Land Cover Change and Its Impact in Crop Yield: A Case Study from Western Nepal.

This study was conducted in Tanahun district of Gandaki Province, Nepal, to analyze the land cover change over two decades, the migration effect in land cover, and the impact caused in crop production by Rhesus macaque. Landsat TM/ETM+ for land use of 2000 and 2010 extracted by ICIMOD and Landsat 8 OLI/TIRS satellite images for land cover 2019 were downloaded from the USGS website. A purposive sample for household survey was carried out based on crops damaged by the monkey. Two hundred and fifty households were taken as samples. The Landsat images were analyzed by ArcGIS, and the social data were analyzed using SPSS and MS Excel. Land cover change data revealed increment of forest cover from 36.57% to 40.91% and drastic decrease in agriculture crops from 57.52% to 43.78% in the period of 20 years. The accuracy of the data showed overall classification accuracy of 86.11%, 81.08%, and 75% with overall kappa statistics 0.83, 0.77, and 0.74, respectively. The migration effect in the land cover was related to remittance and migrated members and found a significant positive relationship. Analyzing the trend of production with an increase in the forest cover, 21% decrease in paddy, 5% decrease in maize, and 26% decrease in millet were found as compared to the production in 2000. The econometric model concluded that the quantity of crop damage was negatively significant in relation to distance from forest and distance from water body while positively significant to distance from settlements and distance from owner's home. The quantity of crop damage was estimated 113.89 kg per household, and the cost was 78.82 USD. This study recommends active forest management; regular thinning, and weeding. Remittance generated should be invested in the agriculture field by the households. Damage relief should be made available for the damage cost by Rhesus macaque.

Pocket infections of cardiac implantable electronic devices treated by negative pressure wound therapy.

AIMS: Managing an infection of the pocket of a cardiac implantable electronic device (CIED) is frequently challenging. The wound is often treated with a drain or wet-to-dry dressings that allow healing by secondary intention. Such treatment can prolong the hospital stay and can frequently result in a disfiguring scar. Negative pressure wound therapy (NPWT) has been frequently used to promote the healing of chronic or infected surgical wounds. Here we describe the first series of 28 patients in which NPWT was successfully used to treat CIED pocket infections. METHODS AND RESULTS: After removal of the CIED and debridement of the pocket, a negative pressure of 125 mmHg continuously applied to the wound through an occlusive dressing. Negative pressure wound therapy was continued for a median of 5 days (range 2-15 days) and drained an average of 260 mL sero-sanguineous fluid (range 35-970 mL). At the conclusion of NPWT, delayed primary closure of the pocket was performed with 1-0 prolene mattress sutures. The median length of stay after CIED extraction was 11.0 days (range 2-43 days). Virtually all infected pockets healed without complications and without evidence of recurrent infection over a median follow-up of 49 days (range 10-752 days). One patient developed a recurrent infection when NPWT was discontinued prematurely and a new device was implanted at the infected site. CONCLUSION: We conclude that NPWT is a safe and effective means to promote healing of infected pockets with a low incidence of recurrent infection and a satisfactory cosmetic result.

3D-Printed Models for Optimizing Tactile Braille & Shape Display.

Existing market-available refreshable Braille displays (RBDs) offer limited functionality at a high cost, hindering accessibility for individuals with blindness and visual impairment for teaching and learning purposes. This motivates us to develop a multi-functional, compact, and affordable RBD tailored for educational institutes to enhance teaching and learning experiences. We propose the development of BLISS (Braille Letters and Interactive Shape Screen), a novel RBD, that BLISS presents a unique configuration arrangement of Braille cells that accommodates up to six letters at a time and shapes by reusing the Braille pins. To determine the optimal specifications, including size, Braille cell spacing, and pin configuration, we fabricated and evaluated 3D-printed sets, mimicking how BLISS would display letters and shapes. We tested 36 variants of 3D-printed sets with 8 individuals with blindness and visual impairment and found that conventional Braille spacing is insufficient for accurately representing shapes. Hence, BLISS will introduce a novel design that uses a pin configuration to raise the extra pins to present shapes and lower them for Braille letters, providing dual-mode operation. Our findings show the potential of BLISS to display both Braille letters and shapes on the same refreshable display, offering a novel, compact, and cost-effective solution.

Effect of the irregular shelterwood system on soil organic carbon stock and soil quality of Shorea robusta Gaertn. f. forest in Nepal.

The effective management of forests relies on the crucial role played bysilvicultural systems. However there exist a significant knowledge gap regarding impact of these systems in Nepalese forests. Therefore, this research was conducted to assess the effects of the forest management activities under irregular shelterwood system on soil organic carbon (SOC) stock and the overall soil quality of Sal (Shorea robusta Gaertn. f.) forests in Terai region of Nepal. Stratified random sampling method with 1.67 % sampling intensity was adopted in this study where management of stands was used as basis of strata. A total of 30 composite soil samples (15 each from managed and unmanaged forest stands) were collected from a depth of 0-30 cm, taken from the four corners and the center of each plot. Soil quality index (SQI) method was used for soil quality assessment using indicators on the basis of prior studies conducted in Nepal. Our study found significant difference in soil parameters except organic carbon, pH, silt, and clay among the managed and unmanaged forest stands (p < 0.05). SOC stock of unmanaged forest stands (48.87 ± 1.34 ton ha-1) was significantly greater than managed forest stands (27.76 ± 1.27 ton ha-1). Similarly, unmanaged forest stands demonstrated better soil quality with higher SQI value (0.66) than managed forest stands (0.50). This negative impact of irregular shelterwood silviculture system highlights the necessity for management interventions to enhance SOC stock and overall soil quality. To establish a robust conclusion, further replication of similar studies at different soil depths and in other management regimes, along with longitudinal studies, is essential.

Dual-specificity protein phosphatase 6 (DUSP6) overexpression reduces amyloid load and improves memory deficits in male 5xFAD mice.

Introduction: Dual specificity protein phosphatase 6 (DUSP6) was recently identified as a key hub gene in a causal VGF gene network that regulates late-onset Alzheimer's disease (AD). Importantly, decreased DUSP6 levels are correlated with an increased clinical dementia rating (CDR) in human subjects, and DUSP6 levels are additionally decreased in the 5xFAD amyloidopathy mouse model. Methods: To investigate the role of DUSP6 in AD, we stereotactically injected AAV5-DUSP6 or AAV5-GFP (control) into the dorsal hippocampus (dHc) of both female and male 5xFAD or wild type mice, to induce overexpression of DUSP6 or GFP. Results: Barnes maze testing indicated that DUSP6 overexpression in the dHc of 5xFAD mice improved memory deficits and was associated with reduced amyloid plaque load, Aß1-40 and Aß1-42 levels, and amyloid precursor protein processing enzyme BACE1, in male but not in female mice. Microglial activation, which was increased in 5xFAD mice, was significantly reduced by dHc DUSP6 overexpression in both males and females, as was the number of "microglial clusters," which correlated with reduced amyloid plaque size. Transcriptomic profiling of female 5xFAD hippocampus revealed upregulation of inflammatory and extracellular signal-regulated kinase pathways, while dHc DUSP6 overexpression in female 5xFAD mice downregulated a subset of genes in these pathways. Gene ontology analysis of DEGs (p < 0.05) identified a greater number of synaptic pathways that were regulated by DUSP6 overexpression in male compared to female 5xFAD. Discussion: In summary, DUSP6 overexpression in dHc reduced amyloid deposition and memory deficits in male but not female 5xFAD mice, whereas reduced neuroinflammation and microglial activation were observed in both males and females, suggesting that DUSP6-induced reduction of microglial activation did not contribute to sex-dependent improvement in memory deficits. The sex-dependent regulation of synaptic pathways by DUSP6 overexpression, however, correlated with the improvement of spatial memory deficits in male but not female 5xFAD.

Above ground tree biomass modeling using machine learning algorithms in western Terai Sal Forest of Nepal.

The monitoring of forest biomass is a crucial biophysical parameter in forest ecosystems, as it provides valuable information for managing forests sustainably and tracking carbon circulation statistics. To achieve sustainable forest management, it is essential to monitor and study forest resources, particularly biomass. This study aimed to model above ground tree biomass (AGTB) using Machine Learning Algorithms (MLAs) in the western terai Sal forest of Nepal. AGTB was calculated using a systematic inventory sample plot, while spectral and textural variables were processed and masked for the study area using Sentinel-2A satellite imagery. Three MLAs namely support vector machine (SVM), random forest (RF), and stochastic gradient boosting (SGB), were employed for modeling with eight categorized variable datasets. Among the MLAs, the RF algorithm with a combination of gray-level co-occurrence matrix (GLCM) and raw bands (RB) dataset variable demonstrated the best performance, with a low RMSE value of 78.81 t ha-1 in the test data. However, the AGTB range from this model ranged from 118.34 to 425.97 t ha-1. The study found that traditional indices, raw bands, and GLCM texture from near-infrared were important variables for AGTB. Nevertheless, the RF algorithm and the dataset combination of GLCM plus raw bands (RB) exhibited excellent performance in all model runs. Thus, this pioneering study on comparative MLAs-based AGTB assessment with multiple datasets variables can provide valuable insights for new researchers and the development of novel approaches for biomass/carbon estimation techniques in Nepal.

Management of Biliary Cysts in Adults: A Single-Center 10-Year Experience.

BACKGROUND: A choledochal cyst is a cystic dilatation of the biliary tree, also termed a biliary cyst, including an intrahepatic cyst as well. Magnetic resonance cholangiopancreatography (MRCP) is the gold standard investigation of choice for this pathology. Todani classification is most commonly used to classify choledochal cysts. MATERIALS AND METHODS: A total of 30 adult patients with choledochal cysts presenting at our center from December 1, 2009, to October 31, 2019, were studied retrospectively. RESULTS: The mean age was 35.13 years ranging from 18 to 62 years with a male-to-female ratio of 1:3.29. Of the patients, 86.6% presented with abdominal pain. Total serum bilirubin was raised in six patients with a mean of 1.84 mg/dL. MRCP was done in all patients, which had almost 100% sensitivity. Two cases had anomalous pancreaticobiliary duct union. In our study, we found only type I and type IVA cysts according to the Todani classification (type IA = 56.3%, IB = 11%, 1C = 16%, and IVA = 17%). The mean size of the cyst was 2.37 cm. Complete cyst excision with Roux-en-Y hepaticojejunostomy was performed in all patients. Four patients had surgical site infections and two had bile leaks. One patient developed hepatic artery thrombosis. All complications were eventually managed conservatively. Mortality was nil in our study with the mean postoperative stay being 7.97 days. CONCLUSION: Adult presentation of biliary cysts is not an uncommon entity in the Indian population and should be considered as a differential diagnosis of biliary pathology in adult patients. Complete excision of cysts with bilioenteric anastomosis is the current treatment of choice.

Electronic correlations in epitaxial CrN thin film.

Chromium nitride (CrN) spurred enormous interest due to its coupled magnetostructural and unique metal-insulator transition. The underneath electronic structure of CrN remains elusive. Herein, the electronic structure of epitaxial CrN thin film has been explored by employing resonant photoemission spectroscopy (RPES) and X-ray absorption near edge spectroscopy study in combination with the first-principles calculations. The RPES study indicates the presence of a charge-transfer screened 3[Formula: see text] ([Formula: see text]: hole in the N-2[Formula: see text]) and 3[Formula: see text] final-states in the valence band regime. The combined experimental electronic structure along with the orbital resolved electronic density of states from the first-principles calculations reveals the presence of Cr(3[Formula: see text])-N(2[Formula: see text]) hybridized (3[Formula: see text]) states between lower Hubbard (3[Formula: see text]) and upper Hubbard (3[Formula: see text]) bands with onsite Coulomb repulsion energy (U) and charge-transfer energy ([Formula: see text]) estimated as [Formula: see text] 4.5 and 3.6 eV, respectively. It verifies the participation of ligand (N-2[Formula: see text]) states in low energy charge fluctuations and provides concrete evidence for the charge-transfer ([Formula: see text]U) insulating nature of CrN thin film.

Assessment of Carbon Sequestration in Private Forests across Two Different Physiographic Regions of Nepal: Implications for Conservation and Climate Change Mitigation.

Private forests offer diverse ecosystem services, including carbon sequestration and biodiversity conservation, which are crucial for Nepal. However, there is a notable absence of comprehensive research on these services. Assessing carbon sequestration in private forests can have economic advantages for forest owners by promoting resource conservation and contributing to greenhouse gas reduction. This study aims to estimate and compare carbon stocks in private forests located in two distinct physiographic regions of Nepal while also identifying the factors influencing these carbon stocks. The analysis focuses on 16 private forests (with 0.1 to 0.5 hectares) each from Chitwan district (Terai region) and Kavrepalanchok district (Hilly region). Field data collection involved direct measurements of tree and sapling diameter at breast height (DBH), as well as height and class of trees and poles, utilizing a total enumeration method. These collected values were utilized to calculate aboveground biomass (AGTB), aboveground sapling biomass (AGSB), belowground biomass, and carbon stock. Private forests of Terai region were dominated by Shorea borneensis, Tectona grandis, and Dalbergia sissoo, whereas the Hilly region was dominated by Pinus patula, Alnus nepalensis, Schima wallichii, and Quercus leucotrichophora. The aboveground biomass carbon in the Terai region's private forests was estimated to be 83.53 t·ha-1, while in the Hilly region, it was 37.32 t·ha-1. The belowground biomass carbon in the Terai region's private forests was found to be 21.72 t·ha-1, compared to 9.70 t·ha-1 in the Hilly region. Consequently, the estimated total carbon stock in the Terai and Hilly regions' private forests was 105.25 t·ha-1 (386.26 t·ha-1 CO2-eq) and 47.02 t·ha-1 (172.57 t·ha-1 CO2-eq), respectively. Carbon sequestration in the Terai region's private forests was discovered to be 2.24 times higher than that in the Hilly region. These findings underscore the significant potential of private forests, which can generate economic benefits through carbon trading and leverage mechanisms such as REDD+/CDM to promote sustainable conservation practices.

Dual-specificity protein phosphatase 6 (DUSP6) overexpression reduces amyloid load and improves memory deficits in male 5xFAD mice.

Background: Dual specificity protein phosphatase 6 (DUSP6) was recently identified as a key hub gene in a causal network that regulates late-onset Alzheimer's disease. Importantly, decreased DUSP6 levels are correlated with an increased clinical dementia rating in human subjects, and DUSP6 levels are additionally decreased in the 5xFAD amyloidopathy mouse model. Methods: AAV5-DUSP6 or AAV5-GFP (control) were stereotactically injected into the dorsal hippocampus (dHc) of female and male 5xFAD or wild type mice to overexpress DUSP6 or GFP. Spatial learning memory of these mice was assessed in the Barnes maze, after which hippocampal tissues were isolated for downstream analysis. Results: Barnes maze testing indicated that DUSP6 overexpression in the dHc of 5xFAD mice improved memory deficits and was associated with reduced amyloid plaque load, Aß 1-40 and Aß 1-42 levels, and amyloid precursor protein processing enzyme BACE1, in male but not in female mice. Microglial activation and microgliosis, which are increased in 5xFAD mice, were significantly reduced by dHc DUSP6 overexpression in both males and females. Transcriptomic profiling of female 5xFAD hippocampus revealed upregulated expression of genes involved in inflammatory and extracellular signal-regulated kinase (ERK) pathways, while dHc DUSP6 overexpression in female 5xFAD mice downregulated a subset of genes in these pathways. A limited number of differentially expressed genes (DEGs) (FDR<0.05) were identified in male mice; gene ontology analysis of DEGs (p<0.05) identified a greater number of synaptic pathways that were regulated by DUSP6 overexpression in male compared to female 5xFAD. Notably, the msh homeobox 3 gene, Msx3 , previously shown to regulate microglial M1/M2 polarization and reduce neuroinflammation, was one of the most robustly upregulated genes in female and male wild type and 5xFAD mice overexpressing DUSP6. Conclusions: In summary, our data indicate that DUSP6 overexpression in dHc reduced amyloid deposition and memory deficits in male but not female 5xFAD mice, whereas reduced neuroinflammation and microglial activation were observed in both males and females. The sex-dependent regulation of synaptic pathways by DUSP6 overexpression, however, correlated with the improvement of spatial memory deficits in male but not female 5xFAD.

Neurotrophin Crosstalk in the Etiology and Treatment of Neuropsychiatric and Neurodegenerative Disease.

This article reviews the current progress in our understanding of the mechanisms by which growth factors, including brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF), and select neurotrophin-regulated gene products, such as VGF (non-acronymic) and VGF-derived neuropeptides, function in the central nervous system (CNS) to modulate neuropsychiatric and neurodegenerative disorders, with a discussion of the possible therapeutic applications of these growth factors to major depressive disorder (MDD) and Alzheimer's disease (AD). BDNF and VEGF levels are generally decreased regionally in the brains of MDD subjects and in preclinical animal models of depression, changes that are associated with neuronal atrophy and reduced neurogenesis, and are reversed by conventional monoaminergic and novel ketamine-like antidepressants. Downstream of neurotrophins and their receptors, VGF was identified as a nerve growth factor (NGF)- and BDNF-inducible secreted protein and neuropeptide precursor that is produced and trafficked throughout the CNS, where its expression is greatly influenced by neuronal activity and exercise, and where several VGF-derived peptides modulate neuronal activity, function, proliferation, differentiation, and survival. Moreover, levels of VGF are reduced in the CSF of AD subjects, where it has been repetitively identified as a disease biomarker, and in the hippocampi of subjects with MDD, suggesting possible shared mechanisms by which reduced levels of VGF and other proteins that are similarly regulated by neurotrophin signaling pathways contribute to and potentially drive the pathogenesis and progression of co-morbid neuropsychiatric and neurodegenerative disorders, particularly MDD and AD, opening possible therapeutic windows.

Dual-Specificity Protein Phosphatase 4 (DUSP4) Overexpression Improves Learning Behavior Selectively in Female 5xFAD Mice, and Reduces ß-Amyloid Load in Males and Females.

Recent multiscale network analyses of banked brains from subjects who died of late-onset sporadic Alzheimer's disease converged on VGF (non-acronymic) as a key hub or driver. Within this computational VGF network, we identified the dual-specificity protein phosphatase 4 (DUSP4) [also known as mitogen-activated protein kinase (MAPK) phosphatase 2] as an important node. Importantly, DUSP4 gene expression, like that of VGF, is downregulated in postmortem Alzheimer's disease (AD) brains. We investigated the roles that this VGF/DUSP4 network plays in the development of learning behavior impairment and neuropathology in the 5xFAD amyloidopathy mouse model. We found reductions in DUSP4 expression in the hippocampi of male AD subjects, correlating with increased CDR scores, and in 4-month-old female and 12-18-month-old male 5xFAD hippocampi. Adeno-associated virus (AAV5)-mediated overexpression of DUSP4 in 5xFAD mouse dorsal hippocampi (dHc) rescued impaired Barnes maze performance in females but not in males, while amyloid loads were reduced in both females and males. Bulk RNA sequencing of the dHc from 5-month-old mice overexpressing DUSP4, and Ingenuity Pathway and Enrichr analyses of differentially expressed genes (DEGs), revealed that DUSP4 reduced gene expression in female 5xFAD mice in neuroinflammatory, interferon-gamma (IFNγ), programmed cell death protein-ligand 1/programmed cell death protein 1 (PD-L1/PD-1), and extracellular signal-regulated kinase (ERK)/MAPK pathways, via which DUSP4 may modulate AD phenotype with gender-specificity.

Economic burden of hospital malnutrition: A cost-of-illness model.

BACKGROUND & AIMS: Hospital malnutrition is a highly prevalent condition that leads to an increased risk of clinical complications and a corresponding increase in healthcare resource utilisation. Despite the high prevalence and adverse clinical consequences, limited data are available on the magnitude of the economic burden associated with hospital malnutrition in Asian countries. The aim of the present analysis was to calculate country-specific estimates of the economic burden of hospital malnutrition in Asia. METHODS: Country-specific cost and prevalence data were used to calculate the incremental healthcare costs attributable to hospital malnutrition in 11 countries in Asia. The cost-of-illness was evaluated from the public perspective. Sources of increased cost included increased length of stay (LOS) and increased antibiotic use in malnourished patients who develop a healthcare-associated infection. Costs were calculated separately for the ward and intensive care unit (ICU) and currencies were converted to US$ to facilitate comparison. RESULTS: The estimated annual economic burden attributable to hospital malnutrition in Asia is $30.1 billion. Increased LOS accounts for the largest portion of the incremental cost, totalling $23.2 billion (77.2%) in the ward and $3.5 billion (11.5%) in the ICU. Medication costs related to the treatment of infectious complications account for an additional $3.4 billion (11.3%). Countries with the highest incremental costs include Japan ($19 billion), South Korea ($2.5 billion), and Taiwan ($2.2 billion). CONCLUSIONS: Hospital malnutrition imposes a substantial economic burden on Asian countries, resulting in an estimated $30 billion per year in additional healthcare costs. This finding underscores the need for rigorous screening and assessment as well as continuous monitoring of nutrition status in hospitalised patients to facilitate early identification and proactive management of hospital malnutrition.

Synthesis of hierarchical structured Gd doped α-Sb2O4 as an advanced nanomaterial for high performance energy storage devices.

Bimetallic oxide nanostructures (NS) of Gdx: α-Sb2O4 (x = 5, 8, 10 wt.%) emerged as novel electrode material for batteries as they exhibit large specific capacity and cyclic stability. Crystal structure of Gd: α-Sb2O4 NS investigated by X-ray diffraction (XRD) patterns and identified as mixed orthorhombic phase. Surface chemical composition, binding energies of the metal oxides and incorporation of Gd into α-Sb2O4 NS analysed by XPS (X-ray photoelectron spectral) studies. Microstructure analysis reveals that distinctive flower/flake like arrays with agglomeration. Morphology, structure and physical/chemical properties of the resulting nanostructure were analysed by SEM (scanning electron microscopy), SEM-EDX (scanning electron microscopy-energy dispersive X-ray), BET (Brunauer-Emmett-Teller), XPS, UV-Visible and XRD studies. Electrochemical performances of Gdx: α-Sb2O4 (x = 10 wt.%) in 6 M KOH aqueous solution dipped in three electrode system evaluated by CV (cyclic voltammetry), GCD (galvanostatic charge-discharge) and EIS (electrochemical impedance spectroscopy) measurements. The as-synthesized NS exhibited higher specific capacitance of 958 mAh/g at a current density of 0.15 A/g and excellent cyclic stability with 86.5% capacitive retention after 1000 cycles. Distinctive flower/flake like structure, large surface area, and abundant active sites of Gdx: α-Sb2O4 NS could be the reason for significant increase in charge transfer and storage. In brief this work offers facile method to synthesize Gdx: α-Sb2O4 NS are promising electrode materials for potential applications in high performance super capacitor.

A multinational observational study of clinical nutrition practice in patients undergoing major gastrointestinal surgery: The Nutrition Insights Day.

BACKGROUND AND AIMS: Patients undergoing major gastrointestinal (GI) surgery, particularly those with malignancies, have a high risk for malnutrition, requiring perioperative nutritional support to reduce complications. During the Nutrition Insights Day (NID), nutritional data of this patient population were documented in seven Asian countries. METHODS: Observational, cross-sectional study with retrospective data collection of nutritional status, calorie/protein targets/intake, and type of clinical nutrition for up to 5 days before NID. INCLUSION CRITERIA: Adult patients following major GI surgery, pre-existing/at (high) risk for malnutrition, on enteral (EN) and/or parenteral nutrition (PN) and latest surgery within 10 days before the NID. EXCLUSION CRITERIA: Burns, mechanical ventilation on NID, oral nutrition and/or oral nutritional supplements (ONS) on the day before the NID, and emergency procedures. RESULTS: 536 patients from 83 hospitals, mean age 58.8 ± 15.1 years, 59.1% males, were eligible. Leading diagnosis were GI diseases (48.7%) and GI cancer (45.9%). Malnutrition risk was moderate to high in 54% of patients, low in 46%. Hospital length of stay (LOS) before the NID was 9.3 ± 19.0 days, and time since last surgery 3.7 ± 2.4 days. Lowest caloric/protein deficits were observed in patients receiving EN + PN, followed by PN alone and EN alone. Type of clinical nutrition, Body Mass Index and LOS on surgical intensive care unit (SICU) and/or surgical ward were independent predictors of caloric and of protein deficit. CONCLUSION: There is a high prevalence of postoperative nutritional deficits in Asian GI surgery patients, who are either preoperatively malnourished or at risk of malnutrition, indicating a need to improve nutritional support and education.

Impact of weight on long-term survival among patients without known coronary artery disease and a normal stress SPECT MPI.

BACKGROUND: While obesity has been shown to be associated with a worse mortality, an "obesity paradox"--lower mortality in obese patients--has been noted among many patients with coronary artery disease (CAD). The extent to which an obesity paradox operates among patients with only suspected CAD, is not well determined. METHODS AND RESULTS: A total of 3,673 patients (60 +/- 13 years, 36% males) with no history of heart disease and a normal stress SPECT were included in this study. Normal weight was defined as BMI of 18.5-24.9 kg x m(2); overweight 25-29.9 kg . m(2), obese >30 kg x m(2). The baseline clinical risk factors were recorded for each patient. The end point of the study was all-cause mortality. Of patients 942 (26%) were normal weight, 1,261 (34%) were overweight, and 1,470 (40%) were obese. Mean patient follow-up was 7.5 +/- 3 years. When compared to normal weight patients (event rate 3.2%/year), there was a lower incidence of death in the overweight (event rate 1.5%/year, P < .0001) and the obese (event rate 1.2%/year, P < .0001) groups. After controlling for baseline risk factors, using a reference HR = 1 for normal weight patients, there was a lower risk of death in the overweight (HR = .54, 95% CI .43-.7) and the obese groups (HR = .49, 95% CI .38-.63). CONCLUSION: In patients without known cardiac disease and a normal stress SPECT, overweight and obese patients had a lower rate of all-cause mortality compared to normal weight patients over long-term follow-up. This study substantially extends the spectrum of patients in whom the obesity paradox is present.

Splenic mass and isolated gastric varices: a rare presentation of a neuroendocrine tumor of the pancreas.

CONTEXT: Splenic involvement in neuroendocrine pancreatic tumors is well known but rarely presents as a primary splenic mass. CASE REPORT: A rare case of a neuroendocrine tumor involving the tail of the pancreas, splenic hilum and splenic flexure of the colon, forming a conglomerate mass and presenting as isolated gastric varices is described. A 75-year-old male presented with hematemesis and melena. Esophagogastroduodenoscopy revealed isolated gastric varices. A CT scan revealed a mass predominantly involving the spleen and a small part of the pancreas. CONCLUSION: A splenic mass with isolated gastric varices should be kept in mind as one of the presentations of a pancreatic neuroendocrine tumor.

Choledocholithiasis: endotherapy versus surgery.

When multiple treatment options are available, debate invariably persists regarding the optimal option. Confusion and controversy must then be resolved based on scientific evidence, but one needs to be practical because options depend on the available expertise. We aimed to evaluate the efficacy of endotherapy vis-à-vis surgery in patients with choledocholithiasis. The records of 349 patients with stone disease from February 2005 to January 2010 were analyzed. A total of 349 patients were analyzed: 279 patients with gallstones alone, 56 with choledocholithiasis, 3 with stones with stricture, 5 with common bile duct (CBD) and pancreatic duct (PD) stones, and 6 with combined choledocholithiasis and hepatolithiasis. In the 56 patients with choledocholithiasis alone, preoperative endoscopic retrograde cholangio pancreatography (ERCP) and endotherapy were followed by cholecystectomy within 48 hours. Endotherapy was successful in 15 patients, whereas surgery was required in the remaining 41 patients. Surgery is an efficacious option and can be carried out safely with acceptable morbidity and no mortality, even in difficult situations.

Hospital malnutrition in northeast and southeast Asia: A systematic literature review.

BACKGROUND & AIMS: Hospital malnutrition is a prevalent yet frequently under-recognised condition that is associated with adverse clinical and economic consequences. Systematic reviews from various regions of the world have provided regional estimates of the prevalence of malnutrition and the magnitude of the associated health and economic burden; however, a systematic assessment of the prevalence and consequences of hospital malnutrition in northeast and southeast Asia has not been conducted. METHODS: We performed a systematic literature search for articles on hospital malnutrition in 11 Asian countries published in English between January 1, 1997 and January 15, 2018. Studies reporting data on the prevalence, clinical consequences, or economic impact of hospital malnutrition in an adult inpatient population with a sample size ≥30 were eligible for inclusion. RESULTS: The literature search identified 3207 citations; of these, 92 studies (N = 62,280) met the criteria for inclusion. There was substantial variability in study populations and assessment methods; however, a majority of studies reported a malnutrition prevalence of >40%. Malnutrition was associated with an increase in clinical complications, mortality, length of hospitalisation, hospital readmissions, and healthcare costs. CONCLUSIONS: Hospital malnutrition is a highly prevalent condition among hospitalised patients in northeast and southeast Asia. Additionally, poor nutritional status is associated with increased morbidity and mortality and increased healthcare costs. Further research aimed at improving the identification and proactive management of hospitalised patients at risk for malnutrition is necessary to improve patient outcomes and alleviate the burden on local healthcare budgets.