A qualitative exploration of transitions, compliance, and onboarding challenges for international students in health professional education degrees.

Background: Australia provides education services to international students which includes international students completing a health professional education (HPE) degree. Studying for a HPE degree can be challenging for most students. There are specific challenges for international students when completing a degree with clinical placements. The challenges international students can face include receiving adequate and timely information, understanding health service access, and receiving the correct information from education providers and agents.Objectives: To gain an in-depth understanding of the challenges for international health professional education students in accessing healthcare, understanding the requirements of compliance to attend clinical placements and the difficulties with attending clinical placements.Design: A semi-structured interview schedule based on findings from a survey (N = 318 participants) was used to explore international student perspectives in one-on-one interviews.Methods: Data were collected from international HPE students from a single Australian metropolitan multi-campus university using a questionnaire, which included qualitative open-ended questions, in addition to semi-structured follow-on interviews. Data collection took place between March and October 2021 and qualitative data were inductively thematically analysed.Results: Challenges reported in interviews by six international students were focused on understanding the navigation of new administrative systems and compliance processes. Students noted gaps in the communication of understanding legislative compliance requirements to attend clinical placements, difficulties accessing healthcare and making use of overseas student health cover, organisational issues, and transport issues when attending clinical placements.Conclusions: Higher education providers and international education agents must address communication deficits in course requirements linked to clinical placement prerequisites. This study highlights gaps in commencing international students' understanding, and higher education providers' communication of clear, timely detailed information.

INFORM-AF II-Phase 1 pilot randomised controlled trial evaluating the effect of an atrial fibrillation digital education programme: study protocol.

AIM: To evaluate the effect of a novel, co-designed, digital AF educational program, 'INFORM-AF', to reduce re-hospitalisation of people with AF. The secondary aims are to examine the effect of the intervention on: (a) reducing cardiovascular-related hospitalisation, (b) increasing medication adherence, AF-related knowledge, and Atrial fibrillation (AF)-related quality of life and (c) determining the cost-effectiveness of the intervention. BACKGROUND: AF is an increasingly prevalent cardiac arrythmia that involves complex clinical management. Comprehensive education is essential for successful self-management of AF and is associated with positive health-related outcomes. There has been an increase in technology-based education for AF. However, its effects on hospitalisation, medication adherence and patient-reported outcomes are unclear. DESIGN: A prospective, randomised (1:1), open-label, blinded-endpoint, multicentre clinical trial. METHODS: Eligible participants are aged 18 years or above, diagnosed with AF, and own a smartphone. The study will be conducted at two metropolitan hospitals. In the intervention group, participants will receive the AF educational program delivered via Qstream®. In the control group, participants will receive the Stroke Foundation 'Living with AF' booklet. The primary outcome is re-hospitalisation within 12 months from an indexed presentation or hospital admission. CONCLUSION: This clinical trial is part of a developing program of work that will examine mHealth educational-behavioural interventions on cardiovascular outcomes. Findings from this pilot study will inform the development of a digital educational framework for patients living with AF. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: There remain many gaps in providing high-quality patient education for patients with AF. This trial will test a new theory-driven, smartphone-based education program on important clinical outcomes, including rehospitalisation. IMPACT: This study evaluates a novel, co-designed, digital AF educational program, 'INFORM-AF', to reduce the re-hospitalisation of people with AF. Study results are expected to be reported in 2025. Findings are expected to inform practice recommendations for AF patient education that may be included in future clinical practice guideline recommendations. REPORTING METHOD: SPIRIT Checklist. PATIENT OR PUBLICATION CONTRIBUTION: JL is a consumer co-researcher on the project and provided critical input into intervention design, and feedback and input across the study duration.

Risk of Primary Gastrointestinal Lymphoma in Patients With Inflammatory Conditions Exposed to Tumor Necrosis Factor Alpha Inhibitors and Immunomodulators: A Case-Control Study.

Introduction: The aim of this case-control study was to determine if exposure to tumor necrosis factor alpha inhibitors (TNFIs) or immunomodulators (thiopurines or methotrexate) was associated with development of primary gastrointestinal lymphoma (PGIL) in patients with chronic inflammatory conditions. Methods: Patients with PGIL and controls evaluated at a tertiary care center over 20 years were matched 1:3 using a medical record informatics search engine based on their chronic inflammatory condition (Crohn's disease [CD], ulcerative colitis [UC], rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis) and duration of follow-up. Patients who started on TNFI within 3 months of PGIL diagnosis were excluded. We extracted demographics, medical history, and medications used. Univariate models using conditional logistic regression were used due to the small number of matched pairs. Results: Twenty PGIL cases matched with 60 controls were followed for a mean 9.9 ±â€…6.9 and 9.7 ±â€…8.6 years, respectively. Mean age at time of PGIL diagnosis was 47.5 ±â€…22.0 (standard deviation) years and the majority (75%) were males. The most common inflammatory diagnosis was inflammatory bowel disease (80% of cases; 45% with UC and 35% with CD). Development of PGIL was not associated with TNFI (odds ratio [OR] = 2.6; 95% confidence interval [CI] 0.69-11.01; P = .18), but with use of TNFI in combination with thiopurines (OR = 8.93; 95% CI 1.43-80.25; P = .014). Risk of PGIL increased with every additional TNFI (2.277 (1.002-5.713); P = .0494). All cases exposed to multiple TNFI were also exposed to thiopurines. Use of thiopurines (alone or in combination) was the greatest risk factor (OR = 6.32; 95% CI 1.55-37.05; P = 0.006) to develop PGIL. Conclusions: TNFI therapy was not associated with increased risk for PGIL unless used in combination with thiopurines and with every switch to a different TNFI.

Understanding retort processing: A review.

Retort processing is a food preservation technique to address the challenge posed by Clostridium botulinum for commercial sterility of a food product to get microbiologically safe and stable products by heating. This review aims to explore the journey of retort processing, starting from its early use in single-batch canned foods and progressing to its contemporary applications with different types of containers and heating mediums. Additionally, it will delve into the adaptability of retort equipment, including its ability to operate in stationary and various agitation states, as well as its flexibility in processing speed for both single-batch and continuous operations.

The Basal Ganglia Downstream Control of Action - An Evolutionarily Conserved Strategy.

The motor areas of the cortex and the basal ganglia both contribute to determining which motor actions will be recruited at any moment in time, and their functions are intertwined. Here, we review the basal ganglia mechanisms underlying the selection of behavior of the downstream control of motor centers in the midbrain and brainstem and show that the basic organization of the forebrain motor system is evolutionarily conserved throughout vertebrate phylogeny. The output level of the basal ganglia (e.g. substantia nigra pars reticulata) has GABAergic neurons that are spontaneously active at rest and inhibit a number of specific motor centers, each of which can be relieved from inhibition if the inhibitory output neurons themselves become inhibited. The motor areas of the cortex act partially via the dorsolateral striatum (putamen), which has specific modules for the forelimb, hindlimb, trunk, etc. Each module operates in turn through the two types of striatal projection neurons that control the output modules of the basal ganglia and thereby the downstream motor centers. The mechanisms for lateral inhibition in the striatum are reviewed as well as other striatal mechanisms contributing to action selection. The motor cortex also exerts a direct excitatory action on specific motor centers. An overview is given of the basal ganglia control exerted on the different midbrain/brainstem motor centers, and the efference copy information fed back via the thalamus to the striatum and cortex, which is of importance for the planning of future movements.

Description of Specialty Practice-10 Years Onward: The Changes in Geriatric Physical Therapy.

BACKGROUND: An analysis of practice is conducted by the American Board of Physical Therapy Specialties (ABPTS) every 10 years to revalidate, update, and revise the description of specialty practice (DSP) for each specialty. The Geriatric Specialty Council recently conducted an analysis of practice and revised its content consistent with established procedures by the ABPTS. PURPOSE: The purpose of this article is threefold: first, to describe the process of the most recent practice analysis; second, to report revisions to the description of specialty practice based on the analysis of practice; and third, to identify elements of practice that define current specialist practice in geriatric physical therapy. METHODS: A 10-member committee of subject matter experts (SMEs) and a psychometric consultant developed a survey instrument addressing geriatric physical therapy specialty practice areas. The survey was initially pilot-tested and subsequently administered online to a sample of 801 board-certified geriatric clinical specialists. The consultant facilitated the consensus process to determine decision rules in selecting the final competencies describing current geriatric physical therapy specialty practice. RESULTS: A total of 372 respondents fully or partially completed the survey, resulting in a response rate of 46.4%. Based on a priori decision rules regarding survey data, consensus of the group of SMEs, and input from the ABPTS, the DSP for geriatric physical therapy specialty practice was revised. Revisions (elimination [-] of prior items and addition [+] of new items) were made in Section 1: Knowledge Areas (-8 and +6), in Section 2: Professional Roles, Responsibilities, and Values (-14 and +4), and Section 3: Practice Expectations (-53 and +28). CONCLUSION: The revised DSP will be used as the basis for the development of the examination blueprint for the specialist examination in geriatric physical therapy and the curricula for residency programs in geriatric physical therapy.

Randomised study of bailout intracranial angioplasty following thrombectomy for acute large vessel occlusion (ANGEL-REBOOT): protocol of a multicentre randomised controlled trial.

RATIONALE: Unsuccessful thrombectomy of acute large vessel occlusions (LVOs) has been associated with unfavourable outcomes. Multiple randomised controlled trials (RCTs) have reported a failure rate of 12%-41% for thrombectomy procedures. Various factors contribute to failed thrombectomy, including technical difficulties in accessing the occlusion, unsuccessful thrombus retrieval, thrombotic reocclusion and pre-existing intracranial atherosclerotic stenosis. Although some studies have explored balloon dilation or permanent stenting as rescue intracranial angioplasty for failed thrombectomy in individual cases, there is currently no evidence from RCTs on this specific topic. AIM: To evaluate the potential superiority of bailout angioplasty over standard treatment in cases of unsuccessful recanalisation (eTICI 0 to 2a) or residual severe stenosis (>70%) after thrombectomy in acute LVO patients within 24 hours of stroke onset. DESIGN: This study is a multicentre, prospective, randomised, controlled clinical trial designed by investigators. It compares bailout angioplasty with standard therapy and follows an open-label treatment approach while maintaining a blinded outcome assessment (PROBE design). Our objective is to allocate 348 patients in a 1:1 ratio to either receive bailout angioplasty as an intervention or standard therapy as a control, following unsuccessful thrombectomy. OUTCOME: The main measure of interest is the modified Rankin Scale (mRS) Score, which will be assessed in a blinded manner at 90 (±14) days following randomisation. The primary effect size will be determined using ordered logistic regression to calculate the common OR, representing the shift on the six-category mRS Scale at the 90-day mark. Additionally, the safety outcomes will be evaluated, including symptomatic intracranial haemorrhage within 18-36 hours, severe procedure-related complications and mortality within 90 (±14) days, among others. DISCUSSION: The ANGEL-REBOOT study aims to generate substantial evidence regarding the efficacy and safety of bailout intracranial angioplasty as a treatment option for patients with LVO who have experienced unsuccessful thrombectomy. TRIAL REGISTRATION NUMBER: NCT05122286.

A Randomized, Controlled Trial of Efficacy and Safety of Cannabidiol in Idiopathic and Diabetic Gastroparesis.

BACKGROUND & AIMS: Cannabis (delta-9-tetrahydrocannabinol), a nonselective cannabinoid-receptor agonist, relieves nausea and pain. Cannabidiol (CBD), a cannabinoid receptor 2 inverse agonist with central effects, also reduces gut sensation and inflammation. We compared the effects of 4 weeks of treatment with pharmaceutical CBD vs placebo in patients with idiopathic or diabetic (diabetes mellitus) gastroparesis. METHODS: We performed a randomized, double-blinded, placebo-controlled study of CBD twice daily (Epidiolex escalated to 20 mg/kg/d; Jazz Pharmaceuticals, Dublin, Ireland) in patients with nonsurgical gastroparesis with delayed gastric emptying of solids (GES). Symptoms were assessed by the Gastroparesis Cardinal Symptom Index Daily Diary. After 4 weeks of treatment, we measured GES, gastric volumes, and Ensure (Abbott Laboratories, Abbott Park, IL) satiation test (1 kcal/mL, 30 mL/min) to assess volume to comfortable fullness and maximum tolerance. Patients underwent specific FAAH and CNR1 genotyping. Statistical analysis compared 2 treatments using analysis of variance including baseline measurements and body mass index as covariates. RESULTS: Among 44 patients (32 idiopathic, 6 diabetes mellitus type 1, and 6 diabetes mellitus type 2), 5 patients did not tolerate full-dose escalation; 3 withdrew before completing 4 weeks of treatment (2 placebo, 1 CBD); 95% completed 4 weeks of treatment and diaries. Compared with placebo, CBD reduced the total Gastroparesis Cardinal Symptom Index score (P = .008), inability to finish a normal-sized meal (P = .029), number of vomiting episodes/24 hours (P = .006), and overall symptom severity (P = .034). Patients treated with CBD had a higher volume to comfortable fullness and maximum tolerance and slower GES. FAAH rs34420 genotype significantly impacted nutrient drink ingestion. The most common adverse events reported were diarrhea (14 patients), fatigue (8 patients), headache (8 patients), and nausea (7 patients). CONCLUSIONS: CBD provides symptom relief in patients with gastroparesis and improves the tolerance of liquid nutrient intake, despite slowing of GES. CLINICALTRIALS: gov NCT #03941288.

Value addition of rice straw cellulose fibers as a reinforcer in packaging applications.

The potential use of agro-waste in food packaging applications is receiving remarkable attention due to its sustainable approach and biodegradable properties. As typical lignocellulosic biomass, rice straw (RS) is widely produced but is usually abandoned and burned, causing tremendous environmental concerns. The exploration of using RS as the source of biodegradable packaging materials is promising for economically converting this agricultural waste into packaging material, thereby providing a considerable solution for RS disposal and an alternative solution to synthetic plastic waste. Polymers have been infused with nanoparticles, fibers, and whiskers, along with plasticizers and cross-linkers, and fillers like nanoparticles and fibers. They have also been blended with natural extracts, essential oils, and other synthetic and natural polymers to improve RS properties. There is still much research to be done before this biopolymer can be applied at an industrial level in food packaging. In this respect, RS can be valued for packaging to add value to these underutilized residues. This review article focuses on the extraction methods and functionality of cellulose fibers and their nanostructured forms from RS and their utilization in packaging applications.

Youth sport specialization associated with poorer lower extremity function & pain as young adults.

OBJECTIVE: Examine the link between youth sports specialization and long-term lower extremity joint health after sports by comparing lower extremity function, pain, and history of sport-related injuries between young adults that were highly, moderately, and low specialized in youth sports. METHODS: We used a cross-sectional design, and all data was collected using an electronic survey. Our sample included N = 356 young adults who participated in a primary sport during youth and high school sports but were no longer participating in that sport as a young adult. Participants were stratified into high (n = 111), moderate (n = 119), and low (n = 126) specialization groups using a 3-criteria sport specialization questionnaire based on youth sports participation prior to high school. We compared participants current Lower Extremity Functional Scale (LEFS) score (0-80), the proportion of participants with clinically important deficits in LEFS score (≤71/80), current lower extremity (foot/ankle, knee, hip) pain scores (0-10), and history of lower extremity (foot/ankle, knee, hip) injuries between the high, moderate, and low specialization groups. RESULTS: The high specialization group reported significantly lower overall LEFS scores, and a greater proportion (40%) reported clinically important deficits in LEFS scores compared to the low specialization group (20%). The high specialization group also reported greater foot/ankle and knee pain and a greater proportion of sport-related knee injuries than the low specialization group (49% vs 25%). CONCLUSIONS: Our findings suggest that even after discontinuing sports, young adults who were highly specialized in youth sports before high school reported clinically important deficits in lower extremity function, greater foot/ankle and knee pain, and a greater history of knee injuries than young adults who were not specialized in youth sports, suggesting a possible link between youth sports specialization and long-term lower extremity health after sports.

Fabrication and characterization of active nanocomposite films loaded with cellulose nanocrystals stabilized Pickering emulsion of clove bud oil.

There is a tremendous increase in the development of alternative food packaging materials which are functional, environment-friendly, and can improve the shelf-life of food products. One such possible approach is to develop biopolymer-based active films loaded with antimicrobial essential oils. In the present study, pearl millet starch (PMS) films reinforced with kudzu cellulose nanocrystals (CNCs) stabilized Pickering emulsions of clove bud oil (CBO) were developed as active and sustainable packaging material. Active nanocomposite films were prepared by blending PMS with Pickering emulsions of CBO at 0.5, 1, 1.5, and 2 wt% conc. Using the solution casting method. Overall, active nanocomposite films displayed improved thermal, mechanical, and water barrier properties, with an optimum CBO-Pickering emulsion concentration of 1.5 %. CBO and PMS films showed strong chemical interactions, which significantly improved the mechanical resistance of the film. Further, SEM showed the appearance of micro-porous holes in the films because of partial evaporation on the cryo-fractured surface due to the vacuum condition. In addition, films exhibited antimicrobial activity against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus), with a rate response from increasing CBO Pickering emulsion concentration from 0.5 to 2 %. E. coli and S. aureus exhibited an inhibition zone ranging from 10.5 to 2.15 mm and 11.2 to 22.1 mm. This study suggests that PMS starch and kudzu CNCs-based active nanocomposite films loaded with CBO-Pickering emulsions have good potential to develop active and sustainable packaging materials.

Deep Dive into the Long Haul: Analysis of Symptom Clusters and Risk Factors for Post-Acute Sequelae of COVID-19 to Inform Clinical Care.

Long COVID is a chronic condition characterized by symptoms such as fatigue, dyspnea, and cognitive impairment that persist or relapse months after an acute infection with the SARS-CoV-2 virus. Many distinct symptoms have been attributed to Long COVID; however, little is known about the potential clustering of these symptoms and risk factors that may predispose patients to certain clusters. In this study, an electronic survey was sent to patients in the UC San Diego Health (UCSDH) system who tested positive for COVID-19, querying if patients were experiencing symptoms consistent with Long COVID. Based on survey results, along with patient demographics reported in the electronic health record (EHR), linear and logistic regression models were used to examine putative risk factors, and exploratory factor analysis was performed to determine symptom clusters. Among 999 survey respondents, increased odds of Long COVID (n = 421; 42%) and greater Long COVID symptom burden were associated with female sex (OR = 1.73, 99% CI: 1.16-2.58; ß = 0.48, 0.22-0.75), COVID-19 hospitalization (OR = 4.51, 2.50-8.43; ß = 0.48, 0.17-0.78), and poorer pre-COVID self-rated health (OR = 0.75, 0.57-0.97; ß = -0.19, -0.32--0.07). Over one-fifth of Long COVID patients screened positive for depression and/or anxiety, the latter of which was associated with younger age (OR = 0.96, 0.94-0.99). Factor analysis of 16 self-reported symptoms suggested five symptom clusters-gastrointestinal (GI), musculoskeletal (MSK), neurocognitive (NC), airway (AW), and cardiopulmonary (CP), with older age (ß = 0.21, 0.11-0.30) and mixed race (ß = 0.27, 0.04-0.51) being associated with greater MSK symptom burden. Greater NC symptom burden was associated with increased odds of depression (OR = 5.86, 2.71-13.8) and anxiety (OR = 2.83, 1.36-6.14). These results can inform clinicians in identifying patients at increased risk for Long COVID-related medical issues, particularly neurocognitive symptoms and symptom clusters, as well as informing health systems to manage operational expectations on a population-health level.

Oral Processing of Three Guenon Species in Taï National Park, Côte d'Ivoire.

Three guenon species in Taï National Park frequently form and maintain stable polyspecific associations despite significant feeding competition. This dietary overlap provides an opportunity to examine how closely related and anatomically similar taxa process the same foods. Our research examines whether the oral-processing behaviors of these guenons differ when they consume the same foods. Methods: Data on oral-processing behavior were collected on one habituated group each of Cercopithecus campbelli, C. diana, and C. petaurista in Taï National Park, Côte d'Ivoire from January 2016 to December 2018. We recorded the frequency with which foods were introduced to the mouth (ingestive action) and the frequency with which foods were processed using incisors, canines, and postcanine teeth. Oral-processing profiles for species-specific plant foods, fungi, and invertebrates were compared using Monte Carlo resampling. We quantified oral-processing behavior during a total of 2316 five-minute focal periods. Diana monkeys use their incisors significantly more per ingestive action than Campbell's monkeys or Lesser spot-nosed guenons. Lesser spot-nosed guenons use their incisors more than Campbell's monkeys. Diana monkeys also use significantly more post-canine chews per ingestive action than Campbell's monkeys and Lesser spot-nosed guenons. Lesser spot-nosed guenons generally use fewer post-canine chews than Diana monkeys but more than Campbell's monkeys. Canine use during feeding was rare in all three taxa. The three study species use different oral-processing profiles when consuming the same foods. These results are intriguing given the overall similarity in dental and cranial anatomy in these taxa. The oral-processing profiles we report do not encompass the full dietary breadth of all species; however, the behavioral diversity demonstrated during consumption of the same foods suggests that insight into feeding behavior is more likely obtained by examining oral processing of individual foods rather than broad food categories. Furthermore, these results underscore that important variation in feeding behavior is not necessarily associated with morphological differences in dental or craniofacial anatomy.

Nonidentical function of Upc2A binding sites in the Candida glabrata CDR1 promoter.

Increased expression of the Candida glabrata CDR1 gene, encoding an ATP-binding cassette membrane transporter, is routinely observed in fluconazole-resistant isolates of this pathogenic yeast. CDR1 transcription has been well-documented to be due to activity of the Zn2Cys6 zinc cluster-containing transcription factor Pdr1. Gain-of-function mutations in the gene encoding this factor are the most commonly observed cause of fluconazole hyper-resistance in clinical isolates. We have recently found that the sterol-responsive transcription factor Upc2A also acts to control CDR1 transcription, providing a direct link between ergosterol biosynthesis and expression of Pdr1 target genes. While this earlier work implicated Upc2A as an activator of CDR1 transcription, our further analyses revealed the presence of a second Upc2A binding site that negatively regulated CDR1 expression. This Upc2A binding site designated a sterol-responsive element (SRE) was found to have significant lower affinity for Upc2A DNA-binding than the previously described SRE. This new SRE was designated SRE2 while the original, positively acting site was named SRE1. A mutant version of SRE2 prevented in vitro DNA-binding by recombinant Upc2A and, when introduced into the CDR1 promoter, caused decreased fluconazole susceptibility and increased CDR1 expression. This negative effect caused by loss of SRE2 was shown to be Pdr1 independent, consistent with the presence of at least one additional activator of CDR1 transcription. The ability of Upc2A to exert either positive or negative effects on gene expression resembles behavior of mammalian nuclear receptor proteins and reveals an unexpectedly complex nature for SRE effects on gene regulation.

Pearl millet starch-based nanocomposite films reinforced with Kudzu cellulose nanocrystals and essential oil: Effect on functionality and biodegradability.

This paper documents the preparation of three biopolymer films: 1) pearl millet starch (PMS) films, 2) PMS films reinforced with cellulose nanocrystals (CNCs), and 3) PMS films reinforced with CNCs stabilized Pickering emulsion of clove bud oil (CBO) and a comparison of their mechanical and water barrier properties and biodegradation behavior in soil. Reinforcing PMS films with Kudzu CNCs/CBO significantly increased tensile strength (from 3.9 to 16.7 MPa) and Young's modulus (from 90 to 376 MPa) but reduced the elongation (54.2 to 30 %) at the break of nanocomposite films. Also, the water vapor permeability of nanocomposite films decreased (from 9.60 to 7.25 × 10-10gm-1s- 1Pa-1) with the incorporation of Kudzu CNCs/CBO. The fastest biodegradation was observed for PMS films (98% in 15 days), followed by PMS films reinforced with Kudzu CNCs (96% in 18 days), followed by PMS films reinforced with Kudzu CNCs stabilized Pickering emulsions (94% in 21 days). The morphological analysis found hyphae-like structure formation due to microbial action, which increased over time. In general, all three biopolymer films showed good biodegradation behavior, and they all degraded between 15 and 21 days, suggesting that starch-based films reinforced with Kudzu CNCs provide a technique for the production of biodegradable packaging material.

Enzymatic modification of starch: A green approach for starch applications.

Native starches are modified to overcome the shortcoming, including retrogradation, syneresis, and low water-holding potential, which limit their industrial applications. The enzymatic modification includes designing a starch with a new structure. The molecular mass, branch chain-length distribution, and amylose/amylopectin ratio can be altered by enzymatic reactions when the enzymes react with gelatinized starch. The enzymatic modification directly affects the properties of the modified starch, including in freeze-thaw stability of gels and retardation of retrogradation during storage. Various enzymatic modifications of starch have been attempted for novel applications to the food industry as food ingredients, the enhancement of product quality, and the improvement of the efficiency of food processing. This review article addresses the key enzymes used for starch modifications, their mechanism of action, functionality and discusses new challenges and opportunities for effective modification. Also, the current review will give a critical snapshot of the applications for starch modifications in food industries.

Prognostic utility of systemic inflammatory markers and chronic hepatitis C virus infection status in hepatocellular carcinoma patients treated with local ablation.

BACKGROUND: Hepatocellular carcinoma (HCC) has high incidence and mortality worldwide. Local ablation using radiofrequency ablation (RFA) or microwave ablation (MWA) is potentially curative for early-stage HCC with outcomes comparable to surgical resection. We explored the influence of demographic, clinical, and laboratory factors on outcomes of HCC patients receiving ablation. METHODS: This retrospective cohort study included 221 HCC patients receiving local ablation at Mayo Clinic between January 2000 and October 2018, comprising 140 RFA and 81 MWA. Prognostic factors determining overall survival (OS) and disease-free survival (DFS) were identified using multivariate analysis. RESULTS: There was no clinically significant difference in OS or DFS between RFA and MWA. In multivariate analysis of OS, pre-ablation lymphocyte-monocyte ratio [Hazard ratio (HR) 0.7, 95% confidence interval (CI) 0.58-0.84, P = 0.0001], MELD score [HR 1.12, 95%CI 1.068-1.17, P <  0.0001], tumor number [HR 1.23, 95%CI 1.041-1.46, P = 0.015] and tumor size [HR 1.18, 95%CI 1.015-1.37, P = 0.031] were clinically-significant prognostic factors. Among HCC patients with chronic hepatitis C (HCV) infection, positive HCV PCR at HCC diagnosis was associated with 1.4-fold higher hazard of death, with 5-year survival of 32.8% vs 53.6% in HCV PCR-negative patients. Regarding DFS, pre-ablation lymphocyte-monocyte ratio [HR 0.77, 95%CI 0.66-0.9, P = 0.001], MELD score [HR 1.06, 95%CI 1.022-1.11, P = 0.002], Log2 AFP [HR 1.11, 95%CI 1.033-1.2, P = 0.005], tumor number [HR 1.29, 95%CI 1.078-1.53, P = 0.005] and tumor size [HR 1.25, 95%CI 1.043-1.51 P = 0.016] were independently prognostic. CONCLUSIONS: Pre-ablation systemic inflammation represented by lymphocyte-monocyte ratio is significantly associated with OS and DFS in HCC patients treated with local ablation. HCV viremia is associated with poor OS. Tumor biology represented by tumor number and size are strongly prognostic for OS and DFS while AFP is significantly associated with DFS only.

Starch-based bio-nanocomposites films reinforced with cellulosic nanocrystals extracted from Kudzu (Pueraria montana) vine.

In the current study, starch-based active nanocomposite films reinforced with cellulosic nanocrystals (CNCs) of Kudzu were developed as an alternative option to existing biodegradable plastic packaging. Firstly, Kudzu CNCs were prepared by subjecting Kudzu fibers to the processes such as depolymerization followed by bleaching, acid hydrolysis, and mechanical dispersion. Further, nanocomposite films were formulated by blending pearl millet starch (PMS) and glycerol (30%) with different Kudzu CNCs compositions (0-7 wt%) using the solution casting process. The prepared PMS/Kudzu CNCs nanocomposite films were analyzed for their morphological (SEM and TEM), thermal (TGA and DSC), structural (FTIR), mechanical (tensile strength (TS), elongation at break and young modulus), and water barrier properties. The PMS/Kudzu CNCs films possessed improved crystallinity, heat and moisture-barrier properties, TS, and young-modulus after reinforcement. The optimum reinforcer concentration of CNCs was 5%. The Kudzu CNCs reinforced starch film offers a promising candidate for developing biodegradable films.