Marijuana use among adult liver transplant candidates and recipients.

BACKGROUND: Data regarding marijuana (MJ) use among liver transplant (LT) candidates are limited. We set out to determine the incidence and pre- and post-LT outcomes of adult LT candidates with a self-reported history of MJ use. METHODS: Baseline clinical characteristics, waitlist, and post-LT outcomes of adult LT candidates from January 2010 to March 2017 were compared. RESULTS: Among 2690 LT candidates, 630(23%) and 298(11%) reported a history of MJ use and use within the past 12 months, respectively. Although the proportion of MJ users increased over time(ß = .76, p = .03), the proportion listed and transplanted did not change. Listing for LT increased with male (OR 1.24, 95% CI 11.01-1.52), MELD score (OR 1.08, 95% CI 1.01-1.15), HCC (OR 1.83, 95% CI 1.39-2.41) but decreased among MJ users (OR 0.67, 95% CI 0.50-0.91, p = .01). The median time to listing was longer among MJ users compared to non-users (115 vs. 87 days, p < .0005). Post-LT survival was similar in 83 MJ users and 306 non-users. CONCLUSION: The proportion of MJ users among LT candidates is increasing. MJ users have a greater burden of psychosocial issues which may contribute to longer evaluations and lower rate of LT listing. Post-LT survival was not impacted by self-reported MJ use history.

Impact of a Prohibitive Versus Restrictive Tobacco Policy on Liver Transplant Candidate Outcomes.

Tobacco use has been associated with poorer outcomes after liver transplantation (LT). Our study examined the effect on LT listing outcomes of a newly implemented policy prohibiting the use of all tobacco products compared with a prior restrictive policy. Medical records of consecutive adult patients evaluated for LT from January 2010 to July 2013 (era 1, n = 1344) and August 2013 to March 2017 (era 2, n = 1350) were reviewed. The proportion of LT candidates listed was the primary outcome. The mean age of the 2694 LT candidates was 54 ± 11 years, 60% were male, and the mean Model for End-Stage Liver Disease (MELD) score was 15 ± 7. Although the proportion of LT candidates who were smokers was significantly higher in era 2 (33% versus 23%; P < 0.005), the proportion of smokers listed for LT remained stable (13% versus 17%; P = 0.25). However, there were more smokers excluded for ongoing tobacco use in era 2 compared with era 1 (9.6% versus 4.4%; P = 0.001). Factors independently associated with LT listing included a diagnosis of hepatocellular carcinoma, being married, private insurance, absence of psychiatry comorbidity, and absence of tobacco, marijuana, or opiate use but evaluation during era 2 was not associated with LT listing. However, the median time to listing significantly increased over time, especially in smokers (from 65 to 122 days; P = 0.001), and this trend was independently associated with evaluation during era 2, a lower MELD score, not having children, and a lower level of education (P < 0.05). In conclusion, despite an increasing incidence of active smokers being referred for LT evaluation, the proportion of smoker candidates listed for LT was unchanged after instituting our prohibitive tobacco use policy. However, the time to get on the waiting list for smokers who were eventually listed was significantly longer due to the need to achieve complete tobacco cessation.

The diagnosis and management of idiosyncratic drug-induced liver injury.

Drug-induced liver injury (DILI) is an uncommon but important cause of liver disease that can arise after exposure to a multitude of drugs and herbal and dietary supplements. The severity of idiosyncratic DILI varies from mild serum aminotransferase elevations to the development of severe liver injury that can progress to acute liver failure resulting in death or liver transplantation within days of DILI onset. Chronic liver injury that persists for more than 6 months after DILI onset is also becoming increasingly recognized in up to 20% of DILI patients. Host demographic (age, gender, race), clinical and laboratory features at DILI onset have been associated with the severity and outcome of liver injury in DILI patients. In addition to cessation of the suspect drug, other medical interventions including the use of N-acetylcysteine and corticosteroids in selected patients have shown some clinical benefit, but additional prospective studies are needed. A number of promising diagnostic, prognostic and mechanistic serum and genetic biomarkers may help improve our understanding of the pathogenesis and treatment of idiosyncratic DILI.

Liver Injury Associated with Sporting Activities.

Exertional heat stroke most commonly develops following prolonged levels of aerobic activity in a warm or humid environment. Hypoperfusion of the vital organs along with activation of the inflammasome can lead to progressive and potentially fatal multiorgan failure including acute liver failure. In the United States, herbal and dietary supplements that are marketed to improve performance, strength, and weight loss are increasingly being used by both amateur and professional athletes. Consumption of bodybuilding supplements that contain androgenic anabolic steroids can lead to adverse hepatic effects ranging from asymptomatic serum aminotransferase elevations to severe cholestatic hepatitis with prolonged jaundice. Various non-bodybuilding nutritional supplements that contain a mixture of botanicals, caffeine, and chemicals have also been associated with idiosyncratic hepatotoxicity. In particular, green tea extract derivatives that contain epigallocatechin gallate are hepatotoxic in animal models and have been associated with severe acute hepatocellular injury in humans.

Autophagy-related approaches for improving nutrient use efficiency and crop yield protection.

Autophagy is a eukaryotic catabolic pathway essential for growth and development. In plants, it is activated in response to environmental cues or developmental stimuli. However, in contrast to other eukaryotic systems, we know relatively little regarding the molecular players involved in autophagy and the regulation of this complex pathway. In the framework of the COST (European Cooperation in Science and Technology) action TRANSAUTOPHAGY (2016-2020), we decided to review our current knowledge of autophagy responses in higher plants, with emphasis on knowledge gaps. We also assess here the potential of translating the acquired knowledge to improve crop plant growth and development in a context of growing social and environmental challenges for agriculture in the near future.

National outbreak of Yersinia enterocolitica infections in military and civilian populations associated with consumption of mixed salad, Norway, 2014.

In May 2014, a cluster of Yersinia enterocolitica (YE) O9 infections was reported from a military base in northern Norway. Concurrently, an increase in YE infections in civilians was observed in the Norwegian Surveillance System for Communicable Diseases. We investigated to ascertain the extent of the outbreak and identify the source in order to implement control measures. A case was defined as a person with laboratory-confirmed YE O9 infection with the outbreak multilocus variable-number tandem repeat analysis (MLVA)-profile (5-6-9-8-9-9). We conducted a case-control study in the military setting and calculated odds ratios (OR) using logistic regression. Traceback investigations were conducted to identify common suppliers and products in commercial kitchens frequented by cases. By 28 May, we identified 133 cases, of which 117 were linked to four military bases and 16 were civilians from geographically dispersed counties. Among foods consumed by cases, multivariable analysis pointed to mixed salad as a potential source of illness (OR 10.26; 95% confidence interval (CI): 0.85-123.57). The four military bases and cafeterias visited by 14/16 civilian cases received iceberg lettuce or radicchio rosso from the same supplier. Secondary transmission cannot be eliminated as a source of infection in the military camps. The most likely source of the outbreak was salad mix containing imported radicchio rosso, due to its long shelf life. This outbreak is a reminder that fresh produce should not be discounted as a vehicle in prolonged outbreaks and that improvements are still required in the production and processing of fresh salad products.

Case report of uneventful resurfacing of the dorsum of foot degloving injury using pedicled lateral supramalleolar flap.

INTRODUCTION AND IMPORTANCE: Foot degloving injuries are serious problem and presented regularly to plastic surgery department. Proper identification of this condition followed by suitable reconstruction reduces disability and limb loss. This study highlights the effectiveness of a supramalleolar flap for covering a foot defect. CASE PRESENTATION: An 18 year- old man was involved in a road traffic accident and received trauma to his left foot which led to loss of the skin of the dorsum of his foot. He was referred to a plastic surgery unit after initial stabilization. After reassessment, he was diagnosed as a left dorsum foot degloving injury. Then he underwent multiple sessions of debridement followed by resurfacing of the foot using pedicaled lateral supramalleolar flap. The flap covers the dorsum aspect of the left foot and the post-surgery period passed uneventfully. CLINICAL DISCUSSION: The Lateral supra malleolar flap reaches distal defects, preserves a main limb neurovascular supply and is aesthetically acceptable. All these advantages, besides ease of harvest, make it more useful for cover of foot defects. Although it is not an ideal reconstructive method, when microvascular surgery is not applicable, this technique will cover foot defects. CONCLUSION: We present this case because foot degloving injury is common but there is limited options for covering, although free flap is gold standard reconstructive tool but pedicaled supramalleolar flap can reach final result similar to complex surgeries. Although complications exist in literature, benefits promote using this method.

Enhancing electric vehicle charging performance through series-series topology resonance-coupled wireless power transfer.

The current electric vehicles (EVs) market is experiencing significant expansion, underscoring the need to address challenges associated with the limited driving range of EVs. A primary focus in this context is the improvement of the wireless charging process. To contribute to this research area, this study introduces a circular spiral coil design that incorporates transceiver coils. First, an in-depth analysis is conducted using Ansys Maxwell software to assess the effectiveness of the proposed solution through the magnetic field distribution, inductance properties, and mutual inductance between receiver and transmitter coils. In the next step, a direct shielding technique is applied, integrating a ferrite core bar to reduce power leakage and enhance power transmission efficiency. The ferrite magnetic shielding guides magnetic field lines, resulting in a significant reduction in flux leakage and improved power transmission. Lastly, a magnetic resonance series (SS) compensation wireless system is developed to achieve high coupling efficiency and superior performance. The system's effectiveness is evaluated through co-simulation using Ansys Simplorer software. The results confirm the effectiveness of the proposed solution, showing its ability to transmit 3.6 kilowatts with a success rate approaching 99%. This contribution significantly advances the development of wireless charging systems for electric vehicles, addressing concerns and promoting global adoption.

Long-term gastrointestinal adverse effects of doxycycline.

INTRODUCTION: Doxycycline is an antibiotic with known gastrointestinal (GI) adverse effects. Esophagitis is the most pronounced among these effects, and might be associated with a prolonged duration of therapy. The aim of this study is to evaluate the incidence of esophagitis and other GI side effects in adults who received doxycycline for at least a month. METHODOLOGY: This retrospective descriptive study included adults who received oral doxycycline for at least one month between 2016 and 2018. The primary outcome was the frequency of esophagitis. The secondary outcomes were frequency of and discontinuation due to GI adverse effects. RESULTS: A total of 189 subjects were included with a median age of 32 years. The median duration of doxycycline use was 44 days (interquartile range 30-60). Twelve patients (6.3%) reported having GI adverse effects resulting in doxycycline discontinuation in five of them (2.6%), and three patients (1.6%) had esophagitis. The incidence of GI adverse effects was significantly higher in patients who were ≥ 50 years than < 50 years old (8/50 vs. 4/139; p = 0.003) and in those who received a daily dose of 200 mg than 100 mg (12/93 vs. 0/96; p < 0.001). CONCLUSIONS: GI adverse events, including esophagitis, are not rare with long-term use of oral doxycycline, particularly in older age and a higher dose of 200 mg/day. Future large and randomized studies are needed to compare the efficacy and safety of different doxycycline doses.

Regulation of multi-area power system load frequency in presence of V2G scheme.

The integration of renewable sources (RSs) and the widespread deployment of electric vehicles (EVs) has transitioned from a luxury to a necessity in modern power systems. This results from the sharp increase in electric power demand and public awareness of switching to green energy. However, in addition to load fluctuations and changes in system parameters, these RSs and EVs negatively impact the load frequency (LF). This work presents a LF control for a modern multi-area power system incorporating photovoltaic (PV) and EV chargers. The proposed controller primarily utilizes EV chargers within modern power systems. This approach offers the advantage of using the already present components instead of introducing new ones. The proposed controller comprises the ecological optimization approach (ECO) and the integral controller (I). Both of these components are designed for autonomous vehicle-to-grid (V2G) devices. The proposed control technique is applied to a three-area power system, where the V2G scheme is located in Area-1. Variations in the load, PV power generated, and system parameters are considered to evaluate the effectiveness of the proposed (I+ECO+V2G) controller for controlling the LF. To assess the performance of the proposed I+ECO+V2G system, a comparative analysis is conducted to compare its performance with both the I+ECO system and the standard I-controller. The simulation findings demonstrate that implementing the I+ECO and the proposed I+ECO+V2G strategies results in enhanced system stability and decreased LF fluctuations compared to the conventional I-control approach. Furthermore, while comparing the I+ECO control technique to the suggested control strategy I+ECO+V2G, it was seen that the latter reaches steady state values more quickly. The results validate the robustness and effectiveness of the proposed controller in mitigating the impacts of load disturbances, uncertainties, and nonlinearities within the system. These simulations were performed using MATLAB/SIMULINK. To validate the outcomes of the simulation results, an experimental setup consisting of a real-time dSPACE DS1103 connected to another PC via QUARC pid_e data acquisition card was used. The experimental findings have substantiated the accuracy of the simulation findings about the superiority of the I+ECO+V2G methodology compared to both the I+ECO and I-control methodologies concerning system performance and LF control.

Adaptive frequency control in smart microgrid using controlled loads supported by real-time implementation.

The operation of the system's frequency can be strongly impacted by load change, solar irradiation, wind disturbance, and system parametric uncertainty. In this paper, the application of an adaptive controller based on a hybrid Jaya-Balloon optimizer (JBO) for frequency oscillation mitigation in a single area smart µG system is studied. The proposed adaptive control approach is applied to control the flexible loads such as HPs and EVs by using the JBO which efficiently controls the system frequency. The suggested technique uses the power balance equation to provide a dynamic output feedback controller. The main target is to regulate the frequency and power of an islanded single area µG powered by a PV and a diesel generator with integrations of smart bidirectional loads (HPs and EVs) that are controlled by the proposed adaptive controller in presence of electrical random loads. Moreover, the JBO is designed to minimize the effect of the system load disturbance and parameter variations. For a better assessment, the proposed controller using JBO technique is compared with two other methods which are the coefficient diagram method (CDM) and adaptive one using classical the Jaya technique. In the obtained results, the frequency deviation is found as 0.0015 Hz, which is fully acceptable and in the range of the IEEE standards. The MATLAB simulation results reveal that the suggested technique has a substantial advantage over other techniques in terms of frequency stability in the face of concurrent disturbances and parameter uncertainties. The real-time simulation tests are presented using a dSPACE DS1103 connected to another PC via QUARC pid_e data acquisition card and confirmed the MATLAB simulation results.

Leveraging cross-view geo-localization with ensemble learning and temporal awareness.

The Global Navigation Satellite System (GNSS) is unreliable in some situations. To mend the poor GNSS signal, an autonomous vehicle can self-localize by matching a ground image against a database of geotagged aerial images. However, this approach has challenges because of the dramatic differences in the viewpoint between aerial and ground views, harsh weather and lighting conditions, and the lack of orientation information in training and deployment environments. In this paper, it is shown that previous models in this area are complementary, not competitive, and that each model solves a different aspect of the problem. There was a need for a holistic approach. An ensemble model is proposed to aggregate the predictions of multiple independently trained state-of-the-art models. Previous state-of-the-art (SOTA) temporal-aware models used heavy-weight network to fuse the temporal information into the query process. The effect of making the query process temporal-aware is explored and exploited by an efficient meta block: naive history. But none of the existing benchmark datasets was suitable for extensive temporal awareness experiments, a new derivative dataset based on the BDD100K dataset is generated. The proposed ensemble model achieves a recall accuracy R@1 (Recall@1: the top most prediction) of 97.74% on the CVUSA dataset and 91.43% on the CVACT dataset (surpassing the current SOTA). The temporal awareness algorithm converges to R@1 of 100% by looking at a few steps back in the trip history.

A new adaptive MPPT technique using an improved INC algorithm supported by fuzzy self-tuning controller for a grid-linked photovoltaic system.

Solar energy, a prominent renewable resource, relies on photovoltaic systems (PVS) to capture energy efficiently. The challenge lies in maximizing power generation, which fluctuates due to changing environmental conditions like irradiance and temperature. Maximum Power Point Tracking (MPPT) techniques have been developed to optimize PVS output. Among these, the incremental conductance (INC) method is widely recognized. However, adapting INC to varying environmental conditions remains a challenge. This study introduces an innovative approach to adaptive MPPT for grid-connected PVS, enhancing classical INC by integrating a PID controller updated through a fuzzy self-tuning controller (INC-FST). INC-FST dynamically regulates the boost converter signal, connecting the PVS's DC output to the grid-connected inverter. A comprehensive evaluation, comparing the proposed adaptive MPPT technique (INC-FST) with conventional MPPT methods such as INC, Perturb & Observe (P&O), and INC Fuzzy Logic (INC-FL), was conducted. Metrics assessed include current, voltage, efficiency, power, and DC bus voltage under different climate scenarios. The proposed MPPT-INC-FST algorithm demonstrated superior efficiency, achieving 99.80%, 99.76%, and 99.73% for three distinct climate scenarios. Furthermore, the comparative analysis highlighted its precision in terms of control indices, minimizing overshoot, reducing rise time, and maximizing PVS power output.

A Case of Post-Colonoscopy Cecal Perforation in a 78-Year-Old Man Responding to Conservative Management.

Since the 1960s, colonoscopy has been the most extensively utilized diagnostic technique for colorectal cancer, and it is also a treatment tool for several colorectal diseases. Like many other medical treatments, it has complications, some of which might pose a major threat to the patient's health and wellbeing if not detected early enough. There is no consensus on the best way to treat colonoscopic perforation, and the majority of cases need immediate surgery. However, iatrogenic colon perforation can sometimes be treated conservatively. In this report, we describe a case of post-colonoscopic cecal perforation that was managed conservatively.

Detection of Radiation-Induced DNA Damage in Breast Cancer Patients by Using Gamma H2AX Biomarker: A Possible Correlation with Their Body Mass Index.

Radiotherapy is one of the most important options for treating breast cancer in humans. The development of biomarkers to monitor radiosensitivity is scarce. The aim of this study is to investigate the γH2AX levels in the human blood samples 0.5 h after radiotherapy compared to the levels before radiotherapy in breast cancer patients in relation to their respective body mass index (BMI). Blood plasma samples were collected from a total of 20 breast cancer patients before and after radiotherapy to measure γH2AX levels with an antibody against γH2AX based on enzyme-linked immunosorbent assay technique. The median BMI of the patients was 30 kg/m2. γH2AX was differentially expressed in breast cancer patients before radiotherapy. γH2AX levels significantly increased in 14 patients after radiotherapy (P = 0.006), whereas γH2AX levels decreased in three patients after radiotherapy, and three patients were excluded. There was no correlation between γH2AX values after radiotherapy and BMI (P = 0.5, r = 0.1). Our results suggest that γH2AX can be used by ELISA technique to measure γH2AX in the blood plasma of breast cancer patients undergoing radiotherapy and can be considered a biomarker of radiosensitivity.

Concentrations and geographical patterns of persistent organic pollutants (POPs) in meat from semi-domesticated reindeer (Rangifer tarandus tarandus L.) in Norway.

The study aimed at investigating the concentrations and geographical patterns of 11 polychlorinated biphenyls (PCBs) and 15 organochlorine pesticides (OCPs) in reindeer muscle samples (n = 100) collected from 10 grazing districts in Norway, 2009. Concentrations were examined for patterns related to geographical region as well as age and sex of animals. Concentrations measured for PCBs and OCPs in reindeer meat samples were generally low. Geographical patterns were revealed and districts with previous mining activities, military trenches, or those that were in the vicinity of the Russian border exhibited slightly elevated concentrations compared to other districts. Calves (10 months) exhibited higher concentrations than young (1.5 year) and old animals (>2 years) adjusted for sex, whereas males exhibited higher concentrations than females, adjusted for age. All PCB congeners inter-correlated strongly with each other, whereas oxy-chlordane and heptachlor epoxide were the strongest inter-correlated OCP compounds. Concentrations of PCBs and OCPs in reindeer meat were all considerably lower than the maximum levels set for those contaminants in foodstuffs for safe human consumption by the European Commission. Thus, reindeer meat is not likely to be a substantial contributor to the human body burden of persistent organic pollutants.

Multiple Small Intestinal Neuroendocrine Tumors With Findings of Intestinal Obstruction.

Carcinoid tumors are one of the most common types of small intestinal neuroendocrine tumors (SI-NETs). However, SI-NETs that manifest as subacute intestinal obstruction are extremely rare. The annual occurrence rate of jejuno-ileal NETs is 0.28-0.8 per 100,000 people. In this report, we describe a case of subacute intestinal obstruction due to a mid-ileal stricture. The patient underwent laparotomy after evaluation and investigation. Mid-ileal growth was noted, and small bowel resection was performed with primary end-to-end anastomosis. Postoperative histopathology revealed the growth to be a well-differentiated NET.