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Background: Extrahepatic, abdominal surgery in patients with cirrhosis is associated with high morbidity and mortality. This systematic review presents the current evidence available on the utility of a preoperative transjugular intrahepatic portosystemic shunt (TIPS), assessed by its effect on surgical candidacy and postoperative mortality and morbidity in patients with cirrhosis undergoing extrahepatic, abdominal surgery. Methods: MEDLINE, EMBASE, Cochrane Library and Web of Science databases were searched till 2022 to identify studies. Studies that reported characteristics and outcomes of participants with cirrhosis that had a TIPS inserted in preparation for extrahepatic, abdominal surgery, were included. Results: Twenty-one studies (292 patients) were included, of which three were comparative studies and the remaining case series or case reports. A TIPS was inserted in 190 patients prior to surgery. At least one clinical sign of portal hypertension identified by ascites, varices, and/or hepatic encephalopathy were present in all patients except one patient. Fifty eight percent had decompensated cirrhosis. TIPS insertion was successful in all patients. Eighty-nine percent of patients underwent surgery. The cumulative 30-day postoperative mortality was 2% (3/148). There were 97 complications reported in 168 patients (57%). In the three comparative studies, there was no difference in mortality or morbidity among patients who underwent TIPS prior to surgery compared to those who did not undergo TIPS prior to surgery. Conclusion: Preoperative TIPS has been used to improve surgical candidacy in patients with cirrhosis undergoing extrahepatic, abdominal surgery, while reducing complications of portal hypertension. However, there is not enough evidence to support that TIPS insertion prior to extrahepatic, abdominal surgery significantly improves surgical outcomes in patients with cirrhosis and further studies are needed.

Many of our healthcare professionals are growing increasingly frustrated and experiencing various psychological conditions, leading to feelings of depression and stress within our society. This editorial will explore the reasons behind the brain draining of healthcare professionals in Pakistan.

Hospital-acquired infections, particularly Central Venous Line-Associated Bloodstream Infections (CLABSIs), are a noteworthy concern in intensive care units (ICUs). CLABSIs not only extend hospital stays but also increase healthcare costs and pose serious threats to patients' well-being. This narrative literature review explores the evidence-based strategies for the prevention of CLABSIs in critical care settings. It emphasizes the importance of proper infection control measures, such as hand hygiene, maximal barrier precautions, and chlorhexidine skin preparation, to reduce the risk of infection. The choice of catheter insertion site, duration of catheter use, and nurse-patient ratios are also discussed as crucial factors in CLABSI prevention. Additionally, post-insertion care, including daily bathing with chlorhexidine, catheter patency maintenance, and dressing changes, is highlighted. The review underscores the need for healthcare workers to adhere to best practices and guidelines to minimize CLABSI rates, ultimately enhancing patient safety and reducing healthcare burdens. The findings emphasize the significance of informed practices in preventing CLABSIs and the potential for improved patient outcomes with their implementation.

This case report presents the clinical management of a 24-year-old female patient who was presented to the emergency room with a history of corrosive ingestion. The patient experienced a complex clinical course involving cardiogenic shock, myocarditis, high anion -gap metabolic acidosis, esophagitis, and pulmonary complications. The issue at hand could not have been caused by only corrosive ingestion; it looked like a distinct matter involved. This case highlights the challenges in diagnosing and managing such cases and the importance of a multidisciplinary approach to optimize patient outcomes.

Abstract Management of nitrogen (N) fertilizer is a critical factor that can improve maize (Zea mays L.) production. On the other hand, high volatilization losses of N also pollute the air. A field experiment was established using a silt clay soil to examine the effect of sulfur-coated urea and sulfur from gypsum on ammonia (NH3) emission, N use efficiency (NUE), and the productivity of maize crop under alkaline calcareous soil. The experimental design was a randomized complete block (RCBD) with seven treatments in three replicates: control with no N, urea150 alone (150 kg N ha−1), urea200 alone (200 kg N ha−1), urea150 + S (60 kg ha−1 S from gypsum), urea200 + S, SCU150 (sulfur-coated urea) and SCU200. The results showed that the urea150 + S and urea200 + S significantly reduced the total NH3 by (58 and 42%) as compared with the sole application urea200. The NH3 emission reduced further in the treatment with SCU150 and SCU200 by 74 and 65%, respectively, compared to the treatment with urea200. The maize plant biomass, grain yield, and total N uptake enhanced by 5–14%, 4–17%, and 7–13, respectively, in the treatments with urea150 + s and urea200 + S, relative to the treatment with urea200 alone. Biomass, grain yield, and total N uptake further increased significantly by 22–30%, 25–28%, and 26–31%, respectively, in the treatments with SCU150 and SCU200, relative to the treatment with urea200 alone. The applications of SCU150 enhanced the nitrogen use efficiency (NUE) by (72%) and SCU200 by (62%) respectively, compared with the sole application of urea200 alone. In conclusion, applying S-coated urea at a lower rate of 150 kg N ha−1 compared with a higher rate of 200 kg N ha−1 may be an effective way to reduce N fertilizer application rate and mitigate NH3 emission, improve NUE, and increase maize yield. More investigations are suggested under different soil textures and climatic conditions to declare S-coated urea at 150 kg N ha−1 as the best application rate for maize to enhance maize growth and yield.

Cadmium (Cd) pollution of soil and food crops is a widespread environmental issue caused by excessive industrialization, unsustainable urbanization, and intensive farming practices. Cd, a hazardous element, poses significant risks to agro-environmental sustainability, food safety, and human health. Using organic materials such as biochar and compost to stabilize Cd in contaminated soil is an environmentally benign and cost-effective strategy for remediating moderately to highly polluted soil. However, in response to the scarcity of comparative studies on biochar and compost efficacy, this research explores the impact of wheat-straw biochar and chicken waste compost on Cd-contaminated soil remediation. A greenhouse experiment using two application rates (1.5 % and 2.5 %) of biochar and compost in 10 mg kg−1 Cd-contaminated soil revealed significant (p≤0.05) effects. The 2.5 % compost application increased soil organic carbon (SOC) from 0.45 % to 0.85 %, while 2.5 % biochar enhanced soil pH from 7.1 to 7.7 and electrical conductivity (EC) from 0.33 to 0.44 dSm−1. Notably, 2.5 % biochar significantly reduced Cd bioavailability from 9.49 to 4.90 mg kg−1, root accumulation from 29.8 to 16.4 mg kg−1 and shoot translocation from 16.8 to 8.4 mg kg−1. This reduction was confirmed through translocation factor (51.5 %) and immobilization efficiency (48.4 %). Furthermore, 2.5 % biochar improved chlorophyll content (a, b, and total) and wheat morphological attributes under Cd stress in soil. Overall, higher rates of biochar (2.5 %) and compost (2.5 %) effectively mitigate Cd uptake, improve soil properties, and enhance physiological and morphological responses, suggesting their promise for sustainable soil management practices.

IntroductionThe progression of coronary atherosclerosis is an active and regulated process. The Wnt signaling pathway is thought to play an active role in the pathogenesis of several cardiovascular diseases; however, a better understanding of this system in atherosclerosis is yet to be unraveled.MethodsIn this study, real-time quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) and Western blotting were used to quantify the expression of Wnt3a, Wnt5a, and Wnt5b in the human coronary plaque, and immunohistochemistry was used to identify sites of local expression. To determine the pathologic significance of increased Wnt, human vascular smooth muscle cells (vSMCs) were treated with Wnt3a, Wnt5a, and Wnt5b recombinant proteins and assessed for changes in cell differentiation and function.ResultsRT-PCR and Western blotting showed a significant increase in the expression of Wnt3a, Wnt5a, Wnt5b, and their receptors in diseased coronary arteries compared with that in non-diseased coronary arteries. Immunohistochemistry revealed an abundant expression of Wnt3a and Wnt5b in diseased coronary arteries, which contrasted with little or no signals in normal coronary arteries. Immunostaining of Wnt3a and Wnt5b was found largely in inflammatory cells and myointimal cells. The treatment of vSMCs with Wnt3a, Wnt5a, and Wnt5b resulted in increased vSMC differentiation, migration, calcification, oxidative stress, and impaired cholesterol handling.ConclusionsThis study demonstrates the upregulation of three important members of canonical and non-canonical Wnt signaling pathways and their receptors in coronary atherosclerosis and shows an important role for these molecules in plaque development through increased cellular remodeling and impaired cholesterol handling.

Abstract Herbicides in wastewater are considered as a serious issue to environmental pollution. Different impregnated metal zinc oxide (Cu/ZnO and Ni/ZnO) as catalysts were prepared through wet impregnation method for the degradation of herbicides Isoproturon and triasulfuron. The prepared impregnated catalysts were characterized using scanning electron microscopy (SEM) and x-ray diffraction (XRD), energy dispersive x-ray (EDX) analysis, Fourier-transform infrared spectroscopyand surface area. The degradation of selected herbicides were investigated using combined effect of photocatalysis and sonication. The experimental parameters such as pH, irradiation time, photocatalyst dose, effect of oxidants, diverse ion effect, herbicide concentration and catalyst reusability have been optimized. The percent removal of isoproturon was found to be 99 and 98% at pH 7 and triasulfuron was 98% at pH 6 using Cu/ZnO and 99% at pH 7 using Ni/ZnO photocatalysts respectively. Graphical Abstract Graphical abstract of Ultrasound Assisted Photocatalytic Degradation of Isoproturon and Triasulfuron Herbicides

Garnet-type Li7La3Zr2O12 (LLZO) is one of the most promising solid-state electrolytes (SSEs). However, the application of LLZO is limited by structural instability, low ionic conductivity, and poor lithium stability. To obtain a garnet-type solid electrolyte with a stable structure and high ionic conductivity, a series of TaCe co-doping cubic Li6·4La3Zr1.4-xTa0.6CexO12 (LLZTCO, x = 0, 0.02, 0.04, 0.06, 0.08, 0.10, 0.20, 0.30) electrolytes were successfully synthesized through conventional solid-phase method. The Ta5+ doping can introduce more lithium vacancies and effectively maintain the stability of the cubic phase. The Ce4+ with a larger ionic radius is introduced into the lattice to widen the Li+ migration bottleneck size, which significantly increased the ionic conductivity to 1.05 × 10−3 S/cm. It also shows excellent stability to lithium metal by the optimization of Li+ transport channel. Li||LLZTCO||Li symmetric cells can cycle stably for more than 6 000 h at a current density of 0.1 mA/cm2 without any surface modifications. The commercialization potential of LLZTCO samples in all solid-state lithium batteries (ASSLBs) is confirmed by the prepared LiFePO4||LLZTCO||Li cells with a capacity retention rate of 98% after 100 cycles at 0.5C. This new co-doping method presents a practical solution for the realization of high-performance ASSLBs.

Nurses are recognized for their vigorous role in healthcare, own untapped potential in politics. Their advocacy skills, honed through patient care, could be harnessed to make policies for improved healthcare access and health equity. The representation of nurses in politics is unreasonably low, in U.S., only 10 out of 535 Congress members are nurses, despite being the largest group of healthcare professionals. Similarly, there is absence of nursing representation in Pakistan's parliament. To tie this gap, nurses should be inspired to enter politics, provided with mentorship, policy training, and financial support.

Autoimmune Encephalitis (AE) presents diagnostic challenges due to its diverse symptoms. We describe a case of a 32-year-old male with fever, seizures, and altered mental status, presented at Aga Khan hospital, Karachi, Pakistan. Unusual cerebrospinal fluid findings and autoimmune markers led to AE diagnosis. Autoimmune encephalitis’s intersection with lupus nephritis required a multidisciplinary approach, resulting in significant improvement. This case highlights the importance of clinical suspicion and antibody testing in AE diagnosis and offers insights into evolving autoimmune disease management.

Mycobacterium tuberculous bacteria infect host lungs while inhaling them from the external environment, causing a localized infection with a potential to spread to local lymph nodes. The bacilli have the property to disseminate to other organs including Central Nervous System (CNS) and lead to tuberculous meningitis (TBM). The bacilli may develop tiny sub-pial or sub-ependymal rich foci. These rich foci get larger as the illness worsens and may finally burst into the sub-arachnoid region, causing meningitis. Tuberculous meningitis is linked to a high mortality rate. The majority of TBM patients who survive have long term neurological disabilities. This case was presented to Aga Khan University Hospital Karachi, Pakistan and the patient has taken Leave Against Medical Advice twice due to financial crises.

ABSTRACT BACKGROUND & OBJECTIVE: COVID-19 is caused by the SARS-CoV-2 virus. It can lead to mild to severe respiratory illness, as well as death. Nurses are frontline health workers to care the COVID-19 patients effectively. The objective of the study was to determine the knowledge, attitude, and practice regarding COVID-19 among nurses working at tertiary care public sector hospitals in Karachi. METHODOLOGY: Analytical cross-sectional study was conducted at Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, for three months from October to December 2020. The calculated sample size was 239 nurses of both genders. Non-probability convenient sampling technique was used to access the participants. A validated and open accessed tool was used for data collection. A Chi-square test was used to assess the association of Knowledge, attitude, and practice toward COVID-19 with demographic variables. The level of significance was considered with a p-value ≤0.05. RESULTS: Out of the total, 145 (59.4%) were female, and a majority of 158 (66.1%) of the study subject's ages ranged from 25-30 years old. Mostly 156 (65.3%) of the study participants had a diploma in nursing. Approximately half of 130 (54.4%) of the participants worked the morning shift. The majority of 209 (87.4%) participants' experiences were two years and above. The gender and work experience of the participants were found statistically significant (p-value

Water is a crucial component of human existence. The earth’s hydrosphere is composed mostly of saline water. Membrane distillation is a process that ensures desalination as a low-pollution and resource-stable technique. Traditional techniques such as reverse osmosis and thermal evaporation are energy intensive and require expensive raw materials. In this work, geopolymer membranes were fabricated from metakaolin and coated with methyltrichlorosilane (MTCS). The coating agent improved the hydrophobicity of the membrane from 28° to 136.5°. A permeation experiment (duration: 3 h) via direct contact membrane distillation (DCMD) was conducted for the MTCS-coated membrane, which showed a water vapor flux of 11 kg/m2.h. The development of a hydrophobic geopolymer membrane is an exciting advancement for desalination. Overall, this work represents a promising step forward towards the development of a novel eco-friendly technique for processing saline water.

Soil aggregation in forest ecosystem is considered as a significant physical process mainly influenced by manure, fertilizers or combination. This aggregation may directly alter the soil nutrient and their fractions in soil. So, soil samples were collected from two types of forests i.e. Natural Korean pine forests (NKPF) and Korean pine plantation (KPP) in order to know the quantities of organic and inorganic Phosphorus (P) amounts in different aggregate sizes viz. >5 mm, 2–5 mm, 0.25–2 mm, 5 mm) and decreased with the decreasing aggregate size, while other variables, i.e., NaOH-Pi, NaHCO3-Po, pH and T-N were not affected in aggregate size. H2O-Pi (48 ppm), NaHCO3-Pi (68 ppm), NaHCO3-Po (80 ppm), NaOH-Po (623 ppm), HCL-Po (67 ppm), SOC (20.36 ± 1.6) was estimated in medium fertilizer treatment. PCA analysis showed that spread/variance of data points on F1 (62.90%) is more than spread/variance of data points on F2 (57.74%) in NKPF and KPP, respectively, while correlation matrix showed high correlation between H2O-Pi and NaOH-Pi (0.63) and H2O-Pi and NaHCO3-Pi (0.63) while a strong negative correlation was present between Res-Pi and Po (−0.61). Moreover, litter inputs increased the organic-P fractions in soil particularly at medium treatment.

OBJECTIVES:. To analyze the temporal trend in enrollment rates in a COVID-19 platform trial during the first three waves of the pandemic in the United States. DESIGN:. Secondary analysis of data from the I-SPY COVID randomized controlled trial (RCT). SETTING:. Thirty-one hospitals throughout the United States. PATIENTS:. Patients who were approached, either directly or via a legally authorized representative, for consent and enrollment into the I-SPY COVID RCT. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Among 1,338 patients approached for the I-SPY COVID trial from July 30, 2020, to February 17, 2022, the number of patients who enrolled (n = 1,063) versus declined participation (n = 275) was used to calculate monthly enrollment rates. Overall, demographic and baseline clinical characteristics were similar between those who enrolled versus declined. Enrollment rates fluctuated over the course of the COVID-19 pandemic, but there were no significant trends over time (Mann-Kendall test, p = 0.21). Enrollment rates were also comparable between vaccinated and unvaccinated patients. In multivariable logistic regression analysis, age, sex, region of residence, COVID-19 severity of illness, and vaccination status were not significantly associated with the decision to decline consent. CONCLUSIONS:. In this secondary analysis of the I-SPY COVID clinical trial, there was no significant association between the enrollment rate and time period or vaccination status among all eligible patients approached for clinical trial participation. Additional studies are needed to better understand whether the COVID-19 pandemic has altered clinical trial participation and to develop strategies for encouraging participation in future COVID-19 and critical care clinical trials.

The rapid increase in population and changes in land use have led to the issue of climate change, which is threatening the overall human well-being in general, and particularly the forest resources. Recognizing the rapid decline in the forest cover and in adherence to the Bonn Challenge, Pakistan has initiated the Billion Tree Afforestation Project (BTAP) to restore forests. Hence, there is a need to analyze the spatio-temporal dynamics of forest cover to assess the efficacy of BTAP. The objectives of this study were: (1) to develop machine learning methods that combine Sentinel-1 and Sentinel-2 data to characterize forest cover; and (2) to characterize the forest cover dynamics in the study area during the study period. In the study area, the land cover was classified using two machine learning models: random forests (RF) and support vector machines (SVM). We then used the models to create forest cover maps for the period of 2016 to 2022. Based on the classifications of land cover, the study area was classified into forest and non-forest classes. Finally, the spatiotemporal distribution of the changes induced by afforestation was generated. The results demonstrate an increase of 3.7% in forest cover in the study area during the study period. The increase in forest cover was more prominent in the northern and central regions as compared to that of the southern region. In terms of species, the increase in broadleaved forests was more prominent. The results show that RF produces superior results as compared to the SVM, with overall accuracy and kappa coefficient of 94%–97% & 0.93–0.96 respectively. The overall accuracy and Kappa coefficient of the SVM model range from 92%–94% & 0.91–0.95. The techniques used in this study are cost-effective for accurately monitoring changes in forest cover.

Summary: Background: An urgent need exists to rapidly screen potential therapeutics for severe COVID-19 or other emerging pathogens associated with high morbidity and mortality. Methods: Using an adaptive platform design created to rapidly evaluate investigational agents, hospitalised patients with severe COVID-19 requiring ≥6 L/min oxygen were randomised to either a backbone regimen of dexamethasone and remdesivir alone (controls) or backbone plus one open-label investigational agent. Patients were enrolled to the arms described between July 30, 2020 and June 11, 2021 in 20 medical centres in the United States. The platform contained up to four potentially available investigational agents and controls available for randomisation during a single time-period. The two primary endpoints were time-to-recovery (

Objective: To assess the outcome in patients with diabetic foot osteomyelitis being treated with antibiotics alone with those being treated with antibiotics coupled with conservative surgery. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital, Rawalpindi from Feb to Aug 2016. Methodology: Sixty patients with diabetic foot osteomyelitis, fulfilling inclusion criteria, were included in this study. They were divided into two groups of 30 each. The "Antibiotic-Group” received only antibiotics while, the "Surgical-Group" underwent surgery in addition to antibiotics. Results: There were 37 males (61.66%) and 23 females (38.33%). The average age of patients was 59.72±9.79 years. 20 patients (66.67%) had full recovery in the Surgical-Group, and in the Antibiotics-Group, 18 patients (60%) had healed wounds (pvalue=0.599) Conclusion: The outcome of antibiotics only and conservative surgery plus antibiotics is similar.

Failure caused by corrosion in industries are the major cause of breakdown maintenance. Acoustic emission during the accelerated corrosion testing is a reliable method for corrosion detection, however, classification of these acoustic emission signals by machine learning techniques is still in its infancy. Proposed approach uses a hybrid technique that combines the detection of corrosion through acoustic emission signals from accelerated corrosion testing with machine learning techniques to accurately predict the corrosion severity levels. Laboratory based experimentation setup was established for accelerated corrosion testing of mild steel samples for different time spans and mass loss of samples were recorded. Acoustic emission signals were acquired at high frequency sampling rate with Sound Well AE sensor, NI Elvis kit and NI Labview software. AE mean, AE RMS, AE energy, and kurtosis were selected as distinct features as they represent a linear relationship with the corrosion process. For multi-class problem, five Corrosion severity levels have been made based on mass loss occurred during accelerated corrosion testing for which Naive Bayes, BP-NN and RBF-NN showed accuracy of 90.4%, 94.57%, and 100% respectively.

Synchronized contractions of cardiomyocytes within the heart are tightly coupled to electrical stimulation known as excitation-contraction coupling. Calcium plays a key role in this process and dysregulated calcium handling can significantly impair cardiac function and lead to the development of cardiomyopathies and heart failure. Here, we describe a method and analytical technique to study myofilament-localized calcium signaling using the intensity-based fluorescent biosensor, RGECO-TnT. Dilated cardiomyopathy is a heart muscle disease that negatively impacts the heart’s contractile function following dilatation of the left ventricle. We demonstrate how this biosensor can be used to characterize 2D hiPSC-CMs monolayers generated from a healthy control subject compared to two patients diagnosed with dilated cardiomyopathy. Lastly, we provide a step-by-step guide for single-cell data analysis and describe a custom Transient Analysis application, specifically designed to quantify features of calcium transients. All in all, we explain how this analytical approach can be applied to phenotype hiPSC-CM behaviours and stratify patient responses to identify perturbations in calcium signaling.

In this paper, we use the concept of quantum (or q-) calculus and define a q-analogous of a fractional differential operator and discuss some of its applications. We consider this operator to define new subclasses of uniformly q-starlike and q-convex functions associated with a new generalized conic domain, Λβ,q,γ. To begin establishing our key conclusions, we explore several novel lemmas. Furthermore, we employ these lemmas to explore some important features of these two classes, for example, inclusion relations, coefficient bounds, Fekete–Szego problem, and subordination results. We also highlight many known and brand-new specific corollaries of our findings.

Objective: To determine frequency of diastolic dysfunction in asymptomatic type 2 diabetic patients by employing twodimensional (2D) echocardiography as a measurement method. Study Design: It was an Analytical Cross sectional study. Place and Duration of Study: Rawalpindi Institute of Cardiology, Rawalpindi Pakistan, from Jul 2021 to Nov 2021 Methodology: Patients, already diagnosed as diabetics for more than 5 years and on dietary control or on medications,presenting to the outpatient department of the hospital were enrolled. They were subjected to a 2D echocardiography in left lateral position. We excluded patients with valvular heart disease, ischemia, congestive heart failure, cardiomyopathy of any aetiology, renal failure, pulmonary illness, anemia, hemoglobinopathies, prior myocardial infarctions in any region, smokers,and hypertension. Diastolic dysfunction was evaluated as per the guidelines of American society of Echocardiography. Results: Overall (n=150) patients were calculated with reference to 11% prevalence of LVDD by sample size calculator, being the part of study who were fulfilling the inclusion criteria. There were 102(68.0%) male and 48(32.0%) female patients; mean age was 45.02±6.07 years. Mean duration of diabetes mellitus in years was 6.93±2.53 with ranges from 5 to 16 years. Patients on oral hypoglycemic were 121(80.7%), on insulin were 5(3.3%), on dietary control were 12(8%) and on mixed treatment were 12(8%). There were 58 (38.7%) patients who had diastolic dysfunction present on echocardiogram. Effect modifiers of duration of diabetes (p=0.2) did not show significant association; however, Age (p=0.001) and Gender (p=0.038) significantly associated with Diastolic Dysfunction. Conclusions: One of the simple and noninvasive approaches to diagnose diastolic dysfunction is doing 2D echocardiography which can identify large percentage of diabetic subjects having pre-clinical diastolic dysfunction. Thus, by on time detection we can initiate treatment and retard the progression of diastolic dysfunction.

Abstract In the present study, the effect of concentration of titanium carbide (TiC) particles on the structural, mechanical, and electrochemical properties of Ni–P composite coatings was investigated. Various amounts of TiC particles (0, 0.5, 1.0, 1.5, and 2.0 g L−1) were co-electrodeposited in the Ni–P matrix under optimized conditions and then characterized by employing various techniques. The structural analysis of prepared coatings indicates uniform, compact, and nodular structured coatings without any noticeable defects. Vickers microhardness and nanoindentation results demonstrate the increase in the hardness with an increasing amount of TiC particles attaining its terminal value (593HV100) at the concentration of 1.5 g L−1. Further increase in the concentration of TiC particles results in a decrease in hardness, which can be ascribed to their accumulation in the Ni–P matrix. The electrochemical results indicate the improvement in corrosion protection efficiency of coatings with an increasing amount of TiC particles reaching to ~ 92% at 2.0 g L−1, which can be ascribed to a reduction in the active area of the Ni–P matrix by the presence of inactive ceramic particles. The favorable structural, mechanical, and corrosion protection characteristics of Ni–P–TiC composite coatings suggest their potential applications in many industrial applications.

Background. Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) remains common, and severe complications are associated with ERCP. There is no previous study detailing the effect of race and gender in a US-based population on risk of PEP. Methods. Data were collected on 269 “first-performed” consecutive ERCPs followed by division by race (White vs. African-American) and sex (Female vs. Male). A total of 53 probable risk factors were evaluated by uni- and multivariate analysis followed by outcomes expressed as an odds ratio (OR) (with a 95% confidence interval, 95% CI). Finally, a principal component analysis was performed to construct a risk prediction model for PEP, which can be used by clinicians at bedside. Results. After analyzing the risk factors based on race and gender-based groups, Caucasian males with PEP are more likely to have prior history of pancreatitis (p = 0.009), lower hemoglobin (p = 0.02)/blood urea nitrogen (BUN) (p = 0.01)/creatinine before ERCP (p = 0.07) and lower BUN (p = 0.01)/creatinine after ERCP (p = 0.07), while Caucasian females with PEP are more likely to have higher white blood cell (WBC) count before ERCP (p = 0.08) and lower amylase (p = 0.10)/bilirubin (p = 0.09)/aspartate aminotransferase (AST) after ERCP (p = 0.08). African-American males with PEP are more likely to have lower weight (p = 0.001)/smaller height (p = 0.0005)/lower alkaline phosphatase (p = 0.002)/AST (p = 0.04)/alanine transaminase (ALT) (p = 0.03) before ERCP and lower alkaline phosphatase (p = 0.002)/AST (p = 0.01)/ALT (p = 0.004) after ERCP, while African-American females with PEP are more likely to have prior history of pancreatitis (p = 0.004)/higher lipase before (p = 0.0001) and after (p = 0.05) ERCP along with increased risk with pancreatic duct cannulation (p = 0.0001) and injection (p = 0.0001)/biliary sphincterotomy (p = 0.0001). Importantly, prior history of ERCP, elevated AST after ERCP, and BUN prior to ERCP were found to be important clinical features predicting post-ERCP pancreatitis. To our knowledge, this is a first known attempt at developing a risk scoring system for PEP in a US population with decision tree learning. Conclusions. It is very evident that both patient and procedure-related risk factors vary by race and gender in the US population, leading to the development of a new risk assessment tool for PEP that can be used in clinical practice. We need to follow up with a larger prospective study to validate this novel race and gender-based risk scoring system for PEP.

Delayed graft function (DGF) in kidney transplantation is associated with ischemic injury and carries long term functional and immunological risks. Extracellular vesicles (EV) released from allografts may signal a degree of ischemic stress, and are thought to play an important role in the development of anti-donor immunity. Here, we show that kidney perfusate-derived extracellular vesicles (KP-EV) express donor-specific human leukocyte antigen. KP-EV from kidneys that experience DGF increase the T-helper 17 (Th17) to T-regulatory (Treg) ratio in third party peripheral blood mononuclear cells to a greater degree than those from kidneys with immediate function. We report miR-218-5p upregulation in KP-EV of kidney transplant recipients with DGF. Levels of miR-218-5p in KP-EV inversely correlated with recipient eGFR at multiple time points following transplantation. Additionally, the degree of increase in Th17/Treg ratio by KP-EV positively correlated with miR-218-5p expression in KP-EV samples. Taken together, these data provide evidence that KP-EV may contribute to modulating immune responses in transplant recipients. This could lead to novel intervention strategies to inhibit DGF in order to improve graft function and survival.

Wind potential analysis is analyzing how much wind energy is available in particular region. It is most important step because the economics of project depends on the site wind resources. Wind plant depends on the variation of long-term mean wind speed and other characteristics which vary from a distance to distance. This study discusses the wind speed characteristics and wind potential analysis using three years 2014-2016 wind data of Jhampir located in district Thatta, situated in the Southeast of Sindh province. The numerical Weibull distribution approach is used to estimate parameters. The correct estimation of wind parameters and class is essential before developing any wind project in the region. The data used in this study is measured at 80 m height. The region is classified as from class 1-7. The results show that monthly mean speed values lie between 4.79-10.96 m/s. The annual mean scale and shape parameters lie in the range of 7.42-7.59. The wind power density was found in a range of 303.31355.64. This study is related to the decision-making process on a significant wind project in Thatta or nearby region. The stable wind energy pattern is observed in the region for harnessing wind energy almost throughout the year. The Weibull probability density curves also indicate a trend of a boost in the chances of observing wind from 2014-2016.

Background: Coordination is critical to successful team-based health care. Most clinicians, however, are not trained in effective coordination or teamwork. Audit and feedback (A&F) could improve team coordination, if designed with teams in mind. Aim: The effectiveness of a multifaceted, A&F-plus-debrief intervention was tested to establish whether it improved coordination in primary care teams compared with controls. Design & setting: Case-control trial within US Veterans Health Administration medical centres. Method: Thirty-four primary care teams selected from four geographically distinct hospitals were compared with 34 administratively matched control teams. Intervention-arm teams received monthly A&F reports about key coordination behaviours and structured debriefings over 7 months. Control teams were followed exclusively via their clinical records. Outcome measures included a coordination composite and its component indicators (appointments starting on time, timely recall scheduling, emergency department utilisation, and electronic patient portal enrolment). Predictors included intervention arm, extent of exposure to intervention, and degree of multiple team membership (MTM). Results: Intervention teams did not significantly improve over control teams, even after adjusting for MTM. Follow-up analyses indicated cross-team variability in intervention fidelity; although all intervention teams received feedback reports, not all teams attended all debriefings. Compared with their respective baselines, teams with high debriefing exposure improved significantly. Teams with high debriefing exposure improved significantly more than teams with low exposure. Low exposure teams significantly increased patient portal enrolment. Conclusion: Team-based A&F, including adequate reflection time, can improve coordination; however, the effect is dose dependent. Consistency of debriefing appears more critical than proportion of team members attending a debriefing for ensuring implementation fidelity and effectiveness.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; initially named 2019-nCoV) is responsible for the recent coronavirus disease (COVID-19) pandemic, and polymerase chain reaction (PCR) is the current standard method for diagnosis from patient samples. As PCR assays are prone to sequence mismatches due to mutations in the viral genome, it is important to verify the genomic variability at primer/probe binding regions periodically. This step-by-step protocol describes a bioinformatics approach for an extensive evaluation of the sequence variability within the primer/probe target regions of the SARS-CoV-2 genome. The protocol can be applied to any molecular diagnostic assay of choice using freely available software programs and the ready-to-use multiple sequence alignment (MSA) file provided.Graphic abstract:Overview of the sequence tracing protocol. The figure was created using the Library of Science and Medical Illustrations from somersault18:24 licensed under a CC BY-NC-SA 4.0 license (https://creativecommons.org/licenses/by-nc-sa/4.0/). Video abstract: https://youtu.be/M1lV1liWE9k

Aortic valve stenosis (AVS) is a prevailing and life-threatening cardiovascular disease in adults over 75 years of age. However, the molecular mechanisms governing the pathogenesis of AVS are yet to be fully unraveled. With accumulating evidence that Wnt signaling plays a key role in the development of AVS, the involvement of Wnt molecules has become an integral study target in AVS pathogenesis. Thus, we hypothesized that the Wnt/β-catenin pathway mediators, SFRP2, DVL2, GSK3β and β-catenin are dysregulated in patients with AVS. Using immunohistochemistry, Real-Time qPCR and Western blotting, we investigated the presence of SFRP2, GSK-3β, DVL2, and β-catenin in normal and stenotic human aortic valves. Markedly higher mRNA and protein expression of GSK-3β, DVL2, β-catenin and SFRP2 were found in stenotic aortic valves. This was further corroborated by observation of their abundant immunostaining, which displayed strong immunoreactivity in diseased aortic valves. Proteomic analyses of selective GSK3b inhibition in calcifying human aortic valve interstitial cells (HAVICs) revealed enrichment of proteins involved organophosphate metabolism, while reducing the activation of pathogenic biomolecular processes. Lastly, use of the potent calcification inhibitor, Fetuin A, in calcifying HAVICs significantly reduced the expression of Wnt signaling genes Wnt3a, Wnt5a, Wnt5b, and Wnt11. The current findings of altered expression of canonical Wnt signaling in AVS suggest a possible role for regulatory Wnts in AVS. Hence, future studies focused on targeting these molecules are warranted to underline their role in the pathogenesis of the disease.

Osteoporotic patients being treated with bisphosphonates present an interesting dilemma when removing hardware such as dynamic hip screws “DHS”. In this paper, we describe the case of a 66-year-old osteoporotic patient who was placed on long term bisphosphonate therapy after sustaining an intertrochanteric hip fracture which was stabilized with a DHS. She presented with a subtrochantric fracture on the ipsilateral side. She was planned for DHS removal and intramedullary nailing. Removal of the dynamic hip screw proved to be difficult, likely due to possible cold welding of the DHS to the barrel of the side plate and sclerotic bone formation around the hardware secondary to the extended bisphosphonate use. The patient had an intra-operative femoral neck fracture while attempting the DHS removal. We had to convert to an unanticipated total hip replacement. Careful considerations should be taken when removing hardware from patients on long term bisphosphonate treatment. Keywords: Case report, Orthopedic surgery, Bisphosphonate, Subtrochanteric fracture

Abstract Background Acute myocardial infarction (MI) remains one of the leading causes of death worldwide with no curative therapy available. Stem cell therapies have been gaining interest as a means to repair the cardiac tissue after MI and prevent the onset of heart failure. Many in vivo reports suggest that the use of stem cells is promising, yet clinical trials suggest that the cells fail to integrate into the native tissue, resulting in limited improvements in cardiac function and repair. To battle this limitation, the combination of using stem cells embedded in a bioactive scaffold that promotes cell retention is growing in interest. Yet, a systematic review of the literature on the use of stem cells embedded in bioactive scaffolds for cardiac repair has not yet been performed. In this protocol, we outline a systematic review and meta-analysis of preclinical trials in animal MI models that utilize stem cell-embedded scaffolds for cardiac repair and compare their effects to stem cell-treated animals without the use of a scaffold. Methods/design We will search the following electronic databases: Cochrane Library, MEDLINE, Embase, PubMed, Scopus and Web of Science, and gray literature: Canadian Agency for Drugs and Technologies in Health and Google Scholar. We will only include randomly controlled preclinical trials that have directly investigated the effects of stem cells embedded in a scaffold for cardiac repair in an animal MI model. Two investigators will independently review each article included in the final analysis. The primary endpoint that will be investigated is left ventricular ejection fraction. Secondary endpoints will include infarct size, end systolic volume, end diastolic volume, fractional shortening and left ventricular wall thickness. Pooled analyses will be conducted using the DerSimonian-Laird random effects and Mantel-Haenszel fixed-effect models. Between-studies heterogeneity will be quantified and determined using the Tau2 and I 2 statistics. Publication bias will be assessed using visual inspection of funnel plots and complemented by Begg’s and Egger’s statistical tests. Possible sources of heterogeneity will be assessed using subgroup-meta analysis and meta-regression. Discussion To date, the use of scaffolds in myocardial repair has not yet been systematically reviewed. The results of this meta-analysis will aid in determining the efficacy of stem cell-embedded scaffolds for cardiac repair and help bring this therapy to the clinic.

Northeast China is persistently affected by heavy nitrogen (N) deposition. Studying the induced variation in leaf traits is pivotal to develop an understanding of the adaptive plasticity of affected species. This study thus assesses effects of increased N deposition on leaf morphological and anatomical traits and their correlation among and with biomass allocation patterns. A factorial experiment was conducted utilizing seedlings of two gymnosperms (Larix gmelinii, Pinus koraiensis) and two angiosperms (Fraxinus mandshurica, Tilia amurensis). Leaf mass per area and leaf density decreased and leaf thickness increased under high N deposition but trait interrelations remained stable. In gymnosperms, leaf mass per area was correlated to both leaf thickness and area, while being correlated to leaf density only in angiosperms. Epidermis, mesophyll thickness, conduit and vascular bundle diameter increased. Despite the differences in taxonomic groups and leaf habits, the common patterns of variation suggest that a certain degree of convergence exists between the species’ reaction towards N deposition. However, stomata pore length increased in angiosperms, and decreased in gymnosperms under N deposition. Furthermore, biomass and leaf mass fraction were correlated to leaf traits in gymnosperms only, suggesting a differential coordination of leaf traits and biomass allocation patterns under high N deposition per taxonomic group.

Use of metformin throughout pregnancy in women with polycystic ovary syndrome (PCOS) has shown to reduce the rates of early pregnancy loss, preterm labor, and prevention of fetal growth restriction. Metformin has been shown to have encouraging effects on several metabolic aspects of polycystic ovarian syndrome, such as insulin sensitivity, plasma glucose concentration and lipid profile and since women with PCOS are more likely than healthy women to suffer from pregnancy-related problems like early pregnancy loss, gestational diabetes mellitus and hypertensive states in pregnancy, the use of metformin therapy in these patients throughout pregnancy may have beneficial effects on early pregnancy loss and development of gestational diabetes.

The utilization of CO2 has become an emerging area of research in response to climate change and global warming. The electrochemical CO2 reduction reaction (CO2RR) holds significant promise as a technology to address this issue by converting CO2 molecules into various commercially valuable chemicals. While CO2RR to C1 hydrocarbons has achieved high activity and selectivity, the C–C coupling to produce higher hydrocarbons remains challenging due to low energy efficiency and the prevalent hydrogen evolution reaction (HER) on the same catalyst, leading to high hydrogenation rates. In this review, we aim to elucidate the fundamental challenges of C–C coupling and explore potential strategies to enhance the selectivity for higher hydrocarbon products. We discuss the mechanisms underlying the formation of C2 and C3 products, focusing on molecular catalysts that facilitate C–C coupling by positioning CO2 molecules in close proximity. Additionally, we provide a comprehensive overview of different approaches to improve higher hydrocarbon selectivity, along with future suggestions and recommendations for new researchers in the field. This review serves as a valuable resource for both academic researchers and industrial stakeholders aiming for the commercialization of CO2RR technologies. [ABSTRACT FROM AUTHOR]