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Objective: Hemodialysis access-induced distal ischemia (HAIDI) is a known complication of hemodialysis (HD) access. Distal revascularization and interval ligation (DRIL) is the preferred treatment for HAIDI by many surgeons. Proximalization of arterial inflow (PAI) is a promising alternative technique that, unlike DRIL, preserves the native arterial inflow. The purpose of this study is to report our experience with PAI on a series of 64 patients., Methods: This is a single-center, retrospective cohort study of patients with both arteriovenous (AV) fistulas and grafts who underwent PAI for HAIDI from 2017 to 2023. A 4 × 7 tapered polytetrafluoroethylene (PTFE) graft was used to connect HD access inflow to the axillary artery in the majority of cases. The primary outcome of the study is resolution of HAIDI (complete, partial, or no resolution). Secondary outcomes include functional patency (primary and secondary) and 30-day complications following PAI., Results: Of the 71 patients identified to have had PAI between May 2017 to August 2023, seven were lost to follow-up. In total, 64 patients were included, with an average age of 65 years (standard deviation, 15 years), 59.4% (38/64) female, and 37.5% (24/64) African American. The study population was notable for numerous comorbid conditions including 95.3% (61/64) hypertension; 50% (32/64) coronary artery disease; 79.7% (51/64) diabetes; and 43.8% (28/64) smoking history. Following PAI intervention for HAIDI, 55 of 64 patients (85.9%) experienced complete resolution of ischemic symptoms; five of 64 patients (7.8%) had partial resolution; two of 64 patients (3.1%) had no resolution, and two of 64 patients (3.1%) had unknown resolution. Primary patency at 1, 12, and 24 months was 94%, 81%, and 71%, respectively. Secondary patency at 1, 12, and 24 months was 97%, 87%, and 84%, respectively. The 30-day complication rate was 10.9% (7/64), with five of 64 (7.8%) thromboses, one of 64 (1.6%) thrombosis and infection, and one of 64 (1.6%) upper extremity swelling secondary to central venous stenosis (resolved with angioplasty of central venous system). Failure rate due to thrombosis at 12 and 24 months was 14% (9/64) and 15.6% (10/64), respectively., Conclusions: Our study, the largest case series of PAI to date, demonstrates that PAI is a reliable option for HAIDI intervention and has comparable safety and efficacy results to DRIL, despite the use of a synthetic graft. Furthermore, PAI has the added benefit of maintaining the native arterial pathway. Further investigation of PAI is warranted as a promising alternative to DRIL for HAIDI management., Competing Interests: Disclosures None., (Copyright © 2024 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

The need for bioresorbable implants that are able to dissolve within the body is rising, unlike their traditional counterparts. Bulk metallic glasses (BMGs) can perhaps serve this need, since they possess incredible properties, including high biocompatibility by virtue of their amorphous structure and absence of dislocations. However, the fabrication of BMGs is challenging, since, to achieve an amorphous structure, fast cooling is a pre-requisite which is very difficult to achieve for casting due to the fact that fast cooling rate and adequate rate of filling of the mold possess a trade-off relationship. Therefore, purpose of this work is to develop a simple novel hybrid approach that is cost effective and attempts to synthesize BMG based on Mg-Ca-Zn constituent. Synthesis of bioresorbable material was attempted by hybridizing friction stir processing (FSP) technique with gas tungsten arc welding (GTAW). FSP was performed with Magnesium as base material and Calcium granules as reinforcement. After FSP, GTAW process was performed by using Zn as filler material. The added Ca and Zn were found to effectively intermix with the Mg matrix in the FSP and GTAW steps, respectively. Especially, a relatively invariable distribution of Ca phases was observed in the stirred microstructure after FSP. Finally, a wide bead consisting of mixed dendritic and columnar cast structure was obtained. The current work is expected to alleviate the physiological issues pertaining to orthopaedic fixations and decrease the need for secondary surgeries in geriatric fractures., Competing Interests: None., (© 2022 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.)

Macular infarction is a visually disabling condition caused by a variety of reasons. It has rarely been described in association with blunt ocular trauma. We describe the case of a young healthy male who sustained injury with a bull's leg and presented with severe visual loss owing to macular infarction and traumatic optic neuropathy. This report of an angiographically documented macular infarct secondary to ocular contusion highlights an additional feature in the spectrum of ocular findings following blunt trauma that might lead to a severe and permanent affliction of vision.

Two antigens ('cattle' type and 'Indian Bison' type) of Mycobacterium avium subspecies paratuberculosis were evaluated for diagnosis of Johne's disease (JD) in a gaushala (cattle herd). Of the 160 cows of Sahiwal and Hariana breeds screened, 81 (50.6%) tested positive in ELISA and 66 (41.8%) in AGPT test. Using the two antigens, 33.5% tested positive in both the tests while 41.1% tested negative. Exclusively, only 8.2% tested positive in ELISA while 17.1% tested positive in AGPT. Two antigens together detected 58.9% prevalence of MAP in the gaushala. Individually, indigenous ELISA using antigen from native source of MAP proved superior to AGPT in the diagnosis of JD in cows.

The initial presentation and diagnosis of an aviator with a pigmented skin lesion. The epidemiology of the skin cancer epidemic, including melanoma is discussed. Prognostic implications of melanoma and the U.S. Air Force experience with melanoma in aircrew are also depicted.

Purpose: The purpose of this paper is to highlight the importance of cultivating belongingness within an organization. This paper will also indicate ways human resources (HR) practitioners can enhance inclusivity and foster a more diverse workplace. Design/methodology/approach: This paper is written for practitioners who want to create a more inclusive organization. Exploring lessons learned from an environment seemingly disparate from a typical workplace revealed common generalizable themes. HR practitioners can use these themes to better understand the need for an intentionally designed workplace that prioritizes belonging as a means of improving overall organizational efficiency. Findings: Organizations compete globally for market share and consumers, who are nonhomogeneous. Attracting, retaining and growing a diverse talent pool that is representative of their heterogeneous customers will help organizations better understand and adjust to dynamic market demands. Research shows that promoting diversity, inclusion and belongingness in the workplace oftentimes enhances employee performance, improves organizational culture and increases profitability. Originality/value: Learnings from outdoor adventure sports are explored to garner insight for HR professionals seeking to enhance diversity and inclusion. This paper proposes three ways HR professionals could foster a more diverse environment where employees will be more engaged, empowered and fulfilled: create safe spaces, open access to opportunities and cultivate belongingness. [ABSTRACT FROM AUTHOR]

Introduction: This study investigated the role of family communication patterns and birth order in the identity state of adolescents. Materials and Methods: The method of this research was descriptive and correlational. The statistical population of the study included 9th grade female students in Hamadan-Iran in the academic year of 2017-2018. Ninety students were selected through the convenient sampling method. The research tools were the Ritchie and Fitzpatrick Family Communication Pattern Questionnaire and the Bennion and Adams Identity Status Questionnaire. We analyzed the data using the Pearson correlation coefficient and multiple regression analysis. Results: The findings showed a positive and significant relationship between conversation pattern and achievement identity and a negative relationship with diffusion, foreclosure, and moratorium identities (P< 0.05). The conformity pattern has a positive and significant relationship with foreclosure and diffusion identities (P< 0.05). The birth order also had a positive and significant relationship with moratorium identity (P< 0.05), and the conformity pattern has a positive and significant role in predicting diffusion (P< 0.01) and foreclosure identity (P< 0.05). The birth order only has a significant role in predicting moratorium identity (P< 0.01). Conclusion: It seems that family communication patterns and birth order can predict adolescent identity states. [ABSTRACT FROM AUTHOR]

Background: To analyze the clinical profile, presentation, possible pathophysiology, and outcomes of central retinal artery occlusion (CRAO) following blunt trauma in pediatric subjects. Methodology: The medical charts of subjects aged 18 years or less with a diagnosis of CRAO following blunt ocular trauma were analyzed retrospectively for demography, details of the trauma, ocular findings, additional imaging reports if any, and final outcome. A Medline search was done (key words like central retinal artery occlusion, blunt trauma, children, pediatric subjects, and adolescents) to gather information available in the literature on the subject. Results: A total of 11 patients (11 eyes), mean age of 14.3 ± 3.4 years, and 100% male preponderance, with an average time duration from trauma to presentation to the hospital of 8.1 days were included. Visual acuity ranged from no light perception (four eyes) to finger count at a 1 m distance. Intraocular pressure was raised in three patients, of which two were suffering from sickle cell disease. In two eyes, the CRAO coexisted with optic nerve avulsion and the cilioretinal artery was spared. Disk pallor was seen in six eyes as early as 12 days from the trauma. None of the cases revealed any bony fracture in the CT scan. Conclusion: CRAO was observed to be an important primary or contributory cause of visual loss in children following blunt trauma, reflex vasospasm being the most common etiology. Early onset disk pallor could suggest an underlying vascular compromise of both retinal and optic disk circulation in addition to direct disk damage. [ABSTRACT FROM AUTHOR]

Herein, the promising world of nanoporous gold (NPG) as an electrode material for energy storage and conversion is reviewed. NPG has excellent conductivity and a porous structure, providing a huge active surface area for deposition of transition metal atoms and electrochemically active materials. Moreover, NPG materials display high intrinsic activity because of their crystallographic structural defects to catalyze hosts of electrochemical reactions, considered pertinent in clean energy technologies. Therefore, taking into account their superior specific and mass activity, they provide a versatile platform for developing high‐performance catalysts for oxidation and reduction reactions, supercapacitors, and battery‐type electrode materials for the assembly of high density electric energy storage devices. Initially, a full overview of the strategies used to build NPG structures and incorporate other metallic elements in the pore walls is presented. Afterward, the water‐splitting parameters and performance of NPG catalysts for hydrogen generation are reviewed. Next, the possibility of using such porous materials as fuel cell electrodes is discussed. In short, the most recent advancements in the field paving the way for the preparation of advanced electrode materials meeting the most stringent requirements are reviewed, demonstrating the bright perspectives for innovation in the key area of energy conversion and storage. [ABSTRACT FROM AUTHOR]

While Appreciative Intelligence® – the capacity to reframe and see the potential in any situation and act on it with success – has generated a robust body of literature, scholarly advancement of this construct has been hampered by the lack of a validated instrument. Over two studies, we develop the Appreciative Intelligence® Scale (AIS), a 26-item survey organized into six factors. Study 1 explores the factor structure of the AIS using EFA. Study 2 uses hierarchical confirmatory factor analysis (HCFA) and hierarchical regression analyses to provide evidence for its convergent, discriminant, and criterion-related validity. The results support the priori six-factor structure of the AIS, indicating it is a valid measure of Appreciative Intelligence® useful in predicting proactive behavior at the individual, team, and organizational levels. [ABSTRACT FROM AUTHOR]

Sub-macular hemorrhage (SMH) is a hematic collection between the neurosensory retina and the retinal pigment epithelium; one of its causes is ocular blunt trauma, that usually affects young patients. Persisting SMH leads to a damage of photoreceptors mediated by three main mechanisms: iron-related toxicity, impairment of diffusion of oxygen and nutriment, mechanical damage due to clot contraction. Since early photoreceptors' damage has been reported within 24 h, it is suggested to provide an early treatment, although there are no guidelines or consensus between authors regarding treatment strategies. The aim of this review was to present and compare available treatment options, like intravitreal tissue plasminogen activator (tPA) associated with pneumatic displacement, pneumatic displacement alone, subretinal tPA injection with pneumatic displacement, and intravitreal anti-vascular endothelial growth factor (VEGF) injection. All procedures obtained consistent results, though the most effective seemed to be pars plana vitrectomy, subretinal tPA and gas tamponade, probably due to a quicker liquefaction and displacement of the clot. Limitations concern the greater invasiveness and the higher incidence of complications. Alternatively, intravitreal injection of tPA and gas may represent a less invasive option with fewer complications. Intravitreal injection of gas and prone position could be preferred in young patients without coexisting ocular pathology, being a minimally invasive treatment, with lower risk of complications and a good visual recovery. Anti-VEGF agent have found, to date, limited employment in cases of traumatic SMH even though they may be useful as alternative or adjuvant therapy. Most of the published literature consists of small studies and case reports, therefore further investigations and larger clinical trials are required to fully understand safety and efficacy of the procedures. A preoperative comprehensive evaluation may be helpful to realize a surgical plan tailored on patient. [ABSTRACT FROM AUTHOR]

Malignant ectomesenchymoma (MEM) is an exceedingly rare rapidly progressing tumor of soft tissues of the central nervous system, believed to be derived from neural crest cells. The majority of cases have been observed in young children or adolescents. So far only 11 patients with intracranial manifestations (with confirmed clinicopathological data) have been documented. We report the first case of adult intracranial MEM in a 54‐year‐old man who presented with a 4 months history of headache and weakness of right side of the body. Magnetic resonance imaging showed a homogenously enhanced dural‐based lesion in the left fronto‐temporo‐parietal lobe with significant perilesional edema and mass effect. No metastatic disease was identified and the lesion was grossly resected. Histopathological and immunohistochemical examination revealed mature and immature neurons and bizarre astrocytes admixed with a mesenchymal spindle cell (rhabdomyoblastic) component. Specific risk factors that contribute toward the development of MEM are unknown. Due to the scarcity of reported cases the role of adjuvant therapy is unclear. [ABSTRACT FROM AUTHOR]

The article describes the case of a 14-year-old boy who, distracted by the mobile phone game Pokéemon GO, fell and completely lost vision in his left eye.

Propionibacterium acnes ( P. acnes), the sebaceous gland and follicular keratinocytes are considered the three actors involved in the development of acne. This exploratory study investigated the characteristics of the skin microbiota in subjects with acne and determined microbiota changes after 28 days of application of erythromycin 4% or a dermocosmetic. Skin microbiota were collected under axenic conditions from comedones, papulo-pustular lesions and non-lesional skin areas from subjects with mild to moderate acne according to the GEA grading using swabs. Samples were characterized using a high-throughput sequencing approach that targets a portion of the bacterial 16S rRNA gene. Overall, microbiota samples from 26 subjects showed an overabundance of Proteobacteria and Firmicutes and an under-representation of Actinobacteria. Staphylococci were more abundant on the surface of comedones, papules and pustules ( P=.004 and P=.003 respectively) than on non-lesional skin. Their proportions increased significantly with acne severity ( P<.05 between GEA-2 and GEA-3). Propionibacteria represented less than 2% of the bacteria on the skin surface. At Day 28, only the number of Actinobacteria had decreased with erythromycin while the dermocosmetic decreased also the number of Staphylococci. A significant reduction ( P<.05) from Day 0 of comedones, papules and pustules with no significant difference between the products was observed. The bacterial diversity on all sampling areas was similar. The dermocosmetic decreased the number of Actinobacteria and Staphylococcus spp. after 28 days. Staphylococcus remained the predominant genus of the superficial skin microbiota. No significant reduction in Staphylococcus spp. was observed with the topical antibiotic. [ABSTRACT FROM AUTHOR]

The article focuses on the study that examines the effectiveness of sleep medication for athletes to reduce illness and injury rates. It offers brief overview of the method of the study to determine the relationship between sleep loss and athletes' performance. It also outline the result of the study which indicates that the positive outcome of the medication and suggests that they should be flexible in terms of drug of choice.

Melatonin, secreted nocturnally by the pineal gland, is an endogenous sleep regulator. Impaired melatonin production and complaints on poor quality of sleep are common among the elderly. Non-restorative sleep (perceived poor quality of sleep) and subsequently poor daytime functioning are increasingly recognized as a leading syndrome in the diagnostic and therapeutic process of insomnia complaints. The effects of 3-weeks prolonged-release melatonin 2 mg (PR-melatonin) versus placebo treatment were assessed in a multi-center randomized placebo-controlled study in 170 primary insomnia outpatients aged ≥55 years. Improvements in quality of sleep (QOS) the night before and morning alertness (BFW) were assessed using the Leeds Sleep Evaluation Questionnaire and changes in sleep quality (QON) reported on five categorical unit scales. Rebound insomnia and withdrawal effects following discontinuation were also evaluated. PR-melatonin significantly improved QOS (−22.5 versus −16.5 mm, P = 0.047), QON (0.89 versus 0.46 units; P = 0.003) and BFW (−15.7 versus −6.8 mm; P = 0.002) compared with placebo. The improvements in QOS and BFW were strongly correlated (Rval = 0.77, P < 0.001) suggesting a beneficial treatment effect on the restorative value of sleep. These results were confirmed in a subgroup of patients with a greater symptom severity. There was no evidence of rebound insomnia or withdrawal effects following treatment discontinuation. The incidence of adverse events was low and most side-effects were judged to be of minor severity. PR-melatonin is the first drug shown to significantly improve quality of sleep and morning alertness in primary insomnia patients aged 55 years and older-suggesting more restorative sleep, and without withdrawal symptoms upon discontinuation. [ABSTRACT FROM AUTHOR]