Management of trihalomethanes in water by ZnO@kaolinite composite: integrated experimental and modeling studies.

The adsorption of trihalomethanes (THMs) from drinking water was investigated in the current study through comparison studies of kaolinite and ZnO@kaolinite nanocomposites. The clay structural network's successful immobilization on the zincite hexagonal structure of ZnO nanoparticles' lattice layers was verified by the SEM/EDX analysis. Under the optimum conditions, the maximum removal of THMs was achieved by kaolinite and ZnO@kaolinite nanocomposites after 60 min. The adsorption performance of the ZnO@kaolinite nanocomposites was greater than that of kaolinite because the former had a larger surface area than the latter. The Freundlich isotherm model best matched the adsorption experimental data, which also reveals the existence of multilayer adsorption on a diverse surface with the greatest correlation (R2 = 0.956 and 0.954, respectively) for both nanoadsorbents using the pseudo-first-order (PFO), pseudo-second-order (PSO), mixed 1, 2-order (MFSO), and intraparticle diffusion (IPD) models. The mechanism by which THMs in drinking water adsorb onto nanoadsorbents was examined. This revealed that both intraparticle and film diffusion were involved in the adsorption process. Kaolinite and ZnO@kaolinite nanocomposites can be used in water treatment to remove THMs due to their great recyclable and reusable properties, even after six cycles.

Box-Behnken design (BBD) for optimization and simulation of biolubricant production from biomass using aspen plus with techno-economic analysis.

The growing concern and limitations for existing lubricants have driven the need for biolubricants, extensively proposed as the most suitable and sustainable lubricating oils. Biolubricant refers to lubricants that quickly biodegrade and are non-toxic to humans and aquatic habitats. Over the last decade, there has been a significant increase in the production of biolubricants due to the rising demand for replacing petroleum-based lubricants with those derived from renewable sources like vegetable oils and lipase that are used in various applications. In this study biodiesel (FAME) produced from blending animal fats and waste cooking was used as a raw material with ethylene glycol for biolubricant production using a transesterification reaction in the presence of calcium oxide which considers the newest and novel part as there is no production of biolubricant from animal fats and waste cooking oil in previous researches. The reaction parameters of biolubricant production were optimized using response surface methodology (RSM) with the aid of Box Behnken Design (BBD) to study the effect of independent variables on the yield of biolubricant. These variables are temperature ranging from (100-150 °C), reaction time ranging from 1 to 4 h, and FAME (Fatty Acid Methyl Ester) to alcohol molar ratio ranging from (2:1) to (4:1). The highest biolubricant yield is 91.56% at a temperature of 141 °C, a FAME/alcohol molar ratio of 2:1, and 3.3 h. Various analyses were performed on the produced biolubricant at the optimum conditions. The results include a pour point of -9 °C, a flash point of 192 °C, a kinematic viscosity at 40 °C of 10.35 cSt, a viscosity index of 183.6, an ash content of 0.76 wt.%, and a carbon residue of 1.5 wt.%, comparing favorably with the ISO VG 10 standard. The production process of biolubricant was simulated with Aspen Plus version 11 using a Non-Random Two-Liquid (NRTL) fluid package. The simulation results indicated that the production process can be applied on an industrial scale. Economic analysis was performed on the biolubricants production plant. The total capital investment was $12.7 M with a payback period of 1.48 years and an internal rate of return (IRR) of 67.5% indicating the suitability and profitability of the biolubricant production.

Coronary accordion effect mimicking coronary dissection in a 41-year-old male during angiography procedure an interesting case report.

The accordion phenomenon is a rare pseudo-complication observed during percutaneous coronary intervention (PCI), which can mimic coronary dissection, spasm, or thrombus formation. Here we present a patient with inferior ST-segment elevation myocardial infarction (STEMI), who developed multiple pseudo lesions in the tortuous right coronary artery (RCA) during PCI. An emergency coronary angiography was performed, but unfortunately, the lesion developed into an accordion-like shape in the middle segment of the right coronary artery (RCA), which looked like a coronary dissection. Despite attempts to resolve the abnormality with intracoronary nitrates, the accordion effect persisted, leading to a drop in blood pressure. Subsequent administration of isotonic solution and additional intracoronary nitrates eventually alleviated the dissection pattern. Due to the small diameter of the posterior descending artery, balloon angioplasty was performed to complete the procedure successfully. The patient was discharged 2 days later with a prescribed regimen of aspirin, prasugrel, atorvastatin, and carvedilol. Follow-up after 1 week indicated the patient's well-being, with no reported complaints.

Streamlined screening platforms lead to the discovery of pachysiphine synthase from Tabernanthe iboga.

Plant-specialized metabolism is largely driven by the oxidative tailoring of key chemical scaffolds catalyzed by cytochrome P450 (CYP450s) enzymes. Monoterpene indole alkaloids (MIAs) tabersonine and pseudo-tabersonine, found in the medicinal plant Tabernanthe iboga (commonly known as iboga), are tailored with oxidations, and the enzymes involved remain unknown. Here, we developed a streamlined screening strategy to test the activity of T. iboga CYP450s in Nicotiana benthamiana. Using multigene constructs encoding the biosynthesis of tabersonine and pseudo-tabersonine scaffolds, we aimed to uncover the CYP450s responsible for oxidative transformations in these scaffolds. Our approach identified two T. iboga cytochrome P450 enzymes: pachysiphine synthase (PS) and 16-hydroxy-tabersonine synthase (T16H). These enzymes catalyze an epoxidation and site-specific hydroxylation of tabersonine to produce pachysiphine and 16-OH-tabersonine, respectively. This work provides new insights into the biosynthetic pathways of MIAs and underscores the utility of N. benthamiana and Catharanthus roseus as platforms for the functional characterization of plant enzymes.

Small versus large-bore thoracostomy for traumatic hemothorax: A systematic review and meta-analysis.

BACKGROUND: Traumatic hemothorax (HTX) is common, and while it is recommended to drain it with a tube thoracostomy, there is no consensus on the optimal catheter size. We performed a systematic review to test the hypothesis that small bore tube thoracostomy (SBTT) (≤14 F) is as effective as large-bore tube thoracostomy (LBTT) (≥20F) for the treatment of HTX. METHODS: Pubmed, EMBASE, Scopus, and Cochrane review were searched from inception to November 2022 for randomized controlled trials or cohort studies that included adult trauma patients with HTX who received a tube thoracostomy. Data was extracted and Critical Appraisal Skills Program checklists were used for study appraisal. The primary outcome was failure rate, defined as incompletely drained or retained HTX requiring a second intervention. Cumulative analysis was performed with χ 2 test for dichotomous variables and an unpaired t-test for continuous variables. Meta-analysis was performed using a random effects model. RESULTS: There were 2,008 articles screened, of which nine were included in the analysis. The studies included 1,847 patients (714 SBTT and 1,233 LBTT). The mean age of patients was 46 years, 75% were male, average ISS was 20, and 81% had blunt trauma. Failure rate was not significantly different between SBTT (17.8%) and LBTT (21.5%) ( p = 0.166). Additionally, there were no significant differences between SBTT vs. LBTT in mortality (2.9% vs. 6.1%, p = 0.062) or complication rate (12.3% vs. 12.5%, p = 0.941), however SBTT had significantly higher initial drainage volumes (753 vs. 398 mL, p < 0.001) and fewer tube days (4.3 vs. 6.2, p < 0.001). There are several limitations. Some studies did not report all the outcomes of interest, and many of the studies are subject to selection bias. CONCLUSION: SBTT may be as effective as LBTT for the treatment of traumatic HTX. LEVEL OF EVIDENCE: Systematic Review/Meta-Analysis; Level IV.

Factors associated with precancerous stomach lesions and progresion: A 7-year multi-center prospective cohort study on the low incidence of gastric cancer in central Saudi Arabia.

BACKGROUND: In Saudi Arabia (SA) no data are available on precancerous stomach lesions (PSLs) or the associated risk factors. We aimed to identify PSLs and investigate factors associated with PSLs and their progression. METHODS: This 7-year prospective study screened for PSLs in asymptomatic Saudi patients aged 45-75 years in central SA (n = 35,640). Those who had high-sensitivity guaiac fecal occult blood tests (HSgFOBT+) and negative colonoscopy results (n = 1242) were subjected to upper GI endoscopy to identify PSLs and were followed up every 3 years or earlier, depending on the type of PSL. Factors associated with PSLs were investigated. RESULTS: The 7-year participation rate was 86.9% (1080/1242). The 7-year prevalence of PSLs was 30.9% (334/1080). The incidence rate of PSLs was 134 new cases/100,000 population/year, total population at risk - 35,640 and 44.3 new cases/1,000 persons/year among the 1080 participants with HSgFOBT+ and negative colonoscopy results. Among the 334 participants with PSLs, 8 (2.4%) had neoplastic progression to GC during the surveillance period. Age, Helicobacter pylori infection, smoking status, a diet with preserved salty foods, low income, and a family history of GC were associated with PSLs. CONCLUSIONS: The incidence of GC is low in central SA, but screening for PSLs among participants with HSgFOBT+ and negative colonoscopy findings may contribute to the early detection and subsequent treatment of GC. HP eradication, not smoking, normal body weight, and adhering to a healthy diet seem to be potential factors associated with the development of PSLs. Further studies are needed to search if such interventions would decrease the incidence of PSLs and progression to early GC.

Efficacy of Coronary Calcium Score in Predicting Coronary Artery Morphology in Patients With Obstructive Coronary Artery Disease.

Background: Coronary artery calcium score (CACS) is an established marker of coronary artery disease (CAD) and has been extensively used to stratify risk in asymptomatic individuals. However, the value of CACS in predicting plaque morphology in patients with advanced CAD is less established. The present analysis aims to assess the association between CACS and plaque characteristics detected by near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) imaging in patients with obstructive CAD. Methods: Seventy patients with obstructive CAD underwent coronary computed tomography angiography (CTA) and 3-vessel NIRS-IVUS imaging were included in the present analysis. The CTA data were used to measure the CACS in the entire coronary tree and the segments assessed by NIRS-IVUS, and these estimations were associated with the NIRS-IVUS measurements at a patient and segment level. Results: In total, 65 patients (188 segments) completed the study protocol and were included in the analysis. A weak correlation was noted between the CACS, percent atheroma volume (r = 0.271, P = .002), and the calcific burden measured by NIRS-IVUS (r = 0.648, P < .001) at patient-level analysis. Conversely, there was no association between the CACS and the lipid content, or the incidence of high-risk plaques detected by NIRS. Linear regression analysis at the segment level demonstrated an association between the CACS and the total atheroma volume (coefficient, 0.087; 95% CI, 0.024-0.149; P = .008) and the calcific burden (coefficient, 0.117; 95% CI, 0.048-0.186; P = .001), but there was no association between the lipid content or the incidence of high-risk lesions. Conclusions: In patients with obstructive CAD, the CACS is not associated with the lipid content or plaque phenotypes. These findings indicate that the CACS may have a limited value for screening or stratifying cardiovascular risk in symptomatic patients with a high probability of CAD.

Transcecal endoscopic appendectomy for management of complex appendiceal polyps extending into the appendiceal orifice.

Background and study aims Endoscopic resection of appendiceal orifice (AO) polyps extending inside the appendiceal lumen is challenging given the inability to determine polyp lateral margins and risk of appendicitis. Transcecal endoscopic appendectomy (TEA) ensures en bloc resection of these complex polyps. Patients and methods This case series includes patients who underwent TEA by a single endoscopist in the United States. Technical success was defined as achieving complete removal of the appendix along with AO polyp in an en bloc fashion. Results In total, nine patients were included (mean age 69.7 ± 9.6 years). The average appendix size was 4.07 ± 2.02 cm. Technical success was achieved in 100% of the patients. The average procedure length was 118.1 ± 44.21 minutes. The en bloc resection rate, R0 resection rate, and curative resection rates were 100%. Patients were observed for an average of 3.1 ± 1.6 days. One patient developed loculated fluid collection 9 days post procedure, which resolved on its own with oral antibiotic therapy. No other adverse events were recorded. Conclusions This was an early study of the feasibility of TEA in the United States. This novel technique, in early-stage development, is potentially safe and associated with a minimal risk profile in expert hands. Further prospective studies are needed to standardize the technique.

Comprehensive insights into phosphorus solubility and organic matter's impact on black phosphate leaching.

The current study introduces groundbreaking insights into how organic matter (OM) of the black phosphate (RB-Ph) uniquely influences phosphorus (P) solubility during acetic acid (AA) leaching, expanding our understanding in this crucial area. To highlight such role, the OM of the RB-Ph was treated separately by different procedures including calcination at 550 â„ƒ/4 h (CB-Ph), 30% hydrogen peroxide (HB-Ph) and intensive grinding to nano-sizes (NB-Ph). The mineralogical, chemical and morphological characteristics of phosphatic and non-phosphatic components of these phosphatic materials were carefully examined pre- and post-treatment via different techniques. The P dissolution of the precursor RB-Ph and its modified derivatives all over the applied experimental parameters traced the following trend: NB-Ph > RB-Ph > CB-Ph > HB-Ph. Intensive grinding to nanoscale resulted in amorphous components with conspicuous OM content (TOC, 0.410%), significantly enhanced P dissolution rate of NB-Ph (730-980 ppm), despite the noticeable reduction in its P2O5 content to 22.34 wt.%. The precursor RB-Ph, thanks to its high OM content (TOC, 0.543%), also displayed a sufficient P dissolution rate (470-750 ppm) compared to the two other modified derivatives, CB-Ph (410-700 ppm) and HB-Ph (130-610 ppm). Such deep and conspicuous impact of OM on P solubility can be tied to their decomposition, releasing not only organic acids but also the adsorbed P by the OM's surficial binding sites to the solution. Finally, the optimum conditions of P leaching were attained at 2:1 acid/solid (w/w) ratio and 2 h of retention time of all investigated samples.

Predictors of residual neoplasia after noncurative (R1) endoscopic submucosal dissection of lesions in the gastrointestinal tract.

BACKGROUND: Endoscopic submucosal dissection (ESD) is a minimally invasive resection technique that enables the en bloc resection of gastrointestinal lesions. Despite en bloc resection, pathological evaluation of lesions can reveal positive vertical or horizontal margins, which is referred to as R1 resection. Not all R1 lesions referred for surgical resection or endoscopic surveillance show evidence of residual tumor. We aimed to identify the predictors of residual neoplasia in patients with an R1 resection following ESD. PATIENTS AND METHODS: All lesions resected via ESD between June 2016 and September 2021 at a tertiary referral center were retrospectively identified. Lesions with an R1 resection and adequate follow-up were eligible for inclusion. Patient, lesion, and procedural characteristics were analyzed to identify predictors of residual neoplasia. RESULTS: Of 614 lesions, 163 (28%) had R1 resection. Of these, 56 lesions in 51 patients had complete follow-up and were included. Thirteen patients (25.5%) underwent surgical resection and the remainder underwent endoscopic surveillance. Seven (12.5%) patients had residual disease. All patients with residual disease had esophageal carcinoma. Positive deep and lateral margins, severe submucosal fibrosis, and moderate/poorly differentiated tumors were identified as significant predictors of residual neoplasia. CONCLUSION: Most R1 lesions (87.5%) resected by ESD did not have residual disease on follow-up. Those without identified risk factors for residual disease, such as esophageal carcinoma, severe submucosal fibrosis, or both histological margin positivity, may benefit from a strategy of close endoscopic surveillance rather than referral for surgical resection.

Incidence, identification and antibiotic resistance of Salmonella spp. in the well waters of Tadla Plain, Morocco.

Concerns about challenges with water availability in the Tadla Plain region of Morocco have grown as a result of groundwater contamination brought on by human activity, climate change, and insufficient groundwater management. The objective of the study is to measure the number of resistant bacteria in the groundwater of Beni Moussa and Beni Aamir, as well as to evaluate the level of water pollution in this area. 200 samples were therefore gathered from 43 wells over the course of four seasonal campaigns in 2017 and 2018. Additionally, the samples were examined to determine whether Salmonella species were present and if they were resistant to the 16 antibiotics that were tested. Salmonella spp. have been identified in 31 isolated strains in total, accounting for 18.02% of all isolated strains. Data on antibiotic resistance show that 58.1% of Salmonella spp. strains are multidrug-resistant (MDR); 38.7% of Salmonella strains are tolerant to at least six antibiotics, 19.4% to at least nine antibiotics, 9.7% to four to seven antibiotics, 6.5% to at least eleven antibiotics, and the remaining 3.2% to up to twelve antibiotics. A considerable level of resistance to cefepime (61.29%), imipenem (54.84%), ceftazidime (45.16%), ofloxacin (70.97%), and ertapenem (74.19%) was found in the data. Consequently, it is important to monitor and regulate the growth of MDR in order to prevent the groundwater's quality from declining.

Radiofrequency Versus CO2 Laser in Posterior Cordotomy for Managing Bilateral Abductor Vocal Fold Immobility.

PURPOSE: This study aimed to assess the outcomes of posterior cordotomy in cases with bilateral abductor vocal fold immobility (BAVFI), either by radiofrequency or CO2 laser. METHODS: This prospective comparative randomized study included 80 patients with BAVFI of different etiologies. They were divided randomly into two groups. Group A included 44 patients for whom radiofrequency was used for posterior cordotomy, while the other group (group B) included 36 patients managed by CO2 laser-assisted posterior cordotomy. RESULTS: The postoperative respiratory chink improved significantly in both groups, with a significant improvement in the dyspnea, especially in group B. The postoperative voice handicapped VHI-10 scores showed significant deterioration in both groups. CONCLUSIONS: CO2 laser and radiofrequency-assisted posterior cordotomy were effective and safe for managing cases with BAVFI. Moreover, the CO2 laser has the upper hand regarding breathing and exercise tolerance outcomes, significantly impacting the quality of life.

Detection of Oral Fluid Stains on Common Substrates Using SEM and ATR-FTIR Spectroscopy for Forensic Purposes.

Attenuated total reflectance (ATR) Fourier-transform infrared (FTIR) spectroscopy has been pursued as a novel approach to detect and differentiate biological materials with high specificity owing to its ability to record unique spectral patterns corresponding to the biochemical composition of a specimen. This study expands the application of ATR-FTIR for detecting oral fluid (OF) stains on various common substrates, including four porous and six nonporous substrates. For nonporous substrates, the spectral contribution from the substrate was minimal, and no background subtraction from the substrate bands was required (except for mirrors). For porous substrates, the contribution from the surface was pronounced and was addressed via background subtraction. The results indicated that major OF bands were detected on all the surfaces, even six months after OF deposition. Furthermore, scanning electron microscopy (SEM) was used to probe the morphologies of OF stains on various substrates. SEM micrographs revealed characteristic salt crystals and protein aggregates formed by the dried OF, which were observed for fresh samples and samples after six months post-deposition. Overall, this study demonstrated the great potential of SEM and ATR-FTIR spectroscopy for detecting OF traces on porous and nonporous substrates for up to six months for forensic purposes.

Evaluation of miRNA-146a, miRNA-34a, and pro-inflammatory cytokines as a potential early indicators for type 1 diabetes mellitus.

Background: Type I diabetes mellitus (T1DM) is one of the most common chronic autoimmune diseases worldwide. miRNAs are a class of small non-coding RNA molecules that have been linked to immune system functions, ß-cell metabolism, proliferation, and death, all of which contribute to pathogenesis of TIDM. Dysregulated miRNAs have been identified in Egyptian TIDM patients. Aim: Several miRNAs were profiled in Egyptian TIDM patients to determine whether they can be used as molecular biomarkers for T1DM. The relationship between the investigated miRNAs and pro-inflammatory cytokines (TNF-α and IL-6) has also been evaluated in the development of TIDM, in addition to the creation of a proposed model for TIDM prediction. Patients & methods: Case-control study included 177 Egyptian patients with confirmed type I diabetes mellitus and 177 healthy individuals. MiRNA-34 and miRNA-146 were detected in serum samples using real-time PCR, whereas TNF-α and IL-6 levels were assessed using ELIZA. Results: Patients with TIDM showed a significant decrease in the expression of miRNA-146, with a cut-off value ≤ 3.3, 48 % specificity, and 92.1 % sensitivity, whereas miRNA-34 had the highest sensitivity (95.5 %) and specificity (97.2 %) for differentiating diabetic patients from controls. Furthermore, other diagnostic proinflammatory markers showed lower sensitivity and specificity. Conclusion: Serum levels of miRNA-34a, miRNA-146, IL-6, and TNF-α provide new insights into T1DM pathogenesis and could be used for screening and diagnosis purposes. They can be also a potential therapeutic target, as well as allowing for more strategies to improve T1DM disease outcomes.

pH-Dependent selective extraction of gold(iii) from synthetic solution and computer motherboard leachate using a hybrid nanocomposite.

Recycling gold from electronic waste offers significant benefits for both environmental protection and resource sustainability. However, this process presents considerable challenges due to high costs, prolonged processing times, and interference from coexisting metals. In this study, we synthesized a hybrid mesoporous nanocomposite comprising platelets-like CoNi2S4 incorporated with g-C3N4 nanosheets (CoNi2S4@g-C3N4) for the selective recovery of gold (Au(iii)) ions from spent computer motherboards. Comprehensive characterization of the CoNi2S4@g-C3N4 nanocomposite was conducted, including its physicochemical properties, textural and structural characteristics, morphology, and elemental composition. The CoNi2S4@g-C3N4 extractor demonstrated an exceptional adsorption capacity of 200.6 mg g-1, with high selectivity at pH 2, rapid equilibrium time of 60 minutes, and satisfactory reusability for over ten cycles. Adsorption isotherm and kinetic studies revealed that the CoNi2S4@g-C3N4 nanocomposite adheres to the Langmuir adsorption model and the pseudo-second-order kinetic model for Au(iii) ion adsorption. Overall, this study introduces a viable adsorbent that shows considerable promise for industrial-scale Au(iii) extraction from e-waste.

Psoralen Isolated from the Roots of Dorstenia psilurus Welw. Modulate Th1/Th2 Cytokines and Inflammatory Enzymes in LPS-Stimulated RAW 264.7 Macrophages.

Dorstenia psilurus is a widely used plant spice in traditional African medicine to treat pain-related conditions. However, the anti-inflammatory mechanisms underlying this activity and the main active ingredients of D. psilurus have not yet been fully characterized. This study aimed to isolate and identify the main active anti-inflammatory constituents of the D. psilurus extract and to investigate the underlying anti-inflammatory mechanisms in murine macrophages. Chromatographic techniques and spectroscopic data were used for compound isolation and structure elucidation. The Griess reagent method and the ferrous oxidation-xylenol orange assay were used to evaluate the inhibition of NO production and 15-lipoxygenase activity, respectively. Cyclooxygenase activity was assessed using the fluorometric COX activity assay kit, and Th1/Th2 cytokine measurement was performed using a flow cytometer. The results indicated that the extract and fractions of D. psilurus inhibit NO production and proliferation of RAW 264.7 macrophage cells. Bioguided fractionation led to the identification of psoralen, a furocoumarin, as the main bioactive anti-inflammatory compound. Psoralen inhibited NO production and 15-lipoxygenase activity and reduced pro-inflammatory Th1 cytokines (IFN-γ, TNF-α, and IL-2) while increasing the secretion of anti-inflammatory cytokines (IL-4, IL-6, and IL-10) in activated RAW 264.7 macrophage cells. The encouraging results obtained in this study suggest that psoralen-based multiple modulation strategies could be a useful approach to address the treatment of inflammatory diseases.

Acaricidal activity of Egyptian crude plant extracts against Haemaphysalis longicornis ticks.

Haemaphysalis longicornis is a common Ixodida tick species found in temperate areas of Asian countries. An anti-tick assay was conducted on adult female H. longicornis ticks. Plant extract solutions were prepared at concentrations of 50, 25, and 10 mg/mL. Tick survival and mortality were assessed by counting the number of dead and live ticks at 24 h, 48 h, 72 h, and 96 h posttreatment. Out of 11 plant extracts screened, Artemisia judaica extract exhibited the highest potency with 100% mortality (5/5) at 48 h when applied at high and moderate concentrations (50 and 25 mg/mL). Similar results were observed at 96 h for the 10 mg/mL group compared to the untreated ticks. Cleome droserifolia extract demonstrated partial activity with 60% (3/5) and 20% (1/5) mortality at 96 h posttreatment at concentrations of 50 and 25 mg/mL, respectively. Forsskaolea tenacissima extract showed a weak effect with 100% tick mortality (5/5) only at the highest treatment concentration after 96 h. To confirm the activity of A. judaica, trial 2 was conducted. A. judaica demonstrated potency within 48 h in high dose and 72 h in moderate dose, with 100% mortality (15/15) at 96 h posttreatment compared to untreated ticks. The median lethal time 50 (LT50) values were 30.37 h for the high and 55.08 h for the moderate doses. Liquid chromatography‒mass spectrometry was performed on the most potent candidate (A. judaica) to identify its phytochemical components. The results revealed the presence of 9 compounds identified through manual annotation and 74 compounds from the Global Natural Products Social library. These compounds included terpenoids, steroids, phenylpropanoids, flavonoid glycosides, flavonoids, and benzenoids. Camphor was identified as the major component via both approaches. These findings suggest the potential use of A. judaica extract in the future development of acaricidal therapeutics.

Learning curve for endoscopic submucosal dissection (ESD) in the United States: Large, untutored, single-operator experience.

Background and study aims Endoscopic submucosal dissection (ESD) allows removal of tumors en-bloc. Western adoption of ESD has been hindered by its steep learning curve. Western data regarding ESD learning curve are limited. We analyzed the learning curve of a single endoscopist at a tertiary referral center in the United States. Patients and methods All consecutive ESDs performed by a single endoscopist at a tertiary referral center in the United States from 2015 through 2022 were identified. Descriptive statistics and CUSUM analysis were used to describe the learning curve for en-bloc, R0 resection, and resection speed. Results In our study, 503 patients with 515 lesions were included. Severe submucosal fibrosis was found in 17% of the lesions. The rates of en-bloc, R0, and curative resections were 81.9%, 71.1%, and 68.4%, respectively. CUSUM analysis showed that the learning curve plateaued at 268, 347, and 170 cases for en-bloc resection, R0 resection, and achieving a resection speed > 9 cm 2 /hr. Fibrosis significantly affected the R0 resection rate in the regression analysis (95% confidence interval 0.21-0.55). In colonic ESD curve analysis, the learning plateau was reached after 185 cases for both en-bloc and R0 resection. Conclusions Following ex-vivo training in an animal model, an untutored expert operator achieved competency in ESD between 250 and 350 procedures. Our data can inform development of future training programs in the West.

Repeated Peritonitis in a Peritoneal Dialysis Patient: An Unusual Case of Bacillus licheniformis With Vancomycin Failure Despite Sensitivity.

Bacillus licheniformis (B. licheniformis) is an aerobic, gram-positive, spore-forming rod typically found in soil, decaying organic matter, vegetables, and water, and occasionally part of normal gut flora. This report highlights a case of unusual repeated peritonitis caused by B. licheniformis, with three episodes occurring over six months, all of which were sensitive to vancomycin yet presented an unclear cause for recurrence. Peritonitis represents a significant cause of mortality, hospitalization, and failure of peritoneal dialysis catheters, leading to forced transitions to hemodialysis. The rarity of B. licheniformis as a pathogen in human infections emphasizes the critical need for precise microbial identification and customized therapeutic strategies.