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The temporal dynamics of 33 major, trace, and rare earth elements (REEs) were studied in the litter samples containing Swedish Norway spruce (Picea abies) (NSL) and Scots pine (Pinus sylvestris) (SPL), with the aim to assess their release and accumulation dynamics. Litter bags (8 × 8 cm) were incubated in paired monoculture stands with both the species for up to 5 years from 1979 to 1984 according to a randomized block design comprising 25 blocks (1 × 1 m) within an area of 625 m2. The decomposition rate was slightly higher for Scots pine litter (k = 0.315) than for Norway spruce litter (k = 0.217). During litter decomposition, at ∼70% accumulated mass loss (AML), the concentration of trace elements increased by >50% in both litter types compared to initial concentrations. The concentration change took place in a non-linear pattern, and polynomial quadratic regression between concentration change and accumulated mass loss resulted in significant relationships (adj R2 = 0.20–0.97; p = 0.15–0.95). A general upward convexity in the dynamics suggests that if further incubated in the field, decomposing litter could have accumulated more REEs in the organic matter. The results of this study can be useful for future studies in other ecosystems including metal-contaminated sites or element-depleted sites. Plant litter accumulation, its decomposition, and build-up of humic substances in the decomposing organic matter can act as a sink for elements and can be used as a management tool for ecological amelioration of metal-contaminated sites as well as natural systems that are impoverished, especially recuperating sites. The study’s findings have implications beyond such sites and can be useful in any research that seeks to understand the patterns of accumulation and release related to decomposition in different ecosystems.

Abstract Background Nitrogen (N) deposition alters litter decomposition and soil carbon (C) sequestration by influencing the microbial community and its enzyme activity. Natural atmospheric N deposition comprises of inorganic N (IN) and organic N (ON) compounds. However, most studies have focused on IN and its effect on soil C cycling, whereas the effect of ON on microbial enzyme activity is poorly understood. Here we studied the effects of different forms of externally supplied N on soil enzyme activities related to decomposition in a temperate steppe. Ammonium nitrate was chosen as IN source, whereas urea and glycine were chosen as ON sources. Different ratios of IN to ON (Control, 10:0, 7:3, 5:5, 3:7, and 0:10) were mixed with equal total amounts of N and then used to fertilize the grassland soils for 6 years. Results Our results show that IN deposition inhibited lignin-degrading enzyme activity, such as phenol oxidase (POX) and peroxidase (PER), which may restrain decomposition and thus induce accumulation of recalcitrant organic C in grassland soils. By contrast, deposition of ON and mixed ON and IN enhanced most of the C-degrading enzyme activities, which may promote the organic matter decomposition in grassland soils. In addition, the β-N-acetyl-glucosaminidase (NAG) activity was remarkably stimulated by fertilization with both IN and ON, maybe because of the elevated N availability and the lack of N limitation after long-term N fertilization at the grassland site. Meanwhile, differences in soil pH, soil dissolved organic carbon (DOC), and microbial biomass partially explained the differential effects on soil enzyme activity under different forms of N treatments. Conclusions Our results emphasize the importance of organic N deposition in controlling soil processes, which are regulated by microbial enzyme activities, and may consequently change the ecological effect of N deposition. Thus, more ON deposition may promote the decomposition of soil organic matter thus converting C sequestration in grassland soils into a C source.

ABSTRACT Local delivery of antibiotics as prophylaxis for prosthetic joint infections (PJIs) is frequently used during total hip replacement surgery. Morselized bone allograft impregnated with vancomycin and tobramycin (TobraVanc) could provide effective prophylaxis against bacteria commonly associated with PJIs. In this study, the concentrations of antibiotics released by bone allograft impregnated with TobraVanc were determined by using an in vitro bioassay system entailing measuring inhibition zone diameters caused by antibiotic-impregnated bone chips cast in agar against standard curves. The concentrations were determined in samples of TobraVanc-impregnated bone graft taken before and after the application of the bone graft in the patients undergoing acetabular revision surgery. Antibiotic-impregnated bone grafts, sampled prior to application in the patient, delivered antibiotics in the concentration ranges of 730–9,800 mg/L for tobramycin and 1,300–11,000 mg/L for vancomycin. Samples taken after application in the patient released lower concentrations of tobramycin (490–1,900 mg/L; P < 0.01) and vancomycin (3,000–5,100 mg/L; P < 0.05); however, these concentrations remained well above the tobramycin minimum inhibitory concentrations (MICs) for investigated, highly tobramycin-resistant Staphylococcus epidermidis strains (MICs > 256 mg/L). At the tested concentrations, bone graft material mixed with TobraVanc delivered antibiotics in potent concentrations above the MICs for bacteria causing PJIs. Clinical trials are needed to evaluate the efficacy and risk of TobraVanc-impregnated bone graft as a prophylactic agent for patients undergoing hip replacement surgery.IMPORTANCEAntibiotic prophylaxis is the cornerstone of successful joint replacement surgery, reducing the risk for the dreaded complication of prosthetic joint infection (PJI) to roughly 0.5%–2% in standard total hip replacement (THR). In addition to systemic antibiotics, antibiotics added locally have the potential to reduce the PJI risk even further, because of the high concentrations that can be achieved in the joint with limited risk for systemic toxicity. The results in the current study show that bone chips impregnated with a combination of tobramycin and vancomycin (TobraVanc) release antibiotics in concentrations that are potent against common bacteria causing PJIs. Especially in high-risk patients, our results support the prophylactic use of TobraVanc in hip replacement surgery requiring the use of a bone graft. A clinical study testing the efficacy of TobraVanc-impregnated bone graft in reducing the incidence of PJI in hip replacement surgery is currently ongoing (EudraCT: 2021-001708-14).

ObjectTumors in the temporo-mesial region often extend into the insula and vice versa. The present study investigated the results of a surgical strategy that combines principles of tumor and epilepsy surgery.MethodsWe retrospectively analyzed 157 consecutive patients with intrinsic brain tumors in the temporo-mesial region, with varying degrees of extensions into the insula (44 patients, 28.0%). The surgical strategy utilized “anatomy-guided resection,” targeting specific anatomical compartments infiltrated by the tumor (e.g., temporal pole, anterior temporo-mesial region = uncus and hippocampal head, posterior temporo-mesial, insula) rather than treating the tumor as a single mass.ResultsThe most frequent histologies were ganglioglioma CNS WHO grade 1 (55 patients, 35.0%) and IDH1 wildtype glioblastoma (36 patients, 22.9%). Tumor infiltration was most commonly found in the anterior temporo-mesial compartment (145 patients, 92.4%). An anterior temporal lobectomy was part of the surgical strategy in 131 cases (83.4%). Seventy-six patients (48.4%) with drug-resistant epilepsy underwent a formal presurgical epilepsy work-up, including depth electrode placement in three cases. Complete resections were achieved in 117 patients (74.5%), with supramarginal resections performed in 89 cases (56.7%). Four patients experienced non-temporary neurological complications (CTCAE grade 3–5). At 6 months, 127 of 147 assessable patients (86.4%) were free from seizures or auras (ILAE class 1), excluding early postoperative seizures (

The functional properties of Andean grain starches of two species, amaranth (Amaranthus caudatus) and canihua (Chenopodium pallidicaule), three cultivars each, were studied. The study focused on chemical composition, pasting properties, thermal properties, water solubility index (WSI), swelling power (SP), and granule morphology. All amaranth starches were waxy starches, with amylose content less than 5 %, which had some differences in chemical composition (p

Abstract Endovascular thrombectomy (EVT) is the most effective treatment for acute ischemic stroke caused by large vessel occlusion (LVO). Yet, long-term outcome (LTO) and health-related quality of life (HRQoL) in these patients have rarely been addressed, as opposed to modified Rankin scale (mRS) recordings. We analysed demographic data, treatment and neuroimaging parameters in 694 consecutive stroke patients in a maximum care hospital. In 138 of these patients with respect on receipt of written informed consent, LTO and HRQoL were collected over a period of 48 months after EVT using a standardised telephone survey (median 2.1 years after EVT). Age 2 according to the telephone survey more often had complaints regarding mobility, self‐care, and usual activity domains of the HRQoL. Our results underline a sustainable positive effect of effective EVT on the quality of life in LVO stroke. Additionally, predictive parameters of outcome were identified, that may support clinical decision making in LVO stroke.

Amaranthus caudatus is a nutrient-rich Andean pseudocereal with wide genetic variability. Six productive varieties (Oscar Blanco, Pucara, Tomina, Cotahuasi, Barbechos, and Guindo Criollo) were compared by proximate, mineral, and fatty acid composition. The proximal content showed certain singularities in the varieties. Barbechos and Guindo Criollo stood out for their fat content (9.50% and 9.01%, respectively), while Tomina stood out for their carbohydrate content (72.6%), and Pucara and Oscar Blanco for their fiber content (4.59% and 4.48%, respectively). The mineral content presented differences, highlighting the Ca content for Pucara (108 mg/100 g), and Tomina with micro-minerals (Zn, Mn, Fe, and Cu, 4.67, 5.90, 9.13 and 1.03 mg/100 g, respectively). All varieties showed high tricosanic acid (C23:0) content, and Cotahuasi was highlighted for its high linoleic acid (C18:2) content. Multivariate analysis showed negative correlations between proteins and carbohydrates, and between fat and fiber in their proximal content, as well as between Fe and Na for their mineral content, and C18:1 and C18:2 for the fatty acids. Although certain differences were found, the total nutritional composition tended to have minor differences between the investigated varieties.

This randomized, prospective clinical trial investigates the impact of a novel undenatured collagen type 2 (T2NDC)-based nutraceutical, ARTHROSHINE® HA² (AS), on postoperative rehabilitation following Tibial Plateau Leveling Osteotomy (TPLO) in 50 dogs with unilateral cranial cruciate ligament rupture (CCLR). The patients were randomly allocated to either group A, receiving AS once daily for 24 weeks post-TPLO surgery, or group B, without any supplementation. Frequency matching was applied to enhance group comparability. Assessment of outcomes included computerized gait analysis and a validated owner questionnaire. AS supplementation was well received, without any reported side effect. Consistently, patients in group A exhibited significantly higher peak vertical force values during all follow-up assessments. By the 12-week mark, gait analysis indicated a return to a physiological gait pattern in group A, while group B achieved this normalization only by the 24-week point. The administration of AS post-TPLO surgery demonstrates promise in enhancing limb function, leading to faster restoration of a physiological gait pattern. The inclusion of AS, a T2NDC-based nutraceutical, in the post-TPLO rehabilitation protocol may contribute to improved limb function and an expedited recovery, potentially facilitating a quicker return to normalcy. It is noteworthy that subjective owner perceptions did not differ between the two groups.

ABSTRACT: Objectives: The global increase in carbapenem-resistant Enterobacteriaceae (CRE) is a growing health concern. Infections caused by CRE are associated with increased mortality and length of hospital stay, emphasising the health and economic burden posed by these pathogens. Although CRE can inhabit the human gut asymptomatically, colonisation with CRE is associated with an increased risk of CRE infection and mortality. In this study, we investigated the occurrence and characteristics of CRE in faecal samples from healthy persons in 12 villages in Shandong Province, China. Methods: Screening for CRE in faecal samples was performed by selective cultivation. Minimum inhibitory concentrations (MICs) of meropenem were determined by the agar dilution method. Multilocus sequence typing (MLST) and carbapenemase gene carriage of the isolates were determined by whole-genome sequencing. Genetic relatedness of Escherichia coli isolates was determined by core genome MLST. Results: CRE carriage increased from 2.4% in 2015 to 13.4% in 2017. Most CRE isolates (93.0%) were E. coli and all carried NDM-type carbapenemases. Sequence types (STs) among the E. coli isolates were diverse. The single most common ST was the highly epidemic strain ST167, which was only observed in 2017. Conclusion: We report a rapid increase in occurrence of CRE (from 2.4% to 13.4%) among faecal samples collected from healthy rural residents of Shandong Province from 2015 to 2017. Colonisation with CRE is known to increase the risk of CRE infection, and the worrying deterioration of the epidemiological situation in the region reported here indicates a need for further monitoring and possible interventions.

BackgroundIn patient care, data are historically generated and stored in heterogeneous databases that are domain specific and often noninteroperable or isolated. As the amount of health data increases, the number of isolated data silos is also expected to grow, limiting the accessibility of the collected data. Medical informatics is developing ways to move from siloed data to a more harmonized arrangement in information architectures. This paradigm shift will allow future research to integrate medical data at various levels and from various sources. Currently, comprehensive requirements engineering is working on data integration projects in both patient care– and research-oriented contexts, and it is significantly contributing to the success of such projects. In addition to various stakeholder-based methods, document-based requirement elicitation is a valid method for improving the scope and quality of requirements. ObjectiveOur main objective was to provide a general catalog of functional requirements for integrating medical data into knowledge management environments. We aimed to identify where integration projects intersect to derive consistent and representative functional requirements from the literature. On the basis of these findings, we identified which functional requirements for data integration exist in the literature and thus provide a general catalog of requirements. MethodsThis work began by conducting a literature-based requirement elicitation based on a broad requirement engineering approach. Thus, in the first step, we performed a web-based systematic literature review to identify published articles that dealt with the requirements for medical data integration. We identified and analyzed the available literature by applying the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In the second step, we screened the results for functional requirements using the requirements engineering method of document analysis and derived the requirements into a uniform requirement syntax. Finally, we classified the elicited requirements into a category scheme that represents the data life cycle. ResultsOur 2-step requirements elicitation approach yielded 821 articles, of which 61 (7.4%) were included in the requirement elicitation process. There, we identified 220 requirements, which were covered by 314 references. We assigned the requirements to different data life cycle categories as follows: 25% (55/220) to data acquisition, 35.9% (79/220) to data processing, 12.7% (28/220) to data storage, 9.1% (20/220) to data analysis, 6.4% (14/220) to metadata management, 2.3% (5/220) to data lineage, 3.2% (7/220) to data traceability, and 5.5% (12/220) to data security. ConclusionsThe aim of this study was to present a cross-section of functional data integration–related requirements defined in the literature by other researchers. The aim was achieved with 220 distinct requirements from 61 publications. We concluded that scientific publications are, in principle, a reliable source of information for functional requirements with respect to medical data integration. Finally, we provide a broad catalog to support other scientists in the requirement elicitation phase.

BackgroundDrug hypersensitivity reactions (DHRs) are major medical problems that influence the treatment of patients by both under- and overdiagnosis. Still, little is known about the role of predisposing or protecting cofactors of DHR.ObjectiveThis study aims to determine drug-specific cofactors in patients with DHR.MethodsRetrospective file chart analysis of inpatients with suspected DHR in our department between 2015 and 2020 was performed. Descriptive statistics and multiple logistic regression were conducted for the estimation and statistical interference.ResultsDHRs were suspected in 393 patients with 678 culprit drugs. In 183 cases, drug hypersensitivities were confirmed, mostly against nonopioid analgesic drugs and antibiotics. Multiple logistic regression analysis identified a positive association of antibiotic hypersensitivity with obesity [odds ratio (OR) 5.75, average marginal effect (AME) +24.4%] and age and a negative association with arterial hypertension, female sex, elevated immunoglobulin E (IgE), and allergic rhinitis. Hypersensitivity to nonopioid analgesics was associated with atopic dermatitis (OR 10.28, AME +28.5%), elevated IgE, and arterial hypertension.ConclusionsDrug-specific cofactors of DHR include obesity for antibiotics and atopic dermatitis for nonopioid analgesics, the knowledge of which may improve the risk calculation for drug provocation tests.

A trichobezoar is commonly formed in the gastrointestinal tract by ingestion of an individual’s own hair. A trichobezoar formed by hair and artificial materials constitutes a rare etiology scarcely reported in the current literature. A mixture with hair-like synthetic fibers not only increases the risk for trichobezoar formation but also makes it more difficult for endoscopic removal. Herein, we report on a case in which a trichobezoar, caused by the consumption of human hair and synthetic yarn, was successfully removed endoscopically with a variceal ligator cap without further complications for the patient. This case report aims to raise awareness among endoscopists that using a variceal ligator cap may be a suitable option in the management of large trichobezoars containing synthetic fibers.

Animal farms have become one of the most important reservoirs of carbapenem-resistant Klebsiella spp. (CRK) owing to the wide usage of veterinary antibiotics. “One Health”-studies observing animals, the environment, and humans are necessary to understand the dissemination of CRK in animal breeding areas. Based on the concept of “One-Health,” 263 samples of animal feces, wastewater, well water, and human feces from 60 livestock and poultry farms in Shandong province, China were screened for CRK. Five carbapenem-resistant Klebsiella pneumoniae (CRKP) and three carbapenem-resistant Klebsiella quasipneumoniae (CRKQ) strains were isolated from animal feces, human feces, and well water. The eight strains were characterized by antimicrobial susceptibility testing, plasmid conjugation assays, whole-genome sequencing, and bioinformatics analysis. All strains carried the carbapenemase-encoding gene blaNDM-5, which was flanked by the same core genetic structure (IS5-blaNDM-5-bleMBL-trpF-dsbD-IS26-ISKox3) and was located on highly related conjugative IncX3 plasmids. The colistin resistance gene mcr-8.1 was carried by three CRKP and located on self-transmissible IncFII(K)/IncFIA(HI1) and IncFII(pKP91)/IncFIA(HI1) plasmids. The genetic context of mcr-8.1 consisted of IS903-orf-mcr-8.1-copR-baeS-dgkA-orf-IS903 in three strains. Single nucleotide polymorphism (SNP) analysis confirmed the clonal spread of CRKP carrying-blaNDM-5 and mcr-8.1 between two human workers in the same chicken farm. Additionally, the SNP analysis showed clonal expansion of CRKP and CRKQ strains from well water in different farms, and the clonal CRKP was clonally related to isolates from animal farms and a wastewater treatment plant collected in other studies in the same province. These findings suggest that CRKP and CRKQ are capable of disseminating via horizontal gene transfer and clonal expansion and may pose a significant threat to public health unless preventative measures are taken.

The representation of tidal energy in future renewable energy systems is growing. Most of the current tidal turbine designs are limited by the minimum current velocity required for efficient operation. The Deep Green (DG) is a kite-borne tidal power plant designed to sustain efficient operation in tidal current velocities as low as 1.2 ms−1. This could increase the geographical areas suitable for large-scale tidal power arrays. Numerical modeling of the Deep Green was carried out in a previous study using large eddy simulations and the actuator line method. This numerical model is compared with acoustic Doppler current profiler (ADCP) measurements taken in the wake of a DG operating in a tidal flow under similar conditions. To be comparable, and since the ADCP measures current velocities using averages of beam components, the numerical model data were resampled using a virtual ADCP in the domain. The sensitivity of the wake observations to ADCP parameters such as pulse length, bin length, and orientation of the beams is studied using this virtual ADCP. After resampling with this virtual ADCP, the numerical model showed good agreement with the observations. Overall, the LES/ALM model predicted the flow features well compared to the observations, although the turbulence levels were underpredicted for an undisturbed tidal flow and overestimated in the DG wake 70 m downstream. The velocity deficit in the DG wake was weaker in the observations compared to the LES. The ALM/LES modeling of kite-borne tidal stream turbines is suitable for further studies of array optimization and wake propagation, etc.

Immunotherapy with immune checkpoint inhibitor (ICI) drugs is gradually becoming a hot topic in cancer treatment. To comprehensively evaluate the safety and efficacy of ICI drugs, we employed the Bayesian model and conducted a network meta-analysis in terms of progression-free survival (PFS), overall survival (OS) and severe adverse events (AEs). Our study found that treatment with ipilimumab was significantly worse than standard therapies in terms of PFS, whereas treatment with cemiplimab significantly improved PFS. The results also indicated that cemiplimab was the best choice for PFS. Treatment with nivolumab, pembrolizumab and nivolumab plus ipilimumab significantly improved OS compared to standard therapies. In terms of OS, cemiplimab was found to be the best choice, whereas avelumab was the worst. In terms of severe AEs, atezolizumab, avelumab, durvalumab, nivolumab, and pembrolizumab all significantly reduced the risk of grade 3 or higher AEs compared to standard therapy. The least likely to be associated with severe AEs were as follows: cemiplimab, avelumab, nivolumab, atezolizumab, and camrelizumab, with nivolumab plus ipilimumab to be the worst. Therefore, different ICI drug therapies may pose different risks in terms of PFS, OS and severe AEs. Our study may provide new insights and strategies for the clinical practice of ICI drugs.

The canihua (Chenopodium pallidicaule) is a native Andean crop that stands out for its high content of protein, fiber, and minerals and that has a good fatty acid profile. We studied six canihuas cultivars, which were compared according to their proximate, mineral, and fatty acid composition. Based on the form of stems, termed growth habit, they belonged to two groups: decumbent (Lasta Rosada, Illimani, Kullaca, and Cañawiri) and ascending (Saigua L24 and Saigua L25). Dehulling is an important process applied to this grain. However, there is no information about how it affects the chemical composition of the canihua. Dehulling resulted in two levels, whole and dehulled canihua. The highest protein and ash contents were in whole Saigua L25 (19.6 and 5.12 g/100 g, respectively), and the highest fat content was found in dehulled Saigua L25, while the whole grains of Saigua L24 presented the highest fiber content (12.5 g/100 g). Dehulling mainly affected the macro-minerals content, while micro-minerals were only slightly linked to the dehulling. The growth habit influenced the C18:1 and C18:3 contents. In conclusion, the canihua had a nutritional composition influenced by each variety, strongly influenced by dehulling, and to a lesser extent by growth habit.

Oil-based drug delivery systems have been studied in different aspects. The present study proposes a new application for an oil-based delivery system, focusing on controlled release until the drug reaches the later part of the small intestine. Bulk surfactants and interfacial surfactants were added into the oil formulation to provide a better mechanistic understating of the lipolysis. Validation of the modified in vitro method shows the overall conversion from medium-chain triglyceride oil (MCT oil) to free fatty acids (FFA) of 100 ± 4% in five replicates. This fully converted level and high reproducibility are fundamental for the following investigations where any retarding effect can be distinguished from the experimental errors. The results show that viscosity and thermodynamic activity have limited retardation. Furthermore, the former may change the kinetics of lipolysis, while the latter changes the equilibrium level. The gel-forming retarder (ethylcellulose) displayed a strong effect. Whereas the lipolysis was significantly retarded (>50%) when the retarders altered the interfacial composition (poloxamer 407), degradable interfacial surfactants did not have the same effect. However, surface-active, lipolysis-resistant retarders with a high CMC did not show a retarding effect.