Background: Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a rescue strategy for non-responders to conventional CPR (CCPR) in cardiac arrest. Definitive guidelines for ECPR deployment do not exist. Prior studies suggest that arrest rhythm and cardiac origin of arrest may be variables used to assess candidacy for ECPR. Aim: To describe a single center experience with ECPR and to assess associations between survival and physician-adjudicated origin of arrest and arrest rhythm. Methods: A retrospective review of all patients who underwent ECPR at a quaternary care center over a 7-year period was performed. Demographic and clinical characteristics were extracted from the medical record and used to adjudicate origin of cardiac arrest, etiology, rhythm, survival, and outcomes. Univariate analysis was performed to determine association of patient and arrest characteristics with survival. Results: Between 2010 and 2017, 47 cardiac arrest patients were initiated on extracorporeal membrane oxygenation (ECMO) at the time of active CPR. ECPR patient survival to hospital discharge was 25.5% (n=12). Twenty-six patients died on ECMO (55.3%) while 9 patients (19.1%) survived decannulation but died prior to discharge. Neither physician-adjudicated arrest rhythm nor underlying origin were significantly associated with survival to discharge, either alone or in combination. Younger age was significantly associated with survival. Nearly all survivors experienced myocardial recovery and left the hospital with a good neurological status. Conclusions: Arrest rhythm and etiology may be insufficient predictors of survival in ECPR utilization. Further multi-institutional studies are needed to determine evidenced based criteria for ECPR deployment.

The photoprotective skincare products are in high demand to meet the consumer market with concern on skin health. Seed oils are commonly used as ingredients in many cosmetic products due to their natural antioxidants and now being increasingly recognised for their effects on skin health and photoprotection. This article briefly reviews the application of seed oils in sunscreen development focusing on the antioxidants that contribute to photoprotection, thus preventing UV-induced erythema and photoaging. The addition of seed oils that contain specific natural bioactive compounds were discussed in the review. Besides that, seed oils acting in molecular pathways that benefit in photoprotection were also summarized. Seed oils (pomegranate seed oil, castor oil, cocoa butter, jojoba oil, rosehip oil, grapeseed oil, kenaf seed oil and pumpkin seed oil) utilization have high potential to act as natural UV filters and at the same time help in skin repairing. The seed oils contributed beneficial properties to the sunscreen formulation by their synergistic effect with antioxidants, antiaging properties, anti-inflammatory effect, and potential hormetic effect. The finding of specific bioactive compound from seed oils provide better understanding on the contribution of seed oils in sunscreen formulation.

BACKGROUND: In patients with breast cancer for whom neoadjuvant chemotherapy (NAC) is planned, it is recommended to mark the primary tumor before treatment (planned surgery). However, surgeons may have to perform breast-conserving surgery on patients whose tumors are not marked (unplanned surgery). This study focused on the results obtained with planned and unplanned level II oncoplastic surgery (OPS) techniques applied to patients after NAC. METHODS: Patient groups who underwent planned, unplanned OPS and mastectomy after NAC were compared. Surgical margin status, re-operation and re-excision requirements, ipsilateral breast tumor recurrence (IBTR) and axillary recurrence rates recorded. Long-term local recurrence-free survival (LRFS), disease-free survival and overall survival were evaluated. RESULTS: There was no significant difference between the planned and unplanned OPS groups in terms of surgical margin status, re-excision requirement, and mastectomy rates. During an average follow-up period of 43 months, 5.3% and 4% of the patients in the planned OPS group developed IBTR and axillary recurrence, respectively, whereas these rates were 6.6% and 5.3% in the unplanned OPS group. In the mastectomy group, the rates of IBTR and axillary recurrence were found to be 4.1% and 3.8%, respectively. There was no significant difference between the three groups in terms of IBTR (p: 0.06) and axillary recurrence (p: 0.08) rates. CONCLUSION: Breast conserving surgery can be applied using level II OPS techniques with the post-NAC radiological examination and marking even if primary tumor marking is not done in the pre-NAC period.

Abstract Background: The effects of minimally invasive surfactant administration (MISA) in preterm infants with neonatal respiratory distress syndrome (NRDS) are unclear. Methods: We searched randomized controlled trials (RCTs) and compared MISA techniques with intubation for surfactant delivery in preterm infants with NRDS in PubMed, Embase, Cochrane Library, and Web of Science. Results: Thirteen RCTs (1931 infants) were included in the meta-analysis. The use of MISA techniques decrease the incidence of bronchopulmonary dysplasia (BPD) at 36 weeks, pneumothorax, and hemodynamically significant patent ductus arteriosus (hsPDA) (Risk Ratio(RR) : 0.59, 95% confidence interval (CI) : 0.46 to 0.75, p < .0001; RR : 0.60, 95% CI : 0.39 to 0.93, p= .02 and RR : 0.88, 95% CI : 0.78 to 1.00, p= .04, respectively). In addition, infants in the MISA group required less mechanical ventilation within 72 h of life or during hospitalization (RR : 0.60, 95% CI : 0.48 to 0.75, p< .00001 and RR : 0.64, 95% CI : 0.49 to 0.82, p = .0005, respectively) compared with infants in the control group. However, the rate of surfactant reflux was higher in the MISA group than that in the control group (RR : 2.12, 95% CI : 1.37 to 3.29, p = .0008). There were no significant differences in mortality and other outcomes beteween the MISA group and the control group. Conclusions: The administration of surfactant with MISA techniques could lower the requirement for mechanical ventilation, and decrease the incidence of BPD at 36 weeks, pneumothorax, and hsPDA.

Ecological processes often exhibit time lags. For plant invasions, lags of decades to centuries between species’ introduction and establishment in the wild (naturalisation) are common, leading to the idea of an invasion debt: accelerating rates of introduction result in an expanding pool of introduced species that will naturalise in the future. Here, I show how a concept from survival analysis, the hazard function, provides an intuitive way to understand and forecast time lags. For plant naturalisation, theoretical arguments predict that lags between introduction and naturalisation will have a unimodal distribution, and that increasing horticultural activity will cause the mean and variance of lag times to decline over time. These predictions were supported by data on introduction and naturalisation dates for plant species introduced to Britain. While increasing trade and horticultural activity can generate an invasion debt by accelerating introductions, the same processes could lower that debt by reducing lag times.

1. Accurate biodiversity and population monitoring is a requirement for effective conservation decision-making. Survey method bias is therefore a concern, particularly when research programs face logistical and cost limitations. 2. We employed point counts (PCs) and autonomous recording units (ARUs) to survey avian biodiversity across elevational gradients in comparable temperate mountain habitats at opposite ends of the Americas (9 mountains in British Columbia (BC), Canada and 10 in southern Chile). We compared detected species richness against multi-year species inventories and examined differences in detection probability by family. By incorporating time costs, we assessed the performance and efficiency of single vs. combined methods. 3. ARUs were predicted to capture ~92% of species present in BC but only ~58% in Chile, despite Chilean mountain communities being less diverse. Community, rather than landscape composition, appears to be the driver of this dramatic difference. Chilean communities contain less-vocal species, which ARUs missed. Further, 6/14 families in BC were better detected by ARUs while 11/11 families in Chile were better detected by PCs. Where survey conditions differentially impacted methods, PC detection varied over the morning and with canopy cover in BC and ARU detection probability mostly varied seasonally in Chile. Within a single year of monitoring, neither method alone was predicted to capture the full avian community, with the exception of ARUs in the alpine and subalpine of BC. PCs contributed little to detected diversity in BC, but including this method resulted in negligible increases in total time costs. Combining PCs with ARUs in Chile significantly increased species detections, again, for little cost. 4. Combined methods were among the most efficient and accurate approaches to capturing diversity. We recommend conducting observer point counts, where possible, when ARUs are deployed and retrieved, in order to capture additional diversity and flag methodology biases with minimal additional effort.

Increasing demands for protein-based therapeutics such as monoclonal antibodies, fusion proteins, bispecific molecules and antibody fragments require researchers to constantly find innovative solutions. To increase yields and decrease costs of next generation bioprocesses, highly concentrated cell culture media formulations are developed but often limited by the low solubility of amino acids such as tyrosine, cystine, leucine and isoleucine, in particular at physiological pH. This work sought to investigate highly soluble and bioavailable derivatives of leucine and isoleucine that are applicable for fed-batch processes. N-lactoyl-leucine and N-lactoyl-isoleucine sodium salts were tested in cell culture media and proved to be beneficial to increase the overall solubility of cell culture media formulations. These modified amino acids proved to be bioavailable for various Chinese hamster ovary (CHO) cells and were suitable for replacement of canonical amino acids in cell culture feeds. The quality of the final recombinant protein was studied in bioprocesses using the derivatives, and the mechanism of cleavage was investigated in CHO cells. Altogether, both N-lactoyl amino acids represent an advantageous alternative to canonical amino acids to develop highly concentrated cell culture media formulations to support next generation bioprocesses.

Chinese hamster ovary (CHO) cells in fed-batch cultures produce several metabolic byproducts derived from amino acid catabolism, some of which accumulate to growth inhibitory levels. Controlling the accumulation of these byproducts has been shown to significantly enhance cell proliferation. Interestingly, some of these byproducts have physiological roles that go beyond inhibition of cell proliferation. In this study, we show that, in CHO cell fed-batch cultures, branched chain amino acid (BCAA) catabolism contributes to the formation of butyrate, a novel byproduct that is also a well-established specific productivity enhancer. Further, the other byproducts of BCAA catabolism, isovalerate and isobutyrate, which accumulate in CHO cell fed-batch cultures also enhance specific productivity. Additionally, the rate of production of these BCAA catabolic byproducts was negatively correlated with glucose uptake and lactate production rates. Limiting glucose supply to suppress glucose uptake and lactate production, like in case of fed-batch cultures employing HiPDOG technology, significantly enhances BCAA catabolic byproduct accumulation resulting in higher specific productivities.

Crystal Storing Histiocytosis and Bing Neel Syndrome are two diseases induced by paraprotein. Herein, we report a rare case of Crystal Storing Histiocytosis associated with Bing-Neel-like neurological manifestations in the context of marginal zone lymphoma with plasmacytic differentiation.

Generations of cryoballoon transformed the atrial fibrillation ablation landscape. New advancements continue to make cryoballoon more successful and safer treatment. A new cryoballoon PolaRx from Boston Scientific has unique features compared to that of the Medtronic Arctic Front Advance system. Comparison of the two available cryoballoons will require ongoing larger trial and clinical experience.

Very late recurrences after ablation of AVNRT have been reported. Age related alterations of nodal tissues caused by fibrous and fatty tissue infiltration and changes of the sympathovagal influence on the AV node, in turn altering AV nodal conduction and refractoriness, could set the stage for a previously not present substrate for AVNRT. Consequently, the occurrence of AVNRT many years after an ablation procedure may perhaps not always implicate a recurrence but instead an arrhythmia caused by a new substrate.

Energetic compounds containing long nitrogen chain, have been a research hotspot. Fused heterocycles are stable due to their aromatic systems. The compound obtained by combining long nitrogen chain and fused ring can not only retain good energetic property, but also ensure better stability. This work designed eight fused heterocycle-based energetic compounds, 3H-tetrazolo[1,5-d]tetrazole (1) and its derivatives (2-8), containing a nitrogen chain with seven nitrogen atoms. The HOF, thermal stability, and energetic properties of these compounds were studied by using the DFT method. The results show that the introduction of -NO2, -N3, -NF2, -ONO2, -NHNO2 groups increased the density, HOF, detonation velocity, and detonation pressure greatly. The densities of 3, 5, 7, and 8 fall within the range designated for high-energy-density materials. The calculated detonation velocity of the compounds 3 and 8 are up to 9.86 km s-1 and 9.78 km s-1, which are superior to that of CL-20. The kinetic study of the thermal decomposition mechanism indicates that the N-R bonds maybe not the weakest bonds of these compounds. The tetrazole ring opening of the heterocycle-based energetic compounds, followed by N2 elimination is predicted to be the primary decomposition channel, whether or not they have substituent groups.

The use of zolpidem has been driven by the still-widespread false belief among doctors that, since zolpidem is chemically not a benzodiazepine, it cannot lead to addiction and tolerance. We would like to contribute to better highlight certain characteristics of zolpidem and its potential as a substance of abuse due to the fact that our operating unit, which is entirely dedicated to medication abuse, has described among the most numerous cases of addiction to high doses of benzodiazepines and related hypnotics. - Zolpidem was in fourth place among the 29 molecules present on the Italian market; - We believe it’s now time to drop the term “Z-drugs”: zolpidem, zopiclone e zaneplon all have different chemical structures, they bind to different receptors and have completely different abuse potentials3. In our case history, both zopiclon and zaneplon were virtually absent, albeit being commonly used in Italy; - Istvan & colleagues highlight the fact that addiciton and abuse are prevalent in samples suffering from mental illness. In our case history this hasn’t been confirmed: about half of our patients had no history of psychiatric illnesses, nor a history of addiction to illicit substances or alcohol; - Lastly, regarding zolpidem’s hazardousness, we would like to report the fact that the drug was significantly preferred by addicts with a positive ADHD test result. In conclusion, the 2000s saw solid confirmation of the effectiveness of partial agonists in the treatment of some common addictions, such as buprenorphine, varenicline, cytisine. This didn’t happen for BZs

The study is aimed to investigate the nature and extent, and assess perception of local community towards wildlife. A total of 140 household heads were selected randomly from nine survey villages using structured and semi-structured questionnaire for interviews. Focus group discussion, key informant interview and personal observation were held used to achieve the study objectives. Data were analyzed using descriptive statistics and responses compared using Chi-square test (2 tailed), one-way ANOVA and Pearson correlation coefficient. Besides, Likert scale statements were used to assess the attitudes of local people towards wildlife conservation. About 47.1% of sampled respondents thought that they experienced livestock predation whereas 57(40.7%) of the respondents faced both crop damage and livestock predation problems. A total of 932.43TLU livestock and 218 Dogs losses reported by households due to predators over the last five years. Thus, large numbers (848.6TLU livestock and 218 Dogs) of attack was happened due to Spotted Hyena (Crocuta crocuta). The frequency of livestock predation (F = 8.157, df = 8, P < 0.05) and type of predators involved (χ2=79.719, df = 8, p <0.05) were significantly differ across study villages. Nearly half, 69(49.3%) of respondents ranked Warthog (Phacochoerus africanus) as primary crop raider. Whilst majority of the respondents 115(82.1%) perceived Maize was frequently and severely damaged cereal crop. Most 80 (57.1%) respondents used different methods simultaneously to minimize damage caused by wild animals. Nearly half, (48.6%) of respondents had negative and strong negative attitude towards wildlife conservation. Level of education and amount of money imposed as penalty for illegal grazing were the most important factors affecting the local community attitudes towards wildlife conservation. Improve livestock husbandry, use appropriate guarding methods, education and make the community the actor of conservation would be vital to enhance the peaceful co-existence between human and wildlife in the study area.

This is the first case report of 2 depressed Malay females prescribed quetiapine, the first developed sleep related eating disorder (SRED) on 200 mg per day and the second at 50 mg per day. Both resolved with discontinuation.Assessment for SRED should be done at every follow up.

Higher risk of allergies at 4-6 years of age after systemic antibiotics in the first week of life To the editor,In humans, the first 100 days appear to be a ”critical window” of colonization during which microbial communities shape immune maturation.1,2. The use of antibiotics early in life may disrupt the normal maturation process leading to adverse health outcomes such as atopic disorders 1,3-5. The effects of antibiotic exposure immediately in the first week of life have rarely been investigated, nor the differences between treatment of 2-3 days and a prolonged treatment of 5-7 days. In the INCA study, a prospective birth cohort study of 151 infants receiving broad-spectrum antibiotics in their first week of life (AB+), and 285 healthy controls (AB-), we previously showed that antibiotic treatment in the first week of life was associated with an increased risk of wheezing, infantile colic and a trend towards more allergic sensitization in the first year of life6. The aim of this follow-up study in 418 eligible children was to determine if antibiotic treatment in the first week of life in term-born children was associated with an increase in atopic disorders at 4-6 years of age, using ISAAC questionnaires filled out by parents, ICPC codes derived from general physicians, and pharmaceutical records from local pharmacies. Detailed information regarding the subjects and methods is described in the online Appendix.In total, 341 of 418 (82%) questionnaires were filled out (114 AB+ and 227 AB-), Parental reported allergy was significantly higher in AB+ vs AB- children (23% vs 11% respectively, p=0.003) as was doctor-diagnosed allergy (12% vs 4% respectively, p=0.008). Confirmed food allergies were more common in AB+ children compared with AB- children (10 vs. 4% respectively, p=0.03). After correcting for sex, age, daycare attendance, family atopy, and parental level of education, parental-reported allergy was clearly associated with antibiotics use in the first week of life (aOR 2.40 [95%CI 1.22-4.72, p=0.01]). Additional adjustment for treatment duration showed that only 5-7 and not 2-3 days AB treatment was associated with a higher risk of parental reported allergy (aOR 2.85 [95%CI 1.37-5.91, p=0.005]). More importantly, this effect was independent of exposure to acid-suppressive drugs or additional antibiotics in the first two years of life (36% and 35% in AB- and AB+ group, respectively). The prevalence of eczema, wheezing/asthma, or allergic rhinitis was not different between AB+ and AB- children (Table 2).These results suggest that very early exposure to AB in the first week of life has a higher impact on microbiota and immune development than when administered later in childhood. It also emphasizes the need for judicious use of AB in neonates, especially prolonged treatment of 5-7 days. Moreover, our findings accentuate the need for finding strategies to modify microbiome development after AB exposure to minimize aberrant immune development.Strengths of this study are the prospective design, the high response rate (82%), and the combined information collected from doctors and pharmacists, contributing to the reliability of the reported results, which allowed us to distinguish between the effect of antibiotics within and after the first week of life. A limitation of the study is the 4-6-year follow-up, which may have been too short for diagnosing asthma and allergic rhinitis.In conclusion, the risk of having an allergy at 4-6 years of age increased nearly 3-fold in children after antibiotic treatment for 5-7 days in their first week of life, independent of later AB treatment. These long-term adverse health effects of neonatal antibiotic use emphasize the need to implement AB stewardship programs to avoid AB overuse and reduce the duration of AB treatment where possible in the first week of life.

A 60-year-old female was referred to our clinic for evaluation of her rapidly progressive dyspnea, she had no previuos history of heart disease. A murmur was noted on her examination and transthoracic echocardiography was so difficult to be performed due to poor acoustic windows so she was referred to do a transesophageal echocardiography that showed an ostium primum atrial septal defect (ASD) with left to right shunt and a quadrileaflet mitral valve with severe regurgitation. Later on, she underwent surgery with Ostium Primum ASD closure by a patch and double cleft repair by suture after right heart catheterization.

Background: Outcomes of catheter ablation (CA) among patients with non-paroxysmal atrial fibrillation (AF) are largely disappointing. Objective: We sought to evaluate the feasibility, effectiveness, and safety of a single-stage stepwise endo-/epicardial approach in patients with persistent/longstanding-persistent AF. Methods: We enrolled 25 consecutive patients with symptomatic persistent (n=4) or longstanding-persistent (n=21) AF and at least one prior endocardial procedure, who underwent CA using an endo-/epicardial approach. Our anatomical stepwise protocol included multiple endocardial as well as epicardial (Bachmann’s bundle [BB] and ligament of Marshall ablations) components, and entailed ablation of atrial tachycardias emerging during the procedure. The primary outcome was freedom from any AF/atrial tachycardia episode after a 3-month blanking period. The secondary outcome was patients’ symptom status during follow-up. Results: The stepwise endo-/epicardial approach allowed sinus rhythm restoration in 72% of patients, either directly (n=6, 24%) or after AF organization into atrial tachycardia (n=12, 48%). BB’s ablation was commonly implicated in arrhythmia termination. After a median follow-up of 266 days (interquartile range, 96 days), survival free from AF/atrial tachycardia was 88%. Antiarrhythmic drugs could be discontinued in 22 patients (88%). As compared to baseline, more patients were asymptomatic at 9-month follow-up (0% vs- 56%, p=0.02). Five patients (20%) developed mild medical complications, whereas one subject (4%) had severe kidney injury requiring dialysis. Conclusion: a single-stage endo-/epicardial CA resulted in favorable rhythm and symptom outcomes in a cohort of patients with symptomatic persistent/longstanding-persistent AF and one or more prior endocardial procedures. Epicardial ablation of BB was commonly implicated in procedural success.