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Md Shahadat Hossain,1,&ast; Sapia Akter,1,&ast; Mustafa Amimul Ehsan Siddique,2 Md Kaoser Bin Siddique,3 G M Reza,1 Foisal Mohammad Mosiul Alom,4 Mohammad Ali,5 Md. Obayadur Rahman Noman,6 M Mazibar Rahman,2 Md. Shofiqul Islam,6 K M Amran Hossain7,&ast; 1Bangladesh Institute of Manual Therapy & Research, Dhaka, Bangladesh; 2Department of Statistics, Jahangirnagar University, Dhaka, Bangladesh; 3Department of Research, Planning & Development, Grand Health Sector, TMSS, Bogura, Bangladesh; 4Department of Physiotherapy, National Institute of Traumatology & Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh; 5Department of Physiotherapy and Rehabilitation, Uttara Adhunik Medical College and Hospital, Dhaka, Bangladesh; 6Department of Physiotherapy, Bangladesh Health Professions Institute (BHPI), Dhaka, Bangladesh; 7Department of Physiotherapy & Rehabilitation, Jashore University of Science & Technology (JUST), Jashore, Bangladesh&ast;These authors contributed equally to this workCorrespondence: K M Amran Hossain, Department of Physiotherapy & Rehabilitation, Jashore University of Science & Technology (JUST), Jashore, 7408, Bangladesh, Tel +8801735661492, Email kma.hossain@just.edu.bdBackground: The study aimed to determine the outcome of Multidisciplinary physiotherapist-led conservative treatment of lumbar disc herniation at an in-patient set-up of a specialized spine center in Dhaka, Bangladesh.Methods: This was a retrospective cross-sectional study of 228 cases completing treatment and follow-up sessions. The outcome was evaluated as pain at rest and five different functional positions, neurological recovery, and Magnetic resonance imaging (MRI) changes during discharge and follow-up.Results: 80.3% had a complete recovery with a typical motor and sensory status, no limitations in straight leg raise (SLR), no cauda equina symptom (CES), and no or < 3 pain during more than 30 minutes of daily living activities. Statistically significant changes were noted at all outcome measures at the follow-up (day 90), compared to baseline (day 1) P< 0.01. In the posthoc tests, pain, SLR, and CES had the most significant improvement at discharge (day 12) compared to the baseline (P < 0.01) and at follow-up compared to discharge (P < 0.01). No major adverse events noted.Conclusion: Physiotherapist-led in-patient treatment results in significant resting and functional pain outcomes in 12 days. Also, the improvements in neurological recovery and normalizing disc position are statistically significant in 90 days.Keywords: lumbar disc herniation, multidisciplinary, conservative treatment, physiotherapy

The influence of CD4(+) T cell nadirs on human immunodeficiency virus (HIV)-specific immune responses in subjects with apparently normal CD4(+) T cell counts is not known. We evaluated the frequency of HIV-1-specific immune responses in a cohort of patients with complete viral suppression (HIV-1 RNA load, <50 copies/mL) who were receiving highly active antiretroviral therapy and had a wide range of CD4(+) T cell nadirs. We found positive associations between CD4(+) T cell nadirs and the magnitude of HIV-specific CD8(+) T cell responses (P=.02) and of T cell helper responses (P=.04). These data show the CD4(+) T cell nadir to be an independent predictor of HIV-specific CD4(+) and CD8(+) T cell responses in HIV-1-infected subjects with optimal suppression of viremia. Copyright © 2006 Infectious Diseases Society of America [ABSTRACT FROM AUTHOR]

Aim: Obesity is a major risk factor for diabetic peripheral neuropathy (DPN) in type 2 diabetes (T2D). This study investigated the effect of glucose lowering medication associated with weight change on DPN., Methods: Participants with T2D were grouped based on whether their glucose lowering medications were associated with weight gain (WG) or weight loss (WL). They underwent clinical, metabolic testing and assessment of neuropathic symptoms, vibration perception threshold (VPT), sudomotor function and corneal confocal microscopy (CCM) at baseline and follow-up between 4 and 7 years., Results: Of 76 participants, 69.7% were on glucose lowering medication associated with WG, and 30.3% were on glucose lowering medication associated with WL. At baseline, participants in the WG group had a significantly longer duration of diabetes (p < .01), higher douleur neuropathique en 4 (DN4) score (p < .0001) and VPT (p = .01) compared with those in the WL group. Over a 56-month period, participants in the WG group showed no significant change in body weight (p = .11), HbA1c (p = .18), triglycerides (p = .42), DN4 (p = .11), VPT (p = .15) or Sudoscan (p = .43), but showed a decline in corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD) and corneal nerve fiber length (CNFL) (p < .0001). Participants in the WL group showed a reduction in weight (p = .01) and triglycerides (p < .05), no change in DN4 (p = .30), VPT (p = .31) or Sudoscan (p = .17) and a decline in the corneal nerve branch density (p < .01)., Conclusions: Participants treated with glucose lowering medication associated with weight gain had worse neuropathy and greater loss of corneal nerves during follow-up, compared to patients treated with medication associated with weight loss., (© 2024 The Author(s). Journal of the Peripheral Nervous System published by Wiley Periodicals LLC on behalf of Peripheral Nerve Society.)

Food contamination by heavy metals is a concerning issue worldwide. The presence of elevated levels of heavy metals in commonly consumed rice has emerged as a critical issue in ensuring food safety. This research encompassed the collection of 44 rice samples, representing seven distinct varieties, through a randomized sampling approach across various retail markets within Dhaka city. The investigation of heavy metal content (including Cr, Mn, Fe, Co, Ni, Cu, Zn, As, Cd, Hg, and Pb) within the rice samples was carried out employing Inductively Coupled Plasma Mass Spectrometry (ICP-MS). The findings disclosed substantial disparities in heavy metal concentrations among the different rice varieties. Notably, the concentrations of Cr (0.99 mg/kg), Fe (8.35 mg/kg), Pb (0.49 mg/kg), and Co (0.02 mg/kg) were observed to exceed the established maximum permissible limits. This contamination of the rice varieties may stem from either natural processes or human activities. Utilizing these metal concentrations, this study employed Monte-Carlo simulation to calculate health risk and probabilistic health risk. The Target Hazard Quotients (THQs) for Cr, Fe, and As exceeded the threshold of 1 in each rice variety, particularly in Amon and Lal Biroi in Mymensingh, Najirshail in Bogra, 28 in Sherpur and Kushtia, Miniket in Bogra and Rajshahi, and lastly, paijam in Rangpur and Tangail. Furthermore, the Hazard Index (HI) exceeded 1 in all rice varieties, implying that the consumption of these selected rice grains may have a substantial impact on overall food quality and its potential health consequences. Both carcinogenic risk and probabilistic risk for As, Ni, Cd, Cr, and Pb were found to surpass the threshold levels and safe limits, respectively. This suggests that individuals who have regularly consumed these rice varieties may face a heightened probability of developing cancer in the future, as predicted. According to sensitivity analysis, metal concentration and food ingestion rate (FIR) are the most relevant components that contribute to the significant impact of carcinogenic health hazards. Finally, the study concluded that heavy metal intake from food poses a risk to human health, necessitating the effective monitoring based on each geographic location and identify the source of this heavy metal to limit its exposure., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Arsenic (As) contamination in groundwater is emerging as a significant global concern, posing serious risks to the safety of drinking water and public health. To understand the release mechanisms, mobilization processes, spatial distribution, and probabilistic health risks of As in western Bangladesh, forty-seven samples were collected and analyzed using an atomic absorption spectrometer (AAS). The As concentrations in groundwater ranged from 1.97 to 697.4 μg L⁻ 1 (mean: 229.9), significantly exceeding recommended levels. The dominant hydrochemistry of As-enriched groundwater was Ca-Mg-HCO₃, with the primary sources of arsenic in groundwater being the dissolution of arsenic-bearing minerals in sediment and the recharge of aquifers from the Ganges River Basin. The assessment using the Entropy Water Quality Index revealed that the groundwater is unsuitable for drinking, with 89.36% (n = 42) of the samples surpassing the WHO's limit for arsenic. Rock-water interactions, including calcite dissolution and silicate weathering within the confined aquifer, predominantly influenced hydrochemical properties. The significant relationships among Fe, Mn, and As indicate that the reductive dissolution of FeOOH and/or MnOOH considerably contributes to the release of As from sediment into groundwater. Geochemical modeling analysis revealed that siderite and rhodochrosite precipitate into aquifer solids, suggesting a weak to moderate relationship among As, Fe, and Mn. The long residence time of groundwater, combined with the presence of a clayey aquitard, likely controls the mobilization of arsenic in the aquifer. For the first time, Monte Carlo simulations have been used in arsenic-prone areas to assess the severity of arsenic contamination in western Bangladesh. The analysis indicates that out of 100,000 people, 10 may develop cancer as a result of drinking arsenic-contaminated water, with children being more susceptible than adults., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: The American Society of Anesthesiologists (ASA) classifications allow physicians to briefly assess a patient's risk for general anesthesia and surgical intervention. Although simple to calculate, a patient's ASA score may correlate with differences in outcomes following spinal operations. The purpose of this study is to establish the effect of ASA score on Patient-Reported Outcomes Measurement Information System (PROMIS) outcomes following Lateral Lumbar Interbody Fusion (LLIF)., Methods: All patient data was collected from a single spinal surgeon database. Patients were separated into cohorts of "Lower ASA" (ASA < 3) and "Higher ASA" (ASA ≥ 3). Demographics, perioperative characteristics, preoperative Patient-Reported Outcomes (PROs), and postoperative PROs at 6 weeks and final postoperative time points were compared statistically. These included Visual Analog Scales for back and leg pain (VAS-B, VAS-L), the Oswestry Disability Index (ODI), the 9-item Patient Health Questionnaire (PHQ-9), and PROMIS measures for Physical Function (PROMIS-PF), Sleep Disturbance (PROMIS-SD), Anxiety (PROMIS-A), and Pain Interference (PROMIS-PI). PRO improvements between preoperative and postoperative time points and Minimum Clinically Important Difference (MCID) were also compared., Results: In total, 154 patients were included (111 and 43 in the Lower and Higher ASA cohorts, respectively). Patient age, body mass index (BMI), presence of diabetes, and Charlson Comorbidity Index (CCI) score were significantly different between the two cohorts (Table 1, p < 0.004 for all). Primary vs. non-primary surgery, number of spinal levels fused, postoperative length of stay, and rates of isthmic spondylolisthesis and foraminal stenosis also significantly differed (Table 2, p < 0.05 for all). Patients with a higher ASA score were found to have higher PROMIS-A preoperatively (Table 3, p = 0.029). These patients also had higher PROMIS-A and PROMIS-PI at final postoperative evaluation (p values of 0.007 and 0.047, respectively). Score changes over time and MCID achievement did not seem to be impacted by baseline ASA score., Conclusions: Patients with a higher preoperative ASA score were found to have worse anxiety pre-operatively and worse anxiety and pain interference at the final postoperative evaluation. Clinical improvement over time was not significantly affected by the ASA score., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Artificial intelligence (AI) is increasingly being applied to wastewater treatment to enhance efficiency, improve processes, and optimize resource utilization. This review focuses on objectives, advantages, outputs, and major findings of various AI models in the three key aspects: the prediction of removal efficiency for both organic and inorganic pollutants, real-time monitoring of essential water quality parameters (such as pH, COD, BOD, turbidity, TDS, and conductivity), and fault detection in the processes and equipment integral to wastewater treatment. The prediction accuracy ( R 2 value) of AI technologies for pollutant removal has been reported to vary between 0.64 and 1.00. A critical aspect explored in this review is the cost-effectiveness of implementing AI systems in wastewater treatment. Numerous countries and municipalities are actively engaging in pilot projects and demonstrations to assess the feasibility and effectiveness of AI applications in wastewater treatment. Notably, the review highlights successful outcomes from these initiatives across diverse geographical contexts, showcasing the adaptability and positive impact of AI in revolutionizing wastewater treatment on a global scale. Further, insights on the ethical considerations and potential future directions for the use of AI in wastewater treatment plants have also been provided., Competing Interests: The authors declare there is no conflict., (© 2024 The Authors This is an Open Access article distributed under the terms of the Creative Commons Attribution Licence (CC BY-NC-ND 4.0), which permits copying and redistribution for non-commercial purposes with no derivatives, provided the original work is properly cited (http://creativecommons.org/licenses/by-nc-nd/4.0/).)

Microbubble contrast agents in ultrasound/echocardiography are used to increase the echogenicity of the target tissues, thereby raising the contrast resolution of the resultant image. Recently, the trend has shifted toward the development of phase-convertible nanodroplets as ultrasound contrast agents due to their promising theragnostic potential by switching capability at the active site. Herein, we fabricated pre-PGS- perfluoropentane phase convertible nanodroplets and checked their in vitro and in vivo enhancement and safety profile. For this, we performed experiments on 20 male Wistar rats and 2 dogs. Biochemical assays of both rats and dogs included complete blood profiles, liver function tests, and renal function tests. For rat vitals, monitoring and histopathological analysis were also performed. Converted nanodroplets showed excellent contrast enhancement, better than Sonovue upon in vitro testing, with an enhancement time of up to 14 min. In vivo, experiments showed comparable opacification of the ventricles of both rats and dogs. All biochemical assays remained within the normal range during the study period. The histopathological analysis did not show any signs of drug-induced toxicity, showing the safety of these nanodroplets. Pre-PGS-PFP nanodroplets hold great potential for use in echocardiography and abdominal imaging in both human and veterinary applications after clinical trials., (© 2024. The Author(s).)

Introduction: This study was undertaken to investigate whether sustained rather than a single measure of corneal nerve loss was associated with the onset of diabetic peripheral neuropathy (DPN) and the progression of neuropathic symptoms and deficits in individuals with type 2 diabetes (T2D)., Methods: Participants underwent clinical, metabolic testing and assessment of neuropathic symptoms, vibration perception threshold (VPT), sudomotor function, and corneal confocal microscopy (CCM) at baseline, 1, 2, and 4-7 years. Sustained corneal nerve loss was defined as abnormal corneal nerve fiber density (CNFD, <24 fibers/mm 2 ), corneal nerve branch density (CNBD, <21 branches/mm 2 ), and corneal nerve fiber length (CNFL, <16 mm/mm 2 ) persisting for ≥50% of the study duration., Results: A total of 107 participants with a mean duration of T2D of 13.3 ± 7.3 years, aged 54.8 ± 8.5 years, underwent baseline and follow-up assessments over a median duration of 4 years, ranging from 1 to 7 years. The DPN prevalence at baseline was 18/107 (16.8%), and of the 89 participants without DPN at baseline, 13 (14.6%) developed DPN during follow-up. Approximately half of the cohort had sustained corneal nerve damage, and corneal nerve measures were significantly lower in this group than those without sustained damage ( p  < 0.0001). Sustained corneal nerve damage was associated with the development of DPN ( p  < 0.0001), a progressive loss of vibration perception ( p  ≤ 0.05), an increased incidence of burning pain, numbness, or a combination of both ( p  = 0.01-0.001), and a borderline association with progressive sudomotor dysfunction ( p  = 0.07). Sustained abnormal CNFL effectively distinguished between participants who developed DPN and those who did not (AUC: 76.3, 95% CI: 65.9-86.8%, p  < 0.0001), while baseline and other sustained measures did not predict DPN onset., Conclusion: Sustained abnormal CCM is associated with more severe corneal nerve damage, DPN development, and the progression of neuropathic symptoms and deficits. Regular CCM monitoring may enable the identification of those at greater risk of developing and worsening DPN who may benefit from more aggressive risk factor reduction., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ponirakis, Al-Janahi, Elgassim, Homssi, Petropoulos, Gad, Khan, Zaghloul, Ali, Siddique, Mohamed, Ahmed, Dakroury, El Shewehy, Saeid, Mahjoub, Al-Thani, Ahmed, Hussein, Mahmoud, Hadid, Al Obaidan, Salivon, Mahfoud, Zirie, Al-Ansari, Atkin and Malik.)

Understanding the evolution of rural landscapes in metropolises during rapid urbanization is crucial for formulating policies to protect the rural ecological environment. In this study, remote sensing and geographical information system data, as well as applied landscape index analysis, are used to examine the spatiotemporal evolution of rural landscape patterns in the Beijing-Tianjin region of China, which has experienced rapid urbanization. The relationships between land use/land cover changes and changes in rural landscape patterns are explored. The results revealed significant spatial differences in the rural landscapes in the Beijing-Tianjin region; farmland and forestland were the main types of landscapes, creating a "mountain-field-sea" natural landscape pattern. The conversion of rural landscapes in the Beijing-Tianjin region involved mainly the conversion of farmland to urban areas, with few exchanges between other landscape types. The urban areas in the Beijing-Tianjin region increased by 3% per decade; farmland decreased at the same rate. Additionally, the rural landscape patterns in the Beijing-Tianjin region were dominated by fragmentation, dispersion, and heterogeneity and moved from complex to regular. Water bodies displayed the most fragmented natural landscape; their number of patches increased by 36%, though their network characteristics were maintained. Forestland was the most concentrated natural landscape. In this study, theoretical support and a scientific reference for the optimization of rural landscape patterns and the improvement in rural living environments in rapidly urbanizing areas are provided., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Xu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Blood-culture overutilization is associated with increased cost and excessive antimicrobial use. We implemented an intervention in the adult intensive care unit (ICU), combining education based on the DISTRIBUTE algorithm and restriction to infectious diseases and ICU providers. Our intervention led to reduced blood-culture utilization without affecting safety metrics.