Objective: This study aimed to evaluate the antibody responses in two adult age groups after diphtheria vaccination. Study Design: An observational analytic study was carried out to determine the difference in serum titer of anti-diphtheria antibody. Methods: Serum antibody titers were measured just before and 3 months after injection of Diphtheria toxoid vaccine. Vaccine was given to two adult age groups of health care personnel in hospital: the young (< 40 years) and the middle-aged (≥ 40 years). Data were analyzed using the Mann-Whitney test (p < 0.05). Results: Significant increase in serum anti-diphtheria antibody titers were recorded after vaccination in both age group (p < 0.001 in young adult and p = 0.001 in middle-aged adult, respectively). There were no substantial differences between the two groups in terms of antibody titer before vaccination (p = 0.741), 3 months after vaccination (p = 0.317) and in the increase of antibody titer (p = 0.479). Conclusions: This study showed that there was no significant difference in the increase of anti-diphtheria antibody titers between the two age groups, proving that both young and middle-aged adults had an equal immune response to a given diphtheria vaccine.

Background: Poor menstrual health literacy impacts adolescents’ quality of life and health outcomes across the world. The aim of this systematic review was to identify concerns about menstrual health literacy in low/middle (LMIC) and high-income (HIC) countries. Methods: Relevant social science and medical databases were searched for peer-reviewed papers from January 2008 to January 2020 identifying 61 relevant studies. Results: A thematic analysis of the data revealed that LMICs report detrimental impacts on adolescents in relation to menstrual hygiene and cultural issues, while in HICs, issues related to pain management and long term health outcomes were reported more frequently. Conclusions: In order to improve overall menstrual health literacy in LMICs and HICs, appropriate policies need to be developed, drawing on input from multiple stakeholders to ensure evidence-based and cost-effective practical interventions.

Ischemic stroke (IS) is a group of vascular disease concomitant with high morbidity and mortality. Berberine is a bioactive substance and it has known to improve stroke, but the mechanism is yet to be proven. Mice were fed with BBR for 14 days. Then, mice were made into MCAO/R models. Neurological score, infarct volume, neuronal damage and markers associated with inflammation were detected. We tested the changes of intestinal flora in model mice after BBR administration by 16SrRNA sequencing. Chromatography-mass spectrometry was used to detect butyrate chemically. Tissue immunofluorescence was used to detect the changes of microglia and astroglia in mice brain. Our findings suggest that berberine improves stroke outcomes by modulating gut microbiota. Specifically, after MCAO/R mice were given berberine, beneficial bacteria producing butyric acid increased significantly, and the mice also had significantly higher levels of butyric acid. Administration of butyric acid and an inhibitor of butyric acid synthesis, heptyl-coA, showed that butyric acid improved stroke outcomes in model mice. In addition, butyric acid could inhibit the activation of microglia and astrocytes in the brain of model mice, thereby inhibiting the release of inflammatory cytokines IL-6, IL-1β, TNF-α and improving stroke outcomes. Our results suggest that berberine may improve stroke outcomes by modulating the gut flora to increase the abundance of butyric acid. These findings elucidate the mechanisms by which berberine improves stroke outcomes and provide some basis for clinical treatment.

The affected upper limb in children with Unilateral Spastic Cerebral Palsy (US CP) has motor and somatosensory impairments, that contribute negatively to children’s bimanual performance and quality of life. Mirror Therapy (MT) is being studied to become an approachable intensive and home-based therapy, suitable for children with US CP. The aim of this study is to examine the feasibility of a 5-week home-based program of MT for children with US CP. Six children aged 8-12 years old performed the therapy, five days per week, 30 minutes per day. A minimum of an 80% of compliance was required. The evaluations included the feasibility of the therapy (compliance, total dosage, perceived difficulty of the exercises, and losses of follow-ups and evaluations), the bimanual performance, the somatosensory function and the quality of life at baseline, at the end of the intervention, and at 1-month follow-up. All children completed the therapy and were included in the analysis. The total accomplishment was 86.47 ± 7.67. The perceived difficulty of the exercises ranged from 2,37 to 4,51. As a conclusion, a home-based program of Mirror Therapy is suitable and feasible for children with US CP.

Hippotherapy is a popular rehabilitation method for children with cerebral palsy (CP), which is done by riding an actual horse or a horse riding simulator (HRS) device. Riding a real horse is more expensive than using an HRS device due to its high maintenance cost. However, most HRS devices commonly sold in the market are designed as exercise devices, not rehabilitation devices. Most of them are designed to simulate a horse's walk, trot, canter, or gallop gait at various speeds. Hippotherapy aims to improve the walking ability of CP patients. Therefore, the device should aim to replicate the walking gait of a healthy human, the end goal of hippotherapy. This problem motivates us to design and build a specialized HRS device replicating the walking gait of a healthy human that is suitable for hippotherapy, which is achievable by simulating a horse walking gait with several adjustments. We first studied and observed the walking gait cycle of a horse, then analyzed and derived a formulation of it. We then continue by designing an HRS device using a single electrical rotational motor and mechanical means to replicate the walking gait of a horse, then tune it to an extent to replicate a human walking gait. To measure the performance of our design, we compare the gait of the user when riding our device versus walking.

Patients with chronic renal failure and vascular diseases require the vascular access for hemodialysis procedure to be performed with the most possible comfort for the patient. Native vein graft has a longer-lasting term in the patients’ limb, lower risk of graft infection and lower price. Native vein graft is constructed from the great saphenous vein, if the diameter of the vessel is smaller than the diameters of vessels (brachial artery, cephalic vein) it is connected to in the cubital fossa region due to the risk of graft folding, that might occur, if the graft diameter is bigger than the diameter of one or both vessels, on which anastomosis is made. The most important sizes, that were taken before graft placement, are the length of the forearm compartment, the distance between the brachial artery and cephalic vein in the cubital fossa region, distance from an expected incision in the brachial artery to the middle of the forearm compartment, the distance between incision in cephalic vein to the middle of the forearm compartment, length of the great saphenous vein (the graft) and diameters of blood vessels, used in the procedure. Finally, the right position of the graft should be determined for the successful outcome of anastomosis creating procedure.

This study aimed to examine the physical response of international referees, participating in different levels of world competitions for footballers with cerebral palsy (CP). Thirteen international referees, who officiated 49 matches in the men’s 2022 World Cup (1st to 15th ranked teams) and 2022 World Championships (16th to 30th ranked teams), participated in this study. A cross-sectional design was used to determine the physical responses and compare the 1st and 2nd halves and the performance in the different tournaments, recording physical variables throughout the matches. Significant higher physical responses (p &lt; 0.05; d = 0.50-0.93; moderate to large) were observed in the World Cup in comparison to the World Championship. Overall, high-level tournaments have been shown to elicit more intense physical responses from referees officiating CP football matches compared to lower-level tournaments. For the World Cup, significantly higher number of accelerations (p = 0.01; d = -0.55; moderate) and decelerations (p &lt; 0.01; d = -0.54; moderate) were registered in the 1st half compared to the 2nd half. This information may be useful for the strength and conditioning coaches of referees to plan weekly training sessions more specifically and adjust the periodical training load and post-match recovery protocols.

The purpose of this study was to quantify characteristics of bimanual movement intensity during 30-hour Hand Arm Bimanual Intensive Therapy (HABIT) and bimanual performance (activities and participation) in real-world using accelerometers in children with unilateral cerebral palsy (UCP). Twenty-five children with UCP participated in a 30-hour HABIT program. Data was collected from bilateral wrist-worn accelerometers during 30-hours HABIT to quantify the movement intensity, and three days pre- and post-HABIT to assess real-world performance gains. Movement intensity and performance gains were measured using six standard accelerometer-derived variables. Bimanual capacity (body function and activities) was assessed using standardized hand function tests. We found that accelerometer variables increased significantly during HABIT, indicating increased bimanual symmetry and intensity. Post-HABIT, children demonstrated significant improvements in all accelerometer metrics, reflecting real-world performance gains. Children also achieved significant and clinically relevant changes in the hand capacity following HABIT. Therefore, our findings suggest that accelerometers can objectively quantify bimanual movement intensity during HABIT. Moreover, HABIT enhances hand function as well as activities and participation in real-world situation in children with UCP.

Survivors of severe brain injury may require care in a neurointensive care unit (neuro-ICU), where the brain is vulnerable to secondary brain injury. Thus, there is a need for noninvasive, bedside, continuous cerebral blood flow monitoring approaches in the neuro-ICU. Our goal is to address this need through combined measurements of EEG and functional optical spectroscopy (EEG-Optical) instrumentation and analysis to provide a complementary fusion of data about brain activity and function. The present case demonstrates in a patient with traumatic brain injury, noninvasive cerebral blood flow transients can be recorded that correlate with gold-standard invasive measurements and with the frequency content changes in the EEG data during clinical care.

The development of 3D cerebral brain organoids which accurately resemble aspects of the human brain permits a more accurate characterization of physiological processes and neurological diseases. Cerebral organoids can be grown from stem cell lines with various genetic backgrounds allowing multiple neurodegenerative diseases to be modeled. While dysfunction in neurotransmission of patients with neurodegenerative diseases is expected, the impact of chronic neurodegeneration on the response to viral infection of the CNS is poorly understood. For instance, several mosquito-borne viruses like Dengue virus and West Nile Virus cause post-viral parkinsonism. How CNS infection might impact a host with inherent CNS dysfunction such as Parkinson’s Disease in poorly understood. This preliminary, observational study aimed to understand dysfunction in intrinsic and innate expression of a patient with a neurodegenerative disease and a non-affected individual in relation to potential viral infection in the CNS. Cerebral organoids were generated from human induced pluripotent stem cells with a normal genetic background or with idiopathic Parkinson’s Disease. After differentiation and maturation, organoid size, gene expression and immunofluorescence were evaluated to assess neurotransmission and innate immunity. While there was no significant difference in size of the organoids with a normal or Parkinson’s genetic background, gene expression studies identified multiple differences in innate immunity and neurotransmission. Immunofluorescence also identified differences in protein expression related to neurotransmission and innate immunity. Of note, organoids derived from a Parkinson’s patient exhibited endogenous up-regulation of dopamine and muscarinic acetylcholine receptors, GABA, glycine, and glutamate targets, and the majority of cytokines. This expression pattern suggests a chronic state of neuroexcitation and neuroinflammation in this population of organoids.

Due to its time effective, joint friendly and highly customizable character whole-body-electromyostimulation (WB-EMS) is regarded as a feasible solution for a large variety of training issues particularly in the area of non-athletic application. To identify gaps in research and summarize prevalent evidence we conducted an evidence map on outcomes addressed by WB-EMS trials in middle-aged to older, non-athletic adults. Based on a comprehensive systematic search in five databases and two study registers according to PRISMA, 54 projects published in 80 articles were included. More than 90% of the studies reported outcomes related to the physical fitness or function domain. Body composition parameters were addressed by two thirds of the projects. Health-related outcomes addressed by WB-EMS included cancer/neoplasm (n=7), endocrine regulation (n=8), glucose metabolism (15), nervous system diseases (n=2), cardiovascular system diseases (n=22), non-specific chronic low back pain (n=4), osteopenia (n=5) and diseases of the renal system (n=12). Outcomes related to inflammation were addressed 18 times. Of importance, no studies reported clinically relevant adverse effects related to the WB-EMS intervention. In summary, while considerable evidence on outcomes related to fitness/function and body composition is prevalent, evidence gaps of WB-EMS research were particular evident for diseases of the nervous and cerebrovascular system.

Office workers often experience occupational musculoskeletal disorders. The aim of the current systematic review was to investigate the effectiveness of workplace exercise intervention on the oldest age group of office workers who have been reported in the literature so far, in terms of workability and well-being. Randomized Controlled Trials were used and the methodological guidelines of PRISMA were followed. The keywords used were: office workers, older, exercise intervention, workplace, microbreaks, workability and well-being. The databases searched were: PubMed, PEDro, ResearchGate, CINAHL, PsychINFO and Science Direct. PROSPERO ID: CRD42022329656. Five studies (total number of participants: 1190, mean age: 46,4) met the inclu-sion criteria. Their quality was deemed to be moderate to high, according to PEDro and MPSER scales. Workplace interventions of gradually increased strengthening and moderate stretching exercises, isometric positioning and postural reminders, either with or without supervision, result in decreasing musculoskeletal pain, disability, sick-leave from work and in the improvement of quality of life and physical activity of the middle-aged office workers, without negative impact on their workability. Despite the worldwide aging workforce, there is a knowledge gap due to research absence in the field of microbreak exercise interventions in the group of older office workers.

The spatiotemporal variability of vegetation in the Middle East was investigated for the period 2001–2019 using the Moderate Resolution Imaging Spectroradiometer (MODIS) 16-day/500 m composites of the Normalized Difference Vegetation Index (NDVI; MOD13A1). The results reveal a strong increase in the NDVI coverage in the Middle East during the study period (R = 0.75, p-value = 0.05). In Egypt, the annual coverage exhibits the strongest positive trend (R = 0.99, p-value = 0.05). In Turkey, both the vegetation coverage and density increased from 2001 to 2019, which can be attributed to the construction of some of the biggest dams in the Middle East, such as the Atatürk and Ilisu dams. Significant increases in the annual coverage and maximum and average NDVI in Saudi Arabia are due to farming in the northern part of the country for which groundwater and desalinated seawater are used. The results of this study suggest that the main factors affecting the vegetation coverage in the Middle East are governmental policies. These policies can have a positive effect on the vegetation coverage in some countries such as Egypt, Saudi Arabia, Qatar, Kuwait, Iran, and Turkey.

This article is an anthropology study on how western-style coffee culture influences Indonesian coffee culture and eventually develops a new localized coffee culture. Immense development of such worldwide coffee franchise as Starbucks affects local community's coffee culture, particularly the middle class. This new wave is considered as an alternative lifestyle for those who are consumptive and seeking for leisure, dynamics, and identity. Broader than just the process of domestication or creolization, Indonesian new coffee culture has an element of “soft countering to” western coffee culture even though it still embraces some parts of the western styles. This phenomenon is referred to by the writer as the cultural encapsulation process or the process of substantial cultural resistance by drawing a line between the two coffee cultures with the intention of taking merely compatible elements.

The human coronaviruses (CoV) include HCoV-229E, HCoV-OC43, HCoV-NL63 and HCoV-HKU1, some known for decades. The severe acute respiratory syndrome (SARS) CoV briefly emerged into the human population but was controlled. In 2012 another novel severely human pathogenic CoV – Middle Eastern Respiratory Syndrome (MERS)-CoV was identified in the Kingdom of Saudi Arabia, where 80% of over 2,000 human cases have been recorded across five years. Targeted research remains key to developing control strategies for MERS-CoV, a cause of mild illness in its camel reservoir. A new therapeutic toolbox being developed in response to MERS is also teaching us more about how CoVs cause disease. Travel-related cases continue to challenge the world’s surveillance and response capabilities and more data are needed to understand unexplained primary transmission. Signs of genetic change have been recorded but it remains unclear whether any impact on clinical disease. How camels came to carry the virus remains academic to the control of MERS. To date, human-to-human transmission has been inefficient, but virus surveillance, characterisation and reporting are key to responding to any future change. MERS-CoV is not currently a pandemic threat; it is spread mainly with the aid of human habit and error.

Backgrounds Linear association has widely been assumed for prediction of aging-related fractional anisotropy (FA) decline in white matter of the brain. While useful for testing significance of the aging effect, it fails to identify a threshold age before and after which the age-FA association changes. Identification of such a threshold is often of clinical interest for timely intervention. Methods We employed a sigmoidal growth function to test a threshold effect in age triggering onset of cerebral decline in 21 white matter tracts, and compared its fitting performance to those of linear, and power regression. The study sample was a normal healthy cohort of 106 participants with ages in mid-life ranging from 18 to 60 years. Results Of the 21 white matter tracts analyzed, the posterior thalamic radiation showed better fit with sigmoidal curve model, compared to a linear or power regression. The estimated threshold age in years (95% confidence interval) were 47.2 (44.1-48.4). Conclusion While available evidence regarding the presence of a specific age threshold for cerebral decline in mid-life based on FA was limited, the posterior thalamic radiation exhibited a threshold age of 47.2. Beyond this age point, we observed a significant change in the FA risk pattern.

Introduction: Adverse events related to vaccines are reactions that can lead to serious complications, in the present that we live at the publication of this article with the need to generate high rates of vaccination have been presented in the case of vaccine agents against COVID-19 adverse events, with thrombotic events being the most important. Case Presentation: This is a 37-year-old female patient who presents 11 days after ChAdOx1-S vaccination against COVID-19 presents with intense headache associated with symptoms of intracranial hypertension, she was initially taken to simple cranial tomography showing presence of cerebral edema and indirect signs of cerebral venous thrombosis, it is proposed to carry out cerebral angiography which showed the presence of thrombosis of both transverse venous sinuses, no hypercoagulability states were found in the laboratories, the immunological tests carried out for antiphospholipid syndrome were negative, the thrombotic event was associated with the ChAdOx1-S vaccine, later the patient was taken to thrombectomy by Neuroradiology, achieving complete channeling of both transverse venous sinuses. Conclusions: Adverse events associated with vaccination have been described with multiple vaccine agents, this component against COVID-19 is also an event to consider, knowing the pathophysiology of these events is essential to be able to reduce these risks and select the least risky agent. Despite this risk, vaccination remains the only cost-effective measure to reduce the morbidity and mortality associated with COVID-19.

Only cross-sectional studies have demonstrated muscle deficits in children with spastic cerebral palsy (SCP). The impact of functional impairments on altered muscle growth remains unclear. This prospective longitudinal study modelled the morphological muscle growth in 87 children with SCP (age range 6 months to 11 years, Gross Motor Function Classification System [GMFCS] level I/II/III=47/22/18). Repeated ultrasound assessments were performed during 2-year (y) follow-up with an interval of minimal 6 months. Three-dimensional freehand ultrasound was applied to assess medial gastrocnemius muscle volume (MV), mid-belly cross-sectional area (CSA) and muscle belly length (ML). Non-linear mixed models compared trajectories of (normalized) muscle growth between GMFCS-I versus GMFCS-II&amp;III. MV and CSA growth trajectories showed piecewise model with 2 breakpoints, with the highest growth before 2y and negative growth rates after 6-9y. Before 2y, children with GMFCS-II&amp;III already showed lower growth rates compared to GMFCS-I. From 2-9y, the growth rates did not differ between GMFCS-levels. After 9y, a more pronounced reduction in normalized CSA was observed in GMFCS-II&amp;III. Different trajectories in ML growth were shown between the GMFCS-level subgroups. These longitudinal trajectories could be used to monitor the SCP muscle pathology during childhood and to optimize treatment planning and goals aiming to stimulate muscle growth

War dominated the royal policies in late Medieval Europe, yet recent historiography has shifted focus to the conflict resolution strategies employed by nonsovereign powers. This essay delves into the escalation of confrontations at sea, distinguishing between legal acts of privateering and criminal acts of piracy. It further compares the conflict mitigation policies of the town ports of Northern Iberia and the duchy of Brittany, highlighting the role of an international arbitration court, the Guild of the Contractation. The analysis concludes that attempts to diminish maritime violence through shortlived bilateral peace agreements were largely unsuccessful, with the more stringent policies of monarchical states taking precedence. Despite this, trade and maritime transport remained crucial for the inhabitants of both regions, who endeavored to surmount the perils of the sea by fostering networks of trust, bolstered by shared institutions for risk management. Nevertheless, these efforts were ultimately eclipsed by the royal policies aimed at extending state jurisdiction over the seas, through the criminalization of certain sea activities, thereby reinforcing the state's control over maritime commerce. The essay underscores the complex interplay between local interests and royal ambitions, illustrating how the latter often subsumed the former in the quest for greater control over maritime resources and trade routes.

Currently the bimatoprost implant (DURYSTA) is approved for a single administration secondary to concern for progressive corneal endothelial cell (CEC) loss with intracameral administration. In order to better understand the cause of CEC loss and other adverse events (AEs) with intracameral administration, multimodal imaging of the implant utilizing optical coherence topography (OCT), robotic ultrasound and bio microscopy video recording was utilized. Inherently the anterior chamber is a non-confined space. In certain examples the implant assumed a round and spotted structure as it picked up iris pigment as it migrated around the anterior chamber. Accordingly, we explored delivery of the implant in the middle segment behind the iris and in front of the pseudophakic lens. We then evaluated the suitability of various imaging modalities to assess the implant in this location. For middle segment administration, the ArcScan Insight 100 robotic ultrasound provided resolution and repeatability sufficient to monitor the implant behind the iris. This preliminary study hypothesizes that DURYSTA migration in the anterior chamber is the main source of AEs. Through use of a confined location, the middle segment, the implant is unlikely to migrate and cause CEC loss while also delivering drug closer to its site of action, the ciliary body. Further efforts are underway to understand the suitability of the middle segment for serial DURYSTA administration to maximize intraocular pressure lowering while minimizing AEs.

The craft guilds have been at the core of important historiographical debates on the economic, social and political history of medieval cities for twenty years. The aim of this article is to examine the seamen’s guilds in the town ports of Northern Peninsula in the late Middle Ages. This study analyzes fundamental aspects of the social assistance, labour organization and social identity of the town ports, located on the maritime border of the Kingdom of Castile. In contrast to the more classical view of the craft guilds as protectionist institutions, which only served the interests of a privileged group of masters, this analysis highlights the contribution of the seamen craft guilds to the organization of labor at sea, the training of sea workers, the ability to negotiate with merchants and avoid labor exploitation, the provision of social assistance to the most vulnerable population, and the ability to lead the social protest for the guilders’ representation in the urban government. In summary, it is concluded that the seafarers’ guilds were constituted as networks of mutual help between individuals in the labor, welfare and political spheres of the population of the town ports of Northern Iberia in the late Middle Ages.

Anesthetics reduce cardiac functions and lower blood pressure (BP), potentially causing excessive BP reduction in dehydrated patients or those with heart conditions, such as coronary artery disease (CAD). Considering the increased prevalence of cardiovascular disease with age, anesthesiologists must be cautious about BP reduction during general anesthesia in older adults. In the present case, an undiagnosed CAD patient in a hypovolemic state experienced a significant systolic blood pressure drop to the 50s during propofol and sevoflurane anesthesia. Despite the use of vasopressors, excessive hypotension persisted, leading to anesthesia suspension. Subsequent cardiac examinations, including computed tomography heart angio and calcium score, and coronary angiogram, revealed a near total occlusion of the left main coronary artery and the formation of collateral circulation. After 5 days of hydration and anticoagulation medications and confirmation of normovolemic state, general anesthesia was attempted again and successfully induced; a normal BP was maintained throughout the surgery. Thus, it is important to conduct a thorough cardiac evaluation and maintain normovolemia for general anesthesia in older adults.

Myocardial infarction is an uncommon manifestation in anomalous coronary artery (ACA). As usual, the electrocardiogram (ECG) was used to detect myocardial infarction. Unfortunately, the ECG’s pattern could not reveal the ACA’s condition. Some investigators tried to describe the pattern in ECG in ACA’s patients. Due to the rare patients of ACA, it was not yet found.

Studies have shown the benefits of endovascular treatment (EVT) in adult stroke cases, but its application in pediatric stroke remains controversial. Despite evidence of improved outcomes in adults, there are no established recommendations for EVT in children. Conducting individual case reports and case series is vital to understanding its potential advantages and disadvantages in this context. This case report presents a 9-year-old boy who experienced basilar artery occlusion leading to a stroke and was effectively treated with mechanical thrombectomy.

The COVID-19 pandemic has caused unprecedented challenges in the care of children with cerebral palsy (CP) and other neuromuscular complex chronic conditions (NCCC). The purpose of this study was to explore the direct impact of the COVID-19 pandemic on healthcare delivery. From May to August 2020, medical professionals caring for CP and NCCC patients across multiple countries and disciplines completed a self-administered cross-sectional survey comparing practices before and during the COVID-19 pandemic. Of the 79 healthcare workers from 8 countries who participated—predominantly pediatric orthopedic surgeons (32%), pediatricians (30%), and pediatric physiatrists (23%)—most felt that caring for NCCC patients during the pandemic presented with unique difficulties and reported a significant decrease in in-person NCCC clinic volume (p<0.001), multidisciplinary appointments (p<0.001), surgical cases (p=0.005), and botulinum toxin/phenol injections. Most providers affirmed that institutional guidelines for perioperative emergent/urgent and elective procedures, workplace settings, and technology were modified to accommodate the ongoing public health crisis. Usage of telemedicine significantly increased for NCCC patient visits (p<0.001). During the COVID-19 pandemic, many children with NCCC lost access to routine, multidisciplinary care. Telemedicine became an integral part of communication and management. In the setting of the COVID-19 pandemic and threat of future healthcare disruptions, these data lay the foundation for trending the evolution of healthcare delivery and accelerating best practice guidelines for children with CP and NCCC.

The main objective of this study is to demonstrate proof of principle that computational fluid dynamics (CFD) modeling is a tool for studying the contribution of covert and overt vascular architecture to the risk of cerebrovascular disease in in sickle cell disease (SCD) as well as uncover one or more mechanism of response to therapy such as chronic red blood cell (cRBC) transfusion. We analyzed baseline (screening), pre-randomization and study exit magnetic resonance angiogram (MRA) images from 10 (5 each from the transfusion and observation arms) pediatric sickle SCD participants in the silent cerebral infarct transfusion (SIT) trial, using CFD modeling. We reconstructed the intracranial portion of the internal carotid artery and branches and extracted the geometry using 3D Slicer. We cut specific potions of the large intracranial artery to include segments of the internal carotid, middle, anterior, and posterior cerebral artery such that the vessel segment analyzed extended from the intracranial beginning of the internal carotid artery up to immediately after (~0.25 inches) the middle cerebral artery branching point. Cut models were imported into Ansys 2021R2/2022R1 and laminar and time-dependent flow simulation was performed. Change in time averaged mean velocity, wall shear stress, and vessel tortuosity were compared between the observation and cRBC arm. We did not observe a correlation between time averaged mean velocity (TAMV) and mean transcranial doppler (TCD) velocity at study entry. There was also no difference in change in time average mean velocity, wall shear stress (WSS), and vessel tortuosity between the observation and cRBC transfusion arms. WSS and TAMV were abnormal for 2 (developed TIA) out of the 3 participants (one participant had SCI) that developed neurovascular outcomes. CFD approaches allows for the evaluation of vascular topology and hemodynamics in SCD using MRA images. In this proof of principle study, we show that CFD could be a useful tool and we intend to carry out future studies with a larger sample to enable more robust conclusions.

Cerebral blood flow (CBF) decreases across the lifespan, and chronic conditions such as dementia and stroke accelerate this decline. Impaired CBF results in reduced delivery of oxygen and nutrients, which can damage the brain over time. Thus, there is a need to identify lifestyle interventions including diet and exercise to maintain CBF with aging and in the presence of chronic disease. In the present study, we used transcranial Doppler ultrasound to record middle cerebral artery velocity (MCAv), a surrogate measure of CBF, during moderate-intensity exercise in sedentary, cognitively-normal older adults (N = 90). A multiple linear regression model (F(4, 85) = 3.21, p = 0.02) showed self-reported omega-3 supplement use significantly moderated the association between age and mean exercising MCAv in these individuals (p = 0.01). Older age was associated with lower exercising MCAv in the group not taking omega-3 supplements, while exercising MCAv showed no decline with increasing age in the group who reported omega-3 supplement use. These findings suggest omega-3 supplementation may have an important role in the preservation of CBF with aging.

Numerous studies were published suggesting that troponin level is related to adverse outcomes in chronic cardiac and non-cardiac conditions. Our study investigated whether troponin levels gathered from an unselected blood sample taken during outpatient care are associated with adverse outcomes in a population with stable coronary artery disease. In a cohort of 949 patients with stable coronary artery disease, average age of 67.5 ± 9.5 years, 69.5% male, 52.1% diabetics, 51.6% with previous myocardial infarction, 57.9% with triple-vessel disease, 21.7% of patients encountered new events during an average period of monitoring of 2.07 ± 0.81 years. Troponin I/99th percentile categorized into tertiles emerged as an independent predictor of death and combined events risk (hazard ratio: 2.02 (1.13-3.60), p=0.017; 2.30 (1.37-3.88, p=0.002, respectively). A troponin ratio > 0.24 was able to identify 53.3% of patients at risk of death and heart failure hospitalization. In patients with stable coronary artery disease and adherent to treatment, troponin level is independently associated with death and heart failure hospitalization in a medium-term follow up.

When a large artery becomes occluded, hemodynamic changes stimulate remodeling of arterial networks to form collateral arteries in a process termed arteriogenesis. However, the structural changes necessary for collateral remodeling have not been defined. We hypothesize that decon-struction of the extracellular matrix is essential to the remodeling of smaller arteries into effective collaterals. Using multiphoton microscopy, we analyzed collagen and elastin structure in maturing collateral arteries isolated from ischemic rat hindlimbs. Collateral arteries harvested at different timepoints showed progressive diameter expansion associated with striking rearrangement of in-ternal elastic lamina (IEL) into a loose fibrous mesh, a pattern persisting at 8 weeks. Despite a 2.5-fold increase in luminal diameter, total elastin content remained unchanged in collaterals compared with control arteries. Among the collateral midzones, baseline elastic fiber content is low. Outward remodeling of these vessels with a 10-20 fold diameter increase was associated with fractures of the elastic fibers and evidence of increased wall tension as demonstrated by straight-ening of the adventitial collagen. Inhibition of lysyl oxidase (LOX) function with β-aminopropionitrile resulted in severe fragmentation or complete loss of continuity of the IEL in developing collaterals. Collateral artery development is associated with permanent redistribution of existing elastic fibers to accommodate diameter growth. We found no evidence of new elastic fiber formation. Stabilization of the arterial wall during outward remodeling is necessary and dependent on LOX activity.

Previous studies have suggested that digitization of finance leads to growth in the economy in several middle- and high-income countries, but research in low- and lower-middle-income countries (LLMICs) remains limited. This research aimed to examine the trends, barriers, relationships, and prospects of finance digitization in LLMICs. This study used analytical and descriptive cross-sectional study designs. Sixty-six countries were purposively selected based on the available data on the Global Findex and the World Development Indicators databases. Descriptive analysis was used to identify the trends in the finance digitization indicators, correlation analysis was used to assess the nature of the association between finance digitization and the economy, and exponential smoothing was used to predict future outcomes in digital finance. The results indicated that the adoption and utilization of finance digitization increased in these countries, but the growth rates varied by region and income group. Low-income countries reported the highest rates of subscriptions to digital finance accounts and storing money in digital accounts, while lower-middle-income countries (LMICs) reported higher rates of inbound/outbound digital transactions, borrowings, and savings using digital channels. Sub-Saharan Africa reported the highest rates of digital finance account subscriptions, digital savings, and digital borrowings, while Europe and Central Asia reported the highest rates of in/out digital transactions. Barriers to digitization in these countries included poor access to the internet, high cost of digital finance products, and lack of a mobile phone, with low-income countries facing more challenges. The analysis revealed a negative significant relationship between finance digitization and Gross National Income growth and a positive significant correlation between finance digitization and other economic growth indicators (gross savings and Gross Domestic Product). Finance digitization was predicted to continue to rise in these countries for the next decade. The study recommended that policymakers should promote the adoption of digital finance and address the barriers and risks of finance digitization in LLMICs, as it had positive effects on economic growth.

During puberty and emerging sexuality, adolescents experience important physical, mental, and social transformations. In the process of dealing with these changes, adolescents can become potentially vulnerable to mental health problems.The aim was to identify and synthesize published research evidence on sexuality-related mental health stressors among adolescent girls and boys, identify gaps (if any) in current knowledge, and contribute to knowledge about the experiences of emerging sexuality and health among adolescents, to further inform research, practice, and policy initiatives in sexual health.A scoping literature review of peer-reviewed articles published between 1990 and 2018. MEDLINE, CINAHL, EMBASE, PsycINFO, Global health, ERIC, and Sociological Abstracts databases were searched for research studies that reported experiences of sexuality related mental health issues and symptomatology of adolescents. We targeted studies conducted with adolescent populations between ages 11-24 years living in LMICs.Data from 12 published research papers, including 8 qualitative studies, 3 quantitative studies, and 1 mixed method study, were systematically analyzed. Four major themes and 4 sub themes were identified regarding sexual health and mental health of adolescents: 1) Relationship of sexuality and mental health; 2) Social and cultural influences; 3) Challenges in seeking sexuality information and services among adolescents; and 4) Educational needs among adolescents related to sexuality; and 4) Educational needs among adolescents related to sexuality. Lack of social support, Unmet needs for accessible adolescent friendly sexual health services, counseling, and age-appropriate information may be associated with several mental health stressors and symptoms, such as sadness, depressive and anxiety symptomatology, regret, fear, embarrassment, low self-esteem, guilt, shame, and anger. Therefore, tackling sexuality-related stressors could play an important role in addressing the overall wellbeing of young people. Future studies need to generate a deeper understanding of the concept of sexual health and its relation to mental health in diverse contexts. Health care professionals need to be aware of sexuality-related experiences of adolescent girls and boys by offering effective youth-friendly sexual and reproductive health education to support overall mental health and improve the experiences of emerging sexuality in adolescents.

Background: In this study, we aimed to evaluate the effect of s-FLT-1 and PlGF concentrations in women in the first trimester of pregnancy on the pulsatility index of the ductus venosus and the right and left uterine arteries. Methods: A total of 108 pregnant women in their first trimester were included in the study, with 87 assigned to the experimental group and 21 to the control group. Ultrasound examination were performed to measure the uterine artery pulsatility index, resistance index, ductus venosus pulsatility index, and blood sampling levels of biomarkers such as b-HCG; PAPP-A; s-FLT-1 and PlGF. Results: There was a significant negative relationship between PAPP-A concentration and the risk of fetal growth restriction, and a significant negative relationship between PlGF concentration and the risk of preeclampsia and fetal growth restriction in women in their first trimester of pregnancy. There was also a significant positive relationship between sFLT-1/PLGF ratio and the risk of developing preeclampsia. No significant relationships were found between the concentrations of biomarkers beta-HCG, PAPP-A, sFLT-1, PlGF, and any of the parameters PIUARt, PIUALt, Mean uterine arteries, and DVPI. Summary: In conclusion, this study did not find conclusive evidence to support the hypothesis that beta-HCG, PAPP-A, s-FLT-1, and PlGF concentrations in women in the first trimester of pregnancy have a significant effect on the Pulsatility Index of the ductus venosus and the Right and left Uterine Arteries. Further research is needed to investigate these potential associations.

In post mortem analyses, SARS-CoV-2 was found in the middle ear of some, but not all patients with COVID-19 disease. It is not clear whether SARS-CoV-2 penetrated the ear passively post mortem, or existed in the middle ear of living patients during, and perhaps also after infection. This study investigates whether SARS-CoV-2 can be found in the middle ear of living patients during ear surgery. Swabs from the nasopharynx, the filter connected to the tracheal tube and secretion from the middle ear were collected during middle ear surgery. All samples were tested for the presence of SARS-CoV-2 with PCR. History of vaccination, COVID-19 and contact with SARS-CoV-2-positive individuals were recorded preoperatively. Postoperative SARS-CoV-2 infection was noted at the follow-up visit. Overall 63 participants (62%) were children and 39 (38%) were adults. SARS-CoV-2 was found in the middle ear and in the nasopharynx of two and four CovEar Study participants, respectively. The filter connected to the tracheal tube was sterile in all cases. Cycle threshold (ct) values of the PCR test were between 25.94 and 37.06. SARS-CoV-2 penetrates into the middle ear of living patients and can be found in asymptomatic patients. The presence of SARS-CoV-2 in the middle ear may have implications for ear surgery and can pose a risk of infection for operating room staff. It may also directly affect the audio-vestibular system.

The object of this research is designing of new robot-to-robot communication system working in the middle of highway/roads to support mobile safety for approaching vehicles. The result of research project directs to a group of safety robot devices which induce a vehicle on a bypass route, as a vehicle guidance method using the same, and a vehicle safety guidance system. According to an embodiment of the present invention, a safety device includes a detector configured to detect a vehicle approaching the safety device, and an image projector configured to project an image onto a road surface approaching the vehicle when the detector recognizes an approach of the vehicle. It can include. According to the present invention, when it is necessary to guide the vehicle to the bypass route, the driver of the vehicle can grasp the detour route in time and move the vehicle to the next lane.

Recanalization poses challenge in coil embolization for cerebral aneurysms. Establishing predictive models for post-embolization recanalization is important for clinical decision-making. However, conventional statistical and machine learning (ML) models may overlook critical parameters during the initial selection process. In this study, we automated the identification of significant hemodynamic parameters using a PointNet-based deep neural network (DNN), leveraging their inherent 3D features. Further feature analysis was conducted utilizing saliency mapping, an explainable artificial intelligence (XAI) technique. The study encompassed the analysis of velocity, pressure, and wall shear stress (WSS) in both pre- and post-coiling models derived from computational fluid dynamic (CFD) simulations for 59 aneurysms. Velocity was identified as the most pivotal parameter, supported by the lowest P-value from statistical analysis and the highest area under the curves (AUROC)/precision-recall curves (AUPRC) values from DNN model. Moreover, visual XAI analysis revealed robust injection flow zones with notable impingement points in pre-coiling models, as well as pronounced interplay between flow dynamics and the coiling plane were important 3D features in identifying the recanalized aneurysms. The combination of DNN and XAI was found to be an accurate and explainable approach not only at predicting post-embolization recanalization but also at discovering unknown features in the future.

The pathogenesis of Cerebral Small Vessel Disease (CSVD) is largely unknown. Endothelial disfunction has been suggested as the turning point in CSVD development. In this study we tested the effect of plasma from CSVD patients on human cerebral microvascular endothelial cells with the aim of describing the pattern of endothelial activation. Plasma samples from 3 groups of young subjects have been tested: PTs (subjects affected by early stage CSVD); CTRLs (control subjects without abnormalities at MRI scanning); BDs (blood donors). Human Brain Endothelial Cells 5i (HBEC5i) were treated with plasma and total RNA was extracted. RNAs were pooled to reduce gene expression-based variability and NGS analysis was performed. Differentially expressed genes were highlighted comparing PTs, CTRLs and BDs with HBEC5i untreated cells. No significantly altered pathway was evaluated in BD related treatment. Regulation of p38 MAPK cascade (GO:1900744) was the solely pathway altered in CTRLs related treatment. Indeed, 36 different biological processes turned out to be deregulated after PTs treatment of HBEC5i, i.e., the cytokine-mediated signaling pathway (GO:0019221). Endothelial cells activate inflammatory pathways in response to stimuli from CSVD patients’ plasma, suggesting the pathogenetic role of neuroinflammation from the early asymptomatic phases of cerebrovascular disease.

The Süttő 21 site is a fissure fill of the freshwater limestone of the Gazda quarry in Süttő. The material was collected between 2017 and 2019, the results are summarised in this article, with a special focus on the small vertebrate fauna of the site and its stratigraphic and paleoecological significance. The fissure fill can be placed around the early/middle Pleistocene boundary (ca. 1.1 and 0.77 Ma). The paleoecological analysis of the herpeto- and mammal fauna of the sequence indicates the proximity of a permanent water body. The lower part of the sequence is dominated by open habitat indicator taxa indicating a cool, dry climate. Towards the upper part of the sequence, the climate remained cool but became wetter, and the vegetation gradually changed to forest-steppe/open forest. The fauna of the Süttő 21 site can be compared with the material of sites, which are of similar age, thus revealing taxonomic and paleoecological differences between different areas of the country. While a warm, dry climate and open vegetation can be reconstructed in the Villány Hills around the early/middle Pleistocene boundary, the northern Hungarian areas had a cooler, wetter climate, and slightly more closed (grove, forest-steppe) vegetation during this period.

Background: A significant percentage of younger patients with myocardial infarction have premature coronary artery disease (CAD). The aims of this study were to analyze all-cause mortality and major adverse cardiovascular events (MACE- cardiovascular death, non-fatal reinfarction and stroke and target vessel revascularization) during eight-year follow-up in STEMI patients with premature CAD. Method: we analyzed 2,560 STEMI patients without previous CAD and without cardiogenic shock at admission who were treated with primary PCI. CAD was classified as premature in men aged <50 years and women <55 years. Results: Of the 2,560 patients analyzed 630(24.6%) patients had premature CAD. Patients with premature CAD have fewer comorbidities and better initial angiographic findings, as compared to patients without premature CAD. The incidence of non-fatal adverse ischemic events was similar to the incidence in older patients. Premature CAD was an independent predictor for lower mortality (HR 0.50, 95%CI 0.28-0.91) and MACE (HR 0.27, 95%CI 0.15-0.47). In patients with premature CAD, EF<40% was the only independent predictor of mortality (HR 5.59 95%CI 2.18-8.52) and MACE (HR 4.18, 95%CI 1.98-8.13). Conclusion: Premature CAD was an independent predictor for lower mortality and MACE. In patients with premature CAD, EF<40% was an independent predictor of eight-year mortality and MACE.

Aims: Chronic coronary syndrome is associated with several risk factors, such as dyslipidemia and hypertension. AIP has been demonstrated to be a biochemical risk factor for coronary artery disease (CAD). This study aimed to determine whether AIP is an effective parameter for estimating obstructive CAD. Methods and Results: A total of 345 patients (mean age 62,2±10,3; 63% male) who underwent coronary angiography were included in this study. Obstructive CAD is defined as having one or more vessels with a stenosis of≥50%. Depending on the presence of obstructive CAD, all patients were divided into two groups. The AIP was significantly higher in the obstructive coronary artery group (AIP; 0,49±0,26 vs. 0,58±0,27, p=0,002). In univariate analysis, AIP was significantly associated with obstructive coronary artery disease [OD:3,74 (CI95% 1,62-8,64), P=0,020]. The AIP was further adjusted for confounding risk factors in three multivariate analysis models. Therefore, all three models showed a significant association. According to ROC analysis, 0.49 is the cut-off value for AIP, and a value above 0.49 indicates 50% coronary artery stenosis Conclusions: AIP may be used in the assessment of cardiovascular risk in patients with stable angina pectoris, and it may also be used to estimate obstructive CAD.

We have shown that lipid-associated loci discovered by genome-wide association studies (GWAS) have pleiotropic effects on lipid metabolism, carotid intima-media thickness (CIMT), and CAD risk. Here, we investigated the impact of lipid-associated GWAS loci on the efficacy of rosuvastatin therapy in terms of changes in plasma lipid levels and CIMT. The study comprised 116 CAD patients with hypercholesterolemia. CIMT, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) were measured at baseline and after 6 and 12 months of follow-up, respectively. Genotyping of fifteen lipid-associated GWAS loci was performed by the MassArray-4 System. Linear regression analysis adjusted for sex, age, body mass index, and rosuvastatin dose was used to estimate the phenotypic effects of polymorphisms, and P-values were calculated through adaptive permutation tests. Over one-year therapy, a decrease in CIMT was linked to rs1689800, rs4846914, rs12328675, rs55730499, rs9987289, rs11220463, rs16942887, and rs881844 polymorphisms (Pperm&lt;0.05). TC change was associated with rs55730499, rs11220463, and rs6065906; LDL-C change was linked to the rs55730499, rs1689800, and rs16942887 polymorphisms; and TG change was linked to polymorphisms rs838880 and rs1883025 (Pperm&lt;0.05). In conclusion, the polymorphisms rs1689800, rs55730499, rs11220463, and rs16942887 were found to be predictive markers for multiple antiatherogenic effects of rosuvastatin in CAD patients.

Investigations are currently in progress to assess the potential of elevated FABP3 levels as biomarkers for assessing cardiac and cerebral injury post-stroke. Ongoing research endeavors are concentrated on elucidating the specific mechanisms by which FABPs, particularly FABP3, contribute to the complex processes involved in ischemic stroke. This study employs molecular docking techniques within a Virtual Screening framework to examine the interaction between various natural substances and the active site of human heart fatty acid-binding protein (PDB Code 4TKH). Utilizing Pyrx and Autodock Vina, the research aims to pinpoint compounds demonstrating robust binding interactions, characterized by high binding energy scores (kcal/mol) and the formation of multiple chemical bonds. The anticipated outcomes have the potential to yield valuable insights into the molecular interactions influencing human heart fatty acid-binding protein, suggesting possible implications for therapeutic interventions using these natural substances.From the docking and predicted toxicity results, Resistomycin has demonstrated superior characteristics compared to Morusin.

Patients with Peripheral-artery-disease (PAD) are prone to risks of major-adverse-limb-events (MALE), and major-adverse-cardiovascular-events (MACE). CHA2DS2-VASc is a prognostic score for Atrial fibrillation stroke risk, however, no study exists that evaluated its predictability for MALE and MACE in PAD patients. In this study, patients with PAD were stratified into four risk groups based on CHA2DS2-VASc score. Cox-proportional hazards models,10-fold cross-validation and Receiver operating characteristic (ROC) analyses were utilized to evaluate the predictability of CHA2DS2-VASc for predicting MALE, MACE, and MALE+MACE. Kaplan-Meier analysis estimated the survival-probability of risk-groups. CHA2DS2-VASc was found to be a significant predictor of MACE (hazard ratio (95% confidence interval; P) = 3.47 (0.99 - 12.18; 0.052), 4.12 (1.19 - 14.14; 0.024), and 5.06 (1.48 – 17.28; 0.009), for moderate-, high- and very-high-risk groups, respectively, while for MALE and MALE+MACE significance was achieved only for high-risk group. MACE demonstrated AUC > 0.8, good-discrimination (c-index > 0.8) and good-calibration. However, MALE and MALE+MACE models failed to achieve good performances. Based on all findings, CHA2DS2-VASc could potentially serve as a risk stratification score for predicting MACE in patients with PAD but failed to qualify as a good predictor for MALE.

Backgroundː Previous studies have shown that both serum creatinine and D-dimer levels were associated with atherosclerotic coronary artery disease (CAD). We aimed to determine whether DCR is associated with coronary Gensini score in patients with ST-elevation myocardial infarction (STEMI). Methodsː 337 STEMI patients with complete D-dimer and creatinine and other necessary information were included in the analysis. According to the values of the DCR, patients were divided into the lower DCR group (DCR ≤ 1.42, n = 173) and the higher DCR group (DFR > 1.42, n = 174), and the differences between the two groups were compared. Multivariate linear and multivariate logistic regression analyses were performed to determine independent predictors of Gensini score. Resultsː High DCR group had higher Gensini score compared with low DCR group (P < 0.05). DCR was positively correlated with Gensini score (r=0.493, P < 0.001). Multiple linear regression analysis showed that Previous MI (r=11.312, P=0.035) and DCR (r=5.129, P<0.001) were independent risk factors associated with Gensini score. Multivariate logistic regression analysis showed that, compared to the group 1, DCR is independent risk factor for Group 2, Group 3, Group 4 (P <0.001). DCR is positively correlated with coronary Gensini score in STEMI patients and can be used as an independent predictor of higher Gensini score. Conclusionsː As a new and useful clinical marker, DCR is positively correlated with coronary Gensini score in STEMI patients and can be used as an independent predictor of higher Gensini score.

The COVID-19 pandemic has become the largest public health crisis since the 1918 influenza pandemic. Despite the extensive research conducted on the SARS-CoV-2 virus in humans, little is still known about animal-related transmission and its consequences. Therefore, this study contributed to a better understanding of this issue by focusing on the serological survey of SARS-CoV-2 in samples from the serum bank of the Bovine Virology Laboratory at the Biological Institute of São Paulo, as well as horses and dogs from the Military Police of the State of São Paulo, and tapirs and bats from the states of Mato Grosso do Sul and São Paulo. To achieve this, the possible presence of anti-SARS-CoV-2 antibodies in domestic and wild animal species was evaluated using the ID Screen® "SARS-CoV-2 Double Antigen Multi Species" ELISA test (ID-Vet.®), following the manufacturer's recommendations. The findings of this study demonstrate a higher occurrence of anti-SARS-CoV-2 antibodies in domestic animals compared to wild animals, as well as different antibody profiles among the species analyzed, with horses showing a wide range of seroconversion comparable to humans.

Background. Oral anticoagulants (OACs) reduce stroke and systemic embolism (SE) in patients with atrial fibrillation (AF) but increase the risk of major bleeding (MB). No study has addressed the incidence and outcomes of bleeding in AF patients in the Middle East (ME). The Jordan AF study evaluated clinical profiles and one-year outcomes of AF patients who sustained bleeding events. Methods. Patients in 29 hospitals and clinics (May 2019 - December 2020) were enrolled and followed up for one year. Demographics and one-year events were compared in patients with or without bleeding. Results. Of 2018 patients enrolled; 166 patients sustained MB or clinically relevant non-major (CRNM) bleeding (8.2 events per 100 patient-years), including 47 patients who had MB (2.3 events per 100 patient-years). Compared with 1852 (91.8%) patients who did not have bleeding, patients with MB were older and had a higher prevalence of hypertension, diabetes mellitus (DM), heart failure, and malignancy, More patients with MB than those with no bleeding were using OACs (93.6% vs. 78.9%, p=0.02). Patients with MB had significantly higher one-year rates of stroke/SE (23.4% vs. 3.6%, p<0.0001) and all-cause mortality (31.9% vs 11.6%, p=0.001). Independent predictors of MB were stroke/SE (OR 10.8, 95% CI 5.3-21.9, p<0.0001), malignancy (3.4, 1.3-8.5, p=0.01), use of OACs (4.4, 1.3-14.7, p=0.02) and DM (1.9, 1.0-3.5, p=0.04). Conclusions. MB and CRNM bleeding occurred in (≈8%) of patients with AF at one year. Patients with MB (≈2%) had worse baseline clinical profiles and one-year prognosis compared with those who did not have bleeding. Keywords: Atrial fibrillation; Major bleeding events; Clinically-relevant non-major bleeding; Oral anticoagulants; Middle Eastern population; Prognosis. Clinical studies registration: the study is registered on clinicaltrials.gov (unique identifier number NCT03917992).

In this paper, we draw on recent experiences from the Young Lives study to discuss some of the ethical and practical challenges facing longitudinal cohort studies in low- and middle-income countries in the time of coronavirus. We argue that COVID-19 has instigated an ‘ethics of disruption’ for social researchers across the world, and for longitudinal cohort studies like Young Lives, this requires navigating three core considerations: first, managing research relationships and reciprocity within an observational study design; second, maintaining methodological continuity and consistency across time; and third, balancing an immediate short-term response to COVID-19 against the longer-term perspective. We refer to the study’s plan to implement a new COVID-19 phone survey to illustrate how the team are navigating this altered ethical terrain.

Nanoporous materials, such as Metal-Organic Frameworks (MOFs), are renowned for their high selectivity as gas adsorbents due to their specific surface area, nanoporosity, and active surface chemistry. A significant challenge for their widespread application is their behavior and reduced gas uptake in wet conditions, attributed to competitive adsorption between gas and water. The current understanding of gas adsorption in wet materials is constrained by studies that utilize only small amounts of powdered porous materials (in the milligram range) within very small reactors (1-5 mL). This leaves a significant gap in knowledge about gas adsorption behaviors in larger reactors and when MOF sample sizes are increased (to the gram scale) for scaling up the process. Additionally, there is a notable dearth of experimental research in situations where MOFs are heavily saturated with water. To address these gaps, this study measures CH4 adsorption in MOFs under conditions of high moisture content, using larger samples of MOFs (in grams) and a large volume reactor. We selected commercially available MOFs, including HKUST-1, ZIF-8, MOF-303, and activated carbon. A high-pressure isotherms (at T = 274.15 K) using volumetric approach were measured to qualitatively compare the moles of gas adsorbed under both dry and wet conditions across different MOFs and weights. Experimental results show that the presence of water led to a decrease in total CH4 mmol adsorption in MOFs, with a more significant decrease observed in hydrophilic MOFs compared to hydrophobic ones. For hydrophilic MOFs, presence of crossover isotherms at crossover pressure provided evidence of water's conversion to hydrate and its positive role in enhancing total gas uptake, which varied among different hydrophilic MOFs. Oversaturated MOFs showed a larger deviation between dry and wet cases at higher pressures. The high-pressure isotherm data confirm the positive role of hydrophilic MOFs in the conversion of water to hydrate in oversaturated MOFs when MOFs sample size is large.

This study aimed to evaluate the early-childhood comorbidities of cerebral palsy (CP) in children with low birth weight (LBW) and assess the impact of maternal bio-psychosocial factors on the risk of CP in preterm infants across varying birth weights. Data for 15,181 prematurely born infants from 2009 to 2013 and 151,810 matched controls from Taiwan's National Health Insurance Research Database were analyzed. Period prevalence of CP, and comorbidities of LBW were verified, and odds ratios (ORs) were calculated. Results confirmed that increasing prematurity and low birth weight (LBW) rates in Taiwan. LBW was associated with higher CP prevalence. Maternal age extremes (&lt;20 and &gt;40 years) were significant risk factors of CP in LBW infants. LBW infants showed higher risks of respiratory, circulatory, and nervous system and psycho-developmental comorbidities compared to controls. Infants with the lowest birth weights had even higher ORs for these comorbidities. However, gastrointestinal and nutritional comorbidities were less prevalent in premature infants. Maternal factors such as family income, number of hospital admissions, and length of hospital stay were significantly correlated with birth weight and subsequent complications. Each additional gestational week significantly reduced the risk of complications in premature infants. Additionally, maternal bio-psychosocial factors were associated with birth weight and related outcomes in premature infants, emphasizing the importance of addressing these factors in prenatal care and interventions.

This study centers on childcare facilities catering to children with moderate cerebral palsy, exploring a four-phase process: (1) cultivating an understanding and acceptance, (2) integrating specialized resources, (3) developing strategic plans, and (4) establishing stable collaboration. The case study demonstrates the profound impact of well-rounded support systems. Children with cerebral palsy showed marked improvements in development and emotional stability. Concurrently, their peers developed greater empathy and cooperative skills, smoothly adjusting to the inclusive setting. Additionally, the childcare staff refined their methods and attitudes, enhancing their ability to meet each child's specific needs and thus elevating the standard of integrated care.Concluding with three strategic recommendations, the paper proposes measures to augment the quality of care for children with special needs. These include defining clearer guidelines and policies for special needs care in childcare environments, emphasizing professional development and the amalgamation of diverse resources to cultivate a more skilled caregiving workforce, and encouraging robust partnerships between parents and childcare facilities. These recommendations are expected to significantly influence the domain of inclusive education, providing crucial insights for those engaged in early childhood care and education..

This study aimed to evaluate the positive effect of autumn olive berries (AOB) extract on aging delay by improving the lipid metabolism of middle-aged C. elegans who became obese due to high glucose (GLU) diet. As a result of investigating the total phenol content and DPPH radical scavenging ability of freeze- or spray-dried AOB, freeze-dried AOB showed better antioxidant potential. Afterward, through HPLC analysis, it was confirmed that catechin was the main compound in the polyphenols of AOB. Therefore, we used freeze-dried AOB in subsequent in vivo experiments. AOB inhibited lipid accumulation in both the young adult and middle-aged groups in a concentration-dependent manner under both normal and 2% GLU conditions. Additionally, AOB inhibited ROS accumulation in a concentration-dependent manner under normal and 2% GLU conditions in the middle-aged worms. In particular, AOB also increased the number of body bending and egg production in middle-aged worms. To confirm the intervention of genetic factors related to lipid metabolism in the effect of AOB, body lipid accumulation was confirmed using worms deficient in the daf-16, atgl-1, aak-1, and akt-1. Regarding the effect of AOB on reducing lipid accumulation, the impact was nullified in daf-16 deficient worms under the 2% GLU condition and nullified in both daf-16 and deficient worms under fasting conditions. This means that AOB regulates lipogenesis and lipolysis by mediating daf-16 and atgl-1 in middle-aged worms. Our results suggest that AOB contributes to the aging delay effect by improving lipid metabolism in metabolic impaired middle-aged worms.

The work analyses the way in which symptoms and life themes manifest in middle-aged adults diagnosed with major recurrent depression. Specifically, the relationships between symptoms, life themes, and life themes - symptoms have been analyzed. For this purpose, Spearman correlation, and the methods of Latent Semantic Indexing (LSI) were used. Seven symptoms and twenty-six life themes were identified in the patients analyzed as well as similarities of symptoms/life themes (at patient level), the ranking of the importance of symptoms on each life theme (at the level of the group of patients), the rankings of the similarities of life themes in relation to different symptoms or various groups of symptoms (at the level of the group of patients), and dysfunctional cycles of symptoms and life themes (at patient level). The findings only refer to the patients analyzed. Although our findings cannot be generalized, there is a possibility that some of them may also be encountered in other patients. However, the design of the work can be used to initiate other similar studies.

Traditional olive orchards have been grown for thousands of years and still occupy most of the world’s olive cultivation area. To compete with olive oil produced in the higher-yielding intensive orchards, the oil from traditional orchards must be of high quality. We evaluated oil quali-ty—potential and actual (under commercial conditions)—and identified the stages in the pro-duction chain that reduce oil quality in the traditional sector in the Middle East region. Our findings show a clear negative impact of growers' traditional practices on both chemical and sensorial characteristics of the olive oil. The oil originating from the commercial process had higher free fatty acid and lower polyphenol and carotenoid contents, lower stability, lower pungency, fruitiness and bitterness, and a higher prevalence of organoleptic defects than oil originating from fruit picked from the same trees in the experimental procedure. The current, commonly harvesting technique of pole beating significantly increased fruit injury and fruit with mold, leading to a reduction in oil polyphenols and an increase in free fatty acid level compared to manual picking. After harvest, storing the fruit for more than 48 h in plastic bags reduced oil quality dramatically. The traditional olive orchard could potentially be a source of high-quality Extra Virgin Olive Oil. However, handling of the fruit—from the trees until the end of the oil-extraction process—is done incorrectly, adversely affecting oil quality.

Advanced Hepatocellular carcinoma (HCC) is no longer a terminal illness. This change was mainly attributed to the development of new treatments including tyrosine-kinase inhibitors (TKIs), vascular endothelial growth factor (VEGF) inhibitors and immune checkpoint inhibitors (ICPIs) but the financial toxicity of treating advanced HCC is of a major concern specially in low middle-income countries (LMICs) where the patients are still battling for their most basic rights. Most of advanced HCC patients in LMICs have very limited accessibility to the new treatments including ICPIs. Searching for out of the box solutions to improve access to treatments -mainly ICPIs- is an utmost necessity for LMICs advanced HCC patients.

Small modular reactors (SMR) (&lt;300 MW) offer a potentially attractive nuclear energy option for the middle-east region (MER). Currently, the MER uses a significant amount of fossil fuel to process heat applications such as water desalination and in petroleum refineries and chemical plants, besides generating electricity. SMR technologies represent an opportunity to meet future energy demand in the MER. This paper discusses issues related to the future development and use of SMR technology in nuclear-renewable hybrid energy systems for application in the middle east. SMRs have also been examined as part of a resilient hybrid energy system that combines nuclear energy with renewable energy and traditional fossil energy to produce chemicals, fuels, and electricity. This paper presents the results of a techno-economic analysis of a Nuclear-Renewable-Conventional Hybrid Energy System. The paper concludes that SMR technology will be an essential feature of future hybrid energy systems for the MER.

This study aimed to compare the prognosis and characteristics of patients with advanced hepatocellular carcinoma treated with first-line atezolizumab plus bevacizumab (AB) combination therapy and hepatic artery infusion chemotherapy (HAIC). We retrospectively assessed 179 and 72 patients treated with HAIC and AB combination therapy, respectively, between January 2018 and January 2023. The progression-free survival of patients treated with HAIC was significantly superior than that of patients treated with AB (P&lt;0.05), but there was no significant difference in overall survival and objective response rate (ORR) between the two groups (P=0.1056 and P=0.137, respectively). After propensity score matching (PSM), our data revealed that there was no significant difference in PFS between patients who received AB combination therapy and HAIC therapy (P=0.8888). However, patients who received AB combination therapy had significantly better overall survival than those who received HAIC therapy (P=0.0133). In addition, after PSM, significant differences in ORR and disease control rate were not observed. In conclusion, our propensity score study reveals that patients treated with AB therapy have a significantly longer OS than those treated with HAIC.

Despite evidence-based therapies, patients presenting with atherosclerosis involving more than one vascular bed, such as those with peripheral artery disease (PAD) and concomitant coronary artery disease (CAD), constitute a particular vulnerable group characterized by enhanced residual long-term risk for major adverse cardiac events (MACE), as well as major adverse limb events (MALE). The latter are progressively emerging as a hard outcome to be targeted, being correlated with increased mortality. Antithrombotic therapy is the mainstay of secondary prevention in both patients with PAD or CAD however, the optimal intensity of such therapy is still topic of debate, particularly in the post-acute and long-term setting. Recent well powered randomized clinical trials (RCTs) have provided data in favor of a more intense antithrombotic therapy, such as prolonged dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor or a therapy with aspirin combined with an anticoagulant drug. Both approaches increase bleeding and patients selection is a key issue. The aim of this review is therefore to discuss and summarize the most updated available evidences for different strategies of anti-thrombotic therapies in patients with chronic PAD and CAD, particularly focusing on studies enrolling patients with both type of atherosclerotic disease and comparing a higher versus a lower intensity antithrombotic strategy. The final objective is to identify the optimal tailored approach in this setting, to achieve the greatest cardiovascular benefit and improving precision medicine.

A single coronary artery is a very rare condition, commonly associated with other congenital anomalies. It could be generally classified as neither benign nor malignant form of congenital coronary artery anomalies since its pathophysiological and clinical implications grossly depend on different anatomical patterns defined by the site of origin and distribution of the branches. By presenting the patient with an isolated single coronary artery, who underwent successful combined aortic valve replacement and coronary artery bypass grafting surgery, we intend to distinguish casual from causal in this extremely rare clinical and surgical scenario. This is the first-ever case published, combining such underlying pathology, clinical presentation, and surgical treatment.

Lower urinary tract symptoms (LUTS) and hematuria are common symptoms in men with benign prostatic hyperplasia (BPH) and prostate cancer (PCa) mainly affecting the elderly population. Prostatic arterial embolization (PAE) is a minimally invasive pro-cedure that has shown promising results in managing massive intractable prostatic he-maturia in patients with BPH and PCa. A few studies, however, have provided valuable insights into the durability and efficacy of PAE focusing on the long-term effectiveness, quality of life, and cancer-specific control of hemostasis and urinary symptoms. As a result of concomitant cardiovascular conditions, these patients often take anticoagulants or antithrombotics, which can worsen their hematuria and clinical status. Transurethral resection of the prostate (TURP) is considered a very high-risk procedure even without massive bleeding, and requires discontinuation of Vitamin K antagonists and antiplate-let therapies. Such patients usually have their surgery postponed, and PAE should be considered a safe alternative treatment. We aimed to report a narrative review from 1976 to June 2023 of the current state of PAE for massive and intractable hematuria highlighting recent developments in this technique, including prospective cohort stud-ies and focusing on long-term outcome, safety, and complication management in PCa patients with significant hemorrhagic symptoms. As an additional contribution, we propose a simple algorithm for treating intractable bleeding associated with prostate cancer in a 92-year-old man with LUTS.

Background Coronary artery disease (CAD) is a widely recognized cardiovascular disease that is considered the leading cause of death worldwide, affecting people on a global scale. Percutaneous coronary intervention (PCI), which involves procedures such as balloon angioplasty or stenting, plays an important role in opening blocked arteries and minimizing damage to the cardiac muscle. While the use of drug-eluting stents (DESs) has significantly reduced the occurrence of coronary restenosis, the problem of in-stent restenosis (ISR) continues to pose a significant clinical challenge. Gaining a deeper understanding of the clinical predictors associated with ISR is vital for early detection and appropriate treatment. Hence, this study aimed to evaluate the clinical predictors of ISR specifically in Taiwanese patients. Methods We conducted a single-center, retrospective case-control study, enrolling 517 CAD patients undergoing previous coronary stenting and stable angina with positive stress test or acute coronary syndrome (ACS) during follow-up between January 2019 and December 2022 at National Taiwan University Hospital. The patients were categorized into two groups: the ISR group, consisting of individuals who received drug-coated balloon (DCB) treatment (n=177), and the non-ISR group, comprising patients who did not receive DCB treatment (n=340). To gather relevant data, we meticulously reviewed the medical records and analyzed the findings from coronary angiography to assess the clinical characteristics of the patients. Results Patients with three-vessel disease (3VD) exhibited a higher prevalence of underlying diseases and were more likely to be taking aspirin and clopidogrel. Moreover, our analysis revealed that age (adjusted odds ratio [aOR] 1.02, 95% confidence interval [CI] 1.00 - 1.04, p = 0.037) and the presence of 3VD (adjusted odds ratio [aOR] 2.15, 95% confidence interval [CI] 1.03 - 4.46, p = 0.039) were significantly associated with an increased risk of coronary ISR. Conclusions Older age and 3VD were the independent predictors of coronary ISR in CAD patients receiving coronary stent implantation.

Kawasaki disease is a form of acute febrile multisystem vasculitis. In Japan, the Kobayashi score is used to predict intravenous immunoglobulin resistance and subsequent complications, including coronary artery abnormalities, in children with Kawasaki disease. If the score is high, it is standard practice to use steroids in the initial treatment of the disease. In this study, we describe a pediatric case of coronary artery abnormality formation after acute steroid treatment for Kawasaki disease, despite the lack of an inflammatory response and Kawasaki disease symptoms. The use of steroids with acute Kawasaki disease patients can mask laboratory findings and clinical symptoms. Echocardiogram should be considered an equivalent technique to physical examination.

Cardiovascular-related diseases are one of the leading causes of death worldwide. An understanding of heart movement based on images plays a vital role in assisting the procedure in the postoperative and postoperative processes. In particular, if the shape information can be provided in real-time using the electrocardiogram(ECG) signal using this information, the heart’s movement information can be used for cardiovascular analysis and imaging guides during surgery. In this paper, we propose creating a 3D+t cardiac coronary artery model that is rendered in real-time according to the ECG signal. Hierarchical cage-based deformation modeling is used to generate mesh deformation used during the procedure according to the ECG signal. We match the blood vessel’s lumen obtained from the ECG-gated 3D+t CT angiography taken at the multiple cardiac phases to derive the optimal deformation. Splines for 3D deformation control points were used to continuously represent the obtained deformation at the multi-view according to the ECG signal. To verify the proposed method, we compared the manually segmented lumen and results of the proposed method for eight patients. The average distance and dice coefficient between the two models was 0.543mm and 0.735, respectively. The required time for registration of the 3D coronary artery model is 23.53 seconds/model. rendering speed to derive the model according to the ECG signal after generating the 3D+t model is faster than 120 FPS.

This study concerns the transport and retention of polydisperse micron-sized (16 ± 6 µm) of microplastics (MPls) in porous media under varying flow rate conditions. Sorption kinetics were modeled using first-order reversible and irreversible kinetic sorption models, with sensitivity analyses providing insights into each sorption parameter's effect. Both numerical modeling and experimental measurements were employed to assess sand filter retention rates. The impact of flow rate on sorption reveals variations in distribution coefficient (Kd), mass transfer coefficient (β), and irreversible sorption rate (K1). Lower flow rates are correlated with higher Kd and β values, indicating an increase in sorption and diminished mass transfer rates. The findings revealed that an increase in Kd resulted in a more gradual sorption process with a decrease in peak concentration, whereas changes in β influenced the rate of sorption and peak concentration to a lesser extent compared to Kd. Lower K1 values are associated with higher peak concentrations and decreased retention efficiency. Retention rates were evaluated by a numerical model and found as 28 ± 1% at a flow rate of 31 ml min⁻¹ and 17 ± 1% at 65 ml min⁻¹. The introduction of MPls into soil environments has been noted to modify transport dynamics into soil. As a result, these alterations effects hydrological characteristics of soil, thereby impacting quality of groundwater and agricultural output. The mean absolute error (MAE) of 6% between modeled and observed retention rates suggests minor discrepancies. This study highlights the importance of examining retention efficiency and the accuracy of numerical models in porous media during MPl transport.

Coptisine (Cop) exerts a neuroprotective effect in central nervous system disease, particularly ischemic stroke. However, its protective mechanism is still unclear. This study aimed to investigate the protective effect of Cop on cerebral ischemia-reperfusion (IR) rats with a middle cerebral artery occlusion model by integrating a gas chromatography-mass spectrometry (GC-MS) based metabolomics approach with biochemical assessment. Our results showed that Cop could improve neurobehavioral function and decrease the ischemia size in IR rats. In addition, Cop was found to decrease inflammatory mediators (e.g., prostaglandin D2 (PGD2) and tumor necrosis factor-α (TNF-α) and attenuate oxidative stress response (e.g., increase the superoxide dismutase (SOD) expression and decrease 8-iso-PGF2α level). Furthermore, GC-MS based cerebrospinal fluid (CSF) metabolomics analysis indicated that Cop influenced the level of glycine, 2,3,4-trihydroxybutyric acid, oleic acid, glycerol, and ribose during IR injury. Cop exhibited a good neuroprotective effect against cerebral IR injury and metabolic alterations which might be mediated through its antioxidant and anti-inflammatory property.

Herein, we examined the effects of weather parameters and individual clinicodemographic risk factors on hemorrhagic stroke (HS) incidence, severity on admission, and disability at discharge in a harsh desert climate. In a retrospective design we studied patients admitted to a stroke unit in Arab Emirates in 2016-2019. With a distributed lag nonlinear model we explored immediate and delayed effects of weather on stroke incidence. Supervised machine learning was used to build models predictive of scores in NIHSS and mRS scales. We assessed model performance by calculating ROC AUC, F1 scores, specificity, and sensitivity. HS risk increased after a significant change in any weather parameter. The risk was reduced below baseline after 1-week adjustment to environmental changes. Climate input from the previous 3 days yielded reliable classification models. Humidex was a better predictor of severity than air temperature, whereas body mass index, age, and time of day at stroke onset were the strongest clinical predictors. Weather parameters before admission were stronger predictors of disease severity than individual clinical factors. We addressed limitations of previous studies by analyzing a full set of climate parameters: ambient temperature, relative humidity, humidex, atmospheric pressure, and wind speed. Predictive models may help to optimize patient management and develop preventative strategies.

Cannabinoids are prescribed to children with cerebral palsy (CP) despite limited evidence. We aimed to assess the prescription practices of cannabinoids in children with CP with a particular focus on indications, what kind of preparations are used and how well cannabinoids are tolerated. Furthermore, we investigated how physicians acquire knowledge on cannabinoid medication. We asked physicians with expertise in the care of children with CP about their prescription prac-tices of cannabinoids. Data was collected through an online survey, which was distributed by email. In addition to the demographic information of participants, we also inquired about the indications for the prescription of cannabinoids, about experiences regarding efficacy, and ob-served side effects of the therapy. Seventy physicians from Europe, North America and Australia completed the survey. Forty-seven participants were experienced in the treatment of children with CP by cannabinoids. The most common indication was epilepsy (69%), followed by spasticity (64%) and pain (63%). The pre-scribed preparations and doses varied considerably. Half of the participants evaluated the effect of the cannabinoids as moderate. Twenty-nine physicians reported side effects, most frequently drowsiness (26%), somnolence (19%), fatigue (13%), and diarrhea (13%). Despite the lack of evidence to date, cannabinoids are used to treat children with CP in a wide variety of indications. Randomized controlled trials in this vulnerable patient group are therefore of utmost importance.

Coronary revascularization is one of the most studied treatment modalities in cardiology, however, there is no consensus among experts about its indications in patients with stable coronary artery disease (SCAD). Contemporary data regarding the role of revascularization in SCAD are in clear conflict with the current European guidelines. This article discusses the main statements of the most significant American and European Guidelines on myocardial revascularization of the last decade, and also analyzes the appropriateness of revascularization to improve the prognosis and symptoms in CCS in the light of new research data, primarily the ISCHEMIA study (NCT01471522) and ACC/AHA 2021 Revascularization Guidelines based on them. Data on the revascularization in CCS obtained after the completion of ISCHEMIA (including the interim analysis of ISCHEMIA-EXTEND) and their potential significance are discussed. The results of ISCHEMIA sub-analyses in the most important ‘controversial’ subgroups (3-vessel disease, proximal left anterior descending artery (LAD) disease, strongly positive stress test, etc.) are reviewed, as well as the results of the ISCHEMIA-CKD substudy in patients with severe chronic kidney disease (CKD).

Oxysterols have been implicated in the pathogenesis of cardiovascular diseases. Serum levels of oxysterols could be positively correlated with cholesterol absorption and synthesis. However, physiological regulation of various serum oxysterols is largely unknown. The aim of this study was to investigate the relationship between clinical factors and cholesterol metabolism markers, and identify oxysterols associated with cholesterol absorption and synthesis in patients with coronary artery disease. Subjects (n=207) who underwent coronary stenting between 2011 and 2013 were studied cross-sectionally. We measured lipid profiles including serum oxysterols. As for the serum biomarkers of cholesterol synthesis and absorption, oxysterol levels were positively correlated with campesterol and lathosterol. Covariance structure analysis revealed that dyslipidemia and statin usage had a positive correlation with “cholesterol absorption”. Statin usage also had a positive correlation with “cholesterol synthesis” Several oxysterols associated with cholesterol absorption and/or synthesis. In conclusion, we elucidated the potential clinical factors that may affect cholesterol metabolism, and the associations between various oxysterols with cholesterol absorption and/or synthesis in patients with coronary artery disease.

Pharmaceutical poisoning is a significant global public health concern, causing approximately 190,000 deaths yearly. This scoping review aims to comprehensively map the available literature on pharmaceutical poisoning and compare patterns between high-income countries (HICs) and low-middle-income countries (LMICs). A systematic search was performed across the following databases: Embase, PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and CINAHL. Studies included were from 1st January 2011 to 31st December 2020, in English, with full text available. Seventy-nine articles were included in the study; 21 were from LMICs and 58 were from HICs. The toxic exposure was largely intentional (77%) in LMICs and accidental (68%) in HICs. Drugs acting on the nervous system were responsible for 95% of toxicities worldwide with analgesics accounting for the largest subtherapeutic group in both LMICs (40%) and HICs (58%). Notable statistics were that HICs accounted for 99% of opioid overdoses, and LMICs accounted for 19% of anti-epileptic-induced toxicities. Overall, the medical outcomes of poisonings were generally worse in LMICs. The review provides possible interventions to target specific geographic locations, based on the trends identified, to reduce the burden worldwide. Many gaps within the literature were recognised, calling for more robust analytical research.

BACKGROUND G6PD deficiency is an inherited an X-linked recessive condition leading to insufficient levels of glucose-6-phosphate dehydrogenase, thus causing hemolytic anaemia under certain conditions. METHODS Our study is explorative for cases admitted to Jordan University Hospital. The studied parameters include demographics, clinical manifestations, biochemical markers including Hb level, WBC count, liver enzymes, and blood grouping. RESULTS Most of the patients were admitted to the emergency unit (53.13%). Individuals who were Rh-positive represented 57.81%, while patients of AB blood group accounted for 75%. The mean values were 4.81 years (age), 29.06 hours (time-to-hospital admission), 38.10 degree Celsius (temperature), 6.11 gm/dl (Hb), 13242.19 (WBC count), 343.20 U/L (S. ALP), and 50.98 IU/L (S. ALT). There was no significant difference between males and females or between favism-induced versus drug-induced hemolytic episodes. AB and Rh positive blood groups are of protective effect in relation to liver enzymes. Patients who were admitted to the hospital within 24 hours from having clinical manifestations had a better prognosis. CONCLUSION This study is the first inferential research on G6PD deficiency from the Middle East to explore cases from one of the largest healthcare centres in Jordan. The role of blood grouping should be investigated prospectively.

BACKGROUND: diabetic foot ulcers (DFU) represent the main cause of major amputations and hospitalizations in diabetic patients. Aim of this study was to assess safety and cost-efficacy of intramuscular injection of peripheral blood mononuclear cells (PBMNCs), in diabetic patients with no-option chronic limb-threatening ischemia (CLTI) and small artery disease (SAD). METHODS: a retrospective study was carried out on a series of types 2 diabetic patients with DFU grade Texas 3 and no-option CLTI and SAD. All patients had undergone at least a previous revascularization and were allocated in a surgery waiting-list for major amputation. The principal endpoint evaluated at 90 days was a composite of TcPO2 values at the first toe ≥30 mmHg and/or TcPO2 increase of at least 50% from baseline and/or ulcer healing. Secondary endpoint were individual components of the primary endpoint, any serious and non-serious adverse events, direct costs at one year. RESULTS: the composite endpoint was achieved in 9 patients (60.0 %); one patient (6.7%) healed within 90 days and 26.7% and 46.7% showed TcPO2 ≥30 mmHg and a TcPO2 increase of at least 50% at 90 days, respectively. At 1-year, three (20.0%) patients underwent a major amputation (all diagnosed SAD grade III). One patient died after seven months, and seven patients (46.7%) healed. The overall median and mean cost per patient were 8,238±7,798€ and 4,426[3,798;8,262]€, respectively. CONCLUSIONS: the use of PBMNCs implants in no-option CLTI diabetic patients with SAD seems to be of help in reducing the risk of major amputation.

Objective. Acute bowel ischemia is a life-threatening abdominal emergency. In many patients percutaneous endovascular repair of visceral arteries in an antegrade direction, across occluding plaques is challenging and sometimes not possible. Case Report. We present the case of technically successful percutaneous retrograde recanalization of occluded superior mesenteric artery in ctitically-ill 82-year-old patient. The superior mesenteric artery was recanalized via the branches of the celiac trunk; the guidewires were navigated to the target artery through the gastroduodenal and pancreatoduodenal arteries. Conclusion. Retrograde percutaneous recanalization of the superior mesenteric artery is technically feasible, even in hemodynamically unstable patients.

To investigate the impact of a magnetic field on plaque development in a stenotic bifurcated artery, a finite element method is utilized. The blood flow is modelled as a stable, incompressible, Newtonian, biomagnetic, and laminar fluid. Furthermore, the arterial wall is assumed to be linear elastic. The Arbitrary Lagrangian Eulerian (ALE) method is employed to describe the hemodynamic flow in a bifurcated artery under the influence of an asymmetric magnetic field, taking into account two-way fluid-structure interaction coupling. A stable $P_2P_1$ finite element pair discretizes a nonlinear system of partial differential equations that requires a solution. The Newton-Raphson method is utilized to find a solution to the resulting nonlinear algebraic equation system. Numerical modelling is used to simulate the presence of magnetic fields, and the resulting displacement, velocity magnitude, pressure, and wall shear stresses are shown for a range of Reynolds numbers ($Re = 500$, $1000$, $1500$, and $2000$). The results of the numerical analysis demonstrate that the presence of a magnetic field has a significant effect not only on the magnitude of displacement but also on the velocity of the flow. The application of a magnetic field reduces flow separation, extends the recirculation area near the stenosis, and increases wall shear stress.

Abstract Background: Cluster randomized controlled trials are increasingly becoming popular in public health research interventions and health services research in primary health care design and use in low and middle-income countries. However, the majority of researchers in these trials did not account correctly for the effect of confounders and clustering in the design and analysis stages. Objectives: This article aimed to review the main implications of implementing a cluster randomized controlled trials design in public health research and emphasize the practical application of proper analytical methods and the performance of different statistical models. Methods: The practical application of various analytical methods is validated via the utilization of experimental data from a public health research case study. This article also demonstrated the performance of hierarchical models and made comparisons in terms of empirically precise effect size estimates. Results: Three hierarchical statistical models were provided with highly varied effect sizes during the analysis of the intervention effect on outcome, such as model 1 (AOR: 14.32; 95% CI: 3.75–54.68), model 2 (ARR: 3.52; 95% CI: 2.16–5.77), and model 3 (ARR: 4.79; 95% CI: 2.69–5.52).Conclusion: Inaccurate results and potentially misleading conclusions can arise from improper cluster randomized controlled trial designs and analyses. This article has shown that real-world data can be adjusted for the effects of confounders and clustering, and we advocate for the routine use of suitable design and analytical methods. This article concludes that researchers should be careful when selecting hierarchical models to analyze cluster randomized controlled trials.

This study was conducted to examine the moderating and mediating effect of ego - resilience, parenting attitude, and peer attachment in the relation between smartphone dependency and aggression. Participants were 1,863 youths using a smartphone among the first middle school students responded in the 7th Korean Children and Youth Panel Survey (KCYPS) conducted by the National Youth Policy Institute in Korea. The data were analyzed by descriptive statistics, a correlation, and a hierarchical regression analysis. First, ego-resilience showed a partial mediating effect on the relationship between smartphone dependency, aggression and significant moderating effects were revealed. Second, parenting behavior showed a partial mediating effect on the relationship between smartphone dependency and aggression, with no moderating effects seen. Third, peer attachment had a partial mediating effect on the relationship between smartphone dependency and aggression, with no moderating effects seen. The research suggested the mental health and growth of students could be improved by applying various nursing and health care programs to improve ego-resilience, parenting behavior and peer attachment as they grow into adulthood.

Through long-term Rayleigh lidar observations during 2010-2022, atmospheric gravity wave (AGW) activities in the middle atmosphere (30–65 km) are statistically investigated at Haikou (110.3°E, 19.9°N) in China. In total, 827 quasi-monochromatic AGW events are identified from the lidar dataset, and the vertical wavelength, observed wave period, and vertical propagation direction of dominant waves are extracted for each AGW event by analyzing the power spectra of wave-induced temperature perturbations. It is revealed that 81.7% of all AGW events were associated with upward-propagating waves, and the proportion of upward-propagating AGWs reached a maximum in autumn and a minimum in winter. The most common vertical wavelengths and wave periods were 6–11 km and 4–10 hours, respectively. In particular, 68 AGW events associated with simultaneous upward and downward propagating waves were observed by lidar, corresponding to 8.2% of the events. The occurrence of such special AGW phenomena is qualitatively discussed, and multiple formation mechanisms may exist. Comparisons are made with previously reported lidar observation results, and the statistical features of AGW activity in the low-latitude middle atmosphere may vary over a relatively wide range depending on the location and altitude. However, a majority of AGWs propagate upward in the middle atmosphere.

Conclusions: HRCT is a valuable tool in preoperative assessment of cholesteatoma, helping in making surgical decisions. It can accurately predict the extent of disease and is helpful for detecting unapparent dangerous situations. However it is not very accurate in detecting Fallopian canal and stapes erosion.

A sustainable diet which is healthy and environmental friendly is a climate change mitigation option in addition to being a health promoting diet. However, there is a scarcity of information if the Asian diets are sustainable. Therefore, this study aimed to investigate if the diet of the Malaysian population is healthy and sustainable. This is a cross sectional study using dietary data generated from food frequency questionnaires (FFQ). The carbon footprint data were linked with the food items/ food groups in the FFQ. The nutrients of the participants’ diet were computed and the proportions of those who met the recommended nutrients intake were established. Contribution of carbon footprint for different food groups and total carbon footprint for each participant’s diet were computed and expressed as kgCO₂eq. Comparison of carbon footprint from participants’ diets between age, sex and ethnicity were carried out. A total of 4825 participants were included in the analysis. Majority were Malays (66.4 %), females (84.0%), married (80.0%) and in the age groups of 30s to 40s (68.8%). The mean total energy intake was 2485+1000 kcal/day. Only 40 to 60% of all participants achieved the Malaysia Recommended Nutrient Intake (RNI) for calcium and less than half of the female participants who were aged 50 years and below fulfilled the RNI for iron. The most commonly consumed food groups were vegetables (270g/day), wheat, rice, fruits, sugar, seafood, poultry, legumes, snacks, milk and beef (46g/day). Total carbon footprint from the participants’ diets were 2.96 kgCO₂eq/day, with the highest contributions of carbon footprint from rice, vegetables, beef, sugar, other cereals, poultry, seafood, wheat, milk, fruits, legume and snacks. Subgroups such as males, Malays and younger participants were more likely to consume diets with higher carbon footprint, compared to their counterparts. The participants’ diet was low in carbon footprint and environmentally friendly, however the quality of diet may need to be improved. Education measures should be targeted for all population and specifically for the sub-groups that consumed diets with higher carbon footprint.

Greenhouse Gases (GHGs) emission has considerable impact on global warming and climate change. Since energy systems and their features noticeably influence on the amount of GHGs emission, it can be modeled based on the specifications of energy sources utilized by the countries. In addition, economic activity is another factor which should be considered in GHG emission modeling. In this work, Artificial Neural Network (ANN) is used for estimating carbon dioxide emission, as one of the most abundant GHGs, on the basis of shares of various energy sources used as primary energy supply and GDP as an indicator for economic activities. Five countries including Iran, Kuwait, Qatar, Saudi Arabia and United Arab Emirates (UAE) are considered as case studies. Comparing between the estimated data by the achieved model and actual quantities showed acceptable precision of the ANN model for prediction of carbon dioxide emission. The average absolute relative error and the R-squared values of the GMDH model are approximately 2.28% and 0.9998, respectively. The obtained values for the mentioned statistical criteria show the precision of the model in forecasting the emission of Co2.

Ischemia stroke is one of a clinically common cerebrovascular disease. And Inhibition of brain tissue ischemia and reperfusion-induced damage, especially apoptosis, has an irreplaceable protective effect on ischemic nerves, and has special significance for the treatment of patients after treatment. However, the development of neuroprotective drugs still has certain challenges. Radix scrophulariae as a valuable medicine, has been discovered to has neuroprotective effects. Our researches initially proved that Radix scrophulariae aqueous extract (RSAE) exerting a neuroprotective effects on cerebral ischemia and reperfusion (I/R) injury in oxygen glucose deprivation and reperfusion (OGD/R)-induced PC12 cells and middle cerebral artery occlusion/reperfusion (MCAO/R) model mice, were associated with attenuation of infarct volume, brain water content, nitric oxide (NO) and malondialdehyde (MDA), inhibiting I/R-induced damage by reducing the levels of LDH release, improving anti-oxidant capacity by upregulating the SOD, GSH-Px and CAT activity, stabilizing mitochondrial membrane potential, reducing neuronal apoptosis, necrosis and neuronal loss by regulating the expression of anti-apoptotic BCL-2and pro-apoptotic protein Bax, and elucidating downregulate the phosphorylation levels of MAPK pathways. Our findings may elaborate the neuroprotective effects and potential mechanisms of RSAE on focal cerebral I/R injury in mice. Since, Radix scrophulariae, as a potential neuroprotective natural plant, has originally been identified to, our results may offer directions and clues for discovering new active compounds or drugs for treatment of ischemic stroke, which allows us to discover many new natural active chemicals by chemical separation and identification, and provide new insights into therapeutic targets in stroke patients.

Horse riding therapy, also known as hippotherapy, is a popular treatment for children with cerebral palsy (CP). However, the need for trained therapists, massive land use, and expensive maintenance of the horse ranch makes hippotherapy not affordable or even available for most patients in Indonesia. This problem motivates us to consider mechanical horse riding simulator machines to replace actual horse hippotherapy. However, most patients are children and are easily bored when asked to do monotonous activities for an extended period. The room setting also does not give the patient visual inputs that usually help motivates the children in real-horse hippotherapy activities. To solve this problem, we designed an exercise game (exergaming) software which we named \textit{Sirkus Apel}, providing the patients with fun activities while doing the therapy. We also design an inertial sensor-based controller that lets the patients control the in-game horse by their back movements, which also benefits CP patients. To make the visual input enjoyable to the user while also considering the user's safety, we built a convex mirror-based dome virtual reality to provide an immersive 3-D experience. We then project the game content to the dome to provide an immersive experience to the patients making it as if they are riding a real horse inside the game.

Background: Genome-wide association studies have identified the chromosome 9p21 locus as one of the most important genetic risk factors for cardiovascular disease. However, the mechanism by which this locus promotes disease remains unclear due to difficulty identifying the causal genes and lack of a suitable animal model. Methods and Results: A total of 180 coronary artery autopsy specimens were analyzed histopathologically. The genotype of 9p21 (rs1333049) was not associated with any coronary risk factors nor the vulnerable plaque phenotype, but carriers of 9p21 risk allele did demonstrate more lesional calcification. To extend these studies into an animal model, mice with a targeted deletion of the orthologous 70-kb non-coding interval on chromosome 4 (chr4^D70kb/D70kb) were bred onto ApoE^-/- and fed with high fat diet. Targeted deletion of the 9p21 risk interval increased susceptibility to atherosclerotic plaque progression, but did not affect plaque rupture in the tandem stenosis model. Coronary risk factors such as body weight, blood pressure, lipid, and glucose levels did not differ between genotypes. Von Kossa staining revealed that chr4^D70kb/D70kb, ApoE^-/- developed more calcification in the plaque compared with chr4^+/+, ApoE^-/- mice, and that this this change was accompanied by increased aortic mRNA expression of Runx2, a key osteogenic transcription factor. Primarily cultured smooth muscle cells from chr4^D70kb/D70kb were hyperproliferative, and showed a calcification-prone phenotype after exposure to high-phosphate medium. Treatment with Palbociclib, a selective inhibitor of cyclin-dependent kinase 4/6, reduced mRNA expression of osteogenic genes in smooth muscle cells. Conclusion: Results from human and mouse studies indicate that the 9p21 non coding risk interval is associated with larger atherosclerotic plaque burden, but not with plaque rupture. 9p21 may promote lesion expansion by inducing the proliferation of de-differentiated and osteogenic smooth muscle cells.

Target 9.c of the 2015 United Nations (UN) sustainable development goals (SDGs) specifically addresses increasing access to information and communication technology (ICT) resources, and striving for universal access to the internet by 2020. The present study seeks to evaluate the effectiveness of the youth related national strategies implemented in this regard by a select number of countries in the Middle East region. The study does so, by relying on a spatial bivariate copula regression analysis of data on youth respondents from five countries, extracted from the 2018 Program for international students’ assessment (PISA). Focusing specifically on evaluating the availability of ICT resources to the youth population, and also identifying the impact of ICT resources on youth subjective well-being in the region, we find that except for the UAE and Qatar that have above OECD average youth performance on the ICT resource index, youth from the remaining countries reported below OECD level average access to ICT resources. The within region cross-country comparative analysis of ICT resources availability to the youth population at home, also highlighted significant heterogeneity across the five countries, post 2015 SDG adoption by UN country members. Furthermore, looking at the impact of ICT resources on youth well-being, controlling for not only cross-country spatial correlations, and factors such as home educational resources, cultural possessions at home, parental occupation status, youth expected occupation status, economic and socio-cultural status, age, gender, and grade level in school; we found that every standard deviation increase in ICT resources to the youth population in the region raises their self-expressed sense of belonging in school by 1.88% standard deviations. Given the empowering nature of ICT resources to youth, and the potential of both to support national as well as regional economic development initiatives, a concerted effort to ease ICT resources diffusion by member countries in the middle east region could assist not only each country in its own development path, but also the region as a whole to live up to its growth potential by the 2030.

Existing evidence suggest that lactoferrin might be beneficial for Alzheimer’s disease. We aimed to determine the effects of lactoferrin intervention on cognitive function from APP/PS1 mice, and possible mechanisms involved in. Both young and middle-aged male APP/PS1 mice were divided into control and lactoferrin group with 16 weeks’ intervention. Lactoferrin intervention had no effects on cognitive function from both young and middle-aged mice, and no key markers involved in Aβ, tau pathology, neuro-inflammation and synaptic plasticity were altered post lactoferrin intervention. In regards to gut microbiota profiles, in the young mice, lactoferrin elevated α diversity index including ACE and Chao 1, and reduced the relative abundance of the genera Bacteroides and Alistipes and elevated Oscillibacter, in addition, Oscillibacter, Anaerotruncus, EF096579_g, EU454405_g, Mollicutes_RF39, EU474361_g, EU774448_g, and EF096976_g were specifically abundant post Lf intervention via LEfSe analysis. In the middle-aged mice, the relative abundance of the phylum Proteobacteria, as well as the genera Oscillospira, Coprococcus and Ruminococcus was significantly reduced post Lf intervention, additionally, S24_7, Bacteroidia, Bacteroidetes and Methylobacterium were specific via LEfSe analysis post lactoferrin intervention. In conclusion, dietary lactoferrin might be beneficial for gut microbiota homeostasis although might have no effects on cognition.

Wildfires are important natural drivers of forest stands dynamics, strongly influencing on their natural regeneration and ecosystem services. This paper presents a comprehensive analysis of spatiotemporal burnt area (BA) patterns over the period 2000–2022 in the Middle Volga region of the Russian Federation on the base of remote sensing time series, considering the impact of cli-matic factors on forest fires. The temporal trends were assessed with the Mann-Kendall nonpara-metric statistical test and Theil-Sen’s slope estimator using the LandTrendr algorithm on the Google Earth Platform (GEE). The accuracy assessment indicated a high overall accuracy (> 84%) and F-score value (> 82%) for forest burnt area detection as evaluated against 581 test sites of ref-erence data. The results revealed that the fire occurrences in the region were mainly irregular with the highest frequency of 7.3 over a 22-year period. The total forest BA was about 280 thousand ha, which equals to 1.7% of the land surface area or 4.0% of the total forested area under study in the Middle Volga region. The coniferous forest stands are the most fire-prone ecosystems accounting for 59.0 % of the total BA; deciduous stands accounts for 25.1%; and insignificant fire occurrences were registered in young forests and shrub lands. On a seasonal scale, temperature generally has a greater impact on the BA than precipitation and wind speed.

Natural ecosystem of Islands and coastal region are vulnerable to climate change phenomena such as increasing temperature, fluctuating rainfalls, ocean acidification and tsunami. Andaman and Nicobar group of islands lies in Bay of Bangal facing such extreme climate phenomena. A spatial-temporal analysis of forest cover of middle Andaman region of the Andaman and Nicobar group of islands was done from 1990 to 2019 with an interval of 5-10 years. Support vector machine classifier, spectral indices such as Normalized Difference Vegetation Index, Normalized Difference Water Index, and Normalized Difference Built-up Index were used for the analysis of greenery, water resources, and urban land. Land surface temperature was estimated using split window algorithm for Landsat 8 and mono window algorithm for Landsat 5. The data showed relative contribution of forest region toward rising temperature in the island region. The research also showed that subsurface hydrology linked to interconnected lineaments provides a stable zone for forest cover. The open forest showed maximum fluctuation while minimum change was observed in Evergreen Forest. The spectral characteristics analysis using indices showed significant change except in 2005 due to Tsunami occurred in 2005. The land surface temperature showed fluctuation near to 30° C from 1990 to 2019.

Objective: To investigate social, economic, and environmental contributors to quit or continue smoking and vaping during the COVID-19 pandemic. Methods: A qualitative study design was adopted to identify smokers’ beliefs in a LMIC, using a small community sample. Results: 276 participants were primarily surveyed. Motivation to continue smoking included temporary pleasurable effects, working remotely, stress or anxiety, whereas a motivator to quit smoking was the overlap with COVID-19 symptomatology. There was a rise in social awareness regarding the potential harm of smoking and vaping during the pandemic yet those participants who were younger felt they were immune from its morbid complications. Conclusions: With paradoxical associations of COVID-19 with cigarette and vape usage, it is important to pay attention to biases in data in favor of educating its users of the increased risk of severe disease.

The purpose of this study was to examine the relationships between smartphone addiction of middle school students and smartphone usage types, depression, attention deficit hyperactivity disorder (ADHD), stress, interpersonal problems, and parenting attitude. This study was also performed with the aim of verifying the relationships among depression, ADHD, perceived stress, interpersonal problems, and parenting attitude, which are predictors of smartphone addiction. The subjects of this study were 487 local middle school students (234 males and 253 females). The measurement instruments used were the smartphone addiction scale, depression scale (PHQ-9), ADHD scale (K-ARS), perceived stress scale (PSS), interpersonal problem scale (KIIP-SC), and the parenting attitude scale. This study identified the relationships between the variables with correlation analysis and examined the predictors of smartphone addiction with hierarchical multiple regression analysis. According to the study results, the factors that influenced smartphone addiction were gender, stress, and interpersonal problems. In addition, when the confounding variables of smartphone addiction were controlled to examine the effects of smartphone usage types on smartphone addiction, social media use and music/videos were found to have a positively significant effect on smartphone addiction while study had a negatively significant effect. The order of the usage types with the highest influence on smartphone addiction was enjoying music/videos, social media use, and study. This suggests that selective intervention depending on the main smartphone usage type can be effective.

Phylogeny construction can help to reveal evolutionary relatedness among molecular sequences. The spike (S) gene of SARS-CoV-2 is the subject of an immune selective pressure which increases the variability in such region. This study aimed to identify mutations in the S gene among SARS-CoV-2 sequences collected in the Middle East and North Africa (MENA), focusing on the D614G mutation, that has a presumed fitness advantage. Another aim was to analyze the S gene sequences phylogenetically. The SARS-CoV-2 S gene sequences collected in the MENA were retrieved from the GISAID public database, together with its metadata. Mutation analysis was conducted in Molecular Evolutionary Genetics Analysis software. Phylogenetic analysis was done using maximum likelihood (ML) and Bayesian methods. A total of 553 MENA sequences were analyzed and the most frequent S gene mutations included: D614G=435, Q677H=8, and V6F=5. A significant increase in the proportion of D614G was noticed from (63.0%) in February 2020, to (98.5%) in June 2020 (p<0.001). Two large phylogenetic clusters were identified via ML analysis, which showed an evidence of inter-country mixing of sequences, which dated back to February 8, 2020 and March 15, 2020 (median estimates). The mean evolutionary rate for SARS-CoV-2 was about 6.5 × 10^-3 substitutions/site/year based on large clusters’ Bayesian analyses. The D614G mutation appeared to be taking over the COVID-19 infections in the MENA. Bayesian analysis suggested that SARS-CoV-2 might have been circulating in MENA earlier than previously reported.

Research on climacteric syndrome among middle-aged men remains scant than the research among women. Research is also scant on climacteric syndrome among older adults living alone, particularly men, who are more vulnerable than such females. This cross-sectional study investigated whether the prevalence of climacteric syndrome is associated with the type of household middle-aged men live in and identified the determinants of climacteric syndrome based on the household type. Six hundred middle-aged men living in multi-person households and 600 living alone were surveyed about general characteristics, diet-related factors, and climacteric syndrome. Data were analyzed using Pearson’s chi-squared test, Fisher’s exact test, and logistic regression. The risk of climacteric syndrome in single-person households was found to be 1.6 times higher than that among in multi-person households (p = 0.006). In multi-person households, income and breakfast frequency predicted climacteric syndrome (p < 0.05), while age, breakfast frequency, dinner frequency, and weekly eating out frequency predicted climacteric syndrome in single-person households (p < 0.05). Thus, dietary factors are more closely linked to the prevalence of climacteric syndrome in single-person households than in multi-person households. This highlights the need for climacteric syndrome interventions for middle-aged men whose health concerns may persist into older adulthood.

The forming of large rivers are the integral consequences of the deep earth process and the surface. In contrast to the hot topics for rivers related to orogenic domains, rift-related large rivers are largely ignored especially in deep time studies. The Cenozoic East Asia margin provides very good opportunity to observe this kind of rivers. It has been believed that basin-and-swell physiography dominated the East Asia margin and impeded the forming of large rives in the early Cenozoic. In this paper, we combined provenance analysis of East China Sea Basin, where is a crucial place to trace the river evolution in East Asia margin, and regional geologic constraints to reveal drainage reorganizations. Detrital zircon U-Pb ages from the Early Eocene sediments of the East China Sea Basin are firstly reported. Our results together with literature data demonstrate that regional provenance changes occurred at the middle Eocene from one singe age peak at ~110 Ma of proximal sources to multiple age spectrum derived from far inland. Source to sink analysis indicated that the North China Block and Korea Peninsular provided the most detritus. Sedimentation and tectonic features of rift basins in the potential source areas indicated that rivers flowed into Bohai Basin and Jianghan Basin cannot provide terrigenous clasts for the lower reaches in the Eocene. Contrastingly, the dominantly fluvial sediments across the Subei-South Yellow Sea Basin suggested external river system and a bypassing region since the middle Eocene, coinciding with provenance change in ECSB. All these demonstrated that a large river (East Asia River) established in east Asia margin in the middle Eocene and flowed southwestward approximately 1500km to the sea in southern ECSB. This river might last to the middle Miocene. The deep earth processes driven by Izanagi-Pacific ridge subduction resulted in the overfilled stage of Subei-South Yellow Sea Basin and the post-rift subsidence in west depression of ECSB, and thus facilitated the initiation of the EAR. Our finding shed new light on the evolving landscape in East Asia and showed how subduction of deep earth process controlled the initiation of rift-related large rivers.

The Middle East spans the transition between temperate Mediterranean climate in the Levant to hyper-arid sub-tropical deserts in the southern part of the Arabian Peninsula, with the complex alpine topography in the northeast feeding the Euphrates and Tigris rivers which support life in the southeastern Fertile Crescent (FC). Climate projections predict severe drying in major parts much of the ME in response to global warming, making it important to understand the controls of hydro-climate perturbations in the region. Here we discuss 23 ME speleothem stable oxygen isotope (δ¹⁸Occ) records from 16 sites from the SISAL_v1 database, which provide a record of past hydro-climatic variability. Sub-millennial changes in ME speleothem δ¹⁸Occ values primarily indicate changes in past precipitation amounts superimposed on variations of the main synoptic pattern in the region, specifically Mediterranean cyclones. The coherency (or lack thereof) between regional records is reviewed from Pleistocene to present, covering the Last Glacial Maximum (LGM), prominent events during deglaciation, and transition into the Holocene. The available speleothem δ¹⁸Occ time-series are investigated by binning and normalizing at 25-year and 200-year time windows over the Holocene. Important Holocene climatic oscillations are discussed, such as the 8.2 ka, 4.2 ka and 0.7 ka (the Little Ice Age) Before Present events. Common trends in the standardized anomalies are tested against different climate archives. Finally, recommendations for future speleothem-based research in the region are given along with comments on the utility and completeness of the SISAL database.

The identification of informal settlements in urban areas is an important step in developing and implementing pro-poor urban policies. Understanding when, where and who lives inside informal settlements is critical to efforts to improve their resilience. This study aims to analyse the capability of machine-learning (ML) methods to map informal areas in Jeddah, Saudi Arabia, using very-high-resolution (VHR) imagery and terrain data. Fourteen indicators of settlement characteristics were derived and mapped using an object-based ML approach and VHR imagery. These indicators were categorised according to three different spatial levels: environ, settlement and object. The most useful indicators for prediction were found to be density and texture measures, (with random forest (RF) relative importance measures of over 25% and 23% respectively). The success of this approach was evaluated using a small, fully independent validation dataset. Informal areas were mapped with an overall accuracy of 91%. Object-based ML as a hybrid approach performed better (8%) than object-based image analysis alone due to its ability to encompass all available geospatial levels.

Fiber-metal laminates (FMLs) such as Kevlar reinforced aluminum laminate (ARALL), Carbon reinforced aluminum laminate (CARALL), and Glass reinforced aluminum laminate (GLARE) offer great potential for weight reduction applications in automobile and aerospace construction. In order to investigate the feasibility for utilizing such materials in the form of laminates, sheet hydro-bulging tests are studied under the condition of uniform blank holder force for three-layered aluminum and aluminum-composite laminates using orthogonal carbon and Kevlar as well as glass fiber in the middle. The experimental results validate the finite element results and they exhibited that the forming limit of glass fiber in the middle is the highest among the studied materials, while carbon fiber material performs the worst. Furthermore, the crack modes are different for the three kinds of fiber materials investigated in the research. This study provides fundamental guidance for the selection of multi-layer sheet materials in the future manufacturing field.

Patients with COVID-19 often experience significant cardiovascular complications, including heart failure, myocarditis, and acute coronary syndrome. We present the case of a male patient with severe COVID-19 pneumonia, complicated with inferior ST-segment elevation myocardial infarction (STEMI), which was attributed to spontaneous coronary artery dissection (SCAD). We also make a review of the literature on case reports of patients with COVID-19 and acute myocardial infarction due to SCAD. Through these clinical cases, a potential correlation between SCAD and COVID-19 infection is implied. Endothelial dysfunction, thrombotic complications and disturbance of the vascular tone are established COVID-19 sequelae, triggered either by direct viral injury or mediated by the cytokines’ storm. These abnormalities in the coronary vasculature and the vasa vasorum could result in SCAD. Moreover, disturbances of the vascular tone can cause coronary vasospasm, a reported precipitant of SCAD. Thus, SCAD should be considered in COVID-19 patients with acute coronary syndrome (ACS), and in the case of STEMI, an early angiographic evaluation, if feasible, rather than thrombolysis performed, to avoid potential adverse events of the latter in the setting of SCAD.

This study aimed to understand the status of knowledge, attitudes, and practices (KAP) of norovirus infection among primary and junior middle school students in Chizhou City, explore its influencing factors. A multistage stratified random sampling method was used to randomly select 1200 students from 8 primary and junior middle schools for the effective questionnaire survey in Chizhou City. A multivariate logistic regression analysis was used to analyse the possible influencing factors. Of 1176 participants, the average knowledge score of norovirus infection was (9.8 ± 3.6), and the scoring rate was 65.3%. The average attitude score was (11.6 ± 1.2), and the scoring rate was 96.3%. The average practice score was (10.4 ± 1.5), and the scoring rate was 86.9%. The difference in the average scoring rate among the three was statistically significant (P < 0.001). The four independent variables of county, education level, sex and age group statistically correlated with the knowledge score. Primary and junior middle school students in Chizhou City had a good attitude and practice compliance in the prevention and control of norovirus infection; however, their professional knowledge still needed further improvement.

Arboviruses of medical and veterinary significance have been identified on all 7 continents with every human and animal population at risk for exposure. Like arboviruses, chronic neurodegenerative diseases like Alzheimer’s and Parkinson’s disease are found wherever there are humans. Viral parkinsonism has been documented for a variety of human pathogens though there are few studies that evaluate the effects of viral infection on degenerative neurological diseases. Significant differences in baseline gene and protein expression have been determined between Human Induced Pluripotent Stem Cell lines derived from a non-Parkinson’s disease individual and from an individual with reported Parkinson’s disease. While the organoids generated from each cell line were physically indistinguishable, significant differences were observed in gene and protein expression for neurotransmission and immunity. It was hypothesized that these inherent differences would impact cerebral organoid responses to viral infection. In this preliminary observational study, cerebral organoids from a non-Parkinson’s and Parkinson’s patient were infected with Chikungunya virus and observed for 2 weeks. Parkinson’s organoids lost mass and exhibited a dysfunctional antiviral response. Neurotransmission data from both non-Parkinson’s and Parkinson’s organoids had dysregulation of IL-1, IL-10, IL-6. These cytokines are associated with mood and could be contributing to persistent depression seen in patients following CHIKV infection. Both organoid types had increased expression of CCR5 and CXCL10 which are linked to demyelination, highlighting a potential mechanism for virus-associated parkinsonism. The dysfunctional antiviral response of Parkinson’s organoids highlights the need for more research in neurotropic infections in a neurologically compromised host.

This study investigates the concentrations of physicochemical and heavy metal contaminants in the groundwater of the Middle Awash Basin, Ethiopia, to inform targeted water management strategies. A total of 32 groundwater samples were collected from 16 stations via piezometers and boreholes at the end of both the dry (June 2021) and wet (October 2021) seasons. Utilizing Inductively Coupled Plasma Mass Spectrometry (ICP-MS), Atomic Absorption Spectroscopy (AAS), and in situ metering, 22 physicochemical and 24 heavy metal parameters were analyzed. The data revealed significant levels of contamination; notably, sample GW11 had extraordinarily high concentrations of total dissolved solids (10,826 mg/L), strontium (908 µg/L), molybdenum (802.4 µg/L), zinc (6060 µg/L), and electrical conductivity (15,645 µS/cm), while GW12 exhibited elevated levels of aluminum (2615 µg/L), zinc (4446 µg/L), and arsenic (117.2 µg/L). Contaminants such as arsenic, vanadium, gallium, lithium, rubidium, chromium, manganese, copper, and zinc were found enriched in groundwater near Lake Beseka, influenced by agricultural runoff from sugarcane plantations and agro-industry activities. Over half of the groundwater sources were unsuitable for drinking, posing significant health risks to local communities that rely heavily on these sources due to limited access to clean surface water. The findings emphasize the urgent need for comprehensive groundwater management and remediation plans in the Middle Awash region to ensure safe and sustainable water use, particularly addressing the variation in contamination levels influenced by Lake Beseka. These measures are critical to protect public health and support local development in the face of ongoing environmental and anthropogenic pressures.

In recent times, the process control network (PCN) of oil and gas installation has been subjected to amorphous cyber-attacks which include Denial-of-Service (DoS), Distributed-Denial-of-Service (DDoS), Man-in-the-Middle (MitM) attacks, and this may have been caused majorly by the integration of open network to Operation Technology (OT) as a result of low-cost network expansion. The connection of the OT to the internet for firmware updates, third-party support, or vendor interventions, has exposed the industry to attacks. The inability to detect these unpredictable cyber-attacks exposes the PCN and a successful attack can lead to devastating effects. This paper reviews the different forms of cyber-attacks in PCN of oil and gas installations and proposes the use of machine learning algorithms to monitor data exchanges between the sensors, controllers, processes, and the final control elements on the network so as to detect anomalies in such data exchanges. Python 3.0 Libraries, Deep-Learning Toolkit, MATLAB, and Allen Bradley RSLogic 5000 PLC Emulator software were used in the simulation of process control. The outcome of the experiments shows the reliability and functionality of the different machine-learning algorithms in detecting these anomalies with significant precise attack detections identified using a coarse tree algorithm.

Background: To date, FM using middle ear packing has rarely reported. In this study, we hypothesized that middle ear packing with dexamethasone soaked gelfoam and fibrin glue over the fat graft could promote the success rate of TMP closure regardless of perforation size. Methods: Between January 2005 and July 2020, a total of 209 patients who underwent fat myringoplasty due to chronic TMP at tertiary referral center were encountered and analyzed. The success rate and audiologic outcome was analyzed. Results: The mean successful TM closure rate was 88.0 %. The success rate by different age generation was not significant difference. The size of the perforation grade showed no significant difference. The perforation site by anterior or posterior was not significant. The preoperative mean threshold of AC, BC and ABG were 55.71, 12.98 and 42.73 dB respectively. The postoperative mean threshold of AC, BC and ABG were 23.67, 12.98 and 10.69 dB. The change of preoperative and postoperative hearing showed statistically significant. Conclusion: From our results, the simple trimming of the perforation edge and middle ear packing with external ear canal packing using fibrin glue induced the stable adhesion between the remnant TM and the fat graft.

We performed a global analysis with data from 149 countries to test whether temperature can explain the spatial variability of the spread rate and mortality of COVID-19 at the global scale. We performed partial correlation analysis and linear mixed effect modelling to evaluate the association of the spread rate and motility of COVID-19 with maximum, minimum, average temperatures and temperature extreme (difference between maximum and minimum temperature) and other environmental and socioeconomic parameters. After controlling the effect of the duration after the first positive case, partial correlation analysis revealed that temperature was not related with the spatial variability of the spread rate of COVID-19. Mortality was negatively related with temperature in the countries with high-income economies. In contrast, temperature extreme was significantly and positively correlated with mortality in the low-and middle-income countries. Taking the country heterogeneity into account, mixed effect modelling revealed that inclusion of temperature as a fixed effect in the model significantly improved model skill predicting mortality in the low-and middle-income countries. Our analysis suggest that warm climate may reduce the mortality rate in high-income economies but in low and middle-income countries temperature extreme may increase the mortality risk.