Functional Characteristics of Four Novel Lone Atrial Fibrillation-Linked Connexin40 Mutants

Atrial fibrillation (AF) is the most common form of cardiac arrhythmia. Recently, four novel heterozygous Cx40 mutations, K107R, L223M, Q236H, and I257L were identified in 4 of 310 unrelated AF patients. To study possible alterations associated with these mutants, we studied their localization and function using gap junction (GJ)-deficient model cells. Cell pairs expressing Q236H alone or together with wildtype Cx43 showed a significantly lower coupling conductance. Impaired GJ function and dominant negative action on Cx43 of this mutant are consistent with previous findings on the majority of AF-linked Cx40 mutants. The remaining three novel AF-linked mutants did not show any apparent defects in our tested GJ or hemichannel assays, which may reflect the limitations of our experimental system

A Systematic Approach for the Design of Integrated Energy and Chemicals Production

With the tightening of the crude oil supply-demand gap, interest in energy independence, and global climate change concerns, attention has been directed to finding alternatives to crude oil. In particular, efforts have focused on alternative feedstock for liquid transportation fuels and chemicals production. The purpose of this work is to investigate the potential use of biomass and natural gas as alternative options to petroleum for liquid transportation fuels and chemicals production. From a broader perspective, this work explores the synthesis of integrated industrial complexes that can lead to various benefits including conservation of material and energy resources, reduction of environmental impact, improvement in capital productivity, increase in material utilization, and enhancement in natural-resource monetization. The fundamental research approach is a process systems approach. First the system is defined and investigated. This investigation is used to determine if the system is feasible through various criteria (economic, environmental, and social). Targeting techniques are used to reduce the number of options investigated. If it is determined that the system is feasible, opportunities for improvement are identified. If the system is not feasible, major issues are identified and potential prospects to achieve feasibility are investigated. Focus is directed to the major issues with the greatest impact on system feasibility. In this work, initial focus is directed to the production of synthetic liquid transportation fuels from biomass. This is followed by focus on intermediates which would facilitate the integration of multiple processing facilities. This understanding is used to synthesis an intra-process resource management framework. Finally the potential to use natural gas to mitigate CO2 emissions by chemically fixating the CO2 is investigated and results presented

Clinical pattern of pediatric ocular trauma in a tertiary referral center

Background: Pediatric ocular trauma may be a major source of lifelong visual morbidity and disability. Objective: To report on the different types of ocular injury in children in a tertiary referral center. Participants and settings: Children presenting with ocular trauma to the casualty department of the pediatric ophthalmology unit of Alexandria Main University Hospital in Alexandria, Egypt. Methods: The study was conducted from June to December 2018. Upon admission, thorough history was obtained from the attending person(s), and thorough ophthalmic examination was performed. Appropriate treatment was subsequently provided to every case (though not the scope of the current study). Results: A total of 146 children (from a total of 436 patients, 33.5%) (103 males, 70.5%) presented with various types of ocular injuries. The mean age ± standard deviation of the injured children was 98.1 ± 56.4 months. Study participants were almost equally distributed between within and outside of the city of the study locale, with a predominance of patients from urban areas in Alexandria (30%) and from rural areas outside of Alexandria (35.6%). Seventy percent of the care providers of the study children were manual workers. The places of the incidents were almost equally distributed between household (40%) and external environment with a slight predominance of the later (50%). Conclusions: Ocular injuries represent one-third of all ocular injuries in the study locale. Ocular injuries in children occur with an almost equal distribution in both urban and rural areas and in both household and external environments. Mechanical trauma was the most common cause of trauma

Role of diffusion-weighted magnetic resonance imaging in the differentiation of benign and malignant pulmonary lesions

Purpose: To evaluate the role of magnetic resonance (MRI) diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) measurement of solid and cystic pulmonary masses in differentiating benign from malignant lesions. Material and methods: The study included 41 patients with pulmonary masses, who underwent conventional MRI and DWI (b value 0, 500, and 1000 s/mm²) examinations with 1.5-T MRI. The diffusion signal and the mean ADC values of the solid and cystic lesions were obtained. Statistical analyses were performed with the Mann-Whitney U test (z), Pearson's chi-square test, and receiver operating characteristic (ROC) analysis. Results: Thirty-three lesions were malignant, and eight lesions were benign. The malignant masses showed significantly higher signal intensity on DWI than benign masses (p = 0.006), and the mean ADC value of malignant solid lesions was significantly lower than that of benign lesions (p = 0.02). By ROC analysis, an ADC cut-off value of 1.4 × 10-3 mm2/s was considered the threshold value, and the sensitivity and specificity were 93.8% and 75%, respectively. There was no significant difference between the ADC value of the cystic parts inside the benign and the malignant lesions. Conclusions: Diffusion-weighted MRI and measurement of ADC value can significantly differentiate between solid benign and malignant pulmonary masses

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries