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Mahdi Sadeghi,1 Fatima Wasti,2 Syeda Anum Zahra3 1Kings College London, London, UK; 2Royal Berkshire NHS Foundation Trust, Berkshire, UK; 3Imperial College NHS Trust, London, UK

Vaishnav Krishna,1 Parmis Vafapour,2 Syeda Anum Zahra3 1Medical University of Plovdiv, Plovdiv, Bulgaria; 2Barts and the London School of Medicine and Dentistry (QMUL), London, UK; 3Imperial NHS Trust, London, UKCorrespondence: Vaishnav Krishna, Medical University of Plovdiv, Plovdiv, Bulgaria, Email contactvaishnavk@gmail.com

Muhammad Haris Ilyas,1 Mahnoor Irfan,2 Syeda Anum Zahra3 1School of Medicine, University of Leeds, Leeds, UK; 2St George’s, University of London, London, UK; 3Imperial College, School of Medicine, London, UKCorrespondence: Mahnoor Irfan, Email mahnoorirfan048@gmail.com

Traumatic brain injury (TBI) causes deficits in neurological function, induces pathological changes, and increases oxidative stress. The current investigation aimed to determine Daidzein's neuroprotective potential in experimental TBI. Initially, the HT-22 cell line exposed to H 2 O 2 underwent in vitro examination, and the results showed that Daidzein had a neuroprotective effect evident from enhanced cell viability and decreased NO generation. Using three different Daidzein doses-1 mg/kg, 5 mg/kg, and 10 mg/kg-in the in vivo experiment, the potential of Daidzein was evaluated against TBI. The neurological severity score (NSS), kondziela's screen test, and elevated plus maze showed improvements after treatment with Daidzein manifested by decreased score, enhanced motor coordination, and anti-anxiety effects. Additionally, Daidzein improved mechanical allodynia and restored the breakdown of the blood-brain barrier. The FTIR spectral analysis showed restoration of the biochemical compositional changes. Furthermore, H & E and Toluidine blue staining revealed an improvement in the histopathological alterations. The RT-qPCR revealed an increase in mRNA expression level of Nrf2, HO-1, and Bcl-2 and the downregulation of Keap-1, Bax and Cleaved caspase-3 expressions. Thus, exhibiting its antioxidant and antiapoptotic potential. The RT-qPCR also manifested a decrease in mRNA expression of GFAP and Iba-1. Further immunohistochemistry results indicated Daidzein's antioxidant and antiapoptotic properties by upregulating Nrf2 and downregulating cleaved caspase-3. Daidzein also lowered the apoptosis index and improved neuronal survival evidenced by flow cytometric analysis. In addition to this, Daidzein notably increased the antioxidant enzyme levels and decreased the oxidative stress markers. The current study's findings point to the neuroprotective potential of the phytoestrogen Daidzein as it lessened neurological abnormalities, decreased oxidative stress, and lowered proapoptotic protein expression., (© 2024 Wiley Periodicals LLC.)

The Asteraceae family is a prominent group of flowering plants found across the globe, with the exception of Antarctica. The Asteraceae family is a largest flowering family pivotal group in plant evolution and diversification. Despite its importance, the genetic diversity within this family remains understudied. We focused on the rps-11 gene, a chloroplast marker previously utilized in phylogenetic studies, to investigate its potential in resolving Asteraceae relationships. The focus was on examining genetic diversity within sixteen specifically chosen species from the Asteraceae family. This assessment was based on an analysis of a chloroplast gene responsible for encoding the ribosomal protein of the smaller subunit 11 (rps 11). Nearly 417 bp of rps 11 gene was amplified, sequenced, computationally translated into amino acid sequence and the data was used for phylogenetic analysis as well as for rps 11 protein structure predictions. Based on nucleotide and amino acid sequences phylograms were drawn with the help of Molecular Evolutionary Genetic Analysis (MEGA 6), which exhibited clear genetic relationship among species under investigation. The observed genetic distance was 0.02 for Maximum likelihood tree based on nucleotide sequences whereas it was 0.05 for phylogram based on amino acid sequences. These values revealed that amino acid-based tree has demonstrated greater diversity among selected species in comparison to nucleotides-based tree. On the basis of pair wise distance calculations, genetic divergence values were found within the range of 0.015-0.309. Moreover, 3D protein modeling for rps 11 protein of sixteen selected species was also carried out by iterative threading assembly refinement (I-Tasser) software. The models exhibiting the highest C-score were picked with satisfactory plot statistics (> 90%) and structurally validated by PROCHECK. Furthermore, Ramachandran plots displayed that the rps 11 protein structures of Tagetes minuta, Xanthium strumarium, Lactuca sativa and Chrysanthemum indicum have best feature models with > 90% of residues in the allowed region and ≤ 2% in the disallowed region. The research is not enough to stand alone to validate the viability of the rps11 gene as a prospective contender for phylogenetic analysis. İn future we will focus on the maximum genetic diversity theory for phylogenetic analysis of this family., (© 2024. The Author(s).)

Biofilms play important roles in water technologies such as membrane treatments and activated sludge. The extracellular polymeric substances (EPS) are key components of biofilms. However, the precise nature of these substances and how they influence biofilm formation and behavior remain critical knowledge gaps. EPS are produced by many different microorganisms and span multiple biopolymer classes, which each require distinct strategies for characterization. The biopolymers additionally associate with each other to form insoluble complexes. Here, we explore recent progress toward resolving the structures and functions of EPS, where a shift towards direct functional assessments and advanced characterization techniques is necessary. This will enable integration with better microbial community and omics analyses to understand EPS biosynthesis pathways and create further opportunities for EPS control and valorization., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Imaging is instrumental in diagnosing and directing the management of atherosclerosis. In 1958 the first diagnostic coronary angiography (CA) was performed, and since then further development has led to new methods such as coronary CT angiography (CTA), optical coherence tomography (OCT), positron tomography (PET), and intravascular ultrasound (IVUS). Currently, CA remains powerful for visualizing coronary arteries; however, recent studies show the benefits of using other non-invasive techniques. This review identifies optimum imaging techniques for diagnosing and monitoring plaque stability. This becomes even direr now, given the rapidly rising incidence of atherosclerosis in society today. Many acute coronary events, including acute myocardial infarctions and sudden deaths, are attributable to plaque rupture. Although fatal, these events can be preventable. We discuss the factors affecting plaque integrity, such as increased inflammation, medications like statins, and increased lipid content. Some of these precipitating factors are identifiable through imaging. However, we also highlight significant complications arising in some modalities; in CA this can include ventricular arrhythmia and even death. Extending this, we elucidated from the literature that risk can also vary based on the location of arteries and their plaques. Promisingly, there are less invasive methods being trialled for assessing plaque stability, such as Cardiac Magnetic Resonance Imaging (CMR), which is already in use for other cardiac diseases like cardiomyopathies. Therefore, future research focusing on using imaging modalities in conjunction may be sensible, to bridge between the effectiveness of modalities, at the expense of increased complications, and vice versa., (Copyright © 2024 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.)

Out of hospital cardiac arrest (OHCA) outcomes can be improved by strengthening the chain of survival, namely prompt cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED). However, provision of bystander CPR and AED use remains low due to individual patient factors ranging from lack of education to socioeconomic barriers and due to lack of resources such as limited availability of AEDs in the community. Although the impact of health inequalities on survival from OHCA is documented, it is imperative that we identify and implement strategies to improve public health and outcomes from OHCA overall but with a simultaneous emphasis on making care more equitable. Disparities in CPR delivery and AED use in OHCA exist based on factors including sex, education level, socioeconomic status, race and ethnicity, all of which we discuss in this review. Most importantly, we discuss the barriers to AED use, and strategies on how these may be overcome., Competing Interests: Declaration of competing interest All other authors declared that there are no conflicts of interest., (Copyright © 2024. Published by Elsevier Inc.)

This letter summarises the perspectives of medical students in the United Kingdom (UK) on the research paper conducted by Wang and colleagues (2023) titled 'Achievement Emotions of Medical Students: Do They Predict Self-Regulated Learning and Burnout in an Online Learning Environment?'. Overall, we find this paper a positive contribution to the literature surrounding medical education. However, we have highlighted some weaknesses in the study design and proposed additional points for exploration in further iterations of this study. We hope the readership takes the time to read our letter and consider the points we have raised.

Abstract: Takotsubo syndrome (TTS) can be described as an acute, transiently occurring form of heart failure. It typically causes systolic dysfunction of the left ventricle (LV). Perhaps what is of most significance is the reversible nature of TTS, with many patients achieving recovery within a few weeks to months. TTS can be referred to by other names, attributed to its various precipitants, as well as the structural manifestations of the syndrome. Physical and emotional stressors have been identified as the most common of causes, hence the terms 'stress cardiomyopathy' and 'broken heart syndrome'. Precipitants can range from psychological, and hormonal, to molecular mechanisms. The symptoms of TTS can coalesce with other conditions and hence give rise to many differential diagnoses. Most patients present with dyspnoea and chest pain. The latter also presents in acute coronary syndrome (ACS); thus, ACS is a common differential diagnosis for TTS. The coronavirus disease 2019 (COVID-19) pandemic saw a drastic increase in mental health concerns which have persisted beyond this period. Further studies into personality disorders and their potential predisposition to COVID-19 and thus TTS would advance our understanding of the neuropsychiatric triggers of TTS. There is also a need for a single sensitive and specific diagnostic test for TTS as its diagnosis relies on the culmination of clinical presentation, echocardiography, cardiac catheterization, and cardiovascular magnetic resonance imaging (CMR)., (Copyright © 2023 Italian Federation of Cardiology - I.F.C. All rights reserved.)

Background: Cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) is a well established therapy in patients with reduced left ventricular ejection fraction (LVEF), heart failure, and wide QRS or expected frequent ventricular pacing. Left bundle branch area pacing (LBBAP) has recently been shown to be a safe alternative to BVP., Objectives: The aim of this study was to compare the clinical outcomes between BVP and LBBAP among patients undergoing CRT., Methods: This observational study included patients with LVEF ≤35% who underwent BVP or LBBAP for the first time for Class I or II indications for CRT from January 2018 to June 2022 at 15 international centers. The primary outcome was the composite endpoint of time to death or heart failure hospitalization (HFH). Secondary outcomes included endpoints of death, HFH, and echocardiographic changes., Results: A total of 1,778 patients met inclusion criteria: 981 BVP, 797 LBBAP. The mean age was 69 ± 12 years, 32% were female, 48% had coronary artery disease, and mean LVEF was 27% ± 6%. Paced QRS duration in LBBAP was significantly narrower than baseline (128 ± 19 ms vs 161 ± 28 ms; P < 0.001) and significantly narrower compared to BVP (144 ± 23 ms; P < 0.001). Following CRT, LVEF improved from 27% ± 6% to 41% ± 13% (P < 0.001) with LBBAP compared with an increase from 27% ± 7% to 37% ± 12% (P < 0.001) with BVP, with significantly greater change from baseline with LBBAP (13% ± 12% vs 10% ± 12%; P < 0.001). On multivariable regression analysis, the primary outcome was significantly reduced with LBBAP compared with BVP (20.8% vs 28%; HR: 1.495; 95% CI: 1.213-1.842; P < 0.001)., Conclusions: LBBAP improved clinical outcomes compared with BVP in patients with CRT indications and may be a reasonable alternative to BVP., Competing Interests: Funding Support and Author Disclosures Dr Vijayaraman has received honoraria and consultancy, research, and fellowship support from Medtronic; has served as a consultant for Abbott and Eaglepoint; has received honoraria from Boston Scientific and Biotronik; and has a patent for a His bundle pacing delivery tool. Dr Sharma has received honoraria from Medtronic; and has served as a consultant for Medtronic, Abbott, and Biotronik. Dr Cano has received honoraria from and served as a consultant for Medtronic, Biotronik, and Boston Scientific. Dr Ponnusamy has received honoraria from Medtronic. Dr Herweg has served as a speaker and consultant for Abbott; and has received speaking and fellowship support from Medtronic. Dr Jastrzebski has received honoraria from and served as a consultant for Medtronic and Abbott. Dr Zou has received honoraria from Abbott, Biotronik, Boston Scientific, Medtronic, and Microport. Dr Chelu has received research support from Patient-Centered Outcomes Research Institute, National Institutes of Health, Abbott, and Impulse Dynamics; and has received honorarium from Impulse Dynamics. Dr Vernooy has served as a consultant for Biosense Webster, Philips, Medtronic, Abbott, and Boston Scientific; and has received research and educational grants to his institution from Philips, Abbott, Medtronic, and Biosense Webster. Dr Whinnett has received honoraria from Medtronic and Boston Scientific; and has served as a consultant for Medtronic and Abbott. Dr Nair has received grants-in-aid from Biosense Webster, Medtronic, Canadian Institutes of Health Research, and Heart and Stroke Foundation of Canada; and has received honoraria and consulting fees from Medtronic, Biosense Webster, and Boston Scientific. Dr Curila has served as a consultant for and received honoraria from Medtronic, Biotronik, and Abbott. Dr Ellenbogen has served as a consultant for Medtronic, Boston Scientific, Abbott, and Biotronik; and has received honoraria from Medtronic, Boston Scientific, and Biotronik. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Limited information is available on the characteristics of algal-bacterial aerobic granular sludge (AGS) treating real wastewater, especially on its alginate-like exopolymers (ALE) production. In addition, the effect of target microalgae species inoculation on the system performance has not been fully understood. This study aimed to reveal the effect of microalgae inoculation on the characteristics of algal-bacterial AGS and its ALE production potential. Two photo-sequencing batch reactors (PSBR) were employed, namely R1 with activated sludge and R2 with Tetradesmus sp. and activated sludge being inoculated, respectively. Both reactors were fed with locally sourced municipal wastewater and operated for 90 days. Algal-bacterial AGS were successfully cultivated in both reactors. No significant difference was observed between the performances of R1 and R2, reflecting that the inoculation of target microalgae species may not be crucial for the development of algal-bacterial AGS when treating real wastewater. Both reactors achieved an ALE yield of about 70 mg/g of volatile suspended solids (VSS), indicating that a substantial amount of biopolymer can be recovered from wastewater. Interestingly, boron was detected in all the ALE samples, which might contribute to granulation and interspecies quorum sensing. The enrichment of lipids content in ALE from algal-bacterial AGS treating real wastewater reveals its high resource recovery potential. Overall, the algal-bacterial AGS system is a promising biotechnology for simultaneous municipal wastewater treatment and resource (like ALE) recovery., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Despite various research works on algal-bacterial aerobic granular sludge for wastewater treatment and resource recovery processes, limited information is available on its application in real wastewater treatment in terms of performance, microbial community variation and resource recovery. This study investigated the performance of algal-bacterial aerobic granular sludge on real low-strength wastewater treatment in addition to the characterization of microbial community and fatty acid compositions for biodiesel production. The results demonstrated 71% COD, 77% NH 4 + -N and 31% phosphate removal efficiencies, respectively. In addition, all the water parameters successfully met the effluent standard A, imposed by the Department of Environment (DOE) Malaysia. Core microbiome analyses revealed important microbial groups (i.e., Haliangium ochraceum, Burkholderiales and Chitinophagaceae) in bacterial community. Meanwhile the photosynthetic microorganisms, such as Oxyphotobacteria and Trebouxiophyceae dominated the algal-bacterial aerobic granular sludge, suggesting their important roles in granulation and wastewater treatment. Up to 12.51 mg/gSS lipid content was recovered from the granules. In addition, fatty acids composition showed high percetages of C16:0 and C18:0, demonstrating high feasibility to be used for biodiesel production application indicated by the cetane number, iodine value and oxidation stability properties., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Elaeagnus angustifolia (EA) mediated green chemistry route was used for the biofabrication of NiONPs without the provision of additional surfactants and capping agents. The formation of NiONPs was confirmed using advanced different characterization techniques such as Scanning electron microscopy, UV, Fourier transmission-infrared, RAMAN, and energy dispersal spectroscopic and dynamic light scattering techniques. Further, different biological activities of EA-NiONPs were studied. Antibacterial activities were performed using five different bacterial strains using disc-diffusion assays and have shown significant results as compared to standard Oxytetracycline discs. Further, NiONPs exhibited excellent antifungal performance against different pathogenic fungal strains. The biocompatibility test was performed using human RBCs, which further confirmed that NiONPs are more biocompatible at the concentration of 7.51-31.25 µg/mL. The antioxidant activities of NiONPs were investigated using DPPH free radical scavenging assay. The NiONPs were demonstrated to have much better antioxidant potentials in terms of % DPPH scavenging (93.5%) and total antioxidant capacity (81%). Anticancer activity was also performed using HUH7 and HEP-G2 cancer cell lines and has shown significant potential with IC 50 values of 18.45 μg/mL and 14.84 μg/mL, respectively. Further, the NiONPs were evaluated against Lesihmania tropica parasites and have shown strong antileishmanial potentials. The EA-NiONPs also showed excellent enzyme inhibition activities; protein kinase (19.4 mm) and alpha-amylase (51%). In conclusion, NiONPs have shown significant results against different biological assays. In the future, we suggest various in vivo activities for EA-NiONPs using different animal models to further unveil the biological and biomedical potentials.

Two-dimensional (2D) multiferroics are key candidate materials towards advancement of smart technology. Here, we employed a simple synthesis approach to address the long-awaited dream of developing ferroelectric and multiferroic 2D materials, especially in the new class of materials called MXenes. The etched Ti 3 C 2 T x MXene was first synthesized after HF-treatment followed by a delamination process for successful synthesis of free-standing Ti 3 C 2 T x film. The free-standing film was then exposed to air at room-temperature and heated at different temperatures to form a TiO 2 layer derived from the Ti 3 C 2 T x MXene itself. The ferroelectric measurement showed a clear polarization hysteresis loop at room-temperature. Also, due to the reported ferromagnetic behavior of Ti 3 C 2 T x MXene, our composite could show multiferroic properties at room-temperature. The magnetoelectric coupling test was also performed that showed a clear, switchable spontaneous polarization under applied magnetic field. TiO 2 is reported to be an incipient ferroelectric that assumes a ferroelectric phase in composite form. The structural and morphological analysis confirmed successful synthesis of free-standing film and the Raman spectroscopy revealed the formation of different phases of TiO 2 and the observed ferroelectricity could be due to structural deformation as a result of the formation of this new phase. The measured value of remanent polarization is 0.5 μC cm -2 . This is the first report on the existence of a ferroelectric phase and multiferroic coupling in 2D free-standing MXene film at room-temperature which opens-up the possibility of 2D material-based electric and magnetic data storage applications at room-temperature., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

In the recent years, green synthesis of zinc oxide nanoparticles (ZnONPs) using plant extracts and phytochemicals has gained significant attention. In present research study, facile, green, and tunable ZnONPs were biosynthesized from Rhamnella gilgitica leaf aqueous extract as a strong reducing and stabilizing agents. The prepared ZnONPs@Rhamnella were characterized and validated using common nanotechnology techniques (UV-Vis, XRD, EDX, FT-IR, SEM, TEM, DLS, and Raman) and revealed spherical morphology with particle size ~21 nm. The asynthesized ZnONPs were further evaluated for different biological applications. Strong antimicrobial efficacies were reported for ZnONPs using disc-diffusion method and were capable of rendering significant antimicrobial potential. ZnONPs were evaluated against HepG2 (IC 50 : 18.40 μg/ml) and HUH7 (IC 50 : 20.59 μg/ml) cancer cell lines and revealed strong anticancer properties. Dose-dependent MTT cytotoxicity assay was confirmed using Leishmania tropica "KWH23 strain" (promastigote: IC 50 : 26.78 μg/ml and amastigote: IC 50 : 29.57 μg/ml). Antioxidant activities (DPPH: 93.36%, TAC: 72.43%) were performed to evaluate their antioxidant potentials. Further, protein kinase and α-amylase inhibition assays were determined. Biocompatibility assays were done using human RBCs and macrophages thus revealed biosafe and non-toxic nature of ZnONPs@Rhamnella. In current experiment, we concluded that greenly orchestrated ZnONPs is an attractive, non-toxic and ecofriendly candidate and showed potential biological activities. In future, different clinical trials and in vivo studies are necessary for the confirmation of these remedial properties of ZnONPs using different animal models. RESEARCH HIGHLIGHTS: Greenly orchestrated ZnONPs were synthesized using Rhamnella gilgitica leaves broth. Analytical techniques such as UV, SEM, TEM, XRD, FTIR, DLS, and Raman confirmed synthesis of ZnONPs. Green ZnONPs determined strong antimicrobial, cytotoxic, and antioxidant potentials. Significant enzyme inhibition and biocompatibility assays were investigated., (© 2022 Wiley Periodicals LLC.)

Utilization of cost-effective, bifunctional, and efficient electrocatalysts for complete water splitting is desirable for sustainable clean hydrogen energy. In last decade, MXenes, a family of emerging two-dimensional (2D) materials with unique physiochemical properties, enticed scientists because of their use in different applications. However, insufficient electron transport, lower intrinsic chemical activity and limited active site densities are the factors inhibiting their use in electrocatalytic cells for hydrogen production. Here, we have presented material design to address this issue and introduced carbon nanotubes (CNTs) on V 2 CT x MXene sheets for conductive network channels that enhance the ion diffusion for enhanced electrochemical activity. The SEM reveals the uniform dispersion of the MWCNTs over the MXene surface that resulted in the formation of conductive network channels and enhances reaction kinetics. The as-synthesized electrocatalyst was subjected to linear sweep voltammetry (LSV) measurements for hydrogen evolution reaction (HER) and oxygen evolution reaction (OER). The hybrid catalyst M2 exhibited an enhanced HER activity with a lower over-potential of 27 mV which is comparable to commercially available Pt-based catalysts (32 mV). Similarly, an enhanced OER activity was observed with a lower over-potential of 469 mV as compared to pristine V 2 CT x MXene. The electrocatalyst was subjected to a durability test through chronoamperometry and was observed to be stable for 16 hours. Hence, this study opens a new avenue for future cost-effective efficient catalysts for overall water splitting as a solution to produce clean hydrogen., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Key Message: Plant heat stress response is a multi-factorial trait that is precisely regulated by the complex web of transcription factors from various families that modulate heat stress responsive gene expression. Global warming due to climate change affects plant growth and development throughout its life cycle. Adds to this, the frequent occurrence of heat waves is drastically reducing the global crop yield. Molecular plant scientists can help crop breeders by providing genetic markers associated with stress resistance. Plant heat stress response (HSR), however, is a multi-factorial trait and using a single stress resistance trait might not be ideal to develop thermotolerant crops. Transcription factors participate in regulation of plant biological processes and environmental stress responses. Recent studies have revealed that plant HSR is precisely regulated by the complex web of transcription factors from various families. These transcription factors enhance plant heat stress tolerance by regulating the expression level of several stress-responsive genes independently or in cross talk with different other transcription factors. This review explores how signaling pathways triggered by heat stress are regulated by multiple transcription factor families. To our knowledge, we for the first time analyze the role of major transcription factor families in plant HSR along with their regulatory mechanisms. In the end, we will also discuss the potential of emerging technologies to improve thermotolerance in plants., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Present study established the biological potential of Schweinfurthia papilionacea , Tricholepis glaberrima and Viola stocksii extracts for their potential applications in drug formulations. Initially, FTIR was performed to ascertain functional groups and then plant extracts were prepared using five solvents depending on the polarity. Total phenolic contents were observed in the range of 36.36 ± 1.08 mg GAE/g to 95.55 ± 2.46 mg GAE/g while flavonoid contents were found in the range of 10.51 ± 0.25 mg QE/g to 22.17 ± 1.79 mg QE/g. Antioxidant activity was determined using TRP, CUPRAC, TAC and DPPH assays and was recorded highest in S. papilionacea followed by T. glaberrima extracts. TPC and TFC were found to be strongly correlated with TRP (r > 0.50), CUPRAC (r > 0.53) and DPPH (r = 0.31 and 0.72) assay while weakly correlated with TAC (r = 0.08 and 0.03) as determined by Pearson correlation analysis. Anticancer activity showed that S. papilionacea chloroform extracts possess highest cell viability (85.04 ± 4.24%) against HepG2 cell lines while T. glaberrima chloroform extracts exhibited highest activity (82.80 ± 2.68%) against HT144 cell lines. Afterwards, highest PXR activation was observed in T. glaberrima (3.49 ± 0.34  μ g/mL fold) at 60  μ g/mL and was correlated with increase in CYP 3 A 4 activity (15.0 ± 3.00  μ g/mL IC 50 value). Furthermore, antimalarial activity revealed >47600 IC 50 value against P. falciparum D6 and P. falciparum W2 and antimicrobial assay indicated highest activity (32 ± 2.80 mm) in S. papilionacea against C. neoformans . At the end, GC-MS analysis of n-hexane plant extracts showed 99.104% of total identified compounds in T. glaberrima and 94.31% in V. stocksii . In conclusion, present study provides insight about the different biological potentials of S. papilionacea and T. glaberrima extracts that rationalize the applications of these extracts in functional foods and herbal drugs for the management of oxidative-stress related diseases, antimicrobial infections and liver and skin cancer., Competing Interests: All authors declare that they have no competing interest., (Copyright © 2022 Amir Shahbaz et al.)

Owing to the tremendous energy storage capacity of two-dimensional transition metal carbides (MXenes), they have been efficiently utilized as a promising candidate in the field of super-capacitors. The energy storage capacity of MXenes can be further enhanced using metal dopants. Herein, we have reported the synthesis of pristine and nickel doped niobium-carbide (Nb 2 C) MXenes, their computational and electrochemical properties. Upon introduction of nickel (Ni) the TDOS increases and a continuous DOS pattern is observed which indicates coupling between Ni and pristine MXene. The alterations in the DOS, predominantly in the nearby region of the Fermi level are profitable for our electrochemical applications. Additionally, the Ni-doped sample shows a significant capacitive performance of 666.67 F g -1 which can be attributed to the additional active sites generated by doping with Ni. It is worth noting that doped MXenes exhibited a capacitance retention of 81% up to 10 000 cycles. The current study unveils the opportunities of using MXenes with different metal dopants and hypothesize on their performance for energy storage devices., Competing Interests: The authors declare that there are no competing interests., (This journal is © The Royal Society of Chemistry.)

Due to their versatile applications, ZnONPs have been formulated by several approaches, including green chemistry methods. In the current study, convenient and economically viable ZnONPs were produced using Elaeagnus angustifolia (EA) leaf extracts. The phytochemicals from E. angustifolia L. are believed to serve as a non-toxic source of reducing and stabilizing agents. The physical and chemical properties of ZnONPs were investigated employing varying analytical techniques (UV, XRD, FT-IR, EDX, SEM, TEM, DLS and Raman). Strong UV-Vis absorption at 399 nm was observed for green ZnONPs. TEM, SEM and XRD analyses determined the nanoscale size, morphology and crystalline structure of ZnONPs, respectively. The ZnONPs were substantiated by evaluation using HepG2 (IC 50 : 21.7 µg mL -1 ) and HUH7 (IC 50 : 29.8 µg mL -1 ) cancer cell lines and displayed potential anticancer activities. The MTT cytotoxicity assay was conducted using Leishmania tropica "KWH23" (promastigotes: IC 50 , 24.9 µg mL -1 ; and amastigotes: IC 50 , 32.83 µg mL -1 ). ZnONPs exhibited excellent antimicrobial potencies against five different bacterial and fungal species via the disc-diffusion method, and their MIC values were calculated. ZnONPs were found to be biocompatible using human erythrocytes and macrophages. Free radical scavenging tests revealed excellent antioxidant activities. Enzyme inhibition assays were performed and revealed excellent potential. These findings suggested that EA@ZnONPs have potential applications and could be used as a promising candidate for clinical development., (© 2021. The Author(s).)

Coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the availability of cardiology services and management of cardiac conditions. Elective surgeries, outpatient appointments and cardiac imaging have been largely cancelled across the world due to the risk of infection transmission and the need for reallocation of resources to deal with the increasing number of COVID-19 patients. The impact on patients with cardiac co-morbidities during these times may be drastic. However, cardiologists and hospitals across the world have implemented measures to ensure on-going monitoring and care of patients remotely. In this review, we discuss the impact of COVID-19 on cardiac services including interventional cardiology services, cardiac imaging and outpatient appointments. In addition, implications for future research and clinical practice are also discussed.

Objective: Lung cancer patients with interstitial lung disease (ILD) are prone for higher morbidity and mortality and their treatment is challenging. The purpose of this study is to investigate whether the survival of lung cancer patients is affected by the presence of ILD documented on CT., Materials and Methods: 146 patients with ILD at initial chest CT were retrospectively included in the study. 146 lung cancer controls without ILD were selected. Chest CTs were evaluated for the presence of pulmonary fibrosis which was classified in 4 categories. Presence and type of emphysema, extent of ILD and emphysema, location and histologic type of cancer, clinical staging and treatment were evaluated. Kaplan-Meier estimates and Cox regression models were used to assess survival probability and hazard of death of different groups. P value < 0.05 was considered significant., Results: 5-year survival for the study group was 41% versus 48% for the control group (log-rank test p = 0.0092). No significant difference in survival rate was found between the four different categories of ILD (log-rank test, p = 0.195) and the different histologic types (log-rank test, p = 0.4005). A cox proportional hazard model was used including presence of ILD, clinical stage and age. The hazard of death among patients with ILD was 1.522 times that among patients without ILD (95%CI, p = 0.029)., Conclusion: Patients with lung cancer and CT evidence of ILD have a significantly shorter survival compared to patients with lung cancer only. Documenting the type and grading the severity of ILD in lung cancer patients will significantly contribute to their challenging management., Competing Interests: The authors have declared that no competing interests exist.

Over the decades, the Frozen Elephant Trunk (FET) technique has gained immense popularity allowing simplified treatment of complex aortic pathologies. FET is frequently used to treat aortic conditions involving the distal aortic arch and the proximal descending aorta in a single stage. Surgical preference has recently changed from FET procedures being performed at Zone 3 to Zone 2. There are several advantages of Zone 2 FET over Zone 3 FET including reduction in spinal cord injury, visceral ischemia, neurological and cardiovascular sequelae. In addition, Zone 2 FET is a technically less complicated procedure. Literature on the comparison between Zone 3 and Zone 2 FET is scarce and primarily observational and anecdotal. Therefore, further research is warranted in this paradigm to substantiate current surgical treatment options for complex aortic pathologies. In this review, we explore literature surrounding FET and the reasons for the shift in surgical preference from Zone 3 to Zone 2.

Sophora alopecuroides L. is a highly medicinal plant. The aim of the current study was to determine the phytochemical screening, pharmacological potentials and application of scanning electron microscope (SEM) of S. alopecuroides (SA) seeds. To achieve this purpose, six different solvents were used to prepare SA seed extracts. Phytochemical and antioxidant activities were determined calorimetrically. To investigate the antidiabetic activity, α-amylase inhibition assay was determined. Brine shrimp assay was used to determine cytotoxicity potential. Anti-leishmanial potential was confirmed using MTT assay. Disc-diffusion method was used to detect protein kinase inhibitory, antibacterial and antifungal activities and showed significant results. SEM analysis was used as an identification tool. Considerable amount of phenolic and flavonoid contents were identified in methanol extract (SASM) (93.76 ± 2.71 GAE/mg) and (77 ± 3.60 QE/mg). Highest DPPH scavenging potential (82%) was reported for SASM. Significant total antioxidant capacity (90.60 ± 1.55 alpha amylase enzyme [AAE]/mg) and total reducing power (94.44 ± 1.38 AAE/mg) were determined for LOSM. Highest α-amylase inhibition was reported in SASM (78.20 ± 1.58%). Highest LD 50 of brine shrimp was found for n-hexane extract (SASH) 13.03 μg/ml. All extracts showed strong anti-leishmanial activity except SASH. The seeds of SA were seen to be oblong to obovate, projections, wavy slightly straight, anticlinal wall was raised with apex acuminate. In conclusion, our experimental findings highly support the ethnomedicinal and biological potentials of the SA seeds. Moreover, SA seeds need to be explored for identification and isolation of bioactive compounds. In future, we recommend further in vivo toxicity assays and clinical efficacies to further evaluate its different biomedical properties., (© 2021 Wiley Periodicals LLC.)

High-output cardiac failure is a rare form of heart failure associated with the formation of arteriovenous fistula (AVF) in hemodialysis patients. The pathophysiology underlying the HOCF is complex and multifactorial. Presence of AVF can cause long term hemodynamic changes that ultimately lead to increased cardiac output and consequently cardiac failure. A number of risk factors have been associated with the development of HOCF post-AVF construction, including male sex, a proximally located AVF and a state of volume overload. Dysregulation of tissue inhibitor of matrix metalloproteinase 4, Sirtuin-1 and Sirtuin-3 gene expression have been associated with the development of heart failure. The differences observed between genders have been attributed to altered activity of the β-adrenoceptor system. Numerous biomarkers including cardiac troponin T and I, atrial natriuretic peptide, brain natriuretic peptide among others have shown both prognostic and diagnostic potential; however further research is needed to establish their utility in clinical practice for patients with AVF associated HOCF. In recent years risk stratification models have been developed to help identify patients at the highest risk of developing HOCF post AVF which could be revolutionary in its identification and management. Potential options for managing HOCF post-AVF include AVF ligation, banding and anastoplasty however these procedures are not without their own associated risks. In this review, we discuss the pathophysiology, risk stratification and management of patients with AVF associated HOCF., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: There is varying evidence on the role of skeletonization of internal mammary artery in reducing the risk of sternal wound infections and ischemia following bilateral internal mammary artery grafting. Post-operative clinical outcomes of skeletonized bilateral internal mammary artery versus pedicled bilateral internal mammary artery harvesting in patients undergoing coronary artery bypass surgery were compared., Methods: A comprehensive electronic search was conducted using MEDLINE, Scopus, EMBASE, Cochrane database and Google Scholar from inception until 15 June 2020. All studies directly comparing skeletonized and pedicled bilateral internal mammary artery harvesting were included. Meta-analysis and trial sequential analysis were conducted., Results: Nine studies (one randomized controlled trial and eight observational studies) consisting of 3649 patients (2050 patients with skeletonized bilateral internal mammary artery grafting and 1599 patients with pedicled bilateral internal mammary artery grafting) were included. Pooled effects analysis and trial sequential analysis reported significantly lower risk of sternal wound infection with skeletonized bilateral internal mammary artery harvesting (OR 0.27, 95% CI 0.20-0.51, p < 0.00001)., Conclusions: Skeletonization reduces the risk of sternal wound infections by preserving vasculature as much as possible. This facilitates its use in patients at high risk of sternal wound infection.

Herein, we studied the novel and emerging group of 2D materials namely MXene along with its nanocomposites. This work entails detailed experimental as well as computational study of the electrochemical behavior of vanadium carbide (V 2 CT x ) MXene and MnO 2 -V 2 C nanocomposite with varying percentages of MnO 2 . A specific capacitance of 551.8 F/g was achieved for MnO 2 -V 2 C nanocomposite in 1 M KOH electrolyte solution, which is more than two times higher than the gravimetric capacitance of 196.5 F/g obtained for V 2 C. The cyclic stability achieved for the MnO 2 -V 2 C nanocomposite resulted in a retentivity of 96.5% until 5000 cycles. The c-lattice parameter achieved for MXene is 22.6 Å, which was 13.01 Å for MAX phase. The nanocomposite resulted in a c-lattice parameter of 27.2 Å, which showed that the spatial distance between the MXene layers was efficiently obtained. The method of wet etching was used for the preparation of pristine MXene and the liquid phase precipitation method was opted for the synthesis of the MnO 2 -V 2 C nanocomposite. Density functional theory calculation was exercised so as to complement the experimental results and to understand the microscopic details, such as structure stability and electronic structure. The current report presents a comprehensive experimental and computational study on 2D MXenes for future energy storage applications.

Lactuca orientalis (Boiss.) Boiss. is one of the most frequently used ethnomedicinal plant. This research study was designed to decipher the phytochemical screening, pharmacological potential and implementation of scanning electron microscope (SEM). Six different solvents were used to prepare L. orientalis (LO) seed extracts. Phytochemical and antioxidant activities were determined calorimetrically. To investigate antidiabetic, α-amylase inhibition assay was performed. Brine shrimp assay was performed for cytotoxicity and anti-leishmanial via MTT assay. Disc-diffusion assay was performed to detect protein kinase inhibitory, antibacterial and antifungal activities. SEM was used as identification tool. Significant amount of phenolic and flavonoid content were identified in methanol extract (LOSM) (95.76 ± 3.71 GAE/mg) and (77 ± 3.60 QE/mg). Highest DPPH scavenging potential (82%) was reported for LOSM. Significant total antioxidant capacity (90.60 ± 1.55 AAE/mg) and total reducing power (94.44 ± 1.38 AAE/mg) were determined for LOSM. Highest α-amylase inhibition was found in LOSM (78.20 ± 1.58%). The highest LD 50 of brine shrimp was found for n-Hexane extract (LOSH) 13.03 𝜇g/ml. All extracts showed strong anti-leishmanial activity except LOSH. L. orientalis seeds showed significant protein kinase inhibition, antibacterial and antifungal activities. The seeds of L. orientalis were seen to be oblong to obovate, projections, wavy slightly straight, anticlinal wall was raised with apex acuminate. The outer-periclinal wall convex with fine texture. In conclusion, our findings scientifically support ethnomedicinal and biological potentials of L. orientalis seeds. In future, L. orientalis seeds need to be explored for identification and isolation of bioactive compounds. The results obtained necessitate further in vivo studies to evaluate their pharmacological potentials., (© 2021 Wiley Periodicals LLC.)

Spontaneous coronary artery dissection (SCAD) is a rare but life-threatening disorder. SCAD is gaining importance as an emerging cause of acute coronary syndrome (ACS), especially in otherwise healthy young women. While SCAD and ACS show similarity in presentation, the management of SCAD differs to that of ACS. If not managed properly SCAD can lead to sudden death. This review examines the pathophysiology, clinical presentation, diagnostic algorithms, and the current and future management of SCAD., (Copyright © 2020 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)

Coronary artery dissection is a serious, life-threatening heart condition. It can occur spontaneously or due to traumatic or iatrogenic causes. Spontaneous coronary artery dissection (SCAD) is often misdiagnosed as most patients present with symptoms resembling those of an acute coronary syndrome. Clinical sequelae of SCAD include debilitating morbidities such as myocardial infarction, myocardial ischaemia, sudden cardiac death, ventricular arrhythmias amongst many other myocardial ischaemia associated complications. There are two main methods of managing patients with SCAD; conservative management with medical therapy or revascularisation by percutaneous coronary intervention or coronary artery bypass grafting., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

The tunable cobalt oxide nanoparticles (CoONPs) are produced due to the phytochemicals present in Rhamnus virgata (RhV) leaf extract which functions as reducing and stabilization agents. The synthesis of CoONPs was confirmed using different analytical techniques: UV-Vis spectroscopy, X-ray diffraction (XRD), scanning electron microscopy (SEM), dynamics light scatterings (DLS), Fourier-transform infrared spectroscopy (FTIR), energy dispersive X-ray, and Raman spectroscopy analyses. Furthermore, multiple biological activities were performed. Significant antifungal and antibacterial potentials have been reported. The in vitro cytotoxic assays of CoONPs revealed strong anticancer activity against human hepatoma HUH-7 (IC 50 : 33.25 μg/ml) and hepatocellular carcinoma HepG2 (IC 50 : 11.62 μg/ml) cancer cells. Dose-dependent cytotoxicity potency was confirmed against Leishmania tropica (KMH 23 ); amastigotes (IC 50 : 58.63 μg/ml) and promastigotes (IC 50 : 32.64 μg/ml). The biocompatibility assay using red blood cells (RBCs; IC 50 : 4,636 μg/ml) has confirmed the bio-safe nature of CoONPs. On the whole, results revealed nontoxic nature of RhV-CoONPs with promising biological potentials., (© 2020 Wiley Periodicals LLC.)

In the present study, green silver nanoparticles (Ag 2 ONPs) were prepared from aqueous and ethanolic leaves extract of Rhamnus virgata in a facile, green, cost-effective, and eco-friendly way. The color changes from light brown to brownish black determined the synthesis of Ag 2 ONPs (Aq) and Ag 2 ONPs (Et) . The phytofabrication of Ag 2 ONPs was confirmed using various spectroscopic and microscopic techniques: energy-dispersive X-ray spectroscopy, dynamic light scattering, ultraviolet-visible spectroscopy, Fourier-transform infrared, X-ray powder diffraction, Raman, scanning electron microscopy, and transmission electron microscopy. Detailed in vitro biological activities determined significant biopotentials for Ag 2 ONPs. The Ag 2 ONPs (Aq) and Ag 2 ONPs (Et) were investigated for anticancer potential against HUH-7 (IC 50 : 9.075 μg/ml for Ag 2 O (Aq) and 25.66 μg/ml for Ag 2 O (Et) ) and HepG2 (IC 50 : 25.18 μg/ml for Ag 2 O (Aq) and IC 50 : 27.74 μg/ml for Ag 2 O (Aq) ) cell lines. Concentration-dependent cytotoxicity was performed against brine-shrimps (IC 50 : 36.04 μg/ml for Ag 2 O (Aq) and 28.82 μg/ml for Ag 2 O (Et) ) and Leishmanial parasite (amastigotes and promastigotes). Disc-diffusion method revealed significant antimicrobial activities. In addition, significant enzyme inhibitory activity and antiradical potentials were studied. The hemocompatible nature of Ag 2 ONPs (Aq) and Ag 2 ONPs (Et) was revealed using biocompatibility tests. In conclusion, the green Ag 2 ONPs (Aq) and Ag 2 ONPs (Et) are nontoxic and biocompatible and has shown significant biological activities. We further encourage in vivo studies to ensure biosafety and biocompatibility, so that they can be effectively utilized in nano-pharmaceutical industries., (© 2020 Wiley Periodicals LLC.)

Objective: Olfactory and taste dysfunction (OTD) is a potential neurological manifestation of coronavirus-2019 (COVID-19). We aimed to investigate the diagnostic value of symptoms of anosmia and dysgeusia for COVID-19., Methods: A comprehensive electronic search was conducted using PubMed, MEDLINE, Scopus, Cochrane database, and Google Scholar from 1 June 2020 to 12 June 2020. All studies reporting symptoms of anosmia and dysgeusia in COVID-19-positive patients were included. A total of 23 studies were included in the systematic review., Results: Symptoms of anosmia and dysgeusia were frequently reported by COVID-19-positive patients. Symptoms were more common in females and in younger patients. There was no direct association between the severity of COVID-19 and the presence of symptoms. However, some evidence was found for a longer duration of these symptoms and increased severity of COVID-19 infection in young patients., Conclusion: OTD is commonly reported by COVID-19 patients. Due to limited literature on the association between OTD and COVID-19, it is currently not possible to conclude that these symptoms alone can be used to diagnose COVID-19. However, the presence of OTD can potentially be used as a screening tool for COVID-19 especially in young and female patients. Further research is required to establish the true diagnostic value of these symptoms and efficacy as screening tools for COVID-19 patients., (© 2020 The Authors. Brain and Behavior published by Wiley Periodicals LLC.)

Coronavirus disease (COVID-19) first presented in Wuhan, Hubei province, China in December 2019. Since then, it has rapidly spread across the world, and is now formally considered a pandemic. The disease does not discriminate but increasing age and the presence of comorbidities are associated with severe form of the disease and poor outcomes. Although the prevalence of COVID-19 in patients with cardiovascular disease is under-reported, there is evidence that pre-existing cardiac disease can render individuals vulnerable. It is thought that COVID-19 may have both a direct and indirect effect on the cardiovascular system; however, the primary mechanism of underlying cardiovascular involvement is still uncertain. Of particular interest is the role of angiotensin-converting enzyme 2, which is well known for its cardiovascular effects and is also considered to be important in the pathogenesis of COVID-19. With a range of different drug candidates being suggested, effective anti-virals and vaccines are an area of on-going research. While our knowledge of COVID-19 continues to rapidly expand, this review highlights recent advances in our understanding of the interaction between COVID-19 and the cardiovascular system., (© 2020 Wiley Periodicals LLC.)

Chemically nickel oxide nanoparticles (NiONPs) involve the synthesis of toxic products, which restrict their biological applications. Hence, we developed a simple, eco-friendly, and cost-efficient green chemistry method for the fabrication of NiONPs using fresh leaf broth of Rhamnus triquetra (RT). The RT leaves broth was used as a strong reducing, capping, and stabilizing agent in the formation of RT-NiONPs. The color change in solution from brown to greenish black suggests the fabrication of RT-NiONPs which was further confirmed by absorption band at 333 nm. The synthesis and different physicochemical properties of RT-NiONPs were investigated using different analytical techniques such as UV-Vis (ultraviolet-visible spectroscopy), XRD (X-ray powder diffraction), FT-IR (Fourier-transform infrared spectroscopy), SEM (scanning electron microscopy), TEM (transmission electron microscopy), EDS (energy-dispersive X-ray spectroscopy), DLS (dynamic light scattering) and Raman. Further, RT-NiONPs were subjected to different in vitro biological activities and revealed distinctive biosafe and biocompatibility potentials using erythrocytes and macrophages. RT-NiONPs exhibited potential anticancer activity against liver cancer cell lines HUH7 (IC 50 : 11.3 µg/mL) and HepG2 (IC 50 : 20.73 µg/mL). Cytotoxicity potential was confirmed using Leishmanial parasites promastigotes (IC 50 : 27.32 µg/mL) and amastigotes (IC 50 : 37.4 µg/mL). RT-NiONPs are capable of rendering significant antimicrobial efficacy using various bacterial and fungal strains. NiONPs determined potent radical scavenging and moderate enzyme inhibition potencies. Overall, this study suggested that RT-NiONPs can be an attractive and eco-friendly candidate. In conclusion, current study showed potential in vitro biological activities and further necessitate different in vivo studies in various animal models to develop leads for new drugs to treat several chronic diseases., Competing Interests: The authors declare no conflict of interest.

Pakistan is in the grip of COVID-19, due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) since 26 February 2020, and the number of infected people and mortality is rising gradually. The health workers, doctors, pathologists and laboratory staff are front line fighters who are facing the risk. Few things are important for public and health workers, human behavior is at the core of preparedness and response i.e, personal protective measures, (handwashing, face masks, respiratory etiquette, surface and objects cleansing), social distancing and travel measures because the virus spreads through the respiratory channels, eyes, nose and mouth. While working in the Pathology labs, use the personal protection equipment (PPE), during the work in the duty. Avoiding the over duties and long shifts. It is good to keep the immune system healthy by taking a healthy balanced diet, vitamin supplements, and a night of proper sleep. It is also important to avoid taking food during duties and avoid making close contact without wearing safety dress., (Copyright: © Pakistan Journal of Medical Sciences.)

Background and Objectives: Stem cells have proved to have great therapeutic potential as stem cell treatment is replacing traditional ways of treatment in different disorders like cancer, aplastic anemia, stroke, heart disorders. The developed and developing countries are investing differently in this area of research so research output and clinical translation of research greatly vary among developed and developing countries. Present study was done to investigate the current status of stem cells research in Pakistan and ways to improve it., Results: Many advanced countries (USA, UK and Canada etc.) are investing heavily in stem cell research and treatment. Different developing countries like Iran, Turkey and India are also following the developed countries and investing a lot in stem cells research. Pakistan is also making efforts in establishing this field to get desired benefits but unfortunately the progress is at very low pace. If Government plays an active role along with private sector, stem cell research in Pakistan can be boosted up. The numbers of publications from Pakistan are very less compared to developed and neighboring countries and Pakistan also has very less number of institutes working in this area of research., Conclusions: Stem cells research is at its initial stages in Pakistan and there is great need to bring Government, academia and industry together so they could make serious efforts to promote research in this very important field. This will help millions of patients suffering from incurable disorders and will also reduce economic loss.

The purpose of our study was to assess the role of a 64-slice multidetector CT (MDCT) scanner in the characterization of different solid renal masses, using a simplified approach to correct the postenhancement attenuation values. The study included 96 consecutive adults (58 men, 38 women) with renal masses; 93 with unilateral and three with bilateral masses. All of our patients underwent multiphasic CT study including pre- and postcontrast corticomedullary (CM) and nephrographic phases. We analyzed the images and corrected the postcontrast attenuation values at the CM phase. The postbiopsy or -surgical data were used as reference standard. There were 53 masses at the right kidney, 40 at the left kidney, and three bilateral. The final diagnosis of the 96 solid parenchymal masses were 28 clear-type renal cell carcinoma (RCC), 22 papillary-type RCC, 21 chromophobe-type RCC, six XP 11.2 chromosomal translocation-type RCC, 15 angiomyolipoma (AML), and seven oncocytoma. All the AML had fat, with attenuation values less than -40 HU at the nonenhanced scan. There is no difference in the precontrast attenuation values for the different types other than AML. At the postcontrast CM phase after the correction of the attenuation values, the clear cell type could be separated easily, with attenuation values >20 with specificity, sensitivity, and overall accuracy of 92, 84, and 93%, respectively. The 64-slice MDCT scanner with application of enhancement values correction allows diagnosis of clear cell carcinoma. Also, AML could be identified easily with fat inside at the precontrast scan.

For a long time, boards of directors have been considered weak, incapable of contributing to the financial success of their companies. This article proposes a way to revitalize boards by involving them in mapping corporate strategic directions. Building on recent changes in boardroom practices, it outlines eight conditions for an effective strategic contribution by boards and specifies areas of potential for an effective strategic contribution by boards and specifies areas of potential interest to directors. Taken together, these suggestions are expected to ensure continuous and disciplined contribution by boards to strategy and, ultimately, to effective corporate performance.