Background: Reduced harvest volumes in pediatric donors appear to have the potential to reduce donor-associated risks while maintaining engraftment in recipients; however, the allowable harvest volume reduction remains undefined. Methods: We retrospectively analyzed the data pairs of 553 bone marrow (BM) harvests from pediatric (age at harvest ＜18 yr) sibling donors and clinical outcomes of 553 pediatric (age at infusion ＜14 yr) transplant-naïve recipients to assess the optimal BM harvest volume needed from pediatric donors to obtain the desired CD34+ cell count (≥3.0×10 6 cells per kg of recipient weight), and to study its impact on the clinical outcomes of transplantation in pediatric recipients. Results: The minimum desired CD34+ cell count of ≥3.0×10 6 per kg of recipient weight was achieved for 506 (95.3%) of donor-recipient pairs. The median CD34+ cell yield was 6.4×10 6 per kg of recipient weight (range, 1.2‒33.8×10 6 ) in donors younger than 5 years old at harvest, 4.7×10 6 (range, 0.3‒28.5×10 6 ) in donors aged 5‒10 years and 2.1×10 6 range, 0.3‒11.3×10 6 ) in donors older than 10 years (P ＜0.001). Conclusion The infused CD34+ cell dose (×10 6 cells/kg of recipient weight) had no impact on GRFS; however, a CD34+ cell dose of ＞7×10 6 cells/kg of recipient weight did not improve hematopoietic recovery

Aim: We designed this study to compare the presence of depressive symptoms pre and 6 months post-MI and to identify the association of various biological and non-biological risk factors with the development of depressive symptoms post-MI. Objective: Coronary artery disease and depressive illness are the largest contributors to global mortality and disability. These disorders frequently occur together and have major health implications. We conducted this study to determine the frequency of increased depressive symptoms following Myocardial Infarction (MI) and analyze associated baseline risk factors. Study Design: Descriptive case series. Place and duration of study: Tertiary care cardiology hospital from Sept 2019 to Jan 2021. Patients and Methods: Patients presenting with a recent episode of myocardial infarction at the out-patient department of cardiology were recruited for this study. Demographic variables and baseline health status were recorded. Hospital Anxiety and Depression Scale (HADS) was applied in two instances, at first contact for depressive symptoms pre-MI and at the second instance 6 months post-MI. An increase in HADS score of 4 or more points after 6 months of MI was considered significant. Association of age, gender, smoking status, employment status, previous MI episode, depression and history of stressful life event with an increase in depression was analyzed. Results: The sample consisted of 140 patients, 88 males and 52 females. The mean age was 51.22 years (SD= ± 12.35). 60.7% (n=85) of patients had an increase in depressive symptoms scores as measured by HADS. Younger age (30 to 50 years), being a smoker and having a previous history of myocardial infarction were associated with a significant increase in depressive symptoms. Conclusion 60.7% of patients have increased depressive symptoms after myocardial infarction. Patients should be regularly screened for emerging depressive symptoms and special attention should be paid to younger patients, smokers and those who have a previous history of coronary artery disease.

PURPOSE: This study aimed to evaluate the effect of incorporating zirconium oxide nanoparticles (nano-ZrO 2 ) in polymethylmethacrylate (PMMA) denture base resin on flexural properties at different material thicknesses. MATERIALS AND METHODS: Heat polymerized acrylic resin specimens (N = 120) were fabricated and divided into 4 groups according to denture base thickness (2.5 mm, 2.0 mm, 1.5 mm, 1.0 mm). Each group was subdivided into 3 subgroups (n = 10) according to nano-ZrO2 concentration (0%, 2.5%, and 5%). Flexural strength and elastic modulus were evaluated using a three-point bending test. One-way ANOVA, Tukey’s post hoc, and two-way ANOVA were used for data analysis (α = .05). Scanning electron microscopy (SEM) was used for fracture surface analysis and nanoparticles distributions. RESULTS: Groups with 0% nano-ZrO2 showed no significant difference in the flexural strength as thickness decreased (P = .153). The addition of nano-zirconia significantly increased the flexural strength (P < .001). The highest value was with 5% nano-ZrO2 and 2 mm-thickness (125.4± 18.3 MPa), followed by 5% nano-ZrO2 and 1.5 mm-thickness (110.3 ± 8.5 MPa). Moreover, the effect of various concentration levels on elastic modulus was statistically significant for 2 mm thickness (P = .001), but the combined effect of thickness and concentration on elastic modulus was insignificant (P = .10). CONCLUSION Reinforcement of denture base material with nano-ZrO2 significantly increased flexural strength and modulus of elasticity. Reducing material thickness did not decrease flexural strength when nano-ZrO2 was incorporated. In clinical practice, when low thickness of denture base material is indicated, PMMAano-ZrO2 could be used with minimum acceptable thickness of 1.5 mm.

Background/Aims: More than 100 million people to date have been affected by the coronavirus disease-2019 (COVID-19) pandemic. Patients with COVID-19 have a higher risk of bleeding complications. We performed a systematic review and meta-analysis to evaluate the outcomes of COVID-19 patients with signs and symptoms of acute gastrointestinal bleeding (GIB). Methods: A systematic literature search was carried out for articles published until until November 11, 2020, in the Embase, MEDLINE, Web of Science, and Cochrane Library databases. We included studies on COVID-19 patients with signs and symptoms of GIB. Results: Our search yielded 49 studies, of which eight with a collective 127 patients (86 males and 41 females) met our inclusion criteria. Conservative management alone was performed in 59% of the patients, endoscopic evaluation in 31.5%, and interventional radiology (IR) embolization in 11%. Peptic ulcer disease was the most common endoscopic finding, diagnosed in 47.5% of the patients. Pooled overall mortality was 19.1% (95% confidence interval [CI]; 12.7%-27.6%) and pooled mortality secondary to GIB was 3.5% (95% CI; 1.3%–9.1%). The pooled risk of rebleeding was 11.3% (95% CI; 6.8%–18.4%). Conclusion The majority of COVID-19 patients with GIB responded to conservative management, with a low mortality rate associated with GIB and the risk of rebleeding. Thus, we suggest limiting endoscopic and IR interventions to those with hemodynamic instability and those for whom conservative management was unsuccessful.

Background/Aims: More than 100 million people to date have been affected by the coronavirus disease-2019 (COVID-19) pandemic. Patients with COVID-19 have a higher risk of bleeding complications. We performed a systematic review and meta-analysis to evaluate the outcomes of COVID-19 patients with signs and symptoms of acute gastrointestinal bleeding (GIB). Methods: A systematic literature search was carried out for articles published until until November 11, 2020, in the Embase, MEDLINE, Web of Science, and Cochrane Library databases. We included studies on COVID-19 patients with signs and symptoms of GIB. Results: Our search yielded 49 studies, of which eight with a collective 127 patients (86 males and 41 females) met our inclusion criteria. Conservative management alone was performed in 59% of the patients, endoscopic evaluation in 31.5%, and interventional radiology (IR) embolization in 11%. Peptic ulcer disease was the most common endoscopic finding, diagnosed in 47.5% of the patients. Pooled overall mortality was 19.1% (95% confidence interval [CI]; 12.7%-27.6%) and pooled mortality secondary to GIB was 3.5% (95% CI; 1.3%–9.1%). The pooled risk of rebleeding was 11.3% (95% CI; 6.8%–18.4%). Conclusion The majority of COVID-19 patients with GIB responded to conservative management, with a low mortality rate associated with GIB and the risk of rebleeding. Thus, we suggest limiting endoscopic and IR interventions to those with hemodynamic instability and those for whom conservative management was unsuccessful.

PURPOSE: This study aimed to evaluate the effect of incorporating zirconium oxide nanoparticles (nano-ZrO 2 ) in polymethylmethacrylate (PMMA) denture base resin on flexural properties at different material thicknesses. MATERIALS AND METHODS: Heat polymerized acrylic resin specimens (N = 120) were fabricated and divided into 4 groups according to denture base thickness (2.5 mm, 2.0 mm, 1.5 mm, 1.0 mm). Each group was subdivided into 3 subgroups (n = 10) according to nano-ZrO2 concentration (0%, 2.5%, and 5%). Flexural strength and elastic modulus were evaluated using a three-point bending test. One-way ANOVA, Tukey’s post hoc, and two-way ANOVA were used for data analysis (α = .05). Scanning electron microscopy (SEM) was used for fracture surface analysis and nanoparticles distributions. RESULTS: Groups with 0% nano-ZrO2 showed no significant difference in the flexural strength as thickness decreased (P = .153). The addition of nano-zirconia significantly increased the flexural strength (P < .001). The highest value was with 5% nano-ZrO2 and 2 mm-thickness (125.4± 18.3 MPa), followed by 5% nano-ZrO2 and 1.5 mm-thickness (110.3 ± 8.5 MPa). Moreover, the effect of various concentration levels on elastic modulus was statistically significant for 2 mm thickness (P = .001), but the combined effect of thickness and concentration on elastic modulus was insignificant (P = .10). CONCLUSION Reinforcement of denture base material with nano-ZrO2 significantly increased flexural strength and modulus of elasticity. Reducing material thickness did not decrease flexural strength when nano-ZrO2 was incorporated. In clinical practice, when low thickness of denture base material is indicated, PMMAano-ZrO2 could be used with minimum acceptable thickness of 1.5 mm.

Objective: To determine the validity and reliability of the floor transfer test (FTT) in people with Parkinson’s disease (PD). Methods: The sample was 25 subjects with PD. The concurrent and convergent validity of FTT was determined by correlation with scores of timed up and go test (TUG), movement disorder society- unified Parkinson’s disability rating scale-III [motor component] (MDS-UPDRS), Schwab and England activities of daily living scale (SEADL). The intra rater reliability (ICC 3, 1), SEM, MDC, Bland & Altman limit of agreement (LOA) were determined. Results: FTT scores were positively correlated with TUG (ρ= 0.59, p=0.02), MDS UPDRS III (ρ= 0.69, p=0.001) and negatively correlated with SEADL (ρ= -0.79, p=0.001) showing moderate concurrent and convergent validity. ICC (3,1) was 0.92, SEM and MDC were 1.28 and 3.54 respectively. Conclusion: FTT is a valid and reliable tool to assess functional mobility in people with mild PD.

BACKGROUND: Maintenance operations on-board ships are highly demanding. Maintenance operations are intensive activities requiring high manemachine interactions in challenging and evolving conditions. The evolving conditions are weather conditions, workplace temperature, ship motion, noise and vibration, and workload and stress. For example, extreme weather condition affects seafarers' performance, increasing the chances of error, and, consequently, can cause injuries or fatalities to personnel. An effective human error probability model is required to better manage maintenance on-board ships. The developed model would assist in developing and maintaining effective risk management protocols. Thus, the objective of this study is to develop a human error probability model considering various internal and external factors affecting seafarers' performance. METHODS: The human error probability model is developed using probability theory applied to Bayesian network. The model is tested using the data received through the developed questionnaire survey of >200 experienced seafarers with >5 years of experience. The model developed in this study is used to find out the reliability of human performance on particular maintenance activities. RESULTS: The developed methodology is tested on the maintenance of marine engine's cooling water pump for engine department and anchor windlass for deck department. In the considered case studies, human error probabilities are estimated in various scenarios and the results are compared between the scenarios and the different seafarer categories. The results of the case studies for both departments are also compared. CONCLUSION: The developed model is effective in assessing human error probabilities. These probabilities would get dynamically updated as and when newinformation is available on changes in either internal (i.e., training, experience, and fatigue) or external (i.e., environmental and operational conditions such asweather conditions, workplace temperature, ship motion, noise and vibration, and workload and stress) factors.
Humans* ; Noise ; Probability Theory ; Risk Management ; Ships ; Vibration ; Water ; Weather

INTRODUCTIONMetabolic heterogeneity among obese individuals is thought to translate into variations in cardiovascular risk. Identifying obese people with an unfavourable metabolic profile may allow preventive strategies to be targeted at high-risk groups. This study aimed to identify clinical, biochemical and immunological differences between insulin-sensitive and insulin-resistant obese subgroups, to understand the population-specific pathophysiological basis of the adverse cardiovascular risk profile in the latter group.

METHODSCardiovascular risk indicators, including anthropometric parameters, blood pressure, acanthosis nigricans area, and related biochemical, endocrine and inflammatory markers, were determined in 255 healthy South Asian volunteers aged 18-45 years, with a 2:1 ratio of obese/overweight to normal-weight individuals. Lifetime atherosclerotic cardiovascular disease (ASCVD) risk was also calculated.

RESULTSBody mass index (BMI) and insulin sensitivity-based tertiles independently showed incremental trends in waist-hip ratio, skinfold thickness, acanthosis nigricans area, blood pressure, serum lipids, hepatic enzymes, adipokines, inflammatory markers and ten-year ASCVD risk. The anthropometric, biochemical and inflammatory parameters of obese insulin-sensitive and obese insulin-resistant groups differed significantly. Extreme group analysis after excluding the middle tertiles of both insulin resistance and BMI also showed significant difference in anthropometric indicators of cardiovascular risk and estimated lifetime ASCVD risk between the two obese subgroups.

CONCLUSIONObese insulin-sensitive individuals had a favourable metabolic profile compared to the obese insulin-resistant group. The most consistent discriminative factor between these phenotypic classes was anthropometric parameters, which underscores the importance of clinical parameters as cardiovascular risk indicators in obesity.