Understanding diagnostic conversations in clinical practice: A systematic review.

OBJECTIVE: Summarize frameworks to understand diagnostic conversations and assessments of diagnostic conversations in practice. METHODS: We systematically searched MEDLINE, Scopus, Cochrane, and other databases from inception to July 2022 for reports of diagnostic conversations. Two authors independently reviewed studies for eligibility, assessed methodological quality with the mixed methods appraisal tool and extracted information related to study characteristics, frameworks and components evaluated in assessments of diagnostic conversations and results. RESULTS: Eight studies were included. One study reported an empiric framework of diagnostic conversations that included the following components: identifying the problem that requires diagnosis, obtaining information, and delivering the diagnosis and treatment plan. Thematic analyses highlighted communication between patients and clinicians as central in diagnostic conversations as it allows a) patient's presentation of their symptoms which guide subsequent diagnostic steps, b) negotiation of the significance of the patient's symptoms through conversation and c) introducing and resolving diagnostic uncertainty. CONCLUSION: Despite the importance of diagnostic conversation only one empiric framework described its components. Additionally, limited available evidence suggests patients can have an important role in the diagnostic process that expands beyond patients as an information source. PRACTICE IMPLICATIONS: Patients should be included as active partners in co-development of diagnostic plans of care.

Current application of seaweed waste for composting and biochar: A review.

To address the origins of ocean acidification, seaweed aquaculture is emerging as a key biosequestration strategy. Nevertheless, seaweed biomass is involved in developing food and animal feed, whereas seaweed waste from commercial hydrocolloid extraction is dumped in landfills, which together limit the carbon cycle and carbon sequestration. This work sought to evaluate the production, properties, and applications of seaweed compost and biochar to strengthen the "carbon sink" implications of aquaculture sectors. Due to their unique characteristics, the production of seaweed-derived biochar and compost, as well as their existing applications, are distinct when compared to terrestrial biomass. This paper outlines the benefits of composting and biochar production as well as proposes ideas and perspectives to overcome technical shortcomings. If properly synchronized, progression in the aquaculture sector, composting, and biochar production, potentially promote various Sustainable Development Goals.

Effect of biomass retention time on performance and fouling of a stirred membrane photobioreactor.

Co-culture of microalgae-activated sludge has the potential to purify wastewater while reduce energy demand from aeration. In this work, a mechanically stirred membrane photobioreactor (stirred-MPBR) was used to evaluate the impact of the biomass retention time (BRT) on the treatment performance and membrane fouling. Results showed that stirred-MPBR was affected by BRT during treating domestic wastewater at a flux of 16.5 L m-2 h-1. The highest productivity was attained at BRT 7d (102 mg L-1 d-1), followed by BRT 10d (86 mg L-1 d-1), BRT 5d (85 mg L-1 d-1), and BRT 3d (83 mg L-1 d-1). Statistical analysis results showed that BRT 7d had a higher COD removal rate than BRT 10d, however, there is no difference in total nitrogen removal rate. The highest TP removal occurred when the biomass operated at BRT as short as 3d. Reduced BRTs caused a change in the microalgae-activated sludge biomass fraction that encouraged nitrification activity while simultaneously contributing to a higher fouling rate. The bound protein concentrations dropped from 31.35 mg L-1 (BRT 10d) to 10.67 mg L-1 (BRT 3d), while soluble polysaccharides increased from 0.99 to 1.82 mg L-1, respectively. The concentrations of extracellular polymeric substance fractions were significantly altered, which decreased the mean floc size and contributed to the escalating fouling propensity. At the optimum BRT of 7d, the stirred-MPBR showed sufficient access to light and nutrients exchange for mutualistic interactions between the microalgae and activated sludge.

Influence of C/N ratios on treatment performance and biomass production during co-culture of microalgae and activated sludge.

Novel phycosphere associated bacteria processes are being regarded as a potential and cost-effective strategy for controlling anthropogenic contaminants in wastewater treatment. However, the underlying concern with the process is its vulnerability to improper organic or nutrient intake. This study established a synergistic interaction between microalgae and activated sludge in a three-photobioreactor system (without external aeration) to understand how pollutants could be mitigated whilst simultaneously yielding biomass under different C/N ratios of 1:1, 5:1 and 10:1. The result showed that the superior biomass productivity was facilitated at a C/N ratio of 5:1 (106 mg L-1 d-1), and the high degradation rate constants (kCOD = 0.25 d-1, kTN = 0.29 d-1, kTP = 0.35 d-1) was approximated using a first-order kinetic model. The removal of pollutants was remarkably high, exceeding 90% (COD), 93% (TN), and 96% (TP). Nevertheless, the C/N ratio of 1:1 resulted in a threefold drop in biomass-specific growth rate (µ = 0.07 d-1). Microalgal assimilation, followed by bacterial denitrification, is the major pathway of removing total nitrogen when the C/N ratio exceeds 5:1. Activated sludge plays an important role in improving microalgae tolerance to high concentration of ammonia nitrogen and boosting nitrification (light phase) and denitrification (dark phase). The use of phycosphere associated bacteria could be a promising strategy for controlling nutrients pollution and other environmental considerations in wastewater.

Comparison of degradation kinetics of tannery wastewater treatment using a nonlinear model by salt-tolerant Nitrosomonas sp. and Nitrobacter sp.

Conventional biological treatment has been reported to be ineffective for pollutant removal in tannery wastewater due to high salinity. To overcome it, this work used salt-tolerant bacteria (STB) isolated from a membrane bioreactor to evaluate the organic and nutrient removal through a series of batch experiments. Compared with the control, the STB reactor enhanced the reduction of persistent organics by 11% based on the double exponential decay model. Besides, the removal of NH4+-N is 26% higher, satisfying the first-order decay model. The nitrification was inhibited entirely in control during 48 h, whilst the assimilation process involved 55% of total nitrogen removal. In the STB reactor, nitrification occurred after 12 h, resulting in significantly increased NO2--N and NO3--N concentrations according to the logistic function. Although nitrification was successfully activated, C/N ratios and free ammonia were identified as limiting factors for STB activity, requiring mitigation strategies in further studies.

Pre-existing cardiovascular disease, acute kidney injury, and cardiovascular outcomes in hospitalized blacks with COVID-19 infection.

BACKGROUND: The Corona Virus 19 (COVID-19) infection is associated with worse outcomes in blacks, although the mechanisms are unclear. We sought to determine the significance of black race, pre-existing cardiovascular disease (pCVD), and acute kidney injury (AKI) on cardiopulmonary outcomes and in-hospital mortality of COVID-19 patients. METHODS: We conducted a retrospective cohort study of blacks with/without pCVD and with/without in-hospital AKI, hospitalized within Grady Memorial Hospital in Georgia between February and July 2020, who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on qualitative polymerase-chain-reaction assay. The primary outcome was a composite of in-hospital cardiac events. RESULTS: Of the 293 patients hospitalized with COVID-19 in this study, 71 were excluded from the primary analysis (for race/ethnicity other than black non-Hispanic). Of the 222 hospitalized COVID-19 patients included in our analyses, 41.4% were female, 78.8% had pCVD, and 30.6% developed AKI during the admission. In multivariable analyses, pCVD (OR 4.7, 95% CI 1.5-14.8, P=0.008) and AKI (OR 2.7, 95% CI 1.3-5.5, P=0.006) were associated with increased odds of in-hospital cardiac events. AKI was associated with increased odds of in-hospital mortality (OR 8.9, 95% CI 3.3-23.9, P<0.0001). The presence of AKI was associated with increased odds of ICU stay, mechanical ventilation, and acute respiratory distress syndrome (ARDS). CONCLUSION: pCVD and AKI were associated with higher risk of in-hospital cardiac events, and AKI was associated with a higher risk of in-hospital mortality in blacks.

Fabrication and characterization of polyamide thin-film composite membrane via interfacial polycondensation for pervaporation separation of salt and arsenic from water.

Pervaporation, mainly utilized to separate azeotropic mixtures, has been paid much attention for desalination in recent years due to its numerous advantages. The membranes based on thin-film composite structure have gained great interest in pervaporation due to their thin thickness, controllable hydrophilicity, and crosslinking density which affects the permeation flux and selectivity of the membranes. In this study, a polyamide thin-film composite (PA-TFC) membrane was fabricated through interfacial polymerization between amine monomers and trimesoyl chloride (TMC) on a polysulfone porous substrate (PSf). Four different diamine monomers, including ethylenediamine (EDA), triethylenetetramine (TETA), m-phenylenediamine (MPD), and piperazine (PIP) were used to investigate the effect of the monomers on the pervaporation performance of the resulting membrane for separation of sodium chloride (NaCl) and arsenate (As(v)) aqueous solution. The physicochemical properties of the membrane were characterized using attenuated total reflection Fourier transform infrared (ATR-FTIR), scanning electron microscopy (SEM), atomic force microscopy (AFM), and pure water contact angle measurement. Furthermore, the performance of the fabricated membranes was studied by pervaporation separation of 0.15 mg L-1 As(v) and 5 g L-1 NaCl aqueous solution at 40 °C, respectively. The results show that the rejections of the membrane are insignificantly affected by the chemical structures of the amines, and both the As(v) rejection and NaCl rejection are higher than 99.9%. However, the permeation flux decreases in the order of PIP-TMC membrane > TETA-TMC membrane ∼ EDA-TMC membrane > MPD-TMC membrane. Furthermore, the operating conditions are found to affect the separation performance of the PIP-TMC membrane significantly. In particular, the elevating operation temperature profoundly increases the permeation flux, while the increase in high salt concentration leads to a slight decrease in rejection but a significant decline in permeation flux. The derived membrane shows a reasonable permeation flux of 16.1 kg m-2 h-1 and ca. 99.9% rejection for 1.5 mg L-1 As(v) removal, as well as 13 kg m-2 h-1 and 99.3% rejection for 30 g L-1 NaCl separation at 60 °C. The sufficient permeation flux and good rejection of As(v) and NaCl of the membrane suggested the promising application of PA-TFC membrane for pervaporation removal of toxic arsenic from water and desalination of seawater.

Macrophage M2 polarization induced by exosomes from adipose-derived stem cells contributes to the exosomal proangiogenic effect on mouse ischemic hindlimb.

BACKGROUND: M2 macrophages and exosomes from adipose-derived stem cells (ASCs) are both reported to promote angiogenesis. However, the possible synergistic effects between exogenous exosomes and endogenous M2 macrophages are poorly understood. METHODS: Exosomes were isolated from conditioned medium of normoxic and hypoxic ASCs using the combined techniques of ultrafiltration and size-exclusion chromatography and were identified with nanoparticle tracking analysis and immunoblotting for exosomal markers. Macrophages were collected from the mouse peritoneal cavity. M1 and M2 macrophages were detected by immunoblotting for the intracellular markers inducible nitric oxide synthase (iNOS) and arginase-1 (Arg-1) and by flow cytometry for the surface markers F4/80, CD86, and CD206. Murine models of Matrigel plug and hindlimb ischemia were employed as in vivo angiogenic assays. RESULTS: When M1 macrophages were treated with exosomes from normoxic ASCs (Nor/Exo), and particularly from hypoxic ASCs (Hyp/Exo), the expression of the M1 marker iNOS decreased, and the M2 marker Arg-1 increased in a time- and dose-dependent manner. Additionally, a decrease in the M1 surface marker CD86 and an increase in the M2 surface marker CD206 were observed, which suggested that M1 macrophages were polarized to an M2-like phenotype. Conditioned medium from these M2-like macrophages presented lower levels of proinflammatory cytokines and higher levels of proangiogenic factors and promoted endothelial cell proliferation, migration, and tube formation. Furthermore, M2 polarization and angiogenesis were induced upon the administration of exosomes in mouse Matrigel plug and hindlimb ischemia (HLI) models. Interestingly, these exosomal effects were attenuated by using a colony stimulating factor 1 receptor (CSF-1R) inhibitor, BLZ945, in vitro and in vivo. Downregulation of microRNA-21 (miR-21) in hypoxic ASCs reduced the exosomal effects on M2 polarization, Akt phosphorylation, and CSF-1 secretion. A similar reduction in exosomal activity was also observed when exosomes were administered along with BLZ945. CONCLUSION: Our findings provide evidence that exosomes from ASCs polarize macrophages toward an M2-like phenotype, which further enhances the exosomal proangiogenic effects. Exosomal delivery of miR-21 and positive feedback of secreted CSF-1 may be involved in macrophage polarization.

Brewers' rice modulates oxidative stress in azoxymethane-mediated colon carcinogenesis in rats.

AIM: To investigate the mechanistic action of brewers' rice in regulating the Wnt/nuclear factor-kappa B (NF-κB)/Nrf2-signaling pathways during colon carcinogenesis in male Sprague-Dawley rats. METHODS: Male Sprague-Dawley rats were randomly divided into the following five groups (six rats in each group): (G1) normal, (G2) azoxymethane (AOM) alone, (G3) AOM + 10% (weight (w)/weight (w)) brewers' rice, (G4) AOM + 20% (w/w) brewers' rice, and (G5) AOM + 40% (w/w) brewers' rice. They were intraperitoneally administered 15 mg/kg body weight of AOM in saline once weekly over a two-week period and treated with an American Institute of Nutrition (AIN)-93G diet containing 10%, 20%, and 40% (w/w) brewers' rice. The mRNA levels of glycogen synthase kinase 3ß (GSK3ß), ß-catenin, key inflammation markers, nuclear factor E2-related factor 2 (Nrf2), and heme oxygenase-1 (HO-1)-dependent transcriptional activity were assessed by quantitative real-time polymerase chain reaction analyses. The colon superoxide dismutase, malondialdehyde, and nitric oxide levels were also analyzed to assess the antioxidant effect of these treatments. The results were analyzed using one-way analysis of variance (ANOVA), and a P value of < 0.05 was considered significant. RESULTS: The overall analyses demonstrated that the dietary administration of brewers' rice in AOM-induced rat colon carcinogenesis resulted in the transcriptional upregulation of GSK3ß, inducible nitric oxide synthase (iNOS), Nrf2, and HO-1. We discovered that the dietary administration of brewers' rice downregulated the ß-catenin and NF-κB mRNA levels. A significant reduction in ß-catenin expression was found in the groups administered with 20% (0.611 ± 0.034) and 40% (0.436 ± 0.045) (w/w) brewers' rice compared with that of the group treated with AOM alone (1.000 ± 0.064) (P < 0.05). The NF-κB expression was significantly lower between the AOM-alone group (1.000 ± 0.048) and those groups fed with diets containing 10% (w/w) brewers' rice (0.255 ± 0.022), 20% (w/w) brewers' rice (0.450 ± 0.045), or 40% (w/w) brewers' rice (0.541 ± 0.027) (P < 0.05). Brewers' rice improved the antioxidant levels, indicating that brewers' rice can enhance effective recovery from oxidative stress induced by AOM. CONCLUSION: Our results provide evidence that brewers' rice can suppress colon cancer via the regulation of Nrf2 expression and the inhibition of the Wnt/NF-κB signaling pathways.

Water extract of brewers' rice induces apoptosis in human colorectal cancer cells via activation of caspase-3 and caspase-8 and downregulates the Wnt/ß-catenin downstream signaling pathway in brewers' rice-treated rats with azoxymethane-induced colon carcinogenesis.

BACKGROUND: Brewers' rice, is locally known as temukut, is a mixture of broken rice, rice bran, and rice germ. The current study is an extension of our previous work, which demonstrated that water extract of brewers' rice (WBR) induced apoptosis in human colorectal cancer (HT-29) cells. We also identified that brewers' rice was effective in reducing the tumor incidence and multiplicity in azoxymethane (AOM)-injected colon cancer rats. Our present study was designed to identify whether WBR confers an inhibitory effect via the regulation of upstream components in the Wnt signaling pathway in HT-29 cells. To further determine whether the in vitro mechanisms of action observed in the HT-29 cells inhibit the downstream signaling target of the Wnt/ß-catenin pathway, we evaluated the mechanistic action of brewers' rice in regulating the expressions and key protein markers during colon carcinogenesis in male Sprague-Dawley rats. METHODS: The mRNA levels of several upstream-related genes in the Wnt signaling pathway in HT-29 cells treated with WBR were determined by quantitative real-time PCR analyses. Caspase-3 and -8 were evaluated using a colorimetric assay. Male Sprague-Dawley rats were administered two intraperitoneal injections of AOM in saline (15 mg/kg body weight) over a two-week period and received with 10, 20, and 40% (w/w) brewers' rice. The expressions and protein levels of cyclin D1 and c-myc were evaluated by immunohistochemical staining and western blotting, respectively. RESULTS: The overall analyses revealed that the treatment of HT-29 cells with WBR inhibited Wnt signaling activity through upregulation of the casein kinase 1 (CK1) and adenomatous polyposis coli (APC) mRNA levels. We discovered that the treatment of HT-29 cells with WBR resulted in the induction of apoptosis by the significant activation of caspase-3 and -8 activities compared with the control (P < 0.05). In vivo analyses indicated that brewers' rice diminished the ß-catenin, cyclin D1, and c-myc protein levels. CONCLUSIONS: We provide evidence that brewers' rice can induce apoptosis and inhibit the proliferation of HT-29 cells through regulation of caspase-dependent pathways and inhibit the Wnt/ß-catenin downstream signaling pathway in vivo. We suggest that brewers' rice may be a useful dietary agent for colorectal cancer.

A novel transcript of oil palm (Elaeis guineensis Jacq.), Eg707, is specifically upregulated in tissues related to totipotency.

In this study, we report the molecular characterization of clone Eg707 isolated from cell suspension culture of the oil palm. The deduced polypeptide of clone Eg707 is highly similar to an unknown protein from Arabidopsis thaliana. The presence of an Ald-Xan-dh-C2 superfamily domain in the deduced protein sequence suggested that Eg707 protein might be involved in abscisic acid biosynthesis. Eg707 might be present as a single copy gene in the oil palm genome. This gene is highly expressed in tissue cultured materials compared to vegetative and reproductive tissues, suggesting a role of this gene during oil palm somatic embryogenesis or at the early stages of embryo development. Expression analysis of Eg707 by RNA in situ hybridization showed that Eg707 transcripts were present throughout somatic embryo development starting from proembryo formation at the embryogenic callus stages till the maturing embryo stages. Since proembryo formation within the embryogenic callus is one of the first key factors in oil palm somatic embryo development, it is suggested that Eg707 could be used as a reliable molecular marker for detecting early stage of oil palm somatic embryogenesis.