Treatment Of Different Types Research Articles

Pulsed dye laser (PDL) versus photodynamic therapy (PDT) for the treatment of port wine stain (PWS): a systematic review and meta-analysis

Objective: Vascular lesions, such as port wine stain (PWS), lead to facial and psychological problems that require careful and timely treatments. This review aims to compare two mainstream methods pulsed dye laser (PDL) therapy and photodynamic therapy (PDT) for PWS. Methods: The Cochrane Library, PubMed, Embase, CNKI Full-Text Chinese Database and VIP Chinese Scientific Journals Database were searched for literatures comparing PDL versus PDT in treating PWS with no dates set. Studies were eligible for inclusion if they were randomised, placebo-controlled or head-to-head trials published in either English or Chinese. The primary outcome was overall response rate judged by physician/investigator-reported outcome scoring system. Adverse effects were also recorded. Review Manager (RevMan) was used to perform data synthesis. Cochrane risk of bias tool was used for methodological quality assessment. Retrospective studies were assessed based on Newcastle-Ottawa Scale. Results: Twelve studies met the inclusion criteria, among which eight studies had the data necessary for the meta-analysis. Among the eight studies, four were retrospective studies with 1,075 patients. The other four were RCT studies with 532 randomised participants. Regarding the overall response rate of RCT studies, PDT demonstrated no significantly higher efficacy than PDL with RR 0.76 (95% credible interval [CI] 0.48–1.20). Regarding purple types, the overall response rate of PDT was statistically significantly superior to that of PDL with RR of 0.47 (95% CI: 0.29–0.79). In terms of red types, PDT also manifested no significantly higher efficacy compared with PDL with RR of 0.85 (95% CI: 0.27–2.71). Conclusion: PDT is an effective and safe treatment for different types of PWS and was more effective than PDL in treating purple type of PWS.

Methodological aspects of statistical analysis in ophthalmology

Statistics can be used to evaluate the prevalence of diseases, differences between patient groups, links between test results, compare the effectiveness of different types of treatment, test the hypothesis and model the interdependencies between variables. In medical universities, preference is given to special medical disciplines. Yet, a skilled medical specialist should have an adequate understanding of statistical data analysis. Purpose: to systematize and demonstrate statistical analysis techniques that could be useful for an ophthalmologist. Results. The major methodological aspects of statistical analysis in ophthalmology are considered. An overview of statistical techniques and an algorithm of choosing such techniques is given. Descriptive statistics and features of in-depth statistical analysis used in ophthalmological research are presented. Examples of scientific work using these methods are listed. Conclusion. The basics of statistical analysis expand the scope of instruments that ophthalmologists have at their disposal. The paper provides links to open sources in which statistical techniques and results achieved therewith are presented. These links increase the ophthalmologist’s awareness of the instruments considered.

Patients accept therapy using embryonic stem cells for Parkinson’s disease: a discrete choice experiment

BackgroundNew disease-modifying ways to treat Parkinson’s disease (PD) may soon become a reality with intracerebral transplantation of cell products produced from human embryonic stem cells (hESCs). The aim of this study was to assess what factors influence preferences of patients with PD regarding stem-cell based therapies to treat PD in the future.MethodsPatients with PD were invited to complete a web-based discrete choice experiment to assess the importance of the following attributes: (i) type of treatment, (ii) aim of treatment, (iii) available knowledge of the different types of treatments, (iv) effect on symptoms, and (v) risk for severe side effects. Latent class conditional logistic regression models were used to determine preference estimates and heterogeneity in respondents’ preferences.ResultsA substantial difference in respondents’ preferences was observed in three latent preference patterns (classes). “Effect on symptoms” was the most important attribute in class 1, closely followed by “type of treatment,” with medications as preferred to other treatment alternatives. Effect on symptoms was also the most important attribute in class 2, with treatment with hESCs preferred over other treatment alternatives. Likewise for class 3, that mainly focused on “type of treatment” in the decision-making. Respondents’ class membership was influenced by their experience in treatment, side effects, and advanced treatment therapy as well as religious beliefs.ConclusionsMost of the respondents would accept a treatment with products emanating from hESCs, regardless of views on the moral status of embryos. Preferences of patients with PD may provide guidance in clinical decision-making regarding treatments deriving from stem cells.

Tumor microenvironment-induced tumor cell plasticity: relationship with hypoxic stress and impact on tumor resistance.

The role of tumor interaction with stromal components during carcinogenesis is crucial for the design of efficient cancer treatment approaches. It is widely admitted that tumor hypoxic stress is associated with tumor aggressiveness and thus impacts susceptibility and resistance to different types of treatments. Notable biological processes that hypoxia functions in include its regulation of tumor heterogeneity and plasticity. While hypoxia has been reported as a major player in tumor survival and dissemination regulation, the significance of hypoxia inducible factors in cancer stem cell development remains poorly understood. Several reports indicate that the emergence of cancer stem cells in addition to their phenotype and function within a hypoxic tumor microenvironment impacts cancer progression. In this respect, evidence showed that cancer stem cells are key elements of intratumoral heterogeneity and more importantly are responsible for tumor relapse and escape to treatments. This paper briefly reviews our current knowledge of the interaction between tumor hypoxic stress and its role in stemness acquisition and maintenance. Our review extensively covers the influence of hypoxia on the formation and maintenance of cancer stem cells and discusses the potential of targeting hypoxia-induced alterations in the expression and function of the so far known stem cell markers in cancer therapy approaches. We believe that a better and integrated understanding of the effect of hypoxia on stemness during carcinogenesis might lead to new strategies for exploiting hypoxia-associated pathways and their targeting in the clinical setting in order to overcome resistance mechanisms. More importantly, at the present time, efforts are oriented towards the design of innovative therapeutical approaches that specifically target cancer stem cells.

Characterization of CAR T Cells Manufactured Using Genetically Engineered Artificial Antigen Presenting Cells.

Chimeric antigen receptor (CAR) T cell therapy has recently emerged as a promising approach for the treatment of different types of cancer. Improving CAR T cell manufacturing in terms of costs and product quality is an important concern for expanding the accessibility of this therapy. One proposed strategy for improving T cell expansion is to use genetically engineered artificial antigen presenting cells (aAPC) expressing a membrane-bound anti-CD3 for T cell activation. The aim of this study was to characterize CAR T cells generated using this aAPC-mediated approach in terms of expansion efficiency, immunophenotype, and cytotoxicity. In this experimental study, we generated an aAPC line by engineering K562 cells to express a membrane-bound anti-CD3 (mOKT3). T cell activation was performed by co-culturing PBMCs with either mitomycin C-treated aAPCs or surface-immobilized anti-CD3 and anti-CD28 antibodies. Untransduced and CD19-CARtransduced T cells were characterized in terms of expansion, activation markers, interferon gamma (IFN-γ) secretion, CD4/CD8 ratio, memory phenotype, and exhaustion markers. Cytotoxicity of CD19-CAR T cells generated by aAPCs and antibodies were also investigated using a bioluminescence-based co-culture assay. Our findings showed that the engineered aAPC line has the potential to expand CAR T cells similar to that using the antibody-based method. Although activation with aAPCs leads to a higher ratio of CD8+ and effector memory T cells in the final product, we did not observe a significant difference in IFN-γ secretion, cytotoxic activity or exhaustion between CAR T cells generated with aAPC or antibodies. Our results show that despite the differences in the immunophenotypes of aAPC and antibody-based CAR T cells, both methods can be used to manufacture potent CAR T cells. These findings are instrumental for the improvement of the CAR T cell manufacturing process and future applications of aAPC-mediated expansion of CAR T cells.

Bado III Monteggia in children - treatment options and outcome: an ultrasound control study.

The Bado III Monteggia lesion is an uncommon fracture in children. Radial head dislocation can occur due to intra- or extra-articular fractures of the olecranon. In extra-articular ulnar fractures, heterogeneous operative methods are proposed in different case reports. The objective of this study is to determine if closed reduction of the ulnar fracture, either without osteosynthesis or by using TEN, is a safe treatment option. In a multicenter study, we retrospectively analyzed 26 children who were treated for an extra-articular proximal metaphyseal ulnar fracture with dislocation of the radial head. These patients underwent a follow-up examination after an average of four years. The investigation included a physical examination, visualization of the elbow anatomy, and specifically, the radial head retention in the joint by ultrasound. Of the 26 patients, 18 were treated by closed reduction and intramedullary osteosynthesis (TEN), 7 were treated by closed reduction and cast immobilization without osteosynthesis, and 1 child was treated by open reduction of the ulna and plate osteosynthesis. In the follow-up examination, 25 children showed an excellent outcome, as well as inapparent sonography. Although this is a retrospective study with different types of treatment, closed reduction of the ulna with or without osteosynthesis appears to be effective. We believe that the correct primary reduction is the key to an excellent long-term outcome. Regarding the invasiveness of the treatment, reduction without or with TEN osteosynthesis should be the preferred approach in extra-articular pediatric Bado III fractures.

Clinical Outcomes of Retinal Arterial Macroaneurysms With Vitreous Hemorrhage Treated With Observation, Antivascular Endothelial Growth Factor Intravitreal Injections, or Pars Plana Vitrectomy.

Purpose: To evaluate the clinical outcomes of different types of treatment of retinal arterial macroaneurysm with vitreous hemorrhage. Methods: This retrospective cohort study comprised patients with retinal arterial macroaneurysm and vitreous hemorrhage who were examined at a single retina clinic between 2013 and 2021. Results: Treatment arms included observation (n = 33), intravitreal injections (IVIs) of antivascular endothelial growth factor agents (n = 5), and pars plana vitrectomy (PPV; n = 12). Baseline characteristics and final best-corrected visual acuity (BCVA) were similar in a combined analysis of all treatment groups (P > .05). The BCVA improved in all eyes, but the IVI and PPV arms had worse presenting BCVA. The mean number of injections was 3.6 ± 2.8. The incidence of subretinal hemorrhage was 18.2% in the observation arm, 25.0% in the PPV group (8.3% had subretinal tissue plasminogen activator), and 60.0% in the IVI group. The mean time to intervention was 13 ± 15.3 days for PPV and 38 ± 69.9 days for IVI. There was no correlation between the number of injections and the final BCVA (r = 0.13, P = .830). The IVI and PPV arms were more frequently on anticoagulants (P = .011). There was no difference in final BCVA between those using anticoagulants (0.52 ± 0.53) vs not using anticoagulants (0.55 ± 0.65) (P = .870). Conclusions: Most patients, regardless of treatment modality, demonstrated significantly improved BCVA and similar final visual outcomes. Patients with worse presenting BCVA were more likely to undergo PPV or IVI whereas those with better presenting BCVA had excellent outcomes with observation alone. Improved BCVA was not associated with the number of IVIs or anticoagulant use.

Anti-Hyperalgesic Efficacy of Acetyl L-Carnitine (ALCAR) Against Visceral Pain Induced by Colitis: Involvement of Glia in the Enteric and Central Nervous System.

The management of abdominal pain in patients affected by inflammatory bowel diseases (IBDs) still represents a problem because of the lack of effective treatments. Acetyl L-carnitine (ALCAR) has proved useful in the treatment of different types of chronic pain with excellent tolerability. The present work aimed at evaluating the anti-hyperalgesic efficacy of ALCAR in a model of persistent visceral pain associated with colitis induced by 2,4-dinitrobenzene sulfonic acid (DNBS) injection. Two different protocols were applied. In the preventive protocol, ALCAR was administered daily starting 14 days to 24 h before the delivery of DNBS. In the interventive protocol, ALCAR was daily administered starting the same day of DNBS injection, and the treatment was continued for 14 days. In both cases, ALCAR significantly reduced the establishment of visceral hyperalgesia in DNBS-treated animals, though the interventive protocol showed a greater efficacy than the preventive one. The interventive protocol partially reduced colon damage in rats, counteracting enteric glia and spinal astrocyte activation resulting from colitis, as analyzed by immunofluorescence. On the other hand, the preventive protocol effectively protected enteric neurons from the inflammatory insult. These findings suggest the putative usefulness of ALCAR as a food supplement for patients suffering from IBDs.

A Broad Examination of Mental Health Literacy Among College Students in the United States.

High levels of mental health literacy (MHL) have been linked to the ability to correctly recognize certain problems as mental health issues, which then may lead to effective help-seeking behaviors. Most research on MHL has focused on a limited number of psychiatric diagnoses, using Australian samples. This study aimed to investigate various components of MHL in a large sample of undergraduate students in the United States. We conducted a vignette-based study with 843 undergraduate students. Six psychiatric diagnoses (and two "non-disordered" scenarios) were represented in distinct vignettes. Participants rated the severity of each vignette character's problem, the helpfulness of numerous treatment options, and the likelihood that different etiological factors contributed to the character's problem. Across all clinical vignettes, therapy/counseling was perceived to be the most helpful treatment. Participants rated "personal weakness/lack of willpower" as contributing the most to the alcohol use disorder (AUD) character's problems. Our hypothesis related to how perceptions of etiology may impact participants' perceptions of different types of treatment was partially supported for the depression character. When participants described the depression character as having a "psychological/mental health problem," they were more likely to perceive therapy/counseling as being helpful compared to medication. Participants recognized most of the psychiatric diagnoses as a mental health problem, acknowledged the seriousness of the presenting problems, and recommended effective help-seeking behavior. However, undergraduate U.S. students could benefit from increased MHL specifically related to AUD. [HLRP: Health Literacy Research and Practice. 2023;7(4):e207-e214.].

Safety Profile of Combination Treatment with Radiotherapy and Immune Checkpoint Blockades: A Multi-Institute Real World Experience

Immune checkpoint blockades have become widely used in recent years and have been approved as standard first-line and subsequent treatment for different types of malignancy. Combination treatment with irradiation also showed promising results in previous clinical studies. However, the treatment toxicities of this combination strategy have not been well defined. We hypothesized combination therapy does not add additional toxicities to immune checkpoint blockade alone. The study aims to investigate the safety profile of combination treatment with immune checkpoint blockade and radiotherapy in all type cancer patients. We conducted a population-based retrospective cohort study using the electronic medical records from three hospitals in Taiwan from January 01, 2015, to December 31, 2020. Baseline demographic data, laboratory examination, and treatment history were collected. Patients with radiotherapy exposure and immune checkpoint blockade were enrolled. The primary endpoint was all grade toxicities. All patients were monitored from the date of initiating immune checkpoint blockade or irradiation until the event of death, loss follow-up, or any defined adverse events. All data was managed using SAS v.9.4 software. Kaplan-Meier estimators and cox proportional hazard regression models were used to compute the safety profile of combination treatment. The statistical significance was considered with a p-value <0.05. A total of 305 cases, including 181 male patients and 124 female patients, received combination treatment with immune checkpoint blockade and radiotherapy with different time sequences. The most common cancer types are lung cancer (33.1%) followed by gastroesophageal cancer (16.7%) and hepatobiliary cancer (13.8%). The most common toxicities were arthralgia (25.9%), followed by enterocolitis (23.6%), and anemia (21%). 11 cases (3.6%) developed pneumonitis, 5 cases (1.6%) developed myocarditis, and 5 cases (1.6%) developed hepatitis during combination treatment. There is no evidence leads to additional toxicities based on current real-world experience. Severe immune related adverse events were not increased with this combination strategy compared to historical data. This warrant further prospective analysis.

Nutraceutical and Functional Properties of Lupin Protein Extracts Obtained via a Combined Ultrasonication and Microwave-Assisted Process

Lupin is an agriculturally economical plant seed. It is considered a rich source of protein for both humans and animals in several regions of the world. Lupin proteins also could act as an encapsulation agent for vitamins and other nutritional factors after extraction. This research evaluated the effects of microwave and ultrasound extraction methods on sweet and bitter lupin proteins intended to act as encapsulation agents. Two distinct sizes of nanoparticles were detected using different types of treatments. Bitter lupin was optimal for generating large nanoparticles, while sweet lupin was optimum for generating small nanoparticles. Ultrasound treatment of bitter lupin after microwave treatment hydrolyzed some of the β-conglutin, which suggested a method to reduce the potential allergic reactions caused by lupin products. The total phenolic content and alpha-amylase inhibitory effect of sweet and bitter lupin proteins was high. Furthermore, the microwave extraction method showed the benefits of reduced solvent consumption and less time. The current results showed a positive effect of the combined application of ultrasound-assisted and microwave-assisted processes on the nutraceutical and functional properties of lupin protein extracts.

A Review on the Antimutagenic and Anticancer Effects of Cysteamine.

Cancer is one of the leading causes of death worldwide. First-line treatments usually include surgery, radiotherapy, and/or systemic therapy. These methods can be associated with serious adverse events and can be toxic to healthy cells. Despite the new advances in cancer therapies, there is still a continuous need for safe and effective therapeutic agents. Cysteamine is an aminothiol endogenously synthetized by human cells during the degradation of coenzyme-A. It has been safely used in humans for the treatment of several pathologies including cystinosis and neurodegenerative diseases. Cysteamine has been shown to be a potent antimutagenic, anticarcinogenic, and antimelanoma in various in vitro and in vivo studies, but a review on these aspects of cysteamine's use in medicine is lacking in the current literature. The efficacy of cysteamine has been shown in vitro and in vivo for the treatment of different types of cancer, such as gastrointestinal cancer, pancreatic cancer, sarcomas, hepatocellular carcinoma, and melanoma, leading to the significant reduction of lesions and/or the increase of survival time. Although the mechanisms of action are not fully understood, possible explanations are (i) free radical scavenging, (ii) alteration of the tumor cell proliferation by affecting nucleic acid and protein synthesis or inhibition of DNA synthesis, and (iii) hormone regulation. In conclusion, regarding the high safety profile of cysteamine and the current literature data presented in this article, cysteamine might be considered as an interesting molecule for the prevention and the treatment of cancer. Further clinical studies should be performed to support these data in humans.

Polymer Gel for Water Shutoff in Complex Oil and Gas Reservoirs: Mechanisms, Simulation, and Decision-Making

Summary Gel treatment is often used for water shutoff in high water-cut oil or gas wells. Although the properties and usage methods of gel have been well documented by different investigators, gel treatment performance is not always satisfactory in field application, especially in oil or gas reservoirs with complex conditions, such as strong bottomwater reservoirs, high-permeability-ratio oil reservoirs, and fractured gas reservoirs. In this work, we attempt to improve gel treatment application in complex situations according to the causes of disappointing performance, including unreliable numerical simulation and the misapplication of experiences. We propose a new numerical simulation method of gel treatment mechanisms and verify it by improving the acquiring method of inaccessible pore volume (IAPV), dynamic polymer adsorption (DPA), and the simulation method of disproportionate permeability reduction (DPR). The performance and optimization measures of gel treatment in different types of complex oil and gas reservoirs are discussed extensively. Moreover, the dominant influencing factor of the gel treatment effect is determined by gray relation analysis to provide more direct and effective suggestions for field application. The results suggest that the improved access methods for IAPV and DPA can help to obtain more precise parameters easily to construct a numerical gel model. In addition, the new DPR simulation method, which considers oil or gas blocking, reduces the overestimation of gel DPR ability obtained with the conventional method. The misapplication of gel treatment experience probably causes a disappointing response, for example, gel treatment time had opposite influences on water shutoff in strong bottomwater reservoirs and high-permeability-ratio oil reservoirs, and the experience of reservoir thickness in oil reservoirs was not suitable for gas reservoirs. Furthermore, the major factors of gel treatment are varied in different oil and gas reservoirs, demonstrating that primary evaluation indicators for candidate wells are not permanent.

Management and nursing strategies for different patterns of adverse events in patients with urological cancer treated with immune checkpoint inhibitors.

This study aimed to explore the patterns of treatment-related adverse events (AEs) associated with immune checkpoint inhibitor (ICI) monotherapy and in combination with chemotherapy or tyrosine kinase inhibitor (TKI) therapy and to summarize the corresponding management and nursing strategies. A total of 69 patients with malignant urological tumors who received ICI treatment between June 2019 and October 2022 were retrospectively analyzed, and AEs that occurred during treatment were observed and reported. Based on the different types of treatment, the patients were divided into ICI monotherapy, ICI plus chemotherapy, and ICI plus TKI therapy groups. Subgroup analysis was performed. The incidence, distribution, and severity of AEs in the different subgroups were evaluated. A total of 138 AEs occurred in 69 patients, among which grade 1 plus 2, and grade 3 plus 4 AEs accounted for 78.99% and 21.01%, respectively. The incidence of AEs per patient in the ICI-TKI therapy group was the highest (3.75 times/person), followed by the ICI-chemotherapy (2.33 times/person) and ICI monotherapy (0.82 times/person) groups. Specific AEs, such as fatigue, nausea, and myelosuppression, were much more common in the ICI-gemcitabine and cisplatin group, whereas renal injury, skin lesions, and diarrhea were most common ones in the ICI-TKI group. Immune checkpoint inhibitors are new treatment options for advanced urological tumors and renal cell carcinoma. Distinctive AE patterns were observed among the different treatment groups. Therefore, strict and meticulous clinical management and nursing measures are required to ensure the safety of patients receiving ICI treatment.

Key Principles of Advanced Oxidation Processes: A Systematic Analysis of Current and Future Perspectives of the Removal of Antibiotics from Wastewater

In line with the development of industrial society, wastewater has caused multiple environmental problems. Contaminants of emerging concern (CECs) in water and wastewater are persistent, and for this reason they can cause serious problems for human health, animal health, and the whole environment. Therefore, it is absolutely necessary to apply efficient methods for the treatment of wastewater that has a high concentration of organic compounds. Over recent years, the prescribed and non-prescribed consumption of antibiotics has increased significantly worldwide. Large quantities of antibiotics are discharged into wastewater because of their incomplete absorption by living organisms. However, even small concentrations present in aquatic environments represent a major risk to human health and environment protection. This paper presents the main advantages and disadvantages of advanced oxidation processes, and the current state and new perspectives in the field of environment protection. This study summarizes data from the most recent specialized scientific literature that focuses on the topic of advanced oxidation processes, thus bringing all these aspects to the attention of researchers in a single work that adds comments and interpretations related to the presented processes. Advanced oxidation processes (AOPs) are often used in the treatment of different types of wastewater. AOPs are based on physicochemical processes that create significant structural changes in chemical species. The majority of antibiotics may be eliminated using physicochemical processes, such as photo-Fenton oxidation, photolysis, ozonation, electrooxidation, heterogeneous catalysis, and other bioprocesses. In comparison to conventional chemical processes, AOPs provide superior oxidation efficiency, ideal operating costs, and zero secondary pollutants.

Cancer Treatment: An Overview of Pulsed Electric Field Utilization and Generation

Patients diagnosed with cancer receive different types of treatments based on the type and the level of the tumour. An emerging treatment that differs from well-developed systematic therapies (i.e., Chemotherapy, Radiotherapy, and Immunotherapy) is Tumour Treating Field (TTF) treatment. Tumour behaviour under TTF treatment varies based on the electric field intensity; the process of exposing the tumour cells to an electric field is called electroporation. From the electrical perspective, the most efficient method for electroporation is to use a voltage pulse generator. Several pulse generator topologies have been introduced to overcome existing limitations, mitigate the drawbacks of classical generators, and provide more controllable, flexible, and portable solid-state voltage pulse generators. This paper provides a review of cancer treatment using TTF and highlights the key specifications required for efficient treatment. Additionally, potential voltage pulse generators are reviewed and compared in terms of their treatment efficacy and efficient use of electrical power.

Orthodontic treatment before restoration of dentition defects

Dentition defects damage the integrity of the dental arch, affecting smile esthetics and oral function. Compared to restorative treatment, pre-restoration orthodontic treatment overcomes the limitations of a single method, effectively avoiding excessive wear of natural teeth, reducing the number of units for restorative production to a certain extent, and potentially improving facial shape and occlusal relationship, which maximizes the therapeutic effect. This article explores the key points of pre-restoration orthodontic treatment for different types of dentition defects in terms of malocclusion manifestations, treatment objectives, treatment methods, and maintenance recommendations from the perspective of combined orthodontic restoration treatment.

First Report of Colletotrichum fructicola Causing Anthracnose on Punica granatum in China.

Punica granatum L. (Pomegranate), a deciduous shrub, is widely cultivated as a fruit tree and decorative plant in China. Its flowers, leaves, roots and fruit bark also has been widely used for the treatment of different types of human disease because of the high anti-inflammatory and antibacterial activitiy (Tehranifar et al. 2011). In October 2022, leaf spot symptoms were observed on P. granatum leaves in a landscaped area on the campus of Jiangxi Agricultural University (28.75°N, 115.83°E), Nanchang, Jiangxi Province, China. A survey of 40 P. granatum of 300 m2 found that up to 20% of the foliage was infected. Infection normally starts at the tip or edge of the leaves, with the initial symptoms of lesions usually being small dark brown spots (0.8 to 1.5 mm) that gradually expand into irregular spots with grayish white central parts, and brown margins (2.3 to 3.8 mm). Ten freshly infected leaves from three different plants were collected and cut into small slices, disinfected with 75% ethanol for 30 seconds followed by 5% NaClO for 1 minute, rinsed 3 times with sterile water, and then plated on potato dextrose agar (PDA) and incubated in the dark at 25°C. After 7 days, all incubated samples produced similar morphology of aerial mycelium pale grey, dense, and cottony. Conidia were hyaline, smooth-walled, cylindrical, aseptate and measuring 12.28 to 21.05 × 3.51 to 7.37 µm (n = 50). Morphological characteristics were consistent with those of Colletotrichum gloeosporioides species complex (Weir et al. 2012; Park et al. 2018). For molecular identification, we used two representative isolates (HJAUP CH005 and HJAUP CH006) for genomic DNA extraction and amplification, using primers for ITS4/ITS5 (White et al. 1990), Bt2a/Bt2b, GDF1/GDR1, ACT-512F/ACT-783R and CL1C /CL2C (Weir et al. 2012), respectively. The sequenced loci (GenBank accession nos. ITS: OQ625876, OQ625882; TUB2: OQ628072, OQ628073; GAPDH: OQ628076, OQ657985; ACT: OQ628070, OQ628071; CAL: OQ628074, OQ628075) exhibited 98 to 100% homology with corresponding sequences of C. fructicola strains (GenBank accession nos. OQ254737, MK514471, MZ133607, MZ463637, ON457800, respectively). A phylogenetic tree was constructed using the maximum-likelihood method in MEGA7.0 for the sequences of five concatenated genes (ITS-TUB2-GAPDH-ACT-CAL). Our two isolates clustered together with three strains of C. fructicola with 99% bootstrap support values in the bootstrap test (1000 replicates). The isolates were identified as C. fructicola based on morpho-molecular approach. The pathogenicity of HJAUP CH005 was tested indoors by inoculating the wounded leaves of four healthy P. granatum plants. Four leaves from each of two healthy plants were punctured with flamed needles and sprayed with a spore suspension (1 × 106 spores/ml), and four wounded leaves from each of other two plants were inoculated with mycelial plugs (5 × 5 mm3), respectively. Mock inoculations with sterile water and PDA plugs on four leaves each were used as controls. Treated plants were incubated in a greenhouse at high relative humidity, 25°C, and a photoperiod of 12 h. After 4 days, typical anthracnose symptoms similar to natural infection appeared on the inoculated leaves, whereas the control leaves remained asymptomatic. Based on morphological and molecular data, the fungus isolated from the inoculated and symptomatic leaves was identical to the original pathogen, confirming Koch's hypothesis. Anthracnose caused by C. fructicola has been reported to affect numerous plants worldwide, including cotton, coffee, grapes and citrus (Huang et al. 2021; Farr and Rossman 2023). This is the first report of C. fructicola causing anthracnose on P. granatum in China. This disease seriously affects the quality and yield of the fruit and should be of wide concern to us.

Rehabilitation on cerebellar ataxic patients with multiple sclerosis: A systematic review.

Multiple Sclerosis (MS) is a chronic inflammatory, autoimmune disease of the Central Nervous System with a vast spectrum of clinical phenotypes. A major aspect of its clinical presentation is cerebellar ataxia where physiotherapy and treatment modalities play a significant role on its management. This systematic review aims to investigate the physiotherapeutic rehabilitation techniques regarding the management of cerebellar ataxia due to MS and secondary to stratify each protocol as part of a multi structural personalized rehabilitation approach based on the gravity of the symptoms. A Pubmed Medline, Scopus and Web of Science research was performed using the corresponding databases. The results were screened by the authors in pairs. In our study, six (6) non-pharmacological interventional protocols, 3 Randomized Controlled Trials and 3 pilot studies, were included with a total of 145 MS patients. Physiotherapeutic techniques, such as NDT-Bobath, robotic and visual biofeedback re-education protocols and functional rehabilitation techniques were included. In most cases cerebellar ataxic symptoms were decreased post-treatment. The overall quality of the studies included was of moderate level (level B). Rehabilitation in cerebellar ataxia due to MS should be based on multicentric studies with the scope of adjusting different types of treatments and physiotherapeutic techniques based on the severity of the symptom.

Barriers and Enablers for Implementation of an Artificial Intelligence-Based Decision Support Tool to Reduce the Risk of Readmission of Patients With Heart Failure: Stakeholder Interviews.

Artificial intelligence (AI) applications in health care are expected to provide value for health care organizations, professionals, and patients. However, the implementation of such systems should be carefully planned and organized in order to ensure quality, safety, and acceptance. The gathered view of different stakeholders is a great source of information to understand the barriers and enablers for implementation in a specific context. This study aimed to understand the context and stakeholder perspectives related to the future implementation of a clinical decision support system for predicting readmissions of patients with heart failure. The study was part of a larger project involving model development, interface design, and implementation planning of the system. Interviews were held with 12 stakeholders from the regional and municipal health care organizations to gather their views on the potential effects implementation of such a decision support system could have as well as barriers and enablers for implementation. Data were analyzed based on the categories defined in the nonadoption, abandonment, scale-up, spread, sustainability (NASSS) framework. Stakeholders had in general a positive attitude and curiosity toward AI-based decision support systems, and mentioned several barriers and enablers based on the experiences of previous implementations of information technology systems. Central aspects to consider for the proposed clinical decision support system were design aspects, access to information throughout the care process, and integration into the clinical workflow. The implementation of such a system could lead to a number of effects related to both clinical outcomes as well as resource allocation, which are all important to address in the planning of implementation. Stakeholders saw, however, value in several aspects of implementing such system, emphasizing the increased quality of life for those patients who can avoid being hospitalized. Several ideas were put forward on how the proposed AI system would potentially affect and provide value for patients, professionals, and the organization, and implementation aspects were important parts of that. A successful system can help clinicians to prioritize the need for different types of treatments but also be used for planning purposes within the hospital. However, the system needs not only technological and clinical precision but also a carefully planned implementation process. Such a process should take into consideration the aspects related to all the categories in the NASSS framework. This study further highlighted the importance to study stakeholder needs early in the process of development, design, and implementation of decision support systems, as the data revealed new information on the potential use of the system and the placement of the application in the care process.