Interstitial lung disease (ILD) is a clinical term that refers to a diverse group of non-neoplastic lung diseases. This group includes idiopathic and secondary pulmonary entities that are often associated with progressive pulmonary fibrosis. Currently, therapeutic approaches based on specific structural targeting of pulmonary fibrosis are limited to nintedanib and pirfenidone, which can only slow down disease progression leading to a lower mortality rate. Lung transplantation is currently the only available curative treatment, but it is associated with high perioperative mortality. The pulmonary vasculature plays a central role in physiological lung function, and vascular remodelling is considered a hallmark of the initiation and progression of pulmonary fibrosis. Different patterns of pulmonary fibrosis commonly exhibit detectable pathological features such as morphomolecular changes, including intussusceptive and sprouting angiogenesis, vascular morphometry, broncho-systemic anastomoses, and aberrant angiogenesis-related gene expression patterns. Dynamic cellular interactions within the fibrovascular interface, such as endothelial activation and endothelial-mesenchymal transition, are also observed. This review aims to summarise the current clinical, radiological and pathological diagnostic algorithm for different ILDs, including usual interstitial pneumonia/idiopathic pulmonary fibrosis, non-specific interstitial pneumonia, alveolar fibroelastosis/pleuroparenchymal fibroelastosis, hypersensitivity pneumonitis, systemic sclerosis-related ILD and coronavirus disease 2019 injury. It emphasises an interdisciplinary clinicopathological perspective. Additionally, the review covers current therapeutic strategies and knowledge about associated vascular abnormalities.

Many patients are unable to identify members of their hospital care team and experience confusion regarding some medical terminology used during hospitalization, including descriptions of the structure of their inpatient care team. This cross-sectional study sought to (1) examine inpatients' understanding of the role of a hospitalist and (2) assess inpatients' familiarity with other medical terminology commonly used in the hospital. We surveyed 172 patients admitted to the hospital medicine service at two academic medical centers. We found that almost half (47%) of respondents were unfamiliar with the term and/or role of a hospitalist, while the remaining patients had varied understanding of the role. Several other medical terms were frequently misunderstood (such as "NPO," "PA," and "Attending"). Ongoing efforts are needed to improve communication to ensure that hospitalized patients understand the hospitalist's role and the medical terms shared with them.

Herein, a cost-effective bio approach using extract derived from desert truffles (Tirmania nivea) is utilized to synthesize gold nanoparticles (AuNPs). AuNPs were thoroughly investigated using UV-vis, XRD, SEM, and TEM analyses. It was shown that nanoparticles had an fcc structure with a smooth spherical surface, an average diameter of 9.44 +/- 0.26 nm, and an SPR band observed at 548 nm. Investigations were conducted on AuNPs' antibacterial and anti-cancer properties of prostate cancer cells. The findings suggest that AuNPs showed better antibacterial effects against S. aureus compared to E. coli, P. aeruginosa, and K. pneumoniae. AuNPs' combination with antibiotics demonstrated a synergistic effect with significant antibacterial activity. Also, AuNPs show toxicity to the prostate cancer cell line (VCaP). The greatest percentage of inhibition rate of AuNPs to the VCaP cells line was 74.6%.

To develop advanced heat transfer composites, new sets of unsymmetrical calamitic molecules with a coumarin unit at one end and a biphenyl group at the other end were synthesised. Their structural characterisation was investigated by routine techniques such as CHN analysis, and FT-IR, and 1D, and 2D NMR spectroscopic techniques. The liquid crystalline properties of these molecules were investigated by POM and DSC along with XRD techniques. All target compounds exhibited mesomorphic behaviour. The smectic C phase was seen for all the compounds. To enhance their thermal conductivities, conductive nanofillers, such as boron nitride nanosheets (BNNSs) and aluminium oxide nanoparticles Al2O3, were added to the synthesised liquid crystals. The LC-nanocomposites exhibit excellent thermal conducting performance when a combination of BNNSs and Al2O3 nanoparticles were added to the liquid crystals. The thermal conductivity of the 4i-BN35-A15 nanocomposite was 1.7 W/m K compared to 0.3 W/m K for the pure liquid crystal compound 4i.

Coumarin compound-derived dimeric molecules are synthesized and characterized for enhancing the thermal conductivity of liquid crystals. The chemical structures are characterized and confirmed by standard spectro-scopic techniques such as FT-IR, 1D and 2D NMR, and elemental analysis. Mesophases were analysed and characterized by the combination of POM, DSC, and X-ray analysis techniques. Most compounds show SmA mesophases upon heating and cooling run except compounds 5b and 5d which are non-mesogenic in the cooling cycle. Mixing coumarin compounds with boron nitride nanosheets (BNNS) and aluminium oxide nanoparticles (Al2O3) dramatically increased the thermal conduction of the liquid crystals (LCs). Doping with 15 wt % of Al2O3 increased the thermal conductivity of LCs from 0.26 W/m K to 0.51 W/m K. While mixing LCs with 35 wt% BNNS increased the thermal conductivity to 0.91 W/m K. The outstanding thermal conductivity of 1.6 W/m K and the specific TCE (per 1 wt% of nanofillers) of similar to 12.5% were obtained by mixing LCs with a combination of 15 wt% Al2O3 and 35 wt% BNNS. In addition, the thermal stability of LCs was intensified when doping with nanofillers due to occupying the free volumes between molecules and reducing the overall mobility of the compound. The obtained thermal performance from the prepared LCs nanocomposites of this work illustrated vast potential in specific electronic applications such as photonic systems and solar energy collectors.

This research investigates the synthesis and characterization of hydrogel and cryogel microspheres that are doped with green synthesised silver nanoparticles (CS-AgNPs). Also, the study assesses the antibacterial activity of hydrogel and cryogel microspheres by comparing them with commercial antibiotics. The porous structure of CS and the adequate dispersion of AgNPs were confirmed by SEM and EDX techniques, respectively. The disk diffusion method and the optical density measurement (OD600) confirm the outstanding antimicrobial activity of CS-AgNPs hydrogel and cryogel microspheres in comparison to antibiotics for both Gram-positive and Gram-negative bacteria. The CS-AgNPs microspheres demonstrate promising antimicrobial and biocompatible agents for medical field applications.

The cornea presents unique challenges to wound care. The cornea is constantly exposed to bacterial colonization, has ongoing risk of wound-related astigmatism, and is cumbersome for traditional wound dressings. A potential solution to these challenges is provided by the corneal glycocalyx. Recent high pressure rapid freezing fixation techniques suggest that the glycocalyx is much thicker than previously believed. In the case of the cornea, the glycocalyx may provide an opportunity for wound care anchored to the transmembrane carbohydrate surface layer. To probe the surface glycocalyx we used a plant-derived structural heteropolysaccharide called pectin. Pectin has been shown to mirror the structure of the glycocalyceal surface layer of visceral organs. To test the adhesivity of pectin to the corneal glycocalyx, high methoxyl citrus pectin was molded into tape form. Bovine globes were obtained from a local abattoir and used same day. Experiments were performed with custom fixtures using a materials analyzer (TA-XT plus, Stable Micro Systems). To assess pectin adhesion to cornea, pectin was compressed onto the corneal surface then withdrawn, recording force and distance. A corneal incision was sealed with pectin and subject to increased pressure, until leak. At least three biologic replicates were analyzed, expressed as mean ± one standard deviation. Significance was assessed by Student's T-test. Pectin films on cornea were also fixed with formalin and imaged using a scanning electron microscope (Philips XL30 ESEM). Pectin films were flexible, translucent, thin (80um), and did not distort an Amsler grid. Pectin was significantly more adherent (3.2±0.54 N) to the bovine cornea than control polymers nanocellulose fibers (1.2±0.4 N), sodium hyaluronate (1.7±0.7 N), and carboxymethyl cellulose (1.3±0.1)(p<0.05). The work of adhesion, reflecting the area under the adhesion curve, was also significantly greater (p<0.05, asterisk, Figure 1). The cornea incisions sealed with pectin were resistant to pressure fluctuations ranging from -51.3±8.9 mmHg to +214.4±68.0 mmHg, both extremes beyond physiologic human intraocular pressures. Sudden or complete sealant failure was not observed. Consistent with these findings, scanning electron microscopy demonstrated a low-profile tape densely adherent to the bovine cornea (Figure 2). The tensile and peel adhesive strength of the pectin biopolymer suggests a mechanism of polymer-polymer entanglement with the corneal glycocalyx. As a therapeutic option for corneal wounds, the entangled pectin provides not only a protective barrier, but also an opportunity for pectin-embedded drug delivery.

INTRODUCTION: Little is understood regarding which patients with T4N0-3M0 esophageal cancer would benefit from esophagectomy. Herein, we describe the impact of resection and identify favorable patient and tumor characteristics, demonstrating in which patients with T4N0-3M0 esophageal cancer it may be appropriate to offer surgery. METHODS: Retrospective review of 1426 esophagectomies for esophageal cancer performed at our institution between 2000 and 2021 identified 21 patients with pT4N0-3M0 disease. RESULTS: Median age at time of surgery was 63.5 years (37 to 80 years). Most patients were men (76.2%) with adenocarcinoma (85.7%) who received neoadjuvant chemoradiation (85.7%). T4 disease was identified preoperatively in 9 (57.1%) cases and intraoperatively in 12 (42.9%) cases. Median follow-up was complete at 7.2 months (32 days to 8.3 years) (Figure). Postoperative complications included pneumonia (21.1%) and anastomotic leak (10.5%). 30-day and 90-day postoperative mortality was 4.8%. Overall, 1-year survival was 50.6% and 5-year survival was 28.9%. There was significant improvement in survival in patients with known preoperative vs intraoperative discovery of T4 disease (p = 0.04), and patients with pathologic (p = 0.02) and radiographic (p = 0.04) near-complete/complete vs partial/absent response to neoadjuvant therapy. R0 resection (p = 0.05) and N0 disease (p = 0.07) were also associated with improved survival.FigureCONCLUSION: Esophagectomy for T4N0-3M0 esophageal cancer after neoadjuvant therapy results in 5-year survival in a subset of patients and reasonable complication rates. Consider surgery in select patients with near-complete/complete radiographic response to neoadjuvant treatment, N0 disease, or in whom an R0 resection is feasible.

e20556 Background: Invasive mediastinal staging is necessary to identify locally advanced non-small cell lung cancer (NSCLC). We sought to validate NCCN guidelines for invasive mediastinal staging. Methods: We retrospectively reviewed all patients who had curative lung resection for pathologically confirmed NSCLC from October 2018 to December 2019. We excluded patients who had induction therapy without undergoing invasive mediastinal staging first. We evaluated methods of mediastinal staging, staging results, and final pathology. Indications for staging were one or more of the following; mediastinal lymph nodes > 1.0cm in short axis, Standardized Uptake Value of > 3.0 on Positron Emission Tomography, > 50% of tumor on medial side of mid-clavicular line (central vs peripheral), or peripheral lesion > 3.0cm in diameter. Staging methods were mediastinoscopy, endobronchial ultrasound (EBUS), and video-assisted thoracoscopic surgery (VATS) ipsilateral mediastinal staging before resection of main tumor. Results: In total, 457 lung resections were performed. Staging was done in 144/275 indicated cases (52.4%). Mediastinoscopy was completed in 49 patients, with 20.4% (n = 10) N2-positive. The false negative rate of mediastinoscopy was 4.1% (n = 2 at station 7). EBUS was performed in 64 patients and 21.9% (n = 14) were N2 positive. The false negative rate for EBUS was 3.1% (n = 2 at station 7). Two mediastinoscopy and 9 EBUS patients had 0 N2 stations sampled. None of the patients were ultimately N2 positive. Staging of three mediastinal stations (4L, 4R, and 7) was done in 26/49 mediastinoscopies and 15/64 EBUS. Of 20 patients who had VATS ipsilateral mediastinal staging, none were N2 positive and there were 0 false negatives. This left 131 patients who did not received indicated staging. The most common indication in this group was central location, 83.2% (n = 109). Four of these unstaged patients were N2 positive at resection (3.1%). The sole indication for these 4 patients was a centrally located tumor. Clinical tumor sizes were 1.2 cm, 1.3 cm, 1.5 cm, and 1.9 cm. Overall, the N2-positive rate of the staged group was 24/144 (16.7%) vs 4/131 (3.1%) N2 positive in the unstaged group, p < 0.001. Conclusions: The current NCCN staging guidelines accurately reflect the risk of N2 disease for NSCLC. The indication of central location for tumors may benefit from being reevaluated in a larger cohort, particularly given efficacy of adjuvant therapy.

Here, we present a pathway for the green synthesis of Ag/AgCl nanoparticles derived from freshwater Chara vulgaris algae. The formation of Ag/AgCl NPs is confirmed by XRD, UV-Vis spectroscopy, and SEM techniques. The volume with an aqueous extract of Chara vulgaris: AgNO3 ratio 3:1 possessed optimal synthesised Ag/AgCl NPs. A plasmon absorbance peak, at 395 nm was observed in the UV-vis spectrum. XRD patterns confirmed the highly crystalline FCC structure of Ag/AgCl NPs. SEM imaging of Ag/AgCl NPs indicated nanoparticles of size 16.99 +/- 0.3 nm. The antibacterial activity of Ag/AgCl NPs was evaluated against Staphylococcus aureus, Escherichia cob, Klebsiella pneumonia, and Pseudomonas aeruginosa. Combining Ag/AgCl NPs with antibiotics causes growth inhibition of both Gram-positive and Gram-negative bacteria. The fractional inhibitory concentration index (FICI) is used to evaluate the synergistic antimicrobial effect of combining nanoparticles with antibiotics. The combinations of Ag/AgCl NPs with Gentamicin, Erythromycin and Vancomycin show a partial synergistic activity against E. cob, K. pneumoniae and P. aeruginosa, respectively. The combination of Ag/AgCl NPs with antibiotics could potentially prohibit the development of resistant bacteria against antibiotics.

Here we study how graphene oxide affects silica aerogels and their physical and mechanical properties by examining volume shrinkage, pore volume, surface area and compressive strength of these composite aerogels. Composite aerogels were made through adding different amount of graphene oxide (GO) to sodium silicate precursor by using ambient pressure drying method. Additionally, the chemical composition of the composite aerogels was determined using X-ray diffraction (XRD) and Fourier transform infrared (FTIR) spectroscopy. A rougher structure was observed when the GO loading increased and the characteristic peak of GO in XRD disappeared due to the random distribution of GO within the silica matrix. FTIR spectrum of composite aerogels shows that the relative intensity of silanol groups on the silica matrix have downward tendency with the addition of GO. The specific surface area had maxima with the addition of 0.01 wt% GO surface area to 578 m 2 /g. The mechanical strength of aerogels was increased, with the loading of GO from 0.0 wt% to 0.2 wt%, and the compressive modulus increased from 0.02 MPa to 0.22 MPa.

Introduction: Congestive heart failure (CHF) remains an epidemic with rising prevalence and a contributing cause of 1 in 9 deaths in the United States. An understanding of internet search engines for congestive heart failure as informational and initial diagnostic tools may enable targeted education strategies. Hypothesis: There is a correlation between CHF google search and outcomes. Methods: We used google trends, a publicly available google tool, to identify search frequency for CHF and related terms like early signs of heart failure, congestive heart failure facts over a 2 year period from 2014-2016 across regions of the United States. We then evaluated the prevalence of hospitalization and mortality rates among Medicare beneficiaries based on Center for Disease Control (CDC) data. Utilizing Pearson correlation (R) test, we determined the association between relative search frequency (RSF) in various states versus CHF hospitalization and mortality rates. Results: Across the 50 states in United States, there were 25 searches related to the search terms. There was a moderate positive correlation (R 0.4-0.7) between CHF hospitalization (R= 0.43) and mortality (R=0.51) with relative search frequency in google trends. Conclusions: We demonstrated a correlation between internet search and CHF prevalence and hospitalization. The emergence of data analytics in CHF care may enable greater understanding of patient questions in CHF to better target education and prevention.

There is limited information about variations in admission rate and outcomes in patients admitted with Acute coronary syndrome(ACS). Our study seeks to explore this gap; its importance in clinical and resource planning cannot be overemphasized. Using the National inpatient sample(NIS), we tested

At present, biosynthesis of AgNPs is a very effective method to produce less toxic nanoparticles. The vision of this research is to use three different plant extracts derived from leaves of Piper nigrum, Ziziphus Spina-Christi and Eucalyptus globulus for rapid biosynthesis of AgNPs. This is in addition to investigating the scolicidal activity against Echinococcus granulosus. The methods of UV-vis spectroscopy, X-ray diffraction (XRD), scanning electron microscopy (SEM), and energy-dispersive X-ray analysis (EDX) were employed to characterise the nanoparticles. UV spectra disclosed a maximum absorption at 437 nm for the biosynthesised AgNPs using EUCGLO extract. The XRD patterns revealed the (fcc) structure of the AgNPs with slightly shifted characteristic peaks at 2θ degree of 37.3˚ and 43.4˚, respectively. The scolicidal activity against E. granulosus revealed that the AgNPs, which were synthesised using Eucalyptus globulus, have powered scolicidal of 47.8 % after 45 min. which is comparable to the treatment by Albendazole.

Silica aerogels are low density solids with high surface area and high porosity which are ideal supports for catalyst materials. The main challenge in aerogel production is the drying process, which must remove liquid from the pores of the wet gel while maintaining the solid network. In this work, the synthesis of silica aerogels and nickel-doped silica aerogels by a low energy budget process is demonstrated. Silica aerogels are produced by ambient drying using ammonium bicarbonate, rather than a conventional low surface tension solvent. Heating dissociates the ammonium bicarbonate, so generating CO 2 and NH 3 within the pores of the wet gel which prevents pore collapse during drying. Nickel-doped aerogels were produced by reducing nickel ions within pre-synthesised silica aerogels. The morphology of the resulting nickel particles—spheres, wires and chains—could be controlled through an appropriate choice of synthesis conditions. Materials were characterized using nitrogen adsorption/desorption isotherms, scanning electron microscopy, Fourier-transform infrared spectroscopy, thermogravimetric analysis and X-ray diffraction. The surface area of undoped aerogel is found to increase with the concentration of ammonium bicarbonate salts from 360 to 530 m 2 g −1 , and that of nickel-doped silica aerogel varies from 240 to 310 m 2 g −1 with nickel doping conditions.

Objectives:Neoadjuvant chemoradiation has been shown to improve survival in locally advanced esophageal and gastroesophageal junction cancer. The purpose of our study was to examine the effects of posttreatment persistent lymph node (LN) disease on overall survival (OS) and recurrence in patients with esophageal adenocarcinoma after neoadjuvant chemoradiation as well as the effect of LN harvest and the potential benefit of adjuvant chemotherapy. Methods:The records of patients who underwent esophagectomy in our hospital from January 2005 until December 2016 were analyzed. Our study group consisted of 509 patients. Results:Patient groups were created based on pathologic staging after esophagectomy (ypT N) as 22.0% of patients were ypT0 N0, 46.2% had incomplete response only at the primary tumor level (ypT + N0), and 31.8% had at least 1 metastatic lymph node (ypTx N+). Median OS was 58.3 months. The ypTx N+ group was divided into ypTx N1 and ypTx N2 or N3 subgroups based on the number of metastatic lymph nodes. The OS between the 2 groups was not significantly different (median OS, 37.6 vs 29.8 months; P = .097). The disease-free survival did show a statistically significant difference (median disease-free survival, 27.6 vs 13.7 months; P = .007). The LN harvest was not found to be significantly associated with OS. However, administration of adjuvant chemotherapy was a significant prognosticator for increased OS (hazard ratio, 0.590; P = .043). Conclusions:Our results demonstrate that residual LN disease after neoadjuvant chemoradiation is associated with increased mortality. Adjuvant chemotherapy, but not number of LNs resected, was correlated with increased OS in this subset of patients.

"Medical students’ perspective on the ‘the tree of training’ model." Education for Primary Care, 30(5), p. 327

"‘How was it for you?’ - GP trainees' experiences of a novel practice swap." Education for Primary Care, 30(2), p. 126

In this work, wavy nickel nanowires (NiNWs) were immobilized on mesoporous silica (SiO2) aerogels by the sol-gel method. We measured the catalytic activity of pure NiNWs and NiNW-SiO2 aerogel composites toward the CO2 hydration reaction (CHR) when they are in water. Dynamic vapor sorption (DVS) analysis was performed at levels of 50% CO2 and 50% H2O vapor for SiO2 aerogels, immobilized nickel nanoparticles (NiNPs) on silica aerogel and NiNW-SiO2 aerogel composites, in order to determine catalytic activity for CHR in the gaseous phase. The results from DVS analysis (gaseous phase) and CHR (aqueous phase) showed that NiNW-SiO2 aerogel composites are good heterogeneous catalysts for CHR in both gaseous and aqueous phases but they are less active than NiNP-SiO2 aerogel composites.

Aerogels are the least dense and most porous materials known to man, with potential applications from lightweight superinsulators to smart energy materials. To date their use has been seriously hampered by their synthesis methods, which are laborious and expensive. Taking inspiration from the life cycle of the damselfly, a novel ambient pressure‐drying approach is demonstrated in which instead of employing low‐surface‐tension organic solvents to prevent pore collapse during drying, sodium bicarbonate solution is used to generate pore‐supporting carbon dioxide in situ, significantly reducing energy, time, and cost in aerogel production. The generic applicability of this readily scalable new approach is demonstrated through the production of granules, monoliths, and layered solids with a number of precursor materials.