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A synthetic route to trans-A2B-corroles combining the macrocyclic core with a hydrazone moiety, based on the reactivity of azoalkenes toward dipyrromethanes, has been established with the aim of developing a new class of photosensitizers for photodynamic therapy of lung cancer. The study of the photophysical properties of the novel macrocycles allowed the identification of photosensitizers with absorption within the phototherapeutic window and high singlet oxygen quantum yield. Relevant structure–photodynamic activity correlations were established by studying the new corroles-based photodynamic therapy (PDT) in human lung cancer cell lines (A549 and H1299). The methyl-hydrazone corroles were more active than phenyl-hydrazone corroles, with the N-Boc and N-Ts groups being key structural features to ensure high activity. The lead photosensitizers, with IC50values below 100 nM and no cytotoxicity per se, were significantly more active than 5,10,15-triphenylcorrole, showing that the presence of the hydrazone functional group has a strong influence on PDT activity.

Background: Patients with chronic limb-threatening ischemia (CLTI) and chronic kidney disease (CKD) are at risk of developing renal injury following revascularization. We aimed to compare the risk of adverse renal events following endovascular revascularization (ER) or open surgery (OS) in patients with CLTI and CKD.Methods: A retrospective analysis of the National Surgical Quality Improvement Program (NSQIP) databases (2011–2017) was performed including patients with CLTI and non-dialysis-dependent CKD, comparing ER to OS. The primary outcome was a composite of postprocedural kidney injury or failure within 30 days. Thirty-day mortality, major adverse cardiac and cerebrovascular events (MACCE), amputation, readmission or target lesion revascularization (TLR) were compared using multivariate logistic regression and propensity-score matched analysis.Results: A total of 5009 patients were included (ER: 2361; OS: 3409). The risk for the composite primary outcome was comparable between groups (odds ratio [OR]: 0.78, 95% confidence interval (CI): 0.53-1.17) as for kidney injury (n=54, OR: 0.97, 95% CI: 0.39-1.19) or failure (n=55, OR: 0.68, 95% CI: 0.39-1.19). In the adjusted regression, a significant benefit was observed with ER for the primary outcome (OR: 0.60, p=0.018) and renal failure (OR: 0.50, p=0.025), but not for renal injury (OR: 0.76, p=0.34). Lower rates of MACCE, TLR, and readmissions were observed after ER. Thirty-day mortality and major amputation rates did not differ. In the propensity score analysis, revascularization strategy was not associated with renal injury or failure.Conclusions: In this cohort, the incidence of renal events within 30 days of revascularization in CLTI was low and comparable between ER and OR.Clinical Impact In a cohort of 5009 patients with chronic limb-threatening ischemia and non-end-stage chronic kidney disease (CKD), postprocedural kidney injury or failure within 30 days was comparable between patients submitted to open or endovascular revascularization (ER). Lower rates of major adverse cardiac and cerebrovascular events, target lesion revascularization, and readmissions were observed after endovascular revascularization. Based on these findings, ER should not be avoided due to fear of worsening renal function in CKD patients with chronic limb-threatening ischemia. In fact, these patients benefit more from ER regarding cardiovascular outcomes with no increased risk of kidney injury.

IMPORTANCE: In-office suprachoroidal viscopexy (SCVEXY) is a relatively new procedure for rhegmatogenous retinal detachment (RRD), but minimal information is available regarding outcomes and safety. OBJECTIVE: To report outcomes with in-office SCVEXY for primary acute RRD. DESIGN, SETTING, AND PARTICIPANTS: This retrospective case series was conducted at St Michael’s Hospital in Toronto, Ontario, Canada from June 2023 to February 2024 among consecutive patients with primary acute RRDs who presented with retinal tears that were reachable with the current in-office SCVEXY technique in the temporal or nasal retina. EXPOSURE: Suprachoroidal injection of 0.6 mL of sodium hyaluronate, 2.3%, at the break location using a 30-gauge needle with a custom-made guard leaving 1 mm of the needle exposed. Laser retinopexy was applied around the break once reattachment was achieved. MAIN OUTCOME AND MEASURES: The primary outcome was primary anatomic reattachment rate with SCVEXY and recovery of function and anatomic integrity. RESULTS: Among 6 patients, 2 patients (33.3%) were female, and mean (SD) patient age was 52.5 (19.7) years. The final follow-up duration for each patient was 510, 420, 360, 360, 330, and 320 days, respectively. Baseline VAs were hand motions, counting fingers, 20/100, 20/100, 20/25, and hand motions for patients 1 through 6, respectively. A dome-shaped suprachoroidal buckle was present in all cases after the procedure. Five of 6 patients (83.3%) achieved anatomic reattachment with no retinal displacement or outer retinal folds, and these patients could resume normal activity immediately after the procedure with no restrictions. The mean (SD) logMAR VA at 3 months was +0.46 (0.34) (Snellen 20/57). The viscoelastic persisted in the suprachoroidal space as confirmed by multimodal imaging for 10, 14, 21, 13, 24, and 14 days, respectively, and the retina remained attached during the entire postoperative follow-up period. One patient’s SCVEXY failed due to inadequate viscoelastic at the posterior edge of the retinal break, and this patient underwent a successful pneumatic retinopexy. One patient developed a localized choroidal effusion unrelated to the SCVEXY site following laser retinopexy that resolved in 1 week associated with topical prednisolone, 1%, 4 times daily and cyclopentolate, 1%, twice daily. CONCLUSIONS AND RELEVANCE: In this case series, the outcomes of these 6 cases suggest that SCVEXY may offer durable retinal reattachment in RRD. However, randomized clinical trial data, larger sample sizes, and longer-term follow-up are necessary to assess the risk-benefit profile of SCVEXY compared with the standard of care.

Fusariumkeratitis (FK) is an important clinical condition that can lead to blindness and eye loss, and is most commonly caused by the Fusarium solanispecies complex (FSSC). This study evaluated the susceptibility of planktonic cells and biofilms of FSSC (n= 7) and non-FSSC (n= 7) isolates obtained from patients with keratitis from a semi-arid tropical region to amphotericin B (AMB), natamycin (NAT), voriconazole (VRZ), efinaconazole (EFZ), and luliconazole (LCZ). Analysis of clinical data showed that trauma was the most common risk factor for FK patients. Disease onset was longer in non-FSSC group (3–30 days) than in the FSSC group (3–7 days). FSSC strains were less susceptible to AMB and VRZ than non-FSSC strains (p< 0.05). Susceptibility to NAT, LCZ and EFZ was similar between isolates of FSSC and non-FSSC groups. Overall, patients infected with non-FSSC showed a better response to antifungal treatment. Corneal transplantation was more common in patients infected with FSSC (3/7) than in those infected with non-FSSC (1/7). Mature biofilms showed a poor response to antifungal treatment. Patients infected with Fusariumstrains capable of forming antifungal tolerant biofilms had more complex therapeutic management, requiring two antifungals and/or corneal transplantation (p< 0.05). This study highlights the importance of mycological diagnosis and the antifungal susceptibility testing in the clinical management of FK. The ability of Fusariumto form antifungal tolerant biofilms poses a challenge to clinicians and urges the development of new antibiofilm therapeutics.

The difference between the phosphorus (P) levels determined by inductively coupled plasma optical emission spectroscopy (ICP-OES) and colorimetry in soil extracts is termed molybdate-unreactive P (MU-P). The dynamics and characterization of MU-P in natural environments remain not fully elucidated, making it essential to understand how different extractants for available P influence MU-P levels and which soil attributes and P forms are associated with this pool. This study compared three extractants used in soil P tests for their ability to access MU-P, explored associations between soil chemical attributes and MU-P, and evaluated whether there is a relationship between P species obtained by XANES and MU-P in soils of contrasting nature. To achieve this, 28 representative soils were collected in non-cultivated forestry areas (native or reforested), which had never received anthropogenic P inputs. On average, Mehlich-3 extracted the highest amounts of MU-P; however, the correlations between Mehlich-3 MU-P with other chemical attributes were weaker than those observed for Mehlich-1 and resin. XANES analysis did not reveal a clear relationship between MU-P levels and P-species in the soil samples. Among soil attributes, organic carbon (OC) displayed the strongest correlations with MU-P, which highlights its potential as a predictive attribute for MU-P in natural environments. Managing OC in soils could influence MU-P levels, affecting phosphorus availability for plants. To this end, it is important to consider the P extractant, with Mehlich-1 and resin being better options in relation to Mehlich-3. There are limitations to XANES K-edge in effectively capturing the complexity of MU-P in soil samples.

Background: The therapeutic targeting of the intestinal microbiota has gained increasing attention as a promising avenue for addressing mood disorders. This study aimed to assess the potential effect of supplementing standard pharmacological treatment with the probiotic kefir in patients with Major Depressive Disorder (MDD). Methods: Thirty-eight female participants diagnosed with moderate MDD by the Hamilton Rating Scale for Depression (HAM-D) were selected to receive the probiotic kefir in conjunction with antidepressant therapy for 12 weeks. The participants were evaluated at baseline (T0) and 90 days after probiotic kefir supplementation (T90). HAM-D scores and blood samples were collected at both time points. Results: Probiotic supplementation significantly reduced MDD severity, as evidenced by lower HAM-D scores compared to baseline. Probiotic consumption for 90 days also significantly decreased interleukin-6 (IL-6), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) levels compared to baseline. However, probiotic kefir supplementation did not significantly affect serum serotonin levels. Additionally, after 90 days of probiotic consumption, insulin and morning cortisol levels were significantly reduced. In contrast, no significant changes were observed in serum levels of prolactin, vitamin D, and afternoon cortisol. Conclusion: This study provides valuable insights into the potential benefits of probiotics, specifically kefir, as adjunctive therapy for female patients with MDD. The findings highlight promising results in ameliorating depressive symptoms and modulating inflammatory and hormonal markers.

Sustained oscillations persist without decay, impacting system stability and performance. Sustained oscillations in distribution systems exhibit unique mechanisms compared to those in transmission systems, yet research in this area of distribution systems is lacking. In distribution systems, these oscillations degrade power quality, jeopardizing stability and causing relay malfunctions and supply discontinuity. Understanding their mechanisms in modern distribution systems is crucial for their detection, classification, and localization. This paper provides a comprehensive review of sustained oscillations in modern distribution systems. Additionally, it discusses key methodologies for detecting and classifying sustained oscillations in transmission systems. Finally, it applies transmission system methodologies to real cases in Ontario's distribution system, shedding light on challenges and future directions.

The exploitation of fruit residues is a tendency that has been raising considerable interest, since it reduces the amount of residues generated during agro-industrial processing, increases the profit generated in the operation and makes use of nutritional principals normally disposed of. Melon seeds are good sources of macronutrients such as proteins, lipids and carbohydrates, as well as micronutrients such as vitamins, minerals and bioactive compounds. The germination process leads to a modification in composition, possibly increasing the nutritional quality and altering the physicochemical characteristics of the original raw material positively. Thus, the aim of the present study was to make a comparative evaluation of the physical and physicochemical characteristics, the bioactive compound content and the technological properties of flours produced from the germinated seeds of Pele-de-Sapo, Gália, Cantaloupe and Orange melons, obtained after drying at 50, 60 and 70 ºC. The germinated seed flours of the four melon varieties presented good protein, lipid, ascorbic acid, flavonoid and carotenoid contents, especially Cantaloupe, with the best values for proteins, lipids and carotenoids and the highest phenolic compound contents. All the flours were highly cohesive with low fluidity and good solubility. The variety Cantaloupe provided flours with good water and oil absorption capacities and greater emulsion activities and stability. The highest drying temperatures led to increases in the phenolic compound, flavonoid and carotenoid compounds and increased the Hausner Factor and Carr Index, but reduced the solubility, the water and oil absorption capacities and the emulsion activity. The flours produced showed good nutritional quality and stability, with emphasis on those produced from Cantaloupe melons, which showed the best nutritional characteristics and technological properties.

In recent years, the focus of research on obesity and its management has expanded beyond traditional dietary factors to include the timing of food intake – in relation to the body's circadian rhythms – known as chrononutrition. However, chrononutrition patterns remain largely unexplored in low-medium income countries. Our study aimed to investigate the association between chrononutrition patterns and BMI.

Although sodium-glucose cotransporter-2 inhibitors (SGLT2i) were shown to lower hyperuricemic events in patients with type 2 diabetes mellitus (T2DM), the extent of this effect in the general population is yet to be elucidated. We performed an updated systematic review and meta-analysis on a large sample of patients with and without T2DM to evaluate the influence of SGLT2i therapy on clinically relevant hyperuricemic events, defined as the composite of acute gout flare episodes, acute anti-gout management or urate-lowering therapy initiation. Furthermore, we conducted a multivariate meta-regression to assess the relationship between different covariates and the pooled effect size.

Charge funneling is a widely used description of charge collection dynamics in semiconductor devices struck by ion irradiation, but it still relies on semiempirical parameters heavily dependent upon available data, which impacts its use for device or circuit-level simulations. The objective of this article is to analyze a comprehensive dataset from low-energy heavy-ion irradiations on a p-MOSFET, varying both the linear energy transfer (LET) and ion penetration depth within the device. A novel methodology is proposed to achieve this goal by analyzing devices without prior knowledge of their parameters, using data from light ion irradiations. Statistical analysis of the data and comparisons to simulated values showed that a LET-dependent funnel length is a more accurate description of the phenomenon than the conventional constant-length approach. A new, lower value for the funnel model’s shielding parameter k was identified, and the method also allowed for determining the metal and passivation layer thicknesses of the device. These results strengthen the reliability of the funnel model, making it a more robust tool for simulation applications.

This study aimed to develop, assess, and test an Objective Structured Clinical Examination (OSCE) to evaluate nurses’ competency in planning and managing infusion therapy. The study adopted a methodological approach with a quantitative design and was conducted from December 2020 to August 2021 at a university hospital in São Paulo, Brazil. Data collection occurred in 3 stages: development of scenarios and assessment checklists, evaluation of expert consensus, and testing scenarios with the target audience. Data analysis involved calculating the Modified Kappa coefficient. The OSCE comprised 8 clinical stations, designed based on the theoretical framework of the Vessel Health and Preservation model and the Infusion Therapy Standards of Practice, which delineate evidence-based procedures for vascular access and infusion therapy. During expert assessment and examination testing, all evaluated items demonstrated coefficient values ≥0.74. Thus, the study successfully developed evidence-based OSCE for infusion therapy, showing strong expert consensus. Testing with nurses yielded positive outcomes, affirming the effectiveness of the educational practice’s design and structure.

Lung metastases occur in up to 54% of patients with metastatic tumours1,2. Contributing factors to this high frequency include the physical properties of the pulmonary system and a less oxidative environment that may favour the survival of cancer cells3. Moreover, secreted factors from primary tumours alter immune cells and the extracellular matrix of the lung, creating a permissive pre-metastatic environment primed for the arriving cancer cells4,5. Nutrients are also primed during pre-metastatic niche formation6. Yet, whether and how nutrients available in organs in which tumours metastasize confer cancer cells with aggressive traits is mostly undefined. Here we found that pulmonary aspartate triggers a cellular signalling cascade in disseminated cancer cells, resulting in a translational programme that boosts aggressiveness of lung metastases. Specifically, we observe that patients and mice with breast cancer have high concentrations of aspartate in their lung interstitial fluid. This extracellular aspartate activates the ionotropic N-methyl-d-aspartate receptor in cancer cells, which promotes CREB-dependent expression of deoxyhypusine hydroxylase (DOHH). DOHH is essential for hypusination, a post-translational modification that is required for the activity of the non-classical translation initiation factor eIF5A. In turn, a translational programme with TGFβ signalling as a central hub promotes collagen synthesis in lung-disseminated breast cancer cells. We detected key proteins of this mechanism in lung metastases from patients with breast cancer. In summary, we found that aspartate, a classical biosynthesis metabolite, functions in the lung environment as an extracellular signalling molecule to promote aggressiveness of metastases.

AimTo assess the primary reattachment rate (PARR) in pneumatic retinopexy (PnR) versus pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) meeting the Pneumatic Retinopexy versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomised Trial (PIVOT) criteria with a single break in detached retina.MethodsA post hoc analysis of two clinical trials. To be included, patients with primary RRD had to meet PIVOT criteria but could have only one break in the detached retina. Patients with additional pathology in the attached retina were included in a secondary analysis. The primary outcome was PARR following PnR versus PPV at 1-year postoperatively.Results162 patients were included. 53% (86/162) underwent PnR and 47% (76/162) had a PPV. 99% (85/86) and 86.8% (66/76) completed the 1-year follow-up visits in the PnR and PPV groups, respectively. PARR was 88.2% (75/85) in the PnR group and 90.9% (60/66) in the PPV group (p=0.6) with a mean postoperative logMAR best-corrected visual acuity of 0.19±0.25 versus 0.34±0.37 (Snellen 20/30 vs 20/44) (p=0.01) each in the PnR and PPV groups, respectively.In an additional analysis of patients who were also allowed to have any pathology in the attached retina, the PARR was 85% (91/107) and 91.6% (66/72) in the PnR and PPV groups, respectively (p=0.18).ConclusionsPnR and PPV provide similar long-term PARR in a substantial proportion of patients meeting PIVOT criteria with only a single break in the detached retina. Therefore, in patients meeting these specific criteria, PnR is an appropriate first-line therapy as it offers superior functional outcomes without compromising PARR.

From January 2008 to December 2018, 1348 HIV-exposed infants were born in Porto Alegre, Brazil; 18.8% had adverse infant outcomes (AIO) including vertical transmission (1.9%), stillbirth/neonatal death (4.0%) and loss to follow-up before HIV diagnosis (12.9%). Timing of maternal HIV diagnosis was not associated with AIO but absent antiretroviral therapy use was. Lack of maternal antiretroviral therapy use is a significant risk factor for AIO.

Acute kidney injury (AKI) is an important contributor to the development of chronic kidney disease (CKD). There is a need to understand molecular mediators that drive recovery and progression to CKD. In particular, the regulatory role of miRNAs in AKI is poorly understood. Herein, miRNA and mRNA sequencing were performed on biobanked human kidney tissues obtained during the routine care of subjects with a diagnosis of AKI, minimal change disease, or on nephrectomy tissue with no known kidney disease. mRNA analysis revealed that nephrectomy tissues exhibited an injury signature similar to that of AKI which was not identified in minimal change disease samples. The transcriptomic signature of human AKI was enriched in pathways involved in cell adhesion, epithelial-to-mesenchymal transition, and cell cycle arrest (eg, CDH6, ITGB6, CDKN1A). In AKI, up-regulation of miR-146a, miR-155, miR-142, and miR-122 was associated with pathways involved in immune cell recruitment, inflammation, and epithelial-to-mesenchymal transition. miR-122 and miR-146 were associated with down-regulation of DDR2and IGFBP6, which are genes involved in the recovery and progression of kidney disease. These data provide integrated miRNA signatures that complement mRNA and other epigenetic data available in kidney atlases.

In recent years, the focus of research on obesity and its management has expanded beyond traditional dietary factors to include the timing of food intake – in relation to the body's circadian rhythms – known as chrononutrition. However, chrononutrition patterns remain largely unexplored in low-medium income countries. Our study aimed to investigate the association between chrononutrition patterns and BMI.

Although sodium-glucose cotransporter-2 inhibitors (SGLT2i) were shown to lower hyperuricemic events in patients with type 2 diabetes mellitus (T2DM), the extent of this effect in the general population is yet to be elucidated. We performed an updated systematic review and meta-analysis on a large sample of patients with and without T2DM to evaluate the influence of SGLT2i therapy on clinically relevant hyperuricemic events, defined as the composite of acute gout flare episodes, acute anti-gout management or urate-lowering therapy initiation. Furthermore, we conducted a multivariate meta-regression to assess the relationship between different covariates and the pooled effect size.

Current guidelines lack clarity about the optimal duration of octreotide therapy for patients with esophageal variceal hemorrhage (EVH). To address this lack of evidence, we conducted a randomized clinical trial (RCT) of 24-hr versus 72-hr continuous infusion of octreotide for patients with EVH.

This study aimed to investigate the epidemiological trends of Pediatric Sickle Cell Disease (SCD) in Brazil over the period 2008–2022, with a focus on understanding the incidence, mortality rates, and associated healthcare costs. The study explored potential associations between patient characteristics and the occurrence of crises in pediatric SCD cases.

Background: Treatment of simple goiter (SG) growing over time with thyroid hormone (TH) therapy is discouraged by international guidelines. Purpose: To ascertain views of European thyroid specialists about TH treatment for euthyroid patients with growing SG and explore associations with management choice. Methods: Online survey on the use of TH for growing SG among thyroid experts from 28 European countries. Results: The response rate was 31.5% (5430/17,247). Most respondents were endocrinologists. Twenty-eight percent asserted that TH therapy may be indicated in euthyroid patients with a growing SG. National and regional differences were noted, from 7% of positive responses in The Netherlands to 78% in Czech Republic (p&lt; 0.0001). TH was more frequently prescribed by respondents over 40 years old (OR 1.77, 2.13, 2.41 if 41–50, 51–60, >60, respectively), and working in areas of former iodine insufficiency (OR 1.24, 95% CI 1.03–1.50). TH was less frequently prescribed by endocrinologists (OR 0.77, 95% CI 0.62-0.94) and respondents working in Southern Europe (OR 0.40, 95% CI 0.33–0.48), Northern Europe (OR 0.28, 95% CI 0.22–0.36) and Western Asia (OR 0.16, 95% CI 0.11–0.24) compared to Western Europe. Associations with respondents’ sex, country, availability of national thyroid guidelines, and gross national income per capita were absent or weak. Conclusions: Almost a third of European thyroid specialists support treating SG with TH, contrary to current guidelines and recommendations. This calls for urgent attention.

Purpose: The purpose of this study is to evaluate the effect of a high protein and low glycemic load diet in preventing weight gain after kidney transplantation. Methods: We designed a prospective, single-center, open-label, randomized controlled study to compare the efficacy of a high protein (1.3–1.4 g/kg/day) and low glycemic load diet versus a conventional diet (0.8–1.0 g/kg/day of protein and no recommendations on glycemic load) in preventing weight gain (ClinicalTrials.gov identifier: NCT02883777). A total of 120 patients were evaluated. Patients were followed for 12 months, and the primary outcome was weight maintenance or weight gain lower than 5%. Results: There were no differences in total energy intake, carbohydrates, and total fats between groups. Intervention group (IG) increased protein intake to 1.38 ± 0.56 g/kg/day and decreased the glycemic load to 87.27 ± 4.54 g/day, while control group (CG) had a dietary protein intake of 1.19 ± 0.43 g/kg/day and a glycemic load of 115.60 ± 7.01 g/day. Total fiber intake was greater and trans-fat was lower in IG. Dietetic cholesterol increased in IG over time and was significantly different between groups. Overall, patients had an increase in body weight over time, with a mean increment of 4.1 ± 5.5 kg (5.75%). The percentage of patients who achieved the primary outcome was 50% of sample size, without differences between groups. The glomerular filtration rate improved over time in both groups. Considering 24-h proteinuria and albuminuria, a similar rise was observed in both groups. Conclusion: The present dietary intervention was safe, but had no effect on weight gain in kidney transplant subjects. Our findings suggest that other strategies, including alternative dietary and/or pharmacological and psychological interventions might be tested in randomized control trials in order to improve patients’ body weight outcomes after transplant.

We aimed to conduct a systematic review and meta-analysis assessing the antiinflammatory effects of various VNS methods while exploring multiple antiinflammatory pathways.

This research investigated the usefulness of magnetic iron oxide nanoparticles (Fe3O4) as a support to immobilize the lipase Eversa Transform 2.0 (ET 2.0) to obtain an active and stable biocatalyst, easily recoverable from the reaction medium for applications in the production of biodiesel. Biodiesel was an alternative fuel composed mainly of fatty acid esters with strong transesterification and esterification capabilities. The study focused on the esterification of oleic acid with ethanol to synthesize ethyl oleate. Magnetic nanoparticles were prepared by coprecipitation, then activated with glutaraldehyde and functionalized with γ-aminopropyltriethoxysilane (APTES). The optimal conditions for immobilizing ET 2.0 were pH 10, 25 mM sodium carbonate buffer, an enzymatic load of 200 U/g, and 1 h of contact time, obtaining 78% yield and enzymatic activity of 205.9 U/g. Postimmobilization evaluation showed that the immobilized enzyme performed better than its free form. Kinetic studies were conducted under these optimized conditions (2–96 h at 150 rpm and 37 °C). The biocatalyst was tested for the synthesis of ethyl oleate using oleic acid as the substrate and ethanol, achieving a conversion of 88.1%. Subsequent recirculation tests maintained approximately 80% conversion until the fourth cycle, confirming the sustainability of ester production. Molecular docking studies revealed that the binding affinity for the enzyme-docked oil composition was estimated at −5.8 kcal/mol, suggesting that the combination of the substrate and lipase was stable and suitable for esterification.

Background/AimsCardiovascular rehabilitation is a secondary preventative care model for outpatients. Despite its benefits, cardiac rehabilitation is greatly underused. Virtual reality‑based therapy could be a complementary treatment for traditional cardiac rehabilitation which promotes physical activity, enhancing motivation and increasing adherence to rehabilitation programmes. This qualitative study examined physiotherapists' perceptions toward using virtual reality‑based therapy based on exergames as part of cardiac rehabilitation programmes.MethodsThis qualitative study used focus groups to evaluate the perceptions of nine physiotherapists who have used virtual reality‑based therapy with exergames in cardiac rehabilitation.ResultsParticipants' attitudes towards virtual reality‑based therapy were overall positive, and found it could improve patients' adherence to a cardiac rehabilitation programme. Barriers to VRBT were also identified, including technical difficulties, patients being insecure about using a new therapeutic modality and managing the level of effort during the session. Suggestions for improvements included training for clinical staff, and having a introductory session for patients to help get used to the therapy and to find out what games they would prefer to play.ConclusionsVirtual reality‑based therapy can provide a change from the traditional treatment routine; however, there are some barriers, including potential safety concerns and technical issues. Feedback on haemodynamic parameters and identification of signs and symptoms of a cardiac event could be incorporated into games made specifically for patients undergoing cardiac rehabilitation.Implications for practiceFinding different ways to engage patients is needed. Based on the perceptions of physiotherapists from this study, VRBT could be one of the solutions to reach these goals for patients receiving cardiac rehabilitation.