Alternative Options Research Articles

Patient Satisfaction with the Implementation of Telehealth in Ambulatory Care during the COVID-19 Pandemic: A Single Institution Experience.

COVID-19 has reduced the capacity for delivering essential health services due to lockdown restrictions. Telehealth is an effective alternative option to improve healthcare access. However, there remain implementation challenges to patient adoption in resource-limited settings such as Ethiopia. Therefore, the purpose of this study was to assess patient satisfaction following the implementation of telehealth in ambulatory settings during the COVID-19 pandemic. A cross-sectional study was conducted at Ayder Comprehensive Specialized Hospital in the Tigray region of Northern Ethiopia. Patients who used the telehealth service were invited to participate in a patient satisfaction survey. All statistical analyses were performed using STATA Version 14.1. A total of 149 patients have participated in the survey. Out of the total participants, 129 (86.6%) found that telehealth is easy to understand and overall satisfaction for telehealth was 87.9%. About two-thirds of the patients (97, 65.1%) reported that the telehealth visit is just as good as a traditional visit. The vast majority of participants (148, 98.6%) stated that they would definitely or probably use telehealth again and would recommend it to others. The majority of respondents (137, 91.9%) followed the recommendations provided. Patients have a high level of satisfaction with the use of telehealth during the COVID-19 pandemic. About two-thirds of patients said the telehealth visit was just as good as a traditional visit. The majority of patients followed the recommendations given to them by the healthcare providers and stated that they would definitely or probably use telehealth in the future and would recommend it to others. This high level of patient satisfaction with telehealth implementation suggests that the service could be considered in low-income countries as well.

TREATMENTS FOR DYSMENORRHEA IN ADOLESCENTS: A SCOPING REVIEW OF THE LAST 5 YEARS

Dysmenorrhea has a high prevalence in the female population with a great impact on affected women, the present study evaluated the literature of the last 5 years to evaluate possible treatments for this condition. It found studies reaffirming therapeutic options already available and studies showing promising alternative therapeutic options.

Reconstruction of the human nipple-areolar complex: a tissue engineering approach.

Introduction: Nipple-areolar complex (NAC) reconstruction after breast cancer surgery is challenging and does not always provide optimal long-term esthetic results. Therefore, generating a NAC using tissue engineering techniques, such as a decellularization-recellularization process, is an alternative option to recreate a specific 3D NAC morphological unit, which is then covered with an in vitro regenerated epidermis and, thereafter, skin-grafted on the reconstructed breast. Materials and methods: Human NACs were harvested from cadaveric donors and decellularized using sequential detergent baths. Cellular clearance and extracellular matrix (ECM) preservation were analyzed by histology, as well as by DNA, ECM proteins, growth factors, and residual sodium dodecyl sulfate (SDS) quantification. In vivo biocompatibility was evaluated 30days after the subcutaneous implantation of native and decellularized human NACs in rats. In vitro scaffold cytocompatibility was assessed by static seeding of human fibroblasts on their hypodermal side for 7days, while human keratinocytes were seeded on the scaffold epidermal side for 10days by using the reconstructed human epidermis (RHE) technique to investigate the regeneration of a new epidermis. Results: The decellularized NAC showed a preserved 3D morphology and appeared white. After decellularization, a DNA reduction of 98.3% and the absence of nuclear and HLA staining in histological sections confirmed complete cellular clearance. The ECM architecture and main ECM proteins were preserved, associated with the detection and decrease in growth factors, while a very low amount of residual SDS was detected after decellularization. The decellularized scaffolds were in vivo biocompatible, fully revascularized, and did not induce the production of rat anti-human antibodies after 30days of subcutaneous implantation. Scaffold in vitro cytocompatibility was confirmed by the increasing proliferation of seeded human fibroblasts during 7days of culture, associated with a high number of living cells and a similar viability compared to the control cells after 7days of static culture. Moreover, the RHE technique allowed us to recreate a keratinized pluristratified epithelium after 10days of culture. Conclusion: Tissue engineering allowed us to create an acellular and biocompatible NAC with a preserved morphology, microarchitecture, and matrix proteins while maintaining their cell growth potential and ability to regenerate the skin epidermis. Thus, tissue engineering could provide a novel alternative to personalized and natural NAC reconstruction.

Understanding Binding of Quaternary Ammonium Compounds with Cellulose-Based Fibers and Wipes for Renewable and Sustainable Hygiene Options

Cellulose-based fibers are desirable materials for nonwoven wipes for their good absorbency, strength, cleaning, and biodegradable properties. However, quaternary ammonium compounds (QACs), being cationic in nature, show electrostatic interactions with anionic cellulosic fibers, reducing the available QACs to efficiently clean surfaces. This research presents sustainable alternative fibers that show better controlled exhaustion than commercial wipes and textile fibers. Textile and lignocellulosic fibers were prepared, soaked in QAC, and a UV–vis spectrophotometer was used to measure their exhaustion percentages. Factors such as immersion time and concentration of the disinfectant were also investigated, which affect the rate of exhaustion of the disinfectant from the fibers. A higher immersion time resulted in better exhaustion, whereas the total exhaustion decreased with an increase in the initial concentration of the disinfectant. The exhaustion of benzalkonium chloride (BAC) from the commercial wipes was also investigated at different immersion times and BAC concentrations. It was found that the wood and non-wood fibers showed more controlled exhaustion than the textile fibers and commercial wipes, and could be considered an alternative option for renewable and sustainable wipes and hygiene products.

"Take a break - Time-out for me": A practice project to promote a healthy rest break

"Take a break - Time-out for me": A practice project to promote a healthy rest break Abstract. Background: Breaks are essential for physical and mental health. In health care professions breaks are often cancelled or interrupted. Nursing staff should be enabled to take breaks regularly and without any interruptions. They should be given alternative options to organize their breaks. Methods: A pre-post survey was carried out with one group by means of questionnaires. The two break models "Feel good manager" and "I'm away" were tested by the nursing staff, followed by a debriefing meeting. Results: Before this project none of the nurses had rated his/her satisfaction regarding the breaks as "very good" or "good". This changed during the project to 45,5% (t1) and 22,2% (t2). None of the nurses felt "very well" or "well" recovered before the project. An increase to 54,6% (t1) respectively 33,3% could be asserted. Only 7,1% (t0) indicated to take their breaks "always" or "usually" in "full-length". With the break model "Feel good manager" it changed to 100% and with the model "I am away" to 33,3%. The amount of interruptions could be reduced from 4 (t0) to 2 (t1) and 0 (t2). Discussion: These break models are not applicable arbitrarily by other wards at will. Instead, individual situation analysis should be carried out with according adjustments. These models cannot be tested in case of lack of break areas or absence of personnel. Conclusion: The described project procedure can be transferred to other wards.

PHYSICO-CHEMICAL PARAMETERS AND CLIMATE CHANGE IMPACT ON ALGAL GROWTH

Identifying the biological processes that influence algal growth is essential for ecosystem management. Algae are little aquatic plants that exist either as solitary cells or in regions of diverse dimensions. Zooplankton rely on them as a crucial component of the aquatic food chain, since they provide as their primary source of nutrition. Algae, via the process of photosynthesis, produce oxygen that is subsequently released into the water, serving as a vital resource for fish and other aquatic organisms. This work presents a methodology for estimating the biological characteristics of algae, which play a crucial role in the regulation of eutrophication, via the use of modelling and exploration methodologies. The estimation of algae growth and respiration rates was conducted by using a one-dimensional water quality model and two-dimensional regionally distributed water quality data taken from Lower Manair Dam of Karimnagar District, Telangana. A total of 24 algae were detected in the sample. The most abundant types of algae include Green algae, Flagellate algae, Cyanobacteria, and Diatoms. In the summer season, 17 types of algae were found, while in the spring season, 20 types were detected. The estimation of biological characteristics of algae in natural freshwater environments may be achieved by a physico-chemical technique, which offers an alternate option to sampling and in situ testing. KEYWORDS: Algal growth, biological parameters, Lower Manair Dam, eutrophication, in situ testing

Characteristics and outcome of patients with left atrial appendage closure in China: a single-center experience

BackgroundClinical characteristics and long-term data on the safety and efficacy of LAAC in preventing cerebrovascular accident and thromboembolism among Chinese patients with non-valvular AF (NVAF) remain limited.MethodsData of consecutive NVAF patients who underwent LAAC at Beijing Anzhen Hospital, Capital Medical University, from June 1, 2014, to December 31, 2021, were collected and analyzed retrospectively. The primary effectiveness endpoint was the composite endpoint of stroke/transient ischemic attack, systemic embolism, and death from cardiovascular causes. The primary safety endpoint is the severe bleeding defined by the LAAC Munich consensus.ResultsOf the 222 patients enrolled, the mean age was 66.90 ± 9.62 years, with a majority being male (77.03%). Many patients are non-paroxysmal AF (71.19%) with a median duration of AF of 4.00 years. The mean CHA2DS2-VASc score was 3.78 ± 1.49, and the mean HAS-BLED score was 1.68 ± 0.86. Thromboembolic events (76.58%) were the most common indication for LAAC. The device, technical, and procedural success rates were 98.65%, 98.65%, and 93.69%, respectively. The anticoagulation continuation rate was 56.36%, 31.25%, and 22.60% at 3-, 6- and 12 months post-procedure, respectively. Throughout a mean 2.81 years of follow-up, the incidence of the primary efficacy endpoint was 4.27 per 100 patient-years, predominantly attributable to stroke/TIA (3.12 per 100 PYs). Five patients experienced major bleeding during the follow-up period. Post-procedure imaging revealed minimal complications, with only one substantial peri-device leak. Device-related thrombus occurred in 2.33% of patients, resolving with anticoagulation.ConclusionThe study demonstrates that LAAC is a safe and effective alternative option for Chinese patients with AF, with a high success rate, few complications as well as fewer long-term adverse outcome events.

Association of MDM2 Overexpression in Ameloblastomas with MDM2 Amplification and BRAFV600E Expression.

Ameloblastoma is a rare tumor but represents the most common odontogenic neoplasm. It is localized in the jaws and, although it is a benign, slow-growing tumor, it has an aggressive local behavior and high recurrence rate. Therefore, alternative treatment options or complementary to surgery have been evaluated, with the most promising one among them being a targeted therapy with the v-Raf murine sarcoma viral oncogene homologue B (BRAF), as in ameloblastoma the activating mutation V600E in BRAF is common. Studies in other tumors have shown that the synchronous inhibition of BRAF and human murine double minute 2 homologue (MDM2 or HDM2) protein is more effective than BRAF monotherapy, particularly in the presence of wild type p53 (WTp53). To investigate the MDM2 protein expression and gene amplification in ameloblastoma, in association with BRAFV600E and p53 expression. Forty-four cases of ameloblastoma fixed in 10% buffered formalin and embedded in paraffin were examined for MDM2 overexpression and BRAFV600E and p53 expression by immunohistochemistry, and for MDM2 ploidy with fluorescence in situ hybridization. Sixteen of forty-four (36.36%) cases of ameloblastoma showed MDM2 overexpression. Seven of sixteen MDM2-positive ameloblastomas (43.75%) were BRAFV600E positive and fifteen of sixteen MDM2-positive ameloblastomas (93.75%) were p53 negative. All MDM2 overexpressing tumors did not show copy number alterations for MDM2. Overexpression of MDM2 in ameloblastomas is not associated with MDM2 amplification, but most probably with MAPK activation and WTp53 expression. Further verification of those findings could form the basis for the use of MDM2 expression as a marker of MAPK activation in ameloblastomas and the trial of dual BRAF/MDM2 inhibition in the management of MDM2-overexpressing/BRAFV600E-positive/WTp53 ameloblastomas.

Bone-Regeneration Therapy Using Biodegradable Scaffolds: Calcium Phosphate Bioceramics and Biodegradable Polymers.

Calcium phosphate-based synthetic bone is broadly used for the clinical treatment of bone defects caused by trauma and bone tumors. Synthetic bone is easy to use; however, its effects depend on the size and location of the bone defect. Many alternative treatment options are available, such as joint arthroplasty, autologous bone grafting, and allogeneic bone grafting. Although various biodegradable polymers are also being developed as synthetic bone material in scaffolds for regenerative medicine, the clinical application of commercial synthetic bone products with comparable performance to that of calcium phosphate bioceramics have yet to be realized. This review discusses the status quo of bone-regeneration therapy using artificial bone composed of calcium phosphate bioceramics such as β-tricalcium phosphate (βTCP), carbonate apatite, and hydroxyapatite (HA), in addition to the recent use of calcium phosphate bioceramics, biodegradable polymers, and their composites. New research has introduced potential materials such as octacalcium phosphate (OCP), biologically derived polymers, and synthetic biodegradable polymers. The performance of artificial bone is intricately related to conditions such as the intrinsic material, degradability, composite materials, manufacturing method, structure, and signaling molecules such as growth factors and cells. The development of new scaffold materials may offer more efficient bone regeneration.

Biomechanical behavior of molars restored with direct and indirect restorations in combination with deep margin elevation

Statement of problemThe existing knowledge is insufficient for comprehending the fatigue survival and fracture resistance of molars that have deep approximal direct and indirect restorations, whether with or without deep margin elevation (DME). PurposeThe aim of this laboratory and in silico study is to investigate the fatigue survival, fracture strength, failure pattern and tooth deformation of molars restored with DME in combination with a direct or indirect restoration. Material and methodsThis study utilized 45 extracted sound human molars, divided into three groups (n = 15). Standardized 100% inter-cuspal inlay preparations were performed, extending 2 mm below the CEJ and immediate dentin sealing (IDS) was applied. Group 1 (Co_1) was restored with direct composite; Group 2 (Hyb_2) with a 2 mm DME of direct composite and a glass-ceramic lithium disilicate restoration; Group 3 (Cer_3) a glass-ceramic lithium disilicate restoration. All specimens were exposed to a fatigue process involving thermal-cyclic loading (50N for 1.2 × 106 cycles at 1.7 Hz, between 5 and 55 °C), if teeth survived, they were fractured using a load-to-failure test and failure types were analyzed. Finite element analysis (FEA) was conducted to assess tooth deformation and tensile stress in the restorations. Statistical evaluation of fracture strength was conducted using the Kruskal-Wallis test. Fisher's exact test was utilized to analyze the fracture types and repairability. A statistical significance level of α < 0.05 was set for all analyses. ResultsAll specimens successfully withstood the fatigue testing procedure, and no statistically significant differences in fracture strength were observed among the three groups (P > 0.05). The Fisher's exact test indicated a significant association between the restorative material and fracture type (F2 = 18.315, df = 2, P = 0.004), but also for repairability (F2 = 13.725, df = 2, P = 0.001). Crown-root fractures were significantly more common in the Cer_3 group compared to the Co_1 group (P = 0.001) and the Co_1 group had significantly more repairable fractures (F2 = 13.197, df = 2, P = 0.001). FEA revealed comparable outcomes of deformation among models and higher maximum tensile stress on models with higher frequency of catastrophic failures. ConclusionsAll tested restoration materials exhibited comparable fatigue survival and fracture strength in this laboratory and in silico study. However, it is important to recognize the potential for more severe and irreparable fractures when opting for deeply luted glass-ceramic inlay restorations in clinical practice. In such cases, it would be prudent to consider the alternative option being a direct composite approach, because of its more forgiving fracture types and repairability. Clinical implicationsMolars with deep approximal direct and indirect restorations, whether with or without DME, are comparable in their fatigue survival and fracture resistance to withstand intra-oral forces. Deep direct restorations exhibit more repairable fractures compared to deeply luted glass-ceramics.

Effectiveness of occupational therapy interventions on function and satisfaction with occupational performance among adults with conditions of the hand, wrist, and forearm: a protocol for a systematic review.

Functional hand use post injury is important in enabling a person's engagement in daily living tasks. Without proper treatment, there may be difficulties in self-care, engaging in job roles, or leisure pursuits. Occupational therapists are key health care practitioners for people with upper limb conditions. This systematic review aims to appraise and summarise current evidence regarding effectiveness of occupational therapy interventions among adults with conditions of the hand, wrist, and forearm. A systematic review of randomised control trials and quasi randomised controlled trials will be completed. MEDLINE OVID, CINAHL, CENTRAL, COCHRANE, PUBMED and EMBASE databases will be systematically searched. Grey literature will be searched for via Google Scholar. Studies will be included if they include provision of occupational therapy to adults with a hand, wrist, or forearm condition when compared to treatment as usual or an alternative treatment option. The primary outcome will be function. Secondary outcomes will include satisfaction with occupational performance, quality of life, pain experience, and participation. The Brief International Classification of Functioning, Disability and Health (ICF) Core Set for Hand Conditions will be used to categorise outcomes. The Cochrane Risk of Bias 2 (RoB 2) tool and the Grading of Recommendations Assessment, Development, and Evaluations (GRADE) framework will be utilised to assess quality. A pooled meta- analysis will be completed using RevMan, depending on the uniformity and availability of data. This review aims to synthesise high quality evidence to identify the effectiveness of occupational therapy interventions with patients with a hand, wrist, or forearm condition, categorising outcomes in relation to the ICF Core Set for Hand Conditions. By synthesising the evidence there is potential for improved evidence base for clinicians; improved outcomes for patients; as well as potential economic benefit.This study is registered with PROSPERO: CRD42022337070.

Trauma surgical simulation: discussing the replacement of live animals used as human patient simulators

BackgroundDespite advances in simulator technology, live anaesthetised animals continue to be used as human patient simulators for medical professionals to practice techniques in the management of surgical trauma. This article describes the process of convening a working group of individuals with a professional interest in simulation to discuss the use of live animals and consider if and how they can be replaced in the future.Main bodyA working group was formed of voluntary attendees to a workshop held at the SESAM 2023 conference. Iterative discussions reflecting on the topic were used to produce statements summarising the working group’s opinions. The working group determined that live animals are used as human patient simulators due to the presence of accurate and responsive physiology in the presence of bleeding, realistic tissue tactility and an emotional response experienced by the learner due to interaction with the animal. They were unable to reach a consensus on replacement, determining that there is currently no single model which is able to provide all the learning aspects which a live animal model can provide. Several suggestions were made regarding development of technologies and pedagogical change.ConclusionReplacement of live animals in surgical simulation is not straightforward but should be an aspiration, if possible. For the ongoing development of trauma surgical simulation models, it is important to combine the knowledge, skills and perspectives of medical stakeholders and educators, academic researchers and industry experts in producing alternative options to the use of live animal simulators.

Management of Secondary Angle Closure Glaucoma in Nanophthalmic Eye : A Challenging Case

Introduction : Nanophthalmos is a condition characterized by short eyeball length (AXL &lt;20.0mm), short and dense anterior segment, high eye volume or lens ratio, hypermetropia (+8.00 to +20.00) and scleral thickening (&gt;1.7mm)&#x0D; Case Illustration : A 63-year-old man came to the Glaucoma outpatient clinic at Cicendo Hospital with complaints of blurry eyes since 3 years ago. The visual acuity in the right eye was light perception, and in the left eye was hand movement. The anterior chamber was shallow, with seclusio pupil in both eyes (Figure1). Biometry showed axial length 17.06 mm in the right eye and 16.82 mm in the left eye. The patient underwent phacoemulsification surgery + IOL + iris retractor + pupiloplasty + synechiolysis + sclerectomy for the right eye with satisfactory result (Figure3).&#x0D; Discussion : This surgical procedure for nanophthalmos has its own challenges for the operator due to the shallow anterior segment and small corneal diameter. In this case, surgery was performed first in the right eye, with consideration of a greater anterior chamber depth than the left eye. The sclerectomy procedure performed on this patient was 4 mm from the limbus and was performed full thickness only in one quadrant (Figure2).&#x0D; Conclusion : Multiple anatomic abnormalities in nanophthalmic eyes make surgery extremely challenging and are associated with a high incidence of significant intraoperative and postoperative complications. Phocoemulsification with sclerectomy can be alternative option to manage secondary glaucoma in nanophthalmic eye.

Intravenous Catheter Use for Inferior Lacrimal Canalicular Laceration Reconstruction: A Life Hack in Low Resource Setting

Introduction : Silicone tube was the standard for stenting canaliculi in lacrimal canalicular laceration. But it was not always in stock at a hospital in remote area with low resource. Use of intravenous catheter to exchange the unavailable slicone tube was a possible option.&#x0D; Case Illustration : We reported two cases of inferior canalicular laceration at NTB provincial hospital. Both cases were adult, one female and one male. First case caused by nail and second because of traffic accident. There were no globe involvement in both case. Reconstruction surgeries with monocanalicular approach were performed. Intravenous catheter was used for stenting the canaliculus. First case was using a 24G, the other was 22G. The catheters were well inserted and planned to be removed at3 month. At the day 7 follow-up, the 24G catheter was extruded spontaneously while the patient with 22G was not. Both patients did not complain of profuse tearing.&#x0D; Discussion : The diameter and length of 24G iv catheter were 0.7mm and 19mm, while 22G were 0.9mm and 25mm. The diameters were similar with the silicone tube (0.6mm) and the lengths were long enough to pass the lower and common canaliculus which has a total 15mm long. The catheter in the first case was extruded possibly because in 24G there was only 4mm inside th lacrimal sac. A high pressure air from the nose would push the catheter backward and extruded. The 22G would have 10mm inside the sac.&#x0D; Conclusion : Intravenous catheter was an alternative option for inferior canalicular laceration stenting in low resource setting.

AUTHENTIC WHEAT GRAIN IS THE RAW MATERIAL FOR MODERN CEREAL PRODUCTS

Wheat grain is one of the eight traditional crops that needs to be reviewed in terms of its processing, product range, and quality properties of the end products. Considering the Rules of management and organization at grain factories, it can be noted that the recommended raw material for the production of grain products is durum wheat, the processing of which allows obtaining the main assortment of wheat:groats "Poltavski" and "Artek". Today, durum wheat in our country are grown in a small amount compared to soft wheat, which is widely used in flour milling, therefore enterprises of the cereal industry in such conditions must either import significant volumes of durum wheat or use soft wheat as an alternative option, but taking into account the peculiarities of the produced groats and the technological process, which is built for a stronger grain, the processing of soft wheat in such conditions and the production of crushed groats "Poltavski" and "Artek" from it cannot be considered effective. A key factor in the efficiency of soft wheat processing in groats production is also the difference in the chemical composition of two types of wheat, in which soft wheat has, for example, a lower mass fraction of protein compared to durum wheat, which does not allow production from soft wheat modern products of healthy and complete nutrition, the demand for which is only growing every year in the World and Ukraine. Emmer is one of the oldest cereal crops that mankind used for food and fodder needs. Cultivation of emmer began approximately 10,000-8,000 BC on the territories of ancient Egypt, Mesopotamia, Syria, Ethiopia, as well as other countries of Asia, North Africa and the Middle East. On the territory of Ukraine, emmer was grown 5-6 thousand years BC. When processing emmer into groats, the total yield of end whole groats can be obtained at the level of traditional cereals from hulled cultures - up to 70%, and flakes in relation to unprocessed grain 60-65%. That is, it will not be possible to significantly increase the yield of finished products during the processing of emmer, and this is primarily explained by the filminess of this culture, but if compare the quality of the obtained products, the advantage is clearly for products from emmer, which is already a proven fact, for example in the countries of the European Union where the demand for products made from "original" hulled wheat, including emmer, is increasing every year. Our country has all the necessary conditions for the development of this culture and increasing the volume of its cultivation and processing into food products, which in turn can increase the export potential of our country not only in the form of raw materials, but also products from it.

Effects of 5-aminolevulinic acid photodynamic therapy for cervical low-grade squamous intraepithelial lesions with HR-HPV infections.

To determine the effectiveness and safety of 5-aminolevulinic acid mediated photodynamic therapy (5-ALA PDT) in HR-HPV infected patients with cervical low-grade squamous intraepithelial lesions (LSIL) and to explore possible factors affecting treatment outcomes. This retrospective study included 96 patients with histologically confirmed cervical LSIL and high-risk human papillomavirus (HR-HPV) infection. They received 5-ALA PDT treatment once a week for a total of 3 courses. All patients were evaluated by cytology tests, HPV DNA assay, colposcopy, and biopsy at 2 weeks, 3 months, and 6 months checkpoint. The chi-square test were used to evaluate the differences in various clinical data, and a p value <0.05 was considered statistically significant. At 2 weeks, 3 months, and 6 months checkpoint, colposcopies showed that the cervical iodine-unstained area under VILI (visual inspection with Lugol's iodine) significantly reduced (p < 0.01) with no structure changes. At 3 months and 6 months checkpoint, the pathological regression rate reached 87.5% (84/96) and 94.79% (91/96), while the HR-HPV clearance rates reached 80.21% (77/96) and 93.75% (90/96) respectively. We also examined the efficacy in the HPV 16/18-related group and non-HPV 16/18-related group. The HR-HPV clearance rate in the HPV16/18 group [94.87% (37/39)] was significantly higher than that of the non-HPV 16/18 group [70.17% (40/57)]. However, at 6 months after treatment, the clearance rate of the HPV 16/18 group [94.87% (37/39)] showed no statistical difference from the non-HPV 16/18 group [92.30% (53/57)]. Topical 5-ALA PDT can effectively eliminate HR-HPV infection and treat low-grade cervical squamous intraepithelial lesions, it offers an alternative treatment option for patients with LSIL, especially for those with fertility requirements and who wish to preserve cervical structure or function.

From Plant to Chemistry: Sources of Antinociceptive Non-Opioid Active Principles for Medicinal Chemistry and Drug Design.

Pain is associated with many health problems and a reduced quality of life and has been a common reason for seeking medical attention. Several therapeutics are available on the market, although side effects, physical dependence, and abuse limit their use. As the process of pain transmission and modulation is regulated by different peripheral and central mechanisms and neurotransmitters, medicinal chemistry continues to study novel ligands and innovative approaches. Among them, natural products are known to be a rich source of lead compounds for drug discovery due to their chemical structural variety and different analgesic mechanisms. Numerous studies suggested that some chemicals from medicinal plants could be alternative options for pain relief and management. Previously, we conducted a literature search aimed at identifying natural products interacting either directly or indirectly with opioid receptors. In this review, instead, we have made an excursus including active ingredients derived from plants whose mechanism of action appears from the literature to be other than the modulation of the opioid system. These substances could, either by themselves or through synthetic and/or semi-synthetic derivatives, be investigated in order to improve their pharmacokinetic characteristics and could represent a valid alternative to the opioid approach to pain therapy. They could also be the basis for the study of new mechanisms of action in the approach to this complex and disabling pathology.

Percutaneous Endoscopic Unilateral-Approach Bilateral Decompression for Lumbar Spinal Stenosis.

Lumbar spinal stenosis (LSS) involves the narrowing of the spinal canal due to degenerative changes in the vertebral joints, intervertebral discs, and ligaments. LSS encompasses central canal stenosis (CCS), lateral recess stenosis (LRS), and intervertebral foramen stenosis (IFS). The utilization of lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) has gained popularity in the treatment of CCS and LRS. This popularity is attributed to the rapid development of endoscopic instruments and the progress of endoscopic philosophy. In this technical report, a detailed introduction to the steps and key points of LE-ULBD is provided. Simultaneously, a retrospective review of 132 consecutive patients who underwent LE-ULBD for central canal and/or lateral recess stenosis was conducted. The outcomes after more than two years of follow-up were assessed using the visual analogue score (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores, and the modified MacNab criteria to evaluate surgical efficacy. All 132 patients underwent LE-ULBD successfully. Among them, 119 patients were rated as "excellent," while 13 patients were rated as "good" based on the modified MacNab criteria during the last follow-up. Incidental dural tears occurred in four cases, but there were no post-operative epidural hematomas or infections. The experience demonstrates that LE-ULBD is a less invasive, effective, and safe approach. It can be considered as an alternative option for treating patients with lumbar central canal stenosis and/or lateral recess stenosis.

Effect of organic nutrient management on yield, quality, nutrient uptake and economics of aromatic rice (Oryza sativa) in hill zone of West Bengal

A field experiment was conducted during the rainy (kharif) season of 2021 at the Uttar Banga Krishi Viswavidyalaya, Kalimpong, West Bengal, to study the response of 2 aromatic rice cultivars (‘Kalture’ and ‘Kalonunia’) under 4 organic nutrient management (cowdung manure @ 5 t/ha, vermicompost @ 1.5 t/ha, mustardcake @ 0.5 t/ha, and leaf mould @ 1 t/ha). ‘Kalonunia’ exhibited greater tiller production (435/m2 ), leaf-area index (3.08) and dry-matter accumulation (452 g/m2 ) at 63 days after planting (DAT), and ‘Kalture’ showed taller plants (137.1 cm) and lodging susceptibility (score 4.0) at maturity. ‘Kalonunia’ performed significantly better in terms of grain yield (3.32 t/ha), non-lodging habit, protein content (7.25%) and net income (`57,043/ha) than ‘Kalture’ cultivar. Although the application of vermicompost @ 1.5 t/ha resulted in the maximum grain yield (3.22 t/ha) and nutrient uptake (44.6 kg N, 16.4 kg P and 39.0 kg K/ha), mustard-cake @ 0.5 t/ha could be an alternative option owing to near-maximum grain yield (3.11 t/ha) with high protein content (7.1%), medium aroma (score 1.7), maximum net income (`51,040/ha) and benefit: cost ratio (2.01) in hill zone of West Bengal.

Angiogenesis in Chronic Thromboembolic Pulmonary Hypertension: A Janus-Faced Player?

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare form of pulmonary hypertension characterized by the presence of organized thrombi that obstruct pulmonary arteries, ultimately leading to right heart failure and death. Among others, impaired angiogenesis and inflammatory thrombosis have been shown to contribute to the progression of CTEPH. In this review, we summarize the 2-faced nature of angiogenesis in both thrombus formation and resolution in the context of CTEPH and highlight the dual role of angiogenesis and neovascularization in resolving venous thrombi. Furthermore, we discuss relevant in vitro and in vivo models that support the benefits or drawbacks of angiogenesis in CTEPH progression. We discuss the key pathways involved in modulating angiogenesis, particularly the underexplored role of TGFβ (transforming growth factor-beta) signaling in driving fibrosis as an integral element of CTEPH pathogenesis. We finally explore innovative treatment strategies that target angiogenic pathways. These strategies have the potential to pioneer preventive, inventive, or alternative therapeutic options for patients with CTEPH who may not qualify for surgical interventions. Moreover, they could be used synergistically with established treatments such as pulmonary endarterectomy or balloon pulmonary angioplasty. In summary, this review emphasizes the crucial role of angiogenesis in the development of in fibrothrombotic tissue, a major pathological characteristic of CTEPH.