Effects of non-invasive respiratory support in post-operative patients: a systematic review and network meta-analysis.

BACKGROUND: Re-intubation secondary to post-extubation respiratory failure in post-operative patients is associated with increased patient morbidity and mortality. Non-invasive respiratory support (NRS) alternative to conventional oxygen therapy (COT), i.e., high-flow nasal oxygen, continuous positive airway pressure, and non-invasive ventilation (NIV), has been proposed to prevent or treat post-extubation respiratory failure. Aim of the present study is assessing the effects of NRS application, compared to COT, on the re-intubation rate (primary outcome), and time to re-intubation, incidence of nosocomial pneumonia, patient discomfort, intensive care unit (ICU) and hospital length of stay, and mortality (secondary outcomes) in adult patients extubated after surgery. METHODS: A systematic review and network meta-analysis of randomized and non-randomized controlled trials. A search from Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, and Web of Science from inception until February 2, 2024 was performed. RESULTS: Thirty-three studies (11,292 patients) were included. Among all NRS modalities, only NIV reduced the re-intubation rate, compared to COT (odds ratio 0.49, 95% confidence interval 0.28; 0.87, p = 0.015, I2 = 60.5%, low certainty of evidence). In particular, this effect was observed in patients receiving NIV for treatment, while not for prevention, of post-extubation respiratory failure, and in patients at high, while not low, risk of post-extubation respiratory failure. NIV reduced the rate of nosocomial pneumonia, ICU length of stay, and ICU, hospital, and long-term mortality, while not worsening patient discomfort. CONCLUSIONS: In post-operative patients receiving NRS after extubation, NIV reduced the rate of re-intubation, compared to COT, when used for treatment of post-extubation respiratory failure and in patients at high risk of post-extubation respiratory failure.

Knowledge, perception, attitude, and practice of complementary and alternative medicine by health care workers in Garki hospital Abuja, Nigeria.

BACKGROUND: Healthcare workers are currently making efforts to offer services that cater to the holistic care needs of their patients. Previous studies have shown that some healthcare workers encounter challenges when advising patients about Complementary and Alternative Medicine (CAM), even though its use is widespread. Many health care workers may not have received formal education or training in CAM and consequently are unable to address their patients' questions about it. This study explored the knowledge, perception, attitude and practice of CAM by healthcare workers in Garki Hospital, Abuja, Nigeria. METHODS: This was an institution-based cross-sectional study, design and a convergent parallel, mixed methods design was used for data collection. Five (5) healthcare workers were purposively selected as participants for the key informant interviews, while two hundred and fifty (250) selected using a simple random sampling method completed the questionnaire. The data collection instruments used were a key informant interview guide and a 35-item self-administered questionnaire. Knowledge was assessed with a 4-item scale with a maximum score of 8. Perceptions and attitudes were assessed using Likert scales with a maximum score of 45 and 20, respectively. Practice was assessed with a 6-item scale with a maximum score of 18. Qualitative data was analysed using framework analysis. Quantitative data was analysed using descriptive and inferential statistics. Data acquired from both methods were integrated to form the findings. RESULTS: The average age of respondents for the quantitative study was 34.0 ± 7.8 years, and they were predominantly females (61.2%) with one to ten years of work experience (68.8%). The mean knowledge, perception and attitude scores were 1.94 ± 1.39, 13.08 ± 2.34 and 32.68 ± 6.28, respectively. Multiple linear regression result showed that knowledge (t = 2.025, p = 0.044) and attitude (t = 5.961, p = 0.000) had statistically significant effects on the practice of CAM. Qualitative data revealed that the majority of the participants perceive CAM favourably, provided it is properly introduced into mainstream medicine with evidence of safety and research to prove its efficacy. CONCLUSION: The study has shown the gaps in knowledge and the practices of CAM by conventional medical practitioners. This has implications for their ability to counsel and refer patients who may require CAM therapies. Policy, research and programmatic initiatives that seek to enhance their knowledge of CAM, and improve collaboration with CAM practitioners are recommended.

Comparative efficacy of five approved Janus kinase inhibitors as monotherapy and combination therapy in patients with moderate-to-severe active rheumatoid arthritis: a systematic review and network meta-analysis of randomized controlled trials.

Background: The European League of Rheumatology(EULAR)guidelines recommend Janus kinase (JAK) inhibitors for patients with moderate to severe rheumatoid arthritis (RA) who are insensitive or under-responsive to conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs). But there was no recommendation for which one was preferred in five currently approved JAK inhibitors. The objective of this network meta-analysis study was to evaluate the efficacy of five JAK inhibitors as monotherapy and combination therapy in patients with moderate-to-severe active rheumatoid arthritis. Methods: The randomized controlled trials (RCTs) of tofacitinib, baricitinib, upadacitinib, filgotinib and peficitinib as monotherapy or combined with csDMARD in the treatment of active RA were searched in database of PubMed, Embase, Web of Science and Cochrane Library, up to December 2023. The control group included placebo or csDMARD. Outcome indicators included American College of Rheumatology 20% response (ACR20), ACR50, ACR70 and the percentage of patients achieving 28-joint disease activity score using C-reactive protein (DAS28(CRP))<2.6 at 12 weeks and 24 weeks. The statistical analysis was performed by Stata14 and RevMan5.4. Data processing, network evidence plots, surface under the cumulative ranking curve (SUCRA) ranking, league plots and funnel plots were generated. Risk ratio (RR) and 95% confidence interval (95%CI) as effect sizes to analyze the statistics. Results: This study included thirty-six RCTs with 16,713 patients. All JAK inhibitors were more effective than placebo in ACR20 (RRs ranging between 1.74 and 3.08), ACR50 (RRs ranging between 2.02 and 7.47), ACR70 (RRs ranging between 2.68 and 18.13), DAS28(CRP) < 2.6 (RRs ranging between 2.70 and 7.09) at 12 weeks. Upadacitinib 30 mg and upadacitinib 15 mg showed relatively good efficacy according to their relative SUCRA ranking. All JAK inhibitors were more effective than csDMARD or placebo in ACR20 (RRs ranging between 1.16 and 1.86), ACR50 (RRs ranging between 1.69 and 2.84), ACR70 (RRs ranging between 1.50 and 4.47), DAS28(CRP) < 2.6 (RRs ranging between 2.28 and 7.56) at 24 weeks. Upadacitinib 15 mg + csDMARD and baricitinib 4 mg + csDMARD showed relatively good efficacy according to their relative SUCRA ranking. The safety analysis results such as serious infection, malignancy, major adverse cardiovascular event (MACE), and venous thromboembolic events (VTE) showed no statistical difference. Conclusion: This NMA study indicated that all JAK inhibitors performed better than placebo. Based on the results of this study, upadacitinib 30 mg, upadacitinib 15 mg, upadacitinib 15 mg + csDMARD and baricitinib 4 mg + csDMARD were recommended treatment options with relatively good efficacy and safety. However, attention should be paid to monitoring the occurrence of adverse events in high-risk RA patients with medication. Combination therapy with csDMARD might be more suitable for the maintenance of long-term efficacy. However, in clinical practice, it is still necessary to select the appropriate therapeutic regimen based on the actual clinical situation.

Microplastics in aquaculture - Potential impacts on inflammatory processes in Nile tilapia.

Aquaculture is essential for meeting the growing global demand for fish consumption. However, the widespread use of plastic and the presence of microplastics in aquaculture systems raise concerns about their impact on fish health and the safety of aquaculture products. This study focused on the Nile tilapia (Oreochromis niloticus), one of the most important aquaculture fish species globally. The aim of this study was to investigate the effects of dietary exposure to a mixture of four conventional fossil fuel-based polymers (microplastics) on the health of adult and juvenile Nile tilapia. Two experiments were conducted, with 36 juvenile tilapia (10-40 g weight) exposed for 30 days and 24 adult tilapia (600-1000 g) exposed for 7 days, the former including a natural particle (kaolin) treatment. In the adult tilapia experiment, no significant effects on intestinal health (Ussing chamber method), oxidative stress, or inflammatory pathways (enzymatic and genetic biomarkers) were observed after exposure to the microplastic mixture. However, in the juvenile tilapia experiment, significant alterations in inflammatory pathways were observed following 30 days of exposure to the microplastic mixture, indicating potential adverse effects on fish health. These results highlight the potential negative impacts of microplastics on fish health and the economics and safety of aquaculture.

Bioactive polysaccharides from Aegle marmelos fruit: Recent trends on extraction, bio-techno functionality, and food applications.

Polysaccharides from non-conventional sources, such as fruits, have gained significant attention recently. Aegle marmelos (Bael), a non-conventional fruit, is an excellent source of biologically active components with potential indigenous therapeutic and food applications. Apart from polyphenolic components, this is an excellent source of mucilaginous polysaccharides. Polysaccharides are one the major components of bael fruit, having a high amount of galactose and glucuronic acid, which contributes to its potential therapeutic properties. Therefore, this review emphasizes the conventional and emerging techniques of polysaccharide extraction from bael fruit. Insight into the attributes of polysaccharide components, their techno-functional properties, characterization of bael fruit polysaccharide, emulsifying properties, binding properties, reduction of hazardous dyes, application of polysaccharides in film formation, application of polysaccharide as a nanocomposite, and biological activities of bael fruit polysaccharides are discussed. This review also systematically overviews the relationship between extraction techniques, structural characteristics, and biological activities. Additionally, recommendations, future perspectives, and new valuable insight towards better utilization of bael fruit polysaccharide have been given importance, which can be promoted in the long term.

The effectiveness and feasibility of ball-milled powdered activated carbon (BPAC) for removal of organic pesticides in conventional drinking water treatment process.

In the conventional drinking water treatment process (CDWTP), powdered activated carbon (PAC) is commonly used for removing organic pesticides, or other organic contaminants. However, the hydraulic retention time (HRT) in CDWTP is insufficient for fulfilling PAC adsorption equilibrium to realize its full capacity. This study examined the adsorption kinetics, adsorption thermal dynamics, and removal efficiency for six organic pesticides using the ball-milled PAC (BPAC) with varying particle sizes in CDWTP. Based on the experiments with the pesticides of atrazine, diazinon, dimethoate, fenitrothion, isoproturon and thiometon, the results indicated that as the particle size reduced from around 38 µm for the commercial PAC to 1 µm for the BPAC, the adsorption rates for hydrophobic pesticides increased up to twentyfold. Diffusional adsorption from the bulk solution to the external PAC surface is the most likely predominant mechanism. This could allow a sufficient pesticides' adsorption within the limited HRT and to achieve a great depth removal of these toxic compounds. However, the addition of BPAC with a diameter of 1 µm was observed to significantly increase residual particles in treated water after the conventional treatment process. With a further systematic evaluation of both adsorption rate and particle penetration, a particle size of around 6 µm BPAC was considered a practical compromise between the adsorption rate and particle penetration for real application. Results from five surface waters of different water quality indicated that, compared to commercial PAC, application of 6 µm BPAC could achieve up to a 75% reduction in adsorbent dosage while maintaining around the same pesticide removal efficiencies. Additionally, thermodynamic analyses suggest that adsorption of these pesticides could be enthalpically or entropically driven depending on the degree of pesticide hydrophobicity.

Comparison the Effect of Conventional and Nanofat Injection Methods on Nasolabial Fold Lipofilling: A Case- Control Study.

Background: Nasolabial folds are a common sign of aging, accompanied by various manifestations such as skin and tissue loosening, wrinkles, lip corner drooping, mandibular angle loss, platysmal bands, and skin pigmentation changes. Limited research has explored Nanofat injection methods. this study was done with the aim of comparing the effect of fat injection by two methods, conventional and Nanofat, in nasolabial folds. Method: The study conducted in 2020-2021 at the skin clinic in Ilam, western Iran was a case-control study. Participants were divided into two groups, and lipofilling procedures were performed using conventional and nanofat methods with autologous fat. Data collection utilized a researcher-made questionnaire and radiographic results. Follow-up visits occurred on the 30th, 90th, and 180th days to assess complications and recovery rates. After 6 months, participant's photographs were taken and compared with pre-intervention photographs using the GIAS criteria. Data analysis was conducted using SPSS22 version software. Results: The average age of the participants was 37.80±8.30 yr. The treatment response in the conventional fat injection group was significantly better than the nanofat group (P<0.05). Both groups were satisfied with the treatment methods, but high satisfaction was reported in the conventional group, but there was no statistically significant difference between the groups. Conclusion: Both methods of improving wrinkles were effective, but the improvement and response to treatment in the conventional method was better than the Nanofat method, and its effect was felt by the participants for an average period of 3 months.

The Therapeutic Efficacy of Ankle Mobilization and Advance Physiotherapy in Alleviating Heel Spur and Plantar Fasciitis: A Case Report.

Plantar fasciitis arises from progressive damage of the plantar fascia, which originates at the medial calcaneal tuberosity and associated perifascial tissues. The plantar fascia is made up of three segments that grow from the calcaneus and serve a crucial role in appropriate foot biomechanics. The plantar fascia itself is vital in supporting the arch and absorbing trauma. The heel spur is one of the most prevalent causes of foot discomfort. It is important to determine the most effective technique of therapy based on the emergence of pain at each step of the day. This case report describes the thorough rehabilitation of a 42-year-old mesomorphic female, a yoga instructor, and a recreational runner who presented with heel spur and plantar fasciitis symptoms. In addition to traditional therapy, the patient received advanced physical therapy with an emphasis on Mulligan joint mobilization to lessen discomfort and increase range of motion. The objective was to evaluate the effect of this intervention on several outcome measures, such as the visual analogue scale, balance test, foot functional scale, range of motion, and lower extremity functional scale. Targeted exercises and treatments were incorporated into the comprehensive rehabilitation plan to enhance foot function. The patient received the enhanced physiotherapy intervention well. The outcome measure showed notable gains. This case contributes greatly to our knowledge of the best physiotherapy treatments for those with plantar fasciitis and heel spurs.

Assessment of harvest and postharvest losses of teff (Eragrostistef (Zucc.)) and methods of loss reduction: A review.

Teff [Eragrostistef (Zucc.)] is one of the most important cereal crops in Ethiopia which is part of the traditional dish of the people in the form of Injera. Interest in Teff has increased noticeably due to its very attractive nutritional profile and the gluten-free nature of the grain. It is a gluten-free cereal, among the major cereal crops, Teff accounts for the largest average annual acreage in the country. It also accounts for the second-largest average annual production, next to maize. The study endeavored to review the harvest and postharvest losses, the causes of these losses, and possible solutions to reduce the postharvest losses of the Teff crop in Ethiopia. There are inadequate postharvest research works conducted in Ethiopia, and most of the limited studies are focused on cereals other than Teff. Teff farming in Ethiopia is dominated by traditional methods of harvesting and postharvest handling. The application of modernharvest and postharvest technologies during Teff production and handling is critically low. As a result, a considerable loss of Teffgrain (16-30 %) in the harvest and postharvest stages has been recorded. The largest share of this loss is observed during the harvesting stage due to shattering, scattering, animal feeding, and contamination with unwanted parts. Lack of awareness of postharvest losses, limited access and availability of postharvest technologies, and low attention given to postharvest research, extension, and infrastructure have also contributed their share to these losses. Transforming the traditional practice into mechanized farming, modern postharvest technologies, and supporting the system by further research works and pieces of training on loss prevention methods could potentially minimize the harvest and postharvest losses of Teff in the country.

Microwave-Assisted Extraction of Secondary Metabolites Using Ethyl Lactate Green Solvent from Ambrosia arborescens: LC/ESI-MS/MS and Antioxidant Activity.

Alternative solvents are being tested as green solvents to replace the traditional organic solvents used in both academy and industry. Some of these are already available, such as ethyl lactate, cyrene, limonene, glycerol, and others. This alternative explores eco-friendly processes for extracting secondary metabolites from nature, thus increasing the number of unconventional extraction methods with lower environmental impact over conventional methods. In this context, the Peruvian Ambrosia arborescens was our model while exploring a microwave-assisted extraction (MAE) approach over maceration. The objective of this study was to perform a phytochemical study including UHPLC-ESI-MS/MS and the antioxidant activity of Ambrosia arborescens, using sustainable strategies by mixing both microwaves and ethyl lactate as a green solvent. The results showed that ethyl lactate/MAE (15.07%) achieved a higher extraction yield than methanol/maceration (12.6%). In the case of the isolation of psilostachyin, it was similar to ethyl lactate (0.44%) when compared to methanol (0.40%). Regarding UHPLC-ESI-MS/MS studies, the results were similar. Twenty-eight compounds were identified in the ethyl lactate/MAE and methanol/maceration extracts, except for the tentative identification of two additional amino acids (peaks 4 and 6) in the MeOH extract. In relation to the antioxidant assay, the activity of the ethyl lactate extract was a little higher than the methanol extract in terms of ORAC (715.38 ± 3.2) and DPPH (263.04 ± 2.8). This study on A. arborescens demonstrated that the unconventional techniques, such as MAE related to ethyl lactate, could replace maceration/MeOH for the extraction and isolation of metabolites from diverse sources. This finding showed the potential of unconventional methods with green solvents to provide eco-friendly methods based on green chemistry.

Large-scale production of non-conventional edible plants for biodiverse school meals.

Introduction: School feeding programs are important for ensuring food security and promoting child health and development, particularly in low-income countries. In view of this importance, it is possible to increase the quality of these meals by diversifying the vegetables offered and incorporating underutilized plants to improve dietary diversity and nutritional quality into school meals. Methods: This study was carried out using the action research methodology following the implementation and development of the "Inova na Horta" project in the city of Jundiaí, São Paulo, Brazil. The project was based on the existing and functioning physical and organizational structure of a municipal organic farm. Vegetables were selected from among 210 non-conventional species and varieties, which were further selected for continuous production based on 8 nutritional, culinary and cultivation criteria. Results: Thirty-four vegetables were selected for continuous cultivation and provisions to the school kitchens. Nine tons of vegetables were produced and provided to 90 municipal schools from 2020-2023. Leafy vegetables accounted for most the production, with a total weight of 6441 kg corresponding to 71.6% of the total harvest. Kitchen teams were trained throughout the project duration. Discussion: The feasibility of the production and culinary use of 34 biodiverse, nutrient-rich and underutilized food vegetables for school meals was demonstrated. The selected vegetables are nutrient-rich and contain higher amounts of minerals and proteins than the control vegetables (conventional vegetables), thus complementing several nutrients in school meals. This methodology can be replicated by municipalities of various sizes as a public policy of food and nutritional security associated with the valorization of local biodiversity.

Comparing the modified socket-shield technique with the conventional immediate implantation technique in the anterior dentition: A 5-year retrospective clinical study.

AIMS: The aim of this retrospective clinical study was to compare the 5-year radiological and clinical outcomes of patients undergoing immediate implantation with or without the modified socket-shield technique. MATERIALS AND METHODS: Patients who underwent anterior tooth replacement via the modified socket-shield technique (MSST) or the conventional immediate implantation technique (CIIT) between 2016 and 2017 were included. The labial bone thickness was assessed at different measurement levels (0, 2, 4 and 6 mm apical to the implant shoulder (IS)) postoperatively (T1), 6 months postoperatively (T2) and 5 years postoperatively (T3). The pink aesthetic score (PES) was evaluated before surgery (T0) and at T2 and T3. Implant success, complications and patient satisfaction were evaluated at every visit. RESULTS: Thirty-six patients (18 in the MSST group) underwent follow-up for 5 years, with no cases of implant failure. Two cases of exposure were detected in the MSST group, but there were no significant effects on hard or soft tissue. Patients in the MSST group showed less and more stable bone resorption than did those in the CIIT group at any measurement level and any time. A higher PES was achieved in the MSST group. Patient satisfaction was similar in both groups. CONCLUSIONS: The MSST is a reliable immediate implantation method because of its ability to preserve the alveolar bone and provide superior recovery of aesthetics.

Physicochemical parameters affecting the adhesion of ciprofloxacin-resistant Escherichia coli to activated sludge.

To investigate the physicochemical conditions necessary to stably remove antibiotic-resistant bacteria (ARB) via contact with activated sludge (AS), the adhesion of ciprofloxacin (CIP)-resistant and -susceptible Escherichia coli to AS was simulated by contact tests in the laboratory. The CIP-resistant E. coli and susceptible E. coli were removed by a 3 log smaller concentration by a 5 h contact test at maximum. Considering the hydraulic retention time of a reaction tank (∼5 h) and step-feeding operation, we considered the removal rate of E. coli in the current simulated contact test to be in agreement with the actual situation where 1-2 log concentrations of E. coli were reported to be removed from an AS reaction tank. With the increase in the AS concentration and/or dissolved oxygen, the removal rate of E. coli increased. The removal rate of CIP-resistant E. coli was greater than that of susceptible E. coli under all experimental conditions. Although the mechanism by which CIP-resistant E. coli preferably adhered to AS was not clearly understood in detail, finding optimum conditions under which bacteria, including ARB, were efficiently removed by the AS process may be possible.

Efficacy and safety of high-dose chemotherapy as the first or subsequent salvage treatment line in patients with relapsed or refractory germ cell cancer: an international multicentric analysis.

BACKGROUND: In relapsed or refractory (RR) metastatic germ cell cancer (GCC), high-dose (HD) chemotherapy (CTX) plus autologous stem cell transplantation is considered the standard of care. Limited data exist regarding the efficacy of HD-CTX following conventionally dosed salvage regimens (CDRs). This analysis explores and contrasts the efficacy of HD-CTX as the first or subsequent salvage regimen. PATIENTS AND METHODS: Data were retrospectively collected to explore the efficacy of HD-CTX administered as the first (group A) or subsequent salvage CTX (group B) after a CDR. The primary endpoint was OS from the time of HD-CTX. Associations of survival, overall response rate (ORR), and toxicity with clinical characteristics were explored using stratified Kaplan-Meier and Cox regression models. RESULTS: Overall, 283 patients with GCC were included from 11 international centers, with 159 patients (56%) in group A and 124 patients (44%) in group B. The first salvage treatment was administered between 1998 and 2022, with a median follow-up of 27.0 [standard deviation (SD) 46.2] months for group A and 17.0 (SD 48.5) months for group B. The median OS from HD-CTX treatment initiation was not reached in group A, compared with 25 months in group B (P = 0.00027), associated with 2- and 5-year OS rates of 74% and 63% (group A) versus 53% and 37% (group B), respectively. When administered as the first salvage treatment, HD-CTX was associated with a higher ORR (79% versus 60%; P = 0.013) and lower nonhematologic grade ≥3 toxicity rate (78% versus 97%; P < 0.001). Concerning risk factor analysis for the total cohort, the International Prognostic Factors Study Group score was the only independent predictor of OS in multivariable analysis (P = 0.006). CONCLUSIONS: When administered as the initial salvage treatment or after CDR, HD-CTX exhibits curative potential for patients with RR GCC. The efficacy and safety outcomes were more favorable when HD-CTX was conducted as the first salvage treatment line.

Pesticide reduction: clustering organic croplands.

Organic and conventional farms often coexist, yet their proximity does not ensure compatibility. Larsen et al. reveal that being surrounded by organic fields reduces pesticide usage in organic fields but increases it in conventional fields. We discuss these findings, emphasizing the need to cluster organic croplands for reduced pesticide use.

Microbiome structure and function in parallel full-scale aerobic granular sludge and activated sludge processes.

Aerobic granular sludge (AGS) and conventional activated sludge (CAS) are two different biological wastewater treatment processes. AGS consists of self-immobilised microorganisms that are transformed into spherical biofilms, whereas CAS has floccular sludge of lower density. In this study, we investigated the treatment performance and microbiome dynamics of two full-scale AGS reactors and a parallel CAS system at a municipal WWTP in Sweden. Both systems produced low effluent concentrations, with some fluctuations in phosphate and nitrate mainly due to variations in organic substrate availability. The microbial diversity was slightly higher in the AGS, with different dynamics in the microbiome over time. Seasonal periodicity was observed in both sludge types, with a larger shift in the CAS microbiome compared to the AGS. Groups important for reactor function, such as ammonia-oxidising bacteria (AOB), nitrite-oxidising bacteria (NOB), polyphosphate-accumulating organisms (PAOs) and glycogen-accumulating organisms (GAOs), followed similar trends in both systems, with higher relative abundances of PAOs and GAOs in the AGS. However, microbial composition and dynamics differed between the two systems at the genus level. For instance, among PAOs, Tetrasphaera was more prevalent in the AGS, while Dechloromonas was more common in the CAS. Among NOB, Ca. Nitrotoga had a higher relative abundance in the AGS, while Nitrospira was the main nitrifier in the CAS. Furthermore, network analysis revealed the clustering of the various genera within the guilds to modules with different temporal patterns, suggesting functional redundancy in both AGS and CAS. KEY POINTS: • Microbial community succession in parallel full-scale aerobic granular sludge (AGS) and conventional activated sludge (CAS) processes. • Higher periodicity in microbial community structure in CAS compared to in AGS. • Similar functional groups between AGS and CAS but different composition and dynamics at genus level.

The evaluation of the effectiveness of conventional and pulsating toothbrushes on the oral health of healthy and mentally disabled pediatric patients.

OBJECTIVES: Children, especially the mentally disabled, are generally incapable of obtaining adequate oral hygiene levels by manual brushing due to their lack of knowledge about oral hygiene and their limited motor skills. In order to handle those limited skills, different designs of manual and electric toothbrushes are developed and put on markets. The aim of this study was to evaluate the effectiveness of pulsating toothbrushes with easy-to-use properties, against conventional toothbrushes and to analyze their benefits on mentally disabled pediatric patients. METHODS: Thirty-one healthy and 31 mentally disabled children (aged between 7 and 12) participated in this study. The effectiveness of three different toothbrushes (Oral-B Pulsar, Colgate 360° Micro Sonic Power, Oral-B Stages 3) was investigated with a cross-over study design. DMFT, dft, modified sulcus bleeding index (MOD-SBI), approximal plaque index (API) and Green and Vermillion simplified oral hygiene index (G&V OHI-S) measurements are performed to evaluate the oral hygiene status. RESULTS: In the mentally disabled group the manual toothbrush for MOD-SBI, and Colgate 360° Micro Sonic Power for API showed the best results respectively. CONCLUSION: The ability of tooth brushing was improved both in healthy and in disabled children during this 5 months study. Unfortunately, it was not obvious in disabled children. Persevering training for tooth brushing might be the most important regardless of the kind of toothbrush.

Reliable smart models for estimating frictional pressure drop in two-phase condensation through smooth channels of varying sizes.

Reliable and comprehensive predictive tools for the frictional pressure drop (FPD) are of particular importance for systems involving two-phase flow condensation. However, the available models are only applicable to specific operating conditions and channel sizes. Thus, this study aims at developing universal models to estimate the FPD during condensation inside smooth mini/micro and conventional (macro) channels. An extensive databank, comprising 8037 experimental samples and 23 working fluids from 50 reliable sources, was prepared to achieve this target. A comprehensive investigation on the literature models reflected the fact that all of them are associated with high deviations, and their average absolute relative errors (AAREs) exceed 26%. Hence, after identifying the most effective input variables through the Spearman's correlation analysis, three soft-computing paradigms, i.e., multilayer perceptron (MLP), gaussian process regression (GPR) and radial basis function (RBF) were employed to establish intelligent and dimensionless predictive tools for the FPD based on the separated model suggested by Lockhart and Martinelli. Among them, the most accurate results were presented by the GPR approach with AARE and R 2 values of 4.10%, 99.23% respectively, in the testing step. The truthfulness and applicability of the models were explored through an array of statistical and visual analyses, and the results affirmed the obvious superiority of the newly proposed approaches over the literature correlations. Furthermore, the novel predictive tools excellently described the physical variations of the condensation FPD versus the operating parameters. Ultimately, the order of importance of factors in controlling the condensation FPD was clarified by a sensitivity analysis.

Absence of Falciform Ligament Found During Laparoscopic Surgery: A Case Report.

Anatomic variants of hepatic ligaments are rare, and complications attributable to these variants may be difficult to diagnose. Our aim is to contribute to the literature surrounding the incidental finding of a congenital absence of the falciform ligament. We report the case of a 37-year-old man who underwent a laparoscopic cholecystectomy for acute cholecystitis. During the operation, the patient was noted to have an apparent absence of the falciform ligament attachment to the liver. The round ligament was attached from the liver to the anterior abdominal wall at the level of the umbilicus. The round ligament is inserted into the inferior surface of the liver as a thick, cordlike structure encased in fat. In rare cases, the small intestine can pass through a falciform ligament defect and become trapped while remaining within the peritoneal cavity, leading to difficult-to-diagnose internal hernias. This condition can lead to intestinal obstruction, incarceration, and strangulation. This directed our decision to divide the remaining round ligament at the liver and close to the abdominal wall. When defects of hepatic ligaments are found incidentally during laparoscopic surgery, these investigators recommend that the operating surgeon consider dividing the remaining ligament as a protective procedure to prevent complications such as internal hernias, intestinal obstruction, incarceration, and strangulation.

Biodegradable film mulching increases soil microbial network complexity and decreases nitrogen-cycling gene abundance.

Biodegradable plastic films have emerged as a substitute for conventional plastic films. Nevertheless, responses of plant-associated microbiomes to the application of biodegradable film mulching at field scale have received little attention. A field experiment was conducted to assess the influence of different film mulching treatments on various microbial attributes and nitrogen (N) cycling functional genes in bulk and rhizosphere soils. Biodegradable film mulching raised the bacterial Shannon index in bulk soils but not in rhizosphere soils. Biodegradable film mulching has led to an increase in the complexity and connectivity of microbial networks, as well as an enhancement in the positive association among microorganisms owing to raised soil nutrients and increased crop biomass. In biodegradable film-treated soils, both bacterial and fungal communities were primarily influenced by stochastic processes associated with dispersal limitation. Moreover, conventional plastic film mulching increased denitrification, anammox, N fixation, and dissimilatory nitrate-reduction (DNRA) gene abundance in bulk soils. In rhizosphere soils, biodegradable film mulching reduced nitrification, denitrification, anammox, N fixation, and DNRA gene abundance. Furthermore, keystone genera (e.g., Nitrosospira, Truepera, Adhaeribacter, Opitutus, and Fusarium) were affected by edaphic variables, contributing to decreased N-cycling gene abundance in biodegradable film-treated soils. Collectively, biodegradable film mulching transformed soil microbiome assembly and functional adaptation, and soil nutrient availability and plant biomass were the critical factors influencing the microbial community. These findings present a novel perspective on the diverse impacts of biodegradable and conventional film mulching on soil microbiome and N-cycling processes.