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Objectives: Parkinson’s disease is the most common neurodegenerative disease. Combining levodopa with other drugs, including decarboxylase inhibitors (DCI) is its most effective treatment. Urinary tract infection (UTI) is the most common cause of hospitalization in Parkinson’s patients, making it crucial to find an appropriate treatment to reduce the incidence of this complication. This study aimed to investigate UTIs in Parkinson’s patients using levodopa with DCI supplements. Methods: In this systematic review and meta-analysis, databases such as PubMed, Scopus, Embase, Cochrane, and Web of Science were searched up to March 2024. Only randomized controlled trials involving Parkinson’s patients were included in the present study. Parkinson’s patients who used levodopa along with carbidopa or benserazide were considered the intervention group, while those who used levodopa with another drug were considered the control group. Results: Nine interventional studies were ultimately analyzed. The relative risk (RR) of UTI in patients taking DCI was 26% lower than those who did not (RR Treatment/Control = 0.74, 95% CI: 0.58-0.95, p = 0.019). Furthermore, observations at different times of follow-up showed that at 13-24 weeks and at > 24 weeks of treatment with DCI, there was a reduction in the incidence of UTI (RR = 0.68, 95% CI: 0.46-1.01 and RR = 0.77, 95% CI: 0.58-1.0, respectively). On the contrary, there was an increase of the risk of UTI in the first 12 weeks of treatment with DCI (RR = 1.11, 95% CI: 0.37-3.33). Conclusions: The results of this study indicated that using DCI drugs is associated with a reduced relative risk of developing UTIs. The beneficial effect of the drug showed after 12 weeks of treatment after an initial negative effect on the risk of UTI.

Seaweeds possess considerable potential for developing and enhancing pharmaceutical drugs because of their wide variety as abundant sources of numerous bioactive secondary metabolites, making them well-suited for developing and enhancing pharmaceutical drugs. This study evaluated the antioxidant, secondary metabolites, total phenolic content, and total flavonoid content of various crude extracts (methanol, ethanol) and their fractions (50 % and 70 %) of Sargassum polycystum. Fourier transform infrared (FT‐IR) analysis was also performed to identify the active chemical composition of the crude extracts. The results showed that various extracts contained varying concentrations of terpenoid, saponin, phlobatannin, cardiac glycosides, phenolic, and flavonoid. FT-IR analysis confirmed the presence of phenols, carboxylic acid, ketones, ethers, aromatics, amides, and sulfonates. 100 % methanolic extract contained the maximum concentrations of total phenols (80.13 mg of GAE/g) and total flavonoids (38.33 mg of quercetin/g). 100 % methanol extracts exhibited higher antioxidant activity in the DPPH assay (78.32 %, IC50 = 1.59 mg/ml) and ABTS assay (69.82 %, IC50 = 2.39 mg/ml). The bio-functional activity of crude extracts depended on their extract and concentration. The present study demonstrates that the macroalgae S. polycystum contains noteworthy secondary metabolites and natural antioxidants, indicating their potential utilization in various pharmacological and functional food applications.

Crossed-fused renal ectopia (CFRE) is a rare congenital anomaly where both kidneys are fused on the same side. We report a case of a 52-year-old male patient who presented with central abdominal pain associated with hematuria and dysuria, with a history of left open ureterolithotomy. Abdominal computed tomography (CT) showed an 18-mm left distal ureteric stone and a CFRE with a bilateral duplex-collecting system. Left ureteroscopy and laser lithotripsy with magnetic double-J stent insertion were carried out successfully, and the patient was discharged on the same day in fair general condition.

Emphysematous prostatic abscess (EPA) is a rare condition characterized by gas and abscess accumulation in the prostate. In this case report we report a successfully treated EPA with liver abscess due to Klebsiella pneumoniae in a 49-year-old man. He was admitted with abdominal pain and fever. Physical examination revealed tender, palpable resonance urinary bladder, and prostatic tenderness on rectal digital examination. High inflammatory markers were found. Abdominal computer tomography (CT) confirmed EPA. The patient was treated with broad-spectrum antibiotics, strict blood glucose control, suprapubic catheterization, and transurethral deroofing of the prostatic abscess. After three weeks patient discharged in good condition.

Opportunist pathogens Escherichia coli and Salmonella spp. enter into human body through consumption of drinking water, causes different gastrointestinal disorders like diarrhea, dysentery and water borne infections like cholera, typhoid etc.. This study was carried out to determine the microbial safety of drinking jar water and antimicrobial resistant pattern against Escherichia coli in jar water samples at Chittagong, Bangladesh. About 189 drinking jar water samples were collected from 63 water treatment plants and market store over a period of two months. Most probable number (MPN) test was done to detect the coliforms in drinking water samples. The MPN number was high (63) after 24 hours incubation. The test results showed that 41 (21%) water samples has presence of coliforms and 27 (14%) plant water samples contain E. coli. But unfortunately Salmonella Spp. was not found in any of the samples. Conformation test of E. coli were performed by Polymeric Chain Reaction (PCR). The E. coli isolates were susceptible to Enrofloxacin (100%), Cephradine (100%), and Gentamycin (92.59%) with an intermediate sensitivity to Amoxicillin (7.40%) and Ceftriaxone (3.70%). The organisms showed 81.48%, 74.02% and 70.30% resistance to Ampicillin, Colistinsulphate, and amoxicillin respectively. So bacteriological assessment of all water sources for drinking should be planned and conducted on regular basis for considering the public health significance of these zoonotic pathogen that are transmitted through drinking jar water. [ABSTRACT FROM AUTHOR]

In vitro maturation (IVM) of oocytes is the first important step for successful in vitro embryo production of any mammalian species. The objectives of the present study were to determine an effective basic medium and its hormone and protein supplementation for IVM of oocytes of indigenous zebu cows. The oocytes were derived from ovaries of locally slaughtered cows after aspiration of follicle. The oocytes were cultured in medium for 24 hrs at 38.5°C with 5% CO2 in humidified air for maturation. The maturation of oocytes was evaluated by examining the presence of first polar body extrusion in denuded oocytes under inverted microscope. To determine an effective basic medium, the oocytes were cultured in fetal bovine serum (FBS) supplemented tissue culture medium (TCM), modified synthetic oviduct fluid (mSOF) and Tyrodes albumin lactate pyruvate (TALP) medium. The maturation rate was significantly higher (74±4.2) in TCM medium than that of TALP medium (58.2±6.2). To determine an effective hormone supplementation for maturation medium, the oocytes were cultured in either in follicle stimulating hormone (FSH) or gonadotrophin supplemented TCM. The maturation rate of oocytes was significantly (p>0.05) higher (73.3±4.0) in FSH supplemented medium than that of gonadotrophin supplemented counterpart (60.2±6.6). To determine an effective protein supplementation, the oocytes were cultured in FBS, oestrus cow serum (OCS) and bovine serum albumin (BSA) supplemented TCM 199. The maturation rate of oocytes were 73.0±5.9, 71.1±2.8, and 62.5±9.4 in medium supplemented with FBS, OCS and BSA respectively (p>0.05). In conclusions, TCM supplemented with either FBS, OCS or BSA as protein and FSH as hormone may be used as medium for IVM of oocytes of indigenous zebu cows. [ABSTRACT FROM AUTHOR]

Background: Black pepper (Piper nigrum) is mainly cultivated in tropical areas such as South India. It is known as a popular spice in all over the world. Although some studies have been carried out to determine the ingredients of black pepper Essential Oil (EO) cultivated in various regions of the world, but there is little data about some physicochemical characteristics of EO of black pepper cultivated in Chittagong, Bangladesh. Methods: Black peppers samples were collected from the local market of Chittagong city. Extraction of black pepper EO was carried out using Clevenger apparatus. Chemical compounds of EO obtained from the black pepper were determined by analytical gas chromatography/mass spectrometry. Some physicochemical characteristics of extracted EO were determined according to the standard methods. All experiments were carried out in triplicate. Results: The major components of black pepper EO were caryophyllene (19.12%), limonene (9.74%), and camphene (8.44%). The contents of moisture, dry matter, protein, fatty oil, ash, carbohydrate, and crude fiber in black pepper samples were determined as 2.20, 96.12, 12.66, 14.41, 12.49, 42.56, and 5.55%, respectively. Also, food energy value was measured as 349.66±0.44 g/calories. Refractive index, specific gravity, as well as optical rotation of EO samples were 0.8590, 1.476 at 30 °C, and -10.300, respectively. Conclusion: The EO of black pepper cultivated in Chittagong, Bangladesh revealed desirable physicochemical characteristics and could be applied in food industry. [ABSTRACT FROM AUTHOR]

The immunologic processes involved in Graves' disease (GD) have one unique characteristic - the autoantibodies to the TSH receptor (TSHR) - which have both linear and conformational epitopes. Three types of TSHR antibodies (stimulating, blocking, and cleavage) with different functional capabilities have been described in GD patients, which induce different signaling effects varying from thyroid cell proliferation to thyroid cell death. The establishment of animal models of GD by TSHR antibody transfer or by immunization with TSHR antigen has confirmed its pathogenic role and, therefore, GD is the result of a breakdown in TSHR tolerance. Here we review some of the characteristics of TSHR antibodies with a special emphasis on new developments in our understanding of what were previously called "neutral" antibodies and which we now characterize as autoantibodies to the "cleavage" region of the TSHR ectodomain. [ABSTRACT FROM AUTHOR]

Purpose: The lack of available guidelines for the management of prostatic abscess (PA) results in inconsistencies in its management. The most commonly used management modalities were conservative treatment with parenteral antibiotics alone, transrectal ultrasound-guided (TRUS) needle aspiration, or transurethral deroofing (TUD). The current study is a retrospective study and examines prostatic abscess cases treated by either one or more of the different modalities. We assess and compare presentation, diagnosis, management, and outcomes of prostatic abscess and we compare the outcomes of the three management modalities. Methods: We retrieved the records of all patients ( n = 23) admitted to the Urology department at Al Wakra hospital with the computed tomography (CT) diagnosis of prostatic abscess from January 2013 to March 2018. Data collected included demographic, clinical, laboratory, and imaging findings, as well as management modality, duration of hospital stay, duration of follow up, outcome, and recurrence. Results: A total of nine (39.1%) patients had conservative treatment only; eight (34.8%) had TUD, and six (26.1%) had TRUS needle aspiration. The mean age was 52.7 years. Lower urinary tract symptoms and fever were the most common presentations (95.7% and 82.6%, respectively). CT scan of the abdomen and pelvis with contrast was undertaken for all patients and it showed that multiple abscesses were observed in 14 (60.9%) cases. The overall mean hospital stay was 8.45 days (range 2–21 days). We observed no recurrences for patients treated conservatively or those who undertook TUD, but three patient (50%) recurrences were noted in TRUS aspiration patients. There was no mortality across the sample. Conclusion: Early diagnosis of prostatic abscess and prompt management may have decreased the morbidity and mortality. Conservative management can succeed in subcentimeter abscesses but TUD is the definite therapy for large and multiloculated abscess. TRUS aspiration does have a role in treatment, but it has higher recurrence and longer hospital stay.

This study was done to analyze the effect of chemical preservatives on watermelon juice. Ten different samples of pasteurized watermelon juices with different chemical preservatives, termed as T1, T2, T3, T4, T5, T6, T7, T8, T9, T10, were made which were stored at 4 - 15°C for three months. T1 and T2 were rejected soon due to spoilage. pH decreased from 5.094 to 4.017 and minimum pH content was reduced in T10 (7.87%), while maximum in T1 (57.55%). The total soluble solids (TSS) increased from 17.460% to 18.980% with maximum in T1 (51.67%) and minimum in T7 (4.88%). Reducing sugar was increased from 15.650 to 17.500% with maximum in T10 (18.22%) and minimum in T2 (5.90%). Minimum microbial load was observed in T10 (0.20cfu/ml) and maximum in T1 (>24 cfu/ml) in case of coliforms; minimum in T10 (78 x105 cfu/ml) and maximum in T1 (258 x 105 cfu/ml) in case of total viable bacteria and same results (minimum in T10 and maximum in T1) were shown in case of fungal count. E.coli was found in T1, T2, T3 and T4 and some bacteria was found in SS agar (especially Salmonella) in T1, T2, T3 and T5. Among all the treated juice samples T10 was most effective in maintaining the sensory and nutritional quality during storage. [ABSTRACT FROM AUTHOR]

The two-dimensional quasistatic simulation code WAKE [P. Mora and T. Antonsen, Phys. Plasmas 4, 217 (1997)] used to model laser pulse propagation in tenuous plasma is modified to describe the dynamics of energetic particles. In the original code, all particles were assumed to satisfy the quasistatic approximation, which assumes that the driver and its wakefields are undisturbed during the transit time of plasma electrons through the pulse. Here, WAKE is modified to include the effects of electron trapping and beam loading by introducing a population of beam electrons, which are no longer subject to the quasistatic approximation. Algorithms for populating the group of beam particles are considered and are benchmarked to the full particle-in-cell simulations and experimental results. These modifications to WAKE provide a tool for simulating GeV laser or plasma wakefield acceleration on desktop computers. [ABSTRACT FROM AUTHOR]

Fluoride has been used to prevent caries in the dentition, but the possible underlying mechanisms of cytotoxicity induction by this compound are still unclear. Since fluoride is known as an inhibitor of glycolytic enzymes, we investigated the possible connection between NaF-induced apoptosis and glycolysis in human promyelocytic leukemia HL-60 cells. NaF-induced apoptotic cell death is characterized by caspase activation, internucleosomal DNA fragmentation, loss of mitochondrial membrane potential, and production of apoptotic bodies. Higher activation of caspases- 3 and -9, as compared with that of caspase-8, suggested the involvement of an extrinsic pathway. Utilization of glucose was nearly halted by NaF, whereas that of glutamine was rather enhanced. NaF enhanced the expression of Bad protein, but not that of Bcl-2 and Bax proteins, and reduced HIF-1α mRNA expression. Analysis of these data suggests a possible link between glycolysis and apoptosis. [ABSTRACT FROM AUTHOR]

The aim of this paper is to localize the fugitive leaks from the above ground facilities of the existing system of Titas Gas (TG) after developing mathematical model for fugitive emission. Soap screening techniques and Gasurveyor 500 series instrument were used in this study for detecting potential leaks. Leaked gas was quantified using either Hi-Flow gas sampler or bagging measurements system. The results show that the respective potential gas leaking point of City Gate Station (CGS), commercial Regulating and Metering Station (RMS), industrial RMS, residential RMS and Town Bordering Station (TBS)/ District Regulating Station (DRS) are scrubber dump valve (average leak rate 217.00 L/min), insulating point (average leak rate 4.04 L/min), tube fitting connector (average leak rate 8.00 L/min), connector (average leak rate 1.55 L/min) and pressure relief valve (average leak rate 437.92 L/min). Fugitive methane emission can be reduced by stopping leaks of fittings or components having high KLeak value.

Summary Whether intermediate TCR (TCRint) cells and natural killer T (NKT or NK1.1+TCRint) cells are extrathymically generated remains controversial. This arises from the fact that there are few of these T cells in athymic nude mice and neonatally thymectomized mice. However, when athymic mice were provided with appropriate microenvironments or stimulation, many TCRint cells (mainly NK1.1-) were found to arise in the liver. NKT cells are known to be positively selected by monomorphic major histocompatibility complex (MHC) -like antigens (e.g. CD1d). This is true even if they are CD4+. In other words, a MHC class I-like antigen is restricted to CD4 antigen. This rule is somewhat different from that seen in conventional T cells (i.e. the restriction of class II with CD4 and that of class I and CD8). In the case of NK1.1-TCRint cells, they were selected by polymorphic MHC antigens, but their MHC restriction to CD4 or CD8 antigen was incomplete. This was revealed by experiments of bone marrow transfer with class I (bm 1) or II (bm 12) disparity. Depending on the disparity, a unique cytokine profile in sera was detected. These results suggest that the development of T lineage lymphocytes and MHC restriction to CD4 and CD8 might have occurred in parallell as a phylogenic event, and that NK1.1- extrathymic T cells (i.e. NK1.1-TCRint) are at an intermediate position between NKT cells and conventional T cells in phylogeny. [ABSTRACT FROM AUTHOR]

Recurrent testicular torsion after previous orchiopexy is rare and needs high index of suspension to avoid misdiagnosis and delayed management. This case showed that this diagnosis can occur even when the testis is still fixed to the scrotal wall. A 31-year-old male who had previous testicular fixation for testicular torsion with a single stitch to the lower pole before 6 years presented with recurrent testicular torsion and missed diagnosis. This case confirm that recurrent testicular torsion after previous fixation should be included in the differential diagnosis of acute scrotum and emphasis on the testicular fixation with nonabsorbable suture in at least two points to prevent recurrent torsion.

Background: Endoscopic papillary dilation (EPD) by balloon in the management of bile duct stones has recently been claimed to be effective for removing bile duct stones. Methods: Without endoscopic sphincterotomy, we attempted to remove large or multiple bile duct stones through EPD combined with drip infusion of isosorbide dinitrate in 35 patients. Isosorbide dinitrate, at a rate of 5 mg/h, was administered intravenously, and a balloon dilator with a 10-mm diameter was inflated within 3 min across the papilla. Stones were then smashed using a mechanical lithotriptor, and the fragments were extracted with a basket or the balloon. Results: Extraction of stones was successful in 33 (94%) of 35 patients by the combined therapy. Two of them (6%) developed mild pancreatitis. Conclusion: EPD combined with medical sphincter dilation was effective for large and multiple bile duct stones. [ABSTRACT FROM AUTHOR]

To assess whether demography is one of the important factors determining antibody response to nuclear antigens [ANA: SSA-Ro (52K and 60K), SSB-La, snRNPs (A, 70K, B'/B), and Cenp-B], we investigated 95 and 47 sera of autoimmune hepatitis (AIH) from North America and Asia, respectively, by immunofluorescent (IF) and recombinant ELISA. Correlations among nuclear IF patterns, ELISA, and disease indices were analyzed. The frequency and titer of individual antibodies differed significantly between the groups. Patients with speckled patterns were younger in both regions and had higher aspartate aminotransferase levels only in North America. HLA-A1, B8, DQ2, and DR4 or DR3 or both in North America, and A2, B61, DQ7, and DR4 in Asia were predominant. In Asia, B61 correlated with anti-70K, and DQ7 correlated with antibodies to 52K, Cenp-B, and B'/B. In North America, A1, B8, DR3 haplotype, and DQ2 correlated with antibodies to A and 70K. Anti-B'/B and DR4 in North America, and A2 in Asia, were associated with concurrent immunologic disorder. Individual ANA clusters correlated with individual HLA in the demography, and different HLA alleles might determine disease expression as well as different ANA being produced in AIH. [ABSTRACT FROM AUTHOR]

To determine whether the liver plays an immunological role in certain extrahepatic disorders, we investigated the expression of interleukin (IL)-1 beta, IL-6, interferon (IFN)-gamma, and tumor necrosis factor (TNF)-alpha in 11 patients who had recovered from cholecystolithiasis, 12 patients with gastric cancer, 20 patients with chronic hepatitis, and 6 healthy controls. Cytokine mRNAs in the liver were detected by semiquantitative reverse transcribed-polymerase chain reaction. Serum cytokines and soluble IL-2 receptor (sIL-2R) were investigated by enzyme-linked immunosorbent assays. Increases in TNF-alpha, IL-6, IL-1 beta, and IFN-gamma mRNAs were found in the livers of patients with extrahepatic diseases. TNF-alpha and IL-6 peptides were increased in the sera of patients with gastric cancer. TNF-alpha in the sera and TNF-alpha mRNA in the liver were correlated in gastric cancer patients. Surprisingly, sIL-2R in the serum of gastric cancer patients was significantly higher than the level in healthy controls. Our findings suggest that the liver produces cytokines in reaction to extrahepatic lesions. Further, the increase in sIL-2R in gastric cancer patients indicates that malignancy may affect the immune network in vivo. [ABSTRACT FROM AUTHOR]

In a pilot study of direct dissolution therapy of gallstones with methyl tert-butyl ether (MTBE), endoscopic transpapillary catheterization in the gallbladder (ETCG) was performed. Complete dissolution was seen in 8 out of 12 (66%) patients and partial dissolution was seen in 2 (16%) patients. In one of the 8 complete dissolution patients, combined extracorporeal shock wave lithotripsy (ESWL) and dissolution therapy was carried out successfully. These 8 patients were followed up for 12-20 months with regular ultrasonography. During this period, 1 patient underwent laparoscopic cholecystectomy due to stone recurrence. Thickening of the gallbladder wall was seen in 2 patients, but there were no other complications. Using Tsuchiya's classification based on ultrasound, complete dissolution was seen in type Ia stones. This pilot study suggests that the direct dissolution of gallstones with MTBE via ETCG might be a useful and safe non-invasive treatment in patients with cholesterol stones in preserved gallbladders. [ABSTRACT FROM AUTHOR]

We have detected cytoplasmic anti-Golgi antibody (AGA) during a routine immunofluorescence test for detecting autoantibodies. Two sera from patients with rheumatoid arthritis (RA) reacted to the Golgi complex by an indirect immunofluorescence technique on HEp-2 cells. Localization of AGA in the Golgi complex was confirmed by double-staining with antibodies to β-COP, The effect of monensin on the integrity and morphology of the Golgi complex was also studied. To confirm the presence of AGA further, we performed immuno-electron microscopy. Both sera reacted with cytoplasmic antigen located in the Golgi complex of various animal tissues. Furthermore, by using the Western blot technique, both sera reacted to a relative molecular weight (MW) of 79 kDa (doublet) Golgi antigen purified from rat liver. To our knowledge, this study may be the first to identify the relative MW of Golgi antigen by the Western blot method. Identification of this antibody could provide better understanding of protein synthesis and secretion. The presence of AGA in RA patients further substantiates the diversified nature of autoantibody production seen in this disease. [ABSTRACT FROM AUTHOR]

Introduction: Open tibia fractures are some of the most common types of Orthopedics injuries in low- and middle-income countries (LMICs). In Tanzania, open tibia fractures are treated either conservatively by prolonged cast or surgically by external fixation (EF) or intramedullary nail (IMN) when available. The cost of treatment and amount of time patients spend away from work are major economic concerns with prolonged casting and EF. The goal of this study was to determine the cost effectiveness of IMN versus EF in the treatment of open diaphyseal tibia fractures at Muhimbili Orthopaedic Institute (Dar es Salaam, Tanzania). Methods: This is a prospective randomized control study conducted of patients with a closeable AO/OTA 42 open diaphyseal tibia fracture. The patients underwent surgical fixation with either IMN or EF at Muhimbili Orthopaedic Institute (MOI), and were followed up at 2, 6, and 12 weeks postoperatively. A micro-costing method was used to estimate the fixed and variable costs of IMN and EF of the open diaphyseal tibial fracture. Results: The mean total cost per patient was lower for the IMN group ($425.8 ± 38.4) compared to the EF group ($559.6 ± 70.5, p

Background: Little is known about the quality of orthopaedic investigations conducted in low- and middle-income countries (LMICs). Academic collaboration is one model to build research capacity and improve research quality. Our study aimed to determine (1) the quality of clinical orthopaedic research conducted in LMICs, (2) the World Bank Regions and LMICs that publish the highest quality studies, (3) the pattern of collaboration among investigators and (4) whether academic collaboration between LMIC and non-LMIC investigators is associated with studies that have higher levels of evidence. Methods: Orthopaedic studies from 2004 to 2014 conducted in LMICs were extracted from multiple electronic databases. The World Bank Region, level of evidence and author country-affiliation were recorded. Collaboration was defined as a study that included an LMIC with non-LMIC investigator. Results: There were 958 studies that met inclusion criteria of 22,714 searched. Ninety-seven (10.1%) of included studies achieved Level 1 or 2 evidence, but case series (52.3%) were the most common. Collaboration occurred in 14.4% of studies and the vast majority of these (88.4%) were among academic institutions. Collaborative studies were more likely to be Level 1 or 2 (20.3% vs. 8.4%, p

Abstract Background A recently published meta-analysis comparing metallic staples to sutures in orthopaedic procedures revealed three fold increase in risk for infection in stapled wounds. The studies included in the meta-analysis are at risk of bias due to experimental design limitations. A large randomized controlled trial is proposed to direct orthopaedic surgeons in their choice of wound closure material. Methods/Design A parallel group randomized controlled trial with institutional review board approval will be conducted. Patients will be randomized intraoperatively to have skin wounds closed with sutures or staples. Dressings will be used to maintain blinding outcome assessors. The primary outcome measure will be a composite all-cause wound complication outcome measure composed of: infection, wound drainage, wound necrosis, blistering, dehiscence, suture abscess and material sensitivity reaction. An independent review board blinded to treatment assignment will adjudicate suspected complications based on clinical data. All deceased patients will also be reviewed. An interim analysis of complications will take place after half of the patients have been recruited. All data will be analyzed by a blinded statistician. Dichotomous primary and secondary outcome measures will be analyzed using the Chi-squared statistic. Continuous outcome measures will be analyzed using Student's t-test. Subgroup analysis will compare infection rates using sutures versus staples in each anatomic area (upper extremity, pelvis/acetabulum, hip/femur, knee, ankle). A further subgroup analysis will be conducted comparing trauma patients to elective surgery patients. Non-infected revision surgery will also be compared to primary surgery. Discussion Wound closure material is an afterthought for many orthopaedic surgeons. The combined results of several comparative trials suggests that the choice of wound closure materials may have an impact on the rate of surgical site infections. However, the strength of the evidence is poor given the heterogeneity of the methods employed in previous studies. The following study protocol aims to guide surgeons in their choice of wound closure material by determining if there is a difference in complication rates in sutured and stapled wounds. Trial Registration This trial was registered at ClinicalTrials.gov under the identifier NCT01146236 (registered June 14, 2010)

Background: The "neutral" thyrotropin receptor autoantibodies (N-TSHR-Ab) directed at the TSHR ectodomain's hinge region have been shown to induce thyroid cell damage in vitro . During these earlier studies, we developed a mouse monoclonal antibody (MC1) specific for a peptide (amino acid 322-340) in the region (MC1-Mab) which was able to induce thyroid cell stress and apoptosis when administered in vivo . Methods: In order to examine the effect of in vivo generated N-TSHR-Abs, rather than an acutely administered monoclonal antibody, we immunized Balb/c mice with the hinge region peptide over 18 weeks. Serum TSHR antibodies, specific TSHR hinge region antibodies, serum thyroglobulin (TG) and anti-TG as well as thyroxine and thyrotropin (TSH) levels were examined to evaluate the response to the immunization. Histological examination of the thyroid glands and flow cytometry of spleen T cells, B cells and macrophages were also performed to explore the underlying mechanisms. Results: We found that TSHR-peptide immunized mice developed N-TSHR-Abs against the peptide which resulted in thyroid damage shown by thyroid follicular destruction with follicular cell apoptosis, M1 macrophage infiltration, thyroglobulin release, and induction of thyroglobulin antibodies. This resulted in hypothyroidism with increased TSH levels. Conclusion: This study demonstrated that endogenous neutral antibodies to the TSHR could induce thyroid cell damage from apoptosis and M1 macrophage infiltration and resulted in hypothyroidism.

This research has evaluated the MPs distribution, characteristics, and potential threats of MPs in surface water and sediments from Hatiya Island. The results showed that the abundance of MPs was 139 ± 44 items/m 3 in surface water and 493 ± 80 items/kg dw in sediments, indicating higher levels of MPs contamination in sediment samples. Fibers were the predominant kind of microplastics, and microscopic sizes (0.3-1.5 mm) MPs were generally more frequent and largely present in both the surface water and sediments. Fourier-transform infrared spectroscopy (FTIR) confirmed that polyethylene terephthalate was the major polymer component of microplastics in surface water, whereas polyethylene was the most abundant polymer in sediments. MPs contamination risk was examined based on multiple risk assessment models. Nemerow pollution index (NPI) and pollutant load index (PLI) show minimal pollution levels of MPs. But potential hazard index (PHI), potential ecological risk factor (Er), and potential ecological risk index (RI), indicate severe MPs contamination due to the presence of polyurethane, polycarbonate, polyvinyl chloride, epoxy that were hazardous MPs and exhibited a critical concern for MPs risk. These statistics will help to understand the environmental difficulties generated by MPs and which hazard is waiting for mankind in the future., 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.)

The thyroid eye disease (TED) of Graves disease is associated with high titers of stimulating TSH receptor antibodies, retro-orbital inflammation, fibroblast release of cytokines and chemokines, and adipogenesis, which in turn leads to proptosis, muscle fibrosis, and dysfunction. Part of this scenario is the induction of fibroblast proliferation and autophagy secondary to synergism between the TSH receptor (TSHR) and the insulin-like growth factor-1 receptor (IGF-1R). While TED is well associated with thyroid-stimulating antibodies to the TSHR, which is also well expressed on fibroblasts, in fact the TSHR reactome has a variety of TSHR antibodies with varying biological activity. Therefore, we have now evaluated the possible role of neutral TSHR antibodies (N-TSHR-mAbs), directed at the hinge region of the TSHR, which do not induce cell proliferation but are known to have effects on multiple proteins in thyroid cells including stress-related signaling molecules. We examined the consequences of an N-TSHR-mAb acting on TSHR-expressing fibroblasts and found marked cell stress, which initiated signaling pathways involving inflammasome activation. This response ended in widespread cell death by pyroptosis through activation of caspase 8 and gasdermin D. Hence, not only can stimulating TSHR autoantibodies influence TED inflammation but the N-TSHR antibodies, representing more of the reactome, may also exaggerate the retro-orbital inflammatory response seen in TED., (Published by Oxford University Press on behalf of the Endocrine Society 2024.)

Background Context: There are a number of risk factors- from biological, psychological, and social domains- for non-specific chronic low back pain (cLBP). Many cLBP treatments target risk factors on the assumption that the targeted factor is not just associated with cLBP but is also a cause (i.e, a causal risk factor). In most cases this is a strong assumption, primarily due to the possibility of confounding variables. False assumptions about the causal relationships between risk factors and cLBP likely contribute to the generally marginal results from cLBP treatments., Purpose: The objectives of this study were to a) using rigorous confounding control compare associations between modifiable causal risk factors identified by Mendelian randomization (MR) studies with associations in a cLBP population and b) estimate the association of these risk factors with cLBP outcomes., Study Design/setting: Cross sectional analysis of a longitudinal, online, observational study., Patient Sample: 1,376 participants in BACKHOME, a longitudinal observational e-Cohort of U.S. adults with cLBP that is part of the NIH Back Pain Consortium (BACPAC) Research Program., Outcome Measures: Pain, Enjoyment of Life, and General Activity (PEG) Scale., Methods: Five risk factors were selected based on evidence from MR randomization studies: sleep disturbance, depression, BMI, alcohol use, and smoking status. Confounders were identified using the ESC-DAG approach, a rigorous method for building directed acyclic graphs based on causal criteria. Strong evidence for confounding was found for age, female sex, education, relationship status, financial strain, anxiety, fear avoidance and catastrophizing. These variables were used to determine the adjustment sets for the primary analysis. Potential confounders with weaker evidence were used for a sensitivity analysis., Results: Participants had the following characteristics: age 54.9 ± 14.4 years, 67.4% female, 60% never smokers, 29.9% overweight, 39.5% obese, PROMIS sleep disturbance T-score 54.8 ± 8.0, PROMIS depression T-score 52.6 ± 10.1, Fear-avoidance Beliefs Questionnaire 11.6 ± 5.9, Patient Catastrophizing Scale 4.5 ± 2.6, PEG 4.4 ± 2.2. In the adjusted models alcohol use, sleep disturbance, depression, and obesity were associated with PEG, after adjusting for confounding variables identified via a DAG constructed using a rigorous protocol. The adjusted effect estimates- the expected change in the PEG outcome for every standard deviation increase or decrease in the exposure (or category shift for categorical exposures) were the largest for sleep disturbance and obesity. Each SD increase in the PROMIS sleep disturbance T-score resulted in a mean 0.77 (95% CI: 0.66, 0.88) point increase in baseline PEG score. Compared to participants with normal BMI, adjusted mean PEG score was slightly higher by 0.37 points (95% CI: 0.09, 0.65) for overweight participants, about 0.8 to 0.9 points higher for those in obesity classes I and II, and 1.39 (95% CI: 0.98, 1.80) points higher for the most obese participants. Each SD increase in the PROMIS depression T-score was associated with a mean 0.28 (95% CI: 0.17, 0.40) point increase in baseline PEG score, while each SD decrease in number of alcoholic drinks per week resulted in a mean 0.12 (95%CI: 0.01, 0.23) increase in baseline PEG score in the adjusted model., Conclusions: Several modifiable causal risk factors for cLBP - alcohol use, sleep disturbance, depression, and obesity- are associated with PEG, after adjusting for confounding variables identified via a DAG constructed using a rigorous protocol. Convergence of our findings for sleep disturbance, depression, and obesity with the results from MR studies, which have different designs and biases, strengthens the evidence for causal relationships between these risk factors and cLBP (1). The estimated effect of change in a risk factors on change in PEG were the largest for sleep disturbance and obesity. Future analyses will evaluate these relationships with longitudinal data.