Design and simulation of a microfluidics-based artificial glomerular ultrafiltration unit to reduce cell-induced fouling.

BACKGROUND: The microfluidic-based Glomerulus-on-Chips (GoC) are mostly cell based, that is, 3D cell culture techniques are used to culture glomerular cells in order to mimic glomerular ultrafiltration. These chips require high maintenance to keep cell viability intact. There have been some approaches to build non-cell-based GoCs but many of these approaches have the drawback of membrane fouling. This article presents a structural design and simulation study of a dialysate free microfluidic channel for replicating the function of the human glomerular filtration barrier. The key advancement of the current work is addressing the fouling issue by combining a pre-filter to eliminate cellular components and performing filtration on the blood plasma. METHODS: The Laminar Flow Mixture Model in COMSOL Multiphysics 5.6 has been utilized to simulate the behavior of blood flow in the microchannels. The geometrical effect of microchannels on the separation of the filtrate was investigated. The velocity at the inlet of the microchannel and pore size of the filtration membrane are varied to see the change in outflow and filtration fraction. RESULTS: The efficiency of the device is calculated in terms of the filtration fraction (FF%) formed. Simulation results show that the filtrate obtained is ~20% of the plasma flow rate in the channel, which resembles the glomerular filtration fraction. CONCLUSION: Given that it is not dependent on the functionality of grown cells, the proposed device is anticipated to have a longer lifespan due to its non-cell-based design. The device's cost can be reduced by avoiding cell cultivation inside of it. It can be integrated as a glomerular functional unit with other units of kidney model to build a fully developed artificial kidney.

Impact of the COVID-19 Public Health Crisis and a Structured COVID Unit on Physician Behaviors in Code Status Ordering.

Purpose: Code status orders are standard practice impacting end-of-life care for individuals. This study reviews the impact of a COVID unit on physician behaviors towards goal-concordant end-of-life care at an urban academic tertiary-care hospital. Methods: We conducted a retrospective cohort study of code status ordering on adult inpatients comparing the pre-pandemic period to patients who tested positive, negative and were not tested during the pandemic from January 1, 2019, to December 31, 2020. Results: We analyzed 59,471 unique patient encounters (n = 35,317 pre-pandemic and n = 24,154 during). 1,631 cases of COVID-19 were seen. The rate of code status orders among all inpatients increased from 22% pre-pandemic to 29% during the pandemic (P < .001). Code status orders increased for both patients who were COVID-negative (32% P < .001) and COVID-positive (65% P < .001). Being in a cohorted COVID unit increased code status ordering by an odds of 4.79 (P < .001). Compared to the pre-pandemic cohort, the COVID-positive cohort is less female (50% to 56% P < .001), more Black (66% to 61% P < .001), more Hispanic (6.5% to 5%) and less white (26% to 30% P < .001). Compared to Black patients, white patients had lower odds (.86) of code status ordering (P < .001). Other race/ethnicity categories were not significant. Conclusions: Code status ordering remains low. Compared to pre-pandemic rates, the frequency of orders placed significantly increased for all patients during the pandemic. The largest increase occurred in patients with COVID-19. This increase likely occurred due to protocols in the COVID unit and disease uncertainty.

Surgeons Approach to Glandular Odontogenic Cyst of Mandible Mimicking Mucoepidermoid Carcinoma.

This article reports a case of glandular odontogenic cyst in a 70-year-old male and discusses the clinical, radiological and histopathological features. The present case shows treatment of GOC which effected the body of mandible with infiltration into submandibular gland.

Linking Green Human Resource Practices and Environmental Economics Performance: The Role of Green Economic Organizational Culture and Green Psychological Climate.

An eco-friendly environment with green strategies can help to achieve better environmental performance. However, literature on the relationship between green human resource management practices (GHRMP) and sustainable environmental efficiency (SEF) is limited. Moreover, there is limited knowledge about the factors that could mediate the relationship between GHRMP and SEF. Therefore, the present study examines the impact of green human resource management practices mediating through green psychological climate (GPC) and green organizational culture (GOC) for better environmental efficacy. For this purpose, the primary data on variables are collected by using structured assessment tools and analyzed through regression models. Unlike previous studies, this study adopts a mediation model and unfolds not only the role of green human resource practices in psychological climate and green organizational culture but also clarifies the mediating role of GPC and GOC in sustainable environmental efficiency. The findings unfolded that ecological factors such as green psychological climate, green organizational culture, and sustainable environmental efficiency are positively affected by green human resources management. In addition, green organizational culture and green psychological climate positively mediate the relationship between GHRMP and SEF. This study recommends adopting green human resource management strategies and increasing technical innovations to improve sustainability and economic performance.

Differentiating Between ß-Lactam-Induced Serum Sickness-Like Reactions and Viral Exanthem in Children Using a Graded Oral Challenge.

BACKGROUND: Serum sickness-like reactions (SSLRs) are defined by the presence of rash (primarily urticaria) and joint complaints (arthralgia/arthritis) that are believed to occur due to a non-IgE-mediated response to medications. However, similar reactions can occur due to viral infections, and it can be difficult to distinguish between the two. This may lead to unnecessary avoidance of the culprit antibiotic. OBJECTIVE: We aimed to evaluate children presenting with suspected SSLRs through a graded oral challenge (GOC). METHODS: All children referred to the Montreal Children's Hospital for potential antibiotic allergy (ß-lactam or other antibiotics) and a clinical presentation compatible with SSLR were recruited for the study between March 2013 and February 2020. A standardized survey with questions on treatment, symptoms, and associated factors was completed, and a GOC (10% and subsequently 90% of the oral antibiotic dose) was conducted. Patients with a negative GOC were contacted annually to query on subsequent antibiotic use. RESULTS: Among 75 patients presenting with suspected SSLRs, the median age was 2.0 years and 46.7% were males. Most reactions were attributed to amoxicillin. Among the 75 patients, 2.7% reacted immediately (within 1 hour) to a GOC and 4.0% had a nonimmediate reaction. Of the 43 patients successfully contacted, 20 reported subsequent culprit antibiotic use of whom 25.0% had a subsequent mild reaction (macular/papular rash). CONCLUSIONS: This is the first and largest pediatric study to assess SSLR using a GOC. Our findings suggest that using a GOC is safe and appropriate for differentiating between ß-lactam-induced SSLR and viral exanthem in this population.

Preventing Readmissions Through Effective Partnerships-Communication and Palliative Care (PREP-CPC): A Multisite Intervention for Encouraging Goals of Care Conversations for Hospitalized Patients Facing Serious Illness.

BACKGROUND: Despite evidence showing that goals of care (GOC) conversations increase the likelihood that patients facing a serious illness receive care that is concordant with their wishes, only a minority of at-risk patients receive the opportunity to engage in such conversations. OBJECTIVE: The Preventing Readmissions through Effective Partnerships-Communication and Palliative Care (PREP-CPC) intervention was designed to increase the frequency of GOC conversations for hospitalized patients facing serious illness. METHODS: The PREP-CPC employed a sequential, multicohort design using a yearlong mentored implementation approach to support nonpalliative care health-care professionals at participating hospitals to implement quality improvement projects focused on GOC conversations. RESULTS: Over the 3-year study period, 134 clinicians from 29 hospital teams were trained to facilitate GOC conversations. After the kickoff conference, participants reported improvements in their confidence in facilitating GOC conversations. The hospital teams then instituted site-specific pilot interventions to promote GOC conversations, identifying essential elements required for ongoing improvement. Since projects varied by hospital, results did as well, but reported positive outcomes included increased GOC conversations, increased Practitioner Orders for Life-Sustaining Treatment form completion rates, new screening and documentation methods, and increased support from leadership. CONCLUSIONS: The PREP-CPC pilot successfully engaged a diverse set of hospitals to participate in quality improvement collaborative promoting primary palliative care and more frequent GOC conversations. This initiative revealed several lessons that should guide future interventions.

Utilization of a fattigation platform gelatin-oleic acid sodium salt conjugate as a novel solubilizing adjuvant for poorly water-soluble drugs via self-assembly and nanonization.

Solubilizing adjuvants are commonly used to dissolve insoluble drugs by simply adding in a formulation. In this study, gelatin and oleic acid sodium salt (OAS), a generally recognized as safe-listed material were chosen and conjugated to develop a natural solubilizing adjuvant using the fattigation platform technology to enhance solubility and dissolution rate of poorly water-soluble drugs according to self-assembly and nanonization principle when simply mixed with poorly water-soluble drugs. We synthesized the gelatin and OAS conjugates (GOC) at three different ratios (1:1, 1:3, 1:5; GOC 1, GOC 2, and GOC 3, respectively) via the 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide/N-hydroxysuccinimide reaction using a spray dryer. This amphiphilic micronized GOC was self-assembled into nanoparticles. The synthesis of new amphiphilic conjugates was identified through Fourier transform-infrared (FT-IR) spectroscopy. The powder properties of the GOCs, such as angle of repose, bulk density, and tapped density were varied with the oleic acid bonding ratio. Then, GOCs were utilized to investigate the enhanced solubility and release rate of various poorly water-soluble drugs such as cilostazol (CSZ), coenzyme Q10, ticagrelor, telmisartan, aprepitant and itraconazole as model drugs. Based on the solubility studies by concentration and type of GOCs, 3% GOC 2 was selected. When this GOC was mixed with these model drugs by the physical mixing, wetting and hot melting methoods, the solubility was highly enhanced compared to the pure control drug, ranging from 20 to 150,000 times. In case of CSZ, all formulations were significantly improved release rate compared to the of CSZ alone and the reference tablet, cilostan® (Korea United Pharm) in simulated intestinal fluid containing 0.2% sodium lauryl sulfate. Differential scanning calorimetry and powder X-ray diffraction were conducted to confirm the crystal polymorphic structure of CSZ, and as a result they changed to diminutive peak intensity compared to CSZ alone. Field-emission scanning electron microscopy indicated that GOC was round with a reduced size of about 100 nm. The reduction of drug particles via nanonization and self-assembly of amphiphilic GOC in an aqueous media could be a key factor to improve poor water solubility by providing a favorable dispersion of drug molecules in an amphiphilic network.

[Periodontal disease, a risk factor for atherosclerotic cardiovascular disease]. / A fogágybetegség mint az atheroscleroticus cardiovascularis betegség rizikófaktora.

Cardiovascular disease is recognized as the leading cause of death and disability in the world. The majority of these deaths can be attributed to atherosclerotic disease and thromboembolic events leading to ischemic heart disease and stroke. The role of inflammation is well recognized in the pathogenesis of atherosclerosis and atherothrombosis. Increasing number of studies support the hypothesis that periodontal disease, specifically periodontitis, is a potential risk factor for atherosclerosis and thus cardiovascular disease. Chronic infections of periodontal pockets act as reservoirs for pathogenic microorganisms, their toxins and degradation products, raising the overall systemic inflammatory burden. Entering the circulation and atherosclerotic lesions themselves, they lead to further local and systemic inflammatory response, in all contributing to atherosclerosis progression, potentially increasing cardiovascular risk. Along these lines, good oral health in general and the periodontal treatment in more severe cases may play a role in cardiovascular risk reduction, primary and secondary prevention. The present review summarizes the possible pathophysiological mechanisms linking periodontal and cardiovascular pathology, lists clinical evidence between periodontitis and specific forms of cardiovascular disease and looks forward at the potential role of periodontal treatment in cardiovascular disease prevention and treatment. Orv Hetil. 2019; 160(11): 419-425.

Which interval is most crucial to presentation and survival in gastroesophageal cancer: A systematic review.

AIM: The aim of this study was to identify the most crucial interval to encourage earlier diagnosis in with gastroesophageal cancer and to identify potential factors effecting this interval. BACKGROUND: Gastroesophageal malignancy is the eighth most commonly presenting cancer with one of the worst survival rates. Identifying the most crucial period for intervention to inform earlier diagnosis is an important step towards improving survival. DESIGN: Mixed methods literature review. DATA SOURCES: CINAHL, MEDLINE and Academic search primer online databases were searched using keywords and inclusion/exclusion criteria. Empirical evidence published between 2000-2016 with a focus on gastroesophageal cancer presentation and survival was reviewed to inform this study. REVIEW METHODS: Twelve studies were extracted for further review. Selected studies were appraised and presented through Olensen's "delay interval" framework to inform the most crucial interval to survival in gastroesophageal cancer. RESULTS: The findings identify the patient interval as the most critical period for encouraging earlier presentation and reducing advanced stage presentation in gastroesophageal cancer. The article also highlighted some methodological limitations to cancer research, such as a lack of consensus in definitions which prevent statistical meta-analysis of cancer data, survivor bias in gastroesophageal cancer studies and a significant lack of qualitative evidence to reveal patient experience in presenting with this cancer. CONCLUSION: Further research into the patient interval is required to elicit information on how and why patients present with their cancer symptoms.

An Assessment of Three Different In Situ Oxygen Sensors for Monitoring Silage Production and Storage.

Oxygen (O2) concentration inside the substrate is an important measurement for silage-research and-practical management. In the laboratory gas chromatography is commonly employed for O2 measurement. Among sensor-based techniques, accurate and reliable in situ measurement is rare because of high levels of carbon dioxide (CO2) generated by the introduction of O2 in the silage. The presented study focused on assessing three types of commercial O2 sensors, including Clark oxygen electrodes (COE), galvanic oxygen cell (GOC) sensors and the Dräger chip measurement system (DCMS). Laboratory cross calibration of O2 versus CO2 (each 0-15 vol.%) was made for the COE and the GOC sensors. All calibration results verified that O2 measurements for both sensors were insensitive to CO2. For the O2 in situ measurement in silage, all O2 sensors were first tested in two sealed barrels (diameter 35.7 cm; height: 60 cm) to monitor the O2 depletion with respect to the ensiling process (Test-A). The second test (Test-B) simulated the silage unloading process by recording the O2 penetration dynamics in three additional barrels, two covered by dry ice (0.6 kg or 1.2 kg of each) on the top surface and one without. Based on a general comparison of the experimental data, we conclude that each of these in situ sensor monitoring techniques for O2 concentration in silage exhibit individual advantages and limitations.

Out of Thin Air: Microbial Utilization of Atmospheric Gaseous Organics in the Surface Ocean.

Volatile and semi-volatile gas-phase organic carbon (GOC) is a largely neglected component of the global carbon cycle, with poorly resolved pools and fluxes of natural and anthropogenic GOC in the biosphere. Substantial amounts of atmospheric GOC are exchanged with the surface ocean, and subsequent utilization of specific GOC compounds by surface ocean microbial communities has been demonstrated. Yet, the final fate of the bulk of the atmospheric GOC entering the surface ocean is unknown. Our data show experimental evidence of efficient use of atmospheric GOC by marine prokaryotes at different locations in the NE Subtropical Atlantic, the Arctic Ocean and the Mediterranean Sea. We estimate that between 2 and 27% of the prokaryotic carbon demand was supported by GOC with a major fraction of GOC inputs being consumed within the mixed layer. The role of the atmosphere as a key vector of organic carbon subsidizing marine microbial metabolism is a novel link yet to be incorporated into the microbial ecology of the surface ocean as well as into the global carbon budget.