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The purpose of the study was to examine the organizational strategy and tools of employee well-being, as perceived by employees. Although improving physical, mental, and social conditions of employees have positive impact on economic performance and competitiveness of organizations, little is known about how employee wellbeing appears in human resource management strategy and practices of organizations. Few research is available examining the adaptability of well-being strategy and tools from the perspective of employees as stakeholders. Therefore, the methodology of the current study was an exploratory sequential mixed method, with an embedded case study. Qualitative exploratory phase consisted of 27 semi-structured interviews with human resource management experts of Hungarian and international for-profit organizations. The results supported the definition for selection criteria of case study sampling and the design of a research tool for the quantitative phase. In the case study, interviews and quantitative research were conducted at the selected organization. The self-developed questionnaire included the Workplace PERMA Profile, reflecting the five pillars of well-being: Positive emotions, Engagement, Relationships, Meaning, and Accomplishment. The questionnaire has been filled out by 222 employees. The data integration results explored that the well-being is less characterized by a strategic approach, despite its importance defined by respondents. Employee perception analysis has led to the creation of employee well-being profiles, mapping organizational tools supporting employee satisfaction, and highlighting the inconsistences of organizational strategy and employee perceptions. The results could contribute to further studies and development of human resource management practices to improve employee well-being by directing the focus on its growing importance in economic and labor competitiveness.

Breast milk represents the best food for growth and healthy development of new-borns and infants. Exclusive breast feeding is recommended for the first 6 months of life. The composition of human milk changes throughout the lactation period. The aim of this preliminary study was to evaluate the variations in fatty acid composition and elemental concentrations of breast milk during the first 6 months of lactation. Fatty acid methyl esters were prepared by standard methods, separated, and quantified by gas chromatography with flame ionization detection (GC-FID). An inductively coupled plasma mass spectrometry (ICP-MS) method was used to determine 16 elements in breast milk after acid microwave digestion. The mean concentrations of essential elements and potentially toxic elements were as follows: 410.3 mg/L (Na), 53.5 mg/L (Mg), 118.4 mg/L (P), 516 mg/L (K), 326.4 mg/L (Ca), 0.5 mg/L (Fe), 0.4 mg/L (Cu), 1.5 mg/L (Zn), 0.2 mg/L (Cr), 0.02 mg/L (Ni), 3.5 µg/L (Li), 5.0 µg/L (Mn), 0.6 µg/L (Co), 7.7 µg/L (As), and 1.5 µg/L (Pb). Analysis of variance (ANOVA), linear discriminant analysis (LDA) and Pearson's correlation analysis was applied to evaluate correlations among the lactation stages as a function of fatty acid and elemental contents and to identify the best discriminant markers. [ABSTRACT FROM AUTHOR]

Introduction: Suicide is the most severe consequence of major depressive disorder (MDD). The most novel researches assume the role of immunological dysregulation in the background – several studies have reported alterations of inflammatory cells related to both MDD and suicidal behaviour (SB). Objectives: Changes in the number of certain immune cells and their ratios have been proposed as potential biomarkers of suicide risk (SR). The aim of our research was to investigate alterations of these values related not only to MDD as an assumed inflammatory state, but also to an increased risk of SB. Methods: In our restrospective cohort study carried out between January 2015 and January 2020, we investigated laboratory parameters of psychiatric patients diagnosed with MDD (n =101). Individuals with recent (≤48 hours prior) suicide attempt (SA) (n =22) and with past SA (>48 hours prior) (n =19) represented the high SR group. MDD patients with no history of SA (n =60) composed the intermediate SR group. We compared the number of neutrophil granulocytes, monocytes, lymphocytes, platelets, leukocytes, neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), platelet-to-lymphocyte ratio (PLR), red blood cell distribution width (RDW) and erythrocyte sedimentation rate (ESR). Furthermore, we evaluated alterations of these parameters related to antidepressant (AD) treatment, which has been proved to have anti-inflammatory effects. Statistical analyses were carried out using GraphPad 9.5.0 and MedCalc 16.8 programmes. Results: We found a significant increase in neutrophil granulocyte count (p =0.016), NLR (p =0.031, Fig. 1), monocyte count (p ≤0.0001), MLR (p =0.005, Fig. 2), leukocyte count (p =0.048) and ESR (p =0.037) in patients with recent SA compared to patients with no history of SA. Moreover, there was a significant elevation in monocyte count (p ≤0.0001), MLR (p =0.020, Fig. 3), ESR (p =0.041) and RDW (p =0.037) in patients with high SR compared to patients with intermediate SR. AD treatment resulted in a significant decrease in neutrophil granulocyte count (p =0.0163) and NLR (p =0.016), however, it did not affect the rest of the parameters. Image: Image 2: Image 3: Conclusions: Assuming immunological mechanisms in the background of MDD and SB, our findings support the role of NLR as a biomarker of acute SR, though its alterations may be masked by AD therapy in the long term. However, MLR – remaining unaffected by AD treatment – may be a possible indicator of both acute and long term suicidal vulnerability. In order to further specify the diagnostic value of these parameters, future prospective research is needed. The study was supported by the FIKP-IV and the TNIL projects. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Introduction: Several research already proved the role of certain immunological factors (neutrophil-lymphocyte (NLR), monocyte-lymphocyte (MLR) and platelet-lymphocyte (PLR) ratio, and C-reactive protein (CRP)) in the background of suicidal behaviour. Objectives: The aim of this research was to study the association between routinely measurable low-grade inflammation parameters and suicidal behaviour among patients in the acute psychiatric care setting. Methods: The study population included psychiatric in-patients (N=100) consecutively treated with depressive disorders and/or suicidal behaviour in a University Clinic between December 1, 2020 and December 31, 2021. Three different patient-groups were generated based on their suicidal behaviour: suicide attempters (N=55) including recent attempters (N=36) and past attempters (N=19) and non-suicidal patients (N=45), who never had a suicide attempt. Basic socio-demographic data, the severity of depression and immunological parameters (white blood cell count: lymphocytes, monocytes, neutrophil, eosinophil, basophil granulocytes; thrombocytes; C-reactive protein) were recorded.Descriptive analyses and multivariate regression model were performed with RStudio version 4.2.3. Results: CRP was significantly higher (2.00 vs. 1.00; p=0.007) in suicidal patients (N=55), however other immunological parameters did not differ significantly between the suicidal and the non-suicidal groups (NLR: 2.02 vs. 2.19; MLR: 0.22 vs. 0.11; PLR: 118 vs. 130). NLR and MLR showed significantly higher values (NLR: 2.83 vs. 1.93, p=0.021; MLR: 0.28 vs. 0.11, p=0.01) for those who currently attempted suicide (N=36) compared to the patients with no or past suicide attempt (N=64). In the regression analysis, the NLR and MLR showed significantly higher values in current suicide attempters even when gender, age, suicidal risk and severity of depression were included in the model. However, no significant differences were found when comparing current and past suicide attempters with the non-suicidal patients. Conclusions: Despite the small number of cases in the samples, our results confirmed the association of certain immunological parameters (NLR, MLR) and acute suicidal behaviour. This relationship was found to be independent of depression and its severity. Our data suggest that, unlike the NLR and MLR parameters, the higher CRP value may not be related to acute suicide attempt, but rather to suicidal vulnerability, as a trait-marker. Markers of chronic systemic inflammation may help in the prediction of suicidal behaviour and in the development of new therapeutic options, however, further prospective studies are needed to identify the specific role of immunological factors in suicidal behaviour more precisely. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Headache attributed to craniotomy is an underestimated and under-treated condition. Previous studies confirmed the efficacy of preemptive analgesia with non-steroidal anti-inflammatory agents. The aim of the present work was to test the hypothesis of whether a single preoperatively administered dose of dexketoprofen (DEX) has the potency to decrease postcraniotomy headache (PCH) as compared to placebo (PL).

The paper addresses how the microwave field influences the drying process of peppermint plants, without affecting their chemical structure. The microwave equipment used allows a uniform heating of the plants with maximum yield. The purpose of the research undertaken is to dry the peppermint plants and then to extract the natural compounds from the plants, ensuring that the product obtained changes its structure as less as possible compared to the natural compound, while also optimizing the main parameters (temperature, time, drying speed).

Introduction: At the time of diagnosis, most patients with lung cancer are in an inoperable stage, with distant metastases. Most often, these patients have metastases to the brain, adrenal glands, liver, or bones. This article presents the case of a patient with non-small-cell lung cancer (NSCLC) metastases in the abdominal wall.

Introduction: Acute abdominal pain persists in defying modern diagnostic procedures. Inflammatory response variables in urine and blood tests can help rule out other disorders and support a clinical diagnosis of acute appendicitis (AA), but there is no specific blood test that can diagnose AA. In order to address this, our study sought to establish the value of (NLR) as a prognostic and severity predictor in patients with AA.

Recurrent epiphytotics of X-disease, caused by ' Candidatus Phytoplasma pruni,' have inflicted significant losses on commercial cherry and peach production across North America in the last century. During this period, there have been multiple studies reporting different disease phenotypes and, more recently, identifying different strains through sequencing core genes, but the symptoms have not, to date, been linked with genotype. Therefore, in this study we collected and assessed differing disease phenotypes from multiple U.S. states and conducted multilocus sequence analysis on these strains. We identified a total of five lineages associated with the induction of X-disease on commercial Prunus species and two lineages that were associated with wild P. virginiana . Despite a century of interstate plant movement, there were regional trends in terms of lineages present, and lineage-specific symptoms were observed on P. avium , P. cerasus , and P. virginiana , but not on P. persica . Cumulatively, these data have allowed us to define "true" X-disease-inducing strains of concern to the stone fruit industry across North America, as well as potential sources of infection that exist in the extraorchard environment., Competing Interests: The author(s) declare no conflict of interest.

Ewing sarcoma (EwS) is a cancer that arises in the bones and soft tissues, typically driven by the Ewing's sarcoma breakpoint region 1-Friend leukemia virus integration 1 (EWS-FLI) oncogene. Implementation of genetically modified animal models of EwS has proved difficult largely owing to EWS-FLI's high toxicity. The EWS-FLI 1FS frameshift variant that circumvents toxicity but is still able to perform key oncogenic functions provided the first study model in Drosophila . However, the quest for Drosophila lines expressing full-length, unmodified EWS-FLI remained open. Here, we show that EWS-FLI 1FS 's lower toxicity is owed to reduced protein levels caused by its frameshifted C-terminal peptide, and report new strategies through which we have generated Drosophila lines that express full-length, unmodified EWS-FLI. Using these lines, we have found that the upregulation of transcription from GGAA-microsatellites (GGAAμSats) presents a positive linear correlation within a wide range of EWS-FLI protein concentrations. In contrast, rather counterintuitively, GGAAμSats-independent transcriptomic dysregulation presents relatively minor differences across the same range, suggesting that GGAAμSat-dependent and -independent transcriptional upregulation present different kinetics of response with regards to changing EWS-FLI protein concentration. Our results underpin the functional relevance of varying EWS-FLI expression levels and provide experimental tools to investigate, in Drosophila , the effect of the EWS-FLI 'high' and 'low' states that have been reported and are suspected to be important for EwS in humans.

Expression of the Drosophila cancer-germline (CG), X-linked, head-to-head gene pair TrxT and dhd is normally germline-specific but becomes upregulated in brain tumours caused by mutation in l(3)mbt. Here, we show that TrxT and dhd play a major synergistic role in the emergence of l(3)mbt tumour-linked transcriptomic signatures and tumour development, which is remarkable, taking into account that these two genes are never expressed together under normal conditions. We also show that TrxT, but not dhd, is crucial for the growth of l(3)mbt allografts, hence suggesting that the initial stages of tumour development and long-term tumour growth may depend on different molecular pathways. In humans, head-to-head inverted gene pairs are abundant among CG genes that map to the X chromosome. Our results identify a first example of an X-linked, head-to-head CG gene pair in Drosophila, underpinning the potential of such CG genes, dispensable for normal development and homoeostasis of somatic tissue, as targets to curtail malignant growth with minimal impact on overall health., (© 2024. The Author(s).)

Deep learning has greatly accelerated research in biological image analysis yet it often requires programming skills and specialized tool installation. Here we present Piximi, a modern, no-programming image analysis tool leveraging deep learning. Implemented as a web application at Piximi.app, Piximi requires no installation and can be accessed by any modern web browser. Its client-only architecture preserves the security of researcher data by running all computation locally. Piximi offers four core modules: a deep learning classifier, an image annotator, measurement modules, and pre-trained deep learning segmentation modules. Piximi is interoperable with existing tools and workflows by supporting import and export of common data and model formats. The intuitive researcher interface and easy access to Piximi allows biological researchers to obtain insights into images within just a few minutes. Piximi aims to bring deep learning-powered image analysis to a broader community by eliminating barriers to entry.

Background: Complex incisional hernia is still a debatable topic, with increasing incidence and an increased local and systemic postoperative morbidity and mortality. The size of the defect is a risk factor for both difficult closure and 30-day readmission due to complications. The main option for closure such defect is a mesh augmented component separation technique. The goal was to evaluate 30-day wound events and general complications including 90 days mortality., Material and Methods: We present a retrospective study that includes patients from two different university hospitals who underwent open incisional hernia repair with anterior component or posterior component separation between January 2015 and December 2021. Only non-contaminated adult patients (over 18 years old) with postoperative primary or recurrent median abdominal wall defects larger than 6 cm and with complete fascial closure were included. Demographics (age, gender, Body Mass Index-BMI, American Society of Anesthesiologists Classification-ASA score), recurrence rank, and co-morbidities), operative details, patient outcomes complications were collected. A native abdomen/pelvis computerized tomography (CT) scan was performed preoperatively in all patients and the anatomy of the defect and volumetry (abdominal cavity volume, incisional hernia volume and peritoneal volume) were evaluated. One of the component separation technique was performed according to Carbonell's equation., Results: Two hundred and two patients (101 from each group) were included. The patients with posterior component separation were more comorbid and with larger defects. The procedure was longer with 80 min but overall length of hospital stay shorter (p < 0.001) for posterior component separation. Seroma, hematoma and skin necrosis were equally distributed for both group of patients and there was no direct relation to surgery (OR 0.887, 95% CI 0.370-2.125, p = 0.788; OR 1.50, 95% CI 0.677-3.33, p = 0.318 and OR 0.386, 95% CI 0.117-1.276, p = 0.119). Surgical Site Infection rate was increased for anterior component separation (p =0.004)., Conclusion: Complex incisional hernia repair is a challenge given by a large amount of wound complications. Choosing between anterior and posterior component separation is still a source of significant debate. We were not able to depict significant different rates of complications between the procedures and we couldn't find any specific factor related to complications., (© 2023. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Objective: To identify factors acting as barriers or enablers to the process of healthcare consent for people with intellectual disability and to understand how to make this process equitable and accessible., Data Sources: Databases: Embase, MEDLINE, PsychINFO, PubMed, SCOPUS, Web of Science and CINAHL. Additional articles were obtained from an ancestral search and hand-searching three journals., Eligibility Criteria: Peer-reviewed original research about the consent process for healthcare interventions, published after 1990, involving adult participants with intellectual disability., Synthesis of Results: Inductive thematic analysis was used to identify factors affecting informed consent. The findings were reviewed by co-researchers with intellectual disability to ensure they reflected lived experiences, and an easy read summary was created., Results: Twenty-three studies were included (1999 to 2020), with a mix of qualitative (n=14), quantitative (n=6) and mixed-methods (n=3) studies. Participant numbers ranged from 9 to 604 people (median 21) and included people with intellectual disability, health professionals, carers and support people, and others working with people with intellectual disability. Six themes were identified: (1) health professionals' attitudes and lack of education, (2) inadequate accessible health information, (3) involvement of support people, (4) systemic constraints, (5) person-centred informed consent and (6) effective communication between health professionals and patients. Themes were barriers (themes 1, 2 and 4), enablers (themes 5 and 6) or both (theme 3)., Conclusions: Multiple reasons contribute to poor consent practices for people with intellectual disability in current health systems. Recommendations include addressing health professionals' attitudes and lack of education in informed consent with clinician training, the co-production of accessible information resources and further inclusive research into informed consent for people with intellectual disability., Prospero Registration: CRD42021290548., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: EP has received funding from the NHMRC and NSW Health. She is a clinical geneticist at Sydney Children’s Hospitals Network-Randwick and a member of the medical and scientific advisory committee for Rare Voices Australia, the national peak body for Australians living with a rare condition. IS has received funding from the NHMRC and the NSW Department of Health. She is also a Board member of Self Advocacy Sydney, an organisation run by and for people with intellectual disability. JS is Director of the Disability Innovation Institute, which has received funding from the NHMRC and the NSW Department of Health. JL, OAM has received funding from the NHMRC and the NSW Department of Health. She is also a Board member of Self Advocacy Sydney, an organisation run by and for people with intellectual disability. SS has received funding from the NHMRC and the NSW Department of Health. She is also an employee at Self-Advocacy Sydney, an organisation run by and for people with intellectual disability. JB and BT have received funding from the NHMRC. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Introduction: Acute cholecystitis (AC) represents a public health problem, increasing hospitalization costs, especially determined by the surgical treatment of these patients. Laparoscopic cholecystectomy (LC) has become the therapeutic gold standard, the timing of the intervention: early (ELC) versus late (DLC), is still debated, impacting the results. The primary objective of the study was to compare postoperative outcomes between ELC and DLC. Secondary objectives assessed surgical outcomes from the pre-pandemic period with those from the Covid-19 pandemic. Material and methods: A retrospective observational study is presented of 266 patients diagnosed with AC who were admitted to Clinic I of General Surgery, County Emergency Clinical Hospital of T #226;rgu Mure #351;, from 2018 to 2022. They were classified into the ELC group ( 72 hours from the onset of symptoms) and DLC ( 72 hours from symptom onset) and were further stratified into prepandemic and pandemic cohorts. Data on clinical symptoms, paraclinical data, surgical details, and postoperative course were collected and analyzed. Discussion: The results confirm fewer conversions to open surgery and reduced hospitalization in the ELC group. The pandemic did not significantly alter the timing of surgeries or patient demographics. Conclusion: In conclusion, ELC for AC patients offers significant advantages, justifying its preference over DLC Despite the decrease in the incidence of AC hospitalizations during the pandemic, postoperative outcomes are comparable to those in the pre-pandemic period. Future multicenter studies are recommended for a broader analysis of the efficacy of laparoscopic surgery in emergency settings., (Celsius.)

Introduction: Pelvic organ prolapse (POP) affects up to 50% of women and has a significant impact on quality of life. Abdominal sacrocolpopexy is the gold standard treatment for vault prolapse and laparoscopic sacrocolpopexy has many advantages. This study aimed to compare the results of two laparoscopic sacrocolpopexy procedures performed at two different surgical centers. Materials and Methods: The primary objective of this retrospective study was to assess surgical feasibility and complication rates associated with sacrocolpopexy procedures performed at Center A (using self-fixating mesh) and Center B (using sutured mesh). Secondary objectives included assessment of length of hospital stay, readmission rates, and surgical outcomes. The study included patients treated between January 2019 and October 2023. Results: Thirteen patients, six from Center A and seven from Center B, were included. Patient characteristics, such as age and body mass index, were similar between the two groups. Operative time and length of stay were not significantly different. Center A reported one postoperative complication (mesh erosion), which occurred two years after surgery and required laparoscopic intervention. Center B also reported one conversion to laparotomy because of metabolic acidosis and hypercapnia. Conclusion: The two laparoscopic sacrocolpopexy techniques were safe and effective for treating POP and our study confirmed the importance of mesh and fixation choices. Further research is needed to improve understanding of these surgical techniques., (Celsius.)

British Columbia (BC) is the lead producer of sweet cherries in Canada with more than 2,000 ha in production and a farm gate value of over CAD$100 million annually. Since 2010, an outbreak of little cherry disease caused by Little cherry virus 1 (LChV1) and Little cherry virus 2 (LChV2), as well as X-disease (XD) caused by 'Candidatus Phytoplasma pruni' has caused significant economic losses in neighboring Washington State (WA), USA. LChV1 and LChV2 have long been known to occur in BC (Theilmann et al. 2002); however, 'Ca. P. pruni' has not yet been reported in BC. Due to its geographical proximity to WA State, the BC cherry industry expressed significant concerns about the possible presence of the phytoplasma in cherry orchards. Accordingly, the main objective of this study was to survey cherry orchards to determine whether 'Ca. P. pruni' was present in symptomatic trees in BC. A total of 118 samples of leaves and fruit stems from individual symptomatic trees were collected prior to harvest from nine cherry orchards and one nectarine orchard in the Okanagan and Similkameen Valleys in BC. Characteristic symptoms included small and misshapen fruit with poor color development. Samples were submitted to AGNEMA, LLC (Pasco, WA) for testing using qPCR TaqMan assays for LChV1 (Katsiani et al. 2018), LChV2 (Shires et al. 2022) and 'Ca. P. pruni' (Kogej et al. 2020). Test results showed 21 samples (17.8%) from three cherry orchards positive for LChV2 and 2 samples (1.7%) from one cherry orchard positive for 'Ca. P. pruni'. In order to confirm the identification of 'Ca. P. pruni', part of the 16S ribosomal RNA gene was amplified by nested PCR using the P1/P7 followed by R16F2n/R2 primer sets (Gundersen and Lee 1996) and Sanger sequenced. BC-XD-Pa-1 (GenBank Acc. No. OR539920) and BC-XD-Pa-2 (OR537699) were identical to one another and showed 99.92% identity to the 'Ca. P. pruni' reference strain CX-95 (JQ044397). Analysis using iPhyClassifier (Zhou et al. 2009) indicated that they were 16SrIII-A strains. Interestingly, the two partial 16S sequences showed 100% nucleotide identity to strain 10324 (MH810016) and others from WA. For additional confirmation, partial secA (Hodgetts et al. 2008) and secY (Lee et al. 2010) translocases were amplified and sequenced. As with the 16S sequences, secY sequences (OR542980, OR542981) showed 99.92% nucleotide identity to strain CX-95 (JQ268249), and 100% to strain 10324 (MH810035). The secA sequences (OR542978, OR542979) had nucleotide identities of 99.77% to strain CX (MW547067), and 100% to the Green Valley strain from California (EU168733). Accordingly, 'Ca. P. Pruni' was confirmed to be present in sweet cherry samples from BC. 'Ca. P. Pruni'-related strains have been previously reported to occur in Canada in commercial poinsettias (Euphorbia pulcherrima) (Arocha-Rosete et al. 2021). To our knowledge, this is the first report of 'Ca. P. Pruni' in sweet cherry in Canada. Due to the important economic value of sweet cherries in BC, these findings are highly significant and represent the first steps towards the development of a surveillance system for early detection of XD, and consequent implementation of management strategies, including vector control. As required by federal and provincial regulations, cherry trees infected with LChV2 and 'Ca. P. Pruni' found in the survey were removed by the growers.

Aim: Intersphincteric resection (ISR) is an oncologically complex operation for very low-lying rectal cancers. Yet, definition, anatomical description, operative indications and operative approaches to ISR are not standardized. The aim of this study was to standardize the definition of ISR by reaching international consensus from the experts in the field. This standardization will allow meaningful comparison in the literature in the future., Method: A modified Delphi approach with three rounds of questionnaire was adopted. A total of 29 international experts from 11 countries were recruited for this study. Six domains with a total of 37 statements were examined, including anatomical definition; definition of intersphincteric dissection, intersphincteric resection (ISR) and ultra-low anterior resection (uLAR); indication for ISR; surgical technique of ISR; specimen description of ISR; and functional outcome assessment protocol., Results: Three rounds of questionnaire were performed (response rate 100%, 89.6%, 89.6%). Agreement (≥80%) reached standardization on 36 statements., Conclusion: This study provides an international expert consensus-based definition and standardization of ISR. This is the first study standardizing terminology and definition of deep pelvis/anal canal anatomy from a surgical point of view. Intersphincteric dissection, ISR and uLAR were specifically defined for precise surgical description. Indication for ISR was determined by the rectal tumour's maximal radial infiltration (T stage) below the levator ani. A new surgical definition of T3isp was reached by consensus to define T3 low rectal tumours infiltrating the intersphincteric plane. A practical flowchart for surgical indication for uLAR/ISR/abdominoperineal resection was developed. A standardized ISR surgical technique and functional outcome assessment protocol was defined., (© 2023 Association of Coloproctology of Great Britain and Ireland.)

Background: To inform future preventive measures including repeated vaccinations, we have searched for a clinically useful immune correlate of protection against fatal COVID-19 among nursing homes residents., Methods: We performed repeated capillary blood sampling with analysis of S-binding IgG in an open cohort of nursing home residents in Sweden. We analyzed immunological and registry data from 16 September 2021 to 31 August 2022 with follow-up of deaths to 30 September 2022. The study period included implementation of the 3rd and 4th mRNA monovalent vaccine doses and Omicron virus waves., Findings: A total of 3012 nursing home residents with median age 86 were enrolled. The 3rd mRNA dose elicited a 99-fold relative increase of S-binding IgG in blood and corresponding increase of neutralizing antibodies. The 4th mRNA vaccine dose boosted levels 3.8-fold. Half-life of S-binding IgG was 72 days. A total 528 residents acquired their first SARS-CoV-2 infection after the 3rd or the 4th vaccine dose and the associated 30-day mortality was 9.1%. We found no indication that levels of vaccine-induced antibodies protected against infection with Omicron VOCs. In contrast, the risk of death was inversely correlated to levels of S-directed IgG below the 20th percentile. The death risk plateaued at population average above the lower 35th percentile of S-binding IgG., Interpretation: In the absence of neutralizing antibodies that protect from infection, quantification of S-binding IgG post vaccination may be useful to identify the most vulnerable for fatal COVID-19 among the oldest and frailest. This information is of importance for future strategies to protect vulnerable populations against neutralization resistant variants of concern., Funding: Swedish Research Council, SciLifeLab via Knut and Alice Wallenberg Foundation, VINNOVA. Swedish Healthcare Regions, and Erling Persson Foundation., Competing Interests: All authors declare no competing interests., (© 2023 The Author(s).)

Background: Orthostatic intolerance (OI)-type events following hip and knee arthroplasty increase the risk of falls, hospital length of stay, and health-care costs. There is a limited understanding of the incidence of and risk factors for OI-type events in patients during the acute hospital stay. Our aim was to systematically review the incidence of and risk factors for OI-type events during the acute hospital stay following hip and knee arthroplasty., Methods: A systematic review and meta-analysis of studies that investigated the incidence of and risk factors for OI-type events was undertaken. A comprehensive search was performed in MEDLINE, Embase, and CINAHL from their inception to October 2021. The methodological quality of identified studies was assessed using the modified version of the Quality in Prognosis Studies (QUIPS) tool., Results: Twenty-one studies (14,055 patients) were included. The incidence was 2% to 52% for an OI event, 1% to 46% for orthostatic hypotension, and 0% to 18% for syncope/vasovagal events. Two studies reported female sex, high peak pain levels (>5 out of 10) during mobilization, postoperative use of gabapentin, and the absence of postoperative intravenous dexamethasone as risk factors. There was no consensus on the definition and assessment of an OI-type event., Conclusions: OI-type events are common during the acute hospital stay following hip and knee arthroplasty, and 4 risk factors have been reported for OI-type events. High-quality prospective cohort studies are required to systematically and reliably determine the incidence of and risk factors for OI-type events., Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/H367)., (Copyright © 2022 by The Journal of Bone and Joint Surgery, Incorporated.)

Ewing sarcoma (EwS) is a human malignant tumor typically driven by the Ewing sarcoma-Friend leukemia integration (EWS-FLI) fusion protein. A paucity of genetically modified animal models, partially owed to the high toxicity of EWS-FLI, hinders research on EwS. Here, we report a spontaneous mutant variant, EWS-FLI 1FS , that circumvents the toxicity issue in Drosophila. Through proteomic and genomic analyses, we show that human EWS-FLI 1FS interacts with the Drosophila homologues of EWS-FLI human protein partners, including core subunits of chromatin remodeling complexes, the transcription machinery, and the spliceosome; brings about a massive dysregulation of transcription that affects a significant fraction of known targets of EWS-FLI in human cells; and modulates splicing. We also show that EWS-FLI 1FS performs in Drosophila the two major neomorphic activities that it is known to have in human cells: activation of transcription from GGAA microsatellites and out competition of ETS transcription factors. We conclude that EWS-FLI 1FS reproduces in Drosophila the known oncogenic activities of EWS-FLI that drive EwS tumorigenesis in humans. These results open up an unprecedented opportunity to investigate EWS-FLI's oncogenic pathways in vivo in a genetically tractable organism., (© The Author(s) 2022. Published by Oxford University Press on behalf of National Academy of Sciences.)

Inflammation plays an important role in peripheral artery disease (PAD), contributing to the onset and progression of atherosclerosis, as well as to the rupture of atherosclerotic plaques. Studies have revealed that due to their inflammatory nature, leucocytes play an important role in the development of atherosclerosis. A retrospective study was conducted involving 203 patients with PAD admitted to Targu Mures Emergency County Hospital for revascularization surgery between January 2017 and June 2019 (of which 47 were treated by endovascular intervention, and 156 underwent classical surgical intervention). Among all patients included in the study, 47 patients required amputation following the revascularization intervention. The results indicated that though the mean patient age in the non-amputation group was higher than that in the amputation group, that the difference was not significant. With regard to sex distribution, 72% of the patients from the amputation group were male, while from the non-amputation group, 74% were male. The neutrophil-to-lymphocyte ratio (NLR) cut-off value for the prediction of amputation in PAD was 3.485 (sensitivity, 60.42%; specificity 72.44%), whereas the platelet-to-lymphocyte ratio (PLR) value was 152, (sensitivity, 54.17%; specificity, 71.79%), and was 2.55 for the lymphocyte-to-monocyte ration (LMR; sensitivity, 56.25%; specificity, 66.88%). The study concluded that in patients with PAD, the NLR and PLR were increased, while the LMR was decreased, which was also associated with a higher rate of amputation after revascularization, despite the lack of correlation between these factors, Fontaine classification and the number of damaged vessels. Therefore, pre-operative alterations in NLR, PLR and LMR may predict the need for amputation in patients with PAD, or those who underwent a revascularization intervention., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Cosarca et al.)

V-set and Immunoglobulin domain containing 1 (VSIG1) is a cell-cell adhesion molecule which role in the genesis and evolution of gastric cancer (GC) is not understood. Only three Medline-indexed papers have focused on the role of VSIG1 in GC. The clinicopathological features of 94 GCs were examined in association with immunohistochemical (IHC) patterns of VSIG1, E-cadherin, and β-catenin which were assessed in the tumor core (central) vs. invasive edge. Cases were classified depending on the VSIG1 expression: membrane/membrane in both core and invasive front; null/negative staining in both core and invasive front; and cases with translocational patterns: membrane core/cytoplasmic buds and cytoplasmic core/null buds. Most of the tumors showed null pattern (n = 54). Cases with translocational patterns (n = 20) were GCs with a high lymph node ratio value (≥ 0.26) and advanced Dukes-MAC-like stage. Of the 20 total cases, 9 showed membrane-to-nuclear translocation of β-catenin and loss of E-cadherin, as indicators of epithelial-mesenchymal transition. All cases with membrane/membrane pattern (n = 20) involved the distal stomach. The poorest overall survival was registered in patients with subcellular translocation of VSIG1, compared to those with either membrane/membrane or null patterns (p = 0.002). In GC, VSIG1 acts as an adhesion membrane protein but its membrane-cytoplasmic translocation can be an indicator of epithelial-mesenchymal transition due to cytoplasmic VSIG1-mediated activation of canonical Wnt/β-catenin signaling pathway., (© 2022. The Author(s).)

Abdominal trauma is a common diagnosis for patients admitted to the emergency room. Evaluation of the severity of such patients can sometimes be difficult due to rapid hemodynamic changes caused by the activation of inflammatory and anti-inflammatory regulatory mechanisms. To evaluate the prognosis of trauma patients, it is crucial to identify these changes and adapt various treatment strategies. Using the records of the Mures County Emergency Clinical Hospital, 126 patients were included in the present study with traumatic splenic injury admitted over 6 years. Blood parameters such as the neutrophil, lymphocyte, and platelet counts, the neutrophil to lymphocyte ratio (NLR), and the platelet to lymphocyte ratio (PLR) were determined, and the association between these and the severity of the traumatic injury [quantified as the injury severity score (ISS)] was calculated. We used linear and multiple regression analyses to identify and quantify the relationships. We found statistically significant associations between the ISS and the NLR (P=0.002), with an AUC of 0.816 and a cut-off value of NLR=6.075 (sensitivity=76.7%, specificity=74.3%), and between the ISS and hemoglobin (P<0.0001), hematocrit (P<0.0001), neutrophil count (P<0.0001), lymphocyte count (P=0.0224), and platelet count (P=0.0163). No association was found between the PLR and the severity of trauma. An elevated NLR at admission in trauma patients had significant predictive power for the severity of trauma. Patients with an NLR greater than the cut-off value of 6.075 were more likely to have suffered serious injuries and undergone deterioration., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Vunvulea et al.)

The loss-of-function conditions for an l(3)malignant brain tumour ( l(3)mbt ) in larvae reared at 29 °C results in malignant brain tumours and hyperplastic imaginal discs. Unlike the former that have been extensively characterised, little is known about the latter. Here we report the results of a study of the hyperplastic l(3)mbt mutant wing imaginal discs. We identify the l(3)mbt wing disc tumour transcriptome and find it to include genes involved in reactive oxygen species (ROS) metabolism. Furthermore, we show the presence of oxidative stress in l(3)mbt hyperplastic discs, even in apoptosis-blocked conditions, but not in l(3)mbt brain tumours. We also find that chemically blocking oxidative stress in l(3)mbt wing discs reduces the incidence of wing disc overgrowths. Our results reveal the involvement of oxidative stress in l(3)mbt wing discs hyperplastic growth.

Incisional hernia (IH) is a postoperative defect of the abdominal wall through which the contents of the peritoneal cavity are externalized beneath the skin in a peritoneal sac. IH differs in anatomic complexity, but also in its associated comorbidities and surgical history. As IH enlarges, complications occur and these become part of its natural history. The goal of the study is to review the impact of loss of domain upon abdominal wall before and after abdominal wall reconstruction. The absence of anatomical and functional linea alba leads to a combination of muscular disturbances, chronic respiratory and gastrointestinal conditions, and psychosocial issues. The pathophysiological changes are also due to the decrease of the intra-abdominal pressure (IAP). During repair, the sudden reintroduction of the viscera into an unprepared cavity leads to a sudden increase in cavity volume and an increase in IAP with fatal pathophysiological implications. For an optimal repair, preoperatively, the abdominal wall must be augmented by achieving the following objectives: reducing the volume of the sac contents, optimizing compliance, enlargement of the container. At the same time, for the optimal repair, the following must be taken into account: increased knowledge about this condition to manage systemic and local changes, CT scan evaluation, monitoring IAP, plateau pressure (PP), and Positive End Expiratory Pressure (PEEP). In conclusion, the goals can be achieved by systemic optimization with a multidisciplinary team, using Preoperative Progressive Pneumoperitoneum (PPP) and/or Botox (BTX), and abdominal wall reconstruction through a mesh with augmented component separation technique., (Celsius.)

Background and Objectives: The aim of this study was to investigate the perioperative complications and short-term outcomes of patients who underwent sacrocolpopexy using a self-adhesive mesh., Materials and Methods: This is a prospective, monocentric study conducted between October 2019 and December 2020. We included 20 consecutive patients on whom sacrocolpopexy using the Parietex ProGripTM Self-Fixating Mesh (Medtronic, Minneapolis, MN, USA) was performed. The patients' demographics, operative data, perioperative complications, and functional and anatomical outcomes were assessed., Results: A total of 20 patients were included in this study. The objective cure rate was 95%, and the subjective cure rate was 94.12%. The failure of the surgery was defined as the recurrence of pelvic organ prolapse (POP) ≥ grade II. The preoperative POP quantification classifications were as follows: grade I: 0%; grade II: 70%; grade III: 30%; and grade IV: 0%. There were no mesh-related complications or other intraoperative complications. The postoperative complications included two urinary tract infections, two incisional hernias, and a prolapse recurrence. The mean operative time was 154 ± 37.04 minutes, and the mean hospital stay time was 7 ± 1.12 days., Conclusions: The present study found that the use of the Parietex ProGripTM Self-Fixating Mesh in abdominal sacrocolpopexy was not associated with greater rates of complications., Key Words: Pelvic organ prolapse, Sacrocolpopexy, Self-fixating mesh.

We have screened a collection of UAS-RNAi lines targeting 10,920 Drosophila protein-coding genes for phenotypes in the adult wing. We identified 3653 genes (33%) whose knockdown causes either larval/pupal lethality or a mutant phenotype affecting the formation of a normal wing. The most frequent phenotypes consist of changes in wing size, vein differentiation, and patterning, defects in the wing margin and in the apposition of the dorsal and ventral wing surfaces. We also defined 16 functional categories encompassing the most relevant aspect of each protein function and assigned each Drosophila gene to one of these functional groups. This allowed us to identify which mutant phenotypes are enriched within each functional group. Finally, we used previously published gene expression datasets to determine which genes are or are not expressed in the wing disc. Integrating expression, phenotypic and molecular information offers considerable precision to identify the relevant genes affecting wing formation and the biological processes regulated by them., (© The Author(s) 2021. Published by Oxford University Press on behalf of Genetics Society of America.)

The Drosophila genome contains approximately 14,000 protein-coding genes encoding all the necessary information to sustain cellular physiology, tissue organization, organism development, and behavior. In this manuscript, we describe in some detail the phenotypes in the adult fly wing generated after knockdown of approximately 80% of Drosophila genes. We combined this phenotypic description with a comprehensive molecular classification of the Drosophila proteins into classes that summarize the main expected or known biochemical/functional aspect of each protein. This information, combined with mRNA expression levels and in situ expression patterns, provides a simplified atlas of the Drosophila genome, from housekeeping proteins to the components of the signaling pathways directing wing development, that might help to further understand the contribution of each gene group to wing formation., (© The Author(s) 2021. Published by Oxford University Press on behalf of Genetics Society of America.)

BH3-mimetics inhibiting anti-apoptotic BCL-2 proteins represent a novel and promising class of antitumor drugs. While the BCL-2 inhibitor venetoclax is already FDA-approved, BCL-XL and MCL-1 inhibitors are currently in early clinical trials. To predict side effects of therapeutic MCL-1 inhibition on the human hematopoietic system, we used RNAi and the small molecule inhibitor S63845 on cord blood-derived CD34+ cells. Both approaches resulted in almost complete depletion of human hematopoietic stem and progenitor cells. As a consequence, maturation into the different hematopoietic lineages was severely restricted and CD34+ cells expressing MCL-1 shRNA showed a very limited engraftment potential upon xenotransplantation. In contrast, mature blood cells survived normally in the absence of MCL-1. Combined inhibition of MCL-1 and BCL-XL resulted in synergistic effects with relevant loss of colony-forming HSPCs already at inhibitor concentrations of 0.1 μM each, indicating "synthetic lethality" of the two BH3-mimetics in the hematopoietic system.

Background: In the case of patients admitted with acute abdomen at the emergency department, interstitial pulmonary pathology (Covid-19 infections) represents a significant operative risk for the patients. The rate of postoperative complications is high with increased morbidity and mortality, a real challenge for the medical staff and surgical/intensive care unit teams. In emergency settings, patients were examined with targeted clinical and paraclinical parameters that assure a fast diagnosis to optimize a rapid medical and surgical treatment. Methods: We conducted a retrospective comparative study that included patients enrolled and diagnosed with an acute surgical abdomen in Surgical Clinic 1 Tg. Mures Emergency County Hospital. Patients were examined and analyzed at the emergency department UPU-SMURD. We included patients admitted over the two years (2019 and 2020) and divided them into two groups. Results: The total number of patients admitted in the UPU-Smurd emergency department Surgical Clinic I over the two years was 1033. There was a significant reduction in total cases diagnosed with the acute surgical abdomen in the pandemic period (p=0.033). The average time from the admission to the surgical procedure was significantly higher in the pandemic period 380Ã+-2 min in comparison with 222+-3 min (p=0.001) and also with an increased average operative time 223+-3 min versus 145+-2 min (p=0.002). Average hospitalization time was higher in the pandemic period 10+-1 (p=0.031) with no significant difference between the groups regarding Intensive Care Unit (ICU) admission (p=0.122). Overall mortality has more than doubled, with 31 cases (19%) in the pandemic and 28 (9%) in the non-pandemic. (p=0.001). Conclusions: The COVID-19 pandemic has played an essential role in treating acute surgical abdomen cases. The high solicitation rate of the emergency department delayed the diagnosis and treatment of severe surgical cases. As the scale of this pandemic is unprecedented, standard protocols with minor changes do not provide adequate results., (Celsius.)