Search

Respiratory diseases such as cystic fibrosis, COPD, and COVID-19 are difficult to treat owing to viscous secretions in the airways that evade mucocilliary clearance. Earlier studies have shown success with BromAc as a mucolytic agent. Hence, we tested the formulation on two gelatinous airway representative sputa models, to determine whether similar efficacy exist. Sputum lodged in an endotracheal tube was treated to aerosol N-acetylcysteine, bromelain, or their combination (BromAc). After measuring the particle size of aerosolized BromAc, the apparent viscosity was measured using a capillary tube method, whilst the sputum flow was assessed using a 0.5 mL pipette. Further, the concentration of the agents in the sputa after treatment were quantified using chromogenic assays. The interaction index of the different formulations was also determined. Results indicated that the mean particle size of BromAc was suitable for aerosol delivery. Bromelain and N-acetylcysteine affected both the viscosities and pipette flow in the two sputa models. BromAc showed a greater rheological effect on both the sputa models compared to individual agents. Further, a correlation was found between the rheological effects and the concentration of agents in the sputa. The combination index using viscosity measurements showed synergy only with 250 µg/mL bromelain + 20 mg/mL NAC whilst flow speed showed synergy for both combinations of bromelain (125 and 250 µg/mL) with 20 mg/mL NAC. Hence, this study indicates that BromAc may be used as a successful mucolytic for clearing airway congestion caused by thick mucinous immobile secretions.

Background No universally accepted guidelines exist for treatment of patients with colorectal cancer peritoneal metastases (CRPM) undergoing cytoreductive surgery and intraperitoneal chemotherapy (CRS/IPC). Several uncertainties remain concerning almost every aspect of this treatment modality, resulting in marked variability in patient management and likely outcomes. This survey aimed to define variations and trends in clinician decision making more clearly. Methods A 41-question web-based survey was distributed electronically via the Peritoneal Surface Oncology Group International (PSOGI), the International Society for the Study of Pleura and Peritoneum (ISSPP) as well as via social media (particularly Twitter). The survey sought to address and record clinician responses regarding patient workup/assessment, selection for preoperative systemic therapy, preoperative and intraoperative selection for CRS/IPC, and consideration of prognosis and complications. Results Complete responses were received from 60 clinicians from 45 centres in 22 countries. Upon assessment of survey responses, several interesting trends were noted in each section of the survey. Significant variability in surgeon practice and opinion were identified concerning almost every aspect of the treatment modality. Conclusion This international survey provides the most comprehensive insight into clinician decision-making trends regarding patient assessment, selection and management. This should allow areas of variability to be more clearly defined and could potentially prompt development of initiatives for achieving consensus and standardisation of care in the future.

We examine to what extent disk and outflow models can reproduce observations of H I gas within a few virial radii of galaxies in pairs and groups. Using highly-sensitive HST/COS and FOS spectra of the Q0107 quasar triplet covering Ly$\alpha$ for z$\lesssim$1, as well as a deep galaxy redshift survey including VIMOS, DEIMOS, GMOS and MUSE data, we test simple disk and outflow models against the H I absorption along three lines-of-sight (separated by 200-500 kpc) through nine galaxy groups in this field. These can be compared with our previous results in which these models can often be fit to the absorption around isolated galaxies. Our models can reproduce $\approx$ 75$\%$ of the 28 identified absorption components within 500 km/s of a group galaxy, so most of the H I around groups is consistent with a superposition of the CGM of the individual galaxies. Gas stripped in interactions between galaxies may be a plausible explanation for some of the remaining absorption, but neither the galaxy images nor the galaxy and absorber kinematics provide clear evidence of such stripped material, and these unexplained absorbers do not preferentially occur around close pairs of galaxies. We find H I column densities typically higher than at similar impact parameters around isolated galaxies ($\approx$ 2.5$\sigma$), as well as more frequent detections of O VI than around isolated galaxies (30$\%$ of sightlines to 7$\%$)., Comment: 33 pages, 15 figures (main text 22 pages, 9 figures). Accepted for publication in MNRAS

While adjacent joint arthritis is a recognized long-term downside of primary tibiotalar arthrodesis (TTA), few studies have identified risk factors for early subtalar arthrodesis (STA) after TTA. This study aims to identify the risk factors for STA within the first few years following TTA. All patients older than 18 years undergoing TTA between 2008 and 2016 were identified retrospectively. Demographic data and comorbidities were collected alongside prior operative procedures, postoperative complications, and subsequent STA. Pre-and postoperative Kellgren-Lawrence osteoarthritis grade of the subtalar joint and postoperative radiographic alignment were obtained. A total of 240 patients who underwent primary TTA were included in this study with median follow up of 13.8 months. Twenty patients (8.3%) underwent STA after TTA due to symptomatic nonunion of TTA in 13 (65%), progression of symptomatic subtalar osteoarthritis (OA) in 4 (20%), and symptomatic nonunion of primary TTA combined progressively symptomatic subtalar OA in 2 (10%). Preoperative radiographic subtalar OA severity and postoperative radiographic alignment were not correlated with subsequent STA. Diabetes mellitus, Charcot arthropathy, neuropathy, alcohol use, substance use disorder, and psychiatric disease were significantly associated with having a subsequent STA. The most common postoperative contributing factor for subsequent STA following primary TTA was the salvage of symptomatic ankle nonunion rather than subtalar joint disease. Patients considering an ankle fusion should be counseled of the risk of subsequent STA, especially if they have risk factors that include diabetes, Charcot arthropathy, neuropathy, alcohol use, substance use disorder, or psychiatric disease.

Alcohol misuse contributes to the dysregulation of immune responses and multiorgan dysfunction across various tissues, which are associated with higher risk of morbidity and mortality in people with alcohol use disorders. Organ-specific immune cells, including microglia in the brain, alveolar macrophages in the lungs, and Kupffer cells in the liver, play vital functions in host immune defense through tissue repair and maintenance of homeostasis. However, binge drinking and chronic alcohol misuse impair these immune cells' abilities to regulate inflammatory signaling and metabolism, thus contributing to multiorgan dysfunction. Further complicating these delicate systems, immune cell dysfunction associated with alcohol misuse is exacerbated by aging and gut barrier leakage. This critical review describes recent advances in elucidating the potential mechanisms by which alcohol misuse leads to derangements in host immunity and highlights current gaps in knowledge that may be the focus of future investigations.

Lymphoma in pregnancy is a rare and challenging diagnosis that complicates ∼1:6000 pregnancies; posing a series of unique therapeutic, social, and ethical challenges to the patient, her family, and the medical professionals involved. These difficulties are compounded by the paucity of real-world data on the management of LIP, and a lack of relevant support systems for women in this setting. We conducted a retrospective multicenter qualitative study, interviewing women aged ≥18 years of age diagnosed with Hodgkin (HL) or non-Hodgkin lymphoma (NHL) during pregnancy or within 12 months postpartum, between 1 January 2009 and 31 December 2020 from 13 Australasian sites. Semi-structured telephone interviews were conducted, recorded, and analyzed using QSR Int NVivo 12 Pro (March 2020, USA) to quantify salient themes. Of the 32 women interviewed, 20 (63%) were diagnosed during pregnancy (16, 34, and 13% in the 1st, 2nd, and 3rd trimesters, respectively), while 12 (37%) were diagnosed post-partum. Women recalled that their chief concerns at diagnosis were the welfare of their child (

Clinicians report that they often rely on descriptive assessments when developing behavior-reduction plans despite literature suggesting that functional analysis is the most rigorous assessment method. Further, research comparing the outcomes of descriptive assessments and functional analyses is mixed, with some studies showing low correspondence and others showing high correspondence. Such persistent use of descriptive assessments suggests that they may yield useful information despite inconsistent correspondence with functional analyses. A more fine-grained analysis of the relation between descriptive assessments and functional analyses may elucidate variables affecting their utility. We conducted a review of 48 studies that included descriptive assessments and functional analyses and evaluated several measures of correspondence between each pair of assessments. Results indicated that descriptive assessments had exact correspondence with functional analyses in 50% of comparisons. Results also suggested that descriptive assessments were more likely to accurately identify and predict the absence of a function relative to the presence of a function and that structured descriptive assessments were more likely to accurately predict functions.

Given the important associations between couple conflict and various physical and mental health outcomes, it is essential to explore factors that may catalyze or exacerbate the frequency and impact of conflict in romantic relationships. One such factor may be relationship mindfulness, or the tendency to have a nonjudgmental awareness of one’s experiences in romantic relationships. Previous research has demonstrated a link between relationship mindfulness and various relational outcomes, but its association with relationship conflict has not yet been explored. Additionally, the current study sought to explore the mechanisms that link relationship mindfulness and relational outcomes. Based on previous research connecting conflict to negative partner attributions, the study examined how relationship mindfulness may predict conflict through negative partner attributions. Furthermore, the study aimed to incorporate loneliness as a potential mediator between relationship mindfulness and negative partner attributions. A sample of 116 different-sex middle-aged married couples were recruited to complete an online assessment. Using an actor–partner interdependence mediation model, the results indicated several significant associations among relationship mindfulness, negative partner attributions, loneliness, and relationship conflict. For example, a significant indirect effect was found; that is, female relationship mindfulness was associated with decreased relationship conflict via its prior association with both male loneliness and additionally through male loneliness and subsequent male negative partner attributions. The results indicate that by employing interventions that increase relationship mindfulness, it may be possible to both reduce loneliness and encourage more charitable partner attributions which, in turn, may reduce couple conflict.

The relativistic addition of velocities is usually introduced early in the study of Einstein’s special theory of relativity. The equations are simple enough, but randomly chosen velocities lead to unwieldy calculations that can dishearten the student. This paper presents tables of velocity components in two dimensions, composed of five or fewer significant digits.

The management of patients with extensive appendiceal mucinous neoplasms and mesothelioma is controversial. Our aims were to analyze overall survival (OS), disease-free survival (DFS) and independent prognostic factors associated with high peritoneal cancer index (PCI) status in patients who underwent cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC).A prospectively-maintained database for patients with appendiceal neoplasms and mesothelioma undergoing CRS/PIC from year 1996 to 2018 was retrospectively analyzed. Patients who achieved complete cytoreduction were stratified into limited (PCI30) and extensive (PCI ≥ 30) disease groups.260 female and 235 male patients were identified. The 5-year survival for low-grade appendiceal mucinous neoplasms (LAMN) was significantly higher in the low PCI group (96.2% vs. 63.5%,Long-term survivals following CRS/PIC are achievable with acceptable mortality and higher morbidity rates in extensive appendiceal mucinous neoplasms and mesothelioma. High PCI status does not preclude treatment with CRS/PIC.

Acharya, Blackwell, and Sen (2018) argue that antebellum slavery is directly related to racial conservatism and support for the Republican Party in the modern South. Yet during the last two decades, the South has begun a subtle but still very significant partisan shift to the left. Areas where population growth has stagnated (or actually declined) have tended to become more Republican; Democratic support has been bolstered by higher population growth. Significantly, local population growth and historic slave populations are largely unrelated. I examine the extent to which antebellum slavery influences county-level southern White partisanship and racial resentment during the second decade of the 21st century. Over the course of this time period, the impact of antebellum slavery evaporates. Not coincidentally, county-level population growth is strongly associated with increased Democratic identification and more progressive racial attitudes at or near the end of this time frame.

In recent years, understanding functional brain connectivity has become increasingly important as a scientific tool with potential clinical implications. Statistical methods, such as graphical models and network analysis, have been adopted to construct functional connectivity networks for single subjects. Here we focus on studying the association between functional connectivity networks and clinical characteristics such as psychiatric symptoms and diagnoses. Utilizing machine learning algorithms, we propose a method to examine predictability of functional connectivity networks from clinical characteristics. Our methods can identify salient clinical characteristics predictive of the whole brain network or specific subnetworks. We illustrate our methods on the analysis of fMRI data in the Philadelphia Neurodevelopmental Cohort study, demonstrating clinically meaningful results.