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Successful brachial plexus blockade produces sympathetic blockade, resulting in increased skin temperature in the blocked segments. This study aimed to evaluate the accuracy of infrared thermography in predicting failed segmental supraclavicular brachial plexus block. This prospective observational study included adult patients undergoing upper-limb surgery under supraclavicular brachial plexus block. Sensation was evaluated at the dermatomal distribution of the ulnar, median, and radial nerves. Block failure was defined as absence of complete sensory loss 30 min after block completion. Skin temperature was evaluated by infrared thermography at the dermatomal supply of the ulnar, median, and radial nerves at baseline, 5, 10, 15, and 20 min after block completion. The temperature change from the baseline measurement was calculated for each time point. Outcomes were the ability of temperature change at each site to predict failed block of the corresponding nerve using area under receiver-operating characteristic curve (AUC) analysis. Eighty patients were available for the final analysis. The AUC (95% confidence interval [CI]) for the ability of temperature change at 5 min to predict failed ulnar, median, and radial nerve block was 0.79 (0.68-0.87), 0.77 (0.67-0.86), and 0.79 (0.69-0.88). The AUC (95% CI) increased progressively and reached its maximum values at 15 min (ulnar nerve 0.98 [0.92-1.00], median nerve 0.97 [0.90-0.99], radial nerve 0.96 [0.89-0.99]) with negative predictive value of 100%. Infrared thermography of different skin segments provides an accurate tool for predicting failed supraclavicular brachial plexus block. Increased skin temperature at each segment can exclude block failure in the corresponding nerve with 100% accuracy.

Reductive Metabolism of AGE Precursors: A Metabolic Route for Preventing AGE Accumulation in Cardiovascular Tissue Shahid P. Baba , Oleg A. Barski , Yonis Ahmed , Timothy E. O'Toole , Daniel J. Conklin , Aruni Bhatnagar and Sanjay Srivastava From the Diabetes and Obesity Center, University of Louisville, Louisville, Kentucky. Corresponding author: Sanjay Srivastava, sanjay{at}louisville.edu . Abstract OBJECTIVE To examine the role of aldo-keto reductases (AKRs) in the cardiovascular metabolism of the precursors of advanced glycation end products (AGEs). RESEARCH DESIGN AND METHODS Steady-state kinetic parameters of AKRs with AGE precursors were determined using recombinant proteins expressed in bacteria. Metabolism of methylglyoxal and AGE accumulation were studied in human umbilical vein endothelial cells (HUVECs) and C57 wild-type, akr1b3 (aldose reductase)-null, cardiospecific- akr1b4 (rat aldose reductase), and akr1b8 (FR-1)-transgenic mice. AGE accumulation and atherosclerotic lesions were studied 12 weeks after streptozotocin treatment of C57, akr1b3 -null, and apoE - and akr1b3-apoE –null mice. RESULTS Higher levels of AGEs were generated in the cytosol than at the external surface of HUVECs cultured in high glucose, indicating that intracellular metabolism may be an important regulator of AGE accumulation and toxicity. In vitro, AKR 1A and 1B catalyzed the reduction of AGE precursors, whereas AKR1C, AKR6, and AKR7 were relatively ineffective. Highest catalytic efficiency was observed with AKR1B1. Acetol formation in methylglyoxal-treated HUVECs was prevented by the aldose reductase inhibitor sorbinil. Acetol was generated in hearts perfused with methylglyoxal, and its formation was increased in akr1b4 - or akr1b8 -transgenic mice. Reduction of AGE precursors was diminished in hearts from akr1b3 -null mice. Diabetic akr1b3 -null mice accumulated more AGEs in the plasma and the heart than wild-type mice, and deletion of akr1b3 increased AGE accumulation and atherosclerotic lesion formation in apoE -null mice. CONCLUSIONS Aldose reductase–catalyzed reduction is an important pathway in the endothelial and cardiac metabolism of AGE precursors, and it prevents AGE accumulation and atherosclerotic lesion formation. Footnotes The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. Received March 12, 2009. Accepted July 18, 2009. © 2009 American Diabetes Association

Abstract Objectives Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in Western populations, being rarer in Asian and African people. It has been suggested that patients with CLL from Africa might have a more aggressive disease compared with white patients. In this study, we aimed to identify genetic factors that may account for this difference. Methods We analyzed immunoglobulin heavy chain (IGH) genes’ mutational status by performing next-generation sequencing in 25 Senegalese and 50 Italian patients with CLL. Results We found that Senegalese patients more frequently had adverse prognostic factors and an unmutated profile. Furthermore, we documented that IGHV1 (IGHV1-69), IGHD3, and IGHJ6 were significantly more frequent in Senegalese patients, whereas IGHV3-30 was common and limited to the Italian cohort. Stereotyped receptors commonly detected in the white population were not recorded in our Senegalese series. Conclusions The different IGH repertoire we observed in the Senegalese cohort may reflect the diverse genetic and microenvironmental (ie, polymicrobial stimulation) background.

To investigate the effects of diabetes and/or hypercholesterolemia on skin development during in utero life at 15, 17 & 19 days old. Sixty pregnant female albino Wistar rats were arranged into three groups: control, diabetic (single i.p. 60 mg streptozotocin/kg B.wt) and hypercholesterolemic (diet supplement 3% cholesterol 6 week prior to conception and throughout gestation). Pregnant rats were sacrificed at 15, 17 & 19 days prenatal). Vibrissae skin biopsies were removed and allowed for scanning (SEM), light, and transmission electron microscopic (TEM) investigation. Also, DNA fragmentation and sodium dodecyl polyacrylamides gel electrophoresis (SDS-PAGE) were carried out. Scanning electron microscopic observations revealed retarded hair follicle growth and deformations of their pattern structure. At light microscopic level, skin exhibited decreased epidermal cornification, as well as degeneration of hair follicles in fetuses of both diabetic and hypercholesterolemic groups. Transmission electron microscopy revealed abundant vacuolar spaces in the epidermis. Degenerative phases become more abundant in keratinocytes as well as in stratum germinativum cells. Fetal skin possessed altered protein expression and missing bands as well as separation of genomic DNA to several degraded bands in skin of 15-, 17-, and 19-day-old, maternally diabetic and/or hypercholesterolemic fetuses. These findings showed that maternal diabetes and/or hypercholesterolemia increased average deformation of hair follicles, vacuolation, and degeneration of epidermal cell layers. The observed findings resulted from altered protein expression and increased DNA fragmentation, which, in turn, disrupt epidermal cell differentiation.

Diseases caused by small ruminant lentiviruses, Mycobacterium avium ssp. paratuberculosis (MAP), Schmallenberg virus, and peste des petits ruminants virus (PPR) is globally recognised as serious threats to the ruminant industry due to their potential to spread rapidly across boundaries. Despite their global distribution and negative impacts on ruminant production, there is a gap in knowledge of the current trends in their epidemiology among sheep and goat populations in Peninsular Malaysia. This study was therefore designed to fill the gap of knowledge concerning the seroprevalence and contributing factors of CAEV, paratuberculosis, SBV, and PPRV among small ruminants from selected flocks in Selangor, Negeri Sembilan, and Pahang states in Peninsular Malaysia. A cross-sectional study design was used to collect animal data and blood samples for serological assays simultaneously. The ID Screen (ID.VET, France) indirect ELISA screening tests were used to detect serum antibodies directed against CAEV/MVV (VISNAS Ver 0922), paratuberculosis (PARAS Ver 0516), SBV (SBVC Ver 1114) and PPRV (PPRC Ver 0821). There was 45.4% (95% CI = 40.74–50.74), 6.8% (95% CI = 4.66–9.69), 27.8% (95% CI = 23.35–32.77), and 2.6% (95% CI = 1.11–0.51) true seroprevalence for CAEV, paratuberculosis, SBV, and PPR, respectively. Geographical location and species were the risk factors for CAEV and paratuberculosis, while the management system and age of small ruminants were the risk factors for SBV. The present study is the first to document a large-scale seroprevalence of MAP and PPR infection among sheep and goat flocks in Peninsular Malaysia. The presence of PPRV and MAP antibodies among small ruminant flocks is signalling current or previous exposure to the pathogens or cross reactions with similar antigens. This finding further suggests the potential for future outbreaks of these devastating diseases among sheep and goats in Malaysia. The high seroprevalence of CAEV and SBV among small ruminants indicates high levels of exposure to the viruses in the environment, which is a potential threat to production.

Q fever is a zoonotic disease caused by Coxiella burnetii, which is associated with reproductive disorders such as abortion and reproductive problems in ruminants, while paratuberculosis is an underdiagnosed disease caused by Mycobacterium avium paratuberculosis (MAP) which causes chronic wasting, low fertility, and mortality in ruminants. Although both C. burnetii and MAP infections have been reported in domestic ruminants worldwide, there is no data on their seroprevalence status among deer in Selangor, Malaysia. This study investigated the seroprevalence status of C. burnetii and MAP among deer in Malaysia. Ninety-two blood sera collected from an institutional deer farm were screened using commercial Multi-species ID Screen indirect ELISA tests to detect specific anti-C. burnetii (FQSMS/1117) and anti-MAP (PARAS Ver 0516) antibodies. The ELISA results showed a 14.1% (95% CI = 8.5-22.7) apparent and 14.8% (95% CI = 8.4-24.4) true prevalence for C. burnetii and a 2.2% (95% CI= 0.6-7.6) apparent and 1.3% (95% CI= -0.45-7.40) true prevalence for MAP among deer. There were statistically significant associations between seropositivity to C. burnetii and the age groups (%2= 7.325, P = 0.011) or herds of deer (%2= 9.732, P = 0.001). To the best of our knowledge, this study provides the first preliminary serological evidence of C. burnetii and MAP in Cervus timorensis, suggesting potential threats to animal and public health in Malaysia.

Chapter I of this thesis describes the synthesis of 3-(2-butyl-2-cyclopropenyl) propanol and its subsequent isomerization reactions. Reaction of 7,7-dibromo-2-oxabicylo[4.1.0]heptane with excess butyllithium afforded 3-(2-butyl-2-cyclopropenyl) propanol via nucleophilic alkylation of a haloorganolithium carbenoid intermediate. The 3-(2-butyl-2-cyclopropenyl) propanol was not stable and isomerized to 2-(2-tetrahydrofuranyl)-1-hexene and E-1-(2-tetrahydrofuranyl)-1-hexene in 9:1 ratio. To study the mechanism of isomerization of 3-(2-butyl-2-cyclopropenyl) propanol, isotopically labeled derivatives 3-(2-butyl 1-3-deuterio-2-cyclopropenyl) propanol and 3-(2-butyl-2-cyclopropenyl)propanol-OD were synthesized and percent deuterations were determined from NMR spectroscopy. Deuterium labeling established that the isomerization was stereospecific and followed an intramolecular pathway. The isomerization reaction is believed to occur via intramolecular addition of a hydroxyl group across the carbon-carbon sigma bond of the cyclopropene ring, a (σ2+σ2) cyclization. In chapter II, the synthesis and structure of several di-benzo-1, 2-tricyclo[7.5.0.0 2, 8] tetradecanes as potential metal ligands is discussed. Dimerization and subsequent hydrolysis of the highly reactive 1-methoxybenzocyclohepta-1, 2-diene and 2-methoxybenzocyclohepta-1, 2-diene provided 4, 5; 12, 13-dibenzol, 2-tricyclo[7.5.0.02, 8]tetradeca-3, 14 dione and 6, 7;10, 11-dibenzo1, 2-tricyclo[7.5.0.02, 8]tetradeca-3, 14 dione. The cis-transoid-cis stereochemistry of the cyclobutane ring of these diones was determined from NMR spectroscopy and confirmed with X-ray crystallography. The reduction of the diones to the corresponding diols has been achieved and X-ray crystallographic analysis indicated that in the solid state the diols crystallized as a dimer, where the hydroxyl groups are located at equatorial position syn to the cyclobutane ring fusion protons. An olefination and hydroboration reaction sequence on 4, 5; 12, 13-dibenzo-1, 2-tricyclo[7.5.0.02, 8]tetradeca-3, 14 dione afforded the corresponding dibenzo-1, 2-tricyclo[7.5.0.02, 8]tetradecane-3, 14 (dihydroxymethyl). X-ray crystallographic analysis indicated that the molecule had undergone change to a higher energy conformation, placing the hydroxyl groups anti to the ring fusion protons. Using the dibenzo-1, 2-tricyclo[7.5.0.02, 8] tetradecane ring as scaffold, other functional groups were introduced at the 3 and 14 positions and their structures were studied.

Background The Republic of Djibouti is a malaria endemic country that was in pre-elimination phase in 2006–2012. From 2013, however, malaria has re-emerged in the country, and its prevalence has been increasing every year. Given the co-circulation of several infectious agents in the country, the assessment of malaria infection based on microscopy or histidine-rich protein 2 (HRP2)-based rapid diagnostic tests (RDT) has shown its limitations. This study, therefore, aimed to assess the prevalence of malaria among febrile patients in Djibouti city using more robust molecular tools. Methods All suspected malaria cases reported to be microscopy-positive were randomly sampled (n = 1113) and included in four health structures in Djibouti city over a 4-year period (2018–2021), mainly during the malaria transmission season (January–May). Socio-demographic information was collected, and RDT was performed in most of the included patients. The diagnosis was confirmed by species-specific nested polymerase chain reaction (PCR). Data were analysed using Fisher’s exact test and kappa statistics. Results In total, 1113 patients with suspected malaria and available blood samples were included. PCR confirmed that 788/1113 (70.8%) were positive for malaria. Among PCR-positive samples, 656 (83.2%) were due to Plasmodium falciparum , 88 (11.2%) Plasmodium vivax , and 44 (5.6%) P. falciparum / P. vivax mixed infections. In 2020, P. falciparum infections were confirmed by PCR in 50% (144/288) of negative RDTs. After the change of RDT in 2021, this percentage decreased to 17%. False negative RDT results were found more frequently ( P  < 0.05) in four districts of Djibouti city (Balbala, Quartier 7, Quartier 6, and Arhiba). Malaria occurred less frequently in regular bed net users than in non-users (odds ratio [OR]: 0.62, 95% confidence interval [CI]: 0.42–0.92). Conclusions The present study confirmed the high prevalence of falciparum malaria and, to a lesser extent, vivax malaria. Nevertheless, 29% of suspected malaria cases were misdiagnosed by microscopy and/or RDT. There is a need to strengthen the capacity for diagnosis by microscopy and to evaluate the possible role of P. falciparum hrp2 gene deletion, which leads to false negative cases of P. falciparum .

Until 2020, Djiboutian health authorities relied on histidine-rich protein-2 (HRP2)-based rapid diagnostic tests (RDTs) to establish the diagnosis of Plasmodium falciparum. The rapid spread of P. falciparum histidine-rich protein-2 and -3 (pfhrp2/3) gene-deleted parasite strains in Djibouti has led the authorities to switch from HRP2-based RDTs to lactate dehydrogenase (LDH)-based RDTs targeting the plasmodial lactate dehydrogenase (pLDH) specific for P. falciparum and P. vivax (RapiGEN BIOCREDIT Malaria Ag Pf/Pv pLDH/pLDH) in 2021. This study was conducted with the primary objective of evaluating the diagnostic performance of this alternative RDT. Operational constraints related, in particular, to the implementation of this RDT during the COVID-19 pandemic were also considered. The performance of BIOCREDIT Malaria Ag Pf/Pv (pLDH/pLDH) RDT was also compared to our previously published data on the performance of two HRP2-based RDTs deployed in Djibouti in 2018–2020. The diagnosis of 350 febrile patients with suspected malaria in Djibouti city was established using two batches of RapiGEN BIOCREDIT Malaria Ag Pf/Pv (pLDH/pLDH) RDT over a two-year period (2022 and 2023) and confirmed by real-time quantitative polymerase chain reaction. The sensitivity and specificity for the detection of P. falciparum were 88.2% and 100%, respectively. For P. vivax, the sensitivity was 86.7% and the specificity was 100%. Re-training and closer supervision of the technicians between 2022 and 2023 have led to an increased sensitivity to detect P. falciparum (69.8% in 2022 versus 88.2% in 2023; p < 0.01). The receiver operating characteristic curve analysis highlighted a better performance in the diagnosis of P. falciparum with pLDH-based RDTs compared with previous HRP2-based RDTs. In Djibouti, where pfhrp2-deleted strains are rapidly gaining ground, LDH-based RDTs seem to be more suitable for diagnosing P. falciparum than HRP2-based RDTs. Awareness-raising and training for technical staff have also been beneficial.

Battery storage systems are subject to frequent charging/discharging cycles, which reduce the operational life of the battery and reduce system reliability in the long run. As such, several Battery Management Systems (BMS) have been developed to maintain system reliability and extend the battery's operative life. Accurate estimation of the battery's State of Charge (SOC) is a key challenge in the BMS due to its non-linear characteristics. This paper presents a comprehensive review on the most recent classifications and mathematical models for SOC estimation. Future trends for SOC estimation methods are also presented.