Unveiling Disparities: Exploring Differential Attainment in Postgraduate Training Within Clinical Oncology

AIMS

Differential attainment (DA) in post graduate medical training is a recognised challenge and refers to unexplained variation across groups when split by several protected characteristics. The Royal College of Radiology is committed to fostering diversity, inclusivity, and equality with the goal of narrowing existing gaps and improving training outcomes.

MATERIALS AND METHODS

This was a mixed methods study aiming to understand the causes of DA with view to helping the RCR develop strategies to address this. A cross-sectional survey was completed by 140 clinical oncology trainees in September 2022. Trainees and trainers (17 and 6 respectively) from across England, Scotland, Wales and Northern Ireland, took part in focus group and interviews from August to December 2022. Quantitative and qualitative data merged and interpreted.

RESULT

Results showed international medical graduates and trainees from ethnic minority backgrounds were more likely to encounter challenges. The qualitative findings were used to identify three themes through which these problems could be framed. The trainee as a "space invader," the hidden curriculum of clinical oncology training and the process of navigating and tacking the training journey.

CONCLUSION

Differential attainment is the product of a complex interplay between the trainee, trainer, and the training environment. Therefore, interventions must be tailored to different people and contexts. At a national level, the RCR can adopt general policies to promote this such as mentorship programmes, protected time for supervision and cultural competency training. Efficacy of proposed interventions for trial and their impact on DA should be evaluated to drive evidence-based changes.

SF-CORNER (splenic flexure colorectal cancer): an international survey of operative approaches and outcomes for cancers of the splenic flexure

AIM

The optimum surgical approach to splenic flexure cancers (SFCs) remains uncertain. The aim of this survey was to explore the opinions of an international surgical community on the management and outcomes of SFC.

METHOD

A questionnaire was constructed comprising five sections (information about respondents; definition and prognosis of SFC; operative approach; approach in specific scenarios; outcomes) and circulated through an international dissemination committee and social media.

RESULTS

The survey received 576 responses over 4 weeks across 50 countries. There was no consensus regarding the definition of the splenic flexure, whilst the proportion of respondents who did and did not think that patients with SFC had a worse outcome was equal. The overall preferred operative approach was left hemicolectomy [203 (35.2%)], followed by segmental resection [167 (29%)], extended right hemicolectomy [126 (21.9%)] and subtotal colectomy [7 (12%)]. The stated pedicles for ligation varied between resection types and also within the same resection. One hundred and sixty-six (28.8%) respondents thought a segmental resection was associated with the worst survival and 190 (33%) thought it was associated with the best quality of life.

CONCLUSION

This survey confirms a lack of consensus across all aspects SFC treatment. The differing approaches described are likely to represent different beliefs around the variable anatomy of this region and the associated lymphatic drainage. Future studies are required to address such inconsistencies and identify the optimum surgical strategy, whilst also incorporating quality-of-life metrics and patient-reported outcomes. A one-size-fits-all approach is probably not appropriate with SFC, and a more bespoke approach is required.

Study loss of vegetative cover and increased land surface temperature through remote sensing strategies under the inter-annual climate variability in Jinhua-Quzhou basin, China

The Jinhua-Quzhou basin in China is one of the most susceptible areas to drought. Due to the loss of vegetation and great fluctuations in rainfall and surface temperature, global warming occurs. Timely, accurate, and effective drought monitoring is crucial for protecting local vegetation and determining which vegetation is most vulnerable to increased LST during the period 1982-2019. It assumes a strong correlation between loss of vegetation cover, changes in monsoon climate, drought, and increases in land surface temperature (LST). Due to significantly increased in LST, low precipitation and vegetation cover, NDVI, TVDI, VCI, and NAP are useful in characterizing drought mitigation strategies. The temperature vegetation drought index (TVDI), normalized difference vegetation index (NDVI), vegetation condition index (VCI), and monthly precipitation anomaly percentage (NAP) can be helped to characterize drought reduction strategies. Monthly NDVI, NAP, VCI, TVDI, normalized vegetation supply water index (NVSWI), temperature condition index (TCI), vegetation health index (VHI), and heat map analysis indicate that the Jinhua-Quzhou basin experienced drought during 1984, 1993, 2000, and 2011. Seasonal SR, WVP, WS, NDVI, VCI, and NAP charts confirm that the Jinhua-Quzhou basin was affected by severe drought in 1984, which continued and led to severe droughts in 1993, 2000, and 2011. Regression analysis showed a significant positive correlation between NDVI, TVDI, VCI, and NAP values, while NVSWI, TVDI, and VHI showed positive signs of good drought monitoring strategies. The research results confirm the correlation between loss of vegetation cover and LST, which is one of the causes of global warming. The distribution of drought changed a trend indicating that compared with the Jinhua region; the Quzhou region has more droughts. The changing trend of drought has characteristics from 1982 to 2019, and there are significant differences in drought changing trends between different Jinhua-Quzhou basin areas. Overall, from 1982 to 2019, the frequency of drought showed a downward trend. We believe that these results will provide useful tools for drought management plans and play a relevant role in mitigating the effects of drought and protecting humanity from climate hazards.

Solvothermal synthesis of VO2 nanoparticles with locally patched V2O5 surface layer and their morphology-dependent catalytic properties for the oxidation of alcohols

Vanadium oxides are promising oxidation catalysts because of their rich redox chemistry. We report the synthesis of VO2 nanocrystals with VO2(B) crystal structure. By varying the mixing ratio of the components of a binary ethanol/water mixture, different VO2 nanocrystal morphologies (nanorods, -urchins, and -sheets) could be made selectively in pure form. Polydisperse VO2(B) nanorods with lengths between 150 nm and a few micrometers were formed at large water : ethanol ratios between 4 : 1 and 3 : 2. At a water : ethanol ratio of 1 : 9 VO2 nanosheets with diameters of ∼50-70 nm were formed, which aggregated to nano-urchins with diameters of ∼200 nm in pure ethanol. The catalytic activity of VO2 nanocrystals for the oxidation of alcohols was studied as a function of nanocrystal morphology. VO2 nanocrystals with all morphologies were catalytically active. The activity for the oxidation of benzyl alcohol to benzaldehyde was about 30% higher than that for the oxidation of furfuryl alcohol to furfural. This is due to the substrate structure. The oxidation activity of VO2 nanostructures decreases in the order of nanourchins > nanosheets > nanorods.

Green, Solvent-Free Mechanochemical Synthesis of Nano Ag2O/MnO2/N-Doped Graphene Nanocomposites: An Efficient Catalyst for Additive-Base-Free Aerial Oxidation of Various Kinds of Alcohols

Herein, we report a solvent-less, straightforward, and facile mechanochemical technique to synthesize nanocomposites of Ag2O nanoparticles-doped MnO2, which is further codoped with nitrogen-doped graphene (N-DG) [i.e., (X %)N-DG/MnO2-(1% Ag2O)] using physical milling of separately prepared N-DG and Ag2O NPs-MnO2 annealed at 400 °C over an eco-friendly ball-mill process. To assess the efficiency in terms of catalytic performance of the nanocomposites, selective oxidation of benzyl alcohol (BlOH) to benzaldehyde (BlCHO) is selected as a substrate model with an eco-friendly oxidizing agent (O2 molecule) and without any requirements for the addition of any harmful additives or bases. Various nanocomposites were prepared by varying the amount of N-DG in the composite, and the results obtained highlighted the function of N-DG in the catalyst system when they are compared with the catalyst MnO2-(1% Ag2O) [i.e., undoped catalyst] and MnO2-(1% Ag2O) codoped with different graphene dopants such as GRO and H-RG for alcohol oxidation transformation. The effects of various catalytic factors are systematically evaluated to optimize reaction conditions. The N-DG/MnO2-(1% Ag2O) catalyst exhibits premium specific activity (16.0 mmol/h/g) with 100% BlOH conversion and <99.9% BlCHO selectivity within a very short interval. The mechanochemically prepared N-DG-based nanocomposite displayed higher catalytic efficacy than that of the MnO2-(1% Ag2O) catalyst without the graphene dopant, which is N-DG in this study. A wide array of aromatic, heterocyclic, allylic, primary, secondary, and aliphatic alcohols have been selectively converted to respective ketones and aldehydes with full convertibility without further oxidation to acids over N-DG/MnO2-(1% Ag2O). Interestingly, it is also found that the N-DG/MnO2-(1% Ag2O) can be efficiently reused up to six times without a noteworthy decline in its effectiveness. The prepared nanocomposites were characterized using various analytical, microscopic, and spectroscopic techniques such as X-ray diffraction, thermogravimetric analysis, Fourier-transform infrared spectroscopy, Raman, field emission scanning electron microscopy, and Brunauer-Emmett-Teller.

Mutations in the bone morphogenetic protein 15 gene causing defective protein secretion in Cholistani infertile sheep

Abstract Naturally occurring mutations in morphogenetic protein 15 (BMP15) are associated with decreased ovulation rate (OR), litter size (LS), and sterility. It is of a great interest to elucidate BMP15 gene in Cholistani sheep breed to uplift socio-economic status and the knowledge of Cholistani sheep breeding in Southern Punjab, Pakistan. In our study, a total of 50 infertile Cholistani sheep aged between 2-6 years and having no blood relation were screened for BMP15 mutations. For this purpose, a high-quality DNA was extracted from the blood of sheep followed by primer designing, Polymerase Chain Reaction (PCR) amplification, DNA sequencing, and in silico analyses. Out of total 50 samples, 9 samples including case 1 (T3), case 2 (T8), case 3 (T17), case 4 (T22), case 5 (T25), case 6 (T33), case 7 (T40), case 8 (T44), and case 9 (T47) were found positive for a variety of already reported and novel BMP15 mutations. Further in silico analyses of the observed mutations have shown the functional impact of these mutations on different characteristics (molecular weight, theoretical PI, estimated half-life, instability index, sub-cellular localization, and 3D confirmation) of the encoded proteins, possibly altering the normal functionality. In a nutshell, findings of this study have confirmed the possible essential role of the BMP15 mutations in the infertility of the Cholistani sheep.

Sb-Doped Cerium Molybdate: An Emerging Material as Dielectric and Photocatalyst for the Removal of Diclofenac Potassium from Aqueous Media

This work reports the influence of antimony substitution in a cerium molybdate lattice for improved dielectric and photocatalytic properties. For this purpose, a series of Ce2-xSbx(MoO4)3 (x = 0.00, 0.01, 0.03, 0.05, 0.07, and 0.09) were synthesized through a co-precipitation route. The as-synthesized materials were characterized for their optical properties, functional groups, chemical oxidation states, structural phases, surface properties, and dielectric characteristics using UV-Vis spectroscopy (UV-Vis), Fourier transform infrared (FTIR) and Raman spectroscopies, X-ray photoelectron spectroscopy (XPS), X-ray diffraction (XRD), Brunauer-Emmett-Teller (BET) analysis, and impedance spectroscopy, respectively. UV-Vis study showed a prominent red shift of absorption maxima and a continuous decrease in band gap (3.35 eV to 2.79 eV) by increasing the dopant concentration. The presence of Ce-O and Mo-O-Mo bonds, detected via FTIR and Raman spectroscopies, are confirmed, indicating the successful synthesis of the desired material. The monoclinic phase was dominant in all materials, and the crystallite size was decreased from 40.29 nm to 29.09 nm by increasing the Sb content. A significant increase in the dielectric constant (ε' = 2.856 × 108, 20 Hz) and a decrease in the loss tan (tanδ = 1.647, 20 Hz) were exhibited as functions of the increasing Sb concentration. Furthermore, the photocatalytic efficiency of pristine cerium molybdate was also increased by 1.24 times against diclofenac potassium by incorporating Sb (x = 0.09) in the cerium molybdate. The photocatalytic efficiency of 85.8% was achieved within 180 min of UV light exposure at optimized conditions. The photocatalytic reaction followed pseudo-first-order kinetics with an apparent rate constant of 0.0105 min-1, and the photocatalyst was recyclable with good photocatalytic activity even after five successive runs. Overall, the as-synthesized Sb-doped cerium molybdate material has proven to be a promising candidate for charge storage devices and a sustainable photocatalyst for wastewater treatment.

[Vascular occlusion following profile harmonization of the chin with hyaluronic acid fillers]

The use of dermal fillers for cosmetic procedures has increased rapidly both worldwide and in the Netherlands in recent years, which has led to an absolute increase in reported side effects and complications. Although most of these complications are mild, serious complications such as vascular occlusion can also occur. In this article, we describe a case of a 35-year-old woman who showed signs of reduced tissue perfusion and the early stage of skin necrosis following injection of hyaluronic acid fillers in the chin. This complication was successfully treated by ultrasound-guided injection of hyaluronidase, resulting in a full recovery without residual symptoms. To minimize the risk of serious complications treatment with hyaluronic acid fillers should be carried out by an experienced practitioner.

Cloning and periplasmic soluble expression of hepatitis B surface antigen gene in Escherichia coli

OBJECTIVE

The objective of this study was to clone and express the hepatitis B surface antigen gene (HBsAg) in Escherichia coli (E. coli), thereby aiming to develop potential local therapeutics for combating Hepatitis B virus (HBV) infection in the Pakistani community by producing HBsAg in E. coli.

MATERIALS AND METHODS

Blood serum samples were collected from hepatitis B-infected patients, and their genomic DNA was extracted. Real-time and nested polymerase chain reaction (PCR) was performed to amplify the HBsAg gene. The gene of interest was cloned into the pET20b expression vector and transformed into E. coli BL21 (DE3) using Isopropyl β-D-1-thiogalactopyranoside (IPTG) induction. The gene's precise size was confirmed with gene-specific external and internal primers (681 bp and 400 bp, respectively).

RESULTS

The HBsAg gene was successfully sequenced and submitted to GenBank, exhibiting 98% homology with targeted HBV sequences worldwide. The expression of HBsAg protein was confirmed through silver staining, Coomassie staining, western blot, and dot blot analysis.

CONCLUSIONS

The expressed protein clones are now available for further development as a local recombinant DNA vaccine to prevent hepatitis B viral infection in the local community.

[Treatment with botulinum toxin of masseter hypertrophy, myalgia of the tendons and attrition induced by bruxism]

Bruxism is a disabling condition in which unconscious contractions of the masticulatory muscles lead to teeth grinding and jaw clenching. Symptoms include toothache, temporomandibular dysfunction, headache and attrition. Treatment options range from conservative approaches to invasive interventions. Education, stress reduction, avoidance of stimulants, and relaxation techniques can help in mild cases. Wearing an occlusal splint can reduce attrition. Botulinum neurotoxin type A (BoNT-A) injections are a treatment option temporarily causing partial paralysis of the masticulatory muscles. BoNT-A is a treatment for reducing symptoms and improving the quality of life of patients with bruxism that has been proven safe and effective. The effects usually last several months. To achieve the best results and minimize side effects, BoNT-A injections should be applied by an experienced practitioner.

Investigation on the origin of hot electrons in laser plasma interaction at shock ignition intensities

Shock Ignition is a two-step scheme to reach Inertial Confinement Fusion, where the precompressed fuel capsule is ignited by a strong shock driven by a laser pulse at an intensity in the order of [Formula: see text] W/cm[Formula: see text]. In this report we describe the results of an experiment carried out at PALS laser facility designed to investigate the origin of hot electrons in laser-plasma interaction at intensities and plasma temperatures expected for Shock Ignition. A detailed time- and spectrally-resolved characterization of Stimulated Raman Scattering and Two Plasmon Decay instabilities, as well as of the generated hot electrons, suggest that Stimulated Raman Scattering is the dominant source of hot electrons via the damping of daughter plasma waves. The temperature dependence of laser plasma instabilities was also investigated, enabled by the use of different ablator materials, suggesting that Two Plasmon Decay is damped at earlier times for higher plasma temperatures, accompanied by an earlier ignition of SRS. The identification of the predominant hot electron source and the effect of plasma temperature on laser plasma interaction, here investigated, are extremely useful for developing the mitigation strategies for reducing the impact of hot electrons on the fuel ignition.

Chemical Characterization and Chemotaxonomic Significance of Essential Oil Constituents of Matricaria aurea Grown in Two Different Agro-Climatic Conditions

A comprehensive study on chemical characterization of essential oil (EO) constituents of a rarely explored plant species (Matricaria aurea) of the Asteraceae family grown in Saudi Arabia and Jordan was carried out. Analyses were conducted employing gas chromatographic approaches such as GC-MS, GC-FID, and Co-GC, as well as RT, LRI determination, and database and literature comparisons, on two diverse stationary phase columns, which led to the identification of a total of 135 constituents from both EOs. Oxygenated sesquiterpenes were found to be the most predominant chemical class of Saudi M. aurea EOs, in which α-bisabolol (27.8%), γ-gurjunenepoxide (21.7%), (E, E)-α-farnesene (16.3%), and cis-spiroether (7.5%) were present as major components. In contrast, the most dominant chemical class of Jordanian M. aurea oil was found to be sesquiterpene hydrocarbons, where (E, E)-α-farnesene (50.2%), γ-gurjunenepoxide (8.5%), (E)-β-farnesene (8.1%), and (Z, E)-α-farnesene (4.4%) were detected as chief constituents. It is interesting to mention here that Saudi and Jordanian M. aurea EOs showed quite interesting chemical compositions and were found to have different chemotypes when compared to previously reported M. aurea EO compositions.

Results of an International Survey on Spinal Imaging by the ASNR/ASSR/ESNR/ESSR "Nomenclature 3.0" Working Group

Our goal was to determine if "Nomenclature 2.0," the classification of lumbar disk pathology consensus, should be updated. We conducted a social media and e-mail-based survey on preferences regarding the use of classification on magnetic resonance spine reporting. Members of the European Society of Neuroradiology, European Society of Musculoskeletal Radiology, American Society of Neuroradiology, and American Society of Spine Radiology received a 15-question online survey between February and March 2022. A total of 600 responses were received from 63 countries. The largest number of responses came from Italy and the United States. We found that 71.28% of respondents used Nomenclature 2.0, Classification of Lumbar Disk Pathology. But classification on stenosis is used less often: 53.94% and 60% of respondents do not use any classification of spinal canal stenosis and foraminal stenosis, respectively. When queried about which part of Nomenclature needs improving, most respondents asked for a Structured Reporting Template (SRT), even though 58.85% of respondents do not currently use any template and 54% routinely use a clinical information questionnaire. These results highlight the importance of an updated Nomenclature 3.0 version that integrates the classifications of lumbar disk disease and spinal canal and foraminal stenosis. Further attention should also be directed toward developing a robust endorsed SRT.

Institutional Validation Study Inferring 2% MGMT Methylation Positive Impact on Survival in Newly Diagnosed Glioblastoma (GBM) Patients

PURPOSE/OBJECTIVE(S)

O6-methylguanine DNA methyltransferase (MGMT) MATERIALS/METHODS: is a well-established prognostic factor in patients with newly diagnosed glioblastoma (GBM). However, there is no consensus on a standardized method of threshold for MGMT testing. Previous studies have reported levels of as little as 1-3% to confer better prognosis. This study reports a single institutional experience of determining methylation status via methylation-sensitive high-resolution melting (MS-HRM). Previous literature suggests 10% cutoff for MGMT methylation using MS-HRM. We hereby report clinical outcomes using a lower threshold of 2%.

MATERIALS/METHODS

GBM patients treated at our institution retrospectively reviewed between the years 2013 and 2022 were included in the study. Patients who received hypofractionated radiation (<60 Gy) were excluded. All patients had MS-HRM test for MGMT methylation status. A real-time PCR assay was used to amplify a 62 base-pair region of MGMT for both methylated and unmethylated alleles. PCR products underwent HRM analysis and the fraction of methylated DNA was determined by comparison with a standard curve. Clinical data were collected retrospectively. Kaplan-Meier and log-rank tests were performed to compare survival.

RESULTS

A total of 181 patients with newly diagnosed GBM were initially included in this study. 42 patients treated with hypofractionated radiation were excluded. All patients received concurrent and maintenance temozolomide. Median age was 61.5 years. A total of 84 patients had MGMT methylation levels <2%, and 55 patients had MGMT methylation level ≥ 2% with a median methylation level of 28.5% (Range 0.8%-100%). Patients with MGMT methylation level ≥ 2% had an improved median overall survival (25.1 vs 16.0 months; p = 0.006) and improved median progression free survival (11.3 vs 7.9 months; p = 0.017). In a multivariable mode that included age, use of tumor-treating fields, KPS, sex, and BMI, only age, KPS, and MGMT remained significant.

CONCLUSION

Our institutional review confirmed low level of MGMT hypermethylation (≥ 2%) predicts improved outcome in patients with newly diagnosed GBM. Further investigation on optimal cut off level for MGMT methylation is still warranted.

Body Mass Index (BMI) at Time of Diagnosis as a Prognostic Indicator in Patients with Newly Diagnosed Glioblastoma (GBM)

PURPOSE/OBJECTIVE(S)

Glioblastoma (GBM) is the most common primary brain cancer in adults with very poor prognosis. Metabolic drivers of tumorigenesis are highly relevant within the central nervous system, where glucose is the sole source of energy. The impact of obesity on survival outcomes in patients with GBM has not been well reported and some initial results are inconsistent. This study investigates the factor of body mass index (BMI) in patients diagnosed with GBM. This study evaluated the prognostic association of BMI with survival outcomes in patients with newly diagnosed GBM.

MATERIALS/METHODS

Patientswith newly diagnosed GBM at our institution from 2015-2022 were included in this study. All patients were >18 years of age and received 60 Gy of radiation therapy with concurrent and adjuvant temozolomide following maximal safe resection. Through retrospective chart review, patient BMI at the time of diagnosis and overall survival (OS) were recorded. Analysis was done between patient groups of underweight/normal weight (BMI <25) and overweight/obese (BMI ≥ 25.00). The subgroup of overweight patients was also divided into subgroups of overweight (BMI 25.00-29.99) and obese (BMI≥30.00). A difference in clinical outcomes of overall survival was evaluated between the groups using Gehan-Breslow-Wilcoxon and log-rank tests.

RESULTS

Atotal of 393 patients met inclusion criteria. Median age 57.3 years, range 18.8-92.7. 185 female and 208 were male. 120 patients had a BMI <25 and 273 had a BMI ≥ 25.00. Median survival in patients with BMI <25 was 24.90 months and in patients with BMI ≥ 25.00, 18.20 months (p = 0.0001; HR 0.6552, 95% CI 0.5299-0.8101). We further divided patients with BMI ≥ 25.00 to 25-29.99 (n = 152) and BMI≥30.00 (n = 121). Both groups' OS were significantly worse than patients with BMI < 25 (p = 0.006). There was no difference in survival outcomes between patients with a BMI 25.00-29.99 and BMI≥30.00, with median OS 19.0 months and 18.1 months, respectively.

CONCLUSION

Patient baseline BMI <25 appears to be a prognostic indicator and correlates to improves overall survival for patients with newly diagnosed GBM. This study adds to the existing literature supporting overweight/obesity is associated with worse survival for GBM patients. Additional studies are warranted for further analysis of BMI and survival outcomes in GBM patients across patient demographics.

Morphology Controlled Deposition of Vanadium Oxide (VOx) Nanoparticles on the Surface of Highly Reduced Graphene Oxide for the Photocatalytic Degradation of Hazardous Organic Dyes

Semiconducting nanomaterials based heterogeneous photocatalysis represent a low-cost, versatile technique for environmental remediation, including pollution mitigation, energy management and other environmental aspects. Herein, we demonstrate the syntheses of various heterogeneous photocatalysts based on highly reduced graphene oxide (HRG) and vanadium oxide (VOx)-based nanocomposites (HRG-VOx). Different shapes (rod, sheet and urchin forms) of VOx nanoparticles were successfully fabricated on the surface of HRG under solvo-/hydrothermal conditions by varying the amount of water and ethanol. The high concentration of water in the mixture resulted in the formation of rod-shaped VOx nanoparticles, whereas increasing the amount of ethanol led to the production of VOx sheets. The solvothermal condition using pure ethanol as solvent produced VOx nano-urchins on the surface of HRG. The as-prepared hybrid materials were characterized using various spectroscopic and microscopic techniques, including X-ray diffraction, UV-vis, FTIR, SEM and TEM analyses. The photocatalytic activities of different HRG-VOx nanocomposites were investigated for the photodegradation of methylene blue (MB) and methyl orange (MO). The experimental data revealed that all HRG-VOx composite-based photocatalysts demonstrated excellent performance toward the photocatalytic degradation of the organic dyes. Among all photocatalysts studied, the HRG-VOx nanocomposite consisting of urchin-shaped VOx nanoparticles (HRG-VOx-U) demonstrated superior photocatalytic properties towards the degradation of dyes.

CBPDdb: a curated database of compounds derived from Coumarin-Benzothiazole-Pyrazole

The present article describes the building of a small-molecule web server, CBPDdb, employing R-shiny. For the generation of the web server, three compounds were chosen, namely coumarin, benzothiazole and pyrazole, and their derivatives were curated from the literature. The two-dimensional (2D) structures were drawn using ChemDraw, and the .sdf file was created employing Discovery Studio Visualizer v2017. These compounds were read on the R-shiny app using ChemmineR, and the dataframe consisting of a total of 1146 compounds was generated and manipulated employing the dplyr package. The web server is provided with JSME 2D sketcher. The descriptors of the compounds are obtained using propOB with a filter. The users can download the filtered data in the .csv and .sdf formats, and the entire dataset of a compound can be downloaded in .sdf format. This web server facilitates the researchers to screen plausible inhibitors for different diseases. Additionally, the method used in building the web server can be adapted for developing other small-molecule databases (web servers) in RStudio. Database URL: https://srampogu.shinyapps.io/CBPDdb_Revised/.

Synthesis and Structural Characterization of Selenium Nanoparticles-Bacillus sp. MKUST-01 Exopolysaccharide (SeNPs-EPS) Conjugate for Biomedical Applications

Exopolysaccharides (EPS) are exogenous microbial metabolites generated predominantly during the development of bacteria. They have several biological potentials, including antibacterial, antioxidant, and anticancer actions. Polysaccharide-coated nanoparticles have high biological activity and are used in treatments and diagnostics. In this research, selenium nanoparticles (SeNPs) are synthesized and conjugated with bacterial (Bacillus sp. MKUST-01) exopolysaccharide (EPS). Initially, the creation of SeNPs conjugates was verified through UV-Vis spectral examination, which exhibited a prominent peak at 264 nm. Additionally, X-ray diffraction (XRD) analysis further substantiated the existence of crystalline Se, as evidenced by a robust reflection at 29.78°. Another reflection observed at 23.76° indicated the presence of carbon originating from the EPS. Fourier transform infrared spectroscopy (FT-IR) analysis of the EPS capped with SeNPs displayed characteristic peaks at 3425 cm-1, 2926 cm-1, 1639 cm-1, and 1411 cm-1, corresponding to the presence of O-H, C-H, C=O, and COO-groups. The SeNPs themselves were found to possess elongated rod-shaped structures with lengths ranging from 250 to 550 nm and a diameter of less than 70 nm, as confirmed using scanning electron microscopy and particle size analysis. In contrast to the SeNPs, the SeNPs-EPS conjugates showed no hemolytic activity. The overall antioxidant activity of SeNPs-EPS conjugates outperformed 20% higher than SeNPs and EPS. Additionally, experimental observations involving gnotobiotic Artemia nauplii experiments were also recorded, such as the supplementation of EPS and SeNPs-EPS conjugates corresponding to enhanced growth and increased survival rates compared to Artemia nauplii fed with SeNPs and a microalgal diet.

Bone marrow mesenchymal/fibroblastic stromal cells induce a distinctive EMT-like phenotype in AML cells

The development of epithelial-to-mesenchymal transition (EMT) like features is emerging as a critical factor involved in the pathogenesis of acute myeloid leukaemia (AML). However, the extracellular signals and the signalling pathways in AML that may regulate EMT remain largely unstudied. We found that the bone marrow (BM) mesenchymal/fibroblastic cell line HS5 induces an EMT-like migratory phenotype in AML cells. AML cells underwent a strong increase of vimentin (VIM) levels that was not mirrored to the same extent by changes of expression of the other EMT core proteins SNAI1 and SNAI2. We validated these particular pattern of co-expression of core-EMT markers in AML cells by performing an in silico analysis using datasets of human tumours. Our data showed that in AML the expression levels of VIM does not completely correlate with the co-expression of core EMT markers observed in epithelial tumours. We also found that vs epithelial tumours, AML cells display a distinct patterns of co-expression of VIM and the actin binding and adhesion regulatory proteins that regulate F-actin dynamics and integrin-mediated adhesions involved in the invasive migration in cells undergoing EMT. We conclude that the BM stroma induces an EMT related pattern of migration in AML cells in a process involving a distinctive regulation of EMT markers and of regulators of cell adhesion and actin dynamics that should be further investigated. Understanding the tumour specific signalling pathways associated with the EMT process may contribute to the development of new tailored therapies for AML as well as in different types of cancers.

Evaluation of Photocatalytic, Antioxidant, and Antibacterial Efficacy of Almond Oil Capped Zinc Oxide Nanoparticles

In this study, ZnO nanoparticles (NPs) were synthesized in the presence of almond oil at various molar ratios of zinc acetate and sodium hydroxide, including 0.5:1, 0.75:1, 1:1, 1.25:1, and 1.5:1, to obtain pH values of 11, 10, 9, 8, and 7, respectively. The XRD results revealed that ZnO NPs exhibit a hexagonal structure, with high crystallinity. SEM results showed that dense and large sized ZnO NPs were formed at pH 11, and relatively small (~30-40 nm) NPs were obtained at pH 9. The size distribution can be explained in terms of the presence of OH- ions at different pH levels. However, the larger size of the NPs at pH 7 compared to those at pH 8-11 were due to the coalescence of NPs suitable for antioxidant/antibacterial activities. ZnO NPs demonstrated a high degradation efficiency (~93%) in 90 min, with a high rate constant for Methyl Orange (MO), which is better than the previously reported rate. The larger sized almond oil capped ZnO NPs also showed excellent radical scavenging activity (94%) and are proven to be good carriers to resist Escherichia coli (E. coli) bacteria.

Measurement of Magnetic Cavitation Driven by Heat Flow in a Plasma

We describe the direct measurement of the expulsion of a magnetic field from a plasma driven by heat flow. Using a laser to heat a column of gas within an applied magnetic field, we isolate Nernst advection and show how it changes the field over a nanosecond timescale. Reconstruction of the magnetic field map from proton radiographs demonstrates that the field is advected by heat flow in advance of the plasma expansion with a velocity v_{N}=(6±2)×10^{5}  m/s. Kinetic and extended magnetohydrodynamic simulations agree well in this regime due to the buildup of a magnetic transport barrier.

OralNet: Fused Optimal Deep Features Framework for Oral Squamous Cell Carcinoma Detection

Humankind is witnessing a gradual increase in cancer incidence, emphasizing the importance of early diagnosis and treatment, and follow-up clinical protocols. Oral or mouth cancer, categorized under head and neck cancers, requires effective screening for timely detection. This study proposes a framework, OralNet, for oral cancer detection using histopathology images. The research encompasses four stages: (i) Image collection and preprocessing, gathering and preparing histopathology images for analysis; (ii) feature extraction using deep and handcrafted scheme, extracting relevant features from images using deep learning techniques and traditional methods; (iii) feature reduction artificial hummingbird algorithm (AHA) and concatenation: Reducing feature dimensionality using AHA and concatenating them serially and (iv) binary classification and performance validation with three-fold cross-validation: Classifying images as healthy or oral squamous cell carcinoma and evaluating the framework's performance using three-fold cross-validation. The current study examined whole slide biopsy images at 100× and 400× magnifications. To establish OralNet's validity, 3000 cropped and resized images were reviewed, comprising 1500 healthy and 1500 oral squamous cell carcinoma images. Experimental results using OralNet achieved an oral cancer detection accuracy exceeding 99.5%. These findings confirm the clinical significance of the proposed technique in detecting oral cancer presence in histology slides.

Light-Driven Catalytic Activity of Green-Synthesized SnO2/WO3-x Hetero-nanostructures

This work reports an environmentally friendly and economically feasible green synthesis of monometallic oxides (SnO₂ and WO₃) and their corresponding mixed metal oxide (SnO₂/WO_3-x) nanostructures from the aqueous Psidium guajava leaf extract for light-driven catalytic degradation of a major industrial contaminant, methylene blue (MB). P. guajava is a rich source of polyphenols that acts as a bio-reductant as well as a capping agent in the synthesis of nanostructures. The chemical composition and redox behavior of the green extract were investigated by liquid chromatography-mass spectrometry and cyclic voltammetry, respectively. Results acquired by X-ray diffraction and Fourier transform infrared spectroscopy confirm the successful formation of crystalline monometallic oxides (SnO₂ and WO₃) and bimetallic SnO₂/WO_3-x hetero-nanostructures capped with polyphenols. The structural and morphological aspects of the synthesized nanostructures were analyzed by transmission electron microscopy and scanning electron microscopy coupled with energy-dispersive X-ray spectroscopy. Photocatalytic activity of the synthesized monometallic and hetero-nanostructures was investigated for the degradation of MB dye under UV light irradiation. Results indicate a higher photocatalytic degradation efficiency for mixed metal oxide nanostructures (93.5%) as compared to pristine monometallic oxides SnO₂ (35.7%) and WO₃ (74.5%). The hetero-metal oxide nanostructures prove to be better photocatalysts with reusability up to 3 cycles without any loss in degradation efficiency or stability. The enhanced photocatalytic efficiency is attributed to a synergistic effect in the hetero-nanostructures, efficient charge transportation, extended light absorption, and increased adsorption of dye due to the enlarged specific surface area.

Anticorrosion, Thermal Degradation, and Hydrophobic Performances of Graphene/TiO2 Nanocomposite Coatings

Globally, researchers have devoted consistent efforts to producing excellent coating properties since coating plays an essential role in enhancing electrochemical performance and surface quality. In this study, TiO₂ nanoparticles in varying concentrations of 0.5, 1, 2, and 3 wt.% were added into the acrylic-epoxy polymeric matrix with 90:10 wt.% (90A:10E) ratio incorporated with 1 wt.% graphene, to fabricate graphene/TiO2 -based nanocomposite coating systems. Furthermore, the properties of the graphene/TiO2 composites were investigated by Fourier-transform infrared spectroscopy (FTIR), thermogravimetric analysis (TGA), ultraviolet-visible (UV-Vis) spectroscopy, water contact angle (WCA) measurements, and cross-hatch test (CHT), respectively. Moreover, the field emission scanning electron microscope (FESEM) and the electrochemical impedance spectroscopy (EIS) tests were conducted to investigate the dispersibility and anticorrosion mechanism of the coatings. The EIS was observed by determining the breakpoint frequencies over a period of 90 days. The results revealed that the TiO2 nanoparticles were successfully decorated on the graphene surface by chemical bonds, which resulted in the graphene/TiO2 nanocomposite coatings exhibiting better dispersibility within the polymeric matrix. The WCA of the graphene/TiO2 coating increased along with the ratio of TiO2 to graphene, achieving the highest CA of 120.85° for 3 wt.% of TiO₂. Excellent dispersion and uniform distribution of the TiO2 nanoparticles within the polymer matrix were shown up to 2 wt.% of TiO₂ inclusion. Among the coating systems, throughout the immersion time, the graphene/TiO2 (1:1) coating system exhibited the best dispersibility and high impedance modulus values (Z0.01 Hz), exceeding 1010 Ω cm2.

Effectiveness of Nonfunctionalized Graphene Oxide Nanolayers as Nanomedicine against Colon, Cervical, and Breast Cancer Cells

Recent studies in nanomedicine have intensively explored the prospective applications of surface-tailored graphene oxide (GO) as anticancer entity. However, the efficacy of nonfunctionalized graphene oxide nanolayers (GRO-NLs) as an anticancer agent is less explored. In this study, we report the synthesis of GRO-NLs and their in vitro anticancer potential in breast (MCF-7), colon (HT-29), and cervical (HeLa) cancer cells. GRO-NLs-treated HT-29, HeLa, and MCF-7 cells showed cytotoxicity in the MTT and NRU assays via defects in mitochondrial functions and lysosomal activity. HT-29, HeLa, and MCF-7 cells treated with GRO-NLs exhibited substantial elevations in ROS, disturbances of the mitochondrial membrane potential, an influx of Ca²⁺, and apoptosis. The qPCR quantification showed the upregulation of caspase 3, caspase 9, bax, and SOD1 genes in GRO-NLs-treated cells. Western blotting showed the depletion of P21, P53, and CDC25C proteins in the above cancer cell lines after GRO-NLs treatment, indicating its function as a mutagen to induce mutation in the P53 gene, thereby affecting P53 protein and downstream effectors P21 and CDC25C. In addition, there may be a mechanism other than P53 mutation that controls P53 dysfunction. We conclude that nonfunctionalized GRO-NLs exhibit prospective biomedical application as a putative anticancer entity against colon, cervical, and breast cancers.

Antimicrobial, anticancer, and biofilm inhibition studies of highly reduced graphene oxide (HRG): In vitro and in silico analysis

Background: Bacterial infections and cancers may cause various acute or chronic diseases, which have become serious global health issues. This requires suitable alternatives involving novel and efficient materials to replace ineffective existing therapies. In this regard, graphene composites are being continuously explored for a variety of purposes, including biomedical applications, due to their remarkable properties.

Methods: Herein, we explore, in-vitro, the different biological properties of highly reduced graphene oxide (HRG), including anti-cancer, anti-bacterial, and anti-biofilm properties. Furthermore, to analyze the interactions of graphene with proteins of microbes, in silico docking analysis was also carried out. To do this, HRG was prepared using graphene oxide as a precursor, which was further chemically reduced to obtain the final product. The as-prepared HRG was characterized using different types of microscopic and spectroscopic techniques.

Results: The HRG revealed significant cytotoxic ability, using a dose-dependent anti-cell proliferation approach, which substantially killed human breast cancer cells (MCF-7) with IC50 of 29.51 ± 2.68 μg/mL. The HRG demonstrated efficient biological properties, i.e., even at low concentrations, HRG exhibited efficient anti-microbial properties against a variety of microorganisms. Among the different strains, Gram-positive bacteria, such as B. subtilis, MRSA, and S. aureus are more sensitive to HRG compared to Gram-negative bacteria. The bactericidal properties of HRG are almost similar to a commercially available effective antibiotic (ampicillin). To evaluate the efficacy of HRG against bacterial biofilms, Pseudomonas aeruginosa and MRSA were applied, and the results were compared with gentamycin and ampicillin, which are commonly applied standard antibiotics. Notably, HRG demonstrated high inhibition (94.23%) against P.aeruginosa, with lower MIC (50 μg/mL) and IC50 (26.53 μg/mL) values, whereas ampicillin and gentamicin showed similar inhibition (90.45% and 91.31% respectively) but much higher MIC and IC50 values.

Conclusion: Therefore, these results reveal the excellent biopotential of HRG in different biomedical applications, including cancer therapy; antimicrobial activity, especially anti-biofilm activity; and other biomedicine-based therapies. Based on the molecular docking results of Binding energy, it is predicted that pelB protein and HRG would form the best stable docking complex, and high hydrogen and hydrophobic interactions between the pelB protein and HRG have been revealed. Therefore, we conclude that HRG could be used as an antibiofilm agent against P. aeruginosa infections.

Cerium Oxide/Graphene Oxide Hybrid: Synthesis, Characterization, and Evaluation of Anticancer Activity in a Breast Cancer Cell Line (MCF-7)

In the present study, we used a simple ultrasonic approach to develop a Cerium oxide/Graphene oxide hybrid (CeO₂/GO hybrid) nanocomposite system. Particle size analysis, Fourier Transform Infrared Spectroscopy (FTIR), Scanning Electron Microscopy (SEM), and X-ray Diffraction (XRD) have been used to analyze the physio-chemical characteristics of the developed nanocomposite. The synthesized hybrid system has also been examined to assess its anticancer capability against MCF-7 cell lines and normal cell lines at different sample concentrations, pH values, and incubation intervals using an antiproliferative assay test. The test results demonstrate that as sample concentration rises, the apoptotic behavior of the CeO₂/GO hybrid in the MCF-7 cell line also rises. The IC₅₀ was 62.5 µg/mL after 72 h of incubation. Cytotoxicity of cisplatin bound CeO₂/GO hybrid was also tested in MCF-7 cell lines. To identify apoptosis-associated alterations of cell membranes during the process of apoptosis, a dual acridine orange/ethidium bromide (AO/EB) fluorescence staining was carried out at three specified doses (i.e., 1000 µg/mL, 250 µg/mL, and 62.5 µg/mL of CeO₂/GO hybrid). The color variations from both live (green) and dead (red) cells were examined using fluorescence microscopy under in vitro conditions. The quantitative analysis was performed using flow cytometry to identify the cell cycle at which the maximum number of MCF-7 cells had been destroyed as a result of interaction with the developed CeO₂/GO hybrid (FACS study). According to the results of the FACS investigation, the majority of cancer cells were inhibited at the R3 (G2/M) phase. Therefore, the CeO₂/GO hybrid has successfully showed enhanced anticancer efficacy against the MCF-7 cell line at the IC50 concentration. According to the current study, the CeO₂/GO platform can be used as a therapeutic platform for breast cancer. The synergetic effects of the developed CeO₂/GO hybrid with the MCF-7 cell line are presented.

Diversity of Citrullus colocynthis (L.) Schrad Seeds Extracts: Detailed Chemical Profiling and Evaluation of Their Medicinal Properties

Seeds and fruits of Citrullus colocynthis have been reported to possess huge potential for the development of phytopharmaceuticals with a wide range of biological activities. Thus, in the current study, we are reporting the potential antimicrobial and anticancer properties of C. colocynthis seeds extracted with solvents of different polarities, including methanol (M.E.), hexane (H.E.), and chloroform (C.E.). Antimicrobial properties of C. colocynthis seeds extracts were evaluated on Gram-positive and Gram-negative bacteria, whereas, anticancer properties were tested on four different cell lines, including HepG2, DU145, Hela, and A549. All the extracts have demonstrated noteworthy antimicrobial activities with a minimum inhibitory concentration (MIC) ranging from 0.9-62.5 µg/mL against Klebsiella planticola and Staphylococcus aureus; meanwhile, they were found to be moderately active (MIC 62.5-250 µg/mL) against Escherichia coli and Micrococcus luteus strains. Hexane extracts have demonstrated the highest antimicrobial activity against K. planticola with an MIC value of 0.9 µg/mL, equivalent to that of the standard drug ciprofloxacin used as positive control in this study. For anticancer activity, all the extracts of C. colocynthis seeds were found to be active against all the tested cell lines (IC₅₀ 48.49-197.96 µg/mL) except for the chloroform extracts, which were found to be inactive against the HepG2 cell line. The hexane extract was found to possess the most prominent anticancer activity when compared to other extracts and has demonstrated the highest anticancer activity against the DU145 cell line with an IC₅₀ value of 48.49 µg/mL. Furthermore, a detailed phytoconstituents analysis of all the extracts of C. colocynthis seeds were performed using GC-MS and GC-FID techniques. Altogether, 43 phytoconstituents were identified from the extracts of C. colocynthis seeds, among which 21, 12, and 16 components were identified from the H.E., C.E., and M.E. extracts, respectively. Monoterpenes (40.4%) and oxygenated monoterpenes (41.1%) were the most dominating chemical class of compounds from the hexane and chloroform extracts, respectively; whereas, in the methanolic extract, oxygenated aliphatic hydrocarbons (77.2%) were found to be the most dominating chemical class of compounds. To the best of our knowledge, all the phytoconstituents identified in this study are being reported for the first time from the C. colocynthis.

Green Synthesized Silver Nanoparticle-Loaded Liposome-Based Nanoarchitectonics for Cancer Management: In Vitro Drug Release Analysis

Silver nanoparticles act as antitumor agents because of their antiproliferative and apoptosis-inducing properties. The present study aims to develop silver nanoparticle-loaded liposomes for the effective management of cancer. Silver nanoparticle-encapsulated liposomes were prepared using the thin-film hydration method coupled with sonication. The prepared liposomes were characterized by DLS (Dynamic Light Scattering analysis), FESEM (Field Emission Scanning Electron Microscope), and FTIR (Fourier Transform Infrared spectroscopy). The in vitro drug release profile of the silver nanoparticle-loaded liposomes was carried out using the dialysis bag method and the drug release profile was validated using various mathematical models. A high encapsulation efficiency of silver nanoparticle-loaded liposome was observed (82.25%). A particle size and polydispersity index of 172.1 nm and 0.381, respectively, and the zeta potential of -21.5 mV were recorded. FESEM analysis revealed spherical-shaped nanoparticles in the size range of 80-97 nm. The in vitro drug release profile of the silver nanoparticle-loaded liposomes was carried out using the dialysis bag method in three different pHs: pH 5.5, pH 6.8, and pH 7.4. A high silver nanoparticle release was observed in pH 5.5 which corresponds to the mature endosomes of tumor cells; 73.32 ± 0.68% nanoparticle was released at 72 h in pH 5.5. Among the various mathematical models analyzed, the Higuchi model was the best-fitted model as there is the highest value of the correlation coefficient which confirms that the drug release follows the diffusion-controlled process. From the Korsmeyer-Peppas model, it was confirmed that the drug release is based on anomalous non-Fickian diffusion. The results indicate that the silver nanoparticle-loaded liposomes can be used as an efficient drug delivery carrier to target cancer cells of various types.

Tools for assessing health research partnership outcomes and impacts: a systematic review

OBJECTIVE

To identify and assess the globally available valid, reliable and acceptable tools for assessing health research partnership outcomes and impacts.

METHODS

We searched Ovid MEDLINE, Embase, CINAHL Plus and PsycINFO from origin to 2 June 2021, without limits, using an a priori strategy and registered protocol. We screened citations independently and in duplicate, resolving discrepancies by consensus and retaining studies involving health research partnerships, the development, use and/or assessment of tools to evaluate partnership outcomes and impacts, and reporting empirical psychometric evidence. Study, tool, psychometric and pragmatic characteristics were abstracted using a hybrid approach, then synthesized using descriptive statistics and thematic analysis. Study quality was assessed using the quality of survey studies in psychology (Q-SSP) checklist.

RESULTS

From 56 123 total citations, we screened 36 027 citations, assessed 2784 full-text papers, abstracted data from 48 studies and one companion report, and identified 58 tools. Most tools comprised surveys, questionnaires and scales. Studies used cross-sectional or mixed-method/embedded survey designs and employed quantitative and mixed methods. Both studies and tools were conceptually well grounded, focusing mainly on outcomes, then process, and less frequently on impact measurement. Multiple forms of empirical validity and reliability evidence was present for most tools; however, psychometric characteristics were inconsistently assessed and reported. We identified a subset of studies (22) and accompanying tools distinguished by their empirical psychometric, pragmatic and study quality characteristics. While our review demonstrated psychometric and pragmatic improvements over previous reviews, challenges related to health research partnership assessment and the nascency of partnership science persist.

CONCLUSION

This systematic review identified multiple tools demonstrating empirical psychometric evidence, pragmatic strength and moderate study quality. Increased attention to psychometric and pragmatic requirements in tool development, testing and reporting is key to advancing health research partnership assessment and partnership science. PROSPERO CRD42021137932.

Riedel's Thyroiditis: Pitfalls in Diagnosis and Subsequent Complications

Riedel's thyroiditis is a rare disease of chronic inflammation with fibrotic infiltration of the thyroid gland and its surrounding vital structures. Due to its low incidence, there are often delays in diagnosis as it is commonly mistaken for other thyroid diseases. We report the case of a 34-year-old female patient who presented with a firm, enlarged mass in the neck, compression symptoms, and hypothyroidism. Lab tests showed elevated A-TG (thyroglobulin antibodies) and A-TPO (thyroid peroxidase antibodies) levels. Based on the disease presentation and supporting lab findings, the patient was misdiagnosed with Hashimoto's thyroiditis and treated accordingly. Yet the patient's symptoms grew progressively worse. She was discovered to have severe tracheal compression and bilateral RLN (recurrent laryngeal nerve) palsy. Tracheotomy became a necessary surgical intervention after the development of respiratory failure, but this procedure was complicated by the development of an intraoperative pneumothorax. After an open biopsy, histology revealed Riedel's thyroiditis. A new treatment was introduced, with which the patient's condition improved. However, she continued to suffer from the open tracheocutaneous fistula left by the tracheostomy, which adversely affected her everyday life. A follow-up operation was performed to close the fistula. In this case report, we discuss the consequences of misdiagnosing the patient and delaying the appropriate treatment for her disease.

Green Synthesis of Silver Nanoparticles Using Aerial Part Extract of the Anthemis pseudocotula Boiss. Plant and Their Biological Activity

Green syntheses of metallic nanoparticles using plant extracts as effective sources of reductants and stabilizers have attracted decent popularity due to their non-toxicity, environmental friendliness and rapid nature. The current study demonstrates the ecofriendly, facile and inexpensive synthesis of silver nanoparticles (AP-AgNPs) using the extract of aerial parts of the Anthemis pseudocotula Boiss. plant (AP). Herein, the aerial parts extract of AP performed a twin role of a reducing as well as a stabilizing agent. The green synthesized AP-AgNPs were characterized by several techniques such as XRD, UV-Vis, FT-IR, TEM, SEM and EDX. Furthermore, the antimicrobial and antibiofilm activity of as-prepared AP-AgNPs were examined by a standard two-fold microbroth dilution method and tissue culture plate methods, respectively, against several Gram-negative and Gram-positive bacterial strains and fungal species such as Escherichia coli (E. coli), Staphylococcus aureus (S. aureus), multidrug-resistant Pseudomonas aeruginosa (MDR-PA) and Acinetobacter baumannii (MDR-AB), methicillin-resistant S. aureus (MRSA) and Candida albicans (C. albicans) strains. The antimicrobial activity results clearly indicated that the Gram-negative bacteria MDR-PA was most affected by AgNPs as compared to other Gram-negative and Gram-positive bacteria and fungi C. albicans. Whereas, in the case of antibiofilm activity, it has been found that AgNPs at 0.039 mg/mL, inhibit biofilms formation of Gram-negative bacteria i.e., MDR-PA, E. coli, and MDR-AB by 78.98 ± 1.12, 65.77 ± 1.05 and 66.94 ± 1.35%, respectively. On the other hand, at the same dose (i.e., 0.039 mg/mL), AP-AgNPs inhibits biofilm formation of Gram-positive bacteria i.e., MRSA, S. aureus and fungi C. albicans by 67.81 ± 0.99, 54.61 ± 1.11 and 56.22 ± 1.06%, respectively. The present work indicates the efficiency of green synthesized AP-AgNPs as good antimicrobial and antibiofilm agents against selected bacterial and fungal species.

Initial Immunomodulation and Outcome of Children with Multisystem Inflammatory Syndrome Related to COVID-19: A Multisite Study from India

OBJECTIVE

To determine the outcomes in children with MIS-C receiving different immunomodulatory treatment.

METHODS

In this multicentric, retrospective cohort study, data regarding treatment and outcomes of children meeting the WHO case definition for MIS-C, were collected. The primary composite outcome was the requirement of vasoactive/inotropic support on day 2 or beyond or need of mechanical ventilation on day 2 or beyond after initiation of immunomodulatory treatment or death during hospitalization in the treatment groups. Logistic regression and propensity score matching analyses were used to compare the outcomes in different treatment arms based on the initial immunomodulation, i.e., IVIG alone, IVIG plus steroids, and steroids alone.

RESULTS

The data of 368 children (diagnosed between April 2020 and June 2021) meeting the WHO case definition for MIS-C, were analyzed. Of the 368 subjects, 28 received IVIG alone, 82 received steroids alone, 237 received IVIG and steroids, and 21 did not receive any immunomodulation. One hundred fifty-six (42.39%) children had the primary outcome. On logistic regression analysis, the treatment group was not associated with the primary outcome; only the children with shock at diagnosis had higher odds for the occurrence of the outcome [OR (95% CI): 11.4 (5.19-25.0), p < 0.001]. On propensity score matching analysis, the primary outcome was comparable in steroid (n = 45), and IVIG plus steroid (n = 84) groups (p = 0.515).

CONCLUSION

While no significant difference was observed in the frequency of occurrence of the primary outcome in different treatment groups, data from adequately powered RCTs are required for definitive recommendations.

Efficacy of pentamidine-loaded chitosan nanoparticles as a novel drug delivery system for Leishmania tropica

The present study compares the in vitro effects of nanoparticles loaded pentamidine drug and conventional pentamidine on Leishmania tropica. Herein, pentamidine-loaded chitosan nanoparticles (PTN-CNPs) have been synthesized through an ionic gelation method with sodium tripolyphosphate (TPP). Next, the physical characteristics of PTN-CNPs were determined through the surface texture, zeta potential, in vitro drug release, drug loading content (DLC), and encapsulation efficacy (EE) and compared its efficacy with free pentamidine (PTN) drug against promastigotes and axenic amastigotes forms of L. tropica in vitro. The PTN-CNPs displayed a spherical shape having a size of 88 nm, an almost negative surface charge (-3.09 mV), EE for PTN entrapment of 86%, and in vitro drug release of 92% after 36 h. In vitro antileishmanial activity of PTN-CNPs and free PTN was performed against Leishmania tropica KWH23 promastigote and axenic amastigote using 3-(4, 5- dimethylthiazol-2-yl)-2, 5-diphenyletetrazolium bromide (MTT) assay. It was observed that the effect of PTN-CNPs and free PTN on both forms of the parasite was dose and time dependent. Free PTN presented low efficacy even at higher dose (40 µg/ml) with 25.6 ± 1.3 and 26.5 ±1.4 mean viability rate of the promastigotes and axenic amastigotes, respectively after 72 hrs incubation. While PTN-CNPs showed strong antileishmanial effects on both forms of parasite with 16 ± 0.4 and 19 ± 0.7 mean viability rate at the same higher concentration (40 µg/ml) after 72 hrs incubation. Half maximal inhibitory concentration (IC50) values of PTN-CNPs toward promastigotes and amastigotes were obtained as 0.1375 µg/ml and 0.1910 µg/ml, respectively. In conclusion, PTN-CNPs effectively inhibited both forms of the L. tropica; however, its effect was more salient on promastigotes. This data indicates that the PTN-CNPs act as a target drug delivery system. However, further research is needed to support its efficacy in animal and human CL.

Shock-Augmented Ignition Approach to Laser Inertial Fusion

Shock ignition enables high gain at low implosion velocity, reducing ablative Rayleigh-Taylor instability growth, which can degrade conventional direct drive. With this method, driving a strong shock requires high laser power and intensity, resulting in inefficiencies in the drive and the generation of hot electrons that can preheat the fuel. A new "shock-augmented ignition" pulse shape is described that, by preconditioning the ablation plasma before launching a strong shock, enables the shock ignition of thermonuclear fuel, but importantly, with substantially reduced laser power and intensity requirements. The reduced intensity requirement with respect to shock ignition limits laser-plasma instabilities, such as stimulated Raman and Brillouin scatter, reducing the risk of hot-electron preheat and restoring the laser coupling advantages of conventional direct drive. Simulations indicate that, due to the reduced power requirements, high gain (∼100) ignition of large-scale direct drive implosions (outer radius ∼1750  μm, deuterium-tritium ice thickness ∼165  μm) may be possible within the power and energy limits of existing facilities such as the National Ignition Facility. Moreover, this concept extends to indirect drive implosions, which exhibit substantial yield increases at reduced implosion velocity. Shock-augmented ignition expands the viable design space of laser inertial fusion.

National audit of non-melanoma skin cancer excisions performed by plastic surgery in the UK

A national, multi-centre audit of non-melanoma skin cancer excisions by plastic surgery.

Incidence and periprocedural outcomes of heparin-induced thrombocytopenia in on-pump vs off-pump coronary artery bypass grafting patients – analysis from 2016–2019 national inpatient sample

Background

Heparin administered after Coronary Artery Bypass Grafting (CABG) can cause Heparin induced thrombocytopenia (HIT) leading to bleeding or thromboembolic complications. Despite its low incidence, HIT can lead to increased morbidity and in-hospital mortality.

Purpose

To study the incidence and periprocedural outcomes of HIT in On-pump vs Off-pump CABG patients.

Methods

This is a retrospective observational study involving index hospitalizations for CABG between January 1 2016–December 31 2019 from the National Inpatient Sample, the largest all-payer public database of hospital care data in the United States. Our study population included discharged adult patients (≥18 years) hospitalised for CABG using ICD-10 codes (validated in previous studies). Confounders were adjusted using Multivariable Regression Analysis.

Results

During 2016–2019, there were 100,715 principal hospitalizations for On-pump and 25,956 for Off-pump CABG. Mean age was 74.6±13.2 years. The incidence of HIT in the On-pump cohort was 0.33% (n=333) and 0.33% (n=85) in the Off-pump cohort. The On-pump cohort had 76% (n=76,543) males, 24% (n=24172) females (p&lt;0.0001) and the Off-pump cohort had 74.5% (n=19337) males, 24.5% (n=6359) females (p&lt;0.001). The On-pump cohort had 78.2% Whites, 7.1% Blacks, 7.7% Hispanics, and 7% other races, while the Off-pump cohort had 76.9% Whites, 7.8% blacks, 8.9% Hispanics and 6.4% other races. A total of 42.9% hospitalizations in the On-pump cohort had a Charlson Comorbidity Index (CCI) of three or higher and it was 43.5% hospitalizations in the Off-pump cohort. In-hospital mortality in the On-pump cohort was 1.6% and 2% in the Off-pump cohort.

Compared to the non-HIT cohort, On-pump HIT cohort had more females (31.2% vs 24%, p=0.02), were older (mean age: 67.2 years vs 65.7 years; p=0.006), had higher CCI of three or higher (65.8% vs 42.8%, p&lt;0.001), longer LOS (22.2 days vs 9.2 days, p&lt;0.001) with higher in-hospital mortality (13.5% vs 1.5%, p&lt;0.001). Multivariate regression analysis showed HIT cohort had higher odds of in-hospital mortality than non-HIT cohort (aOR: 8; 95% CI: 5.7, 11.2; p&lt;0.001) after controlling for age, sex, race, hospital region and status, income, insurance status and CCI.

The Off-pump HIT cohort had similar incidence of females (26% vs 27%, p=0.710), were older (mean age: 68 years vs 65.8 years; p=0.045), had higher CCI of three or higher (65.9% vs 43.5%, p&lt;0.001), had longer LOS (22.9 days vs 9.4 days, p&lt;0.001) with higher in-hospital mortality (10.6% vs 2%, p&lt;0.001) compared to the non-HIT cohort. Multivariate regression analysis showed HIT cohort had higher odds of in-hospital mortality than non-HIT cohort (aOR: 4.7; 95% CI: 2.3, 9.5; p&lt;0.001) after controlling for age, sex, race, hospital region and status, income, insurance status and CCI.

Conclusion

Our study observed that in-hospital mortality in patients with HIT was significantly high compared to patients without HIT after undergoing On-pump or Off-pump CABG.

Funding Acknowledgement

Type of funding sources: None.

Association and outcomes of vf according to involved coronary artery in STEMI – a nationwide analysis

Background

Ventricular fibrillation (VF) is common in acute ST segment elevation myocardial infarction (STEMI) and is associated with increased in-hospital mortality rate.

Purpose

We sought to investigate the association between VF and artery involved in STEMI

Methods

This is a retrospective observational study of hospitalizations between January 1, 2016 and December 31, 2019, using the National Inpatient Sample (NIS), the largest all-payer public database of hospital care in the United States.

Results

A total of 138,201 patients were primarily hospitalized for STEMI from 2016 to 2019. Among them 12,318 had right coronary artery (RCA) lesions, 427 had left main (LM) lesions, 2381 had left circumflex (LCx) lesions and 12,765 had left anterior descending (LAD) lesions. Mean age of patients with VF and STEMI was 62 years and that with RCA (63 years), LM (65 years), LCx (62 years), LAD (60 years), p&lt;0.001. Females were 30.5% (n=42,231) among all STEMI group and 29.8% (n=3672) RCA, 29% (n=124) LM, 27.4%(n=653) LCx and 28.6%(n=3645) LAD, p&lt;0.001. In-hospital mortality for all patients with STEMI was 7.9%. The in-hospital mortality associated with STEMI there was 5%, 23.4%, 6.6%, 7.1%, (p&lt;0.001) for RCA, LM, LCx and LAD respectively. The incidence of VF among all patients with STEMI was 8.3% (n=11425) and for LM, LAD, LCX, and RCA was 12.9%, 10.7%, 9.2% and 7.9% (p&lt;0.001). Mean hospital length of stay for VF with RCA (6.2 days), LM (5.5 days), LCx (6.9 days) and LAD (7.4 days). After adjusting for age, gender, race, income, comorbidities, hospital teaching status, region and year, patients with STEMI who had VF had higher odds of mortality (aOR 6.4, 95% CI, 6.1 to 6.8; P&lt;0.001). The highest likelihood of mortality observed in patients with VF who had and LCx STEMI (aOR 7.9, CI 95%, 5 to 12.4; p&lt;0.001) followed by RCA STEMI (aOR 7.4, 95% CI 6 to 9.1; p&lt;0.001), and LM STEMI (aOR 6.1, 95% 3.1 to 12; p&lt;0.001).

Conclusion

Highest in-hospital mortality was observed in patients with STEMI who had VF in LCx, followed by RCA and LM. There was higher occurrence of VF in STEMI involving LM.

Funding Acknowledgement

Type of funding sources: None.