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This study aims to maintain good relations with consumers so that consumers do not turn to other competitors. The method used is the prototype method, which uses an approach to create a program quickly, gradually, making the information system better and easier. By using Customer Relationship Management (CRM) it can be useful for sales so that they can have good relations with consumers and so that consumers do not turn to others.

Background: Vaccination against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the most desired solution to combat COVID-19. We examined the willingness to accept the vaccine and reasons for vaccine hesitancy, and identified some factors associated with the vaccine hesitancy among the socio-economically disadvantaged urban population from Delhi, India. Methods: We conducted a cross-sectional survey of a randomly selected sample of 1539 households from 31 urban clusters. Data on socio-demographics, health beliefs, and willingness to accept the SARS-CoV-2 vaccine were collected through a face-to-face interviewer-administered, pre-tested questionnaire from an adult member. Vaccine acceptance/hesitancy was analysed by various socio-demographic and health belief variables. Multinomial regressions were carried out to identify the factors associated with the vaccine hesitancy. Results: Overall, 64.9% (95% CI: 62.5 to 67.3) of the respondents would accept the vaccine, 17.4% (95% CI: 15.6 to 19.4) were undecided, and 17.7% (95% CI: 15.8 to 19.7) would not accept the vaccine. The reasons for not accepting the vaccine were: belief that they had immunity (12.9%), the corona was a hoax (11.8%), the vaccine was not necessary (7.4%), and did not want to disturb the natural bodily systems by the vaccine (5.6%). The undecided group mainly would like to wait and see (37.7%), decide when the vaccine become available (11.6%), will take if everyone in their community takes (10.4%). Multinomial logistic regression identified older age, low perceived susceptibility of contracting COVID-19, low perceived severity of COVID-19, low self-efficacy to protect against COVID-19, and unawareness and non-use of Arogyasetu App as significant predictors of vaccine hesitancy. Conclusions: Two-thirds of Delhi’s low-income groups would accept the vaccine against SARS-CoV-2. Vaccine hesitancy was associated with older age, low perceived susceptibility, low perceived severity, and low self-efficacy to protect themselves from COVID-19. Hence, efforts are needed to address these issues and vaccine concerns to increase the vaccine uptake.

Laboratory accreditation is a process by which an authoritative body gives formal recognition of technical competence for specific tests or measurements usually following international standards such as ISO/IEC 15189/17025. The process checks on inaccuracy or imprecision that may crop up during the preanalytical, analytical, or postanalytical phases, which could have an impact on the patient's reports and thereby the treatment aspects. The process itself helps the personnel of the laboratory to be alert, be quality conscious, and provide the best to the customers, namely patients and health-care providers, thereby helping the health-care providers to give the best of their services to the patients. This enhances the quality of the health-care services on the whole due to quality management system being in place in laboratories. The accreditation agency which takes interest in the laboratories of India and ensures quality in them is National Accreditation Board for Testing and Calibration Laboratories. The developed countries already have the system in place, and it is mandatory for every lab to be accredited before releasing patient reports. We are not far behind in this process, and shortly it may be considered to be mandatory for all labs to obtain the accreditation to run the tests. However, there are several challenges one needs to address in the process of accreditation, with the most important being the finances, team work, and planning.

Background: Disparities in healthcare access to internal migrants exist, and the gaps may widen further if appropriate steps are not taken. Innovative approaches are needed to better align the healthcare services with the migrants’ needs. Aim: The aim was to develop and test a supportive strategy of healthcare, which would achieve the desired level of access and delivery of maternal healthcare services to internal migrants living in nine Indian cities. Methods: This intervention with the quasi-experimental design was conducted with pre- vs post-intervention comparisons within the interventional groups and with the control group. The intervention was implemented with an inclusive partnership approach. Advocacy and community mobilization were the main intervention components. Findings: An increased proportion of women sought antenatal care during the intervention. More women initiated seeking antenatal care in the first trimester. Due to intervention, health workers’ prenatal (41.7% in the post- against 14.7% in the pre-interventional phase) and postnatal home visits increased (11.6% to 34.7%) considerably. Conclusions: Interventions with inclusive partnership would improve healthcare access to vulnerable communities such as migrants. Hence, efforts to strengthen the government healthcare system through novel strategies are crucial to provide better healthcare to migrants.

Leptospirosis is an anthropozoonotic disease, which remains under diagnosed in most of the regions of our country due to the lack of awareness, atypical presentation and lack of proper diagnostic facility and set up. Diagnosis usually depends on Microscopy, Culture and Serological tests like ELISA, MAT (Microscopic agglutination test). MAT is the gold standard diagnostic test but it requires live Leptospires and it can only be done in a reference laboratory. Hence, ELISA is the most preferred cost-effective serological method and is genus specific with both sensitivity and specificity of 95%. Aim of the present study is to estimate the seroprevalence of Leptospirosis among suspected Acute Febrile illness (AFI) cases presented to Government General Hospital Kurnool. The study was conducted from August 2023 to March 2024 on 260 AFI cases. Detection of IgM antibody was done by using Recombilisa Leptospira IgM ELISA kit. Out of 260 clinically suspected cases of Leptospirosis, 30 (11.53%) were positive. Majority of cases belonged to 21-40 years age group. Seroprevalence was found to be higher in Males (14.1%) as compared to Females (8.5%). A high seroprevalence of Leptospirosis was noted in AFI cases, so a programmatic approach for prevention, control and management of such emerging zoonotic diseases through NOHP-PCZ (National One Health Program for Prevention and Control of Zoonoses) will be a very useful step towards achieving optimal health. [ABSTRACT FROM AUTHOR]

When simulating a wind turbine, the lowest eigenmodes of the rotor blades are usually used to describe their elastic deformation in the frame of a multi-body system. In this paper, a finite element beam model for the rotor blades is proposed which is based on the transfer matrix method. Both static and kinetic field matrices for the 3-D Timoshenko beam element are derived by the numerical integration of the differential equations of motion using a Runge–Kutta fourth-order procedure. In the general case, the beam reference axis is at an arbitrary location in the cross section. The inertia term in the motion differential equation is expressed using appropriate shape functions for the Timoshenko beam. The kinetic field matrix is built by numerical integration applied on the approximated inertia term. The beam element stiffness and mass matrices are calculated by simple matrix operations from both field matrices. The system stiffness and mass matrices of the rotor blade model are assembled in the usual finite element manner in a global coordinate system accounting for the structural twist angle and possible pre-bending. The program developed for the above-mentioned calculations and the final solution of the eigenvalue problem is accomplished using MuPAD, a symbolic math toolbox in MATLAB®. The natural frequencies calculated using generic rotor blade data are compared with the results proposed from the FAST and ADAMS software.

The study aims to assess the counselling services provided to prevent mother to child transmission of HIV (PMTCT) under the Indian programme of prevention of parent-to-child transmission of HIV (PPTCT). Five hospitals in Delhi providing PMTCT services were randomly selected. A total of 201 post-test counselled women were interviewed using a modified version of the UNICEF-PPTCT evaluation tool. Knowledge about HIV transmission from mother-to-child was low. Post-test counselling mainly helped in increasing the knowledge of HIV transmission; yet 20%–30% of the clients missed this opportunity. Discussion on window period, other sexually transmitted diseases and danger signs of pregnancy were grossly neglected. The PMTCT services during the antenatal period are feasible and agreeable to be provided; however, certain aspects, like lack of privacy, confidentiality of HIV status of the client, counsellor’s ‘hurried’ attitude, communication skills and discriminant behaviour towards HIV-positive clients, and disinterest of clients in the counselling, remain as gaps. These issues may be addressed through refresher training to counsellors with an emphasis on social and behaviour change communication strategies. Addressing attitudinal aspects of the counsellors towards HIV positives is crucial to improve the quality of the services to prevent mother-to-child transmission of HIV.

Research objective is to analyses the impact of sustainable food house area (KRPL) of household income, comestible expenses, and consumption pattern in the village which receive KRPL aid. Research was conducted in Mempawah Regency West Kalimantan Province with survey methods by means of direct observation with sample and location which is pre-determined and selected deliberately. Data is collected by means of interview and using questioner. The result of this research show that there is differences in the income of household of KRPL aid receivers which is IDR 3.267.015 /month compared to non KRPL aid receivers which is IDR 2.851.282 /month. KRPL contribution to household income difference is IDR 99.125 /month, equal to 3,03% of total household income. While in terms of comestible expenses, research shows that percentage of total income spent for comestible is 59,44% for KRPL aid receivers and 59,48% non KRPL aid receivers, there is no significant difference between KRPL aid receivers and non KRPL aid receivers. These numbers indicate that comestible expenses, in low income household, tend to become major component of total expenses. Keywords: Comestible expenses; Household income; KRPL

Mutations in katG gene are often associated with isoniazid (INH) resistance in Mycobacterium tuberculosis strain. This research was perfomed to identify the katG mutation in clinical isolate (L8) that is resistant to INH at 1 μg/ml. In addition to characterize the catalase-peroxidase of KatG L8 and perform the ab initio structural study of the protein to get a more complete understanding in drug activation and the resistan­ce mechanism. The katG gene was cloned and expressed in Escherichia coli, then followed by characterization of catalase-peroxidase of KatG. The structure modelling was performed to know a basis of alterations in enzyme activity. A substitution of A713G that correspond to Asn238Ser replacement was found in the L8 katG. The Asn238Ser modification leads to a decline in the activity of catalase-peroxidase and INH oxidation of the L8 KatG protein. The catalytic efficiency (Kcat/KM) of mutant KatGAsn238Ser respectively decreases to 41 and 52% for catalase and peroxidase. The mutant KatGAsn238Ser also shows a decrease of 62% in INH oxidation if compared to a wild type KatG (KatGwt). The mutant Asn238Ser might cause instability in the substrate binding­ site of KatG, because of removal of a salt bridge connecting the amine group of Asn238 to the carbo­xyl group of Glu233, which presents in KatGwt. The lost of the salt bridge in the substrate binding site in mutant KatGAsn238Ser created changes unfavorable for enzyme activities, which in turn emerge as INH resistan­ce in the L8 isolate of M. tuberculosis.

This study reports the awareness, access, and utilization of health insurance by the urban poor in Delhi, India. The study included 2998 households from 85 urban clusters spread across Delhi. The data were collected through a pretested, intervieweradministered questionnaire. Logistic regression was performed for determinants of health insurance possession. Only 19% knew about health insurance; 18% had health insurance (Employees State Insurance Scheme – ESIS – 8%; Central Government Health Scheme – CGHS – 1.4%; Rashtriya Swasthya Bima Yojana (RSBY) – 9.4% of the eligible households). In case of health needs, 95% of CGHS, 71% ESIS beneficiaries, and 9.5% of RSBY beneficiaries utilized the schemes for episodic and chronic illnesses. For hospitalization needs, 54% of RSBY, 86% of ESIS, 100% CGHS utilized respective services. Residential area, migration period, possession of ration card, household size, and occupation of the head of the household were significantly associated with possession of RSBY. RSBY played a limited role in meeting the healthcare needs of the people, thus may not be capable of contributing significantly in the efforts of achieving equity in healthcare for the poor. Relatively, ESIS and CGHS served the healthcare needs of the beneficiaries better. Expansion of ESIS to the informal workers may be considered.

Macro studies reveal that internal migration is of considerable extent in India, however disaggregated studies on specific migrant groups are lacking from India. The present study is based on a scientifically drawn sample of 10,428 migrant households living in Delhi and the objective is to present socio-economic profile of the socioeconomically disadvantaged migrants living in Delhi. Migration is predominantly male in character and is dominated by younger ages. Migrants form a considerable proportion of the city’s population and are indispensable for the city’s growth. The other characteristics of migrants reveal that migrants are marginalized in the city and have denied access to basic amenities and compromise to live in such conditions in order to earn a livelihood and better incomes. Since migrants are an indispensable population in the cities, they should be recognized as a specific vulnerable group for the provision of basic services and there is a need for policy formulation ensuring rights of the migrants.

Background: Air conditioners (AC) have become indispensable in the contemporary World. However, their effects on respiratory health need to be explored further using dynamic and static lung functions. Objectives: The objectives were: 1. To evaluate and compare dynamic parameters (FEV1, FVC, FEV1/FVC, PEFR, and FEF25-75) in AC users and non-users of Bengaluru. 2. To evaluate and compare airway resistance and specific airway conductance as additional parameters. Materials and Methods: After applying ATS-ERS criteria for lung disorders, 30 AC users and non-users of Bengaluru, aged 18-40 yrs were assessed using body plethysmography. A significant association of restrictive pattern was seen in AC users (9 AC users out of 60 participants, Chi-square 8.37, P = 0.0038) having an Odd's ratio of 26.95 (CI: 1.4876 to 488.3558, Z = 2.229, P = 0.0258). Airway resistance (Raw) was comparable in both groups further indicating a non-obstructive pathology. Conclusion: AC users had a significant decrease in flow rates (PEFR and FEF25-75) as well as an association with restrictive lung disorder suggesting the need for proper ventilation and hygiene. It is crucial to develop policies to maintain indoor air quality. [ABSTRACT FROM AUTHOR]

In India there is an increasing trend in hypertension prevalence among the general population. Studies have shown that tribal populations in India are also experiencing this burden.The aim was to estimate the pooled prevalence of primary hypertension among adult tribal populations of India.A systematic search was conducted in MEDLINE, IndMed, Web of Science, Google Scholar and major journals for studies published between 1981 and 2011. Two authors independently reviewed the studies, did quality assessment and extracted data in pre-coded spread-sheets. Pooled estimates of prevalence of hypertension were calculated using DerSimonian-Laird random effects model. Subgroup and sensitivity analyses and meta-regression were performed.Twenty studies or 53 subpopulations with 64 674 subjects were included in final review. The pooled estimate of hypertension prevalence was 16.1% (95% CI: 13.5, 19.2). There was significant heterogeneity among the studies (I2 = 99% and Q = 4624.0, df = 53, p

The cardiovascular related diseases can however be controlled through earlier detection as well as risk evaluation and prediction. In this paper the application of deep learning methods for CVD diagnosis using ECG is addressed and also discussed the deep learning with Python. A detailed analysis of related articles has been conducted. The results indicate that convolutional neural networks are the most widely used deep learning technique in the CVD diagnosis. This research paper looks into the advantages of deep learning approaches that can be brought by developing a framework that can enhance prediction of heart related diseases using ECG. [ABSTRACT FROM AUTHOR]

Background: The data on Leydig cell hypoplasia (LCH) resulting from biallelic Luteinizing hormone/chorionic gonadotropin receptor (LHCGR) inactivating variants is limited to case series., Methods: We aim to describe our patients and perform systematic review of the patients with LHCGR inactivating variants in the literature. Detailed phenotype and genotype data of three patients from our centre and 85 (46,XY: 67; 46,XX: 18) patients from 59 families with LHCGR-inactivating variants from literature were described., Results: Three 46,XY patients (age 6-18 years) from our center, with two reared as females, had two novel variants in LHCGR. Systematic review (including our patients) revealed 72 variants in 88 patients. 46,XY patients (n = 70, 56 raised as females) presented with pubertal delay (n = 41) or atypical genitalia (n = 17). Sinnecker score ≥3 (suggesting antenatal human chorionic gonadotropin (hCG) inaction) was seen in 80% (56/70), and hCG-stimulated testosterone was low (<1.1 ng/mL) in 77.4% (24/31), whereas puberty/postpubertal age, high luteinizing hormone (LH) (97.6%, 41/42) and low (<1.0 ng/mL) basal testosterone (94.9%, 37/39) was observed in most. Follicle stimulating hormone was elevated in 21/51 of these patients. Variants with <10% receptor function were exclusively seen in cohorts with Sinnecker 4/5 (10/15 vs 0/5, P = 0.033). 46,XX patients (n = 18) presented with oligo/amenorrhea and/or anovulatory infertility and had polycystic ovaries (7/9) with median LH of 10 IU/L (1.2-38)., Conclusion: In summary, this study comprehensively characterizes LHCGR variants, revealing genotype-phenotype correlations and informing clinical management of LCH. In 46,XY LCH patients, pubertal LH inaction is uniform with variable severity of antenatal hCG inaction. Few mutant LHCGR have differential actions for LH and hCG.

Introduction: Childhood stunting has a complex aetiology, with poor gut health being an important contributor. This study will assess inter-relationships between maternal and infant gut health indices and infant linear growth. Inter-relationships between gut health indices, systemic inflammation and growth hormones in early childhood will also be assessed., Methods and Analysis: A longitudinal observational study of cohorts of 600 newborns and their mothers in India, Indonesia and Senegal will be conducted. Women will be recruited during pregnancy and their children followed up to age 24 months. Stool, urine and blood samples will be collected from the women and children for assessments of helminthic and protozoal parasites, bacterial pathogens, faecal microbiota taxa, biomarkers of environmental enteric dysfunction, systemic inflammation and growth hormones. Child anthropometric measurements will be collected at birth and at ages 3, 6, 9, 12, 18 and 24 months. The gut health indices will be integrated with cohort data from other Action Against Stunting Hub (AASH) workstreams for interdisciplinary analyses of childhood stunting and the development of a new typology of stunting., Discussion: This study will advance scientific understanding of the role of gut health in childhood stunting and will contribute to a broader knowledge of the complex aetiology of this condition as part of the interdisciplinary AASH research to reduce the global burden of childhood stunting., Ethics and Dissemination: This study has been approved by the relevant Ethics Committees in Senegal, India, and Indonesia and LSHTM. The results will be submitted for publication in peer-reviewed journals., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Benzimidazole derivatives are considered as important heterocyclic motifs that show a wide range of pharmaceutical applications. In view of their wide-ranging bioactivities, it is imperative to direct research on the sustainable catalytic synthesis of benzimidazole. Therefore, herein, we report a novel approach for the synthesis of benzimidazole and its derivatives with engineered MgO supported on dendritic fibrous nano silica (MgO@DFNS) as a sustainable heterogeneous catalyst. The catalyst MgO@DFNS was thoroughly characterized to understand its physio-chemical properties using XRD, FE-SEM, XPS, FT-IR, zeta potential, HR-TEM, TGA, TPR and TPD. The obtained results suggested that the catalyst MgO@DFNS prepared well and have the desired characteristics in it. After the successful characterisation of the prepared catalyst MgO@DFNS, it was applied in the synthesis of benzimidazole derivatives via condensation of o -phenylenediamine, and various aromatic and aliphatic aldehydes under ambient temperature. The catalyst produced a clean reaction profile with excellent yields in a shorter time under the umbrella of green chemistry. The effect of reaction parameters such as the effect of time, catalyst dosage, loading of MgO, effect of solvents and effect of different homo and heterogeneous catalyst were also tested. Furthermore, to understand the scope of the catalyst different substituted diamines and substituted aldehydes were reacted and obtained desired products in good to efficient yield. In addition, a recyclability study was also conducted and it was observed that the catalyst could be recycled for up to six cycles without noticeable changes in the morphology and activity. We believe that the present methodology gave several advantages such as an eco-friendly method, easy work-up, good selectivity, high yields and quick recovery of catalyst. MgO@DFNS is highly stable for several cycles without significant loss of its activity, which possibly demonstrates its applicability at the industrial scale., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Context: Prolonged hypothyroidism in children commonly causes short stature with delayed bone maturation, and delayed puberty. However, a paradoxical occurrence of peripheral precocious puberty and pituitary enlargement in chronically untreated juvenile hypothyroidism was first reported by Van Wyk and Grumbach in 1960., Objective: To create increased awareness and a better understanding of this clinical entity among emergency room physicians, pediatricians, surgeons, gynecologists and oncologists., Methods: Case records of children diagnosed with Van Wyk-Grumbach syndrome (VWGS) were analyzed retrospectively., Results: Twenty-six girls and 4 boys were identified (2005-2020). All had profound primary hypothyroidism (total thyroxine [T4]: 2.5-33.5 nmol/L, thyrotropin: > 75-3744 μIU/mL). Hypothyroidism was not the referral diagnosis in any of the girls. Among them, 17 were referred for precocious puberty, 5 with a diagnosis of pituitary tumor on magnetic resonance imaging, and others for acute surgical abdomen in 7 girls (painful abdominal mass-2, ovarian tumor-2, ovarian torsion-2, ruptured ovarian cyst-1), acute myelopathy in 1, and menorrhagia with headache in another. All girls were successfully managed with levothyroxine replacement alone, except for the 2 with ovarian torsion, who required surgery. Menstruation ceased promptly with T4 therapy in all girls, occurring at an age-appropriate later date. All boys had testicular enlargement at presentation that regressed partially after T4 treatment. Catch-up growth was remarkable during the first treatment year, but the final height was compromised in all., Conclusion: Increased awareness of varied presentations of VWGS is vital among pediatricians to facilitate early diagnosis and targeted investigations, and to help in the initiation of the simple yet highly rewarding T4 replacement therapy to avoid all possible complications., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society.)

1,5-Benzodiazepine is considered as one of the central moieties in the core unit of most drug molecules. Construction of such moieties with a new C-N bond under solvent-free and mild reaction conditions is challenging. Herein, we present a benign protocol for one pot synthesis of 1,5-benzodiazepine derivatives by using ferrocene (FC) supported activated carbon (AC) as a heterogeneous catalyst. The catalyst FC/AC was characterized by several analytical and spectroscopic techniques to reveal its physicochemical properties and for structural confirmation. The synthesized catalyst FC/AC was explored for its catalytic activity in the synthesis of 1,5-benzodiazepines through condensation of o -phenylenediamine (OPDA) and ketones (aromatic and aliphatic) under solvent-free conditions. The robust 10 wt% FC/AC catalyst demonstrated appreciable activity with 99% conversion of diamines and 91% selectivity towards the synthesis of the desired benzodiazepine derivatives under solvent-free conditions at 90 °C in 8 h. Additionally, several reaction parameters such as catalyst loading, reaction temperature, effect of reaction time and effect of different solvents on selectivity were also studied and discussed in-depth. To understand the scope of the reaction, several symmetrical and unsymmetrical ketones along with different substituted diamines were tested with the synthesized catalyst. All prepared reaction products were obtained in good to efficient yields and were isolated and identified as 1,5-benzodiazepines and no side products were observed. The obtained catalyst characterization data and the activity studies suggested that, the synergetic effect occurred due to the uniform dispersion of ferrocene over the AC surface with numerous acidic sites which triggered the reaction of diamine and ketone to form the corresponding benzodiazepine derivative and the same was illustrated in the plausible mechanism. Furthermore, the synthesized catalyst was tested for leaching and recyclability, and the results confirmed that catalyst can be used for up to six consecutive cycles without much loss in the catalytic activity and its morphology which makes the process sustainable and economical for scale-up production. The present method offered several advantages such as an ecofriendly method, excellent yields, sustainable catalytic transformation, easy work-up and isolation of products, and quick recovery of catalyst., 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., (This journal is © The Royal Society of Chemistry.)

Background: Stunting and anemia in pregnant women and under-five children remain a challenge in developing countries, including Indonesia. One of the significant contributors to these problems is inadequate nutrient intake., Objectives: The aim of the study was to identify, using a linear programming (LP) approach, problem nutrients and optimized food-based recommendations for under-five children and pregnant women in 10 stunting-prioritized districts in Indonesia., Methods: LP analysis was done using the Optifood tool on dietary data collected using single 24-h dietary recall in the National Monitoring of Nutrient Consumption ( Pemantauan Konsumsi Gizi ), conducted by the Ministry of Health from 10 stunting-prioritized districts in Indonesia. Problem nutrients and nutrient-dense foods were identified, and all alternative food-based recommendations or complementary feeding recommendations were compared to identify which recommendation will best contribute to fulfill dietary adequacy., Results: The number of problem nutrients in each district ranged from 0 to 7 nutrients for under-five children and 1 to 6 nutrients for pregnant women. The top 3 problem nutrients were: iron, zinc, and folate (for children aged 6-11 mo); zinc, folate, and calcium (for 12-23-mo-olds and 24-35-mo-olds); folate, zinc, and vitamin C/riboflavin (for 36-59-mo-olds); and iron, folate, and calcium (for pregnant women). The findings showed that problem nutrients identified using LP were in line with nutritional problems in under-five children (stunting and anemia) and pregnant women (anemia). Food-based recommendations (FBRs)/complementary feeding recommendations were developed that best meet dietary adequacy for the nutrients., Conclusions: Despite the similarity in stunting prevalence across the districts, there was variation in number and types of problem nutrients. The developed FBRs that promoted nutrient-dense foods suited to the problem nutrients in each area need to be promoted to improve nutrient intakes of under-five children and pregnant women in these areas with high stunting prevalence., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Delayed union and nonunion fractures are clinical challenges for orthopedic surgeons. The development of fracture complications, such as delayed union and nonunion fractures, is still difficult to predict. Various methods are being investigated to improve fracture healing and prevent complications in patients. There are various methods to promote fracture healing, broadly divided into biological, chemical, and physical methods. One of the most widely used physical methods to promote fracture healing is the pulsed electromagnetic field (PEMF). This study aimed to evaluate the healing process of delayed union fracture after being stimulated by PEMF. Twenty-four rats were randomly divided into two groups: the control group ( n  = 12) and the PEMF group ( n  = 12). Delayed union fracture was performed on the left femur of all rats. Subsequently, the PEMF group was given PEMF stimulus with a magnetic field intensity of 1.6 mT and a frequency of 50 Hz for 4 hours/day and 7 days/week. The fracture healing process was evaluated on days 5, 10, 18, and 28 based on the bone callus histology using safranin O fast green (SOFG) staining. The results of the histological analysis showed that bone cartilage was higher in the PEMF group than in the control group throughout the observation period. In addition, the PEMF group had less fibrous tissue at the beginning of the healing. This finding indicates PEMF stimulation has an effect on inducing osteogenesis on fracture healing and reducing the risk of delayed union., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 U. Umiatin et al.)

The multifaceted extracellular milieu presents biochemical and biophysical stimuli that influence stem cell differentiation. Two-dimensional (2D) micropatterned substrates allow the presentation of these cues in spatially defined geometries that have been demonstrated to guide stem cell fate decisions. Leveraging stem cells to reconstruct microvasculature, made up of an inner lining of endothelial cells (ECs) supported by pericytes, is critical to tissue-engineering advances; thus, methods to improve endothelial differentiation efficiency are vital to these efforts. In this study, we examine the hypothesis that the diameter of micropatterned islands influences endothelial differentiation from human induced pluripotent stem cells (hiPSCs). Comparing island diameters of 80, 140, 225 and 500 µm, we found that co-cultures of control ECs and pericytes did not yield variable ratios of cell types; however, when hiPSCs were differentiated toward a bicellular population of ECs and pericytes on these varying micropattern feature sizes, we found that smaller islands promoted EC differentiation efficiency, yielding a derived population composed of 70% ECs, which exhibited a greater sprouting propensity. Differentiation on the largest feature size exhibited a smaller EC yield, similar to that on non-patterned substrates. Taken together, these data demonstrate that micropatterned islands of varying diameters can be used to modulate EC differentiation efficiency. Copyright © 2015 John Wiley & Sons, Ltd., (Copyright © 2015 John Wiley & Sons, Ltd.)

Blood vessels serve as the lifeline of nearly all living tissue. Vascular cells derived from human pluripotent stem cells hold great potential for clinical use in the regeneration of diseased vasculature and construction of blood vessels in engineered tissue. By deriving these cells in a controllable and clinically relevant manner harnessing physiological cues, we can obtain populations of cells amenable for transplantation. In this chapter, we describe methods to differentiate human pluripotent stem cells toward a bicellular population of early vascular cells using low oxygen cues, guide these subpopulations into mature endothelial cells and pericytes, and expand the vascular derivatives.

Stem cell differentiation underlies many fundamental processes such as development, tissue growth and regeneration, as well as disease progression. Understanding how stem cell differentiation is controlled in mixed cell populations is an important step in developing quantitative models of cell population dynamics. Here we focus on quantifying the role of cell-cell interactions in determining stem cell fate. Toward this, we monitor stem cell differentiation in adherent cultures on micropatterns and collect statistical cell fate data. Results show high cell fate variability and a bimodal probability distribution of stem cell fraction on small (80-140 μm diameter) micropatterns. On larger (225-500 μm diameter) micropatterns, the variability is also high but the distribution of the stem cell fraction becomes unimodal. Using a stochastic model, we analyze the differentiation dynamics and quantitatively determine the differentiation probability as a function of stem cell fraction. Results indicate that stem cells can interact and sense cellular composition in their immediate neighborhood and adjust their differentiation probability accordingly. Blocking epithelial cadherin (E-cadherin) can diminish this cell-cell contact mediated sensing. For larger micropatterns, cell motility adds a spatial dimension to the picture. Taken together, we find stochasticity and cell-cell interactions are important factors in determining cell fate in mixed cell populations.

Background: Despite numerous reports outlining technical modifications in rhinoplasty, few publications discuss the importance of the perioperative assessment and surgical management of the nasal airway. This study's objective is to increase awareness regarding the functional aspects of rhinoplasty surgery and to encourage surgeons to incorporate functional airway management into their rhinoplasty practice., Methods: A web-based survey was given to all members of the American Society of Plastic Surgeons (ASPS). Survey results were analysed to determine if surgeons' experience, annual rhinoplasty volume, or postgraduate training affected their results. The relationship between surgeon satisfaction with the outcome of the airway management and the frequency of performing an inferior turbinate reduction was investigated., Results: Of the 4,383 listed ASPS members, 671 (21%) completed the web-based survey. Surgeons who performed a preoperative internal nasal exam were more satisfied with their results (p = 0.016) and report lower rates of postoperative nasal airway obstruction (p = 0.054). Inferior turbinate reduction did correlate to postoperative satisfaction with the nasal airway (p < 0.001). Overall, 85% of respondents were satisfied with their management of the nasal airway and 87% of respondents agreed that there is a need for more instructional courses on this topic., Conclusion: There is considerable variation in the results and techniques of assessment and treatment of the nasal airway. Rhinoplasty volume and inferior turbinate reduction are associated with surgeon satisfaction of management of the nasal airway. Functional airway considerations should be incorporated into routine rhinoplasty training, assessment, and treatment., Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Tissue-engineered constructs are rendered useless without a functional vasculature owing to a lack of nutrients and oxygen. Cell-based approaches to reconstruct blood vessels can yield structures that mimic native vasculature and aid transplantation. Vascular derivatives of human induced pluripotent stem cells (hiPSCs) offer opportunities to generate patient-specific therapies and potentially provide unlimited amounts of vascular cells. To be used in engineered vascular constructs and confer therapeutic benefit, vascular derivatives must exhibit additional key properties, including extracellular matrix (ECM) production to confer structural integrity and growth factor production to facilitate integration. In this study, we examine the hypothesis that vascular cells derived from hiPSCs exhibit these critical properties to facilitate their use in engineered tissues. hiPSCs were codifferentiated toward early vascular cells (EVCs), a bicellular population of endothelial cells (ECs) and pericytes, under varying low-oxygen differentiation conditions; subsequently, ECs were isolated and passaged. We found that EVCs differentiated under low-oxygen conditions produced copious amounts of collagen IV and fibronectin as well as vascular endothelial growth factor and angiopoietin 2. EVCs differentiated under atmospheric conditions did not demonstrate such abundant ECM expression, but exhibited greater expression of angiopoietin 1. Isolated ECs could proliferate up to three passages while maintaining the EC marker vascular endothelial cadherin. Isolated ECs demonstrated an increased propensity to produce ECM compared with their EVC correlates and took on an arterial-like fate. These findings illustrate that hiPSC vascular derivates hold great potential for therapeutic use and should continue to be a preferred cell source for vascular construction.

Objective: A critical regulator of the developing or regenerating vasculature is low oxygen tension. Precise elucidation of the role of low oxygen environments on endothelial commitment from human pluripotent stem cells necessitates controlled in vitro differentiation environments., Approach and Results: We used a feeder-free, 2-dimensional differentiation system in which we could monitor accurately dissolved oxygen levels during human pluripotent stem cell differentiation toward early vascular cells (EVCs). We found that oxygen uptake rate of differentiating human pluripotent stem cells is lower in 5% O2 compared with atmospheric conditions. EVCs differentiated in 5% O2 had an increased vascular endothelial cadherin expression with clusters of vascular endothelial cadherin+ cells surrounded by platelet-derived growth factor β+ cells. When we assessed the temporal effects of low oxygen differentiation environments, we determined that low oxygen environments during the early stages of EVC differentiation enhance endothelial lineage commitment. EVCs differentiated in 5% O2 exhibited an increased expression of vascular endothelial cadherin and CD31 along with their localization to the membrane, enhanced lectin binding and acetylated low-density lipoprotein uptake, rapid cord-like structure formation, and increased expression of arterial endothelial cell markers. Inhibition of reactive oxygen species generation during the early stages of differentiation abrogated the endothelial inductive effects of the low oxygen environments., Conclusions: Low oxygen tension during early stages of EVC derivation induces endothelial commitment and maturation through the accumulation of reactive oxygen species, highlighting the importance of regulating oxygen tensions during human pluripotent stem cell-vascular differentiation.

As the lifeline of almost all living tissues, blood vessels are a major focus of tissue-regenerative therapies. Rebuilding blood vessels has vast implications for the study of vascular growth and treatment of diseases in which vascular function is compromised. Toward this end, human pluripotent stem cells have been widely studied for their differentiation capacity toward vascular lineages. We demonstrate methods to derive a bicellular population of early specialized vascular cells from human pluripotent stem cells, to differentiate these toward mature endothelial cells and pericytes, and to utilize a collagen scaffold to facilitate organization into vascular networks.

Total spleen lymphocytes, lymphocyte proliferation, tumor necrosis factor-α (TNF-α), and interleukin-10 (IL-10) in spleen lymphocyte culture were studied in malnourished Wistar rats fed with goat milk yoghurt. Malnourished rats were created by using standard feed restriction as much as 50% of normal rats for 21 d. Goat milk yoghurt containing three types of microorganism e.g., Lactobacillus acidophilus, Sterptococcus thermophilus and Bifidobacterium longum derived from Lacto-B culture in powder form. After 21 d, the rats continued to receive restricted feeding and supplemented with goat milk yoghurt for 7 d. Total splenocytes were counted by hemocytometer. Splenocytes proliferation was expressed as stimulation index, whereas the TNF-α and IL-10 of spleen lymphocyte culture were measured by ELISA technique. The total number of splenocytes and stimulation index of splenocytes in moderate malnourished and normal rats supplemented with goat milk yoghurt was not significantly different. The level of TNF-α in the rat supplemented with goat milk yoghurt was lower (p<0.05) than the control group, whereas the level of IL-10 in the rat supplemented with goat milk yoghurt was higher (p<0.05) than the control group. In conclusion, goat milk yoghurt supplementation in malnourished rats could decrease TNF-α as a representation of the proinflammatory cytokine, while it increases IL-10 as a representation of the anti-inflammatory cytokine.

The success of tissue regenerative therapies is contingent on functional and multicellular vasculature within the redeveloping tissue. Although endothelial cells (ECs), which compose the vasculature's inner lining, are intrinsically able to form nascent networks, these structures regress without the recruitment of pericytes, supporting cells that surround microvessel endothelium. Reconstruction of typical in vivo microvascular architecture traditionally has been done using distinct cell sources of ECs and pericytes within naturally occurring matrices; however, the limited sources of clinically relevant human cells and the inherent chemical and physical properties of natural materials hamper the translational potential of these approaches. Here we derived a bicellular vascular population from human pluripotent stem cells (hPSCs) that undergoes morphogenesis and assembly in a synthetic matrix. We found that hPSCs can be induced to codifferentiate into early vascular cells (EVCs) in a clinically relevant strategy amenable to multiple hPSC lines. These EVCs can mature into ECs and pericytes, and can self-organize to form microvascular networks in an engineered matrix. These engineered human vascular networks survive implantation, integrate with the host vasculature, and establish blood flow. This integrated approach, in which a derived bicellular population is exploited for its intrinsic self-assembly capability to create microvasculature in a deliverable matrix, has vast ramifications for vascular construction and regenerative medicine.