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IntroductionBreast conserving surgery of impalpable breast lesions requires safe and effective localisation techniques. Wire localisation has traditionally been used, but has limitations. Newer techniques are now being introduced to mitigate this. The iBRA-NET group aims to robustly evaluate these new techniques in well-designed prospective studies. We report the first phase of this evaluation, a survey to establish current practice and service provision of breast localisation techniques in the UK.MethodsA national practice questionnaire was designed using ‘SurveyMonkey®’ and was circulated to UK breast surgeons via the Association of Breast Surgery and the Mammary Fold. The questionnaire was live from 6th October 2018 to 6th April 2019. Only one response per unit was requested to reflect the unit’s practice.ResultsComplete responses were received from 98 breast units across the UK. Wires were the mostly commonly used localisation technique (n = 82) with fewer units using Magseed® (n = 9), Radioguided Occult Lesion Localisation (n = 5) and Radioiodine Seed Localisation (n = 2). There was significant variation in practice and logistics involved. Frequent delays and theatre overruns were reported in 39 and 16 units, respectively. The median satisfaction score of the current technique was 7 out of 10. The main perceived limitation of existing localisation methods was logistics affecting theatre scheduling and the main barrier to introducing a new technique was cost.ConclusionWires are currently the most commonly used localisation technique but are associated with significant logistical issues. Newer techniques may offer a better solution but will need robust evaluation before they are adopted to ensure safety and efficacy.

The 2013 Breast Cancer Campaign gap analysis established breast cancer research priorities without a specific focus on surgical research or the role of surgeons on breast cancer research. This Review aims to identify opportunities and priorities for research in breast surgery to complement the 2013 gap analysis. To identify these goals, research-active breast surgeons met and identified areas for breast surgery research that mapped to the patient pathway. Areas included diagnosis, neoadjuvant treatment, surgery, adjuvant therapy, and attention to special groups (eg, those receiving risk-reducing surgery). Section leads were identified based on research interests, with invited input from experts in specific areas, supported by consultation with members of the Association of Breast Surgery and Independent Cancer Patients' Voice groups. The document was iteratively modified until participants were satisfied that key priorities for surgical research were clear. Key research gaps included issues surrounding overdiagnosis and treatment; optimising treatment options and their selection for neoadjuvant therapies and subsequent surgery; reducing rates of re-operations for breast-conserving surgery; generating evidence for clinical effectiveness and cost-effectiveness of breast reconstruction, and mechanisms for assessing novel interventions; establishing optimal axillary management, especially post-neoadjuvant treatment; and defining and standardising indications for risk-reducing surgery. We propose strategies for resolving these knowledge gaps. Surgeons are ideally placed for a central role in breast cancer research and should foster a culture of engagement and participation in research to benefit patients and health-care systems. Development of infrastructure and surgical research capacity, together with appropriate allocation of research funding, is needed to successfully address the key clinical and translational research gaps that are highlighted in this Review within the next two decades.

Background Angiotensin II type 1 receptors (AT1Rs) are expressed on podocytes, endothelial and other cells, and play an essential role in the maintenance of podocyte function and vascular homeostasis. The presence of AT1R antibodies (AT1R-Abs) leads to activation of these receptors resulting in podocyte injury and endothelial cell dysfunction. We assessed the correlation between AT1R-Abs and the risk of post-transplant FSGS. Methods This is a retrospective study, which included all kidney transplant recipients with positive AT1R-Abs (≥ 9 units/ml), who were transplanted and followed at our center between 2006 and 2016. We assessed the development of biopsy proven FSGS and proteinuria by urine protein to creatinine ratio of ≥1 g/g and reviewed short and long term outcomes. Results We identified 100 patients with positive AT1R-Abs at the time of kidney transplant biopsy or proteinuria. 49% recipients (FSGS group) had biopsy-proven FSGS and/or proteinuria and 51% did not (non-FSGS group). Pre-transplant hypertension was present in 89% of the FSGS group compared to 72% in the non-FSGS group, p  = 0.027. Of the FSGS group, 43% were on angiotensin converting enzyme inhibitors or angiotensin receptor blockers prior to transplantation, compared to 25.5% in the non-FSGS group, p  = 0.06. Primary idiopathic FSGS was the cause of ESRD in 20% of the FSGS group, compared to 6% in the non-FSGS group, p  = 0.03. The allograft loss was significantly higher in the FSGS group 63% compared to 39% in non-FSGS. Odds ratio and 95% confidence interval were 2.66 (1.18–5.99), p  = 0.017. Conclusions Our data suggest a potential association between AT1R-Abs and post-transplant FSGS leading to worse allograft outcome. Therefore, AT1R-Abs may be considered biomarkers for post-transplant FSGS.

Farmers are using municipal wastewater either treated or untreated for irrigation because of limited fresh water resources. Wastewater extensively used for irrigation purposes is enriched with many nutrients. The reuse of wastewater is imposing a negative impact on human health and the ecosystem. It is a need of the day to identify and assess issues of the reuse of wastewater. In the current experiment, impact of organic/inorganic amendments was studied to mitigate the toxic effects of pollutants present in wastewater. Soil was brought from the site having consistent use of wastewater and different treatments were applied as per plan. The experiment has 28 treatments with 04 replications. Nine different amendments were used at 3 varying levels. Incubation time of 30 days was given after the addition of all treatments. The results of the study showed the application of FYM @ 5.0% w/w soil reduced soil pH (7.44), EC (2.16 dS m −1 ), SAR (8.14), lead (8.48 mg kg −1 ), cadmium (1.14 mg kg −1 ), nickel (10.55 mg kg −1 ) and arsenic (2.03 mg kg −1 ) when compared with control and other treatments. Usage of compost and horse waste followed FYM. On the basis of this study, it is recommended that wastewater can be used for irrigation purpose after treating with FYM preferably and compost in general.

This study delves into the drug release behavior of hydrogels influenced by pH, unveiling a non-Fickian diffusion mechanism and affirming their viability as potent drug carriers through swelling kinetics and FTIR analysis. The primary aim is to explore Psyllium, PEG, Agarose, and Collagen-based hydrogels as a viable alternative for in-vitro or in-vivo insulin delivery, with the objective of mitigating the associated risks of pain and infection linked to traditional delivery methods. Innovative hydrogels were devised by combining natural substances (Psyllium, PEG, Collagen, and agarose) in a systematic manner tailored for insulin delivery. The synthesis involved blending 0.5 g of psyllium thoroughly with 100ml of distilled water, followed by the integration of PEG, agarose, and collagen into the swelling mixture. The resulting hydrogels were formed after overnight incubation at 37°C. FTIR analysis revealed distinctive bonding patterns, elucidating their physical attributes. Collagen isolation from chicken heart samples was validated through SDS-Page and FTIR analysis, and quantified using the Bradford test. The hydrogels exhibited peak swelling and drug release under alkaline pH conditions, indicating potential for intestinal insulin delivery while resisting stomach acidity. Unconventional swelling kinetics suggested an alternative diffusion pattern, facilitating targeted insulin delivery. Furthermore, these hydrogels showcased antimicrobial properties, evident from observed inhibition zones. In vivo insulin release studies in mice demonstrated a successful reduction in glucose levels, affirming insulin delivery, as measured by glucometer readings. The culmination of various analyses underscores the considerable potential of psyllium, PEG, and collagen-centric hydrogels for in-vitro or in-vivo insulin delivery, offering a promising avenue for supporting diabetic patients.

Staphylococcus aureus is a major source of bacteremia and develops several complications, causing high morbidity and mortality. Rapid identification and detection of these bacteria have become an important issue for biomedical applications. Herein, an optical method based on a modified fluorescence in situ hybridization (FISH) approach has been established using DNA hybridization technology for the swift detection of pathogenic S. aureus from clinical samples. The platform was constructed with single-stranded genomic DNA and microbial colony by directly immobilizing in agarose-polyvinyl alcohol (AG-PVA) hydrogel on the surface of a glass slide. The probe was based on an elongation factor encoding the tuf gene, which binds with equal affinity to single-stranded DNA targets as well as surface proteins on microbial cells. The probe was labeled with MFP488 fluorophore having excitation wavelength 501 nm. The hybridization of the labeled probe with the target DNA and surface proteins was carried out under optimal FISH conditions, and the detection of bacteria was based on temporary field excitation of the labeled probe under a fluorescence microscope. Positive hybridization signals were detected by high fluorescence intensity. In comparison to genomic DNA, robust signals were observed with microbial cells, perhaps due to the moonlighting effect of the elongation factor Tu (Ef-Tu) expressed on the surface of bacterial cells. The applicability of the developed platform was tested on pediatric nasal samples, and results were verified with real-time qPCR. The designed platform is stable and sensitive, and after detailed optimization, a portable structure for on-site detection of pathogenic bacteria from clinical samples can be produced.

The opportunities raised from a comprehensive and fully integrated digital healthcare system in terms of research, efficiencies in clinical activity and (to be truly forward thinking) incorporation of Al technologies, amongst others, highlight it as an investment worth making and it will be interesting to see the path taken by healthcare providers. * Assessment of obesity DOI: 10.7861 /clinmed.Let.23.5.2 Editor - In their article1 the authors do not address one of the two fundamental flaws in BMI, that it is proportional to height, the other being it takes no account of composition and little of distribution. 2 Cazzaniga S, Corzo V, Dahlgren S. Digital solutions reduce waste in the health care system. Association between ADHD and obesity: a systematic review and meta-analysis.

Growth hormone is the major gene playing regulatory role in growth and metabolism of vertebrates. Several reports have identified mutations in Gh gene that are associated with animal productivity. The bovine Gh has been studied quite thoroughly but very little information regarding Buffalo growth hormone is available in literature. Buffalo is an important source of milk in Asia and there is a need to identify variations in the genes of buffalo Gh and its possible effects in milk production. The present research was carried out to explore DNA polymorphism in buffalo growth hormone gene. In this study we amplified a 5' flanking region covering exon 1 from local specie of Bubalus bubalis. As the 5' region of the Gh is very important in controlling the expression of the gene and minor changes in this sequence can affect its expression in blood. The PCR amplicon was sequenced and analyzed for homology with the help of BLAST search. Surprisingly, along with various point mutations in this region, we found that a considerable base sequence upstream exon 1 was similar to Bos mutus (yakQh1 chromosome 19) and did not align with reported Bubalus bubalis Gh sequence. Only 49% of the sequenced product aligns with Bubalus Bubalis though 90% of the sequence aligns with Bos mutus and Bos indicus Gh gene. A 46 bp inverted repeat sequence was also identified upstream exon 1. This report not only raises questions about the purity of the gene but also indicates mutations which may affect animal productivity like milk yield, growth regulation and carcass composition. There is a need to report these mutations so that their effects can be studied further. The complete animal history, means of semen supply or the methods used for its introduction can give clues about these findings. Keywords: Bubalus bubalis, Bos mutus, Bos indicus, Growth hormone, Mutation