Who are the patients who use non-pharmacological home remedies? Cross-sectional study in Switzerland and France.

BACKGROUND: Many patients may be tempted to use non-pharmacological home remedies (NPHRs) to relieve various complaints. To the best of our knowledge, there is little data on the characteristics of patients using NPHRs. In this cross-sectional study carried out between March 2020 and July 2021, we examined the socio-demographic factors underlying their use in patient populations in Switzerland and France. METHODS: Using official registries, we randomly selected 50 primary care physicians (PCPs) in Geneva (Switzerland) and Lyon/Grenoble (France). Seven research assistants consecutively recruited patients from PCP waiting rooms (20-25 patients per practice). Patients completed a paper-based questionnaire assessing the use [yes/no] of 304 NPHRs for 79 medical conditions. The NPHR list was developed by our team with input from 97 patients. We used univariable and multivariable logistic regressions, adjusting for intra-cluster correlations, to examine associations between NPHR use and patient characteristics (gender, age, practice location, nationality, education level, and self-rated health). RESULTS: Of the 1198 eligible patients, 1012 agreed to participate (85%). Overall, 635 patients (63%) reported using at least one of the remedies tested in the study. In multivariable analysis, women (OR = 1.7 [95%CI = 1.3-2.3], P-value < 0.001), younger patients (< 40 years: OR = 2.1 [95%CI = 1.6-2.9], P-value < 0.001), and French patients (OR = 1.6 [95%CI = 1.1-2.3], P-value < 0.001) tended to use NPHRs more often than other patients. CONCLUSIONS: Many patients, particularly women, young people, and French patients, reported using NPHRs. This survey's findings hold the potential to inform healthcare providers, policymakers, and researchers about the diverse preferences that shape patients' healthcare choices.

Molybdenum inhibited the growth of Phytophthora nicotiana and improved the resistance of Nicotiana tabacum L. against tobacco black shank.

Tobacco black shank (TBS) is a soil-borne fungal disease caused by Phytophthora nicotiana (P. nicotianae), significantly impeding the production of high-quality tobacco. Molybdenum (Mo), a crucial trace element for both plants and animals, plays a vital role in promoting plant growth, enhancing photosynthesis, bolstering antioxidant capacity, and maintaining ultrastructural integrity. However, the positive effect of Mo on plant biotic stress is little understood. This study delves into the inhibitory effects of Mo on P. nicotianae and seeks to unravel the underlying mechanisms. The results showed that 16.32 mg/L of Mo significantly inhibited mycelial growth, altered mycelial morphological structure, damaged mycelial cell membrane, and ultimately led to the leakage of cell inclusions. In addition, 0.6 mg/kg Mo applied in soil significantly reduced the severity of TBS. Mo increased photosynthetic parameters and photosynthetic pigment contents of tobacco leaves, upregulated expression of NtPAL and NtPPO resistance genes, as well as improved activities of SOD, POD, CAT, PPO, and PAL in tobacco plants. Furthermore, Mo could regulate nitrogen metabolism and amino acids metabolism to protect tobacco plants against P. nicotianae infection. These findings not only present an ecologically sound approach to control TBS but also contribute valuable insights to the broader exploration of the role of microelements in plant disease management.

Nonpharmacological home remedies for upper respiratory tract infections: a cross-sectional study of primary care patients in Switzerland and France.

BACKGROUND: Many patients might be tempted to use nonpharmacological home remedies (NPHRs) to relieve upper respiratory tract infection (URTI) symptoms. However, primary care physicians (PCPs) rarely recommend NPHRs due to a lack of knowledge in this field. We conducted a questionnaire-based survey among primary care patients in Switzerland and France to explore which NPHRs they use and consider effective for 3 common URTI symptoms: sore throat/cough/common cold. METHODS: Using official physician registries, we randomly selected 50 PCPs in Geneva (Switzerland) and Lyon/Grenoble (France). Seven research assistants were involved in the recruitment of consecutive patients from the waiting rooms of these PCPs (20-25 patients per practice). Patients were asked to complete a paper-based questionnaire to assess the use and perceived effectiveness of 72 NPHRs for URTI symptoms. The list of NPHRs was developed by our research team with the help of 97 patients. Remedies were considered effective if patients reported that they were effective/very effective. Data were analysed descriptively. RESULTS: Of the 1,198 eligible patients, 1,012 agreed to participate (84.5%). The 4 most frequently used NPHRs were honey/lemon/thyme/herbal teas. Most patients using these NPHRs considered them as effective (between 77% of patients for onion syrup for cough and 94% of patients for thyme inhalations for common colds). CONCLUSIONS: Many patients reported using honey/lemon/thyme/herbal teas for URTI symptoms, and generally considered these treatments to be effective. Future research should explore the extent to which these remedies can be safely proposed as alternatives for the symptomatic treatment of ear/nose/throat complaints in primary care.

Effect of an app for promoting advance care planning and motivating patients to write their advance directives.

BACKGROUND: Accordons-nous, a smartphone app, was developed to support patients in the advance care planning (ACP) process. The app raises awareness and facilitates communication on this sensitive topic. It helps patients express their values and preferences for care and write their advance directives (AD). OBJECTIVE: Measure the impact of distributing Accordons-nous on patients' propensity to engage in the ACP process, compared with the distribution of a leaflet. A secondary objective was to test the effect of socio-demographic factors (age, health status, gender, level of education) on propensity to engage in ACP. METHODS: Pre-post randomized control study. Participants were patients approached in medical waiting rooms. They received the app (treatment) or an information leaflet (control). They responded to two questionnaires: one at recruitment and a second 3-4 weeks later. Improvement on four variables relevant to ACP was measured: reported contemplation of an event relevant to ACP; decision about treatment in case of that event; discussion about it with relatives or health care professionals; writing advance directives. Statistical analysis included between-group comparisons of pre-post differences with 2-sample tests for equality of proportions and logistic regression models. RESULTS: Four hundred seventy three participants were recruited and full responses obtained from 312. Overall, the intervention (control and treatment together) had a positive effect on the mean reported ACP engagement for all variables: new or renewed contemplation 54%; increase in decision 8%, discussion 11%, and writing 1%, compared to the baseline. Compared to the control (leaflet), the treatment group (app) had a larger effect size for all variables: between-group difference in contemplation + 11% (logistic regression, p = .05), decision + 1% (but p > .05 on this variable), discussion + 5% (p = .05), and writing AD + 5% (p = .03). Moreover, greater age was positively correlated with having written AD at inclusion (21% among retired compared to 2% among young adults) and with the propensity to write AD after our intervention (logistic regression, p = .001). Other factors tested (frequency of consultations, gender, level of education) had no effect on participants' ACP engagement. CONCLUSIONS: When distributed without specific counselling, the tool increased reported ACP engagement, although effect sizes remain modest. Further studies are needed to investigate whether the app could generate greater ACP engagement if used by professionals in dedicated ACP consultations.

Effectiveness of combined tools: adsorption, bioaugmentation and phytoremediation for pesticides removal from wastewater.

The aim of this study was the comparison of two process in pentachlorophenol (PCP: 100 mg L-1) removal by combined process bioaugmentation-adsorption and bioaugmentation-phytoremediation in secondary treated wastewater (STWW). The phytoremediation procedure was conducted by using two plants such as Typha angustifolia and Schoenoplectus acutus, and the bioaugmentation procedure was operated by Pseudomonas putida HM 627618 as a plant growth promoting bacteria (PGPR). The adsorption process was performed by palm date activated carbon. The PCP monitoring was assessed by high performance liquid chromatography (HPLC) and the optical density determination at 600 nm (OD600). The performance of the two processes was observed by the determination of total bacteria, chlorophylls and physical and chemical analysis (COD, pH, conductivity, chloride, and organic carbon). The alfalfa seed germination test was conducted to assess the two operational performance procedures. According to the results obtained from the physical and chemical analysis of the treated STWW, there was no significant differences in the pH and in the EC content of the bioaugmentation-phytoremediation treatment, while a significant increase of the EC content was observed in the bioaugmentation-adsorption to 5.08 mS cm-1. The COD value significantly decreased up to 1320 mg L-1 in bioaugmentation-adsorption treatment (control value 2400 mg L-1) and 98 mg L-1 in bioaugmentation-phytoremediation treatment (control value 98 mg L-1). Microbial biomass monitoring of P. putida shows significant greater in both processes in the order of 9.18 and 7.01 Log CFU mL-1 for bioaugmentation-adsorption and bioaugmentation-phytoremediation, respectively. The chlorophyll content in Typha angustifolia and Schoenoplectus acutus significantly decreased after 144 h with the exception of the chlorophyll a content of Schoenoplectus acutus in which the content increased up to 3.31 mg mL-1. Comparing the performance of these two treatments, it was found according to HPLC analysis that the bioaugmentation-adsorption process was more efficient in removing about 97% of PCP after 48 h, against around 90% of PCP after 72 h for the phytoremediation-bioaugmentation. The alfalfa seeds showed a germination rate after the 5th day of incubation of 100% and 95%, respectively for the PCP-non-contaminated and treated STWW, while for wastewater containing PCP the germination was totally inhibited.

This paper describing sensitive methods of combined bioaugmentation-phytoremediation and bioaugmentation-adsorption for pentachlorophenol (PCP) depletion in wastewater. The novelty is the choice of a macrophyte Typha angustifolia and Schoenoplectus acutus in constructed wetland fixed in clay matrix. The two-selected plants are still used for the elimination of heavy metals but not for pesticide in wastewater. Also, the combined process bioaugmentation-adsorption was not tested in other researches. On the other side, in this study, the phytoremediation technique combined with bacteria positively affected the plants activity in order to promote pollutant remediation. Hence, the Pseudomonas putida HM 627618 in wastewater with the macrophyte presence or date stone adsorbent have a great capacity to reduce this pollutant (PCP) by improving the bioremediation process.

[Physician selfcare or the cobblers of Montaigne]. / Selfcare des médecins ou les cordonniers de Montaigne.

A recent survey conducted in the French-speaking part of Switzerland ("Romandie") showed that only about half of the primary care physicians (PCP) in Romandie had a personal doctor. Moreover, 37 % of the PCP declared they had foregone consulting a doctor for a health problem or a check-up during the past year. Finally, 29 % of them had chosen to continue working despite being ill. The literature describes multiple origins for these behaviors, both systemic (especially workload) and individual (denial, fear of social and peer judgment, culture of invincibility…). There is room for improvement for this still too often overlooked problem, in order to enhance the PCP's health (or well-being), and consequently the quality of care.

Une récente enquête menée en Suisse romande a montré qu'environ la moitié seulement des médecins de premier recours (MPR) romands avaient un médecin traitant. De plus, 37 % des MPR ont déclaré avoir renoncé à consulter un médecin pour un problème de santé durant l'année écoulée. Enfin, ils étaient aussi 29 % à avoir choisi de continuer à travailler tout en étant malades. La littérature évoque divers facteurs pouvant expliquer ou du moins contribuer à ces comportements, qu'il s'agisse de facteurs systémiques (principalement la charge de travail) ou individuels (déni, peur du jugement de la société et des pairs ou culture de la toute-puissance). Des voies d'amélioration, pour traiter cette problématique souvent méconnue, sont non seulement possibles, mais certainement nécessaires pour le bien de nos médecins et la qualité des soins délivrés aux patients.

Prevalence of Middle East Respiratory Syndrome Coronavirus in Dromedary Camels, Tunisia.

Free-roaming camels, especially those crossing national borders, pose a high risk for spreading Middle East respiratory syndrome coronavirus (MERS-CoV). To prevent outbreaks, active surveillance is necessary. We found that a high percentage of dromedaries in Tunisia are MERS-CoV seropositive (80.4%) or actively infected (19.8%), indicating extensive MERS-CoV circulation in Northern Africa.

Isolation and characterization of lytic phage TUN1 specific for Klebsiella pneumoniae K64 clinical isolates from Tunisia.

BACKGROUND: Multidrug-resistant Klebsiella pneumoniae spp. (kp) are emerging agents of severe infections of the respiratory, urinary tract and wounds that can progress to fatal septicemia. The use of bacteriophages is currently being considered as an effective alternative or adjuvant to antibiotic therapy. RESULTS: In this study, we report capsule (K)-typing of 163 carbapenem-resistant Kp (CRKP) isolated 2014-2018 at the Military Hospital of Instruction of Tunis (MHT), Tunisia, by partial amplification and sequencing of the Kp wzi gene. The most prevalent K-type overall was K64 with 50.3% followed by K17 and K27 (22.7 and 11.0%, respectively). K64 Kp strains were most common and associated with increased case/fatality rates, especially at the intensive care unit (ICU). Using a K64 Kp strain we isolated and characterized a lytic Kp phage, vB_KpP_TUN1 (phage TUN1), from wastewater samples of the ICU at the MHT. TUN1 belongs to the Autographiviridae family and specifically digests K64 Kp capsules most probably via a depolymerase encoded by gp47. Furthermore, we successfully assembled phage TUN1 in a non-replicative host (E. coli) raising the possibility of in vitro assembly in the absence of live bacterial hosts. We propose that phage TUN1 is a promising candidate to be used as an adjuvant or an alternative to antibiotic therapy in CRKP infections, facilitating regulatory approval of phage therapy. CONCLUSIONS: K64, K17 and K27 are the most common wzi capsule types in this geographical location in Northern Africa. The lytic phage TUN1 efficiently lyses K64 Kp strains associated with increased case/fatality rates at body temperature. Together with its ability to be rescued in a non-replicative host these features enhance the utility of this phage as an antibacterial agent.

Whole genome sequencing and phylogenetic classification of Tunisian SARS-CoV-2 strains from patients of the Military Hospital in Tunis.

In the present work, two complete genome sequences of SARS-CoV-2 were obtained from nasal swab samples of Tunisian SARS-CoV-2 PCR-positive patients using nanopore sequencing. The virus genomes of two of the patients examined, a Tunisian soldier returning from a mission in Morocco and a member of another Tunisian family, showed significant differences in analyses of the total genome and single nucleotide polymorphisms (SNPs). Phylogenetic relationships with known SARS-CoV-2 genomes in the African region, some European and Middle Eastern countries and initial epidemiological conclusions indicate that the introduction of SARS-CoV-2 into Tunisia from two independent sources was travel-related.

Optical and Mass Flow Sensors for Aiding Vehicle Navigation in GNSS Denied Environment.

Nowadays, autonomous vehicles have achieved a lot of research interest regarding the navigation, the surrounding environmental perception, and control. Global Navigation Satellite System/Inertial Navigation System (GNSS/INS) is one of the significant components of any vehicle navigation system. However, GNSS has limitations in some operating scenarios such as urban regions and indoor environments where the GNSS signal suffers from multipath or outage. On the other hand, INS standalone navigation solution degrades over time due to the INS errors. Therefore, a modern vehicle navigation system depends on integration between different sensors to aid INS for mitigating its drift during GNSS signal outage. However, there are some challenges for the aiding sensors related to their high price, high computational costs, and environmental and weather effects. This paper proposes an integrated aiding navigation system for vehicles in an indoor environment (e.g., underground parking). This proposed system is based on optical flow and multiple mass flow sensors integrations to aid the low-cost INS by providing the navigation extended Kalman filter (EKF) with forward velocity and change of heading updates to enhance the vehicle navigation. The optical flow is computed for frames taken using a consumer portable device (CPD) camera mounted in the upward-looking direction to avoid moving objects in front of the camera and to exploit the typical features of the underground parking or tunnels such as ducts and pipes. On the other hand, the multiple mass flow sensors measurements are modeled to provide forward velocity information. Moreover, a mass flow differential odometry is proposed where the vehicle change of heading is estimated from the multiple mass flow sensors measurements. This integrated aiding system can be used for unmanned aerial vehicles (UAV) and land vehicle navigations. However, the experimental results are implemented for land vehicles through the integration of CPD with mass flow sensors to aid the navigation system.

Soil phosphorus transformation characteristics in response to molybdenum supply in leguminous crops.

Phosphorus (P) is one of the most restrictive essential elements to crop growth and development due to less availability in the soil system. Previous studies have reported the synergistic effects between molybdenum (Mo) and P fertilizer on P uptake in various crops. However, an induced long term effect of Mo on soil P dynamics in the rhizosphere and non-rhizosphere has not been reported yet in leguminous crops. In this study, a long term field experiment was conducted to explore the P transformation characteristics and bioavailability in Mo-deficient (-Mo) and Mo-enriched (+Mo) soil under leguminous (broad bean-soybean) cropping system. The results indicated that long-term Mo application increased the plant dry matter accumulation (14.23%-35.27%, for broad bean; 24.40%-37.46%, for soybean) from March-September. In rhizosphere soil, the percent decrease in pH (8.10%) under +Mo treatment of the soybean crop was recorded more during September as compared to broad bean crop. Under Mo supply, H2O-Pi fraction increased up to 28.53% and 43.67% while for NaHCO3-Pi this increase was up to 5.61% and 11.98%, respectively in the rhizosphere soil of broad bean and soybean, whereas, residual-P exhibited the highest proportion of P fractions. Moreover, compared with -Mo, +Mo treatments significantly increased the soil acid phosphatase (broad bean = 17.43 µmol/d/g; soybean = 28.60 µmol/d/g), alkaline phosphatase (broad bean = 3.34 µmol/d/g; soybean 6.35 µmol/d/g) and phytase enzymes activities (broad bean = 2.45 µmol/min/g; soybean = 5.91 µmol/min/g), transcript abundance of phoN/phoC genes and microbial biomass P (MBP) in rhizosphere soil. In crux, the findings of this study suggest that long term Mo application enhanced P bioavailability through increased available P, MBP, P related enzymes activities and their genes expressions which may represent a strategy of Mo to encounter P deficiencies in the soil system.

Phytoremediation of samples extracted from wastewater treatment plant and their socioeconomic impact.

The physico-chemical and bacteriological quality was evaluated in wastewater samples before and after treatment by microalgae enrichment. Three types of wastewater samples - raw water, inlet water and outlet water - were taken directly from the wastewater treatment plant and subjected to microalgae enrichment culture during two months. The main objective of this work was to apply a phytoremediation process based on the use of compulsory microalgae treatment of wastewater from treatment plants compared to other secondary treatments. The biomass of microalgae was extracted to determine the concentrations of phenolic compounds, sugars and especially lipids, which can be subsequently transformed into biodiesel. As a result, the pH showed a significant increase after microalgae proliferation, with values ranging from 9.94 to 10.36. Bacterial community analysis before and after microalgae culture showed a clear shift in biomass content. The total coliform (TC) and the fecal coliform (FC) contents decreased after microalgae enrichment. In addition, the fecal streptococci (FS) and Pseudomonas present in the different wastewater samples completely disappeared after treatment. The applied phytoremediation process showed a drop until the disappearance of the contagious microbes - which present a very serious health risk - due to the release of the quinic acid. The quinic acid observed in the treated waters exceeded the content of 464.328 mg/L. This phenolic compound naturally produced during the process demonstrated a very effective antimicrobial power. However, a significant increment of 100% of phenol compound removal was observed after microalgae enrichment. The lipid content in the various studied samples appeared after microalgae culture. In addition, the heavy metals, namely cadmium and chromium, were completely eliminated after the treatment. Several socioeconomic advantages can be achieved by the use of this process, notably the environmental advantages of bioenergetics and economic and social benefits of the non-expensive valorization of wastewaters for irrigation.

Steering Angle Assisted Vehicular Navigation Using Portable Devices in GNSS-Denied Environments.

Recently, land vehicle navigation, and especially by the use of low-cost sensors, has been the object of a huge level of research interest. Consumer Portable Devices (CPDs) such as tablets and smartphones are being widely used by many consumers all over the world. CPDs contain sensors (accelerometers, gyroscopes, magnetometer, etc.) that can be used for many land vehicle applications such as navigation. This paper presents a novel approach for estimating steering wheel angles using CPD accelerometers by attaching CPDs to the steering wheel. The land vehicle change of heading is then computed from the estimated steering wheel angle. The calculated change of heading is used to update the navigation filter to aid the onboard Inertial Measurement Unit (IMU) through the use of an Extended Kalman Filter (EKF) in GNSS-denied environments. Four main factors that may affect the steering wheel angle accuracy are considered and modeled during steering angle estimations: static onboard IMU leveling, inclination angle of the steering wheel, vehicle acceleration, and vehicle inclination. In addition, these factors are assessed for their effects on the final result. Therefore, three methods are proposed for steering angle estimation: non-compensated, partially-compensated, and fully-compensated methods. A road experimental test was carried out using a Pixhawk (PX4) navigation system, iPad Air, and the OBD-II interface. The average Root Mean Square Error (RMSE) of the change of heading estimated by the proposed method was 0.033 rad/s. A navigation solution was estimated while changes of heading and forward velocity updates were used to aid the IMU during different GNSS signal outages. The estimated navigation solution is enhanced when applying the proposed updates to the navigation filter by 91% and 97% for 60 s and 120 s of GNSS signal outage, respectively, compared to the IMU standalone solution.

Direction of Arrival Estimation of GPS Narrowband Jammers Using High-Resolution Techniques.

GPS jamming is a considerable threat to applications that rely on GPS position, velocity, and time. Jamming detection is the first step in the mitigation process. The direction of arrival (DOA) estimation of jamming signals is affected by resolution. In the presence of multiple jamming sources whose spatial separation is very narrow, an incorrect number of jammers can be detected. Consequently, mitigation will be affected. The ultimate objective of this research is to enhance GPS receivers' anti-jamming abilities. This research proposes an enhancement to the anti-jamming detection ability of GPS receivers that are equipped with a uniform linear array (ULA) and uniform circular array (UCA). The proposed array processing method utilizes fast orthogonal search (FOS) to target the accurate detection of the DOA of both single and multiple in-band CW jammers. Its performance is compared to the classical method and MUSIC. GPS signals obtained from a Spirent GSS6700 simulator and CW jamming signals were used. The proposed method produces a threefold advantage, higher accuracy DOA estimates, amplitudes, and a correct number of jammers. Therefore, the anti-jamming process can be significantly improved by limiting the erroneous spatial attenuation of GPS signals arriving from an angle close to the jammer.

Modified Rice Straw Enhanced Cadmium (II) Immobilization in Soil and Promoted the Degradation of Phenanthrene in Co-Contaminated Soil.

Very limited information is available about heavy metal-polycyclic aromatic hydrocarbons (PAHs) depollution involving the modified natural material in soil. Using phenanthrene and cadmium (Cd) as model, this study investigated the effect(s) of modified rice straw by a NaOH solution and on PAHs, heavy metal availability, and their interactions. Treatment included chemical contaminant with/without modified/unmodified rice straw. Fourier Transform Infrared (FTIR) analysis revealed that certain functional groups including anionic matters groups, which can a complex with Cd2+, were exposed on the modified rice straw surfaces. Therefore, Cd concentration was significantly reduced by about 60%, 57%, 62.5 %, and, 64% in the root, shoot, CaCl2, diethylenetriaminepentaacetic acid (DTPA), and extractable Cd, respectively. Subsequently, the prediction of the functional profile of the soil metagenome using Clusters Orthologous Groups (COGs) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) database revealed that the significantly changed individual COGs belonged to the carbohydrate metabolism, ion transports, and signaling (including cytochrome P450s) categories. This indicated that ion transports might be involved in Cd management, while carbohydrate metabolism, including bisphenol, benzoate, ethylbenzene degradation, and cytochrome P450s, were rather involved in phenanthrene metabolism. The exposed functional group might serve as an external substrate, and P450s might serve as a catalyst to activate and initiate phenanthrene metabolism process. These finding offer confirmation that modified straw could promote the reduction of heavy metal and the degradation of PAHs in soil.

Molybdenum-Induced Effects on Nitrogen Metabolism Enzymes and Elemental Profile of Winter Wheat (Triticum aestivum L.) Under Different Nitrogen Sources.

Different nitrogen (N) sources have been reported to significantly affect the activities and expressions of N metabolism enzymes and mineral elements concentrations in crop plants. However, molybdenum-induced effects in winter wheat cultivars have still not been investigated under different N sources. Here, a hydroponic study was carried out to investigate these effects on two winter wheat cultivars ('97003' and '97014') as Mo-efficient and Mo-inefficient, respectively, under different N sources (NO3-, NH4NO3, and NH4+). The results revealed that the activities of nitrate reductase (NR) and nitrite reductase (NiR) followed the order of NH4NO3 > NO3- > NH4+ sources, while glutamine synthetase (GS) and glutamate synthase (GOGAT) followed the order of NH4+ > NH4NO3 > NO3- in both the wheat cultivars. However, Mo-induced effects in the activities and expressions of N metabolism enzymes under different N sources followed the order of NH4NO3 > NO3- > NH4+ sources, indicating that Mo has more complementary effects towards nitrate nutrition than the sole ammonium source in winter wheat. Interestingly, under -Mo-deprived conditions, cultivar '97003' recorded more pronounced alterations in Mo-dependent parameters than '97014' cultivar. Moreover, Mo application increased the proteins, amino acids, ammonium, and nitrite contents while concomitantly decreasing the nitrate contents in the same order of NH4NO3 > NO3- > NH4+ sources that coincides with the Mo-induced N enzymes activities and expressions. The findings of the present study indicated that Mo plays a key role in regulating the N metabolism enzymes and assimilatory products under all the three N sources; however, the extent of complementation exists in the order of NH4NO3 > NO3- > NH4+ sources in winter wheat. In addition, it was revealed that mineral elements profiles were mainly affected by different N sources, while Mo application generally had no significant effects on the mineral elements contents in the winter wheat leaves under different N sources.

Endoscopic papillary large balloon dilatation for the extraction of common bile duct stones.

BACKGROUND AND AIM: endoscopic papillary large balloon dilatation (EPLBD) is increasingly accepted as an appropriate option for the management of difficult common bile duct stones (CBDS). This study aimed to evaluate the safety and efficacy of EPLBD with a relatively large balloon (15-20 mm) for the extraction of difficult CBDS. PATIENTS AND METHODS: a total of 40 patients were recruited with obstructive jaundice and dilated CBD (≥ 10 mm) subsequent to a single large CBDS of ≥ 10 mm or multiple stones (≥ 3). All patients underwent endoscopic retrograde cholangio-pancreatography (ERCP) with limited sphincterotomy and large balloon dilatation followed by stone extraction using an extraction balloon or dormia basket, without lithotripsy, stenting or further ERCP sessions. RESULTS: successful stone extraction was achieved in 34 patients (85%) and stone extraction failure occurred in six patients (15%). Complications included minimal pancreatitis in four cases (10%), mild pancreatitis in two cases (5%), cholangitis in two cases (5%) and bleeding in two cases (5%). There were no recorded cases of perforation or mortality subsequent to the procedure. CONCLUSION: EPLBD is a safe and efficient procedure for the extraction of difficult CBDS and may be advisable in patients with a bleeding risk or abnormal papillary anatomy.

Can Selenium and Molybdenum Restrain Cadmium Toxicity to Pollen Grains in Brassica napus?

Cadmium (Cd) is highly toxic, even at very low concentrations, to both animals and plants. Pollen is extremely sensitive to heavy metal pollutants; however, less attention has been paid to the protection of this vital part under heavy metal stress. A pot experiment was designed to investigate the effect of foliar application of Se (1 mg/L) and Mo (0.3 mg/L) either alone or in combination on their absorption, translocation, and their impact on Cd uptake and its further distribution in Brassica napus, as well as the impact of these fertilizers on the pollen grains morphology, viability, and germination rate in B. napus under Cd stress. Foliar application of either Se or Mo could counteract Cd toxicity and increase the plant biomass, while combined application of Se and Mo solutions on B. napus has no significant promotional effect on plant root and stem, but reduces the seeds' weight by 10⁻11%. Se and Mo have decreased the accumulated Cd in seeds by 6.8% and 9.7%, respectively. Microscopic studies, SEM, and pollen viability tests demonstrated that pollen grains could be negatively affected by Cd, thus disturbing the plant fertility. Se and Mo foliar application could reduce the toxic symptoms in pollen grains when the one or the other was sprayed alone on plants. In an in vitro pollen germination test, 500 µM Cd stress could strongly inhibit the pollen germination rate to less than 2.5%, however, when Se (10 µM) or Mo (1.0 µM) was added to the germination medium, the rate increased, reaching 66.2% and 39.4%, respectively. At the molecular level, Se and Mo could greatly affect the expression levels of some genes related to Cd uptake by roots (IRT1), Cd transport (HMA2 and HMA4), Cd sequestration in plant vacuoles (HMA3), and the final Cd distribution in plant tissue at the physiological level (PCS1).

Awareness of food allergies: a survey of pediatricians in Kuwait.

BACKGROUND: Early diagnosis of food allergies (FA) is important for a favorable prognosis. This study aimed to determine the level of awareness of FA among pediatricians in Kuwait. METHOD: A 43-item self-administered questionnaire was designed and distributed to pediatricians working at 4 government hospitals in Kuwait. RESULTS: A total of 140 pediatricians completed the questionnaire, with a participation rate of 51.1% (81 males and 59 females). The mean age of participants was 40.81 years, and the mean number of years working in pediatrics was 13.94 years. The mean overall knowledge score was 22.2. The pediatricians' overall knowledge scores were found to be significantly associated with their age (older pediatricians had higher overall scores) and years of experience as a pediatrician but were independent from hospital site, gender, or rank. A multiple linear regression revealed pediatrician age and gender were the only variables that were significantly associated with the overall knowledge score. Only 16.4% of the participants answered at least 2/3 of the survey questions correctly. The questions that were correctly answered by ≤ 2/3 of the participants constituted 80% of clinical presentation questions, 66.6% of diagnostics questions, 77.7% of treatment questions, and 42.8% of prevention questions. Interestingly, among 68 pediatricians (48.5%) who determined that they felt comfortable evaluating and treating patients with FA, only 12 (17.6%) passed the questionnaire. CONCLUSIONS: This survey demonstrates that there is a noteworthy deficiency of pediatricians' awareness about FA. The implementation of strategies to improve pediatricians' awareness is critical to diagnose food allergy patients early and improve their health and outcomes.

Clinical Outcomes Following the Use of Constrained Condylar Knees in Primary Total Knee Arthroplasty.

BACKGROUND: Certain clinical or adverse intraoperative situations require the use of increased constraint in primary total knee arthroplasty (TKA). These include significant angular deformities causing incompetent collateral ligaments, or inadvertent intraoperative injury to collateral structures as well as the inability to achieve a balanced flexion and extension gap. Clinical success has been described with the use of constrained condylar knee arthroplasty in the primary setting in these situations. Traditionally, increasing constraint has been in conjunction with intramedullary stems, referred to as stemmed constrained condylar knees (SCCK); however, some devices provide an intermediary option by increasing constraint without the use of stems, herein referred to as nonstemmed constrained condylar knees (NSCCK). The aim of this study was to compare the clinical outcomes of both these devices in primary TKA in terms of revision rates and change in outcome measures over the follow-up period. METHODS: Between 2007 and 2012, 85 SCCKs and 354 NSCCKs were identified in our institutional registry database performed in the primary TKA setting with minimum 2-year clinical outcome measure follow-up. Baseline demographic information, as well as Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Lower Extremity Activity Scale (LEAS) were collected preoperatively at 2-year follow-up. Revision data were also collected. RESULTS: Both groups showed substantial improvement in WOMAC scores (pain, stiffness, and function), and LEAS at 2 years postoperatively compared with baseline, although the changes in scores were not statistically significant. One of 85 SCCKs (1.17%) was revised for infection, whereas 9 of 354 NSCCKs (2.54%) were revised (6 for mechanical complications, eg, loosening, 2 for periprosthetic fracture, and 1 for infection). CONCLUSION: Both cohorts demonstrated improvement in clinical outcome measures at 2-year follow-up. None of the SCCKs performed in the primary setting were revised for a mechanical complication. Although both groups had overall low revision rates, there was trend toward a higher revision rate with NSCCKs. Many of these were revised for component loosening. In summary, when necessary, constrained options in the primary TKA setting provide excellent clinical outcome at short-term follow-up. However, constrained constructs with stemmed fixation may provide more rigid fixation and be less susceptible to mechanical failure.