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In this study, the nanocomposite of eggshell membrane is synthesized with ZnO by the chemical bath deposition (CBD) method, and eggshell membrane, which is used as a template, and decomposed. The end product obtained is nanoflowers of zinc oxide (ZnFs). The petals of nanoflowers obtained are of hexagonal cross-section similar to the unit cell structure of zinc oxide. The CBD parameters of temperature, reaction time, and solution pH were varied extensively during this study to obtain optimized parameters for the growth of ZnFs. The obtained nanoflower structure was analyzed using various characterization techniques of Scanning Electron Microscopy (SEM), Energy Dispersive X-Ray Spectroscopy (EDX), X-Ray Diffraction (XRD), and Fourier Transform Infrared Spectroscopy (FTIR).

Perovskite-structured Bismuth ferrite (BiFeO 3 ) nanoparticles as a novel heterogeneous catalyst were designed by an auto combustion route using a different chelating agent and calcination temperature. The effect of different chelating agents like disaccharide (sucrose), α-hydroxy acid (citric acid, tartaric acid), amide (urea) and calcination (150–750 °C) temperature on structure and the catalytic performance of BiFeO 3 have been analyzed. The catalytic performance of BiFeO 3 has been increased by modifying its synthesis with the addition of suitable organic compound and calcination. BiFeO 3 synthesized without the use of chelating agent gave very poor yield, i.e., 36.89%. The augmented effect of the chelating agent on the catalytic performance of BiFeO 3 was obtained in the order of blank < tartaric acid < sucrose < urea < citric acid, whereas the enhancing effect of calcination temperature in the order 150 °C < 450 °C < 550 °C < 650 °C > 750 °C. The calcination temperature results in augmentation in yield of approximately 30% with model reaction on increasing temperature from 150 to 650 °C. Different calcination temperatures (150–750 °C) have been employed to obtain single phase BiFeO 3 nanoparticles. All synthesized BiFeO 3 nanoparticles were fully characterized by FT-IR; XRD; VSM; BET; TGA; XPS and Raman spectroscopy. For the very first time ever we have used them as a recyclable magnetic nanocatalyst in the formation of highly substituted dihydro-2-oxypyrrole by using one-pot, three-component reaction of DMAD, aniline and formaldehyde in methanol at room temperature with 63–88% yield. All the synthesized oxypyrroles have been characterized by various spectroscopic techniques.

Background/aimsTo examine the incidence, causative microorganisms and in vitro antimicrobial susceptibility and resistance profiles of infectious keratitis (IK) in Nottingham, UK.MethodsA retrospective study of all patients who were diagnosed with IK and underwent corneal scraping between July 2007 and October 2019 (a 12-year period) at a UK tertiary referral centre. Relevant data, including demographic factors, microbiological profiles and in vitro antibiotic susceptibility of IK, were analysed.ResultsThe estimated incidence of IK was 34.7 per 100 000 people/year. Of the 1333 corneal scrapes, 502 (37.7%) were culture-positive and 572 causative microorganisms were identified. Sixty (4.5%) cases were of polymicrobial origin (caused by ≥2 different microorganisms). Gram-positive bacteria (308, 53.8%) were most commonly isolated, followed by Gram-negative bacteria (223, 39.0%), acanthamoeba (24, 4.2%) and fungi (17, 3.0%). Pseudomonas aeruginosa (135, 23.6%) was the single most common organism isolated. There was a significant increase in Moraxella spp (p<0.001) and significant decrease in Klebsiella spp (p=0.004) over time. The in vitro susceptibilities of Gram-positive and Gram-negative bacteria to cephalosporin, fluoroquinolone and aminoglycoside were 100.0% and 81.3%, 91.9% and 98.1%, and 95.2% and 98.3%, respectively. An increase in resistance against penicillin was observed in Gram-positive (from 3.5% to 12.7%; p=0.005) and Gram-negative bacteria (from 52.6% to 65.4%; p=0.22).ConclusionIK represents a relatively common and persistent burden in the UK and the reported incidence is likely underestimated. Current broad-spectrum antimicrobial treatment provides a good coverage for IK, although challenged by some level of antimicrobial resistance and polymicrobial infection.

We performed meta-analysis to estimate pooled prevalence, risk factors, and outcomes of interval colorectal cancers (CRCs). Systematic literature search through October 2013, identified population-based studies, reporting prevalence of interval CRCs (CRCs diagnosed within 6-36 months of colonoscopy). We estimated the pooled prevalence, patient, endoscopist, and tumor-related risk factors, as well as outcomes of interval CRCs, as compared with detected CRCs (CRCs diagnosed at or within 6 months of colonoscopy). Twelve studies reporting on 7,912 interval CRCs were included. Pooled prevalence of interval CRCs was 3.7% (95% confidence interval (CI)=2.8-4.9%). These cancers were 2.4 times more likely to arise in the proximal colon (6.5%; 95% CI=4.9-8.6%) as compared with distal colon (2.9%; 95% CI=2.0-4.2%). Patients with interval CRCs were older (age >65-70 years vs. <65-70 years: odds ratio (OR)=1.15; 95% CI=1.02-1.30), have more comorbidities (high Charlson comorbidity index: OR=2.00; 95% CI=1.77-2.27), and have diverticular disease (OR=4.25; 95% CI=2.58-7.00). There was a nonsignificant time trend of declining prevalence of interval CRCs from 4.8% in 1990s to 4.2% between 2000 and 2005 and 3.7% beyond 2005. Patients with interval CRCs were less likely to present at an advanced stage (OR=0.79; 95% CI=0.67-0.94), although there was no survival benefit. Considerable heterogeneity was observed in most of the analyses. Based on meta-analysis, approximately 1 in 27 CRCs are interval CRCs, although the confidence in these estimates is low because of the heterogeneity among the studies. These are more likely to arise in the proximal colon and are diagnosed in older patients, patients with comorbidities or diverticular disease.

Venous thromboembolism (VTE) is known to be increased in inflammatory bowel disease (IBD). We aimed to determine whether rates of VTE in IBD have reduced over the past 30 years. We used the population-based University of Manitoba IBD Epidemiology Database (1984-2018) to determine the incidence of VTE in IBD and the incidence rate ratio vs matched controls. In persons with IBD with and without VTE, we assessed for variables that were associated with an increased risk of VTE on multivariate logistic regression. The incidence of VTE in the IBD cohort was 7.6% which was significantly greater than in controls (3.3%, P < 0.0001). The overall age-standardized incidence rate of VTE was 433 per 100,000 in IBD and 184 per 100,000 in controls. The incidence of VTE was higher in Crohn's disease (8.4%) than in ulcerative colitis (6.9%, P = 0.0028). The incidence rate ratio in IBD vs controls was 2.36 (95% confidence interval 2.16-2.58). The increased risk was similar in males and females and in Crohn's disease compared with ulcerative colitis. The incidence rate among persons with IBD from 1985 to 2018 decreased very slowly, with annual percent change of -0.7% (P = 0.0003). Hospital admission, high comorbidity, use of antibodies to tumor necrosis factor for less than 3 years up until the time of the VTE, and the combination of steroid and antibodies to tumor necrosis factor increased the risk of VTE. Despite advancements in IBD management in the past 30 years, the rates of VTE have only been slowly decreasing and remain significantly increased compared with controls.

PurposeTo report the real-world experience of using topical ciclosporin, Ikervis, in the management of ocular surface inflammatory diseases (OSIDs).MethodsThis was a retrospective study of patients treated with Ikervis for OSIDs at the Queen’s Medical Centre, Nottingham, between 2016 and 2019. Relevant data, including demographics, indications, clinical parameters, outcomes and adverse events, were collected and analysed for patients who had completed at least 6 months follow-up. For analytic purpose, clinical outcome was categorised as ‘successful’ (resolved or stable disease), ‘active disease’ and ‘drug intolerance’.Results463 patients were included; mean age was 51.1±21.6 years, with a 59.0% female predominance. Mean follow-up was 14.6±9.2 months. The most common diagnosis was dry eye disease (DED; 322, 69.5%), followed by allergic eye disease (AED; 53, 11.4%) and ocular mucous membrane pemphigoid/Steven-Johnson syndrome (OMMP/SJS; 38, 8.2%). Successful treatment was achieved in 343 (74.1%) patients, with 44 (9.5%) requiring additional treatment and 76 (16.4%) reporting drug intolerance. The efficacy of Ikervis was highest in DED (264, 82.0%), followed by OMMP/SJS (25, 65.8%) and post-keratoplasty (7, 50.0%; p<0.001). Logistic regression analysis demonstrated age <70 years (p=0.007), AED (p=0.002) and OMMP/SJS (p=0.001) as significant predictive factors for Ikervis intolerance. AED and post-keratoplasty were 8.16 times (95% CI, 2.78 to 23.99) and 13.98 times (95% CI, 4.22 to 46.28), respectively, more likely to require additional treatment compared with DED.ConclusionsIkervis is a useful steroid-sparing topical treatment for managing OSIDs in the real-world setting. Preparations with improved tolerability are needed to benefit a larger number of patients.

Previous studies have reported colectomy rates of over 50% in ulcerative colitis (UC), although changes in management may have influenced the rates of colectomy in the modern era. We sought to determine the incidence of colectomy in UC and identify risk factors associated with early colectomy (EC) and late colectomy (LC). We used the University of Manitoba Inflammatory Bowel Disease Epidemiology Database, a population-based data set including UC patients with up to 25 years of post diagnosis follow-up. We tracked the occurrence of total colectomy in all patients with known UC, subdivided into EC (≤90 days from diagnosis date) and LC (>90 days from diagnosis). Survival curves were created and stratified by age, sex, era of diagnosis, and inpatient/hospital diagnosis. Cox proportional hazards modeling was used to determine which risk factors were predictive of either EC or LC. Among 3,752 patients with UC, 367 underwent colectomy. The 5-, 10- and 20-year actuarial risk of requiring colectomy was 7.5%, 10.4%, and 14.8%, respectively. Male sex (hazard ratio (HR): 2.63, [corrected] 95% confidence interval (CI): 1.58-4.36) and being initially diagnosed during a hospitalization (HR: 12.46, 95% CI: 7.40-21.0) were predictive of EC after adjustment for confounders. In-hospital diagnosis was predictive of LC, whereas being diagnosed more recently was protective against LC (HR: 0.96, 95% CI: 0.93-0.98). The cumulative incidence of colectomy in UC is lower than previously reported, and appears to be decreasing further among more recently diagnosed cohorts of patients. Male sex and hospitalization at the time of diagnosis are major risk factors for EC and LC.

Background We compared risks of nonmelanoma skin cancers (NMSCs) and melanoma preceding and following a diagnosis of inflammatory bowel disease (IBD) and to evaluate the effect of thiopurines and anti-tumor necrosis factor α (anti-TNF-α) on skin cancer risk in IBD. Methods This was a retrospective, historical cohort study using the population-based University of Manitoba IBD Epidemiology Database (11 228 IBD cases and 104 725 matched controls) linked to the Manitoba Cancer Registry. Logistic and Cox regression analyses were performed to calculate skin cancer risks prior to and after IBD diagnosis. Results Persons with ulcerative colitis (UC) were more likely to have basal cell carcinoma (BCC) predating their UC diagnosis (odds ratio, 1.32; 95% confidence interval [CI], 1.08-1.60). Risks of squamous cell carcinoma (SCC), other NMSCs, or melanoma prior to IBD diagnosis were not significantly increased. Post-IBD diagnosis, risks of BCC (hazard ratio, 1.53; 95% CI, 1.37-1.70) and SCC (hazard ratio, 1.61; 95% CI, 1.29-2.01) were significantly increased across all IBD groups except for SCC in UC. There was no significant association between melanoma and IBD post–IBD diagnosis. The risks of BCC and melanoma were increased in thiopurine and anti-TNF users, and risk of SCC was increased in only thiopurine users. Nested cohort analysis of persons with IBD with censoring at both thiopurines and anti-TNF use confirmed a higher baseline risk of BCC and no effect on SCC, comparable to pre-IBD diagnosis findings. Conclusions The risk of BCC preceding a diagnosis of UC is higher than in non-UC controls, compared with a generally increased risk of all NMSCs post–IBD diagnosis. Thiopurine and anti-TNF therapy increase the risks for skin cancers in persons with IBD after their diagnoses. Lay Summary The risk of basal cell carcinoma preceding a diagnosis of ulcerative colitis is higher than in non–inflammatory bowel disease (IBD) controls, compared with a generally increased risk of all nonmelanoma skin cancers post–IBD diagnosis. There was no significant association between melanoma and IBD post–IBD diagnosis. Anti-tumor necrosis factor therapy increase the risks for melanoma and both anti-tumor necrosis factor and thiopurine therapies increase the risk for nonmelanoma skin cancers in persons with IBD after their diagnoses.

We examine the impact of hedge fund activism (HFA) on the investment efficiency of target firms. We find that target firms’ investment efficiency improves after the active involvement of hedge funds. This improvement is mainly evident for HFA campaigns with investment strategy-related reforms as one of the main stated objectives. Among investment strategy-related HFA campaigns, the changes in investment efficiency are more pronounced when hedge funds obtain board representation or privately settle with target firms. HFA improves the investment efficiency of target firms by mitigating overinvestment rather than underinvestment problems. Additional tests reveal that target firms with no resistance to HFA and higher free cash flow accommodate this improvement in investment efficiency following HFA. Overall, our findings highlight the role of HFA as a governance mechanism in improving investment efficiency and influencing managers to reduce overinvestment.

We investigated the spatial disparities and factors associated with gastric cancer (GC) Incidence in Manitoba. We combined information from Manitoba Cancer registry and Census data to obtain an age-sex adjusted relative risk (IRR) of GC incidence. We geocoded the IRR to the 96 regional health authority districts (RHADs) using the postal code conversion file (PCCF). Bayesian spatial and spatio-temporal Poisson regression models were used for the analysis. Adjusting for the effect of socio-economic score index (SESI), Indigenous, and immigrant population, 25 districts with high overall GC risk were identified. One unit increase in SESI was associated with reduced risk of cardia GC (CGC) by 14% (IRR = 0.859; 95% CI: 0.780-0.947) and the risk of non-cardia GC (NCGC) by approximately 10% (IRR = 0.898; 95% CI: 0.812-0.995); 1% increase in regional Indigenous population proportion reduced the risk of CGC by 1.4% (IRR = 0.986; 95% CI: 0.978-0.994). In the analysis stratified by sex, one unit increase in SESI reduced the risk of CGC among women by 26.2% (IRR = 0.738; 95% CI: 0.618-0.879), and a 1% increase in Indigenous population proportion reduced the risk of CGC among women by 1.9% (IRR = 0.981; 95% CI: 0.966-0.996). Our results support a significant association between SESI and NCGC. We report regional variation of GC IRR and a varying temporal pattern across the RHADs. These results could be used to prioritize interventions for regions with high and progressive risk of GC.