Furthermore, Chenzhou, Linfen, Yuncheng, and Hechi had the highest children’s BLLs, with average values above 100.00 μg/L. The leading contributors to lead pollution are lead mining, lead recovery and the smelting industry. Nonetheless, the lead-acid battery industry needs more attention. Although data suggest that BLLs are decreasing in China, many areas still have high BLLs that need to be monitored. Moreover, national standards must improve to decrease acceptable BLL thresholds for children.Lead exposure adversely affects child health and continues to be a major public health concern in the United States (US). Lead exposure risk has been linked with older housing and households in poverty, but more studies of neighborhood socioeconomic status (SES) and lead exposure risk over large and diverse geographic areas are needed. In this paper, we combined lead test result data over many states for a majority of the US ZIP Codes in order to estimate its association with many SES variables and predict lead exposure risk in all populated ZIP Codes in the US. The methods used for estimation and prediction of lead risk included the Vox lead exposure risk score, random forest, weighted quantile sum (WQS) regression, and a Bayesian SES index model. The results showed that the Bayesian index model had the best overall performance for modeling elevated blood lead level (EBLL) risk and therefore was used to create a lead exposure risk score for US ZIP Codes. There was a statistically significant association between EBLL risk and the SES index and the most important SES variables for explaining EBLL risk were percentage of houses built before 1940 and median home value. When mapping the lead exposure risk scores, there was a clear pattern of elevated risk in the Northeast and Midwest, but areas in the South and Southwest regions of the US also had high risk. In summary, the Bayesian index model was an effective method for modeling EBLL risk associated with neighborhood deprivation while accounting for additional heterogeneity in risk using lead test result data covering a majority of the US. The resulting lead exposure risk score can be used for targeting public health intervention efforts.The harmful effect of carbon pollution leads to depletion of the ozone layer, which is one of the main challenges confronting the world. Although progress is made in developing different carbon dioxide (CO2) capturing methods, these methods are still expensive and face several technical challenges. Fuel cells (FCs) are efficient energy converting devices that produce energy via an electrochemical process. Recently varying kinds of fuel cells are considered as an effective method for CO2 capturing and/or conversion. Among the different types of fuel cells, solid oxide fuel cells (SOFCs), molten carbonate fuel cells (MCFCs), and microbial fuel cells (MFCs) demonstrated promising results in this regard. High-temperature fuel cells such as SOFCs and MCFCs are effectively used for CO2 capturing through their electrolyte and have shown promising results in combination with power plants or industrial effluents. An algae-based microbial fuel cell is an electrochemical device used to capture and convert carbon dioxide through the photosynthesis process using algae strains to organic matters and simultaneously power generation. This review present a brief background about carbon capture and storage techniques and the technological advancement related to carbon dioxide captured by different fuel cells, including molten carbonate fuel cells, solid oxide fuel cells, and algae-based fuel cells.Although the influence of environmental factors on the microbial community in water sources is crucial, it is seldom evaluated. The seasonal relationship between microbial diversity of bacteria and fungi and environmental factors was investigated in a large drinking-water reservoir using Illumina MiSeq sequencing. Forty-one bacterial phyla and nine fungal phyla were analyzed in the Qingcaosha Reservoir, Shanghai, China. The predominant bacterial phyla were Actinobacteria, Proteobacteria, Bacteroidetes, and Cyanobacteria, with the maximum relative abundance of 46%, 36.6%, 16.1%, and 14.9%, respectively. Actinobacteria were observed to be the predominant bacterial phylum during spring and summer. The maximum relative abundance of unclassified fungi appeared in summer (98.8%), which was higher than that of Ascomycota and Basidiomycota (11.7% and 8.2%, respectively). Principal coordinate analysis (PCoA) results showed that the structural similarity in the bacterial community was greater during summer and winter; orrelated with TP. Therefore, the relative abundance of predominant bacteria was affected by various environmental factors; however, fungi were mainly influenced by TP.The natural variation of multiple abiotic stresses in hyper-seasonal edaphic savanna provides a unique opportunity to study the rhizobacteriome community structure of plants adapted to climate change-like conditions in the humid tropics. In this study, we evaluated changes in soil, plant and rhizobacteriome community structure parameters across seasons (wet and dry) in two edaphic savannas (SV-1 and SV-5) using four dominant plant species. We then examined relationships between rhizobacteriome community structure and soil properties, plant biomass, and conventional and novel root traits. We further hypothesized that plants adapted to the Aripo Savanna had a core rhizobacteriome, which was specific to plant species and related to root foraging traits. Our results showed that cation exchange capacity (CEC) and the concentration of micronutrients (Fe, Cu and B) were the only soil factors that differed across savanna and season, respectively. Plant biomass traits were generally higher in the dry season, with a hiecologically similar to the Aripo Savanna.The dynamics of As at the sediment-water interface (SWI) is an important link in driving As release into the upper water column to affect biological activities. At present, it is unclear about the As cycling at the SWI, especially under the influence of seasonal hypoxia in the Changjiang Estuary. In this study, the profile variations of As in porewater and solid phases from the Changjiang Estuary were studied. Results suggested that As profiles presented the „removal-release-removal” pattern with depth. Arsenic profiles were typically characterized by subsurface maxima in porewater and surficial enrichment in solid phase, which were closely related to Fe and S cycling. The occurrence of porewater As peaks and its obvious speciation transition at subsurface layers, companied by the conversion of dominant phases of solid As from reductive to oxidative fractions at the same layers indicated the reductive release of As at redoxcline. Arsenic species, saturation indexes (SI) and net reaction rates (RnetAs) suggested that the removal of As at surface and deep layers were attributed to the adsorption of As(V) by Fe oxides and the formation of orpiment and/or adsorption by Fe sulfides, respectively. The benthic hypoxic environment in late-summer was more favorable for upward migration and diffusion of As. This process was considered as an important contribution to the elevated aquatic As in the Changjiang Estuary.Globally, the demand for sustainable energy production and high-value biological compounds have become intertwined in an attempt to improve the feasibility of sustainable algal cultivation. Marine microalgae, especially diatoms and coccolithophores, represent viable cultures that can produce biofuels and high-value compounds. Growing them in co-culture offers the potential to produce lipids and pigments, while also generating CaCO3 for C sequestration. The main objective of this work was to investigate competition or co-existence of the diatom Chaetoceros gracilis and the coccolithophore Pleurochrysis Carterae. The focus was on the effects of silicate and co-culturing on the growth rate, productivity, pigment production, and ash production for C. gracilis and P. carterae in laboratory conditions. The results showed that, in monoculture, 2-mM Si enhanced the specific growth rate of C. gracilis, but did not affect P. carterae. Regardless of silicate concentration, C. gracilis was more productive than P. carterae. In co-culture, P. carterae had a slower growth rate, indicating an inhibitory effect of C. gracilis on P. carterae. Neither silicate concentration nor co-culturing had an impact on the contents of pigments fucoxanthin, chlorophyll-a, and chlorophyll-c, which means that pigment productivity was proportional to biomass productivity. Finally, the ash content increased in all cultures with the lower silicate concentration (0.2 mM) in the medium. With one exception, the ash content was dominated by SiO2 regardless of silicate amount, and CaCO3 was a major part of the ash only when P. carterae was grown separately with the higher silicate level. These results highlight that co-culturing did not provide an advantage for improving biomass, pigments, or CaCO3 productivity.The occurrence of green-tides, whose bloom potential may be increased by various human activities and biogeochemical process, results in enormous economic losses and ecosystem collapse. In this study, we investigated the ecophysiology of the subtropical green-tide forming alga, Ulva ohnoi complex (hereafter U. ohnoi), under simulated future ocean conditions in order to predict its bloom potential using photosynthesis and growth measurements, and stable isotope analyses. Our mesocosm system included four experimental conditions that simulated the individual and combined effects of elevated CO2 and temperature, namely control (450 μatm CO2 & 20 °C), acidification (900 μatm CO2 & 20 °C), warming (450 μatm CO2 & 25 °C), and greenhouse (900 μatm CO2 & 25 °C). Photosynthetic electron transport rates (rETR) increased significantly under acidification conditions, but net photosynthesis and growth were not affected. In contrast, rETR, net photosynthesis, and growth all decreased significantly under elevated temperature conditions (i.e. both warming and greenhouse). These results represent the imbalance of energy metabolism between electron transport and O2 production that may be expected under ocean acidification conditions. This imbalance appears to be related to carbon and nitrogen assimilation by U. ohnoi. In particular, 13C and 15N discrimination data suggest U. ohnoi prefers CO2 and NH4+ over HCO3- and NO3- as sources of carbon and nitrogen, respectively, and this results in increased N content in the thallus under ocean acidification conditions. Together, our results suggest a trade-off in which the bloom potential of U. ohnoi could increase under ocean acidification due to greater N accumulation and through the saving of energy during carbon and nitrogen metabolism, but that elevated temperatures could decrease U. ohnoi’s bloom potential through a decrease in photosynthesis and growth.

Exposure to phthalates is ubiquitous across the United States. While phthalates have anti-androgenic effects in men, there is little research on their potential impacts on sex hormone concentrations in women and that also take into account menopausal status.

Cross-sectional data on urinary phthalate metabolites, serum sex hormones, and relevant covariates were obtained from the National Health and Nutrition Examination Survey 2013-14 and 2015-16. Women over the age of 20 who were not pregnant or breastfeeding and had not undergone oophorectomy were included (n=698 premenopausal, n=557 postmenopausal). Weighted multivariable linear and Tobit regression models stratified by menopausal status were fit with natural log-transformed phthalate concentrations and sex hormone outcomes adjusting for relevant covariates.

Phthalate metabolites were associated with differences in sex hormone concentrations among postmenopausal women only. Di-2-ethylhexyl phthalate (DEHP) was associated with lower serum estradiol andals.Pakistan is highly dependent on water resources from the mountainous regions of the Upper Indus Basin (UIB), especially for irrigation. An evaluation framework was developed and applied in this study to understand the variability in surface water availability to agricultural and domestic sectors across various future climate and socioeconomic pathways in five catchments within the UIB (Astore, Gilgit, Hunza, Shigar, and Shyoke). A planning tool named Water Evaluation and Planning (WEAP) was used to understand the dynamics of past and future water demands for multiple future scenarios. We combined three different climate scenarios (representative concentration pathways) with socioeconomic scenarios (shared socioeconomic pathways) of economic development and population and local agricultural land development pathways. The results indicate that the external driving forces of climate change and socioeconomic growth will cause a discrepancy between the supply and demand of water resources in regions with higher socioeconomic growth, particularly those with agricultural development as the dominant external factor. Among the five catchments within the UIB, Astore and Gilgit face a water shortfall in all future scenarios, whereas Shyoke will encounter water deficiencies only in the case of agricultural land development. We also demonstrated that the impact of climate change is markedly different in Astore and Gilgit. Over Astore, the impact of precipitation will control the unmet water demands by increasing winter streamflow whereas over Gilgit non-climatic factors, such as population and agricultural growth, will control future unmet water demands.Association of both iron/hepcidin and apolipoprotein E (ApoE) with development of Alzheimer disease (AD) and atherosclerosis led us to hypothesize that ApoE might be required for body iron homeostasis. Here, we demonstrated that ApoE knock-out (KO) induced a progressive accumulation of iron with age in the liver and spleen of mice. Subsequent investigations showed that the increased iron in the liver and spleen was due to phosphorylated extracellular regulated protein kinases (pERK) mediated up-regulation of transferrin receptor 1 (TfR1), and nuclear factor erythroid 2-related factor-2 (Nrf2)-dependent down-regulation of ferroportin 1. Furthermore, replenishment of ApoE could partially reverse the iron-related phenotype in ApoE KO mice. The findings imply that ApoE may be essential for body iron homeostasis and also suggest that clinical late-onset diseases with unexplained iron abnormality may partly be related to deficiency or reduced expression of ApoE.Autophagy and apoptosis are powerful regulators of multiple facets of cellular metabolism and homeostasis. Here, we uncover that galanin, a pleiotropic peptide, regulates cardiac autophagy and deactivates apoptotic cell death through the Forkhead box protein O1 (FoxO1) pathway. In hypertrophied heart, galanin promotes autophagy and metabolic shift from fatty acid (FA) to glucose oxidation and preserves mitochondrial integrity. In cardiomyoblasts, galanin triggers autophagosome formation and alleviates hypertrophy, apoptotic cell death, and mitochondrial stress. Mechanistically, galanin dictates cell autophagic and anti-apoptotic phenotypes through FoxO1 pathway. Together, these findings uncover a previously unknown role for galanin in the regulation of cardiac autophagy and provide new insights into the molecular mechanisms supporting cell survival in the hypertrophic reprogramming of the heart.Liver is a unique organ in displaying a reparative and regenerative response after acute/chronic damage or partial hepatectomy, when all the cell types must proliferate to re-establish the liver mass. The NADPH oxidase NOX4 mediates Transforming Growth Factor-beta (TGF-β) actions, including apoptosis in hepatocytes and activation of stellate cells to myofibroblasts. Aim of this work was to analyze the impact of NOX4 in liver regeneration by using two mouse models where Nox4 was deleted 1) general deletion of Nox4 (NOX4-/-) and 2) hepatocyte-specific deletion of Nox4 (NOX4hepKO). Liver regeneration was analyzed after 2/3 partial hepatectomy (PH). Results indicated an earlier recovery of the liver-to-body weight ratio in both NOX4-/- and NOX4hepKO mice and an increased survival, when compared to corresponding WT mice. The regenerative hepatocellular fat accumulation and the parenchyma organization recovered faster in NOX4 deleted livers. Hepatocyte proliferation, analyzed by Ki67 and phospho-Histone3 immunohistochemistry, was accelerated and increased in NOX4 deleted mice, coincident with an earlier and increased Myc expression. Primary hepatocytes isolated from NOX4 deleted mice showed higher proliferative capacity and increased expression of Myc and different cyclins in response to serum. Transcriptomic analysis through RNA-seq revealed significant changes after PH in NOX4-/- mice and support a relevant role for Myc in a node of regulation of proliferation-related genes. Interestingly, RNA-seq also revealed changes in the expression of genes related to activation of the TGF-β pathway. In fact, levels of active TGF-β1, phosphorylation of Smads and levels of its target p21 were lower at 24 h in NOX4 deleted mice. Nox4 did not appear to be essential for the termination of liver regeneration in vivo, neither for the in vitro hepatocyte response to TGF-β1 in terms of growth inhibition, which suggest its potential as therapeutic target to improve liver regeneration, without adverse effects.Amplification-based nucleic acid detection is widely employed in food safety, medical diagnosis and environment monitoring. However, conventional nucleic acid analysis has to be carried out in laboratories because of requiring expensive instruments and trained personnel. If people could do nucleic acid detection at home by themselves, the application of nucleic acid detection would be greatly accelerated. We herein reported a polypropylene (PP) bag-based method for convenient detection of nucleic acids in the oil-sealed space. The PP bag has three chambers which are responsible for lysis, washing and amplification/detection, respectively. After adding sample, nucleic acids are adsorbed on magnetic particles (MPs) and moved into these three chambers successively through immiscible oil channel by an external magnet. Combined with isothermal amplification, the PP bag can be incubated in a water bath or milk warmer and acted as a reaction tube. With highly specific CRISPR technology, Salmonella typhimurium (St) and SARS-CoV-2 can be visually detected in these PP bags within 1 h, indicating its potential household application. To further improve the reliability of nucleic acid testing at home, a logic decision method is introduced by detecting both target and endogenous reference gene. Positive/negative/invalid detection result can be obtained by chronologically adding the CRISPR reagents of target and endogenous reference gene. We anticipate that this PP bag can provide a novel toolkit for nucleic acid detection in people’s daily life.In order to alter the complexion of immunoprobe with large impedance as negative factor in sensitivity of amperometric immunosensor, a strategy of Fenton reaction-mediated dual-attenuation of signal was proposed. Herein, metal-polydopamine-Fe3+ composite with the ability of Fenton reaction was initially prepared as immunoprobe for an ultrasensitive immunoassay. The polymerization of dopamine occurred on the surface of ZIF-67 to gain the metal-polydopamine shell, which possessed rich functional groups, negative charge and high specific surface. Then the prepared functional shell was further used to absorb Fe3+ and immobilize labeling antibody as immunoprobe, which was used to construct a sandwich type immunosensor. With addition of H2O2 and aniline, Fenton reaction was triggered to produce hydroxyl radicals, which can not only decrease the current value by degrading methylene blue molecules, but also further initiate aniline to polymerize into non-conductive polyaniline for successive abatement of signal intensity. Therefore, the dual-attenuation of signal model rendered the immunoprobe into a favorable factor and synchronously enhance sensitivity. Expectedly, the detection performance with a linear range from 1.0 × 10-4-100 ng mL-1 and ultralow detection limit of 9.07 × 10-5 ng mL-1 toward neuron-specific enolase was obtained under optimal conditions. This work offered a novel tactic for enhancing sensitivity of immunosensor through the preparation of functional immunoprobe and its rational utilization as signal enhancer.A new electrochemiluminescence (ECL) immunosensor based on spatially-resolved dual-potential technology was designed for the simultaneous determination of carbohydrate antigen 19-9 (CA 19-9) and carbohydrate antigen 24-2 (CA 242). Luminol-AgNPs@ZIF-67 was used as the anodic probe, and Pt nanoparticle-functionalized graphitic carbon nitride nanosheets (g-C3N4@PtNPs) were used as the cathodic probe. Two spatially-resolved areas on the dual-disk glassy carbon electrode (DDGCE) were modified with a AuNPs film by electrodeposition to improve the conductivity of the sensing interface. By recording the ECL responses at two different excitation potentials, the linear range for CA 19-9 was determined to be 0.0001-10 U/mL, with a limit of detection of 31 μU/mL. The linear range for CA 242 was 0.0005-10 U/mL, with a limit of detection of 0.16 mU/mL. Moreover, the ECL immunosensor possessed high selectivity and stability and successfully detected CA 19-9 and CA 242 in real samples. This immunosensor provides a new platform for clinical immunoassays.The formation of G-quadruplex (G4) structures in Human telomeric DNA (H-Telo) has been demonstrated to inhibit the activity of telomerase enzyme that is associated with the proliferation of many cancer cells. Accordingly, G-quadruplex structures have become one of the well-established targets in anticancer therapeutic strategies. And, the development of simple and selective detection platforms for G4 structures has become a significant focus of research in recent years. In this study, a simple „off-on” fluorometric method was developed for the selective detection of picomolar quantities of H-Telo G4 DNA based on a fluorescent cerium-based metal organic framework (Ce-MOF) conjugated with hemin to form the sensing probe, Hemin@Ce-MOF. The solvothermal synthesis of the Ce-MOF took advantage of 5-aminoisophtlalic acid (5AIPA) as the organic bridging ligand, (Ce2(5AIPA)3(DMF)2). Characterization of Ce-MOF and Hemin@Ce-MOF was performed by XRD, XPS, TEM, SEM, BET and FTIR techniques. The detection and quantification of the H-Telo was carried out through the adsorption/incorporation of hemin molecules on the pores and surface of Ce-MOF resulting in the fluorescent quenching of the system followed by the restoration of the fluorescence upon addition of H-Telo probably due to a competition between H-Telo and Ce-MOF to bind to hemin. The impact of the key variables including MOF quantity, hemin concentration and detection time was investigated and optimized. Under the optimized conditions, the developed probe provides a limit of detection (LOD) of 665 pM, linear dynamic range (LDR) of 1.6-39.7 nM and excellent selectivity towards H-Telo. Taken together, these results present a simple, novel and superior platform for the selective detection of H-Telo G4 DNA.Dependable, specific and rapid diagnostic methods for severe acute respiratory syndrome β-coronavirus (SARS-CoV-2) detection are needed to promote public health interventions for coronavirus disease 2019 (COVID-19). Herein, we have established an entropy-driven amplified electrochemiluminescence (ECL) strategy to detect the RNA-dependent RNA polymerase (RdRp) gene of SARS-CoV-2 known as RdRp-COVID which as the target for SARS-CoV-2 plays an essential role in the diagnosis of COVID-19. For the construction of the sensors, DNA tetrahedron (DT) is modified on the surface of the electrode to furnish robust and programmable scaffolds materials, upon which target DNA-participated entropy-driven amplified reaction is efficiently conducted to link the Ru (bpy)32+ modified S3 to the linear ssDNA at the vertex of the tetrahedron and eventually present an „ECL on” state. The rigid tetrahedral structure of the DT probe enhances the ECL intensity and avoids the cross-reactivity between single-stranded DNA, thus increasing the sensitivity of the assays. The enzyme-free entropy-driven reaction prevents the use of expensive enzyme reagents and facilitates the realization of large-scale screening of SARS-CoV-2 patients. Our DT-based ECL sensor has demonstrated significant specificity and high sensitivity for SARS-CoV-2 with a limit of detection (LOD) down to 2.67 fM. Additionally, our operational method has achieved the detection of RdRp-COVID in human serum samples, which supplies a reliable and feasible sensing platform for the clinical bioanalysis.A novel nano-electrocatalyst based on Cu5V2O10 is successfully fabricated by one-pot hydrothermal treatment and used for the examination of mefenamic acid (MFA) in real samples, for the first time. Controlling the combined factors of complexing agent’s (4, 4′-Diaminodiphenylmethane, DDM) molar ratio, hydrothermal temperature, and reaction time is responsible for providing the optimal structural and morphological changes of the crystals. The effect of operating conditions of Cu5V2O10 nanostructures is investigated using FT-IR, XRD, and EDX as structural and elemental analyses. Also, other properties such as particle size and morphological studies were accomplished by FE-SEM, and HR-TEM. The results reveal that the monoclinic phase of Cu5V2O10 with particle size of 34 nm is the outcome of hydrothermal treatment of 200 °C for 18 h, which DDM template with molar ratio of 2.0 M serves as phase stabilizing matrix. Herein, it is demonstrated the electrochemical biosensing characteristics of the nano-scale Cu5V2O10 modified carbon paste electrode (CV/CPE) by voltammetry techniques. The drug sensing capabilities of the boosted CV/CPE platform exhibit linear dynamic range of 0.01-470 μM, and low detection limit of 2.34 nM with excellent sensitivity and selectivity. The appropriate electrical conductivity and layered structure of the compound causes a valuable platform for minimally invasive assessment of MFA in biological and pharmaceutical media with recovery rate of 98.3%-110.0% and 93.6%-106.7%, respectively. As a result, the proposed nanostructures as great candidate offer excellent electrocatalytic activity in biomedicine applications.Being closely associated with a variety of physiological and pathological processes, matrix metalloproteinases (MMPs) are useful as potential targets for drug therapy and informative markers for disease diagnosis. On the basis of the electrochemically induced grafting of ferrocenyl polymers and the proteolytic cleavage of recognition peptide, a novel electrochemical sensor is presented in this work for the highly specific interrogation of MMP activities at ultralow levels. The recognition peptide, to be immobilized via the N-terminus, is free of carboxyl group. The presence of the target MMP would cleave the end-tethered recognition peptide, generating a free carboxyl group at the C-terminus of the rest fragment. To be used as the reversible addition-fragmentation chain-transfer (RAFT) agent, the dithiobenzoate, 4-cyano-4-(phenylcarbonothioylthio)pentanoic acid (CPAD), can therefore be tethered via the carboxylate-Zr(IV)-carboxylate chemistry. Subsequently, the grafting of ferrocenyl polymers through electrochemically induced RAFT (eRAFT) polymerization of ferrocenylmethyl methacrylate (FcMMA) would recruit a large quantity of Fc redox reporters on electrode surface. With benefits from the excellent specificity of the enzyme-substrate recognition, the presented cleavage-based sensor is highly selective. Under optimal conditions, the detection limit in the presence of MMP-2 as the model target can be as low as 0.27 pg mL-1, with a linear range from 1 pg mL-1 to 1 ng mL-1. Furthermore, its applicability in the interrogation of MMP activity in complex serum samples and the screening of MMP inhibitors is satisfactory. The presented cleavage-based electrochemical MMP sensor is easy to fabricate and low-cost, thus showing great promise in drug discovery and disease diagnosis.

Recent studies suggest that desmoid tumors can be managed more conservatively rather than undergoing wide surgical resection (SR). Ultrasound-guided vacuum-assisted biopsy (UGVAB) is a minimally invasive technique. This retrospective study aimed to compare the outcome in patients with breast desmoid tumor (BDT) who received UGVAB alone versus SR.

The pathology database was searched for patients diagnosed with BDT≤3cm from 2007 to 2019. All patients underwent breast ultrasound examination and were then performed UGVAB alone or local SR. The Kaplan-Meier method with a log-rank test was used as a univariate analysis to compare the relapse-free survival (RFS) rates between UGVAB and SR groups. Cox regression analysis was used for multivariate analysis.

A total of 39 patients were included. The median follow-up was 41mo (range, 5-110mo). The incidence of tumor recurrence was 23.1% (9/39). The 3-y cumulative RFS was 83.1% and 95.8% in the UGVAB and SR group, respectively, which was not significantly different between the two groups (P=0.131, log-rank test). Multivariate analysis also revealed that treatment strategy (UGVAB versus SR) was not associated with an increased risk of relapse events (P=0.274).

Small desmoid tumors (≤3cm) after UGVAB alone did not have a significantly compromised RFS compared with those who underwent SR. UGVAB may be an alternative and relatively conservative method for the diagnosis and local control of BDT with a smaller size. A prospective, randomized study with large sample size is needed to confirm this observation.

Small desmoid tumors (≤3 cm) after UGVAB alone did not have a significantly compromised RFS compared with those who underwent SR. UGVAB may be an alternative and relatively conservative method for the diagnosis and local control of BDT with a smaller size. A prospective, randomized study with large sample size is needed to confirm this observation.

Mobile smartphone thermal imaging (MTI) devices correlate with blood flow, which makes them appealing adjuncts during reconstructive surgery. MTI was assessed in the setting of deep inferior epigastric artery perforator (DIEAP) free flaps. We hypothesized that MTI can be a surrogate for blood flow to identify microvascular flow insufficiencies.

Nineteen patients underwent 30 DIEAP flaps for breast reconstruction. Images were obtained preoperatively, intraoperatively, and at instances of concern for flap viability. Three groups were evaluated normal DIEAP flaps (NDFs), flaps with arterial insufficiency (AI), and flaps with venous congestion (VC).

All flaps were successful. There were significant temperature increases from max ischemia (24.5±2.1°C) to 1min after anastomosis (27.2±1.6°C, P<0.001). NDFs continued to warm until the final MTI was taken when leaving the operating room. There were no differences between MTI flap temperatures before transfer to the chest and after completion of microanastomosis. With questionable flap viability, VC and AI temperatures were found to be significantly colder than the NDF group (28.3±1.9°C versus 32.2±1.8°C, P=0.003) in the VC group and (27.2±0.7°C versus 32.2±1.8°C, P=0.001) in the AI group. After correction of the identified flow insufficiency, VC and AI rewarmed and temperatures were no different compared with NDF.

MTI recognizes microanastomotic failure and is a practical adjunct in the evaluation of free flap perfusion.

MTI recognizes microanastomotic failure and is a practical adjunct in the evaluation of free flap perfusion.

Trauma field triage matches injured patients to the appropriate level of care. Prior work suggests the Glasgow Coma Scale motor (GCSm) is as accurate as the total GCS (GCSt) and easier to use. However, older patients present with higher GCS for a given injury, and as such, it is unclear if this substitution is advisable. Our objective was to compare the GCS deficit patterns between geriatric and adult patients presenting with severe traumatic brain injury (TBI), as well as the diagnostic performance of the GCSm versus GCSt within the field triage criteria in these populations.

We conducted a retrospective, observational cohort study of patients ≥16y in the National Trauma Data Bank 2007-2015. GCS deficit patterns were compared between adults (16-65) and geriatric patients (>65). Measures of diagnostic performance of GCSt≤13 versus GCSm≤5 criteria to predict trauma center need (TCN) were compared.

In total, 4,480,185 patients were analyzed (28% geriatric). Geriatric patients more frequently presented with non-motor-only deficits than adults (16.4% versus 12.4%, P<0.001), and these patients demonstrated higher severe TBI (40.3% versus 36.7%, P<0.001) and craniotomy (5.8% versus 5.1%, P<0.001) rates. GCSt was more sensitive and accurate in predicting TCN for geriatric patients and had lower rates of undertriage as compared to GCSm.

Geriatric patients more frequently present with non-motor-only deficits after injury, and this is associated with severe head injury. Substitution of GCSm for GCSt would exacerbate undertriage in geriatric patients and, thus, the total GCS should be maintained for field triage in geriatric patients.

Geriatric patients more frequently present with non-motor-only deficits after injury, and this is associated with severe head injury. Substitution of GCSm for GCSt would exacerbate undertriage in geriatric patients and, thus, the total GCS should be maintained for field triage in geriatric patients.

Emergency general surgery (EGS) patients are more socioeconomically vulnerable than elective counterparts. We hypothesized that a hospital’s neighborhood disadvantage is associated with vulnerability of its EGS patients.

Area deprivation index (ADI), a neighborhood-level measure of disadvantage, and key characteristics of 724 hospitals in 14 states were linked to patient-level data in State Inpatient Databases. Hospital and EGS patient characteristics were compared across hospital ADI quartiles (least disadvantaged [ADI 1-25] „affluent,” minimally disadvantaged [ADI 26-50] „min-da”, moderately disadvantaged [ADI 51-75] „mod-da”, and most disadvantaged [ADI 76-100] „impoverished”) using chi

tests and multivariable regression.

Higher disadvantage hospitals are more often nonteaching (affluent=38.9%, min-da=53.5%, mod-da=72.1%, and impoverished=67.6%), nonaffiliated with medical schools (50%, 72.4%, 81.8%, and 78.8%), and in rural areas (3.3%, 9.2%, 31.2%, and 27.9%). EGS patients at higher disadvantage ions but are less likely to have robust resources for EGS care or train future EGS surgeons. These findings have implications for measures to improve equity in EGS outcomes.

Multiple serologic markers have been studied to predict complicated acute appendicitis (CAA) (C-reactive protein and procalcitonin); these increase health care costs and are not always available in medical centers in Mexico. There is a need for low-cost serologic markers to predict CAA and guide the preoperative management of patients. Our objective was to analyze the predictive value of hyponatremia and thrombocytosis for complicated acute appendicitis.

We analyzed 274 patients with AA surgically treated and divided them into two groups the CAA group and the uncomplicated AA group. We compared the serum values of sodium and platelet blood counts on presentation in the emergency room between the two groups and the proportion of patients with hyponatremia and/or thrombocytosis. Receiver operating characteristic analysis was performed for the two biochemical markers. Sensitivity, specificity, and positive and negative predictive values were calculated for complicated appendicitis in the presence of hyponatr analyze the association between thrombocytosis and complicated appendicitis.

Patients presenting with acute abdominal pain often undergo a computed tomography (CT) scan as part of their diagnostic workup. We investigated the relationship between availability, timeliness, and interpretation of CT imaging and outcomes for life-threatening intra-abdominal diseases or „acute abdomen,” in older Americans.

Data from a 2015 national survey of 2811 hospitals regarding emergency general surgery structures and processes (60.1% overall response, n=1690) were linked to 2015 Medicare inpatient claims data. We identified beneficiaries aged ≥65 admitted emergently with a confirmatory acute abdomen diagnosis code and operative intervention on the same calendar date. Multivariable regression models adjusted for significant covariates determined odds of complications and mortality based on CT resources.

We identified 9125 patients with acute abdomen treated at 1253 hospitals, of which 78% had ≥64-slice CT scanners and 85% had 24/7 CT technicians. Overnight CT reads were provided by in-house radioatients with abdominal pain may improve outcomes in high-risk patients.

Pancreatic ductal adenocarcinoma is considered as one of the most malignant types of cancer with rapid metastasis and invasion of the cancer cells, having peritoneal metastasis (PM) as a dominant factor of poor prognosis. Although the prevention of peritoneal dissemination would result in the inhibition of the initial metastatic process and contribute in improving the poor prognosis of the pancreatic cancer, the initial dynamics of PM are still unclear because of the lack of adequate models in studying the morphological and molecular details of pancreatic cancer cells.

The artificial human peritoneal tissue (AHPT) that can be applied in studying for the spatial dynamics of cancer PM invitro has been established previously. In this study, the initial dynamics of the three pancreatic cell lines, undifferentiated carcinoma MIA PaCa-2, poorly differentiated adenocarcinoma Panc-1, and moderately differentiated adenocarcinoma BxPC3 on AHPT are examined.

In a morphological analysis using light and electron micr cell lines were demonstrated by AHPT, showing the morphological and molecular diversity depending on the degree of differentiation or the properties of oncogenic protein secretion.In the medical literature, some case reports on the association of the COVID-19 infection and occurrence of spontaneous subarachnoid hemorrhage (SAH)have been reported Aim of the present paper is to search the causes of this association The diagnosis of COVID-19 was based on the real-time reverse-transcription polymerase chain reaction (PCR) test and computed tomography (CT) of the chest. There were four patients, whose median ages were 46,758, ranged 36-54 years). In conclusion, Spontaneous SAH can occur in the early and late course of COVID-19 infection. Its early recognition of the patient with spontaneous SAH is imperative.

Endovascular mechanical thrombectomy (EMT) is the standard of care for acute ischemic stroke (AIS) caused by proximal large vessel occlusions. There is conflicting evidence on outcome of patients undergoing EMT under procedural sedation (PS) or general anesthesia (GA). In this retrospective study we analyze the effect of GA and PS on the functional outcome of patients undergoing EMT.

Patients who have been admitted at our institute AIS and were treated with EMT under GA or PS between January 2015 and September 2018 were included in the study. Primary end point was the proportion of patients with good functional outcome as defined by a modified Rankin score (mRS) 0-2 at discharge.

A total of 155 patients were analyzed in this study including 45 (29.03 %) patients who received 97 GA, 110 (70.9 %) PS and 31 of these received Dexmedetomidine/Remifentanil. The median (IQR) 98 mRS at discharge was 4.0 (1.0-4.0) in the GA group Vs 3.00, (1.00-4.00) in the PS group. Among the secondary outcomes the lowest MAP recorded was significantly less in GA group (64.56 100 ± 18.70) compared to PS group (70.86 ± 16.30); p = 0.03. The PS group had a lower odd of mRS 3-5 (after adjustment), however, this finding was statistically not significant (OR 0.52 [0.07-3.5] 102 p = 0.5).

Our retrospective analysis did not find any influence of GA compared to PS whenever this was delivered by target controlled infusion (TCI) of propofol or by remifentanil/dexmedetomidine (REX) on early functional outcome.

Our retrospective analysis did not find any influence of GA compared to PS whenever this was delivered by target controlled infusion (TCI) of propofol or by remifentanil/dexmedetomidine (REX) on early functional outcome.

Polymerase chain reaction (PCR)-based testing of cerebrospinal fluid (CSF) samples has greatly facilitated the diagnosis of central nervous system (CNS) infections. However, the clinical significance of Epstein-Barr virus (EBV) DNA in CSF of individuals with suspected CNS infection remains unclear. We wanted to gain a better understanding of EBV as an infectious agent in immunocompetent patients with CNS disorders.

We identified cases of EBV-associated CNS infections and reviewed their clinical and laboratory characteristics. The study population was drawn from patients with EBV PCR positivity in CSF who visited Pusan National University Hospital between 2010 and 2019.

Of the 780 CSF samples examined during the 10-year study period, 42 (5.4 %) were positive for EBV DNA; 9 of the patients (21.4 %) were diagnosed with non-CNS infectious diseases, such as optic neuritis, Guillain-Barré syndrome, and idiopathic intracranial hypotension, and the other 33 cases were classified as CNS infections (22 as encephaciated with encephalitis and poor prognosis, and frequently found together with other microbes in CSF.

A transnasal transsphenoidal (TNTS) approach can be performed through a binostril or mononostril technique. The binostril technique is generally preferred, however the mononostril may be an underutilized approach with significant benefits.

All (n = 521) pituitary adenoma transsphenoidal surgeries performed from March 2008 until July 2017 at a university hospital in Indonesia were isolated. The majority (n = 512) were performed through a mononostril approach with no nasal speculum by a single experienced neurosurgeon. A PubMed literature review researching the differences in indications, techniques, and outcomes for both approaches supplements the case series. The mononostril surgical technique is described in detail.

The average mononostril operating time was 105 min. The most prevalent surgical complications were CSF leak (4.1 %), diabetes insipidus (3.7 %) and cacosmia (2.1 %). Visual field deficits noted in 85 %, 89 % improved. Length of stay was less than 2 days for 90 %, with 13 ICU admissions (aveus in low resource settings. Our CSF leak and tumor recurrence rates were lower than reported binostril rates in the literature. The mononostril technique is both safe and effective and should be strongly considered for an appropriately pre-selected subset of pituitary adenomas.

Parkinson’s disease (PD) is a common neurodegenerative disorder, with a higher risk of death than general population. Deep Brain Stimulation (DBS) has been used to treat PD for more than 2 decades, but few studies exist concerning mortality in this subset of patients. Our goal is to analyse mortality in PD patients treated with DBS in our centre.

retrospective evaluation of clinical files of patients with PD who underwent DBS surgery consecutively between October 2002 and May 2019.

346 patients were included in the analysis, 60 % male, with a mean age at disease onset of 48± 8 years (18-64), mean age at surgery of 60 ± 7 years (33-75), and mean disease duration until surgery of 14 ± 6 years (3-52). Mean follow-up after surgery was 7 ± 4 years (range 1-17). Overall mortality rate was 17.9 % and mean age at time of death was 71 ± 6 years. The main causes of death were pneumonia, dementia and acute myocardial infarction. In our series, male gender and disease duration until surgery were the only predictors of mortality in multivariate analysis.

Our study showed a long-term survival higher than previously described, and suggests that the treatment of patients with shorter disease evolution might have a survival benefit. The leading causes of death in PD patients treated with DBS seems unrelated to surgery, as the main causes of death are comparable to non-DBS patients.

Our study showed a long-term survival higher than previously described, and suggests that the treatment of patients with shorter disease evolution might have a survival benefit. The leading causes of death in PD patients treated with DBS seems unrelated to surgery, as the main causes of death are comparable to non-DBS patients.

Whether and when cervical disc arthroplasty (CDA) could be indicated for preoperative cervical spine kyphosis is unclear. The purpose of the study was to compare the clinical and radiological outcomes of single-level CDA and single-level anterior cervical discectomy and fusion (ACDF) in the patient with preoperative reversible kyphosis.

From 2014-2018, patients who underwent single-level CDA and single-level ACDF were consecutively reviewed. The Japanese Orthopedic Association score, Neck Disability Index and VAS were used to evaluate clinical outcomes. Range of motion (ROM), C2-7 Cobb angle, functional spinal unit (FSU) angle, and heterotopic ossification (HO) were assessed.

Thirty-eight CDA patients (a mean follow-up of 39.8 months) and 42 ACDF patients (37.6 months) with preoperative reversible kyphosis were included. Both groups had significant improvements in clinical outcomes, without statistically significant differences. Before surgery, there was no significant difference in cervical alignment a disc degenerative disease and preoperative reversible kyphosis, both CDA and ACDF achieved satisfactory and comparable clinical results. CDA was non-inferior to ACDF regarding the radiological outcomes of cervical alignment. Patients in CDA group had a relatively high incidence of HO formation.

hemorrhagic cerebrovascular disease due to vascular malformations represents an emergency for neurosurgery and neuro-interventional departments. During the COVID-19 pandemic, a dramatic reduction in the number of hospitalizations for acute myocardial infarction or stroke and a larger time interval from symptom onset to first medical contact have been reported. This study aims to verify the hypothesis that there would also have been a reduction of admissions for hemorrhagic cerebrovascular disease during the Italian lockdown.

s A multicenter, observational survey was conducted to collect data on hospital admissions for hemorrhagic cerebrovascular disease due to vascular malformations throughout two-months (March 15th to May 15th); the years 2020 (COVID-19 Italian lockdown), 2019 and 2018 were compared. Cases were identified by ICD-9 codes 430, 431, 432.1, 432.9, 747.81 of each hospital database. The statistical significance of the difference between the event rate of one year versus the others was evaluated using Poisson Means test, assuming a constant population.

During the 2020 lockdown, the total number of admissions for hemorrhagic cerebrovascular disease was 92 compared with 116 in 2019 and 95 in 2018. This difference was not significant. GCS upon admission was 3-8 in 44 % of cases in 2020 (41 patients), 39.7 % in 2019 (46 patients) and 28 % in 2018 (27 patients).

Reduction of admissions for hemorrhagic cerebrovascular disease due to vascular malformations during the COVID-19 lockdown was not confirmed. Nevertheless, some patients reached the emergency rooms only several days after symptoms onset, resulting in a worse clinical condition at admission.

Reduction of admissions for hemorrhagic cerebrovascular disease due to vascular malformations during the COVID-19 lockdown was not confirmed. Nevertheless, some patients reached the emergency rooms only several days after symptoms onset, resulting in a worse clinical condition at admission.

Following stroke, individuals commonly experience persisting loss of function. Whilst long-term care should involve continued support for ongoing stroke sequelae, this is often not routinely practiced globally. The Post Stroke Checklist was designed to standardise the process of detecting persisting treatable problems following stroke.

This cross-sectional study aimed to identify the long-term problems reported in Australian and Chinese participants at six months post stroke using the Post Stroke Checklist. It also aimed to provide global insight into poststroke sequelae by comparing the study results to previously published studies which administered the Post Stroke Checklist in other countries.

Participants were recruited from two hospitals in Australia and one hospital in China. The Post Stroke Checklist consists of 11 problem areas commonly experienced after stroke. This study follows a sequence of studies which have applied the checklist to monitor long-term outcomes after stroke in Germany, Italy, Singapore, Sweden and the United Kingdom.

Comparisons between Australia (n = 112) and China (n = 97) demonstrated statistically significant differences on the Post Stroke Checklist items. Across all seven countries, collectively the most common persisting difficulties post-stroke related to cognition, life after stroke, mood, mobility and activities of daily living. An analysis of means procedure compared individual countries for each checklist item against the overall group mean (all countries combined).

Globally, individuals report persisting functional difficulties following stroke. There appear to be differences in the proportions affected across the various countries, and healthcare systems may benefit from geographically tailoring post-stroke care.

Globally, individuals report persisting functional difficulties following stroke. There appear to be differences in the proportions affected across the various countries, and healthcare systems may benefit from geographically tailoring post-stroke care.

Warfarin remains widely used with a time in therapeutic range (TiTR) above 65% recommended for best outcomes. Patients not achieving or maintaining this warfarin control may be better suited to alternate anticoagulants. Despite this, there is limited data defining a suitable trial time in patients initiating warfarin therapy, therefore the aim of this study was to determine the mean time to stable therapeutic range (TtSTR).

Retrospective data was collected for patients with atrial fibrillation enrolled in a dedicated warfarin program at a private pathology practice within 7 days of warfarin initiation. TiTR at specified timepoints was calculated and median TtSTR determined as defined by TiTR ≥ 65% over three months. Comparisons were made of populations with TtSTR above or below the median.

The 566 patients included in the study had a mean TiTR of 64.9±16.5% at month three and median TtSTR of six months. Patients with TtSTR≤6 months achieved a mean TiTR of 68.9±12.8% at month two and maintained a TiTR over 75% from month 3 to 24.