Synergistic algal/bacterial interaction in membrane bioreactor for detoxification of 1,2-dichloroethane-rich petroleum wastewater.

The study addressed the challenge of treating petroleum industry wastewater with high concentrations of 1,2-dichloroethane (1,2-DCA) ranging from 384 to 1654 mg/L, which poses a challenge for bacterial biodegradation and algal photodegradation. To overcome this, a collaborative approach using membrane bioreactors (MBRs) that combine algae and bacteria was employed. This synergistic method effectively mitigated the toxicity of 1,2-DCA and curbed MBR fouling. Two types of MBRs were tested: one (B-MBR) used bacterial cultures and the other (AB-MBR) incorporated a mix of algal and bacterial cultures. The AB-MBR significantly contributed to 1,2-DCA removal, with algae accounting for over 20% and bacteria for approximately 49.5% of the dechlorination process. 1,2-DCA metabolites, including 2-chloroethanol, 2-chloro-acetaldehyde, 2-chloroacetic acid, and acetic acid, were partially consumed as carbon sources by algae. Operational efficiency peaked at a 12-hour hydraulic retention time (HRT) in AB-MBR, enhancing enzyme activities crucial for 1,2-DCA degradation such as dehydrogenase (DH), alcohol dehydrogenase (ADH), and acetaldehyde dehydrogenase (ALDH). The microbial diversity in AB-MBR surpassed that in B-MBR, with a notable increase in Proteobacteria, Bacteroidota, Planctomycetota, and Verrucomicrobiota. Furthermore, AB-MBR showed a significant rise in the dominance of 1,2-DCA-degrading genus such as Pseudomonas and Acinetobacter. Additionally, algal-degrading phyla (e.g., Nematoda, Rotifera, and Streptophyta) were more prevalent in AB-MBR, substantially reducing the issue of membrane fouling.

Deciphering the role of MicroRNAs in diabetic nephropathy: Regulatory mechanisms and molecular insights.

A serious consequence of diabetes mellitus, diabetic nephropathy (DN) which causes gradual damage to the kidneys. Dietary changes, blood pressure control, glucose control, and hyperlipidemia are all important components of DN management. New research, however, points to microRNAs (miRNAs) as having a pivotal role in DN pathogenesis. Miniature non-coding RNA molecules such as miRNAs control gene expression and impact several biological processes. The canonical and non-canonical routes of miRNA biogenesis are discussed in this article. In addition, several important signaling pathways are examined in the study of miRNA regulation in DN. A deeper knowledge of these regulatory mechanisms would allow for a better understanding of the molecular basis of DN and the development of innovative therapeutic strategies. Finally, miRNAs show tremendous potential as DN diagnostic biomarkers and treatment targets, opening up promising avenues for further study and potential clinical use.

Biochar-enhanced anaerobic mixed culture for biodegradation of 1,2-dichloroethane: Microbial community, mechanisms, and techno-economics.

While anaerobic digestion (AD) has been employed for the degradation of chlorinated aliphatic hydrocarbons, the associated digester performance might suffer from volatile fatty acids accumulation, insufficient substrate-microbes interaction, and lower biogas yields. To overcome these limitations, this study is the first to augment the hydrocarbon-degrading microbial capacities by adding agricultural waste-based biochar to the digestion medium. 1,2-dichloroethane (1,2-DCA) was selected as the target pollutant because it is discharged in large quantities from oil refining, petrochemical, and chemical industries, causing serious environmental and human health concerns. A multi-chamber anaerobic reactor (MAR) was operated at a 1,2-DCA loading rate of 1.13 g/L/d, glucose dosage (as an electron donor) range of 200-700 mg/L, and hydraulic retention time of 11.2 h, giving dechlorination = 32.2 ± 6.9% and biogas yield = 210 ± 30 mL/g CODremoved. These values increased after biochar supplementation (100 mg/g volatile solids, VS, as an inoculum carrier) up to 60.2 ± 11.5% and 290 ± 40 mL/g CODremoved, respectively, owing to the enhancement of dehydrogenase enzyme activities. Burkholderiales (15.3%), Clostridiales (2.3%), Bacteroidales (3.5%), Xanthomonadales (3.3%), and Rhodobacterales (6.1%) involved in 1,2-DCA degradation were dominant in the reactor supplemented with biochar. It's suggested that biochar played a major role in facilitating the direct interspecies electron transfer (DIET) between syntrophic bacteria and methanogens, where chloride, ethylene glycol, and acetate derived from 1,2-DCA dechlorination could be further used to promote methanogenesis and methane production. The synergetic effect of adsorption and dechlorination towards 1,2-DCA removal was validated at various biochar dosages (50-120 mg/g) and 1,2-DCA concentrations (50-1000 mg/L). The techno-economic results showed that the cost of treating 1,2-DCA-laden discharge (100 m3/d) by the MAR module could be 0.83 USD/m3 with a payback period of 6.24 years (NPV = 2840 USD and IRR = 10%), retrieving profits from pollution reduction (9542 USD/yr), biogas selling (10418 USD/yr), and carbon credit (10294 USD/yr).

Preoperative localisation of parathyroid adenomas using ultrasound-guided methylene blue dye injection.

Purpose: Primary hyperparathyroidism is mainly caused by parathyroid adenomas. Preoperative imaging can be performed using different imaging modalities, e.g. ultrasound (US), radionuclide scanning, magnetic resonance imaging, and computed tomography, often used in combination. Currently, US-guided blue dyes, especially methylene blue (MB) injection, are used to identify parathyroid tumours. Material and methods: This was a retrospective study of 228 patients. Preoperative ultrasound, scintigraphy, and bio-chemistry were performed on all patients, and fine-needle aspiration procedures were performed on suspected patients. Using preoperative US-G injection with MB dye, target tumours were injected in all cases. Results: A total of 163 patients were female and 65 were male. The mean age was 42.5 years. US was positive in 203 (89%) cases, 25 (11%) were negative, and all had a positive sestamibi scan (100%). US-G needle injections with MB dye of target tumours were successful in all cases. The average diameter of the lesions was 18 mm. All had positive intraoperative identification of parathyroid adenoma and MB staining (100% accuracy, 100% sensitivity, and 100% specificity). Operating time (min ± SD) was 22.7 ± 11.5 minutes, and the success rate was 100%. All were parathyroid adenomas histologically. Intraoperative parathormone hormone decreased in all patients. In postoperative follow-up, all were normocalcaemic with no local or systemic complications. Conclusions: Localisation of small parathyroid adenomas by US-guided blue dye injection is a safe, simple, and useful tool when performing parathyroidectomy with no complications.

Artificial intelligence-enabled optimization of Fe/Zn@biochar photocatalyst for 2,6-dichlorophenol removal from petrochemical wastewater: A techno-economic perspective.

While numerous studies have addressed the photocatalytic degradation of 2,6-dichlorophenol (2,6-DCP) in wastewater, an existing research gap pertains to operational factors' optimization by non-linear prediction models to ensure a cost-effective and sustainable process. Herein, we focus on optimizing the photocatalytic degradation of 2,6-DCP using artificial intelligence modeling, aiming at minimizing initial capital outlay and ongoing operational expenses. Hence, Fe/Zn@biochar, a novel material, was synthesized, characterized, and applied to harness the dual capabilities of 2,6-DCP adsorption and degradation. Fe/Zn@biochar exhibited an adsorption energy of -21.858 kJ/mol, effectively capturing the 2,6-DCP molecules. This catalyst accumulated photo-excited electrons, which, upon interaction with adsorbed oxygen and/or dissolved oxygen generated •O2-. The •OH radicals could also be produced from h+ in the Fe/Zn@biochar valence band, cleaving the C-Cl bonds to Cl- ions, dechlorinated byproducts, and phenols. An artificial neural network (ANN) model, with a 4-10-1 topology, "trainlm" training function, and feed-forward back-propagation algorithm, was developed to predict the 2,6-DCP removal efficiency. The ANN prediction accuracy was expressed as R2 = 0.967 and mean squared error = 5.56e-22. The ANN-based optimized condition depicted that over 90% of 2,6-DCP could be eliminated under C0 = 130 mg/L, pH = 2.74, and catalyst dosage = 168 mg/L within ∼4 h. This optimum condition corresponded to a total cost of $7.70/m3, which was cheaper than the price estimated from the unoptimized photocatalytic system by 16%. Hence, the proposed ANN could be employed to enhance the 2,6-DCP photocatalytic degradation process with reduced operational expenses, providing practical and cost-effective solutions for petrochemical wastewater treatment.

Transcriptomic Analysis Reveals Sixteen Potential Genes Associated with the Successful Differentiation of Antibody-Secreting Cells through the Utilization of Unfolded Protein Response Mechanisms in Robust Responders to the Influenza Vaccine.

The seasonal influenza vaccine remains one of the vital recommended infection control measures for the elderly with chronic illnesses. We investigated the immunogenicity of a single dose of influenza vaccine in 123 seronegative participants and classified them into four distinct groups, determined by the promptness of vaccine response, the longevity of humoral immunity, and the likelihood of exhibiting cross-reactivity. Subsequently, we used transcriptional profiling and differential gene expression analysis to identify potential genes directly associated with the robust response to the vaccine. The group of exemplary vaccine responders differentially expressed 16 genes, namely: MZB1, MYDGF, TXNDC5, TXNDC11, HSP90B1, FKBP11, PDIA5, PRDX4, CD38, SDC1, TNFRSF17, TNFRSF13B, PAX5, POU2AF1, IRF4, and XBP1. Our findings point out a list of expressed proteins that are related to B cell proliferation, unfolded protein response, and cellular haemostasis, as well as a linkage of these expressions to the survival of long-lived plasma cells.

Tadalafil versus tamsulosin as combination therapy with 5-alpha reductase inhibitors in benign prostatic hyperplasia, urinary and sexual outcomes.

PURPOSE: To compare the urological and sexual outcomes of using either tamsulosin/finateride or tadalafil/finasteride as combination therapies in patients with large prostate. PATIENTS AND METHODS: Selection criteria included prostate volume > 40 ml and IPSS > 7. Patients with severe erectile dysfunction (IIEF-erectile functions ≤ 10) were excluded. Patients were randomized into group I (tamsulosin/finasteride) and group II (tadalafil/finasteride). The primary endpoint was to define urinary and sexual function changes (IPSS, IPSS-quality of life, urinary flow rates and IIEF domains) within each group. The secondary endpoint was to compare the treatment induced changes between both groups. RESULTS: At 4th and 12th weeks, 131 and 127 patients were available in both groups, respectively. Both groups showed significant LUTS improvement (IPSS changes: - 4.9 ± 2.7 and - 4.3 ± 2.9 at 4th week and - 6.1 ± 3 and - 5.4 ± 2.8 points by the 12th week in both groups, respectively). Group I had better average flow rates at both follow-up visits. Meanwhile, maximum flow rates were comparable in both groups at 12th week (13.5 ± 3.9vs. 12.6 ± 3.7, p > 0.05). In group I, all IIEF domains were significantly lowered at both visits (p < 0.05). Group II showed significant increase in IIEF-erectile function scores (1.3 ± 1.1 and 1.8 ± 1.2 at the 4th and 12th weeks) with a transient significant reduction of IIEF-orgasm and sexual desire noted only by the 4th week (- 0.8 ± 0.4 and - 0.6 ± 0.4, respectively). CONCLUSION: Within three months, both combinations are comparably effective in improving BPH related LUTS. Tamsulosin/finasteride provided significantly better Qmax only at 4th week. Tadalafil/finasteride had the advantage of improving sexual performance over the other combination.

Sustainable synthesis of magnetic Sargassum siliquastrum activated carbon loaded with NiS nanorods for adsorption of 2,4-D herbicide.

The upgrade of sustainable resource waste into a valuable and beneficial material is an urgent task. The current paper outlines the development of an economical, sustainable, and prolonged adsorbent derived from Sargassum siliquastrum biomass and its use for potent 2,4-dichlorophenoxyacetic acid (2,4-D) removal. A simple carbonization approach was applied to obtain the highly functionalized carbon structure, which was subsequently transformed into a novel magnetic nanoadsorbent. The magnetic nanoadsorbent was characterized using Fourier transform infrared spectrometer (FTIR), X-ray diffraction (XRD), scanning electron microscopy (SEM), energy dispersive X-ray analysis (EDX), Brunauer Emmett Teller (BET)-specific surface area, and vibrating sample magnetometer (VSM). The characterization results confirm the successful formation of a high specific surface area and a uniform distribution of Fe3O4/NiS NPs grafted activated carbon. The adsorption kinetics was more accurately described via the pseudo-second order model; nevertheless, the isothermal data showed that the Langmuir model was most suitable. The monolayer adsorption capacity for 2,4-D was 208.26 ± 15.75 mg/g at 328 K. The favourability and spontaneity of the adsorption process were demonstrated by thermodynamic studies. The adsorbent displayed exceptional selectivity for 2,4-D and high stability in multi-cycle use. Electrostatic attraction, π-π stacking, and hydrogen bonding were all believed to have an impact on the sorbent's robust 2,4-D adsorption. Analyses of real tap and Nile River water samples showed little effect of the sample matrix on 2,4-D adsorption. This study presents an innovative approach for developing highly efficient adsorbent from natural biomass and offers an affordable way to recycle algal waste into beneficial materials.

Right Ventricular Strain Analysis By Tissue Tracking Cardiac Magnetic Resonance Imaging In Pediatric Patients With End-Stage Renal Disease.

PURPOSE: To investigate right ventricular (RV) volume and mass by cardiac magnetic resonance (CMR) and the added value of tissue tracking strain analysis as markers of RV dysfunction in pediatric patients with end-stage renal disease (ESRD) and preserved RV ejection fraction. MATERIALS AND METHODS: Twenty-five children with ESRD and preserved RVEF (>50%) and 10 healthy control children were enrolled. Tissue tracking CMR was used to assess Global Longitudinal, circumferential (GCS), and radial short and long axes (GRS SAX and GRS LAX) RV strains in the patients group compared with controls. Correlations between strain parameters and other CMR parameters and clinical biomarkers were assessed. Binary logistic regression was used to test the independence of cofounders and detect their significance. RESULTS: RV end-diastolic volume and mass (RVMi) were significantly higher in patients (97.2±19.3 mL/m 2 and 26.6±7gr/m 2 ) than control (71±7.8 mL/m 2 and 11.9±2 gr/m 2 , P values 0.000). All RV global strain parameters were significantly impaired in patients compared with control (all P values <0.05). RV Global Longitudinal was significantly correlated to LVEF (r=-0.416, P =0.039), LVEDVi (r=0.481, P =0.015), LVMi (r=0.562, P =0.004), and systolic blood pressure index (r=0.586, P =0.002). RV GRS (LAX) was significantly correlated to LV GCS (r=-0.462, P =0.020) and LV GRS (SAX) (r=0.454, P =0.023). GRS (SAX) and GCS demonstrated the highest diagnostic accuracy (area under curve: 0.82 and 0.81) to detect strain impairment. Univariate binary logistic regression with patients versus control as dependent variables identified LVMi, RV end-diastolic volume, RVMi, weight, body surface area, RV GCS, RV GRS (LAX), RV GRS (SAX), LV GCS, and LV GRS (SAX) as significantly correlated to patients with ESRD. When adjusted to other cofounders in the multivariable model, only RVMi remained as an independent significant cofounder (Odds ratio:0.395, P =0.046). CONCLUSION: RV global strain, volume, and mass by CMR are markers of RV dysfunction in ESRD pediatric patients with preserved RVEF.

Added value of 3D THRIVE (T1-weighted high-resolution isotropic volume examination) MRI pulse sequence in the detection of bony erosions of sacroiliac joints in patients of spondyloarthritis.

Purpose: Early depiction of bony erosions in sacroiliac (SI) joints increases the diagnostic accuracy of spondyloarthritis. The new 3D magnetic resonance imaging (MRI) sequence THRIVE (T1-weighted high-resolution isotropic volume examination) can depict cartilage erosions in sacroiliac joints. The aim of the study was to compare the diagnostic capacity of the new MRI sequence 3D THRIVE (T1-weighted high-resolution isotropic volume examination) with the routinely used T1 TSE pulse sequence in the depiction of structural erosions in sacroiliac joints by using MRI sequence zero echo time (zero ET) as a reference standard. Material and methods: Seventy five adult patients were included in this study. They underwent MRI sacroiliac joints examination using routine T1 TSE and STIR pulse sequences with the addition of the new 3D THRIVE and zero echo time (zero ET) sequences. Images of T1 TSE, 3D THRIVE, and zero ET sequences were evaluated by 2 radiolo-gists separately for the detection of sacroiliac joints erosions, then a comparison between T1 TSE and 3D THRIVE sequences was done using a CT-like image MRI sequence zero ET as a reference standard. Sensitivity, specificity, and accuracy for each sequence were calculated by the 2 readers. Results: Sensitivity, specificity, and accuracy of 3D THRIVE were higher than those of T1 TSE for reader 1 (sensitivity: 94.5% vs. 86.2%; specificity: 93.4% vs. 85.1%; and accuracy 95.2% vs. 88.5%) and for reader 2 (sensitivity: 93.3% vs. 79.9%; specificity: 94.7% vs. 86.2%; and accuracy 95.8% vs. 82.1%). Conclusions: Using CT-like image MRI sequence zero ET as the reference standard, 3D THRIVE pulse sequencing of the sacroiliac joints has much better diagnostic value in the depiction of bony erosions in patients suspected having spondyloarthritis as compared to the routinely used T1 TSE sequence.

Effect of different sintering protocols on the fracture strength of 3-unit monolithic gradient zirconia fixed partial dentures: An in vitro study.

STATEMENT OF PROBLEM: Strength-gradient zirconia combining 3 zirconia formulations with different flexural strengths has been reported to have outstanding mechanical properties. However, data concerning the effect of different sintering protocols on the fracture strength of 3-unit monolithic gradient zirconia fixed partial dentures (FPDs) are sparse. PURPOSE: The purpose of this in vitro study was to test the effect of different sintering protocols on the fracture strength of 3-unit monolithic gradient zirconia FPDs. MATERIAL AND METHODS: Two custom-made stainless-steel master dies were designed to replicate a mandibular right second premolar and second molar prepared to receive a 3-unit monolithic zirconia FPD. Thirty monolithic zirconia FPDs were milled from gradient zirconia blanks and allocated to 3 groups (n=10) according to the sintering protocols: high-speed sintering, speed sintering, and conventional sintering. The FPDs were cemented onto the corresponding dies with traditional glass ionomer cement. All FPDs were cyclic loaded (600 000 cycles/49 N/1.7 Hz) in a mastication simulator. Fracture load measurements for each FPD were determined by using a universal testing machine. Scanning electron microscopy (SEM) at ×80 magnification was used to examine a fractured FPD from each group. A representative specimen from each group was examined with SEM at ×30 000 magnification to determine the grain size. One-way ANOVA, pair-wise Tukey honestly significant difference (HSD), and Pearson correlation tests were used for statistical analysis of the data (α=.05). RESULTS: The high-speed sintered FPDs recorded the highest statistically significant fracture load mean ±standard deviation value (2526 ±300 N), followed by the speed sintered FPDs (2136 ±127 N), while the lowest statistically significant fracture load mean value was recorded with the conventionally sintered FPDs (1361 ±181 N) (P<.001). In addition, the mean ±standard deviation grain size values were 488 ±272 nm for the high-speed sintered specimen, 578 ±409 nm for the speed sintered specimen, and 832 ±551 nm for the conventionally sintered specimen (P<.001). A significant negative correlation was found between fracture strength and grain size among the 3 groups. CONCLUSIONS: The fracture strength of 3-unit monolithic gradient zirconia FPDs sintered by using a high-speed protocol was significantly higher than that of speed and conventionally sintered FPDs (P<.001). The high-speed sintering protocol reduced the mean grain size of gradient zirconia FPDs compared with that of both speed and conventional sintering protocols.

Trivalent inactivated influenza vaccine response and immunogenicity assessment after one week and three months in repeatedly vaccinated adults.

BACKGROUND: The influenza vaccine administrated every year is a recommended infection control procedure for individuals above the age of six months. However, the effectiveness of repeated annual vaccination is still an active research topic. Therefore, we investigated the vaccine immunogenicity in two independent groups: previously vaccinated versus non-vaccinated individuals at three time points; prior vaccination, one week and three months post vaccination. The assessment enabled us to evaluate the elicited immune responses and the durability of the induced protection in both groups. RESEARCH DESIGN AND METHODS: A research study was conducted to assess the immunogenicity of a single dose of Trivalent Inactivated Influenza Vaccine (A/H1N1, A/H3N2, and B) in 278 healthy adults aged between 32 and 66 years. Almost half of the participants, 140 (50·36%), received influenza vaccination at least once precursor to past influenza seasons. One blood sample was taken prior to vaccination for complete blood analysis and baseline immunogenicity assessment. The selected study participants received a single vaccine dose on the first day, and then followed up for three months. Two blood samples were taken after one week and three months post vaccination, respectively, for vaccine immunogenicity assessment. RESULTS: Before vaccination, the seroprotection, defined as a hemagglutination-inhibiting titer of =>1:40, was detected for the three vaccine virus strains in 20 previously vaccinated participants (14·29%) [8·95%, 21·2%]. We compared the overall vaccine response for the three virus strains using a normalized response score calculated from linearly transformed titer measurements; the score before vaccination was 84% higher in the previously vaccinated group and the mean difference between the two groups was statistically significant. Three months post-vaccination, we didn't find a significant difference in vaccine responses; the number of fully seroprotected individuals became 48 (34·29%) [26·48%, 42·77%] in the previously vaccinated group and 59 (42·75%) [34·37%, 51·45%] in the non-vaccinated group. The calculated response score was almost equal in both groups and the mean difference was no longer statistically significant. CONCLUSION: Our findings suggest that a single dose of influenza vaccine is equally protective after three months for annually vaccinated adults and first-time vaccine receivers.

A novel Corchorus olitorius-derived biochar/Bi12O17Cl2 photocatalyst for decontamination of antibiotic wastewater containing tetracycline under natural visible light.

Herein, a novel composite of Corchorus olitorius-derived biochar and Bi12O17Cl2 was fabricated and utilized for the degradation of tetracycline (TC) in a solar photo-oxidation reactor. The morphology, chemical composition, and interaction between the composite components were studied using various analyses. The biochar showed a TC removal of 52.7% and COD mineralization of 59.6% using 150 mg/L of the biochar at a pH of 4.7 ± 0.5, initial TC concentration of 163 mg/L, and initial COD of 1244 mg/L. The degradation efficiency of TC increased to 63% and the mineralization ratio to 64.7% using 150 mg/L of bare Bi12O17Cl2 at a pH of 4.7 ± 0.5, initial TC concentration of 178 mg/L, and COD of 1034 mg/L. In the case of biochar/Bi12O17Cl2 composite, the degradation efficiency of TC and COD mineralization ratio improved to 85.8% and 77.7% due to the potential of biochar to accept electrons which retarded the recombination of electrons and holes. The synthesized composite exhibited high stability over four succeeding cycles. According to the generated intermediates, TC could be degraded to caprylic acid and pentanedioic acid via the frequent attack by the reactive species. The prepared composite is a promising photocatalyst and can be applied in large-scale systems due to its high degradation and mineralization performance in a short time besides its low cost and stability.

Bioelectrochemical system for enhancing anaerobic digestion of pharmaceutical-containing domestic wastewater.

The unprecedented recent expansion in usage of paracetamol (AAP) has increased the need for suitable wastewater treatment technology. Furthermore, direct interspecies electron transfer promotion (DIET) offers simple and efficient approach for enhancing anaerobic digestion (AD). In this work, using AAP-containing domestic wastewater as feed, control AD reactor (RC) was operated, besides three DIET-promoted AD reactors (REV, RMC and REVMC, referring to electrical voltage "EV"-applied, nFe3O4-multiwall carbon nanotube (MCNT)-supplemented, and "EV applied + MCNT supplemented" reactor, respectively). Maximal treatable organic loading rates by RC, REV, RMC and REVMC were 3.9, 3.9, 7.8 and 15.6 g COD/L/d, corresponding to AAP loading rate of 26, 78, 156 and 312 µg/L/d, respectively. Methane production rate generated by RC, REV, RMC and REVMC reached 0.80 ± 0.01, 0.86 ± 0.04, 1.40 ± 0.07, and 3.01 ± 0.17 L/L/d, respectively. AAP expectedly followed hydroquinone degradation pathway, causing AD failure by acetate accumulation. However, this performance deterioration could be mitigated by DIET-promoted microbes with higher methanogenic activity and advanced electric conductivity. Economic evaluation revealed the favourability of MCNT addition over EV application, since payback periods for RC, REV, RMC and REVMC were 6.2, 7.7, 4.2 and 5.0 yr, respectively.

Implementation of Home-Based Telerehabilitation of Patients With Stroke in the United States: Protocol for a Realist Review.

BACKGROUND: Stroke is a common cause of mortality and morbidity. Insufficient and untimely rehabilitation has been associated with inadequate recovery. Telerehabilitation provides an opportunity for timely and accessible services for individuals with stroke, especially in remote areas. Telerehabilitation is defined as a health care team's use of a communication mode (eg, videoconferencing) to remotely provide rehabilitation services. Telerehabilitation is as effective as facility-based rehabilitation; however, it is infrequently used due to implementation barriers. OBJECTIVE: The aim of the study is to explore the interaction between the implementation strategies, context, and outcomes of telerehabilitation of patients with stroke. METHODS: This review will follow four steps: (1) defining the review scope, (2) literature search and quality appraisal, (3) data extraction and evidence synthesis, and (4) narrative development. PubMed via MEDLINE, the PEDro database, and CINAHL will be queried till June 2023 and supplemented with citation tracking and a gray literature search. The relevance and rigor of papers will be appraised using the TAPUPAS (Transparency, Accuracy, Purposivity, Utility, Propriety, Accessibility, and Specificity) and Weight of Evidence frameworks. The reviewers will extract and synthesize data iteratively and develop explanatory links between contexts, mechanisms, and outcomes. The results will be reported according to the Realist Synthesis publication standards set by Wong and colleagues in 2013. RESULTS: The literature search and screening will be completed in July 2023. Data extraction and analysis will be completed in August 2023, and findings will be synthesized and reported in October 2023. CONCLUSIONS: This will be the first realist synthesis, uncovering the causal mechanisms to explain how, why, and to what extent implementation strategies impact telerehabilitation adoption and implementation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/47009.

Mediation of Bacterial Interactions via a Novel Membrane-Based Segregator to Enhance Biological Nitrogen Removal.

The regulation of microbial subpopulations in wastewater treatment plants (WWTPs) with desired functions can guarantee nutrient removal. In nature, "good fences make good neighbors," which can be applied to engineering microbial consortia. Herein, a membrane-based segregator (MBSR) was proposed, where porous membranes not only promote the diffusion of metabolic products but also isolate incompatible microbes. The MBSR was integrated with an anoxic/aerobic membrane bioreactor (i.e., an experimental MBR). The long-term operation showed that the experimental MBR exhibited higher nitrogen removal (10.45 ± 2.73 mg/L total nitrogen) than the control MBR (21.68 ± 4.23 mg/L) in the effluent. The MBSR resulted in much lower oxygen reduction potential in the anoxic tank of the experimental MBR (-82.00 mV) compared to that of the control MBR (83.25 mV). The lower oxygen reduction potential can inevitably aid in the occurrence of denitrification. The 16S rRNA sequencing showed that the MBSR significantly enriched acidogenic consortia, which yielded considerable volatile fatty acids by fermenting the added carbon sources and allowed efficient transfer of these small molecules to the denitrifying community. Moreover, the sludge communities of the experimental MBR harbored a higher abundance of denitrifying bacteria than those of the control MBR. Metagenomic analysis further corroborated these sequencing results. The spatially structured microbial communities in the experimental MBR system demonstrate the practicability of the MBSR, achieving nitrogen removal efficiency superior to that of mixed populations. Our study provides an engineering method for modulating the assembly and metabolic division of labor of subpopulations in WWTPs. IMPORTANCE This study provides an innovative and applicable method for regulating subpopulations (activated sludge and acidogenic consortia), which contributes to the precise control of the metabolic division of labor in biological wastewater treatment processes.

Analysis of cumulative antibiogram reports in intensive care units at an Egyptian University Hospital.

BACKGROUND: Institutions must have access to antibiograms to monitor changes in antimicrobial resistance and direct empirical antibiotic therapy. The first facility-specific cumulative antibiogram was launched in the ICU in 2019. Consequently, many antibiogram-operation-related actions have been adopted in the institution based on reported data. This study aimed to analyze the cumulative antibiogram reports for multiple intensive care units (ICUs) for 2020, and compare the antimicrobial susceptibility testing (AST) patterns between the 2019 and 2020 years in an academic medical center. METHODS: This cross-sectional study was performed of routine bacterial culture and AST data extracted from a laboratory information system in a 2252-bed capacity hospital. Only the first diagnostic isolate of a given species per patient per year was included in the study. Interpretation and reporting were done in accordance with the applicable Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing guidelines. RESULTS: Of the 46,791 clinical isolates, the Gram-negative bacilli isolation rate witnessed a significant increase: 35,670 isolates in 2020 versus. 33,652 isolates in 2019. Klebsiella pneumoniae showed a statistically significant increase, mainly in pediatric, emergency, and cardiothoracic ICUs (p < 0.001). Neonatal and pediatric ICUs showed statistically significant increases in Pseudomonas aeruginosa and Proteus mirabilis isolates (p < 0.001). A statistically significant decrease was noted in the prevalence of Acinetobacter, Escherichia coli, Burkholderia cepacia, and Enterobacter cloacae. The sensitivities of K. pneumoniae and E. coli to imipenem and tigecycline significantly improved (p < 0.001). The sensitivity to colistin was significantly decreased (p < 0.001). The sensitivity of P. aeruginosa isolates to colistin and carbapenems was improved (p < 0.001). We reported a statistically significant decrease in all Gram-positive cocci (11,121 in 2020 versus. 11,528 in 2019). Staphylococcus aureus showed a statistically significant increase (p < 0.001), particularly in the medical ICU. CONCLUSION: The high susceptibility rates of Enterobacteriaceae toward colistin and tigecycline, should be cautiously considered in empiric therapy while looking for alternatives. The majority of isolates of Gram-positive cocci were coagulase negative staphylococci (CONS), we still need to confirm whether they are true pathogens or commensals before considering anti-staphylococcal agents in the empirical therapy. We underscored some corrective actions that might have improved the susceptibility rates, such as antibiotic cycling.

Micro-CT analysis of marginal and internal fit of milled and pressed polyetheretherketone single crowns.

STATEMENT OF PROBLEM: Polyetheretherketone (PEEK) has been increasingly used as a framework material in prosthetic dentistry. However, data on the marginal and internal fit of PEEK restorations fabricated by using either the computer-aided design and computer-aided manufacturing (CAD-CAM) or heat-pressing technique are sparse. PURPOSE: The aim of this in vitro study was to assess the marginal and internal fit of milled and pressed PEEK single crowns by using microcomputed tomography (µCT). MATERIAL AND METHODS: A custom-made, single stainless-steel die was designed to replicate a maxillary first premolar prepared for a ceramic crown. PEEK copings (N=30) were fabricated and allocated to 3 groups (n=10) according to the fabrication technique: milled from a prefabricated PEEK blank, heat pressed from PEEK pellets, and heat pressed from PEEK granules. All copings were veneered with a composite resin material. The marginal fit was recorded at 4 predetermined points and the internal fit at 8 predetermined points on each crown by using µCT. Two-way ANOVA, pair-wise Tukey honestly significant difference (HSD), and simple main effect tests were used for statistical analysis of the data (α=.05). RESULTS: Concerning marginal fit, the milled crowns demonstrated the best marginal fit overall (44 ±3 µm), followed by those pressed from pellets (92 ±3 µm), and finally by those pressed from granules (137 ±7 µm) (P<.001). The interaction between the effects of the fabrication technique and the measurement point on the marginal fit was not statistically significant (P=.142). The milled crowns demonstrated the lowest mean gap values overall, followed by those pressed from pellets and those pressed from granules (P<.001). The interaction between the effects of the fabrication technique and the measurement point on the internal fit was statistically significant (P<.001). Except for the distal occlusal gap and mesial occlusal gap, all tested groups showed a statistically significant difference (P<.001). In addition, statistically significant differences were observed among all measurement points in different fabrication techniques (P<.001). CONCLUSIONS: The marginal and internal fit of milled PEEK crowns was significantly better than pressed crowns. However, both CAD-CAM and heat-pressing techniques produced PEEK crowns with a clinically acceptable marginal and internal fit. The mean marginal gap of the PEEK crowns pressed from granules was above the range of clinically acceptable value.

Fungal infection profile in critically ill COVID-19 patients: a prospective study at a large teaching hospital in a middle-income country.

BACKGROUND: Critically ill COVID-19 patients are highly susceptible to opportunistic fungal infection due to many factors, including virus-induced immune dysregulation, host-related comorbidities, overuse and misuse of antibiotics or corticosteroids, immune modulator drugs, and the emergencies caused by the pandemic. This study aimed to assess the incidence, identify the potential risk factors, and examine the impact of fungal coinfection on the outcomes of COVID-19 patients admitted to the intensive care unit (ICU). METHODS: A prospective cohort study including 253 critically ill COVID-19 patients aged 18 years or older admitted to the isolation ICU of Zagazig University Hospitals over a 4-month period from May 2021 to August 2021 was conducted. The detection of a fungal infection was carried out. RESULTS: Eighty-three (83) patients (32.8%) were diagnosed with a fungal coinfection. Candida was the most frequently isolated fungus in 61 (24.1%) of 253 critically ill COVID-19 patients, followed by molds, which included Aspergillus 11 (4.3%) and mucormycosis in five patients (1.97%), and six patients (2.4%) diagnosed with other rare fungi. Poor diabetic control, prolonged or high-dose steroids, and multiple comorbidities were all possible risk factors for fungal coinfection [OR (95% CI) = 10.21 (3.43-30.39), 14.1 (5.67-35.10), 14.57 (5.83-33.78), and 4.57 (1.83-14.88), respectively]. CONCLUSION: Fungal coinfection is a common complication of critically ill COVID-19 patients admitted to the ICU. Candidiasis, aspergillosis, and mucormycosis are the most common COVID-19-associated fungal infections and have a great impact on mortality rates.

Whole-body diffusion-weighted imaging with background body signal suppression and quantitative apparent diffusion coefficient in the detection, staging, and grading of non-Hodgkin lymphoma.

Purpose: Assess reproducibility of detection, staging, and grading of non-Hodgkin lymphoma (NHL) using whole-body diffusion-weighted imaging with background body signal suppression (WB-DWIBS). Material and methods: Thirty NHL patients underwent WB-DWIBS, divided into 2 groups according to staging and grading. Image analysis and apparent diffusion coefficient (ADC) measurement of the largest lymph node in each group were performed by 2 observers. Inter-observer agreement was performed. Results: Overall inter-observer agreement for detection of NHL was excellent (k = 0.843; 92.05%) with excellent inter-observer agreement of nodal disease (cervical, thoracic and abdominal) (k = 0.783, 0.769, and 0.856; 96.67%, 90.0%, and 93.3% respectively), extra-nodal disease (k = 1; 100%), and splenic involvement (k = 0.67; 83.3%). The overall inter-observer agreement of DWIBS in staging of NHL was excellent (k = 0.90; 94.9%) with excellent inter-observer agreement for stage I (k = 0.93; 96.4%), stage II (k = 0.90; 94.8%), stage III (k = 0.89; 94.6%), and stage IV (k = 0.88; 94.0%). There was significant difference between ADC in stage I, II (0.77 ± 0.13, 0.85 ± 0.09 × 10-3 mm2/s), and stage III, IV (0.63 ± 0.08, 0.64 ± 0.11 × 10-3 mm2/s, p < 0.002, < 0.001). Interclass correlation showed almost perfect agreement for ADC measurement in staging and grading groups (r = 0.96 and r = 0.85, respectively, p < 0.001). There was significant difference between ADC in aggressive lymphoma (0.65 ± 0.1, 0.67 ± 0.13 × 10-3 mm2/s) and indolent lymphoma (0.76 ± 0.14, 0.84 ± 0.09 × 10-3 mm2/s, p < 0.028, < 0.001). Conclusion: DWIBS is reproducible for detection and staging of nodal and extra-nodal involvement in patients with NHL. ADC can quantitatively participate in the staging and grading of NHL.