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Musculoskeletal urgent care centers (MUCCs) are an increasingly common alternative to emergency departments for patients with orthopedic injuries. As there is a lack of longitudinal data regarding MUCCs impact on the emergency health care system, our study seeks to understand recent trends in MUCC growth and their acceptance of Medicaid insurance. Over the last 6 years, at 2-year intervals (2019, 2021, and 2023), we performed a search to identify all MUCCs in the United States. We determined the affiliation and Medicaid acceptance status of all MUCCs, including those that closed/opened between 2019, 2021, and 2023, to analyze trends in MUCC availability and Medicaid acceptance. In 2019, there were 558 MUCCs, which increased to 596 MUCCs in 2021 and then decreased to 555 MUCCs in 2023, representing a growth and then decline of approximately 7%. Overall, since June 2019, 90 MUCCs have opened and 95 MUCCs have closed. Medicaid acceptance increased nationally between 2019 and 2023, from 58% to 71%. Medicaid acceptance increased for both nonaffiliated and privately affiliated MUCCs. Medicaid acceptance has increased nationally from 2019 to 2023, while MUCC availability has gone through a period of growth and then reversion to 2019 levels. As MUCCs have demonstrated limited Medicaid acceptance previously, it is promising that Medicaid acceptance has improved and MUCCs are providing patients with an additional avenue to access orthopedic care.

Background: Photothermal therapy (PTT) is one of the effective and non-invasive strategies which hold great promise for improving the treatment of cancer cells. PTT is based on activating a photosensitizer by infrared light irradiation and producing heat and reactive species and apoptosis in the tumor area.Objective: The aim of this study was to investigate the effect of photothermal/chemotherapy on melanoma cancer cells using poly (2-amino phenol)/gold (P2AO/AuNPs) and doxorubicin (DOX).Material and Methods: In this experimental study, nanoparticles of P2AO/AuNPs were synthesized, and their mixture with DOX was applied as a photosensitizer for photothermal/chemotherapy of a C540 (B16-F10) melanoma cell line.Results: P2AO/AuNPs generated heat and cytotoxic responsive oxygen species (ROS) upon 808-nm light irradiation with simultaneous intensifying DOX therapeutic effect under domination of synergism effects between light irradiation, P2AO/AuNPs, and doxorubicin. Cell treatment with both P2AO/AuNPs and DOX resulted in a considerable increase in necroptotic cells to 61% with a significant decrease in the living cells (39%). Conclusion: P2AO/AuNPs provided a platform for light absorption and intensifying DOX therapeutic effect. This study approved the applicability of a new photothermal/chemotherapy by domination of synergistic effects attained by combination of laser light, P2AO, AuNPs, and DOX.

Abstract Background This study evaluated the clinical characteristics of neuronal ceroid lipofuscinosis type 7 or CLN7 disease spectrum to characterize the clinical, electrophysiologic and neuroimaging phenotypes. Methods We performed a single-center cross sectional data collection along with retrospective medical chart review in patients with a genetic diagnosis of CLN7. This study received ethical approval by the University of Texas Southwestern Medical Center Institutional Review Board. A total of 8 patients were included between the ages of 4 to 6 years. All patients had a genetic diagnosis of CLN7 with homozygous or compound heterozygous mutations in the MFSD8 gene. The information collected includes patient demographics, developmental history, neurological events including seizures and neurodevelopmental regression along with further evaluation of brain magnetic resonance imaging and electrophysiological findings. The clinical phenotype is described through cross sectional and retrospective data collection and standardized tools assessing quality of life and functional skills. Results Our findings in this cohort of CLN7 patients indicated that development is initially normal with onset of clinical symptoms as early as two years of age. Language problems were noted prior to or at the onset of seizures in all cases. Gait problems were noted prior to seizure onset in 3 of 8 patients, and at or within 6 months after the onset of seizures in 5 of 8 patients. All patients followed a progressive course of language, motor, and neurocognitive deterioration. Congruent with the medical history, our patients had significantly low scores on adaptive abilities. Natural history data such as this can be used to support future clinical trial designs. Conclusions This study provides a comprehensive description of CLN7 disease, highlighting clinical data alongside standardized neuropsychological assessments, neuroimaging, and electrophysiologic data. It emphasizes the value of importance of standardized tools for understanding disease phenotype and their potential use as endpoints in future clinical trials. The findings established can provide a baseline for developing future prospective natural history studies and potential therapeutic clinical trials.

Abstract Introduction Despite the popularity and potential protective effects of intermittent fasting (IF) against metabolic disorders, more human trials must be conducted to highlight its effects on human health. Therefore, the present trial aimed to investigate the effect of IF on the body composition, health markers, and memory status of obese and overweight adults. Methods A parallel randomised controlled trial was conducted in Lahore, Pakistan, with 30 participants recruited from each of the three arms (regular diet, customised diet, and IF group) with a follow-up period of 12 weeks. Results There was no significant difference in the mean percentage change in BMI at the end of the study period (p = 0.55). The IF group exhibited a negative median change (-4.41%) in systolic blood pressure compared with the other two groups (p = 0.014), with no difference among the groups in diastolic blood pressure or blood sugar levels (p > 0.05). The percentage change in waist circumference was more significant in the IF group than in the control group, with a significant improvement in the median percentage change in total cholesterol, LDL, triglyceride, and HDL levels (p

Aims: While residual fixed flexion deformity (FFD) in unicompartmental knee arthroplasty (UKA) has been associated with worse functional outcomes, limited evidence exists regarding FFD changes. The objective of this study was to quantify FFD changes in patients with medial unicompartmental knee arthritis undergoing UKA, and investigate any correlation with clinical outcomes. Methods: This study included 136 patients undergoing robotic arm-assisted medial UKA between January 2018 and December 2022. The study included 75 males (55.1%) and 61 (44.9%) females, with a mean age of 67.1 years (45 to 90). Patients were divided into three study groups based on the degree of preoperative FFD: ≤ 5°, 5° to ≤ 10°, and > 10°. Intraoperative optical motion capture technology was used to assess pre- and postoperative FFD. Clinical FFD was measured pre- and postoperatively at six weeks and one year following surgery. Preoperative and one-year postoperative Oxford Knee Scores (OKS) were collected. Results: Overall, the median preoperative navigated (NAV) FFD measured 6.0° (IQR 3.1 to 8), while the median postoperative NAV FFD was 3.0° (IQR 1° to 4.4°), representing a mean correction of 49.2%. The median preoperative clinical FFD was 5° (IQR 0° to 9.75°) for the entire cohort, which decreased to 3.0° (IQR 0° to 5°) and 2° (IQR 0° to 3°) at six weeks and one year postoperatively, respectively. A statistically significant improvement in PROMs compared with baseline was evident in all groups (p < 0.001). Regression analyses showed that participants who experienced a larger FFD correction, showed greater improvement in PROMs (β = 0.609, p = 0.049; 95% CI 0.002 to 1.216). Conclusion: This study found that UKA was associated with an approximately 50% improvement in preoperative FFD across all three examined groups. Participants with greater correction of FFD also demonstrated larger OKS gains. These findings could prove a useful augment to clinical decision-making regarding candidacy for UKA and anticipated improvements in FFD.

In this study, we investigate the age-hardening behavior and mechanical properties of direct chill (DC)-cast Al–10Si-0.35 Mg alloys subjected to melt thermal rate treatment (TRT). Our findings reveal that TRT refines the microstructure and precipitation morphology. Grain analysis indicates the prevalence of twin dendritic grains in both TRT and non-TRT (NTRT) alloys during casting, with the TRT billet exhibiting smaller grains. The microstructural analysis demonstrates that TRT reduces the size of secondary dendrite arm spacing and eutectic phases while ensuring a uniform distribution of intermetallic particles. The precipitation mechanism in both alloys remains consistent, with the TRT alloy exhibiting a higher density of fine precipitates. Additionally, we observe a novel coprecipitation mechanism of Si and β″ phase, attributed to a lower misfit between (003)β″ and (011)Si compared to that between (003)β″ and (0 2‾ 0)Al. Furthermore, the TRT alloy displays slower precipitation kinetics due to homogeneous solute distribution, resulting in higher activation energy for precipitation nucleation. Consequently, a single age-hardening peak is observed in TRT alloys during aging. TRT alloys exhibit higher hardness and tensile strength after artificial aging at 190 and 210 °C, while maintaining comparable elongation to NTRT alloys. Theoretical calculations of precipitation strengthening also show higher values for TRT alloys, consistent with experimental results. Thus, our findings comprehend the underlying mechanisms of melt treatments crucial for improving precipitation hardening behavior and mechanical properties of Al–Si–Mg alloys.

Abstract Background Normothermic machine perfusion of donor livers has become standard practice in the field of transplantation, allowing the assessment of organs and safe extension of preservation times. Alongside its clinical uses, there has been expanding interest in extended normothermic machine perfusion (eNMP) of livers as a potential vehicle for medical research. Reproducible extended normothermic machine perfusion has remained elusive due to its increased complexity and monitoring requirements. We set out to develop a reproducible protocol for the extended normothermic machine perfusion of whole human livers. Methods Human livers declined for transplantation were perfused using a blood-based perfusate at 36 °C using the Liver Assist device (XVIVO, Sweden), with continuous veno-venous haemofiltration in-parallel. We developed the protocol in a stepwise fashion. Results Perfusion techniques utilised included: targeted physiological vascular flows, phosphate replacement (to prevent hypophosphataemia), N-acetylcysteine (to prevent methaemoglobin accumulation), and the utilisation of sodium lactate as both a nutritional source and real-time measure of hepatocyte function. All five human livers perfused with the developed protocol showed preserved function with a median perfusion time of 168 h (range 120–184 h), with preserved viability throughout. Conclusions Livers can be reproducibly perfused in excess of 120 (range 121–184) hours with evidence of preserved hepatocyte and cholangiocyte function.

BACKGROUND: An unmet need exists to reliably predict the risk of intracranial hemorrhage (ICH) in patients with atrial fibrillation (AF) treated with oral anticoagulants (OACs). HYPOTHESIS: An externally validated model improves ICH risk stratification. METHODS: Independent factors associated with ICH were identified by Cox proportional hazard modeling, using pooled data from the GARFIELD-AF (Global Anticoagulant Registry in the FIELD-Atrial Fibrillation) and ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registries. A predictive model was developed and validated by bootstrap sampling and by independent data from the Danish National Patient Register. RESULTS: In the combined training data set, 284 of 53 878 anticoagulated patients had ICH over a 2-year period (0.31 per 100 person-years; 95% confidence interval [CI]: 0.28-0.35). Independent predictors of ICH included: older age, prior stroke or transient ischemic attack, concomitant antiplatelet (AP) use, and moderate-to-severe chronic kidney disease (CKD). Vitamin K antagonists (VKAs) were associated with a significantly higher risk of ICH compared with non-VKA oral anticoagulants (NOACs) (adjusted hazard ratio: 1.61; 95% CI: 1.25-2.08; p = .0002). The ability of the model to discriminate individuals in the training set with and without ICH was fair (optimism-corrected C-statistic: 0.68; 95% CI: 0.65-0.71) and outperformed three previously published methods. Calibration between predicted and observed ICH probabilities was good in both training and validation data sets. CONCLUSIONS: Age, prior ischemic events, concomitant AP therapy, and CKD were important risk factors for ICH in anticoagulated AF patients. Moreover, ICH was more frequent in patients receiving VKA compared to NOAC. The new validated model is a step toward mitigating this potentially lethal complication.

Summary: Background: Continuous assessment of cerebral autoregulation (CA) using pressure reactivity index (PRx), is a promising tool for individualized management to improve outcome after traumatic brain injury (TBI). However, experience with CA in paediatric TBI (pTBI) is limited to retrospective or single-centre studies. Methods: Studying Trends of AutoRegulation in Severe Head Injury in Paediatrics (STARSHIP) (clinicalTrials.gov identifier-NCT0688462), was a prospective, multicentre, observational, research database study conducted across 10 identified UK Paediatric Intensive Care Units from 01.07.2018 till 31.04.2024. The main objective was to validate and identify optimal thresholds of PRx associated with outcome (as assessed with Glasgow outcome scale extended for Pediatrics at 12 months) in children (

Nowadays, environmental sustainability has become a major concern for the policymakers and researchers, therefore, this study investigated the effects of environmental sustainability factors which are CO2 emissions and Natural Resource Depletion on inward Foreign Direct Investment in Asian economies. The study used data Spanning from 1997 to 2022, and employed the panel data analysis, leveraging econometric models to capture both the short-run and the long-run impacts upon inward FDI. The findings revealed that CO2 emissions have significant negative impact upon FDI in the long run. In addition, it emphasized the importance of environmental concerns in investor decision-making. In contrast, Natural Resource Depletion showed a significant positive impact, highlighting the attraction of resource-dependent industries despite sustainability concerns. The study highlighted the necessity of sustainable policies to strike a balance between economic growth with environmental preservation, offering valuable insights for future research and policymakers.

This study investigates whether the capital markets of BRICS economies promote or hinder energy transition and de-carbonization within these regions. Using Driscoll-Kraay standard errors, we analyze the annual data from 2000 to 2021. We use Fixed Effects and Random Effects Generalized Least Squares (GLS) methods to validate our empirical results. The findings indicate that private sector credit deepening and stock market development exacerbate carbon dioxide emissions, undermining the potential for decarbonization in BRICS economies. Additionally, non-renewable energy intensity and GDP growth are found to contribute significantly to pollution emissions, further impeding decarbonization efforts within this economic bloc. The results reveal that FDI and energy transition play a crucial role in advancing de-carbonization in BRICS countries. This study proposes practical policy implications to mitigate emissions and support sustainable economic growth in the BRICS economies.

Introduction: Exosomes play significant roles in transferring cargo materials like proteins, RNAs (including miRNAs), and DNA. However, the role of serum exosome shuttled RNAs and miRNAs in head and neck cancer (HNC) remains unclear. This study assessed the diagnostic and prognostic significance of exosomal miR-17 , miR-20a , and TGFBR2 in HNC patients. Methods: Exosomes were isolated, from 400 confirmed HNC patients and 400 healthy controls, and characterized by NTA, TEM, Immunolabelling, and ELISA. Quantitative PCR was used to check the expressions of exosomal molecules. Oxidative stress was also measured through ELISA in cancer patients and healthy controls. Results: Data analysis revealed significant dysregulation in the expressional levels of miR-17 (p

Background Differences in the clinical outcomes and level of risk among Asian versus non-Asian patients with atrial fibrillation (AF) have been sparsely investigated.Objective To provide a contemporary prospective comparison of outcomes for newly diagnosed patients with AF, between Asian and non-Asian regions.Methods Six Asian countries (China, Japan, India, Singapore, South Korea and Thailand) and 29 countries outside Asia participated in the Global Anticoagulant Registry in the FIELD-AF (GARFIELD-AF) study. Newly diagnosed patients with AF, enrolled between 2010 and 2016, were followed up for≥2 years. The outcome studies were all-cause, cardiovascular and non-cardiovascular mortality, non-haemorrhagic stroke/systemic embolism (SE), major bleeding. The association of geographical region with clinical outcomes (event rates per 100 person-years) were estimated using multivariable Cox models.Results 13 841/52 057 (26.6%) GARFIELD-AF participants were enrolled in Asia. Average age and prevalence of cardiovascular comorbidities were lower than in non-Asian countries and patients at high risk of stroke (ie, CHA2DS2-VASc≥2 excl. sex) were less frequently anticoagulated (60.1% vs 73.2%). Non-vitamin K oral anticoagulant (NOAC) was similar in both regions (∼28%), though Asian patients were more frequently underdosed. Both Asian and non-Asian patients who received NOAC at enrolment experienced lower all-cause mortality and non-haemorrhagic stroke/SE compared with patients on other treatments or none.All-cause mortality, non-cardiovascular mortality and major bleeding were less frequent in patients from Asia versus non-Asia (HR (95% CI): 0.62 (0.39 to 0.99), 0.52 (0.28 to 0.97), 0.58 (0.36 to 0.96), respectively). Associations of moderate-to-severe chronic kidney disease and vascular disease with increased risk of all-cause mortality were stronger in Asian versus non-Asian patients (interaction p values: 0.0250 and 0.0076, respectively). There was notable heterogeneity in oral anticoagulant (OAC) usage within the Asian countries.Conclusions Patients in Asian countries had a lower risk of all-cause mortality and major bleeding compared to the rest of the world. NOAC had evident benefits for reducing mortality and stroke across populations. Further studies on sociocultural impacts on OAC outcomes are needed.Trial registration number ClinicalTrials.gov NCT01090362.

ABSTRACT We report a rare case of a 29‐year old woman presenting with abdominal pain, whose initial examination failed to identify intrauterine contraceptive device (IUCD) threads. IUCD migration was confirmed by CT scan and subsequent single‐port laparoscopic retrieval alleviated her symptoms.

Human-associated microbial communities are a complex mixture of bacterial species and diverse strains prevalent at varying abundances. Due to the inherent limitations of metagenomic assemblers and genome binning tools in recovering low-abundance species (

AKT2 is crucial for cancer cells' invasion, metastasis, and survival. It is a possible downstream gene target of cancer glycolysis-related microRNAs. The study investigated the role of miRNA-4716–3p, rs2304186, and the AKT2 gene in blood cancer pathogenesis. RT-qPCR was used to analyze AKT2 gene mRNA and miRNA-4716–3p expression in 200 blood cancer samples and 200 healthy controls. Furthermore, Tetra-ARMS PCR was used to examine the rs2304186 AKT2 SNP in 300 patients and 290 control samples. miRNA-4716–3p was shown to be significantly downregulated (p = 0.0294), whereas mRNA expression of the AKT2 gene was found to be significantly upregulated (p = 0.0034) in blood cancer patients compared to healthy individuals. miRNA-4716–3p downregulation (p = 0.0466) was more pronounced, while AKT2 upregulation was non-significant (p = 0.1661) in untreated patients compared to chemotherapy-treated patients. Blood cancer risk was significantly associated with the rs2304186 GT genotype (p = 0.0432), TT genotype (p = 0.0502), and mutant allele (T) frequency (p = 0.0008). Polymorphism rs2304186 was associated with an increased risk of blood cancer in dominant (p = 0.0011), recessive (p = 0.0502), and additive (p = 0.0008) genetic models. The results suggested that the rs2304186 and the deregulated expression of miRNA-4716–3p and AKT2 gene at the mRNA level may significantly increase the incidence of blood cancer, particularly in the Pakistani population. Therefore, these may function as suitable biomarkers for blood cancer diagnosis and prognosis. Additional, larger-scale investigations may be required to affirm these results.