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Purpose: Necrotizing fasciitis (NF) is a rare, but rapidly progressing bacterial infection of the subcutaneous tissues and muscular fascia with high rates of morbidity and mortality. Our study aims to determine if socioeconomic status (SES) is a predictor of outcomes in NF. Methods: A retrospective review was conducted of patients diagnosed with NF at our institution. Demographic information, insurance status, medical and surgical history, vitals, ASA score, blood laboratory values, surgical procedure information, and outcomes prior to patient discharge were collected. Patient zip codes were utilized to obtain median household incomes at the time of the patient's surgical procedure to determine SES. Patients without complete data in their medical record were excluded. Initial descriptive statistics and logistic regression models were performed. Results: We identified 196 patients (mean age 50.13 ± 13.03 years, 31.6% female) for inclusion. Mortality rate was 15.3% (n = 30) and 33.7% (n = 66) underwent amputation. Mortality rate was not significantly different across income brackets. Lower income brackets had higher rates of amputation than higher income brackets (p < 0.05). A logistic regression models showed the rate of amputation decreases by 29% for every $10,000 increment in median household income and ASA score decreased by 0.15 units for every $10,000 increase in median household income. Conclusions: Amputation rates in cases of NF are significantly higher in lower SES groups than higher SES groups. Patients with perivascular disease in lower SES groups were more likely to experience serious complications of NF than their counterparts in higher SES groups. [ABSTRACT FROM AUTHOR]

Introduction: It is important to appropriately risk stratify bariatric surgery patients, as these patients often have obesity-related comorbidities which can increase postoperative complication risk but also benefit the most from bariatric surgery. We aimed to evaluate the utility of risk stratification using ASA class for bariatric surgery patients and assessed predictive factors of postoperative complications. Methods: The 2020 MBSAQIP database was analyzed, and an ASA-deemed high-risk cohort (class IV) and normal-risk (ASA class II and III) cohort were compared. Univariate analysis was performed to characterize differences between cohorts and to compare complication rates. Multivariate logistic regression analysis was performed to determine factors associated with increased odds of postoperative complications. Results: We evaluated 138 612 patients with 5380 (3.9%) considered high-risk and 133 232 (96.1%) normal-risk. High-risk patients were more likely to be older (46.2 ± 12.0vs.43.4 ± 11.9, p < 0.001), male (30.9%vs.18.4%, p < 0.001), have higher BMI (51.4 ± 10.2vs.44.9 ± 7.4, p < 0.001), and have more comorbidities. High-risk patients were more likely to have increased 30-day serious complications (4.5%vs.2.8%, p < 0.001) and death (0.2%vs.0.1%, p = 0.001) but not anastomotic leak (0.2%vs.0.2%, p = 0.983). Multivariate models showed ASA class IV patients were at higher odds for any serious complication by 30 days (aOR 1.36, 95%CI 1.18–1.56, p < 0.001) but not for death (aOR 1.04, 95%CI 0.49–2.21, p = 0.921). The factor independently associated with the highest odds of complication in both models was functional status preoperatively (partially dependent aOR 2.06, 95%CI 1.56–2.72, p < 0.001; fully dependent aOR 3.19, 95%CI 1.10–9.28, p = 0.033 for any serious complication; partially dependent aOR 5.08, 95%CI 2.16–12.00, p < 0.001 for death). Conclusions: While elevated ASA class correlates with increased serious complications, pre-operative functional status appears to have a much greater contribution to odds of serious complications and mortality. These findings question the utility of using ASA to risk stratify patients peri-operatively and provides evidence for using a simpler and more practical functional status approach. [ABSTRACT FROM AUTHOR]

Objectives: Epistaxis is the most common otolaryngological emergency and one-third of epistaxis patients regularly take low-dose acetylsalicylic acid (ASA) for the prevention of cardiovascular disease (CVD). The shift in contemporary guidelines identifies little benefit of ASA intake in patients who have not previously had an infarction. Existing evidence confirms ASA intake as a factor for severe epistaxis, while the evidence concerning its impact on recurrence is ambiguous. There are no available studies which justify the administration of these drugs nor are there any studies correlating the effects of these drugs to the SCORE2 CVD risk stratifying scale. Study design: A retrospective analysis of all admitted epistaxis patients in a tertiary academic hospital for the 10 year period 2011 to 2021. Methods: Patient data were analysed using the hospital information software. A recurrence was defined as an epistaxis episode requiring hospital readmittance for at least one night. Patients taking anticoagulants were excluded (N = 421). Results: 444 patients were included: 246 were taking ASA and 198 were not (NoASA). ASA patients had more frequent recurrence in general (p = 0.03), more recurrences per patient (p = 0.002), and more changes in bleeding localisation (p = 0.04). Recurrence in the ASA group was associated with lower haemoglobin values (HR 0.62, p < 0.0001), while surgery (HR 6.83, p < 0.0001) was associated with recurrence in the NoASA group. ASA patients had a statistically significant (r 0.33, p = 0.032) correlation between the total number of epistaxis recurrences and SCORE2. The indication for drug intake was highly questionable in as much as 40% of ASA patients. Follow-up time was 5.27 years. Conclusions: Epistaxis patients taking prophylactic ASA are significantly more burdened by recurrence, because they have more frequent recurrences, a greater number of recurrences per patient, and more changes in bleeding localisations when compared to control patients. The drug indication is questionable in up to 40% of ASA patients, exposing them unnecessarily to recurrence. Level of evidence: 4. [ABSTRACT FROM AUTHOR]

Background: Although the American Society of Anesthesiologists (ASA) score of 3 is relatively common in elderly patients, there have been few debates on the indications for gastrectomy in elderly gastric cancer (GC) patients with ASA3. Therefore, this study aimed to investigate gastrectomy's clinical relevance in elderly patients with GC and ASA3. Methods: We retrospectively analyzed 228 consecutive elderly GC patients (aged ≥ 75 years) without prior treatments who underwent curative gastrectomy between 2013 and 2017. Results: Thirty-three patients with ASA3 showed significantly poorer prognosis than those with ASA1 and 2 (p = 0.004). The multivariate Cox proportional hazards model showed that ASA3 (p = 0.021) and pStage (p = 0.007) were independent prognostic factors, respectively. Elderly GC patients with pStage III and ASA3 exhibited uniquely dismal prognosis (p < 0.001); however, several survivors were still confirmed. Postoperative complications (PCs) were only the final remnant independent prognostic factor (p = 0.020) among the 33 elderly GC patients with ASA3, where dead patients included cancer-specific and other deaths, especially pneumonia. PCs were independently associated with prognostic nutritional index (PNI) (< 42.7) in elderly GC patients, and the most frequent complication was pneumonia, which was significantly associated with ASA3 and marginally associated with PNI in a multivariate analysis. Conclusions: ASA3 has a dismal prognosis after curative gastrectomy in the elderly GC patients, but the number of survivors was confirmed. Curative gastrectomy is not considered contraindicated even in elderly GC with ASA3. Preoperative malnutrition is associated with PCs, which proposing preoperative nutritional intervention in the context of treatment strategy for the elderly GC patients with ASA3. [ABSTRACT FROM AUTHOR]

Purpose: We investigated the effects of age, American Society of Anesthesiologists Physical Status Classification (ASA) grading and Charlson Comorbidity Index (CCI) on the survival outcomes of upper tract urothelial carcinoma (UTUC). Methods: The CROES-UTUC registry was an international, multicenter study on patients with UTUC. Primary outcomes were overall survival (OS) and disease-free survival (DFS). Kaplan–Meier and multivariate Cox regression analyses were performed by stratifying patients according to their age (≤ 70 and > 70 years old) and ASA grade (I–II and III–V)/CCI (0–1 and ≥ 2). Results: A total of 2352 patients were included in this study. Patients aged ≤ 70 years with ASA grading of I–II (p = 0.002), and patients aged ≤ 70 years with a CCI of 0–1 (p = 0.002) had the best OS. Upon multivariate analysis, both in patients aged ≤ 70 and > 70 years, ASA grading and CCI were not significantly associated with OS. Patients aged ≤ 70 years with ASA grading of III–IV (p = 0.024) had the best DFS. When stratified according to age and CCI, no significant difference in DFS was noted. Upon multivariate analysis, radical nephroureterectomy (RNU) was significantly associated with better DFS in patients aged ≤ 70 and > 70 years; CCI of ≥ 3 was significantly associated with worse DFS in patients ≤ 70 years; ASA grading was not associated with DFS in patients aged ≤ 70 and > 70 years. Conclusions: A high ASA grading and CCI should not be considered contraindications for RNU. RNU should be considered even in elderly patients when it is deemed feasible and achievable after a geriatric assessment. [ABSTRACT FROM AUTHOR]

One of the most used additive manufacturing methods in the market is fused filament fabrication (FFF) due to its affordability and ease of operation. However, identification of optimal processing parameters is still a challenge and can help to achieve desired results in parts made by FFF. This paper presents the influence of two process parameters, i.e. layer height and line width on FFF-printed thermoplastics. Premium PLA, Haydale's Synergy Graphene Enhanced Super Tough PLA, ABS Extrafill and ASA Extrafill have been manufactured and tested according to British and International standards for this study. An extensive comparative analysis has been provided where parts have been manufactured using Anet® ET4 Pro 3D printer with the four materials at five different line widths (0.2 mm, 0.4 mm, 0.6 mm, 0.8 mm, 1 mm) and four different layer heights (0.1 mm, 0.2 mm, 0.3 mm, 0.4 mm). The study analyses the effects of line widths and layer heights on mass, dimensional accuracy, surface texture and mechanical properties of the four materials. Microstructural analysis has also been carried out to evaluate the fractured surfaces and to determine the impact of modifying the two processing parameters on failure modes. Results have shown the trade-offs that can be made with the different materials in terms of properties and manufacturing time by modifying the layer heights and line widths. Designers and manufacturers can use this comparative analysis amongst the four materials to identify the limitations with the default printing settings (0.2 mm layer height and 0.4 mm line width) on most 3D printers and achieve desired results by leveraging the layer heights and line widths. [ABSTRACT FROM AUTHOR]

A method is proposed for the determination of sultones in the anionic surfactant sodium α-olefin sulfonate (AOS Na) and products based on this surfactant. The importance and necessity of quality control in the production of AOS Na and detergents for the presence of sultone impurities is due to their toxic effect on a human body. Under production conditions, the analysis procedure should be rapid and provide results at the ppm level. In the present work, a procedure for determining sultones based on gas chromatography–mass spectrometry is improved. δ-Hexadecanesultone isolated from the sulfonation reaction mass is used as a standard in the determination. Satisfactory performance characteristics of the procedure, ensuring its use for production control, are obtained. Foreign commercial samples of AOS Na from different manufacturers are tested for the content of sultones along with model mixtures of detergents prepared on the basis of these samples. The results of tests for the stability of model mixtures of detergents over time showed that a high concentration of sultones results in the formation of precipitates in the finished product. [ABSTRACT FROM AUTHOR]

In this study, we synthesized a novel Co(II)-containing coordination compound (CP) [Co2(MMBA)2(HPT)2(H2O)2]·2H2O (1) through a solvothermal reaction of Co(NO3)6·6H2O with 3-(pyridin-2-yl)-1 H-1,2,4-triazole (HPT) and 2-(4-methylbenzoyl)benzoic acid (HMMBA). Fluorescence spectroscopy confirmed that this compound exhibited superior blue fluorescence properties compared to the original ligands. Further, aspirin (ASA) was loaded onto this CP via physical adsorption to create CP-ASA. Interestingly, the fluorescence properties of the CP decreased with the loading of the drug but were restored upon drug release. Leveraging the unique optical properties and biocompatibility of Polymer Liquid Crystal (PLC), we further encapsulated CP-ASA, forming the CP-PLC@ASA composite. The target product was confirmed through various characterization techniques including Elemental Analysis (EA), Fourier-Transform Infrared Spectroscopy (FT-IR), Powder X-Ray Diffraction (PXRD), and Thermogravimetric Analysis (TGA). Moreover, the biological activity of this composite was evaluated in vitro for osteoarthritis, and its potential mechanisms were explored. [ABSTRACT FROM AUTHOR]

Triple anti-thrombotic therapy combining oral anticoagulation and dual anti-platelet therapy following percutaneous coronary intervention in patients with atrial fibrillation was considered as standard and recommended by guidelines. While bleeding risk is considerable with that approach, data for efficacy are scare. Several trials assessed the possibility of reducing anti-thrombotic treatment by mainly shortening the exposure to acetylsalicylic acid. Dropping one of the anti-platelet components might increase the risk of stent thrombosis, myocardial infarction or stroke. Despite that fear, the recent trials' primary endpoint was major and/or clinically-relevant non-major bleeding. We review data on major bleedings, intracranial bleedings and major adverse cardiovascular events from the published reports. We demonstrate that Non-Vitamin K oral anticoagulant (NOAC)-based strategies compared to VKA-based triple therapies significantly reduce the risk for TIMI-major bleedings by 39% and for intracranial bleedings by 66%, while they did not increase the risk for overall ischemic or embolic events. However, recent meta-analyses indicate an increased risk for stent thrombosis with less intense anti-thrombotic therapy. While the overall incidence rate for stent thrombosis is rather low, relative increases by about 30–60% are reported, but they did not translate into adverse clinical net-benefit ratios. This review highlights that using certain NOAC regimens proven effective for stroke prevention in AF can reduce the rate of bleeding without increasing ischemic or embolic events. Furthermore, additive ASA in triple anti-thrombotic regimens should be limited to 1 month and individual weighing of ischemic versus bleeding risk during the first 30 days seems to be reasonable. [ABSTRACT FROM AUTHOR]

Purpose: To validate tools to identify patients at risk for perioperative complications to implement prehabilitation programmes in head and neck surgery (H&N). Methods: Retrospective cohort including 128 patients submitted to H&N, with postoperative Intermediate Care Unit admittance. The accuracy of the risk calculators ASA, P-POSSUM, ACS-NSQIP and ARISCAT to predict postoperative complications and mortality was assessed. A multivariable analysis was subsequently performed to create a new risk prediction model for serious postoperative complications in our institution. Results: Our 30-day morbidity and mortality were 45.3% and 0.8%, respectively. The ACS-NSQIP failed to predict complications and had an acceptable discrimination ability for predicting death. The discrimination ability of ARISCAT for predicting respiratory complications was acceptable. ASA and P-POSSUM were poor predictors for mortality and morbidity. Our new prediction model included ACS-NSQIP and ARISCAT (area under the curve 0.750, 95% confidence intervals: 0.63–0.87). Conclusion: Despite the insufficient value of these risk calculators when analysed individually, we designed a risk tool combining them which better predicts the risk of serious complications. [ABSTRACT FROM AUTHOR]

Enhancing energy efficiency and product quality by means of optimal inputs is a cost-effective solution, as compared to the drastic investment. This paper aims to optimize the machining inputs to enhance energy efficiency (EF) as well as the power factor (PO) and decrease the surface roughness (Ra) for the milling process. The factors considered are the feed (f), depth of cut (a), milling speed (V), and tool radius (r). The machining operations were executed on the vertical milling under the dry condition for the stainless steel 304. A type of neutral network entitled the radius basic function (RBF) was used to render the relationships between milling inputs and performances measured. The adaptive simulated annealing (ASA) algorithm was applied to obtain the optimal values. The outcomes indicated that the milling responses are primarily influenced by a, f, V, and r, respectively. The reduction in Ra is approximately 39.18%, while the improvements in EF and PO are around 22.61% and 26.47%, respectively, as compared to the initial parameter settings. The explored findings are expected as a prominent solution for the industrial application of the dry machining. The combination of the RBF models and ASA could be considered as an efficient approach for modeling dry machining processes and generating reliable as well as feasible optimal results. [ABSTRACT FROM AUTHOR]

Introduction: Simultaneous administration of acetylsalicylic acid (ASA) and clopidogrel has demonstrated efficacy in the treatment of acute coronary syndrome. Clopidogrel + ASA in a fixed-dose combination (FDC) provides a pharmaceutical option to enhance adherence to the coadministration of dual antiplatelet therapy (DAPT). Herein, we evaluate the bioequivalence of enteric ASA and clopidogrel in an FDC compared with simultaneous administration of the individual formulations. Methods: This study is a randomized, single-center, open-label, three-sequence, three-period, two-treatment, crossover study conducted in healthy Chinese male and female subjects under fed conditions. Subjects were randomized to receive, in each period, a single dose of (1) a combination tablet containing 75-mg clopidogrel and 100-mg enteric ASA (test formulation) or (2) coadministration of one 75-mg clopidogrel tablet and one 100-mg enteric-coated ASA tablet (reference formulations) under fed conditions. Plasma samples were analyzed for ASA, salicylic acid, clopidogrel, and the clopidogrel metabolite SR26334. For ASA, the reference-scaled average bioequivalence (RSABE) analysis was conducted for Cmax of ASA because within-subject standard deviation (SDW) was ≥ 0.294 for log-transformed Cmax. Results: The point estimate (test/reference geometric mean ratio) was between 0.80 and 1.25, and the upper one-sided 95% confidence interval (CI) for the scaled average bioequivalence metric was ≤ 0 (-0.08). AUC of ASA as SDW was < 0.294 for log-transformed AUClast and AUC. Estimates of 90% CIs for log-transformed AUClast and AUC ratios were within the bioequivalence range of 0.80 to 1.25 (0.98–1.08 and 1.00–1.10, respectively). For clopidogrel, the 90% CIs for the ratios comparing log-transformed Cmax, AUClast, and AUC ratios of clopidogrel following administration of test versus reference formulation were calculated using the ABE method and were well within the acceptable range of 0.80 to 1.25 (1.02–1.12, 0.92–0.99, and 0.92–0.98, respectively). Conclusion: FDC of ASA and clopidogrel was bioequivalent to the simultaneous administration of the individual formulations in healthy Chinese subjects under fed conditions. Trial registration: CTR20190376. [ABSTRACT FROM AUTHOR]

Many strategies have been proposed to address the supply of bespoke essays and other assignments by companies often described as 'Essay Mills' with the act of supply and use being invariably described as 'contract cheating'. These proposals increasingly refer to the law as a solution in common with other action. In this article, the lead author revisits work undertaken in 2016 as a result of recent legal and extra-legal developments to assess whether the UK Fraud Act (2006) might now be used to tackle some of the activities of the companies involved, by comparing their common practises, and their Terms and Conditions, with the Act. It was previously found that all sites have disclaimers regarding the use of their products but there were some obvious contradictions in the activities of the sites which undermined those disclaimers, for example plagiarism-free guarantees for the work. In this article, we ask and consider the question whether this is still the case having regard to the impact of a change in the law by the UK supreme court and recent action of the UK Advertising Standards Authority. We also consider whether a call for a new offence to be created which specifically targets the undesirable behaviours of these companies is still justified. [ABSTRACT FROM AUTHOR]

Left atrial (LA) enlargement is a marker of LA cardiopathy and, in patients with patent foramen ovale (PFO), is associated with an increased risk of ischemic stroke. The primary study outcome was the comparison of LA diameter between patients undergoing percutaneous PFO closure versus those treated conservatively. The secondary endpoints were the association of LA diameter with the Risk of Paradoxical Emboli (ROPE) score and the presence of Atrial septal aneurysm (ASA) and Right-To-Left Shunt (RLS). Retrospective analysis of clinical and instrumental data of 1040 subjects referred to a single tertiary center for PFO evaluation and treatment. Seven hundred and nineteen patients were enrolled: 495 patients (closure group, mean RoPE score 7.6 ± 0.8) underwent PFO closure while 224 patients (control group, mean RoPE score 4.1 ± 0.9. p < 0.001) were left to medical therapy. Preoperative LA diameter was significantly larger in closure group and reduced from 44.3 ± 9.1 to 37.3 ± 4.1 mm (p = 0.01) 1 year after the procedure to the size of controls. A larger LA diameter was associated with permanent RLS, RLS curtain pattern, ASA presence and multiple ischemic brain lesions pattern at neuroimaging. A LA diameter ≥ 43 mm was a predictor a RoPEscore > 7. In our patients' cohort, LA diameter was associated with the clinic severity of PFO and RLS. The reversal of LA enlargement after PFO closure suggests a role for RLS to induce LA cardiopathy. LA enlargement has the potential to be considered per se as an indication to transcatheter PFO repair. [ABSTRACT FROM AUTHOR]

Background: Our previous research has shown American Society of Anaesthesiologists physical status classification (ASA) score and Americal College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) calculator to have the most accuracy in the prediction of postoperative mortality. Aims: The aim of our research was to define the most reliable combination of cardiac biomarkers with ASA and ACS NSQIP. Methods: We have included a total of 78 patients. ASA score has been determined in standard fashion, while we used the available interactive calculator for the ACS NSQIP score. Biomarkers BIRC5, H-FABP, and hsCRP have been measured in specialized laboratories. Results: All of the deceased patients had survivin (BIRC5) > 4.00 pg/ml, higher values of H-FABP and hsCRP and higher estimated levels of ASA and ACS NSQIP (P = 0.0001). ASA and ACS NSQIP alone had AUC of, respectively, 0.669 and 0.813. The combination of ASA and ACS NSQIP had AUC = 0.841. Combination of hsCRP with the two risk scores had AUC = 0.926 (95% CI 0.853–1.000, P < 0.0001). If we add three cardiac biomarkers to this model, we get AUC as high as 0.941 (95% CI 0.876–1.000, P < 0.0001). The correction of statistical models with comorbidities (CIRS-G score) did not change the accuracy of prediction models that we have provided. Discussion: Addition of ACS NSQIP and biomarkers adds to the accuracy of ASA score, which has already been proved by other authors. Conclusion: Cardiac biomarker hsCRP can be used as the most reliable cardiac biomarker; however, the "multimarker approach" adds the most to the accuracy of the combination of clinical risk scores. [ABSTRACT FROM AUTHOR]

Coastal areas are continually impacted by anthropic activities because they shelter large urban conglomerates. Urban effluents directly or indirectly end up reaching the marine environment, releasing a large number of pollutants which include the so-called contaminants of emerging concern (CECs), since the conventional treatment plants are not effective in removing these compounds from the effluents. These substances include hormones, pharmaceuticals and personal care products, nanoparticles, biocides, among others. The aim of this study was to evaluate the toxicity of the 17α-ethinylestradiol (EE2), acetylsalicylic acid (ASA), and bisphenol-A (BPA) to two marine crustaceans and one echinoderm, evaluating the following parameters: survival (Artemia sp. and Mysidopsis juniae), embryo-larval development (Echinometra lucunter). The LC50 values calculated in the acute toxicity tests showed that the compounds were more toxic to M. juniae than to the Artemia sp. Among the three contaminants, EE2 was the most toxic (LC50-48h = 18.4 ± 2.7 mg L−1 to Artemia sp.; LC50-96h = 0.36 ± 0.07 mg L−1 to M. juniae). The three tested compounds affected significantly the embryonic development of the sea urchin in all tested concentrations, including ecologically relevant concentrations, indicating the potential risk that these contaminants may present to the marine biota. [ABSTRACT FROM AUTHOR]

Background: Colonoscopy is associated with multiple adverse outcomes. With an aging population undergoing colorectal cancer screening, few modalities exist to assess the patient risk prior to colonoscopy. Frailty, the age-related decline in reserve and function across multiple organ systems, predicts poor surgical outcomes, but its role in endoscopy is unclear.Aims: This prospective cohort study assesses the efficacy of frailty in predicting acute colonoscopy outcomes.Methods: Participants aged ≥ 50 years undergoing screening colonoscopy at a tertiary care center were recruited over 2 months ending in July 2017. Frailty was assessed using a validated 20-s upper-extremity frailty test, which measures the capacity of muscle performance. Demographic data, American Society of Anesthesiologists (ASA) status, and Charlson comorbidity index (CCI) were evaluated. Procedure-related adverse events and cardiopulmonary changes during and in the immediate post-procedure period were recorded. Adverse events were stratified into minor and major events. Chi-square and ANCOVA models were used in the analysis.Results: Ninety-nine adults (mean age 62.8 years) were enrolled, among which 49 were non-frail and 50 were pre-frail/frail; 50 were female. Overall, 55 participants experienced a total of 87 adverse events. Frailty and ASA status were significantly associated with colonoscopy adverse events (p = 0.01 and p = 0.02, respectively). Age and CCI did not predict colonoscopy outcomes.Conclusions: Compared to age and CCI, frailty status better predicts colonoscopy outcomes in older adults. Among adults undergoing colonoscopy, routine frailty screening should be considered for risk stratification. Additional prospective studies evaluating frailty measurements in endoscopy will further clarify its role in forecasting adverse events. [ABSTRACT FROM AUTHOR]

This study investigates the transdermal release of aspirin (ASA) from films of hydrolyzed collagen obtained from fish scales. The patches were made with 0.2 g of ASA dissolved in 99% ethanol and 1.98 g of the extracted fish scale biopolymer (FSBP) dissolved in 10 mL distilled water which is then dried. Porcine skin is pre-treated with solid metal microneedles. ASA-loaded FSBP patch is then applied. The skin samples were placed on diffusion cells. Samples were taken at varying times: 5, 24, and 48 h and tested for the presence of ASA using UV spectrometry-based method introduced in this study. The results obtained showed that for all repeated study, no ASA was detected in the receiver compartment after 5 h. After 24 h up to 0.24 mg/mL ASA had released into the receiver compartment; and after 48 h, a concentration 0.74 mg/mL had been reached for skin samples treated with microneedles. ASA was not detected in the receiver compartment for skin samples that were not pre-treated with microneedles after 5 h. After 24 h, the concentration of 0.04 mg/mL was recorded, and at 48 h, concentration of 0.045 mg/mL was detected. This study presents for the first time transdermal drug delivery (TDD) films made of FSBP applied as drug delivery films for ASA and the use of microneedles to significantly enhance the release of ASA from the ASA-FSBP TDD films using the ‘poke and patch’ method. We also present a novel method for testing ASA in the TDD study using reaction with ferrous gluconate. [ABSTRACT FROM AUTHOR]

Purpose Many methods for preoperative risk stratifications used in everyday practice do not take into account all of the comorbidities and complex physiological status of older patients. Therefore, anaesthesiologists and surgeons must consider multiple ways of preoperative diagnostics. Determining which of the preoperative clinical risk scores [Revised Lee score, the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) calculator and Surgical Outcome Risk Tool (SORT)] best improves routinely used American Society of Anaesthesiologists (ASA) physical status classification. Methods The prospective pilot study included 78 patients who were being prepared for extensive non-cardiac surgeries under general anaesthesia. Preoperatively, anaesthesiologist determined ASA score according to guidelines. Then, the data of patients have been processed on the interactive calculators of Revised Lee score, ACS NSQIP and SORT. Results Mean age of included patients was 71.4 ± 6.9 years. When it comes to postoperative mortality prediction, three risk scores (ASA, ACS NSQIP and SORT) have been statistically significant, respectively, P = 0.016, P < 0.0001, P < 0.0001. Results showed that AUC being higher in ACS NSQIP and SORT (0.813; 0.797). Out of all three additional risk scores, ACS NSQIP showed to add the most to the specificity and sensitivity of ASA score, with combined AUC = 0.841. Conclusions ACS NSQIP and SORT increase the accuracy of ASA score. Revised Lee score cannot be considered a good indicator of postoperative mortality risk since it is primarily the score which indicates risk for cardiovascular complications. Further studies, with a greater number of patients, are needed. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to evaluate the incidence of complications in elderly patients with a hip fracture following integrated orthogeriatric treatment. To discover factors that might be adjusted, in order to improve outcome in those patients, we examined the association between baseline patient characteristics and a complicated course.Methods: We included patients aged 70 years and older with a hip fracture, who were treated at the Centre for Geriatric Traumatology (CvGT) at Ziekenhuisgroep Twente (ZGT) Almelo, the Netherlands between April 2011 and October 2013. Data registration was carried out using the clinical pathways of the CvGT database. Based on the American Society of Anesthesiologists (ASA) score, patients were divided into high-risk (HR, ASA 3 ≥, n = 341) and low-risk (LR, ASA 1-2, n = 111) groups and compared on their recovery. Multivariate logistic regression was used to identify risk factors for a complicated course.Results: The analysis demonstrated that 49.6% (n = 224) of the patients experienced a complicated course with an in-hospital mortality rate of 3.8% (n = 17). In 57.5% (n = 196) of the HR patients, a complicated course was seen compared to 25.2% (n = 28) of the LR patients. The most common complications in both groups were the occurrence of delirium (HR 25.8% vs. LR 8.1%, p ≤ 0.001), anemia (HR 19.4% vs. LR 6.3%, p = 0.001), catheter-associated urinary tract infections (CAUTIs) (HR 10.6% vs. LR 7.2%, p = 0.301) and pneumonia (HR 10.9% vs. LR 5.4%, p = 0.089). Independent risk factors for a complicated course were increasing age (OR 1.04, 95% CI 1.01-1.07, p = 0.023), delirium risk VMS Frailty score (OR 1.57, 95% CI 1.04-2.37, p = 0.031) and ASA score ≥3 (OR 3.62, 95% CI 2.22-5.91, p ≤ 0.001).Conclusions: After integrated orthogeriatric treatment, a complicated course was seen in 49.6% of the patients with a hip fracture. The in-hospital mortality rate was 3.8%. Important risk factors for a complicated course were increasing age, poor medical condition and delirium risk VMS Frailty score. Awareness of risk factors that affect the course during admission can be useful in optimizing care and outcomes. In the search for possible areas for improvement in care, targeted preventive measures to mitigate delirium, and healthcare-associated infections (HAIs), such as CAUTIs and pneumonia are important. [ABSTRACT FROM AUTHOR]

As a major antioxidant in plants, ascorbic acid (AsA) plays a very important role in the response to aluminum (Al) stress. However, the effect of AsA on the mitigation of Al toxicity and the mechanism of nitrate nitrogen (NO -N) uptake by plants under Al stress are unclear. In this study, a hydroponic experiment was conducted using peak 1 A rice (sterile line, Indica) with weaker resistance to Al and peak 1 superior 5 rice (F1 hybrid, Indica) with stronger resistance to Al to study the effects of exogenous AsA on the physiological and biochemical responses to NO -N uptake by rice roots exposed to 50 μmol L Al. Al stress induced increases in the concentrations of HO and malondialdehyde (MDA) and in the activities of antioxidant enzymes [such as superoxide dismutase (SOD), peroxidase (POD), catalase (CAT), and ascorbate peroxidase (APX)]. Plasma membrane (PM) H-ATPase and H-pump activities, endogenous AsA content and NO -N uptake in rice roots decreased under Al stress. After treatment with 2 mmol L exogenous AsA combined with Al, concentrations of HO and MDA in roots notably decreased, and endogenous AsA content and activities of SOD, POD, CAT, and APX in rice roots increased significantly; furthermore, the interaction of PM H-ATPase and the 14-3-3 protein was also enhanced significantly compared with that in control plants without AsA treatment, which clearly increased NO -N uptake. Based on all of these data, the application of AsA significantly reduced the accumulation of HO and MDA and increased the activities of PM H-ATPase and the H-pump by increasing the endogenous AsA content, the antioxidant enzyme activities, and the interaction of PM H-ATPase and the 14-3-3 protein in the roots of the two rice cultivars under Al stress, thereby improving the uptake of NO -N in rice. [ABSTRACT FROM AUTHOR]

The goal of this study was to evaluate independent risk factors for long-term epistaxis recurrences and their severity. Individual retrospective cohort study-2b level of evidence. The medical information of 603 emergency epistaxis patients was acquired during a former study. This cohort has been contacted 6 years later by conventional mail and asked to answer a specific paper questionnaire. The following parameters were evaluated: recurrent epistaxis episodes, need for a surgical intervention to stop the recurrent bleeding, patient's history for hypertension and diabetes, intake of hemostasis impairing medication now and in the past. One hundred and six (106) patients were included in the study (35.8 % response rate). The mean observation period was 76.58 months. Almost half of the patients (41.5 % = 44/106) reported at least one recurrent epistaxis episode. Patients with exposure to VKA (vitamin K antagonists) showed significantly more frequently a recurrent epistaxis episode. The binary logistic regression confirmed the intake of VKA as an independent and significant risk factor with an odds ratio of 11.6. Every single patient who had to undergo a surgical intervention to stop a recurrent bleeding stated ASA (Acetylsalicylic Acid) intake. We provide evidence that the intake of a vitamin K antagonist is an independent long-term risk factor for recurrent epistaxis episodes. The intake of ASA is a risk factor for the severity of recurrent epistaxis with the increased need for a surgical intervention not only in a short- but also in a long-term perspective. Level of evidence: This prognostic investigation, designed as a combined prospective and retrospective cohort study, reaches level 2b level of evidence as it includes retrospective aspects. [ABSTRACT FROM AUTHOR]

Dabigatran and rivaroxaban are novel, vitamin K-independent oral anticoagulants (NOACs) and act via antagonism of the coagulation factor (F) IIa (dabigatran) or FXa (rivaroxaban), respectively. Compared to vitamin-K-antagonists, NOACs have shown non-inferiority of risk and benefit in patients with non valvular atrial fibrillation (AF). In clinical practice there is increasing use of NOACs combined with platelet inhibitors in patients with AF and coronary artery disease. However, whether NOACs affect the function of platelet inhibitors remains incompletely known. This observational study aimed to assess the platelet function in patients receiving dabigatran or rivaroxaban and concomitant platelet inhibitors. A single centre observational study was performed analysing the platelet aggregation of patients treated with dabigatran or rivaroxaban with or without concomitant platelet inhibitors. Measurements before the initiation of NOAC therapy served as the respective control group. Platelet aggregation was measured by multiple electrode aggregometry and was induced with adenosine diphosphate (ADP, 6.5 µM) and arachidonic acid (AA, 0.5 mM), respectively. In order to evaluate whether NOACs interact with platelet inhibition by ASA or the P2Y-antagonist clopidogrel, 87 patients were grouped according to their concomitant antiplatelet medication. Comparing the ADP- and AA-induced platelet aggregation in patients without concomitant platelet inhibitors (n = 45) no significant differences under therapy with dabigatran (d) or rivaroxaban (r) compared to the control group (c) were observed. In patients taking clopidogrel as a concomitant platelet inhibitor (n = 21), neither dabigatran nor rivaroxaban affected the ADP-induced platelet aggregation (c 20 ± 11, d 21 ± 14, r 18 ± 8 AU*min, p = 0.200). Patients receiving dabigatran or rivaroxaban in combination with ASA (n = 42; 21 ASA only, 21 ASA + clopidogrel) showed no significant differences of the AA-induced aggregation compared to the control group (c 10 ± 8, d 9 ± 7, r 10 ± 8 AU*min, p = 0.810). The antiplatelet effects of ASA and clopidogrel monitored by AA- or ADP-induced platelet aggregation were not affected by NOAC therapy. [ABSTRACT FROM AUTHOR]

Background: Research has revealed that a decreased antiplatelet effect (low response [LR]/high on-treatment platelet reactivity [HPR]) of acetylsalicylic acid (ASA) and clopidogrel is associated with an increased risk of thromboembolic events. There are extensive ASA low response (ALR) and clopidogrel low response (CLR) prevalence data in the literature, but there are only a few studies concerning vascular surgical patients. The aim of this study was to examine the prevalence and risk factors of ALR and CLR in vascular surgical patients. Materials and Methods: We examined n = 154 patients with an antiplatelet long-term therapy, who were treated due to peripheral artery occlusive disease (PAD) and/or arteria carotis interna stenosis (CVD). To detect an ALR or CLR, we examined full blood probes with impedance aggregometry (ChronoLog® Aggregometer model 590). Risk factors were examined by acquisition of concomitant disease, severity of vascular disease, laboratory test results and medication. Results: We found a prevalence of 19.3 % in the ALR group and of 21.1 % in the CLR group. Risk factors for ALR were an increased platelet and leucocyte count and co-medication with pantoprazole. We found no significant risk factors for a decreased antiplatelet effect of clopidogrel treatment. Conclusion: The investigated prevalence for ALR and CLR are in the range of other studies, particularly based on cardiological patients. More investigations are needed to gain a better evaluation of the risk factors for HPR and to develop an effective antiplatelet therapy regime to prevent cardiovascular complications. [ABSTRACT FROM AUTHOR]

The dilemma of the patient with both AS and LVOTO is now commonly encountered in clinical practice; indeed, physicians must be aware of the complex interaction and coexistent nature of both diseases, especially as both HOCM and TAVR have increased in awareness and prevalence. Importantly, the clinician must be aware of the complex interplay hemodynamically, with the two diseases confusing the TTE imaging and potentially affecting each other anatomically and clinically. There is no set guideline on how to approach this from a surgical or percutaneous approach, but we have outlined a set of recommendations which should serve the clinician and patient well. The three cases that are presented illustrate that methodical diagnosis in addition to the order of treatment do indeed matter. In the first case, there was AS and an underestimated LVOT gradient that was also present. Once the AS was corrected, the true LVOT gradient potential was evidenced and she decompensated, likely because there was a rapid decrease in afterload. Patients with concomitant LVOTO are not able to adjust quickly to the hemodynamic changes created by the rapid decline in afterload, as, for example, in HOCM patients who receive nitroglycerin. The second case demonstrated that when the LVOTO was severe and the AS nonsignificant (mild or moderate), the patient was able to live without symptoms for several years after successful alcohol septal ablation (ASA). She eventually needed an aortic valve and mitral valve replacement but that was postponed for several years until the AS became more significant, and the surgical risk was lowered by the elimination of the need for concomitant myectomy. In the last case, the patient was able to have both an ASA and TAVR within 3 months of each other without hemodynamic compromise. Indeed, this latter therapy sequence may be the best way to treat patients with both diseases in the future, as both ASA and TAVR continue to evolve into intermediate and lower-risk patient populations and the safety of ASA continues to be evident. [ABSTRACT FROM AUTHOR]

Copyright of Spektrum der Augenheilkunde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Acetylsalicylic acid is one of the most used analgesics to treat an acute migraine attack. Next to the inhibitory effects on peripheral prostaglandin synthesis, central mechanisms of action have also been discussed. Methods: Using a standardized model for trigeminal-nociceptive stimulation during fMRI scanning, we investigated the effect of acetylsalicylic acid on acute pain compared to saline in 22 healthy volunteers in a double-blind within-subject design. Painful stimulation was applied using gaseous ammonia and presented in a pseudo-randomized order with several control stimuli. All participants were instructed to rate the intensity and unpleasantness of every stimulus on a VAS scale. Based on previous results, we hypothesized to find an effect of ASA on central pain processing structures like the ACC, SI and SII as well as the trigeminal nuclei and the hypothalamus. Results: Even though we did not find any differences in pain ratings between saline and ASA, we observed decreased BOLD signal changes in response to trigemino-nociceptive stimulation in the ACC and SII after administration of ASA compared to saline. This finding is in line with earlier imaging results investigating the effect of ASA on acute pain. Contrary to earlier findings from animal studies, we could not find an effect of ASA on the trigeminal nuclei in the brainstem or within the hypothalamic area. Conclusion: Taken together our study replicates earlier findings of an attenuating effect of ASA on pain processing structures, which adds further evidence to a possibly central mechanism of action of ASA. [ABSTRACT FROM AUTHOR]

Software systems accumulate technical debt (TD) when short-term goals in software development are traded for long-term goals (e.g., quick-and-dirty implementation to reach a release date versus a well-refactored implementation that supports the long-term health of the project). Some forms of TD accumulate over time in the form of source code that is difficult to work with and exhibits a variety of anomalies. A number of source code analysis techniques and tools have been proposed to potentially identify the code-level debt accumulated in a system. What has not yet been studied is if using multiple tools to detect TD can lead to benefits, that is, if different tools will flag the same or different source code components. Further, these techniques also lack investigation into the symptoms of TD 'interest' that they lead to. To address this latter question, we also investigated whether TD, as identified by the source code analysis techniques, correlates with interest payments in the form of increased defect- and change-proneness. Comparing the results of different TD identification approaches to understand their commonalities and differences and to evaluate their relationship to indicators of future TD 'interest.' We selected four different TD identification techniques (code smells, automatic static analysis issues, grime buildup, and Modularity violations) and applied them to 13 versions of the Apache Hadoop open source software project. We collected and aggregated statistical measures to investigate whether the different techniques identified TD indicators in the same or different classes and whether those classes in turn exhibited high interest (in the form of a large number of defects and higher change-proneness). The outputs of the four approaches have very little overlap and are therefore pointing to different problems in the source code. Dispersed Coupling and Modularity violations were co-located in classes with higher defect-proneness. We also observed a strong relationship between Modularity violations and change-proneness. Our main contribution is an initial overview of the TD landscape, showing that different TD techniques are loosely coupled and therefore indicate problems in different locations of the source code. Moreover, our proxy interest indicators (change- and defect-proneness) correlate with only a small subset of TD indicators. [ABSTRACT FROM AUTHOR]

Shock wave lithotripsy (SWL) is the gold standard for the treatment of upper urinary tract stones. Despite being relatively non-invasive, SWL can cause renal hematoma (RHT). The aim of this study was to determine incidence and risk factors for RHT following SWL. 857 patients were included in a prospectively maintained database. The observation period spans from 2007 to 2012. 1,324 procedures were performed due to kidney stones. Treatment protocol included power ramping and shock wave frequency of 60-90 per minute as well as an ultrasound check within 3 days of SWL for all patients. Patients with RHT were analyzed, and treatment characteristics were compared with the complete population in a non-statistical manner due to the low event count. RHTs after SWL, sized between 2.6 × 0.6 cm and 17 × 15 cm, were verified in seven patients (0.53 %). In four patients, the RHT was asymptomatic. Three patients developed pain after SWL treatment due to a RHT. In one patient surgical intervention was necessary due to a symptomatic RHT, the kidney was preserved. The risk of RHT following SWL treatment of kidney stones is about 0.5 %. Clinically relevant or symptomatic RHTs occur in 0.23 %, RHTs requiring surgical intervention are extremely rare. Older age and vascular comorbidities appear to be risk factors for the development of RHT. The technical characteristics of SWL treatment and intake of low-dose acetylsalicylic acid due to an imperative cardiologic indication do not appear to influence the risk. Prospective studies are warranted. [ABSTRACT FROM AUTHOR]

Several epidemiological studies show that aspirin can act as a chemopreventive agent and decrease the incidences of various cancers including melanoma. In this work, we investigated the in vitro and in vivo efficacy of acetylsalicylic acid (ASA) as an antimelanoma agent in B16-F0 cells and skin B16-F0 melanoma tumor mouse model. Our findings indicate that the IC (48 h) for ASA in B16-F0 melanoma cells was 100 μM and that ASA caused a dose- and time-dependent GSH depletion and increase in reactive oxygen species (ROS) formation in B16-F0 melanoma cells. Male C57BL/6 mice were inoculated s.c. with 1 × 10 B16-F0 melanoma cells. ASA (80, 100, and 150 mg/kg) was initiated on day 1 or day 7, or day 9 after cell inoculation and continued daily for 13, 7, and 5 days, respectively. Animals were weighed daily and sacrificed on day 13. The tumors were excised and weighed. The animals receiving 13 days of ASA therapy at 80, 100, and 150 mg/kg demonstrated tumor growth inhibition by 1 ± 12 %, 19 ± 22 %, and 50 ± 29 %, respectively. Animals receiving 7 days of therapy at 80, 100, and 150 mg/kg demonstrated tumor growth inhibition by 12 ± 14 %, 27 ± 14 %, and 40 ± 14 %, respectively. No significant tumor growth inhibition was observed with 5 days of therapy. ASA at 100 and 150 mg/kg caused significant tumor growth inhibition in C57BL/6 mice when administered for 13 and 7 days, respectively. The results obtained in this study are consistent with the recent epidemiologically based report that aspirin is associated with lower melanoma risk in humans. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the operative and clinical outcomes in a series of 302 consecutive laparoscopic splenectomies and to analyze the risk factors of postoperative complications. Methods: The study retrospectively reviewed 302 consecutive patients who underwent laparoscopic splenectomy. The patients were classified into three disease groups: benign spleen-related disease (group 1, n = 196), malignant spleen-related disease (group 2, n = 42), and portal hypertension (group 3, n = 64). The three groups were compared in terms of perioperative data. Postoperative complications were classified into three complication groups according to the Clavien-Dindo Classification of Surgical Complications and Severity: no complication, mild complications, and severe complications. Multivariate logistic regression was used to analyze the independent risk factors of postoperative complications. Results: The patients in group 1 were younger and had a higher body mass index, a lower American Society of Anesthesiology (ASA) score, and a smaller spleen than the patients in groups 2 and 3. Fewer patients in group 1 required hand-port assistance than in the other two groups. Group 1 had shorter operative times, required fewer transfusions, presented a lower incidence of complications, and had shorter postoperative stays than groups 2 and 3. In the analysis of complications, high ASA score was an independent risk factor for the occurrence of complications. Both high ASA score and larger spleen size were independent risk factors for the occurrence of severe complications. Compared with total laparoscopic splenectomy, the data including the hand-assisted cases showed a reduction in odds ratio for both the occurrence of complications and the occurrence of severe complications. Conclusions: The treatment of malignant spleen-related disease and portal hypertension with laparoscopic splenectomy is more challenging than the treatment of benign disease. High ASA score is an independent risk factor for the occurrence of complications, whereas high ASA score and larger spleen size are both independent risk factors for the occurrence of severe complications. The appropriate introduction of the hand-assisted technique may facilitate the laparoscopic procedure and reduce postoperative complications. [ABSTRACT FROM AUTHOR]

The gene encoding l-galactose-1-phosphate phosphatase ( GPP) plays a central role in ascorbic acid (AsA) biosynthesis in plants. Here, we report AsA contents, GPP expression, and functioning of its promoter in response to light, exogenous stress-signalling hormones, or abiotic stresses in kiwifruit ( Actinidia deliciosa). To identify the upstream region of GPP required for promoter activity, we constructed a series of promoter deletion derivatives. Each construct was analyzed by Agrobacterium-mediated transient transformation in tobacco leaves after various treatments. Some correlation was observed between the relative levels of GPP mRNA and AsA contents when kiwi leaves were exposed to varying light conditions, treatment with ABA or SA, wounding, or a hypoxic environment. Analysis of a series of 5′ deletions in tobacco leaves indicated that the proximal area 390 bp from the transcription initiation site was needed for establishing both the constitutive and the induced patterns of expression. This promoter was induced by light or one of our abiotic treatments. These results suggest that GPP is regulated by light or abiotic stress and that it plays an important role in controlling AsA contents in kiwifruit. [ABSTRACT FROM AUTHOR]

Purpose: The attraction-selection-attrition (ASA) model has served as the foundation for numerous investigations. However, the generally supportive evidence for ASA's homogeneity hypothesis has often been based on statistical tests (e.g., MANOVA) that rely on between-group differences to evaluate within-group agreement. The primary purpose of this article was to discuss advantages of direct statistical tests of homogeneity-average deviation (AD) and r-when testing ASA's homogeneity hypothesis, and advantages of other statistical tests for testing other aspects of ASA theory. A secondary goal was to evaluate the extent to which occupational homogeneity is distinct from organizational homogeneity. Design/Methodology/Approach: Data were obtained from the Center for Creative Leadership (CCL) and included scores on the Myers-Briggs Type Indicator (MBTI) personality measure for 1,103 managers from 25 organizations and 17 occupations. Findings: Results were generally supportive of the homogeneity hypothesis. AD values showed that most groups were homogeneous on most assessed personality dimensions. A comparison analysis using traditional statistical tests (i.e., MANOVA) indirectly suggested within-group homogeneity by revealing a significant between-groups effect. In addition, results suggested possible boundary conditions to ASA; notably, meaningful heterogeneity was observed for the S-N (sensing-intuition) MBTI dimension. Implications: The current study provides direct support for ASA's homogeneity hypothesis for both organizations and occupations and offers guidance for future research on ASA theory and its possible boundary conditions. Originality/Value: This is one of the first studies to test the predictions of ASA in both organizations and occupations using a direct index of agreement. [ABSTRACT FROM AUTHOR]

The opening paper gives an account - partly drawn from the archives of an outside state, New Zealand - of the ancestors of ASEAN: ASA and SEAFET. ASEAN developed a life of its own. Yet SEAFET and ASA give some hints of its aims and some indications of its methods: the need to restrict the intervention of major outside powers; and the need to avoid the dominance by one substantial regional power, but to allow it due influence. The paper suggests that a strong motive behind the early attempts at a regional association was an attempt to deal with the disparate size and power of one state, Indonesia. If - but only if - its urge to regional primacy could be moderated and accommodated would it be possible to diminish recourse to or opportunity for the intervention of outside powers. [ABSTRACT FROM AUTHOR]

Aspirin (ASA) is one of the most widely used nonsteroidal anti-inflammatory drugs. ASA has primarily been used to treat headaches, rheumatic pain, and inflammation, but its therapeutic effects have recently been demonstrated on a range of disorders, including those of the central nervous system. In this study, we investigated whether ASA is neuroprotective in inflammation-mediated neurodegenerative diseases. Pretreatment with ASA reduced the lipopolysaccharide (LPS)-induced degeneration of dopaminergic (DA) neurons in mesencephalic neuron-glia cultures in a dose-dependent manner. The neuroprotective effect of ASA was attributed to the inhibition of microglial activation because of its observed inhibitory effects on LPS-stimulated nitric oxide, tumor necrosis factor-α, and superoxide production by microglial cells. Moreover, ASA increased the production of the anti-inflammatory cytokines transforming growth factor beta-1 and interleukin-10 in neuron-glia cultures after stimulation with LPS. Mechanistic studies revealed that the neuroprotective effects of ASA were mediated through the inhibition of nicotinamide adenine dinucleotide phosphate oxidase (PHOX), a key enzyme for superoxide production in microglia. These results suggest that ASA protects DA neurodegeneration by inhibiting the microglial-mediated oxidative stress/inflammatory response and by regulating the production of anti-inflammatory cytokines. [ABSTRACT FROM AUTHOR]

Each year millions of patients are treated for joint pain with total joint arthroplasty, and the numbers are expected to rise. Comorbid disease is known to influence the outcome of total joint arthroplasty, and its documentation is therefore of utmost importance in clinical evaluation of the individual patient as well as in research. In this paper, we examine the various methods for obtaining and assessing comorbidity information for patients undergoing joint replacement. Multiple instruments are reliable and validated for this purpose, such as the Charlson Index, Index of Coexistent Disease, and the Functional Comorbidity Index. In orthopedic studies, the Charnley classification and the American Society of Anesthesiologists physical function score (ASA) are widely used. We recommend that a well-documented comorbidity index that incorporates some aspect of mental health is used along with other appropriate instruments to objectively assess the preoperative status of the patient. [ABSTRACT FROM AUTHOR]

Background: The spinal arteries are innervated by several systems that contribute to the control of spinal cord blood flow. The sensory fibers of upper cervical nerves have vasodilatatory effect on the anterior spinal arteries (ASA). Subarachnoid hemorrhage (SAH) causes severe vasospasm by various neurochemical mechanisms. We examined whether there is a relationship between the neuron density of the C3 dorsal root ganglion and the severity of ASA vasospasm in SAH. Methods: This study was conducted on 20 rabbits. Four of them were used as baseline group. Experimental SAH has been applied to all of 16 animals by injecting homologous blood into cisterna magna. After 20 days of injection, ASA and C3 dorsal root ganglia (C3DRG) were examined histopathologically. ASA volume values and normal and degenerated neuron densities of C3DRG were estimated stereologically and the results were analyzed statistically. Results: The mean ASA volume was 1,010 ± 450 mm, and the mean neuronal density of C3DRG was 10,500 ± 850 in all animals. The mean volume value of ASA was 970 ± 150 mm, and the normal neuron density of C3DRG fell to 8,600 ± 400/mm in slight vasospasm group. In severe vasospasm-developed animals, mean volume value of ASA was 540 ± 90 mm and the normal neuron density of C3DRG fell to 5,500 ± 360/mm. An inverse relationship between the degenerated neuronal density of the C3DRG and ASA volume values may indicate the severity of ASA vasospasm. Conclusion: The neuron density of C3DRG may be an important factor on the regulation of ASA volume values and the continuation of spinal cord blood flow. Low neuron density of C3DRG may be considered as an important factor in the pathogenesis of severe ASA vasospasm in SAH. [ABSTRACT FROM AUTHOR]

Up to 30% of all patients who are treated with a coronary stent do not respond sufficiently to antiplatelet therapy. This condition results in an increased risk for thrombotic complications such as stent thrombosis and myocardial infarction. The aim of the study was to determine clinical parameters modulating ASA and clopidogrel responsiveness. Patients were enrolled into three groups: (A) Patients with coronary artery disease without recent PCI treated with 100 mg/day ASA ( n = 67). (B) Patients who underwent coronary stent implantation taking 100 mg/day ASA and 75 mg/day clopidogrel ( n = 87). (C) Patients in whom CAD was excluded by angiography and who were not treated with anti-platelet medication served as controls ( n = 32). Platelet aggregation was determined by impedance aggregometry using the Multiplate® point of care device. Drug response was differentiated by stimulation of whole blood with arachidonic acid (AA, ASA responsiveness) or adenosine diphosphate (ADP, clopidogrel responsiveness). P2Y12 receptor expression was determined by RT-PCR. ADP induced platelet aggregation correlated with the leukocyte count ( r = 0.61, p < 0.001) suggesting that platelets and leukocytes interact functionally. Clopidogrel treatment abolished the influence of leukocytes on platelets and caused decreased leukocyte activation. We detected the expression of the clopidogrel target P2Y12 on leukocytes suggesting that clopidogrel may act directly on these cells and not only on platelets. In contrast to ASA responsiveness, clopidogrel response correlated with body mass index ( r = 0.34; p = 0.001). In conclusion, (1) leukocytes influence ADP induced platelet aggregation most likely by expression of the P2Y12 receptor. This interaction is abolished by clopidogrel. Therefore, clopidogrel may act directly on leukocytes via the P2Y12 receptor. (2) Clopidogrel may be under dosed in obese patients. [ABSTRACT FROM AUTHOR]

The aim of the study was to assess the effectiveness of laparoscopic colorectal surgery in patients at high preoperative anesthetic risk because of associated pathologies. From January 2003 until January 2005, 116 patients were systematically assigned at a ratio of 1:1 to one of two groups: laparoscopy surgery ( n = 59, of which 31 were American Society of Anesthesiologists score [ASA] I–II [L1] and 28 ASA III–IV [L2]) or open surgery ( n = 57, of which 30 were ASA I–II [O1] and 27 ASA III–IV [O2]). Data on patient demographics and clinical and anesthetic variables were collected prospectively. Informed consent was obtained from the patients, and approval was obtained from the designated review board of the institution involved. The number of minor anesthetic complications during surgery was higher in L2 patients. No differences were observed in blood gas parameters studied during surgery ( pCO2, pH, and pO2/FiO2). Transfusion rates in the laparoscopy group at greater anesthetic risk (L2) were lower than those of the high-risk conventional surgery group (O2; 21.4 vs 63%, P < 0.02). Duration of stay in the surgical recovery room and the inpatient ward were also shorter in the L2 group than in the O2 group (8.7 ± 4.5 vs 12.2 ± 6 days, P = 0.02). There was no difference in perioperative clinical variables between laparoscopy groups (L1, L2). Postoperative recovery of ASA III–IV patients is better after laparoscopic surgery for colorectal cancer, at the expense of a higher rate of minor anesthetic occurrences during surgery. [ABSTRACT FROM AUTHOR]

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Acetylsalicylic acid (ASA, Aspirin) is among the most used drugs worldwide. At present, Aspirin represents a quite versatile drug employed in the control of pain symptomatologies and in situations such as prevention of both ischaemic stroke and cardiovascular events. Aspirin causes inhibition of prostaglandin (PG) synthesis by inactivation of the cyclooxygenase (COX) enzyme. ASA constitutes the focus of new researches explaining more widely Aspirin’s control of inflammation. The induction of the endogenous epimers lipoxins (Aspirin-triggered 15-epi-lipoxins, ATLs) represents one of the most recent achievements. This particular feature of Aspirin is not shared by other NSAIDs. ASA is well known as a headache medication, figuring as a possible treatment choice in tension-type headache but also in acute migraine attacks. Furthermore, a new Aspirin formulation with a greater rapidity of action has been introduced. In conclusion, little information exists on the subject and more studies are required. [ABSTRACT FROM AUTHOR]

A poor pre-injury mobility and high American Society of Anaesthiologist (ASA) grading is thought to be associated with a poor survival following surgical treatment of femoral neck fracture in the elderly. Hence there are concerns among orthopaedic surgeons about surgical treatment in this group of patients. In this retrospective study, the pre-injury mobility and ASA scores of 401 patients with fractured neck of femur treated by surgery was assessed in relation to mortality following surgery within the first 30 days of injury. Following surgery, a temporary deterioration in the ASA grading and mobility was noticed. Patients who required intensive medical care following surgery had higher mortality rate. The mortality was 15% among patients with ASA III and 40% among patients with ASA IV. 14% of 65 immobile patients, 18% of those mobile with Zimmer frame passed away after surgery for femoral neck fracture. 6.1% of ASA I scorers died compared with 40% of ASA IV scorers; this difference was statistically significant (χ2=13.883, df=1, P<0.001). Significant number of patients with ASA-IV (60%) and immobile patients (88%) survived following surgery for femoral neck fracture. Poor pre-injury mobility and high ASA scoring are associated with higher early mortality following surgery for femoral neck fracture, however, this should not preclude surgery for patients with poor pre-injury ASA grading and mobility sustaining femoral neck fracture, as significant number of our patients survived. [ABSTRACT FROM AUTHOR]

Objecive: Acetylsalicylic acid (ASA) is a simple and cost-effective treatment for acute coronary syndromes (ACS). Our objectives were to determine the frequency of ASA administration in the emergency department (ED) for patients with acute myocardial infarction or unstable angina, and to identify patient characteristics associated with its administration. Methods: This is a retrospective chart review of patients discharged with a final diagnosis of ACS. Data on age, gender, mode of presentation, presence of chest pain at triage, administration of ASA or not in the ED, dosage and form of ASA received, timing of administration, presence of contraindications to ASA and use of regular ASA prior to ED presentation were recorded. Results: Six hundred and one charts were analyzed. Five hundred and fifty patients (91.5%) received ASA. Only 444 (73.9%) of these 550 patients were administered the ASA appropriately, according to the American Heart Association/American College of Cardiology (AHA/ACC) guidelines. Univariate analysis showed that chact notes ‘Transport by ambulance,’ ‘Allergy to ASA’ and ‘Gastrointestinal bleed.’ were associated with a lower probability of the patient being administered ASA. If a patient was noted as taking ASA regularly, it increased the chance of this patient being administered ASA in the ED. Conclusion: Although the study ED performed well, administering ASA to 91.5% of patients with ACS, only 73.9% of the patients who received ASA were administered the ASA appropriately, as recommended in the AHA/ACC guidelines. Educational strategies and system changes are necessary to increase the proportion of eligible ACS patients who receive appropriate ASA therapy. [ABSTRACT FROM AUTHOR]

: In a previous work we have discussed the valence band electronic structure of a (001) oriented surface (semi-infinite medium) of some II-VI wide band gap zinc-blende semiconductor compounds. For these systems, we have found three characteristic surface resonances, besides the known bulk bands (hh, lh and spin-orbit bands). Two of these resonances correspond to the anion terminated surface and the third one to the cation terminated one. We have shown, specifically, that three non dispersive (001)-surface-induced bulk states, in the Γ - X direction of the 2D Brillouin zone, do exist and are characteristic of these systems. The existence of these states has been confirmed, independently, by two experimental groups and further evidence of our predictions has been more recently found. In order to continue with the description of these states, in this work, we briefly review the main characteristics of the electronic structure of the (001)-surfaces to up-date their analysis and we present new results concerning the existence of the same kind of states in Cu-based calcopyrites and at interfaces. This shows that, in general, the non-dispersive states occur in several, if not all, crystal surfaces, and, on general grounds, as the consequence of introducing to an infinite medium a frontier of any kind (not only with the vacuum). For that reason we propose here, to name them, more appropriately as Frontier Induced Semi-Infinite Medium (FISIM) states. We present in this paper two new interesting cases where the non-dispersive states appear. First, the (112)-oriented CuInSe2 calcopyrite surface and, secondly, the interface CdTe/CdSexTe1-x (x = 0.15) which, essentially, does not introduce the additional effects due to lattice mismatch so that the FISIM states are clearly seen. We have calculated them for a broader range of x and for other II-VI and III-V semiconductor compounds to check that the result is general. The surface and the interface that we present here, allow us to discuss the characteristics of these newly found states, in a more general way. [ABSTRACT FROM AUTHOR]

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: Tight Binding Linear Muffin-Tin Orbital (TB-LMTO) electronic calculations are presented for the magnetic and structural properties of ordered and disordered FeAl alloys. The total energy, bulk modulus, lattice parameter and magnetic moments of B2, D03 and B32 ordered structures and A2 disordered structure were calculated for different compositions. The different structures are obtained by varying the position of Fe and Al atoms in a BCC superstructure. In this way, we examine the order-disorder transition that takes place in these alloys. Disordered alloys present both larger Fe magnetic moment and lattice parameter than ordered ones. In this work comparison of the calculated quantities with available experimental results is provided and it can be concluded that the results are in quantitative agreement with the experimental trends. [ABSTRACT FROM AUTHOR]

Helicobacter pylori (H. pylori) and NSAIDs are recognized as major pathogenic factors in peptic ulcer disease. However, whether these two factors exert synergistic or antagonistic effects on ulcer healing has not yet been fully explained. In this study, the effects of aspirin (ASA) alone and rofecoxib, a specific prostaglandin cyclooxygenase (COX)-2 inhibitor, were compared with that of ASA and rofecoxib applied in combination with H. pylori on gastric acid secretion and healing of acetic acid ulcers in rats. The H. pylori colonization of gastric mucosa was determined by viable bacterial culture and histology. The area of ulcers was determined by planimetry, the gastric blood flow (GBF) was measured using the H[sub 2]-gas clearance method and the gastric mucosal generation of PGE[sub 2] and plasma gastrin levels were assessed by radioimmunoassay. ASA or rofecoxib applied alone delayed significantly the healing of chronic gastric ulcers and this effect was accompanied by a marked decrease in the GBF at the ulcer margin and gastric mucosal PGE[sub 2] generation without significant influence of gastric acid output. H. pylori that produced moderate gastric inflammation at the ulcer margin as confirmed by bacterial culture, prolonged significantly the healing of these ulcers and decreased the GBF at the ulcer margin and gastric acid output while elevating significantly the gastric mucosal PGE[sub 2] generation and plasma gastrin levels. H. pylori attenuated significantly the ASA- and rofecoxib-induced inhibition of ulcer healing and accompanying fall in the GBF at the ulcer margin and reversed, in part, the ASA- and rofecoxib-induced alterations in PGE[sub 2] generation. We conclude that H. pylori attenuates the delay in ulcer healing induced by ASA and rofecoxib due to enhancement in the generation of endogenous PGE[sub 2] and gastrin release, as well as suppression of acid secretion which may limit deleterious influence of NSAID on ulcer healing. [ABSTRACT FROM AUTHOR]

We present a method for the numerical investigation of the electron dynamics in small metallic clusters in intense laser fields. We obtain information about collective excitations and relaxation processes in the Na 9 + and Pt3 clusters analyzing the power spectrum of the dipole moment within a mean-field approach. The power spectrum is computed for various laser pulse parameters as well as for the limit of an infinitely short laser pulse. Due to the basis set expansion of the wave function our method is capable to follow the dynamics not only of the whole electron cloud, but of any particular molecular orbital. [ABSTRACT FROM AUTHOR]

Band-structure (BS) calculations of the density of states (DOS) using the full potential augmented plane waves code WIEN97 were performed on the four single-valence vanadium oxides VO, V2O3, VO2 and V2O5. The DOS are discussed with respect to the distortions of the VO6 octahedra, the oxidation states of vanadium and the orbital hybridisations of oxygen atoms. The simulated oxygen K-edge fine structures (ELNES) calculated with the TELNES program were compared with experimental results obtained by electron energy-loss spectrometry (EELS), showing good agreement. We show that changes in the fine structures of the investigated vanadium oxides mainly result from changes in the O- p DOS and not from the shift of the DOS according to a rigid band model. [ABSTRACT FROM AUTHOR]