Efficacy and safety of peroral endoscopic myotomy in the management of recurrent achalasia after failed Heller myotomy: a systematic review and meta-analysis

Background

Heller myotomy (HM) is an established treatment for achalasia but can fail in up to 10-20% of patients. Peroral endoscopic myotomy (POEM) may be an appropriate treatment for patients with failed HM.

Methods

We searched several databases to identify non-comparative studies evaluating the efficacy and/or safety of POEM after failed HM and comparative studies comparing the efficacy and/or safety of POEM in patients with and without prior HM. Outcomes assessed included clinical success, technical success, adverse events, post-treatment gastroesophageal reflux disease (GERD), and presence of esophagitis on endoscopy. We calculated weighted pooled rates with 95% confidence intervals (CI) for all outcomes in patients undergoing POEM with prior HM. We calculated pooled odds ratios with 95%CI to compare the outcomes between patients with and without previous HM who underwent POEM.

Results

We included 11 observational studies with 1205 patients. Weighted pooled rates (95%CI) for overall clinical success and technical success in patients with failed HM were 87% (81-91%) and 97% (94-99%), respectively. Weighted pooled rates (95%CI) for major adverse events, new-onset GERD and presence of esophagitis on endoscopy were 5% (2-10%), 33% (26-41%), and 38% (22-58%), respectively. There were no differences in clinical success, adverse events, post-treatment GERD and esophagitis between patients with and without previous HM.

Conclusions

POEM is safe and effective in patients with failed HM and should be considered in patients with recurrent achalasia after HM. Outcomes of POEM are comparable in patients with and without prior HM.

Indoor air quality and its relationship with cluster type in urban Pakistani households

OBJECTIVE: To assess the levels and predictors of formaldehyde, nitrogen dioxide (NO₂), carbon monoxide (CO) and fine particulate matter with diameter less than 2.5 μm (PM2.5) in Karachi, Pakistan.METHODS: A total of 1629 households were selected through multistage cluster sampling in a community-based cross-sectional survey. Formaldehyde, NO₂ and CO levels were measured using YesAir Indoor air monitor and for PM2.5, UCB-PATS (University of California Berkeley Particle and Temperature Sensor) was used. Clusters were classified either as planned (areas of planned housing) or unplanned (informal settlements).RESULTS: We found the median concentrations to be as follows: formaldehyde, 0.03 ppm (IQR 0.00-0.090); CO, 0.00 ppm (IQR 0.00-1.00); NO₂, 0 ppm (IQR 0.00-0.00) and PM2.5, 0.278 mg/m³ (IQR 0.162-0.526). We found a significant association of the upper quartiles of formaldehyde and PM2.5 levels with type of cluster. The risk of obtaining formaldehyde and PM2.5 levels in the upper quartile was higher in unplanned clusters than in planned clusters (adjusted odds ratio [aOR] 33.0, 95% CI 4.02-271.5 and aOR 0.10, 95% CI 0.001-0.16, respectively). No significant association was observed between levels of CO and cluster type (aOR 0.84, 95%CI 0.62-1.14).CONCLUSION: This study reports high levels of indoor air pollutants in Karachi, with considerable variation across planned vs. unplanned clusters.

Review of Current Guided Wave Ultrasonic Testing (GWUT) Limitations and Future Directions

Damage is an inevitable occurrence in metallic structures and when unchecked could result in a catastrophic breakdown of structural assets. Non-destructive evaluation (NDE) is adopted in industries for assessment and health inspection of structural assets. Prominent among the NDE techniques is guided wave ultrasonic testing (GWUT). This method is cost-effective and possesses an enormous capability for long-range inspection of corroded structures, detection of sundries of crack and other metallic damage structures at low frequency and energy attenuation. However, the parametric features of the GWUT are affected by structural and environmental operating conditions and result in masking damage signal. Most studies focused on identifying individual damage under varying conditions while combined damage phenomena can coexist in structure and hasten its deterioration. Hence, it is an impending task to study the effect of combined damage on a structure under varying conditions and correlate it with GWUT parametric features. In this respect, this work reviewed the literature on UGWs, damage inspection, severity, temperature influence on the guided wave and parametric characteristics of the inspecting wave. The review is limited to the piezoelectric transduction unit. It was keenly observed that no significant work had been done to correlate the parametric feature of GWUT with combined damage effect under varying conditions. It is therefore proposed to investigate this impending task.

Addition of straw to the early-lactation diet: Effects on feed intake, milk yield, and subclinical ketosis in Holstein cows

This study evaluated feed intake, milk yield, and subclinical ketosis in dairy cows in early lactation fed 2 different diets postpartum. Cows are typically offered a high-energy ration immediately after calving. We compared a conventional high-energy total mixed ration (TMR) with a transition ration that contained chopped straw. We predicted that adding chopped straw would increase dry matter intake, milk production, and indicators of energy metabolism during the first 3 wk of lactation compared to cows fed a conventional high-energy TMR. We also predicted that carryover effects would be likely for at least 2 wk after treatment ended. A total of 68 mixed-age Holstein cows were enrolled in the study 3 wk before their expected calving. All cows were managed on a single high-forage diet during the dry period. At calving, cows were allocated to 1 of the 2 diets: half to the conventional high-energy TMR (CTMR; n = 34; net energy for lactation = 1.61 Mcal/kg; neutral detergent fiber = 31.7%), and the other half to a high-forage TMR containing chopped wheat straw, equivalent to 4.27% dry matter (STMR; n = 34; net energy for lactation = 1.59 Mcal/kg; neutral detergent fiber = 33.7%) for 3 wk after calving. Cows on STMR were then shifted to CTMR for the next 2 wk to study short-term residual effects on the performance of cows. Treatments were balanced for parity, body condition score, and body weight. Feed intake was measured daily from 2 wk before to 5 wk after calving using automatic feed bins. Blood was sampled twice weekly from 2 wk before to 5 wk after calving, and β-hydroxybutyrate and glucose were measured in serum samples. Subclinical ketosis was identified using a threshold of β-hydroxybutyrate ≥1.0 mmol/L in wk 1 after calving and ≥1.2 mmol/L in wk 2 to 5 after calving. Cows were milked twice daily, and weekly samples (composite samples of morning and afternoon milkings) were analyzed to determine total solids, fat, protein, lactose, and somatic cell count. Data were analyzed in 2 separate periods: the treatment phase (wk +1, +2, and +3) and the post-treatment phase (wk +4 and +5). The addition of straw to the TMR negatively affected the dry matter intake of STMR cows during wk 2 and 3 of lactation. Daily milk yield during the first 5 wk of lactation was lower in STMR cows than in CTMR cows. Concentrations of β-hydroxybutyrate were higher in CTMR cows than in STMR cows during wk 1, but this effect was reversed during wk 2 and 3 of lactation. By 21 d in milk, STMR cows had a greater risk of developing subclinical ketosis than CTMR cows. Adding chopped wheat straw to the TMR during the first 21 d after calving lowered dry matter intake and provided no metabolic or production benefits to lactating dairy cattle.

The Interplay of Disease Modifying Anti Rheumatic Drugs and Tuberculin Skin Test

OBJECTIVE

The study was conducted to determine whether synthetic Disease-Modifying Anti Rheumatic Drugs (DMARDs) suppress the latency of Tuberculosis (TB) infection in Rheumatoid Arthritis (RA) patients along with other variables.

METHODS

This was done through Tuberculin Skin Test (TST) using purified protein derivative (PPD) in a cohort of RA patients. The TST was taken positive when induration post-PPD injection was ≥ 5mm and negative or anergic when it was < 5mm. We included 100 patients (N = 100).

RESULTS

The prevalence of positive TST was 36%, while 64% presented a negative result. Negative TST was significantly associated with steroid usage (39.4%, 95% CI: 28.4%-51.4%). Anergic (TST negative) and non-anergic (TST positive) patients were separated into groups, and a new analysis was conducted with elaboration on DMARDs used.

CONCLUSION

The use of steroids was associated with TST negativity, The same is not true with use of methotrexate or other DMARDs. Thus TST should be interpreted with caution, especially before starting biologicals.

Axial spondyloarthritis: concept, construct, classification and implications for therapy

The axial spondyloarthritis (axSpA) disease concept has undergone substantial change from when the entity ankylosing spondylitis was defined by the modified New York criteria in 1984. Developments in imaging, therapy and genetics have all contributed to changing the concept of axSpA from one of erosions in the sacroiliac joints to a spectrum of disease with and without changes evident on plain radiographs. Changes to the previously held concept and construct of the disease have also necessitated new classification criteria. The use of MRI, primarily of the sacroiliac joints, has substantially altered the diagnosis and differential diagnosis of axSpA. Many in the axSpA community believe that the current classification criteria lack specificity, and the CLASSIC study is underway to examine this area. Although much about the evolving axSpA disease concept is universally agreed, there remains disagreement about operationalizing aspects of it, such as the requirement for the objective demonstration of axial inflammation for the classification of axSpA. New imaging technologies, biomarkers and genetics data will probably necessitate ongoing revision of axSpA classification criteria. Advances in our knowledge of the biology of axSpA will settle some differences in opinion as to how the disease concept is applied to the classification and diagnosis of patients.

[Modern non-drug technologies for medical rehabilitation of children with consequences of perinatal affection of the central nervous system]

The article is devoted to the issues of medical rehabilitation of children with consequences of perinatal affection of the central nervous system (CNS). An important and principal aspect of the medical rehabilitation of children with perinatal pathology is the minimization of drugs, in this regard, in children in the first year of life, the leading role is given to non-drug methods of exposure. Among the important challenges of the medical rehabilitation of children with perinatal pathology are: improvement of blood supply and metabolic processes in the brain tissue, normalization of the central and peripheral regulation of muscle tone, improvement of neuromuscular conduction, stimulation of psychomotor development. In this case, kinesitherapy technologies are of leading importance: massotherapy, therapeutic exercises, reflex kinesitherapy according to V. Vojta; fitball gymnastics, method of fine finger training, dry floatation, etc. Along with physical rehabilitation methods, physiotherapy methods are actively used, which makes it possible to increase the effectiveness of treatment. The analysis of the literature showed that the use of modern non-drug technologies in children with perinatal CNS pathology, and their introduction into practice can significantly increase the effectiveness of medical rehabilitation of such children.

The impact of COVID-19 on emergency general surgery admissions and operative volumes: A single centre experience

Introduction

The COVID-19 pandemic has placed a significant strain on healthcare resources and utilisation globally. The appearance of the disease in the Republic of Ireland resulted in a broad postponement of scheduled and routine surgical care. The influence of the novel coronavirus, and the associated imposition of public health measures such as school closures and social distancing, on the burden of emergency surgical disease is less clear.

Aim

The aim of this study was to examine the impact of COVID-19 on the number of patients presenting to our institution with emergent surgical illnesses or requiring emergency general surgical procedures.

Methods

All patients attending our service between March 1st 2020 and April 30th 2020 were identified retrospectively by examining electronic handover and electronic discharge summaries, and data were collected relating to demographics, presenting illness, critical care utilisation, length of stay, operative or endoscopic procedure performed, and in-hospital mortality. Similar data were collected March 1st to April 30th 2019, 2018, and 2017 respectively to allow direct comparison.

Results

151 patients were admitted during the study period, compared to a total of 788 during the proceeding three years (mean 2.49 admissions per night versus 4.35 per night, 42.8% reduction, p < 0.001). Median age of admitted patients was 51.8 years, compared to 50.3 years formerly (p = 0.35). 53 emergency procedures were performed, compared to a median of 70 over the same period in the previous years (mean 0.87 per day versus 1.16 per day, 25.4% reduction, p = 0.05).

Conclusion

A significant overall reduction in the number of patients being admitted to our unit and requiring emergency surgical procedures during March and April 2020 was seen, in line with patterns reported internationally.

The Prevalence of Beta-Blocker Use Among Medical Students at King Saud bin Abdulaziz University for Health Sciences in Jeddah, Saudi Arabia: A Cross-Sectional Study

Objectives

The aim of this study was to evaluate the prevalence and patterns of beta-blocker usage among medical students. Reasons for the use and demographic factors influencing their consumption were also evaluated.

Methods

This was an observational cross-sectional study among medical students at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) Jeddah, Saudi Arabia. Medical students were surveyed between February and April of 2019 using an electronic self-administered questionnaire. The questionnaire had close-ended questions, 18 of which were about demographics and 17 about propranolol use.

Results

A total of 234 medical students participated in the study, of whom 14.5% (95% CI: 10.44-19.49) reported using propranolol. Fifth-year medical students comprised 50% of propranolol users. The prevalence of males using propranolol was lower compared to females. The most common reasons for using propranolol were anxiety relief and performance enhancement before the objective structured clinical exams (OSCEs; 70.6%) and before oral presentations (38.2%).

Conclusion

The prevalence of propranolol use among medical students in KSAU-HS Jeddah was low compared to other studies, with the highest reported use among fifth-year medical students. The main reasons for using propranolol were anxiety relief during OSCEs and performance enhancement for presentations. Efforts must be directed towards raising medical students' awareness of the risks of inappropriate beta-blocker use to decrease its use and avoid potential adverse effects of the medication. 

[To the question of the possibility of using selective chromotherapy for allergic diseases in children]

Allergic diseases are a common pathology in childhood. In the comprehensive medical rehabilitation of children with allergic pathology, non-drug methods of treatment are widely used, which help to reduce the number of drugs used, achieve and prolong the remission of the disease, favorably affect the clinical and functional indicators.

THE PURPOSE OF THE STUDY

Is the scientific justification for the use of selective chromotherapy in children with bronchial asthma (BA) and atopic dermatitis (AD).

MATERIAL AND METHODS

The study included 120 children with allergic diseases (BA and AD). Among 100 patients with BA, the main group included 50 children, who received exposure to monochromatic polarized green light on biologically active zones for 10 days, 50 - a comparison group that did not receive physiotherapy. The main group of children with AD included 10 patients who received selective blue chromotherapy for foci of skin lesions; the comparison group included 10 children who used only moisturizers without physiotherapy methods. In order to assess the effectiveness of the impact of physical factors in all patients, clinical and functional studies were conducted in the dynamics before and after treatment.

RESULTS AND DISCUSSION

The results of clinical and functional examinations showed high therapeutic efficacy of the use of monochromatic polarized green light in children with BA (92.0%). The effectiveness of treating children with blood pressure AD using monochromatic polarized light (blue) was 80%. Indications for the use of selective chromotherapy in children with allergic diseases have been developed. For children with BA, selective chromotherapy of the green spectrum is indicated in the presence of a mild to moderate course of the disease, a period of incomplete remission, and an increased level of anxiety. It is advisable to prescribe selective chromotherapy of the blue spectrum to children with a moderate and mild course of AD.

CONCLUSION

The positive effect of selective chromotherapy of the green spectrum on the clinical course of BA in children, bronchial patency, the functional state of the central nervous system and its autonomic part, and the psychoemotional status of children have been identified. The use of selective blue spectrum chromotherapy in children with AD helps to decrease the severity of objective symptoms, reduce the intensity of itching and sleep disturbance, as well as a marked decrease in the area of skin lesion.

Immediate and Short-Term Outcome of Percutaneous Atrial Septal Defects Closure in Adult Patients

Background

Atrial septal defect secundum (ASD II) is the commonest of the congenital heart diseases in the adult population and the closure of ASD II causes a significant improvement in hemodynamics and the clinical status of the patient. However, it carries certain risks, especially the development of post-closure pulmonary edema and congestive cardiac failure, which may lead to death. Therefore, this study was designed to share our experience and to evaluate the immediate and short-term outcomes of percutaneous closure of ASD II in adult patients presenting at a tertiary care cardiac center in Karachi, Pakistan.

Methodology

In this study, we included 30 adult (≥ 40 years) patients who underwent percutaneous ASD II closure at the pediatric cardiology department of the National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan, between June 1, 2017, and July 31, 2019. Data for this study were extracted from a prospectively collected departmental database. Extracted data for this study consisted of demographic profile, comorbid conditions, echocardiographic findings, cardiac catheterization data, pre and post six-month electrocardiographic findings, and New York Heart Association (NYHA) Functional Classification (FC).

Results

Out of 30 adult patients, 18 (60%) were female. The mean age of the patients at the time of ASD closure was 51.43 ± 7.09 years, ranging between 40 and 67 years. None of the patients had any post-intervention complications. Mean systolic pulmonary artery pressure (SPAP) on cardiac catheterization pre-implantation was 49.8 ± 16.3 mmHg range was 20-90 mmHg while SPAP immediately after device implantation was 37 ± 11.4 range 20 to 65 mmHg with p<0.001. Mean SPAP on pre-catheterization echocardiography was 58.8 ± 14.3, range 30-95 mmHg, while after six months, the mean SPAP was 34.5 ± 7.2, range 20-45 mmHg, with p<0.001 in 28 (93.3%) patients (in two patients, there was no TR). There was no mortality up till six months after the intervention. The functional class (FC) after six months of the procedure improved in most, 90% (27), of the patients.

Conclusion

There were no complications immediately after the procedure. After six months, post-procedure SPAP decreased to < 50 mmHg in the majority of patients (96.6%). Functional class (FC) improved in most (90%) of the adult (≥ 40 years) patients undergone percutaneous atrial septal defects closure. Therefore, percutaneous closure of ASD II is a safe and effective procedure for adult patients.

[Modern possibilities of cryotherapy for chronic functional constipation in children]

INTRODUCTION

Among the urgent problems of pediatrics, chronic constipation occupies one of the leading positions due to its high prevalence (20-40%) and the possibility of complications. Conductive cryotherapy, used separately and in combination with percutaneous electroneurostimulation, is a promising technology for the treatment of chronic constipation in children.

AIM OF STUDY

Scientific evidence of the use of conductive cryotherapy and its combined effect with percutaneous electroneurostimulation in children with chronic constipation.

MATERIALS AND METHODS

We examined 80 children aged 3-15 years (average age 8±2 years) suffering from chronic constipation: 35 (43.8%) boys, 45 (56.2%) girls. In 47 (58.8%) children, chronic constipation of the hypotonic type (HT) was detected, in 33 (41.2%) - chronic constipation of the spastic type (ST). Children were divided into 4 groups, comparable in number, age, gender and clinical manifestations. Patients of all groups received basic treatment: laxative diet, probiotics, choleretic drugs, enzymes. Patients of the main group used the combined effect of conduction cryotherapy and percutaneous electroneurostimulation - cryoelectroneurostimulation. Conduction cryotherapy was prescribed for children of the 1st comparison group, percutaneous electroneurostimulation was assigned to the 2nd comparison group. Patients in the control group received only basic therapy. In order to assess the effectiveness of impact of physical factors, clinical and functional examinations of children were carried out before treatment, immediately after the course of treatment, and also 3, 6 and 12 months later after treatment.

RESULTS AND DISCUSSION

The highest treatment efficacy was found in children of the main group with HT and ST (91.6 and 87.5%, respectively) after cryoelectronic neurostimulation. Conduction cryotherapy was most effective for the treatment of ST (77.7%). The results of the study made it possible to develop an algorithm for the prescription of percutaneous electroneurostimulation and conduction cryotherapy, depending on the type of dyskinetic disorders of the colon in children. All children, regardless of the type of chronic constipation, are prescribed to use the combined effects of physical factors (cryoelectroneurostimulation), percutaneous electroneurostimulation is recommended for HT, conductive cryotherapy - for ST.

CONCLUSION

The higher therapeutic effectiveness of the combined use of conduction cryotherapy and percutaneous electroneurostimulation in various types of dyskinetic disorders in children has been proved according to immediate and long-term results of treatment. An algorithm is proposed for differential use of conduction cryotherapy and percutaneous electroneurostimulation taking into account the type of dyskinetic disorders of the colon.

Effects of physical forms of starter and milk allowance on growth performance, ruminal fermentation, and blood metabolites of Holstein dairy calves

A 2 × 2 factorial study was conducted to evaluate the effects of milk allowance and physical forms of starter on growth performance, ruminal fermentation, and blood metabolites of Holstein dairy calves. A total of 48 calves [40.4 ± 1.55 kg of body weight (BW), n = 12 per treatment: 6 males and 6 females] were randomly assigned to 1 of the 4 treatments: (1) calves fed low milk allowance and finely ground (FG) starter feed [low-FG; 1.47 ± 2.12-mm geometric mean particle size (GMLP)], (2) calves fed low milk allowance and textured (TS) starter feed [low-TS, includes steam-flaked grains (corn and barley) with a pelleted supplement, GMLP 4.15 ± 1.77 mm], (3) calves fed high milk allowance and FG starter feed (high-FG); and (4) calves fed high milk allowance and TS starter feed (high-TS). The starter diets were blended with 7% of chopped alfalfa hay as a proportion of diet dry matter (DM). No milk refusal was observed in any treatments, and calves on both treatments were weaned from milk by wk 8 of the study using a gradual weaning procedure. We observed no interaction between milk allowance and physical forms of starter on feed intake, average daily gain, feed efficiency, BW, and structural growth. Calves fed high milk allowance had lower starter feed intake but greater feed efficiency and overall BW compared with those fed low allowance. Total DM intake and average daily gain were not different among treatments. Regardless of the physical form of starter feed, hip height, heart girth, the molar proportion of ruminal acetate, acetate to propionate ratio, plasma cholesterol, and high-density lipoprotein were greater, but ruminal total volatile fatty acids, the molar proportion of propionate, and plasma β-hydroxybutyrate were lower in calves fed high milk allowance compared with those fed low allowance. Regardless of the milk allowance, calves fed the FG starter feeds had greater blood urea nitrogen concentrations compared with calves fed the TS starter diets. In conclusion, both forms of the starter feeds can be used when calves are fed high milk allowance with no negative effect on their performance.

Assessment of Mental Health and Various Coping Strategies among general population living Under Imposed COVID-Lockdown Across world: A Cross-Sectional Study

The 2019 corona virus disease (COVID-19) which outbreak in December 2019, in the Chinese city of Wuhan has became a global threat and is currently the largest known outbreak of atypical pneumonia affecting every continent of the world with about 6,416,828 cases and 382,867 deaths. Disease enforced lockdowns are known to cause heightened levels of depression, anxiety, and stress. Our study aimed to investigate the immediate impact of the COVID-19 pandemic enforced lockdown on mental health and quality of life among general population aged 18 years and to identify various coping strategies used under lockdown. An online survey was conducted between 1st of April-10th of May, 2020; using a validated questionnaire based on DASS-42, employing a snowball sampling technique. A total of 418 responses from 16 different countries were received. The respondents had a high level of depression and anxiety scores, which were significantly different among genders. Also, participants from developing countries-India and Pakistan had severe depression while as participants from India, Pakistan and Kingdom of Saudi Arabia had severe anxiety. We also found that among the various coping strategies, (a) watching television for entertainment, (b) social networking, (c) listening to music, (d) sleeping, (e) doing mundane house chores like cleaning, washing, etc. (f) eating well, and (g) clearing/finishing thepiled-up work were ranked among the most utilized coping strategies by all participants. This study identifies the need to provide the free professional and psychological services to help cope with stress during the disease-enforced lockdown.

In Situ and Real-Time Monitoring of Nanoparticle Formation in Microemulsion by Means of Dielectric Spectroscopy

Dielectric spectroscopy was employed, for the first time, to monitor the formation process of silica nanoparticles in a nonionic surfactant-based microemulsion in situ and in real time. Two dominant relaxations were observed in the frequency range of 1 MHz-3 GHz during this process. The relaxation at the lower frequency range was confirmed to be mainly ascribed to interfacial polarization, whose relaxation parameters, together with the electrical property of the synthesis system, were used to characterize the evolution of this dynamic formation process. Four evolution stages are distinctively revealed, including an induction stage, a nucleation dominant stage, an early particle growth stage, and a late growth stage. The dynamic features at each evolution stages were discussed in terms of the dielectric characteristics of the system. It is strongly suggested that dielectric spectroscopy is an effective tool for the in situ mechanistic study of nanoparticle formation in microemulsion.

Effects of step-down weaning implementation time on growth performance and blood metabolites of dairy calves

The current study evaluated the effects of step-down weaning implementation time on starter feed intake, growth performance, blood metabolites, and ruminal pH in dairy calves. A total of 48 Holstein dairy calves (24 male and 24 female; 3 ± 1 d old; 41.2 ± 1.8 kg of body weight) were assigned (n = 12 per treatment; 6 male and 6 female) to 4 experimental treatments in a completely randomized block design. All calves were fed 6 L/d of milk from d 3 to 10 of age, and the treatments consisted of the following: calves were offered 8 L/d of milk from d 11 to 28 of age and then 4 L/d from d 29 to 63 (Step-28; total milk offered = 326 L); calves were offered 8 L/d of milk from d 11 to 42 of age and then 4 L/d from d 43 to 63 (Step-42; total milk offered = 382 L); calves were offered 8 L/d of milk from d 11 to 56 of age and 4 L/d from d 57 to 63 (Step-56; total milk intake = 438 L); and calves were fed 8 L/d of milk from d 11 to 63 of age and abruptly weaned (control; total milk offered = 466 L). All calves were housed individually in pens and had ad libitum access to water and solid feed throughout the experiment. All calves were completely milk weaned on d 64, and their performance was measured until d 80 of age. During the experiment, the starter intake (kg/d and % of body weight) was greater in calves in the Step-28 group compared with those in the other groups. However, the total metabolizable energy intake was greater in the Step-56 calves compared with the other calves. Overall, the average daily gain (ADG), feed efficiency (ADG/dry matter intake), and ADG/total metabolizable energy intake were similar across the treatments. Circulating glucose, β-hydroxybutyrate, blood urea nitrogen, albumin, total protein, alanine aminotransferase, and aspartate aminotransferase, as well as ruminal pH, were not affected by the treatments. The implementation of step-down weaning in early life (4-6 wk of age) could stimulate solid feed intake compared with weaning at a later age with no negative effect on performance.

Prophylactic hemoclips in prevention of delayed post-polypectomy bleeding for ≥ 1 cm colorectal polyps: meta-analysis of randomized controlled trials

Background and aim  Studies evaluating the role of prophylactic hemoclips (HC) in prevention of delayed post-polypectomy bleeding (DPPB) have reported conflicting results. We conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate the role of prophylactic HC placement in prevention of DPPB for polyps ≥ 1 cm in size. Methods  We reviewed several databases to identify RCTs evaluating the role of HC in prevention of DPPB. The outcomes assessed included prevention of DPPB with polyps 1 to 1.9 cm, ≥ 2 cm, any polyp ≥ 1 cm, proximal colon polyps, distal colon polyps, and perforation. We analyzed data using a fixed effect model and reported summary pooled risk ratios (RR) with 95 % confidence intervals (CI). We assessed heterogeneity with the I ² statistic. Results  We included nine RCTs with 4550 patients. For polyps ≥ 2 cm, there was a statistically significantly lower risk of DPPB with use of HC; RR 0.55, 95 % CI 0.36, 0.86. There was also a statistically significantly lower risk for proximal colon polyps ≥ 2 cm; RR 0.41 (0.24, 0.70) but no significant difference for distal polyps; RR 1.23 (0.45, 3.32). There was also no significant difference in risk for polyps 1 to 1.9 cm; RR 1.07 (0.59, 1.97). There was no significant reduction in risk of perforation with HC use for any polyp size. Conclusions  Prophylactic HC placement is effective in prevention of DPPB from proximal colon polyps ≥ 2 cm, but of no significant benefit for polyps 1 to 1.9 cm in size or for distal colon polyps ≥ 2 cm.

Plant growth-promoting endophytic bacteria augment growth and salinity tolerance in rice plants

Salt stress negatively affects growth and development of plants. However, it is hypothesized that plant growth-promoting endophytic bacteria can greatly alleviate the adverse effects of salinity and can promote growth and development of plants. In the present research, we aimed to isolate endophytic bacteria from halotolerant plants and evaluate their capacity for promoting crop plant growth. The bacterial endophytes were isolated from selected plants inhabiting sand dunes at Pohang beach, screened for plant growth-promoting traits and applied to rice seedlings under salt stress (NaCl; 150 mm). Out of 59 endophytic bacterial isolates, only six isolates, i.e. Curtobacterium oceanosedimentum SAK1, Curtobacterium luteum SAK2, Enterobacter ludwigii SAK5, Bacillus cereus SA1, Micrococcus yunnanensis SA2, Enterobacter tabaci SA3, resulted in a significant increase in the growth of Waito-C rice. The cultural filtrates of bacterial endophytes were tested for phytohormones, including indole-3-acetic acid, gibberellins and organic acids. Inoculation of the selected strains considerably reduced the amount of endogenous ABA in rice plants under NaCl stress, however, they increased GSH and sugar content. Similarly, these strains augmented the expression of flavin monooxygenase (OsYUCCA1) and auxin efflux carrier (OsPIN1) genes under salt stress. In conclusion, the pragmatic application of the above selected bacterial strains alleviated the adverse effects of NaCl stress and enhanced rice growth attributes by producing various phytohormones.

Assessment of Obstructive Sleep Apnoea and Sleeping Laterality by Evaluating Upper Eyelid Distraction: A Prospective, Comparative Polysomnographic Study

Objective Our goal was to evaluate upper eyelid laxity by digital distraction, with the aim to determine sleeping laterality and the likelihood of obstructive sleep apnoea (OSA), and correlate these findings with polysomnography (PSG). Design We conducted a prospective, single-centre multidisciplinary study in a large sleep and respiratory department and an ophthalmology department within a tertiary referral university teaching hospital. Methods Patients with known OSA were evaluated using techniques based on the Lateralising Eyelid Sleep Compression (LESC) study. Upper eyelid laxity was assessed by two masked investigators, and the eyelid side with greater laxity was regarded as indicative of that patient's sleeping laterality: 'investigator-detected sleeping laterality' (ID SL). Each patient was then asked about the laterality of his or her accustomed sleeping position: 'patient-reported sleeping laterality' (PR SL). PSG was conducted according to the standard protocol of the Department of Sleep and Respiratory Medicine (DSRM). 'Polysomnography-detected sleeping laterality' (PSG SL) permitted the extraction of sleep positional data by two masked sleep scientists. Results The reliability of the LESC technique for diagnosing ID SL was demonstrated to be statistically significant (p<0.01). Upper eyelid laxity was significantly greater on the patients' sleeping side (t=6.340, df=45, p<0.01, two-tailed). There was a significant correlation between PR SL and ID SL (r_s =0.33). However, PSG SL did not correlate with sleeping laterality compared with both ID SL and PR SL. Conclusion This study confirms that there is a statistically significant correlation of sleeping laterality with increasing upper eyelid laxity in OSA. Counterintuitively, PSG SL correlated poorly with ID SL and PR SL. This may likely be explained by the technical limitations implicit in current PSG techniques.

Effects of conditioner retention time during pelleting of starter feed on nutrient digestibility, ruminal fermentation, blood metabolites, and performance of Holstein female dairy calves

This study evaluated the effects of conditioner retention time during the pelleting process of starter feed on intake, nutrient digestibility, ruminal fermentation, blood metabolites, and growth performance of dairy calves. A total of 30 Holstein female dairy calves [40 ± 1.93 kg of body weight (BW)] were randomly assigned to 1 of 3 treatments: (1) pelleted starter conditioned for 0 min (CON), (2) pelleted starter conditioned for 2 min, and (3) pelleted starter conditioned for 4 min. Three pelleted starter feeds had similar nutritional composition, and the starters were blended with 3% chopped wheat straw and fed to individually housed calves from d 3 to 70 of age. All calves were fed 4 L/d of pasteurized whole milk twice daily at 0800 and 1600 h from d 3 to 50 of calf age, followed by 2 L/d of morning feeding from 51 to 56 d of age. All calves were weaned on d 56 of age and remained in the study until d 70 of age. With the increase of conditioner retention time during pellet processing for 0, 2, and 4 min, the gelatinized starch content of pelleted starter feed linearly increased from 14, 30, and 45%, respectively. Additionally, the pellet durability and hardness also linearly increased with increasing conditioner retention time during pelleting. Feeding pelleted feed prepared using different conditioner retention time did not affect feed dry matter intake, metabolizable energy intake, weaning BW, final BW, or feed efficiency during the study. We observed no differences in the total-tract apparent digestibility of organic matter, neutral detergent fiber, and crude protein around weaning (d 49 to 56 of age) and after weaning (d 63 to 70 of calf cage); however, the digestibility of dry matter and starch after weaning was increased with increasing conditioner retention time during pelleting of starter feed. No difference was found in overall average daily gain (ADG) or growth rates of hip height, withers height, and heart girth. Ruminal volatile fatty acid profile was not affected by pelleting under different conditioner retention times. The ruminal ammonia concentration tended to be lower for calves fed the 4-min diet compared with those fed the CON diet during the postweaning period. The postweaning (d 57-70 of age) ADG was greater for calves fed the 4-min diet compared with those fed the CON diet. In conclusion, the conditioning time during the pelleting process of starter feed increased the gelatinization of starch, durability, and hardness of the pellets but did not influence feed intake, feed efficiency, and skeletal growth during the first 70 d of age. Increasing conditioning time during the pelleting process improved postweaning ADG; however, the final BW of calves was similar among treatments.

Self-Healing Mechanisms for 3D-Printed Polymeric Structures: From Lab to Reality

Existing self-healing mechanisms are still very far from full-scale implementation, and most published work has only demonstrated damage cure at the laboratory level. Their rheological nature makes the mechanisms for damage cure difficult to implement, as the component or structure is expected to continue performing its function. In most cases, a molecular bond level chemical reaction is required for complete healing with external stimulations such as heating, light and temperature change. Such requirements of external stimulations and reactions make the existing self-healing mechanism almost impossible to implement in 3D printed products, particularly in critical applications. In this paper, a conceptual description of the self-healing phenomenon in polymeric structures is provided. This is followed by how the concept of self-healing is motivated by the observation of nature. Next, the requirements of self-healing in modern polymeric structures and components are described. The existing self-healing mechanisms for 3D printed polymeric structures are also detailed, with a special emphasis on their working principles and advantages of the self-healing mechanism. A critical discussion on the challenges and limitations in the existing working principles is provided at the end. A novel self-healing idea is also proposed. Its ability to address current challenges is assessed in the conclusions.