Biodegradation of pyrene by bacterial consortia: Impact of natural surfactants and iron oxide nanoparticles.

Polycyclic aromatic hydrocarbons (PAHs) are potentially hazardous compounds that could cause a severe impact on many ecosystems. They are very challenging to remove using conventional methods due to their hydrophobic nature. However, this issue can be resolved by utilizing surface-active molecules to increase their bioavailability. In this study, pyrene was chosen as the PAH compound to explore its degradability by the effect of individual bacterial strains (Pseudomonas stutzeri NA3 and Acinetobacter baumannii MN3) and mixed consortia (MC) along with natural surfactant derived from Sapindus mukorossi and iron oxide nanoparticles (NPs). Additionally, fatty acids esters, dipeptides, and sugar derivative groups were identified as potent bioactive components of natural surfactants. Various techniques, such as XRD, VSM, TEM, and FE-SEM with EDX, were utilized to characterize the pristine and Fenton-treated iron oxide NPs. The analytical results confirmed that the Fe3O4 crystal phase and spherical-shaped NPs exhibited excellent magnetic properties. The impact of natural surfactants and iron oxide NPs has significantly contributed to the biodegradation process, resulting in a prominent decrease in chemical oxygen demand (COD) levels. Gas chromatography-mass spectrometry (GC-MS) analysis showed that biodegradation systems produced primary hydrocarbon intermediates, which underwent oxidative degradation through Fenton treatment. Interestingly, synthesized iron oxide NPs effectively produced hydroxyl radical (•OH) during the Fenton reaction, which was confirmed by electron paramagnetic resonance (EPR) spectra, and the pristine iron oxide NPs underwent a material transformation observed. The study demonstrated an integrated approach for biodegradation and the Fenton reaction process to enhance the pyrene degradation efficiency (90%) compared to other systems. Using natural surfactants and iron oxide NPs in aquatic environments serves as a crucial platform at the interface of microorganisms and contaminated oil products. This interaction offers a promising solution for PAHs bioremediation.

Frequency and classification of addenda in paediatric neuroradiological reports as part of quality assurance.

AIM: To determine the frequency and classification of addenda seen in paediatric brain magnetic resonance imaging (MRI) reports. MATERIALS AND METHODS: A retrospective review of the addenda of brain MRI reports from a large tertiary children's hospital was undertaken between January 2013 to December 2021 and a subset of above radiology reports was used to classify addenda over 6-month periods, October to March, spanning 2018 to 2021. A radiology fellow and a medical doctor classified the addenda into previously published categories using their best judgement. RESULTS: Out of 73,643 brain MRI reports over 9 years (108 months) included in the study, only 923 reports (1.25%) had addenda. There was a total of 13,615 brain MRI reports from 6-month periods, of which only 179 reports (1.31%) had an addendum. The number of errors according to categories were: observational 88/13,615 (0.65%); interpretational 16/13,615 (0.12%); non-observational and non-interpretative 82/13,615 (0.6%). Notifications to referring physician made in 29/13,615 (0.21%). CONCLUSIONS: The overall proportion of addenda to the brain MRI reports of children in the present study was low, at 1.25%. Categorisation of different addenda revealed the most common errors to be observational in 0.65%, including under-reading in the region of interest in 0.25%. Appropriate measures can now be introduced to minimise the error-based addenda further and improve MRI diagnosis in children. Other paediatric practices may choose to follow suit in evaluating their addenda and errors to improve practice.

Update on Applications and Limitations of Perioperative Tranexamic Acid.

Tranexamic acid (TXA) is a potent antifibrinolytic with documented efficacy in reducing blood loss and allogeneic red blood cell transfusion in several clinical settings. With a growing emphasis on patient blood management, TXA has become an integral aspect of perioperative blood conservation strategies. While clinical applications of TXA in the perioperative period are expanding, routine use in select clinical scenarios should be supported by evidence for efficacy. Furthermore, questions regarding optimal dosing without increased risk of adverse events such as thrombosis or seizures should be answered. Therefore, ongoing investigations into TXA utilization in cardiac surgery, obstetrics, acute trauma, orthopedic surgery, neurosurgery, pediatric surgery, and other perioperative settings continue. The aim of this review is to provide an update on the current applications and limitations of TXA use in the perioperative period.

Coagulation and Transfusion Updates From 2021.

2021 and the COVID 19 pandemic have brought unprecedented blood shortages worldwide. These deficits have propelled national efforts to reduce blood usage, including limiting elective services and accelerating Patient Blood Management (PBM) initiatives. A host of research dedicated to blood usage and management within cardiac surgery has continued to emerge. The intent of this review is to highlight this past year's research pertaining to PBM and COVID-19-related coagulation changes.

The Year in Graduate Medical Education: Selected Highlights From 2021.

This special article is the first in a planned annual series for the Journal of Cardiothoracic and Vascular Anesthesia that will highlight significant literature from the world of graduate medical education (GME) that was published over the past year. The major themes selected for this inaugural review are the educational value of simulation and training workshops, the expanding role of social media and other information technologies in GME and recruitment, the state of residency and fellowship training before the COVID-19 pandemic, and the inevitable effects COVID-19 has had on graduate medical education. The authors would like to thank the editorial board for allowing us to shine a light on a small subset of the writing and research produced in this field, so that educators may understand how best to educate and train the next generation of anesthesiologists.

Direct relationship between transvalvular velocity and cardiac dysfunction, morbidity, and mortality in patients with aortic stenosis.

OBJECTIVE: Current guidelines recommend intervention in subjects with severe symptomatic aortic stenosis (AS), even though any degree of AS is associated with a higher risk of mortality. We investigated the association between the degree of AS, delineated by transvalvular flow velocity, and patient morbidity and mortality. METHODS: Medically managed patients aged 40-95 years with maximum flow velocity (Vmax ) by echocardiography between 2013 and 2018 were stratified into five groups (A-E) based on the 75th, 90th, 97.5th, and the 99th percentiles of Vmax distribution. Patient characteristics, cardiac structural changes, and end-organ disease were compared using Kruskal-Wallis and Cochran-Armitage tests. Mortality over a median of 2.8 (1.52-4.8) years was compared using Kaplan-Meier curves and risk estimates were derived from the Cox model. RESULTS: The Vmax was reported in 37,131 patients. There was a steady increase (from Group A towards E) in age, Caucasian race, structural cardiac changes, end-organ morbidities, and all-cause mortality. In reference to Group A, there as an increased risk of mortality in Groups B (hazard ratio [HR] = 1.3; confidence interval [CI]: 1.2-1.35; p < .0001), C (HR = 1.5; CI: 1.4-1.6; p < .0001), and D (HR = 1.8; CI: 1.6-2; p < .0001), with an exponential increase in Group E (HR = 2.5; CI: 2.2-2.8; p < .0001). CONCLUSIONS: A direct, strong correlation exists between the degree of AS and cardiac structural changes and mortality. Patients with Vmax ≥ 97.5th percentile (≥3.2 m/s) might benefit from early intervention.

Impact of extreme weather events on cropland inundation over Indian subcontinent.

Cyclonic storms and extreme precipitation lead to loss of lives and significant damage to land and property, crop productivity, etc. The "Gulab" cyclonic storm formed on the 24th of September 2021 in the Bay of Bengal (BoB), hit the eastern Indian coasts on the 26th of September and caused massive damage and water inundation. This study used Integrated Multi-satellite Retrievals for GPM (IMERG) satellite precipitation data for daily to monthly scale assessments focusing on the "Gulab" cyclonic event. The Otsu's thresholding approach was applied to Sentinel-1 data to map water inundation. Standardized Precipitation Index (SPI) was employed to analyze the precipitation deviation compared to the 20 years mean climatology across India from June to November 2021 on a monthly scale. The water-inundated areas were overlaid on a recent publicly available high-resolution land use land cover (LULC) map to demarcate crop area damage in four eastern Indian states such as Andhra Pradesh, Chhattisgarh, Odisha, and Telangana. The maximum water inundation and crop area damages were observed in Andhra Pradesh (~2700 km2), followed by Telangana (~2040 km2) and Odisha (~1132 km2), and the least in Chhattisgarh (~93.75 km2). This study has potential implications for an emergency response to extreme weather events, such as cyclones, extreme precipitation, and flood. The spatio-temporal data layers and rapid assessment methodology can be helpful to various users such as disaster management authorities, mitigation and response teams, and crop insurance scheme development. The relevant satellite data, products, and cloud-computing facility could operationalize systematic disaster monitoring under the rising threats of extreme weather events in the coming years.

Moderate resolution LAI prediction using Sentinel-2 satellite data and indirect field measurements in Sikkim Himalaya.

The leaf area index (LAI) has been traditionally used as a photosynthetic variable. LAI plays an essential role in forest cover monitoring and has been identified as one of the important climate variables. However, due to challenges in field sampling, complex topography, and availability of cloud-free optical satellite data, LAI assessment on larger scale is still unexplored in the Sikkim Himalayan area. We used two optical instruments, digital hemispherical photography (DHP) and LAI-2200C, to assess the LAI across four different forests following 20 × 20 m2 elementary sampling units (ESUs) in the Himalayan state of Sikkim, India. The use of Sentinel-2 derived vegetation indices (VIs) demonstrated a better correlation with the DHP based LAI estimates than using LAI-2200C. Further, the combination of both reflectance bands and VIs were integrated to predict the LAI maps using random forest model. The temperate evergreen forests demonstrated the highest LAI value, while the predicted maps exhibited LAI maxima of 3.4. The estimated vs predicted LAI for DHP and LAI-2200C based estimation demonstrated reasonably good (R2 = 0.63 and R2 = 0.68, respectively) agreement. Further, improvements on the LAI prediction can be attempted by minimizing errors from the inherent field protocols, optimizing the density of field measurements, and representing heterogeneity. The recent rise of frequent forest fires in Sikkim Himalaya prompts for better understanding of fuel load in terms of surface fuel or canopy fuel that can be linked to LAI. The high-resolution LAI map could serve as input to forest fuel bed characterization, especially in seasonal forests with significant variations in green leaves and litter, thereby offering inputs for forest management in changing climate.

The Year in Coagulation: Selected Highlights from 2020.

This is the second annual review in the Journal of Cardiothoracic and Vascular Anesthesia to cover highlights in coagulation for cardiac surgery. The goal of this article is to provide readers with a focused summary from the literature of the prior year's most important coagulation topics. In 2020, this included a discussion covering allogeneic transfusion, antiplatelet and anticoagulant therapy, factor concentrates, coagulation testing, mechanical circulatory support, and the effects of coronavirus disease 2019.

Skeletal Muscle Characteristics May Inform Preprocedural Risk Stratification in Transcatheter Aortic Valve Replacement Patients.

OBJECTIVES: Low psoas muscle mass previously has been associated with mortality after transcatheter aortic valve replacement (TAVR). Evidence from other clinical disciplines suggests that psoas density (PD) may be a better predictor than psoas muscle cross-sectional area indexed to body surface area (PI). The authors hypothesized that PD would be more strongly correlated with patient discharge disposition and survival after TAVR than PI. DESIGN: The authors performed a single-center, retrospective study of TAVR patients from 2013 to 2016. PI and PD were assessed at the third lumbar spine level using computed tomography imaging. Propensity-score matching was used to investigate the association of PI and PD with discharge disposition and mortality. SETTING: Tertiary university hospital PARTICIPANTS: Cohort of 245 TAVR patients. INTERVENTIONS: None MEASUREMENTS AND MAIN RESULTS: A total of 245 patients met inclusion criteria. Following propensity score matching, patients with PI <4 cm2/m2 and PD <25 Hounsfield units (HU) were less likely to survive and to be discharged home compared with patients with PI ≥4 cm2/m2 or PD >25 HU. After repeating the propensity score matching with PI as a covariable, PD remained associated with mortality (90 days: odds ratio [OR] 4.59; 95% confidence interval [CI] 2.96-10.31, p < 0.001, 1 year: OR 6.14; 95% CI 3.45-28.57, p = 0.01, 3 years: OR 4.55; 95% CI 2.41-40.00, p = 0.03). CONCLUSIONS: PD may be more relevant than PI in risk stratification for TAVR patients.

Differential gene expression in liver of colored broiler chicken divergently selected for residual feed intake.

Feed constitutes about 60-70% of the total cost of poultry production. So maximizing the feed efficiency will reduce production cost. The rapid growth in the juvenile period is essential to achieve higher body weight. Therefore, identifying the genes and pathways involved in rapid growth at an early age with a lesser requirement of feed is of utmost importance to further economize the broiler production. The efficiency of feed utilization was measured using RFI (residual feed intake). The present study aimed to estimate the RFI (0-5 week) in a population of indigenously developed colored broiler sire line chicken as well as identifying the differentially expressed genes influencing RFI in high and low RFI groups. The liver samples of high and low RFI broiler chicken aged 35 days were used for microarray analysis. A total of 2798 differentially expressed genes (DEGs) were identified, out of which 913 genes were downregulated and 1885 were upregulated. The fold change varied from - 475.17 to 552.94. A subset of genes was confirmed by qRT-PCR, and outcomes were matched well with microarray data. In the functional annotation study of DEGs, the highest significant GO (Gene Ontology) terms in the biological process included protein transport, protein localization, regulation of apoptosis, and mitochondrial transport. Gene network analysis of these DEGs plays an important role to understand the interaction among genes. Study of the important genes which were differentially expressed and the related molecular pathways in this population may hold the potential for future breeding strategies for augmenting feed efficiency.

The Year in Coagulation: Selected Highlights From 2019.

This is the first annual highlights in coagulation article to be published in the Journal of Cardiothoracic and Vascular Anesthesia. Its purpose is to review the most important coagulation literature from 2019. In the review, the authors discuss the recent Society of Cardiovascular Anesthesiologists clinical practice advisory on the management of perioperative bleeding and hemostasis, heparin monitoring, protamine dosing, antiplatelet therapy, factor concentrate therapy, and coagulopathy during mechanical circulatory support.

The Program Evaluation Committee in the Adult Cardiothoracic Anesthesiology Fellowship - Harnessing Opportunities for Program Improvement.

The Program Evaluation Committee has an essential role in the quality improvement process of the adult cardiothoracic anesthesiology fellowship. The annual program evaluation presents all stakeholders with an opportunity to evolve with the changing needs and opportunities of the fellowship milieu. The active engagement of the program in this process is a high-quality approach to successful planning, preparation and conduct of the self-study and site visit that are important extensions of the annual program evaluation and the program evaluation committee.

Contemporary Challenges for Fellowship Training in Adult Cardiothoracic Anesthesiology: Perspectives From Program Directors Around the United States.

The fellowship in adult cardiothoracic anesthesiology has matured as an accredited program. This special article addresses current challenges in this educational milieu. The first challenge relates to serving as a program director in the contemporary era. The second challenge deals with the accreditation process, including the site visit. The third challenge discusses the integration of structural heart disease and interventional echocardiography into daily practice. The fourth challenge deals with the issues that face fellowship education in the near future. Taken together, these perspectives provide a review of the contemporary challenges facing fellowship education in adult cardiothoracic anesthesiology.

Mentoring Fellows in Adult Cardiothoracic Anesthesiology for Academic Practice in the Contemporary Era-Perspectives From Mentors Around the United States.

This special article presents perspectives on the mentoring of fellows for academic practice in adult cardiothoracic anesthesiology. A comprehensive mentoring model should address the areas of clinical care, educational expertise and exposure to scholarly activity. The additional value of educational exposure to patient safety, quality improvement and critical care medicine in this model is also explored.

The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights from 2019.

This highlights in our specialty for 2019 begin with the ongoing major developments in transcatheter valve interventions. Thereafter, the advances in left ventricular assist devices are reviewed. The recent focus on conduit selection and robotic options in coronary artery bypass surgery are then explored. Finally, this special articles closes with a discussion of pulmonary hypertension in noncardiac surgery, anesthetic technique in cardiac surgery, as well as postoperative pneumonia and its outcome consequences.

Morbidity profile of communities in Bhopal city (India) vis-à-vis distance of residence from Union Carbide India Limited plant and drinking water usage pattern.

OBJECTIVE: A cross-sectional study was undertaken to assess the prevalence of morbidities in communities residing at variable distances from the closed down insecticide manufacturing plant premises of Union Carbide India Limited (UCIL), Bhopal, India and to determine association of morbidities, if any, with their drinking water usage pattern and distance of localities from the UCIL plant. MATERIALS AND METHODS: A total of 10,827 individuals belonging to 2,184 families, residing within 0-1 km (Stratum I) and 2.5-5.0 km (Stratum II) radial distances from UCIL plant were surveyed and 9,306 of them (86%) were clinically examined. Data were analyzed to examine the association between the groups of morbidities, likely due to biological and chemical water contamination, and the distance of locality from the UCIL plant. Multiple logistic regression was used to explore the risk factors for morbidities. RESULTS: Nearly similar prevalence (25.3% in stratum I, 25.8% in stratum II) and the trend of all-cause morbidities were recorded in the two strata. While morbidities related to gastrointestinal tract system (P < 0.05), auditory system (P < 0.01), neoplasm/cancers (P < 0.01) and congenital anomalies (P < 0.01) were significantly higher in stratum I, the prevalence of hypertension (6.4% stratum II, 4.7% stratum I; P < 0.01) and diabetes mellitus (3.4% stratum II, 2.0% stratum I; P < 0.001) was found significantly higher in stratum II. No association (P > 0.05) was observed between the prevalence of morbidities, likely due to the consumption of biologically or chemically contaminated drinking water, and the distance of locality/stratum from the UCIL plant. DISCUSSION AND CONCLUSION: By and large similar pattern of morbidities were recorded in the two strata suggesting that the communities, irrespective of the distance of their residences from UCIL plant or sources of their drinking water, are equally vulnerable to various morbidities.

Successful in vitro fertilization in women with Fontan physiology.

PURPOSE: Patients with single ventricle anatomy palliated with Fontan operation are at risk for thromboembolism, arrhythmia, and heart failure rendering pregnancy high risk or even contraindicated. Infertility and high rates of first trimester miscarriage are not uncommon. In vitro fertilization (IVF) with or without gestational surrogacy can be an option, but poses risks during ovarian stimulation, oocyte retrieval, and the post-procedural period. We present six cases of women with complex congenital heart disease status post Fontan operation who underwent successful IVF. METHODS: Case series from a single-center tertiary care setting. RESULTS: Indications for referral were cardiac or fertility concerns for pregnancy of the congenital cardiologist. One woman had mild volume overload after oocyte retrieval requiring furosemide and one experienced post-operative colitis. There were no thrombotic complications. CONCLUSIONS: A multidisciplinary team-based approach can result in successful oocyte retrieval and IVF in women with complex congenital heart disease and Fontan physiology.

Quantifying Argonaute 2 (Ago2) expression to stratify breast cancer.

BACKGROUND: Argonaute-2 (Ago2) is an essential component of microRNA biogenesis implicated in tumourigenesis. However Ago2 expression and localisation in breast cancer remains undetermined. The aim was to define Ago2 expression (mRNA and protein) and localisation in breast cancer, and investigate associations with clinicopathological details. METHODS: Ago2 protein was stained in breast cancer cell lines and tissue microarrays (TMAs), with intensity and localization assessed. Staining intensity was correlated with clinicopathological details. Using independent databases, Ago2 mRNA expression and gene alterations in breast cancer were investigated. RESULTS: In the breast cancer TMAs, 4 distinct staining intensities were observed (Negative, Weak, Moderate, Strong), with 64.2% of samples stained weak or negatively for Ago2 protein. An association was found between strong Ago2 staining and, the Her2 positive or basal subtypes, and between Ago2 intensity and receptor status (Estrogen or Progesterone). In tumours Ago2 mRNA expression correlated with reduced relapse free survival. Conversely, Ago2 mRNA was expressed significantly lower in SK-BR-3 (HER2 positive) and BT-20 (Basal/Triple negative) cell lines. Interestingly, high levels of Ago2 gene amplification (10-27%) were observed in breast cancer across multiple patient datasets. Importantly, knowledge of Ago2 expression improves predictions of breast cancer subtype by 20%, ER status by 15.7% and PR status by 17.5%. CONCLUSIONS: Quantification of Ago2 improves the stratification of breast cancer and suggests a differential role for Ago2 in breast cancer subtypes, based on levels and cellular localisation. Further investigation of the mechanisms affecting Ago2 dysregulation will reveal insights into the molecular differences underpinning breast cancer subtypes.

Comparative analysis of 2-week glycaemic profile of healthy versus mild gestational diabetic pregnant women using flash glucose monitoring system: an observational study.

OBJECTIVE: To compare glycaemic profiles in women with mild gestational diabetes (GDM) and those with a healthy pregnancy. DESIGN: Observational study. SETTING: Hospital-based. POPULATION: Healthy nonpregnant, healthy pregnant, and women with GDM, diagnosed by oral glucose tolerance test. METHODS: Nine nonpregnant women, 33 healthy pregnant women, 29 pregnant women with GDM between 24 and 36 weeks' gestation, received ambulatory glucose profile (AGP) monitoring for a 2-week period. AGP values were compared in the three groups: 100 days (9600 data points) for nonpregnant women, 396 days (33 792 data points) for healthy pregnant women, and 348 days (34 408 data points) for women with GDM. RESULTS: Mean glucose values for fasting and postmeals were highest in nonpregnant healthy women and lowest in healthy pregnant women (P < 0.001). Women with mild GDM had significantly higher blood glucose values than did healthy pregnant women, though still within the target range. Blood glucose values >160 mg/dl were observed in 41.4% (12/29) in the GDM group compared with 18.2% in women with a healthy pregnancy. The maximum peak of day and night time glucose was respectively 234 and 215 mg/dl in women with GDM compared with 183 and 171 mg/dL in the control group. Glycaemic variability as measured by interquartile range was higher in GDM pregnancies. CONCLUSIONS: Although the blood glucose level remained within the target levels in women with mild GDM, glycaemic variability and mean blood glucose levels were significantly higher among women with GDM than among women with a healthy pregnancy. TWEETABLE ABSTRACT: Average blood glucose levels and glycaemic variability are significantly higher in women with GDM than in women with a healthy pregnancy.