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In the country presently, preclinical medical students are not routinely exposed to real patients. Thus, when they start clinical postings, they are found to have poor clinical reasoning skills. Simulated virtual patients (SVPs) can improve clinical skills without endangering real patients. This pilot study describes the development of two SVPs in endocrine physiology and their validation in terms of acquisition of clinical knowledge and student engagement. Two SVPs, Nandini Sharma (unintentional weight gain) and Sunil Yadav (polyuria), were created and published on the i-Human Patients platform through an iterative, interdisciplinary, and transdisciplinary collaborative process using the conceptual framework of Kim et al. (Kim, S., Phillips, W. R., Pinsky, L., Brock, D., Phillips, K., Keary, J. "Med Educ" 40: 867-876, 2006). After internal and external peer validation, the SVPs were piloted on 40 students (20 students per virtual patient) over 2 wk. A cognitive pretest was conducted before exposure, and a posttest soon after. Faculty and student feedback were collected. Faculty found SVPs authentic, helpful as teaching-learning tools, and useful for giving feedback and for assessment. Students found SVPs more engaging than paper cases and helpful in developing clinical reasoning and in imparting clinical exposure. Pretest and posttest scores indicated knowledge gain (P<0.01). Although challenging to create, SVPs created on the i-Human Patients platform improved learning in endocrine physiology and were well accepted by students and faculty as a means to provide early clinical exposure. More SVPs can be developed through collaboration between stakeholder departments and integrated into the curriculum for greater benefit.

Plastic bronchitis, a rare but serious clinical condition, is commonly seen after Fontan surgeries in children. It may be a manifestation of suboptimal adaptation to the diversion of systemic blood flow directly into the pulmonary circulation, thereby leading to unfavorable hemodynamics, which causes the formation of bronchial casts. We hereby report a child who had not responded to conventional medical management of the bronchial casts. He was then subjected to cardiac catheterization where balloon dilatation of the Fontan fenestration was done, following which he remained asymptomatic for 3 months of follow-up.

Tissue factor pathway inhibitor-2 (TFPI-2) is a homologue of TFPI-1 and contains three Kunitz-type domains and a basic C terminus region. The N-terminal domain of TFPI-2 is the only inhibitory domain, and it inhibits plasma kallikrein, factor XIa, and plasmin. However, plasma TFPI-2 levels are negligible (≤20 pM) in the context of influencing clotting or fibrinolysis. Here, we report that platelets contain significant amounts of TFPI-2 derived from megakaryocytes. We employed RT-PCR, Western blotting, immunohistochemistry, and confocal microscopy to determine that platelets, MEG-01 megakaryoblastic cells, and bone marrow megakaryocytes contain TFPI-2. ELISA data reveal that TFPI-2 binds factor V (FV) and partially B-domain-deleted FV (FV-1033) with K(d) ~9 nM and binds FVa with K(d) ~100 nM. Steady state analysis of surface plasmon resonance data reveal that TFPI-2 and TFPI-1 bind FV-1033 with K(d) ~36-48 nM and bind FVa with K(d) ~252-456 nM. Further, TFPI-1 (but not TFPI-1161) competes with TFPI-2 in binding to FV. These data indicate that the C-terminal basic region of TFPI-2 is similar to that of TFPI-1 and plays a role in binding to the FV B-domain acidic region. Using pull-down assays and Western blots, we show that TFPI-2 is associated with platelet FV/FVa. TFPI-2 (~7 nM) in plasma of women at the onset of labor is also, in part, associated with FV. Importantly, TFPI-2 in platelets and in plasma of pregnant women inhibits FXIa and tissue-type plasminogen activator-induced clot fibrinolysis. In conclusion, TFPI-2 in platelets from normal or pregnant subjects and in plasma from pregnant women binds FV/Va and regulates intrinsic coagulation and fibrinolysis.

In this work, we delved into the intriguing realm of nuclear physics by investigating fusion reactions initiated by 7 0 Zn projectiles colliding with various stable isotopes of thorium nuclei, including 2 2 7 − 2 3 2 , 2 3 4 Th. Our primary objective was the synthesis of the superheavy element Z = 1 2 0. To achieve this, we employed an advanced statistical model to evaluate the evaporation residue cross-sections. Remarkably, we observed that the fusion reaction between 7 0 Zn and 2 3 1 Th exhibited the highest evaporation residue cross-sections, reaching a peak value. Furthermore, the 3n channel within this fusion reaction yielded substantially larger evaporation cross-sections, with a notable value of 0.89 picobarns. The predicted cross-sections fall within the measurable range, making them highly valuable for experimental endeavors aimed at synthesizing the superheavy element Z = 1 2 0. This research not only contributes to our understanding of nuclear reactions but also holds promise for expanding our knowledge of the heaviest elements in the periodic table, potentially opening new frontiers in nuclear science. [ABSTRACT FROM AUTHOR]

Objective: Preoperative fasting leads to a catabolic state aggravated by surgical stress. This leads to poor patient outcomes. This study aimed to determine the effect of preoperative oral carbohydrate administration on perioperative hyperglycemia and patient comfort. Methods: This prospective, randomized study was conducted on 60 adult American Society of Anesthesiologist I/II patients undergoing hip fracture fixation after obtaining institutional ethical committee clearance. Patients were randomly kept conventionally fasted before surgery (group F, n = 30) or were given oral carbohydrate 2 h before surgery (group C, n = 30). Under all aseptic precautions, a combined spinal epidural block was administered, and surgery was allowed. The primary outcome was blood glucose, and secondary outcomes included incidence of postoperative hyperglycemia, insulin level, blood urea, hunger, thirst, and anxiety. Results: Blood glucose levels were not statistically different between the two groups at baseline (T0; P=0.400), immediately after surgery (T1; P=0.399) and 24h after surgery (T2; P=0.619). The incidence of postoperative hyperglycemia was significantly higher in group F than in group C (P=0.045) at T2. Insulin levels, blood urea levels, and hunger scores were also not statistically different between the groups. The thirst and anxiety scores were lower at T0 and T1 in group C. Conclusion: Preoperative oral carbohydrate administration does not prevent perioperative increases in blood glucose levels. However, it reduces the incidence of perioperative hyperglycemia and decreases perioperative thirst and anxiety, thereby improving the quality of perioperative patient care. [ABSTRACT FROM AUTHOR]

The textile industry now produces thousands of tons of waste worldwide, and the total amount of discarded material waste increases yearly. Hygrothermal aging of cotton/E-glass (hybrid) fiber reinforced with various proportions of graphene oxide (0%, 1%, 3%, 5%, 7%, and 9%) was performed. Epoxy and vinyl ester (50:50) have been chosen because of the Interpenetrating Polymer Networks (IPNs) concept. Laminates were subjected to 50, 60, and 70°C temperatures for 180 days. Further, Tg and the degree of cross-linking have been determined by using differential scanning calorimetry (DSC). DSC analysis proves that a hot water bath enhances the cross-linking of the polymer. IPN laminates were also intermittently weighed for water uptake, and their consecutive mechanical properties like tensile, flexural, and impact strength were obtained. From this work, it was observed that the addition of 5 w.t% graphene oxide in cotton/E glass fiber vinyl ester/epoxy resin hybrid IPN composites showed a tensile strength of 375.61 MPa, flexural strength of 393.54 MPa, Interlaminar shear strength (ILSS) of 49 MPa and the impact strength of 22.54 MPa. Moreover, the lowest inclusion of particulate addition exhibits better mechanical properties than (up to 5% of GO) the highest particulate loading into the matrix. SEM study was conducted on the broken specimens to know the impact of diffusion characteristics on the physical properties of the IPN composites. Highlights • Natural and synthetic fibers are used as reinforcements. • Waste cotton/E glass fiber vinyl epoxy composites are fabricated. • Laminates were subjected to diverse temperatures for 180 days. • The moisture diffusion coefficient is proportional to water temperature. • Bathtub temperature affects the tensile strength of the laminate. [ABSTRACT FROM AUTHOR]

Graphene-based materials have recently gained attention for regenerating various tissue defects including bone, nerve, cartilage, and muscle. Even though the potential of graphene-based biomaterials has been realized in tissue engineering, there are significantly many more studies reporting in vitro and in vivo data in bone tissue engineering. Graphene constructs have mainly been studied as two-dimensional (2D) substrates when biological organs are within a three-dimensional (3D) environment. Therefore, developing 3D graphene scaffolds is the next clinical standard, yet most have been fabricated as foams which limit control of consistent morphology and porosity. To overcome this issue, 3D-printing technology is revolutionizing tissue engineering, due to its speed, accuracy, reproducibility, and overall ability to personalize treatment whereby scaffolds are printed to the exact dimensions of a tissue defect. Even though various 3D-printing techniques are available, practical applications of 3D-printed graphene scaffolds are still limited. This can be attributed to variations associated with fabrication of graphene derivatives, leading to variations in cell response. This review summarizes selected works describing the different fabrication techniques for 3D scaffolds, the novelty of graphene materials, and the use of 3D-printed scaffolds of graphene-based nanoparticles for bone tissue engineering.

Background: Oral rehydration salts (ORS) therapy for diarrheal diseases is considered an effective therapy that can be applied in many resource-poor settings. Nevertheless, it has been consistently underutilized, and as a result, its potential to reduce child mortality has not been fully exploited. In Ethiopia, the use of ORS therapy for children under five has been inadequate. Like any other health behavior, the provision of ORS therapy to children during diarrheal episodes by caregivers is complex and context dependent. Identifying the factors may help promote wider application. Design and methods: We used data from the 2016 Ethiopia Demographic and Health Survey (EDHS-2016). Samples were selected by a two-stage stratified cluster sampling method. We used data on children under five years of age whose mothers (aged 15-49 years) reported that the child had had diarrhea within two weeks before the survey was conducted (n=1221). The dependent variable was whether these children received ORS therapy. The contextual independent factors were socio-demographic variables (mothers’ age, child’s age, child’s sex, child’s place of residence, household wealth, and mother/ husband/partner’s education levels and work status), as well as media exposure and healthcare utilization. Results: The prevalence of ORS therapy use among the children was 30%. Mothers who had made at least four prenatal visits during their last pregnancy were 87% more likely to use ORS therapy for their children than those who had fewer prenatal visits (OR=1.874; CI: 1.140-3.082; p=0.013). Conclusions: Integrating efforts for scaling-up ORS use with prenatal health care services may have an extra benefit of promoting children’s wellbeing and survival.

The interface between a surgical implant and tissue consists of a complex and dynamic environment characterized by mechanical and biological interactions between the implant and surrounding tissue. The implantation process leads to injury which needs to heal over time and the rapidity of this process as well as the property of restored tissue impact directly the strength of the interface. Bleeding is the first and most relevant step of the healing process because blood provides growth factors and cellular material necessary for tissue repair. Integration of the implants placed in poorly vascularized tissue such as articular cartilage is, therefore, more challenging than compared with the implants placed in well-vascularized tissues such as bone. Bleeding is followed by the establishment of a provisional matrix that is gradually transformed into the native tissue. The ultimate goal of implantation is to obtain a complete integration between the implant and tissue resulting in long-term stability. The stability of the implant has been defined as primary (mechanical) and secondary (biological integration) stability. Successful integration of an implant within the tissue depends on both stabilities and is vital for short- and long-term surgical outcomes. Advances in research aim to improve implant integration resulting in enhanced implant and tissue interface. Numerous methods have been employed to improve the process of modifying both stability types. This review provides a comprehensive discussion of current knowledge regarding implant-tissue interfaces within bone and cartilage as well as novel approaches to strengthen the implant-tissue interface. Furthermore, it gives an insight into the current state-of-art biomechanical testing of the stability of the implants. Current knowledge reveals that the design of the implants closely mimicking the native structure is more likely to become well integrated. The literature provides however several other techniques such as coating with a bioactive compound that will stimulate the integration and successful outcome for the patient.