Shifts in Students' Attitudes Towards Pain Patients, Pain, and Opioid Management Following a Dedicated Medical School Pain Curriculum.

Objective: To examine the immediate effects of a comprehensive pain course on medical students' pre-existing perceptions and attitudes toward pain patients and opioid management. Methods: First-year medical students at a major academic medical center enrolled in a required pre-clerkship pain course in June 2020 and completed pre- and post-course online surveys with Likert-scale questions about their attitudes toward pain management and opioid-related issues. Additionally, the surveys included a free-text question where the students listed the first five words that came to mind when hearing the word "opioids". These words were categorized as "professional" or "lay" words and further as having "positive", "negative", or "neutral" connotations. Data analyses included descriptive statistics, as well as non-parametric and parametric tests. Results: Fifty-four of the 119 students responded to pretest and posttest surveys and were included in paired analyses. There was a significant difference between the number of professional words used before (M=1.21, SD=0.97) and after the course (M=2.40 SD=1.33); t(52)=-6.39, P<0.001. Students also used more lay-positive words after the course (M=0.81, SD=0.63) than they used pre-course (M=0.23, SD=0.43); t(51)=-5.98, P<0.001. Students' post-course responses to several key Likert-scale questions showed significant shifts toward more positive attitudes about caring for patients with pain. For example, students acknowledged greater comfort in providing opioids for chronic pain (P<0.001) where appropriate, and enhanced interest in handling complex pain cases (P<0.001). Conclusion: Results showed that a comprehensive, multi-disciplinary pain course could greatly enhance first-year medical students' attitudes toward pain management, chronic pain patients, and the complex issues surrounding opioids.

Study on the role of nano antibacterial materials in orthodontics (a review) / Estudo sobre o papel dos materiais nanoantibacterianos na ortodontia

Nanoparticles (NPs) are insoluble particles with a diameter of fewer than 100 nanometers. Two main methods have been utilized in orthodontic therapy to avoid microbial adherence or enamel demineralization. Certain NPs are included in orthodontic adhesives or acrylic resins (fluorohydroxyapatite, fluorapatite, hydroxyapatite, SiO2, TiO2, silver, nanofillers), and NPs (i.e., a thin layer of nitrogen-doped TiO2 on the bracket surfaces) are coated on the surfaces of orthodontic equipment. Although using NPs in orthodontics may open up modern facilities, prior research looked at antibacterial or physical characteristics for a limited period of time, ranging from one day to several weeks, and the limits of in vitro studies must be understood. The long-term effectiveness of nanotechnology-based orthodontic materials has not yet been conclusively confirmed and needs further study, as well as potential safety concerns (toxic effects) associated with NP size.

Nanopartículas (NPs) são partículas insolúveis com diâmetro inferior a 100 nanômetros. Dois métodos principais têm sido utilizados na terapia ortodôntica para evitar a aderência microbiana ou a desmineralização do esmalte: NPs são incluídas em adesivos ortodônticos ou resinas acrílicas (fluoro-hidroxiapatita, fluorapatita, hidroxiapatita, SiO2, TiO2, prata, nanopreenchimentos) e NPs são revestidas nas superfícies de equipamentos ortodônticos, ou seja, uma camada fina de TiO2 dopado com nitrogênio nas superfícies do braquete. Embora o uso de NPs em ortodontia possa tornar acessível modernos recursos, pesquisas anteriores analisaram as características antibacterianas ou físicas por um período limitado de tempo, variando de 24 horas a várias semanas, por isso devem ser compreendidos os limites dos estudos in vitro. A eficácia de longo prazo de materiais ortodônticos com base em nanotecnologia ainda não foi confirmada de forma conclusiva, o que exige mais estudos, bem como potenciais preocupações de segurança (efeitos tóxicos) associadas ao tamanho da NP.

Study on the role of nano antibacterial materials in orthodontics (a review)

Abstract Nanoparticles (NPs) are insoluble particles with a diameter of fewer than 100 nanometers. Two main methods have been utilized in orthodontic therapy to avoid microbial adherence or enamel demineralization. Certain NPs are included in orthodontic adhesives or acrylic resins (fluorohydroxyapatite, fluorapatite, hydroxyapatite, SiO2, TiO2, silver, nanofillers), and NPs (i.e., a thin layer of nitrogen-doped TiO2 on the bracket surfaces) are coated on the surfaces of orthodontic equipment. Although using NPs in orthodontics may open up modern facilities, prior research looked at antibacterial or physical characteristics for a limited period of time, ranging from one day to several weeks, and the limits of in vitro studies must be understood. The long-term effectiveness of nanotechnology-based orthodontic materials has not yet been conclusively confirmed and needs further study, as well as potential safety concerns (toxic effects) associated with NP size.

Resumo Nanopartículas (NPs) são partículas insolúveis com diâmetro inferior a 100 nanômetros. Dois métodos principais têm sido utilizados na terapia ortodôntica para evitar a aderência microbiana ou a desmineralização do esmalte: NPs são incluídas em adesivos ortodônticos ou resinas acrílicas (fluoro-hidroxiapatita, fluorapatita, hidroxiapatita, SiO2, TiO2, prata, nanopreenchimentos) e NPs são revestidas nas superfícies de equipamentos ortodônticos, ou seja, uma camada fina de TiO2 dopado com nitrogênio nas superfícies do braquete. Embora o uso de NPs em ortodontia possa tornar acessível modernos recursos, pesquisas anteriores analisaram as características antibacterianas ou físicas por um período limitado de tempo, variando de 24 horas a várias semanas, por isso devem ser compreendidos os limites dos estudos in vitro. A eficácia de longo prazo de materiais ortodônticos com base em nanotecnologia ainda não foi confirmada de forma conclusiva, o que exige mais estudos, bem como potenciais preocupações de segurança (efeitos tóxicos) associadas ao tamanho da NP.

Repurposing the oncolytic virus VSV∆51M as a COVID-19 vaccine.

The coronavirus disease 2019 (COVID-19) pandemic imposes an urgent and continued need for the development of safe and cost-effective vaccines to induce preventive responses for limiting major outbreaks around the world. To combat severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), we repurposed the VSV∆51M oncolytic virus platform to express the spike receptor-binding domain (RBD) antigen. In this study, we report the development and characterization of the VSV∆51M-RBD vaccine. Our findings demonstrate successful expression of the RBD gene by the VSV∆51M-RBD virus, inducing anti-RBD responses without attenuating the virus. Moreover, the VSV∆51M-RBD vaccine exhibited safety, immunogenicity, and the potential to serve as a safe and effective alternative or complementary platform to current COVID-19 vaccines.

ACUTE TOXICITY OF COUMACINES: AN IN VIVO STUDY.

The design and synthesis of new drugs are increasingly challenging in chemistry settings. The synthesis is itself lured by the properties of the product after synthesis, including solubility, hygroscopicity, intensive adverse effects, and biological inefficacy; hence, the creation of a new drug should be considered in light of the avoidance of these downside features, if any. The present study is designed to investigate the acute toxicity of newly discovered heterocyclic frameworks derived from the coumarin backbone, namely coumacine I and coumacine II. To do so, a mouse model of 25 mice was subclassified into 5 groups (5 mice control, 5 mice coumacine I 1000 mg/kg, 5 mice coumacine II 1000 mg/kg, 5 mice coumacine I 2000 mg/kg, and 5 mice coumacine II 2000 mg/kg), a single dose was given, and mice were sacrificed after 4 hours post-dose. The blood sample and tissue were collected for biochemical and histopathological studies. Serums were analyzed for the measurement of renal function and liver enzyme activity using classical biochemical methods. A high dose of either compound caused deleterious changes, as evidenced by a significant (p<0.05) increase in creatinine, urea, GOT, and GPT, as well as disrupting tissue quasi-equilibrium at the cellular level in both kidney and liver. To sum up, coumacine I and coumacine II are relatively safe unless otherwise used in high doses, knowing that either dose in the present study is remarkably higher than the therapeutic dose of coumarins currently in use in clinical settings.

The Effect of Eucalyptus globulus Hydroalcoholic Extract on LH, FSH and Testosterone Concentrations and Sperm Morphology.

Scientists have been paying attention to the life-giving properties of medicinal plants for many years. Among these plants is the eucalyptus plant. This plant has various compounds such as cineole and terpenes. It also contains compounds such as flavonoids, aliphatic aldehydes, sesquiterpene, quinotanen, catechins, salts, and vitamins. In the present study, the hydroalcoholic extract of Eucalyptus leaves with concentrations of 175, 350, and 700 mg/kg body weight, and spermatogenesis were studied in 40 adult Wistar rats in five groups of eight. Adult male mice received the extract at the above concentrations by gavage for 28 days. Control mice received only solvent and water, while control mice received no substance other than municipal tap water and normal food. After the last administration of the drug, the animals were weighed and anesthetized, and then blood samples were taken from their hearts. Concentrations of LH, FSH, and testosterone were measured by an ELISA kit. The results showed that body weight and testis, seminiferous tube diameter, Leydig cell diameter, epithelium thickness, number of Leydig cells, spermatogonium, spermatocytes, spermatids, sperm, and testosterone concentration increased significantly with the group. But no significant difference was observed in the concentration of FSH and LH hormones or the number of Sertoli cells. Therefore, it can be concluded that eucalyptus leaf extract may increase the proliferation of sex cells in the seminiferous tubules of rats.

Evaluation of Phosphorus Storage and Performance of Broilers Using Phytase Synthetic Enzyme.

Phytic acid is a stored form of phosphorus in cereals, 65 to 70% of phosphorus in plant sources is phytate, and broilers are only able to use part of the phosphorus in plant sources. To meet the needs of chickens, it is necessary to use other artificial resources, which not only impose part of the cost of the breeding period because of its presence in the manure but is one of the factors polluting the environment. This study aimed to use different levels of phytase enzyme to reduce dietary phosphorus levels. 600 Ross 308 broilers were used in this experiment with five treatments and six replications, and in each replication, 20 chickens were used in a completely randomized design (CRD). Experimental treatments include 1) basal diet (control) 2) basal diet with 15% less phosphorus 3) basal diet with 15% less phosphorus + 1250 (FTU) phytase enzyme 4) basal diet with 15% less phosphorus + 2500 (FTU) phytase enzyme 5) basal diet with 15% less phosphorus + 5000 (FTU) phytase enzyme. The evaluated traits included weekly feed intake, weekly weight gain, feed conversion ratio, carcass characteristics, ash, calcium, and bone phosphorus. The use of phytase enzyme in different diets had no significant effect on food intake, weight gain, and feed conversion ratio (P>0.05). However, the use of phytase in different diets significantly affected the percentage of Gizzard, Heart, Liver, Proventriculus, and Spleen (P<0.05). The most changes were the increase in the ratio of feed intake and weight gain in the fourth week compared to the third week so that the changes in the ratio of feed intake ranged from 1.85 to 1.91, and this ratio for weight gain also ranged from 3.12 to 3.86 was recorded, and the lowest feed conversion ratio was obtained at the same age. The percentage of raw ash in broiler chickens was significantly increased by adding dietary phytase. The lowest amount of ash, calcium, and phosphorus belonged to the second group (diets with low phosphorus and no enzyme). The difference between the other groups and the control was not significant. Feed intake, weight gain, and feed conversion ratio with the addition of phytase enzyme were not affected by phosphorus reduction and had no significant effect on carcass characteristics. Environmental pollution can be prevented by reducing the level of dietary phosphorus and reducing excreted phosphorus.

The Role of Selenium on the Status of Mineral Elements and Some Blood Parameters of Blood Serum of Lambs.

Selenium is one of the compounds belonging to the trace minerals group, which needs less than 100 mg/day. This element is one of the main constituents of selenoproteins, and the function of selenoproteins is to help make DNA and protect cells from damage and infection. This experiment aimed to evaluate the effect of different sources of selenium on some mineral elements in the blood serum of lambs. This experiment was conducted using twenty 4-month-old lambs with an average weight of 37±2.2 kg, 4 treatments, and 5 replications in a completely randomized design (CRD). The treatments tested included control, sodium selenite, nano selenium, and VitEsel. The experiment duration was 30 days, and blood sampling of lambs was performed at the beginning of the experiment (zero), 15, and 30 days. Different sources of selenium significantly affected the concentrations of iron, copper, and zinc (P<0.05). Different sources of selenium in this experiment decreased the concentration of iron and copper and increased the concentration of zinc and plasma selenium in different periods (P<0.05). Using different sources of selenium changed the concentration of the studied elements and showed the difference in their bioavailability.

Effect of Licorice Essential Oil (Glycyrrhizaglabraglabra) on Performance and Some Biochemical Parameters of Broiler Chickens.

Due to its beneficial components, such as glycyrrhizin, licorice is regarded a medicinal and fragrant plant. This research was designed to investigate the efficacy of licorice essential oil as an alternative to chemical antibiotics on broiler production, carcass features, cellular and humoral safety, and numerous biochemical variables in broiler blood serum. A total of 160 day-old broiler chicks were assigned to four treatment groups using a totally randomized approach. Each treatment consisted of 4 replicates, with 10 chicks in each replication. The experimental treatments included a control group, a group receiving an elemental diet containing 0.1% licorice essential oil, a group receiving an elemental diet containing 0.2% licorice essential oil, and a group receiving an elemental diet containing 0.3% licorice essential oil. Broilers had ad libitum access to feed and water in accordance with a three-phase feeding schedule consisting of a starter, grower, and finisher diet. There was no statistically significant difference (P>0.05) in body weight, feed intake, or feed conversion ratio between birds given the control or essential oil licorice at various stages of the experiment. However, birds receiving 0.1% licorice essential oil had a lower gallbladder relative weight and 0.3% licorice essential oil had less abdominal fat than the control group (P<0.05). Blood glucose, cholesterol, and LDL concentrations all fell considerably in licorice essential oil-treated birds relative to controls (P<0.05). The cellular immune response of birds fed licorice-containing diets did not differ from that of control birds (P>0.05), however there was a significant difference in the humoral immune response at 0.1% licorice essential oil compared to the control group (P<0.05). In overall, the results of this experiment demonstrated that incorporating licorice essential oil into a bird's diet improves its health and safety.

Needs-based novel digital curriculum for the neuromodulation training deficit: Pain Rounds.

This study reports the needs-based development, effectiveness and feasibility of a novel, comprehensive spinal cord stimulation (SCS) digital curriculum designed for pain medicine trainees. The curriculum aims to address the documented systematic variability in SCS education and empower physicians with SCS expertise, which has been linked to utilization patterns and patient outcomes. Following a needs assessment, the authors developed a three-part SCS e-learning video curriculum with baseline and postcourse knowledge tests. Best practices were used for educational video production and test-question development. The study period was from 1 February 2020 to 31 December 2020. A total of 202 US-based pain fellows across two cohorts (early-fellowship and late-fellowship) completed the baseline knowledge assessment, while 122, 96 and 88 participants completed all available post-tests for Part I (Fundamentals), Part II (Cadaver Lab) and Part III (Decision Making, The Literature and Critical Applications), respectively. Both cohorts significantly increased knowledge scores from baseline to immediate post-test in all curriculum parts (p<0.001). The early-fellowship cohort experienced a higher rate of knowledge gain for Parts I and II (p=0.045 and p=0.027, respectively). On average, participants viewed 6.4 out of 9.6 hours (67%) of video content. Self-reported prior SCS experience had low to moderate positive correlations with Part I and Part III pretest scores (r=0.25, p=0.006; r=0.37, p<0.001, respectively). Initial evidence suggests that Pain Rounds provides an innovative and effective solution to the SCS curriculum deficit. A future controlled study should examine this digital curriculum's long-term impact on SCS practice and treatment outcomes.

In search of the bottlenecks of ammonia synthesis over Ru/Vulcan under ambient conditions.

Hydrogenation of the N-N bond under ambient conditions over 1 wt% Ru/Vulcan was monitored through operando Diffuse Reflectance Infrared Spectroscopy (DRIFTS) and DFT. IR signals centered at 3017 cm-1 and 1302 cm-1 were visible with attributes similar to the asymmetric stretching and bending vibrations of gas phase ammonia at 3381 cm-1 and 1650 cm-1. The intensities of the signals increased with consecutive H2 : Ar and N2 flow cycles at room temperature and atmospheric pressure due to accumulation of the formed NHX on the catalyst surface. DFT estimations revealed that a compound with a molecular stoichiometry of N-NH3 can give rise to an IR signal centered at 3051.9 cm-1. The results of this study, combined with the known vapor liquid phase behavior of ammonia, suggest that under subcritical conditions, the bottlenecks of ammonia synthesis are both N-N bond dissociation and ammonia desorption from the pores of the catalyst.

Fouling resistance investigations of seaweed products.

Any solid, unprotected, and undefended surface in the aquatic environment will be fouled. Fouling, on the other hand, can affect a wide range of species that can tolerate some epibiosis. Several others, on the other hand, aggressively keep the epibionts off their body surface (antifouling). Antifouling defenses are built into marine plants like seaweed and seagrass. They do have a distinctive surface structure with tightly packed needle-like peaks and antifouling coverings, which may hinder settling bacteria's ability to cling. Chemical antifouling resistance is most probably a biological reaction to epibiosis' ecological drawbacks, especially for organisms capable of performing photosynthesis. The goal of this study was to see how effective natural compounds derived from littoral seaweeds were in preventing fouling. The brown mussel, an important fouling organism, was evaluated in laboratory bioassays against fifty-one populations' crude organic extracts including fort-two macroalgae species. Antifouling activity, exhibited a distinct phylogenetic pattern, with red macroalgae having the largest share of active species, subsequently brown macroalgae. Antifouling action in green seaweeds has never been significant. Seven species showed some level of induced antifouling defense. Our findings appear to back up previous findings about secondary metabolite synthesis in seaweeds, indicating that in the hunt for novel antifoulants, researchers should concentrate their efforts on tropical red macroalgae.

A Decision-Support System to Schedule Rotations for Trainees.

Background: Each training program has its own internal policies and restrictions, which must be considered while developing trainee schedules. Designing these schedules is complex and time consuming, and the final schedules often contain undesirable aspects for trainees. Objective: We developed a decision-support system (DSS) to optimally schedule daily assignments and monthly rotations for trainees. The proposed DSS aims to 1) reduce the schedule development time, 2) maximize trainee preferences for desired rotations and vacation times, and 3) ensure adaptability of the DSS across multiple graduate medical programs through a flexible design and intuitive graphical user interface. Methods: Using mixed-integer linear programming, we developed a scheduling model that 1) maximized trainees' preferences on specific rotations and vacation times and 2) ensured fairness by assigning equal numbers of vacation days and a balanced schedule of difficult versus easy rotations among trainees. The model was successfully implemented in the Mayo Clinic Division of Pulmonary and Critical Care for the academic year 2018-2019. Results: Using the DSS, it took only a few minutes to produce a schedule versus several days of preparation time required by the manual process. Compared with the manually developed schedule, the DSS schedule satisfied 11% more rotation preferences and improved fairness by 19%. All trainees met duty hours in the DSS schedule compared with 83% in the manually developed schedule. Conclusion: The proposed DSS can dramatically reduce the schedule preparation time, accommodate more of trainees' preferences, and improve fairness in assigning rotations.

Pediatric Floating Elbow Caused by a Novel Mechanism: A Case Report.

A pediatric floating elbow is a rare condition in which there is a humeral supracondylar fracture with an ipsilateral fracture of one or both bones of the forearm. We report a case caused by an unusual mechanism of a semi-automatic washing machine. This injury, on its own, involves the risk of compartment syndrome, however, this particular child came late. We present our approach to this challenging injury along with the controversial management in the literature.

Uterine Serosal Inclusion Cysts with Greater Omentum Involvement in a Cat.

A 7-year-old nulliparous Chinchilla queen was admitted to a veterinary clinic for routine ovariohysterectomy. Examination of the uterus, greater omentum and varicose ovarian veins revealed multiple thin-walled cysts filled with a transparent fluid over the serosal surfaces of these organs. Histologically, the cysts were of variable size, filled with a small amount of mucinous fluid, and had thin walls that contained hypocellular collagen and a few small calibre vessels. The inner and outer epithelium of the cyst walls and the cells that lined the uterine serosa were immunopositive for cytokeratin and vimentin, suggesting a mesothelial origin. Alpha-smooth muscle actin immunolabelling was patchy or continuous in smooth muscle in the wall of many of the cysts.

Non-invasive Hemoglobin Measurement Predictive Analytics with Missing Data and Accuracy Improvement Using Gaussian Process and Functional Regression Model.

Recent use of noninvasive and continuous hemoglobin (SpHb) concentration monitor has emerged as an alternative to invasive laboratory-based hematological analysis. Unlike delayed laboratory based measures of hemoglobin (HgB), SpHb monitors can provide real-time information about the HgB levels. Real-time SpHb measurements will offer healthcare providers with warnings and early detections of abnormal health status, e.g., hemorrhagic shock, anemia, and thus support therapeutic decision-making, as well as help save lives. However, the finger-worn CO-Oximeter sensors used in SpHb monitors often get detached or have to be removed, which causes missing data in the continuous SpHb measurements. Missing data among SpHb measurements reduce the trust in the accuracy of the device, influence the effectiveness of hemorrhage interventions and future HgB predictions. A model with imputation and prediction method is investigated to deal with missing values and improve prediction accuracy. The Gaussian process and functional regression methods are proposed to impute missing SpHb data and make predictions on laboratory-based HgB measurements. Within the proposed method, multiple choices of sub-models are considered. The proposed method shows a significant improvement in accuracy based on a real-data study. Proposed method shows superior performance with the real data, within the proposed framework, different choices of sub-models are discussed and the usage recommendation is provided accordingly. The modeling framework can be extended to other application scenarios with missing values.

Reliability and Educational Value of YouTube Videos of Complete Meso-Colic Excision With Right Hemicolectomy in the COVID-19 Pandemic.

AIM: To investigate the reliability and educational value of YouTube videos of minimally invasive complete mesocolic excision with right hemicolectomy procedures. MATERIALS AND METHODS: We searched YouTube with the terms "Laparoscopic and Robotic Complete Mesocolic Excision with Right Hemicolectomy" on January 12, 2021. To assess the reliability of the videos, we evaluated nine steps in each video and scored the videos based on the key steps they contained. The videos were divided into three groups according to the source of the upload. The total number of views, length, time since upload, and the number of likes, dislikes, and comments were recorded for each video. Narration, the use of descriptive subtitles, and the upload status by an expert surgeon were also examined. RESULTS: Sixty-eight videos were included in the study. A positive significant correlation was identified between the comprehensiveness score (CS) and the number of views (p=0.025). The CSs of the videos accessed from academic channels, as well as those accessed from journals, congress, and association channels, recorded higher CSs than those obtained from the personal channels of consultants (p=0.003). It was also found that CSs were higher in the videos of expert surgeons (p<0.001) and narrated videos (p<0.001). CONCLUSION: Not all YouTube videos on this subject have reliability and educational value. Surgical videos on YouTube may be evaluated by a video review commission formed by academic institutions, surgical associations, or expert surgeons, and videos suitable for education could be brought together and published via a free channel.

Chemical and physical features of biological fluids in treatment of hydatid disease.

The aim of this paper is to better understand the dynamics of crystallogenic and starting activity in biological fluids of patients throughout surgery and the late postoperative phase in alveococcosis. Samples of saliva from 22 individuals with alveococcosis were included in the research. Biological fluid samples were taken at the time of admission and before the patient was discharged. Following that, slides were made utilizing the teziocrystalloscopy method, which incorporates the investigation of the crystal forming activity of mixed saliva with its starting characteristics using a 0.9 percent sodium chloride solution as the foundation ingredient. Using our own set of criteria, we evaluated the outcomes of crystalloscopic and tezigraphic experiments. Specrophotometric examination of tezigraphic and crystalloscopic facies was done using a PowerWave XS microplate spectrophotometer at wavelengths of 400, 350, and 300 nm to augment the results from ocular morphometry of dried saliva micro slides. Surgical therapy results in a partial normalization of physical and chemical parameters, as well as the composition of the patient's biological fluids after the patient is discharged from the hospital.