Characterization of Antioxidant Bioactive Compounds and Rheological, Color and Sensory Properties in 3D-Printed Fruit Snacks.

The influence of wheat starch (6%, 8% and 10%, w/w) and a 3D printing program (program 1 vs. program 2) on the content of bioactive compounds, antioxidant capacity, color parameters and rheological and sensory properties was investigated in 3D strawberry and strawberry tree fruit snacks. Increasing the starch content led to a decrease in the content of almost all the bioactive compounds, while it had no effect on the antioxidant capacity. The printing program had no significant effect on the bioactive compounds (except hydroxycinnamic acids), antioxidant capacity and color parameters. A higher starch content improved the strength of the sample but had no effect on the mechanical properties. Smaller particles with a higher starch content improved the stability of the sample. In contrast to the programs, varying the starch content had a significant effect on all the color parameters except the a* values. Eight different sweeteners in two different concentrations were used for the sensory evaluation of the 3D-printed snacks. The variations in sweetener content only affected the sweet and harmonious taste. In summary, this study confirms the great potential of fruit bases for the production of 3D-printed snacks with excellent biological and rheological properties, which can be a step toward personalized food with the addition of sweeteners.

Correlation between Radiological Characteristics, PET-CT and Histological Subtypes of Primary Lung Adenocarcinoma-A 102 Case Series Analysis.

Background and Objectives: Lung cancer is the second most common form of cancer in the world for both men and women as well as the most common cause of cancer-related deaths worldwide. The aim of this study is to summarize the radiological characteristics between primary lung adenocarcinoma subtypes and to correlate them with FDG uptake on PET-CT. Materials and Methods: This retrospective study included 102 patients with pathohistologically confirmed lung adenocarcinoma. A PET-CT examination was performed on some of the patients and the values of SUVmax were also correlated with the histological and morphological characteristics of the masses in the lungs. Results: The results of this analysis showed that the mean size of AIS-MIA (adenocarcinoma in situ and minimally invasive adenocarcinoma) cancer was significantly lower than for all other cancer types, while the mean size of the acinar cancer was smaller than in the solid type of cancer. Metastases were significantly more frequent in solid adenocarcinoma than in acinar, lepidic, and AIS-MIA cancer subtypes. The maximum standardized FDG uptake was significantly lower in AIS-MIA than in all other cancer types and in the acinar predominant subtype compared to solid cancer. Papillary predominant adenocarcinoma had higher odds of developing contralateral lymph node involvement compared to other types. Solid adenocarcinoma was associated with higher odds of having metastases and with higher SUVmax. AIS-MIA was associated with lower odds of one unit increase in tumor size and ipsilateral lymph node involvement. Conclusions: The correlation between histopathological and radiological findings is crucial for accurate diagnosis and staging. By integrating both sets of data, clinicians can enhance diagnostic accuracy and determine the optimal treatment plan.

The Role of Ketamine as a Component of Multimodal Analgesia in Burns: A Retrospective Observational Study.

Background: Burn wound dressing and debridement are excruciatingly painful procedures that call for appropriate analgesia-typically multimodal. Better post-procedural pain management, less opioid use, and consequently fewer side effects, which could prolong recovery and increase morbidity, are all benefits of this type of analgesia. Intravenously administered ketamine can be effective as monotherapy or in combination with opioids, especially with procedural sedation such as in burn wound dressing. Methods: This observational study investigated the effect of ketamine administered in subanesthetic doses combined with opioids during burn wound dressing. The study was conducted from October 2018 to October 2021. A total of 165 patients met the inclusion criteria. A total of 82 patients were in the ketamine group, while 83 patients were dressed without ketamine. The main outcome was the effect of ketamine on intraprocedural opioid consumption. The secondary outcome included the effect of ketamine on postprocedural pain control. Results: Patients dressed with ketamine were significantly older (p = 0.001), while the mean doses of intraoperatively administered propofol and fentanyl were significantly lower than in patients dressed without ketamine (150 vs. 220 mg, p < 0.001; and 0.075 vs. 0.150 mg, p < 0.001; respectively). Conclusions: Ketamine was an independent predictor of lower intraoperative fentanyl consumption, according to the multivariate regression analysis (p = 0.015). Contrarily, both groups of patients required postoperative tramadol treatment, while intraoperative ketamine administration had no beneficial effects on postoperative pain management.

Influence of psychosocial characteristics of patients and opinions of their relatives on indication for surgical treatment of pectus excavatum.

BACKGROUND: To assess the subjective experience of patients and their parents or relatives about the existing pectus excavatum deformity and to contribute to the definition of indications for surgical treatment of this deformity. METHODS: The initial sample of psychosocial characteristics consisted of self-assessments and observations of patients (and parents) regarding their health, self-image, health care, possible environmental response to their physical appearance, expectations regarding treatment. A modified version of the original Nuss questionnaire on quality of life was used in the psychological part of the examination. RESULTS: The study included a sample of 58 patients aged 10 to 30 years, and a sample of 58 family members of the patient (parents, relatives). The experience of poor emotional status, withdrawals, and bad self-image in patients older than 15 years than younger were significant. The tendency for female patients to have a worse experience is pronounced and significant. The largest percentage of parents have an 'indecisive' or 'weakly expressed' attitude towards surgery. Parents at a significantly higher rate show greater concern for female children. CONCLUSION: A systematic evaluation of the psychosocial perception of patients and their relatives (who will consent for the operation) may be a useful diagnostic assessment before correcting an anterior chest wall malformation.

Multivariate Interaction Analysis of Zea mays L. Genotypes Growth Productivity in Different Environmental Conditions.

Evaluating maize genotypes under different conditions is important for identifying which genotypes combine stability with high yield potential. The aim of this study was to assess stability and the effect of the genotype-environment interaction (GEI) on the grain yield traits of four maize genotypes grown in field trials; one control trial without nitrogen, and three applying different levels of nitrogen (0, 70, 140, and 210 kg ha-1, respectively). Across two growing seasons, both the phenotypic variability and GEI for yield traits over four maize genotypes (P0725, P9889, P9757 and P9074) grown in four different fertilization treatments were studied. The additive main effects and multiplicative interaction (AMMI) models were used to estimate the GEI. The results revealed that genotype and environmental effects, such as the GEI effect, significantly influenced yield, as well as revealing that maize genotypes responded differently to different conditions and fertilization measures. An analysis of the GEI using the IPCA (interaction principal components) analysis method showed the statistical significance of the first source of variation, IPCA1. As the main component, IPCA1 explained 74.6% of GEI variation in maize yield. Genotype G3, with a mean grain yield of 10.6 t ha-1, was found to be the most stable and adaptable to all environments in both seasons, while genotype G1 was found to be unstable, following its specific adaptation to the environments.

Prognostic factors for long-term survival following complete resection by lobectomy in stage I non-small cell lung cancer.

BACKGROUND: The aim of this study was to evaluate predictors for long-term overall survival (OS) in patients with stage I non-small cell lung cancer (NSCLC). METHODS: All patients undergoing complete resection by lobectomy for stage I NSCLC between October 2012 and December 2015 at a single center were included. Univariable and multivariable Cox regression analyses were performed to identify prognostic factors. RESULTS: A total of 92 patients were included. Univariable and multivariable Cox regression analyses revealed preoperative neutrophil to lymphocyte ratio (NLR, p = 0.005), preoperative diffusion capacity of the lungs for carbon monoxide (DLCO, p = 0.010) and forced expiratory volume in 1 second (FEV1, p = 0.041) as well as male gender (p = 0.026) as independent prognostic factors for OS. Combining the calculated cutoff values for FEV1 (<73.0%) and NLR (>3.49) into one parameter resulted in a highly significant difference in survival times when stratified by this variable. CONCLUSIONS: Recently, much emphasis has been put on the prognostic importance of blood biomarkers in NSCLC. In our study, NLR was an independent factor for OS, as were baseline characteristics such as DLCO, FEV1, and gender. Further studies on the association of biomarkers for systemic inflammation and lung function parameters with respect to patient survival are warranted.

A Delphi Consensus report from the "Prolonged Air Leak: A Survey" study group on prevention and management of postoperative air leaks after minimally invasive anatomical resections.

OBJECTIVES: This study reports the results of an international expert consensus process evaluating the assessment of intraoperative air leaks (IAL) and treatment of postoperative prolonged air leaks (PAL) utilizing a Delphi process, with the aim of helping standardization and improving practice. METHODS: A panel of 45 questions was developed and submitted to an international working group of experts in minimally invasive lung cancer surgery. Modified Delphi methodology was used to review responses, including 3 rounds of voting. The consensus was defined a priori as >50% agreement among the experts. Clinical practice standards were graded as recommended or highly recommended if 50-74% or >75% of the experts reached an agreement, respectively. RESULTS: A total of 32 experts from 18 countries completed the questionnaires in all 3 rounds. Respondents agreed that PAL are defined as >5 days and that current risk models are rarely used. The consensus was reached in 33/45 issues (73.3%). IAL were classified as mild (<100 ml/min; 81%), moderate (100-400 ml/min; 71%) and severe (>400 ml/min; 74%). If mild IAL are detected, 68% do not treat; if moderate, consensus was not; if severe, 90% favoured treatment. CONCLUSIONS: This expert consensus working group reached an agreement on the majority of issues regarding the detection and management of IAL and PAL. In the absence of prospective, randomized evidence supporting most of these clinical decisions, this document may serve as a guideline to reduce practice variation.

Long-term outcome in patients with myasthenia gravis: one decade longitudinal study.

INTRODUCTION: Even treated, myasthenia gravis (MG) continues to represent a significant burden and might continuously affect patients' quality of life (QoL). The aim of our longitudinal study was to analyze QoL in a large cohort of MG patients after a 10-year follow-up period. METHODS: This study comprised 78 MG patients (60% females, 50 ± 16 years old at baseline, 70% AchR positive) who were retested after 10 years. Disease severity was evaluated by MGFA classification. QoL was assessed using SF-36 questionnaire and Myasthenia Gravis-specific Questionnaire (MGQ). Hamilton rating scales for depression and anxiety (HDRS and HARS), Multidimensional Scale of Perceived Social Support (MSPSS) and Acceptance of Illness Scale (AIS) were also used. RESULTS: Similar percentage of patients was in remission at both time points (42% and 45%). However, at baseline all patients were treated, while 32% were treatment-free at follow-up. SF-36, MGQ, MSPSS and AIS scores were similar at baseline and retest. Mean HDRS and HARS scores worsened during time (p < 0.05), although percentage of patients with depression and anxiety did not change significantly. Significant predictors of worse SF-36 score at retest were depression (ß = - 0.45, p < 0.01), poor disease acceptance (ß = - 0.44, p < 0.01) and older age (ß = - 0.30, p < 0.01). Significant predictors of worse MGQ score at retest were poor disease acceptance (ß = - 0.40, p < 0.01), retirement (ß = - 0.36, p < 0.01), lower education (ß = 0.25, p < 0.01), and depression (ß = - 0.18, p < 0.05). CONCLUSIONS: Although after 10 years, a significant number of MG patients were in remission, their QoL was still reduced. Neurologists should be aware that patients' perception of poor QoL may persist even if MG is well treated from a physician's perspective.

Communicating During COVID-19 and Other Acute-Event Scenarios: A Practical Approach.

Successfully adapting to organizational changes during the COVID-19 pandemic crisis necessitated the effective deployment of technical communication texts delineating the expectations and structures for guiding behavior and interactions. A dearth of system-wide familiarity with changes in modalities has disrupted expectations and impacted engagement. During acute events, business and technical communicators will probably not be the initial source of transition messaging. Instead, this task will fall on managers, faculty, and other front-line communicators. The authors present pragmatic recommendations for adapting familiar discourses, semiotics, and mental scripts so that communicators can more effectively intervene during crises to ease organizational transitions and decrease uncertainty.

Aberrant activity of mitochondrial NCLX is linked to impaired synaptic transmission and is associated with mental retardation.

Calcium dynamics control synaptic transmission. Calcium triggers synaptic vesicle fusion, determines release probability, modulates vesicle recycling, participates in long-term plasticity and regulates cellular metabolism. Mitochondria, the main source of cellular energy, serve as calcium signaling hubs. Mitochondrial calcium transients are primarily determined by the balance between calcium influx, mediated by the mitochondrial calcium uniporter (MCU), and calcium efflux through the sodium/lithium/calcium exchanger (NCLX). We identified a human recessive missense SLC8B1 variant that impairs NCLX activity and is associated with severe mental retardation. On this basis, we examined the effect of deleting NCLX in mice on mitochondrial and synaptic calcium homeostasis, synaptic activity, and plasticity. Neuronal mitochondria exhibited basal calcium overload, membrane depolarization, and a reduction in the amplitude and rate of calcium influx and efflux. We observed smaller cytoplasmic calcium transients in the presynaptic terminals of NCLX-KO neurons, leading to a lower probability of release and weaker transmission. In agreement, synaptic facilitation in NCLX-KO hippocampal slices was enhanced. Importantly, deletion of NCLX abolished long term potentiation of Schaffer collateral synapses. Our results show that NCLX controls presynaptic calcium transients that are crucial for defining synaptic strength as well as short- and long-term plasticity, key elements of learning and memory processes.

Multivariate Interaction Analysis of Winter Wheat Grown in Environment of Limited Soil Conditions.

The less productive soils present one of the major problems in wheat production. Because of unfavorable conditions, halomorphic soils could be intensively utilized using ameliorative measures and by selecting suitable stress tolerant wheat genotypes. This study examined the responses of ten winter wheat cultivars on stressful conditions of halomorphic soil, solonetz type in Banat, Serbia. The wheat genotypes were grown in field trails of control and treatments with two soil amelioration levels using phosphor gypsum, in amounts of 25 and 50 tha-1. Across two vegetation seasons, phenotypic variability and genotype by environment interaction (GEI) for yield traits of wheat were studied. The additive main effects and multiplicative interaction (AMMI) models were used to study the GEI. AMMI analyses revealed significant genotype and environmental effects, as well as GEI effect. Analysis of GEI using the IPCA (Interaction Principal Components) analysis showed a statistical significance of the first two main components, IPCA1 and IPCA2 for yield, which jointly explained 70% of GEI variation. First source of variation IPCA1 explained 41.15% of the GEI for the grain weight per plant and 78.54% for the harvest index. The results revealed that wheat genotypes responded differently to stressful conditions and ameliorative measures.

Genotype × Environment Interaction for Wheat Yield Traits Suitable for Selection in Different Seed Priming Conditions.

Different seed priming treatments are widely used in order to improve the nutritional status of wheat, as well as to improve its grain yield and yield- related traits. The present study aimed to evaluate the impact of seed priming with zinc oxide nanoparticles (ZnO NPs) on the yield related traits, such as, field emergence, plant height, spike length and grain yield per plant of four winter wheat genotypes (Triticum aestivum L.) during two vegetation seasons of 2018/2019 and 2019/2020. The seeds of each wheat genotypes were primed with different concentrations of ZnO NPs (0 mg L-1, 10 mg L-1, 100 mg L-1 and 1000 mg L-1) for 48 h in a dark box by continuous aeration and were sown in soil pots with 60-70% moisture content until full maturity. The additive main effects and multiplicative interaction (AMMI) models were used to study the genotype environment effects. The results indicated that the plants response to ZnO nanoparticles significantly increased all of the observed traits of the wheat, while its maximum rates reduced the traits of the wheat. The AMMI analysis revealed the very complex nature of the variation observed in the trial and showed the significant effect of the G×E interaction, in which the first main component was significant for all components.

LRRK2 deficiency induced mitochondrial Ca2+ efflux inhibition can be rescued by Na+/Ca2+/Li+ exchanger upregulation.

Variants of leucine-rich repeat kinase 2 (lrrk2) are associated with an increased risk in developing Parkinson's disease (PD). Mitochondrial dysfunction and specifically mitochondrial Ca2+ handling has been linked to the pathogenesis of PD. Here we describe for the second time a mitochondrial Ca2+ efflux deficiency in a model displaying alterations in a PD-associated risk protein. LRRK2 deletion, inhibition and mutations led to an impaired mitochondrial Ca2+ extrusion via Na+/Ca2+/Li+ exchanger (NCLX) which in turn lowered mitochondrial permeability transition pore (PTP) opening threshold and increased cell death. The mitochondrial membrane potential was found not to be the underlying cause for the Ca2+ extrusion deficiency. NCLX activity was rescued by a direct (phosphomimetic NCLX mutant) and indirect (protein kinase A) activation which in turn elevated the PTP opening threshold. Therefore, at least two PD-associated risk protein pathways appear to converge on NCLX controlling mitochondrial Ca2+ extrusion and therefore mitochondrial health. Since mitochondrial Ca2+ overload has been described in many neurological disorders this study warrants further studies into NCLX as a potential therapeutic target.

Functional properties and mode of regulation of the mitochondrial Na+/Ca2+ exchanger, NCLX.

Mitochondrial Ca2+ transient is the earliest discovered organellar Ca2+ signaling pathway. It consist of a Ca2+ influx, mediated by mitochondrial Ca2+ uniporter (MCU), and mitochondrial Ca2+ efflux mediated by a Na+/Ca2+ exchanger (NCLX). Mitochondrial Ca2+ signaling machinery plays a fundamental role in linking metabolic activity to cellular Ca2+ signaling, and in controlling local Ca2+ concertation in distinct cellular compartments. Impaired balance between mitochondrial Ca2+ influx and efflux leads to mitochondrial Ca2+ overload, an early and key event in ischemic or neurodegenerative syndromes. Molecular identification of NCLX and MCU happened only recently. Surprisingly, MCU knockout yielded a relatively mild phenotype while conditional knockout of NCLX led to a rapid fatal heart failure. Here we will focus on recent functional and molecular studies on NCLX structure and its mode of regulation. We will describe the unique crosstalk of this exchanger with Na+ and Ca2+ signaling pathways in the cell membrane and the endoplasmic reticulum, and with protein kinases that posttranslationally modulate NCLX activity. We will critically compare selectivity of pharmacological blockers versus molecular control of NCLX expression and activity. Finally we will discuss why this exchanger is essential for survival and can serve as an attractive therapeutic target.

Allosteric Regulation of NCLX by Mitochondrial Membrane Potential Links the Metabolic State and Ca2+ Signaling in Mitochondria.

Calcium is a key regulator of mitochondrial function under both normal and pathological conditions. The mechanisms linking metabolic activity to mitochondrial Ca2+ signaling remain elusive, however. Here, by monitoring mitochondrial Ca2+ transients while manipulating mitochondrial membrane potential (ΔΨm), we found that mild fluctuations in ΔΨm, which do not affect Ca2+ influx, are sufficient to strongly regulate NCLX, the major efflux pathway of Ca2+ from the mitochondria. Phosphorylation of NCLX or expression of phosphomimicking mutant (S258D) rescued NCLX activity from ΔΨm-driven allosteric inhibition. By screening ΔΨm sensitivity of NCLX mutants, we also identified amino acid residues that, through functional interaction with Ser258, control NCLX regulation. Finally, we find that glucose-driven ΔΨm changes in pancreatic ß-cells control mitochondrial Ca2+ signaling primarily via NCLX regulation. Our results identify a feedback control between metabolic activity and mitochondrial Ca2+ signaling and the "safety valve" NCLX phosphorylation that can rescue Ca2+ efflux in depolarized mitochondria.

Sonographic Indicators for Treatment Choice and Follow-Up in Patients with Pleural Effusion.

Aim: The aim of this study was to evaluate the role of thoracic sonography in treatment of pleural effusions and to identify sonographic indicators for surgical intervention. Materials and Methods: This study included 378 patients with pleural effusions. US characteristics of effusions as the echo structure and pleural thickening were analyzed. Regarding the US finding, the diagnostic or therapeutic procedure was performed. Results: The study included 267 male and 111 female patients, an average of 56.7 years. Infection was the most frequent cause of effusion. Two hundred sixty-nine patients had loculated and 109 free pleural effusion. Most frequent echo structure of loculated effusion was complex septate, whereas free effusion was mostly anechoic. Successful obtaining of the pleural fluid without real-time guidance was in 88% and under real-time guidance in 99% patients (p < 0.012). There was no significant difference in success rate between free and loculated effusion and regarding the echo structure (p=0.710 and 0.126, respectively). Complete fluid removal after serial thoracentesis or drainage was achieved in 86% patients. Forty-five patients with significantly thicker pleural peel and impairment of the diaphragmatic function than remaining of the group (p < 0.001) underwent surgery. Open thoracotomy and decortication was more frequently performed in patients with completely fixed diaphragm and complex, dominantly septated effusions. There is no significant difference in US parameters comparing to patients underwent VATS, but the number of VATS is too small for valid conclusion. Conclusion: Thoracic sonography is a very useful tool in the evaluation of clinical course and treatment options in patients with pleural effusions of a different origin.

Comparison of mediastinal lymph node status and relapse pattern in clinical stage IIIA non-small cell lung cancer patients treated with neoadjuvant chemotherapy versus upfront surgery: A single center experience.

BACKGROUND: In spite of the progress made in neoadjuvant therapy for operable non small-cell lung cancer (NSCLC), many issues remain unsolved, especially in locally advanced stage IIIA. METHODS: Retrospective data of 163 patients diagnosed with stage IIIA NSCLC after surgery was analyzed. The patients were divided into two groups: a preoperative chemotherapy group including 59 patients who received platinum-etoposide doublet treatment before surgery, and an upfront surgery group including 104 patients for whom surgical resection was the first treatment step. Adjuvant chemotherapy or/and radiotherapy was administered to 139 patients (85.3%), while 24 patients (14.7%) were followed-up only. RESULTS: The rate of N2 disease was significantly higher in the upfront surgery group ( P < 0.001). The one-year relapse rate was 49.5% in the preoperative chemotherapy group compared to 65.4% in the upfront surgery group. There was a significant difference in relapse rate in relation to adjuvant chemotheraphy treatment ( P = 0.007). The probability of relapse was equal whether radiotherapy was applied or not ( P = 0.142). There was no statistically significant difference in two-year mortality ( P = 0.577). The median survival duration after two years of follow-up was 19.6 months in the preoperative chemotherapy group versus 18.8 months in the upfront surgery group ( P = 0.608 > 0.05). CONCLUSION: There was significant difference in preoperative chemotherapy group regarding relapse rate and treatment outcomes related to the lymph node status comparing to the upfront surgery group. Neoadjuvant/adjuvant chemo-therapy is a part of treatment for patients with stage IIIA NSCLC, but further investigation is required to determine optimal treatment.

Fissure-last video-assisted thoracoscopic lobectomy for 'non-upper' lobes.

BACKGROUND: Surgical approach into the fissural parenchyma may be an important and modifiable factor for the prevention of air leak after anatomical lung resections. Fissureless fissure-last technique has been described as useful technique to reduce air leak, yet in video-assisted thoracoscopic surgery (VATS) data are limited and mostly on the upper lobes. The purpose of this study is to evaluate the safety and feasibility of fissureless fissure-last VATS 'non-upper' lobectomies and the impact of it on the immediate outcome, especially relating to air leak. METHODS: This study is a monocentric single-surgeon retrospective analysis on prospectively collected data. During 24 months, 46 patients underwent VATS 'non-upper' lobectomy or lower bilobectomy, with conventional (VATS-c) technique in 20 and fissureless fissure-last (VATS-f) technique in 26 patients. Results were evaluated according to preoperative, perioperative and postoperative parameters. RESULTS: There were no differences between VATS-c and VATS-f groups in any characteristics or peri- and postoperative variables, except the number of staplers, where it was significantly higher in VATS-c group (MVATS-c = 5.7; MVATS-f = 7.7; P = 0.001). Operation time did not differ between the groups, but showed gender-related difference, being longer in males (MVATS-c = 188; MVATS-f = 157; P = 0.04). Prevalence of air leak was 20%; prolonged air leak (PAL) (>5 days) being 11% and PAL (>7 days) 0%. Patients with air leak were older by tendency (MVATS-c = 74.9; MVATS-f = 66.5; P = 0.08), had more complications (P = 0.025; relative risk = 2.65) and stayed longer at hospital (MVATS-c = 10.8; MVATS-f = 7.7; P = 0.02). Postoperative complications were present in 24% of patients. CONCLUSION: VATS-f lobectomy is safe and feasible not only for 'upper' but also for 'non-upper' lobes. When applied to properly selected patients, it may reduce air leak and PAL and thus may potentially reduce the rate of complications.