Statistical analysis plan for the replacing protein via enteral nutrition in a stepwise approach in critically ill patients (REPLENISH) randomized clinical trial.

BACKGROUND: The optimal amount and timing of protein intake in critically ill patients are unknown. REPLENISH (Replacing Protein via Enteral Nutrition in a Stepwise Approach in Critically Ill Patients) trial evaluates whether supplemental enteral protein added to standard enteral nutrition to achieve a high amount of enteral protein given from ICU day five until ICU discharge or ICU day 90 as compared to no supplemental enteral protein to achieve a moderate amount of enteral protein would reduce all-cause 90-day mortality in adult critically ill mechanically ventilated patients. METHODS: In this multicenter randomized trial, critically ill patients will be randomized to receive supplemental enteral protein (1.2 g/kg/day) added to standard enteral nutrition to achieve a high amount of enteral protein (range of 2-2.4 g/kg/day) or no supplemental enteral protein to achieve a moderate amount of enteral protein (0.8-1.2 g/kg/day). The primary outcome is 90-day all-cause mortality; other outcomes include functional and health-related quality-of-life assessments at 90 days. The study sample size of 2502 patients will have 80% power to detect a 5% absolute risk reduction in 90-day mortality from 30 to 25%. Consistent with international guidelines, this statistical analysis plan specifies the methods for evaluating primary and secondary outcomes and subgroups. Applying this statistical analysis plan to the REPLENISH trial will facilitate unbiased analyses of clinical data. CONCLUSION: Ethics approval was obtained from the institutional review board, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia (RC19/414/R). Approvals were also obtained from the institutional review boards of each participating institution. Our findings will be disseminated in an international peer-reviewed journal and presented at relevant conferences and meetings. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04475666 . Registered on July 17, 2020.

Whole-brain traumatic controlled cortical impact to the left frontal lobe: Magnetic resonance image-based texture analysis.

This research assesses the capability of texture analysis (TA) derived from high-resolution (HR) T2-weighted magnetic resonance imaging to identify primary sequelae following 1-5 hours of controlled cortical impact mild or severe traumatic brain injury (TBI) to the left frontal cortex (focal impact) and secondary (diffuse) sequelae in the right frontal cortex, bilateral corpus callosum, and hippocampus in rats. The TA technique comprised first-order (histogram-based) and second-order statistics (including gray-level co-occurrence matrix, gray-level run length matrix, and neighborhood gray-level difference matrix). Edema in the left frontal impact region developed within 1 hour and continued throughout the 5-hour assessments. The TA features from HR images confirmed the focal injury. There was no significant difference among radiomics features between the left and right corpus callosum or hippocampus from 1 to 5 hours following a mild or severe impact. The adjacent corpus callosum region and the distal hippocampus region (s), showed no diffuse injury 1-5 hours after mild or severe TBI. These results suggest that combining HR images with TA may enhance detection of early primary and secondary sequelae following TBI.

Bismuth-Based Metal-Organic Framework as a Chemiresistive Sensor for Acetone Gas Detection.

Analyzing acetone in the exhaled breath as a biomarker has proved to be a non-invasive method to detect diabetes in humans with good accuracy. In this work, a Bi-gallate MOF doped into a chitosan (CS) matrix containing an ionic liquid (IL) was fabricated to detect acetone gas with a low detection limit of 10 ppm at an operating temperature of 60 °C and 5 V operating bias. The sensor recorded the highest response to acetone in comparison to other test gases, proving its high selectivity along with long-term stability and repeatability. The sensor also exhibited ultra-fast response and recovery times of 15 ± 0.25 s and 3 ± 0.1 s, respectively. Moreover, the sensor membrane also exhibited flexibility and ease of fabrication, making it ideal to be employed as a real-time breath analyzer.

Pseudoaneurysm and Renal Artery Stenosis Post-renal Transplant: A Rare Presentation.

We report the case of a 51-year-old gentleman who underwent living renal transplantation in Pakistan for end-stage renal disease one and a half years ago. He presented to our hospital with renal artery stenosis and an extra-renal pseudoaneurysm at the anastomotic site of the transplanted kidney. This can cause graft dysfunction and hypertension due to impairment of arterial perfusion in the transplanted kidney. Treatment with percutaneous transluminal angioplasty and covered stenting of the pseudoaneurysm and stenosis improved kidney function and hypertension.

Ag Nanocluster Production through DC Magnetron Sputtering and Inert Gas Condensation: A Study of Structural, Kelvin Probe Force Microscopy, and Optical Properties.

Silver nanoclusters are valuable for a variety of applications. A combination of direct current (DC) magnetron sputtering and inert gas condensation methods, employed within an ultra-high vacuum (UHV) system, was used to generate Ag nanoclusters with an average size of 4 nm. Various analytical techniques, including Scanning Probe Microscopy (SPM), X-ray Diffraction (XRD), Kelvin Probe Force Microscopy (KPFM), UV-visible absorption, and Photoluminescence, were employed to characterize the produced Ag nanoclusters. AFM topographic imaging revealed spherical nanoparticles with sizes ranging from 3 to 6 nm, corroborating data from a quadrupole mass filter (QMF). The XRD analysis verified the simple cubic structure of the Ag nanoclusters. The surface potential was assessed using KPFM, from which the work function was calculated with a reference highly ordered pyrolytic graphite (HOPG). The UV-visible absorption spectra displayed peaks within the 350-750 nm wavelength range, with a strong absorption feature at 475 nm. Additionally, lower excitation wavelengths resulted in a sharp peak emission at 370 nm, which became weaker and broader when higher excitation wavelengths were used.

Replacing protein via enteral nutrition in a stepwise approach in critically ill patients: the REPLENISH randomized clinical trial protocol.

BACKGROUND: Protein intake is recommended in critically ill patients to mitigate the negative effects of critical illness-induced catabolism and muscle wasting. However, the optimal dose of enteral protein remains unknown. We hypothesize that supplemental enteral protein (1.2 g/kg/day) added to standard enteral nutrition formula to achieve high amount of enteral protein (range 2-2.4 g/kg/day) given from ICU day 5 until ICU discharge or ICU day 90 as compared to no supplemental enteral protein to achieve moderate amount enteral protein (0.8-1.2 g/kg/day) would reduce all-cause 90-day mortality in adult critically ill mechanically ventilated patients. METHODS: The REPLENISH (Replacing Protein Via Enteral Nutrition in a Stepwise Approach in Critically Ill Patients) trial is an open-label, multicenter randomized clinical trial. Patients will be randomized to the supplemental protein group or the control group. Patients in both groups will receive the primary enteral formula as per the treating team, which includes a maximum protein 1.2 g/kg/day. The supplemental protein group will receive, in addition, supplemental protein at 1.2 g/kg/day starting the fifth ICU day. The control group will receive the primary formula without supplemental protein. The primary outcome is 90-day all-cause mortality. Other outcomes include functional and quality of life assessments at 90 days. The trial will enroll 2502 patients. DISCUSSION: The study has been initiated in September 2021. Interim analysis is planned at one third and two thirds of the target sample size. The study is expected to be completed by the end of 2025. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04475666 . Registered on July 17, 2020.

Enhancing Hydrogen Sulfide Detection at Room Temperature Using ZIF-67-Chitosan Membrane.

Developing new materials for energy and environment-related applications is a critical research field. In this context, organic and metal-organic framework (MOF) materials are a promising solution for sensing hazardous gases and saving energy. Herein, a flexible membrane of the zeolitic imidazole framework (ZIF-67) mixed with a conductivity-controlled chitosan polymer was fabricated for detecting hydrogen sulfide (H2S) gas at room temperature (RT). The developed sensing device remarkably enhances the detection signal of 15 ppm of H2S gas at RT (23 °C). The response recorded is significantly higher than previously reported values. The optimization of the membrane doping percentage achieved exemplary results with respect to long-term stability, repeatability, and selectivity of the target gas among an array of several gases. The fabricated gas sensor has a fast response and a recovery time of 39 s and 142 s, respectively, for 15 ppm of H2S gas at RT. While the developed sensing device operates at RT and uses low bias voltage (0.5 V), the requirement for an additional heating element has been eliminated and the necessity for external energy is minimized. These novel features of the developed sensing device could be utilized for the real-time detection of harmful gases for a healthy and clean environment.

V2CTX MXene-based hybrid sensor with high selectivity and ppb-level detection for acetone at room temperature.

High-performance, room temperature-based novel sensing materials are one of the frontier research topics in the gas sensing field, and MXenes, a family of emerging 2D layered materials, has gained widespread attention due to their distinctive properties. In this work, we propose a chemiresistive gas sensor made from V2CTx MXene-derived, urchin-like V2O5 hybrid materials (V2C/V2O5 MXene) for gas sensing applications at room temperature. The as-prepared sensor exhibited high performance when used as the sensing material for acetone detection at room temperature. Furthermore, the V2C/V2O5 MXene-based sensor exhibited a higher response (S% = 11.9%) toward 15 ppm acetone than pristine multilayer V2CTx MXenes (S% = 4.6%). Additionally, the composite sensor demonstrated a low detection level at ppb levels (250 ppb) at room temperature, as well as high selectivity among different interfering gases, fast response-recovery time, good repeatability with minimal amplitude fluctuation, and excellent long-term stability. These improved sensing properties can be attributed to the possible formation of H-bonds in multilayer V2C MXenes, the synergistic effect of the newly formed composite of urchin-like V2C/V2O5 MXene sensor, and high charge carrier transport at the interface of V2O5 and V2C MXene.

Brachiocephalic Artery Dissection Following Type A Aortic Dissection Repair.

Acute type A aortic dissection (ATAAD) is a life-threatening emergency that is associated with major morbidity and mortality. Arterial dissections, particularly the brachiocephalic artery, can remain as a residual dissection after type A aortic dissection repair. We present a rare case of brachiocephalic artery dissection due to the clamping effect and the management of ATAAD patients. A 47-year-old male known for aortic aneurysm and uncontrolled hypertension presented with high blood pressure, unequal pulses, and a history of chest pain. A thoracic and abdominal aorta angiogram showed aneurysmal dilatation of the aortic root and ascending aorta with a peripheral linear filling defect shortly distal to the aortic root. The patient underwent the Bentall procedure, hemi-arch replacement, and patent ductus arteriosus closure. The brachiocephalic artery was clamped. The angiogram showed right common carotid occlusion. Endovascular intervention was made by balloon-mounted covered stent graft and kissing technique. The patient had a smooth post-procedure period without major events. Iatrogenic brachiocephalic artery dissection can occur during type A aortic dissection repair and is frequently affected by residual dissection. The decision of intervention versus conservative management is based on a patient's general condition.

Removal of benzene, MTBE and toluene from contaminated waters using biochar-based liquid activated carbon.

Fuel components such as benzene, toluene, and methyl tertiary-butyl ether (MTBE) are frequently detected pollutants in groundwater resources. Ex-situ remediation technologies by activated carbon have been used for treatment for many years. However, due to high cost of these technology, more attention has been given to the in-situ remediation methods of contaminated groundwaters using liquid carbon adsorbents. Literature search showed limited studies on using adsorbents in liquid form for the removal of such contaminants. Therefore, this lab-scale study investigates the capacity of using raw biochar-based liquid activated carbon and iron-modified biochar-based liquid activated carbon to remove these pollutants. The adsorption efficiency of the synthesized liquid activated carbon and iron-modified liquid activated carbon mixed with sand, limestone, and 1:1 mixture of sand/limestone, was tested using batch suspension experiments. Adsorption by granular activated carbon was also investigated for comparison with liquid activated carbon. Results of the study revealed that mixing of liquid activated carbon or LAC-Fe on subsurface materials had not improved the removal efficiency of MTBE. At the same time, it showed a slight improvement in the adsorption efficiency of benzene and toluene. In all cases, the removal by GAC was higher with around 80% and 90% for MTBE and BT, respectively. Results also showed that benzene and toluene were better removed by liquid activated carbon and iron-modified liquid activated carbon (∼ 40%) than MTBE (∼ 20%). It is also found that water chemistry (i.e., salinity and pH) had insignificant effects on the removal efficiency of pollutants under the study conditions. It can be concluded that more research is needed to improve the capacity of biochar-based liquid-activated carbon in removing MTBE, benzene and toluene compounds that will lead to improve the utilization of liquid activated carbon for the in-situ remediation of contaminated groundwaters.

Metal-organic frameworks for advanced transducer based gas sensors: review and perspectives.

The development of gas sensing devices to detect environmentally toxic, hazardous, and volatile organic compounds (VOCs) has witnessed a surge of immense interest over the past few decades, motivated mainly by the significant progress in technological advancements in the gas sensing field. A great deal of research has been dedicated to developing robust, cost-effective, and miniaturized gas sensing platforms with high efficiency. Compared to conventional metal-oxide based gas sensing materials, metal-organic frameworks (MOFs) have garnered tremendous attention in a variety of fields, including the gas sensing field, due to their fascinating features such as high adsorption sites for gas molecules, high porosity, tunable morphologies, structural diversities, and ability of room temperature (RT) sensing. This review summarizes the current advancement in various pristine MOF materials and their composites for different electrical transducer-based gas sensing applications. The review begins with a discussion on the overview of gas sensors, the significance of MOFs, and their scope in the gas sensing field. Next, gas sensing applications are divided into four categories based on different advanced transducers: chemiresistive, capacitive, quartz crystal microbalance (QCM), and organic field-effect transistor (OFET) based gas sensors. Their fundamental concepts, gas sensing ability towards various gases, sensing mechanisms, and their advantages and disadvantages are discussed. Finally, this review is concluded with a summary, existing challenges, and future perspectives.

Organic/Inorganic-Based Flexible Membrane for a Room-Temperature Electronic Gas Sensor.

A room temperature (RT) H2S gas sensor based on organic-inorganic nanocomposites has been developed by incorporating zinc oxide (ZnO) nanoparticles (NPs) into a conductivity-controlled organic polymer matrix. A homogeneous solution containing poly (vinyl alcohol) (PVA) and ionic liquid (IL) and further doped with ZnO NPs was used for the fabrication of a flexible membrane (approx. 200 µm in thickness). The sensor was assessed for its performance against hazardous gases at RT (23 °C). The obtained sensor exhibited good sensitivity, with a detection limit of 15 ppm, and a fast time response (24 ± 3 s) toward H2S gas. The sensor also showed excellent repeatability, long-term stability and selectivity toward H2S gas among other test gases. Furthermore, the sensor depicted a high flexibility, low cost, easy fabrication and low power consumption, thus holding great promise for flexible electronic gas sensors.

Quantifying Tumor Heterogeneity from Multiparametric Magnetic Resonance Imaging of Prostate Using Texture Analysis.

(1) Background: Multiparametric MRI (mp-MRI) is used to manage patients with PCa. Tumor identification via irregular sampling or biopsy is problematic and does not allow the comprehensive detection of the phenotypic and genetic alterations in a tumor. A non-invasive technique to clinically assess tumor heterogeneity is also in demand. We aimed to identify tumor heterogeneity from multiparametric magnetic resonance images using texture analysis (TA). (2) Methods: Eighteen patients with prostate cancer underwent mp-MRI scans before prostatectomy. A single radiologist matched the histopathology report to single axial slices that best depicted tumor and non-tumor regions to generate regions of interest (ROIs). First-order statistics based on the histogram analysis, including skewness, kurtosis, and entropy, were used to quantify tumor heterogeneity. We compared non-tumor regions with significant tumors, employing the two-tailed Mann-Whitney U test. Analysis of the area under the receiver operating characteristic curve (ROC-AUC) was used to determine diagnostic accuracy. (3) Results: ADC skewness for a 6 × 6 px filter was significantly lower with an ROC-AUC of 0.82 (p = 0.001). The skewness of the ADC for a 9 × 9 px filter had the second-highest result, with an ROC-AUC of 0.66; however, this was not statistically significant (p = 0.08). Furthermore, there were no substantial distinctions between pixel filter size groups from the histogram analysis, including entropy and kurtosis. (4) Conclusions: For all filter sizes, there was poor performance in terms of entropy and kurtosis histogram analyses for cancer diagnosis. Significant prostate cancer may be distinguished using a textural feature derived from ADC skewness with a 6 × 6 px filter size.

Flexible Cu3(HHTP)2 MOF Membranes for Gas Sensing Application at Room Temperature.

Mixed matrix membranes (MMMs), possessing high porosity, have received extensive attention for gas sensing applications. However, those with high flexibility and significant sensitivity are rare. In this work, we report on the fabrication of a novel membrane, using Cu3(HHTP)2 MOF (Cu-MOF) embedded in a polymer matrix. A solution comprising a homogenous suspension of poly-vinyl alcohol (PVA) and ionic liquid (IL), and Cu-MOF solid particles, was cast onto a petri dish to obtain a flexible membrane (215 µm in thickness). The sensor membrane (Cu-MOF/PVA/IL), characterized for its structure and morphology, was assessed for its performance in sensing against various test gases. A detection limit of 1 ppm at 23 °C (room temperature) for H2S was achieved, with a response time of 12 s. Moreover, (Cu-MOF/PVA/IL) sensor exhibited excellent repeatability, long-term stability, and selectivity towards H2S gas. The other characteristics of the (Cu-MOF/PVA/IL) sensor include high flexibility, low cost, low-power consumption, and easy fabrication technique, which nominate this sensor as a potential candidate for use in practical industrial applications.

A Highly Sensitive and Flexible Metal-Organic Framework Polymer-Based H2S Gas Sensor.

We report the fabrication of a novel metal-organic framework (MOF)-polymer mixed-matrix flexible membrane for the detection of hydrogen sulfide (H2S) gas at room temperature. This high-performance gas sensor is based on MOF-5 microparticles embedded on a conductivity-controlled chitosan (CS) organic membrane. The conductivity of the organic membrane is controlled by blending it with a glycerol ionic liquid (IL) at different concentrations. The sensor showed a remarkable detection sensitivity for H2S gas at a concentrations level as low as 1 ppm at room temperature. The MOF-5/CS/IL gas sensor demonstrates a highly desirable detection selectivity, fast response time (<8 s), recovery time of less than 30 s, and outstanding sensing stability averaging at 97% detection with 50 ppm of H2S gas. This composite having high sensitivity, low-power consumption, and flexibility holds great promise for addressing current challenges pertinent to environmental sustainability.

Fabrication and characterization of cellulose acetate-based nanofibers and nanofilms for H2S gas sensing application.

Electrospun nanofibers and solution-casting nanofilms were produced from an environmentally friendly cellulose acetate (CA) blended with glycerol (as an ionic liquid (IL)), mixed with polypyrrole (PPy, a conducting polymer) and doped with tungsten oxide (WO3) nanoparticles. The sensing membranes fabricated were used to detect H2S gas at room temperature and shown to exhibit high performance. The results revealed that the lowest operating temperature of both nanofiber and nanofilm sensors was 20 °C, with a minimum gas detection limit of 1 ppm. Moreover, the sensor exhibits a reasonably fast response, with a minimum average response time of 22.8 and 31.7 s for the proposed nanofiber and nanofilm based sensors, respectively. Furthermore, the results obtained indicated an excellent reproducibility, long-term stability, and low humidity dependence. Such distinctive properties coupled with an easy fabrication technique provide a promising potential to achieve a precise monitoring of harmful H2S gas in both indoor and outdoor atmospheres.

Sm3+-doped strontium barium borate phosphor for white light emission: Spectroscopic properties and Judd-Ofelt analysis.

This study aims to explore the spectroscopic properties of a Sr1.0Ba2.0B6O12:0.5Sm3+ phosphor synthesized using the solid-state reaction method. The morphology and elemental composition of the phosphor were determined using scanning electron microscopy and energy-dispersive X-ray spectroscopy, respectively. Phase changes and crystallite phases in the phosphor were studied using differential-scanning calorimetry and X-ray diffraction, respectively. Raman and Fourier-transform infrared spectra were used to identify the molecular vibrations in the phosphor. The energy bandgap and bonding nature of the phosphor were analyzed using the absorption spectrum. The nephelauxetic ratios determined from the absorption peaks revealed the presence of both ionic and covalent bonding in the phosphor. Judd-Ofelt parameters, along with radiative properties of the phosphor, were evaluated using the peaks in the absorption spectrum. Colorimetric analysis using the photoluminescence spectrum showed that the Sr1.0Ba2.0B6O12:0.5Sm3+ phosphor emits a cool-white light. The higher values of the spectroscopic quality factor, stimulated-emission cross-section, quantum efficiency, and the white-light emission of the phosphor suggest that Sr1.0Ba2.0B6O12:0.5Sm3+ is useful for display and lighting applications.

Assembly of Tight Junction Strands: Claudin-10b and Claudin-3 Form Homo-Tetrameric Building Blocks that Polymerise in a Channel-Independent Manner.

Tight junctions regulate paracellular permeability size and charge selectively. Models have been proposed for the molecular architecture of tight junction strands and paracellular channels. However, they are not fully consistent with experimental and structural data. Here, we analysed the architecture of claudin-based tight junction strands and channels by cellular reconstitution of strands, structure-guided mutagenesis, in silico protein docking and oligomer modelling. Prototypic channel- (Cldn10b) and barrier-forming (Cldn3) claudins were analysed. Förster resonance energy transfer (FRET) assays indicated multistep claudin polymerisation, starting with cis-oligomerization specific to the claudin subtype, followed by trans-interaction-triggered cis-polymerisation. Alternative protomer interfaces were modelled in silico and tested by cysteine-mediated crosslinking, confocal- and freeze fracture EM-based analysis of strand formation. The analysed claudin mutants included also mutations causing the HELIX syndrome. The results indicated that protomers in Cldn10b and Cldn3 strands form similar antiparallel double rows, as has been suggested for Cldn15. Mutually stabilising -hydrophilic and hydrophobic - cis- and trans-interfaces were identified that contained novel key residues of extracellular segments ECS1 and ECS2. Hydrophobic clustering of the flexible ECS1 ß1ß2 loops together with ECS2-ECS2 trans-interaction is suggested to be the driving force for conjunction of tetrameric building blocks into claudin polymers. Cldn10b and Cldn3 are indicated to share this polymerisation mechanism. However, in the paracellular centre of tetramers, electrostatic repulsion may lead to formation of pores (Cldn10b) and electrostatic attraction to barriers (Cldn3). Combining in vitro data and in silico modelling, this study improves mechanistic understanding of paracellular permeability regulation by elucidating claudin assembly and its pathologic alteration as in HELIX syndrome.

Low power consumption and fast response H2S gas sensor based on a chitosan-CuO hybrid nanocomposite thin film.

In this work, a novel selective and low temperature H2S gas sensor was fabricated based on copper (II) oxide nanoparticles (CuO NPs) in different concentrations, embedded in a conductivity-engineered organic (glycerol ionic liquid-doped chitosan) membrane/film. The sensing membranes of organic-inorganic nanocomposites (CS-IL-CuO) were prepared by casting method and were tested against H2S gas with reference to time at different temperatures and H2S gas concentrations. The fabricated sensor showed a fast response (14 s) and good sensitivity (15 ppm) towards H2S gas at a low temperature of 40 °C. Moreover, the sensor showed a high reversibility and less humidity dependence at 40 °C. Moreover, this type of hybrid nanocomposites sensor is easy and inexpensive to manufacture and is energy efficient. Thus, it has potential to be used for industrial applications in harsh environments.

Cellulose-Copper Oxide hybrid nanocomposites membranes for H2S gas detection at low temperatures.

We report on novel, sensitive, selective and low-temperature hydrogen sulfide (H2S) gas sensors based on metal-oxide nanoparticles incorporated within polymeric matrix composites. The Copper-Oxide (CuO) nanoparticles were prepared by a colloid microwave-assisted hydrothermal method that enables precise control of nanoparticle size. The sodium carboxymethyl cellulose (CMC) powder with 5% glycerol ionic liquid (IL) was prepared and mixed with different concentrations of CuO NPs (2.5-7.5 wt.%) to produce flexible and semi-conductive polymeric matrix membranes. Each membrane was then sandwiched between a pair of electrodes to produce an H2S gas sensor. The temperature-dependent gas sensing characteristics of the prepared sensors were investigated over the temperature ranges from 40 °C to 80 °C. The sensors exhibited high sensitivity and reasonably fast responses to H2S gas at low working temperatures and at a low gas concentration of 15 ppm. Moreover, the sensors were highly selective to H2S gas, and they showed low humidity dependence, which indicates reliable functioning in humid atmospheres. This organic-inorganic hybrid-materials gas sensor is flexible, with good sensitivity and low power consumption has the potential to be used in harsh environments.