Major Barrier Research Articles

Modelling the availability of water, energy, and food resources in transboundary river basins to achieve Sustainable Development Goals 2, 6, and 7

The Water-Energy-Food Nexus (WEFN) has gained international attention as an approach for managing water more holistically, building on the progress made by the Integrated Water Resources Management (IWRM) approach. However, modelling the availability of water, energy, and food and their interconnections is complex, with major barriers that include the availability of both data and modelling platforms capable of assessing the interconnected systems of the WEFN. There have been attempts to model resource availability in each sector generally, but few attempts to consider the WEFN in complex transboundary basins, especially considering Sustainable Development Goals (SDGs). Here, a water, energy, and food availability model was developed using a combination of remotely sensed, national government reported, and global datasets. The model explores the complex interactions between the physical availability and production of water, energy, and food for several subbasins representing different states. Results showed the potential impacts of socioeconomic development, population changes and transboundary cooperation on resources. Transboundary cooperation in the case study Ma Basin in Southeast Asia, under existing resources and operations could improve monthly food security and reduce coal power operations using excess hydropower in the basin during the dry season. These findings show that transboundary cooperation improves access to energy and food, whilst potentially reducing demands for water. Furthermore, the research has highlighted ways in which transboundary cooperation can further assist in attaining SDGs 12 and 13 on responsible production and climate action, respectively. The modelling framework is easily transferable and can support similar analysis in other basins, contributing to global attainment of several SDGs.

Use of Minimal Important Difference for Patient-Reported Outcome Measures in Plastic Surgery: A Systematic Review.

The minimal important difference (MID) is vital to consider when interpreting the clinical importance of observed changes from surgical interventions assessed by patient-reported outcome measures (PROMs). There is no gold-standard for how to calculate MIDs, and uptake in plastic surgery literature is currently unknown, leading to methodological and interpretation issues. Medline and Embase were searched to identify all plastic surgery randomized controlled trials (RCTs) employing PROMs as outcomes, and MID estimation studies for PROMs used by RCTs. Included studies were assessed for uptake and application of MIDs, and MID estimation methodology and values were categorized. A total of 554 RCTs employing PROMs as outcomes were identified. Of these, 419 RCTs had the possibility of incorporating a previously published MID. Uptake rate of MIDs was 11.5% (n=48/419). The most common ways MIDs were applied was to calculate sample size (37.5%) or to determine whether results were clinically important (35.4%). A total of 99 studies estimating MID values for the most common PROMs in plastic surgery, based on our review, were analyzed. The most common estimation methodologies were receiver-operator curve analysis (49%), change difference (31%), and standard deviation (25%). Our review highlights limited uptake and application of MIDs in plastic surgery. We propose four major barriers: 1) there existed no repository of published MIDs for PROMs used in plastic surgery; 2) available MIDs are not specific to plastic surgery populations; 3) high heterogeneity in MID estimation methodology; 4) wide ranges in MID values with no superior choice.

Exploring the generative AI adoption in service industry: A mixed-method analysis

In the last few years, many service organisations have been exploring the use of Generative Artificial Intelligence (GAI) tools for their businesses and upgrading their existing processes. These tools have the potential and capability to transform the business world in various aspects. However, serval service organisations are facing many challenges while adopting the GAI tools in their organisations. In a similar context, this study explores the adoption of GAI barriers through two studies by a mixed-method approach. The first study is based on YouTube datasets of selected videos where GAI adoption challenges, problems, and barriers were discussed. Further, these YouTube datasets were analysed through text mining and empirical modelling techniques. In the second study, an extensive literature review was done and critical barriers to GAI adoption were identified based on the extensive literature review. Further, these barriers were analysed through three theoretical lenses and a hybrid fuzzy multicriteria decision-making approach. In addition, the results from the first study were further matched and verified with our second study. This establishes the relevance of adopting a mixed-method approach. Our major findings are: (i) trust, anticipation, and surprise emerged as the strongest emotions of the viewers who posted their comments on the YouTube videos; (ii) Five major barriers are revealed through topic analysis of YouTube transcripts and these are ethical, technological, regulations & policies, cost, and human resources; (iii) Six major barriers are identified through second study are privacy & security, return on investment, running cost, misuse, over-reliance, and Lack of digital infrastructure.

AB082. Navigating barriers to epilepsy surgery: a national survey of patient and neurologist perspectives.

Potential barriers to epilepsy surgery can be divided into two broad groups: reluctance of patients/caregivers and deficient knowledge of neurologists. Pakistan, in particular, faces an epilepsy surgery treatment gap of 70-94%. This study aimed to assess the knowledge and practice of neurologists and the knowledge of the patients diagnosed with epilepsy to identify the barriers to adequate provision of this modality in Pakistan. We conducted a cross-sectional study comprising two surveys. Records of patients diagnosed with epilepsy at our hospital during 2.5 years were retrieved from the Neurophysiology database. The second form was designed for neurologists working in Pakistan. The questionnaires were disseminated via email to neurologists and phone calls to patients. In the patients' survey, we obtained 194 responses from caregivers. The median age of patients was 10 years [interquartile range (IQR): 6-14 years]. We found that 74.2% (n=144) of patients were unaware of surgical options in medically refractory epilepsy (MRE). Therefore, most did not comment on it due to the limited information. Forty-eight patients (24.8%) reported more than 1 seizure per month, and 29 (60.4%) were unaware of the surgical treatment. Seizures were disabling in 88% (n=171) of patients. Patients taking more AEDs were significantly more likely to be aware of surgical options (P=0.001). In the survey from neurologists, only 6.6% (n=4) always discussed epilepsy surgery with MRE patients. Around half of the neurologists, 44.3% (n=27), had never referred a patient for epilepsy surgery. However, 95.1% (n=58) were aware of the under-utilization of epilepsy surgery, and 67.2% (n=41) believed that epilepsy surgery is under-recommended. Almost all neurologists (n=60; 98.4%) believe that comprehensive epilepsy treatment centers are required in the country. In our survey, we found a lack of awareness in both patients and neurologists to be a major barrier. This contrasts the literature from developed or high-income countries, where physician awareness seems adequate, and stigmas associated with surgery seem to be the major barrier. Multifaceted approaches catered to local concerns are necessary to address these hindrances.

Approaches towards pragmatic language assessment in Indian pre-schoolers: A survey among speech-language pathologists.

Pragmatic language assessment in children is performed in line with standard protocols, guidelines, and best practices. The absence of these aspects in the Indian context has resulted in the quest to explore the approaches used by speech-language pathologists (SLPs) to assess pragmatic language impairments. This survey explored the current practices of SLPs towards the assessment of pragmatic language among preschool children in India. It also aimed to identify the barriers, facilitators and identify the level of knowledge, skill and overall practice of SLPs towards their practices using self-appraisal. A total of 100 SLPs(94 females and 6 males) working with preschool aged children (three-to-six-year-olds) from across different Indian states participated in the survey. Participants were enquired about the aspects of pragmatic language assessed, methods used for assessment, awareness and use of Indian tools, the settings, members, and language used for the assessment. Additionally, they were asked to mention the specific tools used, informal methods used, barriers and facilitators, and self-appraise their knowledge, skill and overall practice. Majority of participants assessed multiple aspects of pragmatic language. All used a combination of different assessment methods, with the participants commonly using informal compared to formal approaches. Preschoolers were assessed at multiple settings, along with different communication partners. Lack of awareness on assessment tools developed in India was the major barrier, while the use of informal tasks or activities were the major facilitators influencing pragmatic language assessment to a greater extent. The knowledge and skills for the assessment of pragmatic language obtained poorer scores compared to practices. The assessment practices of the SLPs were largely influenced by the unavailability of developed or adapted tools for Indian preschoolers, leading to the need to develop indigenous assessment tools. Certain considerations for further assessment practices have been identified and discussed.

Evaluation of a Primary Care-Integrated Mobile Health Intervention to Monitor between-Visit Asthma Symptoms.

This study aimed to evaluate implementation of a digital remote symptom monitoring intervention that delivered weekly symptom questionnaires and included the option to receive nurse callbacks via a mobile app for asthma patients in primary care. Research questions were structured by the NASSS (Nonadoption, Abandonment, Scale-up Spread, and Sustainability) framework. Quantitative and qualitative methods assessed scalability of the electronic health record (EHR)-integrated app intervention implemented in a 12-month randomized controlled trial. Data sources included patient asthma control questionnaires; app usage logs; EHRs; and interviews and discussions with patients, primary care providers (PCPs), and nurses. We included app usage data from 190 patients and interview data from 21 patients and several clinician participants. Among 190 patients, average questionnaire completion rate was 72.3% and retention was 78.9% (i.e., 150 patients continued to use the app at the end of the trial period). App use was lower among Hispanic and younger patients and those with fewer years of education. Of 1,185 nurse callback requests offered to patients. Thirty-three (2.8%) were requested. Of 84 PCP participants, 14 (16.7%) accessed the patient-reported data in the EHR. Analyses showed that the intervention was appropriate for all levels of asthma control; had no major technical barriers; was desirable and useful for patient treatment; involved achievable tasks for patients; required modest role changes for clinicians; and was a minimal burden on the organization. A clinically integrated symptom monitoring intervention has strong potential for sustained adoption. Inequitable adoption remains a concern. PCP use of patient-reported data during visits could improve intervention adoption but may not be required for patient benefits.

Whole-body distribution of tenofovir, emtricitabine and dolutegravir in non-human primates.

One major barrier to HIV cure is the persistence of virus, possibly linked to an insufficient antiretroviral drug (ARV) distribution into tissues. To draw the whole-body distribution of three antiretroviral drugs-tenofovir disoproxil fumarate, emtricitabine and dolutegravir-in non-human primates (NHPs). Eight uninfected NHPs received a single injection of a solution containing the three ARVs. Forty-five different tissues were sampled 24 h after injection. Median tissue penetration factors (TPFs) were 45.4, 5.8 and 0.5 for tenofovir, emtricitabine and dolutegravir, respectively, and were statistically different between the three ARVs. Tissues were grouped by system, because TPFs were consistent according to these groups, and ranked in order of decreasing TPFs. The digestive system was the system with the highest tissue concentrations. Next came the two main sites of elimination, the liver and the kidney, as well as the tissues of the cardiopulmonary and urinary systems. Then, it was the whole lymphatic system. The next group included the reproductive system, the adipose tissue and the skin. The last two systems were the muscle and the CNS. The intra-tissue variability was rather low with a median coefficient of variation of the concentrations around 15% and no value greater than 80%. Overall, this study determines the first whole-body distribution in a validated NHP model. These data have important implications for future preclinical and clinical studies for the development of novel HIV therapies towards an HIV cure.

The Unforeseen Costs of Medical Education.

Financial burdens of medical education are a major barrier for many students. The goal of this study is to identify and quantify unforeseen costs associated with being a medical student. Medical students at the University of Tennessee Health Science Center were surveyed on unforeseen financial costs. Qualitative data were collected. Students spent significant extra funds in professional development, social spending, living, and technology. Schools and students should consider all aspects of life to have a fruitful education and appropriately provide loan funding and financial education for both enough and thoughtful use of financial resources during medical education.

Impact of alemtuzumab-mediated lymphocyte depletion on SIV reservoir establishment and persistence.

Persistence of the rebound-competent viral reservoir (RCVR) within the CD4+ T cell compartment of people living with HIV remains a major barrier to HIV cure. Here, we determined the effects of the pan-lymphocyte-depleting monoclonal antibody (mAb) alemtuzumab on the RCVR in SIVmac239-infected rhesus macaques (RM) receiving antiretroviral therapy (ART). Alemtuzumab administered during chronic ART or at the time of ART initiation induced >95% depletion of circulating CD4+ T cells in peripheral blood and substantial CD4+ T cell depletion in lymph nodes. However, treatment was followed by proliferation and reconstitution of CD4+ T cells in blood, and despite ongoing ART, levels of cell-associated SIV DNA in blood and lymphoid tissues were not substantially different between alemtuzumab-treated and control RM after immune cell reconstitution, irrespective of the time of alemtuzumab treatment. Upon ART cessation, 19 of 22 alemtuzumab-treated RM and 13 of 13 controls rebounded with no difference in the time to rebound between treatment groups. Time to rebound and reactivation rate was associated with plasma viral loads (pVLs) at time of ART initiation, suggesting lymphocyte depletion had no durable impact on the RCVR. However, 3 alemtuzumab-treated RM that had lowest levels of pre-ART viremia, failed to rebound after ART withdrawal, in contrast to controls with similar levels of SIV replication. These observations suggest that alemtuzumab therapy has little to no ability to reduce well-established RCVRs but may facilitate RCVR destabilization when pre-ART virus levels are particularly low.

Mixed alkyl/aryl phosphonates identify metabolic serine hydrolases as antimalarial targets

Malaria, caused by Plasmodium falciparum, remains a significant health burden. One major barrier for developing antimalarial drugs is the ability of the parasite to rapidly generate resistance. We previously demonstrated that salinipostin A (SalA), a natural product, potently kills parasites by inhibiting multiple lipid metabolizing serine hydrolases, a mechanism that results in a low propensity for resistance. Given the difficulty of employing natural products as therapeutic agents, we synthesized a small library of lipidic mixed alkyl/aryl phosphonates as bioisosteres of SalA. Two constitutional isomers exhibited divergent antiparasitic potencies that enabled the identification of therapeutically relevant targets. The active compound kills parasites through a mechanism that is distinct from both SalA and the pan-lipase inhibitor orlistat and shows synergistic killing with orlistat. Our compound induces only weak resistance, attributable to mutations in a single protein involved in multidrug resistance. These data suggest that mixed alkyl/aryl phosphonates are promising, synthetically tractable antimalarials.

Factors Affecting Colorectal Cancer Screening in Primary Care Physician Practices in Ukraine.

This study aims to identify the factors influencing colorectal cancer (CRC) screening practices, along with the barriers and facilitators from the perspective of primary care physicians (PCPs) in Ukraine. Considering health care system challenges, including those posed by the ongoing war, this research seeks to inform improvements in CRC screening and outcomes in Ukraine and other low- and middle-income countries (LMICs). A survey was designed and distributed electronically to Ukrainian PCPs, focusing on CRC screening practices, beliefs, and barriers. The survey incorporated questions adapted from established cancer screening surveys and frameworks. Complete responses were collected from 740 PCPs. Sample statistics were computed, and population-level perceptions and associations with CRC screening practices were estimated by standardizing responses to national PCP demographics. The majority of respondents were women (91%) and specialized in family medicine (84%). Respondents believed in the effectiveness of colonoscopy for reducing CRC mortality (80%), with 75% of PCPs referring patients for this screening modality. Major barriers identified include inadequate training of PCPs in screening and lack of resources. Respondents reported high utilization of fecal occult blood test and colonoscopy for screening when these tests were said to be available in their practices. Self-reported familiarity with CRC screening guidelines and participation in educational workshops were positively associated with screening referrals. The study highlights the role of access to CRC screening tests and awareness of screening guidelines in enhancing CRC screening practices among Ukrainian PCPs. Addressing training and resource barriers, alongside public health interventions targeting patient-related barriers, is essential. These findings offer valuable insights for LMICs facing similar challenges, emphasizing the need for tailored strategies to improve cancer screening in these health care settings.

Screening of Glaucoma: Consensus and Directions.

Glaucoma is a leading public health concern globally. This summary discusses barriers to glaucoma screening and novel strategies for a cost-effective glaucoma screening. We discuss barriers to glaucoma screening and recent advancements in glaucoma detection and care, including targeted screening approach as well as telemedicine, genetic testing, and artificial intelligence (AI). A major barrier to glaucoma screening is the cost-effectiveness of case finding resulting from the low prevalence of the disease and the complexity of the diagnosis. Targeted-screening, as well as multi-level screening, can reduce the false positive rate and increase the cost-effectiveness of the program. Telemedicine, availability of genetic testing and polygenic risk scores, and AI provide the opportunity for novel glaucoma screening programs in primary care, portable, and home-based settings and will be helpful for lowering the costs, identifying patients in need of urgent treatment and enabling timely diagnosis and early intervention. Screening of glaucoma is challenging and changing. Recent advancements in digital technology and genetics have led to the development of tools that are promising for novel screening methodologies. Clinical trials are needed to demonstrate the long-term effect of targeted screening on the burden of glaucoma worldwide.

Safety assurance and nutritional quality enhancement of Phyllospora comosa biomass using hydrothermal treatment derived ensemble machine learning models

One of the major barriers to the mass industrial utilisation of brown seaweeds as food sources stem from the food safety risks associated with their iodine and arsenic concentrations, which typically exceed regulatory limits. Hydrothermal treatments might effectively reduce the high iodine and arsenic concentration of Phyllospora comosa below the Australian maximum residual limits (iodine = 1 mg/g and arsenic = 0.00667 mg/g; dry weight) set for brown seaweeds. The experimental hydrothermal treatments dictated that the 82 °C–250 s treatment reduced the iodine concentration from 2.76 mg/g to 0.88 mg/g (68% reduction) and arsenic concentration from 0.01693 mg/g to 0.00965 mg/g (43% reduction). Machine learning models predicted that blanching at 100 °C for ∼4 minutes will reduce the arsenic concentration below its maximum residual limit. Additive log-ratio transformations showed that around 50% (dw) of the hydrothermally treated Phyllospora comosa samples were leached out during the highest treatment intensity, 82 °C–250 s. Even though, a half of the biomass is lost, hydrothermally treated Phyllospora comosa products are safer for human consumption and thus may permit the expansion of seaweed production and consumption in Australia.

Polymorphic Localized Heterostructure Design for High-Performance Amorphous/Nanocrystalline Composite Film.

Analogous to linear dielectric, amorphous perovskite dielectrics characterized of high breakdown strength and low remanent polarization possess in-depth application in the sea, land, and air fields. Amorphous engineering is a common approach to balance the inverse relationship between polarization and breakdown strength in dielectric ceramic capacitor, however, the low polarization is the major barrier limiting the improvement of energy storage density. To address this concern, the polymorphic localized heterostructure confirmed by high-resolution transmission electron microscope (HR-TEM) and HADDF images is constructed in BaTiO3-Bi(Ni0.5Zr0.5)O3 amorphous/nanocrystalline composite film with SiO2 addition (BT-BNZ-xS, x = 3, 5, 7, 10 mol%). The stability of nanocrystalline region achieved by Si-rich transition region and the enhancive ultra-short-range ordering in the amorphous region synergistically result in large breakdown strength and nonhysteretic polarized response. This polymorphic localized heterostructure optimizes the thermal stability in a wide temperature range and contributes ultrahigh energy storage density of 149.9 J cm-3 with markedly enhanced efficiency of 79.0%. This study provides a universal strategy to design the polarization behavior in other amorphous perovskite-based dielectrics.

Maximizing tree carbon in croplands and grazing lands while sustaining yields

BackgroundIntegrating trees into agricultural landscapes can provide climate mitigation and improves soil fertility, biodiversity habitat, water quality, water flow, and human health, but these benefits must be achieved without reducing agriculture yields. Prior estimates of carbon dioxide (CO2) removal potential from increasing tree cover in agriculture assumed a moderate level of woody biomass can be integrated without reducing agricultural production. Instead, we used a Delphi expert elicitation to estimate maximum tree covers for 53 regional cropping and grazing system categories while safeguarding agricultural yields. Comparing these values to baselines and applying spatially explicit tree carbon accumulation rates, we develop global maps of the additional CO2 removal potential of Tree Cover in Agriculture. We present here the first global spatially explicit datasets calibrated to regional grazing and croplands, estimating opportunities to increase tree cover without reducing yields, therefore avoiding a major cost barrier to restoration: the opportunity cost of CO2 removal at the expense of agriculture yields.ResultsThe global estimated maximum technical CO2 removal potential is split between croplands (1.86 PgCO2 yr− 1) and grazing lands (1.45 PgCO2 yr− 1), with large variances. Tropical/subtropical biomes account for 54% of cropland (2.82 MgCO2 ha− 1 yr− 1, SD = 0.45) and 73% of grazing land potential (1.54 MgCO2 ha− 1 yr− 1, SD = 0.47). Potentials seem to be driven by two characteristics: the opportunity for increase in tree cover and bioclimatic factors affecting CO2 removal rates.ConclusionsWe find that increasing tree cover in 2.6 billion hectares of agricultural landscapes may remove up to 3.3 billion tons of CO2 per year – more than the global annual emissions from cars. These Natural Climate Solutions could achieve the Bonn Challenge and add 793 million trees to agricultural landscapes. This is significant for global climate mitigation efforts because it represents a large, relatively inexpensive, additional CO2 removal opportunity that works within agricultural landscapes and has low economic and social barriers to rapid global scaling. There is an urgent need for policy and incentive systems to encourage the adoption of these practices.

Sustainable Energy Systems on Near-Future Smart Cities: The Impact of Household´s Greenhouse Gas Emissions in Europe

Objective: The study addresses the urgency of finding alternatives to high-potential greenhouse fluorinated refrigerants, especially for domestic heating systems, due to imminent legal restrictions in Europe. When exploring the concept of Smart Cities, the energy efficiency of heating/cooling systems that use HFCs is highlighted, identifying the refrigerants responsible for serious global warming and which are being gradually eliminated by the European Union. Framework: Starting with a brief historical analysis of artificial heating and international agreements that have monitored the impact of human actions on the environment, followed by theoretical measures adopted and an assessment of the current European legal landscape related to refrigerants, projecting their impact on existing technologies. Method: Aplly efficient diagnostic, especially in low- and middle-income houses in Portugal, observing climate change, including the increase in CO2 in the atmosphere such as use of the Environmental Performance Index (EPI) to evaluate environmental policies. Research Results: The impact of powerful greenhouse gases such as HFCs, with residential heating in the EU a major source of emissions. Sustainable alternatives such as heat pumps and the gradual transition to refrigerants with lower Global Warming Potential (GWP) are promoted, supported by legislative measures and financial incentives. Research implications: One of the major barriers to climate actionin cities, especially in Europe is to access climate finance to attend green and sustenable criterias. As key to ensuring domestic ability to mobilize sources of finance, such as internal programmes of reducing old skills of coverage in local climate action. The study contributes to debate the multi-level governance for Local Climate Action and integrating national climate change policies based on the global urban agenda, SDG. Originality/Value: As result of the master’s investigation the article is prior in the hitting energy consuming in Europe and especially in Portugal, been part of the graduate program of Aveiro University.

A Highly Standardized Pre-Clinical Porcine Wound Healing Model Powered by Semi-Automated Histological Analysis.

The wound-healing process is a physiological response that begins after a disruption to the integrity of tissues present in the skin. To understand the intricacies involved in this process, many groups have tried to develop different in vitro models; however, the lack of a systemic response has, until this day, been the major barrier to the establishment of these models as the main study platform. Therefore, in vivo models are still the most common system for studying healing responses following different treatments, especially porcine models, which share several morphological similarities to the human skin. In this work, we developed a porcine excisional wound model and used semi-automated software as a strategy to generate quantitative morphometric results of healing responses by specific tissues and compartments. Our aim was to extract the most information from the model while producing reliable, reproducible, and standardized results. In order to achieve this, we established a 7-day treatment using a bacterial cellulose dressing as our standard for all the analyzed wounds. The thickness of the residual dermis under the wound (DUtW) bed was shown to influence the healing outcome, especially for the regeneration of epidermal tissue, including the wound closure rate. The analysis of the DUtW throughout the entire dorsal region of the animals opened up the possibility of establishing a map that will facilitate the experimental design of future works, increasing their standardization and reproducibility and ultimately reducing the number of animals needed. Thus, the developed model, together with the automated morphometric analysis approach used, offers the possibility to generate robust quantitative results with a rapid turnaround time while allowing the study of multiple extra morphometric parameters, creating a more holistic analysis.

Enhancing UWB Indoor Positioning Accuracy through Improved Snake Search Algorithm for NLOS/LOS Signal Classification.

Non-line-of-sight (NLOS) errors significantly impact the accuracy of ultra-wideband (UWB) indoor positioning, posing a major barrier to its advancement. This study addresses the challenge of effectively distinguishing line-of-sight (LOS) from NLOS signals to enhance UWB positioning accuracy. Unlike existing research that focuses on optimizing deep learning network structures, our approach emphasizes the optimization of model parameters. We introduce a chaotic map for the initialization of the population and integrate a subtraction-average-based optimizer with a dynamic exploration probability to enhance the Snake Search Algorithm (SSA). This improved SSA optimizes the initial weights and thresholds of backpropagation (BP) neural networks for signal classification. Comparative evaluations with BP, Particle Swarm Optimizer-BP (PSO-BP), and Snake Optimizer-PB (SO-BP) models-performed using three performance metrics-demonstrate that our LTSSO-BP model achieves superior stability and accuracy, with classification accuracy, recall, and F1 score values of 90%, 91.41%, and 90.25%, respectively.

DPP9 regulates NQO1 and ROS to promote resistance to chemotherapy in liver cancer cells

Chemotherapy has been the standard treatment for liver cancer. However, intrinsic or acquired drug resistance remains a major barrier to successful treatment. At present, the underlying molecular mechanisms of chemoresistance in liver cancer have not been elucidated. Dipeptidyl peptidase 9 (DPP9) is a member of the dipeptidyl peptidase IV family that has been found to be highly expressed in a variety of tumors, including liver cancer. It is unclear whether DPP9 affects chemoresistance in liver cancer. In this study, we find that DPP9 weakens the responses of liver cancer cells to chemotherapy drugs by up-regulating NQO1 and inhibiting intracellular ROS levels. In terms of mechanism, DPP9 inhibits ubiquitin-mediated degradation of NRF2 protein by binding to KEAP1, up-regulates NRF2 protein levels, promotes mRNA transcription of NQO1, and inhibits intracellular ROS levels. In addition, the NQO1 inhibitor dicoumarol can enhance the efficacy of chemotherapy drugs in liver cancer cells. Collectively, our findings suggest that inhibiting DPP9/NQO1 signaling can serve as a potential therapeutic strategy for liver cancer.

A Cross-Sectional Study to Assess the Perceived Oral Health Care Needs, Barriers to Accessing Oral Health Care Services, and Utility Among the Rural Population in Chengalpattu District, Tamil Nadu.

Introduction Utilization is the actual attendance of people at oral healthcare facilities to receive treatment. This study aimed to determine the perceived oral health care needs and barriers to utilizing dental services among rural populations. Materials and methods A cross-sectional survey using a questionnaire was designed to identify the perceived oral health care needs and obstacles to accessing dental facilities and their utility among rural populations. The sample size was set at 570. A data collection sheet was used to collect the required data, which included informed consent, demographic details, and the questionnaire.A pretested and validated questionnaire was used in the study. Result Among the 570 respondents, 43.3% of the population had experienced toothache, out of which 67.6% perceived the need for dental care. Only around 37.5% reported that their dental needs were met during the past year. Dental expenses were significantly related to access to the dentist. Conclusion This survey revealed that the majority of the population tends to utilize the available services only when absolutely necessary. High dental service costs and inadequate knowledge about oral problems act as major barriers.