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Recurrence of hiatus hernia reduced QoL. Surgery resulted in resolution of symptoms other than dysphagia which was incompletely improved. Patients’ overall satisfaction with surgery was high.

Composite repair of giant PEH is safe with overall good outcomes. Majority of hernia recurrence are small and asymptomatic. Hernia recurrence negatively affected long-term QoL scores.

Composite repair of giant PEH is safe with overall good outcomes. Majority of hernia recurrence are small and asymptomatic. Hernia recurrence negatively affected long-term QoL scores.Metallic nanostructures have numerous applications as industrial catalysts and sensing platforms. Supercritical carbon dioxide (scCO2 ) is a green medium for the scalable preparation of nanomaterials. Supercritical fluid reactive deposition (SFRD) and other allied techniques can be employed for the mass production of metal nanostructures for various applications. The present article reviews the recent reports on the scCO2 -assisted preparation of zero-valent metal nanomaterials and their applications. A brief description of the science of pure supercritical fluids, especially CO2 , and the basics of binary mixtures composed of scCO2 and a low volatile substance, e.g., an organometallic precursor are presented. The benefits of using scCO2 for preparing metal nanomaterials, especially as a green solvent, are also being highlighted. The experimental conditions that are useful for the tuning of particle properties are reviewed thoroughly. The range of modifications to the classical SFRD methods and the variety of metallic nanomaterials that can be synthesized are reviewed and presented. Finally, the broad ranges of applications that are reported for the metallic nanomaterials that are synthesized using scCO2 are reviewed. A brief summary along with perspectives about future research directions is also presented.A retrospective, single-center, observational study evaluated the difference in time to clearance of high-dose methotrexate between the fluorescence polarization immunoassay (FPIA) and ARK methotrexate assay in pediatric hematology/oncology patients. The post-ARK immunoassay group had an increase in clearance time of 33 h/cycle and 31% increase in cycles with delayed clearance. On posthoc analysis, use of an adjusted clearance threshold of less then 0.15 µmol/L post-ARK immunoassay, as opposed to the traditional less then 0.1 µmol/L threshold, would have similar incidence of delayed clearance. The ARK immunoassay demonstrated a positive bias compared to the FPIA in clinical practice, which led to an institutional policy change.Practical biodiversity conservation relies on delineation of biologically meaningful units. Manta and devil rays (Mobulidae) are threatened worldwide, yet morphological similarities and a succession of recent taxonomic changes impede the development of an effective conservation strategy. Here, we generate genome-wide single nucleotide polymorphism (SNP) data from a geographically and taxonomically representative set of manta and devil ray samples to reconstruct phylogenetic relationships and evaluate species boundaries under the general lineage concept. We show that nominal species units supported by alternative data sources constitute independently evolving lineages, and find robust evidence for a putative new species of manta ray in the Gulf of Mexico. Additionally, we uncover substantial incomplete lineage sorting indicating that rapid speciation together with standing variation in ancestral populations has driven phylogenetic uncertainty within Mobulidae. Finally, we detect cryptic diversity in geographically distinct populations, demonstrating that management below the species level may be warranted in certain species. Overall, our study provides a framework for molecular genetic species delimitation that is relevant to wide-ranging taxa of conservation concern, and highlights the potential for genomic data to support effective management, conservation and law enforcement strategies.Overexpression of the ubiquitous protein kinase, CK2α, has been reported in various human cancers. Pitavastatin chemical structure Here, we demonstrate that nuclear and nucleolar CK2α localization in invasive ductal carcinomas of the breast is a reliable predictor of poor prognosis. Cellular localization of CK2α in nuclei and nucleoli was analyzed immunohistochemically using surgical tissue blocks from 112 patients, who had undergone surgery without neoadjuvant chemotherapy. Clinical data collection and median follow-up period were for more than 5 y. In total, 93.8% of patients demonstrated elevated CK2α expression in nuclei and 36.6% of them displayed elevated expression predominantly in nucleoli. Clinicopathological malignancy was strongly correlated with elevated nuclear and nucleolar CK2α expression. Recurrence-free survival was significantly worse (P = .0002) in patients with positive nucleolar CK2α staining. The 5-y survival rate decreased to a roughly 50% in nucleolar CK2α-positive patients of triple-negative (P = .0069) and p Stage 3 (P = .0073) groups. In contrast, no patients relapsed or died in the triple-negative group who exhibited a lack of nucleolar CK2α staining. Evaluation of nucleolar CK2α staining showed a high secondary index with a hazard ratio of 6.629 (P = .001), following lymph node metastasis with a hazard ratio of 14.30 (P = .0008). Multivariate analysis demonstrated that nucleolar CK2α is an independent factor for recurrence-free survival. Therefore, we propose that histochemical evaluation of nucleolar CK2α-positive staining may be a new and robust prognostic indicator for patients who need further treatment. Functional consequences of nucleolar CK2 dysfunction may be a starting point to facilitate development of novel treatments for invasive breast carcinoma.The goals of learning health systems (LHS) and of AI in medicine overlap in many respects. Both require significant improvements in data sharing and IT infrastructure, aim to provide more personalized care for patients, and strive to break down traditional barriers between research and care. However, the defining features of LHS and AI diverge when it comes to the people involved in medicine, both patients and providers. LHS aim to enhance physician-patient relationships while developments in AI emphasize a physicianless experience. LHS also encourage better coordination of specialists across the health system, but AI aims to replace many specialists with technology and algorithms. This paper argues that these points of conflict may require a reconsideration of the role of humans in medical decision making. Although it is currently unclear to what extent machines will replace humans in healthcare, the parallel development of LHS and AI raises important questions about the exact role for humans within AI-enabled healthcare.