Comparative Oral Absorption of Curcumin in a Natural Turmeric Matrix with Two Other Curcumin Formulations: An Open-label Parallel-arm Study.

Curcuminoids are the major bioactive molecules in turmeric, and poor bioavailability deters them from being the major components of many health and wellness applications. This study was conducted to assess the bioavailability of a completely natural turmeric matrix formulation (CNTMF) and compare its bioavailability with two other commercially available formulations, namely, curcumin with volatile oil (volatile oil formulation) and curcumin with phospholipids and cellulose (phospholipid formulation) in healthy human adult male subjects (15 each group) under fasting conditions. Each formulation was administrated orally as a single 500-mg dose in capsule form, and blood samples were analyzed by liquid chromatography mass spectrometry at various time intervals up to 24 h. The ingestion of the CNTMF was very well absorbed and resulted in a mean curcuminoids plasma Cmax of 170.14 ng/mL (Tmax  = 4 h) compared with 47.54 ng/mL and 69.63 ng/mL for the volatile oil (Tmax  = 3 h) and phospholipid (Tmax  = 2.25 h) formulations, respectively. The extent of absorption of total curcuminoids in the blood for the CNTMF was 6× greater than volatile oil formulation and 5× greater than phospholipids formulation. The results of this study indicate that curcumin in a natural turmeric matrix exhibited greater bioavailability than the two comparator products. Copyright © 2017 John Wiley & Sons, Ltd.

The Impact of Restricted Clinical Experiences During a Pandemic on Newly Graduated Nurses' Experiences: A Descriptive Study.

A multihospital study examined the impact of restricted clinical opportunities during COVID-19 on newly graduated nurses' experiences, self-reported competence, and self-reported errors upon entry into a nurse residency program and at 6 months. Newly graduated nurses' experiences (n = 2,005) were described using comparative data from cohorts before and during restricted experiences across 22 hospitals; minimal differences were observed. Nursing professional development specialists can utilize this information when creating and sustaining transition-to-practice programs.

Middle cerebral artery infarct following multiple bee stings.

Neurologic events following bee stings are very rare. We report a 59-year-old man who became drowsy with slurred speech following multiple bee stings. In the hospital, he was found to have left-sided hemplegia, seventh cranial nerve palsy, and left conjugate gaze palsy. Further investigation revealed dyslipidemia, impaired glucose tolerance, and a middle cerebral artery territory infarct. His limb weakness and speech improved before his discharge from the hospital.

Development of superhydrophillic tannic acid-crosslinked graphene oxide membranes for efficient treatment of oil contaminated water with enhanced stability.

In the present age of industrialization, oil contamination in the waste water has become a huge global concern due to its several negative impacts on human health and aquatic ecosystem. In order to address this problem, a novel oleophobic and super-hydrophilic graphene-based membrane has been developed using simple and cost-effective vacuum filtration methodology. Prior developing the membranes, the graphene oxide (GO) sheets were crosslinked with tannic acid (TA) molecules in order to improve their mechanical and surface properties. To obtain the structural and morphological information of the membranes and their constituents, Field Emission Scanning Electron (FE-SEM) microscopy, X-Ray Diffraction (XRD), FTIR spectroscopy and Raman spectroscopy was used. When tested with simulated oilfield effluent samples, these membranes exhibited significant reduction in the values of chemical oxygen demand (COD), total dissolved solids (TDS), total suspended solids (TSS) and turbidity demonstrating low-oil adhesion and preferable oil rejection rates. Moreover, such crosslinked membranes are highly stable which can withstand the pressure of water filtration. In such a way, TA crosslinked GO membranes present a robust and efficient way to treat oil contaminated water released from various industries which can be reused for numerous further applications.

Nonlinear dynamics based machine learning: Utilizing dynamics-based flexibility of nonlinear circuits to implement different functions.

The core element of machine learning is a flexible, universal function approximator that can be trained and fit into the data. One of the main challenges in modern machine learning is to understand the role of nonlinearity and complexity in these universal function approximators. In this research, we focus on nonlinear complex systems, and show their capability in representation and learning of different functions. Complex nonlinear dynamics and chaos naturally yield an almost infinite diversity of dynamical behaviors and functions. Physical, biological and engineered systems can utilize this diversity to implement adaptive, robust behaviors and operations. A nonlinear dynamical system can be considered as an embodiment of a collection of different possible behaviors or functions, from which different behaviors or functions can be chosen as a response to different conditions or problems. This process of selection can be manual in the sense that one can manually pick and choose the right function through directly setting parameters. Alternatively, we can automate the process and allow the system itself learn how to do it. This creates an approach to machine learning, wherein the nonlinear dynamics represents and embodies different possible functions, and it learns through training how to pick the right function from this function space. We report on how we utilized nonlinear dynamics and chaos to design and fabricate nonlinear dynamics based, morphable hardware in silicon as a physical embodiment for different possible functions. We demonstrate how this flexible, morphable hardware learns through learning and searching algorithms such as genetic algorithm to implement different desired functions. In this approach, we combine two powerful natural and biological phenomenon, Darwinian evolution and nonlinear dynamics and chaos, as a dynamics-oriented approach to designing intelligent, adaptive systems with applications. Nonlinear dynamics embodies different functions at the hardware level, while an evolutionary method is utilized in order to find the parameters to implement the right function.

Association of Time Between Left Ventricular and Aortic Systolic Pressure Peaks With Severity of Aortic Stenosis and Calcification of Aortic Valve.

Importance: Diagnosis of low-gradient severe aortic stenosis (AS) is challenging. We hypothesized that the time between left ventricular (LV) and aortic systolic pressure peaks (TLV-Ao) is associated with aortic stenosis (AS) severity and may have additive value in diagnosing severe AS, especially in patients with low-gradient AS. Objective: To investigate the diagnostic utility of measuring catheter-based TLV-Ao in patients with severe AS. Design, Setting, and Participants: We studied 123 patients with severe AS at the Cleveland Clinic Foundation, a tertiary referral center, who underwent transcatheter aortic valve replacement (TAVR) via femoral access and had pre-TAVR cardiac computed tomography assessment and hemodynamic measurements recorded during a TAVR procedure. All patients received hemodynamic evaluation, echocardiographic assessment, and quantification of aortic valve calcification (AVC) by multidetector computed tomography. Hemodynamic data were collected via left heart catheterization done just before TAVR, and TLV-Ao was calculated offline. Data were analyzed between October 5, 2015, and July 20, 2016. Main Outcomes and Measures: The association between TLV-Ao and AVC or other conventional imaging parameters was analyzed. Results: Of the included patients, the mean (SD) age was 81 (9) years, and 65 (54%) were men (54%). Among 123 patients, 48 patients (39%) had low-gradient AS (<40 mm Hg) and mean (SD) TLV-Ao was 69 (39) milliseconds. In multivariable logistic regression analyses, higher TLV-Ao (odds ratio [OR], 1.02; 95% CI, 1.01-1.04; P = .002) and higher peak aortic valve (AV) velocity (OR, 1.01; 95% CI, 1.00-1.02; P = .008) were independently associated with severe AVC (AVC >1000 AU). Adding TLV-Ao to the peak AV velocity and AV area showed significant incremental value to be associated with AVC, with a net reclassification improvement of 0.61 (95% CI, 0.23-0.99; P = .002) and integrated discriminatory improvement of 0.09 (95% CI, 0.03-0.16; P = .003). In a subgroup of patients with low-grade AS, higher TLV-Ao was the only parameter associated with severe AVC (OR, 1.02; 95% CI, 1.001-1.04; P = .03). Conclusions and Relevance: Prolonged TLV-Ao was associated with severe AVC. This catheter-based hemodynamic index may be an additional surrogate to differentiate low-gradient true severe AS. Larger, prospective studies investigating the role of TLV-Ao as a marker of clinical outcomes in patients undergoing TAVR are required.

Time-Integrated Aortic Regurgitation Index Helps Guide Balloon Postdilation During Transcatheter Aortic Valve Replacement and Predicts Survival.

Background Balloon postdilation ( BPD ) has emerged as an effective strategy to reduce paravalvular regurgitation ( PVR ) during transcatheter aortic valve replacement ( TAVR ). We investigated the utility of a time-integrated aortic regurgitation index ( TIARI ) to guide balloon postdilation ( BPD ) after valve deployment. Methods and Results All consecutive patients who had echocardiography, aortography, and hemodynamic tracings recorded immediately after valve deployment during TAVR were included in the study. Catheter-derived invasive hemodynamic parameters were calculated offline. Among 157 patients who underwent TAVR , 49 (32%) patients required BPD to reduce significant PVR after valve deployment. Two experienced operators decided whether the patients required BPD for significant PVR . Median TIARI measured immediately after valve deployment was significantly lower in patients who required BPD when compared with patients who did not require BPD ( P<0.001). In a multivariable analysis, lower TIARI (odds ratio: 0.81; P=0.003) and higher PVR grade on aortography and echocardiography ( P<0.001 for both) were associated with BPD . Adding TIARI to echocardiography and aortographic PVR assessment resulted in a significant increase in global χ2 ( P<0.001), an integrated discrimination index of 9% ( P=0.002), and combined C-statistics of 0.99 for predicting BPD . Higher TIARI after valve deployment was associated with better survival (hazard ratio: 0.94, P=0.014), while other hemodynamic and imaging parameters did not predict mortality after TAVR . Conclusions Among patients undergoing TAVR , a TIARI measured immediately after valve deployment adds incremental value to guide BPD over aortography and echocardiography. Higher residual TIARI is associated with better survival after TAVR .

Intraoperative diagnosis of glioblastomamultiforme with oligodendroglial and sarcomatous components.

Glioblastoma, the most frequent primary brain tumor and the most malignant neoplasm, can have the most heterogeneous morphological presentation. Along with classical morphological features, areas of oligodendroglial component and mesenchymal differentiation may be seen. The present case was a rare case of glioblastoma presenting with sarcomatous and oligodendroglial components. The case was diagnosed intraoperatively by squash and touch cytology and later on confirmed by histopathological study.

Endothelial progenitor cells, atheroma burden and clinical outcome in patients with coronary artery disease.

OBJECTIVE: We wished to determine the effect of an acute coronary syndrome (ACS) on putative endothelial progenitor cell (EPC) populations, and define their relationship to coronary artery disease (CAD) severity and clinical outcome, in order to clarify their clinical relevance. DESIGN AND SETTING: A prospective cohort study conducted in a tertiary referral cardiac centre. PATIENTS: Two-hundred-and-one patients undergoing coronary angiography for suspected angina or ACS. MAIN OUTCOME MEASURES: Putative EPC populations were determined by flow cytometry. CAD was quantified using the Gensini scoring system. Survival free from revascularisation, recurrent myocardial infarction and death were determined at 3 years. RESULTS: Circulating CD34(+)VEGFR-2(+) and CD34(+)VEGFR-2(+)CD133(+) cells were rare (<0.007% of mononuclear cells), were not increased in patients with ACS, and were unrelated CAD severity or clinical outcome (p>0.1 for all). By contrast, CD34(+)CD45(-) cells were increased in patients with CAD compared with those with normal coronary arteries (p=0.008) and correlated with atheroma burden (r=0.44, p<0.001). Increased concentrations of circulating CD34(+)CD45(-) cells were associated with a shorter cumulative event-free survival (p<0.02). Proangiogenic monocytes (CD14(+)VEGFR-2(+)Tie-2(+)) and endothelial cell-colony forming units were increased in patients with ACS (p<0.01 for both), however, concentrations reflected myocardial necrosis, and did not predict the extent of CAD or clinical outcome. CONCLUSIONS: Traditional EPC populations, CD34(+)VEGFR-2(+) and CD34(+)VEGFR-2(+)CD133(+) are not related to the extent of CAD or clinical outcome. However, CD34(+)CD45(-) cells are increased in patients with CAD and predict future cardiovascular events. It is likely that CD34(+)CD45(-) concentrations reflect the extent of vascular injury and atheroma burden.

Gut barrier dysfunction in critically ill surgical patients with abdominal compartment syndrome.

OBJECTIVES: This study investigated the effects of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) on gut barrier function in critically ill surgical patients. METHODS: A prospective observational cohort study on patients with severe acute pancreatitis or abdominal sepsis admitted to an intensive care or high-dependency unit. Intra-abdominal pressure (IAP) and plasma levels of immunoglobulin G (IgG) and IgM antiendotoxin core antibodies (EndoCAb) and procalcitonin (ProCT) were measured serially. RESULTS: Among 32 recruited patients, 24 (75%) and 8 patients (25%) developed IAH and ACS, respectively. The state of ACS was associated with significant reductions in plasma IgG EndoCAb (P = 0.015) and IgM EndoCAb (P = 0.016) and higher concentrations of plasma ProCT (P = 0.056) compared with absence of ACS. Resolution of IAH and ACS was associated with significant recovery of plasma IgG EndoCAb (P = 0.003 and P = 0.009, respectively) and IgM EndoCAb (P = 0.002 and P = 0.003, respectively) and reduction in plasma ProCT concentration (P = 0.049 and P = 0.019, respectively). Negative correlations were observed between IAP and plasma IgG EndoCAb (P = 0.003) and IgM EndoCAb (P = 0.002). CONCLUSIONS: Intra-abdominal hypertension and ACS are associated with significantly higher endotoxin exposure and ProCT concentrations, suggestive of gut barrier dysfunction. Resolution of IAH and ACS is associated with evidence for recovery of gut barrier function.