Global model for optimizing crossflow microfiltration and ultrafiltration processes: a new predictive and design tool.
A global model and algorithm that predicts the performance of crossflow MF and UF process individually or in combination in the laminar flow regime is presented and successfully tested. The model accounts for solute polydispersity, ionic environment, electrostatics, membrane properties and operating conditions. Computer programs were written in Fortran 77 for different versions of the model algorithm that can optimize MF/UF processes rapidly in terms of yield, purity, selectivity, or processing time. The model is validated successfully with three test cases: separation of bovine serum albumin (BSA) from hemoglobin (Hb), capture of immunoglobulin (IgG) from transgenic goat milk by MF, and separation of BSA from IgG by UF. These comparisons demonstrate the capability of the global model to conduct realistic in silico simulations of MF and UF processes. This model and algorithm should prove to be an invaluable technique to rapidly design new or optimize existing MF and UF processes separately or in combination in both pressure-dependent and pressure-independent regimes.


Continuous amplitude-integrated electroencephalography for prognostication of cardiac arrest patients undergoing extracorporeal cardiopulmonary resuscitation with targeted temperature management.
Extracorporeal cardiopulmonary resuscitation (ECPR) has been increasingly used for adult cardiac arrest (CA) patients refractory to conventional CPR. However, data on early prognosticators of neurological outcome are lacking. CA patients undergoing ECPR were prospectively monitored via amplitude-integrated EEG (aEEG). Targeted temperature management (TTM) was induced using an extracorporeal membrane oxygenation system. aEEG background patterns were classified into continuous normal voltage (CNV), discontinuous normal voltage (DNV), low voltage (LV), flat trace (FT), burst suppression (BS), and status epilepticus (SE). The Cerebral Performance Category (CPC) scale scores at hospital discharge and at 6 months after discharge were assessed, as was wakefulness after TTM. Good neurological outcome was defined as a CPC score of 1 or 2. Twenty-two patients were studied. Six patients who showed CNV within 24 hours after arrival, including one with initial FT and two with initial LV, regained consciousness and had good neurological outcome except for one who died of haemorrhagic complication. Patients with persistent FT or BS at any time did not regain consciousness. Regarding 19 patients in whom aEEG data were obtained within 24 hours, CNV background predicted good outcome at 6 months with 100% sensitivity, 93% specificity, 83% positive predictive values, and 100% negative predictive values. All these indices were 100% concerning wakefulness after TTM. aEEG monitoring was feasible and practical in adult CA patients undergoing ECPR and TTM. Evolution of aEEG background within 24 hours provides early accurate information for neurological prognostication.


Possible mechanisms of the anaerobic threshold. A review.
The anaerobic threshold consists of a lactate threshold and a ventilatory threshold. In some conditions there may actually be 2 ventilatory thresholds. Much of the work detailing the lactate threshold is strongly based on blood lactate concentration. Since, in most cases, blood lactate concentration does not reflect production in active skeletal muscle, inferences about the metabolic state of contracting muscle will not be valid based only on blood lactate concentration measurements. Numerous possible mechanisms may be postulated as generating a lactate threshold. However, it is very difficult to design a study to influence only one variable. One may ask, does reducing F1O2 cause an earlier occurrence of a lactate threshold during progressive exercise by reducing oxygen availability at the mitochondria? By stimulating catecholamine production? By shifting more blood flow away from tissues which remove lactate from the blood? Or by some other mechanism? Processes considered essential to the generation of a lactate threshold include: (a) substrate utilisation in which the ability of contracting muscle cells to oxidise fats reaches maximal power at lactate threshold; and (b) catecholaminergic stimulation, for without the presence of catecholamines it appears a lactate threshold cannot be generated. Other mechanisms discussed which probably enhance the lactate threshold, but are not considered essential initiators are: (a) oxygen limitation; (b) motor unit recruitment order; (c) lactate removal; (d) muscle temperature receptors; (e) metabolic stimulation; and (f) a threshold of lactate efflux. Some mechanisms reviewed which may induce or contribute to a ventilatory threshold are the effects of: (a) the carotid bodies; (b) respiratory mechanics; (c) temperature; and (d) skeletal muscle receptors. It is not yet possible to determine the hierarchy of effects essential for generating a ventilatory threshold. This may indicate that the central nervous system integrates a broad range of input signals in order to generate a non-linear increase in ventilation. Evidence indicates that the occurrence of the lactate threshold and the ventilatory threshold may be dissociated; sometimes the occurrence of the lactate threshold significantly precedes the ventilatory threshold and at other times the ventilatory threshold significantly precedes the lactate threshold. It is concluded that the 2 thresholds are not subserved by the same mechanism.


Microbiome in cancer: Role in carcinogenesis and impact in therapeutic strategies.
Cancer is the world's second-leading cause of death, and the involvement of microbes in a range of diseases, including cancer, is well established. The gut microbiota is known to play an important role in the host's health and physiology. The gut microbiota and its metabolites may activate immunological and cellular pathways that kill invading pathogens and initiate a cancer-fighting immune response. Cancer is a multiplex illness, characterized by the persistence of several genetic and physiological anomalies in malignant tissue, complicating disease therapy and control. Humans have coevolved with a complex bacterial, fungal, and viral microbiome over millions of years. Specific long-known epidemiological links between certain bacteria and cancer have recently been grasped at the molecular level. Similarly, advances in next-generation sequencing technology have enabled detailed research of microbiomes, such as the human gut microbiome, allowing for the finding of taxonomic and metabolomic linkages between the microbiome and cancer. These investigations have found causative pathways for both microorganisms within tumors and bacteria in various host habitats far from tumors using direct and immunological procedures. Anticancer diagnostic and therapeutic solutions could be developed using this review to tackle the threat of anti-cancer medication resistance as well through the wide-ranging involvement of the microbiota in regulating host metabolic and immunological homeostasis. We reviewed the significance of gut microbiota in cancer initiation as well as cancer prevention. We look at certain microorganisms that may play a role in the development of cancer. Several bacteria with probiotic qualities may be employed as bio-therapeutic agents to re-establish the microbial population and trigger a strong immune response to remove malignancies, and further study into this should be conducted.


Using Administrative Data to Assess the Risk of Permanent Work Disability: A Cohort Study.
Purpose Unmet rehabilitation needs are common. We therefore developed a risk score using administrative data to assess the risk of permanent work disability. Such a score may support the identification of individuals with a high likelihood of receiving a disability pension. Methods Our sample was a random and stratified 1% sample of individuals aged 18-65 years paying pension contributions. From administrative records, we extracted sociodemographic data and data about employment and welfare benefits covering 2010-2012. Our outcome was a pension due to work disability that was requested between January 2013 and December 2017. We developed a comprehensive logistic regression model and used the model estimates to determine the risk score. Results We included 352,140 individuals and counted 6,360 (1.8%) disability pensions during the 5-year follow-up. The area under the receiver operating curve was 0.839 (95% CI 0.834 to 0.844) for the continuous risk score. Using a threshold of ≥ 50 points (20.2% of all individuals), we correctly classified 80.6% of all individuals (sensitivity: 71.5%; specificity: 80.8%). Using ≥ 60 points (9.9% of all individuals), we correctly classified 90.3% (sensitivity: 54.9%; specificity: 91.0%). Individuals with 50 to < 60 points had a five times higher risk of a disability pension compared to individuals with low scores, individuals with ≥ 60 points a 17 times higher risk. Conclusions The risk score offers an opportunity to screen for people with a high risk of permanent work disability.


Detection of frailty in older patients using a mobile app: cross-sectional observational study in primary care.
The main instruments used to assess frailty are the Fried frailty phenotype and the Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight (FRAIL) scale. Both instruments contain items that must be obtained in a personal interview and cannot be used with an electronic medical record only. To develop and internally validate a prediction model, based on a points system and integrated in an application (app) for Android, to predict frailty using only variables taken from a patient's clinical history. A cross-sectional observational study undertaken across the Valencian Community, Spain. A sample of 621 older patients was analysed from January 2017 to May 2018. The main variable was frailty measured using the FRAIL scale. Candidate predictors were: sex, age, comorbidities, or clinical situations that could affect daily life, polypharmacy, and hospital admission in the last year. A total of 3472 logistic regression models were estimated. The model with the largest area under the receiver operating characteristic curve (AUC) was selected and adapted to the points system. This system was validated by bootstrapping, determining discrimination (AUC), and calibration (smooth calibration). A total of 126 (20.3%) older people were identified as being frail. The points system had an AUC of 0.78 and included as predictors: sex, age, polypharmacy, hospital admission in the last year, and diabetes. Calibration was satisfactory. A points system was developed to predict frailty in older people using parameters that are easy to obtain and recorded in the clinical history. Future research should be carried out to externally validate the constructed model.


Temporary venovenous extracorporeal membrane oxygenation after cardiopulmonary bypass in minimally invasive cardiac surgery via right minithoracotomy.
In minimally invasive cardiac surgery, it can be difficult at times to maintain adequate oxygenation with single-lung ventilation after weaning from cardiopulmonary bypass (CPB), and intermittent double-lung ventilation is required during hemostasis. Venovenous extracorporeal membrane oxygenation (VV-ECMO) after weaning from CPB eliminates the necessity of overinflation of the left lung and intermittent double-lung ventilation and enables secure and fast hemostasis. We investigated the effectiveness and safety of temporary VV-ECMO in MICS. Between May 2018 and March 2021, 149 patients underwent temporary VV-ECMO during minimally invasive cardiac surgery in our institutions. After weaning from CPB, the arterial circuit was reconnected to the right internal jugular venous cannula, the femoral venous cannula was pulled down by 20 cm, and VV-ECMO was established using the CPB machine and cannulas. After starting VV-ECMO, we administered protamine and performed hemostasis. Operative data and outcomes were retrospectively reviewed. The mean VV-ECMO time and flow were 26 ± 13 minutes and 2.38 ± 0.40 L/m2, respectively. There was no thrombus in the CPB circuit, including the oxygenator. The trans-oxygenator pressure gradient index at the end of VV-ECMO significantly correlated with that at the start of VV-ECMO (r = 0.88; 95% CI, 0.79-0.94; P = .01). The 30-day mortality rate was 2.0%. The incidences of unilateral pulmonary edema, prolonged ventilation, and re-exploration for bleeding were 2.7%, 5.4%, and 2.0%, respectively. Temporary VV-ECMO is safe and useful to maintain single-lung ventilation without overinflation after weaning from CPB for secure and fast hemostasis in minimally invasive cardiac surgery. No thrombotic event was found during temporary VV-ECMO without heparinization.


Revisit of the CatLet (Hexu) angiographic scoring system: a narrative review.
We have recently developed the Coronary Artery Tree description and Lesion EvaluaTion (CatLet or Hexu, invented by He and Xu) angiographic scoring system, which, considering the coronary anatomy in its diversity, the stenosis degree of a coronary artery, and the myocardial territory subtended by the diseased coronary artery, can be utilized to predict clinical outcomes for patients with acute myocardial infarction (available at www.catletscore.com). Its values for clinical practice and coronary artery disease research are building upon. Over the past two years, the principles underlying this novel angiographic scoring system do not materially change although slight adjustments have really happened. Given these adjustments and the scoring experience gained in daily use, we think that it is necessary to elaborate on these points so that readers with interest are capable to better use this CatLet or Hexu angiographic scoring system both in clinical practice and in scientific research. The principles underlying this novel angiographic scoring system include the 17-myocardial segmental model, law of competitive blood supply, and law of flow conservation. The adjustments made to this novel angiographic scoring system include: (I) the short axis of the left ventricle at the basal level is used to characterize the six types of right coronary artery size; (II) segments marked with 'X and 'S have a unified preset difference of one segment as adopted in the characterization of left anterior descending artery; (III) segments marked with '+ have been added to explain the rare variability in the obtuse marginal branches or in the posterolateral vessels in some cases. The CatLet or Hexu angiographic scoring system strictly follows the law of flow conservation in weighting assignment, and the lesion scoring correction has been additionally emphasized and detailed. The elaboration on these adjustments and scoring experience gained on the CatLet or Hexu angiographic scoring system will help to boost its use in cardiovascular field. The utilities of this novel angiographic scoring system have been preliminarily validated and its future is deserving of being anticipated.


The prevalence and treatment gap of epilepsy in Tbilisi, Georgia.
Data on the prevalence of epilepsy and the extent of its treatment gap are important for planning health care delivery for people with epilepsy. The prevalence of active epilepsy in Georgia prior to the social and political re-organization in the early 1990s was estimated at around 5.7 per 1000. Changes to the social structure of the country may have affected this. There is no previous estimate of the treatment gap. A door-to-door survey was carried out using a validated screening questionnaire to determine the prevalence of epilepsy and the extent of the treatment gap amongst a population of about 10,000 people in Tbilisi, the capital of Georgia. The diagnosis of epilepsy amongst those who screened positive was confirmed by a multidisciplinary team. Lifetime prevalence was 11.4/1000. The prevalence of active epilepsy was estimated at 8.8/1000, and 5/1000 had seizures in the previous 12 months. About two thirds of people with active epilepsy had not received appropriate antiepileptic treatment in the month prior to the survey. 89% had focal epilepsy and two thirds had co-morbidity (neurological deficits, behavioral, psychiatric or somatic problems). The prevalence of epilepsy was higher than previously estimated and the treatment gap was substantial. Results should inform the planning of epilepsy care delivery in the country.


MOZ and MORF acetyltransferases: Molecular interaction, animal development and human disease.
Lysine residues are subject to many forms of covalent modification and one such modification is acetylation of the ε-amino group. Initially identified on histone proteins in the 1960s, lysine acetylation is now considered as an important form of post-translational modification that rivals phosphorylation. However, only about a dozen of human lysine acetyltransferases have been identified. Among them are MOZ (monocytic leukemia zinc finger protein; a.k.a. MYST3 and KAT6A) and its paralog MORF (a.k.a. MYST4 and KAT6B). Although there is a distantly related protein in Drosophila and sea urchin, these two enzymes are vertebrate-specific. They form tetrameric complexes with BRPF1 (bromodomain- and PHD finger-containing protein 1) and two small non-catalytic subunits. These two acetyltransferases and BRPF1 play key roles in various developmental processes; for example, they are important for development of hematopoietic and neural stem cells. The human KAT6A and KAT6B genes are recurrently mutated in leukemia, non-hematologic malignancies, and multiple developmental disorders displaying intellectual disability and various other abnormalities. In addition, the BRPF1 gene is mutated in childhood leukemia and adult medulloblastoma. Therefore, these two acetyltransferases and their partner BRPF1 are important in animal development and human disease.


Evaluation of a transparent perfluorodecalin-infused patch as an adjunct to laser-assisted tattoo removal: A pivotal trial.
Laser-assisted treatment of tattoos is well recognized to produce opaque epidermal whitening that prevents multiple sequential passes during a single treatment session. The amount of epidermal whitening produced in association with the procedure can be minimized by topical application of perfluorodecalin (PFD), which is an optical clearing agent. This pivotal trial assessed the ability of a transparent PFD-infused patch used in conjunction with a Q-switched nanosecond laser in the treatment of tattoos to permit multiple laser passes during a single 5 minute treatment session in comparison to the number of passes that could be completed using conventional treatment of the tattoo with the laser alone. Thirty subjects (mean age 37 years; 14 males) with predominantly dark blue or black tattoos were enrolled in a split-tattoo trial. One half of each tattoo was treated conventionally, whereas the other half was treated through the PFD patch. Treatments were performed using a nanosecond Q-switched 755-nm Alexandrite laser. The number of treatments performed in a 5-minute time period was quantified for each side of the tattoo (primary effectiveness outcome). Patient-reported pain scores and adverse events (AEs) were also evaluated. Significantly more laser passes could be made on average using the PFD patch compared with treatment using the laser alone (3.7 passes vs. 1.4 passes; P < 0.001). AEs were limited to those expected during laser removal of tattoos. The proportions of subjects with transient edema and erythema were lower in the PFD patch treatment group (36.7% vs. 63.3% and 33.3% vs. 70.0%, respectively); all AEs were transient and resolved quickly. No patient in either group exhibited dyschromia (hypo- or hyperpigmentation) in the treatment area at the 1-month post treatment visit. Additionally, when surveyed at the 1-month follow-up visit, all subjects (30/30) preferred to continue laser-assisted tattoo removal with the PFD patch. An average of 3.7 laser passes were made in a defined 5-minute treatment session when using the transparent PFD-infused patch, which is significantly more than was possible with the laser alone (average of 1.4 passes). Use of the PFD patch was associated with improved tolerability compared with conventional treatment, with subjects experiencing fewer and less severe AEs related to epidermal injury. Lasers Surg. Med. 49:335-340, 2017. © 2017 Wiley Periodicals, Inc.


Multicenter prospective cohort study of adverse events associated with biliary endoscopic retrograde cholangiopancreatography: Incidence of adverse events and preventive measures for post-endoscopic retrograde cholangiopancreatography pancreatitis.
The reported incidence of adverse events (AEs) in endoscopic retrograde cholangiopancreatography (ERCP) varies between 2.5% and 14%. The aim of this study was to evaluate the incidence and severity of AEs in biliary ERCP and to specify the risk factors and preventive measures for post-ERCP pancreatitis (PEP). Patients with biliary disease with intact papilla were prospectively enrolled at 36 hospitals between April 2017 and March 2018. The primary outcomes were the incidence and severity of AEs. A total of 16,032 ERCP procedures were performed at the 36 hospitals during the study period and 3739 patients were enrolled. The overall incidence of AEs was 10.1% and ERCP-related mortality was 0.08%. PEP developed in 258 cases (6.9%), bleeding in 33 (0.9%), instrumental AEs in 17 (0.5%), infections in 37 (1.0%), cardiovascular AEs in eight (0.2%), pulmonary AEs in eight (0.2%), drug reaction AE in one (0.03%), pain in 15 (0.4%), and other AEs in 15 (0.4%). Multivariable analysis showed significant risk factors for PEP were: female of younger age, pancreatic guidewire-assisted biliary cannulation, temporary guidewire insertion into the pancreatic duct, total procedure time >60 min, and post-ERCP administration of non-steroidal anti-inflammatory drugs. Effective preventive measures were prophylactic pancreatic stenting (PPS) and epinephrine spraying onto the papilla. In patients with intact papilla who underwent biliary ERCP, the incidence of AEs was 10.1% and the mortality was 0.08%. PPS and epinephrine spraying may prevent PEP. This study was registered in the University Hospital Medical Information Network (UMIN000024820).


Venous drainage of the stomach in the golden hamster (Mesocricetus auratus) and the guinea pig (Cavia aperea f. porcellus).
Venous drainage patterns of the stomach were studied in 30 golden hamsters (Mesocricetus auratus) and in 30 guinea pigs (Cavia aperea f. porcellus). In golden hamsters the most frequent group had a v. gastroepiploica dextra (85.6% of cases). The v. gastroepiploica sinistra was found in 63.3% of cases. In the second group, the venous drainage pattern was without a v. gastroepiploica dextra (13.3% of cases). The only constant venous channel from the stomach was the v. gastrica sinistra. Other veins draining the stomach were vv. gastricae (tributaries of the v. lienalis) and interorgan venous anastomoses with neighbouring organs. A venous arch along the curvatura ventriculi major was not observed in any of the cases. In the guinea pig, the first group with a v. gastroepiploica dextra accounted for 90.0% of cases while the second group without this vein represented 10.0% of cases. The only constant venous channel was, once again, the v. gastrica sinistra. Other veins of the stomach were similar to those in the golden hamster. A venous arch along the curvatura ventriculi major was found in 76.6% of cases. Some differences in the venous pattern between the two animal species can be explained by zoological differences in these mammals. The results obtained also stimulate interest in the study of possible variations in venous patterns of the stomach in man.


Retrospective evaluation of paediatric oral biopsies over a 10-year period in Western India.
This retrospective study reviewed the paediatric oral biopsies received over 10 years at a teaching hospital and dental college in India. It is important that paediatric dentists know the diagnostic tendencies of oral pathological conditions in children, and possess updated information for their diagnosis and treatment. Biopsies of patients 17 years of age or younger were selected. Computerised data regarding age, gender, anatomic location, and histopathological diagnosis was retrieved and classified into nine categories. Of a total 2959 oral biopsies, 359 cases (12.1%) were in the paediatric population with a slight male predominance. Salivary gland pathology (21.4%) was most frequently observed followed by dental pathology, maxillofacial tumours and maxillofacial cysts. More than a third of cases (35.9%) were found to occur in the mandible. Five cases of malignancies were found, two of which were salivary gland tumours. The majority of lesions identified were of a benign nature necessitating minimal intervention; however, it is important to recognise that malignant lesions can occur in children. Any swelling, especially related to the salivary glands, must be investigated immediately, so as to prevent mortality and reduce morbidity. Diverse classifications used by previous authors make comparison of data challenging.


Structure-activity relationships of the dimeric analogues of endomorphin-2 with different lengths of spacers.
In the present study, seven novel dimeric analogues of endomorphin-2 with longer spacers were designed and synthesized. Through dimerization, their affinity for delta-opioid receptor was mostly increased, especially the delta-opioid receptor preferred dimeric analogue, DEM(12). The results were confirmed by the in vitro bioassay. The structure-activity relationships were also discussed.


Safety and efficacy evaluation of a novel dietary muramidase for swine.
The safety of a novel microbial muramidase (Muramidase 007) as a feed additive for swine was evaluated in a target animal safety study (Experiment 1). Forty weanling pigs were allotted to 4 dietary treatments: T1 control group, and 3 groups receiving Muramidase 007 in increasing doses: T2 65,000 (1X), T3 325,000 (5X) and T4 650,000 (10X) LSU(F)/kg feed. The efficacy of Muramidase 007 on growth performance was evaluated in a feeding experiment (Experiment 2). A total of 288 piglets were allotted to two groups: T1 control group and T2 receiving Muramidase 007 at 50,000 (LSU(F)/kg feed. In Experiment 1, no growth depression of pigs was observed. No adverse effects of Muramidase 007 were observed for any of the hematology and serum chemistry parameters measured or on pig health status. Post-mortem evaluation showed no adverse effects due to Muramidase 007 supplementation in the gross pathology or in the histological examination. In Experiment 2, Muramidase 007 significantly increased overall (d 0-42) average daily gain (ADG) and tended to improve overall average daily feed intake (ADFI) and day 42 body weight of nursery pigs and had no effect on feed conversion ratio (FCR). Overall, results of these studies show that there were no adverse effects of Muramidase 007 compared to the control group.


Vigorous SO4(2-) influx via the gills is balanced by enhanced SO4(2-) excretion by the kidney in eels after seawater adaptation.
Sulfate (SO(4)(2-)) is maintained at ∼1 mmol(-1) l(-1) in teleost fishes that are exposed to media of varying SO(4)(2-) concentrations. We first measured plasma SO(4)(2-) concentration in euryhaline fishes that adapt to both SO(4)(2-)-poor freshwater (<0.5 mmol l) and SO(4)(2-)-enriched seawater (30 mmol l(-1)). Unlike Mozambique tilapia and chum salmon, Japanese eels maintained higher plasma SO(4)(2-) concentration in freshwater (6.2±2.3 mmol l(-1)) than in seawater (0.7±0.1 mmol l(-1)). We then analyzed the whole-body SO(4)(2-) budget using (35)SO(4)(2-). (35)SO(4)(2-) influx in seawater-adapted eels occurred by 84.5% via body surfaces and 15.5% via digestive tracts. The SO(4)(2-) influx was higher in seawater eels (1.55 μmol kg(-1) h(-1)) than in freshwater eels (0.09 μmol kg(-1) min(-1)), but it was facilitated in freshwater eels when the difference in SO(4)(2-) concentrations between plasma and environment was taken into account (freshwater eels, 6.2 vs 0.3 mmol l(-1); seawater eels, 0.7 vs 30 mmol l(-1)). One hour after injection of (35)SO(4)(2-) into the blood of seawater eels, the kidney excreted ∼97% of the ionized form, whereas the radioactivity increased gradually in the medium and the rectal fluid more than 3 h after injection. As the radioactivity was poorly adsorbed by anion-exchange resin, (35)SO(4)(2-) in the blood may be incorporated into cells and excreted by the intestine, gills and skin, probably as mucus. These results show that freshwater eels take up SO(4)(2-) actively from the environment, but seawater eels cope with the obligatory influx of SO(4)(2-) through the gills by excreting excess SO(4)(2-) via the kidney and in mucus.


Discharge preparation and readiness after birth: a scoping review of global policies, guidelines and literature.
Despite the existence of global recommendations, postnatal care provided following childbirth is variable and often fails to address a woman's concerns about herself and the parents' concerns about their baby. Discharge from a facility after birth is a key moment to ensure the woman, parents and newborn receive support for the transition to care in the home. We mapped the current policies, guidance and literature on discharge preparation and readiness to identify key concepts and evidence and inform recommendations to be considered in a World Health Organization (WHO) guidance on postnatal care. We were guided by the Johanna Briggs Institute approach, and developed inclusion criteria based on existing defintions of discharge preparation and readiness, and criteria for discharge readiness compiled by international professional organisaitons. To identify guidelines and policies we searched websites and archives of guideline organisations, and contacted individuals and professional societies working on postnatal care. We searched 14 electronic databases to locate published research and other literature on discharge preparation and readiness. For documents that met the inclusion criteria we extracted key characteristics, summarised discharge readiness criteria and components and discharge preparation steps, and characterised interventions to improve discharge preparation. The review provides a systematic map of criteria for discharge that are in use and the common steps healthcare providers take in preparing women and newborns for the transition home. The mapping also identified interventions used to strengthen discharge preparation, theories and models that conceptualise discharge preparation, scales for measuring discharge readiness and qualitative studies on the perspectives of women, men and healthcare providers on postnatal discharge. The findings highlight contrasts between the research literature and policy documents. They indicate potential gaps in current discharge policies, and point to the need for more comprehensive discharge assessment and education to better identify and meet the needs of women, parents/caregivers and families prior to discharge and identify those who may require additional support. The protocol for the review was registered with protocols.io on 23 November 2020: https://doi.org/10.17504/protocols.io.bpzymp7w.


Predicting handgrip power of young adult population among major ethnic groups of Sabah: a multivariate analysis.
Handgrip power is an essential indicator of health, vital for grasping or gripping sports, and crucial for providing information related to work capacity. The present study investigated any linear relationship of handgrip power with hand anthropometric variables (hand length, handbreadth, middle finger length, second inter-crease length of the middle finger, and hand span), gender, and ethnicity in young adults of Sabah. In this cross-sectional study (from January 2020 to December 2021), the adult Sabahan population (18-25 years) was stratified into four ethnicities (KadazanDusun, Bajau, Malay, and Chinese) and was further stratified as males and females. Then, 46 subjects were randomly selected from each gender, and the ethnic group met the intended sample size. The hand dimensions were measured using a digital calliper, and the handgrip power was measured using a portable dynamometer. The relationship between the response variable and explanatory variables was analyzed at first through simple linear regression and then multiple linear regression. R2, adjusted R2, and standard errors of the estimates were used to compare different models. Statistical analyses were performed using IBM SPSS Statistics 27 and StatCrunch. The study found a linear relationship between gender, height, hand length, handbreadth, hand span, middle finger length, and second inter-crease length of both hands with the corresponding hand's grip power. The highest percentage (68% and 67%) of handgrip variability was demonstrated by the model predicting handgrip power for right-handed subjects, followed by the general models without stratifying based on hand dominance which was able to explain 63% and 64% of the variability of handgrip power. The study proposes the models for predicted right (RHGP) and left handgrip power (LHGP) of 18 to 25 years old adults from major ethnic groups of Sabah RHGP = - 18.972 - 8.704 Gender + 7.043 Right hand breadth and LHGP = - 11.621 - 9.389 Gender + 5.861 Left hand breadth respectively. The predicted handgrip power would be a key to selecting a better player or a better worker or assessing the prognosis of a disease or the wellbeing of a person. The study can be further expanded to all ethnicities and ages of people of Sabah or even Malaysia.


Extraskeletal versus Skeletal Ewing Sarcoma in the adult population: Controversies in care.
A lack of consensus exists on the prognosis of extraskeletal Ewing sarcoma (EES) relative to its skeletal (ES) counterpart in adults. This study sought to characterize outcome differences between the two diagnoses. From 2004 to 2014, the NCDB identified 2,660 Ewing Sarcoma patients. Cox proportional hazards regression analysis was used to identify risk factors for overall survival (OS). EES patients were older, more likely to be female, and have smaller tumors. Among patients with ES, 4.0% received no treatment, 2.5% received local therapy only (surgery and/or radiation), 16.8% received chemotherapy only, while 52.2% received combination therapy (local and chemotherapy), and 17.0% recieived triple therapy (surgery, radiation and chemotherapy). Among patients with EES, 4.3% recived no treatment, 5.6% received local therapy only, 15.6% received chemotherapy only, while 47.0% received combination therapy, and 21.6% received triple therapy. No difference in OS was observed between the two groups (P = 0.816). Factors independently associated with OS for ES included age (HR = 1.26, P = 0.01), Charlson-Deyo Score (CDS) ≥2 (HR = 3.66, P < 0.001), combination therapy (HR = 0.39, P < 0.001) and triple therapy (HR = 0.34, P < 0.001). For EES, factors for OS were age (HR = 1.52, P < 0.001), CDS ≥2 (HR = 1.90, P = 0.02), combination therapy (HR = 0.44, P < 0.001), triple therapy (HR = 0.34, P < 0.001) and PNET histology (HR = 1.33, P = 0.02). Demographic, histological, and treatment characteristics differ between adult patients diagnosed with ES and ESS. However, survival and independent predictors of survival are consistent between the two diagnoses.


Interface-induced magnetic polar metal phase in complex oxides.
Polar metals are commonly defined as metals with polar structural distortions. Strict symmetry restrictions make them an extremely rare breed as the structural constraints favor insulating over metallic phase. Moreover, no polar metals are known to be magnetic. Here we report on the realization of a magnetic polar metal phase in a BaTiO3/SrRuO3/BaTiO3 heterostructure. Electron microscopy reveals polar lattice distortions in three-unit-cells thick SrRuO3 between BaTiO3 layers. Electrical transport and magnetization measurements reveal that this heterostructure possesses a metallic phase with high conductivity and ferromagnetic ordering with high saturation moment. The high conductivity in the SrRuO3 layer can be attributed to the effect of electrostatic carrier accumulation induced by the BaTiO3 layers. Density-functional-theory calculations provide insights into the origin of the observed properties of the thin SrRuO3 film. The present results pave a way to design materials with desired functionalities at oxide interfaces.


The differential influence of decades and units on multidigit number comparison.
What role do the magnitudes of the constituent digits play in three-digit number comparison (e.g., choosing the larger one of two numbers)? The present study addressed this question by examining compatibility effects between hundred and decade digits and between hundred and unit digits. For example, the number pair 372-845 is hundred-decade incompatible because the larger number contains the smaller decade digit, but hundred-unit compatible because the larger number contains the larger unit digit. We obtained significant effects ofhundred-decade and hundred-unit compatibility on number comparison times. However, the effect of hundred-unit compatibility was largely restricted to the hundred-decade-compatible condition. These results suggest that place-value information, through decomposition, is automatically taken into account when multidigit numbers have to be compared. Implications of our findings for models of number processing are discussed.


Lymphangiomyoma of the thoracic duct with previously undescribed epithelial tubules.
A case of mediastinal lymphangiomyoma with tubules covered with epithelium is reported. The epithelium of these tubules is morphologically identical to that of the bronchi. It is the first time that epithelial, presumably pulmonary, elements have been described in an extrapulmonary lymphangiomyoma. It is concluded that the present case of mediastinal lymphangiomyoma suggests a hamartomatous malformation. Whether this applies in general to lymphangiomyomatosis still remains a matter of discussion.


Double-edged effect of sodium citrate in Nile tilapia (Oreochromis niloticus): Promoting lipid and protein deposition vs. causing hyperglycemia and insulin resistance.
Citrate is an essential substrate for energy metabolism that plays critical roles in regulating glucose and lipid metabolic homeostasis. However, the action of citrate in regulating nutrient metabolism in fish remains poorly understood. Here, we investigated the effects of dietary sodium citrate on growth performance and systematic energy metabolism in juvenile Nile tilapia (Oreochromis niloticus). A total of 270 Nile tilapia (2.81 ± 0.01 g) were randomly divided into three groups (3 replicates per group, 30 fish per replicate) and fed with control diet (35% protein and 6% lipid), 2% and 4% sodium citrate diets, respectively, for 8 weeks. The results showed that sodium citrate exhibited no effect on growth performance (P > 0.05). The whole-body crude protein, serum triglyceride and hepatic glycogen contents were significantly increased in the 4% sodium citrate group (P < 0.05), but not in the 2% sodium citrate group (P > 0.05). The 4% sodium citrate treatment significantly increased the serum glucose and insulin levels at the end of feeding trial and also in the glucose tolerance test (P < 0.05). The 4% sodium citrate significantly enhanced the hepatic phosphofructokinase activity and inhibited the expression of pyruvate dehydrogenase kinase isozyme 2 and phosphor-pyruvate dehydrogenase E1 component subunit alpha proteins (P < 0.05). Additionally, the 4% sodium citrate significantly increased hepatic triglyceride and acetyl-CoA levels, while the expressions of carnitine palmitoyl transferase 1a protein were significantly down-regulated by the 4% sodium citrate (P < 0.05). Besides, the 4% sodium citrate induced crude protein deposition in muscle by activating mTOR signaling and inhibiting AMPK signaling (P < 0.05). Furthermore, the 4% sodium citrate significantly suppressed serum aspartate aminotransferase and alanine aminotransferase activities, along with the lowered expression of pro-inflammatory genes, such as nfκb, tnfα and il8 (P < 0.05). Although the 4% sodium citrate significantly increased phosphor-nuclear factor-kB p65 protein expression (P < 0.05), no significant tissue damage or inflammation occurred. Taken together, dietary supplementation of sodium citrate could exhibit a double-edged effect in Nile tilapia, with the positive aspect in promoting nutrient deposition and the negative aspect in causing hyperglycemia and insulin resistance.


In situ detection of beta-lactamase activity in sodium dodecyl sulfate-polyacrylamide gels.
After beta-lactamase had been denatured by boiling in the presence of sodium dodecyl sulfate (SDS) and then electrophoresed in SDS-polyacrylamide gels, activity could be restored and could be detected in situ as specific molecular species. Renaturation was simple and facilitated by the presence of a carrier protein. The assay was sensitive, detecting 0.8 ng beta-lactamase activity in the gel.