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This paper presents the results of the development of a mechanistic cutting force prediction model for wavy-edge, bull-nose, helical endmill (WEBNHE), which was validated and used to investigate the effects of the geometric parameters of the WEBNHE on the predicted cutting force components and the resultant cutting force. The mechanistic cutting force prediction model was validated by conducting end-milling experiments on Inconel 718 and incorporating the effect of the Minimum Quantity Lubrication (MQL) cooling strategy through experimentally identified six cutting force and edge force coefficients. The geometric parameters investigated in this research were: the wavelength, wave magnitude, axial shift of the linear part, and the helix angle of the wavy cutting edges. These parameters were varied one at a time, and the cutting force components for each variation were predicted using the mechanistic cutting force prediction model. The results show that the predicted and measured cutting force components were in good agreement in magnitude and shape. The cutting force components generated from the end-milling under the MQL cooling strategy were lower than under the emulsion cooling strategy. The magnitudes and shapes of the predicted cutting force components and the resultant cutting force of the WEBNHE were unique (asymmetric) in magnitude and shape compared to those of standard, bull-nose, helical endmill (SBNHE) due to the uniqueness of the wavy-cutting edge geometry. The results also show that the predicted cutting force component in the feed direction Fy is the largest and the most affected by the geometric parameters, followed by Fx. However, Fz is insignificantly affected. It was also observed that the maximum magnitudes and ranges of the cutting force component in the feed direction Fy and the resultant cutting force FR increased with an increase in the wave magnitude and decrease with increase of the wavelength, axial shift, and the helix angle. The wavy cutting edge spends more time in the cutting zone than the standard, helical, cutting edge; this extra time affects the frequency content of the cutting force signals generated by the endmill and improves the end-milling dynamics. Additionally, the distribution of the cutting forces on the wavy cutting edges was not equal due to the asymmetric cutting edge geometry.

Background: Pediatric anemia has a high prevalence in developing countries such as Pakistan. It is common knowledge among hospital specialties but little is done to manage this condition by hospitalists. The issue is compounded with a poor primary care infrastructure nationally. The aim of this study is to bring to light the high prevalence of anemic children in neurosurgery and to describe the difficulties in managing their anemia in a tertiary hospital setting. A literature review is presented highlighting the socioeconomic difficulties that contribute to this widespread comorbidity and the difficulty in managing it from a hospital specialty point of view. Methods: A prospective descriptive case series was carried out between March 2020 and September 2020. All patients under the age of 13 who presented to our department for traumatic brain injury (TBI) meeting our inclusion and exclusion criteria were enrolled and assessed for the presence and severity of anemia. Demographic data were collected. Following discharge, patients were referred to our hospital’s pediatrics’ anemia clinic which was before their first neurosurgery follow-up 2 weeks following discharge and attendance to follow up was documented. Results: The prevalence of anemia was 78.9%. Over 95% of patients attended their neurosurgery follow-up but only 28% of patients attended their referral to the anemia clinic. Conclusion: Anemia is highly prevalent in children presenting to neurosurgery for TBI and its longitudinal management has difficulties with lost to follow up in a tertiary hospital setting. There is a need for national initiatives to reduce the prevalence of anemia but concurrently better strategies need to be devised to manage anemic children in a hospital setting.

Vascular access for cerebral angiography has traditionally been performed via the common femoral artery. It is crucial to obtain safe access to prevent complications that could lead to limb ischemia, groin hematoma, or retroperitoneal hematoma. This is especially true in neurointervention as many patients are anticoagulated or have received intravenous thrombolytics prior to their intervention. Special attention to anatomic landmarks, both grossly and radiographically, can help to assure safe access. The patient consented for this procedure. This video details rapid but safe femoral artery access in a patient undergoing emergent thrombectomy.

Zubair Formation is one of the key producers in North Kuwait; however, the reservoir complexity and hydrocarbon movement along with pressure depletion always poses challenge for determining the perforation and completion strategy to optimize the production. Zubair Formation is broadly divided into three parts e.g. upper, middle and lower, the upper and lower units are of utmost importance for the current study. An integrated approach was adopted utilizing the high-resolution borehole image outputs; which has not only helped in identifying thin bedded reservoir zones but also facilitated the understanding of detail reservoir geology and sand dispersion. Integrated formation evaluation and workover design is always the key to sustain the production and it becomes even more important when the reservoir is highly heterogeneous in nature and coupled with declining pressure trend. Therefore, an innovative methodology was necessary to address the uncertainties. High resolution borehole images were utilized to determine the sand count, which can detect even the thinnest reservoir layer in the formation. Heterogeneity analysis was also performed to understand the relative sorting of the different reservoir units; sorting has a direct relation with reservoir permeability and thus reservoir productivity. High resolution sedimentary analysis was performed to understand the detailed sedimentology using the borehole image derived dip data; cross bedding types were identified which provides fair idea about depositional energy condition along with depositional environment. All the high-resolution inputs were integrated with openhole logs and volumetric results, which led to a clear deterministic picture of the reservoir, based on which crucial decision was taken. This integrated approach was adopted in three deviated well sections in Zubair formation, which has facilitated in improving the well performance. Detail sedimentary analysis and cross bedding typing in multiwell helps in fine tuning the sand dispersion in the reservoir model; which in turn found to be helpful for deciding future well locations.

Digital oil fields have seen major advancements over the past ten years, with the goal of integrating and optimizing the loops of production operation, production optimization, well and reservoir surveillance based on real-time data and model-based workflow automation capabilities. This paper discusses how ADNOC onshore has successfully implemented model-based digital oil field workflows in all its producing fields and describes the process of migrating these workflows to a data-driven platform for improved decision making. In the existing workflows, data-driven diagnostic analytics are applied to validate well performance and accelerate the process of identifying underperforming wells and inefficiencies. These data-driven diagnostic analytics were implemented on a digital oilfield workflow platform where data is aggregated from disparate data sources consisting of non-real time well data, well events, well test history, MPFM, interpreted PTA, reservoir simulation, well integrity and wells tie-in data, along with continuous real-time sensor and model-generated data. The analytics are mapped with workflows and asset hierarchy. The linear regression method is used to forecast trends for water cut and GOR based on historical data. Diagnostic analytics have been successfully configured for a giant onshore field having more than a thousand wells and multiple reservoirs. The alarm diagnostic map is generated based on tolerance and difference with exceptions. The solution framework has a common data abstraction layer and integration. A built-in visualization engine allows customization based on user preferences, linking multiple screens and analytics. Well test validations are improved for non-instrumented wells by using diagnostic based on more than 10 years of well test history. Well level allocation analytics allow comparisons between real-time export meter and terminal figures at the same timestamp, based on well models. For model calibration, wellhead pressure estimation from the last valid model was introduced. Well surveillance and management diagnostic analyze wells which are operating on critical/sub-critical condition and increasing water cut based on models and measured data. The combination of reservoir simulation data, PTA, bottom-hole surveys and estimated data from well models provides insights to validate quality of simulation data and reduce uncertainty in well models. Compartment and reservoir-wise VRR diagnostic enable asset operators to take faster remedial actions for reservoir performance management. These analytics complemented traditional model-based automated workflows for identifying wells for optimization. A digital oilfield solution platform has been leveraged to implement diagnostic analytics in the first phase and to provide a road map to migrate it to next-generation data-driven platform that has more predictive capabilities. This paper discusses solutions and data integration frameworks, analytics visualization, integration with model-based workflows, value cases and the road map ahead.

Nissen fundoplication (NF) is commonly performed in children with gastro-esophageal reflux disease (GERD). Patients undergoing NF often have co-morbidities. Reported outcomes of NF vary considerably. This study investigated which factors might predict multiple readmissions or death in the first year following NF at our institution. A retrospective chart review of 187 children who underwent NF at our institution between January 2004 and December 2015 was undertaken. Underlying medical conditions, age, weight, presence of malnutrition, length of hospital stay prior to surgery and type of surgery were recorded. Patients who had more than one admission in the first post-operative year were compared to those who had one or none, and patients who died within the first post-operative year were compared to those who did not. Risk factors for multiple readmissions were underlying cardiac disease (p = 0.011), esophageal atresia (EA) (p = 0.011), and esophageal stricture (p = 0.0002). Risk factors for death included younger age (p = 0.028), need for gastrostomy tube (GT) (p = 0.01) and prolonged pre-operative hospital admission (p = 0.0003). This study identified multiple factors associated with readmission and death in the first year after NF. These findings will help with the counseling patients and caregivers regarding expectations following NF.

BackgroundPooled individual data from the landmark stroke trials of 2015 conclude that the benefit of endovascular thrombectomy for patients with intracranial arterial occlusion also extends to patients with concomitant (so-called ’tandem') occlusions of proximal vessels. However, there is heterogeneity and debate in the management of these patients, without a clear standard of care. In particular, there is contention regarding whether the proximal or distal lesion should be treated first. We present a case control study and describe the Simultaneous Extracranial, Intracranial Management of (tandem) LESsions in Stroke (SEIMLESS) technique, an efficient approach to the acute ischemic stroke (AIS) patient who presents with tandem lesions (TLs).MethodsWe describe 5 patients, presenting with AIS and TLs between 2015 and 2017, who we treated with SEIMLESS. Cases were reviewed for clinical data, including arterial puncture to intracranial reperfusion, total fluoroscopy time, amount of contrast, age, and gender. Our series was matched to 5 patients treated with the standard ’sequential' approach (angioplasty followed by thrombectomy) in the same time period by the same operator.ResultsArterial access to intracranial recanalization time was significantly shorter in patients treated with SEIMLESS versus those who had angioplasty followed by thrombectomy (39.6±5.9 min vs 85.2±20.6 min; P=0.014). Patients treated ’seimlessly' also received significantly less iodinated contrast (117±13.5 mL vs 213±48.9 mL; P=0.005) and significantly less fluoroscopy time (21.1±5.2 min vs 55.9±17.8 min; P=0.003). There was no difference in the post-procedural Thrombolysis in Cerebral Infarction score for patients treated with SEIMLESS versus the sequential method (p=0.658).ConclusionSEIMLESS is an efficient procedural method that simultaneously treats a distal intracranial occlusion and a more proximal one. Our small case controlled study finds that this technique is feasible and can lead to faster intracranial recanalization compared with the standard ’sequential' method, utilizing less contrast and radiation in the process. Larger studies are needed to verify our findings.

Background and purpose Our mobile stroke unit (MSU) is the first 24/7 MSU worldwide. This provides a unique opportunity to report the temporal variation of its transports, types of patients treated, and therapy administered on the MSU. Methods This was a prospective, observational study conducted over the first year of the MSU’s operation. We compared different variables and metrics across the following times segments: hourly, 8 hour work shifts (morning 07:00–15:00, evening 15:01–23:00, and nocturnal 23:01–06:59), and 12 hour periods (daytime 07:00–19:00, nighttime 19:01–06:59). Results A total of 195 patients were treated and transported by the MSU. Based on hourly segments, the majority of MSU runs occurred from 13:00 to 14:00 (10.4%). The highest rate of transport was 52.3% in the morning shift, followed by 35.8% in the evening shift, and 11.9% during the nocturnal shift. When comparing daytime to nighttime, rate of transport was 73.1% vs 26.9%, respectively. A total of 23 patients received tPA; the most frequent hourly time segment was between 13:00–14:00 (21.7%), and the least frequent period was 02:00 to 07:00 with no tPA given. Of the total tPA administered, 56.5% was given during the morning shift, 34.7% in the evening shift, and 8.6% in the nocturnal shift. Twenty (86.9%) patients received tPA during the daytime and 3 (13%) received it during nighttime runs. Only 7 patients had mechanical thrombectomy (MT), all of which were done during the daytime. Conclusions MSU utilization varies with time of the day, with the highest rate of transport between 13:00–14:00. Higher rates of transport occur during the morning shift, compared to evening and nocturnal shifts; daytime period also has a higher rate of transport compared to nighttime period. tPA administration follows a similar trend. Staffing and utilization of a MSU can be managed more effectively if this variation is taken into account. Disclosures K. Changal: None. A. Sultan-Qurraie: None. V. Calderon: None. E. Lin: None. J. Goins-Whitmore: None. O. Zaidat: None.

The anterior cerebral artery (ACA) is a unique artery with many important variations with substantial clinical significance. Tortuous intracranial arteries usually occur in basilar, communicating, anterior, posterior cerebral arteries and in the white matter arterioles. This could happen for many reasons including but not limited to ageing, hypertension, patients with Moyamoya disease, congenital malformation, or increased flow associated with elastin degradation. While dolichoectasia of the ACA has been described even in children, to our knowledge, a serpiginous ACA without ectasia has not been reported, especially in the pediatric population.

This paper presents the results of the development of a mechanistic cutting force model to predict cutting forces in high-speed end-milling of Inconel 718 using a wavy-edge, bull-nose, helical endmill (which hereafter will be abbreviated as WEBNHE). The model incorporates the effects of emulsion cooling strategy into the mechanistic cutting force model through the experimental determination of six specific cutting force and edge force coefficients. The cutting force is predicted as three components ( F x , F y , and F z ) and the resultant cutting force F R . The mechanistic cutting force model depends on a mathematical model to represent the geometry of this endmill, which is also developed in this research. The mechanistic model also depends on three cutting force coefficients in the tangential, radial, and axial directions ( k tc , k rc , k ac , respectively), and on three edge force coefficients ( k te , k re , k ae ), also in the tangential, radial, and axial directions. These coefficients are determined experimentally in a separate work in which “emulsion” was applied as the cooling strategy. MATLAB codes were developed and used to simulate the developed mathematical and mechanistic cutting force models. Finally, to validate the mechanistic cutting force model, machining experiments were conducted and real cutting force components were measured and compared with the predicted cutting force components. The predicted values agree fairly well with the experimentally measured values in both magnitude and shape. The percentage of the prediction error for the highest peak force magnitudes at 93 rpm were 11.38%, –0.46%, and 11% for the F x , F y , and F z components respectively, while the percentage prediction error for the lowest cutting force magnitudes are 15.25%, 17.84%, and 10% for F x , F y , and F z components respectively. The developed mechanistic cutting force model can be used to investigate the effect of tool geometry and machining parameters on cutting forces, machining power, machine tool vibration, and to simulate the end-milling process to improve machinability and productivity, and also to understand more fully the end-milling process using WEBNHE.

Background and Objectives: Evidence has accumulated linking the effects of licorice for the treatment of many diseases. The objectives of this study were to evaluate the antibacterial action of licorice root extract against Staphylococcus aureus and to study its healing potential on the experimentally induced oral wounds in the rabbit's cheek mucosa. Materials and Methods: Different concentrations of licorice root extract were prepared and their antibacterial activities against S. aureus determined by disk diffusion method. The wound had been created using of biopsy punch at the right cheek mucosa of the rabbit. In the study group, these wounds were irrigated with 1 ml of 60 g/100 ml of licorice root extract twice daily. Seven rabbits from the control and the study group were sacrificed in the 3 rd and 6 th day of the experiment, and biopsies were taken for histological observations of the wounds. Results: There was no sensitivity of S. Aureus to different concentrations of licorice extract. The histological features of oral wounds in the study group showed satisfactory healing potential after twice daily irrigation with 60 g/100 ml of licorice root extract in comparison to control group. Conclusions: Different concentrations of licorice root extract has no antibacterial action against S. aureus, but licorice can shorten the healing time of the induced oral mucosal wounds in rabbits.

The daily routine problems that common man faces on roads while commuting are becoming a serious problem with each passing day. People get late and meet accidents. The model of autonomous car presented in this research paper aims to solve these issues by taking humans off the wheels, so that they do not have to drive anymore and the risk of accidents, getting late and traffic congestions can be reduced to a minimum. This car is able to follow the track, overtake other cars, detect obstacles, take sharp bends and turns, follow traffic signals and turn on its lights under low light conditions. Circuit diagrams for performing all these functions have been presented and the mechanical model of the car has also been shown in the paper, which is practically implemented and successfully run by the authors.

Introduction The efficacy of the endovascular treatment of acute ischemic stroke has been substantiated by several recent randomized clinical trials. While intra-arterial therapy has significantly evolved in recent years, anatomic cerebrovascular variants and disease burden can present challenges to timely recanalization. We present the first reported case of anterior-to-posterior mechanical clot retrieval with use of a stent retriever. Case description A 53-year-old man presented with basilar artery thrombosis. Endovascular mechanical clot retrieval was performed. The typical, antegrade, access to the basilar artery thrombus was precluded by the findings of a hypoplastic left vertebral artery and an occluded proximal right vertebral artery. Given a number of factors including the patient’s worsening symptoms and the high morbidity and mortality associated with basilar stroke, cross-circulation—anterior-to-posterior—intra-arterial therapy was performed. Thrombectomy of the basilar thrombus was achieved via the right internal carotid artery and right posterior communicating artery. Conclusion To our knowledge, we report the first case of cross-circulation, anterior-to-posterior thrombectomy, with the use of a stent-retriever device. Cross-circulation stroke treatment may be beneficial in cases of proximal vessel occlusion or anatomical constraints. Larger studies will need to evaluate the safety and efficacy of these approaches.

Endogenous cannabinoids are considered key regulators of biological systems as they have been shown to exhibit anti-inflammatory properties, while the fatty acid amide hydrolase (FAAH) enzyme plays a role in degrading the endogenous cannabinoid, anandamide. Staphylococcus Enterotoxin B (SEB) is a superantigen that can cause acute lung injury (ALI) through inhalation. In this study, we found that FAAH knockout mice (FAAH−/−) were more resistant to developing SEB-induced ALI 48 hours after intranasal administration of 50 μg dose of SEB compared to wildtype (WT) mice. The SEB-treated FAAH −/− mice had similar clinical parameters and upregulation of endogenous anandamide as naïve FAAH−/− mice. The results from assessing the clinical profile by plethysmography showed unlike with WT groups, there were no significant changes in the functions of the lung in FAAH−/− exposed to SEB when compared to naive FAAH−/−. Immune profiling by flow cytometry revealed there were also no changes in T cells subsets or cytokine levels among naive or SEB-treated FAAH−/− mice. Furthermore, after MiSeq sequencing V3-V4 region of the 16S rRNA of colon/cecal flush and lung samples, both the bacterial phylogenetic and short chain fatty acid (SCFA) profiles showed no significant differences in naïve FAAH−/− mice compared to those treated with SEB, unlike WT groups that had significant differences in these profiles. Lastly, further investigation of the metabolic profile by glycolysis rate assay (GRA) of splenocytes from both experimental groups showed no significant differences in this metabolic pathway. Collectively, these data suggest that knockdown of the FAAH enzyme may lead to increase endogenous cannabinoid, anandamide, thereby preventing SEB-induced ALI.

393 Background and objective: Myristica fragrans is an aromatic green tree usually growing to around 5-13 meters high, and their seeds (nutmegs) is firm broadly ovoid. The objectives of the study were to find the concentration of nutmeg oil that has maximum antibacterial action against Staphylococcus aureus and to evaluate the healing potential of this concentration on a chemically induced oral ulceration in the rabbit’s cheek mucosa. Methods: Different concentrations of nutmeg oil were prepared and their antibacterial activity against Staphylococcus aureus was determined by disk diffusion method. The chemically induced oral ulcerations in rabbit’s cheek mucosa were achieved by ethanol, and then these ulcerations were irrigated with 0.5ml (5%) of nutmeg oil twice daily. Biopsies were taken after four and eight days of the experiment, processed and stained by hematoxylin and eosin. Results: The concentration 100% of nutmeg oil and the dimethyl sulfoxide; which was used as diluents for preparing different concentrations of nutmeg oil, showed no inhibition zone for Staphylococcus aureus. The concentration (5%) showed maximum inhibitory zone (16.8mm) for the micro-organism which was parallel to the effects of amoxicillin (positive control), both with highly significant action (P

Children, and in particular young children under the age of three, are the most vulnerable for aspiration and ingestion of foreign bodies (FBs). The Red Cross War Memorial Children’s Hospital in Cape Town is the only children’s hospital in South Africa and is unique in having a dedicated trauma unit for children under the age of 13 as part of its institution. Core activities of Childsafe South Africa (CSA), located at the hospital, are data accumulation and interpretation, development of educational programmes, health inculcation and advising in legislation involving child health. To achieve this task, CSA works in close co-operation with government, industry, non-governmental and community predicated organisations, community groups and individuals. A database of all children treated for trauma at CSA has been maintained since 1991; it currently contains detailed information of over 170,000 injuries in children under the age of 13. This review consists of a literature review combined with data from our database and aims to provide information on our experiences with tracheobronchial aspiration of FBs in children.

Introduction: The effect of platelet transfusion (PT) has been studied in patients with intracerebral hemorrhage, but has not been reported for aneurysmal subarachnoid hemorrhage (aSAH). We investigated the effect of PT on the outcome of patients with aSAH. Methods: We retrospectively evaluated 84 patients admitted with aSAH to a Comprehensive Stroke Center in the United States between 2011 and 2015. Charts were reviewed for variables including length of hospitalization, 3-month modified Rankin Scale (mRS), and complications related to endovascular treatment of cerebral aneurysm. Intergroup differences were evaluated with the Chi-squared and Student’s t-test. mRS was evaluated using multivariate ordinal logistic regression. Variables with a univariate p-value Results: Patient demographics and clinical variables are seen in Table 1. 30% of patients received PT. PT was associated with male gender, Hunt-Hess score, Fisher Score, external ventricular drain placement, and longer hospital length of stay. After multivariate ordinal regression, PT was associated with higher mRS and there was a trend for association with Hunt-Hess score (Table 2). Conclusion: Our findings suggest that platelet transfusion is common in patients presenting with aSAH. Platelet transfusion in these patients is associated with longer hospital stay and a significantly lower rate of good clinical outcome, with a nearly 4- to 6-fold higher odds of a one-point increase in mRS at 3 months. The association of platelet transfusion to worse outcome in patients with aSAH warrants further study.

Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) carries a high risk of morbidity and mortality. Endovascular coiling is an effective treatment option for ruptured aneurysms and offers certain advantages over microsurgical clipping. Thromboembolism is a known complication of endovascular therapy, but little has been reported regarding its causes. We hypothesized that platelet transfusion (PT) is a risk factor for thrombotic events (TE) during endovascular therapy. Methods: We retrospectively evaluated 84 patients presenting with aSAH to a Comprehensive Stroke Center in the United States between 2011 and 2015 who underwent endovascular treatment. In addition to TE related to endovascular aneurysm repair, charts were reviewed for variables including length of hospitalization, 3-month modified Rankin Scale (mRS), and smoking. Intergroup differences were evaluated with a Chi-squared and Student’s t-test. Logistic regression models were also fitted to the outcome of TE. Results: Patient demographics and clinical variables are seen in Table 1. 23% of patients incurred TE. Platelet transfusion was more common in patients with TE, but this association was not statistically significant in the logistic regression models (Table 2). In the adjusted model, active smoking and procedure length remained significantly associated with TE. Conclusion: To our knowledge, risk factors for thrombotic events in the setting of endovascular cerebral aneurysm treatment have not been previously reported. Procedure length and active smoking are associated with TE, and PT has a trend towards significance. After adjusting for potential confounders, active smoking remains the best predictor of TE (p=0.004), conferring an 11-fold risk.

Background: An echocardiogram or transcranial Doppler (TCD) bubble study to test for a right-to-left shunt (RLS) is a standard component of an ischemic stroke workup. Because the pathway for an intracradiac RLS, such as a patent foramen ovale (PFO), is more direct, it has been proposed that the late appearance of a RLS suggests an extracardiac pathway. We sought to characterize a cohort of ischemic stroke patients with late RLS (LRLS) on TCD. Methods: We searched the medical record of a Comprehensive Stroke Center for patients with ischemic stroke who had a TCD and echocardiogram bubble study during 2011-2013. LRLS was defined as TCD bubbles appearing more than 18 cardiac cycles after contrast injection. TOAST stroke etiology classification was performed by a vascular neurologist blinded to TCD results. Results: 124 patients met inclusion criteria, of which 67/124 (54%) had RLS on TCD; and 32/67 (48%) had LRLS. In the 35/67 patients with normal RLS on TCD, 23% did not have RLS on echocardiography, consistent with prior reports of TCD’s superiority for detecting RLS. In the 32/67 patients with LRLS on TCD, 56% were negative for RLS by echocardiography. In the cohort of 124 patients, the percentage of TOAST classification 4 (stroke of other determined cause) was 26%, while in the 32 patients with LRLS the percentage of TOAST 4 was significantly higher at 52%(p=0.005) (Table 1). The increase in TOAST 4 in LRLS patients was created by an even distribution of decreases in the other TOAST categories. The most common TOAST 4 stroke etiology in LRLS patients was PFO with concurrent deep venous thrombosis. Conclusion: This preliminary data supports prior studies that have shown superiority of TCD over echocardiography for detection of RLS, and challenge the prevailing notion that extracardiac shunt, such as pulmonary AVM, is the most common cause of LRLS in ischemic stroke patients. This subgroup of patients warrants further research to clarify mechanisms of ischemic stroke in patients with RLS.

Staphylococcus Enterotoxin B (SEB) is a superantigen that can activate ~30% of T cells. Inhalation of SEB can lead to toxic shock syndrome and death. We have shown that anandamide (AEA) is effective in ameliorating SEB-induced ALI. Cross-talk between microbiome through the gut-lung axis (GLA) can influence the immune and respiratory functions. In the current study, we found that AEA treatment alleviated SEB-induced ALI in mice by alteration in the microbiome and the metabolome profile especially short-chain fatty acid (SCFA) production in the GLA. Sequencing of the V3–V4 region of 16S rRNA of colon, cecal flushes and lungs was performed and analysis showed that AEA treatment led to a significant increase, starting from the phylum level in Bacteroidetes until genus Aldercreutzia. Mass Spectrometric (MS) analysis revealed that there was a significant increase in the SCFAs in AEA treatment group, especially iso-butyrate, which may be responsible for induction of T regulatory cells (T regs). Flow cytometry data showed that AEA increased CD4+FOXP3+ in the lung compared to vehicle-treated SEB-induced disease group. Our study also showed that AEA treatment significantly decreased the infiltration of inflammatory cells in the lungs. Furthermore, AEA treatment led to a significant decrease in gut and lung leakage, and pro-inflammatory cytokines (IL-2 and TNFα) while increasing anti-inflammatory cytokines (IL-10). Collectively, these data suggest that AEA ameliorates ALI and prevents leakage through modulation of microbiome profile and the metabolome in the GLA while promoting an anti-inflammatory response to include induction of Tregs and decrease in pro-inflammatory cytokines.

Introduction: Hemorrhagic transformation is a serious complication after endovascular therapy for acute ischemic stroke (AIS). Compared to the number of patients who have hemorrhage on follow-up neuroimaging, a fraction of patients develop symptoms related to the hemorrhage. Hypothesis: We sought to identify risk factors for developing symptomatic intracerebral hemorrhage (sICH) following endovascular therapy for AIS, as opposed to hemorrhage incidentally discovered on neuroimaging. Methods: We retrospectively reviewed AIS patients from 2005 to 2013 treated with endovascular therapy and identified those with any intracranial hemorrhage on imaging obtained 24 hours after treatment. We identified univariate associations with sICH that had a p Results: Sixty-five patients had intracranial hemorrhage on imaging, 58% male, mean age 65 ± 13 years, mean admission NIHSS 17 ± 8, and 22/65 (34%) had sICH. In the univariate analysis, post-procedural TICI score, SBP standard deviation (SD) in the first 24 hours, and procedure length achieved significance, but only TICI score and SBP SD retained significance in the multivariable model (Table 1). Several univariates that were presumed to impact sICH proved uninformative (Table 2). Conclusions: In AIS patients who undergo endovascular treatment and have subsequent intracranial hemorrhage, recanalization status and SBP variability are associated with sICH. The later association is novel and warrants further investigation.

Escherichia coli O157:H7, non-O157 E. coli, and Campylobacter spp. are among the top-ranked pathogens that threaten the safety of food supply systems around the world. The associated risks and predisposing factors were investigated in a dynamic animal population using a repeat-cross-sectional study design. Animal and environmental samples were collected from dairy and camel farms, chicken processing plants, and abattoirs and analyzed for the presence of these pathogens using a combination of bacterial enrichment and real-time PCR tests without culture confirmation. Data on putative risk factors were also collected and analyzed. E. coli O157:H7 was detected by PCR at higher levels in sheep and camel feces than in cattle feces (odds ratios [OR], 6.8 and 21.1, respectively). Although the genes indicating E. coli O157:H7 were detected at a relatively higher rate (4.3%) in fecal samples from dairy cattle, they were less common in milk and udder swabs from the same animals (1 and 2%, respectively). Among the food adulterants, E. coli O103 was more common in cattle fecal samples, whereas O26 was more common in sheep feces and O45 in camel feces compared with cattle (OR, 2.6 and 3.1, respectively). The occurrence of E. coli in the targeted populations differed by the type of sample and season of the year. Campylobacter jejuni and Campylobacter coli were more common in sheep and camel feces than in cattle feces. Most of the survey and surveillance of E. coli focused on serogroup O157 as a potential foodborne hazard; however, based on the PCR results, non-O157 Shiga toxin-producing E. coli serotypes appeared to be more common, and efforts should be made to include them in food safety programs.

Salmonella spp. and Listeria monocytogenes are foodborne pathogens of global importance. We assessed their risks and associated factors in a highly dynamic population of animals. Animal and environmental samples were collected from dairy cattle, sheep, camel and chickens at either the farms or the abattoirs. The pathogens were detected using a combination of bacterial enrichment culture and real‐time polymerase chain reaction (PCR). Data on putative risk factors were collect and analysed for their significance of association with these pathogens. Salmonella spp. were detected at higher proportions in sheep faeces and sheep carcasses in comparison to cattle faeces (odds ratio = 2.4 and 2.2, respectively). This pathogen was less common in milk or carcasses samples from cattle or chickens. Sheep and camel carcass samples were highly contaminated with Salmonella spp. Faecal samples from cattle had the most diverse serovars of Salmonella enterica including S. Newport, S. Haifa, S. Kedougou, S. Kentucky, S. Mbandaka and S. Goettingen. Exotic serovars in sheep included S. Eastbourne, S. Chester and S. Kottnus. Serovars that were shed in camel faeces included S. Newport, S. Bovismorbificans and S. Infantis. In all sampled populations, detection of Salmonella spp. was more likely during warmer months than cold months. Listeria monocytogenes was not common in the targeted populations and was detected at a rate of 2.4%, mainly from sheep carcasses. The study highlights the role of food animals as reservoirs of pathogens across boundaries since all feed are imported in that population from different parts of the world.