Present study was conducted to evaluate the clinical efficacy and safety of Liv.52 DS tablets in the management of Non-Alcoholic Fatty Liver Disease (NAFLD) in an open label clinical study. Sixty male and female patients aged between 18-65 years with NAFLD from clinical examination, laboratory test, and ultrasound findings and those willing to give informed consent were included in the study. At the initial visit, a detailed medical history and symptomatic evaluation was done. Biochemical investigations included total bilirubin, aspartate and alanine amino transferase, serum alkaline phosphatase and total proteins. All the patients received Liv.52 DS at the dose of 2 tablets twice daily for a period of 2 months. Subjects were evaluated at baseline, at the end of 1st month, and at the end of 2ndmonth for Liver function tests, hepatomegaly by ultrasound and NAFLD Score, Lipid profile and for safety assessment of Hematology and biochemical investigations. Non-invasive NAFLD fibrosis score was calculated at each assessment visits to assess the severity of fibrosis due to NAFLD. A subgroup analysis was done in Diabetes Mellitus Subjects. Statistical analysis was carried out using GraphPad Prism, Version 4.03 for windows, Graphpad Software. All the patients completed the study and data was available for analysis. Significant improvement in hepatomegaly, liver function parameters (SGPT, SGOT) was observed. A trend towards improvement in NAFLD score was seen signifying improvement in liver fibrosis due to NAFLD. Safety laboratory investigation results are within normal limits and there were no clinically significant adverse effects were reported during the clinical study. Subgroup analysis carried out in diabetic subjects further demonstrated beneficial effects in those populations suffering from NAFLD with respect to hepatomegaly and LFT levels. From the results of the study, it can be summarised that Liv.52 DS is safe and beneficial in individuals suffering from NAFLD.

Oxygen availability and overflow metabolism are often limiting factors in high cell-density cultures. In the present study, expression of Vitreoscilla hemoglobin in the chromosome of Escherichia coli was used as a strategy to improve plasmid DNA (pDNA) production in biphasic fed-batch cultures. During the fully aerobic batch phase, the strain expressing VHb accumulated 28 % less acetate and 19 % more pDNA than the non-expressing strain. The fed-batch phase was carried out with a change of regime from aerobic to microaerobic conditions. The pDNA yields from biomass increased consistently in the VHb-expressing strain during the whole culture, while decreased progressively for the non-expressing strain during microaerobic conditions. The ratio of positive/negative plasmid replication control molecules (RNAII/RNAI) were lower for the VHb-expressing than for the non-expressing strain. However, the final pDNA titer was ca. 74 % higher for the former. Flux balance analysis suggests that VHb presence increases the flux in anaplerotic pathways. The higher lactate production observed in VHb-expressing cells may be triggered by an increased demand of NAD+ in glycolysis under microaerobic conditions. These results are valuable for faster development of robust pDNA production processes.

There is a vast number of biomaterials ranging from drug-eluting stents, coated implants, drug delivery devices and artificial organs, among others, that have been developed in recent years. However, translation of many of these biomaterials to clinic is often plagued by biocompatibility challenges. This review focuses on strategies implemented in some of the recently developed biomaterials -- particularly for soft and hard tissue regeneration, organ manufacturing and disease remediation -- to overcome potential foreign body response to the incorporation of the biomaterials in the host.

Objective: To explore the prognostic factors of different prognosis SARS-COV-2 patients, including early cure (less than 3 weeks), severe death, severe survival (duration of disease over 30 days, stable condition). Methods: The general situation and laboratory tests and other relevant indicators of 50 early cured patients, 50 severe survivors and 50 severe deaths were studied. Results: Through a retrospective cohort study, there were significant differences in age, gender, respiratory distress symptoms, oxygen saturation of fingertip, state of consciousness between cured mild patients and dead patients. Diabetes and cerebrovascular disease were the main influencing factors of previous medical history. Most of the laboratory test indicators, such as the positive rate of nucleic acid test, blood routine test, myocardial infarction marker, DIC, liver and kidney function, inflammatory cytokines, are different between cured patients and dead patients. Further compared the cases of severe survival and dead patents, there were significant differences in gender, breath shortness symptoms, oxygen saturation of fingertip, consciousness, cerebrovascular disease. The laboratory tests showed that the blood routine test, MH, CK-MB, pro BNP,BUN, Cr, albumin, DIC, inflammatory factors and electrolyte disorders were great significance to the prognosis. Further study showed that CTnI, Cr and DIC and shortness of breath were independent prognostic factors of death. Conclusion: Our data may suggest that the main influencing factor of death was the degree of respiratory symptoms. The difference of prognosis was more related to whether there were multiple organ diseases, especially the heart, kidney and immune system dysfunction.

Background: Current basic life support guidelines recommend two-minute shifts for providing chest compressions when two rescuers are performing cardiopulmonary resuscitation. However, various studies have found that rescuer fatigue can occur within one minute, coupled with a decay in the quality of chest compressions. Our aim was to compare chest compression quality metrics and rescuer fatigue between alternating rescuers in performing one and two-minute chest compressions. Methods: This prospective randomized cross-over study was conducted at Songklanagarind hospital, Hat Yai, Songkhla, Thailand. We enrolled sixth-year medical students and residents and randomly grouped them into pairs to perform 8 minutes of chest compression, utilizing both the one-minute and two-minute scenarios on a manikin. The primary end-points were chest compression depth and rate. The secondary end-points included rescuers’ fatigue, respiratory rate, and heart rate. Results: One-hundred and four participants were recruited. Compared with participants in the two-minute group, participants in the one-minute group had significantly higher mean (standard deviation, SD) compression depth [mm] (45.8 (7.2) vs 44.5 (7.1), P=0.01) but there was no difference in the mean (SD) rate [compressions per min] (116.1 (12.5) vs 117.8 (12.4), p = 0.08), respectively. The rescuers in the one-minute group had significantly less fatigue (P<0.001) and changes in respiratory rate (P<0.001), but there was no difference in the change of heart rate (P=0.59) between the two groups. Conclusion: There was significantly higher compression depth and lower rescuer fatigue in the 1-minute chest compression group compared with the 2-minute group. (Thai Clinical Trials Registry TCTR20170823001)

Starting from December 2019 the novel SARS-Cov-2 has spread all over the world, being recognized as the causing agent of COVID-19. Since nowadays no specific drug therapies neither vaccines are available for the treatment of COVID-19, drug repositioning may offer a strategy to efficiently control the clinical course of the disease and the spread of the outbreak. In this paper we aim to describe the main pharmacological properties, including data on mechanism of action, safety concerns and drug-drug interactions, of drugs currently administered in patients with COVID-19, focusing on antivirals and drugs with immune-modulatory and/or anti-inflammatory properties. Where available, data from clinical trials involving patients with COVID-19 were reported. A large number of clinical studies have been registered worldwide and several drugs were repurposed to face the new health emergency of COVID-19. For many of these drugs, including lopinavir/ritonavir, remdesivir, favipiravir, chloroquine and tocilizumab, clinical evidence from literature and real life settings support their favorable efficacy and safety profile in improving patients’ clinical conditions. Even though drug repurposing is necessary, it requires caution. Indeed, too many drugs that are currently tested in patients with COVID-19 have peculiar safety profiles. While waiting for the results of clinical studies demonstrating the efficacy of drugs able to reduce symptoms and complications of COVID-19, the best therapeutic path to pursue is the development of an effective vaccine able to prevent this infection.

Understanding groundwater behavior is essential for water resources management in alluvial deltas. This study investigated the trends of groundwater levels (GWLs), the memory effect of alluvial aquifers, and the response times between surface water and groundwater across the Vietnamese Mekong Delta (VMD). 88 time series of GWL between 1996 and 2017 were collected at 27 national stations. Trend analysis, auto- and cross-correlation, and time-series decomposition were applied within a moving window approach to examine nonstationary behavior. Our study revealed high ratios of the seasonal component in shallow aquifers, and dominating ratios of the trend component in deep aquifers. These findings indicate an effective connection between the Holocene aquifer and surface water, and a high potential for shallow groundwater recharge. On the other hand, low-permeable aquicludes separating the aquifers behave as low-pass filters that reduce the high‐frequency signals in the GWL variations, and limit the recharge to the deep groundwater. Declining GWLs (0.01-0.55 m/year) were detected for all aquifers throughout the 22 years of observation, indicating that the groundwater system is currently not fully recharged. Stronger declining trends were detected for deep groundwater. While the slight decline of GWLs in the Holocene aquifer (0.01-0.11 m/year) is likely caused by natural conditions, the significant decline in the Pliocene and Miocene aquifers (0.30-0.55 m/year) is attributed to the overexploitation of groundwater. The time-variant trend analysis indicates that the decrease of GWL accelerated continuously. The groundwater memory effect varies according to the geographical location, being shorter in shallow aquifers and flood-prone areas and longer in deep aquifers and coastal areas. Variation of the response time between the river and alluvial aquifers is controlled by groundwater depth, seasonal variability, and the location with shorter response times for shallow groundwater, during the flood season, and in flood-prone areas. Our findings are not only essential for groundwater resource management in the VMD, but they also characterize general mechanisms of aquifer systems in alluvial settings.

The runoff generating processes and water fluxes exchange are essential simulating the physical nonlinear rainfall-runoff relations in hydrological models. However, current runoff generation representation in hydrological models is constraint due to both vertical and horizontal heterogeneity of meteorological factors and underlying surface condition, hampering the streamflow simulation performances. To address this concern, by integrating a hybrid runoff generation mechanism in the upper layer and baseflow curve in the lower layer, this work develops a modified Variable Infiltration Capacity (VIC) hydrological model. With consideration of both vertical and horizontal heterogeneity runoff, the modified VIC model can simulate Horton and Dunne runoff through the hybrid mechanism and lateral runoff based on three soil-layer structure. The upper reach of Hanjiang River basin with substantial climate variations is selected as a case study to validate the performance of the modified model. Results show that the modified VIC model can produce a better performance of streamflow simulation in terms of Nash-Sutcliffe Efficiency, at around 0.8 on average, especially for semi-humid and mountainous catchments. In addition, parameters related to the hybrid mechanism are sensitive to the hydrological performance, indicating that the improved performance should be attributed to the hybrid mechanism.

The Fermi paradox concerns the possible existence of advanced extraterrestrial civilizations. The Kardashev scale envisages advanced civilizations that may control and consume energy up to a galactic scale. Postulated extensions of the scale consider advanced entities that are powerful enough to create new universes. In an eternal existence of multiple universes, the emergence of such an entity may be inevitable. Such an advanced entity could perhaps be of sufficient greatness to be God. The scientific and theological feasibility of this idea of God is discussed. A possible advantage of viewing God in this way is that the supernatural might be dispensed with. However, from the viewpoint of religious practice, it is not clear whether such a God would be acceptable to major religions.

The mechanisms by which herbivores induce plant defenses are well studied. However, how specialized herbivores suppress plant resistance is still poorly understood. Here, we discovered a rice (Oryza sativa) leucine-rich repeat receptor-like kinase, OsLRR-RLK2, which is induced upon attack by gravid females of a specialist piercing-sucking herbivore, the brown planthopper (BPH, Nilaparvata lugens). Silencing OsLRR-RLK2 decreases the constitutive activity of mitogen-activated protein kinase (OsMPK6) and alters BPH-induced transcript levels of several defense-related WRKY transcription factors. Moreover, silencing OsLRR-RLK2 reduces BPH-induction of jasmonic acid and ethylene but promotes the biosynthesis of both elicited salicylic acid and H2O2; silencing also enhances the production of volatiles emitted from rice plants infested with gravid BPH females. These changes decrease BPH preference and performance in the glasshouse and the field. Our study identifies OsLRR-RLK2 as a major susceptibility factor of rice against BPH. It is likely to be employed by BPH to suppress host plant defenses for its own benefit via signaling crosstalk and/or changing the plant’s defense-related signaling profile.

This study reports outbreak of a new disease caused by Staphylococcus Pseudintermedius in Raccoon dogs. The disease occurred in a breeding farm of raccoon dogs in Guan County of Shandong Province in China in August of 2019. 47% (425/896) of raccoon dogs showed the abnormal symptoms; 17.6% (75/425) of them had sever skin and soft tissue infections(SSTIs), dyspnea and sever pathological lesions in lungs, hearts, livers, kidneys, etc; 4.2% (18/425) were dead in 4 weeks. The pathogen of the disease was identified as Staphylococcus pseudintermedius by mass spectrometer detection, microscopic examination and biochemical reaction test. Its nucleotide homology of 16SrDNA was 100% with thats of other published strains and its genotype was between American strain and Brazilian strain from other animal species. The isolated Staphylococcus pseudointermediate strain from the diseased raccoon dogs could cause ulceration and suppuration in the skins and sever pathological lesions in some organs of the infected mice, and it is confirmed as a methicillin-resistant Staphylococcus pseudintermedius (MRSP) strain by the amplification of mecA gene; and 12 sensitive drugs were screened by drug sensitivity test. Full attention should be paid to the great economic loss and the potential zoonotic risk caused by the Staphylococcus pseudintermedius in raccoon dogs, and this study can provide a reference for the clinical diagnosis and treatment of this new disease.

Background: The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) is spread through aerosol and fine droplets, and poses many challenges to medical practitioners. Otolaryngologists are at an exceptionally high-risk, due to common aerosol-generating procedures such as tracheostomy. The purpose of this study was to evaluate clinical guidelines for tracheostomy in reference to SARS-CoV-2 and provide a collective summary of recommendations.Methods: Literature review was performed. Articles reporting clinical practice guidelines for tracheostomy in the context of SARS-CoV-2 were included.Results: Tracheostomies are a common surgical procedure performed by otolaryngologists. There may be expanding indications in the COVID-19 patient population. Ventilation using a tracheostomy has many potential benefits and a summary of recommendations for tracheostomy (elective or emergent) and tracheostomy management in COVID-19 positive patients are detailed within this article. Conclusions: In patients testing positive for COVID-19, this summary of recommendations serves as a guideline along with institutional protocols.

Introduction: The COVID-19 pandemic caused by the SARS-CoV-2 virus has put healthcare workers at risk when exposed to aerosolized viral particles during upper airway mucosal surgery. The objective of this review was to discuss topical preparations that could be utilized preoperatively to help to decrease viral load and potentially reduce the risks of viral transmission. Methods: PubMed/MEDLINE database review of articles studying topical preparations with virucidal activity against coronaviruses. Results: Povidone – Iodine (PVP-I) solutions ranging from 0.23% to 7% have been found to demonstrate highly effective virucidal activity against a broad range of viruses including several coronaviruses responsible for recent epidemics: SARS-CoV-1, MERS-CoV.

The occurrence of hepatoblastoma is infrequent in children older than 5 years. Therefore, clinicians need to consider hepatoblastoma even in school-aged children or adolescents.

In this theoretical study, we investigate the electronic potential energy curves, spectroscopic parameters, vibrational energy levels and transition dipole moments for the diatomic dications BeRb2+, BeCs2+ and SrRb2+. We consider an ab initio approach based on the use of non-empirical pseudopotentials and parameterized l dependent polarization potentials. Results show that 1-22Σ+ for BeRb2+, 1-52Σ+ for BeCs2+ and 1-32Σ+ for SrRb2+ are repulsive. While the 32Σ+ for BeRb2+, 42Σ+ for BeCs2+ and 42Σ+ for SrRb2+ are metastable states. These states can accommodate some vibrational energy levels. Interesting avoided crossings between some 2+ states are localized and examined. Until now no experimental and theoretical studies have been made for each system. Consequently, we discuss our results by comparing with some data of similar systems. Besides, the transition dipole moments of the ground state to a few excited states are computed and presented. The information associated with the electronic structures, spectroscopic parameters as well as the transition properties that provide in this paper is anticipated to serve as guidelines for further experimental and theoretical researches for each diatomic dication considered in this work.

Cohesive soils present difficulties in construction projects because of usually contain expansive clay minerals. However, the engineering properties of cohesive soils can be stabilized by using various techniques. The aim of the research is to discover the influences of using hydrated lime on the consistency, compaction, and shear strength properties of clayey soil samples from Sulaimnai city, northern Iraq. The proportions of added hydrated lime are 0%, 2.5%, 5%, 7.5% and 10% to the natural soil sample. The results yielded considerable effects of hydrated lime on the engineering properties of the treated soil sample and developed its strength. The soil’s liquid limit, plasticity index, and optimum moisture content were decreased with the increase of hydrated lime percent. While the soil’s plastic limit and maximum dry density were increased. Also, the soil’s unconfined compressive strength was significantly increased with the hydrated lime content increase. The oedometer test results produced a notable decrease in the compressibility characteristics of the lime-treated soil sample. Hence, hydrated lime is successfully contributed and can be considered as an effective material to improve the strength, compressibility and consistency properties of the cohesive soils in Sulaimani city.

Urea hydrolysis is widely used in agriculture, environment and other engineering fields, among which urease contained in beans can catalyze urea hydrolysis. The urea hydrolysis activity of legume plant leaching solution(LPLS) was investigated, including soybeans, black beans, mung beans, red beans as well as soybean hulls, soybean leaves, soybean stems and soybean pods. For the high urea hydrolysis activity and economic efficiency, soybean is most suitable for agricultural engineering and other fields than other beans and soybean-related parts extract. The urea hydrolysis activity increases with the concentration of LPLS, while decreases gradually with reaction time. When the heating temperature reaches 25, 35, 45, 55 and 65 ℃, the urea hydrolysis activity is steady and the enzyme activity is high. Enzyme activity decreases after 65 ° C (i.e.75, 90 ° C). Meanwhile, the soaking time of LPLS has a little effect on the urea hydrolysis activity compared with other factors. These results make a positive contribution to domestic production urease experimental basis.

A 70-year-old male presented with a neglected slow growing anal wart for many years with bleeding.A deep core biopsy of the tumor confirmed a high-grade squamous intraepithelial lesion and carcinoma in situ.

Accurately estimating abundance is a critical component of monitoring and recovery of rare and elusive species. Spatial capture-recapture (SCR) models are an increasingly popular method for robust estimation of ecological parameters. We provide a maximum likelihood analytical framework to assess results from empirical studies to inform SCR sampling design, using both simulated and empirical data from non-invasive genetic sampling of seven boreal caribou populations (Rangifer tarandus caribou) which varied in range size and estimated population density. We use simulated population data with varying levels of clustered distributions to quantify the impact of non-independence of detections on density estimates, and empirical datasets to explore the influence of varied sampling intensity on the relative bias and precision of density estimates. Simulations revealed that clustered distributions of detections did not significantly impact relative bias or precision of density estimates. The empirical genotyping success rate was 95.1%. Empirical results indicated that reduced sampling intensity had a greater impact on density estimates in smaller ranges. The number of captures and spatial recaptures were strongly correlated with precision, but not relative bias. The best sampling designs did not differ with estimated population density but differed between large and small ranges. We provide an efficient framework implemented in R to estimate the detection parameters required when designing SCR studies. The framework can be used when designing a monitoring program to minimize effort and cost while maximizing effectiveness, which is critical for informing wildlife management and conservation.

Afforestation has been implemented on a large scale in the Loess Plateau of China since 1999. This paper aimed to judge the influence of plantation tree types on soil aggregate stability and carbon stocks. The results showed that : (1)the content of soil organic matter and macro-aggregates, the water stability of aggregates were significantly higher in P. tabuliformis plantation compared with R. pseudoacacia and M. pumila plantations, conversely, the content of soil calcium carbonate in P. tabuliformis plantation was the lowest; (2) the content of soil organic matter and organic carbon density were significantly negatively correlated with soil depth, while soil carbonate calcium and in-organic carbon density fluctuated with the increasing of soil depth; (3) compared with topsoil, subsoil was important carbon sink because there were more in-organic carbon; (4) Aggregate organic carbon increased while inorganic carbon decreased with the increasing of aggregate size respectively. We concluded that: (1) R. pseudoacacia played a more important role in soil carbon sequestration compared with P. tabuliformis; while P. tabuliformis was more beneficial to improve soil organic matter and soil structure; (2) subsoil and in-organic carbon were important carbon sinks compared with topsoil and organic carbon; (3) the bigger water stable aggregates having the higher content of soil organic matter and the lower carbonate calcium.

Palm-pressed fiber oil (PPFO) is unique as it contains higher amount of carotenoids, vitamin E (tocotrienols & tocopherols) and other phytonutrients (squalene and sterols) as compared to crude palm oil (CPO). However, crude PPFO has high phosphorus content and free fatty acid (FFA) and at the same time low in deterioration of bleachability index (DOBI) that requires specific refining steps for achieving a good quality oil properties. The physical refining pilot plant scale was developed, involved a combination of step including wet and acid degumming and bleaching followed by high vacuum deacidification. The optimum refining conditions comprises wet degumming using 5.0 wt/wt% of distilled water at 90°C for 20 min, acid degumming using 0.5 wt% of phosphoric acid at 90°C for 10 min, bleaching using 1.0 wt% of natural bleaching earth at 105°C for 20 min, and deacidification at 160°C and 0.001 mmHg. A significant reduction of phosphorus content of 97% (from 633±83 ppm to 11±2 ppm) and FFA of 91% (from 5.30±0.19% to 0.35 ± 0.09%) were achieved in the pilot scale study. The DOBI value of refined red PPFO improved from 2.02 ± 0.18 to 2.68 ± 0.04. Besides, the carotenoids (986±55 ppm) and vitamin E (1075±64 ppm) in refined red PPFO were preserved by applying the mild temperature of deacidification. The pilot scale results establish a significant contribution to the feasibility of the refined red palm-pressed oil.

Trade-offs exist between the point of early detection and the future cost of controlling any invasive species. Finding optimal levels of early detection, with post-border active surveillance, where time, space and randomness are explicitly considered, is computationally challenging. We use a stochastic programming model to find the optimal level of surveillance and predict damages, easing the computational challenge by combining the Sample Average Approximation approach and parallel processing techniques. The model is applied to the case of Asian Papaya Fruit Fly (PFF), a highly destructive pest, in Queensland, Australia. To capture the non-linearity in PFF spread, we use an agent-based model, which is calibrated to a highly detailed land-use raster map (50m×50m) and weather-related data, validated against a historical outbreak. We find that current surveillance levels are less than optimal.

Background: His bundle pacing (HBP) has evolved as the most physiological form of pacing but associated with limitations. Recently left bundle branch pacing (LBBP) is emerging as an effective alternative strategy for HBP. Objectives: Our study was designed to assess the feasibility, efficacy, electrophysiological parameters and mid-term outcomes of LBBP in Indian population Methods: All patients requiring permanent pacemaker implantation for symptomatic bradycardia and heart failure were prospectively enrolled. Echocardiography, QRS duration, pacing parameters, Left bundle(LB) potentials, paced QRS duration and peak left ventricular activation time (pLVAT) recorded. Results: LBBP was successful in 93 out of 99 patients (94% acute success). Mean age 62.6 ± 13 yrs. Male 59%, diabetes 69%, coronary artery disease 65%. Follow up duration 4.8 months (range1-12 months). Indication for pacing were atrioventricular (AV) block 43%, cardiac resynchronization therapy 40%, AV node ablation 4%. LB potential noted in 37 patients (40%). QRS duration reduced from 144.38 ±34.6ms at baseline to 110.8 ±12.4ms after LBBP (p value 0.0001). Pacing threshold was 0.59 ± 0.22V and sensed R wave 14.14 ± 7.19 mV and it remained stable during follow up. Lead depth in the septum was 9.62 mm. LV ejection fraction increased from 44.96 % to 53.3 % after LBBP (p value 0.0001). One died due to respiratory tract infection on follow up Conclusion: LBBP is a safe and effective strategy (94% acute success) of physiological pacing. The pacing parameters remained stable over a period of 12 months follow up. LBBP can effectively overcome the limitations of HBP

Resource competition among central-place foragers often leads to space partitioning, even if individuals do not show signs of direct agonistic interactions. Using simple individual-based simulations, we show that individual-level spatial awareness and memory of resource availability are sufficient to cause spatial segregation in the foraging ranges of colonial animals. The shapes of the foraging distributions are governed by commuting costs, the emerging distribution of depleted resources, and the fidelity of foragers to their colonies. A spatial imbalance between resource requirement and resource availability in one region can propagate through the landscape and lead to non-trivial space-use patterns elsewhere. Interestingly, while better spatial memory increases segregation between neighbouring colonies, it can lower the average intake rate of the population, suggesting a potential trade-off between an individual strive for optimality and population growth rates.