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Objectives Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.Setting Prospective, international, multicentre, observational cohort study.Participants Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).Primary outcome 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.Results This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).Conclusions Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups.Trial registration number NCT04323644

Abstract Plants have developed elaborate mechanisms for perceiving extracellular stimuli and subsequently activating defense reactions through a multifaceted interaction of signaling cascades. Calcium ion (Ca²⁺), an essential and ubiquitous intracellular second messenger molecules, whose concentration ([Ca2+]cyt) has been observed to rise in response to numerous environmental stresses. The calcium/calmodulin (Ca²⁺/CaM) complex triggers apposite cellular responses through modifying the activities of a varied array of CaM-binding proteins (CBPs). Among CBPs, the CBP60 gene family has been identified as key regulators of stress responses in several crop species. Recently, we have demonstrated the expanded and diversified role of OsCBP60 in rice against devastating pathogens. Here, we analyzed the diversified roles of OsCBP60s in two major abiotic stresses, namely reproductive drought and submergence stress. OsCBP60bcd-2 and OsCBP60g-1/OsSARD1 were consistently upregulated during reproductive drought stress in rice. However, OsCBP60g-5 and OsCBP60g-6 were steadily up-regulated under submergence stress in rice. Interestingly, OsCBP60g-4 was consistently upregulated in both abiotic stresses, except on the third day of reproductive drought. The differential expression of OsCBP60s under water stress highlights the importance of further studying these genes as potential targets for enhancing stress resilience in rice.

Flavored tobacco products (FTPs) have gained global popularity but are associated with significant health concerns. These products, which include flavored cigarettes, cigars, e-cigarettes, hookahs, and nicotine dissolvable, come in a range of different flavors. For example, cigarettes come in a variety of flavors, including menthol, alcohol, spices, and herbs, which are more appealing to young adults, and fruit or candy, which are more appealing to kids. Despite the perceived safety of these flavorings for consumption, their toxicity remains largely unknown. Additionally, the deliberate promotion of FTPs by the tobacco industry in emerging nations such as India has hindered tobacco control efforts. The current review seeks to offer a thorough examination of additives used in tobacco, the various flavors found in emerging tobacco products, patterns of consumption, strategies employed in marketing, and the necessity for regulating these emerging tobacco products. A systematic review methodology was employed for this narrative review using relevant medical subject headings (MeSH) terms. The literature search was conducted between March 2022 and March 2023, utilizing databases such as PubMed, Scopus, Google Scholar, guidelines, advisory, survey reports, factsheets, editorial, communication, and news related to topic of interest. Pertinent articles were selected based on specific inclusion and exclusion criteria. The synthesized results illuminate the prevalence and usage of tobacco products with flavors in the market, effectively fulfilling the research objectives. Moreover, in addition to fulfilling the research objectives, the synthesized results offer valuable perspectives on how FTPs influence patterns of tobacco use, particularly among the younger population. These findings underscore the need for effective regulations and guidelines to curb the appeal and consumption of FTPs, ultimately reducing the prevalence of smoking-related disorders and promoting public health.

Introduction: Pneumothoraces are frequently treated by emergency physicians. Tube thoracostomy, the definitive treatment for a spontaneous pneumothorax, is associated with significant pain. Analgesia prior to tube thoracostomy often involves the administration of opioids and local infiltration of anesthetics. Thus far, regional anesthesia prior to pigtail tube thoracostomy in the emergency department (ED) has not been well described; it offers promise in alleviating pain associated with this procedure. Due to its ability to anesthetize all or most of the structures associated with tube thoracostomy—skin, serratus anterior muscles, intercostal muscles, and the parietal pleura—the serratus anterior plane block (SAPB) is a potentially promising fascial plane block prior to pigtail tube thoracostomy. Case Series: We present three cases of patients in the ED who received a SAPB and had nearly complete or complete anesthesia during pigtail tube thoracostomy. Conclusion: Pigtail tube thoracostomies are commonly performed in the ED and can be associated with significant pain despite a multimodal approach to pain management. The SAPB offers a safe and effective approach to anesthesia for patients in the ED undergoing a pigtail tube thoracostomy.

Abstract Cancer, one of the deadliest diseases, has remained the epicenter of biological research for more than seven decades. Yet all the efforts for a perfect therapeutic cure come with certain limitations. The use of medicinal plants and their phytochemicals as therapeutics has received much attention in recent years. Silymarin, a polyphenolic flavonoid with a variety of anti-cancerous properties, was isolated from the plant Silybum marianum. The present review centres on the function of silymarin in controlling important signalling pathways related to apoptosis and survival, such as the JAK/STAT pathway, PI3K/Akt/mTOR, Bcl-2/Bax, and Fas/FasL. It is emphasised that silymarin's capacity to target these pathways is a key mechanism behind its anticancer effects against a variety of malignancies. By upregulating pro-apoptotic and downregulating anti-apoptotic proteins, silymarin controls a series of events that result in tumor suppression and cell death in a variety of cancer types. The low bioavailability and limited therapeutic efficacy of silymarin are improved by the application of various nano-delivery systems. As efficient carriers, liposomes, polymeric micelles, lipid- and metal-based nanoparticles, increase the solubility and distribution of silymarin in target tissues. Lastly, a number of preclinical studies that provide a basis for upcoming therapeutic interventions are highlighted in the review, providing encouraging directions for additional research and advancement.

Abstract Background Accurate localization of premacular hemorrhages (PMHs) is crucial as treatment strategies vary significantly based on whether the hemorrhage resides within the vitreous gel, subhyaloid space, or beneath the internal limiting membrane (ILM). This report outlines the clinical features, diagnostic findings, and treatment outcomes in a patient diagnosed with a PMH secondary to suspected Valsalva retinopathy. Methods This is a retrospective interventional case report. Results A 43-year-old healthy male presented with sudden vision loss in his left eye, reporting a visual acuity of 6/120 since the previous evening. Fundus examination revealed a PMH characterized by a “double-ring sign” accompanied by diffuse retinal hemorrhages. Optical coherence tomography confirmed that the hemorrhage was located in the sub-ILM space. The patient underwent two sessions of YAG laser membranotomy, utilizing energies of 2.5 mJ and 5 mJ, which successfully facilitated drainage of fresh hemorrhage from the sub-ILM space to the subhyaloid space and vitreous cavity. However, the presence of residual coagulated blood over the fovea resulted in persistent visual impairment, necessitating a subsequent pars plana vitrectomy (PPV). The PPV, in conjunction with internal limiting membrane peeling, effectively removed the remaining blood in front of the fovea and restored the visual acuity. By postoperative day 3, the patient experienced a significant improvement in visual acuity, measuring 6/8. Conclusion This case underscores the importance of thorough clinical examination and precise diagnostic techniques in the individualized management of PMHs, which is essential for achieving optimal visual outcomes.

Rice is a water-intensive crop, conventionally grown under submerged conditions, with standing water for about 80% of its growth period. There is an urgent need for water-saving technologies to address challenges associated with conventional irrigation techniques for rice. The alternate wetting and drying (AWD) technique is one of these water-saving techniques; however, it requires continuous monitoring of water levels in the field. The implementation of real-time, electronic sensor-based precision irrigation technology may address the problems associated with conventional irrigation systems and AWD leading to high water use efficiency. Therefore, a study was undertaken to develop a suitable sensor-based automated irrigation system to maintain optimal water levels in rice fields. This study conceptualized an electronic sensor-based automated irrigation system for rice cultivated under the AWD technique. In this method, the rice field is initially flooded to a maximum depth of 5 cm. Irrigation is reapplied once the water level reduces to 10 cm below the soil surface. This developed system helps address water scarcity by regulating water levels, preventing excess ponding. It uses magnetic float-based sensors and electronic circuits to detect water levels, converting them into electronic signals transmitted wirelessly via radio frequency (RF) to a controller. The controller has been programmed for different growth stages that need to be set manually during the cropping period. The system is designed primarily for the AWD method but includes an option for continuous ponding (CP), needed during the flowering stage. The maximum water level at full maturity is set at 5 cm above the soil surface, while irrigation with the AWD method begins when the water level falls 10 cm below the soil surface. The developed system was tested during the Kharif season of 2018–19; the irrigation water productivity was 6.15 kg ha−1mm−1 with the automated system, compared to 3.06 kg ha−1mm−1 in the control (continuous ponding). Total water productivity was 4.80 kg ha−1mm−1 for the automated system and 2.63 kg ha−1mm−1 for the control. The automated system achieved 36% more water savings over the control, which used continuous ponding as farmers practice. The developed system supports AWD, a proven water-saving technique in rice cultivation.

Abstract Objective Our study aimed to investigate the ototoxicity associated with the iron chelator deferasirox in patients with β‐thalassemia major, who were receiving regular transfusion therapy, along with evaluating the data on audiological tests using appropriate statistical tests. Methods A cross‐sectional observational study was conducted on 100 transfusion‐dependent β‐thalassemia major patients on oral iron chelating agent‐deferasirox. Pure tone audiometry (PTA) and distortion product otoacoustic emissions (DPOAE) was carried out in all patients to assess the auditory side effects of the drug. Data was collected, compiled, and analyzed statistically using appropriate statistical tests. The relationship between ototoxicity and various demographic parameters such as age, sex, hemoglobin (Hb) level, S. ferritin, duration, and dose of chelation therapy was also assessed. Results Sixteen patients had abnormal DPOAE and the number of patients with pure tone average above 25 dB HL which was taken as hearing deficit on PTA was 13. No statistically significant relationship between hearing loss and age, gender, S. ferritin, duration of therapy, cumulative dose, Hb levels were found. Conclusion Despite being a lifesaving drug, the advantages of chelating agent‐Deferasirox must be weighed against its probable ototoxic effects. We could not find a relationship of ototoxicity with variable parameters (age, gender, Hb level, Ferritin level, duration, and cumulative dose of drug), thus future research is encouraged to form a definitive basis.

Abstract Objectives Allergic rhinitis (AR) has a significant effect on the quality of life and accounts for unproductive times at work and school, causes disturbed sleep patterns and can lead to daytime somnolence. It is fairly prevalent in the world with medical management still being the mainstay of treatment. Patients suffer for a significant number of years before they undergo surgical management for their intractable rhinitis. Thus, this prospective observational study was conducted to reinforce the proficiency of posterior nasal neurectomy in being an effective method for ending this suffering. Methods Thirty patients with troublesome intractable rhinitis underwent posterior nasal neurectomy. Pre‐ and postoperative Visual Analogue Scale (VAS) and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores were compared to study the improvement in nasal and ocular symptoms. Each domain of these scores was studied separately. Results The mean reduction in the VAS was from 6.76 ± 0.884 preoperatively to a mean of 5.33 ± 0.675 at 1 month, 3.81 ± 0.462 at 3 months and 2.53 ± 0.405 at 6 months postoperatively. The mean RQLQ score was reduced from preoperative 4.22 ± 1.091 to a mean of 3.82 ± 1.072 at 1 month, 3.55 ± 1.063 at 3 months and 3.18 ± 1.173 at 6 months postoperatively. Thus, a statistically significant improvement was seen in both mean VAS and RQLQ scores (P

Abstract Pneumatic planters are widely adopted in precision agriculture due to their superior field performance and minimal seed damage. However, variations in seed size, shape, and orientation can affect the ability of each orifice to pick and release a single seed accurately. Seed metering units typically incorporate seed cut-off and knock-out devices to improve singulation and ensure timely seed dropping, enhancing the quality feed index and reducing the precision index. These auxiliary devices—whether mechanical, electronic, pneumatic, or magnetic—increase system complexity, require skilled operation, necessitate additional maintenance, consume more energy, and heighten the risk of seed damage. The suctioned seed experiences impact from the seed metering plate during picking, and orifices are not fully sealed after seed pick-up, leading to a need for higher vacuum pressure. Additionally, field vibrations can adversely affect planter performance. To overcome these issues, this study developed a novel flexible orifice seed metering plate and optimised its operating parameters for cotton seed, adopting a central composite rotatable design (CCRD). The plates were developed by adding a layer of elastomeric material on rigid seed metering plate. The experiments were conducted using a developed electronic sticky belt setup in laboratory. An orifice diameter of 3 mm, vacuum pressure of 3.40 kPa, forward speed of 4.67 km/h, extended radius of 1 mm and coating thickness of 0.25 mm were found optimum with a quality feed index of 97.289% and precision index of 4.653%. Minimal difference between laboratory and field performance was noted when operated by an electronic planter. The miss index, multiple index, and precision index obtained under field conditions with rigid seed metering plate were found to be 4.4, 2.8, and 9.08% higher than coated seed metering plate, respectively. A comparatively lower optimal vacuum pressure and higher operation speed was achieved when coated seed metering plate was used in place of rigid seed metering plate. Hence coated seed metering plate can be a low-cost solution to achieve higher speed of precision planting with improved seeding performance. Graphical Abstract

Our objective in this work is to demonstrate how physics-informed neural networks, a type of deep learning technology, can be utilized to examine the mechanical properties of a helicopter blade. The blade is regarded as a one-dimensional prismatic cantilever beam that is exposed to triangular loading, and comprehending its mechanical behavior is of utmost importance in the aerospace field. PINNs utilize the physical information, including differential equations and boundary conditions, within the loss function of the neural network to approximate the solution. Our approach determines the overall loss by aggregating the losses from the differential equation, boundary conditions, and data. We employed a physics-informed neural network (PINN) and an artificial neural network (ANN) with equivalent hyperparameters to solve a fourth-order differential equation. By comparing the performance of the PINN model against the analytical solution of the equation and the results obtained from the ANN model, we have conclusively shown that the PINN model exhibits superior accuracy, robustness, and computational efficiency when addressing high-order differential equations that govern physics-based problems. In conclusion, the study demonstrates that PINN offers a superior alternative for addressing solid mechanics problems with applications in the aerospace industry.

Hanging is suspension of a person by noose or ligature around the neck. Hanging has been used as a judicial execution method since medieval times and is still a common method of suicide in developing countries. The term “near hanging” is used for those who survive long enough to reach the hospital, and these patients still hold mortality as high as 45%. These patients can present with a wide array of complaints involving cardiovascular, neurologic, and pulmonary systems and local injuries to the airway and vascular structures. High serum lactate and cardiac arrest at arrival are some of the prognostic factors which portend a poor prognosis. Early admission and aggressive treatment are essential to provide best neurologic outcome. Due to paucity of definitive guidelines, therapy has to be based on clinical reports and expertise of the treating physician. Hence, near-hanging patients pose a great challenge in primary emergency care and intensive care management. This review aims to outline the pathophysiology, prognostic indicators, and recent evidence in the management of near-hanging patients.

The introduction of computers in Indian schools runs parallel with the development of a digital divide in the country. In addition to the formal ways in which government policies shape access to computers in schools, deeper informal cultures of the state and schools shape opinion about these technologies. In this paper, we examine three levels of these informal cultures: political cultures and their perceptions of technology; bureaucratic cultures, which are distanced from schooling realities; and classroom teaching-learning practices, where digital inequalities add to pre-existing educational inequalities. For examining the interplay of the informal cultures, we scale down from the national level to examine the case of West Bengal, a state in eastern India. The state has been one of the strongholds of Left politics in India. Drawing upon its experiences, we explore the linkage between political ideology and the social embedding of resistance to computers.

Introduction: Non-vitiligo hypopigmented skin lesions may be close clinical mimickers of vitiligo, resulting in a diagnostic dilemma. Dermoscopic features of vitiligo have been studied, but those of other hypopigmentation disorders are not well-characterized. Objectives: We aimed to describe and compare the dermoscopic features of vitiligo and other hypopigmented skin lesions. Methods: A cross-sectional study including 105 vitiligo and 137 other hypopigmented skin lesions, including ash-leaf macules (n=17), nevus depigmentosus (n=16), post-inflammatory hypopigmentation (n=16), pityriasis alba (n=15), pityriasis versicolor (n=14), idiopathic guttate hypomelanosis (IGH) (n=14), lichen sclerosus (n=12), leprosy (n=9) and others. Dermoscopic findings were recorded by concordance of at least 2 qualified dermatologists. Results: Common dermoscopic findings in vitiligo were intermediate or ill-defined margins (96/105, 91.4%), and a complete absence of pigment network (70/105, 66.7%). Nevus depigmentosus lesions were mostly hypopigmented with a faint pigment network throughout the lesion. In 15/17 (88.2%) ash-leaf macules, a characteristic pattern of sharply demarcated areas of normal pigment network was seen within a depigmented lesion. Almost all lesions of IGH had a sharply defined margin with completely absent pigment network; discernible eccrine openings within the lesion were seen in 9/14 (64.3%). Dermoscopic findings of a complete absence of pigment network, perifollicular retention of pigment, presence of vascular pattern, loss of discernibility of eccrine openings within the lesion and lack of scaling were statistically significantly more common in vitiligo than other hypopigmented skin lesions (p

Introduction Cardiovascular disease (CVD) is the leading cause of mortality worldwide, though it may be prevented by increasing physical activity (PA). When behaviour change techniques (BCTs) are bundled together, they increase PA, though which individual BCTs increase PA (and the behavioural mechanism of action (MoA) responsible for said increase) have not been studied. The aim of this study is to conduct a randomised factorial experiment to determine which of four BCTs significantly engage the proposed MoA—self-efficacy for PA—in adults at risk for CVD.Methods and analysis Eight hundred and twenty sedentary adults (18–74 years old) at risk for CVD will be recruited between September 2022 and June 2025 to a fully remote, 24-week randomised BCT intervention. To identify those who might benefit from this intervention, we define self-reported walking

ABSTRACT Background FXYD3 is a Na/K‐ATPase modulator which is upregulated in pancreatic ductal adenocarcinoma (PDAC), but its prognostic role is unknown. This study evaluated FXYD3 expression in chemo‐naive patients with surgically‐resected PDAC at a single centre (1993–2014). Method FXYD3 expression was assessed in tumour specimens using immunohistochemistry. Results 145 of 180 PDAC tumour specimens were FXYD3‐immunopositive (80.5%). There was no difference in median overall survival between the FXYD3 negative (27.60 months) and positive groups (25.00 months) (log‐rank p = 0.9718). FXYD3 expression correlated positively with late‐stage disease (OR 3.041, 95% CI 1.190–7.455, p = 0.0175). There was no significant association with T stage, positive lymph nodes, perineural invasion, lymphovascular invasion or histological grade. Conclusion Immunohistochemical FXYD3 expression does not predict survival in chemo‐naive PDAC patients, but is associated with late‐stage disease. The high rate of FXYD3 overexpression warrants therapeutic evaluation.

Objective: The purpose of this study was to investigate students' perspectives on a newly implemented program of Interprofessional education (IPE) in terms of its effectiveness in increasing the awareness about other health care professionals and providing tools to emerging dental professionals for comprehensive health care needs. Methods: A new IPE course was incorporated in the second year of the predoctoral dental curriculum, and educators and students from various health professionals came together to provide a collaborative learning environment. The study evaluated the survey data from the graduating classes of 2019 and 2020 in the predoctoral program at Harvard School of Dental Medicine. The students were surveyed during and at the end of the course to obtain their perspectives on the effectiveness of the program. Result: The results of the surveys showed most student respondents agreed strongly that they liked getting information from other health professionals and 93-95% agreed that collaborating with other members of the health care team can help facilitate patients' overall health care. The IPE sessions helped bring about awareness of interprofessional relations and communications within the health care team and prepared the students for holistic patient care. Conclusion: The IPE methods facilitated an interactive and interprofessional learning environment to assist students in developing awareness of interprofessional relations and communications within the health care team. The connections between oral and systemic health were reinforced, thus giving predoctoral dental students a wider view of patient treatment and consideration for their patients' comprehensive health care needs.