Mean Total Number Research Articles

The Distribution of Parafollicular Cells (C Cells) in Adult Cadaveric Thyroid Gland

Background: The population of parafollicular cells or C cells in the normal thyroid has subjective variation. These variations in cadaveric thyroid gland are primarily attributed to ethnicity, gender, underlying pathologies, and sampling technique or approach. The lack of homogenous C cell dispersal poses a challenge in the diagnosis and interpretation of C cell hyperplasia. The aim of the study is to analyze the C cell distribution in various parts of the cadaveric thyroid. Methodology: This study was performed with 56 thyroid glands acquired from adult human cadavers (37 males and 19 females). Calcitonin polyclonal antibody was employed to identify the C cells. C cells in tissue sections from the isthmus, upper, middle, and lower regions of the thyroid gland were examined. Results: The number of C cells in the section from the thyroid ranged between 0 and 5/low-power field (LPF) in the upper region, 0 and 12/LPF in the middle region, and 0 and 3/LPF in the lower region. The mean number of C cells displayed in the section from the upper third region of the thyroid was 9 ± 1.92 C cells (range 6–12 C cells). The mean number of C cells quantified in the section from the middle third region was 25 ± 3.34 cells (range 19–30 C cells). The mean number of C cells in the section from the lower third was 3 ± 1.88 C cells (range 0–6 C cells). Sexual dimorphism in the mean total number of C cells in the section from the midzone of the gland was statistically significant. Conclusion: The midzone of thyroid gland has more population of C cells than other region. A significantly higher number of C cells were observed in males. This nonuniform distribution of C cells could result in conflicting reports, especially during the assessment of C cell hyperplasia.

The Surgical Treatment of Deep Infection in the Native Shoulder Joint.

The overall clinical picture surrounding native shoulder infections, and, in particular, the associated long-term functional outcomes of treatment are presently underreported. The purpose of this study is to examine the demographics, diagnostic and treatment strategies, and functional outcomes of isolated shoulder joint sepsis treated with surgical irrigation and debridement (I&D). All patients treated with I&D for native shoulder sepsis between 2007 - 2017 were identified. Those without a minimum of one-year follow-up were excluded. Functional outcomes scores, reoperations, and predictors of poor outcome were evaluated. Twenty-three patients were included in the final study population. Mean age-adjusted CCI score was 4.1 (SD = 3.4, Range = 0 - 10). Twelve patients (52.2%) were treated with open I&D, while 11 patients (47.8%) were treated arthroscopically. Nine patients (39.1%) required multiple I&Ds (mean total number of I&Ds = 1.7, SD = 1.0, Range: 1 - 4). Five patients (21.7%) had at least one documented reinfection after their initial hospitalization, with the initial recurrence of infection occurring 2 - 15 months after the index procedure. Mean ASES score at final follow-up was 55.3 (SD = 26.7, Range: 5.8 - 98.3) and mean SANE score was 53.3 (SD = 30.6, Range: 0 - 100). Stepwise multiple linear regression modeling identified intravenous drug abuse as the most significant predictor for final ASES score [F(1,18) = 6.12, p = .024, adjusted R2 = .254]. Following isolated shoulder joint sepsis, infection clearance and acceptable functional outcomes can be achieved using surgical I&D followed by a course of antibiotics, but outcomes are variable.

Long-Term Effects of Renal Artery Denervation.

Background and Objectives: Renal artery denervation (RDN) procedure is a broadly discussed method in the treatment of resistant hypertension. Many studies report short-term (3–12 months) results for blood pressure and arterial stiffness. The primary endpoints were changes in 24 h mean systolic blood pressure (BP) and office systolic BP 48 months after RDN. The secondary endpoints were changes in aortic pulse wave velocity and impact of polypharmacy on these variables. Materials and Methods: Renal artery denervation was performed in 73 patients treated for resistant hypertension; 49 patients remained in final analysis. Patient examination was carried out before the procedure, and subsequently at 3, 6, 12, 24, and 48 months later. Patients’ antihypertensive and overall medication regimens were carefully analysed. Results: Mean 24 h arterial blood pressure lowered and was sustained at lower levels for up to 48 months; median (interequartile range—IQR) from 158(23.5)/100(14.2) to 140(26.5)/86(16.2) mmHg. Mean reduction in 24 h ambulatory systolic BP was −11 ± 25 mmHg (95% CI, −20 to −2; p < 0.001), while office systolic BP reduced by −7 ± 23 mmHg (95%CI, −24 to −1; p < 0.02). A significant reduction in median aortic pulse wave velocity 12 months after the procedure (drop from baseline 11.2 [3.15] m/s (95%CI 6.1 to 16.2) to 9.8 [2.1] m/s (95%CI 6.1 to 13.7; p = 0.002)). After 48 months, there was no worsening compared to the baseline level of 10.3 [4.0] m/s (95% CI 6.9 to 17.8) (p > 0.05). The total mean number of antihypertensive drugs remained unchanged: 5.97(±1.1) vs. 5.24 (±1.45). A higher number of pills after 48 months was associated with higher aortic pulse wave velocity (1–5 pill group: 8.1 ± 1.6 m/s; 6–10 pill group: 10.9 ± 1.8 m/s; >11 pill group: 15.1 ± 2.6 m/s) (p = 0.003). Conclusions: Antihypertensive effect after renal denervation lasts up to 48 months with no worsening of arterial stiffness compared to baseline. In our study, polypharmacy was associated with increased arterial stiffness 48 months after the procedure.

Peripheral eosinophilia and hypoalbuminemia are associated with a higher biopsy diagnostic yield for eosinophilic gastroenteritis

BackgroundGastric and duodenal mucosa may appear normal in eosinophilic gastroenteritis (EGE). Adult gastroenterologists typically biopsy only in the setting of mucosal abnormalities or symptoms, while pediatric providers biopsy all patients. The biopsy yield of EGE has not been adequately evaluated. AimsTo evaluate the biopsy yield of EGE in a pediatric cohort and assess predictors of increased biopsy yield. MethodsWe identified patients age 0-18 who underwent upper endoscopy. We recorded endoscopic findings, pathology, demographics, and clinical and laboratory characteristics. We identified EGE cases (>20 eosinophils per high-power field on stomach and/or duodenum biopsy). We compared characteristics between EGE and non-EGE cases, calculated biopsy diagnostic yield, and performed multivariate analysis for predictors of increased biopsy yield. ResultsIn 509 patients (55.6% female, mean age 10.3 years, 69.7% white, 58.7% atopic), biopsy diagnostic yield for EGE was 1.2% (6/509) among all subjects, 7.7% (3/39) for those with peripheral eosinophilia (≥500 eos/uL), 9.1% (3/33) for those with hypoalbuminemia (<3.5 g/dL), and 25.0% (3/12) for those with peripheral eosinophilia and hypoalbuminemia. The odds of EGE were 27.8 (95% CI 3.3–231.8) times greater among those with peripheral eosinophilia. The mean total biopsy surface area and number of fragments was similar between patients with and without EGE. The area under the ROC curve for blood eosinophil counts and albumin level for predicting EGE was 0.926. ConclusionsThe biopsy diagnostic yield for EGE is low but increases with peripheral eosinophilia and hypoalbuminemia. Patients with these features should have biopsies obtained, regardless of endoscopic appearance.

Gastrointestinal Toxicity of High-Dose Melphalan in Autologous Stem-Cell Transplantation: Identification of Risk Factors and a Benchmark for Experimental Therapies

Gastrointestinal (GI) adverse effects are the dose limiting toxicity of high-dose melphalan (HDM), and despite prophylactic measures, continue to have a significant impact on morbidity, length of stay, and quality of life. There are limited contemporary data on gastrointestinal toxicity associated with HDM. Our objective was to characterize the GI toxicity of HDM and identify risk factors for severe toxicity in a cohort of patients.We conducted a retrospective study on 100 consecutive patients with multiple myeloma, amyloidosis, or lymphoma who underwent autologous stem-cell transplant at Columbia University Irving Medical Center using HDM, either alone or in combination with other chemotherapeutic agents. Gastrointestinal adverse events, use of rescue medications, infectious complications, and length of stay were collected from electronic medical records. CTCAE (Common Terminology for Adverse Events) grading for GI events was conducted daily. Risk factors for GI toxicity were identified using linear regression and then examined in a multivariable model.Patients (median age 56 years, range 20-73) had myeloma (42%), lymphoma (42%), or amyloidosis (16%). Melphalan dose was 200 (40%), 140 (59%), or 100 mg/m2 (1%). Ninety-seven percent of patients experienced diarrhea ranging 1 - 18 daily bowel movements (Figure 1) and lasting 0 - 17 days (median 7). Nausea and vomiting of any grade occurred in 88% and 61% of patients, respectively. Sixty-two percent developed grade≥2 diarrhea, and grade≥2 nausea and vomiting was observed in 35% and 7%, respectively. The mean total number of bowel movements during a 14-day period post-transplant was 39 (maximum 67). Rescue loperamide was given 10 doses on average overall (range 0-43). Eighteen percent experienced weight loss of more than 10% and 38% dropped albumin level by at least 1g/dL.Patients with grade≥2 diarrhea had a higher incidence of hypokalemia, hypoalbuminemia, required greater electrolyte repletions (Figure 2), utilized more rescue medications, and had prolonged diarrhea (average 8.7 v. 5 days, p<0.0001) compared to patients with grade 1 diarrhea. Patients with grade≥2 diarrhea were also more likely to stay in the hospital more than 23 days (p=0.07). Of the entire cohort, eleven percent had at least one episode of incontinence and 15% had an infection identified in stool studies. To rule out further complications, 31% of patients had CT scans of the abdomen and pelvis but only 8% showed evidence of colitis.Grade≥2 diarrhea was independently associated with age>50 years (p=0.04), creatinine clearance <60 ml/min (p=0.05), and female sex (p=0.04). Female sex was also associated with developing grade≥1 nausea (p=0.05) and vomiting (p=0.09). Melphalan dose, underlying disease, and HDM v. BEAM (BCNU, Etoposide, Ara-C, Melphalan) were not significantly associated with diarrhea severity, although numerically there were more patients with grade≥2 diarrhea in the HDM 200 mg/m2 compared to 140 mg/m2 (70% vs. 59%).Diarrhea remains a very common side effect of HDM with no improvement over historical rates and no known prophylactic measures. Female sex, a low creatinine clearance, and age over 50 years portend a higher risk for severe diarrhea, and female sex for nausea and vomiting. Novel therapies for chemotherapy-induced diarrhea are critically needed for patients undergoing stem-cell transplantation. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

English

BACKGROUND Forensic odontology is a branch of dentistry which deals with appropriate handling and examination of dental evidences and with the proper evaluation and presentation of dental findings in the interest of justice. Identification of an individual is a prerequisite for certification of death and for personal, social and legal reasons. Palatal rugae are permanent and unique to each person, and can be used by clinicians and scientists to establish identity. It can be of special interest in edentulous cases and also in certain conditions, such as burned bodies or bodies that underwent severe decomposition. Thus the uniqueness, postmortem resistance, overall stability and additionally low utilization cost makes palatal rugae ideal forensic identification parameters. We wanted to compare the various palatal rugae patterns between dentate and edentulous subjects and also determine the comparison of the distribution of rugae number, length, shape, direction, unification between dentate and edentulous subjects. METHODS The study sample consisted of 60 subjects, 30 dentulous and 30 edentulous from JSS Dental College &amp; Hospital, Mysuru. The study group was equally divided between the sex, and was observed for number, length, shape, direction and unification of all palatal rugae. RESULTS The total number of rugae was higher in the dentulous group than in the edentulous group. In edentulous group, shorter lengths, lesser complexity rugae were seen compared to dentulous subjects. The total number of rugae on the right side in dentulous casts were 4.20 ± 1.06, while the total number on right side in Edentulous casts were 4.16 ± 0.79. On the left side mean total number of rugae in dentulous casts was 4.46 ± 0.79 whereas the mean total number of rugae in edentulous casts was 3.76 ± 0.77. CONCLUSIONS Palatal rugae pattern changed greatly after aging and loss of teeth regardless of time of edentulism and wearing denture. KEY WORDS Dentulous, Edentulous, Palatal Rugae, Forensic Identification

Earthworm communities are supported by perennial bioenergy cropping systems

During the last decade a variety of perennial bioenergy crops (PECs) have been introduced into European agriculture. This study was designed to investigate the impact of various PECs on earthworm community patterns (species composition, numbers, biomass, α-diversity, life-form categories) at a landscape scale in Western Germany. The PECs investigated were cup plant (CP), tall wheatgrass (TW) and giant knotweed (GK). In total, 4 field replicates of each perennial crop were investigated at 9 study sites with the exception of CP, for which only 3 replicate sites were available. PECs were compared with silage maize as an annual bioenergy crop (AEC) and permanent grasslands (PGL). The earthworm community of the study area consisted of 13 species in total. Mean species number ranged from 2.7 (AEC) < 2.8 (GK) < 3.8 (TW) < 3.9 (PGL) < 4.2 (CP). Overall, PECs took an intermediate position between AEC and PGL concerning earthworm population data including α-diversity and community structure as indicated by Shannon-Weaver index (H’), species number and Evenness (E). There was a clear and close to significant (p < 0.1) increase in the mean total earthworm number in the range AEC (43.3 ind. m−2) – PECs (86.7 ind. m−2) – PGL (114.4 ind. m−2). Fresh earthworm biomass varied from 21.1 g m−2 (AEC) to 35.7 g m−2 (PGL) to 40.1 g m−2 (PECs), however, this difference was only significant for mean biomass of juveniles. Endogeic species were highly dominant in soils cultivated with PECs. Generalized linear mixed models revealed that soil pH, amounts of soil organic carbon and plant available soil water content were partly significant environmental driving variables for the improvement of the earthworm community in soils cultivated with PECs.

Changes in numbers and distribution of wintering waterbirds around Gotland 1969–2020

The coastal areas of the island of Gotland in the center of the Baltic Sea is an important wintering site for waterbirds in Sweden. Gotland offers extensive areas of shallow feeding grounds and, due to its location, some open waters remain available even during harsh winters. Wintering waterbirds have been counted annually on the island since the start of the International Waterbird Census in 1967, with full coverage of all the inshore areas around the main island obtained during the years 1969–1978 and 2013–2020. Between these two periods, the mean total number of wintering waterbirds increased from 32,000 to 111,500. The most numerous species were Mallard Anas platyrhynchos, Tufted Duck Aythya fuligula, and Common Goldeneye Bucephala clangula. Some species such as Eurasian Wigeon Mareca penelope, Eurasian Teal Anas crecca, and Gadwall Mareca strepera started to winter during the second period. Marked increases were also found for Smew Mergellus albellus and Greater Scaup Aythya marila, likely related to progressively milder winters in recent years.

Aerosol number concentrations and new particle formation events over a polluted megacity during the COVID-19 lockdown

The present study investigates the particle number concentrations and size distributions in the ultrafine and fine-sized regimes over a polluted megacity, New Delhi (28.75° N, 77.12° E), India. The experiments were conducted during the periods (April–May 2020) of strict social and travel restrictions (lockdown) imposed by the Government of India aiming to contain the spread of Coronavirus Disease 19 (COVID-19) pandemic. The different phases of the COVID-19 lockdown witnessed restrictions of varying magnitudes with the significant cessation of anthropogenic sources, viz., industrial, road, railways, and air traffic emissions. Using this unique opportunity, the impact of varying urban emissions on particle number size distributions and new particle formation events were examined. The mean total number concentrations were in the range of ~ (2–3.5) x 104 cm−3 and depicted a gradual increase (~26%) with progressive unlock of the anthropogenic activities. At the same time, accumulation particle concentrations were doubled. However, ultrafine particles (UFP) (diameter < 100 nm) dominated (50–88%) the total number concentrations during most of the days and several new particle formation (NPF) events resulting in elevated (2–5 fold) UFP concentrations were observed. Subsequently, the particles grew to larger sizes with rates ~3.31–8.37 nm h−1. The NPF events occurred during the daytime, and during the events, a clear enhancement in the concentrations of [H2SO4] proxy (2–3.5 × 107 molecules cm−3; 2–3 orders higher than the non-event values) suggesting the role of strong gas-phase photochemistry. Also, some of the NPF events were associated with increased odd oxygen concentrations [Ox = O3+NO2], indicating the regional nature of the precursors and participation of VOC precursors in nucleation/growth. Interestingly, different classes of NPF events were seen during the strictest lockdown period, whereas more frequent and well-defined NPF events were witnessed when anthropogenic activities were opened up with conditional relaxations. These events demonstrated the competition between source strengths of precursor vapors from anthropogenic activities and primary particles acting as condensation sink restricting NPF. This study highlighted that urban pollution mitigation policies need to consider ultrafine particles emanating from the secondary aerosol formation process from traffic emissions.

Resilience and vulnerability of maternity services in Zimbabwe: a comparative analysis of the effect of Covid-19 and lockdown control measures on maternal and perinatal outcomes, a single-centre cross-sectional study at Mpilo Central Hospital

BackgroundOn the 27th of March 2020 the Zimbabwean government declared the Covid-19 pandemic a ‘national disaster’. Travel restrictions and emergency regulations have had significant impacts on maternity services, including resource stock-outs, and closure of antenatal clinics during the lockdown period. Estimates of the indirect impact of Covid-19 on maternal and perinatal mortality was expected it to be considerable, but little data was yet available.This study aimed to examine the impact of Covid-19 and lockdown control measures on non-Covid outcomes in a government tertiary level maternity unit in Bulawayo, Zimbabwe, by comparing maternal and perinatal morbidity and mortality before, and after the lockdown was implemented.MethodsThis was a retrospective, observational study, using a cross-sectional design to compare routine monthly maternal and perinatal statistics three months before and after Covid-19 emergency measures were implemented at Mpilo Central Hospital.ResultsBetween January-March and April-June 2020, the mean monthly deliveries reduced from 747.3 (SD ± 61.3) in the first quarter of 2020 to 681.0 (SD ± 17.6) during lockdown, but this was not statistically significant, p = 0.20. The Caesarean section rates fell from a mean of 29.8% (SD ± 1.7) versus 28.0% (SD ± 1.7), which was also not statistically significant, p = 0.18. During lockdown, the percentage of women delivering at Mpilo Central Hospital who were booked at the hospital fell from a mean of 41.6% (SD ± 1.1) to 35.8% (SD ± 4.3) which was statistically significant, p = 0.03. There was no significant change, however, in maternal mortality or severe maternal morbidity (such as post-partum haemorrhage (PPH), uterine rupture, and severe preeclampsia/eclampsia), stillbirth rate or special care baby unit admission. There was an increase in the mean total number of early neonatal deaths (ENND) (mean 18.7 (SD ± 2.9) versus 24.0 (SD ± 4.6), but this was not statistically significant, p = 0.32.ConclusionsOverall, maternity services at Mpilo showed resilience during the lockdown period, with no significant change in maternal and perinatal adverse outcomes, with the same number of man-hours worked before and during the lockdown Maternal and perinatal outcomes should continue to be monitored to assess the impact of Covid-19 and the lockdown measures as the pandemic in Zimbabwe unfolds. Further studies would be beneficial to explore women’s experiences and understand how bookings and deliveries at local clinics changed during this time.

Genetic diversity and population genetic structure in native Ethiopian donkeys (Equus asinus) inferred from equine microsatellite markers.

We investigated the genetic diversity and population genetic structure of six morphologically distinct Ethiopian donkey populations using 12 equine microsatellite markers. The donkey populations were Abyssinian (AB), Afar (AF), Hararghe (HA), Ogaden (OG), Omo (OM) and Sinnar (SI). Blood samples were collected from 180 genetically unrelated donkeys (30 individuals per population). Population genetic diversity estimates showed that total number and mean number of observed alleles, average observed and expected heterozygosity were 94, 5.208 ± 0.0229, 0.555 ± 0.023 and 0.588 ± 0.022, respectively. Highly significant deficiency in heterozygote was detected within the overall samples (FIS = 0.055 ± 0.021; P < 0.001). Though highly significant (P < 0.001), heterozygote deficiency within populations relative to total population was moderate (FST = 0.046 ± 0.016), suggesting a higher diversity within the populations (95.4%) than between populations. Various genetic distance estimation methods produced a similar topology of un-rooted dendrograms that grouped the overall Ethiopian donkeys into lowland (Ogaden, Omo and Sinnar) and highland (Abyssinian, Afar and Hararghe) genetic lineages. Likewise, Bayesian clustering analysis produced a similar pattern of clustering that was highly concordant with traditional donkey classification systems in Ethiopia.

Salvage hepatectomy for local recurrence after particle therapy using proton and carbon ion beams for liver cancer.

AimWith the increased use of particle therapy for liver cancer, local recurrence after particle therapy increased. Salvage hepatectomy is an acceptable treatment option for local recurrence following particle therapy; however, its safety and effectiveness remain unclear. Therefore, this multi‐center study aimed to verify the feasibility and efficacy of salvage hepatectomy and assess clinical issues associated with its application.MethodsWe retrospectively assessed the perioperative outcomes, prognosis, and pathological characteristics of 15 patients who underwent salvage hepatectomy for local recurrence after particle therapy between 2006 and 2019.ResultsHepatocellular carcinoma and metastatic liver tumors were noted in eight and seven patients, respectively. The mean total dose and number of fractions were 66.5 Gy and 12, respectively, and the mean interval between particle therapy and surgery was 30.1 months. Major hepatectomy was performed in seven cases. Moreover, the mortality rate was 0%, and surgical complications of Clavien‐Dindo grade IIIa or higher were observed in four cases (27%)—two bile leakages, one pleural effusion, and one refractory skin fistula. The median overall survival time and 5‐year overall survival rate after salvage hepatectomy were 29.9 months and 43.1%, respectively. Histological examination of the irradiated liver tissue surrounding the tumor showed sinusoidal dilatation, loss of hepatocyte, and fibrosis in most cases.ConclusionSalvage hepatectomy after particle therapy is a feasible therapy; however, the risk of refractory complications associated with particle therapy is relatively high. Therefore, the first‐line treatment for resectable liver cancer should be carefully determined considering second‐line treatment after local recurrence.

Increasing intensities of Anisakis simplex (Rudolphi, 1809 det. Krabbe, 1878) larvae with weight and sea age in returning adult Atlantic salmon, Salmo salar L., of coastal waters of Norway.

Ninety wild Atlantic salmon, Salmo salar L., (1.5-10.3kg) were caught in the Namsen Fjord near the mouth of River Namsen, mid-Norway, and examined for the presence and distribution of Anisakis simplex (Rudolphi, 1809 det. Krabbe, 1878) larvae by digestion of the viscera and muscles in a pepsin/HCl solution. All salmon were migrating spawners after 1-4years of feeding in the Atlantic Ocean. All 90 Atlantic salmon had A.simplex larvae in the viscera, and all, except two, had A.simplex larvae in the musculature. The number of A.simplex larvae in each fish varied between 3 and 181, and the total mean number of nematode larvae was 44.5. The intensity of A.simplex larvae was positively correlated with increasing weight and sea age of the host. However, the proportion of larvae in the muscle fillets decreased with increasing host weight and sea age. Atlantic salmon females had more A.simplex larvae than males. In all the fish examined, 70.2% of the A.simplex larvae were found in the viscera and 29.8% in the musculature. The majority (93%) of the larvae in the musculature occurred in the hypaxial sections anterior to the anus. As A.simplex larvae commonly occur in the musculature of wild Atlantic salmon, consumption of unfrozen, raw or semi-raw musculature represents a risk for humans developing anisakiasis.

Evaluation of the effectiveness of the procedures of creating autologous stem cell product derived bone marrow fluid for treatment of ischemic stroke patients

Objective: To implement the process and to evaluate the effectiveness of extracting necessary stem cell components and removing unnecessary cell components. Subject and method: 57 patients (40 male and 17 female patients) with subacute ischemic stroke (7th day - 30th day) including 40 male and 17 female patients. 240ml of bone marrow taken from iliac crests of each patient had diluted in 60ml of heparin solution for anticoagulation. Then, we continued to implement concentration process to reduce the volume in order to remove erythrocytes, granulocyte cells, concentrate process on mononucleus cells (including stem cells). Result: After the process, the components of stem cell package collected after concentrating were as follows: The bone marrow-derived stem cell product had the mean concentration of nucleus cells which was 29.07 ± 18.29G/l, the mean concentration of CD34+ stem cells was 549.79 ± 378.55 cells/pl; the rate of CD34+ in total nuclear cells was 1.87 ± 0.94% and the viable CD34+ rate was 94.65 ± 4.62%. The retain ratio of CD34+ stem cells was 57.64 ± 32.35% equivalent to the mean total number of CD34+ stem cells which was 10.99 ± 7.37 × 106 cells. Removal ratio of granulocyte and erythrocyte was 90.09 ± 10.82% and 99.59 ± 0.23%, respectively. Conclusion: The process of creating autologous bone marrow-derived stem cell product for the treatment of patients with subacute ischemic stroke has been effectively performed in term of collecting useful stem cells and eliminating unnecessary cell components.

Design-based stereological study of the guinea-pig (Cavia porcellus) cerebellum.

Guinea pigs have proved useful as experimental animal models in studying cerebellar anatomical and structural alterations in human neurological disease; however, they are also currently acquiring increasing veterinary interest as companion animals. The morphometric features of the normal cerebellum in guinea pigs have not been previously investigated using stereology. The objective of the present work was to establish normal volumetric and quantitative stereological parameters for cerebellar tissues in guinea pigs, by means of unbiased design-based stereology. Cerebellar total volume, gray and white matter volume fractions, molecular and granular layers volume fractions, cerebellar surface area, Purkinje cellular and nuclear volumes, and the Purkinje cell total count were stereologically estimated. For this purpose, cerebellar hemispheres from six adult male guinea pigs were employed. Isotropic, uniform random sections were obtained by applying the orientator method, and subsequently processed for light microscopy. The cerebellar total volume, the white and grey matter volume fractions, and the molecular and granular layer volumes were estimated using the Cavalieri's principle and the point counting system. The cerebellar surface area was estimated through the use of test lines; Purkinje cellular and nuclear volumes were analysed using the nucleator technique, whereas the Purkinje cell total count was obtained by means of the optical disector technique. The mean±standard deviation total volume of a guinea-pig cerebellar hemisphere was 0.11±0.01cm3 . The mean volumetric proportions occupied by the gray and white matters were, respectively, 78.0±2.6% and 22.0±2.6%, whereas their mean absolute volumes were found to be 0.21±0.02cm3 and 0.059±0.006cm3 . The volumes of the molecular and granular layers were estimated at 112.4±20.6mm3 and 104.4±7.3mm3 , whereas their mean thicknesses were calculated to be 0.184±0.020mm and 0.17±0.02mm. The molecular and granular layers accounted for 40.7±3.9% and 37.4±1.8% of total cerebellar volume respectively. The surface area of the cerebellum measured 611.4±96.8mm2 . Purkinje cells with a cellular volume of 3210.1µm3 and with a nuclear volume of 470.9µm3 had a higher incidence of occurrence. The mean total number of Purkinje cells for a cerebellar hemisphere was calculated to be 253,090±34,754. The morphometric data emerging from the present study provide a set of reference data which might prove valuable as basic anatomical contribution for practical applications in veterinary neurology.

Optimal ICG dosage of preoperative colonoscopic tattooing for fluorescence-guided laparoscopic colorectal surgery

BackgroundIndocyanine green (ICG) is a multifunctional dye used in tumor localization, tissue perfusion, and lymph node (LN) mapping during fluorescence-guided laparoscopic colorectal surgery.PurposeThis study aimed to establish the optimal protocol for preoperative endoscopic submucosal ICG injection to perform fluorescence lymph node mapping (FLNM), along with undisturbed fluorescent tumor localization and ICG angiography during a single surgery.MethodsColorectal cancer patients (n = 192) were enrolled from May 2017 to December 2019. Colonoscopic submucosal ICG injection was performed 12 to 18 h before surgery. ICG injection protocols were modified based on the total injected ICG (mg) and tattooing site number. The concentrations of ICG were gradually decreased from the standard dose (2.5 mg/ml) to the minimum dose (0.2 mg/ml). Successful FLNM (FLNM-s) was defined as distinct fluorescent LNs observed under NIR camera. The patient’s age, sex, body mass index (BMI), stage, cancer location, obstruction, and laboratory findings were compared between the FLNM-s and failed FLNM (FLNM-f) groups to identify clinical and pathological factors that affect FLNM.ResultsIn the ICG dose section of 0.5 to 1 mg, the success rate was highest within all functions including FLNM, fluorescent tumor localization, and ICG angiography. FLNM-s was related to ICG dose (0.5–1 mg), multiple submucosal injections, location of cancer, camera light source, and lower BMI. In the multivariate analysis, camera light source, non-obesity, and multiple injections were independent factors for FLNM-s). The mean total number of harvested LNs was significantly higher in the FLNM-s group than that in the FLNM-f group (p < 0.001). The number of metastatic lymph nodes was comparable between the two groups (p = 0.859).ConclusionsPreoperative, endoscopic submucosal ICG injection with dose range 0.5 to 1 mg would be optimal protocol for multifunctional ICG applications during fluorescence-guided laparoscopic colorectal surgery.

Ankle arthrodesis using the Taylor Spatial Frame for the treatment of infection, extruded talus and complex pilon fractures.

The treatment of complex pilon fractures and talus fracture-dislocations present several challenges, like avoiding infection, achieving union, management of bone loss and function preservation. Retrospective cohort review of fourteen patients who underwent ankle arthrodesis (AA) using the Taylor Spatial Frame (TSF) after pilon and talus fracture-dislocations. Ten tibiocalcaneal (TC) and four tibiotalar (TT) fusions were performed. Eleven of these cases were Gustilo III open fractures. Seven cases involved an open extruded talus. Four cases had established infections. There was a mean of 2.7 (range 0 - 8) operations prior to AA using TSF. The primary objective was to determine infection and union rates. Patient-reported outcomes (Short Form 36, SF-36) and functional outcomes (Ankle Osteoarthritis Score, AOS) were the secondary measures. Eradication and prevention of deep infection was achieved in all cases. Radiological union was achieved at a mean of 9 months (range 5 - 17). Solid AA was achieved in 12 of 14 cases using the TSF. Two TC fusions required a hindfoot fusion nail to achieve union. Eleven cases had concurrent bone transport, mean of 63mm (range 33 - 180). Mean time of TSF treatment was 11.1 months (range 6 - 16). One case required delayed amputation. Eight patients were able to fully weight bear unaided after the treatment. Mean SF-36 was 65 (range 35 -100). Mean AOS was 36.5 (range 6.6 - 77.5) with 69.3% of scores graded good to excellent. Mean total number of operations was 5.9 (range 2 - 10). Minimum follow up time was 12 months (range 12 - 56). AA using TSF can be considered for complex pilon fractures and extruded talus. It has shown to be effective in achieving a solid fusion and infection eradication. While using the TSF in isolation, non-union must be suspected in TC fusions, absence of radiological signs of healing, massive bone loss, and possibly not using bone graft. Patients must be aware that while treatment of these injuries will be prolonged and carries the risk of many potential complications, it provides a good alternative to amputation.

A Service System with Packing Constraints: Greedy Randomized Algorithm Achieving Sublinear in Scale Optimality Gap

A service system with multiple types of arriving customers is considered. There is an infinite number of homogeneous servers. Multiple customers can be placed for simultaneous service into one server, subject to general packing constraints. The service times of different customers are independent even if they are served simultaneously by the same server; the service time distribution depends on the customer type. Each new arriving customer is placed for service immediately into either an occupied server, that is, one already serving other customers, as long as packing constraints are not violated or into an empty server. After service completion, each customer leaves its server and the system. The basic objective is to minimize the number of occupied servers in steady state. We study a greedy random (GRAND) placement (packing) algorithm, introduced in our previous work. This is a simple online algorithm that places each arriving customer uniformly at random into either one of the already occupied servers that can still fit the customer or one of the so-called zero servers, which are empty servers designated to be available to new arrivals. In our previous work, a version of the algorithm, labeled GRAND(aZ), is considered, in which the number of zero servers is aZ with Z being the current total number of customers in the system and positive a being an algorithm parameter. GRAND(aZ) is shown in our previous work to be asymptotically optimal in the following sense: (a) the steady-state optimality gap grows linearly in the system scale r (the mean total number of customers in service), that is, as c(a)r for some positive c(a), and (b) c(a) vanishes as a goes to zero. In this paper, we consider the GRAND(Z p ) algorithm, in which the number of zero servers is Z p , where p &lt; 1 is a fixed parameter, sufficiently close to 1. We prove the asymptotic optimality of GRAND(Z p ) in the sense that the steady-state optimality gap is sublinear in the system scale r. This is a stronger form of asymptotic optimality than that of GRAND(aZ).

Impact of Delayed Time to Treatment on Visual Outcomes in Neovascular AMD: Data From the HARBOR Study.

To determine the potential impact on visual outcomes of delayed treatment initiation in patients with neovascular age-related macular degeneration (nAMD). Post hoc analysis of anti-vascular endothelial growth factor treatment-naïve patients with nAMD from HARBOR. Time to treatment was defined as first ranibizumab injection date minus screening date. Comparisons were made between the prompt (≤ 6 days) versus delayed (> 10 days) treatment groups. Main outcome measures were best-corrected visual acuity (BCVA) change over time, BCVA, number of ranibizumab injections, and proportion of 3-line gainers/losers. In HARBOR, more than 50% of patients received their first injection within 7 days of screening, with mean (median) time to treatment of 4.6 (5) and 15.9 (14) days for the prompt and delayed treatment groups, respectively. Mean (95% confidence interval [CI]) BCVA change from baseline to Month 24 was 9.1 (7.4-10.8) and 8.8 (6.7-10.8) Early Treatment Diabetic Retinopathy Study letters in the prompt (n = 395) and delayed (n = 230) treatment groups, respectively. Mean (95% CI) total number of ranibizumab injections for the as-needed arms was 12.4 (11.6-13.3) and 11.4 (10.3-12.4) for the prompt and delayed treatment groups, respectively. In HARBOR, time from screening to first ranibizumab injection did not seem to significantly affect mean BCVA change or number of injections. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:62-69.].

A Systematic Review of the Efficacy and Safety of Over-the-Counter Medications Used in Older People for the Treatment of Primary insomnia.

OBJECTIVE: The purpose of this systematic review is to evaluate the available evidence for safety and efficacy of over-the-counter (OTC) sleep aids used for the treatment of insomnia in older people.<br/> DATA SOURCES: PubMed, EBSCO, and International Pharmaceutical Abstracts.<br/> STUDY SELECTION: Five studies were included that involved humans 65 years of age and older being evaluated on OTC sleep aids in the outpatient setting.<br/> DATA EXTRACTION: Data extraction from each study included primary and secondary efficacy endpoints, such as differences in the mean total sleep time, sleep latency, sleep efficiency, and number of awakenings, along with safety endpoints, such as psychomotor ability, cognitive ability, and adverse effect profiles. Both subjective and objective measures of changes in sleep and adverse effects were included.<br/> DATA SYNTHESIS: Diphenhydramine had a statistically significant increase in sedation and decrease in number of awakenings but was not shown to be any less or more safe than compared products. Despite lacking safety issues, valerian was found to have no effect on subjective or objective sleep outcomes. Overall, melatonin had the most evidence and was found to have a statistically significant positive impact on sleep measures without safety issues.<br/> CONCLUSION: Diphenhydramine and melatonin appear to be efficacious in improving some sleep measures while causing minimal adverse effects. However, there are very few studies that examine the use of over-the-counter sleep aids in those 65 years of age and older with primary insomnia. Additional studies are needed in this population.