The Surface Roughness of Contemporary Indirect CAD/CAM Restorative Materials That Are Glazed and Chair-Side-Finished/Polished

The surface roughness (Ra) of indirect computer-aided design/computer-aided manufacturing (CAD/CAM)-fabricated dental restorations is crucial for their long-term durability. This study intended to evaluate the Ra of five different types of contemporary indirect CAD/CAM restorative materials with varying compositions that were glazed and finished/polished. A total of 75 specimens, disc-shaped (10 mm × 2 mm), were obtained from five materials (n = 15) (Tetric CAD, IPS e.max CAD, IPS e.max ZirCAD, CELTRA Duo, and Vita Enamic) and fabricated by CAD/CAM. One of the two surfaces for each specimen was subjected to glazing, while the other surface was subjected to finishing/polishing. The Ra of the two surfaces in micrometers (μm) was evaluated using a Profilometer, while the surface topography was examined using a scanning electron microscope. Using SPSS, the Kruskal-Wallis, post hoc Conover, and Mann-Whitney tests were used to statistically evaluate the data. A comparison of the Ra for the finished/polished surfaces of the five test materials showed significant differences (p < 0.0001). Among the finished/polished surfaces, the mean rank values of Vita Enamic were significantly higher than the other four test materials (p < 0.0001). A comparison of the Ra of glazed surfaces among the five study materials revealed significant differences (p < 0.0001). The Ra for the IPS e.max ZirCAD material was significantly higher than the rest of the four materials (p < 0.001). A comparison of the Ra for two types of surface conditioning within each of the five test materials showed a significant difference (p < 0.05). Only for IPS e.max ZirCAD was the Ra of the glazed surface significantly higher than the finished/polished surface (p < 0.0001). Significant variations in the surface roughness (Ra) were exhibited between the finished/polished and glazed surfaces of the five test materials. Hybrid ceramics showed the highest Ra values for the finished/polished surfaces, and zirconia exhibited the highest Ra values among the glazed surfaces among the tested materials. The Ra values of either finished/polished or glazed surfaces of the test materials were within the clinically acceptable range (0.2-0.5 μm), except for the glazed surface of the zirconia ceramics (0.84 μm).

The Lucy Thermal Emission Spectrometer (L'TES) Instrument

The Lucy Thermal Emission Spectrometer (L'TES) will provide remote measurements of the thermophysical properties of the Trojan asteroids studied by the Lucy mission. L'TES is build-to-print hardware copy of the OTES instrument flown on OSIRIS-REx. It is a Fourier Transform spectrometer covering the spectral range 5.71-100 μm (1750-100 cm-1) with spectral sampling intervals of 8.64, 17.3, and 34.6 cm-1 and a 7.3-mrad field of view. The L'TES telescope is a 15.2-cm diameter Cassegrain telescope that feeds a flat-plate Michelson moving mirror mounted on a linear voice-coil motor assembly to a single uncooled deuterated l-alanine doped triglycine sulfate (DLATGS) pyroelectric detector. A significant firmware change from OTES is the ability to acquire interferograms of different length and spectral resolution with acquisition times of 0.5, 1, and 2 seconds. A single ∼0.851 μm laser diode is used in a metrology interferometer to provide precise moving mirror control and IR sampling at 772 Hz. The beamsplitter is a 38-mm diameter, 1-mm thick chemical vapor deposited diamond with an antireflection microstructure to minimize surface reflection. An internal calibration cone blackbody target, together with observations of space, provides radiometric calibration. The radiometric precision in a single spectrum is ≤2.2 × 10-8 W cm-2 sr-1 /cm-1 between 300 and 1350 cm-1. The absolute temperature error is <2 K for scene temperatures >75 K. The overall L'TES envelope size is 37.6 × 29.0 × 30.4 cm, and the mass is 6.47 kg. The power consumption is 12.6 W average. L'TES was developed by Arizona State University with AZ Space Technologies developing the electronics. L'TES was integrated, tested, and radiometrically calibrated on the Arizona State University campus in Tempe, AZ. Initial data from space have verified the instrument's radiometric and spatial performance.

2 Pathways to detection of non-infectious childhood uveitis in the UK: findings from the UNICORN cohort study

INTRODUCTION

Prompt detection of childhood uveitis is key to minimising negative impact. From an internationally unique inception cohort, we report pathways to disease detection.UNICORNS is a national childhood non-infectious uveitis study with longitudinal collection of a standardised clinical dataset and patient reported outcomes. Descriptive analysis of baseline characteristics are reported.Amongst 150 recruited children (51% female, 31% non-white ethnicity) age at detection ranged from 2-18yrs (median 10). In 69%, uveitis was diagnosed following onset of symptoms: time from first symptoms to uveitis detection ranged from 0-739days (median 7days), with longer time to detection for those presenting initially to their general practitioner. Non symptomatic children were detected through JIA/other disease surveillance (16%), routine optometry review (5%) or child visual health screening (1%). Commonest underlying diagnoses at uveitis detection were JIA (17%), TINU (9%, higher than pre-pandemic reported UK disease frequency) and sarcoid (1%). 60% had no known systemic disease at uveitis detection. At disease detection, in at least one eye: 34% had structural complications (associated with greater time to detection - 17 days versus 4 days for uncomplicated presentation).The larger relative proportions of children with non-JIA uveitis reported here increase the importance of improving awareness of childhood uveitis amongst the wider clinical communities. There is scope for improvement of pathways to detection. Forthcoming analysis on the full cohort (251 recruited to date across 33 hospitals and 4 nations) will provide nationally representative data on management and the determinants of visual and broader developmental/well-being outcomes.

Enhancing EDM Machining Precision through Deep Cryogenically Treated Electrodes and ANN Modelling Approach

The critical applications of difficult-to-machine Inconel 617 (IN617) compel the process to be accurate enough that the requirement of tight tolerances can be met. Electric discharge machining (EDM) is commonly engaged in its machining. However, the intrinsic issue of over/undercut in EDM complicates the achievement of accurately machined profiles. Therefore, the proficiency of deep cryogenically treated (DCT) copper (Cu) and brass electrodes under modified dielectrics has been thoroughly investigated to address the issue. A complete factorial design was implemented to machine a 300 μm deep impression on IN617. The machining ability of DCT electrodes averagely gave better dimensional accuracy as compared to non-DCT electrodes by 13.5% in various modified dielectric mediums. The performance of DCT brass is 29.7% better overall compared to the average value of overcut (OC) given by DCT electrodes. Among the non-treated (NT) electrodes, the performance of Cu stands out when employing a Kerosene-Span-20 modified dielectric. In comparison to Kerosene-Tween-80, the value of OC is 33.3% less if Kerosene-Span-20 is used as a dielectric against the aforementioned NT electrode. Finally, OC's nonlinear and complex phenomena are effectively modeled by an artificial neural network (ANN) with good prediction accuracy, thereby eliminating the need for experiments.

Electric Discharge Machining of Ti6Al4V ELI in Biomedical Industry: Parametric Analysis of Surface Functionalization and Tribological Characterization

The superior engineering properties and excellent biocompatibility of titanium alloy (Ti6Al4V) stimulate applications in biomedical industries. Electric discharge machining, a widely used process in advanced applications, is an attractive option that simultaneously offers machining and surface modification. In this study, a comprehensive list of roughening levels of process variables such as pulse current, pulse ON time, pulse OFF time, and polarity, along with four tool electrodes of graphite, copper, brass, and aluminum are evaluated (against two experimentation phases) using a SiC powder-mixed dielectric. The process is modeled using the adaptive neural fuzzy inference system (ANFIS) to produce surfaces with relatively low roughness. A thorough parametric, microscopical, and tribological analysis campaign is established to explore the physical science of the process. For the case of the surface generated through aluminum, a minimum friction force of ~25 N is observed compared with the other surfaces. The analysis of variance shows that the electrode material (32.65%) is found to be significant for the material removal rate, and the pulse ON time (32.15%) is found to be significant for arithmetic roughness. The increase in pulse current to 14 A shows that the roughness increased to ~4.6 µm with a 33% rise using the aluminum electrode. The increase in pulse ON time from 50 µs to 125 µs using the graphite tool resulted in a rise in roughness from ~4.5 µm to ~5.3 µm, showing a 17% rise.

In silico elucidation of plausible anti-obesity activity by Withaferin-A compound targeting alpha-amylase

OBJECTIVE

The study aimed to evaluate the Withaferin-A against the drug target α-amylase, revealing its plausible mode of action and molecular-level interactions essential for this specific target inhibitory potential computational approach.

MATERIALS AND METHODS

In this scenario, we used computational methods, including docking, molecular dynamics simulation, and model-building simulations, to elucidate the atomic-level details responsible for the inhibitory potential of Withaferin-A derived from W. somnifera. The studio visualizer software was used for the visualization of ligands, structures of the receptor, bond length, and rendering of the image. Absorption, distribution, metabolism, excretion, and toxicity (ADMET) characteristics of phytochemicals were investigated. Crystal structure of protein receptors and ligands were generated. Semi-flexible docking was done using Autodock software. Docking was performed using the Lamarckian Genetic Algorithm (LGA). Molecular descriptors were evaluated, and the pharmacological properties of the phytochemicals were explored. Molecular dynamic simulations were analyzed at the atomic level. All the simulations were conducted under the same temperature, pressure, and volume circumstances over the simulated time scale.

RESULTS

Withaferin-A has shown a strong binding affinity towards α-amylase as demonstrated with -9.79 Kcal/mol with 66.61 estimated nanomolecular IC50 value for plausible anti-obesity activity. Molecular-level relationships and knowledge obtained from this study indicate solid interactions with TYR59, ASP197, and HIS299 residues which are of high importance for future works related to computational screening of target-specific α-amylase inhibitors. The results from the analysis have revealed potential molecular-level interactions useful for further designing/discovering novel α-amylase inhibitors.

CONCLUSIONS

The framework of the studied phytochemicals enables the rapid development of subsequent modifications that could result in more lead-like compounds with better inhibitory efficacy and selectivity for α-amylase.

Beta Elemene induces cytotoxic effects in FLT3 ITD-mutated acute myeloid leukemia by modulating apoptosis

OBJECTIVE: β-Elemene, a sesquiterpene with a broad anti-cancer spectrum, is particularly effective against drug-resistant and complex tumors. It can also be efficient against FLT3-expressed acute myeloid leukemia. This research aims to determine whether β-Elemene has cytotoxic effects on FLT3 ITD-mutated AML cells. MATERIALS AND METHODS: Cytotoxicity, cell morphology, mRNA analysis with apoptotic markers, and analysis of 43 distinct protein markers related to cell death, survival, and resistance were all performed to elucidate its mechanism. Additionally, in order to understand how β-Elemene and FLT3 interact, molecular docking, molecular dynamics simulations, and computational ADME investigations were performed. RESULTS: β-Elemene exhibited cytotoxic activity against FLT3-mutated MV4-11 and FLT3 wild-type THP-1 cells, with an IC50 of around 25 µg/ml. The molecular studies revealed that β-Elemene inhibited cell proliferation by inducing p53, and the involvement of p21, p27, HTRA, and HSPs were also demonstrated. The interactive inhibition in proliferation was confirmed via molecular docking and dynamics analyses. β-Elemene occupied the FLT3 enzymatic pocket with good stability at the FLT3 active site. CONCLUSIONS: We concluded from our observations that β-Elemene causes cell death in ITD mutant AML cells, together with the effects of stress factors and inhibiting cell division.

Prediction of Mechanical Properties for Carbon fiber/PLA Composite Lattice Structures Using Mathematical and ANFIS Models

This study investigates the influence of design, relative density (RD), and carbon fiber (CF) incorporation parameters on mechanical characteristics, including compressive modulus (E), strength, and specific energy absorption (SEA) of triply periodic minimum surface (TPMS) lattice structures. The TPMS lattices were 3D-printed by fused filament fabrication (FFF) using polylactic acid (PLA) and carbon fiber-reinforced PLA(CFRPLA). The mechanical properties of the TPMS lattice structures were evaluated under uniaxial compression testing based on the design of experiments (DOE) approach, namely, full factorial design. Prediction modeling was conducted and compared using mathematical and intelligent modeling, namely, adaptive neuro-fuzzy inference systems (ANFIS). ANFIS modeling allowed the 3D printing imperfections (e.g., RD variations) to be taken into account by considering the actual RDs instead of the designed ones, as in the case of mathematical modeling. In this regard, this was the first time the ANFIS modeling utilized the actual RDs. The desirability approach was applied for multi-objective optimization. The mechanical properties were found to be significantly influenced by cell type, cell size, CF incorporation, and RD, as well as their combination. The findings demonstrated a variation in the E (0.144 GPa to 0.549 GPa), compressive strength (4.583 MPa to 15.768 MPa), and SEA (3.759 J/g to 15.591 J/g) due to the effect of the studied variables. The ANFIS models outperformed mathematical models in predicting all mechanical characteristics, including E, strength, and SEA. For instance, the maximum absolute percent deviation was 7.61% for ANFIS prediction, while it was 21.11% for mathematical prediction. The accuracy of mathematical predictions is highly influenced by the degree of RD deviation: a higher deviation in RD indicates a lower accuracy of predictions. The findings of this study provide a prior prediction of the mechanical behavior of PLA and CFRPLA TPMS structures, as well as a better understanding of their potential and limitations.

Integrated Intelligent Method Based on Fuzzy Logic for Optimizing Laser Microfabrication Processing of GnPs-Improved Alumina Nanocomposites

Studies on using multifunctional graphene nanostructures to enhance the microfabrication processing of monolithic alumina are still rare and too limited to meet the requirements of green manufacturing criteria. Therefore, this study aims to increase the ablation depth and material removal rate and minimize the roughness of the fabricated microchannel of alumina-based nanocomposites. To achieve this, high-density alumina nanocomposites with different graphene nanoplatelet (GnP) contents (0.5 wt.%, 1 wt.%, 1.5 wt.%, and 2.5 wt.%) were fabricated. Afterward, statistical analysis based on the full factorial design was performed to study the influence of the graphene reinforcement ratio, scanning speed, and frequency on material removal rate (MRR), surface roughness, and ablation depth during low-power laser micromachining. After that, an integrated intelligent multi-objective optimization approach based on the adaptive neuro-fuzzy inference system (ANIFS) and multi-objective particle swarm optimization approach was developed to monitor and find the optimal GnP ratio and microlaser parameters. The results reveal that the GnP reinforcement ratio significantly affects the laser micromachining performance of Al₂O₃ nanocomposites. This study also revealed that the developed ANFIS models could obtain an accurate estimation model for monitoring the surface roughness, MRR, and ablation depth with fewer errors than 52.07%, 100.15%, and 76% for surface roughness, MRR, and ablation depth, respectively, in comparison with the mathematical models. The integrated intelligent optimization approach indicated that a GnP reinforcement ratio of 2.16, scanning speed of 342 mm/s, and frequency of 20 kHz led to the fabrication of microchannels with high quality and accuracy of Al₂O₃ nanocomposites. In contrast, the unreinforced alumina could not be machined using the same optimized parameters with low-power laser technology. Henceforth, an integrated intelligence method is a powerful tool for monitoring and optimizing the micromachining processes of ceramic nanocomposites, as demonstrated by the obtained results.

CNC Turning of an Additively Manufactured Complex Profile Ti6Al4V Component Considering the Effect of Layer Orientations

Electron beam melting (EBM) is one example of a 3D printing technology that has shown great promise and advantages in the fabrication of medical devices such as dental and orthopedic implants. However, these products require high surface quality control to meet the specifications; thus, post-processing, such as with machining processes, is required to improve surface quality. This paper investigates the influence of two-part orientations of Ti6Al4V EBM parts on the CNC machining (turning) process. The two possible EBM part orientations used in this work are across EBM layers (AL) and parallel to the EBM layer (PL). The effect of the EBM Ti6Al4V part orientations is examined on surface roughness, power consumption, chip morphology, tool flank wear, and surface morphology during the dry turning, while using uncoated carbide tools at different feed rates and cutting speeds. The results showed that the AL orientation had better surface quality control and integrity after machining than PL orientation. Using the same turning parameters, the difference between the roughness (Ra) value for AL (0.36 μm) and PL (0.79 μm) orientations is about 54%. Similarly, the power consumption in AL orientation differs by 19% from the power consumption in PL orientation. The chip thickness ratio has a difference of 23% between AL and PL orientations, and the flank wear shows a 40% difference between AL and PL orientations. It is found that, when EBM components are manufactured along across-layer (AL) orientations, the impact of part orientation during turning is minimized and machined surface integrity is improved.

Sustainable Microfabrication Enhancement of Graphene Nanoplatelet-Reinforced Biomedical Alumina Ceramic Matrix Nanocomposites

Studies about adding graphene reinforcement to improve the microfabrication performance of alumina (Al₂O₃) ceramic materials are still too rare and incomplete to satisfy sustainable manufacturing requirements. Therefore, this study aims to develop a detailed understanding of the effect of graphene reinforcement to enhance the laser micromachining performance of Al₂O₃-based nanocomposites. To achieve this, high-density Al₂O₃ nanocomposite specimens were fabricated with 0 wt.%, 0.5 wt.%, 1 wt.%, 1.5 wt.%, and 2.5 wt.% graphene nanoplatelets (GNPs) using a high-frequency induction heating process. The specimens were subjected to laser micromachining. Afterward, the effects of the GNP contents on the ablation depth/width, surface morphology, surface roughness, and material removal rate were studied. The results indicate that the micro-fabrication performance of the nanocomposites was significantly affected by the GNP content. All nanocomposites exhibited improvement in the ablation depth and material removal rate compared to the base Al₂O₃ (0 wt.% GNP). For instance, at a higher scanning speed, the ablation depth was increased by a factor of 10 times for the GNP-reinforced specimens compared to the base Al₂O₃ nanocomposites. In addition, the MRRs were increased by 2134%, 2391%, 2915%, and 2427% for the 0.5 wt.%, 1 wt.%, 1.5 wt.%, and 2.5 wt.% GNP/Al₂O₃ nanocomposites, respectively, compared to the base Al₂O₃ specimens. Likewise, the surface roughness and surface morphology were considerably improved for all GNP/Al₂O₃ nanocomposite specimens compared to the base Al₂O₃. This is because the GNP reinforcement reduced the ablation threshold and increased the material removal efficiency by increasing the optical absorbance and thermal conductivity and reducing the grain size of the Al₂O₃ nanocomposites. Among the GNP/Al₂O₃ nanocomposites, the 0.5 wt.% and 1 wt.% GNP specimens showed superior performance with minimum defects in most laser micromachining conditions. Overall, the results show that the GNP-reinforced Al₂O₃ nanocomposites can be machined with high quality and a high production rate using a basic fiber laser system (20 Watts) with very low power consumption. This study shows huge potential for adding graphene to alumina ceramic-based materials to improve their machinability.

Significance of Orlistat in management of dyslipidemia, systolic blood pressure and body mass index

OBJECTIVE

The current study intends to find out the efficacy of Orlistat in the management of hyperlipidemia, Systolic Blood Pressure (SBP) and Body Mass Index (BMI).

MATERIALS AND METHODS

This retrospective study has evaluated the lipid profiles of the patients, who have been using metformin therapy for Type 2 diabetes. The study has obtained data regarding the parameters like triglyceride, Total cholesterol (TC), LDL cholesterol, HDL cholesterol and LDL/HDL ratio, systolic blood pressure and Body Mass Index (BMI). Random distribution of patients was done into placebo and Orlistat groups. The placebo group received only metformin, and patients in the Orlistat group received Orlistat along with metformin. After 24 weeks, the follow-up study was done, and statistical analysis was conducted.

RESULTS

The study found that the Orlistat group has significant improvement (p<0.05) more improvement in LDL cholesterol, HDL cholesterol, Total cholesterol, LDL/HDL Ratio and Triglycerides, while BMI and systolic blood pressure did not show a significant difference between placebo and Orlistat group.

CONCLUSIONS

This study has concluded that Orlistat can be used for significant improvement in lipid profile. The study also found that Orlistat may not have a significant effect on reducing BMI and blood pressure without adequate lifestyle modification.

A Novel Flushing Mechanism to Minimize Roughness and Dimensional Errors during Wire Electric Discharge Machining of Complex Profiles on Inconel 718

One of the sustainability goals in the aeronautical industry includes developing cost-effective, high-performance engine components possessing complex curved geometries with excellent dimensional precision and surface quality. In this regard, several developments in wire electric discharge machining have been reported, but the influence of flushing attributes is not thoroughly investigated and is thus studied herein. The influence of four process variables, namely servo voltage, flushing pressure, nozzle diameter, and nozzle-workpiece distance, were analyzed on Inconel 718 in relation to geometrical errors (angular and radial deviations), spark gap formation, and arithmetic roughness. In this regard, thorough statistical and microscopical analyses are employed with mono- and multi-objective process optimization. The grey relational analysis affirms the reduction in the process's limitations, validated through confirmatory experimentation results as 0.109 mm spark gap, 0.956% angular deviation, 3.49% radial deviation, and 2.2 µm surface roughness. The novel flushing mechanism improved the spark gap by 1.92%, reducing angular and radial deviations by 8.24% and 29.11%, respectively.

Comparison between 2 futility scores in comatosed survivors of out of hospital cardiac arrest in a large tertiary centre in the United Kingdom: MIRACLE2 vs NULL-PLEASE

Background

The management of patients presenting with an out of hospital cardiac arrest (OHCA) is resource intensive, and mortality remains very high. Several scoring systems have been developed to predict mortality and adverse neurological outcomes, and thus aid decision making for patients arriving to heart attack centres. Two of the most commonly used scoring systems are NULL-PLEASE (1) and MIRACLE2 (2).

Purpose

The MIRCALE2 score predicts poor neurological outcome at 6 months, as measured by Cerebral Performance Category (CPC). The NULL-PLEASE score predicts in-hospital morality. We aimed to compare both scores in predicting their primary end-points in a large tertiary centre in the UK.

Method and results

This was a retrospective analysis of 435 patient who were admitted with OHCA via the primary PCI pathway to a large tertiary cardiac centre between January 2016 and September 2020. Only comatosed OHCA survivors requiring pre-hospital ventilatory support were included. 319 patients were eligible 238 patients had complete set of data and were included in the final analysis.

The association of the primary outcome was examined using logistic regression analysis. The predictive ability of the scores for the primary endpoint was tested using AUC analysis.

In-hospital mortality was 45% (108 patients), with 53% having good neurological outcome at 6 months (CPC &lt;3). The median MIRACLE2 score for our cohort was 5 (total score 10). The median neurological outcome measured by CPC was 2. The median NULL-PLEASE score was 2 (total 14). A ROC curve for both scores was plotted, with area under the curve at 0.73 for the MIRACLE2, and 0. 0.81 for NULL-PLEASE (figure 1 and 2). Our final analysis demonstrated a MIRACLE2 score of 5 or more had sensitivity of 67% to predict poor neurological outcome (CPC 3–5). The NULL-PLEASE, score of &gt;3 had 74% sensitivity to predict in hospital mortality.

Conclusion

To our knowledge, this is the first study to compare the MIRCLE2 and NULL-PLEASE scoring systems. Both scores did not perform as expected in our large retrospective analysis. The NULL-PLEASE was more sensitive in predicting in-hospital mortality, although MIRACLE 2 score was easier to use as it had less variables to collect.

Funding Acknowledgement

Type of funding sources: None.

Homozygosity predominantly affects hypertrophic cardiomyopathy minor genes in an Egyptian clinical cohort

Background

Consanguinity is prevalent in Egypt (35%) resulting in a high incidence of homozygosity. The influence of homozygosity on the genetics of Hypertrophic Cardiomyopathy (HCM) has not been adequately studied.

Purpose

The purpose of this study is to define the genetic architecture of HCM in Egypt using ethnically-matched case and control cohorts.

Methods

Prospective Egyptian patients (n=514) and controls (n=400) were recruited to Aswan Heart Centre for clinical phenotyping and genetic testing for 174 genes implicated in inherited cardiac conditions (Illumina). Rare variation (gnomAD filtering allele frequency ≤4x10–5) in 13 validated HCM genes were classified according to the American College of Medical Genetics (ACMG) guidelines and compared with a prospective HCM cohort of predominantly European ancestry (n=684).

Results

Significantly fewer rare variants detected in Egyptian patients could be classified as (likely) pathogenic compared to Europeans (40.8% vs. 61.6%, p-value=1.6x10–5). Incorporating analysis from these Egyptian case-control cohorts into the ACMG guidelines increased this yield to 53.8%. Homozygous variants were more frequently observed in Egyptian patients (4.1% vs 0.1%, p-value=2x10–7), with variants in the minor HCM genes MYL2, MYL3 and CSRP3 more likely to present in homozygosity than the major genes (MYH7, MYBPC3 and troponins), suggesting such variants are less penetrant in the heterozygous state.

Conclusions

The integration of Egyptian-specific genetic and phenotypic data significantly improves variant interpretation in HCM and consequently the precision of genetic testing. The observed prevalence of homozygosity and rare variation in minor HCM genes in Egyptian patients provides important insights into its disease-mechanisms and genetics.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Science and Technology Development FundAl Alfi Foundation

Hydrogen sulfide: an emerging component against abiotic stress in plants

As a result of climate change, abiotic stresses are the most common cause of crop losses worldwide. Abiotic stresses significantly impair plants' physiological, biochemical, molecular and cellular mechanisms, limiting crop productivity under adverse climate conditions. However, plants can implement essential mechanisms against abiotic stressors to maintain their growth and persistence under such stressful environments. In nature, plants have developed several adaptations and defence mechanisms to mitigate abiotic stress. Moreover, recent research has revealed that signalling molecules like hydrogen sulfide (H₂ S) play a crucial role in mitigating the adverse effects of environmental stresses in plants by implementing several physiological and biochemical mechanisms. Mainly, H₂ S helps to implement antioxidant defence systems, and interacts with other molecules like nitric oxide (NO), reactive oxygen species (ROS), phytohormones, etc. These molecules are well-known as the key players that moderate the adverse effects of abiotic stresses. Currently, little progress has been made in understanding the molecular basis of the protective role of H₂ S; however, it is imperative to understand the molecular basis using the state-of-the-art CRISPR-Cas gene-editing tool. Subsequently, genetic engineering could provide a promising approach to unravelling the molecular basis of stress tolerance mediated by exogenous/endogenous H₂ S. Here, we review recent advances in understanding the beneficial roles of H₂ S in conferring multiple abiotic stress tolerance in plants. Further, we also discuss the interaction and crosstalk between H₂ S and other signal molecules; as well as highlighting some genetic engineering-based current and future directions.

332 Paediatric Ultrasound Scan: Are We Providing a Quality Service?

Aim

Ultrasound scan is the preferred imaging modality in children as it carries no risk of radiation exposure. In this audit, the number of inpatient paediatric ultrasound referrals was assessed over a period of one year. The waiting time was also reviewed in addition to the impact of the results on the management plan.

Method

This was a retrospective audit which included patients who were below 16 and had inpatient ultrasound scan. Case notes were included from January 2020 to December 2020 in a busy district hospital in the UK. The time taken to perform the ultrasound scans and the impact on the management plan were only analysed for the scans requested for abdominal pain.

Results

A total of 914 paediatric ultrasounds scans were requested in 2020. A total number of 28 scans were requested for abdominal pain. The waiting time ranged from 3 to 135 hours with a mean of 23 hours. No scans were positive for appendicitis. Only 2 scans were positive for gynaecological pathologies, i.e., ovarian cysts. All the 28 patients were discharged without undergoing any procedure. Out of the 28 patients, 15 patients had a length of hospital stay of more than 24 hours before discharge.

Conclusions

A mean delay of 23 hours could potentially delay the management of paediatric patients with acute abdominal pathology. None of the patients in this audit underwent any procedure following performed scans. This may indicate that such scans did not alter the management of the studied patients in this audit.

EDM of Ti-6Al-4V under Nano-Graphene Mixed Dielectric: A Detailed Investigation on Axial and Radial Dimensional Overcuts

Ti-6Al-4V is considered a challenging material in terms of accurate machining. Therefore, electric discharge machining (EDM) is commonly engaged, but its low cutting rate depreciates its use. This issue is resolved if graphene nanoparticles are mixed in the dielectric. However, the control over the sparking phenomenon reduces because of the dispersion of graphene particles. Subsequently, the machined profile’s geometric accuracy is compromised. Furthermore, the presence of nanographene induces different sparks along axial and radial cutting orientations. This aspect has not been comprehensively examined yet and dedicatedly targeted in this study to improve the quality of EDM process for Ti-6Al-4V. A total of 18 experiments were conducted under Taguchi’s L18 design considering six parameters namely, electrode type, polarity, flushing time, spark voltage, pulse time ratio, and discharge current. The aluminum electrode proved to be the best choice to reduce the errors in both the cutting orientations. Despite the other parametric settings, negative tool polarity yields lower values of axial (A_DE) and radial errors (R_DE). The developed optimal settings ensure 4.4- and 6.3-times reduction in R_DE and A_DE, respectively. In comparison to kerosene, graphene-based dielectric yields 10.2% and 19.4% reduction in R_DE and A_DE, respectively.

1339 Haemoglobin Threshold for Red Blood Cell Transfusion in Traumatic Brain Injury. A Systematic Review and Meta-Analysis

Background

Traumatic Brain Injury (TBI) is a significant and growing worldwide healthcare burden. Minimising brain hypoxia is important in preventing secondary brain injury. Anaemia is common in TBI patients but there is little evidence as to which haemoglobin (Hb) threshold transfusion should be considered in TBI patients.

Objective

This present systematic review and meta-analysis of randomised controlled trials aims to assess the effect of high verses low red blood cell transfusion thresholds on functional outcomes and quality of life in TBI patients.

Method

We searched Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, and Web of Science up to June 2020. We also searched clinical trial registers, conference proceedings, and reference lists from previous systematic reviews and included studies. We included randomised studies comparing high verses low Hb threshold for red blood cell transfusion in TBI patients. We assessed the following major outcomes: all-cause mortality, transfusion related adverse events and favourable outcome (Glasgow Outcome Scale, GOS).

Results

We included 3 RCTs involving 311 participants. Our analysis showed no difference in all-cause mortality (3-6 months) (OR 1.17 (95% CI 0.64 to 2.13)) and no difference in GOS (OR 1.10 (95% CI 0.65 to 1.85)) between transfusing red blood cells at 7g/dL or at 9/10g/dL in moderate to severe TBI.

Conclusions

There is no difference between a high and a low Hb threshold transfusion policy. However, considering the limitations in current evidence there is a need for future high quality randomised controlled trials.

1525 How Far Do Cultural Values Between First and Second Generational Medical Students Differ According to GMC Guidelines

Aim

There are a disproportionately higher number of fitness to practise issues reported to the GMC within the BAME medic group than that any other ethnic group. This research seeks to compare differences in cultural nuances, if any, between second generation BAME medical students and whether there is an opportunity to address these within medical training.

Method

We conducted 4 qualitative one to one interviews of second generation medics (Those whose parents were not from the UK, but were themselves brought up in the UK) and medics who were both from the UK and whose parents had been brought up in the UK. An exploratory interview was conducted of what values were most important to the interviewees and how this affected their decision-making process. The interviewees were medical students from the University of Liverpool all of whom were in their clinical years between year 3-5. The interviewees were randomly chosen after expressing an interest in the research. A literature search across Pubmed and Scopus were conducted to help direct interview questions.

Results

The main themes interviewees reported impacting on decision making included difficulty of balancing cultures, the impact of religion on cultural values and personal professional values. When compared to the GMC guidelines, these values mostly aligned however there were some differences, mainly in communication and whistleblowing.

Conclusions

With an increasingly diverse workforce, there should be some further research conducted to address how the differences in culture affects decision making processes with the consideration of incorporation into medical training.

Risk Factors of UTI in Children with Nephrotic Syndrome

Urinary tract infection (UTI) is a common complication in nephrotic children and leads to most morbidity and mortality in developing countries like Bangladesh. This case control study was conducted in the Department of Pediatrics and Pediatric Nephrology ward of Dhaka Medical College Hospital, Dhaka from July 2016 to June 2018 to identify the risk factors of UTI in children with nephrotic syndrome. Total 90 patient of nephrotic children aged 2-12 years, who were fulfilling the inclusion and exclusion criteria were selected as Group I (case) and Group II (control) according to urine culture report. Group I was UTI positive and Group II was UTI negative. The mean age of Group I was 5.26±3.18 years and Group II was 6.03±2.85 years. There was male predominance in both groups. No significant difference has been found regarding age and sex (p>0.05). No significant difference was also observed regarding economic status and educational level of mother among both groups (p>0.05). Fever, dysuria, abdominal pain, anasarca, vomiting and pallor were found as common presentations in Group I. Children with dysuria and abdominal pain were significantly higher in Group I than Group II (p value <0.001). UTI was found more in relapsed cases than initial attack. E. coli was the most common etiologic agent (37.8%). Mean Hb (gm/dl), serum total protein, serum albumin and serum IgG level were found significantly lower and spot urine protein creatinine ratio was significantly higher in Group I, which implies that those biochemical factors were associated with development of UTI in nephrotic children. Younger age group (<6 years), Constipation and uncircumcised male were found as risk factors and has association with UTI in nephrotic children.

Results from the Survey of Antibiotic Resistance (SOAR) 2015-17 in Pakistan: data based on CLSI, EUCAST (dose-specific) and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints

OBJECTIVES

To determine antibiotic susceptibility of community-acquired respiratory tract infection (CA-RTI) isolates of Streptococcus pneumoniae and Haemophilus influenzae collected in 2015-17 from Pakistan.

METHODS

MICs were determined by CLSI broth microdilution and susceptibility was assessed using CLSI, EUCAST (dose-specific) and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints.

RESULTS

A total of 94 S. pneumoniae and 122 H. influenzae isolates were collected. Susceptibility to penicillin was noted in 23.4% of the S. pneumoniae isolates by CLSI oral/EUCAST low-dose IV breakpoints, although by CLSI IV and EUCAST high-dose breakpoints all isolates were characterized as susceptible. Susceptibility to trimethoprim/sulfamethoxazole (10.6%), macrolides (33%) and cefaclor (28.7%) was low but higher susceptibility was observed to ceftriaxone (100%), amoxicillin and amoxicillin/clavulanic acid (98.9%), cefuroxime (oral, 97.9%), cefpodoxime (96.8%), fluoroquinolones (93.6%-96.8%) and cefdinir (76.6%) by CLSI breakpoints. However, using EUCAST breakpoints, susceptibility to cefpodoxime (70.2%) and cefuroxime (oral, 61.7%) was reduced. H. influenzae isolates were almost all β-lactamase negative (96.7%). Using CLSI breakpoints, ≥93.4% of isolates were susceptible to all antibiotics tested except fluoroquinolones (75.4%-77.1%) and trimethoprim/sulfamethoxazole (41%). The proportion of isolates susceptible using EUCAST breakpoints was similar or identical for penicillins, trimethoprim/sulfamethoxazole and the cephalosporins that have EUCAST breakpoints; the proportion of isolates susceptible using EUCAST breakpoints was similar or identical to that using CSLI breakpoints except for cefuroxime (oral), where only 1.6% of isolates were considered susceptible. Susceptibility of H. influenzae to fluoroquinolones was also lower by EUCAST breakpoints (33.6%-34.4%). The application of different EUCAST breakpoints for low and higher doses for some of the antibiotics (amoxicillin, amoxicillin/clavulanic acid, ampicillin, penicillin, ceftriaxone, clarithromycin, erythromycin, levofloxacin and trimethoprim/sulfamethoxazole) allowed, for the first time in a SOAR study, the effect of raising the dosage on susceptibility to be quantified.

CONCLUSIONS

Antibiotic susceptibility in these important respiratory tract pathogens varied in Pakistan based on different breakpoints. These data are important for empirical therapy choices in the treatment of CA-RTIs.

AB0557 ACHIEVING TREATMENT TARGETS IN PSORIATIC ARTHRITIS WITH APREMILAST IN CANADIAN PRACTICE: REAL WORLD RESULTS FROM APPRAISE

Background:

Real-world evidence on achieving treatment targets with apremilast (APR) in patients (pts) with PsA is limited. In the phase 3 PALACE trials, pts reached remission (REM)/low disease activity (LDA) targets at 52 wks most frequently when early APR treatment was initiated and pts were in moderate disease activity, as measured by Clinical Disease Activity Index for PsA (cDAPSA) score. In APPRAISE, we assessed APR effectiveness/tolerability in pts with PsA in routine clinical practice in Canada.

Objectives:

This interim efficacy analysis focused on the available data on APR effectiveness measuring rate of achieving cDAPSA REM or LDA at 12 mos and Pt Acceptable Symptom Status (PASS) results.

Methods:

The prospective, multicenter, observational APPRAISE study assessed APR effectiveness/tolerability in adults with active PsA in routine clinical care enrolled from July 2018-March 2020. Pts were followed from treatment initiation to 12 mos, with visits suggested every 4 mos. The primary effectiveness endpoint was the rate of achieving at least LDA (cDAPSA <14) at 12 mos. Pt-reported outcome measures were assessed. Data reported are as observed in pts continuing APR treatment.

Results:

In total, 101 pts were enrolled in APPRAISE. Mean age was 52 yrs; 56% were women. Mean (SD) PsA duration at baseline (BL) was 6 (8) yrs. Oligoarticular disease (≤4 joint involvement) was most common (41%), followed by polyarticular (35%). Most pts (92%) received prior conventional DMARDs and 17% received prior biologic therapy; concomitant MTX was reported in 41% at BL. By 12 mos, 41/101 enrolled pts discontinued, 35 reached 12 mos follow-up (4 mos: n=92; 8 mos: n=61), and 25 have yet to reach 12 mos. The majority (92%) of discontinuations due to lack/loss of effectiveness or AEs occurred within 4-8 mos. AEs were primarily GI related early in treatment. The proportion of pts with continued APR achieving cDAPSA REM/LDA treatment targets increased significantly over time (Figure 1). Significant reductions were seen over 12 mos in swollen/tender joint counts and plaque psoriasis, with reduced mean (SD) body surface area of −4% (9%) (Table 1). Prevalence of dactylitis/enthesitis at BL, 4, 8, and 12 mos was 17%/33%, 9%/24%, 5%/19%, and 0%/21%, respectively. Pain assessment (VAS) significantly improved over time. The proportion of pts achieving PASS with continued APR increased significantly over 12 mos (BL: 27%; 12 mos: 65%) (Figure 1). COVID restrictions impacted in-office assessment visits, necessitating reliance on virtual visits.

Conclusion:

Pts with PsA receiving APR were assessed at regular intervals in routine clinical care in Canada. This interim analysis revealed a greater number of pts receiving APR (66%) who completed the 12-mo follow-up achieved REM or LDA, as measured by cDAPSA over 12 mos. A majority of pts (65%) reported satisfaction with their disease state, as measured by PASS. No new safety signals were observed.

Table 1.

Change in Clinical Parameters and Pt-Reported Outcomes From BL to 4, 8, and 12 Mos

Outcome Measure*, Mean (SD)BL (n = 101)4 Mos (n = 92)8 Mos (n = 61)12 Mos (n = 35)Disease/Clinical Parameters Tender joint count (0-68)7.5 (6.7)−2.5 (6.3)*−3.9 (5.2)*−2.2 (6.4) Swollen joint count (0-66)5.4 (5.4)−3.0 (4.5)*−3.1 (4.3)*−3.1 (4.4)* PhGA42.9 (18.8)−19.0 (24.6)*−24.2 (24.2)*−21.2 (26.3)* Body surface area, %3.1 (6.1)−2.2 (6.0)*−2.7 (7.5)*−4.2 (9.1)* cDAPSA22.2 (13.3)−7.9 (12.1)*−10.1 (13.5)*−6.9 (12.0)*Pt-Reported Outcomes PtGA, mm50.0 (24.6)−10.2 (27.5)*−9.1 (31.9)*−3.6 (39.7) Pain, mm48.3 (25.3)−9.5 (26.2)*−12.2 (28.7)*−7.3 (26.0) HAQ-DI0.9 (0.7)−0.13 (0.5)*−0.15 (0.6)−0.1 (0.7)

*Denotes significant change from BL (P<0.05) from paired-sample t-tests; note that mean change from BL may be greater than the mean BL value when improvements of large magnitude, for pts with relatively elevated BL values, are observed in samples with lower n’s. HAQ-DI = Health Assessment Questionnaire-Disability Index; PhGA = Physician’s Global Assessment; PtGA = Patient’s Global Assessment.

Acknowledgements:

This study was funded by Celgene and Amgen Inc. Writing support was funded by Amgen Inc. and provided by Kristin Carlin, RPh, MBA, of Peloton Advantage, LLC, an OPEN Health company.

Disclosure of Interests:

Vinod Chandran Consultant of: AbbVie, Amgen, BMS, Celgene Corporation, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Amgen, BMS, Celgene Corporation, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Louis Bessette Consultant of: AbbVie, Amgen, BMS, Celgene Corporation, Eli Lilly, Janssen, Merck, Pfizer, Sanofi, Novartis, UCB, Grant/research support from: AbbVie, Amgen, BMS, Celgene Corporation, Eli Lilly, Janssen, Merck, Pfizer, Sanofi, Novartis, UCB, Carter Thorne Speakers bureau: AbbVie, Amgen, Celgene Corporation, Eli Lilly, Medexus/Medac, Merck, Novartis, Pfizer, Sandoz, Sanofi, Consultant of: Centocor, Medexus/Medac, Merck, Grant/research support from: Novartis, Pfizer, Maqbool Sheriff Speakers bureau: AbbVie, Celgene Corporation, Eli Lilly, Janssen, Merck, Pfizer, Sandoz, Proton Rahman Speakers bureau: AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, UCB, Dafna D Gladman Consultant of: AbbVie, Amgen, BMS, Celgene Corporation, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Amgen, BMS, Celgene Corporation, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, UCB, Sabeen Anwar Consultant of: AbbVie, Amgen Inc., BMS, Novartis, and Pfizer, Grant/research support from: AbbVie, Amgen Inc., Eli Lilly, Janssen, and Pfizer, Jennifer Jelley Employee of: Amgen Canada Inc., Anne-Julie Gaudreau Employee of: Amgen Canada Inc., Manprit Chohan Employee of: Amgen Canada Inc., John S. Sampalis Employee of: JSS Medical Research.

Investigations on the Effect of Layers' Thickness and Orientations in the Machining of Additively Manufactured Stainless Steel 316L

Laser-powder bed fusion (L-PBF) process is a family of modern technologies, in which functional, complex (3D) parts are formed by selectively melting the metallic powders layer-by-layer based on fusion. The machining of L-PBF parts for improving their quality is a difficult task. This is because different component orientations (L-PBF-layer orientations) produce different quality of machined surface even though the same cutting parameters are applied. In this paper, stainless steel grade SS 316L parts from L-PBF were subjected to the finishing (milling) process to study the effect of part orientations. Furthermore, an attempt is made to suppress the part orientation effect by changing the layer thickness (LT) of the parts during the L-PBF process. L-PBF parts were fabricated with four different layer thicknesses of 30, 60, 80 and 100 μm to see the effect of the LT on the finish milling process. The results showed that the layer thickness of 60 μm has significantly suppressed the part orientation effect as compared to the other three-layer thicknesses of 30, 80 and 100 μm. The milling results showed that the three-layer thickness including 30, 80 and 100 μm presented up to a 34% difference in surface roughness among different part orientations while using the same milling parameters. In contrast, the layer thickness of 60 μm showed uniform surface roughness for the three-part orientations having a variation of 5–17%. Similarly, the three-layer thicknesses 30, 80 and 100 μm showed up to a 25%, 34% and 56% difference of axial force (Fa), feed force (Ff) and radial force (Fr), respectively. On the other hand, the part produced with layer thickness 60 μm showed up to 11%, 25% and 28% difference in cutting force components F_a, F_f and F_r, respectively. The three-layer thicknesses 30, 80 and 100 μm in micro-hardness were found to vary by up to 14.7% for the three-part orientation. Negligible micro-hardness differences of 1.7% were revealed by the parts with LT 60 μm across different part orientations as compared to 6.5–14% variations for the parts with layer thickness of 30, 80 and 100 μm. Moreover, the parts with LT 60 μm showed uniform and superior surface morphology and reduced edge chipping across all the part orientations. This study revealed that the effect of part orientation during milling becomes minimum and improved machined surface integrity is achieved if the L-PBF parts are fabricated with a layer thickness of 60 μm.

Effect of Different Cooling Strategies on Surface Quality and Power Consumption in Finishing End Milling of Stainless Steel 316

In this paper, an experimental investigation into the machinability of AISI 316 alloy during finishing end milling operation under different cooling conditions and with varying process parameters is presented. Three environmental-friendly cooling strategies were utilized, namely, dry, minimal quantity lubrication (MQL) and MQL with nanoparticles (Al₂O₃), and the variable process parameters were cutting speed and feed rate. Power consumption and surface quality were utilized as the machining responses to characterize the process performance. Surface quality was examined by evaluating the final surface roughness and surface integrity of the machined surface. The results revealed a reduction in power consumption when MQL and MQL + Al₂O₃ strategies were applied compared to the dry case by averages of 4.7% and 8.6%, respectively. Besides, a considerable reduction in the surface roughness was noticed with average values of 40% and 44% for MQL and MQL + Al₂O₃ strategies, respectively, when compared to the dry condition. At the same time, the reduction in generated surface roughness obtained by using MQL + Al₂O₃ condition was marginal (5.9%) compared with using MQL condition. Moreover, the results showed that the improvement obtained in the surface quality when using MQL and MQL + Al₂O₃ coolants increased at higher cutting speed and feed rate, and thus, higher productivity can be achieved without deteriorating final surface quality, compared to dry conditions. From scanning electron microscope (SEM) analysis, debris, furrows, plastic deformation irregular friction marks, and bores were found in the surface texture when machining under dry conditions. A slight smoother surface with a nano-polishing effect was found in the case of MQL + Al₂O₃ compared to the MQL and dry cooling strategies. This proves the effectiveness of lubricant with nanoparticles in reducing the friction and thermal damages on the machined surface as the friction marks were still observed when machining with MQL comparable with the case of MQL + Al₂O₃.

3D Echocardiography Provides Highly Accurate 3D Printed Models in Congenital Heart Disease

Cardiac 3D printing is mainly performed from magnetic resonance imaging (MRI) and computed tomography (CT) 3D datasets, though anatomic detail of atrioventricular (AV) valves may be limited. 3D echo provides excellent visualization of AV valves. Thus, we tested the feasibility and accuracy of 3D printing from 3D echo in this pilot series of subjects with congenital heart disease (CHD), with a focus on valve anatomy. Five subjects with CHD were identified. 3D echo data were converted to 3D printable files and printed in collaboration with 3D Systems Healthcare (Golden, Colorado). A novel technique for valve modeling was utilized using commercially available software. Two readers (KM, SA) independently measured valve structures from 3D models and compared to source echo images. 3D printing was feasible for all cases. Table 1 shows measurements comparing 2D echo to 3D models. Bland Altman analysis showed close agreement and no significant bias between 2D and digital 3D models (mean difference 0.0, 95% CI 1.1 to - 1.1) or 2D vs printed 3D models, though with wider limits of agreement (mean difference - 0.3, 95% CI 1.9 to - 2.6). Accuracy of 3D models compared to 2D was within < 0.5 mm. This pilot study shows 3D echo datasets can be used to reliably print AV and semilunar valve structures in CHD. The 3D models are highly accurate compared to the source echo images. This is a novel and value-added technique that adds incremental information on cardiac anatomy over current methods.

Antiviral activities of Cholistani plants against common poultry viruses

Herbal medicines are becoming more popular and acceptable day by day due to their effectiveness, limited side effects, and cost-effectiveness. Cholistani plants are reported as a rich source of antibacterial, antifungal, antiprotozoal, antioxidant, and anticancer agents. The current study has evaluated antiviral potential of selected Cholistani plants. The whole plants were collected, ground and used in extract formation with n-hexane, ethyl acetate and n-butanol. All the extracts were concentrated by using a rotary evaporator and concentrate was finally dissolved in an appropriate vol of the same solvent. All of the extracts were tested for their antiviral potential by using 9-11 days old chick embryonated eggs. Each extract was tested against the Avian Influenza virus H9N2 strain (AIV), New Castle Disease virus Lasoota strain (NDV), Infectious bronchitis virus (IBV) and an Infectious bursal disease virus (IBDV). Hemagglutination test (HA) and Indirect Hemagglutination (IHA) tests were performed for different viruses. The overall order of the antiviral potential of Cholistani plants against viruses was NDV>IBV>IBDV>AIV. In terms of antiviral activity from extracts, the order of activity was n-butanol>ethyl acetate>n-hexane. The medicinal plants Achyranthes aspera, Neuroda procumbens, Panicum antidotale, Ochthochloa compressa and Suaeda fruticose were very effective against all four poultry viruses through their extracts. The low IC50 values of these extracts confirm the high antiviral potential against these viruses. It is worth to mention that Achyranthes aspera was found positive against IBDV through all its extracts which overcome the problem of unavailability of any known drug against IBDV. In short, the study proved that Cholistani plants are rich source of antiviral agent and their extracts can be used as good source of antiviral drugs both in crude and in purified form.

Milling of Graphene Reinforced Ti6Al4V Nanocomposites: An Artificial Intelligence Based Industry 4.0 Approach

The studies about the effect of the graphene reinforcement ratio and machining parameters to improve the machining performance of Ti6Al4V alloy are still rare and incomplete to meet the Industry 4.0 manufacturing criteria. In this study, a hybrid adaptive neuro-fuzzy inference system (ANFIS) with a multi-objective particle swarm optimization method is developed to obtain the optimal combination of milling parameters and reinforcement ratio that lead to minimize the feed force, depth force, and surface roughness. For achieving this, Ti6Al4V matrix nanocomposites reinforced with 0 wt.%, 0.6 wt.%, and 1.2 wt.% graphene nanoplatelets (GNPs) are produced. Afterward, a full factorial approach was used to design experiments to investigate the effect of cutting speed, feed rate, and graphene nanoplatelets ratio on machining behaviour. After that, artificial intelligence based on ANFIS is used to develop prediction models as the fitness function of the multi-objective particle swarm optimization method. The experimental results showed that the developed models can obtain an accurate estimation of depth force, feed force, and surface roughness with a mean absolute percentage error of 3.87%, 8.56%, and 2.21%, respectively, as compared with experimentally measured outputs. In addition, the developed artificial intelligence models showed 361.24%, 35.05%, and 276.47% less errors for depth force, feed force, and surface roughness, respectively, as compared with the traditional mathematical models. The multi-objective optimization results from the new approach indicated that a cutting speed of 62 m/min, feed rate of 139 mm/min, and GNPs reinforcement ratio of 1.145 wt.% lead to the improved machining characteristics of GNPs reinforced Ti6Al4V matrix nanocomposites. Henceforth, the hybrid method as a novel artificial intelligent method can be used for optimizing the machining processes with complex relationships between the output responses.

Translation and validation of the Arabic version of the quality of oncology nursing care scale (QONCS): Psychometric testing in three Arabic countries

BACKGROUND

In the Arab world, little is known about cancer patient's satisfaction with the care provided by the oncology nurses. The only explanation for this dearth of knowledge is lack of a specified, valid and reliable tool that can be utilized with all types of cancer. This regional study was conducted to translate and validate the Arabic version of quality of oncology nursing care scale (QONCS).

METHODS

Brislin's model of translation was used with a cross-sectional, cross-cultural and psychometric design. A convenience sample of 517 from three countries (Jordan, Oman and Egypt) completed the study's surveys.

RESULTS

The results indicated that the total QONCS-Ar was reliable with Cronbach's alpha 0.88 and 0.84, 0.87, 0.83, 0.89 and 0.86 for being supported and confirmed, with the religious and spiritual care, belonging, being valued and being respected domains respectively. Exploratory factor analysis supported the dimensional structure of the 34-item scale with five domains with Kaiser-Meyer-Oklin (KMO) measuring 0.872 and Bartlett's Test of Sphericity being significant (significant p<0.001) CONCLUSION: QONCS-Ar is a relatively short, valid, reliable and easy to use instrument that can be applied with all types of cancer, research and educational institutions in the Arabic region.

Golodirsen for Duchenne muscular dystrophy

Duchenne muscular dystrophy (DMD) is a life-shortening X-linked genetic disorder characterized by progressive wasting and weakening of muscles in boys. Loss-of-function mutations in the DMD gene, which codes for dystrophin, lead to this disease. The majority of mutations in this gene result in the exclusion of one or more exons from the transcript, eventually causing the remaining exons not to fit together correctly (i.e., out-of-frame mutations). Antisense oligonucleotides, e.g., phosphorodiamidate morpholino oligomers (PMOs), can induce therapeutic exon skipping during pre-mRNA processing to restore the reading frame of the primary transcript of DMD. As a result, truncated but partially functional dystrophin is produced, potentially slowing down the disease progression. Golodirsen is a provisionally approved PMO-based drug for approx. 8% of all DMD patients amenable to exon 53 skipping. This article summarizes golodirsen's pharmacology, efficacy and safety information. It also discusses some controversies that golodirsen met after the approval.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Radiotherapy Trial Set-up in the UK: Identifying Inefficiencies and Potential Solutions

AIMS

Radiotherapy clinical trials are integral to the development of new treatments to improve the outcomes of patients with cancer. A collaborative study by the National Cancer Research Institute Clinical and Translational Radiotherapy Research Working Group and the National Institute for Health Research was carried out to understand better if and why inefficiencies occur in the set-up of radiotherapy trials in the UK.

MATERIALS AND METHODS

Two online surveys collected information on the time taken for UK radiotherapy trials to reach key milestones during set-up and the research support currently being provided to radiotherapy centres to enable efficient clinical trial set-up. Semi-structured interviews with project managers and chief investigators identified better ways of working to improve trial set-up in the future.

RESULTS

The timelines for the set-up of 39 UK radiotherapy trials were captured in an online survey showing that the median time from grant approval to trial opening was 600 days (range 169-1172). There were 38 responses from radiotherapy centres to a survey asking about the current support provided for radiotherapy research. Most of these centres have more than one type of staff member dedicated to supporting radiotherapy research. The most frequent barrier to radiotherapy trial set-up identified was lack of physicists' time and lack of time for clinical oncologists to carry out research activities. Four main themes around trial set-up were identified from semi-structured interviews: the importance of communication and building relationships, the previous experience of the chief investigator and clinical trials units, a lack of resources and having the time and personnel required to produce trial documentation and to process trial approval requests.

CONCLUSIONS

This unique, collaborative project has provided up to date information about the current landscape of trial set-up and research support in the UK and identified several avenues on which to focus future efforts in order to support the excellent radiotherapy trial work carried out across the UK.

Towards Optimization of Surface Roughness and Productivity Aspects during High-Speed Machining of Ti-6Al-4V

Nowadays, titanium alloys are achieving a significant interest in the field of aerospace, biomedical, automobile industries especially due to their extremely high strength to weight ratio, corrosive resistance, and ability to withstand higher temperatures. However, titanium alloys are well known for their higher chemical reactive and low thermal conductive nature which, in turn, makes it more difficult to machine especially at high cutting speeds. Hence, optimization of high-speed machining responses of Ti–6Al–4V has been investigated in the present study using a hybrid approach of multi-objective optimization based on ratio analysis (MOORA) integrated with regression and particle swarm approach (PSO). This optimization approach is employed to offer a balance between achieving better surface quality with maintaining an acceptable material removal rate level. The position of global best suggested by the hybrid optimization approach was: Cutting speed 194 m/min, depth of cut of 0.1 mm, feed rate of 0.15 mm/rev, and cutting length of 120 mm. It should be stated that this solution strikes a balance between achieving lower surface roughness in terms of R_a and R_q, with reaching the highest possible material removal rate. Finally, an investigation of the tool wear mechanisms for three studied cases (i.e., surface roughness based, productivity-based, optimized case) is presented to discuss the effectiveness of each scenario from the tool wear perspective.

The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry

Aims 

The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.

Methods and results 

Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.

Conclusion 

The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.

Identification of GH|MspI and GHR|AluI Gene Polymorphism and its Association with Calf Birth Weight of Grati-PO Cattle

<p class="abstrak2">Calf birth weight (CBW) is one of the important selection criteria to predict mature body weight and for calving ease in beef cattle. The GH and GHR genes are considered as candidate genes responsible for growth traits in cattle. The objectives of this study were to identify the polymorphism of GH|MspI and GHR|AluI genes and its association with CBW in Grati-PO cattle. A total of 186 Grati-PO cattle raised by BCRS from May to December 2017. Genomic DNA were isolated from whole blood and used in genotyping analysis using the PCR-RFLP method. The result showed that the average of CBW of Grati-PO cattle in present study was 25.58±3.31 kg. There was no statistical difference for CBW between male and female. The genotype frequency of CC, CT, and TT of GH gene were 1.1, 18.8 and 80.1 %, respectively and allele frequency of C and T of the GH gene were 0.105 and 0.895, respectively. While the genotype frequency of AA, AG, and GG of GHR gene were 66.1, 25.3 and 8.6 %, respectively, and allele frequency of A and G of GHR gene were 0.788 and 0.212, respectively. It concluded that both GH|MspI and GHR|AluI gene are polymorphic but not significantly associated with CBW in Grati-PO cattle.</p>

Genetic Polymorphism of SCD1 Gene of Holstein-Friesian Cows in Indonesia

<p class="abstrak2">Stearoyl-Coenzyme A desaturase 1 (SCD1) belongs to the fatty acid family of desaturases. In lactating ruminants, the SCD1 protein is highly expressed in the mammary gland and is relevant for the fatty acid composition of milk and dairy products. Polymorphism of SCD1 gene in Holstein-Friesian (HF) cows could be used as a basis of molecular selection of cattle in order to increase their productivity. The aim of this study was to investigate the polymorphism of SCD1 gene of Holstein-Friesian cows in Indonesia. A total of 162 blood samples of HF cows were collected from four different locations i.e. Bogor, Sukabumi, Tasikmalaya and Enrekang districts. Genotyping of SCD1 gene used PCR-RFLP method with NcoI restriction enzyme. The result showed that three genotypes (AA, AV and VV) and two alleles (A and V) have successfully found and polymorphic. A allele was dominant in all populations (0.63) and in Hardy Weinberg Equilibrium. The highest A allele was found in Sukabumi (0.78) and the lowest was in Bogor (0.55). Heterozigosity observed and expected reached 0.471 and 0.470, respectively. In conclusion, genetic polymorphism was found in all population with dominant of A allele. This finding can be used as a early genetic information of Holstein-Friesian cattle in Indonesia and to build breeding strategy for improving of productivity especially improving of healthy fat milk. </p><p class="abstrak2"><span><br /></span></p>

Soluble TNF-R1, VEGF and other cytokines as markers of disease activity in systemic lupus erythematosus and lupus nephritis

Background

Current non-invasive methods of assessing disease activity in systemic lupus erythematosus (SLE) are of limited sensitivity and specificity. Testing includes acute phase markers, autoantibodies and complement levels. Although measurements of dsDNA antibodies and complement C3/C4 levels are routine, they remain of limited value. Improved blood and urine markers may help in early detection of flare, distinction between flare and chronic damage, and monitoring response to therapy.

Methods

A total of 87 patients with SLE were tested for the following cytokines in serum and urine: monocyte chemoattractant protein 1 (MCP-1), regulated upon activation, normal T cell expressed and secreted (RANTES), soluble tumour necrosis factor receptor 1 (sTNF-R1), interferon-inducible protein 10 (IP-10), monocyte inhibitory protein 1α (MIP-1α) and vascular endothelial growth factor (VEGF). Patients attending the Lupus Unit at St Thomas’ Hospital, London, UK were divided into active lupus nephritis (LN), inactive LN and non-renal SLE groups based on their renal pathology and SLE disease activity index (SLEDAI). Cytokine testing was performed using the FIDIS multiplex bead assay.

Results

The mean level of serum sTNF-R1 was higher in the active LN group compared with both inactive LN and non-renal SLE groups ( p < 0.001). For urine measurements there were significant differences between active LN and non-renal SLE for VEGF ( p = 0.016), after statistical correction for multiple testing. Both urinary and serum sTNF-R1 and IP-10 levels correlated with SLEDAI scores ( p < 0.001), while serum VEGF correlated weakly with SLEDAI ( p = 0.025). The optimum combination for differentiating active from inactive LN patients was serum VEGF, sTNF-R1, MCP-1 and glomerular filtration rate plus urinary sTNF-R1 and protein-creatinine ratio.

Conclusion

These results indicate that for active LN, sTNF-R1 could be a useful serum cytokine marker, with potential for VEGF in the urine. This study has confirmed the ability of the multiplex bead technique to detect cytokines in a good analytical range, including very low and high levels, in both serum and urine. Combining serum and urine markers provided additional sensitivity in distinguishing active from inactive LN.

Experimental Analysis on the Influence and Optimization of μ-RUM Parameters in Machining Alumina Bioceramic

Fabrication of precise micro-features in bioceramic materials is still a challenging task. This is because of the inherent properties of bioceramics, such as low fracture toughness, high hardness, and brittleness. This paper places an emphasis on investigating the multi-objective optimization of fabrication of microchannels in alumina (Al₂O₃) bioceramics by using rotary ultrasonic machining (RUM). The influence of five major input parameters, namely vibration frequency, vibration amplitude, spindle speed, depth of cut, and feed rate on the surface quality, edge chipping, and dimensional accuracy of the milled microchannels was analyzed. Surface morphology and microstructure of the machined microchannels were also evaluated and analyzed. Unlike in previous studies, the effect of vibration frequency on the surface morphology and roughness is discussed in detail. A set of designed experiments based on central composite design (CCD) method was carried out. Main effect plots and surface plots were analyzed to detect the significance of RUM input parameters on the outputs. Later, a multi-objective genetic algorithm (MOGA) was employed to determine the optimal parametric conditions for minimizing the surface roughness, edge chipping, and dimensional errors of the machined microchannels. The optimized values of the surface roughness (Ra and Rt), side edge chipping (SEC), bed edge chipping (BEC), depth error (DE), and width error (WE) achieved through the multi-objective optimization were 0.27 μm, 2.7 μm, 8.7 μm, 8 μm, 5%, and 5.2%, respectively.

Improvement in Infection Prevention and Control Measures at The Children Hospital, Lahore. A My Child Matters Collaborative Project

Background: Overcrowding, lack of operational funds, and healthcare associated infections are major challenges at the Children Hospital Lahore, a public healthcare facility in Pakistan with 900 new pediatric cancer admissions annually. In 2014, a collaboration between My Child Matters (MCM), St. Jude Global Infectious Diseases Program (SJ-GID), and our institution was established to address these issues. Aim: To describe the effect of a collaborative improvement strategy on the infection prevention and control (IPC) standards in a pediatric oncology unit in a resource-limited setting. Methods: Our study was a prospective before-and-after study. We compare the WHO Hand Hygiene Self-Assessment Framework (HHSAF) and 4 modules of the St. Jude modified Infection Control Assessment Tool (ICAT) scores. Our strategy included: (1) creating a multidisciplinary team of pediatric hematology-oncology, infectious disease physicians, nurses, microbiologist, and a data manager, (2) engaging on monthly online IPC mentoring sessions with the SJ-GID and MCM mentors, (3) performing daily inpatient healthcare associated (HAI) surveillance rounds, and (4) providing regular hand hygiene training and compliance audits. Results: Our hand hygiene facility level per WHO scores increased from “Inadequate” during the baseline assessment to “Intermediate/Consolidation” by the end of 3-year implementation (122 vs 352 HHSAF scores). The sink: bed and hand sanitizer: bed ratios improved to 1:6 and 1:1 respectively. Six washrooms were added to our unit. ICAT general infection control module increased by 40% (45 vs 78 ICAT score) and hygiene compliance improved by 20% from baseline. Identification of HAI increased from baseline (4.07 vs 8.7 infections per 1000 patient days). A 25% of the isolates were multidrug-resistant microorganisms. Conclusion: Implementing a collaborative improvement strategy improved the IPC standards in our pediatric cancer center. The increase of HAI might be a result of a better surveillance and laboratory identification. Further targeted interventions should be develop to decrease HAI rates and infection-related morbidity and mortality in our population.