Comprehensive study of the interplay between immunological and metabolic factors in hepatic steatosis

The pathophysiology of hepatic steatosis is thoroughly reviewed in this comprehensive report, with particular attention to the complex interactions between inflammatory pathways, insulin resistance, lipid metabolism, metabolic dysregulation, and immunological responses in the liver including non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH), and hepatocellular carcinoma (HCC). The study highlights the role of immune cell regulation in disease progression and explores the potential of immune cell-specific treatments for treating hepatic disorders. The development of liver disorders is significantly influenced by immune cells, including dendritic cells, T cells, and natural killer cells. Clinical investigations show that immune cell-specific treatments can effectively reduce liver fibrosis and inflammation. Future research should focus on finding new immunological targets for therapeutic interventions, as well as addressing the management challenges associated with NAFLD/NASH. Hepatic immune microorganisms also impact liver homeostasis and disorders. Improvements in immune cell regulation and liver transplantation methods give patients hope for better prognoses. Important phases include optimizing the selection of donors for malignancy of the liver, using machine perfusion for organ preservation, and fine-tuning immunosuppressive strategies. For focused treatments in hepatic steatosis, it is imperative to understand the intricate interactions between immune and metabolic variables. Understanding the liver's heterogeneous immune profile, encompassing a range of immune cell subpopulations, is crucial for formulating focused therapeutic interventions. To improve patient care and outcomes in hepatic illnesses, there is an urgent need for further research and innovation. Therefore, to effectively treat hepatic steatosis, it is important to enhance therapeutic techniques and maximize liver transplantation strategies.

A multifaceted approach to identifying and managing juvenile delinquency by integrating psycho-physiological indicators

To understand and treat juvenile delinquency, the study explores the relevance of psycho-physiological indicators. It also emphasizes the necessity for thorough research to minimize the gap existing between psycho-physiological measurements and conventional psychosocial components. The study focuses on the relevance of personality features, habituation, and autonomic arousal required to monitor the proper management of delinquent conduct. Through the integration of biological, psychological, and social elements into a multidimensional approach, researchers can uncover novel insights and create cutting-edge therapies for youths who are at risk of delinquent behavior. The study proposes to develop a comprehensive framework that considers biological antecedents in addition to conventional metrics to reach the root cause of delinquency; thereby drawing special attention to current literature and research that emphasizes the psycho-physiological correlates of delinquency. By examining the complex interactions between stress, physiology, emotions, behavior, and social structures, the study highlights the intricacy of delinquent conduct and the necessity for adopting a multifaceted strategy to fully address the problematic areas. Future research paths are emphasized, with a focus on the significance of longitudinal studies, moderating and mediating variables, and creative treatment techniques. By utilizing psycho-physiological markers and psychosocial traits, researchers can tailor intervention strategies to meet individual needs effectively. Early identification of psycho-physiological deficits in children is crucial for implementing successful behavior modification techniques and promoting the well-being of future generations. This is expected to help the government agencies to save time and public money.

Improving newborn screening in India: Disease gaps and quality control

In India, newborn screening (NBS) is essential for detecting health problems in infants. Despite significant progress, significant gaps and challenges persist. India has made great strides in genomics dueto the existence of the National Institute of Biomedical Genomics in West Bengal. The work emphasizes the challenges NBS programs confront with technology, budgetary constraints, insufficient counseling, inequality in illness panels, and a lack of awareness. Advancements in technology, such as genetic testing and next-generation sequencing, are expected to significantly transform the process. The integration of analytical tools, artificial intelligence, and machine learning algorithms could improve the efficiency of newborn screening programs, offering a personalized healthcare approach. It is critical to address gaps in information, inequities in illness incidence, budgetary restrictions, and inadequate counseling. Strengthening national NBS programs requires increased public awareness and coordinated efforts between state and central agencies. Quality control procedures must be used at every level for implementation to be successful. Additional studies endeavor to enhance NBS in India through public education, illness screening expansion, enhanced quality control, government incentive implementation, partnership promotion, and expert training. Improved neonatal health outcomes and the viability of the program across the country will depend heavily on new technology and counseling techniques.

Quercetin counteracts monosodium glutamate to mitigate immunosuppression in the thymus and spleen via redox-guided cellular signaling

BACKGROUND

Chronic inflammation brought on by oxidative stress can result in several immunopathologies. Natural compounds with antioxidant characteristics, like quercetin, have shown effectiveness in reducing oxidative damage and regulating the immune response.

PURPOSE

The commonly used food additive monosodium glutamate (M) causes immunosuppression by disrupting redox equilibrium and inducing oxidative stress. The goal of this work is to examine the therapeutic potential of quercetin against immunotoxicity brought on by M, revealing the molecular route implicated in such immunopathology by targeting the thymus and spleen, to support the development of future anti-inflammatory and antioxidant therapies.

STUDY DESIGN AND METHODS

M-fed rats were employed as an immunotoxicity model and were supplemented with quercetin for four weeks. Hematological and biochemical parameters were measured; H&E staining, immunohistochemistry, flow cytometry, real-time quantitative PCR, and western blotting were performed.

RESULTS

Based on the findings, TLR4 was activated by M to cause oxidative stress-mediated inflammation, which was alleviated by the supplementation of quercetin by modulating redox homeostasis to neutralize free radicals and suppress the inflammatory response. To prevent M-induced inflammation, quercetin demonstrated anti-inflammatory functions by blocking NF-kB activation, lowering the production of pro-inflammatory cytokines, and increasing the release of anti-inflammatory cytokines. By normalizing lipid profiles and lowering the potential risk of immunological deficiency caused by M, quercetin also improves lipid metabolism. Additionally, it has shown potential for modifying insulin levels, suggesting a possible function in controlling M-induced alteration in glucose metabolism. The addition of quercetin to M enhanced the immune response by improving immunoglobulin levels and CD4/CD8 expression in the thymus and spleen. Additionally, quercetin inhibited apoptosis by controlling mitochondrial caspase-mediated cellular signaling, suggesting that it may be able to halt cell death in M-fed rats.

CONCLUSION

The results of this study first indicate that quercetin, via modulating redox-guided cellular signaling, has a promising role in reducing immune disturbances. This study illuminates the potential of quercetin as a safe, natural remedy for immunopathology caused by M, including thymic hypoplasia and/or splenomegaly, and paves the way for future anti-inflammatory and antioxidant supplements.

Bands renormalization and superconductivity in the strongly correlated Hubbard model using composite operators method

We use the composite operator method (COM) to analyze the strongly correlated repulsive Hubbard model, investigating the effect of nearest-neighbor hoppings up to fourth order on a square lattice. We consider two sets of self-consistent equations, one enforcing the Pauli principle and the other imposing charge-charge, spin-spin, and pair-pair correlations using a decoupling scheme developed by Roth (1969Phys. Rev.184451-9). We extract three distinct solutions from these equations: COM1 and COM2 by imposing the Pauli principle and one from Roth decoupling. An overview of the method studying the validity of particle-hole symmetry and the Luttinger theorem for each solution is presented. Additionally, we extend the initial basis to study superconductivity, concluding that it is induced by the Van Hove singularity. Finally, we include higher-order hoppings using realistic estimates for tight binding parameters and compare our results with ARPES measurements on cuprates.

Surface Charge-Switchable Antifouling Block Copolymer with Bacteriostatic Properties

Zwitterionic polymers are an emerging family of effective, low-fouling materials that can withstand unintended interactions with biological systems while exhibiting enhanced activity in bacterial matrix deterioration and biofilm eradication. Herein, we modularly synthesized an amphiphilic block copolymer, ZABCP, featuring potential bacteriostatic properties composed of a charge-switchable polyzwitterionic segment and a redox-sensitive pendant disulfide-labeled polymethacrylate block. The leucine-appended polyzwitterionic segment with alternatively positioned cationic amine and anionic carboxylate functionalities undergoes charge alterations (+ve → 0 → -ve) on pH variation. By introducing appropriate amphiphilicity, ZABCP forms distinct vesicles with redox-sensitive bilayer membranes and zwitterionic shielding coronas, enabling switching of surface charge. ZABCP vesicles exhibit 180 ± 20 nm hydrodynamic diameter, and its charge switching behavior in response to pH was confirmed by the change of zeta potential value from -23 to +36 mV. The binding interaction between ZABCP vesicles with lysozyme and pepsin proteins strengthens when the surface charge shifts from neutral (pH 7.4) to either anionic or cationic. This surface-charge-switchable phenomenon paves the way for implementing cationic ZABCP vesicles for bacterial cell growth inhibition, which is shown by the pronounced transition of cellular morphology, including clustering, aggregation, or elongation as well as membrane disruption for both Bacillus subtilis (Gram-positive) and Escherichia coli (Gram-negative). Such enhanced bacteriostatic activity could be ascribed to a strong electrostatic interaction between cationic vesicles and negatively charged bacterial membranes, leading to cell membrane disruption. Overall, this study provides a tailor-made approach to adopt low-fouling properties and potential bacteriostatic activity using zwitterionic polymers through precise control of pH.

Dimension and Flexibility of Polystyrenesulfonate Chains in Methanol-Water

The influence of the relative permittivity of the solvent medium on the single-chain dimension and flexibility of sodium polystyrenesulfonate chains has been investigated in mixed solvent media of methanol and water using viscosity experiments. Particular attention has been paid to explore the effect of the added low-molar-mass electrolyte. The root-mean-square (rms) radii of gyration of the chains in the unperturbed state have been calculated by applying the Flory model, while the intrinsic persistence lengths by the Benoit-Doty equation on the basis of the Kratky-Porod worm-like chain model. Estimation of the expansion factors for the rms radius of gyration, and the electrostatic persistence length helps evaluate the rms radii of gyration and the total persistence length of polystyrenesulfonate chains in the presence of varying amount of the supporting electrolyte. The polyion chains are highly extended at low ionic strengths but exhibit coil-like behavior with small persistence lengths when an excess of the supporting electrolyte is added in all the methanol-water mixtures investigated. Specifically, in the investigated solvent media, the polystyrenesulfonate chains have been found to shrink by ∼63-65% in the θ-state from their expanded conformation in the presence of 0.0001 mol L-1 NaCl. The chain dimensions pass through a maximum as the medium becomes richer in methanol, which could be explained by the formation and breakup of internal rings involving the polyion chain and water and/or methanol molecules. The intrinsic persistence length of sodium polystyrenesulfonate in a methanol-water mixture containing 0.1 mole fraction of methanol is ca. 1.3 times that in a medium with 0.3 mole fraction of methanol, indicating that flexibility of the polyion depends appreciably on the relative permittivity of the medium.

Low temperature Raman spectroscopic study of anharmonic and spin-phonon coupled quasi-two dimensional rare earth based francisites

Mineral francisites Cu3Bi(SeO3)2O2Cl are unique compounds with interesting quasi two-dimensional structure along with fascinating magnetic properties. The magnetic properties can be fine-tuned when non-magnetic Bi is replaced by a suitable rare earth (RE) metal. It is because of the inclusion of additional magnetic sub-centre RE apart from Cu. Temperature dependent Raman spectroscopy measurements in RE based francisites [Cu3RE(SeO3)2O2Cl, shortly RECufr] were performed in the range of 11 K-295 K. Among the three studied RECufr (LaCufr, NdCufr, and DyCufr) compounds, the properties of phonon vibration vary from moderate (in DyCufr) to weak (in LaCufr) spin phonon coupled and the absence of spin phonon coupling (SPC) (i.e. strictly anharmonic in nature) was observed in NdCufr and the reason for this observation has been provided. More specifically, two Raman-active phonons soften below the antiferromagnetic ordering temperature ofTN≈ 39 K in DyCufr compound, indicating the existence of moderate SPC. This trend of phonon vibration is correlated with magnetic properties, particularly field induced metamagnetic transition (MMT). Strong MMT enabled DyCufr develops SPC, while weak MMT enabled NdCufr is unable to develop SPC.

Quercetin inhibits NF-kB and JAK/STAT signaling via modulating TLR in thymocytes and splenocytes during MSG-induced immunotoxicity: an in vitro approach

BACKGROUND

The most widely used food additive monosodium glutamate (MSG) has been linked to immunopathology. Conversely, quercetin (Q), a naturally occurring flavonoid has been demonstrated to have immunomodulatory functions. Therefore, the purpose of the study is to determine if quercetin can mitigate the deleterious effects of MSG on immune cells, and the possible involvement of TLR, if any.  METHODS AND RESULTS: This study was conducted on Q, to determine how it affects the inflammatory response triggered by MSG in primary cultured thymocytes and splenocytes from rats (n = 5). Q shielded cells by augmenting cell survival and decreasing lactate dehydrogenase leakage during MSG treatment. It decreased IL-1β, IL-6, IL-8, and TNF-α expression and release by hindering NF-kB activation and by inhibiting the JAK/STAT pathway. Moreover, Q prevented NLRP3 activation, lowered IL-1β production, and promoted an anti-inflammatory response by increasing IL-10 production. Q reduced MSG-induced cellular stress and inflammation by acting as an agonist for PPAR-γ and LXRα, preventing NF-kB activation, and lowering MMP-9 production via increasing TIMP-1. Additionally, Q neutralized free radicals, elevated intracellular antioxidants, and impeded RIPK3, which is involved in inflammation induced by oxidative stress, TNF-α, and TLR agonists in MSG-treated cells. Furthermore, it also modulated TYK2 and the JAK/STAT pathway, which exhibited an anti-inflammatory effect.

CONCLUSIONS

MSG exposure is associated with immune cell dysfunction, inflammation, and oxidative stress, and Q modulates TLR to inhibit NF-kB and JAK/STAT pathways, providing therapeutic potential. Further research is warranted to understand Q's downstream effects and explore its potential clinical applications in inflammation.

Intrathecal ropivacaine versus bupivacaine in a non-obstetric population- A meta-analysis and trial sequential analysis

Background and Aims

Intrathecal bupivacaine is used for anaesthesia and analgesia but is associated with hypotension. Ropivacaine is an alternative drug that may have fewer cardiotoxic and neurotoxic events. This meta-analysis investigated whether intrathecal ropivacaine is associated with reduced hypotension as compared to bupivacaine.

Methods

The meta-analysis is registered in the International Prospective Register of Systematic Reviews (PROSPERO). The databases PubMed, Cinahl Plus, Google Scholar, and Scopus were searched, and papers from January 1980 to January 2023 were deemed eligible and filtered using predetermined inclusion and exclusion criteria. The primary outcome was the incidence of hypotension. Secondary outcomes were the duration of sensory block, duration of motor block, incidence of bradycardia, ephedrine usage, and duration of analgesia. Jadad scores were used to evaluate the quality of the papers. RevMan statistical software® utilised inverse variance and a random effect model to calculate the standardised mean difference with 95% confidence intervals for continuous variables and the Mantel-Haenszel test and the random effect model to calculate the odds ratio for dichotomous variables.

Results

Thirty-three papers, including 2475 patients in total, were included. The Jadad score was between 1 and 5. The incidence of hypotension was significantly higher with intrathecal bupivacaine than with ropivacaine (P = 0.02). The duration of sensory block (P < 0.001) and motor block (P < 0.001) was prolonged with intrathecal bupivacaine. The duration of analgesia favoured intrathecal bupivacaine (P = 0.003).

Conclusion

Intrathecal ropivacaine has a reduced incidence of hypotension and a reduced duration of sensory block compared to bupivacaine.

Study of wave motion on the emergence of veering, locking, and coupling in periodic composite panels

This research proposes the effect of micropolar-Cosserat (MC) parameters (length-scale parameters and Cosserat shear modulus) on the dispersion characteristics of propagating wave modes in periodic composite panels (PCPs). These inbuilt parameters are due to the assumption of the length-scale boundary conditions that allow for capturing the micro-rotational (MR) wave mode along with the flexural ones. A significant contribution of this study is the transformation of the two-dimensional (2-D) periodic composite problem into a series of one-dimensional (1-D) ones using the MC continuum theory. The analysis employs the transfer matrix method in the framework of the state-space approach to investigate periodic systems in the eigenvalue domain. Additionally, Bloch-Floquet's periodic boundary conditions (PBCs) are applied to the unit cell to ensure the periodicity of the system. The main innovation lies in observing veering, locking, and coupling phenomena, which occur due to alterations in lamina orientation and MC parameters. Moreover, the presence of inbuilt parameters renders the dispersion characteristics highly sensitive to even minor coefficient variations, with a mere 1% change significantly impacting eigenmode fluctuations. The sudden bandgap (BG) disappearing nature could be used to identify the accurate value of the coefficient for designing and analyzing PCPs.

Two-component nematic superconductivity in 4Hb-TaS2

Most superconductors have an isotropic, single component order parameter and are well described by the standard (BCS) theory for superconductivity. Unconventional, multiple-component superconductors are exceptionally rare and are much less understood. Here, we combine scanning tunneling microscopy and angle-resolved macroscopic transport for studying the candidate chiral superconductor, 4Hb-TaS2. We reveal quasi-periodic one-dimensional modulations in the tunneling conductance accompanied by two-fold symmetric superconducting critical field. The strong modulation of the in-plane critical field, Hc2, points to a nematic, unconventional order parameter. However, the imaged vortex core is isotropic at low temperatures. We suggest a model that reconciles this apparent discrepancy and takes into account previously observed spontaneous time-reversal symmetry breaking at low temperatures. The model describes a competition between a dominating chiral superconducting order parameter and a nematic one. The latter emerges close to the normal phase. Our results strongly support the existence of two-component superconductivity in 4Hb-TaS2 and can provide valuable insights into other systems with coexistent charge order and superconductivity.

Zwitterionic Polysulfobetaine Inhibits Cancer Cell Migration Owing to Actin Cytoskeleton Dynamics

Cell migration is an essential dynamic process for most living cells, mainly driven by the reorganization of actin cytoskeleton. To control actin dynamics, a molecular architecture that can serve as a nucleator has been designed by polymerizing sulfobetaine methacrylate. The synthesized zwitterionic polymer, poly(sulfobetaine methacrylate) (PZI), effectively nucleates the polymerization process of G-actin and substantially accelerates the rate of polymerization. Isothermal titration calorimetry (ITC) and bioinformatics analysis indicated binding between PZI and monomeric G-actin. Thus, in vitro actin dynamics was studied by dynamic light scattering (DLS), pyrene-actin polymerization assay, and total internal reflection fluorescence microscopy (TIRFM). Furthermore, a 4,4-difluoro-4-bora-3a,4a-diaza-s-indacene (BODIPY) fluorophore-containing monomeric unit was incorporated into the sulfobetaine zwitterionic architecture to visualize the effect of polymer in the cellular environment. The BODIPY-containing zwitterionic sulfobetaine polymer (PZI-F) successfully penetrated the cell and remained in the lysosome with minimal cytotoxicity. Confocal microscopy revealed the influence of this polymer on the cellular actin cytoskeleton dynamics. The PZI-F polymer was successfully able to inhibit the collective migration of the human cervical cancer cell line (HeLa cell) and breast cancer cell line (MDA-MB-231 cell), as confirmed by a wound healing assay. Therefore, polyzwitterionic sulfobetaine could be explored as an inhibitor of cancer cell migration.

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

BACKGROUND

Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.

METHODS

This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.

RESULTS

The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (β coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.

CONCLUSION

Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely.

Polylactic acid/polycaprolactone/sawdust based biocomposites trays with enhanced compostability

The major drawback associated with petroleum-based polymer products is pollution, leading to environmental hazards. Biodegradable polymers and biocomposites have the potential to play a major role in replacing the conventional polymers in specific applications on a case to case basis. In the current study, sawdust reinforced polylactic acid/polycaprolactone (PLA/PCL) biocomposites were developed using the melt extrusion technique. Primary processed fine sawdust was reinforced with PLA/PCL blend in a mini twin screw extruder in different weight fractions (10 %, 20 %, 30 %, and 40 %). The developed biocomposites were subjected to tensile testing, which indicated that the increased weight percent of sawdust reduced the tensile strength. The materials were further characterized, using sophisticated analytical such as field emission scanning electron microscopy, differential scanning calorimetry and thermogravimetry analysis. The composite containing 30 % sawdust concentration presented the best results with tensile strength of 26.5 MPa, tensile strain of 4.4 % and onset degradation temperature of 320 °C. The same formulation was successfully scaled up to the pilot level of 5 kg batch. It was further subjected to secondary processing to produce market ready cutlery items. Biodegradability studies in simulated composting environments revealed that addition of sawdust drastically reduces the lag phase in degradation and total degradation may be obtained in approximately 90 days. Based on the investigation, there is optimism that the PLA/PCL composites, blended with sawdust may ensure commercial application of sustainable polymer blends at affordable prices.

On the estimation of the effect of weight change on a health outcome using observational data, by utilising the target trial emulation framework

BACKGROUND/OBJECTIVES

When studying the effect of weight change between two time points on a health outcome using observational data, two main problems arise initially (i) 'when is time zero?' and (ii) 'which confounders should we account for?' From the baseline date or the 1st follow-up (when the weight change can be measured)? Different methods have been previously used in the literature that carry different sources of bias and hence produce different results.

METHODS

We utilised the target trial emulation framework and considered weight change as a hypothetical intervention. First, we used a simplified example from a hypothetical randomised trial where no modelling is required. Then we simulated data from an observational study where modelling is needed. We demonstrate the problems of each of these methods and suggest a strategy.

INTERVENTIONS

weight loss/gain vs maintenance.

RESULTS

The recommended method defines time-zero at enrolment, but adjustment for confounders (or exclusion of individuals based on levels of confounders) should be performed both at enrolment and the 1st follow-up.

CONCLUSIONS

The implementation of our suggested method [adjusting for (or excluding based on) confounders measured both at baseline and the 1st follow-up] can help researchers attenuate bias by avoiding some common pitfalls. Other methods that have been widely used in the past to estimate the effect of weight change on a health outcome are more biased. However, two issues remain (i) the exposure is not well-defined as there are different ways of changing weight (however we tried to reduce this problem by excluding individuals who develop a chronic disease); and (ii) immortal time bias, which may be small if the time to first follow up is short.

Flavone-based dual PARP-Tubulin inhibitor manifesting efficacy against endometrial cancer

Structural tailoring of the flavone framework (position 7) via organopalladium-catalyzed C-C bond formation was attempted in this study. The impact of substituents with varied electronic effects (phenyl ring, position 2 of the benzopyran scaffold) on the antitumor properties was also assessed. Resultantly, the efforts yielded a furyl arm bearing benzopyran possessing a 4-fluoro phenyl ring (position 2) (14) that manifested a magnificent antitumor profile against the Ishikawa cell lines mediated through dual inhibition of PARP and tubulin [(IC50 (PARP1) = 74 nM, IC50 (PARP2) = 109 nM) and tubulin (IC50 = 1.4 µM)]. Further investigations confirmed the ability of 14 to induce apoptosis as well as autophagy and cause cell cycle arrest at the G2/M phase. Overall, the outcome of the study culminated in a tractable dual PARP-tubulin inhibitor endowed with an impressive activity profile against endometrial cancer.

Small extracellular vesicles administered directly in the brain promote neuroprotection and decreased microglia reactivity in a stroke mouse model

Herein, we investigate the bioactivity of small extracellular vesicles (sEVs), focusing on their local effect in the brain. sEVs from mononuclear cells (MNCs) showed superior effects in vitro to sEVs from mesenchymal stem cells (MSCs) and were able to promote neuroprotection and decrease microglia reactivity in a stroke mouse model.

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

INTRODUCTION

The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures.

METHODS

In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025.

FINDINGS

Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2-6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5-5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4-10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32-4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23-11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation.

INTERPRETATION

After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification.

FUNDING

UK Research and Innovation and National Institute for Health Research.

Cardiovascular mortality in Brazil during the COVID-19 pandemic: a comparison between underlying and multiple causes of death

OBJECTIVES

The COVID-19 pandemic has differentially impacted cardiovascular disease (CVD) mortality worldwide. Causes of death misclassification may be one of the reasons. We evaluated the impact of the pandemic on CVD mortality in Brazil, comparing underlying causes (UCs) and multiple causes (MCs) of death.

STUDY DESIGN

Ecological time-series study.

METHODS

An ecological, time-series study was conducted analysing age-standardised death rates for CVD, from epidemiological week (EW) 10/2020 to 39/2021, using data from the Mortality Information System, Brazil. CVD was defined using the International Classification of Diseases (ICD-10) coding, if reported as UC or MC of death. Observed and expected data (mean for the same EW, 2017-2019) were compared. Risk ratios (RiRs) were analysed, and 95% confidence intervals (CIs) were calculated.

RESULTS

Age-standardised mortality rate for CVD as UC of death was 165.8 (95%CI: 165.4-166.3) per 100,000 inhabitants, similar to what was expected (165.6/100,000, 95%CI: 165.2-166.1, RiR = 1.00). There was increased out-of-hospital mortality (RiR = 1.18; 95%CI: 1.17-1.19) and deaths of ill-defined causes (RiR = 1.43; 95%CI: 1.42-1.44). The increase in out-of-hospital deaths was more pronounced in the North (RiR = 1.33; 95%CI 1.30-1.36) region, with a less resilient health system. Conversely, as MCs of death, there was a 10% increase in CVD mortality (observed: 243.2 [95%CI: 242.7-243.7], expected: 221.6 [95%CI: 221.1-222.1] per 100,000). An increase also occurred in the North and Central West regions (RiR = 1.16; 95%CI: 1.15-1.18), among men (RiR = 1.11; 95%CI: 1.11-1.12) and individuals aged ≥60 years (RiR = 1.11; 95%CI: 1.10-1.11).

CONCLUSIONS

During the pandemic, mortality rates for CVD as MCs of death increased in Brazil, whereas as UC mortality rates did not change. Higher out-of-hospital mortality, misclassification, and competing causes of death may explain this pattern.

Human pelvis injury risk curves from underbody blast impact

INTRODUCTION

Underbody blast loading can result in injuries to the pelvis and the lumbosacral spine. The purpose of this study was to determine human tolerance in this region based on survival analysis.

METHODS

Twenty-six unembalmed postmortem human surrogate lumbopelvic complexes were procured and pretest medical images were obtained. They were fixed in polymethylmethacrylate at the cranial end and a six-axis load cell was attached. The specimens were aligned in a seated soldier posture. Impacts were applied to the pelvis using a custom vertical accelerator. The experimental design consisted of non-injury and injury tests. Pretest and post-test X-rays and palpation were done following non-injury test, and after injury test medical imaging and gross dissections were done. Injuries were scored using the Abbreviated Injury Scale (AIS). Axial and resultant forces were used to develop human injury probability curves (HIPCs) at AIS 3+ and AIS 4 severities using survival analysis. Then ±95% CI was computed using the delta method, normalised CI size was obtained, and the quality of the injury risk curves was assigned adjectival ratings.

RESULTS

At the 50% probability level, the resultant and axial forces at the AIS 3+ level were 6.6 kN and 5.9 kN, and at the AIS 4 level these were 8.4 kN and 7.5 kN, respectively. Individual injury risk curves along with ±95% CIs are presented in the paper. Increased injury severity increased the HIPC metrics. Curve qualities were in the good and fair ranges for axial and shear forces at all probability levels and for both injury severities.

CONCLUSIONS

This is the first study to develop axial and resultant force-based HIPCs defining human tolerance to injuries to the pelvis from vertical impacts using parametric survival analysis. Data can be used to advance military safety under vertical loading to the seated pelvis.

Contouring - How Do We Manage This Pivotal but Time-Consuming Workload?

PURPOSE/OBJECTIVE(S)

Advanced radiation treatment planning is a complex, multi-step process beginning with image acquisition and using these images to contour radiation targets and organs at risk prior to radiation treatment planning. Contouring is a time-consuming process. Unfortunately, few radiation oncologists have dedicated contouring time allocated in their daily schedule. Also, across radiation practices there is variability amongst dosimetrists, physicists, and physicians in the assignment of contouring responsibilities. The goal of this survey was to explore how the multi-disciplinary task of contouring for treatment planning is managed across radiation oncology practices and its impact on quality of life (QOL) amongst dosimetrists, physicists, and physicians.

MATERIALS/METHODS

A comprehensive 19-question Qualtrics survey was created evaluating all aspects of contouring and radiation treatment planning and its impact on QOL. The survey was distributed through Twitter, AAMD, a Medical Physics Journal, as well as directly to radiation oncology practices. Survey responses were summarized as proportions and associations tested using Fisher's exact test.

RESULTS

Physicians spent more time completing job responsibilities after work than dosimetrists and physicists, with an average of 6.22 hours (range 0-20) in comparison to 4.16 (0-30) for dosimetrists and 1.55 (0-12) for physicists (p-value 0.001). Physicians on average spent more time contouring on weekends with 1.81 hours (0-10) in comparison to 0.54 (0-10+) for dosimetrists and 0.31 (0-10) for physicists (p-value <0.001). When considering QOL and time spent after work, more respondents agreed there was a negative impact on QOL with increased responsibilities outside work hours (p-value <0.001). On average, respondents performed anywhere from 0 to 85 weekly radiotherapy simulations. The average time delay between simulation and when the imaging datasets are ready for contours was 1.31 days (1-4). 84 respondents signified there is no repercussion for delayed contour plans as planning is fast-tracked to meet the deadline, while 52 respondents signified postponement of radiotherapy start date. Time spent contouring after work hours (p-value 0.148) and on the weekend (p-value 0.403) were similar for both academic and private centers. Similarly, there was no difference in time of days of completion of 3D Conformal Radiation Therapy (p-value 0.551), Intensity Modulated Radiation Therapy (p-value 0.222), or Stereotactic Body Radiation Therapy (p-value 0.551) from academic versus private centers.

CONCLUSION

We present new insight into the amount of time spent in radiation oncology practices by dosimetrists, physicists, and physicians, performing the critical task of contouring for radiation treatment planning and its impact on QOL. These results can be used to guide decisions in the clinic for allocation of radiation treatment planning time and manpower.

Biomass, carbon stock, CO2 mitigation and carbon credits of coffee-based multitier cropping model in Central India

The present work was conducted in the forest-based ecosystem of Chhattisgarh in order to assess the varietal performance of coffee varieties along with silver oak in terms of growth, biomass, and carbon dynamics. Five coffee varieties were planted in silver oak shade in a randomized block design with four replications. The aim of the present investigation is to assess the economic and ecological feasibility of forest-based coffee plantations in the Bastar region of Chhattisgarh. Findings reflect the maximum under-storied plant height in Chandragiri Dwarf (1.85 m) which was at par with CxR (1.82 m) and San Ramon (1.71 m). The maximum above and below-ground carbon stock (48.40 and 12.09 Mg ha-1, respectively), as well as carbon dioxide (CO2) mitigation (177.63 and 44.41 Mg ha-1, respectively) from the under-storied coffee plantation, was recorded in CxR. In the upper-storied plantation, the above and below-ground biomass of silver oak recorded the maximum carbon stock (201.24 and 50.31 Mg ha-1, respectively) and CO2 mitigation (738.54 and 184.63 Mg ha-1) in S-8 intercropped lines. The highest value of carbon credit was recorded under the coffee variety S-8 and silver oak agroecosystem. The S-8, CxR, and Chandragiri Dwarf varieties performed quite well in terms of the expected value of carbon credit.

Highly correlated structural, local structural, Raman spectroscopic and magnetic properties of Mn-substituted Cu2V2O7

Low-dimensional quantum spin ½ system Cu2V2O7has been investigated in the framework of Mn-substitution at the Cu site, which is really un-investigated. The studied compounds Cu2 -xMnxV2O7(x= 0, 0.05, 0.1 and 0.15) have been synthesized and characterized structurally, spectroscopically, local structurally and magnetically via x-ray diffraction, Raman, x-ray absorption and temperature, field dependent magnetization measurements respectively. Although Cu2V2O7can be found inα, βandγ-phase, however all of the studied compounds are found in single orthorhombicα-phase which has crucial magneto-electric application potential. Temperature dependent Raman spectra indicated anharmonic phonon-phonon scattering but there is no spin-phonon coupling for VO4vibrational modes. The local structure probed via x-ray absorption near edge structure and extended x-ray absorption fine structure spectroscopy at 15 K, 300 K indicates Cu2+, V5+and mixed valent Mn2+and Mn3+ionic states and justified local structure for the probed ions. Magnetic measurements indicate long-range antiferromagnetic ordering with doping independent Neel temperature (32.5 K). Further observations are strong magnetic hysteresis at 5 K (due to canted spin structure), zero field exchange-bias and their noteworthy enhancement upon Mn-substitution. Interesting correlation between structural parameters and magnetic exchanges has been developed.

Imaging platforms to dissect the in vivo communication, biodistribution and controlled release of extracellular vesicles

Extracellular vesicles (EVs) work as communication vehicles, allowing the exchange of bioactive molecules (microRNAs, mRNAs, proteins, etc) between neighbouring and distant cells in the organism. EVs are thus important players in several physiological and pathological processes. Thus, it is critical to understand their role in cellular/organ communication to fully evaluate their biological, diagnosis and therapeutic potential. In addition, recent studies have explored the controlled release of EVs for regenerative medicine applications and thus the evaluation of their release profile is important to correlate with biological activity. Here, we give a brief introduction about EV imaging platforms in terms of their sensitivity, penetration depth, cost, and operational simplicity, followed by a discussion of different EV labelling processes with their advantages and limitations. Next, we cover the relevance of these imaging platforms to dissect the tropism and biological role of endogenous EVs. We also cover the relevance of imaging platforms to monitor the accumulation of exogenous EVs and their potential cellular targets. Finally, we highlight the importance of imaging platforms to investigate the release profile of EVs from different controlled systems.

The analgesic effects of bilateral superficial cervical plexus block in thyroid surgery: A systematic review and meta-analysis

Background and Aims

Thyroid surgery is moderately painful, and many techniques to reduce postoperative pain have been studied. Regional techniques are a part of multimodal analgesia employed for various surgical cases. Bilateral superficial cervical plexus block (BSCPB) is a commonly used regional anaesthesia technique for analgesia for thyroid surgery. A previous meta-analysis by this group had left questions about some facets of the technique, to which further trials have contributed.

Methods

The systematic review and meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO) CRD42022315499. It is an update to a previously published paper in 2018. An updated systematic search, critical appraisal, and analysis of clinical trials were performed. Trials investigating preoperative or postoperative BSCPB compared to control in patients undergoing thyroid surgery were included in the search. The primary outcome was postoperative opioid consumption. The secondary outcomes were the duration of analgesia (time to request of analgesia), Visual Analogue Scale (VAS) pain scores at 0, 4, 12, and 24 h, postoperatively, rates of postoperative nausea and vomiting (PONV), postoperative rescue analgesic consumption, and intraoperative morphine use.

Results

A total of 31 studies and 2,273 patients were included in this analysis. BSCPB significantly reduced post-thyroidectomy opioid consumption (P < 0.001). Additionally, the duration of analgesia was prolonged following BSCPB. VAS scores for 24 h (postoperatively), intraoperative morphine use, and rescue analgesia (postoperatively) remained significantly lower in patients who received BSCPB. There was also a statistically significant reduction in PONV (P = 0.02).

Conclusion

BSCPB offers superior postoperative analgesia with a reduction in opioid use, reduction in PONV, and improvement in VAS scores.

Dynamic Asset Allocation with Expected Shortfall via Quantum Annealing

Recent advances in quantum hardware offer new approaches to solve various optimization problems that can be computationally expensive when classical algorithms are employed. We propose a hybrid quantum-classical algorithm to solve a dynamic asset allocation problem where a target return and a target risk metric (expected shortfall) are specified. We propose an iterative algorithm that treats the target return as a constraint in a Markowitz portfolio optimization model, and dynamically adjusts the target return to satisfy the targeted expected shortfall. The Markowitz optimization is formulated as a Quadratic Unconstrained Binary Optimization (QUBO) problem. The use of the expected shortfall risk metric enables the modeling of extreme market events. We compare the results from D-Wave's 2000Q and Advantage quantum annealers using real-world financial data. Both quantum annealers are able to generate portfolios with more than 80% of the return of the classical optimal solutions, while satisfying the expected shortfall. We observe that experiments on assets with higher correlations tend to perform better, which may help to design practical quantum applications in the near term.

Local and Nonlocal Transport Spectroscopy in Planar Josephson Junctions

We report simultaneously acquired local and nonlocal transport spectroscopy in a phase-biased planar Josephson junction based on an epitaxial InAs-Al hybrid two-dimensional heterostructure. Quantum point contacts at the junction ends allow measurement of the 2×2 matrix of local and nonlocal tunneling conductances as a function of magnetic field along the junction, phase difference across the junction, and carrier density. A closing and reopening of a gap was observed in both the local and nonlocal tunneling spectra as a function of magnetic field. For particular tunings of junction density, gap reopenings were accompanied by zero-bias conductance peaks (ZBCPs) in local conductances. End-to-end correlation of gap reopening was strong, while correlation of local ZBCPs was weak. A model of the device, with disorder treated phenomenologically, shows comparable conductance matrix behavior associated with a topological phase transition. Phase dependence helps distinguish possible origins of the ZBCPs.

Morphology of human fetal enteric neurons: A comparative study of different segments of the colon

OBJECTIVES

The Enteric Nervous System (ENS) present in the wall of the gut is currently being explored because of its influence on the gut and beyond. In this context, the morphology of developing ENS has not been completely understood in humans due to lack of adequate literature. The aim of the present study was to observe the morphology of the enteric neurons in the human fetal colon and compare the findings in ascending colon a midgut derivative and descending colon a hindgut derivative at various weeks of gestation (WG).

MATERIAL AND METHODS

Tissue samples from 15 aborted fetuses (11 WG to 2 months postnatal) were processed for Cresyl violet, H & E staining, and NADPH Diaphorase histochemistry. The morphometric analysis was done by calculating the neuronal number density and neuronal fractional area. The Student t-test; Mann-Whitney test and Wilcoxon signed-rank test were used to analyze the data.

RESULTS

The muscularis externa with two distinct layers was visible as early as 13 WG and the muscularis mucosae was first observed at 18 WG. The size of the myenteric neurons appeared to be larger with increasing weeks of gestation suggesting a process of neuronal maturation. The neuronal number density and neuronal fractional area seemed to be reduced with advancing fetal age. There was no marked difference between the ascending and sigmoid colon. At 23 and 26 WG, a mature pattern of nitrergic innervation was observed.

CONCLUSION

This study is done on human fetal tissue samples unlike previous studies on animal samples to comprehend the morphology of developing ENS. It will aid in understanding the effect of ENS on various neurological disorders.

Age-related changes in gonadotropin-releasing hormone (GnRH) splice variants in mouse brain

Gonadotropin-releasing hormone (GnRH) is the primary regulator of the mammalian reproductive axis. We investigated the spatiotemporal expression of GnRH splice variants (V1, V2, and V3) and splicing factors (Srsf7, Srsf9, and Tra-2) in the male mice brain. Further, using in silico tools, we predicted protein structure and the reason for the low translational efficiency of V2 and V3. Messenger RNA levels of GnRH variants and splicing factors were quantified using real-time reverse transcription-polymerase chain reaction at different age groups. Our data show that expression of almost all the variants alters with aging in all the brain regions studied; even in comparison to the hypothalamus, several brain areas were found to have higher expression of these variants. Hypothalamic expression of splicing factors such as Srsf7, Srsf9, and Tra-2 also change with aging. Computational studies have translation repressors site on the V3, which probably reduces its translation efficiency. Also, V2 is an intrinsically disordered protein that might have a regulatory or signaling function. In conclusion, this study provides novel crucial information and multiple starting points for future analysis of GnRH splice variants in the brain.

Bones, groans and sending patients home: Perioperative opioid-related harm reduction strategy utilisation in a regional New South Wales (NSW) hospital

OBJECTIVE

Perioperative initiation of opioids continues to be a major contributor to chronic use, misuse and diversion in regional areas. There is considerable effort to mitigate harm through avoiding excessive prescribing and reducing the risk of persistent postoperative opioid use. Improving perioperative documentation practices has been reported to ensure appropriate opioid initiation and de-escalation. It has not been established whether these strategies are utilised in regional hospitals.

METHODS

A retrospective observational study of perioperative opioid prescribing and documentation practices in Goulburn Base Hospital, a regional centre in the Southern New South Wales (NSW) Local Health District. Data were collected from 110 records and validated for adult patients undergoing elective total knee replacement (TKR) or total hip replacement (THR) from 12 January 2020 to 13 January 2021.

OUTCOME MEASURES

To observe perioperative opioid prescribing and utilisation of harm reduction strategies in a regional hospital.

RESULTS

65% of patients were opioid naïve (ON). Preoperative pain assessments and patient education were completed in 23% and 15% of records, respectively. Postoperative opioids were prescribed for 99% of patients, with 74% prescribed a slow-release (SR) formulation. 50% of patients were discharged with an SR prescription. Inadequate postoperative pain control was reported in 21% of patients. Of the 103 patients prescribed opioids on discharge, only 20% included a de-escalation plan and only 35% of discharge summaries included dose and quantity of opioids supplies.

CONCLUSIONS

This study has identified underutilisation of perioperative harm reduction strategies despite the potential to improve appropriate initiation and de-escalation of opioids. These findings highlight opportunities for improvement in regional hospitals.

Minimum intervention oral care management of early childhood caries: a 17-year follow-up case report

BACKGROUND

Early childhood caries (ECC) has a profound impact on a child's quality of life, and its management remains a challenge for the paediatric dentist, mainly because it depends on radical changes in the child/carers' daily behaviour and any dental treatment must be provided to very young child.

CASE REPORT

This case report describes the on-going care of a 2-year-old child presenting with ECC and management until permanent dentition is complete. All patient-focused, teamdelivered care was delivered using the minimum intervention oral care framework, implementing non-invasive and minimally invasive preventive procedures. Throughout the care provided, oral and dental health education was reinforced in all visits. The child's mother was trained to perform effective biofilm control and dietary habits were adjusted, especially baby-bottle removal during sleep. The child was initially anxious and resistant towards any dental examination and clinical procedures. However, with effort from the oral healthcare team members, the patient became compliant, allowing the mother to perform suitable oral hygiene measures, as well as accepting the clinical procedures carried out by the paediatric dentist. The clinical procedures consisted of atraumatic restorations and fluoride varnish applications. During the subsequent years after the baseline treatment, follow-up visits included continued dietary and oral hygiene instruction with positive behavior reinforcement, fluoride topical applications and tooth-restoration complex maintenance with glass-ionomer cement where needed. Currently, the patient is 19 years old and has a stable, healthy permanent dentition.

CONCLUSION

Understanding of the causes of oral diseases by the patients' caregivers, alongside with pragmatic practical guidance to maintain good oral health, can reduce the risk for acquiring future disease, since caries activity control is the basis for successful caries management.

Early Release Science of the exoplanet WASP-39b with JWST NIRSpec PRISM

Transmission spectroscopy1-3 of exoplanets has revealed signatures of water vapour, aerosols and alkali metals in a few dozen exoplanet atmospheres4,5. However, these previous inferences with the Hubble and Spitzer Space Telescopes were hindered by the observations' relatively narrow wavelength range and spectral resolving power, which precluded the unambiguous identification of other chemical species-in particular the primary carbon-bearing molecules6,7. Here we report a broad-wavelength 0.5-5.5 µm atmospheric transmission spectrum of WASP-39b8, a 1,200 K, roughly Saturn-mass, Jupiter-radius exoplanet, measured with the JWST NIRSpec's PRISM mode9 as part of the JWST Transiting Exoplanet Community Early Release Science Team Program10-12. We robustly detect several chemical species at high significance, including Na (19σ), H2O (33σ), CO2 (28σ) and CO (7σ). The non-detection of CH4, combined with a strong CO2 feature, favours atmospheric models with a super-solar atmospheric metallicity. An unanticipated absorption feature at 4 µm is best explained by SO2 (2.7σ), which could be a tracer of atmospheric photochemistry. These observations demonstrate JWST's sensitivity to a rich diversity of exoplanet compositions and chemical processes.

Differential expression of TLR4 in patients of coronary artery disease with and without traditional cardiovascular risk factors

Funding Acknowledgements

Type of funding sources: None.

Background

Atherosclerosis is inherently an inflammatory process, with a complex interplay of inflammatory markers. It is established that these inflammatory markers play an important role in patients of Coronary Artery Disease(CAD) with traditional cardiovascular risk factors. However, the role of inflammation in the atherosclerotic process in patients of CAD without traditional risk factors is still not clearly known.

Purpose

Our purpose was to determine whether in patients of CAD without traditional risk factors, TLR4(Toll like receptor 4) expression as a marker of inflammation is similar to that in patients of CAD with traditional risk factors.

Materials and Methods

This observational cross sectional study was done between July’20 to Dec’21. Equal number of patients of CAD with and without traditional cardiovascular risk factors undergoing Coronary Artery Bypass Grafting (CABG) were enrolled. The risk factors considered were Hypertension, Diabetes, Dyslipidemia, Obesity and Addiction to Tobacco and/or Alcohol. A minimum of two punch biopsy samples of aortic tissue was taken from each subject undergoing CABG. Immunohistochemistry for TLR4, was done in Ventana BenchMark GX System. The primary TLR4 antibody was procured from reputed source.

Results

The presence or absence of TLR4 expression was associated significantly with the Syntax scores (37.40±4.74 vs 29.5±8.71; p value=0.036), total Cholesterol (187±35.06mg/dL vs 130±35.69 mg/dL ;p value 0.010) and LDL cholesterol (118.86±28.12mg/dL vs 64.21±25.61 mg/dL; p value 0.003). TLR4 expression, however, was not significantly associated with the number of coronary vessels involved (p=0.298). TLR4 expression was also not significantly associated with any other individual risk factors. However, when the traditional risk factors were considered in combination, TLR4 expression was associated significantly with the number of risk factors present(p=0.029) the strongest being in those having 4 traditional risk factors. The level of TLR4 expression gradually declined with the decrease in the number of risk factors, having mostly weak or negative expression in patients without any traditional risk factors.

Conclusion

Patients with CAD without any traditional risk factors, had a less severe coronary artery disease as manifested by lower Syntax scores, and had lower degree of TLR4 expression. Patients with CAD with traditional risk factors had more severe coronary artery disease as evidenced by higher Syntax scores, and had higher degree of TLR4 expression proportional to the number of traditional risk factors present. Thus, differential TLR4 expression in CAD patients with and without traditional risk factors indicated a difference in inflammatory state between the two groups and warrants further investigation.

Simulations of frustrated Ising Hamiltonians using quantum approximate optimization

Novel magnetic materials are important for future technological advances. Theoretical and numerical calculations of ground-state properties are essential in understanding these materials, however, computational complexity limits conventional methods for studying these states. Here we investigate an alternative approach to preparing materials ground states using the quantum approximate optimization algorithm (QAOA) on near-term quantum computers. We study classical Ising spin models on unit cells of square, Shastry-Sutherland and triangular lattices, with varying field amplitudes and couplings in the material Hamiltonian. We find relationships between the theoretical QAOA success probability and the structure of the ground state, indicating that only a modest number of measurements ([Formula: see text]) are needed to find the ground state of our nine-spin Hamiltonians, even for parameters leading to frustrated magnetism. We further demonstrate the approach in calculations on a trapped-ion quantum computer and succeed in recovering each ground state of the Shastry-Sutherland unit cell with probabilities close to ideal theoretical values. The results demonstrate the viability of QAOA for materials ground state preparation in the frustrated Ising limit, giving important first steps towards larger sizes and more complex Hamiltonians where quantum computational advantage may prove essential in developing a systematic understanding of novel materials. This article is part of the theme issue 'Quantum annealing and computation: challenges and perspectives'.

Planar thermal Hall effect of topological bosons in the Kitaev magnet α-RuCl3

The honeycomb magnet α-RuCl₃ has attracted considerable interest because it is proximate to the Kitaev Hamiltonian whose excitations are Majoranas and vortices. The thermal Hall conductivity κ_xy of Majorana fermions is predicted to be half-quantized. Half-quantization of κ_xy/T (T, temperature) was recently reported, but this observation has proven difficult to reproduce. Here, we report detailed measurements of κ_xy on α-RuCl₃ with the magnetic field B ∥ a (zigzag axis). In our experiment, κ_xy/T is observed to be strongly temperature dependent between 0.5 and 10 K. We show that its temperature profile matches the distinct form expected for topological bosonic modes in a Chern-insulator-like model. Our analysis yields magnon band energies in agreement with spectroscopic experiments. At high B, the spin excitations evolve into magnon-like modes with a Chern number of ~1. The bosonic character is incompatible with half-quantization of κ_xy/T.

Revisiting the gonadotropic regulation of mammalian spermatogenesis: evolving lessons during the past decade

Spermatogenesis is a multi-step process of male germ cell (Gc) division and differentiation which occurs in the seminiferous tubules of the testes under the regulation of gonadotropins - Follicle Stimulating Hormone (FSH) and Luteinising hormone (LH). It is a highly coordinated event regulated by the surrounding somatic testicular cells such as the Sertoli cells (Sc), Leydig cells (Lc), and Peritubular myoid cells (PTc). FSH targets Sc and supports the expansion and differentiation of pre-meiotic Gc, whereas, LH operates via Lc to produce Testosterone (T), the testicular androgen. T acts on all somatic cells e.g.- Lc, PTc and Sc, and promotes the blood-testis barrier (BTB) formation, completion of Gc meiosis, and spermiation. Studies with hypophysectomised or chemically ablated animal models and hypogonadal (hpg) mice supplemented with gonadotropins to genetically manipulated mouse models have revealed the selective and synergistic role(s) of hormones in regulating male fertility. We here have briefly summarized the present concept of hormonal control of spermatogenesis in rodents and primates. We also have highlighted some of the key critical questions yet to be answered in the field of male reproductive health which might have potential implications for infertility and contraceptive research in the future.

A systematic review on bioplastic-soil interaction: Exploring the effects of residual bioplastics on the soil geoenvironment

Growing demand for plastic and increasing plastic waste pollution have led to significant environmental challenges and concerns in today's world. Bioplastics offer exciting new opportunities and possibilities where biodegradable and bio-based plastics are expected to be more eco-friendly and rely on renewable resources. With all its promises, evaluating its real impact and fate on the geoenvironment is paramount for promoting bioplastic use. This paper presents a systematic literature review to understand current bioplastic-soil research and the effects of its residues on the geoenvironment. 632 studies related to bioplastic research in soil since 1973 were identified and categorized into different relevant topics. Publication trend showed bioplastic-soil research grew exponentially after 2010 wherein field studies accounted to 33.1 % of the total studies and only about 9.7 % studied the effects of bioplastic residues on the geoenvironment. Majority of the lab studies were on development and subsequent stability of bioplastics in soil. Short-term studies (in months) dominated the longer-term studies and studies over 4 years were almost non-existent. Lab and field experiments often gave inconsistent results with seasonal, climatic and bio-geographical factors strongly influencing the field results and bioplastic stability in soil. Most existing studies reported significant effects for microbioplastic concentrations at or above 1 % w/w. Bioplastic residues were found to substantially affect soil C/N ratio, impact soil microbial diversity by favouring certain microbial taxa and alter soil physical structure by influencing soil aggregates formation. At higher concentrations, plant health and germination success were also negatively affected. Conclusively, the review found it important to focus more on long-term field experiments to better understand the degree and extent of bioplastic residue impact on soil physico-chemical properties, mechanical properties, soil biology, soil-bioplastic-plant response, nutrients and toxicity. There are also very few studies investigating contaminant transport and migration of micro or nano-bioplastics in soil.

Predictors of self-management in patients with chronic low back pain: a longitudinal study

BACKGROUND

Self-management (SM) is a key recommended strategy for managing chronic low back pain (CLBP). However, SM programmes generate small to moderate benefits for reducing pain and disability in patients with CLBP. The benefits of the SM programme can potentially be optimised by identifying specific subgroups of patients who are the best responders. To date, no longitudinal study has examined the predictive relationships between SM and biopsychosocial factors in patients with CLBP. The aim was to determine whether biopsychosocial factors predict SM and its change over time in patients with CLBP.

METHODS

In this multi-centre longitudinal cohort study, we recruited 270 working-age patients with CLBP (mean age 43.74, 61% female) who consulted outpatient physiotherapy for their CLBP. Participants completed self-reported validated measures of pain intensity, disability, physical activity, kinesiophobia, catastrophising, depression and SM at baseline and six months. SM constructs were measured using eight subscales of the Health Education Impact Questionnaire (heiQ), including Health Directed Activity (HDA), Positive and Active Engagement in Life (PAEL), Emotional Distress (ED), Self-Monitoring and Insight (SMI), Constructive Attitudes and Approaches (CAA), Skill and Technique Acquisition (STA), Social Integration and Support (SIS) and Health Service Navigation (HSN). Data were analysed using General Linear Model (GLM) regression.

RESULTS

Physical activity and healthcare use (positively) and disability, depression, kinesiophobia, catastrophising (negatively) predicted (p < 0.05, R² 0.07-0.55) SM constructs at baseline in patients with CLBP. Baseline depression (constructs: PAEL, ED, SMI, CAA and STA), kinesiophobia (constructs: CAA and HSN), catastrophising (construct: ED), and physical disability (constructs: PAEL, CAA and SIS) negatively predicted a range of SM constructs. Changes over six months in SM constructs were predicted by changes in depression, kinesiophobia, catastrophising, and physical activity (p < 0.05, R² 0.13-0.32).

CONCLUSIONS

Self-reported disability, physical activity, depression, catastrophising and kinesiophobia predicted multiple constructs of SM measured using the heiQ subscales in working-age patients with CLBP. Knowledge of biopsychosocial predictors of SM may help triage patients with CLBP into targeted pain management programmes.

TRIAL REGISTRATION

The study protocol was registered at ClinicalTrials.gov on 22 December 2015 (ID: NCT02636777).

Heterogeneity of management practices surrounding operable gallbladder cancer - results of the OMEGA-S international HPB surgical survey

BACKGROUND

Gallbladder cancer (GBC) is an aggressive, uncommon malignancy, with variation in operative approaches adopted across centres and few large-scale studies to guide practice. We aimed to identify the extent of heterogeneity in GBC internationally to better inform the need for future multicentre studies.

METHODS

A 34-question online survey was disseminated to members of the European-African Hepatopancreatobiliary Association (EAHPBA), American Hepatopancreatobiliary Association (AHPBA) and Asia-Pacific Hepatopancreatobiliary Association (A-PHPBA) regarding practices around diagnostic workup, operative approach, utilization of neoadjuvant and adjuvant therapies and surveillance strategies.

RESULTS

Two hundred and three surgeons responded from 51 countries. High liver resection volume units (>50 resections/year) organised HPB multidisciplinary team discussion of GBCs more commonly than those with low volumes (p < 0.0001). Management practices exhibited areas of heterogeneity, particularly around operative extent. Contrary to consensus guidelines, anatomical liver resections were favoured over non-anatomical resections for T3 tumours and above, lymphadenectomy extent was lower than recommended, and a minority of respondents still routinely excised the common bile duct or port sites.

CONCLUSION

Our findings suggest some similarities in the management of GBC internationally, but also specific areas of practice which differed from published guidelines. Transcontinental collaborative studies on GBC are necessary to establish evidence-based practice to minimise variation and optimise outcomes.

Clinical, laboratory and high-resolution computed tomography (HRCT) thorax profile of reverse transcription polymerase chain reaction (RT-PCR) negative COVID-19 suspects with moderate to severe disease

BACKGROUND

Diagnostic dilemma arises when patients with clinical suspicion of COVID-19 disease having moderate-to-severe respiratory symptoms yield negative result for COVID-19 in reverse transcription polymerase chain reaction (RT-PCR). This study evaluated the clinical, laboratory and HRCT thorax findings among RT-PCR-negative COVID-19 suspects with moderate-to-severe disease.

MATERIALS AND METHODS

A hospital-based retrospective observational study was conducted between July 2021 to December 2021, among 60 moderate and severe symptomatic COVID-19 suspects admitted in the severe acute respiratory illness (SARI) ward and intensive care unit (ICU), who were negative for COVID-19 in RT-PCR. Data were abstracted from the medical records section of the hospital using a predesigned data abstraction form and presented by descriptive statistics.

RESULTS

Mean age of study participants was 55.5 years (SD 14.1 years), and majority were males (n = 43, 71.7%). Common presenting symptoms were fever (n = 60, 100%), dyspnea (n = 57, 95%), and cough (n = 54, 90%). The common laboratory findings were rise of C-reactive protein (n = 60, 100%), NLR (n = 49, 81.7%), d-dimer (n = 47, 78.3%), ferritin (n = 46, 76.7%), and LDH (n = 40, 66.7%). HRCT scan of thorax revealed ground glass opacities with or without consolidations located bilaterally with diffuse or peripheral distribution, interlobar septal thickening (n = 43, 74.1%), vascular thickening (n = 35, ≥58.3%), and sub-pleural lines (n = 32, 53.3%). Median CT-SS value was 15 (IQR 11-19), and majority (n = 56, 93.3%) belonged to CO-RADS ≥4.

CONCLUSION

Diagnosis of COVID-19 can be presumed in RT-PCR-negative suspected COVID-19 patients with moderate-to-severe disease, with marked rise of inflammatory markers and HRCT revealing typical findings of COVID-19 pneumonia.

Soil salinity and its associated effects on soil microorganisms, greenhouse gas emissions, crop yield, biodiversity and desertification: A review

Significant research has been conducted on the effects of soil salinity issue on agricultural productivity. However, limited consideration has been given to its critical effects on soil biogeochemistry (e.g., soil microorganisms, soil organic carbon and greenhouse gas (GHG) emissions), land desertification, and biodiversity loss. This article is based on synthesis of information in 238 articles published between 1989 and 2022 on these effects of soil salinity. Principal findings are as follows: (1) salinity affects microbial community composition and soil enzyme activities due to changes in osmotic pressure and ion effects; (2) soil salinity reduces soil organic carbon (SOC) content and alters GHG emissions, which is a serious issue under intensifying agriculture and global warming scenarios; (3) soil salinity can reduce crop yield up to 58 %; (4) soil salinity, even at low levels, can cause profound alteration in soil biodiversity; (5) due to severe soil salinity, some soils are reaching critical desertification status; (6) innovate mitigation strategies of soil salinity need to be approached in a way that should support the United Nations Sustainable Development Goals (UN-SDGs). Knowledge gaps still exist mainly in the effects of salinity especially, responses of GHG emissions and biodiversity. Previous experiences quantifying soil salinity effects remained small-scale, and inappropriate research methods were sometimes applied for investigating soil salinity effects. Therefore, further studies are urgently required to improve our understanding on the effects of salinity, address salinity effects in larger-scale, and develop innovative research methods.

Impact of COVID-19 on cardiac procedure activity in England and associated 30-day mortality

Background

The COVID-19 pandemic had a significant impact on the quality of healthcare provision across all specialities and disciplines. However, there are limited data on the scale of its disruption to cardiac procedure activity from a national perspective and whether procedural outcomes different before and during the COVID-19 pandemic.

Methods

Major cardiac procedures (n=374,899) performed between 1st January and 31st May for the years 2018, 2019 and 2020 were analysed, stratified by procedure type and time-period (pre-COVID: January-May 2018 and 2019 and January-February 2020 and COVID: March-May 2020). Multivariable logistic regression modelling was undertaken to examine the odds ratio (OR) of 30-day mortality for procedures performed in the COVID period (vs. pre-COVID).

Results

There was a deficit of 45,501 procedures during the COVID period compared to the monthly averages (March-May) in 2018–2019. Cardiac catheterisation and cardiac electronic device implantations were the most affected in terms of numbers (n=19,637 and n=10,453) while surgical procedures including mitral valve replacement, other valve replacement/repair, atrial and ventricular septal defect repair, and CABG were the most affected as a relative percentage difference (D) to previous years' averages. TAVR was the least affected (D-10.6%). No difference in 30-day mortality was observed between pre-COVID and COVID time-periods for all cardiac procedures except cardiac catheterisation (OR 1.25 95% confidence interval (CI) 1.07–1.47, p=0.006) and cardiac device implantation (OR 1.35 95% CI 1.15–1.58, p&lt;0.001).

Conclusion

There was a significant decline in national cardiac procedural activity in England during the COVID-19 pandemic, with a deficit in excess of 45000 procedures over the study period. However, there was no increase in risk of mortality for most cardiac procedures performed during the pandemic. While health service pressures are gradually easing given the increased roll out of vaccination and decline in infection rates, there is a need for major restructuring of cardiac services deal with this significant backlog of procedures, which would inevitably impact longer-term morbidity and mortality.

Funding Acknowledgement

Type of funding sources: None.