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Abstract Introduction Currently, there are no data regarding outcomes of the catheter ablation for structural ventricular tachycardia (VT) in Türkiye. In this observational study, we aim to investigate cardiac outcomes of patients undergoing catheter VT ablation at a tertiary center in Türkiye. Methods This was a retrospective observational study performed at a single university center. Patients with a confirmed ischemic or non‐ischemic cardiomyopathy, undergoing structural VT ablation were included. Procedural and mid‐term outcomes were analyzed. Results A total of 124 patients were enrolled in the study. 54(43.5%) patients presented with an electrical storm. During the mean follow‐up of 351 ± 232 days 10(8.1%) patients experienced a recurrence. There was only one peri‐procedural death and cardiac tamponade occurred in two patients.14(11.3%) patients died during the follow‐up, most commonly due to a cardiovascular death. In the multivariate analysis only age >70 was found to be correlated with death during follow‐up, with p =.008, HR = 4.923. Conclusion A good acute success with low complications was observed in patients undergoing VT ablation for structural heart disease in a tertiary center in Türkiye. Mid‐term outcomes are comparable with international studies with no difference in VT recurrence in ischemic and non‐ischemic patients. Similar to international studies, significant mid‐term mortality was observed.

Abstract Aims Cardiac amyloidosis (CA) is a potentially fatal multisystemic disease that remains significantly underdiagnosed, particularly in the Middle East. This study aims to evaluate the prevalence and clinical characteristics of CA in a high‐risk population at a tertiary centre in Saudi Arabia. Methods This cross‐sectional, retrospective, single‐centre study was conducted at a tertiary hospital in Riyadh, Saudi Arabia. We reviewed the medical records of heart failure patients seen between August 2018 and July 2022 who exhibited red flags for CA and subsequently underwent CA screening. Red flags that prompted the workup included at least two of the following factors: the presence of unilateral or bilateral carpal tunnel syndrome, a family history of transthyretin amyloid (ATTR) amyloidosis and specific electrocardiographic features (relative/absolute low QRS voltage, pseudoinfarct pattern and atrioventricular/interventricular conduction abnormalities). Echocardiographic red flags included mainly increased wall thickness (≥12 mm), significant diastolic dysfunction, reduced left ventricular (LV) longitudinal function, right ventricular (RV) dysfunction and elevated right atrial (RA)/pulmonary artery (PA) pressure. Cardiac magnetic resonance (CMR) red flags included aspects similar to those in an echocardiogram as well as a subendocardial or transmural late gadolinium enhancement (LGE) pattern. These patients were assessed for CA through technetium‐99m pyrophosphate ([99mTc]Tc‐PYP) bone scintigraphy, serum and urine protein electrophoresis with immunofixation and a serum‐free light chain assay. Results A total of 177 patients were screened, of which 21.0 (11.9%) patients were diagnosed with transthyretin amyloid CA (ATTR‐CA) and 13 (7.3%) patients were diagnosed with light chain CA (AL‐CA). Compared with patients with negative/equivocal [99mTc]Tc‐PYP scans (grades 0–1), patients with positive [99mTc]Tc‐PYP scans (grades 2–3) were older (78.0 vs. 68.0 years, P

ABSTRACT This case demonstrates the complex dynamics of cavernous transformation of the portal vein and portal vein thrombus due to umbilical cord infection in a child and its consequences, namely portal hypertension. This abnormal process has to be understood for proper treatment and stresses the importance of a thorough assessment of such patients.

ABSTRACT The primary antiphospholipid syndrome and protein S deficiency are known hypercoagulable states predisposing to strokes. We present a 34‐year‐old woman presented to rheumatology clinic complaining of right side weakness and aphasia for 2 months before the visit. There was joint pain in the right elbow and shoulder joints, hyperpigmentation on her face and dry painful red eyes mainly the right eye in addition to dry mouth. She had a history of recurrent abortions. Neurological examination showed hypertonia on right lower and upper limb and normal on left one, while the power was grade 3 on right side and normal in left one. Upper motor neuron signs and facial palsy was noted. Hyperpigmentation in the face was observed. MRI brain showed that left temporoparietal hemorrhagic infraction involving the basal ganglia and MRV brain showed left transverse sinus thrombosis and attenuation of sigmoid and internal jugular vein. B2‐glycoprotein Ig AGM, lupus anticoagulant, anticardiolipin (IgG, IgM, and IgA), protein S were positive. ANA profile was borderline for PCNA. We report unusual venous sinus thrombosis with primary antiphospholipid syndrome and acquired protein S deficiency.

Abstract Biological invasions have substantial and rising social‐ecological impacts threatening human livelihoods and communities and hampering progress towards a just and equitable world. Currently, biological invasions are not adequately recognised and included in the UN Agenda 2030. Using a literature review conducted in Web of Science, we highlight the bias in available literature of biological invasions related to the UN Agenda 2030 and its Sustainable Development Goals. We find abundant scientific literature towards environmental and biodiversity related sustainability targets while other especially provisioning targets are less well represented. Subsequently, we discuss the risks of neglecting biological invasions within sustainable development and how invasive alien species can have changing and adverse effects through time counteracting the intended benefits at the time of introduction. Finally, we provide key recommendations for action at the international scale to ensure that biological invasions are adequately considered in sustainable development. Those recommendations include (1) acknowledgement of biological invasions as a key threat to sustainable development, (2) a call for stronger multilateral exchange under the umbrella of an adequately financed coordinating body and (3) appropriate implementation and resource provisioning for international monitoring, data infrastructure, data exchange and use of adequate indicators of biological invasions to streamline decision making based on a solid evidence base. Read the free Plain Language Summary for this article on the Journal blog.

The selenoenzyme type I iodothyronine deiodinase (DIO1) catalyzes removal of iodine atoms from thyroid hormones. Although DIO1 action is reported to be disturbed in several malignancies, no work has been conducted in high‐grade serous ovarian carcinoma (HGSOC), the most lethal gynecologic cancer. We studied DIO1 expression in HGSOC patients [The Cancer Genome Atlas (TCGA) data and tumor tissues], human cell lines (ES‐2 and Kuramochi), normal Chinese hamster ovarian cells (CHO‐K1), and normal human fallopian tube cells (FT282 and FT109). To study its functional role, DIO1 was overexpressed, inhibited [by propylthiouracil (PTU)], or knocked down (KD), and cell count, proliferation, apoptosis, cell viability, and proteomics analysis were performed. Lower DIO1 levels were observed in HGSOC compared to normal cells and tissues. TCGA analyses confirmed that low DIO1 mRNA expression correlated with worse survival and therapy resistance in patients. Silencing or inhibiting the enzyme led to enhanced ovarian cancer proliferation, while an opposite effect was shown following DIO1 ectopic expression. Proteomics analysis in DIO1‐KD cells revealed global changes in proteins that facilitate tumor metabolism and progression. In conclusion, DIO1 expression and ovarian cancer progression are inversely correlated, highlighting a tumor suppressive role for this enzyme and its potential use as a biomarker in this disease.

Cryptococcus neoformans is the highest‐ranked fungal pathogen in the Fungal Priority Pathogens List (FPPL) released by the World Health Organization (WHO). In this study, through in silico simulations, a multi‐epitope vaccine against Cryptococcus neoformans was developed using the mannoprotein antigen (MP88) as a vaccine candidate. Following the retrieval of the MP88 protein sequences, these were used to predict antigenic B‐cell and T‐cell epitopes via the bepipred tool and the artificial neural network, respectively. Conserved B‐cell epitopes AYSTPA, AYSTPAS, PASSNCK, and DSAYPP were identified as the most promising B‐cell epitopes. While YMAADQFCL, VSYEEWMNY, and FQQRYTGTF were identified as the best candidates for CD8+ T‐cell epitopes; and YARLLSLNA, ISYGTAMAV, and INQTSYARL were identified as the most promising CD4+ T‐cell epitopes. The vaccine construct was modeled along with adjuvant and peptide linkers and the expasy protparam tool was used to predict the physiochemical properties. According to this, the construct vaccine was predicted to be antigenic, nontoxic, nonallergenic, soluble, stable, hydrophilic, and thermostable. Furthermore, the three‐dimensional structure was also used in docking analyses with Toll‐like receptor (TLR4). Finally, the cDNA of vaccine was successfully cloned into the E. coli pET‐28a (+) expression vector. The results presented here could contribute towards the design of an effective vaccine against Cryptococcus neoformans.

Abstract Objective The first international consensus criteria for optic neuritis (ICON) were published in 2022. We applied these criteria to a prospective, global observational study of acute optic neuritis (ON). Methods We included 160 patients with a first‐ever acute ON suggestive of a demyelinating CNS disease from the Acute Optic Neuritis Network (ACON). We applied the 2022 ICON to all participants and subsequently adjusted the ICON by replacing a missing relative afferent pupillary defect (RAPD) or dyschromatopsia if magnetic resonance imaging pathology of the optical nerve plus optical coherence tomography abnormalities or certain biomarkers are present. Results According to the 2022 ICON, 80 (50%) patients were classified as definite ON, 12 (7%) patients were classified as possible ON, and 68 (43%) as not ON (NON). The main reasons for classification as NON were absent RAPD (52 patients, 76%) or dyschromatopsia (49 patients, 72%). Distribution of underlying ON etiologies was as follows: 78 (49%) patients had a single isolated ON, 41 (26%) patients were diagnosed with multiple sclerosis, 25 (16%) patients with myelin oligodendrocyte glycoprotein antibody‐associated disease, and 15 (9%) with neuromyelitis optica spectrum disorder. The application of the adjusted ON criteria yielded a higher proportion of patients classified as ON (126 patients, 79%). Interpretation According to the 2022 ICON, almost half of the included patients in ACON did not fulfill the requirements for classification of definite or possible ON, particularly due to missing RAPD and dyschromatopsia. Thorough RAPD examination and formal color vision testing are critical to the application of the 2022 ICON.

ABSTRACT Background Thromboembolic events are a common cause of morbidity and mortality in patients with cancer. While direct‐acting oral anticoagulants (DOACs) have been established as the preferred agents of anticoagulation in most patients with cancer, data in resource‐limited settings is limited. Aims The study aims to assess the comparative efficacy and safety of warfarin and rivaroxaban for cancer‐associated thrombosis (CAT) in a resource‐limited setting. Methods and results A single‐center retrospective cohort study was conducted on 201 patients who were on follow‐up from September 2021 to August 2023. The patients were categorized into two groups (1) warfarin and (2) rivaroxaban. They were then retrospectively followed for 12 months. The primary endpoint was a composite of recurrence of venous thromboembolism (VTE), major bleeding event, or all‐cause mortality. The Cox regression model was used to compare the outcome of the two groups. The baseline mean (standard deviation) age of the patients was 48.4 (15.0) and 140 (69.7%) of them were female. 41.3% of the participants had one or more comorbidities, and the most common types of cancer were gynecologic (28.9%), hematologic (21.4%), and intra‐abdominal (16.9%). The most common type of thrombosis was deep vein thrombosis (DVT) (77.1%). The primary composite outcome of VTE recurrence, major bleeding event, and all‐cause mortality occurred in 25 (24.3%) patients in the warfarin group and 11 (11.2%) in the rivaroxaban group (hazard ratio (HR), 0.48; 95% confidence interval (CI), 0.24–0.97; p = 0.041). Conclusion Rivaroxaban was found to be more efficacious and safer than warfarin for patients with CAT in a resource‐limited setting. This finding is congruent with reports from resource‐abundant countries and recommendations from major international societies.

ABSTRACT Background and Aim Lubiprostone increases chloride and water secretion in the intestines, and several studies have demonstrated the efficacy of lubiprostone in treating functional constipation. Several new clinical trials have emerged since the previous meta‐analysis conducted in 2020. We conducted this updated meta‐analysis to assess clinical efficacy of lubiprostone in these patients. Methods A systematic search was conducted on MEDLINE, Cochrane, and Scopus. Randomized controlled trials published between July 2019 and June 2024 were selected. Cochrane's RoB 2 tool was used to assess the risk of bias. A meta‐analysis was performed and findings were presented using forest plots. Results A total of 14 studies, comprising 4550 patients, were included in the review. Only 12 studies were pooled in the meta‐analysis. Lubiprostone was associated with greater spontaneous bowel movements (SBM) per week (RR 1.454, 95% CI 1.193–1.771) and SBM within 24 h (RR 1.790, 95% CI 1.491–2.150) in patients with chronic idiopathic constipation (CIC). However, it was not associated with abdominal pain in either arm (RR 1.415, 95% CI 0.873–2.294). In opioid‐induced constipation (OIC), lubiprostone increased SBM within 24 h (RR 1.277, 95% CI 1.105–1.475) but did not significantly affect abdominal pain (RR 4.321, 95% CI 0.624–29.941). Lubiprostone improved all selected SBM‐related and abdominal pain outcomes in patients with irritable bowel syndrome with constipation (IBS‐C). Conclusion Lubiprostone significantly improves all SBM‐related outcomes. Owing to its good safety and efficacy profile, lubiprostone can be used in the combination regimens for management of CIC, IBS‐C, and OIC.

Abstract Background Paediatric sarcomas, including rhabdomyosarcoma, Ewing sarcoma and osteosarcoma, represent a group of malignancies that significantly contribute to cancer‐related morbidity and mortality in children and young adults. These cancers share common challenges, including high rates of metastasis, recurrence or treatment resistance, leading to a 5‐year survival rate of approximately 20% for patients with advanced disease stages. Despite the critical need, therapeutic advancements have been limited over the past three decades. The advent of chimeric antigen receptor (CAR)‐based immunotherapies offers a promising avenue for novel treatments. However, CAR‐T cells have faced significant challenges and limited success in treating solid tumours due to issues such as poor tumour infiltration, immunosuppressive tumour microenvironments and off‐target effects. In contrast, the adaptation of CAR technology for natural killer (NK) cells has demonstrated potential in both haematological and solid tumours, suggesting a new therapeutic strategy for paediatric sarcomas. Methods This study developed and validated a novel CAR‐NK cell therapy targeting the ephrin type‐A receptor‐2 (EphA2) antigen, which is highly expressed in various paediatric sarcomas. Results CAR expression was successfully detected on the surface of NK cells post‐electroporation, indicating successful transfection. Significantly, EphA2‐specific CAR‐NK cells demonstrated enhanced cytotoxic activity against several paediatric sarcoma cell lines in vitro, including those of rhabdomyosarcoma, Ewing sarcoma and osteosarcoma, compared to unmodified NK cells. Transient messenger RNA (mRNA) transfection of NK cells is a safe approach in genetic engineering, with further chemical modifications to mRNA enhancing stability of temporal EphA2‐CAR expression in NK cells, thereby promoting prolonged protein expression. Additionally, in vivo EphA2‐CAR‐NK cells showed promising anti‐cancer activity in rhabdomyosarcoma and osteosarcoma mouse models. Conclusions The study provides a foundational basis for the clinical evaluation of EphA2‐targeted CAR‐NK cell therapy across a spectrum of paediatric sarcomas. The enhanced anti‐tumour effects observed in vitro/vivo suggests potential for improved therapeutic outcomes in hard‐to‐cure paediatric sarcomas. Key points Addressing unmet clinical needs in paediatric Sarcomas. Paediatric sarcomas, including rhabdomyosarcoma, Ewing sarcoma, and osteosarcoma, exhibit poor survival rates in advanced disease stages. The lack of significant therapeutic progress over the past three decades necessitates innovative treatment approaches. Advancing immunotherapy with CAR‐NK cells. Natural killer (NK) cells modified with chimeric antigen receptors (CARs) represent a promising strategy to overcome the limitations of CAR‐T cells, particularly in solid tumours. CAR‐NK cells are associated with enhanced tumour targeting, reduced off‐target effects, and improved safety profiles. EphA2 as a therapeutic target. EphA2, a receptor overexpressed in multiple paediatric sarcomas, is identified as a viable target for CAR‐based immunotherapy due to its critical role in tumour progression and angiogenesis. Innovations in mRNA‐based engineering. This study demonstrates the feasibility of transient mRNA transfection to engineer NK cells for CAR expression, offering a non‐integrative and safer alternative to viral transduction. Enhancements in mRNA stability through chemical modifications, can further optimise protein expression. Preclinical efficacy of EphA2‐CAR NK cells. EphA2‐specific CAR‐NK cells exhibit superior cytotoxicity against sarcoma cell lines in vitro and demonstrate significant anti‐tumour activity in in vivo mouse models of rhabdomyosarcoma and osteosarcoma. Clinical translation potential. The findings establish a strong preclinical rationale for the clinical evaluation of EphA2‐targeted CAR‐NK therapy as a novel immunotherapeutic option for paediatric sarcomas. Future research directions: Combining EphA2‐CAR NK cells with immune checkpoint inhibitors or other immunomodulatory agents could further enhance therapeutic outcomes and durability. Advanced preclinical models mimicking human tumour microenvironments are needed to refine and optimise this therapeutic approach.

ABSTRACT Toxoplasmosis is a significant food‐borne protozoal disease in humans and animals. The study aimed to find out Toxoplasma seropositivity in sheep, estimate epidemiological risk factors and assess haemato‐biochemical parameter changes. Blood samples were collected from 276 indigenous sheep in five districts surrounding Sulaymaniyah Province in the northern region of Iraq. Toxoplasmosis was determined by detecting anti‐Toxoplasma antibodies by ELISA. The impact of various risk factors on seropositivity was evaluated. Haematological and serum biochemical changes from naturally infected sheep were analysed using commercial kits. The overall seroprevalence of Toxoplasma antibodies among the studied population was 41.67%. Sharazoor district had a higher prevalence rate of 46.15% than Bakrajo, with the lowest frequency rate of 38.18%. Ewes with an abortion history had a higher risk for seropositivity of about 47.4% (OR = 1.4, 95% CI: 0.9–1.6). Sampling season and herd size are other risk factors, with higher seropositivity at 42.5% (OR = 1.1, 95% CI: 0.8–1.4) during the dry season and among small flocks ≤ 100 animals/farm at 43.6% (OR = 1.1, 95% CI: 0.7–1.4). Toxoplasma prevalence was correlated with animals' ages; a higher seropositivity of 43.3% was found among older sheep (OR = 0.8, 95% CI: 0.6–1.2). Seropositive sheep had significantly higher total leukocyte, lymphocyte and granulocyte counts but significantly lower haemoglobin, haematocrit and total erythrocyte counts. The serum levels of total protein and albumin were significantly reduced, with increased blood urea nitrogen and creatinine concentrations. Also, AST enzyme activity represents a higher value in positive sheep with toxoplasmosis. Toxoplasma infection among the ovine population is common. Its impact on livestock productivity should not be neglected. A potential risk for humans through infected sheep could be a hazardous source for public health.

ABSTRACT Introduction Laparoscopic surgery (LS) has been a promising development in surgical practice globally ever since its introduction. LS has exhibited many an advantage, including bettering patient outcomes, lowering the risk of postoperative infection, and displaying economical affluence. However, its implementation in the African continent still faces various challenges. In this review, we investigated the status of laparoscopic surgery integration in Africa. Objectives In this review, we aimed to investigate the challenges posed by the implementation of LS in low resource countries as well as critically evaluating initiatives and their impact within said domiciles. We also provide recommendations that may assist in LS prosperity in these settings by focusing efforts on improving training and financial incentives. Methods A comprehensive literature review was conducted to garner up‐to‐date evidence concerning the fate of LS adoption in low‐ to middle‐income countries. This comprised the analysis of different case studies from countries including Nigeria and Botswana, and investigated relevant recommendations and policies provided by other African countries. Results Various challenges face the implementation of LS in countries with low resources comprising poor infrastructure, scarce training programs, and expert training personnel alongside financial boundaries. The adoption of LS in Africa has proved its benefits in improving patient outcomes and reducing hospital admissions. From a perspective of policy, it is crucial to sustain strong ties amongst institutions, stressing the importance of dynamic collaboration and locally tailored policies. Conclusion It has been demonstrated that LS implementations in African nations lower infection rates and expedite recovery. A strong collaboration between governments, stakeholders, and healthcare providers is fundamental for successful integration of LS. Such extension in low‐resource environments may be achieved by providing proper training programs, funding infrastructure and equipment, and fostering effective financial initiatives.

Objective The treatment of acromioclavicular joint (ACJ) dislocations offers numerous options, and ongoing debates persist regarding their comparative effectiveness. Among these options, the suspensory loop device (SLD) is one of the most favored treatment modalities. Despite the observed high reduction loss rate associated with SLD, the treatment yields favorable clinical outcomes. This study aimed to investigate the clinical outcomes of patients with acute type 3 and 5 ACJ dislocations who underwent open and arthroscopic procedures using a single‐bundle SLD, and to evaluate the effect of clavicular tunnel position on reduction loss. Methods Thirty‐seven eligible patients diagnosed with acute type 3 and type 5 ACJ dislocation who underwent open and arthroscopic surgery with a single‐bundle SLD between January 2015 and March 2022 were evaluated retrospectively. Demographic data and radiological measurements including coracoclavicular (CC) interval, clavicle length (CL), and implant distance (ID) were recorded. The ID/CL ratio was calculated and a value between 0.17 and 0.24 was considered as “acceptable implant position”. Reduction loss and other complications were noted. Patients were divided into two groups: open (Group 1) and arthroscopic (Group 2). Constant Murray Score (CMS) and Visual Analog Scale (VAS) were used for clinical and functional outcomes. Non‐parametric tests were used for statistical analysis of variables. Results The study included six females (16.2%) and 31 males (83.8%) with a mean age of 40.2 ± 14.7 years (range: 20–75). The mean follow‐up period was 22.3 ± 16.7 months (range: 6–72). The average time from trauma to surgery was 6.3 ± 5.3 days (range: 1–18). At the last follow‐up, the CMS was 89.3 ± 8.8 and the VAS score was 2.1 ± 0.9. The mean ID/CL ratio was 0.19 ± 0.1 and 19 patients (51.4%) were between 0.17 and 0.24. Reduction loss was observed in nine patients (24.3%). There were no significant differences between Group 1 and Group 2 regarding operation time (p = 0.998), ID/CL ratio (p = 0.442), reduction loss (p = 0.458), CMS (p = 0.325), and VAS score (p = 0.699). Of the 28 patients without reduction loss, 16 had an ID/CL ratio between 0.17 and 0.24 (p = 0.43). Furthermore, within the 0.17–0.24 interval, CMS was higher with an average of 91.8 ± 5.1 compared to the other intervals (p = 0.559). Conclusion The clinical and functional outcomes of acute type 3 and type 5 ACJ dislocation operated open and arthroscopically with single‐bundle SLD are similar and satisfactory. A clavicular tunnel position in the range of 0.17–0.24 (ID/CL ratio) is recommended to maintain postoperative reduction.

Abstract Relapse remains a major cause of treatment failure following allogeneic stem cell transplantation (allo‐SCT) for patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). We retrospectively investigated low‐dose decitabine and venetoclax (DEC/VEN) as post‐transplant maintenance in 26 older patients with AML and MDS. The cumulative incidence of day 100 gIII‐IV acute graft versus host disease (GVHD) and 1‐year moderate‐severe chronic GVHD was 5% and 26%, respectively. One patient relapsed 14 m after transplant. The 1‐year non‐relapse mortality and survival were 11% and 84%, respectively. DEC/VEN is a safe and potentially effective strategy to reduce the risk of post‐transplant relapse.

ABSTRACT Background Warmed intravenous (IV) fluids administration to prevent hypothermia provide controversial results in humans, cats and dogs, but its effect on calves is unknown. Objectivxe To evaluate the effectiveness of warmed IV fluids administered to prevent intraoperative heat loss in anaesthetised calves undergoing umbilical herniorrhaphy. Methods Thirty Simmental breed calves (aged 10–30 days) were randomly divided between two equal groups, wherein the infusion fluid (Ringer's lactate, 5 mL/kg/h) was administered either at room temperature (Group RoT) or warmed (Group WF). Pulse rate (PR), respiratory rate (fR), peripheral haemoglobin oxygen saturation (SpO2) and rectal temperature (RT) were recorded immediately after the onset of anaesthesia induction (T0) at T5, T10, T15, T30, T45 and T60. Duration of anaesthesia, surgery time and recovery scores were also noted. Results The PR, RT and fR values showed no significant difference between groups over time (p > 0.05). There was no significant difference in duration of anaesthesia, surgery time or recovery score between groups (p > 0.05). Conclusions The findings of the current study suggest that warmed IV fluid as the warming method did not prevent intraoperative hypothermia in calves. A constant‐rate infusion of warmed fluid (5 mL/kg/h) is insufficient to prevent intraoperative hypothermia in calves.

Abstract Healthcare professionals (HCPs) have vital roles in providing evidence‐based care to promote healthy micronutrient nutrition in early life. Providing such care requires scalable training to strengthen knowledge and confident application of effective behaviour change skills. Among 33 public and private HCPs (primarily dietitians) in South Africa, we evaluated the behaviour change aspects of a technology‐enabled National Qualification Sub‐Framework level 6 programme, Improving Early Nutrition and Health in South Africa (‘ImpENSA’). This programme comprises two self‐directed micronutrient and behaviour change knowledge‐based eLearning and one facilitated online practical skills modules to improve maternal and infant micronutrient nutrition. Using assessments, questionnaires and interviews, we collected data at baseline, after module completion and at 3‐month follow‐up after programme completion. Questionnaire and interview data showed major improvements in understanding of and attitudes towards person‐centred behaviour change support immediately following the eLearning module on behaviour change. The assessment pass rate increased from 38% at baseline to 88% postmodule, demonstrating significant knowledge gain in behaviour change support. Intention to change practice towards a person‐centred approach was high and many had already started implementing changes. Three months postprogramme, support was centred around patients' needs. Open relationships with patients, improved patient outcomes and increased job satisfaction were among reported outcomes. Many reported becoming better change facilitators and reflective practitioners. Additional improvements in understanding and attitudes to behaviour change support were evident, reinforced by making changes and experiencing positive outcomes. The findings suggest that technology‐enabled learning can equip HCPs with knowledge and skills to effectively support behaviour change for healthy micronutrient nutrition during pregnancy and infancy.

The past several decades have seen rapid advances in diagnosis and treatment of cardiovascular diseases and stroke, enabled by technological breakthroughs in imaging, genomics, and physiological monitoring, coupled with therapeutic interventions. We now face the challenge of how to (1) rapidly process large, complex multimodal and multiscale medical measurements; (2) map all available data streams to the trajectories of disease states over the patient's lifetime; and (3) apply this information for optimal clinical interventions and outcomes. Here we review new advances that may address these challenges using digital twin technology to fulfill the promise of personalized cardiovascular medical practice. Rooted in engineering mechanics and manufacturing, the digital twin is a virtual representation engineered to model and simulate its physical counterpart. Recent breakthroughs in scientific computation, artificial intelligence, and sensor technology have enabled rapid bidirectional interactions between the virtual‐physical counterparts with measurements of the physical twin that inform and improve its virtual twin, which in turn provide updated virtual projections of disease trajectories and anticipated clinical outcomes. Verification, validation, and uncertainty quantification builds confidence and trust by clinicians and patients in the digital twin and establishes boundaries for the use of simulations in cardiovascular medicine. Mechanistic physiological models form the fundamental building blocks of the personalized digital twin that continuously forecast optimal management of cardiovascular health using individualized data streams. We present exemplars from the existing body of literature pertaining to mechanistic model development for cardiovascular dynamics and summarize existing technical challenges and opportunities pertaining to the foundation of a digital twin.

Key Clinical Message The significance of taking femoral neck stress fractures into account as a possible consequence in sickle cell anemia patients is underscored by this case report. In this high‐risk group, early identification, timely diagnosis, and suitable care are crucial for averting major problems and improving results. When sickle cell anemia patients complain with hip or groin discomfort, healthcare practitioners should keep a high index of suspicion for femoral neck stress fractures to assure prompt management and prevent long‐term impairment. Abstract Sickle cell disease (SCD) is a prevalent genetic hemoglobinopathy with significant global implications, affecting a substantial portion of the population. Avascular necrosis of the femoral head is a common complication in SCD, leading to severe joint damage and immobility. This case report is of a 20‐year‐old male who presented with severe hip pain due to a femoral neck stress fracture, which progressed to a complete fracture. This patient had a past medical history of sickle cell anemia and a malunited subtrochanteric fracture that resulted in shortening, external rotation, and a limping gait. Surgical treatment via subtrochanteric osteotomy with fixation using a dynamic hip screw with or without iliac crest bone graft was planned, with a satisfactory reduction and closure of the fracture gap, postoperatively. In cases of sickle cell anemia patients, bone complications such as both osteonecrosis and stress fractures are common. As a healthcare provider, it is important to manage and address these not only through medical interventions, but also through counseling and patient education. Patients must be reminded about the importance of compliance with medical advice to avoid progression or recurrence of complications.

Abstract Background Israeli‐Arab adolescents are reported to consume higher amounts of fast food, sweets, and candies. This study examined possible associations among energy drink consumption, anxiety, and well‐being in Israeli‐Arab adolescents. We also investigated these associations concerning fast food consumption, physical activity, and hours of sleep per night. Methods A cross‐sectional exploratory study assessed adolescents’ energy drink consumption, nutritional and lifestyle habits, well‐being, and anxiety using self‐reported questionnaires. Adolescents aged 12–18 from several cities and villages in northern Israel were considered for the study. Anthropometric measurements—weight, height, and waist circumference—were also assessed. Results One hundred and fourteen adolescents (59 females) participated in the study. Gender and energy drink consumption were associated with psychological status. Energy drink consumers reported a lower well‐being index and a higher anxiety index than nonconsumers (73.02 ± 2.64 and 23 ± 1.56 vs. 79.37 ± 1.67 and 18.86 ± 1.41, respectively). Energy drink consumers ate significantly more fast food per week than nonconsumers (1.25 ± 0.07 vs. 1.03 ± 0.09). Additionally, hours of sleep per night were correlated with anxiety levels among energy drink consumers [rs = 0.352, p = 0.018]. These results differed between genders. Conclusions Our study shows complex associations between energy drink consumption and mental health indices. These associations can serve as a basis for further research into this topic.

Abstract At the current juncture with climate change, centennial projections of species distributions in biodiversity hotspots, using dynamic vegetation models may provide vital insight into conservation efforts. This study aims to answer: (1) if climate change progresses under a business‐as‐usual scenario of anthropogenic emissions for this century, how may the forest ranges be affected? (2) will there be potential regional extinctions of the taxa simulated? (3) may any site emerge as a potential refugium? Study Area: Anatolian Peninsula and its surroundings, longitudes 24–50° E, latitudes 33–46° N. Time Period: 1961‐2100. Major Taxa Studied: 25 woody species and a C3 grass‐type. Method: Keeping a spatial window large enough to track potential changes in the vegetation range and composition especially in the mountain ranges within the study area, we parameterized a process‐based regional‐to‐global dynamic vegetation model (LPJ‐GUESS v 4.1), forced it with ERA5‐Land reanalysis for the historical period, and five different bias‐corrected centennial global circulation model (GCM) datasets under SSP5‐8.5, and simulated the dynamic responses of key forest species. Bivariate spatio‐temporal maps from the simulation results were constructed for final analysis. Results: A significant increase in woody taxa biomass for the majority of our study area, towards the end of the century was simulated, where temperate taxa with high tolerance for drought and a wider range of temperatures took dominance. The mountain ranges in our study area stood out as critical potential refugia for cold favoring species. There were no regional extinctions of taxa, however, important changes in areal dominance and potential future forest composition were simulated. Main Conclusions: Our simulation results suggest a high potential for future forest cover in our study region by the end of the century under a high emissions scenario, sans human presence, with important changes in vegetation composition, including encroachment of grasslands ecosystems by woody taxa.

Abstract Background Although research on the mechanism and control of pain and inflammation in fish has increased in recent years, the use of analgesic drugs is limited due to the lack of pharmacological information about analgesic drugs. Tolfenamic acid is a non‐steroidal anti‐inflammatory drug and can be used in fish due to its low side effect profile and superior pharmacokinetic properties. Objectives The pharmacokinetics, bioavailability and plasma protein binding of tolfenamic acid were investigated following single intravascular (IV), intramuscular (IM) and oral administration of 2 mg/kg in rainbow trout at 13 ± 0.5°C. Methods The experiment was carried out on a total of 234 rainbow trout (Oncorhynchus mykiss). Tolfenamic acid was administered to fish via IV, IM and oral route at a dose of 2 mg/kg. Blood samples were taken at 13 different sampling times until the 72 h after drug administration. The plasma concentrations of tolfenamic acid were quantified using high pressure liquid chromatography–ultraviolet (UV) and pharmacokinetic parameters were assessed using non‐compartmental analysis. Results The elimination half‐life (t1/2ʎz) of tolfenamic acid for IV, IM and oral routes was 3.47, 6.75 and 9.19 h, respectively. For the IV route, the volume of distribution at a steady state and total body clearance of tolfenamic acid were 0.09 L/kg and 0.03 L/h/kg, respectively. The peak plasma concentration and bioavailability for IM and oral administration were 8.82 and 1.24 µg/mL, and 78.45% and 21.48%, respectively. The mean plasma protein binding ratio of tolfenamic acid in rainbow trout was 99.48% and was not concentration dependent. Conclusions While IM route, which exhibits both the high plasma concentration and bioavailability, can be used in rainbow trout, oral route is not recommended due to low plasma concentration and bioavailability. However, there is a need to demonstrate the pharmacodynamic activity of tolfenamic acid in rainbow trout.

Abstract By 2060, an estimated one in four Americans will be elderly. Consequently, the prevalence of osteoporosis and fragility fractures will also increase. Presently, no available intervention definitively prevents or manages osteoporosis. This study explores whether Pool 7 Compound 3 (P7C3) reduces progressive bone loss and fragility following the onset of ovariectomy (OVX)‐induced osteoporosis. Results confirm OVX‐induced weakened, osteoporotic bone together with a significant gain in adipogenic body weight. Treatment with P7C3 significantly reduced osteoclastic activity, bone marrow adiposity, whole‐body weight gain, and preserved bone area, architecture, and mechanical strength. Analyses reveal significantly upregulated platelet derived growth factor‐BB and leukemia inhibitory factor, with downregulation of interleukin‐1 R6, and receptor activator of nuclear factor kappa‐B (RANK). Together, proteomic data suggest the targeting of several key regulators of inflammation, bone, and adipose turnover, via transforming growth factor‐beta/SMAD, and Wingless‐related integration site/be‐catenin signaling pathways. To the best of the knowledge, this is first evidence of an intervention that drives against bone loss via RANK. Metatranscriptomic analyses of the gut microbiota show P7C3 increased Porphyromonadaceae bacterium, Candidatus Melainabacteria, and Ruminococcaceae bacterium abundance, potentially contributing to the favorable inflammatory, and adipo‐osteogenic metabolic regulation observed. The results reveal an undiscovered, and multifunctional therapeutic strategy to prevent the pathological progression of OVX‐induced bone loss.

Abstract Tailwater recovery (TWR) systems, which divert phosphorus‐rich drainage water from cranberry (Vaccinium macrocarpon Ait.) farms into reservoirs, have the potential to improve water quality of freshwater lakes in Massachusetts. However, residents and environmentalists have questioned the potential water quality benefits of TWR systems. In the southeastern United States, research shows that TWR systems decrease agricultural inputs of phosphorus (P) to surface water by 23%–92%. Additionally, a case study in Massachusetts demonstrated the efficacy of TWR and other best management practices in reducing P concentrations in White Island Pond. Although TWR systems appear effective as part of a P management strategy, more research is needed to quantify their environmental benefits and allay public concerns. We propose filling three critical research gaps to strengthen and broaden support for TWR systems in cranberry agriculture in Massachusetts: (1) quantifying physical properties, (2) quantifying water storage potential, and (3) quantifying P retention capacity. Core Ideas Excess phosphorus (P) from cranberry farms may contribute to the eutrophication of freshwater lakes. Agricultural tailwater recovery (TWR) systems are increasingly used to conserve water and improve water quality. Earth removal, critical to create TWR ponds and provide sand for cranberry farms, has drawn public opposition. Research and case studies indicate TWR systems may decrease P inputs from cranberry farms to surface water. Long‐term monitoring, research, and stakeholder engagement are needed to assess efficacy of cranberry TWR systems.

Key Clinical Message Vincristine therapy can be effective in refractory Immune thrombocytopenia (ITP) following COVID‐19 vaccination. Our case report highlights the need for further research to establish standard management guidelines for COVID‐19‐vaccine‐associated ITP. Abstract Adult immune thrombocytopenia (ITP) can occur as a rare complication following several viral infections or a rare adverse event or complication of vaccination. In this paper, we report a case of a 39‐year‐old male patient with severe refractory ITP that began 4‐weeks after receiving his third (booster) dose of the COVID‐19 vaccine (BNT162b2, Pfizer‐BioNTech). He was given oral dexamethasone 40 mg daily for 4 days followed by prednisone at 1 mg/kg (85 mg daily) for 10 days. In the following weeks, we attempted several other lines of therapy to treat his ITP, including anti‐RhD immunoglobulin, which, unfortunately, caused moderate hemolysis requiring packed red blood cell transfusion, intravenous immunoglobulin (given at a subtherapeutic dose of 0.4 g/kg for only 1 day since it was not available), rituximab, and eltrombopag. The patient, unfortunately, showed no response to any of these treatments. This was an indicator to initiate salvage therapy with vincristine 2 mg weekly for 3 weeks. The patient's platelet count started to increase remarkably during the third week of vincristine and normalized after 4 weeks. We review the findings, clinical characteristics, and management approaches that were reported in the literature regarding COVID‐19‐vaccine‐induced ITP. More in‐depth research is needed to delineate standard guidelines for the management of such cases. This report underscores the importance of resorting to vincristine and eltrombopag as great options for severe and refractory ITP related to the COVID‐19 vaccine.

Abstract Operations and maintenance (O&M) of floating offshore wind farms (FOWFs) poses various challenges in terms of greater distances from the shore, harsher weather conditions, and restricted mobility options. Robotic systems have the potential to automate some parts of the O&M leading to continuous feature‐rich data acquisition, operational efficiency, along with health and safety improvements. There remains a gap in assessing the techno‐economic feasibility of robotics in the FOWF sector. This paper investigates the costs and benefits of incorporating robotics into the O&M of a FOWF. A bottom‐up cost model is used to estimate the costs for a proposed multi‐robot platform (MRP). The MRP houses unmanned aerial vehicle (UAV) and remotely operated vehicle (ROV) to conduct the inspection of specific FOWF components. Emphasis is laid on the most conducive O&M activities for robotization and the associated technical and cost aspects. The simulation is conducted in Windfarm Operations and Maintenance cost‐Benefit Analysis Tool (WOMBAT), where the metrics of incurred operational expenditure (OPEX) and the inspection time are calculated and compared with those of a baseline case consisting of crew transfer vessels, rope‐access technicians, and divers. Results show that the MRP can reduce the inspection time incurred, but this reduction has dependency on the efficacy of the robotic system and the associated parameterization e.g., cost elements and the inspection rates. Conversely, the increased MRP day rate results in a higher annualized OPEX. Residual risk is calculated to assess the net benefit of incorporating the MRP. Furthermore, sensitivity analysis is conducted to find the key parameters influencing the OPEX and the inspection time variation. A key output of this work is a robust and realistic framework which can be used for the cost‐benefit assessment of future MRP systems for specific FOWF activities.

Abstract Background Hypothyroidism in dogs is associated with obesity and altered lipid and carbohydrate metabolism. The adipokines, visfatin, and betatrophin, affect glucose tolerance. Betatrophin is involved in lipid regulation. Hypothesis Visfatin and betatrophin serum concentrations are altered in hypothyroid dogs. Animals Dogs with naturally occurring hypothyroidism (n = 25) and healthy dogs (n = 25). Methods Insulin, visfatin, and betatrophin serum concentrations were measured in all dogs and 19 of the hypothyroid dogs after 30 days of thyroxine treatment. Body condition score (BCS) was determined (1‐9 scale). Results Visfatin concentrations were lower in hypothyroid compared with healthy dogs (mean, 95% confidence interval [CI]; 2.0 ng/mL, 1.2‐3.3 vs 5.1 ng/mL, 3.3‐7.8; P = .004) and increased post‐treatment (3.1 ng/mL, 1.9‐4.9 vs 2.6 ng/mL, 1.6‐4.1; P = .05). Betatrophin concentrations were lower in lean to normal (body condition score [BCS], 3‐5) hypothyroid dogs compared to lean to normal healthy dogs (52 pg/mL, 9‐307 vs 597 pg/mL, 216‐1648; P = .03), but were not different between overweight (BCS, 6‐9) hypothyroid and healthy dogs (341 pg/L, 168‐695 vs 178 pg/mL, 77‐415; P = .26), and decreased post‐treatment in overweight dogs (206 pg/mL, 87‐488 vs 268 pg/mL, 112‐640; P = .004). Visfatin concentrations were higher in overweight compared with lean to normal dogs (4.7 ng/mL, 3.3‐6.6 vs 2.2 ng/mL, 1.2‐4.2; P = .04). Betatrophin concentrations were positively correlated with BCS (r = .47, P = .02) and insulin concentrations (r = .48, P = .03) in hypothyroid dogs and negatively correlated with BCS (r = −.47, P = .02) and thyroid stimulating hormone concentrations (r = −.56, P = .01) in healthy dogs. Conclusions and Clinical Importance Hypothyroidism in dogs is associated with alterations in visfatin and betatrophin concentrations that partially resolve with thyroxine treatment.

Abstract Objectives This study aimed to compare the effects of three irrigation activation systems (IAS) on postoperative pain (PP) in activating three final irrigants: sodium hypochlorite 5.25%, ethylenediaminetetraacetic acid 17%, and chlorhexidine 2%. Materials and Methods This parallel randomized clinical trial included referred patients with asymptomatic large‐sized apical lesion incisors. A standard method was followed in the canal cleaning and shaping for all included patients in the study. Then, the patients were randomly assigned (1:1 allocation) into three groups: G1 (n = 20) with passive ultrasonic irrigation activation; G2 (n = 20) with XP‐Endo Finisher file activation; and G3 (n = 20) with diode laser (810 nm) activation. PP was estimated in all groups using a visual analog scale after 1, 3, 7, and 14 days of treatment. Comparisons between the groups were made using the Kruskal−Wallis test, whereas the Mann−Whitney U test was used in the pairwise comparisons. Results Sixty patients were followed‐up in this trial. There were significant differences between the groups in terms of PP After 1, 3, and 7 days of treatment (p = 0.002, p = 0.017, and p = 0.006, respectively). On the first day of treatment, G3 showed the lowest PP compared with G1 and G2 (p = 0.007 and p = 0.001, respectively). On the third day of treatment, G3 showed less PP compared with G2 (p = 0.005). On the seventh day of treatment, G2 showed the highest PP compared with G1 and G3 (p = 0.012 and p = 0.003, respectively). Conclusions The XP‐Endo Finisher file caused the highest PP level especially in the next day and 3 days of the treatment, whereas the diode laser had the lowest PP level during the first week of treatment. It is noteworthy that PP disappeared completely after 2 weeks of treatment with all three IASs. Trial Registration The trial was registered in the ISRCTN registry (Trial ID: SRCTN99457940).

Abstract Background Global variations in epidemiology of type 1 diabetes mellitus (T1DM) exist. This study is designed to examine demographic and clinical features of T1DM over the past 3 decades as well as evolving trends in epidemiology over last 50 years. Methods Clinical characteristics of 925 patients with T1DM over last 30 years (1990–2019) were evaluated and compared to previously published data of 477 patients diagnosed between 1969 and 1990 from one of the major referral centers for diabetes in Turkey. Results Mean age at diagnosis decreased from 9.5 ± 4.0 to 7.1 ± 3.6 years within the past 50 years (p

Abstract Background Health‐seeking behavior (HSB) is an individual's reaction to sickness, for which they seek medical attention, regardless of the form such care may take. Poor HSB is frequently associated with lower health outcomes and greater mortality and disease rates in a nation. Sociodemographic factors, including age, gender, family structure, occupation, ethnicity, and rates of literacy and poverty, can influence a person's HSB. This study would benefit Pakistani parents of the paediatric population to make more informed health choices for their children. Aim This study aims to determine the influence of sociodemographic factors on parental HSB for illnesses among the pediatric age group in Karachi. Materials and Methods A cross‐sectional study was conducted in which 214 parents were interviewed about their choices for health‐seeking healthcare for their pediatric children of the pediatric age group (birth–18 years), who were attending the pediatric OPD and wards at Dr. Ruth Pfau Civil Hospital, Karachi in May 2023. Only parents or guardians with sick children were included. Their sociodemographic characteristics and health‐seeking choices were asked. Informed consent was obtained, and all data were recorded. SPSS version 25 was used for analysis. Results For the first choice, the majority of parents (82.7%) preferred to seek healthcare for their children from medical doctors, followed by spiritual healers (10.7%), traditional healers (5.6%), and homoeopathic doctors (0.9%). For the second choice, the highest percentage was for a doctor (76.2%), followed by a spiritual healer (18.7%), a homoeopathic doctor (3.3%), and a traditional healer (1.9%). A significant correlation was found between the first visit and the decision makers (p = 0.019), the father's education level of the father (p = 0.001), the mother's occupation of the mother (p = 0.019), and the mother's education level of the mother (p = 0.001). Conclusion Sociodemographic characteristics greatly influence parents' HSBs of parents for their children. Despite having low‐paying jobs and being uneducated, most people choose to refer to a doctor for their child due to awareness.

Abstract A breastfeeding‐friendly city is one where there is an enabling environment to support breastfeeding throughout the first 2 years or more of a child's life. Indicators of a breastfeeding‐friendly city have yet to be identified. What are the indicators or criteria used to define breastfeeding friendliness in a geographic area such as a city and the settings within, which we have classified as community, healthcare and workplace? Three major databases and grey literature were searched. Records were screened to identify publications describing criteria such as indicators or descriptions of a breastfeeding‐friendly setting, defined as ‘criteria‐sets’. These criteria‐sets were then categorized and summarized by settings. The search up to 2 September 2021 found 119 criteria‐sets from a range of settings: geographic locations (n = 33), community entities (n = 24), healthcare facilities (n = 28), workplaces (n = 28) and others (n = 6). Overall, 15 community, 22 healthcare and 9 workplace related criteria were extracted from the criteria‐sets. Criteria that were consistently present in all settings were policy, training & education, skilled breastfeeding support and physical infrastructure. Some criteria‐sets of geographic locations contained criteria only from a single setting (e.g., the presence of breastfeeding‐friendly cafes). Criteria‐sets were present for all settings as defined in this review, but few were actual indicators. Specifically, there were no existing indicators of a breastfeeding‐friendly city. Several common components of the criteria‐sets were identified, and these could be used in developing indicators of a breastfeeding‐friendly city. Future studies should determine which of these are important and how each can be measured.

Abstract Background and Aim Obesity affects nearly 650 million adults worldwide, and the prevalence is steadily rising. This condition has significant adverse effects on cardiovascular health, increasing the risk of hypertension, coronary artery disease, heart failure, and atrial fibrillation (AF). While anticoagulation for obese patients with AF is a well‐established therapy for the prevention of thromboembolism, the safety and efficacy of different anticoagulants in this specific population are not well explored. This meta‐analysis aimed to compare direct oral anticoagulants (DOAC) to vitamin K antagonists in obese populations with AF. Methods The PRISMA guidelines were followed for this meta‐analysis, registered in PROSPERO (CRD42023392711). PubMed, PubMed Central, Embase, Cochrane Library, and Scopus databases were searched for relevant articles from inception through January 2023. Two independent authors screened titles and abstracts, followed by a full‐text review in Covidence. Data were extracted in Microsoft Excel and analyzed using RevMan v5.4 using odds ratio as an effect measure. Results Two thousand two hundred fifty‐nine studies were identified from the database search, and 18 were included in the analysis. There were statistically significant reductions in the odds of ischemic and hemorrhagic stroke in the DOAC group compared with the VKA group (OR 0.70, CI 0.66–0.75) and (OR 0.47, CI 0.35–0.62), respectively. In addition, the DOAC group exhibited lower odds of systemic embolism (OR 0.67, CI 0.54–0.83), major bleeding (OR 0.62, CI 0.54–0.72), and composite outcome (OR 0.72, CI 0.63–0.81). Conclusion Based on the findings from this meta‐analysis, DOACs demonstrate superior safety and efficacy in obese patients with AF compared with VKAs. These results may have significant implications for guiding anticoagulation strategies in this patient population.

Abstract Background This study aims to conduct the first‐ever evaluation of our previously proposed behaviors of “hemomania” in individuals engaged with nonsuicidal self‐injury (NSSI). Methods The study encompassed 130 outpatients engaged with NSSI who applied at the psychiatry outpatient clinic. NSSI behaviors were assessed using the Inventory of Statements About Self‐Injury, while psychiatric diagnoses were evaluated using the Structured Clinical Interview for DSM‐5 Disorders‐Clinician Version. Subsequently, participants completed the Depression Anxiety Stress Scale‐21 and Short Form of Barratt Impulsiveness Scale. Results The prevalence of at least one hemomania behavior including seeing blood, tasting blood, bloodletting, and blood‐drinking was observed to be 43.1% in individuals with NSSI. When participants were divided into two groups, individuals with hemomania exhibited: (1) a higher incidence of psychiatric comorbidities, increased suicide attempts, and more severe symptoms of depression, anxiety, stress, and impulsivity, (2) higher comorbidity rates of borderline personality disorder, body‐focused repetitive behaviors, and dissociative disorders, and (3) elevated frequencies of certain NSSI behaviors, including cutting, biting, needle‐ticking, and carving, compared to those without. Conclusion Hemomania could be considered a specific impulse control disorder, characterized by heightened impulsivity and a persistent urge to obtain one's own blood. However, further studies are needed to validate this hypothesis.

Abstract Aim This study aimed to examine the factors that influence the level of flourishing among nursing students. Design Cross‐sectional study. Methods A multistage sampling technique was used to recruit 328 undergraduate nursing students from a nursing college. Data were collected from February to June 2023 using the Global Flourishing Study (GFS) questionnaire, which assesses six domains of flourishing and their determinants. To ensure reliability and validity, a pilot study was conducted and a thorough validation process was employed. Results The Flourishing Index ranged from 24.0 to 100.0, with an average score of 74.2 (SD = 14.8). Well‐being, disposition and behaviour, as well as external factors, correlated strongly positively with the Flourishing Index (r = 0.741, r = 0.565, r = 0.596, all p

Abstract Wind energy is a major and rapidly expanding renewable energy source. Horizontal‐axis wind turbines, the main tool in this industry, induce mortality in flying animals and consequently bring about conservation concerns and regulatory restrictions. We utilized a unique combination of RADAR, LIDAR and ultrasonic acoustic recorders to test the utility of a novel technology meant to prevent wind turbine‐related mortality in bats. Our drone‐mounted deterrent device produces a pulsating combination of strong auditory and visual signals while moving through the air. LIDAR was used to assess the device's impact below its flight altitude and RADAR to assess its influence above its flight altitude. Continuous acoustic recordings from ground level to ~400 m above‐ground‐level were used to monitor bat activity in the research site. We recorded the nightly altitudinal distributions of multiple bat species throughout the experiment. Analysis revealed a significant change in activity while the deterrent was flying compared to baseline conditions. We also recorded a significant ~40% decrease below and a significant ~50% increase above the deterrent's flight altitude during its operation compared to the post‐flight control. The tested technology is independent of wind farm activities and does not require modifying wind turbine form or operation procedures. The device differs from previously proposed solutions by being dynamic – moving in the airspace and emitting constantly changing signals – thus decreasing the probability of animal habituation. Our findings suggest that the deterrent could dramatically decrease wind turbine‐related mortality by deterring bats from approaching rotor‐swept airspace. Focused implementation in conditions where bat activity and energy production are in conflict may provide a practical, cost‐effective mortality mitigation solution compared to current alternatives. Thus, our results should be considered by the wind‐turbine industry and environmental monitoring and animal conservation organizations, as well as by regulatory agencies, when pursuing alleviation of wind turbine‐related mortality.

Abstract Background Individuals with a Prior Cancer History (PCH) are often excluded from clinical trials. However, a growing body of evidence suggests that prior cancer history does not present adverse outcomes on cancer patients. The evidence on the survival of brain cancer patients in this regard remains widely unknown. Methods We conducted a retrospective cohort study to estimate the prevalence and impact of prior cancer on survival of patients diagnosed with brain cancer. Data of patients who were diagnosed with brain cancer as their first or second primary malignancy between 2000 and 2019 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity Score Matching (PSM) was used to ensure comparable baseline characteristics among the patients. Survival analysis was conducted using the Kaplan–Meier method, as well as multivariate Cox proportional hazard and multivariate competing risk models. Results Out of 42 726 patients, 1189 (2.78%) had PCH. Genitourinary (40.4%), Breast (13.6%), Hematologic and Lymphatic (11.4%), and Gastrointestinal malignancies (11.3%) were the most common types of prior cancer. PCH served as a significant risk factor for Overall Survival (OS) (Adjusted Hazard Ratio [AHR] 1.26; 95% CI [1.15–1.39]; p

This study is aimed at developing alginate hydrogel filaments enriched with TEMPO (2,2,6,6-tetramethylpiperidine-1-oxyl radical)–oxidized cellulose nanofibers (TOCNs) through 3D-printing techniques for application in bone tissue engineering. The filaments were designed to act as advanced biomaterials that support bone regeneration by combining alginate dissolved in phosphate ions with TOCNs, followed by extrusion into a calcium chloride solution. This process facilitated the cross-linking of alginate and in situ mineralization of calcium phosphate. The produced hydrogel filaments were characterized using a variety of techniques, including scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), and thermogravimetric analysis (TGA). Additionally, in situ biomineralization tests confirmed the successful formation of apatite. Mechanical testing revealed a significant increase in tensile strength, ranging from 40 to 80 MPa, which underscores the improved structural integrity of the hydrogels. Rheological assessments demonstrated that the addition of TOCNs enhanced the viscoelastic properties of the filaments, making them more suitable for 3D-printing applications. Cytotoxicity tests further confirmed the biocompatibility of the scaffolds, showing enhanced cell proliferation. These results suggest that incorporating TOCNs into alginate hydrogels offers a promising approach to developing functional biomaterials in tissue engineering, particularly for bone regeneration applications.

Objective. The chemokine “Fractalkine” (CX3CL1) and its corresponding receptor (CX3CR1), chemokine belonging to the CX3C family, have an essential role in developing several systemic inflammatory disorders. Accordingly, the proliferation, adhesion, and migration of inflammatory cells are all affected by it. In light of this, the present study attempts to address the following questions: (1) Is the salivary level of fractalkine and its receptor associated with periodontitis patients with different severities? (2) Is it possible to distinguish periodontitis from periodontally healthy subjects? Methods. This study included 30 individuals who had been considered controls, having healthy periodontium, and 90 patients with varying stages of periodontitis. The patients were equally divided into three groups: those with Stage I, Stage II, and Stage III. After each subject’s saliva was collected, periodontal markers including bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment loss (CAL) were recorded. Enzyme-linked immunosorbent assays (ELISA) were used to detect the protein levels of salivary CX3CL1 and CX3CR1. Results. In comparison to the control group, patients with periodontitis had statistically increased salivary concentrations of CX3CL1 and CX3CR1 (P

Background. Childhood cancer affects families and friends and causes lifestyle changes that become overwhelming for them. Childhood cancer may cause decreased physical, emotional, and social health-related quality of life (QOL). Childhood cancer may cause strain on the financial status of the family and shape their coping strategy to the disease. The extent of the impact of childhood cancer on families is associated with several demographic characteristics of the family such as diagnosis, phase of treatment, and parent’s educational level, employment, and marital status of the parents. Objectives. The objective of this study was to explore the impact of childhood cancer on family functioning and family quality of life (QOL) in the Western Region of Saudi Arabia. Methods. This study was a quantitative, randomized, cross-sectional study. 187 participants were randomly selected from the population of parents whose children have cancer and treated at Princess Noorah Oncology Center in King Abdulaziz Medical City, Jeddah. A survey was used to collect data for this study. Healthcare and social systems may have to consider the impact of childhood cancer in the care plans of the patients. Result. Leukemia represents the highest disease prevalence followed by brain tumor. The highest score of the impact on the family survey was familial social concerns domains followed by financial burden with mean scores of 3.59 (98.8%) and 3.56 (98.0%), respectively. Then, mastery domain mean score is 3.43 (85.8%) and finally personal strain with mean score of 3.21 (980.3%). The QOL of the family results indicated that the highest was physical/material well-being with mean score of 3.84 (76.8%) and family interaction with mean score of 3.82 (76.4%), followed by emotional well-being with mean score of 3.54 (70.8%) and parenting with mean score of 3.53 (70.6.%). Significant differences were found between the overall scales of QOL and the scale of impact on the family and some demographic characteristics of children and their parents. Conclusions. Childhood cancer has a substantial effect on family functioning and the family’s QOL. In addition, both were significantly associated with some demographic characteristics of the child and his parents.

Abstract Objective This study was intended to research the sensitivity of the Charlson Comorbidity Index (CCI), COVID‐GRAM, and MuLBSTA risk scores for hospital length of stay (LOS) and mortality in older patients hospitalized with coronavirus disease 2019 (COVID‐19). Methods A total of 217 patients (119 women) were included in the study. The first clinical signs, comorbidities, laboratory and radiology findings, and hospital LOS were recorded for each patient. The CCI, COVID‐GRAM, and MuLBSTA risk scores were calculated, and their sensitivities for hospital LOS and mortality were evaluated using receiver operating characteristic (ROC) curve analysis. Results Of the hospitalized patients, 59 (27.2%) were followed in the intensive care unit, and mortality developed in 44 (20.3%). The CCI positively correlated with COVID‐GRAM and MuLBSTA scores (P

Abstract Background During the last decade, leadless pacemakers (LPMs) have turned into a prevalent alternative to traditional transvenous (TV) pacemakers; however, there is no consolidated data on LPM implantation in emergencies. Methods Digital databases were searched for this review and four relevant studies, including 1276 patients were included in this review with procedure duration, fluoroscopic time, major complications, and mortality as primary outcomes and pacing threshold, impedance, sensing of LPM, and hospital stay as secondary outcomes. Results Gonzales et al. and Marschall et al. showed the duration of the procedure to be 180 ± 45 versus 324.6 ± 92 and 39.9 ± 8.7 versus 54.9 ± 9.8, respectively. Zhang et al. demonstrated the duration of the procedure and fluoroscopy time to be 36 ± 13.4 and 11.1 ± 3.1, respectively. Similarly, Schiavone et al. exhibited intermediate times of implantation at 60 (45–80) versus 50 (40–65) and fluoroscopic times at 6.5 (5–9.7) versus 5.1 (3.1–9). Hospital stay was more with a temp‐perm pacemaker as compared to LPM and pacing parameters were not significantly different in all the studies. Conclusion For underlying arrhythmias, whenever appropriate, our review shows that LPMs may be a better option than temporary pacemakers, even as an urgent treatment.

Introduction The mantra ‘time is brain’ cannot be overstated for patients suffering from acute ischemic stroke. This is especially true for those with large vessel occlusions (LVO) requiring transfer to an endovascular thrombectomy (EVT) capable center. We sought to evaluate the spoke hospital door in‐door out (DIDO) times for patients transferred to our hub center for EVT. Methods Individuals who first presented with LVO to a spoke hospital and were then transferred to the hub for EVT were retrospectively identified from a prospectively maintained database from January 2019 to November 2022. DIDO was defined as the time between spoke hospital door in arrival and door out exit. Baseline characteristics, treatments, and outcomes were compared, dichotomizing DIDO at 90 min based in the American Heart Association goal for DIDO ≤90 min for 50% of transfers. Multivariable regression analyses were performed for determinants of 90‐day ordinal modified Ranking Scale (mRS) and DIDO. Results We identified 194 patients transferred for EVT with available DIDO. The median age was 67 (IQR 57‐80), and 46% were female. The median NIHSS was 16 (10‐20), 50% were treated with intravenous thrombolysis at a spoke, and TICI 2B‐3 reperfusion was achieved in 87% at the hub. The median DIDO was 120 min (97‐149), with DIDO ≤90 min achieved in 18%. DIDO was a significant determinant of 90‐day ordinal mRS (B=0.007, 95%CI=0.001‐0.012, p=0.013), even when accounting for last known well‐to‐spoke door in, spoke door out‐to‐hub arrival, hub arrival‐to‐puncture, puncture‐to‐first pass, age, NIHSS, intravenous thrombolysis, TICI 2B‐3, and symptomatic intracranial hemorrhage. Importantly, determinants of DIDO included Black race or Hispanic ethnicity (B=0.918, 95%CI=0.010‐1.826, p=0.048), atrial fibrillation or heart failure (B=0.793, 95%CI=0.257‐1.329, p=0.004), and basilar LVO location (B=2.528, 95%CI=1.154‐3.901, p

Introduction Coma is an unresponsive state of disordered consciousness characterized by impaired arousal and awareness. The epidemiology and pathophysiology of coma in ischemic stroke has been underexplored. We sought to characterize the incidence and clinical features of coma as a presentation of large vessel occlusion (LVO) stroke. Methods Individuals who presented with LVO were retrospectively identified from July 2018 to December 2020. Coma was defined as an unresponsive state of impaired arousal and awareness, operationalized as a score of 3 on NIH Stroke Scale (NIHSS) item 1a. Results A total of 28/637 (4.4%) patients with LVO stroke were identified as presenting with coma. The median NIHSS was 32 (IQR 29‐34) for those with coma versus 11 (5‐18) for those without (p

Introduction 18‐36% of all intracranial aneurysms are middle cerebral artery(MCA) bifurcation aneurysms. While some are much higher risk than others, they have an overall low estimated annual rupture rate of 0.36%.(1) MCA bifurcation aneurysms have been historically challenging to treat endovascularly given they often have complex morphology and wide necks. The Woven EndoBridge (WEB) is an ellipsoid embolization device designed to provide intrasaccular flow disruption along the aneurysm neck, which has been proven to be an effective method in treating a wide spectrum of wide‐necked bifurcation aneurysms. Thromboembolism and recanalization are the main concerns in treatment with the WEB device, like any aneurysm treatment approach .(2),(3) Occasionally, irregularities and secondary lobules at the base of the primary aneurysm can have persistent filling despite treatment. Methods We present a case of a right MCA bifurcation aneurysm treated by a WEB device and coil embolization. Results 48‐year‐old female with a medical history significant only for active smoking who presented with sudden onset of the worst headache of her life followed by brief loss of consciousness. No neurological evaluation was sought initially, until 2 weeks later as she continued to experience a moderate‐intensity headache associated with nausea and vomiting with frequent falls. On exam, she was alert and oriented, moving all extremities with full strength. CT head revealed an evolving acute to subacute right MCA infarction with adjacent small volume subarachnoid hemorrhage. CTA head revealed a right MCA bifurcation aneurysm measuring 6 x 6 x 7 mm with irregularity of the wall. Multifocal severe stenosis was noted in the right distal right M1 and right M2 divisions. She underwent a diagnostic subtraction angiography which confirmed an irregular right MCA bifurcation aneurysm measuring 4.3 x 4.5 x 5.7 mm (Figure 1 ‐A,B). While it was believed that the subarachnoid hemorrhage was more likely related to the recent infarct, a decision was made to treat the aneurysm given its relatively large size and irregular shape. Embolization was performed with a WEB SL 6 x 4 mm device (Figure 1: C,D ‐blue arrow). Post‐deployment angiograph showed occlusion of the aneurysm dome but persistent filling of the secondary lobule near the base of the aneurysm. Given this residual lobule filling, a decision was made to continue additional embolization with a hyper soft 3D 2 mm X 2 cm coil(Figure 1: C,D ‐ yellow arrow). Final angiography revealed complete occlusion of the aneurysm. Vasospasm of the distal M2 divisions and multiple M3 branches in the right MCA vascular territory was also noted. Therefore, she was treated with 20 mg of intra‐arterial Verapamil with improvement. She was started on Aspirin 325 mg daily. Daily transcranial dopplers were negative for vasospasm. She remained neurologically stable and was discharged home 5 days after admission ambulating independently. Conclusion With modern advances in endovascular devices, many MCA bifurcation aneurysms can be treated minimally invasively. However, there are some limitations to the WEB since every aneurysm is different and there are a finite number of sizes and shapes available for WEB. This case illustrates that adjunctive coil embolization can successfully occlude a residual secondary base lobule after WEB embolization.

Abstract Essential tremor (ET) is a common disease in the elderly population. Severe, medication‐refractory ET may require surgical intervention via ablation or deep brain stimulation (DBS). Thalamic Vim (Ventral intermediate nucleus), targeted indirectly using atlas‐based coordinates, is the classical target in these procedures. We present a case of an ET patient with a non‐MR‐compatible cardiac orphaned leads who was a candidate for DBS surgery. Due to the lead constraints of MR use, we used a head computed tomography (CT) with contrast media as the reference exam to define the AC, PC, and midline, and to register and indirectly target the Vim. For target validation, we used intraoperative electrophysiological recordings and intraoperative CT. We implanted bilateral directional leads at the target location. We used the‐essential‐tremor‐rating‐assessment‐scale (TETRAS) pre and postoperatively to clinically evaluate tremor. Intraoperative micro‐electrode recordings (MERs) showed individual tremor cells and a robust increase in normalized root mean square (NRMS) indicating entry to the Vim. Postoperative visualization using lead‐DBS along with dramatic clinical improvements show that we were able to accurately target the Vim. Our results show that CT‐only registration and planning for thalamic Vim DBS is feasible, and that MERs and intraoperative CT are useful adjuncts for Vim target validation.

Abstract Seed dispersal is a critical phase in plant reproduction and forest regeneration. In many systems, the vast majority of woody species rely on seed dispersal by fruit‐eating animals. Animals differ in their size, movement patterns, seed handling, gut physiology, and many other factors that affect the number of seeds they disperse, the quality of treatment each individual seed receives, and consequently their relative contribution to plant fitness. The seed dispersal effectiveness framework (SDE) was developed to allow systematic and standardized quantification of these processes, offering a potential for understanding the large‐scale dynamics of animal–plant interactions and the ecological and evolutionary consequences of animal behavior for plant reproductive success. Yet, despite its wide acceptance, the SDE framework has primarily been employed descriptively, almost always in the context of local systems. As such, the drivers of variation in SDE across systems and the relationship between its components remain unknown. We systematically searched studies that quantified endozoochorous SDE for multiple animal species dispersing one or more plant species in a given system and offered an integrative examination of the factors driving variation in SDE. Specifically, we addressed three main questions: (a) Is there a tradeoff between high dispersal quality and quantity? (b) Does animal body mass affect SDE or its main components? and (c) What drives more variation in SDE, seed dispersal quality, or quantity? We found that: (a) the relationship between quality and quantity is mediated by body size; (b) this is the result of differential relationships between body mass and the two components, while total SDE is unaffected by body mass; (c)neither quality nor quantity explain more variance in SDE globally. Our results also highlight the need for more standardized data to assess large‐scale patterns in SDE.