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• Gut function and transit change following the initiation of ETI, measured using MRI. • Small bowel transit and small bowel response to food improves after starting ETI. • After 18 months of ETI use, colonic volume reduces. • First imaging study to find changes in gut physiology following ETI initiation. Gastrointestinal (GI) symptoms in cystic fibrosis (CF) are common and disruptive. The effect of cystic fibrosis transmembrane conductance regulator (CFTR) modulators on the GI tract is not fully understood. The aim was to use magnetic resonance imaging (MRI) to determine if elexacaftor/tezacaftor/ivacaftor (ETI) changed GI function and transit. This was an 18 month prospective, longitudinal, observational study. We enrolled 24 people with CF aged 12 years or older to undergo MRI scans before starting ETI and 3, 6, and 18 months after starting ETI. The primary outcome measure was change in oro-caecal transit time (OCTT) at 6 and 18 months. Secondary outcome measures included change in small bowel water content (SBWC), change in the reduction in small bowel water content following a meal (DeltaSBWC) and change in total colonic volume (TCV). A total of 21 participants completed MRI scans at 6 months and 11 completed at 18 months. After 18 months of ETI, median OCTT significantly reduced, from >360 min [IQR 240->360] to 240 min [IQR 180–300] (p = 0.02, Wilcoxon signed-rank). Both SBWC and DeltaSBWC increased after starting ETI. TCV reduced significantly after 18 months (p = 0.005, Friedman). Our findings suggest an improvement in small bowel transit, small bowel response to food and a reduction in colonic volume after starting ETI. These effects may relate to CFTR activation in the small bowel. To our knowledge this is the first study to show a physiological change in GI transit and function in response to CFTR modulator use through imaging studies. [Display omitted] [ABSTRACT FROM AUTHOR]

• The cytokine profile of cord blood tissue has not been extensively evaluated in the ASD population. • Increased G-CSF and lower IL-1α, IL-1β and IL-4 was found in the cord blood from children later diagnosed with ASD. • Inflammatory cytokines in children later diagnosed with ASD were linked to symptom severity, language, and behavioral assessment scores. In studies investigating the etiology and pathophysiology of autism spectrum disorder (ASD), immune dysregulation is commonly observed, with elevated levels of inflammatory cytokines frequently found in gestational tissues. However, studies investigating the relationship between early immune dysregulation within the umbilical cord blood (CB) compartment and neurodevelopmental outcomes remains limited. In this exploratory study, we utilized data from the prospective Markers for Autism Risk in Babies – Learning Early Signs (MARBLES) study to examine cytokine levels in the plasma fraction of CB in infants later diagnosed with ASD (n = 38) compared to infants typically developing (TD) at age 3 years (n = 103), using multiplex cytokine assays. Our findings reveal altered levels of several inflammatory cytokines in children later diagnosed with ASD, including increased granulocyte colony-stimulating factor (G-CSF) and decreased interleukin-1α (IL-1α), IL-1β, and IL-4 in CB. Furthermore, we identified several associations between behaviors and levels of cytokines, chemokines and growth factors. IL-1α, IL-17A, interferon γ-induced protein 10 (IP-10), and epidermal growth factor (EGF) were associated with worse scores on Autism Diagnostic Observation Schedule (ADOS) and the Mullen Scales of Early Learning (MSEL) assessments. In summary, our study demonstrates dysregulated levels of inflammatory cytokine mediators in the CB of children later diagnosed with ASD and that inflammatory mediators were associated with ASD severity, comorbid behaviors, and neurodevelopmental measures. These findings have important implications for the possible predictive value of early cytokine measures in neurodevelopmental outcomes and subsequent behavioral manifestations. [ABSTRACT FROM AUTHOR]

Three sweet potato genotypes NSP-2, NSP-6 (white flesh) and NSP-12 (orange flesh), were subjected under different processing techniques (boiling, steaming, and roasting) to check the nutritional status. Sugars like glucose, fructose, sucrose, and maltose was increased under roasting treatment for all of the genotypes. Crude fiber, cellulose, hemicellulose and ash content were significantly deferred within different genotypes but different treatments remained at par with various processing techniques. Steaming was proved to be the best treatment to decrease loss of vitamin C and phenol content where as roasting was the best performing treatmant to decrease the antinutrients like phytic acid and trypsin inhibitor activity. Comparatively, higher antioxidant activity was observed in steaming treatmet. NSP-12 revealed comparatively lower Glycemic index (GI) indicating high amylase: amylopectin ratio may become a good source of good carbohydrate for diabetic friendly food for near future. [ABSTRACT FROM AUTHOR]

Upper gastrointestinal bleeding (UGIB) is a condition commonly seen in the emergency department (ED). Therefore, it is important for emergency clinicians to be aware of the current evidence regarding the diagnosis and management of this disease. This paper evaluates key evidence-based updates concerning UGIB for the emergency clinician. UGIB most frequently presents with hematemesis. There are numerous causes, with the most common peptic ulcer disease, though variceal bleeding in particular can be severe. Nasogastric tube lavage for diagnosis is not recommended based on the current evidence. A hemoglobin transfusion threshold of 7 g/dL is recommended (8 g/dL in those with myocardial ischemia), but patients with severe bleeding and hemodynamic instability require emergent transfusion regardless of their level. Medications that may be used in UGIB include proton pump inhibitors, prokinetic agents, and vasoactive medications. Antibiotics are recommended for those with cirrhosis and suspected variceal bleeding. Endoscopy is the diagnostic and therapeutic modality of choice and should be performed within 24 h of presentation in non-variceal bleeding after resuscitation, though patients with variceal bleeding may require endoscopy within 12 h. Transcatheter arterial embolization or surgical intervention may be necessary. Intubation should be avoided if possible. If intubation is necessary, several considerations are required, including resuscitation prior to induction, utilizing preoxygenation and appropriate suction, and administering a prokinetic agent. There are a variety of tools available for risk stratification, including the Glasgow Blatchford Score. An understanding of literature updates can improve the ED care of patients with UGIB. [ABSTRACT FROM AUTHOR]

Lower gastrointestinal bleeding (LGIB) is a condition commonly seen in the emergency department. Therefore, it is important for emergency medicine clinicians to be aware of the current evidence regarding the diagnosis and management of this disease. This paper evaluates key evidence-based updates concerning LGIB for the emergency clinician. LGIB is most commonly due to diverticulosis or anorectal disease, though there are a variety of etiologies. The majority of cases resolve spontaneously, but patients can have severe bleeding resulting in hemodynamic instability. Initial evaluation should focus on patient hemodynamics, the severity of bleeding, and differentiating upper gastrointestinal bleeding from LGIB. Factors associated with LGIB include prior history of LGIB, age over 50 years, and presence of blood clots per rectum. Computed tomography angiography is the imaging modality of choice in those with severe bleeding to diagnose the source of bleeding and guide management when embolization is indicated. Among stable patients without severe bleeding, colonoscopy is the recommended modality for diagnosis and management. A transfusion threshold of 7 g/dL hemoglobin is recommended based on recent data and guidelines (8 g/dL in those with myocardial ischemia), though patients with severe bleeding and hemodynamic instability should undergo emergent transfusion. Anticoagulation reversal may be necessary. If bleeding does not resolve, embolization or endoscopic therapies are necessary. There are several risk scores that can predict the risk of adverse outcomes; however, these scores should not replace clinical judgment in determining patient disposition. An understanding of literature updates can improve the care of patients with LGIB. [ABSTRACT FROM AUTHOR]

Introduction and purpose of review: The term glycemic index (GI) is the measure of how much a specific substance increases the postprandial blood glucose level [1]. Substances with lower GI promote a lower glycemic response and are said to promote satiety, postprandial insulin secretion and maintain insulin sensitivity and therefore help to control blood glucose concentrations [2]. According to guidelines on the management of patients with diabetes, type 2 diabetes mellitus patients’ source of carbohydrates in diet should be whole grain cereal products especially with low GI [3]. Type 2 diabetes is a chronic, metabolic disease occurring mostly in adults. It leads to numerous chronic complications that include e.g. macroangiopathy, retinopathy, nephropathy, neuropathy and diabetic foot as well as vulnerability to infections [2]. These complications lower the quality of life, generate costs when treating them and eventually lead to death. Currently there are about 422 million people with diabetes worldwide and the number is expected to rise [3]. Therefore it is crucial for patients to maintain their blood glucose at stable levels to prevent progression of the disease and its complications. The glycemic response can be modified by implementing a low GI diet. The aim of this study is to provide an overview of selected strategies lowering the glycemic index and the probable mechanisms by which they work. Methods: For this review, articles in the Pubmed and Google Scholar databases were analyzed as well as the references of previously found articles. Current state of knowledge: Existing studies show that some strategies alter the glycemic index and glycemic response that can help diabetic patients to better control their glucose blood level. Summary: This review summarizes studies concerning methods of lowering the glycemic index and mechanisms of action of those specific methods.

Plants can sense temperature changes and adjust their growth accordingly. In Arabidopsis, high ambient temperatures stimulate stem elongation by activating a key thermoresponsive regulator, PHYTOCHROME INTERACTING FACTOR 4 (PIF4). Here, we show that warmth promotes the nighttime transcription of GI, which is necessary for the high temperature-induced transcription of TOC1. Genetic analyses suggest that GI prevents excessive thermoresponsive growth by inhibiting PIF4, with this regulatory mechanism being partially reliant on TOC1. GI transcription is repressed by ELF3 and HY5, which concurrently inhibit PIF4 expression and activity. Temperature elevation causes the deactivation or degradation of ELF3 and HY5, leading to PIF4 activation and relief of GI transcriptional repression at high temperatures. This allows PIF4 to further activate GI transcription in response to elevated temperatures. GI, in turn, inhibits PIF4, establishing a negative feedback loop that fine-tunes PIF4 activity. In addition, we demonstrate that ELF3, HY5, and PIF4 regulate GI transcription by modulating the enrichment of histone variant H2A.Z at the GI locus. Together, our findings suggest that thermal release of a negative feedback loop finely adjusts plant thermomorphogenesis.

The use of available treatments for Fabry disease (FD) (including enzyme replacement therapy [ERT]) may be restricted by their limited symptom improvement and mode of administration. Lucerastat is currently being investigated in the MODIFY study as oral substrate reduction therapy for the treatment of FD. By reducing the net globotriaosylceramide (Gb3) load in tissues, lucerastat has disease-modifying potential to improve symptoms and delay disease progression. MODIFY is a multicenter, double-blind, randomized, placebo-controlled, parallel-group Phase 3 study (ClinicalTrial.gov: NCT03425539); here we present the rationale and design of this study. Eligible adults with a genetically confirmed diagnosis of FD and FD-specific neuropathic pain entered screening. Patients were randomized (2:1) to receive either oral lucerastat twice daily or placebo for 6 months; treatment allocation was stratified according to sex and ERT treatment status. The main objectives of MODIFY are to assess the effects of lucerastat on neuropathic pain, gastrointestinal (GI) symptoms, FD biomarkers, and determine its safety and tolerability. Neuropathic pain and GI symptoms are key features of FD that have a significant impact on quality of life. Despite various tools available to assess pain and GI symptoms, there are currently limited tools available to assess neuropathic and GI symptoms in FD, validated according to health authority guidelines. Based on FDA recommendations, we undertook a patient-reported outcome (PRO) validation study, using a novel eDiary-based PRO tool to assess the validity of evaluating neuropathic pain as a primary efficacy endpoint in MODIFY. Results from the PRO validation study are included. To date, MODIFY is the largest Phase 3 clinical study conducted in patients with FD. Enrollment to MODIFY is now complete, with 118 patients randomized. Results will be presented in a separate publication. Long-term effects of lucerastat are being assessed in the ongoing open-label extension study (NCT03737214).

Epithelial cell apoptosis and compromised gut barrier function are features of inflammatory bowel disease. ADS024 is a single-strain live biotherapeutic product (LBP) of Bacillus velezensis under development for treating ulcerative colitis (UC). The cytoprotective effects of the sterile filtrate of ADS024’s secreted products on UC patient-derived colonic tissues, human primary colonic epithelial cells (HPEC), and human colonic epithelial T84 cells were evaluated. ADS024 filtrate significantly inhibited apoptosis and inflammation with reduced Bcl-2 Associated X-protein (BAX) and tumor necrosis factor (TNF) mRNA expression in fresh colonic explants from UC patients. Exposure to UC patient-derived serum exosomes (UCSE) induced apoptosis with increased cleaved caspase 3 protein expression in HPECs. ADS024 filtrate diminished the UCSE-mediated apoptosis by inhibiting cleaved caspase 3. TNFα and interferon-gamma (IFNγ) damaged epithelial barrier integrity with reduced transepithelial electrical resistance (TEER). ADS024 filtrate partially attenuated the TEER reduction and restored tight junction protein 1 (TJP1) expression. Oral live ADS024 treatment reduced weight loss, disease activity, colonic mucosal injury, and colonic expression of interleukin 6 (IL-6) and TNFα in dextran sodium sulfate (DSS)-treated mice with colitis. Thus, ADS024 may protect the colonic epithelial barrier in UC via anti-inflammatory, anti-apoptotic, and tight-junction protection mechanisms. [ABSTRACT FROM AUTHOR]

GIGANTEA (GI) is a conserved nuclear protein crucial for orchestrating the clock-associated feedback loop in the circadian system by integrating light input, modulating gating mechanisms, and regulating circadian clock resetting. It serves as a core component which transmits blue light signals for circadian rhythm resetting and overseeing floral initiation. Beyond circadian functions, GI influences various aspects of plant development (chlorophyll accumulation, hypocotyl elongation, stomatal opening, and anthocyanin metabolism). GI has also been implicated to play a pivotal role in response to stresses such as freezing, thermomorphogenic stresses, salinity, drought, and osmotic stresses. Positioned at the hub of complex genetic networks, GI interacts with hormonal signaling pathways like abscisic acid (ABA), gibberellin (GA), salicylic acid (SA), and brassinosteroids (BRs) at multiple regulatory levels. This intricate interplay enables GI to balance stress responses, promoting growth and flowering, and optimize plant productivity. This review delves into the multifaceted roles of GI, supported by genetic and molecular evidence, and recent insights into the dynamic interplay between flowering and stress responses, which enhance plants' adaptability to environmental challenges. [ABSTRACT FROM AUTHOR]

The newborn who requires intensive care hospitalization is forced into an external environment that can negatively impact the developing microbiome. The NICU nurse has a unique role that affects, and may even protect, the development of the newborn microbiome through daily nursing care. The purpose of this article is to inform neonatal nurses regarding common nursing interventions that can positively or negatively impact the developing microbiome. Evidence-based practices are presented and bundled to describe their impact the neonatal microbiome. [ABSTRACT FROM AUTHOR]

Epithelial cell apoptosis and compromised gut barrier function are features of inflammatory bowel disease. ADS024 is a single-strain live biotherapeutic product (LBP) of Bacillus velezensis under development for treating ulcerative colitis (UC). The cytoprotective effects of the sterile filtrate of ADS024’s secreted products on UC patient-derived colonic tissues, human primary colonic epithelial cells (HPEC), and human colonic epithelial T84 cells were evaluated. ADS024 filtrate significantly inhibited apoptosis and inflammation with reduced Bcl-2 Associated X-protein (BAX) and tumor necrosis factor (TNF) mRNA expression in fresh colonic explants from UC patients. Exposure to UC patient-derived serum exosomes (UCSE) induced apoptosis with increased cleaved caspase 3 protein expression in HPECs. ADS024 filtrate diminished the UCSE-mediated apoptosis by inhibiting cleaved caspase 3. TNFα and interferon-gamma (IFNγ) damaged epithelial barrier integrity with reduced transepithelial electrical resistance (TEER). ADS024 filtrate partially attenuated the TEER reduction and restored tight junction protein 1 (TJP1) expression. Oral live ADS024 treatment reduced weight loss, disease activity, colonic mucosal injury, and colonic expression of interleukin 6 (IL-6) and TNFα in dextran sodium sulfate (DSS)-treated mice with colitis. Thus, ADS024 may protect the colonic epithelial barrier in UC via anti-inflammatory, anti-apoptotic, and tight-junction protection mechanisms.

Background and aims: Amino acids (AAs) not only constitute milk protein but also stimulate milk synthesis through the activation of mTORC1 signaling, but which amino acids that have the greatest impact on milk fat and protein synthesis is still very limited. In this study, we aimed to identify the most critical AAs involved in the regulation of milk synthesis and clarify how these AAs regulate milk synthesis through the G-protein-coupled receptors (GPCRs) signaling pathway. Methods: In this study, a mouse mammary epithelial cell line (HC11) and porcine mammary epithelial cells (PMECs) were selected as study subjects. After treatment with different AAs, the amount of milk protein and milk fat synthesis were detected. Activation of mTORC1 and GPCRs signaling induced by AAs was also investigated. Results: In this study, we demonstrate that essential amino acids (EAAs) are crucial to promote lactation by increasing the expression of genes and proteins related to milk synthesis, such as ACACA, FABP4, DGAT1, SREBP1, α-casein, β-casein, and WAP in HC11 cells and PMECs. In addition to activating mTORC1, EAAs uniquely regulate the expression of calcium-sensing receptor (CaSR) among all amino-acid-responsive GPCRs, which indicates a potential link between CaSR and the mTORC1 pathway in mammary gland epithelial cells. Compared with other EAAs, leucine and arginine had the greatest capacity to trigger GPCRs (p-ERK) and mTORC1 (p-S6K1) signaling in HC11 cells. In addition, CaSR and its downstream G proteins Gi, Gq, and Gβγ are involved in the regulation of leucine- and arginine-induced milk synthesis and mTORC1 activation. Taken together, our data suggest that leucine and arginine can efficiently trigger milk synthesis through the CaSR/Gi/mTORC1 and CaSR/Gq/mTORC1 pathways. Conclusion: We found that the G-protein-coupled receptor CaSR is an important amino acid sensor in mammary epithelial cells. Leucine and arginine promote milk synthesis partially through the CaSR/Gi/mTORC1 and CaSR/Gq/mTORC1 signaling systems in mammary gland epithelial cells. Although this mechanism needs further verification, it is foreseeable that this mechanism may provide new insights into the regulation of milk synthesis. [ABSTRACT FROM AUTHOR]

Background and Aim: Cancer is a major global killer. Incidence and prevalence vary worldwide. Kashmir has a unique cancer belt. We propose to examine upper GI malignancy in south Kashmir's four major districts: Anantnag, Kulgam, Shopian, and Pulwama, representing 33% of Kashmir valley's population. Methods: The study was carried out in the twin districts of Anantnag and kulgam at health care clinics that were administered by the government at the secondary level. Between the years 2010 and 2020, an EGD was performed on a total of 11391 different patients. Results: The initial biopsy was performed on 980 patients who had a suspicion of malignancy; 94% of those patients tested positive for malignancy on HPE; 2.7% of those patients had favourable HPE features; a repeat biopsy was performed on 3.7% of patients whose results were inconclusive, and 2.7% of those patients tested positive for malignancy on the repeat biopsy. In this investigation, the prevalence was determined to be 8.32%. Malignancy of the oesophagus was found in 62.34% of patients, while malignancy of the stomach was found in 37.6% of patients. Conclusion: In conclusion gastrointestinal cancers are leading cause of malignancy in Kashmir with rising trend compared to rest of the world. [ABSTRACT FROM AUTHOR]

BACKGROUND: There are limited data to guide oncology and cardiology decision-making in patients with a left ventricular assist device (LVAD) and concurrent active malignancy. OBJECTIVES: The goal of this study was to describe cancer treatment approaches, complications, and survival among patients with active cancer on LVAD support in 2 tertiary heart failure and oncology programs. METHODS: In this retrospective cohort study, LVAD databases were reviewed to identify patients with a cancer diagnosis at the time of or after LVAD implantation. We created a 3:1 matched cohort based on age, sex, etiology of cardiomyopathy, LVAD implant strategy, and INTERMACS profile stratified by site. Kaplan-Meier analysis and Cox proportional hazards models were used to compare survival between patients with cancer and non-cancer comparators. RESULTS: Among 1,123 patients who underwent LVAD implantation between 2005 and 2019, 22 patients with LVADs with active cancer and 66 matched non-cancer comparators were identified. Median age was 62 years (range 41 to 73 years); 50% of patients with cancer were African-American, and 27% were women. Prostate cancer, followed by renal cell cancer and hematologic malignancies were the most common diagnoses. There was no significant difference in unadjusted Kaplan-Meier median survival estimates from the time of LVAD placement between patients with cancer (3.53 years; 95% confidence interval [CI]: 1.41 to 5.33) and non-cancer comparators (3.03 years; 95% CI: 1.83 to 5.26; log-rank P = 0.99). In Cox proportional hazard models, cancer diagnosis as a time-varying variable was associated with a statistically significant increase in death (hazard ratio: 2.05; 95% CI: 1.03 to 4.12; P = 0.04). Patients with cancer had less gastrointestinal bleeding compared with matched non-cancer comparators (P = 0.016). Other complications were not significantly different. CONCLUSIONS: Our study provides initial feasibility and safety data and set a framework for multidisciplinary team management of patients with cancer and LVADs.

Abstract Background Atelectasis during general anesthesia is a risk for perioperative complications. EIT measurements were performed in mechanically ventilated healthy children during elective surgery to demonstrate the changes in ventilation distribution during general anesthesia. The ventilation distribution was quantified by calculating the Global Inhomogeneity index (GI). Methods EIT measurements were performed in 23 children (9 weeks—10 years) without lung disease to detect changes in regional ventilation during elective surgery. Three previously defined time points were marked during the measurement: after intubation and start of pressure-controlled ventilation (PCV), change to pressure support ventilation (PSV), and after extubation (spontaneous breathing—SB). Ventilation distribution based on regions of interest (ROI) and changes in end-expiratory volume (∆EELV) were collected at these time points and compared. The Global Inhomogeneity index was calculated at the beginning of pressure-controlled ventilation (PCV). Results With increasing spontaneous breathing, dorsal recruitment of atelectasis occurred. The dorsal ventilation fraction increased over the time of general anesthesia with increasing spontaneous breathing, whereas the ventral fraction decreased relatively (Difference ± 5.5 percentage points respectively; 95% CI; 3.5—7.4; p

Context: At present, many cities are facing severe water-resources problems caused by urbanisation. With the development of remote sensing and geostatistics, they have been widely used in urban water-resource monitoring. Aims: To review and summarise the application of remote sensing and geostatistics in monitoring urban water resources and prospect for their furtherdevelopment. Methods: First, bibliometrics was used to analyse the existing literature in this field. We then discuss the use of remote sensing and geostatistics to improve urban water-resources monitoring capacity, focusing on the classification of technologies and equipment and their applications in urban surface-water and urban groundwater monitoring. Finally, a look at the future research direction is taken. Conclusions: In the past decade, the relevant research has shown an upward trend. The use of remote sensing and geostatistics can improve the city's water-resource monitoring capacity, thereby promoting better use of water resources in cities. Implications: In the future, with the development and addition of deep learning, remote-sensing and geographic-analysis systems can be used to conduct remote-sensing monitoring and data analysis on urban water resources more accurately, intelligently, and quickly, and improve the status of urban water resources. Urbanisation leads to water-resource problems; monitoring of urban water resources is needed for urban development. This paper systematically introduces the application of geostatistics and remote sensing for monitoring urban water resources. We used bibliometrics to analyse the existing literature, discussed the use of remote sensing and geostatistics to improve urban water-resource monitoring capacity. It is obvious that improving the accuracy of urban water-resource monitoring is needed, so as to promote the city to use water resources better. [ABSTRACT FROM AUTHOR]

Background: Hirschsprung disease (HD) is an aganglionosis of variable length starting at the rectosigmoid colon with surgery as sole therapeutic option. The length of the resected bowel segment is a crucial information for the treating surgeons and influences the prognosis of the patient. It is often artificially altered due to post operative tissue shrinkage. The objective of this study is to quantify the extent tissue shrinkage of HD specimens. Material and Methods: Colorectal HD specimens were measured at the time of surgery and at the time of cut-up, either fresh or after formalin fixation and statistically analyzed. Results: Sixteen colorectal specimens were included. Following formalin fixation the specimen length decreased by 22.7% (P <.001). Without formalin fixation the specimens shrank by an average of 24.9% (P =.05). There was no significant difference in the extent of tissue shrinkage with or without formalin fixation (P =.76). Conclusion: This study showed that there is significant tissue shrinkage in HD specimens. The 2 different cohorts revealed that tissue shrinkage is mostly caused by tissue retraction/alteration after organ removal but also to a lesser extent by fixation with formalin. Surgeons and (neuro-)pathologists should be aware of the sizeable shrinking artifact to avoid unnecessary confusion. [ABSTRACT FROM AUTHOR]

Background: Atelectasis during general anesthesia is a risk for perioperative complications. EIT measurements were performed in mechanically ventilated healthy children during elective surgery to demonstrate the changes in ventilation distribution during general anesthesia. The ventilation distribution was quantified by calculating the Global Inhomogeneity index (GI). Methods: EIT measurements were performed in 23 children (9 weeks—10 years) without lung disease to detect changes in regional ventilation during elective surgery. Three previously defined time points were marked during the measurement: after intubation and start of pressure-controlled ventilation (PCV), change to pressure support ventilation (PSV), and after extubation (spontaneous breathing—SB). Ventilation distribution based on regions of interest (ROI) and changes in end-expiratory volume (∆EELV) were collected at these time points and compared. The Global Inhomogeneity index was calculated at the beginning of pressure-controlled ventilation (PCV). Results: With increasing spontaneous breathing, dorsal recruitment of atelectasis occurred. The dorsal ventilation fraction increased over the time of general anesthesia with increasing spontaneous breathing, whereas the ventral fraction decreased relatively (Difference ± 5.5 percentage points respectively; 95% CI; 3.5—7.4; p < 0.001). With the onset of spontaneous breathing, there was a significant reduction in end-expiratory volume (Difference: 105 ml; 95% CI, 75–135; p < 0.001). The GI of the lung-healthy ventilated children is 47% (SD ± 4%). Conclusion: Controlled ventilation of healthy children resulted in increased ventilation of the ventral and collapse of the dorsal lung areas. Restart of spontaneous breathing after cessation of surgery resulted in an increase in ventilation in the dorsal with decrease in the ventral lung areas. By calculating the GI, representing the ratio of more to less ventilated lung areas, revealed the presumed homogeneous distribution of ventilation. Trial registration: ClinicalTrials.gov Registration ID: NCT04873999. First registration: 05/05/2021. [ABSTRACT FROM AUTHOR]

Enhancing the low-carbon effect of green finance development (GFD) is an effective way for China to accelerate the comprehensive deepening of supply side structural reform, better realise the high-quality development of green economy and better protect the environment. Therefore, based on the green technology innovation theory and endogenous growth theory, from the four dimensions of green innovation (GI) in the GLOBIO model, the unbalanced panel data of 8976 manufacturing listed companies from 2009 to 2021 were used. This paper deeply explores the low-carbon effect of GI on the development of green finance (GF) in China's manufacturing industry. The results show that: on the whole, GI based on environmental protection has a significant incentive effect on the low-carbon effect of GFD. Compared with green material innovation and green process innovation, green product design innovation and green equipment innovation have more incentive effect. Further analysis shows that green product design innovation and green equipment innovation can produce incremental effect on the low-carbon effect of green financial development through green material innovation. The conclusion not only provides empirical support for green technology innovation theory and endogenous growth theory, but also provides effective evidence for the path of GF to achieve low-carbon development. [ABSTRACT FROM AUTHOR]

To market products with geographical indications in the best possible way, it is necessary to examine the attitudes and habits of consumers. The subject of this paper is a survey on habits and attitudes of consumers about products with GI in Serbia. The aim of this paper is to examine the level of familiarity, attitudes, and habits of consumers, as well as to determine the knowledge and interest in these products. Citizens of Serbia participated in the research (n = 399). The methodology is based on a questionnaire that obtained the data that were processed via t-test statistical methods for independent samples, one-factor analysis of variance, the χ² test, and Pearson’s correlation coefficient. Based on the conducted research, it can be stated that about 70% of respondents are willing to pay a higher price for these products.

Food production is experiencing nowadays the transition to "smart" products which are processed by new protective techniques or minimally processed; there is also an increasing interest in traditional foods, which are perceived as healthier, and more environmentally friendly. In this regard, EU agricultural policies are based on specific measures for the entire food chain, aimed at reducing food waste and increasing sustainability; this has an essential role in protecting the availability, accessibility, and quality of agri-food products. In this paper, we focused on presenting the main categories of foods and drinks protected by geographical indication schemes PDO (Protected Designation of Origin), PGI (Protected Geographical Indication), TSG (Traditional Speciality Guaranteed), GI (Geographical Indication) at the EU and Romanian levels. We presented the statistics based on eAmbrosia EU and the Romanian Ministry of Agriculture database, the procedure for registration, and the role of this certification for the producers, community reputation, and branding. [ABSTRACT FROM AUTHOR]

Semi-natural linear landscape elements, such as hedgerows, are vital structures within agricultural landscapes that have an impact on ecosystem processes and support biodiversity. However, they are typically omitted from green infrastructure planning, which could lead to significant undervaluing of landscapes and their multifunctionality in terms of ecosystem service supply. Using the InVEST (Integrated Valuation of Ecosystem Services and Tradeoffs) model suite, we tested the effects of additionally including semi-natural linear landscape elements on the model outcomes for crop pollination, nutrient regulation, erosion regulation and water flow regulation ecosystem services supply. The results showed that linear semi-natural landscape elements contribute positively to the landscape's multifunctionality. Small changes have been identified for water flow regulation, whereas, considering both spatial extent and magnitude of the changes, the greatest changes have been found with respect to the supply of pollination and nutrient regulation. Direct proximity of the linear elements had the greatest effect on ecosystem service supply, in particular with regard to pollination. Based on our results, a more pronounced consideration of semi-natural linear landscape elements as an important element of green infrastructure is advisable. [ABSTRACT FROM AUTHOR]

To market products with geographical indications in the best possible way, it is necessary to examine the attitudes and habits of consumers. The subject of this paper is a survey on habits and attitudes of consumers about products with GI in Serbia. The aim of this paper is to examine the level of familiarity, attitudes, and habits of consumers, as well as to determine the knowledge and interest in these products. Citizens of Serbia participated in the research (n = 399). The methodology is based on a questionnaire that obtained the data that were processed via t-test statistical methods for independent samples, one-factor analysis of variance, the χ² test, and Pearson's correlation coefficient. Based on the conducted research, it can be stated that about 70% of respondents are willing to pay a higher price for these products. [ABSTRACT FROM AUTHOR]

Background: We aimed to understand the association of gastrointestinal (GI) symptoms at initial presentation with clinical outcomes during COVID-19 hospitalization. Methods: This retrospective, multicenter cohort study included consecutive hospitalized COVID-19 patients from a single, large health system. The presence of GI symptoms was assessed at initial presentation and included one or more of the following: nausea, vomiting, diarrhea and abdominal pain. Patients were divided into three cohorts: Only GI symptoms, GI and non-GI symptoms and only non-GI symptoms. The primary outcome was association of GI symptoms with mortality. Secondary outcomes included prevalence of GI symptoms and survival analysis. Results: A total of 1672 COVID-19 patients were hospitalized (mean age: 63 ± 15.8 years, females: 50.4%) in our system during the study period. 40.7% patients had at least one GI symptom (diarrhea in 28.3%, nausea/vomiting in 23%, and abdominal pain in 8.8% patients), and 2.6% patients had only GI symptoms at initial presentation. Patients presenting with GI symptoms (with or without non-GI symptoms) had a lower mortality rate compared to patients presenting with only non-GI symptoms (20% vs. 26%; p < 0.05). The time from hospitalization to being discharged was less for patients presenting with only GI symptoms (7.4 days vs. > 9 days, p < 0.0014). After adjusting for other factors, the presence of GI symptoms was not associated with mortality (p > 0.05). Conclusion: Among a hospitalized COVID-19 positive Southern US population, 41% patients presented with either diarrhea, nausea, vomiting or abdominal pain initially. The presence of GI symptoms has no association with in-hospital all-cause mortality. [ABSTRACT FROM AUTHOR]

Background & aimsMulticopper ferroxidases (MCFs) facilitate intestinal iron absorption and systemic iron recycling, likely by a mechanism involving the oxidization of Fe2+ from the iron exporter ferroportin 1 for delivery to the circulating Fe3+ carrier transferrin. Hephaestin (HEPH), the only MCF known to be expressed in enterocytes, aids in the basolateral transfer of dietary iron to the blood. Mice lacking HEPH in the whole body (Heph-/- ) or intestine alone (Hephint/int ) exhibit defects in dietary iron absorption but still survive and grow. Circulating ceruloplasmin (CP) is the only other known MCF likely to interact with enterocytes. Our aim was to assess the effects of combined deletion of HEPH and CP on intestinal iron absorption and homeostasis in mice.MethodsMice lacking both HEPH and CP (Heph-/-Cp-/- ) and mice with whole-body knockout of CP and intestine-specific deletion of HEPH (Hephint/intCp-/- ) were generated and phenotyped.ResultsHeph-/-Cp-/- mice were severely anemic and had low serum iron, but they exhibited marked iron loading in duodenal enterocytes, the liver, heart, pancreas, and other tissues. Hephint/intCp-/- mice were moderately anemic (similar to Cp-/- mice) but were iron loaded only in the duodenum and liver, as in Hephint/int and Cp-/- mice, respectively. Both double knockout models absorbed iron in radiolabeled intestinal iron absorption studies, but the iron was inappropriately distributed, with an abnormally high percentage retained in the liver.ConclusionsThese studies indicate that HEPH and CP, and likely MCFs in general, are not essential for intestinal iron absorption but are required for proper systemic iron distribution. They also point to important extra-intestinal roles for HEPH in maintaining whole-body iron homeostasis.

Preclinical and clinical studies have shown bidirectional interactions within the brain-gut-microbiome axis. Gut microbes communicate to the central nervous system through at least 3 parallel and interacting channels involving nervous, endocrine, and immune signaling mechanisms. The brain can affect the community structure and function of the gut microbiota through the autonomic nervous system, by modulating regional gut motility, intestinal transit and secretion, and gut permeability, and potentially through the luminal secretion of hormones that directly modulate microbial gene expression. A systems biological model is proposed that posits circular communication loops amid the brain, gut, and gut microbiome, and in which perturbation at any level can propagate dysregulation throughout the circuit. A series of largely preclinical observations implicates alterations in brain-gut-microbiome communication in the pathogenesis and pathophysiology of irritable bowel syndrome, obesity, and several psychiatric and neurologic disorders. Continued research holds the promise of identifying novel therapeutic targets and developing treatment strategies to address some of the most debilitating, costly, and poorly understood diseases.

Biliary atresia (BA) is an inflammatory obliterative cholangiopathy which is very common during neonatal and infancy period. We present an autopsy report of a BA in an infant suffering from a genetic syndrome. [ABSTRACT FROM AUTHOR]

The presented article deals with the catchments of three streams, which are right-hand tributaries of the Černá Opava river, where new foresthydrology research activities of the Forestry and Game Management Research Institute and Czech Hydrometeorological Institute begun. The focus of the work in the years 2019–2021 was on field research and measurements, spatial analyses in GIS and mathematical modelling using rainfall-runoff and hydrodynamic models, thus we can mention HEC-HMS, SIMWE and MIKE SHE/11 models among others. The article provides an overview of current outputs from these activities. It also outlines the issues of the impact of land use, forest health including its extreme phases on hydrological conditions and the response of river basins to precipitation inputs. Besides that, the issue of variable contribution areas of the river basins and the possibilities of their research at the level of monitoring (e.g. measurement of fl ows and volumetric soil moisture) and mathematical modelling using complex fully distributed precipitation-runoff models are discussed as well. At the same time, basic hydrological characteristics of the studied catchments were provided. [ABSTRACT FROM AUTHOR]

Introduction: Appendicular foreign bodies are a rare, under-described cause of appendicitis. We performed this study to determine the varied causes and consequences of foreign-body appendicitis. Methods: On retrospective review of the pathology archives of seven institutions, we identified 56 appendix specimens containing a foreign body (defined as ingested, non-digestible material). We recorded the type of foreign body, patient age and sex, and other findings, as available. Results: Mean patient age was 7.7 years (range: 1 day–18 years). The foreign bodies included hair, plant material, magnets, other metallic material, BB pellets, foreign material not otherwise specified, and other miscellaneous objects. Of 48 cases with available clinical information, 31 patients presented with abdominal pain, and 22 were preoperatively diagnosed as having appendicitis/appendicular inflammation. Seven patients had appendiceal perforation (13%). The foreign body was grossly identified in 34/47 cases with available gross descriptions. Twenty-seven cases had an identifiable foreign body microscopically; 10 were associated with giant cell reaction. Discussion: Hair and plant materials were the most common foreign objects found in the appendix; they often cause mucosal damage and giant cell reaction. Metallic objects were less common. Although appendicular foreign bodies in children are rare and sometimes asymptomatic, they may lead to perforation. [ABSTRACT FROM AUTHOR]

The circadian clock is a timekeeping, homeostatic system that temporally coordinates all major cellular processes. The function of the circadian clock is compensated in the face of variable environmental conditions ranging from normal to stress-inducing conditions. Salinity is a critical environmental factor affecting plant growth, and plants have evolved the SALT OVERLY SENSITIVE (SOS) pathway to acquire halotolerance. However, the regulatory systems for clock compensation under salinity are unclear. Here, we show that the plasma membrane Na+/H+ antiporter SOS1 specifically functions as a salt-specific circadian clock regulator via GIGANTEA (GI) in Arabidopsis thaliana. SOS1 directly interacts with GI in a salt-dependent manner and stabilizes this protein to sustain a proper clock period under salinity conditions. SOS1 function in circadian clock regulation requires the salt-mediated secondary messengers cytosolic free calcium and reactive oxygen species, pointing to a distinct regulatory role for SOS1 in addition to its function as a transporter to maintain Na+ homeostasis. Our results demonstrate that SOS1 maintains homeostasis of the salt response under high or daily fluctuating salt levels. These findings highlight the genetic capacity of the circadian clock to maintain timekeeping activity over a broad range of salinity levels. [ABSTRACT FROM AUTHOR]

Autism spectrum disorder (ASD) is a highly heterogeneous disorder characterized by impairments in social, communicative, and restrictive behaviors. Over the past 20 years, research has highlighted the role of the immune system in regulating neurodevelopment and behavior. In ASD, immune abnormalities are frequently observed, such as elevations in pro-inflammatory cytokines, alterations in immune cell frequencies, and dysregulated mechanisms of immune suppression. The adaptive immune system - the branch of the immune system conferring cellular immunity - may be involved in the etiology of ASD. Specifically, dysregulated T cell activity, characterized by altered cellular function and increased cytokine release, presence of inflammatory phenotypes and altered cellular signaling, has been consistently observed in several studies across multiple laboratories and geographic regions. Similarly, mechanisms regulating their activation are also disrupted. T cells at homeostasis coordinate the healthy development of the central nervous system (CNS) during early prenatal and postnatal development, and aid in CNS maintenance into adulthood. Thus, T cell dysregulation may play a role in neurodevelopment and the behavioral and cognitive manifestations observed in ASD. Outside of the CNS, aberrant T cell activity may also be responsible for the increased frequency of immune based conditions in the ASD population, such as allergies, gut inflammation and autoimmunity. In this review, we will discuss the current understanding of T cell biology in ASD and speculate on mechanisms behind their dysregulation. This review also evaluates how aberrant T cell biology affects gastrointestinal issues and behavior in the context of ASD., 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 © 2024. Published by Elsevier Inc.)

The aerobic composting process is extensively utilized to manage kitchen waste. Nonetheless, the variability in the quality of compost derived from engineering practices which significantly hinders its broader industrial application. This work investigated the final products of kitchen waste compost at multiple industrial-scale treatment facilities utilizing three distinct aerobic composting processes in a bid to explore key factors affecting compost quality. The quality evaluation was based on technical parameters like seed germination index (GI), and limiting factors such as heavy metal content. The results showed that most of the compost products failed to meet the established standards, with GI being the primary limiting indicator. Furthermore, maturity assessments suggested that compost with low GI exhibited reduced humification could not be recommended for agricultural use. The investigation delved into the primary determinants of GI, focusing on risk factors such as the oil and salt of kitchen waste, and the microbial community of the humification driving forces. The results indicated that products with low GI had higher oil and salt content and a relatively simple microbial community. A thorough analysis suggested that excessive levels oil and salt were potential influencing factors on GI, as they stimulated the activity of acid-producing bacteria like Lactobacillus, suppressed the activity of humification-promoting bacteria such as Actinomarinales, and influenced the decomposition and humification processes of organic matter and total nitrogen, thereby affecting product quality. The findings provide valuable insights for improving kitchen waste compost products for agricultural applications., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:DongLei Wu reports financial support was provided by the National Key Research and Development Project. If there are other authors, they 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 © 2024 Elsevier Inc. All rights reserved.)

Background: There has been a rapid expansion of digital health care services, making the need for measuring and improving digital health readiness a priority. In response, our study team developed the Mobile-Centered Digital Health Readiness: Health Literacy and Equity Scale (mDiHERS) to measure digital health readiness., Objective: We aim to develop and validate a scale that assesses digital health readiness, encompassing literacy and equity, and to ensure the effective use of mobile-centered digital health services., Methods: This study was conducted from October 2021 to October 2022 to develop and validate the mDiHERS. Participants included patients with inflammatory bowel disease, which is a chronic condition requiring continuous management, and experts in medical and nursing informatics. The scale development involved a literature review, focus group interviews, and content validity evaluations. A total of 440 patients with inflammatory bowel disease were recruited for the validation phase, with 403 completing the survey. The scale's validity and reliability were assessed through exploratory factor analysis and Cronbach α. The scale was translated into English by translators and bilingual and native researchers, ensuring its applicability in diverse settings., Results: The mDiHERS consists of 36 items across 6 domains, with a 5-point Likert scale for responses. The validation process confirmed the scale's construct validity, with 4 factors explaining 65.05% of the total variance. The scale's reliability was established with Cronbach α values ranging from 0.84 to 0.91. The scale's development considered the technical proficiency necessary for engaging with health mobile apps and devices, reflecting the importance of subjective confidence and objective skills in digital health literacy., Conclusions: The mDiHERS is a validated tool for measuring patients' readiness and ability to use digital health services. The mDiHERS assesses user characteristics, digital accessibility, literacy, and equity to contribute to the effective use of digital health services and improve accessibility. The development and validation of the mDiHERS emphasize the importance of confidence and competence in managing health digitally. Continuous improvements are necessary to ensure that all patients can benefit from digital health care., (©Hana Kim, Rebecca Schnall, Nagyeom Yoon, Seong-Joon Koh, Jisan Lee, Jae Hee Cheon. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 13.08.2024.)

Abstract By its nature, Gulf war illness (GWI) is multisymptomatic and affects several organ systems in the body. Along with other symptoms, veterans who suffer from GWI commonly report chronic gastrointestinal issues such as constipation, pain, indigestion, etc. However, until recently, most attention has been focused on neurological disturbances such as cognitive impairments, chronic fatigue, and chronic pain among affected veterans. With such high prevalence of gastrointestinal problems among Gulf war (GW) veterans, it is surprising that there is little research to investigate the mechanisms behind these issues. This review summarizes all the available works on the mechanisms behind gastrointestinal problems in GWI that have been published to date in various databases. Generally, these studies, which were done in rodent models, in vitro and human cohorts propose that an altered microbiome, a reactive enteric nervous system or a leaky gut among other possible mechanisms are the major drivers of gastrointestinal problems reported in GWI. This review aims to draw attention to the gastrointestinal tract as an important player in GWI disease pathology and a potential therapeutic target.

This case study presents an infant with non-specific symptoms for esophageal atresia and tracheoesophageal fistula shortly after birth. A detailed examination of the infant provides clues to the potential diagnosis while the radiograph provides confirmation. This column provides the clinician with a detailed evaluation of the x-ray findings specific to the infant with esophageal atresia with and without tracheo esophageal fistula. Additionally, a description of the different types of this congenital anomaly, embryology, pathophysiology, testing, treatment, and nursing considerations is presented. [ABSTRACT FROM AUTHOR]