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Abstract Background While pluripotent stem cell (PSC) therapies move toward clinical and commercial applications at a rapid rate, manufacturing reproducibility and robustness are notable bottlenecks in regulatory approval. Therapeutic applications of PSCs require large cell quantities to be generated under highly robust, well-defined, and economically viable conditions. Small-scale and short-term process optimization, however, is often performed in a linear fashion that does not account for time needed to verify the bioprocess protocols and analysis methods used. Design of a reproducible and robust bioprocess should be dynamic and include a continuous effort to understand how the process will respond over time and to different stresses before transitioning into large-scale production where stresses will be amplified. Methods This study utilizes a baseline protocol, developed for the short-term culture of PSC aggregates in Vertical-Wheel® bioreactors, to evaluate key process attributes through long-term (serial passage) suspension culture. This was done to access overall process robustness when performed with various commercially available media and cell lines. Process output variables including growth kinetics, aggregate morphology, harvest efficiency, genomic stability, and functional pluripotency were assessed through short and long-term culture. Results The robust nature of the expansion protocol was demonstrated over a six-day culture period where spherical aggregate formation and expansion were observed with high-fold expansions for all five commercial media tested. Profound differences in cell growth and quality were revealed only through long-term serial expansion and in-vessel dissociation operations. Some commercial media formulations tested demonstrated maintenance of cell growth rates, aggregate morphology, and high harvest recovery efficiencies through three bioreactor serial passages using multiple PSC lines. Exceptional bioprocess robustness was even demonstrated with sustained growth and quality maintenance over 10 serial bioreactor passages. However, some commercial media tested proved less equipped for serial passage cultures in bioreactors as cultures led to cell lysis during dissociation, reduction in growth rates, and a loss of aggregate morphology. Conclusions This study demonstrates the importance of systematic selection and testing of bioprocess input variables, with multiple bioprocess output variables through serial passages to create a truly reproducible and robust protocol for clinical and commercial PSC production using scalable bioreactor systems.

Young onset breast cancer (YOBC) is an increasing demographic with unique biology, limited screening, and poor outcomes. Further, women with postpartum breast cancers (PPBCs), cancers occurring up to 10 years after childbirth, have worse outcomes than other young breast cancer patients matched for tumor stage and subtype. Early-stage detection of YOBC is critical for improving outcomes. However, most young women (under 45) do not meet current age guidelines for routine mammographic screening and are thus an underserved population. Other challenges to early detection in this population include reduced performance of standard of care mammography and reduced awareness. Women often face significant barriers in accessing health care during the postpartum period and disadvantaged communities face compounding barriers due to systemic health care inequities. Blood tests and liquid biopsies targeting early detection may provide an attractive option to help address these challenges. Test development in this area includes understanding of the unique biology involved in YOBC and in particular PPBCs that tend to be more aggressive and deadly. In this review, we will present the status of breast cancer screening and detection in young women, provide a summary of some unique biological features of YOBC, and discuss the potential for blood tests and liquid biopsy platforms to address current shortcomings in timely, equitable detection.

Background. Mutations in the growth hormone (GH) gene cause various forms of biologically inactive growth hormone (BIGH) syndrome. Ghrelin potentiates the secretion of GH. Ade­nohypophysis hormones take part in human growth mechanisms. Insulin-like growth factor 1 (IGF-1) level is a criterion of GH activity. The purpose of the study was to assess the adenohypo­physis functions and to determine the role of ghrelin in patients with BIGH syndrome to optimize the diagnosis and treatment. Materials and methods. Anthropometric parameters were evalua­ted in 158 children with BIGH syndrome whose average age was 7.83 ± 1.23 years. The function of the adenohypophysis was evalua­ted accor­ding to the levels of somatotropin, thyroid-sti­mulating, adrenocorticotropic, luteinizing, follicle-stimulating hormone and their corresponding peripheral hormones, which were determined by radioimmunological methods and chemiluminescent immunoassay. A statistical analysis of the results was carried out. Results. The release of GH against the background of clonidine and insulin tests in patients with BIGH syndrome was higher than 10 ng/ml, the basal level of IGF-1 was significantly lower than the reference values. After a 4-day test for sensitivity to GH, the level of IGF-1 increased more than 2 times. Against the background of treatment with recombinant GH, serum thyroid-stimulating, adrenocorticotropic hormone, and cortisol indicators changed significantly, but their levels fluctuated within the reference values. Significant changes in ghrelin content were detected 120 minutes after falling asleep. Most children with BIGH syndrome had timely sexual development, precocious puberty was revealed in 19 children, the smallest was the group with delayed puberty (5 children). Gonadotropin-releasing hormone ana­logues were added to the GH treatment in case of unsatisfactory final growth. Conclusions. Normal/high levels of GH and reduced IGF-1 are characteristic of children with BIGH syndrome. In addition, these children have a significant increase in ghrelin in the first hours after falling asleep. The test for sensitivity to GH is a reliable diagnostic method. Thyroid and adrenal disorders were not found in patients with BIGH syndrome. Children with BIGH syndrome have normal sexual development with a tendency to precocious puberty. The simultaneous use of gonadotropin-releasing hormone analogues in combination with GH preparations significantly improves patients’ final growth.

За сучасними уявленнями, дисфункція гіпоталамусу (ДГ) - нейроендокринний синдром, обумовлений дисфункцією гіпоталамо-гіпофізарної системи, проявляється переважно гормонально-обмінними порушеннями і вегетативно-судинними розладами. Підліткове ожиріння в багатьох випадках пов’язане з ДГ та асоціюється з високим ризиком розвитку дефіциту вітаміну D (вітD). Ожиріння в асоціації з ДГ і дефіцитом вітD обумовлює серйозні проблеми зі здоров’ям, причому вісь вітD/паратгормон (ПТГ) відіграє потенційну роль в їхньому етіопатогенезі. Мета - вивчити взаємозв’язок між рівнями вітD, віт D-зв’язуючого білка (ВD-ЗБ) і ПТГ у підлітків з ожирінням на тлі ДГ. Матеріали та методи. Рівень у сироватці крові визначено імунохемілюмінесцентним методом на мікрочастинках («Abbott», США) у 87 дітей та підлітків із надлишковою масою тіла (МТ)/ожирінням на тлі ДГ віком від 10 до 16 років. Рівень ВD-ЗБ - за допомогою імуноферментного аналізу (ІФА) стандартним набором «Elabsciense Biotechnology Co.», Ltd (США). Рівень ПТГ - за допомогою ІФА стандартним набором «Monobind» (США). Результати. Недостатність вітD виявлено у 32,2%, дефіцит - у 56,3% пацієнтів. Тяжкість ожиріння була пов’язана з рівнями вітD: зниження рівня вітD у дітей та підлітків із надлишковою МТ (69,30±5,14 нмоль/л) та I ст. ожиріння (52,60 ±4,17 нмоль/л), значний дефіцит вітD в осіб з ІІ та ІІІ ст. ожиріння (36,20±3,75 нмоль/л, 23,10±3,12 нмоль/л, відповідно). Суттєве зниження вмісту вітD у пацієнтів з ожирінням супроводжувалося значним підвищенням рівня ПТГ. При ожирінні ІІІ ст. рівень ПТГ удвічі перевищував рівень ПТГ у практично здорових дітей і підлітків із нормальною МТ та у пацієнтів із надлишковою МТ (р30 кг/м2 суттєве зниження вмісту вітD асоціювалося зі значним підвищенням рівня ПТГ та різким зниженням рівня ВD-ЗБ. Рівень ВD-ЗБ мав позитивну кореляцію з рівнем вітD та негативний зв’язок з ІМТ. Встановлено суттєве зниження вмісту ВD-ЗБ (58,71±18,43 нг/мл) порівняно з групою практично здорових дітей і підлітків із нормальною МТ (141,65±25,34 нг/мл) (р

The purpose was to study the patterns of dissolution (solubilization) of phosphorus-containing minerals in aqueous and polysaccharide solutions of organic acids in order to model the mechanism of mineral destruction by soil bacteria synthesizing organic acids and exopolysaccharides. Methods. Model, laboratory-analytical, microbiological, statistical. Results. The destructive effect of organic acids on minerals is manifested both in aqueous and polysaccharide solutions. The introduction of bacterial polysaccharide into an aqueous solution of acids increases the decomposition of phosphorus-containing minerals by 1.34̶ 4.96 times. The influence of the chemical structure of acid molecules on the intensity of mineral decomposition is mainly manifested in the presence of bacterial polysaccharide, while in an aqueous solution the effectiveness of acid action depends on the nature of the mineral being destroyed. To the maximum degree, polysaccharide increases the destruction of minerals in a solution of citric acid: molten magnesium phosphate ̶ 2.55 times, thermophosphate ̶ 2.11 times, phosphate flour ̶ 4.96 times. Decomposition of phosphorus compounds in solutions of ascorbic and oxalic acids enhances bacterial polysaccharide to a lesser extent than in citric acid solution. Modeling the destruction of phosphorus-containing minerals under non-sterile conditions (soil conditions) made it possible to establish that organic acids under non-sterile conditions are subject to consumption by soil microbiota, especially ascorbic and citric acids, and to a lesser extent - succinic. Aqueous solutions of organic acids after 18 hours of incubation in non-sterile conditions lose their leaching activity by 1.06 ̶12.1 times. The introduction of a polysaccharide into aqueous solutions of acids makes it possible to avoid their rapid consumption by microorganisms, because of which the efficiency of mineral leaching under non-sterile conditions decreasшes by only 5–20% compared to sterile ones. Conclusions. The introduction of a bacterial polysaccharide into a solution of organic acids enables the latter to be transferred to a sorbed state, as a result of which their susceptibility to consumption by microorganisms is sharply reduced. Thus, polysaccharide-forming bacteria not only destroy minerals more intensively than microorganisms synthesizing only low-molecular-weight metabolites, but also synthesize a more stable and long-term functioning leaching complex in the soil.

Summary: Nuclear mRNA export via nuclear pore complexes is an essential step in eukaryotic gene expression. Although factors involved in mRNA transport have been characterized, a comprehensive mechanistic understanding of this process and its regulation is lacking. Here, we use single-RNA imaging in yeast to show that cells use mRNA retention to control mRNA export during stress. We demonstrate that, upon glucose withdrawal, the essential RNA-binding factor Nab2 forms RNA-dependent condensate-like structures in the nucleus. This coincides with a reduced abundance of the DEAD-box ATPase Dbp5 at the nuclear pore. Depleting Dbp5, and consequently blocking mRNA export, is necessary and sufficient to trigger Nab2 condensation. The state of Nab2 condensation influences the extent of nuclear mRNA accumulation and can be recapitulated in vitro, where Nab2 forms RNA-dependent liquid droplets. We hypothesize that cells use condensation to regulate mRNA export and control gene expression during stress.

Article substantiates the need to ensure high – quality training of the future teachers of the preschool education institutions (hereinafter-PEI) for health-saving professional activities. The relevance of awareness by higher education applicants of the value-motivational attitude to the problem of health preservation, the formation of their readiness for health-saving activities in the educational process of Health has been outlined. The formation of future the preschool education specialists’ readiness to implement the health paradigm in working with preschool children involves mastering first of all the content component of the discipline "Theory and Methodology of Physical Education and Valeological Education", as well as the skills and abilities of organizing one of the types of health – saving technologies-physical culture and health. The essence of the concepts of "Health-Saving Technologies", "Physical Culture and Recreation Technologies", their impact on children’s health and features of use have been revealed. It is emphasized that a necessary component of Physical Culture and Recreation Technology is the use of both individual physical exercises and their complexes. The expediency of introducing Physical Culture and Recreation Technologies in the educational process of Health has been determined, which should provide comfortable conditions for the development of children’s movements and prevent negative impacts on the health of the stressful environment. Modern requirements for Physical Culture and Recreation Work, which is the basis for the rational organization of the motor regime, have been taken into account. Article describes the organizational and pedagogical conditions for the use of Physical Culture and Recreation Technologies in the professional activities of future educators. It is noted that the requirements of the modern market environment for the competitiveness of a specialist are not only a high level of students’ assimilation of theoretical material and practical work skills, but also the development of personal qualities. Examples of the use of individual research tasks (IRT) focused on the activation of educational activities of higher education applicants, the transformation of passive assimilation of knowledge into their active application in quasi-professional and real situations of educational activity are positioned. It is established that mastering the knowledge, skills and abilities of future educators to design and apply Physical Culture and Recreation Technologies will contribute to the formation of health-saving competence in preschool children.

Соматотропна недостатність (СН) - захворювання, обумовлене значним порушенням у системі «гормон росту (ГР) / ростові фактори», виникає внаслідок різних спадкових або набутих причин і характеризується передусім суттєвим відставанням у рості та фізичному розвитку дитини. Дефіцит ГР може бути ізольованим або поєднуватися з недостатністю інших гормонів аденогіпофіза. Наявність взаємозв’язку між системою «ГР / ростові фактори» та вітаміну D (віт D) зумовлює участь генетичних змін рецептора віт D (VDR) у патогенезі СН. Мета - оцінити ризик розвитку СН на основі вивчення розподілу частот алелей і генотипів поліморфного локусу rs1544410 BsmI гена рецептора віт D. Матеріали та методи. Bsm I поліморфізму гена VDR (rs1544410) визначено методом полімеразної ланцюгової реакції з наступним аналізом довжини рестрикційних фрагментів при виявленні їх шляхом електрофорезу в агарозному гелі у 22 дітей препубертатного віку із СН. Рівень 25(ОН)D в сироватці крові визначено імунохемілюмінесцентним методом на мікрочастинках («Abbott», США). Результати. Найчастіше в дітей з ізольованою СН та множинною гіпофізарною недостатністю (МГН) відмічена алель GA (43,8% і 83,3% відповідно).. За наявності генотипів G/А і G/G ризик СН достовірно високий: відповідно ВШ=3,60 (95% ДІ: 1,40-9,23); ВШ=10,69 (95% ДІ 2,34-48,85); при варіанті генотипу А/А ризик СН достовірно низький: ВШ=0,11 (95% ДІ: 0,04-0,33). Носійство алелі G поліморфного локусу rs1544410 Bsm I гена VDR асоціюється з ризиком розвитку СН: ВШ=5,58 (95% ДІ: 4,51-6,90; р

Abstract Monocyte distribution width (MDW) is a novel marker of monocyte activation, which is known to occur in the immune response to viral pathogens. Our objective was to determine the performance of MDW and other leukocyte parameters as screening tests for SARS-CoV-2 and influenza infection. This was a prospective cohort analysis of adult patients who underwent complete blood count (CBC) and SARS-CoV-2 or influenza testing in an Emergency Department (ED) between January 2020 and July 2021. The primary outcome was SARS-CoV-2 or influenza infection. Secondary outcomes were measures of severity of illness including inpatient hospitalization, critical care admission, hospital lengths of stay and mortality. Descriptive statistics and test performance measures were evaluated for monocyte percentage, MDW, white blood cell (WBC) count, and neutrophil to lymphocyte ratio (NLR). 3,425 ED patient visits were included. SARS-CoV-2 testing was performed during 1,922 visits with a positivity rate of 5.4%; influenza testing was performed during 2,090 with a positivity rate of 2.3%. MDW was elevated in patients with SARS-Cov-2 (median 23.0U; IQR 20.5–25.1) or influenza (median 24.1U; IQR 22.0–26.9) infection, as compared to those without (18.9U; IQR 17.4–20.7 and 19.1U; 17.4–21, respectively, P

Pharmaceutically active compounds are common and increasing in the aquatic environment. Evidence suggests they have adverse effects on non-target organisms, and they are classified as emerging pollutants for a variety of aquatic organisms. To determine the effects of environmentally relevant levels of psychoactive compounds on non-target organisms, we analyzed cardiac and locomotory activity in early developmental stages of marbled crayfish Procambarus virginalis. Responses to sertraline, methamphetamine, and a mixture of citalopram, oxazepam, sertraline, tramadol, venlafaxine, and methamphetamine at a concentration of 1 µg L-1 of each compound were assessed. On day four of exposure, cardiac activity was recorded for 5 min, and on day eight, locomotory activity was recorded for 15 min. There was a significant increase (p 0.05) in exposed and control animals. These findings revealed that low concentrations of chemicals and their mixtures can modify the physiological state of aquatic animals without outward manifestations (activity, distance moved, and velocity). Aquatic animals can be impacted earlier than is visible, but effects can potentially lead to substantial changes in populations and in ecosystem processes. Additional research to investigate chemical combinations, exposure systems, and organism physiological and molecular responses may provide evidence of broad impact of environmental pharmaceuticals.

Personal care products, including organic UV filters, are considered emerging contaminants, with their toxic effects being a concern in recent decades. UV filters continually enter surface waters via wastewater and human activity. Despite the presence of organic UV filters in the freshwater environment, little is known of their impact on aquatic biota. In this study, we evaluated the cardiac and locomotor responses of signal crayfish Pacifastacus leniusculus exposed to environmentally relevant concentrations of either 2-Phenylbenzimidazole-5-sulfonic acid (PBSA, 3 µg/L) or 5-Benzoyl-4-hydroxy-2-methoxybenzenesulfonic acid (BP4, 2.5 µg/L). Specimens exposed to the tested compounds for 30 min exhibited significantly greater changes in distance moved and time active than did unexposed controls. Significant differences of mean heart rate change compared to control were detected in both PBSA and BP4 experimental groups. Such behavior and physiological alterations demonstrate ecological effects of personal care products with the tested sunscreen compounds even with a short exposure. Evidence of the consequences of organic UV filters on aquatic organisms is scarce and is an important topic for future research.

Introduction: Older patients frequently present to the emergency department (ED) with nonspecific complaints (NSC), such as generalized weakness. They are at risk of adverse outcomes, and early risk stratification is crucial. Triage using Emergency Severity Index (ESI) is reliable and valid, but older patients are prone to undertriage, most often at decision point D. The aim of this study was to assess the predictive power of additional clinical parameters in NSC patients.Methods: Baseline demographics, vital signs, and deterioration of activity of daily living (ADL) in patients with NSC were prospectively assessed at four EDs. Physicians scored the coherence of history and their first impression. For prediction of 30-day mortality, we combined vital signs at decision point D (heart rate, respiratory rate, oxygen saturation) as “ESI vital,” and added “ADL deterioration,” “incoherence of history,” or “first impression,” using logistic regression models.Results: We included 948 patients with a median age of 81 years, 62% of whom were female. The baseline parameters at decision point D (ESI vital) showed an area under the curve (AUC) of 0.64 for predicting 30-day mortality in NSC patients. AUCs increased to 0.67 by adding ADL deterioration to 0.66 by adding incoherence of history, and to 0.71 by adding first impression. Maximal AUC was 0.73, combining all parameters.Conclusion: Adding the physicians’ first impressions to vital signs at decision point D increases predictive power of 30-day mortality significantly. Therefore, a modified ESI could improve predictive power of triage in older patients presenting with NSCs.

Summary. Purpose: to study changes in the structural and functional parameters of the left atrium and left ventricle in patients with arterial hypertension and atrial fibrillation. Material and methods. The study involved 52 patients with stage II-III arterial hypertension, which were divided into 2 groups depending on the presence or absence of atrial fibrillation. The first group included 21 patients with arterial hypertension without atrial fibrillation, the second group included 31 patients with arterial hypertension with atrial fibrillation. Transthoracic echocardiography was performed using an Acuson X 700 Siemens ultrasound system. Results. All patients had an increased mass index of the left ventricular myocardium. With atrial fibrillation, concentric hypertrophy was noted in 22 (71%) and eccentric hypertrophy in 9 (29%) patients; and without arrhythmia in 17 (81%) and 4 (19%), respectively. In the second group of patients, there was an increase in mean pressure in the left atrium and the presence of type 3 diastolic dysfunction of the left ventricle. Left ventricular hypertrophy increases the stiffness of the left ventricle, which is confirmed in our study by an increase in the decrease in the longitudinal S of the left ventricle in atrial fibrillation in relation to patients without it. There was a significant decrease in the indicator of left atrial deformation in patients with atrial fibrillation compared with patients without arrhythmia (15.9±2.4% and 26.9±4.1%, respectively (p≤0.05)) with a sharp decrease in stool fraction left atrium (15.1±4.1 and 35.0±5.2, respectively (p≤0.05)). Conclusion. In patients with arterial hypertension with atrial fibrillation, there is a change in the remodeling of the left ventricle and atrium, and the deformation and emptying fraction of the left atrium is greater than the increase in its volume.

There are disorders in the growth hormone (GH)/growth factors system in a significant part of patients with short stature; first of all, this concerns such diseases as growth hormone deficiency, where there is a sharp decrease in GH, insulin-like growth factor-1 (IGF-1). The association between vitamin D and GH/growth factor system remains unclear. It was found that vitamin D is able to increase IGF-1 level in healthy individuals. Linear growth is accelerated after treatment of vitamin D deficiency in children, which may indicate the linking role of vitamin D between the proliferative cells of the growth plate cartilage and GH/growth factor system. Research objective: to determine 25-hydroxyvitamin D level in blood plasma in children with short stature, depending on the state of GH/IGF-1 system. Materials and methods. Study included 101 children with short stature: 33 children with partial somatotropic insufficiency (group 1); 44 children with complete somatotropic insufficiency (group 2); 24 children with syndrome of biologically inactive GH (group 3). Patients in groups 1 and 2 had a confirmed GH deficiency and a decrease or sharp decrease in of IGF-1 level; patients in group 3 had a normal stimulated release of GH against the background of a reduced IGF-1 level. GH, IGF-1, 25-hydroxyvitamin D, thyroid-stimulating hormone, and free thyroxine were determined in all children. Results. The average level of vitamin D in three groups corresponded to the vitamin deficiency according to international standards and was 52.24 ± 5.99 nmol/l in patients with partial somatotropic insufficiency, 67.6 ± 5.35 nmol/l in patients with complete somatotropic insufficiency and 58, ± 7.91 nmol/l in patients with syndrome of biologically inactive GH. A direct correlation was found between vitamin D and background GH level, stimulated GH level in children with both partial and complete somatotropic insufficiency. A direct correlation between vitamin D and IGF-1 level in this group of patients was also detected. Conclusions. It is advisable to determine the serum 25(OH)D in all children with short stature. Vitamin D levels should be taken into account in insulin/clonidine diagnostic tests in order to obtain a realistic indication of stimulated GH and IGF-1 levels.

Background: The question of recognition and enforcement of international commercial arbitration (ICA) decisions, as a prototype of a foreign court decision, finds radically opposite answers in different legal systems and in the doctrine of the ICA. Thus, in the Regulation of the Council (EU) 44/2001 of 22 December 2000 on the jurisdiction, recognition, and enforcement of judgments in civil and commercial matters, formerly the Brussels Convention of 1968 and the Lugano Convention of 1988, the notion of ‘arbitration’ was excluded from the sphere of execution and recognition of foreign court decisions. Methods: Nevertheless, the procedure for recognising and enforcing an ICA award has a unified approach in many countries around the world. Thus, national courts, when deciding on the recognition and enforcement of an ICA award, are increasingly faced with such problematic issues as the grounds for refusing to recognise and enforce such an award. This article reveals that these grounds for refusing to recognise and enforce the award of the ICA are a violation of public order of the country where the arbitral award is subject to recognition and enforcement. Particular attention is paid to the distinction between ‘substantive’ and ‘procedural’ public order and the practical approaches of national courts in some countries to this issue. Results and Conclusions: The authors state that the way to overcome this inconsistency is still a unified approach to understanding ‘public order’ in all member states of the New York Convention of 1958 and clearer international regulation of this issue.

Abstract Study Objective Enhancement of a routine complete blood count (CBC) for detection of sepsis in the emergency department (ED) has pragmatic utility for early management. This study evaluated the performance of monocyte distribution width (MDW) alone and in combination with other routine CBC parameters as a screen for sepsis and septic shock in ED patients. Methods A prospective cohort analysis of adult patients with a CBC collected at an urban ED from January 2020 through July 2021. The performance of MDW, white blood count (WBC) count, and neutrophil‐to‐lymphocyte‐ratio (NLR) to detect sepsis and septic shock (Sepsis‐3 Criteria) was evaluated using diagnostic performance measures. Results The cohort included 7952 ED patients, with 180 meeting criteria for sepsis; 43 with septic shock and 137 without shock. MDW was highest for patients with septic shock (median 24.8 U, interquartile range [IQR] 22.0–28.1) and trended downward for patients with sepsis without shock (23.9 U, IQR 20.2–26.8), infection (20.4 U, IQR 18.2–23.3), then controls (18.6 U, IQR 17.1–20.4). In isolation, MDW detected sepsis and septic shock with an area under the receiver operator characteristic curve (AUC) of 0.80 (95% confidence interval [CI] 0.77–0.84) and 0.85 (95% CI 0.80–0 .91), respectively. Optimal performance was achieved in combination with WBC count and NLR for detection of sepsis (AUC 0.86, 95% CI 0.83–0.89) and septic shock (0.86, 95% CI 0.80–0.92). Conclusion A CBC differential panel that includes MDW demonstrated strong performance characteristics in a broad ED population suggesting pragmatic value as a rapid screen for sepsis and septic shock.

Abstract Phenotypic plastic responses to temperature can modulate the kinetic effects of temperature on biological rates and traits and thus play an important role for species adaptation to climate change. However, there is little information on how these plastic responses to temperature can influence trophic interactions. Here, we conducted an experiment using marbled crayfish and their water louse prey to investigate how short‐term thermal acclimation at two temperatures (16 and 24°C) modulates the predator functional response. We found that both functional response parameters (search rate and handling time) differed between the two experimental temperatures. However, the sign and magnitudes of these differences strongly depended on acclimation time. Acclimation to 16°C increased handling time and search rate whereas acclimation to 24°C leads to the opposite effects with shorter handling time and lower search rate for acclimated predators. Moreover, the strength of these effects increased with acclimation time so that the differences in search rate and handing time between the two temperatures were reversed between the treatment without acclimation and after 24 h of acclimation. Overall, we found that the magnitude of the acclimation effects can be as strong as the direct kinetic effects of temperature. Our study highlights the importance of taking into account short‐term thermal plasticity to improve our understanding of the potential consequences of global warming on species interactions.

Introduction: Adequate pain control following ligamentoplasty, plays an important role in early mobilization of the patient. The aim of this study was to determine whether with the adductor canal block we can preserve quadriceps muscle strength better than with the femoral nerve block. Secondary end points were pain, additional analgesic request and patient satisfaction. Methods: In this controlled clinical trial, 80 ASA 1 or 2 patients for ligamentoplasty were divided in two groups. Group 1 received an adductor canal block for postoperative analgesia. Group 2 received femoral nerve block. As a rescue analgesic we used tramadol 100 mg. Following parameters were measured: mean dynamometer reading during knee extension at 6, 12 and 24 hours postoperatively as a percentage of the baseline measurement preoperatively, pain during rest at 6, 12 and 24 hours postoperatively, time of the first request of tramadol, the amount of tramadol requested for the first twelve hours and the second twelve hours (12-24 h) postoperatively and the satisfaction score. Results: A significant difference was found in the quadriceps muscle strength measurement at six and 12 hours postoperatively between the groups. There was not a significant difference in the pain scores, in the time of first request of tramadol and the amount requested, between the two groups. There was not a significant difference in the satisfaction score. Conclusion: With the adductor canal block we preserved quadriceps muscle strength better than femoral nerve block and achieved good postoperative analgesia noninferior to femoral nerve block.