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Breath tests (BTs) are important for the diagnosis of carbohydrate maldigestion syndromes and small intestinal bacterial overgrowth (SIBO). However, standardization is lacking regarding indications for testing, test methodology and interpretation of results. A consensus meeting of experts was convened to develop guidelines for clinicians and research. Pre-meeting survey questions encompassing five domains; indications, preparation, performance, interpretation of results, and knowledge gaps, were sent to 17 clinician-scientists, and 10 attended a live meeting. Using an evidence-based approach, 28 statements were finalized and voted on anonymously by a working group of specialists. Consensus was reached on 26 statements encompassing all five domains. Consensus doses for lactulose, glucose, fructose and lactose BT were 10, 75, 25 and 25 g, respectively. Glucose and lactulose BTs remain the least invasive alternatives to diagnose SIBO. BT is useful in the diagnosis of carbohydrate maldigestion, methane-associated constipation, and evaluation of bloating/gas but not in the assessment of oro-cecal transit. A rise in hydrogen of ≥20 p.p.m. by 90 min during glucose or lactulose BT for SIBO was considered positive. Methane levels ≥10 p.p.m. was considered methane-positive. SIBO should be excluded prior to BT for carbohydrate malabsorption to avoid false positives. A rise in hydrogen of ≥20 p.p.m. from baseline during BT was considered positive for maldigestion. BT is a useful, inexpensive, simple and safe diagnostic test in the evaluation of common gastroenterology problems. These consensus statements should help to standardize the indications, preparation, performance and interpretation of BT in clinical practice and research.

Age estimations are relevant for pre-trial detention and sentencing in criminal cases and as part of the evaluation in asylum processes to protect the rights and privileges of minors. No method can determine an exact chronological age due to individual variations in biological development. Current techniques assess skeletal or dental development and compare to reference populations. A key question is whether both sides of a body part need imaging, especially when asymmetric development occurs. This study evaluates whether bilateral imaging of the clavicles and third molars is necessary or if unilateral imaging suffices. We retrospectively analyzed clinical and radiological data from patients who underwent CT scans at Karolinska University Hospital, along with third molar data from studies using plain radiographs to assess development in relation to chronological age. The primary aim of this study is to examine the frequency of asymmetrical maturation in the medial clavicle and third molar in males and in females. The secondary aim was to examine how asymmetry influences age estimation in medico-legal contexts. To mitigate potential bias from relying on a single-reviewer assessment, we introduced a predefined level of misclassification into our model. Our findings show a strong correlation between right and left clavicle development ( ρ  = 0.871 (males) and ρ  = 0.854 (females)) and near-perfect correlation ( ρ  = 0.980 (males) and ρ  = 0.975 (females)) for third molars in both sexes. Asymmetrical development was found in approximately 23% (clavicle) and 13% (third molar) of males, and 20% and 17% of females, respectively. We recommend bilateral clavicle assessment to capture developmental variation and improve accuracy. For third molars, using the side with the most mature development in males and the least mature side in females enhances accuracy around the 18-year threshold.

Electrolytes have a wide range of technological applications. Despite the recent improvements in characterizing and predicting the phase behavior of microemulsion systems by hydrophilic-lipophilic deviation (HLD) and net-average curvature (NAC) frameworks, they are ineffective in the presence of different salts. This work seeks to bridge this gap by investigating the influence of salt nature on the microemulsion phase formulation. First, a one-dimensional salinity scan on different microemulsion systems consisting of sodium dodecyl benzene sulfonate as a surfactant, hexane as an oil and, several brines was carried out, and the effect of each salt on the phase behavior were precisely evaluated. The results for optimum salinity and solubilization parameter of different salts were consistent with the Hofmeister series. In addition, multiple linear regression model is presented to accurately predicting the optimum salinity of different salts using this research data and all the available experimental data. The results revealed that the values estimated by this model is in significant consistency with the experimental data by correlation coefficient of 0.92. Finally, the effect of salt type on the NAC parameters (length parameter, and characteristic length ) were evaluated to improve the predicting ability of this equation of state in the presence of various salts. We found that salt nature has a significant impact on both these parameters. It was found that the length parameter is linearly dependent on the optimum ionic strength of salts while the salting-out capacity of each salt was predominant factor affecting the characteristic length.

Post-disaster recovery is a complex process in terms of measuring its progress after a disaster and understanding its components and influencing factors. During this process, disaster planners and governments need reliable information to make decisions towards building the affected region back to normal (pre-disaster), or even improved, conditions. Hence, it is essential to use methods to understand the dynamics/variables of the post-disaster recovery process, and rapid and cost-effective data and tools to monitor the process. Google Earth Engine (GEE) provides free access to vast amounts of remote sensing (RS) data and a powerful computing environment in a cloud platform, making it an attractive tool to analyze earth surface data. In this study we assessed the suitability of GEE to analyze and track recovery. To do so, we employed GEE to assess the recovery process over a three-year period after Typhoon Haiyan, which struck Leyte island, in the Philippines, in 2013. We developed an approach to (i) generate cloud and shadow-free image composites from Landsat 7 and 8 satellite imagery and produce land cover classification data using the Random Forest method, and (ii) generate damage and recovery maps based on post-classification change analysis. The method produced land cover maps with accuracies >88%. We used the model to produce damage and three time-step recovery maps for 62 municipalities on Leyte island. The results showed that most of the municipalities had recovered after three years in terms of returning to the pre-disaster situation based on the selected land cover change analysis. However, more analysis (e.g., functional assessment) based on detailed data (e.g., land use maps) is needed to evaluate the more complex and subtle socio-economic aspects of the recovery. The study showed that GEE has good potential for monitoring the recovery process for extensive regions. However, the most important limitation is the lack of very-high-resolution RS data that are critical to assess the process in detail, in particular in complex urban environments.

Small intestinal bacterial overgrowth (SIBO) is highly prevalent and is associated with numerous gastrointestinal disorders, but the microbes involved remain poorly defined. Moreover, existing studies of microbiome alterations in SIBO have utilized stool samples, which are not representative of the entire gastrointestinal tract. Therefore, we aimed to determine and compare the duodenal microbiome composition in SIBO and non-SIBO subjects, using duodenal aspirates from subjects undergoing standard-of-care esophagogastroduodenoscopy without colon preparation. Using the recently-redefined cutoff for SIBO of >10.sup.3 colony forming units per milliliter (CFU/mL), 42 SIBO and 98 non-SIBO subjects were identified. Duodenal samples from SIBO subjects had 4x10.sup.3 -fold higher counts than non-SIBO subjects when plated on MacConkey agar (P<0.0001), and 3.8-fold higher counts when plated on blood agar (P<0.0001). Twenty subjects had also undergone lactulose hydrogen breath tests (LHBTs), of whom 7/20 had SIBO. At the 90-minute timepoint, 4/7 SIBO subjects had positive LHBTs (rise in hydrogen (H.sub.2) [greater than or equal to] 20 ppm above baseline), as compared to 2/13 non-SIBO subjects. 16S ribosomal RNA (rRNA) sequencing revealed that SIBO subjects had 4.31-fold higher relative abundance of Proteobacteria (FDR P<0.0001) and 1.64-fold lower Firmicutes (P<0.0003) than non-SIBO subjects. This increased relative abundance of Proteobacteria correlated with decreased [alpha]-diversity in SIBO subjects (Spearman R = 0.4866, P<0.0001) Specific increases in class Gammaproteobacteria correlated with the area-under-the-curve for H.sub.2 for 0-90 mins during LHBT (R = 0.630, P = 0.002). Increases in Gammaproteobacteria resulted primarily from higher relative abundances of the family Enterobacteriaceae (FDR P10.sup.3 CFU/mL cutoff for the definition of SIBO, and also reveal specific overgrowth of Proteobacteria in SIBO vs. non-SIBO subjects, coupled with an altered Proteobacterial profile that correlates with symptom severity. Future research may elucidate host-microbiome interactions underlying these symptoms in SIBO patients.

Crohn's disease (CD) and ulcerative colitis (UC), known as inflammatory bowel disease (IBD), are fairly common chronic inflammatory conditions of the gastrointestinal tract. Although the exact etiology of IBD remains uncertain, dysfunctional immunoregulation of the gut is believed to be the main culprit. Amongst the immunoregulatory factors, reactive oxygen species are produced in abnormally high levels in IBD. Their destructive effects may contribute to the initiation and/or propagation of the disease. We provided an extensive overview on the evidences from animal and human literature linking oxidative stress to IBD and its activity. Moreover, the effects of antioxidant therapy on IBD patients in randomized, controlled trials were reviewed and the need for further studies elaborated. We also summarized the evidence in support for causality of oxidative stress in IBD.

This study aims to generate a statistical model based on magnetic resonance imaging of the knee and radiography of third molars in the lower jaw, for assessing age relative to the 18-year old threshold. In total, 58 studies correlating knee or tooth development to age were assessed, 5 studies for knee and 7 studies for tooth were included in the statistical model. The relation between the development of the anatomical site, based on a binary system, and age were estimated using logistic regression. Separate meta-populations for knee and tooth were generated from the individual based data for men and women. A weighted estimate of probabilities was made by combining the probability densities for knee and tooth. Margin of errors for males and females in different age groups and knee and tooth maturity were calculated within the larger framework of transition analysis using a logit model as a base. Evidentiary values for combinations of knee and tooth maturity were evaluated with likelihood ratios. For males, the sensitivity for the method was calculated to 0.78 (probability of correctly classifying adults), the specificity 0.90 (probability of correctly classifying minors), the negative predictive value 0.80 (proportion identified minors are minors) and the positive predictive value 0.89 (proportion identified adults are adults) indicating a model better at identifying minors than adults. The point at which half the female population has reached closed knee lies before the 18-year threshold, adding the knee as an indicator lowers specificity and increases sensitivity. The sensitivity when using tooth as an indicator for females is 0.24 and specificity 0.97, signifying few minors misclassified as adults but also a low probability of identifying adults. The negative predictive value for women when using tooth as the sole indicator is 0.56 and positive predictive value 0.88. Probabilities were calculated for males and females assuming a uniform age distribution between 15 and 21years. The calculated margin of error of minors classified as adults in a population between 15 and 21 years with the model was 11% for males and 12% for females. Further, the evidentiary value as well as margin of error vary for different combinations of knee and tooth maturity. The statistical model based on the combination of MRI knee and radiography of mandibular third molars is a valid method to assess age relative to the 18-year old threshold when applied on males and of limited value in females. •A statistical model to assess age relative to the 18-year threshold is presented.•The method is based on MRI knee and radiography of mandibular third molars.•The method is of limited value in females.•The method has high specificity signifying few minors misclassified as adults.•Age-mimicry is avoided by using logistic regression on individual-based data.

Irritable bowel syndrome (IBS) includes diarrhea-predominant (IBS-D) and constipation-predominant (IBS-C) subtypes. We combined breath testing and stool microbiome sequencing to identify potential microbial drivers of IBS subtypes. IBS-C and IBS-D subjects from 2 randomized controlled trials (NCT03763175 and NCT04557215) were included. Baseline breath carbon dioxide, hydrogen (H 2 ), methane (CH 4 ), and hydrogen sulfide (H 2 S) levels were measured by gas chromatography, and baseline stool microbiome composition was analyzed by 16S rRNA sequencing. Microbial metabolic pathways were analyzed using Kyoto Encyclopedia of Genes and Genomes collection databases. IBS-C subjects had higher breath CH 4 that correlated with higher gut microbial diversity and higher relative abundance (RA) of stool methanogens, predominantly Methanobrevibacter , as well as higher absolute abundance of Methanobrevibacter smithii in stool. IBS-D subjects had higher breath H 2 that correlated with lower microbial diversity and higher breath H 2 S that correlated with higher RA of H 2 S-producing bacteria, including Fusobacterium and Desulfovibrio spp. The predominant H 2 producers were different in these distinct microtypes, with higher RA of Ruminococcaceae and Christensenellaceae in IBS-C/CH 4 + (which correlated with Methanobacteriaceae RA) and higher Enterobacteriaceae RA in IBS-D. Finally, microbial metabolic pathway analysis revealed enrichment of Kyoto Encyclopedia of Genes and Genomes modules associated with methanogenesis and biosynthesis of methanogenesis cofactor F420 in IBS-C/CH 4 + subjects, whereas modules associated with H 2 S production, including sulfate reduction pathways, were enriched in IBS-D. Our findings identify distinct gut microtypes linked to breath gas patterns in IBS-C and IBS-D subjects, driven by methanogens such as M. smithii and H 2 S producers such as Fusobacterium and Desulfovibrio spp, respectively.

Postmortem diagnosis of sudden cardiac death (SCD) may escape detection due to the absence of thrombi and slow development of structural and immunohistochemical changes. Therefore, this study explores the possibility of analyzing relevant clinical chemistry biomarkers in myocardial homogenates and serum. Following an initial pilot study, myocardial samples from 113 autopsy cases were homogenized with distilled water, T-PER or 2 M urea. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatine kinase (CK-MB), lactate dehydrogenase (LDH), orosomucoid and total protein were analyzed with an IndikoPlus and a subset was also analyzed with a Roche Cobas 8000 c701 analyzer, which also provided results for cardiac Troponin T, myoglobin and NT-proBNP. Although the yields varied with different extraction buffers depending on the analyte, distilled water was often as effective as T-PER and 2 M urea extraction for most analytes. Biomarker levels were consistently higher in the myocardial homogenates than in serum. Proteomic profiling on a subset confirmed higher concentrations of the cardiac markers in the tissue samples than in serum. Finally, we investigated whether selected markers could support the diagnosis of acute cardiac disease by classifying cases as sudden cardiac death (SCD) or controls. There was no significant difference in serum concentrations of the selected biomarkers between SCD cases and controls, whereas a significant loss of several markers was observed in SCD myocardial samples as compared to controls. Hence, our results suggest that analysis of tissue homogenates is likely better for detecting early ischemia, and we show that an in-house benchtop multi-analyzer can provide rapid results to assist the pathologist’s decision-making during autopsy.

Nano-functionalization of textiles has been developed for various applications that should be adapted to reduce the utilization of chemicals, energy, processing steps and time of the finishing in view of the ecological and economical restrictions. In the current study, for the first time, we introduce an eco-friendly, feasible and facile approach for producing synthetic or natural fabrics with multi-functional properties via green assembling of copper-based nanoparticles in one single step without the use of further chemicals or external physical apparatuses. Copper acetate was only used as a metal salt with textile substrate as a template at boil without using other chemicals. X-ray diffraction analysis, energy-dispersive X-ray spectroscopy, mapping, field-emission scanning electron microscope images, Fourier transform infrared spectra and UV–Vis spectrum were proved the formation of copper or copper oxide nanoparticles on the textile substrates. The treated fabrics indicated very good properties regarding antibacterial, self-cleaning, photocatalytic, UV protection and coloring effect with enhanced mechanical properties. Finally, this novel method can be applied as a cleaner, economic and large-scale strategy for nano-functionalization of textiles and polymers based on copper/copper oxide nanoparticles in the related industries.Graphical abstract