Longitudinal Assessment of Health-Related Quality of Life in Three Different Hyperphosphatemia Management Groups of Stage III and IV Chronic Kidney Disease Patients.

Introduction: Health-related quality of life (HRQoL) has emerged as an important outcome measure inpatients with CKD. The lack of prospective studies on HRQoL and its relation with hyperphosphatemia control measures among pre-dialysis patients necessitated the need for this study. Methods: This is a prospective, randomized, controlled, open-labelled studythat was conducted for one year on 120 CKD stages III and IV patients divided equally into three groups: Group 1, in which patients under went dietary phosphorus modification; Group 2, in which they were administered calcium-based phosphate binders; and Group 3, in which they were administered non-calcium-based phosphate binders. Patients were assessed for HRQoL, fibroblast growth factor 23 (FGF 23), intact parathyroid hormone (iPTH), phosphorus, and nutritional status, and dietary phosphorus control strategies at 0, 6, and 12 months. HRQoL was measured by using the 36-item Short Form Survey (SF-36) that included a physical component score (PCS) and mental component score (MCS). The scores is ranging from 0 to 100. Higher scores indicate better health status. Usingthe two-wayand one-way repeated measure ANOVA, we analyzed equality of group means, time intervals, and interactions. Results: At baseline, the mean PCS and MCS were equal in three groups. PCS improved significantly (P < 0.00) from baseline to one year in all the three groups: ingroup 1, the PCS score was 66.5 ± 13.5to 75.1 ± 9.76; in group 2, it was 68.9 ± 11.80 to 77.2 ± 7.50; and in group 3, it was 66.2 ± 12.16 to 73.8 ± 9.27. Initially, MCS declined substantially on the sixth month but recovered afterone year. Multiple regression analysis in 13 associated parameters yielded R2 of 13.7% and 18.1% in PCS and MCS, respectively, indicating little contribution of various parameters. Conclusion: There has been a significant positive change in PCSs in three hyperphosphatemia management groups over a period of 12 months. Among the three study groups, the incremental changes in PCS and MCS scores were insignificant.

Development of high-yielding white maize hybrids with better chapatti-making quality compared to traditionally used local landraces.

Introduction: The present research focuses on the chapatti making quality of high-yielding white maize hybrids compared to available low-yielding local yellow and white landraces in India. Materials and methods: In this study, the top nine superior hybrids were selected for testing the physical properties of the maize kernels, proximate composition of flours and chapattis, physical parameters of chapatti, textural properties, sensory evaluation of chapattis and pasting properties of maize flour. Results and discussion: The results revealed the superiority of white maize hybrids (WMH), viz., WHM 1, WHM 2, and WHM 8 over the local yellow and white landraces for most of the parameters studied. In sensory analysis, though, the yellow landrace was considered superior by the panellists in terms of colour but the white maize hybrids outperformed in overall sensory analysis and were more acceptable than the yellow and white maize landraces. These high yielding white maize hybrids with good consumer acceptance may cater for the needs of rural and tribal populations in India who prefer white maize as a staple food.

Dual production of human mesenchymal stromal cells and derived extracellular vesicles in a dissolvable microcarrier-based stirred culture system.

BACKGROUND & AIMS: Cell therapies based on mesenchymal stromal cells (MSCs) have gained an increasing therapeutic interest in the context of multiple disorders. Nonetheless, this field still faces important challenges, particularly concerning suitable manufacturing platforms. Here, we aimed at establishing a scalable culture system to expand umbilical cord-derived Wharton's jelly MSC (MSC(WJ)) and their derived extracellular vesicles (EVs) by using dissolvable microcarriers combined with xeno(geneic)-free culture medium. METHODS: MSC(WJ) isolated from three donors were cultured at a starting density of 1 × 106 cells per spinner flask, i.e., 2.8 × 103 cells per cm2 of dissolvable microcarrier surface area. After a 6-day expansion period of MSC(WJ), extracellular vesicles (EVs) were produced for 24 h. RESULTS: Taking advantage of an intermittent agitation regimen, we observed high adhesion rates to the microcarriers (over 90% at 24 h) and achieved 15.8 ± 0.7-fold expansion after 6 days of culture. Notably, dissolution of the microcarriers was achieved through a pectinase-based solution to recover the cell product, reducing the hurdles of downstream processing. MSC identity was validated by detecting the characteristic MSC immunophenotype and by multilineage differentiation assays. Considering the growing interest in MSC-derived EVs, which are known to be mediators of the therapeutic features of MSC, this platform also was evaluated for EV production. Upon a 24-h period of conditioning, secreted EVs were isolated by ultrafiltration followed by anion-exchange chromatography and exhibited the typical cup-shaped morphology, small size distribution (162.6 ± 30.2 nm) and expressed EV markers (CD63, CD9 and syntenin-1). CONCLUSIONS: Taken together, we established a time-effective and robust scalable platform that complies with clinical-grade standards for the dual production of MSC(WJ) and their derived EV.

Aggressive Alternaria brassicicola with reduced fungicide sensitivity can be associated with naturally infested broccoli seeds.

Alternaria brassicicola is a part of Alternaria complex that causes leaf blight and head rot (ABHR) in brassica crops. Infested broccoli seeds can play an important role in introducing A. brassicicola in transplant houses and production fields. However, characterization of natural seed infestation and seed-to-seedling transmission of A. brassicicola in broccoli is yet to be demonstrated. In this research we characterized Alternaria spp. isolates from commercial broccoli seedlots for their species identity, pathogenicity and aggressiveness on broccoli and their sensitivity to Quinone-outside inhibitor (QoI) fungicide (azoxystrobin). Two hundred commercial seedlots from two broccoli cultivars; Cultivar 1 (EC; n=100 seedlots) and Cultivar 2 (ED; n=100 seedlots) were evaluated for the presence of A. brassicicola under in-vitro conditions using a seedling grow-out assay. Alternaria spp. was detected in 31 and 28% of the commercial seedlots of Cultivar 1 and Cultivar 2, respectively. The seed-to-seedling transmission (%) varied considerably within each positive infested seedlot, which ranged from 1.3 to 17.3%. Subsequent molecular identification of single spore cultures (n=138) was made by sequencing four housekeeping genes; actin, the major allergen (Alta1), plasma membrane ATPase and Glyceraldehyde-3-phosphate dehydrogenase (GPD), and later the sequences were concatenated and compared for the phylogenetic distance with diverse Alternaria species. Ninety-six percent (n=133) of the isolates formed a cluster with a known A. brassicicola based on multigene phylogeny, which were later confirmed as A. brassicicola using a species-specific PCR assay. One hundred percent of the A. brassicicola seed isolates (n=133) were either highly- or moderately- aggressive on broccoli (cv. Emerald Crown) based on a detached leaf assay. Sensitivity of representative A. brassicicola isolates (n=58) to azoxystrobin was evaluated using a spore germination assay and the EC50 values (effective fungicide concentration (ppm) at which germination of conidia of isolates were reduced by 50% compared to control) for each isolate was determined. A. brassicicola isolates from naturally infested commercial broccoli seeds were sensitive to azoxystrobin with considerably low EC50 values in the range of <0.0001 ppm to 0.33 ppm; however, there were a few isolates (14%), which showed 100-fold reduced sensitivity from the most sensitive isolate (EC50 =0.0001 ppm). Our results confirm that commercial broccoli seedlots can be naturally contaminated with pathogenic and aggressive A. brassicicola. We also provide evidence for potential presence of A. brassicicola isolates with reduced azoxystrobin-sensitivity in naturally infested commercial broccoli seedlots, which has never been reported before. Together, these findings may have implications in considerations for seed-health testing, seed treatments and greenhouse scouting to limit introduction of infested seedlots in commercial broccoli fields.

Characterization of seed-to-seedling transmission of Alternaria brassicicola in broccoli.

Alternaria brassicicola is a part of a complex of Alternaria species that causes leaf blight and head rot in brassica crops such as broccoli, kale, cabbage, cauliflower, and collards. Seed can serve as a potential source of inoculum for the transmission of A. brassicicola in broccoli as demonstrated earlier; however, seed-to-seedling transmission of pathogen was never characterized empirically. Hence, the objectives of this study were to (i) re-evaluate the effect of artificial seed infestation on seed germination and seed-to-seedling transmission of A. brassicicola in broccoli; (ii) determine the effect of A. brassicicola-seed inoculum levels on seed-to-seedling transmission; (iii) evaluate if variations in A. brassicicola -aggressiveness impact A. brassicicola seed-to-seedling transmission and, (iv) evaluate seed treatments that can reduce seed-to-seedling transmission of A. brassicicola in broccoli. Artificially infested seedlots were generated by inoculating broccoli seeds with a spore suspension of 1 × 105 conidia/ml of A. brassicicola using vacuum infiltration method. Inoculated (n=10 seedlots; 300 seeds/seedlot) or control seedlots in three replicates were planted on two layers of sterile blotter paper saturated with sterile water in transparent plastic boxes and incubated at 20°C and >90% RH under continuous fluorescent light. Percent seed germination and percent seed-to-seedling transmission were recorded every other day until 21 days. Percent seed germination was significantly affected with artificial pathogen inoculation. One hundred percent of the seedlots transmitted the pathogen to broccoli seedlings and seed-to-seedling percentages of the seedlots varied considerably. A strong linear and significant relationship between A. brassicicola inoculum level and seed-to-seedling transmission (%) within each seedlot was observed. Interestingly, variations in aggresiveness of A. brassicicola isolates did not affect seed-to-seedling transmission, as 100% of the seedlots were able to transmit the pathogen. Seed treatment with Miravis (a.i. pydiflumetofen 18.3%) significantly increased seed germination and reduced seed-to-seedling transmission percentages in A. brassicicola-inoculated seedlots. These results indicate that artificial seed inoculation with A. brassicicola can result in consistent seed-to-seedling transmission with significant impact on seed germination. Seed inoculum density of ≥104 conidia/ml is necesssary for reliable transmission of A. brassicicola. Further seed-to-sedling transmission is not dependent on aggresiveness of A. brassicicola isolates and, seed treatment with Miravis can significantly reduce pathogen transmission in broccoli seedings. Overall, this study provides detailed characterization of seed-to-seedling transmission of A. brassicicola in broccoli that can be further used to determine inoculum threshold, which has potential applications in seed-health testing and sample size determination. Further we also provide options for effective seed treatments that can significantly reduce A. brassicicola seed-to-seedling transmission and may potentially aid in managing seedborne fungal infection.

Impact of Just-in-Time TeamSTEPPS Training on Team Performance in a Pediatric Escape Room Interprofessional Experience.

OBJECTIVE: To compare differences in observed and self-reported team dynamics between those who received versus those who did not receive TeamSTEPPS training prior to an interprofessional escape room scenario. METHODS: Final-year pharmacy (N = 27) and physician assistant (N = 88) students participated in an escape room featuring pediatric dosing, asthma, otitis media, type 1 diabetes, and vaccine fundamentals. In total, 29 teams were randomized to control (14) or intervention arm (15). The control group went to the escape room and then returned to the classroom for a team-building module including TeamSTEPPS training. The intervention group started with the team-building module then went to the escape room. One faculty observer was assigned to each team and utilized the Performance Assessment Communication and Teamwork (PACT) expert-observer form to assess team performance. Post-event, students completed an abbreviated PACT post-assessment and a self-reflection on the prompt "What were the most important takeaways from today's interprofessional education experience?" RESULTS: On the PACT expert-observer form, significantly higher global scores were noted for the intervention arm on all items except situation monitoring. On the aggregate observer data from all stations, leadership emerged as statistically different between the 2 groups. On the PACT post-assessment, the intervention arm reported significantly more leadership during the simulation. On the self-reflections, 70.9% versus 64% in the control arm recognized the importance of teamwork in managing patients. CONCLUSIONS: Just-in-time TeamSTEPPS training improved observed and to a lesser extent, self-reported teamwork and communication skills. Incorporating TeamSTEPPS training immediately prior to an interprofessional education experience may enhance team performance.

Aloe vera/Chitosan-Based Edible Film with Enhanced Antioxidant, Antimicrobial, Thermal, and Barrier Properties for Sustainable Food Preservation.

Food bioactive packaging has received increasing attention from consumers and the food industry for its potential to reduce food waste and environmental issues. Several materials can be used to produce edible films/coats; however, bio-based, cost-effective, and sustainable coatings have gained a high reputation these days. For instance, Aloe vera gel (AV) is a promising bio-based material for edible coatings and films; therefore, the present study aimed to investigate the film-forming abilities of AV and Chitosan (CH) combination as a potential active food packaging material. The physicochemical and mechanical characteristics of formed films of various combinations were prepared at different concentrations, i.e., CH (0.5% w/v), AV (100%), CH:AV (75:25), and CH:AV (60:40). The results showed significant differences among all the prepared edible films wherein these differences were mainly on account of incorporating AV gel. The rheological and antioxidant properties of the formulations improved with the inclusion of AV gel. The films composed of CH:AV (60:40) positively affected the water solubility, thermal properties, and water vapour permeability of the edible films. The X-ray Diffraction (XRD) and Scanning electron microscopy (SEM) results showed that the films composed of CH:AV, (60:40) were amorphous and had smooth morphology. Further, the edible film solutions were applied to fresh figs (Ficus carica) to investigate their role in preserving fruits during storage. A significant reduction in microbial growth was found in coated fruits after 28 days of cold storage. The films composed of CH and AV showed overall improved results compared to the CH (0.5%, w/v). Therefore, the used formulations (CH:AV, 60:40) can form a sustainable film that has the potential to be utilized for fresh product preservation to maintain its quality and shelf life.

Evaluation of Stagonospora Nodorum Blotch Severity and Parastagonospora nodorum Population Structure and Genetic Diversity Across Multiple Locations and Wheat Varieties in Virginia.

Parastagonospora nodorum is a necrotrophic pathogen that causes Stagonospora nodorum blotch (SNB) in wheat. Wheat varieties grown in Virginia vary in susceptibility to SNB, and the severity of SNB varies across locations and years. However, the impacts of wheat genetic backgrounds and environments on SNB severity and the structure of P. nodorum populations in the region have not been well studied. Thus, a population genetic study was conducted utilizing P. nodorum isolates collected from different wheat varieties and locations in Virginia. A total of 320 isolates were collected at seven locations over 2 years from five wheat varieties. Isolates were genotyped using multilocus simple sequence repeat markers, and necrotrophic effector (NE) and mating type genes were amplified using gene-specific primers. Wheat varieties varied in susceptibility to SNB, but site-specific environmental conditions were the primary drivers of disease severity. Fungal populations were genetically diverse, but no genetic subdivision was observed among locations or varieties. The ratio of the two mating type idiomorphs was not significantly different from 1:1, consistent with the P. nodorum population undergoing sexual reproduction. Three major NE genes were detected within the P. nodorum population, but not with equal frequency. However, NE gene profiles were similar for groups of isolates originating from different varieties, suggesting that wheat genetic backgrounds do not differentially select for NEs. There was no evidence of population structure among P. nodorum populations in Virginia and, thus, no support for wheat genetic backgrounds shaping these populations. Finally, although varieties only exhibited moderate resistance to SNB, current levels of resistance are likely to be durable over time and remain a useful tool for integrated management of SNB in the region. [Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license.

Pathology, target discovery, and the evolution of XO inhibitors from the first discovery to recent advances (2020-2023).

Hyperuricemia, a disease characterized by elevation of serum uric acid level beyond 6 mg/dL. This elevation led to appearance of symptoms from joint pain to gout and from gout to difficulty in mobility of the patient. So, in this review, we have summarized the pathology of hyperuricemia, discovery of target and discovery of first XO inhibitor. At last, this review provides in-sights about the recently discovered as natural XO inhibitors, followed by design, structure activity relationship and biological activity of synthetic compounds as XO inhibitors discovered between 2020 and 2023 years. At last, the pharmacophores generated in this study will guide new researchers to design and modify the structure of novel XO inhibitors.

Techno-functional attributes of oilseed proteins: influence of extraction and modification techniques.

Plant-based protein isolates and concentrates are nowadays becoming popular due to their nutritional, functional as well as religious concerns. Among plant proteins, oilseeds, a vital source of valuable proteins, are continuously being explored for producing protein isolates/concentrates. This article delineates the overview of conventional as well as novel methods for the extraction of protein and their potential impact on its hydration, surface properties, and rheological characteristics. Moreover, proteins undergo several modifications using physical, chemical, and biological techniques to enhance their functionality by altering their microstructure and physical performance. The modified proteins hold a pronounced scope in novel food formulations. An overview of these protein modification approaches and their effects on the functional properties of proteins have also been presented in this review.

Assessment of the Relation Between Asthma Severity and Serum Vitamin D Levels: A Cross-Sectional Study.

Introduction Vitamin D3's importance for bone health in children and its potential role beyond musculocutaneous health is an ongoing area of research. This study assesses vitamin D3 deficiency prevalence in asthmatic children and its correlation with asthma cases and healthy controls.  Methods This cross-sectional study was conducted in a tertiary care hospital in Punjab, India among children between 5 and 15 years of age. Fifty children diagnosed with "bronchial asthma" who were under follow-up in the asthma clinic in outpatient and inpatient patients were enrolled as cases. Age-matched 50 healthy controls who presented for routine check-ups were enrolled in the control group. Demographic details were noted and clinical examination was done in all the cases. 25-(OH) vitamin D levels were estimated and compared in all cases and controls. The study also analyzed the relationship between 25-(OH) vitamin D levels with asthma control and severity. Results The study showed that serum vitamin D3 level was significantly decreased in asthmatic children (24.62 ± 14.95 ng/ml) as compared with the healthy control group (32.08 ± 12.22 ng/ml). Also, serum vitamin D3 level was significantly decreased in children with uncontrolled asthma (12.06 ± 4.68 ng/ml) as compared to children with well-controlled asthma (44.82 ± 10.48 ng/ml).  Conclusion The findings showed that low serum levels were observed more in asthmatic children as compared to healthy children. A correlation was also found between vitamin D3 levels and asthma severity, its control, and the number of acute exacerbations in the last year.

Gluten Intolerance and Its Association With Skin Disorders: A Narrative Review.

Gluten sensitivity is defined as a chronic intolerance to gluten ingestion in genetically predisposed individuals. The etiology is thought to be immune-mediated and has a variable dermatologic presentation. Celiac disease (CD) is one of the most common forms of gluten intolerance and encompasses a wide range of extra-intestinal pathology, including cutaneous, endocrine, nervous, and hematologic systems. Psoriasis, another long-term inflammatory skin condition, has been linked to significant symptomatic improvement with a gluten-free diet (GFD). Palmoplantar pustulosis (PP), a variant of psoriasis, and aphthous stomatitis, which causes recurrent oral ulcers, have also exhibited beneficial results after the dietary elimination of gluten. In addition to this, dermatitis herpetiformis (DH), another immune-mediated skin disorder, is genetically similar to CD and has, therefore, shown tremendous improvement with a GFD. Another highly prevalent long-term skin condition called atopic dermatitis (AD), however, has revealed inconsistent results with gluten elimination and would require further research in the future to yield concrete results. Hereditary angioedema (HA) has shown an association with gluten intolerance in some patients who had symptomatic benefits with a GFD. Similarly, vitiligo and linear IgA bullous dermatosis have also shown some clinical evidence of reversal with a GFD. On the contrary, rosacea enhances the risk of developing CD. This narrative review emphasizes the potential impact of gluten intolerance on different cutaneous conditions and the potential therapeutic effect of a GFD on various symptomatic manifestations. There is a need for additional clinical and observational trials to further expand on the underlying pathophysiology and provide conclusive and comprehensive recommendations for possible dietary interventions.

Specification, validation, and adherence of quality indicators to optimize the safe use of nonsteroidal anti-inflammatory drugs for knee osteoarthritis pain in the primary care setting.

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) used for osteoarthritis (OA) in primary care may cause gastrointestinal or renal injury. This study estimated adherence to two quality indicators (QIs) to optimize NSAID safety: add proton pump inhibitors (PPI) to NSAIDs for patients with gastrointestinal (GI) risk (QI #1 NSAID-PPI) and avoid oral NSAIDs in chronic kidney disease (CKD) stage G4 or G5 (QI #2 NSAID-CKD). METHODS: This retrospective study included index primary care clinic visits for knee OA at our health system in 2019. The validation cohort consisted of a random sample of 60 patients. The remainder were included in the expanded cohort. Analysis of structured data extracts was validated against chart review of clinic visit notes (validation cohort) and estimated QI adherence (expanded cohort). RESULTS: Among 60 patients in the validation cohort, analysis of data extracts was validated against chart review for QI #1 NSAID-PPI (100% sensitivity and 91% specificity) and QI #2 NSAID-CKD (100% accuracy). Among 335 patients in the expanded cohort, 44% used NSAIDs, 27% used PPIs, 73% had elevated GI risk, and only 2% had CKD stage 4 or 5. Twenty-one percent used NSAIDs and had elevated GI risk but were not using PPIs. Therefore, adherence to QI #1 NSAID-PPI was 79% (95% CI, 74-83%). No patients with CKD stage 4 or 5 used NSAIDs. Therefore, adherence to QI #2 NSAID-CKD was 100%. CONCLUSION: A substantial proportion of knee OA patients with GI risk factors did not receive PPI with NSAID therapy during primary care visits.

An emerging expanse: Novel and eco-friendly-biogenic synthesis of E. cardamomum-wrapped TiO2 nanoparticles for environmental and biological applications.

The present research is targeted at E. cardamomum-derived TiO2-photocatalyst synthesis, reporting for the first time. The structural properties observed from the XRD pattern reveal that EC:TiO2 has an anatase phase and crystallite size is assessed by Debye-Scherrer's method (3.56 nm), WH-method (3.30 nm), and Modified-Debye-Scherrer's method (3.27 nm). An optical study by the UV-Vis spectrum shows strong absorption at 313 nm, and the corresponding band gap value is 3.28 eV. The topographical and morphological properties revealed by SEM and HRTEM images, elucidate the formation of multi-shaped particles of nano-size. Further, the phytochemicals on the EC:TiO2 NPs' surface are confirmed by the FTIR spectrum. The photocatalytic activity is well studied under UV light towards Congo Red dye, along with an effect of the dose of catalyst. EC:TiO2 (20 mg) has exhibited high photocatalytic efficiency up to 97% for 150 min of exposure due to the morphological, structural, and optical properties. CR degradation reaction exhibits pseudo-first-order kinetics, displaying a rate constant value of 0.01320 min-1. Reusability investigations reveal that after four photocatalysis cycles, EC:TiO2 has an effective efficiency of >85%. Additionally, EC:TiO2 NPs have been assessed for antibacterial activity and show potential against two bacterial species (S. aureus and P. aeruginosa). Therefore, these research outcomes from the eco-friendly and low-cost synthesis, are promising for the use of EC:TiO2 as a talented photocatalyst towards the removal of crystal violet dye as well as an antibacterial agent against bacterial pathogens.

Terlipressin-Induced Skin Necrosis While Managing Hepatorenal Syndrome: A Rare Case Report From North India.

Terlipressin is an analogue of vasopressin and is often used in the treatment of bleeding esophageal varices and also in the treatment of hepatorenal syndrome associated with liver cirrhosis. Although terlipressin is a safe drug, but it has been rarely associated with potentially serious adverse effects like ischemic necrosis of skin involving the abdominal skin, extremities, and scrotal skin. We present one such rare case where terlipressin-induced skin necrosis in bilateral lower extremities in a 48-year-old male while we were managing hepatorenal syndrome in the same.

Effect of more versus less intensive blood pressure control on cardiovascular, renal and mortality outcomes in people with type 2 diabetes: A systematic review and meta-analysis.

BACKGROUND AND AIMS: Currently, there is uncertainty as to whether blood pressure control in patients with type 2 diabetes should be treated to standard recommended levels or more intensively. METHODS: Medline, EMBASE, CENTRAL, and Clinicaltrials.gov were searched between January 1, 2000 and April 20th, 2023. Outcomes considered were all-cause mortality, stroke, heart failure, cardiovascular disease, albuminuria, coronary heart disease, and renal outcomes. Random-effects meta-analyses estimated pooled relative risks and mean differences. RESULTS: Nine trials enrolling 11,005 participants with type 2 diabetes were included. The pooled mean difference between the intensive and standard treatment groups at follow-up were -7.98 mmHg (95% CI: 12.19 to -3.76) in systolic blood pressure, and -5.08 mmHg (-7.00 to -3.17) in diastolic blood pressure; although between study heterogeneity was high for both meta-analyses (I2>85%). Intensive blood pressure lowering resulted in a reduction in risk of stroke (risk ratio 0.64; 0.52 to 0.79), and macro-albuminuria (0.77; 0.63 to 0.93). More intensive blood pressure control did not result in a statistically significant reduction in risk of all-cause mortality, heart failure, cardiovascular death, cardiovascular events, renal outcomes, and micro-albuminuria; although the direction of estimated effect was beneficial for all outcomes. CONCLUSIONS: The use of intensive compared with standard blood pressure targets resulted in a significant reduction in blood pressure, stroke, and macro-albuminuria in patients with type 2 diabetes. The post-treatment blood pressure level in the intensive group was 125/73 mmHg, suggesting the current recommendations of 130/80 mmHg blood pressure or lower if tolerated, could be reduced further.

Properties of Naked Silver Clusters with Up to 100 Atoms as Found with Embedded-Atom and Density-Functional Calculations.

The structural and energetic properties of small silver clusters Agn with n = 2-100 atoms are reported. For n = 2-100 the embedded atom model for the calculation of the total energy of a given structure in combination with the basin-hopping search strategy for an unbiased structure optimization has been used to identify the energies and structures of the three energetically lowest-lying isomers. These optimized structures for n = 2-11 were subsequently studied further through density-functional-theory calculations. These calculations provide additional information on the electronic properties of the clusters that is lacking in the embedded-atom calculations. Thereby, also quantities related to the catalytic performance of the clusters are studied. The calculated properties in comparison to other available theoretical and experimental data show a good agreement. Previously unidentified magic (i.e., particularly stable) clusters have been found for n>80. In order to obtain a more detailed understanding of the structural properties of the clusters, various descriptors are used. Thereby, the silver clusters are compared to other noble metals and show some similarities to both copper and nickel systems, and also growth patterns have been identified. All vibrational frequencies of all the clusters have been calculated for the first time, and here we focus on the highest and lowest frequencies. Structural effects on the calculated frequencies were considered.

Tuberculosis Diagnosis Using Isothermal Nucleic Acid Amplification in a Paper-and-Plastic Device.

Nucleic acid (DNA/RNA) amplification technologies are indispensable for applications like disease diagnostics, forensics, epidemiology, evolutionary biology, vaccine development, and therapeutics. While polymerase chain reaction (PCR) has deeply penetrated the abovementioned fields and has been commercially successful, two major common disadvantages are exorbitant costs of associated equipment, which create concerning roadblocks in terms of affordability and accessibility. This work describes development of an inexpensive, portable, easy-to-use and deliverable-to-end-users, nucleic acid amplification technology for infectious disease diagnosis. The device uses loop-mediated isothermal amplification (LAMP) and cell phone-based fluorescence imaging to enable nucleic acid amplification and detection. A regular lab incubator and a custom-made low-cost imaging box are the only two additional equipment required for testing. Material cost for a 12-test zone device was $0.88, and cost of reagents per reaction was $0.43. First successful application of the device was demonstrated for tuberculosis diagnosis with clinical sensitivity of 100% and clinical specificity of 68.75% for testing of 30 clinical patient samples.