Crop switching can enhance environmental sustainability and farmer incomes in China.

Achieving food-system sustainability is a multidimensional challenge. In China, a doubling of crop production since 1990 has compromised other dimensions of sustainability1,2. Although the country is promoting various interventions to enhance production efficiency and reduce environmental impacts3, there is little understanding of whether crop switching can achieve more sustainable cropping systems and whether coordinated action is needed to avoid tradeoffs. Here we combine high-resolution data on crop-specific yields, harvested areas, environmental footprints and farmer incomes to first quantify the current state of crop-production sustainability. Under varying levels of inter-ministerial and central coordination, we perform spatial optimizations that redistribute crops to meet a suite of agricultural sustainable development targets. With a siloed approach-in which each government ministry seeks to improve a single sustainability outcome in isolation-crop switching could realize large individual benefits but produce tradeoffs for other dimensions and between regions. In cases of central coordination-in which tradeoffs are prevented-we find marked co-benefits for environmental-impact reductions (blue water (-4.5% to -18.5%), green water (-4.4% to -9.5%), greenhouse gases (GHGs) (-1.7% to -7.7%), fertilizers (-5.2% to -10.9%), pesticides (-4.3% to -10.8%)) and increased farmer incomes (+2.9% to +7.5%). These outcomes of centrally coordinated crop switching can contribute substantially (23-40% across dimensions) towards China's 2030 agricultural sustainable development targets and potentially produce global resource savings. This integrated approach can inform feasible targeted agricultural interventions that achieve sustainability co-benefits across several dimensions.

Propofol vs etomidate for induction prior to invasive mechanical ventilation in patients with acute myocardial infarction.

BACKGROUND: Patients with acute myocardial infarction (AMI) requiring invasive mechanical ventilation (IMV) have a high mortality. However, little is known regarding the impact of induction agents, used prior to IMV, on clinical outcomes in this population. We assessed for the association between induction agent and mortality in patients with AMI requiring IMV. METHODS: We compared clinical outcomes between those receiving propofol compared to etomidate for induction among adults with AMI between October 2015 and December 2019 using the Vizient® Clinical Data Base, a multicenter, US national database. We used inverse probability treatment weighting (IPTW) to assess for the association between induction agent and in-hospital mortality. RESULTS: We identified 5,147 patients, 1,386 (26.9%) of received propofol and 3,761 (73.1%) received etomidate for IMV induction. The mean (SD) age was 66.1 (12.4) years, 33.0% were women, and 51.6% and 39.8% presented with STEMI and cardiogenic shock, respectively. Patients in the propofol group were more likely to require preintubation vasoactive medication and mechanical circulatory support (both, P < .05). Utilization of propofol was associated with lower mortality compared to etomidate (32.3% vs 36.1%, P = .01). After propensity weighting, propofol use remained associated with lower mortality (weighted mean difference -4.7%; 95% confidence interval: -7.6% to -1.8%, P = .002). Total cost, ventilator days, and length of stay were higher in the propofol group (all, P < .001). CONCLUSIONS: Induction with propofol, compared with etomidate, was associated with lower mortality for patients with AMI requiring IMV. Randomized trials are needed to determine the optimal induction agent for this critically ill patient population.

Aberrant HIF1- α and SIX-1 Expression is Associated with Poor Prognosis in Acute Myeloid Leukemia Patients with Isocitrate Dehydrogenase 1 Mutations.

BACKGROUND: IDH1 mutations are common in many cancers, however, their role in promoting the Warburg effect remains elusive. This study elucidates the putative involvement of mutant-IDH1 in regulating hypoxia-inducible factor (HIF1-α) and Sine-Oculis Homeobox-1 (SIX-1) expression. METHODOLOGY: Genetic screening was performed using the ARMS-PCR in acute myeloid leukemia (AML), brain, and breast cancer (BC) cohorts, while transcript expression was determined using qPCR. Further, a meta-analysis of risk factors associated with the R132 mutation was performed. RESULTS: Approximately 32% of AML and ∼60% of glioma cases were mutants, while no mutation was found in the BC cohort. 'AA' and TT' were associated with higher disease risk (OR = 12.18 & 4.68) in AML and had significantly upregulated IDH1 expression. Moreover, downregulated HIF1-α and upregulated SIX-1 expression was also observed in these patients, suggesting that mutant-IDH1 may alter glucose metabolism. Perturbed IDH1 and HIF-α levels exhibited poor prognosis in univariate and multivariate analysis, while age and gender were found to be contributory factors as well. Based on the ROC model, these had a good potential to be used as prognostic markers. A significant variation in frequencies of R132 mutations in AML among different populations was observed. Cytogenesis (R2 = 12.2%), NMP1 mutation status (R2 = 18.5%), and ethnic contributions (R2 = 73.21%) were critical moderators underlying these mutations. Women had a higher risk of R132 mutation (HR = 1.3, P < 0.04). The pooled prevalence was calculated to be 0.29 (95% CI 0.26-0.33, P < 0.01), indicating that IDH1 mutations are a significant prognostic factor in AML. CONCLUSION: IDH1 and HIF1-α profiles are linked to poor survival and prognosis, while high SIX-1 expression in IDH1 mutants suggests a role in leukemic transformation and therapy response in AML.

IDH1 mutations are common in many types of cancer, but scientists have not fully understood how they contribute to the Warburg effect - a process that alters glucose metabolism in cells. In this study, we evaluate the association between mutant-IDH1 and HIF1 as well as SIX-1 gene expression. We analyzed genetic data from patients with brain cancer, breast cancer, and acute myeloid leukemia (AML), and found that roughly 32% of AML cases and 60% of glioma cases had IDH1 mutations, while no mutations were found in breast cancer. Patients with mutant genotypes had a higher risk of disease and showed upregulated IDH1 expression. They also had downregulated HIF1 and upregulated SIX-1 expression, suggesting that mutant-IDH1 can change glucose metabolism in cancer cells. Patients with abnormal IDH1 and HIF1 levels were more likely to have a poor prognosis. Further, we identified several risk factors that can influence IDH1 mutations, including cytogenesis, NMP1 mutation status, and ethnicity. The researchers calculated that IDH1 mutations are a significant factor in predicting outcomes for AML.

Tracheostomy in Patients with Acute Myocardial Infarction and Respiratory Failure.

OBJECTIVE: Patients with acute myocardial infarction (AMI) complicated by respiratory failure require antiplatelet regimens which often cannot be stopped and may increase bleeding from tracheostomy. However, there is limited available data on both the proportion of patients undergoing tracheostomy and the impact on antiplatelet regimens on outcomes. METHODS: Utilizing the Vizient® Clinical Data Base, we identified patients ≥18 years admitted from 2015 to 2019 with a primary diagnosis of AMI and requiring invasive mechanical ventilation (IMV). We assessed for the incidence of patients undergoing tracheostomy, outcomes stratified by the timing of tracheostomy (≤10 vs >10 days), and the association between dual antiplatelet therapy (DAPT) use and in-hospital mortality. RESULTS: We identified 26 435 patients presenting with AMI requiring IMV. The mean (SD) age was 66.8 (12.3) years and 33.4% were women. The incidence of tracheostomy was 6.0% (n = 1573), and the median IMV time to tracheostomy was 12 days, 55.6% of which underwent percutaneous and 44.4% underwent open tracheostomy. Over 90% (n = 1424) underwent tracheostomy (>10 days) and had a similar mortality when compared to early (≤10 days) tracheostomy (22.5% vs 22.8%, P = 0.94). On the day of tracheostomy, only 24.7% were given DAPT, which was associated with a lower mortality than those not on DAPT (17.4% vs 23.7%, P = 0.01). After multivariable adjustment, DAPT use on the day of tracheostomy remained associated with lower in-hospital mortality (odds ratio 0.68; 95% confidence interval: 0.49-0.94, P = 0.02). Tracheostomy complications were not different between groups (P > 0.05), but more patients in the DAPT group required post-tracheostomy blood transfusions (5.6% vs 2.7%, P = 0.01). CONCLUSION: Approximately 1 in 20 intubated AMI patients requires tracheostomy. The lack of DAPT interruption on the day of tracheostomy but not the timing of tracheostomy was associated with a lower in-hospital mortality. Our results suggest that DAPT should not be a barrier to tracheostomy for patients with AMI.

Percutaneous cholecystostomy in acute complicated versus uncomplicated cholecystitis; is there a difference in outcomes? A single-center experience.

BACKGROUND: Percutaneous cholecystostomy (PC) is a therapeutic intervention for acute cholecystitis. The benefits of cholecystostomy have been demonstrated in the medical literature, with up to 90% of acute cholecystitis cases shown to resolve postoperatively, and only 40% of patients subsequently undergoing an interval cholecystectomy. PURPOSE: To compare the survival outcomes between acute complicated and uncomplicated cholecystitis in patients undergoing PC as an initial intervention, as there is a paucity of evidence in the literature on this perspective. MATERIAL AND METHODS: A retrospective search was conducted of all patients who underwent PC for acute cholecystitis between August 2016 and December 2020 at a tertiary institution. A total of 100 patients were included in this study. RESULTS: The outcome, in the form of 30-day mortality, 90-day mortality, being alive after six months, and reintervention, was compared between complicated and uncomplicated cases using the chi-square test or Fisher's exact test. There was no statistically significant difference in any of the compared outcomes. The only variable that showed a statistically significant association with the risk of mortality was acute kidney injury (AKI) at admission. Patients who had stage 1, 2, or 3 AKI had a higher hazard for mortality as compared to patients with no kidney disease. CONCLUSION: Our results demonstrate that PC is a safe and effective procedure. Mortality is not affected by the presence of complications. The results have, however, highlighted the importance of recognizing and treating AKI, an independent risk factor affecting mortality.

Influence of balloon type and lesion location on outcomes following fistuloplasty.

BACKGROUND: There is limited evidence supporting the optimal use of fistuloplasty to maintain vascular access at various lesion sites, despite its critical role in facilitating renal replacement therapy and the overall high failure rates of arteriovenous fistulas (AVFs). This study aims to identify covariates affecting primary and secondary patency following fistuloplasty of native upper limb vascular access AVFs. METHODS: This retrospective study included all patients who underwent fistuloplasty at a tertiary vascular centre over 4 years. Baseline characteristics were recorded, and factors associated with primary and secondary patency rates were analysed. RESULTS: A total of 206 patients (88 male, 118 female) with a mean age of 68 (±14) years underwent fistuloplasty during the study period. The prevalence of diabetes, ischaemic heart disease and antiplatelet usage were 33%, 21% and 70%, respectively. The median number of fistuloplasties per access during the follow-up period was 2 [1-3]. Fistulas were classified as radiocephalic (65), brachiocephalic (102) and brachiobasilic transposition (39). Recurrent stenosis (RS) was identified in 60 patients who had previous fistuloplasty before the study period, while 146 patients had de novo stenoses (DNS). Stenosis location significantly differed between RS and DNS (p = .03), with DNS primarily being anastomotic and RS predominantly in central and mixed locations. Younger fistulas were more likely to have anastomotic stenoses compared to those older than 1 year (p = .001). While no significant differences in primary patency (PP) were observed, secondary patency (SP) varied by stenosis location: Central 32 [13-42] months, Fistula vein 20 [12.5-35.5] months, Mixed 25 [13.5-37.5] months and Anastomotic 19 [7-29.5] months (p = .012). CONCLUSION: Stenosis location in AVFs is associated with the age and type of the fistula. Younger fistulas often fail due to anastomotic stenoses, which have lower secondary patency compared to stenoses at other sites. Preliminary data suggest that central stenoses, primarily occurring in older fistulas, exhibit better secondary patency following fistuloplasty than stenoses at other locations.

Coronavirus disease 2019 vaccine in pediatric post-kidney transplantation.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and the resulting disease, coronavirus disease 2019 (COVID-19), have spread to millions of persons worldwide. Many vaccines have been developed; however, their efficacy in pediatric solid organ transplant recipients is yet to be determined. METHODS: This is a prospective observational, non-interventional single-center study on the safety and efficacy of a COVID-19 vaccine (BNT162b2) in pediatric kidney transplant recipients. The primary aim of this study was to evaluate immunogenicity according to SARS-CoV-2-specific neutralizing antibody titer after two vaccine doses. The secondary aims were to investigate the safety of the vaccines, solicited local and systemic adverse reactions, incidence of COVID-19 post-vaccination, and effects on transplant graft function. Baseline investigations were conducted on pediatric renal transplant recipients, and recruited participants were advised to have the Comirnaty® mRNA vaccine according to protocol. RESULTS: A total of 48 patients (male, n = 31, 64.6%; female, n = 17, 35.4%), median age 14 [12-16] years were included, and all received two doses of the vaccine. The vaccine had a favorable safety and side-effect profile. The S-antibody titer of all patients ranged between .4 and 2,500 U/ml and was > 50 U/ml in 89% of the patients. No difference in the measured antibody immune response was noted between infected and uninfected children. No major side effects were reported. CONCLUSION: The vaccine had a favorable safety profile in 12- to 15-year-old kidney transplant recipients, producing a greater measured antibody response than that in older transplant recipients.

Barriers experienced by community midwives to provide basic emergency obstetric and newborn care in rural Pakistan.

BACKGROUND: Considering the high maternal mortality rate, the government of Pakistan has deployed Community Midwives (CMWs) in rural areas of Pakistan. This relatively new cadre of community-based skilled birth attendants has previously reported to experience several challenges in providing maternal and child healthcare. However, what barriers they experience in providing basic emergency obstetric and newborn care needs to be further studied. METHODS: This was a cross-sectional study conducted in twelve districts in Sindh province, Pakistan, with poor maternal and child health indicators. A total of 258 CMWs participated in this study and completed the questionnaire on a pretested, validated tool in their community-based stations. The trained data collectors completed the questionnaires from the respondents. The problems identified were categorized into three major issues: financial, and transport and security related; and were analyzed accordingly. Ethical approval was obtained from the institutional review board (IRB) of Health Services Academy (HSA) Islamabad, Pakistan. RESULTS: The majority (90%) of 258 CMWs had formal training in maternal and neonatal care from the recognized institutions. Financial difficulties faced by CMWs were identified as the most frequent barriers and others were transport, security, and other issues. In univariate analysis, 38.1% and 61.9% of the community midwives who faced financial difficulties had completed a graduation or intermediate level of education, respectively (p = 0.006). Round-the-clock availability for emergencies was inversely associated with having financial difficulties, i.e., 71.4%, in contrast to 28.4% who had financial difficulties were available round-the-clock for emergency calls in their community clinics (p = 0.008). Formal training (p = 0.001), work experience (p = 0.015), longer duration of work (p = 0.003), and liaison with health workers and posting district (p = 0.001) had statistically significantly higher transport related issues. Security difficulties faced by CMWs and a set of correlates such as formal training (p = 0.019), working experience (p = 0.001), longer duration of work (p = 0.023), 24 h of availability on call (p = 0.004), liaison with traditional birth attendants (TBAs) in the community (p = 0.002), and district of posting (p = 0.001) were statistically significantly different. Other issues like working experience (p = < 0.001) and Liaison with TBAs in the community (p = < 0.001) were found statistically significant. CONCLUSION: Financial, transportation and security related barriers were commonly reported by community midwives in the delivery of basic emergency obstetric and newborn care in rural Pakistan.

Advancing Brain Tumor Classification through Fine-Tuned Vision Transformers: A Comparative Study of Pre-Trained Models.

This paper presents a comprehensive study on the classification of brain tumor images using five pre-trained vision transformer (ViT) models, namely R50-ViT-l16, ViT-l16, ViT-l32, ViT-b16, and ViT-b32, employing a fine-tuning approach. The objective of this study is to advance the state-of-the-art in brain tumor classification by harnessing the power of these advanced models. The dataset utilized for experimentation consists of a total of 4855 images in the training set and 857 images in the testing set, encompassing four distinct tumor classes. The performance evaluation of each model is conducted through an extensive analysis encompassing precision, recall, F1-score, accuracy, and confusion matrix metrics. Among the models assessed, ViT-b32 demonstrates exceptional performance, achieving a high accuracy of 98.24% in accurately classifying brain tumor images. Notably, the obtained results outperform existing methodologies, showcasing the efficacy of the proposed approach. The contributions of this research extend beyond conventional methods, as it not only employs cutting-edge ViT models but also surpasses the performance of existing approaches for brain tumor image classification. This study not only demonstrates the potential of ViT models in medical image analysis but also provides a benchmark for future research in the field of brain tumor classification.

Designing Click One-Pot Synthesis and Antidiabetic Studies of 1,2,3-Triazole Derivatives.

In the present study, a new series of 1,2,3-triazole derivatives was synthesized via a click one-pot reaction. The synthesized compounds were found to be active during molecular docking studies against targeted protein 1T69 by using the Molecular Operating Environment (MOE) software. The designed and synthesized compounds were characterized by using FT-IR, 1H-NMR and LC-MS spectra. The synthesized triazole moieties were further screened for their α-amylase and α-glucosidase inhibitory activities. The preliminary activity analysis revealed that all the compounds showed good inhibition activity, ranging from moderate to high depending upon their structures and concentrations and compared to the standard drug acarbose. Both in silico and in vitro analysis indicated that the synthesized triazole molecules are potent for DM type-II. Out of all the compounds, compound K-1 showed the maximum antidiabetic activity with 87.01% and 99.17% inhibition at 800 µg/mL in the α-amylase and α-glucosidase inhibition assays, respectively. Therefore these triazoles may be further used as promising molecules for development of antidiabetic compounds.

Improved Interfacial Ion Migration and Deposition through the Chain-Liquid Synergistic Effect by a Carboxylated Hydrogel Electrolyte for Stable Zinc Metal Anodes.

The large-scale applicability of Zn-metal anodes is severely impeded by the issues such as the dendrite growth, complicated hydrogen evolution, and uncontrollable passivation reaction. Herein, a negatively charged carboxylated double-network hydrogel electrolyte (Gelatin/Sodium alginate-acetate, denoted as Gel/SA-acetate) has been developed to stabilize the interfacial electrochemistry, which restructures a type of Zn2+ ion solvent sheath optimized via a chain-liquid synergistic effect. New hydrogen bonds are reconstructed with water molecules by the zincophilic functional groups, and directional migration of hydrated Zn2+ ions is therefore induced. Concomitantly, the robust chemical bonding of such hydrogel layers to the Zn slab exhibits a desirable anti-catalytic effect, thereby greatly diminishing the water activity and eliminating side reactions. Subsequently, a symmetric cell using the Gel/SA-acetate electrolyte demonstrates a reversible plating/stripping performance for 1580 h, and an asymmetric cell reaches a state-of-the-art runtime of 5600 h with a high average Coulombic efficiency of 99.9 %. The resultant zinc ion hybrid capacitors deliver exceptional properties including the capacity retention of 98.5 % over 15000 cycles, energy density of 236.8 Wh kg-1 , and high mechanical adaptability. This work is expected to pave a new avenue for the development of novel hydrogel electrolytes towards safe and stable Zn anodes.

Comparison of the safety and immunogenicity of the BNT-162b2 vaccine and the ChAdOx1 vaccine for solid organ transplant recipients: a prospective study.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and its resulting disease, coronavirus disease 2019 (COVID-19), has spread to millions of people worldwide. Preliminary data from organ transplant recipients have shown reduced seroconversion rates after the administration of different SARS-CoV-2 vaccination platforms. However, it is unknown whether different vaccination platforms provide different levels of protection against SARS-CoV-2. To answer this question, we prospectively studied 431 kidney and liver transplant recipients (kidney: n = 230; liver: n = 201) who received either the ChAdOx1 vaccine (n = 148) or the BNT-162b2 vaccine (n = 283) and underwent an assessment of immunoglobulin M/immunoglobulin G spike antibody levels. The primary objective of the study is to directly compare the efficacy of two different vaccine platforms in solid organ transplant recipients by measuring of immunoglobulin G (IgG) antibodies against the RBD of the spike protein (anti-RBD) two weeks after first and second doses. Our secondary endpoints were solicited specific local or systemic adverse events within 7 days after the receipt of each dose of the vaccine. There was no difference in the primary outcome between the two vaccine platforms in patients who received two vaccine doses. Unresponsiveness was mainly linked to diabetes. The rate of response after the first dose among younger older patients was significantly larger; however, after the second dose this difference did not persist (p = 0.079). Side effects were similar to those that were observed during the pivotal trials.

Trends in Racial and Gender Profiles of United States Academic Emergency Medicine Faculty: Cross-Sectional Survey From 2007 to 2018.

BACKGROUND: Numerous studies have reported existing disparities in academic medicine. The purpose of this study was to assess racial and gender disparity in academic emergency medicine (EM) faculty positions across the United States from 2007 to 2018. OBJECTIVE: The primary objective was to identify the racial and ethnic and gender distributions across academic ranks in EM. The secondary objective was to describe the racial and gender proportions across different tenure tracks and degrees. METHODS: We conducted a retrospective analysis using data from the Association of American Medical Colleges. Simple descriptive statistics and time series analysis were employed to assess the trends and relationship between race and gender across academic rank, type of degree, and tenure status. RESULTS: When averaged, 75% of all faculty members were White physicians and 67.5% were male. Asian faculty members showed an increased representation in the lower academic ranks and underrepresented minority groups demonstrated a small increase. Asian faculty members demonstrated a significantly increasing trend at the level of instructor (t = 0.02; p = 0.034; 95% CI 0.05-1.03). Female faculty members showed a significantly decreasing trend over the study period (t = -0.01; p < 0.001; 95% CI 0.68-0.75). White academic physicians and male faculty members made up most of all degree types and tenure categories. CONCLUSIONS: Despite an increase in proportional representation, the underrepresentation of female faculty members and those from minority groups persists in emergency medicine. Further studies are needed to identify and address the root causes of these differences.

A Novel Routing Protocol Based on Elliptical Shaped Movement of Autonomous Underwater Vehicles in Data Gathering Process for Underwater Wireless Sensor Network.

High end-to-end delay is a significant challenge in the data collection process in the underwater environment. Autonomous Underwater Vehicles (AUVs) are a considerably reliable source of data collection if they have significant trajectory movement. Therefore, in this paper, a new routing algorithm known as Elliptical Shaped Efficient Data Gathering (ESEDG) is introduced for the AUV movement. ESEDG is divided into two phases: first, an elliptical trajectory has been designed for the horizontal movement of the AUV. In the second phase, the AUV gathers data from Gateway Nodes (GNs) which are associated with Member Nodes (MNs). For their association, an end-to-end delay model is also presented in ESEDG. The hierarchy of data collection is as follows: MNs send data to GNs, the AUV receives data from GNs, and forwards it to the sink node. Furthermore, the ESEDG was evaluated on the network simulator NS-3 version 3.35, and the results were compared to existing data collection routing protocols DSG-DGA, AEEDCO, AEEDCO-A, ALP, SEDG, and AEDG. In terms of network throughput, end-to-end delay, lifetime, path loss, and energy consumption, the results showed that ESEDG outperformed the baseline routing protocols.

In situtailoring the morphology of In(OH)3nanostructures via surfactants during anodization and their transformation into In2O3nanoparticles.

The present work reports the effect of various surfactants on the morphology of In(OH)3nanostructures prepared via anodization. In-sheets were anodized in an environmentally benign electrolyte containing a small quantity of CTAB, CTAC, and PDDA surfactants at room temperature. The produced nanostructures were characterized using XRD, HRTEM, SAED, and EDAX. The morphology of indium hydroxide (In(OH)3) nanostructures was successfully tailoredin situwith the help of surfactants in 1 M KCl aqueous electrolyte. XRD results confirmed the formation of In(OH)3and indium oxyhydroxide (InOOH) nanostructures in the pristine form which were transformed into single-phase cubic In2O3nanoparticles (NPs) after calcination. HRTEM analyses showed that the morphology and size of the In(OH)3nanostructures can be tuned to form nanorods, nanosheets and nanostrips using different surfactants. The results revealed that CTAC and PDDA surfactants have a profound effect on the morphology of In(OH)3nanostructure compared to CTAB due to the higher concentration of Cl-ion. The possible mechanism of surfactants effect on the morphology is proposed. Furthermore, annealing converted the In(OH)3nanostructures into spherical In2O3NPs with uniform and homogeneous size. We anticipate that the morphology of other metal-oxides nanostructure can be tuned using this simple, facile and rapid technique. In2O3NPs prepared without and with CTAB surfactant were further explored for the non-enzymatic detection of hydrogen peroxide (H2O2). Electrochemical measurements showed enhanced electrocatalytic performance with fast electron transfer (∼2s) between the redox centers of H2O2and electrode surface. The In2O3NPs prepared using CTAB/Au electrode exhibited about 4-fold increase in sensitivity compared to the bare Au electrode. The biosensor also demonstrated good reproducibility, higher selectivity, and increased shelf life.

Kidney transplantation in low weight pediatric recipients from adult donors: The short- And the long-term outcomes.

Pediatric patients with end-stage renal disease wait longer for KT due to shortage of organs and ultra-selection of donors so that they are age- and size-matched. KT from adult donors is reported to be associated with technical difficulties, complications, and poorer graft survival. We aimed to determine the outcomes of low weight patients who received kidneys from adult donors through extraperitoneal approach. We perform around 40 pediatric transplants/year, mostly from adult donors. Patients were divided into the (LWC: weight < 15 kg) and (HWC: ≥15 kg). From January 2011 to June 2017, 213 patients received KT. KT procedures were performed through extraperitoneal approach. Mean age of recipients was 10 years (5 years and 12 years for LWC and HWC, respectively) and 32 years for donors. Mean weight of recipient was 26 kg (13 kg and 31 kg for LWC and HWC, respectively) and 70 kg for donors. Mean follow-up was 5.5 years. Acute rejection occurred in 18% and delayed graft function in 5%. Three patients died during follow-up. Graft survival at 1 year was 97% and 82% at 5 years. Length of stay (P = .57), surgical complications (P = .74), long-term graft survival (P = .35), and GFR at 5 years (P = .59) were similar in both groups. This study shows that low weight pediatric patients can be transplanted from adult donors with low surgical complications and with favorable patient and graft survival. Extraperitoneal approach is feasible and safe in low weight recipients.

Bacteriophages isolated from dairy farm mitigated Klebsiella pneumoniae-induced inflammation in bovine mammary epithelial cells cultured in vitro.

BACKGROUND: Klebsiella pneumoniae, an environmental pathogen causing mastitis in dairy cattle, is often resistant to antibiotics. K. pneumoniae was used as the host bacteria to support bacteriophage replication; 2 bacteriophages, CM8-1 and SJT-2 were isolated and considered to have therapeutic potential. In the present study, we determined the ability of these 2 bacteriophages to mitigate cytotoxicity, pathomorphological changes, inflammatory responses and apoptosis induced by K. pneumoniae (bacteriophage to K. pneumoniae MOI 1:10) in bovine mammary epithelial cells (bMECs) cultured in vitro. RESULTS: Bacteriophages reduced bacterial adhesion and invasion and cytotoxicity (lactate dehydrogenase release). Morphological changes in bMECs, including swelling, shrinkage, necrosis and hematoxylin and eosin staining of cytoplasm, were apparent 4 to 8 h after infection with K. pneumoniae, but each bacteriophage significantly suppressed damage and decreased TNF-α and IL-1ß concentrations. K. pneumoniae enhanced mRNA expression of TLR4, NF-κB, TNF-α, IL-1ß, IL-6, IL-8, caspase-3, caspase-9 and cyt-c in bMECs and increased apoptosis of bMECs, although these effects were mitigated by treatment with either bacteriophage for 8 h. CONCLUSIONS: Bacteriophages CM8-1 and SJT-2 mitigated K. pneumoniae-induced inflammation in bMECs cultured in vitro. Therefore, the potential of these bacteriophages for treating mastitis in cows should be determined in clinical trials.

Phylogenetic genotyping, virulence genes and antimicrobial susceptibility of Escherichia coli isolates from cases of bovine mastitis.

The study described in this research communication used phylogenetic genotyping to identify virulence genes and antimicrobial susceptibility in Escherichia coli recovered from cases of bovine mastitis. From 385 mastitic milk samples, 30 (7.8%) isolates were confirmed as E. coli. Most isolates (80%) belonged to phylo-group A. These 30 E. coli isolates were also screened for 11 different virulence genes. The majority of isolates (63%) harbored no virulence gene. Only 11 (37%) isolates tested positive for two virulence genes, either the iron uptake gene iucD in 3 (10%) isolates or the serum resistance gene traT in 2 (7%) isolates or both traT and iucD in 6 (20%) isolates. The E. coli isolates showed highest susceptibility to gentamicin, meropenem, and pipracillin. Most isolates were resistant to ampicillin, cefotaxime and streptomycin. This study suggests that mastitis causing E. coli might originate from commensal bacteria and that the presence of these virulence genes, common in extra-intestinal pathogenic E. coli (ExPEC) strains could be attributed to high genetic variability of mastitis-causing E. coli.

TANVEER: Tri-Angular Nearest Vector-Based Energy Efficient Routing for IoT-Enabled Acoustic Sensor and Actor Networks (I-ASANs).

The Internet of Things (IoT) is an emerging technology in underwater communication because of its potential to monitor underwater activities. IoT devices enable a variety of applications such as submarine and navy defense systems, pre-disaster prevention, and gas/oil exploration in deep and shallow water. The IoT devices have limited power due to their size. Many routing protocols have been proposed in applications, as mentioned above, in different aspects, but timely action and energy make these a challenging task for marine research. Therefore, this research presents a routing technique with three sub-sections, Tri-Angular Nearest Vector-Based Energy Efficient Routing (TANVEER): Layer-Based Adjustment (LBA-TANVEER), Data Packet Delivery (DPD-TANVEER), and Binary Inter Nodes (BIN-TANVEER). In TANVEER, the path is selected between the source node and sonobuoys by computing the angle three times with horizontal, vertical, and diagonal directions by using the nearest vector-based approach to avoid the empty nodes/region. In order to deploy the nodes, the LBA-TANVEER is used. Furthermore, for successful data delivery, the DPD-TANVEER is responsible for bypassing any empty nodes/region occurrence. BIN-TANVEER works with new watchman nodes that play an essential role in the path/data shifting mechanism. Moreover, achievable empty regions are also calculated by linear programming to minimize energy consumption and throughput maximization. Different evaluation parameters perform extensive simulation, and the coverage area of the proposed scheme is also presented. The simulated results show that the proposed technique outperforms the compared baseline scheme layer-by-layer angle-based flooding (L2-ABF) in terms of energy, throughput, Packet Delivery Ratio (PDR) and a fraction of empty regions.