Spontaneous Closure of Bile Leak in Abdominal Drain after Cholecystectomy: A Systematic Review.

Bile leakage in abdominal drain after cholecystectomy is reported to close spontaneously without any intervention. The aim of this systematic review was to find out the amount and source of bile leaks that can be closed spontaneously and various factors associated with this closure. A systematic search of PubMed, Google Scholar, and Cochrane under preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines was performed. Ten studies were finally included in the review. Five studies were found from India, two from Pakistan, and one each from Mexico, Nepal, and Romania. Maximum volume of bile reported to close spontaneously was 500 ml per day and took seven days to close. Overall 66.6% cases of bile leaks were laparoscopically operated. Bile leakage in abdominal drain after cholecystectomy up to 500 ml per day closes spontaneously in a week time provided patient has no major ductal injury and peritonitis. Key Words: Bile leakage, Abdominal drain, Endoscopic retrograde cholangiopancreatography.

Comparison of treatment of volar Barton's fracture with T plate using distal end screws and without distal end screws.

Objective: To compare the functional and radiological outcomes of treatment of volar Barton's fractures using T plate with and without distal end screws. Methods: This randomized control trial was conducted at the department of Orthopedics, Mayo Hospital, Lahore, Pakistan from December 2021 to May 2022. Total 60 patients (30 in each group) were randomly allocated to either group A (T-Plate with distal end screws) or B (T-Plate without distal end screws). Patients were followed up on day-0, day-14, day-28 and day-90. Assessments of patients were done by Green O'Brien Score for pain, Modified Warden Score for callus formation on radiographs at 12-weeks of follow-up and Stewart Score for displacement of fracture. Results: At 90th day, significant difference was seen in Green O'Brien Score (Excellent score: Group-A: 80% vs. Group-B: 90%, p=0.278) while Stewart scores remained comparable (Excellent Score: Group-A: 93.33% vs. Group-B: 96.67%, p=0.221) between treatment groups. Fracture healing assessed with Modified Warden score for score 4 did not show significant difference between both groups at 90th day. i.e. (Group-A: 96.67% vs. Group-B: 96.67%). However, callus formation assessed with Modified Warden score for score 3 showed significant differences between groups at 90th day. i.e. (Group-A: 53.33% vs. Group-B: 86.67%, p=0.001). Conclusion: Both treatment approaches appear to yield comparable outcomes in terms of clinical assessment, Stewart scores, and fracture healing, with a potential advantage for T-plate without distal end screw in callus formation at the 90th day.Trial registration: IRCT20221231056999N1.

Evaluating the Impact of Pre-Configured Uplink Resources in Narrowband IoT.

Deploying Cellular Internet of Things (CIoT) devices in urban and remote areas faces significant energy efficiency challenges. This is especially true for Narrowband IoT (NB-IoT) devices, which are expected to function on a single charge for up to 10 years while transmitting small amounts of data daily. The 3rd Generation Partnership Project (3GPP) has introduced energy-saving mechanisms in Releases 13 to 16, including Early Data Transmission (EDT) and Preconfigured Uplink Resources (PURs). These mechanisms extend battery life and reduce latency by enabling data transmission without an active Radio Resource Control (RRC) connection or Random Access Procedure (RAP). This paper examines these mechanisms using the LENA-NB simulator in the ns-3 environment, which is a comprehensive framework for studying various aspects of NB-IoT. The LENA-NB has been extended with PURs, and our analysis shows that PURs significantly enhance battery life and latency efficiency, particularly in high-density environments. Compared to the default RAP method, PURs reduce energy consumption by more than 2.5 times and increases battery life by 1.6 times. Additionally, PURs achieve latency reductions of 2.5-3.5 times. The improvements with PURs are most notable for packets up to 125 bytes. Our findings highlight PURs' potential to enable more efficient and effective CIoT deployments across various scenarios. This study represents a detailed analysis of latency and energy consumption in a simulated environment, advancing the understanding of PURs' benefits.

Non-cell-autonomous regulation of germline proteostasis by insulin/IGF-1 signaling-induced dietary peptide uptake via PEPT-1.

Gametogenesis involves active protein synthesis and is proposed to rely on proteostasis. Our previous work in C. elegans indicates that germline development requires coordinated activities of insulin/IGF-1 signaling (IIS) and HSF-1, the central regulator of the heat shock response. However, the downstream mechanisms were not identified. Here, we show that depletion of HSF-1 from germ cells impairs chaperone gene expression, causing protein degradation and aggregation and, consequently, reduced fecundity and gamete quality. Conversely, reduced IIS confers germ cell resilience to HSF-1 depletion-induced protein folding defects and various proteotoxic stresses. Surprisingly, this effect was not mediated by an enhanced stress response, which underlies longevity in low IIS conditions, but by reduced ribosome biogenesis and translation rate. We found that IIS activates the expression of intestinal peptide transporter PEPT-1 by alleviating its repression by FOXO/DAF-16, allowing dietary proteins to be efficiently incorporated into an amino acid pool that fuels germline protein synthesis. Our data suggest this non-cell-autonomous pathway is critical for proteostasis regulation during gametogenesis.

Increasing trends of non-tuberculous mycobacteria clinical isolates in Guangzhou, China.

Non-tuberculous mycobacteria (NTM) are one of major public health concern. The current study aimed to find the prevalence trends of NTM in Guangzhou, China from January 2018 to December 2023. A total of 26,716 positive mycobacterial cultures were collected. Thirty-six specimens with incomplete personal information were excluded. The remaining 26,680 specimens were identified using a gene chip method. 16,709 isolates were Mycobacterium tuberculosis (MTB) (62.63 %), and 9,971 were NTM (37.37 %). 43.43 % (4,330/9,971) of NTM isolates were male, and 56.57 % (5,641/9,971) were female (χ2 = 24.36, P < 0.05), a male to female ratio of approximately 1:1.30. Infections in individuals with aged 40 years and above was higher (77.63 %) than below 40 years (22.37 %) (χ2 = 4.94, P = 0.026). The annual NTM isolation rates from 2018 to 2023 were 32.03 %, 34.00 %, 36.27 %, 38.58 %, 38.99 %, and 43.24 %, respectively, showing an increasing trend (χ2 for trend = 0.097, P < 0.05) (R = 0.097, P < 0.05). Out of 9,971 NTM isolates, 8,881 cases include only five common NTM species (MAC, M. abscessus/M. chelonae, M. kansasii, M. fortuitum, and M. gordonae). The overall NTM isolation rate was 37.37 %. The NTM isolation rate was significantly higher than the national average, showing an increasing trend over the last six years.

Recent Progress of 2D Materials-Based Photodetectors from UV to THz Waves: Principles, Materials, and Applications.

Photodetectors are one of the most critical components for future optoelectronic systems and it undergoes significant advancements to meet the growing demands of diverse applications spanning the spectrum from ultraviolet (UV) to terahertz (THz). 2D materials are very attractive for photodetector applications because of their distinct optical and electrical properties. The atomic-thin structure, high carrier mobility, low van der Waals (vdWs) interaction between layers, relatively narrower bandgap engineered through engineering, and significant absorption coefficient significantly benefit the chip-scale production and integration of 2D materials-based photodetectors. The extremely sensitive detection at ambient temperature with ultra-fast capabilities is made possible with the adaptability of 2D materials. Here, the recent progress of photodetectors based on 2D materials, covering the spectrum from UV to THz is reported. In this report, the interaction of light with 2D materials is first deliberated on in terms of optical physics. Then, various mechanisms on which detectors work, important performance parameters, important and fruitful fabrication methods, fundamental optical properties of 2D materials, various types of 2D materials-based detectors, different strategies to improve performance, and important applications of photodetectors are discussed.

A superporous and pH-sensitive hydrogel from Salvia hispanica (chia) seeds: stimuli responsiveness, on-off switching, and pharmaceutical applications.

The use of plant seed-based hydrogels to design drug delivery systems (DDSs) has increased due to their swellable, pH-responsive, biocompatible, biodegradable, and non-toxic nature. Herein, the chia seeds hydrogel (CSH) was extracted through an aqueous extraction method to explore its pH and salt-responsive swelling behavior and sustained release potential. The CSH was characterized using Fourier transform infrared (FT-IR) and solid-state cross-polarization magic angle spinning carbon-13 nuclear magnetic resonance (solid/state CP-MAS 13C/NMR) spectra. Thermal analysis indicated that the CSH is a thermally stable material and decomposes in two steps. The scanning electron microscope (SEM) images of CSH witnessed the existence of microscopic channeling and a superporous nature with average pore sizes of 18 ± 11 µm (transverse cross-sections) and 23 ± 15 µm (longitudinal cross-sections). The CSH is a haemocompatible material. The CSH revealed pH and saline-responsive swelling in powder and compressed form (tablet) in the following order; distilled water (DW) > pH 7.4 > pH 6.8 > pH 1.2. Moreover, the swelling of CSH followed second-order kinetics. The swelling of CSH powder and tablets was decreased with increasing salt concentration. The pH, solvent, and saline responsive on/off switching (swelling/deswelling) results of the CSH and tablets disclosed its stimuli-responsive nature. The CSH prolonged the release of valsartan for 5 h at pH 7.4, whereas, negligible release (19.3%) was noted at pH 1.2. The valsartan release followed first-order kinetics and the non-Fickian diffusion. In conclusion, the CSH is a stimuli-responsive smart material with great potential to develop pH-sensitive and targeted DDSs.

Unveiling the complexity of rifampicin drug susceptibility testing in Mycobacterium tuberculosis: comparative analysis with next-generation sequencing.

Introduction. The discordance between phenotypic and molecular methods of rifampicin (RIF) drug susceptibility testing (DST) in Mycobacterium tuberculosis poses a significant challenge, potentially resulting in misdiagnosis and inappropriate treatment.Hypothesis/gap statement. A comparison of RIF phenotypic and molecular methods for DST, including whole genome sequencing (WGS), may provide a better understanding of resistance mechanisms.Aim. This study aims to compare RIF DST in M. tuberculosis using two phenotypic and molecular methods including the GeneXpert RIF Assay (GX) and WGS for better understanding.Methodology. The study evaluated two phenotypic liquid medium methods [Lowenstein-Jensen (LJ) and Mycobacterium Growth Indicator Tube (MGIT)], one targeted molecular method (GX), and one WGS method. Moreover, mutational frequency in ponA1 and ponA2 was also screened in the current and previous RIF resistance M. tuberculosis genomic isolates to find their compensatory role.Results. A total of 25 RIF-resistant isolates, including nine from treatment failures and relapse cases with both discordant and concordant DST results on LJ, MGIT and GX, were subjected to WGS. The phenotypic DST results indicated that 11 isolates (44%) were susceptible on LJ and MGIT but resistant on GX. These isolates exhibited multiple mutations in rpoB, including Thr444>Ala, Leu430>Pro, Leu430>Arg, Asp435>Gly, His445>Asn and Asn438>Lys. Conversely, four isolates that were susceptible on GX and MGIT but resistant on LJ were wild type for rpoB in WGS. However, these isolates possessed several novel mutations in the PonA1 gene, including a 10 nt insertion and two nonsynonymous mutations (Ala394>Ser, Pro631>Ser), as well as one nonsynonymous mutation (Pro780>Arg) in PonA2. The discordance rate of RIF DST is higher on MGIT than on LJ and GX when compared to WGS. These discordances in the Delhi/CAS lineages were primarily associated with failure and relapse cases.Conclusion. The WGS of RIF resistance is relatively expensive, but it may be considered for isolates with discordant DST results on MGIT, LJ and GX to ensure accurate diagnosis and appropriate treatment options.

Modulating alginate-polyurethane elastomer properties: Influence of NCO/OH ratio with aliphatic diisocyanate.

This research addresses the need for enhanced biomaterials by investigating the influence of the NCO/OH ratio on sodium alginate-based polyurethane elastomers(Al-PUEs), offering novel insights into their structural, thermal, mechanical and swelling behavior. Al-PUEs were prepared by blending the chain extenders with key ingredients in a specific molar ratio using aliphatic HMDI and HTPB monomers. The chemical linkages, crystalline behavior, homogeneity, and surface morphology of PUEs were evaluated by FT-IR, XRD, SEM, and EDX analysis. Thermo-mechanical studies were performed using TGA, DSC and tensile testing. Swelling behavior and absorption analysis were analyzed in DMSO and water. The analysis indicated that the hydrophilicity and swelling behavior of the prepared PUEs were affected by the addition of sodium alginate content. The results exhibit the tailor-made network structure of Al-PUEs, resulting in better thermal stability, elasticity of materials via stress-strain behavior and marvelous characteristic features than traditional high-tech yields. Furthermore, the resulting Al-PUEs are potential candidates for biomedical implants.

Flaxseed (Linum usitatissimum) mucilage: A versatile stimuli-responsive functional biomaterial for pharmaceuticals and healthcare.

The present review is novel as it discusses the main findings of researchers on the topic and their implications, as well as highlights the emerging research in this particular area and its future prospective. The seeds of Flax (Linum usitatissimum) extrude mucilage (FSM) that has a diverse and wide range of applications, especially in the food industry and as a pharmaceutical ingredient. FSM has been blended with several food and dairy products to improve gelling ability, optical properties, taste, and user compliance. The FSM is recognized as a foaming, encapsulating, emulsifying, suspending, film-forming, and gelling agent for several pharmaceutical preparations and healthcare materials. Owing to stimuli (pH) -responsive swelling-deswelling characteristics, high swelling indices at different physiological pHs of the human body, and biocompatibility, FSM is considered a smart material for intelligent, targeted, and controlled drug delivery applications through conventional and advanced drug delivery systems. FSM has been modified through carboxymethylation, acetylation, copolymerization, and electrostatic complexation to get the desired properties for pharma, food, and healthcare products. The present review is therefore devoted to the isolation techniques, structural characterization, highly valuable properties for food and pharmaceutical industries, preclinical and clinical trials, pharmacological aspects, biomedical attributes, and patents of FSM.

Diffusible signal factor (DSF)-mediated quorum sensing modulates swarming in Xanthomonas albilineans.

Xanthomonas spp. are plant pathogens known for significantly impacting crop yields. Among them, Xanthomonas albilineans (Xal) is notable for colonizing the xylem and causing sugarcane leaf scald disease. This study employed homologous recombination to mutate quorum sensing (QS) regulatory genes (rpf) to investigate their role in Xal pathogenicity. Deletions of rpfF (ΔrpfF), rpfC (ΔrpfC), and rpfG (ΔrpfG) led to reduced swarming, growth, and virulence. However, DSF supplementation restored swarming and growth in the ΔrpfF mutant. Deleting rpfC, rpfG, and rpfF also reduced twitching motility and affected Type IV Pilus (T4P) expression. Transcriptomic analysis revealed that ΔrpfF positively regulates flagellar genes. DSF supplementation in ΔrpfF (ΔrpfF-DSF) modulated the expression of flagellar, chemotaxis, and T4P genes. These findings elucidate the DSF-mediated swarming pathway in Xal and provide valuable insights into its regulatory mechanisms.

Sources, transmission and hospital-associated outbreaks of nontuberculous mycobacteria: a review.

Nontuberculous mycobacteria (NTM) are widespread environmental organisms found in both natural and man-made settings, such as building plumbing, water distribution networks and hospital water systems. Their ubiquitous presence increases the risk of transmission, leading to a wide range of human infections, particularly in immunocompromised individuals. NTM primarily spreads through environmental exposures, such as inhaling aerosolized particles, ingesting contaminated food and introducing it into wounds. Hospital-associated outbreaks have been linked to contaminated medical devices and water systems. Furthermore, the rising global incidence, prevalence and isolation rates highlight the urgency of addressing NTM infections. Gaining a thorough insight into the sources and epidemiology of NTM infection is crucial for devising novel strategies to prevent and manage NTM transmission and infections.

Non-tuberculous mycobacteria (NTM) are environmental pathogens affecting humans and animals, with a substantial public health impact. These bacteria have been frequently identified in various natural and human-engineered settings, contributing to their potential transmission.

Genomic investigation of bone tuberculosis highlighted the role of subclinical pulmonary tuberculosis in transmission.

BACKGROUND: Extrapulmonary tuberculosis (EPTB) without symptomatic pulmonary involvement has been thought to be non-transmissible, but EPTB with asymptomatic pulmonary tuberculosis (PTB) could transmit tuberculosis (TB). Genomic investigation of Mycobacterium tuberculosis (Mtb) isolates from EPTB may provide insight into its epidemiological role in TB transmission. METHODS: Between January 2017 and May 2020, 107 Mtb isolates were obtained from surgical drainage of bone TB patients at the Beijing Chest Hospital, and 218 Mtb strains were isolated from PTB cases. These 325 Mtb isolates were whole-genome sequenced to reconstruct a phylogenetic tree, identify transmission clusters, and infer transmission links using a Bayesian approach. Possible subclinical PTB in the bone TB patients was investigated with chest imaging by two independent experts. RESULTS: Among 107 bone TB patients, 10 were in genomic clusters (≤12 SNPs). Phylogenetic analysis suggested that three bone TB patients transmitted the infection to secondary cases, supported by epidemiological investigations. Pulmonary imaging of 44 bone TB patients revealed that 79.5 % (35/44) had radiological abnormalities suggestive of subclinical PTB. CONCLUSIONS: This study provides genomic evidence that bone TB patients without clinically diagnosed PTB can be sources of TB transmission, underscoring the importance of screening for subclinical, transmissible PTB among EPTB cases.

Spectral Efficiency Maximization for Mixed-Structure Cognitive Radio Hybrid Wideband Millimeter-Wave Transceivers in Relay-Assisted Multi-User Multiple-Input Multiple-Output Systems.

This paper proposes a cognitive radio network (CRN)-based hybrid wideband precoding for maximizing spectral efficiency in millimeter-wave relay-assisted multi-user (MU) multiple-input multiple-output (MIMO) systems. The underlying problem is NP-hard and non-convex due to the joint optimization of hybrid processing components and the constant amplitude constraint imposed by the analog beamformer in the radio frequency (RF) domain. Furthermore, the analog beamforming solution common to all sub-carriers adds another layer of design complexity. Two hybrid beamforming architectures, i.e., mixed and fully connected ones, are taken into account to tackle this problem, considering the decode-and-forward (DF) relay node. To reduce the complexity of the original optimization problem, an attempt is made to decompose it into sub-problems. Leveraging this, each sub-problem is addressed by following a decoupled design methodology. The phase-only beamforming solution is derived to maximize the sum of spectral efficiency, while digital baseband processing components are designed to keep interference within a predefined limit. Computer simulations are conducted by changing system parameters under different accuracy levels of channel-state information (CSI), and the obtained results demonstrate the effectiveness of the proposed technique. Additionally, the mixed structure shows better energy efficiency performance compared to its counterparts and outperforms benchmarks.

A leaky gut contributes to postural imbalance in male patients with chronic obstructive pulmonary disease.

AIMS: Patients with chronic obstructive pulmonary disease (COPD) frequently exhibit an inability to maintain postural balance. However, the contribution of increased intestinal permeability or leaky gut to the postural imbalance in COPD is not known. METHODS: We measured plasma zonulin, a marker of leaky gut, with relevance to postural balance in male controls (n = 70) and patients with mild (n = 67), moderate (n = 66), and severe (n = 58) COPD. We employed a short physical performance battery to evaluate postural balance in supine, tandem, and semi-tandem positions. We also measured handgrip strength (HGS), gait speed, plasma c-reactive proteins (CRP), and 8-isoprostanes as potential mechanistic connections between postural imbalance and leaky gut. RESULTS: COPD patients demonstrated higher plasma zonulin, CRP, and 8-isoprostanes levels and lower balance, HGS, and gait speed than controls (all p < 0.05). These findings were more robust in patients with moderate and severe than mild COPD. In addition, plasma zonulin exhibited significant potential in diagnosing poor balance, low HGS, and gait speed in COPD patients (all p < 0.05). We also found significant correlations of plasma zonulin with CRP and 8-isoprostanes, providing heightened inflammation and oxidative stress as mechanistic connections between leaky gut and postural imbalance. CONCLUSION: Plasma zonulin may be helpful in evaluating postural imbalance in COPD patients. Repairing intestinal leaks can be a therapeutic target to improve postural control in COPD.

Impact of dental caries on the daily lives of geriatric patients visiting dental hospitals in Rawalpindi, Pakistan.

Background: The objectives were to assess the impact of dental caries on the daily living of the geriatric population and determine the factors that influence the relationship between dental health and the daily living of the geriatric population. Methods: A descriptive cross-sectional study was carried out over six months at Rawalpindi's public and private dental hospitals. Participants aged≥60 years, both male and female, were selected. The calculated sample size was 281. Desired sample from one of the dental hospitals was collected using a non-probability consecutive sampling strategy. Data about sociodemographic characteristics and the DMFT index were collected. Adapted validated tool dental impact on daily living (DIDL) was used to assess the impact of dental health on daily living. Results: Chi-squared test of association showed a positive association between the DIDL and sociodemographic variables, including age (P=0.001), gender (P=0.001), education (P=0.001), income (P=0.001), occupation (P=0.029), marital status (P=0.001), living arrangement (P=0.001), and history of chronic illnesses (P=0.001). The association between the DMFT index and DIDL also showed statistically significant results (P=0.001). Binary logistic regression analysis indicated that gender (OR=6.98, P=0.005) and the individual's dental health (OR=6.43, P=0.001) were the strongest predictors of the impact experienced in daily life activities. The overall model was statistically significant (χ2=51.24, P=0.001), and the variables were responsible for 32.4% of the variance in the outcome variable. Conclusion: The study provides strong evidence that sociodemographic factors, DMFT index, gender, and individual dental health significantly contribute to the impact of dental health on daily living. Gender and individual dental health emerge as particularly influential predictors. These findings emphasize the need for targeted interventions and awareness programs, especially for groups with a higher risk of experiencing a significant impact on daily life due to dental issues.

Adsorption and solar light activity of noble metal adatoms (Au and Zn) on Fe(111) surface: a first-principles study.

Noble metals such as gold (Au), zinc (Zn), and iron (Fe) are highly significant in both fundamental and technological contexts owing to their applications in optoelectronics, optical coatings, transparent coatings, photodetectors, light-emitting devices, photovoltaics, nanotechnology, batteries, and thermal barrier coatings. This study presents a comprehensive investigation of the optoelectronic properties of Fe(111) and Au, Zn/Fe(111) materials using density functional theory (DFT) first-principles method with a focus on both materials' spin orientations. The optoelectronic properties were obtained employing the generalized gradient approximation (GGA) and the full-potential linearized augmented plane wave (FP-LAPW) approach, integrating the exchange-correlation function with the Hubbard potential U for improved accuracy. The arrangement of Fe(111) and Au, Zn/Fe(111) materials was found to lack an energy gap, indicating a metallic behavior in both the spin-up state and the spin-down state. The optical properties of Fe(111) and Au, Zn/Fe(111) materials, including their absorption coefficient, reflectivity, energy-loss function, refractive index, extinction coefficient, and optical conductivity, were thoroughly examined for both spin channels in the spectral region from 0.0 eV to 14 eV. The calculations revealed significant spin-dependent effects in the optical properties of the materials. Furthermore, this study explored the properties of the electronic bonding between several species in Fe(111) and Au, Zn/Fe(111) materials by examining the density distribution mapping of charge within the crystal symmetries.