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Abstract Background Enteral feeding uses feeding tubes for liquid food administration. Enteral feeding maintains gastrointestinal function but has complications like aspiration, diarrhea, and constipation. To avoid complications, nurses in intensive care units must have proper knowledge, attitude, and practice towards enteral feeding. Method A systematic review was conducted. The search was restricted to January 2000 to April 2024, encompassing scientific journals accessible via the following online databases: PubMed (including Medline), Cochrane Library, Scopus, Web of Science, and Embase. Google Scholar was searched comprehensively to include all relevant studies. The search strategy employed the following keywords and medical subject headings: [knowledge OR attitude] AND [enteral feeding OR enteral nutrition] AND nurs*. Only cross-sectional studies were included in this systematic review. Two authors independently conducted the selection of eligible studies, data extraction, and risk of bias assessment. Due to the discrepancies in methodologies and research goals among the investigated studies, a narrative synthesis was conducted. Results In total, there were 3187 articles found in the initial search across five online electronic databases. Finally, a thorough review was conducted, incorporating 22 studies. Based on the studies analyzed in this systematic review, nurses showed a positive attitude toward enteral feeding; there was a necessity to enhance their knowledge and practice. Continuous education combined with interdisciplinary collaboration can significantly improve nurses’ knowledge and practice of enteral feeding. Conclusion Many studies highlight the necessity of enhancing the knowledge and practice of nurses in this area. Implementing educational interventions has positively impacted nurses’ knowledge and performance.

Abstract Non-verbal behaviour, such as facial expressions and body language, plays a critical role in assessments of witnesses’ credibility that inform legal decisions in cases involving crime. While prior research has primarily focused on associations between non-verbal cues and deception, this study investigates the relation between non-verbal cues and recall memory accuracy in honestly reported mock eyewitness testimonies. Using a sample of 36 video-recorded eyewitness testimonies about a violent crime (n = 680 statements), we examined whether non-verbal cues were associated with statement accuracy (correct vs. incorrect), witness credibility as rated by independent observers, and witnesses’ self-reported confidence. Additionally, we explored whether these associations differed for native vs. non-native speaking witnesses. Results revealed no associations between non-verbal cues and statement accuracy or perceived credibility. Furthermore, while non-native speakers were perceived as less credible, these perceptions were not related to non-verbal cues. Our findings contradict common beliefs by showing that non-verbal behaviour is not reliably related to accuracy or perceived credibility in eyewitness testimonies, highlighting the need for caution in their use in high-stakes legal contexts.

Abstract Background Respiratory syncytial virus (RSV) is an important cause of children’s pulmonary infections. However, there are fewer studies on RSV infections in adults. The purpose of this study was to describe the clinical manifestations, para-clinical characteristics, and outcome of RSV infection among adult patients who were referred to the Imam Khomeini Hospital Complex during the winter and spring of 2022–2023. Methods From December 21, 2022, to May 20, 2023, we conducted a cross-sectional study on hospitalized adults having positive RT-PCR results for RSV. We further assessed the clinical and para-clinical characteristics and outcomes of the RSV groups. Results We screened 1375 adults with suspected acute respiratory infections (ARIs) and confirmed RSV infections in 59 of them (4.3%). Of these, 23 patients were excluded from further analysis due to outpatient management, leaving 36 hospitalized patients with confirmed RSV infection (61.01%). The mean age of the hospitalized patients was 53.28 ± 20.37 years (range: 15–83), with a slightly higher proportion of females (52.80%) compared to males (47.20%). Dyspnea, productive cough, and fever were the most common symptoms, with a mean symptom duration of 10.50 days. Ischemic heart disease, hypertension, and liver failure were common underlying conditions. Notably, biochemical and inflammatory markers such as CRP, ESR, and LDH were significantly elevated beyond the normal range. Finally, five patients (13.9%) who received intensive care treatments died. Conclusions Although the rate of RSV infection was not high among Iranian adults, a greater proportion of patients required hospitalization (61%). There was a significant link between liver failure, an elevated INR, more than 30% bilateral pulmonary involvement, abdominal pain, longer ICU stays, and immunodeficiency cases with increased mortality from RSV infection. We suggest that RSV infection may act as a secondary factor in decompensating pre-existing liver failure, which was present in certain patients with underlying conditions, potentially leading to life-threatening consequences.

Abstract Each treatment cycle of radiopharmaceutical therapy (RPT) is administered as a single dose. We aimed to investigate a personalized metronomic RPT paradigm, employing multiple lower-dose administrations, to evaluate its effect on delivering radiopharmaceuticals to tumors. We developed a physiologically-based pharmacokinetic (PBPK) model applied to metastatic castration-resistant prostate cancer patients to analyze the impact of metronomic framework and various infusion durations (1–4 h) on absorbed doses (ADs) in tumors and organ-at-risk (OAR). We designed a treatment algorithm to select optimal regimens with high AD, while investigating what we term radiopharmaceutical delivery payload (RDP). This metric evaluates the efficiency of radiopharmaceutical delivery by quantifying the proportion of the administered dose that successfully reaches the target tissue. The goal is to optimize trade-offs between RDP and tumors-AD among injection profiles, amongst varying radioactivity (1-22GBq), total radiopharmaceutical mass (25-210nmol), number of injections (2–6), and time intervals (12–36 h) between injections. Our framework applied to five patients led to increased AD between 2 and 358 Gy (between 2 and 146%) higher than normally administered to patients, safeguarding OARs. Using single-dose scenarios to match ADs in metronomic approach, led to significant increase in injected activities, requiring injection of 0 to 9GBq additional activity (reducing RDP by 3–75%). Maintaining total administered radioactivity within clinically therapeutic levels, increasing frequency, time interval, and infusion duration increases tumors and OARs AD by 0.05-73%, while it decreased tumors-to-OARs AD ratios by 0.1–30%. Based on the PBPK modeling approach, metronomic RPT appears to improve efficacy (RDP) in delivered doses to tumors for a given total injected radioactivity.

Abstract Asthma diagnosis poses challenges due to underreporting of symptoms, misdiagnoses, and limitations in existing diagnostic tests. Machine learning (ML) offers a promising avenue for addressing these challenges by leveraging demographic and clinical data. In this study, we aim to compare different ML diagnostic models and obtain the most valuable features for asthma diagnosis using data from the National Health and Nutrition Examination Survey (NHANES) dataset. A total of 8,888 participants with available asthma diagnosis data from the 2017–2018 NHANES survey were included. After careful selection of variables related to asthma, various ML algorithms including Support Vector Machine (SVM), Random Forest (RF), AdaBoost (ADA), XGBoost (XGB), K-Nearest Neighbors (KNN), Naive Bayes (NB), and Multi-Layer Perceptron (MLP) were evaluated. SVM and ADA emerged as top performers with the highest area under the curve (AUC) scores of 0.72 and 0.71, respectively. RF exhibited high accuracy but low precision. Feature interpretation using SHapley Additive exPlanations (SHAP) values identified significant predictors such as close relative asthma history, dietary fat intake, and chronic bronchitis. Feature reduction experiments showed promising results without significant loss in predictive performance. Our findings demonstrate the potential diagnosis ability of ML algorithms, particularly SVM and ADA, in asthma diagnosis by incorporating diverse clinical and demographic factors. In addition, close relative asthma history, dietary fat intake, and chronic bronchitis could be suggested as the valuable asthma diagnosis features. These outcomes can bring promising results in early diagnosis of asthma.

Abstract Vertebrate animals benefit from a combination of rigidity for structural support and softness for adaptation. Similarly, integrating rigidity and softness can enhance the versatility of soft robotics. However, the challenges associated with creating durable bonding interfaces between soft and rigid materials have limited the development of hybrid robots. Existing solutions require specialized machinery, such as polyjet 3D printers, which are not commonly available. In response to these challenges, we have developed a 3D printing technique that can be used with almost all commercially available FDM printers. This technique leverages the common issue of underextrusion to create a strong bond between soft and rigid materials. Underextrusion generates a porous structure, similar to fibrous connective tissues, that provides a robust interface with the rigid part through layer fusion, while the porosity enables interlocking with the soft material. Our experiments demonstrated that this method outperforms conventional adhesives commonly used in soft robotics, achieving nearly 200% of the bonding strength in both lap shear and peeling tests. Additionally, we investigated how different porosity levels affect bonding strength. We tested the technique under pressure scenarios critical to soft and hybrid robots and achieved three times more pressure than the current adhesion solution. Finally, we fabricated various hybrid robots using this technique to demonstrate the wide range of capabilities this approach and hybridity can bring to soft robotics.

Controlling an active distribution network (ADN) from a single PCC has been advantageous for improving the performance of coordinated Intermittent RESs (IRESs). Recent studies have proposed a constant PQ regulation approach at the PCC of ADNs using coordination of non-MPPT based DGs. However, due to the intermittent nature of DGs coupled with PCC through uni-directional broadcast communication, the PCC becomes vulnerable to transient issues. To address this challenge, this study first presents a detailed mathematical model of an ADN from the perspective of PCC regulation to realize rigidness of PCC against transients. Second, an $H_{\infty}$ controller is formulated and employed to achieve optimal performance against disturbances, consequently, ensuring the least oscillations during transients at PCC. Third, an eigenvalue analysis is presented to analyze convergence speed limitations of the newly derived system model. Last, simulation results show the proposed method offers superior performance as compared to the state-of-the-art methods.

Abstract Given the escalating global energy consumption and the concurrent economic and energy crises, energy-saving behaviour must be adopted on a large scale. Universities that are energy-intensive institutions should be one of the institutions where energy-saving behaviour is widely adopted. Academics devote a substantial portion of their time to their offices, which leads to increased energy usage. However, no study has investigated academics’ energy-saving behaviours in the literature. Most studies focus on students or employees in various organizations. Our study tries to cover the gap by examining the energy-saving behaviour of academics in four countries (Romania, Bulgaria, Turkey, and Slovakia) based on the expanded Theory of Planned Behaviour. A questionnaire was distributed to 228 academics from the four countries to gather data. The research hypotheses were tested using partial least squares structural equation modelling. The findings show that individual factors (attitude and perceived behaviour control) influence the energy-saving intention of academics but not the organisational factors due to the weak identification with their universities. The study offers valuable insights for policymakers seeking to promote energy-saving programs in academic institutions. The academics can be seen as role models for their students which emphasizes the need to study more their sustainable behaviours.

Abstract The COVID-19 pandemic has resulted in many survivors experiencing post-acute COVID-19 syndrome (PCS) with symptoms including fatigue, breathlessness, and cognitive complaints. E-cigarette use has already been associated with increased susceptibility to COVID-19 because of its effects on ACE2 receptor expression and inflammation, raising concern that it might worsen the long-term outcomes of COVID-19, including PCS. While traditional smoking is associated with a higher risk of PCS, the role of e-cigarettes remains unclear due to conflicting evidence. Using 2022 Behavioral Risk Factor Surveillance System (BRFSS) data, this study investigated the association between e-cigarette use and PCS among US adults who tested positive for COVID-19. The final sample included 107,249 adults after the exclusion of respondents with missing information. It analyzed e-cigarette use (never, former, current) and controlled for key covariates such as age, gender, BMI, smoking, and chronic diseases. The results showed that female gender, obesity, current smoking, and a history of depression, asthma, and chronic obstructive pulmonary disease (COPD) were significantly associated with higher odds of PCS. Nevertheless, e-cigarette use was not related significantly to increased odds for PCS (current e-cigarette use: aOR = 1.07, 95 CI: 0.96, 1.20; former e-cigarette use: aOR = 1.03, 95 CI: 0.96, 1.12). The mediation analysis showed no indirect effect of the use of e-cigarettes on PCS via COPD. In conclusion our findings did not reveal an independent or indirect association between PCS with e-cigarette use.

Synanthropic flies are essential in transmitting various pathogens, producing myiasis, and their application in forensic entomology. The main objective of this study was to identify the medically important flies in the hospital grounds of Tehran. The sampling process for this cross-sectional study was carried out every two weeks on the grounds of four hospitals in Tehran, using bottle traps and insect nets from March 2020 to February 2021. The population data has been transformed by calculating square root due to huge variations among community data, and data was analyzed with Kruskal-Wallis test to estimate the temporal and spatial variation. A total of 18,613 adult flies were collected and 18 species were identified. These flies belonged to four families: Calliphoridae, Muscidae, Sarcophagidae, and Fanniidae. The most common species in each family were Calliphora vicina Robineau-Desvoidy, Muscina stabulans Fallen, Sarcophaga Africa Wiedemann, and Fannia canicularis L., respectively. Temporal variations showed that C. vicina had different seasonal activity, with peaks in colder months, while Lucilia sericata Meigen, Chrysomya albiceps (Wiedemann), and dominant species of Sarcophagidae peaked in mid-summer. Spatial distribution analysis revealed overall unity in collecting all three species of Calliphoridae in all hospital environments. The same status was observed for Muscidae and Fanniidae. The dominant species in all species of the family Sarcophagidae were active during warmer months. Sarcophaga nigriventris Meigen, 1826 is reported for the first time for Iranian fauna.

Abstract Predicting long-term recurrence of disease in breast cancer (BC) patients remains a significant challenge for patients with early stage disease who are at low to intermediate risk of relapse as determined using current clinical tools. Prognostic assays which utilize bulk transcriptomics ignore the spatial context of the cellular material and are, therefore, of limited value in the development of mechanistic models. In this study, Fourier-transform infrared (FTIR) chemical images of BC tissue were used to train deep learning models to predict future disease recurrence. A number of deep learning models were employed, with champion models employing two-dimensional and two-dimensional-separable convolutional networks found to have predictive performance of a ROC AUC of approximately 0.64, which compares well to other clinically used prognostic assays in this space. All-digital chemical imaging may therefore provide a label-free platform for histopathological prognosis in breast cancer, opening new horizons for future deployment of these technologies.

Abstract Background Physicians faced increased workloads during the COVID-19 pandemic, which exposed them to considerable physical and psychological stress. Gaining insight into shapers of job morale of physicians can help healthcare administrators assess the effectiveness of current work conditions and support systems, enabling them to develop policies that improve work environments and prepare healthcare systems for future resurgences of COVID-19 and other future unknown challenges. Therefore, the present study aimed to improve the understanding of physicians’ experiences of job morale in Kazakhstan during the COVID-19 pandemic. Methods This was an explanatory sequential mixed method study that adopted an online structured questionnaire and semi-structured individual interviews as tools for data collection. The Warr-Cook-Wall scale, Maslach Burnout Inventory Human Services Survey for Medical Personnel, and Beck Depression Inventory were used to measure job morale indicators. The interview topic guide, in turn, covered two key areas: general views on physicians’ job morale during the COVID-19 pandemic and specific experiences which worsened or improved job morale during the COVID-19 pandemic. Descriptive statistics and regression models were utilised to analyse the quantitative data, while thematic analysis was employed for the qualitative data. Results A total of 2086 survey responses and 30 interviews were analysed. Although job motivation was moderate, physicians were rather satisfied with their jobs. The prevalence of burnout was 30.97%, and signs of severe depression symptoms were detected among 3.69% of participants. Four themes emerged from the thematic analysis: (1) fear of uncertainty; (2) media scrutiny; (3) resurgence in appreciation; and (4) heightened sense of duty. Conclusions Despite the significant challenges posed by the COVID-19 pandemic, physicians in Kazakhstan’s public healthcare sector maintained generally positive job morale. This was mainly due to their strong sense of calling and a renewed appreciation for their role. Future research should rigorously examine longitudinal changes in job morale and the relationship between physicians’ job morale and patient experiences.

Abstract Background Hospitalization in intensive care units (ICUs) often leads to complications. One such complication is multi-organ dysfunction syndrome (MODS). This study aimed to determine the prevalence of MODS and its relationship with clinical variables in ICU patients in Iran, 2022. Methods This cross-sectional, descriptive-analytical study included 194 ICU patients from Kermanshah hospitals, selected between 30 April and 1 September 2022. Data collection tools included patient demographic forms, Marshall et al.’s MODS calculation formula (1995), shock index, mNUTRIC, SOFA, APACHE II, and free water deficit. Data were analyzed using the SPSS-25 software. Results The study found that 32% were aged 41–60, and 69.6% were male. The average MODS score was 6.87 ± 1.59 (ranging from 0 to 24), with a prevalence of 56.2%. MODS was significantly related to clinical variables such as the number of days in the hospital, days in ICU, number of involved organs, Glasgow Coma Scale (GCS), partial pressure of oxygen (PaO2), shock index, APACHE II score, SOFA score, mNUTRIC score, and free water deficit (P

The Medical Internet of Things (MIoT) plays a pivotal role in modern healthcare by integrating wireless communication and cloud computing to enhance medical practices. However, this framework presents security vulnerabilities, such as the risk of eavesdroppers exploiting public channels to intercept sensitive patient data or impersonate legitimate devices and services. Consequently, authentication between wearable devices and servers is essential before transmitting confidential information through open channels. While several authentication techniques offer protection against quantum attacks, they often incur high communication and computation costs, underscoring the need for further advancement. This paper introduces a multifactor authentication protocol designed to strengthen the integrity of cloud-assisted MIoT systems by incorporating post-quantum security. The proposed protocol utilizes a post-quantum fuzzy commitment (PQFC) scheme to enhance security and is rigorously analyzed under the random oracle model and ProVerif tool. Its functionality and security are thoroughly assessed, demonstrating adherence to key requirements such as memoryless operation, user anonymity, mutual authentication, and resistance to various threats, including biometric tampering, stolen-verifier attacks, and insider attacks. Additionally, a comprehensive comparison with existing schemes highlights a balanced trade-off between security and efficiency.

Abstract The analysis of circulating tumour DNA (ctDNA) through minimally invasive liquid biopsies is promising for early multi-cancer detection and monitoring minimal residual disease. Most existing methods focus on targeted deep sequencing, but few integrate multiple data modalities. Here, we develop a methodology for ctDNA detection using deep (80x) whole-genome TET-Assisted Pyridine Borane Sequencing (TAPS), a less destructive approach than bisulphite sequencing, which permits the simultaneous analysis of genomic and methylomic data. We conduct a diagnostic accuracy study across multiple cancer types in symptomatic patients, achieving 94.9% sensitivity and 88.8% specificity. Matched tumour biopsies are used for validation, not for guiding the analysis, imitating an early detection scenario. Furthermore, in silico validation demonstrates strong discrimination (86% AUC) at ctDNA fractions as low as 0.7%. Additionally, we successfully track tumour burden and ctDNA shedding from precancerous lesions post-treatment without requiring matched tumour biopsies. This pipeline is ready for further clinical evaluation to extend cancer screening and improve patient triage and monitoring.

Clinical trials previously demonstrated the notable capacity to elicit visual percepts in individuals with visual impairments caused by retinal diseases by electrically stimulating the remaining neurons on the retina. However, these implants restored very limited visual acuity and required transcutaneous cables traversing the eyeball, leading to reduced reliability and complex surgery with high postoperative infection risks. To overcome the limitations imposed by cables, a retinal implant architecture in which near-infrared illumination carries both power and data through the pupil to a digital stimulation controller is presented. A high efficiency multi-junction photovoltaic cell transduces the optical power to a CMOS stimulator capable of delivering flexible interleaved sequential stimulation through a diamond microelectrode array. To demonstrate the capacity to elicit a neural response with this approach while complying with the optical irradiance limit at the pupil, fluorescence imaging with a calcium indicator is used on a degenerate rat retina. The power delivered by the laser at the permissible irradiance of 4 mW/mm2 at 850 nm is shown to be sufficient to both power the stimulator ASIC and elicit a response in retinal ganglion cells (RGCs), with the ability to generate of up to 35 000 pulses per second at the average stimulation threshold. This confirms the feasibility of generating a response in RGCs with an infrared-powered digital architecture capable of delivering complex sequential stimulation patterns at high repetition rates, albeit with some limitations.

This study analyzes land cover changes over three decades (1993-2023) in Shapahar Upazila using Geographic Information Systems (GIS) and remote sensing techniques. The analysis reveals significant shifts in vegetation, water bodies, bare soil, and settlement areas, correlating these changes with shifts in temperature and precipitation. Predictions for the next ten years (2024-2033) indicate a significant increase in vegetation cover. The findings highlight the importance of sustainable land management practices and policies to mitigate ecological imbalances. Utilizing GIS strategies, remote sensing statistics, and meteorological datasets, we examine the converting patterns of four key land cover sorts: water bodies, vegetation area, bare soil, and settlement area. This paper also links Land use and Land cover (LULC) with other temperature and precipitation facts to understand the ability correlations and conjuring factors of LULC change. The analysis suggests that LULC has modified in numerous ways over time, including urbanization developments, flora enlargement, changes within the extent of water bodies, and corresponding adjustments in temperature and moisture patterns. Combining an analysis of specific percent changes in land cover types between consecutive years with the calculation of temperature and precipitation changes helps to understand the relationship between multiple environmental parameters influencing the landscape of Shapahar Upazila. Our study provides additional information regarding the changes in environmental conditions and landscape dynamics in the region and gives contextual information to help land managers, stakeholders, and policymakers understand the current trends in the area and develop climate mitigation and adaptation policies for sustainable development.

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor and non-motor symptoms, primarily due to the degeneration of dopaminergic neurons in the substantia nigra pars compacta (SNpc). Factors contributing to this neuronal degeneration include mitochondrial dysfunction, oxidative stress, and neuronal excitotoxicity. Despite extensive research, the exact etiology of PD remains unclear, with both genetic and environmental factors playing significant roles. Given the increasing prevalence of PD, particularly in aging populations, effective preventive and therapeutic strategies are urgently needed. Emerging research suggests that dietary interventions might offer promising approaches to managing PD progression. This literature review examines various dietary interventions that differ in their composition and mechanisms of action, including the Mediterranean, vegan, carnivore, paleo, and ketogenic diets, and their potential neuroprotective effects. By evaluating the current evidence, this review aims to identify dietary strategies that may improve the quality of life for individuals with PD. Additionally, it explores the underlying mechanisms through which diet may influence PD pathophysiology, thus providing insights into how nutritional modifications can be integrated into holistic management plans for the disease.

Abstract Aspergillus-related immune reconstitution inflammatory syndrome (IRIS) is a challenge to diagnose in immunocompromised pediatric cancer patients with Invasive Pulmonary Aspergillosis (IPA). If not recognized, it can mimic disease progression and lead to overtreatment. Studies on Aspergillus-related IRIS in the pediatric population are scarce. We prospectively identified four pediatric cancer patients diagnosed with IPA who developed paradoxical worsening of pulmonary symptoms following neutrophil recovery. The clinical course, imaging findings, and response to corticosteroids were also reviewed. All patients had refractory respiratory symptoms, including cough, breathing difficulties (dyspnea), and chest pain, despite antifungal therapy. Serial imaging revealed new or enlarging pulmonary infiltrates. Symptoms improved dramatically with corticosteroids without antifungal escalation, confirming Aspergillus-related IRIS diagnosis. Aspergillus-related IRIS can occur in immunocompromised children with cancer and IPA, mimicking disease progression. Recognition is important for avoiding overtreatment. This is the first report highlighting the features of Aspergillus-related IRIS in pediatric cancer patients.

Abstract A reliable characterization of x-ray pulses is critical to optimally exploit advanced photon sources, such as free-electron lasers. In this paper, we present a method based on machine learning, the virtual spectrometer, that improves the resolution of non-invasive spectral diagnostics at the European XFEL by up to 40%, and significantly increases its signal-to-noise ratio. This improves the reliability of quasi-real-time monitoring, which is critical to steer the experiment, as well as the interpretation of experimental outcomes. Furthermore, the virtual spectrometer streamlines and automates the calibration of the spectral diagnostic device, which is otherwise a complex and time-consuming task, by virtue of its underlying detection principles. Additionally, the provision of robust quality metrics and uncertainties enable a transparent and reliable validation of the tool during its operation. A complete characterization of the virtual spectrometer under a diverse set of experimental and simulated conditions is provided in the manuscript, detailing advantages and limits, as well as its robustness with respect to the different test cases.

Abstract Background Central serous chorioretinopathy (CSC) is marked by serous retinal detachments caused by fluid leakage from the retinal pigment epithelium, often associated with stress, psychiatric disorders and the use of corticosteroids. This study aims to investigate the clinical and systemic characteristics associated with BALAD in patients with CSC, comparing those with and without BALAD to clarify its function as a biomarker of CSC severity and improve diagnostic and treatment approaches. Purpose Compare the clinical characteristics, risk factors, and optical coherence tomography (OCT) findings in patients with Central Serous Chorioretinopathy (CSC) with and without Bacillary Layer Detachment (BALAD), and to identify the distinguishing features and associated conditions of CSC with BALAD. Methods This observational, retrospective, multicenter case–control study collected data from 12 retina centers worldwide on patients with central serous chorioretinopathy (CSC) from December 1, 2022, to April 1, 2023. CSC was defined by serous retinal detachment and fluid leakage through the retinal pigment epithelium. Patients underwent detailed evaluations, including OCT, and were classified as having acute or chronic CSC. Inclusion criteria included a CSC diagnosis with RPE leakage, BALAD confirmed by three authors, age over 18, and a detailed medical history from the 30 days before symptom onset. The study assessed visual acuity, choroidal thickness, psychiatric disorders, corticosteroid use, prior CSC treatments, and hyperreflective material on OCT. Results Thirty-seven patients (40 eyes; mean age, 48.0 ± 11.9 years) had CSC and BALAD and were followed for a mean of 4.92 ± 6.65 months. The control group was comprised of 40 patients with CSC without BALAD (40 eyes; mean age, 48.2 ± 11.9 years). On clinical examination, BALAD was as a circular, yellowish macular lesion. On OCT, BALAD was a detachment of the ellipsoid zone with splitting of the photoreceptor inner segment. BALAD was associated with psychiatric disorders (p = 0.014), use of corticosteroids (p = 0.004), previous treatment for CSC (p = 0.041) and thickened choroid (p = 0.036). Conclusions BALAD in CSC differs from a typical CSC due to the presence of a circular, yellowish macular lesion, detachment of the ellipsoid zone, segmentation of the inner segment of the photoreceptor, a thicker choroid, the use of corticosteroids, and generally more aggressive previous treatments. These results suggest that BALAD may serve as a valuable biomarker for the severity of CSC and highlight the influence of inflammation and previous treatments.

Abstract SurgeryLLM, a large language model framework using Retrieval Augmented Generation demonstrably incorporated domain-specific knowledge from current evidence-based surgical guidelines when presented with patient-specific data. The successful incorporation of guideline-based information represents a substantial step toward enabling greater surgeon efficiency, improving patient safety, and optimizing surgical outcomes.

Background. Glycemic control and oral health have a two-way relationship. The objective of this study was to compare dental caries and gingival indices in type II diabetic patients based on hemoglobin A1c (HbA1c) levels. Methods. In this case-control study, 150 type II diabetic patients were studied in three groups with HbA1c below 7%, between 7‒9%, and above 9%. The decayed, missing, and filled teeth (DMFT) index and gingival index were determined by oral examination. Demographic variables were collected through patient files. A blood test was requested to measure HbA1c. The data were analyzed using SPSS 17, and the significance level was set at P

Objective: Machine learning (ML) may allow for improved discernment of hemodynamics and oxygen delivery compared to standard invasive monitoring. We hypothesized that an ML algorithm could predict impaired delivery of oxygen (IDO2) with comparable discrimination to invasive mixed venous oxygen saturation (SvO2) measurement. Methods: A total of 230 patients not on mechanical circulatory support (MCS) managed with a pulmonary artery catheter (PAC) were identified from 1012 patients admitted to a single cardiovascular intensive care unit (CVICU) between April 2021 and January 2022. Physiologic data were collected prospectively by the data analytics engine. Inadequate delivery of oxygen (IDO2) was defined as SvO2 ≤50%. Fifty-four patients were used to train the model, which was then validated in 176 patients. Three simulated monitoring situations were constructed by downsampling the physiologic data set to exclude all SvO2 sources (scenario A); all PAC data but allowing for SvO2 values (scenario B); and all PAC data, including SvO2 and cardiac index (CI) (scenario C). The ML platform then calculated the likelihood of IDO2 for rolling 30-minute intervals and compared these values against the gold standard SvO2 values using receiver operating characteristic (ROC) curve analysis to establish discriminatory power. Results: A total of 1047 laboratory-validated SvO2 values were collected for the validation group. The area under the ROC curve for the IDO2 index was 0.89 (95% confidence interval, 0.87-0.91) with the full data set. When blinded to all PAC and SvO2 sources, the AUC was 0.78 (95% confidence interval, 0.75-0.81). Conclusions: The IDO2 index is capable of detecting SvO2 ≤50% with good discriminatory function in non-MCS CVICU patients in a variety of monitoring situations. Further investigation of IDO2 detection and clinical endpoints is needed.

Objective: Racial disparities in organ allocation may result in differential survival for marginalized groups. This study aims to examine the impact of the November 2017 lung allocation policy change (LAPC) on trends and outcomes of Hispanic lung transplant (LT) recipients. Methods: The United Network for Organ Sharing database was used to identify adult (older than age 18 years) LT recipients between January 2010 and March 2023. Recipients were categorized into 3 self-identified racial groups (Hispanic, non-Hispanic White, and non-Hispanic other). The Mann-Kendall trend test was used to assess the trend in rates of Hispanic LT over 5 years pre- and 5 years post-LAPC. The primary outcome was 1-year mortality. Results: A total of 28,495 recipients from 80 centers were included, with 15,343 (53.8%) prepolicy change and 13,152 (46.2%) postpolicy change. The racial distribution of LT recipients was pre-LAPC: Hispanic: 1013 (6.6%), White: 12,601 (82.1%), Other: 1729 (11.3%) and post-LAPC: Hispanic: 1522 (11.6%), White: 9873 (75.0%), Other: 1757 (13.4%) (P

Objectives: Robotic-assisted mitral valve repair (MVr) is a well-established procedure for management of degenerative mitral valve disease. Limited data regarding concomitant robotic-assisted tricuspid valve repair (TVr) is available. This review investigates prevalence and outcomes of concomitant robotic-assisted mitral and tricuspid valve repair. Methods: From 2014 to 2022, 839 patients underwent robotic-assisted MVr, including 76 patients with moderate or greater tricuspid regurgitation and/or tricuspid annular dilatation ≥40 mm. Among the 76 patients, 19 (25%) underwent isolated MVr and 57 (75%) had concomitant mitral and tricuspid valve repair. Outcome data between the 2 groups were analyzed. Results: In the MVr/TVr group, tricuspid regurgitation grades were mild in 4 (7%) patients, moderate in 44 (77%) and severe in 9 (15.7%). Significant tricuspid annular dilatation ≥40 mm was present in all patients. In the isolated MVr group, 3 (15.7%) patients had mild tricuspid regurgitation and 16 (84.2%) had moderate tricuspid regurgitation with significant tricuspid annular dilatation present in only 6 patients. Cardiopulmonary bypass and crossclamp time were 130.6 and 91 minutes versus 85 and 55.4 minutes for robotic MVr/TVr group versus MVr group, respectively (P

Introduction The historical focus of vaccines on child health coupled with the advent of novel vaccines targeting adult populations necessitates exploring strategies for adult vaccine implementation.Areas covered This scoping review extracts insights from the past decade’s experiences introducing adult vaccines in low- and middle-income countries. Among 25 papers reviewed, 19 focused on oral cholera vaccine, 2 on Meningococcal A vaccines, 2 on tetanus toxoid vaccine, 1 on typhoid vaccine, and 1 on Ebola vaccine. Aligned with WHO’s Global Framework for New TB Vaccines for Adults and Adolescents, our findings center on vaccine availability, accessibility, and acceptance.Expert Opinion Availability findings underscore the importance of understanding disease burden for prioritization, multi-sectoral collaboration during planning, and strategic resource allocation and coordination. Accessibility results highlight the benefits of leveraging existing health infrastructure and adequately training healthcare workers, and contextually tailoring vaccine delivery approaches to reach challenging sub-groups like working male adults. Central to fostering acceptance, resonant sensitization, and communication campaigns engaging the communities and utilizing trusted local leaders countered rumors and increased awareness and uptake. As we approach the introduction of a new adult TB vaccine, insights from this review equips decision-makers with key evidence-based recommendations to support successful and equitable vaccinations targeting adults.

IntroductionFaba bean (Vicia faba L.) is one of the oldest cultivated legumes, widely grown in temperate regions and at high altitudes in tropical areas. This crop thrives in wet and cool conditions, while hot and dry weather can severely damage its yield. Therefore, the sowing date must be carefully selected to avoid excessive heat, particularly during the flowering period. In field data analysis, the 'environment' refers to any recommended management practice for producers, such as sowing date, planting density, or fertilizer application. GGE biplot (Genotype plus Genotype-by-Environment biplot) and PLSR (Partial Least Squares Regression) can be used to analyze these datasets. The purpose of this study is to evaluate the interaction between variety and sowing date by multiplicative models such as SREG and GGE biplot and to evaluate the quality of varieties using a sensory panel. Materials and MethodsThe present experiment was carried out in a split plot based on randomized complete block design with three replications in Soamesera, Gilan province. The main factor in this experiment was sowing date (11 November, 11 December, 10 January and 9 February) and the split factor was faba bean varieties (Guilan landrace, Barakat, Feiz, Shadan and Mahta). Evaluation of the effect of sowing date was caried out by analysis of variance, mean comparison, GGE biplot and PLSR methods by GEA-R software. A sensory panel was used to evaluate the quality of taste in the fresh seeds of bean varieties obtained from the first sowing date by Kruskal-Wallis and Mann-Whitney U using SPSS software. Results and DiscussionAnalysis of variance showed that the effect of variety were significant on all traits including days to emergence, days to pod formation, plant height, green pod length, stems per plant, seeds per pod, pods per plant, hundred seed weight, green pod yield, biological yield and harvest index. The effect of sowing date was significant on all traits except stems per plant. The interaction effect of two factors was also significant on all traits except days to emergence and stems per plant. For traits with significant interaction between two factors, the mean comparison of variety (sub factor) was carried out at each level of sowing date (main factor). Days to pod formation, plant height and pods per plant in all varieties had a downward trend from the first to the fourth sowing date. Feiz had the longest length of green pods and the highest number of seeds per pod in all of sowing dates. Mahta and Shadan with smaller seed size had more pods per plant than other varieties. Shadan and Faiz had more hundred seed weight compared to other varieties in the late sowing dates. The highest seed yield was obtained in Shadan (431.65 g.m-2) on 11 November and the lowest yield was obtained in the Guilan landrace (75.65 g.m-2) on 9 February. With the delay in sowing, the seed yield decreased in Barkat, Feiz and Guilan landrace, but in Mahta and Shadan, with the delay in sowing, the seed yield decreased until the third sowing date, and again increased on the fourth sowing date. GGE biplot analysis showed that Barkat, Feiz and Shadan had the highest; and Mahta and Guilan landrace had the lowest seed yield. Also, Faiz and Guilan landrace had more stable yield in different sowing dates. Based on another view of GGE biplot, the best genotype for first sowing date was Guilan landrace; for second sowing date, Feiz; for third sowing date, Barket; and for fourth sowing date, Shadan and Faiz. In PLSR approach was investigated the relationship between the dependent variable (seed yield, Y) and the climatic explanatory variables (X variables). The results showed that the genotypes had different responses to different sowing dates and also their climatic needs were different, so that Mahta, Shadan and Barkat were more under the influence of temperature factors at the end of the growing season, and Faiz and Guilan landrace were more under the influence of temperature factors at the beginning of the growing season, as well as the amount of precipitation and evaporation in whole period of growth. Wide temperature range (difference between high and low temperature) at the end of the growing season has a negative effect on the yield of Feiz and Guilan landrace, while low temperature at the beginning of the growing season has a positive effect on these genotypes. Evaluation of the quality of taste with a sensory panel in the fresh seeds showed that Feiz had the highest rank of taste among the varieties. ConclusionsIn conclusion, although Guilan landrace and Feiz had more stability of yield in comparison with other varieties, considering the higher yield of Faiz compared to Guilan landrace and also its superiority in the sensory panel, this variety can be considered as a substitute for Guilan landrace faba bean in Guilan province. Also, the results of this study show the significant reaction of the seed yield of all five varieties to the sowing date and the necessity of timely sowing to achieve high yield. According to the results of this study, the best time to sowing broad beans in all five varieties was on the 11 November and 11 December; and in case of delay in sowing, Feiz are more recommendable than other varieties.

The purpose of this study is to analyze the performance and effectiveness of political policy strategies in Indonesia using a quantitative research method with a snowball sampling technique with a sample size of 1,200 respondents from 38 provinces. margin of error of approximately 5 percent at a 95 percent confidence level with descriptive statistical data techniques where the data used to describe or summarize the main characteristics of the analysis of performance and effectiveness of political strategy leadership in Indonesia, the data tool uses SPSS statistics version 26, with a time of 2 years, with the results of the analysis of performance and effectiveness of political strategy leadership in Indonesia where scientific selection and training of workers, the role of civil society, political parties, the military, and do not know with an average of 86%.

Introduction: Tooth extraction initiates a cascade of homeostatic and structural modifications within the periodontal tissues, culminating in alveolar ridge resorption. To prevent ridge resorption following extraction and facilitate successful placement of an implant-supported prosthesis, alveolar ridge preservation was performed. Methods: In this study, the biocompatibility of a nanocomposite consisting of self-assembling peptide nanofibers (organic phase) and tri-calcium phosphate-nano hydroxyapatite (mineral phase), was evaluated in rabbits. Subsequently, the nanocomposite was grafted onto a model of alveolar bone repair in patients. Results: The in vivo findings revealed no significant differences in the irritation ranking score and average thickness of the reaction zone between the nanocomposite and control groups. Furthermore, there were no significant differences in the appearance of necrosis, granulation tissue, fibroplasia, neovascularization, and hemorrhage as well as in the number of neutrophils, mast cells, lymphocytes, macrophages, and giant cells between the two groups. The defect area was completely filled with newly formed bone trabeculae and cavities containing bone marrow, indicating angiogenesis, while remnants of the scaffold were observed in the deeper region of the defects, adjacent to the bone marrow, considered osteoinductive. The clinical trial findings (TRN: IR.IUMS.REC.1401.355) demonstrated robust bone regeneration after 3.5 months of socket preservation, whereas the bone in the control group experienced atrophy. The nanocomposite facilitated soft tissue healing without any signs of infection or other periodontal malfunction. Conclusion: The application of nanotechnology has enhanced the bio-functionality of alloplastic materials, positioning this nanocomposite a promising alternative to autografts and allografts in alveolar bone repair.

Objective: This study aimed to compare preoperative and postoperative measures in haemophiliacs who had simultaneous total hip and knee arthroplasties. Methods: A retrospective database search identified five patients with severe factor 8 deficiencies who underwent simultaneous hip and knee joint replacement surgery between 2002-2018. Preoperative and postoperative evaluations included Harris Hip Score (HHS), Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score (KOOS), range of motion, flexion contracture (FC), Visual Analog Scale (VAS), hip-knee angle, and leg length discrepancy. Results: The mean age of the patients was 50.8 years, with a mean follow-up duration of 60 months. Preoperative knee ROM was 55 degrees, improving to 73.8 degrees postoperatively. Preoperative knee FC was 13.7 degrees, improving to 10 degrees postoperatively. HHS increased from 45.6 to 75.7, KSS increased from 36 to 69.3, and KOOS total score increased from 34.4 to 82.7. VAS scores decreased from 6.3 to 1.3. One patient experienced prolonged bleeding and subsequent complications, while the others showed significant improvements. Conclusion: Simultaneous hip and knee arthroplasties in hemophiliacs may provide benefits in terms of physical and functional gains. However, the increased risk of complications necessitates careful patient selection. For patients with comorbidities, staged surgeries may be advisable to avoid potential complications. Level of Evidence: Level IV, Therapeutic study.

Introduction: Research entitled "Establishment of Regional Regulations for Coastal Area Rehabilitation as an Environmental Recovery Effort in Buru Regency". Purposes of the Research: The specific aim of this research is to find out and analyze the impact of traditional mining activities on environmental damage in coastal areas, especially in Kayeli Bay, Buru Regency as the estuary of rivers affected by mining activities and to find and analyze the importance of establishing Regional Rehabilitation Regulations as an effort to restore the marine and coastal environment. in Buru Regency. Methods of the Research: This research uses an exploratory type of empirical normative research. This research approach is a statutory approach, a concept approach and a case approach. The data collection techniques used in this research were interviews and literature study. Results of the Research: Mining activities using dangerous chemicals carried out over a period of 23 years have had a major impact on the environmental conditions of Buru Regency. Environmental pollution and destruction not only occurs in mining areas but also land, river flows, bays, coasts and seas which are the final estuaries of mining remains. Kayeli Bay is an important area for fishing, to support the daily lives of around 50,000 village communities. coast. Kaiely Bay is located between 3º 15' 55” - 3º 22' 50” S and 127º 01'35”-127º 01'35” E and is an estuary in nature because it is influenced by the surrounding land, through runoff that enters through rivers that empties into the bay. Continuous abundance of nutrients causes an increase in water fertility. On the other hand, Kaiely Bay is also able to supply and fertilize the surrounding waters with nutrients and a high concentration of chlorophyll-a, namely > 6 mg/L.

Objective: To determine the overall and pooled prevalence of Leishmania (L.) infantum in sandfly vectors in Iran. Methods: The present research conducted a systematic review and meta-analysis and searched regional databases such as PubMed, Scopus, Web of Science (WoS), Embase, PAHO Iris, LILACS, WHO Iris, and local databases named: SID, Magiran, Civilica, and also grey literatures. The current research included studies that were conducted in Iran and examined L. infantum in different sandfly vectors. The studies’ quality assessment/risk of bias assessment was evaluated by the Joanna Briggs Institute Critical Appraisal Checklist for prevalence data studies, and the data were analyzed by Stata 14 software. In addition, we examined 22 primary studies to estimate the overall prevalence of L. infantum among various vectors of visceral leishmaniasis. Results: According to the meta-analysis, the pooled prevalence of Phlebotomus (Ph.) tobbi, Ph. alexandri, Ph. kandelaki, Ph. perfiliewi, Ph. major, Ph. keshishiani were 5.34%, 4.36%, 2.23%, 1.79%, 4.37% and 1.18%. Ph. tobbi has the highest infection rate (25.00%) of L. infantum among the sandfly vectors. Conclusions: Visceral leishmaniasis is widespread in Fars, Ardebil, and East-Azerbaijan provinces, which are the most important endemic regions in Iran.

Abstract Background Metabolic syndrome is a prevalent and common health problem and numerous studies have revealed the role of diet and lifestyle change in prevention of metabolic syndrome. However, the novel dietary index, cardioprotective index (CPI) and its association with metabolic syndrome is not investigated yet. In the current study, we evaluated the association between metabolic syndrome and its components, CPI, Nesfatin-1 and Omentin-1in a cross-sectional study. Methods Three hundred forty eight overweight and obese individuals with metabolic syndrome were recruited. Subjects underwent anthropometric and laboratory assays including metabolic markers, Nesfatin-1 and Omentin-1 with commercial kits. Results Those at the first tertile of CPI had lower high density lipoprotein concentrations (HDL) and higher low density lipoprotein concentrations (LDL), triglyceride (TG), systolic and diastolic blood pressures (SBP, DBP) levels compared with those at the highest tertiles (P 0.05). Additionally, being at the third tertile of CPI was accompanied with significantly higher Nesfatin-1 and Omentin-1 levels compared with lowest tertiels (P

Abstract Background Dabrafenib plus trametinib is a novel targeted therapy for low-grade (LGG) and high-grade (HGG) gliomas. This systematic review and meta-analysis aimed to evaluate the safety and efficacy of dabrafenib plus trametinib in LGG and HGG gliomas. Methods The electronic databases of PubMed/Medline, Scopus, Embase, and Web of Science were searched from inception to 5 September 2024. The meta-analyses, sensitivity analysis, publication bias, and meta-regression were performed through the R program. Results Nine studies with 313 patients were included. Our data demonstrated that dual blockage resulted in a pooled complete response (CR) rate of 10% (95% CI: 5—18%), partial response rate (PR) rate of 39% (95% CI: 32- 46%), stable disease (SD) rate of 36% (95% CI: 26-46%), and progressive disease (PD) rate of 17% (95% CI: 10- 29%). The PR was significantly higher in LGG (P = 0.03), and the PD was substantially lower in LGG (P

Abstract Introduction This study aimed to evaluate the consistency of lung cancer case assessments across multidisciplinary team (MDT) sites in Denmark. The goal was to appraise the comparability of outcomes between hospitals in a real-world context. Methods We prepared sixty comprehensive, fictitious lung cancer case stories, complete with images, and distributed them to the four primary lung cancer MDT conferences in Denmark. These cases were subsequently evaluated as had they been ordinary patients during regular MDT meetings. We compared the conclusions on assigned TNM stage and proposed treatment intent using Kappa statistics. Results The consensus on assigned stage (Stages IA-B, IIA-B, IIIA-B, IV, and undetermined) corresponded to a Fleiss’ Kappa-value of 0.62 (95% CI: 0.52–0.71). The overall assessment of curability, categorized as Curable, Incurable, and Undetermined, corresponded to a Kappa-value of 0.72 (CI: 0.61–0.84). However, for cases unanimously judged by all MDT sites to be Stage III, the concordance on treatment intent was poor, with an agreement coefficient of only 0.32 (95% CI: -0.27–0.97). Conclusion In detail, the level of agreement on assigned stages was less than desired. In consequence, comparative analyses of treatment results from different hospitals or centres may be prone to bias caused by systematic differences in stage assessment or intent of treatment. The least consensus was observed for cases in Stage III, indicating a need for quality improvement efforts to ensure a higher degree of consistency in MDT decisions.

Abstract Background Radiopharmaceutical therapy with 225Ac- and 177Lu-PSMA has shown promising results for the treatment of prostate cancer. However, the distinct physical properties of alpha and beta radiation elicit varying cellular responses, which could be influenced by factors such as tumour morphology. In this study, we use simulations to examine how cell geometry, region of pharmaceutical uptake within the cell to model different internalization fractions, and the presence of tumour hypoxia and necrosis impact nucleus absorbed doses and dose heterogeneity with 225Ac and 177Lu. We also develop nucleus absorbed dose kernels for application to autoradiography images. Methods We used the GATE Monte Carlo software to simulate three geometries of LNCaP prostate cancer cells (spherical, cubic, and ovoid) with activity of 225Ac or 177Lu internalized in the cytoplasm or bound to the extracellular membrane. Nucleus S-values were calculated for each geometry, source region, and isotope. The cell models were used to create nucleus absorbed dose kernels for each source region describing the dose to each nucleus in a cell layer, which were applied to simulated tumours composed of normoxic, hypoxic, or necrotic cancer cells to obtain dose rate maps. Absorbed doses within the tumours and dose heterogeneity were analyzed for each tumour morphology and isotope. Cell geometry made a minimal impact on S-values to the nucleus, however internalization resulted in higher nucleus doses. Applying the kernels to the simulated tumour maps showed that doses to each cell type varied between 225Ac and 177Lu depending on tumour morphology. Dose heterogeneity within tumours was slightly higher with 225Ac, however the tumour morphology made a larger impact on dose heterogeneity compared to the choice of isotope, with hypoxic and necrotic tumours having very heterogeneous dose distributions. Conclusions Cell geometry simplifications may still allow robust results in simulation studies. Furthermore, the morphology of the tumour itself may make a larger impact on treatment response compared to other variables such as ratio of internalization. Finally, nucleus absorbed dose kernels were created that could enable microdosimetric studies with autoradiography.

Abstract Background Genomic profiling of advanced solid cancer in patients with no further evidence based standard treatment options is a novel approach to identify potential experimental treatment options based on specific genomic alterations. Due to the expected short survival of these patients timely assessment of potential druggable targets is critical to minimize the risk of deterioration during the analysis. The primary objective of this prospective study is to evaluate the turnaround time for genomic profiling and the clinical investigational procedures. The secondary objectives are to investigate how often genomic alterations in tumor tissue gives rise to a matched treatment offer and evaluate the clinical outcome. Methods The PRECODE study is a prospective, non-randomized, single-center cohort study conducted at Departments of Oncology and Pathology, Odense University Hospital, Denmark. Enrollment between March 1, 2019 and December 31, 2024. Eligibility criteria are age ≥ 18 years, written informed consent, advanced solid tumors, exhausted treatment options, ECOG performance status 0–2, adequate organ function and life expectancy ≥ 3 months. A core needle biopsy is analyzed by next generation sequencing using a pan-cancer comprehensive panel. Results are discussed weekly at institutional/local and national multidisciplinary tumor boards. Discussion Strategies and methods for genomic profiling of advanced solid cancers differ. Rapid analysis and interpretation of sequencing data are key to avoiding delays in initiation potential experimental treatments, as these late-stage patients may quickly deteriorate. Although a highly optimized setup with fast-track clinical evaluation and genomic profiling has been established a subset will not be offered a targeted treatment due to deterioration. Local and national multidisciplinary teams have been established to optimize individualized treatment decisions. After genomic profiling a subset of patients will take part in clinical trials, which will constrain the reporting of overall survival or progression free survival. Trial registration Danish Ethics Committee, Projekt-ID: S-2018014, date of approval: 27- FEB- 2019) Danish Data Protection Agency (Journal no: 18/58329, date of approval: 23-NOV-2018). ClinicalTrials.gov Identifier: NCT05385081 (retrospectively registered).

Background: Joint hypermobility syndrome (JHS) and Ehlers-Danlos Syndrome (EDS) are connective tissue disorders characterized by increased joint laxity, affecting musculoskeletal health and quality of life. In this study, we explored recent trends in surgical treatment of shoulder instability among patients with these disorders. Methods: We searched the PearlDiver Mariner database, which includes deidentified US all-payer claims data from 2010 to 2020. We used procedure and diagnostic codes for EDS and JHS to select patients. The primary outcome was the yearly trend in relative utilization of the following 4 shoulder instability procedures: arthroscopic stabilization, Latarjet coracoid transfer, open capsulolabral repair, and open capsulolabral shift. Results: Among 109,274 patients with EDS and 453,885 with JHS, 3.4% and 0.8% underwent shoulder instability procedures, respectively. Arthroscopic stabilization was the predominant treatment, with a mean utilization rate of 78% for EDS and 83% for JHS. Notably, the age at surgery increased for EDS patients but decreased for JHS patients. Female patients represented large proportions of those undergoing procedures in both the EDS group (83%) and the JHS group (77%). Conclusions: Our findings indicate a consistent preference for arthroscopic stabilization in treating shoulder instability in patients with EDS and JHS. The trends in age suggest shifts in treatment strategies, possibly influenced by advancements in nonoperative interventions or varying symptom severity. The higher proportion of female patients aligns with the known prevalence of connective tissue disorders in women. Future research should explore outcomes, complications, and specific EDS subtypes to guide optimal treatment strategies for these challenging connective tissue disorders.

Abstract Background Type-2 diabetes mellitus (T2DM) is considered one of the chronic diseases that can have a relationship with age of menopause onset. Several studies have revealed that early menopause or late menopause can have a correlation with type-2 diabetes. This systematic review and meta-analysis aimed to investigate the association between the age of menopause onset and type-2 diabetes. Methods and materials PubMed, Web of Science, Scopus, Science Direct, Google Scholar, and Cochrane were searched for studies that have evaluated the relationship between T2DM and age of menopause onset. We pooled the effect sizes of the included studies using both adjusted odds ratios (OR) and hazard ratios (HR) of interest outcomes with their 95% confidence interval (CI). Results Nineteen papers were included in this study, 8 studies were cohorts, and 11 were cross sectional. Studies revealed a statistically significant association between early menopause age and increased odds of T2DM (OR = 1.24, 95% CI: 1.09–1.40; I2 = 67%; p = 0.001). Late menopause age was also associated with an increased odds of T2DM (OR = 1.14, 95% CI: 1.03–1.26; I2 = 56%; p = 0.01) compared to the reference group with normal menopausal age. As our secondary outcome, the hazard of developing T2DM in individuals with early or late menopausal age was assessed. Pooled analysis demonstrated a significantly higher hazard of T2DM among women with early menopause age (HR = 1.31, 95% CI: 1.05–1.64; I2 = 72%; p = 0.02). Late menopause age did not show a significant association (HR = 0.96, 95% CI: 0.84–1.10; I2 = 68%; p = 0.56). Conclusion Early and late menopause can both increase the risk of T2DM. Future research is needed to warrant the certainty of our findings.

Abstract Air pollution is a multifaceted issue affecting people’s health, environment, and biodiversity. Gaining comprehension of the interactions between natural and anthropocentric pollutant concentrations and local climate is challenging. This study aims to address the following two questions: (1) What is the influential mechanism of climatic and anthropogenic factors on the ground-level ozone (O3) concentrations in an urban environment during different seasons? (2) Can the ozone weekend effect be observed in a medium-sized city like Craiova, and under which conditions? In order to answer these questions, ozone interactions with meteorological parameters (temperature, pressure, relative humidity) and pollutant concentrations (particulate matter, carbon dioxide, volatile organic compounds, formaldehyde, nitrogen dioxide, nitric oxide and carbon monoxide) is evaluated based on a one-year dataset given by a low-cost sensor and one-year dataset provided by the National Environment Agency. Using two statistical analysis programs, Python and SPSS, a good understanding of the correlations between these variables and ozone concentration is obtained. The SPSS analysis underscores the significant impact of three meteorological factors and nine other pollutants on the ozone level. A positive correlation is noticed in the summer when sunlight is intense and photochemical reactions are elevated. The relationship between temperature and ozone concentration is strong and positive, as confirmed by Spearman’s rho correlation coefficient (r = 0.880). A significant negative correlation is found between relative humidity and ozone (r = -0.590). Moreover, the analysis shows that particulate matter concentrations exhibit a significant negative correlation with ozone (r ≈ -0.542), indicating that higher particulate matter concentrations reduce ozone levels. Volatile organic compounds show a significant negative correlation with ozone (r = -0.156). A negative relationship between ozone and carbon dioxide (r = -0.343), indicates that elevated carbon dioxide levels might also suppress ozone concentrations. A significant positive correlation between nitrogen dioxide and ozone (r = 0.060), highlights the role of nitrogen dioxide in the production of ozone through photochemical reactions. However, nitric oxide shows a negative correlation with ozone (r = -0.055) due to its role in ozone formation. Carbon monoxide has no statistically significant effect on ozone concentration. To observe the differences between weekdays and weekends, T-Test was used. Even though significant differences were observed in temperature, humidity, carbon dioxide, volatile organic compounds, nitrogen dioxide, nitric oxide and carbon monoxide levels between weekdays and weekends, the T-Test did not highlight a significant weekend ozone effect in a mid-sized city as Craiova. Using Python, the daily values were calculated and compared with the limit values recommended by the World Health Organization (WHO) and European Environment Agency (EEA). The WHO O3 recommended levels were exceeded for 13 times in one year. This study offers a comprehensive understanding of ozone pollution in a mid-sized city as Craiova, serving as a valuable reference for local decision-makers. It provides critical insights into the seasonal dynamics of ozone levels, emphasizing the significant role of temperature in ozone formation and the complex interactions between various pollutants and meteorological factors.

Abstract Background Orthopedics is one of the specialized fields of medicine and its residency has always been of interest. This systematic review and meta-analysis aim to evaluate the prevalence of depression and anxiety among orthopedic residents. Methods Digital databases such as PubMed, Scopus and Web of Science were systematically searched until July 27, 2024. Results The analysis included a total of 10 studies for anxiety (1,758 cases, 374 anxiety cases) and depression (2,389 cases, 381 depression cases). The pooled prevalence of anxiety was 31.6% [95% CI: 18.04–45.26%] with significant publication bias (Egger’s test p = 0.0257). After removing a potential outlier, the prevalence of anxiety was recalculated as 25% [95% CI: 16.61–34.01%]. The pooled prevalence of depression was 22.2% [95% CI: 12.08–32.51%] with significant publication bias (Egger’s test p = 0.0434). After removing a potential outlier, the prevalence of depression was recalculated as 18.6% [95% CI: 10.27–26.92%], showing no significant publication bias (Egger’s test p = 0.1229). Conclusion Depression and anxiety are highly prevalent among orthopedic residents, with significant levels of psychological distress affecting nearly one-third of this population.

Abstract Background Control techniques using biological control agents such as Beauveria bassiana (Balsamo) Vuillemin have the advantage of not showing any negative impacts on environmental health and safety issues. This study used isolates from B. bassiana collection from Laboratory of Pest Monitoring belonging to Indonesian Ministry of Agriculture (LPHP) in Central Java which showed potential in controlling target pest. The problems that still occur are the lack of facilities and infrastructure and the lack of quality testing of collection isolates in LPHP, so that the isolate identification process is still carried out in simple method, and bioassay testing on the fall armyworm (FAW), Spodoptera frugiperda J.E. Smith (Lepidoptera: Noctuidae) as a target pest, is not commonly conducted. The results of bioassay testing can be used to determine the potential of a biological agent to control target pest. Result The two DNA extraction methods showed different results regarding DNA concentration and purity values, but both methods were good and could be used to amplify DNA using PCR. The DNA band was amplified at 500–600 bp using primers ITS 1 and ITS 4. The results of molecular analysis showed that the four isolates of B. bassiana from Central Java were found in the same clade as B. bassiana from South Sumatra, Dhaka, and Oromia, where these isolates showed similar similarities descended from a common ancestor. Genetically, B. bassiana isolates from Central Java show more genetic similarities to B. bassiana isolates from South Sumatra, Indonesia. Quality testing was carried out by calculating the density and germination ability values for LPHP isolates from Sukoharjo (Sukoharjo isolate), Temanggung (Purworejo isolate), and Banyumas (Banyumas and Cilacap isolate), which showed varying results. The bioassay test used three isolates, namely B. bassiana from Sukoharjo, Banyumas, and Cilacap, which were selected based on density values, germination ability, and molecular analysis. The ability to cause death of the three isolates against S. frugiperda showed different results where the isolate from Sukoharjo, Banyumas, and Cilacap caused mortality of 60, 40, and 60%, and the LC50 value of each isolate was 3.3 × 106, 1.3 × 107, and 3.5 × 107 conidia ml−1, respectively. Conclusion Morphological identification by macroscopic, microscopic, and molecular analysis showed that the isolate from the LPHP collection in Central Java, Indonesia, was B. bassiana. Genetically, the four isolates showed similar characteristics to isolates from South Sumatra, Indonesia. B. bassiana isolates from collections from Central Java showed potentials as a biological control agent against S. frugiperda.

Background: Despite receiving training on caring for burn wounds in the undergraduate nursing program, nursing students do not acquire enough knowledge and skills in wound dressing and debridement. This research was carried out to determine the effect of a training package on the nursing interns’ knowledge and executive functions regarding the dressing and mechanical debridement of burn wounds. Methods: This quasi-experimental study was conducted on 60 nursing internship students in their 7th semester in Ilam, Iran, in 2023. A convenience sampling method was used, and participants were randomly assigned to groups using dice-throwing for simple randomization. Over six weeks, the intervention group received training on dressing burn wounds through a learning package, virtual gamification, a simulator, and clinical and real exercises. The control group received routine content through oral education by the same lecturer. Knowledge and executive function in mechanical debridement of burn wounds were assessed using the KMDBWT and EFMDBWT tools before and two weeks after the intervention. Data were analyzed with a standard error of 0.05 using Kolmogorov-Smirnov, independent t, paired t, chi-square, and analysis of covariance tests by SPSS V.16. Results: Before the intervention, no significant difference was observed between the mean and standard error of the control and intervention groups' knowledge and executive performance scores. However, after the intervention, the knowledge scores significantly increased in the intervention group (16.35 ± 0.288) compared to the control group (10.00 ± 0.356) (P=0.001). Moreover, after the intervention, the executive function scores in the intervention group (105.00 ± 0.939) were significantly increased compared to the control group (56.81 ± 0.738) (P=0.001). Conclusion: The burn wound dressing and mechanical debridement training increased nursing students' knowledge and executive function. Hence, this educational package is recommended as a supplementary teaching resource.

Background and objectives: Asthma is a chronic airway inflammatory disease. Viola odorata has been traditionally used to treat inflammatory diseases. This study was conducted to explore the anti-inflammatory effects of V. odorata aqueous extract on a murine model of asthma. Methods: Forty-eight Balb/c female mice were divided into six groups of eight animals. The healthy controls received distilled water and other groups became asthmatic using ovalbumin. Then, one group received dexamethasone, and the extract (100, 200, and 400 mg/kg) was administered to three groups for a week. Subsequently, the number of eosinophils, and the levels of interleukins 4, 5, and 13 were measured in bronchoalveolar lavage fluid (BALF) samples. Histopathological changes were analyzed in lung tissues. Results: Eosinophils count and the levels of interleukins 4, 5, and 13 in BALF specimens significantly reduced. Hyperplasia of goblet cells, lymphoid tissue hyperplasia, and peribronchial and perivascular inflammations decreased in the extract-treated mice. The effects of V. odorata aqueous extract on all parameters were comparable with dexamethasone. Conclusion: The present study is the first report of anti-inflammatory activities of V. odorata aqueous extract in a mouse model of allergic asthma. Therefore, these data may suggest V. odorata as a promising drug to treat asthma-induced inflammation.

Abstract Buchdahl star is the most compact object without an event horizon and is an excellent candidate for a black hole mimicker. Unlike black holes, rotating Buchdahl star can be over-extremal with respect to the black hole, sustaining a larger spin. We show that it can also develop an ergosphere above the threshold spin $$\beta > 1/\sqrt{2}$$ β > 1 / 2 , which allows extraction of its rotational energy. Electromagnetic field around Buchdahl star is also expected to differ from that of black hole in both strength and topology. In this paper, we explore the energetics of Buchdahl star focusing on the magnetic Penrose process in the two magnetic field configurations, i.e., uniform and dipole. Below the threshold spin, Buchdahl star is expected to be quiet, while above the threshold it can be much more efficient than the black hole if a dipolar magnetic field is developed on its surface.

Abstract Background and purpose This comparative systematic review and meta-analysis investigated the incidence of ischemic stroke in intermediate-to-high-risk patients undergoing transcatheter aortic valve replacement versus surgical aortic valve replacement. Methods We conducted a systematic review and meta-analysis following the PRISMA guidelines, searching PubMed, Google Scholar, Embase, Web of Science, and Cochrane CENTRAL databases from their inception to December 2023. The evaluated outcomes were primarily incidence of stroke and transient ischemic attack (TIA), along with other secondary safety end-points at 30 days and 1 year post-procedure. Odds ratios (ORs) with 95% confidence intervals (CIs) were utilized for each study, employing a random-effects model for data synthesis irrespective of heterogeneity. Statistical heterogeneity was assessed using I2 statistics. All statistical analyses were conducted using Review Manager. Results We screened 8028 articles and included 8 studies consisting of 5 randomized controlled trials and 3 observational studies. The studies examining 30-day and 1-year stroke incidence found no significant difference between TAVR and SAVR patients (OR 0.83, 95% CI 0.59 to 1.17, p = 0.30, OR 0.92, 95% CI 0.64 to 1.33, p = 0.67, respectively). Both TAVR and SAVR also had a comparable risk of having a transient ischemic attack within 30 days (OR 0.93, 95% CI 0.24 to 3.63, p = 0.92, I2 52%) and 1 year (OR 1.15, 95% CI 0.72 to 1.82, p = 0.56, I2 0%) following the procedure. Regarding safety endpoints, TAVR had lower rates of all-cause mortality and acute kidney injury at 1 year post-procedure, but a higher incidence of major vascular complications at both 30 days and 1 year compared with SAVR. Conclusion The results suggest that TAVR and SAVR have comparable outcomes for both TIA and stroke incidence at 30 days and 1 year post-procedure, but display varying safety profiles in intermediate-to-high surgical risk patients.

Abstract Cybercriminals create phishing websites that mimic legitimate websites to get sensitive information from companies, individuals, or governments. Therefore, using state-of-the-art artificial intelligence and machine learning technologies to correctly classify phishing and legitimate URLs is imperative. We report the results of applying deterministic and probabilistic neural network models to URL classification. Key achievements of this work are: (1) The development of a unique approach based on probabilistic neural networks that improves classification accuracy. (2) We show for the first time in URL phishing research that a machine learning model trained on a combination of open source and private datasets is successful in production. The dataset is constructed from open sources like Alexa, PhishTank, or OpenPhish and, most importantly, real-world production data from EasyDMARC. The daily validation of the model using daily reported URL data and corresponding labels, both from open-source platforms and private production, reach on average a 97% accuracy on the validation dataset, labeled by PhishTank, OpenPhish and EasdDMARC where possible mislabeled data can not be excluded and was not possible to check due to large number of URLs. Feature engineering was done without third-party dependencies. Lastly, the evaluation of both deterministic and probabilistic models shows high accuracy on short and long URLs, where short URLs are defined as having less than 50 characters.

Abstract Photonics offers a transformative approach to artificial intelligence (AI) and neuromorphic computing by enabling low-latency, high-speed, and energy-efficient computations. However, conventional photonic tensor cores face significant challenges in constructing large-scale photonic neuromorphic networks. Here, we propose a fully integrated photonic tensor core, consisting of only two thin-film lithium niobate (TFLN) modulators, a III-V laser, and a charge-integration photoreceiver. Despite its simple architecture, it is capable of implementing an entire layer of a neural network with a computational speed of 120 GOPS, while also allowing flexible adjustment of the number of inputs (fan-in) and outputs (fan-out). Our tensor core supports rapid in-situ training with a weight update speed of 60 GHz. Furthermore, it successfully classifies (supervised learning) and clusters (unsupervised learning) 112 × 112-pixel images through in-situ training. To enable in-situ training for clustering AI tasks, we offer a solution for performing multiplications between two negative numbers.

Usaha Mikro, Kecil, dan Menengah (UMKM) memainkan peran penting dalam perekonomian Indonesia. Namun, UMKM seringkali menghadapi tantangan dalam hal manajemen produk dan interaksi dengan pelanggan terutama dalam pemasaran digital dan E-commerce. Penelitian ini bertujuan untuk mengembangkan platform pencarian visual berbasis Deep Learning untuk identifikasi produk UMKM guna mengatasi tantangan tersebut. Metode penelitian diawali dengan studi literatur tentang Deep Learning dan CNN (Convolutional Neural Network). Selanjutnya dilakukan pengumpulan data berupa gambar produk UMKM, diikuti pra-pemrosesan dan augmentasi data. Kemudian dirancang model menggunakan arsitektur CNN VGG16 yang terdiri dari 16 lapisan untuk pencarian visual dan klasifikasi produk UMKM. Model terbaik yang memenuhi target performa kemudian diintegrasikan pada prototipe platform berbasis web. Platform pencarian visual ini diharapkan dapat membantu pengelolaan produk UMKM serta meningkatkan pengalaman pelanggan dalam mencari dan menemukan produk yang mereka butuhkan. Secara keseluruhan, penelitian ini bertujuan mendukung pertumbuhan UMKM di Indonesia melalui adopsi teknologi Deep Learning