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Background: After pancreatic surgery, the development of postoperative pancreatic fistula (POPF) is a serious concern. POPF involves the leakage of pancreatic fluids from the surgical site, which can lead to complications and even death. Preventing POPF is essential for enhancing patient recovery and lessening the impact on healthcare resources. This systematic review and meta-analysis evaluated medical methods and surgical techniques to prevent POPF. Methods: This study was registered under the International Prospective Register of Systematic Reviews (PROSPERO) with the registration number CRD42024500938. An electronic search was conducted through the PubMed, Google Scholar, Web of Science, and ScienceDirect databases for all relevant articles published in English from 2018 to 2023. The following search terms were used: ((Whipple procedure OR Pancreaticojejunal OR Pancreaticogastrostomy) AND (Prevention of postoperative pancreatic fistula) AND (Prevention OR Octreotide OR Sealant agent OR Stent OR Postoperative drain)). Results: Of 260 papers, 28 articles extracted through the database search were considered suitable for the systematic review. The included studies investigated a variety of surgical approaches for pancreatic resection. Pancreaticoduodenectomy (PD) was the most prevalent intervention. The incidence rates for POPF varied widely across the studies, ranging from as low as 11.6% to as high as 100%. The incidence rate of clinically relevant POPF (CR-POPF) ranged from 11.7% to 33.3%. The length of postoperative hospital stays also varied significantly. Discussion: Postoperative pancreatic fistula (POPF) affects 13–41% of patients post-pancreatic surgery. Despite its high incidence, mortality rates are low. Postoperative hospital stay varies, with higher rates in older patients and overweight individuals. Advancements in surgical techniques and perioperative management have reduced mortality rates to Conclusions: This study provides insights into the outcomes of pancreatectomy, including the incidence of POPF, postoperative hospital stays, and mortality rate. The findings suggest that the incidence of POPF is similar to that suggested in the literature and is influenced by various factors.

Human action recognition (HAR) based on skeleton data is a challenging yet crucial task due to its wide-ranging applications, including patient monitoring, security surveillance, and human- machine interaction. Although numerous algorithms have been proposed to distinguish between various activities, most practical applications require highly accurate detection of specific actions. In this study, we propose a novel, highly accurate spatiotemporal graph autoencoder network for HAR, designated as GA-GCN. Furthermore, an extensive investigation was conducted employing diverse modalities. To this end, a spatiotemporal graph autoencoder was constructed to automatically learn both spatial and temporal patterns from skeleton data. The proposed method achieved accuracies of 92.3% and 96.8% on the NTU RGB+D dataset for cross-subject and cross-view evaluations, respectively. On the more challenging NTU RGB+D 120 dataset, GA-GCN attained accuracies of 88.8% and 90.4% for cross-subject and cross-set evaluations. Overall, our model outperforms the majority of the existing state-of-the-art methods on these common benchmark datasets.

Background/Objectives: Deep hypothermic circulatory arrest (DHCA) is safe, but subtle neurodevelopmental deficits may persist far beyond the perioperative period. We aimed to investigate the relationship between DHCA duration and neurodevelopmental outcomes in young children undergoing cardiac surgery with DHCA. Methods: Children aged < 42 months, including neonates who underwent cardiac surgery using DHCA without regional perfusion techniques, were included as the DHCA group. Children in the same age range who underwent cardiac surgery without DHCA were included as the control group. All enrolled patients underwent neurodevelopmental assessment using the Bayley Scales of Infant and Toddler Development (BSTID) by a trained pediatrician, and 17 DHCA patients and 6 control patients completed the BSTID assessment. Results: Both groups showed no significant preoperative, operative, or postoperative differences. Adjusted multivariable analysis revealed that prematurity and age at assessment were significant changing predictors of each of the BSTID components (p < 0.001), except for the gross motor component, where only age at assessment was a significant adjusting predictor. Longer DHCA was associated with lower fine and gross motor BSTID components; however, the association was not statistically significant (p = 0.06). Conclusions: Long-duration DHCA without regional perfusion techniques may be associated with less optimal neurodevelopmental outcomes.

Introduction: Uterine carcinosarcoma is an aggressive gynecologic malignancy that accounts for 5% of all gynecological malignancies. There is a disproportion in its incidence and mortality among different races. This study describes demographic and clinicopathological factors and racial disparities affecting the survival of patients with uterine carcinosarcoma. Methods: Data on uterine carcinosarcoma patients were obtained from the Surveillance, Epidemiology, and End Results (SEER) database from 2000 to 2020. Results: Of the 11,338 patients identified, the median age at diagnosis was 68 years, and the five-year cause-specific survival (CSS) rate was 38.7%. for all races. Compared with Asian patients (39.5%, 95% CI, 36.0–43.4%), Hispanic patients (39.4%, 95% CI, 36.5–42.5%), and White patients (37.9%, 95% CI, 36.7–39.2%), Black patients accounted for 21% of the patients and had a significantly lower 5-year CSS (95% CI, 27.2–31.2%). The CSS rates were 84.4% (95% CI, 83.3–85.6%) for localized tumors, 68.5% (95% CI, 66.9–70.1%) for regional tumors, and 39.0% (95% CI, 36.9–41.2%) for distant tumors. Multimodal treatment involving chemotherapy, surgery, and radiation improved the overall one- and five-year survival rates by 88.2% (95% CI, 87.0–89.5%) and 52.8% (95% CI, 50.7–55.1%), respectively, across all disease stages. Multivariate analysis identified age >60 years, Black race, tumor size >4 cm, and distant metastases as independent risk factors for mortality (p < 0.0001). Conclusions: This large database study presents the most up-to-date epidemiological information regarding cases of uterine carcinosarcoma. The findings suggest that a combination of surgery, chemotherapy, and radiation may be most efficacious in treating this malignancy, especially in patients with distant disease.

Transplant oncology is an expanding area of cancer therapy that specifically emphasizes the use of liver transplantation (LT) as the preferred treatment for patients with manageable, but unresectable, tumors. The management and optimization of overall survival strategies, accompanied by an arguably decent quality of life, have been at the forefront of liver oncology treatment, as a plurality of all primary liver cancers are identified as either hepatocellular carcinoma (HCC) or cholangiocarcinoma (CCA), which are classified as highly aggressive malignancies and frequently remain asymptomatic until they progress to advanced stages, rendering curative procedures, such as resection, impractical. This has led to an increase in utilization of neoadjuvant interventions conducted prior to surgery, which has yielded favorable outcomes. Though this treatment modality has prompted further investigations into the efficacy of immune checkpoint inhibitors (ICPIs) as standalone treatments and in combination with locoregional treatments (LRTs) to bridge more patients into curative eligibility. This multidisciplinary methodology and treatment planning has seen multiple successful trials of immunotherapy regimes and combinate treatments, setting the groundwork for increasing eligibility through downstaging and “bridging” previously ineligible patients within stringent LT criteria. Surveillance after LT is a crucial component of transplant oncology. The emergence of circulating tumor DNA (ctDNA) has provided a novel approach to identifying the recurrence of cancer in its early stages. Recent research has focused on liquid biopsy, a technique that effectively identifies the dynamics of cancer. This is another innovation to demonstrate the rate at which transplant oncology is rapidly advancing, making the focus of care feel disorienting. Modalities of care are constantly evolving, but when a field is changing as rapidly as this one, it is imperative to reorient to the data and the needs of the patients. In this commentary, we reflect on the update’s utilization of ICPIs in neoadjuvant settings as well as the updates on the utilization of liquid biopsy in post-LT follow-up surveillance.

Background: The COVID-19 pandemic has had a significant impact globally, and understanding the relationship between inflammatory markers and disease progression is crucial for effective management. This retrospective study aimed to examine the association between various inflammatory markers, such as C-reactive protein (CRP), the erythrocyte sedimentation rate (ESR), lactate dehydrogenase (LDH), D-dimer, ferritin, and procalcitonin (PCT), and the characteristics of disease progression and outcomes in individuals affected by COVID-19. Methods: This study collected raw data from 470 patients who tested positive for SARS-CoV-2 using RT-PCR. Results: The logistic regression analysis revealed that elevated LDH levels were associated with male gender, ICU admission, low oxygen saturation (O2 < 93%), the need for mechanical ventilation, death, and the presence of lung infiltrates. Higher D-dimer levels were associated with older age, diabetes mellitus, cardiac disease, and low oxygen saturation. Ferritin levels were significantly associated with older age, ICU admission, low oxygen saturation, mechanical ventilation, and lung infiltrates. In contrast, CRP was only significant regarding lung infiltrates and procalcitonin levels were not significantly associated with any of the examined factors. Conclusion: This study highlights the importance of monitoring key inflammatory markers, such as LDH, D-dimer, and ferritin, as they are significantly associated with the severity of COVID-19 illness. These findings can inform clinical decision-making and guide the development of targeted interventions to improve patient outcomes.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common liver disease worldwide and simultaneously the most common indication for liver transplants in Western countries This study aims to evaluate the effectiveness of laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (RYGB) on MDASLD histologically and biochemically. 14 studies met our criteria with a total population of 1942 who underwent LSG or RYGB 1–14. The Newcastle-Ottawa Scale (NOS) was used for quality evaluation of the included studies. Results: Both surgeries were effective in decreasing laboratory biomarkers like ALP, GGT, AST, and ALT with non-significant superiority of LSG over RYGB which did not significantly improve the AST level after one year. LSG showed more decrease in ALT levels (MD = −17.56, 95% CI = (−23.04, −12.089), p 0.001) and LSG was associated with increased change in NAS score with slight superiority. Both LSG and RYBG improve NAD and NASH outcomes after one and 10 years of surgery. However, randomized clinical trials with large samples are needed to confirm these results.

Immune checkpoint inhibitors (ICI) are a promising form of immunotherapy that have significantly changed the therapeutic landscape for many advanced cancers. They have shown unique clinical benefit against a broad range of tumour types and a strong overall impact on survival in studied patient populations. However, there are still many limitations holding back this immunotherapy from reaching its full potential as a possible curative option for advanced cancer patients. A great deal of research is being undertaken in the hope of driving advancements in this area, building a better understanding of the mechanisms behind immune checkpoint inhibition and ultimately developing more effective, safer, and wider-reaching agents. Taking into account the current literature on this topic, this review aims to explore in depth the basis of the use of ICIs in the treatment of advanced cancers, evaluate its efficacy and safety, consider its current limitations, and finally reflect on what the future holds for this very promising form of cancer immunotherapy.

Carbon-capture technologies are extremely abundant, yet they have not been applied extensively worldwide due to their high cost and technological complexities. This research studies the ability of polymerized fly ash to capture carbon dioxide (CO2) under low-pressure and low-temperature conditions via physical adsorption. The research also studies the ability to desorb CO2 due to the high demand for CO2 in different industries. The adsorption–desorption hysteresis was measured using infrared-sensor detection apparatus. The impact of the CO2 injection rate for adsorption, helium injection rate for desorption, temperature, and fly ash contact surface area on the adsorption–desorption hysteresis was investigated. The results showed that change in the CO2 injection rate had little impact on the variation in the adsorption capacity; for all CO2 rate experiments, the adsorption reached more than 90% of the total available adsorption sites. Increasing the temperature caused the polymerized fly ash to expand, thus increasing the available adsorption sites, thus increasing the overall adsorption volume. At low helium rates, desorption was extremely lengthy which resulted in a delayed hysteresis response. This is not favorable since it has a negative impact on the adsorption–desorption cyclic rate. Based on the results, the polymerized fly ash proved to have a high CO2 capture capability and thus can be applied for carbon-capture applications.

In the healthcare field, diagnosing disease is the most concerning issue. Various diseases including cardiovascular diseases (CVDs) significantly influence illness or death. On the other hand, early and precise diagnosis of CVDs can decrease chances of death, resulting in a better and healthier life for patients. Researchers have used traditional machine learning (ML) techniques for CVD prediction and classification. However, many of them are inaccurate and time-consuming due to the unavailability of quality data including imbalanced samples, inefficient data preprocessing, and the existing selection criteria. These factors lead to an overfitting or bias issue towards a certain class label in the prediction model. Therefore, an intelligent system is needed which can accurately diagnose CVDs. We proposed an automated ML model for various kinds of CVD prediction and classification. Our prediction model consists of multiple steps. Firstly, a benchmark dataset is preprocessed using filter techniques. Secondly, a novel arithmetic optimization algorithm is implemented as a feature selection technique to select the best subset of features that influence the accuracy of the prediction model. Thirdly, a classification task is implemented using a multilayer perceptron neural network to classify the instances of the dataset into two class labels, determining whether they have a CVD or not. The proposed ML model is trained on the preprocessed data and then tested and validated. Furthermore, for the comparative analysis of the model, various performance evaluation metrics are calculated including overall accuracy, precision, recall, and F1-score. As a result, it has been observed that the proposed prediction model can achieve 88.89% accuracy, which is the highest in a comparison with the traditional ML techniques.

Wildlife trade, both legal and illegal, is increasingly recognized as a key factor in the rise of emerging viral infectious diseases, and this is especially apparent in Asia, where large numbers of wildlife are openly offered for sale in bird markets. We here focus on the risk of Psittacosis becoming a zoonotic disease in the wildlife markets of Java and Bali, Indonesia. Psittacosis is particularly prevalent in parrots (hence the name), and the trade in parrots was instrumental in the Great Parrot Fever Pandemic in 1929/1930. Between 2014 and 2023, we conducted 176 surveys of 14 bird markets, during which we recorded 4446 largely wild-caught parrots for sale. On average, each market had nine genera on offer, and the diversity of genera increased with the increasing presence of parrots (up to 16 genera). For most of the bird markets during each survey, parrots from different genera and originating from different parts of the world, were offered for sale alongside each other. Genera offered for sale together did not cluster into natural (geographic) groups. We found no temporal difference in the sale of parrots. We conclude that the omnipresence of wild-caught parrots from various geographic regions in large numbers within the same bird markets increases the risk that psittacosis is present and that this poses a real risk for the zoonotic spread of avian chlamydiosis to humans.

Disease recognition has been revolutionized by autonomous systems in the rapidly developing field of medical technology. A crucial aspect of diagnosis involves the visual assessment and enumeration of white blood cells in microscopic peripheral blood smears. This practice yields invaluable insights into a patient’s health, enabling the identification of conditions of blood malignancies such as leukemia. Early identification of leukemia subtypes is paramount for tailoring appropriate therapeutic interventions and enhancing patient survival rates. However, traditional diagnostic techniques, which depend on visual assessment, are arbitrary, laborious, and prone to errors. The advent of ML technologies offers a promising avenue for more accurate and efficient leukemia classification. In this study, we introduced a novel approach to leukemia classification by integrating advanced image processing, diverse dataset utilization, and sophisticated feature extraction techniques, coupled with the development of TL models. Focused on improving accuracy of previous studies, our approach utilized Kaggle datasets for binary and multiclass classifications. Extensive image processing involved a novel LoGMH method, complemented by diverse augmentation techniques. Feature extraction employed DCNN, with subsequent utilization of extracted features to train various ML and TL models. Rigorous evaluation using traditional metrics revealed Inception-ResNet’s superior performance, surpassing other models with F1 scores of 96.07% and 95.89% for binary and multiclass classification, respectively. Our results notably surpass previous research, particularly in cases involving a higher number of classes. These findings promise to influence clinical decision support systems, guide future research, and potentially revolutionize cancer diagnostics beyond leukemia, impacting broader medical imaging and oncology domains.

Environmental toxins pose significant threats to ecosystems and human health. Monitoring and assessing these toxins are crucial for effective environmental management and public health protection. Recently, plant species have garnered increasing attention as potential bioindicators for identifying and evaluating ecological toxins. Since plants often come into touch with harmful compounds in soil, water, and the atmosphere, they are particularly valuable for analyzing how human activities influence the terrestrial ecosystem, the aquatic system, and the atmosphere. This review paper emphasizes using plant species as a resource for tracking environmental pollution and analyzing contaminants. We focused on plants because they are significant indicators of soil, water, and air quality changes. Many plants have been used as bio-indicators to assess and predict pollution, toxicity, and environmental changes. These include Allium cepa, Vicia faba, Pisum sativum, Zea mays, Nicotiana tabacum, lichens, and mosses. The idea of bioindicators is discussed in the current paper, with a focus on plants as possible candidates for bioindicators for toxin assessment and related outcomes.

(1) Background: Patients who experience acute traumatic injury requiring hospitalisation represent a vulnerable population. The trauma patient often experiences multi-system injuries and complex physiology. Additionally, there are complex socio-ecological issues that impact the care and outcomes of trauma patients. Of interest, culturally and linguistically diverse populations with language barriers experience worse outcomes in trauma settings. This scoping review evaluates the current evidence on language barriers in this population and the influences on outcomes for trauma patients. (2) Methods: A scoping review was performed following a computer-assisted search of the Medline, Embase and Cochrane Central databases. Papers that evaluated the impact of the language barrier in culturally and linguistically diverse populations and outcomes in acute trauma settings were included. (3) Results: A literature search identified eight articles that were eligible for inclusion. Overall, there was no robust evidence to suggest that such populations were disadvantaged in terms of length of hospital stay and overall mortality. However, studies did identify that these populations were at higher risk of disability and poor mental health outcomes, experienced communication barriers more often and had lower social functioning. (4) Conclusions: This scoping review demonstrates that individuals admitted due to trauma who are from culturally and linguistically diverse backgrounds experience more significant disadvantages concerning psychological and functional outcomes. It is posited this is due to their inability to communicate their complex needs in trauma, however more robust and rigorous research is required to better characterise this effect.

Background: Surgeons have limited knowledge of the lumbar intervertebral foramina. This study aimed to classify osteophytes in the lumbar intervertebral foramen and to determine their pathoanatomical characteristics, discuss their potential biomechanical effects, and contribute to developing surgical methods. Methods: We conducted a retrospective, non-randomized, single-center study involving 1224 patients. The gender, age, and anatomical location of the osteophytes in the lumbar intervertebral foramina of the patients were recorded. Results: Two hundred and forty-nine (20.34%) patients had one or more osteophytes in their lumbar 4 and 5 foramina. Of the 4896 foramina, 337 (6.88%) contained different types of osteophytes. Moreover, four anatomical types of osteophytes were found: mixed osteophytes in 181 (3.69%) foramina, osteophytes from the lower endplate of the superior vertebrae in 91 (1.85%) foramina, osteophytes from the junction of the pedicle and lamina of the upper vertebrae in 39 foramina (0.79%), and osteophytes from the upper endplate of the lower vertebrae in 26 (0.53%) foramina. The L4 foramen contained a significantly higher number of osteophytes than the L5 foramen. Osteophyte development increased significantly with age, with no difference between males and females. Conclusions: The findings show that osteophytic extrusions, which alter the natural anatomical structure of the lumbar intervertebral foramina, are common and can narrow the foramen.

Background: Although mood disorders are prevalent among systemic lupus erythematosus (SLE) patients, they are usually underrecognized. This study aimed to estimate the prevalence of anxiety and depression among Saudi SLE patients. Methods: This cross-sectional study was conducted among SLE patients from July 2022 to June 2023 in the Eastern Province of Saudi Arabia. A self-reported questionnaire was used to collect the data through validated tools including the Hamilton Anxiety Rating Scale-A and the Beck Depression Inventory score. Results: There were 133 females (91.7%) and 12 males (8.3%) included in this study. Based on the HAM-A score, 45.5% of participants had an anxiety disorder, and according to the BDI score, 46.2% had a depression disorder. Anxiety and depression were significantly associated with a longer duration of SLE, unemployment status, smoking, and the presence of comorbidities. Moreover, the present study found a significant association between depression and male gender. Conclusion: This study found that Saudi SLE patients have a high prevalence of both anxiety and depression. Therefore, SLE patients should be screened for neuropsychiatric disorders during routine follow-ups and managed as early as possible.

Background: Acetaminophen overdose is a common clinical condition, often leading to liver toxicity. Current treatments involve the three-infusion N-Acetylcysteine (NAC) regimen (FDA-labeled), which may be complex, time-consuming, and need to be changed. An alternative uses two infusions instead, which offers possible advantages regarding simplicity and administration errors. This study sought to compare the respective efficacies and safety outcomes when treating acute acetaminophen overdose among children and adolescents. Methods: At Montreal Children’s Hospital, a retrospective study was conducted comparing pre-2003 FDA-labelled three-infusion NAC therapy with a two-infusion regimen. Information was collected regarding patient demographics, NAC administration details, errors, rates of hepatotoxicity, and adverse reactions, and the statistical test Chi-square test was employed to obtain the results. Results: A total of 126 patients met the inclusion criteria. Of these patients, 65 received a two-infusion regimen, and 61 patients received the FDA-labeled regimen. The two-infusion group experienced significantly fewer administration errors (4 errors vs. 23 errors; p < 0.001), while the rates of hepatotoxicity between them were similar. There were no instances of liver transplantation or mortality due to either regimen. Adverse reactions occurred equally frequently between both regimens with no discernible difference—the meantime to administer NAC was 9 h for the two-infusion regimen and 8.5 h for FDA-labeled regimen groups, respectively. Three cases of hepatitis were successfully treated with timely NAC therapy, and no liver transplantation or mortality occurred. Adverse reactions, including anaphylactoid reactions, were observed in both groups but were resolved when temporarily stopped and restarted at a slower infusion rate. Conclusions: The two-infusion NAC regimen proved similar efficacy at protecting liver damage and improving patient outcomes compared to its FDA-labeled three-stage counterpart, with significantly fewer administration errors for this version of NAC treatment, suggesting potential advantages in terms of safety and simplicity. Future research should investigate larger cohorts and more variables to validate these results further and optimize the management of acetaminophen overdose cases; further investigation should focus on dosing strategies, personalized approaches, and long-term patient care in this context.

Chronic infection of Helicobacter pylori represents a key factor in the etiology of gastrointestinal diseases, with high endemicity in South Asia. The present study aimed to determine the prevalence of H. pylori among dyspeptic patients in north–central Bangladesh (Mymensingh) and analyze risk factors of infection and antimicrobial resistance (AMR) determinants in the pathogen. Endoscopic gastrointestinal biopsy samples were collected from dyspeptic patients for a one-year period from March 2022 and were checked for the presence of H. pylori via the rapid urease test and PCR and further analyzed for the status of virulence factors vacA/cagA and genetic determinants related to AMR via PCR with direct sequencing or RFLP. Among a total of 221 samples collected, 80 (36%) were positive for H. pylori, with the vacA+/cagA+ genotype being detected in almost half of them. H. pylori was most prevalent in the age group of 41–50-year-olds, with it being more common in males and rural residents with a lower economic status and using nonfiltered water, though the rates of these factors were not significantly different from those of the H. pylori-negative group. Relatively higher frequency was noted for the A2147G mutation in 23S rRNA, related to clarithromycin resistance (18%, 7/39). Amino acid substitutions in PBP-1A (T556S) and GyrA (N87K and D91N) and a 200 bp deletion in rdxA were detected in samples from some patients with recurrence after treatment with amoxicillin, levofloxacin, and metronidazole, respectively. The present study describes the epidemiological features of H. pylori infection in the area outside the capital in Bangladesh, revealing the spread of AMR-associated mutations.

Previous research has established that polyphenols increase lifespan and stress resistance in C. elegans. However, the effects of timing of exposure on the extension of lifespan and the mechanisms involved are not completely understood. This study aims to clarify the influence of the timing of polyphenol-rich sugarcane extract (PRSE) administration on the lifespan of Caenorhabditis elegans. C. elegans worms were subjected to a diet containing PRSE powder at various larval stages until their death. The optimal concentration for lifespan extension was found to be 5 mg/mL PRSE, which increased the lifespan of N2 worms by 18.12% compared to the control group. Mutant strains were also tested, and worm thermotolerance assays were used to assess age-related health at different life stages. Lifespan was notably extended when PRSE was introduced at the first larval stage and 15 h thereafter. No significant extension of lifespan was observed when introduced later in life. The lifespan of DAF-16 and DAF-2 mutants remained unaffected by PRSE. Improved thermotolerance was observed, especially in young and middle-aged worms. Early initiation and sustained intake of PRSE might improve the heat stress and lifespan, implicating the insulin/IGF-1 signaling pathway as a likely mediator in C. elegans.

Malignant pleural mesothelioma is a rare, aggressive, and incurable cancer with a poor prognosis and high symptom burden. For these patients, little is known about the impact of palliative care consultation on outcomes such as mortality, hospital admissions, or emergency department visits. The aim of this study is to determine if referral to supportive and palliative care in patients with malignant pleural mesothelioma is associated with survival and decreased hospital admissions and emergency department visits. This is a retrospective chart review. Study participants include all malignant pleural mesothelioma patients seen at The Ottawa Hospital—an acute care tertiary center—between January 2002 and March 2019. In total, 223 patients were included in the study. The mean age at diagnosis was 72.4 years and 82.5% were male. Of the patients diagnosed between 2002 and 2010, only 11 (9.6%) were referred to palliative care. By comparison, of those diagnosed between 2011 and 2019, 49 (45.4%) were referred to palliative care. Median time from diagnosis to referral was 4.1 months. There was no significant difference in the median survival of patients referred for palliative care compared to those who did not receive palliative care (p = 0.46). We found no association between receiving palliative care and the mean number of hospital admissions (1.04 vs. 0.91) from diagnosis to death, and an increase in mean number of emergency department visits in the palliative care group (2.30 vs. 1.18). Although there was increased utilization of palliative care services, more than half of the MPM patients did not receive palliative care despite their limited survival. There was an increase in emergency department visits in the palliative care group; this may represent an increase in the symptom burden (i.e., indication bias) in those referred to palliative care.

The success rate of extracorporeal shock wave lithotripsy (ESWL) is influenced by various factors, including stone density, and is determined through computed tomography scans in terms of Hounsfield units (HU). Materials and Methods: This retrospective single-center study was conducted in the King Fahad Hospital. Sixty-seven adult patients with renal and ureteric stones were selected randomly and enrolled in the study. Their ages ranged from 20 to 69 years. The patients were examined with non-contrast enhancement (NCCT) to assess the HU of their stones and were consequently treated with ESWL. Results: Of the 67 patients, 37.3% had stones that were completely fragmented, while 62.7% had stones that were partially fragmented. The HU, location of the stone, multiplicity of the stone, and patient age were found to be significant factors contributing to stone fragility (p-values < 0.05). The HU data were found to have a positive significant linear correlation with serum calcium (r = 0.28, p-value = 0.036), while serum acid had a negative correlation (r = −0.55, p-value < 0.001). Thus, the probability of calcium-containing stone formation increases with increased HU. In contrast, uric acid stone formation likely develops with decreasing HU with serum uric acid. Renal stones in patients with diabetes mellitus and hypertension were not completely fragmented compared to those without clinical history. Conclusions: Mean HU, location of the stone, laterality, stone status, and the number of ESWL sessions are the most significant factors affecting stone fragility. CT attenuation values can predict the composition of stones from serum calcium and uric acid examinations. Hypertension and diabetes mellitus are risk factors for renal stone fragmentation.

A one-pot multi-component reaction was employed for the stereoselective synthesis of a novel set of dispiro-oxindolopyrrolizidines analogs incorporating a thiazolo[3,2-a]benzimidazole scaffold based on the [3 + 2] cycloaddition (32CA) reaction approach. The desired novel dispiro-oxindolopyrrolizidines 9a–d were achieved using the 32CA reaction of new ethylene derivatives based on thiazolo[3,2-a]benzimidazole moiety seven with thiazolidine derivatives eight and different substituted isatin compounds 5a–d (R = H, Cl, NO2, and Br). The final dispiro-oxindolopyrrolizidines cycloadducts were separated, purified, and fully characterized by means of a set of spectroscopic tools including IR, HNMR, CNMR, and MS. The Molecular Electron Density Theory (MEDT) was applied to explain the mechanism and stereoselectivity in the of the key 32CA reaction step. The reactive pseudo(mono)radical electronic structure of the in situ generated azomethine ylides and the high polar character of the corresponding 32CA reactions account for the low computed activation Gibbs free energies and total endo stereoselectivity of this kinetically controlled exergonic reaction. The computed relative Gibbs free activation energies of competitive reaction paths and regioisomers ratio distribution of 80:20 justify the major formation of 9a via the most favorable ortho/endo reaction path.

Titanium-based dental prostheses are essential for prosthodontics and can now be 3D printed using powder bed fusion (PBF) technology with different densities by controlling the process parameters. This study aimed to assess the surface topography and bonding strength of dental resins made of 3D-printed titanium alloys with varying densities and growth directions. Three groups of titanium alloy (Ti6Al4V) specimens differentiated by density (low, medium, and high) were produced using laser-melting 3D printing technology (N = 8). Each group included specimen surfaces with vertical and horizontal growths. Vickers microhardness, surface profilometry, wettability, and shear bond strength (SBS) of the titanium samples were measured for all groups. Scanning electron microscopy (SEM) was performed. Statistical analyses were conducted using a two-way ANOVA and Fisher’s multiple test. Higher-density specimens exhibited greater microhardness (p < 0.05), and those with horizontal growth directions were harder (p < 0.05) than their vertical counterparts within the same density category. Additionally, low-density specimens in both growth directions had the highest surface roughness values (p < 0.05) compared to the other groups. The wettability values were similar (p > 0.05) among the groups in the vertical direction, but not in the horizontal direction (p < 0.05). However, the density type did not significantly (p > 0.05) influence the bonding strength of 3D-printed titanium. This study revealed significant variations in surface roughness, contact angle, and microhardness based on density and growth direction.

Cardiovascular diseases (CVDs) are classed as diseases of aging, which are associated with an increased prevalence of atherosclerotic lesion formation caused by such diseases and is considered as one of the leading causes of death globally, representing a severe health crisis affecting the heart and blood vessels. Atherosclerosis is described as a chronic condition that can lead to myocardial infarction, ischemic cardiomyopathy, stroke, and peripheral arterial disease and to date, most pharmacological therapies mainly aim to control risk factors in patients with cardiovascular disease. Advances in transformative therapies and imaging diagnostics agents could shape the clinical applications of such approaches, including nanomedicine, biomaterials, immunotherapy, cell therapy, and gene therapy, which are emerging and likely to significantly impact CVD management in the coming decade. This review summarizes the current anti-atherosclerotic therapies’ major milestones, strengths, and limitations. It provides an overview of the recent discoveries and emerging technologies in nanomedicine, cell therapy, and gene and immune therapeutics that can revolutionize CVD clinical practice by steering it toward precision medicine. CVD-related clinical trials and promising pre-clinical strategies that would significantly impact patients with CVD are discussed. Here, we review these recent advances, highlighting key clinical opportunities in the rapidly emerging field of CVD medicine.

Greenhouses are used to create the appropriate environment for plant growth. Controlling the level of lighting using shading nets is one of the most commonly used methods for making suitable environmental modifications in greenhouses. The objective of this study was to examine the impact of three colored shading nets (green, black, and beige at shading rates of 50%) on inside air temperature, relative humidity, and spectral distribution of light in a greenhouse, as well as their effect on the growth and yield of strawberry plants. Data were collected during winter (December and January) and spring (March and April) months from shaded and unshaded blocks. The green net had the highest transmittance to solar radiation (τSR) during the two periods (38% and 35%, respectively) and the highest transmittance to photosynthetically active radiation (τPAR) of 34% during spring months, while the beige net had the highest τPAR of 27% during winter months. The black net had the smallest τPAR values during the two periods (22% and 29%, respectively). The lowest total light levels per season for solar radiation (SR) and photosynthetically active radiation (PAR) (746.8 and 293.7 MJ·m−2, respectively) were obtained under the black net, compared with (906.7 and 320.8 MJ·m−2, respectively) for the beige net, and (969.6 and 337.2 MJ·m−2, respectively) for the green net. The ratio of PAR to SR (PAR:SR) was 41% and 44% outside and inside the greenhouse for the control (without shade), respectively. The black net had the highest ratio of PAR:SR (39%) among the treatment nets. The green net transmitted more light in the blue–green region (400 to 570 nm) and transmitted the highest photon flux at 480 nm, while the beige net increased the infrared radiation flux from 730 nm and above and transmitted the highest photon flux at 604 nm. The study found that the green net increased the ratio of blue to red light (B/R), while the beige and green nets reduced the red to far-red light (R/FR) ratio. The photosynthetic rate, conductance to water, and transpiration were significantly higher for strawberries grown under the beige net. These results indicate that the beige net positively influenced leaf and stem characteristics, leading to improved strawberry yields. The best yields of strawberries were obtained under the beige net and the control group (no shade), surpassing the yields achieved under the black net by 26.3% and 21.4%, respectively.

Sign language is undoubtedly a common way of communication among deaf and non-verbal people. But it is not common among hearing people to use sign language to express feelings or share information in everyday life. Therefore, a significant communication gap exists between deaf and hearing individuals, despite both groups experiencing similar emotions and sentiments. In this paper, we developed a convolutional neural network–squeeze excitation network to predict the sign language signs and developed a smartphone application to provide access to the ML model to use it. The SE block provides attention to the channel of the image, thus improving the performance of the model. On the other hand, the smartphone application brings the ML model close to people so that everyone can benefit from it. In addition, we used the Shapley additive explanation to interpret the black box nature of the ML model and understand the models working from within. Using our ML model, we achieved an accuracy of 99.86% on the KU-BdSL dataset. The SHAP analysis shows that the model primarily relies on hand-related visual cues to predict sign language signs, aligning with human communication patterns.

Opioid-related deaths are attributed to overdoses, and fentanyl overdose has been on the rise in many parts of the world, including the USA. Glutamate transporter 1 (GLT-1) has been identified as a therapeutic target in several preclinical models of substance use disorders, and β-lactams effectively enhance its expression and function. In the current study, we characterized the metabolomic profile of the nucleus accumbens (NAc) in fentanyl-overdose mouse models, and we evaluated the protective effects of the functional enhancement of GLT-1 using β-lactams, ceftriaxone, and MC-100093. BALB/c mice were divided into four groups: control, fentanyl, fentanyl/ceftriaxone, and fentanyl/MC-100093. While the control group was intraperitoneally (i.p.) injected with normal saline simultaneously with other groups, all fentanyl groups were i.p. injected with 1 mg/kg of fentanyl as an overdose after habituation with four repetitive non-consecutive moderate doses (0.05 mg/kg) of fentanyl for a period of seven days. MC-100093 (50 mg/kg) and ceftriaxone (200 mg/kg) were i.p. injected from days 5 to 9. Gas chromatography–mass spectrometry (GC-MS) was used for metabolomics, and Western blotting was performed to determine the expression of target proteins. Y-maze spontaneous alternation performance and the open field activity monitoring system were used to measure behavioral manifestations. Fentanyl overdose altered the abundance of about 30 metabolites, reduced the expression of GLT-1, and induced the expression of inflammatory mediators IL-6 and TLR-4 in the NAc. MC-100093 and ceftriaxone attenuated the effects of fentanyl-induced downregulation of GLT-1 and upregulation of IL-6; however, only ceftriaxone attenuated fentanyl-induced upregulation of TRL4 expression. Both of the β-lactams attenuated the effects of fentanyl overdose on locomotor activities but did not induce significant changes in the overall metabolomic profile. Our findings revealed that the exposure to a high dose of fentanyl causes alterations in key metabolic pathways in the NAc. Pretreatment with ceftriaxone and MC-100093 normalized fentanyl-induced downregulation of GLT-1 expression with subsequent attenuation of neuroinflammation as well as the hyperactivity, indicating that β-lactams may be promising drugs for treating fentanyl use disorder.

This study aimed to investigate the potential of polycaprolactone–vitamin E TPGS (PCL-TPGS) micelles as a delivery system for oral administration of paclitaxel (PTX). The PCL-TPGS copolymer was synthesized using ring opening polymerization, and PTX-loaded PCL-TPGS micelles (PTX micelles) were prepared via a co-solvent evaporation method. Characterization of these micelles included measurements of size, polydispersity, and encapsulation efficiency. The cellular uptake of PTX micelles was evaluated in Caco-2 cells using rhodamine 123 (Rh123) as a fluorescent probe. Moreover, an everted rat sac study was conducted to evaluate the ex vivo permeability of PTX micelles. Additionally, a comparative pharmacokinetic study of PTX micelles versus the marketed formulation, Ebetaxel® (a Taxol generic), was performed after a single oral administration to rats. The results demonstrated that the micellar formulation significantly improved PTX solubility (nearly 1 mg/mL). The in vitro stability and release of PTX micelles in simulated gastric fluid (SGF) and simulated intestinal fluid (SIF) demonstrated that PTX micelles remained stable for up to 24 h and significantly slowed the release of PTX in both media compared to Ebetaxel®. The in vitro cellular uptake, ex vivo intestinal permeability, and in vivo pharmacokinetic profile demonstrated that PTX micelles enhanced the permeability and facilitated a rapid absorption of the drug. Conclusively, the PCL7000-TPGS3500 micelles exhibit potential as an effective oral delivery system for PTX.

Parents are an essential element of family intervention for all children, including those with autism spectrum disorders (ASDs). We can better understand and address parents’ knowledge gaps about ASD through in-depth research and inquiry into parents’ current level of understanding, attitude, and perception. We aimed to assess the knowledge, attitude, and perception of ASD and influencing factors towards ASD among a group of parents with and without a child diagnosed with ASD in Sakaka, Al-Jouf Region, Saudi Arabia. Using the cross-sectional study design, information from the parents was gathered using a pretested questionnaire that included validated scales for measuring knowledge, attitudes, and perceptions related to ASD. The required number of participants was selected using the convenience sampling method. We used Spearman’s correlation test to determine the strength and direction of correlation between each domain. As a last step, we analyzed the influencing factors using binomial logistic regression. Among the 400 participants, 41.2% had high knowledge, 69.1% had a positive attitude, and 60.3% had a high perception of ASD. We found that knowledge was significantly higher among the parents with autistic individuals in the family (p = 038). The high and positive attitude was significantly greater among females (p = 0.010) and parents with high income (p = 0.007), and the perception was significantly associated with females (p = 0.037) and highly educated participants (p = 0.046). Furthermore, we found a positive correlation between knowledge, attitude, and perception. Overall, only less than half of the participants had a high knowledge of ASD. Hence, we recommend awareness-raising programs for the parents in this region. Furthermore, a prospective study involving parents from all provinces of Saudi Arabia is recommended.

Background: Hypertension imposes a significant public health burden. An increased awareness of hypertension complications within a population can positively impact patient care and prevent complications. This study seeks to assess the awareness of hypertension complications among the population of Bisha in Saudi Arabia in 2020. Methods: A cross-sectional study was conducted in 2020. A validated self-administered online-based questionnaire was sent to a sample of the adult population of Bisha to measure their awareness of hypertension complications. Results: Almost three-quarters of the population (72.2%) were aware of hypertension complications. The awareness level was significantly higher among male participants (p < 0.001), those aged 31–40 years, those who were married, those working as police officers or in civilian jobs, those living in urban areas (p = 0.04), those with a university-level education (p = 0.03), those with a medium family income (SAR 5000–14,999) (p = 0.001), and those with a history of hospitalization because of causes other than hypertension (p = 0.05). Marital status was independently predictive of awareness (B = 0.851, Wald test = 12.179, p = 0.000) among the respondents. Conclusion: The study concludes that the awareness of hypertension complications among the Bisha population in Saudi Arabia was deemed acceptable. Factors such as marital status, age, gender, a family history of hypertension, the duration of hypertension, and medication adherence positively influenced this awareness and served as predictors of hypertensive awareness. The findings highlight the importance of health authorities in ensuring the widespread awareness of hypertension complications, particularly among hypertensive individuals.

Amyloid β peptide (Aβ) aggregation and deposition are considered the main causes of Alzheimer’s disease. In a previous study, we demonstrated that anionic Zn-phthalocyanine (ZnPc) can interact with the Aβ peptide and inhibit the fibril-formation process. However, due to the inability of anionic ZnPc to cross the intact blood–brain barrier, we decided to explore the interaction of cationic methylated Zn-phthalocyanine (cZnPc) with the peptide. Using a ThT fluorescence assay, we observed that cZnPc dose-dependently and time-dependently inhibited Aβ1-42 fibril levels under in vitro fibril-formation conditions. Electron microscopy revealed that it caused Aβ1-42 peptides to form small aggregates. Western blotting and dot immunoblot oligomer experiments demonstrated that cZnPc increased rather than decreased the levels of oligomers from the very early stages of incubation. A binding assay confirmed that cZnPc could bind with the peptide. Docking simulations indicated that the oligomer species of Aβ1-42 had a higher ability to interact with cZnPc. ANS fluorescence assay results indicated that cZnPc did not affect the hydrophobicity of the peptide. However, cZnPc significantly increased intrinsic tyrosine fluorescence of the peptide after 8 h of incubation in fibril-formation conditions. Importantly, cell culture experiments demonstrated that cZnPc did not exhibit any toxicity up to a concentration of 10 µM. Instead, it protected a neuronal cell line from Aβ1-42-induced toxicity. Thus, our results suggest that cZnPc can affect the aggregation process of Aβ1-42, rendering it non-toxic, which could be crucial for the therapy of Alzheimer’s disease.

The main focus in this manuscript is to find a numerical solution of a dengue fever disease model by using the Fibonacci wavelet method. The operational matrix of integration has been obtained using Fibonacci wavelets. The proposed method is called Fibonacci wavelet collocation method (FWCM). This biological model has been transformed into a system of nonlinear algebraic equations by using the Fibonacci wavelet collocation scheme. Afterward, this system has been solved by using the Newton–Raphson method. Finally, we provide evidence that our results are better than those obtained by various current approaches, both numerically and graphically, demonstrating the method’s accuracy and efficiency.

Background and Objectives: The frequency of multidrug-resistant Klebsiella pneumoniae (MDRKP) has dramatically increased worldwide in recent decades, posing an urgent threat to public health. The aim of this study was to assess the extent of K. pneumoniae in the Aseer region and explore the corresponding antimicrobial resistance profile over the last ten years. Materials and Methods: A record-based retrospective study was conducted in a tertiary hospital during the period of 2013 to 2022. The study targeted laboratory samples taken from patients admitted to the hospital and sent for K. pneumoniae culturing. We included only samples taken from the patient and confirmed by the lab. Data were extracted using a pre-structured data extraction sheet to avoid data-collection bias and confirm the inter-rater precision. Statistical Package for Social Sciences (SPSS) version 26 was employed for statistical analysis. All relationships were tested using Pearson X2 test for categorical data or chi-square for linear trend for resistance rate over years. Results: We obtained 3921 samples of isolated K. pneumoniae out of 28,420 bacterial samples. The isolation rate began at 11.3% in 2013, decreased to 6.1% in 2016, and then increased to a peak of 16.3% in 2021, before slightly decreasing to 12.8% in 2022. In total, 23.7% of K. pneumoniae samples were identified in urine samples, 19% in sputum samples, 14% in wound samples, and 11.7% in blood samples. The overall antibiotic resistance rate of K. pneumoniae from 2013 to 2022 showed a significant increase, particularly during 2020 and 2021, before decreasing again in 2022. The resistance rate decreased from 22.2% in 2013 to 18.6% in 2016 and increased to 54.6% and 56.4% during 2020 and 2021, respectively (p = 0.039). Conclusions: We observed a significant shift in K. pneumoniae resistance for some antibiotics during the study period, highlighting the urgent need for enhanced antimicrobial stewardship and infection-control measures.

Bakanae is one of the important diseases of rice in Bangladesh that causes substantial yield loss every year. We collected thirty isolates of Fusarium spp. from bakanae-infected rice plants from different agroecological zones of Bangladesh and investigated the variations in cultural and morphological characteristics and pathogenicity. Diversity was found in cultural characteristics, viz., colony features, phialide, chlamydospore formation, shape, and size of macro- and microconidia. Three variants of Fusarium species such as F. moniliforme, F. fujikuroi, and F. proliferatum were identified on PDA media based on their cultural and morphological characteristics. Isolate FM10 (F. moniliforme) exhibited the highest disease aggressiveness in developing elongated plants (26.50 cm), the highest number of chlorotic leaves (5.75), and a lower germination percentage. We evaluated different bioagents against the virulent isolate of F. moniliforme to develop a rice bakanae disease management approach. Four bioagents, viz., Trichoderma spp., Bacillus subtilis, Pseudomonas fluorescens, and Achromobacter spp., were evaluated for growth suppression of F. moniliforme. Among the bioagents, Achromobacter spp. and B. subtilis (BS21) showed 73.54% and 71.61% growth suppression, respectively. The investigation revealed that the application of Achromobacter spp. and B. subtilis (BS21) would be a potential candidate for effective and eco-friendly management of the bakanae disease of rice.

Background: Although sedentary behavior (SB) before and during COVID-19 has been studied, mental activity-based SB patterns have been overlooked. This secondary analysis investigated the patterns of mentally active vs. passive SB in adults post-COVID-19 pandemic and examined sex differences. Methods: Adults (n = 1255; 45% males; 50% aged between 20 and 29 years old) self-reported general characteristics, anthropometric and socioeconomic variables, and mentally active and passive SB (weekdays and weekend days) using a structured web-based survey. Adjusted ANCOVA on Ranks tests assessed differences between mentally active and mentally passive SB during the day, on weekdays, and weekend days. Adjusted Quade Nonparametric ANCOVA tests evaluated these differences in males vs. females. Results: Adults significantly spent greater time in mentally active vs. passive SB (5.61 ± 4.57 vs. 2.50 ± 3.25; p < 0.001). Mentally active SB was more prevalent on weekdays than on weekends (6.00 ± 5.00 vs. 5.00 ± 5.00; p < 0.001). No significant difference was observed for mentally passive SB (p > 0.05). Males significantly accumulated more mentally active SB compared to females (p < 0.001 for all). Females significantly spent more time in mentally passive SB on weekdays than males (p < 0.05). Conclusion: Our results highlight the need for individualized SB reduction strategies based on mental activity to obtain the most benefits of SB reduction interventions and promoting overall health post-COVID-19 pandemic.

Nowadays, individuals can be overwhelmed by a huge number of documents being present in daily life. Capturing the necessary details is often a challenge. Therefore, it is rather important to summarize documents to obtain the main information quickly. There currently exist automatic approaches to this task, but their quality is often not properly assessed. State-of-the-art metrics rely on human-generated summaries as a reference for the evaluation. If no reference is given, the assessment will be challenging. Therefore, in the absence of human-generated reference summaries, we investigated an alternative approach to how machine-generated summaries can be evaluated. For this, we focus on the original text or document to retrieve a metric that allows a direct evaluation of automatically generated summaries. This approach is particularly helpful in cases where it is difficult or costly to find reference summaries. In this paper, we present a novel metric called Summary Score without Reference—SUSWIR—which is based on four factors already known in the text summarization community: Semantic Similarity, Redundancy, Relevance, and Bias Avoidance Analysis, overcoming drawbacks of common metrics. Therefore, we aim to close a gap in the current evaluation environment for machine-generated text summaries. The novel metric is introduced theoretically and tested on five datasets from their respective domains. The conducted experiments yielded noteworthy outcomes, employing the utilization of SUSWIR.

Developing countries in hot climate regions such as Saudi Arabia have witnessed rapid population growth, which has led to greater resource consumption as a result of the increased demand for new buildings. This research proposes a multi-objective evaluation of the potential green engineering solutions to conserve energy using a building within the ROSHN housing project, which is one of the mega projects in Saudi Arabia, as a case study for this paper with the aid of simulation software, taking into consideration the context of the sustainability concept. The results showed that traditional passive architectural design, whether courtyards or Mashrabiya, had the nearly greatest influence, with percentages ranging from −4% to −5.15% for varied parameters and designs compared to the base case energy usage. Furthermore, energy efficiency solutions for the building envelope’s external insulation and finish system (EIFS) enabled a drop in the U-value that lowered energy usage to −5.40%. However, the wall insulation thickness beyond 300 mm in this system has no substantial influence on energy savings. This research’s most clear finding is that a P2P system for PV panels on a district scale can supply enough energy to meet its needs after implementing the optimal strategy of the other proposed solutions.

Photosensitization of proteins mediated by chromophores is a mechanism commonly employed by nature and mimicked in a broad array of laboratory research and applications. Nature has evolved specialized complexes of proteins and photosensitizers (PS) that assemble to form photoreceptor proteins (PRP). These are used by many organisms in diverse processes, such as energy conversion, protection against photodamage, etc. The same concept has been used in laboratory settings for many applications, such as the stimulation of neurons or the selective depletion of proteins in a signaling pathway. A key issue in laboratory settings has been the relationship between the photooxidation of proteins and conformational changes in host proteins. For several years, we have been interested in creating non-native PRP using porphyrin PS. In this study, we investigated the self-assembled complex between zinc protoporphyrin IX (ZnPPIX) and bovine β-lactoglobulin (BLG) as a model of non-native PRP. Since BLG undergoes a significant conformational transition near physiological pH, the study was carried out at acidic (pH 5) and alkaline (pH 9) conditions where the two conformations are respectively prevalent. We employed a series of steady-state and time-resolved optical spectroscopies as well as gel electrophoresis to experimentally characterize the photosensitization mechanisms and their effect on the host protein. Our results show that ZnPPIX prompts light-dependent modifications of BLG, which appear to be much more significant at alkaline pH. The modifications seem to be driven by photooxidation of amino acid residues that do not lead to the formation of cross-links or protein fragmentation.

This work addresses the significant issue of plasma waves interacting with non-linear dynamical systems in both perturbed and unperturbed states, as modeled by the generalized Whitham–Broer–Kaup–Boussinesq–Kupershmidt (WBK-BK) Equations. We investigate analytical solutions and the subsequent emergence of chaos within these systems. Initially, we apply advanced mathematical techniques, including the transform method and the G′G2 method. These methods allow us to derive new precise solutions and enhance our understanding of the non-linear processes dominating plasma wave dynamics. Through a systematic analysis, we identify the conditions under which the system transitions from orderly patterns to chaotic behavior. This investigation provides valuable insights into the fundamental mechanisms of non-linear wave propagation in plasmas. Our results highlight the dynamic interplay between non-linearity and variation, leading to chaos, which may be useful in predicting and potentially controlling similar phenomena in practical applications.

Paragangliomas are rare extra-adrenal neuroendocrine tumors originating from chromaffin tissue that present a diagnostic and therapeutic challenge due to their diverse clinical manifestations and low incidence. While these tumors often manifest as catecholamine-secreting functional tumors, their clinical presentation can vary, leading to delayed diagnosis and challenging management. This study presents the case of a 22-year-old patient with cardiac paraganglioma who initially presented with angina-like symptoms, highlighting the importance of considering this rare condition in young individuals with nonspecific complaints. Diagnostic imaging, including transthoracic echocardiography, CT angiography, and MRI, played a crucial role in identifying the tumor’s location and vascularization. Surgical excision, including pulmonary artery graft and CABG, was the primary management approach, which was accompanied by intraoperative complications that later led to CCU admission, followed by postoperative complications, ultimately leading to the patient’s death. This case highlights the significance of early recognition and management of complications following a surgical approach to treat paragangliomas.

Prosthetic joint infection (PJI) continues to be a devastating complication following total joint replacement surgeries where Staphylococcus aureus is the main offending organism. To improve our understanding of the disease pathogenesis, a histological analysis of infected peri-implant tissue in a hip PJI rat model was utilized to assess S. aureus spread and tissue reaction at early and late stages of infection. Sprague–Dawley rats were used and received a left cemented hip hemiarthroplasty using a 3D-printed titanium femoral stem. The rats received an intra-articular injection of S. aureus Xen36. These infected rats were sacrificed either at 3 days post-infection (early-stage infection) or at 13-days post-infection (late-stage infection). The femoral and acetabular tissues of all animals were harvested at euthanasia. Histological analysis for the harvested tissue was performed using immunohistochemistry, hematoxylin and eosin, as well as Masson’s trichrome stains. Histological examination revealed significant quantitative and qualitative differences in peri-implant tissue response to infection at early and late stages. This hip PJI rat model identified clear histologic differences between early and late stages of S. aureus infection and how quickly bacterial infiltration could occur. These findings can provide insight into why certain surgical strategies like debridement and antibiotics may be associated with high failure rates.

Background and Objectives: This is the first study to examine the role of monocyte distribution width (MDW) in predicting sepsis after cardiovascular surgery. Methods: This study included 43 consecutive patients who had undergone cardiovascular surgery between July 2021 and July 2022. All patients were examined at the following three time points (TPs): preoperative period (TP1), postoperative at 24 h (TP2), and discharge (TP3). SOFA score, leukocyte count, neutrophil-to-lymphocyte ratio (NLR), MDW, C-reactive protein (CRP), and procalcitonin (PCT) levels were tested at each TPs. The Sepsis-3 criteria were used to diagnose patients with sepsis. Results: The mean values of all variables (leukocyte count, NLR, MDW, CRP, and PCT levels) were significantly higher at TP2 and TP3 than at TP1 (p < 0.05). All these values were significantly higher at TP2 than at TP3 (p < 0.05). Patients with sepsis had significantly higher mean values for leukocyte count, NLR, MDW, CRP, and PCT levels than those without sepsis (p < 0.05). There was a significant correlation between MDW and inflammatory markers (CRP, PCT, and NLR) during the three time periods (p < 0.05). According to the ROC analysis, the optimal MDW cutoff value with the highest sensitivity and specificity for predicting sepsis in the postoperative period was 20.5. Conclusions: Our findings indicate that elevated MDW levels may be a valuable predictor of sepsis in patients following cardiovascular surgery.

Background: Neurodegenerative diseases primarily afflict the elderly and are characterized by a progressive loss of neurons. Oxidative stress is intricately linked to the advancement of these conditions. This study focuses on Phoenix dactylifera (P. dactylifera; Family: Arecaceae), commonly known as “Ajwa,” a globally cultivated herbal plant renowned for its potent antioxidant properties and reported neuroprotective effects in pharmacological studies. Method: This comprehensive systematic review delves into the antioxidant properties of plant extracts and their phytochemical components, with a particular emphasis on P. dactylifera and its potential neuroprotective benefits. Preferred reporting items for systemic reviews and meta-analysis (PRISMA) were employed to review the articles. Results: The study includes 269 articles published in the literature and 17 were selected after qualitative analysis. The growing body of research underscores the critical role of polyphenolic compounds found in P. dactylifera, which significantly contribute to its neuroprotective effects through antioxidant mechanisms. Despite emerging insights into the antioxidant actions of P. dactylifera, further investigation is essential to fully elucidate the specific pathways through which it confers neuroprotection. Conclusions: Like many other plant-based supplements, P. dactylifera’s antioxidant effects are likely mediated by synergistic interactions among its diverse bioactive compounds, rather than by any single constituent alone. Therefore, additional preclinical and clinical studies are necessary to explore P. dactylifera’s therapeutic potential comprehensively, especially in terms of its targeted antioxidant activities aimed at mitigating neurodegenerative processes. Such research holds promise for advancing our understanding and potentially harnessing the therapeutic benefits of P. dactylifera in neuroprotection.

Wheat breeding programs are currently focusing on using non-destructive and cost-effective hyperspectral sensing tools to expeditiously and accurately phenotype large collections of genotypes. This approach is expected to accelerate the development of the abiotic stress tolerance of genotypes in breeding programs. This study aimed to assess salt tolerance in wheat genotypes using non-destructive canopy spectral reflectance measurements as an alternative to direct laborious and time-consuming phenological selection criteria. Eight wheat genotypes and sixteen F8 RILs were tested under 150 mM NaCl in real field conditions for two years. Fourteen spectral reflectance indices (SRIs) were calculated from the spectral data, including vegetation SRIs and water SRIs. The effectiveness of these indices in assessing salt tolerance was compared with four morpho-physiological traits using genetic parameters, SSR markers, the Mantel test, hierarchical clustering heatmaps, stepwise multiple linear regression, and principal component analysis (PCA). The results showed significant differences (p ≤ 0.001) among RILs/cultivars for both traits and SRIs. The heritability, genetic gain, and genotypic and phenotypic coefficients of variability for most SRIs were comparable to those of measured traits. The SRIs effectively differentiated between salt-tolerant and sensitive genotypes and exhibited strong correlations with SSR markers (R2 = 0.56–0.89), similar to the measured traits and allelic data of 34 SSRs. A strong correlation (r = 0.27, p < 0.0001) was found between the similarity coefficients of SRIs and SSR data, which was higher than that between measured traits and SSR data (r = 0.20, p < 0.0003) based on the Mantel test. The PCA indicated that all vegetation SRIs and most water SRIs were grouped with measured traits in a positive direction and effectively identified the salt-tolerant RILs/cultivars. The PLSR models, which were based on all SRIs, accurately and robustly estimated the various morpho-physiological traits compared to using individual SRIs. The study suggests that various SRIs can be integrated with PLSR in wheat breeding programs as a cost-effective and non-destructive tool for phenotyping and screening large wheat populations for salt tolerance in a short time frame. This approach can replace the need for traditional morpho-physiological traits and accelerate the development of salt-tolerant wheat genotypes.

Effective project management is crucial for organizations to achieve strategic objectives and maintain competitiveness in today’s market. The project management office (PMO) has emerged as a key enabler in enhancing project management effectiveness through centralized oversight, support, and standardization. However, evaluating the effectiveness of PMOs and identifying areas for improvement remain challenging. This paper aims to provide a comprehensive overview of project management effectiveness and the role of PMOs in achieving organizational success by establishing a maturity rating system. The research objectives include identifying critical success factors relevant to sustainable PMO effectiveness, reviewing existing literature on project management maturity models, analyzing data through literature review and questionnaires, developing a rating system based on identified success factors, and contributing to the existing literature on PMOs. The literature review and thematic analysis identified five critical themes—organizational culture, governance, competence, project controls, and engagement—each with corresponding success factors. Questionnaires were used to assess the maturity levels and relative importance of these factors, where the AHP analysis determined the weighted importance of each success factor and category. The results highlight the critical success factors for PMOs: collaboration, effective leadership, alignment with organizational goals, knowledge management, project planning, risk management, stakeholder satisfaction, and communication. By establishing a standardized and objective approach to evaluating sustainable PMO effectiveness, organizations can enhance their sustainable project management practices, improve project success rates, and address the challenges associated with evaluating PMO performance. Ultimately, adopting a systems approach enables PMOs to align strategies with organizational goals and foster a culture of continuous improvement.

Shiga toxin-producing E. coli (STEC) are considered important zoonotic pathogens of great economic significance, associated with diarrhea, hemolytic uremic syndrome (HUS), hemorrhagic colitis (HC), and death in humans. This study aimed to investigate the distribution of various STEC virulence gene markers and antimicrobial susceptibility (AST) profiles associated within E. coli isolates from the recto-anal mucosal swabs (RAMSs) of slaughtered cattle and buffaloes in Islamabad, Pakistan. The RAMSs (n = 200) were analyzed using multiplex PCR for the presence of stx1, stx2, eae, and ehxA genes. Samples that were positive for one or more of the virulence genes were inoculated with Sorbitol MacConkey agar (SMAC) for isolation of STEC. The isolates were further analyzed for the presence of virulence genes using multiplex PCR. Of the 200 RAMS, 118 (59%) were positive for one or more virulence genes. E. coli isolates (n = 18) with one or more virulence genes were recovered from the 118 positive samples. The DNA of the isolates positive for one or more virulent genes was extracted and subjected to whole genome sequencing using Illumina. Analysis of the WGS data indicated that the E. coli isolates could be differentiated into 11 serotypes. Most E. coli isolates (13/18; 72.2%) carried five genes (stx1, stx2, Iha, iss, and IpfA) in various combinations. In addition to these five genes, other virulence genes identified in these isolates were espI, ireA, espP, exhA, epeA, mcmA, mch, ast, celB, eilA, katP, and capU. The AST was performed using the Kirby–Bauer disk diffusion test. The study indicated that all the isolates were resistant to rifampicin and a significant proportion of the isolates were MDR. A wide range of antimicrobial resistance genes (ARGs) were detected among the isolates, reflecting the complex nature of resistance mechanisms. The study results indicate that cattle and buffaloes slaughtered in Islamabad might be the carriers of antimicrobial resistant STEC of zoonotic significance, thus representing a source of human infection.

Aflatoxin B1 (AFB1), a hepatocarcinogenic metabolite produced by certain strains of Aspergillus section Flavi, is one of the major contaminants in red chili products that affect human health. This study determined the level of AFB1 in chili traded in Oman. In addition, a survey was conducted among 260 respondents to assess consumers’ knowledge and awareness of aflatoxin contamination in chili. A competitive enzyme-linked immunosorbent assay (ELISA) was performed on 58 samples of dried red chili pods, red chili flakes, and red chili powder collected from various markets in Oman. The ELISA results showed the presence of AFB1 in all the samples analyzed. None of the dried red chili pod samples exceeded 10 ppb AFB1, the maximum permissible limit adopted by the Oman Legislation for foods, whereas a few red chili flakes and red chili powder samples exceeded 10 ppb. However, AFB1 content in all the samples was below the maximum tolerance limit of 20 ppb set by the U.S. Food and Drug Administration. The survey results revealed that most respondents were unaware of aflatoxins, as education, gender, and social media were found to be significant determinants of aflatoxin awareness. This study provides valuable insights into the level of AFB1 contamination in red chili products, raises the need for aflatoxin awareness in Oman, and urges for safe culinary practices in the region.

Heat as an abiotic stress significantly impairs the sustainable productivity of wheat (Triticum aestivum L.). To determine the tolerance of genotypes to heat stress, a comprehensive approach should be used that integrates simultaneous phenotyping and genotyping analyses. The aim of this study is to identify local heat-tolerant genotypes using simple sequence repeat (SSR) markers and evaluate the selected genotypes under field conditions for their tolerance to heat stress. Of the 12 SSR markers that showed polymorphism, eight were associated with six important traits. The use of hierarchical cluster analysis (HC) based on SSR markers led to the identification of 13 genotypes that showed varying results and were grouped into three distinct heat tolerance classes: tolerant (T), moderately tolerant (MT), and sensitive (S). The results showed that heat stress had a significant effect on 19 traits under this study, with significant variation in tolerance to heat stress between genotypes. The tolerant genotypes exhibited a range of average thousand-kernel weight (TKW) values between 40.56 and 44.85, while the sensitive genotype (Yecora Rojo) had an average TKW of 35.45. Furthermore, the tolerant genotypes showed two to three times higher levels of antioxidants compared to the sensitive genotypes when exposed to heat stress. Among the traits analyzed, six showed a favorable combination of high heritability (>60%) and genetic gain (>20%). Through the integration of principal component analysis and stepwise multiple linear regression, it was determined that six traits (grain yield, 1000-kernel weight, plant height, intercellular carbon dioxide, flag leaf area, and grain filling duration) revealed differences between the 13 genotypes. HC analysis of the six traits resulted in the same division of genotypes into three main categories as observed in an HC analysis based on SSR markers. It is worth noting that Saudi wheat, including KSU106, KSU105, and KSU115 as local genotypes, in addition to the 16HTWYT-22 genotype, showed higher heat tolerance compared to the other genotypes tested, indicating its potential suitability for agriculture in Saudi Arabia. These results contribute to breeding programs focused on developing heat-tolerant wheat varieties and accelerate progress in wheat productivity improvement programs.

The risk posed by expansive soils can be lessened by placing foundations at a more deep level below the surface. Structures are able to withstand uplift forces because overburden pressure partially suppresses swelling pressure. In order to transfer the forces to a sufficiently deep depth, this study suggests introducing shafts of a low-expansion overburden material. Soil improved with cement is chosen for this purpose. This study suggests using sand with added excavated natural clay and cement. The expansive clay is added to sand in ratios of 10, 20, 30, 40 and 60%. The clay–sand mixture is then enhanced by cement of 1, 2, 4 and 8% by the weight of the mixture under four curing periods of 1, 7, 28, and 90 days. This material is recommended for use under lean concrete to transfer the loads to lower levels below the foundation depth. The thickness of this material depends on the stresses exerted, the type and the properties of the subsurface soils. The cement-enhanced clay–sand shaft’s properties are examined in this work with regard to the swelling potential, compressibility, and the unconfined compressive strength for different clay contents and curing conditions. Stiff shafts were formed and found to support stresses from 600 to 3500 kPa at cement additions in the range of 1% to 8%. Clay content above 30% is found to be not suitable for Al-Qatif clay due to the compressibility and low strength of the mixture. When two percent or more of cement is added, the swelling potential is significantly reduced. This is reliant on the pozzolanic interactions of soils and cement as well as the clay mineralogy. Determining how cement affects clay–sand combinations in regions with expansive soils would facilitate the introduction of a novel, inexpensive technology to support loads applied by the superstructure.

For many years, structural health monitoring (SHM) has held significant importance across diverse engineering sectors. The main aim of SHM is to assess the health status and understand distinct features of structures by analyzing real-time data from physical measurements. The dynamic response (DR) is a significant tool in SHM studies. This response is used primarily to detect variations or damage by examining the vibration signals of DR. Numerous scholarly articles and reviews have discussed the phenomenon and importance of using DR to predict damages in uniform thickness (UT) plate structures. However, previous reviews have predominantly focused on the UT plates, neglecting the equally important varying thickness (VT) plate structures. Given the significance of VT plates, especially for academic researchers, it is essential to compile a comprehensive review that covers the vibration of both the UT and VT cracked plate structures and their identification methods, with a special emphasis on VT plates. VT plates are particularly significant due to their application in critical components of various applications where optimizing the weight, aerodynamics, and dimensions is crucial to meet specific design specifications. Furthermore, this review critically evaluates the damage identification methods, focusing on their accuracy and applicability in real-world applications. This review revealed that current research studies are inadequate in describing crack path identification; they have primarily focused on predicting the quantification of cracks in terms of size or possible location. Identifying the crack path is crucial to avoid catastrophic failures, especially in scenarios where the crack may propagate in critical dimensions of the plate. Therefore, it can be concluded that an accurate analytical and empirical study of crack path and damage identification in these plates would be a novel and significant contribution to the academic field.