Calotropis procera (L.) mediated synthesis of AgNPs and their application to control leaf spot of Hibiscus rosa-sinensis (L.)

Abstract Nature is gifted with a wide range of ornamental plants, which beautify and clean the nature. Due to its great aesthetic value, there is a need to protect these plants from a variety of biotic and abiotic stresses. Hibiscus rosa-sinensis (L.) is an ornamental plant and it is commonly known as China rose or shoeblack plant. It is affected by several fungal and bacterial pathogens. Current study was designed to isolate leaf spot pathogen of H. rosa-sinensis and its control using silver nanoparticles (AgNPs). Based on molecular and morphological features, the isolated leaf spot pathogen was identified as Aspergillus niger. AgNPs were synthesized in the leaf extract of Calotropis procera and characterized. UV-vis spectral analysis displayed discrete plasmon resonance bands on the surface of synthesized AgNPs, depicting the presence of aromatic amino acids. Fourier transform infrared spectroscopy (FTIR) described the presence of C-O, NH, C-H, and O-H functional groups, which act as stabilizing and reducing molecules. X-ray diffraction (XRD) revealed the average size (~32.43 nm) of AgNPs and scanning electron microscopy (SEM) depicted their spherical nature. In this study, in vitro and in vivo antifungal activity of AgNPs was investigated. In vitro antifungal activity analysis revealed the highest growth inhibition of mycelia (87%) at 1.0 mg/ml concentration of AgNPs. The same concentration of AgNPs tremendously inhibited the spread of disease on infected leaves of H. rosa-sinensis. These results demonstrated significant disease control ability of AgNPs and suggested their use on different ornamental plants.

Impact of COVID-19 pandemic on head-neck cancer referral and treatment pathway in North East London

INTRODUCTION

The COVID-19 pandemic has led to wide-ranging disruption of head-neck cancer (HNC) service provision in the UK. Early reports suggest delays in referral, diagnosis and initiation of treatment for new cancer cases compared with before the pandemic.

METHODS

The HNC service was studied retrospectively for the time-periods between 1 January 2020 to 31 October 2020 (hereafter 'post-COVID') and 1 January 2019 to 31 October 2019 (hereafter 'pre-COVID'). We analysed: (1) the number of cases treated at our centre, (2) stage of disease at presentation and (3) treatment delivery times.

RESULTS

In the post-COVID period, the total number of HNC cases treated decreased (48 vs 56 pre-COVID). There was increase in advanced stage at presentation (58% vs 42% pre-COVID) and a significant increase in the need for airway stabilisation (13 vs 5 pre-COVID; p=0.03). Average time from referral to treatment was significantly prolonged (72.5 days vs 49.23 days pre-COVID; p=0.03). Two-week wait referrals were seen in HNC clinics at median time of 11.9 days, compared with 7.1 days during the pre-COVID period (p=0.07). However, there was no delay in the initiation of first treatment after the decision to treat (29.2 days vs 24.7 days pre-COVID; p=0.58).

CONCLUSION

The results of this study call for early referral at the primary care level and rapid radiopathological confirmation at the tertiary level to prevent delays in diagnosis of new HNC cases.

Low Overpotential Amperometric Sensor Using Yb2O3.CuO@rGO Nanocomposite for Sensitive Detection of Ascorbic Acid in Real Samples

The ultimate objective of this research work is to design a sensitive and selective electrochemical sensor for the efficient detection of ascorbic acid (AA), a vital antioxidant found in blood serum that may serve as a biomarker for oxidative stress. To achieve this, we utilized a novel Yb₂O₃.CuO@rGO nanocomposite (NC) as the active material to modify the glassy carbon working electrode (GCE). The structural properties and morphological characteristics of the Yb₂O₃.CuO@rGO NC were investigated using various techniques to ensure their suitability for the sensor. The resulting sensor electrode was able to detect a broad range of AA concentrations (0.5-1571 µM) in neutral phosphate buffer solution, with a high sensitivity of 0.4341 µAµM^-1cm^-2 and a reasonable detection limit of 0.062 µM. The sensor's great sensitivity and selectivity allowed it to accurately determine the levels of AA in human blood serum and commercial vitamin C tablets. It demonstrated high levels of reproducibility, repeatability, and stability, making it a reliable and robust sensor for the measurement of AA at low overpotential. Overall, the Yb₂O₃.CuO@rGO/GCE sensor showed great potential in detecting AA from real samples.

Rapid elimination of antibiotic gemifloxacin mesylate and methylene blue over Pt nanoparticles dispersed chitosan/g-C3N4 ternary visible light photocatalyst

Appropriate material selection and proper understanding of bandgap modification are key factors for the development of efficient photocatalysts. Herein, we developed an efficient, well-organized visible light oriented photocatalyst based on g-C₃N₄ in association with polymeric network of chitosan (CTSN) and platinum (Pt) nanoparticles utilizing a straightforward chemical approach. Modern techniques like XRD, XPS, TEM, FESEM, UV-Vis, and FTIR spectroscopy were exploited for characterization of synthesized materials. XRD results confirmed the involvement of α-polymorphic form of CTSN in graphitic carbon nitride. XPS investigation confirmed the establishment of trio photocatalytic structure among Pt, CTSN, and g-C₃N₄. TEM examination showed that the synthesized g-C₃N₄ possesses fine fluffy sheets like structure (100 to 500 nm in size) intermingled with a dense layered framework of CTSN with good dispersion of Pt nanoparticles on g-C₃N₄ and CTSN composite structure. The bandgap energies for g-C₃N₄, CTSN/g-C₃N₄, and Pt@ CTSN/g-C₃N₄ photocatalysts were found to be 2.94, 2.73, and 2.72 eV, respectively. The photodegradation skills of each created structure have been examined on antibiotic gemifloxacin mesylate and methylene blue (MB) dye. The newly developed Pt@CTSN/g-C₃N₄ ternary photocatalyst was found to be efficacious for the elimination of gemifloxacin mesylate (93.3%) in 25 min and MB (95.2%) just in 18 min under visible light. Designed Pt@CTSN/g-C₃N₄ ternary photocatalytic framework exhibited ⁓ 2.20 times more effective than bare g-C₃N₄ for the destruction of antibiotic drug. This study provides a simple route towards the designing of rapid, effective visible light oriented photocatalyts for the existing environmental issues.

Oral Dextrose gel use in asymptomatic hypoglycemic newborns decreases NICU admissions and parenteral dextrose therapy: A retrospective study

BACKGROUND

Neonatal hypoglycemia is one of the most common causes of admission to neonatal intensive care unit requiring intravenous dextrose therapy. Administration of IV dextrose and transfer to the NICU may interfere with parent-infant bonding, breastfeeding, and has financial implications.

OBJECTIVE

Retrospective study to evaluate the effect of dextrose gel supplementation for asymptomatic hypoglycemia in reducing NICU admissions and intravenous dextrose therapy.

METHOD

A retrospective study conducted for eight months each before and after introduction of dextrose gel in the management of asymptomatic neonatal hypoglycemia. Asymptomatic hypoglycemic infants were given only feeds in pre dextrose gel period and dextrose gel along with feeds in the dextrose gel period. Rates of admission to NICU and the need of IV dextrose therapy were evaluated.

RESULTS

High risk characteristics (Prematurity, Large for Gestational Age, small for Gestational Age, Infants of diabetic mother etc.) were equally distributed among both the cohorts. Primary outcome results showed significant reduction in NICU admissions from 396/1801(22%) to 329/1783 (18.5%) (odds ratio, 95% CI 1.24(1.05-1.46, p 0.008). There was significant reduction in IV dextrose therapy requirement from 277/1405 (15.4%) to 182/1454 (10.2%) (odds ratio, 95% CI 1.59(1.31- 1.95, p <  0.001).Babies discharged on predominant breast feeding showed significant improvement from 237/396(59.8%) in the pre dextrose gel period to 240/329 (72.9%) (odds ratio, 95% CI 0.82(0.73-0.90, p <  0.001) in dextrose gel period.

CONCLUSIONS

Dextrose gel supplementation with feeds reduced NICU admissions, the need for parenteral dextrose therapy, avoided maternal separation and promoted breastfeeding.

The surprises in optical coherence tomography (OCT) findings in patients presenting with in-stent restenosis: the road less travelled

Funding Acknowledgements

Type of funding sources: None.

Background

Morphological features of neointimal tissue play a pivotal role in the pathophysiology of In-Stent Restenosis (ISR) after percutaneous coronary intervention, hence understanding these features and patterns is crucial.

Purpose

The present study was designed to qualitatively and quantitatively assess neointimal characteristics of lesions using OCT in patients presenting with ISR.

Methods

This was a single-center, prospective, observational study performed between 1st August 2020 and 30th December 2021 at a tertiary-care center in India. Patients diagnosed with stable angina and acute coronary syndrome with post-procedural angiographically documented restenosis (&gt;50%) were included. Qualitative and quantitative assessment of neointimal hyperplasia patterns was performed using OCT.

Results

A total of 34 patients with ISR were studied. Neointimal hyperplasia was classified as (i) homogenous group (n=18) and (ii) non-homogenous group (n=16). As many as 14 (77.8%) diabetics belonged to the homogenous group. Predominant plaque characteristics such as neoatherosclerosis, cholesterol crystals, and calcium were documented in 14 (77.8%), 12 (66.7%), and 11 (61.1%) patients in the homogenous group and in 10 (62.5%), 10 (62.5%), and 9 (56.2%) patients in the non-homogenous group, respectively. Unexpanded stent struts were identified in 11 (61.1%) and 11 (68.8%) patients in the homogenous and non-homogenous groups, respectively. Mean strut thickness was 93.73 ± 31.03 µm and 83.54 ± 18.0 µm, ISR was 72.50 ± 15.93% and 65.37 ± 21.69%, the neointimal thickness was 588.06 ± 167.82 mm and 666.25 ± 218.05 mm, and neointimal hyperplasia was 54.54 ± 11.23% and 59.26 ± 8.86% in the homogenous and non-homogenous groups, respectively.

Conclusion

Neoatherosclerosis and stent underexpansion was predominantly observed in our study, which was in contrast to most of the existing literature [1,2,3], and only diabetes was found to be significantly associated with homogenous neointimal hyperplasia, irrespective of the generation of the stent.

A Sensitive Hydroquinone Amperometric Sensor Based on a Novel Palladium Nanoparticle/Porous Silicon/Polypyrrole-Carbon Black Nanocomposite

Exposure to hydroquinone (HQ) can cause various health hazards and negative impacts on the environment. Therefore, we developed an efficient electrochemical sensor to detect and quantify HQ based on palladium nanoparticles deposited in a porous silicon-polypyrrole-carbon black nanocomposite (Pd@PSi-PPy-C)-fabricated glassy carbon electrode. The structural and morphological characteristics of the newly fabricated Pd@PSi-PPy-C nanocomposite were investigated utilizing FESEM, TEM, EDS, XPS, XRD, and FTIR spectroscopy. The exceptionally higher sensitivity of 3.0156 μAμM^-1 cm^-2 and a low limit of detection (LOD) of 0.074 μM were achieved for this innovative electrochemical HQ sensor. Applying this novel modified electrode, we could detect wide-ranging HQ (1-450 μM) in neutral pH media. This newly fabricated HQ sensor showed satisfactory outcomes during the real sample investigations. During the analytical investigation, the Pd@PSi-PPy-C/GCE sensor demonstrated excellent reproducibility, repeatability, and stability. Hence, this work can be an effective method in developing a sensitive electrochemical sensor to detect harmful phenol derivatives for the green environment.

Development of a Toxic Lead Ionic Sensor Using Carboxyl-Functionalized MWCNTs in Real Water Sample Analyses

Functional multiwall carbon nanotubes (f-MWCNTs) are of significant interest due to their dispersion ability in the aqueous phase and potential application in environmental, nanotechnology, and biological fields. Herein, we functionalized MWCNTs by a simple acid treatment under ultra-sonification, which represented a terminal or side-functional improvement for the fabrication of a toxic lead ion sensor. The f-MWCNTs were characterized in detail by XRD, Raman, XPS, BET, UV/vis, FTIR, and FESEM-coupled XEDS techniques. The analytical performance of the f-MWCNTs was studied for the selective detection of toxic lead ions by inductively coupled plasma-optical emission spectrometry (ICP-OES). The selectivity of the f-MWCNTs was evaluated using several metal ions such as Cd²⁺, Co²⁺, Cr³⁺, Cu²⁺, Fe³⁺, Ni²⁺, Pb²⁺, and Zn²⁺ ions. Lastly, the newly designed ionic sensor was successfully employed to selectively detect lead ions in several environmental water samples with reasonable results. This approach introduced a new technique for the selective detection of heavy metal ions using functional carbon nanotubes with ICP-OES for the safety of environmental and healthcare fields on a broad scale.

Sensitive Electrochemical Detection of 4-Nitrophenol with PEDOT:PSS Modified Pt NPs-Embedded PPy-CB@ZnO Nanocomposites

In this study, a selective 4-nitrophenol (4-NP) sensor was developed onto a glassy carbon electrode (GCE) as an electron-sensing substrate, which decorated with sol-gel, prepared Pt nanoparticles- (NPs) embedded polypyrole-carbon black (PPy-CB)/ZnO nanocomposites (NCs) using differential pulse voltammetry. Characterizations of the NCs were performed using Field Emission Scanning Electron Microscopy (FESEM), Energy-Dispersive Spectroscopy (EDS), X-ray Photoelectron Spectroscopy (XPS), Ultraviolet-visible Spectroscopy (UV-vis), Fourier Transform Infrared Spectroscopy (FTIR), High Resolution Transmission Electron Microscopy (HRTEM), and X-ray Diffraction Analysis (XRD). The GCE modified by conducting coating binders [poly(3,4-ethylenedioxythiophene) polystyrene sulfonate; PEDOT:PSS] based on Pt NPs/PPy-CB/ZnO NCs functioned as the working electrode and showed selectivity toward 4-NP in a phosphate buffer medium at pH 7.0. Our analysis of 4-NP showed the linearity from 1.5 to 40.5 µM, which was identified as the linear detection range (LDR). A current versus concentration plot was formed and showed a regression co-efficient R² of 0.9917, which can be expressed by i_p(µA) = 0.2493C(µM) + 15.694. The 4-NP sensor sensitivity was calculated using the slope of the LDR, considering the surface area of the GCE (0.0316 cm²). The sensitivity was calculated as 7.8892 µAµM^-1cm^-2. The LOD (limit of detection) of the 4-NP was calculated as 1.25 ± 0.06 µM, which was calculated from 3xSD/σ (SD: Standard deviation of blank response; σ: Slope of the calibration curve). Limit of quantification (LOQ) is also calculated as 3.79 µM from LOQ = 10xLOD/3.3. Sensor parameters such as reproducibility, response time, and analyzing stability were outstanding. Therefore, this novel approach can be broadly used to safely fabricate selective 4-NP sensors based on nanoparticle-decorated nanocomposite materials in environmental measurement.

Efficient Detection of 2,6-Dinitrophenol with Silver Nanoparticle-Decorated Chitosan/SrSnO3 Nanocomposites by Differential Pulse Voltammetry

Herein, an ultra-sonication technique followed by a photoreduction technique was implemented to prepare silver nanoparticle-decorated Chitosan/SrSnO₃ nanocomposites (Ag-decorated Chitosan/SrSnO₃ NCs), and they were successively used as electron-sensing substrates coated on a glassy carbon electrode (GCE) for the development of a 2,6-dinitrophenol (2,6-DNP) efficient electrochemical sensor. The synthesized NCs were characterized in terms of morphology, surface composition, and optical properties using FESEM, TEM, HRTEM, BET, XRD, XPS, FTIR, and UV-vis analysis. Ag-decorated Chitosan/SrSnO₃ NC/GCE fabricated with the conducting binder (PEDOT:PSS) was found to analyze 2,6-DNP in a wide detection range (LDR) of 1.5~13.5 µM by applying the differential pulse voltammetry (DPV) approach. The 2,6-DNP sensor parameters, such as sensitivity (54.032 µA µM^-1 cm^-2), limit of detection (LOD; 0.18 ± 0.01 µM), limit of quantification (LOQ; 0.545 µM) reproducibility, and response time, were found excellent and good results. Additionally, various environmental samples were analyzed and obtained reliable analytical results. Thus, it is the simplest way to develop a sensor probe with newly developed nanocomposite materials for analyzing the carcinogenic contaminants from the environmental effluents by electrochemical approach for the safety of environmental and healthcare fields in a broad scale.

Head-neck dissection course during COVID-19 pandemic: challenges, adaptations and how we did it

INTRODUCTION

Cadaveric dissection courses have come to a standstill since the onset of the COVID-19 pandemic. In addition to limited operative opportunities, cancellation of such courses has severely impacted surgical training, especially in a craft-based specialty such as head-neck surgery. The aim of this educational project was to: (1) study the feasibility of an in-person head-neck cadaveric dissection course during COVID-19 pandemic; and (2) validate the educational benefit of this teaching method to ear, nose and throat (ENT) trainees.

METHODS

We developed a 2-day head-neck cadaveric dissection course for ENT trainees. The course programme covered essential head-neck open surgical procedures. Content validity (subjective feedback) was assessed using a 5-point Likert scale. Construct validity (objective usefulness) was evaluated via two pre- and post-course questionnaires, estimating knowledge of head-neck surgical anatomy and self-assessment of levels of confidence with head-neck procedures, respectively.

RESULTS

A risk assessment was conducted and a protocol developed (risk was deemed to be low/tolerable). Content validity showed high satisfaction compared with a median Likert score of 3, 'average' (p=0.000002). For construct validity, the mean score per question improved significantly (p=0.001). Overall levels of confidence showed a trend towards improvement (p=0.08). There was significant improvement in laryngectomy (p=0.01) and level I dissection (p=0.01), with an indication of improvement in level II-V dissection (p=0.07).

CONCLUSIONS

We demonstrated that a cadaveric dissection course, using thorough risk assessment and protocol, could be safely conducted with high content and construct validation during these unprecedented times. This is an invaluable learning environment that needs to be encouraged despite infection control restrictions.

TH3.6 Comparison Between Preoperative MRI and Postoperative Histopathological Staging in Rectal Cancer Surgery (RCS)

Aim

To evaluate diagnostic values of preoperative MRI imaging staging in comparison to postoperative histopathological staging (HPS) in rectal cancer surgery.

Methods

A retrospective chart auditing was performed on all RCS patients from 2019 till 2021. Data collected included patient demographic, preoperative MRI imaging and postoperative histopathological analysis.

Results

A total number of 83 rectal surgeries were performed during the given period, mean age was 67(±11) and 60% were males. 62.7% (52) of patients underwent anterior resection (low AR 27.7%). APR and Hartmann's procedure were performed in 27.7% and 6% of patients. Complete resection was achieved in 95.2% with average LN harvest of 20.5 (±5.8) nodes. The most common Tumour (T) burdens on preoperative MRI and postoperative HPS were T2 (45.6%) and T3 (44.5%) respectively with MRI diagnostic accuracy of 47%. Lymph nodes analysis showed diagnostic preoperative predictive values of 56.6%. Extramural vascular invasion (EMVI) was accounted in 68 Pre-MRI with diagnostic accuracy of 50.6%. Pre-MRI evaluated 69 CRM and accurately commented in 73.5%. Although Pre-MRI staging had tendency to over-stage tumour burden, lymph nodes analysis and EMVI in around 30% of reported cases. It showed accuracy in diagnostic values in CRM prediction with around 73%.

Conclusion

Preoperative MRI diagnostic values showed differences when compared with postoperative histopathological analysis. Pre-MRI showed a tendency to over-staging in tumour size, LNs and EMVI. However, Pre-MRI showed favourable values in accurately describing CRM which is the main factor affecting the outcome of surgery and the ongoing treatment.

Scintillation light detection in the 6-m drift-length ProtoDUNE Dual Phase liquid argon TPC

DUNE is a dual-site experiment for long-baseline neutrino oscillation studies, neutrino astrophysics and nucleon decay searches. ProtoDUNE Dual Phase (DP) is a 6  ×  6  ×  6 m 3 liquid argon time-projection-chamber (LArTPC) that recorded cosmic-muon data at the CERN Neutrino Platform in 2019-2020 as a prototype of the DUNE Far Detector. Charged particles propagating through the LArTPC produce ionization and scintillation light. The scintillation light signal in these detectors can provide the trigger for non-beam events. In addition, it adds precise timing capabilities and improves the calorimetry measurements. In ProtoDUNE-DP, scintillation and electroluminescence light produced by cosmic muons in the LArTPC is collected by photomultiplier tubes placed up to 7 m away from the ionizing track. In this paper, the ProtoDUNE-DP photon detection system performance is evaluated with a particular focus on the different wavelength shifters, such as PEN and TPB, and the use of Xe-doped LAr, considering its future use in giant LArTPCs. The scintillation light production and propagation processes are analyzed and a comparison of simulation to data is performed, improving understanding of the liquid argon properties.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Ag nanoparticle-decorated chitosan/SrSnO3 nanocomposite for ultrafast elimination of antibiotic linezolid and methylene blue

Effective design of ultrafast new-generation photocatalysts is a challenging task that requires highly dedicated efforts. This research focused on the development and design of ultrafast smart ternary photocatalysts containing SrSnO₃ nanostructures in conjugation with chitosan (CTSN) and silver (Ag) nanoparticles by a very simple and straightforward methodology. Modern analytical tools such as FESEM, TEM, XRD, XPS, FTIR, and UV-Vis spectroscopy were employed to characterize the synthesized nanostructures. XRD and XPS analysis confirmed the successful creation of ternary organization among the Ag, CTSN, and SrSnO₃. The TEM images clearly confirmed that CTSN possessed overlapping micron-sized sheets with a layered morphology, whereas the undoped SrSnO₃ particles exhibited spherical and elongated shapes and particle sizes ranging from 20 to 80 nm. These particles were produced in high density with homogeneously distributed Ag nanoparticles (4-15 nm). The bandgap energy (E_g) for bare SrSnO₃, CTSN/SrSnO₃, and Ag@CTSN/SrSnO₃ nanocomposites was found to be 4.0, 3.94, and 3.7 eV, respectively. The photocatalytic efficiencies of all newly created photocatalysts were evaluated by considering an antibiotic linezolid drug and methylene blue (MB) dye molecule as target analytes. Among all investigated samples, the Ag@CTSN/SrSnO₃ photocatalyst was found to be highly superior, with ultrafast removal of the linezolid drug at 96.02% within 25 min and almost total removal of the MB dye in just 12 min under UV light irradiation. The Ag@CTSN/SrSnO₃ photocatalyst exhibited removal rate that was 3.36 times faster than that of bare SrSnO₃. The present report delivers a highly promising, extremely efficient, and very simple, straightforward treatment methodology for the effective destruction of lethal and notorious pollutants, enabling the appropriate management of current environmental concerns.

No-slip billiards with particles of variable mass distribution

Astute variations in the geometry of mathematical billiard tables have been and continue to be a source of understanding their wide range of dynamical behaviors, from regular to chaotic. Viewing standard specular billiards in the broader setting of no-slip (or rough) collisions, we show that an equally rich spectrum of dynamics can be called forth by varying the mass distribution of the colliding particle. We look at three two-parameter families of billiards varying both the geometry of the table and the particle, including as special cases examples of standard billiards demonstrating dynamics from integrable to chaotic, and show that markedly divergent dynamics may arise by changing only the mass distribution. Furthermore, for certain parameters, billiards emerge, which display unusual dynamics, including examples of full measure periodic billiards, conjectured to be nonexistent for the standard billiards in Euclidean domains.

Au nanoparticles decorated polypyrrole-carbon black/g-C3N4 nanocomposite as ultrafast and efficient visible light photocatalyst

Modification and bandgap engineering are proposed to be extremely significant in improving the photocatalytic activity of novel photocatalysts. The current research focused on the fabrication of ultrafast and efficient visible light-responsive ternary photocatalyst containing g-C₃N₄ nanostructures in conjugation with polypyrrole doped carbon black (PPy-C) and gold (Au) nanoparticles by highly effectual, simple, and straightforward methodology. Various analytical techniques like XRD, FESEM, TEM, XPS, FTIR, and UV-Vis spectroscopy were applied for characterization purposes. The XRD and XPS results confirmed the successful creation of a nanocomposite framework among Au, PPy-C and g-C₃N₄. The TEM images revealed that bare g-C₃N₄ holds sheets or layered graphitic structure with sizes ranging from 100 to 300 nm. The sponge-like PPy-C network intermingled perfectly with g-C₃N₄ sheets along with homogeneously distributed 5-15 nm Au nanoparticles. The band gap energy (E_g) for bare g-C₃N₄, PPy-C/g-C₃N₄ and Au@PPy-C/g-C₃N₄ nanocomposites were found to be 2.74, 2.68, and 2.60 eV, respectively. The photocatalytic activity for all newly designed photocatalysts have been assessed during the degradation of insecticide Imidacloprid and methylene blue (MB) dye, where Au@PPy-C/C₃N₄ was found to be extremely efficient with ultrafast removal of both imidacloprid and MB in just 25 min of visible light irradiation. It was revealed that the Au@PPy-C/g-C₃N₄ ternary photocatalyst removed 96.0% of target analyte imidacloprid, which is ⁓ 2.91 times more efficient than bare g-C₃N₄ in treating imidacloprid. This report provides a distinctly promising, highly effectual and straightforward route to destruct extremely toxic and notorious pollutants and opens a new gateway in the present challenging scenario of environmental concerns.

Development of Methanol Sensor Based on Sol-Gel Drop-Coating Co3O4·CdO·ZnO Nanoparticles Modified Gold-Coated µ-Chip by Electro-Oxidation Process

Herein, novel Co₃O₄·CdO·ZnO-based tri-metallic oxide nanoparticles (CCZ) were synthesized by a simple solution method in basic phase. We have used Fourier Transform Infrared Spectroscopy (FTIR), X-ray Diffraction (XRD), X-ray photoelectron spectroscopy (XPS), Field Emission Scanning Electron Microscope (FESEM), Dynamic Light Scattering (DLS), Tunneling Electron Microscopy (TEM), and Energy-Dispersive Spectroscopy (EDS) techniques to characterize the CCZ nanoparticles. XRD, TEM, DLS, and FESEM investigations have confirmed the tri-metallic nanoparticles’ structure, while XPS and EDS analyses have shown the elemental compositions of the CCZ nanoparticles. Later, a Au/μ-Chip was modified with the CCZ nanoparticles using a conducting binder, PEDOT: PSS (poly(3,4-ethylenedioxythiophene) polystyrene sulfonate) in a sol-gel system, and dried completely in air. Then, the CCZ/Au/μ-Chip sensor was used to detect methanol (MeOH) in phosphate buffer solution (PBS). Outstanding sensing performance was achieved for the CCZ/Au/μ-Chip sensor, such as excellent sensitivity (1.3842 µAµM⁻¹cm⁻²), a wide linear dynamic range of 1.0 nM–2.0 mM (R² = 0.9992), an ultra-low detection limit (32.8 ± 0.1 pM at S/N = 3), a fast response time (~11 s), and excellent reproducibility and repeatability. This CCZ/Au/μ-Chip sensor was further applied with appropriate quantification results in real environmental sample analyses.

Correlation of signal averaged electrocardiography findings with fibrosis on cardiac magnetic resonance imaging

Background

Signal averaged electrocardiogram (SAECG) is a non invasive test to record delayed depolarization of myocardium with slow conduction that can potentially be the substrate for monomorphic ventricular tachycardia in high risk patients. Cardiac magnetic resonance imaging (cMRI) techniques for fibrosis imaging using late gadolinium enhancement (LGE) and T1 mapping remain the gold standard for characterization of myocardial tissue and triaging patients for risk of ventricular arrhythmias. However, cMRI remains unavailable in some areas, is time consuming, expensive and impossible for some patients to obtain due to claustrophobia, renal impairment or implanted hardware. To date, data is lacking with regards to correlation of findings between these two modalities.

Purpose

To investigate whether late potentials identified by SAECG correlate with the presence of fibrosis seen with cMRI. If correlation is established, SAECG could potentially be used as a non-invasive, cheaper, more convenient and readily available tool for risk stratification in patients at high risk for ventricular arrhythmias.

Methods

SAECGs were obtained in 25 consecutive patients undergoing cMRI. Patients with wide QRS (&gt;120 ms) on ECG were excluded. Positive SAECG was defined as at least 1/3 abnormal criteria. Standard criteria were used. Results of the 2 modalities were compared. Sensitivity and specificity of SAECG for diagnosing fibrosis on cMRI were calculated.

Results

The mean age of the patients was 50.3±5.8 years and the mean ejection fraction was 48.9±5.8% as determined by cMRI. Forty-eight percent of the patients had fibrosis on cMRI by either LGE, T1 mapping or both. The sensitivity and specificity of SAECG were 75% and 100%, respectively. Seven patients had history of ventricular tachycardia and 6 patients had dilated cardiomyopathy.

Conclusion

SAECG is extremely specific in identifying patients with myocardial fibrosis on cMRI. A positive test may confer a lesser indication to pursue cMRI solely for purposes of risk stratification, and may correlate with risk of ventricular arrhythmia.

Funding Acknowledgement

Type of funding sources: None.

124 The Microsurgical Learning Curve: Can We Make the First Steps Faster and Safer; A Cadaveric Study with A Novel Principle of Learning

Aim

Learning anew surgical technique can be a daunting experience for both the teacher and learner. Raising free flaps is a complex process, and our aim is to find out whether using Hi-fidelity simulation on cadavers can make the learning faster and safer.

Method

We used fresh frozen cadavers according to our local protocols. In the first stage of the study, we used 4 upper limbs in the first instance using different dye techniques. We use these in an international course and obtain feedback from the trainees.

Results

To a novel learner, we found that using a bright green dye was the important factor in making the first steps of learning easier and faster. This is perhaps due to the confounding information when raising the flap. We found that it made understanding the concept of free flap raising much faster when clarified with colour. It also made anticipating the steps easier when identifying the perforators. To an experienced trainee/consultant: We found teaching the concept of perforators easier, the ease of finding the perforators would raise confidence of the novel trainees. They will be able to conceptualize the principles of flap raising much faster. They believed it would also make them quicker at anticipating steps of the procedure.

Conclusions

Learning is an incredible process that we still have to better control and understand. Using simple tricks such as colour changes can make initial learning faster, which means cheaper and safer

Using ethnographic film in tackling podoconiosis

Background

Ethiopia has one of the worst podoconiosis rates in the world, affecting >1.5 million patients. We present our ethnographic film ‘Tigist, the story of a girl with podoconiosis’ and its potential use in tackling podoconiosis.

Methods

We conducted visual ethnography, consisting of video-recorded participant observations and interviews with seven patients, three healthcare workers and two podoconiosis experts.

Results

We acquired video recordings of social moments, the state of podoconiosis patients’ bodies and minds, their emotions and the impact of poverty.

Conclusions

Our film allows for an intensified understanding of patients’ daily experiences with podoconiosis, potentially impacting care, awareness and medical teaching programs.

Prospects for beyond the Standard Model physics searches at the Deep Underground Neutrino Experiment: DUNE Collaboration

The Deep Underground Neutrino Experiment (DUNE) will be a powerful tool for a variety of physics topics. The high-intensity proton beams provide a large neutrino flux, sampled by a near detector system consisting of a combination of capable precision detectors, and by the massive far detector system located deep underground. This configuration sets up DUNE as a machine for discovery, as it enables opportunities not only to perform precision neutrino measurements that may uncover deviations from the present three-flavor mixing paradigm, but also to discover new particles and unveil new interactions and symmetries beyond those predicted in the Standard Model (SM). Of the many potential beyond the Standard Model (BSM) topics DUNE will probe, this paper presents a selection of studies quantifying DUNE's sensitivities to sterile neutrino mixing, heavy neutral leptons, non-standard interactions, CPT symmetry violation, Lorentz invariance violation, neutrino trident production, dark matter from both beam induced and cosmogenic sources, baryon number violation, and other new physics topics that complement those at high-energy colliders and significantly extend the present reach.

The predictive value of CHA2DS2-VASc score on adverse in-hospital outcomes among patients with the acute coronary syndrome and atrial fibrillation who undergo PCI

Background

Patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) and having concomitant atrial fibrillation (AF) have a greater risk of adverse short- and long-term outcomes and death compared with patients in the same setting but without AF. On the other hand, the predictive value of CHA2DS2-VASc score in terms of in-hospital mortality and periprocedural adverse events following PCI among patients with ACS and AF is unknown.

Purpose

We retrospectively analyzed data of patients with the main admission diagnosis of ACS that underwent PCI and had AF during the 2004–2014 period from the large nationwide US National Inpatient Sample (NIS) database.

Methods

A CHA2DS2-VASc score was calculated for each patient and incorporated into a multivariable-adjusted logistic regression to determine its independent impact on in-hospital outcomes consisting of death, acute kidney injury (AKI), bleeding, vascular injury, and stroke/transient ischemic attack (TIA).

Results

A total of 283,890 patients with AF who underwent PCI following ACS were included in the analysis. The average reported prevalence of the AF in the whole cohort was 10.0% with a significant trend (p&lt;0.001) of increase during the observed 10-year period. The average age of the cohort was 72.1±11 years, 63.4% were male while the median CHA2DS2-VASc score was 3 (IQR 2–4). Crude rates of adverse in-hospital outcomes were significantly higher among patient groups with higher CHA2DS2-VASc score (Table 1). Following adjustment for baseline covariates, incremental increase in CHA2DS2-VASc score was independently associated with an increased odds of in-hospital death (OR 1.20, CI 95% 1.18–1.22), periprocedural vascular injury (OR 1.18, 95% CI 1.17–1.20), bleeding (OR 1.17, 95% CI 1.16–1.18), stroke/TIA (OR 1.17, 95% CI 1.15–1.19), and AKI (OR 1.05, 95% CI 1.04–1.06) (Figure 1).

Conclusions

The CHA2DS2-VASc score provides important prognostic information in ACS patients with AF undergoing PCI and is independently associated with in-hospital death and periprocedural adverse events. Therefore, CHA2DS2-VASc score could be used as a practical and inexpensive tool for risk stratification in this population.

Figure 1

Funding Acknowledgement

Type of funding source: None

The Rhipicephalus appendiculatus tick vector of Theileria parva is absent from cape buffalo (Syncerus caffer) populations and associated ecosystems in northern Uganda

Rhipicephalus appendiculatus is the major tick vector of Theileria parva, an apicomplexan protozoan parasite that causes the most economically important and lethal disease of cattle in East and central Africa. The African cape buffalo (Syncerus caffer) is the major wildlife host of T. parva from southern Uganda and Kenya to southern Africa. We show herein that R. appendiculatus appears to be absent from the two largest national parks in northern Uganda. Syncerus caffer is common in both of these national parks, specifically Murchison falls (MFNP) and Kidepo Valley (KVNP). We re-confirmed the previously reported absence of T. parva in buffalo sampled in the two northern parks based on RLB data using a nested PCR based on the T. parva p104 gene. By contrast, T. parva-infected R. appendiculatus ticks and parasite-infected buffalo were present in Lake Mburo (LMNP) in South central Uganda. This suggests that the distribution of R. appendiculatus, which is predicted to include the higher rainfall regions of northern Uganda, may be limited by additional, as yet unknown factors.

Electrocatalytic Oxidation of 4-Aminophenol Molecules at the Surface of an FeS2 /Carbon Nanotube Modified Glassy Carbon Electrode in Aqueous Medium

FeS₂ /carbon nanotube (CNT) nanocomposites were synthesized and immobilized on the surface of a glassy carbon electrode (GCE) in order to investigate the electrocatalytic conversion of 4-aminophenol (4-AP) into p-quinone in an aqueous medium. The reformed electronic properties (in terms of lowering of band-gap energy and charge-transfer resistance), as well as improved surface area, result in an enhanced redox reaction of 4-AP in the presence of FeS₂ -CNT NCs compared to that with FeS₂ alone. The 4-AP molecules undergo coupled two-proton and two-electron transfer quasi-reversible redox reactions with a symmetry factor of 0.55 and standard rate constant (k°) of 0.8 cm s^-1 . Here, quinone imine is generated as an intermediate which is later converted into quinone in an irreversible hydrolysis reaction. The best catalytic performance can be obtained at the pH value of 7.0.

Fabrication of a hydrazine chemical sensor based on facile synthesis of doped NZO nanostructure materials

In this approach, nickel-doped zinc oxide (NZO) nanostructure materials were synthesized by the solution method in the basic phase.

P1732The additive value of pre- and post-reperfusion cardiac troponin T levels in risk stratification of patients with ST-segment elevation myocardial infarction

Background

Despite therapeutic advances, mortality rates following ST-segment elevation myocardial infarction (STEMI) are still alarmingly high. There is conflicting evidence regarding the prognostic role of high-sensitivity cardiac troponin T (hs-cTnT) measurements before and after primary percutaneous coronary intervention (PPCI) over traditional predictors of mortality in STEMI patients.

Purpose

To determine the additive prognostic value of pre- and 12h post-PPCI hs-cTnT levels in STEMI patients

Methods

Retrospective longitudinal study including 3,113 consecutive STEMI patients treated with PPCI at a university hospital covering a population of 1.6 million in the North East of England. Clinical, procedural, and laboratory data were prospectively collected during patient hospitalization while hs-cTnT measurements were performed at admission to the catheterization laboratory and at 12h post-PPCI. Median follow-up was 53 months. The study endpoints were in-hospital and overall mortality. Mortality data were obtained from the UK Office of National Statistics.

Results

Admission hs-cTnT >515ng/L (4th quartile) was independently associated with in-hospital mortality [HR=2.39 per highest to lower quartiles; 95% CI: 1.44 to 3.97; p=0.001] after multivariate adjustment for a core clinical model of in-hospital mortality prediction. Likewise, admission hs-cTnT >515ng/L independently predicted overall mortality (HR=1.25 per highest to lower quartiles; 95% CI: 1.00 to 1.57; p=0.044) after adjustment for covariates significantly associated with this endpoint. Admission hs-cTnT correctly reclassified risk for in-hospital death [net reclassification index (NRI)=44.1%, p<0.001) and overall mortality (NRI=60.4%, p<0.001). Conversely, 12h hs-cTnT was not independently associated with mortality.

Conclusion

Admission, but not 12h post-reperfusion, hs-cTnT predicts mortality and improves risk stratification in the PPCI era. These results support the role of hs-cTnT in risk stratification of post-STEMI patients and challenge the cost-effectiveness of routine 12h hs-cTnT measurements.

Assessment of the prevalence of Theileria lestoquardi in sheep from the Sudan using serological and molecular methods

Malignant theileriosis of sheep and goats caused by Theileria lestoquardi is considered to be among the most important tick borne diseases in the Sudan. Information on the prevalence of the disease in different parts of the Sudan is limited. The purpose of this study was to estimate the prevalence of the disease in five states of the Sudan using molecular and serological assays. A total of 393 blood and serum samples from clinically asymptomatic sheep were analysed using nested reverse line blot (nRLB) and loop mediated isothermal amplification (LAMP), as well as an enzyme-linked immunosorbent assay (ELISA). The results indicated a sero-prevalence of 33.8% while RLB and LAMP assays revealed molecular prevalences of 29.5 and 22.6% respectively. The prevalence of Theileria lestoquardi varied significantly according to the geographical origin of the infected animals, whereas age and gender did not have a significant effect. RLB data indicated that T. lestoquardi usually occurred as a co-infection with the non-pathogenic Theileria ovis. Using RLB as a gold standard, a sensitivity of 68.1% and a specificity of 96.4% were recorded for LAMP and a sensitivity of 75.9% and a specificity of 83.8% for ELISA. The Kappa coefficient between nRLB and LAMP indicated a significant level of agreement (0.692), but only moderate concordance (0.572) between nRLB and ELISA. The results of the present study confirm and extend earlier findings regarding the widespread of T. lestoquardi infections in sheep in the Sudan. The data provide evidence that should enable the veterinary authorities to deploy appropriate control measures.

European consensus on the standardization of robotic total mesorectal excision for rectal cancer

AIM

Surgery for rectal cancer is challenging for both technical and anatomical reasons. The European Academy of Robotic Colorectal Surgery (EARCS) provides a competency-based training programme through a standardized approach. However, there is no consensus on technical standards for robotic surgery when used during surgery for rectal cancer. The aim of this consensus study was to establish operative standards for anterior resection incorporating total mesorectal excision (TME) using robotic techniques, based on recommendations of expert European colorectal surgeons.

METHOD

A Delphi questionnaire with a 72-item statement was sent through an electronic survey tool to 24 EARCS faculty members from 10 different countries who were selected based on expertise in robotic colorectal surgery. The task was divided into theatre setup, colonic mobilization and rectal dissection, and each task area was further divided into several subtasks. The levels of agreement (A* > 95% agreement, A > 90%, B > 80% and C > 70%) were considered adequate while agreement of < 70% was considered inadequate. Once consensus was reached, a draft document was compiled and sent out for final approval.

RESULTS

The average length of experience of robotic colorectal surgery for participants in this study was 6 years. Initial agreement was 87%; in nine items, it was < 70%. After suggested modifications, the average level of agreement for all items reached 94% in the second round (range 0.75-1).

CONCLUSION

This is the first European consensus on the standardization of robotic TME. It provides a baseline for technical standards and structured training in robotic rectal surgery.

Findings from aetiological investigation of Auditory Neuropathy Spectrum Disorder in children referred to cochlear implant programs

OBJECTIVES

Auditory neuropathy spectrum disorder (ANSD) is an audiological diagnosis characterised by hearing dysfunction in the presence of intact outer hair cell function in the cochlea. ANSD is thought to account for 7-10% of all childhood permanent hearing impairment, and can result from a range of pathological processes. This paper describes the rationale, methods and findings from the aetiological investigation of ANSD.

METHODS

Retrospective audit of four cochlear implant programmes.

RESULTS

97 patients were identified. 79% of patients were identified before the age of one. Prematurity and jaundice were the most frequently identified aetiological factors. 33 patients had cochlear nerve deficiency on imaging. Genetic diagnoses identified included otoferlin, SX010 gene, connexin 26 and A1FM1 gene mutations. ANSD was seen in conjunction with syndromes including Kallman syndrome, CHARGE syndrome, X-linked deafness, SOTOS syndrome, Brown Vieletto Van Laere syndrome, and CAPOS syndrome.

DISCUSSION

We present a two-level system of aetiological investigation that is clinically practical. Patients with ANSD sufficiently severe to consider cochlear implantation are generally identified at an early age. Aetiological investigation is important to guide prognosis and identify comorbidity.

CONCLUSION

Prematurity and jaundice are the most commonly identified aetiological factors in ANSD. Imaging findings identify crucial factors in a significant minority. An important minority may have genetic and syndromic diagnoses that require further management.

Selective bilirubin sensor fabrication based on doped IAO nanorods for environmental remediation

In this approach, low-dimensional facile IAO nanorods were prepared by using the hydrothermal technique, which is efficiently applied to develop a non-enzymatic sensor coated with GCE probe by electrochemical reduction method.