Notes

ENT mucormycosis. Statement of four cases.
The complete mitochondrial DNA sequence of the scurrinid limpet Scurria scurra (Lesson 1830) is reported here. This mitogenome is 18,482 bp long and includes two rRNA genes, 13 protein-coding genes, and 24 tRNAs. The genus Scurria is a nascent model group for marine ecological studies. This mitogenome will help to gain a better understanding of the phylogenetic relationships within Patellogastropoda, the most primitive group of extant gastropods.In this study, we sequenced and analyzed the complete mitochondrial genome of Ambulyx tobii to compare mitochondrial genome structures and reconstruct phylogenetic relationships. The complete mitochondrial genome sequence of A. tobii is circular, 15,343 bp in size and encodes 13 protein-coding genes (PCGs), two ribosomal RNA genes (rRNAs), 22 transfer RNA genes (tRNAs), and a control region (CR). Nucleotide composition is highly biased toward A + T nucleotides (81.2%). Most PCGs initiate with the standard start codon of ATN and terminate with the typical stop codon TAA/TAG. Phylogenetic analyses were performed using both 13 PCGs and whole mitochondrial genomes showed that A. tobii is closely related to A. substrigilis.
The amount of stepping activity during rehabilitation post-stroke can predict walking outcomes, although the most accurate methods to evaluate stepping activity are uncertain with conflicting findings on available stepping monitors during walking assessments. Rehabilitation sessions also include non-stepping activities and the ability of activity monitors to differentiate these activities from stepping is unclear. The objective of this study was to examine the accuracy of different activity monitors worn by individuals post-stroke with variable walking speeds during clinical physical therapy (PT) and research interventions focused on walking.

In Part I, 28 participants post-stroke wore a StepWatch, ActiGraph with and without a Low Frequency Extension (LFE) filter, and Fitbit on paretic and non-paretic distal shanks at or above the ankle during clinical PT or research interventions with steps simultaneously hand counted. Mean absolute percent errors were compared between limbs and tasks performed. In Part of non-stepping activities affected step counts and should be considered when measuring stepping activity in individuals post-stroke to predict locomotor outcomes following rehabilitation.
The StepWatch and ActiGraph-LFE had smaller errors than the Fitbit or ActiGraph, with greater errors in those walking at slower speeds. Inclusion of non-stepping activities affected step counts and should be considered when measuring stepping activity in individuals post-stroke to predict locomotor outcomes following rehabilitation.
Mucolipidosis type IV (MLIV) is an ultra-rare lysosomal disorder initially described as a static neurodevelopmental condition. However, patient caregivers frequently report progressive muscular hypertonicity and functional decline. We evaluated a cohort of patients with MLIV to determine whether neurologic disability correlates with age.

We performed a cross-sectional, observational study of 26 patients with MLIV in the United States and Israel ranging in age from 2 to 40 years. Medical history was obtained from caregivers, and patients underwent a full neurologic examination. The Brief Assessment of Motor Function (BAMF), Gross Motor Function Classification System, and modified Ashworth scales were applied. Caregivers identified developmental skills on the Oregon Project for Visually Impaired and Blind Children checklist that their child had lost the ability to perform.

Three patients were clinically classified as mildly affected and the remaining 23 patients as typical, severely affected cases. Timingonal trials and optimizing patient care.Anemia in chronic kidney disease (CKD) is associated with reduced health-related quality of life and physical functioning. This study investigated knowledge and awareness of anemia in patients with CKD in the United States (US) through an online, quantitative survey administered to patients aged ≥18 years with self-reported CKD, with or without anemia. Of 446 patients included, 255 (57.2%) were diagnosed with anemia and 191 (42.8%) were in the non-anemia cohort. In patients with anemia, 71.0% were aware of the relationship between CKD and anemia versus 52.9% in the non-anemia cohort. In the anemia cohort, 46.3% of patients were aware of their hemoglobin level, versus 27.2% in the non-anemia cohort. Despite 67.4% of patients with anemia believing their condition was well/very well managed, only 50% reported being informed about different treatments without prompting healthcare providers. In the US, patients with anemia and CKD perceived that anemia had a negative impact on physical health and emotional wellbeing. Results emphasize a lack of disease awareness, suggesting patients would benefit from further education on anemia in CKD.Google searches for hospitals typically yield a Google star rating (GSR). These ratings are an important source of information for consumers. The degree to which GSRs are associated with traditional quality measures has not been evaluated recently. We sought to characterize the relationship between a hospital's GSR, its Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, and Centers for Medicare and Medicaid Services (CMS) quality measures. We found a moderate association between a hospital's GSR and its HCAHPS score. The relationship between a hospital's GSR and CMS quality measures was statistically significant, but the magnitude was quite low. Our findings suggest that consumers should not use GSRs as a hospital quality proxy.Physician's assistants (PA) are an integral part of hospital teams. To the best of our knowledge, this is the first study to examine the effects of a multidisciplinary hospital-wide communication skills training (CST) workshop on PAs. From November 2017 to November 2019, all participants in the CST workshop were sent a web-based retrospective pre-post survey to measure self-reported attitudes and behaviors related to communicating with patients, CST, and specific skills taught. PA responses were analyzed alone and were compared to non-PAs. Non-PAs were physicians and 1 nurse practitioner. In total, 258 PA and 333 non-PA participants were surveyed for an overall response rate of 25%. Among PAs, in 9 out of 10 domains measured, there was a significant change in self-reported attitudes and behaviors toward communicating with patients, CST, and skills taught (P  less then  .05). Similar to other providers, PAs experienced positive changes in these self-reported attitudes and behaviors after CST, however, there were some significant differences found when comparing PAs and non-PAs in the covariate analysis.Objectives. This study was carried out to delineate the patients' characteristics and the imaging findings and their relation to some biochemical markers of 31 critically ill patients with MIS-C. Design. A retrospective cross-sectional study including all critically ill MIS-C patients admitted to the PICU from June 23rd to July 22nd, 2020. Results. Eighteen males and 13 females, with a median age of 9 years (interquartile range 6-11) presented mainly with fever (100%) and hypotension (100%). Abnormalities in the chest computed tomography were detected in 22 cases (71%). Consolidation and architecture distortion were detected in 58.1% of patients; bilateral lesions and lower lobe infiltrates, each, was evident in 64.5% of patients, while the peripheral distribution of lesions was seen in 71% of the cases. Pleural thickening and effusion, each, was found in 51.6% of the patients. In this small case series, the presence of high ferritin was significantly associated with the bilaterality of the lesions. Elevated C-reactive protein was associated with the peripheral distribution of the lesions. Thrombocytopenia and hypoalbuminemia were significantly correlated with the CT disease stage and CT severity score respectively. Conclusions. Although a few children in this group of MIS-C patients presented with respiratory manifestations, yet, most of them demonstrated significant radiological lung involvement, which necessitates a longer-term follow-up.We present three cases of strong one-staged tendon reconstruction for musculotendinous junction avulsion tendon injuries, and called it a 'pull-in suture'. The clinical outcomes of this method are comparable to those of tendon transfer; it is an effective reconstruction method that should be considered as an initial treatment procedure.
Increased posterior tibial slope (PTS) is a risk factor for anterior cruciate ligament (ACL) rupture and failure of ACL reconstruction (ACLR) grafts.

The purpose was to conduct a systematic review of literature on PTS measurements and to conduct a meta-analysis of comparable PTS measurements based on a patient's ACL status. It was hypothesized that patients with torn ACLR grafts would have significantly larger medial and lateral PTS compared with patients with native ACLs or those who underwent primary ACLR.

Systematic review; Level of evidence, 4.

A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included were studies that reported medial and/or lateral PTS measurements, those that reported PTS measurements based on ACL status (ie, intact ACL, primary ACL tear, failed ipsilateral ACLR, or revision ACLR), and those that reported their specific PTS measurement technique. Average PTS measurements, measurement location (medial ct ACL (6.28°; 95% CI, 5.21°-7.35°) groups (
< .001 for both).

Both lateral and medial PTS measurements were greater in patients who had failed previous ACLR than those with a primary ACL tear or an intact native ACL. The lateral PTS of patients with primary ACL tears was greater than those with an intact native ACL.
Both lateral and medial PTS measurements were greater in patients who had failed previous ACLR than those with a primary ACL tear or an intact native ACL. The lateral PTS of patients with primary ACL tears was greater than those with an intact native ACL.
Previous studies have suggested that suture tape-reinforced anterior cruciate ligament (ACL) grafts may have higher ultimate failure loads without stress-shielding. In patients at high risk for graft failure, such as adolescents, the addition of suture tape could have beneficial outcomes.

Suture tape reinforcement (STR) of ACL grafts in adolescent patients would lead to fewer graft ruptures during early recovery, without hindering subjective outcomes.

Cohort study; Level of evidence, 3.

A retrospective review was performed on adolescent patients with a minimum 2-year follow-up after hamstring tendon autograft ACL reconstruction; enrolled were patients from both before (n = 40) and after (n = 40) a shift in surgical technique that added STR. Both the no-STR and the STR cohorts were contacted yearly to obtain patient-reported outcome data for visual analog scale (VAS; range, 0-10) for pain score, Single Assessment Numeric Evaluation, Lysholm score, Tegner activity score, patient satisfaction score (rangifference in outcome measures, with 1 graft failure in each cohort.

Study outcomes indicated that patients treated with ACL reconstruction and STR experienced a significant improvement in Tegner scores while at the same time maintaining the other subjective outcomes.
Study outcomes indicated that patients treated with ACL reconstruction and STR experienced a significant improvement in Tegner scores while at the same time maintaining the other subjective outcomes.
Chronic Achilles and patellar tendinopathy are a significant burden in physically active populations. High-volume image-guided injection (HVIGI) proposes to strip away associated neovascularity, disrupt painful nerve ingrowth, and facilitate rehabilitation.

To investigate the efficacy of HVIGI with and without steroid relative to placebo.

Randomized controlled trial; Level of evidence, 1.

A total of 62 participants were recruited between May 25, 2016, and March 5, 2020. Participants were men aged 18 to 55 years with Achilles or patellar tendinopathy of at least 6-month chronicity that had not improved with nonoperative management (including physical therapy and shockwave therapy), with ultrasound evidence of neovascularization, tendon thickening, and echogenic changes. They were assigned to the following groups control (3 mL of subcutaneous 0.5% bupivacaine), HVIGI (10 mL of 0.5% bupivacaine and 30 mL of normal saline, ultrasound-guided between tendon and underlying fat pad), or HVIGI with steroid (HV), with no group × time interaction (
= .71). One participant was lost to follow-up from each group, multiple imputation was used for missing data points. No adverse events occurred.

Study findings did not demonstrate superiority of HVIGI over control injection.

EU Clinical Trials Register (EudraCT 2015-003587-36).
EU Clinical Trials Register (EudraCT 2015-003587-36).
The effectiveness of platelet-rich plasma (PRP) injection in the treatment of lateral epicondylitis remains debatable.

To evaluate the effectiveness of PRP in lateral epicondylitis treatment using minimal clinically important difference (MCID) values as a reference and to investigate if leukocyte content can influence the effectiveness of the therapy.

Systematic review; Level of evidence, 4.

Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the authors searched the Medline and Scopus databases for studies on lateral epicondylitis and PRP therapy that used the following patient-reported outcome measures (PROMs) visual analog scale (VAS) for pain; Disabilities of the Arm, Shoulder and Hand (DASH); Patient-Rated Tennis Elbow Evaluation (PRTEE); and Mayo Clinic Performance Index (MAYO). The weighted arithmetic means for the PROMs were calculated at baseline (week 0) and follow-up weeks 4, 8, 12, 24, 52, and 104. The mean differences in outcomes (ΔVAS, ΔD PRP systems were effective in the context of meeting the MCID.
Based on comparisons with the MCID values of commonly used outcome scores, PRP seems to be an effective form of treatment for lateral epicondylitis. Both the LR- PRP and the LP- PRP systems were effective in the context of meeting the MCID.
This study was aimed at investigating the potential mechanism of Grubthobrildkr (GTB) on systemic hypoxia-induced gastric ulcers in rats and at detecting the chemical profile of GTB.

Male Sprague-Dawley rats were separated into control, hypoxia, hypoxia+omeprazole, and hypoxia+GTBs (0.25, 0.5, and 1.0 g·kg
·d
) groups. Systemic hypoxia was created in a hypobaric chamber to simulate 5000 m high altitude by adjusting the inner pressure and oxygen content for 6 days. After that, the ulcer index, pH, and volume of gastric juice were assessed. The levels of endothelin-1 (ET-1), gastrin (GAS), motilin (MTL), phospholipase A
(PLA
), and prostaglandin E
(PGE
) were detected by ELISA. The expression level of hydrogen potassium ATPase (H
-K
-ATPase), cyclooxygenase-1 (COX-1), and cyclooxygenase-2 (COX-2) was tested by western blotting. Chemical profile of GTB was revealed by UHPLC-Q-exactive hybrid quadrupole-orbitrap mass (UHPLC-Q-Orbitrap MS).

GTB decreased the ulcer index in rats under hypoxia for si gastrointestinal hormones, including MTL and ET-1. Mechanically, gastrointestinal protection of GTB was based on inhibition of the protons pumping H+-K+-ATPase and regulation of prostaglandin family in rats.
A total of 184 nursing students were recruited by simple random sampling. Data collection tools included a demographic information form, the Internet Abusive Use Questionnaire and Maslach Burnout Inventory-Student Survey. Data were analyzed by the SPSS-18 software using descriptive and inferential statistics.

The abusive use of the Internet in nursing students was lower than the average level. There was a positive correlation between Internet abusive use and academic burnout (
= 0.305,
< 0.001), but there was a negative correlation between Internet abusive use and academic performance (
= -0.478,
< 0.001). The results of multiple regression analysis showed that Internet abusive use could predict the variance of academic burnout and academic performance.

Internet abusive use was correlated with increased academic burnout and decreased academic performance in nursing students. Educational interventions are required to increase students' awareness of the consequences of Internet abusive use.
Internet abusive use was correlated with increased academic burnout and decreased academic performance in nursing students. Educational interventions are required to increase students' awareness of the consequences of Internet abusive use.
Recurrent myocardial infarction is associated with increased mortality. Risk and predictive factors of recurrent myocardial infarction in elderly patients after coronary stenting are not well known. This research sought to investigate the effects of proinflammatory cytokines and toll-like receptor on recurrent myocardial infarction after coronary stenting in elderly patients.

We measured the levels of toll-like receptor 2 (TLR2), toll-like receptor 3 (TLR3), toll-like receptor 4 (TLR4), tumor necrosis factor-
(TNF-
), soluble tumor necrosis factor-
receptor-1 (sTNFR-1), soluble tumor necrosis factor-
receptor-2 (sTNFR-2), endothelial progenitor cells (EPCs), and vascular endothelial growth factor (VEGF) in elderly patients with recurrent myocardial infarction and assessed the changes of proinflammatory cytokines and toll-like receptors in elderly patients with recurrent myocardial infarction after coronary stenting.

Levels of TLR2, TLR3, TLR4, TNF-
, sTNFR-1, and sTNFR-2 were remarkably increaseter coronary stenting. Increased expressions of proinflammatory cytokines and toll-like receptors may be clinically useful biomarkers for predicting recurrent myocardial infarction in the elderly patients after coronary stent implantation.
Most breast cancer diagnoses in Tanzania are in advanced stages. The Ocean Road Cancer Institute (ORCI) established a new breast cancer screening program in 2014 to reduce advanced-stage diagnoses. This study is aimed at describing the screening program's referral process and at identifying patient and health system factors that contribute to patients completing diagnostic testing referrals.

Six-hundred and forty patients were included in the study. Testing types, outcomes, and date of diagnostic results were abstracted from records at ORCI and Muhimbili National Hospital (MNH) to determine the proportion of testing completed and the duration between initial referrals and diagnostic tests. Prediction of completion of diagnostic testing was investigated in logistic regression.

Of the patients who received referrals for further testing, fifty-two percent completed the recommended ultrasound (USS), mammography (MMG), and fine-needle aspiration cytology (FNAC). Only 33.0% of patients completed the recommendtion was a significant predictor of MMG. The odds of receiving MMG was 4.29 (95% CI, 1.05-21.00) for patients with tertiary education or higher compared to primary education or lower. Possession of health insurance for treatment and living in Dar es Salaam were not significant predictors. Discussion. Future research should focus on patients' understanding of recommended referrals and factors that influence decision-making. Investigating the cost effectiveness of scaling up screening programs and setting up a patient navigation program that follow patients as they complete the recommended treatment plan will be crucial for Tanzania and other developing countries as they seek to launch and strengthen screening programs.
Preventive effect of hippocampal sparing on cognitive dysfunction of patients undergoing whole-brain radiotherapy and imaging assessment of hippocampal volume changes.

Forty patients with brain metastases who attended Liaoning Cancer Hospital from January 2018 to December 2019 were identified as research subjects and were randomly divided into a control group and an experimental group, with 20 cases in each group. The control group was treated with whole-brain radiotherapy (WBRT), and the experimental group was treated with hippocampal sparing-WBRT (HS-WBRT). The Montreal Cognitive Assessment (MoCA) score, Eastern Cooperative Oncology Group (ECOG) score, cancer quality-of-life questionnaire (QLQ-C3O) score, hippocampal volume changes, and prognosis of the two groups were compared.

The MoCA scores decreased in both groups at 3, 6, and 12 months after radiotherapy, with significantly higher scores in the experimental group than in the control group (
< 0.05). After radiotherapy, both groups had lower ECOG scores, with those in the experimental group being significantly lower than those in the control group (
< 0.05). After radiotherapy, the QLQ-C30 score was elevated in both groups, and that of the experimental group was significantly higher than that of the control group (
< 0.05). The experimental group outperformed the control group in terms of the prognosis (
< 0.05). The hippocampal volume of the control group was significantly smaller than that of the experimental group (
< 0.05).

The application of hippocampal sparing in patients receiving whole-brain radiotherapy is effective in preventing cognitive dysfunction, improving the quality of life and prognosis of patients, and avoiding shrinkage of hippocampal volume.
The application of hippocampal sparing in patients receiving whole-brain radiotherapy is effective in preventing cognitive dysfunction, improving the quality of life and prognosis of patients, and avoiding shrinkage of hippocampal volume.
When tested on the baseline of isolated tissues, Tfg.Cr was devoid of any activity (stimulant or relaxant) till 10 mg/ml. This is an interesting finding, keeping in mind that the fenugreek seeds are used to alleviate constipation and diarrhoea. When Tfg.Cr was tried for any potential AChE inhibitory activity, it did show an inhibitory effect in increasing concentrations (47-380 
g/ml). This inhibitory effect was comparable to the effect produced by a standard AChE inhibitor physostigmine. One of the known fenugreek constituents, diosgenin, was also tested, and it also showed an AChE inhibitory effect in a concentration-dependent manner (11-190 
g/ml). Interaction between diosgenin and AChE was further investigated by molecular docking and molecular dynamics simulations for 100 ns, which showed that diosgenin interacted with the active-site gorge of AChE through hydrophobic, pi-pi stacking, and hydrogen bonds with various amino acids of the AChE enzyme.

The results show that the fenugreek extract does not possess any GI stimulant or relaxant activity even though it is used traditionally in GI motility disorders. The extract and diosgenin could inhibit the AChE enzyme pointing towards their benefit to enhance the memory.
The results show that the fenugreek extract does not possess any GI stimulant or relaxant activity even though it is used traditionally in GI motility disorders. The extract and diosgenin could inhibit the AChE enzyme pointing towards their benefit to enhance the memory.African swine fever (ASF) is a contagious and lethal hemorrhagic disease with a case fatality rate approaching 100% in domestic pigs. The main objectives of this study were to describe the spatiotemporal analysis as well as to assess the potential risk factors along the pig value chain in Lao Cai province, Vietnam. A total of 925 outbreaks were reported from 2019 to 2020. The three clusters (primary, secondary and 5th) were observed near the Chinese border. The most temporal clusters were detected between May and August during the study period. In addition, we evaluated the association between ASF outbreak locations to the nearest main roads and elevation. For ASF outbreak locations to the nearest main roads, compared with the reference (1,500 m), the farm locations with less then 500 m (55.31 times) showed a significantly increased risk of ASF outbreaks. Farmers perceived that the highest risk of ASF transmission may come from collectors and slaughterers, intermediaries inside and outside the commune, feed agents and maize agents in the commune, and pig retailers. Both commercial and household pig producers considered minimizing the number of people going in and out of pig stables and improving healthcare and husbandry procedures to be both very important and feasible. There is a need for compliance by all pig producers and other actors in the pig value chain to adopt biosecurity practices. Therefore, awareness, knowledge and understanding of infection and risks of ASF need to be improved. Veterinary officials at the provincial and district levels need to improve capacity and resources to perform laboratory analysis for ASF and need to coordinate with local actors on the control and prevention of ASF in the community.The immune system is most likely developed to reduce the harmful impact of infections on the host homeostasis. This defense approach is based on the coordinated activity of innate and adaptive immune system components, which detect and target infections for containment, killing, or expulsion by the body's defense mechanisms. These immunological processes are responsible for decreasing the pathogen burden of an infected host to maintain homeostasis that is considered to be infection resistance. Immune-driven resistance to infection is connected with a second, and probably more important, defensive mechanism it helps to minimize the amount of dysfunction imposed on host parenchymal tissues during infection without having a direct adverse effect on pathogens. Disease tolerance is a defensive approach that relies on tissue damage control systems to prevent infections from causing harm to the host. It also uncouples immune-driven resistance mechanisms from immunopathology and disease, allowing the body to fight infection more effectively. This review discussed the cellular and molecular processes that build disease tolerance to infection and the implications of innate immunity on those systems. In addition, we discuss how symbiotic relationships with microbes and their control by particular components of innate and adaptive immunity alter disease tolerance to infection.Hypocalcemia is a metabolic disorder that occurs when calcium leaves the blood to support milk production or for the growth of the fetus faster than calcium can be put back into the blood. Subclinical hypocalcemia (SCH) refers to clinically normal cows but with concentrations of calcium lower than measured in normal cows. A study was conducted to estimate economic losses and to identify risk factors associated with SCH in Holstein Friesian × Zebu crossbreed Cows in North-West Ethiopia. A total of 221 lactating dairy cows obtained from 81 dairy farms were selected and serum samples were collected and analyzed to estimate the level of calcium in the serum using an automated electrolyte analyzer (Roch, UVL Japan, 2014). Forty-seven cows obtained from 12 farms were grouped into two cows with SCH and cows without SCH and milk yield was measured for eight consecutive days to estimate milk production loss associated with SCH. Prevalence was estimated and univariable and multivariable logistic regression analyses were used to identify determinants of SCH. The prevalence of SCH was 20.3% (51/221, 90% CI = 18.6%-28.1%). Grazing on pasture, membership to dairy cooperative, feeding above the cows' requirement (based on farmers' opinion), and previous experience of metritis reduced the odds of SCH (P less then 0.05). The average economic losses associated with reduced milk production due to SCH were 11.25 Ethiopian Birr (ETB) (1 ETB = 0.023 US Dollar) and 3,026.25 ETB (69.6 US Dollar) per cow per lactation, respectively. The main findings of the study have shown that SCH was a problem in crossbreed dairy cows in Northwestern Ethiopia and identified few risk factors that could be targeted to mitigate the problem. Actually, in this study, the economic cost of SCH was significant and needs attention in the dairy extension and dairy health training programs.Staphylococcus aureus is a common pathogen that can cause pneumonia and a variety of skin diseases. Skin injuries have a high risk of colonization by S. aureus, which increases morbidity and mortality. Due to the emergence of multidrug-resistant strains, antimicrobial peptides are considered to be among the best alternatives to antibiotics due to their unique mechanism of action and other characteristics. MPX is an antibacterial peptide extracted from wasp venom that has antibacterial activity against a variety of bacteria. This study revealed that MPX has good bactericidal activity against S. aureus and that its minimum inhibitory concentration (MIC) is 0.08 μM. MPX (4×MIC) can kill 99.9% of bacteria within 1 h, and MPX has good stability. The research on the bactericidal mechanism found that MPX could destroy the membrane integrity, increase the membrane permeability, change the membrane electromotive force, and cause cellular content leakage, resulting in bactericidal activity. Results from a mouse scratch model experiment results show that MPX can inhibit colonization by S. aureus, which reduces the wound size, decreases inflammation, and promotes wound healing. This study reports the activity of MPX against S. aureus and its mechanism and reveals the ability of MPX to treat S. aureus infection in mice, laying the foundation for the development of new drugs for bacterial infections.In recent years, antimicrobial (AM) use in poultry farming has been attracting attention worldwide mainly due to AM resistance spreading. The role of AM prophylaxis in the modulation of gut microbiota, as well as of gut health, is still not clearly understood. Therefore, this study aimed to investigate the role of different prophylaxis protocols in the modulation of the gut barrier in broilers by applying a histopathological approach. Intestinal tissue samples were collected from a total of 240 male broilers (Ross 306), reared and treated with different AM protocols. Haematoxylin and Eosin (HE) staining and a multiple scoring system were used to evaluate the presence of lesions in ileum, cecum and colon of treated broilers. Moreover, immunohistochemistry (IHC) was performed to assess the expression of claudin-3 and ZO-1 proteins in intestinal tissues. The application of a semi-quantitative scoring system was used in IHC stained samples. HE results revealed that intestinal tissues were mainly characterized by epithelial detachment and fusion of the intestinal villi, but also by the presence of lymphocytic infiltrate in the mucosa and submucosa of AM-treated broilers. However, the IHC approach for the evaluation of claudin-3 and ZO-1 proteins showed that their expression was not affected by the different AM treatments. Nevertheless, the presence of intestinal lesions highlighted by histopathology suggests that AM treatments could harm the gut health of broilers, inducing an inflammatory response and consequent epithelial lesions. In order to clarify the role of AM treatments in the modulation of gut barrier in broilers, further studies are needed.The current study investigated the impact of different concentrations of purified egg yolk immunoglobulin Y (IgY) supplemental food on the growth performance, behaviors, cecal contents of Escherichia coli, and the meat quality of broiler chicks. Four dietary groups were given to 180 female Ross broiler chicks at random (n = 45 for each). The control group was fed a standard diet only, whereas the other three experimental groups were fed the same basic diet supplemented with 1,500, 3,000, and 4,000 μg/ml IgY for a duration of 42 days. Significant greater behavioral activities, including, feeding, drinking, and dust bathing (p less then 0.05), in the birds fed 4,000 μg/ml of IgY compared to the control group were observed. Greater weight gains of the crop, proventriculus, gizzard, and intestine (p less then 0.05) were observed for broiler chicks fed 4,000 μg/ml of IgY when compared to the control group. After 3 weeks of feeding, the groups fed 3,000 and 4,000 μg/ml IgY had significant lower E. coli counts improved the growth rates, behavioral activities, intestinal health indices, and meat quality of broiler chicks.This study was conducted to evaluate the impact of feeding postbiotics and paraprobiotics produced from Lactiplantibacillus plantarum on colon mucosa microbiota in broiler chickens. In this study, 336 one-day-old COBB 500 chicks were randomly allotted to eight treatment groups and replicated six times with seven birds per replicate. The treatment included T1 (Negative control) = Basal diet, T2 (Positive control) = Basal diet + 0.01% oxytetracycline, T3 = Basal diet + 0.2% postbiotic TL1, T4 = Basal diet + 0.2% postbiotic RS5, T5 = Basal diet + 0.2% paraprobiotic RG11, T6 = Basal diet + 0.2% postbiotic RI11, T7 = Basal diet + 0.2% paraprobiotic RG14, and T8 = Basal diet + 0.2% paraprobiotic RI11. There were reported changes in the bacterial community using 16S rRNA sequencing of the colon mucosa. The results of the sequencing of 16S rRNA genes in the colon mucosa samples indicated that compared to birds fed the negative control diet, birds fed paraprobiotic RI11 diets were recorded to have a lower relative abundance of Proteobacteria, while those fed the positive control were recorded to have a higher proportion of Firmicutes. Also, lower Enterococcus was reported in paraprobiotic RI11, while the most abundant genus was Bacteroides in postbiotic TL1. This study revealed that supplementation of postbiotics and paraprobiotics in the diets of broilers demonstrated positive effects on the microbiota by supporting the increase of beneficial microbes like the Firmicutes while decreasing harmful microbes like the Proteobacteria. Therefore, this study has provided knowledge on the modification of chicken mucosa microbiota through the feeding of postbiotics and paraprobiotics.Non-typhoidal salmonella (TS) remains a significant health burden worldwide. In Vietnam, pork accounts for 70% of the total meat consumed, and contamination with Salmonella is high. High levels of antimicrobial resistance (AMR) have emerged among porcine NTS and of particular concern is the emergence of colistin resistance, a "last defense" antibioic against multi-drug resistant (MDR) Gram-negative pathogens. This study aimed to investigate the antibiotic susceptibility of 69 NTS isolates collected from the pork retail outlets and slaughterhouses in Vietnam during 2014 a nd 2018/19. Phenotypic testing and whole genome sequencing was used to assess the serotype and AMR gene profiles of the 69 NTS isolates. Seventeen different serotypes were identified, of which S. enterica subsp enterica serotype Typhimurium was the most common followed by S. ser. Rissen, S. ser. London, S. ser. Anatum, and S. ser. Derby. Phenotype AMR was common with 41 (59.4%) isolates deemed MDR. MDR strains were most common in slaughterhouses (83%) and supermarkets (75%) and lowest in traditional markets (38%) and convenience stores (40%). Colistin resistance was identified in 18 strains (15 resistant, three intermediate) with mcr-1 identified in seven isolates (S. ser. Meleagridis, S. Rissen, S. Derby) and mcr-3 in two isolates (S. Typhimurium). This includes the first mcr positive S. Meleagridis to our knowledge. Surprisingly, boutique stores had high levels (60%) of MDR isolates including 5/20 isolates with mcr-1. This study demonstrates that pork from modern retail stores classed as supermarkets or boutique (with pork claiming to be high quality, traceable, environmentally friendly marketed toward higher income consumers) still contained NTS with high levels of AMR.African swine fever (ASF) is one of the most critical diseases in the pig industry. In Asia, 15 countries have already reported an outbreak as of November 22, 2021. In 2021, China reported the genotype II lower virulent ASF virus (ASFV) and the emergence of genotype I ASFV. ASF is generally known as a contagious and lethal disease, but if chronic infection spreads, then disease control would be more difficult. In the current study, we highlighted the possibility of lower virulent virus distribution throughout China and the subsequent general risk of the virus being released from the country. The kernel density estimation showed that the two highest kernel density areas of ASF notification were located in Northeast and Midwest China. Four of the five provinces where lower virulent ASFV was isolated overlapped with areas of relatively high ASF notification density. In terms of the risk of ASFV spreading from China, eight of the 10 largest airports and three of the 10 largest seaports are located in areas of relatively high ASF notification density. There were flight flow from China to 67 countries and ship flow to 81 countries. Asia had the highest flight flow, followed by Europe, North America, Africa, and Oceania. The highest number of ship flows was also concentrated in Asia, but about 10% of ships head to Africa and South America. Chinese overseas residents were distributed in each continent in proportion to these results. Here, we highlight the potential risk of ASFV spread from China to the world.This study aimed to (1) investigate the prevalence of bovine tuberculosis (bTB) in slaughtered animals at the Chiang Mai Municipal abattoir in Chiang Mai, Thailand; (2) identify animal-level risk factors for bTB at the abattoir; and (3) evaluate the performance of techniques for bTB detection at the abattoir. From April 2020 to March 2021, 161 animals registered for slaughter were randomly selected for the study. Animal data including age, sex, species, body condition scores, and origins of the animals were collected. Meat inspection was performed by a trained meat inspector. Tissue samples of the lung, liver, and lymph nodes were collected for histopathological diagnosis and polymerase chain reaction (PCR) detection of Mycobacteria and specifically Mycobacterium bovis. The prevalence of bTB during meat inspection and PCR was calculated separately. Animal-level factors affecting bTB were determined using multivariate logistic regression analysis. The performance of meat inspection and PCR was evaluated using a Bayesian approach. The prevalence of bTB was 12.4% (20/161) and 34.8% (56/161) when the disease was diagnosed using meat inspection and PCR, respectively. Buffaloes had a significantly higher risk of being identified as bTB-positive using PCR compared to beef cattle (odds ratio = 2.19; confidence interval = 1.11-4.30). The median of posterior estimates of sensitivity (Se) and specificity (Sp) to detect bTB using meat inspection were 20.8% [95% posterior probability interval (PPI) = 9.1-36.5%] and 87.8% (95% PPI = 79.6-95.4%), respectively. The medians of the posterior estimates of Se and Sp for PCR were 88.6% (95% PPI = 70.5-98.3%) and 94.4% (95% PPI = 84.7-98.8%), respectively. These findings demonstrate that bTB is highly prevalent among slaughtered animals. PCR can be used as an ancillary test for bTB surveillance at abattoirs in Thailand.
An increasing proportion of patients with acute myocardial infarction (AMI) are presenting without standard modifiable risk factors (SMuRFs) of hypertension, hypercholesterolemia, diabetes, and smoking, but with an unexpectedly increased mortality. This study examined the SMuRF-less patients presenting with AMI in a multiethnic Asian population.

We recruited patients presenting with AMI from 2011 to 2021 and compared the prevalence, clinical characteristics, and outcomes of SMuRF-less and SMuRF patients. Multivariable analysis was used to compare the outcomes of 30-day cardiovascular mortality, all-cause mortality, readmission, cardiogenic shock, stroke, and heart failure. Kaplan-Meier curves were constructed for 30-day cardiovascular mortality, with stratification by ethnicity, gender and AMI type, and 10-year all-cause mortality.

Standard modifiable risk factor-less patients, who made up 8.6% of 8,680 patients, were significantly younger with fewer comorbidities that include stroke and chronic kidney on the management of this unexpectedly high-risk subgroup of patients.Atrial standstill (AS) is a rare condition defined by the lack of atrial electrical and mechanical activities. It is usually clinically manifested as symptomatic bradycardia, which requires permanent pacemaker (PPM) implantation. Traditional right ventricular apical pacing causes electrical and mechanical dyssynchrony resulting in left ventricular dysfunction, heart failure, and arrhythmias. As a novel physiological pacing strategy, left bundle branch area pacing (LBBaP) has demonstrated effectiveness and safety in recent years, but its application in exceptional conditions is rarely reported. We report the case of a 47-year-old female, who was diagnosed with AS complicated with a giant atrium, and successfully received a single-chamber PPM with LBBaP.Most patients present for catheter ablation of atrial fibrillation (CAAF) with residual or full effect of vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs). In daily practice, it has been observed that the activated clotting time (ACT) was actually poorly sensitive to the effect of DOACs and that patients on DOACs required more unfractionated heparin (UFH) to achieve the ACT target of 300 s during the procedure, leading some authors to worry about potential overdosing. Conversely, we hypothesize that these higher doses of UFH are necessary to achieve adequate hemostasis during CAAF regardless of the residual effect of DOACs. During CAAF, thrombosis is promoted mainly by the presence of thrombogenic sheaths and catheters in the bloodstream. Preclinical data suggest that only high doses of DOACs are able to mitigate catheter-induced thrombin generation, whereas low dose UFH already do so. In addition, the effect of UFH seems to be lower in patients on DOACs, compared to patients on VKAs, explaining part of the differences observed in heparin requirements. Clinical studies could not identify increased bleeding risk in patients on DOACs compared to those on VKAs despite similar efficacy during CAAF procedures. Moreover, targeting a lower ACT was associated with an increased periprocedural thrombotic risk for both DOAC and VKA patients. Therefore, the low sensitivity of the ACT to the residual effect of DOACs should not be a major concern in its use in the interventional cardiology laboratory.Hypertension is a key risk factor for spontaneous coronary artery dissection (SCAD) and aortic dilation. Circulating proteins play key roles in a range of biological processes and represent a major source of druggable targets. The aim of this study was to identify circulating proteins that were associated with blood pressure (BP), SCAD and aortic dilation. We identified shared genetic variants of BP and SCAD in genome-wide association studies, searched for circulating protein affected by these variants and examined the association of circulating protein levels with BP, aortic aneurysm and dissection (AAD) and aortic diameters by integrating data from circulating protein quantitative trait loci (pQTL) studies and genome wide association study (GWAS) in individuals from the UK Biobank using two-sample Mendelian randomization analysis methods. Single nucleotide polymorphisms (SNPs) in JAG1, ERI1, ULK4, THSD4, CMIP, COL4A2, FBN1, FAM76B, FGGY, NUS1, and HNF4G, which were related to extracellular matrix components The findings indicated that BP-associated genetic variants may influence aortic dilation risk by circulating proteins that regulate BP.
Rapid eye movement (REM) sleep is closely related to all-cause mortality. The aim of this study is to explore the role of REM sleep on the incident heart failure (HF).

We selected 4490 participants (2480 women and 2010 men; mean age, 63.2 ± 11.0 years) from the Sleep Heart Health Study. HF was identified as the first occurrence during a mean follow-up period of 10.9 years. REM sleep including percentage of REM sleep and total REM sleep time were monitored using in-home polysomnography at baseline. Multivariable Cox regression analysis was utilized to explore the relationship between REM sleep and HF.

In total, 436 (9.7%) cases of HF were observed during the entire follow-up period. After adjusting for potential covariates, an increased percentage of REM sleep (per 5%) was independently associated with a reduced incidence of HF [hazard ratio (HR) 0.88, 95% confidence interval (CI) 0.82-0.94,
< 0.001]. A similar result was also found between total REM sleep time (increased per 5 min) and incident HF (HR 0.97, 95% CI 0.95-0.99,
< 0.001). Moreover, the fourth quartile of both percentage of REM sleep (HR 0.65, 95% CI 0.48-0.88,
= 0.005) and total REM sleep time (HR 0.64, 95% CI 0.45-0.90,
= 0.010) had lower risk of incident HF when compared with the first quartile.

An increased percentage of REM sleep and total REM sleep time were associated with a reduced risk of HF. REM sleep may be a predictor of the incident HF.

[ClinicalTrials.gov], identifier [NCT00005275].
[ClinicalTrials.gov], identifier [NCT00005275].Emerging research on epigenetics has resulted in many novel discoveries in atherosclerosis (AS), an inflammaging-associated disease characterized by chronic inflammation primarily driven by macrophages. The bulk of evidence has demonstrated the central role of epigenetic machinery in macrophage polarization to pro- (M1-like) or anti-inflammatory (M2-like) phenotype. An increasing number of epigenetic alterations and their modifiers involved in reprogramming macrophages by regulating DNA methylation or histone modifications (e.g., methylation, acetylation, and recently lactylation) have been identified. They may act to determine or skew the direction of macrophage polarization in AS lesions, thereby representing a promising target. Here we describe the current understanding of the epigenetic machinery involving macrophage polarization, to shed light on chronic inflammation-driving onset and progression of inflammaging-associated diseases, using AS as a prototypic example, and discuss the challenge for developing effective therapies targeting the epigenetic modifiers against these diseases, particularly highlighting a potential strategy based on epigenetically-governed repolarization from M1-like to M2-like phenotype.Stereotactic body radiotherapy (SBRT) has been reported as an attractive option for cases of failed catheter ablation of ventricular tachycardia (VT) in structural heart disease. However, even this strategy can fail for various reasons. For the first time, this case series describes three re-do cases of SBRT which were indicated for three different reasons. The purpose in the first case was the inaccuracy of the determination of the treatment volume by indirect comparison of the electroanatomical map and CT scan. A newly developed strategy of co-registration of both images allowed precise targeting of the substrate. In this case, the second treatment volume overlapped by 60% with the first one. The second reason for the re-do of SBRT was an unusual character of the substrate-large cardiac fibroma associated with different morphologies of VT from two locations around the tumor. The planned treatment volumes did not overlap. The third reason for repeated SBRT was the large intramural substrate in the setting of advanced heart failure. The first treatment volume targeted arrhythmias originating in the basal inferoseptal region, while the second SBRT was focused on adjacent basal septum without significant overlapping. Our observations suggested that SBRT for VT could be safely repeated in case of later arrhythmia recurrences (i.e., after at least 6 weeks). No acute toxicity was observed and in two cases, no side effects were observed during 32 and 22 months, respectively. To avoid re-do SBRT due to inaccurate targeting, the precise and reproducible strategy of substrate identification and co-registration with CT image should be used.
Cardiac rehabilitation (CR) is an evidence-based intervention promoting risk factor modification following coronary artery disease events but the relative benefits for patient subgroups is not clear. This review synthesizes the available evidence on the effectiveness of modern CR programs and determines outcomes for age, sex and prior level of fitness.

MEDLINE, CINAHL, and EMBASE were examined for RCT and cohort studies involving exercise prescription or phase II or III CR following Myocardial Infarction (MI), Percutaneous Coronary Intervention (PCI) and cardiac surgery from January 2010 to February 2021. Outcomes assessed included peakVO
max, 6-min walk test and Metabolic Equivalent of Task. Meta-regression was used to determine CR impact for change in fitness and age and sex influences.

The mean age of study participants was 59.5 years and 82.7% were male. Females, younger people and those of average or above cardiorespiratory fitness were substantially under-represented in data and attendance, with and accessible for all.
The uncertainties of grafts' ostium and patency would cause prolonged procedure/fluoroscopy time and extra contrast agent consumption of the invasive coronary angiography (ICA) in patients with coronary artery bypass grafting (CABG) history. This study was conducted to evaluate whether the identification of grafts' ostium and patency by coronary computed tomographic angiography (CTA) could facilitate ICA procedure.

Patients with acute coronary syndrome (ACS) and CABG history who underwent ICA during hospitalization were enrolled. The patients were divided into the CTA-ICA group and the direct ICA group according to whether a coronary CTA was performed before ICA. The complete direct ICA was defined by successful selective angiography of all recorded grafts. The procedure/fluoroscopy time and contrast agent consumption of ICA were compared.

There were 14 patients in the CTA-ICA group and 24 patients in the direct ICA group. In the direct ICA group, twelve cases were conducted complete ICA. The CTA-ICA group had reduced procedure time (17.8 ± 7.1 vs. 25.9 ± 15.4 min,
= 0.03) and fluoroscopy time (fluor-time; 4.6 ± 2.3 vs. 9.8 ± 5.3 min,
< 0.01), and less contrast agent consumption (30.4 ± 5.6 vs. 49.8 ± 20.9 ml,
< 0.01) than the direct ICA group. In a subgroup analysis, the incomplete direct ICA had the longest procedure time (32.8 ± 16.5 min) or fluor-time (12.0 ± 5.5 min) and the most contrast agent consumption (58.3 ± 25.8 ml), whereas the difference between CTA-ICA and complete direct ICA groups was non-significant.

The CTA would facilitate invasive angiography in patients with CABG by reducing procedure/fluoroscopy time and contrast agent consumption.
The CTA would facilitate invasive angiography in patients with CABG by reducing procedure/fluoroscopy time and contrast agent consumption.
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