Background Vasospasm is a treatable cause of deterioration following aneurysmal subarachnoid hemorrhage. Cerebral computed tomography perfusion mean transit times have been proposed as a predictor of vasospasm but suffer from well-known technical limitations. We evaluated fully automated, thresholded time-to-maxima of the tissue residue function (Tmax) for determination of vasospasm following aneurysmal subarachnoid hemorrhage. Methods and Results Retrospective analysis of 540 arterial segments from 36 encounters in 31 consecutive patients with aneurysmal subarachnoid hemorrhage undergoing computed tomography angiography (CTA), computed tomography perfusion, and digital subtraction angiography (DSA) within 24 hours. Tmax at 4, 6, 8, and 10 s was generated using RAPID (iSchemaView Inc., Menlo Park, CA). Dual-reader CTA and computed tomography perfusion interpretations were compared for patients with and without vasospasm on DSA (DSA+ and DSA-). Logistic regression models were developed using CTA and Tmax as input predictors and DSA vasospasm as outcome in adjusted and unadjusted models. Imaging studies from all 31 subjects (mean age 47.3±11.1, 77% female, 65% with single aneurysm with mean size of 6.0±2.9 mm) were included. Vasospasm was identified in 42 segments on DSA and 59 segments on CTA, with significant associations across individual vessel segments (P6 seconds. Conclusions CTA and Tmax offer high specificity for presence of vasospasm; their utility, even in combination, as screening tests is, however, limited by poor sensitivity.Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a heterogeneous clinical entity, encompassing multiple different causes, and a cause of substantial morbidity and mortality. Current guidelines suggest a multimodality imaging approach in establishing the underlying cause for MINOCA, which is considered a working diagnosis. Recent studies have suggested that an initial workup consisting of cardiac magnetic resonance and invasive coronary imaging can yield the diagnosis in most patients. Cardiac magnetic resonance is particularly helpful in excluding nonischemic causes that can mimic MINOCA including myocarditis and Takotsubo cardiomyopathy, as well as for long-term prognostication. Additionally, intracoronary imaging with intravascular ultrasound or optical coherence tomography may be warranted to evaluate plaque composition, or evaluate for plaque disruption or spontaneous coronary dissection. The role of noninvasive imaging modalities such as coronary computed tomography angiography is currently being investigated in the diagnostic approach and follow-up of MINOCA and may be appropriate in lieu of invasive coronary angiography in select patients. In recent years, many strides have been made in the workup of MINOCA; however, significant knowledge gaps remain in the field, particularly in terms of treatment strategies. In this review, we summarize recent society guideline recommendations and consensus statements on the initial evaluation of MINOCA, review contemporary multimodality imaging approaches, and discuss treatment strategies including an ongoing clinical trial.Background Myocardial injury in patients with COVID-19 is associated with increased mortality during index hospitalization; however, the relationship to long-term sequelae of SARS-CoV-2 is unknown. This study assessed the relationship between myocardial injury (high-sensitivity cardiac troponin T level) during index hospitalization for COVID-19 and longer-term outcomes. Methods and Results This is a prospective cohort of patients who were hospitalized at a single center between March and May 2020 with SARS-CoV-2. Cardiac biomarkers were systematically collected. Outcomes were adjudicated and stratified on the basis of myocardial injury. The study cohort includes 483 patients who had high-sensitivity cardiac troponin T data during their index hospitalization. During index hospitalization, 91 (18.8%) died, 70 (14.4%) had thrombotic complications, and 126 (25.6%) had cardiovascular complications. By 12 months, 107 (22.2%) died. During index hospitalization, 301 (62.3%) had cardiac injury (high-sensitivity cardiaore likely to have postacute sequelae of COVID-19. https://www.selleckchem.com/products/d-1553.html Among patients who survived their index hospitalization, the incremental mortality through 12 months was low, even among troponin-positive patients.Background Data in the literature on acute coronary syndrome in sub-Saharan Africa are scarce. Methods and Results We conducted a systematic review of the MEDLINE (PubMed) database of observational studies of acute coronary syndrome in sub-Saharan Africa from January 1, 2010 to June 30, 2020. Acute coronary syndrome was defined according to current definitions. Abstracts and then the full texts of the selected articles were independently screened by 2 blinded investigators. This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. We identified 784 articles with our research strategy, and 27 were taken into account for the final analysis. Ten studies report a prevalence of acute coronary syndrome among patients admitted for cardiovascular disease ranging from 0.21% to 22.3%. Patients were younger, with a minimum age of 52 years in South Africa and Djibouti. There was a significant male predominance. Hypertension was the main risk factelop consensus-based strategies, propose and evaluate tailored interventions, and identify prognostic factors.Background The effect of serum growth differentiation factor 15 (GDF-15) on poststroke depression (PSD) remains unknown. This study aimed to investigate the association between serum GDF-15 and PSD among patients with ischemic stroke. Methods and Results This study was based on a random sample from CATIS (China Antihypertensive Trial in Acute Ischemic Stroke). A total of 572 patients from 7 participating hospitals with GDF-15 levels were included in this analysis. The study outcome was depression (Hamilton Depression Rating Scale score ≥8) at 3 months after ischemic stroke. A total of 231 (40.4%) patients with stroke experienced PSD within 3 months. The multivariate-adjusted odds ratio of PSD associated with the highest tertile of serum GDF-15 was 2.92 (95% CI, 1.36-6.27) compared with the lowest tertile. Each SD increase in log-transformed GDF-15 was associated with a 42% (95% CI, 2%-97%) increased risk of PSD, and a linear association between serum GDF-15 and the risk of PSD was observed (P for linearity=0.006). Conclusions Elevated serum GDF-15 levels in the acute phase of ischemic stroke were independently associated with PSD, suggesting that GDF-15 may be a valuable prognostic biomarker for PSD.Background We aimed to evaluate the association between the Chinese visceral adiposity index (CVAI) and its dynamic change and risk of carotid plaque based on a large Chinese cohort. Methods and Results This cohort included 23 522 participants aged 20 to 80 years without elevated carotid intima-media thickness and carotid plaque at baseline and who received at least 2 health checkups. CVAI was calculated at baseline and at every checkup. The dynamic change in CVAI was calculated by subtracting CVAI at baseline from that at the last follow-up. Cox proportional hazard regression model was used to estimate hazard ratios (HRs) and 95% CIs. The restricted cubic spline was applied to model the dose-response association between CVAI and carotid plaque risk. During the 82 621 person-years of follow-up, 5987 cases of carotid plaque developed (7.25/100 person-years). We observed a significant positive correlation between CVAI and carotid plaque risk (HR, 1.53; 95% CI, 1.48-1.59 [P less then 0.001]) in a nonlinear dose-response pattern (Pnonlinearity less then 0.001). The sensitivity analyses further confirmed the robustness of the results. The association was significant in all subgroup analyses stratified by sex, hypertension, and fatty liver disease except for the diabetes subgroup. The association between CVAI and carotid plaque risk was much higher in men than in women. No significant association was identified between change in CVAI and carotid plaque risk. Conclusions CVAI was positively associated with carotid plaque risk in a nonlinear dose-response pattern in this study. Individuals should keep their CVAI within a normal level to prevent the development of carotid plaque.HKUST-1 [Cu3(BTC)2(H2O)3]n·nH2OMeOH was submitted to thermolysis under controlled conditions at temperatures between 100 and 300 °C. This treatment resulted in partial ligand decarboxylation, generating coordinatively unsaturated Cu2+ sites with extra porosity on the way to the transformation of the initial HKUST-1 framework to CuO. The obtained materials retaining in part the HKUST-1 original crystal structure (quasi-MOFs) were used to promote 4-nitrophenol conversion to 4-aminophenol. Because of the partial linker decomposition, the quasi-MOF treated at 240 °C contains coordinatively unsaturated Cu2+ ions distributed throughout the Q-HKUST lattice together with micro- and mesopores. These defects explain the excellent catalytic performance of QH-240 with an apparent rate constant of 1.02 × 10-2 s-1 in excess of NaBH4 and an activity factor and half-life time of 51 s-1g-1 and 68 s, respectively, which is much better than that of the HKUST parent. Also, the induction period decreases from the order of minutes to seconds in the presence of the HKUST and QH-240 catalysts, respectively. Kinetic studies fit with the Langmuir-Hinshelwood theory in which both 4-nitrophenol and BH4- should be adsorbed onto the catalyst surface. The values of the true rate constant (k), the adsorption constants of 4-nitrophenol and BH4- (K4-NP and KBH4-), as well as the activation energy are in agreement with a rate-determining step involving the reduction of 4-nitrophenol by the surface-bound hydrogen species.Single-molecule Förster resonance energy transfer (FRET) is a versatile technique for probing the structure and dynamics of biomolecules even in heterogeneous ensembles. However, because of the limited fluorescence brightness per molecule and the relatively long fluorescence lifetimes, probing ultrafast structural dynamics in the nanosecond time scale has thus far been very challenging. Here, we demonstrate that nanophotonic fluorescence enhancement in zero-mode waveguides enables measurements of previously inaccessible low-nanosecond dynamics by dramatically improving time resolution and reduces data acquisition times by more than an order of magnitude. As a prototypical example, we use this approach to probe the dynamics of a short intrinsically disordered peptide that were previously inaccessible with single-molecule FRET measurements. We show that we are now able to detect the low-nanosecond correlations in this peptide, and we obtain a detailed interpretation of the underlying distance distributions and dynamics in conjunction with all-atom molecular dynamics simulations, which agree remarkably well with the experiments. We expect this combined approach to be widely applicable to the investigation of very rapid biomolecular dynamics.
This paper aims to examine the leadership competencies of first-line nurse managers (FLNMs) at the unit level in the eastern region of Ghana.

The paper is a quantitative cross-section design.

Nurse managers exhibited a moderate level of knowledge and ability to apply leadership competencies. Gender, rank, qualification, professional experience, management experience and management training jointly predicted the leadership competencies of FLNMs [(

= 0.158,
= 0.016]. However, only management training was a significant predictor in the model.

Inappropriate leadership competencies have severe consequences for patients and staff outcomes. This situation necessitates a call for a well-structured program for the appointment of FLNMs based on competencies.

This study is the first in Ghana which we are aware of that examined the leadership competencies at the unit level that identifies predictors of leadership competencies.
This study is the first in Ghana which we are aware of that examined the leadership competencies at the unit level that identifies predictors of leadership competencies.

Multiple sclerosis is a chronic neuroinflammatory disease with a highly heterogeneous disease course. Preventing lasting disability requires early identification of persons at risk and novel approaches towards patient stratification for personalized treatment decisions. In this comment, we discuss the importance of large datasets of real-world cohorts in order to address this unmet need.
The Protein kinase D3 (PKD3) has been implicated in signal transduction downstream of the T cell receptor (TCR). However, its role for the activation of primary T lymphocytes has not been elucidated so far.

Expression of PKD isoforms in primary murine T cells was determined by RT-PCR and SDS-Page. A germline PKD3-knockout mouse line was analyzed for its immune response to OVA/alum intraperitoneal immunization. Phenotyping of the T cell compartment ex vivo as well as upon stimulation in vitro was performed by flow cytometry. Additionally, cytokine expression was assessed by flow cytometry, RT-PCR and Luminex technology.

PKD expression in T cells is modulated by TCR stimulation, leading to a rapid down-regulation on mRNA and on protein level. PKD3-deficient mice respond to immunization with enhanced T follicular helper cell generation. Furthermore, peripheral PKD3-deficient CD4
T cells express more interleukin-2 than wild type CD4
T cells upon TCR stimulation ex vivo. However, purified naïve CD4
T cells do not differ in their phenotype upon differentiation in vitro from wild type T cells. Moreover, we observed a shift towards an effector/memory phenotype of splenic T cells at steady state, which might explain the contradictory results obtained with pan-T cells ex vivo and naïve-sorted T cells.

While PKD3-deficiency in vivo in mice leads to a skewing of the T cell compartment towards a more activated phenotype, this kinase seems to be dispensable for naïve CD4
T cell differentiation in vitro. Video Abstract.
While PKD3-deficiency in vivo in mice leads to a skewing of the T cell compartment towards a more activated phenotype, this kinase seems to be dispensable for naïve CD4+ T cell differentiation in vitro. Video Abstract.Sertoli cells (SCs) support and nourish germ cells (GCs) through their crosstalk during spermatogenesis. However, the underlying epigenetic mechanism that ensures SCs' functions in this process remains unclear. Here, we report that UHRF1, a critical epigenetic regulator, is mainly expressed in human and mouse pre-mature SCs, and is essential for establishing Sertoli-Germ cell crosstalk. SC-specific UHRF1 knockout mice exhibit complete sterility with Sertoli cell (SC) proliferation and differentiation aberrance, blood-testis barrier (BTB) disruption, and immature germ cell (GC) sloughing. RNA sequencing and Whole Genome Bisulfite Sequencing (WGBS) revealed that many extracellular matrix (ECM)-related genes (e.g., Timp1, Trf, and Spp1) appeared upregulated with the DNA hypomethylation status in UHRF1-deficient SCs. Strikingly, overexpression of Timp1, Trf, and Spp1 in SCs in vitro and in vivo could phenocopy the SC-specific UHRF1-deficient mice. Our data demonstrated that UHRF1 regulates the transcriptional program of ECM-related genes in SCs and establishes SC-GC crosstalk.
Amyloid goiter, defined as excess amyloid within the thyroid gland in such quantities that it produces a clinically apparent goiter, is a very rare manifestation of systemic amyloidosis with cases commonly seen in the setting of Amyloid A (AA) amyloidosis. Amyloid goiter as the primary clinical manifestation secondary to Amyloid light chain (AL) amyloidosis is very rare. We present a case of AL amyloidosis with initial manifestation as goiter with amyloid deposition in the thyroid and the parathyroid gland.

A 73year old male presented with goiter and compressive symptoms of dysphagia and hoarseness. Laboratory workup revealed normal thyroid function, nephrotic range proteinuria, elevated serum calcium level with an elevated parathyroid hormone level (PTH) consistent with primary hyperparathyroidism. Thyroid ultrasound showed an asymmetric goiter with three dominant nodules. Cervical computed tomography revealed a goiter with substernal extension and deviation of the trachea. Fine needle aspiration was uns the thyroid includes systemic amyloidosis or medullary thyroid carcinoma. The definitive diagnosis lies in the histopathology of the thyroid tissue. To diagnose systemic amyloidosis as the etiology for a goiter, a solid understanding of the causes of systemic amyloidosis coupled with a thorough evaluation of the patient's history and laboratory data is necessary.
Amyloid goiter as the primary clinical manifestation secondary to AL amyloidosis with deposition in the thyroid and parathyroid gland is rare. The top differential for amyloid deposits in the thyroid includes systemic amyloidosis or medullary thyroid carcinoma. The definitive diagnosis lies in the histopathology of the thyroid tissue. To diagnose systemic amyloidosis as the etiology for a goiter, a solid understanding of the causes of systemic amyloidosis coupled with a thorough evaluation of the patient's history and laboratory data is necessary.
Different from Fe ions in Fenton reaction, Mn ions can function both as catalyst for chemodynamic therapy and immune adjuvant for antitumor immune responses. In Mn-mediated Fenton-like reaction, bicarbonate ([Formula see text]), as the most important component to amplify therapeutic effects, must be present, however, intracellular [Formula see text] is strictly limited because of the tight control by live cells.

Herein, Stimuli-responsive manganese carbonate-indocyanine green complexes (MnCO
-ICG) were designed for intracellular marriage of bicarbonate and Mn ions as "immune ion reactors" to regulate intracellular redox homeostasis and antitumor immune responses. Under the tumor acidic environment, the biodegradable complex can release "ion reactors" of Mn
and [Formula see text], and ICG in the cytoplasm. The suddenly increased [Formula see text] in situ inside the cells regulate intracellular pH, and accelerate the generation of hydroxyl radicals for the oxidative stress damage of tumors cells because [Formula see text] play a critical role to catalyze Mn-mediated Fenton-like reaction. Investigations in vitro and in vivo prove that the both CDT and phototherapy combined with Mn
-enhanced immunotherapy effectively suppress tumor growth and realize complete tumor elimination.

The combination therapy strategy with the help of novel immune adjuvants would produce an enhanced immune response, and be used for the treatment of deep tumors in situ.
The combination therapy strategy with the help of novel immune adjuvants would produce an enhanced immune response, and be used for the treatment of deep tumors in situ.Scaling scRNA-seq to profile millions of cells is crucial for constructing high-resolution maps of transcriptional manifolds. Current analysis strategies, in particular dimensionality reduction and two-phase clustering, offer only limited scaling and sensitivity to define such manifolds. We introduce Metacell-2, a recursive divide-and-conquer algorithm allowing efficient decomposition of scRNA-seq datasets of any size into small and cohesive groups of cells called metacells. Metacell-2 improves outlier cell detection and rare cell type identification, as shown with human bone marrow cell atlas and mouse embryonic data. Metacell-2 is implemented over the scanpy framework for easy integration in any analysis pipeline.Intervertebral disc degeneration (IVDD) is a chronic age-related degenerative disease accompanied by complex pathophysiological mechanisms. Increasing evidence indicates that NLRP3 inflammasome mediated pyroptosis of nucleus pulposus (NP) cells displays an important role in the pathological progression of IVDD. https://www.selleckchem.com/products/Gefitinib.html Milk fat globule-EGF factor-8 (MFG-E8) is an endogenously secreted glycoprotein with beneficial effects of anti-inflammatory, antioxidant, and modulation of NLRP3 inflammasome. However, the effect of MFG-E8 on IVDD remains unclear. In this study, our purpose is to clarify the expression changes of MFG-E8 in the IVDD process and explore the role and mechanism of MFG-E8. We found that MFG-E8's expression was reduced in degraded nucleus pulposus tissues of humans and rats as well as hydrogen peroxide (H2O2)-treated NP cells. Exogenous supplementation of MFG-E8 could rescue H2O2-induced oxidative stress, mitochondrial dysfunction, and NLRP3 inflammasome activation and protect NP cells from pyroptosis and extracellular matrix (ECM) degradation. Mechanistically, Nrf2/TXNIP/NLRP3 axis plays a crucial role in MFG-E8-mediated suppression of the above-pathological events. In vivo, we established a rat intervertebral disc acupuncture model and found that MFG-E8 administration effectively alleviated IVDD development by imageological and histomorphological evaluation. Overall, our findings revealed the internal mechanisms underlying MFG-E8 regulation in NP cells and its intrinsic value for IVDD therapy.
Sub-Saharan Africa has seen substantial reductions in cases and deaths due to malaria over the past two decades. While this reduction is primarily due to an increasing expansion of interventions, urbanisation has played its part as urban areas typically experience substantially less malaria transmission than rural areas. However, this may be partially lost with the invasion and establishment of Anopheles stephensi. A. stephensi, the primary urban malaria vector in Asia, was first detected in Africa in 2012 in Djibouti and was subsequently identified in Ethiopia in 2016, and later in Sudan and Somalia. In Djibouti, malaria cases have increased 30-fold from 2012 to 2019 though the impact in the wider region remains unclear.

Here, we have adapted an existing model of mechanistic malaria transmission to estimate the increase in vector density required to explain the trends in malaria cases seen in Djibouti. To account for the observed plasticity in An. stephensi behaviour, and the unknowns of how it will estal interventions could be needed to prevent a major public health emergency.
Substantial heterogeneity across the country is predicted and large increases in vector control interventions could be needed to prevent a major public health emergency.
D-allulose, a hexulose monosaccharide with low calorie content and high sweetness, is commonly used as a functional sugar in food and nutrition. However, enzyme preparation of D-allulose from D-frutose was severely hindered by the non-enzymatic browning under alkaline and high-temperature, and the unnecessary by-products further increased the difficulties in separation and extraction for industrial applications. Here, to address the above issue during the production process, a tandem D-allulose 3-epimerase (DPEases) isomerase synergistic expression strategy and an auto-inducible promoter engineering were levered in Bacillus subtilis 168 (Bs168) for efficient synthesis of D-allulose under the acidic conditions without browning.

First, based on the dicistron expression system, two DPEases with complementary functional characteristics from Dorea sp. CAG317 (DSdpe) and Clostridium cellulolyticum H10 (RCdpe) were expressed in tandem under the promoter HpaII in one cell. A better potential strain Bs168/pMA5-DSdpe-RCdpe increases enzyme activity to 18.

The workflow designed for the development of chimeric lures provides an innovative strategy to target odour-mediated behaviours. The chimeric lure identified here can be used in existing trapping systems, and be customized to increase sustainability, in line with goals of the Global Vector Control Response Group.
The workflow designed for the development of chimeric lures provides an innovative strategy to target odour-mediated behaviours. The chimeric lure identified here can be used in existing trapping systems, and be customized to increase sustainability, in line with goals of the Global Vector Control Response Group.
The prognosis of lung metastasis (LM) in patients with chondrosarcoma was poor. The aim of this study was to construct a prognostic nomogram to predict the risk of LM, which was imperative and helpful for clinical diagnosis and treatment.

Data of all chondrosarcoma patients diagnosed between 2010 and 2016 was queried from the Surveillance, Epidemiology, and End Results (SEER) database. In this retrospective study, a total of 944 patients were enrolled and randomly splitting into training sets (n = 644) and validation cohorts(n = 280) at a ratio of 73. Univariate and multivariable logistic regression analyses were performed to identify the prognostic nomogram. The predictive ability of the nomogram model was assessed by calibration plots and receiver operating characteristics (ROCs) curve, while decision curve analysis (DCA) and clinical impact curve (CIC) were applied to measure predictive accuracy and clinical practice. Moreover, the nomogram was validated by the internal cohort.

Five independent risk factors including age, sex, marital, tumor size, and lymph node involvement were identified by univariate and multivariable logistic regression. Calibration plots indicated great discrimination power of nomogram, while DCA and CIC presented that the nomogram had great clinical utility. In addition, receiver operating characteristics (ROCs) curve provided a predictive ability in the training sets (AUC = 0.789, 95% confidence interval [CI] 0.789-0.808) and the validation cohorts (AUC = 0.796, 95% confidence interval [CI] 0.744-0.841).

In our study, the nomogram accurately predicted risk factors of LM in patients with chondrosarcoma, which may guide surgeons and oncologists to optimize individual treatment and make a better clinical decisions.

JOSR-D-20-02045, 29 Dec 2020.
JOSR-D-20-02045, 29 Dec 2020.
Wandering spleen is a rare clinical entity with a less than 0.2% reporting incidence rate. In this case, the spleen is present abnormally in the abdominal or pelvic cavity instead of its normal anatomical location. The aetiology is either congenital or acquired. The condition is caused by the absence or maldevelopment of the spleen's suspensory ligaments, which holds the spleen static in the left hypochondrium.

A 27-year-old female patient presented to the emergency department with complaints of abdominal pain, fever, nausea, vomiting, and constipation for three days. A palpable movable mass was found during the physical examination, and torsion of thewandering spleen's pedicle was confirmed by CT scan. Open splenectomy was performed, and the patient was recovered uneventfully.

Even though ectopic spleen is a rare disease, clinicians should be aware of its incidence. Early diagnosis in the case of an acute abdomen is vital for the preservation of the spleen. Patients presented with acute abdomen and absence of splenic shadow under left hemidiaphragm should be suspected, and further radiological investigation will confirm the diagnosis. Surgery is the gold standard for wandering spleen with either splenopexy or splenectomy, depending on the spleen's condition during surgery.
Even though ectopic spleen is a rare disease, clinicians should be aware of its incidence. Early diagnosis in the case of an acute abdomen is vital for the preservation of the spleen. Patients presented with acute abdomen and absence of splenic shadow under left hemidiaphragm should be suspected, and further radiological investigation will confirm the diagnosis. Surgery is the gold standard for wandering spleen with either splenopexy or splenectomy, depending on the spleen's condition during surgery.
Anopheles stephensi, an invasive malaria vector, was first detected in Africa nearly 10years ago. After the initial finding in Djibouti, it has subsequently been found in Ethiopia, Sudan and Somalia. To better inform policies and vector control decisions, it is important to understand the distribution, bionomics, insecticide susceptibility, and transmission potential of An. https://www.selleckchem.com/products/jq1.html stephensi. These aspects were studied as part of routine entomological monitoring in Ethiopia between 2018 and 2020.

Adult mosquitoes were collected using human landing collections, pyrethrum spray catches, CDC light traps, animal-baited tent traps, resting boxes, and manual aspiration from animal shelters. Larvae were collected using hand-held dippers. The source of blood in blood-fed mosquitoes and the presence of sporozoites was assessed through enzyme-linked immunosorbent assays (ELISA). Insecticide susceptibility was assessed for pyrethroids, organophosphates and carbamates.

Adult An. stephensi were collected with aspiration, bl have in Plasmodium transmission and malaria case incidence. While additional data are being collected, national programmes can use the available data to formulate and operationalize national strategies against the threat of An. stephensi.
Understanding the bionomics, insecticide susceptibility and distribution of An. stephensi will improve the quality of a national response in Ethiopia and provide additional information on populations of this invasive species in Africa. Further work is needed to understand the role that An. stephensi will have in Plasmodium transmission and malaria case incidence. link2 While additional data are being collected, national programmes can use the available data to formulate and operationalize national strategies against the threat of An. stephensi.
Healthcare practitioners (HCPs) play a crucial role in recognising, responding to, and supporting female patients experiencing intimate partner abuse (IPA). However, research consistently identifies barriers they perceive prevent them from doing this work effectively. These barriers can be system-based (e.g. lack of time or training) or personal/individual. This review of qualitative evidence aims to synthesise the personal barriers that impact HCPs' responses to IPA.

Fivedatabases were searched in March 2020. Studies needed to utilise qualitative methods for both data collection and analysis and be published between 2010 and 2020 in order to qualify for inclusion; however, we considered any type of healthcare setting in any country. Article screening, data extraction and methodological appraisal using a modified version of the Critical Appraisal Skills Program checklist for qualitative studies were undertaken by at least two independent reviewers. Data analysis drew on Thomas and Harden's thematic syntheways to do this within the context of complex healthcare organisations.
This review highlights the need for training to address personal issues in addition to structural or organisational barriers. Education and training for HCPs needs to encourage reflection on their own values to reinforce their commitment to addressing IPA; teach HCPs to relinquish the need to control outcomes so that they can adopt an advocacy approach; and support HCPs' trust in the critical role they can play in responding. Future research should explore effective ways to do this within the context of complex healthcare organisations.
The purpose of this study was to present a navigated image-free augmentation technique for the acromioclavicular joint (ACJ) and coracoclavicular (CC) ligaments and to report the clinical and radiological outcomes.

From 2013 to 2018, 35 eligible patients were treated with our navigated image-free ACJ- and CC-augmentation technique. The average follow-up was 3 years. link3 Follow-up evaluations included the Constant-Murley Score, subjective shoulder value, Taft score, and the acromioclavicular joint instability (ACJI) score. The patients' quality of life was assessed using the EuroQol-5D (EQ-5D) questionnaire. In addition, in accordance with the instability criteria, radiographs were evaluated before surgery, after surgery, and during follow-up.

Overall, 25 patients (71%) suffered an acute type V disruption, 5 (14%) had a type IV disruption, and 5 (14%) had an acute Rockwood type IIIb injury. The mean Constant-Murley Score was 90 (range 56-100; p = 0.53) on the injured side, and the mean subjective shoulder vawhich avoids fractures.
Tamoxifen, which is one of the selective estrogen receptor modulators (SERMs), can bring out life-threatening complication, e.g. hypertriglyceridemia-induced acute pancreatitis, although it is rare. We precisely report changes in lipoprotein metabolism before and after tamoxifen discontinuation because there have been few reports of it.

47-year-old premenopausal woman with dyslipidemia, type 2 diabetes, nonalcoholic fatty liver disease and chronic kidney disease was prescribed tamoxifen as adjuvant therapy after operation of breast cancer. She experienced severe tamoxifen-induced hypertriglyceridemia several months after dosing tamoxifen. Before cessation of tamoxifen, lipoprotein fraction test revealed marked stagnation of VLDL and IDL metabolisms, resulting in severe hypertriglyceridemia (serum triglyceride level was 1881 mg/dL). Seven days after tamoxifen withdrawal, lipoprotein fraction test showed that the metabolisms of endogenous lipoproteins were changed drastically.

From these results, we confirmed that tamoxifen certainly changes lipoprotein metabolism through suppression of post-heparin lipolytic activity. It is very important to evaluate the balance between benefit and risk before dosing tamoxifen and survey lipid profiles constantly during treatment to avoid life-threatening complication when prescription of tamoxifen is planned.
From these results, we confirmed that tamoxifen certainly changes lipoprotein metabolism through suppression of post-heparin lipolytic activity. It is very important to evaluate the balance between benefit and risk before dosing tamoxifen and survey lipid profiles constantly during treatment to avoid life-threatening complication when prescription of tamoxifen is planned.
This study aims to investigate the influence of different dentin pretreatment procedures on the resulting abrasive dentin wear.

Two groups (A, B) of 60 dentin samples each were prepared. Group A was brushed with an abrasive slurry (RDA = 85) and group B with a different abrasive slurry (RDA = 174). Four subgroups in each group (n = 15) were created (A1-A4) and (B1-B4). The subgroups were pretreated as follows A1 + B1 with 1200-grit grinding paper, A2 + B2 with 1200- and 2000-grit papers, A3 + B3 with 1200-, 2000-, and 4000-grit papers, A4 + B4 with 1200-, 2000-, 4000-grit papers and with 1000 brushing strokes with a slurry of Elmex toothpaste. All samples were brushed for 25min at 120 strokes/min. Abrasive dentin wear was measured for each sample profilometrically and the subgroups were compared with each other within the same group. Repeated measures one-way ANOVA was conducted to compare the subgroups and pairwise contrasts were estimated for multiple testing according to Tukey (α = 0.05).

The resulting abrasive dentin wear in group A ranged between 15.

Both Arms were tested before and after the BEC course, as well as a 7-month follow-up exam. All participants were invited to focus groups on the course and adjuncts. Results A total of 24 participants were included, 12 (50%) of whom were followed to completion. Mean pre-test scores in Arm 1 (50%) were similar to Arm 2 (53%) (p=0.52). Both arms had improved test scores after the BEC Course Arm 1 (74%) and Arm 2 (87%), (p=0.03). At 7-month follow-up, though with significant participant loss to follow up, Arm 1 had a mean follow-up exam score of 66%, and Arm 2, 74%. Discussion Implementation of flipped classroom educational adjuncts for the WHO BEC course is feasible and may improve healthcare worker learning in low resource settings. Our focus- group feedback suggest that the course and adjuncts are user friendly and culturally appropriate. © 2020 African Federation for Emergency Medicine. Publishing services provided by Elsevier.Introduction Micronutrient supplementation is recommended in Ebola Virus Disease (EVD) care; however, there is limited data on its therapeutic effects. Methods This retrospective cohort study included patients with EVD admitted to five Ebola Treatment Units (ETU) in Sierra Leone and Liberia during September 2014 to December 2015. A uniform protocol was used to guide ETU care, however, due to supply limitations, only a subset of patients received multivitamins. Data on demographics, clinical characteristics, and laboratory testing was collected. The outcome of interest was facility-based mortality and the primary predictor was multivitamin supplementation initiated within 48 h of admission. The multivitamin formulations included thiamine, riboflavin, niacin and vitamins A, C, and D3. Propensity score models (PSM) were used to match patients based on covariates associated with multivitamin administration and mortality. Mortality between cases treated and untreated within 48 h of admission were compared using generalized estimating equations to calculate relative risk with bootstrap methods employed to assess statistical significance. Results There were 424 patients with EVD who had sufficient treatment data for analysis, of which 261 (61.6%) had daily multivitamins initiated within 48 h of admission. The mean age of the cohort was 30.5 years and 59.4% were female. In the propensity score matched analysis, mortality was 53.5% among patients receiving multivitamins and 66.2% among patients not receiving multivitamins, resulting in a relative risk for mortality of 0.81 (p = 0.03) for patients receiving multivitamins. Conclusion Early multivitamin supplementation was associated with lower overall mortality. Further research on the impact of micronutrient supplementation in EVD is warranted. © 2020 African Federation for Emergency Medicine. Publishing services provided by Elsevier.Background Triage is essential for efficient and effective delivery of care in emergency centers (ECs) where numerous patients present simultaneously with varying acuity of conditions. Implementing EC triage systems provides a method of recognizing which patients may require admission and are at higher risks for poor health outcomes. Rwanda is experiencing increased demand for emergency care; however, triage has not been well-studied. The University Teaching Hospital of Kigali (UTH-K) is an urban tertiary care health center utilizing a locally modified South African Triage Score (mSATS) that classifies patients into five color categories. Our study evaluated the utility of the mSATS tool at UTH-K. Methods UTH-K implemented mSATS in April 2013. All patients aged 15 years or older from August 2015 to July 2016 were eligible for inclusion in the database. Variables of interest included demographic information, mSATS category, patient case type (trauma or medical), disposition from the ED and mortality. Results 1ican Federation for Emergency Medicine. Publishing services provided by Elsevier.Introduction With personnel scattered throughout a continent 3 times larger than the United States, a lack of mature medical facilities necessitates a significant transportation network for medical evacuation in US Africa Command (AFRICOM). We describe medical evacuations analyzed from the US Air Force Transportation Command Regulating and Command & Control Evacuation System (TRAC2ES). Methods We performed a retrospective review of all TRAC2ES medical records for medical evacuations from the AFRICOM theater of operations conducted between January 1, 2008 and December 31, 2018. We abstracted free text data entry in TRAC2ES for diagnostic and therapeutic interventions performed prior to the patient movement request. Results During this time, there were 963 cases recorded in TRAC2ES originating within AFRICOM. 961 records were complete for analysis. Most patients were male (82%) and military personnel (92%). Most transports originated in Djibouti (72%), and Germany (93%) was the most common destination. Medical evacuations were largely routine (66%), and routine evacuations were proportionally highest amongst US military personnel compared to all other groups. A small portion of patients were evacuated for battle injuries (4%), compared to non-battle injury (33%) and disease (63%). Within disease, the largest proportion of patient complaints centered on gastrointestinal symptoms (13%), behavioral health (11%) and chest pain (8%). Prior to evacuation, only 55% of patients were document as receiving any medication. Pain control was documented in 21% of cases, most commonly being NSAIDs (7%). Discussion Extremely low numbers of battle injuries highlight the unique nature of AFRICOM operations compared to areas with more intense combat operations. Limitations of the dataset highlight the need for a data collection mandate within AFRICOM as within other areas for optimization and performance improvement. © 2020 African Federation for Emergency Medicine. Publishing services provided by Elsevier.Introduction The nature and scope of emergency nursing exposes nurses to a wide array of patient populations with rapidly changing and unexpected clinical conditions, sophisticated logistics and procedures. Hence, emergency centre (EC) nurses ought to be ready to face diverse clinical challenges and deliver care to patients in a timely cost-effective manner and with the needed competence. The current study aimed at examining the self-assessed competencies of nurses, and comparing ratings among certified emergency nurses (ENs) and general nurses (GNs) working at an EC of a tertiary hospital in Ghana. Methods A descriptive cross-sectional quantitative study was carried out among 109 conveniently sampled nurses. Participants evaluated their perceived competencies on a validated instrument under five domains, namely diagnostic function (DF), administering and monitoring therapeutic interventions (AMTI), effective management of rapidly changing situations (EMRCS), organisational and work load competency (OWLC), annd families that require services in ECs. © 2020 African Federation for Emergency Medicine. Publishing services provided by Elsevier.Introduction Globally respiratory diseases, comprising a broad range of disease conditions due to infectious and non-infectious causes, are a major cause of childhood morbidity and mortality. Thus, identification of the burden of respiratory illness will ensure appropriate interventions towards reducing its attendant morbidity and mortality. The study was conducted to identify the burden, spectrum and outcome of respiratory diseases in hospitalized children at University of Ilorin Teaching Hospital, North-Central Nigeria. Methods A retrospective descriptive cross-sectional study involving children admitted through the emergency paediatric unit over five years (January 2013-December 2017) was conducted. Data on demography, diagnosis, co-morbidities and complications, duration of admission, and outcome were collected and analyzed using SPSS 20. Results Of the total 7012 children admitted, 1939(27.7%) were due to respiratory diseases with a median age of 16 (interquartile range IQR 7-36) months. Males were 994for which interventions towards improving childhood health indices should be prioritized. © 2020 African Federation for Emergency Medicine. Publishing services provided by Elsevier.Types of original research of peer-reviewed publications by hospitalists. © 2020 The Authors. Journal of General and Family Medicine published by John Wiley & Sons Australia, Ltd on behalf of Japan Primary Care Association.This study reports a case of Lyme disease with a large erythema migrans in Hokkaido. This image aims at encouraging physicians to consider Lyme disease after tick bites, especially in endemic areas. © 2020 The Authors. Journal of General and Family Medicine published by John Wiley & Sons Australia, Ltd on behalf of Japan Primary Care Association.A 69-year-old Japanese man with a 10-year history of hemodialysis for end-stage renal disease presented with painful necrosis of the fingers of his right hand. A plain radiograph of the right hand revealed severely calcified arteries, particularly in the ring finger, suggesting the diagnosis of calciphylaxis of the fingers. © 2020 The Authors. Journal of General and Family Medicine published by John Wiley & Sons Australia, Ltd on behalf of Japan Primary Care Association.Uterine prolapse could cause bilateral hydroureteronephrosis by kinking ureters. © 2020 The Authors. Journal of General and Family Medicine published by John Wiley & Sons Australia, Ltd on behalf of Japan Primary Care Association.A 49-year-old housewife with a long-standing migraine presented with "spells" of intensely itchy, well-circumscribed, erythematous patches over the flexor aspect of her left wrist and palm repeatedly for the last 15 years. https://www.selleckchem.com/products/rmc-4550.html Detailed history revealed her oral loxoprofen use for migraine headaches preceding rash development. Although a patch test was negative, inadvertent ingestion of the drug by the patient reproduced the rash within a few hours, thereby establishing the diagnosis of loxoprofen-induced bullous fixed drug eruption. © 2019 The Authors. Journal of General and Family Medicine published by John Wiley & Sons Australia, Ltd on behalf of Japan Primary Care Association.We report a 24-year-old previously healthy woman with Lemierre's syndrome following influenza A virus infection. One week after influenza A was diagnosed by rapid antigen test and treated by oseltamivir, she developed multiple cavitary lung lesions, and a left internal jugular vein thrombosis. The blood culture grew Fusobacterium necrophorum. We administered ampicillin-sulbactam and unfractionated heparin to which she responded very well. Although viral infections have been related to Lemierre's syndrome, influenza virus rarely implicated. Lemierre's syndrome should be included in the differential diagnoses of rare complications of influenza virus infection. © 2019 The Authors. Journal of General and Family Medicine published by John Wiley & Sons Australia, Ltd on behalf of Japan Primary Care Association.At 19-week gestation, a 32-year-old Japanese woman presented with a 3-day history of fever and vesicular rashes on the skin and was diagnosed with varicella, which resolved after antiviral therapy. In the primary clinic, her immunity to rubella and measles, but not to varicella, was confirmed at preconception counseling. Maternal varicella infection can cause congenital varicella syndrome characterized by congenital malformations and neurological deficits. This case recommends that all women of childbearing age should be assessed for immunity to varicella before pregnancy and that primary care physicians should take initiatives for preventing maternal varicella. © 2019 The Authors. Journal of General and Family Medicine published by John Wiley & Sons Australia, Ltd on behalf of Japan Primary Care Association.

The workflow designed for the development of chimeric lures provides an innovative strategy to target odour-mediated behaviours. The chimeric lure identified here can be used in existing trapping systems, and be customized to increase sustainability, in line with goals of the Global Vector Control Response Group.
The workflow designed for the development of chimeric lures provides an innovative strategy to target odour-mediated behaviours. The chimeric lure identified here can be used in existing trapping systems, and be customized to increase sustainability, in line with goals of the Global Vector Control Response Group.
The prognosis of lung metastasis (LM) in patients with chondrosarcoma was poor. The aim of this study was to construct a prognostic nomogram to predict the risk of LM, which was imperative and helpful for clinical diagnosis and treatment.

Data of all chondrosarcoma patients diagnosed between 2010 and 2016 was queried from the Surveillance, Epidemiology, and End Results (SEER) database. In this retrospective study, a total of 944 patients were enrolled and randomly splitting into training sets (n = 644) and validation cohorts(n = 280) at a ratio of 73. Univariate and multivariable logistic regression analyses were performed to identify the prognostic nomogram. The predictive ability of the nomogram model was assessed by calibration plots and receiver operating characteristics (ROCs) curve, while decision curve analysis (DCA) and clinical impact curve (CIC) were applied to measure predictive accuracy and clinical practice. Moreover, the nomogram was validated by the internal cohort.

Five independent risk factors including age, sex, marital, tumor size, and lymph node involvement were identified by univariate and multivariable logistic regression. Calibration plots indicated great discrimination power of nomogram, while DCA and CIC presented that the nomogram had great clinical utility. In addition, receiver operating characteristics (ROCs) curve provided a predictive ability in the training sets (AUC = 0.789, 95% confidence interval [CI] 0.789-0.808) and the validation cohorts (AUC = 0.796, 95% confidence interval [CI] 0.744-0.841).

In our study, the nomogram accurately predicted risk factors of LM in patients with chondrosarcoma, which may guide surgeons and oncologists to optimize individual treatment and make a better clinical decisions.

JOSR-D-20-02045, 29 Dec 2020.
JOSR-D-20-02045, 29 Dec 2020.
Wandering spleen is a rare clinical entity with a less than 0.2% reporting incidence rate. In this case, the spleen is present abnormally in the abdominal or pelvic cavity instead of its normal anatomical location. The aetiology is either congenital or acquired. The condition is caused by the absence or maldevelopment of the spleen's suspensory ligaments, which holds the spleen static in the left hypochondrium.

A 27-year-old female patient presented to the emergency department with complaints of abdominal pain, fever, nausea, vomiting, and constipation for three days. A palpable movable mass was found during the physical examination, and torsion of thewandering spleen's pedicle was confirmed by CT scan. Open splenectomy was performed, and the patient was recovered uneventfully.

Even though ectopic spleen is a rare disease, clinicians should be aware of its incidence. Early diagnosis in the case of an acute abdomen is vital for the preservation of the spleen. Patients presented with acute abdomen and absence of splenic shadow under left hemidiaphragm should be suspected, and further radiological investigation will confirm the diagnosis. https://www.selleckchem.com/products/tdi-011536.html Surgery is the gold standard for wandering spleen with either splenopexy or splenectomy, depending on the spleen's condition during surgery.
Even though ectopic spleen is a rare disease, clinicians should be aware of its incidence. Early diagnosis in the case of an acute abdomen is vital for the preservation of the spleen. Patients presented with acute abdomen and absence of splenic shadow under left hemidiaphragm should be suspected, and further radiological investigation will confirm the diagnosis. Surgery is the gold standard for wandering spleen with either splenopexy or splenectomy, depending on the spleen's condition during surgery.
Anopheles stephensi, an invasive malaria vector, was first detected in Africa nearly 10years ago. After the initial finding in Djibouti, it has subsequently been found in Ethiopia, Sudan and Somalia. To better inform policies and vector control decisions, it is important to understand the distribution, bionomics, insecticide susceptibility, and transmission potential of An. stephensi. These aspects were studied as part of routine entomological monitoring in Ethiopia between 2018 and 2020.

Adult mosquitoes were collected using human landing collections, pyrethrum spray catches, CDC light traps, animal-baited tent traps, resting boxes, and manual aspiration from animal shelters. Larvae were collected using hand-held dippers. The source of blood in blood-fed mosquitoes and the presence of sporozoites was assessed through enzyme-linked immunosorbent assays (ELISA). Insecticide susceptibility was assessed for pyrethroids, organophosphates and carbamates.

Adult An. stephensi were collected with aspiration, bl have in Plasmodium transmission and malaria case incidence. While additional data are being collected, national programmes can use the available data to formulate and operationalize national strategies against the threat of An. stephensi.
Understanding the bionomics, insecticide susceptibility and distribution of An. stephensi will improve the quality of a national response in Ethiopia and provide additional information on populations of this invasive species in Africa. Further work is needed to understand the role that An. stephensi will have in Plasmodium transmission and malaria case incidence. While additional data are being collected, national programmes can use the available data to formulate and operationalize national strategies against the threat of An. stephensi.
Healthcare practitioners (HCPs) play a crucial role in recognising, responding to, and supporting female patients experiencing intimate partner abuse (IPA). However, research consistently identifies barriers they perceive prevent them from doing this work effectively. These barriers can be system-based (e.g. lack of time or training) or personal/individual. This review of qualitative evidence aims to synthesise the personal barriers that impact HCPs' responses to IPA.

Fivedatabases were searched in March 2020. Studies needed to utilise qualitative methods for both data collection and analysis and be published between 2010 and 2020 in order to qualify for inclusion; however, we considered any type of healthcare setting in any country. Article screening, data extraction and methodological appraisal using a modified version of the Critical Appraisal Skills Program checklist for qualitative studies were undertaken by at least two independent reviewers. Data analysis drew on Thomas and Harden's thematic syntheways to do this within the context of complex healthcare organisations.
This review highlights the need for training to address personal issues in addition to structural or organisational barriers. Education and training for HCPs needs to encourage reflection on their own values to reinforce their commitment to addressing IPA; teach HCPs to relinquish the need to control outcomes so that they can adopt an advocacy approach; and support HCPs' trust in the critical role they can play in responding. Future research should explore effective ways to do this within the context of complex healthcare organisations.
The purpose of this study was to present a navigated image-free augmentation technique for the acromioclavicular joint (ACJ) and coracoclavicular (CC) ligaments and to report the clinical and radiological outcomes.

From 2013 to 2018, 35 eligible patients were treated with our navigated image-free ACJ- and CC-augmentation technique. The average follow-up was 3 years. Follow-up evaluations included the Constant-Murley Score, subjective shoulder value, Taft score, and the acromioclavicular joint instability (ACJI) score. The patients' quality of life was assessed using the EuroQol-5D (EQ-5D) questionnaire. In addition, in accordance with the instability criteria, radiographs were evaluated before surgery, after surgery, and during follow-up.

Overall, 25 patients (71%) suffered an acute type V disruption, 5 (14%) had a type IV disruption, and 5 (14%) had an acute Rockwood type IIIb injury. The mean Constant-Murley Score was 90 (range 56-100; p = 0.53) on the injured side, and the mean subjective shoulder vawhich avoids fractures.
Tamoxifen, which is one of the selective estrogen receptor modulators (SERMs), can bring out life-threatening complication, e.g. hypertriglyceridemia-induced acute pancreatitis, although it is rare. We precisely report changes in lipoprotein metabolism before and after tamoxifen discontinuation because there have been few reports of it.

47-year-old premenopausal woman with dyslipidemia, type 2 diabetes, nonalcoholic fatty liver disease and chronic kidney disease was prescribed tamoxifen as adjuvant therapy after operation of breast cancer. She experienced severe tamoxifen-induced hypertriglyceridemia several months after dosing tamoxifen. Before cessation of tamoxifen, lipoprotein fraction test revealed marked stagnation of VLDL and IDL metabolisms, resulting in severe hypertriglyceridemia (serum triglyceride level was 1881 mg/dL). Seven days after tamoxifen withdrawal, lipoprotein fraction test showed that the metabolisms of endogenous lipoproteins were changed drastically.

From these results, we confirmed that tamoxifen certainly changes lipoprotein metabolism through suppression of post-heparin lipolytic activity. It is very important to evaluate the balance between benefit and risk before dosing tamoxifen and survey lipid profiles constantly during treatment to avoid life-threatening complication when prescription of tamoxifen is planned.
From these results, we confirmed that tamoxifen certainly changes lipoprotein metabolism through suppression of post-heparin lipolytic activity. It is very important to evaluate the balance between benefit and risk before dosing tamoxifen and survey lipid profiles constantly during treatment to avoid life-threatening complication when prescription of tamoxifen is planned.
This study aims to investigate the influence of different dentin pretreatment procedures on the resulting abrasive dentin wear.

Two groups (A, B) of 60 dentin samples each were prepared. Group A was brushed with an abrasive slurry (RDA = 85) and group B with a different abrasive slurry (RDA = 174). Four subgroups in each group (n = 15) were created (A1-A4) and (B1-B4). The subgroups were pretreated as follows A1 + B1 with 1200-grit grinding paper, A2 + B2 with 1200- and 2000-grit papers, A3 + B3 with 1200-, 2000-, and 4000-grit papers, A4 + B4 with 1200-, 2000-, 4000-grit papers and with 1000 brushing strokes with a slurry of Elmex toothpaste. All samples were brushed for 25min at 120 strokes/min. Abrasive dentin wear was measured for each sample profilometrically and the subgroups were compared with each other within the same group. Repeated measures one-way ANOVA was conducted to compare the subgroups and pairwise contrasts were estimated for multiple testing according to Tukey (α = 0.05).

The resulting abrasive dentin wear in group A ranged between 15.