Impact of vitamin D on maternal and fetal health: A review

The role of vitamin D in improving maternal health and reducing the risk of developmental disorders in fetus has been an important domain of research since the past few years. Vitamin D, owing to its immunomodulatory, anti‐inflammatory, developmental roles, and regulating calcium homeostasis, is predicted to have a significant influence on maternal and fetal health status. Several observational studies and clinical trials, determining the impact of vitamin D on gestational diabetes, C‐section, postpartum depression, pre‐eclampsia, miscarriages, and preterm delivery, have been elaborated in this review. In addition, fetal birth defects including neurological development, reduced birth weight, respiratory infections, bone development, and altered anthropometrics have also been summarized with available evidences. Other important mechanisms related to the roles of vitamin D in the body are also explained. Furthermore, recent studies determining the effect of vitamin D at genetic level will also help in understanding and future design of research in the area of maternal and fetal health.

Relationship of maternal factors and obstetric complications with term singleton vs term twin neonatal outcomes: A retrospective study in China

Background

Neonatal birth weight and length are important indicators of neonatal survival and morbidity during later life and are influenced by maternal factors and obstetrical complications. Therefore, we aimed to determine the relationship of maternal factors and obstetric complications with term singleton vs term twin neonatal outcomes in Wuhan University Renmin Hospital, Hubei, China.

Methods

A total of 10517 neonatal births were recorded in a tertiary-hospital-based retrospective study and term singleton (n=7787) and term twins (n=169) were included for data analysis. Birth weight and birth length were measured immediately after birth. Correlation, independent student t-test, and backward multiple linear regression were used for statistical analysis.

Results

Women with singleton gestation have an increased rate of obstetric complications compared to women with twin gestation. However, a higher frequency of cesarean section and breech were found in twin gestation compared to singleton gestation. Weight before pregnancy, gestational weight gain, and gestational diabetes mellitus were significantly positive (p<0.05) associated with singleton neonatal birth length and weight. In contrast, preeclampsia, placenta previa, oligohydramnios, premature rupture of membrane, breech, and multiparity had a significantly negative (p<0.05) association with singleton neonatal birth length and weight. Maternal age was significantly positive (p<0.05) associated with only singleton neonatal birth weight. Moreover, the nuchal cord was significantly positive (p<0.05) associated with singleton neonatal birth length. On the other hand, maternal age and multiparity were significantly positive (p<0.05) associated with twins' neonatal birth length and weight. Furthermore, gestational weight gain was significantly positive (p<0.05) associated with only twins' neonatal birth weight.

Conclusion

In term gestation, obstetric complications were significantly associated with singleton birth size rather than twin birth size.

Deeply Virtual Compton Scattering Cross Section at High Bjorken x_{B}

We report high-precision measurements of the deeply virtual Compton scattering (DVCS) cross section at high values of the Bjorken variable x_{B}. DVCS is sensitive to the generalized parton distributions of the nucleon, which provide a three-dimensional description of its internal constituents. Using the exact analytic expression of the DVCS cross section for all possible polarization states of the initial and final electron and nucleon, and final state photon, we present the first experimental extraction of all four helicity-conserving Compton form factors (CFFs) of the nucleon as a function of x_{B}, while systematically including helicity flip amplitudes. In particular, the high accuracy of the present data demonstrates sensitivity to some very poorly known CFFs.

Outcomes of Vasoconstrictor-Induced Non-Occlusive Mesenteric Ischemia of Colon: A Systematic Review

BACKGROUND

Nonocclusive mesenteric ischemia (NOMI) is due to mesenteric arterial hypoperfusion from several causes, such as hypovolemia, heart failure, shock, vasoconstrictors, and severe liver or renal disease. Vasoconstrictor-induced NOMI is usually iatrogenic or associated with cocaine use.

OBJECTIVES

Anecdotal reports suggest that cocaine-induced NOMI has the highest mortality among vasoconstrictors. This review aims to compare the outcomes of colonic NOMI secondary to cocaine versus other vasoconstrictors.

METHODS

We conducted a systematic search of MEDLINE from inception through October 2016 to find articles on colonic NOMI. The study's primary outcomes were mortality and hospital length of stay (LOS), while secondary outcomes included the need for surgery. We reported descriptive statistics as percentages or median and interquartile range (IQR). We compared continuous data with the Mann-Whitney test and categorical data with Fisher's exact test; P < 0.05 was statistically significant.

RESULTS

Of the 59 studies, 20 case reports and 3 case series (n= 27 patients) met the inclusion criteria. There was no difference in mortality between cocaine-induced NOMI and non-cocaine NOMI (P=1.0). There were statistically significant differences between cocaine and non-cocaine vasoconstrictor-induced colonic NOMI regarding surgery (60% vs. 5.8%, P=0.03) and median LOS (7 days vs. 4 days, P=0.04).

CONCLUSION

Cocaine-induced NOMI and non-cocaine NOMI both appear to have a relatively high but similar mortality rate, but the former is associated with increased requirement for surgery and LOS; prompt recognition of this clinical entity is required to improve outcomes.

Efficacy and the safety of endoscopic ultrasound guided radiofrequency ablation of pancreatic cancer: A systematic review and meta-analysis

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Background: Endoscopic ultrasound-guided RFA (EUS-RFA) is a minimally invasive emerging modality that may be an alternative to surgical resection for the management of unresectable pancreatic cancer (UPC). In this review, we highlighted the efficacy, clinical and technical success of the EUS-RFA for UPC. Methods: Studies were selected with a comprehensive search strategy for EUS-RFA and pancreatic cancer on PubMed, Google Scholar, and Embase databases as of October 2021. The primary outcomes were the technical (TS) and clinical success rate (CS) of the EUS-RFA procedure, while the secondary outcome was the adverse events (AEs) rate. Results: Twelve studies including 114 patients with 50% (57) females were included. Common pancreatic tumors were locally advanced pancreatic ductal adenocarcinoma (LAPDAC) 38.3% (49), followed by nonfunctional neuroendocrine tumor (NNET) 32% (41), pancreatic cystic neoplastic lesions 14.8% (19), insulinoma 12.5% (16) and others 2.3% (3). The most common site of the tumor was pancreatic head 45.7% (59) followed by body, neck, and tail 47.6% (61). The average number of ablation sessions per patient was 1.4 based on the total of 115 EUS-RFA sessions performed in 84 neoplastic lesions. The pooled TS rate of EUS-RFA calculated from the total number of procedures was 99.2% [95% CI = 0.90-0.98, I2 = 0%]. The pooled CS rate calculated from the total number of pancreatic lesions was 91.9% [95% CI = 0.77-0.92, I2 = 0%]. Clinical improvement in symptoms was reported in five studies whereas complete resolution or decrease in tumor size was reported in all studies. The pooled AEs rate was 24.6% [95% CI = 0.17-0.39, I2 = 30%]. Common AEs were abdominal pain 10.5% (12), and pancreatitis 3.5% (4). Conclusions: EUS-RFA is a promising and safe modality that can be used for the management of UPC in selected patients with a high TS (99.2%) and CS rates (91.9%). Large clinical trials are needed to identify safety, clinical outcomes, and overall survival benefits of EUS-RFA.[Table: see text]

Exploring the linkage between export diversification and ecological footprint: evidence from advanced time series estimation techniques

In recent literature, scholars discussed the role of export diversification in environmental quality. However, most studies analyzed the role of export diversification in influencing carbon dioxide emissions with mixed results. However, since carbon dioxide emissions specifically capture the environmental effects of energy utilization, a change in the level of carbon dioxide emissions cannot be regarded as a comprehensive measure of environmental deterioration. Also, many previous studies use the original form of the Theil index to measure export diversification, and during the interpretation of the results, they disregard the fact that the lower value of the Theil index indicates higher diversification and vice versa. In this context, to address these gaps in the literature, a study on the contribution of export diversification in ecological footprint is necessary to understand the ecological impacts of export diversification. Therefore, this study analyzes the contribution of export diversification in ecological footprint covering the period between 1965 and 2017 using the STIRPAT model in the context of India which is required to fulfill the demands for resources of over 1.3 billion people. The study relied on the environmental Kuznets curve hypothesis framework to understand the role of export diversification in ensuring environmental sustainability. Using the newly developed Augmented ARDL test, the study established that variables of interest are cointegrated. In the long-run estimation, export diversification reduces the ecological footprint of India and helps establish the inverted-U-shaped nexus between ecological footprint and economic growth. Thus, the environmental Kuznets curve hypothesis was evidenced to hold for India. This important finding divulges that India can control the level of environmental footprints, and therefore decrease environmental degradation by continuously increasing export product diversification. Also, India is on the right path to achieve a reduction in ecological footprint associated with more development when accounting for export diversification in the model. Moreover, energy intensity boosts environmental deterioration, while population density reduces it. Finally, the study discusses strategies to achieve environmental sustainability through increasing export diversification.

Measurement of Compton Scattering at MAMI for the Extraction of the Electric and Magnetic Polarizabilities of the Proton

A precise measurement of the differential cross sections dσ/dΩ and the linearly polarized photon beam asymmetry Σ_{3} for Compton scattering on the proton below pion threshold has been performed with a tagged photon beam and almost 4π detector at the Mainz Microtron. The incident photons were produced by the recently upgraded Glasgow-Mainz photon tagging facility and impinged on a cryogenic liquid hydrogen target, with the scattered photons detected in the Crystal Ball/TAPS setup. Using the highest statistics Compton scattering data ever measured on the proton along with two effective field theories (both covariant baryon and heavy-baryon) and one fixed-t dispersion relation model, constraining the fits with the Baldin sum rule, we have obtained the proton electric and magnetic polarizabilities with unprecedented precision: α_{E1}=10.99±0.16±0.47±0.17±0.34, β_{M1}=3.14±0.21±0.24±0.20±0.35; in units of 10^{-4}  fm^{3} where the errors are statistical, systematic, spin polarizability dependent, and model dependent.

Revisiting the EKC hypothesis by assessing the complementarities between fiscal, monetary, and environmental development policies in China

Recently, China has declared its national objective of becoming carbon neutral by 2060. Hence, mitigating carbon dioxide emissions has become an important agenda of the Chinese government. Against this backdrop, this paper aims to evaluate the effectiveness of pursuing expansionary fiscal and monetary policies on China's carbon dioxide emission figures by using annual frequency data from 1980 to 2018. Accordingly, this study considers the levels of government expenditure and broad money supply as fiscal and monetary policy instruments, respectively. Besides accounting for structural break concerns in the data, the findings from the empirical analysis reveal that there are long-run associations between carbon dioxide emissions, economic growth, and fiscal and monetary expansion in China. Moreover, the results also show that in both the short- and long-run expansionary fiscal policy trigger higher carbon dioxide emissions while expansionary monetary policy inhibits the carbon dioxide emission figures of China. Furthermore, the results invalidate the existence of the Environmental Kuznets Curve hypothesis since the relationship between China's economic growth and carbon dioxide emissions is evidenced to portray an N-shape. In line with these findings, it is recommended that China achieve environmentally sustainable economic growth by aligning the national fiscal and monetary policies with the 2060 carbon-neutrality objective.

Effects of economic complexity, economic growth, and renewable energy technology budgets on ecological footprint: the role of democratic accountability

The economic structure of countries can influence economic growth, energy demand, and environmental footprints. However, the literature on economic complexity and ecological footprint (EFP) nexus is scarce. Besides, democracy is an important factor that may affect environmental policies and environmental sustainability. Hence, this paper investigates the effect of democracy, economic complexity, and renewable energy technology budgets on the EFP in G7 countries controlling income and financial development from 1985 to 2017. The findings from Westerlund (J Appl Econ 23:193-233, 2008) and other cointegration methods depict cointegration among variables. The long-run estimates from the continuously updated fully modified method unfold that economic complexity contributes to reducing the EFP. However, greater democratic accountability boosts the EFP figures rather than reducing them. On the flipside, renewable energy technology budgets and financial development are evidenced to mitigate EFP. Moreover, the study unveils a U-shaped linkage between economic growth and EFP, which indicates that an increase in income level will boost EFP. Further, the study found causality from economic complexity, democracy, and renewable energy budgets to EFP. Based on these findings, it is pertinent for the G7 countries to increase the manufacturing of sophisticated and complex products. In addition, enhancing renewable energy technology budgets is essential to ensure environmental well-being.

The long-run relationship between energy consumption, oil prices, and carbon dioxide emissions in European countries

Global climate change brings environmental quality sensitivity, especially in European countries. In this context, European countries are striving to achieve carbon neutrality by 2050. Renewable energy use can be an effective way to curtail the increasing environmental degradation. How the oil prices shape the energy use pattern and environmental quality remains unclear to date. Therefore, the present research examines the linkage between energy use (non-renewable and renewable energy), oil prices, and CO₂ emissions in 30 European countries between 1997 and 2017. The study applied fully modified ordinary least squares (FMOLS), Westerlund (2007) cointegration and the Driscoll-Kraay Regression tests to explore these associations. The result of individual samples and the full sample provides the same intimations for the use of energy in Europe. The outcomes of the research ratify the existence of a long-run relationship among variables and found that non-renewable energy consumption increases CO₂ emissions, while renewable energy consumption mitigates CO₂ emissions. Furthermore, when the oil prices rise, people switch towards substitute energy sources that reduce CO₂ emissions. Based on the results, the study suggests that European countries should increase the share of renewable energy, promote the use of clean energy resources, and discourage fossil fuel energy consumption to ensure sustainability.

iThermo: A Sequence-Based Model for Identifying Thermophilic Proteins Using a Multi-Feature Fusion Strategy

Thermophilic proteins have important application value in biotechnology and industrial processes. The correct identification of thermophilic proteins provides important information for the application of these proteins in engineering. The identification method of thermophilic proteins based on biochemistry is laborious, time-consuming, and high cost. Therefore, there is an urgent need for a fast and accurate method to identify thermophilic proteins. Considering this urgency, we constructed a reliable benchmark dataset containing 1,368 thermophilic and 1,443 non-thermophilic proteins. A multi-layer perceptron (MLP) model based on a multi-feature fusion strategy was proposed to discriminate thermophilic proteins from non-thermophilic proteins. On independent data set, the proposed model could achieve an accuracy of 96.26%, which demonstrates that the model has a good application prospect. In order to use the model conveniently, a user-friendly software package called iThermo was established and can be freely accessed at http://lin-group.cn/server/iThermo/index.html. The high accuracy of the model and the practicability of the developed software package indicate that this study can accelerate the discovery and engineering application of thermally stable proteins.

Form Factors and Two-Photon Exchange in High-Energy Elastic Electron-Proton Scattering

We present new precision measurements of the elastic electron-proton scattering cross section for momentum transfer (Q^{2}) up to 15.75  (GeV/c)^{2}. Combined with existing data, these provide an improved extraction of the proton magnetic form factor at high Q^{2} and double the range over which a longitudinal or transverse separation of the cross section can be performed. The difference between our results and polarization data agrees with that observed at lower Q^{2} and attributed to hard two-photon exchange (TPE) effects, extending to 8  (GeV/c)^{2} the range of Q^{2} for which a discrepancy is established at >95% confidence. We use the discrepancy to quantify the size of TPE contributions needed to explain the cross section at high Q^{2}.

The trade-off between energy consumption, economic growth, militarization, and CO2 emissions: does the treadmill of destruction exist in the modern world?

Militarization is crucial for the sovereignty of a nation; however, there are many environmental hazards associated with increased military spending. Previous panel studies mainly captured the short-run effects of militarization on the environment. Limited scholars determined the long-run environmental impacts of militarization but they mostly ignored possible cross-sectional dependence and heterogeneity problems in panel data. Our research highlights this deeply neglected area and examines the impact of militarization on the environment in 22 OECD countries by controlling economic growth, renewable energy, and fossil fuel consumption. Drawing on an extensive dataset from 1971 to 2020, we employed advanced econometric approaches robust against endogeneity, heterogeneity, and cross-sectional dependence. The results of the cross-sectional augmented autoregressive distribute lag (CS-ARDL) analysis indicate a positive contribution of militarization to CO₂ emissions implying that militarization is adding to the environmental degradation in OECD nations. This evidence proves the treadmill of destruction theory for OECD nations in the modern world. Economic growth and fossil fuels consumption increase CO₂ emissions, while renewable energy mitigates emissions. Moreover, economic growth Granger causes militarization. Our results suggest that reduction in militarization level and energy conservation strategies will not hamper the economic progress of selected OECD countries.

Characterization and optimization of ZnS thin film properties synthesis via chemical bath deposition method for solar cell buffer layer

Zinc Sulphide is one of most studied semiconductor with wide band gap (3.5–3.9 eV) versatile material due to its physical and chemical properties. ZnS is a non-toxic material and a suitable candidate to be a buffer layer for heterojunction solar cells. In this study, Zinc Sulphide (ZnS) thin films were deposited by chemical bath deposition technique using Zinc Acetate Dihydrate [Zn (CH3COO)2. 2H2O] and Thiourea [CH4N2S]. The ZnS thin films samples were characterized by UV-Vis NIR Spectroscopy, X-ray diffraction (XRD), Scanning Electron Microscopy (SEM), Energy Dispersive Spectroscopy (EDX), Fourier-Transform Infrared Spectroscopy (FTIR) and Thin-Film Measurement Instrument. FTIR spectra confirmed the presence of ZnS bond in the crystalline thin film. XRD data confirmed the cubic structure of the deposited thin film only when the amount of Thiourea was increased and the complexing agent Hydrazine Hydrate was replaced with Tri-Sodium Citrate. Crystallite size and strain were estimated using Debye-Scherrer model and Williamson-Hall model and lattice constant was estimated using Nelson-Riley plot. Otherwise, XRD showed the amorphous phase. UV-Vis data confirmed ZnS thin films as enough transmittive and it showed higher bandgap. Thin-Film Measurement Instrument was used to measure the thickness of the ZnS thin films. Synthesized ZnS thin films exhibited promising characteristics for using as the buffer layer of the heterojunction solar cells. Highlights • ZnS thin films were prepared successfully by simple, low cost and environment friendly chemical bath deposition method. • XRD measurement confirmed both Amorphous and Crystalline phase of ZnS thin films. • By changing the precursor only can be achieved crystalline phase from amorphous phase of ZnS thin film. • The amount of precursor and deposition conditions can be optimized to produce crystalline ZnS thin film.

Is there a tradeoff between financial globalization, economic growth, and environmental sustainability? An advanced panel analysis

In recent years, many empirical studies investigated the effects of globalization on the ecological footprint (EF). Most of these studies relied on the KOF index of globalization and studied the effects of total globalization and disaggregated impacts of economic, social, and political globalization on the EF. However, less attention has been given to financial globalization which can also influence the EF. Hence, this study investigates the association between financial globalization (FG), economic growth (GDP), and EF controlling population density (PD) in the selected West Asian and the Middle East (WAME) nations from 1990 to 2017. The study relied upon second-generation methods for checking stationary properties and Westerlund and other techniques to scrutinize cointegration. The evidence showed cointegration in the model. The long-run approximations from continuously updated fully modified (CUP-FM) and continuously updated bias corrected (CUP-BC) tests divulge that financial globalization is an important factor to promote ecological sustainability in the sample countries because it decreases EF. Population density exacerbates EF and worsens environmental deterioration in sample countries. The study detected the environmental Kuznets curve (EKC) between EF and economic growth in the presence of financial globalization and population density. Besides, financial globalization Granger causes EF, while the feedback effect exists between EF and economic growth. Based on these results, WAME economies can accomplish ecological sustainability and sustainable development by enhancing their financial globalization levels.

Do natural gas, oil, and coal consumption ameliorate environmental quality? Empirical evidence from Russia

Environmental degradation stemming from the combustion of conventional energy sources is not only a major factor behind climate change but it also poses an adverse impact on human health. Undoubtedly, fossil fuels are major drivers of economic growth; however, their detrimental environmental impacts are of global concern. In the literature, there is no comprehensive empirical evidence on the linkage between the use of different energy sources and carbon dioxide emissions in the context of Russia, a nation that is ranked third in the list of the top carbon dioxide-emitting global countries. Hence, this paper aims to scrutinize the relationships between oil consumption, natural gas consumption, coal consumption, and carbon dioxide emissions controlling economic growth for Russia over the 1990-2016 period. The findings from the econometric analysis indicate that carbon dioxide emissions in Russia have long-run associations with economic growth and consumption of oil, gas, and coal. The long-run elasticity estimates reveal that economic growth is not directly harming Russia's environmental quality. However, higher oil, gas, and coal consumption degrades environmental quality by boosting the level of carbon dioxide emissions in Russia. In addition, the results from the Granger causality analysis confirm the existence of both long and short-term causal connections among the variables of concern. In line with these findings, several policy recommendations to address the environmental challenges in Russia are put forward.

The asymmetric associations between foreign direct investment inflows, terrorism, CO2 emissions, and economic growth: a tale of two shocks

Foreign direct investments can exert ambiguous effects on the environmental quality of the host economies. At the same time, terrorism is a worldwide phenomenon that affects human life, FDI inflows, economic growth, and, most importantly, environmental well-being. Hence, it can be expected that there are relationships between terrorism, foreign direct investment inflows, and carbon dioxide emissions. However, in the previous literature, less attention has been given to explore these nexuses. In addition, the possible non-linearities in data are also mostly ignored in the preceding related studies. Against this backdrop, this paper explores the linear and non-linear influences of terrorism and foreign direct investment inflows on carbon dioxide emissions, controlling for energy consumption and economic growth within the model, on carbon dioxide emissions in the context of ten global economies that are most impacted by terrorism. To this end, we used the data from 1973 to 2016 and deployed the linear and non-linear autoregressive distributed lag methods to scrutinize the environmental impacts of the explanatory variables of concern. The results confirmed the presence of non-linearities in the relationships between terrorism, inflows of foreign direct investments, and carbon dioxide emissions. Furthermore, the findings revealed that the positive shocks to terrorism and foreign direct investment inflows significantly deteriorate the environment with a dominating effect. Unlike the previous studies, this current study validates the pollution haven hypothesis for the sample economies. Energy consumption and economic growth  were also evidenced to exacerbate the carbon dioxide emission levels in all selected countries. Based on these results, we recommend that our sample economies should focus on promoting education, employment, economic stability, and public awareness to eradicate terrorism which, in turn, can mitigate the emissions of carbon dioxide further. In addition, stringent environmental regulations on foreign direct investment inflows are required to reduce the adverse environmental effects of such sources of foreign finance. Furthermore, the international firms should be encouraged to invest in cleaner technologies by offering them tax benefits and other financial incentives.

Reinvigorating the role of clean energy transition for achieving a low-carbon economy: evidence from Bangladesh

Achieving carbon-neutrality has become a global agenda following the ratification of the Paris Agreement. For the developing countries, in particular, attaining a low-carbon economy is particularly important since these economies are predominantly fossil-fuel dependent, to which Bangladesh is no exception. Therefore, this study specifically aimed at evaluating the environmental impacts associated with energy consumption and other key macroeconomic variables in the context of Bangladesh over the 1975-2016 period. As opposed to the conventional practice of using carbon dioxide emissions to proxy environmental quality, this study makes a novel attempt to use the carbon footprints to measure environmental welfare in Bangldesh. The outcomes from this study are expected to facilitate the carbon-neutrality objective of Bangladesh and, therefore, enable the nation to comply with its commitments concerning the attainment of the targets enlisted under the Paris Agreement and the United Nations Sustainable Development Goals declarations. The econometric analysis involved the application of methods that are suitable for handling the structural break issues in the data. The overall findings from empirical exercises reveal that aggregate energy consumption, fossil fuel consumption, and natural gas consumption boost the carbon footprint figures of Bangladesh. In contrast, nonfossil fuel consumption and hydroelectricity consumption are witnessed to abate the carbon footprint levels. Besides, economic growth and international trade are also evidenced to further increase the carbon footprints. Hence, these findings suggest that a clean energy transition within the Bangladesh economy can be the panacea to the nation's persitently aggravating environmental hardships. Furthermore, the causality analysis confirmed the presence of unidirectional causalities stemming from total energy consumption, fossil fuel consumption, natural gas consumption, hydroelectricity consumption, economic growth, and international trade to the carbon footprints. On the other hand, nonfossil fuel consumption is found to be bidirectionally associated with carbon footprints. In line with these aforementioned findings, several key policy suggestions are put forward regarding the facilitation of the carbon-neutrality agenda in Bangladesh.

Conservative management of Occult Hemothorax in trauma patients requiring assisted ventilation: An observational descriptive study

Background: Traumatic hemothorax is a common consequence of blunt chest trauma. A hemothorax that is missed by initial chest X-ray, but diagnosed by computed tomography (CT), is known as an occult hemothorax. The present study aims at investigating the clinical outcomes of conservative management of occult hemothorax in mechanically ventilated trauma patients. Methods: A retrospective study of all adult blunt chest trauma patients with occult hemothorax requiring mechanical ventilation in a level 1 trauma center was conducted (2010- 2017). Data were obtained from the trauma registry and electronic medical records. Patients were categorized into (a) successful conservative treatment group, and (b) tube thoracostomy group. Results: During the study period, 78 blunt chest trauma patients who had occult hemothorax required mechanical ventilation. Occult hemothorax was managed conservatively in 69% of the patients, while 31% underwent tube thoracostomy. The main indication for tube thoracostomy was the progression of hemothorax on follow-up chest radiographs. Comparison between groups showed that pulmonary contusions (59% vs. 83%), bilateral hemothorax (26% vs. 58%) and chest infections (9% vs. 29%) were lower in conservatively treated group (p < 0.05). Length of stays in ICU and hospital were also lower (p < 0.05). Longer duration of mechanical ventilation and maximum PEEP were significantly associated with tube thoracostomy. Overall mortality was 12% and was comparable between groups. Conclusion: Mechanically ventilated patients with occult hemothorax following blunt chest trauma can be managed conservatively without tube thoracostomy. Tube thoracostomy can be restricted to patients who had evidence of progression of hemothorax on follow-up or developed respiratory compromise.

The nexus between road transport intensity and road-related CO2 emissions in G20 countries: an advanced panel estimation

This study determines the dynamic linkages between road transport intensity, road transport passenger and road transport freight, and road carbon emissions in G20 countries in the presence of economic growth, urbanization, crude oil price, and trade openness for the period of 1990 to 2016, under the multivariate framework. This study employs the residual-based Kao and Westerlund cointegration technique to find long-run cointegration, and continuously updated bias-corrected (CUP-BC) and continuously updated fully modified (CUP-FM) methods to check the long-run elasticities between the variables. The long-run estimators' findings suggest a positive and significant impact of road transport intensity, road passenger transport, road freight transport on road transport CO₂ emissions. Economic growth and urbanization are significant contributing factors in road transport CO₂ emissions, while trade openness and crude oil price significantly reduce road transport CO₂ emissions. The Dumitrescu and Hurlin causality test results disclose unidirectional causality from road transport intensity and road transport freight to the road transport CO₂ emissions. However, the causality between road passenger transport and road transport CO₂ emissions is bidirectional. Finally, comprehensive policy options like subsidizing environmental-friendly technologies, developing green transport infrastructure, and enacting decarbonizing regulations are suggested to address the G20 countries' environmental challenges.

Linking financial development, economic growth, and ecological footprint: what is the role of technological innovation?

The literature analyzing the ecological impacts of financial development (FD) documents mixed results. In addition, very limited researches consider the role of technological innovation in ecological sustainability even though technological innovation is indispensable to achieve technological advancement, which may help in sustainable development and ecological sustainability. Therefore, this work probes the effects of technological innovation, financial development, and economic growth (GDP) on the ecological footprint (EF) controlling urbanization and employing a STIRPAT framework. The analysis of data from West Asia and Middle East nations from 1990 to 2017 revealed cointegration in the model. The long-run coefficients produced by the continuously updated fully modified technique revealed that a 1% upsurge in technological innovation decreases EF by 0.010%. Interestingly, technological innovation is helpful to decrease EF and enhance economic growth in the West Asia and Middle East (WAME) countries. However, a 1% rise in FD boosts the level of EF by 0.0016% inferring that FD stimulates ecological degradation. Likewise, urbanization in the WAME countries raises EF levels and contributes adversely to ecological quality. In addition to this, the study revealed the environmental Kuznets curve hypothesis in the selected countries accounting for technological innovation, FD, and urbanization in the model. The causal analysis provided evidence of unidirectional causality from FD to EF and bidirectional causality between technological innovation and EF. The study recommends more investment in research and development and strong collaboration between the universities and industries to promote the level of technological innovation for both sustainable development and ecological sustainability. In addition, urban sustainability policies are necessary without decreasing the urbanization level.

Protocol design and preliminary evaluation of the REAL-Health Triple Aim, an open-cohort CVD-care optimisation initiative

Introduction

Effective treatment of cardiovascular disease (CVD) in primary care could be improved. We aim to assess the efficacy of a scalable treatment optimisation programme in unselected community populations in South East England, with the triple aim of improved blood pressure control in people with hypertension, increased high-intensity statin use in people with CVD and reduced gastrointestinal bleeding in patients on antithrombotic medication.

Method

This observational study comprises an open cohort of approximately 200,000 adults at high cardiovascular risk registered with general practitioners in five South East England Clinical Commissioning Groups (CCGs). An intervention programme is planned in four of these CCGs with a further non-intervention CCG acting as a control group. The intervention will consist of: clinical guidelines and educational outreach; virtual patient-reviews software; peer-performance “dashboards” and, where available, financial incentives.

The study will examine 3 primary outcomes: 1. Diagnosed hypertension with a blood pressure &lt;140/90mmHg; 2. Diagnosed CVD on a high-intensity statin; 3. A cardiovascular indication for antithrombotic therapy with one or more factors for increased risk of gastrointestinal bleeding (e.g. age ≥65) on gastroprotection. A further 17 secondary outcomes related to these three aims will be assessed.

Analysis

We will use an interrupted time series analysis over 18 months, representing the pre-implementation, implementation and the post-implementation phases with comparison to the control CCG and applicable national Quality and Outcomes Framework and national prescribing statistics (e.g. OpenPrescribing). Secondary outcomes include an equity impact analysis with results stratified by age, gender, ethnic group and index of deprivation.

Preliminary data

We present preliminary data on Key Performance Indicators (KPIs) collected from 191 GP practices including [percentage achievement on 01/09/2019, on 01/09/2020]: 1. Patients with hypertension and most recent blood pressure ≤140/90mmHg [68.7%, 60.6%]. 2. Patients eligible for treatment with a high-intensity statin on such treatment [53.8%, 55.8%]. 3. Patients on antithrombotics with ≥1 risk factors for gastrointestinal bleeding on gastroprotection [59.0%, 60.1%]. We also present our virtual patient-review software tool and outcome visualisation dashboard.

Conclusion

The REAL-Health Triple Aim initiative is a large-scale primary care cardiovascular risk reduction initiative which was launched almost contemporaneously with the United Kingdom's first SARS-CoV-2 related lockdown. Preliminary data justify the need for the Triple Aim initiative and give us an insight on the impact of the pandemic on its implementation.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): Barts CharityBritish Heart Foundation

Deep Exclusive Electroproduction of π^{0} at High Q^{2} in the Quark Valence Regime

We report measurements of the exclusive neutral pion electroproduction cross section off protons at large values of x_{B} (0.36, 0.48, and 0.60) and Q^{2} (3.1 to 8.4  GeV^{2}) obtained from Jefferson Lab Hall A experiment E12-06-014. The corresponding structure functions dσ_{T}/dt+εdσ_{L}/dt, dσ_{TT}/dt, dσ_{LT}/dt, and dσ_{LT^{'}}/dt are extracted as a function of the proton momentum transfer t-t_{min}. The results suggest the amplitude for transversely polarized virtual photons continues to dominate the cross section throughout this kinematic range. The data are well described by calculations based on transversity generalized parton distributions coupled to a helicity flip distribution amplitude of the pion, thus providing a unique way to probe the structure of the nucleon.

Improved Constraints on Primordial Gravitational Waves using Planck, WMAP, and BICEP/Keck Observations through the 2018 Observing Season

We present results from an analysis of all data taken by the BICEP2, Keck Array, and BICEP3 CMB polarization experiments up to and including the 2018 observing season. We add additional Keck Array observations at 220 GHz and BICEP3 observations at 95 GHz to the previous 95/150/220  GHz dataset. The Q/U maps now reach depths of 2.8, 2.8, and 8.8  μK_{CMB} arcmin at 95, 150, and 220 GHz, respectively, over an effective area of ≈600 square degrees at 95 GHz and ≈400 square degrees at 150 and 220 GHz. The 220 GHz maps now achieve a signal-to-noise ratio on polarized dust emission exceeding that of Planck at 353 GHz. We take auto- and cross-spectra between these maps and publicly available WMAP and Planck maps at frequencies from 23 to 353 GHz and evaluate the joint likelihood of the spectra versus a multicomponent model of lensed ΛCDM+r+dust+synchrotron+noise. The foreground model has seven parameters, and no longer requires a prior on the frequency spectral index of the dust emission taken from measurements on other regions of the sky. This model is an adequate description of the data at the current noise levels. The likelihood analysis yields the constraint r_{0.05}<0.036 at 95% confidence. Running maximum likelihood search on simulations we obtain unbiased results and find that σ(r)=0.009. These are the strongest constraints to date on primordial gravitational waves.

Protective effects of vitexin on cadmium-induced renal toxicity in rats

Cadmium (Cd) is an industrial contaminant that poses severe threats to human and animal health. Vitexin (VIT) is a polyphenolic flavonoid of characteristic pharmacological properties. We explored the curative role of vitexin on Cd-induced mitochondrial-dysfunction in rat renal tissues. Twenty-four rats were equally divided into four groups and designated as control, Cd, Cd + vitexin and vitexin treated groups. The results showed that Cd exposure increased urea and creatinine levels while decreased creatinine clearance. Cd reduced the activities of antioxidant enzymes, i.e., catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx) and glutathione content in the Cd exposed group. Cd exposure significantly (p < 0.05) elevated the reactive oxygen species (ROS) and Thiobarbituric acid reactive substances (TBARS) levels in rat kidney. Cd also caused a significant (p < 0.05) reduction in the mitochondrial TCA-cycle enzymes, including isocitrate dehydrogenase, succinate dehydrogenase, alpha-ketoglutarate dehydrogenase, and malate-dehydrogenase activities. Besides, mitochondrial respiratory chain enzymes, including NADH-dehydrogenase, coenzyme Q-cytochrome reductase, succinic-coenzyme Q, and cytochrome c-oxidase activities were also decreased under Cd exposure. Cd exposure also damaged the mitochondrial membrane potential (MMP). However, VIT treatment potentially reduced the detrimental effects of Cd in the kidney of rats. In conclusion, our study indicated that the VIT could attenuate the Cd-induced renal toxicity in rats.

The effects of research and development and financial development on CO2 emissions: evidence from selected WAME economies

Earth is in the Anthropocene era and humankind deteriorates the global environment; thus, there is a dire need for sustainable policies at all levels. This study investigates the causal and long-run association between financial development, research and development expenditures, and carbon dioxide emission including energy intensity and income level for selected West Asia and Middle East (WAME) economies along the belt and road. The long-run panel estimation findings reveal that the research and development expenditures (R&D) are negatively associated with environmental degradation, as they significantly mitigate carbon emissions. In contrast, financial development contributes to environmental degradation. The findings validated the environmental Kuznets curve (EKC) phenomenon for the WAME economies considering R&D and financial development. Further, energy intensity exacerbates environmental quality. Additionally, the findings from Dumitrescu-Hurlin (DH) causal approach reveal bidirectional causal associations between financial development and carbon emissions and between R&D and emissions. The findings have implications for policy and practice to attain environmental sustainability in the selected WAME countries.

The role of trading environment-friendly goods in environmental sustainability: Does green openness matter for OECD countries?

Achieving carbon neutrality targets is a major challenge for Organization for Economic Co-operation and Development (OECD) countries that experience mounting ecological degradation over the last few decades. To deal with this situation, the trading of green products may play a crucial role. However, previous studies have not captured the net impact of green trading, and also the international trade basket used in these studies is proxied by the trade openness index including both environment-friendly and not-so-friendly goods. To provide a solution, this research intends to capture the net effects of green goods on the environment over the period 2003 to 2016 in 35 OECD countries. This study extends the literature by computing a new Green Openness Index based on the OECD Combined List of Environmental Goods (CLEG) basket that consists of 255 products. After this, an empirical model based on the Environmental Kuznets Curve (EKC) hypothesis is developed to test the role of the Green Openness Index in environmental sustainability using methodology robust against heterogeneity and cross-sectional dependence. The outcomes unfolded the validity of the EKC hypothesis in 35 OECD countries. Empirical estimates confirmed that the Green Openness Index, which considers traditional environment-friendly goods as well as environmentally preferable goods, stimulates environmental sustainability. Finally, numerous policies are directed to accomplish carbon neutrality targets.

Advances in viral oncolytics for treatment of multiple myeloma - a focused review

INTRODUCTION

Oncolytic viruses are genetically engineered viruses that target myeloma-affected cells by detecting specific cell surface receptors (CD46, CD138), causing cell death by activating the signaling pathway to induce apoptosis or by immune-mediated cellular destruction.

AREAS COVERED

This article summarizes oncolytic virotherapy advancements such as the therapeutic use of viruses by targeting cell surface proteins of myeloma cells as well as the carriers to deliver viruses to the target tissues safely. The major classes of viruses that have been studied for this include measles, myxoma, adenovirus, reovirus, vaccinia, vesicular-stomatitis virus, coxsackie, and others. The measles virus acts as oncolytic viral therapy by binding to the CD46 receptors on the myeloma cells to utilize its surface H protein. These H-protein and CD46 interactions lead to cellular syncytia formation resulting in cellular apoptosis. Vesicular-stomatitis virus acts by downregulation of anti-apoptotic factors (Mcl-2, BCL-2). Based upon the published literature searches till December 2020, we have summarized the data supporting the advances in viral oncolytic for the treatment of MM.

EXPERT OPINION

Oncolytic virotherapy is an experimental approach in multiple myeloma (MM); many issues need to be addressed for safe viral delivery to the target tissue.

Mitigation of cisplatin induced nephrotoxicity by casticin in male albino rats

Cisplatin (CP) is a commonly used, powerful antineoplastic drug, having numerous side effects. Casticin (CAS) is considered as a free radical scavenger and a potent antioxidant. The present research was planned to assess the curative potential of CAS on CP persuaded renal injury in male albino rats. Twenty four male albino rats were distributed into four equal groups. Group-1 was considered as a control group. Animals of Group-2 were injected with 5mg/kg of CP intraperitoneally. Group-3 was co-treated with CAS (50mg/kg) orally and injection of CP (5mg/kg). Group-4 was treated with CAS (50mg/kg) orally throughout the experiment. CP administration substantially reduced the activities of catalase (CAT), superoxide dismutase (SOD), peroxidase (POD), glutathione S-transferase (GST), glutathione reductase (GSR), glutathione (GSH) content while increased thiobarbituric acid reactive substances (TBARS), and hydrogen peroxide (H2O2) levels. Urea, urinary creatinine, urobilinogen, urinary proteins, kidney injury molecule-1 (KIM-1), and neutrophil gelatinase-associated lipocalin (NGAL) levels were substantially increased. In contrast, albumin and creatinine clearance was significantly reduced in CP treated group. The results demonstrated that CP significantly increased the inflammation indicators including nuclear factor kappa-B (NF-κB), tumor necrosis factor-α (TNF-α), Interleukin-1β (IL-1β), Interleukin-6 (IL-6) levels and cyclooxygenase-2 (COX-2) activity and histopathological damages. However, the administration of CAS displayed a palliative effect against CP-generated renal toxicity and recovered all parameters by bringing them to a normal level. These results revealed that the CAS is an effective compound having the curative potential to counter the CP-induced renal damage.

Toxicological effects of thimerosal on rat kidney: a histological and biochemical study

Thimerosal is an organomercurial compound, which is used in the preparation of intramuscular immunoglobulin, antivenoms, tattoo inks, skin test antigens, nasal products, ophthalmic drops, and vaccines as a preservative. In most of animal species and humans, the kidney is one of the main sites for mercurial compounds deposition and target organs for toxicity. So, the current research was intended to assess the thimerosal induced nephrotoxicity in male rats. Twenty-four adult male albino rats were categorized into four groups. The first group was a control group. Rats of Group-II, Group-III, and Group-IV were administered with 0.5µg/kg, 10µg/kg, and 50µg/kg of thimerosal once a day, respectively. Thimerosal administration significantly decreased the activities of catalase (CAT), superoxide dismutase (SOD), peroxidase (POD), glutathione reductase (GR), glutathione (GSH), and protein content while increased the thiobarbituric acid reactive substances (TBARS) and hydrogen peroxide (H2O2) levels dose-dependently. Blood urea nitrogen (BUN), creatinine, urobilinogen, urinary proteins, kidney injury molecule-1 (KIM-1), and neutrophil gelatinase-associated lipocalin (NGAL) levels were substantially increased. In contrast, urinary albumin and creatinine clearance was reduced dose-dependently in thimerosal treated groups. The results demonstrated that thimerosal significantly increased the inflammation indicators including nuclear factor kappaB (NF-κB), tumor necrosis factor-α (TNF-α), Interleukin-1β (IL-1β), Interleukin-6 (IL-6) levels and cyclooxygenase-2 (COX-2) activities, DNA and histopathological damages dose-dependently. So, the present findings ascertained that thimerosal exerted nephrotoxicity in male albino rats.

Molecular Phylogenetics of Physa acuta (Pulmonata: Basommatophora): an Invasive species in Central Punjab Pakistan

Physids belong to Class Gastropoda; belong to Phylum Mollusca and being bioindicators, intermediate hosts of parasites and pests hold a key position in the ecosystem. There are three species of Genus Physa i.e. P. fontinalis, Physa acuta and P. gyrina water bodies of Central Punjab and were characterized on the basis of molecular markers High level of genetic diversity was revealed by polymorphic RAPD, however SSR markers were not amplified. The multivariate analysis revealed polymorphism ranging from 9.09 percent to 50 percent among the three Physid species. Total number of 79 loci were observed for the three species under study and 24 loci were observed to be polymorphic. These RAPD fragment(s) can be developed into co dominant markers (SCAR) by cloning and can be further sequenced for the development of the Physa species specific markers to identify the introduced and native species in Pakistan.

Characterization of the species of genus Physa on the basis of typological species concept from Central Punjab

Physids belong to Class Gastropoda; Phylum Mollusca have important position in food web and act as bio indicators, pests and intermediate host. Being resistant these are called cockroaches of malacology. Physid snails were collected from different water bodies of Faisalabad (Punjab) and were identified up to species using morphological markers. The morphometry of the specimens was carried out with the help of a digital Vernier caliper in millimeters (mm) using linear measurement of shell characters. Linear regression analysis of the AL/SW ratio vs AL and SL/SW ratio vs AL indicated that allometric growth exists only in Physa acuta when compared with P.gyrina and P. fontinalis. This study will lead to assess the status of the Physid species in Central Punjab. The Principal component analysis shows that the Component 1 (Shell Length) and component 2 (Shell Width) are the most prolific components and nearly 80 percent of the identification. The distance between P. acuta and P. fontinalis is 5.4699, P. acuta and P. gyrina is 7.6411, P. fontinalis and P. gyrina is 16.6080 showing that P. acuta resembles with P. fontinalis, and both these specimens donot resemble with P. gyrina. P.acuta is an invasive species and shows bioactivity making it a potent candidate for bioactive substances.

Linking Innovative Human Capital, Economic Growth, and CO2 Emissions: An Empirical Study Based on Chinese Provincial Panel Data

To study the economic and environmental effects of human capital, previous studies measure human capital based on education; however, this approach has many shortcomings because not all educated people are innovative human capital. Hence, this study introduces the concept of innovative human capital by developing a new index that measures human capital based on the number of patents every one million R&D staff full-time equivalent. After this, this paper studies the impact of innovative human capital on CO₂ emissions in China. The provincial panel data of 30 Chinese provinces from 2003 to 2017 is analyzed using the fixed effect, ordinary least squares, and the system generalized method of moments (SYS-GMM). The analysis revealed that innovative human capital alleviates environmental deterioration in China. The findings unfold the existence of the environmental Kuznets curve (EKC) considering innovative human capital in the model. It implies that Chinese economic development will eventually support environmental sustainability if China continues to develop its innovative human capital. Among the control variables, economic structure, population density, and energy intensity stimulate environmental degradation by increasing CO₂ emissions. However, FDI has a negative relationship with CO₂ emissions. Lastly, the study proposes comprehensive policies to increase innovative human capital for environmental sustainability.

Determinants of consumption-based carbon emissions in Chile: an application of non-linear ARDL

In recent years, a growing number of scholars have employed various proxies of environmental degradation to understand the reasons behind rising environmental degradation. However, very few studies have considered consumption-based carbon emissions, even though a clear understanding of the impact of consumption patterns is essential for redirecting the pattern to more sustainable consumption. Thus, this study takes a step forward by using consumption-based carbon emissions (CCO2) as a proxy of environmental degradation using the novel non-linear ARDL technique for Chilefrom 1990 to 2018. To the best understanding of the investigators, no prior studies have investigated the drivers of consumption-based carbon emissions utilizing non-linear ARDL. The study employed ADF and KSS (non-linear) tests to check the data series' stationary level. Additionally, the symmetric and asymmetric ARDL approaches are utilized to explore cointegration and long-run linkages. According to the results, there is no symmetric cointegration among the variables; however, the empirical estimates reveal a long-run asymmetric connection between the indicators and CCO2 emissions. The novel results from the asymmetric ARDL indicate that negative and positive changes in economic growth deteriorate the quality of the environment. Interestingly, a reduction in economic growth makes a more dominant contribution to environmental degradation. Moreover, positive changes in renewable energy usage improve the quality of Chile's environment, inferring that the country can achieve a reduction in environmental degradation by boosting renewable energy consumption. Surprisingly, the study found that technological innovation is ineffective in reducing consumption-based carbon emissions, which implies that Chile's technological innovation is not directed towards manufacturing green technology. Finally, the policy implications are discussed with respect to reducing consumption-based carbon emissions.

Dietary association of iron deficiency anemia and related pregnancy outcomes

Iron deficiency anemia (IDA) is a common public health occurrence of pregnancy which is particularly prevalent in developing countries like Pakistan. During this critical period, the deficiency of iron is very common as the iron requirements are greatly enhanced. IDA during pregnancy is associated with intrauterine growth retardation, premature birth, low birthweight, increased labor time, higher risk of infection, elevated maternal and prenatal mortality, muscle dysfunction, and low physical capacity. The present study was aimed to check the prevalence, effect of diet on IDA and its association with the pregnancy outcome, that is, birthweight. Five different public sector hospitals of Rawalpindi and Islamabad were analyzed. A sample size of 500 pregnant females of third trimester was observed which were then followed after delivery from September 2020 to January 2021. A well-designed questionnaire was developed where different demographic factors, dietary recalls, biomarkers, and other determinants were obtained. The data from the questionnaires were later coded for the purpose of analysis in the statistical package (SPSS) using chi-square test. Our study indicated that IDA is a moderate public health problem among pregnant women in twin cities and more than half of study subjects have depleted iron stores. Approximately 63% of the subjects were having iron deficiency and 24.8% were facing severe iron deficiency anemia. Only 12% of the subjects were considered as normal. The high prevalence of anemia in our subjects was probably due to low iron intake and poor dietary habits. The results of the study may not be generalizable due to time constraints and other factors. Maternal anemia still remains a major public health concern that requires more attention especially in developing and underdeveloping countries.

Study the impact of ultra-sonication and pulsed electric field on the quality of wheat plantlet juice through FTIR and SERS

Pulsed electric field (PEF) and Ultrasound (US) are commonly used in food processing. We investigated the combined impact of pulsed electric field (PEF) and ultrasound (US) on the wheat plantlet juice. When compared with the individual treatments, the highest values of total phenolics, total flavonoids, chlorophyll, ORAC assay, and DPPH activities were obtained using the combined (US + PEF) methods. The US + PEF significantly decreased the peroxidase and polyphenol oxidase activities from 0.87 to 0.27 Abs min-1 and 0.031-0.016 Abs min-1. Also, the synergistic application significantly lowered the yeast and mold (3.92 to 2.11 log CFU/mL), E. coli/Coliform (1.95 to 0.96 log CFU/mL), and aerobics (4.41 to 2.01 log CFU/mL). Furthermore, Fourier Transform Infrared (FT-IR) and surface-enhanced Raman spectroscopy (SERS) was used to analyzing juice quality. Gold nanoparticles (AuNPs) were used as the SERS substrates, which provided stronger Raman peaks for the samples treated with US + PEF methods. The FT-IR analysis showed significant enhancement of the nutritional molecules. The enhanced quality of wheat plantlet juice combined with lower yeast and mold suggests the suitability of integrated methods for further research and applications.

A Case of Acute Encephalitis in COVID-19 Patient: A Rare Complication

Coronavirus disease 19 (COVID-19) is a respiratory disease, has a variable presentation, and neurological involvement in COVID-19 is not widely reported. We report a rare case of acute encephalitis in a COVID-19 patient presented with fever, dry cough, and dyspnea. She had a fever, tachypnea, and tachycardia. On auscultation, she had scattered wheezing in both lung fiends. Chest X-ray revealed small infiltrates in the lower lobe of both lungs. A nasopharyngeal swab for the COVID-19 polymerase chain reaction was positive. Later on, she developed sudden onset confusion accompanied by restlessness and visual hallucinations. Neurological examination revealed an altered level of consciousness, slight trembling of the limbs, psychomotor restlessness, and poor speech with no signs of meningeal irritation. Magnetic resonance imaging of the brain revealed diffuse hyperintense signals. A possible diagnosis of acute encephalitis was made due to concurrent COVID-19 infection and lack of other findings suggesting a diagnosis other than COVID-19. She was treated with azithromycin, tocilizumab, and methylprednisolone. Her condition started improving gradually.

Outcomes with CD34-Selected Stem Cell Boost for Poor Graft Function after Allogeneic Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-Analysis

Poor graft function (PGF) is a life-threatening complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT) characterized by multilineage cytopenia in the absence of mixed donor chimerism (<95% donor), relapse, or severe graft-versus-host disease (GVHD). We present a systemic review and meta-analysis aimed at assessing the outcomes with CD34-selected stem cell boost (SCB) for PGF in adult allo-HSCT recipients. We screened a total of 1753 records identified from 4 databases (PubMed, Embase, Cochrane, and ClinicalTrials.gov) following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, using the search terms "hematological malignancies," "hematopoietic stem cell transplantation," "CD34 antigen(s)," "graft failure," and "poor graft function," from the date of inception to January 2021. After excluding review, duplicate, and nonrelevant articles, we included 7 studies reporting outcomes following administration of CD34-selected SCB for PGF after allo-HSCT, including hematologic complete response (CR) and overall response rate (ORR), GVHD, and overall survival (OS). Quality evaluation was done using the National Institutes of Health quality assessment tool. Pooled analysis was done using the R 'meta' package, and proportions with 95% confidence intervals (CIs) were computed. The inter-study variance was calculated using the Der Simonian-Laird estimator. We identified 209 patients who received CD34-selected SCB for PGF after allo-HSCT. The median age was 49 years (range, 18 to 69 years), and 61% were men. Primary graft sources included peripheral blood stem cells (72%) and bone marrow (28%). Donor types were matched sibling (37%), matched unrelated (36%), mismatched unrelated (22%), and haploidentical donors (5%). The median time from allo-HSCT to SCB was 138 days (range, 113 to 450 days). The median SCB dose was 3.45 × 10⁶ CD34 cells/kg (range, 3.1 to 4.9 × 10⁶ cells/kg). CR and ORR were 72% (95% CI, 63% to 79%; I² = 26%) and 80% (95% CI, 74% to 85%; I² = 0%), respectively. After a median follow-up of 42 months (range, 30 to 77 months), the actuarial survival rate was 54% (95% CI, 47% to 61%; I² = 0%). OS ranged from 80% at 1 year to 40% at 9 years. The incidences of acute and chronic GVHD after SCB were 17% (95% CI, 13% to 23%; I² = 0%) and 18% (95% CI, 8% to 34%; I² = 76%), respectively. Nonrelapse mortality was reported in 42 patients, with a pooled rate of 27% (95% CI, 17% to 40; I² = 59%), and death due to relapse was reported in 25 patients, with a pooled rate of 17% (95% CI, 11% to 23%; I² = 0%). Our data show that CD34-selected SCB improves outcomes after PGF post allo-HSCT with an acceptable toxicity profile. The literature lacks high-quality randomized evidence, and there remains an unmet need for prospective studies to address the optimal dosing and manipulation of SCB. © 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.

What drives ecological footprint in top ten tourist destinations? Evidence from advanced panel techniques

The persistent dwindling of the biocapacity has caused the ecological footprint (EF) to keep increasing in the top ten tourist destinations over the last three decades. Moreso, economic growth, natural resource rent, and urbanization substantially increased for the same period. Tourism contributes to economic prosperity. However, growth in tourism promotes an increase in energy consumption, natural resource exploration, transportation, and consequential ecological distortions. It is important to understand the predictors of EF to suggest suitable policies for environmental sustainability. Hence, this study examines the predictors of EF by considering factors that could influence EF. More precisely, the study analyzes the linkage among economic growth, natural resource rent, urbanization, energy intensity, and tourism using some of the most advanced and reliable econometric techniques, such as Westerlund's (J Appl Econ 23(2):193-233, 2008) cointegration technique, and the continuously updated full modified (CUP-FM) and continuously updated bias-corrected (CUP-BC), long-run estimators. The outcomes of the analysis indicate that EF has a negative association with urbanization and natural resources, which implies that an abundance of natural resources and increasing urban population can help to reduce environmental degradation. Likewise, energy intensity helps in decreasing EF, while economic growth adds to EF. Tourist arrival and tourist receipt also add to EF and, therefore, negatively affect environmental quality. Finally, policy directions are discussed to reduce environmental degradation without reducing economic growth.

Single π 0 production off neutrons bound in deuteron with linearly polarized photons

The quasifree γ → d → π 0 n ( p ) photon beam asymmetry, Σ , has been measured at photon energies, E γ , from 390 to 610 MeV, corresponding to center of mass energy from 1.271 to 1.424 GeV, for the first time. The data were collected in the A2 hall of the MAMI electron beam facility with the Crystal Ball and TAPS calorimeters covering pion center-of-mass angles from 49 ∘ to 148 ∘ . In this kinematic region, polarization observables are sensitive to contributions from the Δ ( 1232 ) and N(1440) resonances. The extracted values of Σ have been compared to predictions based on partial-wave analyses (PWAs) of the existing pion photoproduction database. Our comparison includes the SAID, MAID and Bonn-Gatchina analyses; while a revised SAID fit, including the new Σ measurements, has also been performed. In addition, isospin symmetry is examined as a way to predict π 0 n photoproduction observables, based on fits to published data in the channels π 0 p , π + n and π - p .

Primary Mediastinal B-Cell Lymphoma: A 2021 Update on Genetics, Diagnosis, and Novel Therapeutics

Primary mediastinal large B-cell lymphoma (PMBCL) is an aggressive B-cell lymphoma arising from thymic B-cells having clinicopathologic features distinct from systemic diffuse large B-cell lymphoma (DLBCL). PMBCL comprises 2% to 4% of all non-Hodgkin lymphomas (NHL), 7% of DLBCL and seen predominantly in young females with a median age of 35 years at diagnosis. The annual incidence of PMBCL is 0.4 per million with a 5-year survival rate exceeding 70% with improving supportive care and genetic characterization of the disease. Pathogenesis involves dysregulation of Janus kinase-signal transducer and activator of transcription (JAK-STAT), nuclear factor-kB (NF-kB) pathways and amplification of the 9p24.1 region of chromosome 9. PMBCL patients have a prolonged life expectancy necessitating the need for treatment approaches that are based on maximizing cure with minimal long-term toxicity. Due to rarity and its recognition as a distinct entity, therapeutic decisions are guided by clinical presentation, clinician and center experience, and analysis of patients with PMBCL within DLBCL registries. Historically R-CHOP has been the usual first line treatment for PMBCL followed by involved site radiotherapy (ISRT), however clinical practice varies across centers with emerging consensus to avoid upfront RT by utilizing dose intense regimens (DA-EPOCH-R) in younger and fit patients. Prognosis of relapsed refractory PMBCL not responding to salvage chemotherapy is dismal, however there are many emerging options including Brentuximab Vedotin, immune check point inhibitors and chimeric antigen receptor T-cell therapy. In this article, we focus on the pathogenesis, current and evolving treatments, and provide recommendations for optimal management of patients with PMBCL.

Seasonal analysis of food items and feeding habits of endangered riverine catfish Rita rita (Hamilton, 1822)

This investigation presents the food and feeding activity of and endangered riverine catfish Rita rita, during February 2017-January 2018. A total of 225 fish individuals was analyzed for stomach contents by characterizing the dominant food items and morphometric features. The results divulged ten major food items consumed, preferably fish scales and eggs, teleost fishes, copepods, cladocerans, rotifers, and mollusks. Total length and body weight of fish varied between 9-34 cm (20.53 ± 6.90 cm) and 10-400 g (9125.94 ± 102.07 g), respectively. The index of relative importance (IRI%) showed the importance of rotifers over the other food items. Morisita's index of diet overlap indicated seasonal variations in catfish diets with summer and monsoon displaying the least overlap, while maximum overlap during monsoon and winter seasons. The non-metric multidimensional scaling (nMDS) indicated the close association between the food items available during summer and winter seasons with a significant difference among the seasons (ANOSIM, R = 0.638, P = 0.013). Levin's niche breadth index arranged in the order of 0.88>0.81>0.78>0.63>0.43 for the size classes of V, IV, III, II and I, respectively. The PCA explained 95.39% of the total variance among the food items and fish size groups. Small-sized fish individuals displayed a greater correlation with food items suitable for their mouth size. In conclusion, the variety and frequency of food items recorded indicated considerable feeding plasticity and opportunistic feeding behavior with a shift from carnivorous to omnivorous feeding nature. This study could render useful information on the food and feeding habits of R. rita and provide background for preparing its diet for future aquaculture practices.

Rotterdam and Marshall Scores for Prediction of in-hospital Mortality in Patients with Traumatic Brain Injury: An observational study

Background: We aimed to assess the prognostic value of Rotterdam and Marshall scoring systems to predict in-hospital mortality in patients with traumatic brain injury (TBI).Methods: A retrospective analysis was conducted for patients with TBI who underwent head computerized tomography (CT) scan at a Level I trauma center between 2011 and 2018. Receiver operating characteristic (ROC) curves were used to determine the cutoff values for predicting in-hospital mortality.Results: A total of 1035 patients with TBI were included with a mean age of 30 years. The mean Rotterdam and Marshall scores were higher among non-survivors (p = .001). Patients with higher Rotterdam (>3) or Marshall (>2) CT scores were older, had higher injury severity scores and in-hospital mortality and had lower GCS and blood ethanol levels than those with lower scores. The cutoff point of Rotterdam score was 3.5 (sensitivity, 61.2%; specificity, 85.6%) and Marshall score was 2.5 (74.3% sensitivity and 76.3% specificity). Multivariable logistic regression analyses showed that Marshall and Rotterdam scoring systems were independent predictors of mortality (odds ratio 8.4; 95% confidence interval 4.95-14.17 and odds ratio 4.4; 95% confidence interval 2.36-9.39, respectively).Conclusion: Rotterdam and Marshall CT scores have independent prognostic values in patients with TBI even in alcoholic patients.

Growth performance, intestinal histomorphology, gut microflora and ghrelin gene expression analysis of broiler by supplementing natural growth promoters: A nutrigenomics approach

In an epoch of escalating number of antibiotic-resistance bacteria, there is a dire need to develop efficient and novel feeding strategies for animal nutrition as alternatives to antibiotics. Here, implicating nutrigenomic approach, phytobiotics and organic acids were used to evaluate ghrelin gene expression levels, gut microflora composition, performance parameters and intestinal histomorphological changes in broiler chickens. One-day-old chicks (n = 315) were reared for 42 days and distributed randomly into five experimental groups; each with three replicates (21 birds per replicate). Experimental groups were control: basal diet only, antimicrobial growth promoter: 40 g/metric ton of basal diet (virginiamycin), organic acids: 4 kg/metric ton of basal diet, phytobiotics: 3 kg/metric ton of basal diet, combination: 7 kg/metric ton of basal diet (organic acids 4 kg and phytobiotics 3 kg metric ton of feed). Growth performance, histological and ghrelin gene expression analysis were executed on 21 and 42 days while, quantitative bacterial analysis of cecum and ileum was performed on day 42. Increased feed intake and body weight (p < 0.05) were noticed in phytobiotics group. Addition of phytobiotics significantly improved (p < 0.05) villus height and ratio of villus height/crypt depth in ileum, jejunum, and duodenum and down-regulated ghrelin gene expression levels. Total coliform and Escherichia coli in cecal and ileal digesta were decreased significantly (p < 0.05) in organic acids group. Correlation analysis revealed Lactobacillus spp. were positively correlated to villus height/crypt depth ration in duodenum. The findings indicated the importance of gene-nutrient-microbiota interactions based on nutrigenomics approach. Hence, phytobiotics and organic acids might be suitable alternatives to antibiotics for improved performance and immunity, along with healthier meat production in poultry.

Outcomes with venetoclax in myelodysplastic syndromes: A systematic review

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Background: Myelodysplastic syndromes (MDS) are clonal hemopoietic disorders causing cytopenia(s) and increased risk of transformation to acute myeloid leukemia (AML). Venetoclax is a B-cell lymphoma-2 (BCL-2) inhibitor that induces apoptosis in malignant cells. The FDA has approved venetoclax for the treatment of newly diagnosed adult AML patients unfit for intensive chemotherapy and its utility in MDS is being explored. We present a systematic review aimed to evaluate outcomes with venetoclax in MDS patients. Methods: We performed a literature search on 3 databases (Pubmed, Cochrane, and Clinicaltrials.gov) following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We screened 62 studies using the Mesh terms ‘myelodysplastic syndrome’ and ‘venetoclax’. After excluding review, duplicate and non-relevant articles, 8 studies were included in the analysis. Quality evaluation was done using the NIH quality assessment tool. Pooled analysis was done using the ‘meta’ package (Schwarzer et al, R programming language) and proportions with 95% confidence intervals (CI) were computed. The Inter-study heterogeneity among the studies was assessed using the Q statistic proposed by Cochrane and the I2 index introduced by Higgins and Thompson. Results: We identified 313 patients from 8 studies (1 prospective, 3 retrospective, 2 ex-vivo, 2 clinical trials). Venetoclax was used in combination with hypomethylating agents (HMA) in 6 studies and with other agents in 2 studies. Most patients were pre-treated. Complete response (CR) with or without hematological recovery (CRi) was reported in 45% of patients (95% CI 0.26-0.66, I2= 90%, n = 292). Stable disease (SD) was seen in 18% patients (95% CI 0.08-0.37, I2= 85%, n = 223). Overall response rate (ORR) was 51% (95% CI 0.31-0.70, I2= 89%, n = 122). Hematopoietic stem cell transplant (HCT) was performed in 22% patients (95% CI 0.09-0.44, I2= 75%, n = 122). Twenty percent patients (95% CI 0.15-0.28, I2= 0%, n = 149) died. Common adverse events seen with venetoclax were cytopenias, gastrointestinal side effects and infections, often requiring drug interruption or dose. Conclusions: Despite heterogeneity of available literature, venetoclax seems to be a promising agent in treatment of MDS patients. Prospective clinical trial data is needed to ascertain safety and efficacy of venetoclax in MDS and impact on overall survival, in particular, in patients proceeding to HCT.[Table: see text]