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Abstract Background Chronic kidney disease patients are at increased risk of mortality with cardiovascular diseases and infections as the two leading causes of death for end-stage kidney disease treated with hemodialysis (HD). Mortality from bacterial infections in HD patients is estimated to be 100–1000 times higher than in the healthy population. Methods We comprehensively characterized highly pure circulating neutrophils from HD and healthy donors. Results Protein levels and transcriptome of HD patients’ neutrophils indicated massive neutrophil degranulation with a dramatic reduction in reactive oxygen species (ROS) production during an oxidative burst and defective oxidative cellular signaling. Moreover, HD neutrophils exhibit severely impaired ability to generate extracellular NET formation (NETosis) in NADPH oxidase-dependent or independent pathways, reflecting their loss of capacity to kill extracellular bacteria. Ectopic hydrogen peroxidase (H2O2) or recombinant human SOD-1 (rSOD-1) partly restores and improves the extent of HD dysfunctional neutrophil NET formation. Conclusions Our report is one of the first singular examples of severe and chronic impairment of NET formation leading to substantial clinical susceptibility to bacteremia that most likely results from the metabolic and environmental milieu typical to HD patients and not by common human genetic deficiencies. In this manner, aberrant gene expression and differential exocytosis of distinct granule populations could reflect the chronic defect in neutrophil functionality and their diminished ability to induce NETosis. Therefore, our findings suggest that targeting NETosis in HD patients may reduce infections, minimize their severity, and decrease the mortality rate from infections in this patient population.

The executive compensation issue continues to cause protest due to the increasing number of cases of an unjustifiably high level of pay. The main conflict arises from the misalignment of interests between the short-term expectations of the manager and long-term needs of the shareholders. Since there are no universal rules on how to price the executive performance companies reach for different means of establishing the CEO’s compensation and ascertaining manager’s commitment towards maintaining a company’s value. The issue becomes more complex once the compensation rules are not a direct effect of the market power game but are additionally restricted by government. The aim of the paper is to discuss corporate government policies introduced in Israel and their impact on executive compensation level and structure. Israel is amongst those countries that partially regulate CEO compensation and thus the Israeli experience can add to the understanding of the effectiveness of modern corporate governance.

Introduction: Hip fractures in the elderly are related to increased mortality. The identification of patients at risk is essential. Several nutritional and inflammatory parameters were investigated in an effort to find a prognostic indicator for mortality following fragility hip fractures (FHF) surgery. We aim to evaluate their utility and compare between the different factors. Methods: A retrospective cohort study of patients 65 years and older, who underwent surgery following fragility hip fractures between January 2012 and June 2020, was conducted. Patients who died within 90 days were matched at a 1:1 ratio with surviving controls, based on age, gender, fracture type, and comorbidities. Nutritional and inflammatory indices, including serum albumin, protein energy malnutrition (PEM), albumin-to-globulin ratio (AGR), prognostic nutritional index (PNI), the systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR), and the neutrophile-to-lymphocyte ratio (NLR), were compared between groups. Results: 304 patients were included, 152 in each group. Patients’ demographics were similar. Among all indices evaluated, only the PLR significantly differed between the study groups (236.9 ± 193.5 for the study group vs. 186.6 ± 119.3 for the control group (p = 0.007). In patients who survived the initial hospitalization, the PEM was also found to be correlated with 90 days mortality. Discussion: The PLR was found to be correlated with mortality risk following FHF surgery. As it can be easily calculated from accessible blood tests, we recommend its’ routine assessment as a screening tool for personalized management of patients at high risk for mortality.

Introduction: Pre-operative templating prior to hip arthroplasty has traditionally used implant-company-provided acetates, which assumed a magnification factor between 115% and 120%. In recent years, pre-operative planning has been performed with digital calibration devices, in order to calculate the magnification factor. However, these devices are not without their limitations and are not readily available at many institutions. As previous reports suggest a wide range of magnification factors, the determination of an optimal magnification factor is currently unclear. We investigated the relationship between obesity and gender on the magnification factor in order to improve the accuracy of pre-operative templating. Patients and methods: Ninety-seven consecutive pre-operative calibrated pelvic radiographs using the KingMark calibration were analyzed using the TraumaCad templating software. The magnification factor calculated by the software was considered the true magnification factor and analysis was made in order to assess the effect of sex and body mass index (BMI) on the magnification factor. A linear regression analysis was utilized to create a predictive model for optimal magnification factor value. Results: Magnification factor was significantly affected by sex (male, 120.0% vs. female 121.2%, p

Elad Shemesh,1 Barak Zafrir1,2 1Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel; 2Faculty of Medicine, Technion, Israel Institute of Medicine, Haifa, IsraelCorrespondence: Barak ZafrirDepartment of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa 3436212, IsraelTel +972-48250801Fax +972-48250916Email barakzmd@gmail.comAbstract: Disturbances in glucose and lipid homeostasis are cardinal features of the metabolic syndrome that affect millions of people worldwide. These conditions have multi-organ impact, and while cardiovascular effects are usually the core for studies and preventive measures, other systems may also be affected, including the pancreas. Acute pancreatitis related to severe hypertriglyceridemia is an under-recognized condition that could lead to significant morbidity and mortality. Therefore, when suspected, prompt diagnosis and treatment should be initiated to cover the various aspects of this disorder. Though commonly known to be associated with excess of alcohol use, hypertriglyceridemia-related pancreatitis is particularly observed in diabetics, especially when uncontrolled. Here, we portray the possible mechanisms and clinical features that link type 2 diabetes, hypertriglyceridemia and pancreatitis, and discuss their health-related outcomes and the current and novel treatment options for this unique disease.Keywords: hypertriglyceridemia, acute pancreatitis, type 2 diabetes, cardiovascular disease, metabolic syndrome

BackgroundPulmonary ischaemia-reperfusion injury (IRI) is a major contributor to poor lung transplant outcomes. We recently demonstrated a central role of airway-centred natural killer (NK) cells in mediating IRI; however, there are no existing effective therapies for directly targeting NK cells in humans.MethodsWe hypothesised that a depleting anti-CD94 monoclonal antibody (mAb) would provide therapeutic benefit in mouse and human models of IRI based on high levels of KLRD1 (CD94) transcripts in bronchoalveolar lavage samples from lung transplant patients.ResultsWe found that CD94 is highly expressed on mouse and human NK cells, with increased expression during IRI. Anti-mouse and anti-human mAbs against CD94 showed effective NK cell depletion in mouse and human models and blunted lung damage and airway epithelial killing, respectively. In two different allogeneic orthotopic lung transplant mouse models, anti-CD94 treatment during induction reduced early lung injury and chronic inflammation relative to control therapies. Anti-CD94 did not increase donor antigen-presenting cells that could alter long-term graft acceptance.ConclusionsLung transplant induction regimens incorporating anti-CD94 treatment may safely improve early clinical outcomes.

Recent environmental processes are studied in ʻA’rak Naʻasane Cave at the northern Judean Desert, Israel. The outer zone of the cave is heavily influenced by the outside environment through a large entrance, facilitating entry of air flow, fauna and humans, with minor cave-forming modifications. Conversely, the inner cave sustains humid and warm conditions, favoring modifications by condensation corrosion of convective air flow, associated with deposition of popcorn speleothems at the lower parts of dissolution pockets. The warm humid air of the inner cave may be associated with an underlying thermal water table. Active condensation corrosion is decreasing, possibly because of gradual change in the cave microclimate, associated with falling water table and ventilation. Increasing connection with the surface is indicated by high collapse domes, rare flood invasion, and a large Trident Leaf-nosed bat community which spends the winter within the innermost parts of the cave. Bat guano supports bedrock corrosion and a rich invertebrate fauna, but humans preferred the outer parts of the cave, particularly for refuge during the second Jewish revolt against the Romans. Rare occasions of ancient human entry into the inner cave support this scenario by the small number of artifacts compared with the outer cave. Enigmatic small cairns in the largest inner hall were probably erected during the Intermediate Bronze Age.

The increasing trend to mainstream students with educational challenges (SEC) has obligated mainstream teachers to develop different approaches to deal with heterogeneous classes. Previous research on in-service and pre-service teachers has shown that successful inclusion is correlated with positive attitudes towards inclusion, a high sense of self-efficacy, and minimal stigmatization of SEC. However, it remains unclear whether training programs for in-service and pre-service teachers can impact initial attitudes towards inclusive education. This study examined the different components of attitudes towards inclusion in three groups: in-service teachers, pre-service teachers, and college students enrolled in non-education majors. An online questionnaire was administered by a survey company to 489 participants: in-service teachers who had at least one SEC in their classes (n=196), pre-service teachers (n=143), and college students (n=150). The results showed that pre-service teachers had the most positive attitude towards inclusion of SEC, whereas in-service teachers had the most negative attitude. Attitudes towards inclusion were predicted by stigmatizing attitudes and self-efficacy. Stigmatizing attitudes were predicted by gender, religion, education, and self-efficacy. Thus, the main route to more inclusive and less prejudiced teachers may lie in strengthening teachers' self-efficacy. These results have implications for training programs, which should focus on eliminating myths, strengthening the concept of inclusion throughout the entire program, and enhancing the expertise of in-service teachers.

Purpose: To determine the role of diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) in differentiating the inflammatory process and malignant lymphoma of the lacrimal gland. Methods: A retrospective analysis of all subjects who underwent lacrimal gland biopsy and magnetic resonance (MR) imaging with DWI sequences during a 10-year period at the Sheba Medical Center, Israel. The lacrimal glands’ ADC values were documented bilaterally by blinded observers and correlated with the final histology verified diagnoses. Results: Twenty-eight patients were included, with 19 females (68%) with a mean ± SD age of 48.1 ± 25.7 years. The right orbit was involved in 14 cases (50%) and the left in 13 (46%); one patient (4%) had bilateral involvement. Seventeen cases (61%) had a final diagnosis of idiopathic inflammation or dacryoadenitis, and six cases (21%) were diagnosed with lymphoma. Additional diagnoses included pleomorphic adenoma in 3 (11%), adenoid cystic carcinoma, and solitary fibrous tumor. Lower mean ADC values were observed in the lymphoma versus inflammatory group (1.03 × 10-3 Vs. 1.45 × 10-3, P = 0.02). Conclusion: Restricted diffusion on MR imaging can serve as a diagnostic tool in the differentiation between inflammatory processes of the lacrimal gland and lymphoma.

Abstract Background Community water fluoridation began in the 1945 as a public health measure to prevent and control caries and was implemented in Israel in 1981. Community water fluoridation reduced caries significantly, but in 2014, the Ministry of Health decided to stop Community water fluoridation in Israel. The aim of our study was to examine the effect of fluoridation cessation on the dental health of children aged 3–5, treated in “Assuta Tel Aviv” dental clinics, under general anesthesia or deep sedation. Methods The computerized Maccabi-Dent database provided data for this retrospective study. Records from the years 2014–2019 including treatment codes for procedures relevant to the study, the number of stainless-steel crowns and restorations of all types were examined. Kruskal-Wallis test was performed to compare the results from before and after fluoridation cessation. Results A statistically significant increase in the mean number of treatments in the years after fluoridation cessation (P

Primary graft dysfunction (PGD) limits clinical benefit after lung transplantation, a life-prolonging therapy for patients with end-stage disease. PGD is the clinical syndrome resulting from pulmonary ischemia-reperfusion injury (IRI), driven by innate immune inflammation. We recently demonstrated a key role for NK cells in the airways of mouse models and human tissue samples of IRI. Here, we used 2 mouse models paired with human lung transplant samples to investigate the mechanisms whereby NK cells migrate to the airways to mediate lung injury. We demonstrate that chemokine receptor ligand transcripts and proteins are increased in mouse and human disease. CCR5 ligand transcripts were correlated with NK cell gene signatures independently of NK cell CCR5 ligand secretion. NK cells expressing CCR5 were increased in the lung and airways during IRI and had increased markers of tissue residency and maturation. Allosteric CCR5 drug blockade reduced the migration of NK cells to the site of injury. CCR5 blockade also blunted quantitative measures of experimental IRI. Additionally, in human lung transplant bronchoalveolar lavage samples, we found that CCR5 ligand was associated with increased patient morbidity and that the CCR5 receptor was increased in expression on human NK cells following PGD. These data support a potential mechanism for NK cell migration during lung injury and identify a plausible preventative treatment for PGD.

Introduction: In this case report, we demonstrate the application of an aspheric macular lens (Grieshaber, Alcon) for conducting posterior segment procedures after a posterior capsular rupture (PCR) occurrence during cataract surgery. Case Presentation: During a cataract surgery on a 70-year-old female patient, a PCR was identified, accompanied by the descent of the lens into the vitreous, and prompted subsequent interventions. This involved performing posterior-assisted levitation, anterior segment phacoemulsification, and anterior segment vitrectomy. Subsequently, due to the absence of a BIOM posterior viewing system in the operating room, an aspheric macular lens (Grieshaber, Alcon) was positioned on the patient’s eye. Subsequently, pars plana vitrectomy was performed, along with the extraction of residual lens cortical remnants. The procedure concluded with gradually inserting a 3-piece intraocular lens into the sulcus. Conclusion: When managing posterior capsular rupture, using an aspheric macular lens, such as the Grieshaber (Alcon), can be beneficial.

Abstract Requiem sharks (genus Carcharhinus) have previously been reported to form large aggregations around marine infrastructures in the eastern Mediterranean Sea. While this behaviour may offer fitness advantages at the individual level, the implications of extended residency at human-altered habitats for population persistence have yet to be assessed. In this work, we investigated the phylogeographic and demographic composition of sharks near a coal-fired power and desalination station in Israel. Our aim was to infer habitat use and the mechanisms underlying the aggregation behaviour, and to highlight potential conservation impacts. We sampled, measured, and released 70 individuals between 2016 and 2022 to assess genetic variability within the cytochrome C oxidase I (COI) region and to analyse the aggregation’s structure based on the sharks’ size and sex distribution. In addition, we performed meristic counts on a reference specimen collected dead at another power station in Israel to supplement species identification using the abovementioned techniques. Our findings indicate size-based sex segregation of adult female dusky and male sandbar sharks (Carcharhinus obscurus and Carcharhinus plumbeus, respectively), with each species comprising two COI haplotypes. In the dusky shark, one haplotype corresponded to an Indo-Pacific lineage, and the other matched an Atlantic lineage. In the sandbar shark, we observed a haplotype previously sampled in the Mediterranean Sea, the Red Sea, the Northwest Indian Ocean, and South Africa, and another haplotype that was unique to our study site and genetically closer to the former than to sequences sampled in other ocean basins. This study provides the first indication of sympatric aggregation amongst phylogeographically distinct dusky and sandbar shark lineages, suggesting that human-altered habitats in the eastern Mediterranean Sea may influence the distribution of these species. Based on the observed segregation pattern, we conclude that the site does not function as a nursery, parturition, or mating area, and discuss other plausible explanations that warrant further research. Finally, we highlight important directions for future research and the implications of our findings for management and conservation.

Introduction: In this case study, we present the “Ballerina” sign as a potentially valuable clinical indicator for detecting posterior capsular rupture (PCR) during cataract surgery. The purpose of this study is to highlight the significance of PCR in the context of cataract surgery and introduce this novel sign. Case Presentation: During the cataract operation on a 70-year-old patient, we observed a spiraling fragment of the nucleus attached to a vitreous string. Subsequently, an anterior vitrectomy was successfully performed without further intraoperative complications, followed by the insertion of a 3-piece lens into the sulcus. Positive visual outcomes were observed during postoperative follow-up appointments at 1 day, 2 weeks, and 3 months. Conclusion: The documentation of the “Ballerina” sign in the medical literature is innovative, offering ophthalmic surgeons a valuable tool for early PCR detection during cataract surgeries.

Abstract Background Behavioral or mental health disorders are common in children, adolescents, and young adults. Medication use is increasingly common, with few data describing drug-drug combinations in ambulatory settings. The objectives of this study were to describe the pharmaco-epidemiology of behavioral and mental health (BMH) medications among children, adolescents, and young adults in New York Medicaid and assess the prevalence of contraindicated drug pairs within this population. Methods This observational cross-sectional study evaluated New York State Medicaid managed care and fee-for-service enrollees under 21 years of age dispensed BMH medications in 2014. Main outcomes included number of members with prescriptions filled; number filling > 1 medication prescription concurrently for ≥ 30 days (polypharmacy), and number and nature of potentially contraindicated drug pairs. Results Of 2,430,434 children, adolescents, and young adults, 422,486 (17.4%) had a visit associated with a BMH diagnosis and 141,363 (5.8%) received one or more BMH medications. With 84 distinct medications evaluated, polypharmacy was common, experienced by 53,388 individuals (37.8% of those with a prescription filled), generating 11,115 distinct drug combinations. 392 individuals filled prescriptions for a contraindicated pair of ≥ 2 BMH medications for 30 days or longer. With ≥ 1 day overlap, 651 were exposed to contraindicated medications. The most common contraindicated pairs increased potential risk for prolonged QT interval and serotonin syndrome (n = 378 and n = 250 patients, respectively). Most combinations involved ziprasidone (3247.1 per 10,000 ziprasidone prescriptions filled). Conclusions With nearly 6% of members dispensed a BMH medication, contraindicated drug pairs were uncommon. However, any of those combinations represent a potential risk. Clinicians should attend to the balance of potential risks and benefits before contraindicated pairs are dispensed. The methodology described could serve as a basis for monitoring such rare instances and might reduce harm.

Abstract Objective A comparison between commercial computer screens and DICOM-calibrated medical screens for characterizing anatomy and diagnosing dental pathologies was performed. The aim of this study was to evaluate and compare the ability of each of those screens to identify root apices and widening of the periodontal ligament (PDL) in the posterior maxillary area. Materials and Methods Digital X-ray images of 53 maxillary molar teeth were examined by means of a commercial computer screen and again two months later with a DICOM screen to compare their ability to help identify and diagnose PDL widening and to locate the root apices of those teeth. Results The DICOM screen had a significantly better ability to identify widened PDLs (from 31.4% to 34.8% of the cases compared to 19% to 26.1% for the commercial screens, P

This study examines the role of adolescents-parents/teachers/peers relationships as explanatory variables of cyberbullying and problematic Internet-use (PIU) pre-and during COVID-19 pandemic. Questionnaires were delivered to 348 adolescents ages 13 to 18 years (M = 15.05) at two time-points, provided a rare opportunity for assessment the pandemic effect. A significant increase was found in Internet-usage and PIU from pre-pandemic to during the pandemic-lockdown, although no change was found in cyber-perpetrating/victimization, but a decrease in cyber-witnessing. An increase was found in adolescents-teachers/peers relationships, while adolescent-parent relationships remained unchanged and strong. Intensive Internet-use was a positive explanatory variable for stronger teachers/peers relationships. When adolescent-peer relationships were stronger, the cyber-perpetrating/victimization were lower. Also, reinforcements in adolescents-teachers relationships during the lockdown may have influenced the decrease in cyberbullying.