Molecular based identification and phylogenetic relationship of the leech Hirudinaria manillensis from India by using mitochondrial cytochrome c oxidase subunit I gene.

BACKGROUND: A molecular approach for the identification of unknown species by the using mitochondrial cox1 gene is an effective and reliable as compared with morphological-based identification. Hirudinaria manillensis referred to as Asian Buffalo Leech, is found in South Asia and traditionally used as medicine owing to its medicinal properties. METHODS AND RESULTS: The study aimed to isolate and identify the leech species using cox1 gene sequencing and their phylogenetic relationships. The nucleotide sequences of cytochrome c oxidase subunit I (cox1) mitochondrial genes were analyzed for species identification and the phylogenetic relationship of crucial therapeutic leech Hirudinaria manillensis. The isolated DNA from the leech sample was amplified with cox1 gene-specific primers. BLAST results with the H. manillensis sequence showed 89.24% homology with H. manillensis and phylogenetic tree analysis revealed the genetic relationship with other GenBank submitted sequences. CONCLUSION: The present study concluded that the cox1 gene could be an effective way to identify the leech H. manillensis and provided sufficient phylogenetic information to distinguish H. manillensis indicating a significant mtDNA-based approach to species identification.

Effect of solar powered MgO/graphene nano catalysed biodiesel production from Scomber scombrus.

The aim of the work is to find the efficiency of solar power in biodiesel preparation from mackerel fish. The paper also focusses on the ability of MgO/graphene prepared by one-pot synthesis using combustion methodology. The physicochemical properties of the material were analysed by XRD, N2 sorption studies, BET sorption analysis and SEM. The adsorption studies revealed the porosity of the graphene is intact, and the morphology studies indicated that MgO is uniformly distributed on the graphene surface. The highest biodiesel yield of 98.95% was obtained using the solar-powered Fresnel solar concentrator at 12.30 p.m in 6 min reaction time using 3 wt% MgO/GO catalyst at 65 °C. Conventional heating produced only 75% biodiesel at the same reaction condition, consuming25 min to complete. The solar assisted biodiesel had better HHV of 37.81 MJ/Kg, viscosity of 4.3 mm2/s, pour point of -15 °C, and a density of 0.875 g/mL. The optimized catalyst showed a shelf life of 5 cycles. The results portray the efficacy of natural energy source in alternative liquid fuel production.

Using wearable technology for Posture Regulation to Improve Surgical Ergonomics in the paediatric operating room: the UPRISE trial: a pilot study.

BACKGROUND: The rising prevalence of work-related musculoskeletal disorders has numerous physical, financial, and mental repercussions for surgeons. This study aims to establish whether the use of a wearable posture device can improve the operating time spent in suboptimal, high-risk postures. METHODS: Surgeons were recruited in Phase 1 of this prospective randomised study and baseline postural data was obtained. In Phase 2, participants were randomised to receive either a traditional educational workshop or intraoperative vibrations from the device to correct postural lapses. During minor elective day cases, intraoperative postural data was collected and stratified by forward flexion angle, into five risk categories (negligible to very high). Participants' experience with the sensor was also assessed. RESULTS: A total of 100 surgical procedures (Phase 1: n = 50; Phase 2: n = 50) were performed by eight surgeons of varying seniority. Exposure to the educational intervention increased time spent in suboptimal posture (Phase 1 vs. Phase 2); 47.5% vs. 67.8%, p = 0.05. However, the vibrational intervention significantly reduced this time; 50.0% vs. 20.7%, p = 0.005. Procedure type didn't influence posture although, laparoscopic interventions spent most time in negligible-risk postures; 47.7% vs. 49.3%, compared to open procedures. Surgical consultants spent less time in suboptimal posture compared to fellow/registrars; 30.3% vs. 72.6% (Phase 1) and 33.8% vs. 65.3% (Phase 2). CONCLUSION: Vibrational intervention from the device significantly decreased the time spent in suboptimal, high-risk postures. As procedure type wasn't correlated with postural changes, surgeon-specific factors in regulating posture are paramount. Finally, surgeon experience was positively correlated with improved surgical ergonomics.

A review on titanium oxide nanoparticles modified metal-organic frameworks for effective CO2 conversion and efficient wastewater remediation.

Environmental pollution has been increasing since last decade due to increasing industrialisation and urbanisation. Various kinds ofenvironmental pollutants including carbon dioxide (CO2), dyes, pharmaceuticals, phenols, heavy metals along with many organic and inorganic species have been discovered in the various environmental compartments which possess harmful impacts tox human health, wildlife, and ecosystems. Thus, various efforts have been made through regulations, technological advancements, and public awareness campaigns to reduce the impact of the pollution. However, finding suitable alternatives to mitigate their impacts remained a challenge. Metal-organic frameworks (MOFs) are one of the advanced materials with unique features such as high porosity and stability which exhibit versatile applications in environmental remediation. Their composites with titanium oxide nanoparticles (TiO2) have been discovered to offer potential feature such as light harvesting capacity and catalytic activity. The composite integration and properties have been confirmed through characterization using surface area analysis, scanning electron/transmission electron microscopy, atomic force microscopy, fourier transformed infrared spectroscopy, X-ray diffraction analysis, X-ray photoelectron spectroscopy, thermogravimetric analysis, and others. Thus, this work rigorously discussed potential applications of the MOF@TiO2 nanomaterials for the CO2 capture and effective utilization in methanol, ethanol, acetone, acetaldehyde, and other useful products that served as fuel to various industrial processes. Additionally, the work highlights the effective performance of the materials towards photocatalytic degradation of both organic and inorganic pollutants with indepth mechanistic insights. The article will offer significant contribution for the development of sustainable and efficient technologies for the environmental monitoring and pollution mitigation.

Extraction and characterization of novel fibers from Tecoma stans Linn bark for use as reinforcement in polymer composites.

Embarking on a pioneering investigation, this study unravels the extraordinary qualities of Tecoma stans Fibers (TSFs), freshly harvested from the rachis, establishing them as prospective reinforcements for biocomposites. Delving into their intricate characteristics, TSFs exhibit a unique fusion of physical resilience, with a density of 1.81 ± 0.39 g/cc and a diameter of 234.12 ± 7.63 µm. Complementing their physical prowess, their chemical composition boasts a harmonious blend of cellulose (70.1 ± 9.06 wt%), hemicellulose (13.56 ± 4.29 wt%), lignin (7.62 ± 2.39 wt%), moisture (4.21 ± 1.56 wt%), wax (2.37 ± 0.63 wt%), and ash (1.25 ± 0.36 wt%). In the realm of mechanical strength, TSFs showcase an impressive tensile strength of 639 ± 18.47 MPa, coupled with a robust strain at failure of 1.75 ± 0.13 % and a Young Modulus of 36.51 ± 1.96 GPa. Unveiling their crystalline intricacies, these fibers reveal a microfibril angle of 14.66 ± 0.15°, a crystalline index (CI) of 63.83 %, and a crystallite size (CS) of 9.27 nm. Beyond their mechanical marvels, TSFs exhibit unwavering thermal stability, enduring temperatures up to 297.36 °C, with a Tmax reaching an impressive 392.09 °C.

Awareness and practice of Revised Code of Dental Ethics and Consumer Protection Act among dental practitioners in Andhra Pradesh: A cross sectional study.

BACKGROUND: Given the imperative for dental practitioners to be familiar with the existing ethical principles and laws governing their practice, this study aimed to evaluate awareness and practice of the dentists (code of ethics) regulations 2014 and consumer protection act 2019 among dental practitioners in Andhra Pradesh state, India. METHODS: A cross sectional study was conducted among 384 dental practitioners in Andhra Pradesh state, India. A questionnaire consisting of 25 items was used to assess awareness and practice of the dentists (code of ethics) regulations and consumer protection act. The data collected were analysed using IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp. RESULTS: Only 53(13.8%) dental practitioners in the study were aware that the dentists (code of ethics) regulations had been revised in 2014. About 190 (49.5%) practitioners were aware of the precise period for mandatory preservation of patient records. Most dental practitioners (278, 72.4%) accepted commissions in the form of gifts or cash from laboratories, radiologists, or pharmacists and 306 (79.7%) dental practitioners used unregistered dental lab technicians as employees in their practice. Furthermore, 297 (77.3%) practitioners were found to provide or sell drugs to patients in their clinic/office. The new regulations under consumer protection act 2019 were unknown to 194 (50.5%) dental practitioners. CONCLUSIONS: The present study indicates that the awareness of dental practitioners towards the dentists (code of ethics) regulations 2014 and consumer protection act 2019 is inadequate. It highlights the need for training programmes and curriculum changes with a focus on ethical and legal issues in clinical dental practice.

Dyadic practice for the acquisition of laparoscopic skills (DALS)-A randomized controlled trial.

BACKGROUND: Laparoscopic simulation is integral to surgical education but requires significant resources. We aimed to compare the effectiveness of dyadic practice (DP), involving two individuals working together, to individual practice (IP) for novices acquiring laparoscopic skills and assess their learning experience. METHODS: We conducted a Randomized Controlled Trial comparing DP and IP for novice medical students who completed a laparoscopic simulation workshop. Participants were assessed individually pre-course (test 1), post-course (test 2), and 8-week retention (test 3) using a validated quantitative method. A post-course questionnaire and interview, analyzed with thematic analysis, assessed the learning experience. RESULTS: In total, 31 DP and 35 IP participants completed the study. There was no difference in mean scores between DP and IP groups in all three tests: test 1 (p = 0.55), test 2 (p = 0.26), test 3 (p = 0.35). In trend analysis, the DP group improved post-course (test 1 vs. 2: p = 0.02) and maintained this level at the retention test (2 vs. 3: p = 0.80, 1 vs. 3: p = 0.02). Whilst the IP group also improved post-course (test 1 vs. 2: p < 0.001), this improvement was not retained (2 vs. 3: p = 0.003, 1 vs. 3: p = 0.32). Thematic analysis revealed that DP participants valued peer support, peer feedback and observation time, but also acknowledged the limitations of reduced practical time and issues with teamwork. CONCLUSION: DP is non-inferior to IP for novices learning laparoscopic skills, is well received and may lead to superior long-term skill retention.

A guide to outcome evaluation of simulation-based education programmes in low and middle-income countries.

Evaluation is a vital part of any learning activity and is essential to optimize and improve educational programmes. It should be considered and prioritized prior to the implementation of any learning activity. However, comprehensive programme evaluation is rarely conducted, and there are numerous barriers to high-quality evaluation. This review provides a framework for conducting outcome evaluation of simulation-based education programmes in low and middle-income countries (LMICs). The basis of evaluation, including core ideas of theory, purpose and structure are outlined, followed by an examination of the levels and healthcare applications of the Kirkpatrick model of evaluation. Then, methods of conducting evaluation of simulation-based education in LMICs are discussed through the lens of a successful surgical simulation programme in Myanmar, a lower-middle-income country. The programme involved the evaluation of 11 courses over 4 years in Myanmar and demonstrated evaluation at the highest level of the Kirkpatrick model. Reviewing this programme provides a bridge between evaluation theory and practical implementation. A range of evaluation methods are outlined, including surveys, interviews, and clinical outcome measurement. The importance of a mixed-methods approach, enabling triangulation of quantitative and qualitative analysis, is highlighted, as are methods of analysing data, including statistical and thematic analysis. Finally, issues and challenges of conducting evaluation are considered, as well as strategies to overcome these barriers. Ultimately, this review informs readers about evaluation theory and methods, grounded in a practical application, to enable other educators in low-resource settings to evaluate their own activities.

Synthesis of silver­bismuth oxide encapsulated hydrazone functionalized chitosan (AgBi2O3/FCS) nanocomposite for electrochemical sensing of glucose, H2O2 and Escherichia coli O157:H7.

In this work, silver­bismuth oxide encapsulated 1,3,5-triazine-bis(4-methylbenzenesulfonyl)-hydrazone functionalized chitosan (SBO/FCS) nanocomposite was synthesized by a simple hydrothermal method. The amine (-NH2) group was functionalized by the addition of cyanuric acid chloride followed by 4-methylbenzenesulfonol hydrazide. The SBO/FCS has been characterized by FT-IR, X-ray diffraction, XPS, HR-SEM, HR-TEM, AFM, and thermogravimetry (TGA). Under the optimum conditions, the SBO/FCS sensor showed brilliant electrochemical accomplishment for the sensing of glucose and H2O2 by a limit of detection (LOD) of 0.057 µM and 0.006 µM. It also showed linearity for glucose 0.008-4.848 mM and for H2O2 of 0.01-6.848 mM. Similarly, the sensor exhibited a low sensitivity to glucose (32 µA mM-1 cm-2) and a good sensitivity to H2O2 (295 µA mM-1 cm-2). In addition, that the prepared electrode could be used to sense the glucose and H2O2 levels in real samples such as blood serum and HeLa cell lines. The screen printed electrode (SPE) immunosensor could sense the E. coli O157:H7 concurrently and quantitatively with a linear range of 1.0 × 101-1.0 × 109 CFU mL-1 and a LOD of 4 CFU mL-1. Likewise, the immunosensor efficiently detect spiked E. coli O157:H7 in milk, chicken, and pork samples, with recoveries ranging from 89.70 to 104.72 %, demonstrating that the immunosensor was accurate and reliable.

Immunohistochemical analysis of chronic and recurrent dermatophytosis.

BACKGROUND: Dermatophytosis has assumed epidemic proportions with rising resistance, recalcitrance and recurrence, especially in tropical regions. While various factors contribute to high prevalence worldwide, yet little is known about the interactions between host defence mechanisms and dermatophytes, particularly in chronic and recalcitrant dermatophytosis. OBJECTIVES: We aimed to compare the population of various immune cells in specimens of chronic recurrent dermatophytosis and those with acute superficial dermatophytosis. METHODS: We investigated the density of various immune cells-Langerhans cells (CD1a+), macrophages (CD68+), dermal dendrocytes (Factor XIIIa+) in the skin of chronic dermatophytosis patients and those with successfully resolved lesions (controls). RESULTS: Langerhans cells were significantly decreased in the epidermis of patients, both in affected and unaffected areas in comparison with controls. In the dermis, however, no differences in the density of immune cells (macrophages and fibroblasts) were observed. LIMITATIONS: The limited sample size and immune cells evaluated could be expanded further in future research. CONCLUSION: These results indicate that the decreased number of Langerhans cells could be a potential risk factor for the development of chronic and recurrent dermatophytosis.

In vitro anticancer activity of Hirudinaria manillensis methanolic extract and its validation using in silico molecular docking approach.

Cancer has emerged as a potentially lethal illness, which recently upsurged in the mortality rate. Animal-derived compounds could be promising targets with higher efficacy and low toxicity in anticancer therapy. The present study aimed to explore the presence of anticancer potential compounds in Hirudinaria manillensis methanolic extract and their anticancer potential against various cancer cell types and target identification by Auto dock method. Initially, the identification of bioactive compounds was achieved by GC-MS analysis followed by the anticancer activity by MTT assay against A549, HeLa, MDA-MB-231, MG-63, and MOLT-4. Further, the effect of a lead compound on the cancer cell target was analyzed by the Auto dock method. GC-MS analysis results revealed the presence of 25 different bioactive compounds including anticancer potential compounds, such as Lupeol, Carvacrol, and Demecolcine. Interestingly, MTT assay results demonstrated the anticancer potential of Hirudinaria manillensis extract (LE) against various cancer cell lines, such as A549 (54.60 µg/ml), HeLa (19.93 µg/ml), MDA-MB-231 (20.23 µg/ml), MG-63 (20.04 µg/ml), and MOLT-4 (171.8 µg/ml), respectively. Among these cell types, the maximum inhibition was observed against HeLa with the IC50 concentration of 19.93 µg/ml. Furthermore, Demecolcine compound was docked with the EGFR tyrosine kinase showed the binding affinity of the docked complex was predicted to be - 6.2 kcal/mol. Thus, we conclude that H. manillensis has a significant anticancer effect on human cancer cell lines and could be used as a natural target which paves the way for further studies on biomedical applications in cancer therapeutics.

Enhanced photocatalytic degradation of polycyclic aromatic hydrocarbons (PAHs) Using NiO nanoparticles.

The oncogenic and genetic properties of anthracene, a member of the polycyclic aromatic hydrocarbons (PAHs) family, pose a significant health threat to humans. This study aims to investigate the photocatalytic decomposition of anthracene under various conditions, such as different concentrations of PAHs, varying amounts of NiO (nickel oxide) nanoparticles, and different pH levels under ultraviolet light and sunlight. The synthesized NiO nanoparticles showed surface plasma resonance at 230 and 360 nm, while XRD and SEM analysis confirmed the nanoparticles were cubic crystalline in structure with sizes ranging between 37 and 126 nm. NiO nanoparticles exhibited 79% degradation of pyrene at 2 µg/mL of anthracene within 60 min of treatment. NiO at 10 µg/mL concentration showed significant adsorption of 57%, while the adsorption method worked efficiently (72%) at 5 pH. Photocatalytic degradation was confirmed by isotherm and kinetic studies through monolayer adsorption and pseudo-first-order kinetics. Further, the absorption process was confirmed by performing GC-MS analysis of the NiO nanoparticles. On the other hand, NiO nanoparticles showed antimicrobial activity against Gram negative and Gram-positive bacteria. Therefore, the present work is one of its kind proving the dual application of NiO nanoparticles, which makes them suitable candidates for bioremediation by treating PAHs and killing pathogenic bacteria.

A comprehensive characterization of 3D printable poly ether ketone ketone.

The current work focuses on the comprehensive characterization of a 3D printable biomaterial, polyether ketone ketone (PEKK). The PEKK granules are first characterized and then utilized for extrusion of the PEKK filaments. The extruded PEKK filaments are characterized for crystallinity, quality, and printability, wherein they exhibit amorphous nature, good quality, and appropriate printability. Utilizing the filaments, the samples are printed with the appropriate printing parameters, which are further characterized for layer adhesion, voids, and crystallinity, wherein they showed seamless layer adhesion, improper beads consolidation, and the amorphous nature. The as printed samples are further annealed at different temperatures (200 and 250 °C). The scanning electron microscopy (SEM) of the annealed samples (A-200 and A-250) revealed better void consolidation, while the X-ray diffraction (XRD) revealed better crystallinity compared to the un-annealed sample. The printed samples are also investigated for dynamic mechanical analysis (DMA), shape memory, and tensile properties. The storage moduli of the annealed samples are observed to be better than the un-annealed sample. The annealed samples exhibited better shape memory properties: shape fixity and shape recovery ratio of A-200 and A-250 samples, 90.28 and 90.75%, and 99.16 and 94.73%, respectively, compared to the un-annealed samples. The highest shape fixity ratio and the shape recovery ratio are noted for A-250 (90.75%) and A-200 (∼ 100%). The A-200 and A-250 samples showed enhanced tensile modulus and strength, 4.16 and 49.67%, and 36.61 and 35.06%, respectively compared to the un-annealed sample. The highest modulus is noted for A-250, while the strength is comparable (36.61 and 35.06%) for A-200 and A-250.

Strengthening primary health care in China: governance and policy challenges.

Primary care is often the weakest link in health systems despite its acknowledged central importance in promoting population's health at economical cost. A key reason for the lacunae is that both scholars and practitioners working on the subject typically underestimate the enormity of the task and the range of complementary measures required to build an effective primary care system. The objective of the paper is to highlight theoretical gaps and practical limitations to strengthening primary care. The challenges and difficulties are illustrated through a case study of China where primary care continues to struggle despite the government's strong political, financial and policy support in recent years. In this paper, we review the development of primary health care in China and how it is governed, provided, and financed, highlighting the gaps and misalignments that undermine its performance. We argue that governance deficiencies coupled with flawed financing and payments arrangements are major impediments to improving performance. China's experience offers valuable lessons for other governments seeking to strengthen primary health care.

Newborn and Infant Parasympathetic Evaluation (NIPE™) Monitor for Assessing Pain During Surgery and Interventional Procedures: A Systematic Review.

BACKGROUND: The heart rate variability-derived Newborn Infant Parasympathetic Evaluation (NIPE) monitor has been designed to be an objective, non-invasive tool for the assessment of pain and discomfort in children under 2 years of age. The aim of this systematic review was to evaluate the ability of NIPE to assess pain in neonates and infants during surgical and/or painful procedures. METHODS: A systematic review (2010-2023) was conducted using PRISMA guidelines. Studies containing children above 2-years-old were excluded. The ROBINS-I (Risk of Bias in Non-randomised Studies of Interventions) tool was used to assess the quality of included studies. RESULTS: 9 databases were searched identifying 470 articles, 460 did not meet the inclusion criteria and were excluded; therefore, 10 studies with 548 participants were included. NIPE was used to assess intraoperative and postoperative pain for surgery under general anaesthesia (5 studies), as well as acute and prolonged pain from other interventional procedures (5 studies). For surgery under general anaesthesia: NIPE has shown to detect nociceptive events (e.g., skin incision, intubation), insufficient analgesia intraoperatively and to predict early postoperative pain. For painful interventional procedures: NIPE has shown to detect acute pain with a high sensitivity and negative predictive value. CONCLUSION: NIPE has been used to assess pain in surgery and for various painful procedures. NIPE can detect intraoperative pain and reflect early postoperative pain. NIPE may be useful in evaluating procedural pain, however with heterogenous outcomes, more studies are required to confirm its efficacy. TYPE OF STUDY: Systematic Review. LEVEL OF EVIDENCE: Level II.

Assessment of biodegradation of lignocellulosic fiber-based composites - A systematic review.

Lignocellulosic fiber-reinforced polymer composites are the most extensively used modern-day materials with low density and better specific strength specifically developed to render better physical, mechanical, and thermal properties. Synthetic fiber-reinforced composites face some serious issues like low biodegradability, non-environmentally friendly, and low disposability. Lignocellulosic or natural fiber-reinforced composites, which are developed from various plant-based fibers and animal-based fibers are considered potential substitutes for synthetic fiber composites because they are characterized by lightweight, better biodegradability, and are available at low cost. It is very much essential to study end-of-life (EoL) conditions like biodegradability for the biocomposites which occur commonly after their service life. During biodegradation, the physicochemical arrangement of the natural fibers, the environmental conditions, and the microbial populations, to which the natural fiber composites are exposed, play the most influential factors. The current review focuses on a comprehensive discussion of the standards and assessment methods of biodegradation in aerobic and anaerobic conditions on a laboratory scale. This review is expected to serve the materialists and technologists who work on the EoL behaviour of various materials, particularly in natural fiber-reinforced polymer composites to apply these standards and test methods to various classes of biocomposites for developing sustainable materials.

Antimicrobial, anti-inflammatory and anti-arthritic activity of hemolymph lectin (NagLec) isolated from the freshwater crab, Oziotelphusanaga.

Lectins are non-immune glycoproteins or proteins having a unique capacity to interact with carbohydrate ligands found on the surface of their host cells. In the present investigation, the lectin was purified from the hemolymph of freshwater crab, Oziotelphusa naga and its antimicrobial, anti-inflammatory and anti-arthritic activity was analysed. The preliminary characterization of the hemagglutinin was carried out to identify the erythrocyte and sugar specificity, optimum pH and temperature and cation dependency. The agglutinin was found to be highly specific to rabbit erythrocyte and inhibited by fetuin and α-lactose. Maximum hemagglutination activity was noted at pH 7.5-8 and temperature 20-40 °C. An O-acetyl sialic acid specific 75 kDa hemolymph lectin, designated as NagLec was isolated from the freshwater crab, Oziotelphusa naga by affinity chromatography on fetuin coupled Sepharose 4 B, with a purification fold of 185. The bacteria Staphylococcus aureus, Proteus mirabilis and fungus Candida albicans had the greatest zone of inhibition when treated with NagLec. The results of the Minimum inhibitory concentration (MIC) and Minimum bactericidal concentration (MBC) assays showed that the purified lectin inhibited the growth of Staphylococcus aureus at 0.031 and 0.065 µg/ml, which proved the bactericidal property of NagLec. NagLec generated alterations on the bacterial cells and led to protein leakage, which was dosage (24 and 48 µg/ml) and time dependent (10-40 min). COX and LOX enzyme was inhibited to 49.43% and 61.81% with 100 µg/ml concentration of NagLec respectively, demonstrating NagLec's ability to reduce inflammation. Furthermore, NagLec (500 µg) suppressed protein denaturation up to 77.12% whereas diclofenac sodium (a standard drug) was inhibited by 89.36%. The results indicate that NagLec, a sialic acid specific lectin isolated from the freshwater crab O. naga could be formulated as a nano drug in future owing to its antimicrobial, anti-inflammatory and anti-arthritic potential that could be targeted to specific pathogenic microbes and treat arthritis.

Infective Endocarditis Risk with Melody versus Sapien Valves Following Transcatheter Pulmonary Valve Implantation: A Systematic Review and Meta-Analysis of Prospective Cohort Studies.

BACKGROUND: Transcatheter pulmonary valve implantation (TPVI) is an effective non-surgical treatment method for patients with right ventricle outflow tract dysfunction. The Medtronic Melody and the Edwards Sapien are the two valves approved for use in TPVI. Since TPVI patients are typically younger, even a modest annual incidence of infective endocarditis (IE) is significant. Several previous studies have shown a growing risk of IE after TPVI. There is uncertainty regarding the overall incidence of IE and differences in the risk of IE between the valves. METHODS: A systematic search was conducted in the MEDLINE, EMBASE, PubMed, and Cochrane databases from inception to 1 January 2023 using the search terms 'pulmonary valve implantation', 'TPVI', or 'PPVI'. The primary outcome was the pooled incidence of IE following TPVI in Melody and Sapien valves and the difference in incidence between Sapien and Melody valves. Fixed effect and random effect models were used depending on the valve. Meta-regression with random effects was conducted to test the difference in the incidence of IE between the two valves. RESULTS: A total of 22 studies (including 10 Melody valve studies, 8 Sapien valve studies, and 4 studies that included both valves (572 patients that used the Sapien valve and 1395 patients that used the Melody valve)) were used for the final analysis. Zero IE incidence following TPVI was reported by eight studies (66.7%) that utilized Sapien valves compared to two studies (14.3%) that utilized Melody valves. The pooled incidence of IE following TPVI with Sapien valves was 2.1% (95% CI: 0.9% to 5.13%) compared to 8.5% (95% CI: 4.8% to 15.2%) following TPVI with Melody valves. Results of meta-regression indicated that the Sapien valve had a 79.6% (95% CI: 24.2% to 94.4%, p = 0.019; R2 = 34.4) lower risk of IE incidence compared to the Melody valve. CONCLUSIONS: The risk of IE following TPVI differs significantly. A prudent valve choice in favor of Sapien valves to lower the risk of post-TPVI endocarditis may be beneficial.

Simulation-based education in urology - an update.

Over the past 30 years surgical training, including urology training, has changed from the Halstedian apprenticeship-based model to a competency-based one. Simulation-based education (SBE) is an effective, competency-based method for acquiring both technical and non-technical surgical skills and has rapidly become an essential component of urological education. This article introduces the key learning theory underpinning surgical education and SBE, discussing the educational concepts of mastery learning, deliberate practice, feedback, fidelity and assessment. These concepts are fundamental aspects of urological education, thus requiring clinical educators to have a detailed understanding of their impact on learning to assist trainees to acquire surgical skills. The article will then address in detail the current and emerging simulation modalities used in urological education, with specific urological examples provided. These modalities are part-task trainers and 3D-printed models for open surgery, laparoscopic bench and virtual reality trainers, robotic surgery simulation, simulated patients and roleplay, scenario-based simulation, hybrid simulation, distributed simulation and digital simulation. This article will particularly focus on recent advancements in several emerging simulation modalities that are being applied in urology training such as operable 3D-printed models, robotic surgery simulation and online simulation. The implementation of simulation into training programmes and our recommendations for the future direction of urological simulation will also be discussed.

Influence of foetal position on the degree of isolated antenatal hydronephrosis.

BACKGROUNDS: The effect of foetal position on the degree of antenatal hydronephrosis (ANH) is unknown. We hypothesized that foetal position is an important contextual factor in ANH, with consequences on prenatal counselling and postnatal management. The current study aimed to investigate the effect of foetal position on the degree of ANH. METHODS: A retrospective study was carried out on consecutive pregnancies with isolated ANH over a 10-year period. Gestational age, foetal presentation (cephalic vs. breech), and degree of ANH (as measured by the AP diameter) were retrieved. Foetuses with other ultrasound findings of the renal tract (renal parenchymal abnormality, ureteric dilatation, or bladder abnormalities) were excluded. Logistic regression analysis was conducted to examine the relationship between the anterior-posterior diameter (APD) and the mode of presentation (cephalic or breech). A P-value of <0.05 was considered significant. RESULTS: Initially 745 scans were identified, with 436 included in the final analysis. Overall, there was an association between foetal presentation and APD regardless of trimester, with cephalic presentations having a greater APD (OR 1.07, 95% CI 1.02-1.11, P = 0.04). CONCLUSION: Cephalic presentations are associated with a significantly greater APD indicating that foetal position should be considered when stratifying ANH. Furthermore, foetal position may be a contributing factor in the mechanism of 'physiological' hydronephrosis.