IFNL1 rs30461 polymorphism as a risk factor for COVID-19 severity: A cross-sectional study.

INTRODUCTION: The molecular basis of the progression of some COVID-19 patients to worse outcomes is not entirely known. Interferons-lambda-1/interleukin-29 (IFN-λ1/IL-29) is a member of the type III IFNs with a strong antiviral activity. Given the scant data on the potential role of IFN-λ1/IL-29 in COVID-19, we investigated the association of IFN-λ1/IL-29 serum level and the IFNL1 single-nucleotide polymorphism (SNP) (rs30461) with severe course of COVID-19. MATERIAL AND METHODS: This cross-sectional study included 400 COVID-19 patients, in which 262 mild COVID-19 patients and 138 severe COVID-19 patients were recruited and compared. The IFN-λ1/IL-29 serum levels were assessed in both the mild and severe COVID-19 groups. All participants were genotyped for the IFNL1 SNP (rs30461) by allelic discrimination RT-PCR using specific Taqman probes and primers. The associations between IFNL1 variants and risk of severe COVID-19 were examined via the logistic regression analysis. RESULTS: The serum IFN-λ1/IL-29 levels showed no statistically significant difference between mild and severe COVID-19 patients (P = 0.993). The genotype and allele frequencies of IFNL1 SNP (rs30461) were significantly different between the mild and severe groups, in which the minor G allele carried a highly significant risk of severe COVID-19 compared with the wild A allele [OR (95 %CI): 2.1 (1.5-2.9), P ≤ 0.001]. In multivariate analysis, the A/G and G/G genotypes of IFNL1 SNP (rs30461) were independent predictors of COVID-19 severity (P < 0.05). CONCLUSION: The study concluded that the IFNL1 SNP (rs30461) may constitute an independent risk factor for COVID-19 severity.

Genetic association of ACE2 and TMPRSS2 polymorphisms with COVID-19 severity; a single centre study from Egypt.

BACKGROUND: Since the emergence of the COVID-19 infection in China, it has caused considerable morbidity, mortality, and economic burden. It causes the vast majority of clinical manifestations, ranging from mild or even no symptoms to severe respiratory failure. There are many risk factors for severe COVID-19, such as old age, male gender, and associated comorbidities. A major role for genetic factors may exist. The SARS-CoV-2 virus enters the cell primarily through ACE2 receptors. rs2285666 is one of many polymorphisms found in the ACE2 receptor gene. To enable endosome-independent entry into target cells, the transmembrane protease serine-type 2 (TMPRSS2) is necessary to cleave the virus' spike (S) glycoprotein. TMPRSS2 is characterized by an androgen receptor element. The rs12329760 polymorphism in TMPRSS2 may explain different genetic susceptibilities to COVID-19. METHOD: This cross-sectional study was held in Mansoura University Hospitals during the period from June 2020 to April 2022 on patients who had mild and severe COVID-19. Demographic, clinical, and laboratory data were collected, and the TaqMan real-time polymerase chain was used for allelic discrimination in the genotyping of rs2285666 and rs12329760. RESULTS: This study included 317 Egyptian patients, aged from 0.2 to 87 years. Males were 146, while females were 171. They were divided into mild and severe groups (91 and 226 patients, respectively) based on their clinical symptoms. There was a significant association between COVID-19 severity and male gender, hypertension, diabetes mellitus, and high CRP. The genotype and allele frequency distributions of the ACE2 rs2285666 polymorphism showed no significant association with the severity of COVID-19 in both. In contrast, in TMPRSS2 rs12329760 minor T allele and CT, TT genotypes were significantly associated with a reduced likelihood of developing severe COVID-19. CONCLUSION: Our study indicates that the ACE2 rs2285666 polymorphism is not related to the severity of COVID-19, whether genotypes or alleles. In TMPRSS2 rs12329760, the dominant model and T allele showed significantly lower frequencies in severe cases, with a protective effect against severity. The discrepancies with previous results may be due to variations in other ACE2 receptor-related genes, inflammatory mediators, and coagulation indicators. Haplotype blocks and differences in racial makeup must be taken into consideration. Future research should be done to clarify how ethnicity affects these polymorphisms and how other comorbidities combine to have an additive effect.

One-time definitive attachment connection versus healing abutment placement for an implant-retained mandibular overdenture: Peri-implant metabolic activity.

STATEMENT OF PROBLEM: Unscrewing the healing abutment can affect the soft tissue integration and apical migration of the biological width, which may compromise the integrity of peri-implant soft tissue. PURPOSE: The purpose of this clinical study was to determine the level of glycosaminoglycan (GAG) detected in the peri-implant crevicular fluid (PICF) between the test group (1-time abutment) and control group (healing abutment) for implant-retained mandibular overdentures. MATERIAL AND METHODS: Two dental implants were installed in the canine regions of the mandibular ridge of 18 healthy completely edentulous participants using 2-stage surgery and a delayed loading protocol. At the second stage surgery, the implant on the right side was exposed, and a healing abutment was screwed onto the implant (control group), while on the left side the definitive ball abutment was screwed onto the implant (test group). After 10 days, the healing abutment in the control group was unscrewed and replaced with the definitive ball abutment. For both groups, the ball attachment was directly picked up to incorporate the attachment house to the mandibular denture. PICF samples were collected from the participants at 7 days, 3 months, and 6 months after overdenture use. Statistical analysis was done with an independent samples t test (α=.05). RESULTS: A significant difference was found in the volume of PICF and the level of GAG between the test and control groups at the 7-day evaluation period (P=.008, P=.002, respectively), while the volumes of PICF and the levels of GAG were not significantly different (P>.05) at the other evaluation periods. CONCLUSIONS: The 1-time abutment protocol offers biochemical and economic advantages compared with the conventional method of using the healing abutment before placement of the definitive attachment for an implant-retained overdenture with single attachments.

Closed sinus lift and fixed prostheses versus implant-assisted overdentures in management of atrophied distal extension maxillary ridges: A one-year randomized clinical trial.

STATEMENT OF PROBLEM: Rehabilitation of elderly or medically compromised patients with an atrophied unilateral posterior maxillary ridge by an implant-supported prosthesis may be complicated by maxillary sinus pneumatization with insufficient bone for implant placement. PURPOSE: This short-term clinical trial assessed clinical results of closed sinus lift and fixed prosthesis versus implant-assisted overdentures in the management of participants with atrophied distal extension maxillary ridges. MATERIAL AND METHODS: Forty participants with unilateral atrophying distal extension maxillary ridges were randomly assigned into 2 groups. The CSL group (n=20) participants received fixed prostheses supported by 3 implants following a closed sinus lift. The IOD group (n=20) participants received removable partial overdentures assisted by a single implant that was positioned mesially to the maxillary sinus. The modified plaque index (MPI), modified gingival index (MGI), pocket depth (PD), implant stability (IS), and vertical bone loss (VBL) were measured at prosthesis delivery (T0), and 6 (T6) and 12 months (T12) after delivery. The oral health impact profile (OHIP-14) questionnaire was used to assess oral health-related quality of life (OHRQoL) at T12. Significant differences between observation times were performed using Friedman and Wilcoxon signed-rank tests for MPI and MGI and using repeated measures ANOVA with Bonferroni correction of P values for PD, IS, VBL, and OHIP. Between-group comparison of MPI and MGI the Mann-Whitney test was used, while for PD, IS, VBL, and OHIP comparison was made using independent samples t test (α=.05 for all tests). RESULTS: The implant survival rates were 100% for both groups. MPI and PD significantly increased with time for both groups. MGI significantly increased with time for the CSL group only (P=.049). The IS significantly decreased with time for the IOD group. VBL increased significantly from T6 to T12 for the CSL (P=.042) and the IOD (P=.002) groups. The CSL group recorded higher MPI, MGI, PD, and IS values than the IOD group (P<.05). The IOD group recorded higher VBL than the CSL group (P<.001). The CSL group scored significantly lower OHIP-14 values (better OHRQoL) than the IOD group for all values (P<.05). CONCLUSIONS: In comparison with implant-assisted partial overdentures, closed sinus lift with fixed prostheses had higher implant stability, reduced bone loss, and higher participant OHRQoL. However, peri-implant soft tissue health was found to be better with implant overdentures.

Tixagevimab and Cilgavimab (Evusheld) Boosts Antibody Levels to SARS-CoV-2 in End-Stage Renal Disease Patients on Chronic Hemodialysis: A Single-Center Study.

Background and Objectives: In addition to a suboptimal and rapidly diminishing response to the coronavirus disease 2019 (COVID-19) vaccine, hemodialysis (HD) patients are at risk for developing a severe COVID-19 infection. In 2022, the combination of cilgavimab and tixagevimab (Evusheld, AstraZeneca) was approved for COVID-19 preexposure prophylaxis in high-risk groups. The purpose of this study was to evaluate the humoral response and short-term safety of this antibody combination in a group of HD patients. Materials and Methods: Seventy-three adult maintenance hemodialysis patients were recruited from a tertiary-care hospital for this double-blinded, non-randomized, placebo-controlled study. Patients were placed into two groups: the intervention group (n = 43) received a single 300 mg dosage of cilgavimab and tixagevimab, while the control group (n = 30) received a saline placebo. The titer of COVID-19-neutralizing antibodies was measured at baseline and after 1 and 6 months. The patients were evaluated for any drug-related adverse effects and monitored for six months for the emergence of any COVID-19-related events. Results: Patients in the intervention group were substantially older and had been on HD for longer (p = 0.002 and 0.006, respectively). The baseline antibody levels were higher in the Evusheld group. The antibody level in the intervention group increased significantly after 1 month and remained consistent for 6 months, whereas the antibody level in the control group fell significantly after 6 months during the study period (Wald χ2 = 30.620, p < 0.001). The drug-related adverse effects were modest and well-tolerated, and only seven patients experienced them. Six months after study enrollment, 10 patients in the intervention group and 6 patients in the control group had been infected with COVID-19, respectively. In the control group, ICU admission and mortality were observed, but in the intervention group, the infection was milder with no aggressive consequences. Conclusions: This study demonstrated the short-term safety and efficacy of tixagevimab-cilgavimab for COVID-19 preexposure prophylaxis in HD patients. These findings require more studies with more HD patients and longer follow-up periods.

Prognostic impact of toll-like receptors gene polymorphism on outcome of COVID-19 pneumonia: A case-control study.

Toll-like receptor 3 (TLR3) and TLR7 genes are involved in the host immune response against viral infections including SARS-COV-2. This study aimed to investigate the association between the TLR3(rs3775290) and TLR7(rs179008) polymorphisms with the prognosis and susceptibility to COVID-19 pneumonia accompanying SARS-COV-2 infection. This case-control study included 236 individuals: 136 COVID-19 pneumonia patients and 100 age and sex-matched controls. Two polymorphisms (TLR3 rs3775290 and TLR7 rs179008) were genotyped by allelic discrimination through TaqMan real-time PCR. This study also investigated predictors of mortality in COVID-19 pneumonia through logistic regression. The mutant 'T/T' genotypes and the 'T' alleles of TLR3(rs3775290) and TLR7(rs179008) polymorphisms were significantly associated with increased risk of COVID-19 pneumonia. This study did not report association between the mutant 'T/T' genotypes of TLR3(rs3775290) and TLR7(rs179008) and the disease outcome. In multivariate analysis, the independent predictors of mortality in COVID-19 pneumonia were male sex, SPO2 ≤ 82%, INR > 1, LDH ≥ 1000 U/l, and lymphocyte count<900/mm3 (P < 0.05).

Alogliptin attenuates cyclophosphamide-induced nephrotoxicity: a novel therapeutic approach through modulating MAP3K/JNK/SMAD3 signaling cascade.

Cyclophosphamide (CP) is widely used as a chemotherapy against various types of cancers. However, CP is accompanied with multiple organ toxicity due to production of reactive oxygen species (ROS), induction of inflammation and consequently apoptosis. Alogliptin (Alo) is a dipeptidyl peptidase 4 (DPP-IV) inhibitor, which is booming as an antidiabetic agent. Interestingly, gliptins are currently studied for their counter-regulatory effects against oxidative stress and inflammation via multiple pathways, among which is the mitogen-activated protein kinase (MAPK)/c-Jun N-terminal kinase (JNK) pathway. This cascade can reduce inflammation via mitigating the activity of mothers against decapentaplegic homolog 3 (SMAD3) and c-Jun. However, Alo effect against CP-induced kidney injury has not been previously elucidated. This tempted us to investigate the possible beneficial effect of Alo against CP-induced kidney injury via modulating the MAP3K/JNK/SMAD3 signaling cascade. Thirty-two male Wistar rats were randomly allocated into four groups. CP-treated group received a single dose of CP (200 mg/kg; i.p.). Alo-treated group received Alo (20 mg/kg/day; p.o.) for 7 days with single CP injection on day 2. Marked decrease in renal injury was observed upon Alo treatment, as evidenced through declined serum kidney function markers, oxidative stress and apoptosis markers, MAP3K expression, phospho (p)-SMAD3, p-JNK, and p-c-Jun levels. These cellular effects were reflected in reduced transforming growth factor beta (TGF-ß) and tumor necrosis factor alpha (TNF-α) fibrotic and inflammatory mediators, coinciding with improved histopathological portrait. In conclusion, the current study provides novel application of Alo as a therapeutic modality against CP-induced nephrotoxicity.

Polyetheretherketone subperiosteal implant retaining a maxillary fixed prosthesis: A case series.

STATEMENT OF PROBLEM: Patients needing dental rehabilitation of a complete atrophic maxilla would benefit from simplified treatment plans. PURPOSE: The purpose of this case series was to demonstrate the prosthetic management of 4 edentulous patients with severe maxillary ridge resorption who declined multiple stage surgery and sought a fixed prosthesis in single-stage surgery. MATERIAL AND METHODS: The patients were provided with completely digital computer-aided designed and computer-aided manufactured (CAD-CAM) polyetheretherketone (PEEK) maxillary subperiosteal frameworks, which were surgically placed in a 1-step procedure. The patients were followed up for 12 months and evaluated for signs of implant rejection, infection, prosthetic fracture or mobility, or implant exposure. RESULTS: At the 12-month follow-up, all the implants were functionally stable with healthy soft tissue and showed no sign of prosthetic fracture, infection, or pus discharge. CONCLUSIONS: PEEK subperiosteal implants for maxillary atrophied ridges can be considered a promising treatment option within the limitations of this clinical study with low patient numbers and a short observational time.

The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis.

BACKGROUND: Clinical guideline recommendations are against early magnetic resonance imaging (eMRI) within the first 4 to 6 weeks of conservative management of acute low back pain (LBP) without "clinical suspicion" of serious underlying conditions (red flags). There is some limited evidence that a significant proportion of patients with LBP receive eMRI non- indicated by clinical guidelines, which could be associated with increased length of disability (LOD). The aim of this systematic review was to investigate whether eMRI for acute LBP without red flags is associated with increased LOD. The LOD was defined as the number of disability days (absence from work). METHODS: Medline, EMBASE, and CINAHL bibliographic databases were searched from inception until June 5, 2021. Two reviewers independently assessed the methodological quality of included studies using the Newcastle-Ottawa scale and extracted data for the review. The search identified 324 records, in which seven studies met the inclusion criteria. Three of the included studies used the same study population. Owing to between-study heterogeneity, a narrative synthesis of results was used. RESULTS: All included studies were of good methodological quality and consistently reported that patients with acute LBP without red flags who received eMRI had increased LOD compared to those who did not receive eMRI. Three retrospective cohort studies reported that the eMRI groups had a higher mean LOD than the no eMRI groups ranging from 9.4 days (95% CI 8.5, 10.2) to 13.7 days (95% CI 13.0, 14.5) at the end of 1-year follow-up period. The remaining studies reported that the eMRI groups had a higher hazard ratio of work disability ranging between 1.75 (95% CI 1.23, 2.50) and 3.57 (95% CI 2.33, 5.56) as compared to the no eMRI groups. CONCLUSION: eMRI is associated with increased LOD in patients with acute LBP without red flags. Identifying reasons for performing non-indicated eMRI and addressing them with quality improvement interventions may improve adherence to clinical guidelines and improve disability outcomes among patients with LBP.

Patient satisfaction and oral health-related quality of life (OHRQoL) of conventional denture, fixed prosthesis and milled bar overdenture for All-on-4 implant rehabilitation. A crossover study.

OBJECTIVES: This study aimed to evaluate patient satisfaction and oral health-related quality of life (OHRQoL) of conventional denture, fixed prosthesis and milled bar overdenture for All-on-4 implant rehabilitation. MATERIALS AND METHODS: Sixteen completely edentulous patients with ill-fitted mandibular dentures received new mandibular dentures (CDs). After 3 months, 4 implants were installed according to the "All-on-4 concept" and immediately loaded with mandibular dentures. Three months after osseointegration, patients received either fixed prosthesis (FP) or milled bar overdenture (MB) in a crossover design. Patient satisfaction was evaluated using a visual analog scale (VAS). OHRQoL was evaluated using the OHIP-14. Questionnaires of VAS and OHIP-14 were measured 3 months after wearing each of the following prostheses: CD, FP, and MB. RESULTS: For all questions of VAS and OHIP-14, CD showed significant lower satisfaction compared to FP and MB (p < .00025). FP recorded significant higher VAS scores than MB regarding retention and stability (p < .00007). MB recorded significant higher scores than FP regarding general satisfaction, comfort, ease of cleaning, and handling (p < .00008). Regarding OHIP-14, no significant differences in OHIP scores between FP and MB were observed for all domains of OHIP. CONCLUSION: "All-on-4" implant rehabilitation of edentulous mandible with FP and MB achieves high patient satisfaction and OHRQoL compared to CD. No significant difference in OHRQoL between FP and MB was observed. Regarding VAS, FP rated greater satisfaction with retention, stability, and chewing compared to MB. However, MB rated greater satisfaction with ease of cleaning and handling compared to FP.

Isolated drainage of right superior vena cava into left atrium: A rare etiology of childhood central cyanosis.

Isolated right superior vena cava drainage into the left atrium (RSVC-LA) is an extremely rare anomaly in the absence of other cardiac or extracardiac abnormalities. The clinical and echocardiographic diagnosis is considered challenging. We report a female infant with cyanosis on crying who was diagnosed as isolated RSVC-LA using conventional and contrast echocardiography, but further confirmation was possible via multidetector CT. The surgical correction was performed with smooth postoperative recovery. In conclusion, isolated RSVC-LA must be in the differential diagnosis of cyanosis in the absence of intracardiac anomalies. Surgical correction is necessary management to guard against brain abscesses or paradoxical embolization.

Synthesis of androstanopyridine and pyrimidine compounds as novel activators of the tumor suppressor protein p53.

A series of androstane derivatives 2-16 were synthesized from 3ß-hydroxyandrostan-17-one derivatives (1a-e). Compounds (1a,b) were treated with ethyl cyanoacetate, cyanoacetamide, or malononitrile and gave the corresponding derivatives 2-7, respectively. Additionally, compounds (1a-e) were condensed with cyanothioacetamide, urea, or guanidine hydrochloride afforded the corresponding derivatives 8-12, which then by Moffat oxidation gave the oxidized derivatives 9, 11 and 13, respectively. Finally, compound (1) condensed with acetyl acetone or ethyl acetoacetate gave cyclohexene derivatives (14a-c) and (15a,b), respectively. Compound 15 was oxidized with a Moffat oxidizing agent and afforded the corresponding oxidized compound 16. The newly synthesized compounds activated the tumor suppressor p53 in cancer cells through inhibition of the p53-specific ubiquitin E3 ligase HDM2.

Optimized multi-frequency nonlinear broadband piezoelectric energy harvester designs.

Many electrical devices can be powered and operated by harvesting the wasted energy of the surroundings. This research aims to overcome the challenges of output power with a sharp peak, small bandwidth, and the huge dimensions of the piezoelectric energy harvesters relative to the output power. The aforementioned challenges motivated us to investigate the effect of nonlinearity in the shape (tapered and straight cross-section area) as well as the fixation method (the number of fastened ends) to determine the optimal design with high output power and wide working frequency. This research proposes a novel piezoelectric energy harvester array, where each beam is made up of three fixed beams that are joined together by a center mass. The proposed design produces an output power of 35 mW between 25 and 40 Hz. The output power of the proposed design is 3.24 times more than the conventional designs. The recommended approach is simulated utilizing finite element analysis FEA. Analytical and experimental methods validate the proposed FEA, which exhibits excellent agreement.

Plasma Neutrophil Gelatinase-Associated Lipocalin (2-0) Index: A Precise and Sensitive Predictor of Acute Kidney Injury in Children Undergoing Cardiopulmonary Bypass.

OBJECTIVE: To detect the efficacy of neutrophil gelatinase-associated lipocalin (NGAL) in the early prediction of acute kidney injury (AKI) in children undergoing cardiopulmonary bypass (CPB). METHODS: A prospective observational study was conducted wherein 174 patients, aged 6 to 60 months, with congenital heart disease, undergoing CPB and who had a normal baseline renal function were enrolled. Plasma NGAL measurement was done preoperatively and serially at 2, 12, 24, 36, and 48 hours post-CPB initiation. Patients were classified into 2 groups according to the development of postoperative AKI. RESULTS: Plasma NGAL levels post-CPB were significantly higher in the AKI group compared to the non-AKI group with positive significant correlations between plasma NGAL level and severity of AKI. A rise in plasma NGAL of 500% from its preoperative basal level, when measured at 2 hours post-CPB initiation (NGAL 2-0 index), showed sensitivity and specificity of 83% and 64%, respectively (AUC = 0.667) and at 12 hours post-CPB initiation (NGAL 12-0 index) showed sensitivity and specificity of 66% and 64% respectively (AUC = 0.762). CONCLUSION: Plasma NGAL is a predictive biomarker for acute kidney injury after pediatric cardiac surgery. A 500% rise in plasma NGAL at 2 hours post-CPB initiation from its basal preoperative level (NGAL 2-0 index) is a precise, sensitive, and early predictor of AKI in children.

Successful Resection of Gastric Subepithelial Lipoma Using the Bite-on-Bite Approach: Reviving Old Techniques in a Peripheral Hospital.

Subepithelial lesions (SELs) are common findings in the gastrointestinal (GI) tract. They are often benign and asymptomatic but can cause symptoms in some cases. The approach to endoscopic management of these lesions depends on various factors, including associated symptoms, location, available equipment, and operator expertise. In this case report, we present a 50-year-old male with long-standing dyspepsia who was found to have a submucosal lesion in the stomach. The lesion was successfully treated using the bite-on-bite method with cold biopsy forceps. This report aims to discuss gastric subepithelial lesions and current management options, and highlight an old technique for endoscopists in the era of advanced endoscopy.

Left Ventricular Pseudoaneurysm: Unexpected Sequel of Tamponade-Complicated Infectious Pericarditis in Infancy.

Left ventricular pseudoaneurysm (LV-PsA) is a critical finding that could result in a fatal outcome. It may complicate myocardial infarction, cardiac surgery, trauma, or endocarditis but rarely follows pericarditis. We report a case of infectious pericarditis complicated by pericardial tamponade in an infant. After effusion drainage and medical therapy, a large LV-PsA was detected. Successful closure of the pseudoaneurysmá¾½s neck was accomplished using a Gore-tex patch.

Severe Anaplasmosis With Multiorgan Involvement in a Rheumatoid Arthritis Patient.

Anaplasmosis, caused by the tick-borne bacterium Anaplasma phagocytophilum, is an emerging infectious disease with a broad spectrum of clinical manifestations. Here, we present a case report of a 66-year-old Caucasian woman residing in Connecticut who exhibited severe anaplasmosis with multi-organ involvement. The patient, with a medical history of rheumatoid arthritis and hypothyroidism, presented with confusion, lethargy, fever, myalgia, generalized weakness, and poor appetite in May 2023. Laboratory investigations revealed pancytopenia, hyponatremia, elevated liver enzymes with mild hyperbilirubinemia, and lactic acidosis. A buffy coat smear analysis demonstrated basophilic intracytoplasmic inclusion bodies in the neutrophils, supporting the diagnosis of severe anaplasmosis. Prompt administration of doxycycline, the recommended treatment for anaplasmosis, was initiated. However, the patient subsequently developed acute respiratory distress syndrome (ARDS) necessitating heated humidified high-flow nasal cannula (HFNC) therapy. Anaplasma polymerase chain reaction (PCR) confirmed the presence of the bacterium in the patient's blood. Following doxycycline treatment, the patient demonstrated improvement in peripheral blood findings, resolution of ARDS, and complete neurologic recovery. This case underscores the potential severity and diverse clinical manifestations of anaplasmosis, highlighting the importance of early recognition, prompt diagnosis, and timely initiation of appropriate treatment to prevent severe complications and improve patient outcomes.

Partnering With Residents on the Redesign of the Internal Medicine Resident Self-Evaluation Form.

INTRODUCTION: The positive impact of resident-driven synthesis of assessment data has been associated with increased intrinsic motivation to learn and create an individualized strategy to improve performance. The objective of the study was to incorporate residents' recommendations for restructuring the self-assessment metric into a tool that will promote a well-organized and effective self-improvement plan. MATERIALS AND METHODS: Residents and faculty collaborated on pre- and post-intervention questionnaires to assess the barriers to the timely completion of the current self-evaluation form and gather information on the tool's ability to stimulate the formation of concrete goals. The residents were also invited to provide their recommendations on the structure of the new tool and the educational domains that were assessed by the tool. The post-survey also evaluated the capacity of the proposed tool to guide residents in establishing specific goals.  Results: The new form is concise and more precise in assisting the learner in developing short-term and long-term goals and the strategies and resources to achieve them.  Discussion: Collaborating with the learners created an opportunity to address the faculty's and residents' most important concerns about the effectiveness of the metric. CONCLUSION:  In a learner-centered model, resident participation is critical in designing/redesigning a practical self-assessment tool for residents in Internal Medicine.

Synthesis and characterization of mussel-inspired nanocomposites based on dopamine-chitosan-iron oxide for wound healing: In vitro study.

There are many challenges faced the soft tissue adhesives in the medical application field. For example, there is a limited effective binding between the medical adhesive and different types of soft tissues. Chitosan (CS) and dopamine (DA) were used as structural units for synthesizing nanocomposites utilized as a wet tissue adhesive. To produce dopamine-chitosan-iron oxide nanocomposites (DA-CS-Fe3O4 NCs), DA was loaded onto chitosan-iron oxide nanocomposites. The nanocomposites have been prepared using ionic gelation method under vigorous homogenization and characterized by different techniques. Fourier-transform infrared spectroscopy (FTIR) have shown that DA-CS- Fe3O4 NCs could attach to the tissue through two possible functional groups, namely, the catechol and amine groups. The results of in vitro scratch wound-healing assay suggested that the prepared DA-CS- Fe3O4 NCs facilitate cell migration (the wound-closure percentage reached 96% at 72 h). All experimental results confirm that DA-CS- Fe3O4 NCs are strongly recommended for use as a soft medical tissue adhesive in wound healing and surgeries such as vascular surgery. In addition, the results of the whole blood clotting, antibacterial assessment, live and dead assay, cytotoxicity test, and wound-healing assay indicate that DA-CS-Fe3O4 NCs can be used as a multifunctional biomedical adhesive.

The number of hepatocellular carcinoma foci as predictor of poor response to tumor-directed therapies in patients awaiting liver transplantation: a prospective cohort study.

BACKGROUND AND AIMS: Tumor-directed therapies (TDTs) are a constitutive part of hepatocellular carcinoma (HCC) treatment in patients awaiting liver transplantation (LT). While most patients benefit from TDTs as a bridge to LT, some patients drop out from the waiting list due to tumor progression. The study aimed to determine the risk factors for poor treatment outcome following TDTs among patients with HCC awaiting LT. METHODS: A total of 123 patients with HCC were evaluated with 92 patients meeting Milan Criteria enrolled in the prospective cohort study. Tumor response was evaluated using the modified Response Evaluation Criteria for Solid Tumors for HCC 1 month after the procedure. The risk factors for progressive disease (PD) and dropout were evaluated. RESULTS: After TDT, 55 patients (59.8%) achieved complete or partial response (44.6% and 15.2% respectively), 17 patients (18.5%) had stable disease, and 20 patients (21.7%) were assessed as PD. Multivariate analysis revealed a significant and independent association between the number of HCC foci and PD ( P  = 0.03, OR = 2.68). There was no statistically significant association between treatment response and demographics, MELDNa score, pre-and post-treatment alpha-fetoprotein (AFP), cumulative tumor burden the largest tumor size, or TDT modality. PD was the major cause of dropout in our cohort. Pre-treatment AFP levels ≥200 ng/ml had a strong association with dropout after TDTs ( P  = 0.0005). CONCLUSION: This study demonstrated the presence of multifocal HCC is the sole prognostic factor for PD following TDTs in HCC patients awaiting LT. We recommend prioritizing patients with multifocal HCC within Milan criteria by exception points for LT to improve the dropout rate.