A phase II randomized, double-blind, placebo-controlled study of Nuvastatic (C50SEW505OESA), a standardized rosmarinic acid-rich polymolecular botanical extract formulation to reduce cancer-related fatigue in patients with solid tumors.

AIM: We evaluated the efficacy and safety of Nuvastatic™ (C5OSEW5050ESA) in improving cancer-related fatigue (CRF) among cancer patients. METHODS: This multicenter randomized double-blind placebo-controlled phase 2 trial included 110 solid malignant tumor patients (stage II-IV) undergoing chemotherapy. They were randomly selected and provided oral Nuvastatic™ 1000 mg (N = 56) or placebo (N = 54) thrice daily for 9 weeks. The primary outcomes were fatigue (Brief Fatigue Inventory (BFI)) and Visual Analog Scale for Fatigue (VAS-F)) scores measured before and after intervention at baseline and weeks 3, 6, and 9. The secondary outcomes were mean group difference in the vitality subscale of the Medical Outcome Scale Short Form-36 (SF-36) and urinary F2-isoprostane concentration (an oxidative stress biomarker), Eastern Cooperative Oncology Group scores, adverse events, and biochemical and hematologic parameters. Analysis was performed by intention-to-treat (ITT). Primary and secondary outcomes were assessed by two-way repeated-measures analysis of variance (mixed ANOVA). RESULTS: The Nuvastatic™ group exhibited an overall decreased fatigue score compared with the placebo group. Compared with the placebo group, the Nuvastatic™ group significantly reduced BFI-fatigue (BFI fatigue score, F (1.4, 147) = 16.554, p < 0.001, partial η2 = 0.333). The Nuvastatic™ group significantly reduced VAS-F fatigue (F (2, 210) = 9.534, p < 0.001, partial η2 = 0.083), improved quality of life (QoL) (F (1.2, 127.48) = 34.07, p < 0.001, partial η2 = 0.243), and lowered urinary F2-IsoP concentrations (mean difference (95% CI) = 55.57 (24.84, 86.30)), t (55) = 3.624, p < 0.001, Cohen's d (95% CI) = 0.48 (0.20, 0.75)). Reported adverse events were vomiting (0.9%), fever (5.4%), and headache (2.7%). CONCLUSION: Nuvastatic™ is potentially an effective adjuvant for CRF management in solid tumor patients and worthy of further investigation in larger trials. TRIAL REGISTRATION: ClinicalTrial.gov ID: NCT04546607. Study registration date (first submitted): 11-05-2020.

A rare presentation of retroperitoneal liposarcoma presented with jejunal intussusception: An interesting radiological findings.

A jejunal intussusception as a presentation of retroperitoneal liposarcoma (RLPS) is a rare occurrence. The majority of RLPS are presented as an abdominal mass, however, having a jejunal obstruction is an interesting case. The aim is to describe the management of jejunal intussusception secondary to atypical lipomatous tumours with concurrent RLPS. A 61-year-old lady presented with a sudden onset of intestinal obstruction with 1 month of constitutional symptoms and an enlarging right lumbar mass. Computed tomography showed a small bowel intussusception with diffuse peritoneal and retroperitoneal lipomatosis. Emergency exploratory laparotomy, segmental bowel resection, and partial excision of intraperitoneal mesenteric lipoma were performed. A stage En-bloc resection of the RLPS and right nephrectomy was done later. However, she refused for subsequent surgery. A complete resection is the gold standard in managing RLPS. In this report, the management is rendered not to the standard as the patient first presented with intestinal obstruction requiring emergency reduction with a piecemeal resection. A stage surgery was required to determine a promising prognosis, but the patient refused such surgery. A small bowel intussusception in adults is rare but is mostly caused by a tumor or neoplasm. Early recognition of the complexity of the case should be preempted and referred to the tertiary team for further definitive surgery. Patient exhaustion from the subsequent surgery might hamper the only management available for the case.

Powder Bed Fusion 3D Printing in Precision Manufacturing for Biomedical Applications: A Comprehensive Review.

Precision manufacturing requirements are the key to ensuring the quality and reliability of biomedical implants. The powder bed fusion (PBF) technique offers a promising solution, enabling the creation of complex, patient-specific implants with a high degree of precision. This technology is revolutionizing the biomedical industry, paving the way for a new era of personalized medicine. This review explores and details powder bed fusion 3D printing and its application in the biomedical field. It begins with an introduction to the powder bed fusion 3D-printing technology and its various classifications. Later, it analyzes the numerous fields in which powder bed fusion 3D printing has been successfully deployed where precision components are required, including the fabrication of personalized implants and scaffolds for tissue engineering. This review also discusses the potential advantages and limitations for using the powder bed fusion 3D-printing technology in terms of precision, customization, and cost effectiveness. In addition, it highlights the current challenges and prospects of the powder bed fusion 3D-printing technology. This work offers valuable insights for researchers engaged in the field, aiming to contribute to the advancement of the powder bed fusion 3D-printing technology in the context of precision manufacturing for biomedical applications.

A peculiar case of intususception in a pregnant woman: A diagnostic challenge.

Adult intussusception presents a diagnostic challenge given its non-specific symptoms. It is not as common as in infants and young children. Traditionally, diagnostic steps are invariably fit for normal adults, but not in pregnancy which faces certain limitations. A 40-year-old pregnant mother, gravida 9 para 8 at 34-week gestation, complained of intermittent epigastric pain for 2 days, requiring hospitalization. She soon developed minimal per rectal bleeding that was ruled out as hemorrhoid. Imaging was limited due to her pregnancy status. She later developed spontaneous delivery to a premature baby. Computed tomography (CT) revealed an ileocolic intussusception, which was confirmed via exploratory laparotomy. Histology was consistent with inflammatory fibroid polyp. Acute abdomen in pregnancy can be due to various causes, thus a high index of suspicion and early CT abdomen might help in early diagnosis and treatment. The benefit of doing CT on the mother and the risk of CT on the fetus is to be weighed as the timely diagnosis can prevent bowel ischemia and reduce maternal morbidity and mortality. Surgery remains the definite management in adult intussusception and an exact diagnosis can be made during the operation.

Comparison of the effect of vitamin C and selenium nanoparticles on gentamicin-induced renal impairment in male rats: a biochemical, molecular and histological study.

Renal failure caused by gentamicin is mainly mediated through oxidative damage, inflammation, and apoptosis. Hence, vitamin C and selenium, which have antioxidant, anti-inflammatory, and anti-apoptotic properties, and their nanoparticle forms, which have recently received attention, may reduce gentamicin-induced side effects. Therefore, the aim of this study was to investigate the therapeutic effects of vitamin C and selenium, and their nanoparticles on gentamicin-induced renal damage in male rats. 128 adult male Wistar rats were randomly divided into equal sixteen controlled and treated groups. Serum levels of uric acid, blood urea nitrogen, urea, and creatinine were measured. Renal levels of oxidative parameters such as MDA, SOD, and CAT and inflammatory parameters including IL-1ß, and TNF-α were measured. Renal expression of Nrf2, NF-κB, Bcl-2, caspase-3, BAX and mTORc1 was also evaluated. The results showed that gentamicin causes oxidative damage, inflammation, apoptosis and disruption of autophagy in kidney tissue in a dose-dependent manner. However, treatment with vitamin C, selenium and their nanoparticles could significantly improve these effects. Also, the results showed that the inflammatory and oxidative parameters and the expression of genes involved in them and apoptosis in the gentamicin groups treated with vitamin C nanoparticles and selenium nanoparticles reduced significantly compared to those treated with vitamin C and selenium. It can be concluded that vitamin C, selenium and their nanoparticles can improve gentamicin-induced kidney damage by inhibiting oxidative damage, inflammation and apoptosis-induced by autophagy, and can be a good option for kidney damage caused by gentamicin or as an adjunctive treatment to reduce its side effects.

Rare Coincidence of Gallbladder Perforation in Blunt Traumatic Injury: A Case Report

@#Traumatic gallbladder perforation is an unusual but potentially life-threatening injury that can occur following blunt or penetrating abdominal trauma. A 46-year-old male presented to the emergency department following a motor vehicle accident (MVA). He complained of severe abdominal pain and sustained ecchymosis with localized tenderness over the right upper quadrant. Despite a positive focused assessment with sonography in trauma scan, initial computed tomography of the abdomen revealed grade 1 liver and splenic injury but was unable to identify gallbladder perforation. He was initially managed conservatively until he developed secondary signs of sepsis after 24 hours. An exploratory laparotomy revealed a perforated gallbladder. A subtotal cholecystectomy was done. A retrospective review revealed a missed gallbladder perforation from an earlier CT scan assessment. We report a case of missed gallbladder perforation following MVA which was only diagnosed intraoperatively after failing non-operative management, following which the patient underwent laparotomy and subtotal cholecystectomy.

Effect of Cyrtostachys renda Fiber Loading on the Mechanical, Morphology, and Flammability Properties of Multi-Walled Carbon Nanotubes/Phenolic Bio-Composites.

This research focuses on evaluating the effect of Cyrtostachys renda (CR) fiber and the impact of adding multi-walled carbon nanotubes (MWCNT) on the morphological, physical, mechanical, and flammability properties of phenolic composites. MWCNT were supplemented with phenolic resin through a dry dispersion ball milling method. Composites were fabricated by incorporating CR fiber in 0.5 wt.% MWCNT-phenolic matrix by hot pressing. Nevertheless, the void content, higher water absorption, and thickness swelling increased with fiber loading to the MWCNT/phenolic composites. The presence of MWCNT in phenolic enhanced the tensile, flexural, and impact strength by as much as 18%, 8%, and 8%, respectively, compared to pristine phenolic. The addition of CR fiber, however, strengthened MWCNT-phenolic composites, improving the tensile, flexural, and impact strength by as much as 16%, 16%, and 266%, respectively, for 50 wt.% loading of CR fiber. The CR fiber may adhere properly to the matrix, indicating that there is a strong interface between fiber and MWCNT-phenolic resin. UL-94 horizontal and limiting oxygen index (LOI) results indicated that all composite materials are in the category of self-extinguishing. Based on the technique for order preference by similarity to the ideal solution (TOPSIS) technique, 50 wt.% CR fiber-reinforced MWCNT-phenolic composite was chosen as the optimal composite for mechanical and flammability properties. This bio-based eco-friendly composite has the potential to be used as an aircraft interior component.

Testing of Silicon Rubber/Montmorillonite Nanocomposite for Mechanical and Tribological Performance.

Nanocomposite made by blending nano-montmorillonite (MMT) and Silicon Rubber (SR) for mechanical and tribological performance is explored in this work. Different configurations of MMT/SR nanocomposite, with 0, 0.5, 2 and 5 wt % of MMT are manufactured by two roll mixing methods. Noticeable improvement in the mechanical and tribological performance is observed, which is also justified by a morphological study of fractured and wear surfaces through SEM. Two percent of MMT loading is found to be the optimum content that shows excellent performance compared to other compositions. The performance improvement can be linked to the good interfacial interaction between the MMT and SR. Statistical modeling through ANOVA is carried out for tribological performance, which reveals the influence of load on the coefficient of friction (COF) and the influence of sliding distance on the wear rate.

Physical, Mechanical, and Morphological Properties of Hybrid Cyrtostachys renda/Kenaf Fiber Reinforced with Multi-Walled Carbon Nanotubes (MWCNT)-Phenolic Composites.

Adequate awareness of sustainable materials and eco-legislation have inspired researchers to identify alternative sustainable and green composites for synthetic fiber-reinforced polymer composites in the automotive and aircraft industries. This research focused on investigating the physical, mechanical, and morphological properties of different hybrid Cyrtostachys renda (CR)/kenaf fiber (K) (10C:0K, 7C:3K, 5C:5K, 3C:7K, 0C:10K) reinforced with 0.5 wt% MWCNT-phenolic composites. We incorporated 0.5 wt% of MWCNT into phenolic resin (powder) using a ball milling process for 25 h to achieve homogeneous distribution. The results revealed that CR fiber composites showed higher voids content (12.23%) than pure kenaf fiber composites (6.57%). CR fiber phenolic composite was more stable to the swelling tendency, resulting in the lowest percentage of swelling rate (4.11%) compared to kenaf composite (5.29%). The addition of kenaf fiber into CR composites had improved the tensile, flexural, and impact properties. The highest tensile and flexural properties were found for weight fraction of CR and kenaf fiber at 5C:5K (47.96 MPa) and 3C:7K (90.89 MPa) composites, respectively. In contrast, the highest impact properties were obtained for 0C:10K composites (9.56 kJ/m2). Based on the FE-SEM image, the CR fiber lumen was larger in comparison to kenaf fiber. The lumen of CR fiber was attributed to higher void and water absorption, lower mechanical properties compared to kenaf fiber. 5C:5K composite was selected as an optimal hybrid composite, based on the TOPSIS method. This hybrid composite can be used as an interior component (non-load-bearing structures) in the aviation and automotive sectors.

Low-Velocity Impact Analysis of Pineapple Leaf Fiber (PALF) Hybrid Composites.

The low-velocity impact behaviour of pineapple leaf fiber, PALF reinforce epoxy composite (P), PALF hybrid (GPG), and four-layer woven glass fiber (GGGG) composite was investigated. As for post-impact analysis, the damage evaluation was assessed through photographic images and X-ray computed tomography, using CT scan techniques. The key findings from this study are that a positive hybrid effect of PALF as a reinforcement was seen where the GPG shows the delayed time taken for damage initiation and propagation through the whole sample compared to GGGG. This clearly shows that the addition of fibers does have comparable composite properties with a fully synthetic composite. Through the visual inspection captured by photographic image, the presence of woven fiber glass mat in GPG presents a different damage mode compared to P. Moreover, CT scan results show extended internal damage at the cross-section of all impacted composite.

Investigations on the Mechanical Properties of Glass Fiber/Sisal Fiber/Chitosan Reinforced Hybrid Polymer Sandwich Composite Scaffolds for Bone Fracture Fixation Applications.

This study aims to explore the mechanical properties of hybrid glass fiber (GF)/sisal fiber (SF)/chitosan (CTS) composite material for orthopedic long bone plate applications. The GF/SF/CTS hybrid composite possesses a unique sandwich structure and comprises GF/CTS/epoxy as the external layers and SF/CTS/epoxy as the inner layers. The composite plate resembles the human bone structure (spongy internal cancellous matrix and rigid external cortical). The mechanical properties of the prepared hybrid sandwich composites samples were evaluated using tensile, flexural, micro hardness, and compression tests. The scanning electron microscopic (SEM) images were studied to analyze the failure mechanism of these composite samples. Besides, contact angle (CA) and water absorption tests were conducted using the sessile drop method to examine the wettability properties of the SF/CTS/epoxy and GF/SF/CTS/epoxy composites. Additionally, the porosity of the GF/SF/CTS composite scaffold samples were determined by using the ethanol infiltration method. The mechanical test results show that the GF/SF/CTS hybrid composites exhibit the bending strength of 343 MPa, ultimate tensile strength of 146 MPa, and compressive strength of 380 MPa with higher Young's modulus in the bending tests (21.56 GPa) compared to the tensile (6646 MPa) and compressive modulus (2046 MPa). Wettability study results reveal that the GF/SF/CTS composite scaffolds were hydrophobic (CA = 92.41° ± 1.71°) with less water absorption of 3.436% compared to the SF/CTS composites (6.953%). The SF/CTS composites show a hydrophilic character (CA = 54.28° ± 3.06°). The experimental tests prove that the GF/SF/CTS hybrid composite can be used for orthopedic bone fracture plate applications in future.

A Review on the Kenaf/Glass Hybrid Composites with Limitations on Mechanical and Low Velocity Impact Properties.

Environmental awareness and trends to develop sustainable resources have directed much research attention towards kenaf fibre as an alternative reinforcement in composite manufacturing. Numerous studies have been conducted on kenaf and its hybrid composites. Most studies were conducted on kenaf/glass hybrid composites compared to other kenaf/synthetic hybrid composites. Similar with other materials, mechanical properties were the fundamental knowledge identified by the researcher. Limited studies conducted on other properties have restricted the use of kenaf composites to non-structural applications. To extend the potential of kenaf composites to automotive exterior or other critical applications, studies on impact properties can be a valuable contribution in the material field. This review discusses the mechanical and low velocity impact properties of kenaf/glass hybrid composites reported previously. Percentage loading of fibre, the angle of orientation in woven fibres and the chemical treatment applied to the fibre before compounding are the three major parameters that affect the mechanical and impact properties of the composites. This review provides insights into the mechanical and impact properties of kenaf/glass hybrid composites for future research.

Experimental Evaluation of Low Velocity Impact Properties and Damage Progression on Bamboo/Glass Hybrid Composites Subjected to Different Impact Energy Levels.

Six impact energy values, ranging from 2.5 J to 10 J, were applied to study the impact properties of neat epoxy and bamboo composites, while six impact energy values, ranging from 10 J to 35 J, were applied on bamboo/glass hybrid composites. Woven glass fibre was embedded at the outermost top and bottom layer of bamboo powder-filled epoxy composites, producing sandwich structured hybrid composites through lay-up and molding techniques. A drop weight impact test was performed to study the impact properties. A peak force analysis showed that neat epoxy has the stiffest projectile for targeting interaction, while inconsistent peak force data was collected for the non-hybrid composites. The non-hybrid composites could withstand up to 10 J, while the hybrid composites showed a total failure at 35 J. It can be concluded that increasing the filler loading lessened the severity of damages in non-hybrid composites, while introducing the woven glass fibre could slow down the penetration of the impactor, thus lowering the chances of a total failure of the composites.

A review on the orthotics and prosthetics and the potential of kenaf composites as alternative materials for ankle-foot orthosis.

Since ancient Egypt, orthosis was generally made from wood and then later replaced with metal and leather which are either heavy, bulky, or thick decreasing comfort among the wearers. After the age of revolution, the manufacturing of products using plastics and carbon composites started to spread due to its low cost and form-fitting feature whereas carbon composite were due to its high strength/stiffness to weight ratio. Both plastic and carbon composite has been widely applied into medical devices such as the orthosis and prosthesis. However, carbon composite is also quite expensive, making it the less likely material to be used as an Ankle-Foot Orthosis (AFO) material whereas plastics has low strength. Kenaf composite has a high potential in replacing all the current materials due to its flexibility in controlling the strength to weight ratio properties, cost-effectiveness, abundance of raw materials, and biocompatibility. The aim of this review paper is to discuss on the possibility of using kenaf composite as an alternative material to fabricate orthotics and prosthetics. The discussion will be on the development of orthosis since ancient Egypt until current era, the existing AFO materials, the problems caused by these materials, and the possibility of using a Kenaf fiber composite as a replacement of the current materials. The results show that Kenaf composite has the potential to be used for fabricating an AFO due to its tensile strength which is almost similar to polypropylene's (PP) tensile strength, and the cheap raw material compared to other type of materials.

Enhanced Thermal and Dynamic Mechanical Properties of Synthetic/Natural Hybrid Composites with Graphene Nanoplateletes.

The aim of the present research work is to enhance the thermal and dynamic mechanical properties of Kevlar/Cocos nucifera sheath (CS)/epoxy composites with graphene nano platelets (GNP). Laminates were fabricated through the hand lay-up method followed by hot pressing. GNP at different wt.% (0.25, 0.5, and 0.75) were incorporated with epoxy resin through ultra-sonication. Kevlar/CS composites with different weight ratios (100/0, 75/25, 50/50, 25/75, 0/100) were fabricated while maintaining a fiber/matrix weight ratio at 45/55. Thermal degradation and viscoelastic properties were evaluated using thermogravimetric analysys (TGA), differential scanning calorimetric (DSC) analysis, and a dynamic mechanical analyser (DMA). The obtained results revealed that Kevlar/CS (25/75) hybrid composites at 0.75 wt.% of GNP exhibited similar thermal stability compared to Kevlar/epoxy (100/0) composites at 0 wt.% of GNP. It has been corroborated with DSC observation that GNP act as a thermal barrier. However, DMA results showed that the Kevlar/CS (50/50) hybrid composites at 0.75 wt.% of GNP exhibited almost equal viscoelastic properties compared to Kevlar/epoxy (100/0) composites at 0 wt.% GNP due to effective crosslinking, which improves the stress transfer rate. Hence, this research proved that Kevlar can be efficiently (50%) replaced with CS at an optimal GNP loading for structural applications.

Improved Mechanical and Moisture-Resistant Properties of Woven Hybrid Epoxy Composites by Graphene Nanoplatelets (GNP).

This research investigated the effect of adding different wt.% (0, 0.25, 0.50, and 0.75) of GNP (graphene nanoplatelets) to improve the mechanical and moisture resistant properties of Kevlar (K)/cocos nucifera sheath (CS)/epoxy hybrid composites. The laminates were fabricated with different K/CS weight ratios such as 100/0 (S1), 75/25 (S2), 50/50 (S3), 25/75 (S4), and 0/100 (S5). The results revealed that the addition of GNP improved the tensile, flexural, and impact properties of laminated composites. However, the optimal wt.% of GNP varies with different laminates. A moisture diffusion analysis showed that the laminates with a 0.25 wt.% of GNP content efficiently hindered water uptake by closing all the unoccupied pores inside the laminate. Morphological investigations (SEM and FE-SEM (Field Emission Scanning Electron Microscope)) proved that the addition of GNP improved the interfacial adhesion and dispersion. Structural (XRD and FTIR) analyses reveals that at 0.25 wt.% of GNP, all the hybrid composites showed a better crystallinity index and the functional groups presents in the GNP can form strong interactions with the fibers and matrix. A statistical analysis was performed using One-way ANOVA, and it corroborates that the mechanical properties of different laminates showed a statistically significant difference. Hence, these GNP-modified epoxy hybrid composites can be efficiently utilized in load-bearing structures.

Ecosystem responses in the southern Caribbean Sea to global climate change.

Over the last few decades, rising greenhouse gas emissions have promoted poleward expansion of the large-scale atmospheric Hadley circulation that dominates the Tropics, thereby affecting behavior of the Intertropical Convergence Zone (ITCZ) and North Atlantic Oscillation (NAO). Expression of these changes in tropical marine ecosystems is poorly understood because of sparse observational datasets. We link contemporary ecological changes in the southern Caribbean Sea to global climate change indices. Monthly observations from the CARIACO Ocean Time-Series between 1996 and 2010 document significant decadal scale trends, including a net sea surface temperature (SST) rise of ∼1.0 ± 0.14 °C (±SE), intensified stratification, reduced delivery of upwelled nutrients to surface waters, and diminished phytoplankton bloom intensities evident as overall declines in chlorophyll a concentrations (ΔChla = -2.8 ± 0.5%⋅y(-1)) and net primary production (ΔNPP = -1.5 ± 0.3%⋅y(-1)). Additionally, phytoplankton taxon dominance shifted from diatoms, dinoflagellates, and coccolithophorids to smaller taxa after 2004, whereas mesozooplankton biomass increased and commercial landings of planktivorous sardines collapsed. Collectively, our results reveal an ecological state change in this planktonic system. The weakening trend in Trade Winds (-1.9 ± 0.3%⋅y(-1)) and dependent local variables are largely explained by trends in two climatic indices, namely the northward migration of the Azores High pressure center (descending branch of Hadley cell) by 1.12 ± 0.42°N latitude and the northeasterly progression of the ITCZ Atlantic centroid (ascending branch of Hadley cell), the March position of which shifted by about 800 km between 1996 and 2009.