Background: Injury is an important cause of mortality and morbidity.(1). FA is the immediate assistance provided to a suddenly injured or sick person until professional help arrives or that person has recovered.(2), could be a potential factor differentiating between life and death in RTA . Many lives would be saved if proper first aid is provided early. (3) In the middle east, there are limited studies that explore knowledge and practices towards first aid needed during RTA. Objective: The main aim of this study is to investigate the knowledge and attitude towards first aid among drivers in Sharjah. Methodology: A cross-sectional study was conducted through a self-administered questionnaire written in Arabic and English languages. Participants were 18 years or older holding a driving license in the city of Sharjah. Paramedics and certified participants with a certification from authorized organizations were excluded . A non-proportional convenient sampling method was used. A total of 343 participants have completed the questionnaires. Data was entered and analysed using SPSS. Results: Majority of the study participants were less than 40 years old and (56.76%) were males. Most participants(94.2%) indicated that they know the term ‘First Aid’. However, (49.73%) of the participants knew the ambulance number and (52.43%) of the participants indicated that the victim should be moved to the hospital without the ambulance. With regards to attitude, 34.86% were not willing to provide first aid in the case of RTA. The main reason was lack of knowledge followed by fear of legal consequences. Most participants (83,78%) were willing to participate in first aid classes to improve their knowledge and attitude. Conclusion: Most participants are aware of the basic term of first aid; however, they are not willing to provide first aid in cases of RTA due to lack of knowledge and fear of legal consequences. Based on these findings we recommend providing first aid classes for new drivers and to obtain certification. References: 1 and 3. Midani, O., Tillawi, T., Saqer, A., Hammami, M., Taifour, H. and Mohammad, H., 2020. Knowledge And Attitude Toward First Aid: A Cross-Sectional Study In The United Arab Emirates. 2.Van de Velde S, Heselmans A, Roex A, Vandekerckhove P, Ramaekers D, Aertgeerts B. Effectiveness of nonresuscitative first aid training in laypersons:A systematic review. Ann Emerg Med 2009;54:447-57, 457e1-5.

Plasmonic sensors exploiting the Localized Surface Plasmon Resonance (LSPR) of noble metal nanoparticles are common in the visual spectrum. However, for bio-sensors the near infra-red (NIR) windows (600 nm – 900 nm and 1000 nm -1400 nm) are of interest, as it is a region where the absorption coefficient of water, melaninm deoxy- and hemoglobin are all low. The first part of this paper reviews the work that has been undertaken on using gold (Au) and silver (Ag) particles in Metal Enhanced Fluorescence (MEF) in the NIR. Despite this success there are limitations, as there is only a narrow band in the visual and NIR where losses are low for traditional plasmonic materials. Further, noble metals are not compatible with standard silicon manufacturing processes, making it challenging to produce on-chip integrated plasmonic sensors with Au or Ag. Therefore, it is desirable to use different materials for plasmonic chemical and biological sensing, that are foundry-compatible with silicon (Si) and germanium (Ge). One material that has received significant attention is highly doped Ge which starts to exhibit metallic properties at a wavelength as short as 6 μm. This is discussed in the second part of the paper and the results of recent analysis are included.

Background/Objectives: Chemerin, which is a multifunctional cytokine and adipokine, has been implicated in inflammatory and metabolic processes and might play a role in upper gastrointes-tinal (GI) malignancies, particularly gastric and esophageal cancer. The aim of this review is to explore the role of chemerin in the pathophysiology of upper GI cancers, as well as its potential as a biomarker for early detection and as a therapeutic target. Methods: A comprehensive review of recent studies about chemerin's biochemical properties and interaction with its receptors, as well as its effects on inflammatory responses, immune regulation and metabolic processes was con-ducted. Clinical implications of chemerin on gastric and esophageal cancer were analyzed, whereas the potential therapeutic strategies targeting chemerin were discussed. Results: Elevated chemerin levels are associated with poor prognosis in gastric cancer and promote invasiveness and metastasis in esophageal cancer. Chemerin receptor antagonists show promising results in inhibiting cancer cell migration, invasion and progression. Conclusions: Chemerin could repre-sent a valuable prognostic biomarker and therapeutic target for upper GI cancers. Future observa-tional studies should validate its clinical applications and investigate the efficacy of chemerin in-hibitors as potential therapeutic targets.

The climate change constitutes nowadays an enormous global threat for human health and environmental sustainability. The expanding world population and the increased global needs for food production have an important negative impact upon environment. Diet can link human health with environmental sustainability. Food production systems are closely related to anthropogenic greenhouse gas emissions and the aggravation of climate change, and current western type, animal-based, dietary patterns may lead to adverse environmental footprints. In the present narrative review, we address the interconnection of the Mediterranean diet (MD) with climate change and sustainability. MD is a highly recommended dietary intervention for the prevention and management of various endocrine and cardiometabolic diseases. Beyond its evidence-based, health-promoting effects, it also has beneficial environmental impact, reducing greenhouse gas emissions and enhancing biodiversity, food security and sustainability. Based on the evidence reviewed herein, MD should be incorporated within the framework of a “One Health” model, which involves the improvement not only of human health but also of planetary health and food system sustainability. Our review aims to provide a stimulus for health pro-fessionals to strongly recommend the implementation of MD under the current pressure of climate change, despite all barriers, targeting both human health preservation and the planetary well-being.

Existing scales assessing family relations are usually quite long. Our aim was to develop and validate the Family Functioning and Cohesion Scale (FFCS), a self-reported short instrument consisting of 14 items. The validation of the FFCS was based on its administration through an online platform to 481 subjects living in 46 different countries around the world. Cronbach's alpha was 0.85 (ranging from 0.83 to 0.86 if any one item was deleted), signifying high internal consistency. The scale can be considered as a sole factor based on its high consistency, while factor analysis produced three factors corresponding to “communication”, “anger/resentment/aggression” and “values and beliefs”. Test-retest reliability correlation coefficient was found to be 0.88 at a 2-week interval. As far as external validity is concerned, the correlation coefficient of the FFCS with the General Functioning subscale of the McMaster Family Assessment Device (FAD) was 0.83. The high measures of consistency, reliability, and validity of the FFCS, combined with its short length, make it an invaluable tool for use in research as well as in any professional dealing with families in the clinical fields of psychiatry, psychology, social work or any other relevant specialty.

Background: Diagnostic accuracy of Parkinson’s disease (PD), a synucleinopathy, based on diagnostic criteria is suboptimal. A biomarker for synucleinopathies is pivotal both from a clinical and from a research aspect. CSF a-synuclein has been extensively studied over the past two decades as a candidate biomarker of synucleinopathies. Herein we present data on studies focusing on total, phosphorylated and oligomeric CSF a-synuclein in PD. Methods: Pubmed, Scopus and Web of Science were searched for studies with >10 PD patients and control subjects, with data (mean, SD) on total, phosphorylated or oligomeric a-synuclein. Cohen’s d, as a measure of effect size, was calculated for all a-synuclein forms. Subgroup analysis and meta-regression were performed in an effort to explain between-study heterogeneity. Results: Thirty studies on total, six studies on oligomeric and one study on phosphorylated a-synuclein were included. Total a-synuclein was decreased and oligomeric a-synuclein increased in PD patients vs. controls. Effect size was medium for total and high for oligomeric a-synuclein. A-syn forms provided suboptimal combined sensitivity/specificity for the differentiation of PD from controls. There was significant between-study heterogeneity. PD cohort characteristics (sex, age, disease duration, UPDRS, H&Y) and study characteristics (study design, healthy vs. neurological controls, control for CSF blood contamination, method of a-syn measurement) could not account for between-study heterogeneity. Publication bias was limited. Conclusions: CSF a-synuclein levels lack sufficient accuracy to be used as biomarkers for PD. Standardization of (pre)analytical variables may improve the discriminatory power of a-synuclein forms in the future.

Background: The popularity of climbing via ferratas (VF) in the European Alps has increased a lot. We have analysed the pattern of injuries from accidents, which have occurred on VF, and First Aid (FA) knowledge from the persons on such alpine routes. The aim was to create specific FA courses for those who climb VF. Material and Methods: Incidences and FA knowledge of the alpinists were investigated by a questionnaire. Data included details of the individual’s alpine experience, accidents or any kind of medical emergency they have ever experienced. FA knowledge was evaluated by 18 multiple choice questions with 5 answers each. The questionnaire was based on those of previous studies but was slightly adopted for VF. For this data from rescue operations on VF were used. Finally every participant was asked to judge his FA knowledge by a Likert scale (1 to 5). Results: The collective consisted of 391 participants (28.4% women) with an average age of 41 years. A significant portion did no regular fitness training and in most cases the last FA training was years ago. Nobody had joined a specific FA course for climbers or mountaineers. The most common causes of emergencies were: weather conditions (19%), stumble (18.6%), falls (13.4%), and weariness and deficiency in concentration (13.4%). FA questions most often answered correctly were cardiac emergencies (49.6%), high altitude cerebral edema (HACE) (43.2%), snow blindness (40.9%), injuries of the head (37.1%) and hemorrhagic shock (35.3%). Those most often wrong were injuries of the back (1.0%), injuries of the thorax (2.8%), frostbite (9.0%), acute mountain sickness (AMS) (4.1%) and strategy of rescue (4.1%). VF climbers show significant less FA knowledge than mountaineers in the Western Alps and trekkers. Conclusions: Data support the need of a specific FA training for VF climbers. Their FA knowledge does not fit with the demands in the mountains while some other knowledge they have is negligible on VFs (e.g. HACE). This is in accordance with earlier studies in “classic” alpine mountaineering and in trekking.

Although the jellyfish species that inhabit the Mediterranean coastal waters are not lethal, their sting can cause severe pain and systemic effects that pose a health risk to humans. Despite the frequent occurrence of jellyfish stings, currently no consensus exists regarding the most appropriate first aid protocol among the scientific community. Over the years, several different rinse solutions have been proposed of which vinegar, or acetic acid, is one of the most noticeable as a rinse solution with efficacy data published. We investigated the effect of vinegar and seawater on the nematocyst discharge process in species representative of the Mediterranean region such as Pelagia noctiluca (Scyphozoa) and Carybdea marsupialis (Cubozoa) by means of: (1) direct observation on the nematocyst discharge by light microscope (Tentacle solution assay) and (2) the quantification of hemolytic area (Tentacle skin blood agarose assay). The nematocyst discharge of both species was not stimulated by seawater, and it was classified as a neutral solution. In P. noctiluca, vinegar produced nematocyst discharge per ser while inhibiting the nematocyst discharge of C. marsupilais. These results suggest that the use of vinegar cannot be universally recommended. While in case of a cubozoan C. marsupialis sting, the inhibitory effect of vinegar makes it the best rinse solution par excellence, in case of a scyphozoan P. noctiluca sting, its application can be counterproductive, worsening the pain and discomfort of the stung area.

Signal approximation, is the basic idea of signal processing and mathematical analysis where complex signals can be represented with simpler ones. This paper explores unifying two mathematical fundamentals, Dirichlet-type problems, and hyperbolic series identities, into signal approximation. In this paper, we address a well-known classic topic in mathematical analysis - the Dirichlet problem - to improve (the approximation of) signal using Fourier series. We also discuss using hyperbolic series representations to increase signal modeling flexibility. In this way, we hope to create new links that span some distance along this dimension and result in a somewhat theoretical view of signal behavior - present with the mathematical rigor needed for speculation but absent from an understanding capable of appropriately handling real-world complexity. This paper provides a theoretical investigation of the mechanics at play and reveals by analogy how these mathematical tools can potentially advance signal processing techniques and understanding. This paper illustrates Fourier series and fuzzy logic methods by two case studies on signal processing, satellite communication and financial risk measurement. The first case study performs signal approximation using the Fourier series and hyperbolic function identities to provide insight into how signals behave and are modeled. The second case study deals with applying fuzzy logic for risk evaluation of investment portfolios, emphasizing the utility in evasion systems solving uncertainty and imprecision problems related to financial decisions.

The aim of the present study was to predict the response of non-small cell lung cancer (NSCLC) patients to immune checkpoint inhibitors (ICIs) by leveraging computed tomography (CT) images using deep learning techniques. Retrospectively, 624 sequential CT images were gathered from 156 patients at Jiangsu Province Hospital, along with their clinical data. The dataset was subsequently partitioned into three groups: training (n=547), validation (n=64), and test (n=64). Moreover, an external validation cohort included 37 CT images from patients at Nanjing Pukou Peoples' Hospital, accompanied by comprehensive clinical data. An advanced Video Vision Transformer (ViViT) model incorporating global self-attention was utilized to analyse patients treated with ICIs and predict their response. The ViViT model's efficacy was evaluated using a confusion matrix and a receiver operating characteristic curve (ROC). Notably, the ViViT model demonstrated predictive prowess for ICIs response, yielding respective areas under the receiver operating characteristic curve (AUC) of 0.74 (95% CI: 0.69-0.78), 0.74 (95% CI: 0.61-0.86), 0.76 (95% CI: 0.62-0.88), and 0.69 (95% CI: 0.5-0.87) in the training, validation, test, and external validation cohorts. The present study illustrates how a deep learning model can provide a non-invasive means to predict clinical outcomes in NSCLC patients undergoing ICIs, potentially transforming personalized treatment approaches for individuals with NSCLC.

Background. A direct clinical and morphological comparison of non-COVID myocarditis than was diagnosed before the SARS-CoV-2 pandemic and post-COVID myocarditis has not been performed so far. Purpose: to compare morphological activity, toll-like receptors expression and response to the immunosuppressive therapy in patients with non-COVID and post-COVID myocarditis. Metodhs. Seventy-seven patients (52 male and 25 female, 48.7±11.7 y.o.) with biopsy proven myocarditis, NYHA class 2 or more heart failure, ejection fraction (EF) <45% were included. A history of myocardial infarction, verified cardiomyopathies, systemic autoimmune diseases, viral DNA in the myocardium, except parvovirus B19, were exclusion criteria. The right ventricular endomyocardial biopsy with hematoxylin and eosin, Van Gieson stains, PCR for virus (herpes viruses, parvovirus B19, adeno-, enteroviruses and SARS-CoV-2), immunohistochemical study for CD3, CD45, CD68, CD20, nucleocapsid / spike proteins of SARS-CoV-2 and in addition toll-like receptors (TLR) type 4 and 9 expression (in 38 patients) were performed. The steroids (methylprednisolone 24-40 mg per day), azathioprine, mycophenolate mofetil were prescribed. The mean follow-up was 16 [6; 30] month. Results. In 45 patients, myocarditis was diagnosed before the SARS-CoV-2 pandemic (giant-cell in one case and lymphocytic in the others). Other 32 patients had post-COVID myocarditis positive for RNA or/and proteins of SARS-CoV-2 (giant-cell in one case, eosinophilic in three cases and lymphocytic in the others). There were no differences in age, NYHA class, CRP and anti-heart antibodies level, echocardiographic parameters (mean EF 30.2±7.8 vs 28.7±6.7%), parvovirus B19 positivity (22 vs 34%), doses of methylprednisolone (24-40 mg/day) and death / transplantation rate (11.1 vs 9.4%). Differences between non-COVID vs post-COVID myocarditis focused on higher CD3, CD 45*, TLR 4 (4+ vs 6+), TLR 9 (0 vs 2+) expression and better response to therapy [10% or more increase in EF in 53 vs 86%* of patients, mean EF (43.9±12.3 vs 49.8±7.6%*) by the end of follow-up], *p<0.05. Conclusion. Post-COVID myocarditis is characterised by different morphological types, higher morphological activity, tendency to higher TLR expression and the best response to the immunosupressive therapy in comparison with non-COVID myocarditis.

Multiple sclerosis (MS) is an immune-mediated disease characterized by inflammation, demyelination, and neurodegeneration within the central nervous system. Brain plasticity, the brain's ability to adapt its structure and function, plays a crucial role in mitigating MS's impact. This paper explores the potential benefits of lifestyle changes and nutraceuticals on brain plasticity in MS population. Lifestyle modifications, including physical activity and dietary adjustments, can enhance brain plasticity by upregulating neurotrophic factors, promoting synaptogenesis, and reducing oxidative stress. Nutraceuticals, such as vitamin D, omega-3 fatty acids, and antioxidants like alpha-lipoic acid, have shown promise in supporting brain health through anti-inflammatory and neuroprotective mechanisms. Regular physical activity has been linked to increased levels of brain-derived neurotrophic factor and improved cognitive function. Dietary interventions, including caloric restriction and the intake of polyphenols, can also positively influence brain plasticity. Integrating these lifestyle changes and nutraceuticals into the management of MS could provide a complementary approach to traditional therapies, potentially improving neurological outcomes and enhancing the quality of life for MS population.

Pulmonary arterial hypertension (PAH) is a chronic disease characterized by a progressive in-crease in mean pulmonary arterial pressure. Mutations in the BMPR2 and AQP1 genes have been described in familial PAH. The bone morphogenetic proteins BMP9 and BMP10 bind with high affinity to BMPR2. Administration of BMP9 has been proposed as a potential therapeutic strategy against PAH, although recent conflicting evidence dispute the effect of such practice. Considering the involvement of the above molecules in PAH onset, progression, and therapeutic value, we ex-amined the effects of modulation of BMP9, BMPR2, and AQP1 on BMP9, BMP10, BMPR2, AQP1, and TGFB1 expression in human pulmonary microvascular endothelial cells in vitro. Our results demonstrated that silencing the BMPR2 gene resulted in increased expression of its two main ligands, namely BMP9 and BMP10. Exogenous administration of BMP9 caused return of BMP10 to basal levels, while restored the decreased AQP1 protein levels and the decreased TGFB1 mRNA and protein expression levels caused by BMPR2 silencing. Moreover, AQP1 gene silencing also resulted in increased expression of BMP9 and BMP10. Our results might possibly imply that the effect of exogenously administered BMP9 on molecules participating in the BMP-signaling pathway could depend on the expression levels of BMPR2. Taken together, these results may pro-vide insight into the highly complex interactions of the BMP-signaling pathway.

MicroRNAs (miRNAs), particularly miR-16 and miR-21, play a crucial role in mul-tiple myeloma (MM) pathogenesis by regulating gene expression. This study evalu-ated the prognostic significance of circulating miR-16 and miR-21 expression levels in 48 patients with MM at diagnosis treated with lenalidomide/dexamethasone (LD) compared with 15 healthy individuals (HI). All patients were treated with LD, 13 at first line and 35 at relapse, of whom 21 were tested twice at diagnosis and before LD initiation. The results revealed significantly lower levels of miR-16 and miR-21 in patients than in HIs, both at diagnosis and relapse, with decreased miR-16 levels at diagnosis, indicating improved overall survival (OS) (p value 0.024). Furthermore, miR-16 and miR-21 levels were associated with disease markers, while both corre-lated with the depth of response and mir-16 with sustained response to LD treatment. The ratios of both miR-16 and miR-21 expression levels (prior to LD treat-ment/diagnosis) below 2 predicted a shorter time to response (P = 0.027) and a longer time to next treatment (P = 0.042), respectively. These findings suggested a prognostic value for serum miR-16 and miR-21 levels in MM, as their expression levels corre-lated with disease variables and treatment outcomes.

Choking and foreign body aspiration are significant causes of mortality and morbidity in young youngsters. This study aimed to investigate the effects of education programs on school students ' knowledge, attitude, and practice towards a choking person. This quasi-experimental study with a pretest-posttest control group design included a total of 282 school students. The students were divided into an intervention group (n = 141) and a control group (n = 141). After both groups completed the pretest, the intervention group received an education program on first aid for a choking person. Then, both groups were subjected to a posttest at the end of the program. The descriptive and inferential statistics analyzed the data. There were no significant differences between the two groups within the study parameters at the pretest (P = > 0.05). However, at posttest, a significant difference was observed in the knowledge (p = 0.001), attitude (p = 0.024), and practice (p = 0.001) of the intervention group compared to the control group. The intervention group showed significant improvement in the students’ knowledge, attitudes, and practices regarding first aid for a choking person. We suggest a continuous training program to improve the competency of first aid for a choking person.

Anemonia viridis is an abundant and widely-distributed temperate sea anemone that can form dense congregations of individuals. Despite the potential severity of its sting, few detailed cases have been reported. We report a case of a severe toxic reaction following an A. viridis sting in a 35-year-old oceanographer. She developed severe pain, itching, redness and burning sensation, which worsened one week after treatment with anti-inflammatories, antihistamines and corticosteroids. Prompted by this event, and due to the insufficient risk prevention, lack of training for marine-environment users and lack of research into sting-specific first-aid protocols, we evaluated the cnidocyst response to five different compounds commonly recommended as rinse solutions in first-aid protocols (seawater, vinegar, ammonia, baking soda and freshwater) by means of the Tentacle Solution Assay. Vinegar and ammonia triggered an immediate and massive cnidocyst discharge after their application and were classified as activator solutions. Baking soda and freshwater were also classified as activator solutions, although with a lower intensity of discharge. Only seawater was classified as a neutral solution and therefore recommended as a rinse solution after A. viridis sting, at least until an inhibitory solution is discovered.

Supported wellbeing centres were set up in UK hospital trusts as an early intervention aimed at mitigating the psychological impact of COVID-19 on healthcare workers. These provided high quality rest spaces with peer-to-peer psychological support provided by National Health Service (NHS) staff volunteers called ‘wellbeing buddies’, trained in psychological first aid. The aim of the study was to explore the views of centre visitors and operational staff towards this COVID-19 workforce wellbeing provision. Qualitative semi-structured interviews were undertaken with twenty-four (20F, 4M) employees from an acute hospital trust in the UK. Interviews were digitally recorded and transcribed, data were handled and analysed using thematic analysis. Interviews generated 3 over-arching themes, and 13 sub-themes covering ‘exposure and job roles’, ‘emotional impacts of COVID-19 and ‘the wellbeing centres’. Supported wellbeing centres were viewed as critical for the wellbeing of hospital employees during the first surge of COVID-19 in the UK. Wellbeing initiatives require managerial advocacy and must be inclusive. Job-related barriers to work breaks and accessing staff wellbeing provisions should be addressed. High quality rest spaces and access to peer-to-peer support are seen to benefit individuals, teams, organisations and care quality. Training NHS staff in psychological first aid is a useful approach to supporting the wellbeing of the NHS workforce during and beyond the COVID-19 pandemic.

Background: There is lack of data on types of community first aids use and treatment given post injuries from many low-middle income countries, including India. Materials and Methods: A cross-sectional study was conducted among children up-to 18 years of age, in Ujjain district, India to understand types of first aid given and health seeking post injury. Results: A total of 1087 injuries, in 1049 children were identified in last one year, 729 (67%) received, first aid and 758 (72%) sought some healthcare. Children with burns received most (86%) first aid, while most children (84%) with road traffic accidents (RTA) sought health care. Most children (52%) sought healthcare from a private health set-up; most (65%) being transported within the golden hour; motorbikes being the most preferred (50%) mode of transport. Only 1% injured used ambulance services. Commonly reported first aid included: use of coconut oil on wounds from falls (38%) and burns (44%); antiseptic cream on wounds from RTA (31%), turmeric in falls (16%), and rubbing of metal on a bitten site (47%). Potentially harmful substances applied included lime, toothpaste, clay and mud. Conclusion: In most injuries, appropriate locally available substances, were used by the community. Our findings will help design community interventions to increase appropriate first aid in childhood injuries.

Sick sinus syndrome (SSS) is a disease of sinus rhythm abnormalities. This study aimed to establish an SSS model by injecting 3% NaOH into the jugular vein(JV). Sprague-Dawley rats were randomly divided into sham, 3% NaOH, and 10% NaOH groups. Anesthetized rats underwent electrocardiogram recording before right JV exposure. Rats in the experimental groups received NaOH injections at 0.01 ml/s, while the sham group did not. Model success was evaluated after one hour. Heart rate(HR) and rhythm were documented at 1 hour, 1 week, and 2 weeks post-molding, including HE staining, membrane ion transcription and expression, and calcium ion content test. In the 3% NaOH group, the model establishment rate was 87%, and the mortality rate was 13%, whereas in the 10% NaOH group, they were 57% and 43% respectively (P < 0.01). The HR of the 3% NaOH group decreased at multiple time points post-molding (P < 0.001), presenting as arrhythmias such as sinus bradycardia. The JV sustained less damage, with necrosis of P cells, changes in membrane ion channels, and reduced calcium ion distribution. In conclusion, JV injection of 3% NaOH can establish the SSS model and benefit animals.

Individuals have different rumination patterns after experiencing traumatic events in different cultural backgrounds and situations. This study was aimed to explore the experience of Chinese young and middle-aged patients with acute coronary syndrome (ACS) to understand the content and nature of their rumination. Fourteen participants were selected using the purposive sampling method in XXX hospital from May 2023 to December 2023. Data were collected using semi-structured interviews and analyzed using Colaizzi’ s 7-step phenomenological method. The content of rumination in young and middle-aged patients with ACS can be summarized into 2 categories: non-adaptive rumination and adaptive rumination. Non-adaptive rumination included 3 themes: worry or anxiety, scare, and depression. Adaptive rumination included 4 themes: tracing of disease processes, enhancement of disease cognition, improvement of health awareness, and adjustment of lifestyle cognition. In conclusion, although Chinese young and middle-aged patients with ACS experience negative emotions after a traumatic cardiac event, they gradually make positive changes, and optimism and information support play important roles in this transition, which provide a fundamental understanding of rumination experiences in Chinese young and middle-aged patients with ACS and provide new data for healthcare providers when designing intervention programs to enhance post-traumatic growth in these patients.

Related studies have shown that mitophagy plays a role in the progression of Atherosclerosis (AS). Utilizing GSE43292, GSE100927, and GSE159677 datasets, WGCNA and differential expression analysis identified mitophagy-related module genes and DEGs1, while single-cell analysis screened DEGs2. MR analysis revealed causal AS-linked genes in DEGs1. LASSO and expression validation identified biomarkers, evaluated via ROC curves. Further analyses included GSEA, immune infiltration, ANN, regulatory networks, and drug prediction. Four candidate genes were identified through WGCNA, differential expression analysis and MR analysis. The LASSO analysis identified CD36, IL1RN, and MME as biomarkers, while the MR analysis showed that IL1RN and MME are protective factors and CD36 is a risk factor in AS. The ROC curves disclosed that the ANN model had greater diagnostic power for AS than any other biomarker. The GSEA revealed that the biomarkers were enriched in lysosomes and hematopoietic cell lineage and were significantly positively correlated with monocytes. The regulatory network construct showed that small nucleolar RNA host gene 16 regulates MME via the micro RNAs. This study identified CD36, IL1RN, and MME as biomarkers of mitophagy in AS and indicated that they could be applied in the diagnosis and treatment of this condition.

The COVID-19 pandemic, like previous major crises, such as the 2008 financial crisis, has had a severe negative impact on international trade flows. International institutions are now exploring ways to help their member states recover from the health crisis, and foster the resilience of their economies to future crises. As far as trade is concerned, institutions that deal primarily with trade matters are making effort to help their member states foster the resilience of their trade performance to future shocks. In this context, the World Trade Organization (WTO), which is the only international organization that deals with the global rules of trade between nations, has organized a series of events since the onset of the COVID-19 pandemic. It has now planned to hold in September 2021 the 2021 WTO Public Forum whose theme is "Trade Beyond COVID-19: Building Resilience". The present paper aims to contribute to this debate by examining the effect of development aid, i.e., the so-called official development aid, in particular its Aid for Trade (AfT) component, on export resilience. The resilience of exports refers to the capacity of countries' aggregate exports to resist to shocks, whether environmental or external shocks. The core argument of the analysis is that development aid would affect export resilience through its effect on productive capacities. The analysis covers 93 developing countries over the period 2002-2018. The findings indicate that total development aid flows, including both AfT flows and NonAfT flows exert a positive effect on export resilience. Among AfT components, AfT for productive capacities appears to exert a higher positive effect on export resilience than AfT for economic infrastructure and AfT for trade policy and regulation. In addition, development aid (whatever the aid variable considered) exerts the highest positive effect on export resilience in countries (such as Least developed countries - LDCs) that have the lowest level of productive capacities. These findings highlight the need for donor-countries to supply higher development aid flows, in particular AfT flows to countries such as LDCs that have low levels of productive capacities.

Biological nanoparticles (NPs), such as extracellular vesicles (EVs), exosome-mimetic nanovesicles (EMNVs) and nanoghosts (NGs), are perspective non-viral delivery vehicles for all types of therapeutic cargo. Biological NPs are renowned for their exceptional biocompatibility and safety, alongside their ease of functionalization, but a significant challenge arises when attempting to load therapeutic payloads, such as nucleic acids (NAs). One effective strategy involves fusing biological NPs with liposomes loaded with NAs, resulting in hybrid carriers that offer the benefits of both biological NPs and the capacity for high cargo loads. Despite their unique parameters, one of the major issues of virtually any nanoformulation is the ability to escape degradation in the compartment of endosomes and lysosomes which determines the overall efficiency of nanotherapeutics. In this study, we fabricated all major types of biological and hybrid NPs and studied their response to acidic environment observed in endolysosomal compartment. In this study, we show that EMNVs display increased protonation and swelling relative to EVs and NGs in an acidic environment. Furthermore, the hybrid NPs exhibit an even greater response compared to EMNVs. Short-term incubation of EMNVs in acidic pH corresponding to late endosomes and lysosomes again induces protonation and swelling, whereas hybrid NPs are ruptured, resulting in the decline of their quantities. Our findings demonstrate that in an acidic environment, there is enhanced rupture and release of vesicular cargo observed in hybrid EMNVs that are fused with liposomes compared to EMNVs alone. This was confirmed through PAGE electrophoresis analysis of mCherry protein loaded into nanoparticles. In vitro analysis of NPs colocalization with lysosomes in HepG2 cells demonstrated that EMNVs mostly avoid endolysosomal compartment whereas hybrid NPs escape it over time. To conclude, (1) hybrid biological NPs fused with liposomes appear more efficient in the endolysosomal escape via the mechanism of proton sponge associated with scavenging of protons by NPs, influx of counterions and water, and rupture of endo/lysosomes, but (2) EMNVs are much more efficient than hybrid NPs in actually avoiding endolysosomal compartment in human cells. These results reveal biochemical differences across four major types of biological and hybrid NPs, and indicate that EMNVs are more efficient in escaping or avoiding endolysosomal compartment.

Background/Objectives Gastroparesis, a chronic digestive disorder characterized by delayed gastric emptying, often results from diabetes, post-surgical complications, autoimmune diseases, and neurological disorders. In approximately 50% of cases, the cause is idiopathic gastroparesis (IGD). Recent studies suggest a link between chronic enteroviral infections and persistent gas-trointestinal symptoms, including delayed gastric emptying. This study investigates the effects of a silydianin-rich extract from Silybum marianum seeds on enteroviral infections in vitro and the mitigation of delayed gastric emptying in mice. Silydianin, a key bioactive compound known for its liver-protective and antioxidant properties, has not been extensively studied for its impact on enteroviral infections and gastroparesis; Methods NMR spectroscopy (¹H, ¹³C, and DEPT) identi-fied silydianin as the primary compound, with minor flavonolignans and trace amounts of an oxidation product. The study assessed the cytotoxicity and antiviral activity of the extract at various stages of the viral life cycle, including virucidal activity, cell protection, and post-infection effects, using neutral red assays in RD cells, with results confirmed by real-time PCR. The viruses studied included Coxsackievirus B2, Coxsackievirus A10, Poliovirus SL-1, and Enterovirus EV71. The impact on delayed gastric emptying was evaluated in a mouse model of gastroparesis using doses of 100 and 200 mg/kg compared to a control; Results: The silydianin-rich extract exhibited con-sistent antiviral activity, with the highest selectivity index (SI) for EV71 (4.08) during virucidal activity. It provided moderate cell protection, with EC50 values ranging from 120.88 to 186.10 µg/mL and SI values from 2.20 to 3.39. Post-infection treatment showed varying efficacy, with Coxsackie A10 demonstrating the highest SI (3.90). In vivo, the extract at 200 mg/kg significantly improved gastric emptying to 96.47% and slightly increased gastrointestinal transit from 50.33% to 61.46%; Conclusions These results suggest that silydianin may be effective in treating enteroviral infections and enhancing intestinal function, making it a promising candidate for gastroparesis treatment and warranting further research.

The past few decades have brought tremendous insight into the molecular and pathophysiological mechanisms responsible for thrombus generation. For the clinician it is usually sufficient to explain the incident deep vein thrombosis (DVT) with provoking factors such as trauma with vascular injury, immobilization, hormonal factors, or inherited or acquired coagulation defects. About half of the DVTs are, however, lacking such triggers and are called unprovoked. Venous stasis and hypoxia at the valve sinus level may start a chain of reactions. In order to better understand the mechanisms behind DVT and reach beyond the above-mentioned simplifications animal models and clinical epidemiological studies have informed of the complex interplay between leukocytes, platelets, endothelium, cytokines, complements and coagulation factors and inhibitors. These pathways and the interplay will be reviewed here.

Infection with human immunodeficiency virus (HIV) and induced acquired immune deficiency syndrome (AIDS) represent one of the greatest health burdens worldwide. The complex pathophysiological pathways that link highly active antiretroviral therapy (HAART) and HIV infection per se with dyslipidemia make the management of lipid disorders and the subsequent increase in cardiovascular risk essential for the treatment of people living with HIV (PLHIV). Amongst the HAART regimens, darunavir and atazanavir in terms of protease inhibitors, tenofovir disoproxil fumarate, nevirapine or rilpivirine in terms of nucleoside reverse transcriptase inhibitors and non-nucleoside reverse transcriptase inhibitors respectively, and especially integrase inhibitors, have demonstrated the most favorable lipid profile emerging as sustainable options in HAART substitution. To this day, statins remain the cornerstone pharmacotherapy for dyslipidemia in PLHIV, although important drug-drug interactions with different HAART agents should be taken into account upon treatment initiation. For those intolerant or not meeting therapeutic goals, the addition of ezetimibe, PCSK9, bempedoic acid, fibrates or fish oils should also be considered. This review summarizes the current literature on the multifactorial etiology and intricate pathophysiology of hyperlipidemia in PLHIV, with an emphasis on the role of different HAART agents, while also providing valuable insights into potential switching strategies and therapeutic options.

Postprandial plasma glucose between 4 and 7.9 hours is associated with the diagnosis of diabetes, diabetes mortality, and cardiovascular mortality. However, it is unknown whether 2-hour plasma glucose during the oral glucose tolerance test conducted in this postprandial period (4–7.9 hours), termed as 2-h PGOGTT@4–7.9h, can accurately classify diabetes diagnosis and predict mortality risks. This study aimed to address these questions using 2,347 adult participants. Diabetes was defined as HbA1c ≥6.5%, and the ability of 2-h PGOGTT@4–7.9h to classify diabetes was analyzed using receiver operating characteristic curves. Cox proportional hazards models were employed to estimate mortality hazard ratios (HRs) and 95% confidence intervals (CIs). The results showed that 2-h PGOGTT@4–7.9h could classify diabetes with 92% accuracy. Participants were followed up for a mean of 21.4 years. A 1-natural-log higher 2-h PGOGTT@4–7.9h was associated with an increased risk of mortality from diabetes (adjusted HR, 21.1; 95% CI, 9.2–48.0) and cardiovascular disease (adjusted HR, 1.47; 95% CI, 1.13–1.91). Simulation analysis indicated that future studies may require at least 100 participants to investigate 2-h PGOGTT@4–7.9h for diabetes diagnosis. In conclusion, 2-h PGOGTT@4–7.9h may be useful for diabetes classification and prediction of mortality risk.

Loneliness is becoming prevalent across Japan in spite of its a dense population and communal culture. Surveys show 40% of adults report isolation across demographics. The contradiction emerges due to deteriorating social structure with modernization, economic parity, urbanization, and fading conventional setup. The continually social withdrawals, called “hikikomori." Relief seekers have embraced AI based emotive robots, digital avatars, and immersive VR as low-stakes social surrogates despite limited capacity to cultivate human intimacy. To stabilise government attempts awareness through reforms, scheme and support services. But a concrete transformation can be brough in with work-life balance, gender equality and rewire the metrics for self-esteem. Even a perfectly personalized AI cannot replace the human affection lacking in the society. Lasting solutions demand technological aids be balanced by confronting and reinventing community purpose and bring in structural change. Overall Japan’s endemic isolation reveals the societal fraying when modernization privileges independence over interdependence. The path forward rests on restoring cultural foundations to reverse loneliness and social isolation.

Abstract: Background/Objectives: There are indications that the microbial composition of the maternal mucosal surfaces is associated with adverse events during pregnancy. The aim of this review is to investigate the link between vaginal microbiome alterations and gestational com-plications risk. Methods: This comprehensive literature review was performed using Medline and Scopus databases. The following search algorithm was used "Pregnancy Complications"[Mesh] AND (Vagin*) and after literature screening 44 studies were included in the final review. Results: The studies that were included investigated the association between vaginal microbial composi-tion and preterm birth, miscarriage, preeclampsia, ectopic pregnancy, gestational diabetes mellitus, chorioamnionitis and preterm premature rupture of membranes. In most of the studies, it was well established that increased microbial diversity is associated with these conditions. Also, the depletion of Lactobacillus species is linked to most of the gestational complication, while the increased relative abundance and especially L. crispatus may exerts a protective effect in favor of the pregnant woman. Several pathogenic taxa including Gardnerella, Prevotella, Sneathia, Bac-terial Vaginosis-Associated Bacteria-2, Atopobium and Megasphera seem to be correlated to higher maternal morbidity. Conclusions: Vaginal microbiome aberrations seem to have an as-sociation with pregnancy related adverse events, but more high-quality homogenous studies are necessary to reliably verify this link.

Contemporary financial systems, despite their inherent complexity and resilience, face significant challenges related to transparency, efficiency, and security. Notable deficiencies in transparency and emerging security vulnerabilities underscore the pressing need for innovative solutions in current financial practices. Hence, this paper introduces a financial distribution system based on a consortium blockchain. Given organizations’ preference for keeping sensitive data private, the partially decentralized nature of consortium blockchains plays a pivotal role in the proposed system’s architecture. Moreover, within this system, the proposed smart contract serves a dual role. It functions not only as a transactional tool but also as a specialized solution designed to improve transactional procedures. Its multifaceted capabilities include ensuring data accuracy, facilitating swift execution, and ensuring adherence to regulatory requirements within the dynamic financial distribution landscape. Through rigorous testing and empirical analysis utilizing the Hyperledger Besu platform, it has been observed that the performance of the proposed system surpasses traditional blockchain frameworks. The results unequivocally demonstrate the proposed system’s proficiency in handling high-frequency financial transactions with minimal computational burden.

In this paper we consider constructions of first derivative approximations using the generating function. The weights of the approximations contain the powers of a parameter whose modulus is less than one. The values of the initial weights are determined, and the convergence and order of the approximations are proved. The paper discusses applications of approximations of first derivative for numerical solution of ordinary and partial differential equations and proposes an algorithm for fast computation of the numerical solution. Proofs of the convergence and accuracy of the numerical solutions are presented and the performance of the numerical methods considered is compared with the Euler method. The main goal of constructing approximations for integer-order derivatives of this type is their application in deriving high-order approximations for fractional derivatives, whose weights have specific properties. The paper proposes the construction of an approximation for the fractional derivative and its application for numerically solving fractional differential equations. The theoretical results for the accuracy and order of the numerical methods are confirmed by the experimental results presented in the paper.

Microbicides, topical antiseptic agents, and a revolutionary advance in HIV prevention aim to prevent the entry of infectious agents into the human body, thus stopping the sexual transmission of HIV and other sexually transmitted diseases. Microbicides represent the promise of a new age in preventive measures against one of the world's most pressing health challenges. In addition to their direct antiviral effects during HIV transmission, microbicides also influence vaginal mucosal immunity. This article reviews microbicides by presenting different drug classifications and highlighting significant representatives from each group. It also explains their mechanisms of action and presents information about vaginal mucosal immune responses, emphasizing the critical role they play in responding to HIV during sexual transmission. For each chemical compound, the article provides a brief overview of relevant preclinical and clinical research, emphasizing their potential as microbicides.The article offers insights into the multifaceted impact of microbicides, which signify a pivotal step forward in the pursuit of effective and accessible pre-exposure prophylaxis (PrEP).

Diabetes is one of the metabolic syndromes that demands the great concern affecting millions of people all over the world. Viral infections were also considered as responsible for diabetes. Though, variety of medications for prevention and treatment of diabetes are available, numerous limitations are also prevailing that cannot be neglected. Precise drug-targetability, controlled drug-release, oral bioavailability, minimizing side effects are a few to consider. To address most of these shortcomings of traditional drug-delivery models, nanoformulation has been employed therein a wide range of nanoformulation models are developed. The pharmacology of a drug can be greatly enhanced through nanoformulation models in diabetes treatment in terms of enhanced bioavailability, prolonged and sustained drug-lease, maintain maximum drug concentration in serum, higher intestinal absorption, and protection from enzymatic degradation. In this review work, recently designed nanoformulation models for efficient insulin delivery and the other properties concerning diabetes such as reducing blood glucose level, total cholesterol, triglycerides, lipid profile, wound healing, elevating antioxidant enzymes etc. are discussed. Classification of the nanoformulation models is done based on the nature of the fabricating material employed in nanoformulation. This review may be helpful in designing a more efficient nanoformulation model for diabetes treatment.

In everyday life, the birth of a number of blind people takes place and millions of people are already available. Visually impaired people struggle to walk safely and in- dependently because they have trouble detecting obstacles. In this work, we suggest a novel approach to detecting obstacles utilizing an Arduino UNO board and an ul- trasonic sensor (HC-SR04). The main goal of this research is to increase the mobility and security of blind people in a variety of settings. The suggested system makes use of the HC-SR04 ultrasonic sensor’s capability to precisely measure distance and identify nearby obstructions. As the main processor component, the Arduino UNO board processes algorithms for real-time obstacle detection while also collecting data from the sensor. The device is intended to give the visually impaired user immedi- ate aural input while informing them of the location and proximity of obstacles. To Extensive testing is done in controlled and real-world settings to assess the system’s performance and dependability. In the studies, the effectiveness of obstacle detec- tion, the system’s response time, and its practicality and usefulness for blind people are all measured. The findings show that the suggested obstacle detection method provides very accurate obstacle identification at a safe distance. Users who are blind or visually handicapped may successfully understand their surroundings thanks to the aural feedback system, which helps them to navigate by making judgments that are well-informed. Additionally, the system responds quickly, guaranteeing that the user receives real-time obstacle updates to increase safety and confidence while mov- ing. The study’s conclusions demonstrate the possibility of using the Arduino UNO board with the HC-SR04 ultrasonic sensor as a practical and affordable approach for detecting obstacles.

Background/Objectives: Multisystem Inflammatory Syndrome in children (MIS-C) is a rare but severe post-infectious complication of COVID-19, that often requires admission to the Pediatric Intensive Care Unit (PICU). The present study aimed to compare the demographic, clinical and laboratory characteristics between children diagnosed with MIS-C who were admitted to the PICU or did not require PICU admission. Methods: Children diagnosed with MIS-C from September 2020 to April 2023 were included in this case-control study. Patient’s demographic, clinical and laboratory data, were collected from medical records. Results: Fifty children with MIS-C were included in the study [median (IQR) age: 7.5 (4.3, 11.4) years, 28/50 (56%) males]. Twenty-two (22/50, 44%) children required admission to the PICU. In the multivariate regression analysis, hepatic (OR:12.89, 95%CI: 1.35-123.41, p-value=0.03) and cardiological involvement (OR:34.55, 95%CI: 2.2-541.91, p-value=0.01) were significantly associated with hospitalization at the PICU. Regarding the laboratory and imaging parameters during the first 48 hours from admission, D-dimer levels higher than 4μg/mL and decreased Left Ventricular Ejection Fraction were associated with an increased risk of PICU admission (OR:7.95, 95%CI:1.48-42.78, p-value=0.02 and OR=1.28, 95%CI:1.07-1.53, p-value=0.01). Children who were admitted to the PICU were more likely to develop complications during their hospitalization (10/22, 45.5% vs. 3/28, 10.7%, p-value=0.005) and were hospitalized for more days, than children in the pediatric wards (median length of stay (IQR): 20 (15,28) days vs. 8.5 (6, 14) days, p-value&lt;0.001). Conclusions: In the present study, cardiovascular, hepatic involvement and increased D-dimer levels in children with MIS-C were associated with admission to the PICU.

(1) Background: Impaired colonic motility is common in patients with ulcerative colitis. The patients often complain the symptoms related to colonic motility dysfunction such as loose stools or diarrhea and these symptoms make therapy more challenging; (2) Methods: This study aimed to examine the movement of the colon in mice with ulcerative colitis and determine if the glial-derived neurotrophic factor (GDNF) may enhance aberrant colonic motility through Connexin 43 (Cx43).A model of ulcerative colitis was created using 32 male C57BL/6 mice. Colonic transit time was measured in all mice, and colon tissues were examined using hematoxylin-eosin staining (HE) and transmission electron microscopy (TEM). The levels of GDNF and Cx43 were determined via immunohistochemistry, immunofluorescence, and RT-PCR techniques. The levels of C-reactive protein (CRP),TNF-α, IL-1β, and IL-6 were quantified using the enzyme-linked immunosorbent assay (ELISA); (3) Results: 1) The UC models were effectively established by administering dextran sodium sulfate (DSS) water. Mice with ulcerative colitis exhibited a delay in colonic transit time. 2) GDNF can improve the delayed movement of the colon in mice with UC by activating the Cx43 protein; (4) Conclusions: GDNF can ameliorate impaired colonic motility in mice with ulcerative colitis, and its mechanism is related to the activity of Cx43. GDNF could potentially be utilized as a therapeutic option for addressing aberrant colonic motility in patients.

Extreme heat is a climate, public health, and environmental justice issue. This case study examined public transit exposure and vulnerability to extreme heat by investigating the microenvironment, land cover characteristics, and social vulnerability of heat-vulnerable bus stops in Knoxville, Tennessee. The community’s temperature and Heat Index information, bus stop point data, land cover characteristics data, and the microenvironment of bus stops (i.e., trees and shelters) were processed and mapped with ArcGIS Pro. The pictures of the microenvironment of the bus stop were collected from Google Maps, and the social vulnerability of the area where the bus stops are located was investigated by analyzing the Center for Disease and Prevention's Social Vulnerability Index. Results found that the most heat-vulnerable bus stops were concentrated in West Knoxville, South, North, Northeast, and Northwest Knoxville. In addition, the most heat-vulnerable bus stops were concentrated in commercial complexes and areas a large number of systematically marginalized populations reside.

Background: Colorectal cancer is a major global health burden, with surgical resection being the standard treatment aimed at curative tumor removal. Oxidative stress plays a crucial role in colorectal cancer progression and prognosis. This study hypothesized that physical removal of colorectal cancer, a primary source of oxidative stress, would reduce blood levels of reactive oxygen metabolite derivatives (d-ROMs), a marker of oxidative stress, and biologic antioxidant potential (BAP) levels, a marker of antioxidant potential. Methods: The study included 123 patients who underwent radical resection for colorectal cancer. d-ROM and BAP levels were measured before and one month after surgery. Results: The clinicopathological analysis showed a correlation between preoperative d-ROM levels and tumor size (p&lt;0.001). The study confirmed a significant reduction in d-ROM levels following tumor resection, indicating reduced systemic oxidative stress. The reduction was significant in stages II and III but not in stage I. The d-ROM ratio before and after tumor resection was significantly higher in cases with positive lymph node metastasis and larger tumor size. BAP levels showed no significant changes post-surgery. Conclusion: These results suggest that d-ROMs could serve as a valuable biomarker for monitoring tumor burden and surgical efficacy in patients with colorectal cancer.

T-cell redirecting therapies, which include chimeric antigen receptor T-cells (CAR-T) and bispecific antibodies (BSAs), have revolutionized the treatment of relapsed\refractory large B-cell lymphoma (LBCL). Expanding clinical experience with these advanced therapies shows the potential for optimization of their use with combination or consolidation strategies, which necessitates prognostic stratification of patients. While traditional clinical prognostic factors identified in the era of chemotherapy are characterized by limited value, the tumor microenvironment (TME) is becoming a new prognostic cluster. We examine how the heterogeneity of LBCL, characterized by variations in tumor parameters and differences in TME immune cell composition, immune checkpoint expression, and cytokine milieu, correlates with both positive responses and resistance to treatment. While classical parameters such as histological subtype, cell of origin, and target antigen expression lack proven prognostic value for T-cell redirecting therapies, the density and functional state of tumor-infiltrating lymphocytes, tumor-associated macrophages, and immune checkpoint molecules are shown to be critical determinants of therapeutic success, particularly in CAR-T therapy. We identify several gaps in current knowledge and suggest that insights gained from CAR-T experience could be instrumental in refining BSA applications. This report also highlights limitations in current knowledge, as TME data derive from a limited number of registrational trials with varying methodologies, complicating cross-study comparisons and often focusing on immediate response metrics rather than long-term outcomes. By dissecting the complex interactions within the TME, this review aims to identify new prognostic factors and targets, ultimately fostering more effective and tailored treatment strategies for LBCL patients.

Endothelin-1 (ET-1) is a potent vasoconstrictor produced by endothelial cells and cleared from circulating blood mainly in the pulmonary vasculature. In a healthy pulmonary circulation, the rate of local production of ET-1 is less than its rate of clearance. In the present study we aimed to investigate whether abnormal pulmonary circulatory handling of ET-1 relates to poor clinical outcomes in patients with COVID-19-induced ARDS. Plasma ET-1 levels were measured in 18 mechanically ventilated COVID-19-induced ARDS patients, with simultaneous central venous and systemic arterial blood sampling on Days 1 and 3 following ICU admission. Two age- and sex-matched non-COVID-19 control groups were also used [mechanically ventilated non-COVID-19 critically ill and ARDS patients]. On ICU admission, COVID-19-induced ARDS patients had higher systemic arterial and venous ET-1 levels compared to non-COVID-19 ARDS and critically ill patients (p< 0.05). The arterial:venous (A:V) ET-1 ratio was higher in the non-COVID-19 ARDS patients [1.06 (0.93-1.20)] compared to the other two groups (p< 0.05). The A:V ratio was 0.63 (0.49-1.02) in the COVID-19-induced ARDS patients and 0.79 (0.52-1.11) in the non-COVID-19 critically ill patients. On Day 3, the A:V ratio in all three groups was < 1. The COVID-19 patient group was then divided based on 28-day ICU mortality. Although arterial and venous levels did not differ, the A:V ratio was statistically significantly higher on ICU admission in the non-survivors [0.95 (0.78-1.34)] vs 0.57 (0.48-0.92), p= 0.027]. Measurement of ET-1 clearance via A:V plasma ET-1 levels on ICU admission may assist in predicting outcomes in COVID-19 critically ill patients.

Pancreatic cancer is a serious and aggressive type of cancer that affects the digestive system and has a low chance of survival. Although traditional treatment methods have achieved some efficacy, the survival rate of patients remains low. Therefore, exploring novel treatment strategies is important. This article looks at the research done on bioactive compounds and plant extracts for treating pancreatic cancer. Bioactive compounds, such as naringenin and ziyuglycoside II, have significant anticancer activity and exert anti-pancreatic-cancer effects by inducing cell apoptosis, inhibiting the cell cycle, and blocking signaling pathways. Plant extracts, such as epigallocatechin-3-gallate and resveratrol, also demonstrate good anti-pancreatic cancer activity and inhibit tumor growth and metastasis. Additionally, the combined application of bioactive compounds and plant extracts may result in improved therapeutic effects. This article aims to provide a theoretical basis for the application of bioactive compounds and plant extracts in the treatment of pancreatic cancer and to help guide future medical research and practice.

Pediatric onset multiple sclerosis (POMS), characterized by the onset of multiple sclerosis before the age of 18, is gaining increased recognition. Approximately 5 percent of MS cases manifest before the age of 18, with less than 1 percent occurring before the age of 10. Despite its rarity, pediatric MS exhibits distinct characteristics, with an association between younger age at onset and a comparatively slower disease progression. Despite this slower progression, individuals with POMS historically reach disability milestones at earlier ages than those with adult-onset multiple sclerosis. While various immunomodulatory agents demonstrate significant benefits in MS treatment, such as reduced relapse rates and slower accumulation of brain lesions on magnetic resonance imaging (MRI), the majority of disease-modifying therapies (DMTs) commonly used in adult MS lack evaluation through pediatric clinical trials. Current evidence is predominantly derived from observational studies. This comprehensive review aims to consolidate existing knowledge on the mechanisms of action, efficacy, safety profiles, and recommended dosages of available DMTs specifically in the context of pediatric MS. Furthermore, the review outlines recent advancements and explores potential medications still in developmental stages, providing a thorough overview of the current landscape and future prospects for treating POMS.

Background: Good reduction of the articular surface and restoration of the congruent joint space are crucial for promoting positive outcomes in ankle fracture treatment. A good understanding of the mechanism of ankle fractures is indispensable to achieve these goals. Unfortunately, until now, the mechanism has still not been fully elucidated, particularly regarding the posterior malleolar fractures (PMFs). This study aims to provide insight into the mechanism of PMFs, thereby grasping the key to proceeding with PMFs reduction and fixation. Methods: An FE model of a normal ankle in tiptoe posture with 9 collateral ligaments was constructed from CT images. On the model, lateral malleolar fractures were made below, through, and above the syndesmosis; the medial malleolus was broken at its base; and ligaments were suppressed to simulate ligament rupture. A force of 1000 Newtons was applied on the talus head along talus axis. The posterior malleolar fragment (PMF) displacement, whether the talus impacts the posterior malleolus, and the initial mechanism displacing the PMF, were recorded. Results: A total of 15 tests were conducted. The tests, 'all collateral ligaments rupture', 'LMFB', 'LMFC+AITFL rupture', 'ATFL+CFL+PTFL rupture', 'ATTL+PTTL+TCL rupture', 'MMF', and 'MMF+AITFL rupture', presented significant PMF displacement. In tests 'MMF' and 'ATTL+PTTL+TCL rupture', the talus hit the medial edge of the PMF; but in tests 'ATFL+CFL+PTFL rupture' and 'all collateral ligaments rupture', the talus impacted the center part of the PMF. Except tests 'all collateral ligaments rupture' and 'ATFL+CFL+PTFL rupture', where PMF displacement was initially caused by talus impact, the other tests demonstrated PMF displaced following PITFL drag. Conclusions: This research discovered that rotation is the initial and major mechanism causing PMF displacement. The subsequent impact of the talus on the posterior malleolus may be the reason for large/blocky PMF. The talus impacting the posterior malleolus is always combined with talus rotation. Without the medial ankle structure being broken, big/blocky PMF may not occur. These findings suggest that, in clinical practice, reconstructing both the medial and lateral ankle structures is critical for achieving ankle stability, and this procedure even takes precedence over posterior malleolar fracture fixation itself.

By using the particle swarm optimization algorithm for crystal structure prediction, we reveal a newly orthorhombic Cmcm structure of HfB4, which is more energetically superior to the previously proposed YB4-, ReP4-, FeB4-, CrB4-, and MnB4-type structures in the considered pressure range. The phonon dispersion and elastic constants calculations confirm that the new phase is dynamically and mechanically stable. The calculated large shear modulus (240 GPa) and high hardness (45.7 GPa) imply that the predicted Cmcm-HfB4 is a potential superhard material. Meanwhile, the directional dependences of the Young's modulus, bulk modulus, and shear modulus for HfB4 are systematically investigated. Further analyses of the density of states and electronic localization function indicate that the strong B-B and B-Hf covalent bonds greatly contribute to its high hardness and stability.

Klebsiella pneumoniae (KP) is an important gram-negative zoonotic conditional pathogen. It can infect humans and a variety of farm animals, leading to infections such as pneumonia, meningitis and even sepsis. thereby posing a significant threat to public health. OmpX acts as a virulence protein that can participate in bacterial pathogenesis, mediates bacterial adhesion to and invasion of epithelial cells, and is involved in bacterial adaptation to the osmotic pressure of the external environment. In this study, MBs-SELEX was used as the main strategy for screening aptamers. Omp X was used as the target protein and Omp A as the counter-screening target. qPCR and flow cytometry were used to determine the nature and specificity of the obtained aptamers for the Omp X protein. The analysis showed that among the obtained aptamers, three aptamers, Apt-1, Apt-2 and Apt-3, were selected with Kd values of 62.50 nM, 22.05 nM and 7.9 nM, respectively. In addition, total internal reflection fluorescence microscopy (TIRFM) was used for the characterization of KP in complex with specific FITC-labeled aptamers (FITC-Apt-3) and AuNCs. The complexes were characterized by observing blue fluorescent dots from AuNCs and green fluorescent dots from FITC-labeled aptamers overlapping with bacterial presence. These results suggest that AuNCs and aptamers can specifically bind to target bacteria, forming complexes. Furthermore, in vitro results demonstrated that Apt-1, Apt-2 and Apt-3 inhibited bacterial growth, with Apt-3 having the most significant inhibitory effect. The results suggest that aptamers can selectively recognize membrane proteins, thereby disrupting bacterial cell membrane formation and effectively inhibiting bacterial growth. Aptamers have a potential mechanism to inhibit bacterial growth.

The study of localized surface plasmons (LSPs) in nanoscale structures is an essential step towards identifying optimal plasmonic modes that can facilitate robust optomechanical coupling and deepen our understanding of light-matter interactions at the nanoscale. This paper investigates numerically, using the finite element method, LSPs modes in a design comprising two coupled nano-ridges deposited on a gold layer, with an interposing polymer spacer layer. Such a structure, usually referred to as particles-on-mirror, shows exquisite optical properties at the nanoscale. We first examine the LSPs modes of a single nano-ridge through the analysis of its scattering cross-section in the visible and infrared range. To enhance the plasmonic response, a thin polymer layer is placed at the middle of the ridge, which introduces additional LSPs modes confined within the former. Then, we extend the analysis to the dimer configuration, which exhibits more complex and enhanced plasmonic behavior compared to a single nano-ridge. In particular, the dimer configuration yields LSPs resonances with a quality factor enhancement of approximately threefold relative to single nano-ridge. Furthermore, the presence of the polymer layer within the ridges significantly improves plasmon field localization and quality factor. These findings underscore the potential of nano-ridge-based structures in advancing optomechanical coupling and plasmon-phonon interaction studies, offering valuable insights for the development of high-performance acousto-plasmonic devices. In particular, the proposed device could help significantly improve the design of nano-acousto-optic modulators operating in the visible or in the near infrared, that require enhanced light-photon coupling rate.

Background: Despite tremendous advances in medicine, infective endocarditis (IE) continues to be a challenge for physicians due to increasing morbidity and unchanged high mortality. Objectives: Our aim was to evaluate clinical outcomes in patients with IE and to identify predictors of in-hospital mortality. Material and methods: The study was retrospective, single-centered, and included 270 patients diagnosed with IE, for the period 2005-2021 (median age 65 (51–74), man 177 (65.6%). Results: Native IE (NVIE) was found in 180 (66.7%), prosthetic IE (PVIE) in 88 (33.6%) and cardiac device-related IE (CDRIE) in 2 (0.7%), significantly more in the non-survivors group. Healthcare associated IE (HAIE) was 72 (26.7%), the most common pathogen were Staphylococci and the proportion of Gram-negative bacteria (GNB) non-HACEK were significantly higher in non-survivor’s vs survivors (11 (15%) vs 9 (4.5%), p=0.004). Overall, early surgery was performed in 54 (20%) patients, with a significant difference between deceased/alive (3 (4.5%) vs 51 (25.1%, p=0.000). The all-cause in-hospital mortality rate was 24.8% (67). The risk factors identified that increased the risk of death were septic shock (OR – 83 1; 95% CI (17.0-405.2), p=0.000) and acute heart failure (OR –24.6; 95% CI (9.2-65.0), p=0.000). Early surgery (OR – 0.03, 95% CI (0.01-0.16), p=0.000) and low Charlson comorbidity index (OR – 0.85, 95% CI (0.74-0.98, p=0.026) in turn reduce this risk. Conclusion: We found that acute heart failure and septic shock are independent predictors of in-hospital mortality. Low Charlson comorbidity index and early surgery increased survival. Knowing the predictors of death would change the therapeutic approach to a more aggressive one and improve the near and long-term prognosis of patients with IE.

Background: Infective endocarditis (IE) continues to be a disease with high mortality despite medical advances. Objective: To investigate the characteristics and prognosis of IE according to the affected valves. Material and methods: The study is retrospective, single-center, cross-sectional and includes 270 patients with diagnosis IE, for the period 2005 – 2021, who received treatment at the University Hospital "St. Georgi" in Plovdiv, Bulgaria. Results: Single-valve IE (SIE) was found in 82.6% (n-222), multivalvular IE (MIE) in 16.66% (n=45) and device IE (CDRIE) in 0.74% (n=2) patients. The most commonly affected valve was the aortic 44.8% (n=121). The predominant multivalvular involvement was aortic-mitral valves (AV-MV) – 13.7% (n=37). The patients with tricuspid valve (TV) IE were significantly younger – 39 (30) years and were more frequently male (80.8%). Mortality was higher in MIE than SIE (31.1% vs 23.8%) and highest in multivalve aortic-tricuspid (AV-TV) IE (75%). Early surgery was done most in AV-MV IE 29.7% (n=11). Charlson comorbidity index was significantly higher in MV 4 (4) and AV 3 (3) than TV IE 1 (5) (p=0.048 and p=0.011, respectively). Septic shock occurred most frequently in AV-TV involvement (75%; p=0.0001). The most common causative agent was Staphylococcus group. Staphylococcus aureus affected more often TV alone 46.2% (n=124) vs. AV 9.9% (n=14); p=0.0001 and vs. MV 22.6% (n=17), p=0.022; Staphylococcus coagulase-negative (CNG) was the prevalent cause of MV IE 22.7% (n=17) vs AV-MV 2.7% (n=1); p=0.007. Streptococci were represented in a low percentage and only in left-sided IE, and more frequently in AV-MV 18.9% (n=7); vs. AV 6.6% (n=8); (p=0.025). Conclusion: Aortic valve is the most frequently affected valve, as single valve IE or multivalve AV-MV, with the predominant causative agents Staphylococcus group. The AV-TV IE has the worst prognosis, with the most common complication of septic shock and the highest in-hospital mortality.

Aimed to obtain purple garlic varieties, 360 bolting bulbs from the Protected Geographical Indication (PGI) “Las Pedroñeras” were selected for their size, and the presence of abundant external scales. After a further selection, 243 out of the 360 bulbs were discarded due to undesired characteristics, as light purple color, high number of small cloves, cloves affected by Fusarium spp. and mites, among other. It was stablished that each bulb would give rise to a family. Thus, 117 families were planted under a random design during season 2021-2022. Either physiological, morphological and phenological traits were assessed for each family, and the affectations by pest and pathogens were also controlled. After the assessment of this trial, 103 out 117 families remained in the program, and were used for the establishment of a second trial the next season. Unlike the first trial, after the evaluations only 23 families remained in the program. There was observed a high variability for most of traits, with a great influence of families. The phenotypic behavior of families was significative influenced by environment, highlighting the need of their assessment under different environmental conditions. The high variability registered for the target sample, opens the possibility to select new garlic varieties from this PGI.

To achieve n-type doping in diamond, extensive investigations employing first principles have been conducted on various models of phosphorus doping and boron-phosphorus co-doping. The primary focus of this study is to comprehensively analyze the formation energy, band structure, density of states, and ionization energy of these structures. It is observed that within a diamond structure solely composed of phosphorus atoms, the formation energy of an individual carbon atom is excessively high. However, the substitution of two carbon atoms leads to the conversion of diamond into a p-type semiconductor. Upon examining the P-B co-doping structure, it is revealed that the doped impurities exhibit a tendency to form more stable cluster configurations. As the separation between the freely doped atoms and the cluster impurity structure increases, the overall stability of the structure diminishes, consequently resulting in an elevation of the ionization energy. Analysis of the electronic density of states demonstrates that the electron orbit of the B atom makes negligible contributions to the impurity levels during P-B doping.

Gastric cancer has become one of the most common cancers in the world.Immunotherapy, especially immune point inhibitors targeting programmed cell death 1 or its ligand PD-L1, has been successfully applied in the clinical treatment of GC. However, only a small number of cancer patients experience persistent clinical responses during immunotherapy. In this review, we discussed the current status of immunotherapy for colorectal cancer, elucidated the mechanisms mediating immunotherapy resistance, predicted biomarkers for immunotherapy resistance, and strategies for improving immunotherapy efficacy.

The quest for surgical advancements regarding the enhancement of the submental and cervicofacial regions has witnessed a remarkable upsurge in recent years. Informed patients are actively seeking sophisticated plastic surgery techniques to achieve comprehensive rejuvenation in these specific areas. Common complaints expressed by these patients include sagging of the jawline, the emergence of deep perioral wrinkles, and the formation of "marionette lines" within the lower third of the face. Furthermore, the manifestation of age-related signs, including neck laxity, submental adipose accumulation, "witch's chin" deformity, and weakened platysma musculature, are common within this anatomical region. This literature review aims to summarize the recent technical improvements, historical evolution, indications, postoperative care, and challenges for facial rejuvenation of the lower third of the face and neck. Lastly, the application of minimally invasive procedures as part of a comprehensive approach to an aging face will also be discussed.

Cuproptosis, a copper-dependent cellular death mechanism, is typically overlooked in glioblastoma diagnosis. Lipoylation is needed for cuproptosis, and FDX1 controls this process. Cuproptosis in prognostic models may drive cancer treatment. This study evaluated cuproptosis and glioblastoma cell proliferation. The Cancer Genome Atlas provided annotated clinical, genetic mutation, and RNA sequencing data for the TCGA_GBM and TCGA_LGG cohorts. Patients with gliomas were randomly allocated to the validation or training cohort. Least absolute shrinkage and selection operator (LASSO) and multivariate Cox regression models were utilized to evaluate which model best predicted prognosis in the training cohort. The models' independent predictive power was evaluated throughout the cohort. A previous study revealed 19 genes related to ferroptosis. LncRNAs associated with cuproptosis were identified by coexpression analysis. Cox discovered 17 cuproptosis-associated lncRNAs and established a predictive model. The median risk score classified patients as high- or low-risk. K‒M survival analysis demonstrated significant differences in overall survival among risk categories. Principal component analysis (PCA) and receiver operating characteristic (ROC) curve analysis were used to test the model’s predictive power. Univariate and multivariate Cox regression analyses revealed risk score-related independent prognostic factors. Multivariate Cox regression analysis was used to construct a nomogram for marker-based prognosis. The risk category affected the tumour mutation rate. High-risk glioma patients benefit from immunotherapy. Glioma drug sensitivity was also substantially linked with the risk score. The expression of 17 cuproptosis-related long noncoding RNAs (lncRNAs) may assist in the stratification of glioma patient prognosis, molecular characteristics, cell cycle gene regulation pathways, the TME, and clinicopathological aspects. Our clinical sample and database analysis revealed that cuproptosis influences glioma prognosis and may guide therapy.

Pancreatic cancer is one of the most fatal common cancers affecting both men and women, representing about 3 percent of all new cancer cases in the United States. In this study, we aimed to investigate the association of pancreatic cancer risk with alcohol consumption as well as folate intake. We performed a case-control study of 384 patients diagnosed with pancreatic cancer from May 2004 to December 2009 and 983 primary care healthy controls. Our findings showed no significant association between risk of pancreatic cancer and either overall alcohol consumption or type of alcohol consumed (drinks/day). Our study showed dietary folate intake was modestly but significantly inversely associated with pancreatic cancer (OR=0.99, P <.0001). The current study supports the hypothesis that pancreatic cancer risk is reduced with higher food-based folate intake.

Introduction: Patients with chronic lymphocytic leukemia (CLL) and multiple myeloma (MM) are susceptible to viral infections, including varicella-zoster virus (VZV) reactivation due to both disease-related and treatment-induced immunosuppression. The recombinant adjuvanted herpes zoster vaccine (RZV) has shown high efficacy in immunocompetent adults, but immunogenicity data in CLL and MM patients is limited. This study evaluates the immunogenicity and safety of RZV in this population. Methods: Patients with CLL and MM vaccinated with RZV (administered in two doses at least one month apart) were included in the study. Pre- and post-vaccination anti-VZV IgM and IgG antibody levels were measured to assess immunogenicity, and adverse events (AEs) were captured for safety evaluation. Results: Seventy-eight patients received both vaccine doses, and 71 had post-vaccination samples. Most of the patients were IgM seronegative and IgG seropositive before vaccination. Pre-vaccination IgG levels were higher in CLL compared to MM patients (p=0.001), while post-vaccination IgG levels significantly increased in both CLL (p<0.0001) and MM (p<0.0001) patients. In actively treated CLL patients, the pre-vaccination IgG levels were significantly lower than in not actively treated patients (p=0.002). Post-vaccination IgG levels were lower in MM patients receiving antiviral prophylaxis concurrently with the vaccination (p=0.013). AEs were reported in 49.4% after the first dose and 48.7% after the second dose, mostly mild (local or low-grade systemic). One case of immune thrombocytopenia was noted. Conclusion: RZV demonstrated strong immunogenicity and acceptable safety in CLL and MM patients, significantly boosting IgG levels, even in actively treated or heavily pretreated patients.

Polyphenols are the most prevalent naturally occurring phytochemicals in the human diet and range in complexity from simple molecules to high-molecular-weight polymers. They have a broad range of chemical structures and are generally categorized as "neuroprotective," "anti-inflammatory," and "antioxidant" given their main function of halting disease onset and promoting health. Research has shown that some polyphenols and their metabolites can penetrate the blood-brain barrier and hence increase neuroprotective signaling and neurohormonal effects to provide anti-inflammatory and antioxidant effects. Therefore, multi-targeted modulation of polyphenols may prevent the progression of neuropsychiatric disorders and provide a new practical therapeutic strategy for difficult-to-treat neuropsychiatric disorders. Therefore, multi-target modulation of polyphenols has the potential to prevent the progression of neuropsychiatric disorders and provide a new practical therapeutic strategy for such nervous system diseases. Herein, we review the therapeutic benefits of polyphenols on autism-spectrum disorders, anxiety disorders, depression, and sleep disorders, along with in vitro and ex vivo experimental and clinical trials. Although their methods of action are still under investigation, polyphenols are still seldom employed directly as therapeutic agents for nervous system disorders. Comprehensive mechanistic investigations and large-scale multicenter randomized controlled trials are required to properly evaluate the safety, effectiveness, and side effects of polyphenols.

Drone imagery has the potential to enrich urban planning and preservation, especially where it converges with the growing creation and use of 3D models. The authors have conducted a systematic literature review of articles published between 2002 and 2022, drawing from reputable academic repositories including Science Direct, Web of Science, and China National Knowledge Infrastructure (CNKI), to identify current gaps in existing research in the application of UAVs to the creation of 3D models in urban planning and preservation. Findings indicate five research shortcomings: limited participation of planning experts, research focus imbalance, lack of usage for special scenarios, lack of integration with smart city planning, and limited interdisciplinary collaboration. The study also acknowledges current limitations with UAV applications and discusses possible countermeasures as well as future prospects.

Approximately 20% of patients with colorectal cancer (CRC) are diagnosed with a mucinous subtype of this tumor, have a worse prognosis, and often show resistance to available therapies. Molecules from the mucin family are involved in the regulation of epithelial-mesenchymal transition (EMT), which significantly determines the cancer aggressiveness. This study aimed to examine the diagnostic and prognostic significance of mucinous histology and EMT markers in patients with early-onset CRC and their association with disease severity and tumor characteristics. The study included tumor tissue samples from 106 patients diagnosed with CRC before the age of 45, 53 with mucinous and 53 with non-mucinous tumors. The EMT status was determined by immunohistochemical analysis of E-cadherin and Vimentin in tissue sections. Mucinous tumors had a significantly higher cytoplasmic E-cadherin score (P=0.043), they were significantly less differentiated (P=0.007), more advanced (P=0.005), and predominately affected right colon (P=0.030) in comparison to non-mucinous tumors. Epithelial tumors were significantly better differentiated (P=0.034) and with less prominent tumor budding (P < 0.001) than mesenchymal tumors. The process of EMT appears to be more prominent in tumors of younger patients regardless of mucinous histology. EMT status may represent a useful prognostic tool in early-onset CRC.

Background and Objectives: The existing recommendations for female pelvic magnetic susceptibility weighted imaging MRI (FP-SWI) have not been optimized to capture the disease characteristics of the female pelvis. Therefore, it is imperative to explore acquisition parameters before conducting larger-scale studies. To establish optimized flip angle (FA) for acquiring FP-SWI to improve the image quality of female pelvic lesion sites. Materials and Methods: To evaluate signal quality and lesion conspicuity, regions of interest (ROIs) were manually drawn within the lesion on SWI sequences. Signal intensity was measured within the ROIs. Additionally, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated for SWI sequences acquired at three FA: 10°, 15°, and 20°. Finally, a qualitative assessment of anatomical detail visualization, geometric distortion extent, artifacts, and lesion clarity was performed using a four-point scale. The Wilcoxon rank sum test was employed to compare the qualitative evaluation parameters. The intra-class correlation coefficient (ICC) was calculated to determine the consistency of subjective ratings between two observers. Results: FA=10° showed significantly higher SNR than FA=15° and 20° in most anatomical regions (P&lt;0.05), while the CNR was significantly higher than FA=15° and 20° (P&lt;0.05). Compared with FA=15° and 20°, the image quality of FA=10° was significantly higher, with less distortion and ghosting, and better image contrast (P&lt;0.05). Lesions with FA=10° exhibited higher clarity compared to FA=15° and 20° (P&lt;0.05). Conclusions: The image quality of FP-SWI images at FA=10° exceeds that at FA=15° and 20°. We recommend that when conducting SWI examination of the female pelvic cavity, the FA value should be set at 10° to stabilize the SWI sequence and improve image quality.

The BL Lacertae (BL Lac) object OJ 287 underwent an intense X-ray activity phase, exhibiting its brightest recorded X-ray flare in 2016-2017, characterized by much softer X-ray spectra and, concurrently, its first-ever recorded very-high-energy (VHE) emission (100--560 GeV), reported by the VERITAS observatory. Broadband spectral energy distribution reveals a new jet emission component similar to high-synchrotron-peaked BL Lac objects, thereby implying the soft X-ray spectrum for the synchrotron emission. Using the advantage of simultaneous X-ray and VHE spectral information, as well as the source being a low-synchrotron-peaked BL Lac object, we systematically explored the extragalactic background light (EBL) spectrum by demanding that the VHE spectrum cannot be harder than the X-ray spectrum. We used three different phenomenological forms of the EBL spectral shape (power-law, parabola, and polynomial) motivated by current constraints on the EBL with the Bayesian Monte Carlo approach to infer the credible EBL range. Our study favors an almost flat power-law spectral shape and is consistent with previous studies. The other spectral forms capable of capturing curvature though result in a better statistics value; the improvement is statistically insignificant given the additional parameters.

Introduction: Subtalar Arthroereisis (STA) is a surgical intervention for pediatric flexible flatfoot (PFF), primarily targeting hindfoot alignment by limiting excessive subtalar eversion. However, its effects on forefoot parameters remain underexplored. This study aims to investigate radiological changes following STA in pediatric patients. Materials and Methods: A retrospective analysis was conducted on consecutive patients treated with STA for PFF. First ray-related angles, including Hallux Valgus Angle (HVA) and Inter-Metatarsal Angle (IMA), alongside hindfoot radiological parameters such as Meary, Calcaneal Pitch, and Costa Bartani angles, were assessed. Subgroup analysis by gender was performed, and correlations between demographic and pre-operative radiological parameters were examined. Results: Forty-one patients (81 feet) with a mean age of 11.6 years were included, with a mean follow-up duration of 6.4 months. No significant differences were observed in first ray-related an-gles pre- and post-operatively, with mean IMA changing from 7.97° to 7.18° and mean HV angles from 9.51° to 8.66°. Noteworthy improvements were seen in flat foot angles, including Meary, Calcaneal Pitch, and Costa Bartani angles, postoperatively. Age subgroup analysis revealed similar trends in IMA and HVA changes between Group A (operated before peak growth) and Group B (operated later). Higher preoperative angles tended to improve, while lower preoperative IMA and HVA tended to worsen postoperatively, all remaining within normal ranges. Conclusion: STA showed positive radiological outcomes for PFF treatment, while negligible changes in first ray-related angles were observed. Age subgroup analysis indicated similar trends regardless of operation timing. Higher preoperative angles tended to improve, while lower preoperative angles tended to worsen postoperatively, despite all falling within non-pathological ranges. Further re-search is warranted to confirm this correlation.

Objectives. To compare the audiological benefits of a non-implantable wearing option of a bone conduction (BC) implant mounted on an arch (SoundArc) to traditional BC hearing aids (HA) mounted on eyeglasses (BCHA) in patients with moderate to severe conductive or mixed hearing loss. Methods: A preliminary cross-sectional observational prospective cohort study was conducted at a Tertiary Audiological Department, University Hospital. Fourteen adults with conductive or mixed hearing loss (PTA at 0.5-1-2-4 KHz = 67 ± 15 dB HL) had been wearing conventional BCHA on eyeglasses for at least 3 years, and refused the surgical implantation of a BC hearing implant (BCHI). Unaided and aided pure-tone AC and BC thresholds and speech test in quiet and in noise were recorded at baseline and in two different settings: with a BCHI mounted on SoundArc®, and with their own BCHA with two couplers, mounted on eyeglasses. International Inventory for Hearing Aids [IOI – HA], the Hearing Handicap Inventory [HHIA/E], Speech, Spatial, Qualities of Hearing Scale [SSQ], a 10-scores visuo-analogic scale [VAS], and Fatigue impact scale [FIS] score were asked in both conditions. Results: a statistical significative functional gain was observed for both settings. (p=.0001) Better speech perception performances in quiet and in noise were observed with SoundArc compared to their conventional BCHA on eyeglasses (word repetition score in noise improvement of +19.3 at SNR +10 dB, p=.002; + 12.1 at SNR 0 dB, p=.006; and +11.4 at SNR -10 dB, p=.002) No significant differences were found in IOI–HA, FIS, and HHIA/E scores, while significative better SSQ scores in all domains were reported for SoundArc. (p=.0038) Conclusions: Although patients were accustomed to their BCHA on eyeglasses, the non-implanted wearable option of the BCHI proved to be a viable alternative in adult patients with conductive or mixed hearing loss unable to receive or refusing BCHI surgery.

Multiplex genome editing may induce genotoxicity and chromosomal rearrangements due to double-strand DNA breaks at multiple loci simultaneously induced by programmable nucleases, including CRISPR/Cas9. However, recently developed base-editing systems can directly substitute target sequences without double-strand breaks. Thus, the base-editing system is expected to be a safer method for multiplex genome-editing platforms for livestock. Target-AID is a base editing system composed of PmCDA1, a cytidine deaminase from sea lampreys, fused to Cas9 nickase. It can be used to substitute cytosine for thymine in 3-5 base editing windows, 18 bases upstream of the protospacer-adjacent motif site. In the current study, we demonstrated Target-AID-mediated base editing in porcine cells for the first time. We targeted multiple loci in the porcine genome using the Target-AID system and successfully induced target-specific base substitutions with up to 63.15% efficiency. This system can be used for the further production of various genome-engineered pigs.

A perfectly balanced wine can be said to create a symphony in the mouth. To achieve the sublime, both in wine and music, requires imagination and skilled orchestration of artistic craftmanship. For wine, inventiveness starts in the vineyard. Similar to a composer of music, the grapegrower produces grapes through a multitude of specifications to achieve a quality result. Different Vitis vinifera grape varieties allow the creation of wine of different genres. Akin to a conductor of music, the winemaker decides what genre to create and considers resources required to realise the grape’s potential. A primary consideration is the yeast: inoculate the grape juice or leave it ‘wild’; which specific or combined Saccharomyces strain(s) should be used; or proceed with a non-Saccharomyces species? Whilst the various Saccharomyces and non-Saccharomyces yeasts perform their role during fermentation, the performance is not over until the ‘fat lady’ (S. cerevisiae) has sung (i.e. the grape sugar has been fermented to specified dryness and alcoholic fermentation is complete). Is the wine harmonious or discordant? Will the consumer demand an encore and make a repeat purchase? Understanding consumer needs lets winemakers orchestrate different symphonies (i.e. wine styles) using single- or multi-species ferments. Some consumers will choose the sounds of a philharmonic orchestra comprising a great range of diverse instrumentalists (as is the case with wine created from spontaneous fermentation); some will prefer to listen to a smaller ensemble (analogous to wine produced by a selected group of non-Saccharomyces and Saccharomyces yeast); and others will favour the well-known and reliable superstar soprano (i.e. S. cerevisiae). But what if a digital music synthesiser ‒ such as a synthetic yeast ‒ becomes available that can produce any music genre with the purest of sounds by the touch of a few buttons? Will synthesisers spoil the character of the music and lead to the loss of the much-lauded romantic mystique? Or will music synthesisers support composers and conductors to create novel compositions and even higher quality performances that will thrill audiences? This article explores these and other relevant questions in the context of winemaking and the role that yeast and its genomics play in the betterment of wine quality.

Background: Infective endocarditis (IE) remains a difficult disease to diagnose and treat, with a persistently high mortality rate. There is a lack of recent data on IE in Bulgaria over the last decades. Methods: The study is retrospective, single centered, includes 270 patients diagnosed with IE, for the period 2005 - 2021. We compared the two periods 2005-2015 (n=119) and 2016-2021 (n=151) to find the characteristics changes. Results: The median age was 65 (23) years and 65.5% (177) were male. In the second period, there is a significant increase in age from 62 (29) to 67 (22), (p=0.023); Charlson comorbidities index (CCI) from 3 (3) to 4 (4), (p=0.000); cases with chronic kidney diseases (CKD) from 12.6% (15) to 36.9% (55), (p=0.001); coronary arterial diseases (CAD) from16.85% (20) to 29.1% (44), (p=0.018); atrial fibrillation (AF) from 10.9% (13) to 23.8% (36), (p=0.006). Injection fraction decreased significantly in the second period from 63 (14) to 59 (15), (p=0.000). Almost half of the patients 45.6% (123) had no known predisposing cardiac condition and 46.3 (125) had an unknown port of entry. IE was community-acquired in 173 (64.1%), healthcare-associated in 26.7% (72), and injection drug use related IE in 9.3% (25).The study population included 67.8% (183) native valve IE, 31.5% (85) prosthetic IE, and 0.74% (2) intracardiac device­related IE. The hemoculture were positive in 59.6%, and the most frequent pathogenic agent was Staphylococcus - 33.3 % ( aureus – 16.5 % and coagulase negative - 16.8 %). Only 20% of patients underwent early surgery. The all­cause 30 days mortality rate was 24.8%. There is no significant difference between the two periods in terms of the characteristics listed above. Conclusion: The profile of IE in Bulgaria has changed with increasing age and comorbidity, changing predisposing cardiac conditions and entry door. The most common pathogen was the Staphylococcus group. The 30 day mortality rate remains high.

A position sensing glove, called SmartScan, that creates a 3D virtual model of a real object is presented. The data from the glove is processed by a volume minimization algorithm to validate the position sensor data. This allows only data from the object’s surface to be retained. The data validation algorithm allows the user to progressively improve an image by repeatedly moving their hand over the object. In addition, the user can choose their own balance between feature resolution and invalid data rejection. The SmartScan glove is tested on a foot model and is shown to be robust against motion artifacts, and has a mean accuracy of 2.9 mm (compared to a 3D model generated from optical imaging) without calibration.

Since the implementation of the Materials Genome Project by the Obama administration in the United States, the development of various computational materials databases has fundamentally expanded the choices of industries such as materials and energy. In the field of thermoelectric materials, the thermoelectric figure of merit ZT quantifies the performance of the material. From the viewpoint of calculations for vast materials, the ZT values are not easily obtained due to their computational complexity. Here, we show how to build a database of thermoelectric materials based on first-principles calculations for the electronic and heat transport of materials. Firstly, the initial structures are classified according to the values of bandgap and other basic properties using the clustering algorithm K-means in machine learning, and high-throughput first principles calculations are carried out for narrow-bandgap semiconductors which exhibiting potential thermoelectric application. The present framework of calculations mainly includes deformation potential module, electrical transport performance module, mechanical and thermodynamic properties module. We have also set up a search webpage for the calculated database of thermoelectric materials, providing searching and viewing the related physical properties of materials. Our work may inspire the construction of more computational databases of first-principle thermoelectric materials and accelerate research progress in the field of thermoelectrics.

: Cytokine storm is usually described as one of the main reasons behind COVID-associated mor-tality. Cytokines are essential protein molecules engaged in immune responses; they play a critical role in protection against infections. However, they also contribute to inflammatory reactions and tissue damage, becoming a double-edged sword in the context of COVID-19. Recent studies have suggested various cytokines and chemokines that play a crucial role in the immune response to SARS-CoV-2 infection. One such cytokine is Interleukin 27 (IL-27), which has been found to be elevated in the blood plasma of patients with COVID-19. Within this study, we will explore the role of IL-27 in immune responses and address our own findings concerning this cytokine in COVID-19. It affects a wide variety of immune cells; regardless of the pathological process it is involved in, IL-27 is critical for upholding the necessary balance between tissue damage and cytotoxicity against in-fectious agents and/or tumors. In COVID-19, it is involved in multiple processes, including antiviral cytotoxicity via CD8+ cells, IgG subclass switching, and even the activation of Tregs.

Because Canadian Nitrogen (N) fertilizer use has more than doubled since 1990 (1.2 to 2.9 MtN by 2021), a better understanding of this trend is needed. A comprehensive set of Recommended N Rates (RNR) that agreed with fertilizer sales data from 1996 and 2001 was compared with the Fertilizer Use Survey (FUS). The FUS was conducted from 2014 to 2021, with 2017 being the most representative year for these data. Using non-parametric statistics, confidence intervals were derived from the histograms used to present the FUS data. N application rates from the RNR for Canola, Spring and Duram wheat, and Oats in the west were all below their respective FUS confidence intervals, whereas N application rates for Grain corn showed almost no difference in N use between the RNR and FUS. Crop-specific N application rates interpolated from the RNR and FUS were integrated over their respective crop areas and plotted against national fertilizer sales records from 1990 to 2021. The rapid increase in N use between 2001 and 2017 (0.89 MtN), 90% of it (0.80 MtN) in Western Canada, was primarily due to increased application rates per crop, rather than crop area changes. The FUS-RNR interpolations were a good approximation of N sales records and could improve farm GHG emissions modelling. The economically important crops in Western Canada should be the main focus for N-related GHG reduction measures, but production losses need to be avoided.

Background - Compared to the da Vinci platform, there is limited experience with the Hugo RAS platform for colorectal surgery in Europe. This difference is especially notable when considering a single complex procedure, such as total colectomy. Aim - To demonstrate the feasibility and safety of using the Hugo RAS for assisted total colectomy. Clinical case- Female patient: eighteen-year-old with Familial Adenomatous Polyposis (FAP). Her IBM was 19. She underwent a total colectomy with ileorectal anastomosis using the Hugo RAS platform. The procedure took 230 minutes and had no complications. The postoperative period was uneventful. She was discharged from the hospital on the third postoperative day. Conclusion - The Hugo RAS platform is one of the emergent minimally invasive robotic platforms that can be used even in total colectomy if the proper patient selection is made. The placement choice of arms and trocars was crucial to obtain a similar operative time of the single laparoscopic approach. The certification of Hugo’s new instruments, such as energy devices and staplers, will make this platform even more competitive.

Optical coherence tomography (OCT) is a non-invasive imaging technique widely used in ophthalmology for visualizing retinal layers, aiding in early detection and monitoring of retinal diseases. OCT is useful for detecting diseases such as age-related macular degeneration (AMD) and diabetic macular edema (DME), which affect millions of people globally. Over the past decade, the area of application of Artificial Intelligence (AI), particularly Deep Learning (DL), has significantly increased. The number of medical applications is also rising, with solutions from other domains being increasingly applied to OCT. The segmentation of biomarkers is an essential problem that can enhance the quality of retinal disease diagnostics. For 3D OCT scans, AI is beneficial since manual segmentation is very labor-intensive. In this paper, we employ the new SAM 2 and MedSAM 2 for the segmentation of OCT volumes for two open-source datasets, comparing their performance with the traditional U-Net. The model achieved an overall Dice score of 0.913 and 0.902 for macular holes (MH) and intraretinal cysts (IRC) on OIMHS and 0.888 and 0.909 for intraretinal fluid (IRF) and pigment epithelial detachment (PED) on the AROI dataset, respectively.

Background: The morbidity of myocardial infarction is keeping raise in this decade. Because of high safety and operability , percutaneous coronary intervention(PCI) has been used to conquer this disease for more than 20 years.An important complication of PCI is contrast induced nephropathy(CIN), which raises our attention. Previously, we started a study to explore the correlation between acute kidney injury and myonecrosis after scheduled percutaneous coronary intervention. Our study showed that the rate of CI-AKI in patients with post-procedural myocardial injury and undergoing elective PCI was higher than that in patients free of injury. Methods: In this study,forty male rats were randomly divided into four groups: control group (n=8), CM group (n=12), AMI group (n=8) and AMI+CM group (n=12), then velocity of renal artery blood flow (VRABF), computer tomography (CT), serum creatinine(Scr), reactive oxidative species (ROS), periodic acid-Schiff (PAS) and TUNEL were used to estimate the injury of kidney. We analyzed 327 non-ST-segment elevation acute coronary syndrome subjects undertaking elective PCI. Serum levels of creatinine (SCr) and the eGFR before coronary angiography, and 24–72 h after contrast administration were recorded to assess the renal function. Results: The data showed that VRABF was lower in AMI+CM group than CM group from 0 minute to 24h and CT number in cortex was higher in AMI+CM group than CM group at 4-hour. As well as the level of Scr in AMI+CM group displayed a significantly increase at 24-hour compared with CM group. The histopathologic scores and percentage of tubular cell apoptosis were higher in AMI+CM group at 24-hour. In 327 patients, we found that CI-AKI occurred more often in subjects with post-procedural myonecrosis (PMN) than in those without PMN (20.8% versus 5.8%, respectively, P=0.001). Conclusion: Compared to the elective patient, the injury of CIN exhibited a higher severity in AMI patient.

Background: Upper respiratory tract infections (URTIs) are a major public health concern due to their high incidence and potential for complications. Pharmacists often serve as the first point of contact for patients with URTIs. This study aims to develop and evaluate the RESP-8 tool to assist pharmacists in determining the need for medical evaluation. Methods: This prospective interventional cohort study was conducted over six months (October 2023 to March 2024) in community pharmacies. Participants included adults aged 18 years and older presenting with URTI symptoms. Pharmacists used the RESP-8 tool, which comprises eight criteria to assess the need for medical referral. Data on medical history, symptom duration, and progression were recorded. The primary outcome was the feasibility of implementing the RESP-8 tool. Secondary outcomes included the accuracy of the tool, the percentage of patients recommended for medical evaluation, and compliance with these recommendations. Results: A total of 64 participants were included, with an average age of 55.7 years. Pharmacists recommended medical evaluation for 75% (48/64) of patients using the RESP-8 tool. Among these, 70.83% (34/48) complied with the recommendation. The tool demonstrated high accuracy in identifying patients needing further medical evaluation, with only two noted errors. All compliant patients received appropriate treatment without complications. The tool was easy to implement, taking less than 5 minutes per patient. Discussion: The RESP-8 tool effectively guided pharmacists in recommending medical evaluations for URTI patients. The high compliance rate indicates patient trust in pharmacists' guidance. While the study's small sample size limits generalizability, the results are promising. Future studies with larger populations are necessary to validate these findings and further refine the tool. Conclusion: The RESP-8 tool shows potential in enhancing pharmacists' ability to make informed decisions about medical referrals for URTIs, ultimately improving patient outcomes and optimizing healthcare resource management.

Evaluation of the effectiveness of protected areas is critical for forest conservation policies and priorities. To evaluate their effectiveness, we used 30-m resolution forest cover change data between 1990 and 2010 for ~4,000 protected areas and analyzed the relationships of the effectiveness of protected areas with socio-economic variables. Our results show that protected areas in the Tropics avoided 83,500 ± 21,200 km2 of deforestation during the 2000s. Brazil’s protected areas have the largest amount of avoided deforestation of 50,000 km2. We also show the amount of international aid received by tropical countries compared to the effectiveness of protected areas. International aid had major benefits in Latin America led by Brazil while tropical Asian countries used the resource ineffectively. Our results demonstrate that protected areas have been relatively more efficient in countries where deforestation pressures were increasing, and governance and forest change monitoring capacity are important factors for enhancing the efficacy of international aid.

Background: Approximately 10-20% of subjects vaccinated with HBsAg-based hepatitis B virus (HBV) vaccines are non-responders. BM32 is a recombinant grass pollen allergy vaccine containing the HBV-derived preS surface antigen as immunological carrier protein. PreS includes the binding site of HBV to its receptor on hepatocytes. We investigated if immunological non-responsiveness to HBV after repeated HBsAg-based vaccinations can be overcome by immunization with VVX001 (i.e., Alum-adsorbed BM325, a component of BM32). Methods: A subject failing to develop protective HBV-specific immunity after HBsAg-based vaccination received five monthly injections of 20 µg VVX001. PreS-specific antibody responses were measured by ELISA and micro-array technology. Serum reactivity to subviral particles of different HBV genotypes was determined by sandwich ELISA. PreS-specific T cell responses were monitored by CFSE staining and subsequent FACS analysis. HBV neutralization was assessed using cultured HBV-infected HepG2 cells. Results: Vaccination with VVX001 induced a strong and sustained preS-specific antibody response composed mainly of the IgG1 subclass. PreS-specific IgG antibodies were primarily directed to the N-terminal part of preS containing the NTCP attachment site. IgG reactivity to sub-viral particles as well as to the N-terminal preS-derived peptides was comparable for HBV genotypes A-H. A pronounced reactivity of CD3+CD4+ lymphocytes specific for preS after the complete injection course remaining up to one year after the last injection was found. Maximal HBV neutralization (98.4%) in vitro was achieved 1 month after the last injection which correlated with the maximal IgG reactivity to the N-terminal part of preS. Conclusion: Our data suggest that VVX001 may be used as a preventive vaccination against HBV even in non-responders to HBsAg-based HBV vaccines.

Chronic Kidney Disease is a medical condition that causes the decrease in the kidney function and can eventually derive in a total cessation of the work of the organ. It currently affects >10% of the global population, and the number is expected to grow within the next few years, since the correlated diabetes condition is escalating too. Diagnosing the disease on its early stages is crucial to improve life quality, and to increase the chances of survival. The traditional diagnostic methods, which include a biopsy, are invasive, expensive and dangerous. With the use of machine learning algorithms like neural networks, random forest and genetic algorithms, this paper seeks to discover an algorithm with high accuracy, whose selected attributes will be the most optimal combination aiming to reduce the cost, level of invasiveness, and easiness to obtain.

The 1783-1784 Laki eruption was one of the most severe natural catastrophes to occur in Iceland in historical times (since 1140 years). Vegetation damage by sulphate aerosol and fluorine poisoning caused a massive decimation of livestock. The impact of fluorine poisoning and sulphate aerosol on human mortality is uncertain, but the loss of animals caused a famine which took many lives. The vulnerability of the Icelandic society to famine is discussed. 18th Century Iceland was a Danish dependency and, despite the abundance of fish in the surrounding waters, a subsistence farming community and thus highly dependent on livestock. On the other hand, the farming community possessed coping strategies which mitigated the impact of livestock loss. During the famine, the Danish government was in principle willing to provide relief. However, local authorities in Iceland were slow to ask for help, and did not dare to exploit the means at their disposal (e.g. the right to ban the export of Icelandic foodstuff) without consent from Copenhagen. The Danish officials in turn were unwilling to act decisively upon incomplete information. These two factors prevented timely measures. While 4.4 × 10^5kg of grain were provided for famine relief in summer 1784, the merchants exported 1.2 × 10^6kg of fish, which greatly aggravated the hunger in the second winter. The effects of this ‘natural’ catastrophe could therefore have been significantly reduced by efficient government.

There is paucity of data in the available medical literature regarding the parameters of volumetric perfusion of pancreas grafts. Materials and methods From February 5, 2016 to December 23, 2021, we performed perfusion computed tomography in 41 patients at different times after simultaneous pancreas and kidney transplantation. The study group consisted of 18 men (44%) and 23 women (56%) with a long history of type 1 diabetes complicated by terminal chronic renal failure. The results of perfusion computed tomography of the pancreas graft were studied, and the effects of post-transplantation timing and graft revascularization peculiarities on volumetric perfusion parameters were evaluated. Results The median arterial blood flow, arterial blood volume, and permeability of the pancreas graft were 115.1 [99.7;130.3] mL/100 mL/min, 46.7 [37.4;56.9] mL/min and 8.6 [4.1;11.4] mL/100 mL/min, respectively. No statistically significant differences in the averaged perfusion values were found in the head, body, and tail of the pancreas graft. The post-transplantation timing and the number of arteries involved in graft revascularization did not have a significant effect on the volumetric perfusion of the graft. Conclusion The volumetric perfusion results of the pancreas graft correspond to those obtained in the study of pancreatic perfusion in healthy participants.

Developing a dependable gas and condensate value chain is vital for the ongoing prosperity of the oil and gas industries. To achieve this, NNPC is enhancing its production facilities by employing process modeling and simulation with the assistance of Symmetry iCON®. As a part of this initiative, a simulation model was created using the Symmetry iCON® pipe plexus solver to simulate the dynamic environment of the gas and condensate pipeline network in the Nigerian Southern region. To validate the model, data from a single month, specifically December 2022, was utilized. Furthermore, the algorithm was utilized to generate projections for the month of January 2023, providing valuable insights into its effectiveness. The study also highlighted the significance of accurately estimating the characteristics and properties of a pseudo component of C6+ in relation to thermodynamics and material properties, which was a particularly insightful finding. he assessment of this property has transitioned from being relatively unimportant to becoming critically important, primarily due to the lack of condensate data monitoring at specific terminals. However, it's worth noting that the model currently has an error margin of 4-6% when predicting the data. As more information becomes available in the future, the model can be easily fine-tuned to better align with the actual conditions, allowing for more accurate predictions.

This study investigates job satisfaction, burnout, and well-being among first-generation migrant physicians in anesthesia and intensive care medicine in Germany, comparing them to their native German counterparts. Utilizing a cross-sectional survey design, the study collected data from 513 physicians, 110 of whom identified as having a migration background. Job satisfaction was measured using the German version of the Warr-Cook-Wall (WCW) Job Satisfaction Scale, burnout was assessed with the Copenhagen Burnout Inventory (CBI), and well-being was evaluated using the WHO-5 Well-Being Index. The job satisfaction ratings revealed no significant differences between migrant and German physicians in most dimensions, including physical workload, freedom to choose work methods, satisfaction with colleagues, responsibility, income, skill utilization, and variety in work tasks. However, migrant physicians reported significantly higher satisfaction with recognition received for their work and lower dissatisfaction with working hours. Burnout assessments showed that migrant physicians experienced higher psychological strain, perceiving every work hour as more exhausting and having significantly less energy for family and friends. Notably, migrant physicians reported higher difficulty and frustration in working with patients. Well-being ratings indicated that migrant physicians felt less energetic and active but found their daily life more filled with interesting activities. The findings underscore the unique challenges faced by migrant physicians, particularly in terms of recognition and patient-related burnout. These results highlight the need for targeted interventions to support migrant physicians, including cultural competence training and flexible working hours to enhance their job satisfaction and overall well-being. Addressing these issues is crucial for maintaining the quality of patient care and the occupational health of migrant physicians in Germany.

Introduction: A plethora of biological molecules regulate chondrogenesis in the epiphyseal growth plate. Disruptions of quantity and function of these molecules can manifest clinically as stature abnormalities of various etiologies. Traditionally, the growth hormone/insulin-like growth factor 1 (IGF1) axis represents the etiological center of final stature attainment. Of note, little is known about the molecular events that dominate the growth of the craniofacial complex and its correlation with somatic stature. Aim: Given the paucity of the relevant data, this review discusses available information regarding potential applications of lateral cephalometric radiography as a potential clinical indicator of genetic short stature in children. Materials and Methods: A literature search was conducted in the PubMed electronic database using the key words: cephalometric analysis and short stature; cephalometric analysis and achondroplasia; cephalometric analysis and hypochondroplasia; cephalometric analysis and skeletal abnormalities; cephalometr* and SHOX; cephalometr* and CNP; cephalometr* and ACAN; cephalometr* and CNVs; cephalometr* and IHH; cephalometr* and FGFR3; cephalometr* and Noonan syndrome; cephalometr* and “Turner syndrome”; cephalometr* and achondroplasia. Results: In individuals with genetic syndromes causing short stature, linear growth of the craniofacial complex is confined, following the pattern of somatic short stature regardless of its etiology. The angular cephalometric measurements differ from the average height normal individuals and are suggestive of a posterior placement of the jaws and a vertical growth pattern of the face. Conclusion: The greater part of the existing literature regarding cephalometric measurements in short statured children with genetic syndromes provides qualitative data. Furthermore, cephalometric data for individuals affected with specific rare genetic conditions causing short stature, should be the focus of future studies. These quantitative data are required to potentially establish cut-off values to refer for genetic testing based on craniofacial phenotypes.

To instruct interior lighting design of aviation cockpit and ensure the work efficiency and comfort of pilots, and reduce safety accidents caused by light environment and visual fatigue during flight, it is important to establish a multi-dimensional ergonomic evaluation mechanism of cockpit light environment. In this paper, by improving Jdms' mental load theory, we establish a thorough experimental scheme based on physiological workload, mental workload, work performance and physiological work performance to evaluate the cockpit ergonomic under different light environment multi-dimensionally. Firstly, 12 evaluation indexes including job accuracy, job speed, blinking, heart rate variability, average fixation time, saccadic speed, mental demand, physical demand, operational performance, time demand, degree of confusion and degree of effort are obtained through the experiment, and then the weight of each evaluation index is calculated by entropy method to construct the ergonomic evaluation model. The evaluation results of physiological workload, mental load, work performance and physiological work performance were combined to obtain the final ergonomic evaluation results. According to our experimental results, it was found that light environment for pilot to get the highest ergonomic efficiency is 1500 lx light illumination and 5000K color temperature. The results provide a reference for the ergonomic experiment of aircraft cockpit and the design of aviation cockpit lighting system.

Electrolyte disturbances are common in patients with traumatic brain injury (TBI), particularly affecting sodium, potassium, chloride and calcium levels. This study aims to provide insights into these disturbances within the first 24 hours post-injury. We conducted a cross-sectional analysis of 50 TBI patients, excluding those with conditions affecting electrolyte balance. Electrolyte levels were measured, and correlations with demographic data, trauma mechanisms, imaging findings, and Glasgow Coma Scale (GCS) scores were analyzed. Results indicated that chloride levels inversely correlated with GCS scores (ρ = -0.515; p = 0.002), suggesting that elevated chloride may indicate severe neurological impairment. Potassium levels were significantly associated with subdural hematoma (p = 0.032) and subarachnoid hemorrhage (p = 0.043), highlighting their potential as markers for severe brain injuries. No significant associations were found between sodium or calcium levels and the studied variables. These findings underscore the importance of early monitoring of chloride and potassium levels in TBI patients to improve management and outcomes. Future research should focus on larger, multi-center studies to validate these findings and develop comprehensive guidelines for managing electrolyte imbalances in TBI patients.

Preeclampsia (PE) is a complex and multifaceted obstetric syndrome characterized by several distinct molecular subtypes. It complicates up to 5% of pregnancies and significantly contributes to maternal and newborn morbidity, thereby diminishing the long-term quality of life for affected women. Due to the widespread dissatisfaction with the effectiveness of existing approaches for assessing PE risk, there is a pressing need for ongoing research to identify newer, more accurate predictors. This study aimed to investigate early changes in the maternal serum proteome and associated signaling pathways. The levels of 125 maternal serum proteins at 11-13 weeks of gestation were quantified using liquid chromatography-multiple reaction monitoring mass spectrometry (LC-MRM MS) with the BAK-125 kit. Ten serum proteins emerged as potential early markers for PE: Apolipoprotein M (APOM), Complement C1q subcomponent subunit B (C1QB), Lysozyme (LYZ), Prothrombin (F2), Albumin (ALB), Zinc-alpha-2-glycoprotein (AZGP1), Tenascin-X (TNXB), Alpha-1-antitrypsin (SERPINA1), Attractin (ATRN), and Apolipoprotein A-IV (APOA4). Notably, nine of these proteins have previously been associated with PE in prior research, underscoring the consistency and reliability of our findings. These proteins play key roles in critical molecular processes, including complement and coagulation cascades, platelet activation, and insulin-like growth factor pathways. To improve the early prediction of PE, a highly effective Support Vector Machine (SVM) model was developed, analyzing 19 maternal serum proteins from the first trimester. This model achieved an Area Under the Curve (AUC) of 0.91, with 87% sensitivity and 95% specificity, and a hazard ratio (HR) of 13.5 (4.6 - 40.8) with p&lt;0.001. These findings demonstrate that serum protein-based SVM models possess significantly higher predictive power compared to the routine first-trimester screening test, highlighting their superior utility in the early detection and risk stratification of PE.

By providing useful tools to study host-pathogen interactions, next-generation omics has recently enabled the study of gene expression changes in both pathogen and infected host simultaneously. However, since great discriminative power is required to study pathogen and host simultaneously throughout the infection process, the depth of quantitative gene expression profiling has proven to be unsatisfactory when focusing on bacterial pathogens, thus preferentially requiring specific strategies or the development of novel methodologies based on complementary omics approaches. In this review, we focus on the difficulties encountered when making use of omics approaches to study bacterial pathogenesis. Besides, we review different omics strategies (i.e. transcriptomics, proteomics and secretomics) and their applications for studying interactions of pathogens with their host.

This study is aimed to assess the prevalence of Coxiella burnetii infection among veterinary medicine students from two Bulgarian Universities, located in Sofia and Stara Zagora. A total of 185 veterinary students blood samples were collected and tested for the detection of C. burnetii phase II antibodies and presence of DNA using an enzyme-linked immunosorbent assay (ELISA) and end-point PCR test, respectively. Out of all samples, 29.7% were positive for at least one C. burnetii phase II antibody marker or by PCR test. Veterinary students from Stara Zagora showed significantly seropositive status of Q fever (33.6%), then those who studied in Sofia (23%). The evidence for recent exposition with detection of anti-C. burnetii IgM (+) antibodies had 14.6%. Seroprevalence among students in Stara Zagora was higher (15.3%). Anti-C. burnetii phase II IgG antibodies were detected in 21.6% examined samples. Our study revealed a higher seropositivity among male students (32.8%) as compared to the female ones (16.0%). End-point PCR assay detected as positive 5.9% blood samples. The relative risk (RR) of Q fever exposure for male students was 40.7%, whereas for female (24.6%). Findings from this study indicated that the C. burnetii infection is widely distributed amongst veterinary students from Bulgaria. The study emphasizes the need for improved safety protocols and infection control measures in veterinary training programs.

ABSTRACT Background: To date, the COVID-19 pandemic has been the foremost health concern for humankind in the new millennia. This paper aims to describe the related hospitalizations in Italy during the first two years of the health emergency. Design and methods: This is a retrospective, population-based study of Italian hospitalizations for patients diagnosed with COVID-19 during the 2020-2021 period, extracted from the National Hospital Discharge Registry. The outcome variables considered include hospital admissions, costs, and length of stay, among other hospitalization-level variables. Costs were estimated through the charges associated with the Diagnosis-Related Group and Major Diagnostic Categories coding system, plus an additional cost attributed to COVID-19 admissions. To these charges was added an extra cost defined by the ministry of health. Results: In Italy, there were 357,354 hospitalizations for COVID-19 attributed to 298,856 patients in 2020 and 399,043 hospitalizations for COVID-19 attributed to 333,447 patients in 2021. COVID-19 patients faced a transfer rate thrice that of other patients. Hospitalizations were concentrated predominantly in the northern regions, particularly in the first year. Hospitalization rates varied by age in a sine wave pattern, peaking in the youngest and oldest age groups, with mortality rates escalating with age— tending to remain below 3% for those under 44 but surging to 40% in individuals over 75. The financial impact of COVID-19 hospitalizations was substantial, with total costs reaching €3.97 billion in 2020 and €4.99 billion in 2021. Costs per admission and per day also rose, from €11,112 and €807 in 2020 to €12,503 and €844 in 2021, respectively. Excluding the added financial burden of COVID-19, costs would have been notably lower. Hospitalizations involving continuous invasive mechanical ventilation were particularly costly (about 24.000 euros x admission), reflecting the significant resources required for these treatments. Conclusion: Implementing a protective pad around the entire health system that leverages networks of family doctors and nurses, connected in real time to the entire health system, can be crucial. Such a network, tasked with monitoring the local epidemiological situation, protecting vulnerable individuals also through telehealth visits, and establishing a triage system for infections in the initial phase, may effectively help in managing virus spread and protecting hospitals from unpredictable waves of admission demand. Strengthening primary health care could be a decisive factor for the future and enhance the system's resilience in facing new challenges.

In this article, we analyse the computer aid screening method of COVID19 using Xray and CT scan images. The main objective is to set an analytical closure about the computer aid screening of COVID19 among the X-ray image and CT scan image. The computer aid screening method includes deep feature extraction, transfer learning and traditional machine learning image classification approach. The deep feature extraction and transfer learning method considered 13 pre-trained CNN model. The machine learning approach includes three sets of features and three classifiers. The pre-trained CNN models are alexnet, googlenet, vgg16, vgg19, densenet201, resnet18, resnet50, resnet101, inceptionv3, inceptionresnetv2, xception, mobilenetv2 and shufflenet. The features and classifiers in machine learning approaches are GLCM, LBP, HOG and KNN, SVM, Naive bay’s respectively. In addition, we also analyse the different paradigms of classifiers. In total, the comparative analysis is carried out in 65 classification models, i.e. 13 in deep feature extraction, 13 in transfer learning and 39 in machine learning approaches. Finally, all the classification models perform better in X-ray image set compare to CT scan image set.

Introduction: Management of hypoxic-ischemic encephalopathy (HIE) has been the subject of international recommendations. However, some aspects remain within the realm of service practices and appear to vary greatly from one center to another. Objectives: To achieve a multidisciplinary consensus in France regarding management of HIE newborns that are not covered by international and national guidelines. Methods: This is a prospective, multicenter study using the Delphi method from April 21, 2021, to July 15, 2021. Perinatal professionals were contacted through professional societies. Participants received a questionnaire in three successive rounds. Each proposal was rated using a Likert scale from 1 (completely disagree) to 8 (completely agree). An item was considered consensual if at least 70% of responses were in agreement or disagreement. Results: 58 french neonatal professionals participated. A consensus was reached in the first round concerning the use of passive hypothermia in maternity ward, with 84% agreement and to define the target temperature between 35.0°C and 35.5°C at the third round. Regarding hypoglycemia in the delivery room, 79.2% agreed in the first round to correct blood glucose levels below a threshold of <2.2 mmol/l. Parenteral route was the preferred correction method for 91.4% of respondents, while enteral route via nasogastric tube did not reach consensus. Conclusion: This study highlights the variability in definitions and practices among professionals in the management of HIE. Consensus was found regarding certain care practices performed without formal guidelines. The work to harmonize definitions and practices for the management of HIE likely needs to continue.

This mini-review explores the comparative efficacy, safety, and clinical outcomes of high-dose proton pump inhibitor (PPI) intravenous infusion versus oral acid pump inhibitor therapy following endoscopic treatment for bleeding peptic ulcers. Recent evidence suggests that intravenous PPIs can significantly reduce the rebleeding rates within the critical first 72 hours post-intervention, with a noted rebleeding rate of 6% compared to 14% in patients receiving oral Vonoprazan (VPZ) therapy. Additionally, the rapid onset of action associated with intravenous administration leads to faster stabilization of vital signs and a reduced need for subsequent blood transfusions. Safety profiles for both intravenous and oral VPZ were favourable, with minimal adverse effects, the most common being transient headaches.However, the findings from our single-centre study with a moderate sample size prompt consideration of more extensive, multicentre trials to enhance the generalizability of the results. Current limitations include potential biases, short-term focus, missing data issues, and a need for long-term outcome data, necessitating further research. Future studies should also explore the cost-effectiveness of intravenous versus oral VPZ and the impact on patient quality of life and long-term mortality rates.This review underscores the importance of tailored PPI therapy in managing bleeding peptic ulcers post-endoscopy. It suggests a potentially pivotal role for intravenous PPIs in high-risk patient groups, advocating for a shift towards more aggressive and immediate care protocols in specific clinical settings.

Introduction: Senescence-resembling alterations on lymphocytes of dialysis patients have been widely described. However, pathophysiology behind these phenomena has not been clarified. In this study, we examine the impact of dialysis prescription and residual renal function on T and B lymphocytes, in dialysis patients. Methods: T and B cell subsets were determined with flow cytometry in 36 hemodialysis and 26 hemodiafiltration patients, according to the expression of CD45RA, CCR7, CD31, CD28, CD57 and PD1 for T cells, and IgD and CD27 for B cells. Immune phenotype was associated with dialysis modality, hemofiltration volume, and mortality. Results: Compared to hemodialysis, hemodiafiltration patients had significantly decreased percentage of CD4+CD28-CD57- T cells [3.8(2.4-5.3) vs 2.1(1.3-3.3)%, respectively, P=0.002] and exhausted CD4+ T cells [14.1(8.9-19.4) vs 8.5(6.8-11.7)% , respectively, P=0.005]. Additionally, hemofiltration volume was negatively correlated to CD8+ EMRA T cells (r=-0.46, P=0.03). Finally, exhausted CD4+ T cells percentage could predict all-cause mortality in dialysis patients, independently of age. Conclusion: Hemodiafiltration, especially with high hemofiltration volume, may have beneficial effects on senescence-related immune phenotype. Immune phenotype may also be a predicting factor for mortality in dialysis patients.

Background: Despite hearing aids adequately compensate for hearing loss, a substantial proportion of the population leave their hearing difficulties untreated. Even though this is a well-known clinical issue, the optimal approach to address this issue during the hearing rehabilitation process is still unclear. Purpose: The present study aims to characterise behavioural and neurophysiological auditory and cognitive processing skills in experienced hearing aid users versus those with normal hearing, aimed at providing clinicians with the evidence required to adequately manage the expectations of their clients, thus indirectly reinforcing hearing-aid adoption within the adult population with hearing loss. Research design: Behavioural tests included auditory, cognitive, and speech-in-noise tasks; and neurophysiological testing included cortical auditory evoked potentials evoked by a /da/ stimulus presented at 65 dB SPL. The tests were selected based on previous literature supporting specific speech-understanding skills. Study sample: Ten participants (7 female, 21—68 years) with bilateral, mild-moderate to moderately-severe sensorineural hearing loss (HL), and 10 with clinically normal hearing (NH, 8 female, 19—62 years) participated in the study. Data collection and analysis: Behavioural data was analysed using multivariate analysis of variance (MANOVA) and neurophysiological analysis used measurements such as independent t-test, time-frequency analysis and inter-trial phase coherence. Results: The NH and HL groups presented similar scores in all the behavioural tasks. Time-frequency analysis revealed a statistically significantly reduction in alpha (8–12 Hz) synchronisation at the centro-frontal electrodes in the HL group – a brain activity pattern that has been associated with listening effort, inhibition and selective attention. Conclusions and significance: Results support the conclusion that hearing aids are effective in compensating for the audibility of their users, enabling them to perform at similar levels than their normal-hearing peers. However, the reduced alpha synchronisation observed in the HL population indicates that adequate audibility does not extend to improved neural responses. Future studies need to investigate the induced activity in speech understanding paradigms to explore the auditory processing differences at cortical level. The results are only from a small sample size but the findings have the potential to support clinicians in managing adequately the expectations of their clients in regards the benefits of hearing aid technologies.

A methodological similarity between Thomas Hobbes and Pëtr Kropotkin is the intention to spread a theoretical foundation to everyone, in the sense that they are willing to give to all the people a clear description of the reality and a subsequent political view. To do so, they use a scientific method, deductive (starting from empirical observations) in the case of Hobbes, inductive-deductive in the case of Kropotkin. Kropotkin underlines the educational value of the scientific method.In this work we want to highlight that, although they both start their argumentations from a materialist ontology, Hobbes and Kropotkin conjecture two completely different states of nature. Hobbes describes the state of nature through the two famous metaphors homo homini lupus (citing Plautus) and bellum omnium contra omnes, while Kropotkin introduced the theory of mutual aid. Both the theory of a state of war by Hobbes and the theory of mutual aid by Kropotkin have been revolutionary. Hobbes has been influenced by the scientific revolution initiated by Francis Bacon, one of his mentors, and Galileo Galilei, together with a criticism towards the ancient Greece philosophers, in particular Aristotle. Kropotkin has been influenced by the ground-breaking writings of Charles Darwin together with a very fruitful Russian scientific environment.We want to stress here that the disenchanted view of the human nature in Hobbes, a state of war due to the fact that everyone has rights on everything, helps him to legitimate sovereignty, while the positive view of human nature in Kropotkin, a spontaneous mutual aid among people in a community, helps him to legitimate anarchy. Therefore, the fascinating scientific methods of the two materialists Hobbes and Kropotkin to structure a solid political theory cannot neglect different views on human nature due to their historical contexts.

A multimodal detection system with complementary capabilities for efficient detection was developed for impurity detection. The system consisted of a visible light camera, a multispectral camera, image correction and registration algorithms. It can obtain spectral feature and color feature at the same time, and has higher spatial resolution than a single spectral camera. This system was applied to detect impurities in Pu ’er tea to verify its high efficiency. The spectral and color features of each pixel in the images of Pu ’er tea were obtained by this system and used for pixel classification. The experimental results show that the accuracy of Support Vector Machine (SVM) model based on combined features is 93%, which is 7% higher than that based on only spectral features. By applying median filtering algorithm and contour detection algorithm to the label matrix extracted from pixel-classified images, 8 impurities except hair were detected successfully. Moreover, taking advantage of the high resolution of visible light camera, small impurities can be clearly imaged. By comparing the segmented color image with the pixel-classified image, small impurities such as hair could be detected successfully. Finally, it is proved that the system can obtain multiple images to allow a more detailed and comprehensive understanding of the detected items, and has excellent ability to detect small impurities.

Toxic metal wastewater is a challenge for exposed terrestrial, aquatic environments and the recyclability of the water, prompting inputs for the development of promising treatment methods. Consequently, the rGO/ZnONP nanocomposite was synthesized at room temperature for four hours and was tested for adsorption of cadmium and lead in wastewater. The optimized nanocomposite had the lowest band gap energy (2.69 eV) and functional group interactions were at 516, 1220, 1732, 3009, and 3460 cm-1. The nanocomposite showed saturation of ZnO nanoparticles on rGO with a weight percentage of zinc (60.02 %), oxygen (22.96 %), and carbon (16.58 %), and the micrograph showed slight agglomeration on the sheet surface. The nanocomposite’s D and G band intensities were almost the same constituting the ZnO presence on rGO from the raman spectrum. The adsorption equilibrium time for cadmium and lead was reached within 10 and 90 minutes with efficiencies of ~ 100 %. Sips and Freundlich were best fitting the cadmium and lead adsorption data (R2 ~ 1), therefore the adsorption was a multilayer coverage for lead and a mixture of heterogenous and homogenous coverage for cadmium adsorption. Both adsorptions were best fitted by the pseudo first order model, suggesting the multilayer coverage dominance. The adsorbent was reused for three and seven times for cadmium and lead. The nanocomposite showed selectivity towards lead (95 %) and cadmium (100 %) in the interfering wastewater matrix. Conclusively, the nanocomposite may be embedded within upcoming lab-scale treatment plants which could lead to further upscaling and serving as industrial wastewater treatment material.

Over recent years, the Ghanaian economy has struggled to find its feet on the ground despite rising public debt and unending inflows of foreign aid. Against this backdrop, this study employs the Vector Error Correction Model (VECM) estimation technique on data from 1970 to 2020 to test the usefulness of the debt overhang hypothesis and the dependency theory in the special case of Ghana. The results confirm evidence of the debt overhang hypothesis and the center-periphery wisdom of the dependency theory in Ghana. The findings depict that an increase in external debt stock and total debt service on external debt have both short and long-run growth-limiting effects on the Ghanaian economy. Similarly, foreign aid catalyzes growth only in the short run and later suppresses rather than stimulates economic growth in Ghana over the long run. The study recommends that harnessing domestic resources, maintaining fiscal discipline by cutting down unproductive expenditures, enhancing an effective tax system, and promoting institutional capabilities to counteract corruption and openness to trade are better ways to fast-track growth development in Ghana.

Background: In most cases, intra-labyrinthine schwannoma (ILS) occurs in patients with unilateral hearing deterioration or neurofibromatosis type II (NF II). The pattern of localization of these tumors is various but affects mostly the cochlea. Extirpation of the ILS, if hidden by the cochlea modiolus, is difficult under the aspect of complete removal. Therefore, a tissue removal device (TRD) was designed and tested in temporal bones. The principle of handling the new device is a pushing and pipe cleaner handling inside the cochlea. This present study aimed to describe the first in vivo experience with the newly developed TRD for removing cochlear intra-labyrinthine schwannoma. Methods: In three patients, the TRD was used for the tumor removal of ILS. In two patients with a cochlear schwannoma in combination with a cochlea implantation and one patient suffering from NF II, a cochlear schwannoma was removed with the TRD. The access was performed with a posterior tympanotomy, an enlarged round window approach, and an additional second-turn access. The device was inserted and extracted gradually from the second turn access until the rings were visible in the second turn access. By pushing and pipe cleaner handling, the tumors were removed. An MRI control was performed on the day postoperatively with a T1 GAD sequence. Results: Tumor removal with the TRD was performed in a 15-minute procedure. MRI control confirmed a complete removal on the postoperative day in both cases. Conclusion: In vivo handling of the device confirmed a straightforward handling for tumor removal. MRI scanning showed a complete removal of the tumor by the TRD.

Recent developments in optical biosensors based on integrated photonic devices are reviewed with a special emphasis on silicon-on-insulator ring resonator. The review is mainly devoted to the following aspects: (1) Principles of sensing mechanism, (2) sensor design, (3) biofunctionalization procedures for specific molecule detection and (4) measurement set-ups and advances in chip-integration. The inherent challenges of implementing photonics-based biosensors to meet specific requirements of applications in medicine, food analysis, and environmental monitoring are discussed.

The vomeronasal system serves as a pivotal element in mammalian sensory biology, allowing the perception of chemical signals essential for social communication via the activation of two main receptor families, V1R and V2R. The expression of V1Rs and V2Rs is linked with that of the G-protein alpha-subunits, Gαi2 and Gαo, respectively. The exploration of the evolutionary pathways of V1Rs and V2Rs across all mammalian species remains a main challenge, juxtaposing available genomic data against emerging immunohistochemical evidence. However, recent investigations, in contrast to what is predicted by the currently annotated genomic sequences, have revealed the expression of Gαo in the vomeronasal neuroepithelium of wild canids, including wolves and foxes. In the present study, the employment of a specific antibody raised against the mouse V2R2, member of the C-family of vomeronasal receptors, V2Rs, has confirmed the expression of this receptor in the fox and wolf, but it has revealed the lack of expression in the dog. This may reflect the impact of domestication on the regression of the VNS in this species, in contrast to their wild counterparts, and underscores the effects of artificial selection on sensory functions. Thus, these findings suggest a more refined chemical detection capability in wild species.

Cystic echinococcosis (CE), caused by the larval stage of Echinococcus granulosus, is significantly underreported in Mongolia due to geographical remoteness, lack of early diagnostics, and poor clinical management. This study aimed to provide a more accurate estimate of CE in Mongolia by comparing data of surgical (reported) and diagnosed (unreported) cases, and assessing the challenges faced by rural doctors in disease management and surveillance. We collected data on surgical cases hospitalized between 2006-2016 and newly diagnosed CE cases in 2016 from eight provinces. Using a quasi-Poisson regression model of the collected data, we used extrapolation to estimate the number of diagnosed cases for the entire country. Additionally, fourty health professionals from all 21 provinces rated local clinical management for CE through a questionnaire. Results reveal that surgical cases (2.2 per year) represent only one-eighth of diagnosed cases (15.9 per year). The laboratory facilities, disease reporting, and cyst classification usage scored below 2. These results highlight the significant underreporting of CE in Mongolia and urges human and animal health experts, along with policymakers, to invest into combating CE, particularly in remote provincial areas. It also emphasizes the need for standard clinical management involving cyst classification according to WHO-IWGE, seamless integration of CE reporting and monitoring mechanisms, which can significantly contribute to the national and global burden estimation of CE.