Not applicable.

Aging leads to cognitive impairments characterized by reduced hippocampal functions that are associated with impairment of long-term potentiation of CA1 synapses. Here, we assessed the safety and efficacy of modified (-)-gallocatechin gallate (GCG)-enriched green tea extract (HTP-GTE) in ameliorating the cognitive dysfunctions in late middle-aged murine model. We developed a novel HTP-GTE that was enriched with GCG via epimerization that involved heating. We compared the effects of oral administrations of conventional green tea and HTP-GTE in young and aged male C57/BL6 mice, and examined the changes in the hippocampal functions related to aging process. The functional outcome was assessed by the electrophysiological experiments to measure the long-term potentiation (LTP). HTP-GTE improved the age-related cognitive impairments via restoring long-term synaptic plasticity. We also identified that GCG was the main active component responsible for the HTP-GTE effect. The main molecular pathway in ameliorating the age-related cognitive dysfunctions involved protein kinase A (PKA) which was shown to be modulated by HTP-GTE. Thus, HTP-GTE has a therapeutic potential as a dietary supplement which may aid to rescue the impaired cognitive functions at the early phase of aging process through the modulation of LTP threshold.

Keywords: Aging; DIC, differential interference contrast; DMSO, dimethyl sulfoxide; EGCG, (−)-epigallocatechin-3-gallate; GCG, (−)-gallocatechin gallate; GTE, conventional green tea extract; HPLC-PDA, high performance liquid chromatography photometric diode array; HTP-GTE, GCG-enriched green tea extract; Hippocampus; LTP, long-term potentiation; Long-term potentiation; MTT, methylthiazolyldiphenyl-tetrazolium bromide; MWM, Morris water maze; Memory; NMDARs, N-Methyl-d-aspartate receptors; PKA, protein kinase A; SC, Schaffer collateral; TTX, tetrodotoxin; aCSF, artificial cerebrospinal fluid; fEPSPs, field excitatory postsynaptic potentials; −)-Gallocatechin gallate.

Genetic mutations in HSF4 cause congenital cataracts. HSF4 exhibits both positive and negative regulation on the transcription of heat shock and non-heat shock proteins during lens development, and its activity is regulated by posttranslational modifications. Biotin is an essential vitamin that regulates gene expression through protein biotinylation. In this paper, we report that HSF4b is negatively regulated by biotinylation. Administration of biotin or ectopic bacterial biotin ligase BirA increases HSF4b biotinylation at its C-terminal amino acids from 196 to 493. This attenuates the HSF4b-controlled expression of αB-crystallin in both lens epithelial cells and tested HEK293T cells. HSF4b interacts with holocarboxylase synthetase (HCS), a ubiquitous enzyme for catalyzing protein biotinylation in mammal. Ectopic HA-HCS expression downregulates HSF4b-controlled αB-crystallin expression. Lysine-mutation analyses indicate that HSF4b/K444 is a potential biotinylation site. Mutation K444R reduces the co-precipitation of HSF4b by streptavidin beads and biotin-induced reduction of αB-crystallin expression. Mutations of other lysine residues such as K207R/K209R, K225R, K288R, K294R and K355R in HSF4's C-terminal region do not affect HSF4's expression level and the interaction with streptavidin, but they exhibit distinct regulation on αB-crystallin expression through different mechanisms. HSF4/K294R leads to upregulation of αB-crystallin expression, while mutations K207R/K209R, K225R, K288R, K255R and K435R attenuate HSF4's regulation on αB-crystallin expression. K207R/K209R blocks HSF4 nuclear translocation, and K345R causes HSF4 destabilization. Taken together, the data reveal that biotin maybe a novel factor in modulating HSF4 activity through biotinylation.

Keywords: Biotin; Gene mutation; Gene transcription; Hsf4; αB-crystallin.

Objective: The objective of this study was to measure gamma interferon (IFN-γ) and tumor necrosis factor alpha (TNF-α) expression in endometrial tissue and/or aspirate from suspected genital tuberculosis patients with ectopic pregnancy and infertility in Bangladesh.

Methodology: A total 78 women of clinically suspected genital tuberculosis patients were enrolled as study population. These patients underwent manual vaccum aspiration (MVA) procedure, and endometrial tissues and/or aspirates were collected. Ziehl -Neelsen staining (Z-N staining) and Lowen-Stein Jensen (L-J) culture were done to detect Mycobacterium. The study participants were categorized as genital tuberculosis positive cases, genital tuberculosis negative cases and presumptive for tuberculosis cases based on the case definition used in this study. TNF-α and IFN-γ were measured by ELISA. Statistical analysis was done using SPSS (version-22).

Results: Out of 78 participants, pro-inflammatory cytokines IFN-γ and TNF-α were significantly increased in TB positive patients than TB negative patients (p < 0.05). IFN-γ value of TB positive patients (41.26 ± 41.05) was higher than TB negative (22.94 ± 44.51) patients. TNF-α value (44.31 ± 64.22) of TB positive patients was higher than TB negative (15.86 ± 41.45) patients. IFN-γ and TNF-α value of presumptive for tuberculosis cases were not statistically significant. According to ROC analysis, cut off value for IFN-γ was 23.5 and for TNF-α was 10 with highest sensitivity and specificity of 66.7%, 89.3%, and 66.7% and 73.1% respectively.

Conclusion: IFN-γ and TNF-α were significantly higher in TB positive patients and it may act as a potential biomarker for diagnosis of genital tuberculosis.

Keywords: ELISA; FGTB; IFN-γ; L-J culture; TNF-α; Z-N staining.

Introduction: Psychological suffering is commonly found among stroke survivors, particularly in the acute stage.

Objectives: This study aimed to explore the phenomenon of psychological sufferings of stroke survivors and analyze the applicability of Samkhya philosophy for enhancing their psychological wellbeing.

Methods: A qualitative study was conducted at a university hospital of Nepal among 16 stroke patients in the acute stage, selected by purposive sampling. Data collection was done by using semi-structured interviews. Data were analyzed using deductive content analysis. Additionally, the analysis of Samkhya philosophy was done by using descriptive literature review from online databases.

Results: Stroke survivors in the acute stage experienced psychological sufferings, which were analyzed as intrinsic, extrinsic, and divine based on Samkhya philosophy. The intrinsic sufferings were (a) shock and denial with a sudden loss of normal body function, (b) worry about the possibility of lifelong disability and future life, and (c) fear and concern about the consequences of the disease to self. The extrinsic sufferings consisted of (a) worry when thinking about dependent family members and (b) feelings of making trouble or being a burden to the family members because of their dependency. The divine suffering consisted of feeling of being a burden caused by distress resulting from an inability to perform religious rituals. Samkhya philosophy explains the methods of relieving these sufferings by using yoga practice.

Conclusion: Psychological sufferings are prevalent among Nepalese stroke survivors, and Samkhya philosophy might be one of suitable strategies to relieve these sufferings of the Hindu stroke survivors in the acute stage, and promote their psychological wellbeing. This study recommends integrating yoga in caring for stroke patients in the acute stage to promote psychological wellbeing.

Keywords: Samkhya philosophy; psychological suffering; stroke in acute stage; yoga.

Evaluation of patients with acute kidney injury requires comprehensive assessment that includes a urinalysis, which features both semi-quantitative assessment with a urine dipstick and urine microscopy. This process is labor intensive for clinical laboratories, and availability of excellent automated instruments for urinalysis has prompted utilization and acceptance of this strategy by both by laboratories and clinicians. Recently, however, interest in provider performed microscopy has enjoyed a renaissance thanks to both improved microscopy techniques and the endorsement from social media in nephrology. Here, we present two cases of acute kidney injury in which manual microscopy added valuable information to the automated microscopy.

Keywords: AIN, Acute interstitial nephritis; Acute interstitial nephritis; Acute kidney injury; Acute tubular necrosis; CLIA, Clinical Laboratory Improvement Amendment; FENa, Fractional Excretion of Sodium; FOAMed, Free Open Access Medical Education; RBC, Red Blood Cell; Urinalysis; WBC, White Blood Cell.

Hungary is northernmost temperate rice growing country in Europe. One of the main limiting factors is low temperature, especially at germination and seedling developmental stages. In early developmental stages, low temperature can impair and delay germination, as well as have negative impacts on seedling growth, causing poor stand establishment and non-uniform crop maturation [1]. Temperatures lower than 15 °C are generally detrimental for germination [2] under filed conditions for establishment of the crop. This article describes some key germination parameters of 165 rice accessions including breeding lines and varieties. Each genotype was grown in three replicates in a controlled cabinet under 13 °C for 4 weeks' duration. Growth was measured every 7th day. Growth traits such as coleoptile and radicle length were measured at the end of the experiment. The average data were calculated for three replicates. This dataset contains germination raw data and five germination parameters such as median germination time (MGT), final germination percentage (FGP), germination index (GI), coleoptile length (CL) and radicle length (RL). These data may provide reliable support for researchers and breeders to select the right rice genotypes for low temperature conditions.

Keywords: Chilling stress; Germination index; Germplasm; Oryza sativa.

Acoustic telemetry allows for high-resolution, long-term tracking of moving animals. Here, we describe data on the movement patterns of 37 adult red king crab (RKC, Paralithodes camtschaticus) obtained by means of acoustic telemetry. Acoustically tagged RKC were released in Gamvikfjorden (Sørøya, northern Norway) the 24th of May 2016 and tracked until the 1st of November 2016. Individual crabs resided in the fjord for 1-162 days and were recorded 16 - 11,501 times (mean number of records per crab: 2,851). In total, the data set consist of 105,484 pairs of accurate spatio-temporal coordinates. The acoustic receivers (n = 38) deployed close to the seabed were integrated with temperature sensors that continuously recorded the ambient seawater temperature, resulting in 174,154 water temperature recordings. These novel tracking data can be used to investigate the species' migratory behaviour, spatio-temporal habitat selection, and the relative role of their environment and their possible food sources. Moreover, the high-resolution seawater temperature dataset may serve independently as input data in physical-oceanographic models of this sub-Arctic sill fjord.

Keywords: Acoustic telemetry; Crustaceans; Movement; Oceanography; Tracking.

Objective: The aim of this case series was to retrospectively assess the impact on volume control and patients' quality of life (QOL) when a night-time garment was added to their previous compression regimen for a full 24-hour interval compression plan.

Method: Patients who had a history of chronic oedema presented to one of two oedema management centres in the US for treatment for oedema exacerbation and/or suboptimal performance of their current garments. Objective data examined were circumferential limb volume (cm³) measurements and QOL measured with the Lymphoedema QOL Tool (LYMQOL-Leg and LYMQOL-Arm). Subjective comments on functional abilities and perception of improvement with a compression plan that comprised a 24-hour interval were documented.

Results: All three patients presented in this case series had a reduction in limb volume and improvement in QOL when their daytime regimen of garments was updated and new night-time garments were added. Their subjective comments indicated improvement in activities of daily living and ease of controlling daytime oedema with a 24-hour interval compression plan.

Conclusion: This case series illustrates the need for clinicians to create a partnership with the patient to promote concordance and adherence as part of their individual 24-hour interval compression plan. This partnership allows the plan to be uniquely changed and adjusted to allow each patient to feel in control of refreshing their mood, their skin and their garments.

Keywords: 24-hour interval compression plan; chronic oedema; compression options; lymphoedema; mood; night-time garments; patient–clinician partnership; pressure; skin; wound; wound care; wound healing.

Desmoid tumors most commonly occur in the anterior abdominal wall in approximately 50% of cases and are locally aggressive. We describe a case of a 38-year-old lady who was investigated as a case of gastrointestinal tumor. Post-operative immunohistochemistry staining showed the presence of a synchronous desmoid in the abdominal wall and proximal ileum. Wide local excision remains the gold-standard of treatment with pharmacotherapeutics and radiotherapy serving as adjuvant or palliative treatment options.

Keywords: case report; desmoid; fibromatosis; immunohistochemistry..

Aim: Multisystem inflammatory syndrome in children (MIS-C) may cause shock and even death in children. The aim of this study is to describe the clinical features, laboratory characteristics and outcome of children diagnosed with MIS-C in 25 different hospitals in Turkey.

Methods: The retrospective study was conducted between 8 April and 28 October 2020 in 25 different hospitals from 17 cities. Data were collected from patients' medical records using a standardised form. Clinical and laboratory characteristics and outcomes according to different age groups, gender and body mass index percentiles were compared using multivariate logistic regression analysis.

Results: The study comprised 101 patients, median age 7 years (interquartile range (IQR) 4.6-9.3); 51 (50.5%) were boys. Reverse-transcriptase polymerase chain reaction (PCR) assay was positive in 21/100 (21%) patients; 62/83 (74.6%) patients had positive serology for SARS-CoV-2. The predominant complaints were fever (100%), fatigue (n = 90, 89.1%), and gastrointestinal symptoms (n = 81, 80.2%). Serum C-reactive protein (in 101 patients, median 165 mg/L; range 112-228), erythrocyte sedimentation rate (73/84, median 53 mm/s; IQR 30-84) and procalcitonin levels (86/89, median 5 μg/L; IQR 0.58-20.2) were elevated. Thirty-eight patients (37.6%) required admission to intensive care. Kawasaki disease (KD) was diagnosed in 70 (69.3%) patients, 40 of whom had classical KD. Most patients were treated with intravenous immunoglobulin (n = 92, 91%) and glucocorticoids (n = 59, 58.4%). Seven patients (6.9%) died.

Conclusion: The clinical spectrum of MIS-C is broad, but clinicians should consider MIS-C in the differential diagnosis when persistent fever, fatigue and gastrointestinal symptoms are prominent. Most patients diagnosed with MIS-C were previously healthy. Immunomodulatory treatment and supportive intensive care are important in the management of cases with MIS-C. Glucocorticoids and intravenous immunoglobulins are the most common immunomodulatory treatment options for MIS-C. Prompt diagnosis and prompt treatment are essential for optimal management.

Keywords: COVID-19; Kawasaki disease; MIS-C; child; shock.

Testicular oocytes (TOs) in wild adult bass (Micropterus spp.) are considered a potential indication of exposure to estrogenic compounds in municipal, agricultural, or industrial wastewater. However, our ability to interpret links between TO occurrence in wild fish species and environmental pollutants is limited by our understanding of normal and abnormal gonadal development. We previously reported low-to-moderate TO prevalence (7 - 38%) among adult male bass collected from Minnesota waters with no known sources of estrogenic compounds. In the present study, two experiments were conducted in which bass (M. dolomieu) fry were exposed to control water or ethinylestradiol (EE2) during gonadal differentiation, then reared in clean water for an additional period. Histological samples were evaluated at several time points during the exposure and grow-out periods, and sequence and timing of gonadal development in the presence of estrogen was compared with that of control fish. TOs were not observed in any control or EE2-exposed fish. Among groups exposed to 1.2 or 5.1 ng/L EE2 in Experiment 1 or 3.0 ng/L EE2 in Experiment 2, ovaries were observed in 100% of fish up to 90 days after exposure ceased, and approximately half of those ovaries had abnormal characteristics, suggesting that they likely developed in sex reversed males. Groups exposed to 0.1 ng/L, 0.4 ng/L, or 1.0 ng/L in Experiment 2 developed histologically normal ovaries and testes in proportions not significantly different from 1:1. These findings suggest that, while presumably able to cause sex reversal, juvenile exposure to EE2 may not be a unique cause of TOs in wild bass, although the long-term outcomes of exposure are unknown. This article is protected by copyright. All rights reserved. © 2022 SETAC.

Keywords: Intersex; Micropterus; endocrine disruption; ethinylestradiol; sex differentiation.

This study aimed to describe our experience and discuss the results, controversies, and the use of percutaneous transhepatic biliary drainage (PTBD) in patients with biliary complications after liver transplantation (LT). Between November 2009 and August 2020, 76 consecutive patients who underwent 77 LTs (44 deceased donor LTs and 33 living donor LTs [LDLT]) were enrolled retrospectively. Endoscopic therapy as initial approach and PTBD as rescue therapy were used for patients with biliary complications. There were 31 patients (31/76, 40.8%) with biliary complications, and two of them died (2/31, 6.5%). Clinical success rate of endoscopic therapy alone was 71.0% (22/31). The remaining nine patients received salvage PTBD and their clinical results were observed according to whether their intrahepatic bile ducts (IHBDs) was dilated (group A, n = 5) or not (group B, n = 4). In group A, the technical and long-term clinical success rates of PTBD were 100% and 20%, respectively. These five patients received PTBD ranging from 75 to 732 days after their LTs, and no procedure-related complications were encountered. In group B, the technical and long-term clinical success rates of PTBD were 50% and 25%, respectively. Three group B patients (75%) underwent PTBD within 30 days after LDLT and had lethal complications. One patient had graft laceration and survived after receiving timely re-transplantation. The other two patients died of sepsis due to PTBD-related bilioportal fistula or multiple liver abscesses. Our experience showed salvage PTBD played a limited role in biliary complications without dilated IHBDs within 1 month after LT.

Keywords: biliary complications; endoscopic retrograde biliary drainage; intrahepatic bile ducts; liver transplantation; percutaneous transhepatic biliary drainage.

This study aims to evaluate the effect of dexmedetomidine (DEX)-on esophageal cancer (EC) via regulating long noncoding RNA (lncRNA) metastasis-associated lung adenocarcinoma transcript 1 (MALAT1). The effect of DEX on MALAT1 expression and EC cell viability was detected. EC cells were divided into Blank, DEX, scrambled/MALAT1 siRNA, and DEX + control/MALAT1 groups, followed by a series of experiments including quantitative reverse-transcription polymerase chain reaction (qRT-PCR), western blotting, 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT), Annexin V-FITC/PI staining, wound healing, and Transwell assays. Additionally, mice were subjected to the subcutaneous injection of Eca109 cells transfected by control/MALAT1 activation lentiviral vector to construct EC models with the DEX treatment, and then the tumor volume and the expression of Ki-67 and active caspase-3 were determined. DEX reduced the expression of MALAT1 in EC cells in a dose-dependent manner. DEX inhibited the viability of EC cells, but increased the cell apoptosis, which, however, was reversed by MALAT1 overexpression. Moreover, MALAT1 overexpression abolished the inhibitory effect of DEX on the epithelial-mesenchymal transition (EMT) of EC cells, with enhanced migration and invasion. Furthermore, DEX succeeded in decreasing the tumor volume with the down-regulation of MALAT1. In comparison with the DEX group, mice in the DEX + MALAT1 group had larger tumors, with the up-regulation of Ki-67 and the down-regulation of active caspase-3. DEX can reduce the expression of MALAT1 in EC cells, thereby inhibiting the proliferation, invasion and migration, as well as EMT, and promoting the apoptosis of EC cells.

Keywords: MALAT1; dexmedetomidine; esophageal cancer; lncRNA.

Glutamine synthetase (GS) is a key enzyme responsible for the incorporation of inorganic nitrogen in the form of ammonium into the amino acid glutamine. In plants, two groups of functional GS enzymes are found: eubacterial GSIIb (GLN2) and eukaryotic GSIIe (GLN1/GS). Only GLN1/GS genes are found in vascular plants, which suggests that they are involved in the final adaptation of plants to terrestrial life. The present phylogenetic study reclassifies the different GS of seed plants into three clusters: GS1a, GS1b and GS2. The presence of genes encoding GS2 has been expanded to Cycadopsida gymnosperms, which suggests the origin of this gene in a common ancestor of Cycadopsida, Ginkgoopsida and angiosperms. GS1a genes have been identified in all gymnosperms, basal angiosperms and some Magnoliidae species. Previous studies in conifers and the gene expression profiles obtained in ginkgo and magnolia in the present work could explain the absence of GS1a in more recent angiosperm species (e.g., monocots and eudicots) due to the redundant roles of GS1a and GS2 in photosynthetic cells. Altogether, the results provide a better understanding of the evolution of plant GS isoenzymes and their physiological roles, which is valuable for improving crop nitrogen use efficiency and productivity.

Keywords: adaptation; glutamine synthetase; new gene classification; nitrogen metabolism; phylogeny; plant evolution.

Multiple outcomes reflecting different aspects of routine care are a common phenomenon in health care research. A common approach of handling such outcomes is multiple univariate analyses, an approach which does not allow for answering research questions pertaining to joint inference. In this study, we sought to study associations among nine pediatric pneumonia care outcomes spanning assessment, diagnosis and treatment domains of care, while circumventing the computational challenge posed by their clustered and high-dimensional nature and incompletely recorded covariates. We analyzed data from a cluster randomized trial conducted in 12 Kenyan hospitals. There were varying degrees of missingness in the covariates of interest, and these were multiply imputed using latent normal joint modeling. We used the pairwise joint modeling strategy to fit a correlated random effects joint model for the nine outcomes. This entailed fitting 36 bivariate generalized linear mixed models and deriving inference for the joint model using pseudo-likelihood theory. We also analyzed the nine outcomes separately before and after multiple imputation. We observed joint effects of patient-, clinician- and hospital-level factors on pneumonia care indicators before and after multiple imputation of missing covariates. In both pairwise joint modeling and separate univariate analysis methods, enhanced audit and feedback improved documentation and adherence to recommended clinical guidelines over time in six and five pneumonia care indicators, respectively. Additionally, multiple imputation improved precision of parameter estimates compared to complete case analysis. The strength and direction of association among pneumonia outcomes varied within and across the three domains of pneumonia care.

Keywords: multiple imputation; pairwise joint modeling; pediatric care; pneumonia; pseudo-likelihood.

A previous calcium scoring system using circumferential angle, thickness, and length of coronary calcium by OCT could assist in predicting stent under-expansion. However, this scoring system only reflects the calcification distribution within a single cross-section and fails to consider the lumen's original size. The current study aims to investigate whether novel parameters to quantify calcium lesions, including calcium burden, area, and volume assessed by optical coherence tomography (OCT), could predict stent under-expansion related to calcium lesions. Consecutive patients admitted between March 10th to October 19th 2021 with calcified coronary lesions undergoing percutaneous coronary intervention (PCI) with OCT guidance were screened for inclusion. The calcium burden, area, and volume of the target lesions were measured using OCT at pre-PCI. After successful stent implantation, stent expansion at the corresponding lesions was also measured by OCT. A total of 125 patients who underwent OCT-guided PCI were included in this study. While the calcium grades by angiography failed to show a significant correlation with stent expansion, maximum and average calcium burden, maximum calcium area, and calcium volume exhibited a moderate correlation with stent expansion. According to the receiver operating characteristic curves, the optimal cutoffs of calcium volume and area for predicting stent under-expansion were 4.37 mm³ and 2.48 mm² , respectively. Calcium burden, area, and volume by OCT are more favorable predictors of stent under-expansion given its better performance than calcium grades by angiography. Using cutoffs of calcium area and volume could identify high-risk patients of under-expansion and might guide future clinical practice.

Keywords: ROC curve; calcium lesion; coronary angiography; percutaneous coronary intervention.

Hematoporphyrin monomethyl ether (HMME) is a newly authorized photosensitizer for the treatment of port-wine stain (PWS) in China. However, no research on its efficacy for treating PWS lesions of Sturge-Weber syndrome (SWS) has been made. To assess the efficacy and safety of HMME-PDT in the treatment of SWS and simple large segmental facial PWS. Medical records of patients with SWS and large segmental facial PWS were reviewed. Efficacy was evaluated according to colour blanching and graded as excellent (≥75%), good (50-74%), fair (25-49%), and poor (≤24%). Adverse events were analysed. 19 patients with SWS and 33 patients with large segmental facial PWS were analysed. 52.6% SWS and 69.7% PWS patients (P>0.05) achieved at least 25% improvement. Common adverse events included short-term pain, edema, pruritus, exudation, and scab. No severe adverse event occurred. HMME-PDT was effective and safe for SWS and large segmental facial PWS. This article is protected by copyright. All rights reserved.

Keywords: Sturge-Weber syndrome; photodynamic therapy; photosensitizer; port-wine stain.

The International Workshop for Ex-Situ Marine Teleost Nutrition and Health, hosted by Disney's Animals, Science and Environment in conjunction with the Comparative Nutrition Society, brought together over fifty animal experts and scientists representing twenty institutions, to review current science and identify challenges of marine teleost nutrition and health. Invited speakers presented key information and current research topics for areas of emphasis and expertise. Subject matter experts identified knowledge gaps and key areas of focus to guide the scientific community's research efforts to improve the care of ex-situ marine teleosts. The Clinical Medicine working group highlighted standardized approaches to ante- and postmortem sample collection, diet biosecurity and supplementation, advanced diagnostic methods, and expanded training in fish nutrition. Nutrition identified creation of a husbandry and feeding management manual, comprehensive feeding program review and design, and specialty feeder/life stage nutrition as areas of focus, while Animal Husbandry focused on body condition scoring, feed delivery techniques, and behavioral husbandry topics. The Physiology and Chemistry, and Water Quality working groups discussed components of the aquatic environment and their impacts on fish health including organic matter constituents, microbial diversity, disinfection, and managing microbiota. Finally, we reviewed how Epidemiological approaches and considerations can improve our evaluation of aquarium teleost nutrition and health. The goals outlined by each working group and supporting literature discussion are detailed in this communication, and represent our aims for the next three to five years, with the ultimate objective of the workshop being the production of a husbandry manual for marine teleost nutrition and health. Any scientists who feel their experience, research, or interests align with these goals are invited to participate by contacting the authors.

Background: Discharge planning is a routine feature of health systems in many countries that aims to reduce delayed discharge from hospital, and improve the co-ordination of services following discharge from hospital and reduce the risk of hospital readmission. This is the fifth update of the original review.

Objectives: To assess the effectiveness of planning the discharge of individual patients moving from hospital.

Search methods: We searched CENTRAL, MEDLINE, Embase and two trials registers on 20 April 2021. We searched two other databases up to 31 March 2020. We also conducted reference checking, citation searching and contact with study authors to identify additional studies.

Selection criteria: Randomised trials that compared an individualised discharge plan with routine discharge that was not tailored to individual participants. Participants were hospital inpatients.

Data collection and analysis: Two review authors independently undertook data analysis and quality assessment using a pre-designed data extraction sheet. We grouped studies by older people with a medical condition, people recovering from surgery, and studies that recruited participants with a mix of conditions. We calculated risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous data using fixed-effect meta-analysis. When combining outcome data it was not possible because of differences in the reporting of outcomes, we summarised the reported results for each trial in the text.

Main results: We included 33 trials (12,242 participants), four new trials included in this update. The majority of trials (N = 30) recruited participants with a medical diagnosis, average age range 60 to 84 years; four of these trials also recruited participants who were in hospital for a surgical procedure. Participants allocated to discharge planning and who were in hospital for a medical condition had a small reduction in the initial hospital length of stay (MD - 0.73, 95% confidence interval (CI) - 1.33 to - 0.12; 11 trials, 2113 participants; moderate-certainty evidence), and a relative reduction in readmission to hospital over an average of three months follow-up (RR 0.89, 95% CI 0.81 to 0.97; 17 trials, 5126 participants; moderate-certainty evidence). There was little or no difference in participant's health status (mortality at three- to nine-month follow-up: RR 1.05, 95% CI 0.85 to 1.29; 8 trials, 2721 participants; moderate certainty) functional status and psychological health measured by a range of measures, 12 studies, 2927 participants; low certainty evidence). There was some evidence that satisfaction might be increased for patients (7 trials), caregivers (1 trial) or healthcare professionals (2 trials) (very low certainty evidence). The cost of a structured discharge plan compared with routine discharge is uncertain (7 trials recruiting 7873 participants with a medical condition; very low certainty evidence).

Authors' conclusions: A structured discharge plan that is tailored to the individual patient probably brings about a small reduction in the initial hospital length of stay and readmissions to hospital for older people with a medical condition, may slightly increase patient satisfaction with healthcare received. The impact on patient health status and healthcare resource use or cost to the health service is uncertain.

Background: The prognostic significance of blood urea nitrogen (BUN)/creatinine ratio specifically in chronic heart failure with preserved ejection fraction (HFpEF) patients remained unclear. We aimed to evaluate the association of BUN/creatinine ratio (baseline level and visit-to-visit variation) with the risk of adverse clinical outcomes among patients with chronic HFpEF.

Methods and results: This is a secondary analysis of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial. Of the enrolled 3445 participants in the TOPCAT trial, associations between BUN/creatinine and clinical outcomes were examined in a subset of 1521 (baseline measurements level) and 1453 (visit-to-visit variation) participants. A multivariable Cox proportional hazard model was used to assess the prognostic significance of BUN/creatinine ratio and BUN/creatinine ratio variation for the prespecified clinical outcomes. A higher BUN/creatinine ratio was associated with a higher risk of all-cause mortality (hazard ratio [HR] = 1.52, 95%CI, 1.21-1.91; p < .001) as well as cardiovascular disease mortality (HR = 1.83, 95%CI, 1.35-2.49; p < .001) in the fully adjusted model. Greater visit-to-visit variability in BUN/creatinine ratio tended to be independently associated with a higher risk of heart failure hospitalization and primary endpoint (p < .001 for both outcomes). Furthermore, those findings were consistent across participants stratified by the presence of chronic kidney disease at baseline.

Conclusions: Higher BUN/creatinine ratio and greater BUN/creatinine ratio variability are independently associated with adverse outcomes in HFpEF participants in the TOPCAT trial.

Keywords: blood urea nitrogen /creatinine ratio; heart failure with preserved ejection fraction; morbidity; prognosis.

Smartphone users' posture can affect the musculoskeletal load of the user's neck. This study aims to compare the effect of the posture of using smartphones on head and neck angles among college students. The cross-sectional study was conducted among 80 college students. The Severity of Neck Pain (SNP) and the head and neck tilt angles, the gaze angle, and the amount of change in the forward head posture were determined. The angles were measured in three postures including standing, sitting on a chair with and without a backrest. Most of the participants (51.3%) reported moderate and severe neck pain. The angles during using smartphone had a significant difference in different positions, so that the best head (100.6 ± 11.3 degree) and neck (32.5 ± 11.2 degree) tilt angles and gaze angle (58.2 ± 13.7 degree) were in sitting position with leaning on a backrest of the chair. Head (109.6 ± 14.4 degree) and neck (22.0 ± 12.6 degree) tilt angles, and the forward head posture (15.9 ± 4.9 cm) have the worst posture in sitting position on a chair without a backrest while gaze angle (67.1 ± 12.0 degree) has the most awkward posture in standing.Practitioner Summary: The posture of using a smartphone affects the amount of pressure on the neck. This study aims to investigate the effect of different positions of using smartphone on head and neck angles among Iranian university students. The angles during using smartphone had a significant difference in different positions.

Keywords: Neck; Posture; Smartphone; Student.

Keywords: growth rate; laterality; mitochondria; sex determination.