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Introduction and Importance: Gallstone ileus remain a rare but significant cause of small bowel obstruction, especially in the elderly population. It is associated with high mortality due to nonspecific symptoms and delayed diagnosis., Case Presentation: A 69-year-old male with a history of cholelithiasis presented with symptoms and signs suggestive of small bowel obstruction. Computed tomography (CT) scan showed pneumobilia, and small bowel obstruction, suggestive of gallstone ileus. Initial management involved exploratory laparotomy with enterotomy and gallstone removal followed by cholecystectomy and fistula closure three months later., Clinical Discussion: Gallstone ileus results from large gallstones causing mechanical intestinal obstruction, often via a cholecysto-intestinal fistula. CT scans are crucial for diagnosis, with surgical options for better patients' outcomes. Management of gallstone ileus involves removing the obstruction and repairing the cholecysto-intestinal fistula, but surgical approaches vary based on patient factors., Conclusion: Surgeons should be aware of the variable clinical presentations and the rationale behind choosing either a one-stage or staged surgical approach, particularly in managing patients with fistulas or severe adhesions., Competing Interests: Conflict of interest statement All the authors declare that they have no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The need to address antimicrobial resistance (AMR) through a One Health (OH) approach is now well recognized. There is, however, limited guidance on how AMR surveillance should be implemented across sectors to generate meaningful AMR and AMU data for decision-making. Using a sympatric approach to cross-sector sample collection, Nepal adopted the WHO extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli ( E. coli ) Tricycle Project as a step toward OH surveillance for assessing the prevalence of ESBL-producing E. coli across human, veterinary, and environment sectors. This involved a three-stage approach: identification of human hotspots (Stage 1) and sample collection sites for poultry (Stage 2) and wastewater (Stage 3). A total of 53 blood cultures from patients with bloodstream infections (BSIs), 100 stool samples from healthy pregnant women, 220 poultry ceca from slaughterhouses and live markets, and 48 wastewater samples were processed for bacterial culture and analyzed for the presence of ESBL-producing E. coli . The prevalence of ESBL-producing E. coli among isolated E. coli was the highest in wastewater samples (91%) followed by human BSIs (49%), poultry (38.6%), and fecal carriage isolates from healthy pregnant females (15%). A statistically significant association was seen in the prevalence of multidrug resistance among ESBL producers (52%) and nonproducers (26%). ESBL-producing E. coli was detected in all wastewater samples tested except for the upstream river. The findings of the study showed a high prevalence of ESBL-producing E. coli in samples from all three sectors and provided baseline data based upon which strategies for the safe disposal of communal and hospital waste, integrated AMR surveillance, and control strategies could be planned and implemented., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Jyoti Acharya et al.)

Introduction: Currently, no reporting guidelines exist for observational and qualitative study protocols. In an effort to enhance the quality of research protocols, we introduce two study protocol reporting checklists that we have developed., Main Recommendations: These checklists include educational components and examples intended to assist novice researchers. Through the analysis of 333 study protocols submitted for ethical review, our checklists have been developed and validated, demonstrating their applicability across various observational and qualitative study designs., Changes in Management: We provide insights into the systematic implementation of these checklists alongside complementary elements that support their effectiveness. We recommend longitudinal monitoring and evaluation of checklist utilization., 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 Ltd. All rights reserved.)

Variable selection methods have been extensively developed for and applied to cancer genomics data to identify important omics features associated with complex disease traits, including cancer outcomes. However, the reliability and reproducibility of the findings are in question if valid inferential procedures are not available to quantify the uncertainty of the findings. In this article, we provide a gentle but systematic review of high-dimensional frequentist and Bayesian inferential tools under sparse models which can yield uncertainty quantification measures, including confidence (or Bayesian credible) intervals, p values and false discovery rates (FDR). Connections in high-dimensional inferences between the two realms have been fully exploited under the "unpenalized loss function + penalty term" formulation for regularization methods and the "likelihood function × shrinkage prior" framework for regularized Bayesian analysis. In particular, we advocate for robust Bayesian variable selection in cancer genomics studies due to its ability to accommodate disease heterogeneity in the form of heavy-tailed errors and structured sparsity while providing valid statistical inference. The numerical results show that robust Bayesian analysis incorporating exact sparsity has yielded not only superior estimation and identification results but also valid Bayesian credible intervals under nominal coverage probabilities compared with alternative methods, especially in the presence of heavy-tailed model errors and outliers.

Joint infections cause significant morbidity and mortality. Rapid diagnosis enables prompt initiation of appropriate antimicrobial therapy and surgical treatment. We conducted a systematic review and meta-analysis to evaluate the accuracy of genus- or species-specific polymerase chain reaction (PCR) in diagnosing joint infections. The literature databases were searched for articles from January 2010 to December 2022. The meta-analysis using the split component synthesis (SCS) method, included 20 studies with 2,457 adult participants. The pooled sensitivity, specificity, diagnostic odds ratio, and AUC of PCR were 49 % (95 % CI [37.9-60.2]), 95.7 % (95 % CI [91.6-97.8]), 21.32, and 0.82 respectively. Sensitivity was highest for sonicate fluid and lowest for periprosthetic tissue. The mean turnaround time to results was 4.7 hours (SD 1.1). PCR is a favourable option for diagnosing joint infections due to its rapid results, but it has low sensitivity. To enhance diagnostic yield, the test should be used in conjunction with other methods., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Patrick NA Harris reports a relationship with Gilead Sciences Inc that includes: funding grants. Patrick NA Harris reports a relationship with Pfizer Inc that includes: speaking and lecture fees. Patrick NA Harris reports a relationship with OpGen, Inc. that includes: speaking and lecture fees. Patrick NA Harris reports a relationship with Gilead Sciences Inc that includes: speaking and lecture fees. Patrick NA Harris reports a relationship with bioMérieux Inc that includes: speaking and lecture fees. Patrick NA Harris reports a relationship with OpGen, Inc. that includes: consulting or advisory. Patrick NA Harris reports a relationship with Sandoz Inc that includes: consulting or advisory. David L Paterson reports a relationship with Shionogi Inc that includes: funding grants. David L Paterson reports a relationship with Pfizer Inc that includes: funding grants. David L Paterson reports a relationship with Merck & Co Inc that includes: funding grants. David L Paterson reports a relationship with bioMérieux Inc that includes: non-financial support. David L Paterson reports a relationship with Pfizer Inc that includes: consulting or advisory. David L Paterson reports a relationship with Entos Inc that includes: consulting or advisory. David L Paterson reports a relationship with Shionogi Inc that includes: consulting or advisory. David L Paterson reports a relationship with bioMérieux Inc that includes: consulting or advisory. David L Paterson reports a relationship with Cepheid that includes: consulting or advisory. David L Paterson reports a relationship with GSK that includes: consulting or advisory. David L Paterson reports a relationship with Menarini that includes: consulting or advisory. David L Paterson reports a relationship with Aurobac Therapeutics that includes: consulting or advisory. Shradha Subedi reports a relationship with GSK that includes: funding grants. Shradha Subedi reports a relationship with bioMérieux Inc that includes: funding grants. 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 The Authors. Published by Elsevier Inc. All rights reserved.)

Probabilistic topic modelling has become essential in many types of single-cell data analysis. Based on probabilistic topic assignments in each cell, we identify the latent representation of cellular states. A dictionary matrix, consisting of topic-specific gene frequency vectors, provides interpretable bases to be compared with known cell type-specific marker genes and other pathway annotations. However, fitting a topic model on a large number of cells would require heavy computational resources-specialized computing units, computing time and memory. Here, we present a scalable approximation method customized for single-cell RNA-seq data analysis, termed ASAP, short for Annotating a Single-cell data matrix by Approximate Pseudobulk estimation. Our approach is more accurate than existing methods but requires orders of magnitude less computing time, leaving much lower memory consumption. We also show that our approach is widely applicable for atlas-scale data analysis; our method seamlessly integrates single-cell and bulk data in joint analysis, not requiring additional preprocessing or feature selection steps., (© 2024 Subedi et al.)

Background: Outpatient parenteral antimicrobial treatment (OPAT) is a safe and effective therapy used in several settings across Australia. As OPAT services expand their inclusion criteria to include complex patient populations, there is an increased need for selecting appropriate patients to receive either healthcare-administered OPAT (H-OPAT) or self-administered OPAT (S-OPAT)., Aims: To describe patient demographics, diagnosis, microbiology and outcomes of patients treated by H-OPAT and S-OPAT within the Sunshine Coast Hospital and Health Service, Australia., Methods: Data on demographics, diagnoses, treatment and outcomes on all patients treated by H-OPAT and S-OPAT from March 2017 to December 2019 were collected retrospectively., Results: One hundred and sixty-five patients (62.26%) were enrolled in H-OPAT and 100 patients (37.74%) in S-OPAT. S-OPAT patients were significantly younger. H-OPAT patients were more comorbid. Bone and joint infections were the most treated infections and were more likely to be treated by S-OPAT. There was no difference in treatment duration, cure and complication rates between S-OPAT and H-OPAT. Longer duration of therapy was associated with more complications. Treatment failure was associated with infections due to multiple organisms, number of comorbidities and treatment of surgical site, skin and soft tissue infections., Conclusions: There were significant differences in demographics between H-OPAT and S-OPAT without any difference in outcomes. Overall failure and complication rates were low. Higher rates of treatment failure were predicted by the diagnosis, number of comorbidities and number of organisms treated., (© 2024 Royal Australasian College of Physicians.)

Aims: Approximately 55% of patients diagnosed with primary or metastatic cancer endure pain directly attributable to the disease. Consequently, it becomes imperative to address pain management through a comparative analysis of stereotactic radiotherapy (SRT) and conventional radiation therapy (CRT), especially in light of the less efficacious improvement achieved solely through pharmacological interventions., Materials and Methods: A systematic exploration was undertaken on PubMed, the Cochrane Library, and Elsevier's ScienceDirect databases to identify studies that compare Stereotactic Radiotherapy to Conventional radiation therapy for pain management in individuals with metastatic bone cancer. The analyses were executed utilizing the random-effects model., Results: A cohort of 1152 participants with metastatic bone cancer was analyzed, demonstrating significantly higher complete pain relief in the Stereotactic Radiotherapy group during both early and late follow-up (RR: 1.61; 95% CI: 1.17, 2.23, p-value: 0.004; I2: 0%). Stereotactic Radiotherapy also showed a non-significant increase in the incidence of partial pain relief (RR: 1.07; 95% CI: 0.85, 1.34, p-value: 0.56; I2: 18%). Furthermore, Stereotactic Radiotherapy was associated with a significantly reduced risk of stationary pain throughout follow-up (RR: 0.61; 95%CI: 0.48, 0.76, p-value: <0.0001; I2: 0. The incidence of progressive pain was non-significantly reduced with Stereotactic Radiotherapy during both early and late follow-up (RR: 0.77; 95% CI: 0.50, 1.17, p-value: 0.22; I2: 0%). Secondary outcomes exhibited a non-significant trend favoring Stereotactic Radiotherapy for dysphagia, esophagitis, pain, and radiodermatitis, while a non-significant increase was observed for nausea, fatigue, and vertebral compression fracture., Conclusion: In summary, stereotactic radiation therapy (SRT) has improved in achieving complete pain relief while exhibiting a decreased probability of delivering stationary pain compared to conventional radiation therapy (CRT). Nevertheless, it is crucial in future research to address a noteworthy limitation, specifically, the risk of vertebral compression fracture., (Copyright © 2024 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Background/aims: To describe the role of ustekinumab in inducing remission and endoscopic healing in anti-tumor necrosis factor α nonresponsive pediatric ulcerative colitis patients at a tertiary care inflammatory bowel disease center., Methods: A retrospective chart review was performed on patients with ulcerative colitis receiving ustekinumab. Primary outcome was steroidfree clinical remission at follow-up. Secondary outcomes were biochemical remission and endoscopic healing., Results: Ten children were analyzed; 7 (70%) had ulcerative colitis, and 3 (30%) had inflammatory bowel disease unspecified with colitis. Median follow-up period was 56 weeks. Nine patients (90%) achieved steroid-free clinical remission and biochemical remission. Seven patients had follow-up colonoscopies, out of which 6 (86%) achieved endoscopic remission, while 1 (14%) underwent colectomy. Out of the 3 patients without a follow-up colonoscopy, fecal calprotectin levels downtrended to < 150 mg/kg in 2 patients and < 400 mg/kg in 1 patient from baseline level of > 2,000 mg/kg., Conclusions: Ustekinumab appears efficacious in achieving not only clinical and biochemical remission but also has promising role in inducing endoscopic healing end point in patients who fail other biologics.

Cage-free (CF) housing systems are expected to be the dominant egg production system in North America and European Union countries by 2030. Within these systems, bumblefoot (a common bacterial infection and chronic inflammatory reaction) is mostly observed in hens reared on litter floors. It causes pain and stress in hens and is detrimental to their welfare. For instance, hens with bumblefoot have difficulty moving freely, thus hindering access to feeders and drinkers. However, it is technically challenging to detect hens with bumblefoot, and no automatic methods have been applied for hens' bumblefoot detection (BFD), especially in its early stages. This study aimed to develop and test artificial intelligence methods (i.e., deep learning models) to detect hens' bumblefoot condition in a CF environment under various settings such as epochs (number of times the entire dataset passes through the network during training), batch size (number of data samples processed per iteration during training), and camera height. The performance of 3 newly developed deep learning models (i.e., YOLOv5s-BFD, YOLOv5m-BFD, & YOLOv5x-BFD) were compared in detecting hens with bumblefoot of hens in CF environments. The result shows that the YOLOv5m-BFD model had the highest precision (93.7%), recall (84.6%), mAP@0.50 (90.9%), mAP@0.50:0.95 (51.8%), and F1-score (89.0%) compared with other models. The observed YOLOv5m-BFD model trained at 400 epochs and batch size 16 is recommended for bumblefoot detection in laying hens. This study provides a basis for developing an automatic bumblefoot detection system in commercial CF houses. This model will be modified and trained to detect the occurrence of broilers with bumblefoot in the future., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: A significant number of women die from pregnancy and childbirth complications globally, particularly in low- and middle-income countries (LMICs). Receiving at least four antenatal care (ANC) visits may be important in reducing maternal and perinatal deaths. This study investigates factors associated with attending ≥ 4 ANC visits in Sarlahi district of southern Nepal., Methods: A secondary analysis was conducted on data from the Nepal Oil Massage Study (NOMS), a cluster-randomized, community-based longitudinal pregnancy cohort study encompassing 34 Village Development Committees. We quantified the association between receipt/attendance of ≥ 4 ANC visits and socioeconomic, demographic, morbidity, and pregnancy history factors using logistic regression; Generalized Estimating Equations were used to account for multiple pregnancies per woman., Results: All pregnancies resulting in a live birth (n=31,867) were included in the model and 31.4% of those pregnancies received 4+ ANC visits. Significant positive associations include socioeconomic factors such as participation in non-farming occupations for women (OR=1.52, 95% CI: 1.19, 1.93), higher education (OR=1.79, 95% CI: 1.66, 1.93) and wealth quintile OR=1.44, 95% CI: 1.31, 1.59), nutritional status such as non-short stature (OR=1.17, 95% CI: 1.07, 1.27), obstetric history such as adequate interpregnancy interval (OR=1.31, 95% CI: 1.19, 1.45) and prior pregnancy but no live birth (OR=2.14, 95% CI: 1.57, 2.92), symptoms such as vaginal bleeding (OR=1.35, 95% CI:1.11, 1.65) and awareness of the government's conditional cash transfer ANC program (OR=2.26, 95% CI: 2.01, 2.54). Conversely, belonging to the lower Shudra caste (OR=0.56, 95% CI: 0.47, 0.67), maternal age below 18 or above 35 (OR=0.81, 95% CI:0.74, 0.88; OR=0.77, 95% CI: 0.62, 0.96)), preterm birth (OR=0.41, 95% CI: 0.35, 0.49), parity ≥ 1 (OR=0.66, 95% CI: 0.61, 0.72), and the presence of hypertension during pregnancy (OR=0.79, 95% CI: 0.69, 0.90) were associated with decreased likelihood of attending ≥ 4 ANC visits., Conclusions: These findings underscore the importance of continuing and promoting the government's program and increasing awareness among women. Moreover, understanding these factors can guide interventions aimed at encouraging ANC uptake in the most vulnerable groups, subsequently reducing maternal-related adverse outcomes in LMICs., Trial Registration: The clinicaltrial.gov trial registration number for NOMS was #NCT01177111. Registration date was August 6 th , 2010., Competing Interests: Competing interests The authors declare that they have no competing interests.

Mucormycosis is a devastating disease with a high mortality rate, typically affecting immunosuppressed individuals. Postoperative surgical site infections due to mucromycosis are rare, with only a handful of cases reported in the literature. Here, we describe a fatal case of post operative abdominal wound infection caused by mucormycosis in an immunocompetent man in his 70 s, who developed the infection following a laparotomy for bowel perforation. Initially, the growth of fungal species from a superficial wound swab was not considered significant until the patient exhibited signs of worsening sepsis. Limited operative debridement was performed for prognostication, in accordance with the family's wishes. There was evidence of extensive significant invasive fungal infection, marked by necrosis extending into the abdominal wall fat and muscle. The patient was then transitioned to comfort measures and subsequently died. This case emphasizes the importance of maintaining a high level of clinical suspicion for mucormycosis, even in patients with minimal risk factors, and highlights the importance of prompt and aggressive treatment., Competing Interests: The authors report there are no competing interests to declare., (© 2024 The Authors. Published by Elsevier Ltd.)

Agricultural productivity relies upon energy input in the form of improved seeds, fertilizers, chemicals, irrigation and mechanization including management practices. This energy input is crucial for enhancing crop yields and meeting the demands of an ever-growing population. The increasing demand for rice production from an ever-increasing population and the dwindling nature of natural resources as a result of their continuous and excessive use underscore the urgency of studying energy use efficiency and sustainability in rice production. By conducting this experiment, the goal was to assess the yields, economics, and energy use efficiencies in rice. The experiment employed a Randomized Complete Block Design (RCBD) with three replications, comprising ten treatment combinations viz. US-312 + 60:30:20 kg NPK ha -1 , US-312 + 0:30:20 kg NPK ha -1 , US-312 + 60:0:20 kg NPK ha -1 , US-312 + 60:30:0 kg NPK ha -1 , US-312 + 0:0:0 kg NPK ha -1 , Sukhadhan-2+60:30:20 kg NPK ha -1 , Sukhadhan-2+0:30:20 kg NPK ha -1 , Sukhadhan-2+60:0:20 kg NPK ha -1 , Sukhadhan-2+60:30:0 kg NPK ha -1 , Sukhadhan-2+ 0:0:0 kg NPK ha -1 . Results revealed that the highest grain yield and yield attributes were obtained from US-312 + 60:30:20 kg NPK ha -1 (4.98 t ha -1 ) followed by US-312 + 60:30:0 kg NPK ha -1 (4.76 t ha -1 ), and US-312 + 60:0:20 kg NPK ha -1 (4.54 t ha -1 ). The highest energy use efficiency of 3.95 was observed under US-312 + 60:30:0 kg NPK ha -1 which was supported by the highest output energy obtained from grain and biomass yield (153 GJ ha -1 ) and the highest net energy (117 GJ ha -1 ). The benefit-cost ratio was found highest in US-312 + 60:30:20 kg NPK ha -1 (1.98), signifying its economic viability and potential profitability. In the context of the western mid-hills of Nepal, the rice variety US-312, coupled with a nutrient composition of 60:30:20 kg NPK ha -1 proved to be an optimal selection. This combination demonstrated higher grain yields and noteworthy economic efficiency., Competing Interests: 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., (© 2024 The Authors.)

Background: Virtual ward (VW) models of care established during the coronavirus disease 2019 (COVID-19) pandemic provided safe and equitable provision of ambulatory care for low-risk patients; however, little is known about patients who require escalation of care to hospitals from VWs., Aim: To assess our VW model of care and describe the characteristics of patients admitted to the hospital from the VW., Methods: Observational study of all patients admitted to a tertiary hospital COVID-19 VW between 1 December 2021 and 30 June 2022. Utilisation and epidemiological characteristics were assessed for all patients while additional demographics, assessments, treatments and outcomes were assessed for patients admitted to the hospital from the VW., Results: Of 9494 patient admissions, 269 (2.83%) patients identified as Aboriginal and Torres Strait Islander and 1774 (18.69%) were unvaccinated. The median length of stay was 5.10 days and the mean Index of Relative Socio-economic Advantage and Disadvantage decile was 5.73. One hundred sixty (1.69%) patients were admitted to the hospital from the VW, of which 25 were adults admitted to medical wards. Of this cohort, prominent comorbidities were obesity, hypertension, asthma and frailty, while the main symptoms on admission to the VW were cough, fatigue, nausea and sore throat. High Pandemic Respiratory Infection Emergency System Triage (PRIEST), Veterans Health Administration COVID-19 (VACO), COVID Home Safely Now (CHOSEN) and 4C mortality scores existed for those readmitted., Conclusions: This VW model of care was both safe and effective when applied to a broad socioeconomic population during the COVID-19 pandemic. While readmission to the hospital was low, this study identified key characteristics of such presentations, which may assist future triaging, escalation and resource allocation within VWs during the COVID-19 pandemic and beyond., (© 2023 Royal Australasian College of Physicians.)

The increasing demand for cage-free (CF) poultry farming raises concern regarding air pollutant emissions in these housing systems. Previous studies have indicated that air pollutants such as particulate matter (PM) and ammonia (NH 3 ) pose substantial risks to the health of birds and workers. This study aimed to evaluate the efficacy of electrostatic particle ionization (EPI) technology with different lengths of ion precipitators in reducing air pollutants and investigate the relationship between PM reduction and electricity consumption. Four identical CF rooms were utilized, each accommodating 175 hens of 77 wk of age (WOA). A Latin Square Design method was employed, with 4 treatment lengths: T1 = control (0 m), T2 = 12 ft (3.7 m), T3 = 24 ft (7.3 m), and T4 = 36 ft (11.0 m), where room and WOA are considered as blocking factors. Daily PM concentrations, temperature, and humidity measurements were conducted over 24 h, while NH 3 levels, litter moisture content (LMC), and ventilation were measured twice a week in each treatment room. Statistical analysis involved ANOVA, and mean comparisons were performed using the Tukey HSD method with a significance level of P ≤ 0.05. This study found that the EPI system with longer wires reduced PM 2.5 concentrations (P ≤ 0.01). Treatment T2, T3, and T4 led to reductions in PM 2.5 by 12.1%, 19.3%, and 31.7%, respectively, and in small particle concentrations (particle size >0.5 μm) by 18.0%, 21.1%, and 32.4%, respectively. However, no significant differences were observed for PM 10 and large particles (particle size >2.5 μm) (P < 0.10), though the data suggests potential reductions in PM 10 (32.7%) and large particles (33.3%) by the T4 treatment. Similarly, there was no significant impact of treatment on NH 3 reduction (P = 0.712), possibly due to low NH 3 concentration (<2 ppm) and low LMC (<13%) among treatment rooms. Electricity consumption was significantly related to the length of the EPI system (P ≤ 0.01), with longer lengths leading to higher consumption rates. Overall, a longer-length EPI corona pipe is recommended for better air pollutant reduction in CF housing. Further research should focus on enhancing EPI technology, assessing cost-effectiveness, and exploring combinations with other PM reduction strategies., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Inflammation is a common condition of prostate tissue, whose impact on carcinogenesis is highly debated. Microbial colonization is a well-documented cause of a small percentage of prostatitis cases, but it remains unclear what underlies the majority of sterile inflammation reported. Here, androgen- independent fluctuations of PSA expression in prostate cells have lead us to identify a prominent function of the Transient Receptor Potential Cation Channel Subfamily M Member 8 (TRPM8) gene in sterile inflammation. Prostate cells secret TRPM8 RNA into extracellular vesicles (EVs), which primes TLR3/NF-kB-mediated inflammatory signaling after EV endocytosis by epithelial cancer cells. Furthermore, prostate cancer xenografts expressing a translation-defective form of TRPM8 RNA contain less collagen type I in the extracellular matrix, significantly more infiltrating NK cells, and larger necrotic areas as compared to control xenografts. These findings imply sustained, androgen-independent expression of TRPM8 constitutes as a promoter of anticancer innate immunity, which may constitute a clinically relevant condition affecting prostate cancer prognosis., (© 2024. The Author(s).)

Introduction: Hospital-based studies have demonstrated topical applications of sunflower seed oil (SSO) to skin of preterm infants can reduce nosocomial infections and improve survival. In South Asia, replacing traditional mustard with SSO might have similar benefits., Methods: 340 communities in Sarlahi, Nepal were randomised to use mustard oil (MO) or SSO for community practice of daily newborn massage. Women were provided oil in late pregnancy and the first month post partum, and visited daily through the first week of life to encourage massage practice. A separate data collection team visited on days 1, 3, 7, 10, 14, 21 and 28 to record vital status and assess serious bacterial infection., Results: Between November 2010 and January 2017, we enrolled 39 479 pregnancies. 32 114 live births were analysed. Neonatal mortality rates (NMRs) were 31.8/1000 (520 deaths, 16 327 births) and 30.5/1000 (478 deaths, 15 676 births) in control and intervention, respectively (relative risk (RR)=0.95, 95% CI: 0.84, 1.08). Among preterm births, NMR was 90.4/1000 (229 deaths, 2533 births) and 79.2/1000 (188 deaths, 2373 births) in control and intervention, respectively (RR=0.88; 95% CI: 0.74, 1.05). Among preterm births <34 weeks, the RR was 0.83 (95% CI: 0.67, 1.02). No statistically significant differences were observed in incidence of serious bacterial infection., Conclusions: We did not find any neonatal mortality or morbidity benefit of using SSO instead of MO as emollient therapy in the early neonatal period. Further studies examining whether very preterm babies may benefit are warranted., Trial Registration Number: ClinicalTrials.gov Registry (NCT01177111)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Abbreviations: AFM: aromatic finger mutant; BH3D: BCL2 homology 3 domain; CCD: coiled-coil domain; CD: circular dichroism spectroscopy; [CysDM1]: C18S and C21S double mutant; [CysDM2]: C137S, and C140S double mutant; [CysTM], C18S, C21S, C137S, and C140S tetrad mutant; D max : maximum particle diameter; dRI, differential refractive index; EFA: evolving factor analysis; FHD: flexible helical domain; FL: full length; GFP: green fluorescent protein; HDX-MS: hydrogen/deuterium exchange mass spectrometry; ICP-MS: inductively coupled plasma mass spectrometry; IDR: intrinsically disordered region; ITC, isothermal titration calorimetry; MALS, multi angle light scattering; MBP: maltose-binding protein; MoRFs: molecular recognition features; P(r): pairwise-distance distribution; PtdIns3K: class III phosphatidylinositol 3-kinase; R g : radius of gyration; SASBDB: small angle scattering biological data bank; SEC: size-exclusion chromatography; SEC-SAXS: size-exclusion chromatography in tandem with small angle X-ray scattering; TEV: tobacco-etch virus; TFE: 2,2,2-trifluoroethanol; TPEN: N,N,N,N-tetrakis(2-pyridinylmethyl)-1,2-ethanediamine; Vc: volume of correlation; WT: wild-type.

Toxic megacolon and pulmonary nodules are not seen frequently on diagnosis in pediatric ulcerative colitis patients. This report emphasizes the importance of carefully evaluating and managing complications in pediatric ulcerative colitis cases, especially in the presence of pulmonary nodules.

Introduction: Intimate partner violence (IPV) is a significant public health, human rights, and development issue. While existing evidence posits that addressing social norms is key to IPV prevention, successful IPV interventions that include a norms approach are limited in number and methodological rigor and rarely include a formal investigation of the diffusion of intervention impact. We contribute novel findings to this intellectual and programmatic space with evidence on a social and behavior change communication (SBCC) intervention (Change Starts at Home) in Nepal designed to prevent IPV and shift social norms towards greater gender equity., Methods: Participants included 442 married women across 13 communities assessed at three timepoints: before intervention (baseline), at the completion of the core couple's curriculum and edutainment (midline), and at the conclusion of the diffusion curriculum (endline). Generalized estimating equations with propensity-score adjustments were used to determine change in outcomes at midline and endline for two intervention conditions (direct beneficiary, N  = 173; and resident of the intervention community, ( N  = 178) relative to control ( N  = 91)., Results: IPV victimization significantly decreased in both intervention conditions at midline, with larger reductions in direct beneficiaries. At endline, direct beneficiaries had sustained reduction in IPV relative to control participants. Positive injunctive norms also significantly improved by midline for both intervention groups, whereas improvements in descriptive norms for intervention groups were matched by improvements in the control group at both midline and endline. Several secondary outcomes showed significant improvements for both intervention groups at midline and/or endline, including in-law violence, financial decision-making, communication, and relationship quality, with additional improvements for the direct beneficiaries in attitudes, leadership, GBV advocacy, and diffusion., Conclusion: This study sheds light on the effectiveness of the Change intervention, the role of addressing social norms in IPV prevention efforts, and the benefits of organized diffusion., Competing Interests: None., (© 2023 The Authors.)

Background: Oral Pathology curriculum is taught as didactic lectures which promotes rote learning. This study intends to introduce and assess the impact of Case based Learning in student's performance and to obtain the perception of students towards it., Methods: This cross-sectional study was conducted from March 2021 to January 2022 among dental undergraduate students (N=25) of Gandaki Medical College, Pokhara. The syllabus of Potentially Malignant Oral Lesions and Oral Cancer were covered for BDS third year students by didactic lectures, followed by Case Based Learning sessions (session I- Oral Leukoplakia, session II- Oral Squamous Cell Carcinoma). A pre-test and post-test, containing Multiple Choice questions relevant to the topics, were administered before and after the interventions. Students' perceptions were collected using feedback questionnaire. The scores obtained in the pre and post-test were compared by Wilcoxon pair test and Mann Whitney U test. The level of significance was set at p <0.05., Results: Twenty and 21 students participated in session I and II respectively, and all (100%) of them felt that the case scenarios made the subject more interesting, and 19 (90.5%) students felt more such sessions should be added and be used along with lectures. Post test score after case-based learning was significantly higher (For Oral Leukoplakia p=0.028, for Oral Squamous Cell Carcinoma p<0.001) in comparison to didactic lectures., Conclusions: As case-based learning was positively perceived and preferred along with lectures, an attempt to incorporate it along with lectures in clinically important topics should be made.

Nepal initiated numerous hydropower and irrigation-related infrastructure projects to enhance and promote green energy, water security, and agricultural productivity. However, these projects may pose risks to natural habitats and the well-being of aquatic fauna, leading to significant effects on delicate ecosystems. To understand these potential impacts, it is crucial to gather reliable baseline data on the population status and habitat characteristics of species. This study specifically focuses on Gharials ( Gavialis gangeticus ), a critically endangered species. We recorded data on pre-determined habitat variables at stations spaced 500 m apart along the two major river streams of Bardia National Park, as well as at locations where Gharials were sighted between February and March 2023. We used binary logistic regression with a logit link function to investigate the habitat characteristics related to the occurrence of Gharials. The presence/absence of Gharials at sampling points served as the dependent variable, while 10 other predetermined variables (ecological variables and disturbance variables) served as independent variables. Our study recorded 23 Gharials, comprising 14 adults, six sub-adults, and three juveniles, with a sex ratio of 55.56 males per 100 females. Most individuals (83%) were found basking. Among the 10 habitat predictors, three variables (mid-river depth, river width, and water temperature) were significantly correlated ( p  < .05) with the probability of Gharial occurrence. The model shows that Gharial detection probability increases with greater mid-river depth and width and lower water temperature. This study establishes a population baseline for Gharials within the river system before the construction of large infrastructure projects, such as dams and irrigation canals. It also recommends continuous monitoring of Gharial populations after water release and/or diversion to evaluate the impact of large infrastructure projects on the population and their associated habitat characteristics. This will help enable more informed and targeted conservation efforts., (© 2023 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)

Heparan sulfate (HS) plays a critical role in various biological processes as a vital component of the extracellular matrix. In this study, we synthesized three fluorescent probes (1-3) comprising Arg-rich peptides as HS receptors and a fluorophore capable of exhibiting red-shifted emissions upon aggregation. All three probes demonstrated ratiometric responses to HS and heparin in aqueous solutions. Remarkably, probe 3 exhibited a unique ratiometric response to HS in both aqueous solutions at physiological pH and HS proteoglycans on live cells. Probe 3 displayed exceptional sensing properties, including high biocompatibility, water solubility, visible light excitation, a large Stokes shift for ratiometric detection and remarkable selectivity and sensitivity for HS (with a low limit of detection: 720 pM). Binding mode studies unveiled the crucial role of charge interactions between probe 3 and negatively charged HS sugar units. Upon binding, the fluorophore segments of the probes overlapped, inducing green and red emission changes through restricted intramolecular rotation of the fluorophore moiety. Importantly, probe 3 was effectively employed to quantify the reduction of HS proteoglycan levels in live cells by inhibiting HS sulfation using siRNA and an inhibitor. It successfully detected decreased HS levels in cells treated with doxorubicin and irradiation, consistent with results obtained from western blot and immunofluorescence assays. This study presents the first ratiometric fluorescent probe capable of quantitatively detecting HS levels in aqueous solutions and live cells. The unique properties of peptide-based probe 3 make it a valuable tool for studying HS biology and potentially for diagnostic applications in various biological systems., 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 © 2023 Elsevier B.V. All rights reserved.)

In recent years, it has been shown that the liquid-liquid phase separation (LLPS) of virus proteins plays a crucial role in their life cycle. It promotes the formation of viral replication organelles, concentrating viral components for efficient replication and facilitates the assembly of viral particles. LLPS has emerged as a crucial process in the replication and assembly of herpes simplex virus-1 (HSV-1). Recent studies have identified several HSV-1 proteins involved in LLPS, including the myristylated tegument protein UL11 and infected cell protein 4; however, a complete proteome-level understanding of the LLPS-prone HSV-1 proteins is not available. We provide a comprehensive analysis of the HSV-1 proteome and explore the potential of its proteins to undergo LLPS. By integrating sequence analysis, prediction algorithms and an array of tools and servers, we identified 10 HSV-1 proteins that exhibit high LLPS potential. By analysing the amino acid sequences of the LLPS-prone proteins, we identified specific sequence motifs and enriched amino acid residues commonly found in LLPS-prone regions. Our findings reveal a diverse range of LLPS-prone proteins within the HSV-1, which are involved in critical viral processes such as replication, transcriptional regulation and assembly of viral particles. This suggests that LLPS might play a crucial role in facilitating the formation of specialized viral replication compartments and the assembly of HSV-1 virion. The identification of LLPS-prone proteins in HSV-1 opens up new avenues for understanding the molecular mechanisms underlying viral pathogenesis. Our work provides valuable insights into the LLPS landscape of HSV-1, highlighting potential targets for further experimental validation and enhancing our understanding of viral replication and pathogenesis., (© 2023 Wiley Periodicals LLC.)

Objectives: To assess the association between maternal characteristics, adverse birth outcomes (small-for-gestational-age (SGA) and/or preterm) and neonatal mortality in rural Nepal., Design: This is a secondary observational analysis to identify risk factors for neonatal mortality, using data from a randomised trial to assess the impact of newborn massage with different oils on neonatal mortality in Sarlahi district, Nepal., Setting: Rural Sarlahi district, Nepal., Participants: 40 119 pregnant women enrolled from 9 September 2010 to 16 January 2017., Main Outcome: The outcome variable is neonatal death. Cox regression was used to estimate adjusted Hazard Ratios (aHRs) to assess the association between adverse birth outcomes and neonatal mortality., Results: There were 32 004 live births and 998 neonatal deaths. SGA and/or preterm birth was strongly associated with increased neonatal mortality: SGA and preterm (aHR: 7.09, 95% CI: (4.44 to 11.31)), SGA and term/post-term (aHR: 2.12, 95% CI: (1.58 to 2.86)), appropriate-for-gestational-age/large-for-gestational-age and preterm (aHR: 3.23, 95% CI: (2.30 to 4.54)). Neonatal mortality was increased with a history of prior child deaths (aHR: 1.53, 95% CI: (1.24 to 1.87)), being a twin or triplet (aHR: 5.64, 95% CI: (4.25 to 7.48)), births at health posts/clinics or in hospital (aHR: 1.34, 95% CI: (1.13 to 1.58)) and on the way to facilities or outdoors (aHR: 2.26, 95% CI: (1.57 to 3.26)). Risk was lower with increasing maternal height from <145 cm to 145-150 cm (aHR: 0.78, 95% CI: (0.65 to 0.94)) to ≥150 cm (aHR: 0.57, 95% CI: (0.47 to 0.68)), four or more antenatal care (ANC) visits (aHR: 0.67, 95% CI: (0.53 to 0.86)) and education >5 years (aHR: 0.75, 95% CI: (0.62 to 0.92))., Conclusion: SGA and/or preterm birth are strongly associated with increased neonatal mortality. To reduce neonatal mortality, interventions that prevent SGA and preterm births by promoting ANC and facility delivery, and care of high-risk infants after birth should be tested., Trial Registration Number: NCT01177111., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Discrete data such as counts of microbiome taxa resulting from next-generation sequencing are routinely encountered in bioinformatics. Taxa count data in microbiome studies are typically high-dimensional, over-dispersed, and can only reveal relative abundance therefore being treated as compositional. Analyzing compositional data presents many challenges because they are restricted to a simplex. In a logistic normal multinomial model, the relative abundance is mapped from a simplex to a latent variable that exists on the real Euclidean space using the additive log-ratio transformation. While a logistic normal multinomial approach brings flexibility for modeling the data, it comes with a heavy computational cost as the parameter estimation typically relies on Bayesian techniques. In this paper, we develop a novel mixture of logistic normal multinomial models for clustering microbiome data. Additionally, we utilize an efficient framework for parameter estimation using variational Gaussian approximations (VGA). Adopting a variational Gaussian approximation for the posterior of the latent variable reduces the computational overhead substantially. The proposed method is illustrated on simulated and real datasets., (© 2023. Springer Nature Limited.)

This study aimed to investigate the performance of oyster mushrooms on different substrate combinations, including rice straw alone, rice straw and water hyacinth (1:1), rice straw and water hyacinth (1:2), and rice straw and water hyacinth (2:1), in Pokhara, Kaski from April to June in 2022. A Completely Randomized Design with four replications was used to analyze the growth and yield parameters of the four different substrate combinations. The data were analyzed using R-Studio. Highly significant results (P > 0.001) were found in all growth and yield parameters. The best response in terms of days to colonization, pinhead formation, and total crop duration was observed with rice straw alone (11.5, 13.25, and 54.00 days, respectively). The stipe length, pileus diameter, and fruiting body per bunch had their highest values (3.44 cm, 5.21 cm, and 34.50 cm, respectively) with rice straw alone, followed by rice straw and water hyacinth in a 2:1 ratio (3.05 cm, 4.63 cm, and 34.25 cm, respectively). The maximum total fresh yield of mushrooms (1.53 kg with 153.16% BE) was observed for rice straw alone, followed by rice straw and water hyacinth in a 2:1 ratio (1.17 kg with 116.5% BE), while the poorest yield (0.76 kg with 76.38% BE) was observed in the case of rice straw and water hyacinth in a 1:2 ratio. The highest profitability was observed for mushroom production using rice straw alone with a B:C ratio of 1.24, followed by using rice straw and water hyacinth in a 2:1 ratio (1.03), while the lowest B:C ratio was observed for rice straw and water hyacinth in a 1:2 ratio (0.74). Overall, the best treatment was found to be rice straw alone, followed by rice straw and water hyacinth in a 2:1 ratio. These results suggest that using rice straw alone or in combination with water hyacinth in a 2:1 ratio can be an effective strategy for oyster mushroom cultivation., Competing Interests: 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., (© 2023 The Authors.)

Introduction: The COVID-19 pandemic has expanded the use of telemedicine to patient populations that were previously constrained to in-person visits. Few studies have investigated the role that telemedicine plays in shaping the care of these patient populations. This project explores the impact of telemedicine for one such population: patients and parents of gender-diverse individuals seeking gender-affirming surgery., Methods: A 10-question survey using previously validated questions was completed by 34 patients and 9 parents of patients (aged 15-31) who received virtual care at the Center for Gender Surgery at Boston Children's Hospital between March 2020 and April 2021. The survey was divided into two parts. The first section collected demographic information. The second assessed participant perspectives on remote surgical gender care through a series of Likert-type and open-ended questions., Results: A total of 100% of the respondents felt that their telemedicine visit was convenient; 60% (18) of the patients and 87% (7) of the parents stated that they look forward to future use of this modality. Free responses highlighted common perspectives on remote surgical gender care, including the increased accessibility of gender-affirming care through telehealth, the limitations of telehealth for addressing physical and relational aspects of gender care, patients' desire for autonomy and privacy during telehealth visits, and parents' desire to be involved throughout their children's gender journey., Conclusion: These results demonstrate the unique ability of telemedicine, if implemented thoughtfully, to enhance outcomes for patients seeking surgical gender affirmation., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

We describe an unusual presentation of myeloperoxidase positive antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis managed by a multidisciplinary approach. A 75-year-old man gave a 3-week history of proximal lower limb weakness and exertional myalgia. His serum creatine kinase was normal and many of his non-specific symptoms suggested small vessel vasculitis. His investigations for common causes of muscle weakness were normal, and renal biopsy was normal despite haemoproteinuria. CT scan of the chest identified a pulmonary nodule of uncertain significance, not amenable to biopsy. MR scan of the thighs showed muscle oedema, and muscle biopsy confirmed typical features of vasculitis. Following high-dose corticosteroids his exertional myalgia quickly resolved and his normal mobility returned. Early immunosuppression is essential to improving clinical outcomes in ANCA-associated vasculitis, but diagnostic investigations often lack sensitivity., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Infliximab (IFX) is commonly used to treat children with inflammatory bowel disease (IBD). We previously reported that patients with extensive disease started on IFX at a dose of 10 mg/kg had greater treatment durability at year one. The aim of this follow-up study is to assess the long-term safety and durability of this dosing strategy in pediatric IBD., Methods: We performed a retrospective single-center study of pediatric IBD patients started on IFX over a 10-year period., Results: Two hundred ninety-one patients were included (mean age = 12.61, 38% female) with a follow-up range of 0.1-9.7 years from IFX induction. One hundred fifty-five (53%) were started at a dose of 10 mg/kg. Only 35 patients (12%) discontinued IFX. The median duration of treatment was 2.9 years. Patients with ulcerative colitis ( P ≤ 0.01) and patients with extensive disease ( P = 0.01) had lower durability, despite a higher starting dose of IFX ( P = 0.03). Adverse events (AEs) were observed to occur at a rate of 234 per 1000 patient-years. Patients with a higher serum IFX trough level (≥20 µg/mL) had a higher rate of AEs ( P = 0.01). Use of combination therapy had no impact on risk of AEs ( P = 0.78)., Conclusions: We observed an excellent IFX treatment durability, with only 12% of patients discontinuing therapy over the observed timeframe. The overall rate of AEs was low, the majority being infusion reactions and dermatologic conditions. Higher IFX dose and serum trough level> 20 µg/mL were associated with higher risk of AEs, the majority being mild and not resulting in cessation of therapy., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 by European Society for European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)

Introduction: Infant and neonatal mortality estimates are typically derived from retrospective birth histories collected through surveys in countries with unreliable civil registration and vital statistics systems. Yet such data are subject to biases, including under-reporting of deaths and age misreporting, which impact mortality estimates. Prospective population-based cohort studies are an underutilized data source for mortality estimation that may offer strengths that avoid biases., Methods: We conducted a secondary analysis of data from the Child Health Epidemiology Reference Group, including 11 population-based pregnancy or birth cohort studies, to evaluate the appropriateness of vital event data for mortality estimation. Analyses were descriptive, summarizing study designs, populations, protocols, and internal checks to assess their impact on data quality. We calculated infant and neonatal morality rates and compared patterns with Demographic and Health Survey (DHS) data., Results: Studies yielded 71,760 pregnant women and 85,095 live births. Specific field protocols, especially pregnancy enrollment, limited exclusion criteria, and frequent follow-up visits after delivery, led to higher birth outcome ascertainment and fewer missing deaths. Most studies had low follow-up loss in pregnancy and the first month with little evidence of date heaping. Among studies in Asia and Latin America, neonatal mortality rates (NMR) were similar to DHS, while several studies in Sub-Saharan Africa had lower NMRs than DHS. Infant mortality varied by study and region between sources., Conclusions: Prospective, population-based cohort studies following rigorous protocols can yield high-quality vital event data to improve characterization of detailed mortality patterns of infants in low- and middle-income countries, especially in the early neonatal period where mortality risk is highest and changes rapidly., (© 2023. The Author(s).)

Background: With the technological advances, microincision pars plana vitrectomy is commonly used method for primary treatment of eyes with rhegmatogenous retinal detachment. Objective of this study is to evaluate anatomical and visual outcomes of microincision pars plana vitrectomy in eyes with rhegmatogenous retinal detachment., Methods: This was a hospital based prospective observational study done in Tilganga Institute of Ophthalmology, Kathmandu, Nepal. All consecutive cases of rhegmatogenous retinal detachment who underwent primary microincision pars plana vitrectomy from October 2020 to March 2021 were included in the study. Patients were evaluated at baseline, postoperative day 1, 1 week, 6 weeks and 3 months. Outcome measures evaluated were anatomical results, visual outcomes and complications of the surgery., Results: Forty-nine eyes with rhegmatogenous retinal detachment treated with primary microincision pars plana vitrectomy with minimum follow up of at least 3 months were evaluated. Anatomical success was achieved in 91.8% of cases (45/49). Baseline mean best corrected visual acuity was logMAR 1.63±0.88 and median best corrected visual acuity was 2.00 (range 0.00 to 2.70) while at 3 months follow up mean best corrected visual acuity was logMAR 1.22±0.66 and median BCVA was 1.00 ( range 0.00 to 2.70). There was significant improvement in median BCVA ( p= 0.005). There were no cases of postoperative hypotony and endophthalmitis. Other complications were also minimal such as silicon oil in anterior chamber in 1 eye, epiretinal membrane in 3 eyes and macular hole in 2 eyes., Conclusions: Microincision pars plana vitrectomy is an effective surgical method of primary treatment for rhegmatogenous retinal detachment with good anatomical and visual outcomes with minimal complications.

Defective eggs diminish the value of laying hen production, particularly in cage-free systems with a higher incidence of floor eggs. To enhance quality, machine vision and image processing have facilitated the development of automated grading and defect detection systems. Additionally, egg measurement systems utilize weight-sorting for optimal market value. However, few studies have integrated deep learning and machine vision techniques for combined egg classification and weighting. To address this gap, a two-stage model was developed based on real-time multitask detection (RTMDet) and random forest networks to predict egg category and weight. The model uses convolutional neural network (CNN) and regression techniques were used to perform joint egg classification and weighing. RTMDet was used to sort and extract egg features for classification, and a Random Forest algorithm was used to predict egg weight based on the extracted features (major axis and minor axis). The results of the study showed that the best achieved accuracy was 94.8% and best R2 was 96.0%. In addition, the model can be used to automatically exclude non-standard-size eggs and eggs with exterior issues (e.g., calcium deposit, stains, and cracks). This detector is among the first models that perform the joint function of egg-sorting and weighing eggs, and is capable of classifying them into five categories (intact, crack, bloody, floor, and non-standard) and measuring them up to jumbo size. By implementing the findings of this study, the poultry industry can reduce costs and increase productivity, ultimately leading to better-quality products for consumers.

The purpose of this study is to assess the safety and efficacy of finerenone therapy in type 2 diabetes mellitus (T2DM) patients with cardiovascular and chronic renal diseases. This meta-analysis assesses the efficacy and safety of finerenone in the treatment of diabetic kidney disease (DKD). A comprehensive search of PubMed, Embase, and Google Scholar databases was performed to identify relevant randomized controlled trials (RCTs). To quantify the effects of finerenone, the analysis included the estimation of aggregated mean differences (MDs) and relative risks (RRs), as well as 95% confidence intervals (CIs). This meta-analysis included seven double-blind trials with patients suffering from chronic kidney disease (CKD) and T2D. Participants received finerenone or a placebo was assigned at random. The primary efficacy outcomes were cardiovascular mortality, non-fatal myocardial infarction, non-fatal stroke, hospitalization for heart failure, kidney failure, a sustained 57% decrease in the estimated glomerular filtration rate from baseline over four weeks, or renal death. Among the 39,995 patients included in the analysis, finerenone treatment was associated with a lower risk of cardiovascular and renal-related mortality compared to placebo (RR = 0.86 (0.80, 0.93), p = 0.0002; I-squared statistic (I 2  ) = 0%) and (RR = 0.56 (0.17, 1.82), p = 0.34; I 2  = 0%). In addition, finerenone treatment was associated with a marginally reduced risk of serious adverse events (RR = 0.95 (0.92, 0.97), p = 0.0001; I 2  = 0%), although no significant difference in the overall risk of adverse events was observed between the two groups (RR = 1.00 (0.99, 1.01), p = 0.56; I 2  = 0%). This study's findings suggest that finerenone administration can reduce the risk of end-stage kidney disease, renal failure, cardiovascular mortality, and hospitalization. Patients with both T2DM and CKD are therefore advised to consider finerenone therapy., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Jyotsna et al.)

Purpose: Methicillin-resistant Staphylococcus aureus , a common bacterial pathogen causes various infections. The acquisition of various antimicrobial-resistant genes in S. aureus has led to the transformation of this bacterium into a superbug. Vancomycin resistance among MRSA isolates is an emerging threat in empirical therapy of various infections. The study was hence aimed to find out the susceptibility status of S. aureus isolates toward vancomycin and detect mecA, vanA , and vanB genes among the isolates., Methods: A total of 1245 clinical samples from the participants attending a tertiary care hospital in Kathmandu were processed. S. aureus isolated from the samples were subjected to antibiotic susceptibility patterns using the modified Kirby-Bauer disk diffusion method. Agar dilution method was used to determine the minimum inhibitory concentration of vancomycin. The antibiotic-resistant genes such as mecA, vanA , and vanB among S. aureus isolates were screened by a conventional polymerase chain reaction., Results: Of 1245 samples, 80 S. aureus were identified. Out of which, 47.5% (38/80) were phenotypically confirmed MRSA isolates. mec A gene was detected in 84.2% (32/38) of MRSA isolates. 10.5% (4/38) were confirmed as vancomycin-intermediate S. aureus (VISA) by MIC determination. None of the isolates was positive for the vanA gene; however, 2 isolates were found to possess the vanB gene. The 2 isolates have vancomycin MIC breakpoints of 4 to 8 μg/mL., Conclusion: There might be a spreading of vancomycin resistance among S. aureus , creating serious public health problems. Therefore, measures to limit vancomycin resistance should be considered in healthcare facilities as immediately as possible., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Floor egg-laying behavior (FELB) is one of the most concerning issues in commercial cage-free (CF) houses because floor eggs (i.e., mislaid eggs on the floor) result in high labor costs and food safety concerns. Farms with poor management may have up to 10% of daily floor eggs. Therefore, it is critical to improving floor eggs management. Detecting FELB timely and identifying the reason behind its cause may address the issue. The primary objectives of this research were to develop and test a new deep-learning model to detect FELB and evaluate the model's performance in 4 identical research CF houses (200 Hy-Line W-36 hens per house), where perches and litter floor were provided to mimic commercial tiered aviary system. Five different YOLOv5 models (i.e., YOLOv5n, YOLOv5s, YOLOv5m, YOLOv5l, and YOLOv5x) were trained and compared. According to a dataset of 5400 images (i.e., 3780 for training, 1080 for validation, and 540 for testing), YOLOv5m-FELB and YOLOv5x-FELB models were tested with higher precision (99.9%), recall (99.2%), mAP@0.50 (99.6%), and F1-score (99.6%) than others. However, the YOLOv5m-NFELB model has lower recall than other YOLOv5-NFELB models, although it was tested with higher precision. Similarly, the speed of data processing (4%-45% FPS), and training time (3%-148%) were higher in the YOLOv5s model while requiring less GPU (1.8-4.8 times) than in other models. Furthermore, the camera height of 0.5 m and clean camera outperform compared to 3 m height and dusty camera. Thus, the newly developed and trained YOLOv5s model will be further innovated. Future studies will be conducted to verify the performance of the model in commercial CF houses to detect FELB., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Bone metastasis of hepatocellular carcinoma (HCC) is usually seen in the course of advanced intrahepatic HCC. Isolated bone metastasis as an initial manifestation of HCC is uncommon., Case Presentation: The authors report a case of a 68-year-old male with a history of chronic alcohol consumption who presented with epigastric pain, abdominal distension, and a hard, tender lump on the right posterolateral aspect of his back. Investigation revealed HCC with isolated metastasis to the posterior thoracic wall., Clinical Discussion: HCC usually develops secondary to chronic hepatitis B and C infection in the background of chronic liver disease. Common presenting symptoms of bone metastasis include local pain, neurological manifestations, palpable subcutaneous masses, and pathological fractures. An immunohistochemistry analysis is important to differentiate HCC from non-HCC metastasis in patients without known underlying HCC. Treatment is often directed towards palliative care as the prognosis is poor., Conclusion: An isolated rib mass can be an initial presentation of metastatic HCC. Thus, HCC with bone metastasis should be considered in the differential diagnosis in patients presenting with painful swelling in the thoracic region., Competing Interests: None to declare., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

The detection of Pb 2+ ions in aquatic environments and biofluid samples is crucial for assessment of human health. Herein, we synthesized two fluorescent probes (1 and 2) consisting of the peptide receptor for Pb 2+ and a benzothiazolyl-cyanovinylene fluorophore that exhibited excimer-like emission when it aggregated. The peptide-based probes sensitively detected Pb 2+ in purely aqueous solution (1% DMF) through ratiometric fluorescent response with a decrease in monomer emission at 520 nm and an increase in excimer emission at 570 nm. Specially, probe 2 showed remarkable detection features such as high selectivity for Pb 2+ over 15 metal ions, high binding affinity (K d  = 5.83 × 10 -7 M) for Pb 2+ , significant emission intensity changes, low detection limit (3.8 nM) of Pb 2+ , high water solubility, and visible light excitation (450 nm). Probe 2 was successfully used to quantify nanomolar concentration (0 ∼ 800 nM) of Pb 2+ in real water samples (ground water and tap water). Specially, 2 was successfully applied for the quantification of Pb 2+ in human serum by combination of microwave-assisted human serum digestion and filtration of digested serum by anion exchange cartridge. We clearly investigated the binding mode of 2 with Pb 2+ using 1 H NMR, IR spectroscopy, pH titration, confocal microscopy, and size analysis. The peptide-based fluorescent probe might have great application potential for sensing Pb 2+ in aquatic environments and biofluid samples., 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 © 2023 Elsevier B.V. All rights reserved.)

Photonic crystals (PC) are of great importance in technology, especially in optics and photonics. In general, the structural color of PCs responds to external stimuli primarily by changing their periodicity. Herein, the authors report on refractive index (RI) adaptive PCs. Cross-linked cholesteric films with interconnected nanopores exhibit a very low RI without light scattering. Transparent PC films with maximum reflectance in the ultravoilet (UV) region respond to various chemicals by changing the reflective color of the PC. The authors demonstrate its unique colorimetric chemical detections of hazardous organic liquids. Loading various chemicals into nanopores significantly shifts the structural color into the visible range depending on the chemical's RI. These results are unique in that the structural color of photonic films is mediated by RI changes rather than periodicity changes. In principle, nanoporous photonic crystal films can detect the RI of a chemical substance by its unique color. In contrast to volumetric changes, this sensing mechanism offers several advantages, including durability, excellent sensitivity, fast response time, and wide detection range. These results provide useful insight into stimulus-responsive PCs. The structural color of PC films can be effectively tuned by adjusting average RIs instead of changing periodicity., (© 2023 Wiley-VCH GmbH.)

Some of the major restaurants and grocery chains in the United States have pledged to buy cage-free (CF) eggs only by 2025 or 2030. While CF house allows hens to perform more natural behaviors (e.g., dust bathing, perching, and foraging on the litter floor), a particular challenge is floor eggs (i.e., mislaid eggs on litter floor). Floor eggs have high chances of contamination. The manual collection of eggs is laborious and time-consuming. Therefore, precision poultry farming technology is necessary to detect floor eggs. In this study, 3 new deep learning models, that is, YOLOv5s-egg, YOLOv5x-egg, and YOLOv7-egg networks, were developed, trained, and compared in tracking floor eggs in 4 research cage-free laying hen facilities. Models were verified to detect eggs by using images collected in 2 different commercial houses. Results indicate that the YOLOv5s-egg model detected floor eggs with a precision of 87.9%, recall of 86.8%, and mean average precision (mAP) of 90.9%; the YOLOv5x-egg model detected the floor eggs with a precision of 90%, recall of 87.9%, and mAP of 92.1%; and the YOLOv7-egg model detected the eggs with a precision of 89.5%, recall of 85.4%, and mAP of 88%. All models performed with over 85% detection precision; however, model performance is affected by the stocking density, varying light intensity, and images occluded by equipment like drinking lines, perches, and feeders. The YOLOv5x-egg model detected floor eggs with higher accuracy, precision, mAP, and recall than YOLOv5s-egg and YOLOv7-egg. This study provides a reference for cage-free producers that floor eggs can be monitored automatically. Future studies are guaranteed to test the system in commercial houses., (Copyright © 2023. Published by Elsevier Inc.)

Introduction: Traumatic brain injuries are one of the leading causes of mortality, morbidity, and economic burden in context to Nepal. Non-contrast computed tomography is used for rapid diagnosis and repeat computed tomography helps to detect the progression and complications of cerebral injury. The aim of this study was to find out the prevalence of traumatic brain injury among patients admitted in the neurosurgical unit in a tertiary care centre., Methods: This descriptive cross-sectional study was conducted among patients admitted to the neurosurgery unit in the tertiary care centre from 1 August 2019 to 29 August 2020. Ethical approval was taken from Institutional Review Committee (Reference number: CMC-IRC/075/076-156). Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated., Results: Among 350 patients admitted in the neurosurgical unit, the prevalence of traumatic brain injury was 140 (40%) (34.87-45.13, 95% Confidence Interval). Change in management was required among 28 (20%) when computed tomography was done within 12-24 hours. Among them, 27 (19.29%) underwent surgical intervention after a repeat computed tomography scan., Conclusions: The prevalence of traumatic brain injury was found to be higher than similar studies done in similar settings., Keywords: contusion; craniotomy; traumatic brain injury.

Optimal treatment regimen for patients with antiphospholipid syndrome (APS) remain unclear. Therefore, the authors sought to compare the outcomes of vitamin K antagonists (VKAs) vs. direct oral anticoagulants (DOACs) in patients with APS., Methods: MEDLINE, Embase, and Cochrane Central databases were searched for randomized controlled trials comparing efficacy and safety of VKAs and DOACs inhibitors in patients with APS. Recurrent thrombosis, all-cause mortality, stroke, adverse reactions, and bleeding were among outcomes of interest. Mantel-Haenszel weighted random-effects model was used to calculate relative risks (RRs) with 95% CIs., Results: The analysis included 625 patients from four randomized controlled trials and one post hoc analysis. Meta-analysis showed statistically non-significant difference between DOACs inhibitors and VKAs in the recurrent thrombosis risk (arterial or venous) [RR 2.77 (95%, CI 0.79, 9.65); P =0.11, I 2 =50%]. Consistent results were revealed among patients with the previous history of arterial thrombosis [RR 2.76 (95% CI 0.93, 8.16); P =0.75, I 2 =0%], venous thrombosis [RR 1.71 (95% CI 0.60, 4.84); P =0.31, I 2 =15%] and patients who were triple antiphospholipid positive [RR 4.12 (95% CI 0.46, 37.10); P =0.21, I 2 =58%]. DOACs inhibitors were significantly associated with increased risk of stroke [RR 8.51 (95% CI 2.35, 3.82); P =0.47, I 2 =0%]., Conclusion: DOACs exhibited increased risk of stroke among patients with APS. In addition, although not significant, the higher RRs among patients on DOACs may indicate higher risk of thrombotic events associated with DOACs., Competing Interests: None to declare., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Motivation: Three-way data structures, characterized by three entities, the units, the variables and the occasions, are frequent in biological studies. In RNA sequencing, three-way data structures are obtained when high-throughput transcriptome sequencing data are collected for n genes across p conditions at r occasions. Matrix variate distributions offer a natural way to model three-way data and mixtures of matrix variate distributions can be used to cluster three-way data. Clustering of gene expression data is carried out as means of discovering gene co-expression networks., Results: In this work, a mixture of matrix variate Poisson-log normal distributions is proposed for clustering read counts from RNA sequencing. By considering the matrix variate structure, full information on the conditions and occasions of the RNA sequencing dataset is simultaneously considered, and the number of covariance parameters to be estimated is reduced. We propose three different frameworks for parameter estimation: a Markov chain Monte Carlo-based approach, a variational Gaussian approximation-based approach, and a hybrid approach. Various information criteria are used for model selection. The models are applied to both real and simulated data, and we demonstrate that the proposed approaches can recover the underlying cluster structure in both cases. In simulation studies where the true model parameters are known, our proposed approach shows good parameter recovery., Availability and Implementation: The GitHub R package for this work is available at https://github.com/anjalisilva/mixMVPLN and is released under the open source MIT license., (© The Author(s) 2023. Published by Oxford University Press.)