The Clinical Relevance of Autonomic Dysfunction, Cerebral Hemodynamics, and Sleep Interactions in Individuals Living With SCI.

A myriad of physiological impairments is seen in individuals after a spinal cord injury (SCI). These include altered autonomic function, cerebral hemodynamics, and sleep. These physiological systems are interconnected and likely insidiously interact leading to secondary complications. These impairments negatively influence quality of life. A comprehensive review of these systems, and their interplay, may improve clinical treatment and the rehabilitation plan of individuals living with SCI. Thus, these physiological measures should receive more clinical consideration. This special communication introduces the under investigated autonomic dysfunction, cerebral hemodynamics, and sleep disorders in people with SCI to stakeholders involved in SCI rehabilitation. We also discuss the linkage between autonomic dysfunction, cerebral hemodynamics, and sleep disorders and some secondary outcomes are discussed. Recent evidence is synthesized to make clinical recommendations on the assessment and potential management of important autonomic, cerebral hemodynamics, and sleep-related dysfunction in people with SCI. Finally, a few recommendations for clinicians and researchers are provided.

Electrospinning of photochromic poly(ethylene terephthalate) nanofibers toward information authentication.

The use of photochromism to enhance the anti-counterfeiting of a wide range of economic goods is an intriguing prospect. Creating a translucent anti-counterfeiting nanocomposite is critical to improving the engineering procedures of the encoding materials. Herein, we use electrospinning to produce anti-counterfeiting nanofibrous films from nanoparticles of rare-earth aluminate (NREA) and recycled poly(ethylene terephthalate) (PET). Different nanofiber films with distinct emission properties were created using different ratios of NREA. The ultraviolet (UV)-induced photochromism of the NREA@PET nanofibers was proved. Immobilizing NREA at the nanoscale ensures better dispersion without agglomeration in the PET nanofibrous matrix, which is essential for the development of transparent NREA@PET films. Diameters of 4-13 nm for NREA were shown using transmission electron microscopy. X-ray fluorescence spectroscopy, energy-dispersive X-ray spectroscopy, Fourier-transform infrared spectroscopy, scanning electron microscopy, elemental mapping, and other techniques were used to investigate the photochromic nanofibers' morphology, elemental contents, optical transmittance, and mechanical performance. It was observed that the nanofiber diameter in NREA@PET was between 150 and 250 nm. Excitation and emission bands of electrospun NREA@PET nanofibrous films were monitored at 365 and 518 nm, respectively. The superhydrophobicity of NREA@PET increased with increasing NREA concentration. The transparent nanofibers exhibited fast and reversible dual-mode fluorescent photochromism to green emission without fatigue when stimulated beneath a UV source. Using the present anti-counterfeiting films can be regarded as a simple technique to develop flexible materials to launch an ideal marketplace with affordable societal and economic advantages.

Electrospinning of poly(ethylene oxide)/glass hybrid nanofibres for anticounterfeiting encoding.

The use of photochromism to increase the credibility of consumer goods has shown great promise. To provide mechanically dependable anticounterfeiting nanofibres, it has also been critical to improve the engineering processes of authentication patterns. Mechanically robust and photoluminescent electrospun poly(ethylene oxide)/glass (PGLS) nanofibres (150-350 nm) immobilized with nanoparticles of lanthanide-doped aluminate (NLA; 8-15 nm) were developed using electrospinning technology for anticounterfeiting purposes. The provided nanofibrous membranes changed colour from transparent to green when irradiated with ultraviolet light. By delivering NLA with homogeneous distribution without aggregations, we were able to keep the nanofibrous membrane transparent. When excited at 365 nm, NLA@PGLS nanofibres showed an emission intensity at 517 nm. The hydrophobicity of NLA@PGLS nanofibres improved by raising the pigment concentration as the contact angle was increased from 146.4° to 160.3°. After being triggered by ultraviolet light, NLA@PGLS showed quick and reversible photochromism without fatigue. It was shown that the suggested method can be applied to reliably produce various anticounterfeiting materials.

Preparation of photoluminescent nano-biocomposite nacre from graphene oxide and polylactic acid.

Nano-biocomposites of inorganic and organic components wereprepared to produce long-persistent phosphorescent artificial nacre-like materials. Biodegradable polylactic acid (PLA), graphene oxide (GO), and nanoparticles (13-20 nm) of lanthanide-doped aluminate pigment (NLAP) were used in a simple production procedure of an organic/inorganic hybrid nano-biocomposite. Both polylactic acid and GO nanosheets were chemically modified to form covalent and hydrogen bonding. The high toughness, good tensile strength, and great endurance of those bonds were achieved by their interactions at the interfaces. Long-persistent and reversible photoluminescence was shown by the prepared nacre substrates. Upon excitation at 365 nm, the nacre substrates generated an emission peak at 517 nm. When ultraviolet light was shone on luminescent nacres, they displayed a bright green colour. The high superhydrophobicity of the generated nacres was obtained without altering their mechanical characteristics.

KIF26A is mutated in the syndrome of congenital hydrocephalus with megacolon.

Human disorders of the enteric nervous system (ENS), e.g., Hirschsprung's disease, are rarely associated with major central nervous system involvement. We describe two families each segregating a different homozygous truncating variant in KIF26A with a unique constellation of severe megacolon that resembles Hirschsprung's disease but lacks aganglionosis as well as brain malformations that range from severe to mild. The intestinal phenotype bears a striking resemblance to that observed in Kif26a-/- mice where KIF26A deficiency was found to cause abnormal GDNF-Ret signaling resulting in failure to establish normal neuronal networks despite myenteric neuronal hyperplasia. Very recently, a range of brain developmental phenotypes were described in patients and mice with KIF26A deficiency and were found to result from abnormal radial migration and increased apoptosis. Our report, therefore, reveals a recognizable autosomal-recessive human KIF26A deficiency phenotype characterized by severe ENS dysfunction and a range of brain malformations.

Daily Exposure to Mild Intermittent Hypoxia Reduces Blood Pressure in Male Patients with Obstructive Sleep Apnea and Hypertension.

Rationale: Daily exposure to mild intermittent hypoxia (MIH) may elicit beneficial cardiovascular outcomes. Objectives: To determine the effect of 15 days of MIH and in-home continuous positive airway pressure treatment on blood pressure in participants with obstructive sleep apnea and hypertension. Methods: We administered MIH during wakefulness 5 days/week for 3 weeks. The protocol consisted of twelve 2-minute bouts of hypoxia interspersed with 2 minutes of normoxia. End-tidal carbon dioxide was maintained 2 mm Hg above baseline values throughout the protocol. Control participants were exposed to a sham protocol (i.e., compressed air). All participants were treated with continuous positive airway pressure over the 3-week period. Results are mean ± SD. Measurements and Main Results: Sixteen male participants completed the study (experimental n = 10; control n = 6). Systolic blood pressure at rest during wakefulness over 24 hours was reduced after 15 days of MIH (142.9 ± 8.6 vs. 132.0 ± 10.7 mm Hg; P < 0.001), but not following the sham protocol (149.9 ± 8.6 vs. 149.7 ± 10.8 mm Hg; P = 0.915). Thus, the reduction in blood pressure from baseline was greater in the experimental group compared with control (-10.91 ± 4.1 vs. -0.17 ± 3.6 mm Hg; P = 0.003). Modifications in blood pressure were accompanied by increased parasympathetic and reduced sympathetic activity in the experimental group, as estimated by blood pressure and heart rate variability analysis. No detrimental neurocognitive and metabolic outcomes were evident following MIH. Conclusions: MIH elicits beneficial cardiovascular and autonomic outcomes in males with OSA and concurrent hypertension. Clinical trial registered with www.clinicaltrials.gov (NCT03736382).

Effect of Zolpidem on nocturnal arousals and susceptibility to central sleep apnea.

PURPOSE: Arousals may contribute to the pathogenesis of sleep-disordered breathing (SDB) and central sleep apnea (CSA). We aimed to determine the effect of the nonbenzodiazepine hypnotic zolpidem on the frequency of respiratory-related arousals and central apnea in patients with moderate-to-severe SDB. We hypothesized that zolpidem decreases the severity of SDB by decreasing the frequency of respiratory-related arousals. METHODS: Patients with apnea-hypopnea index ≥ 15 events/hour and central apnea-hypopnea index ≥ 5 events/hour underwent a sleep study on zolpidem 5 mg and a sleep study with no medication in a randomized order. The respiratory arousal index was compared between the two studies using a randomized crossover design. Sleep, respiratory, and physiologic parameters, including the CO2 reserve and the respiratory arousal threshold, were also compared. RESULTS: Eleven participants completed the study. Compared to no treatment, zolpidem reduced the respiratory arousal index (39.7 ± 7.7 vs. 23.3 ± 4.4 events/h, P = 0.031). Zolpidem also lowered the total apnea-hypopnea index (55.6 ± 8.5 vs. 41.3 ± 7.5 events/hour, P = 0.033) but did not affect other clinical and physiologic parameters. Compared to control, zolpidem did not widen CO2 reserve (- 0.44 ± 1.47 vs. - 0.63 ± 0.86 mmHg, P = 0.81). The respiratory arousal threshold did not show a significant change on zolpidem compared to control (- 8.72 ± 2.1 vs. - 8.25 ± 2.81 cmH2O, P = 0.41). CONCLUSION: Nocturnal arousals and overall SDB severity were reduced with a single dose of zolpidem in patients with moderate-to-severe sleep-disordered breathing with increased susceptibility for central apnea. Zolpidem did not widen the CO2 reserve or increase the arousal threshold. TRIAL REGISTRATION: Clinicaltrials.gov. Sleep and Breathing in the General Population - Chemical Stimuli (NCT04720547).

Identifying gaps in clinical evaluation and treatment of sleep-disordered breathing in women veterans.

PURPOSE: Sleep-disordered breathing (SDB) is a common sleep disorder in veterans; however, limited research exists in women veterans. We sought to estimate patterns of care in terms of evaluation, diagnosis, and treatment among women veterans with factors associated with elevated SDB risk. METHODS: Within one VA healthcare system, women identified through electronic health record data as having one or more factors (e.g., age >50 years, hypertension) associated with SDB, completed telephone screening in preparation for an SDB treatment study and answered questions about prior care related to SDB diagnosis and treatment. RESULTS: Of 319 women, 111 (35%) reported having completed a diagnostic sleep study in the past, of whom 48 (43%) were diagnosed with SDB. Women who completed a diagnostic study were more likely to have hypertension or obesity. Those who were diagnosed with SDB based on the sleep study were more likely to have hypertension, diabetes, or be ≥50 years old. Of the 40 women who received treatment, 37 (93%) received positive airway pressure therapy. Only 9 (24%) had used positive airway pressure therapy in the prior week. Few women received other treatments such as oral appliances or surgery. CONCLUSIONS: Findings support the need for increased attention to identification and management of SDB in women veterans, especially those with conditions associated with elevated SDB risk.

Development of hydrophobic, mechanically reliable, and glow-in-the-dark glue using Arabic gum.

A smart nanocomposite adhesive was created to facilitate a simple production of long-persistent photoluminescent and hydrophobic commercial products. Even after being left in the dark for up to 90 min, the created photoluminescent adhesive agent continued to generate light. A surface-specific nanocomposite adhesive agent consisting of lanthanide-activated strontium aluminate (LSA) nanoparticles (NPs; 5-14 nm) immobilized in the environmentally friendly Arabic gum (AG) was developed. A light-transmitting nanocomposite adhesive agent was manufactured by dispersing LSA nanoparticles evenly across the AG matrix without agglomeration. An excitation peak at 365 nm and an emission wavelength at 519 nm were observed for the prepared adhesives at different concentrations of LSA NPs. The emission spectra showed either fluorescence or afterglow phosphorescence, depending on the LSA ratio. The photochromic transition from colourless to green beneath an ultraviolet (UV) lamp and greenish yellow in a dark room was tracked. The LSA NPs in the Arabic gum matrix imparted enhanced hydrophobicity and scratch resistance to the LSA@AG nanocomposite. The LSA@AG nanocomposite demonstrated excellent durability and photostability. This study confirmed that the mass production of smart adhesives for applications such as smart windows, smart packaging, and safety directional signs in buildings is possible.

Photoluminescent polymer-based smart window reinforced with electrospun glass nanofibres.

Poly(vinyl chloride) (PVC) was reinforced with electrospun glass nanofibres (EGN) to develop photochromic and afterglow materials such as smart windows and anti-counterfeiting prints. A colourless electrospun glass nanofibres@poly(vinyl chloride) (EGN@PVC) sheet was prepared by physical integration of lanthanide-doped aluminate nanoparticles (LANP). The low concentrations of LANP in the photochromic and photoluminescent EGN@PVC hybrids displayed fluorescence emission with instant reversibility. EGN@PVC with the highest phosphor concentrations showed persistent phosphorescence emission with slow reversibility. Based on the results of the Commission Internationale de l'éclairage Laboratory and luminescence spectroscopy, the translucent EGN@PVC samples became green in the presence of ultraviolet illumination and greenish-yellow in the absence of light. According to scanning electron microscopy (SEM) and transmission electron microscopy (TEM) analyses, the morphological study of EGN and LANP showed diameters of 75-95 and 11-19 nm, respectively. The morphology of the EGN@PVC substrates was studied using SEM, X-ray fluorescence, and energy-dispersive X-ray spectroscopy. The mechanical characteristics of PVC were enhanced by reinforcement with EGN as a roughening agent. When comparing the scratching resistance of LANP-free substrate to photoluminescent EGN@PVC substrates, it was observed that the latter was much superior. The photoluminescence spectra were reported to have an emission peak at 519 nm when excited at 365 nm. These findings demonstrated that the luminous transparent EGN@PVC composites had improved superhydrophobic and UV-blocking characteristics.

Enhanced Adsorption of Textile Dyes by a Novel Sulfonated Activated Carbon Derived from Pomegranate Peel Waste: Isotherm, Kinetic and Thermodynamic Study.

The rapid growth of the dye and textile industry has raised significant public concerns regarding the pollution caused by dye wastewater, which poses potential risks to human health. In this study, we successfully improved the adsorption efficiency of activated carbon derived from pomegranate peel waste (PPAC) through a single-step and surface modification approach using 5-sulfonate-salicylaldehyde sodium salt. This innovative and effective sulfonation approach to produce sulfonated activated carbon (S-PPAC) proved to be highly effective in removing crystal violet dye (CV) from polluted water. The prepared PPAC and S-PPAC were characterized via FESEM, EDS, FTIR and BET surface area. Characterization studies confirmed the highly porous structure of the PPAC and its successful surface modification, with surface areas reaching 1180.63 m2/g and 740.75 m2/g for the PPAC and S-PPAC, respectively. The maximum adsorption capacity was achieved at 785.53 mg/g with the S-PPAC, an increase of 22.76% compared to the PPAC at 45 °C. The isothermic adsorption and kinetic studies demonstrated that the adsorption process aligned well with the Freundlich isotherm model and followed the Elovich kinetic model, respectively. The thermodynamic study confirmed that the adsorption of CV dye was endothermic, spontaneous and thermodynamically favorable onto PPAC and S-PPAC.

Is Sleep Disordered Breathing Confounding Rehabilitation Outcomes in Spinal Cord Injury Research?

The purpose of this article is to highlight the importance of considering sleep-disordered breathing (SDB) as a potential confounder to rehabilitation research interventions in spinal cord injury (SCI). SDB is highly prevalent in SCI, with increased prevalence in individuals with higher and more severe lesions, and the criterion standard treatment with continuous positive airway pressure remains problematic. Despite its high prevalence, SDB is often untested and untreated in individuals with SCI. In individuals without SCI, SDB is known to negatively affect physical function and many of the physiological systems that negatively affect physical rehabilitation in SCI. Thus, owing to the high prevalence, under testing, low treatment adherence, and known negative effect on the physical function, it is contended that underdiagnosed SDB in SCI may be confounding physical rehabilitation research studies in individuals with SCI. Studies investigating the effect of treating SDB and its effect on physical rehabilitation in SCI were unable to be located. Thus, studies investigating the likely integrated relationship among physical rehabilitation, SDB, and proper treatment of SDB in SCI are needed. Owing to rapid growth in both sleep medicine and physical rehabilitation intervention research in SCI, the authors contend it is the appropriate time to begin the conversations and collaborations between these fields. We discuss a general overview of SDB and physical training modalities, as well as how SDB could be affecting these studies.

Research Priorities for Patients with Heart Failure and Central Sleep Apnea. An Official American Thoracic Society Research Statement.

Background: Central sleep apnea (CSA) is common among patients with heart failure and has been strongly linked to adverse outcomes. However, progress toward improving outcomes for such patients has been limited. The purpose of this official statement from the American Thoracic Society is to identify key areas to prioritize for future research regarding CSA in heart failure.Methods: An international multidisciplinary group with expertise in sleep medicine, pulmonary medicine, heart failure, clinical research, and health outcomes was convened. The group met at the American Thoracic Society 2019 International Conference to determine research priority areas. A statement summarizing the findings of the group was subsequently authored using input from all members.Results: The workgroup identified 11 specific research priorities in several key areas: 1) control of breathing and pathophysiology leading to CSA, 2) variability across individuals and over time, 3) techniques to examine CSA pathogenesis and outcomes, 4) impact of device and pharmacological treatment, and 5) implementing CSA treatment for all individualsConclusions: Advancing care for patients with CSA in the context of heart failure will require progress in the arenas of translational (basic through clinical), epidemiological, and patient-centered outcome research. Given the increasing prevalence of heart failure and its associated substantial burden to individuals, society, and the healthcare system, targeted research to improve knowledge of CSA pathogenesis and treatment is a priority.

Single Stage Cleft Lip and Palate Repair In Toddlers: Retrospective Review of Feasibility and Operative Experience.

ABSTRACT: In children with cleft lip and palate (CLP), we aimed to compare a single-stage surgery group or all in one (AIO) approach with a 2-stage surgery group (2-SSG) of 18 and 12 toddlers, respectively. A retrospective review of 30 patients with CLP was conducted between 2007 and 2019. All in one procedure was performed at 12 to 24 months and 2-SSG patients had lip and primary nasal correction at 3 to 9 months, followed by palatoplasty and myringotomies at 12 to 16 months. In the AIO group, 13 (72.2%) patients had unilateral CLP, while 5 (27.8%) had bilateral CLP, which is comparable to the 2-SSG who had 8 (66.7%) unilateral CLP, 3 (25%) bilateral CLP, and 1 (8.3%) incomplete CL with submucous CP. The 2-SSG had a 30 minutes longer cumulative operative time and increased blood loss that was not statistically significant (P = 0.149 and 0.219, respectively). The AIO group had a slightly longer intubation (0.67 versus 0.33 day) and pediatric intensive care unit admission duration of 1.72 versus 1.67 days, (P = 0.427, 0.927), respectively. Total hospitalization time was significantly shorter with the AIO (8 versus 10.67 days, P = 0.016). The duration of postoperative pediatric intensive care unit and need for supplemental oxygen were higher in the AIO (38.9% versus 8.3%, P = 0.064). The "AIO" approach of lip, nasal, and palate surgery from 12 to 24 months completes early surgical care in a single operation. However, based on our review, this protocol must be selective; children with comorbidities or syndromes are advised to be exempted and operated in stages.

Microsatellite Variation in the Most Devastating Beetle Pests (Coleoptera: Curculionidae) of Agricultural and Forest Crops.

Weevils, classified in the family Curculionidae (true weevils), constitute a group of phytophagous insects of which many species are considered significant pests of crops. Within this family, the red palm weevil (RPW), Rhynchophorus ferrugineus, has an integral role in destroying crops and has invaded all countries of the Middle East and many in North Africa, Southern Europe, Southeast Asia, Oceania, and the Caribbean Islands. Simple sequence repeats (SSRs), also termed microsatellites, have become the DNA marker technology most applied to study population structure, evolution, and genetic diversity. Although these markers have been widely examined in many mammalian and plant species, and draft genome assemblies are available for many species of true weevils, very little is yet known about SSRs in weevil genomes. Here we carried out a comparative analysis examining and comparing the relative abundance, relative density, and GC content of SSRs in previously sequenced draft genomes of nine true weevils, with an emphasis on R. ferrugineus. We also used Illumina paired-end sequencing to generate draft sequence for adult female RPW and characterized it in terms of perfect SSRs with 1-6 bp nucleotide motifs. Among weevil genomes, mono- to trinucleotide SSRs were the most frequent, and mono-, di-, and hexanucleotide SSRs exhibited the highest GC content. In these draft genomes, SSR number and genome size were significantly correlated. This work will aid our understanding of the genome architecture and evolution of Curculionidae weevils and facilitate exploring SSR molecular marker development in these species.

Comparative analysis of transposable elements provides insights into genome evolution in the genus Camelus.

BACKGROUND: Transposable elements (TEs) are common features in eukaryotic genomes that are known to affect genome evolution critically and to play roles in gene regulation. Vertebrate genomes are dominated by TEs, which can reach copy numbers in the hundreds of thousands. To date, details regarding the presence and characteristics of TEs in camelid genomes have not been made available. RESULTS: We conducted a genome-wide comparative analysis of camelid TEs, focusing on the identification of TEs and elucidation of transposition histories in four species: Camelus dromedarius, C. bactrianus, C. ferus, and Vicugna pacos. Our TE library was created using both de novo structure-based and homology-based searching strategies ( https://github.com/kacst-bioinfo-lab/TE_ideintification_pipeline ). Annotation results indicated a similar proportion of each genomes comprising TEs (35-36%). Class I LTR retrotransposons comprised 16-20% of genomes, and mostly consisted of the endogenous retroviruses (ERVs) groups ERVL, ERVL-MaLR, ERV_classI, and ERV_classII. Non-LTR elements comprised about 12% of genomes and consisted of SINEs (MIRs) and the LINE superfamilies LINE1, LINE2, L3/CR1, and RTE clades. Least represented were the Class II DNA transposons (2%), consisting of hAT-Charlie, TcMar-Tigger, and Helitron elements and comprising about 1-2% of each genome. CONCLUSIONS: The findings of the present study revealed that the distribution of transposable elements across camelid genomes is approximately similar. This investigation presents a characterization of TE content in four camelid to contribute to developing a better understanding of camelid genome architecture and evolution.

Statins and clinical outcomes in hospitalized COVID-19 patients with and without Diabetes Mellitus: a retrospective cohort study with propensity score matching.

BACKGROUND: The pleiotropic effects of statins may reduce the severity of COVID-19 disease. This study aims to determine the association between inpatient statin use and severe disease outcomes among hospitalized COVID-19 patients, especially those with Diabetes Mellitus (DM). RESEARCH DESIGN AND METHODS: A retrospective cohort study on hospitalized patients with confirmed COVID-19 diagnosis. The primary outcome was mortality during hospitalization. Patients were classified into statin and non-statin groups based on the administration of statins during hospitalization. Analysis included multivariable regression analysis adjusting for confounders and propensity score matching to achieve a 1:1 balanced cohort. Subgroup analyses based on presence of DM were conducted. RESULTS: In the cohort of 922 patients, 413 had a history of DM. About 27.1% patients (n = 250) in the total cohort (TC) and 32.9% patients (n = 136) in DM cohort received inpatient statins. Atorvastatin (n = 205, 82%) was the most commonly prescribed statin medication in TC. On multivariable analysis in TC, inpatient statin group had reduced mortality compared to the non-statin group (OR, 0.61; 95% CI, 0.42-0.90; p = 0.01). DM modified this association between inpatient statins and mortality. Patients with DM who received inpatient statins had reduced mortality (OR, 0.35; 95% CI, 0.21-0.61; p < 0.001). However, no such association was noted among patients without DM (OR, 1.21; 95% CI, 0.67-2.17; p = 0.52). These results were further validated using propensity score matching. CONCLUSIONS: Inpatient statin use was associated with significant reduction in mortality among COVID-19 patients especially those with DM. These findings support the pursuit of randomized clinical trials and inpatient statin use appears safe among COVID-19 patients.

Preexisting respiratory diseases and clinical outcomes in COVID-19: a multihospital cohort study on predominantly African American population.

BACKGROUND: Comorbidities play a key role in severe disease outcomes in COVID-19 patients. However, the literature on preexisting respiratory diseases and COVID-19, accounting for other possible confounders, is limited. The primary objective of this study was to determine the association between preexisting respiratory diseases and severe disease outcomes among COVID-19 patients. Secondary aim was to investigate any correlation between smoking and clinical outcomes in COVID-19 patients. METHODS:  This is a multihospital retrospective cohort study on 1871 adult patients between March 10, 2020, and June 30, 2020, with laboratory confirmed COVID-19 diagnosis. The main outcomes of the study were severe disease outcomes i.e. mortality, need for mechanical ventilation, and intensive care unit (ICU) admission. During statistical analysis, possible confounders such as age, sex, race, BMI, and comorbidities including, hypertension, coronary artery disease, congestive heart failure, diabetes, any history of cancer and prior liver disease, chronic kidney disease, end-stage renal disease on dialysis, hyperlipidemia and history of prior stroke, were accounted for. RESULTS:  A total of 1871 patients (mean (SD) age, 64.11 (16) years; 965(51.6%) males; 1494 (79.9%) African Americans; 809 (43.2%) with ≥ 3 comorbidities) were included in the study. During their stay at the hospital, 613 patients (32.8%) died, 489 (26.1%) needed mechanical ventilation, and 592 (31.6%) required ICU admission. In fully adjusted models, patients with preexisting respiratory diseases had significantly higher mortality (adjusted Odds ratio (aOR), 1.36; 95% CI, 1.08-1.72; p = 0.01), higher rate of ICU admission (aOR, 1.34; 95% CI, 1.07-1.68; p = 0.009) and increased need for mechanical ventilation (aOR, 1.36; 95% CI, 1.07-1.72; p = 0.01). Additionally, patients with a history of smoking had significantly higher need for ICU admission (aOR, 1.25; 95% CI, 1.01-1.55; p = 0.03) in fully adjusted models. CONCLUSION:  Preexisting respiratory diseases are an important predictor for mortality and severe disease outcomes, in COVID-19 patients. These results can help facilitate efficient resource allocation for critical care services.

Polyamine biomarkers as indicators of human disease.

The significant increase of periodontitis, chronic kidney disease (CKD), Alzheimer's disease and cancer can be attributed to an ageing population. Each disease produces a range of biomarkers that can be indicative of disease onset and progression. Biomarkers are defined as cellular (intra/extracellular components and whole cells), biochemical (metabolites, ions and toxins) or molecular (nucleic acids, proteins and lipids) alterations which are measurable in biological media such as human tissues, cells or fluids. An interesting group of biomarkers that merit further investigation are the polyamines. Polyamines are a group of molecules consisting of cadaverine, putrescine, spermine and spermidine and have been implicated in the development of a range of systemic diseases, in part due to their production in periodontitis. Cadaverine and putrescine within the periodontal environment have demonstrated cell signalling interfering abilities, by way of leukocyte migration disruption. The polyamines spermine and spermidine in tumour cells have been shown to inhibit cellular apoptosis, effectively prolonging tumorigenesis and continuation of cancer within the host. Polyamine degradation products such as acrolein have been shown to exacerbate renal damage in CKD patients. Thus, the use of such molecules has merit to be utilized in the early indication of such diseases in patients.

The Nasal Lift Technique in Primary Cleft Lip Surgery.

Whether it is a unilateral or bilateral cleft lip, the nose tends to act as a collapsing pyramid with a tilt in case of the former. This gives the nose a tethered and flattened look with varying degrees of asymmetries. No matter how aggressive soft tissue manipulations are made to the tip and columella, we believe unless the nose is lifted and secured to a stable structure, the correction is inadequate. Here, we are describing our approach. Initially closed nasal correction is considered utilizing method described by Mulliken. This is followed by lifting the entire cartilaginous framework with a suture being looped around tip cartilages and secured into the periosteum of the nasal bones in a "Cantilever" fashion.