Mechanisms and Control of Self-Emulsification upon Freezing and Melting of Dispersed Alkane Drops

Emulsification requires drop breakage and creation of a large interfacial area between immiscible liquid phases. Usually, high-shear or high-pressure emulsification devices that generate heat and increase the emulsion temperature are used to obtain emulsions with micrometer and submicrometer droplets. Recently, we reported a new, efficient procedure of self-emulsification (Tcholakova et al. Nat. Commun. 2017, 8, 15012), which consists of one to several cycles of freezing and melting of predispersed alkane drops in a coarse oil-in-water emulsion. Within these freeze-thaw cycles of the dispersed drops, the latter burst spontaneously into hundreds and thousands of smaller droplets without using any mechanical agitation. Here, we clarify the main factors and mechanisms, which drive this self-emulsification process, by exploring systematically the effects of the oil and surfactant types, the cooling rate, and the initial drop size. We show that the typical size of the droplets, generated by this method, is controlled by the size of the structural domains formed in the cooling-freezing stage of the procedure. Depending on the leading mechanism, these could be the diameter of the fibers formed upon drop self-shaping or the size of the crystal domains formed at the moment of drop-freezing. Generally, surfactant tails that are 0-2 carbon atoms longer than the oil molecules are most appropriate to observe efficient self-emulsification. The specific requirements for the realization of different mechanisms are clarified and discussed. The relative efficiencies of the three different mechanisms, as a function of the droplet size and cooling procedure, are compared in controlled experiments to provide guidance for understanding and further optimization and scale-up of this self-emulsification process

Funkcionalne osobine sojeva bakterija mlečne kiseline i mikrokoka u sredini sličnoj mesnoj masi sirovih kobasica kao modelu

In this study we investigated the potential probiotic properties of Lactobacillus plantarum L 24 - 2, Lactococcus lactis biovar diacetylactis N 237 and strain Micrococcus sp. It has been found that microbial species exhibited the ability to survive under conditions of high concentrations of bile salts (2.0%) and low pH (2.0). This ability varies for different types, but they will remain until the end of experiments zivotosposobne. This, together with the antimicrobial activity projavljenoj them makes them suitable for the new composition uklucivane the starter culture, which can be effectively used as an antimicrobial barrier to the development of pathogenic bacteria in the manufacture of a crude - product of dried meat.U ovom radu su ispitivana potencijalna probiotska svojstva bakterija Lactobacillus Plantarum soj L 24 - 2, Lactococcus lactis biovar diacetilactis soj N 237 i Micrococcus sp. Utvrđeno je da mikrobne vrste pokazuju sposobnost za preživljavanje pod uslovima visoke koncentracije žučnih soli (2,0%) i niskog pH (2.0). Ova sposobnost varira kod različitih ispitivanih bakterija, ali sve one ostaju životno sposobne do kraja eksperimenata. Ovo, zajedno sa dokazanom antimikrobnom aktivnošću čini ih pogodnim za uključivane u sastav novih starter kultura, koje mogu efikasno poslužiti kao antimikrobna barijera za razvoj patogenih bakterija u proizvodnji sirovih - sušenih proizvoda od mesa

A survey of UK medical schools' arrangements for early patient contact

Background: Many U.K. medical schools have patient contact in the first two years of the undergraduate course. Aim: To compare the purposes and organization of early patient contact in UK medical schools and to relate these arrangements to the schools' curricular objectives. Methods: A telephone survey of lead educators in UK medicals schools. Categories of contact were plotted against phases of the course to discern patterns of organisation. Results: The quantity of contact varies considerably (four to 65 days). There is a pattern, with learning objectives around the social context of health and illness preceding skills based work and integrated clinical knowledge for practice coming later. Schools fall into three categories: close adherence to the preclinical/clinical split, with limited early contact acting as an introduction to social aspects of health; provision of substantial patient contact to maximize the integration of knowledge and skills; and transitional, with limited clinical goals. General practice provides between one third and one half of early patient contact. Conclusions: Arrangements meet the objectives set by each school and reflect differing educational philosophies. Change is toward more early contact. There appears to be no national guidance which supports a minimum quantity of patient contact or specific educational purpose in the early years of U.K. basic medical training

Doctor-patient interaction in Finnish primary health care as perceived by first year medical students

BACKGROUND: In Finland, public health care is the responsibility of primary health care centres, which render a wide range of community level preventive, curative and rehabilitative medical care. Since 1990's, medical studies have involved early familiarization of medical students with general practice from the beginning of the studies, as this pre-clinical familiarisation helps medical students understand patients as human beings, recognise the importance of the doctor-patient relationship and identify practicing general practitioners (GPs) as role models for their professional development. Focused on doctor-patient relationship, we analysed the reports of 2002 first year medical students in the University of Kuopio. The students observed GPs' work during their 2-day visit to primary health care centres. METHODS: We analysed systematically the texts of 127 written reports of 2002, which represents 95.5% of the 133 first year pre-clinical medical students reports. The reports of 2003 (N = 118) and 2004 (N = 130) were used as reference material. RESULTS: Majority of the students reported GPs as positive role models. Some students reported GPs' poor attitudes, which they, however, regarded as a learning opportunity. Students generally observed a great variety of responsibilities in general practice, and expressed admiration for the skills and abilities required. They appreciated the GPs' interest in patients concerns. GPs' communication styles were found to vary considerably. Students reported some factors disturbing the consultation session, such as the GP staring at the computer screen and other team members entering the room. Working with marginalized groups, the chronically and terminally ill, and dying patients was seen as an area for development in the busy Finnish primary health care centres. CONCLUSION: During the analysis, we discovered that medical students' perceptions in this study are in line with the previous findings about the importance of role model (good or bad) in making good doctors. Therefore, medical students' pre-clinical primary health care centre visits may influence their attitudes towards primary health care work and the doctor-patient relationship. We welcome more European studies on the role of early pre-clinical general practice exposure on medical students' primary care specialty choice

A systematic review of natural health product treatment for vitiligo

<p>Abstract</p> <p>Background</p> <p>Vitiligo is a hypopigmentation disorder affecting 1 to 4% of the world population. Fifty percent of cases appear before the age of 20 years old, and the disfigurement results in psychiatric morbidity in 16 to 35% of those affected.</p> <p>Methods</p> <p>Our objective was to complete a comprehensive, systematic review of the published scientific literature to identify natural health products (NHP) such as vitamins, herbs and other supplements that may have efficacy in the treatment of vitiligo. We searched eight databases including MEDLINE and EMBASE for vitiligo, leucoderma, and various NHP terms. Prospective controlled clinical human trials were identified and assessed for quality.</p> <p>Results</p> <p>Fifteen clinical trials were identified, and organized into four categories based on the NHP used for treatment. 1) L-phenylalanine monotherapy was assessed in one trial, and as an adjuvant to phototherapy in three trials. All reported beneficial effects. 2) Three clinical trials utilized different traditional Chinese medicine products. Although each traditional Chinese medicine trial reported benefit in the active groups, the quality of the trials was poor. 3) Six trials investigated the use of plants in the treatment of vitiligo, four using plants as photosensitizing agents. The studies provide weak evidence that photosensitizing plants can be effective in conjunction with phototherapy, and moderate evidence that <it>Ginkgo biloba </it>monotherapy can be useful for vitiligo. 4) Two clinical trials investigated the use of vitamins in the therapy of vitiligo. One tested oral cobalamin with folic acid, and found no significant improvement over control. Another trial combined vitamin E with phototherapy and reported significantly better repigmentation over phototherapy only. It was not possible to pool the data from any studies for meta-analytic purposes due to the wide difference in outcome measures and poor quality ofreporting.</p> <p>Conclusion</p> <p>Reports investigating the efficacy of NHPs for vitiligo exist, but are of poor methodological quality and contain significant reporting flaws. L-phenylalanine used with phototherapy, and oral <it>Ginkgo biloba </it>as monotherapy show promise and warrant further investigation.</p

Medical students' and facilitators' experiences of an Early Professional Contact course: Active and motivated students, strained facilitators

Background: Today, medical students are introduced to patient contact, communication skills, and clinical examination in the preclinical years of the curriculum with the purpose of gaining clinical experience. These courses are often evaluated from the student perspective. Reports with an additional emphasis on the facilitator perspective are scarce. According to constructive alignment, an influential concept from research in higher education, the learning climate between students and teachers is also of great importance. In this paper, we approach the learning climate by studying both students' and facilitators' course experiences.\ud \ud In 2001, a new "Early Professional Contact" longitudinal strand through term 1–4, was introduced at the Sahlgrenska Academy, University of Gothenburg, Sweden. General practitioners and hospital specialists were facilitators.\ud \ud The aim of this study was to assess and analyse students' and clinical facilitators' experiences of the Early Professional Contact course and to illuminate facilitators' working conditions.\ud \ud Methods: Inspired by a Swedish adaptation of the Course Experience Questionnaire, an Early Professional Contact Questionnaire was constructed. In 2003, on the completion of the first longitudinal strand, a student and facilitator version was distributed to 86 students and 21 facilitators. In the analysis, both Chi-square and the Mann-Whitney tests were used.\ud \ud Results: Sixty students (70%) and 15 facilitators (71%) completed the questionnaire. Both students and facilitators were satisfied with the course. Students reported gaining [inspiration] for their future work as doctors along with increased confidence in meeting patients. They also reported increased motivation for biomedical studies. Differences in attitudes between facilitators and students were found. Facilitators experienced a greater workload, less reasonable demands and less support, than students.\ud \ud Conclusion: In this project, a new Early Professional Contact course was analysed from both student and facilitator perspectives. The students experienced the course as providing them with a valuable introduction to the physician's professional role in clinical practice. In contrast, course facilitators often experienced a heavy workload and lack of support, despite thorough preparatory education. A possible conflict between the clinical facilitator's task as educator and member of the workplace is suggested. More research is needed on how doctors combine their professional tasks with work as facilitators

Эпидемиологические факторы прогноза выживаемости больных раком тела матки: популяционный анализ

Cancer of the corpus uteri (CCU) is one of the most common gynecological malignancies in high- and middleincome countries. The objective of the study was to evaluate the factors predicting survival in CCU patients over the period 2000-2021 using the data of population-based cancer registry of the Arkhangelsk region. Material and Methods. Cancer-specific survival (CSS) of patients with CCU for the period 2000-21 was evaluated using life tables and Kaplan-Mayer methods with a log-rank test. The Cox proportional hazards regression model was used to assess the effect of prognostic factors on survival time. Results. A total of 3272 cases were selected for the analysis. The 5-year survival rates improved from 70.6 % in 2000-04 to 75.6 % in 2015-19. In stage I, II, III, and IV CUN, the 5-year survival rates were 90.8 % (95 % CI 89.3-92.0 %), 71.1 (95 % CI 66.3-75.4 %), 46.7 (95 % CI 41.4-51.8 %), and 3.9 (95 % CI 1.5-7.5 %), respectively; p&lt;0.001. In the multivariate regression model, for stage II, III, and IV CCU, the hazard ratios for death from cancer were respectively 2.69 (2.14-3.39), 5.73 (4.66-7.03), and 20.26 (16.13-25.44) compared to stage I. The risk of death from CCU was 2.0-2.7 times higher in patients with aggressive histological subtypes and sarcomas compared to that in patients with endometrioid adenocarcinoma; 2.0-2.8 times higher in patients older than 60 years compared to younger patients, and 1.3 times higher in rural patients compared to urban patients (p&lt;0.05). There was no increase in the risk of death from CCU over the period of COVID-19 pandemic. Conclusion. In this population-based study, we have found that the survival of patients with CCU is significantly affected by age and place of residence, which may indicate a limited access of some patients to effective treatment and requires further analysis. No increased risk of death from CCU during the COVID-19 pandemic was found.Актуальность. Злокачественные новообразования тела матки (ЗНО ТМ) лидируют среди гинекологических опухолей в России и мире. Цель исследования - оценить факторы прогноза выживаемости при ЗНО ТМ в период с 2000 по 2021 г. по данным популяционного канцер-регистра Архангельской области (АОКР). Материал и методы. Опухолеспецифическую выживаемость (ОСВ) больных ЗНО ТМ, зарегистрированных в АОКР за период 2000-21 гг., оценивали актуарным методом и методом Каплана-Майера с лог-ранговым критерием. Прогностическое значение популяционных факторов определяли с помощью регрессии Кокса; включение в модель прогностических факторов осуществляли форсированным способом. Результаты. Для анализа отобрано 3272 случая. Показатели 5-летней выживаемости улучшались с 70,6 % в 2000-04 гг. до 75,6 % в 2015-19 гг. При I, II, III, IV стадиях ЗНО ТМ 5-летняя выживаемость составила 90,8 (95 % ДИ 89,3-92,0 %), 71,1 (95 % ДИ 66,3-75,4 %), 46,7 (95 % ДИ 41,4-51,8 %), 3,9 % (95 % ДИ 1,5-7,5 %), p&lt;0,001. В множественной регрессионной модели при II, III, IV стадиях отношение рисков смерти по сравнению с I стадией составило 2,69 (2,14-3,39), 5,73 (4,66-7,03), 20,26 (16,13-25,44) соответственно. Риск смерти от ЗНО ТМ в 2,0-2,7 раза был выше при агрессивных гистологических подтипах и саркомах по сравнению с эндометриоидной аденокарциномой, в 2-2,8 раза выше у больных старше 60 лет по сравнению с более молодыми пациентками, у больных, проживающих в сельской местности, - в 1,3 раза выше по сравнению с больными из городов (р&lt;0,05). Заключение. Установлено, что на выживаемость пациенток с ЗНО ТМ, помимо клинических факторов, значимо влияют возраст и место проживания, что может свидетельствовать об ограниченном доступе части больных к эффективному лечению и требует дальнейшего изучения. Риск смерти от ЗНО ТМ в период пандемии COVID-19 не повышался

Влияние пандемии COVID-19 на показатели заболеваемости злокачественными опухолями, подлежащими скринингу в рамках диспансеризации (популяционное исследование)

Background. During the COVID-19 pandemic, annual adult check-ups have been postponed, resulting in cancer screening disruption.The aim of the study was to evaluate changes in the incidence and stage distribution of malignancies included in the screening program during the COVID-19 pandemic using the Arkhangelsk Regional Cancer Registry (ARRC).Material and Methods. We assessed the changes of the incidence rates and stage distribution for the colon, rectum, lung, breast, cervix, uterine body, ovary, prostate and kidney cancers over the periods 2018–19 and 2020–21. Results. A total of 12354 cases with 9 cancers were selected: 6680 for the period 2018–19 and 5674 (-15.1 %) for the period 2020-21. The most significant decrease in crude and age-standardized incidence rates was registered in patients with lung (-18.0–18.1 %), rectum (-25.1–25.9 %) and cervix (-33.6–36.9 %) cancers, p&lt;0.001. The decrease was not signifcant in patients with breast, uterine body, and kidney cancers. The proportion of patients with stage I decreased in lung cancer (-20.0 %, from 14.8 % to 11.8 %), rectum (-20.2 %, from 20.9 % to 16.7 %), and uterine cervix (-37.1 %, from 53.2 % to 33.5 %). In prostate and kidney cancers, the proportion of patients with stage I increased by 30 % (from 19.5 % to 25.4 %) and 17.6 % (from 45.9 % to 54.0 %), respectively. A signifcant reduction in the proportion of early stages during the COVID-19 pandemic was observed in lung and cervical cancer. Conclusion Postponed health checkups due to COVID-19 pandemic disruptions have led to substantial reductions in new cancers being diagnosed, mainly for cervical, lung, colon and rectal cancers. No signifcant changes were observed for other cancers. Further analysis of mortality and survival of cancer patients is required. Key words: health checkup, cancer screening, COVID-19 pandemic, cancer incidence, stage distribution&gt;˂0.001. The decrease was not significant in patients with breast, uterine body, and kidney cancers. The proportion of patients with stage I decreased in lung cancer (-20.0 %, from 14.8 % to 11.8 %), rectum (-20.2 %, from 20.9 % to 16.7 %), and uterine cervix (-37.1 %, from 53.2 % to 33.5 %). In prostate and kidney cancers, the proportion of patients with stage I increased by 30 % (from 19.5 % to 25.4 %) and 17.6 % (from 45.9 % to 54.0 %), respectively. A significant reduction in the proportion of early stages during the COVID-19 pandemic was observed in lung and cervical cancer.Conclusion. Postponed health checkups due to COVID-19 pandemic disruptions have led to substantial reductions in new cancers being diagnosed, mainly for cervical, lung, colon and rectal cancers. No significant changes were observed for other cancers. Further analysis of mortality and survival of cancer patients is required. Актуальность. В период пандемии COVID-19 была приостановлена диспансеризация отдельных групп взрослого населения (ДОГВН), что могло привести к ухудшению скрининга ряда злокачественных новообразований (ЗНО).Цель исследования ‒ оценить изменения заболеваемости и стадийной структуры ЗНО, включенных в программу скрининга в рамках ДОГВН, во время пандемии COVID-19 по данным Архангельского областного канцер-регистра (АОКР).Материал и методы. Оценивали динамику показателей заболеваемости и распределения по стадии при индексных ЗНО (иЗНО) ободочной, прямой кишки, легкого, молочной железы, шейки, тела матки, яичников, предстательной железы и почки в периоды 2018–19 гг. и 2020–21 гг.Результаты. Всего отобрано 12354 случая заболевания при девяти иЗНО: в 2018–19 гг. выявлено 6680, в 2020–21 гг. – 5674 (-15,1 %). Наиболее выраженное снижение «грубых» и стандартизованных по возрасту показателей заболеваемости зарегистрировано при раке легкого (-18,0–18,1 %), прямой кишки (-25,1–25,9 %) и шейки матки (-33,6–36,9 %), различия статистически значимы (р&lt;0,001). Снижение было статистически незначимым при раке молочной железы, тела матки, почки. Доля больных I стадии уменьшалась при раке легкого (на 20,0 %, с 14,8 до 11,8 %), прямой кишки (на 20,2 %, с 20,9 до 16,7 %), шейки матки (на 37,1 %, с 53,2 до 33,5 %). При раке предстательной железы и почки зарегистрировано увеличение доли I стадии на 30 % (с 19,5 до 25,4 %) и 17,6 % (с 45,9 до 54,0 %) соответственно. В возрастных группах скрининга в рамках ДОГВН значимое снижение доли ранних стадий в период пандемии COVID-19 наблюдали при раке легкого и шейки матки. Заключение. Ограничение ДОГВН в период пандемии привело к уменьшению числа выявленных иЗНО в основном за счет ранних стадий при раке шейки матки, легкого, ободочной и прямой кишки. При других иЗНО эти изменения были не столь явными. В дальнейшем требуется анализ смертности и выживаемости больных иЗНО. Ключевые слова: диспансеризация взрослого населения, скрининг рака, индексные злокачественные новообразования, пандемия COVID-19, заболеваемость, распределение по стадии.&gt;˂ 0,001). Снижение было статистически незначимым при раке молочной железы, тела матки, почки. Доля больных I стадии уменьшалась при раке легкого (на 20,0 %, с 14,8 до 11,8 %), прямой кишки (на 20,2 %, с 20,9 до 16,7 %), шейки матки (на 37,1 %, с 53,2 до 33,5 %). При раке предстательной железы и почки зарегистрировано увеличение доли I стадии на 30 % (с 19,5 до 25,4 %) и 17,6 % (с 45,9 до 54,0 %) соответственно. В возрастных группах скрининга в рамках ДОГВН значимое снижение доли ранних стадий в период пандемии COVID-19 наблюдали при раке легкого и шейки матки.Заключение. Ограничение ДОГВН в период пандемии привело к уменьшению числа выявленных иЗНО в основном за счет ранних стадий при раке шейки матки, легкого, ободочной и прямой кишки. При других иЗНО эти изменения были не столь явными. В дальнейшем требуется анализ смертности и выживаемости больных иЗНО.

Temporal changes in the epidemiology, management, and outcome from acute respiratory distress syndrome in European intensive care units: a comparison of two large cohorts

Background: Mortality rates for patients with ARDS remain high. We assessed temporal changes in the epidemiology and management of ARDS patients requiring invasive mechanical ventilation in European ICUs. We also investigated the association between ventilatory settings and outcome in these patients. Methods: This was a post hoc analysis of two cohorts of adult ICU patients admitted between May 1–15, 2002 (SOAP study, n = 3147), and May 8–18, 2012 (ICON audit, n = 4601 admitted to ICUs in the same 24 countries as the SOAP study). ARDS was defined retrospectively using the Berlin definitions. Values of tidal volume, PEEP, plateau pressure, and FiO2 corresponding to the most abnormal value of arterial PO2 were recorded prospectively every 24&nbsp;h. In both studies, patients were followed for outcome until death, hospital discharge or for 60&nbsp;days. Results: The frequency of ARDS requiring mechanical ventilation during the ICU stay was similar in SOAP and ICON (327[10.4%] vs. 494[10.7%], p = 0.793). The diagnosis of ARDS was established at a median of 3 (IQ: 1–7) days after admission in SOAP and 2 (1–6) days in ICON. Within 24&nbsp;h of diagnosis, ARDS was mild in 244 (29.7%), moderate in 388 (47.3%), and severe in 189 (23.0%) patients. In patients with ARDS, tidal volumes were lower in the later (ICON) than in the earlier (SOAP) cohort. Plateau and driving pressures were also lower in ICON than in SOAP. ICU (134[41.1%] vs 179[36.9%]) and hospital (151[46.2%] vs 212[44.4%]) mortality rates in patients with ARDS were similar in SOAP and ICON. High plateau pressure (&gt; 29 cmH2O) and driving pressure (&gt; 14 cmH2O) on the first day of mechanical ventilation but not tidal volume (&gt; 8&nbsp;ml/kg predicted body weight [PBW]) were independently associated with a higher risk of in-hospital death. Conclusion: The frequency of and outcome from ARDS remained relatively stable between 2002 and 2012. Plateau pressure &gt; 29 cmH2O and driving pressure &gt; 14 cmH2O on the first day of mechanical ventilation but not tidal volume &gt; 8&nbsp;ml/kg PBW were independently associated with a higher risk of death. These data highlight the continued burden of ARDS and provide hypothesis-generating data for the design of future studies

The clinical relevance of oliguria in the critically ill patient : Analysis of a large observational database

Funding Information: Marc Leone reports receiving consulting fees from Amomed and Aguettant; lecture fees from MSD, Pfizer, Octapharma, 3 M, Aspen, Orion; travel support from LFB; and grant support from PHRC IR and his institution. JLV is the Editor-in-Chief of Critical Care. The other authors declare that they have no relevant financial interests. Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Urine output is widely used as one of the criteria for the diagnosis and staging of acute renal failure, but few studies have specifically assessed the role of oliguria as a marker of acute renal failure or outcomes in general intensive care unit (ICU) patients. Using a large multinational database, we therefore evaluated the occurrence of oliguria (defined as a urine output 16 years) patients in the ICON audit who had a urine output measurement on the day of admission were included. To investigate the association between oliguria and mortality, we used a multilevel analysis. Results: Of the 8292 patients included, 2050 (24.7%) were oliguric during the first 24 h of admission. Patients with oliguria on admission who had at least one additional 24-h urine output recorded during their ICU stay (n = 1349) were divided into three groups: transient - oliguria resolved within 48 h after the admission day (n = 390 [28.9%]), prolonged - oliguria resolved > 48 h after the admission day (n = 141 [10.5%]), and permanent - oliguria persisting for the whole ICU stay or again present at the end of the ICU stay (n = 818 [60.6%]). ICU and hospital mortality rates were higher in patients with oliguria than in those without, except for patients with transient oliguria who had significantly lower mortality rates than non-oliguric patients. In multilevel analysis, the need for RRT was associated with a significantly higher risk of death (OR = 1.51 [95% CI 1.19-1.91], p = 0.001), but the presence of oliguria on admission was not (OR = 1.14 [95% CI 0.97-1.34], p = 0.103). Conclusions: Oliguria is common in ICU patients and may have a relatively benign nature if only transient. The duration of oliguria and need for RRT are associated with worse outcome.publishersversionPeer reviewe