationships between loss of biodiversity and environmental change in fabricated ecosystems; and (iii) forecasts the likely future of ecosystem services and their socioeconomic impact under different pollution and climate scenarios. We illustrate the framework by applying it to watersheds, and provide system-level approaches that enable natural capital restoration by associating multidecadal biodiversity changes to chemical pollution., Competing Interests: Declaration of interests No interests are declared., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Microplastics (MPs) are a group of emerging contaminants that have attracted increasing scientific and societal attention over the past decade due to their ubiquitous detection in all environmental compartments. So far, most studies on MPs focus on characterizing their occurrence, fate, and impact in the aquatic environment. Therefore, very little is known about the magnitude, patterns, and associated risks of human exposure to MPs, particularly indoors. This is a significant research gap given that people spend most of their time (up to 90%) indoors, which is exacerbated over the past year by COVID-19 lockdown measures. Critical evaluation of the existing literature revealed the presence of MPs at higher concentrations in indoor air and dust (from homes and offices) compared to outdoors. This was attributed to several factors including: indoor MPs sources ( e.g. furniture, textiles), increased deposition of atmospheric MPs indoors, and less atmospheric mixing and dilution compared to outdoor air. Current understanding is that indoor human exposure to MPs occurs via a combination of inhalation, ingestion, and dermal contact. Dietary intake was considered the major pathway of human exposure to MPs until recent studies revealed potential high exposure via inhalation. Moreover, exposure via inadvertent dust ingestion and dermal contact cannot be neglected, particularly for young children. This is alarming due to the potential toxic implications of MPs exposure. Early toxicological evidence indicates that small MPs (<20 µm) can cause oxidative stress and inflammation, while particles <5 µm can be engulfed by cells and translocated to accumulate in different organs. Also, there is increasing concern over potential leaching of toxic chemicals used as plastic additives ( e.g. plasticizers and flame retardants) upon exposure to MPs due to their large surface area. However, MPs exposure and risk assessment in humans is still in its infancy and more research is necessary to provide the knowledge base required for regulations to protect human health and environment against MPs.

Introduction: Fistula Laser Closure (FiLAC) is a method that was originally applied in the treatment of perianal fistulas. Because of promising results, diode lasers were later on used to treat pilonidal sinus disease in a method called sinus Laser Closure (SiLaC). The aim of this study is to compare between SiLaC and Limberg flap in management of pilonidal disease., Methods: A prospective, nonrandomized comparative study. A short-term follow-up of 71 patients with pilonidal disease was analyzed (24 operated on using the SiLaC technique and 47 using the Limberg technique). With a primary outcome is healing rate and recurrence and a secondary outcome is other measures i.e. complications, hospital stay and postoperative pain., Results: The median operative time in the SiLaC group was 26.45 ± 5.41 min (20-35 min) and in the Limberg group 58.63 ± 7.42 min (50-75 min). In the SiLaC group, the primary healing was achieved in 23 out of 24 patients (95.8%) with a total complication rate of 20.83%. There were two cases of recurrence after initial healing in each group., Conclusion: Sinus laser Closure (SiLaC) is comparable to Limberg flap technique in the terms of healing rate and recurrence with better outcome regarding operative time, hospital stay and post-operative pain., Competing Interests: Declaration of competing interest No conflicts of interest., (Copyright © 2021. Published by Elsevier Taiwan LLC.)

It has been estimated that over 28 million tonnes of plastics end up in water bodies annually. These plastics degrade into microplastics (MPs), which along with microbeads and MPs from other sources such as wastewater treatment plants continue to threaten the aquatic system. At such small sizes, and corresponding larger surface areas per unit mass/volume, MPs exhibit enhanced capacity for absorbing and desorbing toxic chemicals/additives. Therefore, MPs can serve as vectors through which additives as well as other persistent, bio-accumulative, and toxic chemicals can enter the food chain. Additives are a significant component of most plastic products with some identified as hazardous to health and the environment. One group of additives that has continued to attract interest is organophosphate esters (OPEs), which are used both as flame retardants and plasticizers. Some of these OPEs are suspected carcinogens and endocrine disruptors and have been reported to exert serious toxic effects on freshwater biota. Separate studies on the presence and fate in the freshwater environment of these additives and MPs have emerged recently. However, no studies exist that examine the extent to which plastics additives such as OPEs in sediments are sorbed to MPs as opposed to the sediment itself. This has potentially important implications for the bioavailability of such additives and studies to examine this are recommended. This paper reviews critically the current state-of-knowledge on MPs in freshwater sediments, methods for their analysis, as well as their occurrence, temporal trends, and risks to the freshwater aquatic environment. Moreover, to facilitate the study of additives associated with MPs that have been extracted from sediments, we consider the possible effect of MP isolation methods on the determination of concentrations of associated additives like OPEs., (Copyright © 2021 Elsevier Inc. All rights reserved.)

In this research, we claim to join the efforts of practitioners and researchers to provide managerial responses to an unprecedented health crisis such as COVID-19. To do this, we study the concept of 'collective resilience' as a mechanism for responding to crisis in the Tunisian context. The aim of this research is to explain the impact of collective resilience processes on the ability of organizations to withstand crisis. We conducted sixteen semi-structured interviews with Tunisian companies that had experienced the COVID-19 crisis. Continuous analysis of these interviews was carried out with the Nvivo12 software. Our results showed a positive effect of collective resilience on the capacity of organizations to resist the COVID-19 crisis by developing protective factors. These are manifested by new intersubjective interactions (massive exchanges, shared representation, collective consciousness, collaboration, solidarity, mutual aid, etc.), generic interactions (actions and assembly rules not used before: less formalized rules and procedures, more flexible and decentralized structure, new organizational diagrams based on trust, accountability, etc.) and finally the improvisation and tinkering of the organization which made it possible to bring about a change affecting all levels of the organization: strategic and organizational., Competing Interests: Conflict of interestThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© The Author(s) under exclusive licence to Global Institute of Flexible Systems Management 2021.)

Video 1Video showing successful placement of 4 uncovered self-expanding metal stents in a stent-in-stent, Y-shaped configuration for cholangitis from plastic stents in a patient with unresectable cholangiocarcinoma., (© 2022 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc.)

Objectives: To compare pain perception of young children treated with SDF and ART, as well as their parents' acceptability of both modalities., Methods: Eighty, 3 to 8-years old children, having at least one deciduous asymptomatic tooth with active caries, as defined by the ICDAS II scores 4, 5, 6 were randomly assigned into two groups; SDF for caries arresting in the test group, and ART for caries removal in the control group. Pain perception was assessed using Sound, Eye, Motor scale (SEM), whereas parental acceptability was assessed using a self-administered questionnaire., Results: Patients treated with SDF reported significantly less discomfort and pain compared to the ART group, with a mean SEM of 3.70 ± 1.47 and 6.18 ± 3.06, respectively (p < 0.001). A significantly higher mean parental acceptability score was detected for SDF treatment (31.85 ± 2.30) than ART treatment (26.75 ± 3.60), p < 0.001, with regard to the treatment duration, child comfortability and quality of treatment (p < 0.001). The only dimension showing more satisfaction for the ART treatment was esthetics of anterior teeth (p= 0.01)., Conclusions: Parental acceptability was higher for the SDF caries treatment of primary teeth compared to ART treatment, especially in relation to the shorter intervention time, child comfortability and acceptance as well as quality of treatment., Clinical Significance: The shorter average time needed and the ease of application of SDF on cavitated primary lesions, in addition to parental acceptability, place SDF in an advantageous position over the ART on clinical level., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Aortic cross-clamp utilized during cardiac surgery facilitates motionless and bloodless surgical field. However, the duration of clamp time has an inverse effect on early post-operative recovery period. In this study, we sought to examine the predictors of aortic clamp duration and intensive care unit length of stay., Results: Six hundred and nine adult patients presented for elective cardiac surgery between December 2019 and December 2020 were enrolled. The age of patients ranged from 18 to 82 years (mean 55.62 years, SD ± 12.3 years). Male/female ratio is 4.6:1. Most patients (87.2%) were planned for coronary artery bypass grafting (CABG) and 78 patients (12.8%) for single heart valve procedure. Operative time (OT) ranged from 120 to 402 min and averaged 259.4 min (SD ± 45.9 min). ACC time ranged from 15 to 159 min and averaged 50.56 min (SD ± 19.4 min). Factors associated with significantly longer ACCT were: smoking (OR = 1.89 (95% CI 1.3-2.74), p value = 0.01), respiratory disease (OR = 0.48 (95% CI 0.24-0.96), p value = 0.039), obesity (OR = 1.76 (95% CI 1.18-2.63), p value = 0.005) and AVR (OR = 2.11 (95% CI 1.17-3.83), p value = 0.013). Low cardiac output syndrome (LCOS) was observed in 19.2% of patients. Longer than average ACCT was associated with increased use of inotropes (p value < 0.001), intra-aortic balloon pump (p value < 0.001) and first 24 h post-operative blood loss (p value < 0.001). The average intensive care unit length of stay (ICULOS) was 1.64 days (SD ± 1.1 days). Patients' ACCT converged positively and significantly on ICULOS (Beta coefficient = 1.013 (95% CI 1.01-1.015), p value < 0.001)., Conclusion: Aortic cross-clamping is a crucial method in cardiac surgery to achieve motionless field; however, prolongation of this method had an incremental risks for the development of low cardiac output syndrome, increased first 24 h post-operative blood loss and longer stay in the intensive care unit., (© 2021. The Author(s).)

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel virus that belongs to the coronaviruses and causes coronavirus disease 2019 (COVID-19). In this study, we explored the demographic details, clinical features, and routinely conducted laboratory investigations of patients with COVID-19 during the second and third waves of the pandemic to understand their possible diagnostic and prognostic values in Egypt., Methods: In this retrospective cohort study, the demographic characteristics, detailed medical history, laboratory findings, and symptoms of all enrolled patients with SARS-CoV-2 were collected from the medical records of Beni Suef University Hospitals between December 15, 2020, and April 15, 2021., Results: This retrospective study included 473 patients, almost all of whom were elderly. The median age of the patients was 48 years, and those with moderate and severe disease were older than those with mild infections. The proportion of females was higher (63.4%) than males (36.6%). Diabetes mellitus (DM) was the most common comorbidity (17.3%), and fever was the most typical manifestation of COVID-19 (62.6%). Those with severe disease showed a higher C-reactive protein level (CRP) than those with moderate (p-value 0.009) or mild (p-value 0.01) diseases. Serum ferritin levels were significantly higher in patients with severe disease than in those with moderate disease (p-value 0.018). In contrast, d-dimer and serum creatinine were normal and showed no significant difference in all comparisons (p-value overall 0.21)., Conclusion: This study observed several variations in COVID-19 patients' characteristics. The new manifestations included skin rash, bone and low back pains, and rigors. In contrast to females, most males had moderate-to-severe illness. Old age and higher body mass index was associated with increasing severity. d-dimer and complete blood count were normal and could not identify potential COVID-19 patients. Patients who had mild illness were still at risk of developing post-COVID complications., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The antioxidant and antimicrobial effect of sesame oil (10, 30, and 50 g/kg) and sesamol (0.1, 0.3, and 0.5 g/kg) in meatballs during cold storage for 18 days at 3 ± 1 °C was investigated. Sesame oil and sesamol did not alter the sensory attributes of meatballs. Addition of either sesame oil or sesamol significantly delayed lipid oxidation when compared with control. Sesamol exhibited more potent antioxidant activities more than sesame oil. During storage, the aerobic plate counts (APCs) and Enterobacteriaceae counts (EBCs) were markedly (P < 0.01) decreased in meatballs treated with sesame oil or sesamol in comparison with untreated control samples. Control meatballs showed signs of quality deterioration at day 7 of storage, while treated meatballs exhibited longer shelf lifes ranged from 9-18 days according to sesame oil or sesamol concentrations. Both sesame oil and sesamol induced marked (P < 0.01) decline in the counts of E. coli O157:H7, Salmonella enterica serovar Typhimurium, Staphylococcus aureus and Listeria monocytogenes that artificially inoculated to meatballs. Sesamol was more effective than sesame oil in the reduction of APCs, EBCs as well as foodborne pathogens. The results suggest that both sesame oil and sesamol are potentially useful natural additives to fresh meat products for improving its microbial quality and extending its shelf life during cold storage., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Identifying the presence of brominated flame retardants (BFRs) within individual polymer types prior to extrusion has given us a unique perspective on which polymers may be problematic in meeting European Union (EU) low persistent organic pollutant (POP) content limits (LPCLs) and the potential for mixed engineering plastics (MEP) to be used as a viable recycled product. Our findings suggest that careful management of the polymer types within the feed chips prior to extrusion could deliver extruded polymer pellets that meet the EU LPCL values for POP-BFRs (i.e. <1000 mg/kg). Within this study, three fractions of extruded polymer pellets ("light", "medium", and "heavy" MEP) were created using density separation. Each fraction was characterised for 28 legacy and novel BFRs with brominated diphenyl ether-209 (BDE-209) (68-37,000 mg/kg) and tetrabromobisphenol-A (TBBP-A) (17-120,000 mg/kg) both predominant and ubiquitous. Portable X-ray fluorescence (XRF) was utilised to measure Br in 120 individual MEP chips of various polymer types. Those chips that XRF flagged as having high Br concentrations (>2500 mg/kg) were subjected to further evaluation for BFR content via mass spectrometry analysis and the results compared with the XRF Br data. This revealed that in 22% of the 120 chips studied, XRF incorrectly identified the LPCL to be exceeded. Our data also identifies the presence of the novel BFRs decabromodiphenyl ethane (DBDPE) and 1,2-bis(2,4,6-tribromophenoxy) ethane (BTBPE) in plastics derived from waste electronic and electrical equipment (WEEE). While the "light-MEP" samples contained POP-BFR concentrations below LPCLs, the "medium-MEP" and "heavy-MEP" fractions exceeded such limits. Management of the polymer chips by colour sorting resulted in significant reductions in concentrations of all BFRs in the clear polymers such that LPCL limits were not exceeded; however, concentration reductions in white polymers were insufficient to meet LPCLs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objectives: To investigate the effect of Co-curing versus Staged-curing and No-bonding on retention of different resin-based sealants (RBS)., Study Design: For shear bond strength (SBS) and microleakage tests, 90 extracted premolars were divided equally into 3 groups (I, II, III). Each group was further subdivided equally into 3 subgroups (a, b, c). No-bonding subgroups did not receive a bonding agent, Staged-curing subgroups received a bonding agent that was cured before sealant application, while Co-curing subgroups received a bonding agent that was cured after sealant application. Seal-it was applied for group I, Helioseal-F for group II and Clinpro for group III. SBS buttons were tested using Instron machine, while microleakage specimens were examined using micro-CT., Results: Clinpro showed the highest SBS values in Staged-curing and No-bonding groups (8.72±2.39, 12.51±3.16) respectively. Staged-curing was significantly greater in SBS values than those for other groups (P<0.05). There was a significant difference in microleakage values of Staged-curing among different RBS (P = 0.003), while there was no significant difference in values of No-bonding and Co-curing among different RBS (P = 0.541, P = 0.521)., Conclusions: The use of a bonding agent as Staged-curing was more effective in improving sealant retention than No-bonding and Co-curing.

Background & Aims: Among candidates listed for liver transplant (LT), the model for end-stage liver disease (MELD) score may not capture acute-on-chronic liver failure (ACLF) severity. Data on the interaction between ACLF and MELD score in predicting waitlist mortality are scarce., Methods: We analyzed the UNOS database (01/2002 to 06/2018) for LT listings in adults with cirrhosis and ACLF (without hepatocellular carcinoma). ACLF grades 1, 2, 3a, and 3b- were defined using the modified EASL-CLIF criteria., Results: Of 18,416 candidates with ACLF at listing (mean age 54 years, 69% males, 63% Caucasians), 90-day waitlist mortality (patient death or being too sick for LT) was 21.6% (18%, 20%, 25%, and 39% for ACLF grades 1, 2, 3a, and 3b, respectively). Using a Fine and Gray regression model, we identified an interaction between MELD and ACLF grade, with ACLF having a higher impact at lower MELD scores. Other variables included candidate's age, sex, liver disease etiology, listing MELD, ACLF grade, obesity, and performance status. A score developed using parameter estimates from the interaction model on the derivation cohort (n = 9,181) stratified the validation cohort (n = 9,235) into quartiles: Q1 (score <10.42), Q2 (10.42-12.81), Q3 (12.82-15.50), and Q4 (>15.50). Waitlist mortality increased with each quartile from 13%, 18%, 23%, and 36%, respectively. Observed vs. expected waitlist mortality deciles in the validation cohort showed good calibration (goodness of fit p = 0.98) and correlation (R = 0.99)., Conclusion: Among selected candidates who have ACLF at listing, MELD score and ACLF interact in predicting cumulative risk of 90-day waitlist mortality, with higher impact of ACLF grade at lower listing MELD score. Validating these findings in large prospective studies will support consideration of both MELD and ACLF when prioritizing transplant candidates and allocating liver grafts., Lay Summary: In patients with cirrhosis listed for liver transplantation, the presence of multiorgan failure, a condition referred to as acute-on-chronic liver failure, is associated with high waiting list mortality rates. Current organ allocation policy disadvantages patients with this condition. This study describes and validates a new scoring method that performs better than the currently available scoring systems. Further validation of this approach may reduce the deaths of patients with cirrhosis and acute-on-chronic liver failure on the transplant waiting list., Competing Interests: Conflict of interest None of the authors have any financial or any other conflicts of interests to disclose. Please refer to the accompanying ICMJE disclosure forms for further details., (Copyright © 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)

Organophosphate esters (OPEs) are common additives in a wide range of commercial and industrial products. Elevated and prolonged exposure to OPEs may induce several adverse effects. This is concerning as they are ubiquitous in air, indoor dust, drinking water, and other environmental matrices. However, information on the presence of OPEs in foodstuffs and consequent health risks remains scant. This review critically evaluates available information on levels and sources of OPEs in food, discusses the relative significance of diet as a pathway of human exposure, identifies knowledge gaps, and suggests directions for future research. For toddlers, dermal uptake from dust ingestion appears the predominant pathway of exposure to chlorinated OPEs, as well as ethylhexyl diphenyl phosphate (EHDPP) and triphenyl phosphate (TPHP). In contrast, diet appears the main pathway of exposure to all eight OPEs considered for adults, and for tri n-butyl phosphate (TnBP), tris 2-ethylhexyl phosphate (TEHP), and tris (2-butoxyethyl) phosphate (TBOEP) for toddlers. While summed exposures via all pathways are within reference dose (RfD) values, they do not include high-end exposure estimates, and for highly-exposed individuals, the margin between exposure and RfD values is smaller. Moreover, our exposure estimates are based on a meta-analysis of multiple exposure assessments conducted over a range of points in space and time. There is an urgent need for assessments of human exposure to OPEs that examine all relevant pathways in a spatially and temporally-consistent fashion. Given food is an important exposure pathway to OPEs, regular monitoring of their presence as well as their metabolites (that may have toxicological significance) in foodstuffs is recommended. While dermal uptake from indoor dust appears an important human exposure pathway, no evaluations exist of exposure via dermal uptake from OPE-containing products such as foam-filled furniture. This review also highlights very few data exist on OPEs in drinking water., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021. Published by Elsevier B.V.)

Background: The BALAD score and BALAD-2 class derived from bilirubin, albumin, AFP, AFP-L3, and des-gamma-carboxyprothrombin (DCP) are effective in predicting mortality in HCC, but have not been validated in North America., Methods: 148 HCC patients from 2000 to 2015 who had all five biomarkers tested at diagnosis were included. Hazard ratios (HR) were calculated., Results: 75 patients died during a median follow-up of 21.9 months. 1-and 3-year survival rates were 70.8% and 47.6%. 114 (77%) had cirrhosis. The HR (95%CI) for death were 1.24 (0.42-3.67), 1.79 (0.61-5.26), 2.83 (0.95-8.38), and 7.19 (2.26-22.91) for BALAD scores 1, 2, 3, and 4 vs. BALAD 0. The HR (95%CI) for death were 1.25 (0.65-2.40), 1.75 (0.94-3.23), and 6.20 (3.29-11.68) for BALAD-2 classes 2, 3, and 4 vs. BALAD-2 class 1. A multivariate model incorporating maximal tumor diameter, tumor number, neutrophil-lymphocyte ratio, and BALAD had HR of 1.43 (1.14-1.81) per increase of 1 BALAD score. A similar model with BALAD-2 had HR of 1.50 (1.18-1.90) per increase of 1 BALAD-2 class., Conclusion: BALAD models at diagnosis can predict the survival of HCC patients in North America. AFP, AFP-L3, and DCP reflect tumor progression and metastasis of HCC and distinguish the BALAD model from other predictive models., (Copyright © 2020 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)

There is a pressing need to find reliable biomarkers for the early diagnosis of silica-induced nephropathy. Abundant genes are upregulated in damaged kidneys with subsequent protein products appearing in the urine. Liver-type fatty acid-binding protein (L-FABP) and kidney injury molecule-1 (KIM-1) are among the most promising. Our objective was to study the importance of L-FABP and KIM-1 genes and their urinary proteins in the early detection of silica-induced renal injury, as compared with other conventional biomarkers. A cross-sectional study was conducted among 90 pottery workers occupationally exposed to silica, as compared to 90 controls. A full history taking and complete clinical examination were performed. Levels of serum creatinine, liver enzymes, urinary silicon, KIM-1, and L-FABP gene expression and protein products were measured. Estimated glomerular filtration rate (eGFR) was calculated, and abdominal ultrasound was performed. The results showed that the silica-exposed group had a statistically significant increase in serum creatinine and urinary silica, as well as a significant decrease in eGFR. Additionally, a significant increase in KIM-1 and L-FABP gene expression, associated with a significant increase in their urinary protein, was found among the exposed group. A positive correlation between urinary silica level and L-FABP gene expression was also found. A receiver operating characteristic curve analysis for L-FABP and KIM-1 gene as predictors for silica-induced nephropathy showed that L-FABP gene and protein specificity were greater than the KIM-1 gene and protein. Taken together, these findings suggest that the L-FABP gene and its protein product may be used as early indicators for renal injury among silica exposed workers.

Background: In the early postoperative period after cardiac surgery the heart may be temporarily dysfunctional and prone to arrhythmias due to the phenomenon of myocardial stunning, vasoplegic syndrome, systemic inflammatory response syndrome (SIRS), electrolyte disturbances, operative trauma and myocardial edema. Most cases of cardiac arrest after cardiac surgery are reversible., Objective: To analyse the factors that may influence the outcome of cardiac arrest after adult and pediatric cardiac surgery., Methods: Retrospective analysis that included cardiac surgical procedures (886 adult and 749 pediatric patients) performed during the 18 month period of this study at Queen Alia Heart Institute/ Amman, Jordan. All cardiac arrest events were recorded and analysed. Data was collected on Utstein style templates designed for the purpose of this study. The outcome of cardiac arrest is examined as an early outcome (ROSC or lethal outcome) and late outcome (full recovery, recovery with complications, or in-hospital mortality). Factors that may influence the outcome of cardiac arrest were recorded and statistically analysed. Ethical committee approval obtained., Results: The overall mortality rate was 3.3%. Cardiac arrest occurred in 114 patients (6.97%). The age of patients ranged from 5 days to 82 years and constituted 66 pediatric and 48 adult patients. Most pediatric cardiac arrests manifested as non-shockable rhythms (77%). Most in-hospital cardiac arrests occurred in the intensive care unit (86.5%). The majority of patients were mechanically ventilated at the time of occurrence of arrest (62.5% and 54.5% in adult and pediatric patients, respectively). Average time of cardiopulmonary resuscitation was 32.24 minutes. Overall, CA survival was 20% higher in the paediatric sub-group (full recovery rate of 51.5%). Neurological injury was slightly lower in pediatric than adult cardiac arrest survivals. (2% vs. 3%)., Conclusion: Shockable rhythms are more common in adult cardiac arrest, while non-shockable rhythms are more frequent in the pediatric sub-population. Hemodynamic monitoring, witnessed-type of cardiac arrest, non-interrupted cardiac massage, and early recognition of cardiac tamponade are the factors associated with higher rates of survival., Competing Interests: The authors declare that they have no conflict of interest., (© 2021 Ashraf Fadel Moh’d, Mohammad Abdallah Khasawneh, Hayel Talal Al-Odwan, Yaser Ahmad Alghoul, Zeid Mohammad Makahleh, Salah E Altarabsheh.)

Piroplasms, which include Babesia spp. and Theileria spp., are protozoan parasites carried by ticks and commonly cause disease in animals and humans. Those caused by Babesia spp. manifest as fever, anemia, and hemoglobinuria, while Theileria spp. can lead to high fever, diarrhea, and lymphadenopathy. Recently, Theileria capreoli and an undescribed Babesia sp. were detected for the first time in sika deer ( Cervus nippon yesoensis ) from Hokkaido; however, there is limited information available on their epidemiology in Japan. Here, a touchdown polymerase chain reaction and reverse line blot hybridization were used to perform an epidemiological survey of T. capreoli and Babesia sp. using blood samples from 82 sika deer in Hokkaido, Japan. This was followed by partial sequencing and phylogenetic analysis of the 18S rRNA and β-tubulin genes to characterize both piroplasm species. A total of 43 (52.4%) and 3 (3.7%) of the sika deer were positive for T. capreoli and Babesia sp., respectively. The β-tubulin gene partial sequences for Babesia sp. were distinct from those of Babesia spp. in GenBank. Phylogenetic analysis showed that the unknown Babesia sp. is more closely related to B. bigemina and B. ovata than other Babesia spp. based on the β-tubulin gene. Further studies are required to understand the ecology of these tick-borne pathogens in Japan.

Purpose: This work aims to evaluate the clinical utility and feasibility of a novel scanning laser ophthalmoscope-based navigated ultra-widefield swept-source optical coherence tomography (UWF SS-OCT) imaging system., Methods: A retrospective, single-center, consecutive case series evaluated patients between September 2019 and October 2020 with UWF SS-OCT (modified Optos P200TxE, Optos PLC) as part of routine retinal care. The logistics of image acquisition, interpretability of images captured, nature of the peripheral abnormality, and clinical utility in management decisions were recorded., Results: Eighty-two eyes from 72 patients were included. Patients were aged 59.4 ± 17.1 years (range, 8-87 years). During imaging, 4.4 series of images were obtained in 4.1 minutes, with 86.4% of the image series deemed to be diagnostic of the peripheral pathology on blinded image review. The most common pathologic findings were chorioretinal scars (18 eyes). In 31 (38%) eyes, these images were meaningful in supporting clinical decision-making with definitive findings. Diagnoses imaged included retinal detachment combined with retinoschisis, retinal hole with overlying vitreous traction and subretinal fluid, vitreous inflammation overlying a peripheral scar, Coats disease, and peripheral retinal traction in sickle cell retinopathy., Conclusions: Navigated UWF SS-OCT imaging was clinically practical and provided high-quality characterization of peripheral retinal lesions for all eyes. Images directly contributed to management plans, including laser, injection or surgical treatment, for a clinically meaningful set of patients (38%). Future studies are needed to further assess the value of this imaging modality and its role in diagnosing, monitoring, and treating peripheral lesions., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: S.K. declared consulting and research funding from Optos (research funding was not received for the development of this study). He has also served as a consultant for Adverum, Alcon, Novartis, and Genentech/Roche; received research funding from Allergan, Novartis, Genentech/Roche, and Regeneron; received equity from Adverum, Regenxbio, and Fortress Bio; and intellectual property—gene therapy for age-related macular degeneration, and T cells for CMV retinitis—assigned to Cornell University. K.D.K. has served as a consultant for Regenxbio. D.J.D. has served as a consultant for Alcon, Iveric bio, and Aufbao Holdings; received equity from Iveric bio and Aufbau Holdings; and holds intellectual property for Aufbau Holdings. The other authors have nothing to declare., (© The Author(s) 2021.)

Occupational stress is a major health problem among nurses. Critical care nurses appear to experience more stress at work compared to others. Stress is associated with multiple system disorders, hormonal, and immunological disturbances, and genetic effects. The aim of our study was the detection of health effects of work-related stress and to investigate the link between stress and immune response, alterations of hormones, and expression of micro-RNA (miRNA) among critical care nurses. An exposed 80 critical care nurses matched to 80 controls were involved in our study. Full history, psychological assessment using the General Health Questionnaire (GHQ12) and a complete clinical examination were done for both groups. Serum interleukin (IL)-6, IL-10, luteinizing hormone (LH), follicle-stimulating hormone, thyroid-stimulating hormone (TSH), free triiodothyronine, and free thyroxine (FT4) were measured by enzyme-linked immunosorbent assay, micro-RNA26, and 142 extractions. The exposed group had a mean age of 41 ± 10 years old and mean work duration of 22 ± 9.7 years, matched to 80 controls. The exposed group (32.5%) was associated with severe psychological distress (GHQ scores > 20) compared to only 5% among controls. In addition, the exposed group had a significantly higher level of miRNA 26, miRNA 142, TSH, LH, and IL-6 when compared to the control group. However, there a significantly lower level of FT4 among the exposed group compared to the control group, there were no statistically significant differences between the studied participants regarging FT3,FSH and IL-10 levels. Stress is prevalent among critical care nurses and is reflected on their psychological health with an increase in inflammatory cytokines and disturbances in endocrine functions.

In the context of a health crisis of unprecedented magnitude that we have experienced such as COVID-19 we join the efforts of practitioners and researchers to answer the question: 'What is the organizational context that promotes individual adaptation in a context of adversity?'. Specifically, our research aims to explore organizational practices that promote individual resilience in a COVID-19 crisis situation and in a Tunisian context. Therefore, we believe that the paradigm (resilience in the face of the COVID-19 crisis) and the context (Tunisian) both constitute the originality of our article. Our research contribution consists in demonstrating that the company has a managerial need to strengthen the psychological protective factors of its employees, which will promote their individual resilience in the organization. This necessarily leads it to develop the individual's defense mechanisms against trauma, psychological reconstruction and post-resilience learning. This modeling of resilience allowed us to observe and recognize it in sixteen Tunisian companies by using a qualitative study based on sixteen semi-structured interviews analyzed by the 'Nvivo 12' software in order to explore the functioning of individual resilience in a real organizational context., Competing Interests: Conflict of interestThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© Global Institute of Flexible Systems Management 2021.)

Background: Bariatric procedures are the most effective management for obesity. There is no standard venous thromboembolism (VTE) prophylaxis for both dosing and duration of anticoagulation following laparoscopic sleeve gastrectomy. Our purpose was to assess the optimum regimen for VTE prophylaxis in bariatric procedures and to reduce the incidence of perioperative bleeding., Methods and Materials: This is a prospective randomized study which involved 100 morbidly obese patients, subdivided into two groups; group A received postoperative low molecular weight heparin (LMWH) prophylaxis alone starting from day 1 to day 15 in dose 1 mg/kg/day in a maximum dose 120 mg/day, and group B received both pre- and postoperative LMWH; at night of surgery 12 h preoperatively and postoperative starting from day 1 to day 15 with the same dose. All patients underwent mesenteric and bilateral lower limbs duplex 15 days postoperative using Philips iU machine and linear (L9-3), convex (C5-1) and sector (S5-1) probes., Results: Regarding postoperative VTE, we found statistically significant increase in postoperative VTE in patients of group A (four cases) without any case complicated with VTE in patients of group B (P value = 0.041). Regarding postoperative bleeding, we found statistically insignificant percent of cases complicated with postoperative bleeding in group B compared to group A (P value 0.315)., Conclusion: Preoperative as well as a postoperative prophylactic anticoagulant as LMWH is recommended to prevent perioperative VTE. There was an insignificant increase in postoperative bleeding in patients who received preoperative prophylactic anticoagulants.

Background: Alcoholic hepatitis (AH) is a unique syndrome characterized by high short-term mortality. The impact of the academic status of a hospital (urban and teaching) on outcomes in AH is unknown., Methods: National Inpatient Sample dataset (2006-2014) on AH admissions stratified to academic center (AC) or non-academic center (NAC) and analyzed for in-hospital mortality (IHM), hospital resource use, length of stay in days (d), and total charges (TC) in United States dollars (USD). Admission year was stratified to 2006-2008 (TMI), 2009-2011 (TM2), and 2012-2014 (TM3)., Results: Of 62,136 AH admissions, the proportion at AC increased from 46% in TM1 to 57% in TM3, Armitage trend, p < 0.001. On logistic regression, TM3, younger age, black race, Medicaid and private insurance, and development of acute on chronic liver failure (ACLF) were associated with admission to an AC. Of 53,264 admissions propensity score matched for demographics, pay status, and disease severity, admissions to AC vs. NAC (26,622 each) were more likely to have liver disease complications (esophageal varices, ascites, and hepatic encephalopathy) and hospital-acquired infections (HAI), especially Clostridioides difficile and ventilator-associated pneumonia. Admissions to AC were more likely transfers from outside hospital (1.6% vs. 1.3%) and seen by palliative care (4.8% vs. 3.3%), p < 0.001. Use of endoscopy, dialysis, and mechanical ventilation were similar. With similar IHM comparing AC vs. NAC (7.7% vs. 7.8%, p = 0.93), average LOS and number of procedures were higher at AC (7.7 vs. 7.1 d and 2.3 vs. 1.9, respectively, p < 0.001) without difference on total charges ($52,821 vs. $52,067 USD, p = 0.28). On multivariable logistic regression model after controlling for demographics, ACLF grade, and calendar year, IHM was similar irrespective of academic status of the hospital, HR (95% CI): 1.01 (0.93-1.08, p = 0.70). IHM decreased over time, with ACLF as strongest predictor. A total of 63 and 22% were discharged to home and skilled nursing facility, respectively, without differences on academic status of the hospital., Conclusion: Admissions with AH to AC compared to NAC have higher frequency of liver disease complications and HAI, with longer duration of hospitalization. Prospective studies are needed to reduce HAI among hospitalized patients with AH., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2020 Waleed, Abdallah, Kuo, Arab, Wong and Singal.)

Background: We hypothesized that 1st generation everolimus-eluting bioresorbable vascular scaffold (BVS) stent associated with less complication and less restenosis rate than everolimus-eluting stent (EES) in chronic total occlusion (CTO) recanalization guided by intracoronary imaging. Therefore, we aimed to assess the safety and performance of BVS stent in CTO revascularization in comparison to EES guided by intracoronary imaging. Our prospective comparative cross-sectional study was conducted on 60 CTO patients divided into two groups according to type of stent revascularization: group I (EES group): 40 (66.7%) patients and group II (BVS group): 20 (33.3%) patients. All patients were subjected to history taking, electrocardiogram (ECG), echocardiography, laboratory investigation, stress thallium study to assess viability before revascularization. Revascularization of viable CTO lesion guided by intracoronary imaging using optical coherence tomography (OCT). Then, long-term follow-up over 1 year clinically and by multi-slice CT coronary angiography (MSCT). Our clinical and angiographic endpoints were to detect any clinical or angiographic complications during the follow-up period., Results: At 6 months angiographic follow-up, BVS group had not inferior angiographic parameters but without statistically significant difference (p = 0.566). At 12 months follow-up, there was no difference at end points between the two groups (p = 0.476). No differences were found at angiographic or clinical follow-up between BVS and EES., Conclusion: This study shows that 1st generation everolimus-eluting BVS is non-inferior to EES for CTO revascularization. Further studies are needed to clearly state which new smaller footprint BVS, faster reabsorption, magnesium-based less thrombogenicity, and advanced mechanical properties is under development. We cannot dismiss the efficacy and safety of new BVS technology., Trial Registration: ZU-IRB#2498/3-12-2016 Registered 3 December 2016, email: IRB&#95;123@medicine.zu.edu.eg.

Background: Helicobacter pylori (H pylori) is responsible for various diseases including cancer It co-evolved with humans, and human migrations shaped the expansion and the diversity of strains around the world. The risk of developing a disease depends on virulence factors, mainly the cytotoxin-associated gene A protein (CagA). The aim of this study was to determine the cagA status in H pylori strains from Mauritanian patients and to search for a relationship with endoscopic and histologic findings., Material and Methods: H pylori was searched in gastric biopsies taken during endoscopy in patients with gastro-duodenal symptoms. RT-PCR was used for the diagnosis and resistance to clarithromycin. The cagA status was determined with PCR and the EPIYA-cagA polymorphism with sequencing., Results: At all, 76/78 (97.4%) biopsies were positive. The rate of clarithromycin resistance was 4/76 (5.26%) due to the A2143G mutation, with a mixed population in 2 cases. The cagA gene was present in 23/76 (30.26%) biopsies, and the EPIYA motif was ABC in 21 (91.3%). High bacterial load and inflammation were significantly associated with cagA-positive status (P < .01). Phylogenetic analysis of the glmM and hspA genes highlighted a mixture of African and European genes in strains of H pylori isolated from patients of Moor origin., Conclusion: We report a high prevalence of H pylori infection in Mauritanian patients, a low rate of clarithromycin resistance (5.26%) and high bacterial load and inflammation associated with cagA-positive status. The phylogenetic analysis highlights the mix of different populations leading to the Moor ethnicity., (© 2020 John Wiley & Sons Ltd.)

Background: Childhood cancer is a highly curable disease when timely diagnosis and appropriate therapy are provided. A negative impact of the coronavirus disease 2019 (COVID-19) pandemic on access to care for children with cancer is likely but has not been evaluated., Methods: A 34-item survey focusing on barriers to pediatric oncology management during the COVID-19 pandemic was distributed to heads of pediatric oncology units within the Pediatric Oncology East and Mediterranean (POEM) collaborative group, from the Middle East, North Africa, and West Asia. Responses were collected on April 11 through 22, 2020. Corresponding rates of proven COVID-19 cases and deaths were retrieved from the World Health Organization database., Results: In total, 34 centers from 19 countries participated. Almost all centers applied guidelines to optimize resource utilization and safety, including delaying off-treatment visits, rotating and reducing staff, and implementing social distancing, hand hygiene measures, and personal protective equipment use. Essential treatments, including chemotherapy, surgery, and radiation therapy, were delayed in 29% to 44% of centers, and 24% of centers restricted acceptance of new patients. Clinical care delivery was reported as negatively affected in 28% of centers. Greater than 70% of centers reported shortages in blood products, and 47% to 62% reported interruptions in surgery and radiation as well as medication shortages. However, bed availability was affected in <30% of centers, reflecting the low rates of COVID-19 hospitalizations in the corresponding countries at the time of the survey., Conclusions: Mechanisms to approach childhood cancer treatment delivery during crises need to be re-evaluated, because treatment interruptions and delays are expected to affect patient outcomes in this otherwise largely curable disease., (© 2020 American Cancer Society.)

Background: Data on liver transplantation (LT) in acute on chronic liver failure (ACLF) are scanty., Aim: To perform meta-analysis on outcomes after LT for ACLF compared with ACLF patients not receiving LT or with LT recipients for indications other than ACLF., Methods: We pooled data from 12 studies on LT outcomes among ACLF patients., Results: Among nine studies, 22 238 LT recipients for ACLF vs 30 791 for non-ACLF were younger by 1.1 years, less males (64% vs 66.4%), and higher model for end-stage disease score by 14.5 (14.4-14.6), P < 0.01 for all. Post-transplant patient survival at 30 day, 90 day, 6 months, 1 year and 5 years was lower in ACLF: 96.2% vs 98.1%, 92.6% vs 96.2%, 89.9% vs 94.4%, 86.0% vs 91.9%, 66.9% vs 80.7% respectively, P < 0.01 for all. ACLF patients stayed longer in hospital and ICU by 5.7 and 10.5 days respectively, P < 0.001, with similar post-transplant complications [74.4% vs 55.5%, P = 0.12]. Among three studies, 441 LT recipients for ACLF vs 301 ACLF patients not selected for LT had better 30 day and 1 year survival: 95.2% vs 60% and 85.3% vs 28.2% respectively, P < 0.001. Outcomes were worse in ACLF-3 and better for ACLF-1 and ACLF-2 patients at the time of LT., Conclusion: In this pooled analysis with a large sample size across the globe, LT for select patients with ACLF provided survival benefit. However, larger prospective studies are needed to further refine selection criteria, especially for ACLF-3 patients as basis for improving outcomes and optimal utilisation of scarce donor pool., (© 2020 John Wiley & Sons Ltd.)

Objectives: Yttrium-90 transarterial radioembolization (TARE) is a safe, effective modality of locoregional therapy for intermediate and advanced-stage hepatocellular carcinoma (HCC). We aim to identify novel predictors of important outcomes of TARE therapy., Methods: A single-center retrospective study of 166 patients treated with TARE for HCC at Mayo Clinic Rochester between 2005-2015 and followed until December 2017. Multivariate logistic and stepwise regression analysis models were used to identify variables associated with overall survival (OS) and progression-free survival (PFS)., Results: The median OS and the median PFS were12.9  (95% CI: 11.0-17.3), and 8 months (95% CI: 6-11), respectively. Macrovascular invasion (HR: 1.9 [1.3-2.8]), Child-Pugh score (CPS) B or C vs. A (HR: 1.8 [1.2-2.7]), Eastern Cooperative Oncology Group Performance status (ECOG-PS) 2 or 1 vs. 0 (HR: 1.6 [1.1-2.4]) and activity (A) of administered radiation dose (HR: 1.005[1.00-1.010), independently correlated with poorer OS. Infiltrative HCC (HR: 2.4 [1.3-4.5), macrovascular invasion (HR: 1.6 [1.1-2.7]), and high activity of administered radiation dose (HR: 1.005 [1.00-1.010) were associated with worse PFS., Conclusion: In HCC patients treated with TARE; macrovascular invasion, the activity of radiation dose, CPS, ECOG-PS, and infiltrative HCC predict OS and PFS.

Background: The mainstay for the definitive diagnosis of pancreatic lesions is endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). However, there is evidence that EUS-FNA has low sensitivity in the setting of chronic pancreatitis (CP). This single-center retrospective study aimed to compare and analyze the diagnostic yield of EUS-FNA for solid pancreatic lesions in the presence and absence of CP, and to further investigate strategies for overcoming the low diagnostic yield in the setting of CP., Methods: This study identified patients who underwent EUS-FNA at Sanford USD Medical Center (SD, USA) for a solid pancreatic lesion between July 15, 2011, and November 30, 2017. Data on demographics, clinical features, cross-sectional imaging findings, EUS findings, cytology/pathology, and clinical follow up were collected., Results: The final diagnosis was adenocarcinoma in 156 patients (67%), neuroendocrine tumor in 27 (12%), lymphoma in 6 (3%), metastatic malignancy in 8 (4%), and benign etiologies in 35 (15%). CP was identified in 44/234 (19%) patients. The overall diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for EUS-FNA were 92.9%, 97.1%, 99.5%, 70.8%, and 93.5%, respectively. The sensitivity (80% vs. 95%, P=0.020) and accuracy (86% vs. 95%, P=0.043) were significantly lower in patients with CP compared to those without CP., Conclusion: CP can significantly affect the EUS-FNA diagnostic yield of solid pancreatic neoplasms. A high index of clinical suspicion is required in these cases to make a definitive diagnosis., Competing Interests: Conflict of Interest: None, (Copyright: © Hellenic Society of Gastroenterology.)

We report concentrations of brominated flame retardants (BFRs) in 23 plastic samples from 20 new and second-hand children's toys sourced from the UK that had been previously shown to be Br-positive by XRF. The results reinforce existing evidence that the recycling of BFR-treated electronic plastics has led to the unintentional BFR contamination of articles not required to be flame-retarded. The principal BFRs detected were PBDEs (and in particular BDE-209), HBCDD and TBBP-A. PBDEs were detected in all samples with a maximum concentration of BDE-209 of 2500 mg/kg, and while TBBP-A was detected in 11 samples with a maximum concentration of 3100 mg/kg. HBCDD was detected in 14 cases and was present in four toys at concentrations (139-840 mg/kg) that would currently prevent their sale on the EU market. While estimated exposures to PBDEs via accidental ingestion of toy plastic fell well below USEPA reference doses, a child weighing 8.67 kg and ingesting 8 mg/day of a toy (the default assumption of the European Commission's Toy Safety Directive for scraped-off toy material) contaminated at our arithmetic mean concentration would be exposed to 0.2 ng/kg bw/day BDE-99. This compares closely to a health-based limit value (HBLV) proposed in The Netherlands of 0.23-0.30 ng/kg bw/day BDE-99. Of greater concern, the same child playing with a toy contaminated at the maximum concentration in this study would be exposed to 1.4 ng/kg bw/day BDE-99, thereby exceeding the HBLV. This paper is the first to consider BFR exposure via incidental ingestion of plastic from both contemporary and historical toys, revealing it to be considerable and for some children their most significant pathway of exposure., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Concentrations of 10 perfluoroalkyl substances (PFASs) were measured in 16 pools of human milk from Ireland. Only four PFASs were detected (PFOA, PFNA, PFHxS and PFOS), with concentrations dominated by PFOA which was detected in all samples at a median of 0.10 ng/mL. Concentrations and the relative abundance of PFASs in human milk from Ireland are within the range reported for other countries. Estimated exposures for nursing infants to perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) do not suggest a health concern. A one compartment pharmacokinetic model was used to predict the intakes of PFOS and PFOA required to support the observed concentrations in human milk. This suggests current adult exposure in Ireland to PFOS is below the provisional tolerable weekly intake (TWI) proposed by EFSA. In contrast, the model predicts that the maximum concentration detected in human milk in this study, implies a level of adult exposure that would exceed EFSA's provisional TWI for PFOA. As exposure of the Irish population to PFASs via drinking water, indoor air and dust is well-characterised, current understanding suggests that the major contributor to overall exposure of the Irish population is via the diet and/or less well-studied pathways like dermal uptake from PFAS-containing fabrics and cosmetics., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Acne vulgaris (AV) is an inflammatory skin disorder that may be associated with metabolic disorders. The relation between lipid profile in acne is not widely investigated. Chitinase-3-like protein 1 (YKL-40) has been found to be implicated in different inflammatory conditions., Aims: We aimed at investigating the role YKL-40 in acne pathogenesis and associated dyslipidemia in acne patients., Patients/methods: This study included 50 acne vulgaris patients and 30 matched control subjects. Serum YKL-40 in addition to lipid profile were assessed in all studied subjects., Results: Serum YKL-40 level was significantly elevated in acne patients than healthy controls (P < .001). We also found a significant positive correlations between serum YKL-40, serum TGs, TC, and LDL-C (P value: .022, .001, .017 respectively) while, a significant negative correlation between serum YKL-40 and HDL-c (P value: .036) was detected., Conclusion: Our study results suggest that YKL-40 might have a role in AV pathogenesis. In addition, it could provide a new potential link between inflammation and dyslipidemia observed in acne patients., (© 2019 Wiley Periodicals, Inc.)

This research investigates the means to improve the compressive strength of mortar mixtures through using novel mixtures. These mixtures include magnetic water (MW) and fly ash (FA). MW was obtained by circulating tap water (TW) through a magnetic field. The magnetization duration was represented by the number of cycles, the content of FA was replaced with cement, and the super plasticizer percentage (SP) and the curing age were used and evaluated experimentally for producing the mortar mixtures. Mortar flow, crushing compressive strength, and ultrasonic pulse velocity (UPV) tests were applied to evaluate the performances of mixing characteristics. The results demonstrate that the MW-treated mortar mixtures show higher compression strength results than those prepared by TW. The compressive strength was increased up to 60% with 150 cycles, a dose of 0.5% of SP and no FA content at the age of 56 days. The dose of SP can be cut down by a maximum of 40% to 50% in cementitious mortar. the workability was enhanced by a percentage of 70%.

Background: Data following laparoscopic sleeve gastrectomy (LSG) for type 2 diabetes mellitus obese patients are extremely variable and we herein present our results. Methods: The data of 320 (90 diabetic) obese patients who had LSG were retrieved from prospectively collected database. Postoperative weight loss and glycemic control were evaluated during 24 months follow-up. Results: Diabetic patients had a significantly higher percentage excess weight loss (%EWL) (60.21 ± 11 and 72.9 ± 13) than nondiabetics (53.4 ± 12 and 62.5 ± 29) at 12 and 24 months post LSG, respectively. Diabetic patients with body mass index (BMI) >40 kg/m 2 had significantly higher %EWL (64.17 ± 13 and 75.2 ± 16) than patients with BMI ≤40 at 12 and 24 months, respectively. The mean glycated hemoglobin and fasting blood glucose were 6.6% ± 1.4%, 6.1% ± 1.1%, 5.9% ± 1.2%, 5.8% ± 0.5%, and 110 ± 1.6 mg/dL, 106.7 ± 1.8 mg/dL, 99.2 ± 1.9 mg/dL, and 98.1 ± 1.2 mg/dL at 1, 6, 12, and 24 months, respectively. All patients had complete diabetes remission at 12 months, and this was maintained at 24 months. Conclusion: Diabetic obese patients with BMI >40 kg/m 2 , had a better %EWL compared with nondiabetics and to diabetics with lower BMI. Diabetes remission started early at 1 month. At 12 months, all diabetics had complete diabetes remission and this was maintained at 24 months. Our results need to be validated in a larger study, which evaluates impact of gastrointestinal motility on diabetes control.