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We describe a 9-year-old male who suffered a linear, non-displaced scaphoid fracture following a pedestrian motor vehicle accident. Initially, X-ray imaging failed to detect the fracture, but MRI confirmed the diagnosis, highlighting the challenges in identifying scaphoid fractures in pediatric patients due to the bone's cartilaginous nature in this age group. The patient was treated with immobilization using a Plaster of Paris cast, consistent with standard management for non-displaced fractures in children. He experienced pain improvement and achieved bone union after eight weeks, returning to normal activities without complications. The discussion emphasizes the rarity of scaphoid fractures in children under 10 and underscores the increasing incidence of such injuries in pediatric populations due to sports participation. A comparative analysis of similar cases in children of different ages is included, demonstrating variations in fracture types, treatment approaches, and outcomes, providing valuableinsights into the management of pediatric scaphoid fractures.

Our case details the atypical presentation of postpartum pituitary apoplexy in a 20-year-old female, who exhibited general weakness, dizziness, and brief loss of consciousness following an uncomplicated vaginal delivery. Despite normal vital signs except for bradycardia, imaging revealed a pituitary hemorrhage, leading to the diagnosis of pituitary apoplexy. Managed conservatively with IV hydrocortisone and intensive care, the patient experienced persistent bradycardia and severe abdominal pain, requiring transfer to another ICU. This case highlights the diagnostic challenges posed by the rarity and complexity of pituitary apoplexy during pregnancy and the postpartum period, emphasizing the importance of early diagnosis and tailored treatment strategies. The discussion further contrasts this case with existing literature, particularly in the context of postpartum pituitary apoplexy, and explores the broader implications for managing such rare cases, reinforcing the viability of conservative management in the absence of visual field disturbances.

Introduction: Leiomyosarcoma (LMS) is a malignancy with smooth muscle differentiation. Metastatic LMS is associated with poor prognosis and limited efficacy of systemic treatment. Novel treatment modalities are desperately needed for this entity. Case Presentation: We report the first use of pembrolizumab plus pharmacologic ascorbate in 3 patients with metastatic LMS. All cases resulted in persistent objective responses and disease control significantly better than has been reported with chemotherapy or other immunotherapeutic approaches. Three patients with metastatic LMS, one each of uterine, vascular, and soft tissue origin, were treated with pembrolizumab plus pharmacologic ascorbate. The patient with uterine LMS received combination therapy at presentation and had persistent response for 12 months, which is ongoing. The patient with metastatic LMS of the inferior vena cava received combination therapy at presentation and had persistent response for 12 months, at which time new metastases were found. The patient with soft tissue LMS had disease progression on pembrolizumab monotherapy prior to the addition of ascorbate, after which she had a 17-month response, which is ongoing. No side effects attributed to treatment were reported. Conclusion: Pembrolizumab plus pharmacologic ascorbate is a novel immunotherapeutic approach and warrants further study in LMS.

Abstract Background Diabetes mellitus (DM) is a major public health concern with considerable morbidity and mortality. DM affects patients’ quality of life and can lead to multiple complications, including chronic kidney disease (CKD) and the need for dialysis. Higher patient activation can improve health outcomes in hemodialysis patients with DM. This study aimed to explore the factors associated with higher patient activation and health-related quality of life (HRQoL) among hemodialysis patients with DM. Methods This was a cross-sectional, questionnaire-based study conducted on hemodialysis patients with DM in Palestine. The quota sampling method was utilized to draw samples from six dialysis centers. The questionnaire consists of three sections. The first section includes demographic, socioeconomic and clinical questions. The second section utilizes the patient activation measure-13 (PAM-13) to measure patient activation, while the third section assesses HRQoL using the EQ-5D-5 L tool and the visual analog scale (VAS). Mann‒Whitney and Kruskal‒Wallis tests were employed to examine the relationships between variables at the bivariate level, and multiple regression analysis was employed at the multivariate level. Results Of the 200 patients who were approached, 158 were included. The median PAM, EQ-5D index, and VAS score were low at 51.0, 0.58, and 60.0, respectively. A higher PAM score was independently associated with a higher household income level and taking medications independently. A higher EQ-5D index was associated with taking more than eight medications, taking medications independently, living with fewer than three comorbid conditions, and having a higher PAM. A higher VAS score was associated with being married, and receiving less than 3.5 hours of hemodialysis. Conclusions A higher patient activation level was associated with a higher income level and independence in taking medications. Interventions designed to improve patient activation, such as medication management programs, should address these factors among the target population. Longitudinal studies are needed to assess the time effect and direction of causation between health status and patient activation.

This study aims to demonstrate the electronic payment channels applied in Jordanian Islamic banks and their impact on the profitability of these banks during the period 2015-2020. The study used the descriptive analytical approach to reach the objectives of the study. The study included three Jordanian Islamic banks, One of the most important results of the study that there is a statistically significant effect of mobile phone applications, ATMs, and internet banking in Jordanian Islamic banks on the ROA, and that there is no statistically significant effect of all electronic payment channels in Jordanian Islamic banks on the ROE. The study recommended that the Islamic banks should make intensive marketing efforts to attract many dealers to increase the volume of transactions in electronic payment channels, work to increase their banking technological awareness, and encourage innovation in the field of electronic payment.

IntroductionCarotenoids are naturally occurring pigments in plants and are responsible for the orange, yellow, and red color of fruits and vegetables. Carrots are one of the primary dietary sources of carotenoids. The biological activities of carotenoids in higher organisms, including their immunomodulatory activities, are well documented in most tissues but not the large intestine. The gastrointestinal barrier acts as a line of defense against the systemic invasion of pathogenic bacteria, especially at the colonic level.MethodsTo test whether carotenoids in orange carrots can alleviate obesity-associated gut inflammation and strengthen the intestinal barrier function, male C57BL/6J mice were randomized to one of four experimental diets for 20 weeks (n = 20 animals/group): Low-fat diet (LFD, 10% calories from fat), high-fat diet (HFD, 45% calories from fat), HFD with white carrot powder (HFD+WC), or HFD with orange carrot powder (HFD + OC). Colon tissues were harvested to analyze the biochemical effects of carotenoids in carrots. The distal sections were subjected to isobaric labeling-based quantitative proteomics in which tryptic peptides were labeled with tandem mass tags, followed by fractionation and LC-MS/MS analysis in an Orbitrap Eclipse Tribrid instrument.ResultsHigh-performance liquid chromatography results revealed that the HFD+WC pellets were carotenoid-deficient, and the HFD+OC pellets contained high concentrations of provitamin A carotenoids, specifically α-carotene and β-carotene. As a result of the quantitative proteomics, a total of 4410 differentially expressed proteins were identified. Intestinal barrier-associated proteins were highly upregulated in the HFD+OC group, particularly mucin-2 (MUC-2). Upon closer investigation into mucosal activity, other proteins related to MUC-2 functionality and tight junction management were upregulated by the HFD+OC dietary intervention.DiscussionCollectively, our findings suggest that carotenoid-rich foods can prevent high-fat diet-induced intestinal barrier disruption by promoting colonic mucus synthesis and secretion in mammalian organisms. Data are available via ProteomeXchange with identifier PXD054150.

This study examines the impact of Artificial Intelligence (AI) on the field of education, with particular focus on its implications for academic integrity and the adoption of comprehensive assessment approaches. This research fits within the specific setting of university students and faculty members in the Kingdom of Bahrain.MethodsA cross-sectional survey was designed to examine the impact Artificial Intelligence (AI) in field of education, with particular focus on its implications for academic integrity and the adoption of comprehensive assessment approaches. A total of 218 participants were randomly selected from 250 employed in this survey study.ResultsOut of 250 invited participants, 203 responded to the survey. This study evaluated the influence of Educational Impact (EI), Policy and Ethics (PE), and Pedagogical Implications (PI) on Academic Outcomes (AO). Results revealed a significant association between EI → AO with a beta of 0.490, t-value of 4.504, and p

Background In this open-label, randomized, non-comparative, multicenter phase II study (Alliance A091401) we report on three expansion cohorts treated with nivolumab (N) with and without ipilimumab (N+I) and provide a multi-omic correlative analysis of actionable biomarkers.Methods Patients were randomized (non-comparative) to receive either N or N+I. The primary endpoint was a 6-month confirmed response rate (CRR) defined by Response Evaluation Criteria in Solid Tumors version 1.1. Secondary endpoints included treatment-related adverse events (TRAEs), progression-free survival, and overall survival. Multi-omic correlative analyses were conducted using samples from both the primary and expansion cohorts.Results A total of 66 patients were evaluated for the primary endpoint with disease including gastrointestinal stromal tumor (GIST, n=18), undifferentiated pleomorphic sarcoma (UPS, n=24), and dedifferentiated liposarcoma (DDLPS, n=24). Neither N nor N+I achieved a complete or partial response in the GIST expansion cohort. In DDLPS and UPS, the primary response endpoint of CRR was met with N+I (both 16.6%, 2/12) but not with N alone (both 8.3%, 1/12). In the GIST cohort, TRAE was higher with N+I treatment, halting enrollment as required per protocol. In a correlative analysis of patients for the expansion cohort and the original cohort (n=86), traditional biomarkers of immunotherapy response were not correlated with response in any histological subtype. Markers of genomic instability including the presence of gene fusions and increased subclonal mutations correlated with improved clinical outcomes.Conclusions This expansion cohort reaffirms the outcomes of A091401. There remains a pressing need to determine the role of and predictive biomarkers for immunotherapy in sarcoma.Trial registration number NCT02500797.

خلفية البحث: تتطلب إمكانية قبول الطعم الجلدي بواسطة سرير الجرح اتصالاً مباشراً بين الاثنين للسماح بالانتشار الأمثل للمواد المغذية. إن تثبيت الطعم مفيد لهذا الغرض في منع تشكل الورم المصلي والتمزق. ومن طرق التثبيت المستخدمة الخياطة باستخدام القطب العابرة، تتضمن الخياطة العابرة وضع الغرز الأساسية على سطح الطعم، وقطب أخرى عابر بين مركز الطعم والسرير المستقبل معاً، لزيادة الثباتية والالتصاق على الأرضية وبالتالي تكييفه جيدًا مع السرير المتلقي. الهدف: هدفنا في هذه الدراسة إلى تقييم فعالية الضماد الضاغط مقارنة بالقطب الجلدية العابرة في تثبيت الطعوم الجلدية كاملة السماكة من حيث زمن الشفاء التام ونسبة حدوث المضاعفات. مواد وطرائق البحث: بـعـد موافقة المرضى على الدخول في عينة الدراسة، أجري تنضير جيد لسرير الجرح وبعدها أجري طعم كامل السماكة للجرح وتم تطبيق الضماد. تم توزيع المرضى عشوائياً الى مجموعتين، في المجموعة الأولى: المرضى الذين أجري لهم طعم جلدي كامل السماكة مع تطبيق ضماد ضاغط. وفي المجموعة الثانية: المرضى الذين أجري لهم طعم جلدي كامل السماكة مع تثبيت عبر القطب الجلدية العابرة. عدد القطب المستخدمة ونوع الخيط كان مختلفاً بحسب موقع وحجم كل ضياع مادي. بعد تطبيق الضماد تمت متابعة المرضى في اليوم الخامس من العمل الجراحي وكشف الضماد والتأكد من حيوية الطعم، ثم توبع المرضى بعد شهر للتأكد من النجاح الكامل للطعم والتحقق من وجود أي اختلاط. النتائج: شملت الدراسة 36 مريضاً، تراوحت أعمار المرضى في العينة بين 19-63 سنة، كان عدد المرضى الذكور في العينة 21 مريضاً (58.3%)، أما الإناث 15 مريضةً (41.7%). كانت الضياعات المادية الناجمة عن العمليات الجراحية هي السبب الأشيع (16 مريضاً)، وكان أشيع مكان لتوضع الإصابات كان في الوجه والعنق عند 19 مريضاً، تراوح متوسط مساحة الضياع المادي لدى مرضى العينة 6.8 ± 0.5 سم2، وبلغت مدة الإجراء بين (40-60) دقيقة، حدث تموت في الطعم بعد 5 أيام، كان 6 مرضى منهم من المجموعة الأولى، ومريضين فقط من المجموعة الثانية، أما بعد شهر من المتابعة وجد تموت في الطعم عند 3 مرضى من المجموعة الأولى، واثنان من المجموعة الثانية، كان متوسط زمن الشفاء عند المرضى 17.2 ± 2.8 يوماً، تراوح متوسط مدة الاستشفاء لدى مرضى المجموعة الأولى 5.9 يوماً ± 1.2، وعند أولئك في المجموعة الثانية 5.1 يوماً ± 0.9. أما عدد مرات الضماد فقد كانت في المجموعة الأولى 15.2 يوماً ± 2.7، وفي المجموعة الثانية كان 9.7 يوماً ± 3.2. بلغ عدد المرضى الذين حدثت لديهم اختلاطات أثناء فترة المتابعة 19 مريضاً (52.8%). الاستنتاجات: قللت القطب العابرة من مدة العمل الجراحي، واختلاطات ما بعد العمل الجراحي، كما قللت من عدد مرات الضماد ومدة الاستشفاء عند المرضى، ما أدى إلى تقليل التكاليف وتحقيق الراحة للطبيب والمريض على حد سواء، ولذلك فإننا نفضل استخدام القطب العابرة في تثبيت الطعوم.

خلفية البحث: تتطلب إمكانية قبول الطعم الجلدي بواسطة سرير الجرح اتصالاً مباشراً بين الاثنين للسماح بالانتشار الأمثل للمواد المغذية. إن تثبيت الطعم مفيد لهذا الغرض في منع تشكل الورم المصلي والتمزق. ومن طرق التثبيت المستخدمة الخياطة باستخدام القطب العابرة، تتضمن الخياطة العابرة وضع الغرز الأساسية على سطح الطعم، وقطب أخرى عابر بين مركز الطعم والسرير المستقبل معاً، لزيادة الثباتية والالتصاق على الأرضية وبالتالي تكييفه جيدًا مع السرير المتلقي. الهدف: هدفنا في هذه الدراسة إلى تقييم فعالية الضماد الضاغط مقارنة بالقطب الجلدية العابرة في تثبيت الطعوم الجلدية كاملة السماكة من حيث زمن الشفاء التام ونسبة حدوث المضاعفات. مواد وطرائق البحث: بـعـد موافقة المرضى على الدخول في عينة الدراسة، أجري تنضير جيد لسرير الجرح وبعدها أجري طعم كامل السماكة للجرح وتم تطبيق الضماد. تم توزيع المرضى عشوائياً الى مجموعتين، في المجموعة الأولى: المرضى الذين أجري لهم طعم جلدي كامل السماكة مع تطبيق ضماد ضاغط. وفي المجموعة الثانية: المرضى الذين أجري لهم طعم جلدي كامل السماكة مع تثبيت عبر القطب الجلدية العابرة. عدد القطب المستخدمة ونوع الخيط كان مختلفاً بحسب موقع وحجم كل ضياع مادي. بعد تطبيق الضماد تمت متابعة المرضى في اليوم الخامس من العمل الجراحي وكشف الضماد والتأكد من حيوية الطعم، ثم توبع المرضى بعد شهر للتأكد من النجاح الكامل للطعم والتحقق من وجود أي اختلاط. النتائج: شملت الدراسة 36 مريضاً، تراوحت أعمار المرضى في العينة بين 19-63 سنة، كان عدد المرضى الذكور في العينة 21 مريضاً (58.3%)، أما الإناث 15 مريضةً (41.7%). كانت الضياعات المادية الناجمة عن العمليات الجراحية هي السبب الأشيع (16 مريضاً)، وكان أشيع مكان لتوضع الإصابات كان في الوجه والعنق عند 19 مريضاً، تراوح متوسط مساحة الضياع المادي لدى مرضى العينة 6.8 ± 0.5 سم2، وبلغت مدة الإجراء بين (40-60) دقيقة، حدث تموت في الطعم بعد 5 أيام، كان 6 مرضى منهم من المجموعة الأولى، ومريضين فقط من المجموعة الثانية، أما بعد شهر من المتابعة وجد تموت في الطعم عند 3 مرضى من المجموعة الأولى، واثنان من المجموعة الثانية، كان متوسط زمن الشفاء عند المرضى 17.2 ± 2.8 يوماً، تراوح متوسط مدة الاستشفاء لدى مرضى المجموعة الأولى 5.9 يوماً ± 1.2، وعند أولئك في المجموعة الثانية 5.1 يوماً ± 0.9. أما عدد مرات الضماد فقد كانت في المجموعة الأولى 15.2 يوماً ± 2.7، وفي المجموعة الثانية كان 9.7 يوماً ± 3.2. بلغ عدد المرضى الذين حدثت لديهم اختلاطات أثناء فترة المتابعة 19 مريضاً (52.8%). الاستنتاجات: قللت القطب العابرة من مدة العمل الجراحي، واختلاطات ما بعد العمل الجراحي، كما قللت من عدد مرات الضماد ومدة الاستشفاء عند المرضى، ما أدى إلى تقليل التكاليف وتحقيق الراحة للطبيب والمريض على حد سواء، ولذلك فإننا نفضل استخدام القطب العابرة في تثبيت الطعوم.

Abstract Background The COVID-19 pandemic has presented multiple psychological challenges for healthcare workers, such as anxiety, depression, burnout, and substance use disorders. In this research, we investigate the different ways Romanian physicians dealt with the difficult period of the COVID-19 pandemic. We also analyze how positive and negative stress-reducing strategies, as well as demographic variables, affect their psychological resilience and quality of life. Our goal is to provide a comprehensive overview of how physicians coped with the unprecedented global health challenges. Methods We carried out a national cross-sectional study of 265 physicians in Romania between January 2021 and January 2022 using a web-based questionnaire. The study employed a web-based questionnaire to assess coping mechanisms using the COPE inventory, resilience through the Connor-Davidson Resilience Scale 25 (CD-RISC 25), and quality of life via the WHOQOL-BREF scale. The COPE inventory, consisting of 60 items across 15 subscales, categorizes coping strategies into problem-focused, emotion-focused, and dysfunctional types, with each item rated on a 4-point scale. The CD-RISC 25 measures resilience on a 5-point Likert scale, with total scores ranging from 0 to 100. WHOQOL-BREF assesses quality of life through 26 items in 4 domains: physical, mental, social relations, and environmental, scored from 1 to 5 and converted to a 0–100 scale for domain scores. Univariate and multivariate linear regression models were employed to discern the intricate relationships between coping strategies, resilience levels, quality of life dimensions, and pertinent demographic factors. Results The average CD-RISC score among participants was 66.2. The mean scores for the values for the QOL subscales were 64.0 for physical well-being, 61.7 for psychological well-being, 61.2 for social relationships, and 64.7 for environment. Individuals tend to use problem-focused and emotion-focused coping more than dysfunctional mechanisms, according to the COPE inventory. Problem-focused and emotion-focused coping are positively correlated with resilience, while dysfunctional coping is negatively correlated. Resilience is significantly influenced by gender and professional status, with males and senior specialists reporting higher levels while younger physicians and residents reporting lower levels. Conclusions Our data points to specific protective characteristics and some detrimental factors on physicians' resilience and quality of life during the pandemic.

The perceptions of employees about their work and organization are influenced by a variety of attitudes. As a result, the impact of employee attitudes like job involvement (JI) and job satisfaction (JS) on organizational performance (service quality) is still unknown, and it is also uncertain how job involvement will mediate this relationship. Therefore, the goal of this work is to incorporate a mediating model to enhance Service Quality (SQ) through JI and JS and explore how that model can improve and sustain SQ in institutions of higher learning in poor nations. This work utilized a conceptual integration between service providers and how well the service is received by customers. It applied dual-perspective and the cross-sectional, ex-post facto survey method by using two sets of questionnaires, and a two-sample study design was used to obtain data from the respondents. For this study, the sample size consisted of the lecturers (296 participants) and their students (1480 participants). SEM was utilized to examine the data that had been gathered. The data analysis revealed that JS had a sizable influence on JI and SQ (i.e. the caliber of the lectures they heard in class that influenced their learning capabilities). JI had a significant impact on SQ and partly mediated the impact of JS & and SQ. This research adds to knowledge by connecting the JI, JS of employees and SQ perceived by customers. In order to promote SQ, employees JI and JS are essential. This study also has practical applications for students, employees, organizations and society.

This study examined the mediating effect of school culture on the relationship between transformational leadership and teaching performance in Yemeni public schools. A stratified random sample of 375 teachers from schools in Sana’a, Yemen, was selected to participate. Data were collected through questionnaires and analyzed using structural equation modeling with SmartPLS 3. The results showed that transformational leadership and a positive school culture significantly predicted better teaching performance. Furthermore, school culture mediated the positive relationship between transformational leadership and teaching performance. These findings provide valuable insights for school leaders on the critical role of school culture in achieving teaching excellence. The results also shed light on mechanisms to improve school culture and educational leadership to implement policies for better student outcomes. Thus, this study addressed a gap in research on the connections between leadership styles, teaching performance, and school culture in the understudied context of Yemen’s education system.

Heart failure (HF) increases the risk of developing atrial fibrillation (AF), leading to increased morbidity and mortality. Therefore, better prediction of this risk may improve treatment strategies. Although several predictors based on clinical data have been developed, the establishment of a transcriptome-based predictor of AF incidence in HF has proven to be more problematic. We hypothesized that the transcriptome profile of coronary sinus blood samples of HF patients is associated with AF incidence. We therefore enrolled 192 HF patients who were selected for biventricular cardioverter defibrillator implantation. Both coronary sinus and peripheral blood samples were obtained during the procedure. Patients were followed-up during two years and AF occurrence was based on interrogation of the defibrillator. A total of 96 patients stayed in sinus rhythm (SR) during follow-up, 13 patients developed AF within 1 year and 10 patients developed AF during the second year of follow up. Gene expression profiling of coronary sinus samples led to the identification of 321 AF predictor genes based on their differential expression between patients developing AF within 1 year of blood sampling and patients remaining in SR. The expression levels of these genes were combined to obtain a molecular atrial fibrillation prediction score for each patient which was significantly different between both patient groups (Mann-Whitney, p = 0.00018). We conclude that the cardiac blood transcriptome of HF patients should be further investigated as a potential AF risk prediction tool.

This paper aims to explore the nexus between leadership emotional intelligence and employee engagement within Palestine’s information and communication technology sector. It seeks to fill a research gap by highlighting the impact of leaders’ emotional intelligence on fostering a committed workforce. The study used a quantitative approach and a descriptive research design. Its target population was 5,281 full-time employees in Palestine’s ICT sector, and 328 employees were sampled through probability multistage random sampling. The sample was split into groups based on job types and companies with more than 50 employees. The study’s findings corroborate the hypothesized positive effect, with statistical analysis revealing that emotional intelligence directly influences employee engagement levels within the ICT context (Beta = 0.302; P-value = 0.000). Although highlighted as a crucial element, emotional intelligence is designated as only part of a complex engagement equation that requires further investigation into additional contributing factors, such as different dimensions of emotional processing. AcknowledgmentThe authors express their gratitude to Gulf University for the significant financial resources that facilitated the publication of this work.

Abstract Background Cryoballoon ablation is safe and effective for pulmonary vein isolation in patients with symptomatic drug‐refractory paroxysmal atrial fibrillation. To monitor adhesion between the balloon and the pulmonary vein, an alternative technique to pulmonary venography is to analyze changes in the pressure curve. Methods We have described the adhesion level characterized by four types of pressure waveforms. Results These correlated with the extent of contrast agent leakage (Cohen's kappa of 0.81 [IC 95%: 0.63–0.99]). Conclusion Monitoring the venous pressure curve is easy to perform and has the advantage of being able to detect balloon movement during the first few seconds of treatment.

Este trabalho, baseado em amostra nacional representativa da população com 50 anos ou mais, objetivou estimar a prevalência da fragilidade entre homens e mulheres, identificar fatores sociodemográficos e de saúde associados e estimar a fração atribuível populacional. Foram utilizados dados da segunda onda (2019-2021) do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil). A fragilidade foi classificada pelo número de itens positivos entre perda de peso não intencional, exaustão, baixo nível de atividade física, lentidão da marcha e fraqueza. As análises principais foram baseadas na regressão logística multinomial estratificada por sexo. A prevalência da fragilidade foi menor nos homens (8,6%; IC95%: 6,9; 10,7) do que nas mulheres (11,9%; IC95%: 9,6; 14,8), sendo o item mais frequente o baixo nível de atividade física em ambos. A idade e a escolaridade foram os fatores sociodemográficos associados à pré-fragilidade e à fragilidade entre homens e mulheres. Houve diferença da fração atribuível populacional para fragilidade entre os sexos. Nos homens, a maior fração atribuível populacional foi para não ter companheiro (23,5%; IC95%: 7,7; 39,2) e escolaridade baixa (18,2%; IC95%: 6,6; 29,7). Nas mulheres, maiores frações atribuíveis populacionais foram para déficit de memória (17,1%; IC95%: 7,6; 26,6), déficit da visão (13,4%; IC95%: 5,1; 21,7) e diabetes mellitus (11,4%; IC95%: 4,6; 18,1). Observou-se fração atribuível populacional semelhante para doença cardíaca (8,9%; IC95%: 3,8; 14,1, em mulheres; e 8,8%; IC95%: 2,0; 15,6, em homens). Estratégias voltadas para a prática de atividade física têm o potencial de prevenir a fragilidade em ambos os sexos, enquanto a prevenção de condições crônicas é mais importante nas mulheres.

الأهداف: هدفت الدراسة التعرف إلى مساهمة مؤسسات التمويل الأصغر الإسلامي في الأردن في تمويل المشروعات الصغيرة والمتوسطة، والتعرف إلى أهم التحديات التي تواجهها هذه المؤسسات. كما هدفت الدراسة إلى تقييم تجربة الشركة النموذجية الإسلامية للتمويل الأصغر في تمويل المشروعات الصغيرة والمتوسطة خلال الفترة (2017-2022). المنهجية: استخدمت الدراسة المنهج الوصفي التحليلي في وصف وتحليل مؤسسات التمويل الأصغر الإسلامي والمشروعات الصغيرة والمتوسطة في الأردن، واستخدمت أسلوب دراسة حالة لدراسة حالة الشركة النموذجية الإسلامية للتمويل الأصغر. النتائج: خلصت الدراسة إلى أن المنشآت الصغيرة والمتوسطة ومتناهية الصغر تشكل ما يقارب 99.5% من إجمالي المنشآت العاملة في المملكة. وتساهم الشركة النموذجية الإسلامية للتمويل الأصغر في تمويل هذه المشروعات من خلال مجموعة متنوعة من المنتجات ومن أهمها منتج أعمالي، ومنتج مشروعي المنزلي، ومنتج انطلاقتي، ومنتج مزرعتي، ومنتج ورشتي. كما بلغت أعلى قيمة تمويل من قبل الشركة النموذجية الإسلامية للتمويل الأصغر لمشاريع الأعمال (1,783,373) دينار وللمشاريع المنزلية (846,388) دينار في عام 2018. تواجه شركات التمويل الأصغر الإسلامي مجموعة من التحديات من أهمها عدم تنوع صيغ التمويل، والتكاليف العالية، والتثقيف والتدريب للعاملين، والمخاطر الائتمانية، والانتشار والوصول، والبيئة التنافسية، والتحول الرقمي. الخلاصة: لتطوير قدرة التمويل الأصغر الإسلامي في الأردن على تمويل المشروعات الصغيرة والمتوسطة، يجب تدريب وتطوير الموارد البشرية العاملة في مؤسسات التمويل الأصغر الإسلامي لتفعيل صيغ تمويل إسلامية متنوعة، والعمل على تعزيز الموارد المالية، وتشجيع إقامة مؤسسات إسلامية تسعى للتخفيف من مخاطر التمويل بالصيغ الإسلامية للمشروعات. توصي الدراسة كذلك التوسع في إقامة مؤسسات للتمويل الأصغر الإسلامية في الأردن، وضرورة تنويع وتطوير منتجات متوافقة مع أحكام الشريعة الإسلامية تلبي احتياجات العملاء.

The research aimed to study the contribution of the Islamic economy in reducing the unemployment problem caused by Corona pandemic (Covid-19) in the Jordanian labor market. The study used the descriptive analytical approach and the inductive approach. One of the most important results of the study was that the Corona pandemic and its accompanying economic repercussions had caused an increase in the unemployment rate in Jordan, and that the Islamic economics tools and institutions have contributed to mitigating this increase. The Jordanian Zakat Fund, Awqaf Funds Development Department, and donations to the Al-Khair Account, contributed to mitigating the economic effects of the Corona pandemic on the Jordanian labor market. Jordanian Islamic banks also contributed, through Al-Qard Al-Hasan, to mitigate the effects of the pandemic on unemployment. The study recommended the need to urge the rich to provide financial assistance in its forms, and encouraging investment in projects that employ large numbers of unemployed.

The study aims to examine the effect of employee loyalty on job performance in Bahrain. Further, it investigates the mediating effect of job satisfaction on the relationship between employee loyalty and job performance. One hundred two participants employed by Zain company were selected through an online convenience sampling technique. The study chose Zain, a telecommunication company in Bahrain, due to easy access to employees, interest in studying company culture/methods, collaboration opportunities, and Zain’s reputation for innovation. SmartPLS4 was used to investigate potential correlations between employee loyalty and job performance and how job satisfaction indirectly affects employee loyalty and job performance. Findings show that employee loyalty significantly influences job performance and job satisfaction. Further, job satisfaction is significantly associated with job performance. In terms of mediating effect, the study found that job satisfaction significantly influences the relationship between employee loyalty and job performance. Every variable studied had an impact on job performance. As a result, the current study’s hypotheses are all confirmed. The model of the study is well fit, as the R-square is greater than 51%. The main contribution of this study is the insight that job satisfaction is a substantial mediator of the relationship between employee loyalty and job performance. Through theoretical and practical contributions, this study offers valuable implications that might benefit managers at companies, including Zain company, as well as interested readers and researchers.

Os objetivos foram descrever a prevalência de baixo peso e excesso de peso, avaliados pelo índice de massa corporal (IMC), estratificada por sexo e faixa etária, e analisar as características sociodemográficas associadas ao IMC em mulheres e homens mais velhos. Trata-se de uma análise transversal de 8.974 participantes com ≥ 50 anos da linha de base do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil, 2015-16). O IMC foi classificado em baixo peso, eutrofia e excesso de peso de acordo com a idade do participante. Foi utilizado modelo de regressão logística multinominal, considerando-se as características sociodemográficas de mulheres e homens. Os resultados evidenciaram maior prevalência de excesso de peso nas mulheres em comparação aos homens (64,1% vs. 57,3%). Em ambos os sexos, a prevalência de baixo peso foi maior nos mais longevos, enquanto que o excesso de peso foi menor. Nas mulheres, a chance de baixo peso foi maior do que a chance de eutrofia naquelas solteiras/viúvas/divorciadas (OR = 1,95; IC95%: 1,42-2,66) e nas residentes na área rural (OR = 1,58; IC95%: 1,01-2,49), ao passo que a chance de excesso de peso foi menor do que a chance de eutrofia nas residentes na área rural (OR = 0,78; IC95%: 0,62-0,97) e em todas as macrorregiões geográficas relativas à Região Sul. Para os homens, a chance de excesso de peso foi menor do que a chance de eutrofia entre solteiros/viúvos/divorciados (OR = 0,58; IC95%: 0,48-0,69). Os mais ricos apresentaram menor chance de baixo peso (OR = 0,59; IC95%: 0,38-0,90), bem como maior chance de excesso de peso (OR = 1,52; IC95%: 1,20-1,92). Em conclusão, as características sociodemográficas associadas ao IMC diferiram entre os sexos.

Soft tissue sarcomas (STSs) are mesenchymal malignant lesions that develop in soft tissues. Despite current treatments, including radiation therapy (RT) and surgery, STSs can be associated with poor patient outcomes and metastatic recurrences. Neoadjuvant radiation therapy (nRT), while effective, is often accompanied by severe postoperative wound healing complications due to damage to the surrounding normal tissues. Thus, there is a need to develop therapeutic approaches to reduce nRT toxicities. Avasopasem manganese (AVA) is a selective superoxide dismutase mimetic that protects against IR-induced oral mucositis and lung fibrosis. We tested the efficacy of AVA in enhancing RT in STSs and in promoting wound healing. Using colony formation assays and alkaline comet assays, we report that AVA selectively enhanced the STS (liposarcoma, fibrosarcoma, leiomyosarcoma, and MPNST) cellular response to radiation compared to normal dermal fibroblasts (NDFs). AVA is believed to selectively enhance radiation therapy by targeting differential hydrogen peroxide clearance in tumor cells compared to non-malignant cells. STS cells demonstrated increased catalase protein levels and activity compared to normal fibroblasts. Additionally, NDFs showed significantly higher levels of GPx1 activity compared to STSs. The depletion of glutathione using buthionine sulfoximine (BSO) sensitized the NDF cells to AVA, suggesting that GPx1 may, in part, facilitate the selective toxicity of AVA. Finally, AVA significantly accelerated wound closure in a murine model of wound healing post RT. Our data suggest that AVA may be a promising combination strategy for nRT therapy in STSs.

(1) Background/Aim: People infected with SARS-CoV-2 may develop COVID-19 in a wide range of clinical severity. Pulmonary fibrosis is characterized by several grades of chronic inflammation and collagen deposition in the interalveolar space. SARS-CoV-2 infection has been demonstrated to cause lung fibrosis without a currently elucidated mechanism. Some studies emphasize the role of proinflammatory cytokines. This research studies the correlation of the released cytokines with mortality or lung injury in COVID-19 patients. (2) Methods: Electronic medical record data from 40 patients diagnosed with COVID-19 in the COVID-19 Department, Galilee Medical Center, Nahariya, Israel, were collected. Epidemiological, clinical, laboratory, and imaging variables were analyzed. The cytokine levels were measured upon admission and discharge. A correlation between cytokine levels and severity and mortality or lung involvement was undertaken. (3) Results: IFN-gamma and IL-10 are the most powerful risk factors for mortality in the COVID-19 patient groups in a multivariate analysis. However, in a univariate analysis, TGF-β, CXCL-10, IFN gamma, and IL-7 affected mortality in COVID-19 patients. MMP-7 was significantly correlated with a cytokine storm and a high 4-C (severity) score in COVID-19 patients. MMP-7, TGF-β, IL-10, IL-7, TNF-α, and IL-6 were correlated with high lung involvement in COVID-19 patients. Serum concentrations of IGF-1 were significantly increased upon discharge, but MMP-7 was decreased. (4) Conclusions: Proinflammatory cytokines predict clinical severity, lung fibrosis, and mortality in COVID-19 patients. High concentrations of TGF-β, CXCL-10, IL-10, IL-6, and TNF-α are correlated to severity and lung injury. However, certain cytokines have protective effects and higher levels of these cytokines increase survival levels and lower lung damage. High levels of INF-γ, IL-7, MMP-7, and IGF-1 have protection probabilities against lung injury and severity.

Objetivou-se identificar diferenças alimentares e antropométricas entre adultos mais velhos brasileiros (≥ 50 anos) residentes em áreas urbano-rurais. Trata-se de um estudo transversal com dados da segunda onda (9.949 participantes) do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil), de 2019-2021. Foram avaliados: consumo alimentar semanal de fruta/hortaliça, feijão e peixe; autopercepção do consumo de sal; ambiente alimentar (disponibilidade de fruta/hortaliça na vizinhança e produção própria de alimentos); e parâmetros antropométricos objetivos (índice de massa corporal [IMC] e circunferência da cintura [CC]). As análises foram ajustadas por escolaridade. Em comparação com as áreas urbanas, observaram-se nas rurais: menor consumo de fruta/hortaliça em cinco dias da semana ou mais (74,6% vs. 86,4%) e maior consumo adequado de sal (96,8% vs. 92,1%) - diferenças observadas para homens e mulheres. A CC elevada foi menor nas áreas rurais (61,9% vs. 68%), sendo significativa somente para homens. Houve menor disponibilidade de fruta/hortaliça na vizinhança (41,2% vs. 88,3%) e maior produção própria de alimentos (38,2% vs. 13,2%) nas áreas rurais. O consumo de fruta/hortaliça em cinco dias da semana ou mais foi menor nas áreas rurais quando houve disponibilidade de fruta/hortaliça na vizinhança e ausência de produção própria de alimentos. Há diversidade alimentar e nutricional entre áreas urbano-rurais. O incentivo ao consumo de fruta/hortaliça nas áreas urbanas deve considerar a disponibilidade de fruta/hortaliça na vizinhança, enquanto nas áreas rurais deve ser em conjunto com a produção do próprio alimento. O consumo adequado de sal e a manutenção da CC nos valores ideais devem ser reforçados nas áreas urbanas.

This comprehensive study explored the efficiency landscape of the Jordanian banking industry from 2006 to 2021, utilizing a dual-pronged approach. First, we assessed the efficiency scores of 15 commercial banks, comprising 13 conventional and 2 Islamic institutions, through data envelopment analysis (DEA). Secondly, we investigated the determinants influencing relative efficiency using the Tobit regression model. Our dataset, spanning 240 observations over 16 years, provides a nuanced examination of industry dynamics. DEA, specifically focusing on variable return to scale (VRS), unveils efficiency scores by accounting for scale inefficiencies. The research contributes insights into the operational efficacy of Jordanian banks and provides a robust methodology for understanding efficiency dynamics in the broader financial landscape. The results reveal significant relationships between return on assets, return on equity, GDP growth, and efficiency. Furthermore, it is noteworthy that Islamic banks demonstrate higher efficiency compared to conventional banks. Additionally, non-significant associations were observed with credit risk, bank size, and the ratio of loan loss provision over net income. The findings hold implications for policymakers, industry stakeholders, and researchers aiming to bolster the resilience and competitiveness of Jordan’s banking sector.

Individually, metabolic variations can significantly influence predisposition to obesity in the form of the obesity-prone (super-responders) and obesity-resistant (non-responders) phenotypes in response to modern calorie-dense diets. In this study, C57BL/6J mice (n = 76) were randomly assigned to either a low-fat diet (LFD) or a high-fat diet (HFD) for 6 weeks, followed by selection of the normally obese (HFD), non-responders (NR), super-responders (SR), or super-responders switched back to the low-fat diet (SR-LFD) for an additional 8 weeks. SR mice showed the highest gains in body weight, lean and fat body mass, and total and free water, in part due to increased feed efficiency, despite having a respiratory exchange ratio (RER) similar to that of NR mice. A switch to the LFD was sufficient to revert most of the observed physiological changes in the SR-LFD mice; however, voluntary physical activity and exercise capacity did not return to the basal level. NR mice showed the highest food intake, lowest feed efficiency, increased oxygen consumption during the light (rest) cycle, increased physical activity during the dark (active) cycle, and increased heat production during both cycles. These variations were observed in the absence of changes in food intake and fecal parameters; however, NR fecal lipid content was lower, and the NR fecal microbiome profile was characterized by reduced abundance of Actinobacteria. Taken together, our findings suggest that NR mice showed an increased ability to metabolize excessive dietary fats in skeletal muscle at the expense of reduced exercise capacity that persisted for the duration of the study. These findings underscore the need for further comprehensive investigations into the mechanisms of obesity resistance, as they hold potential implications for weight-loss strategies in human subjects.

This paper presents a comprehensive analysis of key financial indicators influencing the operational efficiency of banks in Jordan over the period 2006 to 2021. The study, focusing on fifteen commercial banks, employs seven regression models to assess the impact of selected variables on bank operating efficiency. Our findings reveal novel insights with substantial contributions to banking practice. We identify a statistically significant influence of both bank-specific factors and temporal effects, demonstrating the nuanced dynamics shaping the operational efficiency of Jordanian banks. Notably, a positive and significant correlation is established between the operating efficiency ratio and return on assets, bank size, and the ratio of loan loss provisions to net interest income, providing valuable strategic guidance for effective management. Conversely, a significant negative relationship is observed between the operating efficiency ratio and the total expense ratio, underscoring the critical importance of careful cost management. No significant associations are found between the operating efficiency ratio and credit risk, the equity-to-asset ratio, the deposit-to-liability ratio, and the equity-to-liability ratio. This study makes a unique contribution by shedding light on these previously unexplored correlations, offering actionable insights for enhancing operational efficiency in the banking sector. Additionally, our research advocates for the Central Bank of Jordan (CBJ) to persist in adaptive policy measures, which are crucial for ongoing banking reforms and improved monitoring practices. Based on our empirical findings, these recommendations aim to fortify the resilience and adaptability of Jordan’s banking sector, contributing both academically and practically. Importantly, they reinforce the symbiotic link between a stable banking sector and sustained economic development in Jordan.

Obesity-resistant (non-responder, NR) phenotypes that exhibit reduced susceptibility to developing obesity despite being exposed to high dietary fat are crucial in exploring the metabolic responses that protect against obesity. Although several efforts have been made to study them in mice and humans, the individual protective mechanisms are poorly understood. In this exploratory study, we used a polygenic C57BL/6J mouse model of diet-induced obesity to show that NR mice developed healthier fat/lean body mass ratios (0.43 ± 0.05) versus the obesity-prone (super-responder, SR) phenotypes (0.69 ± 0.07, p < 0.0001) by upregulating gene expression networks that promote the accumulation of type 2a, fast-twitch, oxidative muscle tissues. This was achieved in part by a metabolic adaptation in the form of blood glucose sparing, thus aggravating glucose tolerance. Resistance to obesity in NR mice was associated with 4.9-fold upregulated mitoferrin 1 (Slc25a37), an essential mitochondrial iron importer. SR mice also showed fecal volatile metabolite signatures of enhanced short-chain fatty acid metabolism, including increases in detrimental methyl formate and ethyl propionate, and these effects were reversed in NR mice. Continued research into obesity-resistant phenotypes can offer valuable insights into the underlying mechanisms of obesity and metabolic health, potentially leading to more personalized and effective approaches for managing weight and related health issues.

Talimogene laherparepvec (T-VEC) plus ipilimumab has demonstrated greater antitumor activity versus ipilimumab alone, without additional toxicity, in patients with advanced melanoma. Here, we report the 5-year outcomes from a randomized phase II study. These data provide the longest efficacy and safety follow-up for patients with melanoma treated with a combination of an oncolytic virus and a checkpoint inhibitor.Eligible patients with unresectable stage IIIB‒IV melanoma were randomized 1:1 to receive T-VEC plus ipilimumab or ipilimumab alone. T-VEC was administered intralesionally at 106 plaque-forming units (PFU)/mL in week 1, followed by 108 PFU/mL in week 4 and every 2 weeks thereafter. Ipilimumab (3 mg/kg every 3 weeks; ≤4 doses) was administered intravenously starting at week 1 in the ipilimumab arm and week 6 in the combination arm. The primary end point was investigator-assessed objective response rate (ORR) per immune-related response criteria; key secondary end points included durable response rate (DRR), duration of response (DOR), progression-free survival (PFS), overall survival (OS), and safety.Overall, 198 patients were randomized to receive the combination (n=98) or ipilimumab (n=100). The combination improved the ORR versus ipilimumab (35.7% vs 16.0%; OR 2.9; 95% CI 1.5 to 5.7; p=0.003). DRR was 33.7% and 13.0% (unadjusted OR 3.4; 95% CI 1.7 to 7.0; descriptive p=0.001), respectively. Among the objective responders, the median DOR was 69.2 months (95% CI 38.5 to not estimable) with the combination and was not reached with ipilimumab. Median PFS was 13.5 months with the combination and 6.4 months with ipilimumab (HR 0.78; 95% CI 0.55 to 1.09; descriptive p=0.14). Estimated 5-year OS was 54.7% (95% CI 43.9 to 64.2) in the combination arm and 48.4% (95% CI 37.9 to 58.1) in the ipilimumab arm. Forty-seven (48.0%) and 65 (65.0%) patients in the combination and ipilimumab arms, respectively, received subsequent therapies. No new safety signals were reported.At the 5-year follow-up, the improved response rates observed with T-VEC plus ipilimumab were durable. This is the first randomized controlled study of the combination of an oncolytic virus and a checkpoint inhibitor that meets its primary end point.Trial registration number: NCT01740297.

Introduction The COVID‑19 pandemic has raised multiple psychological challenges among most healthcare workers, from anxiety to depression, burnout, sleep disorders, and substance use disorders. Thus, the burden caused by this prolonged medical crisis has inevitably drastically lowered the quality of life of the medical staff. In order to mitigate the negative effects of the pandemic, healthcare workers resorted to various coping strategies, with better or worse outcomes. Objectives The present study aims to identify Romanian physicians’ main coping mechanisms and evaluate the role of positive and negative stress-reducing strategies on quality of life. Methods A cross‑sectional national survey was conducted using a web-based questionnaire among physicians practicing in Romania (n=265). In addition to socio-demographic and professional information, the questionnaire addressed participants’ coping mechanisms using the COPE inventory and quality of life with the WHOQOL-Brief scale. Descriptive statistics, Pearson correlations, and multiple linear regressions were used in the statistical analysis. Results In total, 265 physicians consented to their participation in the survey. Of those who responded, 84.5% identified as female, 92.1% had a permanent residence in a urban setting, 63.8% were married and 55.1% attained a master’s degree, a PhD diploma or equivalent level of education. The results showed that optimism was higher in male professionals, while avoidance coping was higher in female health professionals. The mean values of QoL subscales were: 74.7± 18.3 for the general quality of life, 70.8± 20.7 for health satisfaction, 64.0± 14.2 for the physical area, 61.7± 16.2 for the psychological area, 61.2± 20.3 for the social relationships area and 64.7± 12.7 for the environment area. Specific coping mechanisms (emotional venting, behavioral and mental disengagement) were associated with lower quality of life. In contrast, emotion-focused (positive reinterpretation and acceptance), problem-focused strategies (planning, active coping, suppression of competing activities) and humor were associated positively with most QoL subscales scores. Conclusions Our data points to specific protective characteristics and some detrimental factors on physicians’ quality of life during the pandemic, with the implication that these factors may be important considerations for mitigating distress and psychiatric disorders for healthcare workers during times of high stress. Concerted initiatives to improve wellness in healthcare workers ought to develop targeted programs to ensure adequate psychological support. Disclosure of Interest None Declared

Obesity is a multifactorial disorder that is remarkably heterogeneous. It presents itself in a variety of phenotypes that can be metabolically unhealthy or healthy, associate with no or multiple metabolic risk factors, gain extreme body weight (super-responders), as well as resist obesity despite the obesogenic environment (non-responders). Progression to obesity is ultimately linked to the overall net energy balance and activity of different metabolic fluxes. This is particularly evident from variations in fatty acids oxidation, metabolic fluxes through the pyruvate-phosphoenolpyruvate-oxaloacetate node, and extracellular accumulation of Krebs cycle metabolites, such as citrate. Patterns of fat accumulation with a focus on visceral and ectopic adipose tissue, microbiome composition, and the immune status of the gastrointestinal tract have emerged as the most promising targets that allow personalization of obesity and warrant further investigations into the critical issue of a wider and long-term weight control. Advances in understanding the biochemistry mechanisms underlying the heterogenous obesity phenotypes are critical to the development of targeted strategies to maintain healthy weight.

Cutaneous T-cell lymphoma (CTCL) is a lymphoproliferative disorder of the skin. The most common subtype of CTCL in pediatrics is mycosis fungoides (MF). There are multiple variants of MF. The hypopigmented variant represents more than 50% of MF cases in pediatrics. Misdiagnosis of MF can occur because it may resemble other benign skin pathologies. This is a case of an 11-year-old Palestinian boy presented with generalized nonpruritic hypopigmented maculopapular patches with progressive course for 9-months. Biopsy samples from a hypopigmented patch revealed appearances diagnostic of MF. Immunohistochemical staining was positive for CD3 and CD7 (partial) and a mixture of CD4 and CD8 positive cells. The patient’s case was managed with narrowband ultraviolet B (NBUVB) phototherapy. After a few sessions, the hypopigmented lesions improved significantly.

We describe the case of a 69-year-old woman who presented with a decline in vision in the left eye and was found to have a choroidal lesion with clinical and echographic features concerning for primary uveal melanoma. Systemic imaging identified numerous metastases to the liver, kidneys, paratracheal lymph nodes, lung, and brain. The hepatic lesion was biopsied, and genetic analysis identified a Val600Glu (c.1799T>A) BRAF mutation, consistent with a cutaneous primary malignancy, although no primary tumor was identified. This case highlights that metastasis to the choroid is a rare presentation of nonuveal melanoma that can mimic primary uveal melanoma. Genetic analysis of tumor tissue can identify the origin of the melanoma and guide treatment options. Systemic imaging should be performed prior to intervention for choroidal neoplasms.

Abstract Background Although less common, typical atrial flutter shares similar pathophysiological roots with atrial fibrillation. Following successful cavo‐tricuspid isthmus ablation using radiofrequency, many patients, however, develop atrial fibrillation in the mid‐to‐long‐term. This study sought to assess whether pulmonary vein isolation conducted at the same time as cavo‐tricuspid isthmus ablation would significantly modify the atrial fibrillation burden upon follow‐up in patients suffering from typical atrial flutter. Methods This was a multicenter randomized controlled study involving typical atrial flutter patients with history of non‐predominant atrial fibrillation (1 atrial fibrillation episode only, in 67% of population) who were scheduled for cavo‐tricuspid isthmus radiofrequency ablation. Patients were randomly assigned to either undergo cavo‐tricuspid isthmus ablation alone or cavo‐tricuspid isthmus plus pulmonary vein isolation (CTI+). Pulmonary vein isolation was performed using cryoballoon technology. An outpatient consultation with ECG and 1‐week Holter monitoring was performed at 3, 6 months, 1 year, and 2 years postprocedure. The primary endpoint was atrial fibrillation recurrences lasting more than 30 s at 2 years postablation. Results Of the patients enrolled, 36 were included in each group. At 2‐year follow‐up, the atrial fibrillation recurrence rate was significantly higher in the CTI vs CTI+group (25/36, 69% vs. 12/36, 33% respectively; P

BackgroundSarcomas are a diverse group of neoplasms that vary greatly in clinical presentation and responsiveness to treatment. Given the differences in the sites of involvement, rarity, and treatment modality, a multidisciplinary approach is required. Previous literature suggests patients with sarcoma suffer from poorer quality of life (QoL) especially physical and functional wellbeing. Adolescent and young adult (AYA) patients are an underrepresented population in cancer research and have differing factors influencing QoL.MethodsRetrospective analysis of Young Adult patients (age 18–39) enrolled in the Sarcoma Tissue Repository at University of Iowa. QoL was assessed using the self-report FACT-G questionnaire at enrollment and 12 months post-diagnosis; overall scores and the 4 wellbeing subscales (Physical, Emotional, Social, Functional) were calculated. Linear mixed effects models were used to measure the association between the rate of change in FACT-G subscale scores and baseline clinical, comorbidity, and treatment characteristics.Results49 patients were identified. 57.1% of patients had a malignancy involving an extremity. Mean FACT-G scores of overall wellbeing improved from baseline to 12 months (76.4 vs. 85.4, p < 0.01). Social and emotional wellbeing did not differ significantly between baseline and 12 months. Physical wellbeing (18.8 vs. 23.9, p < 0.01) and functional wellbeing (16.8 vs. 20.0, p< 0.01) scores improved from baseline to 12 months. No difference was seen for FACT-G overall scores for age, sex, laterality, marital status, performance status, having children, clinical stage, limb surgery, chemotherapy, or tumor size. A difference was demonstrated in physical wellbeing scores for patients with baseline limitation (ECOG 1-3) compared to those with no baseline limitation (ECOG 0) (p = 0.03). A difference was demonstrated in social wellbeing based on anatomical site (p = 0.02).ConclusionYoung adults with sarcoma treated at a tertiary center had improvements in overall reported QoL at 12 months from diagnosis. Overall baseline QoL scores on FACT-G were lower than the general adult population for YA patients with sarcoma but at 12 months became in line with general population norms. The improvements seen merit further investigation to evaluate how these change over the continuum of care. Quality of life changes may be useful outcomes of interest in sarcoma trials.

Chronic lymphocytic leukemia (CLL), the most common adult’s leukemia in the western world, is caused in 95% of the cases by uncontrolled proliferation of monoclonal B-lymphocytes. The complement system in CLL is chronically activated at a low level via the classical pathway (CP). This chronic activation is induced by IgG-hexamers, which are formed after binding to alpha-2-macroglobulin (A2M). The study investigated for the first time the serum levels of A2M in CLL patients, their association with the disease severity, and A2M production by the malignant B-lymphocytes. Blood samples were collected from 65 CLL patients and 30 normal controls (NC) subjects, and used for quantifications of the A2M levels, the complement activation marker (sC5b-9), the complement components C2, C3 and C4, and clinical biochemistry and hematology parameters. The production of A2M was studied in B-lymphocytes isolated from blood samples as well as in CLL and non-CLL cell lines.The serum A2M levels were significantly higher in CLL patients vs NCs, showing values of 3.62 ± 0.22 and 1.97 ± 0.10 mg/ml, respectively. Within the CLL group, A2M levels correlated significantly with the disease stage, with sC5b-9, and with clinical indicators of the disease severity. Increased A2M production was showed in three out of four CLL B-lymphocytic lines that were studied, as compared to non-CLL lines, to a non-lymphocytic line, and to blood-derived primary B-lymphocytes. A2M production was further increased both in primary cells and in the CLL cell-line after incubation with CLL sera, compared to NC sera. This study shows for the first time that serum A2M levels in CLL are significantly increased, likely due to A2M production by the malignant B-lymphocytes, and are correlated with the disease severity and with chronic complement activation. The moderate change in A2M production after incubation with NC sera in-vitro supports the hypothesis that inhibition of excess A2M production can be achieved, and that this may potentially down-regulate the IgG-hexamerization and the resulting chronic CP activation. This may also help restore complement system activity, and eventually improve complement activity and immunotherapy outcomes in CLL.

Abstract Background Multimorbidity of intestinal cancer (IC), type 2 diabetes (T2D) and obesity is a complex set of diseases, affected by environmental and genetic risk factors. High‐fat diet (HFD) and oral bacterial infection play important roles in the etiology of these diseases through inflammation and various biological mechanisms. Methods To study the complexity of this multimorbidity, we used the collaborative cross (CC) mouse genetics reference population. We aimed to study the multimorbidity of IC, T2D, and obesity using CC lines, measuring their responses to HFD and oral bacterial infection. The study used 63 mice of both sexes generated from two CC lines (IL557 and IL711). For 12 weeks, experimental mice were maintained on specific dietary regimes combined with co‐infection with oral bacteria Porphyromonas gingivalis and Fusobacterium nucleatum, while control groups were not infected. Body weight (BW) and results of a intraperitoneal glucose tolerance test (IPGTT) were recorded at the end of 12 weeks, after which length and size of the intestines were assessed for polyp counts. Results Polyp counts ranged between 2 and 10 per CC line. The combination of HFD and infection significantly reduced (P

On 24 February 2022, the Russian Federation invaded Ukraine, starting a military conflict that soon turned into a full-scale war. The Romanians have been actively involved in helping their neighbors, causing the accumulation of emotional and mental pressure upon the Romanian population exposed to such a close military conflict. This cross-sectional study assessed, through an online survey (1586 adult Romanian residents), the primary coping mechanisms, quality of life and anxiety levels in response to the psychological trauma associated with the Russo—Ukrainian war. Based on the results, focusing on and venting emotions along with behavioral disengagement were the coping strategies that had the strongest negative impact on anxiety and well-being. On the other hand, positive reinterpretation and growth were associated with less anxiety, a higher degree of overall health and better quality of life. To the best of our knowledge, this study is the first of its kind to be performed among the Romanian population so far. Thus, we equip mental health practitioners with the tools (real-life evidence data) that will allow them to establish a more meaningful doctor—patient relationship, maximizing therapy results.

While urothelial carcinoma is the most common histologic type of bladder cancer in the United States, leiomyosarcoma is a rare and aggressive variant. The rarity of bladder leiomyosarcoma results in uncertainty regarding the optimal treatment pathway. We report on a patient with a giant non-metastatic bladder leiomyosarcoma effectively managed with primary surgical intervention without chemoradiation.

The study attempted to characterize students’ conceptions of learning and approaches to learning and revealing the correlation between the students’ concepts and approaches to learning. The researchers used qualitative content analysis and a descriptive approach. The study population comprised 90 male and female students of the Faculty of Educational Science in the HU University, Jordan, during the 2019/2020 academic year. The quantitative concepts were dominating among students (87.77%), especially the concept of learning as a knowledge increase (33.33%). On the other hand, the qualitative concepts of learning were low (12.22%), especially on the person change (2.22%). In addition, there was an emergence of a new concept of learning outside the traditional concepts, namely learning as exam preparation. The results showed that the deep approach to learning was low, and the surface approach to learning was high. The results further showed a correlation between the quantitative concepts of learning and the surface approach to learning, as well as a correlation between the qualitative concepts of learning the deep approach to learning. Hence, the general conclusion implies that if teachers are to place learners at the heart of the learning process, they must be aware of the concepts of learning and learning approaches of the students.

Abstract Background Host genetic background and sex, play central roles in defining the pathogenesis of type 2 diabetes (T2D), obesity and infectious diseases. Our previous studies demonstrated the utilization of genetically highly diverse inbred mouse lines, namely collaborative cross (CC), for dissecting host susceptibility for the development of T2D and obesity, showing significant variations following high‐fat (42% fat) diet (HFD). Here, we aimed to assessing the host genetic background and sex effects on T2D and obesity development in response to oral‐mixed bacterial infection and HFD using the CC lines. Materials and Methods Study cohort consists of 97 mice from 2 CC lines (both sexes), maintained on either HFD or Standard diet (CHD) for 12 weeks. At week 5 a group of mice from each diet were infected with Porphyromonas gingivalis (Pg) and Fusobacterium nucleatum (Fn) bacteria (control groups without infection). Body weight (BW) and glucose tolerance ability were assessed at the end time point of the experiment. Results The CC lines varied (P

Abstract Background More than 85% of women sustain different degrees of trauma during vaginal birth. Randomized controlled trials on childbirth pelvic floor trauma have reported a wide range of outcomes and used different outcome measures. This variation restricts effective data synthesis, impairing the ability of research to inform clinical practice. The development and use of a core outcome set (COS) for childbirth pelvic floor trauma aims to ensure consistent use of outcome measures and reporting of outcomes. Methods An international steering group, within CHORUS, an International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women’s Health, including academic community members, researchers, healthcare professionals, policy makers and women with childbirth pelvic floor trauma will lead the development of this COS. Relevant outcome parameters will be identified through comprehensive literature reviews. The selected outcomes will be entered into an international, multi-perspective online Delphi survey. Subsequently and based on the results of the Delphi surveys consensus will be sought on ‘core’ outcomes. Discussion Dissemination and implementation of the resulting COS within an international context will be supported and promoted. Embedding the COS for childbirth pelvic floor trauma within future clinical trials, systematic reviews, and clinical practice guidelines is expected to enrich opportunities for comparison of future clinical trials and allow better synthesis of outcomes, and will enhance mother and child care. The infrastructure created by developing a COS for childbirth pelvic floor trauma could be leveraged in other settings, for example, advancing research priorities and clinical practice guideline development.

Stator inter-turn fault diagnosis system for electric motors is of a considerable concern due to its significant effect on industrial production. In this paper, a new method for detecting the inter-turn fault and quantifying its severity in the line start permanent magnet synchronous motor (LSMPSM) is proposed. The new method depends on monitoring the stator current during steady-state period to detect the fault. The convolutional neural network (CNN) method is proposed to correlate the motor steady-state current with the status of the motor winding conditions and detect any presence of inter-turn faults. The data used in this study is extracted from both an experimental setup of a one-horsepower LSPMSM and the corresponding verified mathematical model through several testing cases under various loading conditions. One of the main features of the proposed technique is that it does not require separate feature extraction phase. The results indicate that the proposed technique is able to detect the inter-turn fault under different loading conditions varies from 0NM to 4NM with accuracy of 97.75% for all defined fault levels. The use of steady-state current for fault detection regardless of motor load enables the proposed technique to detect the fault online without disturbing the system functionality and reliability as well as without adding any extra hardware to the system.

Abstract The ER is hub for protein folding. Proteins that harbor a Frizzled cysteine-rich domain (FZ-CRD) possess 10 conserved cysteine motifs held by a unique disulfide bridge pattern which attains a correct fold in the ER. Little is known about implications of disease-causing missense mutations within FZ-CRD families. Mutations in FZ-CRD of Frizzled class receptor 4 (FZD4) and Muscle, skeletal, receptor tyrosine kinase (MuSK) and Receptor tyrosine kinase-like orphan receptor 2 (ROR2) cause Familial Exudative Vitreoretinopathy (FEVR), Congenital Myasthenic Syndrome (CMS), and Robinow Syndrome (RS) respectively. We highlight reported pathogenic inherited missense mutations in FZ-CRD of FZD4, MuSK and ROR2 which misfold, and traffic abnormally in the ER, with ER-associated degradation (ERAD) as a common pathogenic mechanism for disease. Our review shows that all studied FZ-CRD mutants of RS, FEVR and CMS result in misfolded proteins and/or partially misfolded proteins with an ERAD fate, thus we coin them as “disorders of FZ-CRD”. Abnormal trafficking was demonstrated in 17 of 29 mutants studied; 16 mutants were within and/or surrounding the FZ-CRD with two mutants distant from FZ-CRD. These ER-retained mutants were improperly N-glycosylated confirming ER-localization. FZD4 and MuSK mutants were tagged with polyubiquitin chains confirming targeting for proteasomal degradation. Investigating the cellular and molecular mechanisms of these mutations is important since misfolded protein and ER-targeted therapies are in development. The P344R-MuSK kinase mutant showed around 50% of its in-vitro autophosphorylation activity and P344R-MuSK increased two-fold on proteasome inhibition. M105T-FZD4, C204Y-FZD4, and P344R-MuSK mutants are thermosensitive and therefore, might benefit from extending the investigation to a larger number of chemical chaperones and/or proteasome inhibitors. Nonetheless, FZ-CRD ER-lipidation it less characterized in the literature and recent structural data sheds light on the importance of lipidation in protein glycosylation, proper folding, and ER trafficking. Current treatment strategies in-place for the conformational disease landscape is highlighted. From this review, we envision that disorders of FZ-CRD might be receptive to therapies that target FZ-CRD misfolding, regulation of fatty acids, and/or ER therapies; thus paving the way for a newly explored paradigm to treat different diseases with common defects.

Introduction: stability is one of the main goals of orthodontic treatment, and circumferential supracrestal fiberotomy is an alternative to prevent relapse in cases of tooth rotation, crowding and inclined teeth. However, there are no studies demonstrating the effectiveness of this treatment and its effects on the periodontal condition. The aim of this systematic review (SR) was to evaluate the effectiveness of circumferential supracrestal fiberotomy (CSF) as an adjuvant in the stability of orthodontic treatment during retention and its effects on the periodontal condition once it has been performed. Methods: the search for topic-related studies was conducted on the PubMed and EMBASE databases until October 2018. The studies were considered eligible if they covered the use of CSF during the retention period and reported the periodontal condition in a follow-up period longer than or equal to 1 year. For bias-risk assessment in the chosen studies, the Newcastle-Ottawa Scale was applied to observational studies, and the Cochrane Collaboration tool for Randomized Clinical Trials (RCTs) and Controlled Clinical Trials (CCTs). Results: the search strategy yielded 85 potential eligible articles, of which 5 were included in the SR. Four of the five studies reported a lower irregularity rate in patients who had CSF when compared to a control group. No changes in plaque index, gingival index, insertion levels, probe depth and keratinized gingiva amount were reported. Conclusions: fiberotomy is an effective method to prevent relapse of previously rotated teeth and does not cause periodontal alterations. However, it is important to note that the studies’ methodological quality was low.

BackgroundStudies evaluating cosmetic gynecological interventions have followed variable methodology and reported a diversity of outcomes. Such variations limit the comparability of studies and the value of research-based evidence. The development of core outcome sets (COS) and core outcome measures sets (COMS) would help address these issues, ensuring a minimum of outcomes important to all stakeholders, primarily women requesting or having experienced cosmetic gynecological interventions. ObjectiveThis protocol describes the methods used in developing a COS and COMS for cosmetic gynecological interventions. MethodsAn international steering group within CHORUS, including health care professionals, researchers, and women with experience in cosmetic gynecological interventions from 4 continents, will guide the development of COS and COMS. Potential outcome measures and outcomes will be identified through comprehensive literature reviews. These potential COS and COMS will be entered into an international, multi-perspective web-based Delphi survey where Delphi participants judge which domains will be core. A priori thresholds for consensus will get established before each Delphi round. The Delphi survey results will be evaluated quantitatively and qualitatively in subsequent stakeholder group consensus meetings in the process of establishing “core” outcomes. ResultsDissemination and implementation of the resulting COS and COMS within an international context will be promoted and reviewed. ConclusionsThis protocol presents the steps in developing a COS and COMS for cosmetic gynecological interventions. Embedding the COS and COMS for cosmetic gynecological interventions within future clinical trials, systematic reviews, and practice guidelines could contribute to enhancing the value of research and improving overall patient care. Trial RegistrationCore Outcome Measures in Effectiveness Trials (COMET) 1592; https://tinyurl.com/n8faysuh International Registered Report Identifier (IRRID)PRR1-10.2196/28032