Equal Number Research Articles

A novel approach for intelligent diagnosis and grading of diabetic retinopathy

Diabetic retinopathy (DR) is a severe ocular complication of diabetes that can lead to vision damage and even blindness. Currently, traditional deep convolutional neural networks (CNNs) used for DR grading tasks face two primary challenges: (1) insensitivity to minority classes due to imbalanced data distribution, and (2) neglecting the relationship between the left and right eyes by utilizing the fundus image of only one eye for training without differentiating between them. To tackle these challenges, we proposed the DRGCNN (DR Grading CNN) model. To solve the problem caused by imbalanced data distribution, our model adopts a more balanced strategy by allocating an equal number of channels to feature maps representing various DR categories. Furthermore, we introduce a CAM-EfficientNetV2-M encoder dedicated to encoding input retinal fundus images for feature vector generation. The number of parameters of our encoder is 52.88 M, which is less than RegNet_y_16gf (80.57 M) and EfficientNetB7 (63.79 M), but the corresponding kappa value is higher. Additionally, in order to take advantage of the binocular relationship, we input fundus retinal images from both eyes of the patient into the network for features fusion during the training phase. We achieved a kappa value of 86.62% on the EyePACS dataset and 86.16% on the Messidor-2 dataset. Experimental results on these representative datasets for diabetic retinopathy (DR) demonstrate the exceptional performance of our DRGCNN model, establishing it as a highly competitive intelligent classification model in the field of DR. The code is available for use at https://github.com/Fat-Hai/DRGCNN.

Basis Electronic Activity of Molecular Systems. A Theory of Bond Reactivity.

In this paper, we present a new finding, the basis electronic activity (BEA) of molecular systems; it corresponds to the significant, although nonreactive, vibrationally induced electronic activity that takes place in any molecular system. Although the molecule's BEA is composed of an equal number of local contributions as the vibrational degrees of freedom, our results indicate that only stretching modes contribute to it. To account for this electronic activity, a new descriptor, the bond electronic flux (BEF), is introduced. The BEF combined with the force constant of the potential well hosting the electronic activity gives rise to the effective bond reactivity index (EBR), which turns out to be the first density functional theory-based descriptor that simultaneously accounts for structural and electronic effects. Besides quantifying the bond reactivity, EBR provides a basis to compare the reactivities of bonds inserted in different chemical environments and paves the way for the exertion of selective control to enhance or inhibit their reactivities. The new concepts formulated in this paper and the associated computational tools are illustrated with characterization of the BEA of a set of representative molecules. In all cases, the BEFs follow the same linear pattern, whose slopes indicate the intensity of the electronic activity and quantify the reactivity of chemical bonds.

The "Starting-Small" Effect in Phonology: Evidence From Biased Learning of Opaque and Transparent Vowel Harmony.

The starting-small effect is a cognitive advantage in language acquisition when learners begin by generalizing on regularities from structurally simple and shorter tokens in a skewed input distribution. Our study explored this effect as a potential explanation for the biased learning of opaque and transparent vowel harmony. In opaque vowel harmony, feature agreement occurs strictly between adjacent vowels, and an intervening "neutral vowel" blocks long-distance vowel harmony. Thus, opaque vowel harmony could be acquired even if learners start with structurally simpler and more frequent disyllabic tokens. Alternatively, transparent vowel harmony can only be observed in longer tokens demonstrating long-distance agreement by skipping a neutral vowel. Opaque vowel harmony is predicted to be learned more efficiently due to its compatibility with local dependency acquired via starting-small learning. In two artificial grammar learning experiments, learners were exposed to both vowel harmony patterns embedded in an equal number of disyllabic and trisyllabic tokens or a skewed distribution with twice as many disyllabic tokens. In Exp I, learners' test performance suggests the consistently biased learning of local and opaque vowel harmony with starting-small learning. Furthermore, in Exp II, the acquired vowel harmony patterns varied significantly by working memory capacity with a balanced but not skewed input distribution, presumably because of the ease of cognitive demand with starting-small learning.

66 Effect of copper oxide wire particles on parasitism and growth in Katahdin lambs divergently selected for fecal egg count estimated breeding value

Abstract Internal parasites are one of the greatest threats to small ruminant production across the United States and parasitic resistance to anthelmintics continues to increase. Genetic selection and copper oxide wire particles (COWP) are two tools that could help reduce effects of parasites in small ruminants. The objective of this project was to determine the effects and interactions of COWP and genetic selection based on fecal egg count (FEC) estimated breeding value (EBV) on gastrointestinal nematode (GIN) infection and performance in naturally infected Katahdin lambs. Spring-born Katahdin ram lambs (n = 52) selected for extremely high FEC EBV (HighFEC, PFEC EBV = +100%) or low FEC EBV (LowFEC, PFEC EBV = -81%) were managed on a fescue-based pasture at the Southwest Virginia Agricultural Research and Extension Center (Glade Spring, VA). At weaning (June 29), lambs were dewormed with a three-combination treatment and rested for 21 d. At the start of the project (July 18), a random subset of lambs (HighFEC, n = 11; LowFEC, n = 15) were given a 2 g copper oxide wire particle bolus, while an equal number of remaining lambs were managed as controls without a copper bolus. All lambs were managed as one contemporary group. Fecal egg counts, FAMACHA scores, body weights, and packed cell volume (PCV) were measured bi-weekly for 10 weeks. Statistical analysis was performed using PROC Mixed Procedure of SAS (SAS Institute, Cary, NC) and FEC data were log transformed for normality. There were no effects of COWP treatment on FEC (P = 0.18). However, LowFEC-selected lambs had less FEC than HighFEC-selected lambs (230 vs. 565 eggs/g, respectively; P < 0.01). There was no interaction of COWP treatment and FEC genotype (P = 0.37). Copper oxide wire particle treatment had no effect on lamb body weight (P = 0.21), PCV (P = 0.69), FAMACHA score (P = 0.41), or overall ADG (P = 0.12). Lamb FEC genotype did not affect FAMACHA score or overall ADG (P = 0.10 and P = 0.22, respectively). LowFEC-selected lambs had lighter body weights (27.7 vs. 30.6 kg, respectively) and PCV (29.2% vs. 30.4%, respectively) than the HighFEC-selected lambs (P < 0.05). None of the 52 lambs met the requirement for deworming (FAMACHA ≥ 3) during the study. These results indicate that lamb FEC genotype may have a greater effect on parasitism than COWP treatment when given once during the post-weaning period. Even so, multiple tools should be considered, in addition to selection, for an integrated parasite management plan.

Use of potentially inappropriate medication for elderly patients in tertiary care hospital of Riyadh, Saudi Arabia

Background and objectivesThe elderly population is affected by chronic diseases and lifelong medication. The American Geriatrics Society (AGS) Beers Criteria is a comprehensive approach to medication usage in the older population to reduce potentially inappropriate medication (PIM) use. The purpose of this study was to assess the usage of PIMs in elderly patients upon discharge from tertiary care hospital settings in Riyadh, Saudi Arabia, using the AGS Beers Criteria 2019. MethodsThe data was obtained from the medical records of 1237 patients (>65 years) who were discharged from medical or surgical wards at two hospitals affiliated with King Abdulaziz Medical City. The data was analyzed to determine the prevalence of PIM prescription, and the proportional odds of the independent factors influencing outcomes were estimated using ordinal regression analysis for criteria 1 and 2, while Binary regression analysis was conducted for criterion 3. ResultsThere were approximately equal numbers of male and female participants in our study (male: 50.8 % vs. female: 49.2 %). One-third of the patients were above the age of 80 years, with 41 % being between the ages of 70 and 80 years. Moreover, almost 70 % of the samples had chronic illnesses. The overall prevalence of PIMs was 29.2 %, with 11 % of PIMs to be avoided in elderly patients and 17 % to be used with caution in the elderly, while disease-specific PIMs were identified in 1.2 % of the patients. The most common PIM class was proton pump inhibitors (44.41 %), and patients discharged from the surgical unit were more likely to be prescribed PIMs. Proton pump inhibitors (44.41 %) were the most inappropriately prescribed drug class, and patients discharged from the surgical unit were more likely to be prescribed PIMs. ConclusionThe study noticed that male gender, the presence of multiple diseases, and obesity are associated with more than one PIM prescription. There is a need to streamline the surgical department’s prescription procedure to eliminate prescription disparities. Prescription monitoring is recommended to avoid medication errors, particularly in patients who are taking multiple medications.

Gender differences in concussion-related knowledge, attitudes and reporting behaviors of varsity athletes.

Concussion is a pathophysiological process that occurs due to a traumatic biomechanical force. Concussions are an "invisible" and common traumatic brain injury with symptoms that may be underestimated. This necessitates fundamental improvements in public knowledge specifically addressing young university athletes and different genders. This cross-sectional study aimed to explore the possibility of gender differences with respect to university student athletes' concussion knowledge, attitude and reporting behaviors. We hypothesized that there should be no significant difference in concussion knowledge among male and female student athletes; however, females would show a more positive attitude and more reporting behaviors than male student athletes. Overall, 115 university athlete students completed a survey questionnaire; we eliminated some participants based on required inclusion criteria of Rosenbaum Concussion Knowledge and Attitude Survey-student version (RoCKAS-ST). Our final analysis consisted of 96 participants: 20 males (mean age 21.15 years) and 75 females (mean age 22.36 years). This study included questions about the athletes' given reasons for reporting or not reporting a concussion. Additionally, 33 RoCKAS-ST questions on Concussion Knowledge Index (CKI) with fair test-retest reliability (r=0.67) and 15 items on Concussion Attitude Index (CAI) with satisfactory test-retest reliability (r=0.79) were provided. Males reported more sources for learning about concussions and more sport-related reasons for reporting a concussion than females (P<0.05). Both genders provided equal numbers of reasons for neglecting a concussion report or not disclosing a concussion for the sake of others (i.e., family, teammates or the coach). Out of 16 given reasons for not reporting a concussion, males significantly chose sport-related reasons over female athletes (P<0.05). Additionally, by looking at the two components of RoCKAS-ST, the independent t-test results showed no significant gender-based differences in concussion knowledge and attitude indices (P>0.05). Nevertheless, females were less optimistic about evaluating other athletes' attitude over concussion reporting (P<0.05). Our study indicated that concussion knowledge is not gender biased among Canadian university athletes; however, more investigation is required to learn how safe environments for concussion disclosure could encourage reporting the symptoms in varsity athletes, especially in males who are more susceptible to not reporting a concussion to not miss their sport-related goals.

Deep learning for precise diagnosis and subtype triage of drug-resistant tuberculosis on chest computed tomography.

Deep learning, transforming input data into target prediction through intricate network structures, has inspired novel exploration in automated diagnosis based on medical images. The distinct morphological characteristics of chest abnormalities between drug-resistant tuberculosis (DR-TB) and drug-sensitive tuberculosis (DS-TB) on chest computed tomography (CT) are of potential value in differential diagnosis, which is challenging in the clinic. Hence, based on 1176 chest CT volumes from the equal number of patients with tuberculosis (TB), we presented a Deep learning-based system for TB drug resistance identification and subtype classification (DeepTB), which could automatically diagnose DR-TB and classify crucial subtypes, including rifampicin-resistant tuberculosis, multidrug-resistant tuberculosis, and extensively drug-resistant tuberculosis. Moreover, chest lesions were manually annotated to endow the model with robust power to assist radiologists in image interpretation and the Circos revealed the relationship between chest abnormalities and specific types of DR-TB. Finally, DeepTB achieved an area under the curve (AUC) up to 0.930 for thoracic abnormality detection and 0.943 for DR-TB diagnosis. Notably, the system demonstrated instructive value in DR-TB subtype classification with AUCs ranging from 0.880 to 0.928. Meanwhile, class activation maps were generated to express a human-understandable visual concept. Together, showing a prominent performance, DeepTB would be impactful in clinical decision-making for DR-TB.

Abstract PR004: CD73 is a novel repressor of mutant β-catenin oncogenic activity in endometrial cancer

Abstract β-catenin is an important oncogene commonly (20-30%) activated by somatic missense exon 3 CTNNB1 mutations in low grade, early stage endometrioid-type endometrial cancer (EEC). Although exon 3 CTNNB1 mutation is associated with increased risk of recurrence in many (~50%) patients with low grade, early-stage EEC, an equal number of patients with β-catenin mutant tumors will not recur. It remains unclear why patient outcomes are so variable. The variability suggests there are unknown determinants of β-catenin mutant tumor aggressiveness. The purpose of this study was to evaluate CD73, a cell surface 5’-nucleotidase, as a critical factor controlling mutant β-catenin oncogenic activity in EEC. We previously identified CD73 downregulation in exon 3 CTNNB1 mutant EEC predicts recurrence and reported, using a highly homologous Xenopus exon 3 β-catenin mutant, that CD73 restrains mutant β-catenin to the membrane. For this study, we interrogated patient-relevant exon 3 CTNNB1 mutation frequencies in 5 publicly available databases and developed 7 (D32N, S33F, S33Y, G34R, S37C, S37F, and S45F) myc-tagged β-catenin mutant lentiviral vectors for expression in HEC-1-A and Ishikawa cells in which we applied CRISPR-Cas9 deletion or the re-expression of CD73. Reporter assays showed all patient-relevant β-catenin mutants at baseline induce transcriptional activity compared to endogenous levels. With CD73 loss, transcriptional activity for all mutants increased significantly in HEC-1-A cells (normally CD73+/+). With re-expression of CD73 in Ishikawa cells (normally CD73−/−), transcriptional activity of several but not all β-catenin mutants decreased, which provides evidence for the first time that β-catenin mutants are differentially controlled in endometrial cancer. Cell viability assays also demonstrated mutant-specific control by CD73. Using RNA-seq data from TCGA, we assessed whether β-catenin mutants in EECs lacking CD73 exhibited unique tumorigenic transcriptomes. Contrary to current paradigms for exon 3 mutant β-catenin, a dependency on expression of canonical Wnt/β-catenin gene targets was not observed in CD73-deficient β-catenin mutant tumors. In contrast, unique gene signatures (e.g., neuron biology and alcohol metabolic process) that have not previously been linked to β-catenin mutant EEC were identified. Specifically, loss of NAAA and SRD5A3 (encoding N-acylethanolamine-hydrolyzing acid amidase and steroid 5-alpha reductase 3, respectively) were found in β-catenin mutant CD73 low EECs. Loss of these genes are associated with poor outcomes in EEC. Ongoing computational studies of pooled EEC datasets are assessing the unique transcriptomes of individual patient-specific β-catenin mutants in the context of CD73 loss. Our results describe CD73 as a novel determinant controlling mutant β-catenin in EEC. Furthermore, we provide mechanistic rationale to explain the variability in outcomes in endometrial cancer patients with exon 3 β-catenin mutant tumors. Citation Format: Rebecca M. Hirsch, Xingyuan Zhang, Lilly F. Chiou, Sunthoshini Premsankar, Hannah N. Lee, Katherine C. Kurnit, Russell R. Broaddus, Cyrus Vaziri, Jessica L. Bowser. CD73 is a novel repressor of mutant β-catenin oncogenic activity in endometrial cancer [abstract]. In: Proceedings of the AACR Special Conference on Endometrial Cancer: Transforming Care through Science; 2023 Nov 16-18; Boston, Massachusetts. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(5_Suppl):Abstract nr PR004.

The influence of hospital and home environments on physical activity and sedentary behaviour: Perceptions of people recovering from fractures

BackgroundA lack of evidence exists contrasting the factors that influence physical activity and sedentary behaviour in both hospital and home settings before and after discharge from acute hospitalisation for fractures. ObjectiveTo describe and compare perceptions of environmental influences on physical activity in hospital and home settings in people recovering from fractures. MethodSemi-structured interviews were conducted with patients hospitalised following fractures (hip fracture or multi-trauma), exploring the barriers and enablers to physical activity within hospital and home settings. Interviews were conducted within two weeks of hospital discharge, audio recorded and transcribed prior to thematic analysis via a framework approach. ResultsBetween December 2022 and May 2023, 12 semi-structured interviews were undertaken with an equal number of participants who sustained an isolated hip fracture or multi-trauma. The median (IQR) age of participants was 60 (52–68) years, with half being male, and the majority sustaining their injuries via transport crashes. Three main themes that influenced physical activity behaviours in hospital and home settings were: having the opportunity, having a reason, and having support and assistance to be active. ConclusionDuring the period of reduced physical capability following fracture, patients need to be provided with opportunities and motivation to be active, particularly within the hospital setting. Findings from this study will assist clinicians to better support people recovering from fractures via greater engagement in physical activity within hospital and home settings.

Effect of Lactobacillus reuteri NCIMB 30351 drops on symptoms of infantile functional gastrointestinal disorders and gut microbiota in early infants: Results from a randomized, placebo-controlled clinical trial.

Infantile functional gastrointestinal disorders, such as colic, constipation, diarrhea, and gastroesophageal reflux (regurgitation), often occur in early infancy and, representing one of the causes of significant parental anxiety, lead to a significant strain on the healthcare resources. In this study, we aimed to evaluate the effects of Lactobacillus reuteri drops (L. reuteri NCIMB 30351) on the symptoms of infantile colic, constipation, diarrhea, and gastroesophageal reflux, as well as on the levels of intestinal microbiota in full-term newborns during the first months of life. A randomized, placebo-controlled, single-masked (blinded), post-marketing clinical study was conducted in two clinical units-Children's City Clinical Hospital of Moscow and Medical Center "St. Andrew's Hospitals-NEBOLIT" from March 2020 to May 2022 in 90 infants aged from 1 to 4months (mean age (± SD) 12.3 ± 5.09weeks; 53.3% females, 46.7% males). Patients with colic, regurgitation (single symptom or combination of several symptoms), and constipation or diarrhea were randomly allocated in two parallel arms to receive either 5 drops (2 × 108 colony forming unit) of L. reuteri NCIMB 30351 (n = 60) or masked placebo (n = 30) for 25 consecutive days. Two treatment arms had equal numbers of patients with constipation and diarrhea (n = 30 each). Daily crying times and their duration, evacuations, and regurgitations were recorded in a structured diary. The levels of gut microbiota were analyzed by deep sequencing of bacterial 16S rRNA gene. Infants with colic receiving supplementary L. reuteri NCIMB 30351 for 25days had significant reduction in the numbers of colic (change from baseline - 6.3 (7.34) vs - 3.0 (7.29) in placebo, P < 0.05) and numbers of crying cases and mean duration of crying (decrease from baseline - 144 (70.7) minutes, lower in the diarrhea subgroup than in constipation infants, compared with - 80 (58.9) in placebo, P < 0.0001), as well as regurgitation numbers (decreased by - 4.8 (2.49) with L. reuteri vs - 3 (7.74) with placebo). We also observed increased numbers of evacuations in infants with constipation (L. reuteri 2.2 (2.4) vs 0.9 (1.06) in placebo, P < 0.05). There was a remarkable reduction of evacuations in infants with diarrhea, while not statistically significant. The analysis of bacterial 16S rRNA gene in the collected samples showed that L. reuteri positively influences the proportions of prevalent species, while it negatively affects both conditionally pathogenic and commensal microbes. Additional in vitro test for formation of Clostridium colonies in the presence of the probiotic demonstrated that L. reuteri effectively inhibits the growth of pathogenic Clostridium species. No adverse events were reported in this study. Conclusion:The uptake of L. reuteri NCIMB 30351 leads to a significant reduction in the number of regurgitations, feeding-induced constipations, and diarrhea as well as mean daily numbers of crying and crying duration in infants during the first months of life. Our results suggest that L. reuteri NCIMB 30351 represents a safe and effective treatment for colic in newborns. Trial registration: ClinicalTrials.gov : NCT04262648. What is Known: • Infantile functional gastrointestinal disorders, such as colic, constipation, diarrhea, and gastroesophageal reflux (regurgitation), often occur in early infancy and, represent one of the causes of significant parental anxiety. • A number of studies have shown that both the composition and diversity of the intestinal microbiota play important roles in the development and function of the gastrointestinal tract. What is New: • The uptake of L. reuteri NCIMB 30351 leads to a significant reduction in the number of regurgitations, feeding-induced constipations, and diarrhea as well as mean daily numbers of crying and crying duration in infants during the first months of life. • L. reuteri positively influences the proportions of prevalent species, while it negatively affects both conditionally pathogenic and commensal microbes in gut microbiota.

How does physical activity improve adolescent resilience? Serial indirect effects via self-efficacy and basic psychological needs.

Resilience is vital for improving mental health and well-being during adolescence, which is an important yet vulnerable period. Previous research has indicated that physical activity enhances individual resilience. However, limited studies have examined underlying psychological mechanisms between them. The current study aimed to investigate the effect of physical activity on adolescent resilience via self-efficacy and basic psychological needs. A cross-sectional survey was conducted with 1,732 high school students aged 16 to 20 years old (mean age: 16.51 ± 0.77 years), with nearly equal number of boys (47.63%) and girls (52.37%). They each completed the Physical Exercise Questionnaire, Basic Psychological Needs in Exercise Scale, General Self-Efficacy Scale, and Resilience Scale, respectively. A serial indirect model was constructed to examine how physical activity influences resilience. Structural equation model analysis revealed that physical activity significantly and directly predicted resilience. When self-efficacy and basic psychological needs were included in the model, both direct and indirect effects were observed. Specifically, the positive relationship between physical activity and resilience was partially mediated by self-efficacy and basic psychological needs. In addition, basic psychological needs and self-efficacy were found to serially mediate the direct relathonship between physical activity and resilience. The present study provides novel theoretical insights into sports psychology by establishing a link between basic psychological needs and self-efficacy. The findings have implications for school administrators and physical education instructors in designing targeted interventions to promote adolescent resilience. These interventions may involve creating supportive environment conductive to fulfilling students' basic psychological needs, implementing strategies to enhance self-efficacy beliefs, and providing opportunities for skill development and mastery experiences in sports and physical activities.

Assessing the Impact of Self-Medication with Antibiotics Among Medical Students

Self-medication is different from self-care in that it uses drugs, which might be helpful or detrimental. According to a number of studies, improper self-medication carries significant health concerns like unpleasant side effects, prolonged pain, and drug dependence. Objective: To explore the adverse effects of self-medication with antibiotics among medical students. Methods: Over the course of seven months, from November 2022 to May 2023, a multi-institutional cross-sectional study was conducted at the University Medical and Dental College of the University of Faisalabad and Bahria University Health Sciences, Karachi (BUHS). The ethical approval was obtained from the Ethical Review Committee of BUHS (Ref: ERC/05/2023) and Institutional Review Board of The University of Faisalabad (Ref: TUF/IRB/153/2022). A sample size was calculated by OpenEpi website calculator. Microsoft excel was used to store the data and IBM SPSS version 23.0 was used for data analysis. A self-designed performa was used to collect data. Results: There was a total of 1340 students in our survey, and an equal number of students 670 (50%) were recruited from each institute. 414 (61.8%) students from BUHS and 494 (73.7%) from UMDC were found to have self-medication practices. 39.9% and 38.2% of the students from 1st year and 2nd year of medical education were found to self-medicate. 69.5% of the hostelite students were found to self-medicate antibiotics. Conclusions: Our research can be concluded as self-medication of antibiotics is a common practice among future health care professionals, with the highest incidence seen in the 1st and 2nd year of medical education. Several adverse symptoms arising due to this practice were seen with the highest being tiredness and dizziness.

Deciphering the omicron variant: integrated omics analysis reveals critical biomarkers and pathophysiological pathways

BackgroundThe rapid emergence and global dissemination of the Omicron variant of SARS-CoV-2 have posed formidable challenges in public health. This scenario underscores the urgent need for an enhanced understanding of Omicron's pathophysiological mechanisms to guide clinical management and shape public health strategies. Our study is aimed at deciphering the intricate molecular mechanisms underlying Omicron infections, particularly focusing on the identification of specific biomarkers.MethodsThis investigation employed a robust and systematic approach, initially encompassing 15 Omicron-infected patients and an equal number of healthy controls, followed by a validation cohort of 20 individuals per group. The study's methodological framework included a comprehensive multi-omics analysis that integrated proteomics and metabolomics, augmented by extensive bioinformatics. Proteomic exploration was conducted via an advanced Ultra-High-Performance Liquid Chromatography (UHPLC) system linked with mass spectrometry. Concurrently, metabolomic profiling was executed using an Ultra-Performance Liquid Chromatography (UPLC) system. The bioinformatics component, fundamental to this research, entailed an exhaustive analysis of protein–protein interactions, pathway enrichment, and metabolic network dynamics, utilizing state-of-the-art tools such as the STRING database and Cytoscape software, ensuring a holistic interpretation of the data.ResultsOur proteomic inquiry identified eight notably dysregulated proteins (THBS1, ACTN1, ACTC1, POTEF, ACTB, TPM4, VCL, ICAM1) in individuals infected with the Omicron variant. These proteins play critical roles in essential physiological processes, especially within the coagulation cascade and hemostatic mechanisms, suggesting their significant involvement in the pathogenesis of Omicron infection. Complementing these proteomic insights, metabolomic analysis discerned 146 differentially expressed metabolites, intricately associated with pivotal metabolic pathways such as tryptophan metabolism, retinol metabolism, and steroid hormone biosynthesis. This comprehensive metabolic profiling sheds light on the systemic implications of Omicron infection, underscoring profound alterations in metabolic equilibrium.ConclusionsThis study substantially enriches our comprehension of the physiological ramifications induced by the Omicron variant, with a particular emphasis on the pivotal roles of coagulation and platelet pathways in disease pathogenesis. The discovery of these specific biomarkers illuminates their potential as critical targets for diagnostic and therapeutic strategies, providing invaluable insights for the development of tailored treatments and enhancing patient care in the dynamic context of the ongoing pandemic.

Is High-Flow Nasal Oxygenation a Game Changer in Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration?: A pilot study.

This study aimed to compare the high-flow nasal oxygen (HFNO) and supraglottic airway device (SAD) techniques in oncological patients undergoing endobronchial ultrasound (EBUS) and transbronchial needle aspiration (TBNA) to evaluate the efficacy of HFNO in them. This pilot study was conducted at Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman, from May 2022 to March 2023. Patients undergoing EBUS TBNA under moderate sedation were quasi-randomised into the HFNO and SAD groups. The episodes and duration of hypoxia and the lowest level of oxygen saturation were the primary outcomes measured. A total of 24 patients were included in the study (10 of them were in the HFNO group and 14 were in the SAD group), with an equal number of males and females. The duration of the procedure in both groups was similar (45 ± 20 and 44 ± 17 minutes in the HFNO and SAD groups, respectively). The mean lowest oxygen saturation in the HFNO group was 93.5 ± 4.5%, which was significantly higher than that of the SAD group (90 ± 3%; P <0.001). In both groups, maximum hypoxia occurred during the early phase of the procedure. However, the HFNO and SAD groups were similar in terms of the cumulative duration of hypotension (140 versus 95 seconds, respectively) and bradycardia (25 versus 40 seconds, respectively). HFNO is a good alternative to SAD and could be used safely and efficiently in patients undergoing EBUS TBNA.

Core stability is associated with dynamic postural balance in soccer players experiencing groin pain without time-loss

ObjectivesThe study sought to evaluate possible relationships between dynamic postural balance and pain, core stability, and hip range of motion in soccer players who were experiencing groin pain (GP). Furthermore, the study aimed to compare these measurements in symptomatic and asymptomatic players. MethodsThe study included 42 male soccer players experiencing GP and an equal number of asymptomatic players. Dynamic postural balance, pain, hip range of motion and trunk endurance were measured. ResultsThe GP group revealed reduced dynamic balance performance (p < 0.01–0.001) in injured and non-injured limbs compared to control group. Further, players experiencing GP demonstrated lower hip range of motion in internal (p < 0.05) and total rotations (p < 0.01) in the injured limb, and lower trunk endurance (p < 0.001) compared to their asymptomatic peers. In general, core stability was associated (r = 0.13–0.61, p < 0.05–0.001) with the poor dynamic balance performance in the GP group while standing on injured and non-injured limbs. No significant correlations between dynamic postural balance, pain and hip range of motion were observed. ConclusionPoor core endurance was found to be associated with dynamic balance disorders in soccer players experiencing GP. This information can aid in the development of targeted strategies to enhance dynamic postural balance in these players.

Exploring the Impact of Treating Functional Constipation on Headache Episodes in Children Suffering from Migraine

Background: Migraine and functional constipation are prevalent chronic conditions among children, with many children suffering from migraines also experiencing functional constipation. Objectives: This study aims to investigate the impact of constipation treatment on headaches in children with migraines. Methods: This clinical trial involved 32 children aged 4 to 15 years, all diagnosed with both migraine and functional constipation. They were randomly divided into two groups: An intervention group and a control group, each comprising an equal number of participants. In the intervention group, both migraine and constipation were treated concurrently, whereas in the control group, only migraine was addressed. The outcomes of the two groups were then monitored and compared. Results: After the treatment, the intervention group experienced a significant reduction in the average number of monthly headache attacks (3 ± 2.4) compared to the control group (7.1 ± 6.9) with a P-value of 0.016. The average duration of each headache attack was shorter in the intervention group (2.3 ± 4.8 hours) compared to the control group (2.9 ± 4.2 hours), although this difference was not statistically significant. Parental satisfaction with the treatment was higher in the intervention group than in the control group, but this difference also lacked statistical significance. Constipation treatment was successful in all children in the study. Conclusions: The study's findings indicate that treating constipation in children with both migraine and functional constipation significantly reduces the frequency of headache attacks. However, it does not have a significant impact on the duration of headache attacks or on parental satisfaction with the treatment.

Intrinsic factors responsible for brittle versus ductile nature of refractory high-entropy alloys

Refractory high-entropy alloys (RHEAs) are of interest for ultrahigh-temperature applications. To overcome their drawbacks — low-temperature brittleness and poor creep strength at high temperatures — improved fundamental understanding is needed. Using experiments, theory, and modeling, we investigated prototypical body-centered cubic (BCC) RHEAs, TiZrHfNbTa and VNbMoTaW. The former is compressible to 77 K, whereas the latter is not below 298 K. Hexagonal close-packed (HCP) elements in TiZrHfNbTa lower its dislocation core energy, increase lattice distortion, and lower its shear modulus relative to VNbMoTaW whose elements are all BCC. Screw dislocations dominate TiZrHfNbTa plasticity, but equal numbers of edges and screws exist in VNbTaMoW. Dislocation cores are compact in VNbTaMoW and extended in TiZrHfNbTa, and different macroscopic slip planes are activated in the two RHEAs, which we attribute to the concentration of HCP elements. Our findings demonstrate how ductility and strength can be controlled through the ratio of HCP to BCC elements in RHEAs.

Optimizing geriatric palliative care in Egypt: Comprehensive patient and family perspectives.

In Egypt, palliative care for geriatric patients is understudied, necessitating exploration for service optimization. Amidst rising chronic illnesses and aging, understanding perspectives of geriatric patients and families is crucial for targeted improvements. This study aims to explore geriatric patients' and their families' perspectives on palliative care in Egypt, seeking opportunities to optimize service delivery for the elderly. Employing a cross-sectional design with 110 geriatric patients and an equal number of family caregivers from the Damietta Oncology Institute and the pain treatment clinics for cancer patients at Zagazig University Hospital, the study focuses on a specialized pain clinic. Validated tools (Palliative Care Outcome Scale, Family Satisfaction with End-of-Life Care [FAMCARE] Scale, Edmonton Symptom Assessment System [ESAS], Caregiver Strain Index [CSI]) assess quality of life, family satisfaction, symptom severity, and caregiver strain. Geriatric patients (mean age: 65.0 ± 8.1 years; 45.5% male, 55.5% female) have diverse diagnoses (e.g., breast cancer 22%). Palliative care outcomes reveal challenges: low emotional well-being (2.6 ± 0.0) and alarming overall quality of life (1.8 ± 0.0). Family dissatisfaction (FAMCARE) is pervasive (total mean score 2.6 ± 0.5). Symptom severity (ESAS) is high, and caregiver strain (CSI) is notable (8.5 ± 2.2). The findings underscore the significance of the challenges faced by geriatric patients and caregivers in palliative care. Patients confront considerable symptom burdens and emotional distress, while caregivers experience notable strain. Urgently needed are targeted interventions designed to enhance patient well-being, alleviate caregiver burden, and elevate satisfaction. The critical importance of implementing these interventions promptly is highlighted, as they are instrumental in improving the overall care experience for geriatric patients and their caregivers. Moreover, the results underscore the imperative of developing comprehensive support mechanisms to address the intricate dimensions of palliative care, ultimately contributing to a more compassionate and effective care continuum.

Ибрутиниб в лечении хронического лимфолейкоза у пациентов старше 60 лет из групп высокого и очень высокого риска

Aim. To assess the efficacy and tolerability of ibrutinib in chronic lymphocytic leukemia (CLL) therapy for high- and very-high-risk patients over 60 years of age.&#x0D; Materials &amp; Methods. The study enrolled 18 CLL patients aged 60 and older. The patients were stratified by age: group 1 included 10 patients aged 60–70 years (median age 64.5 years) and group 2 included 8 patients aged ≥ 71 years (median age 75.8 years); there was equal number of men and women. All patients were subjected to molecular genetic analysis to identify poor prognosis factors and determine the IGHV gene mutation status. The cytogenetic analysis revealed karyotypic abnormalities including 17p deletion in 3 female patients aged 60, 66, and 77 years, respectively. All the patients had CLL without mutation in IGHV genes. They received ibrutinib 420 mg/day per os as first- and second-line therapies.&#x0D; Results. All patients showed aggravated comorbidity. The median follow-up was 28 months (range 18–42 months) in age group 1 and 46 months (range 12–78 months) in group 2. In group 1, a complete remission in 2 patients with del(17p) and a partial remission (PR) in 3 patients were achieved. PR with lymphocytosis was reported in the rest of 5 patients treated with ibrutinib for 12 months. In group 2, PR with the management of autoimmune complications in 5 out of 8 patients and PR with lymphocytosis in 3 patients were reported. The drug was well tolerated in both groups. No signs of severe hematological toxicity were observed in either of them.&#x0D; Conclusion. The choice of ibrutinib for high- and very-high-risk CLL patients aged 60 and older appeared to be optimal. This is also proved by the ease of administration of oral capsules, high efficacy, absence of tumor lysis syndrome, good tolerability, and acceptable toxicity profile.

Wastewater Surveillance of SARS-CoV-2 RNA in a Prison Facility

Prison populations are unlikely to have access to prompt, effective medical care as the general population. Therefore, vaccination and effective surveillance systems have been recommended to mitigate coronavirus disease 2019 (COVID-19) transmission in prison settings. This pilot study aimed to assess the application of wastewater-based epidemiology (WBE) in a prison to act as an early warning tool for COVID-19 transmission. In this study, weekly wastewater samples (n = 21) were collected for 21 weeks from a prison facility in New Orleans, LA, USA, and analyzed for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the results were compared with the number of confirmed cases during the same period. SARS-CoV-2 was concentrated using two methods and quantified via RT-qPCR using CDC N1 and N2 assays. Overall, SARS-CoV-2 was detected in eight samples (38%). An equal number of samples tested positive for SARS-CoV-2 using the two concentrating methods, indicating the effectiveness of both methods for building-scale WBE. Despite limited clinical testing in the studied prison facility, instances of SARS-CoV-2 detection in wastewater prior to the diagnosis of COVID-19 depict the potential use of wastewater surveillance in detecting the presence of early and averting outbreaks in asymptomatic COVID-19 patients.