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Neutron sources are utilized for different aims, such as studying the material’s internal structure, investigating the materials’ crystal structures, and neutron therapy. Using more than one isotopic neutron source in some aims could be beneficial. Herein, a neutron irradiator consisting of two 241Am-9Be neutron sources has been designed. Radiation characterizations, including the neutron fluence and dose rate, were investigated. The Monte Carlo simulation code Monte Carlo N-particle transport code version 5 (MCNP5) was used to conduct all the required investigations to achieve an optimal design. Two factors were considered; the first was the dose rate due to both neutron and gamma radiations to meet radiation protection requirements; MCNP5 was used to determine the adequate thickness of the shielding material. The second parameter is the neutron fluence. Two irradiation sites have been proposed, one for fast neutron irradiation and the other for thermal neutron irradiation. By utilizing MCNP5, we have determined the radiation characterization at the two sites to be used as the irradiation sites. After the optimal design had been produced, the thermal and the epithermal neutron fluences inside the two irradiation sites were determined experimentally. The experimental results showed a perfect agreement with the simulation ones. The neutron irradiator designed from merged two isotopic neutron sources could be a benefit in the neutron radiation applications in the labs.

Purpose: To systematically review in vitro studies that incorporated MMP inhibitors into adhesive systems in terms of the effect on immediate and aged bond strength of dental composite to dentine. Materials and methods: Independently, two reviewers conducted an electronic search in three databases (MEDLINE, EMBASE, and Google Scholar) following the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P), up to 6 March 2022. Results: The search resulted in 894 papers, 33 of which were eligible to be included in the review; of those, 13 fulfilled the meta-analysis eligibility criteria. Nineteen inhibitors were used among the studies, and those included in the meta-analysis were 2%, 0.2% chlorhexidine (CHX), 5 µM GM1489, and 0.5%, 1% benzalkonium chloride (BAC). In the meta-analysis, while above inhibitors showed no adverse effect on bond strength, 0.2% CHX and 5 µM GM1489 caused a significant increase in immediate and 12-months bond strength. All other inhibitors resulted in a significant increase in bond strength at six months of ageing. Conclusions: Incorporation of MMP inhibitors into the adhesive system has no unfavourable effect on immediate bond strength but a favourable effect on longer-term bond strength. Additionally, inhibitors other than CHX could have similar or better effects on bond strength.

With the phase-out of amalgam and the increase in minimally invasive dentistry, there is a growing need for high-strength composite materials that can kill residual bacteria and promote tooth remineralization. This study quantifies how antibacterial polylysine (PLS) and re-mineralizing monocalcium phosphate monohydrate (MCPM) affect Streptococcus mutans biofilms and the strength of dental composites. For antibacterial studies, the MCPM-PLS filler percentages were 0-0, 8-4, 12-6, and 16-8 wt% of the composite filler phase. Composite discs were immersed in 0.1% sucrose-supplemented broth containing Streptococcus mutans (UA159) and incubated in an anaerobic chamber for 48 h. Surface biomass was determined by crystal violet (CV) staining. Growth medium pH was measured at 24 and 48 h. Biofilm bacterial viability (CFU), exo-polysaccharide (water-soluble glucan (WSG) and water-insoluble glucan (WIG)), and extracellular DNA (eDNA) were quantified. This was by serial dilution plate counting, phenol-sulfuric acid microassay, and fluorometry, respectively. The biaxial flexural strengths were determined after water immersion for 1 week, 1 month, and 1 year. The MCPM-PLS wt% were 8-4, 8-8, 16-4 and 16-8. The normalized biomass, WSG, and WIG showed a linear decline of 66%, 64%, and 55%, respectively, as the PLS level increased up to 8%. The surrounding media pH (4.6) was all similar. A decrease in bacterial numbers with the 12-6 formula and a significant reduction with 16-8 compared to the 0-0 formulation was observed. The eDNA concentrations in biofilms formed on 12-6 and 16-8 formulations were significantly less than the 0-0 control and 8-4 formulations. Doubling MCPM and PLS caused a 14 and 19% reduction in strength in 1 week, respectively. Average results were lower at 1 month and 1 year but affected less upon doubling MCPM and PLS levels. Moreover, a 4% PLS may help to reduce total biomass and glucan levels in biofilms on the above composites. Higher levels are required to reduce eDNA and provide bactericidal action, but these can decrease early strength.

Continuing cariogenic bacterial growth demineralizing dentine beneath a composite filling is the most common cause of tooth restoration failure. Novel composites with antibacterial polylysine (PLS) (0, 4, 6, or 8 wt%) in its filler phase were therefore produced. Remineralising monocalcium phosphate was also included at double the PLS weight. Antibacterial studies involved set composite disc placement in 1% sucrose-supplemented broth containing Streptococcus mutans (UA159). Relative surface bacterial biofilm mass (n = 4) after 24 h was determined by crystal violet-binding. Live/dead bacteria and biofilm thickness (n = 3) were assessed using confocal laser scanning microscopy (CLSM). To understand results and model possible in vivo benefits, cumulative PLS release from discs into water (n = 3) was determined by a ninhydrin assay. Results showed biofilm mass and thickness decreased linearly by 28% and 33%, respectively, upon increasing PLS from 0% to 8%. With 4, 6, and 8 wt% PLS, respectively, biofilm dead bacterial percentages and PLS release at 24 h were 20%, 60%, and 80% and 85, 163, and 241 μg/disc. Furthermore, initial PLS release was proportional to the square root of time and levelled after 1, 2, and 3 months at 13%, 28%, and 42%. This suggested diffusion controlled release from water-exposed composite surface layers of 65, 140, and 210 μm thickness, respectively. In conclusion, increasing PLS release initially in any gaps under the restoration to kill residual bacteria or longer-term following composite/tooth interface damage might help prevent recurrent caries.

With the phase-out of amalgam and the increase in minimally invasive dentistry, there is a growing need for high-strength composite materials that can kill residual bacteria and promote tooth remineralization. This study quantifies how antibacterial polylysine (PLS) and re-mineralizing monocalcium phosphate monohydrate (MCPM) affect Streptococcus mutans biofilms and the strength of dental composites. For antibacterial studies, the MCPM-PLS filler percentages were 0-0, 8-4, 12-6, and 16-8 wt% of the composite filler phase. Composite discs were immersed in 0.1% sucrose-supplemented broth containing Streptococcus mutans (UA159) and incubated in an anaerobic chamber for 48 h. Surface biomass was determined by crystal violet (CV) staining. Growth medium pH was measured at 24 and 48 h. Biofilm bacterial viability (CFU), exo-polysaccharide (water-soluble glucan (WSG) and water-insoluble glucan (WIG)), and extracellular DNA (eDNA) were quantified. This was by serial dilution plate counting, phenol-sulfuric acid microassay, and fluorometry, respectively. The biaxial flexural strengths were determined after water immersion for 1 week, 1 month, and 1 year. The MCPM-PLS wt% were 8-4, 8-8, 16-4 and 16-8. The normalized biomass, WSG, and WIG showed a linear decline of 66%, 64%, and 55%, respectively, as the PLS level increased up to 8%. The surrounding media pH (4.6) was all similar. A decrease in bacterial numbers with the 12-6 formula and a significant reduction with 16-8 compared to the 0-0 formulation was observed. The eDNA concentrations in biofilms formed on 12-6 and 16-8 formulations were significantly less than the 0-0 control and 8-4 formulations. Doubling MCPM and PLS caused a 14 and 19% reduction in strength in 1 week, respectively. Average results were lower at 1 month and 1 year but affected less upon doubling MCPM and PLS levels. Moreover, a 4% PLS may help to reduce total biomass and glucan levels in biofilms on the above composites. Higher levels are required to reduce eDNA and provide bactericidal action, but these can decrease early strength. [ABSTRACT FROM AUTHOR]

Abstract Background The transfusion strategy in the acute phase of myocardial infarction (AMI) remains a debated topic with non-standardized guidelines. This study aimed to evaluate the impact of liberal versus restrictive transfusion strategies on mortality during AMI. Methods A systematic search was conducted across MEDLINE, EMBASE, and the COCHRANE library databases, focusing on randomized controlled trials (RCTs). The primary endpoint was the latest measured mortality within 90 days following myocardial infarction (MI). Secondary endpoints included recurrence of MI, cardiovascular mortality, stroke occurrence, unplanned revascularization, and a composite endpoint of death or recurrent MI. Mixed and random-effects models were employed to estimate relative risks. Sensitivity analyses were conducted using two approaches: one incorporating only studies assessed as low risk of bias according to the Rob2 tool, and another employing a Bayesian analysis. Results Four RCTs including a total of 4324 participants were analyzed. Neither the fixed-effect nor random-effects models demonstrated a significant reduction in mortality, with risk ratios (RR) of 1.16 (95% CI 0.95–1.40) for the fixed-effect model and 1.13 (95% CI 0.67–1.91) for the random-effects model (GRADE: low certainty of evidence). Sensitivity analyses, including the exclusion of two high-risk-of-bias studies and a Bayesian analysis, were consistent with the primary analysis. For the composite outcome death or MI both fixed-effect and random-effects models showed a statistically significant RR of 1.18 (95% CI 1.01–1.37) with negligible heterogeneity (I2 = 0%, p = 0.46), indicating results unfavorable to restrictive transfusion (GRADE: very low certainty of evidence). However, this result was primarily driven by a single study. For cardiac mortality, the fixed-effects model indicated a significant RR of 1.42 (95% CI 1.07–1.88), whereas the random-effects model showed non-significant RR of 1.05 (95% CI 0.36–3.80). Analyses of other secondary endpoints did not show statistically significant results. Conclusions Our analysis did not demonstrate a significant benefit in early mortality with a liberal transfusion strategy compared to a restrictive strategy for AMI, low certainty of evidence. Liberal transfusion may reduce the risk of the composite outcome death or MI, with very low certainty of evidence. These findings should be interpreted with caution in critically ill patients.

Bone healing occurs through three consecutive and interdependent phases. While the acute inflammatory response is vital to fracture healing, chronic and systemic inflammation negatively affect the healing process. The bone tissue relies heavily on the immune system for its normal physiology and turnover. The interactions are more pronounced in injury states, such as fractures and autoimmune disorders. Recently, the field of osteoimmunology, the study of the molecular interplay of the immune and skeletal systems, has gained much-needed attention to develop new therapeutic strategies to accelerate fracture healing and prevent the complications of fracture healing. This review provides an overview of the process of fracture healing and discusses the role of immune cells, their interplay with the released cytokines, and the current state of the art in the field of osteoimmunology.

Introduction Continuous renal replacement therapy (CRRT) is a critical therapeutic intervention for patients with severe acute kidney injury in intensive care. However, premature filter clotting remains a significant challenge during CRRT, impacting treatment efficacy, costs and patient outcomes. Anticoagulation is essential to maintain circuit patency, with regional citrate anticoagulation (RCA) emerging as a preferred strategy due to its favourable bleeding profile. The standard target for post-filter ionised calcium (iCa) concentration during RCA-CRRT is set between 0.25 and 0.35 mmol/L, although evidence supporting this range is limited. We hypothesise that a higher post-filter iCa target (0.35–0.45 mmol/L) can provide comparable circuit patency while potentially reducing adverse effects associated with citrate administration.Methods and analysis This multicentre randomised controlled non-inferiority trial will compare a low post-filter iCa target (0.25–0.35 mmol/L) with a higher post-filter iCa target (0.35–0.45 mmol/L) in patients undergoing RCA-CRRT in the intensive care unit. A total of 412 CRRT sessions will be randomised with a 1:1 ratio into these two groups. The primary outcome is the incidence of filter clotting. Secondary outcomes include filter lifespan, post-filter iCa levels, citrate infusion rates, the occurrence of metabolic adverse effects, financial costs and blood loss.Ethics and dissemination The study has obtained approval from the ethics committee (Ethics Committee Est III, Nancy, France) and patients will be included after providing informed consent. The results will be disseminated at academic conferences and in peer-reviewed publications. All procedures were developed in order to assure data protection and confidentiality.Trial registration number NCT05814341.

Abstract Iron is an essential nutrient and a constituent of ferroproteins and enzymes crucial for human life. Generally, nonmenstruating individuals preserve iron very efficiently, losing less than 0.1% of their body iron content each day, an amount that is replaced through dietary iron absorption. Most of the iron is in the hemoglobin (Hb) of red blood cells (RBCs); thus, blood loss is the most common cause of acute iron depletion and anemia worldwide, and reduced hemoglobin synthesis and anemia are the most common consequences of low plasma iron concentrations. The term iron deficiency (ID) refers to the reduction of total body iron stores due to impaired nutrition, reduced absorption secondary to gastrointestinal conditions, increased blood loss, and increased needs as in pregnancy. Iron deficiency anemia (IDA) is defined as low Hb or hematocrit associated with microcytic and hypochromic erythrocytes and low RBC count due to iron deficiency. IDA most commonly affects women of reproductive age, the developing fetus, children, patients with chronic and inflammatory diseases, and the elderly. IDA is the most frequent hematological disorder in children, with an incidence in industrialized countries of 20.1% between 0 and 4 years of age and 5.9% between 5 and 14 years (39% and 48.1% in developing countries). The diagnosis, management, and treatment of patients with ID and IDA change depending on age and gender and during pregnancy. We herein summarize what is known about the diagnosis, treatment, and prevention of ID and IDA and formulate a specific set of recommendations on this topic.

Running cadence is crucial in running biomechanics and physiology, impacting performance and injury risk. The relationship between running cadence, height, weight, and gender is explored using data from 29 participants (14 males, 15 females) with varying attributes. Taller individuals tend to have a lower cadence due to longer stride length, while fewer steps are required by heavier individuals at the same pace. A higher cadence is observed in males, possibly due to differences in leg length and muscle fiber composition, although considerable variability exists among individuals of both genders. Linear regression analysis revealed robust models for both genders, with negative correlations between cadence and height, indicating that increased cadence correlates with decreased height for males and females. Females typically have higher BMI than males, with BMI variability in the population. Weight influences running cadence by affecting ground force. Heavier individuals may take fewer steps, but risk increased strain on joints and muscles, raising injury risk. Furthermore, the connection between running cadence and injury risk is investigated. It is found that adjusting cadence significantly reduces stress on weight-bearing joints and prevents common overuse running injuries. It is demonstrated by several reputable studies in the field that even minor cadence increases greatly reduce stress on knee and hip joints during running, making it a commendable method for injury prevention. In conclusion, while height and weight impact running cadence, each person's cadence is unique and influenced by various factors beyond gender alone. Understanding the relationship between running cadence and its impact on injury prevention is crucial for runners seeking to improve performance and avoid injuries.

Objectives The aim of this study is a descriptive presentation of cases of acute watery diarrhoea (AWD) that were presented to Aleppo University Hospital (AUH) during the recent cholera outbreak in Syria.Design Prospective, observational, cohort study.Setting and participants A total of 1061 patients with AWD were admitted to AUH during the timeframe of 20 September 2022 to 20 October 2022. The data collection was done through a structured questionnaire. This includes comprehensive clinical observation, laboratory analyses, therapeutic interventions and holistic case evaluations.Results The analysis has revealed notable insights: a predominant proportion of patients (58.6%) were residents from urban areas and 40.3% were residents from rural areas. Intriguingly, a diverse range of potential infection sources emerged from patient data within our hospital, including uncontrolled well water, vegetables and faecal-oral transmission through contaminated street/fast food. At discharge, most patients were in good health (79.7%), followed by moderate health (17.6%) and poor health (2.3%), with a minimal percentage dying before discharge (0.4%). The most common complications reported at admission and during hospitalisation included electrolyte imbalance (28.2%), followed by severe dehydration (16.3%). In the follow-up period, the majority of patients exhibited good health (81.0%). Older patients (>60 years) had poorer outcomes, with 8.4% having poor health and 4.2% death rate.Conclusions The study found results consistent with previous AWD outbreaks in developing countries like Yemen, Nigeria and Lebanon. Preventative measures like improving water sanitation and hygiene practices are essential to prevent future outbreaks and ease the strain on healthcare systems. Therefore, future studies must investigate the risk factors that increase the spread and the severity of the disease and investigate the best management method.

Several studies have investigated muscle rigidity using SWE. However, the assessments may not consider the most affected regions within the same muscle tissue nor the intramuscular variability of rigidity between muscles of the same muscle group, e.g., plantar flexors. The data presented in this article aimed to explore the inter–and intramuscular variability of plantar flexors stiffness during prone and standing positions at different muscle lengths in healthy and paretic individuals. Shear wave ultrasound images were acquired for the three plantar flexor muscles (gastrocnemius medialis [GM], gastrocnemius lateralis [GL], and soleus [SOL]) in two positions: prone and standing. The imaging was conducted at various dorsiflexion angles (0°, 10°, and 20°), and measurements were taken at different proximo-distal regions within each muscle. This data set allowed us to highlight the impact of stroke on mechanical properties that varies depending on whether ankle muscles are in an active or passive state during dorsiflexion. Additionally, the modification of the ankle muscle state influences the distribution of stiffness both within and between the plantar flexors.

Abstract Electrostatic microelectromechanical (MEMS) switches are the basic building blocks for various radio-frequency (RF) transceivers. However, conventional cantilever-based designs of MEMS switches require a large actuation voltage, exhibit limited RF performance, and suffer from many performance tradeoffs due to their flat geometries restricted in two dimensions (2D). Here, by leveraging the residual stress in thin films, we report a novel development of three-dimensional (3D) wavy microstructures, which offer the potential to serve as high-performance RF switches. Relying on standard IC-compatible metallic materials, we devise a simple fabrication process to repeatedly manufacture out-of-plane wavy beams with controllable bending profiles and yields reaching 100%. We then demonstrate the utility of such metallic wavy beams as RF switches achieving both extremely low actuation voltage and improved RF performance owing to their unique geometry, which is tunable in three dimensions and exceeds the capabilities of current state-of-the-art flat-cantilever switches with 2D-restricted topology. As such, the wavy cantilever switch presented in this work actuates at voltages as low as 24 V while simultaneously exhibiting RF isolation and insertion loss of 20 dB and 0.75 dB, respectively, for frequencies up to 40 GHz. Wavy switch designs with 3D geometries break through the design limits set by traditional flat cantilevers and provide an additional degree of freedom or control knob in the switch design process, which could enable further optimization of switching networks used in current 5G and upcoming 6G communication scenarios.

BackgroundHospital discharge is often associated with a lack of continuity resulting in fragmented care, particularly in low-income countries. As there is limited information about interventions in these countries and no study evaluating the effectiveness of hospital discharge interventions, we conducted a scoping review to identify effective hospital-to-home transitional care interventions and explore their applicability in a low-income country (Sudan).MethodsOur scoping review of systematic reviews and meta-analyses classed interventions as effective, ineffective, undesirable, or uncertain, based on the quality of their evidence and their estimated effects on the following outcomes: readmission rates, mortality, costs, quality of life, and adverse outcomes) and certainty of evidence. Our authors from Sudan used the SUPPORT summary tool to determine if three effective interventions could be implemented in Sudan.ResultsOut of 3,276 articles that were identified, and 72 articles were reviewed, 10 articles has been included in the review. Seven interventions were classified as effective, one as ineffective, and none with undesirable effects. Eight interventions were classified as having an uncertain effect. The effective interventions were composed of home visits, information and communication technology (ICT), case manager models, multidisciplinary teams, and self-management support.ConclusionsThe finding of this study suggested that a combining two to four interventions can improve enhance hospital-to-home transitional care. Effective interventions are composed of home visits, ICT, case manager models, multidisciplinary teams, and self-management support. The implementation of these interventions in Sudan was found to be undermined by contextual factors such as inadequate human resources, telecommunication instability, and inequality in accessibility. These interventions could be tailored based on an in-depth understanding of the contextual factors in low-income countries that influence implementation.Systematic Review Registrationhttps://osf.io/9eqvr/, doi: 10.17605/OSF.IO/9EQVR

Background: Breast cancer susceptibility genes such as BRCA1, BRCA2, PALB2, CHEK2 and many others are increasingly recognized among our patient population. In addition to their impact on treatment decisions of tested patients themselves, identifying at-risk family members offer opportunities for cancer preventive measures.Methods: This is an observational cross-sectional study of adult breast cancer patients with positive breast-cancer-susceptibility germline variants who received treatment at our institution. Patients with variants of uncertain significance (VUS), or who refused to give consent, were excluded. The data was collected from an eligible sample of breast cancer patients using a structured questionnaire developed by the study team and tested for validity and reliability, as well as a clinical chart review form. Patients were invited to participate in the study during their scheduled oncology clinics visit.Results: 169 patients were enrolled, including 42 (24.9%) with pathogenic/likely pathogenic (P/LP) BRCA1 variants, 84 (49.7%) with BRCA2 and 43 (25.4%) with non-BRCA variants. All patients were female and the mean age was 45 ± 9.9 years. Among 140 eligible patients, 104 (74.3%) underwent prophylactic mastectomy, while 79 (59.0%) of 134 eligible patients had prophylactic bilateral salpingo-oophorectomy (BSO). Results were communicated with family members by majority (n = 160, 94.7%), including 642 first degree female relatives, and 286 (44.5%) of them have taken no action. Fear of positive test results, cost of testing, unwillingness to undergo preventive measures, and social stigma were cited as barriers to genetic testing in 54%, 50%, 34% and 15%, respectively.Conclusion: Risk-reducing interventions including mastectomy and BSO were carried by majority of patients with P/LP variants. However, though the rate of communication of genetic testing results with family members was high, proper preventive measures were relatively low. Cost and fear of cancer diagnosis, were the leading causes that prevented cascade testing in our cohort.

Beta thalassemia is an inherited disorder resulting in abnormal or decreased production of hemoglobin, leading to hemolysis and chronic anemia. The long-term complications can affect multiple organ systems, namely the liver, heart, and endocrine. Myocardial iron overload is a common finding in β-thalassemia. As a result, different cardiovascular complications in the form of cardiomyopathy, pulmonary hypertension, arrhythmias, and vasculopathies can occur, and in extreme cases, sudden cardiac death. Each of these complications pertains to underlying etiologies and risk factors, which highlights the importance of early diagnosis and prevention. In this review, we will discuss different types of cardiovascular complications that can manifest in patients with β-thalassemia, in addition to the current diagnostic modalities, preventive and treatment modalities for these complications.

Background: An increase in the number of visitors to the emergency department (ED) leads to overcrowding, long wait, and patient dissatisfaction. It is important to implement the decision-making process to avoid congestion and nonurgent cases. This study aims to assess patients' knowledge and attitude about the triage system and waiting times in ED. Methods: This was a cross-sectional study conducted at the ED at Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia. Data were collected using an online questionnaire form for all participants who met the inclusion criteria. Results: In this study, 389 participants with mean age of 33.77 (SD =12.96) years were included, of them 54.2% were males. Moreover, only 15.2% of patients reported having primary care doctor or health providers among whom 41.9% reported that they tried to call their primary care doctor before coming to the ED. Moreover, 66.2% of participants reported having no knowledge about triage. Furthermore, 57% of participants wanted to know how long other patients have been waiting. Moreover, results showed that the most important information required by the patients was the periodic updates from ED staff about the delays (51.4%) followed by information about the health care system and how to find a primary care provider. Conclusion: Most of the population were unaware of the triage and its definition; however, most of the participants had good knowledge considering why some patients were seen before others. Finally, the waiting expectation of tests results was worse in this study, which reflected low satisfaction level. [SJEMed 2022; 3(2.000): 130-137]

JAK2V617F mutation is associated with an increased risk for athero-thrombotic cardiovascular disease, but its role in aortic disease development remains unknown. Here, the authors show that JAK2V617F mutation drives vascular resident macrophages toward a pathogenic phenotype and promotes dissecting aortic aneurysm.

BackgroundCardiopulmonary bypass (CPB) during cardiac surgery leads to deleterious systemic inflammation. We hypothesized that TREM-1, a myeloid receptor shed after activation, drives systemic inflammation during CPB.MethodsProspective observational bi-centric study. Blood analysis (flow cytometry and ELISA) before and at H2 and H24 after CPB. Inclusion of adult patients who underwent elective cardiac surgery with CPB.ResultsTREM-1 expression on neutrophils decreased between H0 and H2 while soluble (s)TREM-1 plasma levels increased. sTREM-1 levels increased at H2 and at H24 (p

Abstract Background Ovarian cancer is one of the most common gynecological malignancies. Due to the absence of effective screening methods, ovarian cancer is usually diagnosed at late stages. Patients with pathogenic and likely‐pathogenic germline variants (PGVs) in BRCA1 or BRCA2 harbor elevated risk of developing both ovarian and breast cancers. Identifying PGVs may help in both cancer prevention and active disease treatment. Worldwide prevalence of PGVs varies and the matter is poorly addressed among Arab patients. Methods Patients with epithelial ovarian, fallopian tube or primary peritoneal cancers were offered the universal 20 or 84‐multi‐gene panel testing as per standard guidelines. Cascade family screening was also offered to all first and second‐degree relatives of PGV positive patients. Genetic testing was done at a referral lab using a next generation sequencing (NGS)‐based platform. Results During the study period, 152 patients, median age (range): 50 (18–79) years old, were tested. The majority (n = 100, 65.8%) had high‐grade serous carcinoma, and 106 patients (69.7%) had metastatic disease at presentation. In total, 38 (25.0%) had PGVs, while 47 (30.9%) others had variants of uncertain significance (VUS). PGVs were mostly in BRCA1 (n = 21, 13.8%) and in BRCA2 (n = 12, 7.9%), while 6 (3.9%) others had PGVs in non‐BRCA1/2 genes. PGV rates were significantly higher among 15 patients with a positive family history of ovarian cancer (60.0%, p = .022) and among 52 patients with a positive family history of breast cancer (40.4%, p = .017). Conclusions PGVs are common among Jordanian women with ovarian cancer, and mostly occur in BRCA1/2. Given its clinical impact on disease prevention and precision therapy, universal testing should be routinely offered.

Mice are the most commonly used model animals for itch research and for development of anti-itch drugs. Most laboratories manually quantify mouse scratching behavior to assess itch intensity. This process is labor-intensive and limits large-scale genetic or drug screenings. In this study, we developed a new system, Scratch-AID (Automatic Itch Detection), which could automatically identify and quantify mouse scratching behavior with high accuracy. Our system included a custom-designed videotaping box to ensure high-quality and replicable mouse behavior recording and a convolutional recurrent neural network trained with frame-labeled mouse scratching behavior videos, induced by nape injection of chloroquine. The best trained network achieved 97.6% recall and 96.9% precision on previously unseen test videos. Remarkably, Scratch-AID could reliably identify scratching behavior in other major mouse itch models, including the acute cheek model, the histaminergic model, and a chronic itch model. Moreover, our system detected significant differences in scratching behavior between control and mice treated with an anti-itch drug. Taken together, we have established a novel deep learning-based system that could replace manual quantification for mouse scratching behavior in different itch models and for drug screening.

هدفت هذه الدِّراسة إلى بيان واقع المهارات الريادية لأصحاب المشاريع الصغيرة والمتوسطة في الساحل السوري، من خلال بيان واقع كل من المهارات الشخصية، مهارات حل المشاكل، مهارات التفكير الإبداعي، مهارات القيادة، وقد اعتمد الباحث على المنهج الوصفي كمنهج عام للبحث، حيث تم جمع المادة العلمية المتعلقة بموضوع البحث وذلك بالاعتماد على الدراسات السابقة العربية والأجنبية والكتب العربية والأجنبية والدوريات والنشرات والمؤتمرات التي تخص موضوع الدراسة، وذلك من أجل تحديد كافة جوانب الظاهرة المدروسة والتعرف على حقيقتها على أرض الواقع، وتم الاطلاع على أهم التجارب العربية والعالمية في هذا المجال. تم أخذ عينة ميسرة من أصحاب العاملين في (المشاريع الصغيرة والمتوسطة) في الساحل السوري تم توزيع الاستبانة عليهم في مناطق مختلفة؛ حيث تم توزيع 130 استبيان، وتم استرداد 120 استبيان منها 110 استبيان صالح للدراسة بنسبة استجابة بلغت 84,62%. وقد خلصت الدِّراسة إلى تتوفر المهارات الريادية (المهارات الشخصية، مهارات حل المشاكل، مهارات التفكير الإبداعي، ومهارات القيادة) لأصحاب المشاريع الصغيرة والمتوسطة في الساحل السوري ولكن بدرجة منخفضة، وهذا يتطابق مع نتائج الفرضيات الأربعة المتفرعة عن الفرضية الرئيسة.

Beta-thalassemia and particularly its transfusion-dependent form (TDT) is a demanding clinical condition, requiring life-long care and follow-up, ideally in specialized centers and by multidisciplinary teams of experts. Despite the significant progress in TDT diagnosis and treatment over the past decades that has dramatically improved patients’ prognosis, its management remains challenging. On one hand, diagnostic and therapeutic advances are not equally applied to all patients across the world, particularly in several high-prevalence eastern regions. On the other, healthcare systems in low-prevalence western countries that have recently received large numbers of migrant thalassemia patients, were not ready to address patients’ special needs. Thalassaemia International Federation (TIF), a global patient-driven umbrella federation with 232 member-associations in 62 countries, strives for equal access to quality care for all patients suffering from thalassemia or other hemoglobinopathies in every part of the world by promoting education, research, awareness, and advocacy. One of TIF’s main actions is the development and dissemination of clinical practice guidelines for the management of these patients. In 2021, the fourth edition of TIF’s guidelines for the management of TDT was published. The full text provides detailed information on the management of TDT patients and the clinical presentation, pathophysiology, diagnostic approach, and treatment of disease complications or other clinical entities that may occur in these patients, while also covering relevant psychosocial and organizational issues. The present document is a summary of the 2021 TIF guidelines for TDT that focuses mainly on clinical practice issues and recommendations.

Background/purpose: Several pharmacotherapeutic methods have been used for the treatment of COVID-19 with varying degrees of success. No definitive treatment or vaccine has been officially approved to-date. This review aimed to highlight COVID-19 pharmacotherapeutic agents that are relevant to dental practice in terms of their clinical indications in COVID-19 and dental practice, as well as their adverse effects as they impact the dental patient. Material and methods: Systematic search was performed using the following keywords combinations: Pharmacotherapy AND COVID-19 OR Pharmacotherapy AND SARS-CoV-2 OR Treatment AND COVID-19. Studies were categorized according to the type of pharmacotherapy used. Pharmacotherapeutic agents were extracted and only those relevant to dental practice were included for review. Results: For analysis, a total of 79 clinical trials research articles were included that included COVID-19 pharmacotherapeutic agents relevant to dental practice. Those were analgesics (paracetamol; non-steroidal anti-inflammatory agents); antibiotics (azithromycin, doxycycline, metronidazole); antivirals (penciclovir); and immunomodulatory agents (hydroxychloroquine, corticosteroids). While some COVID-19 drugs are less relevant to dental practice, as antivirals and hydroxychloroquine, their association with long-term adverse effects requires adequate knowledge among dental practitioners. Conclusion: Many of COVID-19 pharmacotherapeutic agents are used to treat oral diseases particularly orofacial pain and inflammatory conditions. Furthermore, some of these drugs may induce adverse effects that complicate dental treatment. Thorough knowledge of COVID-19 therapy and its dental implications is essential for dental practitioners, and is expected to contribute to a better understanding and effective utilization of these therapeutic agents.

Abstract BRCA1 and BRCA2 mutations are not uncommon in breast cancer patients. Western studies show that such mutations are more prevalent among younger patients. This study evaluates the prevalence of germline mutations in BRCA1 and BRCA2 among breast cancer patients diagnosed at age 40 or younger in Jordan. Blood samples of patients with breast cancer diagnosed at age 40 years or younger were obtained for DNA extraction and BRCA sequencing. Mutations were classified as benign/likely benign (non-carrier), pathogenic/likely pathogenic variant (carrier) and variant of uncertain significance (VUS). Genetic testing and counseling were completed on 616 eligible patients. Among the whole group, 75 (12.2%) had pathogenic or likely pathogenic variants; two of the BRCA2 mutations were novel. In multivariate analysis, triple-negative disease (Odd Ratio [OR]: 5.37; 95% CI 2.88–10.02, P

Abstract In developing countries, breast cancer is diagnosed at a much younger age. In this study we investigate the dichotomies between older and young breast cancer patients in our region. The study involved two cohorts; older patients (≥ 65 years, n = 553) and younger ones (≤ 40 years, n = 417). Statistical models were used to investigate the associations between age groups, clinical characteristics and treatment outcomes. Compared to younger patients, older patients were more likely to present with advanced-stage disease (20.6% vs. 15.1%, p = .028). However, among those with non-metastatic disease, younger patients tended to have more aggressive pathological features, including positive axillary lymph nodes (73.2% vs. 55.6%, p

Abstract Background This study determined the knowledge, attitudes, and practice regarding COVID-19 and assessed the acceptance of the COVID-19 vaccine among healthcare workers and the general population. Methods A web-based, cross-sectional study was conducted using convenience sampling in Libya from December 1 to 18, 2020 among the general population and healthcare workers. Data on demographic characteristics, COVID-19 vaccination-related concerns, knowledge, attitudes, and practice regarding COVID-19, and knowledge, attitudes, and acceptance regarding the COVID-19 vaccine were collected using a self-administered survey. A binomial logistic regression was performed with 70% efficacy to determine the association between acceptance of the vaccine and study variables. Results Valid and complete responses were collected from 15,087 participants. Of these, 6227 (41.3%) were male and 8860 (58.7%) were female, with a mean (SD) age of 30.6 ± 9.8 years. Moreover, 485 (3.2%) participants were infected with COVID-19 at the time of the study, while 2000 (13.3%) had been previously infected. Overall, 2452 (16.3%) participants agreed, and 3127 (20.7%) strongly agreed, with “having concerns about serious vaccine-related complications.” Mask-wearing adherence was reported by 10,268 (68.1%) of the participants. Most participants (14,050, 93.1%) believed that the vaccine should be provided for free, while 7272 (48.2%) were willing to buy it. Regarding vaccine acceptance and efficacy, 12,006 (79.6%) reported their willingness to take the vaccine with an efficacy of 90% or more, 9143 (60.6%) with an efficacy of 70% or more, and only 6212 (41.2%) with an efficacy of 50%. The binomial logistic regression revealed that vaccine acceptance was not associated with belonging to the medical field versus the general population. Acceptance was statistically associated with younger age groups, especially 31–40 (OR = 1.3 [1.09, 1.55]) and 41–50 years (OR = 1.29, [1.09, 1.54]). However, having a family member or friend infected with COVID-19 was positively associated with the likelihood of vaccine acceptance (OR = 1.09 [1.02, 1.18]), while having a friend or family member who died due to COVID-19 was negatively associated with it (OR = 0.89 [0.84, 0.97]). Conclusions Acceptance of the COVID-19 vaccine is an essential determinant of vaccine uptake and the likelihood of controlling the COVID-19 pandemic. Developing strategies to decrease public hesitation and increase trust is vital for implementing vaccination programs.

The ability of WWTP outflow bacteria at colonizing rock surfaces and contributing to the formation of river epilithic biofilms was investigated. Bacterial community structures of biofilms (b-) developing on rocks exposed to treated wastewaters (TWW) of a hospital (HTWW) and a domestic (DTWW) clarifier, and to surface waters of the stream located at 10 m, 500 m, and 8 km from the WWTP outlet, were compared. Biofilm bacterial contents were analyzed by cultural approaches and a tpm-based DNA metabarcoding analytical scheme. Co-occurrence distribution pattern analyses between bacterial datasets and eighteen monitored pharmaceuticals were performed. Higher concentrations of iohexol, ranitidine, levofloxacin, and roxithromycin were observed in the b-HTWW while atenolol, diclofenac, propranolol, and trimethoprim were higher in the b-DTWW. MPN growth assays showed recurrent occurrences of Pseudomonas aeruginosa and Aeromonas caviae among these biofilms. An enrichment of multi-resistant P. aeruginosa cells was observed in the hospital sewer line. P. aeruginosa MPN values were negatively correlated to roxithromycin concentrations. The tpm DNA metabarcoding analyses confirmed these trends and allowed an additional tracking of more than 90 species from 24 genera. Among the recorded 3082 tpm ASV (amplicon sequence variants), 41% were allocated to the Pseudomonas. Significant differences through ANOSIM and DESeq2 statistical tests were observed between ASV recovered from b-HTWW, b-DTWW, and epilithic river biofilms. More than 500 ASV were found restricted to a single sewer line such as those allocated to Aeromonas popoffii and Stenotrophomonas humi being strictly found in the b-HTWW file. Several significant correlations between tpm ASV counts per species and pharmaceutical concentrations in biofilms were recorded such as those of Lamprocystis purpurea being positively correlated with trimethoprim concentrations. A tpm source tracking analysis showed the b-DTWW and b-HTWW tpm ASV to have contributed, respectively, at up to 35% and 2.5% of the epilithic river biofilm tpm-taxa recovered downstream from the WWTP outlet. Higher contributions of TWW taxa among epilithic biofilms were recorded closer to the WWTP outlet. These analyses demonstrated a coalescence of WWTP sewer communities with river freshwater taxa among epilithic biofilms developing downstream of a WWTP outlet.

The two-step batch foaming process of solid-state assisted by supercritical CO2 is a versatile technique for the foaming of polymers. In this work, it was assisted by an out-of-autoclave technology: either using lasers or ultrasound (US). Laser-aided foaming was only tested in the preliminary experiments; most of the work involved US. Foaming was carried out on bulk thick samples (PMMA). The effect of ultrasound on the cellular morphology was a function of the foaming temperature. Thanks to US, cell size was slightly decreased, cell density was increased, and interestingly, thermal conductivity was shown to decrease. The effect on the porosity was more remarkable at high temperatures. Both techniques provided micro porosity. This first investigation of these two potential methods for the assistance of supercritical CO2 batch foaming opens the door to new investigations. The different properties of the ultrasound method and its effects will be studied in an upcoming publication.

RF-MEMS technology has evolved significantly over the years, during which various attempts have been made to tailor such devices for extreme performance by leveraging novel designs and fabrication processes, as well as integrating unique materials; however, their design optimization aspect has remained less explored. In this work, we report a computationally efficient generic design optimization methodology for RF-MEMS passive devices based on multi-objective heuristic optimization techniques, which, to the best of our knowledge, stands out as the first approach offering applicability to different RF-MEMS passives, as opposed to being customized for a single, specific component. In order to comprehensively optimize the design, both electrical and mechanical aspects of RF-MEMS device design are modeled carefully, using coupled finite element analysis (FEA). The proposed approach first generates a dataset, efficiently spanning the entire design space, based on FEA models. By coupling this dataset with machine-learning-based regression tools, we then generate surrogate models describing the output behavior of an RF-MEMS device for a given set of input variables. Finally, the developed surrogate models are subjected to a genetic algorithm-based optimizer, in order to extract the optimized device parameters. The proposed approach is validated for two case studies including RF-MEMS inductors and electrostatic switches, in which the multiple design objectives are optimized simultaneously. Moreover, the degree of conflict among various design objectives of the selected devices is studied, and corresponding sets of optimal trade-offs (pareto fronts) are extracted successfully.

PURPOSECancer is a leading cause of morbidity and the second leading cause of mortality in Jordan and worldwide. Because of their age and comorbidities, older patients may receive suboptimal cancer therapy. This article addresses trends in cancer incidence and reports key treatment outcomes in this age group.MATERIALS AND METHODSThis is a retrospective study using data obtained from the national Jordan Cancer Registry (JCR) and our institutional cancer registry. The first data set reports only on demographics, whereas the second data set reports also on treatment outcomes. Older patients were defined as those age 65 years or older at time of diagnosis.RESULTSBetween 2001 and 2015, a total of 19,397 older patients were diagnosed with cancer, representing 29.8% of the total 65,050 patients with cancer diagnosed during this time. More men than women developed cancer, and colorectal, breast, lung, prostate, and bladder cancers were the most commonly reported cancers. Among this age group over the 15-year study period, cancer diagnoses increased by a rate of 77%, much higher than the 55% increment among all ages during the same study period. The 5-year survival rate for all of the 3,821 older patients diagnosed, treated, and followed up at our institution was 33% but varied by stage (63% for stage I disease and 14% for stage IV disease).CONCLUSIONCancer diagnoses among older patients are increasing at a rate higher than that of all ages and much higher than the witnessed increase in Jordanian population in same age group, which highlights the importance of looking for factors other than just aging to explain this increase. Strategies to offer better care for this rapidly expanding group are highly needed.

PurposeContrary to BRCA pathogenic variants, recommendations for management of variants of uncertain significance (VUS) are not clear and focus more on the patient’s family and personal history of cancer. Local and regional data on VUS are scarce. In this paper, we study patterns and frequency of VUS among breast cancer patients undergoing genetic testing.Patients and MethodsPatients with breast cancer at high risk for pathogenic variants, as per the National Comprehensive Cancer Network (NCCN) guidelines, were tested at reference laboratories. Related surgical interventions were reviewed.ResultsAmong a group of 1,197 patients with breast cancer who underwent genetic testing and counseling, 110 (9.2%) had VUS; most (n = 79, 71.8%) were in BRCA2. Median age (range) was 39 (25–66) years with 65 (59.1%) patients who were 40 years or younger at diagnosis. Among 103 patients with non-metastatic disease, 48 (46.6%) had breast-conserving surgery (BCS) while only 5 (4.9%) had bilateral mastectomies; all were due to bilateral disease and not prophylactic. VUS diagnosis was known prior to initial surgery in 34 (33.0%) patients; 11 (32.4%) of them had BCS only. Over the study period, only one VUS variant was upgraded to “likely positive.” The recent introduction of multiple-gene panel testing had resulted in a surge in VUS rate (22.2%) in genes other than BRCA1 or BRCA2, like PALB2, CHEK2, and ATM.ConclusionsRates of VUS are relatively high and increasing, mostly in non-BRCA1 or BRCA2, and this had no impact on the therapeutic or prophylactic surgical decisions. Adherence to guidelines is extremely important to avoid unnecessary procedures.

Abstract Background Fraser syndrome or “cryptophthalmos syndrome” is a rare autosomal recessive disease. It is characterized by a group of congenital malformations such as: crytophthalmos, syndactyly, abnormal genitalia, and malformations of the nose, ears, and larynx. Although cryptophthalmos is considered as a main feature of Fraser syndrome, its absence does not exclude the diagnosis. Clinical diagnosis can be made by Thomas Criteria. Here we present the first documented case of Fraser Syndrome in Aleppo, Syria that is characterized by bilateral anophthalmia and intrahepatic biliary atresia. Case presentation During pregnancy, several ultrasound scans revealed hyperechoic lungs, ascites, and unremarkable right kidney at the 19th-week visit; bilateral syndactyly on both hands and feet at the 32nd-week visit. On the 39th week of gestation, the stillborn was delivered by cesarean section due to cephalopelvic disproportion. Gross examination showed bilateral anophthalmia, bilateral syndactyly on hands and feet, low set ears, and ambiguous genitalia. Microscopic examination of the lung, spleen, liver, ovary, and kidneys revealed abnormalities in these organs. Conclusion The diagnosis of Fraser syndrome can be made prenatally and postnatally; prenatally by ultrasound at 18 weeks of gestation and postnatally by clinical examination using Thomas criteria. Moreover, intrahepatic biliary atresia was not described previously with Fraser syndrome; this recommends a more detailed pathologic study for Fraser syndrome cases.

Objective: To investigate the effect of maxillary single and multiple rooted teeth on the success rate of buccal infiltration anesthesia. Subjects and Methods: This clinical study was performed by dividing the participants into three groups. Group one included 30 patients with upper anterior teeth, group two 23 patients with upper premolars teeth and group three 39 patients with upper molars for extraction. Onset time of anesthtic action was evaluted by using electronic pulp tester. Pulp testing assessments were carried out immediately before the injection and at the intervals of 2 mins following the injection until the anesthetic success obtains. Results: Seventy-nine patients in this study secured anesthetic success within study duration time (10 min). However, there were 13 patients with dental anesthesia failures (3 patients with single rooted teeth and 10 patients with multiple rooted teeth). There were no significant differences in the mean onset time of pulpal anesthesia between the anterior, middle and posterior teeth (P value = 0.449). Clinically, patients with single rooted teeth reported faster dental anesthesia and earlier teeth extraction than patients with multiple rooted teeth. Conclusion: This study showed that the single rooted teeth have faster pulpal anesthesia and early extraction than teeth with multiple roots but not statistically significant. Administration of extra local anesthetic cartridge or using intraseptal injection technique can be a solution to overcome the failure of anesthesia in the maxillary posterior teeth.

Background Patients with aggressive lymphomas are at higher risk for venous thromboembolism (VTE). ThroLy is a risk assessment model (RAM) derived to predict the occurrence of VTE in various types of lymphomas. In this study, we assess the clinical application of ThroLy RAM in a unified group of patients with diffuse large B-cell lymphoma (DLBCL). Methods Hospital databases were searched for patients with DLBCL and radiologically-confirmed VTE. Items in the ThroLy RAM, including prior VTE, reduced mobility, obesity, extranodal disease, mediastinal involvement, neutropenia and hemoglobin 3) ThroLy score, 22.3% developed VTE compared to 8.4% and 12.4% in those with low and intermediate risk scores, respectively ( P = .014). Simplifying the ThroLy model into two risk groups; high-risk (score ≥ 3) and low risk (score

Malignancy, including testicular tumors, significantly increases the risk of venous thromboembolism (VTE). In this study, we search for predictors that may help identify subgroups of patients at higher risk of VTE. Patients with confirmed diagnosis of testicular germ cell tumor and proven VTE were identified. Clinical and pathological features possibly associated with VTE were reviewed. A total of 322 patients, median age (range) 31 (18-76) years were identified. Tumors were mostly non-seminoma (n = 194, 60.2%), node-positive (n = 130, 40.4%) and 58 (18.0%) had metastatic disease at diagnosis. Venous thromboembolism were confirmed in 27 (8.4%) patients; however, rates were significantly higher ( P < 0.001) in patients with node-positive (18.5%), metastatic disease (22.4%), and those with high lactate dehydrogenase (LDH) (21.3%). Rates were also significantly higher among those who received multiple lines of chemotherapy (27.5%) compared to those who received one line (13.8%) or none (

BackgroundVenous thromboembolic events (VTE) are commonly encountered in patients with lymphoma. Several risk assessments models (RAM) had attempted to identify higher risk patients with varying success. The International Prognostic Index (IPI) is a clinicopathological tool developed to help predict both response to treatment and prognosis of patients with diffuse large B-cell lymphoma (DLBCL).ObjectiveIn this study, we utilize the IPI index to identify group of patients with DLBCL at higher risk for VTE.Patients/MethodsPatients with pathologically-confirmed diagnosis of DLBCL and with image-confirmed VTE, treated and followed at our institution were included. Rates of VTE was calculated for each risk category.ResultsA total of 373 patients, median age 49 (range: 18-90) years were included. VTE were reported in 56 (15.0%) patients; 51 (91.1%) had active disease while 29 (51.8%) were ambulatory at time of VTE diagnosis. VTE rates were particularly high among patients with poor performance status (26.2%, P=0.028) and high LDH (19.0%, P=0.023). Applying the age-adjusted IPI separated patients into two risk categories; VTE were diagnosed in 9.7% in patients with “low and low-intermediate” scores compared to 19.8% in patients with “high and high-intermediate” scores, P=0.020.ConclusionsThe original IPI and its modified versions, routinely used at diagnosis as a prognostic and predictive tool for patients with DLBCL, can also be utilized to define high risk patients for VTE; the risk of whom might be high enough to recommend thromboprophylaxis even in the ambulatory settings. More work is needed to refine and improve currently available RAMs.

Objectives The crisis in Syria has had a profound impact on the entire region. In this study, we report the patterns of presentation and management of Syrian patients with breast cancer treated at our institution. Methods We retrospectively collected data on Syrian refugees treated for breast cancer over the past 10 years at our center. Management was compared against our approved clinical practice guidelines. Results A total of 113 patients were eligible and included. The median age (range) at diagnosis was 47 (21–84) years and most women presented with locally advanced or metastatic disease (n = 74, 65.5%). Breast-conserving surgery and breast reconstruction were performed in 27 (33.8%) and 11 (35.4%) patients, respectively. Only a few patients received targeted (35.5%) or advanced endocrine therapy (30.0%). In total, 37 (32.7%) patients had considerable deviations from our institutional treatment guidelines and had worse outcomes. Conclusions Syrian refugees with breast cancer present late, have more advanced-stage disease, and are more likely to receive delayed and suboptimal therapy. An international systematic approach for cancer care among such vulnerable populations is urgently needed.