A microbiota-directed complementary food intervention in 12-18-month-old Bangladeshi children improves linear growth.

BACKGROUND: Globally, stunting affects ∼150 million children under five, while wasting affects nearly 50 million. Current interventions have had limited effectiveness in ameliorating long-term sequelae of undernutrition including stunting, cognitive deficits and immune dysfunction. Disrupted development of the gut microbiota has been linked to the pathogenesis of undernutrition, providing potentially new treatment approaches. METHODS: 124 Bangladeshi children with moderate acute malnutrition (MAM) enrolled (at 12-18 months) in a previously reported 3-month RCT of a microbiota-directed complementary food (MDCF-2) were followed for two years. Weight and length were monitored by anthropometry, the abundances of bacterial strains were assessed by quantifying metagenome-assembled genomes (MAGs) in serially collected fecal samples and levels of growth-associated proteins were measured in plasma. FINDINGS: Children who had received MDCF-2 were significantly less stunted during follow-up than those who received a standard ready-to-use supplementary food (RUSF) [linear mixed-effects model, ßtreatment group x study week (95% CI) = 0.002 (0.001, 0.003); P = 0.004]. They also had elevated fecal abundances of Agathobacter faecis, Blautia massiliensis, Lachnospira and Dialister, plus increased levels of a group of 37 plasma proteins (linear model; FDR-adjusted P < 0.1), including IGF-1, neurotrophin receptor NTRK2 and multiple proteins linked to musculoskeletal and CNS development, that persisted for 6-months post-intervention. INTERPRETATION: MDCF-2 treatment of Bangladeshi children with MAM, which produced significant improvements in wasting during intervention, also reduced stunting during follow-up. These results suggest that the effectiveness of supplementary foods for undernutrition may be improved by including ingredients that sponsor healthy microbiota-host co-development. FUNDING: This work was supported by the BMGF (Grants OPP1134649/INV-000247).

Exploring the nutraceutical potential: Evaluating the nutritional and bioactive functions of five pomelo fruit varieties in Bangladesh.

Pomelo (Citrus maxima), the largest citrus fruit, provides a variety of nutrients that have several health benefits, including antioxidant and antidiabetic functions. Antioxidants help combat oxidative stress by neutralizing reactive oxygen species (ROS) and reducing cellular damage. On the other hand, antidiabetic properties involve mechanisms such as enhancing insulin secretion, improving insulin sensitivity, inhibiting carbohydrate digestion and absorption, and regulating glucose metabolism. However, there is a lack of data on the comparative analysis of the physicochemical composition, bioactive properties, and antidiabetic effects of pomelo fruits grown in Bangladesh. To address this issue, the most common and popular high-yielding five cultivars of pomelo fruits grown in Bangladesh including LOCAL, BARI-2 (BARI: Bangladesh Agricultural Research Institute, Batabi Lebu-2), BARI-3, BARI-4, and BARI-6 were evaluated concerning proximate, minerals, and physicochemical properties with their antidiabetic and antioxidant properties. Research has revealed that all pomelo varieties contained a significant amount of proximate compositions and major minerals (Ca, Mg, K, Na, and Fe). The highest juice yield (75.37 ± 0.33 %), vitamin C content (79.56 ± 2.26 mg/100 mL of fresh juice), and carotenoid content (919.33 ± 0.62 µM ß-Carotene Equivalent/g DM) were found in BARI-3 pomelo fruit and adhered to the sequence (p < 0.05): BARI-3 > LOCAL > BARI-4 > BARI-6 > BARI-2; BARI-3 > LOCAL > BARI-2 > BARI-4 > BARI-6, and BARI-3 > BARI-2 > BARI-6 > LOCAL > BARI-4, respectively. The anthocyanin content and inhibitory activity of α-glucosidase were found to be at their peak in the BARI-2 pomelo variety and the values were 50.65 ± 2.27 µg cyanidin 3-glucoside equivalents/100 g DM and 85.57 ± 0.00 µM acarbose equivalents/g DM, respectively. BARI-3 pomelo variety showed highest DPPH antioxidant capacity (170.47 ± 0.01 µM Trolox equivalents/g DM), while the BARI-6 pomelo variety exhibited the highest total phenolic content (6712.30 ± 1.84 µg gallic acid equivalents/g DM), and ferric-reducing antioxidant power activity (183.16 ± 0.01 µM Fe(II) equivalents/g DM). Therefore, this study explores the nutritional value and bioactivity of five popular pomelo varieties in Bangladesh, offering valuable insights for utilizing high-value citrus resources and understanding their health-promoting functions.

Insights into the Transmission, Host Range, Genomics, Vaccination, and Current Epidemiology of the Monkeypox Virus.

This review delves into the historical context, current epidemiological landscape, genomics, and pathobiology of monkeypox virus (MPXV). Furthermore, it elucidates the present vaccination status and strategies to curb the spread of monkeypox. Monkeypox, caused by the Orthopoxvirus known as MPXV, is a zoonotic ailment. MPXV can be transmitted from person to person through respiratory droplets during prolonged face-to-face interactions. While many cases of monkeypox are self-limiting, vulnerable groups such as young children, pregnant women, and immunocompromised individuals may experience severe manifestations. Diagnosis predominantly relies on clinical presentations, complemented by laboratory techniques like RT-PCR. Although treatment is often not required, severe cases necessitate antiviral medications like tecovirimat, cidofovir, and brincidofovir. Vaccination, particularly using the smallpox vaccine, has proven instrumental in outbreak control, exhibiting an efficacy of at least 85% against mpox as evidenced by data from Africa. Mitigating transmission requires measures like wearing surgical masks, adequately covering skin lesions, and avoiding handling wild animals.

Rotavirus trends and distribution of genotypes before and during COVID-19 pandemic era: Bangladesh, 2017-2021.

Rotavirus gastroenteritis is accountable for an estimated 128 500 deaths among children younger than 5 years worldwide, and the majority occur in low-income countries. Although the clinical trials of rotavirus vaccines in Bangladesh revealed a significant reduction of severe rotavirus disease by around 50%, the vaccines are not yet included in the routine immunization program. The present study was designed to provide data on rotavirus diarrhea with clinical profiles and genotypes before (2017-2019) and during the COVID-19 pandemic period (2020-2021). Fecal samples were collected from 2% of the diarrheal patients at icddr,b Dhaka hospital of all ages between January 2017 and December 2021 and were tested for VP6 rotavirus antigen using ELISA. The clinical manifestations such as fever, duration of diarrhea and hospitalization, number of stools, and dehydration and so on were collected from the surveillance database (n = 3127). Of the positive samples, 10% were randomly selected for genotyping using Sanger sequencing method. A total of 12 705 fecal samples were screened for rotavirus A antigen by enzyme immunoassay. Overall, 3369 (27%) were rotavirus antigen-positive, of whom children <2 years had the highest prevalence (88.6%). The risk of rotavirus A infection was 4.2 times higher in winter than in summer. Overall, G3P[8] was the most prominent genotype (45.3%), followed by G1P[8] (32.1%), G9P[8] (6.8%), and G2P[4] (6.1%). The other unusual combinations, such as G1P[4], G1P[6], G2P[6], G3P[4], G3P[6], and G9P[6], were also present. Genetic analysis on Bangladeshi strains revealed that the selection pressure (dN/dS) was estimated as <1. The number of hospital visits showed a 37% drop during the COVID-19 pandemic relative to the years before the pandemic. Conversely, there was a notable increase in the rate of rotavirus positivity during the pandemic (34%, p < 0.00) compared to the period before COVID-19 (23%). Among the various clinical symptoms, only the occurrence of watery stool significantly increased during the pandemic. The G2P[4] strain showed a sudden rise (19%) in 2020, which then declined in 2021. In the same year, G1P[8] was more prevalent than G3P[8] (40% vs. 38%, respectively). The remaining genotypes were negligible and did not exhibit much fluctuation. This study reveals that the rotavirus burden remained high during the COVID-19 prepandemic and pandemic in Bangladesh. Considering the lack of antigenic variations between the circulating and vaccine-targeted strains, integrating the vaccine into the national immunization program could reduce the prevalence of the disease, the number of hospitalizations, and the severity of cases.

Are young and older children with diarrhea presenting in the same way?

BACKGROUND: Diarrhoea is a global health problem. More than a quarter of diarrhoeal deaths occur among children less than five years. Different literatures analyzed presentation and outcomes of less than five diarrhoeal children. The world has made remarkable progress in reducing child mortality. So, older children are growing in number. Our aim was to identify clinical differentials and variations of pathogens among younger (less than five) and older (five to nine years) diarrhoeal children. METHOD: Data were extracted from the diarrhoeal disease surveillance system (DDSS) of Dhaka Hospital (urban site) and Matlab Hospital (rural site) of the International Centre for Diarrhoeal Disease Research, Bangladesh for the period of January 2012 to December 2021. Out of 28,781 and 12,499 surveillance patients in Dhaka and Matlab Hospital, 614 (2.13%) and 278 (2.22%) children were five to nine-years of age, respectively. Among under five children, 2456 from Dhaka hospital and 1112 from Matlab hospital were selected randomly for analysis (four times of five to nine years age children, 1:4). RESULTS: Vomiting, abdominal pain, and dehydrating diarrhoea were significantly higher in older children in comparison to children of less than five years age (p-value <0.05) after adjusting study site, gender, antibiotic use before hospitalization, diarrhoeal duration < 24 hours, intake of oral rehydration fluid at home, parental education, WASH practice and history of cough. Vibrio. cholerae, Salmonella, and Shigella were the common fecal pathogen observed among older children compared to under five after adjusting for age, gender and study site. CONCLUSION: Although percentage of admitted diarrhoeal children with five to nine years is less than under five years children but they presented with critical illness with different diarrhoeal pathogens. These observations may help clinicians to formulate better case management strategies for children of five to nine years that may reduce morbidity.

Letter to the editor 'Prednisolone 20 mg vs. 40 mg in complex regional pain syndrome type I: An imperative consideration'.

Corticosteroids are a potential treatment to combat Complex Regional Pain Syndrome, however the adverse effect profile far outweighs the benefits of using them. Avascular necrosis and Osteonecrosis are among well defined adverse effects. Postmenopausal women are especially affected by corticosteroids due to loss of estrogen. Diabetics are an interesting study as their pain perception is altered due to either high cortisol levels or the development of peripheral neuropathy.

Development of eco-friendly biofilms by utilizing microcrystalline cellulose extract from banana pseudo-stem.

Banana pseudo-stem, often considered as an underutilized plant part was explored as a potential reinforced material to develop an eco-friendly biofilm for food packaging applications. In this study, Microcrystalline cellulose (MCC) was extracted from banana pseudo-stem by alkali and acid hydrolysis treatment. The extracted MCC was used as a reinforced material in different concentrated polyvinyl alcohol (PVA) matrix alone as well as both PVA and Carboxymethyl Cellulose (CMC) matrix to develop biofilm by solvent casting method. The synthesized MCC powder was characterized by scanning electron microscope to ensure its microcrystalline structure and to observe surface morphology. The biofilms composed of MCC, PVA, and CMC were assessed through Fourier-transform infrared spectroscopy (FTIR), mechanical properties, water content, solubility, swelling degree, moisture barrier property (Water Vapor Permeability - WVP), and light barrier property (Light Transmission and Transparency). The FTIR analysis showed the rich bonding between the materials of the biofilms. The film incorporating a combination of PVA, CMC, and MCC (S6) exhibited the highest tensile strength at 26.67 ± 0.152 MPa, making it particularly noteworthy for applications in food packaging. MCC incorporation increased the tensile strength. The WVP content of the films was observed low among the MCC-induced films which is parallel to other findings. The lowest WVP content was showed by 1% concentrated PVA with MCC (S4) (0.223 ± 0.020 10-9 g/Pahm). The WVP content of S6 film was also considerably low. MCC-incorporated films also acted as a good UV barrier. Transmittance of the MCC induced films at UV range were observed on average 38% (S2), 36% (S4) and 6% (S6) which were almost 6% lower than the control films. The S6 film demonstrated the lowest swelling capacity (1.42%) and water content, indicating a significantly low solubility of the film. The film formulated with mixing of PVA, CMC and MCC (S6) was ahead in terms of food packaging characteristics than other films. Also, the outcomes of this study point out that MCC can be a great natural resource for packaging applications and in that regard, banana pseudo-stem proves to be an excellent source for waste utilization.

Trends and challenges of fruit by-products utilization: insights into safety, sensory, and benefits of the use for the development of innovative healthy food: a review.

A significant portion of the human diet is comprised of fruits, which are consumed globally either raw or after being processed. A huge amount of waste and by-products such as skins, seeds, cores, rags, rinds, pomace, etc. are being generated in our homes and agro-processing industries every day. According to previous statistics, nearly half of the fruits are lost or discarded during the entire processing chain. The concern arises when those wastes and by-products damage the environment and simultaneously cause economic losses. There is a lot of potential in these by-products for reuse in a variety of applications, including the isolation of valuable bioactive ingredients and their application in developing healthy and functional foods. The development of novel techniques for the transformation of these materials into marketable commodities may offer a workable solution to this waste issue while also promoting sustainable economic growth from the bio-economic viewpoint. This approach can manage waste as well as add value to enterprises. The goal of this study is twofold based on this scenario. The first is to present a brief overview of the most significant bioactive substances found in those by-products. The second is to review the current status of their valorization including the trends and techniques, safety assessments, sensory attributes, and challenges. Moreover, specific attention is drawn to the future perspective, and some solutions are discussed in this report.

Complete genome sequence of hepatitis B virus identified from a patient suffering from chronic kidney disease in Bangladesh.

Hepatitis B virus (HBV) infection is reported as a risk factor for chronic kidney disease (CKD). In this study, we sequenced the complete genome of an HBV strain identified in a CKD patient in Bangladesh, followed by genomic characterization and mutational analyses.

Prognostic accuracy of early warning scores for predicting serious illness and in-hospital mortality in patients with COVID-19.

A simple bedside triage tool is essential to stratify COVID-19 patients in the emergency department (ED). This study aimed to identify an early warning score (EWS) that could best predict the clinical outcomes in COVID-19 patients. Data were obtained from medical records of 219 laboratory-confirmed COVID-19 positive patients. We calculated 13 EWSs based on the admission characteristics of the patients. Receiver operating characteristic (ROC) curve analysis was used to assess the performance of the scores in predicting serious illness and in-hospital mortality. The median patient age was 51 (38, 60) years, and 25 (11.4%) patients died. Among patients admitted with mild to moderate illness (n = 175), 61 (34.9%) developed serious illness. Modified National Early Warning Score (m-NEWS) (AUROC 0.766; 95% CI: 0.693, 0.839) and Rapid Emergency Medicine Score (REMS) (AUROC 0.890; 95% CI: 0.818, 0.962) demonstrated the highest AUROC point estimates in predicting serious illness and in-hospital mortality, respectively. Both m-NEWS and REMS demonstrated good accuracy in predicting both the outcomes. However, no significant difference was found between m-NEWS (p = 0.983) and REMS (p = 0.428) as well as some other EWSs regarding the AUROCs in predicting serious illness and in-hospital mortality. We propose m-NEWS could be used as a triage score to identify COVID-19 patients at risk of disease progression and death especially in resource-poor settings because it has been explicitly developed for risk stratification of COVID-19 patients in some countries like China and Italy. However, this tool needs to be validated by further large-scale prospective studies.

A stroke prediction framework using explainable ensemble learning.

The death of brain cells occurs when blood flow to a particular area of the brain is abruptly cut off, resulting in a stroke. Early recognition of stroke symptoms is essential to prevent strokes and promote a healthy lifestyle. FAST tests (looking for abnormalities in the face, arms, and speech) have limitations in reliability and accuracy for diagnosing strokes. This research employs machine learning (ML) techniques to develop and assess multiple ML models to establish a robust stroke risk prediction framework. This research uses a stacking-based ensemble method to select the best three machine learning (ML) models and combine their collective intelligence. An empirical evaluation of a publicly available stroke prediction dataset demonstrates the superior performance of the proposed stacking-based ensemble model, with only one misclassification. The experimental results reveal that the proposed stacking model surpasses other state-of-the-art research, achieving accuracy, precision, F1-score of 99.99%, recall of 100%, receiver operating characteristics (ROC), Mathews correlation coefficient (MCC), and Kappa scores 1.0. Furthermore, Shapley's Additive Explanations (SHAP) are employed to analyze the predictions of the black-box machine learning (ML) models. The findings highlight that age, BMI, and glucose level are the most significant risk factors for stroke prediction. These findings contribute to the development of more efficient techniques for stroke prediction, potentially saving many lives.

Effect of Gut Microbiota-Directed Complementary Food Supplementation on Fecal and Plasma Biomarkers of Gut Health and Environmental Enteric Dysfunction in Slum-Dwelling Children with Moderate Acute Malnutrition.

Dietary supplementation with a gut microbiota-directed complementary food (MDCF-2) significantly improved weight gain and repaired gut microbiota, as reported in a recent randomized controlled trial on Bangladeshi children with moderate acute malnutrition (MAM). Environmental enteric dysfunction (EED) is a small bowel disorder, and recent evidence shows that it is linked to growth failure in children. Therefore, we intended to investigate whether supplementation with MDCF-2 has any role in modifying gut health by changing the levels of biomarkers of EED and gut inflammation in children with MAM. We randomly assigned 124 children aged 12-18 months to one of two intervention diets, either MDCF-2 or ready-to-use supplementary food (RUSF). Approximately 50 g of the diet was administered in two feeding sessions daily for 12 weeks. Stool and plasma biomarkers were assessed to evaluate intestinal health. Results showed that the average change in citrulline concentration (µmol/L) significantly increased among children who consumed MDCF-2 compared to those who consumed RUSF (mean difference-in-differences: 123.10; 95% CI: 3.60, 242.61; p = 0.044). The research findings demonstrated that MDCF-2 might have a beneficial effect on improving the gastrointestinal health of malnourished children.

Development of functional noodles by encapsulating mango peel powder as a source of bioactive compounds.

Antioxidant compounds such as phenolics and carotenoids scavenge reactive oxygen species and protect against degenerative diseases such as cancer and cardiovascular disease when used as food additives or supplements. Mango peel is a by-product of mango which is a good source of bioactive substances such as phytochemicals, antioxidants, and dietary fibers. Unfortunately, the study on mango peel as a potential food additive is very limited. Accordingly, the present study aimed to develop functional noodles through extrusion technology with the encapsulation of mango peel powder as a natural source of bioactive compounds. First, mango peel powder (MPP) was prepared and incorporated during the mixing of ingredients before noodles formation at three different levels (2.5, 5 and 7.5 %). Afterward, the noodles were studied to determine how the encapsulated MPP affects the proximate composition, physicochemical characteristics, polyphenols, carotenoids, anthocyanin, antioxidant and antidiabetic activity, and sensory characteristics. The noodles exhibited a dose-dependent relationship in the content of bioactive components and functional activities with the encapsulation of MPP levels. A significantly (p 0.05) higher value was noticed in 7.5 % of MPP-encapsulated noodles than in any level of MPP encapsulation in noodles. The fiber and protein contents in the MPP-encapsulated noodles were increased by about 0-1.22 % and 0-3.16 %, respectively. However, noodles' color index and water absorption index were decreased with the level of MPP encapsulation. The cooking loss of noodles increased from 4.64 to 5.17, 6.49, and 7.32 %, whereas the cooked weight decreased from 35.11 to 34.40, 33.65, and 33.23 % with 2.5, 5.0, and 7.5 % of MPP encapsulation, respectively. However, MPP was stable during storage of noodles exhibiting higher phenolic content and antioxidant activity than control samples. The sensory evaluation showed that MPP-encapsulated noodles at levels 2.5 and 5 % had approximately similar overall acceptability values with the control sample. As a result of the findings, it appears that adding MPP up to 5 % to noodles improves their nutritional quality without changing their cooking, structural, or sensory aspects. Therefore, mango peel powder can be a potential cheap source for the development of functional noodles and food ingredients.

Alteration of stool pH and its association with biomarkers of gut enteropathy among slum-dwelling women of reproductive age in Bangladesh.

BACKGROUND: Recent evidence suggests that measures of maternal gut enteropathy are associated with unfavorable fetal outcomes. It is, therefore, crucial to identify and treat the features of intestinal enteropathy among reproductive-age women living in areas where enteropathy is highly prevalent. However, there is a lack of non-invasive diagnostic tests to determine EED, making it difficult to identify the disease in field settings. In this study, we tested the potential of fecal pH as a biomarker of gut enteropathy and investigated its relationship with fecal biomarkers of intestinal enteropathy in reproductive-age women living in resource-limited environments. METHODS: Data on socio-demographic information, anthropometry, and biological samples were collected from 78 apparently healthy women aged between 20 and 27 years from November 2018 to December 2019. The association of stool pH with two fecal biomarkers of gut enteropathy (i.e., intestinal alkaline phosphatase [IAP] and fecal lipocalin-2 [LCN-2] was investigated using multiple linear regression models after adjusting for relevant covariates. RESULTS: In the adjusted models, alkaline stool pH (pH > 7.2) was found to be significantly associated with a decrease in the fecal IAP level by 1.05 unit (95% CI: -1.68, -0.42; p < 0.001) in the log scale, and acidic stool pH (pH < 6) was found to be significantly associated with an increase in the fecal LCN-2 level by 0.89 units (95% CI: 0.12, 1.67; p < 0.025) in the log scale. CONCLUSIONS: The study findings demonstrated an association of fecal pH with biomarkers of gut enteropathy indicating its applicability as a simple tool for understanding intestinal enteropathy among reproductive-age women living in resource-limited settings.

A semiconducting hybrid of RhOx/GaN@InGaN for simultaneous activation of methane and water toward syngas by photocatalysis.

Prior to the eventual arrival of carbon neutrality, solar-driven syngas production from methane steam reforming presents a promising approach to produce transportation fuels and chemicals. Simultaneous activation of the two reactants, i.e. methane and water, with notable geometric and polar discrepancy is at the crux of this important subject yet greatly challenging. This work explores an exceptional semiconducting hybrid of RhOx/GaN@InGaN nanowires for overcoming this critical challenge to achieve efficient syngas generation from methane steam reforming by photocatalysis. By coordinating density functional theoretical calculations and microscopic characterizations, with in situ spectroscopic measurements, it is found that the multifunctional RhOx/GaN interface is effective for simultaneously activating both CH4 and H2O by stretching the C-H and O-H bonds because of its unique Lewis acid/base attribute. With the aid of energetic charge carriers, the stretched C-H and O-H bonds of reactants are favorably cleaved, resulting in the key intermediates, i.e. *CH3, *OH, and *H, to sit on Rh sites, Rh sites, and N sites, respectively. Syngas is subsequently produced via energetically favored pathway without additional energy inputs except for light. As a result, a benchmarking syngas formation rate of 8.1 mol·gcat-1·h-1 is achieved with varied H2/CO ratios from 2.4 to 0.8 under concentrated light illumination of 6.3 W·cm-2, enabling the achievement of a superior turnover number of 10,493 mol syngas per mol Rh species over 300 min of long-term operation. This work presents a promising strategy for green syngas production from methane steam reforming by utilizing unlimited solar energy.

Supplementary Motor Area Activity Differs in Parkinson's Disease with and without Freezing of Gait.

The study aimed to investigate the neural changes that differentiate Parkinson's disease patients with freezing of gait and age-matched controls, using ambulatory electroencephalography event-related features. Compared to controls, definite freezers exhibited significantly less alpha desynchronization at the motor cortex about 300 ms before and after the start of overground walking and decreased low-beta desynchronization about 300 ms before and about 300 and 700 ms after walking onset. The late slope of motor potentials also differed in the sensory and motor areas between groups of controls, definite, and probable freezers. This difference was found both in preparation and during the execution of normal walking. The average frontal peak of motor potential was also found to be largely reduced in the definite freezers compared with the probable freezers and controls. These findings provide valuable insights into the underlying structures that are affected in patients with freezing of gait, which could be used to tailor drug development and personalize drug care for disease subtypes. In addition, the study's findings can help in the evaluation and validation of nonpharmacological therapies for patients with Parkinson's disease.

Inpainting surgical occlusion from laparoscopic video sequences for robot-assisted interventions.

Purpose: Medical technology for minimally invasive surgery has undergone a paradigm shift with the introduction of robot-assisted surgery. However, it is very difficult to track the position of the surgical tools in a surgical scene, so it is crucial to accurately detect and identify surgical tools. This task can be aided by deep learning-based semantic segmentation of surgical video frames. Furthermore, due to the limited working and viewing areas of these surgical instruments, there is a higher chance of complications from tissue injuries (e.g., tissue scars and tears). Approach: With the aid of digital inpainting algorithms, we present an application that uses image segmentation to remove surgical instruments from laparoscopic/endoscopic video. We employ a modified U-Net architecture (U-NetPlus) to segment the surgical instruments. It consists of a redesigned decoder and a pre-trained VGG11 or VGG16 encoder. The decoder was modified by substituting an up-sampling operation based on nearest-neighbor interpolation for the transposed convolution operation. Furthermore, these interpolation weights do not need to be learned to perform upsampling, which eliminates the artifacts generated by the transposed convolution. In addition, we use a very fast and adaptable data augmentation technique to further enhance performance. The instrument segmentation mask is filled in (i.e., inpainted) by the tool removal algorithms using the previously acquired tool segmentation masks and either previous instrument-containing frames or instrument-free reference frames. Results: We have shown the effectiveness of the proposed surgical tool segmentation/removal algorithms on a robotic instrument dataset from the MICCAI 2015 and 2017 EndoVis Challenge. We report a 90.20% DICE for binary segmentation, a 76.26% DICE for instrument part segmentation, and a 46.07% DICE for instrument type (i.e., all instruments) segmentation on the MICCAI 2017 challenge dataset using our U-NetPlus architecture, outperforming the results of earlier techniques used and tested on these data. In addition, we demonstrated the successful execution of the tool removal algorithm from surgical tool-free videos that contained moving surgical tools that were generated artificially. Conclusions: Our application successfully separates and eliminates the surgical tool to reveal a view of the background tissue that was otherwise hidden by the tool, producing results that are visually similar to the actual data.

Quail Rearing Practices and Potential for Avian Influenza Virus Transmission, Bangladesh.

In 2015, human influenza surveillance identified a human infection with A/H9N2 in Dhaka, Bangladesh with evidence of exposure to a sick quail. We conducted in-depth interviews with household quail caregivers, pet bird retail shop owners, and mobile vendors, key informant interviews with pet bird wholesale shop owners, one group discussion with pet bird retail shop workers and unstructured observations in households, pet bird wholesale and retail markets, and mobile bird vendor's travelling areas to explore quail rearing and selling practices among households, mobile vendors, and retail pet bird and wholesale bird markets in Dhaka. Every day, quail were supplied from 23 districts to two wholesale markets, and then sold to households and restaurants directly, or through bird shops and mobile vendors. All respondents (67) reported keeping quail with other birds in cages, feeding quail, cleaning feeding pots, removing quail faeces, slaughtering sick quail, and discarding dead quail. Children played with quail and assisted in slaughtering of quail. Most respondents (94%) reported rinsing hands with water only after slaughtering and disposing of wastes and dead quail. No personal protective equipment was used during any activities. Frequent unprotected contact with quail and their by-products potentially increased the risk of cross-species avian influenza virus transmission. Avian influenza surveillance in retail pet bird and wholesale bird markets, mobile vendors, and households may identify cases promptly and reduce the risk of virus transmission.

Atomic model for core modifying region of human fatty acid synthase in complex with Denifanstat.

Fatty acid synthase (FASN) catalyzes the de novo synthesis of palmitate, a 16-carbon chain fatty acid that is the primary precursor of lipid metabolism and an important intracellular signaling molecule. FASN is an attractive drug target in diabetes, cancer, fatty liver diseases, and viral infections. Here, we develop an engineered full-length human FASN (hFASN) that enables isolation of the condensing and modifying regions of the protein post-translation. The engineered protein enables electron cryo-microscopy (cryoEM) structure determination of the core modifying region of hFASN to 2.7 Å resolution. Examination of the dehydratase dimer within this region reveals that unlike its close homolog, porcine FASN, the catalytic cavity is close-ended and is accessible only through one opening in the vicinity of the active site. The core modifying region exhibits two major global conformational variabilities that describe long-range bending and twisting motions of the complex in solution. Finally, we solved the structure of this region bound to an anti-cancer drug, Denifanstat (i.e., TVB-2640), demonstrating the utility of our approach as a platform for structure guided design of future hFASN small molecule inhibitors.