Control Study Research Articles

Real-world impact of routine addition of anti-thymocyte globulin to standard GVHD prophylaxis in myeloablative unrelated donor transplants: important gains in graft vs host disease prevention though no difference in overall survival.

Anti-thymocyte globulin (ATG) has been demonstrated to reduce the incidence of graft-versus-host disease (GVHD); however, it remains controversial whether these gains are offset by an increase in relapse. We conducted a retrospective historical control study consisting patients (n=210) who underwent myeloablative allogeneic hematopoietic stem-cell transplantation (HSCT) from 2014 to 2020. The incidence of acute GVHD was lower in the ATG group (51.4%) than the non-ATG group (control) (70.0%, p=0.010). The incidence of chronic GVHD was also lower in the ATG group at 1-year (36.4% vs. 62.9%, p <0.001) and 2-year (40.0% vs. 65.7%, p <0.001) post-HSCT. The mortality due to GVHD was higher in the control (18.5%) than the ATG group (4.3%; p= 0.024). The severe GVHD-relapse-free survival was higher in the ATG group (36.4%) than the control (12.9%; p <0.001). Nevertheless, the 2-year overall survival was similar. Our results confirm the effectiveness of ATG in prevention of GVHD in the real-world setting and enhanced GVHD-free survival. An important result is the equalization of overall survival between the ATG and control groups at 1- and 2-year post-HSCT and implies that earlier GVHD-associated mortality may be offset by later relapse mortality producing similar overall survival over time.

Predicting risk factors for acute pain after hepatobiliary and pancreatic surgery: an observational case control study

BackgroundInadequate postoperative analgesia is associated with increased risks of various postoperative complications, longer hospital stay, decreased quality of life and higher costs.ObjectivesThis study aimed to investigate the risk factors for...

Predictive value of perioperative NT-proBNP levels for acute kidney injury in patients with compromised renal function undergoing cardiac surgery: a case control study

BackgroundAcute kidney injury (AKI) significantly increases morbidity and mortality following cardiac surgery, especially in patients with pre-existing renal impairments. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a marker of cardiac stress and dysfunction, conditions often exacerbated during cardiac surgery and prevalent in chronic kidney disease (CKD) patients. Elevated NT-proBNP levels can indicate underlying cardiac strain, hemodynamic instability and volume overload. This study evaluated the association between perioperative changes in NT-proBNP levels and the incidence of AKI in this particular patient group.MethodsThis retrospective study involved patients with impaired renal function (eGFR 15–60 ml/min/1.73 m²) who underwent cardiac surgery from July to December 2022. It analyzed the association between the ratio of preoperative and ICU admittance post-surgery NT-proBNP levels and the development of AKI and AKI stage 2–3, based on KDIGO criteria, using multivariate logistic regression models. Restricted cubic spline analysis assessed non-linear associations between NT-proBNP and endpoints. Subgroup analysis was performed to assess the heterogeneity of the association between NT-proBNP and endpoints in subgroups.ResultsAmong the 199 participants, 116 developed postoperative AKI and 16 required renal replacement therapy. Patients with AKI showed significantly higher postoperative NT-proBNP levels compared to those without AKI. Decreased baseline eGFR and increased post/preoperative NT-proBNP ratios were associated with higher AKI risk. Specifically, the highest quantile post/preoperative NT-proBNP ratio indicated an approximately seven-fold increase in AKI risk and a ninefold increase in AKI stage 2–3 risk compared to the lowest quantile. The area under the receiver operating characteristic curve for predicting AKI and AKI stage 2–3 using NT-proBNP were 0.63 and 0.71, respectively, demonstrating moderate accuracy. Subgroup analysis demonstrated that the positive association between endpoints and logarithmic transformed post/preoperative NT-proBNP levels was consistently robust in subgroup analyses stratified by age, sex, surgery, CPB application, hypertension, diabetes status and fluid balance.ConclusionPerioperative NT-proBNP level changes are predictive of postoperative AKI in patients with pre-existing renal deficiencies undergoing cardiac surgery, aiding in risk assessment and patient management.

Statistical Modeling of Within-Laboratory Precision Using a Hierarchical Bayesian Approach.

Reproducibility has been well-studied in the field of food analysis; the relative standard deviation is said to follow the Horwitz curve with certain exceptions. However, little systematic research has been done on predicting repeatability or intermediate precision. We developed a regression method to estimate within-laboratory standard deviations using hierarchical Bayesian modeling and analyzing duplicate measurement data obtained from actual laboratory tests. The Hamiltonian Monte Carlo method was employed and implemented using R with Stan. The basic structure of the statistical model was assumed to be a chi-squared distribution, the fixed effect of the predictor was assumed to be a nonlinear function with a constant term and a concentration-dependent term, and the random effects were assumed to follow a lognormal distribution as a hierarchical prior. By analyzing over 300 instances, we obtained regression results that fit well with the assumed model, except for moisture, which was a method-defined analyte. The developed method applies to a wide variety of analytes measured using general principles, including spectroscopy, GC, and HPLC. Although the estimated precisions were within the HorRat(r) criteria, some cases using high-sensitivity detectors, such as mass spectrometers, showed standard deviations below that range. We propose utilizing the within-laboratory precision predicted by the model established in this study for internal quality control and measurement uncertainty estimation without considering the sample matrices. Performing statistical modeling on data from double analysis, which is conducted as a part of internal quality controls, will simplify the estimation of the precision that fits each analytical system in a laboratory.

Relationship Between Baseline Infarct and Clinical Outcome in Pediatric Large‐Vessel Occlusion Ischemic Stroke

Background In adults with large‐vessel occlusion stroke, the extent of the baseline infarct measured using the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) predicts outcome and is used during patient selection for mechanical thrombectomy. The relationship between ASPECTS and clinical outcome is unknown in pediatric large‐vessel occlusion stroke. Methods Secondary analysis of a retrospective multicenter case–control study assessing mechanical thrombectomy versus medical management alone for pediatric large‐vessel occlusion stroke across 5 centers in Australia and Canada from 2011 to 2022. ASPECTS was measured on baseline computed tomography or magnetic resonance imaging–diffusion‐weighted imaging while blinded to clinical outcome and treatment status. The relationship between ASPECTS and pediatric modified Rankin scale scores at 3 months following stroke was assessed using ordinal logistic regression. Results In total, n = 24 thrombectomy patients (F = 10, mean age, 11.3 years [SD, 4.36]) and n = 24 control patients (F = 10, mean age, 10.2 years [SD, 4.32) were included. Mean ASPECTS was 6.3 (SD, 2.37) in the thrombectomy group and 6.1 (SD, 2.64) in the control group. In patients undergoing thrombectomy, baseline ASPECTS significantly correlated with pediatric modified Rankin scale scores at 3 months (odds ratio, 1.58 [95% CI, 1.10–2.27]; P = 0.013). In control patients, there was no significant correlation (odds ratio, 1.17 [95% CI, 0.87–1.55]; P = 0.298). Six of 7 thrombectomy patients with a large baseline infarct (ASPECTS <6) had a pediatric modified Rankin scale score of 0 to 2 at final follow‐up. Conclusion Baseline ASPECTS was significantly associated with clinical outcome in pediatric patients with large‐vessel occlusion stroke who received mechanical thrombectomy. Thrombectomy patients with low ASPECTS demonstrated favorable long‐term outcomes, suggesting ASPECTS alone should not be used to exclude pediatric patients from receiving thrombectomy.

Growth Stunting and Nutritional Deficiencies among Children and Adolescents with Celiac Disease in Kuwait: A Case–Control Study

Background/Objectives: This study aimed to assess the nutritional status of children and adolescents with celiac disease (CD) in Kuwait and investigate the nutritional deficiencies and sociodemographic factors associated with growth stunting in this population. Methods: This case–control study included 77 CD patients aged 3–18 years diagnosed with CD using IgA anti-tissue transglutaminase and duodenal biopsy and 33 healthy controls. Nutritional status was evaluated based on demographic and clinical characteristics, anthropometric measurements, and biochemical parameters. Univariate and multivariate logistic regression models were used to determine the association between CD and growth stunting. Results: Approximately one-third (31%) of children with CD had stunted growth, 20.8% had a low body mass index for their age, and 5.2% had both growth stunting and wasting. Children with CD had higher odds of iron-deficiency anemia, vitamin D deficiency, anemia, and lower socioeconomic status. They were also younger and had decreased serum levels of vitamin D compared to the controls. These factors were all significantly associated with an increased risk of CD, collectively explaining over 50% of the risk. For growth stunting, lower education status among mothers, family income, and serum ferritin were identified as risk factors. Conclusions: A significant proportion of children and adolescents with CD had malnutrition, overt deficiencies, and impaired growth despite coherence with a gluten-free diet. Recommendation: Routine monitoring and targeted nutritional interventions are recommended for children and adolescents with CD to address malnutrition and growth stunting. Addressing socioeconomic disparities and enhancing maternal education may also help mitigate the risk factors.

Intranasal administration of insulin on the incidence of postoperative delirium in middle-aged patients undergoing elective on-pump cardiac surgery (INIPOD-MOPS): a prospective double-blinded randomized control study protocol

BackgroundDelirium, marked by acute cognitive decline, poses a life-threatening issue among older individuals, especially after cardiac surgery, with prevalence ranging from 15 to 80%. Postoperative delirium is linked to increased morbidity and mortality. Although clinical trials suggest preventability, there is limited research on intranasal insulin (INI) for cardiac surgery-related delirium. INI has shown promise in managing cognitive disorders. It rapidly elevates brain hormone levels, enhancing memory even in non-impaired individuals. While effective in preventing delirium in gastrointestinal surgery, its impact after cardiac surgery remains understudied, especially for middle-aged patients.MethodThis is a prospective randomized, double-blind, single-center controlled trial. A total of 76 eligible participants scheduled for elective on-pump cardiac surgery will be enrolled and randomly assigned in a 1:1 ratio to either receive Intranasally administered insulin (INI) or intranasally administered normal saline. The primary outcome of our study is the incidence of postoperative delirium (POD). Secondary outcomes include duration of ICU, postoperative hospital length of stay, all in-hospital mortality, the change in MMSE scores pre- and post-operation, and incidence of postoperative cognitive dysfunction at 1 month, 3 months, and 6 months after operation. Moreover, we will subjectively and objectively evaluate perioperative sleep quality to investigate the potential impact of nasal insulin on the development of delirium by influencing sleep regulation.DiscussionOur study will aim to assess the impact of intranasal administration of insulin on the incidence of postoperative delirium in middle-aged patients undergoing on-pump elective cardiac surgery. If intranasal insulin proves to be more effective, it may be considered as a viable alternative for preventing postoperative delirium.Trial registrationChiCTR ChiCTR2400081444. Registered on March 1, 2024.

Vitamin D serum levels in patients with systemic sclerosis and very early systemic sclerosis (VEDOSS)

Introduction: Vitamin D may be capable of interfering with the pathophysiological pathways involved in systemic sclerosis, by virtue of its well-known immunomodulatory effects. In this study, we aimed at evaluating the differences and the correlations between vitamin D levels in systemic sclerosis patients versus patients with very early systemic sclerosis. Methods: One hundred twenty-six patients (80 definite systemic sclerosis and 46 very early systemic sclerosis) were included in this case control study. Anthropometric, clinical, biochemical, and instrumental data were recorded and correlated with serum vitamin D levels. Results: Briefly, systemic sclerosis patients and very early systemic sclerosis subjects significantly differed for telangectasias, scleredema, autoantibody profile, and videocapillaroscopic pattern. In addition, the mean vitamin D levels were significantly lower in systemic sclerosis patients when compared to those of very early systemic sclerosis subjects. When systemic sclerosis patients were divided into two groups, that is, those with ⩽20 ng/ml versus >20 ng/ml vitamin D serum levels, significantly higher serum vitamin D levels were observed in patients with a lesser skin and vascular involvement. With regard to very early systemic sclerosis subjects, who exhibited baseline satisfactory vitamin D levels, only the autoantibody profile was found to correlate with vitamin D serum levels. Conclusion: Vitamin D serum levels were found to be generally satisfactory in very early systemic sclerosis subjects, but they were reduced in systemic sclerosis patients. Advanced skin and microvascular involvement were found to predispose to hypovitaminosis D. Due to the well-documented immunomodulatory properties of vitamin D, studies are needed to determine whether vitamin D supplementation may prevent the subsequent evolution of very early systemic sclerosis into definite systemic sclerosis.

Real-world effectiveness of nirsevimab immunisation against bronchiolitis in infants: a case–control study in Paris, France

Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis in infants. Nirsevimab, an RSV-neutralising monoclonal antibody, was approved for use in the EU in 2022, and a national immunisation campaign began in France in September, 2023. We aimed to assess the effectiveness of nirsevimab in reducing paediatric emergency department visits (and subsequent hospitalisations) for all-cause bronchiolitis and RSV-associated bronchiolitis. In this case-control study in a paediatric emergency department in Paris, France, we included all infants aged 12 months or younger who attended the department between Oct 14, 2023, and Feb 29, 2024, and whose nirsevimab status was known. Infants were classed as cases if they had all-cause bronchiolitis; all other infants were classed as controls. The primary outcome was the effectiveness of nirsevimab against paediatric emergency department visits for all-cause bronchiolitis during the 2023-24 RSV season. Secondary outcomes were paediatric emergency department visits for RSV-associated bronchiolitis; hospitalisations for all-cause bronchiolitis, RSV-associated bronchiolitis, and severe RSV-associated bronchiolitis requiring supplemental oxygen or feeding by nasogastric tube; and severe RSV-associated bronchiolitis requiring admission to the paediatric intensive care unit. Effectiveness estimates were adjusted for age, week of paediatric emergency department visit, and sex. Our study included 2786 infants, 864 with all-cause bronchiolitis (cases) and 1922 without bronchiolitis (controls). 178 (21%) of the 864 cases had received nirsevimab, and 305 (35%) cases were hospitalised for all-cause bronchiolitis. 200 (72%) of the 277 cases tested for RSV were positive, of whom 22 (11%) had received nirsevimab. 701 (36%) of 1922 infants in the control group had received nirsevimab. The effectiveness of nirsevimab against paediatric emergency department visits for all-cause bronchiolitis was 47% (95% CI 33-58). Nirsevimab effectiveness was 83% (71-90) against paediatric emergency department visits for RSV-associated bronchiolitis, 59% (42-71) against hospitalisations for all-cause bronchiolitis, 83% (72-90) against hospitalisations for RSV-associated bronchiolitis (91% [78-96] against those necessitating supplement oxygen and 88% [74-95] against those necessitating feeding via a nasogastric tube). Nirsevimab did not significantly reduce admissions to the paediatric intensive care unit (67% [95% CI -100 to 95]). During the first French national immunisation campaign, a single dose of nirsevimab effectively reduced paediatric emergency department visits (both all-cause visits and visits related to RSV-associated bronchiolitis) and subsequent hospitalisations. None.

Asprosin in nonalcoholic fatty liver disease and hypothyroidism: a case-control study

ABSTRACT Purpose The present study aimed to determine the serum level of asprosin, a novel glucogenic and orexigenic hormone, in NAFLD and hypothyroidism patients. Methods This is a case–control study that included three groups of age and sex-matched subjects: hypothyroid patients with NAFLD (n = 26), hypothyroid patients without NAFLD (n = 25) and normal control subjects (n = 27). A detailed clinical history was obtained, and an examination was performed. Laboratory tests included fasting plasma glucose and insulin, lipid profile, TSH, free T4, AST, ALT, albumin, and asprosin. The homeostatic model assessment of insulin resistance (HOMA-IR) score was calculated. Abdominal ultrasonography was performed to calculate the hepatorenal index and define participants with NAFLD. The data were statistically analyzed. Results There was a statistically significant difference between the three groups regarding serum asprosin concentration (p < 0.01). Serum asprosin levels were significantly higher in the patients with hypothyroidism and NAFLD compared to both other groups [2.70 ng/mL (2.17–4.10), 1.26 ng/mL (0.96–2.50), and 1.72 ng/mL (1.41–2.12), respectively]. There was no significant difference between the other two groups. There was a significant positive correlation of moderate strength between asprosin and HOMA-IR, BMI, and waist circumference. Asprosin and HOMA-IR were significantly higher in patients with NAFLD compared to subjects with normal liver (p < 0.001). Conclusion The coexistence of NAFLD and hypothyroidism is more strongly associated with increased asprosin than is the presence of hypothyroidism alone. This could be due to increased insulin resistance as a possible link.

Asymmetric Intermolecular Conjugate Addition of 3-Substituted-2-benzofuranones to Maleimides via Non-covalent NHC Catalysis

An efficient NHC-catalyzed asymmetric conjugate addition reaction to afford synthetically challenging benzofuranone derivatives having vicinal all-carbon quaternary and tertiary stereocenters is presented. The reaction operates solely via non-covalent interaction between newly designed NHC and substrates providing access to a series of functionalized benzofuranones with good yields and ee values. The protocol applies to preparative scale synthesis. A catalytic cycle involving non-covalent substrate-NHC interaction is implicated in the process, based on the mechanistic control study.

What could be the role of genetic tests and machine learning of AXIN2 variant dominance in non-syndromic hypodontia? A case-control study in orthodontically treated patients

BackgroundHypodontia is the most prevalent dental anomaly in humans, and is primarily attributed to genetic factors. Although genome-wide association studies (GWAS) have identified single-nucleotide polymorphisms (SNP) associated with hypodontia, genetic risk assessment remains challenging due to population-specific SNP variants. Therefore, we aimed to conducted a genetic analysis and developed a machine-learning-based predictive model to examine the association between previously reported SNPs and hypodontia in the Saudi Arabian population. Our case–control study included 106 participants (aged 8–50 years; 64 females and 42 males), comprising 54 hypodontia cases and 52 controls. We utilized TaqManTM Real-Time Polymerase Chain Reaction and allelic genotyping to analyze three selected SNPs (AXIN2: rs2240308, PAX9: rs61754301, and MSX1: rs12532) in unstimulated whole saliva samples. The chi-square test, multinomial logistic regression, and machine-learning techniques were used to assess genetic risk by using odds ratios (ORs) for multiple target variables.ResultsMultivariate logistic regression indicated a significant association between homozygous AXIN2 rs2240308 and the hypodontia phenotype (ORs [95% confidence interval] 2.893 [1.28–6.53]). Machine-learning algorithms revealed that the AXIN2 homozygous (A/A) genotype is a genetic risk factor for hypodontia of teeth #12, #22, and #35, whereas the AXIN2 homozygous (G/G) genotype increases the risk for hypodontia of teeth #22, #35, and #45. The PAX9 homozygous (C/C) genotype is associated with an increased risk for hypodontia of teeth #22 and #35.ConclusionsOur study confirms a link between AXIN2 and hypodontia in Saudi orthodontic patients and suggests that combining machine-learning models with SNP analysis of saliva samples can effectively identify individuals with non-syndromic hypodontia.

TO ASSESS THE ROLE OF NASAL TAPENTADOL AS PRE-EMPTIVE ANALGESIA, IN BREAST SURGERY PATIENTS

Patients undergoes moderate to severe postoperative pain after surgery, which is troublesome during the postoperative period. Inadequately treated acute post operative pain causes prolonged morbidity to patients. Pre-emptive analgesic minimises the pain in perioperative period by central neuro sensitization. We assessed the role of Nasal Tapentadol in breast surgery patients, as a pre-emptive analgesic, in the reduction of post-operative analgesic requirement. In a double blinded prospective randomized control study, sixty breast surgery patients, received nasal spray of tapentadol (Group A) or saline Spray (Group B), 30 minutes prior to general anaesthesia. Perioperative analgesic requirement, time taken for first analgesic requirement in post operative period, post operative pain and sedation scores, we compared the following parameters in the first 24h during the postoperative period in all patients: Analgesic requirement during perioperative period, time taken for first post operative analgesic dose, pain score and sedation score in postoperative period.Data Of all sixty patients were analysed. Patients in Tapentadol Group A had significantly lower requirement of analgesics and lower Visual analog scale (VAS) than Saline group in the post operative period. However, Ramsay sedation score was more in Tapentadol group, immediately after shifting the patient to the postanaesthetic care unit. Single Pre-emptive nasal spray of tapentadol (45mg) is an effective intervention to, reduce the surgical pain and lesser requirement of analgesics, in post operative period, without added side effects.

Evaluation of the Effect of Low-Level Laser Therapy Versus Photodynamic Therapy on the Level of Serum IL-17 and Salivary IL-4 in Patients Suffering from Erosive/Atrophic Oral Lichen Planus: A Case Control Study

Evaluation of the Effect of Low-Level Laser Therapy Versus Photodynamic Therapy on the Level of Serum IL-17 and Salivary IL-4 in Patients Suffering from Erosive/Atrophic Oral Lichen Planus: A Case Control Study

Estimation of vitamin D status and calcium level among pregnant women in Tikrit city: case control study

The demand for calcium and vitamin D rises during pregnancy, increasing the chance of hypocalcemia and vitamin D deficiency. Hypocalcemia may be associated with pregnancy-related complications. This study thus sought to ascertain the frequency of hypocalcemia and vitamin D insufficiency in pregnant women seeking secondary care, as well as to explore the possible associations between these disorders and pregnancy outcomes. Subjects, Materials and method: This study was conducted without the use of vitamin D supplements in the first, second, and third trimesters at gestational ages more than 40 weeks, even before the convenience sample number 36 became pregnant. Control groups for Case number 10 non pregnant women. The age of cases and control women in range from 20-35years. Using the Roche Cobas e411 immunoassay device, we calculated the serum concentrations of calcium and vitamin D. The study carried out between December 2023 and February 2024 in Tikrit Teaching Hospital. Results: A total of 36 pregnant women were enrolled in the study Mean (SD) serum Vitamin D level was 17.9±0.12mg/dl pregnant women with First trimester, 11.8± 0.18mg/dl pregnant women with second trimester and 10.5 ± 0.20mg/dl pregnant women with third trimester compared with control groups 44.4 ± 0.40 (p-value = &lt;0.001). As well as Mean (SD) serum calcium level was (7.9±0.10, 8.2± 0.18, 7.5 ± 0.20 mg/dl) pregnant women with First, second and third trimester respectively, compared with control groups 8.4 ± 0.40 (p-value = 0.06).

The Role of Intestinal Epithelial Permeability in Multisystem Inflammatory Syndrome in Children: A Case–Control Study

Background: Multisystem inflammatory syndrome in children (MIS-C) occurs after SARS-CoV-2 infection, with gastrointestinal symptoms a prominent feature. This syndrome has been proposed to be triggered by persistent SARS-CoV-2 antigenemia due to increased intestinal epithelial permeability. We obtained evidence for this in this study. Methods: In a single-centre study, we recruited 83 children and analysed blood samples to quantify the circulating markers of increased intestinal permeability following SARS-CoV-2 infection. Publicly available proteomics MIS-C datasets were also accessed to assess the evidence for increased intestinal permeability. We further quantified SARS-CoV-2 antigenemia and the humoral response to SARS-CoV-2 spike protein. Results: Following SARS-CoV-2 infection, healthy children demonstrated no dysregulation of the intestinal epithelial barrier. In MIS-C, considerable increases in markers of epithelial dysfunction were observed, with similar increases noted in febrile controls. Furthermore, we found little evidence of persistent SARS-CoV-2 antigenemia in MIS-C. Conclusions: Our results suggest that although increased intestinal epithelial permeability is a feature of MIS-C, it is not unique to the condition, and persistent SARS-CoV-2 antigenemia does not occur.

Securing industrial control systems: Developing a SCADA/IoT test bench and evaluating lightweight cipher performance on hardware simulator

This paper addresses the critical need for enhancing security in Supervisory Control and Data Acquisition (SCADA) networks within Industrial Control Systems (ICSs) to protect the industrial processes from cyber-attacks. The purpose of our work is to propose and evaluate lightweight security measures to safeguard critical infrastructure resources. The scope of our effort involves simulating a secure SCADA/IoT-based hardware test bench for ICSs, utilizing Modbus and MQTT communication protocols. Through case studies in remote servo motor control, water distribution systems, and power system voltage level indicators, vulnerabilities such as Denial of Service (DoS) and Man-in-The-Middle (MiTM) attacks are identified, and security recommendations are provided. To execute our work, we deploy lightweight ciphers such as Prime Counter & Hash Chaining (PCHC) and Ascon algorithm with Compression Rate (ACR) for secure information exchange between the plant floor and the control center. Evaluation of these ciphers on Raspberry Pi focuses on execution speed and memory utilization. Additionally, a comparison with the AGA-12 protocol standard for SCADA networks is conducted to underscore the efficacy of the proposed security measures. Our findings include the identification of SCADA network vulnerabilities and the proposal of lightweight security measures to mitigate risks. Performance evaluation of the proposed ciphers on Raspberry Pi demonstrates their effectiveness, emphasizing the importance of deploying such measures to ensure resilience against cyber threats in SCADA environments.

Localized Control of the Swarming of Kinesin-Driven Microtubules Using Light.

The swarming of self-propelled cytoskeletal filaments has emerged as a new aspect in the field of molecular machines or robotics, as it has overcome one of the major challenges of controlling the mutual interaction of a large number of individuals at a time. Recently, we reported on the photoregulated swarming of kinesin-driven cytoskeletal microtubule filaments in which visible (VIS) and ultraviolet (UV) light triggered the association and dissociation of the swarm, respectively. However, systematic control of this potential system has yet to be achieved to optimize swarming for further applications in molecular machines or robotics. Here, we demonstrate the precise and localized control of a biomolecular motor-based swarm system by varying different parameters related to photoirradiation. We control the reversibility of the swarming by changing the wavelength or intensity of light and the number of azobenzenes in DNA. In addition, we regulate the swarming in local regions by introducing different-sized or shaped patterns in the UV light system. Such a detailed study of the precise control of swarming would provide new perspectives for developing a molecular swarm system for further applications in engineering systems.

Pfizer-BioNTech (BNT162b2) Vaccine Effectiveness against Symptomatic Laboratory-Confirmed COVID-19 Infection among Outpatients in Sentinel Sites, Lebanon, July–December 2021

On 14 February 2021, Lebanon implemented nationwide vaccination, offering the Pfizer-BioNTech (BNT162b2) vaccine to adults over 50 years of age. We estimated the effectiveness of the Pfizer-BioNTech vaccine in preventing symptomatic laboratory-confirmed COVID-19. We conducted a test-negative case–control (TND) study among symptomatic adults aged 50 years and older who presented with influenza-like illness (ILI) or COVID-19-like illness (CLI) in surveillance sentinel sites between 1 July and 31 December 2021. Unvaccinated participants did not receive any vaccine dose before symptom onset. Vaccinated participants received at least one dose within 14 days before onset of symptoms. We estimated vaccine effectiveness against symptomatic laboratory-confirmed COVID-19, adjusted for demographic and behavioral factors, using multivariable logistic regression. Out of 457 participants with symptoms, 150 (33%) were positive and 307 (67%) were negative for SARS-CoV-2. Adjusted vaccine effectiveness was 22% (95% CI: −70–65%) for those partially vaccinated and 44% (95% CI: 6–67%) for those fully vaccinated. Vaccination with two doses of the Pfizer-BioNTech vaccine was effective in preventing COVID-19 symptomatic illness in the older population. Vaccine effectiveness was lower for those partially vaccinated. We recommend enhancing vaccine uptake with at least one dose among risk groups for COVID-19 and keeping general recommendations on contact and droplet precautions in the general population.

Diagnosis of perimenopausal coronary heart disease patients using radiomics signature of pericoronary adipose tissue based on coronary computed tomography angiography

To assess whether the radiomics signature of pericoronary adipose tissue (PCAT) from coronary computed tomography angiography (CCTA) can distinguish between perimenopausal women with coronary heart disease (CHD) and those without coronary artery disease (CAD). This single-center retrospective case–control study comprised 140 perimenopausal women with CHD presenting with chest pain who underwent CCTA within 48 h of admission. They were matched with 140 control patients presenting with chest pain but without CAD, based on age, risk factors, radiation dose and CT tube voltage. For all participants, PCAT around the proximal right coronary artery was segmented, from which radiomics features and the fat attenuation index (FAI) were extracted and analyzed. Subsequently, corresponding models were developed and internally validated using Bootstrap methods. Model performance was assessed through measures of identification, calibration, and clinical utility. Using logistic regression analysis, an integrated model that combines clinical features, fat attenuation index and radiomics parameters demonstrated enhanced discrimination ability for perimenopausal CHD (area under the curve [AUC]: 0.80, 95% confidence interval [CI]:0.740–0.845). This model outperformed both the combination of clinical features and PCAT attenuation (AUC 0.67, 95% CI 0.602–0.727) and the use of clinical features alone (AUC 0.66, 95% CI 0.603–0.732). Calibration curves for the three predictive models indicated satisfactory fit (all p > 0.05). Moreover, decision curve analysis demonstrated that the integrated model offered greater clinical benefit compared to the other two models. The CCTA-based radiomics signature derived from the PCAT model outperforms the FAI model in differentiating perimenopausal CHD patients from non-CAD individuals. Integrating PCAT radiomics with the FAI could enhance the diagnostic accuracy for perimenopausal CHD.