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A significant proportion of revisions after reverse shoulder arthroplasty (RSA) is attributed to the humeral component. The purpose of this study is to evaluate the radiographic and clinical outcomes of the hybrid humerus technique for RSA using a Grammont-style humeral prosthesis in an onlay fashion with metaphyseal bone impaction grafting technique and undersized stem to avoid humeral stress shielding, notching, and loosening. This is a prospective case series of patients who underwent RSA using the hybrid humerus technique with a minimum 2-year follow-up. Key steps of this technique include the use of undersized Grammont-style stem, impaction bone grafting of the proximal 5 cm of the humerus, and adjusting the height and offset of the stem depending on the patient stature, desired lateralization and distalization, and joint and soft tissue tension. Radiographic assessments were performed immediately after surgery, and at 1 and 2 years after surgery. These included assessment of metaphyseal and diaphyseal filling ratio, cortical narrowing, radiolucent lines, cortical lucencies, spot welding, scapular notching, and stem alignment. Preoperative and 2-year postoperative clinical assessments included American Shoulder and Elbow Surgeons score, Constant-Murley Score, University of California Los Angeles score, visual analog scale for pain, and active range of motion. Correlation between the filling ratios and clinical outcomes were also evaluated. Sixty-one patients were included in the study. The average metaphyseal and diaphyseal filling ratio on the postoperative X-ray was 0.66 and 0.54, and 0.67 and 0.54 at 2 years, respectively. Stress shielding was graded as none in 24 (40.7%), mild in 33 (55.9%), and moderate in 2 (3.4%). No stem had a change in position of more than 5°. At 2 years of follow-up, no humeral implant loosening was noted, with only 2 (3.4%) of the stems at risk of loosening. Thirty-nine (66.1%) had no notching, 14 (23.7%) were graded as mild, and 6 (10.2%) had moderate signs of notching. All clinical assessments significantly improved at 2 years (P <.001), with a weak negative correlation between visual analog scale and metaphyseal filling ratio (r = −0.268, P =.036) but none between diaphyseal filling ratio and clinical outcomes. The hybrid humerus technique of metaphyseal bone grafting with a low filling ratio stem presents a promising solution for reducing humeral complications in RSA. This technique demonstrates a low incidence of stress shielding and loosening, with excellent clinical outcomes at 2 years. [ABSTRACT FROM AUTHOR]

Component positioning affects clinical outcomes of reverse shoulder arthroplasty, which necessitates an implantation technique that is reproducible, consistent, and reliable. This study aims to assess the accuracy and precision of positioning the humeral component in planned retroversion using a forearm referencing guide. Computed tomography scans of 54 patients (27 males and 27 females) who underwent primary reverse shoulder arthroplasty for osteoarthritis or cuff tear arthropathy were evaluated. A standardized surgical technique was used to place the humeral stem in 15° of retroversion. Version was assessed intraoperatively visualizing the retroversion guide from above and referencing the forearm axis. Metal subtraction techniques from postoperative computed tomography images allowed for the generation of 3D models of the humerus and for evaluation of the humeral component position. Anatomical humeral plane and implant planes were defined and the retroversion 3D angle between identified planes was recorded for each patient. Accuracy and precision were assessed. A subgroup analysis evaluated differences between male and female patients. The humeral retroversion angle ranged from 0.9° to 22.8°. The majority (81%) of the measurements were less than 15°. Mean retroversion angle (±SD) was 9.9° ± 5.8° (95% CI 8.4°-11.5°) with a mean percent error with respect to 15° of −34% ± 38 (95% CI –23 to −44). In the male subgroup (n = 27, range 3.8°-22.5°), the mean retroversion angle was 11.9° ± 5.4° (95% CI 9.8°-14.1°) with a mean percent error with respect to 15° of −21% ± 36 (95% CI –6 to −35). In the female subgroup (n = 27, range 0.9°-22.8°), mean retroversion angle was 8.0° ± 5.5° (95% CI 5.8°-10.1°) and the mean percent error with respect to 15° was −47% ± 36 (95% CI –32 to −61). The differences between the 2 gender groups were statistically significant (P =.006). Referencing the forearm using an extramedullary forearm referencing system to position the humeral stem in a desired retroversion is neither accurate nor precise. There is a nonnegligible tendency to achieve a lower retroversion than planned, and the error is more marked in females. [ABSTRACT FROM AUTHOR]

The discovery of drugs from marine natural products has witnessed a significant resurgence in recent years. A diverse range of marine organisms, including cone snails, bacteria, cyanobacteria, fungi, and halophytes, have yielded valuable compounds for drug development. These organisms contribute over 90% of the oceanic biomass, offering unique chemical properties with great potential, particularly in the field of anticancer research. The review highlights the historical successes in marine natural product-based drug discovery, emphasizing their novel chemical structures and bioactive properties. It sheds light on critical factors contributing to these discoveries, such as interdisciplinary collaborations between marine biologists, chemists, and pharmacologists, advanced isolation and characterization techniques, and the understanding of marine ecological niches. Challenges include limited supply, environmental concerns, and the complexity of chemical synthesis. Translating marine-derived compounds into viable pharmaceuticals requires rigorous testing, preclinical studies, and clinical trials. Looking forward, advances in research and technology, such as metagenomics and synthetic biology, offer promising avenues for faster and more efficient discovery and development of marine-derived drugs. The potential for uncovering new therapeutic agents remains vast, and the continued exploration of marine natural products holds the promise of significant breakthroughs in drug development while considering sustainable practices and environmental concerns. [Display omitted] • The unique and extreme conditions of the ocean contribute to the exceptional chemical diversity found in marine organisms. • Widespread use of plant-derived medicines highlights the importance of exploring natural products for medical purposes. • Around 30,000 marine natural products have been identified and characterized till date. • Success of marine-derived drugs like Ziconotide and Trabectedin exemplify their pharmaceutical potential. • A comprehensive table detailing other recently approved marine-derived drugs has been included in the manuscript. [ABSTRACT FROM AUTHOR]

Tuberculosis is a disease of poverty, discrimination, and socioeconomic burden. Epidemiological studies suggest that the mortality and incidence of tuberculosis are unacceptably higher worldwide. Genomic mutations in embCAB, embR, katG, inhA, ahpC, rpoB, pncA, rrs, rpsL, gyrA, gyrB, and ethR contribute to drug resistance reducing the susceptibility of Mycobacterium tuberculosis to many antibiotics. Additionally, treating tuberculosis with antibiotics also poses a serious risk of hepatotoxicity in the patient's body. Emerging data on drug-induced liver injury showed that anti-tuberculosis drugs remarkably altered levels of hepatotoxicity biomarkers. The review is an attempt to explore the anti-mycobacterial potential of selected, commonly available, and well-known phytocompounds and extracts of medicinal plants against strains of Mycobacterium tuberculosis. Many studies have demonstrated that phytocompounds such as flavonoids, alkaloids, terpenoids, and phenolic compounds have antibacterial action against Mycobacterium species, inhibiting the bacteria's growth and replication, and sometimes, causing cell death. Phytocompounds act by disrupting bacterial cell walls and membranes, reducing enzyme activity, and interfering with essential metabolic processes. The combination of these processes reduces the overall survivability of the bacteria. Moreover, several phytochemicals have synergistic effects with antibiotics routinely used to treat TB, improving their efficacy and decreasing the risk of resistance development. Interestingly, phytocompounds have been presented to reduce isoniazid- and ethambutol-induced hepatotoxicity by reversing serum levels of AST, ALP, ALT, bilirubin, MDA, urea, creatinine, and albumin to their normal range, leading to attenuation of inflammation and hepatic necrosis. As a result, phytochemicals represent a promising field of research for the development of new TB medicines. [ABSTRACT FROM AUTHOR]

Introduction: Healthy meals play an essential role in the healthy physical and mental development of adolescents. Breakfast at home is associated with improved nutritional choices, and skipping breakfast is detrimental. This study assessed prevalence of skipping breakfast at home among adolescent students in the Badia Region of Jordan, identifying the reasons and characteristics associated with such behavioural choice. Methods: A cross-sectional survey among adolescent students (aged 13-16 years, in 8th-9th grades) from six public schools in Badia Region, Mafraq Governorate, Jordan, was conducted through self-administered questionnaire from February to March 2022. Results: Results showed that 68.1% of 552 student participants regularly skipped breakfast at home (72.4% boys vs. 61.3% girls; p=0.007). Among those who regularly skipped breakfast, three main rationales for this choice were not feeling hungry (5.3%), lack of time (2.7%), and lack of appetite (3.5%). Conclusion: The prevalence of skipping breakfast at home among adolescents in Badia Region was high for various reasons, including lack of time, not feeling hungry, seeking to manage weight, and insufficient knowledge on the importance of healthy breakfast. Therefore, understanding the reasons and factors that contribute towards breakfast skipping may help in solving the problem, underscoring that positive beliefs should be reinforced in schools, with parents encouraging adolescents to eat healthy breakfast. [ABSTRACT FROM AUTHOR]

Despite English teachers' acknowledgement of the plurality of English and the emergence of different varieties of the language, the actual manifestations of this plurality and the associated principles do not seem to be equally embraced in their classroom approach. Against this background, this study investigated Iranian English teachers' conceptions of English as an International Language (EIL) and their corresponding instructional practices through semistructured interviews and non-participant classroom observations. Drawing upon the theory of planned behavior (TPB), as the theoretical/analytical framework, the researchers explored the participant teachers' behavioral, normative, and control beliefs underlying their intentions and actual classroom practices with regard to EIL. Findings revealed that although the teachers acknowledged the importance of raising learners' awareness of EIL in different aspects of their language use, they still leaned towards standard American or British English in their actual instructional practices. Such propensity was informed by their attitudes toward the inclusion of EIL principles, their perceptions of the existing social pressures, and their perceived difficulty of adopting an EIL-aware pedagogy. Moreover, the participant teachers' actual classroom instructions were found to be incongruent with their beliefs about the importance of raising students' awareness regarding different English varieties. Implications for language teacher education are discussed. [ABSTRACT FROM AUTHOR]

Most models for predicting pressure-flow scour depth are based on use of the continuity and energy equations. The current study presents a model to predict pressure-flow scour depth using the momentum equation considering the jet flow deflected by the bridge deck. When approaching the bridge deck, the upstream flow acts as a jet flow that deviates toward the bed. Below the bridge deck, a combined jet-flow is created as a result of merging the initial jet-flow and the pressure-flow. The continuity equation is used to determine the thickness of the separation zone and the combined jet-flow angle. Equations are presented to estimate the combined jet-flow velocity and the thickness of the combined jet-flow. The study results reveal that the flow intensity, submergence ratio, and relative separation zone thickness are the principal parameters affecting the pressure-flow scour depth. The equation proposed in this study shows satisfactory accuracy to predict the equilibrium pressure-flow scour depth for a relative opening height of the bridge deck greater than 0.25. For relative opening heights of the bridge deck less than 0.25, insufficient duration of tests is a limitation of the available data to verify the proposed equation. [ABSTRACT FROM AUTHOR]

As of 25th July, 2022, global Disease burden of 575,430,244 confirmed cases and over 6,403,511 deaths have been attributed to coronavirus disease 2019 (COVID-19). Co-infections/secondary infections continue to plague patients around the world as result of the co-morbidities like diabetes mellitus, biochemical changes caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) especially significant elevation in free iron levels, immune suppression caused by SARS-CoV-2, and indiscriminate use of systemic corticosteroids for the treatment of severe COVID-19 disease. In such circumstances, opportunistic fungal infections pose significant challenge for COVID-19 disease therapy in patients with other co-morbidities. Although COVID-19-associated Mucormycosis (CAM) has been widely recognized, currently extensive research is being conducted on mucormycosis. It has been widely agreed that patients undergoing corticosteroid therapy are highly susceptible for CAM, henceforth high index of screening and intensive care and management is need of an hour in order to have favorable outcomes in these patients. Diagnosis in such cases is often delayed and eventually the disease progresses quickly which poses added burden to clinician and increases patient load in critical care units of hospitals. A vast perusal of literature indicated that patients with diabetes mellitus and those with other co-morbidities might be highly vulnerable to develop mucormycosis. In the present work, the case series of three patients presented at Chest Disease Hospital Srinagar, Jammu and Kashmir infected with CAM has been described with their epidemiological data in supplementary section. All these cases were found to be affected with co-morbidity of Diabetes Mellitus (DM) and were under corticosteroid therapy. Furthermore, given the significant death rate linked with mucormycosis and the growing understanding of the diseases significance, systematic review of the literature on CAM has been discussed and we have attempted to discuss emerging CAM and related aspects of the disease. [ABSTRACT FROM AUTHOR]

Failure of optimal growth and lack of appropriate weight gain are major nutritional problems in children with inflammatory bowel disease (IBD). Therefore, this study was designed to assess the nutritional and growth status of patients with very-early-onset IBD (VEO-IBD) before and after individual-based nutritional interventions. This prospective cohort study assessed the nutritional status of 30 pediatric patients with VEO-IBD by performing comprehensive clinical examinations and evaluating anthropometric and biochemical parameters. The latter included the initial evaluation of serum albumin, prealbumin, minerals, and 25-hydroxyvitamin D. A 24-month nutritional strategy was designed for each patient. Patients who completed the study were reassessed after 6 months and their growth rate was calculated 2 years later. The initial assessment of malnutrition severity using the World Health Organization's z-score revealed that 36.7%, 43.3%, and 26.7% of the study group were underweight, stunted, and wasted, respectively. Among the study population, Crohn's disease has the highest prevalence. Almost all patients had micronutrient deficiencies (i.e., iron, calcium, zinc, magnesium, and vitamin D) and subnormal serum levels of nutritional markers (i.e., prealbumin and albumin). Six months after the intervention, a significant improvement in anthropometric and biochemical parameters was detected (p < 0.05); nevertheless, the calculated growth rate revealed a considerable decrease after 2 years. The early detection of nutritional impairment in patients with VEO-IBD remains a major challenge. Therefore, nutritional support and constant monitoring of these patients are necessary to ensure the improvement in their nutritional status and achieve an acceptable growth rate. Furthermore, we found that prealbumin could be a good discriminative tool for screening malnutrition in such patients. [ABSTRACT FROM AUTHOR]

Developing L2 learners' emotional balance through adaptive regulation is a significant determinant of successful learning. Despite the recent surge of interest in emotion regulation (ER) programs, research on L2 learners' ER strategies is surprisingly underdeveloped. To address this gap, the current qualitative study explored ten L2 learners' understanding of achievement emotions and ER strategies throughout a longitudinal ER-oriented training course. Data were collected from four rounds of semi-structured interviews and diaries at different junctures of time. Data analysis revealed that the most frequent ER strategies in the pre-training phase were distraction and suppression, which showed a gradual decrease in the post-training phases. However, the use of self-regulated learning strategies and reassurance had the lowest frequency, showing a great improvement during the post-training phases. Additionally, the students grew in regulating their emotions across four major areas: (a) sufficient perceived control over negative emotions in high-stakes situations, (b) use of explicit ER strategies, (c) efficient use of competency-oriented strategies, and (d) decreased distraction as a function of negative simulators. The study provides implications for employing ER-based training to transform students' negative emotional experiences into positive emotions. [ABSTRACT FROM AUTHOR]

Complex, kinetically stable emulsions with an average droplet size of 50–100 nm and a mean droplet diameter of 50–1000 nm is known as nanoemulsions. They are often referred to as tiny submicron, ultrafine, or finely dispersed emulsions; they have a tyndal effect and are transparent to the naked eye. Antimicrobial nanoemulsion is a type of o/w emulsion system that is stabilized by surfactants and alcohols that are used as co-surfactants. It is effective against a wide range of microorganisms, such as viruses (such as herpes simplex and HIV), fungi (such as Candida and dermatophytes), and bacteria (such as Escherichia coli , Salmonella , and Staphylococcus aureus). The nanoemulsion droplets were designed to fuse by electrostatic attraction and a thermodynamic mechanism with lipid-coated microorganisms. The active component and the trapped energy generated by the nanoemulsion break down the pathogen's lipid membrane when a sufficient number of nanoparticles fuse with the pathogens, resulting in cell lysis and the eventual death of the invasion microorganisms. Because there is less surfactant in each droplet, the targeted bacteria become unstable without endangering the healthy cells, giving the nanoemulsions a safety margin. Nanoemulsion has many benefits, such as being clear, biocompatible, non-immunogenic, biodegradable, able to hold drugs, release them slowly and steadily, being nanometrically small, having a large surface area, being easy to make, and being thermodynamically stable. [ABSTRACT FROM AUTHOR]