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Since the adoption of guidelines for the non-invasive imaging diagnosis of hepatocellular carcinoma (HCC), the need for sampling of a lesion in cirrhosis has decreased. We aimed to retrospectively investigate the use of percutaneous imaging-guided biopsy for LI-RADS observations in cirrhosis in two large liver transplant centers. A review of the pathology database in the two Institutions (Institution A, Institution B) was conducted to identify patients that underwent percutaneous imaging-guided biopsy for a liver lesion in the interval time 01/01/2015-12/312020. Liver observations on pre-procedure contrast-enhanced CT or MRI were classified according to LI-RADS v2018. Among the 728 patients who underwent imaging guided biopsy of a liver lesion in Institution A, and among the 749 patients who underwent imaging guided biopsy of a liver lesion in Institution B, respectively 50 (6.8 %) and 16 (2.1 %) were cirrhotic with available pre-procedural contrast-enhanced CT or MRI. A total of 67 lesions were biopsied. 30/67 (45 %) biopsied observations were classified as LR-M. 55/67 (82 %) biopsies were positive for malignancy at histopathology and among them 33 (60 %) were HCC. In conclusion, a small percentage of percutaneous, imaging-guided biopsies for liver lesions are performed in cirrhosis, and more frequently for LR-M observations. [ABSTRACT FROM AUTHOR]

Risk factors for a primary cutaneous squamous cell carcinoma (CSCC) are well-established; however, the host and primary tumor risk factors for subsequent CSCC have not been fully explored. We performed a retrospective chart review of patients diagnosed with CSCC in an academic dermatology clinic in Rhode Island from 2016-2019. Logistic regression was used to evaluate the associations between host factors and multiple CSCC and between primary tumor characteristics and the risk of subsequent CSCC. Adjusted odds ratios (aORs) and 95% CIs were calculated. A total of 1312 patients with CSCC diagnoses were included. Host risk factors significantly associated with multiple CSCCs included: aged >80 years (aOR, 2.18; 95% CI, 1.46-3.31); history of: solid organ transplant (aOR, 2.41; 95% CI, 1.20-4.80); skin cancer (aOR, 1.96; 95% CI, 1.52-2.54); other cancer (aOR, 1.49; 95% CI, 1.11-2.00); family history of skin cancer (aOR, 1.36; 95% CI, 1.03-1.78); and actinic keratosis (aOR, 1.52; 95% CI, 1.18-1.95). Tumor location, diameter, histologic differentiation, and treatment were not significant predictors of subsequent CSCCs. Study patients were predominantly White and from a single institution, limiting the generalizability of results. Certain host characteristics were associated with the development of subsequent CSCC, which may inform clinical guidelines for follow-up. [ABSTRACT FROM AUTHOR]

Despite sleep's fundamental role in maintaining and improving physical and mental health, many people get less than the recommended amount of sleep or suffer from sleeping disorders. This review highlights sleep's instrumental biological functions, various sleep problems, and sleep hygiene and lifestyle interventions that can help improve sleep quality. Quality sleep allows for improved cardiovascular health, mental health, cognition, memory consolidation, immunity, reproductive health, and hormone regulation. Sleep disorders, such as insomnia, sleep apnea, and circadian-rhythm-disorders, or disrupted sleep from lifestyle choices, environmental conditions, or other medical issues can lead to significant morbidity and can contribute to or exacerbate medical and psychiatric conditions. The best treatment for long-term sleep improvement is proper sleep hygiene through behavior and sleep habit modification. Recommendations to improve sleep include achieving 7 to 9 h of sleep, maintaining a consistent sleep/wake schedule, a regular bedtime routine, engaging in regular exercise, and adopting a contemplative practice. In addition, avoiding many substances late in the day can help improve sleep. Caffeine, alcohol, heavy meals, and light exposure later in the day are associated with fragmented poor-quality sleep. These sleep hygiene practices can promote better quality and duration of sleep, with corresponding health benefits. [ABSTRACT FROM AUTHOR]

Purpose: To systematically review the associations between mental health and preoperative or postoperative outcomes of hip arthroscopy for femoroacetabular impingement.Methods: The literature search was conducted using the PubMed, EMBASE and PsychINFO databases following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines.Results: Nine studies were identified that met the inclusion and exclusion criteria. All studies assessing patient-reported outcomes found significantly lower patient-reported outcomes (modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports-Specific Subscale, and International Hip Outcome Tool scores) related to worse mental health functioning before surgery. Specifically, preoperative Hip Outcome Score-Activities of Daily Living and Hip Outcome Score-Sports-Specific Subscale were significantly greater in control patients than patients in the mental health group by 11.6 points (mean difference; 95% confidence interval 7.58-15.79, P < .001) and 10 points (95% confidence interval 5.14-14.87, P < .001), without significant heterogeneity between studies (I2 = 28.59, P = .25; I2 = 0, P = .93), respectively. Patients with lower mental health status also had lower rates of achieving a minimal clinically important difference in 5 studies included in this review.Conclusions: This systematic review finds consistent evidence supporting the association between negative psychological function and worse preoperative and postoperative outcomes for patients with hip disorders. Understanding both the effect of mental health on surgical outcomes and the potential benefits of psychological intervention may represent an opportunity to improve patient outcomes following hip arthroscopy.Level Of Evidence: IV, systematic review of Level II-IV studies. [ABSTRACT FROM AUTHOR]

Increased orthodontic treatment duration is associated with iatrogenic risks such as root resorption, white spot lesions etc. Recent research using pharmacological agents to accelerate tooth movement has mostly been conducted on animals and there is no reported research conducted on humans comparing the effects of Vitamin D3 and Platelet Rich Plasma (PRP) in the same subjects using a split mouth technique. To determine and compare effects of local injection of PRP and Vitamin D3 on the rate of tooth movement. Also, to assess association of external apical root resorption with the use of PRP, Vitamin D3 and compare it to a control group. 11 subjects who diagnosed with Class I bi-maxillary malocclusion and who gave informed consent were recruited in the study. The patients were randomly divided using split mouth design and each quadrant served as either experimental or control group one. At the beginning of retraction phase, Vitamin D3 and PRP were injected to the randomly assigned quadrants while the contralateral side served as a control. The amount of space closure in 4 months was measured from distal surface of canine to mesial surface of 2nd premolar. Root resorption was assessed using CBCT taken at the beginning and at the closure of retraction phase. Mean rate of tooth movement was higher in PRP and Vitamin D3 groups compared to their controls. In the PRP group, the increased rate of tooth movement was observed throughout the study interval, but in the Vitamin D3 group it was only seen in first two months. Also, the PRP group demonstrated a higher rate of tooth movement compared to Vitamin D3 group. Root resorption was lesser in both experimental groups. Among the teeth assessed, lateral incisor showed maximum root resorption and canine the least. PRP is a more efficient pharmacological agent compared to Vitamin D3 for accelerating tooth movement. [Display omitted] [ABSTRACT FROM AUTHOR]

Purpose: To (1) determine the effect of severe patella alta on lateral patellar displacement after medial patellofemoral ligament (MPFL) reconstruction and medial quadriceps tendon-femoral ligament (MQTFL) reconstruction and (2) determine whether lateral displacement significantly differs between MPFL and MQTFL reconstructions in the setting of severe patella alta (Caton-Deschamps Index [CDI] of 1.6).Methods: Eight cadaveric specimens were included. High-tensile strength suture was used to create a model of adjustable patellar height. Patellar height was set using fluoroscopy to CDI ratios of 1.0 (normal) and 1.6 (alta). Specimens underwent testing (1) with MPFL reconstruction, (2) with MQTFL reconstruction, and (3) in a medial patellofemoral complex (MPFC)-deficient control state, in randomized order, at both CDI settings: 1.0 and 1.6. Lateral patellar translation was measured at 0°, 10°, 20°, 30°, 45°, 60°, and 90° of knee flexion with 10 N of laterally directed load.Results: At a CDI of 1.6, MPFL reconstruction showed significantly lower lateral displacement than MQTFL reconstruction at 0° and 20°. When compared with MPFC-deficient controls at a CDI of 1.6, MPFL reconstruction showed significantly lower displacement at 0° and 20° whereas MQTFL reconstruction was not significantly different at any degree of flexion.Conclusions: In the setting of severe patella alta (CDI of 1.6), MPFL reconstruction results in less lateral patellar displacement than MQTFL reconstruction at 0° and 20° of knee flexion. At higher flexion angles (≥30°), there is no difference between the 2 reconstruction techniques and the CDI no longer has an effect. At a CDI of 1.0, MPFL reconstruction shows lower displacement than MQTFL reconstruction in full extension only. Surgeons performing MPFC reconstruction should evaluate patients for patella alta and consider patellar height when deciding on the reconstruction technique.Clinical Relevance: This study suggests that MQTFL reconstruction may be less stable than MPFL reconstruction in the setting of patella alta, without other known pathoanatomic factors, at early knee flexion angles. Patellar height should be considered when choosing the appropriate reconstruction technique in the absence of a distalization procedure. [ABSTRACT FROM AUTHOR]

This study investigated the impact of a mixture of six endophytic bacterial strains isolated from cucumber plants on the growth and microbiome diversity of six cucumber traditional varieties and hybrids. Six bacterial species were isolated and identified by 16 s rRNA sequencing. All the bacteria showed plant growth promoting traits. Bacillus tequilensis showed 80 % inhibition of the mycelia growth of Fusarium oxysporum f.sp. cucumarinum (Foc). Mixed culture of all the bacteria was prepared and applied back to the varieties and hybrids of cucumber plants through seed soaking. Plant growth characteristics indicated that the treated plants showed increased plant growth in terms of plant height, number of leaves, vine length, male:female flower ratio, number of fruits and fruit length. Bacteria treated plants of hybrid HiVeg Chitra recorded 19 cm increase in vine length compared to control plants. The matataxonomic analysis of leaf samples by Illumina sequencing highlighted a diverse bacterial community shift in treated plants, with significant increases in genera like Bacillus and Staphylococcus. The core microbiome analysis identified key genera such as Bacillus, Staphylococcus, Sphingomonas, Methylobacterium , etc that could be pivotal in plant growth promotion. Bacillus and Staphylococcus showed increased abundance in treated varieties, correlating with the observed in plant growth parameters thus indicating their role in growth promotion of cucumber plants. Endophytic bacterial species identified from cucumber plants when re-applied by seed soaking, they promote the plant growth by modulating the microbiome. The bacterial species identified in the study could be potential candidates as microbial bioinputs for cucumber cultivation. [ABSTRACT FROM AUTHOR]

To identify frequently studied significant preoperative risk factors for meniscal allograft transplantation (MAT) failure. Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were used to conduct this systematic review. The database analysis was performed in May 2022 and included PubMed, Embrace, and Cochrane. Studies between January 1, 2000, and January 1, 2021, were reviewed with search terms, including "meniscal," "meniscus," "transplantation," "transplant," and "allograft." Twenty-one full-text manuscripts met inclusion criteria of studies assessing preoperative risk factors for MAT failure defined as either clinical failure (Lysholm <65) or surgical failure (revision, removal, or conversion to knee arthroplasty). In total, 21 studies were included, comprising 47.6% with Level of Evidence III and 52.4% with Level of Evidence IV. The analysis involved 2,533 patients, and the mean final follow-up ranged from 2.2 to 20.0 years. The presence of high-grade cartilage defects was the only factor found predictive of MAT surgical failure in the majority of studies in which it was analyzed (5/7 studies, 71.4%). Four of the 5 studies that found high-grade cartilage defects to be a predictor of MAT surgical failure did not treat all cartilage lesions, whereas the 2 studies that found high-grade cartilage defects an insignificant predictor of MAT surgical failure treated all defects at the time of MAT. For clinical failure, no risk factors were predictive of MAT failure in the majority of studies, although smoking and concomitant ligamentous or realignment procedures were significant in 1 study. The presence of untreated high-grade cartilage appears to elevate the risk of surgical MAT failure; however, concomitant treatment of defects may mitigate their detrimental effect. There is no clear risk factor that consistently predicts clinical failure. Age, sex, body mass index, knee compartment, time from prior meniscectomy, femorotibial alignment (after correction), concomitant cartilage procedure, and laterality do not routinely influence MAT failure. Level IV, systematic review of Level III and IV studies. [ABSTRACT FROM AUTHOR]

Background: Proximal femoral replacement (PFR) is reserved as a salvage procedure after failed total hip arthroplasty (THA) or after wide margin resection of tumors involving the proximal femur. Although failure of the PFR construct remains a significant problem, indication has not previously been investigated as a risk factor for failure.Methods: This study retrospectively evaluated patients who underwent PFR over a consecutive 15-year period for primary sarcoma or metastatic disease of the proximal femur, compared with conversion to PFR after failed THA. PFR failure was defined as recurrent prosthetic dislocations, periprosthetic fracture, aseptic loosening, or infection that ultimately resulted in revision surgery.Results: Overall, 99 patients were evaluated, including 58 in the neoplasm and 41 in the failed THA cohorts. Failed THA patients were older (P < .001), with a greater proportion having comorbid hypertension (P = .008), cardiac disease (P = .014), and history of prior ipsilateral and intracapsular surgeries (P < .001). The failure rate was significantly higher in failed THA patients (39.0% vs 10.3%; P < .001) with significantly shorter implant survivorship on Kaplan-Meier analysis (P = .003). A multivariate Cox proportional hazards model showed that THA failure was the only independent predictor for PFR failure (hazard ratio: 4.26, 95% confidence interval: 1.66-10.94; P = .003).Conclusion: This study revealed significantly worse PFR implant survivorship in patients undergoing PFR for the indication of failed THA compared with neoplasm. Although the underlying etiology of this relationship remains to be explicitly outlined, poor bone quality and soft tissue integrity, multiple prior surgeries, and comorbid conditions are likely contributing factors. [ABSTRACT FROM AUTHOR]

Electrocautery is a common surgical technique and is often used during shoulder arthroplasty to elevate or transect the subscapularis tendon. The relative amount of tissue damage caused by cautery as opposed to sharp transection is not currently known. The purpose of this study was to examine local tissue damage resulting from electrocautery vs. sharp transection with a scalpel. We hypothesized that the electrosurgical unit would cause higher collateral tissue damage and cell death compared with sharp transection. Twelve cadaveric ovine shoulders were randomized to either the electrosurgical or sharp transection group. The infraspinatus tendon was isolated, and a partial-thickness transection was made using either a monopolar electrosurgical device (Bovie) or No. 10 scalpel blade. Tendon explants were then visualized with confocal microscopy to evaluate tissue architecture. A live/dead assay was performed using microscopy imaging analysis software. Comparisons between Bovie and scalpel transection were made using the Mann-Whitney U test, and the cell death percentage at standardized distances from the transection site was compared between groups using a mixed-model analysis. Significance was defined at P <.05. The cellular and tendon fibril architecture was well maintained beyond the scalpel transection site, whereas Bovie transection disrupted the architecture beyond its transection path. The percentage of dead cells in the Bovie group (74.9% ± 31.2%) was significantly higher than that in the scalpel group (27.6% ± 29.9%, P =.0004). Compared with the transection site, the cell death percentage after Bovie transection significantly declined at 2.5 mm whereas that after scalpel transection significantly declined at 1 mm from the transection site. There was a significantly higher dead cell percentage in the Bovie transection group, indicating extensive damage beyond the local incision site, compared with sharp transection. Electrosurgical transection of the ovine infraspinatus tendon ex vivo caused higher cell death and greater tissue architecture disruption compared with sharp scalpel transection. [ABSTRACT FROM AUTHOR]

Rotator cuff repair in the setting of a chronic tear or poor tissue quality presents a surgical challenge because of the high risk of structural failure. Patients with an increased risk of retear may be candidates for enthesis augmentation with a novel, biphasic allograft, composed of a demineralized cancellous matrix with a layer of mineralized bone. This interpositional graft was designed with the intention to promote both soft-tissue and osseous integration into the matrix, thereby conferring greater stability and regeneration of the transitional zone of the rotator cuff enthesis. Here, we describe a technique for a transosseous-equivalent supraspinatus repair with placement of a biphasic interpositional allograft. [Display omitted] [ABSTRACT FROM AUTHOR]

Repetitive transcranial magnetic stimulation (rTMS) has been found to be helpful for the treatment of obsessive-compulsive disorder (OCD). However, the relative efficacy of different rTMS protocols is unclear. To conduct a systematic review and network meta-analysis (NMA) of published literature to compare the relative efficacy of different rTMS protocols for decreasing Yale-Brown Obsessive Compulsive Severity (Y-BOCS) scores in patients with OCD. Relevant articles published between 1985 to September 2023 were searched from the Cochrane Central Register of Controlled Trials, PubMed and PsycInfo. Double or single-blinded randomized controlled studies conducted on patients with OCD comparing an active rTMS protocol with either another active or sham rTMS protocol were included. Network meta-analysis (NMA) was conducted using a frequentist approach. Standardized mean difference (SMD) of change in Y-BOCS scores was calculated employing Hedge's g. Pairwise meta-analysis using random effects model was conducted which was extended to the NMA using restricted maximum likelihood estimation procedure. Surface under the cumulative ranking (SUCRA) probabilities were used to rank the interventions. Excitatory rTMS of the bilateral dorsolateral prefrontal cortex (DLPFC), inhibitory rTMS of right DLPFC, inhibitory as well as excitatory rTMS of bilateral medial prefrontal cortex/anterior cingulate cortex (mPFC/ACC) and inhibitory rTMS of bilateral supplementary motor area (SMA) were superior to sham stimulation. The DLPFC and mPFC/ACC protocols had a higher probability of being among the top-ranked interventions. The majority of studies had a modest sample size and at least some concerns in the risk of bias assessment. rTMS targeting either the medial or lateral prefrontal cortices is a promising intervention for resistant OCD. There is a need to confirm these findings in large systematic studies. [ABSTRACT FROM AUTHOR]

The lateral patellofemoral complex is an important stabilizer to medial and lateral displacement of the patella. Soft tissue abnormalities can range from pathologic tightness to laxity, presenting with symptoms related to patellar instability, anterior knee pain, or arthritis. Clinical evaluation should be performed to confirm patellar dislocation, assess the integrity of the lateral and medial soft tissues, and explore other pathoanatomic factors that may need to be addressed. Lateral retinacular lengthening is recommended over lateral release owing to the potential of iatrogenic medial instability with release, and a lateral patellofemoral ligament reconstruction can be performed to effectively treat medial instability. [ABSTRACT FROM AUTHOR]

The emergence of many infectious diseases has been of serious public health implication in the 21st century. Hospital preparedness is a key step in strengthening a country's ability to address any public health emergency of international concern caused by these diseases. In India, because 80% of the health-care utilization happens in the private hospitals, it is of at most importance to assess the preparedness level of these hospitals against emerging infectious diseases. The study was a cross-sectional study, and hospitals which provided consent were included. The estimated participants for the study were 54. The results were expressed in a descriptive manner. For the purpose of analysis, the questionnaire was redistributed based on the monitoring and evaluation framework of International Health Regulations and its core capacities. It was found that there was a need to enhance the preparedness of the hospitals in the response against emerging infectious diseases. There were gaps in the implementation of various plans and protocols for staff training, risk communication, surge capacity, laboratory capacity, and infection control in the hospitals. The findings were suggestive of a need for preparedness of the hospitals against the upsurge of emerging infectious diseases. [ABSTRACT FROM AUTHOR]

Patellar instability is a complex disorder with multiple etiologies, and treatment must be individualized to the unique pathoanatomy of each patient. Medial patellofemoral ligament reconstruction is one of the most commonly performed procedures for the treatment of patellar instability. Patients with a symptomatic supratrochlear spur, defined by the presence of a "jumping" J sign on examination, also may benefit from an adjunctive proximal trochlear resection. Here, we describe a technique for an arthroscopic proximal trochlear resection, or "bumpectomy," involving resection of the supratrochlear spur. In appropriately indicated patients, we have found this procedure to be a useful adjunct to medial patellofemoral ligament reconstruction without the need for concurrent trochlear sulcus deepening. [Display omitted] [ABSTRACT FROM AUTHOR]

Urinary tract infections (UTI) are a common reason for emergency department (ED) and urgent care (UC) visits. Fluoroquinolones (FQ) are frequently prescribed for treatment of UTI in the outpatient setting; however, data evaluating prescribing patterns after FDA safety warnings is limited, especially in UC. The study goal was to investigate and compare antimicrobial prescribing for UTIs in a single-site ED and an off-site UC in an urban, academic health system. This retrospective study included patients presenting with a UTI to the ED or UC between January and June 2018. Those 18 years or older with uncomplicated, complicated UTI, or pyelonephritis were included. Exclusion criteria were catheter-related UTI, urinary tract abnormalities, immunocompromised, or hospitalization. Primary outcome was FQ prescribing rate for all UTI in the ED and UC. Secondary outcomes were rates of non-FQ prescribing, re-presentation, bug-drug mismatch, and treatment durations. 184 patients were included. FQ prescribing rate was similar in ED and UC (21.2% vs. 16.3%, p = 0.4). Non-FQs prescribed in ED and UC were nitrofurantoin (20.2% vs 53.6%), beta-lactams (46.1% vs 22.6%), and trimethoprim/sulfamethoxazole (12.5% vs. 5%). A longer than recommended duration was identified in 46.3% UC patients compared to 21.2% ED patients. Thirty-day re-presentation with persistent UTI symptoms occurred more frequently in the ED compared to UC (13.5% vs. 7.5%). Predictors of FQ prescribing on logistic regression were male, recurrent UTI, and malignancy. FQ prescribing rate for UTI treatment was low with no difference between ED and UC. Opportunity exists to improve treatment duration and antimicrobial choice. [ABSTRACT FROM AUTHOR]

We present the case of a 93-year-old woman with dementia, with no pertinent cardiac history except for hyperlipidemia, who presented to the emergency department with six months of progressive dysphagia, weakness, and falls. While she had no seemingly cardiac symptoms and or remarkable cardiovascular examination features, the patient's initial electrocardiogram (ECG) showed occasional brief pauses with no atrial or ventricular activity. Computer interpretation of the rhythm was "sinus pause," but upon closer investigation, the true diagnosis was different, but with potential to be equally ominous if not accurately recognized and appropriately managed. [ABSTRACT FROM AUTHOR]

Background: Cardiac sympathetic denervation (CSD) is an important adjunctive option for patients with refractory ventricular arrhythmias (VAs). Reports of efficacy of CSD in patients with structural heart disease (SHD) and refractory VA vary widely in literature.Objective: The purpose of this study was to conduct a systematic review of arrhythmic outcomes and complications in patients with SHD who underwent CSD due to recurrent VAs.Methods: Electronic databases (Google Scholar and PubMed) were searched to identify reports on CSD in SHD using appropriate medical subject terms. No sample size restriction was applied. All patients with known channelopathies were excluded. Baseline demographic and surgical data, arrhythmic outcomes, and procedural complications were evaluated.Results: A total of 13 studies and 173 patients were included. Of the 173 patients (121 [70%] male); pooled mean age 54.6 [95% confidence interval 52.6-56.7] years), 48 (28%) had ischemic cardiomyopathy, and 141 (82%) underwent bilateral CSD. Overall freedom from events ranged from 58% to 100%. Complications were reported in 49 patients(28%). Transient hypotension (9%), pneumothorax (5%), neuropathic pain (skin sensitivity) (4%), Horner syndrome (3%), sweating pattern changes (3%), and hemothorax (2%) were the most common complications. No procedure-related deaths were reported.Conclusion: CSD reduced the number of VA events in patients with SHD, and the benefit from the intervention seemed to be independent of the underlying SHD. Although overall rate of postprocedural complications was high, most of the complications were temporary. Major postprocedural complications after CSD were infrequent. [ABSTRACT FROM AUTHOR]

Brominated flame retardants (BFRs) are a class of compounds with many persistent, toxic, and bioaccumulative members. BFRs have been widely detected in breast milk, posing health risks for breastfeeding infants. Ten years after the phaseout of polybrominated diphenyl ethers (PBDEs) in the United States, we analyzed breast milk from 50 U.S. mothers for a suite of BFRs to assess current exposures to BFRs and the impact of changing use patterns on levels of PBDEs and current-use compounds in breast milk. Compounds analyzed included 37 PBDEs, 18 bromophenols, and 11 other BFRs. A total of 25 BFRs were detected, including 9 PBDEs, 8 bromophenols, and 8 other BFRs. PBDEs were found in every sample but at concentrations considerably lower than in previous North American samples, with a median ∑PBDE concentration (sum of 9 detected PBDEs) of 15.0 ng/g lipid (range 1.46–1170 ng/g lipid). Analysis of time trends in PBDE concentrations in North American breast milk indicated a significant decline since 2002, with a halving time for ∑PBDE concentrations of 12.2 years; comparison with previous samples from the northwest U.S region showed a 70% decline in median levels. Bromophenols were detected in 88% of samples with a median ∑ 12 bromophenol concentration (sum of 12 detected bromophenols) of 0.996 ng/g lipid and reaching up to 71.1 ng/g lipid. Other BFRs were infrequently detected but concentrations reached up to 278 ng/g lipid. These results represent the first measurement of bromophenols and other replacement flame retardants in breast milk from U.S. mothers. In addition, these results provide data on current PBDE contamination in human milk, as PBDEs were last measured in U.S. breast milk ten years ago. The presence of phased-out PBDEs, bromophenols, and other current-use flame retardants in breast milk reflects ongoing prenatal exposure and increased risk for adverse impacts on infant development. [Display omitted] • Brominated flame retardants (BFRs) were detected in 100% of breast milk samples from U.S. mothers. • Bromophenols were detected for the first time in breast milk from U.S. women. • PBDE levels were 70% lower than samples from the same region taken in 2003. • Presence of BFRs in breast milk raises concerns about harm to infant development. [ABSTRACT FROM AUTHOR]

Academic support in the form of formal, peer-led study groups was initiated at a four-year college of pharmacy utilizing paid group facilitators and a student program coordinator under the direction of the Associate Dean for Student Affairs. This study's purpose was to assess the first year of this program from the viewpoints of the student participants, study group facilitators, and faculty. Student, study group facilitator, and faculty perceptions of the study group initiative were collected following the first year of operation via cross-sectional surveys and qualitative content analysis. Surveys addressed the perceived value of study groups and their impact on study habits, supportive relationships, and professional growth. A five-point Likert scale was used to note participants' level of agreement with each survey item, while open-ended questions gathered subjective feedback. The mean, standard deviation, and frequency were calculated for each survey item across the three participant groups and qualitative themes from free-responses were identified. Student survey responses overwhelmingly supported the value and continuation of study groups (93% to 100% agreed or strongly agreed), with both participants and facilitators expressing enthusiasm for the program. Facilitators felt adequately trained (85.7%) and that their roles positively influenced their professional development (85.7% to 100%). Faculty respondents agreed that the program was valuable and should be continued. Overall, students and facilitators perceived study groups to be valuable in supporting the academic success of pharmacy students. [ABSTRACT FROM AUTHOR]

Background: Breast cancer has the highest incidence of cancers in women in the United States. Previous research has shown that screening mammography contributes to reduced breast cancer mortality. This study aimed to clarify why late screening might occur in an at-risk population.Materials and Methods: This study was a prospective cross-sectional study including 758 patients presenting to our radiology department for routine screening mammography who completed a 30-question survey regarding personal characteristics and mammography history. Univariate and multivariate logistic regression were performed to determine whether survey responses correlated with late screening.Results: Of the 758 patients, 184 (24%) were noncompliant with screening mammography guidelines. Risk factors for late screening included younger age (P = 0.001), white race/ethnicity (P = 0.03), self-reported lack of financial means or health insurance (P = 0.005), lack of satisfaction with a previous mammogram experience (P = 0.001), inadequate mammography education by a physician (P = 0.001), and lack of awareness/comprehension of screening mammography guidelines (P = 0.002).Conclusion: Many factors contribute to late screening mammography. Although some are outside physician control, others can be influenced: patient education regarding screening mammography guidelines, and patient satisfaction with the mammography experience. This study highlights the importance of communication with and education of patients. [ABSTRACT FROM AUTHOR]

Abstract Background and purpose A research-focused capstone course was designed to improve flexibility in the way pharmacy students meet the university's capstone requirement. The requirement aims to integrate knowledge, skills, and attitudes from didactic coursework and to apply them in a scholarly way to improve critical and evidence-based thinking, communication skills, and professionalism. This report describes the capstone course and faculty and student perceptions after the first year of implementation. Educational activity and setting The course allows students to work with a faculty advisor on a four-semester hour research project of mutual interest that can be completed in any one of three semesters. After the first student cohort completed their projects, faculty and student perceptions were captured via electronic survey. Findings A total of 38 students (36%) and 22 advisors (71%) responded to the survey. Approximately 90% of students and faculty agreed that student groups had achieved course objectives upon completion. Although faculty members felt that participating in the capstone course increased their workload and in some cases reduced their productivity, faculty members felt that the course had a beneficial impact for students. Summary: The new capstone course was well received. The flexibility of the course was both a strength and a limitation as most students wanted more structure in the expectations and grading of the project in the form of a rubric or other standardized assessments. [ABSTRACT FROM AUTHOR]

Highlights • Antimicrobial resistance is a major issue confronting healthcare providers and their patients. • Empirical antimicrobial therapy should be composed of antimicrobials to cover Gram-positive and Gram-negative organisms. • The antibiogram suggests that certain pathogens still remain sensitive to number of antimicrobial agents. • No single antimicrobial agent can cover all possible pathogens isolated from diabetic foot infections. Abstract Purpose Diabetic foot infections (DFIs) are major public health concerns. In the view of the ever increasing burden of multidrug-resistant (MDR) organisms, improving the use of antimicrobial agents (AMAs) is a national priority. Objective of the study was to determine antimicrobial susceptibility (AMS) pattern of aerobes in DFIs. Methods A cross-sectional study was conducted for a period of 3 years at Department of Surgery, Kasturba hospital, Manipal, India during which, 260 diabetic foot ulcer (DFU) patients admitted in the general surgery wards were enrolled for the study. These patients' culture specimens were observed as Gram-stained smears and cultured aerobically on blood agar and MacConkey agar plates. AMS test was performed by disc diffusion technique according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Results A total of 354 microbes were isolated from the ulcer wounds of 213 diabetic foot patients, with an average of 1.7 organisms per lesion. Monomicrobial infections were less common (n = 81; 31.2%) than polymicrobial infections (n = 132; 50.7%). Gram-negative bacteria were the most common among the isolates (n = 192; 54.2%). Aerobic Gram-positive Cocci accounted for 162 (45.8%) of all isolates. On the other hand, Staphylococcus aureus was the most frequently isolated aerobe (n = 106; 29.9%) followed by Pseudomonas aeruginosa (n = 91; 25.7%). Conclusion AMS data from our study recommends that doxycycline would be the appropriate choice as single drug for empirical coverage for Gram-positive organisms. The most appropriate antibiotic for Gram-negative organisms is meropenem. One of the critical observations is the presence of Acinetobacter, an MDR isolated from DFIs, which is either relatively or totally resistant to all the AMAs tested. [ABSTRACT FROM AUTHOR]

to determine the oral health practices in patients with DM and to identify their perspectives on treatment-seeking for oral health. We conducted a cross-sectional study in the diabetes clinic of a government hospital in Delhi, India. Data was collected through face-face interviews with the patients. We enrolled a total of 339 participants having a mean (SD) age of 46.1 (5.4) years. An optimal glycemic control was present in 109 (32.2%) participants. Self-reported poor or very poor condition of teeth and gums was reported by 161 (47.5%) and 69 (20.35%) participants, respectively. The awareness that DM worsens oral health was correctly reported by 15.2% participants. The prevalence of twice-daily brushing was 18.6%, and 15.6% participants underwent a dental examination in the previous 12 months. There exists a high prevalence of poor oral care despite unsatisfactory oral health status among patients with DM in India. We recruited 339 patients with DM in Delhi, India. Twice-daily brushing was practiced by 18.6% participants. Self-reported poor or very poor condition of teeth and gums was reported by 47.5% and 20.3% participants, respectively. Patients avoided dental visits when asymptomatic, if not referred and due to fatalistic health beliefs. • We interviewed face-face 339 Diabetes patients in the outpatient setting of a tertiary care government hospital in Delhi. • Self-reported poor or very poor condition of teeth and gums was reported by 47.5% and 20.3% patients, respectively. • Patients avoided dental visits when asymptomatic, not referred, costs involved and occasionally fatalistic health beliefs. [ABSTRACT FROM AUTHOR]

Periodontitis is a chronic bacterial infection of tooth that increases the risk of systemic diseases like diabetes, cancer, and cardiovascular diseases. Although it has been have found altered lipids in periodontitis patients, its gene regulation is largely unknown. This study aimed to examine the lipid meditated regulatory network in periodontitis that may helpful in early detection of periodontal mediated systemic diseases. We employed a high-throughput gene expression data of 1) patients with periodontitis (n = 6); 2) the periodontitis patients with dyslipidemia (n = 6); and 3) healthy control group (n = 6). The over represented (DEGs) genes in SET-A (control vs. periodontitis) and SET-B (control vs. periodontitis with dyslipidemia) was identified. The protein interaction network was generated for the over represented genes in both the conditions. The constructed network was dissected into multiple regulatory clusters, containing over expressed transcription factors with its interacting proteins. Further the behavior of the clusters was determined through gene ontology and molecular pathways. On expression analysis, 751 in SET-A and 561 in SET-B were over expressed compared to healthy control. Using over expressed genes, protein interaction networks were constructed for SET-A and SET-B, respectively. Topological analysis revel the difference in the complexity of both the network. Four regulatory clusters (ESR1, FOS, RUNX2, and SP1) from SET-A and six (ESR1, ESR2, FOS, JDP2, PBX1, and TAL1) from the SET-B network was extracted. Each cluster displayed a variety of molecular mechanism associated with immune system, cell cycle, and signal processing. Clusters from SET-B showed diverse regulatory pattern in associated with cancer, neurological, psychiatric and metabolic diseases. Our findings demonstrate difference in regulatory patterns between periodontitis and periodontitis with dyslipidemia. These finding may provide evidence for dyslipidemia mediated periodontitis contribute to progressive systemic diseases. Further experiments are required to validate these regulators as biomarkers and drug targets. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare failure rates and patient-reported outcomes between transosseus (TO) suture and suture anchor (SA) quadriceps tendon repairs. Following institutional review board approval, patients who underwent primary repair for quadriceps tendon rupture with TO or SA techniques between January 2009 and August 2018 were identified from an institutional database and retrospectively reviewed. Patients were contacted for satisfaction (1-10 scale), current function (0-100 scale), failure (retear), and revision surgeries; International Knee Documentation Committee (IKDC) score and Knee Injury and Osteoarthritis Outcomes Score (KOOS) were also collected to achieve a minimum of 2-year follow-up. Sixty-four patients (34 SA, 30 TO) were available by phone or e-mail at a mean of 4.81 ± 2.60 years postoperatively. There were 10 failures, for an overall failure rate of 15.6%. Failure incidence did not significantly differ between treatment groups (P =.83). Twenty-seven patients (47% of nonfailed patients) had completed patient-reported outcomes. The SA group reported higher subjective function (SA: 90 [85-100] vs TO: 85 [60-93], 95% CI of difference: –19.9 to –2.1 × 10–5, P =.042), final IKDC (79.6 [50.0-93.6] vs 62.1 [44.3-65.5], 95% CI of difference: –33.0 to –0.48, P =.048), KOOS Pain (97.2 [84.7-97.2] vs 73.6 [50.7-88.2], 95% CI of difference: –36.1 to –3.6 × 10–5, P =.037), Quality of Life (81.3 [56.3-93.8] vs 50.0 [23.4-56.3], 95% CI of difference: –50.0 to –6.2, P =.026), and Sport (75.0 [52.5-90.0] vs 47.5 [31.3-67.5], 95% CI of the difference: –45.0 to –4.1 × 10–5, P =.048). There is no significant difference in failure rate between transosseus and suture anchor repairs for quadriceps tendon ruptures (P =.83). Most failures occur secondary to a traumatic reinjury within the first year postoperatively. Despite the lack of difference in failure rates, at final follow-up, patients who undergo suture anchor repair may report significantly greater subjective function and final IKDC, KOOS Pain, Quality of Life, and Sport scores. III, retrospective cohort study. [ABSTRACT FROM AUTHOR]

A bioflocculant-producing bacterial strain, designated MSI021, was isolated from the marine sponge Dendrilla nigra and demonstrated 94% flocculation activity in a kaolin clay suspension. MSI021 was identified as Bacillus cereus based on phylogenetic affiliation and biochemical characteristics. The purified extra-cellular bioflocculant was chemically elucidated as a polysaccharide molecule. The polysaccharide bioflocculant was stable under both acidic and alkaline conditions (pH 2.0–10.0) and temperatures up to 100 °C. The purified bioflocculant efficiently nucleated the formation of silver nanoparticles which showed broad spectrum antibacterial activity. The ability of the bioflocculant to remediate heavy metal toxicity was evaluated by measuring the inhibition of bioluminescence expression in Vibrio harveyi . Enrichment of heavy metals such as zinc, mercury and copper at concentrations of 1, 2 and 3 mM in culture media showed significant reduction of bioluminescence in Vibrio , whereas media enriched with heavy metals and bioflocculant showed dose dependent improvement in the expression of bioluminescence. The assay results demonstrated that the polysaccharide bioflocculant effectively mitigates heavy metal toxicity, thereby improving the expression of bioluminescence in Vibrio . This bioluminescence reporter assay can be developed into a high-throughput format to monitor and evaluate of heavy metal toxicity. The findings of this study revealed that a novel polysaccharide bioflocculant produced by a marine B. cereus demonstrated strong flocculating performance and was effective in nucleating the formation antibacterial silver nanoparticles and removing heavy metals. These results suggest that the MSI021 polysaccharide bioflocculant can be used to develop greener waste water treatment systems. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is a multifactorial neurodegenerative disease involving oxidative stress, neuroinflammation and apoptosis. Epoxyeicosatrienoic acids (EETs) are arachidonic acid metabolites and they play a role in cytoprotection by modulating various cell signaling pathways. This cytoprotective role of EETs are well established in cerebral stroke, cardiac failure, and hypertension, and it is due to their ability to attenuate oxidative stress, endoplasmic reticulum stress, inflammation, caspase activation and apoptosis. The actions of EETs in brain closely parallel the effects which is observed in the peripheral tissues. Since many of these effects could potentially contribute to neuroprotection, EETs are, therefore, one of the potential therapeutic candidates in PD. Therefore, by increasing the half life of endogenous EETs in vivo via inhibition of sEH, its metabolizing enzyme can, therefore, constitutes an important therapeutic strategy in PD. [ABSTRACT FROM AUTHOR]

Seismic retrofitting is the modification of existing structures so as to improve the system behaviour or its components repair/strengthening up to the performance it is expected. Detailed seismic evaluation and assessing the vulnerability of the structure are the key ingredients in order to arrive at an appropriate retrofitting scheme. This study proclaims a complete process of retrofitting on a building designed with two different philosophies i.e., as per IS 456: 2000 and IS 1893 (Part 1): 2002 and retrofitted with steel bracing. The fragility analysis was also carried out to indicate the probability of damage under different states which reduces considerably after retrofitting of building. [ABSTRACT FROM AUTHOR]

Two dissimilar magnesium (Mg) alloy sheets, one with low aluminium (AZ31) and another with high aluminium (AZ91) content, were successfully joined by friction stir welding (FSW). The effect of process parameters on the formation of hot cracks was investigated. A sound metallurgical joint was obtained at optimized process parameters (1400 rpm with 25 mm/min feed) which contained fine grains and distributed β (Mg 17 Al 12 ) phase within the nugget zone. An increasing trend in the hardness measurements has also confirmed more amount of dissolution of aluminium within the nugget zone. A sharp interface between nugget zone and thermo mechanical affected zone (TMAZ) was clearly noticed at the AZ31 Mg alloy side (advancing) but not on the AZ91 Mg alloy side (retreating). From the results it can be concluded that FSW can be effectively used to join dissimilar metals, particularly difficult to process metals such as Mg alloys, and hot cracking can be completely eliminated by choosing appropriate process parameters to achieve sound joint. [ABSTRACT FROM AUTHOR]

Nothing to disclose. None. Metabolic syndrome has been extensively studied to understand its consequences on systemic vascular system. Conversely, the significance of metabolic syndrome on pulmonary arterial system remains to be elucidated. The role of metabolic diseases in PAH has gained increasing interest in recent years. We conducted this study to identify the association and outcomes of metabolic syndrome in patients with PAH. To identify the association and outcomes of metabolic syndrome in patients with pulmonary arterial hypertension We conducted a retrospective analysis of the 2016 to 2018 Nationwide Inpatient Sample. Adult patients with PAH and metabolic syndrome (age ≥ 18) were selected using the ICD-10 diagnosis code. Discharge-level weight analysis was used to produce a national estimate. A univariate and multivariable hierarchal regression analysis was performed to calculate odds ratio (OR). During the study period, 90,902,481patients were hospitalized of which 150,095 (0.17%) had metabolic syndrome. Metabolic syndrome patients tended to be male (53.1% vs 57.8%), obese (64.0% vs 16.5%), hypertensive (46.1% vs 34.4%) and diabetic (58.5% vs 26.4%). Mean age was similar in both groups (57.7 SE 0.09 vs 57.9 SE 0.005). After adjusting for age, sex and comorbidity burden, metabolic syndrome increased the risk for PAH (OR 1.8; 1.2-2.8; p= 0.006). Among those who developed PAH, metabolic syndrome was associated with higher risk of major adviser cardiac events (OR 3.6; 1.0- 12.5; p=0.04). However, in-hospital mortality (p=0.9), length of stay (p=0.4), acute coronary syndrome (p=0.1), acute respiratory failure (p=0.6) and acute heart failure (p=0.8) were not influenced by metabolic syndrome in PAH. In conclusion, metabolic syndrome was associated with higher risk of pulmonary arterial hypertension. However, in-hospital mortality, complications and length of stay were not affected. Further studies are needed to explicate the association of metabolic syndrome and PAH as well as to develop potentially effective therapies. [ABSTRACT FROM AUTHOR]

Nothing to disclose. None. Hypertriglyceridemia (HTG) is a known independent risk factor for coronary heart disease (CHD). However, there has been a paucity of data on the racial difference in patients with HTG and its association with CHD. To identify the effects of race on development of hypertriglyceridemia and associated complications. We conducted a retrospective analysis of the 2016 to 2018 Nationwide Inpatient Sample. Adult patients with HTG (age ≥ 18) were selected using the ICD-10 diagnosis code. Discharge-level weight analysis was used to produce a national estimate. A univariate and multivariable hierarchical regression analysis were performed to calculate odds ratio (OR). During the study period, 90,856,281 patients were hospitalized of which 350,250 (0.39%) had HTG. The most common races patients identified themselves as, in descending order of frequency, were White (69.7%), Hispanic (14.5%), Black (8.8%), Asian (3.4%), and Native American (0.4%). The population with the highest prevalence of HTG was Hispanic (0.5%), followed by Asian (0.48%), Native American (0.41%), White (0.4%), and Black (0.22%). After adjusting for age, sex, obesity, and comorbidity burden, Black (OR 0.46; p < 0.001) and Native American races (OR 0.86; p = 0.001) decreased the risk of HTG and Hispanic (OR 1.14; p < 0.001) and Asian (OR 1.33; p < 0.001) populations had the elevated risk of it compared to White population. Among those who developed HTG, Asian patients had the lowest proportion of obesity (BMI > 30) (19.5%; mean 33.1% of whole population) and White patients had the lowest prevalence of diabetes (47.4%; mean 49.7%). After adjusting for age, sex and comorbidity burden, Black (OR 0.69; p < 0.001), Hispanic (OR 0.73; p < 0.001) and Asian (OR 0.75; p < 0.001) populations were related to lower risk of CHD compared to White race. There was no significant difference in hospital mortality of CHD among different races (p=0.33). Also, race did not affect the risk of ischemic or hemorrhagic strokes in patients with HTG(p=0.39). The incidence of HTG was the highest in Hispanic and the lowest in Native American races. Also, Hispanic and Asian populations were associated with elevated risk of HTG. White patients with HTG were at higher risk of CHD than other ethnicities. Further studies are need to understand the racial-specific risk factors contributing to the observed difference in HTG and CHD. [ABSTRACT FROM AUTHOR]

Nothing to disclose. None. Socioeconomic status (SES) reflected by patients' ZIP code may detrimentally influence a healthcare access, education level and dietary options which affect the development of dyslipidemia (DL) and associated complications. There has been a lack of updated data on socioeconomic disparities in dyslipidemia and hospital complications. To identify the effects of socioeconomic status on dyslipidemia and its complications. We conducted a retrospective analysis of the 2016 to 2018 Nationwide Inpatient Sample. Patients with DL were selected using the ICD-10 diagnosis. SES was evaluated using median household income of patients' ZIP code and dived into quarter. Discharge-level weight analysis was used to produce a national estimate. A univariate and multivariable hierarchical regression analysis was performed to calculate Odds Ratio (OR). During the study period, 90,856,281 patients were hospitalized of which 27,529,453 patients (30.3%) had DL. 30.4% were from the lowest (1st) quartile followed by 26.4%, 23.4% and 19.6% in ascending order of quartile. The prevalence of DL increased in ascending order of quartile (28.5% vs 30.5% vs 31.2% vs 32.0%). Obesity (17.6% vs 14.3% of 4th quartile) and diabetes (29.8% vs 21.8% of 4th quartile) were the most prevalent in the lowest quartile. After adjusting for age, sex, race, and comorbidity burden, the highest quartile was associated with elevated risk of DL compared the lowest quartile (OR 1.1; 1.1-1.1; p < 0.001). Among those who developed DL, the lowest quartile was at the highest risk for coronary heart diseases (OR 1.2; 1.2- 1.2; p < 0.001) and peripheral artery diseases (OR 1.3; 1.2-1.3; p < 0.001). There is no significant difference in the rate of an ischemic stroke by SES (p = 0.79), but the highest quartile was associated with higher risk for a hemorrhagic stroke (OR 1.3; 1.2-1.3; p < 0.001). The prevalence of DL increased with higher SES even with lower proportion of obesity and diabetes. However, the associated complications including coronary heart diseases and peripheral artery disease increased in the lowest SES except hemorrhagic strokes. It may reflect the different healthcare utilization pattern by SES and warrants further study and public intervention to improve DL associated complications in patients from low SES.+++++ [ABSTRACT FROM AUTHOR]

A self-determined, autonomous and socially integrated life is nearly impossible for hearing-impaired persons of all ages. Hearing damage affects 16% of the European and 11.5% of the US population, but only every fifth is wearing a hearing aid as they are not able to restore the biological listening experience and allow no interactive influence on it. Thus, a natural user interface is presented as an artificial simulation for an interactive enhancement of the user-preferred sound source. Therefore, established blind source separation algorithms are ported on a smartphone with Android operating system and their performance is evaluated regarding efficiency and robustness. [ABSTRACT FROM AUTHOR]

The objective of this work is to formulate and evaluate an emulgel containing calcipotriol for treatment of psoriasis. Emulgels have emerged as a promising drug delivery system for the delivery of hydrophobic drugs. Isopropyl alcohol and polyethylene glycol have been employed as permeation enhancers. Formulation chart is made with seven formulations, evaluated for physical parameters, drug content, viscosity, thixotropy, spreadability, extrudability, mucoadhesion, diffusion studies, skin irritation test along with short term stability studies. Carbopolis is reported to have a direct influence on appearance and viscosity of final formulation. The photomicroscopic evaluations showed the presence of spherical globules in size range of 10–15 μm. Rheograms revealed that all the formulations exhibited pseudoplastic flow. Optimized formulation (F6) had shown 86.42 ± 2.0% drug release at the end of 8 h study. The release rate through dialysis membrane and rat skin is higher when compared to commercial calcipotriol ointment. Hence it is concluded that calcipotriol can be delivered topically with enhanced penetration properties when formulated as emulgel. [ABSTRACT FROM AUTHOR]

Meniscus repairs for vertical, peripheral tears can be troublesome due to poor tissue quality and/or vascularity that can lead to re-rupture and subsequent removal. The gold standard, inside-out repair technique, has been challenged by all-inside devices for the benefit of improved efficiency and less morbidity but for the sake of expense and potential structural inferiority. Successful meniscus repair requires multiple components, only one of which is deciding the repair construct of choice. I feel the most important aspect will always be the indication based on tear configuration while respecting biology, because all fixation will eventually fail if the meniscus does not ultimately heal. While all-inside devices may have biomechanical properties that are similar to inside-out techniques, the burden of proof still lies on showing superiority of these devices in a clinical setting. Clinically, I still use inside-out repair techniques for large tears or for high-demand patients due to its structural integrity and small penetration of the meniscus. [ABSTRACT FROM AUTHOR]

Abstract: This paper describes a system for tuning PI controller of cascade control system. The tuning approach is based on Evolutionary Multiobjective Optimization Algorithm (EMOA). The EMOA used are NSGA-II (Non Dominated Sorting Genetic Algorithm-II) and NSPSO (Non Dominated Sorting Particle Swarm Optimization). In the proposed method, steady state analysis and disturbance rejection are the objectives considered. Therefore Multiobjective optimization technique is used. PI controllers are used for controlling both level and flow process. PI controllers are preferred for a fast process like flow, the reason being its faster than other conventional controllers. The multiobjective optimization results in approximation of Pareto fronts. The final optimal solution is selected based on the objectives. Simulation results obtained using NSGA-II and NSPSO are compared. [Copyright &y& Elsevier]

Buerger's disease (BD) is a peripheral vascular disease, the etiology of which was largely unknown until recently. Currently, various studies demonstrated the involvement of heavy metals in tobacco and other source as one of the causative factors. Heavy metals induce vascular dysfunction by inducing high oxidative stress, reducing the activities of endothelial nitric oxide synthase and enhancing the phosphorylation of myosin light chain kinases. Targeting and modulating these pathological mechanisms may provide novel pharmacological intervention to halt the progression of the BD. Hence, we hypothesized that chelating agents and antioxidants alone or combination therapy can help manage BD. [ABSTRACT FROM AUTHOR]

Down syndrome is one of the most common congenital genetic disorders. Generally, individuals with Down syndrome presents perceptually strained, husky, monotonous, raucous and a typically low pitched voice quality. There are very few attempts made to investigate objective voice characteristics in these individuals. Further, there is no reported data with a specific focus on laryngeal aerodynamics in these individuals. Hence the present study aimed at performing perceptual (GRBAS scale) and laryngeal aerodynamic assessments of the voice (Aeroview 1.4.4 version. The clinical group consists of 17 children with down syndrome (12 boys and 5 girls) aged 4.5 to 10 years. The obtained results were compared with that of an age-matched typically developing control group. Perceptual evaluations showed significant differences in the group of children with Down syndrome. The laryngeal aerodynamic evaluation revealed significantly increased ESGP and LAR in children with down syndrome than the control group on Mann-Whitney U at p<0.005. Though MAFR values were found to be less in these individuals compared to controls, the difference was not statistically significant on Mann-Whitney U at p<0.005. Hence, the author concluded that laryngeal hyper function as a plausible cause for the strained and guttural quality of voice in children with down syndrome. It is also highlighted to verify the efficacy of manual therapies and physiological voice therapies to improve vocal efficiency in these children. [ABSTRACT FROM AUTHOR]

Background: Polycystic ovary syndrome is the most common endocrine disorder affecting women of reproductive age. A number of criteria have been developed for clinical diagnosis of polycystic ovary syndrome, with the Rotterdam criteria being the most inclusive. Evidence suggests that polycystic ovary syndrome is significantly heritable, and previous studies have identified genetic variants associated with polycystic ovary syndrome diagnosed using different criteria. The widely adopted electronic health record system provides an opportunity to identify patients with polycystic ovary syndrome using the Rotterdam criteria for genetic studies.Objective: To identify novel associated genetic variants under the same phenotype definition, we extracted polycystic ovary syndrome cases and unaffected controls based on the Rotterdam criteria from the electronic health records and performed a discovery-validation genome-wide association study.Study Design: We developed a polycystic ovary syndrome phenotyping algorithm on the basis of the Rotterdam criteria and applied it to 3 electronic health record-linked biobanks to identify cases and controls for genetic study. In the discovery phase, we performed an individual genome-wide association study using the Geisinger MyCode and the Electronic Medical Records and Genomics cohorts, which were then meta-analyzed. We attempted validation of the significant association loci (P<1×10-6) in the BioVU cohort. All association analyses used logistic regression, assuming an additive genetic model, and adjusted for principal components to control for population stratification. An inverse-variance fixed-effect model was adopted for meta-analysis. In addition, we examined the top variants to evaluate their associations with each criterion in the phenotyping algorithm. We used the STRING database to characterize protein-protein interaction network.Results: Using the same algorithm based on the Rotterdam criteria, we identified 2995 patients with polycystic ovary syndrome and 53,599 population controls in total (2742 cases and 51,438 controls from the discovery phase; 253 cases and 2161 controls in the validation phase). We identified 1 novel genome-wide significant variant rs17186366 (odds ratio [OR]=1.37 [1.23, 1.54], P=2.8×10-8) located near SOD2. In addition, 2 loci with suggestive association were also identified: rs113168128 (OR=1.72 [1.42, 2.10], P=5.2×10-8), an intronic variant of ERBB4 that is independent from the previously published variants, and rs144248326 (OR=2.13 [1.52, 2.86], P=8.45×10-7), a novel intronic variant in WWTR1. In the further association tests of the top 3 single-nucleotide polymorphisms with each criterion in the polycystic ovary syndrome algorithm, we found that rs17186366 (SOD2) was associated with polycystic ovaries and hyperandrogenism, whereas rs11316812 (ERBB4) and rs144248326 (WWTR1) were mainly associated with oligomenorrhea or infertility. We also validated the previously reported association with DENND1A1. Using the STRING database to characterize protein-protein interactions, we found both ERBB4 and WWTR1 can interact with YAP1, which has been previously associated with polycystic ovary syndrome.Conclusion: Through a discovery-validation genome-wide association study on polycystic ovary syndrome identified from electronic health records using an algorithm based on Rotterdam criteria, we identified and validated a novel genome-wide significant association with a variant near SOD2. We also identified a novel independent variant within ERBB4 and a suggestive association with WWTR1. With previously identified polycystic ovary syndrome gene YAP1, the ERBB4-YAP1-WWTR1 network suggests involvement of the epidermal growth factor receptor and the Hippo pathway in the multifactorial etiology of polycystic ovary syndrome. [ABSTRACT FROM AUTHOR]