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Metabolic syndrome (MetS) is characterized as a gathering of various metabolic disorders, for example, hyperglycemia, dyslipidemia, and obesity. The present research was conducted to prepare fortified almond milk as functional beverages and evaluate their protective effect against MetS and associated hepatic and vascular complications. Three beverages (I, II, and III) were prepared by fortification almond milk with carrot juice or powder of quinoa seeds and carrot juice or oat powder and banana juice. The sensory attributes, physicochemical properties, bioactive compounds (total phenolic, beta-carotene, tocopherols) and B-complex vitamins were determined in the beverages. In-vitro antioxidant activity of the beverages was assessed. MetS was induced in rats via feeding on high-fat high-fructose diet (HFHF). The biochemical (lipid profile, oxidative stress, liver, and kidney functions), nutritional and histopathological parameters were assessed in rats. The beverage I recorded the highest sensory attributes' scores. The physicochemical properties of the beverages revealed that acidity and viscosity of all beverages ranged from 4.55 to 4.88 and from 40 to 59, respectively. The beverage I showed the highest content of alpha-tocopherol (14.994 μg/g) and beta-carotene (104.541 μg/g), while the beverage II showed the highest content of gamma-tocopherol (0.557 μg/g), folic acid (0.806 μg/g), and total phenols (147.43 μg GAE/g). The results of animals revealed that the beverage II was the most promising in attenuation levels of total cholesterol, triglycerides, low-density lipoprotein cholesterol, malondialdehyde, and tumor necrosis factor-alpha. Also, the beverage II was the superior in the protection of the liver and heart tissues as reflected by the histopathological examination findings. So, it can be concluded that the newly prepared almond milk with quinoa seeds and carrot juice could be used as an effective functional beverage for the prevention of MetS and its complications., (© 2020 Published by Elsevier Ltd.)

Ramírez-Vélez, R, Castro-Astudillo, K, Correa-Bautista, JE, González-Ruíz, K, Izquierdo, M, García-Hermoso, A, Álvarez, C, Ramírez-Campillo, R, and Correa-Rodríguez, M. The effect of 12 weeks of different exercise training modalities or nutritional guidance on cardiometabolic risk factors, vascular parameters and physical fitness in overweight adults: cardiometabolic high-intensity interval training-resistance training randomized controlled study. J Strength Cond Res 34(8): 2178-2188, 2020-Evidence suggests that exercise training improves cardiometabolic risk factors. The aim of this study was to investigate whether 12 weeks of high-intensity interval training (HIIT), resistance training (RT), concurrent training (CT = HIIT + RT), or nutritional guidance (NG) induced improvements in cardiometabolic risk factors, vascular parameters, and physical fitness in overweight adults, and to compare the responses between the 4 intervention groups. This is a twelve-weeks factorial randomized design examining the effects of different exercise regimes and/or NG on anthropometric and body composition (fat and lean mass at whole body, trunk fat, fat mass index, appendicular muscle mass, and waist circumference); cardiometabolic risk factors and vascular parameters (blood lipids, fasting glucose, blood pressure, flow-mediated dilation [FMD%], aortic pulse wave velocity (PWV), and augmentation index); and physical fitness (cardiorespiratory fitness and handgrip strength). Adjusted mixed linear models revealed a significant improvement in cardiorespiratory fitness (mL·kg·min): HIIT +8.3, RT +4.1, and CT +6.3 (all p < 0.001). The improvement difference between the groups was statistically significant between the HIIT and NG group (p = 0.014), (time × group interaction F(23.564); p < 0.001; η partial = 0.365). In addition, the RT and CT groups have a significant positive impact on PWV (m·s) (d = 0.391 and 0.229 respectively; p < 0.001, (time × group interaction F(5.457); p = 0.003; η partial = 0.280). Hereafter, the RT group has a significant positive impact on the FMD (%) in comparison to HIIT, CT, or NG group (time × group interaction F(2.942); p = 0.044; η partial = 0.174). The main findings of this study are that 12 weeks of HIIT leads to significant improvements in cardiorespiratory fitness, whereas RT resulted in improvements in the vascular profile, supporting the positive effect of both training programs for cardiometabolic risk factors in sedentary and overweight adults.

Introduction: Cohort studies have recently initiated a paradigm shift in the field of preoperative bowel preparation. Indeed, the adjunction of oral antibiotics (OAB) to mechanical bowel preparation (MBP) is now the gold standard for the American guidelines. However, this strategy is highly controverted., Areas Covered: This review was an up-to-date analysis of literature on bowel preparation. We conducted a systematic review for randomized controlled trials (RCTs) and meta-analyses published since 2009. A non-exhaustive overview of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) cohort studies and the international guidelines was also given, and future leads were discussed., Expert Opinion: The methodology of the ACS NSQIP studies did not allow a strong conclusion in favor of the association MBP+OAB. Besides, guidelines were not univocal, with non-American guidelines promoting no preparation at all. RCTs favored OAB alone: indeed, MBP+OAB showed no benefits in terms of surgical site infection (SSI) except when compared to MBP alone, while OAB alone seemed superior to no preparation. Likewise, the meta-analyses also favored OAB alone in terms of overall SSI and organ space infection. Large RCTs are currently running and may change these conclusions. Finally, microbiota is a future lead for personalized OAB.

The objectives of this secondary analysis are (1) to investigate the differential effects of exercise training modalities-high-intensity interval training (HIIT), resistance training (RT), combined training (CT = HIIT + RT), and/or nutritional guidance (NG) alone-on local fat/lean mass indexes in adults with excess of adiposity; (2) to identify the individual patterns of response based on either a clinical criterion of weight loss (≥5%) and/or technical error (TE) of measurement of local fat/lean mass indexes; and (3) to assess the individual change for body composition parameters assigned either to HIIT, RT, CT, and/or NG groups utilizing a TE. A 12-week trial was conducted in 55 participants randomized to one of the four interventions. The primary outcome was clinical change in body weight (i.e., weight loss of ≥5%). Secondary outcomes included change in ratio of android and gynoid fat mass, as well as local fat and lean mass indexes (arms, trunk, and legs), before and after intervention. The main findings from the current analysis revealed that (i) after 12 weeks of follow-up, significant decreases in several body composition indexes were found including body weight, arm, trunk, and legs fat mass, and android and gynecoid fat mass were observed in HIIT, RT, and CT groups ( p < 0.05); (ii) a significant proportion of individuals showed a positive response following 12 weeks of training, led by the HIIT group with 44% and followed by RT with 39% in 9 indexes; (iii) the HIIT group showed lowest rates of adverse responders with (6%); and (iv) the individual patterns of response utilizing clinically meaningful weight loss were not necessarily associated with the corresponding individual training-induced changes in body composition indexes in adults with excess of adiposity. Overall, the study suggests that HIIT has an important ability to reduce the prevalence of non-response to improve body composition indexes.

Aim: This paper aims to study the correlation between religiosity and research misconduct in graduate nursing students and determine other factors that may have an impact on research misconduct in graduate nursing students., Design: A cross-sectional descriptive study was used to collect data from 49 graduate nursing students., Method: The target population comprised all graduate nursing students enrolled at Jordan University of Science and Technology, Jordan. Participants who met the criteria were approached by the researcher and given a letter that provided detailed information about the study, and their informed consent was obtained. The questionnaire was consisted of three parts: a demographic datasheet, research misconduct tool and a religiosity questionnaire., Results: The results demonstrated a significant interaction between perceptions about research misconduct and one of predictors such as religiosity, where higher religiosity was associated with perceiving research misconduct as a critical issue., Competing Interests: The authors have no funding or conflict of interest to disclose. All authors participated in all research steps., (© 2020 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Introduction: Electronic cigarette (ECIG) use has increased worldwide, including among pregnant and breastfeeding women. In this study, we examined the effect of ECIG aerosol exposure during gestation and lactation on learning and memory of adult male offspring rats., Methods: Rats were exposed to either fresh air or ECIG aerosol for one hour daily during gestational period as well as days 4-21 of lactation. Male offspring were followed through 19 weeks and then spatial learning and memory were tested by radial arm water maze (RAWM). The hippocampus was examined for biomarkers of harm, including oxidative stress, superoxide dismutase, catalase, glutathione peroxidase and thiobarbituric acid reactive substances and brain derived neurotrophic factor (BDNF)., Results: Relative to exposure to fresh air, exposure to ECIG aerosol during gestation/lactation impaired long-term memory in adult offspring (P < 0.05). This impairment was associated with increased activity of superoxide dismutase in the hippocampus (P < 0.05). BDNF and the other tested oxidative stress biomarkers were not affected by ECIG aerosol exposure (p > 0.05)., Conclusions: In conclusion, ECIG aerosol exposure during gestation and lactation impaired long-term memory and increased the activity of superoxide dismutase in the hippocampus of offspring adult rats. These results support the development of strategies to enhance ECIG cessation during pregnancy and breastfeeding., Competing Interests: Declaration of interest Dr. Eissenberg is a paid consultant in litigation against the tobacco industry and electronic cigarette industry and Drs. Eissenberg and Shihdaeh are named on a patent application for a device that measures the puffing behavior of electronic cigarette users. All other authors have no disclosures., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: Investigate the prevalence of vitamin D deficiency in an equatorial population through a large-sample study., Methods: Cross-sectional study with 30,224 healthy individuals from the North Region, in Brazil (Amazônia - state of Pará), who had 25-hydroxy-vitamin D (25(OH)D) and intact parathyroid hormone (PTH) serum levels measured by immunoassay method. Those with history of acute or chronic diseases were excluded. Abnormal levels of calcium, creatinine, glycemia and albumin were also exclusion criteria., Results: 25(OH)D levels were 29.1 ± 8.2 ng/mL and values <12.7 ng/mL were equal to < -2 s.d. below average. Hypovitaminosis D was present in 10% of subjects according to the Institute of Medicine (values <20 ng/mL) and in 59%, in consonance with Endocrine Society (values 20-30 ng/mL as insufficiency and <20 ng/mL as deficiency) criteria. Individuals were divided according to four age brackets: children, adolescents, adults and elderly, and their 25(OH)D levels were: 33 ± 9; 28.5 ± 7.4; 28.3 ± 7.7; 29.3 ± 8.5 ng/mL, respectively. All groups differed in 25(OH)D, except adolescents vs adults. Regression model showed BMI, sex, living zone (urban or rural) and age as independent variables to 25(OH)D levels. Comparing subjects with vitamin D deficiency (<20 ng/mL) to those with vitamin D insufficiency (20-30 ng/mL), a difference between PTH levels in these two groups was observed (95.9 ± 24.7 pg/mL vs 44.2 ± 64.5 pg/mL; P < 0.01). Additionally, the most accurate predictive vitamin D level for subclinical hyperparathyroidism in ROC curve was 26 ng/mL., Conclusion: Our equatorial population showed low prevalence of vitamin D hypovitaminosis ranging with age bracket. The insufficient category by Endocrine Society was corroborated by our PTH data.

Background: There is a level-1 evidence indicating that postoperative antibiotics are unnecessary following cholecystectomy for grade I or II acute calculous cholecystitis (ACC). We wanted to evaluate the applications of this recommendation in clinical practice four years after the original publication in ABCAL-participating centers., Methods: A retrospective analysis of patients operated for grade I or II ACC from January to December 2016 in ABCAL-participating centers was performed. Inclusion criteria were the same as for the ABCAL-study. The primary endpoint was the postoperative antibiotic administration rate. The secondary endpoints were postoperative outcomes., Results: Of the 283 patients included, 64% received postoperative antibiotics. Only 19% received antibiotics after POD1. The perioperative outcomes were similar between those that did or did not receive antibiotics after POD1. The median [range] length of stay was significantly shorter in patients who did not receive postoperative antibiotics (4 days [1-20]) compared to the others (6 days [1-50], p > 0.001)., Conclusion: Despite strong recommendations included in the Tokyo 2018 guidelines, the results of the ABCAL-study are poorly applied even if the absence of postoperative antibiotics has no impact on morbidity. It is important to stress that postoperative antibiotics are not necessary after cholecystectomy for grade I or II ACC., (Copyright © 2019 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)

Cytotoxic CD4 T cells are linked to cardiovascular morbidities and accumulate in both HIV and CMV infections, both of which are associated with increased risk of cardiovascular disease (CVD). In this study, we identify CMV coinfection as a major driver of the cytotoxic phenotype, characterized by elevated CD57 expression and reduced CD28 expression, in circulating CD4 T cells from people living with HIV infection, and investigate potential mechanisms linking this cell population to CVD. We find that human CD57 + CD4 T cells express high levels of the costimulatory receptor CD2 and that CD2/LFA-3 costimulation results in a more robust and polyfunctional effector response to TCR signals, compared with CD28-mediated costimulation. CD57 + CD4 T cells also express the vascular endothelium-homing receptor CX3CR1 and migrate toward CX3CL1-expressing endothelial cells in vitro. IL-15 promotes the cytotoxic phenotype, elevates CX3CR1 expression, and enhances the trafficking of CD57 + CD4 T cells to endothelium and may therefore be important in linking these cells to cardiovascular complications. Finally, we demonstrate the presence of activated CD57 + CD4 T cells and expression of CX3CL1 and LFA-3 in atherosclerotic plaque tissues from HIV-uninfected donors. Our findings are consistent with a model in which cytotoxic CD4 T cells contribute to CVD in HIV/CMV coinfection and in atherosclerosis via CX3CR1-mediated trafficking and CD2/LFA-3-mediated costimulation. This study identifies several targets for therapeutic interventions and may help bridge the gap in understanding how CMV infection and immunity are linked to increased cardiovascular risk in people living with HIV infection., (Copyright © 2020 by The American Association of Immunologists, Inc.)

Background: Both chronic hypoxia (CH) and long-term chronic intermittent hypoxia (CIH) exposure lead to right ventricular hypertrophy (RVH). Weight loss is an effective intervention to improve cardiac function and energy metabolism in cardiac hypertrophy. Likewise, caloric restriction (CR) also plays an important role in this cardioprotection through AMPK activation. We aimed to determine the influence of body weight (BW) on RVH, AMPK and related variables by comparing rats exposed to both hypoxic conditions., Methods: Sixty male adult rats were separated into two groups ( n = 30 per group) according to their previous diet: a caloric restriction (CR) group and an ad libitum (AL) group. Rats in both groups were randomly assigned to 3 groups: a normoxic group (NX, n = 10), a CIH group (2 days hypoxia/2 days normoxia; n = 10) and a CH group ( n = 10). The CR group was previously fed 10 g daily, and the other was fed ad libitum. Rats were exposed to simulated hypobaric hypoxia in a hypobaric chamber set to 428 Torr (the equivalent pressure to that at an altitude of 4,600 m above sea level) for 30 days. Measurements included body weight; hematocrit; serum insulin; glycemia; the degree of RVH (Fulton's index and histology); and AMPK, mTOR, and PP2C expression levels in the right ventricle determined by western blotting., Results: A lower degree of RVH, higher AMPK activation, and no activation of mTOR were found in the CR groups exposed to hypobaric hypoxia compared to the AL groups ( p < 0.05). Additionally, decreased glycemia and serum insulin levels were observed. Interestingly, PP2C expression showed an increase in the AL groups but not in the CR groups ( p < 0.05)., Conclusion: Maintaining a low weight before and during exposure to high-altitude hypoxia, during either CH or CIH, could prevent a major degree of RVH. This cardioprotection would likely be due to the activation of AMPK. Thus, body weight is a factor that might contribute to RVH at high altitudes., (Copyright © 2020 Flores, Siques, Brito, Ordenes, Arriaza, Pena, León-Velarde, López, López de Pablo and Arribas.)

Objective: Granular cell tumour (GCT) is a benign neoplasm that originates from Schwann cells. Within the oral cavity, it usually appears as a lingual nodule and especially amongst female adults. Histologically, GCT shows a proliferation of polygonal cells with eosinophilic granular cytoplasm, which can be associated with a pseudoepitheliomatous hyperplasia (PEH). In this study, we analyse the main clinicopathological data of intraoral GCT and we compare our results with previous studies., Material and Methods: We have studied a series of 56 cases of oral GCT in Spain and Brazil, and we have conducted a systematic review in PubMed, Web of Knowledge and Scopus databases, using the keywords: "granular cell tumour" and oral., Results: In our series, GCT appeared as an asymptomatic benign tumour that is more frequent in women and in the tongue. PEH was observed in 32% of the lesions. In the review, we collected 282 cases of oral GCT with a similar clinical profile; seven patients had multiple lesions, and 33% of the cases presented PEH. No cases of malignant oral GCT have been described to date. GCT is an uncommon oral benign neoplasm, mainly unique and asymptomatic, derived from Schwann cells., Conclusions: Although the etiopathogenesis of this oral tumour is unknown, its characteristics suggest that it could have a reactive nature. Conducting a complete clinicopathological study in all intraoral GCT is fundamental in order to dismiss other entities, including oral carcinoma., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. All rights reserved.)

A new approach for biogenic amines (BA) determination in fermented beverages was developed coupling ultrafast dansylation conditions with ultra-high-performance liquid chromatography (UHPLC) method. Derivatization conditions for 8 amines analysis were optimized using D-optimal and central composite designs reducing in 88% the reaction time. Dansylated amines were separated on C18 column using a mobile phase composed of ammonium formate buffer and acetonitrile. Detection was performed by UV and fluorescence. Migration from conventional HPLC to UHPLC allowed a 60% reduction in analysis. The developed method was validated following ICH recommendations. Calibration data fitted a linear regression model with R 2 were values highest to 0.984. Repeatability and intermediate precision in matrix showed relative standard deviation (RSD) values lower than 4.86 and 11.53%, respectively. Detection and quantification limits ranged from 0.03 to 0.18 and from 0.20 to 0.59 mg mg L -1 . BA content in beer and wine samples were 10.53 to 73.17 mg L -1., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Clays, hydrous aluminous phyllosilicates, have a significant impact on the interpretation of physical measurements and properties of porous media. In particular, the presence of paramagnetic and/or ferromagnetic ions like iron, nickel, and magnesium in clays can complicate the analysis of nuclear magnetic resonance (NMR) data for porous media characterization. This is due to the internal magnetic field gradient induced by the clay minerals. In this study, we aim to investigate the impact of clay content on spin-spin relaxation time ( T 2 ), which is strongly influenced by the pore surface chemistry. Seven rock core plugs, characterized with variable clay content, were used for this purpose. The clay mineralogy and volume were determined by means of quantitative evaluation of minerals by scanning electron microscopy (QEMSCAN). The T 2 relaxation time was measured using a Carr-Purcell-Meiboom-Gill (CPMG) sequence with variable echo spacing ( T E ). The maximum percentage difference in dominant T 2 values (MRD T 2 ) between shortest and longest echo spacing was subsequently correlated with clay content obtained from QEMSCAN. Our results show that the reduction in T 2 distribution with increasing echo time T E is more significant in samples characterized by higher clay contents. The MRD T 2 was found to be strongly correlated with clay content. An analytical equation is presented expressing MRD T 2 as a function of clay content providing a quick and non-destructive approach for clay content estimation. Moreover, the MRD T 2 -clay content relationship showed a nonlinear behavior: MRD T 2 increases drastically as the clay content increases up to 15%, beyond which the rate of MRD T 2 change with clay content diminishes. This behavior could be attributed to the clay distribution. At higher clay contents (above 15%), it is more likely for clay to form clusters (structural clays), which will not significantly increase the clay surface in contact with the pore fluid. Further, experimental data suggests that ignoring the impact of clay on internal magnetic gradients and T 2 signal may result in considerable underestimation of the actual pore size distribution., Competing Interests: The authors declare no competing financial interest., (Copyright © 2020 American Chemical Society.)

Background Natural anti-inflammatory nutraceuticals may be useful in suppressing the incessant aggravation of rheumatoid arthritis. Chia seeds as a natural source of antioxidants help prevent several oxidative stress-mediated diseases. The current study was focused on arthritis combined with obesity and evaluated the validation of oil and mucilage extracted from chia seeds as anti-inflammatory nutraceuticals in obese and non-obese adjuvant arthritic rat model. Methods Chia seeds oil was extracted by pressing method, whereas the mucilage was extracted using water (50 °C for 30 min). Oil and freeze-dried mucilage were tested for their anti-inflammatory effects using 48 male Sprague-Dawley rats. Obesity was developed in rats after 8 weeks of feeding on high-fat high-sucrose diet; on the first day of the ninth week, chia seeds oil and mucilage were administrated for 21 days, and arthritis was induced either in obese or non-obese rats via the injection with Freund's complete adjuvant. Swelling of the paw was then measured. Plasma tumor necrosis factor (TNF-α), lipid profile, liver and kidney functions, serum lipid peroxidation, and erythrocyte catalase activity were determined. Results Results emphasized that arthritis with obesity resulted in the elevation of the swelling of the paw, TNF-α, dyslipidemia, and oxidative stress. Chia seeds oil and mucilage, more promisingly the oil, attenuated TNF-α and the swelling of the paw, improved lipid profile, and diminished the oxidative stress both in obese and non-obese arthritic rats. Conclusions Results showed that chia seeds oil and mucilage exhibited anti-inflammatory effects against adjuvant-induced arthritis in obese and non-obese rats.

The subject of this paper is the review of advanced technology used in hydraulic systems. The technology in question is termed Independent Metering (IM); this is used in hydraulically driven mobile machinery, such as agricultural, construction, municipal, and forestry vehicles. The idea behind the concept is to modify the connection between the actuator, which could be a cylinder or a motor, and a flow control valve. Traditionally, spool hydraulic valves were used to control the fluid flow into and out of hydraulic actuators. This keeps the meter-in and the meter-out of the actuator mechanically connected due to the construction of these valves. This connection makes the control system blind to pressure changes in one of the hydraulic chambers in the actuator. This, in turn, reduces the overall system controllability. It also increases energy losses, especially under an overrunning load. These two main weaknesses led researchers to break this mechanical connection and get into a new technology with different characteristics. The proposed technology was called Independent Metering. New and more complex control techniques can now be applied to the hydraulic systems using this technology that were not possible before or could be applied to more conventional servo design. This paper reviews Independent Metering (IM) and the technologies used or developed in this field to date. The paper reviews the state of art hydraulic technologies and indicates the links between them and IM. It also reviews the different types of hydraulic valves used when implementing IM. This review also discusses some control algorithms, IM layouts, IM challenges, and identifies where further improvements may be achieved., 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 © 2019 ISA. Published by Elsevier Ltd. All rights reserved.)

Background The number of global clinical trials is increasing. Recruitment rate in clinical trials is a challenging task that affects sample size, power of the study, and adequate representation of the targeted population. An understanding of the worries and reasons why patients may refrain from participation in trials may lead to improved enrollment rates. Objectives To assess the rate of patients who are willing to participate in clinical trials, and aspects that might have an impact on the patients' willingness to participate. Setting Government tertiary hospital in Jordan. Methods This is a cross-sectional study. Patients were interviewed by pharmacists in different clinics in a tertiary hospital and information was collected using a data collection sheet. Main outcome measure Factors that might predict the inclination of a patient to participate in clinical trials, and the rate of willingness to participation in randomized controlled trials in cancer patients compared to non-cancer patients. Results A total of 1193 participants were enrolled in the study, one hundred and thirty-five participants (11.3%) had cancer and 80% of the participants had at least one chronic medical condition. Majority of patients (n = 882, 73.9%) believed that trials were safe and 1106 (92.7%) patients thought they were important. Age, education level, income, having cancer or any chronic medical condition, and degree of control of chronic diseases were statistically significant predictors of the willingness of patients to participate in trials. Patients with cancer had a higher rate of acceptance to participation in randomized controlled trials compared to non-cancer patients, 80.0% versus 62.4%, p value < 0.001. Conclusion In general, almost two-thirds of patients were willing to participate in clinical trials, with a higher rate in cancer patients. Factors such as education level, income, and extent of control of medical conditions that might refrain patients from enrollment in trials will lower recruitment rate and must be addressed and taken into consideration before launching clinical trials.

Objectives: To provide an update to the 1999 French guidelines on "Muscle relaxants and reversal in anaesthesia", a consensus committee of sixteen experts was convened. A formal policy of declaration and monitoring of conflicts of interest (COI) was developed at the outset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding (i.e. pharmaceutical, medical devices). The authors were required to follow the rules of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE®) system to assess the quality of the evidence on which the recommendations were based. The potential drawbacks of making strong recommendations based on low-quality evidence were stressed. Few of the recommendations remained ungraded., Methods: The panel focused on eight questions: (1) In the absence of difficult mask ventilation criteria, is it necessary to check the possibility of ventilation via a facemask before muscle relaxant injection? Is it necessary to use muscle relaxants to facilitate facemask ventilation? (2) Is the use of muscle relaxants necessary to facilitate tracheal intubation? (3) Is the use of muscle relaxants necessary to facilitate the insertion of a supraglottic device and management of related complications? (4) Is it necessary to monitor neuromuscular blockade for airway management? (5) Is the use of muscle relaxants necessary to facilitate interventional procedures, and if so, which procedures? (6) Is intraoperative monitoring of neuromuscular blockade necessary? (7) What are the strategies for preventing and treating residual neuromuscular blockade? (8) What are the indications and precautions for use of both muscle relaxants and reversal agents in special populations (e.g. electroconvulsive therapy, obese patients, children, neuromuscular diseases, renal/hepatic failure, elderly patients)? All questions were formulated using the Population, Intervention, Comparison and Outcome (PICO) model for clinical questions and evidence profiles were generated. The results of the literature analysis and the recommendations were then assessed using the GRADE® system., Results: The summaries prepared by the SFAR Guideline panel resulted in thirty-one recommendations on muscle relaxants and reversal agents in anaesthesia. Of these recommendations, eleven have a high level of evidence (GRADE 1±) while twenty have a low level of evidence (GRADE 2±). No recommendations could be provided using the GRADE® system for five of the questions, and for two of these questions expert opinions were given. After two rounds of discussion and an amendment, a strong agreement was reached for all the recommendations., Conclusion: Substantial agreement exists among experts regarding many strong recommendations for the improvement of practice concerning the use of muscle relaxants and reversal agents during anaesthesia. In particular, the French Society of Anaesthesia and Intensive Care (SFAR) recommends the use of a device to monitor neuromuscular blockade throughout anaesthesia., (Copyright © 2020 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Objective: To determine the best cutoff value for classifying breast masses by ultrasound elastography, using dedicated software for strain elastography, and to determine the level of interobserver agreement., Materials and Methods: We enrolled 83 patients with 83 breast masses identified on ultrasound and referred for biopsy. After B-mode ultrasound examination, the lesions were manually segmented by three radiologists with varying degrees of experience in breast imaging, designated reader 1 (R1, with 15 years), reader 2 (R2, with 2 years), and reader 3 (R3, with 8 years). Elastography was performed automatically on the best image with computer-aided diagnosis (CAD) software. Cutoff values of 70%, 75%, 80%, and 90% of hard areas were applied for determining the performance of the CAD software. The best cutoff value for the most experienced radiologists was then compared with the visual assessment. Interobserver agreement for the best cutoff value was determined, as were the interclass correlation coefficient and concordance among the radiologists for the areas segmented., Results: The best cutoff value of the proportion of hard area within a breast mass, for experienced radiologists, was found to be 75%. At a cutoff value of 75%, the interobserver agreement was excellent between R1 and R2, as well as between R1 and R3, and good between R2 and R3. The interclass concordance coefficient among the three radiologists was 0.950. When assessing the segmented areas by size, we found that the level of agreement was higher among the more experienced radiologists., Conclusion: The best cutoff value for a quantitative CAD system to classify breast masses was 75%.

Objective: To assess the general attitude toward women's participation in research studies in Jordan and determine the various cultural and religious issues that could impact the rate of inclusion of Arab and Muslim women in research studies., Methods: A descriptive cross-sectional questionnaire-based survey study was conducted among Jordanian university students using a 17-item opinion questionnaire., Results: A total of 1265 students from different professional disciplines completed the questionnaire. The majority of the respondents (69.1%) believed that females in Jordan do not have the full autonomy to make their decision to participate in research studies. Study findings also showed that females are more likely to avoid the participation in research studies that require staying outside home or involve direct interaction between researcher and study participants. Females would prefer to deal with female research assistants when participating in research studies., Conclusion: More efforts are required to encourage and enhance the rate of participation in research studies among women in Jordan and, probably, other Middle Eastern societies. When designing and conducting research studies in these countries, researchers should seriously consider the cultural and religious beliefs., Competing Interests: Conflicts of interest: None to declare

Background: Transportation of laboratory samples in low-income and middle-income countries is often constrained by poor road conditions, difficult geographical terrain, and insecurity. These constraints can lead to long turnaround times for laboratory diagnostic tests and hamper epidemic control or patient treatment efforts. Although uncrewed aircraft systems (UAS)-ie, drones-can mitigate some of these transportation constraints, their cost-effectiveness compared with land-based transportation systems is unclear., Methods: We did a comparative economic study of the costs and cost-effectiveness of UAS versus motorcycles in Liberia (west Africa) for transportation of laboratory samples under simulated routine conditions and public health emergency conditions (based on the 2013-16 west African Ebola virus disease epidemic). We modelled three UAS with operational ranges of 30 km, 65 km, and 100 km (UAS30, UAS65, and UAS100) and lifespans of 1000 to 10 000 h, and compared the costs and number of samples transported with an established motorcycle transportation programme (most commonly used by the Liberian Ministry of Health and the charity Riders for Health). Data for UAS were obtained from Skyfire (a UAS consultancy), Vayu (a UAS manufacturer), and Sandia National Laboratories (a private company with UAS research experience). Motorcycle operational data were obtained from Riders for Health. In our model, we included costs for personnel, equipment, maintenance, and training, and did univariate and probabilistic sensitivity analyses for UAS lifespans, range, and accident or failures., Findings: Under the routine scenario, the per sample transport costs were US$0·65 (95% CI 0·01-2·85) and $0·82 (0·56-5·05) for motorcycles and UAS65, respectively. Per-sample transport costs under the emergency scenario were $24·06 (95% CI 21·14-28·20) for motorcycles, $27·42 (95% CI 19·25-136·75) for an unadjusted UAS model with insufficient geographical coverage, and $34·09 (95% CI 26·70-127·40) for an adjusted UAS model with complementary motorcycles. Motorcycles were more cost-effective than short-range UAS (ie, UAS30). However, with increasing range and operational lifespans, UAS became increasingly more cost-effective., Interpretation: Given the current level of technology, purchase prices, equipment lifespans, and operational flying ranges, UAS are not a viable option for routine transport of laboratory samples in west Africa. Field studies are required to generate evidence about UAS lifespan, failure rates, and performance under different weather conditions and payloads., Funding: None., (Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

NaClO 3 is achiral in solution. If crystallization is performed under a static set-up, it is recognized that the stochastic nucleation probability results in a racemic mixture of the conglomerate. In this paper, we report a reexamination of the crystallization of NaClO 3 from static solution in petri dishes that was conducted over a number of years and is based on the count and analysis of several thousand d- vs. l-NaClO 3 crystals. Remarkably, instead of an expected nearly 50/50 coin-tossing situation for the d/l crystal frequency, in most of our experiments a statistically significant bias in favor of d- over l-NaClO 3 crystals was found. The experiments also showed that the NaClO 3 system was relatively insensitive regarding the intentional addition of a variety of optically active agents. Only in some cases, the persisting d-bias observed in the unseeded experiments slightly increased upon the presence of such additives. Nevertheless, experiments in plastic petri dishes or in presence of fungal spores were able to reverse this bias. A literature survey shows that mainly d-directed non-stochastic behavior in the NaClO 3 system has been previously observed in other laboratory settings and by the application of different crystallization techniques. So far, the kind of chiral influence that could be at the origin of the observed bias remains unknown. After the examination of several possible chiral influences of physical, chemical and biological origin, we carefully consider the presence of bio-contaminants as most likely for the cause of this effect., (© 2019 Wiley Periodicals, Inc.)

Case: A 69-year-old woman presented with a brachial artery pseudoaneurysm causing median, ulnar, and radial nerve compressive neuropathies 8 weeks after a proximal humerus shaft fracture treated with intramedullary nailing. She underwent a brachial artery bypass with a reverse cephalic vein interposition graft and neurolysis after decompression of a large pseudoaneurysm. Postoperatively, the patient had a normal vascular examination with recovering neurological function., Conclusions: A high index of suspicion for a brachial artery pseudoaneurysm should be maintained in patients with a displaced proximal humerus shaft fracture, particularly when an abnormal neurovascular examination is present.

α-glucosidase inhibitors (AGIs) are very attractive bioactive compounds due to their therapeutic profile that includes beneficial effects over glycemic control in type 2 diabetes mellitus and viral infections. Its detection and identification in plants and fruits has gained growing attention, and certainly requires efficient screening methodologies. The objective of the present work was to develop a fast methodology to detect and identify AGIs in cherimoya fruit (Annona cherimola Mill.) applying effect-directed analysis via high-performance thin layer-chromatography (HPTLC) linked with bioassay and mass spectrometry (MS). Both, HPTLC and bioassay conditions, were optimized accomplishing 50% and 83% reduction on enzyme concentration and incubation time respectively, compared to the original method. Additionally, the contrast between inhibitory bands and purple background was also enhanced by enzyme substrate impregnation on HPTLC plate. The optimized detection conditions established were the following: 5.0 U mL -1 of enzyme solution, 1.0 mg mL -1 of 2-naphthyl-α-D-glucopyranoside substrate, 1.0 mg mL -1 of Fast Blue B salt solution and 10 min as incubation time. Applying this methodology, coupled to HPTLC-MS and ultra-high-performance liquid chromatography (UHPLC)-diode array detector (DAD)-MS/MS, it was possible for the first time to detect and identify three AGIs in cherimoya peel and seeds. Compounds were tentatively assigned as phenolamides (phenylethyl cinnamides): N-trans-feruloyl tyramine (m/z 314 [M+H] + ; UV λ max 293 and 316 nm), N-trans-p-coumaroyl tyramine (m/z 284 [M+H] + ; UV λ max 296 nm) and N-trans-feruloyl phenethylamine (m/z 298 [M+H] + ; UV λ max 288 nm). To the best of our knowledge, the presence of latter compound is reported for the first time in cherimoya., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Finding renal and hepatoprotective agents preferably with antioxidant activities against environmental pollutants especially lead which can adversely affect liver and kidney is a great demand. In the current study, flaxseed protein isolate (FPI) was extracted from defatted flaxseed meal. Amino acids profile, antioxidant capacity and solubility of the extracted FPI were determined. The solubility of FPI in the acidic media was exploited in preparation of lemon juice with FPI. Twenty four male rats were assigned to four groups; normal control, lead intoxicated (oral daily dose of 60 mg/kg b.w. in distilled water for four weeks), lead intoxicated and orally administrated with daily dose equal 1 ml of lemon juice as well as lead intoxicated and orally administered with FPI (daily dose equal 100 mg/kg) in 1 ml of lemon juice. The oral administration of FPI incorporated in lemon juice suppressed the elevation in kidney functions, lipid peroxidation of kidney tissues, urinary protein and creatinine as well as liver functions caused by lead intoxication. Additionally, lemon juice with FPI combated the reduction of GSH of kidney tissues. It was revealed also that lemon juice without FPI suppressed the elevation in kidney and liver functions caused by lead. It can be concluded that flaxseed protein isolate is a good source of protein with potent antioxidant activity. Additionally, lemon juice and FPI are considered protective sources of kidney and liver against lead toxicity., Competing Interests: 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., (© 2019 Published by Elsevier B.V.)

We evaluated the factor structure, reliability, and discriminative capacity of the Positive and Negative Affect Schedule (PANAS) questionnaire in four different samples: two general adult populations ( N = 1,548, N = 964), one adolescent population ( N = 1,044), and young people with depressive symptomatology ( N = 307). Exploratory factor analyses (EFAs) were performed with subsamples from Studies 1 ( n = 773) and 2 ( n = 527), finding that the two- and three-factor solutions had a good fit. In a confirmatory factor analysis, the two-factor solution resulted in an adequate fit in a second set of subsamples from both studies ( n = 775, n = 517). In Study 3, we found good convergent and divergent validity with adequate and significant correlations found for depression (Beck's Depression Inventory), anxiety (State-Trait Anxiety Inventory), and neuroticism and extroversion (Big Five Inventory). In Study 4, the results of an EFA performed in a subsample ( n = 154) found that the two- and three-factor solutions were appropriate with the former solution being confirmed in a second subsample ( n = 153). Reliability was α = .85 for positive affect and α = .87 for negative affect. The PANAS questionnaire showed adequate indicators of validity and reliability in adult and adolescent populations as well as in a sample with depressive symptoms.

Introduction: Acetylcholinesterase (AChE) inhibitors are considered an important strategy in the treatment of neurological disorders such as Alzheimer's disease. A simple and fast planar chromatography-bioassay methodology has been established to detect bioactive molecules in cherimoya fruit., Objective: Detect and identify AChE inhibitors in cherimoya by high-performance thin-layer chromatography (HPTLC)-bioassay-mass spectrometry (MS) and related techniques., Methodology: Effect-directed analysis by planar chromatography-bioassay-mass spectrometry was applied to detect and identify AChE inhibitors in pulp, peel and cherimoya seed. Bioassay was optimised establishing the following conditions: enzymatic solution (1.0 U mL -1 ), 1-naphtyl acetate substrate (1.5 mg mL -1 ) and Fast Blue B salt (1.0 mg mL -1 ). TLC-MS interface was used to directly elute the active zones into a mass spectrometer or to a micro-vial for further off-line studies., Results: Two AChE inhibitory bands were detected in peel extracts. An analysis via HPTLC-MS and high-performance liquid chromatography diode array detector tandem mass spectrometry (HPLC-DAD-MS/MS) allowed to characterise three potential AChE inhibitors: anonaine (m/z 266 [M + H] + ; UV λ max = 269.6 nm), glaucine (m/z 256 [M + H] + ; UV λ max = 282.9 and 300.6 nm) and xylopine (m/z 296 [M + H] + ; UV λ max = 278.5 nm)., Conclusions: The application of this optimised high throughput method allowed to establish the presence of three potential AChE inhibitors in cherimoya peel. For the first time AChE inhibitory capacity of these alkaloids is reported., (© 2019 John Wiley & Sons, Ltd.)

Advances in imaging techniques, such as MR perfusion and spectroscopy, are increasingly indispensable in the management and treatment plans of brain neoplasms: from diagnosing, molecular/genetic typing and grading neoplasms, augmenting biopsy results and improving accuracy, to ultimately directing and monitoring treatment and response. New developments in treatment methods have resulted in new diagnostic challenges for conventional MR imaging, such as pseudoprogression, where MR perfusion has the widest current application. MR spectroscopy is showing increasing promise in noninvasively determining genetic subtypes and, potentially, susceptibility to molecular targeted therapies., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: It has been demonstrated that azole-resistant strains of Candida albicans have a greater resistance to antimicrobial photodynamic therapy (aPDT) when compared to their more susceptible counterparts. For this reason, the present study evaluated the efficacy of aPDT, together with nystatin (NYS), in the treatment of oral candidiasis in vivo., Methods: Mice were infected with fluconazole-resistant C. albicans (ATCC 96901). To perform the combined therapy, aPDT, mediated by Photodithazine (PDZ) and LED light, was used together with NYS. The efficacy of the treatments was evaluated by microbiological, macroscopic, histopathological and Confocal Scanning Laser Microscopy analyses of the lesions. The expression of p21 and p53, proteins associated with cell death, from the tongues of mice, was also performed., Results: The combined therapy reduced the fungal viability by around 2.6 log 10 and decreased the oral lesions and the inflammatory reaction. Additionally, it stimulated the production of p53 and p21., Conclusions: The combined therapy is a promising alternative treatment for oral candidiasis induced by C. albicans resistant to fluconazole.

Enhanced recovery after surgery (ERAS) is an evident advance in the management of patients. Its feasibility and its effectiveness have been little analyzed in elderly's orthopedics. The aim of this systematic review of the literature was to analyze the feasibility (realization of classic ERAS items) and the efficiency (length of stay, morbidity and mortality) of ERAS in the elderly during total arthroplasty hip., Materials and Methods: A bibliographic search was performed with PubMed, Medline, CINAHL, Cochrane and Embase, using keywords "total hip arthroplasty", "orthopedics surgery", "fast track", "enhanced recovery after surgery", and" elderly ". Seventy-two articles were listed and 47 fully analyzed by 2 independent authors., Results: Thirty-two articles were selected. All the articles demonstrated ERAS feasibility in the elderly. The most frequently performed items were: preoperative information, spinal anesthesia and local or regional anesthetic infiltrations, multimodal analgesia with opioids sparing. Early stand-up is desirable but more difficult to achieve than in younger. Compared with traditional management, ERAS decreases the average length of stay without increasing complications, re-admissions and mortality rates. Medico-economic analyzes would be in favor of a reduction in the overall cost. The elderly's adherence to ERAS program depends on information's quality provided at the time of the consultation., Conclusion: The application of ERAS program in total hip arthroplasty in the elderly is feasible and efficient to reduce hospital stay and morbidity without increasing the complication rates. Protocols must be adapted to the particularities of this population.

There is a general agreement that deep aquifers experience significant lag time in their response to climatic variations. Analysis of Temporal Gravity Recovery and Climate Experiment (GRACE), Soil Moisture and Ocean Salinity mission (SMOS), satellite altimetry, stable isotopic composition of groundwater, and precipitation and static global geopotential models over the Nubian Sandstone Aquifer System (NSAS) revealed rapid aquifer response to climate variability. Findings include: (1) The recharge areas of the NSAS (Northern Sudan Platform subbasin) witnessed a dry period (2002-2012), where average annual precipitation (AAP) was modest (85 mm) followed by a wet period (2013-2016; AAP: 107 mm), and during both periods the AAP remained negligible (<10 mm) over the northern parts of the NSAS (Dakhla subbasin); (2) the secular trends in terrestrial water storage (TWS) over the Dakhla subbasin were estimated at -3.8 ± 1.3 mm/yr and + 7.8 ± 1 mm/yr for the dry and wet periods, respectively; (3) spatial variations in TWS values and phase are consistent with rapid groundwater flow from the Northern Sudan Platform subbasin and Lake Nasser towards the Dakhla subbasin during the wet period and from the lake during the dry period; and (4) networks of densely fractured and karstified bedrocks provide preferential pathways for groundwater flow. The proposed model is supported by (1) rapid response in groundwater levels in distant wells (>280 km from source areas) and in soil moisture content in areas with shallow (<2 m) groundwater levels to fluctuations in Lake Nasser surface water, and (2) the isotopic composition (O, H) of groundwater along the preferred pathways, consistent with mixing of enriched (Lake Nasser water or precipitation over Sudan) and depleted (NSAS fossil water) endmembers. Findings provide new insights into the response of large, deep aquifers to climate variability and address the sustainability of the NSAS and similar fossil aquifers worldwide., (Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: The purpose of this work was to evaluate computable Breast Imaging Reporting and Data System (BI-RADS) radiomic features to classify breast masses on ultrasound B-mode images., Methods: The database consisted of 206 consecutive lesions (144 benign and 62 malignant) proved by percutaneous biopsy in a prospective study approved by the local ethical committee. A radiologist manually delineated the contour of the lesions on greyscale images. We extracted the main ten radiomic features based on the BI-RADS lexicon and classified the lesions as benign or malignant using a bottom-up approach for five machine learning (ML) methods: multilayer perceptron (MLP), decision tree (DT), linear discriminant analysis (LDA), random forest (RF), and support vector machine (SVM). We performed a 10-fold cross validation for training and testing of all classifiers. Receiver operating characteristic (ROC) analysis was used for providing the area under the curve with 95% confidence intervals (CI)., Results: The classifier with the highest AUC at ROC analysis was SVM (AUC = 0.840, 95% CI 0.6667-0.9762), with 71.4% sensitivity (95% CI 0.6479-0.8616) and 76.9% specificity (95% CI 0.6148-0.8228). The best AUC for each method was 0.744 (95% CI 0.677-0.774) for DT, 0.818 (95% CI 0.6667-0.9444) for LDA, 0.811 (95% CI 0.710-0.892) for RF, and 0.806 (95% CI 0.677-0.839) for MLP. Lesion margin and orientation were the optimal features for all the machine learning methods., Conclusions: ML can aid the distinction between benign and malignant breast lesion on ultrasound images using quantified BI-RADS descriptors. SVM provided the highest ROC-AUC (0.840).

Background: The massive weight loss induced by bariatric surgery is associated with major benefits, but the effect on semen variables is still uncertain., Objectives: To explore semen modifications with gastric bypass and sleeve gastrectomy., Setting: Five French University Hospitals., Methods: Male candidates for bariatric surgery with no history of infertility were recruited in this controlled prospective study. Sperm characteristics were collected before surgery and then 6 months and up to 12 months after surgery., Results: Forty-six adult men who underwent gastric bypass (n = 20) or sleeve gastrectomy (n = 26) were included. Total sperm count tended to be lower at 6 months and showed a significant decrease at 12 months in both surgery groups, at -69.5 million (-96.8 to -42.2 million; P = 0.0021). Total sperm count at 12 months relative to baseline was -41.4 million (P = .0391) after gastric bypass and -91.1 million (P = .0080) after sleeve gastrectomy. This was counterbalanced by an associated resolution of hypogonadism and decrease of DNA fragmentation in most patients with time after surgery., Conclusion: Improvement in some semen variables after bariatric surgery observed in 3 previous studies is in contrast to the lower mean total sperm count found in this study at 1 year. The possible reversibility of this effect in the long term and the impact of surgery on fertility both remain unknown., (Copyright © 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Bone metastasis (BM) in differentiated thyroid cancer (DTC) is the second most common site of metastasis after lung. Bone metastases are associated with worse prognosis in DTC. In this study, we examined risk factors for overall survival in patients with BM and for the first time explore the pattern of genomic alterations in DTC BM., Patients and Methods: A Health Insurance Portability and Accountability Act (HIPAA) compliant, institutional review board-approved retrospective evaluation of the medical record was performed for all patients treated at a single institution for thyroid cancer over a 16-year period. Seventy-four patients met inclusion criteria. Multiple prognostic factors including age, sex, genes, radioactive iodine, and radiation or kinase inhibitor therapies were analyzed. Univariate and multivariate analyses were performed., Results: Treatment with external beam radiation was found to significantly increase survival (P = 0.03). The 5-year survival rate was 59% and median survival was 92 months. Patients who developed bone metastasis earlier tend to live longer (P = 0.06). The presence of TERT and BRAF mutations did not significantly worsen the prognosis (P = 0.10)., Conclusion: Patients with DTC can benefit from early treatment with external beam radiation therapy, especially those who develop bone metastasis within 3 years of primary TC diagnosis. Kinase inhibitor treatment tended to prolong survival but not in a statistically significant manner. Sex, age, and TERT or BRAF genetic mutations did not significantly affect the prognosis.

Background: Peripheral arterial disease in patients with type 2 diabetes mellitus is an important risk factor for vascular events. Recommendations about whether ankle-brachial index should be performed differ depending on the source; therefore, it is necessary to re-evaluate the most important risk factors associated with peripheral arterial disease and whether it is useful to perform ankle-brachial index in newly diagnosed and drug-naïve patients with diabetes, independent of age or peripheral arterial disease symptoms., Methods: A total of 711 subjects were divided into groups: group 1, 600 type 2 diabetes mellitus patients, symptomatic or not for peripheral arterial disease; group 2, 61 type 2 diabetes mellitus patients newly diagnosed and drug naïve; and group 3, 50 subjects without diabetes. Ankle-brachial index, medical records and physical examination were performed in all patients, accessing cardiovascular risk factors., Results: Analysing group 1 asymptomatic patient to peripheral arterial disease, we found abnormal ankle-brachial index in 49% (77/156) ⩾50 years and 42% (16/38) <50 years ( p  = not significant). Considering drug-naïve patients, a peripheral arterial disease prevalence of 39% (24/61) was found; among these, 48% (13/27) were <50 years and 32% (11/34) were ⩾50 years ( p  = not significant). A forward stepwise regression model was developed, with type 2 diabetes mellitus duration ( r 2  = 0.12) and sedentary lifestyle ( r 2  = 0.14) found as independent variable predictors of severity of peripheral arterial disease, related to ankle-brachial index., Conclusion: We suggest that, in type 2 diabetes mellitus, ankle-brachial index should be measured at diagnosis. In addition, sedentary lifestyle was strongly associated with presence and severity of peripheral arterial disease.

Objectives: The aim of this study was to determine the incidence of metabolic syndrome in patients treated with second-generation antipsychotics (SGAs). Methods: In this retrospective study, we reviewed patients' electronic medical records (EMRs) of all patients who received one SGA for at least six months, excluding patients who were taking other medications that are associated with significant effect on metabolic syndrome. Relevant clinical information was collected prior to starting the SGA and after six months of continuous use of the same SGA. Results: A total of 91 patients were included in the study. The majority of patients (72%) were diagnosed with schizophrenia. After six months of taking the SGA, 44% of patients experienced elevated systolic pressure, 54.9% had elevated triglyceride, and 31.9% had impaired glucose levels ( p value < 0.05). Prior to initiating SGA therapy, 14.3% of patients had metabolic syndrome, while 37.4% had metabolic syndrome after six months of therapy, and it was more prominent in males compared to female patients ( p value < 0.05) . Conclusion: This study found a strong correlation between SGA use and the appearance of metabolic alterations, such as weight gain, glucose intolerance, and increased triglyceride levels. These findings highlight the importance of assessing metabolic deregulations to minimize SGA associated metabolic abnormalities., Competing Interests: The authors declare no conflict of interest.

The development of live-attenuated vaccines against Dengue virus (DENV) has been problematic. Dengvaxia, licensed in several countries where DENV is endemic, has shown low efficacy profiles and there are safety concerns prohibiting its administration to children younger than 9 years old, and the live-attenuated tetravalent vaccine (LATV) developed by NIAID has proven too reactogenic during clinical trialing. In this work we examined whether the combination of TV005, a LATV-derived formulation, with Tetra DIIIC, a subunit vaccine candidate based on fusion proteins derived from structural proteins from all four DENV serotypes, can overcome the respective limitations of these two vaccine approaches. Rhesus macaques were first primed with one or two doses of Tetra DIIIC and then boosted with TV005, following the time course of the appearance of virus-binding and neutralizing antibodies, and evaluating protection by means of a challenge experiment with wild-type viruses. Although the two evaluated prime-boost regimes were equivalent to a single administration of TV005 in terms of the development of virus-binding and neutralizing antibodies as well as the protection against viral challenge, both regimes reduced vaccine viremia to undetectable levels. Thus, the combination of Tetra DIIIC with TV005 offers a potential solution to the reactogenicity problems, which have beset the development of the latter vaccine candidate.

Competing Interests: Conflicts of Interest: The author has no conflicts of interest to declare.

Purpose: Variability in response to warfarin is one of the main obstacles challenging its use in clinical practice. Vitamin K epoxide reductase complex (VKORC) is the target enzyme of warfarin, and variations in the form of single nucleotide polymorphisms (SNPs) in VKORC1 , coding for this enzyme, are known to cause resistance to warfarin treatment. This study aimed to explore VKORC1 variants in Emirati patients receiving warfarin treatment and to correlate their genotypes at the studied SNPs to their maintenance warfarin dose. Patients and methods: Sanger sequencing of the majority of the VKORC1 gene was applied to samples from 90 patients and 117 normal individuals recruited from Tawam Hospital, Al-Ain, UAE. Genotypes at the following variants were determined (rs9923231, rs188009042, rs61742245, rs17708472, rs9934438, rs8050894, rs2359612, rs7294). Statistical analysis was applied, including ANOVA, cross-tabulation, and multiple linear regression analysis, to determine the ability of nongenetic factors (age and gender) and genetic factors ( VKORC1 genotypes) to explain variability in warfarin dose in patients. Results: Different frequencies of minor alleles were detected in the selected SNPs. Significant variation among genotypes at six VKORC1 variants were identified (rs9923231, rs9934438, rs8050894, rs2359612, rs7294). The main predictors for warfarin dose were rs9923231, age, and rs61742245 with 50.7% of the average warfarin dose in our sample could be explained by a regression model built on these three factors. Conclusion: This is the first report of the explanatory power of VKORC1 genotypes and nongenetic factors (age and gender) on warfarin dose among Emiratis. Also, this study highlighted the positive effect of considering rare pharmacogenomic variants on explaining warfarin dose variability., Competing Interests: The authors confirm that there are no potential conflicts of interest associated with this work.

Background: The objective of this study was to characterize tumor activity and mineralization status in newly-detected multiple myeloma (MM) bone lesions using 2- 18 F-fluoro-2-deoxy-D-glucose ( 18 F-FDG)-PET/CT and 18 F-sodium fluoride ( 18 F-NaF)-PET/CT before and after antitumor treatment., Materials and Methods: In this retrospective study, seven patients with histologically-verified MM were included (four women, three men; median age=57 years, standard deviation=11.23 years). PET/CT was performed with 18 F-FDG and with 18 F-NaF, both at baseline and after treatment. All patients had positive scans. Volumes of interest (VOIs) were drawn over all 18 F-FDG-PET/CT-positive bone lesions, as well as the corresponding regions in 18 F-NaF-PET/CT. For characterization of bone lesions, semi-quantitative standard uptake value (SUV) parameters were measured., Results: 18 F-FDG-PET/CT in the seven patients detected 39 metabolically active lesions that were correlated with the corresponding sites in 18 F-fluoride-PET/CT. Overall, the lesions showed a response to therapy, with a significant decrease in SUV max on PET/CT using 18 F-FDG (p<0.001) and with 18 F-NaF (p<0.001). In four patients with a second follow-up scan (at a median of 17 months after baseline scan), there was no significant change in lesion uptake., Conclusion: Based on our data, antitumor therapy in MM reduces not only tumor activity, but also the mineralization status of bone lesions. A second follow-up scan in a subset of the cohort yielded no change in mineralization status., (Copyright© 2019, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

All sensory stimuli produce transient excitability changes in various central nervous system circuits. One example is prepulse inhibition (PPI), which is the inhibition generated by a preceding weak stimulus (prepulse) over the reflex response to a subsequent suprathreshold stimulus. The PPI is a ubiquitous phenomenon, common to many different sensory modalities. However, it has not yet been studied with thermoalgesic stimuli. These stimuli take a relatively long time to reach their peak, which implies some uncertainty in the exact timing of prepulse effects with respect to stimulus onset. In 20 healthy volunteers, we determined when thermoalgesic stimuli cause PPI of the blink reflex and measured conscious awareness (AW) of thermoalgesic stimulus perception using the Libet's clock. In this way, we determined the temporal relationship between AW and PPI. In a second experiment, we investigated whether prepulse effects on blink reflex also involved a change in conscious perception of the supraorbital nerve stimulus. Our results show that thermoalgesic stimuli generate PPI of the blink reflex long before subjects were consciously aware of the stimulus, confirming the already-known principle that conscious perception is not required for PPI to take place, and that prepulse stimuli induce a change in the time of conscious perception of prepulse and pulse stimuli, in such a way that AW of both stimuli tended to become closer to each other., (© 2018 Society for Psychophysiological Research.)

Background: Waterpipe smoking is a method of tobacco consumption that continues to spread globally. In 2002, a ban of tobacco sales was adopted in the Saudi Arabian cites of Mecca and Medina., Aims: This study aimed to examine prevalence of waterpipe and cigarette smoking among students of Taibah University, the biggest in Medina, where the tobacco sales ban has been implemented., Methods: A structured questionnaire was distributed between February and April 2015 to examined tobacco use among Taibah University students., Results: The prevalence of current and ever waterpipe use was 24.2% and 36.04%, respectively, compared with 31.9% and 42.7% for current and ever cigarette smoking. This prevalence is similar to that reported in other Saudi cities where tobacco sales are allowed. Multivariate analysis showed that waterpipe use was higher among senior students; those with pocket money spending of > 500 Saudi Arabia riyal (SAR)/month; and if > 5 individuals were living in the household. In addition, waterpipe use was lower among students with monthly household income of 5000-9000 SAR. In contrast, current cigarette smoking was more frequent in those aged > 22 years; among male students; in those with pocket money spending of > 500 SAR/month; and those who lived away from their parents., Conclusions: Waterpipe and cigarette smoking, despite the ban on tobacco sales, is still common among Taibah University students in Medina, Saudi Arabia., (Copyright © World Health Organization (WHO) 2019. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Background: Sustainability of ERP is a challenge and data are scarce on the subject. The aim of this study was to assess if application of enhanced recovery elements through the Francophone Group of Enhanced Recovery after Surgery (Grace) in the anaesthesia management was sustainable 2 years after its implementation., Materials and Methods: We conducted a retrospective analysis of the prospective Grace database between October 2014 and October 2016. The evolution of each recommendation item over time was analysed using non-parametric Spearman correlation coefficient., Results: A total of 67 and 43 centres corresponding to 2067 and 3022 patients participated to the Grace audit in colorectal and orthopaedics surgery, respectively. Colorectal surgery: Mean length of stay was 5 (±4) days and readmission rate was 6.6%. Application of most items did not statistically change. It worsened over time for PONV prophylaxis (P=0.01) and prevention of intraoperative hypothermia (P=0.02); and improved for NSAID administration (P=0.01). Orthopaedics surgery: Mean length of stay was 3 (±2) days and readmission rate was 1.7%. There was a trend towards improvement for most items. It reached statistical significance for PONV prophylaxis (P=0.001), limited preoperative fasting (P=0.01). While the use of a perineural catheter (P=0.001) decreased over time, infiltration of the surgical site statistically increased (P=0.05)., Conclusion: This study shows on a large scale a trend towards less application of all ERP items over time. Continuous audits should be encouraged to expect further improvements., (Copyright © 2018 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.)