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971 95% confidence interval 1.071-3.624, P=.029).

Preoperative malnutrition in patients who underwent curative PD for pancreatic head cancer is associated with adverse short-term outcomes.
Preoperative malnutrition in patients who underwent curative PD for pancreatic head cancer is associated with adverse short-term outcomes.Climate change is outpacing the ability of species and populations to naturally adapt warranting active interventions to boost climate resilience. In their review paper, Gaitán-Espitia and Hobday discuss how such interventions may, however, counter natural evolutionary processes and adaptive capacity if not underpinned by background knowledge from genes through to ecosystems. They present a robust decision framework to guide implementation of climate adaptation interventions to avoid unintended evolutionary outcomes.The diagnosis of lung lobe torsion in dogs is usually based on radiological, endoscopic, and CT features. Few ultrasonographic descriptions have been published. The purpose of this multicenter, retrospective, and prospective observational study was to investigate the presence of a hypoechoic area forming a pulmonary band or line at the periphery of the twisted lobe on ultrasonography and assess its significance by comparing it to CT and histological findings. Fifteen dogs with lung lobe torsion confirmed surgically or postmortem were included. All had received ultrasonography and CT examinations; 13 had additional histopathological examination performed. In 14 cases, thoracic ultrasonography revealed a peripheral hypoechoic band, overlying areas of scattered, hyperreflecting interfaces in the affected lobe. On CT, central emphysema was surrounded by a peripheral, soft tissue attenuation band, affecting the periphery in 14 cases. No band was observed in one case, in which the lobe was entirely consolidated. Histological examination yielded a comparable peripheral band, consisting of a thickened visceral pleura with or without hemorrhagic necrosis of the underlying pulmonary parenchyma. This peripheral band may be related to the specific fractal organization of airways and vessels, which plays an important role in lung perfusion and ventilation and makes the lung periphery more prone to ischemia. Our findings suggest that the presence of a peripheral hypoechoic band, associated with central emphysema in a noncollapsed lung lobe on ultrasonography, is suggestive of compromised blood supply and air flow, and lung lobe torsion should therefore be suspected.
To evaluate a mixture of selected lactic acid bacteria (LAB) (a riboflavin-producer, a folate-producer and an immunomodulatory strain) as co-adjuvant for 5-fluorouracil (5-FU) chemotherapy in cell culture and using a 4T1 cell animal model of breast cancer.

The viability of Caco-2 cells exposed to 5-FU and/or LAB was analysed. Mice bearing breast tumour were treated with 5-FU and/or LAB. Tumour growth was measured. Intestinal mucositis (IM) was evaluated in small intestine; haematological parameters and plasma cytokines were determined. The bacterial mixture did not negatively affect the cytotoxic activity of 5-FU on Caco-2 cells. The LAB mixture attenuated the IM and prevented blood cell decreases associated with 5-FU treatment. Mice that received 5-FU and LAB mixture decreased tumour growth and showed modulation of systemic cytokines modified by both tumour growth and 5-FU treatment. The LAB mixture by itself delayed tumour growth.

The mixture of selected LAB was able to reduce the side-effects associated with chemotherapy without affecting its primary anti-tumour activity.

This bacterial mixture could prevent the interruption of conventional oncologic therapies by reducing undesirable side-effects. In addition, this blend would provide essential nutrients (vitamins) to oncology patients.
This bacterial mixture could prevent the interruption of conventional oncologic therapies by reducing undesirable side-effects. In addition, this blend would provide essential nutrients (vitamins) to oncology patients.One of the major pathological hallmarks of Alzheimer´s disease (AD) is an accumulation of amyloid-β (Aβ) in brain tissue leading to formation of toxic oligomers and senile plaques. Under physiological conditions, a tightly balanced equilibrium between Aβ-production and -degradation is necessary to prevent pathological Aβ-accumulation. Here, we investigate the molecular mechanism how insulin-degrading enzyme (IDE), one of the major Aβ-degrading enzymes, is regulated and how amyloid precursor protein (APP) processing and Aβ-degradation is linked in a regulatory cycle to achieve this balance. In absence of Aβ-production caused by APP or Presenilin deficiency, IDE-mediated Aβ-degradation was decreased, accompanied by a decreased IDE activity, protein level, and expression. Similar results were obtained in cells only expressing a truncated APP, lacking the APP intracellular domain (AICD) suggesting that AICD promotes IDE expression. In return, APP overexpression mediated an increased IDE expression, comparable results were obtained with cells overexpressing C50, a truncated APP representing AICD. Beside these genetic approaches, also AICD peptide incubation and pharmacological inhibition of the γ-secretase preventing AICD production regulated IDE expression and promoter activity. By utilizing CRISPR/Cas9 APP and Presenilin knockout SH-SY5Y cells results were confirmed in a second cell line in addition to mouse embryonic fibroblasts. In vivo, IDE expression was decreased in mouse brains devoid of APP or AICD, which was in line with a significant correlation of APP expression level and IDE expression in human postmortem AD brains. Our results show a tight link between Aβ-production and Aβ-degradation forming a regulatory cycle in which AICD promotes Aβ-degradation via IDE and IDE itself limits its own production by degrading AICD.Tuberculosis remains a major source of morbidity and mortality worldwide, with 10 million cases and 1.5 million deaths in 2018. Achieving 'End TB' prevention and care goals by 2035 will likely require a new tuberculosis vaccine. The tuberculosis vaccine development pipeline has seen encouraging progress; however, questions around their population impact and implementation remain. Mathematical modelling investigates these questions to inform vaccine development and deployment strategies. We provide an update on the current vaccine development pipeline, and a systematic literature review of mathematical modelling of the epidemiological impact of new tuberculosis vaccines. Fourteen prophylactic tuberculosis vaccine candidates are currently in clinical trials. Two candidates have shown promise in phase II proof-of-concept efficacy trials M72/AS01E demonstrated 49.7% (95% CI; 2.1, 74.2) protection against tuberculosis disease, and BCG revaccination demonstrated 45.4% (95% CI; 6.4, 68.1) protection against sustained Mycobacterium tuberculosis infection. Since the last modelling review, new studies have investigated the epidemiological impact of differential vaccine characteristics, age targeting and spatial/risk group targeting. Critical research priorities for M72/AS01E include completing the currently in-design trial, powered to improve the precision of efficacy estimates, include uninfected populations and further assess safety and immunogenicity in HIV-infected people. For BCG revaccination, the priority is completing the ongoing confirmation of efficacy trial. Critical modelling gaps remain on the full value proposition of vaccines, comparisons with other interventions and more realistic implementation strategies. Using carefully designed trials and modelling, we must prepare for success, to ensure that new vaccines will be promptly received by those most in need.
To isolate and identify cellulolytic bacteria from yak rumen and further evaluate the effects of the isolates on the silage quality, structural carbohydrates degradation and cellulose convertibility of Napier grass silage.

Two out of 218 strains were selected based on their most extensive transparent zone and the highest filter paper disintegration rate. The two isolates (JFL12 and JF85) could grow normally at 15-55°C, pH 3·0-7·0 and NaCl (3·0, 6·5%), and were identified as Enterococcus casseliflavus and Enterococcus faecalis by 16S rDNA sequence analysis, respectively. Napier grass was ensiled with no additive control (C), Lactobacillus plantarum (Lp), JFL12, JF85, JFL12+Lp and JF85+Lp for 3, 5, 7, 14, 30 and 60days. All inoculated silages had higher lactic acid content, lower pH, ammonia nitrogen (NH
-N) and lignocellulose contents than the control silage. Silages treated with JFL12+Lp and JF85+Lp had the lowest pH and NH
-N contents, the highest lactic acid content and lignocellulose degradation amensiled forages.This study utilized the UNOS database to assess clinical outcomes after kidney retransplantation in patients with a history of posttransplant lymphoproliferative disease (PTLD). Among second kidney transplant patients from 2000 to 2019, 254 had history of PTLD in their first kidney transplant, whereas 28,113 did not. After a second kidney transplant, PTLD occurred in 2.8% and 0.8% of patients with and without history of PTLD, respectively (p = .001). Over a median follow-up time of 4.5 years after a second kidney transplant, 5-year death-censored graft failure was 9.5% vs. 12.6% (p = .21), all-cause mortality was 8.3% vs. 11.8% (p = .51), and 1-year acute rejection was 11.0% vs. 9.3% (p = .36) in the PTLD vs. non-PTLD groups, respectively. There was no significant difference in death-censored graft failure, mortality, and acute rejection between PTLD and non-PTLD groups in adjusted analysis and after propensity score matching. We conclude that graft survival, patient survival, and acute rejection after kidney retransplantation are comparable between patients with and without history of PTLD, but PTLD occurrence after kidney retransplantation remains higher in patients with history of PTLD.
To describe reasons why nurse managers in perioperative settings decide to leave their employment.

Current literature has shown that perioperative nurse managers' reasons to leave their positions are formed through an interaction of factors.

Individual in-depth interviews were performed with seven nurse managers, all women, in perioperative settings in Sweden. Data were analysed using systematic text condensation.

Five key themes were identified (a) to end where I started, as a frontline nurse; (b) I wanted to develop further to the next level in my career; (c) I ran out of ideas; (d) I lost trust in my head manager and did not believe in the new organisation and (e) I had had enough of being offended by my superior manager and my employees.

Nurse managers experienced feeling forced into a decision to leave because of being offended by their superiors or their employees. Furthermore, the findings indicate that nurse managers should be offered support from superior managers and the organisation together with time for discussions.

The most essential element should be the influence of caritative leadership and the obvious expectation of being treated with dignity, respect and appreciation.
The most essential element should be the influence of caritative leadership and the obvious expectation of being treated with dignity, respect and appreciation.
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