Consensus-Based Guidelines for Acute Myeloid Leukemia Management in Gulf Cooperation Council Countries: Addressing Unmet Regional Needs and the Changing AML Landscape.

PURPOSE: AML is a heterogeneous hematologic malignancy. Region-specific recommendations for AML management can enhance patient outcomes. This article aimed to develop recommendations for the Gulf Cooperation Council (GCC) countries. METHODS: Ten AML panel members from Kuwait, Oman, Qatar, and the United Arab Emirates (KOQU) participated in a modified two-round Delphi process. The panel first identified the unmet regional needs and finalized a list of core variables. Next, they voted on iterative statements drawn from international recommendations and provided feedback via a questionnaire. Consensus voting ≤70% was discussed, and additional clinical decision making statements were suggested. At round closure, a consensus vote took place on revised statements. RESULTS: The panel reached ≥97.8% consensus on AML management. The panel agreed to use international risk stratification categories for personalized treatment of AML. The presence of ≥10% blasts for recurrent genetic abnormalities was required for a diagnosis of AML. Key consensus was reached for different treatment stages. The panel noted that older patients pose a challenge because of poor cytogenetics and genetic anomalies and require different treatment approaches. The panel recommended venetoclax-hypomethylating agents; fludarabine, cytarabine, idarubicin, and granulocyte colony-stimulating factor; and targeted therapy for AML relapsed/refractory disease. Supportive care is considered on the basis of prevailing organisms and drug resistance. CONCLUSION: The GCC KOQU's consensus-based recommendations for managing AML include an evidence-based and region-specific framework.

Performance of CBNAAT on Pleural Biopsies Obtained by Semirigid Thoracoscopy for Diagnosis of Unexplained Pleural Effusion: A Prospective Study from North India.

BACKGROUND: Exudative pleural effusions are commonly encountered in clinical practice, but in about one-fourth of cases, etiology remains elusive after initial evaluation. Medical thoracoscopy with semirigid thoracoscope is a minimally invasive procedure with high diagnostic yield for diagnosing pleural diseases, especially these undiagnosed exudative pleural effusions. In tubercular endemic areas, often, these effusions turn out to be tubercular, but the diagnosis of tubercular pleural effusion is quite challenging due to the paucibacillary nature of the disease. Although culture is the gold standard, it is time-consuming. Cartridge-based nucleic acid amplification test (CBNAAT) is a novel rapid diagnostic test for tuberculosis (TB) and has been recommended as the initial diagnostic test in patients suspected of having extrapulmonary TB (EPTB). MATERIALS AND METHODS: We conducted a prospective observational study of 50 patients with undiagnosed pleural effusion admitted to our tertiary care hospital. The primary aim of the study is to evaluate the diagnostic performance of CBNAAT on thoracoscopic guided pleural biopsy and compare it with conventional diagnostic techniques like histopathology and conventional culture. RESULTS: Of 50 undiagnosed pleural effusions, TB (50%) was the most common etiology. The overall diagnostic yield of semirigid thoracoscopy in this study was 74%. Our study showed that CBNAAT of pleural biopsies had a sensitivity of 36% only but a specificity of 100%. The sensitivity of CBNAAT was not far superior to the conventional culture. CONCLUSION: Tuberculosis (TB) is a common cause of undiagnosed pleural effusion in our set-up. CBNAAT testing of pleural biopsy, though, is a poor rule-out test for pleural TB, but it may aid in the early diagnosis of such patients.

Fluoride-Ion-Responsive Sol-Gel Transition in an L-Cysteine/AgNO3 System: Self-Assembly Peculiarities and Anticancer Activity.

Supramolecular hydrogels based on low-molecular-weight compounds are a unique class of so-called "soft" materials, formed by weak non-covalent interactions between precursors at their millimolar concentrations. Due to the variety of structures that can be formed using different low-molecular-weight gelators, they are widely used in various fields of technology and medicine. In this study, we report for the first time an unusual self-assembly process of mixing a hydrosol obtained from L-cysteine and silver nitrate (cysteine-silver sol-CSS) with sodium halides. Modern instrumental techniques such as viscosimetry, UV spectroscopy, dynamic light scattering, zeta potential measurements, SEM and EDS identified that adding fluoride anions to CSS is able to form stable hydrogels of a thixotropic nature, while Cl-, Br- and I- lead to precipitation. The self-assembly process proceeds using a narrow concentration range of F-. An increase in the fluoride anion content in the system leads to a change in the gel network morphology from elongated structures to spherical ones. This fact is reflected in a decrease in the gel viscosity and a number of gel-sol-gel transition cycles. The mechanism of F-'s interaction with hydrosol includes the condensation of anions on the positive surface of the CSS nanoparticles, their binding via electrostatic forces and the formation of a resulting gel carcass. In vitro analysis showed that the hydrogels suppressed human squamous carcinoma cells at a micromolar sample concentration. The obtained soft gels could have potential applications against cutaneous malignancy and as carriers for fluoride anion and other bioactive substance delivery.

Cysteine-Silver-Polymer Systems for the Preparation of Hydrogels and Films with Potential Applications in Regenerative Medicine.

Herein, the problem concerning the poorer mechanical properties of gels based on low molecular weight gelators (LMWGs)-L-cysteine and silver nitrate-was solved by the addition of various polymers-polyvinyl alcohol (PVA), polyvinyl pyrrolidone (PVP) and polyethylene glycol (PEG)-to the initial cysteine-silver sol (CSS). The physicochemical methods of analysis-viscosimetry, UV spectroscopy, DLS, and SEM-identified that cysteine-silver hydrogels (CSG) based on PVA possess the best rheological properties and porous microstructure (the average pore size is 2-10 µm) compared to gels without the polymer or with PVP or PEG. Such gels are able to form cysteine-silver cryogels (CSC) and then porous cysteine-silver films (CSF) with an average pore size of 10-20 µm and good mechanical, swelling, and adhesion to skin characteristics as long as the structure of CSS particles remains stable. In vitro experiments have shown that hydrogels are non-toxic to normal human fibroblast cells. The obtained materials could potentially be applied to regenerative medicine.

L-Cysteine and N-acetyl-L-cysteine-mediated synthesis of nanosilver-based sols and hydrogels with antibacterial and antibiofilm properties.

The need of the synthesis of a new generation of medicines aimed at combating bacteria and biofilms that cause various infections is a great urgency. There has been a gradual decrease in the conventional techniques of treatment with the use of antibiotics. Consequently, much effort has focused on the search for new methods and approaches to obtain antibacterial drugs and determine their rational use such that microorganisms do not acquire resistance. Although silver nanoparticles (AgNPs) and silver nanoclusters (AgNCs) have exhibited certain levels of effectiveness against multidrug-resistant bacteria and biofilms, there are very few simple, cheap and easy-to-scale methods to obtain AgNPs and AgNCs with well-desired characteristics. In this study, we carried out the one-pot synthesis of sols and gels containing AgNPs and AgNCs using only L-cysteine (CYS) or N-acetyl-L-cysteine (NAC), as bioreducing/capping/gel-forming agents, and different silver salts - nitrate, nitrite and acetate. HRTEM, SAED, EDX mapping, AFM, SEM, EDX, ICP-MS and FTIR spectroscopy analysis confirmed the formation of spherical/elliptical CYS-AgNP and NAC-AgNC particles consisting of AgNPs or AgNCs "core" and CYS/Ag+ or NAC/Ag+ complexes "shell" with mean average diameters of 10 and 5 nm, respectively. UV-Vis spectroscopy fixed the localized surface plasmon resonance (LSPR) at 390-420 nm for the CYS-AgNPs systems and LSPR absence for the NAC-AgNCs ones. DLS and nanoparticle tracking analysis (NTA) data indicated that the mean average diameter of the particles is about 80 nm for the CYS-AgNPs systems and 20 nm for the NAC-AgNCs ones. The Zeta potential measurements showed that the particles possess positive and negative charge values for CYS-AgNPs and NAC-AgNCs systems, respectively. The prepared materials demonstrated the high antibacterial activity against the most common types of bacteria at the MIC range of 10-100 µM, wherein the effect of the NAC-AgNCs systems is 2 times stronger than that of the CYS-AgNPs ones. Both systems are non-toxic or have low-toxicity at 300 µM for normal human cells: erytrocytes, fibroblasts and macrophages. Sols and hydrogels in the concentration range of 20-40 µM showed the complete inhibition of the formation of biofilms from Acinetobacter baumannii and Pseudomonas aeruginosa, which belong to the ESKAPE pathogenes group and represent the most serious problem in practical medicine. NAC-AgNCs systems were the most active. The simple strategy of the preparation of AgNP/AgNC-based sols and gels, along with their pronounced antibacterial and antibiofilm activity, could open new perspectives for its applications in medicine.

Incidence, predictors, and 30-day outcomes of Clostridioides difficile infection in patients undergoing cystectomy: A national database analysis.

Clostridioides difficile infection (CDI) is the second most common health care acquired infection (HAI) and the most common gastrointestinal HAI, with an estimated 365,200 cases reported by the center for disease control in 2017. CDI continues to remain a major cause of inpatient admission and utilization of health care resources. This study aimed to determine the true incidence, risk factors, and outcomes of CDI in patients undergoing cystectomy. We conducted an analysis of patients undergoing cystectomy between 2015 and 2017 using the American college of surgeon National Surgical Quality Improvement Program to study the incidence, risk factors, and 30 day postsurgical outcomes associated with CDI following cystectomy. Developed by the American College of Surgery, this is a nationally validated, risk adjusted, and outcomes based program designed to determine and improve the quality of surgical and postsurgical care. The incidence of CDI following cystectomy was 3.6% in our patient cohort. About 18.8% of patients developed CDI following hospital discharge. None elective surgeries and complete cystectomy procedures had a higher rate of CDI. About 48.4% of patients with CDI had a preceding postoperative infection. Postoperative organ space infections, postoperative renal failure, postoperative sepsis, and septic shock were independently associated with the development of CDI, (all P < 0.05). Patients who developed postoperative CDI during hospitalization had lengthier hospital admissions than those who did not develop a CDI and had a higher risk of deep venous thrombosis formation. A sizable number of patients experience CDIs after cystectomy procedures in the USA, and CDI development is associated with an increase in length of stay and unplanned readmissions. Interventions and initiatives are needed to reduce this burden of disease.

Cancer in Kashmir Valley: Current trends, burden and pattern.

BACKGROUND: There is an overall surge of malignancies in most of the developing countries including India. Dearth of data from Kashmir prompted us to embark upon a study on burden and pattern of cancer in Kashmir over previous 5 years. METHODS: Data acquisition from January 2016 to December 2020 was accomplished from the departmental archives of a large tertiary care institute of Kashmir valley. All histologically proven malignant cases were included for the present study. Information regarding the age, gender, site of primary malignancy and histological diagnosis was obtained. RESULTS: A total of 5,392 cases of malignancies were considered for final analysis with a mean age at diagnosis of 56.73 years (SD = 15.96). Maximum number of cases were recorded in the age group of 60-69 years. Maximum number of malignancies were encountered in year 2018 with substantial drop in subsequent years. Gastrointestinal malignancies constitute more than one-third of total number of malignancies across both genders. In males, stomach was the common site of malignancy followed by lung and colorectal region whereas in females most common sites were breast, colorectal, and stomach. CONCLUSION: This study portrays close reflection of the cancer patterns within the valley in recent years which is strikingly different from rest of the country and world.

Synthesis and Biological Evaluation of New Isoxazolyl Steroids as Anti-Prostate Cancer Agents.

Steroids with a nitrogen-containing heterocycle in the side chain are known as effective inhibitors of androgen signaling and/or testosterone biosynthesis, thus showing beneficial effects for the treatment of prostate cancer. In this work, a series of 3ß-hydroxy-5-ene steroids, containing an isoxazole fragment in their side chain, was synthesized. The key steps included the preparation of Weinreb amide, its conversion to acetylenic ketones, and the 1,2- or 1,4-addition of hydroxylamine, depending on the solvent used. The biological activity of the obtained compounds was studied in a number of tests, including their effects on 17α-hydroxylase and 17,20-lyase activity of human CYP17A1 and the ability of selected compounds to affect the downstream androgen receptor signaling. Three derivatives diminished the transcriptional activity of androgen receptor and displayed reasonable antiproliferative activity. The candidate compound, 24j (17R)-17-((3-(2-hydroxypropan-2-yl)isoxazol-5-yl)methyl)-androst-5-en-3ß-ol, suppressed the androgen receptor signaling and decreased its protein level in two prostate cancer cell lines, LNCaP and LAPC-4. Interaction of compounds with CYP17A1 and the androgen receptor was confirmed and described by molecular docking.

Short-term rapamycin treatment increases life span and attenuates aortic aneurysm in a murine model of Marfan-Syndrome.

BACKGROUND: Marfan syndrome (MFS) is a genetic disorder leading to medial aortic degeneration and life-limiting dissections. To date, there is no causal prevention or therapy. Rapamycin is a potent and selective inhibitor of the mechanistic target of rapamycin (mTOR) protein kinase, regulating cell growth and metabolism. The mgR/mgR mice represent an accepted MFS model for studying aortic pathologies to understand the underlying molecular pathomechanisms. This study investigated whether rapamycin inhibits the development of thoracic aortic aneurysms and dissections in mgR/mgR mice. METHODS: Isolated primary aortic smooth muscle cells (mAoSMCs) from mgR/mgR mice were used for in vitro studies. Two mg kg/BW rapamycin was injected intraperitoneally daily for two weeks, beginning at 7-8 weeks of age. Mice were sacrificed 30 days post-treatment. Histopathological and immunofluorescence analyses were performed using adequate tissue specimens and techniques. Animal survival was evaluated accompanied by periodic echocardiographic examinations of the aorta. RESULTS: The protein level of the phosphorylated ribosomal protein S6 (p-RPS6), a downstream target of mTOR, was significantly increased in the aortic tissue of mgR/mgR mice. In mAoSMCs isolated from these animals, expression of mTOR, p-RPS6, tumour necrosis factor α, matrix metalloproteinase-2 and -9 was significantly suppressed by rapamycin, demonstrating its anti-inflammatory capacity. Short-term rapamycin treatment of Marfan mice was associated with delayed aneurysm formation, medial aortic elastolysis and improved survival. CONCLUSIONS: Short-term rapamycin-mediated mTOR inhibition significantly reduces aortic aneurysm formation and thus increases survival in mgR/mgR mice. Our results may offer the first causal treatment option to prevent aortic complications in MFS patients.

Clinical Laboratory Results as Prognosis Marker in Advanced Stage Non-small Cell Lung Cancer (NSCLC) in Indonesia.

BACKGROUND: Lung cancer is the most common cause of cancer-related death among men in the world. Given the very high mortality caused by lung cancer, a biological marker to determine a more sensitive therapy among non-small cell lung cancer (NSCLC) patients is needed. This study aims to demonstrate that the clinical laboratory result can be a prognosis marker in NSCLC patients in Indonesia. METHODS: This study was a retrospective cohort study. The sample was obtained from the patient's serum and the examined routine blood test (hemoglobin, leukocyte, platelets), hemostasis (fibrinogen and D-dimers), blood chemistry test (aspartate transaminase [AST], alanine transaminase [ALT], albumin, urea, creatinine, and blood glucose), electrolyte (sodium, potassium, chloride, and calcium) and tumor markers (carcinoembryonic antigen [CEA] and Cyfra 21-1). Data were analyzed and interpreted using SPSS (IBM Corp., Armonk, NY, USA). Analysis of the data was done to find the survival rate of sociodemographic variables, clinicopathologic variables, and clinic laboratory variables. RESULTS: The study findings showed statistically significant results that were poor prognosis for these following conditions: performance status (PS) 3-4 median survival (MS):26 days, p=<0.001; TNM stage IVb MS:58 days, p=0.001; high leukocyte MS:69 days, p=0.018; low platelet MS:50 days, p=0.013; high D-dimer MS:69 days, p=0.020; low albumin MS:56 days, p=0.001; high sodium MS:15 days, low sodium MS:50 days, p=<0.001; high chloride MS:15 days, low chloride MS:27 days, p=<0.001. CONCLUSION: In the advanced stage NSCLC, these findings indicate poorer prognoses; PS 3-4, IVb clinical stage, leukocytosis, thrombocytopenia, hyper-coagulopathy, hypoalbuminemia, hyper-hyponatremia, and hyper-hypochloremia. Further studies regarding the correlation between clinical laboratory and survival rate are needed.

L-Cysteine as a reducing/capping/gel-forming agent for the preparation of silver nanoparticle composites with anticancer properties.

The present article reports the in situ preparation of silver nanoparticles (AgNPs) homogeneously distributed in the gel matrix formed using only L-cysteine (CYS) as a bio-reducing agent. The physicochemical methods of analysis confirmed the formation of a gel-network from aggregates consisting of spherical/elliptical cystine-stabilized AgNPs (core) and cysteine/Ag+ complexes (shell) regardless of the used silver salt - AgNO3, AgNO2 or AgOOCCH3. CYS/AgNO3 and CYS/AgOOCCH3 aqueous solution systems needed the addition of electrolytes (Cl- and SO42-) for the gelation process, but the gel-formation in CYS/AgNO2 occurred in one stage without any additional components. The AgNP sizes were about 1-5 nm in diameter for CYS/AgNO3, 5-10 nm for CYS/AgOOCCH3 and 20-40 nm for CYS/AgNO2 systems. The zeta-potential values varied from +60 mV for CYS/AgNO3 to +25 mV for the CYS/AgNO2 system. The MTT-test showed that the obtained composites suppressed the MCF-7 breast cancer cells and the CYS/AgNO3 system possessed the highest activity. Flow cytofluorimetry confirmed that the cell death occurred by apoptosis and this effect was the strongest for the CYS/AgNO3 system. All systems were non-toxic to fibroblast cells. The novel simplest "green chemistry" approach, combining the knowledge of organic, inorganic, physical and supramolecular chemistry could open possibilities for the creation of the newest soft gel materials used in various fields of our life.

The role of clopidogrel resistance-related genetic and epigenetic factors in major adverse cardiovascular events among patients with acute coronary syndrome after percutaneous coronary intervention.

Despite patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) and receiving clopidogrel therapy, some patients still experience major adverse cardiovascular events (MACEs). Clopidogrel resistance, which may be regulated by genetic and epigenetic factors, may play a role in MACEs. This study aimed to determine the association between genetic (CYP2C19 and P2Y12 polymorphisms) and epigenetic (DNA methylation of CYP2C19 and P2Y12 and miRNA-26a expression) factors and their effects on MACEs among post-PCI patients. Post-PCI patients who received a standard dosage of clopidogrel at Harapan Kita Hospital between September 2018 and June 2020 were included in this study. MACEs were observed in patients within 1 year after PCI. Platelet aggregation was assessed using light transmission aggregometry (LTA). DNA methylation of CYP2C19 and P2Y12 was assessed using the bisulfite conversion method. CYP2C19 and P2Y12 polymorphisms and miRNA-26a expression were evaluated using quantitative real-time polymerase chain reaction (qRT-PCR). Among a total of 201 subjects, 49.8% were clopidogrel-resistant, and 14.9% experienced MACEs within 1 year after PCI (death was 7.5%). Hypomethylation of CYP2C19 (p = 0.037) and miRNA-26a upregulation (p = 0.020) were associated with clopidogrel resistance. CYP2C19*2/*3 polymorphisms (p = 0.047) were associated with MACEs in 1 year. This study demonstrated that hypomethylation of CYP2C19 and miRNA-26a upregulation increased the risk of clopidogrel resistance in post-PCI patients, but there was no correlation between clopidogrel resistance and MACEs. However, CYP2C19*2/*3 polymorphisms were the factors that predicted MACEs within 1 year.

Outcomes of SARS-CoV-2 infection in patients with cystic fibrosis: A multicenter retrospective research network study.

BACKGROUND: In this study, we report clinical outcomes in COVID-19 infection in a large cohort of people with cystic fibrosis (pwCF) and compare these outcomes to a propensity score matched cohort of people without CF. METHODS: Analysis of a multicenter research network TriNETX was performed including patients more than 16 years of age diagnosed with COVID-19. Outcomes in COVID-19 positive pwCF were compared with a propensity-matched cohort of people without CF. RESULTS: A total of 507,810 patients with COVID-19 were included (422 patients, 0.08% with CF; 507,388 patients, 99.92% without CF. Mean age at COVID-19 diagnosis in CF cohort was 46.6 ± 19.3 years, with female predominance (n = 225, 53.32%). Majority of the participants were Caucasian (n = 309, 73.22%). In the crude, unmatched analysis, mortality, hospitalization, critical care need, mechanical ventilation, acute kidney injury and composite (combination of intubation and mortality) outcome at 30 days was higher in the pwCF. Following robust propensity matching, pwCF had higher hospitalization rate (RR 1.56, 95% CI 1.20-2.04), critical care need (RR 1.78, 95% CI 1.13-2.79), and acute renal injury (RR 1.60, 95% CI 1.07-2.39) as compared to patients without CF. CONCLUSION: People with CF are at risk of poor outcomes with COVID-19.5.2% of these patients died within one month of COVID-19 diagnosis, and more than one in 10 patients required critical care. Therefore, the relatively young median age of cystic fibrosis patients, and lower prevalence of obesity do not protect these patients from severe disease contrary to prior reports.

An older male with an unusual presentation of disseminated coccidioidomycosis.

Coccidioidomycosis is a fungal disease endemic to the southwestern United States and other areas in the Western Hemisphere. Infection is usually acquired through inhalation. While infection is most often asymptomatic, early respiratory illness and infrequently extrapulmonary dissemination may occur. Immunocompromised individuals, particularly those with impaired cell-mediated immunity, are at greatest risk for dissemination. We present an atypical case of disseminated coccidioidomycosis in an immunocompetent male manifesting as peritoneal disease diagnosed during elective inguinal herniorrhaphy.

Delays in lumbar puncture are independently associated with mortality in cryptococcal meningitis: a nationwide study.

BACKGROUND: Cryptococcal meningitis (CM) is the most serious presentation of invasive cryptococcosis. Seen in patients with and without HIV infection, CM is associated with significant morbidity and mortality. Early lumbar puncture is a cornerstone of treatment in cryptococcal meningitis. We present findings from a nationwide analysis of patients admitted with CM in the United States between 2007 and 2016, with the aim of determining the impact of delays in lumbar puncture on inpatient outcomes. METHODS: The national inpatient sample (NIS) database was queried for all inpatient visits for cryptococcal meningitis between January 2007 and December 2016. Logistic regression models were used to determine risk factors for inpatient mortality, prolonged admissions, and delays in obtaining an initial lumbar puncture. RESULTS: The annual number of admissions for CM decreased during the study interval, from 3590 in 2007 to 2830 in 2016. Mortality did not change over this period (9.9%); however, length of stay and inpatient cost significantly increased. The proportion of patients with HIV declined from 70.7% to 54.0%. Delay in lumbar puncture beyond the first 24 h was independently associated with mortality (OR = 1.55, CI = 1.31-1.82, p-value <.001). Patients admitted on a weekend, those of African-American ethnicity, and those without a known history of HIV were more likely to have delays in obtaining an early LP. HIV patients had a lower risk of mortality (OR = 0.77, CI = 0.68-0.86, p-value <.001). CONCLUSION: We found an independent association of delay in early lumbar puncture with worsened patient outcomes. Inpatient mortality for patients with CM continues to remain high, with an increasing proportion of patients without underlying HIV infection. There were significant deviations in management of CM from Infectious Diseases Society of America (IDSA) guidelines.

Experience with negative-pressure wound therapy with instillation in complex infected orthopaedic wounds.

Chronic exudative wounds are frequently seen in hospitalised patients, consuming hospital resources and leading to increased morbidity. Negative-pressure therapy (NPWT) with topical instillation "NPWTi" may be used to improve the wound healing process, with the unique features (removal of wound exudate, edema reduction, promotion of tissue perfusion and granulation tissue formation, as well as drawing the edges of the wound to facilitate, in addition to the cyclic cleansing mechanism). This report is a descriptive study of our experience with NPWTi on complex infected orthopaedic wounds as a potential method to decrease the need for multiple surgical debridements required for the closure of such wounds. A prospective observational study was conducted. Twenty patients with complex infected orthopaedic wounds were enrolled in our study. These patients were consulted by the Bone and Joint Infection Service and enrolled to receive NPWTi intraoperatively and to be used during their inpatient stay. Twenty patients with 20 complex infected lower limb wounds were included in our study. Of all the 20 wounds, the etiology was post-surgical in 80% (n = 16) and post-traumatic in 20% (n = 4). None of the patients received previous treatment with conventional NPWT before participation in the study. There were 11 males (55%) and 9 females (45%) with an average age of 57 years (22-83). All wounds were located in the lower limbs, with 25% leg (n = 5), 20% thigh (n = 4), 20% knee (n = 4), 20% foot (n = 4), 10% heel (n = 2), and 5% ankle (n = 1). The average length of treatment with NPWTi was 5.2 days (2-10). Successful wound closure within 6 weeks was achieved in 65% of the cases (n = 13). Of the closed wounds (n = 13), 54% (n = 7) were closed primarily and 46% (n = 6) were closed by secondary procedures (skin graft or skin flap). NPWTi is still considered a novel technique that can be used in the management of complex wounds, and the goal of this prospective study is to report our experience with NPWTi in the management of complex infected orthopaedic lower limb wounds. Randomised control studies with optimally matched wounds comparing NPWTi to the conventional methods of treatment are warranted.

Neurotized free VRAM used to create myoelectric signals in a muscle-depleted area for targeted muscle reinnervation for intuitive prosthesis control: A case report.

Targeted muscle reinnervation enables native muscles to send electromyographic signals to myoelectric receptors, which drive movements in a prosthesis. This system requires voluntary contracture of muscles for sequential control of powered prosthetic joints. This report describes a surgical solution for cases where the chest wall is depleted of muscle targets. A 13-year-old boy with left forequarter amputation and pectoralis major resection as a result of extended necrotizing facilities 8 years prior received a neurotized free Vertical Rectus Abdominus Mycocutaneous (VRAM) flap (28 × 10 cm) designed to produce myoelectric signals, reduce pain, and provide stability for prosthetic fitting. Five intercostal nerves from the VRAM were coapted to portions of the brachial plexus to create a myoelectric interface for targeted muscle reinnervation. The postoperative course was uneventful. At 39 months of follow-up, the patient gained control of the transferred VRAM and was able to operate a custom-fitted myoelectric prosthesis together with contraction of the ipsilateral infraspinatus muscle. The neurotized VRAM transfer created a neural interface in an area with depleted neuromuscular targets while decreasing pain and adding tissue bulk for proper prosthesis fitting. Such a surgical strategy may have applications in other areas of the body.

Late Prosthetic Valve Infective Endocarditis by Enterococcus durans.

Enterococcus durans is an extremely rare cause of infective endocarditis. We have reported the first case where a 56-year-old female presented with late prosthetic valve infective endocarditis on a mechanical mitral valve. Medical management failed and eventually lead to the demise of the patient.

L-Cysteine/AgNO2 low molecular weight gelators: self-assembly and suppression of MCF-7 breast cancer cells.

We report a new supramolecular hydrogel based on simple amino acids and silver salt compounds with low molecular weights. The in situ formation of silver nanoparticles during the self-assembly process endows the hydrogel with high cytotoxicity towards adenocarcinoma breast cells but no toxic effects towards embryonic fibroblasts.

The Indonesian Version of the Exercise Self-Efficacy Scale: Cross-cultural Adaptation and Psychometric Testing.

PURPOSES: The study aimed to translate the Exercise Self-Efficacy Scale (ESES) into Indonesian and test the cultural equivalence, reliability, and validity of the new version for university students. METHODS: The cross-sectional study recruited 379 Indonesian university students using convenience sampling. Phase 1, a culturally appropriate version of the ESES was developed in the Indonesian language. Phase 2, the psychometric properties were determined through exploratory factor analysis, bootstrap factor analysis, and confirmatory factor analysis. The internal consistency reliability was tested using Cronbach's α, whereas the stability using intraclass correlation coefficient to assess. RESULTS: The students' ages ranged from 17 to 39 years, and 65.0% were women. For translation equivalence, the mean item content validity indexes ranged from 3.5 to 4, and all items were understandable. The 16-item scale exhibited cross-cultural appropriateness and readability, with a three-factor model explaining 62.3% of the variance in exercise self-efficacy. A bootstrap analysis using 100 resamples further confirmed the three-factor model. The indices of the good-fit model that used the three-factor by two-stage least squares method were satisfactory, with χ2/df = 3.3, goodness of fit index = .88, and root mean-square error of approximation = .05 (p < .001). The Cronbach's α was .78, .80, and .92 for factors 1, 2, and 3, respectively. The test--retest reliability was demonstrated with an intraclass correlation coefficient of .91, indicating adequate measurement stability. CONCLUSION: The 16-item ESES-I has acceptable validity and reliability; however, a broader application of the scale requires further testing in different populations to confirm its external validity.