Optimization by Box-Behnken design for environmental contaminants removal using magnetic nanocomposite

In this study, a CoO-Fe2O3/SiO2/TiO2 (CIST) nanocomposite was synthesized and utilized as an adsorbent to remove methylene blue (MB), malachite green (MG), and copper (Cu) from aqueous environments. The synthesized nanocomposite was characterized using field emission scanning electron microscopy (FE-SEM), Fourier-transform infrared spectroscopy (FTIR), thermogravimetric analysis (TGA), and X-ray diffraction (XRD). Input parameters included pH (3-10), contact time (10-30 min), adsorbent amount (0.01-0.03 g), and pollutant concentration (20-60 mg L-1). The effects of these parameters on the removal process efficiency were modeled and optimized using the response surface methodology (RSM) based on the Box-Behnken design (BBD). The RSM-BBD method demonstrated the capability to develop a second-degree polynomial model with high validity (R2 ˃ 0.99) for the removal process. The optimization results using the RSM-BBD method revealed a removal efficiency of 98.01%, 93.06%, and 88.26% for MB, MG, and Cu, respectively, under optimal conditions. These conditions were a pH of 6, contact time of 10 min, adsorbent amount of 0.025 g, and concentration of 20 mg L-1. The synthesized adsorbent was recovered through five consecutive adsorption-desorption cycles using hydrochloric acid. The results showed an approximately 12% reduction from the first to the seventh cycle. Also, MB, MG, and Cu removal from real water samples in optimal conditions was achieved in the range of 81.69-98.18%. This study demonstrates the potential use of CIST nanocomposite as an accessible and reusable option for removing MB, MG, and Cu pollutants from aquatic environments.

Revolutionizing Infection Control: Harnessing MXene-Based Nanostructures for Versatile Antimicrobial Strategies and Healthcare Advancements

The escalating global health challenge posed by infections prompts the exploration of innovative solutions utilizing MXene-based nanostructures. Societally, the need for effective antimicrobial strategies is crucial for public health, while scientifically, MXenes present promising properties for therapeutic applications, necessitating scalable production and comprehensive characterization techniques. Here we review the versatile physicochemical properties of MXene materials for combatting microbial threats and their various synthesis methods, including etching and top-down or bottom-up techniques. Crucial characterization techniques such as XRD, Raman spectroscopy, SEM/TEM, FTIR, XPS, and BET analysis provide insightful structural and functional attributes. The review highlights MXenes' diverse antimicrobial mechanisms, spanning membrane disruption and oxidative stress induction, demonstrating efficacy against bacterial, viral, and fungal infections. Despite translational hurdles, MXene-based nanostructures offer broad-spectrum antimicrobial potential, with applications in drug delivery and diagnostics, presenting a promising path for advancing infection control in global healthcare.

A versatile magnetic nanocomposite based on cellulose-cyclodextrin hydrogel embedded with graphene oxide and Cu2O nanoparticles for catalytic application

The study focused on creating a novel and environmentally friendly nanocatalyst using cellulose (Cell), β-Cyclodextrin (BCD), graphene oxide (GO), Cu2O, and Fe3O4.The nanocatalyst was prepared by embedding GO and Cu2O into Cell-BCD hydrogel, followed by the in-situ preparation of Fe3O4 magnetic nanoparticles to magnetize the nanocomposite. The effectiveness of this nanocatalyst was evaluated in the one-pot, three-component symmetric Hantzsch reaction for synthesizing 1,4-dihydropyridine derivatives with high yield under mild conditions. This novel nanocatalyst has the potential for broad application in various organic transformations due to its effective catalytic activity, eco-friendly nature, and ease of recovery.

Overcoming drug resistance with specific nano scales to targeted therapy: Focused on metastatic cancers

Metastatic cancer, which accounts for the majority of cancer fatalities, is a difficult illness to treat. Currently used cancer treatments include radiation therapy, chemotherapy, surgery, and targeted treatment (immune, gene, and hormonal). The disadvantages of these treatments include a high risk of tumor recurrence and surgical complications that may result in permanent deformities. On the other hand, most chemotherapy drugs are small molecules, which usually have unfavorable side effects, low absorption, poor selectivity, and multi-drug resistance. Anticancer drugs can be delivered precisely to the cancer spot by encapsulating them to reduce side effects. Stimuli-responsive nanocarriers can be used for drug release at cancer sites and provide target-specific delivery. As previously stated, metastasis is the primary cause of cancer-related mortality. We have evaluated the usage of nano-medications in the treatment of some metastatic tumors.

Adjusted estimate of the prevalence of hepatitis delta virus in 25 countries and territories

BACKGROUND & AIMS

Hepatitis delta virus (HDV) is a satellite RNA virus that requires the hepatitis B virus (HBV) for assembly and propagation. Individuals infected with HDV progress to advanced liver disease faster than HBV-monoinfected individuals. Recent studies have estimated the global prevalence of anti-HDV antibodies among the HBV-infected population to be 5-15%. This study aimed to better understand HDV prevalence at the population level in 25 countries/territories.

METHODS

We conducted a literature review to determine the prevalence of anti-HDV and HDV RNA in hepatitis B surface antigen (HBsAg)-positive individuals in 25 countries/territories. Virtual meetings were held with experts from each setting to discuss the findings and collect unpublished data. Data were weighted for patient segments and regional heterogeneity to estimate the prevalence in the HBV-infected population. The findings were then combined with The Polaris Observatory HBV data to estimate the anti-HDV and HDV RNA prevalence in each country/territory at the population level.

RESULTS

After adjusting for geographical distribution, disease stage and special populations, the anti-HDV prevalence among the HBsAg+ population changed from the literature estimate in 19 countries. The highest anti-HDV prevalence was 60.1% in Mongolia. Once adjusted for the size of the HBsAg+ population and HDV RNA positivity rate, China had the highest absolute number of HDV RNA+ cases.

CONCLUSIONS

We found substantially lower HDV prevalence than previously reported, as prior meta-analyses primarily focused on studies conducted in groups/regions that have a higher probability of HBV infection: tertiary care centers, specific risk groups or geographical regions. There is large uncertainty in HDV prevalence estimates. The implementation of reflex testing would improve estimates, while also allowing earlier linkage to care for HDV RNA+ individuals. The logistical and economic burden of reflex testing on the health system would be limited, as only HBsAg+ cases would be screened.

IMPACT AND IMPLICATIONS

There is a great deal of uncertainty surrounding the prevalence of hepatitis delta virus among people living with hepatitis B virus at the population level. In this study, we aimed to better understand the burden in 25 countries and territories, to refine techniques that can be used in future analyses. We found a lower prevalence in the majority of places studied than had been previously reported. These data can help inform policy makers on the need to screen people living with hepatitis B virus to find those coinfected with hepatitis delta virus and at high risk of progression, while also highlighting the pitfalls that other researchers have often fallen into.

lncRNA-microRNA axis in cancer drug resistance: particular focus on signaling pathways

Cancer drug resistance remains a formidable challenge in modern oncology, necessitating innovative therapeutic strategies. The convergence of intricate regulatory networks involving long non-coding RNAs, microRNAs, and pivotal signaling pathways has emerged as a crucial determinant of drug resistance. This review underscores the multifaceted roles of lncRNAs and miRNAs in orchestrating gene expression and cellular processes, mainly focusing on their interactions with specific signaling pathways. Dysregulation of these networks leads to the acquisition of drug resistance, dampening the efficacy of conventional treatments. The review highlights the potential therapeutic avenues unlocked by targeting these non-coding RNAs. Developing specific inhibitors or mimics for lncRNAs and miRNAs, alone or in combination with conventional chemotherapy, emerges as a promising strategy. In addition, epigenetic modulators, immunotherapies, and personalized medicine present exciting prospects in tackling drug resistance. While substantial progress has been made, challenges, including target validation and safety assessment, remain. The review emphasizes the need for continued research to overcome these hurdles and underscores the transformative potential of lncRNA-miRNA interplay in revolutionizing cancer therapy.

A chemometric approach based on response surface methodology for optimization of antibiotic and organic dyes removal from water samples

In this study, the Fe3O4/rGO/Ag magnetic nanocomposite was synthesized and employed as an adsorbent for the removal of tetracycline (TC), crystal violet (CV), and methylene blue (MB) from water samples. The influential parameters in the removal process were identified and optimized using response surface methodology (RSM). Characterization of the product was performed through field emission scanning electron microscopy (FE-SEM), Fourier-transform infrared spectroscopy (FTIR), energy dispersive X-ray spectroscopy (EDX), vibrating-sample magnetometer (VSM), and X-ray diffraction (XRD) analysis. XRD and SEM analysis revealed the successful synthesis of the Fe3O4/rGO/Ag nanocomposite. EDX analysis elucidated the accuracy and clarity of the chemical composition of the magnetic nanocomposite structure. Additionally, the separation of the nano-adsorbent from the solution can be achieved using a magnetic field. Maximum removal of analytes was obtained at pH of 6, amount of nanocomposite 0.014 g, ultrasonic time of 8 min and concentration of 21 mg L-1. Under optimal conditions, the removal efficiencies for TC, CV, and MB were 91.33, 95.82, and 98.19%, respectively. Also, it was observed that after each adsorption-desorption cycle, Fe3O4/rGO/Ag magnetic nanocomposite had good stability to remove TC, CV, and MB. Achieving nearly 98% removal efficiency in optimal conditions showed that Fe3O4/rGO/Ag magnetic nanocomposite is an effective adsorbent for removing TC, CV, and MB from wastewater samples.

Aptamer-Magnetic Nanoparticle Complexes for Powerful Biosensing: A Comprehensive Review

The selective and sensitive diagnosis of diseases is a significant matter in the early stages of the cure of illnesses. To elaborate, although several types of probes have been broadly applied in clinics, magnetic nanomaterials-aptamers, as new-generation probes, are becoming more and more attractive. The presence of magnetic nanomaterials brings about quantification, purification, and quantitative analysis of biomedical, especially in complex samples. Elaborately, the superparamagnetic properties and numerous functionalized groups of magnetic nanomaterials are considered two main matters for providing separation ability and immobilization substrate, respectively. In addition, the selectivity and stability of aptamer can present a high potential recognition element. Importantly, the integration of aptamer and magnetic nanomaterials benefits can boost the performance of biosensors for biomedical analysis by introducing efficient and compact probes that need low patient samples and fast diagnosis, user-friendly application, and high repeatability in the quantification of biomolecules. The primary aim of this review is to suggest a summary of the effect of the employed other types of nanomaterials in the fabrication of novel aptasensors-based magnetic nanomaterials and to carefully explore various applications of these probes in the quantification of bioagents. Furthermore, the application of these versatile and high-potential probes in terms of the detection of cancer cells and biomarkers, proteins, drugs, bacteria, and nucleoside were discussed. Besides, research gaps and restrictions in the field of biomedical analysis by magnetic nanomaterials-aptamers will be discussed.

Effective exosomes in breast cancer: focusing on diagnosis and treatment of cancer progression

Breast cancer (BC) is the most prevalent aggressive malignant tumor in women worldwide and develops from breast tissue. Although cutting-edge treatment methods have been used and current mortality rates have decreased, BC control is still not satisfactory. Clarifying the underlying molecular mechanisms will help clinical options. Extracellular vesicles known as exosomes mediate cellular communication by delivering a variety of biomolecules, including proteins, oncogenes, oncomiRs, and even pharmacological substances. These transferable bioactive molecules can alter the transcriptome of target cells and affect signaling pathways that are related to tumors. Numerous studies have linked exosomes to BC biology, including therapeutic resistance and the local microenvironment. Exosomes' roles in tumor treatment resistance, invasion, and BC metastasis are the main topics of discussion in this review.

The mechanistic role of NAT10 in cancer: Unraveling the enigmatic web of oncogenic signaling

N-acetyltransferase 10 (NAT10), a versatile enzyme, has gained considerable attention as a significant player in the complex realm of cancer biology. Its enigmatic role in tumorigenesis extends across a wide array of cellular processes, impacting cell growth, differentiation, survival, and genomic stability. Within the intricate network of oncogenic signaling, NAT10 emerges as a crucial agent in multiple cancer types, such as breast, lung, colorectal, and leukemia. This compelling research addresses the intricate complexity of the mechanistic role of NAT10 in cancer development. By elucidating its active participation in essential physiological processes, we investigate the regulatory role of NAT10 in cell cycle checkpoints, coordination of chromatin remodeling, and detailed modulation of the delicate balance between apoptosis and cell survival. Perturbations in NAT10 expression and function have been linked to oncogenesis, metastasis, and drug resistance in a variety of cancer types. Furthermore, the bewildering interactions between NAT10 and key oncogenic factors, such as p53 and c-Myc, are deciphered, providing profound insights into the molecular underpinnings of cancer pathogenesis. Equally intriguing, the paradoxical role of NAT10 as a potential tumor suppressor or oncogene is influenced by context-dependent factors and the cellular microenvironment. This study explores the fascinating interplay of genetic changes, epigenetic changes, and post-translational modifications that shape the dual character of NAT10, revealing the delicate balance between cancer initiation and suppression. Taken together, this overview delves deeply into the enigmatic role of NAT10 in cancer, elucidating its multifaceted roles and its complex interplay with oncogenic networks.

A perspective on emerging therapies in metastatic colorectal cancer: Focusing on molecular medicine and drug resistance

The majority of cancer cases are colorectal cancer, which is also the second largest cause of cancer-related deaths worldwide. Metastasis is the leading cause of death for patients with colorectal cancer. Metastatic colorectal cancer incidence are on the rise due to a tiny percentage of tumors developing resistant to medicines despite advances in treatment tactics. Cutting-edge targeted medications are now the go-to option for customized and all-encompassing CRC care. Specifically, multitarget kinase inhibitors, antivascular endothelial growth factors, and epidermal growth factor receptors are widely used in clinical practice for CRC-targeted treatments. Rare targets in metastatic colorectal cancer are becoming more well-known due to developments in precision diagnostics and the extensive use of second-generation sequencing technology. These targets include the KRAS mutation, the BRAF V600E mutation, the HER2 overexpression/amplification, and the MSI-H/dMMR. Incorporating certain medications into clinical trials has significantly increased patient survival rates, opening new avenues and bringing fresh viewpoints for treating metastatic colorectal cancer. These focused therapies change how cancer is treated, giving patients new hope and better results. These markers can significantly transform and individualize therapy regimens. They could open the door to precisely customized and more effective medicines, improving patient outcomes and quality of life. The fast-growing body of knowledge regarding the molecular biology of colorectal cancer and the latest developments in gene sequencing and molecular diagnostics are directly responsible for this advancement.

Isolation and Identification of Phenol-Degrading Bacteria from Iranian Soil and Leaf Samples

BACKGROUND

By considering the importance and role of soil in the health of humanity, it is important to remove the presence of harmful compounds, such as phenol.

METHODS

In this study, four types of soil and leaf samples were collected from Kerman, Iran, and the amounts of heterotrophic and degradation bacteria were determined using the serial dilution and most probable number (MPN) methods. The amount of removed phenol was investigated using the Gibbs method with different concentrations of phenol. Then, an isolate with the highest percentage of phenol degradation was identified as the superior strain using 16 sRNA sequencing. The effects of the different factors, such as the carbon source (1% molasses and 1 g glucose), nitrogen source (0.1 g yeast extract), mixed culture, and time (14 and 28 days), on the biodegradation ability of the superior strain was investigated.

RESULTS

A total of 18 bacterial strains were isolated from the samples. Isolate B3 had the highest rate (75%) of phenol degradation, at a concentration of 1000 ppm, meaning it was identified as the superior strain. The molecular analysis results identified this isolate as the Comamonas testosteroni strain F4. This bacterium can degrade 89% of the phenol at 30 °C, 180 rpm, and 800 ppm over 28 days. C. testosteroni did not show a favorable phenol degradation ability in the presence of the investigated carbon sources, while this ability was also reduced in mixed cultures.

CONCLUSIONS

C. testosteroni bacterial strain isolated from soil samples of pistachio orchards in Kerman, Iran, has a favorable ability to biodegrade phenol.

CO2 reduction reaction on Sc-doped nanocages as catalysts

CONTEXT

The catalytic ability of Sc-doped C46 and Sc-doped Al23P23 as catalysts of CO2-RR to create the CH4 and CH3OH is investigated. The mechanisms of CO2-RR are examined by theoretical methods and ΔGreaction of reaction steps of CO2-RR mechanisms are calculated. The overpotential of CH4 and CH3OH production on Sc-doped C46 and Sc-doped Al23P23 is calculated. The Sc atoms of Sc-doped C46 and Sc-doped Al23P23 can adsorb the CO2 molecule as the first step of CO2-RR. The CH4 is produced from hydrogenation of *CH3O and the *CO → *CHO reaction step is the rate limiting step for CH4 production. The CH3OH can be formed on Sc-doped C46 and Sc-doped Al23P23 by *CO → *CHO → *CH2O → *CH3O → CH3OH mechanism and HCOOH → *CHO → *CH2O → *CH3O → CH3OH mechanism. The Sc-C46 and Sc-Al23P23 can catalyze the CO2-RR to produce the CH4 and CH3OH by acceptable mechanisms.

METHODS

Here, the structures are optimized by PW91PW91/6-311+G (2d, 2p) and M06-2X/cc-pVQZ methods in GAMESS software. The frequencies of nanocages and their complexes with species of CO2-RR are investigated by mentioned methods. The transition state of each reaction step of CO2-RR is searched by Berny method to find the CO2-RR intermediates. The ∆Eadsorption of intermediates of CO2-RR on surfaces of nanocages is calculated and the ∆Greaction of reaction steps of CO2-RR is calculated.

Prediction of geomechanical bearing capacity using autoregressive deep neural network in carbon capture and storage systems

Carbon Capture and Storage (CCS) field is growing rapidly as a means to mitigate the accumulation of greenhouse gas emissions. However, the geomechanical stability of CCS systems, particularly related to bearing capacity, remains a critical challenge that requires accurate prediction models. In this research paper, we investigate the efficacy of employing an Autoregressive Deep Neural Network (ARDNN) algorithm to predict the geomechanical bearing capacity in CCS systems through shear wave velocity prediction as an index for bearing capacity evaluation of deep rock formations. The model utilizes a dataset consisting of 23,000 data points to train and test the ARDNN algorithm. Its scalability, use of deep learning techniques, automatic feature extraction, adaptability to changes in data, and versatility in various prediction tasks make it an attractive option for accurate predictions. The results demonstrate exceptional performance, as evidenced by an R-squared value of 0.9906 and a mean squared error of 0.0438 for the test data compared to the measured data. This research has significant practical implications for effectively predicting geomechanical stability in CCS systems, thus mitigating potential risks associated with their operation.

Mise à jour thérapeutique et pronostique de la rupture utérine dans une maternité à Bangui, CAR

BACKGROUND

Maternal mortality rates remain high (882/100,000 births) in the Central African Republic (CAR), primarily due to frequent obstetric complications. Médecins Sans Frontières supports a referral maternity ward in the capital, Bangui.

OBJECTIVES

To describe the prevalence, associated factors and fatality of one of the most severe complications, uterine rupture, as well as the effect of a history of uterine surgery.

METHODS

This is a cross-sectional study based on retrospectively collected data between January 2018 and December 2021 for women who delivered new-borns weighing over 1,000 g.

RESULTS

Of 38,782 deliveries, 229 (0.6%) cases of uterine rupture were recorded. Factors associated with uterine rupture were parity ⩾5 (adjusted odds ratio [aOR] 7.5, 95% confidence interval [CI] 4.6-12.2), non-occipital foetal presentation (aOR 2.8, 95% CI 2.1-3.7) and macrosomia (OR 4, 95% CI 2.6-6.4). The fatality rate was 4.4%, and the stillbirth rate was 64%. Uterine rupture occurred in non-scarred uterus in 150 (66.1%) women. Adverse outcomes were more common in cases of uterine rupture on non-scarred uterus compared to scarred uterus, with higher maternal mortality (6% vs. 0%, P = 0.023) and lower Apgar scores (<2) for new-borns (69.1% vs. 45.8%, P < 0.001).

CONCLUSION

Uterine rupture remains a major issue for maternal and perinatal health in the CAR, and efforts are needed to early detect risk factors and increase coverage of the comprehensive emergency obstetric and neonatal care.

Central serous chorioretinopathy secondary to intramuscular testosterone therapy

Summary

A patient treated with intramuscular testosterone replacement therapy for primary hypogonadism developed blurred vision shortly after receiving his testosterone injection. The symptom resolved over subsequent weeks and recurred after his next injection. A diagnosis of central serous chorioretinopathy (CSR) was confirmed following ophthalmology review. A decision was made to change the patient's testosterone regime from this 12-weekly intramuscular injection to a daily topical testosterone gel, given the possibility that peak blood levels of testosterone following intramuscular injection were causing his ocular complaint. His CSR did not recur after this change in treatment. CSR secondary to testosterone therapy is a rare finding but has been reported previously in the literature.

Learning Points

Blurred vision in patients treated with testosterone replacement therapy (TRT) should prompt an ophthalmology review. The potential for reduced risk of central serous chorioretinopathy (CSR) with daily transdermal testosterone remains a matter of conjecture. CSR is a rare potential side effect of TRT.

Antibacterial Activity of the Novel Drug Gepotidacin against Stenotrophomonas maltophilia—An In Vitro and In Vivo Study

Stenotrophomonas maltophilia is increasingly recognized as a nosocomial bacterial pathogen with a multi-drug resistance profile. In this study, the novel drug gepotidacin, the first compound of the novel triazaacenaphthylene topoisomerase inhibitor antibiotics class, was evaluated on its activity against clinical S. maltophilia isolates. Ninety-nine S. maltophilia isolates plus reference strain K279a (N = 100) were tested on their susceptibility towards gepotidacin in a broth microdilution. Additional susceptibility testing was performed towards the commonly applied combination trimethoprim/sulfamethoxazole (TMP/SXT), moxifloxacin, and levofloxacin. The time–kill kinetic of gepotidacin was observed in a time–kill assay. The greater wax moth Galleria mellonella was used to determine the activity of gepotidacin against S. maltophilia in vivo. Gepotidacin showed minimum inhibitory concentrations (MICs) between 0.25 and 16 mg/L (MIC50: 2 mg/L; MIC90: 8 mg/L), independently of its susceptibility towards TMP/SXT. The five TMP/SXT resistant strains exhibited gepotidacin MICs from 1 to 4 mg/L. The S. maltophilia strains resistant to the assessed fluoroquinolones showed in parts high MICs of gepotidacin. The time–kill assay revealed a time- and strain-dependent killing effect of gepotidacin. In vivo, injection of gepotidacin increased the survival rate of the larvae from 61 % to 90 % after 2 days. This study showed antimicrobial effects of gepotidacin towards S. maltophilia.

Parent-Child Attachment: A Principle-Based Concept Analysis

Introduction

Extensive evidence indicates that the quality of parent-child attachment is related to later socio-emotional and physical health outcomes. Yet, despite its clinical relevance, the parent-child attachment concept has been inconsistently applied across the disciplines of nursing, medicine and psychology and is often conflated with parent-child bonding in nursing literature.

Objectives

To provide readers with a critical analysis of the concept of parent-child attachment. Using a principle-based concept analysis, we clarify how parent-child attachment is understood from a multidisciplinary perspective to advance the use of this concept in nursing practice.

Concept Description: Attachment is an affectionate, mutually satisfying relationship between a child and a caregiver that serves the purpose of making the child feel safe, secure, and protected.

Discussion

In this principle-based concept analysis, each definitional (i.e., epistemological, pragmatic, linguistic, and logical) principle contributes to an understanding of the strengths and limitations of the state of science about this concept. The discussion highlights how applying the concept of parent-child attachment security may offer exciting and promising opportunities for nursing clinical work with families.

Conclusion

The understanding of the concept of parent-child attachment differs among disciplines of nursing, medicine and psychology and offers exciting and promising opportunities for clarity and collaborative, multi-disciplinary work.

A Pre-implementation Study of Volumetric Modulated Arc Therapy for Same-day Planning and Treatment of Vertebral Bone Metastases Within a Rapid-access Palliative Radiotherapy Programme

AIMS

We aimed to develop a process for same-day contouring, planning, quality assurance and delivery of volumetric modulated arc therapy (VMAT) for vertebral bone metastases within our institution's rapid-access palliative radiotherapy programme.

MATERIALS AND METHODS

Two thoracic (T6-7, T3-7) and two lumbar (L2-3, L1-5) targets were contoured on computed tomography images acquired from an anthropomorphic phantom and five patient scans. Inverse planning aimed to provide coverage of a prescribed dose of 8 Gy with a combined lung V2Gy < 25% and a combined kidney mean dose <2 Gy. Serial plans were created to identify an efficient combination of six main planning variables specific to our treatment planning system: (i) voxel size (3 mm versus 5 mm), (ii) Monte Carlo statistical uncertainty (1% per calculation versus 3% per control point), (iii) fluence smoothing (medium versus high), (iv) number of iterations of segment shape changes during optimisation (1 versus 5), (v) dose calculation algorithm (Monte Carlo versus pencil beam) and (vi) number of arcs (single versus multiple). Contouring, planning, quality assurance and treatment delivery were timed.

RESULTS

The combination of planning variables deemed efficient and appropriate was: a 3 mm voxel size, statistical uncertainty of 1% per calculation, medium fluence smoothing, five iterations of segment shape changes, Monte Carlo dose calculation and single full arc delivery. Patient scan contouring times ranged from 7 to 9 min (T6-7), 11-13 min (T3-7), 5-7 min (L2-3) and 8-10 min (L1-5) and planning times ranged from 9 to 15 min (T6-7), 13-25 min (T3-7), 18-25 min (L2-3) and 21-31 min (L1-5). Physics quality assurance times ranged from 15 to 21 min and beam-on times ranged from 3 to 6 min.

CONCLUSIONS

The combined elements of VMAT for thoracic and lumbar vertebral bone metastases were completed in under 2 h. This new process makes same-day contouring, planning, quality assurance and treatment delivery of VMAT feasible within our rapid-access palliative radiotherapy programme.

Chitosan nanoparticles effectively combat salinity stress by enhancing antioxidant activity and alkaloid biosynthesis in Catharanthus roseus (L.) G. Don

Chitosan nanoparticles (CSNPs) are non-toxic and biodegradable stimulants of growth and secondary metabolite production, which offer new routes to combat plant stress. Salinity is a common and significant abiotic stress that adversely affects plant growth and development. The possible benefits of CSNPs in salt stress mitigation have not yet been reported in Catharanthus roseus, an important source of anticancer alkaloids. Plants were exposed to 150 mM NaCl as a salt stress treatment, while CSNPs were applied as a foliar spray at 1% concentration. Plant growth was considerably impaired under salt stress conditions; however, CSNPs treatment significantly reversed this effect. Specifically, CSNPs retarded chlorophyll reduction and induced activities of catalase, ascorbate peroxidase, and glutathione reductase. Thus, CSNPs alleviated the oxidative stress, indicated by lower levels of malondialdehyde and H₂O₂, thereby enabling membrane function retention and enhancing salt tolerance. Higher alkaloid accumulation was observed in salt-stressed plants following CSNP spraying than in controls. Interestingly, the expression levels of mitogen-activated protein kinases (MAPK3), geissoschizine synthase (GS), and octadecanoid-derivative responsive AP2-domain (ORCA3) genes were significantly elevated in salt-stressed plants sprayed with CSNPs. Overall, CSNP treatment overcame the deleterious effects of salinity in C. roseus by activating the antioxidant defense system, which helps to scavenge reactive oxygen species, and inducing expression of MAPK3, GS, and ORCA3 genes, thus, leading to higher alkaloid accumulation and better protection against salinity stress.

Outcomes of decentralizing hypertension care from district hospitals to health centers in Rwanda, 2013-2014

Setting

Three district hospitals (DHs) and seven health centers (HCs) in rural Rwanda.

Objective

To describe follow-up and treatment outcomes in stage 1 and 2 hypertension patients receiving care at HCs closer to home in comparison to patients receiving care at DHs further from home.

Design

A retrospective descriptive cohort study using routinely collected data involving adult patients aged ⩾18 years in care at chronic non-communicable disease clinics and receiving treatment for hypertension at DH and HC between 1 January 2013 and 30 June 2014.

Results

Of 162 patients included in the analysis, 36.4% were from HCs. Patients at DHs travelled significantly further to receive care (10.4 km vs. 2.9 km for HCs, P < 0.01). Odds of being retained were significantly lower among DH patients when not adjusting for distance (OR 0.11, P = 0.01). The retention effect was consistent but no longer significant when adjusting for distance (OR 0.18, P = 0.10). For those retained, there was no significant difference in achieving blood pressure targets between the DHs and HCs.

Conclusion

By removing the distance barrier, decentralizing hypertension management to HCs may improve long-term patient retention and could provide similar hypertension outcomes as DHs.

Population structure and genetic diversity of Setosphaeria turcica from corn in Heilongjiang province, China

AIM

The aims of this study were to identify races and mating types of Setosphaeria turcica causing northern corn leaf blight in Heilongjiang province of China and analyse the genetic diversity of S. turcica isolates using SSR markers.

METHODS AND RESULTS

Based on gene-for-gene interactions, 13 races of S. turcica (races 0, 1, 2, 3, 12, 13, 23, 123, N, 1N, 12N, 3N and 23N) were isolated from infected corn plants in Heilongjiang province. Races 0 and 1 were the predominant races, and race 23N was identified for the first time in the region. Using two pairs of specific primers, three mating types, 'a', 'Aa' and 'A', were identified, with 'a' being the predominant mating type. SSR markers were used to analyse genetic diversity of 60 S. turcica isolates. Five SSR primers were polymorphic, which resulted in 45 reproducible bands with 2-15 bands for each primer. Cluster analysis separated the isolates into five groups at a similarity coefficient of 0·84. Analysis of molecular variance showed that there was significant correlation between SSR groups and mating type of the isolates. No significant correlation was found between SSR groups and physiological races or geographical location of the isolates.

CONCLUSIONS

The work reported that races 0 and 1 were the predominant races, and race 23N was identified for the first time in Heilongjiang province with 'a' being the predominant mating type. There was significant correlation between SSR groups and mating type of S. turcica isolates.

SIGNIFICANCE AND IMPACT OF THE STUDY

Our results provide information on population structure and genetic diversity of S. turcica causing Northern corn leaf blight, which will facilitate the development of effective disease management programs.

A dynamical (e,2e) investigation into the ionization of the outermost orbitals of R-carvone

We report an experimental and theoretical investigation into the dynamics of electron-impact ionization of R-carvone. Experimental triple differential cross sections are obtained in asymmetric coplanar kinematic conditions for the ionization of the unresolved combination of the three outermost molecular orbitals (41a-39a) of R-carvone. These cross sections are compared with theoretical cross sections calculated within a molecular 3-body distorted wave (M3DW) framework employing either a proper orientation average or orbital average to account for the random orientation of the molecule probed in the experiment. Here, we observe that the overall scattering behavior observed in the experiment is fairly well reproduced within the M3DW framework when implementing the proper average over orientations. The character of the ionized orbitals also provides some qualitative explanation for the observed scattering behavior. This represents substantial progress when trying to describe the scattering dynamics observed for larger molecules under intermediate-impact energy and asymmetric energy sharing scattering conditions.

Treatment of open upper limb injuries with infection prevention and negative pressure wound therapy: a systematic review

OBJECTIVE

Open upper limb injuries requiring soft reconstruction can pose a dilemma for trauma surgeons when considering the treatment options. The British Orthopaedic Association and British Association of Plastic, Reconstructive and Aesthetic Surgeons Standard for Trauma (BOAST) have addressed the management of severe open lower limb fractures with the creation of the BOAST 4 guidelines. However, no such gold standard exists for the treatment of open injuries of the upper limb. Furthermore, treatment of these injuries is often more difficult and requires complicated strategies. Since the advent of negative pressure wound therapy (NPWT), there has been an improvement in wound care, though a focused review of its use in wound closure and infection prevention in the upper limb has not been published. We examine wound care management for open upper limb injuries with regard to the dressings applied, NPWT, wound closure and infection prevention.

METHOD

A systematic search of Medline, Cochrane and Google Scholar was performed using the key words. The key word searches were performed by two independent reviewers and 8,792 papers were found. Manuscripts between 1990 and 2010 were included, with the addition of key manuscripts before this date. Each manuscript was assessed by the two authors independently for methodology and validity Results: Approximately 120 manuscripts fulfilled selection criteria examining the influence of NPWT on open upper and lower limb injuries, and those examining infection risk in the same injuries. Of these 120 manuscripts, 28 were suitable for inclusion in the review. The systematic review is presented, allied to the BOAST 4 principles, examining the use of NPWT and the tools available for infection prevention for wounds of the upper and lower limb. The use of NPWT in conjunction with antibiotic-bead therapy improved the way in which open fractures of both the upper and lower limb are treated.

CONCLUSION

Production of guidelines is warranted for the treatment of upper limb injuries. The treatment options available for wound closure and infection prevention that are used in the treatment of open injuries of the lower limb could be adopted to open injuries of the upper limb.

Abstract P1-09-06: Blocking ER coregulator signaling enhances CDK4/6 inhibitor palbociclib therapy in ER-positive advanced breast cancer

BACKGROUND: Recently,CDK4/6 inhibitors in combination with endocrine therapy (AE/AI/SERDs) is approved for the treatment of ER+ advanced breastcancer (BCa). However, not all patients benefit from CDK4/6 inhibitors therapy. Emerging studies indicate many therapy-resistant tumors retainER signaling, via interaction with critical oncogenic coregulatorproteins. Considering complex signaling interplay of ER and CDK4/6 axis, combination therapy of CDK inhibitor with other potent ER-targeted agents that block ER coregulatory signaling may extend the efficacy and may prevent the development of resistance to the CDK4/6 inhibitors. We recently developed a small organic molecule, ER coregulator binding modulator ERX-11 (EtiraRx-11). The objective of this study is to test the utility of novel combination therapy of ERX-11 with CDK4/6 inhibitor palbociclib in treating therapy resistant advanced BCa.

METHODS: We have utilized multiple therapy sensitive and therapy-resistant BCa models with various genetic backgrounds. We tested efficacy using both acquired resistance and engineered models that express ER mutations or oncogenes. Efficacy of combination therapy was tested using established in vitro assays including, MTT, colony formation, apoptosis, and cell cycle progression. Mechanistic studies were conducted using reporter gene assays, gene expression, RNA-seq analysis and signaling alterations. Patient-derived BCa explant and Xenograft studies were used to determine the in vivo efficacy of the combination therapy.

RESULTS: ERX-11 effectively blocked ER-mediated and ER-coregulator mediated oncogenic signaling and has potent anti-proliferative activity against both endocrine therapy-sensitive and therapy-resistant BCa cells. Mechanistic studies using IP-Mass spectrometry showed that ERX-11 blocks the interaction between a subset of coregulators with ER in resistant BCa models. ERX-11 exhibited potent anti-proliferative activity against therapy-sensitive and therapy-resistant ER-driven BCa cells in vitro, in xenograft models in vivo and in patient-derived breast tumor explants ex vivo. Co-treatment of ERX-11 with palbociclib synergistically reduced cell viability and induced apoptosis of therapy sensitive and resistant BCa model cells. Importantly, combination therapy of ERX-11 and the palbociclib synergistically reduced the growth and induced apoptosis of tamoxifen and letrozole resistant xenograft tumors compared to either drug alone. RNA-seq studies revealed that combinational treatment with ERX-11 and palbociclib uniquely activated p53 and unfolded response mediated apoptotic pathways and suppressed E2F and Myc target genes. Biochemical studies confirmed combination therapy significantly altered E2F1 and ER signaling pathways and promoted apoptosis.

CONCLUSIONS: Our data support a critical role of blocking ER coregulator signaling in treating therapy resistance in advanced ER+ BCa. Combinational treatment with ERX-11 and palbociclib may overcome/delay endocrine therapy resistance.

Citation Format: Viswanadhapalli S, Sareddy GR, Zhou M, Ali E, Li X, Ma S-H, Lee T-K, Tekmal RR, Ahn J-M, Raj GV, Vadlamudi RK. Blocking ER coregulator signaling enhances CDK4/6 inhibitor palbociclib therapy in ER-positive advanced breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-09-06.

Closing the gap: decentralising mental health care to primary care centres in one rural district of Rwanda

Setting: Programmes that integrate mental health care into primary care settings could reduce the global burden of mental disorders by increasing treatment availability in resource-limited settings, including Rwanda. Objective: We describe patient demographics, service use and retention of patients in care at health centres (HC) participating in an innovative primary care integration programme, compared to patients using existing district hospital-based specialised out-patient care. Design: This was a retrospective cohort study using routinely collected data from six health centres and one district hospital from October 2014 to March 2015. Results: Of 709 patients, 607 were cared for at HCs; HCs accounted for 88% of the total visits for mental disorders. Patients with psychosis used HC services more frequently, while patients with affective disorders were seen more frequently at the district hospital. Of the 68% of patients who returned to care within 90 days of their first visit, 76% had a third visit within a further 90 days. There were no significant differences in follow-up rates between clinical settings. Conclusion: This study suggests that a programme of mentorship for primary care nurses can facilitate the decentralisation of out-patient mental health care from specialised district hospital mental health services to HCs in rural Rwanda.

The burden of road traffic injuries in an emergency department in Addis Ababa, Ethiopia

SETTING

The emergency department (ED) of Zewditu Memorial Hospital, Addis Ababa, Ethiopia.

OBJECTIVE

To document the proportion, trend, characteristics and outcomes of road traffic injury (RTI) related ED admissions (⩾15 years) between 2014 and 2015.

DESIGN

A retrospective, cross-sectional study using routinely collected ED data.

RESULTS

Of 10 007 ED admissions, 779 (8%) were RTI cases; this proportion peaked in the month of January (11%). Medical records were available for 522 (67%) of these RTI cases. The median age was 28 years and 69% were males. The majority were pedestrians (69%) injured by an automobile (78%). On triage, 32% were classified as needing urgent/immediate intervention. Head injuries (20%) were the second most common injury after lower limb injuries (36%). ED outcomes were as follows: discharged (68%), hospitalised (17%), referred (17%) and died (1%). Among the 78 hospitalised cases, respectively 62% and 16% were admitted to the surgical and orthopaedic departments. Of 146 RTI cases with head injuries, 25% were hospitalised, of whom 82% were admitted to the surgical department.

CONCLUSION

Our findings can guide policy makers in referral hospitals in improving the planning of hospital resources and the prioritisation of public health needs linked to further urban development. A comprehensive plan to prevent RTIs, particularly among pedestrians in Addis Ababa, is urgently needed.

Managing and monitoring chronic non-communicable diseases in a primary health care clinic, Lilongwe, Malawi

SETTING

Patients with chronic non-communicable diseases attending a primary health care centre, Lilongwe, Malawi.

OBJECTIVE

Using an electronic medical record monitoring system, to describe the quarterly and cumulative disease burden, management and outcomes of patients registered between March 2014 and June 2015.

DESIGN

A cross-sectional study.

RESULTS

Of 1135 patients, with new registrations increasing each quarter, 66% were female, 21% were aged ⩾65 years, 20% were obese, 53% had hypertension alone, 18% had diabetes alone, 12% had asthma, 10% had epilepsy and 7% had both hypertension and diabetes. In every quarter, about 30% of patients did not attend the clinic and 19% were registered as lost to follow-up (not seen for ⩾1 year) in the last quarter. Of those attending, over 90% were prescribed medication, and 80-90% with hypertension and/or diabetes had blood pressure/blood glucose measured. Over 85% of those with epilepsy had no seizures and 60-75% with asthma had no severe attacks. Control of blood pressure (41-51%) and diabetes (15-38%) was poor.

CONCLUSION

It is feasible to manage patients with non-communicable diseases in a primary health care setting in Malawi, although more attention is needed to improve clinic attendance and the control of hypertension and diabetes.

A consortium of rhizobacterial strains and biochemical growth elicitors improve cold and drought stress tolerance in rice (Oryza sativa L.)

In the present study, a consortium of two rhizobacteria Bacillus amyloliquefaciens Bk7 and Brevibacillus laterosporus B4, termed 'BB', biochemical elicitors salicylic acid and β-aminobutyric acid (SB) and their mixture (BBSB) were investigated for cold and drought stress tolerance in rice plants. After withholding water for 16 days, rice plants treated with BBSB showed 100% survival, improved seedling height (35.4 cm), shoot number (6.12), and showed minimum symptoms of chlorosis (19%), wilting (4%), necrosis (6%) and rolling of leaves. Similarly, BB inoculation enhanced plant growth and reduced overall symptoms in rice seedlings subjected to 0 ± 5 °C for 24 h. Our results imply several mechanisms underlying BB- and BBSB-elicited stress tolerance. In contrast to the control, both treatments significantly decreased leaf monodehydroascorbate (MDA) content and electrolyte leakage, and increased leaf proline and cholorophyll content. Moreover, activities of antioxidant enzymes, superoxide dismutase (SOD) and catalase (CAT) increased 3.0- and 3.6-fold, respectively. Moreover, expression of OsMYB3R-2, OsDIL, OsDREB1A and OsCDPK13 genes was significantly up-regulated, suggesting that these genes play important roles in abiotic stress tolerance of rice. In addition, bacterial strains Bk7 and B4 were able to produce high amounts of IAA and siderophores, and colonise the plant roots, while only strain Bk7 exhibited the capability to form biofilms and solubilise inorganic phosphate. This study indicates that the BB and BBSB bio-formulations can be used to confer induced systematic tolerance and improve the health of rice plants subject to chilling and drought stress.