Notes

Photothermal microfluidic-assisted self-cleaning impact for the remarkably recyclable SERS warning.
The prevalence and clinical significance of extrahepatic autoimmune diseases (EHAIDs) have not been evaluated in a large cohort of primary biliary cholangitis (PBC).

The medical records of 1554 patients with PBC from 20 international centers were retrospectively reviewed. Development of decompensated cirrhosis (ascites, variceal bleeding, and/or hepatic encephalopathy) and hepatocellular carcinoma were considered clinical endpoints.

A total of 35 different EHAIDs were diagnosed in 440 (28.3%) patients with PBC. Patients with EHAIDs were more often female (92.5% vs 86.1%, P<0.001) and seropositive for anti-mitochondrial antibodies (88% vs 84%, P=0.05) and antinuclear antibodies and/or smooth muscle antibodies (53.8% vs 43.6%, P=0.005). At presentation, patients with EHAIDs had significantly lower levels of alkaline phosphatase (1.76 vs 1.98×upper limit of normal [ULN], P=0.006), aspartate aminotransferase (1.29 vs 1.50×ULN, P<0.001), and total bilirubin (0.53 vs 0.58×ULN, P=0.002). Patients with EHAIDs and without EHAIDs had similar rates of GLOBE high-risk status (12.3% vs 16.1%, P=0.07) and Paris II response (71.4% vs 69.4%, P=0.59). Overall, event-free survival was not different in patients with and without EHAIDs (90.8% vs 90.7%, P=0.53, log rank). Coexistence of each autoimmune thyroid diseases (10.6%), Sjögren disease (8.3%), systemic sclerosis (2.9%), rheumatoid arthritis (2.7%), systemic lupus erythematosus (1.7%), celiac disease (1.7%), psoriasis (1.5%), and inflammatory bowel diseases (1.3%) did not influence the outcome.

Our study confirms that EHAIDs are frequently diagnosed in patients with PBC. The presence of EHAIDs may influence the clinical phenotype of PBC at presentation but has no impact on PBC outcome.
Our study confirms that EHAIDs are frequently diagnosed in patients with PBC. The presence of EHAIDs may influence the clinical phenotype of PBC at presentation but has no impact on PBC outcome.
Shame results from a negative global self-evaluation and can have devastating effects. Shame research has focused primarily on graduate medical education, yet medical students are also susceptible to its occurrence and negative effects. This study explores the development of shame in medical students by asking how does shame originate in medical students? and what events trigger and factors influence the development of shame in medical students?

The study was conducted using hermeneutic phenomenology, which seeks to describe a phenomenon, convey its meaning and examine the contextual factors that influence it. Data were collected via a written reflection, semi-structured interview and debriefing session. It was analysed in accordance with Ajjawi and Higgs' six steps of hermeneutic analysis immersion, understanding, abstraction, synthesis, illumination and integration.

Data analysis yielded structural elements of students' shame experiences that were conceptualised through the metaphor of fire. Shame trienvironments, (b) facilitating growth mindsets in medical trainees and (c) eliminating intentional shaming in medical education.
This qualitative examination of shame in medical students reveals complex, deep-seated aspects of medical students' emotional reactions as they navigate the learning environment. The authors posit that medical training environments may be combustible, or possessing inherent risk, for shame. Educators, leaders and institutions can mitigate this risk and contain damaging shame reactions by (a) instilling a true sense of belonging and inclusivity in medical learning environments, (b) facilitating growth mindsets in medical trainees and (c) eliminating intentional shaming in medical education.
Body image has been previously defined as the mental figure we have of the contours and shape of our body; and the feelings concerning these characteristics. A change in body perception can influence one's feelings of self-worth and compromise functional abilities. #link# Thus, the detection of distortions in body image could be important data for clinical evaluation of subjects with COPD.

To assess the body image perception of subjects with COPD. Also, to investigate the association between body image and levels of physical activity in these subjects.

109 subjects were recruited and divided into the COPD group and control subjects without any pulmonary conditions. For this cross-sectional study, we performed an initial evaluation and participants were evaluated regarding physical activity level, body image (silhouette scale) and determination of body mass index (BMI). Finally, we performed the evaluation of lung function (spirometry) and body composition analysis (bioelectrical impedance).

BothCOPD and control subjects presented alterations in body image. link2 Both groups desired significantly lower BMI and weight measures, according to the silhouette scale, demonstrating body dissatisfaction (P < .05). No differences in the level body dissatisfaction were found between Control and COPD groups (P > .05). No associations between physical activity levels and body image were observed (P > .05; r = -0.24 to 0.14).

In conclusion, patients with COPD present significant body dissatisfaction, similar to control individuals. Furthermore, body image perception in COPD is related to body composition measurements but not to physical activity levels.
In conclusion, patients with COPD present significant body dissatisfaction, similar to control individuals. Furthermore, body image perception in COPD is related to body composition measurements but not to physical activity levels.Recently, Akalin et al.1 reported a 28% mortality among kidney-transplant patients infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Two of the 10 patients who died had been transplanted within the previous 5 weeks. During the coronavirus disease (COVID)-19 outbreak, kidney transplant programs were suspended in several countries2 . Although the pandemic is still ongoing, the stop of lockdown has prompted several transplant centers to restart kidney transplantation programs. It is recommended to consider that donors and recipients are screened for SARS-CoV-2 before transplantation by means of nuclear acid tests with or without chest CT scans.The following is a review of published literature on textile wastewater in 2019. Presented are the sections described for the review concise introduction on the textiles wastewater, followed by a review of present textile treatment technologies organized by physicochemical, biological, and combined processes. Lastly, a discussion of the future topics is presented. PRACTITIONER POINTS The discharge of textile dye wastewater represents a serious environmental problem and public health concern. Effluents from textile manufacturing, dyeing, and finishing processes contain high-concentration recalcitrant chemicals that are resistant to biodegradation. The textile wastewater needs environmental-friendly and cost-effective combined treatment process.
The explicit, intentional and systematic application of continuous quality improvement (QI) in medical education practice and research can improve medical education and help it achieve its goals. Quality improvement and medical education share a foundation centred on learning-experiencing, reflecting, thinking and acting in continuous cycles that spiral to sustained advancement. This suggests that a QI mindset can be brought to bear on various aspects of medical education research and practice.

To explore this possibility, we turn to W. Edwards Deming's System of Profound Knowledge, widely regarded as one of the foundational frameworks in quality improvement, where he argues strongly that there are four highly interrelated elements that are required for improvement Appreciation of a System, Theory of Knowledge, Knowledge about Variation and Knowledge of Psychology. In this article, we define and explore each of the four domains and their application in medical education, highlighting both opportunities and challenges.

Medical educators who utilise QI in their educational practices can help create learning environments that imprint positively on learners and contribute to better outcomes in their clinical learning environments. We provide recommendations for how educators' informed use of QI can improve medical education and help it achieve its ultimate goal of improved health and health care.
Medical educators who utilise QI in their educational practices can help create learning environments that imprint positively on learners and contribute to better outcomes in their clinical learning environments. We provide recommendations for how educators' informed use of QI can improve medical education and help it achieve its ultimate goal of improved health and health care.Rad54 and Rdh54 are closely related ATP-dependent motor proteins that participate in homologous recombination (HR). During HR, these enzymes functionally interact with the Rad51 presynaptic complex (PSC). Despite their importance, we know little about how they are organized within the PSC, or how their organization affects PSC function. Here, we use single-molecule optical microscopy and genetic analysis of chimeric protein constructs to evaluate the binding distributions of Rad54 and Rdh54 within the PSC. link3 We find that Rad54 and Rdh54 have distinct binding sites within the PSC, which allow these proteins to act cooperatively as DNA sequences are aligned during homology search. Our data also reveal that Rad54 must bind to a specific location within the PSC, whereas Rdh54 retains its function in the repair of MMS-induced DNA damage even when recruited to the incorrect location. These findings support a model in which the relative binding sites of Rad54 and Rdh54 help to define their functions during mitotic HR.
The objective of this retrospective observational study was to determine the incidence of direct-acting oral anti-coagulant (DOA) use in patients receiving invasive dental procedures. The secondary objective was to investigate the precautionary measures implemented and the post/intraoperative complications associated with DOA use.

Selleck AP20187 , Axium, was retrospectively reviewed, and patients using NGOA and treated between 2010 and 2017 were identified. Charts of patients who underwent invasive dental procedures were further reviewed to investigate the preoperative/intraoperative precautionary measures taken and identify any intraoperative/postoperative complications.

A total of 130 patients were identified, with their annual number steadily rising from 12 in 2011 to 52 in 2016. Among those, 64 patients (49.23%) underwent invasive dental procedures. Pretreatment medical consults were obtained in all patients undergoing invasive procedures; however, only 7 (10.94%) were instructed to discontinue their DOA. Preoperative laboratory testing was obtained for two patients. Intraoperatively, 34 (53.13%) cases of excessive bleeding were reported, all were locally controlled with hemostatic agents. Only 4 instances of postoperative complications were documented.

Despite the rise in the use of DOA, there is no consistent pattern for preoperative laboratory testing and DOA discontinuations. Expert consensus may be of great importance to develop practice guidelines.
Despite the rise in the use of DOA, there is no consistent pattern for preoperative laboratory testing and DOA discontinuations. Expert consensus may be of great importance to develop practice guidelines.
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