The crucial role of stability of intercalating agent for DNA binding studies in DMSO/water system

In recent years, extensive research has been directed towards understanding the interactions between various zinc complexes with DNA, specifically delving into their intercalation and binding behaviors. The binding of zinc complexes to DNA is particularly intriguing due to their distinctive intercalating capabilities. This study unveils a remarkable phenomenon observed with a specific Zn complex, ([B-Zn-N3], where B is a Schiff base ligand), during DNA intercalation investigations in the popular DMSO-Water binary solvent mixture. An unanticipated observation revealed time-dependent changes in the UV-visible absorption spectroscopic studies, coupled with the existence of an isosbestic point. This observation questions the stability of the intercalating agent itself during the intercalation process. The emergence of a decomposed product during the intercalation study has been confirmed through various analytical techniques, including CHN analysis, MALDI mass, XPS, Raman spectroscopy, and Powder XRD. The change in the chemical species on intercalation is further substantiated by theoretical studies, adding depth to our understanding of the intricate dynamics at play during DNA intercalation with the [B-Zn-N3] complex in the DMSO-Water system.

Modified realist evaluation of a complex, multi-centred, multi-intervention programme

Well North was a complex, multi-intervention health improvement programme spanning 10 sites across the North of England. The aim was to address inequalities by improving the health of the poorest fastest, increasing resilience and reducing levels of worklessness. The intention of the programme was for all sites to have freedom and flexibility to conduct different interventions reflecting local priorities. Evaluation ran concurrently with the programme, and an iterative approach was required to ensure constant feedback, allowing the programme to be adapted and improved as necessary. Realist methodology was chosen for evaluation, as it provides insight into what works, for whom and in what circumstances. Due to the complex nature of the programme and diverse approaches, it was necessary to adapt the methodology to meet the needs of the evaluation. The Evaluation Team utilized a range of qualitative and quantitative techniques within the context of a Rapid Cycle Evaluation framework. For each project, Contexts, Mechanisms and Outcomes (CMOs) were identified at three stages and were incorporated into the CMO configuration, leading to the development of a middle range theory. Validation and testing of theory took place at every stage. Realist methodology was the most appropriate existing method. However, it still necessitated modification.

Active video games and weight management in overweight children and adolescents-systematic review and meta-analysis

BACKGROUND

The prevalence of childhood obesity has been increasing for several decades. Active video games (AVG) may be an effective intervention to help manage this rising health crisis. The aim of this review is to evaluate whether AVG are effective at reducing weight or improving body composition in overweight youths.

METHOD

Medline, Embase, SportDiscus, ASSIA, CINAHL Plus, CENTRAL, CDSR and PsychINFO databases were searched for studies assessing quantitative or qualitative impact of AVG in overweight adolescents published in English. Three authors screened the results using inclusion/exclusion criteria.

RESULTS

A total of 12 studies met the inclusion criteria; 11 reported a significant decrease in at least one weight outcome. Results from seven randomized controlled trials were pooled by meta-analysis, which compared with controls subjects in AVG groups demonstrated greater body mass index (BMI) Z-score reduction (mean difference: -0.09 (-0.12, -0.05) I2 = 34%, P < 0.0001). The mean weight reduction (-2.66 Kg (-5.67, +0.35) I2 = 0%, P = 0.08) and BMI (-2.29 (-4.81, +0.22) I2 = 49%, P = 0.07) were greater in AVG groups but results did not reach statistical significance.

CONCLUSIONS

BMI Z-score was significantly reduced in the AVG group and the majority of included studies reported significant results in at least one weight outcome, suggesting AVG can be used to reduce weight or improve body composition in overweight youths. Further studies investigating the long-term sustainability of this change in body composition are needed.

Slow magnetic relaxation in a ferromagnetic CuII chain complex, induced by a phonon bottleneck effect

The first slow magnetic relaxation in a ferromagnetic Cu(II) chain compound, Cu(dipic)(OH2)2 (dipicH2 = pyridine-2,6-dicarboxylic acid), induced by a phonon bottleneck effect under a magnetic field of 0.6 T, with a relaxation time of 2.2 s at 2.8 K, was observed.

UNDERSTANDING THE LONG-TERM INTERPLAY BETWEEN GLUCOCORTICOIDS, PARATHYROID HORMONE LEVELS, AND OSTEOPOROSIS IN PATIENTS

Drugs called glucocorticoids (GC) are often prescribed for both inpatient and outpatient settings. They are often used to treat a number of disorders due to their anti-inflammatory activity. Long-term use of GCs, especially long-term high-dose administrations, may result in a variety of negative effects. In Hilla City, Babylon Governorate of Iraq, Merjan Teaching Hospital, Al-Hilla Teaching Hospital's Joint Enology Clinic, and Al-Imam Al-Sadiq Hospital, were the sites of this case-control research, which was carried out. There were 100 total participants in this trial, of whom 50 were patients with osteoporosis (OP). The ages of the patients and the control collection were. They were chosen since their gender and ages matched. The findings show extensively senior level of parathyroid hormone (PTH) in OP patients when compared to the control group, whereas calcium (Ca) level into the patient group significantly lowered during association toward the manage set. In summary, there is a positive correlation between PTH and the condition of bone mineralization. In those who use GCs for a long time, PTH may be used as a prognostic marker to predict when bone mineral abnormalities would develop.

LIVER FIBROSIS: PATHOPHYSIOLOGY, DIAGNOSIS, AND EMERGING THERAPEUTIC TARGETS FOR A COMMON COMPLICATION OF CHRONIC LIVER DISEASES

Fibrosis of the liver, which can be caused by either viral or chemical chronic liver illnesses, is a serious issue for the world's health. Collagen is crucial for the development of the illness and the possibility of developing hepatocellular carcinoma (HCC), which is linked to the progression of liver damage. Although there are various mechanisms for acute liver injury and diseases-specific cells response, almost all of fatty liver aetiologies share similar trends in the development of fibrous liver damage. The scientific community's knowledge of the fundamental causes of fibrosis of the liver has undergone a significant shift during the last ten years. It has been shown that the fundamental trigger, such as the control or management of an infectious disease, can be eradicated or eliminated in order to reverse liver fibrosis. Reversing frequently occurs prematurely or too rarely, particularly in severe fibrosis, to avoid possibly fatal effects. Therefore, there is an urgent need for anti-fibrotic medications to halt the progression of liver damage and the appearance of HCC. Even though various anti-fibrotic medication options have shown strong anti-fibrotic effects in lab animals, research studies have only seen a small amount or none of these advantages. There is not an approved remedy for the condition as a result. In this article, we give a general overview of the physiological and molecular origins of collagen in chronic liver disease and investigate how these causes can impact the quickly developing field of anti-fibrotic treatments.

PSORIASIS PATHOGENESIS: INSIGHTS FROM TRANSCRIPTOMICS AND PROTEOMICS STUDIES OF KERATINOCYTES

Complex inflammatory skin disease with autoimmune roots is psoriasis. This disease affects various cell types, and the underlying signaling processes are complicated yet not fully understood. Extensive psoriatic lesions' proteome and transcriptome of several researches were combined to understand disease's underlying biological mechanisms. According to a network-based study, both transcriptomics and proteomics control were comparable. They discovered many pathways of signaling previously undiscovered and possibly involved in overexpression of psoriasis genes. They also found a collection of transcription factors in charge of this process. The functional overlap between the results of transcriptomics and proteomics was also examined. There created a network-based method for combining the analysis of many high-throughput data sources. Proteomic and transcriptome studies of psoriasis data sets demonstrated regulatory flexibility apparatus underpinning disease and complementary relationships within two cellular organizations.

Unusual Effect of Minor Change in Ligand Substitution in Modulation of NIR Emission: A Case Study with [L-ZnII-LnIII] Complexes

There have been numerous instances of lanthanide NIR emitting material where one or more types of ligands or metal ion-ligand complexes operate as antennas. The antenna's role in NIR emission has also been thoroughly investigated and validated. The emission properties of the different antennae are predicted to differ. Here we describe the structural and photophysical properties of two series of [Zn^II-Ln^III] complexes, where a minor difference between the two series (ethoxy vs methoxy substitution) affected the photophysical properties, particularly the f-f transition, in an unprecedented manner. Both steady-state and time-resolved luminescence spectra were affected by this change. Detailed single-crystal X-ray diffraction (SCXRD) and X-ray photoelectron spectroscopy (XPS) studies of both complexes revealed the crucial structural differences in crystal packing, which astonishingly remains unaffected in solution.

Primary sphincter repair after fistulectomy: A simple and safe option for complex fistula-in-ano

Complete tract excision for complex fistula-in-ano, where the sphincter, is divided is increasingly being followed by immediate sphincter repair. We concluded, by a prospective study conducted on 60 consecutive patients, that this procedure is feasible and safe, and polydioxanone and polyglactin 910 in repair result in a comparable outcome.

A215 EVALUATING THE COMPARABILITY OF CARE FOR PERSONS ADMITTED TO TORONTO AREA HOSPITALS WITH ACUTE SEVERE ULCERATIVE COLITIS

Background

Approximately 20% of patients with ulcerative colitis will experience an acute severe exacerbation requiring hospitalization. Acute severe ulcerative colitis (ASUC) is a medical emergency associated with significant morbidity and a mortality rate of 1%. Timely initiation of treatment and assessment of clinical response is critical in the management of ASUC. With an aim to reduce treatment variability and improve outcomes, multiple gastrointestinal societies have published guidelines highlighting recommendations for optimal care in ASUC. It remains unclear how closely these guidelines are implemented in clinical practice. Measuring adherence to these recommended processes of care may act as a surrogate measure for quality of care and a way to indirectly evaluate outcomes in the management of patients with ASUC. Studies have shown that even amongst experienced providers practice pattern variability exists. Identifying significant variations in the management of patients with ASUC will highlight where improvement in guideline dissemination and greater adherence is required.

Purpose

We sought to evaluate how quality of care indicators varied across 7 hospital sites for patients admitted ASUC in the Greater Toronto Area.

Method

Using GEMINI, a research collaborative that collects and analyses data from inpatient admissions at 7 Toronto area hospitals, we identified patients admitted to hospital with ASUC from June 2016-December 2019. Hospital sites were further categorized into 3 hospital types; 1 IBD specialty centre (ISC), 3 other academic centres (AC) and 3 community centres (CC). Process measures assessed included proportion tested for C-reactive protein at baseline and following treatment initiation, duration of corticosteroid use, timing and initiation of biologic agents, rates of venous thromboembolism prophylaxis and opioid use. Outcome measures included hospital length of stay, rates of colectomy and mortality.

Result(s)

765 hospitalizations were included in the study; 320 occurring at ISC, 308 at AC and 137 at CC. Corticosteroid use on admission were highest at the ISC at 78% compared to 64% at AC and 63% at CC (p <0.001). Among those who received steroids on admission, 47% of patients remained on intravenous corticosteroids for at least 5 days in the ISC compared to 39% in AC and 75% in CC (p< 0.001). Initiation of biologic rescue therapy was highest at the ISC occurring in 37% of hospitalizations compared to 22% in AC and 23% in CC (p<0.001). In addition, VTE prophylaxis rates were highest at the ISC at 83% followed by 60% in AC and 45% in CC (p<0.001). Rates of colectomy were highest at ISC (12% of hospitalizations vs. 7% in AC).

Conclusion(s)

Greater adherence to indicators of quality of care were seen at the ISC compared to ACs and CCs, although patient outcomes assessed were not clearly different between sites. Further strategies are required to improve adherence to markers of quality care for patients admitted with ASUC.

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Disclosure of Interest

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Ostreopsis Schmidt and Coolia Meunier (Dinophyceae, Gonyaulacales) from Cook Islands and Niue (South Pacific Ocean), including description of Ostreopsis tairoto sp. nov

It is important to decipher the diversity and distribution of benthic dinoflagellates, as there are many morphologically indistinct taxa that differ from one another in production of potent toxins. To date, the genus Ostreopsis comprises twelve described species, of which seven are potentially toxic and produce compounds presenting a threat to human and environmental health. In this study, isolates previously identified as "Ostreopsis sp. 3" were sampled from the area where it was first reported, Rarotonga, Cook Islands, and have been taxonomically and phylogenetically characterised as Ostreopsis tairoto sp. nov. Phylogenetically, the species is closely related to "Ostreopsis sp. 8", O. mascarenensis, "O. sp. 4", O. fattorussoi, O. rhodesiae and O. cf. siamensis. Previously, it was considered a part of the O. cf. ovata complex but can be distinguished from O. cf. ovata based on the small pores identified on this study, and from O. fattorussoi and O. rhodesiae based on relative lengths of the 2' plates. No known palytoxin -like compounds were detected in strains investigated in this study. Strains of O. lenticularis, Coolia malayensis and C. tropicalis were also identified and described. This study advances our knowledge of biogeography, distribution, and toxins of Ostreopsis and Coolia species.

Impact of diabetes and glucose-lowering therapy on post-operative atrial fibrillation after cardiac surgery: secondary analysis of the SEARCH-AF CardioLink-1 randomized clinical trial

Background

Diabetes mellitus is an important risk factor for atrial fibrillation (AF) and is associated with an increased risk of complications for patients with AF. The impact of diabetes on post-operative AF after cardiac surgery is not well-defined.

Purpose

We sought to characterize the effect of diabetes, insulin, and oral hypoglycemic agents on the incidence of post-operative atrial fibrillation (POAF) after cardiac surgery. Accordingly, we conducted a secondary analysis of the Post-Surgical Enhanced Monitoring for Cardiac Arrhythmias and Atrial Fibrillation (SEARCH-AF) CardioLink-1 randomized trial.

Methods

In the SEARCH-AF trial, 336 patients with risk factors for stroke (CHA2DS2-VASc score ≥2) and no history of preoperative AF were randomized to usual care or continuous cardiac rhythm monitoring for 30 days after discharge from cardiac surgery with a wearable, patched-based device. The primary outcome was occurrence of cumulative atrial fibrillation/flutter (AF/AFL) lasting for ≥6 minutes detected by continuous monitoring or AF/AFL documented by a 12-lead electrocardiogram within 30 days of randomization. We assessed the association between diabetes and occurrence of post-operative AF. In addition, we examined the association between POAF and glucose-lowering therapy among patients with diabetes.

Results

Among the 176 (52%) patients with diabetes in the study cohort, 80 (45%) patients were treated with at least 1 oral hypoglycemic agent and 44 (25%) patients were treated with insulin. The incidence of POAF occurring within 30 days after discharge from surgery was similar between patients with or without diabetes (cumulative incidence: 10.8% vs. 10.0%, log-rank p=0.77). Among patients with diabetes, the incidence of POAF was highest in those who were not treated with glucose-lowering therapy (17.3%) when compared with those treated with oral hypoglycemic agents (10.0%) or insulin (4.5%) (log-rank ptrend=0.045 among the 3 groups). In an exploratory analysis, we observed a trend suggesting a lower incidence of POAF among cardiac surgical patients who were treated with SGLT-2 inhibitors (log-rank ptrend=0.084).

Conclusion

The incidence of POAF occurring after discharge from cardiac surgery is equally high among patients with or without diabetes. Our results suggest a potential association between specific glucose-lowering therapies and risk of POAF after cardiac surgery, meriting further investigations.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): Heart and Stroke Foundation of Canada

Valvular surgery is associated with an increased risk of post-operative atrial fibrillation: secondary analysis of the SEARCH-AF CardioLink-1 randomized trial

Background

Patients undergoing valve surgery have a higher risk of developing post-operative atrial fibrillation (POAF) relative to those undergoing isolated coronary artery bypass grafting (CABG). Whether this risk extends beyond hospital discharge is unknown.

Purpose

We examined the association between surgery type (isolated CABG vs. valve repair/replacement) on the incidence of post-operative atrial fibrillation (POAF) by conducting a secondary analysis of the Post-Surgical Enhanced Monitoring for Cardiac Arrhythmias and Atrial Fibrillation (SEARCH-AF) CardioLink-1 randomized trial.

Methods

In the SEARCH-AF trial, 336 patients with risk factors for stroke (CHA2DS2-VASc score ≥2) and no history of preoperative AF were randomized to usual care or continuous cardiac rhythm monitoring for 30 days after discharge from cardiac surgery with a wearable, patched-based device. The primary outcome was occurrence of cumulative atrial fibrillation/flutter (AF/AFL) lasting for ≥6 minutes detected by continuous monitoring or AF/AFL documented by a 12-lead ECG within 30 days of randomization. We compared the risk of POAF between patients who underwent CABG vs. valve repair/replacement. Patients who experienced post-operative AF during hospitalization were excluded from this analysis.

Results

The overall cohort consisted of 255, 39, and 42 patients who underwent isolated CABG, isolated valve replacement/repair, and CABG + valve repair/replacement, respectively. Baseline characteristics were similar among the groups except for younger age (p=0.0014), higher prevalence of preoperative myocardial infarction (p=0.002) and lower ejection fraction (p=0.025) in the isolated CABG group. Eighteen patients experienced post-operative AF during hospitalization. Patients who underwent CABG + valve surgery or isolated valve surgery were more likely to experience post-operative AF compared with those who underwent isolated CABG (Log-Rank ptrend=0.0096). Among patients who were randomized to continuous cardiac rhythm monitoring, the probability of post-operative AF among patients who underwent isolated CABG, valve surgery, and CABG + valve surgery was 15.8%, 29.4%, and 35.0%, respectively (Log-Rank ptrend=0.017). After multivariable adjustment, the risk of developing post-operative AF within 30 days after discharge remained higher among patients who underwent valve surgery compared with those who underwent isolated CABG (hazard ratio (HR) 2.22, 95% CI 1.01–4.87. Patients who underwent CABG + repair/replacement had the highest risk of experiencing post-operative AF when compared to patients who underwent isolated CABG (HR 2.78, 95% CI 1.12–6.86).

Conclusion

Patients undergoing valve repair or bioprosthetic valve replacement have a substantial risk of post-operative AF within 30 days after discharge from surgery. An aggressive cardiac rhythm monitoring strategy during this vulnerable period should be considered for this high-risk patient population.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): Heart and Stroke Foundation of Canada

The impact of statin on post-operative atrial fibrillation after discharge from cardiac surgery: secondary analysis of the SEARCH-AF CardioLink-1 randomized trial

Background

There is conflicting evidence regarding the use of statins to reduce the risk of post-operative atrial fibrillation (POAF) in patients undergoing cardiac surgery.

Purpose

We sought to determine the effects of statin use on the burden of new-onset post-discharge POAF in the Post-Surgical Enhanced Monitoring for Cardiac Arrhythmias and Atrial Fibrillation (SEARCH-AF) CardioLink-1 randomized controlled trial.

Methods

In the SEARCH-AF trial, 336 patients with risk factors for stroke (CHA2DS2-VASc score ≥2) and no history of preoperative AF were randomized to usual care or continuous cardiac rhythm monitoring for 30 days after discharge from cardiac surgery with a wearable, patched-based device. The primary endpoint was the occurrence of cumulative atrial fibrillation/flutter (AF/AFL) lasting for ≥6 minutes detected by continuous monitoring or AF/AFL documented by a 12-lead electrocardiogram within 30 days of randomization. Using time-to-event analysis and Cox regression, we evaluated the association between the risk of post-operative AF in relation to statin use and dosing intensity (low, moderate, high) at the time of discharge. We excluded patients who experienced post-operative AF during hospitalization in this analysis.

Results

In the overall cohort (n=336), 260 (77.4%) patients were treated with statins at the time of hospital discharge. There were 18 (5.4%) patients who experienced post-operative AF during hospitalization. Patients prescribed with statins were more likely to be male (p=0.018), had lower CHA2DS2-VASc scores (p=0.011), and were more likely to undergo isolated coronary artery bypass grafting (CABG) (p=0.083). Baseline characteristics were otherwise similar between the 2 groups. Patients treated with statins at discharge had a 2-fold lower rate of post-operative AF than those who were not treated with statins in the overall cohort (17.6% vs. 8.2%, Log-Rank p=0.017) and among those who were randomized to continuous cardiac rhythm monitoring (31.6% vs. 16.0%, Log-Rank p=0.027) (Figure). After adjusting for surgery type (CABG vs. valve surgery) and the CHA2DS2-VASc score, statin use at discharge was associated with a lower risk of post-operative AF within 30 days after surgery (hazard ratio 0.48, 95% CI 0.24–0.97). Furthermore, increasing intensity of statin therapy was associated with lower risk of POAF (ptrend=0.0012) (Figure 1)

Conclusion

Among cardiac surgery patients with risk factors for stroke and no history of pre-operative AF, the use of statins was associated with a reduction in post-operative AF risk within 30 days of discharge. The routine use of high-intensity statin to prevent post-operative AF after cardiac surgery deserves further study.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): Heart and Stroke Foundation of Canada

636 Impact of the COVID-19 Pandemic on Emergency Admissions with Colorectal Cancer

Aim

Method

Results

Conclusions

Anharmonic phonon interactions and the Kondo effect in a FeSe/Sb2Te3/FeSe heterostructure: a proximity effect between ferromagnetic chalcogenide and di-chalcogenide

In this report, we have introduced magnetic ordering into the nontrivial system of conventional topological insulators (TIs) by creating magnetic interfaces. In this context, antimony di-chalcogenide Sb₂Te₃ sandwiched between two thin layers of FeSe was prepared using the pulsed laser deposition (PLD) technique. The prepared heterostructure demonstrated good crystallinity along with homogeneous morphology displaying pyramid-shaped characteristic triangular islands. To comprehend the temperature and magnetic field modulated inter-layer properties of the prepared hetero-structure, transport, magneto-transport and magnetic properties were investigated. These properties establish the signature of the Kondo effect below 15 K, which has been attributed to the antiferromagnetic spin alignment in that temperature range. At around 150 K, longitudinal and transverse resistivity shows the metal-semiconductor transition, which was further elucidated through the anharmonic decay model in vibration phonon modes using Raman spectroscopy. Furthermore, a significant local spin evolution was explored at around 475 K by studying the magnetic properties of the system. The temperature dependency of the Raman modes confirmed the spin-phonon coupling initiated by local charge ordering at the proximity of the interface in the prepared hetero-structure.

Confocal Raman microscopic evidence for cyclic water Pentamer, at high temperatures in a supramolecular host of [Cu(cyclam)(N3)2]·4H2O

Here, we report the existence of a pentameric water cluster in the host framework of [Cu(cyclam)(N₃)2]·4H₂O, that is stable upto 167 °C, well above the boiling point of water. The pentameric cluster structure embedded in the host framework is evident from the single crystal studies. The high thermal stability is confirmed by TGA and temperature dependent confocal Raman microscopic studies, where loss of water bands is well captured between 167 and 170 °C, besides its existence through SCXRD studies. To the best of our knowledge, this is the first report where temperature dependent confocal Raman microscopic investigation is used to study the stability of water in crystal environment. The study promises that temperature dependent confocal Raman microscopy can be an efficient tool to investigate the existence and stability of small water clusters, precisely in restricted environments.

Safety and acute performance of paroxysmal and early persistent atrial fibrillation ablation using temperature-controlled, very high power, short duration catheter with a new radiofrequency generator

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Biosense Webster Inc.

Background/Introduction

The temperature-controlled contact force radiofrequency (RF) ablation catheter (QDM) has 6 thermocouples to maintain target catheter tip temperature and 3 tip microelectrodes for high local signal resolution. It has an enhanced irrigation profile to reduce char formation. Three prospective multicenter trials demonstrated safety and effectiveness of the QDM catheter using very high-power, short duration (vHPSD; 90W/4s), conventional power (CP; ≤50W) or combined modes. These studies were performed with an older RF generator. A new generator was developed to support the full suite of legacy, temperature controlled and multichannel ablation catheters, but has not yet been formally tested in a clinical setting.

Purpose

Evaluate safety and acute performance of the QDM catheter with the new 90W-enabled generator.

Methods

This prospective, multicenter study (4 Canadian sites) used vHPSD as primary mode for Pulmonary Vein (PV) isolation with overlapping 3mm lesion tags for anterior, inferior and roof of left atrium. Adjacent, non-overlapping lesions were used posteriorly to avoid esophageal heating. CP mode was used at operator discretion for thicker atrial tissue, touch ups, and non-PV triggers (Figure). Primary endpoint was confirmed entrance block in all PVs after adenosine and/or isoproterenol challenge. Acute procedural and safety data were assessed. Systematic char evaluation was performed.

Results

Effectiveness analysis included 38/40 subjects with mean 110-day follow up (mean age, 61.7 ± 9.5 years; 63.2% male). Hypertension (47.4%) and congestive heart failure (15.8%) were the most common comorbidities. Fourteen subjects were treated with version V0 of the generator, and 24 subjects were treated using version V1c which included further software adjustments to the power titration, and current response to optimize performance. Combination vHPSD/CP workflow was used for PV isolation in 28 (75.7%) subjects and vHPSD was used solely in 10. A non-study catheter was used in 1 subject during connectivity troubleshooting. Primary endpoint of entrance block confirmation was achieved in 37/38 subjects and in all 37 subjects treated with study catheter only. No incidences of char or device-related adverse events were reported. There were no noted differences in the endpoints evaluated between the V0 and V1c groups. Median (Q1/Q3) RF application times for ablating PVs was 13.0 min (9.0/16.0) for the entire cohort. Median (Q1/Q3) time to achieve PV isolation in vHPSD-only group was 9 (7/12) min, and 14 (11/18) min, respectively.

Conclusion(s)

Consistent with data from prior 3 clinical studies, QDM catheter with the new 90W-enabled generator demonstrated the acute safety and effectiveness of temperature-controlled AF ablation with short PV ablation time and no char observed.

Grading of Anatomopathological Disparity in the Cases of Invasive Pulmonary Aspergillosis in wild avian species as recorded in Pigeons (Columba livia), Peafowls (Pavo cristatus), and Griffon Vultures (Gyps fulvus)

Aspergillosis which is caused by Aspergillus fumigatus, a fungal pathogen, can vary from a localized infection to severe life-threatening invasive or disseminated systemic diseases in birds. The present study aimed to evaluate and grade the anatomopathological disparity in the cases of invasive pulmonary aspergillosis (IPA) in Columba livia (pigeons), Pavo cristatus (peafowls), and Gyps fulvus (Griffon vultures). Necropsy gross lesions varied from mere congestion of lungs in P. cristatus, congestion and large necrotizing masses surrounded by a zone of hyperemia (10 mm dia) in lungs of C. livia, and typically disseminated granuloma in the lungs, air sacs, and organs of other serous membranes in G. fulvus. Histopathology varied from extensive parenchymal necrosis amidst exuberant fungal invasion in P. cristatus, multifocal to focally extensive tissue necrosis with colonies of fungal hyphae surrounded by heterophils and lymphocytes in C. livia, as well as typical mycotic granuloma embedded in the lungs, air sacs, and thoracoabdominal serous membranes with angio-invasion in G. fulvus. Based on gross and histopathological findings, we diagnosed the cases as Acute Invasive Pulmonary Aspergillosis (AIPA) in peafowls and pigeons, as well as Chronic Invasive Pulmonary Aspergillosis (CIPA) in Griffon vultures. There is a paucity of case reports on aspergillosis in wild avian species, and this report strived to document the cases of IPA in peafowls, pigeons, and vultures. This is the first report of its kind which evaluated anatomopathological disparity of IPA in pigeons, peafowls, and vultures with a proposed anatomopathological grading system which would help to understand and investigate the nature of aspergillosis in different avian hosts.

A systematic review and meta-analysis of disease burden of healthcare-associated infections in China: an economic burden perspective from general hospitals

BACKGROUND

Healthcare-associated infections (HAIs) are a global public health issue. However, the economic burden attributable to HAIs at a national level is unknown in China. The aim of this systematic review was to estimate the direct economic burden caused by HAIs in China.

METHODS

Medline, EMBASE and Chinese Journals Online databases were searched, including studies published from 2009 to 2019. The pooled estimates with 95% Confidential Interval were calculated with Quantile Estimation. The random effect model of the DerSimonian-Laird method was used. The statistical significance was set as P<0.05.

RESULTS

2,756 publications were identified; 6 studies were included in a meta-analysis to calculate the pooled estimates of direct economic burden, while 5 were included in the pooled estimates of the additional economic burden. The pooled median estimates of the total medical expenditure, the medicine expenditure and hospitalisation days per inpatient of patients with HAIs were ¥34,415.62, ¥20,065.21 and 34.01 days, respectively (P <0.0001). The pooled median estimates of the differences of the total medical expenditure, the medicine expenditure and hospitalisation days per inpatient between patients with HAIs and patients without HAIs were ¥24,881.37, ¥9,438.46 and 13.89 days, respectively (P < 0.01).

CONCLUSIONS

The cost of care for patients with HAIs was significantly higher than that for those without HAIs. This excess economic burden is likely to impact on patients and their families as well as health service providers and the health care system as a whole. Effective surveillance systems and cost-effective interventions are needed to control HAIs.

The development of a robust folded scaffold as a fluorescent material using butylidine-linked pyridazinone-based systems via aromatic π⋯π stacking interactions

Fluorescence-capable robust folded pyridazinone-based homo- and heterodimers linked with butylidine linkers, whose crystals exhibit fluorescence with quantum yields of 11% (1CN) and 28% (2CN) due to intramolecular stacking, were synthesized.

Biocompatible Thermoresponsive N-isopropyl-N-(3-(isopropylamino)-3-oxopropyl)acrylamide - Based Random Copolymer : Synthesis and Studies of Its Composition Dependent Properties and Anticancer Drug Delivery Efficiency

A new acrylamide monomer, N-isopropyl-N-(3-(isopropylamino)-3-oxopropyl)acrylamide (M3i), consisting of both isopropyl and isopropylamidopropyl moieties, has been synthesized from isopropylamine and N-isopropylacrylamide via aza-Michael addition reaction followed by amidation with acryloyl chloride....

Structurally characterised new twisted conformer for cyclen, controlled by metal ion complexation as seen in NiII and CuII complexes with halides and pseudohalides

Conformational flexibility of cyclen controlled by complexation with Ni(ii) and Cu(ii) as evidenced by structural studies.

Achieving AIE from ACQ in positional isomeric triarylmethanes

This report demonstrate that the usual ‘aggregation caused quenching’ (ACQ) can be overcome by a change in the substitution position in naphthalene derivatives, leading to the much desired ‘aggregation induced emission’ (AIE).

Giant Cell Tumor of Distal Ulna – A Rare Case Report

Introduction: Among the benign primary bone tumors, Giant cell tumor (GCT) accounts for about 3% to –5%. It is a locally aggressive tumor with maximum incidence between 20 to and 40 years of age. The sites where GCT is most commonly seen are distal femur, and proximal tibia followed by distal end radius. Distal end of ulna is a rare site with an incidence of only 0.45% to –3.2%. Case Report: We report a case of a 32- year- old male with (GCT) giant cell tumor of the left distal ulna. We managed the patient with en bloc resection of distal ulna along with reconstruction of distal radio ulnar joint (DRUJ) and triangular fibro cartilage complex (TFCC) using proximal fibula graft and palmaris longus graft. DRUJ was stabiliszed with a k- wire. Conclusion: After 1 year of follow- up, patient showed good results in terms of range of movements of the wrist joint with no evidence of recurrence.

Metastatic Neoplasms of the Large Bile Ducts- A Clinicopathological Study

Introduction/Objective

Biliary strictures are often considered malignant until proven otherwise. While the majority of malignant biliary strictures represent a primary neoplasm, secondary involvement by metastasis also rarely occurs. Primary cholangiocarcinoma and metastatic disease have different treatment considerations and likely different prognoses. The aim of this study is to look at the clinico-pathological characteristics of metastatic neoplasms of the bile duct.

Methods/Case Report

We retrospectively searched the pathology archives for biliary biopsies between 1991-2020. Patients with primary biliary, gallbladder, pancreatic, ampullary and hepatic malignancies and all cases of lymphoma were excluded from the study. A total of 20 cases were included.

Results (if a Case Study enter NA)

The median age of the patients was 63 years with a M:F ratio of 1.9:1. The biopsies were taken from the common bile duct (n=17), common hepatic duct (n=2) and left hepatic duct (n=1). 8 patients had synchronous and 12 had metachronous presentation. The overall median interval between the bile duct metastasis and primary was 18 months (Range: 0-100 months) for all patients and 33 months for metachronous cases. For 13 tumors, the primary site of origin was in the gastrointestinal tract (colon: 7; stomach: 4; anal canal: 1; gastro-esophageal junction: 1). Other primary sites included breast (3 cases), lung, endometrium and adrenal (1 each). One case presented with metastatic melanoma with an occult primary. Adenocarcinoma was the most common histological subtype seen in 17 cases. Other histological subtypes were squamous cell carcinoma, adrenocortical carcinoma and melanoma.

Conclusion

Secondary involvement of the bile duct by metastasis is rare. Most cases are metastasis from the lumenal gastrointestinal tract, with colon being the most common primary site. They are more likely to have a metachronous presentation with rare instances of bile duct metastasis as the first presentation. Awareness of secondary involvement of the biliary tree by metastasis is important as they can have prognostic and therapeutic significance.

Atrial fibrillation in unexplained syncope: observations from the Reveal LINQ registry

Background

Implantable loop recorders (ILRs) have come to play an important role in the workup of patients with recurrent syncope of uncertain origin. In addition to detecting bradyarrhythmias related to syncope, which is the main diagnostic focus in these patients, ILRs are also capable of uncovering subclinical atrial fibrillation (AF).

Purpose

We sought to determine the percentage of patients monitored with an ILR for unexplained syncope who have AF detected and to describe clinical actions taken in these patients.

Methods

Patients enrolled in the Reveal LINQ Registry who received an ILR for unexplained syncope and had at least one follow-up form were included. The device automatically detects AF episodes lasting ≥2 minutes. Patients were considered to have AF based on an AF diagnosis made by the treating physician during follow-up or if device-detected AF was adjudicated as true AF by an external reviewer. AF detection rates were calculated using Kaplan-Meier methods.

Results

In total, 498 patients (aged 61.8±20.0 years, 49.6% female, CHA2DS2VASc score 2.2±1.7) were included and followed for 22±12 months. A history of AF was present in 97 (20%) patients, while 401 patients had no history. By 18 months, the incidence of AF was 70.9% (95% CI, 60.8%, 80.3%) in patients with a history of AF and 21.4% (95% CI, 17.4%, 26.1%) in patients without (Figure). AF detection in those with (30.4%) and without (30.1%) syncope during follow-up was similar. By the end of follow-up, and among patients with newly detected AF, 29/86 (33.7%) were on oral anticoagulation, 7 (8.1%) underwent AF ablation, 6 (7.0%) underwent other type of ablation, and 2 (2.3%) received cardioversion. Other actions among the whole cohort included implant of an IPG, ICD, or CRT in 98/498 (19.7%).

Conclusion

Among patients monitored with ILRs to determine the cause of recurrent syncope episodes, approximately 1 in 5 patients had new AF detected. In addition to improving the management of patients with syncope, ILR data served to support AF-related clinical decisions.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Medtronic Inc Incidence of AF according to baseline AF

Perinatal mental health in India: protocol for a validation and cohort study

BACKGROUND

Common mental disorders (CMD) are among the largest contributors to global maternal morbidity and mortality. Although research on perinatal mental health in India has grown in recent years, important evidence gaps remain, especially regarding CMD. Our study aims to improve understanding of CMD among perinatal and non-perinatal women of reproductive age across two settings in India: Bangalore (Karnataka) and Tanda (Himachal Pradesh).

METHODS

The study is embedded within the Maternal and Perinatal Health Research Collaboration India (MaatHRI). This mixed-methods observational study comprises three consecutive phases: (i) focus group discussions and individual interviews to explore women's knowledge and seek feedback on CMD screening tools; (ii) validation of CMD screening tools; and (iii) prospective cohort study to identify CMD incidence, prevalence and risk factors among perinatal and non-perinatal women. Results of the three phases will be analyzed using inductive thematic analysis, psychometric analysis and multivariable regression analysis, respectively.

CONCLUSION

Improving understanding, detection and management of CMD among women is key to improving women's health and promoting gender equality. This study will provide evidence of CMD screening tools for perinatal and non-perinatal women in two diverse Indian settings, produce data on CMD prevalence, incidence and risk factors and enhance understanding of the specific contribution of the perinatal state to CMD.

Compact X-Band Electron Linac for Radiotherapy and Security Applications

RadiaBeam has developed a 6 MeV accelerator that is compact and light enough to be placed on a robotic arm or light truck. The main drivers of size and weight in conventional accelerators are the power source and the shielding. Small dimensions are enabled by operation at 9.3 GHz frequency (X-band), which allows reducing the size and weight of all accelerator components. Thanks to the robust design of the accelerating structure, the accelerator can be used as a source for novel cargo inspection and radiotherapy techniques. In this paper, we present the linac design and its components, as well the results of the experimental demonstration of beam acceleration.