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IntroductionAspiration represents the most potent method for exploring the potential occurrence of Periprosthetic Joint Infection (PJI). However, dry taps are common. While aspiration under ultrasound (US) guidance in the radiology department has become increasingly popular, hip aspiration is still routinely conducted in the operating room (OR) under x-ray guidance in numerous medical centers. When conducted within the confines of the OR, a dry tap aspiration not only subjects the patient to an unnecessary invasive procedure but also constitutes a substantial strain on OR time and resources. Our objective was to assess whether an outpatient US conducted before aspiration could reliably predict the likelihood of encountering a dry hip aspiration.MethodsIn a prospective study, we enrolled 50 hips who were suspected of PJI and slated for revision total hip arthroplasty and required hip aspiration. Before the aspiration procedure, we conducted an outpatient hip ultrasound (US) to assess the presence of fluid collection. Subsequently, all patients underwent aspiration under fluoroscopy in the OR, irrespective of the ultrasound findings We then assessed the level of agreement between the ultrasound results and the outcomes of hip aspiration.ResultsThe US exhibited a sensitivity of 95.7% (95% CI 69.8–91.8), a specificity of 74.1% (95% CI 52.8–91.8), a positive predictive value of 75.9% (95% CI 50.9–91.3), and a negative predictive value of 95.2% (95% CI 71.3-99.8) in predicting the success of aspiration.DiscussionPre-aspiration outpatient US demonstrates a high degree of accuracy in predicting dry taps in these patients. We recommend its incorporation into the hip aspiration procedure in medical centers where aspiration is performed in the operating room. In the broader context, these findings reinforce the preference for US-guided aspiration within the radiology department over x-ray-guided aspiration in the operating room since about ¼ of the positive USs for hip collection will lead to a dry tap if the aspiration is performed in the OR under fluoroscopy guidance.

Abstract Introduction Calcific tendinosis is a common condition caused by the deposition of hydroxyapatite crystals within the tendons that can impact any tendinous insertion. In this situation, ultrasound (US) may be a viable imaging modality in addition to radiography. Case presentation A 56-year-old Iranian male presented with left elbow pain. US evaluation at the lump site revealed a subcutaneous lipoma. Ultrasonography showed a thickened and diffusely heterogeneously hypoechoic pronator teres tendon. These characteristics were consistent with the diagnosis of calcific tendinosis. Discussion and conclusion Radiography is the most common and practical imaging modality for calcific tendinosis diagnosis. Despite this, the real-time nature of ultrasonography makes it both diagnostic and therapeutic in this condition. Other conditions, such as lipoma, may interfere with the proper diagnosis of calcific tendinosis.

Abstract Background Sagittal and coronal standing radiographs have been the standard imaging for assessing spinal alignment. However, their disadvantages include distortion at the image edges and low interobserver reliability in some parameters. EOS® is a low-dose biplanar digital radiographic imaging system that can avoid distortion by obtaining high-definition images. Methods This study aimed to evaluate spinopelvic parameters in conventional lateral C1S1 upright radiographs and EOS® images and compare them. Patients with non-deformity changes were subjected to routine clinical examinations. Plain AP and lateral X-ray radiographs were obtained along the entire spine length. Patients were also referred for full-length EOS® of the spine. Thoracic Kyphosis (TK), Lumbar Lordosis (LL), Pelvic Tilt (PT), Sacral Slope (SS), Pelvic Incidence (PI), and Sagittal Vertical Axis (SVA) were measured in the two studies by an orthopedic surgeon and a radiologist using PACS software. Also, the orthopedic surgeon evaluated the studies again after two weeks. Intra- and inter-observer reliability was then assessed using the interclass correlation coefficient (ICC). Also, the coefficient of variation was used to assess intra- and inter-observer reliability. Bland-Altman plots were drawn for each parameter. Results The mean age was 48.2 ± 6.6 years. Among the 50 patients, 30 (60%) were female. The mean ICC for TK, LL, PT, SS, PI, and SVA in EOS® images are 0.95, 0.95, 0.92, 0.90, 0.94, and 0.98, respectively, and in C1S1 radiography images, it was 0.92, 0.87, 0.94, 0.88, 0.93, and 0.98, respectively which shows good to excellent results. The coefficient of variation for intraobserver reliability was relatively low (

Background: Ketamine has emerged as one of the most promising therapies for treatment-resistant depression. However, inter-individual variability in response to ketamine is still not well understood and it is unclear how ketamine’s molecular mechanisms connect to its neural and behavioral effects. Methods: We conducted a single-blind placebo-controlled study, with participants blinded to their treatment condition. 40 healthy participants received acute ketamine (initial bolus 0.23 mg/kg, continuous infusion 0.58 mg/kg/hr). We quantified resting-state functional connectivity via data-driven global brain connectivity and related it to individual ketamine-induced symptom variation and cortical gene expression targets. Results: We found that: (i) both the neural and behavioral effects of acute ketamine are multi-dimensional, reflecting robust inter-individual variability; (ii) ketamine’s data-driven principal neural gradient effect matched somatostatin (SST) and parvalbumin (PVALB) cortical gene expression patterns in humans, while the mean effect did not; and (iii) behavioral data-driven individual symptom variation mapped onto distinct neural gradients of ketamine, which were resolvable at the single-subject level. Conclusions: These results highlight the importance of considering individual behavioral and neural variation in response to ketamine. They also have implications for the development of individually precise pharmacological biomarkers for treatment selection in psychiatry. Funding: This study was supported by NIH grants DP5OD012109-01 (A.A.), 1U01MH121766 (A.A.), R01MH112746 (J.D.M.), 5R01MH112189 (A.A.), 5R01MH108590 (A.A.), NIAAA grant 2P50AA012870-11 (A.A.); NSF NeuroNex grant 2015276 (J.D.M.); Brain and Behavior Research Foundation Young Investigator Award (A.A.); SFARI Pilot Award (J.D.M., A.A.); Heffter Research Institute (Grant No. 1–190420) (FXV, KHP); Swiss Neuromatrix Foundation (Grant No. 2016–0111) (FXV, KHP); Swiss National Science Foundation under the framework of Neuron Cofund (Grant No. 01EW1908) (KHP); Usona Institute (2015 – 2056) (FXV). Clinical trial number: NCT03842800

There is a growing appreciation for the role of the thalamus in high-level cognition. Motivated by findings that internal cognitive state drives activity in feedback layers of primary visual cortex (V1) that target the lateral geniculate nucleus (LGN), we investigated the role of LGN in working memory (WM). Specifically, we leveraged model-based neuroimaging approaches to test the hypothesis that human LGN encodes information about spatial locations temporarily encoded in WM. First, we localized and derived a detailed topographic organization in LGN that accords well with previous findings in humans and non-human primates. Next, we used models constructed on the spatial preferences of LGN populations in order to reconstruct spatial locations stored in WM as subjects performed modified memory-guided saccade tasks. We found that population LGN activity faithfully encoded the spatial locations held in memory in all subjects. Importantly, our tasks and models allowed us to dissociate the locations of retinal stimulation and the motor metrics of memory-guided saccades from the maintained spatial locations, thus confirming that human LGN represents true WM information. These findings add LGN to the growing list of subcortical regions involved in WM, and suggest a key pathway by which memories may influence incoming processing at the earliest levels of the visual hierarchy.

The relative roles of visual, parietal, and frontal cortex in working memory have been actively debated. Here, the authors show that distraction impacts visual working memory representations in primary visual areas, indicating that these regions play a key role in the maintenance of working memory.

Introduction: Survival rate in brain tumors have not been reported in Iran. The purpose of this study, given the lack of such information, has set to evaluate 3 years survival rate in patients with all kinds of glioma tumors who had been admitted and already diagnosed with one type of glioma tumor, in department of neurosurgery, Al-Zahra hospital, Isfahan, Iran over period of 2001-2010. Methods: This study was descriptive and retrospective, including 222 patients who had been admitted to the department of neurosurgery, already diagnosed with one type of glioma tumor. All patients (for minors, their parents) were contacted and explained whole structure of the study and its objectives and consented (according to regulations of the Ethics committee and declaration of Helsinki) if they desired to participate in the study; also, they were asked about 3 years survival rate following their tumor resection surgery. Data such as patient age at time of admission, gender, histological diagnosis of tumor and treatment regimen (surgical/non-surgical, radiation, chemotherapy) were collected from patients’ medical record. 3 years survival rate and frequency of each tumor based upon age and gender, were measured. Patients with Diffuse Astrocytoma, Oligodendroglioma, Ependymoma and Pilocytic Astrocytoma had been treated with surgery and radiation. Patients with Glioblastoma Multiform (GBM) and Anaplastic Astrocytoma had been treated with surgery plus chemo-radiation. Results: 3 years survival rate in this study for GBM and Anaplastic Astrocytoma were 8.7% and 0% respectively. These tumors are categorized as high-grade glioma with poor prognosis. On the other hand, 3 years survival rate for Diffuse Astrocytoma, Oligodendroglioma, Ependymoma and Pilocytic Astrocytoma were 100%, 95.2%, 100% and 100% respectively. These tumors are considered as low-grade glioma which have good prognosis. Conclusion: In this study, 3 years survival rate in patients with low-grade glioma following surgery and radiation was almost 100%. In contrast, 3 years survival rate in patients with high-grade glioma following surgery plus chem-radiation was almost 0%.

While interest toward caloric restriction (CR) in various models of brain injury has increased in recent decades, studies have predominantly focused on the benefits of chronic or intermittent CR. The effects of ultra-short, including overnight, CR on acute ischemic brain injury are not well studied. Here, we show that overnight caloric restriction (75% over 14 h) prior to asphyxial cardiac arrest and resuscitation (CA) improves survival and neurological recovery as measured by, behavioral testing on neurological deficit scores, faster recovery of quantitative electroencephalography (EEG) burst suppression ratio, and complete prevention of neurodegeneration in multiple regions of the brain. We also show that overnight CR normalizes stress-induced hyperglycemia, while significantly decreasing insulin and glucagon production and increasing corticosterone and ketone body production. The benefits seen with ultra-short CR appear independent of Sirtuin 1 (SIRT-1) and brain-derived neurotrophic factor (BDNF) expression, which have been strongly linked to neuroprotective benefits seen in chronic CR. Mechanisms underlying neuroprotective effects remain to be defined, and may reveal targets for providing protection pre-CA or therapeutic interventions post-CA. These findings are also of high importance to basic sciences research as we demonstrate that minor, often-overlooked alterations to pre-experimental dietary procedures can significantly affect results, and by extension, research homogeneity and reproducibility, especially in acute ischemic brain injury models.

Land-use dynamic is a major challenge for town and country planners especially in developing countries such as Iran. Iran has been under rapid urban expansion and population growth for past three decades which led to lack of resources, environmental deterioration and haphazard landscape development. In this paper, an attempt has been made to map the urbanization dynamics of Tehran in 40 years based on remote sensing imagery and by means of artificial neural networks. The presented scheme could be taken into consideration when planning initiatives aimed at surveying, monitoring, managing and sustainable development of the territory. Moreover, it can serve the experts in the fields of geography, urban studies and planning as a background for number of geographical analyses.

The dynamic nature of the price information transfer when stock and futures markets switch between different price trading phases is examined. This is undertaken by decomposing Australian stock indexes and share price index futures contract data into bear– and bull–market phases and analyzing the change in the power of the bidirectional information feedback between the futures market and small, medium, and large stocks. Results support the hypothesis that the nature of the price–discovery process varies with the trading phase. In particular, during the bull phase small stocks show a marked increase in price exogeneity and futures prices contain relatively less price–sensitive fundamental information. We argue that in bull phases, futures trading becomes increasingly associated with noninformation trading such as realizing paper profits, portfolio rebalancing, and increased noise trading. [ABSTRACT FROM AUTHOR]

مقدمه: گلیوما یکی از انواع تومورهای مغزی است که در مغز و نخاع ایجاد می‌شود. این تومورها از سلول‌های گلیال منشأ می‌گیرند. بر اساس پاتولوژی به دو دسته‌ی Low grade و High grade (Anaplastic یا Malignant) تقسیم می‌شوند. فراوانی، میزان بقا و همچنین پاسخ به درمان در این تومورها به سن و جنس وابسته است. در این تومورها میزان بقا از چند ماه تا چند سال متفاوت است. مطالعه‌ی حاضر، با هدف بررسی میزان بقای 3 ساله در بیماران مبتلا به انواع تومورهای گلیوما، بستری در بیمارستان الزهرای (س) اصفهان در سال‌های 89-1380 انجام شد. روش‌ها: در مطالعه‌ی حاضر، جامعه‌ی هدف از افراد مبتلا به انواع تومورهای گلیومای (ثابت شده) که تحت عمل جراحی برداشت تومور قرار گرفتند، تشکیل شد. حجم جامعه، تمام افراد مبتلا به انواع تومورهای گلیوما که در سال‌های 89-1380 در بیمارستان الزهرای (س) اصفهان عمل جراحی شدند، تعیین گردید. تعداد کل بیماران 490 نفر و معیارهای ورود به مطالعه شامل تمایل بیماران به شرکت در مطالعه، درست بودن اطلاعات پایه‌ای موجود در مدارک بایگانی بیماران و همچنین عدم فوت بیماران در بیمارستان قبل از عمل جراحی، در حین عمل و یا در دوره‌ی بهبودی پس از عمل بود. بر این اساس، تنها 221 نفر واجد شرایط ورود به مطالعه بودند. با استفاده‌ از لیست بیماران، اطلاعاتی نظیر نام و نام خانوادگی، سن، جنس، نوع تومور، نوع درمان و شماره‌ی تلفن بیماران استخراج و طی تماس با آنان، پرسش‌نامه‌ها تکمیل گردید. برای واکاوی داده‌ها از نرم‌افزار Microsoft Excel استفاده گردید؛ به گونه‌ای که داده‌های آن تعداد افراد مبتلا به هر یک از انواع تومورها، سن، جنس بیماران و در نهایت میزان بقای 3 ساله‌ی حاصل از هر تومور بود. یافته‌ها: بقای 3 ساله در مورد Glioblastoma multiform (GBM) 7/8 درصد، در مورد Diffuse astrocytoma، Pilocytic astrocytoma و Epondymoma 100 درصد، در مورد Oligodandroglioma 2/95 درصد و در مورد Anaplastic astrocytoma برابر صفر بود. نتیجه‌گیری: در این مطالعه، جراحی به اضافه‌ی پرتودرمانی در Diffuse astrocytoma، Epondymoma و Oligodandroglioma و جراحی در Pilocytic astrocytoma، به عنوان درمان اولیه، بقای 3 ساله را افزایش داده است. در Glioblastoma multiform و Anaplastic astrocytoma، جراحی به اضافه‌ی پرتودرمانی با یا بدون شیمی‌‌درمانی به میزان مختصر در افزایش میزان بقا نقش داشته است.

Lake Urmia, the second largest saline Lake on earth and a highly endangered ecosystem, is on the brink of a serious environmental disaster similar to the catastrophic death of the Aral Sea. Progressive drying has been observed during the last decade, causing dramatic changes to Lake Urmia’s surface and its regional water supplies. The present study aims to improve monitoring of spatiotemporal changes of Lake Urmia in the period 1975–2015 using the multi-temporal satellite altimetry and Landsat (5-TM, 7-ETM+ and 8-OLI) images. In order to demonstrate the impacts of climate change and human pressure on the variations in surface extent and water level, Lake Sevan and Van Lake with different characteristics were studied along with the Urmia Lake. Normalized Difference Water Index-Principal Components Index (NDWI-PCs), Normalized Difference Water Index (NDWI), Modified NDWI (MNDWI), Normalized Difference Moisture Index (NDMI), Water Ratio Index (WRI), Normalized Difference Vegetation Index (NDVI), Automated Water Extraction Index (AWEI), and MultiLayer Perceptron Neural Networks (MLP NNs) classifier were investigated for the extraction of surface water from Landsat data. The presented results revealed that MLP NNs has a better performance in the cases where the other models generate poor accuracy. The results show that the area of Lake Sevan and Van Lake have increased while the area of Lake Urmia has decreased by ~65.23% in the past decades, far more than previously reported (~25% to 50%). Urmia Lake’s shoreline has been receding severely between 2010 and 2015 with no sign of recovery, which has been partly blamed on prolonged droughts, aggressive regional water resources development plans, intensive agricultural activities, and anthropogenic changes to the system. The results also indicated that (among the proposed factors) changes in inflows due to overuse of surface water resources and constructing dams (mostly during 1995–2005) are the main reasons for Urmia Lake’s shoreline receding. The model presented in this manuscript can be used by managers as a decision support system to find the effects of building new dams or other infrastructures.

Background: Preoperative cardiac risk assessment is an integral part of preoperative evaluation; however, there is significant variation among providers, leading to inappropriate referrals for cardiology consultation or excessive low-value cardiac testing. We implemented a novel electronic medical record (EMR) form in our preoperative clinics to decrease variation., Objective: This study aimed to investigate the impact of the EMR form on the preoperative utilization of cardiology consultation and cardiac diagnostic testing (echocardiograms, stress tests, and cardiac catheterization) and evaluate postoperative outcomes., Methods: A retrospective cohort study was conducted. Patients who underwent outpatient preoperative evaluation prior to an elective surgery over 2 years were divided into 2 cohorts: from July 1, 2021, to June 30, 2022 (pre-EMR form implementation), and from July 1, 2022, to June 30, 2023 (post-EMR form implementation). Demographics, comorbidities, resource utilization, and surgical characteristics were analyzed. Propensity score matching was used to adjust for differences between the 2 cohorts. The primary outcomes were the utilization of preoperative cardiology consultation, cardiac testing, and 30-day postoperative major adverse cardiac events (MACE)., Results: A total of 25,484 patients met the inclusion criteria. Propensity score matching yielded 11,645 well-matched pairs. The post-EMR form, matched cohort had lower cardiology consultation (pre-EMR form: n=2698, 23.2% vs post-EMR form: n=2088, 17.9%; P<.001) and echocardiogram (pre-EMR form: n=808, 6.9% vs post-EMR form: n=591, 5.1%; P<.001) utilization. There were no significant differences in the 30-day postoperative outcomes, including MACE (all P>.05). While patients with "possible indications" for cardiology consultation had higher MACE rates, the consultations did not reduce MACE risk. Most algorithm end points, except for active cardiac conditions, had MACE rates <1%., Conclusions: In this cohort study, preoperative cardiac risk assessment using a novel EMR form was associated with a significant decrease in cardiology consultation and testing utilization, with no adverse impact on postoperative outcomes. Adopting this approach may assist perioperative medicine clinicians and anesthesiologists in efficiently decreasing unnecessary preoperative resource utilization without compromising patient safety or quality of care., (©Mandeep Kumar, Kathryn Wilkinson, Ya-Huei Li, Rohit Masih, Mehak Gandhi, Haleh Saadat, Julie Culmone. Originally published in JMIR Perioperative Medicine (http://periop.jmir.org), 13.09.2024.)

There is inadequate evidence regarding the role of percutaneous coronary intervention (PCI) in patients who underwent transcatheter aortic valve replacement (TAVR). The current American Heart Association/American College of Cardiology guidelines are limited to class 2A recommendations for pre-TAVR revascularization in the setting of hemodynamically significant left main (LM), proximal left anterior descending (pLAD), or extensive bifurcation disease regardless of angina status. We performed a multicenter, retrospective, observational study assessing the benefit of PCI in patients with coronary artery disease who underwent transfemoral TAVR for severe symptomatic aortic stenosis. Patients were divided into 2 cohorts: (1) patients who did not undergo pre-TAVR PCI within the preceding 12 months (no-PCI group) and (2) patients who received pre-TAVR PCI within the preceding 12 months (PCI group). The primary outcome was defined as the composite end point of in-hospital and 30-day adverse events, including all-cause mortality, cardiac arrest, and myocardial infarction. Subgroup analyses were performed on patients with LM and/or pLAD disease and other high-risk features, including angina and heart failure. Comparisons were made between 1,809 consecutive patients (1,364 in the no-PCI group and 445 in the PCI group). There were no differences between the 2 cohorts regarding the primary composite outcome (2.0% vs 2.8%, p = 0.918) or individual secondary outcomes. Although LM/pLAD disease, New York Heart Association classes III to IV, and Society of Thoracic Surgeons risk score ≥8 were all independent predictors of the primary outcome, none of the subgroups demonstrated a benefit favoring PCI. In conclusion, there is no observed benefit from PCI within 12 months pre-TAVR in patients with severe aortic stenosis and concomitant coronary artery disease, including patients with LM/pLAD disease., Competing Interests: Declaration of Competing Interest The authors have no competing interests to declare., (Copyright © 2023. Published by Elsevier Inc.)

Background: There have been limited reports with inconsistent results on the impact of long-term use of oxygen therapry (LTOT) in patients treated with transcatheter aortic valve replacement (TAVR)., Methods: We compared in-hospital and intermediate TAVR outcomes in 150 patients requiring LTOT (home O 2 cohort) with 2,313 non-home O 2 patients., Results: Home O 2 patients were younger, and had more comorbidities including chronic obstructive pulmonary disease (COPD), diabetes, carotid artery disease, lower forced expiratory volume (FEV 1 ) (50.3±21.1% vs. 75.0±24.7%, P < 0.001), and lower diffusion capacity (DLCO, 48.6±19.2% vs. 74.6±22.4%, P < 0.001). These differences represented higher baseline Society of Thoracic Surgeons (STS) risk score (15.5±10.2% vs. 9.3±7.0%, P < 0.001) and lower pre-procedure Kansas City Cardiomyopathy Questionnaire (KCCQ-12) scores (32.5 ± 22.2 vs. 49.1 ± 25.4, P < 0.001). The home O 2 cohort required higher use of alternative TAVR vascular access (24.0% vs. 12.8%, P = 0.002) and general anesthesia (51.3% vs. 36.0%, P < 0.001). Compared to non-home O 2 patients, home O 2 patients showed increased in-hospital mortality (5.3% vs. 1.6%, P = 0.001), procedural cardiac arrest (4.7% vs. 1.0%, P < 0.001), and postoperative atrial fibrillation (4.0% vs. 1.5%, P = 0.013). At 1-year follow-up, the home O 2 cohort had a higher all-cause mortality (17.3% vs. 7.5%, P < 0.001) and lower KCCQ-12 scores (69.5 ± 23.8 vs. 82.1 ± 19.4, P < 0.001). Kaplan-Meir analysis revealed a lower survival rate in the home O 2 cohort with an overall mean (95% confidence interval (CI)) survival time of 6.2 (5.9 - 6.5) years (P < 0.001)., Conclusion: Home O 2 patients represent a high-risk TAVR cohort with increased in-hospital morbidity and mortality, less improvement in 1-year KCCQ-12, and increased mortality at intermediate follow-up., Competing Interests: None to declare., (Copyright 2023, Patail et al.)

The objective of this work was to study kinetics of thermal degradation of curcumin in ambient-1023 K range and identify degradation products by GC-MS. No weight loss was observed up to ∼470 K and two major weight losses occurred beyond this. Sixteen degradation products were identified by GC-MS. Pharmacological properties, including LD 50 , LC 50 , gastrointestinal absorption, blood-brain barrier permeation and effect on cytochromes, of the products were calculated using standard software. The LD 50 values indicated that the degradation products are more toxic than curcumin. All the decomposition products, except 2-methyl-6-(4-methylphenyl)-hept-2-en-4-one, have the potential to cross the blood-brain barrier that can affect brain functions. Twelve of the compounds showed the potential to inhibit the metabolism of xenobiotics and all the compounds appeared to be non-inhibitors of CYP2C9 and CYP3A4 in contrast to curcumin. Thus, this study suggests that the food materials containing curcumin when heated beyond 470 K will produce toxic substances., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Neurocognitive impairment remains a common complication of human immunodeficiency virus (HIV) despite effective antiretroviral therapy (ART). We previously reported improved neurocognitive functioning with ART initiation in 7 resource-limited countries for HIV+ participants from the AIDS Clinical Trials Group (ACTG) 5199 International Neurological Study (INS). Here, we apply normative data from the International Neurocognitive Normative Study (INNS) to INS to provide previously unknown rates of neurocognitive impairment., Methods: The A5199 INS assessed neurocognitive and neurological performance within a randomized clinical trial with 3 arms containing World Health Organization first-line recommended ART regimens (ACTG 5175; PEARLS). The ACTG 5271 INNS collected normative comparison data on 2400 high-risk HIV-negative participants from 10 voluntary counseling and testing sites aligned with INS. Normative comparison data were used to create impairment ratings for HIV+ participants in INS; associations were estimated using generalized estimating equations., Results: Among 860 HIV+ adults enrolled in ACTG 5199, 55% had no neurocognitive impairment at baseline. Mild neurocognitive impairment was found in 25%, moderate in 17%, and severe in 3% of participants. With the initiation of ART, the estimated odds of impairment were reduced 12% (95% confidence interval, 9%, 14%) for every 24 weeks (P < .0001) on ART. Mild impairment dropped slightly and then remained at about 18% out to week 168., Conclusions: Almost half of HIV+ participants had neurocognitive impairment at baseline before ART, based on local norms. With ART initiation, there were significant overall reductions in neurocognitive impairment over time, especially in those with moderate and severe impairments., Clinical Trials Registration: NCT00096824., (© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Background: AIDS Clinical Trial Group 5199 compared neurological and neuropsychological test performance of human immunodeficiency virus type 1 (HIV-1)-infected participants in resource-limited settings treated with 3 World Health Organization-recommended antiretroviral (ART) regimens. We investigated the impact of tuberculosis (TB) on neurological and neuropsychological outcomes., Methods: Standardized neurological and neuropsychological examinations were administered every 24 weeks. Generalized estimating equation models assessed the association between TB and neurological/neuropsychological performance., Results: Characteristics of the 860 participants at baseline were as follows: 53% female, 49% African; median age, 34 years; CD4 count, 173 cells/μL; and plasma HIV-1 RNA, 5.0 log copies/mL. At baseline, there were 36 cases of pulmonary, 9 cases of extrapulmonary, and 1 case of central nervous system (CNS) TB. Over the 192 weeks of follow-up, there were 55 observations of pulmonary TB in 52 persons, 26 observations of extrapulmonary TB in 25 persons, and 3 observations of CNS TB in 2 persons. Prevalence of TB decreased with ART initiation and follow-up. Those with TB coinfection had significantly poorer performance on grooved pegboard (P < .001) and fingertapping nondominant hand (P < .01). TB was associated with diffuse CNS disease (P < .05). Furthermore, those with TB had 9.27 times (P < .001) higher odds of reporting decreased quality of life, and had 8.02 times (P = .0005) higher odds of loss of productivity., Conclusions: TB coinfection was associated with poorer neuropsychological functioning, particularly the fine motor skills, and had a substantial impact on functional ability and quality of life., Clinical Trials Registration: NCT00096824., (© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Objectives: People living with HIV have increased Human Papillomavirus (HPV) related lesions and malignancies. We describe HPV DNA recovered from the cervix and anal canal, explore the effect of vaccination on HPV detection, and examine the durability of vaccine titers in women living with HIV-1 who were vaccinated with the quadrivalent HPV vaccine., Methods: AIDS Clinical Trials Group A5240 was a prospective study of the quadrivalent HPV (qHPV) vaccine in 315 HIV-1 infected women in three CD4 strata (A: >350, B; 201-350, C: ≤200 cells/mm 3 ). Vaccine was administered at entry, week 8 and week 24. Cervical and anal HPV DNA specimens were collected at baseline, weeks 28 and 52; serum for antibody testing was obtained at baseline, weeks 28 and 72., Results: Vaccine antibody titers decreased across all four HPV types at week 72 compared to week 28. Lower proportions of sustained seropositivity were observed in women with lower CD4 counts for all four vaccine types, with the lowest titers for HPV 18. Despite the decrease, the geometric mean titer levels were above the seroconversion cut-off levels for all types except HPV 18 in the lowest CD4 stratum. Of the 174 participants who had a negative baseline HPV 16 antibody and developed antibody response at week 28, 95%, 88%, and 86% retained seropositivity at week 72 in strata A, B, and C respectively. Lower antibody retention was observed in women with CD4 < 200 compared to CD4 > 350 (p = 0.016). Anal HPV detection was more prevalent compared to cervical detection at all visits. Among high risk types, type 52, 31, 16, 18 and 51 were the most common in the cervical compartment, while types 16, 35, 18, and 51 were the most prevalent in the anal canal at baseline (listed in the order of prevalence). Later detection of HPV not present at baseline was uncommon in either compartment. Serial recovery of HPV over time was more commonly observed in the anal canal., Conclusion: The qHPV vaccine elicits durable titer response above the seroconversion cut-off levels in HIV-infected women. However, the titer levels were substantially lower by Week 72, most noticeably in type 18. HPV DNA was detected more frequently in the anal canal. Detection of non-vaccine high risk HPV suggests a role for the nonavalent vaccine., (Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: To review the procedural safety and postimplantation complications of Watchman device implanted at 2 community hospitals for primary prevention of systemic embolization in patients with nonvalvular atrial fibrillation (NVAF) who were not candidates for long-term oral anticoagulation (OAC)., Methods: This was a retrospective case series of 48 patients carried out in 2 community hospitals in the United States. Patients with NVAF who had a CHADS2 higher than 2 or CHADS2VASc2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack [TIA] or thromboembolism, vascular disease, age 65-74 years, and female gender) score of 3 or higher and were not candidates for long-term OAC. These patients were selected for implantation of Watchman device. They were followed up at 45 days, 6 months, 9 months, and 12 months after implantation of Watchman device to assess for complications involving the device and to determine if anticoagulation could be discontinued at the 45 days follow-up. They were monitored for any systemic thromboembolism while off anticoagulation., Results: The success rate of device implantation was 98% (48 of 49). Only a single patient could not get Watchman implantation because of unfavorable left atrial appendage anatomy. Access-related and device implantation-related complications were zero (0%). At 45 days follow-up and end of follow-up duration, the rate of thrombus formation on the Watchman device was 4% (2 of 48). One patient had TIA after warfarin discontinuation., Conclusion: With improved procedural technique and well-trained operators, Watchman implantation is feasible in a community hospital also., (Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Carissa opaca is a shrub known for its variety of medicinal applications. This study reports isolation and identification of four chemical compounds from its roots for the first time. The methanolic extract of the roots was fractionated into various solvents with increasing polarity. Chloroform fraction was subjected to column and thin layer chromatography to ultimately yield 2H-cyclopropanaphthalene-2-one, 7-hydroxy-6-methoxy-2H-1-benzopyran-2-one, 3-(4-methoxyphenyl)-2,6-dimethylbenzofuran and 5(1H)-azulenone, 2,4,6,7,8,8a-hexahydro-3,8-dimethyl-4-(1-methylethylidene)-,(8S-cis). They were identified by GC-MS analysis. The compounds exhibited considerable antimicrobial activities against Bacillus subtilis, Escherichia coli, Pseudomonas aeruginosa, Candida albicans and Aspergillus niger with zones of inhibition ranging from 10 to 13 mm as compared to the standard drug amoxicillin with zones of inhibition 13-17 mm under the similar conditions. In conclusion, the roots of C. opaca can provide new leads for future antimicrobial drugs.

Isoconversional thermal analysis of some important polysaccharides from functional foods is reported. Various thermal parameters including apparent activation energy (Ea), pre-exponential factor (A) were worked out, and the fitness of data to different models describing the degradation kinetics of polysaccharides was studied. The polysaccharides from Mimosa pudica (MP), Plantago ovata (PO), Argyreia speciosa (AS), Acacia nilotica (AN), P. ovata husk (HK) and Acacia modesta (AM) exhibited multistep degradation while those from Astragalus gummifer (AG), Salvia aegyptiaca (SA) and Ocimum basicilicum (OB) degraded mainly in single step. Generally, the degradation was exothermal. The average Ea values as determined by Flynn-Wall-Ozawa method were found to be in the range 132-187 kJ mol(-1). The mean comprehensive index of thermal stability (ITS) fell in the range 0.33-0.43. All the materials under investigation except those from SA and AS appear to be as stable as some of the important commercial materials used as pharmaceutical ingredients. Model-fitting analysis revealed that the major degradation step follows first-order kinetics., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

This work aims at study of thermal degradation kinetics and mechanism of pentose- and hexose-based carbohydrate polymers isolated from Plantago ovata (PO), Salvia aegyptiaca (SA) and Ocimum basilicum (OB). The analysis was performed by isoconversional method. The materials exhibited mainly two-stage degradation. The weight loss at ambient-115°C characterized by low activation energy corresponds to loss of moisture. The kinetic triplets consisting of E, A and g(α) model of the materials were determined. The major degradation stage represents a loss of high boiling volatile components. This stage is exothermic in nature. Above 340°C complete degradation takes place leaving a residue of 10-15%. The master plots of g(α) function clearly differentiated the degradation mechanism of hexose-based OB and SA polymers and pentose-based PO polymer. The pentose-based carbohydrate polymer showed D(4) type and the hexose-based polymers showed A(4) type degradation mechanism., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Little is known about how the prevalence and incidence of neurological disease in HIV-infected patients in resource-limited settings. We present an analysis of neurological and neurocognitive function in antiretroviral naïve individuals in multinational resource-limited settings. This prospective multinational cohort study, a substudy of a large international randomized antiretroviral treatment trial, was conducted in seven low- and middle-income countries in sub-Saharan Africa, South America, and Asia. Subjects were HIV-infected and met regional criteria to initiate antiretroviral therapy. Standardized neurological examination and a brief motor-based neuropsychological examination were administered. A total of 860 subjects were studied. Overall 249 (29%) had one or more abnormalities on neurological examinations, but there was a low prevalence of HIV-associated dementia (HAD) and minor neurocognitive disorder (MND). Twenty percent of subjects had evidence of peripheral neuropathy. There were significant differences across countries (p < 0.001) in neuropsychological test performance. In this first multinational study of neurological function in antiretroviral naïve individuals in resource-limited settings, there was a substantial prevalence of peripheral neuropathy and low prevalence of dementia and other CNS diseases. There was significant variation in neurocognitive test performance and neurological examination findings across countries. These may reflect cultural differences, differences in HIV-related and unrelated diseases, and variations in test administration across sites. Longitudinal follow-up after antiretroviral treatment initiation may help to define more broadly the role of HIV in these differences as well as the impact of treatment on performance.

Targeting canarypox (CP)-HIV vaccine to dendritic cells (DCs) elicits anti-HIV-1 immune responses in vitro. We conducted a phase I/II clinical trial to evaluate whether adding DC to a CP-HIV vaccine improved virologic control during analytic treatment interruption (ATI) in HIV-1-infected subjects. Twenty-nine subjects on suppressive antiretroviral therapy were randomized to vaccination with autologous DCs infected with CP-HIV+keyhole limpet hemocyanin (KLH) (arm A, n=14) or CP-HIV+KLH alone (arm B, n=15). The mean viral load (VL) setpoint during ATI did not differ between subjects in arms A and B. A higher percentage of subjects in the DC group had a VL setpoint < 5,000 c/mL during ATI (4/13 or 31% in arm A compared with 0/13 in arm B, p=0.096), but virologic control was transient. Subjects in arm A had a greater increase in KLH lymphoproliferative response than subjects in arm B; however, summed ELISPOT responses to HIV-1 antigens did not differ by treatment arm. We conclude that a DC-CP-HIV vaccine is well-tolerated in HIV-1-infected patients, but does not lower VL setpoint during ATI compared with CP-HIV alone. New methods to enhance the immunogenicity and antiviral efficacy of DC-based vaccines for HIV-1 infection are needed.

Prolongation of pancreas allograft survival has been difficult to achieve in rodent models despite use of immunosuppression regimens that successfully increase graft survival of other organs. The purpose of this study was to evaluate a new immunosuppressive agent, mycophenolate mofetil (MM), for its ability to prevent rejection in a rat pancreas transplant model. In addition, using congenic strains of rats, the efficacy of MM in rat pancreas transplantation was treated in the context of isolated class I or class II major histocompatibility (MHC) differences. MM in doses of 12.5 to 37 mg/kg significantly prolonged BUF to LEW heart transplant survival beyond a 14-day course of therapy thereby demonstrating its immunosuppressive efficacy. In similar pancreas transplant experiments, however, most grafts were rejected during the period of MM administration. Combination therapy with MM and cyclosporine did not extend pancreas survival beyond that achieved with MM alone (Mean Survival Time of 13.8 +/- 2.7 vs 11.7 +/- 1.6 days, respectively). Conversely, combined therapy with MM and antilymphocyte serum achieved a mean survival for BUF to LEW pancreas transplants of 52.3 +/- 24.8 days, which was significantly longer than that observed for either MM (11.7 +/- 1.6) or ALS (18.0 +/- 7.6) alone. MM therapy doubled pancreas allograft survival when used in the face of class I MHC disparity and compared to controls (19.5 +/- 1.0 vs 10.0 +/- 1.9 days) but did not prolong grafts that were disparate at only the class II locus (12.6 +/- 1.5 vs 12.0 +/- 1.2 days, respectively, for MM vs control). These data indicate that MM may not be an effective single agent immunosuppressive for pancreas transplantation except when MHC disparity is limited to the class I locus.

Background: Prostaglandin E1 (PGE1), a vasodilating prostaglandin, has been shown to protect against renal ischemic-reperfusion injury in acute experiments. The purpose of this study was to determine whether or not delayed administration of PGE1 would also be effective, as it has been suggested to be, in ischemic hepatic injury., Study Design: In a chronic model, rats underwent 60 minutes of total renal ischemia followed by either NaCl or PGE1 therapy delivered at either time 0, 30, or 60 minutes after reperfusion. Serum creatinine and renal histology were evaluated for seven days. In an isolated perfused kidney model, kidneys were similarly treated but were removed and perfused in order to measure renal vascular resistance (VR)., Results: Prostaglandin E1 administration at time 0 resulted in lower creatinine values when compared with controls at both day 2 (2.1 +/- 0.4 compared with 4.2 +/- 0.9 mg/dL) and day 7 (0.9 +/- 0.1 compared with 2.3 +/- 0.8 mg/dL). Conversely, no improvement was observed when PGE1 was delayed for either 30 or 60 minutes. Renal morphology at seven days was essentially intact in PGE1-treated rats (time 0) whereas changes characteristic of acute tubular necrosis were observed in control kidneys. Ischemia caused a twofold increase in VR compared with nonischemic controls (6.18 +/- 1.12 compared with 3.45 +/- 0.66 mm Hg/mL/min/g at 20 minutes of perfusion). Prostaglandin E1-treated kidneys (time 0) had a VR that was unchanged from that calculated for nonischemic controls (3.28 +/- 0.63 compared with 3.45 +/- 0.66 mm Hg/mL/min/g at 20 minutes)., Conclusions: These data demonstrate that after total renal ischemia, PGE1 administration at reperfusion ameliorates the expected injury, whereas delayed treatment is ineffective. Decreased vascular resistance may be responsible for this protective effect.