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Introdução: O IHEBE é um serviço de hemoterapia privado, localizado no município de Belém/Pará, responsável pelo atendimento de Maternidades e Hospitais, que atendem público de perfil variado, localizados na região metropolitana. Possui 6 Agências Transfusionais e recebe em média 8.000 solicitações de unidades de plaquetas anuais e transfunde em média 6.000 unidades de plaquetas/ano. Objetivo: Realizar liberação do estoque de concentrado de plaquetas previamente irradiadas para otimizar o atendimento ao receptor. Material e métodos: Estudo retrospectivo, descritivo, realizado no IHEBE no período de 01/01/2021 a 31/07/2021. Foram selecionadas todas as solicitações médicas de plaquetas irradiadas e não-irradiadas deste período e todas as plaquetas processadas neste intervalo de tempo. Todos os dados foram tabulados em planilhas do programa Microsoft Office Excel 2013 para análise. Resultados: Dos 5.152 Concentrados de Plaquetas (CP5) solicitados neste período, foram requeridos em janeiro 819 CP5, sendo 547 (67%) irradiados. Em fevereiro, 630 CP5, sendo 455 (72%) irradiados. Em março, 687 CP5, sendo 624 (91%) irradiados. Em abril, 1.192 CP5, sendo 594 (50%) irradiados. Em maio, 432 CP5, sendo 369 (85%) irradiados. Em junho, 615 CP5, sendo 483 (79%) irradiados. Em julho 777 CP5, sendo 673 (87%) irradiados. Dos 5.152 CP5 solicitados, foram transfundidos 4.500 unidades, sendo a diferença 652 (13%) referente a pacientes que tiveram seus pedidos atendidos parcialmente. Discussão: Analisando a variação percentual de solicitações de concentrado de plaquetas irradiadas, observou-se que a maior demanda é de unidades irradiadas, a exceção aconteceu no mês de abril que devido ao bandeiramento vermelho pela pandemia por Coronavívus, em que houve um incremento de CP5 não-irradiadas devido ao perfil de atendimento da época. Conclusão: Diante deste cenário o IHEBE implementou o protocolo de irradiação de todas as plaquetas previamente à liberação. Desta forma, os Concentrados de Plaquetas Randômicas (CP5) ou Concentrado de Plaquetas de Buffy Coat (CPBC) processados são enviados à Irradiação, sendo em seguida são devolvidos ao Setor de Processamento para liberação, rotulagem e distribuição às Agências Transfusionais, garantindo a otimização da disponibilidade de plaquetas irradiadas e diminuindo o tempo de espera para o atendimento ao receptor.

Background/Aims: Ursodeoxycholic acid (UDCA) is the only well-established and widely used agent for dissolving gallstones. Epidemiological and animal studies have suggested potential therapeutic benefits of n-3 polyunsaturated fatty acids (PUFA) for dissolving cholesterol gallstones. We evaluated whether adding PUFA to UDCA improves gallstone dissolution in patients with cholesterol gallstones. Methods: This randomized, prospective, preliminary clinical trial compared the efficacy and safety of UDCA plus PUFA combination therapy (combination group) with those of UDCA monotherapy (monotherapy group). The inclusion criteria were a gallstone diameter ≤15 mm on ultrasonography, radiolucent stones on plain X-ray, and no to mild symptoms. Gallstone dissolution rates, response rates, and adverse events were evaluated. Results: Of the 59 screened patients, 45 patients completed treatment (24 and 21 in the monotherapy and combination groups, respectively). The gallstone dissolution rate tended to be higher in the combination group than in the monotherapy group (45.7% vs 9.9%, p=0.070). The radiological response rate was also significantly higher in the combination group (90.5% vs 41.7%, p=0.007). In both groups, dissolution and response rates were higher in patients with gallbladder sludge than in those with distinct stones. Four adverse events (two in each group) were observed, none of which were study drug-related or led to drug discontinuation. The incidence of these adverse events was similar in both groups (combination vs monotherapy: 9.5% vs 8.3%, p=0.890). Conclusions: UDCA plus PUFA therapy dissolves cholesterol gallstones more effectively than UDCA monotherapy, without significant complications. Further prospective, large-scale studies of this combination therapy are warranted.

Sensors are applied to many fields nowadays because of their high sensitivity, low cost, time-saving, user-friendly, and excellent selectivity. Current biomedical and pharmaceutical science has one focus on developing nanoparticle-based sensors, especially biopolymeric nanoparticles. Alginate is a widely used biopolymer in a variety of applications. The hydrogel-forming characteristic, the chemical structure with hydroxy and carboxylate moieties, biocompatibility, biodegradability, and water solubility of alginate have expanded opportunities in material and biomedical sciences. Recently, research on alginate-based nanoparticles and their applications has begun. These materials are gaining popularity because of their wide usage potential in the biomedical and pharmaceutical fields. Many review papers describe applications of alginate in the drug delivery field. The current study covers the structural and physicochemical properties of alginate-based nanoparticles. The prospective applications of alginate-based nanomaterials in various domains are discussed, including drug delivery and environmental sensing applications for humidity, heavy metals, and hydrogen peroxide. Moreover, biomedical sensing applications of alginate-based nanoparticles regarding various analytes such as glucose, cancer cells, pharmaceutical drugs, and human motion will also be reviewed in this paper. Future research scopes highlight existing challenges and solutions.

Abstract Acute biliary pancreatitis (ABP) with cholangitis requires endoscopic retrograde cholangiopancreatography (ERCP) within 24 h to resolve ductal obstruction. However, this recommendation is based on the timing of emergency room (ER) visits. We wanted to determine the optimal timing of ERCP for ABP based on the timing of symptom onset, not the timing of the ER visit. We retrospectively reviewed 162 patients with ABP with cholangitis who underwent urgent ERCP (within 24 h of ER admission). Area under the receiver operating characteristic (ROC) curve (AUC) was analyzed to determine differences in complication rates according to time from symptom onset. A difference in ERCP-related adverse events (AEs) was identified, and Youden’s J statistic was used to determine a cutoff time from symptom onset (18 h). We compared mortality and complications based on this cutoff. Based on time to symptom onset, significantly higher rates of aspiration pneumonia (odds ratio [OR] 4.00, 95% confidence interval [CI] 1.15–13.92, P = 0.021) and post-ERCP hypotension (OR 11.9, 95% CI 1.39–101.33, P = 0.005) were observed in the ≤ 18-h group than in the > 18-h group. The study found that patients who underwent ERCP within 18 h of symptom onset is associated with an increased risk of ERCP-related AEs.

Recent experimental findings have shown that tantalum single crystals display strong anisotropy during Taylor impact testing in stark contrast to isotropic deformation in polycrystalline counterparts. In this study, a coupled dislocation dynamics and finite element model was developed to simulate the complex stress field under dynamic loading of a Taylor impact test and track the intricate evolution of the dislocation microstructure. Our model allowed us to investigate detailed motion of dislocations and their mutual interactions and the effect of varying simulation parameters, such as sample size, initial dislocation density, crystallographic orientation, and temperature. Simulation results show good agreement with experimental observations and shed light on the mechanical response at small-scale under extreme loading conditions. In addition, resolved shear stress analysis incorporating the effect of shear stress from impact was performed to quantitatively support and provide a means to understand the model predictions of the impact foot shape.

Background: Approximately half of the patients with advanced pancreatic ductal adenocarcinoma (PDAC) receive subsequent lines of chemotherapy. Recently, the liposomal irinotecan (nal-IRI) plus 5-fluorouracil/leucovorin (5-FU/LV) regimen is recommended as subsequent lines of chemotherapy. However, little is known about the predictive factors for the nal-IRI + 5-FU/LV regimen, especially in patients with previous irinotecan (IRI) exposure. Objectives: We investigated the predictive factors associated with nal-IRI + 5-FU/LV treatment in patients with PDAC. Design: Multicenter, retrospective cohort study. Methods: This study included patients with advanced PDAC who received the nal-IRI + 5-FU/LV regimen for palliative purposes. Results: Overall, 268 patients were treated with nal-IRI + 5-FU/LV. The median overall survival (OS) was 7.9 months (95% confidence interval (CI): 7.0–8.8), while the median progression-free survival (PFS) was 2.6 months (95% CI: 1.9–3.2). An albumin level of3 lines of palliative chemotherapy were associated with worse OS. An NLR of ⩾3.5 and liver metastasis were significant predictive factors for worse PFS. Previous exposure to IRI was not a significant predictor. Patients without prior IRI (no-IRI) treatment showed relatively longer OS and PFS compared to IRI responders and nonresponders, but these differences were not significant when compared specifically to the responders (OS: 8.8 vs 8.1 months, p = 0.388; PFS: 3.6 vs 2.6 months, p = 0.126). Conclusion: An NLR of ⩾3.5 and liver metastasis were associated with worse PFS. Prior IRI exposure was not a significant predictive factor for OS and PFS, especially in IRI responders.

Abstract We report an innovative and facile approach to fabricating an ultrasensitive plasmonic paper substrate for surface-enhanced Raman spectroscopy (SERS). The approach exploits the self-assembling capability of poly(styrene-b-2-vinyl pyridine) block copolymers to form a thin film at the air-liquid interface within the single microdroplet scale for the first time and the subsequent in situ growth of silver nanoparticles (AgNPs). The concentration of the block copolymer was found to play an essential role in stabilizing the droplets during the mass transfer phase and formation of silver nanoparticles, thus influencing the SERS signals. SEM analysis of the morphology of the plasmonic paper substrates revealed the formation of spherical AgNPs evenly distributed across the surface of the formed copolymer film with a size distribution of 47.5 nm. The resultant enhancement factor was calculated to be 1.2 × 107, and the detection limit of rhodamine 6G was as low as 48.9 pM. The nanohybridized plasmonic paper was successfully applied to detect two emerging pollutants—sildenafil and flibanserin—with LODs as low as 1.48 nM and 3.45 nM, respectively. Thus, this study offers new prospects for designing an affordable and readily available, yet highly sensitive, paper-based SERS substrate with the potential for development as a lab-on-a-chip device.

Abstract Limited information is available regarding the association between preoperative lung function and postoperative pulmonary complications (PPCs) in patients with esophageal cancer who undergo esophagectomy. This is a retrospective cohort study. Patients were classified into low and high lung function groups by the cutoff of the lowest fifth quintile of forced expiratory volume in 1 s (FEV1) %predicted (%pred) and diffusing capacity of the carbon monoxide (DLco) %pred. The PPCs compromised of atelectasis requiring bronchoscopic intervention, pneumonia, and acute lung injury/acute respiratory distress syndrome. Modified multivariable-adjusted Poisson regression model using robust error variances and inverse probability treatment weighting (IPTW) were used to assess the relative risk (RR) for the PPCs. A joint effect model considered FEV1%pred and DLco %pred together for the estimation of RR for the PPCs. Of 810 patients with esophageal cancer who underwent esophagectomy, 159 (19.6%) developed PPCs. The adjusted RR for PPCs in the low FEV1 group relative to high FEV1 group was 1.48 (95% confidence interval [CI] = 1.09–2.00) and 1.98 (95% CI = 1.46–2.68) in the low DLco group relative to the high DLco group. A joint effect model showed adjusted RR of PPCs was highest in patients with low DLco and low FEV1 followed by low DLco and high FEV1, high DLco and low FEV1, and high DLco and high FEV1 (Reference). Results were consistent with the IPTW. Reduced preoperative lung function (FEV1 and DLco) is associated with post-esophagectomy PPCs. The risk was further strengthened when both values decreased together.

Abstract Alcohol and cocaine (COC) are commonly co-used drugs that cause addiction and have harmful effects. Their abuse may threaten the health of the abuser and public safety by causing serious accidents or crimes. The recidivism rate of drug-related crimes closely correlates with alcoholism. Several incidences of alcohol consumption in combination with drug abuse have been reported. Here, liquid chromatography tandem mass spectrometric method was developed to simultaneously analyze ethyl glucuronide (EtG), a metabolite of ethanol; COC; cocaethylene (CE), an alcohol-derived metabolite of COC; and benzoylecgonine (BZE), a major metabolite of COC, to determine the concurrent use of alcohol with COC. For pre-treatment, ultracentrifugation (5 min, 50,000 g) and mixed-mode anion exchange solid-phase extraction were used to increase the recovery of target compounds and minimize the matrix effect of hair. The lower limits of quantification were: 7 pg/mg (EtG), 2 pg/mg (COC), 10 pg/mg (CE), and 1 pg/mg (BZE). The correlation coefficient (r) of the calibration curve within the quantified range of target compounds was ≥ 0.9978. The intra- and inter-day accuracies were − 6.1–9.7% and − 9.3–8.3%, and intra- and inter-day precisions were 0.5–10.3% and 0.6–14.4%, respectively. The recovery, matrix effect, process efficiency, and autosampler stability were 89.2–104.8%, 81.6–105.4%, 81.5–107.1%, and 96.6–109.7%, respectively. The novel analytical method was validated with hair samples from individuals suspected of alcohol and COC use, and the method could distinguish between independent and concurrent use. Based on the findings, the analytical approach developed in this study is anticipated to be valuable in drug and alcohol dependence tests that require the simultaneous detection of alcohol and COC abuse.

Background: Anastomotic leakage (AL) following esophagectomy represents a serious complication that often results in prolonged hospitalization and necessitates repeated interventions, including nothing-by-mouth (NPO) restriction, endoscopic vacuum therapy (EVT), or surgical repair. In this study, we evaluated the patterns and outcomes of AL treatment. Methods: We retrospectively reviewed the medical records of patients who underwent esophagectomy for esophageal cancer at a single center between 2003 and 2020. Of 3,096 examined cases, 181 patients (5.8%) with AL were included in the study: 114 patients (63%) with cervical anastomosis (CA) and 67 (37%) with intrathoracic anastomosis (TA). Results: The incidence of AL was 11.9% in the CA and 3.2% in the TA group (p

Abstract Background In the United States, the rate of benign histology among resected renal tumors suspected to be malignant is increasing. We evaluated the rates in the Republic of Korea and assessed the racial effect using recent multi-institutional Korean-United States data. Methods We conducted a multi-institutional retrospective study of 11,529 patients (8,812 from The Republic of Korea and 2,717 from the United States) and compared the rates of benign histology between the two countries. To evaluate the racial effect, we divided the patients into Korean, Asian in the US, and Non-Asian in the US. Results The rates of benign histology and small renal masses in Korean patients were significantly lower than that in United States patients (6.3% vs. 14.3%, p

Background/Aims: Endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/B) is essential in diagnosing solid pancreatic lesions (SPLs), but without rapid on-site evaluation (ROSE), a repeat EUS-FNA/B is crucial for clarifying an inconclusive diagnosis. We aimed to evaluate factors associated with improved diagnostic performance of repeat EUS-FNA/B for initially inconclusive SPL diagnoses without ROSE. Methods: Of 5,894 patients subjected to EUS-FNA/B, 237 (4.0%) with an initially inconclusive diagnosis of SPLs were retrospectively enrolled from five tertiary medical centers between January 2016 and June 2021. Diagnostic performance and procedural factors of EUS-FNA/B were analyzed. Results: The diagnostic accuracies of first and repeat EUS-FNA/B were 96.2% and 67.6%, respectively. Of 237 patients with an inconclusive diagnosis from initial EUS-FNA/B, 150 were pathologically diagnosed after repeat EUS-FNA/B. In multivariate analysis of repeat EUS-FNA/B, tumor location (body/tail vs head: odds ratio [OR], 3.74; 95% confidence interval [CI], 1.48 to 9.46), number of needle passes (≥4 vs ≤3: OR, 4.80; 95% CI, 1.44 to 15.99), needle type (FNB vs FNA: OR, 3.26; 95% CI, 1.44 to 7.36), needle size (22 gauge vs 19/20 gauge: OR, 2.35; 95% CI, 1.19 to 4.62), and suction method (suction vs others: OR, 5.19; 95% CI, 1.30 to 20.75) were associated with a significantly improved diagnostic performance. Conclusions: Repeat EUS-FNA/B is essential for patients with an inconclusive EUS-FNA/B without ROSE. To improve the diagnostic performance of repeated EUS-FNA/B, it is recommended that 22-gauge FNB needles, ≥4 needle passes, and suction methods are used.

Voltage source converter (VSC)-based high-voltage direct-current (HVDC) systems are being increasingly considered to support grid frequency regulation (FR) by using fast responses to reference signals. This paper proposes a control strategy for the optimal real-time FR of multi-terminal (MT) HVDC grids to reduce grid frequency variations. The novelty of the proposed strategy is that it realizes coordinated power control (CPC) of MT-HVDC system to consider the malfunctions of the HVDC converters and communication time delays between the malfunctioning and compensated HVDC converters. Accordingly, a state-space model of MT-HVDC grids is derived considering the DC-link voltage and active power controls at the rectifier and inverter, respectively, which are combined with inertia emulation (IE) and droop controllers. Based on the developed model for MT-HVDC grids, optimal secondary frequency control (SFC) is achieved using a linear quadratic Gaussian (LQG) controller. Moreover, CPC is integrated into the LQG to compensate for the inaccurate output power owing to malfunctions of the HVDC converter. Simulation case studies are performed to verify that the proposed strategy can alleviate real-time frequency fluctuations of inverter-side grids more effectively than conventional strategies.

Alzheimer’s disease (AD) is a progressive neurodegenerative disease, and it is currently the seventh leading cause of death worldwide. It is characterized by the extracellular aggregation of the amyloid β-peptide (Aβ) into oligomers and fibrils that cause synaptotoxicity and neuronal death. Aβ exhibits a dual role in promoting oxidative stress and inflammation. This review aims to unravel the intricate connection between these processes and their contribution to AD progression. The review delves into oxidative stress in AD, focusing on the involvement of metals, mitochondrial dysfunction, and biomolecule oxidation. The distinct yet overlapping concept of nitro-oxidative stress is also discussed, detailing the roles of nitric oxide, mitochondrial perturbations, and their cumulative impact on Aβ production and neurotoxicity. Inflammation is examined through astroglia and microglia function, elucidating their response to Aβ and their contribution to oxidative stress within the AD brain. The blood–brain barrier and oligodendrocytes are also considered in the context of AD pathophysiology. We also review current diagnostic methodologies and emerging therapeutic strategies aimed at mitigating oxidative stress and inflammation, thereby offering potential treatments for halting or slowing AD progression. This comprehensive synthesis underscores the pivotal role of Aβ in bridging oxidative stress and inflammation, advancing our understanding of AD and informing future research and treatment paradigms.

BackgroundWe sought to assess whether persistent COVID-19 symptoms beyond 6 months (Long-COVID) among patients with mild COVID-19 is associated with poorer health status, quality of life, and psychological distress.MethodsThis was a multicenter prospective cohort study that included adult outpatients with acute COVID-19 from eight sites during 2-week sampling periods from April 1 and July 28, 2020. Participants were contacted 6-11 months after their first positive SARS-CoV-2 to complete a survey, which collected information on the severity of eight COVID-19 symptoms using a 4-point scale ranging from 0 (not present) to 3 (severe) at 1 month before COVID-19 (pre-illness) and at follow-up; the difference for each was calculated as an attributable persistent symptom severity score. A total attributable persistent COVID-19 symptom burden score was calculated by summing the attributable persistent severity scores for all eight symptoms. Outcomes measured at long-term follow-up comprised overall health status (EuroQol visual analogue scale), quality of life (EQ-5D-5L), and psychological distress (Patient Health Questionnaire-4). The association between the total attributable persistent COVID-19 burden score and each outcome was analyzed using multivariable proportional odds regression.ResultsOf the 2092 outpatients with COVID-19, 436 (21%) responded to the survey. The median (IQR) attributable persistent COVID-19 symptom burden score was 2 (0, 4); higher scores were associated with lower overall health status (aOR 0.63; 95% CI: 0.57-0.69), lower quality of life (aOR: 0.65; 95%CI: 0.59-0.72), and higher psychological distress (aOR: 1.40; 95%CI, 1.28-1.54) after adjusting for age, race, ethnicity, education, and income.ConclusionsIn participants with mild acute COVID-19, the burden of persistent symptoms was significantly associated with poorer long-term health status, poorer quality of life, and psychological distress.

Background/Aims: The use of a self-expandable metal stent (SEMS) is recommended for unresectable malignant biliary obstruction (MBO). Stent-related adverse events might differ according to the position of the stent through the ampulla of Vater (AOV). We retrospectively evaluated SEMS patency and adverse events according to the position of the SEMS.Methods: In total, 280 patients who underwent endoscopic SEMS placement due to malignant distal biliary obstruction were analyzed retrospectively. Suprapapillary and transpapillary SEMS insertions were performed on 51 patients and 229 patients, respectively.Results: Between the suprapapillary group (SPG) and transpapillary group (TPG), the stent patency period was not significantly different (median [95% confidence interval]: 107 days [82.3 to 131.7] vs 120 days [99.3 to 140.7], p=0.559). There was also no significant difference in the rate of adverse events. In subgroup analysis, the stent patency for an MBO located within 2 cm from the AOV was found to be significantly shorter than that for an MBO located more than 2 cm from the AOV in the SPG (64 days [0 to 160.4] vs 127 days [82.0 to 171.9], p

Abstract Background Pneumocystis jirovecii pneumonia (PJP) is an opportunistic, life-threatening disease commonly affecting immunocompromised patients. The distribution of predisposing diseases or conditions in critically ill patients admitted to intensive care unit (ICU) and subjected to diagnostic work-up for PJP has seldom been explored. Materials and methods The primary objective of the study was to describe the characteristics of ICU patients subjected to diagnostic workup for PJP. The secondary objectives were: (i) to assess demographic and clinical variables associated with PJP; (ii) to assess the performance of Pneumocystis PCR on respiratory specimens and serum BDG for the diagnosis of PJP; (iii) to describe 30-day and 90-day mortality in the study population. Results Overall, 600 patients were included in the study, of whom 115 had presumptive/proven PJP (19.2%). Only 8.8% of ICU patients subjected to diagnostic workup for PJP had HIV infection, whereas hematological malignancy, solid tumor, inflammatory diseases, and solid organ transplants were present in 23.2%, 16.2%, 15.5%, and 10.0% of tested patients, respectively. In multivariable analysis, AIDS (odds ratio [OR] 3.31; 95% confidence interval [CI] 1.13–9.64, p = 0.029), non-Hodgkin lymphoma (OR 3.71; 95% CI 1.23–11.18, p = 0.020), vasculitis (OR 5.95; 95% CI 1.07–33.22, p = 0.042), metastatic solid tumor (OR 4.31; 95% CI 1.76–10.53, p = 0.001), and bilateral ground glass on CT scan (OR 2.19; 95% CI 1.01–4.78, p = 0.048) were associated with PJP, whereas an inverse association was observed for increasing lymphocyte cell count (OR 0.64; 95% CI 0.42–1.00, p = 0.049). For the diagnosis of PJP, higher positive predictive value (PPV) was observed when both respiratory Pneumocystis PCR and serum BDG were positive compared to individual assay positivity (72% for the combination vs. 63% for PCR and 39% for BDG). Cumulative 30-day mortality and 90-day mortality in patients with presumptive/proven PJP were 52% and 67%, respectively. Conclusion PJP in critically ill patients admitted to ICU is nowadays most encountered in non-HIV patients. Serum BDG when used in combination with respiratory Pneumocystis PCR could help improve the certainty of PJP diagnosis.

Background/Aims: Acute pancreatitis (AP) is a common gastrointestinal disease associated with hospitalization. With the increase in its incidence, AP has become a greater burden on healthcare resources. Early identification of patients with mild AP can facilitate the appropriate use of resources. We aimed to investigate the ability of inflammatory markers, including interleukin-6 (IL-6), procalcitonin, and C-reactive protein (CRP), as well as various scoring systems to differentiate mild AP from more severe diseases.Methods: We retrospectively investigated patients hospitalized with AP, for whom severity assessment and clinical course confirmation were possible. Inflammatory markers were measured at admission, and CRP levels were measured 24 hours after admission (CRP2). Predictive values were calculated using the area under the receiver operating characteristic curve (AUROC) and logistic regression model analysis.Results: Of 103 patients with AP, 42 (40.8%) were diagnosed with mild AP according to the revised Atlanta classification. Based on the AUROC, IL-6 (0.755, p

The detection of harmful chemicals in the environment and for food safety is a crucial requirement. While traditional techniques such as GC–MS and HPLC provide high sensitivity, they are expensive, time-consuming, and require skilled labor. Surface-enhanced Raman spectroscopy (SERS) is a powerful analytical tool for detecting ultralow concentrations of chemical compounds and biomolecules. We present a reproducible method for producing Ag nanoparticles that can be used to create highly sensitive SERS substrates. A microfluidic device was employed to confine the precursor reagents within the droplets, resulting in Ag nanoparticles of uniform shape and size. The study investigates the effects of various synthesis conditions on the size distribution, dispersity, and localized surface plasmon resonance wavelength of the Ag nanoparticles. To create the SERS substrate, the as-synthesized Ag nanoparticles were assembled into a monolayer on a liquid/air interface and deposited onto a porous silicon array prepared through a metal-assisted chemical etching approach. By using the developed microfluidic device, enhancement factors of the Raman signal for rhodamine B (at 10−9 M) and melamine (at 10−7 M) of 8.59 × 106 and 8.21 × 103, respectively, were obtained. The detection limits for rhodamine B and melamine were estimated to be 1.94 × 10−10 M and 2.8 × 10−8 M with relative standard deviation values of 3.4% and 4.6%, respectively. The developed SERS substrate exhibits exceptional analytical performance and has the potential to be a valuable analytical tool for monitoring environmental contaminants.

Abstract Background Percutaneous coronary intervention (PCI) has been developed using drug-eluting stents (DES); however, stent implantation is associated with concerns of stent thrombosis and target vessel revascularization (TVR). The stent diameter is a critical factor in TVR and clinical events. The nitrate administration in coronary angiography can dilate the reference vessel diameter, enabling accurate vessel size measurement and optimal stent implantation support. This study was designed to evaluate the effect of stent implantation in the maximally dilated coronary artery in patients with coronary artery disease (CAD). Methods This prospective double-blinded randomized (1:1) study is designed to compare the efficacy and safety between DES implantation into the nitrate-induced maximally dilated vessels and conventional DES implantation in patients with CAD. A total of 400 patients who underwent PCI with a sirolimus-eluting stent will be enrolled. The primary endpoint is the mean diameter of the deployed stents. Secondary endpoints include cardiac death, myocardial infarction, stent thrombosis, or ischemia-driven TVR 1 year after the procedure. Discussion This study will be the first randomized controlled trial to evaluate the effect of DES implantation on nitrate-induced maximally dilated vessels in patients with CAD. Trial registration The trial was registered on 18 June 2021 as Effect of Ultimaster Stents Treated to the Most Dilated Coronary Vessels (ClinicalTrials.gov Identifier: NCT04931784).

This article provides evidence-based recommendations and expert opinions to aid urologists in making optimal decisions regarding managing urolithiasis in various clinical scenarios. The most frequently asked questions by urologists in their clinical practice have been collected and answered in the form of FAQs; based on the latest evidence and expert opinions. The natural history of urolithiasis is divided into active treatment and silent phases, with the active treatment stage divided into typical and special situations and peri-treatment management. The authors address 28 key questions, offering practical guidance for the proper diagnosis, treatment, and prevention of urolithiasis in clinical practice. This article is expected to be served as a valuable resource for urologists.

Summary: Background: Lung cancer diagnostic guidelines advocate for invasive mediastinal nodal staging (IMNS), but the survival benefits of this approach in patients with non-small cell lung cancer (NSCLC) without radiologic evidence of lymph node metastasis (rN0) remain uncertain. We aimed to investigate the impact of IMNS in patients with rN0 NSCLC by comparing the long-term survival between patients who underwent IMNS and those who did not (non-IMNS). Methods: In this retrospective cohort study, we included patients with NSCLC but without radiologic evidence of lymph node metastasis from the Registry for Thoracic Cancer Surgery and the clinical data warehouse at the Samsung Medical Centre, Republic of Korea between January 2, 2008 and December 31, 2016. We compared the 5-year overall survival (OS) rate as the primary outcome after propensity score matching between the IMNS and non-IMNS groups. The age, sex, performance statue, tumor size, centrality, solidity, lung function, FDG uptake in PET-CT, and histological examination of the tumor before surgery were matched. Findings: A total of 4545 patients (887 in the IMNS group and 3658 in the non-IMNS group) who received curative treatment for NSCLC were included in this study. By the mediastinal node dissection, the overall incidence of unforeseen mediastinal node metastasis (N2) was 7.2% (317/4378 patients). Despite the IMNS, 67% of pathological N2 was missed (61/91 patients with unforeseen N2). Based on propensity score matching, 866 patients each for the IMNS and non-IMNS groups were assigned. There was no significant difference in 5-year OS and recurrence-free survival (RFS) between two groups: 5-year OS was 73.9% (95% confidence interval, CI: 71%–77%) for IMNS and 71.7% (95% CI: 68.6%–74.9%; p = 0.23), for non-IMNS (hazard ratio, HR 0.90, 95% CI: 0.77–1.07), while 5-year RFS was 64.7% (95% CI: 61.5%–68.2%) and 67.5% (95% CI: 64.3%–70.9%; p = 0.35 (HR 1.08, 95% CI: 0.92–1.27), respectively. Moreover, the timing and locations of recurrence were similar in both groups. Interpretation: IMNS might not be required before surgery for patients with NSCLC without LN suspicious of metastasis. Further randomised trials are required to validate the findings of the present study. Funding: None.

A fabrication technique using Al2O3-passivated local contacts was employed to produce narrow-bandgap CuInSe2 (CISe) photoabsorbers, which are well-suited as bottom cell materials in tandem devices. However, the performances of CISe cells with narrow bandgaps are impeded by the recombination of charge carriers, which reduces the open-circuit voltage (VOC). To overcome this limitation, an additional Al2O3 passivation layer was added to CISe solar cells. This enhanced the VOC while maintaining a spectral response of up to 1.0 eV, thereby boosting the photovoltaic conversion efficiency of the devices. Further, the Al2O3 passivation layer within the CISe absorber effectively mitigated the recombination of charge carriers, resulting in a substantial improvement in efficiency. Specifically, the Al2O3-passivated local contact hindered the charge-carrier recombination at the rear contact, leading to a marked increase in the VOC. Consequently, the overall photovoltaic conversion efficiency increased significantly from 10.4 % to 13 %. These results are expected to greatly further the development of CISe solar cells and achieve remarkable photovoltaic conversion efficiencies.

Severe acute respiratory syndrome coronavirus 2 causes direct damage to the airway epithelium, enabling aspergillus invasion. Reports of COVID-19-associated pulmonary aspergillosis have raised concerns about it worsening the disease course of COVID-19 and increasing mortality. Additionally, the first cases of COVID-19-associated pulmonary aspergillosis caused by azole-resistant aspergillus have been reported. This article constitutes a consensus statement on defining and managing COVID-19-associated pulmonary aspergillosis, prepared by experts and endorsed by medical mycology societies. COVID-19-associated pulmonary aspergillosis is proposed to be defined as possible, probable, or proven on the basis of sample validity and thus diagnostic certainty. Recommended first-line therapy is either voriconazole or isavuconazole. If azole resistance is a concern, then liposomal amphotericin B is the drug of choice. Our aim is to provide definitions for clinical research and up-to-date recommendations for clinical management of the diagnosis and treatment of COVID-19-associated pulmonary aspergillosis.

Abstract Background In recent years, numerous dosing studies have been conducted to optimize therapeutic antibiotic exposures in patients with serious infections. These studies have led to the inclusion of dose optimization recommendations in international clinical practice guidelines. The last international survey describing dosing, administration and monitoring of commonly prescribed antibiotics for critically ill patients was published in 2015 (ADMIN-ICU 2015). This study aimed to describe the evolution of practice since this time. Methods A cross-sectional international survey distributed through professional societies and networks was used to obtain information on practices used in the dosing, administration and monitoring of vancomycin, piperacillin/tazobactam, meropenem and aminoglycosides. Results A total of 538 respondents (71% physicians and 29% pharmacists) from 409 hospitals in 45 countries completed the survey. Vancomycin was mostly administered as an intermittent infusion, and loading doses were used by 74% of respondents with 25 mg/kg and 20 mg/kg the most favoured doses for intermittent and continuous infusions, respectively. Piperacillin/tazobactam and meropenem were most frequently administered as an extended infusion (42% and 51%, respectively). Therapeutic drug monitoring was undertaken by 90%, 82%, 43%, and 39% of respondents for vancomycin, aminoglycosides, piperacillin/tazobactam, and meropenem, respectively, and was more frequently performed in high-income countries. Respondents rarely used dosing software to guide therapy in clinical practice and was most frequently used with vancomycin (11%). Conclusions We observed numerous changes in practice since the ADMIN-ICU 2015 survey was conducted. Beta-lactams are more commonly administered as extended infusions, and therapeutic drug monitoring use has increased, which align with emerging evidence.

Objective We aimed to evaluate the efficacy of a modified Double-Ovsynch protocol vs artificial insemination following estrus detection (AIED) for the enhancement of reproductive performance in Hanwoo cattle. Methods Four hundred twelve Hanwoo cows were allocated to two treatment groups. The first group of cows were administered gonadotropin releasing hormone (GnRH) on Day 36 (±0.6), prostaglandin F2α (PGF2α) on Day 46 (8 to 12 days later), and GnRH on Day 49, which was followed by Ovsynch, consisting of an injection of GnRH on Day 56, PGF2α on Day 63, and GnRH 56 h and timed AI (TAI) 16 h later (modified Double-Ovsynch group, n = 203). The second group of cows underwent AIED (AIED group, n = 209) and were designated as controls. Results The pregnancy per AI 60 days after the first AI was higher in the modified Double-Ovsynch (68.5%) than in the AIED (56.5%) group, resulting in a higher probability of pregnancy per AI (odds ratio: 1.68, p

MPW produces a high Lorentz force for welding through the interaction of magnetic fields between the working coil and outer workpiece. Therefore, the design of the working coil is crucial in the MPW process. In particular, it is important to understand and estimate the distribution of Lorentz force on the outer tube and the stress on the working coil. These factors greatly impact the efficiency of energy delivery and the durability of the process. The purpose of this research was to analyze the effect of coil design parameters on the Lorentz force and stress. The ultimate objective was to optimize these design parameters specifically for welding tubular workpieces; for this, an electromagnetic-mechanical FE-model was developed. The design parameters considered in this study included the angle, radius, and protruding length. The Lorentz force and stress were calculated based on these parameters. Notably, the response surface method (RSM) and sequential quadratic programing (SQP) were utilized to develop a prediction model and optimize the design parameters, respectively. The findings revealed that the protruding length and angle are significant design parameters. Consequently, a working coil was manufactured using the optimized design parameters, leading to a successful Al/Cu joint. These results emphasize the indispensability of optimizing design parameters to achieve high-quality joints.

OBJECTIVES:. To comprehensively classify interventions performed by pediatric critical care clinical pharmacists and quantify cost avoidance (CA) generated through their accepted interventions. DESIGN:. A multicenter, prospective, observational study performed between August 2018 and January 2019. SETTING:. Academic and community hospitals in the United States with pediatric critical care units. SUBJECTS:. Pediatric clinical pharmacists. INTERVENTIONS:. Pharmacist recommendations were classified into one of 38 total intervention categories associated with CA. MEASUREMENTS AND MAIN RESULTS:. Nineteen pediatric pharmacists at five centers documented 1,458 accepted interventions during 112 shifts on 861 critically ill pediatric patients. This calculated to an associated CA of $450,590. The accepted interventions and associated CA in the six established categories included as follows: adverse drug event prevention (155 interventions, $118,901 CA), resource utilization (267 interventions; $59,020), individualization of patient care (898 interventions, $217,949 CA), prophylaxis (8 interventions, $453 CA), hands-on care (30 interventions, $35,509 CA), and administrative/supportive tasks (108 interventions, $18,758 CA). The average associated CA was $309 per accepted intervention, $523 per patient day, and $4,023.13 per pediatric clinical pharmacist shift. The calculated potential annualized CA of accepted interventions from a pediatric pharmacist was $965,550, resulting in a potential monetary-associated CA-to-pharmacist salary ratio between $1.5:1 and $5.2:1. CONCLUSIONS:. There is potential for significant avoidance of healthcare costs when pediatric pharmacists are involved in the care of critically and emergently ill pediatric patients, with a monetary potential CA-to-pediatric pharmacist salary ratio to be between $1.5:1 and $5.2:1.

Objetivos: O objetivo deste estudo é relatar a experiência de monitores da disciplina de Hematologia da UNIRIO, com um projeto de graduação que reforça o esfregaço de sangue periférico como ferramenta diagnóstica. Materiais e métodos: Relatar na forma de relato de experiência a atividade prática desenvolvida por monitores da disciplina de Hematologia e Hemoterapia da UNIRIO. Resultados: A turma de 70 alunos foi dividida em quatro grupos, ques participaram da monitoria em momentos diferentes. A monitoria ocorreu em 3 fases: (1) preparo da lâmina; (2) interpretação do resultado da hematoscopia ao microscópio e (3) identificação de alterações relacionadas a doenças hematológicas. Na primeira fase, durante o preparo da lâmina, os alunos foram ensinados a limpar e identificar a lâmina, coleta adequada do sangue, distensão e coloração da lâmina. Na segunda fase, a interpretação das lâminas foi feita na sala de microscopia do setor de Patologia do Hospital Universitário Gaffrée e Guinle. Cada lâmina foi colocada sob a lente do microscópio e a imagem foi transmitida para uma tela, como uma “lousa eletrônica”. Nesse momento, ocorre discussão sobre os diagnósticos, correlacionando os achados com o quadro clínico. Na terceira fase, os monitores imprimiram e plastificaram imagens de hematoscopias e solicitaram aos discentes participação ativa na identificando das alterações encontradas (com o respectivo nome técnico) e qual doença se associava com a alteração. Ao fim da atividade, os discentes receberam no formato “.PDF” o arquivo confeccionado como gabarito para revisão. Discussão: A disciplina e/ou especialidade de Hematologia e Hemoterapia é uma das mais complexas vivenciadas pelo estudante de medicina, englobando doenças e condições patológicas que frequentemente tangenciam outras especialidades. Nesse contexto, o médico generalista muitas vezes se depara com alguns casos que outros colegas inadequadamente encaminham ao hematologista. Durante a formação acadêmica do médico generalista, é necessário familiarizar o acadêmico com os achados mais marcantes de algumas doenças. Para isso, foi organizada uma monitoria de esfregaço de sangue periférico para os alunos do 7º período de medicina na UNIRIO, na disciplina de Hematologia e Hemoterapia. O resultado da estruturação dessa monitoria pode ser visto nas provas que os discentes entregaram, nas quais, ainda que a hipótese diagnóstica não fosse compatível com a descrição clínica no enunciado da questão, eles sabiam, em geral, o que esperar encontrar no esfregaço de sangue periférico para aquela hipótese. Conclusão: Foi possível enriquecer a formação médica generalista dos acadêmicos, com ilustrações reais de alterações na hematoscopia, com estímulo ao desenvolvimento do aprendizado e, por fim, com resultados satisfatórios nas respostas das avaliações da disciplina.