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Six isomeric molecules, featuring a minimum of three fluorine atoms on either the benzoyl or aniline side, have been synthesized, crystallized and characterized through single crystal X-ray diffraction (SCXRD). In addition, two other compounds, containing six fluorine atoms, three on each of the benzoyl and aniline side of the benzanilide scaffold have also been characterized through SCXRD. This current study aims to augment the capacity for hydrogen bond formation, specifically involving organic fluorine, by elevating the acidity of the involved hydrogens through the incorporation of highly electronegative fluorine atoms, in the presence of strong N-H×××O=C H-bonds. Lattice energy calculations and assessment of intermolecular interaction energies elucidate the contributions of electrostatics and dispersion forces in crystal packing. The topological analysis of the electron density is characterized by the presence of bond critical points (BCPs) involving C-H×××F and F×××F contacts, thus establishing the bonding nature of these interactions which play a crucial role in the crystal packing in addition to the presence of traditional N-H×××O=C H-bonds., (© 2024 Wiley‐VCH GmbH.)

We investigated the hemotoxic effects of three North American pit vipers in healthy human donor blood. Using experiments focusing on platelet and red blood cell activity, we found differential effects of these venoms on these cellular components. Platelet aggregation was most induced by C. adamanteus. Platelet activation was highest with C. atrox. Red blood cells had calcium expression and erythrocyte formation most induced by C. adamanteus and A. piscivorus. These results demonstrate the complex interplay of individual cellular effects with clinical presentations seen in envenomings from these species., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Samuel Francis reports financial support was provided by BTG Specialty Pharmaceuticals. Luke Welton reports a relationship with BTG Specialty Pharmaceuticals that includes: employment. Richard Straight reports a relationship with BTG Specialty Pharmaceuticals that includes: employment. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Arachnoid cysts can be intra-cranial or along the spinal cord. Intracranial arachnoid cyst is a very rare finding, trauma being the leading case of it. It is extremely rare for the development of intra-diploic arachnoid cyst without a traumatic history. We present a case of an intra-diploic arachnoid cyst communicating with the greater wing of the sphenoid and in close proximity to the cavernous sinus in a known case of Wilson disease for 22 years. Due to its low incidence, there is a gap in the knowledge and discussion of this cystic lesion, its pathophysiology and management, which are discussed in this case report., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Chiral state transfer along closed loops in the vicinity of an exceptional point is one of the many counterintuitive observations in non-Hermitian physics. The application of this property beyond proof-of-principle in quantum physics, is an open question. In this work, we demonstrate chiral state conversion between singlet and triplet Bell states through fully quantum Liouvillian dynamics. Crucially, we demonstrate that this property can be used for the chiral production of Bell states from separable states with a high fidelity and for a large range of parameters. Additionally, we show that the removal of quantum jumps from the dynamics through postselection can result in near-perfect Bell states from initially separable states. Our work presents the first application of chiral state transfer in quantum information processing and demonstrates a novel way to control entangled states by means of dissipation engineering.

The squid, Sepioteuthis lessoniana, is a remarkable fishery product which is exported by many nations for use in industrial production or human consumption. This study focused on the synthesis of silver nanoparticles (AgNPs) from squid ink (SI) and its wide range of applications. The formation of the nanoparticles was confirmed through UV-Visible spectroscopy, FTIR, XRD, SEM with EDX, DLS, and zeta potential analysis. The results showed a strong absorbance peak at 407 nm, the presence of various functional groups, a nanocrystalline structure with a crystalline size of 17.56 nm, spherical-shaped particles with an average size of 76 nm, and the presence of the highest % mass of Ag and uniformly dispersed particles, respectively. The bioactivity of the synthesized squid ink silver nanoparticles was analyzed through antibacterial, antioxidant, anticancer, and toxicity studies. The dye degradation assay was also analyzed as a means of wastewater treatment for different industrial dyes. The antibacterial activity showed the highest zone of inhibition of 24 mm at a concentration of 100 μg/ml against Escherichia coli, followed by other tested strains. The nitric oxide radical scavenging assay showed the highest antioxidant activity (92%) at a concentration of 100 μg/ml. The cytotoxic ability of SI-AgNPs against the MDA-MB-231 breast cancer cell line revealed an IC 50 value of 4.52 μg/ml. The toxicity study revealed a dose and time-dependent activity with the LC 50 value of 5.090 and 3.303 mg/ml for 24 and 48 h, respectively. The successful degradation of dyes by SI-AgNPs is attributed to the cooperative action of the electron relay system with Ag as a catalyst and SI as a catalytic support. These findings indicate that SI-AgNPs are a novel potential product that should be further studied to improve its pharmacological, biomedical, and environmental applications., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Competing Interests: Competing interests: None declared.

Ghosal hematodiaphyseal dysplasia (GHDD) is an autosomal recessive disorder characterized by diaphyseal dysplasia of long bones, bone marrow fibrosis, and steroid-responsive anemia. Patients with this disease have a mutation in the thromboxane-AS1 (TBXAS1) gene located on chromosome 7q33.34. They present with short stature, varying grades of myelofibrosis, and, hence cytopenias. Patients with the above presentation were evaluated through clinical presentation, X-ray of long bones, bone marrow examinations, and confirmed by genetic testing. In this article, we present two cases: The first case is a 3-year-old boy who presented with progressive pallor and ecchymotic patches for a year. On investigation, he had bicytopenia and bone marrow fibrosis. His anemia was steroid responsive and was finally diagnosed as GHDD. The second case is a 20-month-old girl who presented with blood in stools, developmental delay, anemia, and increased intensity of long bones on X-ray. Since other investigations were normal, suspicion of GHDD was raised, and a genetic workup was conducted which suggested mutation in TBXAS1 gene, confirming the diagnosis of GHDD. Children with refractory anemia and cortical thickening on skeletogram should always be evaluated for dysplasias. Timely treatment with steroids reduces transfusion requirements and halts bone damage, thus leading to better growth and improved quality of life., (© The Author(s) [2024]. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Purpose: The incidence of unresolved postoperative reflux after bariatric surgery varies considerably. Consistent perioperative patient characteristics predictive of unresolved reflux remain unknown. We leverage our institution's comprehensive preoperative esophageal testing to identify predictors of postoperative reflux., Materials and Methods: We performed a single-center retrospective review of adult patients with preoperative reflux symptoms who underwent either vertical sleeve gastrectomy (VSG) or Roux-en-Y gastric bypass (RYGB) from 2015 to 2021. All patients had pH and high-resolution manometry preoperatively. Predictors of postoperative unresolved reflux at 1 year were explored via Fisher's exact test, Kruskal Wallis test, and univariate logistic regression., Results: Unresolved reflux was higher in patients undergoing VSG (n = 60/129,46.5%) vs. RYGB (n = 19/98, 19.4%). Median DeMeester scores were higher (22 vs. 13, p = .07) along with rates of ineffective esophageal motility (IEM) (31.6 vs. 8.9%, p = .01) in the 19 (19.3%) patients with unresolved postoperative reflux after RYGB compared to the resolved RYGB reflux cohort. Sixty (46.5%) of VSG patients had unresolved postoperative reflux. The VSG unresolved reflux cohort had similar median DeMeester and IEM incidence to the resolved VSG group but more preoperative dysphagia (13.3% vs. 2.9%, p = .04) and higher preoperative PPI use (56.7 vs. 39.1%, p = .05). In univariate analysis, only IEM was predictive of unresolved reflux after RYGB (OR 4.74, 95% CI 1.37, 16.4)., Conclusion: Unresolved reflux was higher after VSG. Preoperative IEM predicted unresolved reflux symptoms after RYGB. In VSG patients, preoperative dysphagia symptoms and PPI use predicted unresolved reflux though lack of correlation to objective testing highlights the subjective nature of symptoms and the challenges in predicting postoperative symptomatology., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Invasive ductal carcinoma is the most common type of breast cancer and can affect any age group, predominantly females older than 55 years of age. We present a case of a female in her mid-30s complaining of a fungating mass in the upper outer quadrant of the left anterior chest wall. On workup of the patient, it was histopathologically found that the patient was affected by infiltrating ductal carcinoma of the left breast, which was causing tumoral thrombosis of the left axillary vein. Also, thrombosis of the right axillary vein, bilateral brachiocephalic veins, and superior vena cava with a focal hepatic hotspot sign were appreciated on contrast-enhanced computed tomography scan. No such case of tumoral thrombosis of the axillary vein causing superior vena cava obstruction has been reported in recent literature., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Hemifacial microsomia (HFM) presents a complex congenital anomaly characterized by the asymmetric underdevelopment of facial structures, predominantly affecting the ear, mouth, and mandible on one side of the face. This case study examines the intricacies of HFM through the presentation of a 23-year-old female with congenital deformities of the left ear and mandibular hypoplasia. Clinical and radiological evaluations revealed significant facial malformations, including mandibular hypoplasia, left temporomandibular joint fusion, and maxillary abnormalities, confirming the diagnosis of HFM. Management of HFM necessitates a multidisciplinary approach involving otolaryngologists, maxillofacial surgeons, orthodontists, and audiologists to comprehensively address functional and aesthetic concerns. Early diagnosis and intervention, along with psychosocial support, are essential for optimizing outcomes and improving the quality of life for individuals with HFM., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Khandelwal et al.)

Aim: To assess the oral health status of the Sevayats of Sakhigopal temple, Puri, Odisha., Methodology: An assessment of the oral health status of 111 Sevayats at the Sakhigopal temple in Puri was carried out using a cross-sectional survey. The World Health Organization oral health assessment form for adults (2013) was used to collect data. Chi-square test and one-way analysis of variance were the statistical tests used for the investigation using Statistical Package for the Social Sciences 27 version. When the P value was less than 0.05, it was deemed statistically significant., Results: The mean DMFT of all the participants was 3.70 ± 1.71. The prevalence of caries was 91%. Bleeding and periodontal pocket were present in 82.9% and 83.8% of Sevayats, respectively., Conclusion: There was a higher prevalence of dental caries and periodontal disease among the subjects., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Pharmacy and Bioallied Sciences.)

Competing Interests: There are no conflicts of interest.

Objective: The aim of the study is to identify appropriate definitions and patient-reported outcome measures (PROMs) for each of the eight core outcomes previously selected for genitourinary symptoms associated with menopause: pain with sex, vulvovaginal dryness, vulvovaginal discomfort or irritation, discomfort or pain when urinating, change in most bothersome symptom, distress, bother or interference of genitourinary symptoms, satisfaction with treatment, and side effects., Methods: We conducted a systematic review to identify possible definitions and PROMs, including their measurement properties. Identified definitions and relevant PROMs with acceptable measurement properties were entered into an international consensus process involving 28 participants from 10 countries to achieve final recommendations for each core outcome., Results: A total of 87 publications reporting on 34 PROMs were identified from 21,207 publications screened. Of these 34 PROMs, 29 were not considered to sufficiently map onto the core outcomes, and 26 of these also had insufficient measurement properties. Therefore, only five PROMs corresponding to two core outcomes were considered for recommendation. We recommend the PROMIS Scale v2.0 - Sexual Function and Satisfaction: Vaginal Discomfort with Sexual Activity to measure the outcome of "pain with sexual activity" and the Day-to-Day Impact of Vaginal Aging (DIVA) Questionnaire to measure "distress, bother or interference" from genitourinary symptoms. Six definitions of "side effects" were identified and considered. We recommend that all trials report adverse events in study participants, which is a requirement of Good Clinical Practice., Conclusions: Suitable PROMs and definitions were identified to measure three of eight core outcomes. Because of the lack of existing measures, which align with the core outcomes and have evidence of high-quality measurement properties, future work will focus on developing or validating PROMs for the remaining five core outcomes., Competing Interests: Financial disclosure/conflicts of interest: M.G. received past funding from Effik SA. M.P. received institutional funding from University of Melbourne (Internal Grant Schemes), Royal Women's Hospital (Internal grant scheme), and Cancer Council NSW Project Grant RG 21-06, Centre for Research Excellence in Women's Health in Reproductive Life (CREWHiRL) Seed Funding and Project Support Grant, NHMRC (APP1163202), and Royal Children's Hospital Foundation. She received past funding from FertilityIQ webinar honorarium. She has received fee registration fees as an invited speaker by the Pacific Society of Reproductive Medicine 2023 Conference and had subsidized flights and accommodations as an invited speaker for the European Society of Human Reproduction and Embryology 2022 Conference. She was also given free registration as an invited speaker for the Annual Scientific Meeting of Breast Cancer Trials 2021. D.A. has consulted for Evestra, Exeltis, Lupin, Mithra, ObsEva, and TherapeuticsMD, received industry support for research from AbbVie, Mithra, Myovant, and ObsEva, and has stock holdings in Agile Therapeutics and InnovaGyn, Inc. R.B. was named CI on two grants to Monash University, one from the National Health and Medical Research Council of Australia and one from the Medical Research Future Fund for work not related to the current publication. M.C. has been paid for developing and delivering educational presentations for AllianceChicago, wrote a White Paper on GSM for Materna (no financial reimbursement), and is a member of The Menopause Society Board of Trustees, FDA BRUDAC Committee, and Grand Rounds Presenter University of Indians. S.R.D. reports honoraria from BesinsHealthcare, Mayne Pharma, Health Ed, BioSyent, Lawley Pharmaceuticals, Abbott Laboratories, and Que Oncology. She has served on advisory boards for Mayne Pharm, Astellas Pharmaceuticals, Theramex, Abbott Laboratories, and Gedeon Richterand and has been an institutional investigator for QueOncology and Ovoca Bio. L.K. has lectured and/or acted in an advisory capacity for Gedeon Richter, Dr. KADE Besins and Mithra. C.M.M. has served as a consultant for Scynexis and Ferring Pharmaceuticals, receives research funding from Scynexis, and receives Royalties from UpToDate. R.E.N. has ongoing relationships with Abbott, Astellas, Bayer HealthCare AG, Besins Healthcare, Exeltis, Fidia, Gedeon Richter, HRA Pharma, Merck Healthcare, Novo Nordisk, Shionogi Limited, Theramex, and Viatris. N.P. has lectured and/or acted in an advisory capacity for Abbott, Bayer, Besins, Gedeon Richter, Kora, Lawley, Mithra, Mylan, Novo Nordisk, Roche Diagnostics, SeCur, Shionogi, Theramex, and Viatris. S.R. has lectured and/or acted in an advisory capacity or conducted studies for Abbott, Bayer, Gedeon Richter, Mylan, Amgen, UCB, Theramex, and Viatris. J.S. receives grant/research support from AbbVie, Inc., Bayer Healthcare LLC., Dare´ Bioscience, Ipsen, Mylan/Viatris Inc., Myovant Sciences, and Sebela Pharmaceuticals Inc. He acts as a consultant is on advisory boards for Bayer HealthCare Pharmaceuticals Inc., Besins Healthcare, California Institute of Integral Studies (CIIS), Dare´ Bioscience, Femasys Inc., Khyria, Madorra Pty Ltd., Mayne Pharma, Inc., and Vella Bioscience Inc. He serves on speaker's bureaus for Astellas Pharma, Inc., Mayne Pharma, Inc., Myovant Sciences, Inc., Pfizer Inc., Pharmavite LLC., and Scynexis Inc. He is a stockholder (direct purchase) of Sermonix Pharmaceuticals. P.S. has received fees for giving educational presentations, and participating in advisory boards and conducting research by Besins Healthcare, Astellas, Mylan, Labatec, Exeltis, Effik, Theramex, and Gedeon-Richter. A.J.V. has received fees for presentations and participation in an advisory board from Besins and Theramex. W.W. has received institutional support with an unrestricted grant from Pfizer and sits on the advisory boards of Pfizer, Lupin, and Biosyent. She has received fees for educational presentations for Lupin, Astellas, Bayer and Pfizer, and Biosyent. She is currently president of the Canadian Menopause Society and a Board Member of the International Menopause Society. M.H. has received funding from Madorra for a study of a device to manage GU symptoms. All other authors report no conflicts of interest., (Copyright © 2024 by The Menopause Society.)

Objective: The aim of the study is to identify suitable definitions and patient-reported outcome measures (PROMs) to assess each of the six core outcomes previously identified through the COMMA (Core Outcomes in Menopause) global consensus process relating to vasomotor symptoms: frequency, severity, distress/bother/interference, impact on sleep, satisfaction with treatment, and side effects., Methods: A systematic review was conducted to identify relevant definitions for the outcome of side-effects and PROMs with acceptable measurement properties for the remaining five core outcomes. The consensus process, involving 36 participants from 16 countries, was conducted to review definitions and PROMs and make final recommendations for the measurement of each core outcome., Results: A total of 21,207 publications were screened from which 119 reporting on 40 PROMs were identified. Of these 40 PROMs, 36 either did not adequately map onto the core outcomes or lacked sufficient measurement properties. Therefore, only four PROMs corresponding to two of the six core outcomes were considered for recommendation. We recommend the Hot Flash Related Daily Interference Scale to measure the domain of distress, bother, or interference of vasomotor symptoms and to capture impact on sleep (one item in the Hot Flash Related Daily Interference Scale captures interference with sleep). Six definitions of "side effects" were identified and considered. We recommend that all trials report adverse events, which is a requirement of Good Clinical Practice., Conclusions: We identified suitable definitions and PROMs for only three of the six core outcomes. No suitable PROMs were found for the remaining three outcomes (frequency and severity of vasomotor symptoms and satisfaction with treatment). Future studies should develop and validate PROMs for these outcomes., Competing Interests: Financial disclosure/conflicts of interest: V.P. received past funding from Sigvaris AG. M.P. received institutional funding from University of Melbourne (Internal Grant Schemes), Royal Women's Hospital (Internal grant scheme), and Cancer Council NSW Project Grant RG 21-06, Centre for Research Excellence in Women's Health in Reproductive Life (CREWHiRL) Seed Funding and Project Support Grant, NHMRC (APP1163202), and Royal Children's Hospital Foundation. She received past funding from FertilityIQ webinar honorarium. She has received fee registration fees as an invited speaker by the Pacific Society of Reproductive Medicine 2023 Conference and had subsidized flights and accommodations as an invited speaker for the European Society of Human Reproduction and Embryology 2022 Conference. She was also given free registration as an invited speaker for the Annual Scientific Meeting of Breast Cancer Trials 2021. D.A. has consulted for Evestra, Exeltis, Lupin, Mithra, ObsEva, and TherapeuticsMD, received industry support for research from AbbVie, Mithra, Myovant, and ObsEva, and has stock holdings in Agile Therapeutics, InnovaGyn, Inc. N.A. receives ongoing institutional funding from the National Cancer Institute. J.C. is owner of JSCarpenter, LLC which received scale licensing fees from Mapi Research Trust (2022), consulting fees from the University of Wisconsin (spring 2022), and consulting fees from Simumetrix SMX Health (spring 2022). M.C. has been paid for developing and delivering educational presentations for Alliance Chicago, received fees for an educational video and speaking engagements with Fertility IQ, wrote a White Paper on GSM for Materna (no financial reimbursement), and is a member of The Menopause Society Board of Trustees. M.D. receives current institutional funding from National Institute of Health Research. She serves as a chief investigator on POISE study (research relevant to HRT) and a chief investigator for BLUSH study (research on treatment of menopause). She received past institutional funding from Best Practice & Research Clinical Obstetrics & Gynaecology as editor of volume on menopause management published 2022. She is an elected member of the Medical Advisory Council of the British Menopause Society, is a member of the ESHRE guideline update group on Premature Ovarian Insufficiency, is a member of the British Endocrine Society working group producing clinical guidelines on estrogen treatment, and is a member of the British Gynaecological Cancer Society working group producing clinical guidelines on HRT. T.H. received past funding from Besins and Astellas. M.H. receives ongoing funding from Rightsteps and current funding from Hello Therapeutics. L.K. has lectured and/or acted in an advisory capacity for Gedeon Richter, Dr. KADE Besins and Mithra. P.M. has received compensation as a member of the scientific advisory board of Astellas, Bayer, and Johnson & Johnson; compensation from AbbVie and Pfizer for consulting; and serves as a member of the scientific advisory board and has/had equity in Alloy, Estrigenix, and MidiHealth. She has received speaking fees and travel support from Mithra. R.E.N. has ongoing relationships with Abbott, Astellas, Bayer HealthCare AG, Besins Healthcare, Exeltis, Fidia, Gedeon Richter, HRA Pharma, Merck Healthcare, Novo Nordisk, Shionogi Limited, Theramex, and Viatris. N.P. has lectured and/or acted in an advisory capacity for Abbott, Lawley, Mithra, Novo, SeCur, and Viatris. S.R. has lectured and/or acted in an advisory capacity or conducted studies for Abbott, Bayer, Gedeon Richter, Mylan, Amgen, UCB, Theramex, and Viatris. J.S. receives grant/research support from AbbVie, Inc., Bayer Healthcare LLC., Dare´ Bioscience; Ipsen, Mylan/Viatris Inc., Myovant Sciences, Sebela Pharmaceuticals Inc. He acts as a consultant is on advisory boards for Bayer HealthCare Pharmaceuticals Inc., Besins Healthcare, California Institute of Integral Studies (CIIS), Dare´ Bioscience, Femasys Inc., Khyria, Madorra Pty Ltd., Mayne Pharma, Inc., and Vella Bioscience Inc. He serves on speaker's bureaus for Astellas Pharma, Inc., Mayne Pharma, Inc., Myovant Sciences, Inc., Pfizer Inc., Pharmavite LLC., Scynexis Inc. He is a stockholder (direct purchase) of Sermonix Pharmaceuticals. P.S. has received fees for giving educational presentations, participating in advisory boards and conducting research by Besins Healthcare, Astellas, Mylan, Labatec, Exeltis, Effik, Theramex, and Gedeon-Richter. A.J.V. has received fees for presentations and participation in an advisory board from Besins and Theramex. W.W. has received institutional support with an unrestricted grant from Pfizer and sits on the advisory boards of Pfizer, Lupin, and Biosyent. She has received fees for educational presentations for Lupin, Astellas, Bayer and Pfizer, and Biosyent. She is a board member of the International Menopause Society and the President of the Canadian Menopause Society. M.H. has received funding from Madorra for a study of a device to manage GU symptoms and is a clinical expert for the NICE Menopause Guidelines. J.T.G. is a speaker for NurtureMed Pharma, Bayer Phils, Corbridge Phils, and Zuellig Pharma. P.S. has a research consultancy relationship with Chugai Pharmaceuticals. H.J. receives grant funding from the National Institutes of Health, Merck, and Pfizer and is a consultant to Bayer, Merck, and Hello Therapeutics. She receives in kind support from Sage to her institution (drug provided to support NIH-funded trial), funds from Bayer support a pilot grant program she lead within an NIH-funded Center grant. Her spouse is employed by Arsenal Biosciences and receives equity from Merck Research Labs. N.J. is on the advisory board of Vira Health, UK. All other authors report no conflicts of interest., (Copyright © 2024 by The North American Menopause Society.)

Pollen, a significant natural bioaerosol and allergen for sensitized individuals, is expected to increase in prevalence due to climate change. Mitigating allergy symptoms involves avoiding pollen exposure and pre-medication, emphasizing the importance of real-time knowledge of localized ambient air pollen concentrations. Laser diode Optical Particle Counters (OPCs) are commonly used for monitoring particle number concentrations in ambient air. This study explores the hypothesis that OPCs can monitor pollen but may struggle to distinguish them from other particles. We aimed to isolate the pollen signal from collective particle number concentrations using source apportionment models, specifically Positive Matrix Factorization (PMF) and Unmix, applied to multiple bin OPC data. The pollen signals isolated using PMF show slightly better correlation values than those isolated using Unmix. PMF-derived pollen signals exhibit strong correlations with Holoptelea (r = 0.64) and total pollen (r = 0.54) concentrations, while a moderate correlation is observed with Poaceae (r = 0.47). Exclusion of low pollen events strengthens correlations for Holoptelea and Poaceae to very strong (r = 0.87) and strong (r = 0.67), respectively. Although both model types effectively isolate the pollen signal, metrics suggest that Unmix has the potential for more accurate predictions of both moderate and extreme pollen events simultaneously. The Mean Absolute Error (MAE), Root Mean Square Error (RMSE), and Relative Root Mean Square Error (RRMSE) metrics for Holoptelea are 46.2 grains m -3 , 72.4 grains m -3 , and 15.3; for Poaceae, 3.9 grains m -3 , 4.9 grains m -3 , and 13.0; and for total pollen, 43.5 grains m -3 , 72.1 grains m -3 , and 14.1. This study represents a significant development in the use of source apportionment models and ambient OPCs for real-time pollen monitoring, offering a cost-effective alternative to conventional automated pollen sensors. Despite challenges, the proposed methodology provides a practical and accessible solution for pollen monitoring, contributing to the advancement of bioaerosol monitoring technologies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Entanglement engines are autonomous quantum thermal machines designed to generate entanglement from the presence of a particle current flowing through the device. In this work, we investigate the functioning of a two-qubit entanglement engine beyond the steady-state regime. Within a master equation approach, we derive the time-dependent state, the particle current, as well as the associated current correlation functions. Our findings establish a direct connection between coherence and internal current, elucidating the existence of a critical current that serves as an indicator for entanglement in the steady state. We then apply our results to investigate kinetic uncertainty relations (KURs) at finite times. We demonstrate that there is more than one possible definition for KURs at finite times. Although the two definitions agree in the steady-state regime, they lead to different parameter ranges for violating KUR at finite times.

Background: Dental implantology is continually evolving in its quest to discover new biomaterials to improve dental implant success rates. The study explored the potential of innovative biomaterials for dental implant surfaces, including titanium-zirconium (Ti-Zr) alloy, hydroxyapatite-coated titanium (HA-Ti), and porous polyetheretherketone (PEEK), in comparison to conventional commercially pure titanium (CP Ti)., Materials and Methods: A total of 186 samples were harvested for the analysis. Biomaterials were thoroughly evaluated in terms of surface topography, chemical composition, biocompatibility, mechanical properties, osseointegration performance, and bacterial adhesion. Study methods and techniques included scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS), cell culture variants, tensile tests, hardness measurements, histological analysis, and microbiological testing., Results: Surface topography examination showed significant disparities between the biomaterials: Ti-Zr had a better roughness of 1.23 μm, while HA-Ti demonstrated a smoother surface at 0.98 μm. Chemical composition evaluation indicated the presence of a Ti-Zr alloy in Ti-Zr, calcium-phosphorus richness in HA-Ti, and high titanium amounts in CP Ti. The mechanical properties assessment showed that Ti-Zr and CP Ti had good tensile strengths of 750 MPa and 320 HV. In addition, bacterial adhesion tests showed low propensities for Ti-Zr and HA-Ti at 1200 and 800 cfu/cm 2 , respectively., Conclusion: Ti-Zr and HA-Ti performed better than the other biomaterials in surface topography and mechanical properties and against bacterial adhesion. This study emphasizes that multi-parameter analysis is critical for clinical decision-making, allowing for the selection of the currently available biomaterial, which could be conducive to the long-term success of the implant., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethical Committee of Sibar Institute of Dental Sciences issued approval SIDS/IEC/41/2021. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Lakshmi Mounika et al.)

Many studies have focused on the overall oral health of people with visual impairment, but there is a dearth of studies on the barriers to accessing dental healthcare services among institutionalized visually impaired people. Therefore, the current study aims to assess the barriers to accessing dental healthcare services among institutionalized visually impaired people., Methods: A qualitative study design was conducted over the course of 10 months among institutionalized visually impaired individuals. A semi-structured interview was conducted among the participants. Interviews were audio-recorded, transcribed, translated, and qualitatively analyzed using MAXQDA software, version 22.0 (VERBI Software, Berlin)., Results: A total of 20 participants participated in the study. Three levels were used to classify the investigated barriers: the individual's level, which pertains to the obstacles they encountered in receiving oral health care and their viewpoints on the way that care is provided; the interpersonal degree and the system level, in order to determine the broader components and their impact., Conclusion: This study gives insight into the problems people have in assessing the dental services and facilities available. Three levels were used to identify the barriers among the study participants. Six themes emerged in the study that described their problems, which affected their mental health directly., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Jena et al.)

Introduction: Amyand's hernia, a rare condition where the appendix becomes lodged in the inguinal canal, poses diagnostic challenges due to its varied clinical presentations and lack of distinctive radiological features. This case underscores the importance of early detection and comprehensive diagnostic evaluation., Case Presentation: A 30-year-old male presented with a 2-year history of right inguinoscrotal swelling, culminating in agonizing symptoms and irreducible masses over the inguinoscrotal area. Despite the absence of significant medical history, diagnostic imaging confirmed a complete right inguinoscrotal hernia and bilateral hydrocele with internal echoes., Clinical Discussion: The case illustrates the difficulties in preoperative diagnosis of Amyand's hernia, emphasizing the reliance on imaging modalities and clinical assessment. Successful surgical intervention involving appendectomy and hernioplasty highlights the necessity for prompt diagnosis and management., Conclusion: This case exemplifies the challenges and complexities associated with Amyand's hernia, emphasizing the importance of early recognition and comprehensive surgical planning. Moving forward, increased clinical vigilance and awareness are essential to ensure optimal patient outcomes in cases of inguinoscrotal pathology., Competing Interests: The authors declare no conflicts of interest relevant to this article. No financial or nonfinancial interests have influenced the development of this work.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

We present the newly isolated Streptomyces sungeiensis SD3 strain as a promising microbial chassis for heterologous production of secondary metabolites. S. sungeiensis SD3 exhibits several advantageous traits as a microbial chassis, including genetic tractability, rapid growth, susceptibility to antibiotics, and metabolic capability supporting secondary metabolism. Genomic and transcriptomic sequencing unveiled the primary metabolic capabilities and secondary biosynthetic pathways of S. sungeiensis SD3, including a previously unknown pathway responsible for the biosynthesis of streptazone B1. The unique placement of S. sungeiensis SD3 in the phylogenetic tree designates it as a type strain, setting it apart from other frequently employed Streptomyces chassis. This distinction makes it the preferred chassis for expressing biosynthetic gene clusters (BGCs) derived from strains within the same phylogenetic or neighboring phylogenetic clade. The successful expression of secondary biosynthetic pathways from a closely related yet slow-growing strain underscores the utility of S. sungeiensis SD3 as a heterologous expression chassis. Validation of CRISPR/Cas9-assisted genetic tools for chromosomal deletion and insertion paved the way for further strain improvement and BGC refactoring through rational genome editing. The addition of S. sungeiensis SD3 to the heterologous chassis toolkit will facilitate the discovery and production of secondary metabolites.

Overview and Significance: Pulmonary sequestration (PS) is a rare congenital anomaly characterized by aberrant formation of nonfunctional lung tissue with anomalous systemic blood supply. Despite its rarity, PS presents significant diagnostic and management challenges, often necessitating a multidisciplinary approach for optimal patient outcomes. This case report provides insights into the clinical presentation, diagnostic modalities, and management strategies for PS., Case Summary: The authors present a case of a 30-year-old male who complained of chronic cough and hemoptysis and was eventually diagnosed with intralobar PS by computed tomography (CT) imaging. The patient underwent a surgical procedure, specifically a lobectomy, to address the lung tissue., Clinical Discussion: The diagnosis of intralobar PS is confirmed by CT imaging, showing features of abnormalities, including irregular cystic communication. A large area with abnormal systemic arterial supply and variable venous fluid. This patient presented with symptoms consistent with PS, including chronic cough and hemoptysis, highlighting the importance of timely diagnosis and intervention to prevent life-threatening complications., Conclusion: Lung sequestration has diagnostic challenges due to its variable clinical presentation and potential for misdiagnosis. However, advances in technology, such as CT angiography, make accurate diagnosis and precise surgical planning easier. Prompt intervention via lobectomy or transarterial embolization is important to reduce the risk of life-threatening complications associated with PS. These data highlight the importance of multidisciplinary collaboration between physicians, radiologists, and surgeons to effectively manage PS and improve patient outcomes., Competing Interests: The authors declare that they have no conflict of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article, (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Emerging research indicates growing concern over long COVID globally, although there have been limited studies that estimate population burden. We aimed to estimate the burden of long COVID in three districts of Haryana, India, using an opportunity to link a seroprevalence study to follow-up survey of symptoms associated with long COVID., Methods: We used a population-based seroprevalence survey for COVID-19 conducted in September 2021 across Haryana, India. Adults from three purposively selected districts (Rohtak, Gurugram, and Jhajjar) were eligible to participate; 2205 of 3213 consented to participate in a survey on health status. Trained investigators administered a structured questionnaire that included demographic characteristics, self-reported symptoms of illness in the last six months before the survey, mental health, and history of COVID-19., Findings: Unadjusted regression estimates indicated positive correlations between symptomatic complaints and COVID-19 exposure, suggesting lingering effects of COVID-19 in this population. The overall physical morbidity index was higher among those who tested positive for COVID-19, as was the incidence of new cases. However, both morbidity and incidence became statistically insignificant after adjustment for multiple comparisons. Cough emerged as the only statistically significant individual persistent symptom. Sex-stratified analyses indicated significant estimates only for physical morbidity in women., Interpretation: This study is one of the first from India that uses a large population-based sample to examine longer term repercussions of COVID infections. The burden of long COVID should primarily be addressed in clinical settings, where specialised treatment for individual cases continues to evolve. Our analyses also provide insight into the size and nature of studies required to assess the population-level burden of long COVID., Funding: This paper was produced under the auspices of the Lancet COVID 19 Commission India Task Force, which was supported financially by the Reliance Foundation. The Lancet COVID 19 Commission was set up in July 2020 and submitted its final report by October 2022. This report by the India Task Force was prepared during the same period., Competing Interests: All the authors have declared no conflict of interest., (© 2024 The Author(s).)

Background: Fluoride is a noxious element known to destroy gastrointestinal mucosa, leading to erythrocytes' destruction and causing anaemia. The birth weight of newborn babies is a significant indicator of a child's vulnerability to the risk of childhood diseases and chances of existence., Methods: This prospective cohort study was planned to find linkages between fluorosis and the low-birth weight of newborn babies with anaemic mothers. Antenatal mothers until the 20th week of gestation were followed up till delivery in the Antenatal Clinic of a District Hospital in one of the known fluoride-endemic districts (Nagaur) and the other not-so-endemic district (Jodhpur) of Western Rajasthan., Results: Around 19% of the newborn in Jodhpur and around 22% in Nagaur had low birth weight. Mean fluoride values in water samples were measured to be 0.57 (range from 0.0 to 2.7 PPM) in Jodhpur and 0.7 (range from 0.0 to 3.4 PPM) in Nagaur., Conclusions: Thus, in fluoride endemic areas, other factors should be included besides iron and folic acid supplementation for improving anaemia in pregnant women. This calls for assessing the effectiveness of de-fluoridation activities along with the area's most common indigenous food practices., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Bhardwaj P et al.)

The discovery of a new class of heteroatom-rich boron-containing molecules (BCMs) and iterative cross-coupling (ICC) partners created a toolbox for future drug developments using organoboron compounds. Herein, we report the potential utility of 1,3-enyne MIDA boronates to access diverse gem -difluoro MIDA boronates via novel 1,2-alkyne shift. This unique reactivity of 1,3-enyne MIDA boronates offers facile access to previously challenging β-difluorinated alkyl borons. Furthermore, we demonstrated the synthesis of various novel furan-based BCMs via 5- endo-dig cyclization and iterative coupling partners via copper-catalyzed hydroboration and platinum-catalyzed diboration reaction., Competing Interests: The authors declare no competing financial interest., (This journal is © The Royal Society of Chemistry.)

The classical pathway (CP) is a potent mechanism for initiating complement activity and is a driver of pathology in many complement-mediated diseases. The CP is initiated via activation of complement component C1, which consists of the pattern recognition molecule C1q bound to a tetrameric assembly of proteases C1r and C1s. Enzymatically active C1s provides the catalytic basis for cleavage of the downstream CP components, C4 and C2, and is therefore an attractive target for therapeutic intervention in CP-driven diseases. Although an anti-C1s mAb has been Food and Drug Administration approved, identifying small-molecule C1s inhibitors remains a priority. In this study, we describe 6-(4-phenylpiperazin-1-yl)pyridine-3-carboximidamide (A1) as a selective, competitive inhibitor of C1s. A1 was identified through a virtual screen for small molecules that interact with the C1s substrate recognition site. Subsequent functional studies revealed that A1 dose-dependently inhibits CP activation by heparin-induced immune complexes, CP-driven lysis of Ab-sensitized sheep erythrocytes, CP activation in a pathway-specific ELISA, and cleavage of C2 by C1s. Biochemical experiments demonstrated that A1 binds directly to C1s with a Kd of ∼9.8 μM and competitively inhibits its activity with an inhibition constant (Ki) of ∼5.8 μM. A 1.8-Å-resolution crystal structure revealed the physical basis for C1s inhibition by A1 and provided information on the structure-activity relationship of the A1 scaffold, which was supported by evaluating a panel of A1 analogs. Taken together, our work identifies A1 as a new class of small-molecule C1s inhibitor and lays the foundation for development of increasingly potent and selective A1 analogs for both research and therapeutic purposes., (Copyright © 2024 by The American Association of Immunologists, Inc.)

This comprehensive review explores the role of sonographic assessment in diagnosing and characterizing peripheral slow-flow vascular malformations (PSFVM). The review begins with an introduction providing the background and significance of PSFVM, defining these vascular anomalies, and emphasizing the importance of sonography in their diagnosis. The objectives focus on a thorough examination of existing literature, assessing the effectiveness of sonography in delineating morphological and hemodynamic features crucial for accurate classification. The summary of key findings highlights the diagnostic accuracy of sonography while acknowledging its limitations. Implications for clinical practice emphasize the practical utility of sonography in early diagnosis and preoperative planning, suggesting integration into multimodal approaches. The conclusion underscores the need for standardized criteria, ongoing education, and future research, positioning sonography as a valuable tool in the comprehensive management of PSFVM., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Shelar et al.)

This study provides the fatty acid profile, presence of Omega 3 fatty acids (ω3FAs) and therapeutic potential of the skin of Garfish ( Belone belone ), a highly nutritious fish. The ω3FAs were obtained using the urea crystallization method and confirmed by UV VIS spectroscopy, HPLC, FT-IR, and NMR. Additionally, the therapeutic potential of the ω3FAs was assessed through antioxidant, antimicrobial, antibiofilm, and toxicity assays. The oil extracted from Garfish skin (GS) predominantly contains ω3FAs, palmitic acids, and oleic acids. The ω3FAs exhibit high anti-free radical activity and ferric reducing activity. It reduces nitric oxide production as well as lipid peroxidation under certain time. They also demonstrate effective antibacterial activity against Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Streptococcus pneumoniae . The biofilm formation is efficiently reduced by ω3FAs and eradication effects on biofilm are higher at 4000 µg/mL of concentration. When tested against brine shrimp larvae, ω3FAs were found to be non-toxic. The study indicates that GS skin oil contains a significant amount of omega-3 fatty acids and has potential therapeutic benefits due to its antioxidant and antibacterial properties, without causing any toxic effects. Omega-3 fatty acids have the potential to enhance the treatment of infections caused by harmful bacteria and their biofilm formation. Further research is needed to understand how omega-3 fatty acids work to kill bacteria and how they affect bacterial gene expression., Competing Interests: Conflict of interestThe authors declare that they have no potential conflict of interest in relation to the study in this paper., (© King Abdulaziz City for Science and Technology 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Abstract: Cell-surface exposure of phosphatidylserine (PS) is essential for phagocytic clearance and blood clotting. Although a calcium-activated phospholipid scramblase (CaPLSase) has long been proposed to mediate PS exposure in red blood cells (RBCs), its identity, activation mechanism, and role in RBC biology and disease remain elusive. Here, we demonstrate that TMEM16F, the long-sought-after RBC CaPLSase, is activated by calcium influx through the mechanosensitive channel PIEZO1 in RBCs. PIEZO1-TMEM16F functional coupling is enhanced in RBCs from individuals with hereditary xerocytosis (HX), an RBC disorder caused by PIEZO1 gain-of-function channelopathy. Enhanced PIEZO1-TMEM16F coupling leads to an increased propensity to expose PS, which may serve as a key risk factor for HX clinical manifestations including anemia, splenomegaly, and postsplenectomy thrombosis. Spider toxin GsMTx-4 and antigout medication benzbromarone inhibit PIEZO1, preventing force-induced echinocytosis, hemolysis, and PS exposure in HX RBCs. Our study thus reveals an activation mechanism of TMEM16F CaPLSase and its pathophysiological function in HX, providing insights into potential treatment., (© 2024 American Society of Hematology. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)

Competing Interests: Competing interests: None declared.

Octacosamicin A is an antifungal metabolite featuring a linear polyene-polyol chain flanked by N-hydroxyguanidine and glycine moieties. We report here that sub-inhibitory concentrations of streptomycin elicited the production of octacosamicin A in Amycolatopsis azurea DSM 43854 T . We identified the biosynthetic gene cluster (oca BGC) that encodes a modular polyketide synthase (PKS) system for assembling the polyene-polyol chain of octacosamicin A. Our analysis suggested that the N-hydroxyguanidine unit originates from a 4-guanidinobutyryl-CoA starter unit, while the PKS incorporates an α-hydroxyketone moiety using a (2R)-hydroxymalonyl-CoA extender unit. The modular PKS system contains a non-canonical terminal module that lacks thioesterase (TE) and acyl carrier protein (ACP) domains, indicating the biosynthesis is likely to employ an unconventional and cryptic off-loading mechanism that attaches glycine to the polyene-polyol chain via an intermolecular amidation reaction., (© 2023 Wiley-VCH GmbH.)

BACKGROUND Immunoglobulin A (IgA) vasculitis is a small-vessel vasculitis characterized by the deposition of IgA immune complexes primarily in the skin, kidneys, and gastrointestinal tract. While it predominantly affects children, cases in adults are associated with more severe manifestations. Evidence suggests that infectious triggers play a pivotal role in its etiology. Often, it follows a self-limiting course and doesn't necessitate intervention. CASE REPORT We present the case of a 51-year-old man who presented with a maculopapular rash, arthralgia, and abdominal pain. An examination revealed a purpuric rash on lower extremities and abdomen. A lower extremity duplex ultrasound identified deep vein thrombosis (DVT) in the right leg. Skin biopsy of the rash confirmed the diagnosis of IgA vasculitis, demonstrating perivascular neutrophilic infiltrate and IgA complex deposition. Stool studies revealed co-infection with Cryptosporidium and Giardia. The patient was treated with a prednisone taper with significant improvement in symptoms. CONCLUSIONS This case highlights the potential role of Cryptosporidium as a trigger for IgA vasculitis. The presence of concurrent infections underscores the complex interplay between infections and the development of IgA vasculitis. The co-infection with Giardia suggests that a secondary infection may be involved, further complicating the disease's etiology. The observation of DVT suggests a possible link between IgA vasculitis and a prothrombotic state. This report serves to expand the knowledge of IgA vasculitis triggers and associated complications, guiding clinicians in diagnosing and managing similar cases while emphasizing the importance of vigilance in adults with these symptoms.

We present a complete basis to study gauged curvature-squared supergravity in five dimensions. We replace the conventional ungauged Riemann-squared action with a new log invariant, offering a comprehensive framework for all gauged curvature-squared supergravities. Our findings address long-standing challenges and have implications for precision tests in the AdS/CFT correspondence.

Background: To facilitate the shift from risk-factor management to primordial prevention of cardiovascular disease, the American Heart Association developed guidelines to score and track cardiovascular health (CVH). How the prevalence and trajectories of a high level of CVH across the life course compare among high- and lower-income countries is unknown., Methods: Nationally representative survey data with CVH variables (physical activity, cigarette smoking, body mass index, blood pressure, blood glucose, and total cholesterol levels) were identified in Ethiopia, Bangladesh, Brazil, England, and the US for adults (aged 18-69 years and not pregnant). Data were harmonized, and CVH metrics were scored using the American Heart Association guidelines, as high (2), moderate (1), or low (0), with the prevalence of high scores (better CVH) across the life course compared across countries., Results: Among 28,092 adults (Ethiopia n = 7686, 55.2% male; Bangladesh n = 6731, 48.4% male; Brazil n = 7241, 47.9% male; England n = 2691, 49.5% male, and the US n = 3743, 50.3% male), the prevalence of high CVH scores decreased as country income level increased. Declining CVH with age was universal across countries, but differences were already observable in those aged 18 years. Excess body weight appeared to be the main driver of poor CVH in higher-income countries, and the prevalence of current smoking was highest in Bangladesh., Conclusions: Our findings suggest that CVH decline with age may be universal. Interventions to promote and preserve CVH throughout the life course are needed in all populations, tailored to country-specific time courses of the decline. In countries where the level of CVH remains relatively high, protection of whole societies from risk-factor epidemics may still be feasible., (© 2023 The Authors.)

In the current study, the squid, Sepioteuthis lessoniana ink was used as a raw material. It summarizes physicochemical, elemental, and spectral properties (UV/Visible spectroscopy and FT-IR) of crude ink, whereas the biochemical analysis was performed with crude ink (CI) as well as melanin-free ink (MFI). The percentage yield was analyzed using various solvent extracts of CI and MFI. GC-MS was performed for the chemical constituents of the methanolic extract of ink. Furthermore, the methanolic extract was subjected to various biological applications. The physicochemical analysis defines the presence of moisture, ash, extractive value, solubility, and thermal stability of CI. The biochemical analysis reveals protein, lipid, and carbohydrate of 2.5, 2.2, and 2.37 mg/ml for CI and 2.8, 3.7, and 4.51 mg/ml for MFI respectively. The extract showed the highest zone of inhibition at 100 μg/ml. The antioxidant activity reveals the highest percentage of radical-scavenging activity in nitric oxide (NO) (89%), and total antioxidant capacity (TAC) assay showed the highest inhibition activity of 0.41 nm at 100 µg/ml. The cytotoxic ability of methanolic extract against MDA-MB-231 breast cancer cell line revealed an IC 50 value of 10.13 μg/ml. Toxicity assay showed increased mortality of Artemia nauplii at higher concentrations (1000 ppm/40%) of extract. These findings indicate that S. lessoniana ink is a novel prospective product that needs to be characterized in order to increase its pharmacological activity., Supplementary Information: The online version contains supplementary material available at 10.1007/s13205-023-03830-6., Competing Interests: Conflict of interestThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© King Abdulaziz City for Science and Technology 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Sleep Apnea (SA) can cause health complications including heart stroke and neurological disorders. The Polysomnography (PSG) test can detect the severity of sleep disturbance. However, it is expensive and requires a dedicated sleep laboratory and expertise to examine the patients. Therefore, it is not available to a large population in developing countries. This leads to the development of cost-effective and automated patient examination methods for the detection of sleep apnea. This study suggests an approach of using the ECG signals to categorize sleep apnea. In this work, we have devised an original technique of feature space designing by intelligently hybridizing the multirate processing, a mix of wavelet-empirical mode decomposition (W-EMD), modes-based Hjorth features extraction, and Adam-based optimized Multilayer perceptron neural network (MLPNN) for automated categorization of apnea. A publicly available ECG dataset is used for evaluating the performance of the suggested approach. Experiments are performed for four different sub-bands of the considered ECG signals. For each selected sub-band, five "Intrinsic Mode Functions" (IMFs) are extracted. Onward, three Hjorth features: complexity, activity, and mobility are mined from each IMF. In this way, four feature sets are formed based on wavelet-driven selected sub-bands. The performance of optimized MLPNN, for the apnea categorization, is compared for each feature set. Five different evaluation parameters are used to assess the performance. For the same dataset, a systematic comparison with current state-of-the-artwork has been done. Results have shown a classification accuracy of 98.12%., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Khandelwal et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Obstructive uropathy, a prevalent clinical problem, can irreparably harm the kidneys if not treated promptly. As a result, accurate diagnosis is necessary for prompt management. This study examines the utility of multidetector computed tomography (MDCT) urography in identifying obstructive uropathy. PubMed, Google, Embase, Medline, and other electronic databases were used to search the English-language literature. The search phrases were obstructive urinary infections or urinary bladder or kidneys or MDCT. The authors' expertise and experience in the subject area aided in archiving pertinent publications. Even though the dilated upper tract of the ureters can be seen, ultrasonography (USG) has limitations because it cannot show the middle portion of the ureters, even if they are dilated mostly due to bowel gas artifacts. The USG does not emphasize the functioning of the renal tract. To evaluate obstructive uropathy, MDCT urography plays a very important role. For speedy, effective therapy, it provides a quick diagnosis of the source of obstruction., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Khandelwal et al.)

Background and Aims: The aim of this in vitro study is to quantitatively evaluate the effect of different alcoholic and non alcoholic beverages on the tooth enamel surface topography pretreated with various remineralizing agents using Atomic Force Microscopy., Methods: 120 tooth specimens were prepared from 60 freshly extracted intact human premolars by sectioning from mesial to distal surfaces using low speed diamond discs and were randomly assigned to study groups and control group. Specimens of Group I, Group II and Group III were pre-treated with β-Tri calcium phosphate, bioactive glass and amine fluoride respectively for 4 minutes for 28 days, followed by storage in artificial saliva. All the specimens were evaluated for surface roughness using Atomic Force Microscopy. The specimens were then placed in alcoholic and non-alcoholic beverages for 10 minutes for 4 days and were again analyzed by Atomic Force Microscopy.Descriptive statistics was performed by using the proportional or frequency distribution of the parameters. The respondents were then grouped according to the branch of specialty if any and the data was evaluated by the one-way ANOVA with post-hoc, with p value <0.005., Results: In the present study, among the remineralizing agents tested, bioactive glass was found to be more effective than β-Tri Calcium Phosphate and Amine Fluoride. Among the demineralizing agents used in this study, the demineralization potential of Coca Cola was found to be highest, followed by wine and green tea pretreated with β-tricalcium phosphate, bioactive glass and amine fluoride., Conclusions: The present study concluded that all the remineralizing agents tested were found to be effective in inhibiting the demineralization caused by various alcoholic and non alcoholic beverages. Among the remineralizing agents tested, bioactive glass was found to be more effective than β-tri calcium phosphate and amine fluoride.

Background: Low concentrations of docosahexaenoic acid (DHA) or high n-6 (ω-6):n-3 ratio in pregnant women is associated with poor fetal growth velocity and suboptimal neurodevelopment. However, there is a lack of data on levels of important n-6 and n-3 fatty acids (FAs) at different time points during pregnancy and lactation from India. Data on how much DHA is transferred during actual supplementation are also scarce., Objectives: We report the concentrations of n-6 and n-3 FAs in maternal and infant blood and in breast milk following maternal supplementation with DHA or placebo., Methods: A total of 957 pregnant women (≤20 wk) from Belagavi, Karnataka, were randomly assigned to receive either 400 mg/d of algal DHA or placebo through 6 mo postpartum. Blood samples were collected from the mother at recruitment/baseline, delivery, and 6 mo postpartum and from the infant at birth (cord) and 12 mo (venous). Breast milk samples were collected from a subsample at delivery, 1 mo and 6 mo postpartum. The FA profile was analyzed using gas chromatography., Results: The concentration of DHA appeared to be higher in erythrocyte and breast milk samples of the DHA-supplemented group at all subsequent time points. The n-6:n-3 ratio was lower among women in the DHA group at delivery [DHA: 4.08 (1.79); placebo: 5.84 (3.57); P < 0.001] and at 6 mo postpartum [DHA: 5.34 (2.64); placebo: 7.69 (2.9); P < 0.001]. Infants of DHA-supplemented mothers also had a lower n-6:n-3 ratio at delivery and 12 mo. The n-6:n-3 ratio of breast milk increased from delivery through 1 to 6 mo but remained lower in the DHA-supplemented group than in the placebo., Conclusions: Maternal DHA supplementation with 400 mg/d from early pregnancy through 6 mo postpartum significantly increased circulating DHA in breast milk and infant erythrocyte, whereas decreased erythrocyte and breast milk n-6:n-3 ratio. However, maternal supplementation did not get the ratio to the recommended levels., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Shweta Khandelwal reports financial support was provided by Wellcome Trust DBT India Alliance., (© 2023 The Author(s).)

Patients present to the orthopedic outpatient department with complaints of shoulder pain on movement or restriction of movement in the shoulder joint and are referred for magnetic resonance imaging (MRI) of the shoulder joint. Almost all the patients have similar complaints but may have a wide range of pathology affecting the joint and causing pain. Rotator cuff tears or tendinopathy are the most common causes of shoulder pain. Ultrasound (USG) and MRI are the most commonly used imaging modalities for assessing rotator cuff pathologies. There is a wide range of pathologies affecting the shoulder joint, other than rotator cuff tendinopathies or tears, for which USG is less sensitive and specific in detecting accurate pathology. MRI is the choice of imaging for shoulder joint pathologies. We present a pictorial review discussing and depicting MRI features of a wide list of pathologies of the shoulder joint complex that should be kept in mind when the patient presents with shoulder pain., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Sood et al.)

Objective: The Covid-19 pandemic resulted in a shift in communication of difficult, emotionally charged topics from almost entirely in-person to virtual mediated communication (VMC) methods due to restrictions on visitation for safety. The objective was to train residents in VMC and assess performance across multiple specialties and institutions., Design: The authors designed a teaching program including asynchronous preparation with videos, case simulation experiences with standardized patients (SPs), and coaching from a trained faculty member. Three topics were included - breaking bad news (BBN), goals of care / health care decision making (GOC), and disclosure of medical error (DOME). A performance evaluation was created and used by the coaches and standardized patients to assess the learners. Trends in performance between simulations and sessions were assessed., Setting: Four academic university hospitals - Virginia Commonwealth University Medical Center in Richmond, Virginia, The Ohio State University Wexner Medical Center in Columbus, Ohio, Baylor University Medical Center in Dallas, Texas and The University of Cincinnati in Cincinnati, Ohio- participated., Participants: Learners totaled 34 including 21 emergency medicine interns, 9 general surgery interns and 4 medical students entering surgical training. Learner participation was voluntary. Recruitment was done via emails sent by program directors and study coordinators., Results: A statistically significant improvement in mean performance on the second compared to the first simulation was observed for teaching communication skills for BBN using VMC. There was also a small but statistically significant mean improvement in performance from the first to the second simulation for the training overall., Conclusions: This work suggests that a deliberate practice model can be effective for teaching VMC and that a performance evaluation can be used to measure improvement. Further study is needed to optimize the teaching and evaluation of these skills as well as to define minimal acceptable levels of competency., (Copyright © 2023 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Degeneration of the lumbar intervertebral disc is the most common cause of lower back pain. It is directly related to daily activities, mechanical stress, and other biological factors. We use imaging modalities to assess the degree of disc degeneration, out of which magnetic resonance imaging (MRI) is the most popular non-invasive modality. It is believed that early changes in disc degeneration are due to the biochemical events in the disc and can be evaluated by sequences in MRI involving the diffusion of water molecules. The apparent diffusion coefficient (ADC) is one such sequence that captures the signals based on the diffusion of water molecules. Ten articles were chosen from PubMed and Google Scholar using the MeSH terms 'lumbar spine degeneration' and 'apparent diffusion coefficient'. This review article has summarized various studies intending to gain a better understanding of the biochemical events leading to the development of disc degeneration. This study has also gathered the role of various sequences in MRI that can quantitatively assess disc degeneration., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Sood et al.)

When judging the quality of a computational system for a pathological screening task, several factors seem to be important, like sensitivity, specificity, accuracy, etc. With machine learning based approaches showing promise in the multi-label paradigm, they are being widely adopted to diagnostics and digital therapeutics. Metrics are usually borrowed from machine learning literature, and the current consensus is to report results on a diverse set of metrics. It is infeasible to compare efficacy of computational systems which have been evaluated on different sets of metrics. From a diagnostic utility standpoint, the current metrics themselves are far from perfect, often biased by prevalence of negative samples or other statistical factors and importantly, they are designed to evaluate general purpose machine learning tasks. In this paper we outline the various parameters that are important in constructing a clinical metric aligned with diagnostic practice, and demonstrate their incompatibility with existing metrics. We propose a new metric, MedTric that takes into account several factors that are of clinical importance. MedTric is built from the ground up keeping in mind the unique context of computational diagnostics and the principle of risk minimization, penalizing missed diagnosis more harshly than over-diagnosis. MedTric is a unified metric for medical or pathological screening system evaluation. We compare this metric against other widely used metrics and demonstrate how our system outperforms them in key areas of medical relevance., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Saha et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Heparin-induced thrombocytopenia (HIT) is characterized by thrombocytopenia associated with a highly prothrombotic state due to the development of pathogenic antibodies that recognize human platelet factor 4 (hPF4) complexed with various polyanions. Although nonheparin anticoagulants are the mainstay of care in HIT, subsequent bleeding may develop, and the risk of developing new thromboembolic events remain. We previously described a mouse immunoglobulin G2bκ (IgG2bκ) antibody KKO that mimics the sentinel features of pathogenic HIT antibodies, including binding to the same neoepitope on hPF4-polyanion complexes. KKO, like HIT IgGs, activates platelets through FcγRIIA and induces complement activation. We then questioned whether Fc-modified KKO could be used as a novel therapeutic to prevent or treat HIT. Using the endoglycosidase EndoS, we created deglycosylated KKO (DGKKO). Although DGKKO retained binding to PF4-polyanion complexes, it inhibited FcγRIIA-dependent activation of PF4-treated platelets triggered by unmodified KKO, 5B9 (another HIT-like monoclonal antibody), and IgGs isolated from patients with HIT. DGKKO also decreased complement activation and deposition of C3c on platelets. Unlike the anticoagulant fondaparinux, injection of DGKKO into HIT mice lacking mouse PF4, but transgenic for hPF4 and FcγRIIA, prevented and reversed thrombocytopenia when injected before or after unmodified KKO, 5B9, or HIT IgG. DGKKO also reversed antibody-induced thrombus growth in HIT mice. In contrast, DGKKO was ineffective in preventing thrombosis induced by IgG from patients with the HIT-related anti-PF4 prothrombotic disorder, vaccine-induced immune thrombotic thrombocytopenia. Thus, DGKKO may represent a new class of therapeutics for targeted treatment of patients with HIT., (© 2023 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.)

Background: Patients who undergo vertical sleeve gastrectomy (VSG) are at risk of postoperative GERD. The reasons are multifactorial, but half of conversions to Roux-en Y gastric bypass are for intractable GERD. Our institution routinely performs preoperative pH and high-resolution manometry studies to aid in operative decision making. We hypothesize that abnormal pH studies in concert with ineffective esophageal motility would lead to higher rates of postoperative reflux after VSG., Methods: A single institution retrospective review was conducted of adult patients who underwent preoperative pH and manometry testing and VSG between 2015 and 2021. Patients filled out a symptom questionnaire at the time of testing. Postoperative reflux was defined by patient-reported symptoms at 1-year follow-up. Univariate logistic regression was used to examine the relationship between esophageal tests and postoperative reflux. The Lui method was used to determine the cutpoint for pH and manometric variables maximizing sensitivity and specificity for postoperative reflux., Results: Of 291 patients who underwent VSG, 66 (22.7%) had a named motility disorder and 67 (23%) had an abnormal DeMeester score. Preoperatively, reflux was reported by 122 patients (41.9%), of those, 69 (56.6%) had resolution. Preoperative pH and manometric abnormalities, and BMI reduction did not predict postoperative reflux status (p = ns). In a subgroup analysis of patients with an abnormal preoperative pH study, the Lui cutpoint to predict postoperative reflux was a DeMeester greater than 24.8. Postoperative reflux symptoms rates above and below this point were 41.9% versus 17.1%, respectively (p = 0.03)., Conclusion: While manometry abnormalities did not predict postoperative reflux symptoms, GERD burden did. Patients with a mildly elevated DeMeester score had a low risk of postoperative reflux compared to patients with a more abnormal DeMeester score. A preoperative pH study may help guide operative decision-making and lead to better counseling of patients of their risk for reflux after VSG., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Healthcare-associated activity accounts for 10% of the United States' carbon dioxide (CO 2 ) emissions. Using telemedicine for bariatric surgery evaluations decreases emissions and reduces patient burden during the multiple required interdisciplinary visits. After adopting telemedicine during COVID, our clinic continues to utilize telemedicine for preoperative bariatric evaluations. We evaluated the reduced environmental impact associated with this practice., Methods: A retrospective review of all new evaluations for vertical sleeve gastrectomy (SG) or Roux-en Y gastric bypass (RYGB) from 2019 and 2021 was conducted. The 2019 year represents pre-pandemic, in-person evaluations and 2021 represents telemedicine evaluations during the COVID pandemic. Carbon emissions were calculated using the Environmental Protection Agency's (EPA's) validated formula of 404g CO 2 per car-mile. Preoperative evaluation time was calculated from the initial clinic visit to the operation date., Results: There were 51 patients in the 2019 cohort and 55 patients in the 2021 cohort. In the 2019 in-person cohort, there was significantly more kg of estimated CO 2 emitted (10,225 vs. 2011.4, p<.001) compared to the 2021 cohort. For time required to complete the preoperative workup, there was no statistically significant difference between the two groups (162 days vs. 193 days, p=.226). The attrition rate was lower in the 2021 cohort (22.22% v. 35.9%, p<.001)., Conclusions: Implementation of telemedicine for bariatric preoperative evaluations reduced patient travel, carbon emissions, and improved attrition rate. We encourage bariatric providers to use telemedicine as we believe this eases patient burdens and, with wider adoption, could significantly reduce our carbon footprint., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)