Impact of preoperative sarcopenia in patients undergoing sacral tumor resection.

INTRODUCTION: Sacral tumor resection is known for a high rate of complications. Sarcopenia has been found to be associated with wound complications; however, there is a paucity of data examining the impact of sarcopenia on the outcome of sacral tumor resection. METHODS: Forty-eight patients (31 primary sarcomas, 17 locally recurrent carcinomas) undergoing sacrectomy were reviewed. Central sarcopenia was assessed by measuring the psoas:lumbar vertebra index (PLVI), with the 50th percentile (0.97) used to determine which patients were high (>0.97) versus low (<0.97). RESULTS: Twenty-four (50%) patients had a high PLVI and 24 (50%) had a low PLVI (sarcopenic). There was no difference (p > 0.05) in the demographics of patients with or without sarcopenia. There was no difference in the incidence of postoperative wound complications (odds ratio [OR] = 1.0, p = 1.0) or deep infection (OR = 0.83, p = 1.0). Sarcopenia was not associated with death due to disease (hazard ratio [HR] = 2.04, p = 0.20) or metastatic disease (HR = 2.47, p = 0.17), but was associated with local recurrence (HR = 6.60, p = 0.01). CONCLUSIONS: Central sarcopenia was not predictive of wound complications or infection following sacral tumor resection. Sarcopenia was, however, an independent risk factor for local tumor recurrence following sacrectomy and should be considered when counseling patients on the outcome of sacrectomy.

Future advances and challenges of nanomaterial-based technologies for electromagnetic interference-based technologies: A review.

The emerging growth of the electronic devices applications has arisen the serious problems of electromagnetic (EM) wave pollution which resulting in equipment malfunction. Therefore, polymer-based composites have been considered good candidates for better EMI shielding due to their significant characteristics including, higher flexibility, ultrathin, lightweight, superior conductivity, easy fabrication processing, environmentally friendly, corrosion resistive, better adhesion with physical, chemical and thermal stability. This review article focused on the concept of the EMI shielding mechanism and challenges with the fabrication of polymer-based composites. Subsequently, recent advancements in the polymer composites applications have been critically reviewed. In addition, the impact of polymers and polymer nanocomposites with different fillers such as organic, inorganic, 2D, 3D, mixture and hybrid nano-fillers on EMI shielding effectiveness has been explored. Lastly, future research directions have been proposed to overcome the limitations of current technologies for further advancement in EMI shielding materials for industrial applications. Based on reported literature, it has been found that the low thickness based lightweight polymer is considered as a best material for excellent material for next-generation electronic devices. Optimization of polymer composites during the fabrication is required for better EMI shielding. New nano-fillers such as functionalization and composite polymers are best to enhance the EMI shielding and conductive properties.

The Early (2009-2017) Experience With Robot-assisted Cholecystectomy in New York State.

OBJECTIVE: The aim of this study was to examine real-life patterns of care and patient outcomes associated with robot-assisted cholecystectomy (RAC) in New York State (NYS). BACKGROUND: Although robotic assistance may offer some technological advantages, RACs are associated with higher procedural costs and longer operating times compared to traditional laparoscopic cholecystectomies (LCs). Evidence on long-term patient outcomes after RAC from large population-based datasets remains limited and inconsistent. METHODS: Using NYS inpatient and ambulatory surgery data from the Statewide Planning and Research Cooperative System (2009-2017), we conducted bivariate and multivariate analyses to examine patterns of utilization, complications, and secondary procedures following cholecystectomies. RESULTS: Among 299,306 minimally invasive cholecystectomies performed in NYS between 2009 and 2017, one thousand one hundred eighteen (0.4%) were robot-assisted. Compared to those undergoing LC, RAC patients were older, travelled further for surgery, and were more likely to have public insurance and preoperative comorbidities. RAC versus LC patients were more significantly likely to have conversions to open procedure (4.9% vs 2.8%), bile duct injuries (1.3% vs 0.4%), and major reconstructive interventions (0.6% vs 0.1%), longer median length of stay (3 vs 1 day), readmissions (7.3% vs 4.4%), and higher 12-month post-index surgery hospital charges (P < 0.01 for all estimates). Other postoperative complications decreased over time for LC but remained unchanged for RAC patients. CONCLUSIONS: Patients receiving RAC in NYS experienced higher rates of complications compared to LC patients. Addressing patient-, surgeon-, and system-level factors associated with intra/postoperative complications and applying recently promulgated safe cholecystectomy strategies coupled with advanced imaging modalities like fluorescence cholangiography to RAC may improve patient outcomes.

Influence of Soil Properties and Aging on Antimony Toxicity for Barley Root Elongation.

The study explored the Sb toxicity by investigating the impacts of 10% and 20% effective concentrations (EC10 and EC20, respectively) of Sb on the inhibition of barley root elongation in 21 Chinese soils with a wide range of physicochemical properties after aging for 3 months. The results demonstrated that various soil properties profoundly influenced the Sb toxicity which was ranged from 201-2506 mg Sb kg-1 to 323-2973 mg Sb kg-1 under EC10 and EC20, respectively. Soil sand fraction was a significant soil factor responsible for elevating Sb bioavailability. The bioavailable Sb concentration accounted for 2.08%-11.94% of total Sb content in all 21 soil samples and the decreased Sb bioavailability in this study was attributed to soil properties including soil clay fraction, amorphous and crystalloid iron, and oxides of manganese and aluminum. The findings would contribute in developing Sb toxicity threshold for establishing standard for Sb regulation in crop production.

Co-prescription of ciprofloxacin and statins; a dangerous combination: Case Report.

Drug interaction is a common clinical problem which is often underestimated by physicians. Statins are one of the commonly prescribed medicines worldwide that are generally well tolerated. Muscle-related symptoms have a varied clinical presentation which usually increases if a new medicine is co-prescribed. We report the case of a 65- year-old woman who presented with a 10-day history of extreme fatigue, slowly progressing muscle weakness and insomnia. Drug-induced myopathy was diagnosed with concomitant use of atorvastatin and ciprofloxacin. Muscle weakness improved after the medicines were withdrawn. Co-prescription of Ciprofloxacin and statin therapy appeared to have contributed to muscle weakness in this patient. Drug interaction should also be kept in mind, when managing patients on statins as it may be underappreciated as a cause of muscle weakness and its consequences can have potentially serious outcomes.

Effects of various warming patterns on Cd transfer in soil-rice systems under Free Air Temperature Increase (FATI) conditions.

Global warming has become an important research topic in different disciplines around the world, especially in the fields of environment quality and food security. As a potential problem in soil environments, cadmium (Cd) contamination of rice under global warming conditions has not been thoroughly investigated. In this study, the fate of Cd in soil-rice systems under various warming patterns was studied via pot experiments under Free Air Temperature Increase (FATI) conditions. The patterns of warming included different temperatures (0.5 °C and 0.8 °C), different day-night durations (nighttime, daytime, and the whole day), and different warming stages (WSx) (including WS1 (seedling to tillering), WS2 (jointing to booting), WS3 (heading), WS4 (grain filling to milk ripening)). At harvest, samples of different rice tissues were collected and the Cd concentrations were measured. The results showed that warming significantly increased Cd concentrations in grain by 1.45 and 2.31 times, which was positively correlated with the two temperature increases (0.5 °C and 0.8 °C), respectively. Both daytime and nighttime warming significantly increased the Cd concentration in grain, and the daytime dominated Cd translocation from roots to shoots. In addition, warming in individual growth stages contributed to increases in Cd accumulation in grain by 31.6% (WS1), 15.0% (WS2), 20.6% (WS3), and 32.8% (WS4), respectively. Specifically, warming during the vegetative phase boosted Cd translocation from roots to shoots, while warming during maturation further increased Cd uptake and remobilization into grain. The projected results could provide a new and in-depth understanding of the fate of Cd in soil-rice systems under global warming conditions in Cd contaminated areas.

Comparison of cumulative dispersed energy (CDE) in femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification.

PURPOSE: To compare the amount of phacoemulsification ultrasound energy used between eyes undergoing femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification. METHODS: One eye of consecutive patients undergoing routine non-complicated phacoemulsification from January 2014 to December of 2015 was included in the analysis. FLACS was performed using the Alcon LenSx. Linear regression was used for analysis with type of surgery (FLACS versus conventional phacoemulsification) as the exposure and cumulative dispersed energy (CDE) as the outcome variable. Age, surgeon, eye side, and eye sequence (first versus second eye) were covariates. RESULTS: A total of 1159 surgeries met inclusion criteria. The average age of the cohort was 70.6 (SD 8.6) years, 590 cases (51%) were performed by surgeon 1, and 582 cases (50%) were right eyes. Overall, FLACS resulted in significantly lower CDE as compared to conventional phacoemulsification (ß = 0.89, 95% CI 0.83, 0.95). When stratified by eye side and surgeon, FLACS performed on left eyes operated on by surgeon 1 resulted in lower CDE as compared to conventional phacoemulsification (ß = 0.76, 95% CI 0.66, 0.87), but not for right eyes operated on by surgeon 1 (ß = 0.92, 95% CI 0.79, 1.07) or for eyes operated on by surgeons 2 or 3. CONCLUSIONS: The use of FLACS on the Alcon LenSx platform results in a small decrease in phacoemulsification energy as compared to conventional phacoemulsification in certain cases. Further study assessing optimal laser settings and surgical technique is necessary.

The learning environment of four undergraduate health professional schools: Lessons learned.

BACKGROUND AND OBJECTIVES: Learning is an interplay between cognition and environmental factors. Any learning environment, that fulfills the intrinsic and extrinsic needs of the students will probably lead to better and more promising learning outcomes. This study aimed to investigate the student perceptions of Learning Environment (LE) in four health schools of a large university and compare between schools, years of study, and gender. METHODS: Dundee Ready Education Environment Measure (DREEM) questionnaire and a socio-demographic questionnaire were completed by 1185 undergraduate students enrolled in the school of Medicine, Dentistry, Nursing and Applied Medical Sciences (AMS) of a large university during the academic year 2012-2013. Chi-square test was used to compare categorical variables. Independent student t-test or ANOVA (with Tukey post-hoc test) was used for continuous variables at a significance level of p≤0.05. RESULTS: The mean total DREEM score was 89.23±33.3. The total DREEM mean scores for Dentistry (120.54±23.45) and Medicine (110.72±19.33) were higher compared with AMS (63.48±21.36) and Nursing (57.48±22.80) (p=0.000) (Post hoc Tukey p=0.000). First year students gave significantly higher positive perceptions ratings than the rest of the years (p=0.000). Total scores were significantly higher for male (92.78±33.86) than female students (84.70±32.25) p=0.000. CONCLUSION: The LE significantly differed by year and gender. The students from non-integrated curricula (nursing and AMS) perceived the LE less positively than their integrated curriculum counterparts (medicine and dentistry). A qualitative study is needed to investigate the variation in the perception of LE among these groups.

Phyto-management of chromium contaminated soils through sunflower under exogenously applied 5-aminolevulinic acid.

Soil contamination with heavy metals is threatening the food security around the globe. Chromium (Cr) contamination results in poor quality and reduction in yield of crops. The present research was performed to figure out the Cr toxicity in sunflower and the ameliorative role of 5-aminolevulinic acid (ALA) as a plant growth regulator. The sunflower (FH-614) was grown under increasing concentration of Cr (0, 5, 10 and 20mgkg-1) alone and/or in combination with 5-ALA (0, 10 and 20mgL-1). Results showed that Cr suppressed the overall growth, biomass, gas exchange attributes and chlorophyll content of sunflower plants. Moreover, lower levels of Cr (5 and 10mgkg-1) increased the production of reactive oxygen species (ROS) and electrolyte leakage (EL) along with the activities of antioxidant enzymes i.e., superoxide dismutase (SOD), guaiacole peroxidase (POD), ascorbate (APX), catalase (CAT). But at higher concentration of Cr (20mgkg-1), the activities of these enzymes presented a declining trend. However, the addition of 5-ALA significantly alleviated the Cr-induced toxicity in sunflower plant and enhanced the plant growth and biomass parameters along with increased chlorophyll content, gas exchange attributes, soluble proteins and soil plant analysis development (SPAD) values by scavenging the ROS and lowering down the EL. The 5-ALA also enhanced the activities of antioxidant enzymes at all levels of Cr. The increase in Cr concentration in all plant parts such as leaf, root and stem was directly proportional to the Cr concentration in soil. The application of 5-ALA further enhanced the uptake of Cr and its concentration in the plants. To understand this variation in response of plants to 5-ALA, detailed studies are required on plant biochemistry and genetic modifications.

Lymph node ratio may predict relapse free survival and overall survival in patients with stage II & III colorectal carcinoma.

BACKGROUND/AIMS: Lymph node ratio (LNR) defined as the number of lymph nodes (LNs) involved with metastases divided by number of LNs examined, has been shown to be an independent prognostic factor in breast, stomach and various other solid tumors. Its significance as a prognostic determinant in colorectal cancer (CRC) is still under investigation. This study investigated the prognostic value of LNR in patients with resected CRC. METHODOLOGY: We retrospectively ex- amined 145 patients with stage II & III CRC diagnosed and treated at a single institution during 9 years pe- riod. Patients were grouped according to LNR in three groups. Group 1; LNR < 0.05, Group 2; LNR = 0.05-0.19 & Group 3 > 0.19. Chi square, life table analysis and multivariate Cox regression were used for statistical analysis. RESULTS: On multivariate analysis, number of involved LNs (NILN) (HR = 1.15, 95% CI 1.055-1.245; P = 0.001) and pathological T stage (P = 0.002) were statistically significant predictors of relapse free survival (RFS). LNR as a continuous variable (but not as a categorical variable) was statistically significant predictor of RFS (P = 0.02). LNR was also a statistically significant predictor of overall survival (OS) (P = 0.02). CONCLUSION: LNR may predict RFS and OS in patients with resected stage II & III CRC. Studies with larger cohorts and longer follow up are needed to further examine and validate theprognostic value of LNR.

Percutaneous Acetabuloplasty Compared With Open Reconstruction for Extensive Periacetabular Carcinoma Metastases.

For destructive metastatic periacetabular disease, options include open acetabular reconstruction or percutaneous cement acetabuloplasty (PA). We reviewed 28 consecutive patients with Harrington grade II or III lesions, 17 who underwent Harrington-type or anti-protrusio reconstruction and 11 who underwent PA. Primary outcome measures were performance status (PS), ambulatory status (0=unassisted ambulation, 1=assisted ambulation, 2=nonambulatory), and 10-point VAS score. The surgery group had better pain reduction than the PA group at 3 months (3.6 vs. 1.5 points, P=0.04), and a trend at final follow-up (3.8 vs. 1.4 points, P=0.06). Improvement in ambulatory status was better in the surgery group at 3 months only (0.53 vs. -0.14, P=0.03). Thus compared with PA, open reconstruction may provide improved pain relief and ambulation.

Emergency contraception: Awareness, attitudes and barriers of Saudi Arabian Women.

OBJECTIVES: To assess knowledge, attitude, and barriers about emergency contraception (EC) among married women of child bearing age. METHODS: A quantitative cross-sectional study was conducted over a 6-month period, commencing in March 2013 at Family Practice Clinics of King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia. Data was collected using a structured pretested questionnaire and analyzed using SPSS version 21.0 statistical software. RESULT: A total of 242 women were enrolled in the study. Only 6.2% (15/242) had some knowledge of EC and of these only two had ever used it. Health care professionals were the least reported source of EC information (6.6%, n=1). Majority (73.3%) had negative attitude toward EC being available over-the-counter without a prescription. The most common barriers to using EC were concerns about possible health effects. Only two women (13.3%) considered religious belief as a major hindrance to its use. CONCLUSION: Awareness of emergency contraception is very low among women of Saudi Arabia. Health care professionals were the least reported source of information, which is a cause for concern. Our findings reveal an urgent need to educate women about EC, keeping in view the social norms and the Islamic values.

Advanced Persistent Threat (APT) and intrusion detection evaluation dataset for linux systems 2024.

The novel dataset called Linux-APT Dataset 2024 captures Advanced Persistent Threat (APT) attacks along with other latest and sophisticated payloads. Existing datasets lacks latest attacker's techniques and procedures, APTs tactics and configuration to capture maximum Linux log sources to observe the working and behaviour of an APT in a detailed manner. The environment which supported us in capturing the logs is composed of Linux machines and a centralized logging system configured appropriately to captures and detect all possible events and logs for an APT and other complex intrusion. Unlike Microsoft Windows, Linux logging system are investigated enough and usually systems relies on limited log sources but for an APT, all possible log sources should be evaluated and added to completely analyse the behaviour, trajectory, and operation of an APT. To keep the dataset up to date and realistic, recent payloads and APTs are emulated in the environment. A well-known cyber-security framework 'MITRE ATT&CK' is utilised to map the behaviour and operation in a generalized manner after capturing the events and logs. This dataset can be used for training and conducting a variety of experiments to build as well as design the solutions for detecting most recent intrusions and APT attacks for Linux System.

Correction: Men's knowledge, attitude, and barriers towards emergency contraception: A facility based cross-sectional study at King Saud University Medical City.

[This corrects the article DOI: 10.1371/journal.pone.0249292.].

Efficacy of bisphosphonates and other bone-targeted agents in metastatic bone disease from solid tumors other than breast and prostate cancers.

Metastatic bone disease complicates the course of malignancy in a substantial proportion of patients with advanced cancer. Bisphosphonates are now widely used to improve skeleton-related outcomes of patients with metastatic cancer to the bone. Most studies evaluating the efficacy of bisphosphonates and other bone-targeted agents have been performed in patients with metastatic breast and prostate cancer. Only a few studies have evaluated the role of bisphosphonates in other tumor types involving the skeletal system. We present a review of the clinical literature focusing on the current and potential roles of bisphosphonates (particularly zoledronic acid) and newer bone-targeted therapies in patients with metastasis to bone arising from solid tumors other than breast and prostate cancer.

Views of Family Medicine Trainees of a Teaching Hospital in Riyadh regarding their Hospital Rotations: A Qualitative Study.

OBJECTIVE: To explore Family Medicine Trainees views regarding the hospital component of their Family Medicine (FM) training program. METHODOLOGY: This is a qualitative focus group discussion based study. Thirteen trainees, eight from final year of FM training program and five from third year of the same program participated in the study. The structure for discussion included a previously distributed and completed questionnaire that included three sections. The first section was evaluation of the satisfaction of trainees with the different hospital specialties rotations. The second section related to reasons for rating the different rotations as excellent and very good. The third section related to deficiencies in training for those rotations which received a score of 3-5. The items in the questionnaire were utilized in the focus group discussion. Two facilitators who were investigators facilitated the discussion. The data was qualitatively analyzed to identify emergent themes and subthemes that described the trainees' views. RESULTS: The trainees highlighted the following views: Teaching in the hospital component is not relevant to the needs of Family Medicine trainees. Duration of the hospital posts should be reviewed. Emphasis should be on out-patient clinics rather than in-patient. More emphasis must be given to procedural skills, minor surgery and teaching in clinical contexts. CONCLUSION: Hospital training component of the Family Medicine training program should be reviewed, as the structure and its implementation doesn't reflect the views of trainees regarding its relevance to their day to day practice.

Evaluation of Continuing Professional Development Program for Family Physicians.

OBJECTIVES: To evaluate the King Saud University Continuing Professional Development (CPD) Program for Family Physicians in relation to the Convenience, Relevance, Individualization, Self-Assessment, Interest, Speculation and Systematic (CRISIS) criteria. METHODOLOGY: A descriptive study was conducted at King Saud University (KSU) in Riyadh, Saudi Arabia. The authors used the six strategies of Convenience, Relevance, Individualization, Self-Assessment, Interest, Speculation and Systematic (CRISIS) for evaluation. The program was independently analyzed by the three authors using CRISIS framework. The results were synthesized. The suggestions were discussed and agreed upon and documented. RESULTS: The results indicate that KSU-CPD program meets the CRISIS criteria for effective continuing professional development and offers a useful approach to learning. The course content covers specific areas of practice, but some shortcomings were found that need to be improved like self assessment area and individual learning needs analysis. CONCLUSION: This program is suitable for Family Physicians, as it is well planned and utilizes most of the principles of CRISIS, but there is still room for improvement. Designing a program for general practitioners using hybrid model that offers a blend of e-learning as well as face-to-face learning opportunities would be an ideal solution.

Hepatitis C Prevalence on the Rise but Screening at Safety Net Institutions Lagging behind.

Introduction: In the United States, the hepatitis C virus (HCV) is a leading contributor to liver-related illnesses and fatalities. Despite effective antiviral medications, acute infections have increased in recent years, likely due to IV drug use and the opioid epidemic. Previous guidelines recommended one-time screening for individuals born between 1945 and 1965. The CDC now recommends screening all adults over 18 unless there is a low prevalence in the area. Accurate measurement of HCV prevalence is essential for targeted prevention. In New York, over 100,000 individuals have HCV. We present data on HCV screening at a safety net hospital in Long Island, NY. Objective: To identify screening rates for hepatitis C and the exposure prevalence and specific demographics of a community in Long Island, NY. Methods: We performed a review of all patients seen in our hospital from 2012 to 2019. We identified patients born in the years 1945 to 1965 using our electronic medical record (EMR) system and subsequently analyzed those who were anti-HCV positive. We reviewed their demographics, including age, gender, and ethnicity, as well as their history of intravenous drug use and HIV coinfection status. Basic statistical analysis was used. Results: Our study identified 21,722 patients born between 1945 and 1965 and found that only 8.5% or 1,858 individuals were screened for hepatitis C. Among them, we found that 5.9% (109) tested positive for HCV antibody, with 3.0% (56) having an active infection. Demographic characteristics of those with HCV antibodies included 70.6% male, 53.2% Caucasian, 33.9% Black, and 15.6% persons who inject drugs (PWID). Conclusion: Our study findings suggest that a significant portion of patients in our community had missed opportunities for screening in our hospital. Our community had an estimated 5.9% prevalence, higher than the national and state averages. Caucasian men had higher prevalences. This study suggests the need for broader screening initiatives and more focused resource allocation, perhaps to safety net institutions, to decrease the burden of HCV.

An LSTM-based Gesture-to-Speech Recognition System.

Fast and flexible communication options are limited for speech-impaired people. Hand gestures coupled with fast, generated speech can enable a more natural social dynamic for those individuals - particularly individuals without the fine motor skills to type on a keyboard or tablet reliably. We created a mobile phone application prototype that generates audible responses associated with trained hand movements and collects and organizes the accelerometer data for rapid training to allow tailored models for individuals who may not be able to perform standard movements such as sign language. Six participants performed 11 distinct gestures to produce the dataset. A mobile application was developed that integrated a bidirectional LSTM network architecture which was trained from this data. After evaluation using nested subject-wise cross-validation, our integrated bidirectional LSTM model demonstrates an overall recall of 91.8% in recognition of these pre-selected 11 hand gestures, with recall at 95.8% when two commonly confused gestures were not assessed. This prototype is a step in creating a mobile phone system capable of capturing new gestures and developing tailored gesture recognition models for individuals in speech-impaired populations. Further refinement of this prototype can enable fast and efficient communication with the goal of further improving social interaction for individuals unable to speak.

Prediction of transient and permanent protein interactions using AI methods.

Protein-protein interactions (PPIs) can be classified as permanent or transient interactions based on their stability or lifetime. Understanding the precise details of such protein interactions will pave the way for the discovery of inhibitors and for understanding the nature and function of PPIs. In the present work, 43 relevant physicochemical, geometrical and structural features were calculated for a curated dataset from the literature, comprising of 402 protein-protein complexes of permanent and transient categories, and 5 different Supervised Machine Learning models were developed with Scikit-learn to predict transient and permanent PPI. Additionally, deep learning method with Artificial Neural Network was also performed using Tensor Flow and Keras. Predicted models achieved accuracy ranging from 76.54% to 82.71% and k-NN has achieved the highest accuracy. Detailed analysis of these methods revealed that Interface areas such as Percent interface accessible area, Interface accessible area and Total interface area and the parameters defining the shape of the PPI interface such as Planarity, Eccentricity and Circularity are the most discriminating factors between these two categories. The present method could serve as an effective tool to understand the mechanism of protein association and to predict the transient and permanent interactions, which could supplement the costly and time-consuming experimental techniques.