Magnets and children: a dangerous combination

BACKGROUND

Accidental ingestion of foreign bodies is a common problem in children. Fortunately, the gastrointestinal tract is quite resilient to foreign bodies. On the other hand, the ingestion of magnets can result in enormous morbidity. Because of their natural tendency to firmly adhere they can cause intestinal obstruction, pressure necrosis, fistula formation or perforation. With this case report, we aim to raise awareness of the risks that these magnets pose to children.

METHODS

We describe a case of intestinal perforation caused by the separate ingestion of multiple magnets from a children's toy (buckyballs, Neodymium spheres) by a two-year-old boy. A search in the Pubmed database showed some publications and varied management guidelines.

RESULTS

The boy was treated with an exploratory laparoscopy converted to a mini-laparotomy. We removed the four magnets through separate enterotomies. Postoperative recovery was uneventful. The boy was discharged on a postoperative day five and had no complications at three months follow-ups.

CONCLUSION

Accidental ingestion of multiple magnets is rare but can create a life-threatening situation in children. If the magnets are still in the stomach, endoscopic retrieval is needed. If they are beyond the stomach, in asymptomatic cases close clinical and radiographic vigilance is mandatory. When symptomatic we advise urgent removal. If treated on time, the surgical outcome is good and fast recovery is expected.

Fluorescent molecular rotors detect O6-methylguanine dynamics and repair in duplex DNA

Alkylation at the O6 position of guanine is a common and highly mutagenic form of DNA damage. Direct repair of O6-alkylguanines by the "suicide" enzyme O6-methylguanine DNA methyltransferase (MGMT, AGT, AGAT) maintains genome stability and inhibits carcinogenesis. In this study, a fluorescent analogue of thymidine containing trans-stilbene (tsT) is quenched by O6-methylguanine residues in the opposite strand of DNA by molecular dynamics that propagate through the duplex with as much as ∼9 Å of separation. Increased fluorescence of tsT or the cytosine analogue tsC resulting from MGMT-mediated DNA repair were distinguishable from non-covalent DNA-protein binding following protease digest. To our knowledge, this is the first study utilizing molecular rotor base analogues to detect DNA damage and repair activities in duplex DNA.

Formal [4 + 2] Cycloadditions of Maleimides on Duplex DNA

Near-quantitative DNA bioconjugation and detailed mechanistic investigations of reactions involving 5-(vinyl)-2'-deoxyuridine (VdU) and maleimides are reported. According to accelerated reaction rates in solvents with increasing polarity and trends in product stereochemistry, VdU-maleimide reactions proceed via a formal [4 + 2] stepwise cycloaddition. In contrast, 5-(1,3-butadienyl)-2'-deoxyuridine (BDdU) reacts with maleimides in a concerted [4 + 2] Diels-Alder cycloaddition. VdU-maleimide reactions enable high-yielding bioconjugation of duplex DNA in vitro (>90%) as well as metabolic labeling experiments in cells.

A Bright and Ionizable Cytosine Mimic for i-Motif Structures

A new fluorescent cytosine analog "^tsC" containing a trans-stilbene moiety was synthesized and incorporated into hemiprotonated base pairs that comprise i-motif structures. Unlike previously reported fluorescent base analogs, ^tsC mimics the acid-base properties of cytosine (pK_a ≈ 4.3) while exhibiting bright (ε × Φ ≈ 1000 cm^-1 M^-1) and red-shifted fluorescence (λ_em = 440 → 490 nm) upon its protonation in the water-excluded interface of ^tsC⁺:C base pairs. Ratiometric analyses of ^tsC emission wavelengths facilitate real-time tracking of reversible conversions between single-stranded, double-stranded, and i-motif structures derived from the human telomeric repeat sequence. Comparisons between local changes in ^tsC protonation with global structure changes according to circular dichroism suggest partial formation of hemiprotonated base pairs in the absence of global i-motif structures at pH = 6.0. In addition to providing a highly fluorescent and ionizable cytosine analog, these results suggest that hemiprotonated C⁺:C base pairs can form in partially folded single-stranded DNA in the absence of global i-motif structures.

Size-dependent molecular interaction of nontraditional 2D antibiotics withStaphylococcus aureus

The application of nanomaterials for their antibacterial properties is the subject of many studies due to antibiotic resistance of pathogen bacteria and the necessity of omitting them from food and water resources. Graphene oxide (GO) is one of the most popular candidates for antibacterial application. However, the optimum condition for such an effect is not yet clear for practical purposes. To shed light on how GO and bacteria interaction depends on size, a wide range of GO flake sizes from hundreds of µm²going down to nano-scale as low as 10 N m²was produced. In anin-vitrosystematic study to inhibitStaphylococcus aureusgrowth, the correlation between GO flake size, thickness, functional group density, and antibacterial activity was investigated. The GO suspension with the average size of 0.05 µm², in the order of the size of the bacteria itself, had the best bacteriostatic effect onS. aureuswith the minimum inhibitory concentration value of 8 μg ml^-1, well within the acceptable range for practical use. The bacteriostatic effect was measured to be a 76.2% reduction of the colony count over 2 h of incubation and the mechanism of action was the wrapping and isolation of cells from the growth environment. Furthermore,in-vivoanimal studies revealed that 16 μg ml^-1of the optimum GO has efficient antibacterial performance against the methicillin-resistant strains of the bacteria with an enhanced wound healing rate and tensiometrial parameters which is important for realized targets.

Prevalence and Clinical Characteristics of Low Back Pain among Operating Room Personnel: A Cross-Sectional Study in South of Iran

Background

Low back pain is one of the most common musculoskeletal disorders and the most common cause of activity restriction in people younger than 45 years. Nurses have a high incidence and prevalence of low back pain in terms of physical and emotional factors among healthcare workers. This study aimed to evaluate the prevalence and clinical characteristics of low back pain.

Methods

This cross-sectional study was performed on 385 operating room personnel of the hospitals affiliated with Shiraz (the largest city in southern Iran) University of Medical Sciences. The data were collected via a research-made developed questionnaire. The questionnaire consisted of two parts, including the demographic information and prevalence and dimensions of low back pain.

Results

The results showed that the prevalence of low back pain was 74% among operating room personnel. There was a significant relationship among low back pain, education level, and marital status (p < 0.05).

Conclusion

Hospital managers should reduce the prevalence of this disorder among operating room staff by teaching preventative patient handling techniques via training courses.

Association of Bridging Integrator 1 Gene Polymorphism with Susceptibility to Alzheimer’s Disease

Background: Alzheimer's disease (AD) is the most common type of dementia. The role of genetic factors in the development of AD has not been demonstrated yet. Objectives In this study, our aim was to investigate the association between one of the BIN1 gene’s single-nucleotide polymorphism (SNP( (rs744373) and late-onset Alzheimer's disease (LOAD) in an Iranian population in the Guilan province. Materials & Methods: In this case-control study, 110 patients with LOAD, and 110 unrelated healthy controls were recruited. Polymerase chain reaction-restriction length polymorphism (PCR-RFLP) was performed for genotyping BIN1 gene’s SNP (rs744373). Electrophoresis was there after carried out using agarose gel and DNA safe stain and the gels were visualized under an ultraviolet (UV) trans-illuminator. The allelic and genotypic frequencies were determined. Results: The frequency of allele T (Wild-type allele) in the control and the LOAD groups was 70.9% (n = 159) and 58.6% (n = 129), respectively (p = 0.007). The frequency of allele C in the LOAD group (41.4%) (n = 91) was significantly higher than that of the control group (29.1%) (n=64) (p=0.007). Frequency of homozygous genotype (CC) of BIN was significantly higher in the LOAD group than in the control group (p = 0.043). Conclusion: rs744373 SNP of BIN1 gene is significantly associated with the risk of developing AD in the studied population.

Novel Therapies for Critical Limb-Threatening Ischemia

PURPOSE OF REVIEW

This review intends to discuss the latest endovascular and surgical advancement in the treatment of critical limb-threatening ischemia (CLTI).

RECENT FINDINGS

We discuss novel endovascular technological advancements such as intravascular lithotripsy, the Tack endovascular stent, the PQ Bypass DETOUR system, and the LimFlow System for deep venous arterialization (DVA) in the very high risk "no-option" CLTI population. We also discuss the increasing adoption of radial and pedal approaches for endovascular revascularization and the tibiopedal arterial minimally invasive (TAMI) technique. On the surgical front, we discuss the distal vein patch technique and surgical and hybrid DVA. Recent advancements in the treatment options of CLTI will likely lead to reducing the rate of major amputations if they are adopted in a collaborative environment in order to apply the most appropriate treatment option to each individual patient based on the anatomy, comorbidities, functional status, and local expertise.

Modulation of Negative Effects of Physiological Stress on Frozen-Thawed Semen with Nutrition of Organic Selenium in Ross 308 Rooster

Current experiment was carried out in factorial 2×2 arrangement to study the effects of stress (with or without dexamethasone administration) and addition of dietary selenium (with or without selenium supplementation in the diet) in male broiler breeder on the quality of frozen-thawed sperm under oxidative stress induced by dexamethasone. A total of 24 broiler breeder roosters with the age of 28 weeks were used based on a completely randomized design with four therapeutic approaches (factorial 2×2) and six birds in each approach. The experimental treatments were: 1) basal diet without selenium supplementation and injection of saline (CON), 2) basal diet with dexamethasone injection (4 mg/kg BW, three times every other day for one week), (DEX), 3) without dexamethasone injection and supplementation with 0.3 mg/kg selenium (Sel-Plex), and 4) dexamethasone injection and basal diet supplemented with 0.3 mg/kg of diet selenium (Sel-Plex+Dex). Sperm samples were collected from roosters. Motility, progressive motility, plasma membrane integrity, viability, malondialdehyde concentration and antioxidant parameters were evaluated in fresh and frozen-thawed semen. In spite of non-significant interaction effects, factorial analysis indicated the significant effect of every factor on different experimental parameters in fresh and frozen-thawed semen (P<0.05); The results revealed that total and progressive motility, plasma membrane integrity and viability were lower in DEX group when compared with other treatments (P<0.05). On the other hand, malondialdehyde concentration was higher in DEX group in comparison with Con, Sel-Plex and Sel-Plex+DEX groups (P<0.05). Moreover, total antioxidant capacity, level of glutathione peroxidase and superoxide dismutase were lower in DEX group as compared with other treatments (P<0.05). Our findings indicated that administration of selenium in dexamethasone-receiving roosters (Sel-Plex+DEX) improved the parameters of fresh and frozen-thawed sperm; but the best results were observed in Sel-Plex treatment. Therefore, selenium supplementation in the diet of roosters without dexamethasone injection improved total motility, progressive motility, membrane integrity, viability, malondialdehyde, total antioxidant capacity, glutathione peroxidase and superoxide dismutase pre- and post-freezing. It can be concluded, selenium in organic forms in stressed and non-stressed rooster's diet might improve all motility and antioxidant parameters in fresh and frozen-thawed sperm.

Highly diastereoselective cascade [5 + 1] double Michael reaction, a route for the synthesis of spiro(thio)oxindoles

The first diastereoselective synthesis of spirothiooxindoles is reported via the Michael reaction between thiooxindoles and dibenzalacetones. The reaction was conducted without any catalyst or additive under green conditions, i.e., ethanol as the solvent and at room temperature. In addition, the described robust method benefits from scalability, simple work-up, and column chromatography-free purification. This work demonstrates the art of governing regio- and stereoselectivity, which has been discussed in the light of Density Functional Theory calculations. Our method represents the first synthesis of spiro[cyclohexanone-thiooxindoles] with the relative configuration of the aryl moieties at the cyclohexanone ring as cis. The obtained cis-spirothiooxindoles, can be used to afford cis-spirooxindoles, which their synthesis had not been explored before. According to our molecular docking studies, cis-spirooxindoles demonstrate higher binding affinities than corresponding trans-spirooxindoles for the OPRT domain of the Leishmania donovani uridine 5′-monophosphate synthase (LdUMPS). Thus, the reported method may eventually be utilized to develop new hit compounds for leishmaniasis treatment.

Prevalence of Ureaplasma urealyticum and Mycoplasma genitalium in men with non-gonococcal urethritis

The study in Teheran, Islamic Republic of Iran, investigated the prevalence of Ureaplasma urealyticum and Mycoplasma species in men with non-gonococcal urethritis. Urethral swab samples were collected from 125 cases and 125 healthy men as a control group. The samples were then investigated by culture methods. The rates of detected bacteria in case and control groups were 19.2% and 7.2% for U. urealyticum, 7.2% and 0.8% for M. genitalium, and 2.4% and 1.6% for M. hominis respectively. Statistical analysis showed a significant difference between case and control groups in the prevalence of U. urealyticum and M. genitalium but not M. hominis. It is concluded that in men, U. urealyticum and M. genitalium may have an etiologic role in non-gonococcal urethritis

Effects of supplemental fat sources and forage feeding levels on growth performance, nutrient digestibility, ruminal fermentation, and nitrogen utilization in dairy calves

Knowledge regarding the potential interactions between supplemental fat source and fiber level in starter diet of dairy calves is lacking. The aim of the present study was to investigate the effects of supplemental saturated fat [palm fat (PLF) containing 86% palmitic acid (C16:0)] vs. unsaturated fat [soybean oil (SBO) containing 51% linoleic acid (C18:2)] and forage level on feed intake, growth performance, ruminal fermentation, nutrient digestibility, and metabolic traits in dairy calves. Forty newborn Holstein female calves (BW = 39.7 ± 1.8 kg) were assigned to 1 of 4 treatment groups (each consisting of 10 animals) in a 2 × 2 factorial arrangement of fat source [soybean oil vs. palm fat; 3% of starter based on DM basis] and alfalfa hay level (0 vs. 15%, on DM basis): SBO or PLF with (AH) or without (NAH) alfalfa hay. Calves had ad libitum access to water and starters throughout the study and a constant amount of milk was offered among experimental calves during the pre-weaning period. All calves were weaned on day 63 of age and remained in the study until day 73 of age. The results showed that the lowest and the highest starter intake and average daily gain during pre-weaning period was observed when calves received SBO-AH and PLF-AH, respectively. Accordingly, the lowest wither and hip heights at weaning time (day 63) and final wither height (day 73) were observed in SBO-AH group across treatments. Calves received PLF-AH had the highest weaning and final BW compared to other groups. Feed efficiency tended to be higher in PLF groups compared with SBO calves. Calves fed SBO-AH had the lowest digestibility of organic matter and neutral detergent fiber and also total short chain fatty acid concentrations in rumen compared with other groups. The SBO calves had lower urinary allantoin, urinary purine derivatives, and microbial protein synthesis than PLF calves; however, urinary nitrogen increased with SBO supplementation. In summary, the supplementation of SBO rich in C18:2 and AH during the pre-weaning period resulted in negative responses on growth performance, digestibility, and ruminal fermentation profile. Therefore, the inclusion SBO rich in C18:2 along with forage in the starter is not recommendable for young dairy calves.

Evaluation of Heating and Irradiation Methods for Production of Purified Protein Derivative (PPD) of Mycobacterium Tuberculosis

Tuberculin skin test, also known as the tuberculin or purified protein derivative (PPD) test, is an extensively applied diagnostic test for the detection of primary infection with Mycobacterium tuberculosis (Mtb). The production of PPD is accompanied by some difficulties that require a series of modifications in the production and purification processes. The present study aimed to determine the facilitation level of the manufacturing process by modifying evaluation methods for the production of PPD tuberculin. Mtb strains were cultured in Lowenstein-Jensen media, and the cultured strains were inoculated into the Dorset-Henley liquid medium by the biphasic medium of potato-Dorset-Henley. After incubation, flasks containing cultured strain were selected for bacterial inactivation, and the optimal gamma radiation dose(s) was determined. Tuberculoproteins were precipitated by ammonium sulfate (AS) and Trichloroacetic acid (TCA). Protein concentration was determined using the Bradford and Kjeldahl protein assay methods. Finally, the lymphocyte transformation test and potency test were performed. Based on the results, the Dorset-Henley liquid medium is suitable for the massive growth of the bacterium. The transferal of Mtb from solid to liquid medium was directly carried out without intermediate culture. It was found that during tuberculoprotein production, heating at 100&amp;deg;C for 3 h would be safe for killing mycobacterium. Furthermore, the simultaneous use of heating and gamma irradiation (8 kGgy) killed all of the mycobacteria, while doses of 1, 1.5, and 7 kGy decreased a significant number of bacterial cells. The results also indicated that the concentration of tuberculoprotein extracted by TCA precipitation method was higher than that obtained by AS precipitation. The tuberculoproteins which were produced by these two methods in the lymphocyte transformation test were not significantly different in terms of potency (P&amp;gt;0.05). Moreover, due to the high volume of produced protein, the protein measurement was more efficiently carried out by the Kjeldahl method, compared to the Bradford method. Finally, the results of the present study demonstrated that in addition to the novel approach of gamma irradiation, optimum methods are efficient and applicable in the production of PPD tuberculin.

The effects of the fiber source and xylanase supplementation on production, egg quality, digestibility, and intestinal morphology in the aged laying hen

This study was conducted to evaluate the effects of the fiber source (wheat bran [WB] or sugar beet pulp [SBP]) and xylanase supplementation on production, egg quality, ileal digestibility, intestinal morphology, and gastrointestinal pH in aged laying hens. A total of 540 laying hens (Lohman LSL Lite; 70 wk of lay) were randomized into 10 treatments (6 replicate cages of 9 birds) consisting of a corn soy control supplemented with 0, 3, or 6% WB or SBP with or without xylanase (100 mg of xylanase preparation per kg) for a period of 9 wk in a 5 × 2 factorial arrangement. Hens fed with the diets containing either of the levels of SBP or 6% WB had lower hen-day production, and addition of the enzyme improved hen-day production (P < 0.05), but it could not compensate for the lost production due to the higher levels of either of the fiber sources. Supplementation of 6% SBP to the control diet decreased egg mass (P < 0.05). All fiber-supplemented diets significantly decreased ADFI, which was restored on enzyme addition, with the exception of 3% WB diet. Treatments had no effects on egg weight, feed conversion ratio, egg quality, and serum and carcass traits, except for ileum weight, which was greater in hens fed with the 6% SBP diet (P < 0.05). Adding 3% SBP increased ileal DM digestibility (P < 0.05). Addition of 3% WB improved jejunal villus height, villus height-to-crypt depth ratio, and villus surface area (P < 0.05). Villus surface area, DM, organic matter, and protein digestibility increased as a result of enzyme supplementation (P < 0.05). Cecal pH was reduced on feeding diets containing 3% WB, containing 3% SBP, and with enzyme supplementation (P < 0.05). In conclusion, addition of 3% WB in a corn soy control diet has the potential to improve small intestine morphology in older hens without adverse effects on performance, especially if accompanied by the use of an enzyme, which simultaneously improved morphological traits and nutrient digestibility.

A Highly Fluorescent Nucleobase Molecular Rotor

Fluorescent base analogs (FBAs) are powerful probes of nucleic acids' structures and dynamics. However, previously reported FBAs exhibit relatively low brightness and therefore limited sensitivity of detection. Here we report the hitherto brightest FBA that has ideal molecular rotor properties for detecting local dynamic motions associated with base pair mismatches. The new trans-stilbene annulated uracil derivative "^tsT" exhibits bright fluorescence emissions in various solvents (ε × Φ = 3400-29 700 cm^-1 M^-1) and is highly sensitive to mechanical motions in duplex DNA (ε × Φ = 150-4250 cm^-1 M^-1). ^tsT is thereby a "smart" thymidine analog, exhibiting a 28-fold brighter fluorescence intensity when base paired with A as compared to T or C. Time-correlated single photon counting revealed that the fluorescence lifetime of ^tsT (τ = 4-11 ns) was shorter than its anisotropy decay in well-matched duplex DNA (θ = 20 ns), yet longer than the dynamic motions of base pair mismatches (0.1-10 ns). These properties enable unprecedented sensitivity in detecting local dynamics of nucleic acids.

A Multidisciplinary Focus Review of Musculoskeletal Disorders Among Operating Room Personnel

Musculoskeletal disorder is one of the major health issues and is recognized as the second most common occupational disease. The aim of the present study was to investigate the different aspects of musculoskeletal disorders in operating room personnel. The present study was conducted to evaluate the prevalence of MSDs among operating room personnel, in January 2020. In this study, the authors explored 30 articles from five databases including Medline/PubMed, ProQuest, Scopus, Embase, and Google Scholar. The present study found that physical, psychological, and demographic characteristics including age, gender, work experience, and smoking were the most important risk factors for these disorders. Musculoskeletal disorders were also prevalent in different areas of the body, with the highest prevalence being in the lumbar region. In addition, regular exercise and physical activity, the use of stretching and gentle exercise to reduce physical pressure, regard to the principles of ergonomics in the workplace, regular physical examinations, and awareness of the risk factors for these disorders. Therefore, operating room officials need to promote operating room programs focused on reducing musculoskeletal disorders and increase the awareness of the personnel about the risk factors by conducting training courses.

High frequency of BRAF V600E mutation in Iranian population ameloblastomas

Background

Ameloblastoma is a common locally invasive but slow-growing neoplasm of the jaws with an odontogenic origin. Association between BRAF V600E mutation and clinicopathologic features and behavior of ameloblastoma remains controversial. This study aimed to evaluate BRAF V600E gene mutation and expression of its related proteins with clinicopathologic parameters in conventional ameloblastoma.

Material and Methods

50 Formalin-fixed paraffin-embedded blocks were included in this study. Immunohistochemistry was done using rabbit monoclonal BRAF V600E mutation-specific antibody VE1. Quantitative real-time polymerase chain reaction assay was used for evaluating of BRAF V600E mutation.

Results

Expression of BRAF V600E antibody was Positive in 42 out of 50 cases (84%). 46 (92%) out of 50 specimens showed BRAF V600E mutation. There were 13 cases of recurrence (26%). 3 out of 4 cases with negative mutations did not show recurrence.

Conclusions

We report the highest frequency (92%) of BRAF V600E mutation in ameloblastomas in the Iranian population. Although there was not a significant association between BRAF V600E‑positive immunoexpression and recurrence and clinicopathologic parameters, its high frequency could emphasize its role as a therapeutic marker in the future.

Key words:Conventional ameloblastoma, BRAF V600E, recurrence.

Investigation into passing behavior at passing zones to validate and extend the use of driving simulators in two-lane roads safety analysis

A passing maneuver allows drivers to maintain their desired speed on two-lane highways. However, it entails a high risk of collision with vehicles travelling in the opposite direction. Investigating drivers' behavior while performing passing maneuvers could provide helpful information on the factors that influence this process. Driving simulators have become important tools for driving behavior research studies as they are safe, facilitate the controlled use of experimental variables, and generate detailed output data. It remains to be seen whether simulator results can be considered representative of real-life driving conditions. With respect to passing maneuvers, no study has made a comprehensive and direct comparison between drivers' passing behavior in the field and driver behavior observed in a simulated environment. In this validation study, a fixed-base interactive simulator was used to collect data from fifty-four participants (eighteen Iranians and thirty-six Italians) involved in several traffic scenarios on a two-lane rural highway segment (obtained by varying the speed of opposing vehicles, lead vehicles and headways in the opposite direction). A 3D model and its environmental characteristics were realized from the real segment which had previously been surveyed with drones to collect videos and derive data on real passing maneuvers. The results for the two-sided K-S test revealed no statistically significant difference in the accepted gap, effective accepted gap, perception reaction time, and time to collision variables between the field and the simulator at the 95 % confidence level. However, when conducting a one-sided K-S test, some statistical directional differences were found in the cases of the accepted gap and perception reaction time variables, which exhibited lower values in the field compared to the simulator again at the 95 % confidence level. Although the passing duration was statistically higher in the simulator than in the field, the shape of the two distributions was not statistically different. Analysis showed that differences in the passing duration are due to the lower passing vehicle speed and lower speed difference with the simulator than in the field, which are caused by truncating headways in the subject direction in the simulator. The cultural background of participants did not result in any discernible difference in passing behavior. The results would support a more extensive use of driving simulators in future passing behavior studies.

Comparative Analysis of Gait Speed Estimation Using Wideband and Narrowband Radars, Thermal Camera, and Motion Tracking Suit Technologies

Research has shown that cognitive and physical functioning of older adults can be reflected in indicators such as walking speed. While changes in cognition, mobility, or health cause changes in gait speed, often gradual variations in walking speed go undetected until severe problems arise. Discrete clinical assessments during clinical consultations often fail to detect changes in day-to-day walking speeds and do not reflect walking speeds in everyday environments, where most of the mobility issues happen. In this paper, we compare four walking speed measurement technologies to a GAITRite mat (gold standard): (1) an ultra wideband radar (covering the band from 3.3 GHz to 10 GHz), (2) a narrow band 24-GHz radar (with a bandwidth of 250 MHz), (3) a perception Neuron Motion Tracking suit, and (4) a thermal camera. Data were collected in parallel using all sensors at the same time for 10 healthy adults for normal and slow walking paces. A comparison of the sensors indicates better performance at lower gait speeds, with offsets (when compared to GAITRite) between 0.1 and 20% for the ultra wideband radar, 1.9 and 17% for the narrowband radar, 0.1 and 38% for the thermal camera, and 1.7 and 38% for the suit. This paper supports the potential of unobtrusive radar-based sensors and thermal camera technologies for ambient autonomous gait speed monitoring for contextual, privacy-preserving monitoring of participants in the community.

Epidemiology and outcome analysis of 3030 burn patients with an ICD-10 approach

The present study aims to document the epidemiologic features and outcomes of burn injuries in Southeastern Iran based on International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) guidelines. This retrospective cross-sectional study was carried out at Khatam-Al-Anbiya Hospital. Patient demographics, including burn injury data and outcome data were collected from medical records and analyzed through descriptive and analytical statistics using SPSS software. A total of 3,030 burn patients were included in this study. A total of 55% of the subjects were males. The largest age group included patients aged 15-44 (61%). The majority of burns were caused by flame (70.5%), and most of them were third-degree burns (73%). Mean affected total body surface area (TBSA) was 43.98%±30.75% in all subjects and 80.85%±21.41% in the deceased individuals. Most of the burns were accidental (66.2%), and 37% of them occurred in winter. Mean hospital stay was 4.49±4.67 days (within the range of 1-113 days). A quarter of all patients admitted to the hospital died (24.9%). The number of admitted patients, mean length of stay (LOS), and the mortality rate showed a decreasing trend from 2007 to 2016. In contrast, the total mortality rate was high. The significant predictors of mortality included being female, flame burns, longer LOS, a larger TBSA, burns of higher degrees, as well as burn complications. The documentation of burn data, based on ICD-10 directives, standardizes findings from burn injury analyses and leads to the comparability of data at different national and international levels.

Modelling and optimizing of calcium and non-phytate phosphorus requirements of male broiler chickens from 1 to 21 days of age using response surface methodology

The skeleton is the main site of P and Ca deposition; therefore, accurate estimation of Ca and P requirements is necessary to maintaining health and optimum performance of broiler chickens. A response surface methodology (RSM) using a central composite design (CCD) was used for evaluating and optimizing of Ca and non-phytate P (NPP) requirements of broiler chickens for optimal performance, ileal nutrient digestibility and bone mineralization from 1 to 21 days of age. A total of 750 one-day-old male broiler chickens (Ross 308) were randomly distributed into 50 cages including 9 treatments, each replicated 5 times (except central treatment with 10 replicates) and 15 birds in each cage by CCD. The dietary Ca levels of 4.3, 5.6, 8.6, 11.7 and 13.0 g/kg and NPP of 2.5, 2.9, 4.0, 5.0 and 5.4 g/kg were used for nine treatments of CCD. The results indicated that the linear and quadratic effects of NPP, quadratic effects of Ca and Ca × NPP were significant for average weight gain (AWG, P < 0.05), average feed intake (AFI, P < 0.05), feed conversion ratio (FCR, P < 0.05) and Ca and P apparent ileal digestibility (AID, P < 0.05); however, the linear effect of Ca was significant only for FCR (P < 0.05). On the other hand, tibia and toe ash were affected by NPP (linear and quadratic, P < 0.01) and Ca (quadratic, P < 0.01). The second-order polynomial regression model was significant for AWG (R2 = 0.93, P < 0.001), AFI (R2 = 0.88, P < 0.001), FCR (R2 = 0.78, P < 0.001), AID of Ca (R2 = 0.78, P < 0.001) and P (R2 = 0.88, P < 0.001), tibia ash (R2 = 0.86, P < 0.001) and toe ash (R2 = 0.85, P < 0.001). The multi-objective optimization indicated that broiler chickens from 1 to 21 days of age need 7.03 and 4.47 g/kg of Ca and NPP, respectively, to achieve optimal AWG, FCR, tibia and toe ash. However, the dietary Ca and NPP levels can be reduced to 6.57 and 3.95 g/kg with a slight negative impact on performance and bone mineralization, respectively. In conclusion, the findings indicate that using multi-objective optimization model such as RSM provides more information regarding optimum Ca and NPP requirements of broiler chickens, considering the complex interaction between these two minerals. While the NPP levels are in line with current recommended requirements, Ca levels are considerably lower and suggest that current recommended Ca requirements may be in excess of the needs of the broiler.

Serogroups, and drug resistance of nontyphoidal Salmonella in symptomatic patients with community-acquired diarrhea and chicken meat samples in Tehran

BACKGROUND

Salmonella is considered as a main cause of community-acquired diarrhea in humans, however, sources of the multi-drug resistant (MDR) strains and their link with the disease are not well known.

AIMS

This study aimed to investigate the frequency, serogroup diversity, and antimicrobial susceptibility patterns of Salmonella strains in poultry meat and stool samples of patients with community acquired diarrhea in Tehran.

METHODS

We compared the frequency of non-typhoidal Salmonella serogroups, the similarities of their resistance patterns to 10 antimicrobial compounds, the prevalence of extended spectrum β-lactamase (ESBL) and ampicillinase C (AmpC) genetic determinants, and class 1 and 2 integrons in 100 chicken meat and 400 stool samples of symptomatic patients in Tehran during June 2018 to March 2019.

RESULTS

Salmonella was isolated from 75% and 5.5% of the chicken meats and human stool samples, respectively. The chicken meat isolates mainly belonged to serogroup C (88%, 66/75), while the human stool isolates were mainly related to serogroup D (59.1%, 13/22). The MDR phenotype and the most common rates of resistance to antibiotics, including tetracycline, trimethoprim/sulfamethoxazole (TS) and azithromycin, were detected in 4.5% and 45.3%, 59% and 13.6%, 43% and 9.1%, 42% and 9.1% of the human stool and chicken meat samples, respectively. Carriage of bla _CTX, bla _SHV, and bla _PER genes in the meat isolate with ESBL resistance phenotype and bla _ACC, bla _FOX, and bla _CMY-2 among the 7 meat strains with AmpC resistance phenotype was not confirmed using polymerase chain reaction (PCR). High prevalence of class 1 and 2 integrons was characterized and showed a correlation with resistance to TS and chloramphenicol.

CONCLUSION

These findings showed a lack of association between chicken meats and human isolates due to discrepancy between the characterized serogroups and resistance phenotypes.

The utility of trough mycophenolic acid levels for the management of lupus nephritis

Background

Monitoring of mycophenolic acid (MPA) levels may be useful for effective mycophenolate mofetil (MMF) dosing. However, whether commonly obtained trough levels are an acceptable method of surveillance remains debatable. We hypothesized that trough levels of MPA would be a poor predictor of area under the curve (AUC) for MPA.

Methods

A total of 51 patients with lupus nephritis who were on MMF 1500 mg twice a day and had a 4-h AUC done were included in this study. MPA levels were measured prior to (C0) and at 1 (C1), 2 (C2) and 4 (C4) h, followed by 1500 mg of MMF. The MPA AUC values were calculated using the linear trapezoidal rule. Regression analysis was used to examine the relationship between the MPA trough and AUC. Differences in the MPA trough and AUC between different clinical and demographic categories were compared using t-tests.

Results

When grouped by tertiles there was significant overlap in MPA, AUC 0-4 and MPA trough in all tertiles. Although there was a statistically significant correlation between MPA trough levels and AUC, this association was weak and accounted for only 30% of the variability in MPA trough levels. This relationship might be even more unreliable in men than women. The use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with increased MPA trough levels and AUC at 0-4 h (AUC0-4).

Conclusion

Trough levels of MPA do not show a strong correlation with AUC. In clinical situations where MPA levels are essential to guide therapy, an AUC0-4 would be a better indicator of the adequacy of treatment.

Effect of a high dose of exogenous phytase and supplementary myo-inositol on mineral solubility of broiler digesta and diets subjected to in vitro digestion assay

This study was conducted to evaluate the effect of microbial phytase and myo-inositol supplementation in low non-phytate phosphorus (nPP) diets on pH and the solubility of minerals in an in vitro digestion procedure (IVDP) and to compare this with digesta from birds fed different diets (grower diets) compared to the in vitro test (starter diets). A total of 660 1-day-old broilers were randomly allotted into 11 dietary treatments and fed a corn-soybean-meal-based diet with recommended nPP (positive control; PC), an nPP-deficient diet (negative control; NC), NC diets supplemented with phytase (500; 1,000; 2,000; 3,000; 4,000; 5,000; and 6,000 FTU/kg), an NC diet plus 0.15% myo-inositol, and an NC diet with reduced Ca level (Ca: nPP ratio same as PC) from 1 to 23 D of age. The pH and Ca solubility of the NC diet was increased compared with the PC when subjected to IVDP (P < 0.05). P solubility in the gizzard and jejunal digesta was reduced in the NC compared with the PC diet and this was also reflected in the IVDP. Phytase addition to the NC diets linearly increased (P < 0.05) the pH value and Ca and P solubilities in both digesta and diets subjected to IVDP. Higher doses of microbial phytase increased (P < 0.05) Zn and Fe solubilities in both digesta and IVDP. Myo-inositol supplementation of the NC diet had no effect on mineral solubility, but decreased (P < 0.05) the pH of the IVDP. Lowering the Ca content of the NC diet decreased (P < 0.05) the pH of the in vitro digested diets and Ca solubility in both broiler digesta and IVDP and also increased (P < 0.05) P solubility in both the jejunal digesta and IVDP. Correlations were noted between the solubility of P in the in vitro assay and that in the gizzard and jejunal digesta, and also with bird performance, confirms the usefulness of in vitro assay.

Concerted dynamics of metallo-base pairs in an A/B-form helical transition

Metal-mediated base pairs expand the repertoire of nucleic acid structures and dynamics. Here we report solution structures and dynamics of duplex DNA containing two all-natural C-Hg^II-T metallo base pairs separated by six canonical base pairs. NMR experiments reveal a 3:1 ratio of well-resolved structures in dynamic equilibrium. The major species contains two (N3)T-Hg^II-(N3)C base pairs in a predominantly B-form helix. The minor species contains (N3)T-Hg^II-(N4)C base pairs and greater A-form characteristics. Ten-fold different ¹J coupling constants (¹⁵N,¹⁹⁹Hg) are observed for (N3)C-Hg^II (114 Hz) versus (N4)C-Hg^II (1052 Hz) connectivities, reflecting differences in cytosine ionization and metal-bonding strengths. Dynamic interconversion between the two types of C-Hg^II-T base pairs are coupled to a global conformational exchange between the helices. These observations inspired the design of a repetitive DNA sequence capable of undergoing a global B-to-A-form helical transition upon adding Hg^II, demonstrating that C-Hg^II-T has unique switching potential in DNA-based materials and devices.

The Florida Sleeve Procedure Is Durable and Improves Aortic Valve Function

Background  The Florida (FL) Sleeve procedure was introduced as a simplified approach for valve-sparing correction of functional Type I aortic insufficiency (AI) associated with aortic root aneurysms. In this study, short- and long-term outcomes after the FL Sleeve procedure were investigated.

Methods  From May 2002 to January 2016, 177 patients underwent the FL Sleeve procedure. Left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter, left ventricular ejection fraction, and degree of AI (none = 0, minimal = 1, mild = 2, moderate = 3, severe = 4) were evaluated by echocardiography.

Results  Mean ± standard deviation of age was 49.41 ± 15.37 years. Survival rate was 98% at 1 year, 97% at 5 years, and 93% at 8 years. Freedom from reoperation was 99% at 1 year and 98% at 2 to 8 years. Three patients (1.69%) died during hospitalization. Three patients (1.69%) developed periprocedural stroke. Postoperative follow-up echocardiography was available in 140 patients at 30 days, and 31 patients at 5 years. AI grade significantly improved from baseline at 30 days (2.18 ± 1.26 vs. 1.1 ± 0.93, p  < 0.001) and at 5 years (2.0 ± 1.23 vs. 1.45 ± 0.88, p  = 0.04). Preoperative mean LVEDD significantly decreased from 52.20 ± 6.73 to 46.87 ± 8.40 ( p  < 0.001) at 30 days, and from 53.22 ± 7.07 to 46.61 ± 10.51 ( p  = 0.01) at 5 years.

Conclusions  The FL Sleeve procedure is a safe, effective, and durable treatment of aortic root aneurysm and Type I AI. Long-term survival and freedom from reoperation rates are encouraging.

Effect of Gamma Irradiation on Microbial Decontamination, Crude Nutrient Content, and Mineral Nutrient Composition of Laboratory Animal Diets

Laboratory animal models are an important part of test design. Certain conditions such as microbial contamination in diets of these models could affect the results of experiments. One of the most important routes that predispose to contamination is generated through feeding of laboratory animals. This study aimed to show the effect of gamma irradiation in reducing bacteria concentrations, crude nutrient content, and concentrations of some minerals and trace elements in laboratory animal diets. Large-sized pellets with 10&amp;ndash;15 mm diameter (commonly used for rats and hamsters) and small-sized pellets with 3&amp;ndash;5 mm diameter (used for rabbits and guinea pigs) along with skimmed milk powder (SMP) as a food additive were exposed to gamma irradiation with different doses ranging from 3 to 30 kGy. The total microbial contamination and any possible changes in some mineral nutrient composition and the crude nutrient content were determined pre- and post-irradiation. Our data revealed that 25 kGy in pelleted diets and 18 kGy in SKM had superior effects in the reduction of bacterial contamination with little change in crude nutrient content and minerals and trace elements in nutrient requirements of laboratory animals. According to the results, gamma irradiation had minimal effects on crude nutrient content and the concentrations of some minerals and trace elements of laboratory animal diets, and it also eliminated bacterial and fungal contamination load. By using gamma irradiation, this method could yield a favorable outcome in controlling microbial contamination of animal diets.

Cerebral hemodynamic abnormalities of patients with ischemic stroke who are opium addicted: A study by transcranial doppler ultrasonography

Background: Ischemic stroke as the major cause of mortality and morbidity worldwide has different risk factors. One of its modifiable risk factors is opium addiction whose role is not clear yet. This study aimed at assessing the hemodynamic parameters in ischemic stroke patients addicted to opium using transcranial Doppler (TCD) ultrasonography and comparing them with non-addicted patients. Methods: This comparative cross-sectional study was conducted in an academic hospital in the north of Iran in 2016. All the patients diagnosed as ischemic stroke underwent cerebrovascular ultrasound in the first 4 days of symptoms onset. Frequency of hemodynamic abnormalities confirmed by pulsatility index (PI) and mean flow velocity (MFV) were determined and compared between the two groups. The data were analyzed by chi-square test, t-test, and multiple logistic regression models using SPSS software. Results: A total of 353 patients with ischemic stroke (92 addicted and 261 non-addicted patients) were enrolled in the study. Univariate analysis indicated that the PI and MFV differences were statistically significant between two groups of addicted and non-addicted patients (P = 0.0001). By multivariate logistic regression model, the age [odds ratio (OR) = 1.143], diabetes mellitus (DM) (OR = 3.875), hypertension (HTN) (OR = 2.557), and opium usage (OR = 9.615) had influence on PI and only opium usage (OR = 3.246) had influence on MFV. Conclusion: Opium usage affects the cerebral hemodynamic parameters and increases the chance of having abnormal PI as ten-fold and abnormal MFV as three-fold.

Erratum: Exploring spiral defect chaos in generalized Swift-Hohenberg models with mean flow [Phys. Rev. E 84, 046215 (2011)]

This corrects the article DOI: 10.1103/PhysRevE.84.046215.

Thiazide Therapy in Chronic Kidney Disease: Renal and Extra Renal Targets

BACKGROUND

Thiazides are the most commonly used medications for the treatment of mild and moderate hypertension. Despite their recognized effect, the mechanism by which thiazides reduce systemic blood pressure remains uncertain. The prevailing belief is that thiazides reduce blood pressure primarily via enhancement of salt excretion consequent to the inhibition of the Na-Cl Cotransporter (NCC) in the Distal Convoluted Tubules (DCT). However, recent reports point to a reduction in peripheral vascular resistance as a major mechanism of antihypertensive effect of thiazides. It is plausible that both mechanisms, renal and extra-renal, may be operating simultaneously. Recent studies point to compensatory mechanisms in the kidney distal nephron that may play a role in blunting the diuretic effect of thiazides. Not much information is available about the efficacy of thiazides in controlling blood pressure in individuals with Chronic Kidney Disease (CKD).

OBJECTIVE

This review will discuss the latest updates on the use and efficacy of thiazides derivatives as diuretics and antihypertensive medications in CKD patients.

CONCLUSION

Thiazides remain effective as diuretics and antihypertensive agents in individuals with low GFR.

Outcomes of Direct Transcatheter Aortic Valve Replacement Without Balloon Aortic Valvuloplasty Using a New Generation Valve

PURPOSE

We investigated the outcomes of patients who underwent Transcatheter Aortic Valve Replacement (TAVR) with and without Balloon Aortic Valvuloplasty (BAV) using the SAPIEN 3 (S3) valve.

METHODS

All patients who underwent TAVR using S3 valve were included. The primary outcomes were the incidence of stroke and significant paravalvular leak (PVL). Secondary outcomes were the incidence of mortality, balloon post dilation, and need for permanent pacemaker.

RESULTS

From July-2014 to April-2018, 34 (9%) patients underwent BAV prior to TAVR and 344 (91%) patients underwent direct TAVR without BAV using the S3 valve. The Society of Thoracic Surgeons (STS) risk score was similar between two groups; 5.8 ± 3.5 in no BAV group and 5.4 ± 3.3 in BAV group, p = 0.53. After TAVR, 6 (1.7%) patients in no BAV group but no patient in BAV group developed stroke (p = 1.0). No patient had severe PVL and only 5 patients (1.3%) had moderate PVL at 30-day; 4 (1.2%) in no BAV group and 1 (2.9%) in BAV group (p = 0.38). Forty-six patients (13.4%) in the no BAV group and 4 (11.8%) patients in the BAV group needed balloon post dilation (p = 1.0). Six (1.6%) patients died during hospitalization, all in the no BAV group (p = 1.0). Forty-five (11.9%) patients needed new pacemaker implantation; 44 (12.8%) patients in no BAV group and 1 (2.9%) patient in BAV group (p = 0.1). Two-year survival rate was 85% in no BAV group and 84% in BAV group (p = 0.46).

CONCLUSIONS

TAVR using S3 valves is associated with very low rates of post-TAVR stroke and significant PVL. Outcomes of direct TAVR are similar to the outcomes of TAVR with BAV, without an increased rate of stroke, significant PVL, or balloon post dilation.

The effects of calcium source and concentration on performance, bone mineralisation and serum traits in male broiler chickens from 1 to 21 days of age

In total, 840 1-day-old male broiler chickens (Ross 308) were used to evaluate the effects of seven dietary calcium (Ca) concentrations (4.0, 5.5, 7.0, 8.5, 10.0, 11.5 and 13.0 g/kg, at a fixed concentration of 4.0 g/kg of non-phytate phosphorus) and two calcium sources (oyster shell and limestone) on broiler chicken Ca requirements for optimal growth rate and bone mineralisation from 1 to 21 days of age. All chickens were randomly distributed into 14 treatment groups (seven treatments of each Ca source), each being replicated four times, with 15 birds per each replicate. Results indicated that Ca source and Ca source × Ca concentration interaction had no significant (P &gt; 0.05) effects on birds average feed intake, but increasing Ca concentration to &gt;8.5 g/kg significantly deteriorated average feed intake. Average weight gain and feed conversion ratio were significantly influenced by Ca source × Ca concentration interaction, whereby high concentrations of Ca from oyster shell resulted in a poorer performance for both criteria than did those from limestone. Serum Ca, P and total protein were not affected by Ca source. However, increasing Ca concentrations had adverse effects on serum P concentration (P &lt; 0.05). Toe ash, tibia ash and phosphorus concentrations at 21 days were not influenced by Ca source, but were depressed as dietary Ca concentration increased (P &lt; 0.05). A broken-line regression analysis indicated that the Ca requirements to optimise average weight gain and tibia ash when limestone was used as a Ca source were 5.54 and 6.58 g/kg of diet respectively, and 5.80 and 6.43 g/kg of diet respectively, when oyster shell was used. In conclusion, the results indicated that Ca concentration, more than Ca source, has a significant influence on broiler chicken performance and bone mineralisation, all of which deteriorate when the dietary Ca concentration exceeds 8.5 g/kg at the constant available-phosphorus concentration of 4.0 g/kg.

An ethical framework for evaluation of public health plans: a systematic process for legitimate and fair decision-making

OBJECTIVES

Given the increasing threats of communicable and non-communicable diseases, it is necessary for policy-makers and public health (PH) professionals to address ethical issues in health policies and plans. This study aimed to develop a practical framework for the ethical evaluation of PH programs.

STUDY DESIGN

A multidisciplinary team developed an ethical framework to evaluate PH plans from 2015 to 2017.

METHODS

In this study, the multi-method approach was used. First, a list of moral norms in PH policy and practice was drafted and completed in two interactive sessions. Then, the Delphi method was used for consensus about the structural components to be adopted in the framework. After developing the framework, its efficiency was assessed by evaluating Iran's Fourth Strategic Plan for HIV/AIDS Prevention and Control.

RESULTS

The framework was developed in the following three sections: (i) determination of the general moral norms in PH practice and policy; (ii) five steps of evaluation; and (iii) a procedural evaluation step to ensure fair decision-making. The ratio of the ethical points of the PH plan increased by 46% after implementation of the framework, and the frequency of ethical points increased significantly after applying the framework (P = 0.001).

CONCLUSION

The application of the framework for the ethical evaluation of various PH programs ensures a comprehensive and scientific-deliberative decision-making process, while also contributing to the development of the framework.

Combination Effects of Organic and Inorganic Chromium on Production Performance, Reproductive Response, Immune Status, and Maternal Antibody Transmission in Breeder Quails Under Heat Stress

This experiment was carried out to investigate the combination effects of organic and inorganic chromium (Cr) on egg production, egg quality, reproductive response, and immune status of breeder quails and their offspring under heat stress. A total of 140 7-week-old Japanese breeder quails (120 females and 20 males) according to a completely randomized design were used in four treatment groups (five replicate and seven birds per each) lasted for 8 weeks. Quails exposed to 35 °C for 8 h/day for induction of cyclic heat stress treatments consisted of diets supplemented with (1) 1 mg CrCl₃ per kilogram of diet as control (CNT); (2) 1 mg Cr-L-Met per kilogram of diet as organic Cr (OCr); (3) 0.5 mg CrCl₃ plus 0.5 mg Cr-L-Met per kilogram of diet (ISO); (4) 1 mg CrCl₃ plus 0.5 mg Cr-L-Met per kilogram of diet (On-top). Productive performance and egg quality parameters were determined weekly. Fertility, hatchability, and embryonic mortality were measured at the end of experiment. Humoral immunity was assessed by primary and secondary antibody titer in sheep red blood cells (SRBC) and Newcastle disease (ND) tests. Cell-mediated immunity was assessed by the cutaneous basophil hypersensitivity (CBH) test to phytohemagglutinin (PHA) at days 20 and 45 of age. White blood cell count and immunoglobulin Y (IgY) content in serum and yolk of breeders and in serum and yolk residues of offspring were also measured. Results showed that maximum egg production, egg shell thickness, and Haugh unit were observed in birds fed ISO and On-top diets (P ≤ 0.05). The highest (P ≤ 0.05) antibody levels in ND test were observed in birds fed with OCr, ISO, and On-top diets. The highest cellular response (P ≤ 0.05) was in 12 h after primary PHA injection and 12 and 24 h after secondary PHA injection in birds fed with On-top diets. The highest count of heterophil and (H/L) were gained in breeder quails fed with CNT diet, and the lowest of them were reached with On-top diet (P ≤ 0.05). Results showed that the highest IgY level in serum of breeder and their offspring and that of yolk suck and egg yolk were observed in birds fed with On-top diet (P ≤ 0.05). These results suggest that extra supplemental organic Cr in combination with CrCl₃ could lead to higher egg production, egg quality, and immune status of breeder quails and their offspring.