RHEOLOGICAL BEHAVIOR OF DSPC-, DBPC-, AND DPPC-OXYGEN MICROBUBBLES AND THEIR EFFECTIVENESS IN IMPROVING SURVIVAL IN A RAT MODEL OF LIPOPOLYSACCHARIDE-INDUCED ACUTE RESPIRATORY DISTRESS SYNDROME

Acute respiratory distress syndrome (ARDS) causes 75,000 deaths in the U.S., annually. It is characterized by hypoxemia and damage to the lung alveoli. ARDS Management strategies involve extracorporeal membrane oxygenation (ECMO) and mechanical ventilation, but none of these methods improve the mortality rates. Oxygen microbubbles (OMBs) consist of a lipid shell with an oxygen core and have potential to augment oxygenation to manage ARDS. Previous studies demonstrated significant improvements in systemic oxygenation and mortality upon administering OMBs. We replicated an ARDS rat model by intratracheal administration of lipopolysaccharide at a 24 mg/kg dose. After inducing the disease in rats, the distearoylphosphatidylcholine (DSPC), dibehenoylphosphatidylcholine (DBPC), or dipalmitoylphosphatidylcholine (DPPC) OMBs were administered intraperitoneally at a 100 mL/kg dose every 12 h, up to 36 h. Arterial blood gas analysis and pulse oximetry were then performed. Results showed 77.8%, 20%, and 10% survival in the DSPC, DBPC, and DPPC groups. Rats in the first group had significantly greater survival than others. Beyond 12 hours, the mean %SpO2 and PaO2 of rats was greater in the DSPC group. Additionally, the mean edema score, wet/dry ratio, and inflammation scores were lower in the DSPC group. The rheological behavior was characterized using a rotating rheometer. The oxygen microbubbles showed a shear-thinning behavior. The results also showed that the viscosity decreased with a decreasing volume fraction and increasing temperature. Lipids with longer chain lengths showed greater viscosities and greater storage and loss moduli. The viscoelastic behavior at lower angular frequencies was predominantly viscous. At greater frequencies, the behavior was predominantly elastic. These results explain the behavior of OMBs when acted upon by a stress. Non-Newtonian fluid models (Casson, Herschell-Bulkley, Power-law) were fit to the shear stress-shear strain data and the R2 and best-fit parameters were obtained to assess the fit. The viscoelastic behavior provides insight into the structure, molecular weight, and temperature-dependent properties of a material. Advisor: Benjamin S. Terr

Outcomes Among Patients With Chronic Critical Limb Ischemia With No Revascularization Option And Deep Vein Arterialization As A Novel Revascularization Approach: A Systematic Review And Meta-Analysis

Objective: To quantify the 6- and 12-month amputation-free survival (AFS) in patients with “no-option” Rutherford category 5/6 critical limb ischemia (CLI) in current clinical practice and to characterize outcomes and methods for deep vein arterialization as a possible means for revascularization in patients who are not candidates for conventional surgical or endovascular revascularization. We also sought to determine if there was any trend in amputation-free survival before and after 2003 which was the year of publication for the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). Background: The natural history of patients with Rutherford category 5/6 CLI who are not candidates for revascularization is not well-known. Deep vein arterialization, or arterial shunting of blood to the deep veins, may offer a potential revascularization option for this select patient population. Methods: Data Sources and Study Selection Natural History of “no-option” Rutherford category 5/6 CLI: 6- and 12-month AFS A systematic review was performed according to PRISMA guidelines. Two pre-specified literature searches were conducted via Ovid utilizing the following databases: MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews (CDSR). For the first literature search, we identified studies reporting AFS in patients with non-revascularizable Rutherford Category 5 or 6 CLI (or any symptomatic/ischemic equivalent) at a minimum follow-up of 6 months. Studies that included a subset of patients with less severe disease (Rutherford Category ≤4) were included. An exploratory search had determined that nearly all studies also included Ruther category 4 patients. As such, a supplemental search was conducted to identify hazard ratios for amputation-free survival or its components between patients (regardless of revascularization status) with more severe (Rutherford Category 5/6), compared with less severe (Rutherford Category ≤4) disease to inform appropriate risk adjustment due to limited available outcome data in high risk patients. For the supplemental search, we selected studies of Rutherford category 4, 5, or 6 patients that reported hazard ratios (HR) for outcomes (AFS, all-cause mortality, or major amputation) between high-risk (Rutherford 5/6) and lower-risk (Rutherford 4) patients. Deep Vein Arterialization A separate (third) systematic review was conducted via Ovid utilizing the following databases: MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews (CDSR). We identified prospective, randomized clinical trials as well as retrospective studies utilizing surgical or percutaneous deep vein arterialization (DVA) for revascularization of lower-extremity peripheral vascular disease. Data Extraction and Synthesis: Natural History of “no-option” Rutherford category 5/6 CLI: 6- and 12-month AFS Data was extracted from relevant articles in duplicate. Extracted information included qualifying CLI criteria, baseline demographics, enrollment dates, and proportion of patients with each Rutherford classification [(3) severe claudication; (4) ischemic rest pain; (5) minor tissue loss; or 6 (major tissue loss)]or Fontaine stage [(IIa) mild claudication; (IIb) moderate severe claudication; (III) ischemic rest pain with or without minor tissue loss; (IV) ulceration or gangrene], and 6- and 12- month endpoints of interest (major amputation, defined as any amputation performed above the level of the ankle, all-cause mortality, and amputation-free survival). Risk of bias of individual studies was assessed with the Cochrane Risk of Bias tool. Objective criteria such as the ability to complete standard treadmill exercise testing, ankle pressures before and after exercise, metatarsal peripheral vascular resistance, and toe pressures were used to impute the Rutherford categories of a study population if they were not directly reported. For studies that included a subset of lower-risk patients (Rutherford class ≤4), an adjustment factor was developed and applied to the observed rates to better reflect outcomes in the population of interest. An adjustment factor for AFS rates was calculated from the reported HRs by log transforming the HR, calculating the weighted average of the log HR, and inverting back to the arithmetic scale. The adjustment factor was then applied to the observed AFS rates in the applicable studies of no-option CLI patients according to the proportion of high-risk (Rutherford category 5/6) and low-risk (Rutherford category ≤4) patients in each study to arrive at an adjusted AFS rate Deep Vein Arterialization Data was extracted from relevant articles in duplicate for studies of deep vein arterialization in patients with CLI (Rutherford class 4 or higher or Fontaine stage III or higher). Extracted information included baseline patient demographics (Rutherford classification or Fontaine stage and comorbidities), peri-procedural outcomes (technical success rate, mortality, and complications within 30 days of procedure), medium-term outcomes (survival, limb salvage rate, cumulative patency, and mean follow-up time). Main Outcomes and Measures: Natural History of “no-option” Rutherford category 5/6 CLI: 6- and 12-month AFS Amputation-free survival (a composite of major amputation, defined as any amputation performed above the level of the ankle, and all-cause mortality) at 6- and 12-months in patients with Rutherford class 5 or 6 CLI and no revascularization options. Due to a scarcity of evidence, we collected HRs for any outcome (n=1 AFS; N=1 death; and N=1 major amputation). Deep Vein Arterialization Technical success, peri-procedural (within 30 days of procedure) mortality and complications, and postprocedural (\u3e30 days postprocedure) survival, limb salvage, and cumulative patency. Results: Natural History of “no-option” Rutherford category 5/6 CLI: 6- and 12-month AFS The meta-analytic adjustment factor for AFS rate at 6- and 12-months between Rutherford 4 patients and Rutherford 5/6 patients was 2.18. A total of 36 studies meeting the selection criteria reported AFS at 6 and/or 12 months; the meta-analytic average AFS rates were 56.5% and 49.8%, respectively. An analysis by time of enrollment determined that AFS was significantly higher at 6 and 12 months in studies enrolling patients after 2003 versus before 2003; therefore, analyses were limited to the recent (after 2003) cohort. The unadjusted meta-analytic average AFS rates at 6 and 12 months were 60.0% (n=23 publications; 1238 patients; 67.5% average Rutherford 5/6) and 56.1% (n=19 studies; 1161 patients; 57.7% average Rutherford 5/6), respectively. The risk-adjusted estimated AFS rates were 43.6% (95% CI, 33.7 – 53.5) at 6 months (n=16 publications, 826 patients; 67.5% average Rutherford 5/6) and 36.8 (95% CI, 19.6-54.1) at 12 months (n=12 publications, 659 patients; 57.7% Rutherford 5/6) in no-option Rutherford category 5 or 6 CLI patients. Deep Vein Arterialization A total of 16 studies were identified reporting results for surgical DVA while 5 studies were identified reporting results for percutaneous (endovascular) DVA. We collected baseline patient comorbidities, Rutherford classification, Fontaine stage, peri-procedural outcomes (technical success, mortality, and complications) and medium-term outcomes (survival, limb salvage, cumulative patency). The average proportions of comorbidities in the surgical deep vein arterialization studies were 73% for diabetes, 60% for hypertension, 38% for hyperlipidemia, 54% for coronary artery disease, 28% for chronic renal disease, and 45% for current smokers. The average technical success rate for surgical deep vein arterialization was 81% with an average periprocedural (\u3c30 \u3edays) mortality of 2.4% and an average complication (\u3c30 \u3edays) rate of 25%. The average technical success rate for percutaneous deep vein arterialization was 93% with an average periprocedural (\u3c30 \u3edays) mortality of 0% and an average periprocedural (\u3c30 \u3edays) complication rate of 16%. Conclusions and Relevance: Approximately half of all patients with advanced critical limb ischemia who are not candidates for current revascularization approaches will die or require major amputation within 1 year. These outcomes have not changed significantly in recent years, and alternative treatments that can address this high-risk population are urgently needed. Percutaneous deep vein arterialization is a promising technique for revascularization in patients with no other treatment options

Adding value to milk by increasing its protein and CLA contents

End of project reportThe mid-summer milk protein study was undertaken on 34 commercial dairy farms in 2005 to evaluate the influence of dietary and management variables on milk protein content in mid-season. Data on grass composition, genetic merit of the herds and milk protein content were collected and analysed by multiple regression. Both calving date and genetic merit for milk protein content were significantly associated with milk protein content and were used as adjustment factors when evaluating the association between measures of grass quality and milk protein content. Milk protein content was associated with grass OMD (P = 0.04) and NDF content (P = 0.02) but not with CP content (P = 0.80). It is concluded that herds calving earlier, with a greater genetic merit for milk protein content and consuming better quality pasture would have greater milk protein contents in mid-season

Cutaneous Ulcers as Initial Presentation of Localized Granulomatosis with Polyangiitis: A Case Report and Review of the Literature

Background. Granulomatosis with polyangiitis (GPA) is an ANCA associated small vessel vasculitis characterized by necrotizing granulomatous inflammation involving the upper and the lower respiratory tract and the kidneys. The disease has a broad clinical spectrum that ranges from limited/localized involvement of a single organ system to a generalized systemic vasculitis that affects several organs with evidence of end organ damage. Atypical forms of the disease have been recognized with or without respiratory tract involvement with a long protracted course before manifesting as generalized disease. Case Presentation. We describe a 57-year-old woman who presented with recurrent fever and cutaneous ulcers on her legs who was diagnosed to have granulomatosis with polyangiitis (GPA) after an extensive evaluation which excluded infectious, other vasculitides, connective tissue disease and malignant etiologies. Conclusion. In the absence of typical manifestations, granulomatosis with polyangiitis (GPA) is indeed a diagnostic challenge to the physician. Atypical manifestations like unexplained recurrent fever and cutaneous ulcers nevertheless call for keeping a low threshold for the diagnosis of GPA as the disease can initially present in localized form before heralding into a generalized disease

Physical education class participation is associated with physical activity among adolescents in 65 countries

In this study we examined the associations of physical education class participation with physical activity among adolescents. We analysed the Global School-based Student Health Survey data from 65 countries (N = 206,417; 11–17 years; 49% girls) collected between 2007 and 2016. We defined sufficient physical activity as achieving physical activities ≥ 60 min/day, and grouped physical education classes as ‘0 day/week’, ‘1–2 days/week’, and ‘ ≥ 3 days/week’ participation. We used multivariable logistic regression to obtain country-level estimates, and meta-analysis to obtain pooled estimates. Compared to those who did not take any physical education classes, those who took classes ≥ 3 days/week had double the odds of being sufficiently active (OR 2.05, 95% CI 1.84–2.28) with no apparent gender/age group differences. The association estimates decreased with higher levels of country’s income with OR 2.37 (1.51–3.73) for low-income and OR 1.85 (1.52–2.37) for high-income countries. Adolescents who participated in physical education classes 1–2 days/week had 26% higher odds of being sufficiently active with relatively higher odds for boys (30%) than girls (15%). Attending physical education classes was positively associated with physical activity among adolescents regardless of sex or age group. Quality physical education should be encouraged to promote physical activity of children and adolescents

Dicyanidobis(thio­urea-κS)cadmium(II) monohydrate

In the title compound, [Cd(CN)2(CH4N2S)2]·H2O, the Cd atom lies on a twofold rotation axis and is bonded to two S atoms of thio­urea and two C atoms of the cyanide anions in a distorted tetra­hedral environment. The crystal structure is stabilized by N—H⋯N(CN), N—H⋯O, O—H⋯N and N—H⋯S hydrogen bonds

Phytochemical screening, free radical scavenging, antioxidant activity and phenolic content of Dodonaea viscosa

The purpose of this study was to evaluate the antioxidant potential of Dodonaea viscosa Jacq. Methanolic extract of the plant was dissolved in distilled water and partitioned with n-hexane, chloroform, ethyl acetate and nbutanol sequentially. Phytochemical screening showed presence of phenolics, flavonoides and cardiac glycosides in large amount in chloroform, ethyl acetate and n-butanol fraction. The antioxidant potential of all these fractions and remaining aqueous fraction was evaluated by four methods: 1,1-Diphenyl-2-picrylhydrazyl (DPPH) free radical scavenging activity, total antioxidant activity, Ferric Reducing Antioxidant Power (FRAP) assay and ferric thiocyanate assay along with determination of their total phenolics. The results revealed that ethyl acetate soluble fraction exhibited highest percent inhibition of DPPH radical as compared to other fractions. It showed 81.14 ± 1.38% inhibition of DPPH radical at a concentration of 60 μg/ml. The IC50 of this fraction was found to be 33.95 ± 0.58 μg/ml, relative to butylated hydroxytoluene (BHT), having IC50 of 12.54 ± 0.89 μg/mL. It also showed highest FRAP value (380.53 ± 0.74 μM of trolox equivalents) as well as highest total phenolic contents (208.58 ± 1.83 GAE μg/g) and highest value of inhibition of lipid peroxidation (58.11 ± 1.49% at concentration of 500 μg/ml) as compared to the other studied fractions. The chloroform fraction showed highest total antioxidant activity i.e.1.078 ± 0.59 (eq. to BHT)

Restoration of elective spine surgery during the first wave of COVID-19:a UK-wide British Association of Spine Surgeons (BASS) prospective, multicentre, observational study

AIMS: With resumption of elective spine surgery services in the UK following the first wave of the COVID-19 pandemic, we conducted a multicentre British Association of Spine Surgeons (BASS) collaborative study to examine the complications and deaths due to COVID-19 at the recovery phase of the pandemic. The aim was to analyze the safety of elective spinal surgery during the pandemic. METHODS: A prospective observational study was conducted from eight spinal centres for the first month of operating following restoration of elective spine surgery in each individual unit. Primary outcome measure was the 30-day postoperative COVID-19 infection rate. Secondary outcomes analyzed were the 30-day mortality rate, surgical adverse events, medical complications, and length of inpatient stay. RESULTS: In all, 257 patients (128 males) with a median age of 54 years (2 to 88) formed the study cohort. The mean number of procedures performed from each unit was 32 (16 to 101), with 118 procedures (46%) done as category three prioritization level. The majority of patients (87%) were low-medium “risk stratification” category and the mean length of hospital stay was 5.2 days. None of the patients were diagnosed with COVID-19 infection, nor was there any mortality related to COVID-19 during the 30-day follow-up period, with 25 patients (10%) having been tested for symptoms. Overall, 32 patients (12%) developed a total of 34 complications, with the majority (19/34) being grade 1 to 2 Clavien-Dindo classification of surgical complications. No patient required postoperative care in an intensive care setting for any unexpected complication. CONCLUSION: This study shows that safe and effective planned spinal surgical services can be restored avoiding viral transmission, with diligent adherence to national guidelines and COVID-19-secure pathways tailored according to the resources of the individual spinal units. Cite this article: Bone Jt Open 2021;2(12):1096–1101

Early versus delayed flow diversion for ruptured intracranial aneurysms: A meta-analysis

Objective: The use and timing of flow diversion for aneurysmal subarachnoid hemorrhage is controversial. The objective of this study is to perform a meta-analysis and systematic review to compare overall complication rate between early versus delayed flow diversion for ruptured aneurysms.Methods: A literature search for all eligible articles was performed using PubMed, Cochrane, and Web of Science databases. The primary outcome was the overall complication rate (any complication in the perioperative period), and secondary outcomes were 1) hemorrhage and 2) stroke/death (all hemorrhagic/ischemic strokes and/or death).Results: Thirteen articles including 142 patients met inclusion criteria. Eighty-nine (62.7%) patients underwent early deployment of flow diverters (i.e., 2 days or less). The odds ratio for overall complication rate with early versus delayed flow diversion was 0.95 (95% confidence interval [CI] 0.36-2.49, P = 0.42). The odds ratio for the secondary outcome of hemorrhagic complication for early versus delayed flow diversion was 1.44 (95% CI 0.45-4.52, P = 0.87) and of stroke/death was 1.67 (95% CI 0.5-4.9, P = 0.69). The odds ratio of early versus delayed flow diversion for blister/dissecting/fusiform aneurysms was 0.82 (95% CI 0.29-2.30) and for saccular/giant aneurysms was 2.23 (95% CI 0.17-29.4). At last follow-up, 71.6% of patients had good performance status (modified Rankin Scale score 0-2), and the rate of angiographic aneurysm occlusion was 90.2%.Conclusions: This meta-analysis did not show a difference in overall complication rate between early versus delayed flow diversion for ruptured aneurysms. Early flow diversion for ruptured blister/fusiform/dissecting aneurysms carries a lower risk of aneurysm rerupture and overall complications as compared with that for ruptured saccular/giant aneurysms

Improving oral health in people with severe mental illness (SMI) : A systematic review

BACKGROUND: Those with severe mental illness (SMI) are at greater risk of having poor oral health, which can have an impact on daily activities such as eating, socialising and working. There is currently a lack of evidence to suggest which oral health interventions are effective for improving oral health outcomes for people with SMI. AIMS: This systematic review aims to examine the effectiveness of oral health interventions in improving oral health outcomes for those with SMI. METHODS: The review protocol was registered with PROSPERO (ID CRD42020187663). Medline, EMBASE, PsycINFO, AMED, HMIC, CINAHL, Scopus and the Cochrane Library were searched for studies, along with conference proceedings and grey literature sources. Titles and abstracts were dual screened by two reviewers. Two reviewers also independently performed full text screening, data extraction and risk of bias assessments. Due to heterogeneity between studies, a narrative synthesis was undertaken. RESULTS: In total, 1462 abstracts from the database search and three abstracts from grey literature sources were identified. Following screening, 12 studies were included in the review. Five broad categories of intervention were identified: dental education, motivational interviewing, dental checklist, dietary change and incentives. Despite statistically significant changes in plaque indices and oral health behaviours as a result of interventions using dental education, motivational interviewing and incentives, it is unclear if these changes are clinically significant. CONCLUSION: Although some positive results in this review demonstrate that dental education shows promise as an intervention for those with SMI, the quality of evidence was graded as very low to moderate quality. Further research is in this area is required to provide more conclusive evidence