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Since the Syrian conflict started, Lebanon became a common destination receiving a huge number of Syrian refugees that are living in camps spread all over the country, with the largest concentration in the Bekaa Valley. Generous steps are being taken to increase the access to formal education, such as offering free public education and opening second shifts in the public schools in the afternoon. Yet barriers, such as child labor and health-related factors like the spreading of some communicable diseases, like Leishmania, are keeping children out of classroom. The present study was done with the aim of investigating the effect of leishmaniasis on the performance and the academic achievement of Syrian refugee children. The results showed varying degrees of knowledge and dealing with the case of leishmaniasis. The disease clearly had an effect on the students’ attendance in schools, and by proxy on their academic performance.

A survey design was used to elicit workers' perceptions of providing crisis outreach services to survivors of the 1993 flood in Illinois. Findings highlight the benefits of recruiting local workers in disaster relief work. Positive outcomes of the experience include both personal and professional growth.

Context: Contrast-enhanced ultrasound (CEUS) is a cost-effective radiation-free diagnostic method that can be used for renal tumor postoperative visualization after ablative treatment., Objective: To assess CEUS diagnostic accuracy comparing with CT and MRI as a follow-up method in short-term and long-term postoperative periods after renal tumor ablation., Materials and Methods: A systematic review and meta-analysis were performed in Scopus and Medline databases using the query "(kidney OR rena* OR RCC) AND (ablation OR RFA OR MWA OR cryo*) AND CEUS". The endpoint of the study was the evaluation of the overall accuracy of CEUS., Results: Twelve trials were included in the review. With CT or MRI as a reference, for a short-term group (< 6 weeks after ablation) pooled sensitivity was 90.2%, I 2  = 0%; pooled specificity was 99.3%, I 2  = 0%; pooled NPV was 98.6%, I 2  = 0%; pooled PPV was 94.6%, I 2  = 0%; the AUC on the SROC curve was 0.971. For the long-term group (> 6 weeks after ablation), pooled sensitivity was 95.3%, I 2  = 0%; pooled specificity was 97.6%, I 2  = 0%; PPV was 74.2%, I 2  = 4%; NPV was 99.4%, I 2  = 5%; AUC = 0.93., Conclusion: CEUS has high sensitivity and specificity in ruling out the presence of local recurrence after renal tumor ablation with a higher risk of false-positive results within follow-up > 6 weeks compared with that for CT or MRI. Further studies with a unified protocol and morphological control of local renal tumor recurrence after ablation are needed., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

The diverse environmental distribution of Salmonella makes it a global source of human gastrointestinal infections. This study aimed to detect Salmonella spp. and explore their diversity and antimicrobial susceptibility patterns in clinical and environmental samples. Pre-enrichment, selective enrichment, and selective plating techniques were adopted for the Salmonella detection whereas the API 20E test and Vitek Compact 2 system were used to confirm the identity of isolates. Salmonella serovars were subjected to molecular confirmation by 16S rDNA gene sequencing. Disc diffusion method and Vitek 2 Compact system determined the antibiotic susceptibility of Salmonella serovars. Multiple antibiotic resistance index (MARI) was calculated to explore whether Salmonella serovars originate from areas with heavy antibiotic usage. Results depicted low Salmonella prevalence in clinical and environmental samples (3.5%). The main detected serovars included Salmonella Typhimurium, S. enteritidis, S. Infantis, S. Newlands, S. Heidelberg, S. Indian, S. Reading, and S. paratyphi C. All the detected Salmonella serovars (27) exhibited multidrug resistance to three or more antimicrobial classes. The study concludes that the overall Salmonella serovars prevalence was found to be low in environmental and clinical samples of Western Saudi Arabia (Makkah and Jeddah). However, antimicrobial susceptibility patterns of human and environmental Salmonella serovars revealed that all isolates exhibited multidrug-resistance (MDR) patterns to frequently used antibiotics, which might reflect antibiotic overuse in clinical and veterinary medicine. It would be suitable to apply and enforce rules and regulations from the One Health approach, which aim to prevent antibiotic resistance infections, enhance food safety, and improve human and animal health, given that all Salmonella spp. detected in this investigation were exhibiting MDR patterns., (© 2024. Institute of Microbiology, Academy of Sciences of the Czech Republic, v.v.i.)

Objectives: To determine the optimum combination therapy of Silodosin-Tadalafil versus Silodosin-Vardenafil in terms of both tolerability and efficacy for the management of distal ureteric stones., Methods: This prospective, double blinded, randomized clinical trial included 140 patients with distal ureteric stones, randomized into two groups: Group I (n = 67) received Silodosin 8 mg once daily combined with Tadalafil 5 mg once daily, and Group II (n = 68) received Silodosin 8 mg once daily combined with Vardenafil 10 mg once daily. The primary outcome was the tolerability of the combination therapies, assessed through the incidence of adverse events. Secondary outcomes included stone expulsion rate, expulsion time, and the need for analgesics., Results: Both combination therapies demonstrated similar efficacy, with no significant differences in stone expulsion rate (70.1% vs. 67.6%, P = 0.754), expulsion time (19 ± 3 days for both groups, P = 0.793), and analgesic requirements (P > 0.05). However, the Silodosin-Tadalafil combination showed a significantly lower occurrence of adverse events, with notable differences in headache (23.9% vs. 57.4%, P < 0.001), dizziness (32.8% vs. 60.3%, P = 0.001), and gastrointestinal upset (9% vs. 66.2%, P < 0.001), and other adverse effects. The overall occurrence of any adverse event was significantly lower in the Silodosin-Tadalafil group (88.1% vs. 98.5%, P = 0.017)., Conclusions: Both Silodosin-Tadalafil and Silodosin-Vardenafil therapies are effective in managing distal ureteric stones. However, the Silodosin-Tadalafil combination is associated with a significantly lower incidence of adverse events, making it a more tolerable option for patients., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

The purpose of this study is to compare the outcomes of transperitoneal laparoscopic ureterolithotomy (TPLU), retrograde flexible ureteroscopy (R-fURS), and mini-percutaneous antegrade flexible ureteroscopy (A-fURS) for treating large (≥ 15 mm) impacted proximal ureteral stones. A total of 105 adult patients were randomized into 3 equal groups: group A (35) patients underwent TPLU, group B (35) patients underwent R-fURS, and group C (35) patients underwent A-fURS. The initial stone-free rate was 100%, 68.6%, and 80% in groups A, B, and C, respectively. The mean operative time (OT) was (85.0 ± 7.57 min) in group A, (61.0 ± 8.21 min) in group B, and (89.57 ± 15.12 min) in group C. The three groups were comparable concerning the overall complications. R-fURS is a less invasive modality for treating such stones; however, it is associated with a lower SFR and a higher rate of auxiliary procedures. Both TPLU and miniperc A-fURS are effective and valuable alternatives for treating large impacted proximal ureteric stones., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Germinal matrix hemorrhage (GMH) can be a fatal condition responsible for the death of 1.7% of all neonates in the USA. The majority of GMH survivors develop long-term sequalae with debilitating comorbidities. Higher grade GMH is associated with higher mortality rates and higher prevalence of comorbidities. The pathophysiology of GMH can be broken down into two main titles: faulty hemodynamic autoregulation and structural weakness at the level of tissues and cells. Prematurity is the most significant risk factor for GMH, and it predisposes to both major pathophysiological mechanisms of the condition. Secondary brain injury is an important determinant of survival and comorbidities following GMH. Mechanisms of brain injury secondary to GMH include apoptosis, necrosis, neuroinflammation, and oxidative stress. This review will have a special focus on the mechanisms of oxidative stress following GMH, including but not limited to inflammation, mitochondrial reactive oxygen species, glutamate toxicity, and hemoglobin metabolic products. In addition, this review will explore treatment options of GMH, especially targeted therapy., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Clomiphene citrate (CC) and letrozole are the predominant medical interventions for the management of infertility in patients with polycystic ovary syndrome (PCOS). To comprehensively summarize the evidence, a systematic review and meta-analysis of randomized clinical trials (RCTs) was carried out to assess the effect of letrozole and CC on pregnancy outcomes in PCOS patients. We searched PubMed/MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials from inception to January 2023. We included RCTs conducted on PCOS women comparing letrozole to CC and assessing endometrial thickness, the number and size of follicles, and ovulation and pregnancy rates. The endpoints were summarized as risk ratio (RR) or standardized mean difference (SMD) with 95% confidence interval (CI) using the random-effects model. Heterogeneity was examined using the I 2 statistic. Fifty trials met our inclusion criteria. The mean endometrial thickness was significantly higher in the letrozole group compared to CC group (SMD: 0.89; 95% CI: 0.49, 1.28; I 2 =97.72%); however, the number of follicles was higher in the CC group (SMD: -0.56; 95% CI: -0.96, -0.17; I 2 =96.34%). Furthermore, letrozole intake induced higher ovulation rate (RR: 1.20; 95% CI: 1.13, 1.26; I 2 =54.49%) and pregnancy rate (RR: 1.44; 95% CI: 1.28, 1.62; I 2 =65.58%) compared to CC. Compared to CC, letrozole has a positive effect on endometrial thickness, monofollicular development, and ovulation and pregnancy rates suggesting that letrozole may be a strong alternative to CC as a first-line medical intervention for chronic anovulation in PCOS women. Larger studies are warranted to further clarify these findings., (© 2023. The Author(s), under exclusive licence to Society for Reproductive Investigation.)

Purpose: To investigate threshold values for obstructive apnea-hypopnea index (OAHI) and nadir oxygen saturation (NspO 2 ) in children with severe obstructive sleep apnea (OSA) to identify children most appropriate for preoperative echocardiography., Methods: A multi-institutional retrospective chart review was performed on children who underwent echocardiography and polysomnogram within a year. Children with severe OSA as defined by OAHI > 10 or NspO 2  < 80% were included. Receiver operator curves and Youden's J index were used to assess the discriminatory ability and threshold values of OAHI and NspO 2 for right heart strain (RHS) on echocardiography., Results: A total of 173 prepubertal (< 10 years) children and 71 postpubertal (≥ 10 years) children of age were included. RHS was seen in 9 (5%) prepubertal children and 4 (6%) postpubertal children. In prepubertal children, OAHI and NspO 2 were poor predictors of RHS (area under the curve [AUC] 0.53 [95%CI 0.45-0.61], p = 0.748; AUC 0.56 [95%CI 0.48-0.64], p = 0.609). In postpubertal children, threshold values of 55 events/hour and 69% were strong predictors for RHS (AUC 0.88 [95%CI 0.78-0.95], p < 0.001; AUC 0.92 [95%CI 0.83-0.97], p < 0.001)., Conclusion: In children with severe OSA, evidence of RHS is low. Postpubertal children with OAHI > 55 and NspO 2  < 69% appear most appropriate for echocardiography. Clinicians should weigh the risks and benefits of preoperative echocardiography for each child with these threshold values in mind., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Soil salinization is a serious environmental problem that affects agricultural productivity and sustainability worldwide. Organic amendments have been considered a practical approach for reclaiming salt-affected soils. In addition to improving soil physical and chemical properties, organic amendments have been found to promote the build-up of new halotolerant bacterial species and microbial diversity, which plays a critical role in maintaining soil health, carbon dynamics, crop productivity, and ecosystem functioning. Many reported studies have indicated the development of soil microbial diversity in organic amendments amended soil. But they have reported only the development of microbial diversity and their identification. This review article provides a comprehensive summary of the current knowledge on the use of different organic amendments for the reclamation of salt-affected soils, focusing on their effects on soil properties, microbial processes and species, development of soil microbial diversity, and microbial processes to tolerate salinity levels and their strategies to cope with it. It also discusses the factors affecting the microbial species developments, adaptation and survival, and carbon dynamics. This review is based on the concept of whether addition of specific organic amendment can promote specific halotolerant microbe species, and if it is, then which amendment is responsible for each microbial species' development and factors responsible for their survival in saline environments., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Emerging data indicated that long noncoding RNAs (lncRNAs) are crucial players in the biological processes via regulating epigenetics, transcription, and protein translation. A novel lncRNA, LINC00857, was indicated to upregulate in several types of cancer. In addition, LINC00857 was functionally related to the modulation of the cancer-linked behaviors, including invasion, migration, proliferation, epithelial-mesenchymal transition (EMT), cell cycle, and apoptosis. The importance of LINC00857 in cancer onset and development proposed that LINC00857 has major importance in the cancer progression and may be considered as a novel prognostic/diagnostic biomarker as well as a treatment target. Here, we retrospectively investigate the available progress in biomedical research investigating the functions of LINC00857 in cancer, focusing on finding the molecular mechanisms affecting various cancer-related behaviors and exploring its clinical applications., (© 2023. The Author(s) under exclusive licence to Japan Human Cell Society.)

Background: Ambulatory diagnostic errors are increasingly being recognized as an important quality and safety issue, and while measures of diagnostic quality have been sought, tools to evaluate diagnostic assessments in the medical record are lacking., Objective: To develop and test a tool to measure diagnostic assessment note quality in primary care urgent encounters and identify common elements and areas for improvement in diagnostic assessment., Design: Retrospective chart review of urgent care encounters at an urban academic setting., Participants: Primary care physicians., Main Measures: The Assessing the Assessment (ATA) instrument was evaluated for inter-rater reliability, internal consistency, and findings from its application to EHR notes., Key Results: ATA had reasonable performance characteristics (kappa 0.63, overall Cronbach's alpha 0.76). Variability in diagnostic assessment was seen in several domains. Two components of situational awareness tended to be well-documented ("Don't miss diagnoses" present in 84% of charts, red flag symptoms in 87%), while Psychosocial context was present only 18% of the time., Conclusions: The ATA tool is a promising framework for assessing and identifying areas for improvement in diagnostic assessments documented in clinical encounters., (© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.)

Introduction: Maxillary expansion in patients at the end of their growth relies on the possibility to use miniscrew supported expanders to apply expansion forces directly to the midpalatal suture. Although miniscrews provide a stable anchorage unit, several studies have reported that they do not remain in exactly the same position during treatment. The aim of the present study was to analyze miniscrew position changes after the expansion using bone-borne appliances in late adolescent patients., Methods: Nineteen patients (13 females, 6 males), with a mean age of 17.81 (SD = 4.66), were treated with a Bone-Borne Expander Device. The appliance was designed with 4 miniscrews: 2 in the anterior palatal area, at the third rugae level; 2 in the posterior area. A CBCT and an intraoral scan were obtained before treatment (T0), and then, a second CBCT was obtained after the expansion (T1). Data on peri-suture bone thickness were collected at T0, then the CBCTs were superimposed, and changes between mini-screws position on T0 and T1 were evaluated, both by linear and angular displacements., Results: Significant longitudinal differences were found in the distance of the head and the tip of miniscrews measured at the occlusal plane, as well as angular changes. Correlations between displacement measurements and peri-suture bone thickness and height measurements were found as well., Conclusions: While acting as bone anchor units, miniscrews do not remain in the same position during bone-borne expansion. The amount of displacement was related to peri-sutural total bone height and cortical thickness, especially in the anterior area of the naso-frontal maxillary complex., (© 2023. The Author(s).)

Background: Cardiovascular diseases (CVDs) are considered a leading cause of death worldwide. Allelic variation in the CYP2C19 gene leads to a dysfunctional enzyme, and patients with this loss-of-function allele will have an impaired clopidogrel metabolism, which eventually results in major adverse cardiovascular events (MACE). Ischemic heart disease patients (n = 102) who underwent percutaneous cardiac intervention (PCI) followed by clopidogrel were enrolled in the present study., Methods: The genetic variations in the CYP2C19 gene were identified using the TaqMan chemistry-based qPCR technique. Patients were followed up for 1 year to monitor MACE, and the correlations between the allelic variations in CYP2C19 and MACE were recorded., Results: During the follow-up, we reported 64 patients without MACE (29 with unstable angina (UA), 8 with myocadiac infarction (MI), 1 patient with non-STEMI, and 1 patient with ischemic dilated cardiomyopathy (IDC)). Genotyping of CYP2C19 in the patients who underwent PCI and were treated with clopidogrel revealed that 50 patients (49%) were normal metabolizers for clopidogrel with genotype CYP2C19*1/*1 and 52 patients (51%) were abnormal metabolizers, with genotypes CYP2C19*1/*2 (n = 15), CYP2C19*1/*3 (n = 1), CYP2C19*1/*17 (n = 35), and CYP2C19*2/*17 (n = 1). Demographic data indicated that age and residency were significantly associated with abnormal clopidogrel metabolism. Moreover, diabetes, hypertension, and cigarette smoking were significantly associated with the abnormal metabolism of clopidogrel. These data shed light on the inter-ethnic variation in metabolizing clopidogrel based on the CYP2C19 allelic distribution., Conclusion: This study, along with other studies that address genotype variation of clopidogrel-metabolizing enzymes, might pave the way for further understanding of the pharmacogenetic background of CVD-related drugs., (© 2023. The Author(s).)

The purpose of this investigation was to formulate and evaluate the interaction between cation exchange resins and verapamil hydrochloride. The uptake studies were conducted using the rotating bottle apparatus. The Langmuir-like equation was applied to the experimental data and the maximum drug loading was determined from the Langmuir-like parameters. The drug-resin complexes were evaluated using XRD, SEM, and particle size analysis. Release studies were performed using USP dissolution apparatus 2. The resin with the lowest percentage of cross-linking had the highest uptake capacity. The percent increase in particle size due to complexation was found to be associated with drug loading; the highest drug loading had the highest increase in particle size. The X-ray diffraction patterns of the resins and the drug-resin complexes showed that they were both amorphous. The maximum drug release was approximately 40% when conventional dissolution testing was used. Results showed that sink conditions could not be maintained using conventional dissolution methods. Maximum drug release increased dramatically by increasing the volume of samples withdrawn and fresh dissolution medium added. Excellent correlation was obtained between sample volume and drug release rate with an R-value of 0.988. Particle diffusion-controlled model and film diffusion-controlled model were both applied to the experimental data. The results indicated that the rate-limiting step is the diffusion of the exchanging cations through the liquid film. The modified release formulation was prepared successfully and correlated very well with the USP monograph for verapamil hydrochloride extended release capsules., (© 2023. The Author(s), under exclusive licence to American Association of Pharmaceutical Scientists.)

Introduction: Pancreaticoduodenectomy (PD) remains a complex surgical procedure with infectious complications affecting nearly 50% of patients. Patients who undergo biliary drainage with stent placement prior to neoadjuvant treatment (NAT) reportedly have higher infection rates following PD. The aim of the current study is to evaluate the differences in postoperative infectious complication rates based on the duration of post operative prophylactic antibiotics in patients with indwelling metal biliary stent who had NAT., Methods: A retrospective institutional pancreatic cancer database was queried for patients who had a metal biliary stent placed prior to NAT initiation, followed by subsequent PD between 2014 and 2021. Duration of postoperative prophylactic antibiotics was defined as short (SC: ≤ 24 h) or extended (EC: > 24 h-7 days). The primary outcome of interest was surgical site infection (SSI)., Results: Two hundred and ninety-five (n = 295) patients were identified of which the majority (n = 205, 69.5%) received a short course of antibiotics postoperatively. Baseline characteristics were similar between the two cohorts including age, sex, BMI, and comorbidity index. EC patients received more NAT cycles (4 vs. 3, p < 0.001) and underwent an open PD more frequently (61.8% vs. 41.0%, p < 0.001). SSI occurred in 64 (21.7%) patients; SC cohort: 54, 26.3% vs. EC cohort:10, 11.1%, (p = 0.003). Additionally, the SC cohort demonstrated a higher incidence of major complications (Clavien-Dindo ≥ 3: 51 [24.9%] vs. 13 [14.4%], p = 0.045). On the logistic regression model examining factors associated with SSI, higher BMI (continuous variable) was associated with increased odds of SSI (OR: 1.05 [95%CI: 1.00, 1.10, p = 0.040), while EC was protective (OR: 0.36 [95%CI: 0.17, 0.75], p = 0.007)., Conclusions: These data suggest that an extended course of perioperative antibiotic correlates with reductions in SSI and major morbidity following PD in patients with a metallic biliary stent placed prior to NAT course. These results require validation in a future randomized clinical trial examining a larger cohort of patients with further emphasis on the types of perioperative antibiotics administered., (© 2023. The Society for Surgery of the Alimentary Tract.)

Urban waste disposal is a problem that poses a major challenge to city planners as a result of rapid population growth and urbanization. Finding suitable sites for solid waste is one of the most important solutions developed globally to manage this problem. In this regard, a set of physical, socio-economic and technological criteria must be considered to tackle the problem. Safita area (Tartous governorate) witnessed a rapid population growth during the decade of the war in Syria due to the onrush of internal refugees, which resulted in several environmental problems, including random waste dumps. After perusing the previous literature and considering expert opinions, a map of the spatial suitability of sustainable waste sites in the Safita area was developed by integrating the multi-criteria decision- making methodology (analytic hierarchy process) with the geographic information system. Thirteen criteria, including elevation, slope, permeability, distance to faults, distance to settlement, land use/land cover, distance to drainage, distance to water supplies, distance to lakes, distance to road, distance from tourist centers, distance from archaeological centers, and distance from religious centers, were used to achieve the goal of this study. The layer maps for these criteria were developed based on various data sources, including conventional and remote sensing data. Potential landfill sites were identified and divided into five categories: unsuitable (83.28%), less suitable (8.49%), moderately suitable (4.49%), highly suitable (2.57%), and very highly suitable (0.72%). The results of this study provide reliable spatial outputs that will help in suggesting new landfill sites that maintain environmental and socio-economic sustainability in the post-war phase. Moreover, the application of the methodology of this study can be generalized to the rest of the regions in Syria within the framework of the integrated management of the problem of random landfills., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Traumatic brain injury (TBI) engenders traumatic necrosis and penumbra-areas of secondary neural injury which are crucial targets for therapeutic interventions. Segmenting manually areas of ongoing changes like necrosis, edema, hematoma, and inflammation is tedious, error-prone, and biased. Using the multi-parametric MR data from a rodent model study, we demonstrate the effectiveness of an end-end deep learning global-attention-based UNet (GA-UNet) framework for automatic segmentation and quantification of TBI lesions. Longitudinal MR scans (2 h, 1, 3, 7, 14, 30, and 60 days) were performed on eight Sprague-Dawley rats after controlled cortical injury was performed. TBI lesion and sub-regions segmentation was performed using 3D-UNet and GA-UNet. Dice statistics (DSI) and Hausdorff distance were calculated to assess the performance. MR scan variations-based (bias, noise, blur, ghosting) data augmentation was performed to develop a robust model.Training/validation median DSI for U-Net was 0.9368 with T2w and MPRAGE inputs, whereas GA-UNet had 0.9537 for the same. Testing accuracies were higher for GA-UNet than U-Net with a DSI of 0.8232 for the T2w-MPRAGE inputs.Longitudinally, necrosis remained constant while oligemia and penumbra decreased, and edema appearing around day 3 which increased with time. GA-UNet shows promise for multi-contrast MR image-based segmentation/quantification of TBI in large cohort studies., (© 2023. International Federation for Medical and Biological Engineering.)

Background: The role of preoperative upper gastrointestinal endoscopy before bariatric surgery is still debated, and a consensus among the international scientific community is lacking. The aims of this study, conducted in three different geographic areas, were to analyze data regarding the pathological endoscopic findings and report their impact on the decision-making process and surgical management, in terms of delay in surgical operation, modification of the intended bariatric procedure, or contraindication to surgery., Methods: This is a multicenter cross-sectional study using data obtained from three prospective databases. The preoperative endoscopic reports, patient demographics, Body Mass Index, type of surgery, and Helicobacter pylori status were collected. Endoscopic findings were categorized into four groups: (1) normal endoscopy, (2) abnormal findings not requiring a change in the surgical approach, (3) clinically important lesions that required a change in surgical management or further investigations or therapy prior to surgery, and (4) findings that contraindicated surgery., Results: Between 2006 and 2020, data on 643 patients were analyzed. In all of the enrolled bariatric institutions, preoperative endoscopy was performed routinely. A total of 76.2% patients had normal and/or abnormal findings that did not required a change in surgical management; in 23.8% cases a change or a delay in surgical approach occurred. Helicobacter pylori infection was detected in 15.2% patients. No patient had an endoscopic finding contraindicating surgery., Conclusions: The role of preoperative UGE is to identify a wide range of pathological findings in patients with obesity that could influence the therapeutic approach, including the choice of the proper bariatric procedure. Considering the anatomical modifications, the incidence of asymptomatic pathologies, and the risk of malignancy, we support the decision of performing preoperative endoscopy for all patients eligible for bariatric operation., (© 2022. The Author(s).)

The role of nanozinc source (nanohydrozincite: nHZ; nanozinc oxide: nZO) on the performance of alkali-activated slag (AAS) was explored for the first time in the present work. The results showed that nHZ with different contents (0.5, 1.0, and 1.5 wt%) retards the early hydration rate of AAS, whereas nZO showed the lowest retardation effect. Zn(OH) 2 is the main retarder inside AAS-nZO and AAS-nHZ, which consumes the dissolved Ca 2+ (responsible for the early hardening of AAS) from slag to yield calcium zincate hydrate (CZH). The high retardation rate of nHZ is originated from its high affinity to consume much Ca 2+ through the formation of additional pirssonite (Na 2 CO 3 .CaCO 3 .2H 2 O) double salt. Although adding nHZ induced the drying shrinkage of AAS, it improved the later compressive strengths (28 to 365 days), especially at low nHZ content (0.5 wt%), via the formation of CASH with lower Ca/Si ratio and higher binding capacity compared to that formed inside AAS and AAS-nZO. A further research is needed to reduce the drying shrinkage and to accelerate the early strength of AAS containing nHZ., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This study exploits multifractal cross-correlation analysis (MFCCA) to investigate the impact of the COVID-19 pandemic on the cross-correlations between gold and U.S. equity markets using 1-min high-frequency data from January 1, 2019, to December 29, 2020. The MFCCA method shows that the pandemic caused an increase of multifractality in cross-correlations between the two markets. Specifically, the cross-correlations of small fluctuations became more persistent while those of large fluctuations became less persistent, explaining the source of multifractality. The findings of this study carry significant implications for investors, academicians, and policymakers. For example, the increase of multifractality of cross-correlation means that the non-linear relationship between gold and U.S. equity returns prevails more during economic downturns. Therefore, academicians may resort to non-linear techniques to evaluate the relationship between gold and U.S. equity markets during the health pandemic. Moreover, investors can know the value of hedging benefits over different investment time horizons during the pandemic. Finally, policymakers can better assess the economic downturns (i.e., those caused by health pandemics) over the dynamics of cross-correlation between gold and equity markets to make sound financial policies., Competing Interests: Conflict of interestThe authors have not disclosed any competing interests., (© The Author(s), under exclusive licence to Springer Nature B.V. 2022.)

Despite Bangladesh being vulnerable to cyclones, there is a dearth of research on cyclone vulnerability assessment. Assessing a household's vulnerability is considered a crucial step in avoiding the adverse effects of catastrophe risks. This research was conducted in the cyclone-prone district of Barguna, Bangladesh. This study's purpose is to evaluate this region's vulnerability. A questionnaire survey was conducted using a convenience sample technique. A door-to-door survey of 388 households in two Unions of Patharghata Upazila, Barguna district, was conducted. Forty-three indicators were selected to assess cyclone vulnerability. The results were quantified using an index-based methodology with a standardized scoring method. Where applicable, descriptive statistics have been obtained. In terms of vulnerability indicators, we also utilized the chi-square test to compare Kalmegha and Patharghata Union. When appropriate, the non-parametric Mann-Whitney U test was employed to evaluate the relationship between the Vulnerability Index Score (VIS) and the union. According to the results, the environmental vulnerability (0.53 ± 0.17) and the composite vulnerability index (0.50 ± 0.08) were significantly greater in Kalmegha Union than in Patharghata Union. They faced inequity in government assistance (71%) and humanitarian aid (45%) from national and international organizations. However, 83% of them underwent evacuation practices. 39% were satisfied with the WASH conditions at the cyclone shelter, whereas around half were dissatisfied with the status of the medical facilities. Most of them (96%) rely only on surface water for drinking. National and international organizations should have a comprehensive plan for disaster risk reduction that encompasses all individuals, regardless of race, geography, or ethnicity., Competing Interests: Competing interestsThe authors have no competing interests to declare., (© The Author(s) 2023.)

Bacterial cellulose has drawn the attention for its unique properties and applications including; medicine, pharmacy, food, agricultural, textile and electronics. The present study focused on the production of bacterial cellulose nanofibrils (BCNF) from black tea as cost effective alternative medium in addition to study the effect of gamma radiation on BCNF properties. A symbiotic culture of bacteria and yeast (SCOBY) were isolated from commercial Kombucha beverage and were identified as Acinetobacter lowffii and Candida krusei, respectively. The symbiotic culture was used for production of BCNF on Hestrin-Schramm (HS), black tea (BT) and modified BT media. BCNF was purified (0.5 N NaOH) and quantified by dry weight, yield and productivity determination. Characterization and effect of gamma radiation (5-25 kGy) on BCNF were studied using Scanning Electron Microscope (SEM), Fourier transform infrared (FTIR) and X-Ray Diffraction (XRD). The highest BCNF production was achieved using BT medium with 0.2% tea and 6.0% commercial sugar (with dry weight 4.77-4.61 g/l and productivity 68.14% and 65.85%, respectively). Supplementation of BT medium with 1% ethanol, 0.27% Na 2 HPO 4 and 0.5% yeast extract individually, enhanced the BCNF production (7.85, 6.84 and 5.73 g/l), respectively. FTIR spectrum of BCNF from sugared water (SW), HS and BT showed similar structure with high purity. As a conclusion, gamma irradiation has no effect on the BCNF structure while showed different effects on its crystallinity index and size with the different doses. The changes in CrI were ranged between (17 and 23.5%), while the crystallinity size (Cs) was affected by gamma irradiation in a positive relationship where the crystalline size was decreased (33%) by exposure to 5 kGy then increased by increasing the dose of radiation reaching 25.7% at 25 kGy. SEM graphs showed the morphology of microbial culture and its symbiotic relationship in addition to the ultrafine structure of non-irradiated and irradiated BCNF., (© 2022. The Author(s).)

Extreme temperature could affect traffic crashes by influencing road safety, vehicle performance, and drivers' behavior and abilities. Studies evaluating the impacts of extreme temperatures on the risk of traffic crashes have mainly overlooked the potential role of vehicle air conditioners. The aim of this study, therefore, was to evaluate the effect of exposure to extreme cold and hot temperatures on seeking medical attention due to motorcycle crashes. The study was conducted in Iran by using medical attendance for motorcycle crashes from March 2011 to June 2017. Data on daily minimum, mean and maximum temperature (°C), relative humidity (%), wind velocity (km/h), and precipitation (mm/day) were collected. We developed semi-parametric generalized additive models following a quasi-Poisson distribution with the distributed nonlinear lag model to estimate the immediate and lagged associations (reported as relative risk [RR], and 95% confidence interval [CI]). Between March 2011 and June 2017, 36,079 medical attendances due to motorcycle road traffic crashes were recorded (15.8 ± 5.92 victims per day). In this time period, the recorded temperature ranged from -11.2 to 45.4 °C (average: 25.5 ± 11.0 °C). We found an increased risk of medical attendance for motorcycle crashes (based on maximum daily temperature) at both extremely cold (1st percentile) and hot (99th percentile) temperatures and also hot (75th percentile) temperatures, mainly during lags 0 to 3 days (e.g., RR: 1.12 [95% CI: 1.05: 1.20]; RR: 1.08 [95% CI: 1.01: 1.16]; RR: 1.20 [95% CI: 1.09: 1.32] at lag0 for extremely cold, hot, and extremely hot conditions, respectively). The risk estimates for extremely hot temperatures were larger than hot and extremely cold temperatures. We estimated that 11.01% (95% CI: 7.77:14.06) of the medical attendance for motorcycle crashes is estimated to be attributable to non-optimal temperature (using mean temperature as exposure variable). Our findings have important public health messaging, given the considerable burden associated with road traffic injury, particularly in low- and middle-income countries., (© 2022. The Author(s).)

Tuberculosis is the most common infectious disease in the world and the lingual location represents less than 1% of extra-pulmonary forms. We report a case of primary lingual tuberculosis which was presented to us in the form of a cold abscess in a 46-year-old alcohol and tobacco drinker weaned for 01 years. Confirmation was histological after biopsy of the lesion. Treatment with anti-tuberculosis drugs for 06 months resulted in a cure. Primary tuberculosis of the tongue is rare and can take several macroscopic forms, including cold abscess which is exceptional. A histological examination after biopsy will make the diagnosis., Competing Interests: Conflict of interestThere is no conflict of interest between the authors., (© Association of Otolaryngologists of India 2021.)

COVID-19 lockdowns affected educational programs. Online learning has suddenly become the main form of medical education. However, attendance enhances a student's competency and professionalism. Rising student numbers and the COVID-19 pandemic make in-class learning challenging. This study investigates medical students' perceptions of a recently implemented tool for recording attendance using a QR code that detects students' location while scanning. An online questionnaire was designed to collect responses. One hundred thirty-two students completed the survey. Students agreed that the method was usable, reliable, accurate, secure, and convenient. This method should be investigated as a standard tool for attendance recording., Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01625-7., Competing Interests: Conflict of InterestThe authors declare no competing interests., (© The Author(s) under exclusive licence to International Association of Medical Science Educators 2022.)

Background: Hepatopancreaticobiliary (HPB) diseases carry high morbidity despite efforts aimed at their reduction. An assessment of their trial characteristics is paramount to determine trial design adequacy and highlight areas for improvement. As such, the aim of this study is to assess HPB surgery trial characteristics, summarize logistic, financial, and practical reasons behind early discontinuation, and propose potential interventions to prevent this in the future., Methods: All clinical trials investigating HPB surgery registered on ClinicalTrials.gov from October 1st, 2007 (inclusive), to April 20th, 2021 (inclusive), were examined. Trial characteristics were collected including, but not limited to, study phase, duration, patient enrollment size, location, and study design. Peer-reviewed publications associated with the selected trials were also assessed to determine outcome reporting., Results: A total of 1776 clinical trials conducted in 43 countries were identified, the majority of which were conducted in the USA. Of these trials, 32% were reported as "completed" whereas 12% were "discontinued." The most common cause of trial discontinuation was low accrual, which was reported in 37% of terminated studies. These resulted in 413 published studies. Most trials had multiple assignment, randomized, or open-label designs. Treatment was the most common study objective (73%) with pharmacological therapy being the most commonly studied intervention., Conclusions: The main reasons for early discontinuation of clinical trials in HPB surgery are poor patient recruitment and inadequate funding. Improved trial design, recruitment strategies and increased funding are needed to prevent trial discontinuation and increase publication rates of HPB surgery clinical trials., (© 2022. The Society for Surgery of the Alimentary Tract.)

E-waste is one of the fastest growing streams of solid waste globally, and its effective management has become a focused issue, which requires a deep understanding of the core guiding theory of extended producer responsibility (EPR). Over the past 20 years, China, one of the world's largest producers of electrical and electronic equipment (EEE), has made great efforts to improve e-waste management along with the massive generation of e-waste. In 2012, China implemented a unique EPR-based e-waste fund policy. However, the fund policy is unsustainable due to the challenges of non-closed resource use, informal recycling, and fund imbalance. Beginning with an overview of these challenges, this paper focuses on redesigning the fund policy from a closed-loop lifecycle perspective in order to maintain a balanced development of the resource use loop and the fund system in China's ten-year plan. In doing so, two EPR instruments, recycling content standards and consumer-oriented deposits, are added to the current fund policy. Subsequently, three extension scenarios alternately changed a critical parameter of the model to test the impact on sustainable capabilities. In this way, the sustainable supply of funds and secondary resources for the e-waste industry can be established in China and effectively demonstrate solid waste management in developing countries., (© 2022. The Author(s).)

The use robotics in surgery is gaining momentum. This approach holds substantial promise in pancreas surgery. Robotic surgery for pancreatic lesions and malignancies has become well accepted and is expanding to more and more center annually. The number of centers using robotics in pancreatic surgery is rapidly increasing. The most studied robotic pancreas surgeries are pancreaticoduodenectomy and distal pancreatectomy. Most studies are in their early phases, but they report that robotic pancreas surgery is safe feasible. Robotic pancreas surgery offers several advantages over open and laparoscopic techniques. Data regarding costs of robotics versus conventional techniques is still lacking. Robotic pancreas surgery is still in its early stages. It holds promise to become the new surgical standard for pancreatic resections in the future, however, more research is still needed to establish its safety, cost effectiveness and efficacy in providing the best outcomes., (© 2021. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Exciting advances in melanoma systemic therapies have presented the opportunity for surgical oncologists and their multidisciplinary colleagues to test the neoadjuvant systemic treatment approach in high-risk, resectable metastatic melanomas. Here we describe the state of the science of neoadjuvant systemic therapy (NAST) for melanoma, focusing on the surgical aspects and the key role of the surgical oncologist in this treatment paradigm. This paper summarizes the past decade of developments in melanoma treatment and the current evidence for NAST in stage III melanoma specifically. Issues of surgical relevance are discussed, including the risk of progression on NAST prior to surgery. Technical aspects, such as the definition of resectability for melanoma and the extent and scope of routine surgery are presented. Other important issues, such as the utility of radiographic response evaluation and method of pathologic response evaluation, are addressed. Surgical complications and perioperative management of NAST related adverse events are considered. The International Neoadjuvant Melanoma Consortium has the goal of harmonizing NAST trials in melanoma to facilitate rapid advances with new approaches, and facilitating the comparison of results across trials evaluating different treatment regimens. Our ultimate goals are to provide definitive proof of the safety and efficacy of NAST in melanoma, sufficient for NAST to become an acceptable standard of care, and to leverage this platform to allow more personalized, biomarker-driven, tailored approaches to subsequent treatment and surveillance., (© 2022. Society of Surgical Oncology.)

Background: Sanjad Sakati syndrome (SSS) is a rare autosomal recessive genetic disorder caused by mutation in TBCE (tubulin folding cofactor E) gene. Reported cases were almost exclusively of Middle-Eastern and Arabian children of consanguineous parents. We report the clinical manifestations, outcome, and an observed new association of sleep-disordered breathing (SDB) among children with Sanjad Sakati syndrome., Methods: Clinical and routine laboratory data of SSS cases attending Sultan Qaboos University Hospital, Oman, were collected from the electronic patient records or through direct clinic interviews. In-lab polysomnography (PSG) and echocardiography were carried out for all the cases. SDB diagnosis was based on the guidelines of the American Academy of Sleep Medicine., Results: Of 12 patients with SSS, 5 males (42%), all of them (100%) had obstructive sleep apnea (OSA) and 4 of them (33%) had additional significant central apnea and sleep-related hypoventilation. Eight patients (67%) had severe SDB with mean apnea-hypopnea index (AHI) of 26.5 events/h. Age at time of diagnosis with SDB ranged from 2 to 17 years with mean of 8.9 [Formula: see text] Two patients had severe pulmonary hypertension as a complication of severe SDB and died from type 2 respiratory failure., Conclusions: Sleep-disordered breathing is prevalent among children with SSS, especially OSA. This is the first study to report SDB in a large cohort of patients with this extremely rare syndrome. The study results encourage the importance of screening affected patients with SSS for sleep-disordered breathing early before developing severe morbidities such as pulmonary hypertension that further compromise their quality of life., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Diabetes mellitus (DM)-induced cardiac morbidities have been the leading cause of death among diabetic patients. Recently, sodium-glucose cotransporter-2 (SGLT-2) inhibitors including empagliflozin (EMPA), which have been approved for the treatment of DM, have gained attention for their cardioprotective effect. The mechanism by which SGLT-2 inhibitors exert their cardioprotective effect remains unclear. Recent studies have suggested that EMPA exerts its cardioprotective effect by inhibiting the Na + /H + exchanger (NHE), a group of membrane proteins that regulate intracellular pH and cell volume. Increased activity and expression of NHE isoform 1 (NHE1), the predominant isoform expressed in the heart, leads to cardiac hypertrophy. p90 ribosomal s6 kinase (p90 RSK) has been demonstrated to stimulate NHE1 activity. In our study, H9c2 cardiomyoblasts were treated with angiotensin II (ANG) to activate NHE1 and generate a hypertrophic model. We aimed to understand whether EMPA reverses the ANG-induced hypertrophic response and to elucidate the molecular pathway contributing to the cardioprotective effect of EMPA. Our study demonstrated that ANG-induced hypertrophy of H9c2 cardiomyoblasts is accompanied with increased SGLT-1 and NHE1 protein expression, an effect which is prevented in the presence of EMPA. EMPA reduces ANG-induced hypertrophy through the inhibition of SGLT-1 and NHE1 expression., (© 2022. The Author(s).)

Background: In rectal cancer surgery, larger mesorectal fat area has been shown to correlate with increased intraoperative difficulty. Prior studies were mostly in Asian populations with average body mass indices (BMIs) less than 25 kg/m 2 . This study aimed to define the relationship between radiological variables on pelvic magnetic resonance imaging (MRI) and intraoperative difficulty in a North American population., Methods: This is a single-center retrospective cohort study analyzing all patients who underwent low anterior resection (LAR) or transanal total mesorectal excision (TaTME) for stage I-III rectal adenocarcinoma from January 2015 until December 2019. Eleven pelvic magnetic resonance imaging measures were defined a priori according to previous literature and measured in each of the included patients. Operative time in minutes and intraoperative blood loss in milliliters were utilized as the primary indicators of intraoperative difficulty., Results: Eighty-three patients (39.8% female, mean age: 62.4 ± 11.6 years) met inclusion criteria. The mean BMI of included patients was 29.4 ± 6.2 kg/m 2 . Mean operative times were 227.2 ± 65.1 min and 340.6 ± 78.7 min for LARs and TaTMEs, respectively. On multivariable analysis including patient, tumor, and MRI factors, increasing posterior mesorectal thickness was significantly associated with increased operative time (p = 0.04). Every 1 cm increase in posterior mesorectal thickness correlated with a 26 min and 6 s increase in operative time. None of the MRI measurements correlated strongly with BMI., Conclusion: As the number of obese rectal cancer patients continues to expand, strategies aimed at optimizing their surgical management are paramount. While increasing BMI is an important preoperative risk factor, the present study identifies posterior mesorectal thickness on MRI as a reliable and easily measurable parameter to help predict operative difficulty. Ultimately, this may in turn serve as an indicator of which patients would benefit most from pre-operative resources aimed at optimizing operative conditions and postoperative recovery., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Axial spondyloarthritis is a chronic inflammatory disorder that primarily involves the axial skeleton (sacroiliac joints and spine), causing stiffness, severe pain and fatigue. In some patients, definitive structural damage of sacroiliac joints is visible on imaging and is known as radiographic axial spondyloarthritis. Some patients do not have a clear radiographic damage of the sacroiliac joints, and this subtype is known as non-radiographic axial spondyloarthritis. Early diagnosis is important for reducing the risk of irreversible structural damage and disability. Management of axial spondyloarthritis is challenging in Saudi Arabia because of inadequate disease knowledge and the unavailability of local guidelines. Therefore, this expert consensus is intended to provide recommendations, including the referral pathway, the definition of remission and the treat-to-target approach, to all healthcare professionals for the management of patients with axial spondyloarthritis. A Delphi technique of consensus was developed by involving an expert panel of 10 rheumatologists, 1 dermatologist and 1 general physician. The experts offered consensus-based recommendations based on a review of available scientific evidence and clinical experience for the referral, screening and management of patients with axial spondyloarthritis., (© 2022. International League of Associations for Rheumatology (ILAR).)

The increasing demand for food in the world has made sustainable agriculture practices even more important. Nanotechnology applications in many areas have also been used in sustainable agriculture in recent years for the purposes to improve plant yield, pest control, etc. However, ecotoxicology and environmental safety of nanoparticles must be evaluated before large-scale applications. This study comparatively explores the efficacy and fate of different iron oxide NPs (γ-Fe 2 O 3 -maghemite and Fe 3 O 4 -magnetite) on barley (Hordeum vulgare L.). Various NP doses (50, 100, and 200 mg/L) were applied to the seeds in hydroponic medium for 3 weeks. Results revealed that γ-Fe 2 O 3 and Fe 3 O 4 NPs significantly improved the germination rate (~37% for γ-Fe 2 O 3 ; ~63% for Fe 3 O 4 ), plant biomass, and pigmentation (P < 0.005). Compared to the control, the iron content of tissues gradually raised by the increasing NPs doses revealing their translocation, which is confirmed by VSM analysis as well. The findings suggest that γ-Fe 2 O 3 and Fe 3 O 4 NPs have great potential to improve barley growth. They can be recommended for breeding programs as nanofertilizers. However, special care should be paid before the application due to their unknown effects on other living beings., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The correlation of P wave indices on surface ECG and phasic LA dysfunction in patients with significant primary mitral regurgitation (MR) due to the adverse LA adaptive structural and functional changes needs to be more studied. This study aims to investigate the diagnostic value of P wave indices to predict LA function assessed both by volumetric analysis using 3-dimensional (3D)echocardiography, and by strain analysis using speckle tracking echocardiography. (STE). The study included 107 subjects, we measured maximum P-duration (Pmax), P dispersion (PD), and V1 negative terminal force (V1-NTF) (negative duration x negative amplitude) on surface ECG. Both Basic and Dynamic LA volumes (LAV) during reservoir, conduit, and contractile phases were measured. The global LA strain and strain rate parameters were calculated By STE. LA ejection fraction (LAEF) and ejection force were also calculated.V1-NTF showed a significant positive correlation while P-max a significant negative correlation with global peak atrial longitudinal strain (GPALS) (r = 0.75; P < 0.001 and r = - 0.72; P < 0.001 respectively). Using ROC curve analysis, Pmax > 110 ms, 1-NTF ≥ 4 ms.mV and P notching > 40 ms had a sensitivity of 90%, 95% and 50% and a specificity of 87.4%, 94.3% and 100% respectively in predicting GPALS ≤ 30%. P notching > 40 ms was associated with severe LA dysfunction. ECG P wave indices represent a simple bedside tool that could have an incremental role in predicting LA dysfunction as well as size in patients with significant primary MR., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

This article discusses three important pieces of work that the Competition and Markets Authority has completed over the last year. The first two are market studies: The Mobile Ecosystems Market Study was launched over concerns that Apple and Google have too much control over operating systems (iOS and Android), app stores (App Store and Play Store), and web browsers (Safari and Chrome) that together form their 'ecosystems'; the Electric Vehicles Charging Market Study took actions and provided recommendations in a nascent but critically important market. The final piece of work is "State of Competition": a research project that assesses the evolution of competition in the UK over the past two decades., (© Crown 2022.)

Background: Extracellular vesicles (EVs) are regulators of cell-cell interactions and mediators of horizontal transfer of bioactive molecules between cells. EV-mediated cell-cell interactions play roles in physiological and pathophysiological processes, which maybe modulated by exposure to pathogens and cocaine use. However, the effect of pathogens and cocaine use on EV composition and function are not fully understood., Results: Here, we used systems biology and multi-omics analysis to show that HIV infection (HIV +) and cocaine (COC) use (COC +) promote the release of semen-derived EVs (SEV) with dysregulated extracellular proteome (exProtein), miRNAome (exmiR), and exmiR networks. Integrating SEV proteome and miRNAome revealed a significant decrease in the enrichment of disease-associated, brain-enriched, and HIV-associated miR-128-3p (miR-128) in HIV + COC + SEV with a concomitant increase in miR-128 targets-PEAK1 and RND3/RhoE. Using two-dimensional-substrate single cell haptotaxis, we observed that in the presence of HIV + COC + SEV, contact guidance provided by the extracellular matrix (ECM, collagen type 1) network facilitated far-ranging haptotactic cues that guided monocytes over longer distances. Functionalizing SEV with a miR-128 mimic revealed that the strategic changes in monocyte haptotaxis are in large part the result of SEV-associated miR-128., Conclusions: We propose that compositionally and functionally distinct HIV + COC + and HIV-COC- SEVs and their exmiR networks may provide cells relevant but divergent haptotactic guidance in the absence of chemotactic cues, under both physiological and pathophysiological conditions., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

There are no data from Saudi Arabia about the use of botulinum toxin for migraine prevention. In this article, we aim to study the clinical profile, safety, and response to treatment with botulinum toxin injection for migraine patients. In addition, we aim to share our experience with the use of botulinum toxin modified injection protocol (5/20/100 protocol) in the management of migraine in Saudi patients. A retrospective single-center observational study was conducted at King Abdulaziz Medical City in Jeddah, Saudi Arabia. The protocol for botulinum toxin injection for migraine in our hospital consisted of injecting five muscles with a total of 20 injection sites consuming 100 units of Onabotulinumtoxin A (BOTOX ® , Allergan, Inc., Irvine, CA). A total of 30 patients were included in our study. The mean frequency of migraine days showed a significant reduction from baseline at 15.61 ± 10.92 days per month to 6.14 ± 6.16 days (9.47 days reduction) after botulinum toxin injection (39.3% reduction; paired t test = 5.177; p = 0.0001). The frequency of using abortive medications was reduced in 19 patients (63.3%). Only four patients (13.3%) achieved a headache-free status. Only three patients (10%) had adverse events from botulinum toxin injection. In conclusion, botulinum toxin is an effective, safe, and well-tolerated treatment option for the prevention of chronic migraine. Our protocol (5/20/100 protocol) may improve the safety and cost and reduce the incidence of adverse events. Patients who do not respond to our protocol may switch to the standard protocol after the failure of the first treatment session., (© 2020. Belgian Neurological Society.)

The impact of the human nasal airway complexity on the pharyngeal airway fluid mechanics is investigated at inspiration. It is the aim to find a suitable degree of geometrical reduction that allows for an efficient segmentation of the human airways from cone-beam computed tomography images. The flow physics is simulated by a lattice Boltzmann method on high-performance computers. For two patients, the flow field through the complete upper airway is compared to results obtained from three surface variants with continuously decreasing complexity. The most complex reduced airway model includes the middle and inferior turbinates, while the moderate model only features the inferior turbinates. In the simplest model, a pipe-like artificial structure is attached to the airway. For each model, the averaged pressure is computed at different cross sections. Furthermore, the flow fields are investigated by means of averaged velocity magnitudes, in-plane velocity vectors, and streamlines. By analyzing the averaged pressure loss from the nostrils to each cross section, it is found that only the most complex reduced models are capable of approximating the pressure distribution from the original geometries. In the moderate models, the geometry reductions lead to overpredictions of the pressure loss in the pharynx. Attaching a pipe-like structure leads to a higher deceleration of the incoming flow and underpredicted pressure losses and velocities, especially in the upper part of the pharynx. Dean-like vortices are observed in the moderate and pipe-like models, since their shape comes close to a [Formula: see text]-bend elbow pipe., (© 2021. Society for Imaging Informatics in Medicine.)

Background/purpose: Permanent vision loss (PVL) is a feared complication and a leading cause of morbidity in giant cell arteritis (GCA). The objective of this study is to describe visual manifestations and identify risk factors of ocular involvement in GCA., Methods: A retrospective database from a single vasculitis referral center was used. Descriptive statistics comparing patients with and without ocular involvement were performed., Results: One hundred patients with GCA were included. Visual symptoms were present in 53% of patients at diagnosis and included blurred vision (30%), diplopia (16%), amaurosis fugax (14%), and blindness (19%). Out of 19 patients with blindness, 16 did not recover and had PVL. Patients with PVL were older (79.2 ± 6.7 vs 74.2 ± 7.6 years; p = 0.008) and more likely to have coronary artery disease (31% vs 10%; p = 0.018). However, they were less likely to have other cranial symptoms (81% vs 96%; p = 0.019), mainly headaches (64% vs 92%; p = 0.003). Risk factors associated with an abnormal ophthalmologic examination were the same as for PVL, but patients were also more likely to have diabetes (29% vs 7%; p = 0.040) and less likely to have constitutional symptoms (53% vs 80%; p = 0.033)., Conclusion: Patients with GCA and ocular involvement were more likely to have baseline diabetes and atherosclerosis. A predisposing vascular vulnerability might therefore increase the risk of ocular involvement. Key points • Most patients with GCA and complete vision loss at presentation will not recover and evolve to have permanent vision loss. • A GCA patient with visual manifestations at presentation has more baseline vascular risk factors (diabetes, atherosclerosis) than patients without ocular involvement. • Patients with GCA and visual manifestations have fewer constitutional symptoms and lower inflammatory markers than patients without ocular involvement., (© 2021. International League of Associations for Rheumatology (ILAR).)

The outbreak of the novel coronavirus disease in 2019 (COVID-19) caused a plethora of challenges worldwide and tested healthcare systems across the six continents. Lebanon had recently faced harsh political and economic crises. We aim to describe the effect of COVID-19 on an already crisis-stricken country. A descriptive analysis of the burden of COVID-19 pandemic on Lebanon was performed. Relevant data on COVID-19 was retrieved from the Lebanese Ministry of Public Health from February 21 till June 13th, 2020. Results obtained were analyzed and a literature review was performed. 1422 confirmed COVID-19 cases were identified and reported in Lebanon by June 13th, 2020, comprising an incidence rate of 208/million persons. There has been a total of 31 deaths thus far, with a reported death rate of 5/million persons. The age group with the highest number of cases was 20-29 years. Beirut was the district with the highest number of cases (18%). The COVID-19 crisis has impacted the country on a multifactorial level. COVID-19 could not have come at a worse time for Lebanon. The country is on brink of bankruptcy, the healthcare system is struggling for survival and the government is striving to regain the trust of the population.

Background: Gamma Knife radiosurgery (GKRS) inverse dose planning is currently far from competing effectively with the quality of dose planning developed by experienced experts. A new inverse planning (IP) method based on « efficient convex optimization algorithms » is proposed, providing high-quality dose plans in real time., Materials and Methods: Eighty-six patients treated by GKRS for vestibular schwannomas (VS) were recruited. The treatment plans created by the first author, who has 27 years of experience and has developed and delivered more than 15,000 dose plans, served as reference. A first set of basic constraints determined by default led the IP for an initial real-time dose plan. Additional constraints were interactively proposed by the planner to take other parameters into account. A second optimized plan was then calculated by the IP. The primary endpoint was the Paddick Conformity Index (PCI). The statistical analysis was planned on a non-inferiority trial design. Coverage, selectivity, and gradient indexes, dose at the organ(s) at risk, and 12 Gy isodose line volume were compared., Results: After a single run of the IP, the PCI was shown to be non-inferior to that of the "expert." For the expert and the IP, respectively, the median coverage index was 0.99 and 0.98, the median selectivity index 0.92 and 0.90, the median gradient index 2.95 and 2.84, the median dose at the modiolus of the cochlea 2.83 Gy and 2.86 Gy, the median number of shots 14.31 and 24.13, and the median beam-on time 46.20 min and 26.77 min. In a few specific cases, advanced tools of the IP were used to generate a second run by adding new constraints either globally (for higher selectivity) or locally, in order to increase or decrease these constraints focally., Conclusion: These preliminary results showed that this new IP method based on « efficient convex optimization algorithms », called IntuitivePlan®, provided high-quality dose plans in real time with excellent coverage, selectivity, and gradient indexes with optimized beam-on time. If the new IP evaluated here is able to compete in real time with the quality of the treatment plans of an expert with extensive radiosurgical experience, this could allow new planners/radiosurgeons with limited or no experience to immediately provide patients with high-quality GKRS for benign and malignant lesions.