Background: Disseminated juvenile xanthogranuloma (JXG) and central nervous system (CNS) involvement has unfavorable outcome. Observation: A 3.5-year-old presented with headache, left hemiparesis of 2 weeks duration and encephalopathy, polyuria, polydipsia of > 6 months, multiple skin lesions from infancy, diagnosed as JXG with diabetes insipidus. Regression for >2 years was observed with Langerhans Cell Histiocytosis (LCH)-III protocol, desmopressin. Relapse after six months off-treatment was treated with LCH-IV protocol, later with salvage regimen; maintenance therapy for a year and now in remission for > 6 years. Conclusions Good neurological outcome is possible in chemo sensitive JXG is despite extensive CNS lesions.

Here we investigated changes in primary metabolism and cell death around oviposition sites in two hybrid clones of Eucalyptus with different degree of resistance to Leptocybe invasa Fisher & La Salle (Hymenoptera: Eulophidae), as well as, tolerance to water deficiency. We showed that apices of the resistant clone with oviposition had a higher content of amino acids organic acids, and the compound putrescine, than those of the susceptible clone with oviposition. In contrast, apices of the resistant clone with oviposition had lower sugar content and pyruvate organic acid content than those of the susceptible clone with oviposition. Small areas of necrosis were induced around the oviposition sites in the stem apices of Eucalyptus 24 h after infestation. The resistant clone developed larger necrotic areas that showed progressive increases 24–72 h after infestation than the susceptible clone, in which cell death was significantly lower and no changes were observed in necrotic area over time. Thus, the programmed death of cells around the egg, modulated by several amino acids, is likely the first defence response of Eucalyptus against L. invasa. Our results serve as the basis for the early identification of key metabolites produced in plants in defence against galling insects.

The research and development of cardiac drugs often focus on drug efficacy and side effects. However, traditional drug detection model of two-dimensional cell culture in Petri dish can not meet the need of drug industry with lower cost and quick time. Heart-on-a-chip (HOC) as an alternative physiological model to simulate human heart microenvironment in vitro now is accelerating medicine Research and Development, and is developing towards the direction of multi-disciplinary integration. The technical fields involved include biology, chemistry, material, and especially AI. Biosensor and machine vision, as frequently used engineering methods in computer science and bioelectronics, can also be used in HOC at present, which undoubtedly improve the rich functions of HOC and the prediction ability of drug safety and efficiency in pharmacology research, and definitely provide big data for real-time data analysis. In this paper, we firstly introduce the physiological structure of heart, and secondly clarify the heart-on-a-chip and its working principle, materials, and fabrication, furtherly present some interesting samples of heart-on-a-chip combined with biosensor and machine vision, and finally put forward the research vision and challenges in the future.

In recent years, Akebia trifoliata used to restore rocky desertification environment. We first discovered that the medicinal content of A. trifoliata will increase in rocky desertification habitats, but its mechanism of action is not clear. In this study, A. trifoliata was planted in normal habitats and rocky desertification habitats, and changes in the content of secondary metabolites and related enzyme activities were analyzed. The results showed that: (1) the biomass of the roots, stems and leaf of A. trifoliata reduced significantly, but the content of secondary metabolites increased significantly in rocky desertification habitats. It is mainly reflected in the content of tannins in leaves, flavonoids in roots, and total phenols in roots, stems and leaves. (2) A. trifoliata changed the enzyme activities of PAL (Phenylalanine ammonialyase), C4H (Cinnamate-4-Hydroxylase) and 4CL (4-Coumarate: Coenzyme A Ligase), thereby regulated the increase in the content of secondary metabolites in rocky desertification habitat. (3) the content of medicinal components of A. trifoliata increased significantly in rocky desertification habitat. The highest content of oleanolic acid in the roots from July to August, and the highest content of α-hederagenins in the stems in July; (4) principal component analysis showed that the main response index of A. trifoliata secondary metabolites and related enzymes in rocky desertification habitats was total phenols. This study revealed the response mechanism of A. trifoliata secondary metabolites and related enzymes in rocky desertification habitats. It not only provided a new choice for the exploiting of medicinal resources of A. trifoliata, but also provided a new theoretical basis for A. trifoliata to restore rocky desertification environment.

In the present manuscript, we are going to research a numerical scheme of the nonlinear Benjamin-Bona-Mahony-Burgers (BBMB) equation using the Strang time-splitting technique based on cubic B-spline lumped Galerkin method. In line with our aim, this equation is split into two sub-equations containing the derivative in time direction. Each sub-equations is applied Galerkin finite element method with cubic B-splines and after that the resulting equations are solved with the Strang time-splitting technique. Stability analysis of numerical algorithm is investigated. Five test problems with both exact solution and not is suggested to test the accuracy and reliability of the presented method. The error norms $L_{2}$ and $L_{\infty}$ with three invariants $I_{1},I_{2}$ and $I_{3}$ are computed and compared with existing studies in the literature and the obtained numerical results are displayed in graphics as well as tables. The numerical results obtained with this new approach set light to the solution of nonlinear equations as an effective mathematical tool.

Background: Various studies show that the quality of sleep, in employees can be effective in improving the quality and performance of their work. Numerous factors such as nutrition and diet can affect the quality of sleep of people, especially employees. This study was performed to investigate the relationship between food quality scores (HEI, DII and DASH score) and sleep quality in employees. Materials and methods: The present cross-sectional study was performed on 211 employees with a mean age of 38.75±11.31. Nutritional status of individuals was determined through the Food Frequency Questionnaire (FFQ) and to assess sleep quality, the Pittsburgh Sleep Quality Index (PSQI)was used which contains questions about delay, duration, sleep effectiveness, sleep disorders, sleeping pills and daily dysfunction. The quality of sleep decreases with increasing Pittsburgh index score. The calculated dietary quality scores include DASH Dietary Adherence Index, Healthy Nutrition Index (HEI) and Diet Inflammation Index (DII). Results: The results of this study after adjusting for confounding factors including age, sex, daily energy intake and BMI showed a significant positive relationship between DASH diet score and sleep duration (p <0.001). There was a significant negative relationship between HEI score and total score of Pittsburgh Sleep Quality Index (P = 0.003). Also, HEI score had a significant positive relationship with sleep duration in the unmodified and modified models (p <0.001), and a significant negative relationship was seen in unadjusted and modified model between DII score and sleep duration (p <0.001). Conclusion: DASH and HEI score had a significant positive relationship with sleep duration and DII had a significant negative relationship with sleep duration. HEI also significantly improved sleep quality.

Summary Human and dog health are inextricably linked, and although our relationship with dogs brings numerous benefits for our well-being , it is known that they can transmit disease. Bariloche is a Patagonian tourist city with heterogeneous social composition. This study evaluates the population of free-roaming dogs and their intestinal parasites in relation to the socioeconomic level of the city’s human population. Census areas were used as survey units, stratified in three levels according to socioeconomic status. The free-roaming dog population was estimated by walking around each census area. Eight fresh feces per census count area were collected and analyzed using coproparasitological flotation tests, and CoproELISA was used to detect Echinococcus sp. A total of 858 free-roaming dogs were registered along 40.9 km, with significant differences between socioeconomic strata: the highest numbers were found in the lowest income strata. Of the feces collected, 39.2% tested positive for parasites, those associated with a lower socioeconomic level having higher percentages of positive feces and a greater number of species. Eight species of helminths were found, some of which were zoonotic, such as Echinococcus sp., Toxocara canis, and Dibothriocephalus latus. The presence of parasites can be explained by dog size and the number of free-roaming dogs per block. The free-roaming dogs generally have owners, and their parasitic infection is strongly associated with the socioeconomic level of the population. The main problem is irresponsible pet care, which generates bad conditions for both dogs and humans. Thus, both dogs and humans deserve effective and ethical public policies.

Acetyl-coenzyme A (acetyl-CoA) is a key metabolite for energy metabolism and biosynthetic pathways produced by acetyl-CoA synthetase (ACS) gene. In previous study, ACS gene were speculated to be related to metabolites production of Monascus sp. In this study, the expression level of ACS gene was inhibited by RNAi. 10 transformants were picked out to measure the expression level of ACS gene by RT-qPCR. The ACS gene expression level of transformant T7 was the lowest, 0.401 times higher than that of the wild strain. So T7 was selected for the follow-up study. The effects on the colonial morphology of Monascus had been observed. And the morphology of mycelia and spores were observed by scanning electron microscope. The contents of main secondary metabolites of Monascus- MK, citrinin were determined by HPLC. And the color values of wild-type strain and T7 transformant have been measured to reflect the content of pigments by spectrophotometer. The results showed that low expression level of ACS gene by RNAi could inhibit the growth of Monascus colonies and could affect the mycelial growth and the type of pigments. The low expression level of ACS gene could affect the formation and morphology of M. buliginosus M1 spores. It also could inhibit all the production of main secondary metabolites of Monascus-MK, citrinin and pigment at the same time.

Surface water of rivers like the Rhine is a highly relevant environmental and logistic compartment and an important source of the Dutch drinking water. To improve protection of the environment and drinking water supply, it is important to have a continuous overview of the chemical composition of the river. Such an overview may be obtained with contemporary, untargeted analytical platforms like Gas Chromatography-Mass Spectrometry (GC-MS). Interpretation of such untargeted data is however challenged by the presence of many compounds of biological origin. We have developed a novel approach to screen for anthropogenic compounds using statistical tests on the time-trends of ions that are not (yet) chemically identified. This approach filters out many naturally occurring compounds, leaving more resources available for wet-lab identification of anthropogenic compounds).

This study investigates the spatio-temporal changes in the downstream river bed during a dam construction on the Büyükkumla river channel in Bursa’s Gemlik district in Turkey. To achieve this goal, an evaluation of the seasonal and annual effectiveness of dam construction activities in the study area, identifying geomorphological effects during dam construction, determining the spatio-temporal changes in the downstream river bed based on the comprehensive field observations, and analyzing the impacts on erosion–accumulation dynamics caused during the establishment of the dam is discussed. The measurements for March of 2014, June and October of 2016, March and November of 2017, and April of 2018 were recorded from the beginning to the end of the dam construction. The results dividing the downstream side from the dam to the sea into two parts were obtained. In the upper zone of the study area, just downstream of the dam, accumulation in summer and scouring in winter were observed during the dam construction activities. Contrarily, in the lower part of the study area where the river flows into the sea, scouring in summer and accumulation in winter were dominant. One and half years later, after the dam excavation was over, with a little accumulation, the river bed reached an equilibrium condition.

Rationale, Aims and objectives The management of vaginal health care in general practice settings is performing suboptimal. Vaginal complaints are of frequent and recurrent nature and often stay untreated or are maltreated. eHealth and increased empowerment of patients offer opportunities to improve vaginal health care offered by GPs. The aim is to develop and evaluate an e-tool for women with vaginal complaints, for improving vaginal health care. With this e-tool women can estimate the necessity to schedule a GP consult, wait, or self-diagnose and self-treat. Methods For this qualitative study, the setting is a large general practitioners’ office in the Netherlands. After developing the electronic decision aid, we used a purposive sample of 10 women of different ages, to evaluate the e-tool. The data was collected through semi-structured and cognitive interviews, encouraging the thinking aloud method. The interviews were processed with thematic content analysis. Information about (dis)satisfaction was obtained with comparing expectations and perceptions of the subsets content, development process and effectiveness of the e-tool. Results Besides providing information, the e-tool enables women to self-structure their symptoms and prepare them for consultation with their GP (if necessary) or self-diagnose and self-treat (if appropriate). Although in general the women were satisfied, we also got various tips for improvement and further refinement of this electronic decision aid. Conclusions To the best of our knowlegde, this is the first, scientifically developed, (prototype) of an e-tool for self-diagnosis and treatment of vaginal complaints. In the near future, implementing an e-tool for vaginal complaints in general practice, seems promising in making vaginal health care more effective and efficient.

Background: Healthcare workers (HCWs) are the occupational group with the highest potential to be affected by infectious diseases and epidemics. Objectives: In this study, it was aimed to reveal the fatigue and sleep quality levels of HCWs who survived COVID-19 and influencing factors. Methods: This cross-sectional study was conducted with 133 post-COVID-19 HCWs who applied to internal medicine outpatient clinic between March 1, 2021 and April 15, 2021 in Turkey. Sociodemographic Data Form, Fatigue Assessment Scale (FAS) and Pittsburgh Sleep Quality Index (PSQI) were used to obtain research data. Results: More than half of the post-COVID-19 HCWs had fatigued (55.6%) and had poor sleep quality (59.4%). The mean fatigue and sleep quality score was higher under the age of 40. Increasing PSQI score (the worse sleep quality), increased the fatigue 1.54 times. Being female worsened sleep quality 6.61 times, being overweight worsened sleep quality 4.81 times, and increasing FAS score worsened sleep quality 1.39 times. Discussion: In this study, it was determined that post-COVID-19 HCWs had high levels of fatigue and sleep quality. order for the health service to continue without interruption during the prolonged pandemic process, it is thought that post-COVID-19 HCWs should be followed up regularly in terms of possible health problems.

There are many scientific problems related to the topic of interpolation, especially for non-‎continuous functions, as well as the evaluating of the integrals of such non-continuous ‎‎functions. These needs appear clearly in the development of profit and loss plans in economic ‎‎projects, stock exchange transactions, and investment funds, solving ecological issues and ‎‎recording data on the evolution of epidemics and virology. We investigate a new straightforward ‎‎method for interpolating and integrating discontinuous valued functions. The method is based ‎‎on some modified ‎matrix-vector ‎barycentric Lagrange interpolation formulas. We developed ‎‎seven rules for the ‎optimum distribution of nodes ‎inside the domain of integration; five for ‎‎single-valued ‎discontinuous functions, and two rules for the two independent variables ‎‎discontinuous ‎functions. We designed these rules to be depending on the length of the ‎‎integration domain and ‎the degree of the interpolant polynomials. Thus, we obtained uniform ‎‎interpolation and the ‎minimum roundoff errors. Based on these rules with the application of the ‎‎modified matrix-vector barycentric formulas, we easily isolated the singularities of the ‎‎interpolant integrands and ‎evaluated the corresponding interpolant integral values with super ‎‎accuracy. The numerical ‎solutions of the given five examples show the ‎super accuracy, and ‎‎efficiency of the ‎presented method compared with a cited method.‎ ‎ Keywords- interpolation, singular integrals, computational methods‎

In this paper, we study the existence, nonexistence and L∞−solutions to the following p−Kirchhoff equation −M(||∇u||p)∆pu + V(x)|u|p−2u = f(x, u), x ∈ R^N ,where M(t) = a + btpτ , t ≥ 0, a > 0, b, τ ≥ 0, 1 < p < N, and V (x) is a continuous and nonnegative function in RN . Under suitable conditions on V (x) and f(x, u), the existence of infinitely many bounded solutions and the nonexistence of solutions to Eq.(0.1) are investigated.

Background: The aim of our analysis was to evaluate the impact of the COVID-19 pandemic on the procurement program and kidney transplantation in Slovakia and to identify the risk factors for a severe course of COVID-19 disease, as well as the risk factors for COVID-19 fatalities, with focus on the parameters preceding the infection. Methods: 305 KTRs (68.8% males) with confirmed SARS-CoV-2 positivity were included in the multicentric retrospective analysis. Results: The procurement program and kidney transplants in Slovakia dropped in the observed period by 28.6% (P<0.0001) and by 33.5% (P<0.0001) respectively. Age over 59 years (OR=1.03, P=0.0088) and diabetes mellitus (OR=2.04, P=0.0106) were identified as independent risk factors for severe course of the disease. Risk factors for death were age over 59 years (OR=1.05, P=0.0003) and graft dysfunction with CKD-EPI<0.5 mL/s (OR=4.87, P=0.0029). The prevalence of the alpha variant in Slovakia was associated with a severe course in KTRs treated with corticoids (OR=5.72, P=0.0273) and in graft dysfunction with CKD-EPI<0.5 mL/s (OR=2.94, P=0.0076); the risk of death was higher in KTRs over 59 years (OR=1.07, P=0.0173) and again with CKD-EPI<0.5 mL/s (OR=4.42, P=0.0393). KTRs had a 3.7 times lower risk of infection compared to hemodialysis patients (14% vs 52%, P<0.0001), with mortality of 9.8% vs 30% (P<0.0001). Conclusion: The procurement and transplant program is sustainable even during a pandemic, provided that measures are set up quickly. Morbidity and mortality from COVID-19 in KTRs was comparable to the situation in EU countries.

In order to solve the problem of bone regeneration, the design of suitable implant materials and control of its physical and chemical properties, have become particularly important. Graphene with excellent biocompatibility, high electrical conductivity, thermal conductivity, become one of the most exciting application platforms for in bone regeneration. Nevertheless, how Graphene and the immune microenvironment, regulating bone regeneration, especially, its mechanisms remains controversial. Above all, the role of angiogenesis and antimicrobial activity in bone regeneration cannot be ignored. Therefore, this article summarizes the relationship between graphene-based biomaterials and bone regeneration, explores their mechanisms or signaling pathways in osteogenesis and osteoinductivity, immunomodulation, angiogenesis and antibacterial properties, and also discusses the challenges and opportunities of graphene-based biomaterials with bone regeneration. This summary expects to be a powerful help in the development of new graphene-based bone biomaterials.

Eimeria tenella is the causative agent of cecal coccidiosis characterized by weight loss, hemorrhagic diarrhea, and high mortality rates. Research into herbal candidates to control the disease increased in the last decades by studying plant extracts with possible anticoccidial activity. As alternative to animal experiments, an in vitro reproduction inhibition assay (RIA) was previously designed to determine the sensitivity of E. tenella isolates against ionophores. In this study, RIA was used to test the anticoccidial activity of nutmeg oil, cinnamon oil, and glabridin. The concentration of nutmeg oil used in this study ranged between 1.1 μg/ml and139.1 μg/ml. Nutmeg oil exhibited a moderate in vitro inhibitory activity ranging from 35.5% to 49.5%. In contrast, no inhibitory effect was detected by incubating E. tenella sporozoites for 24 h with cinnamon oil at concentrations of 0.3 μg/ml to80.5 μg/ml. Glabridin (0.08 - 41.7 μg/ml) impaired sporozoites to replicate at a rate of14.1% to81.7% of inhibition. The calculated minimum concentrations of glabridin needed to inhibit parasite replication by 75%, 50%, and 30% (MIC 75, MIC 50, and MIC 30) were 21.43μg/ml, 5.28μg/ml, and 0.96 μg/ml, respectively. Further studies to assess the in vitro efficacy of glabridin were performed by studying mRNA gene expression of stress provoker genes (HSP-70, NADPH, and EtPP5) after exposure of E. tenella sporozoites to glabridin at MIC 75 for 0.5 h, 1 h, 2 h, and 4 h (time-dependent experiment). Moreover, a dose-dependent experiment was performed using glabridin at a concentration resembling MIC 75, MIC 50, and MIC 30 for 24 h. In the time-dependent experiment, NADPH and EtPP5 were significantly ( p<0.05) overexpressed after 4 h of incubation with glabridin at a concentration of 21.43 μg/ml. The dose-dependent experiment exhibited a gradual overexpression in all studied genes which indicates stress imposed by glabridin on E. tenella sporozoites. In our hands, RIA was suitable toassess the strength of anticoccidial activity exhibited by the tested natural products. Such in vitro assays help to identify novel anticoccidial candidates such as herbal extracts.

Diatoms (Bacillariophyta) constitute one of the most diverse and ecologically significant groups of phytoplankton, comprising at least 100,000 species in three classes Bacillariophyceae, Mediophyceae, and Coscinodiscophyceae. Nevertheless, diatom biodiversity and evolutionary history remain elusive due to limited genomic information. Here, we constructed complete mitochondrial genomes (mtDNAs) of 15 diatom species including five Coscinodiscophyceae species (Guinardia delicatula, Guinardia striata, Stephanopyxis turris, Paralia sulcata, and Actinocyclus curvatulus), four Mediophyceae species (Hemiaulus sinensis, Odontella aurita var. minima, Lithodesmioides polymorpha, Helicotheca tamesis), and six Bacillariophyceae species (Nitzschia ovalis, Nitzschia sp., Nitzschia traheaformis, Cylindrotheca closterium, Haslea tsukamotoi, Pleurosigma intermedium). Comparative analysis of these mtDNAs, together with diatom mtDNAs that have been published, revealed extensive genome rearrangement events, gene duplications, gene losses, and gains and losses of introns. Duplication of cox1 was discovered for the first time in diatoms in Nitzschia traheaformis and Haslea tsukamotoi. Phylogenetic analysis of 68 Bacillariophyta species revealed that species of the genus Nitzschia were so diverse that they could represent multiple genera. mtDNAs showed extensive genome rearrangement events including translocations and/or inversion at the class level, while high conservation at the order level. Molecular dating analysis revealed that the three diatom classes split 100 Mya and many diatom species appeared 50 Mya. More mtDNAs of diatoms representing different orders will play great dividends to explore biodiversity and speciation of diatoms in different ecological regions.

Introduction: Interleukin-38 has been involved as an inflammatory mediator in rheumatic diseases. Little is known about the role of IL-38 in primary Sjögren’s syndrome development. The aim of this study was to evaluate the role of IL-38 in primary Sjögren’s syndrome and its association with disease activity. Materials and Methods: Between 2019-2020, 40 patients with primary Sjögren’s syndrome and 39 healthy participants were included in the study. Serum level of IL-38 was measured by ELISA in all participants. Serum levels of IL-38 were compared with clinical and laboratory features, and disease activity. Results: There was not a significant difference regarding serum IL-38 level between primary Sjögren’s syndrome patients and controls (58.0 pg/ml, min-max: 0-641.0 vs. 55.0 ng/ml, min-max: 0-338.0; p=0.511). Any significant correlations were not found between serum IL-38 level and SSDAI (r=-0.104, p=0.523). Conclusion: IL-38 may trigger the inflammatory process in primary Sjögren’s syndrome, but we couldn’t demonstrate any association of serum IL-38 level in primary Sjögren’s syndrome neither clinical findings nor disease activity.

Accurate nuclear and cell segmentations plays an important role in improving the accuracy of target recognition in microscopic cell images. As the traditional SLIC (Simple Linear Iterative Clustering) algorithm cannot segment microscopic cell images well, an improved SLIC superpixel segmentation algorithm based on gray scale enhancement and regional equalization is proposed. According to the characteristics of microscopic cell images, selecting different transformation parameters with the conditional iterative algorithm, the best classification multi-threshold method based on maximum entropy criterion is used to nonlinearly enhance the gray scale of the original images, while enhancing the contrast of the image, it also greatly improves the balance of each classification region. Then the gray distance and spatial distance are calculated respectively in the circle neighborhood of the cluster center to realize the superpixel segmentation of the image. Finally, the improved SLIC algorithm and the comparison algorithm are tested and evaluated. The experimental results show that our improved SLIC algorithm model has higher segmentation accuracy and is more suitable for cell segmentation in microscopic cell images than original SLIC algorithm.

Background: At present, the global shortage of nurses is prominent. No research prove whether nursing managers can prevent the loss of nurses according to the characteristics of nurses’ occupational anchor types and their psychological capital level. Objective: To investigate the distribution of career anchor types and the status quo of psychological capital of newly graduated nurses and to analyze the influencing factors. Methods: 484 nurses graduated within 3 years from 5 public general hospitals were selected by convenience sampling. Career anchor and psychological capital questionnaire were used to investigate. Results: 481 valid questionnaires were collected. Career anchor type distribution is the most Secure /Stable, accounting for 48%, General Managerial Competence is the least, only 1.9%, psychological capital score of the Challenge type nurse is the highest (P<0.05). The residence and singleness of new graduated nurses were the influencing factors of Career capital score (P < 0.05); The age, single status, education background and residence of newly graduated nurses were the influencing factors for the classification of career anchor (P < 0.05). Conclusion: nursing managers can arrange appropriate nursing posts according to the characteristics and psychological capital level of different types of career anchor nurses to establish a stable nursing team.

Filgrastim is a granulocyte colony-stimulating factor (G-CSF) that stimulates the production of neutrophils, and is used to prevent or treat febrile neutropenia in patients undergoing chemotherapy. Hypersensitivity reactions (HSRs) to G-CSF formulations, such as filgrastim, pegfilgrastim and biosimilars are rare, and few reports exist regarding desensitization protocols, particularly in the pediatric population. In this brief report, we describe successful desensitization and subsequent use of G-CSF (biosimilar product Nivestym®) in an adolescent with Hodgkin lymphoma who experienced anaphylaxis after her first dose.

Abstract Research demonstrates that heart failure is one of the most common causes of readmission following hospitalization. Evaluating the options for transitional care in this population and further identifying what may be most effective for reducing hospital readmission is imperative for improving both patient safety and care quality. Aim: The purpose of this review was to assess the state of the science of transitional care interventions and their utility for reducing hospital readmissions in patients with heart failure during an 11-year period, from 2010 to 2021. Method: A systematic search was conducted within five databases, including CINAHL, EMBASE, OVID Medline, SCOPUS and Cochrane. Results: Thirteen studies were included. Four transitional care intervention were included such as home healthcare services, multidisciplinary team care, telephone support/follow-up, and telemonitoring. Conclusion: The evidence was consistent that home healthcare services were effective in decreasing readmission rates among heart failure patients, but telemonitoring programs were not effective. On the other hand, evidence differed regarding the effect of telephone support interventions and multidisciplinary team care in reducing readmission rates.

Aim: Critical ill patients experience catabolic stress which results in the systemic inflammatory response. The inflammatory response is associated with increased complications including infection, multi-organ dysfunction, increased length of ICU stays, and mortality. L-Carnitine supplementation may play an important role in these patients by regulating inflammatory cell function. The purpose of the present study was to investigate the effect of L-Carnitine supplementation on clinical status, inflammatory markers, and mortality rate in critically ill patients admitted in the intensive care unit(ICU) Methods: This randomized, double-blind, placebo-controlled trial was performed on critically ill patients. Subjects were randomly assigned into placebo (n=27) and L-Carnitine (n=27) groups. L-Carnitine (3000mg/day) was administered via nasogastric tube for the intervention group for 7 days while the other group received a placebo for the same duration. Serum levels of inflammatory markers including C-reactive protein (CRP) and interleukin-6 (IL-6) were measured. Nutritional status and the acute physiology and chronic health evaluation (APACHE) score, sequential organ failure assessment (SOFA) score, and 28-day mortality were also recorded. Results: Fifty-one critically ill patients completed the study. L-Carnitine supplementation significantly reduced the levels of CRP (mean change± SE: -34.9 ± 6.5) and IL-6 (mean change ±SE: -10.64 ± 2.16) compared to the baseline, which are both statistically significant compared with the control group (p<0.05). The SOFA and APACHE scores were significantly reduced in the L-Carnitine group compared with the placebo group (p=0.02 and p<0.001, respectively). Conclusions: L-Carnitine supplementation has substantial beneficial effects on inflammatory and clinical outcomes of critically ill patients.