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A unified heteroannelation method to achieve the synthesis of 1,3-dibenzyl-3,4-dihydropyrrolo[2,3- d ]imidazole-2(1 H)-thione derivatives with an iron catalyst is proposed. The annelation reaction follows a C(sp 3)–C(sp 3) radical coupling between a thiohydantoin and an O -acetyloxime. The synthetic approach enables access to several alkynylated thiohydantoins and O -acetyloximes with controlled selectivity toward C(sp 3)–C(sp 3) coupling rather than C(sp 3)–C(sp 3)–O coupling in moderate to high yields. An optimization study has been carried out by changing the catalyst loading, oxidants, solvents, and temperature. Synthesized compounds were characterized through 1 H and 13 C NMR and mass spectral studies. [ABSTRACT FROM AUTHOR]

BACKGROUND: Microalbuminuria, marker of endothelial abnormality, is a predictor of mortality for any reason and of cardiovascular events. Recent research on the management of COPD has focused more on comorbidities, including cardiovascular events. The main objective of this study was to investigate microalbuminuria and its association with physiological and clinical characteristics in a subject group that was classified in line with the new version of the GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages. METHODS:101 stable patients with mild stage to very severe stage COPD were included. The urinary albumin/creatinine (UACR) ratio was calculated using an established formula. Microalbuminuria was accepted as UACR >20 in males and >30 in females as positive finding. Results: UACR was significantly higher in subjects grouped as having more symptoms. In addition, significant differences were observed when the subjects were grouped based on PaO2 (<65 mm Hg vs >65 mm Hg), PaCO2 (<41 mm Hg vs >41 mm Hg), arterial oxygen saturation (<92% vs >92%), and median. Pearson correlation analysis revealed that the UACR was significantly inversely correlated with percent of predicted FEV1 (r-0.56, p = .001), SaO2 (r-0.48, p = .001) and PaO2 (r -0.60, p= .001). Positive correlation was also found between UACR and CAT scores (r =0.53, p = .001). CONCLUSIONS: We conclude that there is a strong relationship between microalbuminuria and cardiovascular incidents in patients with COPD, commonly in patients with higher symptoms and high future risk. Key words: COPD; microalbuminuria; severity of illness; scoring system. [ABSTRACT FROM AUTHOR]

Overuse injury is a frequent diagnosis in occupational medicine and athletics. Using an established model of upper extremity overuse, we sought to characterize changes occurring in the forepaws and forelimbs of mature female rats (14–18 months of age). Thirty-three rats underwent a 4-week shaping period, before performing a high-repetition low-force (HRLF) task for 12 weeks, with the results being compared to 32 mature controls. HRLF animals showed a reduced grip strength versus controls. ELISAs carried out in the HRLF rats, versus controls, showed elevated levels of IL1-α in tendons, IL1-α and TNF-α in distal bones/entheses, and TNF-α, MIP1-α/CCL3, and CINC-2/CXCL-3 in serum, as well as IL-6 in forelimb muscles and tendons, and IL-10 in serum. HRLF rats had elevated collagen deposition in the forepaw intrinsic muscles (i.e., fibrosis), entheseal microdamage, and articular cartilage degradation versus the control rats. CD68/ED1+ osteoclasts and single-nucleated cells were elevated in distal forelimb metaphyses of the HRLF animals, versus controls. Declines in grip strength correlated with muscle fibrosis, entheseal microdamage, articular cartilage damage, distal bone/enthesis IL1-α, and serum IL-6. These data demonstrate inflammatory and persistent degradative changes in the forearm/forepaw tissues of mature female animals exposed to prolonged repetitive tasks, changes with clinical relevance to work-related overuse injuries in mature human females. [ABSTRACT FROM AUTHOR]

Understanding hydrogen dispersion in a semi-confined space is crucial for the safe operation of hydrogen-related systems, such as hydrogen fuel cell vehicles. Analyzing hydrogen release and its subsequent dispersion can be effectively conducted using computational models, which necessitate experimental measurements for validation. For safety reasons, accidental scenarios are frequently replicated using helium as a hydrogen simulant in experiments, despite some concerns about the comparability of helium and hydrogen dispersions. Hence, this study conducts a comprehensive parametric numerical analysis of the similarities between hydrogen and helium dispersion when released in a semi-confined space. The model is based on the Macquarie Dispersion Chamber and the simulation results are first validated against the measurements. The study focuses on the impact of the leakage rate and ventilation velocity. Three release models were analysed: equal concentration (Method A), equal volumetric flow rate (Method B), and equal buoyancy (Method C). This study extends previous research on Method B, used for gas release in open spaces, to environments where flow-wall interactions become important. It also compares Methods A and C for a few scenarios, examining variations in concentration distribution, purge time, and activation time under different conditions. In the absence of ventilation, Method B effectively compares hydrogen and helium flow rates by accounting for volumetric flow rates, regardless of buoyancy effects. However, under increased ventilation velocities, Method A and Method C exhibit superior agreement across sensors, highlighting the necessity of choosing detection methods according to prevailing environmental conditions. [Display omitted] • A CFD model for gas release in semi-confined space equipped with ventilation is established. • Three release models are studied to investigate similarity between hydrogen and helium gas dispersion. • Purge time and activation time are analysed with the aim of safe hydrogen infrastructure development. • Influence on gas dispersion by various ventilation velocity and flow rate at leakage are analysed. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Absent contractility on high-resolution manometry (HRM) defines severe hypomotility but needs distinction from achalasia. We retrospectively identified achalasia within absent contractility using HRM provocative maneuvers, barium esophagography, and functional lumen imaging probe (FLIP). METHODS: Adult patients with absent contractility on HRM during the 4-year study period were eligible for inclusion. Inadequate studies, achalasia after therapy, or prior foregut surgery were exclusions. Upright integrated relaxation pressure (IRP) >12mmHg, panesophageal pressurization, and/or elevated IRP on multiple rapid swallows and rapid drink challenge (RDC) were considered abnormal. Esophageal barium retention and abnormal esophagogastric junction distensibility index (<2.0 mm²/mm Hg) on FLIP defined achalasia. Clinical, endoscopic, and motor characteristics of patients with achalasia were compared with absent contractility without obstruction. RESULTS: Of 164 patients, 20 (12.2%) had achalasia (17.9%of 112 patients with adjunctive testing),while 92 did not, and 52 did not undergo adjunctive tests. Achalasia was diagnosed regardless of IRP value, but the median supine IRP was higher (odds ratio 1.196, 95% confidence interval 1.041-1.375, P = 0.012). Patients with achalasia were more likely to present with dysphagia (80.0% vs 35.9%, P < 0.001), with obstructive features on HRM maneuvers (83.3% vs 48.9%, P = 0.039), but lower likelihood of GERD evidence (20.0% vs 47.3%, P = 0.027) or large hiatus hernia (15.0% vs 43.8%, P = 0.002). On multivariable analysis, dysphagia presentation (P = 0.006) and pressurization on RDC (P = 0.027) predicted achalasia, while reflux and presurgical evaluations and lack of RDC obstruction predicted absent contractility without obstruction. DISCUSSION: Despite HRM diagnosis of absent contractility, achalasia is identified in more than 1 in 10 patients regardless of IRP value. [ABSTRACT FROM AUTHOR]

Nanomedicine, leveraging the unique properties of nanoparticles, has revolutionized the diagnosis and treatment of neurological diseases. Among various nanotechnological advancements, ultrasound-mediated drug delivery using micro- and nanobubbles offers promising solutions to overcome the blood-brain barrier (BBB), enhancing the precision and efficacy of therapeutic interventions. This review explores the principles, current clinical applications, challenges, and future directions of ultrasound-mediated drug delivery systems in treating stroke, brain tumors, neurodegenerative diseases, and neuroinflammatory disorders. Additionally, ongoing clinical trials and potential advancements in this field are discussed, providing a comprehensive overview of the impact of nanomedicine on neurological diseases. [ABSTRACT FROM AUTHOR]

Background: Anastomotic strictures following colectomy and proctectomy are a significant cause of benign lower gastrointestinal tract (LGIT) obstruction, with a reported incidence of up to 30%. Endoscopic interventions such as balloon dilation, stricturotomy, mechanical dilation, electrocautery incision, and stent placement are utilized for management. This meta-analysis aimed to evaluate the efficacy and safety of endoscopic interventions for the management of benign LGIT anastomotic strictures. Methods: Literature search was performed for published full-text articles using the Embase, Pubmed, Web of Sciences, and Cochrane databases for endoscopic management of anastomosis strictures and related terms including endoscopic balloon dilation (EBD), stricturotomy (EST), mechanical dilation, electrocautery incision (ECI), and stent placement. Results: A total of 1363 patients from 33 studies were included. The most common indication for anastomosis was colorectal cancer (92%). Overall technical success (ability to pass the endoscope) was achieved in 93% of cases, with immediate clinical success in 85% and sustained success in 81% at follow-up. ECI demonstrated the highest clinical success rates (98% immediate, 91% at the end of follow-up). Adverse events occurred in 6% of patients, most commonly perforation, which was most frequent with EBD. Stent placement showed high initial success but had issues with stent migration and adverse events. Conclusion: Overall, EBD and ECI were the most effective, with ECI showing the highest success rates. Despite its technical challenges, EST was both effective and safe. This study underscores the need for further prospective research comparing various endoscopic interventions to improve management strategies for LGIT anastomotic strictures. [ABSTRACT FROM AUTHOR]

Most cases of optic neuritis (ON) occur in women and in patients between the ages of 15 and 45 years, which represents a key demographic of individuals who seek health information using the internet. As clinical providers strive to ensure patients have accessible information to understand their condition, assessing the standard of online resources is essential. To assess the quality, content, accountability, and readability of online information for optic neuritis. This cross-sectional study analyzed 11 freely available medical sites with information on optic neuritis and used PubMed as a gold standard for comparison. Twelve questions were composed to include the information most relevant to patients, and each website was independently examined by four neuro-ophthalmologists. Readability was analyzed using an online readability tool. Journal of the American Medical Association (JAMA) benchmarks, four criteria designed to assess the quality of health information further were used to evaluate the accountability of each website. Freely available online information. On average, websites scored 27.98 (SD ± 9.93, 95% CI 24.96–31.00) of 48 potential points (58.3%) for the twelve questions. There were significant differences in the comprehensiveness and accuracy of content across websites (p <.001). The mean reading grade level of websites was 11.90 (SD ± 2.52, 95% CI 8.83–15.25). Zero websites achieved all four JAMA benchmarks. Interobserver reliability was robust between three of four neuro-ophthalmologist (NO) reviewers (ρ = 0.77 between NO3 and NO2, ρ = 0.91 between NO3 and NO1, ρ = 0.74 between NO2 and NO1; all p <.05). The quality of freely available online information detailing optic neuritis varies by source, with significant room for improvement. The material presented is difficult to interpret and exceeds the recommended reading level for health information. Most websites reviewed did not provide comprehensive information regarding non-therapeutic aspects of the disease. Ophthalmology organizations should be encouraged to create content that is more accessible to the general public. [ABSTRACT FROM AUTHOR]

The prediction of protein 3D structure from amino acid sequence is a computational grand challenge in biophysics and plays a key role in robust protein structure prediction algorithms, from drug discovery to genome interpretation. The advent of AI models, such as AlphaFold, is revolutionizing applications that depend on robust protein structure prediction algorithms. To maximize the impact, and ease the usability, of these AI tools we introduce APACE, AlphaFold2 and advanced computing as a service, a computational framework that effectively handles this AI model and its TB-size database to conduct accelerated protein structure prediction analyses in modern supercomputing environments. We deployed APACE in the Delta and Polaris supercomputers and quantified its performance for accurate protein structure predictions using four exemplar proteins: 6AWO, 6OAN, 7MEZ, and 6D6U. Using up to 300 ensembles, distributed across 200 NVIDIA A100 GPUs, we found that APACE is up to two orders of magnitude faster than off-the-self AlphaFold2 implementations, reducing time-to-solution from weeks to minutes. This computational approach may be readily linked with robotics laboratories to automate and accelerate scientific discovery. [ABSTRACT FROM AUTHOR]

Background Diverticular bleeding is the leading cause of lower gastrointestinal bleeding, affecting 3-5% of patients with diverticulosis. Current management protocols include resuscitation, diagnosis via direct visualization, computed tomography imaging, endoscopic interventions, angioembolization, and surgery when needed. However, predictive factors for outcomes and optimal interventions remain ambiguous. Methods This retrospective cohort study analyzed data from the National Inpatient Sample (NIS) database (2016-2020) to determine predictors of adverse in-hospital outcomes in diverticular bleeding patients without perforation or abscess. Demographic and clinical data were extracted, and multivariate regression models were applied. Analysis was conducted using R statistical software (version 4.1.3), with significance set at P<0.05. Results A total of 28,269 patients hospitalized for diverticular bleeding were identified. Age >85 years, moderate to severe Charlson Comorbidity Index, hypovolemic shock, blood transfusion requirement, and requirement for colectomy were significantly associated with greater in-hospital mortality. Factors such as late colonoscopy timing and colon resection led to longer hospital stays, while arterial embolization was predicted by older age, Black race, hypovolemic shock, and blood transfusion. Predictors of colon resection included advanced age, presence of colon cancer, and hypovolemic shock. Conclusions Our retrospective study identified significant predictors of in-hospital outcomes among patients with diverticular bleeding, informing risk stratification and management strategies. Further research is warranted to validate these findings and refine management algorithms for improved patient care. Integrating these insights into clinical practice may enhance outcomes and guide personalized interventions in diverticular bleeding management. [ABSTRACT FROM AUTHOR]

An intermolecular copper catalyzed heteroannelation reaction using Csp3‐Csp3 radical coupling approach has been accomplished to synthesize 2,5‐diphenyl‐3‐(pyrimidin‐2‐yl)‐3,4‐dihydro‐2H‐pyrrolo[2,3‐d]thiazole. C−C coupling between 4‐thiazolidinones and O‐acetyl oximes under Cu catalyst further cyclizes to get the target molecule thiazolidine‐fused nucleus. This unified method offers access to novel fused heterocycles with pyrimidines bearing 4‐thiazolidinone in moderate to higher yields. The optimization study includes various copper catalysts, oxidants, bases and solvents at different temperatures. [ABSTRACT FROM AUTHOR]

Humans continue to be at risk from the Zika virus. Although there have been significant research advancements regarding Zika, the absence of a vaccine or approved treatment poses further challenges for healthcare providers. In this study, we developed a microparticulate Zika vaccine using an inactivated whole Zika virus as the antigen that can be administered pain-free via intranasal (IN) immunization. These microparticles (MP) were formulated using a double emulsion method developed by our lab. We explored a prime dose and two-booster-dose vaccination strategy using MPL-A® and Alhydrogel® as adjuvants to further stimulate the immune response. MPL-A® induces a Th1-mediated immune response and Alhydrogel® (alum) induces a Th2-mediated immune response. There was a high recovery yield of MPs, less than 5 µm in size, and particle charge of −19.42 ± 0.66 mV. IN immunization of Zika MP vaccine and the adjuvanted Zika MP vaccine showed a robust humoral response as indicated by several antibodies (IgA, IgM, and IgG) and several IgG subtypes (IgG1, IgG2a, and IgG3). Vaccine MP elicited a balance Th1- and Th2-mediated immune response. Immune organs, such as the spleen and lymph nodes, exhibited a significant increase in CD4+ helper and CD8+ cytotoxic T-cell cellular response in both vaccine groups. Zika MP vaccine and adjuvanted Zika MP vaccine displayed a robust memory response (CD27 and CD45R) in the spleen and lymph nodes. Adjuvanted vaccine-induced higher Zika-specific intracellular cytokines than the unadjuvanted vaccine. Our results suggest that more than one dose or multiple doses may be necessary to achieve necessary immunological responses. Compared to unvaccinated mice, the Zika vaccine MP and adjuvanted MP vaccine when administered via intranasal route demonstrated robust humoral, cellular, and memory responses. In this pre-clinical study, we established a pain-free microparticulate Zika vaccine that produced a significant immune response when administered intranasally. [ABSTRACT FROM AUTHOR]

Background and Aim: Researchers have documented instances of direct cardiac involvement in individuals with dengue fever, indicating a possible link between heart malfunction and the onset of shock. The objective of this study was to establish a correlation between cardiac symptoms and the severity of dengue fever. Material and Methods: The study comprised a cohort of 200 individuals who had symptoms consistent with dengue fever. The presence of Dengue NS1 antigen was identified using the Enzyme Linked Immunosorbent Assay (ELISA) technique. Every patient had Electrocardiography (ECG) for all leads in addition to 2-dimensional Echocardiography (ECHO). The samples were labeled and tested for indicators of acute cardiac myocyte injury, such as total CK, CK-MB, and Trop T, by an investigator who was uninformed of the clinical state of the participants. Results: The study comprised patients aged between 20 and 60 years, with a mean age of 39.23 ± 90.9. Among the many cardiac signs found in the patients, bradycardia was the most prevalent, occurring in the majority (40%) of the patients. Among the 96 patients who had abnormal CKMB levels at admission, 82 individuals were seen to have normal CK-MB levels upon discharge. Upon admission, troponin I tested positive in 26 individuals. Upon arrival, 124 individuals exhibited a normal electrocardiogram (ECG), whereas 96 patients displayed ECG changes. Conclusion: ECG, cardiac enzymes, and echocardiography are the primary diagnostic methods for identifying myocardial involvement in cases of dengue fever. The degree of cardiac involvement was greater in DHF and DSS cases compared to DF cases. [ABSTRACT FROM AUTHOR]

Background: Complement‐mediated thrombotic microangiopathy (CM‐TMA), also called atypical hemolytic uremic syndrome (aHUS), is a difficult‐to‐diagnose rare disease that carries severe morbidity and mortality. Anti‐C5 monoclonal antibodies (aC5‐mab) are standard treatments, but large studies and long‐term data are scarce. Here, we report our single institution experience to augment the knowledge of CM‐TMA treated with aC5‐mab therapy. Methods: We aimed to assess the short and long‐term effects of aC5‐mab in patients diagnosed with CM‐TMA treated outside of a clinical trial. This was a retrospective study. We included all patients diagnosed with CM‐TMA and treated with aC5‐mab at our institution. There were no exclusion criteria. Endpoints included complete TMA response (CR) defined as normalization of hematological parameters and ≥25% improvement in serum creatinine (Cr) from baseline in patients with renal disease, relapse defined as losing the previously achieved CR, morbidity, adverse events, and survival. Results: We found 28 patients with CM‐TMA treated with aC5‐mab. The median age was 50 years. Baseline laboratories: platelet counts 93 × 109/L, hemoglobin 8.6 g/dL, lactate dehydrogenase 1326 U/L, serum Cr 4.7 mg/dL, and estimated glomerular filtration rate 19 mL/min. One individual was on renal replacement therapy (RRT) and 10 initiated RRT within 5 days of the first dose of aC5‐mab. Genetic variants associated with CM‐TMA included mutations in C3, CFB, CFH, CFHR1/3, CFI, and MCP. The mean duration of hospitalization was 24 days. The median time to initiation of aC5‐mab was 10 days. Sixteen subjects received RRT. At the time of hospital discharge, 27 were alive, 14 remained on RRT, and 4 had a CR. At 6 months, 23 patients were alive, 18 continued aC5‐mab, 8 remained on RRT, and 9 had a CR. At the last follow‐up visit past 6 months, 20 were alive, 14 continued aC5‐mab, 5 remained on RRT, 12 had a CR, and 1 was lost to follow‐up. Conclusions: Our study provides real‐world experience and insight into the long‐term outcomes of CM‐TMA treated with aC5‐mab. Our findings validate that CM‐TMA is an aggressive disease with significant morbidity and mortality, and confirm that aC5‐mab is a relatively effective therapy for CM‐TMA. Our study adds practical, real‐world experience to the literature, but future research remains imperative. [ABSTRACT FROM AUTHOR]

Heat transport can serve as a fingerprint identifying different states of matter. In a normal liquid, a hotspot diffuses, whereas in a superfluid, heat propagates as a wave called “second sound.” Direct imaging of heat transport is challenging, and one usually resorts to detecting secondary effects. In this study, we establish thermography of a strongly interacting atomic Fermi gas, whose radio-frequency spectrum provides spatially resolved thermometry with subnanokelvin resolution. The superfluid phase transition was directly observed as the sudden change from thermal diffusion to second-sound propagation and is accompanied by a peak in the second-sound diffusivity. This method yields the full heat and density response of the strongly interacting Fermi gas and therefore all defining properties of Landau’s two-fluid hydrodynamics. [ABSTRACT FROM AUTHOR]

Background: Ultrasound (USG)-guided interscalene block (ISB) provides excellent anesthesia and analgesia for humerus surgery. Various adjuvants have been used to improve the quality of block and duration of analgesia. Aim: The aim of the study was to compare the efficacy of dexmedetomidine (DXM) and dexamethasone (DXA) as an adjuvant to 0.75% ropivacaine for interscalene brachial plexus block among patients undergoing humerus surgery. Settings and Design: The study design was a prospective randomized comparative study at a tertiary care teaching hospital. Materials and Methods: After ethical approval and CTRI registration, 52 patients of 18-60 years of age, American Society of Anesthesiology Grade I-II, scheduled for proximal and mid-shaft humerus surgery were randomly allocated in Groups A and B. Group A (n=26) received Ropivacaine 0.75% (20 ml) along with DXM 0.5 μg/ Kg and 2 ml saline (total 22 ml) and Group B (n=26) received Ropivacaine 075% along with DXA 8 mg (total 22 ml). ISB was performed with an in-plane technique using a linear probe. Duration of analgesia, block characteristics (onset, complete sensory, and motor block), and complications were recorded and compared for 24 h. Statistical Analysis: Data were statistically analyzed with Social Science Statistics. Student's unpaired t-test and Chi-square tests were used, and all statistical tests were examined with P ≤ 0.05 level of significance. Results: The duration of analgesia in Group B was significantly longer than Group A (13 h 12 min ± 2 h 33 min-8 h 48 min ± 1 h 52 min, P < 0.00001). The groups were comparable regarding block characteristics, baseline demographics, and intraoperative hemodynamic parameters. Conclusion: DXA as an adjuvant to ropivacaine provides analgesia for longer duration compared to DXM in USG-guided ISB. [ABSTRACT FROM AUTHOR]

Background: Anticoagulants including direct oral anticoagulants (DOACs) are among the highest-risk medications in the United States. We postulated that routine consultation and follow-up from a clinical pharmacist would reduce clinically important medication errors (CIMEs) among patients beginning or resuming a DOAC in the ambulatory care setting. Objective: To evaluate the effectiveness of a multicomponent intervention for reducing CIMEs. Design: Randomized controlled trial. Participants: Ambulatory patients initiating a DOAC or resuming one after a complication. Intervention: Pharmacist evaluation and monitoring based on the implementation of a recently published checklist. Key elements included evaluation of the appropriateness of DOAC, need for DOAC affordability assistance, three pharmacist-initiated telephone consultations, access to a DOAC hotline, documented hand-off to the patient's continuity provider, and monitoring of follow-up laboratory tests. Control: Coupons and assistance to increase the affordability of DOACs. Main measure: Anticoagulant-related CIMEs (Anticoagulant-CIMEs) and non-anticoagulant-related CIMEs over 90 days from DOAC initiation; CIMEs identified through masked assessment process including two physician adjudication of events presented by a pharmacist distinct from intervention pharmacist who reviewed participant electronic medical records and interview data. Analysis: Incidence and incidence rate ratio (IRR) of CIMEs (intervention vs. control) using multivariable Poisson regression modeling. Key Results: A total of 561 patients (281 intervention and 280 control patients) contributed 479 anticoagulant-CIMEs including 31 preventable and ameliorable ADEs and 448 significant anticoagulant medication errors without subsequent documented ADEs (0.95 per 100 person-days). Failure to perform required blood tests and concurrent, inappropriate usage of a DOAC with aspirin or NSAIDs were the most common anticoagulant-related CIMEs despite pharmacist documentation systematically identifying these issues when present. There was no reduction in anticoagulant-related CIMEs among intervention patients (IRR 1.17; 95% CI 0.98–1.42) or non-anticoagulant-related CIMEs (IRR 1.05; 95% CI 0.80–1.37). Conclusion: A multi-component intervention in which clinical pharmacists implemented an evidence-based DOAC Checklist did not reduce CIMEs. NIH Trial Number: NCT04068727 [ABSTRACT FROM AUTHOR]

Large-scale longitudinal biobank data can be leveraged to identify genetic variation contributing to human diseases progression and traits trajectories. While methods for genome-wide association studies (GWAS) of multiple correlated traits have been proposed, an efficient multiple-trait approach to model longitudinal phenotypes is not currently available. We developed GAMUT, a genome-wide association approach for multiple longitudinal traits. GAMUT employs a mixed-effects model to fit longitudinal outcomes where a fast algorithm for inversion by recursive partitioning of the random effects submatrix is introduced. To evaluate performance of the algorithms introduced and assess their statistical power and type I error, stochastic simulation was conducted. Consistent with our expectation, power was greater for cross-sectional (CS) than longitudinal (LT) effects, particularly with a diminishing LT/CS ratio. With a minimum minor allele count of 3 within genotype by time categories, observed type I error was roughly equal to theoretical genome-wide significance. Additionally, 28 blood-based biomarkers measured at 2 time points on participants of the UK Biobank were used to compare GAMUT against single-trait standard and longitudinal GWAS (including rate of change). Across all biomarkers, we observed 539 (CS) and 248 (LT) significant independent variants for the GAMUT method, and 513 (CS) and 30 (LT) for single-trait longitudinal GWAS, respectively. Only 37 variants were identified by modeling rates of change using standard GWAS. [ABSTRACT FROM AUTHOR]

Coumarin is a highly proficient scaffold with great effectiveness which uplifts emerging chemists to create coumarin derivatives using cutting‐edge synthetic techniques. However, severe reaction conditions are required to develop substituted coumarin analogous. Notably, the carboxylic acid group in coumarin has emerged as a flexible functionality facilitating the construction of coumarin‐containing building blocks, emphasizing the decarboxylative strategy. Use of the decarboxylative technique has tremendously increased, due to its ability to increase the reactivity of the substrate. Moreover, it is the most extensively investigated synthetic strategy incorporating various functionalities in coumarin nuclei. This review discusses the decarboxylative strategies for creating C‐3 and C‐4 substituted coumarin derivatives. It emphasizes various interactions, including catalyst‐based, catalyst‐free, Michael addition, cyclo addition, three components, oxidative, and photocatalytic system involving the decarboxylation process. [ABSTRACT FROM AUTHOR]

Background: The study aimed to know the adverse pregnancy outcome in patients with previous spontaneous abortions. Material and methods: The present prospective observational study was conducted on 80 patients of age between 18 to 40 years with a history of one or more spontaneous abortions irrespective of the period of gestation. A detailed history of each patient including details of the present pregnancy, previous pregnancy, and previous abortion was obtained. All the routine examination was done and patients were followed up till delivery and obstetrics outcomes were noted. Results: The majority of women were belonged to 21-30 years of age (82.6%).30% of subjects were from socioeconomic class IV followed by 27.5%, 18.8%, 12.5%, and 11.3% of patients belonged to socioeconomic class III, II, I, and V respectively. Moreover, 56.25% and 20% of women were gravida 3 and 2 respectively. The maximum number of study subjects (78.75%) had one previous abortion whereas 17.5% and 3.75% of women had two and three previous abortions respectively. In 77.6% of women, the type of delivery was LSCS followed by in 11.3% of patients it was FTVD. The most common intrapartum complication was foetal distress (17.5%) followed by intrapartum haemorrhage (5%), followed by prolonged labour (3.7%). In 75% of cases foetal outcomes were abnormal this including low birth weight, prematurity, meconium stained liquor, intrauterine growth restriction, intrauterine death, and tachypnoea. Previous spontaneous delivery was found to be significantly associated with type of delivery and foetal outcomes (P<0.05). Conclusion: Pregnancy with previous spontaneous abortion are associated with the adverse pregnancy and foetal outcomes. The maternal and foetal complications can be overcome by providing proper antennal care. [ABSTRACT FROM AUTHOR]

The post-Norwood interstage period for infants with hypoplastic left heart syndrome is a high-risk time with 10–20% of infants having a complication of recurrent coarctation of the aorta (RCoA). Many interstage programs utilize mobile applications allowing caregivers to submit home physiologic data and videos to the clinical team. This study aimed to investigate if caregiver-entered data resulted in earlier identification of patients requiring interventional catheterization for RCoA. Retrospective home monitoring data were extracted from five high-volume Children's High Acuity Monitoring Program®-affiliated centers (defined as contributing > 20 patients to the registry) between 2014 and 2021 after IRB approval. Demographics and caregiver-recorded data evaluated include weight, heart rate (HR), oxygen saturation (SpO2), video recordings, and 'red flag' concerns prior to interstage readmissions. 27% (44/161) of infants required interventional catheterization for RCoA. In the 7 days prior to readmission, associations with higher odds of RCoA included (mean bootstrap coefficient, [90% CI]) increased number of total recorded videos (1.65, [1.07–2.62]) and days of recorded video (1.62, [1.03–2.59]); increased number of total recorded weights (1.66, [1.09–2.70]) and days of weights (1.56, [1.02–2.44]); increasing mean SpO2 (1.55, [1.02–2.44]); and increased variation and range of HR (1.59, [1.04–2.51]) and (1.71, [1.10–2.80]), respectively. Interstage patients with RCoA had increased caregiver-entered home monitoring data including weight and video recordings, as well as changes in HR and SpO2trends. Identifying these items by home monitoring teams may be beneficial in clinical decision-making for evaluation of RCoA in this high-risk population. [ABSTRACT FROM AUTHOR]

OBJECTIVES Existing aortic graft complicates the surgical management of prosthetic valve endocarditis (PVE); yet, its impact has not been well studied. We compared outcomes of patients with prior aortic valve replacement (AVR) versus aortic surgery plus AVR, who underwent reoperative aortic root replacement (ARR) for PVE of the aortic valve. METHODS All patients who underwent reoperative ARR for PVE between 2004 and 2021 from 2 aortic centres were included. Two groups were formed based on the presence/absence of aortic graft: prior aortic surgery (AO) and prior AVR (AV) alone. Inverse propensity treatment weighting matched the groups. The Kaplan–Meier method was used to analyse long-term survival, and Fine and Gray model was used to compare the cumulative incidence of reoperation. RESULTS A total of 130 patients were included (AO n  = 59; AV n  = 71). After matching, AO patients had increased stroke incidence (12.4% vs 0.9%) and renal failure requiring dialysis (11.5% vs 2.5%). In-hospital mortality was comparable (21.5% AO and 18.6% AV). Survival over 5 years was 68.9% (56.6–83.8%) in AO and 62.7% (48.1–81.7%) in AV (P  = 0.70). The cumulative incidence of reoperation was similar [AO 6.3% (0.0–13.2%) vs AV 6.1% (0.0–15.1%), P  = 0.69]. CONCLUSIONS Reoperative ARRs for prosthetic valve/graft endocarditis are high-risk procedures. AO patients had higher incidence of postoperative morbidity versus AV patients. For all patients surviving operative intervention, survival and reoperation rates over 5 years were comparable between groups. [ABSTRACT FROM AUTHOR]

Accordingly, our investigation sought to evaluate gender bias among YouTube videos concerning prevalent ophthalmic conditions by analysing linguistic patterns in the context of speaker characteristics. Relative to other conditions, keratoconus videos had a greater percentage of positive tone words, whereas refractive error videos had the lowest percentage of negative tone words. Gender bias in YouTube videos describing common urology conditions. [Extracted from the article]

Physician turnover is costly to health care systems and affects patient experience due to discontinuity of care. This study aimed to assess the frequency of turnover by ophthalmologists and identify physician and practice characteristics associated with turnover. Retrospective cross-sectional study. Actively practicing United States ophthalmologists included in the Centers for Medicare and Medicaid Services Physician Compare and Physician and Other Supplier Public Use File between 2014 and 2021. We collected data for each ophthalmologist that was associated with practice/institution and then calculated the rate of turnover both annually in each year window and cumulatively as the total proportion from 2014 to 2021. Multivariable logistic regression analysis was used to identify physician and practice characteristics associated with turnover. We also evaluated turnover characteristics surrounding the Coronavirus disease 2019 (COVID-19) pandemic. Ophthalmologist turnover, defined as a change of an ophthalmologist's National Provider Identifier practice affiliation from one year to the next. Of 13 264 ophthalmologists affiliated with 3306 unique practices, 34.1% separated from at least 1 practice between 2014 and 2021. Annual turnover ranged from 3.7% (2017) to 19.4% (2018), with an average rate of 9.4%. Factors associated with increased turnover included solo practice (adjusted odds ratio [aOR], 9.59), university affiliation (aOR, 1.55), practice location in the Northeast (aOR, 1.39), and practice size of 2 to 4 members (aOR, 1.21; P < 0.05 for all). Factors associated with decreased turnover included male gender (aOR, 0.87) and more than 5 years of practice: 6 to 10 years (aOR, 0.63), 11 to 19 years (aOR, 0.54), 20 to 29 years (aOR, 0.36), and ≥ 30 years (aOR, 0.18; P < 0.05 for all). In the initial year (2020) of the COVID-19 pandemic, annual turnover increased from 7.8% to 11.0%, then decreased to 8.7% in the postvaccine period (2021). One-third of United States ophthalmologists separated from at least 1 practice from 2014 through 2021. Turnover patterns differed by various physician and practice characteristics, which may be used to develop future strategies for workforce stability. Because administrative data cannot solely determine reasons for turnover, further investigation is warranted given the potential clinical and financial implications. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. [ABSTRACT FROM AUTHOR]

Although green hydrogen is an appropriate clean energy alternative, hydrogen leakage and dispersion are the challenges to establishing safe and reliable hydrogen infrastructure. Released hydrogen in confined or semi-confined space may build up flammable gas clouds, which can have severe consequences for the safety of human life and property. Proper ventilation systems will help in reducing hydrogen gas accumulation. This study presents a comprehensive study to analyse hydrogen dispersion behaviour and the influence of ventilation variations on hydrogen volumetric concentration and stratification. A computational model is developed for the leakage diffusion of hydrogen in an enclosed cuboid space with roof and door ventilation. A detailed analysis is conducted to shed light on the impact of door and roof ventilation positions on forming the flammable cloud. It is observed that the displacement flow and multi-layer stratification are established in the absence of wind or imperceptible air circulation. Single-vent configurations were ineffective, when installed at the top of the leakage point, but multiple-vent arrangements incorporating door and roof vents were found to be more efficient in extracting hydrogen. However, it should be noted that not all multiple-vent arrangements may meet safety requirements. The result indicated that the optimal arrangement for minimizing the size of a flammable cloud involves placing the door vent close to the ceiling while situating the roof vent near the source of leakage. These findings will aid in devising strategies for minimizing the occurrence of flammable cloud formation and preventing hydrogen fire and explosion incidents within partially enclosed facilities. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES Non-small-cell lung cancer mortality has declined at a faster rate than incidence due to multiple factors, including changes in smoking behaviour, early detection which shifts diagnosis, and novel therapies. Limited resources require that we quantify the contribution of early detection versus novel therapies in improving lung cancer survival outcomes. METHODS Non-small-cell lung cancer patients from the Surveillance, Epidemiology, and End Results-Medicare data were queried and divided into: (i) stage IV diagnosed in 2015 (n  = 3774) and (ii) stage I–III diagnosed in 2010–2012 (n  = 15 817). Multivariable Cox-proportional hazards models were performed to assess the independent association of immunotherapy or diagnosis at stage I/II versus III with survival. RESULTS Patients treated with immunotherapy had significantly better survival than those who did not (HRadj: 0.49, 95% confidence interval: 0.43–0.56), as did those diagnosed at stage I/II versus stage III (HRadj: 0.36, 95% confidence interval: 0.35–0.37). Patients on immunotherapy had a 10.7-month longer survival than those who were not. Stage I/II patients had an average survival benefit of 34 months, compared to stage III. If 25%% of stage IV patients not on immunotherapy received it, there would be a gain of 22 292 person-years survival per 100 000 diagnoses. A switch of only 25% from stage III to stage I/II would correspond to 70 833 person-years survival per 100 000 diagnoses. CONCLUSIONS In this cohort study, earlier stage at diagnosis contributed to life expectancy by almost 3 years, while gains from immunotherapy would contribute ½ year of survival. Given the relative affordability of early detection, risk reduction through increased screening should be optimized. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES To examine short- and long-term outcomes of patients with moderate-to-severe aortic insufficiency (AI) undergoing either a Bentall aortic root replacement (ARR) or valve-sparing root replacement (VSRR). METHODS A two-centre retrospective database of patients undergoing ARR from 2004 to 2021 was reviewed. Patients <18 years old were excluded. A total of 1527 adult patients underwent Bentall ARR (n  = 1150, 75%) or VSRR (n  = 377, 25%). Propensity score matching based on preoperative comorbidities was used and 195 matched pairs were identified. Perioperative outcomes, reoperation rates, recurrence of AI and long-term survival were evaluated. RESULTS ARR patients had more concomitant ascending aortic replacement (35% vs 20%, P  = 0.002) and shorter cardiopulmonary bypass (189 vs 233 min, P  < 0.0001) and aortic cross-clamp (170 vs 204 min, P  < 0.0001) times than the VSRR group. Postoperatively, outcomes were similar between groups, including stroke (3% vs 2%) and in-hospital mortality (1.5% vs 2.1%), all P  > 0.05. Indications for and rates of reoperation (4% vs 5%, P  = 0.62) of the aortic valve and proximal aorta were similar between ARR and VSRR groups with reoperations occurring a mean of 3.2 years after initial root replacement. The ARR group had less moderate-to-severe AI than the VSRR group (1.6% vs 14%, P  = 0.002) a mean of 3 years after surgery. Ten-year survival was similar between ARR (84%) and VSRR (82%) (P  = 0.69) groups. CONCLUSIONS Both ARR and VSRR can be performed with acceptable short- and long-term outcomes in patients with moderate-to-severe AI. [ABSTRACT FROM AUTHOR]

Patients who are active pilots may be avoiding healthcare or witholding pertinent medical information from their physician. This may result in challenging clinical scenarios in which potential diagnoses and treatments are delayed. Clinician awareness of this topic may help to promote healthcare seeking in the pilot occupation group. Objective: Canadian pilots may avoid health care and report inaccurate medical information due to fear of medical invalidation. We sought to determine if health care avoidance due to fear of certificate loss exists. Methods: We conducted an anonymous 24-item Internet survey of 1405 Canadian pilots between March and May 2021. Responses were collected using REDCap, and the survey was advertised through aviation magazines and social media groups. Results: Seventy-two percent of respondents (n = 1007) have felt worried about seeking medical care because it may impact their career or hobby. Respondents participated in various health care avoidance behaviors with the most common being having actually avoided or delayed medical care for a symptom (46%, n = 647). Conclusion: Canadian pilots fear medical invalidation and consequently, avoid health care. This may be severely impacting aeromedical screening effectiveness. [ABSTRACT FROM AUTHOR]

To examine trends in ophthalmic trauma secondary to five major sports (baseball, soccer, tennis, football, basketball) and identify differences between patient characteristics and time period (pre-COVID vs COVID) of injury. The National Electronic Injury Surveillance System was queried to extract cases related to the sports of interest from 2011–2020. Entries were analyzed by age, sex, diagnosis, location, and disposition, with narrative descriptions assessed to characterize the mechanism of injury and visual sequelae. National incidence was extrapolated and Pearson's ?2 and Fisher's exact tests were performed. Among 98,995 presentations, most involved male (83.5%) and pediatric patients (59.2%). Contusion/abrasion (57.3%) was the predominant diagnosis, with injuries primarily precipitated by contact with a ball (44.9%) and occurring in the recreational setting (49.0%). Visual sequelae were documented in 6.4% of injuries. Patients were commonly treated/examined and released (95.6%). Between sports, significant differences in diagnosis (p <.001), mechanism of injury (p <.001), location (p <.001), visual sequelae (p <.001), and disposition (p =.005) were observed. Stratification by age indicated significant differences in diagnosis, mechanism of injury, and location (all p <.001). Stratification by sex indicated significant differences in the mechanism of injury (p <.001) and visual sequelae (p =.04). Stratification by time period indicated significant differences in diagnosis (p =.002) and mechanism of injury (p =.001). There are notable differences in sports-related ocular injuries by patient characteristic, revealing important considerations for their clinical evaluation and the development of safety guidelines. [ABSTRACT FROM AUTHOR]

With the increasing prevalence of diabetic retinopathy (DR), screening is of the utmost importance to prevent vision loss for patients and reduce financial costs for the healthcare system. Unfortunately, it appears that the capacity of optometrists and ophthalmologists to adequately perform in-person screenings of DR will be insufficient within the coming years. Telemedicine offers the opportunity to expand access to screening while reducing the economic and temporal burden associated with current in-person protocols. The present literature review summarizes the latest developments in telemedicine for DR screening, considerations for stakeholders, barriers to implementation, and future directions in this area. As the role of telemedicine in DR screening continues to expand, further work will be necessary to continually optimize practices and improve long-term patient outcomes. [ABSTRACT FROM AUTHOR]

This study was conducted to evaluate morphometry of ovarian functional structures and effect of two different commercially available in vitro maturation (IVM) media on cytoplasmic and nuclear maturation of slaughter origin buffalo oocytes. The buffalo ovaries were collected from Ahmedabad Municipal slaughter-house, Ahmedabad and were transported at the laboratory within 2-3 h of slaughter at 33 to 35°C warm normal saline. The ovaries were washed and processed under laminar floor and evaluated for functional structures like mature corpus luteum (CL) and follicles i) <3 mm (small), ii) 3 to 6 mm (medium) and iii) >6 mm (large). The cumulus oocytes complexes (COCs) were aspirated with 18 G needle in 5 mL sterile disposable needle. The COCs were graded in to four categories (I to IV) and first three categories of COCs were used for IVM. For IVM 90 µL drops of BO IVM (IB; Bioscience) and IVM (VB; Vitrogen, Brazil) media were prepared and kept in benchtop incubator at 5 % O2, 5% CO2 and rest N2 at 38.5 °C. The selected COCs were randomly allocated to two media treatments and incubated for 22 h. The cytoplasmic and nuclear maturation were observed using morphology and nuclear staining method (Hoechst 334452). The weight of ovaries with CL (6.63 ± 0.18 g) was significantly higher as compared to without CL (4.33 ± 0.14 g). Total 546 visible follicles with average 2.15 per ovary observed were aspirated from 254 buffalo ovaries and 440 COCs were collected. Overall oocyte recovery per ovary (OR/O), follicle recovery per ovary (FR/O) and oocyte retrieval per follicle (OR/F) were 1.73, 2.15 and 0.81, respectively. The small, medium and large follicles were 43.04, 41.94 and 15.01 %, respectively. The mean ± SE (n) count of oocytes with Grade I, Grade II, Grade III and Grade IV were 6.90 ± 0.61 (138), 6.50 ± 0.48 (130), 4.35 ± 0.40 (87) and 4.25 ± 0.54 (85) with recovery rate of 31.36, 29.54, 19.77 and 19.31 %, respectively. Total 133 and 137 COCs were randomly allocated to IB and VB media treatment. Total cytoplasmic maturation in IB and VB was 79.69 and 73.71 %. Similarly, the nuclear maturation was 78.19 and 71.53 % in IB and VB media. No significant differences in cytoplasmic or nuclear maturation between two media were observed. The study concludes that CL influences ovarian weight and both commercial medias can be used for successful in vitro maturation of COCs of buffaloes. [ABSTRACT FROM AUTHOR]

The construction of heterocyclic nucleus by enabling photoredox C−H functionalization is an efficient, resurgence, and astonishing evolution for many different scientific disciplines. Recent research has shown interest in photolytically activated radical species, which involve the generation of an annulative or aromatic nucleus by triggering C−H bond cleavage. Single‐electron‐transfer (SET) events between substrates and a metal photocatalyst are eye‐catching synthesis under visible light irradiation. The approach functions without the need for substrate preactivation by employing reductive or oxidative quenching cycles to initiate SET. When a single electron is added at a deficiency, causes electron circulation, which results in cascade radical cyclization. They are found to be a prevalent, powerful, and reliable technique for the modern synthesis of valuable molecular entities. In current review photoredox catalyzed distinct radical generation strategies and transformations acting through a proton coupled electron transfer (PCET), C−H functionalization to form carbon‐carbon and carbon‐nitrogen atom bond are discussed. [ABSTRACT FROM AUTHOR]

The diagnosis and prognosis of cardiovascular disease are crucial medical tasks to ensure correct classification, which helps cardiologists provide proper treatment to the patient. Machine learning applications in the medical niche have increased as they can recognize patterns from data. Using machine learning to classify cardiovascular disease occurrence can help diagnosticians reduce misdiagnosis. This research develops a model that can correctly predict cardiovascular diseases to reduce the fatality caused by cardiovascular diseases. This paper proposes a method of k-modes clustering with Huang starting that can improve classification accuracy. Models such as random forest (RF), decision tree classifier (DT), multilayer perceptron (MP), and XGBoost (XGB) are used. GridSearchCV was used to hypertune the parameters of the applied model to optimize the result. The proposed model is applied to a real-world dataset of 70,000 instances from Kaggle. Models were trained on data that were split in 80:20 and achieved accuracy as follows: decision tree: 86.37% (with cross-validation) and 86.53% (without cross-validation), XGBoost: 86.87% (with cross-validation) and 87.02% (without cross-validation), random forest: 87.05% (with cross-validation) and 86.92% (without cross-validation), multilayer perceptron: 87.28% (with cross-validation) and 86.94% (without cross-validation). The proposed models have AUC (area under the curve) values: decision tree: 0.94, XGBoost: 0.95, random forest: 0.95, multilayer perceptron: 0.95. The conclusion drawn from this underlying research is that multilayer perceptron with cross-validation has outperformed all other algorithms in terms of accuracy. It achieved the highest accuracy of 87.28%. [ABSTRACT FROM AUTHOR]

Background and Aims: Hereditary hemochromatosis (HH) is associated with increased risk of hepatocellular carcinoma (HCC). However, HCC risk factors within this population and across various HFE genotypes remain unclear. Methods: We conducted a retrospective cohort study of patients with ≥ 1 HFE genotype test in the Veterans Health Administration. We followed patients until HCC, death, or 6/30/19. We calculated incidence rates (IRs) and used Cox proportional hazards models to estimate HCC risk. In patients with type-1 HH genotypes (C282Y/C282Y or C282Y/H63D), we examined risk factors for HCC. Results: We identified 5225 patients: 260 were C282Y/C282Y; 227 were C282Y/H63D; 436 were H63D heterozygous; 535 had other HFE mutations; 3767 without mutation. IR for C282Y/C282Y homozygotes (5.59/1000 PYs) and C282Y/H63D compound heterozygotes (4.12/1000 PYs) were significantly higher than controls (0.92/1000 PYs) with adjusted hazard ratio (adj HR), 95% CI 8.80, 4.17–18.54; and 5.25, 2.24–12.32, respectively. HCC risk was higher in H63D heterozygote than controls (adj HR = 2.82, 95% CI 1.21–6.58); cases were related to non-alcoholic fatty liver disease. Among patients with HH, age ≥ 65 (adj HR = 2.2, 95% CI 0.47–10.27), diabetes (adj HR 3.74, 95% CI 1.25–11.20) and high baseline aspartate-aminotransferase to platelet ratio-index (APRI, adj HR = 3.91, 95% CI 1.29–11.89) had higher risk. Among patients with high baseline ferritin, persistent ferritin > 250 ng/mL had higher risk. Conclusion: HCC risk was high in C282Y homozygous and C282Y/H63D patients. These HFE genotypes, older age, diabetes, high APRI/ferritin levels were associated with increased risk. While H63D heterozygous genotype was associated with HCC risk, this association might be due to metabolic factors. [ABSTRACT FROM AUTHOR]

This article discusses the financial compensation of medical residents, specifically in the field of surgery. It highlights the significant pay discrepancy between surgical residents and other professionals, such as lawyers, dentists, physician assistants, and registered nurses. The article acknowledges that some of the pay difference may be attributed to the service component of medical training, but argues that the extensive education and training required for surgeons warrant further discussion on fair compensation. It also mentions the challenges faced by residents, such as limited moonlighting opportunities, rising costs of living, and the impact on family life. The article concludes by advocating for financial literacy education for residents and a conversation on appropriate compensation. [Extracted from the article]

Two isostructural MOFs {[Cd(BDC)(L)] ⋅ CH3OH}n (1) and {[Cd(NH2‐BDC)(L)] ⋅ CH3OH}n (1‐NH2) involving Cd metal center and different dicarboxylate ligands (1,4‐benzenedicarboxylate (BDC) in 1 and 2‐amino‐1,4‐benzenedicarboxylate (NH2‐BDC) in 1‐NH2) and a common amide functionalized N‐donor ligand ((E)‐N′‐(pyridin‐3‐ylmethylene)nicotinohydrazide (L)) has been synthesized in bulk by diverse routes with phase‐purity. The MOFs were characterized by spectroscopic methods such as FT‐IR, elemental, TGA analysis, PXRD, and SXRD analysis. Amide functionality of L in 1 and both amide/‐NH2 functional groups attached to the ligands in 1‐NH2 of the interpenetrated isostructural 3D framework has been found to be catalytically active basic site towards multiple organic transformations. Both 1 and 1‐NH2 showed good catalytic activity towards both CO2‐epoxide cycloaddition and Biginelli reaction. A comparative study of the catalytic activity of 1 and 1‐NH2 for cycloaddition and Biginelli reaction revealed that the amine‐functionalized framework 1‐NH2 showed better catalytic performance than 1 due to the existence of additional amino site. Presence of accessible functionally decorated Lewis basic ‐NH2 and amide sites on BDC and N‐donor ligands of 1‐NH2 synergistically activate the substrate making this framework interesting and efficient heterogeneous base catalyst. Excellent product yield under moderate conditions with reusability is the highlight in both catalytic reactions. [ABSTRACT FROM AUTHOR]

Objective: To investigate voiding time (VT) in asymptomatic and symptomatic men, and compare VT to other parameters such as maximum flow rates (Qmax) as a possible solution to disparity related lack of access to standard urodynamic testing.Methods: We conducted a controlled prospective study on a total of 30 patients. Exclusion criteria included ongoing medical therapy for lower urinary tract symptoms (LUTS) or a history of invasive therapy for LUTS. Patients completed International Prostate Symptom Score (IPSS) questionnaire, uroflowmetry, and post-void residual (PVR) testing. Symptomatic LUTS was defined as an IPSS ≥8.Results: On univariate analysis, men with a symptomatic LUTS had a significantly longer VT than asymptomatic men (30.6 seconds (Interquartile rage [IQR] 24.2-42.4) vs 20.5 seconds (IQR 16.6-40.5), P = .04). VT was not otherwise associated with age, race, or primary complaint. There was trend towards lower Qmax in symptomatic patients (13.4 vs 20.5 seconds, P = .07), although this was not statistically significant. Our study demonstrated that the sensitivity of a VT ≥23.5 seconds, or probability of observing a VT exceeding 23.5 seconds when the patient has a symptomatic IPSS, is 85%. On sensitivity and specificity analysis, there was no difference between the abilities of VT and Qmax to predict that a patient would have symptomatic LUTS (P = .80).Conclusion: In this controlled prospective study, we found that VT was as accurate as Qmax in predicting symptomatic IPSS scores. This novel finding might improve the ability to diagnose and treat LUTS, especially in primary care offices and underserved areas. [ABSTRACT FROM AUTHOR]

Introduction: Amidst the COVID-19 pandemic, telemedicine has emerged as a safe and cost-effective alternative to traditional ophthalmology clinic visits. This study evaluated patient attitudes towards telemedicine at a full-service, retina-only practice to identify areas for growth in implementation. Methods: A survey was distributed to established patients at University Retina and Macula Associates following the completion of a telemedicine encounter in July 2021. On a 5-point Likert scale, patients compared telemedicine to in-person visits for six domains: ability to ease COVID-related anxiety, efficiency, patient education, quality of care, fulfillment of personal needs, and convenience. Pearson's χ2 and Fisher's exact test were used to assess correlations between demographic factors and patient attitudes or preference towards telemedicine. Results: Among 103 respondents, two-thirds (68.7%) preferred in-person compared to telemedicine encounters. Overall, patients had a neutral attitude towards telemedicine [mean Likert rating (SD) = 3.11/5 ± 0.82]. Questions assessing "patient education" and "telemedicine efficiency" received the greatest proportion of positive and negative responses, respectively. Positive attitudes were more frequent among patients with prior telemedicine experience (87.5%) compared to never-users (71.8%; p = 0.046). Patients ≥ 75 years old tended to negatively assess telemedicine regarding reduction of COVID-19-related anxiety, efficiency, patient education, and physician facetime (p < 0.05 for all). A positive but non-significant trend was observed between higher education level and positive attitude towards telemedicine (p = 0.18). Telehealth never-users more often negatively rated receiving adequate facetime with the physician virtually (54.7%) compared to prior users (25.6%; p = 0.004). Younger age, prior history of telemedicine use, and higher education level were associated with increased preference for telemedicine (p < 0.05 for all). Conclusion: Our findings revealed hesitance remains among patients towards adoption of telemedicine. Targeting age-, experience-, and education-related barriers will be invaluable for increasing acceptance of this healthcare delivery model. [ABSTRACT FROM AUTHOR]

Background and Purpose: More than 40% of patients undergoing percutaneous nephrolithotomy (PCNL) are left with residual stone fragments and often require secondary procedures. Portable CT (PCT) technology allows surgeons to obtain intraoperative cross-sectional imaging, identify and extract residual stones immediately, and thereby reduce the need for subsequent procedures. This prospective trial evaluates how incorporation of PCT during PCNL affects perioperative outcomes. Patients and Methods: We prospectively enrolled eligible patients undergoing initial PCNL for this trial (n = 60), which entailed a single intraoperative CT abdomen and ipsilateral antegrade ureteroscopy when the surgeon felt stone treatment was visually complete. If residual fragments were identified, the surgeon continued nephroscopy to find and remove them; if not, the procedure was concluded. These patients were compared with a retrospective cohort (n = 174) who underwent initial PCNL with postoperative imaging performed the following day. Results: The two cohorts had similar demographic properties and stone characteristics, and location of percutaneous access. In the prospective arm, 50% of intraoperative PCT scans identified residual fragments, prompting continuation of surgery to remove them. This cohort had significantly higher stone-free rate (82% vs 36%, p < 0.01), lower rate of planned reintervention (7% vs 32%, p < 0.01), lower rate of urgent presentation with ureteral obstruction (0% vs 7%, p = 0.04), lower total CT-based effective radiation dose (8.4 mSv vs 14.6 mSv, p < 0.01), and shorter length of stay (2.3 days vs 3.5 days, p < 0.01) when compared with the retrospective cohort that did not use intraoperative PCT. Conclusions: Obtaining an intraoperative PCT scan during PCNL can substantially improve perioperative outcomes. Further evaluation of this modality through a randomized controlled trial is warranted. Clinical Trial Registration Number: NCT04556396. [ABSTRACT FROM AUTHOR]

Objectives: To determine the predictive value of voiding efficiency on acute urinary retention after discharge from BPH surgery.Materials and Methods: We performed a prospective observational cohort study of three surgeons' practices from 2019 to present. All men included underwent trial of void on post-operative day one after transurethral resection of prostate or Holmium enucleation of prostate . Active filling void trials were performed on all patients and voiding efficiency (percent of bladder volume emptied) was calculated. Multivariable logistic regression was performed to determine predictors of developing acute urinary retention.Results: During the study period, 188 men met inclusion criteria. 110 (59%) men underwent Holmium enucleation of prostate , and 78 (41%) underwent transurethral resection of prostate. The median age of our cohort was 70 (IQR 65-75). The median prostate size was 100g (IQR 61-138g). Nineteen patients (10%) returned after discharge with acute urinary retention requiring catheterization. On post-operative day one, the median voiding efficiency was 75% (IQR 55%-94%). On multivariable analysis, patients with a voiding efficiency less than 50% were 3.8 times more likely (95% confidence interval 1.1-12.8) to develop subsequent retention compared to a voiding efficiency of greater than 75%. Increasing pre-operative prostate size was associated with lower risk of urinary retention after discharge (aOR 0.8, 95%CI 0.6-0.9).Conclusions: Voiding efficiency after an active void trial helps stratify risk of urinary retention in patients undergoing benign prostate surgery. High-risk patients include those with voiding efficiencies less than 50% and smaller pre-operative prostate sizes (<80g). [ABSTRACT FROM AUTHOR]

• Compounds 2a-l were synthesized using microwave synthetic method. • All derivatives were characterized by FT IR, NMR and Mass spectral analysis. • Screening for antibacterial, antifungal and antitubercular activities. • ADME prediction for their drug-likeness and toxic properties. • Strong binding against active macromolecules during molecular docking study. Twelve analogues of 1-thia-4-azaspiro[4.5]decan-3-one (2a-l) were synthesized via microwave-assisted methods and confirmed using spectroscopic techniques. These compounds were evaluated for in vitro antimicrobial and antitubercular activities, with compound 2k showing superior activity against S. aureus and S. pyogenes compared to ampicillin. Compounds 2a, 2b, 2c, 2f, and 2 g displayed strong antimycobacterial activity, with MIC values between 0.49 and 0.56 µg/mL. Molecular docking using Schrödinger Glide revealed a correlation between docking scores and antitubercular activity, with 2a (-7.456 kcal/mol) and 2 g (-8.165 kcal/mol) showing similar MICs of 0.49 µg/mL. The stability of the ligand-receptor complexes of 2a and 2 g was confirmed through 100 ns molecular dynamics simulations. ADME studies further supported these molecules as promising drug candidates, with favourable results across all parameters. [Display omitted] 1-thia-4-azaspiro[4.5]decan-3-one derivatives are derived via microwave method and outcomes are subjected to their in vitro including antimicribial, antimycobacterial and in silico such as molecular docking, molecular dynamic, ADME analysis. [ABSTRACT FROM AUTHOR]

The role of basement membraneAm J Ophthalmol0.557491289196823286Canalicular inflammation in ophthalmic cases of herpes zoster and herpes simplexAm J Ophthalmol0.55555555619652287Prevalence of ocular anomalies among school childrenAm J Ophthalmol0.5555555561960688Neodymium laser cyclocoagulationJAMA Ophthalmol0.554140127197310589Ocular echometry in the diagnosis of congenital glaucomaJAMA Ophthalmol0.55263157919826190The use of liquid silicone in retinal detachment surgeryJAMA Ophthalmol0.551252847196241491Uveitis and joint diseases. I. Surgical techniques and managementJAMA Ophthalmol0.678899083195722629Changing trends in intraocular lens implantationJAMA Ophthalmol0.67619047619898830Trabeculectomy. [Extracted from the article]

Objectives: To evaluate contemporary clinical presentations of priapism, their association with socioeconomic characteristics, and the role of prescribing providers in priapism episodes in a large cohort of patients managed at 3 major academic health systems.Methods: We identified all consecutive patients presenting with ischemic priapism to the emergency departments of three major academic health systems (2014 -2019). Demographic characteristics, priapism etiologies, and clinical management were evaluated. Univariable and multivariable analyses were used to assess the contribution of socioeconomic characteristics and the role of prescribing providers in priapism episodes.Results: We identified 102 individuals with a total of 181 priapism encounters. Hispanic race, lower income quartile, sickle-cell disease, and illicit drug use were associated with increased risk of recurrent episodes. Of ICI users, 57% received their prescriptions from non-urological medical professionals (NUMPs); the proportion with recurrent episodes was higher for NUMPs compared to urologists (24% vs 0%, P = 0.06) with no demographic differences identified between patients treated by either group.Conclusion: Socioeconomic disparities exist among patients presenting with recurrent episodes of priapism, potentially highlighting systemic issues with access to care and patient education. With most patients who developed ischemic priapism from ICI being prescribed these medications by NUMPs, further investigation is required to elucidate the prescribing and counseling patterns of these providers. Increased awareness of disparities and complications may improve patient safety. [ABSTRACT FROM AUTHOR]

Purpose: Epidemiologic studies related to the demographics and trends of ocular injury in the pediatric cohort in the last decade are limited. This study describes epidemiologic trends in consumer product–related pediatric ocular injuries from 2010 to 2019. Methods: This is a retrospective observational study utilizing data from the National Electronic Injury Surveillance System (NEISS). Inclusion criteria include pediatric patients ages 1–20 presenting to NEISS emergency departments with an ocular injury from January 1, 2010, to December 31, 2019. Outcome measures include prevalence of ocular injury related to consumer products stratified by age group, sex, and injury setting. Results: There were an estimated 636,582 consumer product (CP)–related incidents of ocular injury in children ages 1–20 years with an average age of 9.7 years (SD = 5.92) between 2010 and 2019; 416,378 (65.4%) patients were males with a male-to-female ratio of 1.9:1. The annual incidence of CP-related ocular injury in males decreased from 2010 to 2019 while that in females remained unchanged. The greatest number of injuries occurred in the 1–5-year age group (31%) followed 6–10 group (25%), 16–20 (22%), and 11–15 (21%). Ocular contusion was the most common diagnosis. The most common setting of injury was home (63%). The majority (96%) of patients were treated and released from the ED suggesting a minor injury. Of the 1% of patients admitted to the hospital with ocular injuries, one-fourth were due to an open globe injury. Most ocular injuries occurred in the summer months, and presentation to the ED was more frequent on the weekend than a weekday. Over one-fourth (28%) of injuries were sports-related followed by detergents/chemicals (16%), toys (11%), home workshop equipment (8%), kitchenware (5.0%), and home furniture in (4.4%). Conclusions: The frequency and rate of pediatric ocular injuries in the USA decreased during the last decade. Sports and non-powder guns caused the greatest number of eye injuries in the older pediatric cohorts (11–15- and 16–20-year age groups), while detergents/chemicals accounted for nearly 1/3 of all injuries in younger children (1–5 years). Prophylactic measures targeted to specific age groups will be important in reducing eye injuries further. [ABSTRACT FROM AUTHOR]