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Early detection of joint bleeds is challenging yet critical for preserving joint health among individuals with haemophilia. This work explored early indicators of joint bleeds and young people with haemophilia B (YPwHB) self-monitoring practices to develop a joint health patient-reported outcome (PRO) tool for YPwHB aged between 8-25 years.

The aim of the current study was to evaluate therapeutic potentials of Hydroxyquinoline Sulfanilamide (HSM) for Alzheimer’s disease in a mice model of Streptozotocin (STZ)-induced diabetes. The antioxidant analysis of mice brain homogenates was carried out by catalase (CAT) assay, reduced glutathione (GSH) assay, and lipid peroxidation (LPO) assay. Biochemical analysis of blood plasma was conducted by peroxidase (POD) assay and superoxide dismutase (SOD) assay. The expression of mice brain proteins was evaluated using Western Blotting analysis. The administration of HSM increased the activity of antioxidant enzymes including CAT, SOD, GSH, and POD and lowered LPO actions. These findings indicate that STZ may lead to diabetes in mice, followed by hypercholesterolemia, expressed as triglycerides in mice blood. However, HSM significantly decreased STZ-induced hyperglycemia and hypercholesterolemia in adult albino mice. The data confirmed that HSM lowered STZ-induced oxidative stress, inhibited phosphorylated JNK, NF-kB, and upregulated Nrf-2 to improve and restore the synapse and memory defects in adult albino mice. Conclusively, the current findings suggested that HSM is a safe, novel, and potential drug candidate against metabolic dysfunction and induced cognitive impairment.

The management of a Class III malocclusion in the mixed dentition presents with many challenges, in particular, the post-treatment growth-related changes which can continue into adulthood. This case report describes the multidisciplinary management of a 9-year-old female using titanium dental implants, rapid maxillary expansion and a Delaire facemask. Pre-treatment, post-treatment and long-term follow-up records of the patient are presented.

OBJECTIVES: The objective of the study was to assess the diversity of mosquitoes in various towns of the southern belt of KPK. METHODOLOGY: This was a descriptive study that was conducted in numerous towns of Western belt of Khyber Pakhtunkhwa. The study areas were Darra Adam Khel, District Kohat, District Karak, District Banu, District D.I. Khan and newly merged districts Mir Ali and Miranshah. From each study site, the samples were collected randomly. The sample collection was done through survey and area visits whereas; the identification process was done in a parasitology laboratory of Hayatabad-Peshawar. Sampling was done from June 2016 to May 2017. RESULTS: A total of 2150 adult mosquitoes were gathered and collected from 42 different locations of the southern belt of KPK and were identified. Based on their identification, 5 genera of the mosquitoes were recognized which were Culex, Anopheles, Psorophora, Aedes and Uranotenia. Culex was found to be most dominant in all the visited areas with a percentage of 12.65 in Miranshah followed by 11.81 in Mirali, 7.16 in Karak, 6.88 in Darra Adam Khel, 6.69 in D.I.Khan, 6.41 in Kohat and 5.11 in Bannu respectively. The results of our findings also revealed the presence of Culex genera in all the habitats and remained the dominant genera among the others followed by Anopheles and Psorophora. Aedes was found in the habitat of plants and grasses etc. whereas Uranotenia was found in marsh/swampy areas as well as in plants/grasses habitat only. CONCLUSION: The outcomes reveal that a climate shifting and extensive urbanization process is enforcing the diversity of mosquitos’ fauna in the southern belt of KPK.

Effective research utilization in program planning and implementation is a continuing problem in both developed and less developed nations. This is particularly so in social programs. This paper addresses the issue from the standpoint of some twelve years of experience in the Bangladesh population program. The focus of this paper is on communication between administrators and researchers-the problems that arise, and the strategies that may be used to facilitate communication in order to improve use of research findings. [ABSTRACT FROM AUTHOR]

Zero tillage with residues retention and optimizing nitrogen fertilization are important strategies to improve soil quality and wheat (Triticum aestivum L.) yield in rice (Oryza sativa L.)-wheat system. Field experiments were conducted on silty clay soil (Hyperthermic, and Typic Torrifluvents) in D. I. Khan, Pakistan, to explore the impact of six tillage methods (zero tillage straw retained (ZTsr), ZT straw burnt (ZTsb), reduced tillage straw incorporated (RTsi, including tiller and rotavator), RT straw burnt (RTsb), conventional tillage straw incorporated (CTsi, including disc plow, tiller, rotavator, and leveling operations), CT straw burnt (CTsb)) and five nitrogen rates, i.e., 0, 100, 150, 200, and 250 kg ha−1 on wheat yield. Mean values for N revealed that spikes m−2, grains/spike, 1000-grain weight (g), and grain yield (kg ha−1) were significantly higher at 200 kg N ha−1 in both the years as well as mean over years than all other treatments. Mean values for tillage revealed that ZTsr produced highest number of spikes m−2 among tillage methods. However, grains/spike, 1000-grain weight, and grain yield were higher in tillage methods with either straw retained/incorporated than tillage methods with straw burnt. Interaction effects were significant in year 1 and in mean over years regarding spikes m−2, 1000-grain weight, total soil organic matter (SOM), and total soil N (TSN). ZTsr produced the most spikes m−2 and 1000-grain weight at 200 kg N ha−1. ZTsr also produced higher SOM and TSN at 200–250 kg N ha−1 at the end of 2 yr cropping. Thus ZTsr with 200 kg N ha−1 may be an optimum and sustainable approach to enhance wheat yield and soil quality in rice-wheat system.

Abstract Background Pakistan is highly vulnerable to climate change due to its geographic location, high dependence on agriculture and water resources, low adaptive capacity of its people, and weak system of emergency preparedness. This paper is the first ever attempt to rank the agro-ecological zones in Pakistan according to their vulnerability to climate change and to identify the potential health repercussions of each manifestation of climate change in the context of Pakistan. Methods A climate change vulnerability index is constructed as an un-weighted average of three sub-indices measuring (a) the ecological exposure of each region to climate change, (b) sensitivity of the population to climate change and (c) the adaptive capacity of the population inhabiting a particular region. The regions are ranked according to the value of this index and its components. Since health is one of the most important dimensions of human wellbeing, this paper also identifies the potential health repercussions of each manifestations of climate change and links it with the key manifestations of climate change in the context of Pakistan. Results The results indicate that Balochistan is the most vulnerable region with high sensitivity and low adaptive capacity followed by low-intensity Punjab (mostly consisting of South Punjab) and Cotton/Wheat Sindh. The health risks that each of these regions face depend upon the type of threat that they face from climate change. Greater incidence of flooding, which may occur due to climate variability, poses the risk of diarrhoea and gastroenteritis; skin and eye Infections; acute respiratory infections; and malaria. Exposure to drought poses the potential health risks in the form of food insecurity and malnutrition; anaemia; night blindness; and scurvy. Increases in temperature pose health risks of heat stroke; malaria; dengue; respiratory diseases; and cardiovascular diseases. Conclusion The study concludes that geographical zones that are more exposed to climate change in ecological and geographic terms- such as Balochistan, Low-Intensity Punjab, and Cotton-Wheat Sindh -also happen to be the most deprived regions in Pakistan in terms of socio-economic indicators, suggesting that the government needs to direct its efforts to the socio-economic uplift of these lagging regions to reduce their vulnerability to the adverse effects of climate change.

Vermiform appendiceal cancers are rare and commonly diagnosed incidentally after appendectomy for acute appendicitis. Establishing a diagnosis and staging appendiceal cancer is important as the treatment options differ based on the subtypes of tumor and their spread in the peritoneum. The role of endosonography in tissue diagnosis of appendiceal cancer is limited. Most cases are diagnosed and staged radiologically and surgically. Tissue diagnosis is key in management, especially when diagnosis is unclear by other modalities. We report a case of transduodenal endoscopic ultrasound-guided biopsy of an appendiceal lesion, which had significant impact on patient outcome., (© 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)

Background: The National Heart, Lung, and Blood Institute (NHLBI) defines acute chest syndrome (ACS) as a new infiltrate on chest x-ray (CXR) and at least 1 of the following: fever (≥38.5 0 C), hypoxia, or respiratory symptoms. NHLBI expert consensus recommends a CXR in patients with sickle cell disease (SCD) who have fever and respiratory symptoms. Past work has shown that physicians fail to recognize ACS in children with SCD who present with fever, leading to varied CXR obtainment criteria., Purpose: To determine the prevalence of ACS in patients with SCD presenting to our ED with fever with or without respiratory symptoms., Methods: A retrospective analysis of ED visits by patients with SCD (ages 0 to 20 years) who presented with fever (>/= 38.5 o C) within the past 24 h between January 2019 to December 2022 was done. The presence or absence of NHLBI-defined respiratory symptoms and CXR results were extracted. The prevalence of ACS, demonstrated on CXR, for febrile children with and without respiratory symptoms was estimated., Results: There were 137 children (288 unique ED visits) with fever. We found 0 % of visits with fever and no respiratory symptoms had ACS whereas 22.6 % with at least 1 respiratory symptom (p < 0.001)., Conclusions: Our findings provide strong evidence that a CXR is not necessary in a child with SCD presenting to the ED with fever and no NHLBI-defined respiratory symptoms. This evidence could improve quality of care and decrease unnecessary CXR use in the SCD population., Competing Interests: Declaration of competing interest None., (Published by Elsevier Inc.)

Background and Objectives: Patent foramen ovale (PFO) is present in approximately 25% of adult population. The prevalence of PFO is high in patients with cryptogenic stroke suggesting paradoxical embolism. PFO closure in carefully selected patients is an effective secondary preventive strategy in these patients. We report predictors of management recommendations by the multidisciplinary Board and their impact on outcomes., Methods: Brain-Heart Board comprises vascular and interventional neurology and cardiology subspecialties (structural, electrophysiology, and cardiac imaging). Adult patients referred to the Board for consideration of PFO closure between October 2017 to March 2021 were included in this retrospective cohort analysis. Demographics, comorbid conditions, risk of paradoxical embolism (RoPE) score, event frequencies (transient ischemic attack [TIA] or stroke, intracranial hemorrhage [ICH], post-PFO closure cardiac arrhythmias), and modified Rankin Scale (mRS) at 1 year were compared between the groups (PFO closure vs medical management). Multivariable logistic regression was used to identify factors associated with management recommendation and chi-square tests to test differences in outcomes for patients according to management., Results: Two hundred seventy patients (229 stroke; 41 TIA) were discussed by the Board for PFO closure. 119 (44.0%) patients were recommended for PFO closure of which 117 (98.3%) had evidence of ischemic infarct on imaging. In univariate analysis, age was similar (50 ± 11.9 vs 52 ± 12.8, p = 0.17), but RoPE score was higher in closure as compared with the medical management group (6 [IQR 5-7] vs 5 [IQR 4-7], p < 0.05). In multivariable analysis, TIA as the index event was an independent predictor of Board recommendation against PFO closure (OR 0.05, 95% CI 0.01-0.19, p < 0.05). Event frequency was low in both cohorts (5.9% vs 4.8%, p > 0.05) and comprised cardiac arrhythmias (6 cases of atrial fibrillation and 1 ICH in closure group; 1 TIA and 1 recurrent stroke in medical management group). Excellent functional outcome (mRS 0-1) was similar in both cohorts (66.3% vs 70.7%, p > 0.05) at 1 year., Discussion: Multidisciplinary Brain-Heart Board provides a clinical practice model of collaborative care to ensure proper patient selection for PFO closure. TIA as the index event is associated with recommendation of medical management by the multidisciplinary Brain-Heart Board., Competing Interests: M. Khan, P. Mccarthy, M. Miller, W. Merhi, N. Wees, N.I. Khan, A. Ahrar, E. Evans, M. Dahu, T. Moelker: No conflicts of interest relevant to the manuscript. J.P. Tsai: received compensation from Cerenovus and Microvention as a consultant. J. Min: received compensation from Abbott Laboratories and Medtronic as a consultant. Andre Gauri: received compensation from Medtronic as a consultant. N. Chalfoun: received compensation from Medtronic and Atricure as a consultant. D. Berkompas: received compensation from Medtronic and Abbott as a consultant. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp., (© 2024 American Academy of Neurology.)

Objective: To evaluate whether subcategorization of perineural invasion (PNI) improves the prognostic resolution of the American Joint Committee on Cancer, Eighth Edition (AJCC8) staging system in oral cavity squamous cell carcinoma (OCSCC)., Methods: OCSCC tumor specimens from patients seen at a tertiary care institution who underwent primary surgical resection between January 2019 and June 2021 were sorted into four PNI categories: negative, intratumoral, peripheral, and extratumoral. The prognostic effect of these PNI categories were assessed through Kaplan-Meier, Cox regression, and log-rank testing using recurrence-free survival (RFS) and overall survival (OS) as primary and secondary outcomes respectively., Results: A total of 158 patients were examined. The median follow-up time was 21 months. PNI subcategorization further stratified RFS (p = 0.007) and OS (p = 0.002). Extratumoral PNI was associated with a 4.5-fold increase in recurrence risk (adjusted hazards ratio [aHR]: 4.53; 95% confidence interval [CI]: 1.1-18.66) and worse OS when compared with PNI negative disease (aHR: 5.71; 95% CI: 1.0-32.67). Peripheral PNI was associated with worse OS (aHR: 5.7; 95% CI: 1.35-24.08) but not worse RFS (p = 0.18) when compared with PNI negative disease. Interestingly, intratumoral PNI was not associated with significant differences in RFS (p = 0.087) or OS (p = 0.22) when compared with PNI negative disease., Conclusions: Subcategorization of OCSCC tumors into extratumoral, peripheral, and intratumoral PNI stratifies RFS and OS when compared with patients with PNI negative disease in an incremental fashion. This pilot study suggests that there may be added benefit in subcategorization of PNI in the prognostic evaluation of OCSCC., Level of Evidence: 4 Laryngoscope, 134:1656-1662, 2024., (© 2023 The American Laryngological, Rhinological and Otological Society, Inc.)

Introduction: Psychiatric emergency department (ED) visits among youth have risen in the United States in recent years. A major factor contributing to this increase is the lack of accessible inpatient and outpatient services, making the ED a safety net for mental and behavioral health emergencies. This study sought to assess outpatient mental and behavioral health care after ED discharge and understand barriers and facilitators that caregivers encounter when attaining outpatient care., Methods: This was a mixed methods study conducted at a tertiary care pediatric ED. Patients ages 3 to 17 years seen for mental health concerns received a social work consult and were contacted 1 week after the ED visit by the mental and behavioral health navigator as part of ongoing quality improvement efforts. Descriptive data included types of outpatient care received, demographics, and repeat ED visit within 30 and 60 days. Results were analyzed via logistic regression. Patients' caregivers also were interviewed 4 weeks after the ED visit to explore barriers and facilitators to accessing outpatient care. Thematic content analysis was then performed., Results: The navigator successfully reached 533 out of 720 (74%) patients. Most patients were unable to obtain follow-up mental and behavioral health care. Univariate regression analyses revealed that being White, having commercial insurance, or a positive suicide screen had higher odds of receiving intensive outpatient care. However, these variables were not statistically significant after multivariate analyses. Barriers to follow-up included long wait times and expense. Facilitators included support from ED staff and close relationships with primary care clinicians., Conclusions: We found potential socioeconomic disparities that influence mental health care follow-up. Our findings highlight challenges patients face to receiving outpatient care, serving as a valuable guide for improving the transition from the ED to outpatient settings., (Copyright© Board of Regents of the University of Wisconsin System and The Medical College of Wisconsin, Inc.)

Purpose: Co-surgery with two attending reconstructive surgeons is becoming increasingly common in breast microvascular reconstruction due to case complexity and the potential for improved outcomes and operative efficiency. The impact of co-surgery on outcomes in head and neck microvascular reconstruction has not been studied., Methods: Our multidisciplinary head and neck reconstruction team (Otolaryngology, Plastic Surgery) at the University of Pittsburgh transitioned to a practice of co-surgery on head and neck free flaps. In this study, we compare outcomes of two surgeon head and neck reconstruction to single surgeon reconstruction in a prospectively maintained database., Results: 384 patients met our inclusion criteria from 2020 to 2022. Cases were performed by a single surgeon in 77.8 % of cases (299/384) and two surgeons in 22.1 % (85/384). The mean age was 62.5 years. There was no difference between the single surgeon cohort and the co-surgery cohort in terms of flap survival, procedure time, ischemia time, hospital length of stay, recipient site complications, or rates of return to the operating room. Donor site complications were less common in the co-surgery cohort (0 % vs 4.7 %, p = 0.021). For our reconstructive team, the transition to co-surgery has increased total surgeon fee collection per free flap by 28 % and increased surgeon flap related RVU production by 35 %., Conclusion: Co-surgery is feasible and safe in head and neck microvascular reconstruction. Benefits may include reduced complications, increased reimbursement, and improved interdisciplinary collaboration., Competing Interests: Declaration of competing interest The authors have no relevant financial or non-financial interests to disclose., (Copyright © 2023 Elsevier Inc. All rights reserved.)

The identification and description of novel plastic forms, such as pyroplastics and plastiglomerates, in coastal areas raised several concerns in the field of plastic pollution. Under the growing literature in the field, the present study preliminarily reports the occurrence of novel plastic forms on Cox's Bazar beach, Bangladesh. The description of the novel plastic forms agrees with the literature, mostly consisting of lithic and biogenic elements within a synthetic polymer matrix (HDPE, LDPE, PP, and PET identified). Several knowledge gaps regarding the interaction between the novel plastic forms and colonizing organisms, as well as the leaching rates of plastic additives, remain to be addressed as crucial points to understand their implications. Illegal waste dumping and burning were identified as the primary catalysts for the emergence of new plastic forms in Cox's Bazar. Overall, researchers must reach a baseline consensus regarding the methodologies and next steps in the field., 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 © 2023 Elsevier B.V. All rights reserved.)

Background: Venous thromboembolism (VTE) is a major concern for the postoperative hospitalized patient, especially after long and complex procedures. Cancer itself also contributes to the hypercoagulable state, further complicating the management of patients. Despite prophylaxis, breakthrough events can occur. We aimed to assess our institutional VTE and bleeding rates after free flap reconstruction of the head and neck (H&N) region and the factors associated with VTE events., Methods: A retrospective review of the patients who underwent H&N free flap reconstruction at an academic center from 2012 to 2021 was performed from a prospectively maintained database. Data regarding patient demographics, medical history, surgical details, and overall outcomes were collected. Outcomes studied included postoperative 30-day VTE rates and major bleeding events. Patients who had a VTE event were compared with the rest of the cohort to identify factors associated with VTE., Results: Free flap reconstruction of the H&N region was performed in 949 patients. Reconstruction after cancer extirpation for squamous cell carcinoma was the most common etiology (79%). The most common flap was thigh based (50%), followed by the fibula (29%). The most common postoperative VTE chemoprophylaxis regimen was enoxaparin 30 mg twice daily (83%). The VTE and bleeding rates over the 10-year period were 4.6% (n = 44) and 8.7% (n = 83), respectively. Body mass index (28.7 ± 5.8 vs 26.2 ± 6.6, P = 0.013) and pulmonary comorbidities were found to be significantly higher in patients who had a VTE event (43% vs 27%, P = 0.017). Patients with a VTE event had a prolonged hospital stay of 8 more days (19.2 ± 17.4 vs 11 ± 7, P = 0.003) and a higher incidence of bleeding events (27% vs 8%, P < 0.001)., Conclusions: Postoperative VTE is a significant complication associated with increased length of hospitalization in patients undergoing free flap reconstruction of the H&N region. Institutional measures should be implemented on an individualized basis based on patient comorbidities to improve the postoperative VTE rates, while balancing the bleeding events., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

The concept of using bio-inspired healing mechanisms in fiber-reinforced polymer (FRP)-based laminated composites is one of the trending areas of research for lightweight high-performance materials. To introduce self-healing in laminated composites, we developed Diels-Alder (DA) grafted graphene nanoplatelets (GNPs) and introduced them into carbon-fiber-reinforced polymer (CFRP) composites. The DA-grafted GNPs provided dual benefits, such as repetitive self-healing along with an increased mechanical performance of the modified CFRP. The GNPs were functionalized with DA adducts, i.e. , bismaleimide and furfurylamine via a facile functionalization approach. The highest healing efficiency evaluated using double cantilever beam (DCB) tests was observed as ∼87% with more than 10 times repeated healing cycles. The innovative concept and strategy proposed in this work could be a gateway to a new area of research to upscale for industrialization of DA-based repetitive self-healable and durable CFRP-based composites.

Prognosis is defined as the likely outcome or course of a disease and is the result of a complex interplay between patient and tumor factors. Unfortunately, the prognosis of patients with laryngeal cancer has not changed significantly over the past several decades. However, as our understanding of these patient and tumor factors becomes more nuanced and the resulting treatment options become more precise, there is the potential to improve the prognosis for these patients., Competing Interests: Disclosure The authors above have no commercial or financial disclosures., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Purpose: In head and neck squamous cell carcinoma (HNSCC), HRAS mutation is a new actionable oncogene driver. We aimed to evaluate HRAS mutational variants, comutation profile, and survival outcomes of this molecularly defined population., Methods: We leveraged four deidentified patient data sets with HRAS -mutant HNSCC, MD Anderson Cancer Center, Kura Oncology, Inc trial, Foundation Medicine, and American Association for Cancer Research GENIE v.12. Patient demographic information and clinical courses were extracted, when available, in addition to HRAS mutation type and co-occurring mutations. Survival outcomes were analyzed (Kaplan-Meier method)., Results: Two hundred forty-nine patients with HRAS -mutant HNSCC were identified from the four data sets. Median age ranged from 55 to 65 years, with a higher frequency in male patients (64%); the majority of HRAS -mutant HNSCC occurred in human papillomavirus-negative HNSCC. HRAS mutation patterns were similar across data sets; G12S was the most common (29%). Treatment responses to tipifarnib were not codon-specific. Compared with wild-type, significantly co-occurring mutations with HRAS were Casp8 (Fisher's exact test, P < .00013), TERT ( P < .0085), and NOTCH1 ( P < .00013). Analysis of clinical courses from the MD Anderson Cancer Center and Kura Oncology, Inc data sets demonstrated poor clinical outcomes with a high rate of recurrence following primary definitive treatment (50%-67% relapse < 6 months) and short disease-free survival (4.0 months; 95% CI, 1.0 to 36.0) and overall survival (OS; 15.0 months; 95% CI, 6.0 to 52.0). Use of tipifarnib in this data set demonstrated improved OS (25.5 months; 95% CI, 18.0 to 48.0)., Conclusion: Oncogenic mutations in HRAS occur in 3%-4% of HNSCC, with G12S being the most frequent. Without targeted therapy, patients with HRAS -mutant HNSCC had poor clinic outcomes; observable trend toward improvement in OS has been noted in cohorts receiving treatments such as tipifarnib. The comutation pattern of HRAS -mutant in HNSCC is distinct, which may provide insight to future therapeutic combination strategies.

While the availability of arsenic (As) in soil is well known to be highly correlated with the presence of iron (Fe) oxides and humic acid (HA) in the soil, the relationship between Fe oxides and HA and As species in the soil is less well understood. In this study, As speciation in an unsaturated soil in the presence of external HA and green synthesized Fe oxide nanoparticles (FeNPs) showed that As(V) was mainly distributed to the specifically-bound (F2), amorphous and poorly-crystalline hydrous oxides of Fe, Al (F3) and the well-crystallized hydrous oxides of Fe and Al (F4). While As(III). This was the major component in unsaturated soil, and was mainly distributed to F4 and the residual fraction (F5). As bound to F3 and F5 was most sensitive to the addition of HA and FeNPs, while HA/FeNPs treatment increased the F3-bound As(V); however, it decreased the F5-bound As(III). Nonetheless the effect of HA on As is completely different to the HA/FeNPs treatment. The increase of As(V) in F3 resulted from F5-bound As(III) oxidation when treated by HA/FeNPs. Cyclic voltammetry confirmed that HA and Fe 3+ /Fe 2+ redox enhanced As(III) oxidation, while FTIR revealed that HA-bound As(III) was the least available fraction in the soil. Finally, a mechanism involving a combination of HA and FeNPs was proposed for explaining the redistribution of As species in the soil., 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 © 2022 Elsevier Ltd. All rights reserved.)

Despite arsenic (As) bioavailability being highly correlated with water status and the presence of iron (Fe) minerals, limited information is currently available on how externally applied Fe nanomaterials in soil-rice systems affect As oxidation and stabilization during flooding and draining events. Herein, the stabilization of As in a paddy soil by a phytosynthesized iron oxide nanomaterials (PION) and the related mechanism was investigated using a combination of chemical extraction and functional microbe analysis in soil at both flooding (60 d) and draining (120 d) stages. The application of PION decreased both specifically bound and non-specifically bound As. The As content in rice root, stem, husk and grain was reduced by 78.5, 17.3, 8.4 and 34.4%, respectively, whereas As(III) and As(V) in root declined by 96.9 and 33.3% for the 1% PION treatment after 120 d. Furthermore, the 1% PION treatment decreased the ratio of As(III)/As(V) in the rhizosphere soil, root and stem. Although PION had no significant effect on the overall Shannon index, the distribution of some specific functional microbes changed dramatically. While no As(III) oxidation bacteria were found at 60 d in any treatments, PION treatment increased As(III) oxidation bacteria by 3-9 fold after 120 d cultivation. Structural equation model analysis revealed that the ratio of Fe(III)/Fe(II) affected As stabilization directly at the flooding stage, whereas nitrate reduction and As(III) oxidation microbial groups played a significant role in the stabilization of As at the draining stage. These results highlight that PION exhibits a robust ability to reduce As availability to rice, with chemical oxidation, reduction inhibition and adsorption dominating at the flooding stage, while microbial oxidation, adsorption and coprecipitation dominant during draining., 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 © 2022 Elsevier Ltd. All rights reserved.)

Importance: Venous thromboembolism (VTE) is a severe complication after free tissue transfer to the head and neck (H&N). Enoxaparin 30 mg twice daily (BID) is a common regimen for chemoprophylaxis. However, differences in enoxaparin metabolism based on body weight may influence its efficacy and safety profile., Objective: To assess the association between BMI and postoperative VTE and hematoma rates in patients treated with prophylactic enoxaparin 30 mg BID., Design, Setting, and Participants: This was a retrospective review of a prospectively collected cohort from 2012 to 2022. Postoperative VTE, hematoma, and free flap pedicle thrombosis were recorded within 30 days of index surgery. The setting was a tertiary academic referral center. Participants included patients undergoing H&N reconstruction with free flaps that received fixed-dose subcutaneous enoxaparin 30 mg BID postoperatively. Statistical analysis was conducted from April to May 2022., Main Outcomes and Measures: Outcomes include incidence of VTE, hematoma, and flap pedicle thrombosis events within 30 days of the surgery. Univariate and multivariable regression models were used to evaluate associations between BMI and other patient factors with these outcomes., Results: Among the 765 patients included, 262 (34.24%) were female; mean (SD) age was 60.85 (12.64) years; and mean (SD) BMI was 26.36 (6.29). The rates of VTE and hematoma in the cohort were 3.92% (30 patients) and 5.09% (39 patients), respectively. After adjusting for patient factors, BMI was the only factor associated with VTE (OR, 1.07; 95% CI, 1.015-1.129). Obesity (BMI >30) was associated with increased odds of VTE (OR, 2.782; 95% CI, 1.197-6.564). Hematoma was not associated with BMI (OR, 0.988; 95% CI, 0.937-1.041). Caprini score of at least 9 was not associated with VTE (OR, 1.259; 95% CI, 0.428-3.701)., Conclusions and Relevance: This cohort study found that obesity was associated with an increased risk of VTE in patients after microvascular H&N reconstruction and while on standard postoperative chemoprophylaxis regimens. This association may suggest insufficient VTE prophylaxis in this group and a potential indication for weight-based dosing.

Since the advent of the worldwide COVID-19 pandemic, analyzing public sentiment has become one of the major concerns for policy and decision-makers. While the priority is to curb the spread of the virus, mass population (user) sentiment analysis is equally important. Though sentiment analysis using different state-of-the-art technologies has been focused on during the COVID-19 pandemic, the reasons behind the variations in public sentiment are yet to be explored. Moreover, how user sentiment varies due to the COVID-19 pandemic from a cross-country perspective has been less focused on. Therefore, the objectives of this study are: to identify the most effective machine learning (ML) technique for classifying public sentiments, to analyze the variations of public sentiment across the globe, and to find the critical contributing factors to sentiment variations. To attain the objectives, 12,000 tweets, 3000 each from the USA, UK, and Bangladesh, were rigorously annotated by three independent reviewers. Based on the labeled tweets, four different boosting ML models, namely, CatBoost, gradient boost, AdaBoost, and XGBoost, are investigated. Next, the top performed ML model predicted sentiment of 300,000 data (100,000 from each country). The public perceptions have been analyzed based on the labeled data. As an outcome, the CatBoost model showed the highest (85.8%) F1-score, followed by gradient boost (84.3%), AdaBoost (78.9%), and XGBoost (83.1%). Second, it was revealed that during the time of the COVID-19 pandemic, the sentiments of the people of the three countries mainly were negative, followed by positive and neutral. Finally, this study identified a few critical concerns that impact primarily varying public sentiment around the globe: lockdown, quarantine, hospital, mask, vaccine, and the like., Competing Interests: The authors declare no conflict of interest., (© 2022 The Authors. Engineering Reports published by John Wiley & Sons Ltd.)

Objective: The distal hyperintense vessel sign (DHV) on fluid-attenuated inversion recovery magnetic resonance image (MRI) is an imaging biomarker of slow leptomeningeal collateral flow in the presence of large artery stenosis or occlusion reflecting impaired cerebral hemodynamics. In this study, we aim to investigate the significance of the DHV sign in patients with symptomatic ≥ 70% intracranial atherosclerotic stenosis., Methods: We retrospectively reviewed patients with ischemic stroke or transient ischemic attack admitted to a single center from January 2010 to December 2017. Patients were included if they had symptomatic ≥ 70% atherosclerotic stenosis of the intracranial internal carotid artery or middle cerebral artery. The presence of the DHV sign was evaluated by blinded neuroradiologist and vascular neurologists. Recurrent ischemic stroke in the vascular territory of symptomatic intracranial artery was defined as new neurological deficits with associated neuroimaging findings during the follow up period., Results: A total of 109 patients were included in the study, of which 55 had DHV sign. Average duration of follow up was 297 ± 326 days. Four patients were lost during follow up. Patients with the DHV sign had a higher rate of recurrent ischemic stroke (38%), compared to patients without the DHV sign (17%; p=0.018). In multivariate regression analysis, the presence of DHV sign was an independent predictor of recurrent ischemic stroke. A DHV score of ≥ 2 had a 63% sensitivity and 69% specificity for recurrent ischemic stroke., Interpretation: In patients with severe symptomatic intracranial atherosclerotic stenosis, those with a DHV sign on MRI are at higher risk of recurrent ischemic stroke., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Machine Learning (ML) has been widely used in predicting the mode of childbirth and assessing the potential maternal risks during pregnancy. The primary aim of this review study is to explore current research and development perspectives that utilizes the ML techniques to predict the optimal mode of childbirth and to detect various complications during childbirth. A total of 26 articles (published between 2000 and 2020) from an initial set of 241 articles were selected and reviewed following a Systematic Literature Review (SLR) approach. As outcomes, this review study highlighted the objectives or focuses of the recent studies conducted on pregnancy outcomes using ML; explored the adopted ML algorithms along with their performances; and provided a synthesized view of features used, types of features, data sources and its characteristics. Besides, the review investigated and depicted how the objectives of the prior studies have changed with time being; and the association among the objectives of the studies, uses of algorithms, and the features. The study also delineated future research opportunities to facilitate the existing initiatives for reducing maternal complacent and mortality rates, such as: utilizing unsupervised and deep learning algorithms for prediction, revealing the unknown reasons of maternal complications, developing usable and useful ML-based clinical decision support systems to be used by the expecting mothers and health professionals, enhancing dataset and its accessibility, and exploring the potentiality of surgical robotic tools. Finally, the findings of this review study contributed to the development of a conceptual framework for advancing the ML-based maternal healthcare system. All together, this review will provide a state-of-the-art paradigm of ML-based maternal healthcare that will aid in clinical decision-making, anticipating pregnancy problems and delivery mode, and medical diagnosis and treatment., (© 2022. The Author(s).)

During the COVID-19 pandemic, surface disinfection using prevailing chemical disinfection methods had several limitations. Due to cost-inefficiency and the inability to disinfect shaded places, static UVC lamps cannot address these limitations properly. Moreover, the average market price of the prevailing UVC robots is huge, approximately 55,165 USD. In this research firstly, a requirement elicitation study was conducted using a semi-structured interview approach to reveal the requirements to develop a cost-effective UVC robot. Secondly, a semi-autonomous robot named UVC-PURGE was developed based on the revealed requirements. Thirdly, a two-phased evaluation study was undertaken to validate the effectiveness of UVC-PURGE to inactivate the SARS-CoV-2 virus and the capability of semi-autonomous navigation in the first phase and to evaluate the usability of the system through a hybrid approach of SUPR-Q forms and subjective evaluation of the user feedback in the second phase. Pre-treatment swab testing revealed the presence of both Gram-positive and Gram-Negative bacteria at 17 out of 20 test surfaces in the conducted tests. After the UVC irradiation of the robot, the microbial load was detected in only 2 (1D and 1H) out of 17 test surfaces with significant reductions (95.33% in 1D and 90.9% in 1H) of microbial load. Moreover, the usability evaluation yields an above-average SUPR-Q score of 81.91% with significant scores in all the criteria (usability, trust, loyalty, and appearance) and the number of positive themes from the subjective evaluation using thematic analysis is twice the number of negative themes. Additionally, compared with the prevailing UVC disinfection robots in the market, UVC-PURGE is cost-effective with a price of less than 800 USD. Moreover, small form factor along with the real time camera feedback in the developed system helps the user to navigate in congested places easily. The developed robot can be used in any indoor environment in this prevailing pandemic situation and it can also provide cost-effective disinfection in medical facilities against the long-term residual effect of COVID-19 in the post-pandemic era.

By monitoring opioid metabolites, wastewater-based epidemiology (WBE) could be an excellent tool for real-time information on the consumption of illicit drugs. A key limitation of WBE is the reliance on costly laboratory-based techniques that require substantial infrastructure and trained personnel, resulting in long turnaround times. Here, we present an aptamer-based graphene field effect transistor (AptG-FET) platform for simultaneous detection of three different opioid metabolites. This platform provides a reliable, rapid, and inexpensive method for quantitative analysis of opioid metabolites in wastewater. The platform delivers a limit of detection 2-3 orders of magnitude lower than previous reports, but in line with the concentration range (pg/mL to ng/mL) of these opioid metabolites present in real samples. To enable multianalyte detection, we developed a facile, reproducible, and high-yield fabrication process producing 20 G-FETs with integrated side gate platinum (Pt) electrodes on a single chip. Our devices achieved the selective multianalyte detection of three different metabolites: noroxycodone (NX), 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), and norfentanyl (NF) in wastewater diluted 20× in buffer.

Since the incidences of arsenicosis have significantly increased worldwide in the last decade, remediation of arsenic (As) pollution is now imperative. In this study, calcined green synthesized Fe/Ni nanoparticles (C-Fe/Ni NPs) were evaluated for their efficacy for As (V) removal from aqueous solution. Under optimal experimental conditions As (V) removal efficiency reached 87.3%. Analysis of changes in the surface properties of C-Fe/Ni NPs before and after interaction with As (Ⅴ) using a range of advanced characterization techniques including IC-AFS, SEM-EDS, XPS and XRD revealed that the As removal mechanism involved only adsorption. Adsorption kinetics followed a pseudo-second order rate model (R 2  > 0.986) and adsorption best fit the Langmuir isotherm model (R 2  > 0.958). Thermodynamic studies indicated that adsorption was a spontaneous endothermic process. On the basis of these results, a removal mechanism of As (Ⅴ) by C-Fe/Ni NPs was proposed. Finally, the efficacy of the material for practical remediation of As from aqueous solution was assessed, including the influence of coexisting anions. While Cl - , NO 3 - and SO 4 2- had little influence on As (V) removal, both H 2 PO 4 - and HCO 3 - significantly negatively affected removal., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objectives: To determine which surgical factors are associated with quality-of-life (QOL) outcomes in oral cavity cancer survivors after free flap reconstruction of the oral cavity., Patients and Methods: A cross-sectional study was conducted from a multidisciplinary head and neck cancer (HNC) survivorship clinic. Oral cavity cancer survivors with at least 6-months of postoperative follow-up from ablation and free flap reconstruction were included. Primary outcome measures were validated patient-reported outcome measures (PROMs) including the Eating Assessment Tool-10 (EAT-10) measure of swallowing-specific QOL, University of Washington Quality of Life (UW-QOL) physical and social-emotional subscale scores and feeding tube dependence., Results: Extent of tongue resection was associated with EAT-10 and the UW-QOL Physical subscale scores. Patients with oral tongue defects reported worse scores than with composite defects in the EAT-10 and UW-QOL physical domain (p = 0.0004, 0.0025, respectively). This association no longer applies when controlling for differences in extent of tongue resection. Patients with anterior composite resections reported worse EAT-10 scores than lateral resections (p = 0.024). This association no longer applies when controlling for extent of tongue resection (p = 0.46). Gastric tube dependence demonstrates similar trends to PROMs., Conclusion: Extent of tongue resection was strongly associated with poor QOL outcomes after free tissue reconstruction of the oral cavity and mediates the associations between other defect characteristics and QOL. These findings demonstrate the need for emphasis on expected oral tongue defects when counseling patients and highlight the need to address QOL in a multidisciplinary fashion post-operatively., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Plant components have been extensively evaluated for their pharmacological activities. This study provides scientific rationale towards the therapeutic effect of Eucalyptus camaldulensis aqueous bark extract against induced atherosclerosis and hyperlipidemia in pigeons. Phytochemical components of Eucalyptus bark extract possess a great antioxidant activity that potentially reduced the risk of heart diseases. A total of 42 Pigeons of both sexes were distributed into negative control (fed normal grain diet), hyperlipidemic control (fed HFD 1% animal fat oil and 0.1% cholesterol for 3 months), test groups of variable doses (0.05, 0.1, 0.2 to 0.4 gms/kg BW for 21 days) and the group received atorvastatin daily after induction used. At the end of the experiment biochemical and histological evaluation has been performed. After HFD induction the serum levels of liver enzyme AST, glucose, urea, cholesterol, LDL, VLDL, and TG were significantly increased with the reduction in HDL levels. The atherogenic index was also found significantly raised. Microscopic examination of the liver and aorta showed the appearance of lipid-filled foam cells all over the liver parenchyma and intima after the HFD induction. Thus it was concluded that Eucalyptus aqueous bark extract can be effective against atherosclerosis and hyperlipidemia.

The annual influx of antimony (Sb) into the environment due to the widespread use of Sb compounds in industry and agriculture has become of global concern. Herein, a functional nanomaterial composite based on loading bimetallic iron/nickel nanoparticles on reduced graphene oxide (rGO-Fe/Ni) was initially prepared in a one-step phytogenic synthesis using a green tea extract. Subsequently, when applied for Sb(III) removal, the removal efficiency of rGO-Fe/Ni reached 69.7% within 3 h at an initial Sb concentration of 1.0 mg·L -1 . Advanced materials characterization via scanning electron microscopy-energy dispersive X-ray spectroscopy and X-ray photoelectron spectroscopy revealed that Sb(III) was initially adsorbed onto the surface of rGO and then oxidized to Sb(V). This result was also supported by adsorption isotherm, kinetics, and thermodynamic analysis. These studies revealed that the adsorption was spontaneous and endothermic, following a Langmuir adsorption model with pseudo-second-order kinetics and allowed a Sb(III) removal mechanism based on adsorption and catalytic oxidation to be proposed. Furthermore, when rGO-Fe/Ni was practically used to remove Sb(III) in groundwater a 95.7% removal efficiency was obtained at 1 mg·L -1 Sb(III), thus successfully demonstrating that rGO-Fe/Ni has significant potential for the practical remediation of Sb contaminated groundwater., 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 © 2021 Elsevier B.V. All rights reserved.)

Neonatal sepsis is associated with increased mortality and morbidity including prolonged hospital stay. Management of such cases is difficult, costly and need expert centers in many cases. Therefore, continued surveillance is mandatory to identify risk factors of neonatal sepsis which help optimizing its management. With the above idea, this cross-sectional descriptive study was conducted at the neonatal intensive care unit (NICU) in the department of Neonatology, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from July 2017 to December 2017 to observe the effects of maternal and neonatal risk factors in the development of neonatal sepsis and to determine risk factors of neonatal sepsis. Ninety four neonates (0-28 days) who were admitted in NICU with suspected sepsis were included in this study by purposive sampling technique. After admission written informed consent from parents or guardians obtained and histories were obtained including perinatal history and full physical examination of the infants were done and septic screening were sent. All the relevant information was recorded in a pre-designed questionnaire and all data were compiled, tabulated and then analyzed by SPSS version 21.0. Among 94 cases, 72.3% were preterm and 27.6% were term. There was male predominance and male/ female ratio was 1.9:1. Most (76.6%) of the patient admitted within 72 hours of birth. Most (83%) had low birth weight (<2500gm). Most came from rural area 61(64.9%) and also from low income family 59(62.8%). Premature onset of labour 40(42.6%), PROM >18 hours 36(38.3%), vaginal route of delivery 52(55.3%), instrumental resuscitation 15(16%), prelacteal feeding 11(11.7%), bottle feeding 15(16%) were the antenatal, natal and postnatal risk factors in this study. Also the neonatal factors, like prematurity, resuscitation at birth and low APGAR score carried the significant risk of developing sepsis. Poor feeding, lethargy, respiratory distress, jaundice were more common presenting symptoms. Tachycardia, tachypnea, chest indrawing, cyanosis hypothermia, hyperthermia and apnoea were found as more common presenting sign of sepsis in this study. Based on result it is concluded that prolonged rupture of membrane>18 hours, vaginal route of delivery, preterm birth, instrumental resuscitation, prelacteal feeding, bottle feeding were the major perinatal risk factors in this study.

Wastewater generated during mining remains a significant source of antimony pollution, because techniques to quickly and efficiently remove antimony from wastewater do not exist. In this study, zeolitic imidazolate framework-8 (ZIF-8), a specific type of Metal Organic Frameworks (MOFs), was successfully used to remove trace levels (1 mg L -1 ) of Sb(V) with a high removal efficiency when the ZIF-8 dose was 0.5 g L -1 . Scanning electron microscopy-X-ray energy dispersive spectrometry (SEM-EDS) indicated that Sb(V) was adsorbed onto the ZIF-8surface. The powder X-ray diffraction (XRD) pattern of ZIF-8 before and after adsorption of Sb(V) indicated that ZIF-8 was successfully synthesized, and remained structurally stable after Sb(V) was adsorbed. Fourier transform infrared (FTIR) and X-ray photoelectron spectroscopy (XPS) both suggested complexation of zinc on ZIF-8 with Sb(V), where removal of Sb(V) by ZIF-8 followed the Langmuir adsorption isotherm with pseudo second-order kinetics. Thus, a possible removal mechanism was proposed which involved Sb(V) complexing with the zinc hydroxyl groups on ZIF-8 (Zn-OH-Sb). Practically, ZIF-8, could remove 78.6% of Sb(V) from a mining wastewater containing 20 μg L -1 Sb(V). Furthermore, ZIF-8 could be remain active after repeated uses and could still remove and 42.3% of Sb(V) from wastewater containing 1 mg L -1 ) Sb(V) even when the ZIF-8 was reused five time. This indicated that ZIF-8 had potential for practical removal of Sb(V) from mining wastewaters., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

While iron-based nanoparticles (nFe) prepared using green tea extracts have been successfully used to degrade many organic contaminants, their application to remove As(V) remains limited. Thus, in this work, nFe (GT-1) prepared using a green tea extract was used to removal As(V). The maximum adsorption capacity of GT-1 for As(V) was 19.9 mg g -1 at 298 K. The formation of GT-1 and the removal mechanism of As(V) by GT-1, was examined using XRD, TEM and SEM, which showed that GT-1 was composed of amorphous particulates sized between 50 and 100 nm. GC-MS and LC-MS analysis also showed that biomolecules presented in the green tea extract, including polyphenols and L-theanine, participated in the formation of GT-1. Mössbauer spectral analysis confirmed that an organo-Fe(III) complex was formed due to the reaction between biomolecules and Fe(III). FTIR and XPS showed that the adsorption of As(V) by GT-1 occurred both via complexation with Fe(III) in GT-1 and via coordination of As(V) with free hydroxyl groups on the surface of GT-1. Batch experiments showed that adsorption was spontaneous and conformed to the pseudo-second order kinetic model. Finally, mechanisms for the formation of GT-1 and the removal of As (V) by GT-1 were proposed., 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 © 2020 Elsevier B.V. All rights reserved.)

Aptamer-immobilized graphene field-effect transistors (GFETs) have become a well-known detection platform in the field of biosensing with various biomarkers such as proteins, bacteria, virus, as well as chemicals. A conventional aptamer immobilization technique on graphene involves a two-step crosslinking process. In the first step, a pyrene derivative is anchored onto the surface of graphene and, in the second step, an amine-terminated aptamer is crosslinked to the pyrene backbone with EDC/NHS (1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride/N-hydroxysuccinimide) chemistry. However, this process often requires the use of organic solvents such as dimethyl formamide (DMF) or dimethyl sulfoxide (DMSO) which are typically polar aprotic solvents and hence dissolves both polar and nonpolar compounds. The use of such solvents can be especially problematic in the fabrication of lab-on-a-chip or point-of-care diagnostic platforms as they can attack vulnerable materials such as polymers, passivation layers and microfluidic tubing leading to device damage and fluid leakage. To remedy such challenges, in this work, we demonstrate the use of pyrene-tagged DNA aptamers (PTDA) for performing a one-step aptamer immobilization technique to implement a GFET-based biosensor for the detection of Interleukin-6 (IL-6) protein biomarker. In this approach, the aptamer terminal is pre-tagged with a pyrene group which becomes soluble in aqueous solution. This obviates the need for using organic solvents, thereby enhancing the device integrity. In addition, an external electric field is applied during the functionalization step to increase the efficiency of aptamer immobilization and hence improved coverage and density. The results from this work could potentially open up new avenues for the use of GFET-based BioMEMS platforms by broadening the choice of materials used for device fabrication and integration.

Lab-on-a-chip technology offers an ideal platform for low-cost, reliable, and easy-to-use diagnostics of key biomarkers needed for early screening of diseases and other health concerns. In this work, a graphene field-effect transistor (GFET) functionalized with target-binding aptamers is used as a biosensor for the detection of thrombin protein biomarker. Furthermore, this GFET is integrated with a microfluidic device for enhanced sensing performances in terms of detection limit, sensitivity, and continuous monitoring. Under this platform, a picomolar limit of detection was achieved for measuring thrombin; in our experiment measured as low as 2.6 pM. FTIR, Raman and UV-Vis spectroscopy measurements were performed to confirm the device functionalization steps. Based on the concentration-dependent calibration curve, a dissociation constant of K D = 375.8 pM was obtained. Continuous real-time measurements were also conducted under a constant gate voltage (V GS ) to observe the transient response of the sensor when analyte was introduced to the device. The target selectivity of the sensor platform was evaluated and confirmed by challenging the GFET biosensor with various concentrations of lysozyme protein. The results suggest that this device technology has the potential to be used as a general diagnostic platform for measuring clinically relevant biomarkers for point-of-care applications.

Knowledge of the genetic landscape of aggressive well differentiated thyroid cancers (WDTC) is lacking. Retrospective review of institutional database was performed to identify locally-invasive thyroid carcinomas and a comparison cohort of low-risk WDTC. ThyroSeq v2 next-generation sequencing was performed on available tissue. Survival time was analyzed by Kaplan-Meier methods and compared between groups via the log-rank test. Time to recurrence, treating death as a competing risk, was analyzed by cumulative incidence and compared between groups. Of 80 T4 tumors, 29 (36%) were met inclusion criteria, of which, 25 had genetic and clinicopathologic data. Most (24/25, 96%) harbored at least one genetic alteration, most commonly BRAF V600E (19, 76%), followed by mutations in the promoter region of TERT (14, 56%). Co-occurrence of BRAF and TERT was identified in 12 (48%) and associated with significantly higher risk of recurrence (p < 0.05). Conversely, co-occurrence of BRAF and TERT was present in only 5 of 102 (5%) patients presenting with early-stage WDTC. Compared to early-stage WDTC, co-occurrence of BRAF and TERT mutations are common in locally advanced (T4) thyroid cancer and are associated with an increased risk of recurrence. This knowledge may help predict aggressive behavior pretreatment and inform perioperative decision-making.

Solar-steam generation is one of the most promising technologies to mitigate the issue of clean water shortage using sustainable solar energy. Photothermal aerogels, especially the three-dimensional (3D) graphene-based aerogels, have shown unique merits for solar-steam generation, such as lightweight, high flexibility, and superior evaporation rate and energy efficiency. However, 3D aerogels require much more raw materials of graphene, which limits their large-scale applications. In this study, 3D photothermal aerogels composed of reduced graphene oxide (RGO) nanosheets, rice-straw-derived cellulose fibers, and sodium alginate (SA) are prepared for solar-steam generation. The use of rice straw fibers as skeletal support significantly reduces the need for the more expensive RGO by 43.5%, turning the rice straw biomass waste into value-added materials. The integration of rice straw fibers and RGO significantly enhances the flexibility and mechanical stability of the obtained photothermal RGO-SA-cellulose aerogel. The photothermal aerogel shows a strong broad-band light absorption of 96-97%. During solar-steam generation, the 3D photothermal aerogel effectively decreases the radiation and convection energy loss while enhancing energy harvesting from the environment, leading to an extremely high evaporation rate of 2.25 kg m -2 h -1 , corresponding to an energy conversion efficiency of 88.9% under 1.0 sun irradiation. The salinity of clean water collected during the evaporation of real seawater is only 0.37 ppm. The materials are environmentally friendly and cost-effective, showing great potential for real-world desalination applications.

Aptamers are oligonucleotides or peptides that are selected from a pool of random sequences that exhibit high affinity toward a specific biomolecular species of interest. Therefore, they are ideal for use as recognition elements and ligands for binding to the target. In recent years, aptamers have gained a great deal of attention in the field of biosensing as the next-generation target receptors that could potentially replace the functions of antibodies. Consequently, it is increasingly becoming popular to integrate aptamers into a variety of sensing platforms to enhance specificity and selectivity in analyte detection. Simultaneously, as the fields of lab-on-a-chip (LOC) technology, point-of-care (POC) diagnostics, and personal medicine become topics of great interest, integration of such aptamer-based sensors with LOC devices are showing promising results as evidenced by the recent growth of literature in this area. The focus of this review article is to highlight the recent progress in aptamer-based biosensor development with emphasis on the integration between aptamers and the various forms of LOC devices including microfluidic chips and paper-based microfluidics. As aptamers are extremely versatile in terms of their utilization in different detection principles, a broad range of techniques are covered including electrochemical, optical, colorimetric, and gravimetric sensing as well as surface acoustics waves and transistor-based detection.

Background: Ultrasound guided foam sclerotherapy is an outdoor, office based and minimally invasive procedure for the treatment of varicose veins. This study was carried out to highlight the potential of foam sclerotherapy as a first line treatment for varicose vein., Methods: This prospective observational study was conducted at CMH Rawalpindi, form 1 Aug 2017 to 30 Aug 2018The demographic and outcome data of the patients, who underwent ultrasound guided foam sclerotherapy, were collected and analysed., Results: A total of 662 patients and 752 legs were treated with foam sclerotherapy. Four hundred and ten (61.93%) were males and 252 (38.06%) were females. Their ages ranged from 17 to 68 years with the mean age of 43.21 years. Six hundred and sixty-eight (88.82%) legs were having Great Saphenous Vein while 84 (11.17%) legs were having short saphenous vein disease. Maximum legs 256 (34.04%) had C3 disease. single session of Foam sclerotherapy was enough in 511 (67.95%) legs, while 197 (26.19%) legs were treated with two and 44 (5.85%) legs were treated with three sessions of foam sclerotherapy. Percentages of main trunk occlusion were 98.01% at 1 month while 97.39% at 3 months follow up. Only 2 (0.30%) patients had Deep Venous Thrombosis while 3 (0.45%) patients had thrombophlebitis which required surgery., Conclusion: Ultrasound Guided Foam sclerotherapy is an OPD based, innovative, minimally invasive and safe method of treatment for varicose veins. In the context of prevalence of varicose vein disease in our community, it relieves the Burdon of operation theatre list and creates the theatre space for vascular surgeon for arterial Surgery.

BYL719 is a PI3K inhibitor that has demonstrated efficacy in the treatment of head and neck squamous cell carcinoma. BYL719 exerts its therapeutic effect by suppressing AKT and other proliferative signaling mechanisms. Despite PI3K inhibition and AKT suppression, residual activity of protein S6, a core marker of proliferative activation, has been observed. HER3, either via dimerization or activation by its ligand neurgeulin (NRG), is known to activate PI3K. Thus, we hypothesized that co-targeting HER3 and PI3K would lead to greater suppression of the PI3K-AKT signaling pathway and greater tumor suppression than with BYL719 alone. We investigated biochemical expression and activation of the HER3-PI3K-AKT-S6 pathway in HNSCC cell lines and patient-derived xenografts (PDXs). Antitumor effects of HER3 and PI3K inhibitors alone and in combination were evaluated in cell culture and murine models. Treatment of HNSCC cell lines with BYL719 significantly reduced AKT activation and suppressed tumor growth. However, S6 was persistently activated despite suppression of AKT. Combination treatment with KTN3379, a monoclonal antibody targeted against HER3, and BYL719 led to enhanced suppression of in vitro and in vivo cancer growth and durable suppression of AKT and S6. Therefore, inhibition of HER3 with KTN3379 enhanced the effects of PI3K inhibition in pre-clinical HNSCC models. These data support co-targeting HER3 and PI3K for the treatment of HSNCC.

Background: Sinonasal malignancies are a rare subset of head and neck tumors, and surveillance strategies after definitive tumor treatment are often generalized from those for overall head and neck cancer outcomes data. However, recent literature suggests that the posttreatment period in sinonasal cancer is fundamentally different and a more tailored surveillance approach may be beneficial. Although rates of symptomatology are high in head and neck cancer recurrence and patient-driven follow-up is common, rates of symptomatology are unknown in sinonasal cancer specifically., Methods: Patients with recurrence of sinonasal malignancy were identified at 3 academic rhinology and skull base surgery centers. Demographic, tumor, and treatment data were collected. Rates of symptomatology at presentation were tabulated and examined in the context of several other variables., Results: Fifty-five patients had recurrence of sinonasal malignancy after definitive treatment. Fifty-one percent of patients had no suspicious symptoms at the time of tumor recurrence, with an average time to recurrence of 33 months. Male patients and patients with stage IVA or lower disease were significantly more likely to be asymptomatic at the time of recurrence (p < 0.05)., Conclusion: Patients with sinonasal malignancy have a much lower rate of symptomatology during tumor recurrence than that observed in head and neck cancer overall. Furthermore, time to recurrence is substantially longer, as a majority of head and neck cancer recurrences occur in the first 12 months after treatment. These differences highlight the need for more tailored surveillance paradigms in asymptomatic patients with a history of a definitively treated sinonasal neoplasm., (© 2019 ARS-AAOA, LLC.)

Background: The aim of this study was to see the efficacy of different surgical procedures performed for the salvage of failing arteriovenous fistulas. Study design: Prospective observational study. Study was conducted at Department of Vascular surgery, CMH Rawalpindi from 1st August 2017 to 31st December 2018., Methods: Those surgical procedures were included which were done for the AVFs that failed to mature due to stealing veins or developed complications like thrombosis, hematoma, pseudo or true aneurysm, steal syndrome, stenosis and venous hypertension. The procedures like stealing vein ligation, hematoma evacuation, thrombectomies, redo-anastomosis, pseudo aneurysm excision, aneurysmorrhaphies, excision of stenotic segment, RUDI for steal syndrome and central veno venous bypasses for central vein occlusion were assessed for their efficacy., Results: Sixty-two patients were included. 21 stealing veins were ligated, 15 for fistula maturation and 6 for venous hypertension. Twelve out of these 15 non-maturing AVFs, matured after ligation of stealing vein (80%). In case of reverse vein ligation for venous hypertension all the 6 patients showed reduction in their limb swelling (100%). Nine thrombectomies were performed, 7 were successful (78%). Nine patients presented with stenosis. In 3 patients with stenosis near the anastomotic site, a proximal AVF was formed. In 2 patients the stenotic segment was excised and end to end anastomosis was done. In 1 patient an interposing vein graft was used. In 3 patients, the flow was redirected to basilic vein. All the patients had patent AVF on follow up (100%). In 8 non-infected pseudo aneurysms, excision and end to end anastomosis was done in 3, aneurysmorrhaphies in 2 and revision of the anastomosis in 3 cases. Seven out of 8 (87.5%) had good patency on follow up. In 7 patients with true aneurysm and 3 with bleeding from needle prick site sinus, aneurysmorrhaphies were performed. Two wound site hematomas were evacuated. Two patients presented with severe limb swelling due to central venous occlusion for whom a veno venous cross over bypass was done with good results. In 1 patient with steal syndrome, RUDI was done with acceptable results., Conclusions: Failing arteriovenous fistula can be salvaged by a variety of techniques provided that it is picked up in time..

Competing Interests: Conflict of interest The authors declare that there is no conflict of interests.

Background and Purpose: Cerebral microbleeds (CMB) are reported to be frequent in moyamoya disease (MMD) and moyamoya syndrome (MMS) in the Asian population. It is associated with an increased risk of intracerebral hemorrhage. The significance of CMB in MMD/MMS in non-Asian populations has not been well established. Our study aimed to investigate the prevalence of CMB in MMD/MMS in a moymoya cohort with a majority of non-Asians and to identify risk factors for developing a CMB and its predictive value for subsequent vascular events., Methods: The moyamoya database was compiled by screening for MMD/MMS among patients admitted to the Zale-Lipshy University Hospital at the University of Texas Southwestern Medical Center. We identified and analyzed data of 67 patients with MMD or MMS. Patients were characterized as CMB+ or CMB- based on MRI findings. In CMB+ patients, the total number and location of CMB were identified. Univariate and multivariate logistic regression were used to identify risk factors for developing CMB and whether CMB are associated with the development of subsequent vascular events., Results: Out of a total of 67 patients, 11 (16%) had CMB. Males had significantly higher odds of having CMB as compared to females (OR 1.76; 95% CI 1.40-24.3, p = 0.021). The incidence of CMB was also associated with age at diagnosis (mean age of CMB+ patients vs. CMB- patients: 44 vs. 34 years, respectively, p = 0.024), smoking (p = 0.006), and hemorrhagic stroke at presentation (p = 0.034). Logistic regression with multivariate analysis found that gender and age at diagnosis remained statistically significant. New ischemic events occurred in 2 (20%) out of 10 CMB+ patients and 13 (23%) out of 55 CMB- patients, respectively (p = 0.79). While 2 (3%) CMB- patients had a new cerebral hemorrhage during follow-up, none of the CMB+ patients did., Conclusions: CMB are less prevalent in MMD/MMS in the USA than in Asia. An older age at diagnosis and male gender were associated with CMB. The presence of CMB was not associated with an increased risk of a subsequent ischemic or hemorrhagic stroke., (© 2019 The Author(s) Published by S. Karger AG, Basel.)

Informed consent is gaining an ever-important place in modern medicine. The practice of patient-centered medicine along with evidence-based medicine requires a balance between the patient's wishes and the physician's oath to do no harm. Surrogate consent, emergency consent, and intraoperative consultation are 3 situations prone to legal and ethical dilemmas in the fulfillment of informed consent. By examining the proposed models and legal precedents that address the challenges in informed consent, discussion of these dilemmas in the context of both law and bioethics may provide a better understanding of how to resolve them. [Orthopedics. 2018; 41(6):e741-e746.]., (Copyright 2018, SLACK Incorporated.)

Increased error-related negativity (ERN) has been implicated in the pathophysiology of multiple forms of psychopathology. Although there is increasing evidence that the ERN can be shaped by environment and experience, no studies to date have examined this question in a clinical sample. In the current study, we examined the influence of combat exposure on the ERN using electroencephalogram (EEG) in a sample of military veterans with a high prevalence of psychopathology. Participants included sixty-seven U.S. military veterans from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND). The degree of combat exposure was assessed using the Deployment Risk and Resilience Inventory-2 (DRRI-2) and Combat Exposure Scale (CES). A well-validated flanker task was used to elicit the ERN during continuous EEG recording. Results revealed that veterans who reported experiencing greater combat exposure exhibited a more enhanced ERN, even when adjusting for broad anxiety and posttraumatic stress disorder (PTSD) symptoms. The association between combat exposure and ERN was not moderated by PTSD symptom severity. The current study demonstrates that greater combat exposure is associated with a more enhanced ERN among OEF/OIF/OND veterans. This enhanced ERN may be one mechanism that places veterans at greater risk for developing psychiatric disorders following exposure to combat. Future longitudinal studies are needed to directly test whether the ERN mediates the relation between level of combat exposure and the development of internalizing disorders., (Copyright © 2018 Elsevier B.V. All rights reserved.)