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Objectives It is important to assess healthcare providers (HCPs) knowledge, attitudes, perceptions, and preferences towards new pneumococcal vaccines for adults.Methods HCPs who met eligibility criteria completed an online survey between March – May 2024 that included a discrete choice experiment (DCE) to elicit preferences.Results Among 340 participating HCPs, the average age was 44.9 years old, and the majority were male (55.6%), and White (85.3%). Most HCPs reported that they would support (90.3%) and implement (91.5%) a lower age-based recommendation for pneumococcal vaccines (from adults 65+ years to adults 50+ years). A majority of HCPs would offer a supplemental dose of a pneumococcal vaccine to high-risk adults 19–49 years, at-risk or high-risk adults 50–64 years, and adults 65+ years regardless of risk status to increase protection after completing the recommended series. DCE results showed that coverage of pneumococcal pneumonia and invasive pneumococcal disease (IPD) in adults 65+ years were the two most important attributes in evaluating pneumococcal vaccines.Conclusions HCPs preferred a pneumococcal vaccine with increased coverage against pneumococcal pneumonia and IPD, and they supported lowering the age recommendation for pneumococcal vaccination as well as a supplemental vaccine dose to provide additional coverage for adults.

Abstract Particle tracking (PT) is a popular technique in microscopy, microfluidics and colloidal transport studies, where image analysis is used to reconstruct trajectories from bright spots in a video. The performance of many PT algorithms has been rigorously tested for directed and Brownian motion in open media. However, PT is frequently used to track particles in porous media where complex geometries and viscous flows generate particles with high velocity variability over time. Here, we present an evaluation of four PT algorithms for a simulated dispersion of particles in porous media across a range of particle speeds and densities. Of special note, we introduce a new velocity-based PT linking algorithm (V-TrackMat) that achieves high accuracy relative to the other PT algorithms. Our findings underscore that traditional statistics, which revolve around detection and linking proficiency, fall short in providing a holistic comparison of PT codes because they tend to underpenalize aggressive linking techniques. We further elucidate that all codes analyzed show a decrease in performance due to high speeds, particle densities, and trajectory noise. However, linking algorithms designed to harness velocity data show superior performance, especially in the case of high-speed advective motion. Lastly, we emphasize how PT error can influence transport analysis.

Abstract Background In low- and middle-income countries (LMICs), such as Tanzania, the competency of healthcare providers critically influences the quality of pediatric care. To address this issue, we introduced Pediatric Acute Care Education (PACE), an adaptive learning program to enhance provider competency in Tanzania’s guidelines for managing seriously ill children. Adaptive learning is a promising alternative to current in-service education, yet optimal implementation strategies in LMIC settings are unknown. Objectives (1) To evaluate the initial PACE implementation in Mwanza, Tanzania, using the construct of normalization process theory (NPT); (2) To provide insights into its feasibility, acceptability, and scalability potential. Methods Mixed-methods study involving healthcare providers at three facilities. Quantitative data was collected using the Normalization MeAsure Development (NoMAD) questionnaire, while qualitative data was gathered through in-depth interviews (IDIs) and focus groups discussions (FGDs). Results Eighty-two healthcare providers completed the NoMAD survey. Additionally, 24 senior providers participated in IDIs, and 79 junior providers participated in FGDs. Coherence and cognitive participation were high, demonstrating that PACE is well understood and resonates with existing healthcare goals. Providers expressed a willingness to integrate PACE into their practices, distinguishing it from existing educational methods. However, challenges related to resources and infrastructure, particularly those affecting collective action, were noted. Early indicators point toward the potential for long-term sustainability of the PACE, but assessment of reflexive monitoring was limited due to the study’s focus on PACE’s initial implementation. Conclusion This study offers vital insights into the feasibility and acceptability of implementing PACE in a Tanzanian context. While PACE aligns well with healthcare objectives, addressing resource and infrastructure challenges as well as conducting a longer-term study to assess reflexive monitoring is crucial for its successful implementation. Furthermore, the study underscores the value of the NPT as a framework for guiding implementation processes, with broader implications for implementation science and pediatric acute care in LMICs.

Objectives The attitudes and perceptions of healthcare consumers (HCCs) are increasingly becoming more relevant in decision-making with healthcare providers and incorporated into healthcare decision-making by national immunization technical advisory groups and health technology assessment agencies. With newer pneumococcal vaccine options available, HCCs’ attitudes and perceptions play a key role in gauging potential acceptance. The objective of this study was to assess HCCs’ knowledge, attitudes, and perceptions toward pneumococcal vaccines for adults.Methods Between March and May 2024, eligible U.S. adult HCCs were invited to participate in an online survey focusing on experiences and attitudes toward vaccines.Results Among 141 participating HCCs, average age was 53.1 years. The majority of participants were male (51.1%) and 64.5% identified as White. Most HCCs received at least one vaccine in the past year (81.6%). HCCs most often received vaccines at medical offices and pharmacies. HCCs supported lowering the age-based pneumococcal vaccine recommendation to all adults 50 years and older and were willing to receive a supplemental pneumococcal vaccine dose following completion of the recommended series for additional protection.Conclusions These findings indicate that new adult pneumococcal vaccines would be accepted and valued by HCCs if recommended by HCPs.

Several amendments have been used to reduce ammonia (NH3) emissions from broiler litter (BL); however, a comparative study between amendments and their application rates has not been fully explored. This study evaluated the potential of biochar (B), zeolite (Z), Flue Gas Desulphurization-Gypsum (FGD-G), and sodium bisulfate (S) at four application rates in reducing NH3 emissions from BL. The treatments comprised of amendment types (4) and their application rates (4), and a control with no amendment for a total of 17 treatments replicated twice and arranged in a completely randomized design. The treatments were incubated at 30 °C for 40 days at a moisture content of 40% (w/w), and NH3 emissions were measured every day for the first 10 days and 3 days intervals afterward for 40 days. Results showed that the application of 13 and 17% B (w/w) reduced cumulative NH3 emissions by 41 and 46%, respectively, compared to control over a 40-day period. Zeolite application at 8 and 11% reduced NH3 by 20 and 33%, respectively. There was no significant difference between the different rates of FGD-G, and they were generally less effective; however, a 15% FGD-G rate reduced NH3 by 9.1%. Application of S at rates of 2, 4, 6, and 7% significantly reduced NH3 emissions by 91, 99, 100, and 100 %, respectively. The effectiveness of amendments to reduce ammonia emissions followed the order: S > B > Z > FGD-G. These findings contribute to an ongoing effort to identify non-acidic amendments to minimize NH3 emissions in broiler houses.

ABSTRACTAs higher-valent pneumococcal conjugate vaccines (PCVs) become available for pediatric populations in the US, it is important to understand healthcare provider (HCP) preferences for and acceptability of PCVs. US HCPs (pediatricians, family medicine physicians and advanced practitioners) completed an online, cross-sectional survey between March and April 2023. HCPs were eligible if they recommended or prescribed vaccines to children age

Manure is an important source of plant nutrients and organic matter that can benefit soil health over time. However, indiscriminate use of manure can lead to environmental problems including eutrophication of water bodies caused by nutrient runoff during precipitation events. There is a need to understand the effect of manure source and application rate on nitrogen (N) and phosphorus (P) forms and their losses during runoff events. In this study, we assessed the impact of application rate of broiler litter (BL) and swine liquid manure (SLM) on runoff volume, soil, N, and P losses using a rainfall simulator and three consecutive 2.45 cm rainfall events. Surface Decatur silty clay loam (0–0.06 m) was collected and packed in trays (0.55 x 0.30 × 0.06 m3). Manure was surface-applied to the soil at equivalent P rates ranging from 62 to 249 kg ha−1 for BL and 5–18 kg ha−1 for SLM, respectively. Rainfall events took place 7, 14, and 21 d after manure application. Results indicated that the runoff volume decreased at the highest manure application rate compared to the lowest manure application rate. The total suspended solids (TSS) loss was lower in control compared to BL and SLM treatments. The loss of nitrate-N (NO3-N) dissolved reactive P (DRP) and dissolved organic P (DOP) in runoff water was maximum at the highest application rates for both the BL and SLM with respect to control. Mehlich 3 extractable P (M3P) and water soluble P (WSP) increased with increasing P application rates for both manure types in soils following post rainfall simulation study. An increase in M3P and WSP, along with a decrease in soil P storage capacity following post-rainfall simulation for higher P application rates, indicates caution should be taken for considering the manure application rate to prevent environmental nutrient loss during runoff events.

Objectives: Booster COVID-19 vaccinations are used to protect the elderly, a group vulnerable to severe disease. We compared humoral and cellular immunity in older versus younger adults up to eight months after administering a BNT16b2 booster vaccine dose. Next, we analyzed the plasma levels of soluble T cell activation/exhaustion markers. Methods: Home-dwelling older adults (n = 68, median age 86) and younger healthcare workers (n = 35, median age 39), previously vaccinated with two doses of BNT162b2, were given a booster dose at ten months after the initial dose. Our analysis consisted of spike-specific IgG, neutralizing antibodies, memory B cells, IFN-γ and IL-2 secreting T cells and soluble T cell exhaustion/activation markers. Results: Following the initial two doses, the elderly cohort exhibited lower humoral and IFN-γ responses compared to younger adults. The booster dose increased the humoral responses in both older and younger adults. At two months after the booster dose, older and younger vaccinees had comparable levels of antibodies and the responses were maintained up to 18 months. The younger cohort elicited an increase in the cellular response, while no increase was detected in the elderly. The elderly had higher plasma levels of soluble forms of the T cell activation/exhaustion markers CD25 and TIM-3, which inversely correlated with age and T-cell cytokine responses. This suggests that these markers may be related to the observed dysfunctional cellular cytokine response in older adults. However, both elderly and younger adults who experienced breakthrough infections after booster vaccination, elicited more robust humoral and IFN-γ responses. Conclusions: The booster dose elicited neutralizing and spike-specific antibody responses in the elderly that were comparable with that of the younger cohort. However, the lack of a strong cellular cytokine response to the third dose in the elderly may explain their vulnerability to severe infection and may be a consequence of exhausted or senescent T cell responses. (https://clinicaltrials.gov/study/NCT04706390).

Neuropsychiatric disorders are multifaceted syndromes with confounding neurological explanations. It includes anxiety, depression, autism spectrum disorder, attention deficit hyperactivity disorder, schizophrenia, Tourette’s syndrome, delirium, dementia, vascular cognitive impairment, and apathy etc. Globally, these disorders occupy 15% of all diseases. As per the WHO, India has one of the largest populations of people with mental illnesses worldwide. The blood-brain barrier (BBB) makes it extremely difficult to distribute medicine to target cells in the brain tissues. However, it is possible through novel advancements in nanotechnology, molecular biology, and neurosciences. One such cutting-edge delivery method, nose-to-brain (N2B) drug delivery using nanoformulation (NF), overcomes traditional drug formulation and delivery limitations. Later offers more controlled drug release, better bioavailability, improved patient acceptance, reduced biological interference, and circumvention of BBB. When medicines are delivered via the intranasal (IN) route, they enter the nasal cavity and go to the brain via connections between the olfactory and trigeminal nerves and the nasal mucosa in N2B. Delivering phytochemical, bioactive and synthetic NF is being investigated with the N2B delivery strategy. The mucociliary clearance, enzyme degradation, and drug translocations by efflux mechanisms are significant issues associated with N2B delivery. This review article discusses the types of neuropsychiatric disorders and their treatment with plant-derived as well as synthetic drug-loaded NFs administered via the IN-delivery system. In conclusion, this review provided a comprehensive and critical overview of the IN applicability of plant-derived NFs for psychiatric disorders.

Background The treatment of severe aortic stenosis has evolved considerably since the introduction of transcatheter aortic valve replacement (TAVR), yet trends in complications for patients undergoing TAVR or surgical aortic valve replacement (SAVR) at a national level have yet to be evaluated. Methods and Results We performed a retrospective cohort study using Medicare data to evaluate temporal trends in complications among beneficiaries, aged ≥65 years, treated with elective isolated transfemoral TAVR or SAVR between 2012 and 2019. The study end point was the occurrence of a major complication (composite outcome) during index and up to 30 days after. Multivariable logistic regression was used to assess odds of complications for TAVR and SAVR, individually over time, and for TAVR versus SAVR, over time. The cohort included 211 212 patients (mean±SD age, 78.6±7.3 years; 45.0% women). Complication rates during index following elective isolated aortic valve replacement decreased from 49% in 2012 to 22% in 2019. These reductions were more pronounced for TAVR (41% to >19%, Δ=22%) than SAVR (51% to >47%, Δ=4%). After risk adjustment, the risk of any complication with TAVR was 47% (P

Background Studies have shown inconclusive results on the effectiveness of cerebral protection devices (CPDs) with transcatheter aortic valve replacement. We aimed to analyze the national statistics on stroke and other outcomes with CPD use. Methods and Results The Nationwide Readmissions Database (2017–2020) was queried to obtain data on patients undergoing transcatheter aortic valve replacement. Outcomes were compared between patients with a CPD and patients without a CPD. Of 271 804 patients undergoing transcatheter aortic valve replacement, CPD was used in 7.3% of patients. In a multivariable logistic regression analysis, CPD use was not associated with lower overall stroke rates (1.6% versus 1.9% without CPD; odds ratio, 0.95 [95% CI, 0.84–1.07]; P=0.364), but it was significantly associated with lower major stroke rates (1.2% versus 1.5% without CPD; odds ratio, 0.85 [95% CI, 0.74–0.98]; P=0.02). Patients with a CPD also had a shorter length of stay, higher routine discharges to home/self‐care (74.9% versus 70.6%), and lower mortality rates (0.7% versus 1.3%). The 30‐day (9.6% versus 11.7%) and 180‐day (24.6% versus 28.2%) readmission rates were significantly lower in the CPD cohort. Among patients who developed stroke, patients with a CPD had more frequent routine discharges. Prior valve surgery was associated with the highest risk of overall and major stroke. Conclusions CPD use during transcatheter aortic valve replacement was not independently associated with a lower risk of overall stroke but was associated with a lower risk of major stroke in a multivariable model. Data from future randomized trials that may offset any potential confounders in our study are required to help identify patients who would benefit from the use of these devices.

Background: Appendicitis is an acute and life-threatening situation if not treated promptly encountered in surgery practice. Even today, most cases of appendicitis are diagnosed by clinical findings and imaging. Scanty information is available to diagnose the perforation of the appendix using serological tests; hence, an attempt is made. The present study aimed to find out the correlation of hyperbilirubinemia as a diagnostic predictor for perforation in acute appendicitis patients. Methods: This prospective observational study was conducted among patients diagnosed with acute appendicitis attending OPD of the general surgery department of Narayana Medical College Hospital. The duration of the study is between January 2023 and December 2023. A total of 400 patients with a diagnosis of either acute appendicitis or perforation were recruited into the study, and they collected blood samples for estimation of hyperbilirubinemia. Results: In the study population of 400 patients, 72 cases were diagnosed as appendicular perforation, and 328 patients had acute appendicitis. The cut-off value of hyperbilirubinemia was taken as serum bilirubin >1.0 mg/dl. Out of 72 cases of appendicular perforations, 64 patients have hyperbilirubinemia (89%), while in the acute appendicitis patients group, 82 of 328 patients have elevated serum bilirubin (25%). The observed mean values of serum bilirubin in the two groups were 1.74 and 0.89, and the difference in the standard error of the mean value of the two groups is statistically significant at a P-value of 1.0 mg/dl had a higher probability of appendicular perforation. Hence, measuring serum bilirubin can be considered an additional diagnostic tool to existing clinical diagnosis and radiological evaluation for more precision in diagnosis.

Abstract Background Medical school curricula strive to train community-engaged and culturally competent physicians, and many use service learning to instill these values in students. The current standards for medical service learning frameworks have opportunities for improvement, such as encouraging students to have more sustainable and reciprocal impact and to ingrain service learning as a value to carry throughout their careers rather than a one-time experience. PEDS 220: A COVID-19 Elective is a Stanford University course on the frontlines of this shift; it provides timely education on the COVID-19 pandemic, integrating community-oriented public health work to help mitigate its impact. Methods To analyze our medical service learning curriculum, we combined qualitative and quantitative methods to understand our students’ experiences. Participants completed the Course Experience Questionnaire via Qualtrics, and were invited to complete an additional interview via Zoom. Interview transcripts were analyzed using an interactive, inductive, and team-based codebook development process, where recurring themes were identified across participant interviews. Results We demonstrate through self-determination theory that our novel curriculum gives students valuable leadership and project management experience, awards strong academic and community-based connections, and motivates them to pursue future community-engaged work. Conclusions This educational framework, revolving around students, communities, and diversity, can be used beyond the COVID-19 pandemic at other educational institutions to teach students how to solve other emergent global health problems. Using proven strategies that empower future physicians to view interdisciplinary, community-engaged work as a core pillar of their responsibility to their patients and communities ensures long-term, sustainable positive impact. Trial registration N/A.

Walled-off pancreatic necrosis (WOPN) is a local complication of acute necrotizing pancreatitis frequently requiring intervention. Treatment is typically through the coordinated efforts of a multidisciplinary team. Current management guidelines recommend a step-up approach beginning with minimally invasive techniques (percutaneous or transmural endoscopic drainage) followed by escalation to more invasive procedures if needed. Although the step-up approach is an evidence-based treatment paradigm for management of pancreatic fluid collections, it lacks guidance regarding optimal invasive technique selection based on the anatomic characteristics of pancreatic fluid collections. Similarly, existing cross-sectional imaging-based classification systems of pancreatic fluid collections have been used to predict disease severity and prognosis; however, none of these systems are designed to guide intervention. We propose a novel classification system which incorporates anatomic characteristics of pancreatic fluid collections (location and presence of disconnected pancreatic duct) to guide intervention selection and clinical decision making. We believe adoption of this simple classification system will help streamline treatment algorithms and facilitate cross-study comparisons for pancreatic fluid collections.

Abstract Case reports have speculated if COVID-19 vaccinations may be associated with retinal vascular occlusions (RVO). Specifically, previous literature speculated an increased risk of RVOs days to weeks after vaccination. After reviewing two recent analyses, mRNA COVID-19 vaccinations do not appear to increase the risk of RVOs at 3 and 12 weeks post-vaccination. Although both studies had different designs, mRNA vaccines do not appear to influence the risk of RVO development.

Brain microvessels possess the unique properties of a blood–brain barrier (BBB), tightly regulating the passage of molecules from the blood to the brain neuropil and vice versa. In models of brain injury, BBB dysfunction and the associated leakage of serum albumin to the neuropil have been shown to induce pathological plasticity, neuronal hyper-excitability, and seizures. The effect of neuronal activity on BBB function and whether it plays a role in plasticity in the healthy brain remain unclear. Here we show that neuronal activity induces modulation of microvascular permeability in the healthy brain and that it has a role in local network reorganization. Combining simultaneous electrophysiological recording and vascular imaging with transcriptomic analysis in rats, and functional and BBB-mapping MRI in human subjects, we show that prolonged stimulation of the limb induces a focal increase in BBB permeability in the corresponding somatosensory cortex that is associated with long-term synaptic plasticity. We further show that the increased microvascular permeability depends on neuronal activity and involves caveolae-mediated transcytosis and transforming growth factor β signaling. Our results reveal a role of BBB modulation in cortical plasticity in the healthy brain, highlighting the importance of neurovascular interactions for sensory experience and learning.

IntroductionPatients with cirrhosis undergoing liver transplantation frequently exhibit systemic inflammation, coagulation derangements, and edema, indicating endothelial dysfunction. This syndrome may worsen after ischemia–reperfusion injury of the liver graft, coincident with organ dysfunction that worsens patient outcomes. Little is known about changes in endothelial permeability during liver transplantation. We hypothesized that sera from these patients would increase permeability in cultured human endothelial cells ex vivo.MethodsAdults with cirrhosis presenting for liver transplantation provided consent for blood collection during surgery. Sera were prepared at five time points spanning the entire operation. The barrier function of human pulmonary microvascular endothelial cells in culture was assessed by transendothelial resistance measured using the ECIS ZΘ system. Confluent cells from two different endothelial cell donors were stimulated with human serum from liver transplant patients. Pooled serum from healthy men and purified inflammatory agonists served as controls. The permeability response to serum was quantified as the area under the normalized resistance curve. Responses were compared between time points and analyzed for associations with clinical characteristics of liver transplant patients and their grafts.ResultsLiver transplant sera from all time points during surgery-induced permeability in both endothelial cell lines. The magnitude of permeability change was heterogeneous between patients, and there were differences in the effects of sera on the two endothelial cell lines. In one of the cell lines, the severity of liver disease was associated with greater permeability at the start of surgery. In the same cell line, serum collected 15 min after liver reperfusion induced significantly more permeability as compared to that collected at the start of surgery. Early postreperfusion sera from patients undergoing living donor transplants induced more permeability than sera from deceased donor transplants. Sera from two exemplary cases of patients on preoperative dialysis, and one patient with an unexpectedly long warm ischemia time of the liver graft, induced exaggerated and prolonged endothelial permeability.DiscussionSerum from patients with cirrhosis undergoing liver transplantation induces permeability of cultured human pulmonary microvascular endothelial cells. Increased endothelial permeability during liver transplantation may contribute to organ injury and present a target for future therapeutics.

In 2019, 80% of the 7.4 million global child deaths occurred in low- and middle-income countries (LMICs). Global and regional estimates of cause of hospital death and admission in LMIC children are needed to guide global and local priority setting and resource allocation but are currently lacking. The study objective was to estimate global and regional prevalence for common causes of pediatric hospital mortality and admission in LMICs. We performed a systematic review and meta-analysis to identify LMIC observational studies published January 1, 2005-February 26, 2021. Eligible studies included: a general pediatric admission population, a cause of admission or death, and total admissions. We excluded studies with data before 2,000 or without a full text. Two authors independently screened and extracted data. We performed methodological assessment using domains adapted from the Quality in Prognosis Studies tool. Data were pooled using random-effects models where possible. We reported prevalence as a proportion of cause of death or admission per 1,000 admissions with 95% confidence intervals (95% CI). Our search identified 29,637 texts. After duplicate removal and screening, we analyzed 253 studies representing 21.8 million pediatric hospitalizations in 59 LMICs. All-cause pediatric hospital mortality was 4.1% [95% CI 3.4%–4.7%]. The most common causes of mortality (deaths/1,000 admissions) were infectious [12 (95% CI 9–14)]; respiratory [9 (95% CI 5–13)]; and gastrointestinal [9 (95% CI 6–11)]. Common causes of admission (cases/1,000 admissions) were respiratory [255 (95% CI 231–280)]; infectious [214 (95% CI 193–234)]; and gastrointestinal [166 (95% CI 143–190)]. We observed regional variation in estimates. Pediatric hospital mortality remains high in LMICs. Global child health efforts must include measures to reduce hospital mortality including basic emergency and critical care services tailored to the local disease burden. Resources are urgently needed to promote equity in child health research, support researchers, and collect high-quality data in LMICs to further guide priority setting and resource allocation.

Background The aims of this study were to understand the incidence and outcomes of patients with cardiogenic shock (CS) due to severe aortic stenosis (AS), and the impact of conventional treatment strategies in this population. Methods and Results All patients admitted to the Cleveland Clinic cardiac intensive care unit between January 1, 2010 and December 31, 2021 with CS were retrospectively identified and categorized into those with CS in the setting of severe AS versus CS without AS. The impact of various treatment strategies on mortality was further assessed. We identified 2754 patients with CS during the study period, of whom 216 patients (8%) had CS in the setting of severe AS. Medical management was associated with the highest 30‐day mortality when compared with either balloon aortic valve replacement or aortic valve replacement (surgical or transcatheter aortic valve replacement) (hazard ratio, 3.69 [95% CI, 2.04–6.66]; P

Abstract Repeated broiler litter application on agricultural lands can cause nutrient enrichment of subsurface effluent, especially with the existence of preferential flow through soil macropores. Previous studies quantifying soil macropores have not attempted to establish a connection of soil macropore characteristics with the subsurface nutrient (nitrogen [N] and phosphorus [P]) losses, across different topographical locations in the field. This study investigated the effect of broiler litter application and preferential flow on subsurface nutrient transport (N and P) at different topographical positions (upslope, midslope, and downslope) in a no‐till pasture field located in Alabama, USA. Twelve intact soil columns (150 mm id and 500 mm length) were used, and the nutrient leaching measurements from laboratory experiments were linked to soil macropore characteristics quantified using X‐ray computed tomography image analysis and solute transport modeling. Treatments included surface broadcast broiler litter (5 Mg ha−1, on dry basis) and unamended control. Leachates were analyzed for dissolved reactive P (DRP), total P (TP), and nitrate + nitrite‐N (NO3− + NO2−–N). The bromide breakthrough curves provided evidence of preferential flow in all columns. Litter application significantly increased leachate P concentrations, and average TP and DRP concentrations were significantly higher in the leachate from upslope columns compared to those at downslope location. The NO3−–N concentrations in leachate exceeded the US EPA drinking water standard of 10 mg L−1 in all the treatment columns. The highest flow‐weighted mean concentrations of TP and DRP, at 2.7 and 2.5 mg L−1, respectively, were recorded in the upslope columns. Soil physicochemical properties and nutrient leaching losses varied substantially across topographical positions, indicating a need for variable litter application rates to reduce P build‐up and subsequent leaching in vulnerable locations within the field. The relevance of the effect of topographic position on nutrient leaching found in this study should be further tested by investigating a wider range of slopes and soil types in pastures.

ABSTRACTMucosal immunity is important in protecting from upper respiratory tract influenza infection. Human challenge provides a unique model to define correlates of protection with baseline immune responses being correlated to the quantity and length of viral shedding and clinical outcomes. Here, we discuss recent work on mucosal and systemic correlates of protection (R. Bean, L. T. Giurgea, A. Han, L. Czajkowski, et al., mBio 15:e02372-23, 2024, https://doi.org/10.1128/mbio.02372-23) and place it in the context of previous work on mucosal immunity. We also discuss the importance of standardized assays to allow global comparison of relevant immune responses in defining correlates of protection. Correlates of protection are important for designing next-generation broadly protective influenza vaccines.

Abstract Background Automated identification of spectral domain optical coherence tomography (SD-OCT) features can improve retina clinic workflow efficiency as they are able to detect pathologic findings. The purpose of this study was to test a deep learning (DL)-based algorithm for the identification of Idiopathic Full Thickness Macular Hole (IFTMH) features and stages of severity in SD-OCT B-scans. Methods In this cross-sectional study, subjects solely diagnosed with either IFTMH or Posterior Vitreous Detachment (PVD) were identified excluding secondary causes of macular holes, any concurrent maculopathies, or incomplete records. SD-OCT scans (512 × 128) from all subjects were acquired with CIRRUS™ HD-OCT (ZEISS, Dublin, CA) and reviewed for quality. In order to establish a ground truth classification, each SD-OCT B-scan was labeled by two trained graders and adjudicated by a retina specialist when applicable. Two test sets were built based on different gold-standard classification methods. The sensitivity, specificity and accuracy of the algorithm to identify IFTMH features in SD-OCT B-scans were determined. Spearman’s correlation was run to examine if the algorithm’s probability score was associated with the severity stages of IFTMH. Results Six hundred and one SD-OCT cube scans from 601 subjects (299 with IFTMH and 302 with PVD) were used. A total of 76,928 individual SD-OCT B-scans were labeled gradable by the algorithm and yielded an accuracy of 88.5% (test set 1, 33,024 B-scans) and 91.4% (test set 2, 43,904 B-scans) in identifying SD-OCT features of IFTMHs. A Spearman’s correlation coefficient of 0.15 was achieved between the algorithm’s probability score and the stages of the 299 (47 [15.7%] stage 2, 56 [18.7%] stage 3 and 196 [65.6%] stage 4) IFTMHs cubes studied. Conclusions The DL-based algorithm was able to accurately detect IFTMHs features on individual SD-OCT B-scans in both test sets. However, there was a low correlation between the algorithm’s probability score and IFTMH severity stages. The algorithm may serve as a clinical decision support tool that assists with the identification of IFTMHs. Further training is necessary for the algorithm to identify stages of IFTMHs.

Basal‐like breast cancer (BBC) and glioblastoma multiforme (GBM) are aggressive cancers associated with poor prognosis. BBC and GBM have stem cell‐like gene expression signatures, which are in part driven by forkhead box O (FOXO) transcription factors. To gain further insight into the impact of FOXO1 in BBC, we treated BT549 cells with AS1842856 and performed RNA sequencing. AS1842856 binds to unphosphorylated FOXO1 and inhibits its ability to directly bind to DNA. Gene Set Enrichment Analysis indicated that a set of WNT pathway target genes, including lymphoid enhancer‐binding factor 1 (LEF1) and transcription factor 7 (TCF7), were robustly induced after AS1842856 treatment. These same genes were also induced in GBM cell lines U87MG, LN18, LN229, A172, and DBTRG upon AS1842856 treatment. By contrast, follow‐up RNA interference (RNAi) targeting of FOXO1 led to reduced LEF1 and TCF7 gene expression in BT549 and U87MG cells. In agreement with RNAi experiments, CRISPR Cas9‐mediated FOXO1 disruption reduced the expression of canonical WNT genes LEF1 and TCF7 in U87MG cells. The loss of TCF7 gene expression in FOXO1 disruption mutants was restored by exogenous expression of the DNA‐binding‐deficient FOXO1‐H215R. Therefore, FOXO1 induces TCF7 in a DNA‐binding‐independent manner, similar to other published FOXO1‐activated genes such as TCF4 and hes family bHLH transcription factor 1. Our work demonstrates that FOXO1 promotes canonical WNT gene expression in examined BBC and GBM cells, similar to results found in Drosophila melanogaster, T‐cell development, and murine acute myeloid leukemia models.

Hydrogen has gained tremendous momentum worldwide as an energy carrier to transit to a net zero-emission energy sector. It has been widely adopted as a promising large-scale renewable energy (RE) storage solution to overcome RE resources’ variability and intermittency nature. The fuel cell (FC) technology became in focus within the hydrogen energy landscape as a cost-effective pathway to utilize hydrogen for power generation. Therefore, FC technologies’ research and development (R&D) expanded into many pathways such as cost reduction, efficiency improvement, fixed and mobile applications, lifetime, safety and regulations, etc. Many publications and industrial reports about FC technologies and applications are available. This raised the necessity for a holistic review study to summarize the state-of-the-art range of FC stacks, such as manufacturing, the balance of plant, types, technologies, applications and R&D opportunities. At the beginning the principal technologies to compare the well-known types, followed by the FC operating parameters, are presented. Then the FC balance of the plant, i.e., building components and materials with its functionality and purpose, types and applications, are critically reviewed with their limitations and improvement opportunities. Subsequently, the electrical properties of FCs with their key features, including advantages and disadvantages, were investigated. Applications of FCs in different sectors are elaborated with their key characteristics, current status and future R&D opportunities. Economic attributes of fuel cells with a pathway towards low cost are also presented. Finally, this study identifies the research gaps and future avenues to guide researchers and the hydrogen industry.

Vigna radiata (L.) R. Wilczek, generally known as mung bean, is a crucial pulse crop in Southeast Asia that is renowned for its high nutritional value. However, its cultivation faces substantial challenges due to numerous abiotic stresses. Here, we investigate the influence of salt and drought stress on mung bean genotypes by evaluating its morpho-physiological traits and biochemical characteristics. This phenotypic analysis revealed that both salt and drought stress adversely affected mung bean, which led to reduced plant height, leaf senescence, loss of plant biomass, and premature plant death. Reactive oxygen species (ROS) production increased under these abiotic stresses. In response, to prevent damage by ROS, the plant activates defense mechanisms to scavenge ROS by producing antioxidants. This response was validated through morpho-physiological, histological, and biochemical assays that characterized KVK Puri-3 and KVK Jharsuguda-1 as salt and drought sensitive genotypes, respectively, and Pusa ratna was identified as a drought and salt tolerant genotype.

Abstract Background Lysine carbamylation is a biomarker of rheumatoid arthritis and kidney diseases. However, its cellular function is understudied due to the lack of tools for systematic analysis of this post-translational modification (PTM). Methods We adapted a method to analyze carbamylated peptides by co-affinity purification with acetylated peptides based on the cross-reactivity of anti-acetyllysine antibodies. We also performed immobilized-metal affinity chromatography to enrich for phosphopeptides, which allowed us to obtain multi-PTM information from the same samples. Results By testing the pipeline with RAW 264.7 macrophages treated with bacterial lipopolysaccharide, 7,299, 8,923 and 47,637 acetylated, carbamylated, and phosphorylated peptides were identified, respectively. Our analysis showed that carbamylation occurs on proteins from a variety of functions on sites with similar as well as distinct motifs compared to acetylation. To investigate possible PTM crosstalk, we integrated the carbamylation data with acetylation and phosphorylation data, leading to the identification 1,183 proteins that were modified by all 3 PTMs. Among these proteins, 54 had all 3 PTMs regulated by lipopolysaccharide and were enriched in immune signaling pathways, and in particular, the ubiquitin-proteasome pathway. We found that carbamylation of linear diubiquitin blocks the activity of the anti-inflammatory deubiquitinase OTULIN. Conclusions Overall, our data show that anti-acetyllysine antibodies can be used for effective enrichment of carbamylated peptides. Moreover, carbamylation may play a role in PTM crosstalk with acetylation and phosphorylation, and that it is involved in regulating ubiquitination in vitro. Graphical Abstract Video Abstract

Abstract Objectives Malignant gastric outlet obstruction (GOO) has traditionally been managed with enteral stenting and surgical gastrojejunostomy. Our study aimed to compare outcomes between endoscopic ultrasound‐guided gastrojejunostomy (EUS‐GJ) using a lumen‐apposing metal stent and robotic GJ (R‐GJ) for unresectable malignant GOO. Methods Patients undergoing EUS‐GJ or R‐GJ for unresectable malignant GOO were retrospectively analyzed. The primary outcome was clinical success defined by the ability to tolerate oral intake at the time of discharge. Secondary outcomes included technical success, procedure duration, adverse events, and post‐procedure length of stay (LOS). Results A total of 44 patients met the inclusion criteria. Of the 44, 29 underwent EUS‐GJ and 15 underwent R‐GJ. Age, gender, malignant etiology, and presence of ascites were similar between the two groups. Patients treated with EUS‐GJ had a higher mean Charlson comorbidity index (10.3 vs. 7.0; p ≤ 0.0001) and a lower preoperative body mass index (22.3 vs. 27.2; p = 0.007). Technical and clinical success was achieved in 100% of patients in both groups (p > 0.99). EUS‐GJ was associated with shorter procedure duration (57.5 vs. 146.3 min; p < 0.0001), hospital LOS (4.3 vs. 8.2 days, p = 0.0009), and time to oral intake (1.0 vs. 5.8 days; p < 0.0001) when compared to R‐GJ. Adverse events occurred in 5 of the R‐GJ patients and none of the EUS‐GJ patients (p = 0.003). Conclusions EUS‐GJ has similar efficacy and superior clinical outcomes compared to R‐GJ in the management of malignant GOO. Prospective studies with longer follow‐up duration are needed to validate these findings.

In this study, charged AdS black holes with a string cloud are taken into consideration. We identify three distinct black hole solutions within a specific temperature range, which subsequently merge into a single black hole beyond this range in the case of spherical space with low chemical potential and string density. However, in the case of large chemical potential and string density, only one black hole solution exists for all temperatures. Notably, we observe that for flat and hyperbolic space, there is only one black hole solution irrespective of the chemical potential and string density. By subtracting the contribution of the extremal black hole from the on-shell Euclidean action, the thermodynamical quantities associated with these black holes are calculated. We also investigate the stability of these black holes and find that medium-sized black hole is unstable. In the dual boundary theory side we verify the existence of bound state of quark-antiquark pair. Finally, we establish the Cardy-Verlinde formula for the boundary theory and we observed an additional energy term arising because of the presence of string cloud.

Objective Patients with moderate aortic stenosis (AS) exhibit high morbidity and mortality. Limited evidence exists on the role of aortic valve replacement (AVR) in this patient population. To investigate the benefit of AVR in moderate AS on survival and left ventricular function.Methods In a retrospective cohort study, patients with moderate AS between 2008 and 2016 were selected from the Cleveland Clinic echocardiography database and followed until 2018. Patients were classified as receiving AVR or managed medically (clinical surveillance). All-cause and cardiovascular mortality were assessed by survival analyses. Temporal haemodynamic and structural changes were assessed with longitudinal analyses using linear mixed effects models.Results We included 1421 patients (mean age, 75.3±5.4 years and 39.9% women) followed over a median duration of 6 years. Patients in the AVR group had lower risk of all-cause (adjusted HR (aHR)=0.51, 95% CI: 0.34 to 0.77; p=0.001) and cardiovascular mortality (aHR=0.50, 95% CI: 0.31 to 0.80; p=0.004) compared with those in the clinical surveillance group irrespective of sex, receipt of other open-heart surgeries and underlying malignancy. These findings were seen only in those with preserved left ventricular ejection fraction (LVEF) ≥50%. Further, patients in the AVR group had a significant trend towards an increase in LVEF and a decrease in right ventricular systolic pressure compared with those in the clinical surveillance group.Conclusions In patients with moderate AS, AVR was associated with favourable clinical outcomes and left ventricular remodelling.

Transcatheter aortic valve replacement is not widely used in patients with congenital heart disease. We describe our single-center experience of transcatheter aortic valve replacement in congenital heart disease, demonstrating short-term feasibility and safety, role in lifetime management of congenital aortic valve disease, and use as a bridge to recovery, future surgery, or transplantation.

Background Patients who experience in-hospital ST-segment elevation myocardial infarction (iSTEMI) represent a uniquely high-risk cohort owing to delays in diagnosis, prolonged time to reperfusion and increased mortality. Quality initiatives aimed at improving the care of this vulnerable, yet understudied population are needed.Methods This study included consecutive patients with iSTEMI treated with percutaneous coronary intervention (PCI) between 1 January 2011 and 15 July 2019 at a single, tertiary referral centre. A comprehensive iSTEMI protocol (CSP) was implemented on 15 July 2014, incorporating: (1) cardiology fellow activation of the catheterisation lab using standardised criteria, (2) nursing chest pain protocol, (3) improved electronic access to electrocardiographic studies, (4) checklist for initial triage and management, (5) 24/7/365 catheterisation lab readiness and (6) radial-first PCI approach. Key metrics and clinical outcomes were compared before and after CSP implementation.Results Among 125 total subjects, the post-CSP cohort (n=81) was younger, had more males and were more likely to be hospitalised for cardiac-related reasons relative to the pre-CSP cohort (n=44) who were more likely hospitalised for operative-related aetiologies. After CSP adoption, median ECG-to-first-device-activation time decreased from 113 min to 64 min (p

Abstract Background Retinal diseases, including wet or dry age-related macular degeneration, diabetic macular edema, and diabetic retinopathy (DR), are underdiagnosed and undertreated in the United States. Clinical trials support the effectiveness of anti-vascular endothelial growth factor (anti-VEGF) therapies for several retinal conditions, but real-world data suggest underuse by clinicians, resulting in patients experiencing poorer visual outcomes over time. Continuing education (CE) has demonstrated effectiveness at changing practice behaviors, but more research is needed to understand whether CE can help address diagnostic and treatment gaps. Methods This test and control matched pair analysis examined pre-/post-test knowledge of retinal diseases and guideline-based screening and intervention among 10,786 healthcare practitioners (i.e., retina specialists, ophthalmologists, optometrists, primary care providers, diabetes educators, pharmacists/managed care specialists, and other healthcare providers, such as registered nurses, nurse practitioners, and physician assistants) who participated in a modular, interactive CE initiative. An additional medical claims analysis provided data on practice change, evaluating use of VEGF-A inhibitors among retina specialist and ophthalmologist learners (n = 7,827) pre-/post-education, compared to a matched control group of non-learners. Outcomes were pre-/post-test change in knowledge/competence and clinical change in application of anti-VEGF therapy, as identified by the medical claims analysis. Results Learners significantly improved knowledge/competence scores on early identification and treatment, identifying patients who could benefit from anti-VEGF agents, using guideline-recommended care, recognizing the importance of screening and referral, and recognizing the importance of early detection and care for DR (all P-values = 0.003 to 0.004). Compared with matched controls, learners’ incremental total injections for anti-VEGF agents for retinal conditions increased more after the CE intervention (P

Left ventricular (LV) longitudinal function is mechanically coupled to the elasticity of the ascending aorta (AA). The pathophysiologic link between a stiff AA and reduced longitudinal strain and the subsequent deterioration in longitudinal LV systolic function is likely relevant in heart failure with preserved ejection fraction (HFpEF). The proposed therapeutic effect of freeing the LV apex and allowing for LV inverse longitudinal shortening was studied in silico utilizing the Living Left Heart Human Model (Dassault Systémes Simulia Corporation). LV function was evaluated in a model with (A) an elastic AA, (B) a stiff AA, and (C) a stiff AA with a free LV apex. The cardiac model simulation demonstrated that freeing the apex caused inverse LV longitudinal shortening that could abolish the deleterious mechanical effect of a stiff AA on LV function. A stiff AA and impairment of the LV longitudinal strain are common in patients with HFpEF. The hypothesis-generating model strongly suggests that freeing the apex and inverse longitudinal shortening may improve LV function in HFpEF patients with a stiff AA.

During systole, longitudinal shortening of the left ventricle (LV) displaces the aortic root toward the apex of the heart and stretches the ascending aorta (AA). An in silico study (Living Left Heart Human Model, Dassault Systèmes Simulia Corporation) demonstrated that stiffening of the AA affects myocardial stress and LV strain patterns. With AA stiffening, myofiber stress increased overall in the LV, with particularly high-stress areas at the septum. The most pronounced reduction in strain was noted along the septal longitudinal region. The pressure–volume loops showed that AA stiffening caused a deterioration in LV function, with increased end-systolic volume, reduced systolic LV pressure, decreased stroke volume and effective stroke work, but elevated end-diastolic pressure. An increase in myofiber contractility indicated that stroke volume and effective stroke work could be recovered, with an increase in LV end-systolic pressure and a decrease in end-diastolic pressure. Longitudinal and radial strains remained reduced, but circumferential strains increased over baseline, compensating for lost longitudinal LV function. Myofiber stress increased overall, with the most dramatic increase in the septal region and the LV apex. We demonstrate a direct mechanical pathophysiologic link between stiff AA and reduced longitudinal left ventricular strain which are common in patients with HFpEF.

Bicuspid aortic valve (BAV) is a common congenital valvular malformation, which may lead to early aortic valve disease and bicuspid-associated aortopathy. A novel BAV classification system was recently proposed to coincide with transcatheter aortic valve replacement being increasingly considered in younger patients with symptomatic BAV, with good clinical results, yet without randomized trial evidence. Procedural technique, along with clinical outcomes, have considerably improved in BAV patients compared with tricuspid aortic stenosis patients undergoing transcatheter aortic valve replacement. The present review summarizes the novel BAV classification systems and examines contemporary surgical and transcatheter approaches.

Abstract Broiler litter (BL), a byproduct of the broiler (Gallus gallus sp.) production cycle, can be regarded as a beneficial organic source to supply essential nutrients for crop growth. Understanding BL nutrient mineralization helps producers better manage nutrients on farms. However, the effects of BL age (length of time BL stays in poultry house before it is cleaned out, also known as the clean out frequency of BL) and application rate on the mineralization of BL nutrients are still poorly understood. Therefore, a 150‐day laboratory incubation study investigated the influence of BL age (6, 18, and 30 months) and application rate (5 and 10 Mg ha−1) on nutrient mineralization. The experimental design was a completely randomized design with three replications. Soil samples were collected at day 0, 10, 30, 60, 90, 120, and 150 and analyzed for nitrogen (N) species nitrate, ammonium, total N, and water‐extractable nutrients (water‐extractable phosphorus, potassium [WEK], calcium [WECa], magnesium [WEMg], iron [WEFe], copper [WECu], zinc (WEZn), boron [WEB], and manganese [WEMn]). Results showed that BL nutrient mineralization was affected by BL age or application rate, except WEFe. A greater amount of nitrate‐N was released during the first month, suggesting faster nitrification during the first 30 days after application. Mineral N (sum of nitrate‐ and ammonium‐N) release was more significant with the increasing age of BL and application rate. Greater availability of WEK, WECa, WEMg, and WEB was found in 18‐ and 30‐month BL from 10 Mg ha−1, and lowest in 6‐month BL from 5 Mg ha−1, whereas 6‐month BL with 10 Mg ha−1 has the greatest WECu. Our results suggested that older BL (30 months) with a greater application rate (10 Mg ha−1) had greater nutrient supply potential.

Introduction Catecholamine vasopressors such as norepinephrine are the standard drugs used to maintain mean arterial pressure during liver transplantation. At high doses, catecholamines may impair organ perfusion. Angiotensin II is a peptide vasoconstrictor that may improve renal perfusion pressure and glomerular filtration rate, a haemodynamic profile that could reduce acute kidney injury. Angiotensin II is approved for vasodilatory shock but has not been rigorously evaluated for treatment of hypotension during liver transplantation. The objective is to assess the efficacy of angiotensin II as a second-line vasopressor infusion during liver transplantation. This trial will establish the efficacy of angiotensin II in decreasing the dose of norepinephrine to maintain adequate blood pressure. Completion of this study will allow design of a follow-up, multicentre trial powered to detect a reduction of organ injury in liver transplantation.Methods and analysis This is a double-blind, randomised clinical trial. Eligible subjects are adults with a Model for End-Stage Liver Disease Sodium Score ≥25 undergoing deceased donor liver transplantation. Subjects are randomised 1:1 to receive angiotensin II or saline placebo as the second-line vasopressor infusion. The study drug infusion is initiated on reaching a norepinephrine dose of 0.05 µg kg-1 min-1 and titrated per protocol. The primary outcome is the dose of norepinephrine required to maintain a mean arterial pressure ≥65 mm Hg. Secondary outcomes include vasopressin or epinephrine requirement and duration of hypotension. Safety outcomes include incidence of thromboembolism within 48 hours of the end of surgery and severe hypertension. An intention-to-treat analysis will be performed for all randomised subjects receiving the study drug. The total dose of norepinephrine will be compared between the two arms by a one-tailed Mann-Whitney U test.Ethics and dissemination The trial protocol was approved by the local Institutional Review Board (#20–30948). Results will be posted on ClinicalTrials.gov and published in a peer-reviewed journal.Trial registration number ClinicalTrials.govNCT04901169

This article uses the FP-LAPW approach within the DFT method, and the quasi-harmonic Debye model to investigate the electronic and thermodynamic properties of intermetallic rare earth materials (such as SmInZn, SmInCd, and SmTlZn). Thermodynamic properties were determined by the quasi-harmonic Debye model, whereas the FP-LAPW approaches within DFT method were utilized to derive electronic properties. The calculated structural parameters and the available experimental data have been examined, and it was observed that there was a good agreement between available experimental and calculated values of structural parameters. The electronic behavior of SmInZn, SmInCd and SmTlZn compounds shows the metallic character. We have examined a few thermodynamic characteristics. All calculated characteristics were found to match experimental or theoretical calculations.

Summary: In several long-lived Caenorhabditis elegans strains, such as insulin/IGF-1 receptor daf-2 mutants, enhanced proteostatic mechanisms are accompanied by elevated intestinal lipid stores, but their role in longevity is unclear. Here, while determining the regulatory network of the selective autophagy receptor SQST-1/SQSTM1, we uncovered an important role for lipid droplets in proteostasis and longevity. Using genome-wide RNAi screening, we identified several SQST-1 modulators, including lipid droplets-associated and aggregation-prone proteins. Expansion of intestinal lipid droplets by silencing the conserved cytosolic triacylglycerol lipase gene atgl-1/ATGL enhanced autophagy, and extended lifespan. Notably, a substantial amount of ubiquitinated proteins were found on lipid droplets. Reducing lipid droplet levels exacerbated the proteostatic collapse when autophagy or proteasome function was compromised, and significantly reduced the lifespan of long-lived daf-2 animals. Altogether, our study uncovered a key role for lipid droplets in C. elegans as a proteostatic mediator that modulates ubiquitinated protein accumulation, facilitates autophagy, and promotes longevity.

Patients with severe tricuspid regurgitation and right ventricular dysfunction have limited therapeutic options due to anatomic complexity, advanced disease at presentation, and comorbidities. Caval valve implantation is an emerging transcatheter therapy. We present a case series of contrast-sparing caval valve implantation using intravascular ultrasound guidance in patients with renal failure. (Level of Difficulty: Advanced.)

Objective: Hesperetin is a natural flavonoid with antioxidant potential and can be used to treat disorders of the brain. Therefore, present study is designed to investigate effect of hesperetin on dimethylsulphoxide induced cognitive dysfunction mediated through oxidative stress marker and neuroinflammation in hippocampus Methodology: The experiment was conducted using five treatment groups, each group consisting six rats. Group 1 (control) received 1 ml/kg normal saline interperitoneally for 14 days. Group 2 received 1 ml/kg DMSO per oral for14 days. Group 3 received donepezil 3 mg/kg per day for 14 days and DMSO (1 ml/kg p.o.) for 14th day. Group 4 and 5 received a dose of 25 mg /kg of hesperetin (H1) and 50 mg/kg hesperetin (H2) per oral, per day for 14 days, respectively. Hesperetin was dissolved in DMSO to get 25 mg/ml solution. On 14th day, the memory of rats was assessed by Cook's pole climbing apparatus and Morris water maze test. On 15th day, six rats of each group were sacrificed and the isolated brain tissues were subjected for the estimation of biochemical parameters, beta actin blot analysis and histopathological examination. Results: The DMSO treated rats showed significantly enhanced escape latency time (P

Introduction: Depression is the more common mental health condition found among the chronic diseases. The prevalence of both diabetes and depression are rapidly increasing and the presence of depression in patients with type 2 diabetes could hinder the adherence and effectiveness of treatment. Objective: This study aimed to estimate the prevalence of depression and to identify the factors influencing depression among patients with type 2 diabetes mellitus in Non Communicable Disease(NCD) clinic. Method: A cross – sectional study was conducted among Type 2 diabetes mellitus attending the NCD clinic of the urban health training centre between January and April 2021. Demographic, clinical and diabetes related information was collected through a semi – structured questionnaire. Level of depression was assessed using a standard questionnaire (PHQ – 9 questionnaire). The total score of 5 – 9, 10 – 14 and >15 were graded as mild, moderate and severe forms of depression respectively. Data analysis was done using SPSS software version 21. The mean age of the study subjects was 53 7 yrs and majority (60%) Results: + were males. The prevalence of depression was 30.8 % and among them 71.7 % had mild depression while 12.8 % had severe form of depression. Factors such as female gender, higher educational status and substance use such as alcohol and smoking were found to be significantly associated with the presence of depression. It is imperative to screen for depression and lay emphasis on counseling services Conclusion: for the effectivemanagement of diabetes therebyimprove the quality of theirlife.

Background Peripheral vascular intervention (PVI) is occasionally required to facilitate delivery system insertion or to treat vascular complications during transfemoral transcatheter aortic valve replacement (TF‐TAVR). However, the impact of PVI on outcomes is not well understood. Therefore, we aimed to compare outcomes between TF‐TAVR with versus without PVI and between TF‐TAVR with PVI versus non‐TF‐TAVR. Methods and Results We retrospectively reviewed 2386 patients who underwent TAVR with a balloon‐expandable valve at a single institution from 2016 to 2020. The primary outcomes were death and major adverse cardiac/cerebrovascular event (MACCE), defined as death, myocardial infarction, or stroke. Of 2246 TF‐TAVR recipients, 136 (6.1%) required PVI (89% bailout treatment). During follow‐up (median 23.0 months), there were no significant differences between TF‐TAVR with and without PVI in death (15.4% versus 20.7%; adjusted HR [aHR], 0.96 [95% CI, 0.58–1.58]) or MACCE (16.9% versus 23.0%; aHR, 0.84 [95% CI, 0.52–1.36]). However, compared with non‐TF‐TAVR (n=140), TF‐TAVR with PVI carried significantly lower rates of death (15.4% versus 40.7%; aHR, 0.42 [95% CI, 0.24–0.75]) and MACCE (16.9% versus 45.0%; aHR, 0.40 [95% CI, 0.23–0.68]). Landmark analyses demonstrated lower outcome rates following TF‐TAVR with PVI than non‐TF‐TAVR both within 60 days (death 0.7% versus 5.7%, P=0.019; MACCE 0.7% versus 9.3%; P=0.001) and thereafter (death 15.0% versus 38.9%, P=0.014; MACCE 16.5% versus 41.3%, P=0.013). Conclusions The need for PVI during TF‐TAVR is not uncommon, mainly due to the bailout treatment for vascular complications. PVI is not associated with worse outcomes in TF‐TAVR recipients. Even when PVI is required, TF‐TAVR is associated with better short‐ and intermediate‐term outcomes than non‐TF‐TAVR.

Background: The incidence of button battery ingestion has increased over time along with its most alarming complications including tracheoesophageal fistula. Historically this issue has been treated with sternotomy and closure of the fistula. However, morbidity and mortality of this invasive approach can be improved upon. Methods: This is an expert report from a tertiary care center, utilizing an adult biliary stent for closure of a giant 2 cm traumatic TEF secondary to a button battery ingestion in a 9 month old. Results: The patient's fistula healed with this radical approach and demonstrated a full return to swallowing, without invasive operative interventions. Conclusion: We present a radical approach with successful treatment of a TEF. This is the first study of its kind to utilize adult biliary stents for closure of a traumatic TEF in an infant. Level of evidence: V.