Scoring systems, expert assessment, and identification of risk factors for the emergence of delirium in paediatric patients: Prospective cohort study

INTRODUCTION

Emergence delirium (ED) is a transient irritative and dissociative state that arises after the cessation of anaesthesia in patients who do not respond to calming measures. There are many risk factors for ED, but the exact cause and underlying mechanism have not been determined because the definition of ED is still unclear in consensus. This study aims to determine ED incidence, identify ED risk factors and external validation of Watcha, Cravero and expert assessment to Pediatric Anesthesia Emergence Delirium (PAED) scoring system in ED prediction.

MATERIALS AND METHODS

This study is a prospective cohort study on 79 paediatrics who underwent elective surgery with general anaesthesia. Parameter measures include the incidence of ED, ED risk factors, and the relationship between PAED, Watcha, Cravero score and expert assessment. The ED risk factor was analysed using univariate and multivariate analysis. The relationship between PAED, Watcha, Cravero score, and expert assessment was determined using Receiver Operating Characteristic (ROC) curve analysis.

RESULTS

The incidence of ED was 22.8%. All parameters examined in this study showed p < 0.05. Watcha's scoring correlates with the PAED scoring and shows the highest discrimination ability with AUC 0.741 and p < 0.05.

CONCLUSION

The incidence of ED in paediatrics is relatively high. Compared to others, Watcha score are more reliable for ED prediction. However, some demographic and perioperative factors are not the risk factor of ED.

The Fastest and Most Reliable Identification of True Hybrids in the Genus Pisum L

After crosses, the identification of true hybrids is not only the most important step in the initiation of a breeding program but also plays a crucial role in the improvement of hybrid varieties. However, current morphological or molecular-based hybrid identification methods are time-consuming and costly approaches that require knowledge and skill, as well as specific lab equipment. In the current study, xenia, direct or immediate effect of pollen on seeds was used to identify true hybrids in the genus Pisum L. for the first time without growing F1 plants. The current study was therefore aimed to (i) elucidate the xenia effect on seeds in intra- and interspecific crosses between P. sativum L. subsp. sativum var. sativum or var. arvense L. Poir. and its wild relatives, including P. sativum subsp. elatius (M. Bieb.) Aschers & Graebn. and P. fulvum Sibth. & Sm., and (ii) illuminate the beneficialness of the xenia effect in a practical improvement of the genus Pisum L. The pea cultivars, including P. sativum subsp. sativum var. sativum and P. sativum subsp. sativum var. arvense, were therefore crossed with P. sativum subsp. elatius and P. fulvum, and the occurrence of the xenia effect was studied on the seeds of fertilized female plants immediately after the crosses. It was concluded that using the xenia effect for the early detection of true hybrid immediately after crossing was not only the fastest, most reliable, and least expensive option as early selection criteria, but that xenia also provided information about dominant seed and pod traits after double fertilization.

Genome-wide discovery of di-nucleotide SSR markers based on whole genome re-sequencing data of Cicer arietinum L. and Cicer reticulatum Ladiz

Simple sequence repeats (SSRs) are valuable genetic markers due to their co-dominant inheritance, multi-allelic and reproducible nature. They have been largely used for exploiting genetic architecture of plant germplasms, phylogenetic analysis, and mapping studies. Among the SSRs, di-nucleotide repeats are the most frequent of the simple repeats distributed throughout the plant genomes. In present study, we aimed to discover and develop di-nucleotide SSR markers by using the whole genome re-sequencing (WGRS) data from Cicer arietinum L. and C. reticulatum Ladiz. A total of 35,329 InDels were obtained in C. arietinum, whereas 44,331 InDels in C. reticulatum. 3387 InDels with 2 bp length were detected in C. arietinum, there were 4704 in C. reticulatum. Among 8091 InDels, 58 di-nucleotide regions that were polymorphic between two species were selected and used for validation. We tested primers for evaluation of genetic diversity in 30 chickpea genotypes including C. arietinum, C. reticulatum, C. echinospermum P.H. Davis, C. anatolicum Alef., C. canariense A. Santos & G.P. Lewis, C. microphyllum Benth., C. multijugum Maesen, C. oxyodon Boiss. & Hohen. and C. songaricum Steph ex DC. A total of 244 alleles were obtained for 58 SSR markers giving an average of 2.36 alleles per locus. The observed heterozygosity was 0.08 while the expected heterozygosity was 0.345. Polymorphism information content was found to be 0.73 across all loci. Phylogenetic tree and principal coordinate analysis clearly divided the accessions into four groups. The SSR markers were also evaluated in 30 genotypes of a RIL population obtained from an interspecific cross between C. arietinum and C. reticulatum. Chi-square (χ²) test revealed an expected 1:1 segregation ratio in the population. These results demonstrated the success of SSR identification and marker development for chickpea with the use of WGRS data. The newly developed 58 SSR markers are expected to be useful for chickpea breeders.

A kabuli chickpea ideotype

The concept of 'crop ideotype' is coined as a desirable plant model expected to better perform for seed yield, oils and other useful characteristics when developed as a cultivar, and it consists of two major approaches, namely, (i) 'defect elimination', that is, integration of disease resistance to a susceptible genotype from a resistant genotype and (ii) 'selection for yield' by improving yield after crosses between desirable parents. For consideration of these approaches, here we introduced an ideotype in kabuli chickpea (Cicer arietinum L.) which is high-yielding, extra-large-seeded, and double- or multi-podded, has high plant height and imparipinnate-leafed traits, and is heat tolerant and resistant to ascochyta blight [Ascochyta rabiei (Pass.) Labr.], which causes considerable yield losses, via marker-assisted selection. F3 and F4 lines were evaluated for agro-morphological traits divided into six classes, namely, (i) imparipinnate-leafed and single-podded progeny, (ii) imparipinnate-leafed and double-podded progeny, (iii) imparipinnate-leafed and multi-podded progeny, (iv) unifoliolate-leafed and single-podded progeny, (v) unifoliolate-leafed and double-podded progeny, (vi) unifoliolate-leafed and multi-podded progeny. F3:4 lines having 100-seed weight ≥ 45 g and double- or multi-podded traits were additionally assessed for resistance to ascochyta blight using molecular markers including SCY17590 and CaETR-1. Superior lines having higher values than their best parents were determined for all studied traits indicating that economic and important traits including yield and seed size in chickpea could be improved by crossing suitable parents. Imparipinnate-leafed and multi-podded plants had not only the highest number of pods and seeds per plant but also the highest yield. On the other hand, imparipinnate-leafed and single podded progeny had the largest seed size, followed by imparipinnate-leafed and double-podded progeny. Multi-podded plants produced 23% more seed yield than that of single-podded plants, while multi-podded plants attained 7.6% more seed yield than that of double-podded plants. SCY17590 and CaETR-1 markers located on LG4 related to QTLAR2 and QTLAR1 were found in 14 lines among 152 F3:4 lines. Six superior lines were selected for being double- or multi-podded, imparipinnate-leafed, suitable for combine harvest, heat-tolerant, and resistant to ascochyta blight, and having both of two resistance markers and extra-large seeds as high as 50-60 g per 100-seed weight. Resistance alleles from two different backgrounds for resistance to ascochyta blight were integrated with double- or multi-podded kabuli chickpea lines having high yield, extra-large seeds, high plant height, imparipinnate-leaves and high heat tolerance, playing a crucial role for future demands of population and food security. These approaches seem to be applicable in ideotype breeding for other important crop plants.

De novo super-early progeny in interspecific crosses Pisum sativum L. × P. fulvum Sibth. et Sm

Earliness in crop plants has a crucial role in avoiding the stress of drought and heat, which are the most important challenging stressors in crop production and are predicted to increase in the near future due to global warming. Furthermore, it provides a guarantee of vegetable production in the short growing season of agricultural lands in the northern hemisphere and at high altitudes. The growing human population needs super early plant cultivars for these agricultural lands to meet future global demands. This study examined de novo super-early progeny, referred to as much earlier than that of the earlier parent, which flowered in 13-17 days and pod setting in 18-29 days after germination, discovered in F2 and studied up to F5 derived from interspecific crosses between garden pea (P. sativum L.) and the most distant relative of pea (P. fulvum Sibth. et Sm.). De novo super-early progeny were found to be earlier by about one month than P. sativum and two months than P. fulvum under short day conditions in the F5 population. In respect of days to flowering and pod setting, de novo super-early progeny had a relatively high level of narrow sense heritability (h2 = 82% and 80%, respectively), indicating that the selections for earliness in segregating populations was effective for improvement of extreme early maturing varieties. De novo super-early progeny could be grown under heat stress conditions due to the escape ability. Vegetable types were not only high yielding but also free of any known undesirable traits from the wild species, such as pod dehiscence and non-uniform maturity. It could be considered complementary to "speed breeding", possibly obtaining more than six generations per year in a suitable climate chamber. Not only de novo super-early progeny but also transgressive segregation for agro-morphological traits can be created via interspecific crosses between P. sativum and P. fulvum, a precious unopened treasure in the second gene pool. Useful progeny obtained from crossing wild species with cultivated species reveal the importance of wild species.

Cicer turcicum: A New Cicer Species and Its Potential to Improve Chickpea

Genetic resources of the genus Cicer L. are not only limited when compared to other important food legumes and major cereal crops but also, they include several endemic species with endangered status based on the criteria of the International Union for Conservation of Nature. The chief threats to endemic and endangered Cicer species are over-grazing and habitat change in their natural environments driven by climate changes. During a collection mission in east and south-east Anatolia (Turkey), a new Cicer species was discovered, proposed here as C. turcicum Toker, Berger & Gokturk. Here, we describe the morphological characteristics, images, and ecology of the species, and present preliminary evidence of its potential utility for chickpea improvement. C. turcicum is an annual species, endemic to southeast Anatolia and to date has only been located in a single population distant from any other known annual Cicer species. It belongs to section Cicer M. Pop. of the subgenus Pseudononis M. Pop. of the genus Cicer L. (Fabaceae) and on the basis of internal transcribed spacer (ITS) sequence similarity appears to be a sister species of C. reticulatum Ladiz. and C. echinospermum P.H. Davis, both of which are inter-fertile with domestic chickpea (C. arietinum L.). With the addition of C. turcicum, the genus Cicer now comprises 10 annual and 36 perennial species. As a preliminary evaluation of its potential for chickpea improvement two accessions of C. turcicum were field screened for reproductive heat tolerance and seeds were tested for bruchid resistance alongside a representative group of wild and domestic annual Cicer species. C. turcicum expressed the highest heat tolerance and similar bruchid resistance as C. judaicum Boiss. and C. pinnatifidum Juab. & Spach, neither of which are in the primary genepool of domestic chickpea. Given that C. arietinum and C. reticulatum returned the lowest and the second lowest tolerance and resistance scores, C. turcicum may hold much potential for chickpea improvement if its close relatedness supports interspecific hybridization with the cultigen. Crossing experiments are currently underway to explore this question.

The antimicrobial and tissue healing efficacy of the atmospheric pressure cold plasma on grade III infected pressure ulcer: randomized controlled in vivo experiment

AIM

To evaluate the antimicrobial efficacy and wound healing effect of atmospheric pressure cold plasma (APCP) on an infected pressure ulcer (IPUs) model that was created on rats.

METHODS

A total of 18 rats was divided into APCP, silver sulfadiazine (AgS) and control groups to have six rats in each group. A third-grade pressure ulcer model was developed on the back of each of the rats, and pressure ulcers were infected by inoculation of multidrug resistance (MDR) Pseudomonas aeruginosa. A portable dielectric barrier discharge device was used to generate cold air plasma. APCP, AgS and saline treatments were carried out once a day for 14 days. The effectiveness of the treatment was evaluated on days 5, 10 and 15. Surface area, depth, pressure ulcer healing scale (PUSH) and microbiological examination were used for evaluation.

RESULTS

The results of this study showed that APCP was superior over AgS application and irrigation with saline by means of the reduction in surface area and depth of ulcers. Furthermore, PUSH score in plasma group was lower than other groups and histopathological examination showed a higher epithelization in APCP group. The average reductions of MDR P. aeruginosa for APCP, AgS and control groups were determined as 5·64 ± 1·87, 1·91 ± 0·90 and 1·22 ± 0·88 log10 CFU per gram tissue, respectively.

CONCLUSION

Atmospheric pressure cold plasma healed IPUs better than AgS.

SIGNIFICANCE AND IMPACT OF THE STUDY

Portable cold plasma devices could be a potential novel treatment modality for the patients who have IPUs.

The MultiBac Baculovirus/Insect Cell Expression Vector System for Producing Complex Protein Biologics

Multiprotein complexes regulate most if not all cellular functions. Elucidating the structure and function of these complex cellular machines is essential for understanding biology. Moreover, multiprotein complexes by themselves constitute powerful reagents as biologics for the prevention and treatment of human diseases. Recombinant production by the baculovirus/insect cell expression system is particularly useful for expressing proteins of eukaryotic origin and their complexes. MultiBac, an advanced baculovirus/insect cell system, has been widely adopted in the last decade to produce multiprotein complexes with many subunits that were hitherto inaccessible, for academic and industrial research and development. The MultiBac system, its development and numerous applications are presented. Future opportunities for utilizing MultiBac to catalyze discovery are outlined.

PD-1 alters T-cell metabolic reprogramming by inhibiting glycolysis and promoting lipolysis and fatty acid oxidation

During activation, T cells undergo metabolic reprogramming, which imprints distinct functional fates. We determined that on PD-1 ligation, activated T cells are unable to engage in glycolysis or amino acid metabolism but have an increased rate of fatty acid β-oxidation (FAO). PD-1 promotes FAO of endogenous lipids by increasing expression of CPT1A, and inducing lipolysis as indicated by elevation of the lipase ATGL, the lipolysis marker glycerol and release of fatty acids. Conversely, CTLA-4 inhibits glycolysis without augmenting FAO, suggesting that CTLA-4 sustains the metabolic profile of non-activated cells. Because T cells utilize glycolysis during differentiation to effectors, our findings reveal a metabolic mechanism responsible for PD-1-mediated blockade of T-effector cell differentiation. The enhancement of FAO provides a mechanistic explanation for the longevity of T cells receiving PD-1 signals in patients with chronic infections and cancer, and for their capacity to be reinvigorated by PD-1 blockade.

Activation of T cells results in metabolic reprogramming to favour glycolysis. Here, Patsoukis et al. show that the surface receptor PD-1 inhibits glycolysis and increases the metabolism of lipids, providing a potential mechanism for the blockade of T effector functions but also for the longevity accompanying T cell exhaustion.

PD-1 inhibits T cell proliferation by upregulating p27 and p15 and suppressing Cdc25A

The programmed cell death-1 (PD)-1 receptor (CD279) is a potent T cell inhibitor with a critical role in peripheral tolerance, but it can also compromise anti-viral and antitumor T cell responses. The effects of PD-1 on the cell cycle leading to inhibition of T cell expansion are poorly understood. Recently, we examined the effects of PD-1 on the molecular control of the cell cycle machinery and on TCR-activated signaling pathways that regulate these downstream outcomes. Our studies showed that PD-1 blocks cell cycle progression in the G 1 phase. PD-1 did not alter the expression of G 1 phase cyclins or cyclin-dependent kinases (Cdks) but, instead, suppressed the transcription of SKP2, the substrate recognition component of the SCF (Skp2) ubiquitin ligase that leads p27 (kip1) to degradation and resulted in accumulation of p27 (kip1) . Subsequently, T cells receiving PD-1 signals displayed impaired Cdk2 activation and failed to phosphorylate two critical Cdk2 substrates, the retinoblastoma gene product (Rb) and the TGFβ-specific transcription factor Smad3, leading to suppression of E2F target genes but enhanced Smad3 transactivation. These events resulted in upregulation of the Cdk4/6 inhibitor p15 (INK4B) and repression of the Cdk-activating phosphatase Cdc25A. The suppressive effect of PD-1 on Skp2 expression was mediated by inhibition of both PI3K/Akt and Ras/MEK/Erk pathways and was only partially reversed by IL-2, which restored activation of MEK/Erk but not Akt. Thus, PD-1 targets Ras and PI3K/Akt signaling to inhibit transcription of Skp2 and to activate Smad3 as an integral component of a pathway that regulates blockade of cell cycle progression in T lymphocytes. Here, we discuss the detailed sequence of these signaling events and their implications in mediating cell-intrinsic and -extrinsic mechanisms that inhibit proliferation of T effector cells in response to PD-1-mediated signaling.

Src and Syk family kinases phosphorylate distinct tyrosines of RIAM (178.4)

RIAM is a novel adaptor involved in actin polymerization, cell adhesion and PLC-γ1 activation. RIAM contains two coiled-coil regions in the N-terminus, a small proline-rich N-terminus region, a Ras-association (RA) domain, a pleckstrin homology (PH) domain and a large proline-rich C-terminus region. Via its domains RIAM mediates distinct interactions and serves different functions. It was previously determined that RIAM is a substrate of the TCR proximal Src family kinases Fyn and Lck and the Syk family kinase ZAP-70. In the present study we sought to determine the precise tyrosine(s) of RIAM, which are phosphorylated by these kinases, by co-expressing RIAM deletion mutants (N-terminus, RA-PH, and C-terminus) along with active forms of each kinase in COS cells. Immunoprecipitations and immunoblot assays revealed that Src family kinases mediated robust and selective tyrosine phosphorylation of RIAM within the RA-PH domain. Mass spectrometry identified that tyrosine 340 within the PH domain was the specific and predominant target of Fyn and Lck. In contrast, ZAP-70 did not mediate phosphorylation in the RA-PH domain but, instead, induced robust phosphorylation in RIAM C-terminus downstream of the PH domain. The distinct tyrosine phosphorylation of RIAM mediated by Src family kinases and ZAP-70 suggests unique roles of these kinases in regulating RIAM interactions and functions. The role of the distinct phosphorylation events in these outcomes will be discussed.

Knowledge, attitudes, risk factors, and early detection of cancer relevant to the schoolteachers in Izmir, Turkey

BACKGROUND

Teachers are the population of interest because of the important role they play in education and possibly in prevention of cancer. The purpose of the research is to describe knowledge, attitudes, risk factors and early detection relevant to cancer of schoolteachers.

METHODS

A descriptive survey is conducted among 358 schoolteachers who are randomly selected from the eight schools in Izmir, Turkey. A self-administered questionnaire is used to investigate their knowledge in cancer, risk factors, attitudes, and early detection of cancer.

RESULTS

Knowledge in cancer and symptoms are assessed using the data collected from a series of simple questions. Potential scores ranged from 0 to 15.

CONCLUSIONS

In the sample, scores are distributed around a mean of 7.43 +/- 2.87. Risk factors and early detection associated with cancer are generally low.

Determination of sunburn and skin cancer risk of outpatients in a dermatology polyclinic

Public health experts and medical professionals continue to issue warnings to people about the dangers of ultraviolet (UV) radiation fromthe sun, tanning beds, and sun lamps. Skin cancer is more common than any other type of cancer and exposure to sun is known to contribute to all three major types, namely, basal-cell carcinoma, squamous-cell carcinoma and cutaneous melanoma. While skin cancer has been associated with sunburn, moderate tanning may also exert an influence. Seven steps to safer sunning are avoiding the sun, using a sunscreen, wearing a hat, wearing sunglasses, covering up, avoiding artificial tanning, and checking skin regularly. The present study was performed to examine the knowledge, attitudes, and risk factors of individuals concerning skin cancer. A descriptive survey was conducted among 475 patients randomly selected from the Dermatology Polyclinic of Ege University. A self-administered questionnaire was used to investigate their knowledge about skin cancer. A total of 297 female and 178 male participants were questioned, with a mean age of 32.48 +15.12. Some 36.8% had skin type II and 39.8% type III. The most common hair and eye color were brown, respectively at 56.0% and 58.7%. 79.8% had a mole(s), 19.2% had birthmark. A total of 8 of the 475 participants consulted for sunburns (1.7%). Glasses were the most popular preventive behaviour (28.8%). A total of 56 of the 475 outpatients questioned did not use any protective measure. Individuals need to be better educated on the dangers of the sun and sun protection as well as skin cancer.