Gold Nanoparticle-Based Plasmonic Detection of Escherichia coli, Salmonella enterica, Campylobacter jejuni, and Listeria monocytogenes from Bovine Fecal Samples.

Current diagnostic methods for detecting foodborne pathogens are time-consuming, require sophisticated equipment, and have a low specificity and sensitivity. Magnetic nanoparticles (MNPs) and plasmonic/colorimetric biosensors like gold nanoparticles (GNPs) are cost-effective, high-throughput, precise, and rapid. This study aimed to validate the use of MNPs and GNPs for the early detection of Escherichia coli O157:H7, Salmonella enterica spp., Campylobacter jejuni, and Listeria monocytogenes in bovine fecal samples. The capture efficiency (CE) of the MNPs was determined by using Salmonella Typhimurium (ATCC_13311) adjusted at an original concentration of 1.5 × 108 CFU/mL. One (1) mL of this bacterial suspension was spiked into bovine fecal suspension (1 g of fecal sample in 9 mL PBS) and serially diluted ten-fold. DNA was extracted from Salmonella Typhimurium to determine the analytical specificity and sensitivity/LOD of the GNPs. The results showed that the CE of the MNPs ranged from 99% to 100% and could capture as little as 1 CFU/mL. The LOD of the GNPs biosensor was 2.9 µg/µL. The GNPs biosensor was also tested on DNA from 38 naturally obtained bovine fecal samples. Out of the 38 fecal samples tested, 81.6% (31/38) were positive for Salmonella enterica spp., 65.8% (25/38) for C. jejuni, 55.3% (21/38) for L. monocytogenes, and 50% (19/38) for E. coli O157:H7. We have demonstrated that MNP and GNP biosensors can detect pathogens or their DNA at low concentrations. Ensuring food safety throughout the supply chain is paramount, given that these pathogens may be present in cattle feces and contaminate beef during slaughter.

Three-Dimensional-Evaluation of Aortic Changes after Frozen Elephant Trunk (FET) in Zone 0 vs. Zone 2 in Acute Type A Aortic Dissection.

Introduction: The management of aortic dissection has evolved significantly over the decades, with the frozen elephant trunk (FET) procedure emerging as a key technique for treating complex aortic pathologies. Recent practices involve deploying the FET prosthesis more proximally in the aorta (Zone 0) to reduce complications, leading to questions about its impact on long-term aortic remodeling compared to traditional Zone 2 deployment. Methods: This retrospective analysis utilized 3D segmentation software to assess the volumetric changes in aortic remodeling after acute Type A aortic dissections, comparing FET stent graft deployment in Zone 0 and Zone 2. The study included 27 patients operated on between 2020 and 2022, with volumetric measurements taken from postoperative and 6-month follow-up CT scans. Statistical analyses were performed to evaluate the differences in the aortic true lumen (TL) and the perfused false lumen (PFL) between the two groups. Results: Both Zone 0 and Zone 2 deployments resulted in significant true lumen (TL) increases (Z0 p = 0.001, Z2 p < 0.001) and perfused false lumen (PFL) decreases (Z0 p = 0.02, Z2 p = 0.04), with no significant differences in volumetric changes between the groups (p = 0.7 post op and p = 0.9 after 6 months). The distal anastomosis in Zone 0 did not compromise the aortic remodeling outcomes and was associated with reduced distal ischemia and cerebral perfusion times (p = 0.041). The angle measurements in Zone 0 did not show any significant changes after the 6-month control (p = 0.2). However, in Zone 2, a significant change was detected. (p = 0.022). The part comparison analyses did not indicate significant differences in aortic deviation between the groups (p = 0.62), suggesting comparable effectiveness in aortic remodeling. Conclusions: Performing the distal anastomosis more proximally in Zone 0 offers technical advantages without compromising the effectiveness of aortic remodeling compared to the traditional Zone 2 deployment. This finding supports the continued recommendation of Zone 0 deployment in the management of acute Type A aortic dissections, with ongoing studies being needed to confirm the long-term outcomes and survival benefits.

Photo-Physical Characteristics of Janus Green B in Different Solvents and its Interaction Mechanism with Silver Nanoparticles.

This work explores the effects of solvent polarity on Janus Green B (JGB) photophysical properties. The Lippert-Mataga, Billot, and Ravi equations were utilized to calculate the singlet-state excited dipole moments (µe) and ground state dipole moments (µg) using absorption and fluorescence spectra analyses. The results showed an increase in the former, which is suggestive of electronic structural alterations upon excitation. Analysis of fluorescence quantum yield values revealed that JGB's environment had an impact on its emission characteristics; it was particularly sensitive to silver nanoparticles, suggesting possible interactions. While simulations of electron density, electrostatic potential, and energy gap (Eg) helped to understand the electronic structure of JGB, theoretical absorption spectra produced by Time Dependent Density Function Theory (TD-DFT) calculations offered insights into electronic transitions during absorption. To sum up, the present study contributes to our comprehension of the molecular behavior of JGB in various solvents by elucidating the intricate relationship among solvent polarity, molecular environment, and interactions with silver nanoparticles. Additionally, theoretical computations support the interpretation of experimental results.

A Rare Association of Autoimmune Hypophysitis With Seronegative Rheumatoid Arthritis: A Case Report.

Autoimmune hypophysitis (AH) is an uncommon condition where there is inflammation of the pituitary gland which leads to hormonal imbalances. It is often associated with autoimmune diseases; however, a case is yet to be reported with an association of AH with seronegative rheumatoid arthritis (RA). We present a case of a 45-year-old female who complained of polyuria/polydipsia and rapid weight gain. An MRI of the head revealed enlargement of the pituitary gland, concerning for AH. Although she was initially treated for diabetes insipidus, she began reporting new complaints of joint pains and morning stiffness. She was clinically diagnosed with seronegative RA and improved with a trial of hydroxychloroquine. A repeat MRI showed improvement in the abnormal pituitary findings, and the patient was closely monitored with a multidisciplinary approach. Diagnosing and managing patients with AH are topics that are still being explored and researched as it is a relatively rare pathology. Consequently, we found the need to discuss the relationship of AH with seronegative RA and delve into the various diagnostic and treatment approaches.

DNA barcoding, phylogeography and evolutionary dynamics of Chrysichthys auratus.

This study embarked on an exploration into the genetic structure and evolutionary history of the Chrysichthys auratus species, leveraging PCR amplification, phylogenetic trees, and haplotype networks. Specific DNA segments were successfully amplified and visualized through electrophoresis. Newly obtained sequences were Bank into GenBank and given accession numbers (OR730807-OR730808-OR730809). The Neighbor-Joining method provided insights into the evolutionary relationships among taxa, further augmented by bootstrap values and the Tamura 3-parameter method. A comprehensive geographical haplotype network showcased pronounced genetic differentiation, especially between remote populations. Nonetheless, shared haplotypes between proximate regions indicated either ancestral genetic connections or ongoing gene flow. Employing the COI-DNA barcodes, an in-depth understanding of intra- and inter-populational genetic diversity was achieved. The study's findings unravel the intricate genetic landscape and evolutionary dynamics of C. auratus, offering novel perspectives into its demographic history across its vast native habitat.

Sex Differences in Short- and Long-Term Survival after Acute Type A Aortic Dissection.

Background and Objectives: Acute type A aortic dissection (AAD) is a life-threatening disease. No differences between men and women have been made in the treatment of AAD so far and knowledge about sex differences regarding long-term outcomes is limited. Materials and Methods: Between 01/2004 and 12/2021, 874 patients were operated on for AAD, including 313 (35.8%) women and 561 (64.2%) men. Clinical and surgical records, including long-term follow-up information, were obtained and analyzed retrospectively. To account for differences in the outcome determined by different preoperative life expectancies, a subgroup analysis for a set of patients matched according to their remaining life expectancy was performed. Results: At the time of AAD, women were older than men (69.1 ± 13.0 vs. 61.8 ± 13.3 years, p < 0.001) and had a shorter remaining statistical life expectancy (18.6 ± 10.8 vs. 21.4 ± 10.4 years, p < 0.001). Significantly more DeBakey type II AAD was found in women (37.1% vs. 25.7%, p < 0.001). Comorbidities and preoperative status at the time of presentation were similar in women and men. More hemiarch procedures (63.3% vs. 52.0%, p < 0.001) and less arch replacements (8.6% vs. 16.6%, p < 0.001) were performed in women, resulting in shorter cross-clamp times for women (92 ± 39 vs. 102 ± 49 min, p < 0.001). The in-hospital mortality was similar in women and men (11.5% vs. 12.7%, p = 0.618). Long-term survival was significantly shorter in women compared to men (9.8 [8.1-11.5] vs. 15.1 [11.9-18.4] years, p = 0.011). A matched subgroup analysis revealed that when comparing groups with a similar remaining life expectancy, the long-term survival showed no significant differences between women and men (9.8 [7.9-11.6] vs. 12.4 [10.1-14.7] years, p = 0.487). Conclusions: There are sex differences in AAD, with DeBakey type II dissection being more frequent in women. The seemingly worse long-term outcome can mostly be attributed to the shorter remaining statistical life expectancy at the time of presentation.

Microwave-assisted of new derivatives of polyimine conjugated polymer based on Schiff base: synthesis, characterization, and photo-physical properties as a photoluminescent materials.

The condensation of pyrrole-2,5-dicarbaldehyde (1) with 5-(2-amino-4-phenylthiazol-5-yl)-4-phenylthiazol-2-amine (2) and/or 5-(4-Amino-phenyl)-4-phenylthiazol-2-amine (3) gave new poly(Z)-N-((5-(iminomethyl)-1H-pyrrol-2-yl)methylene)-5-(2-((E)-(5-(iminomethyl)-I-pyrrol-2-yl)methyleneamino)-4-phenylthiazol-5-yl)-4-phenylthiaol-2-amine (P1) and/or poly(E)-N-((5-(iminomethyl)-1H-pyrrol-2-yl)methylene)-5-(4-((E)-(5-(iminomethyl)-1H-pyrrol-2-yl)methyleneamino)phenyl)-4-phenylthiaol-2-amine (P2) as a novel conjugated polymer by microwave irradiation and traditional heating.. It is evident that the microwave irradiation technique quickly raised the molecular weight of polyimines. In addition to quantifying the molecular weight of the resultant polyimines. All the polyimines were characterized using FTIR, XRD, H1NMR, TGA, and DSC. The optical characteristics of polyimine derivatives were investigated using a UV-Vis spectrophotometer. The absorption spectra showed a main absorption band around 372 nm for polyimine (P1) and 381 nm for polyimine (P2). The optical energy was calculated and found to be 2.49 and 2.68 eV. The photoluminescence of the polyimine derivatives was measured and analyzed by spectrofluorometer and Laser photoluminescence experiment and the emission color was studied using CIE graphs. The fluorescence spectra showed an emission peak at 548 nm for polyimine (P1) with yellow green color in CIE graph, while for polyimine (P2) the emission band was located at 440.5 nm with blue color in CIE graph. Photoluminescence quantum yield PLQY was measured for the polyimine P1 and P2 in both liquid and Solid states and indicated the AIE behavior of the polyimines. TD-DFT simulations were applied to the polyimine derivatives where the structures were geometrically optimized and the spectroscopic characterizations were evaluated.

Understanding tumor localization in multiparametric MRI of the prostate-effectiveness of 3D printed models.

Introduction: Understanding tumor localization in multiparametric MRI (mpMRI) of the prostate is challenging for urologists but of great importance in mpMRI-fused prostate biopsy or radical prostatectomy. The aim was to evaluate the effectiveness of 3D printed models of the prostate to help urologists to locate tumors. Methods and Participants: 20 urologists from University Medical Center Mainz (Germany) were asked to plot the location of a cancer suspicious lesion (PI-RADS ≥ 4) on a total of 30 mpMRI on a prostate sector diagram. The following 3 groups (as matched triplets) were divided into: mpMRI only, mpMRI with radiological report and mpMRI with 3D printed model (scaled 1:1). Statistical analysis was performed using one-way and two-way ANOVA (with bonferroni post-test). Results: Overall, localization of the suspicious lesion was superior with the radiological report (median of max. 10 [IQR]: MRI 2 [IQR 1;5], MRI + report: 8 [6.3;9], MRI + 3D model 3 [1.3;5.8]; p < 0.001). Residents with <1 year of experience had a significantly higher detection rate using a 3D printed model [5 (5;5.8)] compared to mpMRI alone [1.5 (1;3.5)] (p < 0.05). Regarding the estimation of index lesion extension, the 3D model showed a significant benefit (mean percentage difference [95% CI]: MRI alone 234% [17.1;451.5], MRI + report 114% [78.5;149.6], MRI + 3D model 17% [-7.4;41.3] (p < 0.01). Conclusion: Urologists still need the written radiological report for a sufficient understanding of tumor localization. The effectiveness of the 3D printed model regarding tumor localization is particularly evident in young residents (<1 year) and leads to a better overall assessment of the tumor extension.

Synthesis, electrospinning, and molecular docking of poly(methyl methacrylate) Schiff bases and their applications as polymeric antimicrobial agents and for dye removal.

The antibacterial activity of a variety of modified poly(methyl methacrylate) Schiff bases against common microbial infections and removal of methylene blue (MB) dye were screened. The Schiff bases were synthesized from the reaction of the modified (PMMA) with vanillin (PMMA)Van and cinnamaldehyde (PMMA)Cin. By using Fourier transformer infrared (FT-IR), X-ray diffraction analysis (XRD), thermogravimetric analysis (TGA), and scanning electron microscopy (SEM), the structures of the nanofibers of the synthesized Schiff bases were confirmed. The modified Kirky-Bauer method was used to screen the antibacterial activities of all the obtained materials against various bacterial species, including gram-positive bacterial (Bacillus subtilis (4k1p), Staphylococcus aureus), Gram-negative bacteria (Escherichia coli (7ab3), Pseudomonas aeruginosa). Inhibition zones against gram-positive bacteria ranged in diameter from 7 to 14 mm, whereas for the Gram-negative bacteria, the inhibition zones found to be ranged between 6 and 13 mm. With a minimum bactericidal concentration (MBC) of 8 mg/mL and a minimum inhibitory concentration (MIC) of 2 mg/mL, (PMMA)Van shown the greatest antibacterial activity. Lastly, molecular docking research was done to better understand the interactions between this series' targets and inhibitors for (PMMA)Van and (PMMA)Cin (4k1p and 7ab3). Molecular modeling of these surface-adsorbed polymers indicated that (PMMA)Van binds more strongly with Nitrogen than does (PMMA)Cin through extra hydrogen-bonding interactions. All the developed materials were evaluated for the removal of 0.1 g/L methylene blue dye (MB) from an aqueous solution. The elimination percentage of MB dye ranged from 26.67% by using 0.05 g powder of (PMMA)Cin to 85.63% by employing 0.05 g nanofibers of (PMMA)Van.

Staphylococcus lugdunensis Infective Endocarditis With Mitral Valve Vegetations in a Hemodialysis Patient With Recurrent Arteriovenous Fistula Cannulation: A Case Report.

Infective endocarditis is a severe medical condition that occurs when the endocardium of the heart gets infected by different microorganisms, including coagulase-negative staphylococci such as Staphylococcus lugdunensis. The source of infection is often related to procedures done in the groin area, such as femoral catheterization for cardiac catheterization, vasectomy, or central line placement in an already infected mitral or aortic valve. Herein, we are discussing a case of a 55-year-old female with a past medical history of end-stage renal disease on hemodialysis with a history of recurrent cannulation of her arteriovenous (AV) fistula. She presented with fever, myalgia, and generalized weakness, and was later found to have Staphylococcus lugdunensis bacteremia and infective endocarditis with mitral valve vegetations, for which the patient was transferred to the mitral valve specialized center for mitral valve replacement. This case acts as a reminder to consider recurrent cannulation of the AV fistula as one of the potential ports of entry of Staphylococcus lugdunensis to the body.

Synthesis, Characterization, and Anticancer Potency of Branched Poly (p-Hydroxy Styrene) Schiff-Bases.

A significant issue in cancer biology is finding anticancer therapies that effectively kill cancer cells. Through the use of several aldehydes, Schiff bases based on branched poly (p-hydroxy styrene) are created. The branched polymer is first chloroacetylated, then aminated with 1,4-phenylenediamine, and finally, aldehydes are reacted with the aminated polymer to produce the Schiff base compounds. Through the utilization of FTIR, TGA, XRD, NMR, and elemental analysis, all synthesized Schiff-bases are identified and characterized. Further, the antineoplastic potential of all Schiff bases is evaluated against different cancer cell lines. The results gained from this study indicate that the Schiff base polymers have cytotoxic power against cancer cells depending on cancer cell type and this antiproliferation potency is dose-concentration dependent. Importantly, the prepared S1 Schiff-base polymer shows potent cytotoxicity and is able to trigger the apoptosis and reactive oxygen species (ROS) in MCF-7 cells. Further, it downregulates VEGFR protein expression. The Schiff base polymers would have extensive applications in the biological disciplines.

Structural, optical, and cytotoxicity studies of laser irradiated ZnO doped borate bioactive glasses.

Borate glasses (BG) doped with different amounts of ZnO (0-0.6 mol%) were formed by the traditional melt quenching technique. The different glasses so made were characterized using different characterization techniques such as X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), scanning electron microscope (SEM), and UV-Vis absorption optical properties. The XRD patterns showed an amorphous structure with one broad peak at 2θ = 29°, while the phonons bands were studied in terms of the FTIR bands. Optical properties of the glasses were studied using UV-Vis absorption spectra in the range 190-1100 nm, in which the prominent band lies at about 261.5 nm of peak position, from which the bandgab (Eg) was calculated from its edge using Tauc's plot, with Eg ~ 3.5 eV. The laser irradiation showed no significant changes in the absorption bands, despite a significant change observed in the amorphous behavior in the XRD pattern. The cell viability was performed for two samples of the BG and 0.6 mol% ZnO doped using 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay method. The result showed better cell viability and low toxicity. So, ZnO doped BG can be used in various biomedical applications.

Island remodelling in acute and chronic aortic dissection treated with frozen elephant trunk.

OBJECTIVES: The island technique for reimplantation of supra-aortic vessels in frozen elephant surgery is commonly used but might be questioned for dissected vessels. This study analyses the remodelling of reimplanted supra-aortic vessels after FET in acute and chronic aortic dissection (CAD). METHODS: Between June 2017 and April 2021, 133 patients were operated for acute and CAD using the frozen elephant technique. The island technique for reimplantation of the supra-aortic vessels was used in 94/133 patients. In 68 acute and 21 chronic patients, the total vessel lumen (VL), true lumen, false lumen (FL) and perfused FL area were measured in the innominate, right common carotid and left common carotid artery. Relative luminal changes were compared. RESULTS: In acute aortic dissection, 80% innominate, 40% right carotid and 59% left carotid arteries were dissected preoperatively, but postoperatively FL was only patent in 29%, 12% and 10% (P < 0.001). FL disappearance resulted in >20% total VL reduction in innominate, right carotid and left carotid artery (P < 0.01). In CAD, only 38% innominate, 14% right carotid and 43% left carotid arteries were dissected preoperatively, but postoperatively FL was patent in 19% (ns), 10% (ns) and 5% (P = 0.009). CONCLUSION: Vascular remodelling is frequently found after the island technique. In acute aortic dissection, the island technique frequently initiates FL disappearance associated with VL decrease. Continuously dissected head vessels show positive remodelling with true lumen increase without VL increase. FL disappearance is frequently found in CAD.

Perioperative Safety of Bilateral Internal Thoracic Artery Coronary Bypass in Elderly.

Background: The benefits of utilizing internal thoracic arteries (ITAs) in coronary bypass surgery are well-known. However, the safety of this practice in elderly patients needs to be proven. Methods: We studied all patients who are 75 years of age and older, who received at least one ITA graft while undergoing isolated, conventional (median sternotomy) coronary artery bypass graft surgery (CABG) between Jan 1st 2002 and Dec 31st 2020 (19 years). Emergent surgeries were excluded. Propensity score matching was used to reduce the patient selection effect. Study outcomes were 30-days mortality, and two sets of dependent intraoperative parameters and postoperative parameters. Results: A total of 1855 patients undergoing CABG was included, of which 1114 received a single left (s)ITA and 741 received combined left and right (d)ITA grafts. 519 pairs were matched. The decision for sITA or dITA was made individually. Thirty-days mortality was low and similar in both groups (sITA 3.3%; dITA 2.9%, p = 0.859). The incidence of sternal wound healing disorder was higher after dITA (3.3 vs 6.9%; p < 0.011), which had also a longer skin-to-skin operative time (181 vs 205 min; p < 0.0001). Re-thoracotomy rates were similar (4.6 vs 6.2%; p = 0.340). There were no significant differences in other secondary parameters. Conclusions: harvesting both ITAs in elderly patients is safe and feasible. However, it increases the risk of sternal wound healing disorders. Long term benefit still needs to be proven.

Does Mental Distress Predict Cardiac Surgical Outcome?

BACKGROUND: Mental distress is suspected to influence the morbidity of cardiac patients. Evaluating mental distress in cardiac patients is rare and the impact on surgical outcome is still not certified. METHODS: In 94 cardiac surgical patients, mental distress was assessed by the Patient Health Questionnaire-4 (PHQ-4). We defined length of stay in hospital and on intensive care unit as well as time of mechanical ventilation as outcomes on surgery. Age, physical activity, diabetes, overweight, PHQ-4, and an inflammation marker were tested for their predictive value on outcomes. RESULTS: Reportedly prevalence of generalized anxiety was 16.0% and depression rate was 13.8%. Length of stay in hospital was 13 ± 8 days, time of mechanical ventilation was 10 (0-1,207) hours, and length of stay on intensive care unit was 3 ± 6 days. Length of stay in hospital was significantly predicted by age (p = 0.048), low physical activity (p = 0.029), and high C-reactive protein (CRP; p = 0.031). Furthermore, CRP was the only significant predictor of time of mechanical ventilation and length of stay on intensive care unit. CONCLUSION: Outcome was not predicted by mental distress. However, inflammation marker CRP was predictive for outcome, potentially caused by higher cardiovascular risk profile. Additionally, depression was referred to be associated with inflammation. Probably, the small sample and the timing of assessment were responsible for the missing relation between mental distress and outcome. We presume a relation with low physical activity and depression. Nevertheless, further randomized studies are needed to pay more attention on patients' distress to intervene preoperatively to improve postoperative outcome.

Simulation of Biomass Air Gasification in a Bubbling Fluidized Bed Using Aspen Plus: A Comprehensive Model Including Tar Production.

This work studied a multistage gasification system that is designed for producing a syngas with a low tar content. The proposed system is an atmospheric bubbling fluidized-bed gasifier and comprises mainly pyrolysis, combustion, and gasification zones. The numerical investigation is performed using Aspen Plus to study Prosopis Juliflora gasification. Chemical reactions as well as tar treatment in the process are investigated. Two different pyrolysis temperatures were considered: 500 and 600 °C, along with three different particle size ranges: 0.2-0.5, 0.5-1, and 1-2 mm. The effect of the air-to-biomass ratio, with values from 0.2 to 1.2, and the gasification reactor temperature, from 800 to 1000 °C, on the composition of product gas and tar species formation during the process (phenol, naphthalene, benzene, and toluene), its lower heating value (LHV), and cold gasification efficiency (CGE) were studied. Results showed that a pyrolysis temperature of 600 °C and a particle size range of 0.2-0.5 mm displayed less tar produced from both combustion and gasification zones and were associated with greater CO, H2, and CH4 yields, compared to the other pyrolysis parameters tested. Increasing the gasification temperature led to increasing the CO, H2, and tar yields and decreasing the CH4 yield and CGE. The maximum CGE combined with the minimum tar amount produced could be obtained with values of 800 °C and 1.2 for the gasification temperature and the air-to-biomass ratio, respectively. The numerical simulation results will be used to improve the performance of the proposed system.

Training Cardiac Surgeons: Safety and Requirements.

To analyze whether cardiac surgical residents can perform their first surgeries without compromising patients' safety or outcomes, by comparing their performance and results to those of senior surgeons. All documented CABGs conducted between 2002 and 2020 were included. Surgeries were divided according to the experience level of the main surgeon (defined by the number of CABG conducted by him/her) using the following thresholds: 1000; 150; 80 and 35. This resulted in 5 groups: senior surgeons (the reference group); attending surgeons; fellow surgeons; advanced residents and new residents. Primary endpoint was 30 day mortality. Secondary endpoints included a list of intra and post-operative parameters (including in-hospital complications). A multivariable analysis was conducted. 16,486 CABG were conducted by 66 different surgeons over a period of 18 years. Multivariable analysis did not find significant differences between both the primary and the secondary endpoints. Skin-to-skin time correlated significantly with experience level, as new residents needed almost 30% more time than senior surgeons (234 vs 180 minutes). With a suitable supervision by experienced surgeons, patient selection and sufficient resources (longer duration of surgery), surgical residents can perform CABGs with good results and without compromising the patient's outcome.

Flexibility during the COVID-19 Pandemic Response: Healthcare Facility Assessment Tools for Resilient Evaluation.

Healthcare facilities are facing huge challenges due to the outbreak of COVID-19. Around the world, national healthcare contingency plans have struggled to cope with the population health impact of COVID-19, with healthcare facilities and critical care systems buckling under the extraordinary pressures. COVID-19 has starkly highlighted the lack of reliable operational tools for assessing the level sof flexibility of a hospital building to support strategic and agile decision making. The aim of this study was to modify, improve and test an existing assessment tool for evaluating hospital facilities flexibility and resilience. We followed a five-step process for collecting data by (i) doing a literature review about flexibility principles and strategies, (ii) reviewing healthcare design guidelines, (iii) examining international healthcare facilities case studies, (iv) conducting a critical review and optimization of the existing tool, and (v) assessing the usability of the evaluation tool. The new version of the OFAT framework (Optimized Flexibility Assessment Tool) is composed of nine evaluation parameters and subdivided into measurable variables with scores ranging from 0 to 10. The pilot testing of case studies enabled the assessment and verification the OFAT validity and reliability in support of decision makers in addressing flexibility of hospital design and/or operations. Healthcare buildings need to be designed and built based on principles of flexibility to accommodate current healthcare operations, adapting to time-sensitive physical transformations and responding to contemporary and future public health emergencies.

Association of vitamin B12 deficiency with metformin use in patients with type 2 diabetes treated in the largest tertiary care hospital in Qatar.

BACKGROUND: Data on the effect of metformin on serum vitamin B12 (VitB12) level in patients with type 2 diabetes mellitus (T2DM) in Qatar are limited; therefore, we aimed to assess the prevalence of VitB12 deficiency and its related factors among patients with tbl2DM treated with metformin at Hamad General Hospital in Doha, Qatar, from January 1, 2017, to December 31, 2017. METHODS: This cross-sectional analytical study involved patients with tbl2DM aged ≥ 18 years who used metformin for at least 3 months. The serum VitB12 was quantified on a chemiluminescent enzyme immunoassay analyzer using Cobas e 801 module, Roche, and VitB12 deficiency was defined as serum VitB12 level of ≤ 145 pmol/L. All data were obtained from the patients' electronic medical records. RESULTS: The study recruited 3124 eligible patients with tbl2DM. The overall prevalence of metformin-associated VitB12 deficiency was 30.7% [95% confidence of interval, 0.290-0.323]. A significant difference exists in the median VitB12 levels between the VitB12-normal and VitB12-deficient groups [129 vs. 286; p < 0.001]. Compared with the VitB12-normal group, the VitB12-deficient group had higher mean body mass index (BMI) (p < 0.001) and consumed higher doses of metformin (p = 0.001). They also more often used sulfonylurea (p = 0.004), dipeptidyl peptidase-4 inhibitor (p < 0.001), thiazolidinediones (p < 0.001), glucagon-like peptide 1 [GLP-1] receptor agonists (p < 0.001), alpha-glucosidase inhibitor (p < 0.001), and H2 blocker/proton pump inhibitors [PPI] (p < 0.001) than the VitB12-normal group. Moreover, the VitB12-normal group consumed more calcium supplements (p < 0.001) than the VitB12-deficient group. In the multivariate analysis, independent risk factors for metformin-associated VitB12 deficiency in patients with tbl2DM include high daily dose of metformin >2000 mg, male gender, high BMI, smoking, sulfonylurea, dipeptidyl peptidase-4 inhibitor, H2 blockers/PPI, low fasting blood glucose, and low hemoglobin. CONCLUSION: This study showed a high prevalence of VitB12 deficiency in patients with tbl2DM taking metformin and a significant negative correlation between the daily dose of metformin and serum VitB12 level. Therefore, regular screening for serum VitB12 is necessary in patients with tbl2DM on metformin treatment, especially those who have the abovementioned risk factors.

Negative effect of high-level infrasound on human myocardial contractility: In-vitro controlled experiment.

BACKGROUND: Human exposure to infrasound is increasing due to man-made factors, such as occupational conditions, wind farms and transportation. The concern among the public regarding the safety of infrasound exposure is growing. AIMS: To evaluate whether exposure to infrasound interferes directly with human cardiac function and contributes to pathological processes. SETTING: The University Hospital of Mainz, Germany. METHODS: Human myocardial tissues, obtained from patients undergoing cardiac surgery, were prepared in small muscle samples and stimulated electrically in-vitro for a period of almost two hours under physiological conditions to induce continuous pulsatile contractions and simulating a working human heart. Two samples were obtained from each donor: one was subjected to infrasound for 60 min and the other served as a control. Their contraction forces (CF) and durations (CD) were measured before and after each testing period and their relative changes (CF% and CD%) were calculated and introduced in a multilinear regression model. The following three infrasound levels of exposure were used in this study: 100, 110 and 120 dBz. RESULTS: The measured CF% corresponded negatively with the infrasound level measured in dBz (R2 = 0.631; P = 0.018). The decrease measured almost -11% at 110 dBz and -18% at 120 dBz, after correction for control. The CD on the other hand remained unchanged. CONCLUSIONS: Exposure to high levels of infrasound (more than 100 dBz) interferes with cardiac muscle contractile ability, as early as one hour after exposure. There are numerous additional studies which support this conclusion. These results should be taken into account when considering environmental regulations.