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Juthaporn Cowan,1,2 Sunita Mulpuru,1,2 Sara J Abdallah,2 Anchal Chopra,3 Andrew Purssell,1 Michaeline McGuinty,1 Gonzalo G Alvarez,1,2 Antonio Giulivi,2,4 Vicente Corrales-Medina,1,2 Derek MacFadden,1,2 Loree Boyle,1 Delvina Hasimja,1 Kednapa Thavorn,2,5,6 Ranjeeta Mallick,2 Shawn D Aaron,1,2 D William Cameron1,2 1Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; 2Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; 3Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada; 4Department of Pathology and Laboratory Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada; 5School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada; 6Institute for Clinical Evaluative Sciences, Toronto, Ontario, CanadaCorrespondence: Juthaporn Cowan Email jcowan@toh.caBackground: Observational studies suggest that immunoglobulin treatment may reduce the frequency of acute exacerbations of COPD (AECOPD).Objective: To inform the design of a future randomised control trial (RCT) of intravenous immunoglobulin (IVIG) treatment efficacy for AECOPD prevention.Methods: A pilot RCT was conducted. We recruited patients with COPD hospitalized for AECOPD, or from ambulatory clinics with one severe, or two moderate AECOPD in the previous year regardless of their serum IgG level. Patients were allocated in a 1:1 ratio with balanced randomisation to monthly IVIG or normal saline for 1 year. The primary outcome was feasibility defined as pre-specified accrual, adherence, and follow-up rates. Secondary outcomes included safety, tolerance, AECOPD rates, time to first AECOPD, quality of life, and healthcare costs.Results: Seventy patients were randomized (37 female; mean age 67.7; mean FEV1 35.1%). Recruitment averaged 4.5± 0.9 patients per month (range 0– 8), 34 (49%) adhered to at least 80% of planned treatments, and four (5.7%) were lost to follow-up. There were 35 serious adverse events including seven deaths and one thromboembolism. None was related to IVIG. There were 56 and 48 moderate and severe AECOPD in the IVIG vs control groups. In patients with at least 80% treatment adherence, median time to first moderate or severe AECOPD was 275 vs 114 days, favoring the IVIG group (HR 0.76, 95% CI 0.3– 1.92).Conclusion: The study met feasibility criteria for recruitment and retention, but adherence was low. A trend toward more robust treatment efficacy in adherent patients supports further study, but future trials must address treatment adherence.Trial registration number: NCT0290038, registered 24 February 2016, https://clinicaltrials.gov/ct2/show/NCT02690038 and NCT03018652, registered January 12, 2017, https://clinicaltrials.gov/ct2/show/NCT03018652.Keywords: recurrent AECOPD, pilot RCT, immunoglobulin treatment, IVIG

Michail Sideris,1,* Marios Nicolaides,2,* Jade Jagiello,3 Kathrine S Rallis,2 Elif Emin,1 Efthymia Theodorou,2 John Gerrard Hanrahan,4 Rebecca Mallick,5 Funlayo Odejinmi,6 Nikolaos Lymperopoulos,7 Apostolos Papalois,8 George Tsoulfas9 1Women’s Health Research Unit, Queen Mary University of London, London, UK; 2Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; 3University College London Hospital, London, UK; 4Addenbrooke’s Hospital, Cambridge University Hospitals, Cambridge, UK; 5Princess Royal Hospital, Brighton and Sussex University Hospitals NHS Trust, Haywards Heath, UK; 6Whipps Cross University Hospital, Barts Health NHS Trust, London, UK; 7Guy’s and St Thomas Hospitals NHS Foundation Trust, London, UK; 8Special Unit for Biomedical Research and Education, Aristotle University of Thessaloniki, Thessaloniki, Greece; 9Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece*These authors contributed equally to this workCorrespondence: Michail SiderisWomen’s Health Research Unit, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UKEmail m.sideris@qmul.ac.ukAbstract: An increasing emphasis on simulation has become evident in the last three decades following fundamental shifts in the medical profession. Simulation-based learning (SBL) is a wide term that encompasses several means for imitating a skill, attitude, or procedure to train personnel in a safe and adaptive environment. A classic example has been the use of live animal tissue, named in vivo SBL. We aimed to review all published evidence on in vivo SBL for undergraduate medical students; this includes both teaching concepts as well as focused assessment of students on those concepts. We performed a systematic review of published evidence on MEDLINE. We also incorporated evidence from a series of systematic reviews (eviCORE) focused on undergraduate education which have been outputs from our dedicated research network (eMERG). In vivo SBL has been shown to be valuable at undergraduate level and should be considered as a potential educational tool. Strict adherence to 3R (Reduce, Refine, Replace) principles in order to reduce animal tissue usage, should always be the basis of any curriculum. In vivo SBL could potentially grant an extra mile towards medical students’ inspiration and aspiration to become safe surgeons; however, it should be optimised and supported by a well-designed curriculum which enhances learning via multi-level fidelity SBL.Keywords: in vivo simulation-based learning, medical simulation, surgical education

Prajna Jena1, Soumitra Mohanty1, Rojee Mallick1, Biju Jacob2, Avinash Sonawane11School of Biotechnology, KIIT University, Bhubaneswar, Orissa, India; 2Center for Innovation, Technopark Technology Business Incubator, Bangalore, Karnataka, IndiaBackground: Pathogenic bacteria are able to develop various strategies to counteract the bactericidal action of antibiotics. Silver nanoparticles (AgNPs) have emerged as a potential alternative to conventional antibiotics because of their potent antimicrobial properties. The purpose of this study was to synthesize chitosan-stabilized AgNPs (CS-AgNPs) and test for their cytotoxic, genotoxic, macrophage cell uptake, antibacterial, and antibiofilm activities.Methods: AgNPs were synthesized using chitosan as both a stabilizing and a reducing agent. Antibacterial activity was determined by colony-forming unit assay and scanning electron microscopy. Genotoxic and cytotoxic activity were determined by DNA fragmentation, comet, and MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] assays. Cellular uptake and intracellular antibacterial activity were tested on macrophages.Results: CS-AgNPs exhibited potent antibacterial activity against different human pathogens and also impeded bacterial biofilm formation. Scanning electron microscopy analysis indicated that CS-AgNPs kill bacteria by disrupting the cell membrane. CS-AgNPs showed no significant cytotoxic or DNA damage effect on macrophages at the bactericidal dose. Propidium iodide staining indicated active endocytosis of CS-AgNPs resulting in reduced intracellular bacterial survival in macrophages.Conclusion: The present study concludes that at a specific dose, chitosan-based AgNPs kill bacteria without harming the host cells, thus representing a potential template for the design of antibacterial agents to decrease bacterial colonization and to overcome the problem of drug resistance.Keywords: chitosan-silver nanoparticles, antibiofilm, cytotoxicity, genotoxicity

Geologic reconstructions of the Main Himalayan Thrust in Nepal show a laterally extensive midcrustal ramp, hypothesized to form the downdip boundary of interseismic locking. Using a recent compilation of interseismic GPS velocities and a simplified model of fault coupling, we estimate the width of coupling across Nepal using a series of two-dimensional transects. We find that the downdip width of fault coupling increases smoothly from 70 to 90 km in eastern Nepal to 100–110 km in central Nepal, then narrows again in western Nepal. The inferred coupling transition is closely aligned with geologic reconstructions of the base of the midcrustal ramp in central and eastern Nepal, but in western Nepal, the data suggest that the location is intermediate between two proposed ramp locations. The result for western Nepal implies either an anomalous coupling transition that occurs along a shallowly dipping portion of the fault or that both ramps may be partially coupled and that a proposed crustal-scale duplexing process may be active during the interseismic period. We also find that the models require a convergence rate of 15.5 ± 2 mm/year throughout Nepal, reducing the geodetic moment accumulation rate by up to 30% compared with earlier models, partially resolving an inferred discrepancy between geodetic and paleoseismic estimates of moment release across the Himalaya.

Purpose: The objective of this study is to determine primary survival endpoints in women with recurrent and metastatic endometrial carcinoma (RMEC) treated with progestins. Methods: A retrospective chart review was conducted at The Ottawa Hospital using electronic medical records. Inclusion criteria were a diagnosis of RMEC between 2000 and 2019, endometrioid histology, and ≥one line of progestin treatment. Progression‐free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method. Results: Of 2342 cases reviewed, 74 met inclusion criteria. Sixty‐six (88.0%) patients received megestrol acetate and 9 (12.0%) received a progestin alternative. The distribution of tumors by grade was: 1: 25 (33.3%), 2: 30 (40.0%), and 3: 20 (26.7%). The PFS and OS for the entire study sample was 14.3 months (95% CI 6.2–17.9) and 23.3 months (14.8–36.8), respectively. The PFS for patients with Grade 1–2 RMEC was 15.7 months (8.0, 19.5), compared to 5.0 months (3.0, 23.0) with Grade 3 disease. The OS for patients with Grade 1–2 versus Grade 3, was 25.9 months (15.3, 40.3) versus 12.5 months (5.7, 35.9), respectively. Thirty‐four (45.9%) and 40 (54.1%) patients were treated with 0 and ≥1 line of chemotherapy. The PFS for chemotherapy‐naïve patients was 17.9 months (14.3, 27.0), versus 6.2 months (3.9, 14.8) following ≥1 line of treatment. The OS was 29.1 months (17.9, 61.1) for chemotherapy‐naïve patients versus 23.0 months (10.5, 37.6) for patients previously exposed. Conclusions: This real‐world data on RMEC suggests there is a role for progestins in select subgroups of women. The PFS for chemotherapy‐naïve patients was 17.9 months (14.3, 27.0), versus 6.2 months (3.9, 14.8) following ≥1 line of treatment. The OS was 29.1 months (17.9, 61.1) for chemotherapy‐OS was 29.1 months (17.9, 61.1) for chemotherapy‐naïve patients versus 23.0 months (10.5, 37.6) for patients previously exposed. This real‐world data on recurrent and metastatic endometrial carcinoma (RMEC) suggests there is a role for progestins in select subgroups of women. The PFS for chemotherapy‐naïve patients was 17.9 months (14.3, 27.0), versus 6.2 months (3.9, 14.8) following>=1 line of treatment. The OS was 29.1 months (17.9, 61.1) for chemotherapy‐OS was 29.1 months (17.9, 61.1) for chemotherapy‐naïve patients versus 23.0 months (10.5, 37.6) for patients previously exposed. [ABSTRACT FROM AUTHOR]

Biopriming and integrated disease management have the potential to reduce the hazards associated with the increasing use of agrochemicals in agriculture. Field trials were therefore conducted during the two consecutive summer seasons of 2020 and 2021 at Agricultural Experimental Farm, Institute of Agricultural Science, University of Calcutta, West Bengal to evaluate the impact of biopriming and integrated disease management (IDM) practices on disease incidence in sesame as well as its productivity. The treatments consisted of three modules, viz., Bio-intensive (M1): Seed treatment with Trichoderma asperellum @10 g kg-1 + furrow application of enriched Trichoderma (2.5 kg Trichoderma asperellum + 100 kg vermicompost) @250 kg ha-1 + spray of Pseudomonas fluorescens @10 g L-1 at 30-35 DAS and wettable sulphur @2 g L-1 at 50-60 DAS; Chemical (M2): Seed treatment with carbendazim @2 g L-1 + spray of combi-product (Tebuconazole 50% + Trifloxystrobin 25%) @0.5 g L-1 at 30-35 DAS and second spray @2 g L-1 at 50-60 DAS; Adaptive (M3): Seed treatment with Trichoderma asperellum @10 g kg-1 + furrow application of enriched Trichoderma (2.5 kg Trichoderma asperellum + 100 kg vermicompost) @250 kg ha-1+ spray of combi-product (Tebuconazole 50% + Trifloxysrobin 25%) @0.5 g L-1 at 30-35 DAS and second spray at 50-60 DAS, and Control (M4): Untreated check. The results revealed that the adaptive module, M3, was highly effective and recorded significantly the lowest disease incidence of root rot (18.9%), severity of Alternaria (11.0%) and Cercospora leaf spots (7.0%) with highest seed yield of 0.59 t ha-1 and highest benefit:cost ratio of 2.13:1. This module can be used for the effective management of root rot and leaf spot diseases of sesame and ensuring sustained yields, particularly in the coastal agro-climatic condition of West Bengal. [ABSTRACT FROM AUTHOR]