Purpose Guidelines recommend low-molecular-weight heparins (LMWHs) for patients with cancer associated thrombosis. However, until recently, only dalteparin and tinzaparin were approved in the European Economic Area (EEA) for these patients. This study compares the benefit–risk profile of enoxaparin with dalteparin and tinzaparin, based on real-world evidence (RWE) for the extended treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and prevention of recurrence in adult patients with active cancer. Methods A semi-quantitative structured benefit–risk assessment was conducted for the label-extension application of enoxaparin employing the following steps of the benefit–risk action team descriptive framework: define decision context; determine key benefit and risk outcomes; identify data sources; extract data; interpret results. Results The key benefits were defined as reduced all-cause mortality and VTE recurrence (including symptomatic DVT, fatal PE and non-fatal PE); the key risks were major and non-major bleeding of clinical significance. When compared with other EEA-approved LMWHs (dalteparin, tinzaparin), enoxaparin demonstrated a trend toward favourable effects for the reduction of VTE recurrence and all-cause mortality. There was a trend in favour of other LMWHs for major bleeding, and a trend in favour of enoxaparin for non-major bleeding with no evidence of significant difference between enoxaparin and the comparator groups. Conclusions The assessment using RWE demonstrated a favourable benefit–risk profile for enoxaparin similar to that of other EEA-approved LMWHs for the treatment of DVT and PE and the prevention of recurrence in patients with active cancer and thus supported the label-extension approval.

In this work, the advantage of Coulomb repulsion in the intermolecular forces experienced by molecules on the solid-liquid nanosized contact interface is taken, and the superior friction-reducing property of Cu3(PO4)2·3H2O (CuP) oil-based additives has been confirmed for titanium alloy. 3D CuP nanoflowers (CuP-Fs) with a strong capillary absorption effect are prepared to achieve the homogeneous mixing of solid CuP and lubricating oil. Lubrication by CuP-Fs additives for titanium alloy, friction coefficient (COF) can be reduced by 73.68%, and wear rate (WR) reduced by 99.69%. It is demonstrated that the extraordinary friction-reducing property is due to the repulsive solid-liquid interface with low viscous shear force originating from Coulomb repulsion between polar water molecules in CuP and non-polar oil molecules. However, any steric hindrance or connection between this repulsive solid-liquid interface will trigger the adhesion and increase the viscous shear force, for example, dispersant, hydrogen bondings, and shaky adsorbed water molecules. Besides, the lamellar thickness of CuP and molecular size of lubricant both have a great influence on tribological properties. Here the lubrication mechanism based on interface Coulomb repulsion is proposed that may help broaden the scope of the exploration in low-friction nanomaterial design and new lubricant systems.

A 60-year-old male patient presented skin flushing all over the body, who was diagnosed with toxic epidermal necrolysis syndrome (TEN). According to the suggestions of multi-disciplinary team, the patient was discharged healthily with the comprehensive treatments, including fluid infusion, nutritional support, intravenous gamma globulin and strict skin care. And the follow-up was good. This article is going to summarized experience of this case and review related literature to provide reference for future treatment.

Abstract Drug-drug interactions (DDIs) are common in cancer management and complicate the choice of anticoagulation in cancer-associated thrombosis. Cancer patients incur an increased risk of thrombotic events. Also, more bleeding events are observed in those who receive anticoagulation compared to those without cancer. In the treatment of cancer-associated thrombosis, non-vitamin K oral anticoagulants (NOACs) are at least as effective as low-molecular weight heparins, which became the standard of care after several trials demonstrated superiority over vitamin K antagonists. Non-inferiority has been shown for rivaroxaban, edoxaban and apixaban with a signal of fewer recurrent thrombotic events, albeit with an increase in bleeding events. Yet, potentially major drug-drug interactions have been identified as a reason to withhold NOACs and to rather choose an alternative. Furthermore, practical guidance on what constitutes a major interaction and/or how to deal with these interactions in clinical practice is limited. Hence, here we have provided a framework to allow clinicians to better deal with drug-drug interactions between NOACs and cancer therapies in the management of cancer-associated thrombosis. In this review we have discussed the current literature, how the pharmacokinetic profile links to the label information on DDI, and have provided a practical proposal, applied to a clinical case. Key words: drug-drug interactions, anticoagulation, non-vitamin K oral anticoagulants, cancer, cancer associated thrombosis

This paper presents the application software HYRCAN, which evaluates the factor of safety of circular failure surface in soil or rock slopes. HYRCAN offers a stand-alone windows system that is very simple to use, yet complex models can be created and analyzed quickly and easily. The graphical user interface enables quick generation of advanced models, and the enhanced output facilities provide a detailed presentation of computational results. The analysis procedures are fully automated and based on robust numerical procedures. Embedded scripting languages in HYRCAN enable the user to interact with and manipulate the models. This paper addresses the capabilities provided by pre- and post-processors for slope stability analysis and suggests enhancements and new features likely to be developed in the near future.

In arid and semi-arid areas, groundwater flow is a potent geological agent. The typical profile of Aksu river basin was chosen as the research object. First, the survey region’s geological background and hydrological conditions were systematically analysed. Combined with geophysical and remote sensing characteristics, the thickness change of the Quaternary loose layer, boundary of the subaqueous system, and basement of the water circulation depth were revealed. Hydrogeochemistry and environmental isotopes were applied to explain the recharge-runoff-discharge process, water-rock interaction, movement law, and residence time of surface-groundwater. Owing to the dissolution of carbonate and gypsum minerals and evaporates, cation exchange between Ca 2+ (Mg 2+) and Na + (K +), and the evaporation-concentration effect, specific ions (SO 4 2-, Cl -, Na +) and [total dissolved solids](javascript:;)(TDS) from the surface to groundwater gradually increased with the flow direction and gradually decreased with depth. This difference was more evident in the downstream discharge area, which indicated that they belonged to different groundwater flow systems(GFSs).Because of the elevation effect of the recharge source, the δ 18O values in different sections showed different degrees of depletion in the horizontal and vertical directions. In [association with](javascript:;) the structural ‘one convex and two concaves’ frameworks and the particle size variation of loose sediments, it reflected the distribution pattern of multiple local GFSs. The vertical zonation between the 3H and 14C isotope concentrations and the recorded groundwater [residence](javascript:;) time (modern-24000years) further illustrated the existence of intermediate and regional GFSs. Three surface-conversion boundary key zone (GFS cbz) were identified, and the GFS conceptual model was established. Finally, the corresponding relationship between the GFSs and the environmental effects, such as the distribution and aggregation of phreatic water with high F and As and soil salinization, were analysed, which had important theoretical significance for protecting the ecological balance of Aksu River basin.

Using 16S rRNA sequencing, we investigated the gut microbial diversity, variability, and functional prediction of gut microbes in dung beetles in starvation and heavy diet states. The results showed that the gut microflora was richer in the re-eating state than in the starving state. The dominant flora at the phylum level for the starvation and re-diet states are Firmicutes, Proteobacteria, but the proportions are not the same. At the genus level, the dominant flora in the starvation group was Vagococcus, while the dominant flora in the rediet group was Romboutsia. In terms of functional prediction, 27 metabolic pathways in 6 areas of Metabolism, Genetic Information Processing, Environmental Information Processing, Cellular Processes, Organismal Systems, and Human Diseases were significantly different. The study shows that status affects the diversity of the gut microbes of the Chinese dung beetle, and the results may provide the necessary data for the study and development of the gut microbes of the Chinese dung beetle.

Various herbivorous insects prefer plants of the Brassicaceae family as their hosts, although they are toxic. The two-component chemical defence system of the Brassicaceae against herbivores consists of glucosinolates (GLS) and the activating enzyme myrosinase. GLS hydrolysis by myrosinase leads to isothiocyanate (ITC) products, which are toxic and deterrent to many insect herbivores. Some insects that feed on Brassicaceae, however, have evolved specific adaptations (called counter-defences) against GLS. Two different types of counter-defences can be distinguished: a preemptive counter-defence that prevents the GLS from being hydrolysed to ITC due to metabolic redirection and direct counter-defence, where the ITC is formed, but then metabolized to a non-toxic conjugate. Preemptive counter-defence is believed to be more efficient due to the lower exposure to ITC, but this has not been well demonstrated experimentally. Here, we prove on theoretical grounds that preemptive counter-defence reduces exposure to ITC compared to direct counter-defence by studying the dynamics of GLS defence and counter-defence with two separate ordinary differential equation models. By quantifying the specific ITC concentrations that herbivores are exposed to during feeding with the two types of counter-defences, we show that herbivores with a preemptory detoxification system are less exposed to ITC. In addition, our models explain how the decline in the level of ITC is achieved by both counter-defences, which helps to understand the overall mechanisms and benefits of these techniques.

The drifting behavior of fish eggs is crucial for early-stage fish resources estimation, fish spawning ground identification and river management. To understand their move patterns in longitudinal, vertical, and lateral directions in deceleration flow, self-made model fish eggs similar to the real ones in the upper reaches of the Yangtze River was adopted to carry out the experiments. And the experiments were carried out in a 28 m flume equipped with particle tracing system (PTV) with different average decelerating flow velocity. The results showed that the longitudinal velocity of fish eggs was 0.83 times of the flow velocity, while the vertical velocity of fish eggs was not significantly related to the flow velocity. During drifting, fish eggs spread almost uniformly to both sides along the central axis of the main current. The results are useful for early-stage fish resource conservation and ecological scheduling of the rivers with rapid flows. However, more studies are needed to confirm whether high flow velocity is beneficial to the survival of drifting fish eggs.

Aiming at the problem that short circuit tripping may be caused by the insufficient safe distance between trees and lower phase conductors in high voltage transmission line corridors, a high-power pruning robot with RTK positioning and heavy-load mounting is studied and designed, which includes five modules: mathematical model and control principle of multi-rotor UAV, multi-rotor auxiliary obstacle avoidance control system, RTK aircraft positioning, UAV digital video transmission, and remote control cutting. First of all, according to the analysis of working space, the configuration principle of a high-power pruning robot based on RTK positioning and heavy-load mounting is put forward, and the three-dimensional model is set up. The finite element stress-strain analysis and modal analysis of the combined insulation clamping arm are carried out by using ABAQUS software, and the minimum mass solution that meets the mechanical performance requirements is given, which is 15.3% lower than that of similar robots, and the load capacity of trimming tools is increased by 20.2%. Secondly, the mathematical model of a multi-rotor UAV is established, and the multi-rotor auxiliary obstacle avoidance control system is designed. The control accuracy is 10.1% higher than that of the traditional control system, and the positioning of RTK aircraft is realized. In addition, based on RTK positioning, three design schemes of pruning robots are given: pruning tool and camera handling, UAV tree obstacle pruning control, and UAV tree obstacle removal. Finally, the prototype has carried out several heavy-load pruning tests on 220KV live lines, and the test results show that the prototype meets the tree pruning requirements of 220KV live lines, and the pruning accuracy is 89.42% higher than that of similar robots, and the live working time is extended by 26.8%, which verifies the rationality and practicability of the design.

Objectives: Primary objective was to compare screening accuracy of fetal growth assessment by conventional fundal height assessment by palpation with plotting of symphysio-fundal height (SFH) measurement on 21 st Intergrowth charts for detecting small for gestational age (SGA) foetuses. Secondary objective was to find an agreement between these two methods. Design: Prospective observational analytic study Setting: Lady Hardinge Medical College and associated hospitals, Delhi, India Population: Five hundred low risk pregnant women with singleton pregnancy, with reliable dates at ≥28 weeks from Antenatal Clinic of Lady Hardinge Medical College and associated hospitals from November 2019 to October 2021. Outcome measures: Assessment of fundal height in weeks by palpation and a lag of ≥3 weeks, suggested SGA fetus. SFH measured in centimetres and plotted on Intergrowth 21 st foetal growth charts. SFH of less than 10 th centile suggested SGA. Birthweight of new-born was plotted on Intergrowth 21 st Estimated Foetal Weight Chart. Birthweight of less than 10 th centile was classified as SGA. Results: Thirteen percent women delivered new-borns with birthweight below 10 th centile. Fundal height palpation had 98.6 % specificity and 69.9% sensitivity compared to 99.5% specificity and 83.3% sensitivity by SFH measurement for detecting SGA neonates. Conclusions: SFH measurement plotted on Intergrowth 21 st chart is more sensitive and specific for detecting SGA neonates compared to conventional fundal height palpation. Agreement between the methods measured by Cohen’s Kappa Statistic was 0.804, indicating substantial agreement between the methods. SFH measurement is a more accurate and practical tool, for use in low resource settings.

It is difficult to anatomically understand the three-dimensional structure of the middle ear and temporal bone during surgery, and great surgical technique are required. Therefore, complications are avoided through simulation using a three-dimensional printer, which was effective in not only safe and reliable surgery but also educating young physicians.

The search for robust, reliable biomarkers of schizophrenia remains a high priority in psychiatry. Biomarkers are valuable because they can reveal the underlying mechanisms of symptoms and monitor treatment progress, and may predict future risk of developing schizophrenia. Despite the existence of various promising biomarkers that relate to symptoms across the schizophrenia-spectrum, and despite published recommendations encouraging multivariate metrics, they are rarely investigated simultaneously within the same individuals. In those with schizophrenia, the magnitude of purported biomarkers is complicated by comorbid diagnoses, medications, and other treatments. Here, we argue three points. First, we reiterate the importance of assessing multiple biomarkers simultaneously. Second, we argue that investigating biomarkers in those with schizophrenia-related traits (schizotypy) in the general population can accelerate progress in understanding the mechanisms of schizophrenia. We focus on biomarkers of sensory and working memory in schizophrenia and their smaller effects in individuals with nonclinical schizotypy. Third, we note irregularities across research domains leading to the current situation in which there is a preponderance of data on auditory sensory memory and visual working memory, but markedly less in visual (iconic) memory and auditory working memory, particularly when focusing on schizotypy where data are either scarce or inconsistent. Together, this review highlights opportunities for researchers without access to clinical populations to address gaps in knowledge. We conclude by highlighting the theory that early sensory memory deficits contribute negatively to working memory and vice versa. This presents a mechanistic perspective where biomarkers may interact with one another and impact schizophrenia-related symptoms.

Objective: To investigate whether the use of bispectral index (BIS) monitoring would decrease total propofol consumption during the transvaginal oocyte retrieval procedure Design: Prospective, randomized, controlled, parallel-group clinical trial Setting: Operating room, postoperative recovery room Population: One hundred and thirty, American Society of Anesthesiologists (ASA) I-II patients, over age 18, undergoing transvaginal oocyte retrieval Methods: All patients were administered 2μg/kg fentanyl, and 2mg/kg propofol for the induction of anesthesia. The patients were divided into two groups. Patients in the group bolus were given 0.5 mg/kg of propofol when necessary, according to the observer’s range of motion. Patients in the group BIS were given 10 mg/kg/hour propofol infusion adjusted to keep the BIS value between 40-60. Main Outcome Measures: The primary outcome was the total dose of propofol administered per patient. The secondary outcomes were the time to reach the value of 5 on the Modified Observer’s Assessment of Alertness Sedation Scale (MOASs), the time to reach Post Anesthetic Discharge Scoring System (PADSS) ≥9 of the patients, satisfaction of the patient, and the gynecologist. Results: The amount of total propofol was higher in the group BIS than in the group bolus administered according to the patient’s clinic. There was no difference in the time to reach the value of 5 on the MOASs between the groups. The time to reach PADSS ≥9 was longer in the group BIS than in the group bolus. There was no difference between the two groups in terms of the satisfaction of the patient and the gynecologist. Conclusion: Administration of propofol as an infusion with BIS monitoring did not reduce the amount of propofol administered to patients during transvaginal oocyte retrieval. Funding: This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.

This paper focuses on the compressed sensing $\ell_1-\ell_2-$minimization model and develops new bounds on cumulative coherence $\mu_1(s)$. We point out that if cumulative coherence $\mu_1(s)$ satisfies (2) or (11), then the sparse signal can stably recover in noise model and exactly recover in free noise by $\ell_1-\ell_2$-minimization model.

A woman presented with intermittent left lower abdominal pain associated with a mass and didn't have any other symptoms. During the operation, a local inflammatory mass was found in left lower quarter of abdominal cavity. There are two bony foreign bodies in it. Postoperative pathology suggested an inflammatory mass.

ANTI-LIPOMA POTENTIAL OF FRESH PALM FRUITS EXTRACT 3Okorie Uchechukwu, 1,2Uro-Chukwu Henry Chukwuemeka, 3Eleazu Chinedum Ogbonna 1National Obstetric Fistula Centre, Abakaliki, Ebonyi State, Nigeria 2Institute for Nutrition, Nutraceutical & Public Health Research & Development, Nigeria, 3Department of Biochemistry, Alex-Ekwueme Federal University Ndufu Alike, Abakaliki, Ebonyi State, Nigeria *Corresponding author: uchechukwuc20022yahoo.com Abstract Antilipoma potential of fresh palm fruit extract was observed on three subjects who gave their consents. The individuals involved did topical application of the fresh crude palm fruits oil extract on the spots of the lipoma on their body between two to six months leading to the disappearance of the lipoma. There is no recurrence after two years. Although a follow-up is still on-going for the next five years. Keywords: anti-lipoma, liposuction, palm fruits, lipoma

TitleA quality improvement project evaluating haemostasis techniques during tonsillectomy

Background A peritonsillar abscess (PTA) is a collection of infectious material within the peritonsillar space, seen most often in teenagers and young adults. The diagnosis of a PTA is reliant on a patient’s history and physical exam; however, CT scans continue to be used. The rationale for imaging in the diagnosis of a PTA may be better understood based on patient presenting symptoms and physical exam findings. Methods A retrospective review of adult patients diagnosed with a peritonsillar abscess in an acute care/emergency setting at a tertiary hospital between January 1 to December 31, 2019, was performed. Patients were arranged into two groups: those who underwent a CT scan versus patients who did not scan as part of their clinical work-up. Patient demographics, and differences in the rate of subjective and objective findings were compared. Results 43 patients were included in the study: 19 in the CT scan group, and 23 in the no-CT scan group. There was no statistically significant difference in the history of previous peritonsillar abscess incidence, patient chief complaint at triage, subjective complaints, or objective physical exam findings. The most common patient reported symptoms in both groups were odynophagia and dysphagia. The most common objective findings in both groups included peritonsillar fullness and erythema, and uvular deviation. Conclusion Patients who underwent a CT scan as part of their work-up for a peritonsillar abscess had no difference in symptoms or physical exam findings when compared to patients who did not have a CT scan.

Objective To analyze frequency-specific hearing results surgery for chronic ear diseases, in relation to various surgical factors. Study design Retrospective cohort study. Setting Tertiary referral centre. Participants A total of 173 patients with chronic ear diseases who underwent surgical management at our hospital. Main outcome measures Air conduction threshold (AC), bone conduction threshold (BC), and air-bone gap (ABG) were tested at 250, 500, 1000, 2000, and 4000 Hz, respectively. Frequency-specific results were investigate in relation to various surgical factors. Results The radical mastoidectomy group and tympanoplasty group significantly improved in AC changes at every frequency. In the tympanoplasty group, ABG at all frequencies except 4,000 (P =.069) significantly improved. AC improved at low and mid frequencies when ossicular reconstruction was conducted. Different tympanic membrane repair materials showed significant improvement in AC at all frequencies. In all groups, BC data revealed significant improvements at 500, 1000 and 2000 Hz. Conclusions The hearing improved significantly postoperatively in AC and ABG test, mainly at low and mid frequencies. The BC improved significantly at 500-2000Hz.

What should be encouraged to develop the scientific competence of scholars and researchers (S&R)? What should a scientific evaluation focus on? These are important topics in medical education. In fact, there are several core competencies that should be encouraged, including learning, research, scientific writing, innovation and translational applications. Scientific evaluation should pay attention to several “hard indicators”, including academic leadership, independence, guidance, diversity, cooperation and innovation. But how to become an excellent cardiovascular S&R, it is necessary to continuously improve the scientific ability and levels, including innovation and publishing academic papers as the first or single author in one of the “345” top international journals. Since these key indicators are vital markers, it is time to develop a new scoring system to better and more rationally evaluate one’s scientific performance. In addition, there is a need for more innovative, value-added courses and hands-on experience to greatly improve their academic level.

Plastics are found in ecosystems worldwide and can have widespread impacts on organisms and the environment. Cathartid vultures, including the black vulture (Coragyps atratus) and the turkey vulture (Cathartes aura), have adapted to urbanized environments, making frequent use of human-made structures and anthropogenic resources. Thus, urban vultures are likely exposed to more plastic materials than rural vultures, which they intentionally or unintentionally ingest when foraging or loafing. Our objective was to determine the extent and type of plastic ingested by black and turkey vultures in an urban environment by (1) measuring the plastic content of regurgitated pellets collected along an urban-to-rural gradient, and (2) identifying the plastics within pellets. We dissected 1,087 pellets collected at eight vulture congregation sites in the Charlotte Metropolitan Area, USA between January 2021 and July 2022. Sixty percent of pellets contained plastic materials, with an average plastic composition by weight of 2.66 ± 8.76%. Repeated measures linear mixed models of the proportion of pellets that were plastic suggested that black and turkey vultures are ingesting more plastic materials when congregation sites are surrounded by more developed landcover and a greater density of commercial food providers, such as food stores and restaurants, within 20km. Fourier transform infrared (FTIR) spectroscopy of a subset of pellets indicated that the most common types of plastic ingested by vultures were silicone rubber (used in tires and automobile/boat seals) and polyethylene (used in plastic bags and food packages). Future research should investigate the relative importance of plastic sources in vulture diets, vulture behavioral changes associated with plastic ingestion, and the consequences of plastic pollution on species health and urban ecosystem functioning.

Background and Purpose: Nicotinamide phosphoribosyltransferase (NAMPT) is the rate-limiting enzyme within the NAD+ salvage biosynthetic pathway and also a cytokine modulator with effects on inflammation and fibrogenesis. FK866 (NAMPT inhibitor) has shown anti-inflammatory properties. However, FK866-induced depletion of NAD+ may also impair liver bioenergetic metabolism during Chronic Liver Disease (CLD). The aim of this study was to evaluate the effects of NAMPT inhibition and NAD+ restoration on experimental CLD. Experimental Approach. CCl4-induced liver cirrhosis was established after 6 weeks. Treatment groups (n=5 mice per group) included: 1) vehicle; 2) CCl4 control; 3) Silymarin + CCl4; 4) FK866 + CCl4; and 5) NMN+FK866+CCl4. At the end of the experimental induction and treatments, mice were sacrificed and liver was collected for weight, and paraformaldehyde fixed for histological characteristics of inflammation and fibrosis, as well as NAD+/NADH determination by colorimetric assay. Liver function tests were performed from blood sample. Statistical analysis was performed by T-test. Key Results. NAMPT inhibition resulted in a mild attenuation of histological and biochemical features of the CCl4-induced liver damage. NAD+ restoration, by the concomitant administration of its precursor NMN, resulted in a significant improvement of the histological characteristics; evidenced by a lower inflammatory infiltrate and fibrosis as well as lower levels of bilirubin. NAMPT inhibition and adequate NAD+ restoration were confirmed by a colorimetric assay of NADH and NAD+ and biochemical features were measured by routinary Liver Function Tests. Conclusion and implications. This study shows that NAMPT inhibition concomitant to NAD restoration significantly attenuate experimental liver damage.

Dopamine transmission in the striatum is a critical mediator of the rewarding and reinforcing effects of commonly misused psychoactive drugs. G protein-coupled receptors (GPCRs) that bind a variety of neuromodulators including dopamine, endocannabinoids, acetylcholine, and endogenous opioid peptides regulate dopamine release by acting on several components of dopaminergic circuitry. Striatal dopamine release can be driven by both somatic action potential firing and local mechanisms that depend on acetylcholine released from striatal cholinergic interneurons. GPCRs that primarily regulate somatic firing of dopamine neurons via direct effects or modulation of synaptic inputs are likely to impact distinct aspects of behavior and psychoactive drug actions compared with GPCRs that primarily regulate local acetylcholine-dependent dopamine release in striatal regions. This review will highlight mechanisms by which GPCRs modulate dopaminergic transmission and the relevance of these findings to psychoactive drugs involved in substance use disorders.