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Pregnancy is a fascinating immunological phenomenon because it allows allogeneic fetal and placental tissues to survive inside the mother. As a component of innate immunity with high inflammatory potential, the complement system must be tightly regulated during pregnancy. Dysregulation of the complement system plays a role in pregnancy complications including pre-eclampsia and intrauterine growth restriction. Complement components are also used as biomarkers for pregnancy complications. However, the mechanisms of detrimental role of complement in pregnancy is poorly understood. C5a is the most potent anaphylatoxin and generates multiple immune reactions via two transmembrane receptors, C5aR1 and C5aR2. C5aR1 is pro-inflammatory, but the role of C5aR2 remains largely elusive. Interestingly, murine NK cells have been shown to express C5aR2 without the usual co-expression of C5aR1. Furthermore, C5aR2 appears to regulate IFN-γ production by NK cells in vitro . As IFN-γ produced by uterine NK cells is one of the major factors for the successful development of a vital pregnancy, we investigated the role anaphylatoxin C5a and its receptors in the establishment of pregnancy and the regulation of uterine NK cells by examinations of murine C 5ar2 -/- pregnancies and human placental samples. C 5ar2 -/- mice have significantly reduced numbers of implantation sites and a maternal C5aR2 deficiency results in increased IL-12, IL-18 and IFN-γ mRNA expression as well as reduced uNK cell infiltration at the maternal-fetal interface. Human decidual leukocytes have similar C5a receptor expression patterns showing clinical relevance. In conclusion, this study identifies C5aR2 as a key contributor to dNK infiltration and pregnancy success., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Froehlich, Landerholm, Neeb, Meß, Seiler, Tilburgs and Karsten.)

Background: There is currently a lack of consensus regarding the timing of ventral hernia repair relative to bariatric surgery., Objectives: To compare outcomes between patients undergoing simultaneous and selectively deferred ventral hernia repair and bariatric surgery., Setting: High volume UPPER gastrointestinal and Bariatric Unit. Sydney, Australia., Methods: A retrospective case series from a single institution's prospectively collected database (2003-21) was performed to determine the characteristics and outcomes in patients having simultaneous and deferred hernia repair relative to their bariatric surgery., Results: In our patient cohort (N = 134), 111 patients underwent simultaneous repair and 23 had a deferred procedure. Of the simultaneous patients, 95 (85.6%) underwent resection bariatric surgery. The median operative time in the simultaneous versus deferred groups was 155 versus 287 minutes and the length of stay was 3 versus 7 days. There has been one (.9%) mesh infection requiring explant, in an open, simultaneous repair undertaken in a gastric band patient, 3 (2.8%) infected seromas, 1 (.9%) surgical site infection, and 8 (7.5%) hernia recurrences in the simultaneous group. The deferred group has had no mesh infections, no hernia recurrence, and 2 (9.5%) infected seromas to date. There was 1 mortality in the simultaneous cohort (simultaneous gastric bypass group), from a massive Pulmonary Embolism (<30 days postoperatively) and one in the deferred group from an interval small bowel obstruction., Conclusions: Simultaneous ventral hernia repair with bariatric surgery had a low rate of infection and a low mesh explant rate, even when coupled with resection bariatric surgery in this series. A combined approach may be safe, even in the clean-contaminated surgical context., (Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.)

Introduction: Children living with chronic illnesses are offered formulations based on manufacturer and distributor research. The aim of this study is to better understand the perspectives of children and their caregivers in accepting Lopinavir/ritonavir (LPV/r) formulations., Methods: 362 participants were recruited from two pediatric HIV/AIDS clinics in Mbeya and Mwanza, Tanzania, from December 2021 to May 2022. A translated questionnaire was piloted and validated at both clinics, followed by the implementation of a cross-sectional study., Results: 169 participants (47.1%) reported general difficulties in swallowing, regardless of formulation, while 34.3% and 38.5% reported vomiting tablets and syrups, respectively. Statistical significance is shown to support that children can swallow medications if they can eat stiffened porridge (Ugali). This correlated with the lower incidence of younger children being able to swallow compared to older children (above six years of age). Children older than six years preferred taking tablets (independent of daily dosage) better than other formulations. Significantly, older children who attend school were associated with high odds of swallowing medicine (AOR = 3.06, 95%CI; 1.32-7.05); however, age was not found to be statistically related to ease of administration for Lopinavir/Ritonavir in this study., Conclusions: Lopinavir/Ritonavir tablets remain the most accepted formulation among children and adolescents with HIV/AIDS. This study highlights the impact of various factors affecting the acceptability of pediatric formulation, suggesting that children younger than six years, unable to eat Ugali and not attending schools may be most vulnerable regarding their ability to accept Lopinavir/Ritonavir formulations. Further studies are needed to assess the acceptability of other medications in chronically ill children., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Jiwa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Epidermolysis bullosa acquisita (EBA) is a rare blistering skin disease induced by autoantibodies directed against type VII collagen. The transfer of antibodies against murine type VII collagen into mice mimics the effector phase of EBA and results in a subepidermal blistering phenotype. Activation of the complement system, and especially the C5a/C5aR1 axis driving neutrophil activation, is critical for EBA pathogenesis. However, the role of the alternative C5a receptor, C5aR2, which is commonly thought to be more immunosuppressive, in the pathogenesis of EBA is still elusive. Therefore, we sought to delineate the functional relevance of C5aR2 during the effector phase of EBA. Interestingly, C5ar2 -/- mice showed an attenuated disease phenotype, suggesting a pathogenic contribution of C5aR2 in disease progression. In vitro, C5ar2 -/- neutrophils exhibited significantly reduced intracellular calcium flux, ROS release, and migratory capacity when activated with immune complexes or exposed to C5a. These functions were completely absent when C5ar1 -/- neutrophils were activated. Moreover, C5aR2 deficiency lowered the ratio of activating and inhibitory FcγRs, impeding the sustainment of inflammation. Collectively, we show here a proinflammatory contribution of C5aR2 in the pathogenesis of antibody-induced tissue damage in experimental EBA., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: The use of radiotherapy is frequently required in the treatment of locally advanced esophageal squamous cell carcinoma. However, the margins of the tumor are often difficult to ascertain on computed tomography. Thus, EUS-guided fiducial marker insertion can aid the localization of the margins of the tumor. However, the optimal technique of the procedure is still uncertain., Methods: This was a retrospective study of all patients that received EUS-guided fiducial marker insertion between March 2015 and December 2018. All patients suffering from esophageal squamous cell carcinoma scheduled for radiotherapy underwent the procedure within one week of the scheduled appointment. Gold fiducial markers were inserted under EUS guidance either intratumorally or within the submucosa just proximal and distal to the tumor. Outcome parameters included tumor characteristics, early and late migration rates, and tumor response rates., Results: During the study period, 40 patients were recruited. 10 fiducial markers were placed intratumorally and 30 markers were placed submucosally. When comparing fiducials that were placed in the submucosa versus intratumorally, significantly more fiducials had early (40% vs 0%, RR = 0.6, 95% CI 0.36, 1.00) and late migration (60% vs 0%, RR = 0.33, 95% CI 0.13, 0.84) in the intratumoral group. The submucosal group had significantly more patients intended for curative intent (96.7% vs 70%, RR = 0.34, 95%CI 0.003, 0.361) and more patients with partial and complete response. There was no difference between the gross tumor volume, the clinical target volume, and the total radiation dose., Conclusion: In esophageal carcinomas planned for radiotherapy, fiducial markers placed in the submucosa may lead to less migration., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background and Aims: EUS-guided gallbladder drainage (EUS-GBD) is a safe alternative to percutaneous cholecystostomy (PT-GBD) for acute cholecystitis. How the procedure compares with laparoscopic cholecystectomy (LC) is uncertain. The aim of the current study is to compare the outcomes of EUS-GBD with LC for acute cholecystitis., Methods: This was propensity score analysis of all patients admitted for acute cholecystitis between 2012 and 2018. Consecutive patients who received EUS-GBD or LC were included. Patients were matched for age, sex, and age-adjusted Charlson score. Outcome measurements included 30-day adverse events, mortality, recurrent cholecystitis, recurrent biliary events, reinterventions, and readmissions., Results: During the study period, 60 patients were selected (30 EUS-GBD vs 30 LC) after propensity score matching. Technical success rates (100% vs 100%), clinical success rates (93.3% vs 100%, P = 1), lengths of hospital stay (6.8 [8.1] vs 5.5 [2.7], P = 1), 30-day adverse events (4 [13.3%] vs 4 [13.3%], P = 1), and mortality rates (2 [6.7%] vs 0 [0%], P = .492) were similar. The rates of recurrent biliary events (3 [10%] vs 3 [10%], P = .784), reinterventions (4 [13.3%] vs 3 [10%], P = 1), and unplanned readmissions (3 [10%] vs 3 [10%], P = .784) in 1 year were also similar., Conclusions: The outcomes of EUS-GBD for acute cholecystitis were comparable with LC with acceptable rates of recurrent acute cholecystitis. These results support the role of EUS-GBD as an alternative to LC in patients who may or may not be surgically fit to undergo definitive cholecystectomy., (Copyright © 2021 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)

Purpose: Bariatric and metabolic surgery is increasing in Asia to address the growing obesity epidemic. Literature is scarce regarding this surgery in vegetarian patients. We aim to survey surgeons regarding their practices and experiences with the vegetarian population., Materials and Methods: The regional bariatric and metabolic surgery society distributed a multi-national electronic questionnaire to surgeon members. The questionnaire was in the English and Chinese languages., Results: Fifty-six bariatric and metabolic surgeons responded to the questionnaire (response rate 40.6%). Twenty-two respondents (48.9%) have vegetarian patients in their case volume. Patients mostly consume a vegetarian diet for religious (66.7%) and health (66.7%) reasons. More than 60% of surgeons are unsure of micronutrient deficiency status amongst these patients. Over half of the respondents (58.8%) reported that their vegetarian patients do not take multivitamins or vitamin supplements. Significant proportions of respondents (44.4-61.1%) were unsure of the iron, vitamin B12, vitamin D, zinc, and folic acid deficiency status of these patients. Only 38.9% of respondents routinely prescribe multivitamin supplementation., Conclusions: Vegetarian bariatric patients in East and South-East Asia are an under-recognized patient cohort at risk of micronutrient deficiencies. There is a knowledge gap among regional surgeons in long-term nutritional assessment and management., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2020. Published by Elsevier Taiwan LLC.)

Background: Diverticula of the appendix (DA) are infrequent and their clinical implications are often overlooked. Several studies have found a significantly increased prevalence of neoplasms in appendiceal specimens with diverticula. Despite the potential clinical implications, there is a paucity of literature. A systematic review and meta-analysis was performed to evaluate the prevalence of DA and its association with neoplasia., Methods: A systematic search of literature (Cochrane, EMBASE, PubMed and Medline) reporting the prevalence of DA and association with neoplasia was performed in November 2019. Relevant articles were assessed in accordance with the PRISMA guidelines. Risk of bias assessment was carried out using modified Newcastle-Ottawa scale. Meta-analysis with risk ratio and random-effects model was performed using RevMan., Results: The initial search identified 1122 potential articles of which 11 were appropriate for quantitative analysis. The prevalence rate of DA was 1.74%. The mean age of patients with DA and those without DA was 41.2 and 33.9 years, respectively. The ratio of male to female was 1.8:1. The prevalence of neoplasia in specimens without DA versus those with DA was 1.28% and 26.94%, respectively. Only four studies addressed the prevalence of locoregional neoplasia in the setting of DA compared to control. Meta-analysis with random-effects model demonstrated that pooled risk ratio was 25.46 (95% confidence interval 12.77-50.75, P < 0.00001)., Conclusion: The strong association with neoplasia in this meta-analysis reinforces the clinical significance of DA. Surgeons, pathologists and radiologists should be mindful of this uncommon pathology and consider individualized patient management, until further evidence can direct clinical guidelines for the management of patients with DA., (© 2020 Royal Australasian College of Surgeons.)

Background: Alpacas are being more frequently presented to veterinarians in the UK. It is important to validate whether published normal ocular parameters are consistent with the alpaca population in the UK., Methods: Ophthalmic examinations were performed on healthy alpacas ( Vicugna pacos ) from three farms in East Anglia, UK., Results: On direct ophthalmoscopy of 35 alpacas, there was a 50 per cent prevalence of opacities within the lens in alpacas older than two years old (n=8/16). There was a 36.8 per cent prevalence of persistent hyaloid arteries in alpacas under two years old (n=7/19). The mean Schirmer tear test-1 value was 20.0 ±6 mm/minute (n=40). The mean intraocular pressure measured by rebound tonometry was 17.2 ±5.5 mmHg (n=46), and applanation tonometry resulted in statistically similar values (P=0.30; n=25). There was a significant variation in intraocular pressure throughout a 24-hour period (n=8). Fluorescein dye was not detected at the nostrils of any of the alpacas which underwent a Jones test to assess nasolacrimal duct patency (n=8)., Conclusion: The ophthalmic findings appear largely consistent with previously published values from North America and continental Europe. Variations include the large range of measurements obtained and evidence of diurnal variation in intraocular pressure., Competing Interests: Competing interests: None declared., (© British Veterinary Association 2020. Re-use permitted under CC BY. Published by BMJ.)

Background: Offspring of type 2 diabetes patients have an absolute risk of 20-40% of developing the condition. Type 2 diabetes patients should be encouraged to speak to their offspring regarding diabetes risk and prevention strategies. The Health Belief Model conceptualises that the higher the perceived risk, the more likely an individual will modify their behaviour. The objectives of this study were to i) determine the distribution of type 2 diabetes patients regarding their willingness to accept training to speak to their offspring, ii) determine the distribution of type 2 diabetes patients regarding their willingness to accept training based on the HBM and iii) to determine the factors associated with their willingness to accept training., Methods: This was a cross-sectional study amongst type 2 diabetes patients attending two primary care clinics in Malaysia. Sociodemographic data and knowledge of diabetes risk factors were collected. The adapted, translated and validated Diabetes Mellitus in the Offspring Questionnaire-Malay version (DMOQ-Malay) was self-administered. Statistical analysis included descriptive statistics, univariate and multiple logistic regression (MLogR)., Results: A total of 425 participants were recruited. Of these, 61.6% were willing to accept training. In MLogR, six variables were found to be significantly associated with willingness to accept training. These were i) positive family history [Adj. OR 2.06 (95% CI: 1.27, 3.35)], ii) having the correct knowledge that being overweight is a risk factor [Adj. OR 1.49 (95%CI: 1.01, 2.29)], iii) correctly identifying age ≥ 40 years old as a risk factor [Adj. OR 1.88 (95%CI: 1.22, 2.90)], iv) agreeing that speaking to their offspring would help them to prevent type 2 diabetes [Adj. OR 4.34 (95%: 1.07, 17.73)], v) being neutral with the statement 'I do not have much contact with my offspring' [Adj. OR: 0.31 (95% CI: 0.12, 0.810] and vi) being neutral with the statement 'my offspring are not open to advice from me' [Adj. OR: 0.63 (95% CI: 0.31, 0.84]., Conclusion: The majority of type 2 diabetes patients were willing to accept training to speak to their offspring to prevent diabetes. A training module should be designed to enhance their knowledge, attitude and skills to become family health educators.

Background: Superficial skin abscesses account for a significant burden of emergency surgical admissions. The aim of this study was to evaluate the effectiveness of an ambulatory care pathway for emergently treating abscesses of the body requiring operative drainage., Method: A retrospective study of a prospective patient database was performed, using randomized patient selection. Patient demographics, length and cost of stay were compared between patients undergoing operative management for skin abscess before and after the implementation of the fast-track ambulatory abscess pathway (FAAP)., Results: In total, 100 patients were analysed with 50 in the pre-ambulatory care pathway group and 50 in the FAAP group. The pre-ambulatory care pathway group had a mean age of 37.7 ± 15.8 years versus FAAP group of 35.3 ± 14.5 years. Total length of stay for the group was 85 versus 17 days with a mean comparison of 1.7 days versus 0.34 days (P < 0.001). This translated into a total cost saving of $74 100 in the FAAP group, with a mean comparison cost between the groups of $2884 versus $1402 (P < 0.001). Both reductions in length of stay and cost of stay were statistically significant after implementation of the pathway., Conclusion: This is the first Australian study to report the findings from an ambulatory care pathway for an emergency surgical intervention. We have shown that skin abscesses presenting through emergency can be managed as a day-case procedure, thereby decreasing these patients' overall length and cost of stay., (© 2019 Royal Australasian College of Surgeons.)

Background: The purpose of this study was to evaluate the values of Schirmer tear test (STT) and determine effects of age, life stage, sex, breed and neuter status on tear production in healthy cats., Methods: Three hundred and forty-three domestic shorthair (DSH) and Persian cats, 50 days through 18 years old, were examined in this study. STT I was used to measure tear production in both eyes of each cat., Results: A mean STT 14.9±4.8 mm/min was calculated for the eyes of all cats. There was a significant difference between STT values in kittens (≤6 months old) and cats of other age groups (P<0.001). A substantial number of cats with clinically normal eyes had STT values less than 10 mm/min. No significant difference was found between males (14.7±5.0 mm/min) and females (15.1±4.5 mm/min) in STT values (P=0.46). Significant differences were found between entire (14.4±4.2 mm/min) and neutered (16.2±4.1 mm/min) cats (P=0.001), and between STT values of DSH (14.6±5.0 mm/min) and Persian (16.5±3.1 mm/min) cats in the study population (P=0.001)., Conclusions: This study documents the average STT values for a sizeable feline population demonstrating that, in contradistinction to the situation in dogs, a number of cats with clinically normal eyes have STT values below 10 mm/min., Competing Interests: Competing interests: None declared., (© British Veterinary Association 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Aims: Zenker's diverticulum is a false diverticulum through Killian's dehiscence. Symptoms include halitosis, dysphagia, regurgitation, cough, and aspiration pneumonia. Treatment options include open transcervical cricopharyngeal myotomy, trans-oral rigid endoscopic stapling, and minimally invasive endoscopic myotomy. Although open surgical techniques have historically been the criterion standard for treatment, endoscopic options have become increasingly used. We propose the use of flexible endoscopy in the management of Zenker's diverticulum., Methods: We present a retrospective case series of 9 patients undergoing endoscopic cricopharyngeal myotomy from 2014 to 2018 using our endoscopic technique., Results: We demonstrate that endoscopic technique provided adequate symptomatic relief in 7 of 9 patients, with no operative adverse events., Conclusions: Cricopharyngeal myotomy using flexible endoscopy is a safe and effective technique for the management of Zenker's diverticulum. Potential benefits of this approach include shorter operative times, shorter postoperative admissions, and earlier progression of diet. Initial treatment with endoscopic technique does not preclude future open repairs.

Introduction: Diverticula of the appendix (DA) have a reported incidence of up to 2.1%. They are primarily detected incidentally, through imaging and intraoperative or histologic diagnosis. This study's objective was to examine the prevalence of DA, and its relationship with inflammation and neoplasia, as well as review the literature with respect to clinical outcomes and ability to identify DA preoperatively., Methodology: A retrospective search of all patients undergoing an appendicectomy for right lower quadrant pain at a single institution between 2004 and 2017 was conducted. Histopathology reports for evidence of DA, location of the DA, presence of inflammation, and any relationship between DA and neoplasms (adenoma, carcinoma, carcinoid, lymphoma, and mucinous neoplasm) within the appendix were reviewed. Clinical notes, operative records, and preoperative imaging were also reviewed., Results: Two thousand seven hundred eleven patient were included in the study, with a mean age of 34 years, with acute appendicitis found in 82.5%. 31.6% of patients with DA had associated inflammation of the DA. DA was present in 57 patients (2.1%), with 55 patients in the total cohort having neoplasia (2.0%). Patients with DAs were ten times more likely to have appendicular neoplasm than patients without a DA (17.5 vs 1.8%; p < 0.0001, OR 11.8 95%, CI 5.6-24.8)., Conclusion: This is the first Australian study demonstrating DAs are a significant marker of appendiceal neoplasm. Appendicectomy in all incidentally discovered diverticulum should be considered. Due to a paucity of data, research is required into this area to assess for the need for endoscopy following diagnosis.

The present study examined corticospinal excitability of the contralateral and ipsilateral hemispheres during actual (ACT) and imaginary (IMG) unilateral hand force-matching tasks of different difficulty. Seventeen young male adults (21.2 ± 2.2 yrs) actually and imaginarily matched their left index finger abduction force to a displayed target force. Task difficulty was manipulated by varying the acceptable force range about each mean target force (5 and 15% MVC for ACT, 15% MVC for IMG). Specifically, easy (EASY) and difficult (DIFF) tasks were assigned an acceptable force range of ±7% and ±0% of target force, respectively. Single pulse transcranial magnetic stimulation was applied to the both hemispheres in ACT and over the left hemisphere in IMG. Motor evoked potentials (MEPs) were collected from the first dorsal interosseous muscle during tasks. In ACT, MEPs in both the contracting and resting hands were significantly larger (P < 0.05) during DIFF than EASY when collapsed across target force levels. In IMG, MEPs in the resting right hand were significantly larger (P < 0.05) during DIFF than during EASY. The relative change in MEP amplitude in the right hand from EASY to DIFF in ACT was positively correlated (r = 0.63) with that in IMG. These results indicate that greater task difficulty increases corticospinal excitability of the contralateral hemisphere in ACT, and increases corticospinal excitability of the ipsilateral hemisphere in both ACT and IMG. The relative changes in corticospinal excitability of the ipsilateral hemisphere with increasing task difficulty are correlated between ACT and IMG., (Copyright © 2018 IBRO. Published by Elsevier Ltd. All rights reserved.)

Background: Esophageal anastomotic leakage (EAL) is a severe complication following gastric and esophageal surgery for cancer. Several non-modifiable, patient or surgery related risk factors for EAL have been identified, however, the contribution of modifiable intraoperative parameters remains undetermined. This review provides an overview of current literature on potentially modifiable intraoperative risk factors for EAL., Materials and Methods: The PubMed, EMBASE and Cochrane databases were searched by two researchers independently. Clinical studies published in English between 1970 and January 2017 that evaluated the effect of intraoperative parameters on the development of EAL were included. Levels of evidence as defined by the Centre of Evidence Based Medicine (CEBM) were assigned to the studies., Results: A total of 25 articles were included in the final analysis. These articles show evidence that anemia, increased amount of blood loss, low pH and high pCO2 values, prolonged duration of procedure and lack of surgical experience independently increase the risk of EAL. Supplemental oxygen therapy, epidural analgesia and selective digestive decontamination seem to have a beneficial effect. Potential risk factors include blood pressure, requirement of blood products, vasopressor use and glucocorticoid administration, however the results are ambiguous., Conclusion: Apart from fixed surgical and patient related factors, several intraoperative factors that can be modified in clinical practice can influence the risk of developing EAL. More prospective, observational studies are necessary focusing on modifiable intraoperative parameters to assess more evidence and to elucidate optimal values of these factors., (Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Self-efficacy has been shown to be positively correlated with self-care behaviour and glycaemic control among patients with type 2 diabetes mellitus. However, such evidence is lacking in the Malaysian primary care setting. The objectives of this study were to i) determine the levels of self-efficacy, self-care behaviour and glycaemic control among patients with type 2 diabetes mellitus in the Malaysian primary care setting ii) determine the relationship between self-efficacy, self-care behaviour and glycaemic control iii) determine the factors associated with glycaemic control., Methods: This was a cross-sectional study involving patients with type 2 diabetes mellitus from two public primary care clinics in Malaysia. Self-efficacy and self-care behaviour levels were measured using previously translated and validated DMSES and SDSCA questionnaires in Malay versions, respectively. Glycaemic control was measured using HbA 1c. RESULTS: A total of 340 patients with type 2 diabetes mellitus were recruited. The total mean (±SD) of self-efficacy and self-care behaviour scores were 7.33 (±2.25) and 3.76 (±1.87), respectively. A positive relationship was found between self-efficacy and self-care behaviour (r 0.538, P < 0.001). Higher self-efficacy score was shown to be correlated with lower HbA 1c (r - 0.41, P < 0.001). Multiple linear regression analysis demonstrated that higher self-efficacy scores (b - 0.398; 95% CI: -0.024, - 0.014; P < 0.001), shorter duration of diabetes (b 0.177; 95% CI: 0.002, 0.007; P < 0.001) and smaller waist circumference (b 0.135; 95% CI: 0.006, 0.035; P = 0.006), were significantly associated with good glycaemic control., Conclusion: This study demonstrated that higher self-efficacy was correlated with improved self-care behaviour and better glycaemic control. Findings of this study suggest the importance of including routine use of self-efficacy measures in the management of type 2 diabetes mellitus in primary care.

Introduction: Intra-Gastric Balloon (IGB) is increasingly used as a non-operative management strategy in bariatric patients. However, as IGB use has become more prevalent, new potentially life-threatening adverse effects have emerged. We report a case of IGB-related acute pancreatitis from a tertiary referral hospital. A literature review of electronic databases was conducted to identify other cases PRESENTATION OF CASE: A 20-year-old female presented to the emergency department with acute onset of epigastric pain on day-1 post-insertion of an IGB (Orbera ® ). The diagnosis of acute pancreatitis was made on the basis of the clinical picture, with radiological and serological confirmation. Complete resolution of symptoms promptly followed endoscopic removal of the balloon., Discussion: We examine all prior reported cases of IGB associated pancreatitis in the literature, as well as the impact of the particular balloon subtypes. Mass effect of the device on the pancreas or dislodgement of the rigid catheter into the second part of the duodenum appear to be the underlying cause in all cases. While there were no deaths reported, major sequelae have been noted, including presence of mucosal ischemia and failure to retrieve the balloon endoscopically, necessitating laparotomy., Conclusion: Although the incidence of IGB-induced pancreatitis is still rare, this complication which must be highlighted as a potentially serious adverse outcome., (Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Anastomotic leakage following esophageal surgery is a major contributor to mortality. According to the national database leakage occurs in 20% of esophagectomies carried out in the Netherlands. Therefore anastomotic leakage has been the topic of many studies. However, studies discussing application of tissue adhesives for either prevention or management of anastomotic leakage are limited. This article systematically reviewed all available literature on the potential use of tissue adhesives in esophageal surgery., Methods: Medline, Embase and Cochrane were searched to identify studies that used tissue adhesives as anastomotic sealants to prevent esophageal anastomotic leakage or used tissue adhesives to treat esophageal anastomotic leakage. Two authors independently selected nineteen out of 3107 articles., Results: Eight articles, of which five were experimental and three clinical, discussed prevention of anastomotic leakage. Eleven articles, of which one was experimental and ten clinical, discussed treatment of anastomotic leakage. Most articles reported positive results, however overall quality was low due to a high degree of bias and lack of homogeneity., Conclusion: This study shows mainly positive results for the use of tissue adhesives for the esophageal anastomosis both in prevention of leakage as treating anastomotic leakage. However, the quality of current literature is poor., (Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.)

The viability of many species has been jeopardized by numerous negative factors over the centuries, but climate change is predicted to accelerate and increase the pressure of many of these threats, leading to extinctions. The Hawaiian honeycreepers, famous for their spectacular adaptive radiation, are predicted to experience negative responses to climate change, given their susceptibility to introduced disease, the strong linkage of disease distribution to climatic conditions, and their current distribution. We document the rapid collapse of the native avifauna on the island of Kaua'i that corresponds to changes in climate and disease prevalence. Although multiple factors may be pressuring the community, we suggest that a tipping point has been crossed in which temperatures in forest habitats at high elevations have reached a threshold that facilitates the development of avian malaria and its vector throughout these species' ranges. Continued incursion of invasive weeds and non-native avian competitors may be facilitated by climate change and could also contribute to declines. If current rates of decline continue, we predict multiple extinctions in the coming decades. Kaua'i represents an early warning for the forest bird communities on the Maui and Hawai'i islands, as well as other species around the world that are trapped within a climatic space that is rapidly disappearing.

The thermostable NAD(+)-dependent alcohol dehydrogenase from Geobacillus stearothermophilus (BsADH) was exploited with regard to the biocatalytic synthesis of ω-oxo lauric acid methyl ester (OLAMe), a key intermediate for biobased polyamide 12 production, from the corresponding long-chain alcohol. Recombinant BsADH was produced in Escherichia coli as a homogeneous tetrameric enzyme and showed high activity towards the industrially relevant substrate ω-hydroxy lauric acid methyl ester (HLAMe) with K M = 86 μM and 44 U mg(-1). The equilibrium constant for HLAMe oxidation to the aldehyde (OLAMe) with NAD(+) was determined as 2.16 × 10(-3) from the kinetic parameters of the BsADH-catalyzed forward and reverse reactions. Since BsADH displayed limited stability under oxidizing conditions, the predominant oxidation-prone residue Cys257 was mutated to Leu based on sequence homology with related enzymes and computational simulation. This substitution resulted in an improved BsADH variant exhibiting prolonged stability and an elevated inactivation temperature. Semi-preparative biocatalysis at 60 °C using the stabilized enzyme, employing butyraldehyde for in situ cofactor regeneration with only catalytic amounts of NAD(+), yielded up to 23 % conversion of HLAMe to OLAMe after 30 min. In contrast to other oxidoreductases, no overoxidation to the dodecanoic diacid monomethyl ester was detected. Thus, the mutated BsADH offers a promising biocatalyst for the selective oxidation of fatty alcohols to yield intermediates for industrial polymer production.

A 67-year-old lady was found to have a giant appendicolith during a colorectal cancer screening colonoscopy, following a positive faecal occult blood test. Computed tomography confirmed the presence of a calcified giant appendicolith within the base of the appendix, which otherwise appeared normal. Appendicoliths are widely believed to be a major cause of acute appendicitis via obstruction of the appendix lumen, although this is disputed due to a lack of strong evidence. They may also cause chronic abdominal pain. All of the few cases of giant appendicoliths reported so far have been managed by extracting the lesions. Our patient was asymptomatic and had bilateral lung transplants, so a conservative watchful waiting approach was adopted. The authors propose expectant management of giant appendicoliths as a reasonable option in patients with significant operative risks., (Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2015.)

Archaeamphora longicervia H. Q. Li was described as an herbaceous, Sarraceniaceae-like pitcher plant from the mid Early Cretaceous Yixian Formation of Liaoning Province, northeastern China. Here, a re-investigation of A. longicervia specimens from the Yixian Formation provides new insights into its identity and the morphology of pitcher plants claimed by Li. We demonstrate that putative pitchers of Archaeamphora are insect-induced leaf galls that consist of three components: (1) an innermost larval chamber; (2) an intermediate zone of nutritive tissue; and (3) an outermost wall of sclerenchyma. Archaeamphora is not a carnivorous, Sarraceniaceae-like angiosperm, but represents insect-galled leaves of the previously reported gymnosperm Liaoningocladus boii G. Sun et al. from the Yixian Formation.

Background: Tissue fibrosis and microvascular rarefaction are hallmarks of progressive renal disease. CD248 is a transmembrane glycoprotein expressed by key effector cells within the stroma of fibrotic kidneys including pericytes, myofibroblasts and stromal fibroblasts. In human disease, increased expression of CD248 by stromal cells predicts progression to end-stage renal failure. We therefore, hypothesized that the genetic deletion of the CD248 gene would protect against fibrosis following kidney injury., Methods: Using the unilateral ureteral obstruction (UUO) model of renal fibrosis, we investigated the effect of genetic deletion of CD248 on post obstructive kidney fibrosis., Results: CD248 null mice were protected from fibrosis and microvascular rarefaction following UUO. Although the precise mechanism is not known, this may to be due to a stabilizing effect of pericytes with less migration and differentiation of pericytes toward a myofibroblast phenotype in CD248-/- mice. CD248-/- fibroblasts also proliferated less and deposited less collagen in vitro., Conclusion: These studies suggest that CD248 stromal cells have a pathogenic role in renal fibrosis and that targeting CD248 is effective at inhibiting both microvascular rarefaction and renal fibrosis through modulation of pericyte and stromal cell function., (© 2015 S. Karger AG, Basel.)

Aims: To Describe injury profile and costs of older person trauma in New South Wales; quantify variations with peer group costs; and identify predictors of higher costs., Methods: Nine level 1 New South Wales trauma centres provided data on major traumas (aged ≥ 55 years) during 2008-2009 financial year. Trauma register and financial data of each institution were linked. Treatment costs were compared with peer group Australian Refined Diagnostic Related Groups costs, on which hospital funding is based. Variables examined through multivariate analyses., Results: Six thousand two hundred and eighty-nine patients were admitted for trauma. Most common injury mechanism was falls (74.8%) then road trauma (14.9%). Median patient cost was $7044 (Q1-3: $3405-13 930) and total treatment costs $76 694 252. Treatment costs were $5 813 975 above peer group average. Intensive care unit admission, age, injury severity score, length of stay and traumatic brain injury were independent predictors of increased costs., Conclusion: Older person trauma attracts greater costs and length of stay. Cost increases with age and injury severity. Hospital financial information and trauma registry data provides accurate cost information that may inform future funding., (© 2013 ACOTA.)

The introduction of laparoscopic cholecystectomy was associated with increased incidences of bile duct injury. The primary cause appears to be misidentification of the biliary anatomy. Routine intra-operative cholangiography has been recommended to reduce accidental duct injury, although in practice it is more often reserved for selected cases. There has been interest in the use of fluorescent agents excreted via the biliary system to enable real-time intra-operative imaging, to aid the laparoscopic surgeon in correctly interpreting the anatomy. The primary aim of this review is to evaluate the ability of fluorescent cholangiography to identify important biliary anatomy intra-operatively. Secondary aims are to investigate its ability to detect important intra-operative pathology such as bile leaks, identify potential alternative fluorophores, and evaluate the evidence regarding patient outcomes.

Background: Obesity is a significant risk factor in abdominal hernia occurrence and recurrence. In patients having bariatric surgery, there are no clear guidelines as to whether repair should be done simultaneously, especially if procedures involve division or resection of part of the gastrointestinal tract., Methods: A retrospective case series review over a 6-year period to December 2012 from a prospective database was conducted. As per existing practice for bariatric procedures, patients were followed up indefinitely. Short- and long-term outcomes were analysed., Results: Forty-five patients underwent combined laparoscopic bariatric surgery and abdominal wall hernia repair. Of these, 36 had resection procedures (gastric bypass or sleeve gastrectomy) and 9 had non-resection procedures (gastric banding). The mean operative time was 151 min and the mean length of stay was 3 days. Two patients developed post-operative mesh seroma infections. To date, there have been no mesh removals or recurrent hernias. There was no mortality in this series., Discussion: This study demonstrated a low rate of mesh infection (4.44%) at a median follow-up of 13 months, even when a resectional procedure was performed (5.56%). These results suggest the possible viability and reasonable short-/long-term outcomes of simultaneous laparoscopic abdominal wall hernia repair during bariatric surgical procedures, even if the surgery involved division or resection of part of the gastrointestinal tract. This topic is an area of clinical research that warrants further study., (© 2013 The Authors. ANZ Journal of Surgery © 2013 Royal Australasian College of Surgeons.)

World governments have committed to halting human-induced extinctions and safeguarding important sites for biodiversity by 2020, but the financial costs of meeting these targets are largely unknown. We estimate the cost of reducing the extinction risk of all globally threatened bird species (by ≥1 International Union for Conservation of Nature Red List category) to be U.S. $0.875 to $1.23 billion annually over the next decade, of which 12% is currently funded. Incorporating threatened nonavian species increases this total to U.S. $3.41 to $4.76 billion annually. We estimate that protecting and effectively managing all terrestrial sites of global avian conservation significance (11,731 Important Bird Areas) would cost U.S. $65.1 billion annually. Adding sites for other taxa increases this to U.S. $76.1 billion annually. Meeting these targets will require conservation funding to increase by at least an order of magnitude.

The aim of this cohort study was to determine the predictive value of a 2-item self-reported questionnaire regarding in-hospital toileting behavior for predicting falls in older inpatients and to compare its performance with an existing state-based falls assessment scale. Between May 28, 2009 and January 30, 2010, we assessed aged care inpatients for risk of falls using the standard STRATIFY fall screening tool and the 2-item self-reported questionnaire developed for this study. The participants were then followed up, with the primary outcome being the occurrence of falls. Results indicated that participants who were unable to answer the 2-item questionnaire appropriately or sensibly were 14.1 times (confidence interval [CI]: 4.4-45, p <. 001) to 17.0 times (CI: 6.7-43, p < .001) more likely to fall than those who gave an appropriate negative or positive answer. Participants who were assessed to be at high risk of falls on the STRATIFY scale were 9.5 times (odds ratio: 9.5, CI: 1.3-72, p = .03) more likely to fall than those who were low risk. In conclusion, a simple bedside questionnaire regarding patients' toileting behavior with a careful appraisal of answers for appropriate and inappropriate answers may be used as a quick screening tool of fall risk., (Copyright © 2012 Mosby, Inc. All rights reserved.)

Since the introduction of the Norwood procedure for surgical palliation of hypoplastic left heart syndrome in 1983, refinements have been made to the original procedure to improve patient outcomes while still accomplishing the original goals of the procedure. One of these refinements has been the introduction of regional selective perfusion to limit the duration of circulatory arrest times and optimize the regional flow distribution. In this paper we describe our technique for performing selective cerebral and lower body perfusion during the Norwood procedure.

The Critical Appraisal of light-emitting-diode (LED) curing lights published in 2003 found that early first-generation LED curing lights did not meet manufacturers' claims and required exposure times twice as long as conventional quartz-tungsten-halogen (QTH) curing lights to adequately polymerize resin composites. This Critical Appraisal reviews a sample of the recently published research on the performance of the latest generation of LED curing lights.

This study evaluated the effect of dental handpiece lubricant on the shear bond strength of three bonding agents to dentin. A lubrication-free handpiece (one that does not require the user to lubricate it) and a handpiece requiring routine lubrication were used in the study. In addition, two different handpiece lubrication methods (automated versus manual application) were also investigated. One hundred and eighty extracted human teeth were ground to expose flat dentin surfaces that were then finished with wet silicon carbide paper. The teeth were randomly divided into 18 groups (n=10). The dentin surface of each specimen was exposed for 30 seconds to water spray from either a lubrication-free handpiece or a lubricated handpiece. Prior to exposure, various lubrication regimens were used on the handpieces that required lubrication. The dentin surfaces were then treated with total-etch, two-step; a self-etch, two-step or a self-etch, one-step bonding agent. Resin composite cylinders were bonded to dentin, the specimens were then thermocycled and tested to failure in shear at seven days. Mean bond strength data were analyzed using Dunnett's multiple comparison test at an 0.05 level of significance. Results indicated that within each of the bonding agents, there were no significant differences in bond strength between the control group and the treatment groups regardless of the type of handpiece or use of routine lubrication.

ATP-binding cassette protein E (ABCE) gene has been annotated as an RNase L inhibitor in eukaryotes. All eukaryotic species show the ubiquitous presence and high degree of conservation of ABCEs, however, RNase L is present only in mammals. This indicates that ABCEs may function not only as RNase L inhibitors, but also may have other functions that have yet to be determined. As an initial investigation into the novel functions of ABCE, we characterized the gene (Y39E4B.1) in Caenorhabditis elegans by a combination of data mining and functional assays. ABCE promoters drove GFP expressions in hypoderm, pharynx, vulvae, head, and tail neurons at all developmental stages. Three genes, rpl-4, nhr-91, and C07B5.3, were previously found to interact with ABCE. Our expression data showed overlapping expression patterns of ABCE and rpl-4 and nhr-91, but not C07B5.3. RNAi against ABCE resulted in embryonic lethality and slow growth. These data suggest that ABCE protein might be involved in the control of translation and transcription, work as shuttle protein between cytoplasm and nucleus, and possibly as a nucleocytoplasmic transporter. In addition, RNAi data suggest that ABCE and NHR-91 may function in vulvae development and molting pathways in C. elegans. Furthermore, our data suggest that ABCE, along with its interacting components, functions in a well-conserved pathway., (Copyright 2004 Elsevier Inc.)

Objective: To evaluate the effect of a light-transmitting post on the depth of cure of a resin composite., Methods: Acetate resin molds were filled with resin composite in which a light-transmitting post was inserted into the center and photopolymerized to the manufacturer's recommendations. Identical molds without a light-transmitting post were photopolymerized in a similar matter and served as a control. Molds were sectioned on a water-cooled, diamond saw at prescribed distances and the depth of cure was determined using a Knoop Hardness bottom-to-top ratio criterion. Data within each group were analyzed using 2-way (depth-by-distance) repeated measure ANOVA. Between-group contrasts (post versus no post) were accessed by a 3-way (2 within-subjects and 1 between-subjects) ANOVA with critical p = 0.05., Results: The presence of the post did increase (p < 0.001) Knoop Hardness values in simulated apical regions as compared to a control. However, there was no difference in the depth of cure between the groups (3-way analysis p = 0.2) and also when evaluated using an 80% bottom-to-top Knoop Hardness ratio., Significance: The results suggest that these posts may have a limited utility when judged against a Knoop Hardness ratio criterion.

With respect to determining sub-surface resin polymerization sufficiency, this study compared a traditional method of applying linear regression to bottom- to top-surface Knoop hardness ratios to an alternative method based on nonlinear regression. Inverse linear regression on ratios was used to estimate the exposure duration required for 80% bottom-surface hardness with respect to the top, in six light-by-material groups. Alternatively, a one-phase, two-parameter, exponential association of the form Y=Y(max)(1-e(-kt)) (where Y(max) is maximum hardness, k is a rate constant, and t is exposure duration), was used to model hardness. Inverse nonlinear regression estimated, for each condition, the exposure duration required for the bottom surface to achieve 80% of corresponding condition (light and material) top-surface Y(max). Mathematically, analysis of ratios was demonstrated to yield potentially less precise and biased estimates. Nonlinear regression yielded better statistical fit and provided easily accessible tests for differences in k across light-system groups. Another recently proposed nonlinear model for polymerization, Y=Y(max)kt(n)/(1+kt(n)), was also considered. While this new model has substantially greater phenomenological and mechanistic justification, we found that the model-fitting process was more sensitive to initial parameter values and sometimes yielded untenable results when applied to our data. However, we believe that these problems would not occur if sample points are well distributed across a wide range of exposure durations, and that the model, Y=Y(max)kt(n)/(1+kt(n)), should be considered for such data sets.

Background: We present a 13-year followup of a case of Wallenberg's syndrome, including a first-person account and ocular motor abnormalities., Methods: Objective infrared eye-tracking systems were used to record horizontal and vertical eye movements binocularly under a variety of conditions., Results: Fixation in the dark along the midline remained as before, with vestibular jerk nystagmus continuously present. While saccades and pursuit to a visual target also remained the same as found earlier, fixation was somewhat worse, revealing not only saccadic intrusions but also a prominent right-jerk nystagmus., Discussion: The results suggest lack of additional oculomotor neural plasticity after the end of the initial 10-year test period, and furthermore reveal apparent subtle age-related changes in oculomotor responsivity.

Purpose: The purpose of this study was to compare the curing efficiency of three commercially available light-emitting diode (LED)-based curing lights with that of a quartz tungsten halogen (QTH) curing light by means of hardness testing. In addition, the power density (intensity) and spectral emission of each LED light was compared with the QTH curing light in both the 380- to 520-nm and the 450- to 500-nm spectral ranges., Materials and Methods: A polytetrafluoroethylene mold 2 mm high and 8 mm in diameter was used to prepare five depth-of-cure test specimens for each combination of exposure duration, composite type (Silux Plus [microfill], Z-100 [hybrid]), and curing light (ZAP Dual Curing Light, LumaCure, VersaLux, Optilux 401). After 24 hours, Knoop hardness measurements were made for each side of the specimen, means were calculated, and a bottom/top Knoop hardness (B/T KH) percentage was determined. A value of at least 80% was used to indicate satisfactory polymerization. A linear regression of B/T KH percentage versus exposure duration was performed, and the resulting equation was used to predict the exposure duration required to produce a B/T KH percentage of 80% for the test conditions. The power densities (power/unit area) of the LED curing lights and the QTH curing light (Optilux 401) were measured 1 mm from the target using a laboratory-grade, laser power meter in both the full visible light spectrum range (380-780 nm) and the spectral range (between 450 and 500 nm), using a combination of long- and short-wave edge filters., Results: The emission spectra of the LED lights more closely mirrored the absorption spectrum of the commonly used photoinitiator camphorquinone. Specifically, 95% of the emission spectrum of the VersaLux, 87% of the LumaCure, 84% of the ZAP LED, and 78% of the ZAP combination LED and QTH fell between 450 and 500 nm. In contrast, only 56% of the emission spectrum of the Optilux 401 halogen lamp fell within this range. However, the power density between 450 and 500 nm was at least four times greater for the halogen lamp than for the purely LED lights. As a result, the LED-based curing lights required from 39 to 61 seconds to cure a 2-mm thick hybrid resin composite and between 83 and 131 seconds to adequately cure a microfill resin composite. By comparison, the QTH light required only 21 and 42 seconds to cure the hybrid and microfill resin composites, respectively., Clinical Significance: The first-generation LED-based curing lights in this study required considerably longer exposure durations than the QTH curing light to adequately polymerize a hybrid and a microfill resin composite.