Group Level Research Articles

‘You’ve gotta be a man and be strong’: Pakistani fathers’ experiences of perinatal loss

ABSTRACT Aims/Background Although women physically experience pregnancy, and grief might manifest differently, both mothers and fathers are affected similarly by perinatal loss. Research has predominately focused on Caucasian men, with the experiences of men from ethnic minority groups not researched. In the UK, the Pakistani community has one of the highest rates of perinatal loss, therefore this research aimed to explore the experiences of perinatal loss in Pakistani men. Design/Method Five Pakistani men who experienced perinatal loss, sometime between four months to eight years ago, were recruited via posters placed at NHS maternity and mental health services, a third sector service, and social media. Semi-structured interviews were used, and transcripts analysed using Interpretative Phenomenological Analysis. Results/Conclusion Three Group Experiential Themes with a total of six group level subthemes were identified: ‘A rollercoaster of emotions: from shock and distress to having hope’, ‘The hidden experience of baby loss as a Muslim man’, and ‘The felt stigma of baby loss in the Muslim community’. Perinatal loss results in ever-changing emotions, with a shift from shock to sense making through religion. Perinatal loss was considered a hidden experience, with men masking emotional responses by a desire to be seen as strong and supportive. The felt stigma of perinatal loss was discussed in the context of silenced conversations and a disconnection between religion and community. Further research is needed to consider different experiences of perinatal loss such as time frames since loss, having children prior to or after a loss, and other Muslim subgroups.

Efficiency of immersive virtual reality game technology on pain management in children with limb fractures: A randomized controlled trial.

Children with fractured limbs usually have moderate to high pain, and distraction can help reduce their pain and anxiety. Virtual reality technology is an emerging method of distraction. We investigated whether the use of immersive virtual reality gaming technology to treat perioperative pain in children with school-age limb fractures effectively. Ninty-nine patients who had limb fracture surgery between October 2021 and September 2022 were randomly assigned to receive immersive virtual reality game therapy (Group A), non-immersive virtual reality game therapy (Group B), or conventional treatment group (Group C). Changes in pain, anxiety, fear, and biochemical markers were assessed at various time points in the three groups using subjective and objective rating scales. Both Group A and Group B consistently showed lower pain scores, fear levels, and anxiety levels compared to Group C after surgery, statistical analysis revealed significant differences among the three groups (p<0.001). Additionally,serum levels in group A were significantly lower than those in other groups, showing a notable statistical discrepancy (p<0.001). Both immersive and non-immersive virtual reality gaming significantly reduce perioperative pain, fear, and anxiety in children with limb fractures, and have practical significance for pain management of pediatric orthopedic patients. Immersive virtual reality, however, appears to have a more pronounced effect. The trial was registered prior to patient enrollment at the Chinese Clinical Trial Registry(ChiCTR210004583).

Do children with type 1 diabetes mellitus remain protected against hepatitis B?

Because patients with type 1 diabetes mellitus (T1DM) have persistent and profound limitations in immune functions, immune response to vaccines may diminish. The aim of our study was to compare the antibody to Hepatitis B surface antigen (anti-HBs) serologies of children with T1DM, at the time of T1DM diagnosis, who were vaccinated according to the vaccination schedule with the anti-HBs serologies of healthy children. And to investigate the relationship between anti-HBs levels and the accompanying variables of these patients. Anti-HBs and Hepatitis B surface antigen (HBs Ag) results of 214 children with T1DM and 210 healthy children were recorded retrospectively. Seropositivity rates for anti-HBs were compared between T1DM and control groups and the odds of seropositivity were examined. Clinical andlaboratory data of T1DM patients were investigated according to anti-HBs seropositivity. Anti-HBs seropositivity rates and titers in the T1DM group were significantly lower than those in the healthy group. According to anti-HBs status among T1DM patients; no difference was found in terms of gender, BMI, presence of comorbidities, presence of autoantibodies and lipid profiles. Diagnosis age and HbA1c levels of anti-HBs negative group were higher than anti-HBs positive group in patients diagnosed with T1DM. However, neither age nor HbA1c level was found to significantly change the odds of the seropositivity for anti-HBs in T1DM patients after adjustment. We recommend that children diagnosed with T1DM should have anti-HBs serology tested at the time of diagnosis and seronegative patients should have additional hepatitis B vaccination.

The use of the Crohn's disease exclusion diet (CDED) in adults with Crohn's disease: A randomized controlled trial.

The Crohn's disease exclusion diet (CDED) has been shown to induce remission in adult Crohn's disease (CD) patients. The aim of the study is to provide additional evidence-based validation. We conducted an open-label, randomized trial on adult CD patients with mild-to-moderate symptoms to assess CDED efficacy in inducing symptomatic remission using Mediterranean diet as control. We evaluate demographic data, body mass index (BMI), Harvey-Bradshaw Index (HBI), faecal calprotectin, and serum inflammatory indices at baseline, 12, and 24 weeks. Bioelectrical impedance analysis (BIA) was used to ensure the safety of the CDED group every 12 weeks. Twenty-four patients were assigned to CDED, and 21 to controls, with no baseline differences among the parameters considered. Five CDED patients dropped out due to intolerance within the first 6 weeks. At 12 weeks, CDED patients showed significantly lower HBI and higher remission rates than controls. By 24 weeks, remission rates increased (70.8% vs. 38.1% at 12 weeks and 79.2% vs. 42.9% at 24 weeks; p = .027 and p < .0001, respectively), with significantly lower fibrinogen levels in the CDED group. The administration of CDED was associated with a significant decrease in BMI (25.8 kg/m2-24.5 kg/m2, p = .047), although BIA analysis showed a decrease in fat mass (18.2%-15.5%, p < .0001), while fat-free mass and body cellular mass significantly increased at 12 weeks (p = .001 and p = .042, respectively) and remained stable at 24 weeks. The CDED was effective in inducing remission among patients with mild-to-moderate CD and appeared to be safe and well-accepted.

Systemic disease activity measured with ESSDAI varies largely over 5 years in a prospective, longitudinal cohort of patients with Sjögren’s disease

ObjectivesThe objectives are to evaluate variation in systemic disease activity (European Alliance of Associations For Rheumatology (EULAR) Sjögren’s Syndrome Disease Activity Index (ESSDAI)) over time at group and individual patient...

How can we make therapy better for autistic adults? Autistic adults' ratings of helpfulness of adaptations to therapy.

Autistic people experience more mental health conditions like depression or anxiety than non-autistic people. They are also more likely to experience difficulties in accessing mental health supports Clinicians have published suggestions on how to improve therapy for autistic people. However, whether these ways to adapt (i.e. adaptations) therapy for autistic people are seen as helpful by autistic people themselves has not been investigated. We recruited 130 autistic adults to complete an online survey. They rated 55 adaptations to therapy from "Not at all helpful" to "Extremely helpful." We also asked for ideas of additional adaptations. Adaptations classified as neurodiversity affirming (e.g. having a therapist that embraces differences in brains and provides support to affirm neurodivergent identity) were rated highest. Approximately half of adaptations were rated positively at a group level. However, for almost every adaptation at least one person rated it as not at all helpful and at least one rated it as extremely helpful. Additional adaptations were around general good practice, financial cost, neurodiversity-affirming practices, practical, sensory/environmental, structure, and therapy style/techniques. Our findings add how helpful autistic people themselves rate adaptations to therapy and similarities and differences to clinicians. This is important to consider how these perspectives can differ. Findings also identify additional suggestions that clinicians could use in their practice and ideas for future research. Findings can help autistic adults in advocating for adaptations to therapy that address their needs by providing a list of possible adaptations. Furthermore, findings may help clinicians to better support their autistic clients.

Anti-proliferative and photodynamic activities of Senna didymobotrya (Fresen.) leaf alkaloid-rich extracts against breast cancer cells

BackgroundAmongst all neoplastic diseases, breast cancer represents a major cause of death among the female population in developed and developing countries. Since alkaloid drugs are commonly used in chemotherapy to manage this disease, this study investigated the anti-proliferative effectiveness of alkaloid-rich fractions of Senna didymobotrya leaves only and with laser irradiation against MCF-7 breast cancer cells.Method and materialsA powdered sample of the plant leaves was extracted with 50% ethanol, filtered and their pH was adjusted with acid and base solution followed by partitioning with chloroform and ethyl acetate solvents. Cells were treated with 240 μg/mL of the respective extracts, while those in the photodynamic therapy groups, cells were exposed to laser (405 nm wavelength and 10 Jcm−2) irradiation 6 h post extracts' administration.ResultsTreatment with the S. didymobotrya leaves alkaloid extracts significantly decreased the ATP concentration and overall viability of the MCF-7 cells. Reactive oxygen species (ROS) levels in cell groups treated with the extracts and laser light were considerably higher than in experimental groups treated with only the extracts. Moreover, the molecular docking analysis revealed the involvement of only hydrophobic bonds in the interactions of the plant’s alkaloid-derived phytoconstituents’ with selected cancer protein biomarkers.ConclusionAlthough the in silico analysis suggests that the plant-identified alkaloid phytoconstituents inhibition of estrogen receptor-alpha, human epidermal growth factor receptor-2 and progesterone receptor proteins involved in breast cancer pathogenesis could explain a possible mechanism for the observed anticancer effect, more detailed in vitro molecular experiments are necessary to confirm these findings.

The role of 1-Deoxysphingolipids and Polyamines in the pathogenesis of placental syndrome

BackgroundPlacental syndrome, mainly composed of preeclampsia and fetal growth restriction, has an impact on the health of mother and baby dyads. While impaired placentation is central to their pathophysiology, the underlying molecular mechanisms remain incompletely understood. This study investigates the association between placental syndrome and metabolic alterations in 1-deoxysphingolipids (1-deoxySLs) and polyamines, along with their regulatory enzymes.MethodsThis prospective case-control study involved 26 healthy pregnant women and 17 with placental syndrome. Blood samples were collected from maternal, uterine venous, and umbilical cord veins. Levels of 1-deoxySL, spermine, and spermidine, as well as related enzymes of polyamine metabolism such as ornithine decarboxylase (ODC), spermidine/spermine N1-acetyltransferase (SSAT), polyamine oxidase (PAO), and spermine oxidase (SMO), were measured using the techniques of LC-MS and ELISA, respectively.ResultsWomen with placental syndrome had significantly higher levels of 1-deoxySL, spermine, and spermidine in all blood samples compared to the healthy pregnancy group. Additionally, ODC and SSAT levels were reduced significantly in the placental syndrome group, while PAO and SMO levels showed no significant differences. Strong positive correlations were found between the studied enzymes and biomolecules in healthy pregnancies, which were notably weaker in the placental syndrome group.ConclusionThis study demonstrates significantly altered levels of 1-deoxySL and polyamines, with corresponding enzyme activity changes, in placental syndrome compared to healthy pregnancies. The disrupted correlations between these biomolecules suggest alterations in their metabolic pathways and potential utility as biomarkers. Further mechanistic studies are warranted to elucidate their role in placental syndrome pathophysiology.

Improvement of ovarian function in a premature ovarian failure mouse model using Vitex agnus-castus extract.

Premature ovarian failure (POF) leads to infertility. Numerous researchers have endeavored to enhance ovarian function through antioxidant interventions. Extract from Vitex agnus-castus (VAC) has demonstrated a protective effect. Therefore, the objective of this study was to investigate the amelioration of ovarian function following VAC treatment in a POF mouse model. In this investigation, 30 female NMRI mice were categorized into control, POF model (cyclophosphamide 120 mg/kg I.P), and experimental groups (100, 300, and 500 of VAC extract). Parameters such as body weight, vaginal smears, and follicular evaluation were examined. FSH, estradiol levels, free radicals, and the expression of the FMR1 gene were assessed. The microscopic assessment revealed that POF induced morphological alterations in ovarian tissue, whereas VAC treatment significantly ameliorated ovarian tissue conditions. The follicles number exhibited a significant reduction in the POF group; however, VAC led to an increase in follicular count and elevated estradiol levels in the treatment groups. Serum FSH levels displayed an elevation in the POF group, whereas the treatment groups exhibited a substantial reduction in FSH levels compared to the POF group. The expression of the FMR1 gene demonstrated upregulation in the POF group compared to the control group (p<0.05). Moreover, this expression significantly decreased in the 500-dose VAC group compared to the POF group (p<0.001). ROS generation exhibited a significant increase in the POF group, which was conversely mitigated in all experimental groups. Our findings underscore the potential of this extract to ameliorate POF symptoms, however, further investigations are needed.

NLRP3 is a BMI-independent mediator of stable COPD

PurposeThe inflammatory response in animal models of chronic obstructive pulmonary disease (COPD) is activated by the NLR-family-pyrin-domain-containing-3 (NLRP3) inflammasome pathway, which is also known to play a role in obesity-related inflammation. The NLRP3/caspase-1/interleukin (IL)-1β pathway might be involved in the progression of COPD with increasing body mass index. To our knowledge, no previous studies have explored the role of NLRP3 inflammasome markers in linking COPD and obesity. Here, we aim to investigate this potential connection by examining levels of NLRP3, caspase-1, IL-1β, and IL-17A and to provide additional data on the expression of these molecules in relation to smoking status and COPD severity.MethodsA case‒control study was conducted between July 2020 and March 2023. Peripheral blood mononuclear cells were isolated, and total RNA was extracted for real-time quantitative polymerase chain reaction (qPCR) analysis to measure the expression levels of inflammasome molecules.Results29 subjects who were diagnosed with stable COPD and 32 controls were included in the data analysis. NLRP3 and IL-17A but not caspase-1 or IL-1β expression was significantly greater in the COPD group than in the control group. We detected a significant increase in NLRP3 levels in the smoker COPD group (p = 0.009) and nonsmoker COPD group (p = 0.045) compared with those in the nonsmoker control group. There was no significant correlation between BMI and the inflammasome markers.ConclusionAs proinflammatory biomarkers, NLRP3 and IL-17A are prominent in stable COPD patients. Smoking may trigger NLRP3-mediated inflammation in stable COPD patients. The expression levels of NLRP3 inflammasome molecules did not differ in terms of disease severity or BMI.Graphical

Effects of gestational diabetes mellitus and diabetes mellitus on lipid profile, antioxidants, hormones and electrolytes status in a population of Nigerian women

AimGestational diabetes mellitus (GDM) cases are rising globally. This research examined the effects of GDM and diabetes mellitus whose hallmark is hyperglycemia on hormones, lipid profiles, electrolytes and antioxidants in freshly diagnosed women attending teaching hospitals in Ekiti State, Nigeria.MethodsThe cross-sectional design followed convenience sampling in four groups (n = 50): gestational diabetes women (GDM), normal pregnant women (NP), diabetes nonpregnant women (DM) and nondiabetes nonpregnant women (ND-NP). Blood samples were collected from fasting subjects through antecubital fossa. BMI, FPG, TC, TG, LDL-C, HDL-C, sodium, potassium and bicarbonate ions, MDA and antioxidants were investigated using standard procedures and spectrophotometer. Results were analysed using one-way ANOVA and p < 0.05 was used as significant difference.ResultsThere was significant (p < 0.05) increase in FPG of GDM and DM (> 5.56 mmol/l) subjects compared to NP and ND-NP subjects. TC, TG, HDL-C and LDL-C were elevated in GDM and DM groups compared to NP and ND-NP groups. Sodium ion concentration was significantly (p˂0.05) elevated in ND-NP group relative to GDM and DM groups. There was significant (p < 0.05) increase in MDA levels in DM and NP groups compared to ND-NP. Superoxide dismutase activity was significantly (p < 0.05) greater in ND-NP than in DM and NP. Progesterone level was greater in GDM group than in other groups. The FSH concentration was lower in the GDM and NP groups than in the DM and ND-NP groups, and prolactin concentration was greater in the GDM group than in the NP.ConclusionThis study suggested that GDM and DM could result in hormonal and electrolyte imbalances, elevated lipid profiles, and reduced antioxidant levels.

Effect of selenium on the dysfunction of rat salivary glands induced by 131I and expression of insulin-like growth factors and aquaporins.

To investigate the effects of selenium on functional and histopathological changes and mRNA expression levels of insulin-like growth factors 1 and 2 (IGF-1 and -2) and aquaporins 4 and 5 (AQP-4 and -5) in 131I-induced damaged rat parotid glands. Rats were divided into three groups: iodotherapy-with-selenium, iodotherapy-only, and control. Rats in the iodotherapy-with-selenium group were intragastrically administered 131I on the first day and selenomethionine through drinking water. Rats in the iodotherapy-only group were only administered 131I. Changes in parotid gland function were evaluated using the functional parameters of salivary gland dynamics imaging pre-experiment and on days 7, 30, and 90 post-treatment. Immunofluorescence and quantitative real-time PCR analyses detected IGF-1, IGF-2, AQP-4, and AQP-5 expression levels in tissues. The gland-to background ratio at a maximum count (G/BGmax), Tmax/Tmin, and Smax values were significantly impacted over time in the iodotherapy-with-selenium group; on day 30, the G/BGmax value was significantly higher than that in the iodotherapy-only group. Histopathological analysis revealed that on days 30 and 90, the iodotherapy-with-selenium group displayed greater parotid gland repair than the iodotherapy-only group. In the iodotherapy-with-selenium group, fluorescence intensity and mRNA levels of AQP-5 increased with the selenium supplementation period, reaching significantly higher levels on days 30 and 90 than in the iodotherapy-only group. Whereas the fluorescence intensity and mRNA levels of IGF-1 in the iodotherapy-with-selenium group were significantly higher on day 7 than on day 30 in the iodotherapy-only group. Selenium may repair 131I-induced tissue and functional damage in rat salivary glands by upregulating AQP-5 and IGF-1 expression.

Unloader brace or high tibial osteotomy in the treatment of the young patient with medial knee osteoarthritis: a randomized controlled trial.

For medial knee osteoarthritis (OA), operative and nonoperative treatment options are available. Two widely applied unloading therapies are a valgus unloader brace and a high tibial osteotomy (HTO). We aimed to compare the effects of a valgus unloader knee brace with an HTO on knee pain after 1 year in patients with symptomatic medial knee OA. We recruited patients from 9 Dutch hospitals between August 2014 and February 2019 for an open-labeled multi-center randomized controlled trial (Dutch Trial Register NL4200). Patients aged 18 to 65 years with symptomatic medial compartmental knee OA were randomized to either a valgus unloader brace or an HTO. The primary outcome was the pain subscale of the Knee injury and Osteoarthritis Outcome score (KOOS) after 1 year. Patients were evaluated at 3, 6, 9, 12, and 24 months. 51 patients were included in the study, of whom 23 were randomized to the unloader brace and 28 to the HTO. The HTO, compared with the unloader brace, showed a significant and clinically relevant difference at 12 months of follow-up in KOOS pain of -28 (95% confidence interval -43 to -13). We found that, on group level, an HTO is more effective in reducing knee pain than an unloader brace after 12 months.

Impact of drinking water temperature and mineral supplementation on the performance of pregnant ewes

The study was conducted at Mountain Research Centre for Sheep and Goat (MRCSG) Shuhama, SKUAST-K with the objective to observe impact of watering temperature and mineral supplementation on the performance of pregnant ewes during winter, which is a critical period for the sheep industry in Jammu and Kashmir. A total of 40 pregnant Corriedale ewes, aged from 3 to 5 years, in their last trimester of gestation were divided into four uniform groups (Groups A, B, C, and D) with 10 animals in each group on basis of body weight and parity. Four different treatments were given to animals. Group A animals were given cold water (5 °C), Group B animals were provided with warm water (20 °C), Group C animals were given cold water (5 °C) along with mineral mixture 10 g/animal/day, lastly Group D animals were provided warm water (20 °C) along with mineral mixture 10 g/animal/day. Over the period of experiment, water and feed intake, body weight, body condition score, biochemical parameters and wool quality were recorded in the study. The results indicated a significant difference (p ≤ 0.05) in average water intake between the cold and warm water groups, regardless of mineral supplementation. The average water intake was highest in Group D (20.08 ± 0.26 L) which differed significantly from Group A (16.1 ± 0.18 L). The average feed intake also differed significantly (p ≤ 0.05) among the cold and warm water treatment groups, irrespective of mineral supplementation. The average feed intake for Group B and Group D was 16.78 ± 0.04 and 16.59 ± 0.08 kg, respectively that differed significantly from Group A and Group C having an average feed intake of 15.12 ± 0.07 kg and 15.12 ± 0.08 kg, respectively. The animals exhibited improvement in body condition score (ranging from 2.71 ± 0.13 to 3.04 ± 0.19) until lambing, and those changes were significant (p ≤ 0.05) among all treatment groups. Biochemical parameters like glucose, creatinine, BHBA, cortisol, and phosphorous, were within the normal ranges and did not show any statistically significant difference between the treatment groups. However, blood urea nitrogen (BUN) levels remained elevated above the normal prescribed range in all treatment groups. However, the levels were significantly (p ≤ 0.05) lower in treatment groups provided warm water in the parturition and post parturition phase, ranging between 19.64 ± 1.28 to 24.83 ± 1.38 mg/dL. Significant (p ≤ 0.05) differences were observed in calcium levels in treatment groups with the groups C and D, supplemented with the mineral mixture having higher levels of serum calcium. The calcium levels were 7.55 ± 0.04 and 7.53 ± 0.06 mg/dL for group C and D respectively. Similar trend was observed for magnesium levels, which were higher and differed significantly (p ≤ 0.05) in supplemented groups C and D, in pre and post-partum period. Among the wool quality parameters, staple length, fiber diameter, medullation and burr content were not varying significantly among the treatment groups, indicating no profound impact of water temperature and mineral supplementation. The present study revealed that augmenting the drinking water temperature and supplementing the feed with minerals contributed to better water and feed intake. However, no profound impact of these interventions was observed on biochemical and wool quality parameters except for crimp frequency. The crimp frequency ranged between 2.15 ± 0.04 to 2.67 ± 0.05 and varied significantly (p ≤ 0.05) among the treatment groups.

Relationship between klotho, neurotrophic factors (BDNF, NGF, GDNF) and cognitive functions in patients with bipolar disorder

BackgroundKlotho and neurotrophic factors, including brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), and glial cell line-derived neurotrophic factor (GDNF), have been shown to play a role in cognitive functions. However, these molecules have not been investigated in bipolar disorder simultaneously to assess the interactions among them and their relationships with cognitive functions. This study investigated the relationships among cognitive function, klotho, and neurotrophic factors in patients with bipolar disorder in the remission period.MethodsMale, bipolar disorder (BD) patients (patient group, n = 48) in the remission period and healthy volunteers (control group, n = 48) were included in the study. The Stroop test and Wechsler Memory Scale–Visual Production Subtest were applied, and the serum levels of Klotho, BDNF, GDNF, and NGF were measured with an ELISA reader.ResultsThe klotho protein levels (0.12 ± 0.15 and 0.17 ± 0.16) and NGF levels (34.36 ± 41.99 and 48.54 ± 41.06) in the patient group were significantly lower than those in the control group (Z = -3.071, p = 0.002 and Z = -2.217, p = 0.027, respectively). In the patient group, there was a positive correlation between the klotho and NGF levels (p = 0.003, rs = 0.413), and a negative correlation was detected between the NGF and GDNF levels (p = 0.013, rs = -0.355). Klotho and NGF were predictors of Weshler 40-min test results (adjusted R2 = 0.467), and Klotho and BDNF were predictors of Stroop test colour word reading time (adjusted R2 = 0.391) with other variables.ConclusionIn BD patients, klotho, BDNF, GDNF and NGF are associated with cognitive functions and exhibit different characteristics from those of the control group. Nevertheless, the differences related to these molecules seem to be associated with a regulatory system rather than merely an increase or decrease in serum levels.

Changes in tear cytokine and lactoferrin levels in postmenopausal women with primary acquired nasolacrimal duct obstruction complicated with obstructed meibomian gland dysfunction

BackgroundEpiphora and secondary ocular surface damage are increasingly impairing the quality of life of people, particularly elderly women. We aimed to investigate the changes in tear cytokine and lactoferrin levels in postmenopausal women with primary acquired nasolacrimal duct obstruction (PANDO) complicated with obstructed meibomian gland dysfunction (OMGD) and preliminary explore the pathological mechanisms of OMGD in patients with PANDO.MethodsThe prospective study involved 43 and 41 postmenopausal women with and without PANDO, respectively. Based on the presence or absence of OMGD, the participants were subdivided. Tear fluid was collected from affected eyes of all participants using Schirmer I test and tested for cytokine concentrations (interleukin (IL)-6, IL-8, IL-1β, interferon-gamma, tumour necrotic factor (TNF)-α, IL-10, epidermal growth factor (EGF)) using the Multiplex Luminex Assay. Tear lactoferrin levels was determined using ELISA.ResultsIn the PANDO with OMGD group, the IL-8, IL-1α, IL-1β, and macrophage inflammatory protein-1α levels were significantly higher than those in the other groups. The IL-6 and TNF-α levels were significantly higher than those in the controls. The lactoferrin level in the PANDO with OMGD group was lower than that in the Non-PANDO with OMGD group. The IL-10 and EGF levels were not significantly different among the groups.ConclusionThe level of pro-inflammatory factors in the tears of patients with PANDO complicated with OMGD was significantly increased, which is likely to cause further damage to ocular surface. Anti-inflammatory therapy may help protect ocular surface in postmenopausal women with PANDO.

Impact of Low Inclusion Rate of Olive Cake in Dairy Cow Rations on Uterine Health and Fertility Indices During Early Lactation.

Olive cake was incorporated at a low inclusion rate (3.7%) into the rations of dairy cows through partial substitution of maize, and its effects on milk production, general health, and fertility traits were investigated. Multiparous purebred Holstein dairy cows (n = 148) were divided into two groups: a treated group (n = 86) and a control group (n = 62). The control ration (group C) was modified by replacing 1 kg of maize with an equal quantity of olive cake (group T). The experiment lasted from 60 days prepartum to 150 days postpartum. Electronic aids were utilized to quantify daily milk yield and detect estrus expression, while clinical and uterine examinations were performed weekly. Blood samples, uterine epithelial cells, and endometrial tissue samples were collected from a subgroup of healthy animals in both groups at specific time points. Blood samples were examined to determine the β-hydroxybutyric acid (BHBA), acute phase proteins (haptoglobin [Hpt] and serum amyloid A [SAA]), progesterone, and pregnancy-associated glycoproteins concentrations. Uterine epithelial cells were assessed for polymorphonuclear neutrophil (PMN) counts, and the expression of nine genes encoding inflammatory cytokines and immune system activation was analyzed in uterine biopsy tissue. No significant differences (p > 0.05) were observed between groups in milk yield, general morbidity, clinical endometritis, or conception rates. However, animals in group T came to estrus approximately 6 days earlier (p = 0.013) than those in group C; progesterone concentrations on day 7 of the subsequent cycle tended (p = 0.07) to be higher in group T. On day 21, BHBA concentrations were higher in group C than in group T (p < 0.05). Throughout the experiment, Hpt levels in group T were consistently lower (p < 0.001), while SAA was lower on day 7 compared to group C. From days 21 to 42 postpartum, there was a significant reduction in PMN numbers (group C p = 0.02; group T p < 0.0001), with a tendency for a greater reduction rate in group T (p = 0.08). Among the genes studied, a significant difference was revealed in the expression of the ILA1 gene, with strong correlations of gene expression in group C and weak to moderate correlations in group T. In conclusion, under the conditions of this experiment, the inclusion of olive cake into dairy cows' rations did not affect milk production but improved certain health and fertility parameters, making olive cake a suitable alternative feedstuff for high-producing animals.

Optimal use of limited proton resources for liver cancer patients in combined proton–photon treatments

Objective. Liver cancer patients may benefit from proton therapy through increase of the tumor control probability (TCP). However, proton therapy is a limited resource and may not be available for all patients. We consider combined proton-photon liver SBRT treatments (CPPT) where only some fractions are delivered with protons. It is investigated how limited proton fractions can be used best for individual patients and optimally allocated within a patient group.Approach. Photon and proton treatment plans were created for five liver cancer patients. In CPPT, limited proton fractions may be optimally exploited by increasing the fraction dose compared to the photon fraction dose. To determine a patient's optimal proton and photon fraction doses, we maximize the target biologically effective dose (BED) while constraining the mean normal liver BED, which leads to an up- or downscaling of the proton and photon plan, respectively. The resulting CPPT balances the benefits of fractionation in the normal liver versus exploiting the superior proton dose distributions. After converting the target BED to TCP, the optimal number of proton fractions per patient is determined by maximizing the overall TCP of the patient group.Main results. For the individual patient, a CPPT treatment that delivers a higher fraction dose with protons than photons allows for dose escalation in the target compared to delivering the same proton and photon fraction dose. On the level of a patient group, CPPT may allow to distribute limited proton slots over several patients. Through an optimal use and allocation of proton fractions, CPPT may increase the average patient group TCP compared to a proton patient selection strategy where patients receive single-modality proton or photon treatments.Significance. Limited proton resources can be optimally exploited via CPPT by increasing the target dose in proton fractions and allocating available proton slots to patients with the highest TCP increase.

Predictive Value of First Amniotic Sac IL-6 and Maternal Blood CRP for Emergency Cerclage Success in Twin Pregnancies.

Objectives: To assess the usefulness of first amniotic sac Interleukin-6 (IL-6) to rule out intra-amniotic inflammation (IAI), as well as maternal blood c-reactive protein (CRP), to select patients with a twin pregnancy who may benefit from an emergency cerclage. Materials and Methods: Retrospective, descriptive study among all patients with a twin pregnancy and mid-trimester bulging membranes admitted to a tertiary Hospital from January 2012 to September 2023. According to the Hospital's Protocol, all patients received a vaginal and abdominal ultrasound, a maternal blood test, and an amniocentesis of the first sac to rule out IAI, defined by IL-6 ≥ 2.6 ng/dL. Results: A total of 28 patients with a twin pregnancy and mid-trimester bulging membranes were included. Among them, 18 patients (64.28%) had IL-6 levels ≥ 2.6 ng/dL. Cerclage was placed in 10 patients with IL-6 < 2.6 ng/dL. Perinatal mortality in pregnancies with IL-6 ≥ 2.6 ng/dL was 77.22%. The gestational age at delivery of patients with IL-6 < 2.6 ng/dL was 34 ± 3 weeks, compared to 23 ± 4 weeks when IL-6 was ≥2.6 ng/dL (p < 0.001). The latency to delivery with IL-6 < 2.6 ng/dL was 88.1 ±31.56 days, compared to 13.11 ± 20.43 days when IL-6 was ≥2.6 ng/dL (p < 0.001). Significant differences were found in maternal blood CRP levels in both study groups (no IAI 4.32 ± 3.67 vs. IAI 13.32 ± 15.07, p < 0.05). The area under the curve with an ROC curve was 0.799 (IC 95% 0.596-0.929), with a cut-off of 3.9 mg/L (S 94.4%, % E 62.5%). The gestational age at delivery with CRP < 3.9 mg/L was 33 ± 5 weeks, while in cases with CRP ≥ 3.9 mg/L, it was 24 ± 5 weeks (p < 0.001). The latency days to delivery were 86.5 ± 44.88 and 21.95 ± 30.97 days (p < 0.01), respectively. A positive correlation between the IL-6 values of both amniotic sacs was obtained, along with the Spearman coefficient correlation rank (rho = 0.835, p < 0.001). Conclusions: Compared to those with IAI, patients with a twin pregnancy and mid-trimester bulging membranes without IAI who underwent emergency cerclage had a significantly higher interval from diagnosis to delivery, as well as a significantly lower incidence of preterm birth < 34 weeks and perinatal death. Further studies are needed to assess whether the IL-6 of the first amniotic sac and maternal blood CRP might constitute a useful parameter to select patients who may benefit from an emergency cerclage.

The Role of the Sagittal Pars Inclination Angle in the Development of a Spondylolysis

Background and Aims: Spondylolysis refers to a stress fracture of the pars interarticularis. We investigated if there is a correlation between a novel measurement, the sagittal pars inclination angle and the incidence of spondylolysis (pars defect) in adolescent and young adult patients. Methods: A retrospective cohort study was conducted at the Royal Orthopaedic Hospital, UK (a tertiary referral orthopaedic centre) over two years identifying 37 Adult patients under the age of 30 years who had a computed tomography (CT) scan of the lumbar spine. In total 255 pars interarticularis, from levels L2 to L5, were analysed in 37 patients (19 male, 18 female). The pars interarticularis were divided into two groups: (1) pars intact ( N = 217) and (2) pars defect ( N = 38). Statistical analysis of each group and vertebral level was performed including load measurements. Results: In the pars intact group ( N = 217), the sagittal mean ± standard deviation (SD) pars inclination angle for the pars intact group was 17.91 ± 5.62°. In the pars defect group ( N = 38), the mean ± SD sagittal pars inclination angle was 35.95 ± 6.42°. A two-tailed P value was less than .0001. There was an increase in the normal sagittal pars angle from L2 to L5. Conclusion: In this study, an increased sagittal pars inclination angle demonstrated a significant association with spondylolysis. Its implications in the management of athletic individuals, surgical planning and indeed a true causative relationship are yet to be evaluated in future studies.