Pectoralis Major Tendon Rupture in a Spastic Hemiplegic Shoulder: a Complication of Home Stretching Pulley System.

ABSTRACT: Pectoralis major (PM) injuries are uncommon, typically affecting young male athletes engaging in high-intensity activities like weight-lifting. A 62-year-old male, who previously suffered a stroke leading to left hemiparesis, hemisensory loss, and spasticity, exhibited a left chest swelling during a rehabilitation clinic visit. Subsequent inquiries revealed his recent incorporation of a home-based pulley system for stretching exercises. On examination, the swelling was diffuse, firm, and non-tender, located at the midclavicular line of his left chest, with a positive dropped nipple sign and loss of the left anterior axillary fold sign. An ultrasound confirmed a low-grade injury to the left PM tendon. Spastic muscle ruptures are extremely rare, with only three published reports linked to traumatic brain injury, multiple sclerosis, and spinal cord injury. Spasticity increases muscle vulnerability due to structural and mechanical changes to the skeletal muscles. This is the first report of a spastic PM tendon rupture and the first following a stroke. This case highlights the need for optimized multimodal spasticity management and reinforces the importance of comprehensive patient education on the safe execution of home-based stretching exercises.

Bioassay-guided isolation of cycloartane-type triterpenes, their cytotoxic properties and identification of potential chemical markers from Geniotrigona thoracica propolis.

Phytochemical investigation through cytotoxicity bioassay-guided isolation of Geniotrigona thoracica propolis led to the identification of five cycloartane-type triterpenes, including mangiferonic acid 1, ambonic acid 2, mangiferolic acid 3, ambolic acid 4 and cycloartenol 5. Their structures were established based on detailed spectroscopic analysis and comparison with literature data. Compounds 1-5 were isolated for the first time in this species. From cytotoxicity MTT assay, compound 3 inhibited the growth of breast (MCF-7) and hepatocellular carcinoma (HepG2) cancer cell lines with IC50 of 5.08 and 4.82 µg/mL, respectively. Cytotoxicity of compounds 1-5 were reported for the first time against HepG2 cancer cell lines. Compounds 1-4 were suggested to serve as main and/or analytical markers for G. thoracica propolis based on HPLC analysis. To our knowledge, this is the first report on the isolation of bioactive constituents and identification of chemical markers for G. thoracica propolis.

Highly Pathogenic Avian Influenza A(H5N1) Virus Clade 2.3.4.4b in Domestic Ducks, Indonesia, 2022.

Highly pathogenic avian influenza A(H5N1) clade 2.3.4.4b viruses were isolated from domestic ducks in South Kalimantan, Indonesia, during April 2022. The viruses were genetically similar to those detected in East Asia during 2021-2022. Molecular surveillance of wild birds is needed to detect potential pandemic threats from avian influenza virus.

Scbean: a python library for single-cell multi-omics data analysis.

SUMMARY: Single-cell multi-omics technologies provide a unique platform for characterizing cell states and reconstructing developmental process by simultaneously quantifying and integrating molecular signatures across various modalities, including genome, transcriptome, epigenome, and other omics layers. However, there is still an urgent unmet need for novel computational tools in this nascent field, which are critical for both effective and efficient interrogation of functionality across different omics modalities. Scbean represents a user-friendly Python library, designed to seamlessly incorporate a diverse array of models for the examination of single-cell data, encompassing both paired and unpaired multi-omics data. The library offers uniform and straightforward interfaces for tasks, such as dimensionality reduction, batch effect elimination, cell label transfer from well-annotated scRNA-seq data to scATAC-seq data, and the identification of spatially variable genes. Moreover, Scbean's models are engineered to harness the computational power of GPU acceleration through Tensorflow, rendering them capable of effortlessly handling datasets comprising millions of cells. AVAILABILITY AND IMPLEMENTATION: Scbean is released on the Python Package Index (PyPI) (https://pypi.org/project/scbean/) and GitHub (https://github.com/jhu99/scbean) under the MIT license. The documentation and example code can be found at https://scbean.readthedocs.io/en/latest/.

Design and Rationale for the Direct Oral Anticoagulant Apixaban in Left Ventricular Assist Devices (DOAC LVAD) Study.

Implantable left ventricular assist device (LVAD) therapy is used to improve quality of life, alleviate symptoms and extend survival rates in patients with advanced heart failure. Patients with LVADs require chronic anticoagulation to reduce the risk of thromboembolic complications, and they commonly experience bleeding events. Apixaban is a direct oral anticoagulant that has become first-line therapy for patients with nonvalvular atrial fibrillation and venous thromboembolism; however, its safety in patients with LVADs has not been well characterized. The evaluation of the hemocompatibility in the DOAC LVAD (Direct Oral Anti-Coagulant apixaban in Left Ventricular Assist Devices) trial is a phase 2, open-label trial of patients with LVADs who were randomized to either apixaban or warfarin therapy. Patients randomized to apixaban will be started on a dosage of 5 mg twice daily, whereas those randomized to warfarin will be managed at an International Normalized Ratio goal of 2.0-2.5. All patients will be treated with aspirin at 81 mg daily. We plan to randomize and follow as many as 40 patients for 24 weeks to evaluate the primary outcomes of freedom from death or hemocompatibility-related adverse events (stroke, device thrombosis, bleeding, aortic root thrombus, and arterial non-CNS thromboembolism). The DOAC LVAD trial will establish the feasibility of apixaban anticoagulant therapy in patients with LVADs. Clinicaltrials.gov: NCT04865978.

Association of ABCG2 Polymorphisms on Triple Negative Breast Cancer (TNBC) Susceptibility Risk.

OBJECTIVE: The aim of this study was to elucidate the association of ATP-binding cassette super-family G member 2 (ABCG2) gene polymorphisms with individual susceptibility to Triple Negative Breast Cancer (TNBC) as well as clinicopathological variables in TNBC patients. Two common polymorphisms in Asian population, ABCG2 34 G>A and 421 C>A was selected in this study. METHODS: Blood samples were collected from 75 TNBC patients and 83 controls. Genomic DNA was extracted from blood samples and the SNP genotyping was performed by using PCR-RFLP technique. The genotypes were characterized and grouped into homozygous wildtype, heterozygote and homozygous variant based on the band size. The result was subjected to statistical analysis. RESULTS: The A allele and AA genotype of ABCG2 421 C>A had OR of 3.011 (p=0.003, 95% CI: 1.417-6.398) and 9.042 (p=0.011, 95% CI: 1.640-49.837), to develop advanced staging carcinoma respectively. The AA genotype of ABCG2 421 C>A polymorphism was also associated with metaplastic and medullary carcinoma with an OR of 6.429 (p=0.018, 95% CI: 1.373-30.109). A significant association was also found in haplotype 34G/421A of ABCG2 with advanced cancer staging as well as metaplastic and medullary carcinoma with OR of 2.347 (p=0.032, 95% CI: 1.010-5.560) and 2.546 (p=0.008, 95% CI: 1.005-6.447), respectively.  Conclusion: The present study suggests that ABCG2 421 C>A polymorphism was associated with metaplastic and medullary histology and advanced cancer staging in TNBC patients.

Phytoconstituents of Endiandra kingiana; antidiabetic effects and molecular docking studies on alpha-amylase and alpha-glucosidase.

Phytochemical investigation on the bark of E. kingiana plant afforded ten compounds, including six polyketides namely kingianin A 1, kingianin B 2, kingianin E 3, kingianin F 4, kingianin K 5 and kingianin L 6, three endiandric acids; kingianic acid A 7, tsangibeilin B 8 and endiandric acid M 9, and one sesquiterpene; daibuoxide 10. All compounds were separated as racemic mixture by recycling high-performance liquid chromatography (RHPLC), except for daibuoxide. Their structures were elucidated by detailed spectroscopic and comparative literature data analysis. This is the first report on the presence of the sesquiterpene; daibuoxide in Endiandra genus. In vitro enzymatic bio-evaluation of the isolated compounds against α-amylase and α-glucosidase showed that 4 demonstrated the best α-amylase and α-glucosidase inhibitory activity with IC50 values of 181.54 ± 6.27 µg/mL and 237.87 ± 0.07 µg/mL, respectively. In addition, molecular docking analysis confirmed the α-amylase and α-glucosidase inhibitory activities demonstrated by 4.

Training Pathways in Critical Care Cardiology: Competencies and Considerations for Cardiologists.

PURPOSE OF REVIEW: Critical care cardiology (CCC) is a rapidly developing field undergoing a renaissance of interest and growth to meet the well-documented population shift in the cardiac intensive care unit (CICU). With this has come the emergence of novel training paradigms that seek to combine specialties with meaningful overlap. RECENT FINDINGS: The benefit of having critical care expertise in the CICU has been clearly established; however, there is no formal or uniform CCC training pathway. Contemporary approaches seek to provide appropriate clinical and procedural experience while minimizing opportunity cost. The combination of additional cardiology subspecialties, specifically advanced heart failure or interventional cardiology, has been demonstrated. Educational tracks that integrate critical care training have generated interest but have not yet manifested. CCC training strives to meet the needs of an increasingly sick and diverse patient population while preparing trainees for fulfilling and meaningful careers. The hope is for ongoing development of novel training pathways to satisfy evolving needs.

New pattern of atypical advanced interatrial block.

INTRODUCTION: Interatrial block (IAB) is defined as prolonged P-wave duration (≥ 120 ms) due to delayed conduction in the Bachmann bundle. This is readily identifiable using surface electrocardiogram (ECG). Advanced IAB can be classified as typical and atypical. Atypical IAB can be further categorized by (i) duration or (ii) morphology. In this report, we have identified a new pattern of atypical IAB with triphasic morphology of the P-wave in the inferior leads. METHODS: Two clinical cases were evaluated including surface ECGs. P-wave durations and amplitudes were measured with digital calipers using ECG analysis software (MUSE, GE HealthCare). Comparisons were made using prior data to evaluate IAB and P-wave duration and morphology. RESULTS: A new pattern of atypical advanced IAB shows prolonged P-wave duration (P wave >160 ms) and triphasic morphology in all inferior leads with P +/+/- and P +/-/+, respectively. We speculate that triphasic P-waves in the inferior leads represent three moments of atrial depolarization; from right to left. CONCLUSION: This study describes a novel pattern of atypical advanced IAB. Further investigation regarding the increased risk of atrial fibrillation and stroke associated with this new pattern is warranted in the future.

Influence of particle size in supercritical carbon dioxide extraction of roselle (Hibiscus sabdariffa) on bioactive compound recovery, extraction rate, diffusivity, and solubility.

The purpose of this work was to establish the best particle size for recovering high yields of total phenolic compounds (TPC), total anthocyanin compounds(TAC) and total flavonoid compounds (TFC) from roselle (Hibiscus sabdariffa) by applying supercritical carbon dioxide (ScCO2). The extraction rate, diffusivity and solubility of yield in ScCO2 were also studied and calculated utilizing models. Pressure (10 and 30 MPa), temperature (40 and 60 °C), and particle size (250 µm < dp < 355 µm, 355 µm < dp < 425 µm and 425 µm < dp < 500 µm) were employed as variables in this experiment. The greatest recovery was 11.96% yield, 7.16 mg/100 g TAC, 42.93 mg/100 g TPC and 239.36 mg/100 g TFC under the conditions of 30 MPA, 40 °C and 250 µm < dp < 355 µm, respectively. The extraction rate of supercritical carbon dioxide in roselle extraction ranged from 5.19 E-03 to 1.35 E-03 mg/s fitted using the Esquivel model. The diffusivity coefficient of ScCO2 ranged from 2.17E-12 to 3.72E-11 mg/s2, as fitted by a single sphere model. The greatest solubility of global yield, TAC, TPC and TFC in ScCO2 was 1.50 g/L, 0.3 mg/L, 1.69 mg/L and 9.97 mg/L, respectively, with a particle size of 250 µm < dp < 355 µm. The smaller particle size of roselle provides the maximum bioactive compound recovery and solubility. Furthermore, the diffusivity and extraction of ScCO2 are increased by decreasing the particle size. Therefore, a smaller particle size is appropriate for roselle extraction by ScCO2 based on the experimental and modelling data.

Valorization of Peanut Skin as Agricultural Waste Using Various Extraction Methods: A Review.

Peanuts (Arachis hypogea) can be made into various products, from oil to butter to roasted snack peanuts and candies, all from the kernels. However, the skin is usually thrown away, used as cheap animal feed, or as one of the ingredients in plant fertilizer due to its little value on the market. For the past ten years, studies have been conducted to determine the full extent of the skin's bioactive substance repertoire and its powerful antioxidant potential. Alternatively, researchers reported that peanut skin could be used and be profitable in a less-intensive extraction technique. Therefore, this review explores the conventional and green extraction of peanut oil, peanut production, peanut physicochemical characteristics, antioxidant activity, and the prospects of valorization of peanut skin. The significance of the valorization of peanut skin is that it contains high antioxidant capacity, catechin, epicatechin resveratrol, and procyanidins, which are also advantageous. It could be exploited in sustainable extraction, notably in the pharmaceutical industries.

Mechanical Circulatory Support and Critical Care Management of High-Risk Acute Pulmonary Embolism.

Hemodynamically significant pulmonary embolism (PE) remains a widely prevalent, underdiagnosed condition associated with mortality rates as high as 30%. The main driver of poor outcomes is acute right ventricular failure that remains clinically challenging to diagnose and requires critical care management. Treatment of high-risk (or massive) acute PE has traditionally included systemic anticoagulation and thrombolysis. Mechanical circulatory support, including both percutaneous and surgical approaches, are emerging as treatment options for refractory shock due to acute right ventricular failure in the setting of high-risk acute pulmonary embolism.

Orange Pomace and Peel Extraction Processes towards Sustainable Utilization: A Short Review.

More than 58 million metric tonnes of oranges were produced in 2021, and the peels, which account for around one-fifth of the fruit weight, are often discarded as waste in the orange juice industry. Orange pomace and peels as wastes are used as a sustainable raw material to make valuable products for nutraceuticals. The orange peels and pomace contain pectin, phenolics, and limonene, which have been linked to various health benefits. Various green extraction methods, including supercritical carbon dioxide (ScCO2) extraction, subcritical water extraction (SWE), ultrasound-assisted extraction (UAE), and microwave-assisted extraction (MAE), are applied to valorize the orange peels and pomace. Therefore, this short review will give insight into the valorization of orange peels/pomace extraction using different extraction methods for health and wellness. This review extracts information from articles written in English and published from 2004 to 2022. The review also discusses orange production, bioactive compounds in orange peels/pomaces, green extractions, and potential uses in the food industry. Based on this review, the valorization of orange peels and pomaces can be carried out using green extraction methods with high quantities and qualities of extracts. Therefore, the extract can be used for health and wellness products.

KRAS Mutational Profiles among Colorectal Cancer Patients in the East Coast of Peninsular Malaysia.

BACKGROUND: KRAS is a key driver gene in colorectal carcinogenesis. Despite this, there are still limited data on the mutational status of KRAS amongst colorectal cancer (CRC) patients in Malaysia. In the present study, we aimed to analyze the KRAS mutational profiles on codons 12 and 13 amongst CRC patients in Hospital Universiti Sains Malaysia, Kelantan, located on the East Coast of Peninsular Malaysia. METHODS: DNA were extracted from formalin-fixed, paraffin-embedded tissues obtained from 33 CRC patients diagnosed between 2018 and 2019. Amplifications of codons 12 and 13 of KRAS were conducted using conventional polymerase chain reaction (PCR) followed by Sanger sequencing. RESULTS: Mutations were identified in 36.4% (12/33) of patients, with G12D (50%) being the most frequent single-point mutation observed, followed by G12V (25%), G13D (16.7%), and G12S (8.3%). No correlation was found between mutant KRAS and location of the tumor, staging, and initial carcinoembryonic antigen (CEA) level. CONCLUSION: Current analyses revealed that a significant proportion of CRC patients in the East Coast of Peninsular Malaysia have KRAS mutations, where this frequency is higher compared to those in the West Coast. The findings of this study would serve as a precursor for further research that explores KRAS mutational status and the profiling of other candidate genes among Malaysian CRC patients.

Perspectives on the Application of Cytogenomic Approaches in Chronic Lymphocytic Leukaemia.

Chronic lymphocytic leukaemia (CLL) is a haematological malignancy characterised by the accumulation of monoclonal mature B lymphocytes (positive for CD5+ and CD23+) in peripheral blood, bone marrow, and lymph nodes. Although CLL is reported to be rare in Asian countries compared to Western countries, the disease course is more aggressive in Asian countries than in their Western counterparts. It has been postulated that this is due to genetic variants between populations. Various cytogenomic methods, either of the traditional type (conventional cytogenetics or fluorescence in situ hybridisation (FISH)) or using more advanced technology such as DNA microarrays, next generation sequencing (NGS), or genome wide association studies (GWAS), were used to detect chromosomal aberrations in CLL. Up until now, conventional cytogenetic analysis remained the gold standard in diagnosing chromosomal abnormality in haematological malignancy including CLL, even though it is tedious and time-consuming. In concordance with technological advancement, DNA microarrays are gaining popularity among clinicians as they are faster and better able to accurately diagnose the presence of chromosomal abnormalities. However, every technology has challenges to overcome. In this review, CLL and its genetic abnormalities will be discussed, as well as the application of microarray technology as a diagnostic platform.

Selection and Validation of Reference Genes for Gene Expression Studies in an Equine Adipose-Derived Mesenchymal Stem Cell Differentiation Model by Proteome Analysis and Reverse-Transcriptase Quantitative Real-Time PCR.

Adipose-derived stem cells (ADSCs) are used in tissue regeneration therapies. The objective of this study is to identify stable reference genes (RGs) for use in gene expression studies in a characterized equine adipose-derived mesenchymal stem cell (EADMSC) differentiation model. ADSCs were differentiated into adipocytes (ADs) or osteoblasts (OBs), and the proteomes from these cells were analyzed by liquid chromatography tandem mass spectrometry. Proteins that were stably expressed in all three cells types were identified, and the mRNA expression stabilities for their corresponding genes were validated by RT-qPCR. PPP6R1, CCDC97, and then either ACTB or EPHA2 demonstrated the most stable mRNA levels. Normalizing target gene Cq data with at least three of these RGs simultaneously, as per MIQE guidelines (PPP6R1 and CCDC97 with either ACTB or EPHA2), resulted in congruent conclusions. FABP5 expression was increased in ADs (5.99 and 8.00 fold, p = 0.00002 and p = 0.0003) and in OBs (5.18 and 5.91 fold, p = 0.0011 and p = 0.0023) relative to ADSCs. RUNX2 expression was slightly higher in ADs relative to ADSCs (1.97 and 2.65 fold, p = 0.04 and p = 0.01), but not in OBs (0.9 and 1.03 fold, p = 0.58 and p = 0.91).

Proximate Compositions, Texture, and Sensory Profiles of Gluten-Free Bario Rice Bread Supplemented with Potato Starch.

Current gluten-free food development trends tend to favour pigmented rice flour. Bario Merah Sederhana is a type of red-pigmented rice that is indigenous to Sarawak, Malaysia. This research investigates the nutritional, texture, and sensory properties of gluten-free rice bread produced from a composite of BMS rice flour and potato starch, producing samples referred to as F1 (100:0), F2 (90:10), F3 (80:20), and F4 (70:30). The gluten-free rice bread formulations demonstrated higher ash and crude fibre content and lower carbohydrate content than wheat bread. However, the crude protein content of the bread decreased significantly (p < 0.05) with a decreased amount of rice flour, owing to wheat flour containing greater protein. The crumb of rice bread appeared to be darker due to the red pigment of rice flour; in contrast, the crust was lighter than the control sample, possibly due to a lower Maillard reaction. Among rice bread formulations, F4 demonstrated the lowest hardness in dough and bread, as well as the highest stickiness and springiness in dough and bread, respectively. The wheat bread received the highest rating (p < 0.05) in the sensory test; nonetheless, among the rice breads, F4 was considered to be an acceptable formulation owing to its high score in colour (7.03), flavour (5.73), texture (6.03), and overall acceptability (6.18). BMS has potential in gluten-free rice breads; the formulation of 70% rice flour combined with 30% potato starch was indicated to be acceptable.

Insight into Green Extraction for Roselle as a Source of Natural Red Pigments: A Review.

Roselle (Hibiscus sabdariffa L.) is a source of anthocyanins as red pigments that is extensively farmed in tropical and subtropical regions, including Indonesia, Malaysia, China, Thailand, Egypt, Mexico, and West India. The roselle plant contains a variety of nutrients, including anthocyanins, organic acids, pectin, etc. Due to the toxicity and combustibility of the solvents, traditional extraction methods for these compounds are restricted. Obtaining pure extracts is typically a lengthy procedure requiring many processes. Supercritical carbon dioxide (ScCO2) extraction as a green technology is rapidly improving and extending its application domains. The advantages of this method are zero waste production, quicker extraction times, and reduced solvent consumption. The ScCO2 extraction of natural pigments has great promise in food, pharmaceuticals, cosmetics, and textiles, among other uses. The ScCO2 technique for natural pigments may also be advantageous in a variety of other contexts. Due to their minimal environmental risk, the high-quality red pigments of roselle rich in anthocyanins extracted using ScCO2 extraction have a high sustainability potential. Therefore, the objective of this review is to increase knowledge related to the natural colorant of roselle as a substitute for chemically manufactured colorants using ScCO2 as a green method. This article covers ScCO2 extraction, particularly as it relates to the optimization of pigments that promote health. This article focuses on the high extraction efficiency of ScCO2 extraction. Natural colorants extracted via ScCO2 are regarded as safe compounds, especially for human consumption, such as novel functional food additives and textile and pharmaceutical colors.

Bibliometric Analysis of Human Metapneumovirus Studies.

Objective: This study aimed to estimate research productivity and general characteristics of research in different regions of the world in the field of human metapneumovirus (hMPV). Materials and Methods: We used the Web of Science (WoS) electronic database to retrieve articles on "human metapneumovirus," published up to March 31, 2023. Parameters such as research productivity, the total number of publications, average citation counts of all articles, research productivity by top publishing countries and affiliated organizations, links between countries/organizations, and top keywords were assessed. Results: We found 826 articles in the WoS database. The first article on hMPV was published in 2002, and 2008 was the year that the most articles on hMPV were published, with 70 articles. The articles were cited 26,797 times (14,498 times without self-citations) and 32.25 times on average per article. Hirsch (H)-index was 80. The year 2008 also had the highest number of citations, with more than 1800. The United States was the most productive country, producing 295 documents (35.714%), one-third of all publications in this field worldwide. Canada (6.5%) and Japan (6.5%) followed the United States regarding total hMPV publications worldwide. The leading funding agencies for hMPV research were from the United States, Europe, China, and Japan. Conclusion: Our findings imply that developed countries should assist developing countries in enhancing their research infrastructures.