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Background: Despite improving understanding of trauma-induced coagulopathy (TIC), mortality and morbidity due to exsanguinating trauma remain high. Increased complications due to hemorrhage have been reported in blood group O, possibly due to reduced levels of von Willebrand factor (vWF)., Methods: An urban level 1 adult trauma center registry was retrospectively queried. Patients receiving ≥6 units of pRBC within 4 ​h of presentation were included. Patient demographics, admission labs and outcomes were obtained. Univariate and multiple logistic regression analyses were performed., Results: 562 patients were identified. There were no significant differences in demographics, admission labs, or outcome between different ABO groups. After adjustment, Type A patients were more likely to be hypocoagulable compared to Type O patients (p ​= ​0.014). No mortality differences were seen between ABO types in multiple regression analysis., Conclusions: No outcome or mortality differences were seen between ABO types, therefore factors other than vWF expression should be considered to explain coagulopathy in trauma patients., Competing Interests: Declaration of competing interest This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors have no conflicts of interest to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Context: The prevalence of early childhood caries (ECC) is widespread, as reported in studies conducted in various states across India. Many children residing in the rural areas attend Anganwadi centers for preprimary education, nourishment, and health care., Aim: The aim of the study was to determine the prevalence of ECC among children attending Anganwadi centers in the state of Goa and their treatment needs., Settings and Design: The study was approved by the Institutional Ethical Committee of Goa Dental College and Hospital. The study was carried out in Anganwadi centers spanning the various districts and talukas of Goa state., Materials and Methods: The decayed, missing, and filled teeth (dmft) index was recorded in 3-5-year-old children along with treatment needs as per the modified WHO pro forma., Statistical Analysis: Statistical software (STATA) for data science by StataCorp LLC (version 17), descriptive statistics, and Chi-square test., Results: A total of 386 children were examined, out of which 47% had ECC. The prevalence of ECC was highest in Canacona and the least in Tiswadi talukas. The severity and occurrence of ECC were found to the proportional to age. With regard to treatment needs, 8.55% needed restoration of at least one surface, 10.88% needed restoration of 2 or more surfaces, 5.44% required a crown, 11.4% needed pulpal treatment, and 6.74% needed extractions. Within the dmft component, the percentage of decayed teeth was 46.89%, followed by filled (0.52%) and missing (0.52%) teeth., Conclusion: The prevalence and severity of ECC in children attending Anganwadi centers in Goa were found to be large and proportional with increasing age., (Copyright © 2024 Copyright: © 2024 Journal of Indian Society of Pedodontics and Preventive Dentistry.)

Objectives: Evidence shows many misconceptions exist around permanent contraception, and there are numerous barriers to accessing the procedure. This qualitative study explored physician perspectives regarding patients' informational and decision-support needs, the complexities and challenges of counseling and access, and how these factors may differ for people living on lower incomes., Study Design: We conducted 15 semistructured, telephone interviews with obstetrician-gynecologists in three geographic regions of the United States to explore their perspectives on providing permanent contraception counseling and care. We analyzed the interviews using content analysis., Results: Physicians discussed a tension between respecting individual reproductive autonomy and concern for future regret; they wanted to support patients' desire for permanent contraception but were frequently concerned patients did not have the information they needed or the foresight to make high-quality decisions. Physicians also identified barriers to counseling including lack of time, lack of continuity over the course of prenatal care, and baseline misinformation among patients. Physicians identified additional barriers in providing a postpartum procedure even after thedecision was made including lack of personnel and operating room availability. Finally, physicians felt that people living on lower incomes faced more challenges in access primarily due to the sterilization consent regulations required by Medicaid., Conclusions: Physicians report numerous challenges surrounding permanent contraception provision and access. Strategies are needed to support physicians and patients to enhance high-quality, patient-centered sterilization decision making and ensure that patients are able to access a permanent contraceptive procedure when desired., Implications: This qualitative study demonstrates the various challenges faced by physicians to support permanent contraception decision making. These challenges may limit patients' access to the care they desire. This study supports the need to transform care delivery models and improve the federal sterilization policy to ensure equitable patient-centered access to desired permanent contraception., Disclaimer: Although the term permanent contraception has increasingly replaced the word sterilization in clinical settings, we use sterilization in some places throughout this paper as that was the standard terminology at the time the interviews were conducted and the language the interviewed physicians used., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Zeolite nanosheets can be used for the fabrication of low-defect-density, thin, and oriented zeolite separation membranes. However, methods for manipulating their morphology are limited, hindering progress toward improved performance. We report the direct synthesis (i.e., without using exfoliation, etching, or other top-down processing) of thin, flat MFI nanosheets and demonstrate their use as high-performance membranes for xylene isomer separations. Our MFI nanosheets were synthesized using nanosheet fragments as seeds instead of the previously used MFI nanoparticles. The obtained MFI nanosheets exhibit improved thickness uniformity and are free of rotational and MEL intergrowths as shown by transmission electron microscopy (TEM) imaging. The nanosheets can form well-packed nanosheet coatings. Upon gel-free secondary growth, the obtained zeolite MFI membranes show high separation performance for xylene isomers at elevated temperature (e.g., p -xylene flux up to 1.5 × 10 -3 mol m -2 s -1 and p -/ o -xylene separation factor of ~600 at 250°C).

The fractionation of crude-oil mixtures through distillation is a large-scale, energy-intensive process. Membrane materials can avoid phase changes in such mixtures and thereby reduce the energy intensity of these thermal separations. With this application in mind, we created spirocyclic polymers with N -aryl bonds that demonstrated noninterconnected microporosity in the absence of ladder linkages. The resulting glassy polymer membranes demonstrated nonthermal membrane fractionation of light crude oil through a combination of class- and size-based "sorting" of molecules. We observed an enrichment of molecules lighter than 170 daltons corresponding to a carbon number of 12 or a boiling point less than 200°C in the permeate. Such scalable, selective membranes offer potential for the hybridization of energy-efficient technology with conventional processes such as distillation., (Copyright © 2020 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.)

Zeolite MFI is a widely used catalyst and adsorbent that also holds promise as a thin-film membrane. The discovery of nanometre-thick two-dimensional (2D) MFI nanosheets has facilitated methods for thin-film zeolite fabrication that open new horizons for membrane science and engineering. However, the crystal structure of 2D-MFI nanosheets and their relationship to separation performance remain elusive. Using transmission electron microscopy, we find that one- to few-unit-cell-wide intergrowths of zeolite MEL exist within 2D-MFI. We identify the planar distribution of these 1D or near-1D-MEL domains, and show that a fraction of nanosheets have high (~25% by volume) MEL content while the majority of nanosheets are MEL-free. Atomistic simulations show that commensurate knitting of 1D-MEL within 2D-MFI creates more rigid and highly selective pores compared to pristine MFI nanosheets, and permeation experiments show a separation factor of 60 using an industrially relevant (undiluted 1 bar xylene mixture) feed. Confined growth in graphite is shown to increase the MEL content in MFI nanosheets. Our observation of these intergrowths suggests strategies for the development of ultra-selective zeolite membranes.

Objective  To investigate the utility of obtaining weekly laboratory testing in patients managed as an outpatient for gestational hypertension and preeclampsia without severe features. Study Design  A multisite retrospective cohort study was performed evaluating preterm women diagnosed with gestational hypertension/preeclampsia managed in an outpatient setting between gestational ages of 23 0/7 and 36 6/7 . Patients were divided into two groups: weekly laboratory evaluation (laboratories group) and a no laboratories group. The primary study outcome was composite maternal morbidity including more than one of the following: development of severe features, HELLP syndrome, eclampsia, placental abruption, maternal intensive care unit admission, or maternal death. Results  A total of 204 patients were included in this study, laboratories group ( n  = 120) and no laboratories group ( n  = 84). The laboratories group was older (28.8 vs. 26.6 years, p  = 0.02), had a higher rate of chronic hypertension (44 [36.7%] vs. 17 [20.2%], p  = 0.01), and more often experienced the primary composite outcome (53 [44.2%] vs. 24 [28.5%], p  = 0.02). No patients in our cohort were delivered for abnormal laboratory values. Conclusion  This study found that weekly laboratory testing may have minimal clinical utility in the outpatient management protocol in monitoring patients with mild gestational hypertension or preeclampsia. Delivery was guided by other clinical factors.

A zeolite with structure type MFI is an aluminosilicate or silicate material that has a three-dimensionally connected pore network, which enables molecular recognition in the size range 0.5-0.6 nm. These micropore dimensions are relevant for many valuable chemical intermediates, and therefore MFI-type zeolites are widely used in the chemical industry as selective catalysts or adsorbents. As with all zeolites, strategies to tailor them for specific applications include controlling their crystal size and shape. Nanometre-thick MFI crystals (nanosheets) have been introduced in pillared and self-pillared (intergrown) architectures, offering improved mass-transfer characteristics for certain adsorption and catalysis applications. Moreover, single (non-intergrown and non-layered) nanosheets have been used to prepare thin membranes that could be used to improve the energy efficiency of separation processes. However, until now, single MFI nanosheets have been prepared using a multi-step approach based on the exfoliation of layered MFI, followed by centrifugation to remove non-exfoliated particles. This top-down method is time-consuming, costly and low-yield and it produces fragmented nanosheets with submicrometre lateral dimensions. Alternatively, direct (bottom-up) synthesis could produce high-aspect-ratio zeolite nanosheets, with improved yield and at lower cost. Here we use a nanocrystal-seeded growth method triggered by a single rotational intergrowth to synthesize high-aspect-ratio MFI nanosheets with a thickness of 5 nanometres (2.5 unit cells). These high-aspect-ratio nanosheets allow the fabrication of thin and defect-free coatings that effectively cover porous substrates. These coatings can be intergrown to produce high-flux and ultra-selective MFI membranes that compare favourably with other MFI membranes prepared from existing MFI materials (such as exfoliated nanosheets or nanocrystals).

Nanoscale crystal growth control is crucial for tailoring two-dimensional (2D) zeolites (crystallites with thickness less than two unit cells) and thicker zeolite nanosheets for applications in separation membranes and as hierarchical catalysts. However, methods to control zeolite crystal growth with nanometer precision are still in their infancy. Herein, we report solution-based growth conditions leading to anisotropic epitaxial growth of 2D zeolites with rates as low as few nanometers per day. Contributions from misoriented surface nucleation and rotational intergrowths are eliminated. Growth monitoring at the single-unit-cell level reveals novel nanoscale crystal-growth phenomena associated with the lateral size and surface curvature of 2D zeolites., (© 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Two-dimensional zeolite nanosheets that do not contain any organic structure-directing agents were prepared from a multilamellar MFI (ML-MFI) zeolite. ML-MFI was first exfoliated by melt compounding and then detemplated by treatment with a mixture of H2 SO4 and H2 O2 (piranha solution). The obtained OSDA-free MFI nanosheets disperse well in water and can be used for coating applications. Deposits made on porous polybenzimidazole (PBI) supports by simple filtration of these suspensions exhibit an n-butane/isobutane selectivity of 5.4, with an n-butane permeance of 3.5×10(-7)  mol m(-2)  s(-1)  Pa(-1) (ca. 1000 GPU)., (© 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

A zeolite membrane fabrication process combining 2D-zeolite nanosheet seeding and gel-free secondary growth is described. This process produces selective molecular sieve films that are as thin as 100 nm and exhibit record high permeances for xylene- and butane-isomers., (© 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Stable suspensions of zeolite nanosheets (3 nm thick MFI layers) were prepared in ethanol following acid treatment, which partially removed the associated organic structure-directing agent. Nanosheets from these suspensions could then be dispersed at the air-water interface and transferred to silicon wafers using Langmuir-Schaefer deposition. Using layer-by-layer deposition, control on coating thickness was demonstrated. In-plane X-ray diffraction (XRD) revealed that the deposited nanosheets contract upon calcination similar to bulk MFI crystals. Different methods for secondary growth resulted in preferentially oriented thin films of MFI, which had sub-12-nm thickness in certain cases. Upon calcination, there was no contraction detectable by in-plane XRD, indicating well-intergrown MFI films that are strongly attached to the substrate., (© 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

The gastrointestinal tract (GIT) is a common site of metastases for malignant melanoma. These metastatic tumors are often asymptomatic. We describe a case of a 58-year-old male who presented with a sudden onset of generalized abdominal pain. The patient's past medical history was significant for lentigo melanoma of the right cheek. Laparotomy was performed and two segments of small bowel, one with a perforated tumor, the other with a non-perforated tumor, were removed. Histology and immunohistochemical staining revealed the perforated tumor to be a metastatic malignant melanoma and the non-perforated tumor was found to be a gastrointestinal stromal tumor (GIST). The patient was discharged 7 d postoperatively. To the best of our knowledge, this is the first reported case in the literature of a simultaneous metastatic malignant melanoma and a GIST. Surgical intervention is warranted in patients with symptomatic GIT metastases to improve the quality of life or in those patients with surgical emergencies.

The purpose of this study was to evaluate prospectively the efficacy of bilateral thoracoscopic splanchnicectomy (TS) for pain due to chronic pancreatitis. Pain is invariably a major debilitating factor in the course of chronic pancreatitis. This study was performed to evaluate the effect of bilateral TS on pain intensity, hospital admissions, and daily functions in patients with debilitating pain due to chronic pancreatitis. Twenty bilateral TS were performed in 20 patients. Follow-up was obtained in all patients and averaged 15 months (6 months to 3 years). To evaluate efficacy of the procedure, all 20 patients were personally interviewed after TS regarding impact of pain and change in lifestyle. Using the 0-10 numeric rating scale, patients ranked pre- and postoperative pain level and overall mood. A KASPER report was obtained for 17 of 20 patients from the Kentucky Drug Control and Professional Practices to obtain accurate information on all narcotic prescriptions filled for 1 year prior to surgery until today. Information from the KASPER report provided very objective information on pain medication use before and after TS. Thirteen patients (65%) had a decreased pain level, and 12 patients (55%) also developed an improved overall mood. The number of hospital admissions for chronic pancreatitis pain decreased in 19 patients (95%), and the days spent in the hospital decreased for 15 patients (75%). Overall, 12 patients (60%) indicated pain symptom relief during a mean duration of 14.8 months after the procedure. KASPER reports indicated a decrease in pain medication prescriptions filled for 9 patients (53%), 3 of which were able to discontinue completely use of opioids for pain associated with chronic pancreatitis. TS is a minimally invasive procedure that appears to offer pain relief, improve quality of life, and reduce narcotic dependence in patients with pain from chronic pancreatitis. The decrease in hospital admissions represents further quality of life improvement in this difficult to treat group of patients.

Objectives: The aim of this study was to characterize absorption and pH control of simplified omeprazole suspension (SOS), 2 mg/ml in 8.4% sodium bicarbonate, administered via the nasogastric versus jejunal or duodenal route., Methods: Nine critically ill surgical patients, NPO and mechanically ventilated, were enrolled in this randomized cross-over study. Patients received a single 40 mg dose of SOS by the nasogastric and either the jejunal or duodenal route. Twenty-four-hour continuous intragastric pH monitoring was performed during the study period. Sequential blood samples were collected over 24 h to characterize SOS absorption and pharmacokinetic parameters., Results: Nasogastric administration of SOS resulted in lower maximum mean +/- SD serum concentrations compared to jejunal/duodenal dosing (0.970 +/- 0.436 vs 1.833 +/- 0.416 microg/ml, p = 0.006). SOS absorption was significantly slower when administered via nasogastric tube (108.3 +/- 42.0 vs 12.1 +/- 7.9 min, p < 0.001). However, all routes of administration resulted in similar SOS area under the serum concentration-time curves (AUC(0-infinity)) (415.1 +/- 291.8 vs 396.7 +/- 388.1 microg x min/ml, p = 0.91) [corrected]. Mean intragastric pH values remained >4 at 1 h after SOS administration and remained >4 for the entire 24-h study (6.32 +/- 1.04, 5.57 +/- 1.15, nasogastric vs jejunal/duodenal, p = 0.015), regardless of administration route., Conclusions: In critically ill surgical patients, pharmacokinetic parameters and subsequent pH control after the administration of SOS are similar by the jejunal, nasogastric, or duodenal route. SOS suspension offers an alternative acid control measure when patients are unable to take oral medications, yet have an enteral tube in place.

Background: Urinary-vaginal fistula is one of the most common and dreaded complications of obstetric trauma in developing countries. Management of these fistulas is complicated by the presence of substantial urethral loss and the tendency of the repair to break down., Study Design: We retrospectively studied 46 patients with urinary-vaginal fistulas operated on in our institution over 5 years. Most of the patients had obstetric trauma as the causative factor. Twelve patients had urethrovaginal and 34 had vesicovaginal fistulas. Of the 12 patients with urethrovaginal fistulas, 8 underwent a Martius procedure and 4 were treated with simple anatomic repair. Of the 34 patients with vesicovaginal fistulas, 13 underwent a Martius procedure and 21 were treated with anatomic repair. Nineteen patients had recurrent fistulas and 17 had multiple fistulas., Results: Only one patient with a urethrovaginal fistula treated with a Martius procedure had recurrence, compared with three of four of the patients having anatomic repair. None of the patients with vesicovaginal fistulas treated with a Martius flap had recurrence, compared with 4 of 21 in the anatomic-repair group (19.05%). Thirteen patients with single fistulas (7 urethrovaginal and 6 vesicovaginal) treated with a Martius procedure healed well without failure, compared with 1 failure among 16 fistulas (1 urethrovaginal and 15 vesicovaginal) in the anatomic-repair group. In the group of patients with multiple fistulas, the Martius flap also showed a definite advantage. Eight patients with multiple fistulas were offered the Martius flap. The procedures were successful in all but one, compared with six failures out of nine treated with anatomic repair. None of the patients having primary treatment with the Martius flap had postoperative recurrence, compared with 3 of 18 having anatomic repair (16.67%). Only 1 of 12 patients with recurrent fistulas undergoing Martius flap repair had failure (8.33%), compared with 4 of 7 undergoing anatomic repair (57.14%). None of the patients treated with the Martius procedure experienced dyspareunia postoperatively, compared with 33.33% of the patients treated with anatomic repair., Conclusions: The overall success rate was far better and the complication rate (especially incontinence and dyspareunia) was considerably less with the Martius procedure. We recommend the Martius procedure for urethrovaginal and vesicovaginal fistulas, especially those that are recurrent or multiple.

Introduction: Intestinal fistulae are a daunting clinical problem., Aim: To evaluate the influence of various severity factors on morbidity and mortality in patients with intestinal fistulae., Method: In 29 patients with intestinal fistulae, eight severity factors, viz., age, associated bowel disease, anemia, hypoalbuminemia, high-output fistula, category IV fistula, excoriation of skin surrounding the stoma, and sepsis, were analyzed prospectively to assess their effect on healing of fistulae and mortality. Chi-squared test with Yates' correction was used., Results: Age, presence of associated bowel disease, and hemoglobin levels had no significant effect on healing or mortality. Hypoalbuminemia, category IV fistulae, presence of local skin excoriation, and sepsis significantly delayed healing (p < 0.05). High-output fistula, category IV fistula, local skin excoriation, and sepsis were significantly associated with high mortality (p < 0.05)., Conclusion: Identification of these prognostic factors in intestinal fistulae may guide the need for more intensive care or intervention.

Though a rare lesion, a parathyroid cyst is of clinical significance because it mimics a thyroid cyst and can be associated with hyperparathyroidism. The cyst can be ectopic in location and therefore constitutes a differential diagnosis to a bronchial or thymic cyst. Four cases of parathyroid cyst are presented. Fine needle aspiration with parathyroid hormone assay is diagnostic. Surgical removal of the cyst is recommended.