One-tailed Research Articles

Women Tourism Entrepreneurs in KwaZulu – Natal, South Africa: Capabilities and Challenges?

This study conducted in the context of South Africa, aims to explore gender nuances in the performances of tourism-related businesses in the Durban Central Business District, KwaZulu-Natal, with emphases on traditional societal perceptions and access to capital. Questionnaire survey, a quantitative research method, was used to collect data from 150 tourism-related business owners and managers using purposive sampling method. Data was analysed using IBM’s SPSS version 25 software. Descriptive (frequency, mean), bivariate (Spearman’s Rank Correlation (two-tailed) test, Pearson’s Chi-Square test, Mann-Whitney U test) and multivariate (Reliability test using Cronbach’s Alpha) data analyses were applied in this study. Results shows that entrepreneurial performance is influenced by the belief system of the society, marketing capabilities, and the entrepreneur background. Hence, there may be the influence of African traditional societal perceptions on African women entrepreneurs to be more contented than men with the small size of their businesses (because society expects them not to manage large businesses). This study did not make a conclusive finding that gender plays a strong role in differentiating business success or performance. However, the study found that it is somewhat easier for female entrepreneurs to find business start-up capital. Based on this study results, authors recommend that entrepreneurial training and mentorship programmes should emphasise that gender has no role in determining entrepreneurial success. Better optimisation of marketing capability and increased awareness of entrepreneurs regarding sources of business funding, are crucial for business start-ups and success.

Factors that Influence Stunting in the Maratua District of Berau, Indonesia

Highlights:1. This study investigated the factors contributing to stunting in a remote area, which has not received sufficient attention from key stakeholders.2. The findings of this study can serve as a reference for the government in addressing stunting through intervention strategies that incorporate paternal roles to improve children's nutritional status. AbstractStunting is a community health problem with significant impacts. The estimated prevalence rate of stunting was 24.4% in Indonesia and 25.7% in the Berau Regency. Stunting is a growth disorder caused by chronic malnutrition during the first 1,000 days of life. It is characterized by a height-for-age Z-score below -2 standard deviations from the child growth standards median of the World Health Organization, an insufficient growth rate, and a reduced potential final height. The contributing factors to stunting include maternal variables, as mothers are the primary caregivers. The objective of this study was to determine the factors for stunting and specifically investigate if there is a relationship between maternal employment and stunting in the Maratua District of Berau, Indonesia. This study used a cross-sectional research design. The sample size was determined using the Sample Size Calculator from the World Health Organization for a two-sided test (α = 0.05; β = 0.2; p1 = 0.63; p2 = 0.25; 95% CI). The data were collected from the nutrition report and anthropometric measurements at Maratua Primary Healthcare Center. The research was carried out at the Integrated Health Posts (Pos Layanan Terpadu/ Posyandu) in the Maratua District. The toddlers (n = 56) were examined with their parental consent. Toddlers with overnutrition, obesity, and acute infectious diseases were excluded from this study. The data were processed using Chi-square and Fisher tests (p < 0.05). In the analysis, no significant relationship was found between stunting and maternal employment. However, the results revealed that fathers who were not fishermen had a 6.3 times greater risk of having stunted toddlers compared to fathers who worked as fishermen. Fathers with a junior high school degree showed a 6.1 times higher risk of having stunted toddlers than fathers with different educational levels. In conclusion, stunting in the Maratua District is associated with the fathers' educational attainment and employment.

A study on the prevalence and risk factors of coronary artery disease in patients with metabolic syndrome infected and not infected with COVID 19 from El- Oued (Algeria) region

Introduction and Aim: Coronary artery disease (CAD) is a pathological process described by atherosclerosis plaque in the epicardial arteries. CAD is a chronic process that begins during adolescence and slowly progresses through life. Several traditional risk factors genetics and environmental, involve in the development of atherosclerosis process. This study was aimed to investigate the prevalence of CAD and its associated risk factors among the El Oued (Algeria) population. Materials and Methods: An epidemiological study was carried out on 23422 patients who suffered from cardiovascular diseases. The study of risk factors analysis was focused on 300 voluntary individuals, their origins from different El-Oued areas, and the CAD and metabolic syndrome patients selected from public and private health interests. All the information was obtained by a questionnaire. The risk of socio-clinical factors has been estimated by Binary Logistic regression was carried out between CVD and its associated risk factors. P < 0.05 from two-sided statistical tests was regarded as statistically significant. Results: Through the results presented in our study, we found that the clinical factors such as hypertension (OR=154.846, and; P =0.000), the group aged> 60 (OR=154.84, and; P =0.000 and chest pain (OR=42.667, and; P =0.000), present significant risk factors with CAD patients compared to healthy people (control), respectively, in contrast we show that the most dangerous Socioeconomic factors alcohol consumption and stress respectively for (OR=13.500= and; P =0.001), and obesity (OR=4.495= and; P =0.000), but we estimate that sport is important protective factors for the disease with OR=52.6, P 0.500) in the CAD patients compared to metabolic syndrome patients. Conclusion: The increasing prevalence of risk factors for coronary artery disease among the population has raised concerns for public health, which creates a health threat, especially with inadequate promotion and awareness programs.

The dynamics in food selection stemming from price awareness and perceived income adequacy: a cross-sectional study using 1-year loyalty card data

BackgroundHigher cost of healthy foods may explain unhealthy dietary patterns in lower-income households. Unfortunately, combining food selection and nutrient intake data to price and expenditure is challenging. Food retailer’s customer loyalty card data, linked to nutrient composition database, is a novel method for simultaneous exploration of food purchases, price, and nutrition. ObjectivesWe studied the associations between perceived income adequacy (PIA) as a grouping variable with price (per kilogram or megajoule) and the volume of purchases (percentage of expenditure or energy) simultaneously as outcome variables for 17 most purchased food groups. MethodsWe used 1-year (2018) loyalty card data from the largest grocery chain in Finland. Participants were 28,783 loyalty cardholders who made ≥41% of food purchases from the retailer and answered an online questionnaire at the midpoint of data collection. The 5-level PIA described the perceived financial situation in the household. Energy and nutrient content of foods purchased were from the Finnish Food Composition Database Fineli. We calculated the Nutrient Rich Food Index per 100 g food using 11 nutrients. Trends in prices and expenditures between PIA levels were analyzed using 2-sided Jonckheere–Terpstra tests, with false discovery rate control (Benjamini–Hochberg method) and confounder adjustments (inverse probability weighting). ResultsLower PIA participants selected cheaper foods per kilogram and megajoule within most food groups. They also favored unhealthy food groups cheap in energy [<1 € (USD 1.18)/MJ]. Despite lower purchase price, the expenditure (%) among lower PIA was higher on alcohol, snacks, sugar-sweetened beverages, and sweets and chocolates. ConclusionsParticipants with lower PIA showed stronger price awareness. It is crucial to consider the pricing of competing alternative food groups, when steering toward environmentally sustainable and healthier food purchases. Package labeling might also direct the selection of healthier choices among the less expensive items within a food group.

On the distribution of the power function for the scale parameter of exponential families.

The expected value of the standard power function of a test, computed with respect to a design prior distribution, is often used to evaluate the probability of success of an experiment. However, looking only at the expected value might be reductive. Instead, the whole probability distribution of the power function induced by the design prior can be exploited. In this article we consider one-sided testing for the scale parameter of exponential families and we derive general unifying expressions for cumulative distribution and density functions of the random power. Sample size determination criteria based on alternative summaries of these functions are discussed. The study sheds light on the relevance of the choice of the design prior in order to construct a successful experiment.

Power calculation for detecting interaction effect in cross-sectional stepped-wedge cluster randomized trials: an important tool for disparity research

BackgroundThe stepped-wedge cluster randomized trial (SW-CRT) design has become popular in healthcare research. It is an appealing alternative to traditional cluster randomized trials (CRTs) since the burden of logistical issues and ethical problems can be reduced. Several approaches for sample size determination for the overall treatment effect in the SW-CRT have been proposed. However, in certain situations we are interested in examining the heterogeneity in treatment effect (HTE) between groups instead. This is equivalent to testing the interaction effect. An important example includes the aim to reduce racial disparities through healthcare delivery interventions, where the focus is the interaction between the intervention and race. Sample size determination and power calculation for detecting an interaction effect between the intervention status variable and a key covariate in the SW-CRT study has not been proposed yet for binary outcomes.MethodsWe utilize the generalized estimating equation (GEE) method for detecting the heterogeneity in treatment effect (HTE). The variance of the estimated interaction effect is approximated based on the GEE method for the marginal models. The power is calculated based on the two-sided Wald test. The Kauermann and Carroll (KC) and the Mancl and DeRouen (MD) methods along with GEE (GEE-KC and GEE-MD) are considered as bias-correction methods.ResultsAmong three approaches, GEE has the largest simulated power and GEE-MD has the smallest simulated power. Given cluster size of 120, GEE has over 80% statistical power. When we have a balanced binary covariate (50%), simulated power increases compared to an unbalanced binary covariate (30%). With intermediate effect size of HTE, only cluster sizes of 100 and 120 have more than 80% power using GEE for both correlation structures. With large effect size of HTE, when cluster size is at least 60, all three approaches have more than 80% power. When we compare an increase in cluster size and increase in the number of clusters based on simulated power, the latter has a slight gain in power. When the cluster size changes from 20 to 40 with 20 clusters, power increases from 53.1% to 82.1% for GEE; 50.6% to 79.7% for GEE-KC; and 48.1% to 77.1% for GEE-MD. When the number of clusters changes from 20 to 40 with cluster size of 20, power increases from 53.1% to 82.1% for GEE; 50.6% to 81% for GEE-KC; and 48.1% to 79.8% for GEE-MD.ConclusionsWe propose three approaches for cluster size determination given the number of clusters for detecting the interaction effect in SW-CRT. GEE and GEE-KC have reasonable operating characteristics for both intermediate and large effect size of HTE.

Subthreshold Doses of Inflammatory Mediators potentiate one another to Elicit Reflex Cardiorespiratory Responses in Anesthetized Rats.

Reflex cardio-vascular and respiratory (CVR) alterations evoked by intra-arterial instillation of nociceptive agents are termed vasosensory reflexes. Such responses elicited by optimal doses of inflammatory mediators have been described in our earlier work. The present study was designed to evaluate the interactions between subthreshold doses of inflammatory mediators on perivascular nociceptive afferents in urethane anesthetized rats. Healthy male adult rats (Charles-Foster strain) were anesthetized with an intraperitoneal injection of urethane. After anesthesia, the right femoral artery was cannulated. Respiratory movements, blood pressure, and electrocardiogram were recorded. The interactions between subthreshold doses of algogens in the elicitation of vasosensory reflex responses were studied by instillation of bradykinin (1 nM) and histamine (100 µM) into the femoral artery one after the other, in either temporal combination in separate groups of rats. The CVR responses obtained in these groups were then compared with the responses produced by 100 µM histamine and 1 nM bradykinin in saline-pretreated groups, which served as control. Subthreshold doses of histamine elicited transient tachypnoeic, hyperventilatory, hypotensive, and bradycardiac responses, in rats pretreated with subthreshold doses of bradykinin [P <0.01, two-sided Dunnett's test] but not in saline pretreated groups [P >0.05, two-sided Dunnett's test]. Similar responses were elicited by bradykinin after histamine pretreatment compared to the saline-pretreated group. Furthermore, CVR responses produced by histamine in the bradykinin-pretreated group were greater in magnitude as compared to bradykinin-induced responses in the histamine-pretreated group [P <0.05, two-sided Dunnett's test]. The present study demonstrates that both bradykinin and histamine potentiate one another in the elicitation of vasosensory reflex responses, and bradykinin is a better potentiator than histamine at the level of perivascular nociceptive afferents in producing reflex CVR changes.

Burden and predictors of distress among persons with type 2 diabetes mellitus: Excerpts of an observational study from Eastern India.

Diabetes distress (DD) is a common psychological condition distinct from depression. This is a unique, hidden emotional burden and worry that the patient experiences under ongoing treatment. To assess the prevalence and predictors of DD among adult diabetics attending a tertiary healthcare facility. This hospital-based observational, analytical, cross-sectional study recruited 152 adult patients with type 2 diabetes. The sociodemographic and diabetes-related information was collected with the help of a predesigned, structured proforma. Clinical and anthropometric examinations were conducted. Distress was determined by the standardized Diabetic Distress Scale (DDS). Statistical Analysis Used: The mean (SE) value was calculated for quantitative variables. The mean item score in DDS of ≥2 is taken as the presence of distress. Fisher's exact Chi-square test was done to check for association. Two-tailed significance test with a P value of < 0.05 was considered statistically significant. Majority of study participants were literate, married, and from the lower middle socioeconomic class. High blood pressure was the most common co-morbidity and tobacco use was the most prevalent addiction. The prevalence of diabetes distress was 77.0%. Emotional DD was found to be more common than regimen, interpersonal, and physician-related DD. The major determinants that emerged were young age, low socioeconomic class, physical inactivity, longer time duration to reach the hospital, associated known co-morbidities, and poor glycaemic control. A target-specific and routine counseling sessions merged with pronged strategic services are essential to improve the mental health of respondents.

Association of genetic variation on X chromosome with systemic lupus erythematosus in both Thai and Chinese populations

ObjectivesX chromosome has been considered as a risk factor for SLE, which is a prototype of autoimmune diseases with a significant sex difference (female:male ratio is around 9:1). Our study...

Serum Vitamin D Deficiency and Male Infertility: A Relationship?

Background Male infertility is one of the major reproductive health concerns, causing a lot of distress for couples globally. Others have looked into its connection to vitamin D deficiency, but their findings are conflicting. Aim This study aimed to determine the relationship between male infertility and vitamin D deficiency among Nigerians. Method This analytical cross-sectional study was conducted among 132 men. A purposive sampling technique was employed to recruit 66 participants in the study (men with infertility) and control groups (men with proven fertility). Descriptive statistics were conducted, while the association between vitamin D level and sperm parameters was assessed using bivariate and regression modeling. A two-tailed test of the hypothesis was assumed, and the level of statistical significance was set at a P-value < 0.05. Results None of the participants had a serum vitamin D deficiency. However, the overall serum vitamin D insufficiency rate was 15%. The median vitamin D level for the total study population (both fertile and infertile) was 37.52 ng/ml (IQR: 32.1 - 51.69). This study demonstrated no association between serum vitamin D levels and male infertility, as well as no association between serum vitamin D levels and the quality of semen parameters. Conclusion There was no significant association between vitamin D levels, male infertility, and seminal fluid parameters. However, larger multi-center studies are recommended to provide further insights into this conclusion.

The Influence of Internal Communication in the Organization on PT Wahyu Abadi (CIKARANG) Employee Performance

PT Wahyu Abadi is a company operating in the manufacturing industry specializing in printing and packaging. The company seeks to push the printing and packaging industry to new levels of innovation. This company provides business solutions in the fields of printing, packaging, digital and supply chain. PT Wahyu Abadi was chosen as the research location, which is located on Jl. Angsana Raya Blok L1 No 17, Delta Silicon 1 Industrial Area, Lippo Cikarang Bekasi, Indonesia. The analysis carried out using SPSS 21.0 found that the value of the influence of Internal Communication (X) on Employee Performance (Y) can be narrated using the regression formula Y= a+bX, so the regression value resulting from the calculation above is Y = 55.517 + 0.151X. The constant value (a) is = 55.517 while the coefficient value (b) = 0.151. The meaning of this equation is that if there is no internal communication, the employee's performance will be worth 55,517 units. However, if there is an increase of one unit/unit of the internal communication variable, it will be affected by an increase in employee performance by 0.515. Thus the t table: if the error level α = 5% (0.05%) and the two-sided test df = n – 2 (33 – 2 = 31), then the t table value is 2.040 and based on the calculation above the t count is obtained equal to 0.742 &lt; t table 2.040, then it can be concluded that H_0 is accepted and H_a is rejected because the calculated t is smaller than the t table. Thus it can be concluded that internal communication variables do not influence employee performance variables at PT Wahyu Abadi

A smartphone-based colorimetric assay using Cu-tannic acid nanosheets (Cu-TA NShs) as a laccase-mimicking nanozyme for visual detection of quercetin in vegetables.

Theinteraction of Cu-tannic acid nanosheets (Cu-TA NShs) as nanozyme in a surfactant solution of CTAB under relatively acidic conditions is shown toexhibit a catalytic effect on quercetin (Qur). This catalytic property of Cu-TA NShs, which mimics laccase enzyme with many advantages, has been applied todeveloping a selective colorimetric sensor for the determination of trace amounts of Qur in vegetable samples. This strategy presents a desirable linear relationship between the absorbance signal intensity and the concentrations of Qur from 0.350 to 32.09 µM with a detection limit (LOD) of 0.064 µM (S/N = 3). The feasibility of the proposed portable colorimetric sensor for in situ analysis of the real samples has been validated with the high-performance liquid chromatography (HPLC) method as reference method, and two-tailed test (t test) statistical analysis certifies good agreement between the results. This enzyme-free and sensitive naked-eye sensor with the smartphone-based color map is promising to provide technical support for the rapid and visual detection of Qur in vegetables.

Morphometric and clinical comparison of MRI-based synthetic CT to conventional CT of the hip in children.

MRI-based synthetic CT (sCT) generates CT-like images from MRI data. To evaluate equivalence, inter- and intraobserver reliability, and image quality of sCT compared to conventional (cCT) for assessing hip morphology and maturity in pediatric patients. We prospectively enrolled patients <21 years old with cCT and 3T MRI of the hips/pelvis. A dual-echo gradient-echo sequence was used to generate sCT via a commercially available post-processing software (BoneMRI v1.5 research version, MRIguidance BV, Utrecht, NL). Two pediatric musculoskeletal radiologists measured seven morphologic hip parameters. 3D surface distances between cCT and sCT were computed. Physeal status was established at seven locations with cCT as reference standard. Images were qualitatively scored on a 5-point Likert scale regarding diagnostic quality, signal-to-noise ratio, clarity of bony margin, corticomedullary differentiation, and presence and severity of artifacts. Quantitative evaluation of Hounsfield units (HU) was performed in bone, muscle, and fat tissue.Inter- and intraobserver reliability were measured by intraclass correlation coefficients. The cCT-to-sCT intermodal agreement was assessed via Bland-Altman analysis. The equivalence between modalities was tested using paired two one-sided tests. The quality parameter scores of each imaging modality were compared via Wilcoxon signed-rank test. For tissue-specific HU measurements, mean absolute error and mean percentage error values were calculated using the cCT as the reference standard. Thirty-eight hips in 19 patients were included (16.6 ± 3 years, range 9.9-20.9; male = 5). cCT- and sCT-based morphologic measurements demonstrated good to excellent inter- and intraobserver correlation (0.77<ICC<0.98). Measurements were statistically equivalent (P< 0.05), with average intermodal differences <2°. Mean surface distance between cCT and sCT was 0.23 ± 0.18mm. Accuracy to determine physeal maturity status by sCT was 98.4% (242/246, 95% CI 96.0-99.6). No significant differences were found on overall diagnostic quality, bony margin clarity, corticomedullary differentiation, and artifacts between sCT and cCT; signal-to-noise ratio was higher on sCT (P< 0.001). HU were within reference values on both sCT and cCT. sCT is equivalent to cCT for the assessment of hip morphology, physeal status, and radiodensity assessment in pediatric patients.

Genetic Diversity of the Human Adenovirus C Isolated from Hospitalized Children in Russia (2019-2022).

The human adenovirus (HAdV) is a common pathogen in children that can cause acute respiratory virus infection (ARVI). However, the molecular epidemiological and clinical information relating to HAdV among hospitalized children with ARVI is rarely reported in Russia. A 4-year longitudinal (2019-2022) study among hospitalized children (0-17 years old) with ARVI in Novosibirsk, Russia, was conducted to evaluate the epidemiological and molecular characteristics of HAdV. Statistically significant differences in the detection rates of epidemiological and virological data of all positive viral detections of HAdV were analyzed using a two-tailed Chi-square test. The incidence of HAdV and other respiratory viruses such as human influenza A and B viruses, respiratory syncytial virus, coronavirus, parainfluenza virus, metapneumovirus, rhinovirus, bocavirus, and SARS-CoV-2 was investigated among 3190 hospitalized children using real-time polymerase chain reaction. At least one of these respiratory viruses was detected in 74.4% of hospitalized cases, among which HAdV accounted for 4%. A total of 1.3% co-infections with HAdV were also registered. We obtained full-genome sequences of 12 HAdVs, which were isolated in cell cultures. Genetic analysis revealed the circulation of adenovirus of genotypes C1, C2, C5, C89, and 108 among hospitalized children in the period from 2019-2022.

Deep learning segmentation of the choroid plexus from structural magnetic resonance imaging (MRI): validation and normative ranges across the adult lifespan

BackgroundThe choroid plexus functions as the blood-cerebrospinal fluid (CSF) barrier, plays an important role in CSF production and circulation, and has gained increased attention in light of the recent elucidation of CSF circulation dysfunction in neurodegenerative conditions. However, methods for routinely quantifying choroid plexus volume are suboptimal and require technical improvements and validation. Here, we propose three deep learning models that can segment the choroid plexus from commonly-acquired anatomical MRI data and report performance metrics and changes across the adult lifespan.MethodsFully convolutional neural networks were trained from 3D T1-weighted, 3D T2-weighted, and 2D T2-weighted FLAIR MRI using gold-standard manual segmentations in control and neurodegenerative participants across the lifespan (n = 50; age = 21–85 years). Dice coefficients, 95% Hausdorff distances, and area-under-curve (AUCs) were calculated for each model and compared to segmentations from FreeSurfer using two-tailed Wilcoxon tests (significance criteria: p < 0.05 after false discovery rate multiple comparisons correction). Metrics were regressed against lateral ventricular volume using generalized linear models to assess model performance for varying levels of atrophy. Finally, models were applied to an expanded cohort of adult controls (n = 98; age = 21–89 years) to provide an exemplar of choroid plexus volumetry values across the lifespan.ResultsDeep learning results yielded Dice coefficient = 0.72, Hausdorff distance = 1.97 mm, AUC = 0.87 for T1-weighted MRI, Dice coefficient = 0.72, Hausdorff distance = 2.22 mm, AUC = 0.87 for T2-weighted MRI, and Dice coefficient = 0.74, Hausdorff distance = 1.69 mm, AUC = 0.87 for T2-weighted FLAIR MRI; values did not differ significantly between MRI sequences and were statistically improved compared to current commercially-available algorithms (p < 0.001). The intraclass coefficients were 0.95, 0.95, and 0.96 between T1-weighted and T2-weighted FLAIR, T1-weighted and T2-weighted, and T2-weighted and T2-weighted FLAIR models, respectively. Mean lateral ventricle choroid plexus volume across all participants was 3.20 ± 1.4 cm3; a significant, positive relationship (R2 = 0.54-0.60) was observed between participant age and choroid plexus volume for all MRI sequences (p < 0.001).ConclusionsFindings support comparable performance in choroid plexus delineation between standard, clinically available, non-contrasted anatomical MRI sequences. The software embedding the evaluated models is freely available online and should provide a useful tool for the growing number of studies that desire to quantitatively evaluate choroid plexus structure and function (https://github.com/hettk/chp_seg).

Improvements in Patient-Reported Outcomes Through Six Months of Guselkumab Treatment in Patients With Active Psoriatic Arthritis: Real-World Data From the CorEvitas Psoriatic Arthritis/Spondyloarthritis Registry.

Evaluate patient-reported outcomes after 6 months of on-label guselkumab use in patients with rheumatologist-diagnosed active psoriatic arthritis (PsA) enrolled in the CorEvitas PsA/Spondyloarthritis Registry. This analysis includes registry participants who initiated and persisted with on-label guselkumab (after US Food and Drug Administration approval for PsA; 100 mg at weeks 0, 4, and every 8 weeks) at their 6-month follow-up visit (On-Label Persisters). Among patients not meeting response criteria at baseline, responses at 6 months were determined for patient-reported outcomes, including patient-reported pain (0-100 mm visual analog scale), patient global assessment of arthritis + psoriasis (PtGA; 0-100 visual analog scale), and Health Assessment Questionnaire-Disability Index (HAQ-DI; 0-3). Unadjusted, nominal P values were calculated via single-proportion, one-sided test (H0 = 0%; α=0.05). Of 90 On-Label Persisters, most had treatment-resistant PsA (92.2% and 73.3% previously received ≥1 and ≥2 biologic/targeted synthetic disease-modifying antirheumatic drugs, respectively), with mean (SD) baseline patient-reported pain, PtGA, and HAQ-DI scores of 57.0 (24.6), 50.3 (24.4), and 0.9(0.6), respectively. Among those with patient-reported pain and PtGA scores of at least 15 at baseline, 40.2% (33/82) and 46.8% (36/77), respectively, achieved at least 15-mm reductions at 6 months; among those with HAQ-DI scoresof at least 0.35 and more than 0.5 at baseline, respectively, 30.4% (21/69) achieved improvements of at least 0.35 and 10.3% (6/58) achieved scores of 0.5 or lower at 6 months (all nominal P < 0.001). Pain and physical function are important contributors to health-related quality of life. In this real-world population of patients with treatment-resistant PsA and 6 months of persistent guselkumab treatment, clinically meaningful improvements in pain and physical function were achieved by approximately 40% and 30% of patients, respectively.

An eight-year follow-up on auditory outcomes after neonatal hearing screening.

The aim of this study is to assess the neonatal click Auditory Brainstem Response (ABR) results in relation to the subsequently determined mean hearing loss (HL) over 1, 2 and 4 kHz, as well as over 2 and 4 kHz. Between 2004-2009, follow-up data were collected from Visual Reinforcement Audiometry (VRA) at 1 and 2 years and playaudiometry at 4 and 8 years of newborns who had failed neonatal hearing screening in the well-baby clinics and who had been referred to a single Speech and Hearing center. Hearing Level data were compared with ABR threshold-levels established during the first months of life. The Two One-Sided Tests equivalence procedure for paired means was applied, using a region of similarity equal to 10 dB. Initially, in 135 out of 172 children referred for diagnostic procedures hearing loss was confirmed in the neonatal period. In 106/135 of the HL children the eight-year follow-up was completed. Permanent conductive HL was established in 5/106 cases; the hearing thresholds were predominantly stable over time. Temporary conductive HL was found in 48/106 cases and the loss disappeared by 4 years of age at the latest. Sensorineural hearing loss (SNHL) was found in 53/106 cases, of which 13 were unilateral and 40 bilateral. ABR levels were equivalent (within a 10 dB range) to VRA levels at age 1 and 2 and play audiometry levels at age 4 and 8, both when VRA and play audiometry were averaged over both frequency ranges. Long term follow-up data of children with SNHL suggest that the initial click ABR level established in the first months of life, are equivalent to the hearing threshold measured at the age of 1, 2, 4 and 8 years for both mean frequency ranges. Click ABR can reliably be used as starting point for long-term hearing rehabilitation.

Outcomes of Kidney Transplantation Among COVID-19 Recovered Patients in a Single Transplant Center

The COVID-19 pandemic significantly lowered kidney transplantation (KT) rates worldwide, and studies regarding outcomes of patients who developed COVID-19 infection before KT are limited, especially in low to middle-income countries. To determine the 1-year graft and patient survival of kidney transplant recipients who recovered from COVID-19 infection before KT. We retrospectively reviewed all adult end-stage renal disease patients who underwent KT at the National Kidney and Transplant Institute from June 2020 through October 2021. Transplant parameters, graft and patient survival, pretransplant COVID-19 infection, and post-KT infectious complications were recorded. Data was analyzed using two-tailed descriptive statistical tests. Of the 219 recipients, 23 (11%) had COVID-19 infection within 1 to 16 months before KT. The mean age of KT recipients was 36 years (range, 25-57), and 61.9% had chronic glomerulonephritis as primary renal disease. The mean duration from COVID-19 recovery to KT was 79 days (range, 21-207). There was no significant difference in the 1-year biopsy-proven acute rejection in the 2 groups, at 4.5% vs 12.5% for the COVID-19 and non-COVID-19 group, respectively. Both the 1-year graft and patient survival were similar in the COVID-19 and non-COVID-19 groups at 98.4% vs 100% and 100% vs 98.44%, respectively. There was no significant difference in biopsy-proven acute rejection, 1-year graft, and patient survival among patients who had a prior COVID-19 infection vs those who did not. Kidney transplantation appears safe when performed at least 1 month from COVID-19 infection.

Fibrochondrogenic Differentiation Potential of Human Adiposederived Mesenchymal Stem Cells in a Type I Collagen-based Meniscus Scaffold with Activated Platelet-Rich Plasma Stimulation In-vitro

Introduction: Despite efforts to use scaffolds to treat meniscus tears, minimal progress has been made in facilitating meniscus regeneration and return of function. Our research objective was to develop a meniscus repair and regeneration implant by applying a resorbable scaffold in combination with cells and growth factors. We report here the results of using Platelet-Rich Plasma (PRP) as a source of growth factors to induce fibrochondrogenic differentiation of human Adipose- Derived Mesenchymal Stem Cells (hADSC) in a three-dimensional (3D) Type I collagen-based scaffold in-vitro. Methods: Scaffold Preparation: Type I collagen scaffolds were prepared following a protocol previously published. Two different densities of scaffolds, High Density (HD) and Low Density (LD), were produced for in-vitro study. hADSC and PRP Preparation. hADSCs were cultured to the fifth passage to reach the desired number for experimentation. PRP was collected from human blood and activated. Cell Culture Procedure: Effects of PRP on hADSC proliferation and differentiation into fibrochondrogenic cells were examined in four scaffold groups: LD, HD, LD+PRP and HD+PRP. hADSCs were seeded onto scaffolds (n=5) at a concentration of 2 × 106 cells/scaffold. 1% of PRP was added to the experimental media. Cellular proliferation was assessed at 1, 7, 14 and 21 days. Differentiation was measured using qRT-PCR on Days 14 and 21. qRT- PCR analysis of gene expression was completed with primers for COLLAGEN 1 and AGGRECAN. Data Analysis: ANOVAs were conducted (two-tailed tests) at the .05 significance level. Results: Cellular proliferation of hADSCs seeded on each scaffold increased over time. Similar trend was observed for cells seeded on HD scaffolds with and without PRP. hADSC showed significant increase in cellular proliferation on the LD scaffolds at Days 1 and 7. At Day 21, PRP treatment and LD scaffold had a synergistic positive effect on Type I collagen gene expression. PRP did not elevate type I collagen gene in the HD group, the HD scaffold alone had the same level of type I collagen gene expression as LD+PRP. Aggrecan expression was elevated in the presence of PRP in both the HD and LD scaffold groups, indicating enhanced fibrochondrogenic differentiation of hADSCs. Effective cell infiltration was observed across both HD and LD scaffolds with and without PRP treatment. HD scaffolds displayed larger cell clusters and more extensive cell migration over time compared to LD scaffolds. However, LD scaffolds resulted a more uniform cellular distribution than HD scaffolds. Conclusion: Our study demonstrates that PRP can play an important role in directing hADSCs towards fibrochondrogenic differentiation in Type I collagen-based scaffolds in-vitro. Additionally, our study shows that collagen scaffold density can influence the spatial distribution and cellular behavior of infiltrated cells.

Comparison of block characteristics and outcomes in opioid-free and opioid-based thoracic continuous spinal anaesthesia in patients undergoing major abdominal surgery: A double-blinded randomised controlled trial.

Thoracic continuous spinal anaesthesia (TCSA) is emerging as the sole anaesthetic for major abdominal surgery due to its better perioperative outcomes. This study was designed to evaluate block characteristics and outcomes in 'opioid-free' and 'opioid-based' TCSA. After ethical approval, trial registration and written informed consent, 50 adult patients undergoing major abdominal surgery were randomised into 'opioid-free' (bupivacaine alone) and 'opioid-based' (bupivacaine with fentanyl) groups. After confirmation of T4-L1 dermatome level of spinal anaesthesia, sedation by intravenous (IV) midazolam (0.02-0.05 mg/kg), ketamine (0.25 mg/kg) and dexmedetomidine (bolus dose of 1 µg/kg IV over 10 min followed by 0.2-0.7 µg/kg/h infusion) were started. The primary outcome measured was postoperative pain scores for 72 h in both groups. The secondary objectives were rescue opioid requirement, and the dose of bupivacaine required to achieve T4 level. Data were compared using the two-sided Student t-test, Mann-Whitney and Fisher's exact tests. The 'opioid-based' group performed significantly better compared with the 'opioid-free' group concerning pain scores at rest at 0 h (P = 0.023), 18 h (P = 0.023) and 24 h (P = 0.016) postoperatively, decreased intrathecal bupivacaine requirement [(induction (P = 0.012) and maintenance (P = 0.031)], postoperative rescue fentanyl requirement (P = 0.018) and patient satisfaction (P = 0.032) at the cost of increased postoperative nausea and vomiting (P = 0.049). The 'opioid-based' TCSA provided better postoperative analgesia with significantly lesser postoperative pain scores when compared to the 'opioid-free' group in patients undergoing major abdominal surgery.