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A 21-year-old man presented with acute onset of jaundice, abdominal pain, ascites, and hepatomegaly, along with a history of Budd-Chiari syndrome previously treated with vena cava angioplasty. Investigations revealed rapidly worsening jaundice, coagulopathy, elevated creatinine levels, reactive hepatitis B serology, and positive antiphospholipid antibodies, with scores indicating a poor prognosis for liver transplant-free survival. Abdominal computed tomography demonstrated a narrowed intrahepatic vena cava and new thrombosis in the right and middle hepatic veins. Renal biopsy, prompted by nephritic range proteinuria, indicated mesangioproliferative glomerulonephritis (MPGN) with immune complex deposition. The described case involves acute-on-chronic liver failure with acute insults from new onset hepatic vein thrombosis and hepatitis B reactivation, in a patient at a non-transplant center, who also had underlying antiphospholipid antibody syndrome, and MPGN. The patient was successfully treated with antiviral, anticoagulation, and antiplatelet agents, along with a sodium-glucose cotransporter 2 inhibitor and a direct intrahepatic portosystemic shunt, despite having a Model for End-Stage Liver Disease score of 35.

Objectives This study aims to evaluate whether stent removal through endoscopic retrograde cholangiopancreatography (ERCP) with balloon sweeps is necessary or whether stent removal by forward-viewing gastroscope without cholangiogram is sufficient.

Introduction Difficult biliary cannulation leads to prolonged papillary manipulation and repeated attempts at cannulation are known to increase the risk of postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. This study aims to compare the efficacy and complications of three rescue methods, transpancreatic biliary sphincterotomy (TP), double guidewire technique (DGW), and precut sphincterotomy (precut) in difficult common bile duct (CBD) cannulations.

Abstract Background Although APOE ε4 allele carriage confers a risk for coronary artery disease, its persistence in humans might be explained by certain survival advantages (antagonistic pleiotropy). Methods Combining data from ~ 37,000 persons from three older age British cohorts (1946 National Survey of Health and Development [NSHD], Southall and Brent Revised [SABRE], and UK Biobank) and one younger age cohort (Avon Longitudinal Study of Parents and Children [ALSPAC]), we explored whether APOE ε4 carriage associates with beneficial or unfavorable left ventricular (LV) structural and functional metrics by echocardiography and cardiovascular magnetic resonance (CMR). Results Compared to the non-APOE ε4 group, APOE ε4 carriers had similar cardiac phenotypes in terms of LV ejection fraction, E/e’, posterior wall and interventricular septal thickness, and LV mass. However, they had improved myocardial performance resulting in greater LV stroke volume generation per 1 mL of myocardium (higher myocardial contraction fraction). In NSHD (n = 1467) and SABRE (n = 1187), ε4 carriers had a 4% higher MCF (95% CI 1–7%, p = 0.016) using echocardiography. Using CMR data, in UK Biobank (n = 32,972), ε4 carriers had a 1% higher MCF 95% (CI 0–1%, p = 0.020) with a dose-response relationship based on the number of ε4 alleles. In addition, UK Biobank ε4 carriers also had more favorable radial and longitudinal strain rates compared to non APOE ε4 carriers. In ALSPAC (n = 1397), APOE ε4 carriers aged

Bronchobiliary fistula is a very rare entity that presents with bilioptysis. We present a noteworthy case involving a patient with portal cavernoma cholangiopathy complicated by cholangitis and bronchobiliary fistula. The diagnosis was established through high-resolution computed tomography of the thorax and bronchoscopic evaluation. Subsequently, the patient underwent endoscopic retrograde cholangiopancreatography with stenting of the common bile duct. Remarkably, the bronchobiliary fistula resolved 1 month after the procedure.

A 13-year-old boy presented with an 8-year history of repeated episodes of anemia. Laboratory investigations confirmed iron deficiency anemia due to occult blood loss from the gastrointestinal tract. Despite undergoing esophagogastroduodenoscopy, colonoscopy, and push enteroscopy, no abnormalities were detected. Subsequent computed tomography enterography also yielded normal results. However, a capsule endoscopy revealed multiple superficial ulcers in the jejunum and proximal ileum. Initially, the patient was treated for Crohn’s disease using various therapeutic approaches, all of which were unsuccessful. Further investigation led to a positive diagnosis for a rare condition known as chronic enteropathy associated with SLCO2A1 mutation (CEAS), marking the first reported case in India.

CyberGIS—geographic information science and systems (GIS) based on advanced cyberinfrastructure—is becoming increasingly important to tackling a variety of socio-environmental problems like climate change, disaster management, and water security. While recent advances in high-performance computing (HPC) have the potential to help address these problems, the technical knowledge required to use HPC has posed challenges to many domain experts. In this paper, we present CyberGIS-Compute: a geospatial middleware tool designed to democratize HPC access for solving diverse socio-environmental problems. CyberGIS-Compute does this by providing a simple user interface in Jupyter, streamlining the process of integrating domain-specific models with HPC, and establishing a suite of APIs friendly to domain experts.

Background: Efficacy of nonoperative treatment for rotator cuff tears has been debated, especially for full-thickness tears. The purpose of this study was to a) define the minimal clinically important difference (MCID) of nonoperative treatment with regard to Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference (PI) and upper extremity (UE), and b) determine the proportion of patients with both partial and full-thickness tears (PTRCT, FTRCT) who achieve this improvement following initial nonoperative treatment. We hypothesized that >75% of PTRCT and FTRTC patients would achieve MCID for PROMIS PI and UE. Methods: We performed a retrospective cohort study evaluating nonoperatively managed patients with image-confirmed PTRCT and FTRCT. Treatment modalities and follow-up PROMIS scores at least 6 months after their initial visit were recorded. Using a distribution technique, MCID was calculated. Results: A total of 111 FTRCT and 68 PTRCT patients were included with at least 6 months of follow-up. At 6 months from initial presentation, the MCID for PROMIS UE was 3.75 and 3.95 for FTRCT and PTRCT patients, respectively. For PROMIS PI, the MCID was 3.35 and 3.90 for FTRCT and PTRCT, respectively. In total, 41% of FTRCT and 41% of PTRCT achieved MCID for PROMIS UE. Thirty-four percent of FTRCT and 35% of PTRCT achieved MCID for PROMIS PI. Conclusion: The majority of patients undergoing nonoperative treatment for supraspinatus/infraspinatus rotator cuff tears did not achieve MCID at 6 months for PROMIS PI (34% for FTRCT and 35% for PTRCT) or UE (41% for FTRCT and 41% for PTRCT).

Abstract Cardiovascular ageing is a process that begins early in life and leads to a progressive change in structure and decline in function due to accumulated damage across diverse cell types, tissues and organs contributing to multi-morbidity. Damaging biophysical, metabolic and immunological factors exceed endogenous repair mechanisms resulting in a pro-fibrotic state, cellular senescence and end-organ damage, however the genetic architecture of cardiovascular ageing is not known. Here we use machine learning approaches to quantify cardiovascular age from image-derived traits of vascular function, cardiac motion and myocardial fibrosis, as well as conduction traits from electrocardiograms, in 39,559 participants of UK Biobank. Cardiovascular ageing is found to be significantly associated with common or rare variants in genes regulating sarcomere homeostasis, myocardial immunomodulation, and tissue responses to biophysical stress. Ageing is accelerated by cardiometabolic risk factors and we also identify prescribed medications that are potential modifiers of ageing. Through large-scale modelling of ageing across multiple traits our results reveal insights into the mechanisms driving premature cardiovascular ageing and reveal potential molecular targets to attenuate age-related processes.

The Chemical Looping Combustion (CLC) technique shows great potential as an innovative technology to enhance thermal efficiency of system. It has a capability to achieve complete carbon capture (up to 100 %) and prevent the formation of nitrogen oxides (NOx). The current study focuses on the computational analysis of bubble behavior within fuel reactor of CH4-fueled Chemical Looping Combustion (CLC) setup. During numerical examination, a user-defined function (UDF) was utilized to integrate a reaction kinetics into active environment of fuel reactor. In the current research, CuO and NiO are employed as mixed oxygen carrier substances, while CH4 is utilized as fuel within the combustion procedures. The preparation, growing, rising, and bursting of bubbles' hydrodynamics has been observed; additionally, it has been evaluated in addition to examining the solidus-gaseous molar fraction within a fuel reactor. The current simulation opted for a gaseous fuel composed of natural gas (CH4), a hydrocarbon, alongside mixed metal oxides as CuO and NiO in varying ratios. A mixed metal oxide has been chosen in the proportion of CuO as 0.3 and NiO as 0.7, CuO as 0.5 and NiO as 0.5, and CuO as 0.7 and NiO as 0.3 by weightage. The fuel conversion rate has been observed 20 %, 25 %, and 30 % respectively for the different metal oxide mixture proportions. It has been clearly noticed that in the mixture of NiO and CuO; if the CuO amount is more, then the fuel conversion rate is high due to highly reactivity of CuO at high temperatures.

Introdução: O sistema Diego, desde sua descoberta em 1953, tem sido associado a aloimunizações por via transfusional e gravidez. A evolução em torno do antígeno D é notável com a existência de uma vacina específica, porém a aloimunização por antígenos deste e de outros sistemas de grupo sanguíneo permanece uma lacuna a ser preenchida. Por sua imunogenicidade, o antígeno D, mesmo quando não envolvido diretamente numa aloimunização, acaba por contribuir indiretamente nos achados laboratoriais de outros antígenos e anticorpos presentes nas hemácias humanas. Relato de caso: A Secretaria de Saúde de Prudentópolis-PR encaminhou ao Hemocentro Regional de Guarapuava-PR uma amostra de sangue de uma paciente daquele município paranaense para confirmação de tipagem ABO/Rh e identificação de anticorpos em razão da mesma ter apresentado teste de Coombs Indireto Positivo e, a partir do resultado, optar pela aplicação ou não de imunoglobulina anti-D (Mathergan/Rhogam ou equivalente). Os exames com a amostra da mãe utilizando técnicas em gel demonstraram: tipagem ABO/Rh B negativo, fenotipagem estendida C(-)c(+)E(-)e(+)K(-)Kp(a-)Kp(b+)Jk(a+)Jk(b-)P1(+)Le(a-)Le(b+)Lu(a-)Lu(b+)M(+)N(-)S(+)s(-)Fy(a)+Fy(b+)Di(a-), pesquisa de anticorpos irregulares positiva e a identificação de anticorpos detectou a presença de anti-Di(a) e não de anti-D, como se esperava. Para excluir-se a possibilidade de DHPN causada por este anticorpo, foram coletadas amostras de sangue do marido da paciente e do seu primeiro filho e, por meio de fenotipagem, verificou-se a ausência do antígeno Di(a) em ambas. Para identificar-se a origem da aloimunização, pesquisou-se o histórico de transfusões da paciente no sistema SHTWEB, o qual retornou duas transfusões de concentrados de hemácia no ano de 2018, uma das quais Di(a)- e outra não fenotipada para o antígeno. O doador da bolsa não fenotipada foi convocado e a fenotipagem de suas hemácias demonstraram a presença dos antígenos Di(a). Conclusão: A ausência de antígenos Di(a) nas hemácias da paciente, do marido e do filho demonstraram que a aloimunização da mãe aconteceu por meio de uma transfusão de hemácias Di(a)+ e não por transmissão vertical. A presença de anticorpos contra o sistema Diego demonstrou a importância da realização do Teste de Coombs Indireto nas gestantes para a proteção das mesmas e dos seus bebês não somente ao antígeno D mas também aos antígenos de outros sistemas de grupo sanguíneo.

Abstract Objective To determine the impact of patient demographics and social determinants of health on treatment pathways for unilateral vocal fold paralysis (UVFP) at a tertiary laryngology clinic. Study design Retrospective medical record review. Methods Patient demographics (age, gender, race, ethnicity, and insurance status) were extracted for adults diagnosed with UVFP between 2009 and 2019. Odds ratios for the associations between sociodemographic factors and UVFP treatment pathways were determined by chi‐square analyses. Results A total of 1490 UVFP diagnoses were identified during the study period with the majority being female (58%), White (85%), non‐Hispanic (97%), and publicly insured (54%). Five treatment pathways were identified: observation, injection laryngoplasty, voice therapy, laryngeal framework surgery/thyroplasty, and reinnervation surgery. There were 538 patients who underwent observation, 512 injection laryngoplasty, 366 voice therapy, 136 thyroplasty, and 26 laryngeal reinnervation surgery. Males were more likely to undergo injection laryngoplasty than females (OR 1.32; CI 1.08–1.61), whereas females were more likely to undergo voice therapy (OR 1.39; CI 1.09–1.76). Patients with public insurance (OR 1.48; CI 1.03–2.14) and Hispanics (OR 2.60; CI 1.18–5.72) were more likely to undergo thyroplasty. Patients who underwent reinnervation surgery were younger than those in other treatment pathways (median: 39.1 years vs. 50.7–56.1 years). Conclusions Gender, ethnicity, and insurance status were significantly associated with specific UVFP treatment pathways. Patients with public insurance were more likely to undergo surgical intervention than voice therapy. This data overall supports differences in care pathway utilization for UVFP based on social determinants of health. Level of evidence Level IV.

Objective: Fragmented QRS (fQRS), as defined by additional spikes in the QRS complex of a 12-lead electrocardiogram (ECG), is a marker of scarred myocardium. In patients with coronary artery disease (CAD), fQRS is a predictor of heart failure (HF) and other major adverse cardiac events (MACE). The study was aimed to evaluate the role of fQRS in prediction of HF in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods: In a prospective, non-randomized, small observational study, we enrolled 188 consecutive patients with STEMI undergoing primary PCI. Patients were grouped according to the presence or absence of fQRS and their in-hospital, 1 and 6-month MACE outcomes were assessed. Results: Of the 188 patients, fQRS were noted in 92 (48.94%) patients. Patients with fQRS were more likely to have Killip class II/III/IV. Patients with fQRS had a significantly higher corrected QT interval, lower left ventricular ejection fraction (LVEF), and higher N-terminal pro brain natriuretic peptide (NT-pro BNP) at 24 hours and 48 hours compared to patients without fQRS. The in-hospital (P=0.001), 30-day (P=0.03) and 6-month (p=0.01) MACE were higher in patients with fQRS. On logistic multiple analysis, fQRS in anterior leads (OR=3.70, CI=1.68-10.02, p=0.001), fQRS in more than 2 leads (OR=5.20, CI=1.51-12.83, p=0.01), NT-proBNP (OR=1.05, CI=1.03-1.08, p=0.02) and Killip class II/III/IV were found to be significant predictors for HF hospitalization. Conclusion: Our findings suggest that fQRS can be a predictor for HF in patients with STEMI and provide a simple and readily available technique for predicting prognosis. Larger studies are required to validate these findings.

Background Colonoscopy is currently gold standard for visualizing colonic mucosa. Presence of constipation is generally associated with poor bowel preparation. We compared effect on colonic cleansing when prucalopride was used as adjunct with polyethylene glycol (PEG) in patients of constipation. Methods A retrospective study was conducted at our center. One 70 patients with constipation were enrolled in two groups of who took only PEG and other of prucalopride plus PEG+ for bowel preparation. They underwent colonoscopy by a single-blinded experienced endoscopist. Bowel preparation quality was reported by Boston bowel preparation scale prior to washing or suctioning. The groups were analyzed for bowel preparation quality and side effects in either groups based on preformed questionnaire. Results Mean Boston Stool preparation Score (BSS) in PEG group (5.33 ± 1.43) was slightly higher than PEG+ (5.16 + 1.37) (p-value =0.44). The total number of patients with side effects was higher in PEG+ group than PEG group. (p

Chemical looping combustion (CLC) process is a promising technology for improving the thermal efficiency of a system with the potential of 100% carbon capture and no NOx formation. In the present research work, bubble hydrodynamics inside the fuel reactor of a CH4–fueled CLC system has been numerically investigated. The reaction kinetics has been incorporated into the reactive system of the fuel reactor by a user-defined function (UDF) during numerical analysis. The present study uses CuO as an oxygen carrier material and CH4 as a fuel in combustion processes. The bubble hydrodynamics in terms of development, growth, rise, and burst are visualized and analyzed the solid-gas molar fraction inside the fuel reactor. In the present work, authors have chosen different operating temperatures varying from 923 K to 1323 K. The fuel conversion rate has been observed to increase with the increased temperature. Different granular size of metal oxide particles varying from 100 µm to 400 µm has been considered to observe the effect of various grain size of metal oxide and it was observed that the fuel conversion rate is decreasing with increased granular size.

Trimethoprim-Sulfamethoxazole is a commonly used antibiotic for treatment of urinary tract infections, but also used to treat less common conditions such as pulmonary nocardiosis. N4-acetyl-sulfamethoxazole is the main active metabolite of Sulfamethoxazole. Pure stones of this compound are very rare with only a few cases documented in the literature. Here we present a case of a patient treated with long term trimethoprim-sulfamethoxazole therapy for pulmonary nocardiosis who developed pure N4-acetyl-sulfamethoxazole nephrolithiasis resulting in upper tract obstruction. This report provides an additional data point for this unique calculus etiology.

Healthcare professionals such as nurses faced a tough time during the pandemic. Despite the personal and professional challenges, they contributed immensely during the pandemic. However, there were variations in nurses’ work engagement during the pandemic. One reason could be their personality, especially neuroticism. Neuroticism represents individuals’ proneness to distress in stressful situations, such as COVID-19. Hence, understanding how and in which conditions neuroticism influences work engagement is crucial. We used the Job Demand-Resource (JD-R) model to test the association between neuroticism and work engagement. As neuroticism represents the stress-proneness of an individual, we further investigated if stress mediates the neuroticism-work engagement link. For the nurses, patient interaction is an integral part of their job. Based on the data collected from the nurses, we tested if contact with patients (i.e., beneficiary contact) alleviates the adverse effect of neuroticism on work engagement. During COVID-19, there was an intense need for nursing support. Hence, avoiding duty when society is looking for support might induce a fear of stigmatization among the nurses. We examined if the perceived stigma of duty avoidance would affect the neuroticism-engagement relationship. Our results indicated that higher patient contact alleviated the adverse effect of neuroticism on work engagement. On the other hand, higher fear of stigma exacerbated the adverse effect of neuroticism on work engagement. We further checked the combined effect of beneficiary contact and fear of stigma on neuroticism-work engagement relationships. The findings highlighted the importance of societal factors and policymakers in enhancing nurses’ work engagement.

Introduction: Women undergo menstruation as part of their normal physiological cycle. In Indian society, it is associated with taboos, myths, misbelieves and malpractice. Majority of adolescent girls are unprepared in terms of knowledge, attitude and hygienic practices for managing the menstrual cycle when they enter menarche. A better understanding of the scientific process of menstruation and good menstrual hygiene is very crucial for the health and well-being of adolescent girls. Unsafe practices are associated with unwanted outcomes. Aim: To assess the knowledge, beliefs and sources of information adolescents have about menstruation, along with their management of menstrual hygiene. Materials and Methods: The present community-based crosssectional study was conducted among the adolescent school going girls of rural and urban areas in 2019 in Vadodara, Gujarat, India, among 240 adolescent girls of 14-17 years of age using multistage sampling methods. Data were collected by using pre tested, structured self-administered questionnaire after having informed consent. Descriptive statistics was applied for analysis and results were presented into table and graph. Results: A total of 98 (40.8%) girls were aware of menstruation before attaining menarche. Out of total 240, 26(10.83%) did not knew the cause of menstruation and 11 (4.58%) were not aware about the organ from where menstrual bleeding occurs. Total 55.42% girls used only sanitary pads whereas 43.33% used both old clothes and sanitary pads as the absorbents. A 46.25% changed absorbent frequently (≥4 times in a day). A 54.17% washed their genitals frequently. The most common method of absorbent disposal was disposal in a dustbin. Mother was the main source of information regarding menstruation. Conclusion: Majority of adolescent girls were not having enough knowledge regarding menstruation and their menstrual practices are inexact. This is requisite for menstrual hygiene programme.

Objective: To study correlation between HB1C and serum lipid profile among type 2 diabetes mellitus. Methods: The cross-sectional study was carried out on 146 patients above the age of 30 years presenting with type 2 diabetes in OPD/wards of medicine department at Tertiary Care Center, South Gujarat. Result: In study the parameters Fasting blood sugar (FBS), Glycated hemoglobin (HB1AC), triglycerides (TG), total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), very low-density lipoprotein (VLDL)were studied. LDL, TC, were high in poor glycemic control group (HB1C>7) as compared to good glycemic control group (HB1C

Despite the weak, van der Waals interlayer coupling, photoinduced charge transfer vertically across atomically thin interfaces can occur within surprisingly fast, sub-50 fs time scales. An early theoretical understanding of charge transfer is based on a noninteracting picture, neglecting excitonic effects that dominate optical properties of such materials. We employ an ab initio many-body perturbation theory approach, which explicitly accounts for the excitons and phonons in the heterostructure. Our large-scale first-principles calculations directly probe the role of exciton-phonon coupling in the charge dynamics of the WS2/MoS2 heterobilayer. We find that the exciton-phonon interaction induced relaxation time of photoexcited excitons at the K valley of MoS2 and WS2 is 67 and 15 fs at 300 K, respectively, which sets a lower bound to the intralayer-to-interlayer exciton transfer time and is consistent with experiment reports. We further show that electron-hole correlations facilitate novel transfer pathways that are otherwise inaccessible to noninteracting electrons and holes.

Most living organisms possess varying degrees of regenerative capabilities but how these regenerative processes are controlled is still poorly understood. Naturally occurring bioelectric voltages (like Vmem) are thought to be playing instructive role in tissue regeneration, as well as embryonic development. The different distribution of ions on the either side of the cell membrane results in intra- and extra-cellular voltage differences, known as membrane potential or Vmem. The relationship between Vmem and cell physiology is conserved in a wide range of cell types and suggests that Vmem regulation is a fundamental control mechanism for regeneration related processes e.g., proliferation and differentiation. In the present study we measured Vmem in three different cell types (human osteogenic sarcoma cell line (OSC), rat bone marrow derived mesenchymal stem cells (BM-MSC), and rat dermal fibroblasts) and characterized the relationship between their Vmem and proliferation. In order to find out if Vmem controls proliferation, or visa-versa, we blocked and then unblocked Na+/K+-exchanging ATPase using ouabain and measured the proliferation. Our results demonstrate that Vmem can be pharmacologically manipulated to control proliferation in certain cell types like BM-MSC. Taken together, it is clear that control of bioelectrical properties in non-excitable cells could prove to be potentially a useful tool in regenerative medicine efforts.

Dendrite microtubules are polarized with minus-end-out orientation in Drosophila neurons. Nucleation sites concentrate at dendrite branch points, but how they localize is not known. Using Drosophila, we found that canonical Wnt signaling proteins regulate localization of the core nucleation protein γTubulin (γTub). Reduction of frizzleds (fz), arrow (low-density lipoprotein receptor-related protein [LRP] 5/6), dishevelled (dsh), casein kinase Iγ, G proteins, and Axin reduced γTub-green fluorescent protein (GFP) at branch points, and two functional readouts of dendritic nucleation confirmed a role for Wnt signaling proteins. Both dsh and Axin localized to branch points, with dsh upstream of Axin. Moreover, tethering Axin to mitochondria was sufficient to recruit ectopic γTub-GFP and increase microtubule dynamics in dendrites. At dendrite branch points, Axin and dsh colocalized with early endosomal marker Rab5, and new microtubule growth initiated at puncta marked with fz, dsh, Axin, and Rab5. We propose that in dendrites, canonical Wnt signaling proteins are housed on early endosomes and recruit nucleation sites to branch points.

Abstract Background The outbreak of the Ebola virus disease (EVD) in 2014 led to massive dropouts in HIV care in Guinea. Meanwhile, Médecins Sans Frontières (MSF) was implementing a six-monthly appointment spacing approach adapted locally as Rendez-vous de Six Mois (R6M) with an objective to improve retention in care. We sought to evaluate this innovative model of ART delivery in circumstances where access to healthcare is restricted. Methods A retrospective cohort study in 2014 of the outcome of a group of stable patients (viral load ≤1000 copies/μl) enrolled voluntarily in R6M compared with a group of stable patients continuing standard one to three monthly visits in Conakry. Log-rank test and Cox proportional hazards model were used to compare rates of attrition (deaths and defaulters) from care between the two groups. A linear regression analysis was used to describe the trend or pattern in the number of clinical visits over time. Results Included were 1957 adults of 15 years old and above of whom 1166 (59.6%) were enrolled in the R6M group and 791 (40.4%) in the standard care group. The proportion remaining in care at 18 months and beyond was 90% in the R6M group; significantly higher than the 75% observed in the control group (p

BackgroundPediatric renal trauma is rare and lacks sufficient population-specific data to generate evidence-based management guidelines. A nonoperative approach is preferred and has been shown to be safe. However, bleeding risk assessment and management of collecting system injury are not well understood. We introduce the Multi-institutional Pediatric Acute Renal Trauma Study (Mi-PARTS), a retrospective cohort study designed to address these questions. This article describes the demographics and contemporary management of pediatric renal trauma at Level I trauma centers in the United States.MethodsRetrospective data were collected at 13 participating Level I trauma centers on pediatric patients presenting with renal trauma between 2010 and 2019. Data were gathered on demographics, injury characteristics, management, and short-term outcomes. Descriptive statistics were used to report on demographics, acute management, and outcomes.ResultsIn total, 1,216 cases were included in this study. Of all patients, 67.2% were male, and 93.8% had a blunt injury mechanism. In addition, 29.3% had isolated renal injuries, and 65.6% were high-grade (American Association for the Surgery of Trauma Grades III-V) injuries. The mean Injury Severity Score was 20.5. Most patients were managed nonoperatively (86.4%), and 3.9% had an open surgical intervention, including 2.7% having nephrectomy. Angioembolization was performed in 0.9%. Collecting system intervention was performed in 7.9%. Overall mortality was 3.3% and was only observed in patients with multiple injuries. The rate of avoidable transfer was 28.2%.ConclusionThe management and outcomes of pediatric renal trauma lack data to inform evidence-based guidelines. Nonoperative management of bleeding following renal injury is a well-established practice. Intervention for renal trauma is rare. Our findings reinforce differences from the adult population and highlights opportunities for further investigation. With data made available through Mi-PARTS, we aimed to answer pediatric specific questions, including a pediatric-specific bleeding risk nomogram, and better understanding indications for interventions for collecting system injuries.Level of evidencePrognostic and Epidemiological; Level IV.

Abstract Background Pre-operative chemoradiotherapy (CRT) for MRI-defined, locally advanced rectal cancer is primarily intended to reduce local recurrence rates by downstaging tumours, enabling an improved likelihood of curative resection. However, in a subset of patients complete tumour regression occurs implying that no viable tumour is present within the surgical specimen. This raises the possibility that surgery may have been avoided. It is also recognised that response to CRT is a key determinant of prognosis. Recent radiological advances enable this response to be assessed pre-operatively using the MRI tumour regression grade (mrTRG). Potentially, this allows modification of the baseline MRI-derived treatment strategy. Hence, in a ‘good’ mrTRG responder, with little or no evidence of tumour, surgery may be deferred. Conversely, a ‘poor response’ identifies an adverse prognostic group which may benefit from additional pre-operative therapy. Methods/design TRIGGER is a multicentre, open, interventional, randomised control feasibility study with an embedded phase III design. Patients with MRI-defined, locally advanced rectal adenocarcinoma deemed to require CRT will be eligible for recruitment. During CRT, patients will be randomised (1:2) between conventional management, according to baseline MRI, versus mrTRG-directed management. The primary endpoint of the feasibility phase is to assess the rate of patient recruitment and randomisation. Secondary endpoints include the rate of unit recruitment, acute drug toxicity, reproducibility of mrTRG reporting, surgical morbidity, pathological circumferential resection margin involvement, pathology regression grade, residual tumour cell density and surgical/specimen quality rates. The phase III trial will focus on long-term safety, regrowth rates, oncological survival analysis, quality of life and health economics analysis. Discussion The TRIGGER trial aims to determine whether patients with locally advanced rectal cancer can be recruited and subsequently randomised into a control trial that offers MRI-directed patient management according to radiological response to CRT (mrTRG). The feasibility study will inform a phase III trial design investigating stratified treatment of good and poor responders according to 3-year disease-free survival, colostomy-free survival as well as an increase in cases managed without a major resection. Trial registration ClinicalTrials.gov, ID: NCT02704520 . Registered on 5 February 2016.

The low rate of productivity in agriculture sector potentially reduce its ability to provide welfare to farmers. Furthermore, it will preserve vicious circle of poverty. Thus, it is important to produce superior products of one region. Superior products, which made by local resources, potentially affect the community in a village. This research aimed to identify local resources and potential relationship that may be build. This research used mix methods, which is combine qualitative and quantitative methods, by using sequential exploratory strategy. This research is conducted in Kabupaten Lumajang, Indonesia. Some problems raised in our study area. They are asymmetric information, income disparity, and weak farming management. All of them persist from a long time ago, without no strong desire to overcome them. We propose two models to overcome the problem. The first is Siparti 3-S. Siparti 3-S involve synergy of the three basic resources: human resources, natural resources, and social and cultural resources. The second models are Synergy Government-University-Industry into Triple Helix. It is important to work together with the university, local government, and local industry. Thus, by implement those models, citizens are able to produce superior products so that they can raise their welfare.

Background Electrochemical signals play an important role in cell communication and behavior. Electrically charged ions transported across cell membranes maintain an electrochemical imbalance that gives rise to bioelectric signaling, called membrane potential or Vmem. Vmem plays a key role in numerous inter- and intracellular functions that regulate cell behaviors like proliferation, differentiation and migration, all playing a critical role in embryonic development, healing, and regeneration. Methods With the goal of analyzing the changes in Vmem during cell proliferation and differentiation, here we used direct current electrical stimulation (EStim) to promote cell proliferation and differentiation and simultaneously tracked the corresponding changes in Vmem in adipose derived mesenchymal stem cells (AT-MSC). Results We found that EStim caused increased AT-MSC proliferation that corresponded to Vmem depolarization and increased osteogenic differentiation that corresponded to Vmem hyperpolarization. Taken together, this shows that Vmem changes associated with EStim induced cell proliferation and differentiation can be accurately tracked during these important cell functions. Using this tool to monitor Vmem changes associated with these important cell behaviors we hope to learn more about how these electrochemical cues regulate cell function with the ultimate goal of developing new EStim based treatments capable of controlling healing and regeneration.