A study of the pro-oxidant capacity of amphotericin B was carried out by analyzing the photosensitizing ability of an amphotericin B model. Although amphotericin B is a well-known broad-spectrum antibiotic, little is known about the mechanism of its pro-oxidant capability. This study employed density functional theory to assess the photosensitizing capacity of AMP. Furthermore, electron transfer reactions were modeled according to the Marcus theory, considering that lipid media can mimic the environment of the cell membrane. The results show that AMP is a pro-oxidant molecule mainly through the type II mechanism, with the corresponding production of 1O2. In this way, AMP could induce oxidative stress because it is capable of generating reactive oxygen species. In this case, AMP showed a reaction rate constants of 8.94 x 109 and 1.89 x 1010 M−1 s−1 for the type I and II mechanisms, respectively, while the overall reaction rate constant was 2.79 x 1010 M−1 s−1. Therefore, the results of this study support the pro-oxidant capacity of amphotericin B in lipid media, and considering that ergosterol is more susceptible to undergoing oxidative damage by reactive oxygen species than cholesterol, this mechanism could contribute to the antifungal activity of amphotericin B.

Background: CD14 is involved in the modulation of immune reaction via toll-like receptors (TLR) and may influence the development of allergic diseases. The role of CD14 in vernal keratoconjunctivitis (VKC) has not yet been investigated. The aim of this study is to evaluate changes of tear soluble sCD14 and conjunctival CD14, TLR-4 and 9 expression in patients with VKC in the active and quiescent phases. Methods: 18 patients with VKC during active inflammation (group A, N=9), in the quiescent phase (group Q, N=5) and after recovery (group R, N=4) and 10 healthy subjects were included. Patients in group A were treated with corticosteroid eye drops 4 times daily for 7 days. Expression of sCD14 in tears and of CD14, TLR-4, and TLR-9 by conjunctival epithelium were evaluated by Western Blot in all groups and after corticosteroid treatment. Results: expression of sCD14 and of CD14, TLR-4 and TLR-9 was significantly decreased in group A when compared with healthy subjects and with VKC group Q and R. Lower expression of sCD14, CD14, TLR-4 and TLR-9 were significantly correlated with the severity of papillary reaction, while the lower sCD14 was correlated with severity of conjunctival hyperemia. Conjunctival expression of TLR-4, but not sCD14, CD14 and TLR-9, was significantly reduced after topical corticosteroid treatment. Conclusion: tear sCD14, and conjunctival CD14, TLR4 and TLR-9 decreased during ocular surface inflammatory reaction in patients with VKC. CD14 and TLRs may represent potential therapeutic targets, although it requires further studies.

Large scale, complex biobanking of biofluids for immunology research and testingRohit K. Gupta1, Vanitha Sampath2, Kari C. Nadeau2, Holden T. Maecker3,1 Biospecimen Resource Program, Office of Research, University of California, San Francisco, CA, USA.2 Sean N. Parker Center for Allergy and Asthma Research at Stanford University and Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA.3 Institute for Immunity, Transplantation, and Infection, Stanford University, Stanford, CA, USA.Corresponding Author: Prof. Holden Maecker, Department of Microbiology and Immunology, Fairchild Science Building, room D039, 299 Campus Drive, Stanford, CA 94305-5124, USA, Email: maecker@stanford.edu, Phone: (650) 723-1671Funding: Sean N. Parker Center for Allergy and Asthma Research at Stanford University and Sunshine Foundation.Conflict of Interest: Dr. Nadeau reports grants from National Institute of Allergy and Infectious Diseases (NIAID), Food Allergy Research & Education (FARE), End Allergies Together (EAT), Allergenis, and Ukko Pharma; Grant awardee at NIAID, National Institute of Environmental Health Sciences (NIEHS), National Heart, Lung, and Blood Institute (NHLBI), and the Environmental Protection Agency (EPA); is involved in Clinical trials with Regeneron, Genentech, AImmune Therapeutics, DBV Technologies, AnaptysBio, Adare Pharmaceuticals, and Stallergenes-Greer; Research Sponsorship by Novartis, Sanofi, Astellas, Nestle; Data and Safety Monitoring Board member at Novartis and NHLBI; Cofounded Before Brands, Alladapt, ForTra, and Iggenix; Chief Intellectual Office at FARE, Director of the World Allergy Organization (WAO) Center of Excellence at Stanford, Personal fees from Regeneron, Astrazeneca, ImmuneWorks, and Cour Pharmaceuticals; Consultant and Advisory Board Member at European Academy of Allergy and Clinical Immunology (EAACI) Research and Outreach Committee, Ukko, Before Brands, Alladapt, IgGenix, Probio, Vedanta, Centecor, Seed, Novartis, NHBLI, EPA, National Scientific Committee of Immune Tolerance Network (ITN) and NIH Programs; US patents for basophil testing, multifood immunotherapy and prevention, monoclonal antibody from plasmoblasts, and device for diagnostics. HM, RG, and VS indicate no conflict of interest.Author Contributions : All authors wrote and edited the final manuscript.Word Count: 978To the Editor:Biobanks have evolved from simple localized storage of samples in individual labs and clinics to large industrialized repositories with sophisticated sample life cycle infrastructure. By enabling collaborations between researchers working on different aspects of a disease, biobanks can bridge the gap between clinical care and research, accelerating medical care towards precision medicine. The concomitant advances in trans-omic technologies, big data analytics, and biorepositories make possible a coordinated, robust systems biology approach. Biobanks can be envisioned as a central hub responsible for compliant custodianship of specimens and associated clinical and biological data. Operationally, biobanks should strive to provide universal consent, standardized processing, cold-chain management, and quality control checks. Here, we discuss biobanks with respect to optimal utilization of biofluid derivatives, such as cells, supernatants, and genomic material, for immunology research and testing.A number of parameters need to be considered for specimen optimization and standardization based on sample type and downstream assays to be performed. Choices begin with the blood collection tubes to be used. For DNA and RNA analysis, EDTA anticoagulated blood is most common, as heparin can inhibit downstream polymerase reactions. However, at least one source suggests that citrate may provide higher quality RNA and DNA than other stabilizers.1For immunoassays, either serum or plasma can be effectively used, but there are subtle differences for some cytokine analytes.2 As such, a minimal requirement should be to use the same matrix (serum or plasma) and same anticoagulant if using plasma, for all samples to be compared in a study. For metabolome and lipidome studies, a report by Yin et al suggests EDTA plasma as the preferred matrix, since clotting in serum tubes activates additional processes, including the release of metabolites and enzymes from activated platelets.3For cellular assays such as flow cytometry, CyTOF, or single-cell RNAseq, viably cryopreserved peripheral blood mononuclear cells (PBMCs) or other cells of interest are key. Protocols for cryopreservation are readily available, but careful attention to both freezing and thawing protocols is particularly important to maintain viability and recovery. Traditionally, heparinized blood is used for Ficoll isolation of PBMCs, but other anticoagulants are generally equivalent for functionality of cryopreserved PBMC. Concomitant use of the whole blood for other purposes (e.g., stimulation or DNA isolation) may dictate the optimal anticoagulant—for example, EDTA would inhibit T cell receptor-based stimulation, but would be compatible with molecular assays). There are also variations to traditional Ficoll protocols, using Cell Preparation Tubes (CPTs) or SepMate tubes.4 These should be considered, as they can save time and labor and overcome some hurdles for standardization of the Ficoll procedure. The main drawbacks are a slight reduction in yield or increase in erythrocyte contamination. Importantly, training and protocol adherence are still important to prevent, for example, breakage of CPT from improper centrifuge holders, inadequate PBMC separation from improper spin speed, or loss of separation if CPT are shipped in very cold temperatures. Another variable to be considered is time to processing5, which is of course highly related to whether samples are shipped prior to processing (see Figure 1). This is particularly relevant to functional cellular assays. An alternative to overnight shipping and PBMC cryopreservation for functional assays is to perform on-site stimulation and stabilization of whole blood (e.g., Smart Tube Inc., http://smarttubeinc.com); however, proper monitoring of cold-chain storage is critical to ensure frozen specimens are not compromised. For example, when using the Smart Tube system, biobanks must maintain the frozen samples at -80°C, as micro-fluctuations in temperature can cause the specimens to coagulate, rendering them unusable. In any case, there are a number of potential variables that can be detrimental to downstream analysis and even reproducibility; biobanks should strive to harmonize collection, processing, and storage of samples related to biofluids.Research institutes often have multiple laboratories, each of which may be supporting various collections of human specimens. Unfortunately, most labs have employed their own data solutions to track and search for specimens, which has led to fragmented processes and inconsistent ontologies. Utilization of biospecimens that have been collected for scientific purposes continues to be problematic and may be more effective when paired with informatics tools that enable researchers to track, annotate, and interrogate.6 Biobanks should have a sample management system (SMS) which permits labs to accurately register, label (Figure 2), and track biospecimen inventory related to study participants7; in addition, the software should be configurable to align with lab workflows, while maintaining best practices for biobanking and ensuring governance can be maintained by the individual laboratory or institute. Further, for bioinventory tracking, it is critical to connect de-identified clinical attributes from electronic health records to biological assays following analysis of specimens in a central ecosystem; this enables researchers to rapidly search and request specimens for further analysis.8 To date, although many solutions have been developed to support virtual sample catalogs, most require extensive software engineering support in order to be deployed and require data to be migrated to a central database; robust and innovative solutions for identifying unused biospecimens in the life sciences are still desired.Long thought of as freezer farms, a biobank’s primary role has always been to provide proper cold-chain storage and logistics related to biospecimens. While much literature exists on optimal storage conditions and management,9 biobanks have evolved to now facilitate research in the life sciences that extend from the physical management of the sample life cycle to supporting standardized processing, assay optimization, and modernized data infrastructure. As compliant use of biospecimens continues to be a major component being addressed through community engagement, biobanks are poised to play an important role in medical research with increasing demand for high quality biospecimens. However, a number of questions and challenges exist regarding standardization, classification, management, sustainability, as well as ethical considerations including ownership and informed consent. Ultimately, improving how biospecimens are utilized for downstream analysis can accelerate our understanding of biological mechanisms and fuel a better tomorrow.Rohit K. Gupta1Vanitha Sampath2Kari C. Nadeau2Holden T. Maecker31 Biospecimen Resource Program, Office of Research, University of California, San Francisco, CA, USA.2 Sean N. Parker Center for Allergy and Asthma Research at Stanford University and Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA.3 Institute for Immunity, Transplantation, and Infection, Stanford University, Stanford, CA, USA.

Coronavirus disease of 2019 (COVID-19) is a public health emergency of international concern caused by a novel coronavirus, i.e., Severe Acute Respiratory Syndrome Coronavirus -2 (SARS-CoV-2). Since it is a new virus, an effective remedy against the virus is yet unknown. SARS-CoV-2 is a member of order nidovirales, family coronaviridae. Previously known treatment strategies against Middle East Respiratory Syndrome and Severe Acute Respiratory Syndromes are being tested for their effectiveness against SARS-CoV-2. Thus, various clinical and observational studies aimed at identifying potential therapies against the disease. In our study, we reviewed various drugs along with their mechanism of action including anti-virals, anti-bacterials, glucocorticoids, ACE inhibitors, anti retrovirals, anti-malarials, monoclonal antibodies, plasma and many more. Individual drugs are described and evaluated for their potential to treat SARS-CoV-2 infection. This study offers a brief review of the findings of trials conducted so far. Dexamethasone, convalescent plasma therapy, tocilizumab, remdesivir and combination therapies are found to be beneficial against SARS-CoV-2.

Desert pavements are the common features widespread in arid region, which are important for regulating the ecological and hydrologic processes. However, few studies focused on the role of water movement in maintaining ecologic function in desert pavement landscapes. This study determined the role of desert pavements in water infiltration on fluvial fans, which were reflected by characteristics of desert pavements and infiltration parameters in the middle reaches of Hexi Corridor. Six sites (i.e. one site in hill slope and other five sites in the piedmont) were selected for surveying soil properties within a 50-cm depth soil profile and measuring sorptivity (S), initial water infiltration (ii), steady-state infiltration rate (is) and infiltration time (T) in crust and scalped crust conditions under 5-cm pressure head. The results indicated that desert pavement surfaces were covered by a thin layer of protective crusts, which were primarily composed of fine earth (56.94%) and fine-medium gravel (40.46%). Although characterized by a big range of gravel coverage (19.48%- 97.63%), the crusts had small gravels (mean size: 0.58 cm) and extremely low soil moisture content (SMC; less than 1.30%), which two parameters did not significantly differ from each site in fluvial fans. The crusts were effective in restricting water infiltration capacity. When the crusts were scalped, the S, ii and is would improve 1.6, 1.7 and 1.6-fold, respectively. These three parameters significantly increased with gravel coverage and medium gravels, but significantly decreased with crust thickness and fine gravels. Desert pavements were closely with water regulation in arid systems, reflecting the vegetation distribution. This study highlights that desert pavements have a strong impact on water infiltration to function as regulating water resource and supplying water for vegetation growth.

Background: Some studies have found a slowly increasing or decreasing trend of FA. However, the trends of FA in China are unknown. To investigate the prevalence of and characteristic changes in FA in children aged <2 years across 20 years. Methods: Data from three cross-sectional surveys on FA epidemiology conducted in 1999, 2009, and 2019 were assessed, and the outcomes were compared. The skin prick test was performed in all participants; open food challenge tests were used for diagnosis confirmation. Results: The prevalences of FA in 2009 and 2019 were significantly higher than that in 1999 (3.5% in 1999, 7.7% in 2009, 11.1% in 2019, P<0.001). However, there was no significant difference in prevalence between 2009 and 2019 (P=0.086). Cow’s milk protein allergy (5.7%) replaced egg allergy (5.5%) as the most common food allergy in infants as per the results of the 2019 survey. The incidence of skin symptoms did not differ significantly over the study period (90.9% in 1999, 87.1% in 2009, and 57.9% in 2019, P>0.05), while the incidence of gastrointestinal symptoms increased significantly over time (18.2% in 1999, 12.9% in 2009, and 43.9% in 2019, P<0.05). Conclusion: The prevalence of FA in infants rapidly increased after the 1990s and gradually stabilized after 2010. Cow’s milk protein has become the most common food allergen among infants in Chongqing, China. The incidence of gastrointestinal symptoms as a manifestation of FA has increased significantly since 2010.

Background: Several studies have suggested that a short course of corticosteroid therapy with the standard care increases complete sore throat resolution in 24 hours, however, corticosteroids are yet to be a common prescription for acute sore throat patients. This study aimed to confirm the effectiveness and safety of adjuvant corticosteroid treatment with standard care, by investigating the treatment response and prognostic factors associated with increased symptom resolution. Methods: This retrospective study included 40 patients with acute sore throat symptoms. The degree of sore throat was checked using the manner of Numeral Rating Scale (NRS). Patients were orally or intramuscularly administered a single dose of 10 mg of dexamethasone as an adjuvant therapy with conventional treatments. Treatment response was stratified according to the degree of resolution of sore throat at 24 hours. Results: Of the 40 patients involved, 27 (67.5%) showed more than 50% reduction in NRS in 24 hours. On the contrary, 9 patients (22.5%) experienced less than 50% sore throat resolution, while 4 (10%) reported no significant pain relief. Multivariable logistic model controlling for significant covariables revealed that cough (OR, 0.02; 95% confidence interval, 0.01-0.40; p = 0.01) was an independent factor for predicting treatment response. In addition, post-hoc analysis showed a negative association between treatment response and the degree of cough (86.7% in no cough vs. 75.0% in intermittent cough vs. 47.1% in persistent cough, P = 0.023). Additionally, none of the patients experienced infection complications. Conclusions: A single-dose dexamethasone as an adjuvant therapy with standard care is an effective and safe strategy for patients presenting with acute sore throat in primary care clinics. Specifically, the efficacy of corticosteroid treatment for sore throat was higher in patients without cough.

Introduction The methodological, diagnostic and therapeutic aspects of lumbar puncture (LP) and CSF study have undergone many radical changes, since it was first done in 1890 by Quincke. Objectives To explore the current trends in LP practice and to suggest a safety checklist to avoid the common complications and pitfalls. To study recent advances in diagnostic and therapeutic aspects of LP and safety and efficacy of outpatient LP. We also intended to explore the common practices that are being followed peri-LP procedure, whether these are real diligences or myth only. Methods With the key words of lumbar puncture, spinal tap, and CSF examination, we searched google scholar, Embase, PubMed, Medline and Cochrane library for relevant articles, case reports, case series, consensus guidelines, expert opinions, meta- analysis, and systematic reviews. Search terms included combinations of the Medical Subject Headings “spinal puncture”, “meningitis”, “cerebrospinal fluid”, “injections, spinal”, “Trends”, “Check List”, “Outpatient”,” Complication”, “Meningeal Enhancement Post LP”, “CT prior to LP”, “Difficult LP” and “biomarkers/ cerebrospinal fluid”. Articles published between January 1990 to May 2020in English were considered and were categorised into case reports, case series, meta-analysis, systematic review. Results Common complications of lumbar puncture can be avoided if a step by step approach to rule out complications is followed, and a safety checklist is adhered to. Atraumatic LP needle better than conventional ones. Outpatient LP is safe and efficacious. Medications administered through intrathecal and intraventricular routes are ever increasing. Biomarkers in CSF will have substantial clinical implications in neurodegenerative diseases. MRI prior to LP does not cause significant meningeal enhancement and the practice of delaying LP for imaging in every case should not be encouraged. Conclusions LP has evolved from being primarily a tool to diagnose CSF infections, to diagnosing, and treating major CNS autoimmune, neuroinflammatory and neurodegenerative and congenital diseases.

Background: The place of sport is indisputable for a healthy society. This study aimed to assess the health risks of athletes engaged in sports activities in various branches in the Youth Center operating. Methods: In this cross-sectional study, data from 181 athletes were analyzed. A 20-item questionnaire including demographic information and sports history of the athletes was applied to the participants. Physical examinations were performed. Additionally, complete blood count, biochemistry, lipid profile, TSH, T4, and ECG examinations were requested from the participants. Results: In 25 (13.8%) of the participants, a pathology that could constitute a sport obstacle was detected. When the data examined concerning the presence of pathological status were compared, cardiac rate, HDL, LDL, calcium, ALT, diastolic blood pressure, the frequency of training per week, the presence of ventricular hypertrophy, t wave, and deviation in cardiac axis were statistically significant. Conclusion: The presence of conditions that may pose a risk to the health of athletes in people who are engaged in active sports suggests that some findings have been missed in the examinations for entry to sports. Family physicians should take a full anamnesis when evaluating people who want to do sports, carry out a detailed examination, and predicate their findings on laboratory findings.

In a stratified clinical trial design with time to event end points, stratification factors are often accounted for the log-rank test and the Cox regression analyses. In this work, we have evaluated the impact of inclusion of stratification factors on the power of the stratified log-rank test and have compared the bias and standard error in HR estimate between multivariate and stratified Cox regression analyses through simulation. Results from our investigation suggests that both failing to consider stratification factor in presence of their prognostic effect and stratification with smaller number of events may substantially reduce the power of the log-rank test. Further, the HR estimate from the multivariate Cox analysis is more accurate and precise compared to the stratified Cox analysis. Our findings point towards the necessity of evaluating the impact of stratification factors on the time to event analyses at the time of study design which is presently not a norm.

Aims The study was to investigate the effects of Intravenous Nicorandil on blood pressure and drug safety in patients with coronary heart disease. Methods In order to evaluate the blood pressure lowering effects and safety of Intravenous Nicorandil, we recruited 43 inpatients with unstable angina to intravenously pump Nicorandil, and the pumping speeds (2mg/h, 4mg/h and 6mg/h, respectively) were adjusted according to the patient’s blood pressure. After treatment, the effects of Intravenous Nicorandil on blood pressure and drug safety were observed. Results After treatment, the average reduction in SBP was 22.86±19.83mmHg，and the average reduction in DBP was 9.80±18.58mmHg. And Nicorandil could decrease patients blood pressure in a concentration-dependent manner. During the following-up, no serious adverse events were observed. Conclusion Intravenous Nicorandil could significantly reduce systolic and diastolic blood pressure in patients without affecting heart rate, and it reduced in depending on concentrations, suggesting that Intravenous Nicorandil may be a new intravenous antihypertensive drug in future clinical application.

Introduction: Transition from pediatric to adult care for emerging adults with sickle cell disease (SCD) has been challenging due to limited availability of experienced adult providers and patient difficulty navigating the adult health care system. The purpose of this study was to determine among adults with SCD, healthcare utilization and their trust and satisfaction with their health care provider. Methods: We surveyed adult patients greater than 21 years old with SCD previously transitioned from Children’s Hospital Los Angeles. Assessments of provider trust and satisfaction were conducted along with health care utilization and the transition experience. Results: Of 31 participants, 61% and 68% identified having an adult primary care provider (PCP) and adult hematologist respectively. Increased satisfaction with care was associated with increased trust in the adult hematologist (r=0.72 p<0.001) and PCP (r=0.76 p=0.001) and improved communication (p< 0.001). Trust in their hematologist was greater than PCP (76.5 vs 64.2, p = 0.058). For SCD complications, 65% of participants visited the ED, 80% of whom had negative experiences including sub-optimal pain management. Regarding transition experience, 55% felt unprepared for adult care. Discussion: More than 30% of adult SCD patients transferred out of pediatric care are not receiving regular hematology care for their SCD, resulting in fragmented medical care. Increased trust in their adult hematologist and clear communication are associated with higher levels of satisfaction with care. These findings will be utilized to develop a transition program to improve patient preparation and build on partnerships with adult providers to improve long-term outcomes.

We report a rare acute neurological complication associated with COVID-19 in a 6-year-old girl with hematopoietic stem cell transplantation (HSCT) for sickle cell anemia. 21 days after transplant she presented an acute facial diplegia, followed by a swallowing and left sensitive involvement, associated with an MRI T2 hypersignal and gadolinium enhancement of facial and hypoglossal nerves. Fever and severe respiratory symptoms appeared secondarily leading to the diagnosis of COVID-19. This cranial polyneuropathy in a child was inaugural, questioning the typical post-infectious mechanism. Physicians should consider SARS-CoV-2 in patients with cranial nerve abnormalities even without respiratory manifestations or fever.

Rationale, aims, and objectives: The coronavirus pandemic has disrupted normal activities across the world, from economy to socialization, and claiming hundreds of thousands of lives. The activities in radiopharmacy laboratories across the globe have been affected significantly. This survey was conducted to assess the effect of COVID-19 on radiopharmacy and activities going on in the laboratories around the world. This was meant to undertake a preliminary record of the continuing survey. Methods: A three-sectioned questionnaire with 12 questions was distributed to the professional working on radiopharmacy laboratories. The sections included demographic information, the effect of the pandemic on the regular operation on a radiopharmacy, and the measures taken to prevent the spread of the virus among the laboratory staff. Random sampling approach was used to select 100 respondents, including staff and radiochemists, across different parts of the world. Results: The survey demonstrated that the pandemic hugely impacted activities in a radiopharmacy laboratory. 98% of the respondents reported major disruptions in the normal schedule in the laboratory. Even though some laboratories continued working normally, strict measures were put in place to prevent the spread of the virus among the staff. In many radiopharmacy laboratories, diagnostic procedures and tests quantitatively decreased. The survey reported positron emission radiopharmaceutical fluorodeoxyglucose F-18 (F18-FDG) as the frequently organ imaging radiopharmaceutical during the pandemic. Conclusions: The survey showed that COVID-19 has negatively impacted activities in a radiopharmacy laboratory, consequently affecting research activities.

Introduction: The use of high resolution ultrasonography (US) became a very important tool in nail assessment. This study evaluated nails clinical and ultrasound measurements in the psoriatic arthritis (PsA) patients and control groups. Methods: A cross sectional study was performed and 44 patients with PsA, 10 health individuals and 6 hand osteoarthritis patients (OA) were selected. PsA patients were included when filling the CASPAR criteria. Results: spectral Doppler (sD) was analyzed in 208 nail beds. Nail plates appearance on gray scale (GS) showed loss of the normal three-layered appearance in 89 nails (45.9%). Power Doppler (PD) signal was detected in 189 nail beds (92.2%), showing inflammatory activity in most of the patients and nails examined. Resistance index (RI) measured was significantly lower in PsA patients as compared with controls group in both longitudinal and transverse planes (p<0.001). The nail enthesitis was observed when RI values below 0.4, characterizing 100% sensitivity and 96% specificity (p<0.01). Conclusions: Nail US measurements presented statistical significance in PsA patients, in studies future could show many inflammatory situations, as treatment assessment.

Objective: The aim of the present study is to assess interactions between the moral sensitivity of physicians and satisfaction of patients. Materials and Methods: The present study is a cross-sectional research performed on physicians and patients in Tehran, Iran. The physicians were selected through census method, and patients were selected using quota sampling for equally selecting each physician from each work shift. Data were collected through a standard questionnaire of the physicians’ moral sensitivity for decision-making and a researcher-made patient satisfaction questionnaire. Data were analyzed by the SPSS software version 23. Ethical Considerations: The study received ethical approval by Ethics Committee of Shahid Beheshti University of Medical Sciences. After explaining the objectives of the study, all participants completed and signed the written consent form. Results: The mean score for physicians’ moral sensitivity was 91.6±0.63 (out of 100) which shows a high level of moral sensitivity. The highest scores were related to the domain of “honesty and benevolence” and the lowest score was related to the domain of “The level of career knowledge”. The average patient satisfaction was 61.97±3.55 out of the total score (23-115) which shows a moderate level of satisfaction with the highest scores in the domain of “professionalism” and the lowest scores were related to the domain of “Technical Quality of Care”. According to the results, physician moral sensitivity and patient satisfaction are correlated (r= 0.611). Conclusion: Regarding the observed relationship between physicians’ moral sensitivity and patients’ satisfaction, it is suggested that improving patient satisfaction, adopting appropriate strategies like performing periodic evaluation of this phenomenon and providing some codified training in this regard are required to increase the level of moral sensitivity of physicians and provide high-quality care

Protein Tyrosine Phosphatase non-receptor type 11 (PTPN11; encoding protein SHP2) is an important protein tyrosine phosphatase (PTP) in the human body and plays an important role in regulating cell proliferation and differentiation. Overexpression of SHP2 will promote the development of cancer diseases, so research on SHP2 inhibitors has become one of the popular targets for the treatment of cancer. Recent studies have shown that combining SHP099 (an allosteric site 1 inhibitor) with SHP844 (an allosteric site 2 inhibitor) will enhance pharmacological pathway inhibition in cells. This study uses molecular dynamics simulations to explore the inhibition mechanism of SHP099 and SHP844 on SHP2 protein. The result shows that the interactions of allosteric site 1 (THR108-TRP112, LEU236-GLN245), allosteric site 2 (GLN79-GLN87, LEU262-GLN269), P-loop (HIS458-ARG465), and Q-loop (ARG501-THR507) are obviously enhanced in SHP2-SHP099-SHP844 system, which makes the fluctuation of residues more stable and the active site more difficult to be exposed. Meanwhile, residue GLU110 (allosteric site 1), ARG265 (allosteric site 2), and ARG501 (Q-loop) are speculated to be the key residues that led to the SHP2 protein in auto-inhibition conformation. This study provides an idea that help people to understand the mechanism of inhibition of the combining SHP099 with SHP844 on the SHP2.

Initially, Coronavirus disease-2019 (COVID-19) caused by SARS-CoV-2 virus is strikingly thought to be manifested by respiratory illness such as cough, chest tightness, and dysponea. Therefore, we are presenting a confirmed case of COVID-19 who developed acute pancreatitis-a rare manifestation during disease process without any known aggravating factors

Multiple myeloma had been an incurable hematological malignancy, recent advances in novel anti-neoplastic agents, including carfilzomib (CFZ), have improved the prognosis. CFZ has been reported to have cardiotoxic effects. Notably, the incidence of peripheral blood eosinophilia was not described. This is the first report of eosinophilia developing after CFZ.

Diets containing different crude protein levels (16%, 14%, and 12%) were created to feed Bamei pigs in order to study the effect of these compositions on intestinal colonies. Therefore, 27 healthy Bamei pigs of similar weight (20.99 kg±0.16 kg) were selected and randomly divided into three groups for microbial diversity analysis. The results of this study show that microbial diversities and abundances in Bamei pig jejunum and caecum samples after feeding with different dietary protein levels were significantly different. Dietary crude protein level exerted no significant effect on the Shannon index for cecum microbes in these pigs, while Simpson, ACE, and Chao1 indices for group I were all significantly higher than those of either the control group or group II (P < 0.05). Indeed, data show that microbial diversities and abundances in the 14% protein level group were higher than those in either the 16% or 12% groups. Dominant bacteria present in jejunum and cecum samples given low-protein diets were members of the phyla Firmicutes and Bacteroidetes. Data show that as dietary crude protein level decreases, representatives of the microbial flora genus Lactobacillus in jejunum and cecum samples gradually increases. Values for the KEGG functional prediction of microbial flora at different dietary protein levels also shows that genes of jejunum and cecum microorganisms were mainly enriched in the ‘metabolism’ pathway, and indicate that low protein diets increase intestinal metabolic activity. Therefore, we recommend that Bamei pig dietary protein levels are reduced 2% from their existing level of 16% crude protein. We also suggest that essential synthetic amino acids (AA) are added to optimize this ideal protein model as this will increase intestinal flora diversity in these pigs and enhance health. These changes will have a positive effect in promoting the healthy growth of Bamei pigs.

Increasing rate of pollution is a matter of global concern nowadays. One of the major sources of pollution is found to be the combustion products of diesel engine containing hazardous gases like carbon mono oxide, carbon di oxide, unburnt hydrocarbons and oxides of nitrogen. NOx reduction from exhaust of diesel engines is the topic of research for automobile Manufacturers nowdays. Lean NOx trap was used for a long time for this purpose but it was not successful. Then SCR technology came into existence which was found to be the very effective Technology for reduction of nitrogen oxides from diesel engine exhaust. This paper involves the study of a better NOx reduction technology called solid selective catalyst reduction (SSCR). After analysis the results of various experiments it is concluded that NOx reduction efficiency of about 95% can be easily achieved using SSCR system.

In this work, we develop two generic mixed-integer linear programming formulations for scheduling of multipurpose batch plants using the unit-specific event-based modelling approach. While related non-recycling production and consumption tasks are allowed to take place at the same event points but in different real time in the first model, they are not allowed in the second model. We also introduce the concept of indirect and direct material transfer, which allows to conditionally align the operational sequence of related production and consumption tasks. Processing units are able to hold materials previously produced over multiple event points. The computational results demonstrate that the proposed models do not require a task to span over multiple event points to generate the optimal solution. As a result, the proposed models are able to generate the same or better solutions with up to one order of magnitude less computational time compared to the existing models.

The present study depicts the hydrodynamics along with the mixing characteristics inside a millichannel-based serpentine fixed-bed device to attain the particular demands of the fabrication of the miniature adsorption devices. Residence Time Distribution (RTD) analyses were accomplished to analyze the velocity distribution inside the packed bed geometry. The operating variables effect the hydrodynamics, mixing, and the lead adsorption characteristics, which were pronounced clearly in the present context. Depending on the results obtained in the experiment, the new correlations were proposed. The parametric effects on the lead ions adsorption were studied in the same millichannel geometry packed with the graphene oxide (GO) coated glass beads. Thomas model was utilized to investigate the kinetics of the adsorptive removal process. The regeneration study of the said millichannel-based fixed-bed device was also executed.

A Salinity Gradient Flow Battery (SGFB) is a novel type of battery that utilizes the selective ion-transition across ion exchange membranes to produce Donnan potential and stores energy in the form of salinity gradient power (SGP). Nevertheless, the commercialization of SGFB had been halted because of the low charging-discharging efficiency due to the relatively high ohmic solution resistance in the low salinity solution. By considering the contribution of supporting ions in a redox flow battery (RFB), we proposed an “Ion-plus SGFB” system by internally-integrating the RFB and SGFB system for the breakthrough of SGFB recycling efficiency. The supporting ions in the salinity solutions overcome the trade-off limitation between Donnan potential and internal-resistance without sacrificing on the SGP, and increase the power density to 1.15 W cm-2 which is two times higher than control system (0.45 W cm-2). The novel designed system is environmental-friendly and gentle for ion exchange membrane