Standard Protocol Research Articles

Inflammatory biomarkers as cost-effective predictive tools in metabolic dysfunction-associated fatty liver disease

Qu and Li emphasize a fundamental aspect of metabolic dysfunction-associated fatty liver disease in their manuscript, focusing on the critical need for non-invasive diagnostic tools to improve risk stratification and predict the progression to severe liver complications. Affecting approximately 25% of the global population, metabolic dysfunction-associated fatty liver disease is the most common chronic liver condition, with higher prevalence among those with obesity. This letter stresses the importance of early diagnosis and intervention, especially given the rising incidence of obesity and metabolic syndrome. Research advancements provide insight into the potential of biomarkers (particularly inflammation-related) as predictive tools for disease progression and treatment response. This overview addresses pleiotropic biomarkers linked to chronic inflammation and cardiometabolic disorders, which may aid in risk stratification and treatment efficacy monitoring. Despite progress, significant knowledge gaps remain in the clinical application of these biomarkers, necessitating further research to establish standardized protocols and validate their utility in clinical practice. Understanding the complex interactions among these factors opens new avenues to enhance risk assessment, leading to better patient outcomes and addressing the public health burden of this worldwide condition.

Sequential pulmonary functions in survivors of leptospirosis pulmonary haemorrhage syndrome: a prospective cohort study

BackgroundLeptospirosis, a spirochaete infection, can lead to Leptospirosis Pulmonary Haemorrhage Syndrome (LPHS), which requires intensive care admission and has a high mortality. Although data on short-term outcomes are available, the long-term respiratory sequelae of LPHS survivors are not known. We aimed to identify the post-discharge pulmonary functions and functional limitations in survivors of LPHS.MethodsWe conducted a prospective cohort study from January to December 2022 at the Medical Intensive Care Unit (ICU) of the National Hospital of Sri Lanka to assess the sequential changes in the spirometry parameters in patients who survived LPHS. The Forced Vital Capacity (FVC) and Forced Expiratory Volume in 1 s (FEV1) were measured on the day of discharge from the ICU (D0), 7th day after discharge (D7) and 28th day after discharge (D28). The predicted lung volume was calculated using the gender, age and height as per standard protocol. Physical and functional role limitations were assessed on D28 using the modified Medical Outcomes Study Questionnaire Short Form 36 Health Survey (SF-36).ResultsTwenty-one patients with a mean age of 44 years (SD 16.07) were enrolled for the study. The majority were male patients (n = 19, 90.5%). Leptospirosis was serologically confirmed in all individuals. Seventeen (81%) patients had reduced FEV1 and FVC on D0, indicating a restrictive lung abnormality. FVC and FEV1 improved during the first 7 days (p < 0.01) but did not change significantly afterwards. Only seven individuals (33.3%) achieved a normal FVC (exceeding 80% of the predicted volume) at D28. However, 19 (90.5%) individuals achieved a normal FEV1 (exceeding 80% of predicted volume) by D28. In our study, administering corticosteroids during ICU stay did not impact lung recovery in FVC (p = 0.521) or FEV1 (p = 0.798). The participants did not have significant physical, functional, and role limitations at D28.ConclusionsThe spirometry measurements of individuals diagnosed with LPHS significantly improved during the first 7 days. Most survivors did not have a functional impairment despite the FVC not recovering to normal by D28.

Effect of goal-directed perceptual-motor exercise on children with specific learning difficulties: a randomized controlled trial

BackgroundAlthough perceptual interventions focus on sensory and cognitive skills, they significantly enhance the effectiveness of motor interventions by improving coordination, decision-making, and overall engagement in physical activities. A comprehensive literature review has demonstrated that incorporating perceptual interventions into motor exercises is beneficial. While there are several treatment strategies for SLD-diagnosed children, the potential role of goal-directed perceptual-motor exercises has not been studied. This study examined the effectiveness of goal-directed perceptual-motor training on attention, motor skills, and quality of life in children with Specific Learning Disorder (SLD).MethodsThis was a randomized clinical study with 38 children diagnosed with SLD between September 2021 and April 2022. The control group (n = 19) received a standard intervention protocol, and the intervention group (n = 19) additionally received a perceptual-motor training program. Bourdon Attention Test, the Bruininks-Oseretsky Test 2–Short Form (BOT2- SF), and the Pediatric Quality of Life Inventory (PEDSQL) were used as outcome measures.ResultsThe intervention significantly improved attention, fine and gross motor skills, and life quality as evidenced by the within- and between-group comparisons at the end of therapy.ConclusionsGoal-directed perceptual-motor physical training with cognitive aspects may enhance academic performance, social participation, and life quality for children with SLD by improving basic motor skills. Therefore, the inclusion of physical and task-specific perceptual-motor exercises in educational programs may offer several avenues for cognitive skill development in SLD children.Trial registrationThe protocol is retrospectively registered with http://clinicaltrials.gov/ (16/August/2023, Clinical Trial, NCT05998083).

Metagenomic analysis reveals the community composition of the microbiome in different segments of the digestive tract in donkeys and cows: implications for microbiome research

IntroductionThe intestinal microbiota plays a crucial role in health and disease. This study aimed to assess the composition and functional diversity of the intestinal microbiota in donkeys and cows by examining samples collected from different segments of the digestive tract using two distinct techniques: direct swab sampling and faecal sampling.ResultsIn this study, we investigated and compared the effects of multiple factors on the composition and function of the intestinal microbial community. Approximately 300 GB of metagenomic sequencing data from 91 samples obtained from various segments of the digestive tract were used, including swabs and faecal samples from monogastric animals (donkeys) and polygastric animals (cows). We assembled 4,004,115 contigs for cows and 2,938,653 contigs for donkeys, with a total of 9,060,744 genes. Our analysis revealed that, compared with faecal samples, swab samples presented a greater abundance of Bacteroidetes, whereas faecal samples presented a greater abundance of Firmicutes. Additionally, we observed significant variations in microbial composition among different digestive tract segments in both animals. Our study identified key bacterial species and pathways via different methods and provided evidence that multiple factors can influence the microbial composition. These findings provide new insights for the accurate characterization of the composition and function of the gut microbiota in microbiome research.ConclusionsThe results obtained by both sampling methods in the present study revealed that the composition and function of the intestinal microbiota in donkeys and cows exhibit species-specific and region-specific differences. These findings highlight the importance of using standardized sampling protocols to ensure accurate and consistent characterization of the intestinal microbiota in various animal species. The implications and underlying mechanisms of these associations provide multiple perspectives for future microbiome research.

A comprehensive analysis of household air pollution due to traditional cooking in the himalayan belt

Abstract Household air pollution (HAP) and its health concerns are a significant challenge in the Indian subcontinent and other developing nations. Approximately 4.3 million deaths worldwide are attributed to indoor air pollution rather than outdoor air pollution, most of which occur in low- and middle-income countries. Traditional cookstoves, widely used in rural Himalayan areas of India, Nepal, and Pakistan, emit pollutants like particulate matter (PM), carbon monoxide (CO), and carbon dioxide (CO2). These stoves, which burn solid fuels such as wood, dung, charcoal, and agricultural waste, contribute to respiratory infections, cancer, premature mortality, and cardiovascular diseases. Improving biomass cookstoves can help reduce exposure to the harmful indoor air pollutants. This study evaluates household pollution levels in Uttarakhand, India, using direct data collection to determine the daily contaminant exposure. The findings show extremely high PM 2.5 and 10 emissions (2,100 μg/m³ and 5,000 μg/m³, respectively) due to inefficient cookstove design and incomplete fuel combustion. By comparing traditional and improved cookstoves using standardized testing protocols, the study also measures the efficiency and identifies the causes of high emissions. The results corroborated the hypothesis that traditional cookstoves have a very low thermal efficiency of ∼11 %, leading to the high emissions gathered from sensor data. This comparison provides specific insights into the reasons behind high emissions and suggests targeted improvements. The findings suggest potential improvements in cookstove efficiency, offering a foundation for further research and stakeholder involvement to enhance rural livelihoods in India.

Preliminary study: Evaluating the reliability of cone-beam computed tomography images for upper airway volume in orthodontics

Objectives: The primary aim of this study was to evaluate the reliability of cone-beam computed tomography (CBCT) in measuring upper airway volume in orthodontics. The secondary aim was to compare the upper airway volumes between laypeople and military personnel (physically fit individuals). Material and Methods: This study included 36 male participants aged 21–29 years who had no upper airway pathology or history of upper airway surgery. CBCT scans had been previously obtained as part of routine dental checkups using a standardized protocol by the same operator. The digital imaging and communications in the medicine files of the subjects were imported into the 3D analysis software SimPlant® 17 Pro (Materialize Dental, Leuven, Belgium) to facilitate the measurement of upper airway volume. The upper airway volume was divided into three sections and measured on days 0 and 14 by the same operator. The intrarater intra-class correlation coefficient (ICC) and Bland-Altman plot were used to assess reliability. The upper airway volumes of the laypeople and military personnel were compared using Tukey’s pairwise test. Results: The variables demonstrated excellent reliability across all sections of the upper airway; the Superior part of the upper airway has an ICC of 0.993, the middle part of the upper airway has an ICC of 0.995, and the inferior part of the upper airway has an ICC of 0.989. The ICC for the entire upper airway was 0.987. The intrarater plot for superior airway measurement showed that 8 out of 8 measurements (100%) fell within the limits of agreement. Similarly, the intrarater plot for the middle airway measurements indicated that 8 out of 8 measurements (100%) fell within the limits of agreement. For inferior airway measurement, the intrarater plot revealed that 7 out of 8 measurements (87.5%) fell within the limits of agreement. No significant differences were found between the upper airway volumes of the laypeople and military personnel. Conclusion: Preliminary evidence suggests that CBCT using a standardized protocol is reliable for measuring upper airway volume. Separating the upper airway into three different parts also demonstrated high reliability and reproducibility among the raters. The ability to accurately measure the upper airway enhances the evaluation of the effects of orthodontic treatment by comparing the pre-and post-upper airway volume.

Population genetics and molecular xenomonitoring of Biomphalaria freshwater snails along the southern shoreline of Lake Malawi, Malawi

BackgroundIntestinal schistosomiasis was confirmed endemic in Mangochi District, Malawi, in May of 2018 following an unexpected encounter with discreet populations of Biomphalaria spp. freshwater snails during routine malacological surveillance activities. Since then, only limited malacological surveillance of Biomphalaria has been carried out, and so the distribution of Biomphalaria populations in this area is currently unclear. Additionally, sites of active Schistosoma mansoni transmission in this area are also unknown. In the present study, through extensive malacological surveillance, we aimed to formally document the distribution of Biomphalaria in Mangochi District. We also aimed to identify active intestinal schistosomiasis transmission sites in this area through subjecting all collected Biomphalaria to a recently developed S. mansoni-specific molecular xenomonitoring PCR.MethodsThree malacological surveys were carried out along the southern shoreline of Lake Malawi, Mangochi District, Malawi, in November 2021, July 2022 and October/November 2022. All collected Biomphalaria were subjected to cercarial shedding analysis to identify active Schistosoma infections. Shed cercariae were then genotyped to species level using a standard multi-locus PCR and Sanger sequencing protocol. Following this, a subset of Biomphalaria from each collection site were also genotyped to species level using a standard PCR and Sanger sequencing protocol. All collected Biomphalaria were then subjected to a recently developed S. mansoni-specific molecular xenomonitoring PCR to identify infected, but non-shedding, Biomphalaria.ResultsA total of 589 Biomphalaria were collected across all three surveys. One single Biomphalaria (0.17%) specimen was found to be actively shedding Schistosoma cercariae, which were molecularly confirmed as S. mansoni. All genotyped Biomphalaria (n = 42) were molecularly identified as B. pfeifferi. A further 19 Biomphalaria specimens, collected from four different surveillance sites, were found to be infected with S. mansoni through molecular xenomonitoring. Intestinal schistosomiasis transmission was therefore identified at four different foci in Mangochi District.ConclusionsOur study highlights the importance of molecular approaches to investigate Biomphalaria populations and monitor Biomphalaria-associated intestinal schistosomiasis transmission in endemic areas. As such, the continued development and use of such approaches, in particular the development and use of molecular xenomonitoring assays that can be carried out in resource-poor schistosomiasis-endemic settings, is encouraged. The revision of ongoing schistosomiasis control programmes in Mangochi District, in line with WHO recommendations, is also encouraged.Graphical abstract

Increased epicardial adipose tissue is associated with left ventricular reverse remodeling in dilated cardiomyopathy

BackgroundEpicardial adipose tissue (EAT) has been suggested to play paradoxical roles in patients with heart failure. The role of EAT in dilated cardiomyopathy (DCM) patients remains unclear. We aimed to assess the associations between the dynamic changes EAT and left ventricular reverse remodeling (LVRR) in DCM patients based on baseline and follow-up CMR.MethodsIn this prospective study, we consecutive enrolled DCM patients with baseline and follow-up cardiac magnetic resonance (CMR) examinations. All participating patients underwent 1–2 years of guideline-directed medical therapy (GDMT) at follow-up. The EAT was measured as pericardial and epicardial fat thickness, and paracardial fat volume, while the abdominal adiposity was measured in terms of subcutaneous and visceral fat thickness. The univariable and multivariable logistic regression analyses were performed to evaluate the associations of changes in abdominal and epicardial adiposities with the presence of LVRR.ResultsA total of 232 patients (mean age, 45.7 ± 15.1 years, 157 male) at baseline were enrolled. After a period of GDMT with a median duration of 15.5 months (interquartile range, 12.5–19.1 months) all participants underwent follow-up CMR with the same standardized protocol. Patients who reached LVRR showed a significant increment in EAT parameters compared to those who did not. After adjusting for age, sex, and delta changes of body mass index (BMI), the increment of pericardial fat thickness (odds ratio [OR]: 1.53; 95% confidence interval [CI]: 1.27 to 1.83; p < 0.001), epicardial fat thickness (OR: 2.10; 95% CI: 1.68 to 2.63; p < 0.001), and paracardial fat volume (OR: 1.01; 95% CI: 1.01 to 1.02; p = 0.001) were significantly associated with LVRR.ConclusionsIn DCM patients, the CMR-derived EAT parameters increased after 1–2 years of GDMT and significantly correlated with improved ventricular structure and function, independent of changes in BMI and abdominal adiposity, which may indicate the potential protective role of EAT in DCM patients.Trial registration: URL: https://www.clinicaltrials.gov; Unique identifier: ChiCTR1800017058.Graphical abstract

GC–MS, 1H and 13C NMR, and physiochemical properties of oils of Dacryodes Edulis and Persea Americana

A comparative investigation was carried out on the seed oils of P. americana and D. edulis for their physiochemical properties and spectroscopic properties. Oils were extracted from the respective powdered seeds using Soxhlet extraction technique giving 18.63% and 45.49% yields for P. americana and D. edulis, respectively. The seed oils were subjected to physiochemical analysis using standard protocols as prescribed by the American Oil Chemist Society (AOCS) and the American Society for Testing and Materials (ASTM). The fatty acid content was determined using Gas Chromatography, Proton (1H) and Carbon-13 (13C) Nuclear Magnetic Resonance spectroscopy. The results indicates that linoleic acid is the most unsaturated fatty acid, while stearic acid is the most saturated fatty acid in both oils. Unsaturated fatty acid peaks for olefinic H were observed at 5.34 and 5.31 ppm for P. americana and at 5.43 and 5.32 ppm for D. edulis oils in 1H-NMR. For 13C-NMR, the presence of C with triple bond attached to an alkyl group was observed at 85 ppm for the P. americana, while similar peak was observed for D. edulis at 128.21 to 130.1 ppm. The chemical characterization of the oils gave iodine values of 51.86 mgI2/g for P. americana oil and 48.72 mgI2/g for D. edulis oil. Similarly, acid values of 3.45 mg KOH/kg and 5.76 mg KOH/kg were obtained for P. americana and D. edulis seed oils respectively. The physiochemical and spectroscopic results obtained showed that P. americana and D. edulis seed oils have the potential for use in a number of industrial applications.

Impact of hypertension, diabetes, and obesity on quality of life in rural Punjab, India

BackgroundAdverse health conditions are believed to reduce one’s quality of life (QoL). However, the impact of common lifestyle-related conditions like hypertension, obesity, and diabetes on the QoL in rural communities in India remains largely unexplored. This study aims to understand the impact of hypertension, diabetes, and obesity on the QoL in rural Punjab, India.MethodsThis cross-sectional study was conducted among 931 individuals of both sexes, aged 20–75 years, in the Mansa district of Punjab, India. Sociodemographic data were collected by using a pre-tested interview schedule. Somatometric measurements, blood pressure (BP), and fasting glucose were measured using standard protocols. QoL was evaluated using WHOQOL-BREF.ResultsIndividuals with already-diagnosed hypertension were at a significantly higher risk of poor QoL, both overall and specifically in the psychological and social relationships domains than those with normal BP. Underweight individuals exhibited a greater risk of poor QoL in the physical health domain compared to those with normal weight. Additionally, individuals with diagnosed diabetes were at an elevated risk of poor QoL in the psychological health domain compared to non-diabetics. However, neither general nor central obesity, nor newly screened cases of hypertension and diabetes (individuals who were previously unaware of their conditions), showed a significant impact on QoL.ConclusionsThe study suggests that the diagnosis of hypertension and diabetes, rather than the mere presence of these conditions, may be associated with poor QoL. Counseling and awareness post-diagnosis may help reduce the effects of diagnostic labeling and counter misinformation.Graphical

Probiotic Microorganisms in Inflammatory Bowel Diseases: Live Biotherapeutics as Food

(1) Background: Inflammatory bowel diseases (IBDs) are characterized by chronic and complex inflammatory processes of the digestive tract that evolve with frequent relapses and manifest at any age; they predominantly affect young individuals. Diet plays a direct role in maintaining the gut mucosal integrity and immune function. Regarding the diet, the administration of probiotics stands out. The use of probiotics for IBD treatment has shown promising effects on consumers’ quality of life. (2) Methods: This study aimed to conduct a literature review on the effects of probiotic and smart probiotic ingestion on IBD and analyze the available literature based on the searched keywords using boxplot diagrams to search for scientific data in the online literature published up to October 2024. (3) Results: Google Scholar (containing ~6 × 106 articles) and Science Direct (containing ~5 × 106 articles) were the databases with the highest number of articles for the keywords used in the study. When analyzing the content of the articles, although probiotic microorganisms are currently not part of the standard treatment protocol for IBD, these live biotherapeutics have proven to be an effective treatment option, considering the adverse effects of conventional therapies. Furthermore, the development of genetically engineered probiotics or smart probiotics is a promising treatment for IBD. (4) Conclusions: Probiotics and smart probiotics could represent the future of nutritional medicine in IBD care, allowing patients to be treated in a more natural, safe, effective, and nutritious way. However, although many studies have demonstrated the potential of this biotherapy, clinical trials standardizing dosage and strains are still necessary.

Age-Stage, Two-Sex Life Tables of Megalurothrips usitatus (Bagnall) and Frankliniella intonsa (Trybom) on Different Bean Pods Under Laboratory Conditions: Implications for Their Competitive Interactions

As two major pests of cowpea in South China, bean flower thrips [Megalurothrips usitatus (Bagnall)] and flower thrips [Frankliniella intonsa (Trybom)] always occur on the same plant. In this study, the two-sex life table parameters of these two species were investigated on three bean pods: cowpea (Vigna unguiculata L. var. Chunqiu Wujiadou), snap bean (Phaseolus vulgaris L. var. Yonglong 3), and green bean (Phaseolus vulgaris L. var. Linghangzhe) using standard cut bean protocols. Longevity of female adult M. usitatus showed no significant difference on cowpea and snap bean, but was shortest on green bean, with the highest fecundity on snap bean, followed by cowpea and green bean. Longevity and fecundity of female adult F. intonsa were both highest on cowpea, followed by snap bean and green bean. On snap bean, the population parameters (R0, GRR, T) of M. usitatus were higher than F. intonsa, whereas r and λ were not different, suggesting that M. usitatus were more competitive on snap bean. On cowpea, the population parameters (R0, GRR, r, λ) of F. intonsa were higher than M. usitatus, suggesting a competitive advantage of F. intonsa on cowpea. To better mimic field conditions, we investigated the survival and fecundity of adult M. usitatus under two distinct scenarios: when they could feed directly on cut surfaces of cowpeas (standard lab protocol), and when they could not. Adult survival of M. usitatus is not significantly influenced by whether or not they fed directly on cut surfaces of cowpeas. However, a notable decrease in fecundity was observed in M. usitatus that fed on surface-covered cut pods. This suggested that direct feeding on cut surfaces of cowpea did have an impact on thrips’ fecundity, offering fresh perspectives for future research into the growth and development of thrips in a laboratory. Our study suggests that experiments involving cut surfaces may be misleading, and further investigations are ongoing to address these concerns.

A conceptual modeling approach of MQTT for IoT-based systems

The Message Queuing Telemetry Transport (MQTT) is one of the most commonly used standard messaging protocols that enable the Internet of Things (IoT). The messaging standard specification document defines the transactions, attributes, conventions, timers, values, types, structures, etc. MQTT encounters wide implementation possibilities: hardware vendors need to implement MQTT drivers for their devices, software vendors need to implement it in their solutions, developers and researchers need an MQTT simulation framework, etc. The IoT technology can enable unlimited number of use cases, and each case has its implementation of the messaging protocol. From the above facts, on the basis that any user needs to have a deep understanding of the specification in order to implement the protocol and also developers need to study it well for improving the protocol, there is a need for a standard conceptual way that conveys the messaging standard specifications, integrates the specifications of the use cases built upon with a more abstracted mental representation, improves the communication between developers, and facilitates the protocols and applications developments. This paper addresses this issue by proposing a graphical conceptual modeling approach for MQTT-based IoT applications called Example-oriented System Conceptual Modeling for MQTT use cases (EoSCM-MQTT). The paper explains the EoSCM-MQTT and gives an example of its use in an MQTT simulation implementation for a specific IoT application: smart parking. EoSCM-MQTT was validated using three methods: comparison, analysis, and implementation. The details and results of the implementation and the conclusions from the comparison and analysis indicated that EoSCM-MQTT has the required characteristics of conceptual models: good syntactic semantic, and pragmatic quality, clarity, coherence, accuracy, flexibility, reliability, and effectiveness.

Effectiveness of a Telerehabilitation-Based Exercise Program in Patients with Chronic Neck Pain—A Randomized Clinical Trial

Background: Non-specific chronic neck pain is a prevalent musculoskeletal disorder with a significant impact on individuals’ quality of life. The lack of consensus on effective therapeutic management complicates the establishment of standardized treatment protocols. Home exercise programs have yielded positive results. This study aimed to assess the effectiveness of a telerehabilitation program distributed through videoconferencing for patients with non-specific chronic neck pain compared to a home-based exercise program. Methods: A randomized controlled trial was conducted involving 36 participants who were divided into two groups: the experimental group (n = 18) received manual therapy combined with telerehabilitation, while the home-based group (n = 18) received the same manual therapy treatment along with recommendations for home exercises. Key outcome measures, including neck-related disability, kynesiophobia, anxiety and depression, pain intensity, pressure pain threshold, quality of life, and adherence to self-treatment, were evaluated at baseline and post-treatment. Results: No statistically significant differences were observed between groups. However, both groups demonstrated improvements in all study variables except for the mental component of quality of life immediately post-treatment. Conclusions: After eight weeks of manual therapy and exercise, both the telerehabilitation and home-based exercise programs resulted in significant improvements in disability, pain, and kynesiophobia, indicating that telerehabilitation is as effective as home-based exercise.

Challenges of providing of special care services in hospitals during emergencies and disasters: a scoping review

BackgroundThe ability of hospitals to provide special care services for critically ill or injured patients during emergencies and disasters poses very significant challenges that necessitate the response in-place plans. the increasing frequency of such events, coupled with limited hospital resources and increasing patient volumes, underscores the urgency of addressing these issues. Specifically, this study aims to identify the challenges faced by hospitals in providing special services during disasters.MethodThis scoping review, conducted in 2024, based upon the framework developed by Arksey and O’Malley. An extensive search of Literature searching was performed using gray literature and databases including Google Scholar, PubMed, Web of Science, and Scopus. Applying the selection criteria, a total of 33 relevant studies were identified that discuss the challenges faced when providing special care services in hospitals during emergencies and disasters. Results are presented in accordance with the PRISMA checklist to ensure quality and transparency. Data was analyzed through a systematic coding process where common themes across the studies were identified.ResultsThis review identified 15 distinct challenges associated with providing special care services in hospitals during emergencies and disasters: limited resources, inadequate infrastructure, lack of pre-hospital care, financial constraints, failures in the emergency response system, triage, deficiencies in management structure, planning, and preparation, communication and coordination deficits, training and protocols development, employee welfare challenges, challenges of continuity of care, increased demand, different and complex needs of patients, ethical challenges, imbalance in distribution of service resources.ConclusionsResponse in a hospital to the needs of special care during a disaster has to be responded to with more effective preparedness through comprehensive disaster preparedness plans, better communication and coordination, and training of staff and allocation of resources. In particular, standardized triage protocols and ethical frameworks will provide the foundation for the optimization of resource use in emergency responses. Better communication among departments and also with other outside organizations will improve how resources are used to better achieve good patient outcomes within emergency responses.

Dental Considerations in Children with Inherited Bleeding Disorders and Inhibitors: A Systematic Review

Background/Objectives: This systematic review evaluates the effectiveness of various hematological treatment protocols and local hemostatic measures in preventing oral bleeding and other complications during and after dental treatments in children with inherited bleeding disorders and inhibitors. Methods: This study was registered in the PROSPERO database. The comprehensive search strategy for this systematic review was conducted across five databases, namely, PubMed, Google Scholar, Web of Science, Scopus, and Cochrane Library. The search was aimed at identifying relevant literature published from January 2000 up to February 2024. Eligible studies included those with various designs, such as randomized controlled trials (RCTs), observational studies, cohort studies, case–control studies, and cross-sectional studies. Data extraction was carried out systematically, and relevant information on study characteristics, interventions, treatment protocols, local measures, complications, and outcomes was collected. Results: The systematic review included a total of five studies, encompassing participants ranging from ages of 2 to 18 years. These studies varied in their scope, with some focusing on hemophilia A with inhibitors while others addressed broader inherited bleeding disorders. The interventions examined included various prophylactic and treatment measures such as Emicizumab, recombinant factor VIIa, and local hemostatic measures. The study outcomes primarily assessed the efficacy of these interventions in preventing postoperative bleeding and improving quality of life. Emicizumab has significantly shifted the treatment paradigm for children with inherited bleeding disorders and inhibitors. This prophylactic treatment has been associated with a marked reduction in the frequency of bleeding episodes, fewer hospital admissions for bleeding management, and enhanced participation in daily activities. Conclusions: This review highlights gaps in the management of dental care in children with inherited bleeding disorders and inhibitors. It underscores the need for standardized protocols that integrate new prophylactic treatments such as Emicizumab. Our findings suggest that adopting updated protocols can significantly reduce bleeding complications during dental procedures.

An Economic Analysis of Metal-on-Metal Versus Ceramic-on-Ceramic Hip Resurfacing: Costs and Clinical Implications

Background: Ceramic may be an alternative bearing surface that could be used to deal with the negative sequalae associated with the use of metal-on-metal (MoM) hip resurfacing implants, keeping the benefits of hip resurfacing without the risks. The aim of this study is to evaluate the additional financial and logistical implications that MoM hip resurfacing has, in comparison to its ceramic-on-ceramic (CoC) counterpart. Methods: Two different follow up protocols were analysed, according to current practice guidance, on how to follow up with hip resurfacing procedures. Reference costs were identified using the latest national cost collection data and data from the local biochemistry department. The results incorporated the number of hip resurfacings performed nationally. Results: The non-MoM protocol yielded a per operation lifetime follow up cost of £802.50, whereas the MoM protocol yielded a cost of £2132.83 at 25 years. Nationally, according to the 2023 data, this amounted to £561,750 versus £1,492,981 per year, respectively. MoM hip resurfacing is 2.6 times more expensive to be followed up with when compared to the standard protocol. Conclusion: The cost of the follow up of MoM bearings far exceeds that of non-MoM bearings. If CoC hip resurfacing is as clinically effective as MoM hip resurfacing, then the economics favour CoC bearing for resurfacing.

Venipuncture site and population affect blood analytes in head-started and free-ranging eastern box turtles (Terrapene carolina).

To compare head-started and free-ranging eastern box turtle (Terrapene carolina) blood analytes to evaluate head-starting practices and venipuncture site suitability. Eastern box turtles were head-started by Jekyll Island State Park Authority's Georgia Sea Turtle Center. Free-ranging resident box turtles on Jekyll Island State Park were captured. A physical examination and CBC were performed. Blood collection was performed from a jugular vein and the subcarapacial venous sinus. Passive integrated transponder tags were placed prior to release. Recapture and repeat assessments were attempted annually. Blood analyte data were analyzed for observational study of effects of group (head-started or free-ranging) and venipuncture site. Jugular blood samples from 15 head-started turtles (mostly immature; 88 samples) had lower total solids, lower heterophil-to-lymphocyte ratio, and higher lymphocytes than jugular samples from 24 free-ranging turtles (mostly adult; 64 samples). In head-started individuals, PCV, total solids, WBC count, and heterophils were lower in subcarapacial than jugular samples. Disparities between head-started and free-ranging turtles could indicate variance in stress, age, sex, or season. The jugular vein is the most suitable venipuncture site in comparison to the subcarapacial venous sinus, which exhibited lymphatic and/or CSF dilution. Results of the present study provide insight into variances in head-started and free-ranging box turtle populations, which must be considered for accurate hemogram interpretation. The importance of standardized protocol and serial sampling from individuals is emphasized, as values may vary by venipuncture site, population, and intrinsic factors (eg, age, sex, season) within species.

Towards Accurate Biocompatibility: Rethinking Cytotoxicity Evaluation for Biodegradable Magnesium Alloys in Biomedical Applications

Magnesium and its alloys represent promising candidates for biomedical implants due to their biodegradability and mechanical properties, which are similar to natural bone. However, their rapid degradation process characterized by dynamic pH fluctuations and significant hydrogen gas evolution during biocorrosion adversely affects both in vitro and in vivo assessments. While the ISO 10993-5 and 12 standards provide guidelines for evaluating the in vitro biocompatibility of biodegradable materials, they also introduce testing variability conditions that yield inconsistent results. To address these inherent characteristics of Mg alloys, developing improved methods that accurately simulate the physiological environment for in vitro biocompatibility testing is essential. This study introduces two novel extraction approaches for evaluating Mg alloys: a buffered solution utilizing PBS/DMEM with quaternary dilutions and a modified ISO standard protocol employing decuple dilution of conventional unbuffered extracts. The present findings establish that controlled optimization of extraction conditions, specifically buffer composition and dilution parameters, enables reliable in vitro cytotoxicity assessment of Mg alloys, providing a robust methodology that advances the preclinical evaluation of these promising biodegradable materials.

Child Maltreatment Data After Implementation of Hospital-Wide Protocol and Utilization of Sexual Assault Forensic Examiners for Child Maltreatment Cases.

Child maltreatment is a significant global health concern with significant morbidity and mortality. Sexual assault forensic examiners (SAFEs) provide a valuable skill set and may be utilized in child maltreatment evaluations. The purpose of the study was to describe patient characteristics and trends after implementation of a hospital-wide standardized child maltreatment protocol including forensic examiners in child maltreatment cases. Data from January 2017 through December 2022 were retrospectively collected and reviewed on all children under 18 years old who had a child maltreatment evaluation after initiation of a standardized child maltreatment screening process and protocol incorporating SAFE forensic evaluations at a tertiary care Level 1 trauma center. From January 2017 through December 2022, there were 764 child maltreatment evaluations of 742 total patients completed, with 763 (99.9%) evaluations completed by a trained SAFE. There were 378 examinations (49%) completed in children under 2 years old, 281 (37%) in children 2 years old until the 10th birthday, and the remaining 105 (14%) in children 10 years and older. The overall number of cases increased since the initiation of standardized screening and protocol from 68 cases in 2017 to 158 cases in 2022, with peak of 167 cases in 2020. SAFE-trained providers can be successfully incorporated in the multidisciplinary evaluation of child maltreatment patients and can add invaluable education, forensic documentation, and standardization of practice in the care of this vulnerable population.