Panicum miliaceum L.), their expression under NaCl  and Na2SeO3 (sodium selenite)treatments. This study identified eight transporters  that have a potential role in Se uptake in proso millet. We analyzed physicochemical properties, conserved structures, sub-cellular locations, chromosome location, molecular phylogenetic analysis, promoter regions prediction, protein-protein interactions, three-dimensional structure modeling and evaluation of these transporters. The analysis revealed the chromosome location and the number of amino acids present in these transporters as RLM65282.1 (16/646); RLN42222.1 (1/543); RLN18407.1 (2/483); RLM74477.1 (15/474); RLN41904.1 (1/521); RLN17428.1 (2/522); RLN17268.1(2/537);RLM65753.1 (16/539). The sub-cellular locations revealed that all the selenite transporters are located in plasma membrane whereas among selenate transporters RLM65282.1 and RLM74477.1 are located in mitochondria and RLN42222.1 and RLN18407.1 in chloroplast. The transcriptomic studies revealed that NaCl stress decreased the expression of both selenate and selenite transporters in proso millet and the applications of exogenous 1µM Se (Na2SeO3) increased the expression of these Se transporter genes. It was also revealed that selenate shows similar behavior as sulfate, while selenite transport resembles phosphate. Thus, it can be concluded that phosphate and sulphate transporters in millets are responsible for Se uptake.Crops are susceptible to a variety of stresses and amongst them salinity of soil is a global agronomic challenge that has a detrimental influence on crop yields, thus posing a severe danger to our food security. Therefore, it becomes imperative to examine how plants respond to salt stress, develop a tolerance that allows them to live through higher salt concentrations and choose species that can endure salt stress. From the perspective of food, security millets can be substituted to avoid hardships because of their efficiency in dealing with salt stress. Besides, this problem can also be tackled by using beneficial exogenous elements. Selenium (Se) which exists as selenate or selenite is one such cardinal element that has been reported to alleviate salt stress. The present study aimed for identification of selenate and selenite transporters in proso millet ( Panicum miliaceum L.) has been valued as a healthy food for centuries. About ten thousand years ago, it originated in Northern China as a prime domesticated plant of the Poaceae family   application.Most plant species utilize only a little amount of Se from soil and they differ in their ability to accumulate Se in their tissues . Se absoosum L.) . We specosum L.)  and thusosum L.) . In Arabmilation . In ricemilation . Similarmilation . The mecArabidopsis thaliana L. Q9LIK9 (APS1_ARATH) and selenite transporter sequence of Oryza sativa L. Q8GSD9  were retrieved from UniProtKB database (https://www.uniprot.org/). In Arabidopsis thaliana Q9LIK9, a sulfur transporter controls the reduction of selenate and assists selenate and sulfur absorption and assimilation (Panicum miliaceum L. (Proso millet) database. The NCBI protein blast tool (https://blast.ncbi.nlm.nih.gov/Blast.cgi) was employed to search for homologous genes in Proso millet.For this study, the experimentally reviewed selenate transporter amino acid sequence of milation . Q8GSD9,milation . These phttps://web.expasy.org/protparam). The trans-membrane domains were identified by the TMHMM server v2 (http://pfam.xfam.org).The physicochemical properties of resultant transporters were calculated with the help of ProtParam   .The molecular phylogenetic analysis of selenite and selenate transporter proteins was performed using MEGAX v 11 . The evohttps://blast.ncbi.nlm.nih.gov/Blast.cgi). These respective sequences were searched with similar proteins in their genome . Among the results 32 amino acid sequences for selenate and 52 for selenite were used with selected Se (both selenate and selenite) transporters in proso millet to construct a tree. Clustal W was used for aligning the sequences. Gap opening penalty of 10 and gap extension penalty of 0.1 in pair wise alignment and opening penalty of 10 and extension penalty of 0.2 in multiple alignments was kept with delay divergent cut-off as 30%. Tajima’s relative rate test with complete deletion method was carried to check P-values . These nucleotides were used to predict location of Pol II promoter in regions .The gene sequences of RLM65282.1, RLN42222.1, RLN18407.1, RLM74477.1, RLN41904.1, RLN17428.1, RLN17268.1, RLM65753.1 were screened for promoter regions. The gene sequences were converted into nucleotide sequences by Sequence manipulation suite reverse translate ( regions  (https:/The protein-protein interactions (PPI) of the selected transporter proteins were compared and examined by STRING V 11.5 and the multiple sequence searches of these transporter proteins were performed with proso millet.https://swissmodel.expasy.org). For the target sequence of interest, a Swiss repository was searched (https://swissmodel.expasy.org/repository). The target sequence and sequences with known structures comparable to the query sequence were aligned using homology modeling. A structural model of the target is created from the sequence alignment and template structure. Based on the obtained BLAST results, the sequence with the highest sequence identity score was chosen. To evaluate Swiss models, the in-build structure assessment tool was employed (https://swissmodel.expasy.org/assess).The three-dimensional structures of the transporter proteins from proso millet were determined using Swiss modeling software  solution (w/v), followed by washing in sterilized distilled water. The seeds were sown in pots that measured 20 cm in diameter that contained autoclaved sand. A controlled environment with a 26 ± 1°C temperature and a 16-h photoperiod was maintained (2SeO3) were applied to the pots (The seeds were sterilized in 70% (v/v) ethanol for 1 minute before being rinsed with sterile distilled water. Seeds were surface sterilized for 3 minutes in 0.1 percent HgClintained . Three sthe pots . A HoaglThe samples were prepared using liquid nitrogen and the trizol reagent (Invitrogen) was used to isolate total RNA from plant material . GenomicXLSTAT 2021 and graph pad prism v6 was used for data analysis.Panicum miliacieum L. produced significant alignments. Four sequences produced alignments for selenate transporters in Arabidopsis thaliana L. and four for selenite transporters in Oryza sativa L From the NCBI results, a total of 8 sequences from The conserved structures of the screened selenite and selenate transporters are shown in Arabidopsis thaliana were used to construct the tree  which showed an identity of 76.87%, 79.85%, 80.10% and 76.87% with RLM65282.1 (UniProt ID A0A3L6PUA6), RLN42222.1 (UniProt ID A0A3L6TPY9), RLN18407.1 (UniProt ID A0A3L6SBK6) and RLM74477.1 (UniProt ID A0A3L6QB84) respectively. The BLAST results for selenite transporters selected the template to be 7sp5.1 (eukaryotic phosphate transporter) which showed an identity of 34.9%, 34.61%, 40.09% and 34.54% with RLN41904.1 (UniProt ID A0A3L6TSS2), RLN17428.1 (UniProt ID A0A3L6S8X1), RLN17268.1 (UniProt ID A0A3L6S8F9) and RLM65753.1 (UniProt ID A0A3L6PXC9) respectively. The three-dimensional models selected for these transporters are shown in To investigate the expression of selenate and selenite transporters under salt stress only and salt stress followed selenium. It was revealed that the expression of RLM65282.1 was 5.42 folds in control, 4.64 in salt-treated plants and 5.81 folds in plants treated with salt and selenium together. Similarly, the expression of RLN42222.1 and RLN18407.1 was 2.80, 2.76, 2.81 in control, salt and salt with selenium treated plants respectively. Among selenite transporter genes, the expression of inorganic phosphate transporter was 3.24, 2.46 and 3.95 folds in control, salt and salt with selenium treated plants respectively. The expression of putative transporters was found to be 1.7, 1.3 and 1.98 whereas for putative inorganic phosphate transporter it was 2.5, 2.5 and 2.6 respectively. The expression studies reveal that both selenate and selenite transporters are down-regulated with salt and up-regulated upon selenium applications.Oryza sativa L. and Arabidopsis thaliana L. have revealed that phosphate and sulphate transporters play a vital role in Se uptake  which was used as the source of BLAST has an amino acid length of 463 and the selenate transporter amino acids sequences of proso millet have more length than Arabidopsis thaliana L. Similarly the number of amino acid in selenite transporter sequence of Oryza sativa L. (Q8GSD9) is 528, indicating a similar number of amino acids with proso millet selenite transporters. RLM65282.1 has a higher molecular weight of 72171.69 Da among selenate transporters whereas among selenite transporters the highest molecular weight was 59138.29 Da which corresponds to RLM65753.1. The theoretical isoelectric point of selenate and selenite transporters ranged from 7.4 to 8.38 and 8.1 to 8.32 respectively. From these, it is clear that all these transporters are basic in nature . Studies on lettuce plants revealed the role of selenite and selenate in the alleviation of salt stress . Therefore, authors gratefully acknowledge technical and financial support from the Ministry of Education and King Abdulaziz University, Jeddah, Saudi Arabia.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


The incidence of infections in patients with chronic inflammatory rheumatic disease is increased. It is often due to the disease itself and to the immunosuppressive treatments used.To assess the incidence of infections during JIA.We conducted a repeated cross-sectional study including 29 patients followed for JIA according to the International League of Associations for Rheumatology (ILAR) criteria over a period from 1994 to 2022. Sociodemographic and anthropometric parameters, clinical data, biological assessments, and prescribed therapies were collected. We identified patients who had at least one infectious episode during their follow-up.There were 17 women and 12 men. The mean age was 35.69 ± 11.72 [18–61] years. The polyarticular form was seen in 55.2% of cases. The mean age of disease onset was 11.10 ± 4.25 [2–16] years. The average disease duration was 24.48 ± 12.76 [1–47] years.Diabetes and arterial hypertension were the main comorbidities associated with JIA, observed in 13.8% of cases each. At least one extra-articular manifestation was noted in 16 cases: pulmonary (3 cases), cardiac (4 cases), renal (2 cases), cutaneous (4 cases) and ocular (7 cases).n = 23), biotherapy was used in 3 (10.3%), NSAIDs and corticosteroids were used in 62.1% (n = 18) and 69% (n = 20) respectively.The most prescribed DMARDs was Methotrexate in 79.3% (n = 5). Bronchopulmonary infections were observed in 2 cases including a case of tuberculosis. Sub periosteal abscess of the femur was also seen in one of the patients.All the infections observed in our population were of community origin. Urinary tract infection was the most common infection (Regarding the SARS-CoV-2 infection, 6 patients were infected, 2 of whom required hospitalization, including one in the intensive care.The risk of infections is increased during JIA. This is due to the immunosuppression induced by the disease, the treatment, and comorbidities.


Electroconvulsive therapy (ECT) is a current, relevant treatment for severe mental illness. In this article we describe our experience on ECT in a public hospital in Chile.Describe a 34 patients’ cohort who received ECT and their outcomes.Data was extracted from ECT records between 2018-2020, patients’ evaluations before and after ECT, and case files. Data was then analyzed and described.ECT was received by 18 males and 16 females. Age ranged from 19 to 73 years (41 average). More than 75% had 12 or more years of education. Patients’ diagnoses and indications for ECT are shown in Figures 1-2The CGI-SI scale was applied to subjects before treatment, and 85% had a score of 5 or more. On average, patients received 8.7 ECT sessions. Right unilateral electrode placement (RUL) was preferred initially for 94% of patients. Brief pulse width (0.3ms) was most commonly used (76%). Seizure duration averaged in 29 seconds. Adverse reactions presented on 32%, most being mild. One treatment had to be stopped due to confusional symptoms post ECT. After ECT, 91% of patients improved according to CGI-GI scale. 55% were assessed CGI-GI 1 “very much improved”. MoCA scale was also evaluated, showing a 2,1 point gain.Schizophrenia and psychosis were the most frequent diagnosis and indication for ECT. RUL and brief pulse width were the preferred settings. This cohort suggests that ECT had an impact on markedly ill patients, based on CGI and MoCA scales.


The structure of the oxide film needs to be weakened to facilitate ion transfer during electrochemical activity. This study addresses oxide film challenges by studying Al alloy anodes with different iron content. The results reveal that using an anode of 99% Al 1% Fe in a cell increases the cycling lifetime by 48%, compared to a 99.99% Al anode. The improvement observed with the 99% Al 1% Fe anode is attributed to its fractional surface area corrosion being about 12% larger than that of a 99.99% Al anode. This is coupled to precipitation of a higher number of Al3Fe particles, which are evenly scattered in the Al matrix of 99% Al 1% Fe. These Al3Fe particles constitute weak spots in the oxide film for the electrolyte to attack, and access to fresh Al. The addition of iron to an Al anode thus offers a cheap and easy route for targeting the oxide passivating film challenge in Al-ion batteries.Considerable research has been devoted to the development of cathode materials for Al-ion batteries, but challenges remain regarding the behavior of aluminum anodes. Inert oxide (Al Only Li (3860 mAh g−1) has a higher gravimetric capacity. However, the theoretical volume capacity of Al (8040 mAh cm−3) is higher than that of Li (2060 mAh cm−3). These factors suggest Al as an attractive candidate for anode materials  and AlCld enough . In thisc layers ,10. Whilc layers ,11,12. Nc layers . This urc layers ,13. Thisficiency ,16,17,18ficiency ,19,20. Hficiency .3Fe particles in the Al matrix. These phases exist even in Al with a purity marked as 99.99 [3Fe particles induce localized corrosion of the surrounding Al matrix due to galvanic coupling between the micro-particle, and the matrix [3Fe phases in the Al matrix produce points where the passivating oxide layer is potentially weak when in contact with an electrolyte [3Fe phases acted as beneficial sites for the electrolyte to eliminate the oxide barrier on an Al surface, resulting in enhanced electrochemical performance.Iron is a main impurity element that is always found in Al metals. It has very low solubility (0.05 wt%) in Al and is precipitated as intermetallic phases, that is, as Alas 99.99 ,25,26,27e matrix ,25. In octrolyte . A previctrolyte  about an3). The correlation between cell performances and corrosion in Al anodes were explored in detail from a metallurgical perspective of the intermetallic phases. This would give an insight to approach the oxide film barrier of Al in Al-batteries.The purpose of this work is to study the performance of Al alloy anodes with different Fe content in Al-ion batteries, focusing on Al corrosion behavior in Al/graphitic cell using ionic liquid electrolyte of  in an argon-filled glove box. Whatman glass microfiber sheets (grade GF/D) were chosen as the separator. The assembled batteries were held for 4 h before starting the electrochemical tests. Additionally, symmetric cells of 99.99% Al, 99.5% Al 0.5% Fe, and 99% Al 1% Fe, respectively, were assembled using a similar coin-type cell, electrolyte and separator that were mentioned above.Al alloy foils with iron content of 0.01, 0.5, and 1 wt%  were used as the anode electrode. All Al foils were 100 µm thick and were purchased from Goodfellow, Friedberg, Germany. The cathode was a composite of nanographite (NG) and activated carbon with nanocellulouse binder, as described in ,30. The −1. Galvanostatic charge–discharge (GCD) measurements were conducted in a voltage range of 0.4 V to 2.2 V at a current density of 0.5 Ag−1 using a VersaSTAT 4 potentiostat. The capacities and current densities were computed based on the loading of the active material, which was about 4 mg/cm2. The electrochemical impedance spectroscopy measurements were performed with an amplitude of 10 mV in the frequency range of 100 kHz to 100 mHz for the as-assembled symmetric cells of 99.99% Al, 99.5% Al 0.5% Fe, and 99% Al 1% Fe, respectively.Cyclic voltammetry (CV) tests were carried out using a VersaSTAT 4 potentiostat, Sweden in a voltage range of 0.1 V to 3.0 V with scan rates of 5 mVsThe surface morphology and microstructure of the Al alloy electrodes were investigated using a field emission scanning electron microscopy at 15 kV . Energy dispersive X-ray spectroscopy (EDX)  was also used to identify the chemical composition of the particles. 3D stereoscopic SEM images  were created to analyze and measure the corrosion volume in the Al electrodes. Structural characterization was also carried out using X-ray diffraction analysis  with Cu-Kα radiation in the range of 2θ = 5–100° for Al alloy electrodes.4− anions intercalation and de-intercalation in graphite layers when Al plating and stripping happens on the Al surface side. The peaks about 2.5 V are ascribed to the intercalation of AlCl4– into the graphite layer, whereas the peaks about 1.7 V correspond to the de-intercalation of AlCl4– from the graphite layers [The cyclic voltammetry (CV) graphs from Al-NG battery using Al alloy anode with different Fe content is illustrated in e layers ,31,32.−1. As can be seen in Electrochemical impedance spectroscopy measurements for symmetric cells that were constructed of 99.99% Al, 99.5% Al 0.5% Fe, and 99% Al 1% Fe, respectively, are revealed in 3Fe intermetallic phases , its role has not been noticed and discussed in Al anode performance.c phases . Additioshown in . As stataluminum ,21,25,373Fe phases (white particles), as shown in 3Fe particles and the Al matrix [l matrix ,25.The SEM images of 99.99% Al, 99.5% Al 0.5% Fe, and 99% Al 1% Fe electrodes taken from the last cycles are shown in A 3D stereoscopic SEM imaging technique was applied to the images of the Al alloy anode electrodes after the last cycle to visualize the corrosion morphology, and to quantify the corrosion . A smootAl-NG cells using Al alloy anodes with higher Fe contents, 99% Al 1% Fe and 99.5% Al 0.5% Fe, respectively, have about 48% and 24% longer cycling lifetime, compared with 99% Al 1% Fe  Al3Fe particles per cm2, which is 4 times and 50 times larger than the number of Al3Fe particles precipitated in Al alloy containing 0.5 and 0.01 wt% Fe, respectively. That is why a larger surface area has been corroded in the 99% Al 1% Fe electrode. Here, it can be concluded that about a 12% increase in surface area corrosion occurred in the 99% Al 1% Fe anode, compared to 99.99% Al, which was due to an increase in population densities of Al3Fe particles. This calculation provides an estimate of the contribution of the population density of Al3Fe particles to Al surface corrosion, and thus to electrochemical performance. In other words, the cell performance enhancement observed with the 99% Al 1% Fe anode is coupled to the higher number of Al3Fe particles precipitated in 99% Al 1% Fe.References ,28 state3Fe as impurities, and variations in the population of such phases can cause random variations in battery performance. This is also could be seen in 3Fe phases, as is shown in Very pure and expensive Al (99.99%) still contains Al3Fe intermetallic phases that are evenly distributed in the Al matrix. This research thus suggests that a simple metallurgical treatment could improve Al alloy anode behavior in Al-ion batteries.The behavior of aluminum alloy anodes with different iron content was studied for aluminum-ion batteries. Adding 1 wt% Fe to the Al alloy electrode enhanced the cell performance and resulted in an Al-ion battery with a longer lifetime and a higher capacity. The enhancement in the electrochemical performance of Al with 1 wt% Fe was attributed to the higher surface area corrosion of the Al alloy anode. It was concluded that the addition of Fe up to 1 wt% facilitates the fragmentation of the oxide barrier on the Al surface and, thus, electrolyte access to bulk Al. This mechanism occurs through the precipitation of a high number of Al


Anaplastic lymphoma kinase (ALK) inhibitors have shown significant efficacy in ALK -rearranged non-small cell lung cancer (NSCLC) patients with good performance status (PS) in multiple randomised studies. However, there is limited data on patients with poor performance status.We carried out a retrospective analysis of prospectively collected data of patients with ALK-rearranged NSCLC and Eastern Cooperative Oncology Group (ECOG) PS of 2–4 treated at a single academic cancer centre from January 2013 to November 2018. The outcomes, progression-free survival (PFS) and overall survival (OS) were calculated from the date of diagnosis. SPSS version 20 was used for all statistical calculations.p = 0.027). The corresponding median OS were 17.9 months (95% CI = 12.8–23.1) and 33.5 months (95% CI = 28.6–38.4), respectively . Among poor PS patients, a subgroup of patients with PS 2 had median OS of 20.6 months (95% CI = 10.8–47.3) as compared to 8.6 months for PS 3–4 (95% CI = 7.8–27.8) . The patients treated with upfront ALK inhibitors had better survival as opposed to those treated with chemotherapy. On multivariate analysis, PS 3–4, smoking, stage 4 and not using ALK inhibitors as first-line therapy were associated significantly with poor outcomes.Out of the total 441 ALK-positive patients, 97 (21.9%) had ECOG PS 2–4 (poor PS). The median PFS was 9.3 months (95% CI = 6.6–12.0) as compared to 14.9 months (95% CI = 13.4–16.4) for patients with a PS of 0–1 (HR = 1.38, 95% CI = 1.04–1.84, The ALK-rearranged NSCLC patients with poor PS derived significant benefits with ALK inhibitors. The outcomes were significantly poorer as compared to patients with PS 0–1; the subgroup of patients with PS 2 had better outcomes as compared to patients with PS 3–4. Very few studies have included NSCLC patients with poor PS in chemotherapy or targeted therapy trials. In a study by Rogerio et al , NSCLC hAnaplastic lymphoma kinase (ALK) rearrangements are the most common targetable oncogenic driver mutations found in never smokers who are wild-type for epidermal growth factor receptor mutation . In the In today’s era, multiple ALK inhibitors, viz. crizotinib, ceritinib, alectinib, brigatinib and lorlatinib, have been approved. They have shown significant improvement in overall response rates (ORR), progression-free survival (PFS) and overall survival (OS) as compared to chemotherapy as the first-line or subsequent lines of therapy with less toxicity as compared to conventional chemotherapy –9 In mosThis study is a retrospective analysis of prospectively collected data of patients treated at a single academic cancer centre from January 2013 to November 2018. Out of all the patients from this database, patients with ALK rearrangement-positive advanced lung cancer having poor PS, defined as Eastern Cooperative Oncology Group (ECOG) PS 2–4, who were registered between January 2013 and September 2018, were included in this study. The patients who were not found to harbour ALK rearrangement were excluded. No sample size calculation was carried out as all the patients who were registered in the lung audit during the specified time period were evaluated for the study. The data included baseline demographics, comorbidities, habits, ALK testing method and disease sites, in addition to the dates of diagnosis, the start of first-line therapy, progression, the start of a subsequent line of treatment, last follow-up and death (if occurred). The best response to the treatment and sites of progression was also recorded. The primary outcome of this study was the estimation of PFS, while the secondary outcomes included OS and toxicities. The details of pre-treatment evaluation and ALK testing have been mentioned in detail in our previous publication .Response assessment was carried out every 8–12 weeks of therapy or earlier as per the treating physician’s discretion if clinically indicated and measured as per RECIST version 1.1 criteria. PFS was defined as the duration between the date of starting treatment and the date of disease progression or change in therapy or death, if it occurred before disease progression. OS was defined as time duration from the date of diagnosis of advanced-stage disease to date of death or last follow-up date. The data were analysed using SPSS for Windows version 20 . Descriptive statistics were used to analyse demography data. The Kaplan–Meier method was used to calculate PFS and OS, and the comparisons of survival were made using the log-rank test. The Wilcoxon signed-rank test was carried out to check for the significance of change in ECOG PS post-first-line therapy.Out of 441 patients, 97 (22%) patients had poor PS at presentation. The median age of the patients was 53 years (range = 24–74), with 29 (29.9%) being >60 years at presentation; 43 (44.3%) were female and 37 (38.1%) had comorbidities. Smoking habit was present in 12 (12.4%), while 18 (18.6%) were tobacco chewers. Brain metastasis was present at baseline in 25 (25.8%) patients . ALK tesThe median follow-up duration was 22.4 months. On intention to treat analysis, median PFS on first-line therapy for overall population was 14.1 months (95% CI = 12.3–15.9). The median PFS for patients with PS 0–1 was 14.9 months (95% CI = 13.4–16.4) versus 9.3 months (95% CI = 6.6–12.0) in patients with poor PS (2–4) . Median OS in patients with PS 0–1 was 33.5 months (95% CI = 28.6–38.4) versus 17.9 months (95% CI = 12.8–23.1)  as compared to PS 2; smokers had HR = 2.07  as compared to non-smokers, while the use of ALK inhibitors in first line was associated with HR = 0.49  as against not used in first line (p = 0.049).Univariate analysis of the various factors affecting OS found that ECOG PS 3–4 (versus PS 2), smokers and ALK inhibitors not received in first line led to significantly poorer outcomes. ECOG PS 3–4 was associated with HR = 1.79  (p < 0.001). The Wilcoxon signed-rank test showed that first-line therapy elicited a statistically significant change in PS . Indeed, the median PS improved from 2 at baseline to 1 post-first-line therapy.Among patients with PS 2, the median PFS on first-line therapy was 11.4 months (95% CI = 7.2–15.6) as against 7.4 months (95% CI = 3.3–11.6) for patients with PS 3–4 . Among patients with PS 2, median OS was 20.6 month (95% CI = 3.8–37.5) versus 8.6 month (95% CI = 6.1–11.4) in patients with PS 3 or 4 (= 0.010) . For patp = 0.016).The median PFS was 20 months in patients who received upfront TKI or as switch after platinum-based chemotherapy versus 8.8 months who received upfront chemotherapy. The median OS was 29.8 months (95% CI = 10.4–49.4) in patients who received upfront TKI or as switch after initial chemotherapy versus 11.7 months (95% CI = 1.8–21.7) who received upfront chemotherapy  patients received crizotinib at some point during their treatment. Transaminitis was the most common adverse effect with grade ½ in 42 (60%) patients and grade ¾ in 3 (4.3%) patients . Anaemian = 18) by Iwama et al [et al [The prognosis of patients with ALK-rearranged NSCLC has improved in the last decade, and the median survival time is over 5 years in advanced stages with the use of third-generation ALK inhibitors . Althougma et al , alectinl [et al , only pal [et al .The use of ALK inhibitors in first line came as the only significant factor in multivariate analysis for OS. The data of use in first line included patients who were initially started on chemotherapy but later shifted to ALK inhibitors after few cycles. This highlights the importance of using ALK inhibitors in first line instead of reserving them for second line or beyond. This is line with the data of PROFILE 1014 published in 2014, showing PFS at 18 months to be 31% (95% CI = 23–39) in the crizotinib arm and 5% (95% CI = 2–10) in patients who received chemotherapy in the first line . This diAlso, our study showed that the majority of poor PS patients had extensive metastatic disease at presentation which may be related to the EML4-ALK variant 3 . This vaThere are few important limitations of the study, which include the obvious drawbacks of a retrospective audit limiting the recording of toxicities, besides the treatment being heterogeneous. However, this study adds important real-world data in the treatment of ALK-rearranged NSCLC and gives confidence to the clinicians in prescribing ALK inhibitors to patients with poor PS at baseline.ALK-rearranged NSCLC patients with poor PS derived significant benefits with ALK inhibitors. The outcomes were significantly poorer as compared to patients with PS 0–1; the subgroup of patients with PS 2 had better outcomes as compared to patients with PS 3–4.The study was conducted in accordance with the Declaration of Helsinki and the International Conference on Harmonisation Guidelines for Good Clinical Practice.No funding was received for this study.The authors declare that they have no competing interests.


PM2.5 levels were significantly higher during winter. When PM2.5 levels were beyond the daily limit, there was a statistically significant increase in respiratory-related ED visits . PM2.5 levels were also statistically significantly related to the number of URI-related ED visits . The temperature was negatively correlated with ED visits  and age was found to be positively correlated with ED visits , while no statistically significant correlation was found concerning humidity . In conclusion, PM2.5 levels had a significant effect on ED visits for respiratory causes in the city of Volos.Fine particulate matter that have a diameter of <2.5 μm (PM2.5) are an important factor of anthropogenic pollution since they are associated with the development of acute respiratory illnesses. The aim of this prospective study is to examine the correlation between PM2.5 levels in the semi-urban city of Volos and Emergency Department (ED) visits for respiratory causes. ED visits from patients with asthma, pneumonia and upper respiratory infection (URI) were recorded during a one-year period. The 24 h PM2.5 pollution data were collected in a prospective manner by using twelve fully automated air quality monitoring stations. PM2.5 levels exceeded the daily limit during 48.6% of the study period, with the mean PM2.5 concentration being 30.03 ± 17.47 μg/m Anthropogenic air pollution is a major cause of environmental pollution, which can have detrimental effects on human health . Fine paHigh levels of PM2.5 have been previously associated with several respiratory diseases, as well as increased morbidity and mortality due to respiratory causes . In a meWhile the connection between PM2.5 pollution and respiratory diseases has been extensively researched, there is a lack of studies pertaining to the relationship between air pollution and health in rural or semi-urban areas. Although these areas may have lower exposure to industrial and motor vehicle pollution , studiesThe aim of the present study was to investigate the relationship between daily PM2.5 levels in the semi-urban Greek city of Volos and the number of adult ED visits for respiratory causes. This study retrospectively analysed a prospectively collected database. The study was approved by the local scientific committee (2/7-2-2019). The methodology has been previously described in detail for our pediatric ED visits study . Data were collected for adult patients visiting the ED of Volos with respiratory symptoms, including asthma, pneumonia, COPD and upper respiratory tract infection (URI)-related visits between 1 March 2019 and 29 February 2020. We used the following inclusion criteria: (1) residents of Volos city, (2) those who visited the adult ED and (3) those with respiratory conditions . The following data were collected for all patients: age, gender, address of residence, main complaint/diagnosis and date of visit. The GreenYourAir research group established a fully automated network for monitoring air pollution in the city of Volos. Twelve stations located throughout the central and greater Volos areas collected the data prospectively during the entire study period. The locations were chosen based on a mathematical formula and an optimization model developed by the GreenYourAir team that parcellated the city into smaller areas. Briefly, the team divided the city into five distinct areas, namely the commercial and recreational zone; the industrial zone; and the high-density, medium-density and low-density residential zones, while the traffic jam of the city was divided into three categories . Furthermore, additional information regarding the city was taken into consideration, such as the geographical and geomorphological characteristics of the area, the commercial port, the passenger port, the urban and intercity bus stations, the train station, the main roads, the recreational parks, the sport facilities, the schools and other academic institutions and two big industrial plants located just outside the city (one cement company and one petroleum company). It should be mentioned that the residents of the city use oil, natural gas and fireplaces for heating during the winter. The exact location of the sensors throughout the city of Volos is presented in The devices that were used for monitoring (GreenYourAir Device 1178/PM2.5) used light-scattering methods for data collection, as described previously in the literature ,13. The A two-phase calibration methodology was implemented to check the accuracy of the devices. During the first stage development and testing period, the sensors were validated in laboratory conditions using reference equipment that followed EU standards EN 14907:2005 (gravimetric device with filters that collects PM2.5). Later, during the second stage, the sensors were validated in real-life conditions. http://greenyourair.org/ (accessed on 30 October 2022).The network created started operating on 1 March 2019 and is still working 24/7 at the time of writing this manuscript. The real-time data for the city of Volos can be found at p values < 0.05 and all tests were two-tailed. The SPSS statistical package was used for all statistical analyses .The independent samples t-test and analysis of variance were used for the between groups comparisons of continuous variables as appropriate. The chi-square test was used to identify possible relationships between categorical variables. We used regression analysis and Pearson’s correlation in order to describe the relationship between the number of ED visits and temperature, humidity, age and PM2.5 levels. The significance for all tests was set at During our study period, a total of 728 patients visited the adult ED for respiratory causes. The male to female ratio was 1.05 , while the mean age for male patients was 64.50 ± 19.69, and for female patients, it was 61.43 ± 20.52.A total of 310 patients (mean age (standard deviation): 66.35 ± 20.77; male gender: 166 (54%)) were diagnosed with an URI, 202 patients were diagnosed with a lower respiratory tract infection/pneumonia (mean age (standard deviation): 52.41 ± 20.70; male gender: 106(52%)), 53 patients were diagnosed with asthma exacerbation (mean age (standard deviation): 50.39 ± 20.05; male gender: 15(28%)) and 163 patients were diagnosed with COPD exacerbation (mean age (standard deviation): 69.49 ± 12.20; male gender: 85(52%)).3) was exceeded for 178 days, which was 48.60% of the study period. The recorded levels of PM2.5 were found to be higher in winter when compared with summer , autumn  and spring .In the city of Volos, the mean annual PM2.5 concentration during the study period was calculated to be 30.03 ± 17.47 μg/m3 compared to WHO’s yearly limit of 10 μg/m3. Overall, the suggested daily limit of PM2.5 (25 μg/mp: 0.018). Further analyses performed by season (3 (p = 0.018).The mean number of daily ED visits for respiratory causes was 1.99 ± 1.81. The number of monthly ED alongside the corresponding monthly PM2.5 levels are presented in y season  illustrap < 0.001), while humidity did not exhibit any statistically significant correlation . Finally, age was found to be positively correlated with ED visits .Additionally, we identified that temperature was negatively correlated with ED visits . p = 0.05; Pneumonia: p = 0.42; Asthma: p = 0.28; COPD: p = 0.47) when comparing males and females.A statistically significant increase in ED visits for URI was noted during the days that PM2.5 levels exceeded the limit of 25 μg/mp < 0.001) was noted between the levels of PM2.5 and the total number of daily ED visits. This is described by the following equation: total number of ED visits = 1.524 + 0.015 × PM2.5 levels (p < 0.001) although the only parameter with statistical significance was temperature.In regression analysis, a linear correlation (r square: 0.022; 5 levels . When we3 during 48.6% of the study period, with the mean PM2.5 concentration being 30.03 ± 17.47 μg/m3. PM2.5 levels were higher during the winter compared to autumn, spring, and summer. ED visits were significantly higher on days when PM2.5 concentrations exceeded the daily limit, or the day after. Although age and temperature had a significant correlation with ED visits, humidity did not play a role in the number of daily ED visits. Moreover, high PM2.5 levels were associated with an increase in URI-related ED visits.In our study, PM2.5 levels exceeded the daily limit of 10 μg/mAir pollution has become increasingly prevalent during the last decades, since many global areas are exposed daily to high levels of air pollutants . While lDespite the fact that the city of Volos is a semi-urban area, high levels of air pollutants have been previously recorded ,11. In aPM2.5 production is mainly anthropogenic . Fine paApproximately 4.2 premature million deaths annually can be attributed to PM2.5 pollution, placing fine particle pollution as the fifth most common cause of death worldwide . ExposurAccording to our findings, in the semi-urban city of Volos, there was a statistically significant association between PM2.5 levels and ED visits for respiratory causes. These findings are in accordance with two similar studies conducted in the city of Volos, which demonstrated that fine particulate matter pollution is associated with increased hospital admissions for respiratory causes in both adult and pediatric patients ,11. As pSeveral meteorological factors have been shown to influence the concentration of PM2.5 and its effect on human health ,26. In oIn our study, there was a statistically significant association between URI-related ED visits and PM2.5 levels. The association between PM2.5 levels and respiratory infections has been proved by numerous studies, which showcase that increased PM2.5 levels lead to increased ED visits and hospital admissions for upper and lower respiratory infections ,32. The Τhe association between PM2.5 pollution and chronic respiratory diseases has been well documented. Both PM2.5 and PM10 may cause COPD exacerbations, leading to more ED visits for respiratory causes and increased morbidity and mortality in COPD patients ,36. IntePM2.5 pollution may also worsen asthma symptoms, leading to increased ED visits and hospital admissions for asthma exacerbations ,37,38. AOur study has some limitations that should be acknowledged. Firstly, is it a single-center study that collected data from a single ED; thus, our results should be interpreted with caution. Moreover, the diagnoses were made in an emergency setting; therefore, there may have been some misdiagnoses. It is also important to note that our analysis was conducted based on the mean PM2.5 levels of each day and may not accurately reflect patient exposure, since no regional analysis was conducted.In our study, high PM2.5 levels were associated with an increase in adult ED visits for respiratory causes. PM2.5 pollution was statistically significantly related to the number of URI-related visits but not COPD or asthma-related visits. Moreover, low temperatures and increased age increased ED visits for respiratory causes. While the association between fine particle pollution and respiratory illnesses has been well documented, more studies are necessary in order to ascertain the pathophysiological mechanisms leading to respiratory dysfunction, as well as individual factors that may predispose certain patients to PM2.5-related respiratory symptoms.


Anguilla anguilla) recruitment over the past half-century is partly due to river infrastructure that delays or blocks upstream migration to rearing habitat. Stimuli, such as electricity, can be used to modify the behaviour of downstream moving fish and guide them to preferred routes of passage at river infrastructure; but research on upstream migrating juvenile eel remains limited. The response of upstream migrating juvenile eel exposed to pulsed direct current (PDC) electric fields was investigated using a recirculatory flume. Eel were presented a choice of two routes upstream under either: (1) a treatment condition, in which the selection of one route resulted in exposure to High Electric Field (HEF) strength that was between 1.5–2 times stronger than the Low Electric Field (LEF) strength encountered in the alternative route; or (2) a control in which the electric field was absent in both routes. Under the treatment, five different mean HEF strengths  were tested at one of two frequencies (2 and 10 Hz). Route choice, distance downstream of the first set of electrodes at which an initial response was observed and avoidance behaviours  were compared among treatments. For the 1.22, 2.17 and 3.74 Vcm-1 and under 2 Hz, eel preferred to pass the LEF route. Avoidance was greater in the HEF route and positively related to field strength. The distance of the initial response did not differ between routes, field strengths or frequency. Upstream migrating eel avoided electric fields indicating potential to develop this approach for fish guidance. Further work is needed to test prototypes in field settings, particularly in combination with traditional physical screens to water intakes as part of a process of applying the concept of marginal gains to advance environmental impact mitigation technology.The decline in European eel ( Anguilla anguilla) has experienced substantial declines in escapement and recruitment since the 1970s  and Pacific lampreys [Entosphenus tridentatus]  . Howeverentatus] ).acceleration, retraction, switching and rejection) of avoidance response was investigated. We predicted that: (1) eel would prefer (deviation from the 50:50 route selection expected if choice was random) to pass the LEF route when offered a choice; and (2) distance of the initial response from the source of the EF and (3) occurrence of avoidance behaviour exhibited would be positively related to field strength, and that these relationships would be stronger under the high frequency (10 Hz) condition.This study investigated the response of upstream migrating juvenile (glass) eel to pulsed direct current (PDC) electric fields when offered a choice of route in an experimental flume. In the test section, the flume was divided longitudinally into two routes of equal dimension by a series of eight earthed vertical electrodes, presenting the upstream swimming eel with an opportunity to select a route: (1) of differing field strength (High or Low Electric Field Strength–HEF / LEF) under the treatment conditions; or (2) a control in which the electric field was absent in both routes. The influence of electric field strength and frequency on: (1) route selection, (2) distance from the electrodes at which an initial response was exhibited by upstream moving juvenile eel, and (3) nature . After experimental trials all eel were released back into the wild as requested by the Environment Agency.st and 2nd dummy earthed electrodes, respectively) at the same longitudinal position as the positive and negative earthed electrodes in the HEF route. Earthed electrodes were arranged to best localise the electric field to the HEF route and prevent the field extending outside the experimental area. Each electrode was covered and secured with mesh fabric (mesh size: 0.28 x 0.79 mm) to prevent direct contact by the eel.The experiment was conducted in an indoor open channel flume . Within the flume a 2.04 m long section was isolated by a downstream flow straightener and upstream plastic mesh screen (mesh size: 0.28 x 0.79 mm) . Eight eA black screen was placed alongside the flume to prevent disturbance to the fish by the observers. Six CCTV cameras  were positioned above the experimental area (55 cm above the base of the flume) along the length of the flume. Two infrared lights  were positioned at the downstream and upstream mesh to provide sufficient illumination for video capture under conditions of darkness.-1; Electrode Array: 18.4 [± 0.11] cm and 0.135 [± 0.001] ms-1; Downstream: 17.8 [± 0.15] cm and 0.118 [± 0.001] ms-1). The velocities were measured midway in the water column and at three lateral points across the flume. The test velocities were selected based on juvenile eel prolonged swimming capabilities of 0.2–0.4 ms-1 and maximum burst speeds of up to 0.5 ms-1  = 12.5 [± 0.04]°C). Two aquarium air pumps were used to provide aeration. Fish health and water quality was monitored daily to ensure consistent conditions .Trials were conducted during hours of darkness (18:00–02:00), to replicate the natural nocturnal migration of glass eel , betweenA single eel was removed from the holding tank and placed in a plastic tube secured at both ends with mesh coverings before being placed in a 0.4 m long acclimatisation zone located at the downstream end of the flume section . Eel werFlume temperature was maintained close to the target of 12°C (mean [± SE] = 12.6 [± 0.01]°C), as the migratory behaviour of glass eel is reported to decline below a threshold temperature range of around 11–12°C –51, and Analysis of video recordings allowed the characterisation and quantification of route choice and avoidance exhibited  as eel px and y spatial coordinates for the downstream distance (cm) from the positive electrodes in the HEF and the first dummy earthed electrodes in the LEF at which the initial response  was used to obtain 2) test determined whether the route choice (HEF or LEF) deviated from the 50:50 ratio expected if the selection was random . For statistical purposes the route that was assigned the HEF during the treatment conditions was also designated as the HEF for the control, even though the electric field was absent. Due to the low number of observations of some of the behaviours (i.e. rejection), all defined responses  were combined as a single avoidance response. Differences between the routes, field strength and frequency for distance of initial response were analysed using separate Kruskal-Wallis tests. A generalised linear mixed model (GZLMM) with a binomial distribution was used to determine whether route choice (HEF or LEF), field strength or frequency influenced avoidance behaviour. Eel-ID was included as a random effect as some individuals sampled both routes (HEF and LEF) and so have two observations.Statistical analyses were conducted using R 4.0.2 . Normali-1 control, 0.53 Vcm-1 and 0.77 Vcm-1 treatments (p > 0.05) (-1 (p > 0.05) (-1 with a significant deviation from 50% (1.22 Vcm-1: χ 2(1) = 7.35, p = 0.007, 2.17 Vcm-1: χ2(1) = 5.26, p = 0.02 and 3.74 Vcm-1: χ 2(1) = 6.76, p = 0.009) (The percentage of eel that passed through the LEF route did not differ from 50% under the 0 Vcm > 0.05) . There w > 0.05) . Convers= 0.009) .2(1) = 0.39, p = 0.53). Consequently, data was aggregated for comparison between field strength and frequency. There was no effect of field strength (χ 2(4) = 1.1, p = 0.89) or frequency (χ 2(1) = 0.61, p = 0.44) on the distance of initial response . Route had no effect on the distance of initial response (χ response .52(1) = 4.75, p = 0.03) with more eel responding in the HEF (73.7%) than the LEF (63.0%) route (switching (44.0%), whereas no change was more frequent in the LEF route (37.0%).The exhibition of avoidance differed with route selected (χ %) route . The mos2(5) = 25.5, p < 0.001), with eel more likely to exhibit avoidance under 2.17 Vcm-1  and 3.74 Vcm-1  than the control (46.7%). There was also greater avoidance in the 2.17 Vcm-1  and 3.74 Vcm-1  than the 0.53 Vcm-1 (43.3%) treatment. Avoidance was not affected by pulse frequency (χ 2(1) = 0.72, p = 0.4). The percentage of eel exhibiting rejection in the HEF was < 10% for all field strengths except for 3.74 Vcm-1 (22.2%). Field strength was also influential in the LEF route, (χ 2(5) = 25.9, p < 0.001), with eel more likely to exhibit avoidance under 2.42 Vcm-1  than the control (35.7%), 0.27 Vcm-1 , 0.44 Vcm-1  and 1.28 Vcm-1  treatments. For all the field strength treatments in the LEF the percentage of eel exhibiting rejection was < 10%. Avoidance was not influenced by pulse frequency (χ 2(1) = 0.004, p = 0.95).As avoidance differed between routes, the results in the HEF and LEF were analysed separately to enable comparisons between field strength and frequency. For the HEF, behaviour was influenced by field strength (χ Anguilla anguilla) were more likely to pass a route in which they encountered a weak electric field (Low Electric Field [LEF] strength) than one with a strong field (High Electric Field [HEF] strength) when offered a choice, but only at the higher field strengths  and under the 2 Hz frequency treatment. More eel exhibited avoidance in the HEF route, and avoidance was positively related to field strength. There was no relationship between distance of initial response and field strength or frequency. To the best of our knowledge, this is the first study to directly test guidance and avoidance in juvenile (glass) eel in relation to PDC electric fields. The results support the potential use of electric fields as a method for guiding juvenile European eel movements, perhaps in combination with traditional physical screens at intakes to abstraction points as part of the application of the marginal gains concept to advancing environmental impact mitigation technology [Under the experimental conditions described, upstream migrating juvenile European eel (chnology .-1), suggesting that there is some threshold at which guidance is induced. Interestingly, this was the case only under 2 Hz treatment, contradicting the prediction greater avoidance occurs at higher pulse frequencies [Oncorhynchus mykiss) in that longer pulse widths can enhance the efficiency of experimental electric deterrents [Eel were more likely to pass the LEF route under the higher field strengths . Intereterrents . These oterrents , 57–61).Oncorhynchus clarkii bouvieri, and rainbow trout) and invasive species management  is a strong predictor of fish response to electric fields . When punt . Moreover, relatively high rates of rejection (> 10% of eel) were observed in the HEF route under the 3.74 Vcm-1 only. This might be explained by the migratory phase juvenile eel used in this study being highly motivated to move upstream and unlikely to respond in a contrary fashion until the stimulus was sufficiently intense. We are unable to discount the possibility of different physiological mechanisms underpinning the behaviours observed [rejections may have been an unconditioned reflex stimulated at higher field strengths, rather than being a volitional avoidance behaviour. Nevertheless, aside from the mechanisms a deterrent/guidance system will only be effective if it elicits the desired response  from the management perspective, and this is likely to change with species, site and application (e.g. barrier versus guidance). Hence, further work is needed to understand the mechanisms which underpin this behavioural variability to improve design criteria.While some avoidance behaviours, such as observed , and it From the perspective of developing behavioural guidance systems for eel, this study demonstrates that under certain field strengths and pulse frequencies the upstream migrating juvenile life-stage exhibits avoidance to electric fields. Enhanced guidance towards areas with a weaker electric field was achieved at higher field strengths and the lower frequency waveform (e.g. 2 Hz rather than 10 Hz), the latter providing the additional benefit of lower risk of injury and power consumption costs. We recommend further investigation to optimise electric field parameters (e.g. pulse frequencies) and electrode orientation (e.g. 45° to the flow) to continue to improve guidance for juveniles, other life stages of eel (e.g. downstream migrating silver-phase and yellow-phase eel) and species (including those that are group living), under different site conditions  and management strategies (e.g. upstream passage solutions). In particular, we suggest that future research should investigate further an approach based on the marginal gains concept to enhance the effectiveness of existing environmental impact mitigation measures, such as eel passes and physical screens, to provide more efficient and cost-effective hybrid behavioural guidance systems.


Breast arterial calcifications are common mammographic findings which are associated with coronary artery disease. The aim of this study was to find the prevalence of breast arterial calcifications in women presenting for mammography in a tertiary care centre.This descriptive cross-sectional study was performed in the Department of Radiology, in a tertiary care hospital after taking ethical clearance, Reference number 352(6-11)E-2, 077/078, data was collected from Syngovia database from March-June 2021 which included 1614 mammograms. Convenience sampling was done and mammograms evaluated for presence of vascular or non-vascular calcification. Further, vascular calcification was graded. Data was entered in Statistical Package for Social Sciences version 25. Point estimate at 95% Confidence Interval was done, and frequency and proportion were calculated.The prevalence of breast arterial calcification was 188 (11.6%) at 95% Confidence Interval (10.03-13.2). The mean age of women included in this study was 48.42±9.55 years with the largest number of patients in the age group 40-49 years, 682 (42.3%), and least in the age group 80-89 years, 3 (0.2%). All patients in the age group 80-89 years, 3 (100%) had vascular calcifications followed by 70-79 years group, 22 (57.5%) and none in patients younger than 30 years.We found an increase in the number and grade of vascular calcifications in breasts with the patient's age. When present breast arterial calcifications must be mentioned in mammogram report. Identification of such calcifications on mammogram should prompt further screening for atherosclerotic disease. In Nepal, diagnostic mammograms are done more often than screening due to lack of awareness and absence of guidelines facilitating screening studies.4 In addition to CAD, other risk factors like age, Diabetes Mellitus, CAD risk factors, pregnancy, lactation and renal impairment are also associated with BAC.5 Reporting BAC may help identify group of patients at higher risk of CAD and prompt appropriate and timely evaluation.Different calcifications, including vascular, are often seen in mammograms, but being unrelated to breast disease, are often not reported. Various studies have shown an increased risk of Coronary Artery Disease (CAD) with BAC.The aim of our study was to find the prevalence of BAC in women presenting for mammography in our tertiary care hospital.This was a descriptive cross-sectional study conducted in the Department of Radiology, Tribhuvan University Teaching Hospital (TUTH). Data was collected from the database over a period of 4 months (March-June 2021). Ethical clearance  was obtained from the Institutional Review Committee and patient confidentiality was maintained. Convenient sampling technique was used. Patients with breast implants or previous breast surgery deforming the breast, rendering evaluation difficult were excluded.The sample size was calculated using the formula,2 × p × q / e2n = Z2 × 0.5 × 0.5 / (0.03)2  = (1.96)  = 1,067where,n = required sample sizep = prevalence 50%q = 1-pe = margin of error, 3%Z = 1.96 at 95% Confidence Interval (CI)Adding a non-response rate of 10%, the sample size was 1,174. However, 1614 samples were included in the study.7Two basic projections  of the breasts were obtained with the MAMMOMAT Fusion mammographic unit. These mammograms available in Syngovia work station YLXR019095 database were evaluated by radiologists with more than 10 years of expertise. The pattern and extent of calcification was evaluated visually in the workstation using appropriate magnification tools. Presence of calcification of any type was noted and classified as benign vascular, benign non-vascular or malignant. Vascular calcification was further graded as follows, which was adapted from the previously proposed scoring systems.0. No vascular calcification;1. Few punctate vascular calcifications with no coarse, tram track or ring calcifications;2. Abundant punctate vascular calcification or tram track calcifications;3. Severe coarse or tram track calcification obliterating or clouding the lumen.Study variables were recorded in a predesigned datasheet. Statistical analyses were done with the SPSS version 25.0 and Microsoft Excel. Simple statistical measures were used to determine the overall prevalence and grade of calcification and that in the different age groups.This study was done as a part of the University Grant Commission project FRG-HS-3 075-76.The prevalence of BAC in our study was found to be 188 (11.6%) at 95% CI (10.03-13.2).The study sample consisted of 1614 female patients with age ranging from 20 to 89 years, mean age of 48.42±9.55 years. The maximum number of patients were in 40-49 years, 682 (42.3%) age group and minimum in 80-89 years, 3 (0.2%) .The mean age of patients without vascular calcification was 46.32±8.38 and that with vascular calcification was 58.13±10.27 years. A total of 22 (1.4%) women in the age group 20-29 years and 213 (13.2%) women in the age group 30-39 years in our study were below the recommended age for mammography, which is suggested for women above the age of 40. However, these women had risk factors like personal or family history of breast cancer, or had undergone diagnostic mammography.Calcifications were seen in a total of 522 (32.3%) mammograms of which 188 (36%) were benign vascular, 305 (58.4%) were benign non vascular and 29 (5.5%) malignant . The prevalence of BAC in our study was 188 (11.6%) with a maximum number in the 60-69 years age group. There were 121 (7.5%) cases with grade 1, 48 (3%) with grade 2 and 19 (1.2%) with grade 3 calcification. Maximum percentage of grade 1 calcification was in 50-59, grade 2 in 60-69 and grade 3 in 80-89 years age groups  and BAC was 188 (11.6%). Studies have shown the prevalence of BAC generally varies from 9-17%, being higher in older patients.14 It is important to make a note on this incidental finding.15While such vascular calcifications are often seen on mammography, being unrelated to breast cancer, they are not always mentioned in the report. An interesting study found that patients and preventive cardiologists prefer BAC being reported in mammogram studies done for other indications.Since there is an increase in prevalence and grade of vascular calcification with age. We recommend that the benign vascular calcification when present must always be reported in the mammogram report, as such patients may have higher risk of atherosclerotic disease.


Typhoid fever, an acute systemic febrile illness caused by Salmonella Typhi & Paratyphi, is an important public health problem in developing countries. It requires frequent observation regarding proper diagnostic protocol and treatment practices. The aim of the study is to find the prevalence of typhoid fever among admitted pediatric patients in a tertiary care center.This is a descriptive cross-sectional study conducted among the admitted patients of pediatric and adolescent medicine of a tertiary care center from August 2016 to May 2018 after obtaining ethical clearance (IRC/609/015). Convenience sampling was used and data was analyzed using the Statistical Package of Social version 11.5. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data.Among 7450 patients, 151 (2.03%) at 95% Confidence Interval (1.71-2.35) patients were diagnosed with enteric fever of which 85 (56.29%) were male and 66 (43.71%) were female. Common symptoms were fever 151 (100%), and abdominal pain 94 (62.25%). Azithromycin 54 (38.03%) was the most common antibiotic received before presenting to hospital and ceftriaxone 151 (100%) was prescribed to all the patients after admission. Two-third of the patients (96/151) was hospitalized for at least 6 days, with the longest hospital stay of 14 days and shortest of 3 days.Occurrence rate of Typhoid Fever was similar to other studies. Antibiotic susceptibility could not be well established; further surveillance on typhoid fever and the antimicrobial susceptibility pattern is recommended. WHO estimates between 11 and 21 million cases and 128 000 to 161 000 typhoid-related deaths occur annually worldwide.3 Antimicrobial agents are the definitive therapy in order to prevent the complications associated with TF.3 Appropriate and timely antibiotic administration reduces the durations of fever from 3-4 weeks to 3-4 days.4TF in some patients can develop life threatening complications. It remains a public health concern and the incidence is highest in children with higher rates of hospitalization.In this study we aim to find the prevalence of typhoid fever among admitted pediatric patients of a tertiary care center in Eastern Nepal.A descriptive cross-sectional study was conducted among the admitted patients of pediatric and adolescent medicine ward in B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal from August 2016 to May 2018. Ethical approval was obtained from the Institutional Review Committee of B.P. Koirala Institute of Health Sciences (IRC). Convenience sampling technique was used and the sample size was calculated using the formula,2 × p × q / e2n = Z2 × 0.50 × 0.50 / (0.02)2  = 1.96  = 2401Where,n = minimum required sample sizeZ = 1.96 at 95% confidence intervalp = prevalence taken as 50%q = 1-pe = margin of error, 2%Since convenience sampling was used after doubling the sample size, the sample size becomes 4802, however we took a sample size of 7450.Data was collected from all the pediatric patients (0-18 years) admitted during the study period with fever or history of fever with clinical diagnosis of TF. Patients admitted with other diagnosis of fever were excluded from the study. Before the study, the guardians of the patients were informed about the objectives of the study, confidentiality was maintained and written informed consent and written assent were taken. Data was collected using semi-structured proforma. Blood samples were collected using universal precautions and brain heart infusion which establishes the growth of pathogens causing bacteremia and septicemia was used as culture medium. Data was analyzed using the Statistical Package of Social version 11.5. Point estimate at 95% confidence interval and descriptive statistics were calculated.Among 7450 patients, 151 (2.03%) at 95% Confidence Interval (1.71-2.35) patients were diagnosed with enteric fever. Among them, 85 (56.29%) were male and 66 (43.71%) were female .Median year of presentation with inter-quartile range was 7.00 (1.60-14.00). Oldest patient with the diagnosis was 14 years and the youngest was 3 years old. The mean weight was 22.14±8.35, the heaviest one being 52kg and the lightest one 9kg weight.Antibiotics followed by paracetamol and ibuprofen combination were the most common drugs taken by patient while presenting to the hospital .Fever was present in all patients presenting to the hospital followed by abdominal pain 94 (62.25%) and diarrhoea 73 (48.34%) .The mean duration of fever was 5.63±3.23. At extremes, one patient had a fever duration of 3 days (minimum) and other had that of 16 days (maximum). The mean temperature was 102.1±0.25°F.Ceftriaxone was prescribed to all patients admitted as typhoid fever. Chloroquine was prescribed to 48 (71.70%) patients and Artesunate to 5 (3.31%) patients as they came from malaria endemic area, which were later withdrawn after ruling it out .Widal test was positive in only 11 (7.28%) patients, however, 140 (92.72%) patients had non-significant titre (<1:80) in the widal test. Ceftriaxone was the most commonly prescribed empirical antibiotic while ciprofloxacin was sensitive.3 (43x102 - 124x102) where maximum and minimum total blood count were 269x102 and 27x102 respectively. The median and interquartile platelet count was 213x103 (12x104-286x103) respectively.Only 14 (9.27%) patients were leucopenic and 23 (15.23%) patients had leukocytosis. The median and interquartile total blood count was 5.9x10Two-third of the patients (96/151) was hospitalized for at least 6 days, with the longest hospital stay of 14 days and shortest of 3 days. Mean defervesecene period azithromycin and ceftriaxone combination was 6±1.38 days with maximum of 12 and minimum of 3 days respectively. Mean defervesecene period for ceftriaxone when used alone was 6±2.72 with maximum and minimum defervesecene period of 11 and 3 days respectively. All the admitted patients recovered with no complications.Typhoid fever is predominantly caused by serovars typhi and paratyphi of Salmonella enterica. A blood culture is required to establish the confirmatory diagnosis of TF.5 The current study shows highest frequency in above 10 years of age whereas Prajapati et al.5 found the highest frequency among below 10 children in their study. This may be due to difference in location and cultural pattern and that the tween age groups at Terai belt are more independent from their parents and hence are more exposed to unsafe drinking water and improper hygiene. Male showed more predominance in this study than females which is in consistent to the study conducted by Gosai Mehul et al.6 which may be because male are more exposed to outdoor activities in comparison to female.7This study showed the occurrence rate of typhoid fever in the pediatric age group of BPKIHS was 2.03% which was similar to the study done by Prajapati et al.th patients received treatment before reaching BPKIHS. This may be because of easy accessibility of medicine over the counter and fear of relatively higher expenditure for treatment in the hospital. The most common prehospital antibiotic received by patient before being admitted in BPKIHS was Azithromycin followed by Ceftriaxone.Our study showed more than 3/48 but in contradictory to the study conducted in Kathmandu9 which reports coated tongue, relative bradycardia and splenomegaly as the commonest presentation. Ceftriaxone was empirically in all admitted patients. This may be because third generation cephalosporin are bactericidal drugs with increased activity against gram negative bacteria with lesser toxicity and greater safety10 and have fever clearance time averaging one week.11 Serum positivity for Widal test and Blood culture is low in this study as compared to other studies5 which might be because of initiation of antibiotics prior to sample collection. Resistance to ampicillin and trimethoprim-sulfamethoxazole and no resistance to ceftriaxone was observed in this study however, taking defervescence period into consideration, this study sample did not prove superiority of ceftriaxone and azithromycin (mean defervescence period 6±1.38 days over ceftriaxone (mean deference period 6±2.72 days alone.Fever 100%, abdominal pain 62.25%, headache 47.02% and diarrhea 48.34% were the commonest presentation in this study which is in consistent to the study conducted in Dhulikhel hospitalrd of the patients had at least 6 days of hospital stay which is comparatively longer for quinolone group.12This study reveals that 2/3Small sample size and short duration of study were the major limitation of this study.Occurrence rate of Typhoid Fever was similar to other studies. Azithromycin was the most common pre-hospital antibiotic and Ceftriaxone was the most common empirical inpatient antibiotic prescribed. As the majority of patients were treated with antibiotic prior to hospital visit, antibiotic susceptibility could not be well established. Therefore, based on these observations, a further surveillance on typhoid fever and the antimicrobial susceptibility pattern is recommended.


Little is known regarding life-course trajectories of important diseases. We aimed to identify diseases that were strongly associated with mortality and test temporal trajectories of these diseases before mortality.Our analysis was based on UK Biobank. Diseases were identified using questionnaires, nurses’ interviews, or inpatient data. Mortality register data were used to identify mortality up to January 2021. The association between 60 individual diseases at baseline and in the life course and incident mortality was examined using Cox proportional regression models. Those diseases with great contribution to mortality were identified and disease trajectories in life course were then derived.During a median follow-up of 11.8 years, 31,373 individuals (median age at death (interquartile range): 70.7 (65.3–74.8) years, 59.4% male) died of all-cause mortality (with complete data on diagnosis date of disease), with 16,237 dying with cancer and 6702 with cardiovascular disease (CVD). We identified 37 diseases including cancers and heart diseases that were associated with an increased risk of mortality independent of other diseases (hazard ratio ranged from 1.09 to 7.77). Among those who died during follow-up, 2.2% did not have a diagnosis of any disease of interest and 90.1% were diagnosed with two or more diseases in their life course. Individuals who were diagnosed with more diseases in their life course were more likely to have longer longevity. Cancer was more likely to be diagnosed following hypertension, hypercholesterolemia, CVD, or digestive disorders and more likely to be diagnosed ahead of CVD, chronic kidney disease (CKD), or digestive disorders. CVD was more likely to be diagnosed following hypertension, hypercholesterolemia, or digestive disorders and more likely to be diagnosed ahead of cancer or CKD. Hypertension was more likely to precede other diseases, and CKD was more likely to be diagnosed as the last disease before more mortality.There are significant interplays between cancer and CVD for mortality. Cancer and CVD were frequently clustered with hypertension, CKD, and digestive disorders with CKD highly being diagnosed as the last disease in the life course. Our findings underline the importance of health checks among middle-aged adults for the prevention of premature mortality.The online version contains supplementary material available at 10.1186/s12916-022-02384-3. Chronic conditions were estimated to account for 63% of 54.6 million global deaths in 2008, and this number increased to 71% of 56.7 million in 2016 ), or frequency (percentage) according to the number of types of diseases. ANOVA analysis for normally distributed continuous variables, Wilcoxon rank-sum test for skewed continuous variables, and chi-square test for categorical variables were used to examine the difference in baseline characteristics across the number of diseases in the life course.Temporal disease trajectories were identified using the permutation of diseases (multiple diseases in order of age at diagnosis) among individuals who were diagnosed with two or more diseases before mortality. The age at diagnosis of diseases was based on self-reported or inpatient data. For example, among those who were diagnosed with two diseases in the life course, the primary disease was defined as the disease diagnosed at a younger age and the secondary disease as the disease diagnosed at an older age. This analysis was also conducted for those with 3, 4, 5, and ≥6 diseases separately. The disease trajectories were identified for all mortality, cancer mortality, and CVD mortality, separately.For chronic diseases at baseline that were associated with a lower risk of incident mortality, a matched analysis was conducted to test these associations with controls matched by age and gender. For each individual with the disease, one control was randomly selected from those free of the corresponding disease.The percentage of participants with missing values in physical activity, household income, education, BMI, alcohol consumption, smoking, sleep duration, LDL-C, triglycerides, blood pressure, and HbA1c was 19.9%, 15.3%, 2.0%, 2.0%, 0.3%, 0.6%, 0.8%, 14.4%, 6.6%, 6.0%, and 7.2%, respectively. Missing values for categorical variables were assigned as a single category. Missing values for continuous covariates were assigned as the mean. Sensitivity analysis for associations between individual diseases and mortality was conducted among participants with complete data.All data analyses were conducted using SAS 9.4 (SAS Institute Inc.), and P values were two-sided with statistical significance set at <0.05.During a median follow-up of 11.8 years (IQR 11.1–12.6), 33,393 individuals died of all-cause mortality , and their longevity ranged from 40.3 to 83.7 years (69.5 ± 7.4). Around 97.0% of them were defined as premature mortality with the age at death younger than the life expectancy at birth in the UK .n=394), 502,131 participants were included in the analysis. There was no violation of the proportional hazards assumption for most diseases examined : 0.91 (0.84–0.98)), endometriosis (0.82 (0.69–0.97)), and prostate disorder ). As Additional file When analyzing diseases in the life course, 55 out of 60 diseases were significantly associated with incident mortality after adjustment for false discovery rate. In the multivariable analysis, the highest HRs (95% CIs) for diseases that were significantly associated with incident mortality were 3.76 (3.48–4.07) for ovarian cancer, 3.22 (3.14–3.31) for other cancer, 2.98 (2.84–3.13) for lung cancer, 2.37 (2.17–2.59) for oesophageal cancer, and 2.20 (2.06–2.35) for Parkinson’s disease , followed by CVD (n=6702). There were 2.2% (n=702) of deaths who did not have a diagnosis of any disease of interest using questionnaires or inpatient data before mortality. The percentages of deaths who were diagnosed with 1, 2, 3, 4, 5, or ≥6 (6–14) diseases were 7.7%, 12.8%, 15.7%, 15.8%, 14.5, and 31.3%, respectively. Individuals without being diagnosed with any disease of interest in life course were more likely to be younger and male and have higher levels of education, income, and total cholesterol, but lower levels of HbA1c compared to those with one or more diseases : 70.7 (65.3–74.8) years, 59.4% male) were included in the disease trajectory analysis. The leading cause of mortality was cancer  among individuals who were diagnosed with one disease in their life course. Among individuals who were diagnosed with two diseases in the life course, the median time from initial diagnosis of the primary disease to mortality was 10.4 years (IQR 3.3–19.5) and the number for the secondary disease was 1.7 years (IQR 0.8–5.9). Among individuals who were diagnosed with three or more diseases in the life course, the median time from initial diagnosis of the primary disease to mortality ranged from 14.3 IQR 7.1–24.1) to 24.1 years (IQR 16.6–35.8) and the number for the last disease ranged from 0.9 (IQR 0.5–1.6) to 5.0 years  or cancer (16.9%) as the primary disease. A large proportion of CVD as the tertiary disease was diagnosed following cancer (25.0%), hypertension (19.2%), or digestive disorders (10.1%) as the secondary disease. A large proportion of cancer as the secondary disease was diagnosed following hypertension (49.5%) or digestive disorders (26.8%) as the primary disease. The proportion of cancer as the tertiary disease was diagnosed following digestive disorders or hypertension as the secondary disease was 19.5% or 17.9%, respectively  were overlapped in both analyses , 48 out of 60 diseases were significantly associated with incident mortality after adjustment for false discovery rate. Migraine, endometriosis, and glaucoma were significantly associated with mortality in the main analysis but not in the sensitivity analysis. Irritable bowel syndrome was associated with a decreased risk of mortality after adjustment for age and gender in the sensitivity analysis but not in the main analysis. In the multivariable analysis, an inverse association between irritable bowel syndrome and mortality was observed in both sensitivity and main analyses. All other diseases , they had shorter longevity compared to those who were diagnosed with one or more diseases in life course even when those who died from external reasons were excluded from the analysis. As the reduction in longevity was possibly due to the unawareness of diseases in those individuals, it is imperative to screen diseases, especially CVD and neurogenerative/mental disorders among middle-aged adults. Higher total cholesterol but lower HbA1c was observed in this subgroup of individuals. As further analysis showed that individuals with fewer diseases were more likely to have fewer deadly diseases  in the life course among individuals who died prematurely. This is consistent with a previous study demonstrating that cancer was the leading cause of life years lost and life years lost due to cancer increased by 16% from 1995 to 2015 . Around A systematic analysis for the Global Burden of Disease Study showed that hypertension is the leading contributor to global mortality . We founTo our knowledge, this is the first study to examine the disease trajectory in the life course based on a large population cohort. There are several potential limitations in our study. Firstly, most cases of many chronic conditions at baseline including hypertension, high cholesterol, stroke, asthma, depression, and anxiety were captured by self-reported data (Additional file Cancer is frequently diagnosed following hypertension, or digestive disorders, and is more likely to be diagnosed ahead of CVD, CKD, or digestive disorders. Whilst CVDs are more likely to be diagnosed following hypertension, cancer, or digestive disorders and more likely to be diagnosed ahead of cancer or CKD in the life course. Hypertension tends to precede other diseases and CKD tends to follow other diseases before mortality. Our findings also underline the importance of health check for the prevention of premature mortality given no diagnosed disease was identified before mortality in some people.Additional file 1: Table S1. Field codes for diseases of interest. Table S2. ICD codes for diseases of interest. Table S3. Matching analysis for diseases that were inversely associated with incident mortality. Table S4. Classification of diseases. Table S5. Death and the number of diseases. Table S6. Baseline characteristics of participants by mortality. Table S7. Disease contribution among individuals who were diagnosed with one disease only in life-course. Table S8. Risk for mortality associated with individual diseases of interest at baseline among individuals with complete data. Table S9. Prevalence of individual diseases by a number of diseases in life-course. Table S10. Number of events at baseline captured by self-reported and inpatient data.Additional file 2: Figure S1. Proportional hazards assumption test for cardiometabolic disorders and incident mortality. Figure S2. Proportional hazards assumption test for cardiometabolic disorders and incident mortality. Figure S3. Proportional hazards assumption test for cancers and incident mortality. Figure S4. Proportional hazards assumption test for musculoskeletal disorders, digestive disorders and incident mortality. Figure S5. Proportional hazards assumption test for other diseases and incident mortality.Additional file 3: Figure S6. Risk for mortality associated with individual diseases of interest in life-course. Figure S7. Disease trajectory in life-course among individuals who were diagnosed with two diseases before dying from any reasons. Figure S8. Disease trajectory in life-course among individuals who were diagnosed with three diseases before dying from any reasons. Figure S9. Disease trajectory in life-course among individuals who were diagnosed with four diseases before dying from any reasons. Figure S10. Disease trajectory in life-course among individuals who were diagnosed with five diseases before dying from any reasons. Figure S11. Disease trajectory in life-course among individuals who were diagnosed with six or more diseases before dying from any reasons.Additional file 4: Figure S12. Disease trajectory in the whole life-course among individuals who were diagnosed with two diseases before dying from cancer. Figure S13. Disease trajectory in the whole life-course among individuals who were diagnosed with three diseases before dying from cancer. Figure S14. Disease trajectory in the whole life-course among individuals who were diagnosed with four diseases before dying from cancer. Figure S15. Disease trajectory in the whole life-course among individuals who were diagnosed with five diseases before dying from cancer. Figure S16. Disease trajectory in the whole life-course among individuals who were diagnosed with six or more diseases before dying from cancer. Figure S17. Disease trajectory in the whole life-course among individuals who were diagnosed with two diseases before dying from cardiovascular disease. Figure S18. Disease trajectory in the whole life-course among individuals who were diagnosed with three diseases before dying from cardiovascular disease. Figure S19. Disease trajectory in the whole life-course among individuals who were diagnosed with four diseases before dying from cardiovascular disease. Figure S20. Disease trajectory in the whole life-course among individuals who were diagnosed with five diseases before dying from cardiovascular disease. Figure S21. Disease trajectory in the whole life-course among individuals who were diagnosed with six or more diseases before dying from cardiovascular disease.


Pigs were fed one of three cornstarch-based diets with either MSPC1 or MSPC2 or SBM as the sole source of AA at a rate of 2.8 times the estimated maintenance energy requirement. In each period, pigs were adapted to diets for 7 d followed by 2 d of fecal collection and subsequently, 2 d of continuous ileal digesta collection for 8 h. The SID of AA was calculated using basal endogenous losses from a previous study for pigs fed a nitrogen-free diet. The digestible energy of the ingredients was calculated according to the difference method using a nitrogen-free diet that contained the same cornstarch:sucrose:oil ratio as the three test diets. The total Lys content was 33% and 38% greater for MSPC1 vs. MSPC2 and SBM, respectively. The SID of crude protein was greater for MSPC1 (96.9%) than for SBM , whereas an intermediate value was observed for MSPC2 (94.3% ± 1.2%). The SID of Ile (93.8%), Leu (93.6%), Lys (93.9%), Phe (96.7%), and Val (93.2%) were not different between MSPC1 and MSPC2 but greater than for SBM . The SID of His and Thr was greater for MSPC1 than MSPC2 and SBM (P < 0.05), which were not different. The SID of Met was greater for MSPC1 and SBM vs. MSPC2 (P < 0.05). The SID of Arg was greater for MSPC1 than MSPC2 and SBM (P < 0.05), and greater for MSPC2 than SBM (P < 0.05). The digestible energy was greater for MSPC1  than MSPC2 and SBM , which were not different. Therefore, the MSPC1 was a better source of SID Lys and digestible energy than either MSPC2 or SBM and could be used as a highly digestible protein ingredient in swine rations.Six ileal-cannulated barrows  were used in a replicated 3 × 3 Latin square design with one additional period ( Soybean products are commonly used as protein sources in swine diets globally . HoweverAnimal care and use protocols were approved by the University of Guelph Animal Care and Use Committee (AUP #4439). Pigs were cared for in accordance with the Canadian Council on Animal Care guidelines .The two MSPC batches were obtained after pH reduction, drying, and sifting from two different lots  and SBM from University of Guelph feed mill . Pigs were weighed at the start of each experimental period to determine individual feed allowance  were obtained from the University of Guelph Arkell Swine Research Station  and housed individually in a temperature-controlled room (20 to 22 °C) for 7 d prior to surgery. Pigs were surgically fitted with a simple T-cannula at the distal ileum followed by a 1-wk postsurgical recovery period . The surEach experimental period lasted for 10 d, with a 7-d adaptation period, followed by 2 d of fecal collection, and subsequently, 2 d of continuous ileal digesta collection for 8 h after the morning meal. For fecal collection, fresh samples were collected twice per day after pen washing and pooled per pig per period. For ileal digesta collection, 10 mL of 10% formic acid was added to a collection bag and then attached to the cannula using an elastic band and was replaced as needed. Digesta was stored in the refrigerator (~4 °C) during collection and pooled per pig per period. Fecal and ileal digesta samples were then stored at −20 °C until analysis.2O2 after precipitate settled in 100-mL volumetric flasks) and measured using a UV spectrophotometer. The experimental diets and fecal samples were analyzed for gross energy (GE) using a bomb calorimeter  and neutral detergent fiber (NDF) according to Prior to analysis, fecal and ileal digesta samples were freeze-dried and finely ground. The particle sizes of test ingredients were determined using a RO-TAP Sieve Shaker . Test ingredients, experimental diets, fecal, and ileal digesta samples were analyzed for DM  and standard ileal digestibility (SID) of crude protein and AA contents were calculated according to P < 0.05), differences among individual means were assessed using the Tukey–Kramer post hoc test. A probability of P < 0.05 was considered significant, whereas 0.05 < P ≤ 0.10 was considered a tendency.All data were analyzed using the GLIMMIX procedure of SAS . Individual pig was considered the experimental unit. The fixed effects of diet and the random effects of period and diet fed within period were included . When appropriate , which were not different (P < 0.001), and greater for MSPC2 than SBM (P < 0.001). The AID of Ile, Leu, Val, Ala, and Ser was not different between MSPC1 and MSPC2, but was greater for both MSPC1 and MSPC2 vs. SBM (P < 0.005). The AID of Met and Cys was greater for MSPC1 and SBM vs. MSPC2 (P < 0.001), the AID of Phe was greater for MSPC1 than SBM (P < 0.05) and intermediate for MSPC2, and the AID of Pro was greater for MSPC1 than MSPC2 (P < 0.05) and intermediate for SBM.The AID of crude protein, His, Thr, and Gly was greater for MSPC1 vs. MSPC2 and SBM (ifferent . The AIDP < 0.005), whereas MSPC2 was intermediate (P < 0.001), and greater for MSPC2 than SBM (P < 0.001). The SID of His, Thr, Gly, and Pro was greater for MSPC1 than either MSPC2 or SBM (P < 0.05), which were not different. The SID of Ile, Leu, Lys, Phe, Val, Ala, and Ser was greater for both MSPC1 and MSPC2 vs. SBM (P < 0.005) and the SID of Met and Cys was greater for both MSPC1 and SBM vs. MSPC2 (P < 0.005).The SID of crude protein was greater for MSPC1 than SBM (rmediate . The SIDP < 0.01) and intermediate for SBM (P < 0.005), which were not different.The ATTD of GE (%) was greater for MSPC1 than MSPC2  fed to growing pigs, of which both MSPC1 and MSPC2 were digestible sources of AA. However, MSPC1 had 33% and 38% greater total Lys content vs. MSPC2 and SBM, respectively, which when combined with the SID coefficients, resulted in 35% and 46% greater SID Lys content . Moreover, the MSPC1 had 7% greater GE than SBM and greater ATTD of GE vs. MSPC2, resulting in greater DE values for MSPC1 vs. either MSPC2 or SBM, despite relatively greater NDF contents. The improvements in SID Lys and DE for MSPC1 could be partially mediated by relatively smaller, though more variable, particle size vs. MSPC2 and SBM . TherefoIn the current study, the crude protein and Lys contents and the SID coefficients for SBM closely reflect the values determined in previous studies e.g.,  when conHighly digestible protein ingredients are often included in pig diets for the first phase(s) after weaning to attenuate the postweaning growth lag caused by exposure to novel pathogens and food allergens, an immature gastrointestinal tract, and other environmental stressors that reduce feed intake . Based oThe use of MSPC to partially replace SBM in broiler chick diets improved ADG and feed efficiency during the first week after hatch and reduced plasma uric acid concentration and improved breast yield at 42 d of age, which indicates an improvement in postabsorptive utilization of AA for net protein gain . Better In summary, further processing of soybean products to generate MSPC generally improved the SID of crude protein and AA and DE contents. However, for some products, overheating may have occurred during processing, specifically reducing the SID Lys content. Therefore, the MSPC1 was a better source of SID Lys and DE than either MSPC2 or SBM and could be used as a highly digestible protein ingredient in swine rations.