Group A1 Research Articles

IGF-1 and myostatin-mediated co-regulation in skeletal muscle and bone of Daurian ground squirrels (Spermophilus dauricus) during different hibernation stages

Muscle and bone are cooperatively preserved in Daurian ground squirrels (Spermophilus dauricus) during hibernation. As such, we hypothesized that IGF-1 and myostatin may contribute to musculoskeletal maintenance during this period. Thus, we systematically assessed changes in the protein expression levels of IGF-1 and myostatin, as well as their corresponding downstream targets, in the vastus medialis (VM) muscle and femur in Daurian ground squirrels during different stages. Group differences were determined using one-way analysis of variance (ANOVA). Results indicated that the co-localization levels of IGF-1 and its receptor (IGF-1R) increased by 50% during the pre-hibernation period (PRE) and by 35% during re-entry into torpor (RET) compared to the summer active period (SA). The phosphorylation level of FOXO1 in the VM muscle increased by 50% in the torpor (TOR) group and by 82% in the inter-bout arousal (IBA) group compared to the PRE group. The phosphorylation level of SGK-1 increased by 54% in the IBA group and by 62% in the RET group compared to the SA group. In contrast, the protein expression of IGF-1 and phosphorylation levels of PI3K, Akt, mTOR, and GSK3β in the VM muscle showed no obvious differences among the different groups. β-catenin protein expression was up-regulated by 84% in the RET group compared to the SA group, while the content of IGF-1 protein, correlation coefficients of IGF-1 and IGF-1R, and phosphorylation levels of PI3K, Akt, and GSK3β in the femur showed no significant differences among groups. Regarding myostatin and its downstream targets, myostatin protein expression decreased by 70% in the RET group compared to the SA group, whereas ActRIIB protein expression and Smad2/3 phosphorylation in the VM muscle showed no obvious differences among groups. Furthermore, Smad2/3 phosphorylation decreased by 58% in the TOR group and 53% in the RET group compared to the SA group, whereas ActRIIB protein expression in the femur showed no obvious differences among groups. Overall, the observed changes in IGF-1 and myostatin expression and their downstream targets may be involved in musculoskeletal preservation during hibernation in Daurian ground squirrels.

The Evaluation of Written Tests at Nurussyifa Islamic Kindergarten to Support Merdeka Curriculum

Early childhood is the nation's next generation whose development and growth we must maximize. During this golden age, children receive stimulation from the environment at home, at school and in the community. At school, teachers provide stimulation to children through learning activities according to the kurikulum merdeka. In the pre-school period, children are also introduced to basic writing activities. Indicators of beginning writing are, the child can hold a writing instrument well and correctly, is able to move his hand well, the child can imitate letter shapes, the child can recognize letter shapes. Writing test activities in kindergarten are implemented with very simple activities such as bolding letters, making dashes, making shapes and many more. This research was conducted to evaluate written test activities at TKIT Nurussyifa Krebet Jambon Ponorogo. The data sources in this research are the principal, group A teachers, and group A1 students at TKIT Nurussyifa. The method used in this research is a qualitative research method, using a field case study approach. The techniques used in collecting data are observation, interviews and documentation. From the research results, the written test activities carried out at TKIT Nurussyifa have gone well, and are not burdensome for therapy children, showing positive results and are effective in training children's motor skills in beginning writing.

Blocking Air in the Filtering Bleb: Effects on Graft Adhesion After Descemet's Stripping Automated Endothelial Keratoplasty.

To evaluate the outcome of Descemet's stripping automated endothelial keratoplasty (DSAEK) with "blocking air" in the filtering bleb in patients with previous trabeculectomy. In total, 299 eyes in 283 patients who underwent DSAEK were retrospectively reviewed. Endothelial graft adhesion, intraocular pressure (IOP), and air volume in the anterior chamber with (group A) or without (group B) a filtering bleb were compared between the groups. Group A was divided into two subgroups according to the presence (group A1) or absence (group A2) of air in the filtering bleb; the same three factors were compared between the subgroups. The graft detachment rate was significantly higher in group A (14.3%) than in group B (6.5%) (p = 0.04). IOP was significantly lower in group A than in group B before surgery (p = 0.01), at the end of surgery (p = 0.04), at three hours (p < 0.001), and one week postoperatively (p = 0.02). The graft detachment rate did not significantly differ between groups A1 and A2. There were no differences in IOP at each follow-up time, whereas there was a statistically significant increase in IOP from the preoperative measurement to the end of surgery in group A1 (21.0±7.0 mmHg) compared with group A2 (14.2±8.6 mmHg) (p = 0.02). The presence of blocking air in the filtering bleb helps ensure increased IOP during the early postoperative period but had no significant effect on graft detachment rates.

Assessing shade matching capability of Omnichroma, a single shade composite in posterior restorations: an in vitro study.

Recent composites are being developed to simplify shade matching in composite restorations. Only a limited amount of research has been conducted to determine the optical performance of this newly introduced composite in this area. This study investigated the Omnichroma (OMN) color matching (a single shade composite within type-I restorations) via simulated clinical cavities. A total of 72 frames were created by occupying the mold with Estelite Σ Quick (ES) of A1, A2, and A3 shades (n = 24). Each shade of composite frame was divided into three subgroups (n = 8) according to cavity dimension (width = 2, 3, and 4 mm/depth = 2 mm). Cavities were filled with Omnichroma. Color parameters were calculated based on CIEDE2000 (ΔE00) using a non-contact spectrophotometer. Finally, the data were analyzed using a two-way ANOVA (the Tukey HSD test) (P = 0.05). The surrounding frame color significantly affected the color-matching capacity of OMN (P < 0.0001). Groups A1 and A3 showed the lowest and highest amounts of ΔE00, respectively. The cavity width also influenced the color-matching ability of OMN (P < 0.0001) significantly. According to the results, 4 mm cavity width showed the lowest amount of ΔE00, and 2 mm showed the highest amount. Monochromatic composites (OMN) did not match colors well in Class I cavities in posterior teeth. In cases of teeth with less chromatic surroundings, OMN matched shades better. OMN could better match shades in posterior teeth with wider cavities.

Exploring the link between T-regulatory cells and inflammatory cytokines in atherogenesis: findings from patients with stable angina pectoris.

Atherosclerosis, a chronic inflammatory disease impacting arteries, is closely linked to cardiovascular conditions. Dyslipidemia, marked by high low-density lipoprotein (LDL), low high-density lipoprotein (HDL), and increased plasma triglycerides, is a key risk factor. Atherogenesis begins when modified lipoproteins like oxidized LDL (ox-LDL) activate the immune system. This study explores the roles of T-regulatory cells (Tregs) and interleukins 10 (IL-10), 6 (IL-6), and 17 (IL-17) in atherogenesis. Samples were collected from the Hospital patients with stable angina pectoris (SAP). Peripheral blood mononuclear cells (PBMCs) were isolated using Ficoll density gradient and analyzed via flow cytometry. IL-10, IL-6, and IL-17 levels in cell culture supernatant were measured using ELISA. Data were expressed as mean ± SEM and analyzed with statistical software. Results indicate that only patients exhibited reduced Treg and IL-10 levels after high-dose ox-LDL treatment. Significant IL-6 reduction was observed in both NCA and SA groups after high-dose n-LDL and low/high ox-LDL treatments compared to untreated PBMCs. Future research will explore n-LDL and ox-LDL effects on Th17/Treg immune responses within a specific cytokine environment known for inducing inflammation, assessing their potential role in atherosclerosis progression.

A Dynamic Scheduling Method for Logistics Supply Chain Based on Adaptive Ant Colony Algorithm

To reduce the dynamic scheduling cost of logistics supply chain and improve customer satisfaction, this paper proposes a dynamic scheduling method for logistics supply chain based on adaptive ant colony algorithm. First, determine the goal of dynamic scheduling in the logistics supply chain. Second, considering supplier satisfaction, transportation costs, and maximum delivery distance constraints, a dynamic scheduling model for logistics supply chain is constructed. Then by smoothing the pheromones and designing a transition function, adjusting factors are introduced to update the pheromone rules. Finally, based on the adaptive ant colony algorithm, the solution of the dynamic scheduling function of the logistics supply chain is solved to achieve the dynamic scheduling of the current logistics supply chain. The experimental results show that after 19 iterations, the method can search for the optimal route A1 group with a length of 33.85 km, with fewer iterations and shorter paths. The total cost is 114,290 yuan, and the degree of cargo loss is low, with a maximum of only 0.14%. The task completion time is short, customer satisfaction is above 0.85, and the scheduling accuracy is 99.9%. It can effectively control costs, improve customer satisfaction, and accurately arrange logistics supply chains.

Pediatric asthma knowledge: Insights from a Portuguese central hospital study.

Asthma is a common chronic condition in children, with parental and child health literacy affecting health outcomes and asthma control. This study examined pediatric asthma knowledge at a Portuguese central hospital and its determinants. We conducted a comparative cross-sectional study, applying the Asthma Knowledge Questionnaire (QCSA), answered by adolescents and/or caregivers. The sample was categorized into two groups based on the presence or absence of respiratory conditions, such as asthma or recurrent wheezing, in children. Those with such conditions (Group A) were further divided into two subgroups: those receiving general pediatric care (Group A2) and those receiving specialized care, followed in pulmonology or allergology consultations (Group A1). The study involved 154 participants, predominantly female (74%) with an average age of 31.2 years ( ± 13.4). The average QCSA score was 14.8 ( ± 3.2), and Group A exhibited a statistically higher score, 15.5 points ±3.2 versus Group B, 14.2 points ± 3.2, p = .034. Group A1 achieved significantly better scores (16 points: range 4-21) than Group A2 (14 points: range 9-21) (p = .029). Scores were correlated positively with the duration of specialized follow-up (ρ = .326; p = .027). Asthma knowledge was correlated with the level of education (r = .468; p < .001). The number of wheezing episodes (r = -.466; p < .001) within the past year were associated to QCSA scores. In summary, the presence of respiratory condition, the follow-up in specialized appointments and higher levels of education were associated with greater asthma knowledge.

Defining Suicidal Thought and Behavior Phenotypes for Genetic Studies.

Standardized definitions of suicidality phenotypes, including suicidal ideation (SI), attempt (SA), and death (SD) are a critical step towards improving understanding and comparison of results in suicide research. The complexity of suicidality contributes to heterogeneity in phenotype definitions, impeding evaluation of clinical and genetic risk factors across studies and efforts to combine samples within consortia. Here, we present expert and data-supported recommendations for defining suicidality and control phenotypes to facilitate merging current/legacy samples with definition variability and aid future sample creation. A subgroup of clinician researchers and experts from the Suicide Workgroup of the Psychiatric Genomics Consortium (PGC) reviewed existing PGC definitions for SI, SA, SD, and control groups and generated preliminary consensus guidelines for instrument-derived and international classification of disease (ICD) data. ICD lists were validated in two independent datasets (N = 9,151 and 12,394). Recommendations are provided for evaluated instruments for SA and SI, emphasizing selection of lifetime measures phenotype-specific wording. Recommendations are also provided for defining SI and SD from ICD data. As the SA ICD definition is complex, SA code list recommendations were validated against instrument results with sensitivity (range = 15.4% to 80.6%), specificity (range = 67.6% to 97.4%), and positive predictive values (range = 0.59-0.93) reported. Best-practice guidelines are presented for the use of existing information to define SI/SA/SD in consortia research. These proposed definitions are expected to facilitate more homogeneous data aggregation for genetic and multisite studies. Future research should involve refinement, improved generalizability, and validation in diverse populations.

Synthetic thymic hexapeptide in the correction of alterations of antibacterial immune defense and normalization of the profile of proinflammatory cytokines in immunocompromized Children with local unlimited acute peritonitis

The study of dysregulatory disorders of the immune system underlying the immunopathogenesis of severe purulent-inflammatory diseases (PIDs) is important for development of new therapeutic tactics of restoring antibacterial defense. Acute peritonitis (AP) is a severe PID of the abdominal cavity, the course of which are dependent on the treatment, cytokine balance and adequate functioning of the immunity. Objective: to evaluate the modulating effects on the immune system and the levels of proinflammatory cytokines of the synthetic thymic hexapeptide, active substance of Imunofan, included in the complex postoperative treatment (CPOT) of immunocompromised children with local AP. Clinical and immunological examination of 20 immunocompromised children aged 5–12 years with local AP was carried out before (study group 1, SG1) and after (study group 1a, SG1a) CPOT including synthetic thymic hexapeptide (Arginyl-alpha-AspartylLysyl-Valyl-Tyrosyl-Arginine, НР), alongside 20 conditionally healthy children (comparison group, SG). The content of T and B lymphocytes, natural killer cells (NK), levels of serum pro-inflammatory cytokines IL-1β, IL-6, TNFα, IL-8, IL-18, phagocytic and microbicidal activity of neutrophils (NG) were assessed. In SG1, before treatment, a decrease in the number of T lymphocytes, T helpers, CTL-lymphocytes, NK and an increase in the level of B lymphocytes was revealed. Defects in the effector functions of NG were determined: impaired bacterial antigen killing and decreased NADPH oxidase activity. It was established that in case of AP in immunocompromised children, the cytokine profile is characterized by overproduction of studied proinflammatory and neutrophil-associated cytokines. After complex treatment including immunomodulatory therapy, there was a restoration of the content of T lymphocytes, T helper cells, TCTL lymphocytes, an increase in the number of NK and decrease in the level of B lymphocytes. In addition, regression of the levels of inflammatory, including neutrophil-associated, cytokines and emergence of effector functions of NG due to restoration of NADPH oxidases activity, was noted. Thus, the restoration of immunological parameters in AP leads to earlier regression of the purulent-inflammatory process in the abdominal cavity and to the absence of postoperative complications. The clinical and immunological effects of the immunomodulatory therapy program with inclusion of the drug based on HP determines the feasibility of its use in the postoperative period in immunocompromised children with local AP.

Impact of a Mediterranean-Inspired Diet on Cardiovascular Disease Risk Factors: A Randomized Clinical Trial.

Cardiovascular diseases (CVDs) are the leading cause of death worldwide. This study focused on evaluating the impact of a Mediterranean-type diet combined with physical exercise on CVD risk factors of high-risk individuals. A randomized clinical trial (RCT) recruited individuals (≥50 years old) with no history of acute myocardial infarction, but with high CVD risk criteria according to the SCORE2/SCORE2 OP. Anthropometric and biochemical parameters were assessed at baseline and after 12 weeks of diet and exercise intervention. Participants were randomly assigned into 3 groups: no intervention group (Group 1a), physical exercise group (Group 1b), and physical exercise (±2 h/week) plus diet group (Group 2). Briefly, the dietary intervention was based on the principles of an isocaloric Mediterranean diet (MD), with seven main meals/week centered on plant-based foods (legumes and pulses). The combined effect of exercise and the diet showed significant decrease in WC (p = 0.002), BST (p < 0.001), visceral fat (p < 0.001), and TG (p = 0.029), compared with control groups. The intervention significantly increased legume intake (p < 0.001), as well as adherence to the MD, which associates with WC decrease (p = 0.024) and visceral fat (p = 0.017). A combined intervention of exercise and diet should be endorsed as an efficient modifier of cardiometabolic parameters.

Chorioamniotic Membrane Separation after Fetal Spina Bifida Repair: Impact of CMS Size and Patient Management.

Chorioamniotic membrane separation (CMS) is a known complication after fetal spina bifida (fSB) repair. This study's goal was to analyze women's outcomes with open fSB repair and CMS (group A) compared to the ones without (group B) and to assess the influence of CMS size and patient management. A total of 194 women with open fSB repair at our center were included in this retrospective study. Outcomes of group A were compared to the ones of group B. Regression analysis was performed to assess risk factors for CMS. Two subgroup analyses assessed the impact of CMS size (small [A-small] vs. large [A-large]) as well as patient management (A1 = hospitalization vs. A2 = no hospitalization) on pregnancy outcomes. Of 194 women, 23 (11.9%) were in group A and 171 (88.1%) in group B. Preterm premature rupture of membranes (PPROMs) (69.6% vs. 24.1%, p = &lt;0.001), amniotic infection syndrome (AIS) (22.7% vs. 7.1%, p = 0.03), histologically confirmed chorioamnionitis (hCA) (40.0% vs. 14.7%, p = 0.03), length of hospital stay (LOS) after fSB repair (35 [19-65] vs. 17 [14-27] days), and overall LOS (43 [33-71] vs. 35 [27-46] days, p = 0.004) were significantly more often/longer in group A. Gestational age (GA) at delivery was significantly lower in group A compared to group B (35.3 [32.3-36.3] vs. 36.7 [34.9-37.0] weeks, p = 0.006). Regression analysis did not identify risk factors for CMS. Subgroup analysis comparing CMS sized in group A-small versus A-large showed higher AIS rate (42% vs. 0%, p = 0.04), lower LOS (22.0 [15.5-42.5] vs. 59.6 ± 24.1, p = 0.003). Comparison of group A1 versus A2 showed longer LOS (49.3 ± 22.8 vs. 15 [15-17.5] days, p &lt; 0.001), lower planned readmission rate (5.6% vs. 80%, p = 0.003). CMS significantly increased the risk of PPROM, AIS, hCA, caused longer LOS, and caused lower GA at delivery. Women with small CMS had higher AIS rates but shorter LOS compared to women with large CMS, while apart from LOS pregnancy outcomes did not differ regarding patient management (hospitalization after CMS yes vs. no).

Associations between fetal position at delivery and duration of active phase of labor: A historical cohort study.

In clinical experience, occiput posterior (OP) position is associated with longer labor duration than occiput anterior (OA) position, but few studies have investigated the association between labor duration and fetal position. We aimed to compare duration of the active phase of labor in OP deliveries with OA deliveries in a contemporary population using survival methods. Secondary aims were to compare the frequencies of operative interventions, obstetric anal sphincter injuries (OASIS), postpartum hemorrhage, and newborn outcomes in OP with OA deliveries. We did a historical cohort study in three university hospitals in Norway from 2012 to 2022. Women with a single fetus in cephalic presentation, no previous cesarean section and gestational age ≥37 weeks were eligible and stratified into the first four groups of the Robson ten-group classification system (TGCS). We estimated the mean duration and calculated the hazard ratio (HR) for delivery using survival analyses. Cesarean sections and instrumental vaginal deliveries were censored. The study population comprised 112 019 women, 105 571 (94.2%) were delivered in OA and 6448 (5.8%) in OP position. The estimated mean duration of the active phase of labor was longer in women with the fetus in OP position in all four TGCS groups. The estimated duration was longer in the OP groups in analyses stratified with respect to epidural analgesia and oxytocin augmentation. The graphical abstract illustrates the probability of delivery in OP compared with OA position in merged TGCS groups 1 and 2a, as a function of time. The unadjusted HR was 0.33 (95% CI 0.31-0.36) for fetuses delivered in OP position compared with OA position in TGCS group 1, 0.25 (95% CI 0.21-0.27) in group 2a, 0.70 (95% CI 0.67-0.73) in group 3, and 0.61 (95% CI 0.55-0.67) in group 4a, respectively. Neither maternal age, gestational age, BMI nor birthweight had confounding effect. Operative delivery rates and OASIS rates were higher in OP position in all four groups. We found longer duration of the active phase of labor in women with the fetus delivered in OP position in all four TGCS groups.

The influence of implant depth, abutment height and mucosal phenotype on peri‑implant bone levels: A 2-year clinical trial

ObjectivesTo evaluate the bone changes around equicrestal and subcrestal implants, analyzing the effect of abutment height [short abutments (SA < 2 mm) and long abutments (LA > 2 mm)] and the three components of the peri‑implant soft-tissue phenotype. MethodsTwenty-six patients received 71 implants that were placed according to supracrestal tissue height (STH) in an equicrestal (n = 17), shallow subcrestal ≈1 mm (n = 33), or deep subcrestal ≈2 mm (n = 21) position. After 3 months of healing, rehabilitation was completed using metal-ceramic crowns on multi-unit abutments of 1.5 mm, 2.5 mm, or 3.5 mm in height, depending on the prosthetic space and STH. Longitudinal clinical parameters (STH, mucosal thickness, and keratinized mucosa width) and radiographic data [bone remodelling and marginal bone loss (MBL)] were collected at 3, 6, 12, and 24 months postsurgery. ResultsThe gain in STH was significantly greater around the implants placed in a subcrestal ≈2 mm position. After 2 years, the mean change in bone remodelling in the SA group was significantly greater than in the LA group. According to the multiple linear regression, bone remodelling depends primarily on abutment height (β = -0.43), followed by crestal position (β = 0.34), and keratinized mucosa width (β = -0.22), while MBL depends on abutment height (β = -0.37), and the patient's age (β = -0.36). ConclusionsImplants placed in an equicrestal or subcrestal ≈1 mm position with LA undergo less bone remodelling, while the lowest level of MBL occurs in subcrestal ≈2 mm implants with LA. Differing soft-tissue thicknesses combined with the use of either SA or LA produced significant intergroup differences in bone remodelling and MBL. Clinical significanceAbutment height is the most powerful predictor variable affecting bone remodelling and MBL. Depending on the dimensions of the peri‑implant soft-tissue phenotype, placing the implants subcrestally may also be a viable option to decrease bone remodelling and, consequently, reduce MBL. Clinical trial registrationidentification number: NCT05670340.

Investigation of the Biosafety of Commercially Available Natural Rubber Latex and Synthetic Polyurethane Condom Materials

To investigate the biological safety of commercially available natural rubber latex and synthetic polyurethane condoms. Natural rubber latex condom brands of A1 and A2 and polyurethane condom brands of B1 and B2 were purchased from large chain pharmacies in Chengdu, with three packages randomly selected for each brand. The study assessed the toxic effects of condom extracts on L-929 mouse fibroblasts according to GB/T standards. Gross observation and histopathological evaluation were conducted to assess the irritation reactions of condoms on the vagina and penis of rabbits (3 rabbits were used for each brand), as well as their sensitization effects on guinea pig skin. Additionally, the impact of continuous perfusion of condom extracts of the vaginas of SD rats for 30 days on their reproductive systems was evaluated, following GB/T standards (5 rats were used for each brand). Extracts from natural rubber latex condom brands A1 and A2, at concentrations of 100% and 50%, exhibited significant cytotoxicity, with optical density (OD) values being significantly lower than those of the blank control group and the polyurethane condom brands B1 and B2 (P<0.01). There was no significant difference in cell morphology and OD values between the extracts of B1 and B2 and the blank control group (P>0.05). Vaginal congestion was found in 3 rabbits from A1 group and 1 rabbit from the A2 group, while no obvious congestion was noted in rabbits from the B1 and the B2 groups. Histopathological examination showed scattered inflammatory cell infiltration in the vaginal tissue of 3 rabbits from the A1 group and 2 rabbits from the A2 group, and slight congestion in the blood vessels of the lamina propria. No obvious pathological changes were observed in the vaginal tissue of polyurethane brand rabbits. Two rabbits from the A1 group and 1 rabbit from the A2 group showed transient and mild erythema on the penis during the experiment. Histopathological examination showed that 1 rabbit from A1 group had small foci of pericapillary lymphocytes in the dermis of the penis, while no significant pathological changes were observed in the penile tissue of A2, B1, and B2 groups. After 30 days of continuous vaginal perfusion with condom extract, 3 rats in A1 group and 2 rats in the A2 group had uterine congestion, with the degree of congestion being lower in the A2 group. No significant congestion or pathological changes were observed in the vaginal and penile tissues of rabbits, or in the uterine tissues of rats from the polyurethane groups. None of the 4 groups of guinea pigs showed significant skin allergic reactions to the condom extracts. Significant differences in biosafety exist among condoms of various materials and brands. To ensure product safety, it is crucial to strengthen quality control and regulatory oversight after condoms become commercially available.

A novel nanohydroxyapatite/polyamide 66 strut for reducing subsidence after one-level anterior cervical corpectomy and fusion: a finite-element study

BackgroundThe aim of this study is to introduce a novel nanohydroxyapatite/polyamide 66(n-HA/PA66)n strut to improve biomechanical performance and reduce subsidence.MethodsOne validated intact and 2 ACCF-simulated C3–C7 cervical spine models were developed (old strut: Group A, new strut: Group B). In the ACCF models, C5 underwent corpectomy and was fixed by an anterior cervical plate. Screw angles were categorized as 1 (0 ) and 2 (45 ) and divided into 4 groups, A1, A2, B1 and B2, for each model. An axial force of 74 N and a moment couple of 1.0 Nm were imposed on the C3 vertebra. The range of motion (ROM) of each segment and the stress distribution on the screw–vertebra interface, strut, and strut–endplate interface were recorded and analysed.ResultsThere was no significant difference in ROM between Group A and Group B during bending, extension and rotation under 74 N axial pressure. The stress concentration on the strut body in Group A was higher than that in Group B. The peak stress values at the screw–vertebral interface in Groups A1 and A2 were higher than those in Groups B1 and B2, except for during extension and lateral bending. Under axial pressure, the peak stress values at the strut body–endplate interface during bending, extension and rotation were lower in the A1 and A2 groups than in the B1 and B2 groups. The Group B model showed much higher graft stress than the Group A model.ConclusionsBased on finite-element analysis, compared with the old strut, the novel strut showed better biomechanical performance at the screw–vertebra interface.

Age-Specific Outcomes of Bioprosthetic vs. Mechanical Aortic Valve Replacement: Balancing Reoperation Risk with Anticoagulation Burden.

The choice of prosthesis for aortic valve replacement (AVR) remains challenging. The risk of anticoagulation complications vs. the risk of aortic valve reintervention should be weighed. This study compared the outcomes of bioprosthetic vs. mechanical AVR in patients older and younger than 50. This retrospective study was conducted from 2009 to 2019 and involved 292 adult patients who underwent isolated AVR. The patients were divided according to their age (above 50 years or 50 years and younger) and the type of valves used in each age group. The outcomes of bioprosthetic valves (Groups 1a (>50 years) and 1b (≤50 years)) were compared with those of mechanical valves (Groups 2a (>50 years) and 2b (≤50 years)) in each age group. The groups had nearly equal rates of preexisting comorbidities except for Group 1b, in which the rate of hypertension was greater (32.6% vs. 14.7%; p = 0.025). This group also had higher rates of old stroke (8.7% vs. 0%, p = 0.011) and higher creatinine clearance (127.62 (108.82-150.23) vs. 110.02 (84.87-144.49) mL/min; p = 0.026) than Group 1b. Patients in Group 1a were significantly older than Group 2a (64 (58-71) vs. 58 (54-67) years; p = 0.002). There was no significant difference in the NYHA class between the groups. The preoperative ejection fraction and other echocardiographic parameters did not differ significantly between the groups. Re-exploration for bleeding was more common in patients older than 50 years who underwent mechanical valve replacement (p = 0.021). There was no difference in other postoperative complications between the groups. The groups had no differences in survival, stroke, or bleeding rates. Aortic valve reintervention was significantly greater in patients ≤ 50 years old with bioprosthetic valves. There were no differences between groups in the changes in left ventricular mass, ejection fraction, or peak aortic valve pressure during the 5-year follow-up. The outcomes of mechanical and bioprosthetic valve replacement were comparable in patients older than 50 years. Using bioprosthetic valves in patients younger than 50 years was associated with a greater rate of valve reintervention, with no beneficial effect on the risk of bleeding or stroke.

Efficacy, safety, tolerability and treatment durability of microneedling plus topical tranexamic acid in combination with topical modified Kligman lightening formula for melasma: A four-arm assessor and analyst blinded randomized controlled clinical trial.

The challenging management of melasma highlights the inadequacies of conventional therapies and their high risk of recurrence. Integrating microneedling for device-assisted drug delivery with tranexamic acid (TA), recognized for its melanin synthesis inhibition, presents a novel approach that warrants further investigation to fully assess its potential in enhancing melasma treatment efficacy. Fifty moderate to severe melasma patients participated in this randomized outcome-assessor-blinded controlled trial. Patients were randomly allocated into two main groups. Group A received a modified Kligman formula on one hemi-face on alternate nights for 2 months (A1) and three sessions of microneedling with 10% topical TA on the other hemi-face at 1-month intervals (A2). Group B used the same modified Kligman formula on both sides of the face, with one side additionally receiving three sessions of microneedling with 4% TA (B1) and the opposite side with 10% TA (B2). Primary outcomes were % Modified Melasma Area and Severity Index (mMASI) and % visual analogue scale (VAS) change during 6 month follow-up. Adverse events including post-inflammatory hyperpigmentation (PIH) and treatment tolerability were recorded. Compared to baseline, the mean mMASI reduction immediately after the final session was higher in A1, B1, and B2 (56.84%, 50.88%, and 55.87%, respectively) than in A2, which saw only a 13.16% reduction. Efficacy notably declined after the cessation of treatment across all groups. While the efficacy within groups A1, B1, and B2 was comparable, microneedling with 4% or 10% TA combined with the topical modified Kligman formula proved more potent in patients at a lower risk of PIH. Overall, 22% of patients reported PIH, particularly in the A2 group (28% of hemi-faces), with its occurrence significantly associated with treatment during warmer seasons and in darker skin phototypes. Other adverse events were not observed in any patient. Patient satisfaction was highest in groups B1 and B2, where approximately 72% reported 'excellent' satisfaction. The lowest durability rate (16%) was observed in group A2, while the highest (72%) was seen in group B2, comparable with groups A1 and B1. Treatment tolerability was reported 100% in all groups. It was found that the modified Kligman formula outperformed microneedling-TA alone. However, with optimal patient selection, particularly targeting those at lower risk for PIH with lighter skin phototypes and scheduling treatments during less-sunny seasons, combining microneedling with 4% or 10% TA and the modified Kligman formula significantly enhanced efficacy and satisfaction rates compared to conventional topical treatment.

Single-Portal Arthroscopy Improves the Assessment of Radial-sided Disorders of the Wrist

Abstract Purpose This study aimed to describe the technique, indications, and advantages of the single-portal arthroscopic approach for the diagnosis and staging of chronic radial-sided disorders, including scapholunate interosseous ligament (SLIL) tear, scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) deformities. Methods The single portal technique was used in 138 patients affected by suspected SLIL lesions, SLAC and SNAC wrist injuries with positive clinical symptoms and inconclusive imaging (X-ray and MRI). It was used to grade the nature of the SLIL lesion and the extension of the osteochondral damage in the SLAC and SNAC wrist deformity to guide appropriate treatment. Results Patients were divided into group 1 (SLIL: 45 cases), group 2a (SLAC: 65 cases), and group 2b (SNAC: 28 cases). In group 1, stage 4 SLIL lesions were confirmed in 36 cases and 9 were assessed as SLAC wrist deformity. In group 2a, single-portal arthroscopy confirmed the preoperative diagnosis in 74% of cases. In the remaining 26% of patients, arthroscopy modified the preoperative diagnosis: 1 case of SLAC 1 resulted in SLAC 2, 14 cases of SLAC 2 resulted in SLAC 3, 1 case of SLAC 3 resulted in SLAC 2. A case of SLAC 2 turned out to be an SLIL lesion stage 4. In group 2b, single-portal arthroscopy confirmed the preoperative diagnosis in 86% of cases. In the remaining 14% (4 cases), it modified the preoperative diagnosis: 1 of SNAC 1 resulted in SNAC 2 and the other in SNAC 3, 1 case of SNAC 2 turned out to be an SNAC 3, and 1 case of SNAC 3 resulted in SNAC 4. Conclusion Single-portal wrist arthroscopy modified the preoperative diagnosis of wrist pathology in 42 patients over 138 cases. The use of single-portal wrist arthroscopy should be considered in the evaluation of the radiocarpal and midcarpal joints to allow accurate visualization of the joint surfaces for surgeon and patient planning. Type of Study/Level of Evidence Observational study level of evidence IV.

The RP11-417E7.1/THBS2 signaling pathway promotes colorectal cancer metastasis by activating the Wnt/β-catenin pathway and facilitating exosome-mediated M2 macrophage polarization

BackgroundMetastasis is the major cause of colorectal cancer (CRC) mortality. Emerging evidence suggests that long noncoding RNAs (lncRNAs) drive cancer metastasis and that their regulatory pathways could be targeted for preventing metastasis. However, the underlying mechanisms of lncRNAs in CRC metastasis remain poorly understood.MethodsMicroarray analysis was used to screen for differentially expressed lncRNAs. Transwell assays, fibronectin cell adhesion assays, and mouse metastasis models were utilized to evaluate the metastatic capacities of CRC in vitro and in vivo. Chromatin isolation by RNA purification, chromatin immunoprecipitation and chromosome conformation capture were applied to investigate the underlying mechanism involved. qRT‒PCR and transmission electron microscopy were performed to confirm macrophage polarization and the presence of cancer-derived exosomes.ResultsThe lncRNA RP11-417E7.1 was screened and identified as a novel metastasis-associated lncRNA that was correlated with a poor prognosis. RP11-417E7.1 enhances the metastatic capacity of CRC cells in vivo and in vitro. Mechanistically, RP11-417E7.1 binding with High mobility group A1 (HMGA1) promotes neighboring thrombospondin 2 (THBS2) transcription via chromatin loop formation between its promoter and enhancer, which activates the Wnt/β-catenin signaling pathway and facilitates CRC metastasis. Furthermore, exosomes derived from CRC cells transport THBS2 into macrophages, thereby inducing the M2 polarization of macrophages to sustain the prometastatic microenvironment. Notably, netropsin, a DNA-binding drug, suppresses chromatin loop formation mediated by RP11-417E7.1 at the THBS2 locus and significantly inhibits CRC metastasis in vitro and in vivo.ConclusionsThis study revealed the novel prometastatic function and mechanism of the lncRNA RP11-417E7.1, which provides a potential prognostic indicator and therapeutic target in CRC.

Joint venture offer: should Agastya accept or decline?

Learning outcomes This case study is designed to enable students to understand the demand for flexible containment products in India, understand the need for a joint venture (JV) with an international company, assess Agastya Inventions Private Limited’s (AIPL) cost and benefits of acceptance of the JV offer, evaluate the growth possibilities in the Indian biogas sector, and conduct the valuation of AIPL for its better positioning during the JV deal. Case overview/synopsis The case study is about the dilemma faced by Prantik Sinha, co-founder and director of Indian company AIPL, to accept or decline a JV offer from a French industrial conglomerate Serge Ferrari Group SA (SFG). AIPL is a leading manufacturer and trader of biogas storage tanks, water storage tanks, airlifting bags, floating boom barriers, trash floating boom barriers and inflatable swimming pools. The company adopts business-to-business and direct-to-customer business models. It develops products as per clients’ specifications and their exact requirements. In 2022, SFG proposed collaborating with AIPL to market its biogas digesters in India and abroad. As per the partnership deal, AIPL needed to split its biogas digester portfolio and sell it to the proposed JV for a specific one-time value. Sinha believed that the JV was an opportunity to scale the business globally and would likely shape the company’s future. However, he was in a quandary about making a final decision on accepting the JV offer because biogas digesters remained the company’s highest revenue-generating product portfolio. It was against this backdrop, what would Sinha do to accomplish his business objective and protect the interest of the company? The case study highlights Sinha’s commitment to nurture and expand AIPL’s business in India and beyond. It provides ample scope for students to analyze the pros and cons of AIPL’s JV initiative with SFG and suggest whether the company can leverage this offer for business growth. Complexity academic level This case study is meant for MBA-level students as part of their strategic management and financial management curriculum. Supplementary materials Teaching notes are available for educators only. Subject code CSS 1: Accounting and finance