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Eric Kawana,1 Benjamin Vachirakorntong,2 Vladislav Pavlovich Zhitny,3,4 Michael C Wajda,3 Luzviminda Alexander,1,5 Jake Patrick Young,6 Kyaw Min Tun,4 Omar Al-Taweel,1,5 Chowdhury Ahsan,1,5 Gyorgy Varsanyi,7 Aditi Singh1,4 1Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, Las Vegas, NV, USA; 2Touro University Nevada College of Osteopathic Medicine, Henderson, NV, USA; 3Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University, New York City, NY, USA; 4Department of Internal Medicine, Kirk Kerkorian School of Medicine, Las Vegas, NV, USA; 5Department of Cardiology, University Medical Center of Southern Nevada, Las Vegas, NV, USA; 6Department of Biology, University of Utah, Salt Lake City, UT, USA; 7Department of Anesthesiology and Perioperative Medicine, OptumCare, Las Vegas, NV, USACorrespondence: Vladislav Pavlovich Zhitny, New York University, Department of Anesthesiology, Perioperative Care and Pain Medicine, 5578 Victoria Regina Avenue, Las Vegas, Nevada, 89139, USA, Email vladislav.zhitny@unlv.eduBackground: In the United States, echocardiography is an essential component of the care of many cardiac patients. Recently, increased attention has been given to the accuracy of interpretation of cardiac-based procedures in different specialties, amongst them the field of cardiac anesthesiology and primary echocardiographers for transesophageal echocardiogram (TEE). The purpose of this study was to assess the TEE skills of cardiac anesthesiologists in comparison to primary echocardiographers, either radiologists or cardiologists. In this systematic review, we evaluated available current literature to identify if cardiac anesthesiologists interpret TEE procedures at an identical level to that of primary echocardiographers.Methods: A PRISMA systematic review was utilized from PubMed from the years 1952– 2022. A broad keyword search of “Cardiology Anesthesiology Echocardiogram” and “Echocardiography Anesthesiology” to identify the literature was used. From reviewing 1798 articles, there were a total of 9 studies included in our systematic review, 3 of which yielded quantitative data and 6 of which yielded qualitative data. The mean accuracy from each of these three qualitative studies was calculated and used to represent the overall accuracy of cardiac anesthesiologists.Results: Through identified studies, a total of 8197 TEEs were interpreted by cardiac anesthesiologists with a concordance rate of 84% to the interpretations of primary echocardiographers. Cardiac anesthesiologists had a concordance rate of 83% when compared to radiologists. On the other hand, cardiac anesthesiologists and cardiologists had a concordance rate of 87% in one study and 79% in another study.Conclusion: Based on these studies, cardiac anesthesiologists are shown to interpret TEEs similarly to that of primary echocardiographers. At this time, there is no gold standard to evaluate the accuracy of TEE readings. One way to address this is to individually assess the TEE interpretation of anesthesiologists and primary echocardiographers with a double-blind study.Keywords: echocardiography, transesophageal echocardiogram, cardiac anesthesia

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The article is a collection of analyses carried out on the basis of literature on the subject and data collected with the utilization of desk research method. It also presents conclusions from surveys conducted by means of a qualitative method — IDI technique — during the Congress of Public Relations Professionals, which took place in April 2018 in Rzeszów. In the group of respondents there were representatives of public relations branch who cooperate with influencers and on top of that have rich experience in the area of PR activities conducted by means of the Internet. The goal of this article is assessment of the relationships occurring in the context of cooperation of PR specialists with influencers, as well as identifying the prospects for changes and potential trends in this area.

Background: Recent developments in computer-aided design/computer-aided manufacturing (CAD/CAM) and 3D printing have enabled the fabrication of digital indirect bonding (IDB) transfer trays. These modern products require thorough investigation., Objectives: The aim of the study was to determine the accuracy of one-piece and three-piece IDB transfer trays in vitro., Material and Methods: An initial dental scan (IDS) of a randomly selected patient with digitally positioned brackets served as the master scan (MS) for designing 16 IDB transfer trays of each type. They were 3D printed and used for bonding 448 brackets to the models. Subsequently, the models were scanned with a TRIOS® 3 Intraoral Scanner (3Shape A/S, Copenhagen, Denmark), producing actual scans (ASs). The accuracy of bracket positioning was measured digitally on both MSs and ASs. The measurements were compared to the Objective Grading System for dental casts provided by the American Board of Orthodontics (ABO)., Results: The 2 types of IDB transfer trays showed comparable accuracy. All linear errors were within the clinically acceptable range, whereas the angular measurements demonstrated significant variability, resulting in clinically unacceptable transfer errors that ranged from 3.3% to 90.3%., Conclusions: The study results cannot be unconditionally extrapolated to other types of IDB transfer trays due to the diversity of their properties and features. The study evaluated the in vitro accuracy of IDB transfer trays. The revealed number of errors may be even higher in vivo due to limitations in visibility, salivary flow, interference from the tongue, and difficulties in achieving a proper fit of the IDB transfer tray to the teeth.

Despite continuous and rapid progress in the transplantation of cells, tissues, and organs, many patients die before receiving them. This is because of an insufficient number of donors, which leads to a significant disproportion between the need for donors and their availability. This review aims to present the possibilities offered by alternative therapies. We use the term "functional transplantology" to describe such alternative methods of transplantation that could help change the current state of transplantation medicine. Its purpose is not to replace a defective or removed organ with another but to replace its functions using complementary biological, mechanical, or biomechanical structures or devices. Implementation of many innovative solutions shown in the work for clinical applications is already a fact. In the case of others, it should be considered a future vision. We hope that the role of a defective or damaged tissue or a group of tissues will be taken over by different structures that are functionally complementary with the organ being substituted. Undoubtedly, developing the described methods based on functional transplantology will change the face of transplantation medicine. Thus, we show current trends and new directions of thinking and actions in transplantation medicine that combine technology and transplantology. The review considers the latest technologies, including 3D bioprinting, nanotechnology, cell encapsulation, and organoids. We discuss not only the advantages of new approaches but also the limitations and challenges that must be overcome to achieve significant progress in transplantation. That is the only option to provide a safe and efficient way of improving the quality of life of many patients.

Breast cancer is one of the most commonly diagnosed cancer types worldwide. Regarding molecular characteristics and classification, it is a heterogeneous disease, which makes it more challenging to diagnose. As is commonly known, early detection plays a pivotal role in decreasing mortality and providing a better prognosis for all patients. Different treatment strategies can be adjusted based on tumor progression and molecular characteristics, including personalized therapies. However, dealing with resistance to drugs and recurrence is a challenge. The therapeutic options are limited and can still lead to poor clinical outcomes. This review aims to shed light on the current perspective on the role of miRNAs in breast cancer diagnostics, characteristics, and prognosis. We discuss the potential role of selected non-coding RNAs most commonly associated with breast cancer. These include miR-21, miR-106a, miR-155, miR-141, let-7c, miR-335, miR-126, miR-199a, miR-101, and miR-9, which are perceived as potential biomarkers in breast cancer prognosis, diagnostics, and treatment response monitoring. As miRNAs differ in expression levels in different types of cancer, they may provide novel cancer therapy strategies. However, some limitations regarding dynamic alterations, tissue-specific profiles, and detection methods must also be raised.

Background: One of the most critical decisions that emergency department (ED) physicians make is the discharge versus admission of patients. We aimed to study the association of the decision in the ED to admit patients with chest pain and/or breathlessness to a ward with risk assessment using the Rapid Emergency Triage and Treatment System (RETTS), the National Early Warning Score (NEWS), and plasma levels of the biomarkers copeptin, midregional proadrenomedulin (MR-proADM), and midregional proatrial natriuretic peptide (MR-proANP)., Methods: Patients presenting at the ED with chest pain and/or breathlessness with less than one week onset were enrolled. Patients were triaged according to RETTS. NEWS was calculated from the vital signs retrospectively., Results: Three hundred and thirty-four patients (167 males), mean age 63.8 ± 16.8 years, were included. Of which, 210 (62.8%) patients complained of chest pain, 65 (19.5%) of breathlessness, and 59 (17.7%) of both. Of these, 176 (52.7%) patients were admitted to a ward, and 158 (47.3%) patients were discharged from the ED. In binary logistic models, age, gender, vital signs (O 2 saturation and heart rate), NEWS class, and copeptin were associated with admission to a ward from the ED. In receiver-operating-characteristics (ROC) analysis, copeptin had an incremental predictive value compared to NEWS alone ( P = 0.002)., Conclusions: Emergency physicians' decisions to admit patients with chest pain and/or breathlessness from the ED to a ward are related to age, O 2 saturation, heart rate, NEWS category, and copeptin. As an independent predictive marker for admission, early analysis of copeptin might be beneficial when improving patient pathways at the ED., Competing Interests: Authors declare no conflict of interest., (© 2022 The Author(s). Published by Upsala Medical Society.)

We present a male patient born at 38-wk gestation with rhizomelic shortening of extremities, hepatomegaly, ventriculomegaly, heart failure, severely depressed left ventricular function, biventricular hypertrophy, and biatrial enlargement. Additional physical findings included anteriorly displaced anus, vertebral anomalies, and brachydactyly. The patient's cardiac malformations led to persistent hypotension, sinus tachycardia, and multiorgan failure in the absence of arrhythmias. Rapid whole-exome sequencing was ordered on day of life (DOL) 8. The patient's family elected to withdraw supportive care, and he passed away that evening. Whole-exome sequencing returned posthumously and identified a variant in NAA10 , E100K. The genotype-phenotype was closest to Ogden syndrome or amino-terminal acetyltransferase deficiency. Typical features of this rare X-linked syndrome include progeroid appearance, failure to thrive, developmental delays, hypotonia, and cardiac arrhythmias. Other family members were tested and the patient's mother, who has a history of mild intellectual disability, as well as a daughter born later, were identified as carriers. All carriers showed no cardiac findings. The carrier sister has manifested developmental delay and cortical atrophy. Protein modeling, evolution, dynamics, population variant assessments, and immunoprecipitation depict the deleterious nature of the variant on the interactions of NAA10 with NAA15 These findings had subsequent implications for posthumous diagnosis of the index patient, for female carriers, and regarding family planning. We highlight how these rapid genetic tests and variant characterization can potentially lead to informed decision-making between health-care providers and family members of patients with critical or lethal conditions when treatment options are limited., (© 2020 Afrin et al.; Published by Cold Spring Harbor Laboratory Press.)

New anionic rhodium(iii) complexes, obtained by a simple reaction of RhCl 3 with organic chlorides (derivatives of imidazole and pyridine), have been employed as catalysts for hydrosilylation (reduction) of acetophenone derivatives. The reactions, in which 1,1,1,3,5,5,5-heptamethyltrisiloxane was a reducing agent, proceeded in a biphasic system because the above complexes are insoluble in the reaction medium. Thereby easy isolation of the complexes from post-reaction mixtures was possible after reaction completion. This is the first example of the application of rhodium complexes of this type as catalysts for ketone reduction. The complexes have shown high activity and enabled obtaining the hydrosilylation product in a very short time and in the range of low concentrations (0.1 mol%). By using FT-IR in situ analysis that enables measuring product concentrations in real time, a comparison has been made of the catalytic activity for hydrosilylation of acetophenone and methoxyacetophenone isomers shown by four rhodium complexes ([C + ][RhCl 4 - ]) differing in cations and the most effective catalyst for this process has been distinguished., Competing Interests: There are no conflicts of interest to declare., (This journal is © The Royal Society of Chemistry.)

Studies were performed on the catalytic activity for olefin hydrosilylation shown by three rhodium complexes, [{Rh(μ-OSiMe 3 )(cod)} 2 ] (I), [{Rh(μ-Cl)(cod)} 2 ] (II) and [RhCl(PPh 3 ) 3 ] (III), and three platinum complexes, [Pt(PPh 3 ) 4 ] (IV), [Pt(PPh 3 ) 2 Cl 2 ] (V) and PtCl 4 (VI), immobilized in a series of different anion-containing morpholinium ionic liquids. The effect of the kind of anion (its nucleophilic character) on the activity, stability and possibility of a catalytic system with multiple uses in the hydrosilylation process has been established. In the case of the best systems it was possible to reuse the same catalyst sample 10 times almost without any decrease in the activity and a TON value over 99 000 was obtained., Competing Interests: There are no conflicts of interest to declare., (This journal is © The Royal Society of Chemistry.)

In this paper, the Pt-catalyzed hydrosilylation of hydroxyl ethers is described. Various bifunctional alkoxysilanes were obtained and applied in O-silylation of free hydroxyl groups on the silica surface. These modified solid materials have been used as excellent supports for linking synthetic nucleic acids. Nucleic acids permanently attached to the solid surface were tested in hybridization with complementary fluorescence-labeled sequences. Detection of nucleic acids anchored to the solid support was performed by fluorescence microscopy after hybridization., Competing Interests: The authors declare no competing financial interest.

Objective: Elderly patients suffer fractures through low-energy mechanisms. The distal radius is the most frequent fracture localization. Insulin-like growth factor-1 (IGF1) plays an important role in the maintenance of bone mass and its levels decline with advancing age and in states of malnutrition. Our aim was to investigate the association of IGF1 levels, bone mass, nutritional status, and inflammation to low-energy distal radius fractures and also study if fracture healing is influenced by IGF1, nutritional status, and inflammation., Methods: Postmenopausal women, 55 years or older, with low-energy distal radius fractures occurring due to falling on slippery ground, indoors or outdoors, were recruited in the emergency department (ED) and followed 1 and 5 weeks after the initial trauma with biomarkers for nutritional status and inflammation. Fractures were diagnosed according to standard procedure by physical examination and X-ray. All patients were conservatively treated with plaster casts in the ED. Patients who needed interventions were excluded from our study. Fracture healing was evaluated from radiographs. Fracture healing assessment was made with a five-point scale where the radiological assessment included callus formation, fracture line, and stage of union. Blood samples were taken within 24 h after fracture and analyzed in the routine laboratory. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA)., Results: Thirty-eight Caucasian women, aged 70.5 ± 8.9 years (mean ± SD) old, were recruited. Nutritional status, as evaluated by albumin (40.3 ± 3.1 g/L), IGF1 (125.3 ± 39.9 μg/L), body mass index (26.9 ± 3.6 kg/m 2 ), arm diameter (28.9 ± 8.9 cm), and arm skinfold (2.5 ± 0.7 cm), was normal. A positive correlation was found between IGF1 at visit 1 and the lowest BMD for hip, spine, or radius (r = 0.39, P = 0.04). High sensitive C-reactive protein (hsCRP) and leukocytes were higher at the fracture event compared to 5 weeks later (P = 0.07 and P < 0.001, respectively). Fracture healing parameters (i.e. callus formation, fracture line, and stage of union) were positively correlated with the initial leukocyte count and to difference in thrombocyte count between visit 1 and 3., Conclusions: In elderly women with low-energy distal radius fractures, an association between IGF1 and lowest measures of BMD was found, indicating that low IGF1 could be an indirect risk factor for fractures. Fracture healing was associated with initial leukocytosis and a lower thrombocyte count, suggesting that inflammation and thrombocytes are important components in fracture healing., (© 2017 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.)

Study Objective: The objective of this study was to determine whether lavender fleur oil (LFO) aromatherapy would reduce anxiety when administered to women before undergoing breast surgery., Design: This was a single-site, randomized study comparing the effect of LFO to unscented oil (UO)., Setting: The study was conducted in the preoperative holding area of the ambulatory surgery department of NYU Langone Medical Center., Patients: Ninety three women, 18 years and older, scheduled for breast surgery. Women meeting inclusion/exclusion criteria were randomized to either LFO or UO aromatherapy and were blind to their assigned treatment., Outcome Measures: Subjects completed a Speilberger State Anxiety Inventory for Adults (STAI) before and after aromatherapy. Vital signs were recorded before and after aromatherapy., Results: STAI-State questions were divided into positive and negative emotions for analysis. Before aromatherapy, there was no significant difference between groups by individual questions or overall average answer of either positive or negative questions. The use of both LFO and UO increased the positive STAI score totals, with the LFO group having a slightly, but statistically significant, greater increase. Both resulted in a statistically significant decrease in the negative score totals after treatment. There were no differences in vital signs between groups for either treatment. Following the conclusion of the trial LFO was analyzed and found to contain a very low content of the 2 major Lavandula angustifolia constituents., Conclusions: Both LFO and UO aromatherapy treatments lowered anxiety before surgery despite no significant changes in vital signs. LFO treatment generated a slight but statistically significant increase in positive feelings compared with UO treatment. It is probable that the beneficial effect observed was due to both aromatherapy with LFO and a placebo effect related to the added attention given to the patients., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Vinyl-substituted boronates in the presence of complexes containing Ru-H bonds (preferably [Ru(CO)ClH(PCy(3))(2)], Cy: cyclohexyl) react regioselectively with terminal ethynes (involving silylethynes), albeit with the exception of phenylacetylene, to produce boryl- and borylsilyl-substituted buta-1,3-dienes with a preference for E,E-diene. The reaction opens a new catalytic route for the preparation of dienylboronates, and particularly dienylsilylboronates, that are functionalised building blocks in the synthesis of organic and natural products. The mechanism of this new reaction was proved to involve an insertion of alkyne into Ru-H bonds followed by an insertion of coordinated vinyl boronate into the Ru-C= bond and beta-hydrogen transfer to the metal to eliminate boryldiene or borylsilyldiene.

Background: Parenteral administration of opioids and NSAIDs has been the mainstay for postoperative pain control in patients undergoing laparoscopic adjustable gastric banding (LAGB). Both classes of drugs, however, are associated with serious adverse effects. An addition of complimentary analgesic techniques may decrease requirement for traditional analgesics, thus reducing the incidence of side-effects. We designed the study to evaluate the effectiveness of Lavender aromatherapy in reducing opioid requirements after LAGB., Methods: A prospective randomized placebo controlled study was carried out on 54 patients undergoing LAGB. Upon arrival to the post-anesthesia care unit (PACU), patients in the study group were treated with lavender oil, which was applied to the oxygen face mask; the control group patients received nonscented baby oil. Postoperative pain was treated with morphine. Numerical rating scores (0-10) were used to measure the level of pain at 5, 30, and 60 min. Sedation was evaluated using the Observer Assessment of Alertness/Sedation scale (0-5). Data analyzed included the amount of opioids, NRS, OAA/S, PACU discharge time, as well as the incidence of side-effects., Results: The two groups were comparable with regard to patient characteristics, intraoperative drug use, and surgical time. Significantly more patients in the Placebo group (PL) required analgesics for postoperative pain (22/27, 82%) than patients in the Lavender group (LAV) (12/26, 46%) (P = .007). Moreover, the LAV patients required significantly less morphine postoperatively than PL patients: 2.38 mg vs 4.26 mg, respectively (P = .04). There were no differences in the requirements for post-operative antiemetics, antihypertensives, or PACU discharge time., Conclusions: Our results suggest that lavender aromatherapy can be used to reduce the demand for opioids in the immediate postoperative period. Further studies are required to assess the effect of this therapy on clinically meaningful outcomes, such as the incidence of respiratory complications, delayed gastric emptying, length of hospital stay, or whether this therapy is applicable to other operations.

This study compared the analgesic efficacy of postoperative lavender oil aromatherapy in 50 patients undergoing breast biopsy surgery. Twenty-five patients received supplemental oxygen through a face mask with two drops of 2% lavender oil postoperatively. The remainder of the patients received supplemental oxygen through a face mask with no lavender oil. Outcome variables included pain scores (a numeric rating scale from 0 to 10) at 5, 30, and 60 minutes postoperatively, narcotic requirements in the postanesthesia care unit (PACU), patient satisfaction with pain control, as well as time to discharge from the PACU. There were no significant differences in narcotic requirements and recovery room discharge times between the two groups. Postoperative lavender oil aromatherapy did not significantly affect pain scores. However, patients in the lavender group reported a higher satisfaction rate with pain control than patients in the control group (P = 0.0001).

Study Objective: The aim of this study was to compare the analgesic efficacy of premedication with rofecoxib vs intravenous (IV) ketorolac in reducing postoperative pain after arthroscopic knee surgery., Study Design: This is a prospective, randomized, double-blinded study., Setting: This study was set at a university hospital., Subjects: The subjects include 54 patients with American Society of Anesthesiologists physical statuses I, II, and III undergoing knee arthroscopy., Interventions: Group 1 received 50 mg oral rofecoxib preoperatively with IV placebo injection, which was administered 20 minutes before the end of the operation. Group 2 received a preoperative placebo and 30 mg IV ketorolac 20 minutes before the end of surgery., Measurements: The primary outcome measure was the proportion of patients reporting pain in the postoperative anesthesia care unit, 6 hours and 24 hours after discharge. Additional end points included the use of 5:325 mg oxycodone-acetaminophen (O/A) tablets, pain scores, patient's satisfaction survey, and comparison of side effects. Data were analyzed using independent samples t tests for continuous variables or chi2 tests for categorical variables. P < .05 was considered significant., Results: The 2 groups were comparable with regard to patient characteristics, intraoperative medication use, and duration of surgery. There was no difference either in pain scores or O/A use in the postoperative anesthesia care unit. At 24 hours after discharge, significantly more patients in the ketorolac group (91%) reported pain than the rofecoxib group (63%) (P = .02). Sixty-one percent of patients in the ketorolac group used O/A during the first 24 hours vs 38% in the rofecoxib group. The difference, however, was not statistically significant., Conclusion: Preoperative rofecoxib is as effective as ketorolac for the treatment of pain after knee arthroscopy. Higher frequency of pain reporting at 24 hours by patients in ketorolac group is explained by the longer analgesic effect of rofecoxib. Future studies should directly compare gastrointestinal injury of these drugs, as well as cost-effectiveness of rofecoxib vs ketorolac.

The aim of the study was to assess an effect of lipid lowering diet on serum lipids in peritoneal dialysis patients. Total cholesterol (TC) decreased after 3 months of low-fat diet from 203.7 mg/dl to 181 mg/dl, probably due to increased P/S ratio (PUFA/SFA) from 0.4 to 0.57. After another 3 months of the diet, a decrease in P/S ratio and concomitant increase in TC and LDL-C levels were found. Nutritional status of patients during lipid lowering diet was stable.

Rubinstein-Taybi syndrome is a constellation of clinical findings characterized by mental and motor retardation, broad thumbs and broad first toes, typical facies. Ocular and adnexal abnormalities are quite common and include antimongoloid slant of the palpebral fissures, epicanthal folds, congenital obstruction of the lacrimal excretory system, ptosis, strabismus, congenital cataract and congenital glaucoma. The authors describe the case of a 1-year-old male with the Rubinstein-Taybi syndrome associated with unilateral congenital glaucoma. The case emphasizes the importance of detailed complete ocular examinations in patients with Rubinstein-Taybi syndrome, and also highlights the occurrence of ocular abnormalities rarely associated with this disease.

Two glycolipids were isolated from pig brain and were shown to be the fatty acid esters of kerasin and cerebron in which the second fatty acid moiety is attached to the 6-position of the galactose. The point of attachment was shown in two ways: by permethylation and by cleavage with periodate. Methanolysis of the permethylated cerebroside esters yielded O-methyl sphingosines, methyl esters of nonhydroxy or 2-methoxy acids, and methyl 2,3,4-trimethyl galactoside. Cleavage of the cerebron ester with periodate, followed by treatment with sodium borohydride and dilute HCl, yielded ceramide plus 1-monoglyceride. The ester-linked fatty acids were primarily 16:0, 18:0, and 18:1, while the amide-linked fatty acids showed the wide assortment of chain lengths typical of brain cerebrosides. The methylation step, with silver oxide and methyl iodide, yielded two derivatives with the cerebroside esters, but the structural explanation for the difference was not elucidated. The galactose in the cerebron ester was shown to exist in the beta-pyranoside form.