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Background: Maternal Mortality Ratio is one of the crucial indicators of the Sustainable Development Goal-3, which is to be achieved below 70 per 100 000 live births by 2030. It is essential to assess the current status of antenatal care (ANC), uptake of skilled birth attendants (SBAs), and postnatal care (PNC) to improve the health of a mother and child in developing countries like Nepal. This study assesses the utilisation and factors associated with maternal healthcare services among reproductive-aged women in the Shubhakalika Rural municipality of Nepal., Methods: A cross-sectional study using proportionate simple random sampling was performed to select 180 participants. A Nepali-translated tool based on Andersen's Behaviour Model of healthcare service utilisation was used to collect the data. ANC services, SBAs, PNC services and continuum of care were dependent variables while independent variables were categorised into predisposing, enabling and need factors. Bivariate and multivariable regression analysis was performed using the Statistical Package of Social Sciences V.20 to determine the association between dependent and independent variables. All the tests were set at a CI of 95%., Results: This study included 180 participants with a mean (±SD) age of 24.3±4.9 years. Women whose husbands completed formal schooling were more likely to have four ANC visits (adjusted OR (AOR)=3.2, CI=1.0-10.3). Women with a planned pregnancy were significantly associated with the use of four ANC visits (AOR=10.3, CI=3.5-30.3), institutional delivery (AOR=3.2, CI=1.1-9.3) and continuum of care (AOR=7.4, CI=1.4-37.8). Ethnicity (AOR=2.4, CI=1.1-5.4), education of women (AOR=2.7, CI=1.0-7.7), having problems in receiving maternal healthcare services (AOR=4.5, CI=1.5-15.2) and distance to the nearest health facilities of less than 30 minutes (AOR=2.4, CI=1.0-5.7) were significantly associated with the use of institutional delivery. Similarly, women who were 18 years or above at the time of marriage were more likely to attend at least one PNC (AOR=3.2, CI=1.5-6.5) than women who were under 18. Meanwhile, women with health insurance were less likely to attend at least one PNC visit (AOR=0.3, CI=0.1-0.6) compared with those without health insurance., Conclusion: Women with planned pregnancies, higher education and husbands who completed formal schooling were more likely to access comprehensive maternal healthcare services, including ANC, institutional delivery and PNC. This study demonstrated proximity to health facilities, and lower ethnic groups were deprived of maternal healthcare services. These results emphasise the need to address socio-demographic disparities and improve healthcare accessibility. Since, health insurance programmes facilitate the utilisation of maternal healthcare services, efforts should focus on expanding coverage to reach the target population effectively, such as newly married couples., Competing Interests: None declared., (Copyright © Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. Published by BMJ Group.)

Cold stress is an adverse environmental factor that limits the growth and productivity of horticulture crops such as grapes (Vitis vinifera). In this study, we identified a grapevine cold-induced basic helix-loop-helix (bHLH) transcription factor (VvbHLH036). Overexpression and CRISPR/Cas9-mediated knockout (KO) of VvbHLH036 enhanced and decreased cold tolerance in grapevine roots, respectively. Transcriptome analysis of VvbHLH036-overexpressed roots identified threonine synthase (VvThrC1) as a potential downstream target of VvbHLH036. We confirmed that VvbHLH036 could bind the VvThrC1 promoter and activate its expression. Both the transcripts of VvThrC1 and the content of threonine were significantly induced in the leaves and roots of grapevine under cold treatment compared to controls. Conversely, these dynamics were significantly suppressed in the roots of CRISPR/Cas9-induced KO of VvbHLH036. These observations support the regulation of threonine accumulation by VvbHLH036 through VvThrC1 during cold stress in grapevine. Furthermore, overexpression and CRISPR/Cas9-mediated KO of VvThrC1 also confirmed its role in regulating threonine content and cold tolerance in transgenic roots at low temperature. Exogenous threonine treatment increased cold tolerance and reduced the accumulation of superoxide anions and hydrogen peroxide in grapevine leaves. Together, these findings point to the pivotal role of VvbHLH036 and VvThrC1 in the cold stress response in grapes by regulating threonine biosynthesis., Competing Interests: Conflict of interest statement. The authors declare that they have no competing interests., (© The Author(s) 2024. Published by Oxford University Press on behalf of American Society of Plant Biologists. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: The tobacco epidemic is one of the biggest public health threats and the world's leading cause of preventable death which is responsible for killing 8 million people every year. Adolescents are the vulnerable age group and are at greater risk of any tobacco use including smokeless tobacco (SLT) and nicotine addiction. Tobacco use at a young age increases the risk of various non-communicable diseases (NCDs) such as respiratory illness, asthma, chronic obstructive respiratory disease (COPD), reduced pulmonary function, and cancers. This study aimed to determine the prevalence of smokeless tobacco and its associated factors among secondary school students of grades 11 and 12 in Rangeli Municipality, Nepal., Methodology: A cross-sectional study was conducted among 355 students from the selected secondary schools. A self-administered questionnaire was used to collect the data. Data was cleaned and then exported to IBM SPSS Statistics 20 for analysis. Participants' characteristics were described using frequencies, percentages, mean, and standard deviation. Multivariate logistic regression was conducted to determine the association between individual characteristics and prevalence of smokeless tobacco. All the tests were performed at a 95% Confidence Interval (CI) and a p-value less than 0.05., Results: The mean (±SD) age of the participants was 18.0±1.3 years. Most participants were female (61.1%). The majority of the participants were from grade 11 (58.3%), government schools (60%), and nuclear families (64.8%). This study found that 38.4% and 61.6% of the participants were SLT ever users and never users respectively. Among the ever users, 29.5% were current users and most tried (47.7%) at the age of 10-14 years. Most participants revealed that homes and public places were common sites for SLT use. Paan Masala and Gutkha were the most commonly preferrable SLTs. This study found that age (AOR = 1.5, CI: 1.2-2.2), sex (AOR = 2.6, CI:1.6-4.4), and school type (AOR = 1.8, CI:1.1-3.0) were significantly associated with the prevalence of SLT., Conclusion: This study found that the prevalence of current SLT users is higher than the national survey. This study concludes that males, young adolescents, and students from private schools are at greater risk of SLT use and are unaware of the consequences on their health. Concerned stakeholders must expand awareness and promote educational programs on the harmful use of tobacco targeting secondary school students. The government organizations, educational institutions, and private organizations jointly work to strengthen the implementation of tobacco cessation programs and tobacco control strategies., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Rajbanshi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Osteoporosis is a major public health problem that can lead to physical disability, working performance limitations, decreased self-sufficiency, and increased hospitalization and mortality rates. People are unaware of osteoporosis, and it is often undiagnosed until fractures occur. Limited studies have been conducted to determine the knowledge, attitude, and practice regarding osteoporosis among middle-aged women in Nepal. This study aimed to determine existing knowledge, attitude, and practice towards osteoporosis among middle and old-aged women in Nepal. A cross-sectional study was conducted among the selected wards of Kirtipur Municipality to recruit 405 participants. Participants were selected using a stratified random sampling technique. Face-to-face interviews using a structured questionnaire were performed to collect the data. Frequencies, percentages, mean, and standard deviation were used to describe the characteristics of participants. Multivariate logistic regression was used to determine the factors associated with knowledge, attitude, and practice regarding osteoporosis. Pearson's correlation coefficient was used to determine the correlation between knowledge, attitude, and practice regarding osteoporosis. The mean ± SD age of the participants was 46.2 ±9.1 years. Nearly half of the participants (48.8%) had good knowledge, while 57.7% and 51.8% had positive attitudes and good practices regarding osteoporosis, respectively. The occupation and income of the participants were statistically significant and associated with the knowledge level. Meanwhile, age, ethnicity, education, occupation, and monthly household income were associated with attitude level. With a good practice level, ethnicity, family type, and education were statistically significant. The knowledge-attitude (rka = 0.093, p < 0.05), attitude-practice (rap = 0.171, p < 0.001), and knowledge-practice (rkp = 0.274, p < 0.001) for osteoporosis were positively correlated. The study found that still around half of the middle and old-aged women had poor knowledge, negative attitudes, and poor practices regarding osteoporosis. Moreover, it highlighted inadequate dietary practices, such as low consumption of milk, vegetables, fruits, and calcium supplements among women, indicates are at greater risk of osteoporosis. The study emphasized the need for community-based awareness programs for the target population such as housemakers, and lower-income groups, to prevent osteoporosis among women., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Khanal et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction and Importance: Tetanus, though potentially fatal, is preventable with proper vaccination, but high tetanus titers from frequent or higher doses can lead to increased adverse events. In countries like Nepal, where tetanus vaccines are readily available over the counter, irrational and frequent dosing, especially in certain occupational groups, is a noted issue., Case Presentation: A 28-year-old metal worker presented with a superficial cut on his forearm, managed with standard wound care, and reported a history of frequent tetanus vaccinations. Given his extensive vaccination history, a tetanus toxoid injection was deemed unnecessary, and he was educated on proper vaccination schedules and advised to seek medical attention for future injuries., Clinical Discussion: Timely administration of vaccines for pre-exposure and postexposure prophylaxis is crucial for combating tetanus, with booster doses recommended every 10 years or as needed for wound management. High antibody titers from frequent tetanus vaccinations can increase the risk of adverse events, prompting guidelines to avoid administering Td more frequently than every 10 years unless necessary. Local reactions, like pain and swelling at the injection site, are common, while systemic reactions can include fever and peripheral neuropathy. Over-immunization is a concern in some regions, with frequent unnecessary booster doses potentially causing harm and highlighting the need for adherence to vaccination guidelines., Conclusion: Modifying and monitoring adult Td booster vaccination can lead to significant cost savings and fewer adverse events, requiring proper vaccination record-keeping, accurate assessment, and adherence to guidelines by healthcare workers., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Coxa vara is a condition in which the neck-shaft angle of the femur decreases below its normal value (<110 degrees) based on age. The deformity can be primarily caused by a congenital defect of the femoral neck cartilage or by secondary causes related to skeletal dysplasia, trauma, infection, and pathological bone disorders. The surgical treatment aims to restore the normal anatomy, thereby improving the mechanics and function of the hip joint. Generally, the HE angles should be corrected to <35 to 40 degrees, converting the shear forces into compressive forces. Our study aims to report the surgical outcome of coxa vara with various pathologies using radiographic measurement and functional scoring., Methods: Thirty-eight hips in 28 patients who underwent surgery for treatment of coxa-vara from 2013 to 2022 were included. Radiographic parameters like Hilgenreiner-epiphyseal angle and neck-shaft angle were assessed preoperatively and at the latest follow-up. Harris hip score was used for functional outcome., Results: The mean age was 11.13 (5 to 18). The average follow-up was 48 (ranging from 24 to 96) months. The mean preoperative neck-shaft angle was 82 degrees, and the Hilgenreiner-epiphyseal angle was 71 degrees. At the latest follow-up, the mean neck-shaft angle was 127 degrees, and the Hilgenreiner-epiphyseal angle was 33 ( P <0.001). The Harris hip score improved from 63 preoperatively to 92 at the latest follow-up ( P <0.001). There was no recurrence of deformities at the mean follow-up of 37.87 months. Four complications occurred with k-wire fixation in whom revalgus osteotomy was done., Conclusions: Surgical correction of coxa vara in various pathologies can be done successfully with the Hilgenreiner-epiphyseal angle corrected to ≤ 35 degrees or the neck shaft angle corrected to >110 degrees to prevent deformity recurrence. The majority of the patients reported improvement in hip function. However, a longer-term follow-up is required to determine further outcomes regarding the recurrence of the deformity., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

In order to monitor public health trends and identify disease outbreaks early, efficient and reliable notification and surveillance systems are essential. Nepal uses a 1-3-7 malaria surveillance approach. The Short Message System (SMS) -based system for timely notification has been established. However, knowledge gaps exist regarding the timeliness of notification, treatment initiation, and case-based investigations. Hence, this study identifies the timeliness of notification and factors associated with delayed notification. This study used a cross-sectional approach and used secondary malaria surveillance data from Nepal's national malaria elimination program for the period of 2018 to 2022. The study revealed that the majority (79.9%) of malaria cases were male, with a male-to-female ratio of 3.96:1. Occupation was found to be significantly associated with delayed notification. Repatriate workers had 0.60 times lower odds of experiencing delayed notification compared to the reference occupation. Similarly, individuals diagnosed in the Sudurpaschim and Lumbini provinces had significantly lower odds (0.48 and 0.38, respectively) of encountering delayed notification compared to the reference province. Furthermore, relying on a single laboratory tool for malaria diagnosis (either RDT or microscopy only) was significantly associated with delayed notification. Individuals diagnosed solely with RDT or microscopy had 2.04 and 1.79 times higher odds of experiencing delayed notification, respectively, compared to those diagnosed using both laboratory tools. This study provides insight into the timeliness of surveillance system approach by assessing delayed notification and the factors associated with it. No delays are identified in median notification, treatment time and in case investigation. Improvement in the timeliness of malaria reporting over the years was observed. Provinces with high burden of malaria and repatriate workers showed lower delayed notification and conversely, cases diagnosed with single laboratory tool showed delayed notification time., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Kandel et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: This review specifically investigates ketamine's role in SRSE management., Methods: PubMed, EMBASE, and Google Scholar databases were searched from inception to May 1st, 2023, for English-language literature. Inclusion criteria encompassed studies on SRSE in humans of all ages and genders treated with ketamine., Results: In this systematic review encompassing 19 studies with 336 participants, age ranged from 9 months to 86 years. Infections, anoxia, and metabolic issues emerged as the common causes of SRSE, while some cases had unknown origins, termed as NORSE (New Onset RSE) or FIRESs (Febrile Infection-Related Epilepsy Syndrome). Most studies categorized SRSE cases into convulsive (N = 105) and non-convulsive (N = 197). Ketamine was used after failed antiepileptics and anesthetics in 17 studies, while in others, it was a first or second line of treatment. Dosages varied from 0.5 mg/kg (bolus) and 0.2-15 mg/kg/hour (maintenance) in adults and 1-3 mg/kg (bolus) and 0.5-3 mg/kg/hour (maintenance) in pediatrics, lasting one to 30 days. Ketamine was concurrently used with other drugs in 40-100% of cases, most frequently propofol and midazolam. Seizure resolution rate varied from 53.3 to 91% and 40-100% in larger (N = 42-68) and smaller case series (N = 5-20) respectively. Seizure resolution occurred in every case of case report except in one in which the patient died. Burst suppression in EEG was reported in 12 patients from two case series and two case reports. Recurrence was reported in 11 patients from five studies. The reported all-cause mortality varied from 38.8 to 59.5% and 0-36.4% in larger and smaller case series., unrelated directly to ketamine dosage or duration., Significance: Ketamine demonstrates safety and effectiveness in SRSE, offering advantages over GABAergic drugs by acting on NMDA receptors, providing neuroprotection, and reducing vasopressor requirement., (© 2024. The Author(s).)

Dengue poses a significant public health concern worldwide. It is identified as a recent emerging infectious disease in Nepal. Understanding the situation and dynamics between knowledge, attitudes, and practices (KAP) related to dengue among students is crucial for effective prevention and control strategies. This study aimed to assess the KAP and their associated factors of dengue among non-health undergraduate students of Nepal to identify gaps and suggest appropriate interventions. A web-based cross-sectional study was conducted among 429 non-health undergraduate students at eleven Nepalese Universities, with 80% of participants from the four most prominent ones in the country. Self-administered online forms were administered via Google Forms platform predominantly through social media for data collection. Data was cleaned and then exported to IBM SPSS Statistics 20.0 for analysis. Demographic characteristics of respondents were described using descriptive statistics. Multivariate logistic regression was conducted to determine the association between individual characteristics and KAP. Pearson's correlation coefficient was used to determine the association between knowledge-attitude, attitude-practice, and knowledge-practice. Statistical significance was determined at the P-value < 0.05. Around half of the participants were female (50.3%). The majority of participants were between 22 to 37 years, unmarried, and belonged to the Brahmin/Chhetri ethnic group. This study demonstrated a significant gap in KAP. Only 15.2% of participants had good knowledge while 25.9% and 68.3% of participants exhibited good attitudes and practices respectively. Marital status (AOR = 3.32, CI: 1.32-8.34), third-year educational level (AOR = 3.59, CI:1.34-9.57), and fourth-year educational level (AOR = 4.93, CI:1.88-12.94) were significantly associated with knowledge regarding dengue. Age (AOR = 1.73, CI: 1.10-3.01) was significantly associated with preventive practice regarding dengue. None of the demographic or socio-economic characteristics of respondents was associated with attitude on dengue. The knowledge-attitude (rka = 0.01), knowledge-practice (rkp = 0.22), and attitude-practice (rap = 0.01) were positively correlated in this study., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Bhandari et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

There has been limited research and understanding of the water quality in developing countries. Fresh produce consumed raw is nutrient-dense but is more susceptible to causing foodborne illness when contaminated water is used in production and consumption. There have been increasing reported incidences of foodborne outbreaks in Nepal linked to fresh produce contamination. However, water used in washing fresh produce by consumers and water used by growers or vendors is rarely tested. This research examines the source water used by consumers and growers in fresh produce systems in Nepal. To examine Escherichia coli (E. coli) detection as an indicator of contamination risk in water, we selected five major metropolitan cities for consumer households and ten districts representing commercial growers of vegetable growing areas of all seven provinces of Nepal. Altogether, we collected 394 water samples from randomly selected individual households: 156 from consumer households and 238 from growers or vendors. Results suggest that 59% of the water used in fresh produce systems is contaminated with E. coli in Nepal. On the water source used by consumers to wash fresh produce before consumption, we found that the dominant sources are the stored water in tanks or containers (46%) and municipal or communal supply water (39%)-which have E. coli prevalence rate of 66% and 57%, respectively. On the dominant sources of water used in fresh produce by growers or vendors, we found up to 88% of E. coli prevalence in the water they use. We also discussed the location or regional differences in contamination risks. This nationally represented study has implications for intervention policies and programs for safer food production and consumption practices in countries like Nepal where food safety is an emerging priority., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Cissus quadrangularis is a tetraploid species belonging to the Vitaceae family and is known for the Crassulacean acid metabolism (CAM) pathway in the succulent stem, while the leaves perform C 3 photosynthesis. Here, we report a high-quality genome of C. quadrangularis comprising a total size of 679.2 Mb which was phased into two subgenomes. Genome annotation identified 51 857 protein-coding genes, while approximately 47.75% of the genome was composed of repetitive sequences. Gene expression ratios of two subgenomes demonstrated that the sub-A genome as the dominant subgenome played a vital role during the drought tolerance. Genome divergence analysis suggests that the tetraploidization event occurred around 8.9 million years ago. Transcriptome data revealed that pathways related to cutin, suberine, and wax metabolism were enriched in the stem during drought treatment, suggesting that these genes contributed to the drought adaption. Additionally, a subset of CAM-related genes displayed diurnal expression patterns in the succulent stems but not in leaves, indicating that stem-biased expression of existing genes contributed to the CAM evolution. Our findings provide insights into the mechanisms of drought adaptation and photosynthesis transition in plants., Competing Interests: The authors declare no competing interests., (© The Author(s) 2024. Published by Oxford University Press on behalf of Nanjing Agricultural University.)

Introduction: According to the WHO, more than two-thirds of all antibiotics are used in the community, of which about 30% are used inappropriately. The antimicrobial resistance (AMR) problem is a growing threat to Nepal because of indiscriminate and inappropriate use. However, exact data on the extent of inappropriate use of antibiotics in the community is scarce in Nepal., Objectives: To know the extent of inappropriate use of antibiotics among the community and their knowledge and practice towards the usage of antibiotics., Methods: A community-based cross-sectional study was conducted from 20 December 2017 to 20 March 2018 using a purposive sampling technique. A semi-structured questionnaire was used while conducting face-to-face interviews with 336 respondents to find out the knowledge and practice regarding antibiotic use. Investigators took different antibiotics (in all dosage forms) with them to show participants whether they knew and/or used the antibiotics in the last year., Results: The mean age of respondents with standard deviation was 39.87±13.67 years ranging from 18 to 84 years. Around 35.42% of respondents were farmers and 34.52% were homemakers. 28.87% of respondents were illiterate, 32.44% had primary education and 33.33% had secondary education. Almost half of them (48.51%) think that antibiotics are safe and can be commonly used. So, 43.15% of them preferred taking antibiotics when they had a common cold. The majority of the participants (81.84%) did not have any idea about antibiotic resistance. 94.6% of the respondents used antibiotics inappropriately., Conclusion: The results of the present study revealed that inappropriate use of antibiotics is high and associated with low earning wages in both males and females in the age group 18-39 years., Competing Interests: There are no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Stigma among mental disorders like anxiety has been identified as an important barrier in help-seeking by national policymakers. Anxiety disorders are quite common among college students, and their severity and prevalence are growing. This study aimed to assess help-seeking behavior (HSB) towards anxiety among undergraduate students of Kathmandu University (KU)., Methodology: A web-based cross-sectional study was conducted among 422 undergraduate students. General Help-Seeking Questionnaire (GHSQ) tool was used to assess HSB. Frequencies, percentages, mean, and Standard Deviation were calculated to assess the characteristics of the participants. Factors associated with HSB were examined using Chi-Square test. Pearson correlation was determined to find out the association between professional and informal sources for seeking help. All the tests were carried out at the statistically significant level at a P -value of 0.05., Results: The mean (±SD) age was 20.3±1.1 years in this study. This study demonstrated that 36.5 and 17.5% of the participants were extremely likely to seek help from parents and psychiatrists towards anxiety, respectively. Sex (OR=1.5, 95% CI: 1.0-1.3) was significantly associated with parents, education was significantly associated with parents (OR=0.4, 95% CI: 0.2-0.6), and friends (OR=0.5, 95% CI: 0.3-0.9), meanwhile, ethnicity (OR=0.6, 95% CI: 0.4-0.9), and residence (OR=0.5, 95% CI: 0.3-0.8) were significantly associated with psychiatrists and psychologists for help-seeking behavior, respectively. Fear of criticism (34.1%) and stigma (20.3%) were the main reasons for not seeking help among the participants. The maximum number of participants (41.5%) preferred to seek help immediately if they ever experienced anxiety. This study showed professional and informal sources were positively correlated with anxiety (r pi =0.3) at a P -value <0.05., Conclusion: This study showed that students preferred to seek help from informal sources rather than professional sources. In addition, there is still stigma and fear among students regarding mental health. This study suggests that there is a need to have psychosocial intervention at colleges and educational institutions in order to promote professional help-seeking for any mental disorders including anxiety., Competing Interests: All the authors declare no conflicts of interest for this study.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Reliable and high-throughput genotyping platforms are of immense importance for identifying and dissecting genomic regions controlling important phenotypes, supporting selection processes in breeding programs, and managing wild populations and germplasm collections. Amongst available genotyping tools, single nucleotide polymorphism arrays have been shown to be comparatively easy to use and generate highly accurate genotypic data. Single-species arrays are the most commonly used type so far; however, some multi-species arrays have been developed for closely related species that share single nucleotide polymorphism markers, exploiting inter-species cross-amplification. In this study, the suitability of a multiplexed plant-animal single nucleotide polymorphism array, including both closely and distantly related species, was explored. The performance of the single nucleotide polymorphism array across species for diverse applications, ranging from intra-species diversity assessments to parentage analysis, was assessed. Moreover, the value of genotyping pooled DNA of distantly related species on the single nucleotide polymorphism array as a technique to further reduce costs was evaluated. Single nucleotide polymorphism performance was generally high, and species-specific single nucleotide polymorphisms proved suitable for diverse applications. The multi-species single nucleotide polymorphism array approach reported here could be transferred to other species to achieve cost savings resulting from the increased throughput when several projects use the same array, and the pooling technique adds another highly promising advancement to additionally decrease genotyping costs by half., Competing Interests: Conflicts of interest The author(s) declare no conflict of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Genetics Society of America.)

Introduction: Blackberry ( Rubus subgenus Rubus ) is a soft-fruited specialty crop that often suffers economic losses due to degradation in the shipping process. During transportation, fresh-market blackberries commonly leak, decay, deform, or become discolored through a disorder known as red drupelet reversion (RDR). Over the past 50 years, breeding programs have achieved better fruit firmness and postharvest quality through traditional selection methods, but the underlying genetic variation is poorly understood., Methods: We conducted a genome-wide association of fruit firmness and RDR measured in 300 tetraploid fresh-market blackberry genotypes from 2019-2021 with 65,995 SNPs concentrated in genic regions of the R. argutus reference genome., Results: Fruit firmness and RDR had entry-mean broad sense heritabilities of 68% and 34%, respectively. Three variants on homologs of polygalacturonase (PG), pectin methylesterase (PME), and glucan endo-1,3-β-glucosidase explained 27% of variance in fruit firmness and were located on chromosomes Ra06, Ra01, and Ra02, respectively. Another PG homolog variant on chromosome Ra02 explained 8% of variance in RDR, but it was in strong linkage disequilibrium with 212 other RDR-associated SNPs across a 23 Mb region. A large cluster of six PME and PME inhibitor homologs was located near the fruit firmness quantitative trait locus (QTL) identified on Ra01. RDR and fruit firmness shared a significant negative correlation ( r = -0.28) and overlapping QTL regions on Ra02 in this study., Discussion: Our work demonstrates the complex nature of postharvest quality traits in blackberry, which are likely controlled by many small-effect QTLs. This study is the first large-scale effort to map the genetic control of quantitative traits in blackberry and provides a strong framework for future GWAS. Phenotypic and genotypic datasets may be used to train genomic selection models that target the improvement of postharvest quality., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Chizk, Clark, Johns, Nelson, Ashrafi, Aryal and Worthington.)

Amyotrophic lateral sclerosis (ALS) is a disease that affects both upper and lower motor neurons, causing a range of symptoms beyond the motor system. Recent research has shown that the autonomic nervous system can also be affected, with symptoms such as orthostatic hypotension, fluctuations in blood pressure, and dizziness being reported., Case Presentation: A 58-year-old male presented with left lower limb limping, difficulty climbing stairs, and left foot weakness, followed by right upper limb weakness and was diagnosed with ALS and received edaravone and riluzole treatment. He presented again with right lower limb weakness, shortness of breath, and wide fluctuations in blood pressure, leading to ICU admission with new diagnosis of ALS with dysautonomia with respiratory failure and was managed with non-invasive ventilation, physiotherapy, and gait training exercises., Clinical Discussion: ALS is a progressive neurodegenerative disease affecting motor neurons but non-motor symptoms can also occur, including dysautonomia, which can result in blood pressure fluctuations. Dysautonomia in ALS is caused by several mechanisms such as severe muscle atrophy, prolonged ventilatory support, and upper and lower motor neuron lesions. Management of ALS involves giving a definitive diagnosis, providing nutritional support, using disease-modifying drugs such as riluzole and non-invasive ventilation to improve survival and quality of life. Early diagnosis is essential for effective management of the disease., Conclusion: Early diagnosis, use of disease-modifying drugs, non-invasive ventilation, and maintaining the patient's nutritional status are crucial for managing ALS which can have non-motor symptoms as well., Competing Interests: The authors have no competing interests to declare., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Organizing pneumonia (OP) is one of the rare pulmonary manifestations of systemic lupus erythematosus (SLE) which is infrequently reported as a presenting manifestation. Early diagnosis of lupus-related OP with the help of imaging, can drive to prompt initiation of immunosuppressive therapy leading to a better prognosis. We present a case of a 34-year-old young male who presented with fever, myalgia, and a dry cough for 1 month and was later diagnosed as SLE-related organizing pneumonia., Competing Interests: The authors have no conflict of interest declare., (© 2023 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Painful tonic spasms initially described in association with multiple sclerosis are actually more common in patients with neuromyelitis optica spectrum disorder. Characterized by fierce pain and tonic posture of limbs, painful tonic spasms are common in patients during the recovery phase after the first episode of myelitis. A 68-year-old man presented with painful tonic spasm after 2 months of diagnosis of neuromyelitis optica spectrum disorder. Eventual use of eslicarbazepine resulted in significant control of spasms. Early recognition of painful tonic spasms and appropriate therapeutic medications can significantly decrease the impact it can have on the quality of life among neuromyelitis optica spectrum disorder patients., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Hepatitis E virus causes self limiting hepatitis most of the times but, during pregnancy it can lead to severe hepatitis along with various complications thereby increasing the mortality., Case Presentation: A 27-year-old woman gravida two, para one at 38 weeks and 6 days of gestation presented with multiple episodes of nonbilious vomiting, severe dehydration, and later developed right upper quadrant abdominal pain. The patient had a positive serological test for the hepatitis E virus, and liver enzymes were severely elevated. Under supportive treatment she delivered a healthy baby, and her liver enzymes returned to normal levels after 2 weeks of delivery., Clinical Discussion: Although the hepatitis E virus usually causes self-limiting hepatitis, it can quickly progress to severe hepatitis, liver failure, and even death during pregnancy. Immunological change with a Th2 biased response and increased hormonal levels during pregnancy could possibly facilitate the development of severe liver damage. No particular drug has been approved for the treatment of hepatitis E viral infection in pregnant women, and the commonly used drugs are contraindicated due to the risk of teratogenicity. Supportive therapy and intensive monitoring are the core management techniques for hepatitis E virus infection in pregnant women., Conclusion: Due to the high mortality risk, pregnant women should try to avoid possible exposure to the hepatitis E virus, but once infected, symptomatic therapy is the mainstay., Competing Interests: The authors have no competing interests to declare.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Guillain-Barré syndrome (GBS) is an immunological demyelinating disorder characterized by progressive, ascending flaccid weakness, usually resulting after infection or some immune stimulation. Its occurrence during pregnancy is rare and due to attribution of its symptoms to pregnancy, diagnosis might be delayed., Case Presentation: A 39-year-old G4P3L2A0 woman at 13 weeks 6 days period of gestation presented with acute, symmetrical, ascending type of flaccid quadriparesis leading to slurring of speech, swallowing difficulty, and eventually respiratory failure. With the diagnosis of GBS, she was admitted to the intensive care unit, five sessions of plasma exchange were done along with physiotherapy and her symptoms started improving. After discharge she was on regular antenatal care visits and eventually, she delivered a healthy baby at term with an uneventful labor event and postpartum period., Clinical Discussion: There is a huge maternal-fetal risk of respiratory failure, aspiration pneumonia, preterm delivery, possible use of forceps or vacuum, and operative interference due to GBS in pregnancy, whose causative agents are similar to that of the general population. The swinging pattern of risk of GBS in pregnancy might be due to immunological changes with predominant Th2 response seen in pregnancy. Treatment measures are similar as in the general population with initial symptomatic care and administration of disease-specific therapy later which consists of intravenous immunoglobulin and/or plasmapheresis., Conclusion: A well-timed diagnosis of GBS in pregnancy might allow successful management with the help of intensive monitoring with or without immunotherapy., Competing Interests: The authors declare that they have no financial conflict of interest with regard to the content of this report.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

A bushfire is a spontaneous vegetation fire that can fundamentally affect lives, property, the environment, and even the global climate. Ash from fire carries hazardous pollutants like metal oxides/hydroxides, minerals, black carbons, and by-products of partial combustion, such as hydrocarbons and colloidal charcoal. Bushfire gases and residues can heavily pollute surface and groundwater resources. This paper focuses on the impact of bushfire residue on water quality and explores methods to remediate impacted water supplies. Soils burned in controlled furnace conditions between 150 °C, and 600 °C were characterised, suspended in water, and changes in water quality was measured following leaching from the burned residues. Results indicate that once the soil is burned at temperatures above 300 °C, there is little evidence of leached organic matter. At temperatures below 300 °C, the water discolouration was evident after 24 h leaching, and much higher quantities of leached organic matter were measured. Higher burning temperatures resulted in more alkaline residues. Leachate and charred sample characterisation data shows that the charcoal is highly porous and mainly consists of- amorphous material. The ash is a heterogeneous concoction of smaller particles and comprises significant mineral content. The results also indicate that the primary pollutant among the brushfire residuals is ash which increases pH, alkalinity, turbidity, and UV 254 . Coagulation experiments reveal that dual coagulation systems with metal salts- organic polyelectrolyte reduced the turbidity by 84 %, and dissolved organic carbon (DOC) reduced by 68 % of water containing ash residues. However, some other treatments are needed to reduce the alkalinity., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Blackberries (Rubus spp.) are the fourth most economically important berry crop worldwide. Genome assemblies and annotations have been developed for Rubus species in subgenus Idaeobatus, including black raspberry (R. occidentalis), red raspberry (R. idaeus), and R. chingii, but very few genomic resources exist for blackberries and their relatives in subgenus Rubus. Here we present a chromosome-length assembly and annotation of the diploid blackberry germplasm accession "Hillquist" (R. argutus). "Hillquist" is the only known source of primocane-fruiting (annual-fruiting) in tetraploid fresh-market blackberry breeding programs and is represented in the pedigree of many important cultivars worldwide. The "Hillquist" assembly, generated using Pacific Biosciences long reads scaffolded with high-throughput chromosome conformation capture sequencing, consisted of 298 Mb, of which 270 Mb (90%) was placed on 7 chromosome-length scaffolds with an average length of 38.6 Mb. Approximately 52.8% of the genome was composed of repetitive elements. The genome sequence was highly collinear with a novel maternal haplotype-resolved linkage map of the tetraploid blackberry selection A-2551TN and genome assemblies of R. chingii and red raspberry. A total of 38,503 protein-coding genes were predicted, of which 72% were functionally annotated. Eighteen flowering gene homologs within a previously mapped locus aligning to an 11.2 Mb region on chromosome Ra02 were identified as potential candidate genes for primocane-fruiting. The utility of the "Hillquist" genome has been demonstrated here by the development of the first genotyping-by-sequencing-based linkage map of tetraploid blackberry and the identification of possible candidate genes for primocane-fruiting. This chromosome-length assembly will facilitate future studies in Rubus biology, genetics, and genomics and strengthen applied breeding programs., Competing Interests: Conflicts of interest None declared., (© The Author(s) 2022. Published by Oxford University Press on behalf of Genetics Society of America.)

Reverse osmosis concentrate (ROC) produced as the by-product of the reverse osmosis process consists of a high load of organics (macro and micro) that potentially cause eco-toxicological effects in the environment. Previous studies focused on the removal of such compounds using oxidation, adsorption, and membrane-based treatments. However, these methods were not always efficient and formed toxic by-products. The impact of ion-exchange resin (IEX) (Purolite ® A502PS) was studied in a micro-filtration-IEX hybrid system to remove organics from ROC for varying doses of Purolite ® A502PS (5-20 g/L) at a flux of 36 L/m 2 h. The purolite particles in the membrane reactor reduced membrane fouling, evidenced by the reduction of transmembrane pressure (TMP), by pre-adsorbing the organics, and by mechanically scouring the membrane. The dissolved organic carbon was reduced by 45-60%, out of which 48-81% of the hydrophilics were removed followed by the hydrophobics and low molecular weight compounds (LMWs). This was based on fluorescence excitation-emission matrix and liquid chromatography-organic carbon detection. Negatively charged and hydrophobic organic compounds were preferentially removed by resin. Long-term experiments with different daily replacements of resin are suggested to minimize the resin requirements and energy consumption.

An infrequent form of ectopic pregnancy, pregnancy in an isthmocele can be hazardous due to hemorrhage or uterine rupture. With no clear guidelines for the management of this condition, surgery is the preferred option., Competing Interests: None to declare., (© 2023 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Genitogluteal porokeratosis is a rare localized disorder of keratinization. Due to the rarity of the case and non-specific keratotic lesion, it is often misdiagnosed until a histological examination is performed. Treatment of this condition can be challenging, which comprises various topical and systemic drugs, lasers, cryotherapy, phototherapy, and also surgical intervention. Regular follow-up is necessary in the view of this disorder being a premalignant condition., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Rete ovarii giving rise to cysts, and benign and malignant tumors is a rare entity. Radiological and histopathological examinations can be used to make the diagnosis of rete cyst and differentiate it from cystic tumor of ovarian origin, with surgery being the treatment of choice., Competing Interests: None to declare., (© 2022 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Introduction and Importance: Pregnant women under warfarin for mechanical heart valves can pose a variety of challenges which requires fine tuning of various anticoagulants throughout the pregnancy and in the postpartum period as hemorrhage can lead to maternal and fetal morbidity and mortality., Case Presentation: A 36-year-old woman gravida two, para one at 35 weeks 5 days gestation, with hypothyroidism with mitral valve replacement and tricuspid valve repair due to rheumatic heart disease underwent emergency lower section cesarean section for fetal bradycardia. B-lynch suturing was eventually done to control atonic postpartum hemorrhage. During hospital stay she developed surgical site infection of abdominal skin incision site which was also subsequently managed. Postpartum anticoagulation was started late due to postpartum hemorrhage and finally the patient was discharged on warfarin., Clinical Discussion: There is always a risk of both thromboembolic and hemorrhagic manifestations in a pregnant woman with a prosthetic heart valve which requires fine tuning of anticoagulants throughout the pregnancy and in the postpartum period. Hemorrhagic manifestation in the form of postpartum hemorrhage is common which can be difficult to manage and also poses a great dilemma in restarting the anticoagulation after delivery. Excessive blood loss can itself lead to mortality and morbidity, and also via increased risk of surgical site infection., Conclusion: Appropriate preconception counseling along with meticulous assessment, management and monitoring of pregnant women with prosthetic heart valves is necessary to decrease fetal and maternal morbidity and mortality., Competing Interests: Declaration of competing interest None to declare., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction and Importance: Conjoined twins represent a rare phenomenon and the etiology has not been clarified yet. There is a high rate of stillbirth and neonatal deaths resulting in very few cases surviving long enough for surgical separation., Case Presentation: A 33-year-old gravida 2 para 1 mother without any first and second trimester antenatal care visits was diagnosed to have conjoined twins in the third trimester. Mother and her family chose to terminate the pregnancy for which elective lower section cesarean section was done with the delivery of female conjoined twins, both of them subsequently declared dead within 4 h of birth., Clinical Discussion: A conjoined twin gestation provides inimitable intricacy for obstetric management irrespective of the patient's areas of care. Early diagnosis through ultrasonography can be done and detailed evaluation is necessary along with fetal echocardiography regardless of site of fusion. Cesarean section is the recommended mode of delivery as this reduces various complications., Conclusion: The obstetricians' role in timely prenatal diagnosis, counseling, and organization of interdisciplinary medical care is indispensable in cases of conjoined twins., Competing Interests: Declaration of competing interest None to declare., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Cissus is the largest genus in Vitaceae and is mainly distributed in the tropics and subtropics. Crassulacean acid metabolism (CAM), a photosynthetic adaptation to the occurrence of succulent leaves or stems, indicates that convergent evolution occurred in response to drought stress during species radiation. Here we provide the chromosomal level assembly of Cissus rotundifolia (an endemic species in Eastern Africa) and a genome-wide comparison with grape to understand genome divergence within an ancient eudicot family. Extensive transcriptome data were produced to illustrate the genetics underpinning C. rotundifolia 's ecological adaption to seasonal aridity. The modern karyotype and smaller genome of C. rotundifolia ( n  = 12, 350.69 Mb/1C), which lack further whole-genome duplication, were mainly derived from gross chromosomal rearrangements such as fusions and segmental duplications, and were sculpted by a very recent burst of retrotransposon activity. Bias in local gene amplification contributed to its remarkable functional divergence from grape, and the specific proliferated genes associated with abiotic and biotic responses (e.g. HSP-20 , NBS-LRR ) enabled C. rotundifolia to survive in a hostile environment. Reorganization of existing enzymes of CAM characterized as diurnal expression patterns of relevant genes further confer the ability to thrive in dry savannas., (© The Author(s) 2022. Published by Oxford University Press on behalf of Nanjing Agricultural University.)

Aims: To examine the long-term outcome of arthrodesis of the hip undertaken in a paediatric population in treating painful arthritis of the hip. In our patient population, most of whom live rurally in hilly terrain and have limited healthcare access and resources, hip arthrodesis has been an important surgical option for the monoarticular painful hip in a child., Methods: A follow-up investigation was undertaken on a cohort of 28 children previously reported at a mean of 4.8 years. The present study looked at 26 patients who had an arthrodesis of the hip as a child at a mean follow-up of 20 years (15 to 29)., Results: The mean Harris Hip Score (HHS) increased from 39.60 (SD 11.06) preoperatively to 81.02 (SD 8.86; p = 0.041) at final review. At latest follow-up, the HHS was found to be excellent in four patients (15%), good in 11 (42%), and fair in 11 (42%). A total of 16 patients (62%) reported mild low back pain, five (19%) had moderate pain, and five (19%) patients had no back pain. Mild ipsilateral knee pain was reported by 19 (73%), moderate pain by one (4%), and no pain by six (23%) patients. Mild contralateral hip pain was reported by ten patients (38%), and no pain by 16 (62%). The 36-Item Short Form Health Survey scores were very good in four patients (15%), good in 18 (70%), and poor in four (15%), with a mean score of 70.92 (SD 12.65). Of 13 female patients who had given birth, 12 did so with uncomplicated vaginal delivery. All patients had to modify their posture for toileting, putting on lower body clothes, foot care, and putting on shoes., Conclusion: Our results show that with hip arthrodesis, most patients have relatively good function at long-term follow-up, although some pain is experienced in adjacent joints, and modification in some activities of daily living is common.Cite this article: Bone Joint J  2022;104-B(9):1089-1094.

Pure Sertoli cell tumors are an uncommon variant of rare ovarian Sertoli-Leydig cell tumors. Due to nonspecific clinical and imaging features, diagnosis is often made after histopathological examination. The prognosis is excellent as most are detected in the early stages and surgical resection is often curative in most cases., Competing Interests: None to declare., (© 2022 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Coronavirus disease 2019 (COVID-19) has now spread widely after the outbreak since December 31, 2019. Guillain-Barré syndrome is an immunological postinfectious neuropathy, which has been reported to be a rare but possible complication COVID-19. We report a case of Guillain-Barré syndrome associated with COVID-19 in Nepal., Competing Interests: The authors declare that there are no conflicts of interest., (© 2022 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Two hemibiotrophic pathogens, Colletotrichum acutatum (Ca) and C . gloeosporioides (Cg), cause anthracnose fruit rot and anthracnose crown rot in strawberry ( Fragaria × ananassa Duchesne), respectively. Both Ca and Cg can initially infect through a brief biotrophic phase, which is associated with the production of intracellular primary hyphae that can infect host cells without causing cell death and establishing hemibiotrophic infection (HBI) or quiescent (latent infections) in leaf tissues. The Ca and Cg HBI in nurseries and subsequent distribution of asymptomatic infected transplants to fruit production fields is the major source of anthracnose epidemics in North Carolina. In the absence of complete resistance, strawberry varieties with good fruit quality showing rate-reducing resistance have frequently been used as a source of resistance to Ca and Cg. However, the molecular mechanisms underlying the rate-reducing resistance or susceptibility to Ca and Cg are still unknown. We performed comparative transcriptome analyses to examine how rate-reducing resistant genotype NCS 10-147 and susceptible genotype 'Chandler' respond to Ca and Cg and identify molecular events between 0 and 48 h after the pathogen-inoculated and mock-inoculated leaf tissues. Although plant response to both Ca and Cg at the same timepoint was not similar, more genes in the resistant interaction were upregulated at 24 hpi with Ca compared with those at 48 hpi. In contrast, a few genes were upregulated in the resistant interaction at 48 hpi with Cg. Resistance response to both Ca and Cg was associated with upregulation of MLP-like protein 44, LRR receptor-like serine/threonine-protein kinase, and auxin signaling pathway, whereas susceptibility was linked to modulation of the phenylpropanoid pathway. Gene regulatory network inference analysis revealed candidate transcription factors (TFs) such as GATA5 and MYB-10, and their downstream targets were upregulated in resistant interactions. Our results provide valuable insights into transcriptional changes during resistant and susceptible interactions, which can further facilitate assessing candidate genes necessary for resistance to two hemibiotrophic Colletotrichum spp. in strawberry., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Adhikari, Aryal, Redpath, Van den Broeck, Ashrafi, Philbrick, Jacobs, Sozzani and Louws.)

Background: Japanese encephalitis (JE) is a potentially fatal viral infection with a wide range of manifestations and can also present with a variety of movement disorders (MD) including dystonia. Dystonic features in JE are uncommon. Here, we have tried to summarize the clinical features and management of dystonia among JE patients with a comprehensive literature search., Methods: Various databases, including PubMed, Embase, and Google Scholar, were searched against the predefined criteria using suitable keywords combination and boolean operations. Relevant information from observational and case studies was extracted according to the author, dystonic features, radiological changes in the brain scans, treatment options, and outcome wherever provided., Result: We identified 19 studies with a total of 1547 JE patients, the diagnosis of which was confirmed by IgM detection in serum and/or cerebrospinal fluid in the majority of the patients (88.62%). 234 (15.13%) of JE patients had dystonia with several types of focal dystonia being present in 131 (55.98%) either alone or in combination. Neuroimaging showed predominant involvement of thalami, basal ganglia, and brainstem. Oral medications including anticholinergics, GABA agonists, and benzodiazepines followed by botulinum toxin were the most common treatment modalities., Conclusion: Dystonia can be a disabling consequence of JE, and various available medical therapies can significantly improve the quality of life. Owing to insufficient studies on the assessment of dystonia associated with JE, longitudinal studies with a larger number of patients are warranted to further clarify the clinical course, treatment, and outcome of dystonia., (© 2022 The Authors. Brain and Behavior published by Wiley Periodicals LLC.)

Background: In northern Iran and other cold regions, winter freezing injury and resultant yield instability are major limitations to strawberry production. However, there is scarcity of information on the physiological and biochemical responses of strawberry cultivars to freezing stress. This study aimed to investigate the physiological and biochemical responses of strawberry cultivars (Tennessee Beauty, Blakemore, Kurdistan, Queen Elisa, Chandler, Krasnyy Bereg, and Yalova) to different freezing temperature treatments (- 5, - 10, - 15, - 20, and - 25 °C) under controlled conditions., Results: All measured physiological and biochemical features were significantly affected by the interaction effect between low temperatures and cultivars. Tennessee Beauty showed the highest RWC at - 25 °C. The highest Fv/Fm was observed in Queen Elisa. Krasnyy Bereg had the least freezing injury (FI) in crown and leaf, while Yalova and Chandler showed the highest crown and leaf FI, respectively. At - 20 to - 25 °C, the highest carbohydrates contents of crown and leaf were noted in Blakemore and Krasnyy Bereg cultivars, respectively. The Yalova showed the highest protein content in both crown and leaf tissues at - 25 °C. The Tennessee Beauty and Blackmore cultivars showed the highest proline in crowns and leaves at - 15 °C, respectively. The highest ThioBarbituric Acid Reactive Substances (TBARS) contents in the crown and leaf were observed in Kurdistan and Queen Elisa, respectively. Queen Elisa and Krasnyy Bereg cultivars showed SOD and POD peaks in the crown at - 15 °C, respectively., Conclusion: Freezing stress was characterized by decreased Fv/Fm and RWC, and increased FI, TBARS, total carbohydrates, total proteins, proline content, and antioxidant enzyme activity. The extent of changes in above mentioned traits was cultivar dependent. FI and TBARS were the best traits among destructive parameters for evaluating freezing tolerance. Moreover, maximum quantum yield of PSII (Fv/Fm index), as non-destructive parameters, showed a significant efficiency in rapid assessment for screening of freezing tolerant strawberry cultivars. The cultivars Krasnyy Bereg, Queen Elisa, and Kurdistan were the most tolerant cultivars to freezing stress. These cultivars can be used as parents in breeding programs to develop new freezing tolerant cultivars., (© 2021. The Author(s).)

What Is Known and Objective: The rise of vancomycin-resistant enterococci (VRE) has been a major health problem in most countries of the world including Asia, since its discovery. There is a paucity of data on VRE in many countries of Asia as well as limited pooled estimates. Therefore, we performed a systematic review and meta-analysis to estimate a pooled prevalence of VRE in Asia., Methods: A literature search in electronic databases like PubMed, Embase and Google Scholar and manual searching of references and grey literature, comprising the information on the prevalence of VRE with at least two species of enterococci, conducted in different countries of Asia from January 1, 2000, to September 20, 2020, was done. The random-effect model and 95% CIs was used to calculate the pooled prevalence. Subgroup, sensitivity and meta-regression analyses were performed to address heterogeneity while Egger's test for publication bias., Results and Discussions: We identified 39 studies, comprising a total of 11,875 enterococcal isolates. The result of the analysis showed that the pooled prevalence of VRE in Asia was 8.10% (95% CI; 7-9; I 2  = 93.79%; p < 0.001). Resistance to vancomycin was greater among strains of E. faecium compared to the strains of E. faecalis (22.40% vs. 3.70%). Amongst various regions of Asia, the highest prevalence of VRE was found in the Western Asian region and the lowest in the South-east Asian region. Moreover, the rate of VRE was higher than most European countries and lower than USA., What Is New and Conclusions: With an upsurge of VRE in Asia in recent years, efficient infection control programmes, robust surveillance systems and adherence to antibiotic stewardship are paramount to halt the further rise of VRE., (© 2021 John Wiley & Sons Ltd.)

Even though posterior or postero-lateral dislocations of elbow are more common, both isolated medial and lateral dislocations of elbow are extremely uncommon. Since there are subtle findings and minimum pain after medial dislocation of elbow, these are sometimes missed by attending physician at first presentation and changes into chronic type with guarded prognosis. We report a case of a 15-year old boy with isolated medial dislocation of elbow which was correctly identified and treated with closed reduction and posterior slab application. Flexion extension as well as supination pronation of elbow 3 months after injury was nearly normal.

Background: Tripidium ravennae is a cold-hardy, diploid species in the sugarcane complex (Poaceae subtribe Saccharinae) with considerable potential as a genetic resource for developing improved bioenergy and ornamental grasses. An improved understanding of the genetic regulation of reproductive processes (e.g., floral induction, inflorescence development, and seed development) will enable future applications of precision breeding and gene editing of floral and seed development. In particular, the ability to silence reproductive processes would allow for developing seedless forms of valuable but potentially invasive plants. The objective of this research was to characterize the gene expression environment of reproductive development in T. ravennae., Results: During the early phases of inflorescence development, multiple key canonical floral integrators and pathways were identified. Annotations of type II subfamily of MADS-box transcription factors, in particular, were over-represented in the GO enrichment analyses and tests for differential expression (FDR p-value < 0.05). The differential expression of floral integrators observed in the early phases of inflorescence development diminished prior to inflorescence determinacy regulation. Differential expression analysis did not identify many unique genes at mid-inflorescence development stages, though typical biological processes involved in plant growth and development expressed abundantly. The increase in inflorescence determinacy regulatory elements and putative homeotic floral development unigenes at mid-inflorescence development coincided with the expression of multiple meiosis annotations and multicellular organism developmental processes. Analysis of seed development identified multiple unigenes involved in oxidative-reductive processes., Conclusion: Reproduction in grasses is a dynamic system involving the sequential coordination of complex gene regulatory networks and developmental processes. This research identified differentially expressed transcripts associated with floral induction, inflorescence development, and seed development in T. ravennae. These results provide insights into the molecular regulation of reproductive development and provide a foundation for future investigations and analyses, including genome annotation, functional genomics characterization, gene family evolutionary studies, comparative genomics, and precision breeding.

Atrial fibrillation (AF) has become one of the most significant health problems worldwide, warranting urgent answers to currently pending questions on the effects of AF on brain function. Recent evidence has emerged to show an association between AF and an increased risk of developing dementia and worsening of stroke outcomes. A healthy brain is protected by the blood-brain barrier (BBB), which is formed by the endothelial cells that line cerebral capillaries. These endothelial cells are continuously exposed to shear stress (the frictional force generated by blood flow), which affects endothelial cell structure and function. Flow disturbances as experienced during AF can disrupt the BBB and leave the brain vulnerable to damage. Investigating the plausible mechanisms in detail, linking AF to cerebrovascular damage is difficult in humans, leading to paucity of available clinical data. Here, we discuss the available evidence for BBB disruption during AF due to altered cerebral blood flow, and how this may contribute to an increased risk of dementia and worsening of stroke outcomes.

A Rosaceae family-level candidate gene approach was used to identify genes associated with sugar content in blackberry ( Rubus subgenus Rubus ). Three regions conserved among apple ( Malus × domestica ), peach ( Prunus persica ), and alpine strawberry ( Fragaria vesca ) were identified that contained previously detected sweetness-related quantitative trait loci (QTL) in at least two of the crops. Sugar related genes from these conserved regions and 789 sugar-associated apple genes were used to identify 279 Rubus candidate transcripts. A Hyb-Seq approach was used in conjunction with PacBio sequencing to generate haplotype level sequence information of sugar-related genes for 40 cultivars with high and low soluble solids content from the University of Arkansas and USDA blackberry breeding programs. Polymorphisms were identified relative to the 'Hillquist' blackberry ( R. argutus ) and ORUS 4115-3 black raspberry ( R. occidentalis ) genomes and tested for their association with soluble solids content (SSC). A total of 173 alleles were identified that were significantly (α = 0.05) associated with SSC. KASP genotyping was conducted for 92 of these alleles on a validation set of blackberries from each breeding program and 48 markers were identified that were significantly associated with SSC. One QTL, qSSC-Ruh-ch1.1, identified in both breeding programs accounted for an increase of 1.5 °Brix and the polymorphisms were detected in the intron space of a sucrose synthase gene. This discovery represents the first environmentally stable sweetness QTL identified in blackberry. The approach demonstrated in this study can be used to develop breeding tools for other crops that have not yet benefited directly from the genomics revolution., (Copyright © 2020 Zurn et al.)

Accumulating evidence highlights links between iron regulation and respiratory disease. Here, we assessed the relationship between iron levels and regulatory responses in clinical and experimental asthma.We show that cell-free iron levels are reduced in the bronchoalveolar lavage (BAL) supernatant of severe or mild-moderate asthma patients and correlate with lower forced expiratory volume in 1 s (FEV 1 ). Conversely, iron-loaded cell numbers were increased in BAL in these patients and with lower FEV 1 /forced vital capacity (FVC) ratio. The airway tissue expression of the iron sequestration molecules divalent metal transporter 1 ( DMT1 ) and transferrin receptor 1 ( TFR1 ) are increased in asthma, with TFR1 expression correlating with reduced lung function and increased Type-2 (T2) inflammatory responses in the airways. Furthermore, pulmonary iron levels are increased in a house dust mite (HDM)-induced model of experimental asthma in association with augmented Tfr1 expression in airway tissue, similar to human disease. We show that macrophages are the predominant source of increased Tfr1 and Tfr1 + macrophages have increased Il13 expression. We also show that increased iron levels induce increased pro-inflammatory cytokine and/or extracellular matrix (ECM) responses in human airway smooth muscle (ASM) cells and fibroblasts ex vivo and induce key features of asthma in vivo , including airway hyper-responsiveness (AHR) and fibrosis, and T2 inflammatory responses.Together these complementary clinical and experimental data highlight the importance of altered pulmonary iron levels and regulation in asthma, and the need for a greater focus on the role and potential therapeutic targeting of iron in the pathogenesis and severity of disease., Competing Interests: Conflict of interest: M.K. Ali has nothing to disclose. Conflict of interest: R.Y. Kim has nothing to disclose. Conflict of interest: A.C. Brown has nothing to disclose. Conflict of interest: J.R. Mayall has nothing to disclose. Conflict of interest: R. Karim has nothing to disclose. Conflict of interest: J.W. Pinkerton has nothing to disclose. Conflict of interest: G. Liu has nothing to disclose. Conflict of interest: K.L. Martin has nothing to disclose. Conflict of interest: M.R. Starkey has nothing to disclose. Conflict of interest: A.L. Pillar has nothing to disclose. Conflict of interest: C. Donovan has nothing to disclose. Conflict of interest: P.S. Pathinayake has nothing to disclose. Conflict of interest: O.R. Carroll has nothing to disclose. Conflict of interest: D. Trinder has nothing to disclose. Conflict of interest: H.L. Tay has nothing to disclose. Conflict of interest: Y.E. Badi has nothing to disclose. Conflict of interest: N.Z. Kermani has nothing to disclose. Conflict of interest: Y-K. Guo has nothing to disclose. Conflict of interest: R. Aryal has nothing to disclose. Conflict of interest: S. Mumby has nothing to disclose. Conflict of interest: S. Pavlidis has nothing to disclose. Conflict of interest: I.M. Adcock reports grants from EU-IMI, during the conduct of the study. Conflict of interest: J. Weaver has nothing to disclose. Conflict of interest: D. Xenaki has nothing to disclose. Conflict of interest: B.G. Oliver has nothing to disclose. Conflict of interest: E.G. Holliday has nothing to disclose. Conflict of interest: P.S. Foster has nothing to disclose. Conflict of interest: P.A. Wark has nothing to disclose. Conflict of interest: D.M. Johnstone has nothing to disclose. Conflict of interest: E.A. Milward has nothing to disclose. Conflict of interest: P.M. Hansbro has nothing to disclose. Conflict of interest: J.C. Horvat has nothing to disclose., (Copyright ©ERS 2020.)

Alzheimer's disease, the most common form of dementia, was first formally described in 1907 yet its etiology has remained elusive. Recent proposals that Aβ peptide may be part of the brain immune response have revived longstanding contention about the possibility of causal relationships between brain pathogens and Alzheimer's disease. Research has focused on infectious pathogens that may colonize the brain such as herpes simplex type I. Some researchers have proposed the respiratory bacteria Chlamydia pneumoniae may also be implicated in Alzheimer's disease, however this remains controversial. This review aims to provide a balanced overview of the current evidence and its limitations and future approaches that may resolve controversies. We discuss the evidence from in vitro, animal and human studies proposed to implicate Chlamydia pneumoniae in Alzheimer's disease and other neurological conditions, the potential mechanisms by which the bacterium may contribute to pathogenesis and limitations of previous studies that may explain the inconsistencies in the literature., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The occurrence and fate of five drugs of abuse in raw influent and treated effluent wastewater were investigated over a period of 1 year in the Adelaide region of South Australia. Four wastewater treatment plants were chosen for this study and monitored for five drugs which included cocaine in the form of its metabolite benzoylecgonine (BE), methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA) and two opioids (codeine and morphine) during the period April 2016 to February 2017. Alongside concentrations in raw sewage, the levels of drugs in the treated effluent were assessed and removal efficiencies were calculated. Drug concentrations were measured by mixed-mode solid phase extraction and liquid chromatography coupled to a quadrupole mass spectrometer. Drug concentrations detected in the raw wastewater ranged from 7 to 6510 ng/L and < LOD to 4264 ng/L in treated effluent samples. Drug removal rates varied seasonally and spatially. The mass loads of drugs discharged into the environment were in descending order: codeine > methamphetamine > morphine > MDMA > BE. Results showed that all the targeted drugs were on average incompletely removed by wastewater treatment, with removal performance highest for morphine (94%) and lowest for MDMA (58%). A screening-level environmental risk assessment was subsequently performed for the drugs based on effluent wastewater concentrations. Based on calculated risk quotients, overall environmental risk for these compounds appears low, with codeine and methamphetamine likely to pose the greatest potential risk to receiving environments. Given the recognised limitations of current ecotoxicological models and risk assessment methods for these and other pharmaceutical drugs, the potential for environmental impacts associated with the continuous discharge of these compounds in wastewater effluents should not be overlooked.

A two-chambered microbial fuel cell (MFC) was used for the first time for the remediation of an emerging contaminant-1,4-dioxane in its anode chamber. Groundwater historically detected 1,4-dioxane contamination was sampled from a Superfund site. Comparative study was carried out between metabolic (i.e., 1,4-dioxane as sole carbon source) and cometabolic (i.e., 1,4-dioxane and methanol as carbon sources) anodic degradations. It was found that cometabolic degradation increased 1,4-dioxane removal by 10%-52% after 7 days and increased maximum power production of the MFC by 18% to 88.9 mW/m 3 . Oxalic acid was detected as a main metabolic degradation product. Beside oxalic acid, acetic acid and isopropanol were also detected as main products for cometabolic degradation. The presence of a biofilm for 1,4-dioxane anodic degradation was observed by a scanning electron microscopy. Phyla of Bacteroidetes, Firmicutes, and Proteobacteria, as well as a variety of species, were identified for the first time-especially Rikenella sp. and Solitalea canadensis, whose relative abundances were the highest of 18.8% and 24.0% for metabolic and cometabolic degradation, respectively. This study provided an innovative and sustainable approach for 1,4-dioxane anodic biodegradation, which would be potentially utilized for remediation of groundwater contaminated by 1,4-dioxane. PRACTITIONER POINTS: Groundwater contaminated with 1,4-dioxane was remediated in the anode chamber of a two-chambered microbial fuel cell. Cometabolic pathway increased 1,4-dioxane removal and power production of the MFC compared to metabolic pathway. The presence of a biofilm for 1,4-dioxane anodic degradation was observed, and oxalic acid was a main degradation product. This study would be potentially utilized for 1,4-dioxane-contaminated groundwater remediation with simultaneous energy production. External voltage supply for bioelectrochemical remediation of groundwater would potentially be reduced when treating chlorinated hydrocarbons co-occurred with 1,4-dioxane., (© 2019 Water Environment Federation.)

Assessing urban stormwater quality by investigation and characterisation of pollutants is a prerequisite for its effective management, for reuse and safe discharge. The stochastic nature of rainfall, dry weather periods, topology, human activities and climatic conditions generate and wash-off pollutants differently from event to event. This study investigated the major physico-chemical pollutants in stormwater runoff collected from an urban catchment over a period of two years. The aim of this study was to explore the use of UV spectroscopy to identify the first flush. In this study, the variation of pollutants during the passage of a rain event and the relationships among the measured pollutants was analysed to help broaden the application of UV spectroscopy beyond the detection of organic matter. Correlation analysis and principal component analysis (PCA) were performed to identify the possible relationship among measured pollutants. Although correlation analysis revealed some relationships between pollutants, in general they were not strong enough and was not helpful. PCA biplots suggested a few groups and revealed that the two components model could explain nearly 72% of the variability between pollutants. Pollutants in the group that included dissolved organic carbon (DOC) behaved in a similar manner. UV spectroscopy was applied to identify the first flush by comparing the recorded spectrum of consecutive samples that were collected in an event. Analysis of the spectra was able to isolate the point when first flush ends for DOC and pollutants that behave similar to it., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Incorporating the patient's perspective to evaluate national surgical quality has yet to be achieved in the United States and represents a tremendous unrealized opportunity for continuous quality improvement. The first phase of a multiphase pilot to measure patient-reported outcomes (PROs) using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) is described., Methods: After conducting a baseline knowledge assessment and stakeholder engagement activities, a pilot to capture PROs was implemented using the ACS NSQIP platform. Hospital participation was voluntary. A 45-item survey was compiled from three validated PRO measures and administered electronically to patients accrued into the ACS NSQIP registry. Constructs measured were overall health-related quality of life, pain interference, and experiences of care. Lessons learned during implementation were compiled, and preliminary data analyses were conducted., Results: Between October 2017 and March 2018, 1,324 patients from 17 hospitals in the United States and Canada responded to the survey. Responding patients underwent 348 different types of operations, varying in complexity and riskiness. The median age of respondents was 63 years (interquartile range: 52-70), and the survey took on average 6.4 minutes to complete. Hospital response rates ranged from 10% to 50% with a 20% median., Conclusion: The implementation of this first phase demonstrates that the measurement of PROs is possible using the ACS NSQIP and that the barriers-perceived or real-can be reasonably overcome., (Copyright © 2018 The Joint Commission. Published by Elsevier Inc. All rights reserved.)

Background: The physiological and metabolic processes involved with grapevine growth and production are influenced by key macro- and micronutrients. Potassium is an essential plant nutrient that affects growth and fruit quality. In this study, the impact of foliar spraying of potassium sulfate (K 2 SO 4 ) on qualitative characteristics of grape berries was evaluated in the cultivar 'Rasha', a commonly cultivated cultivar in Kurdistan province of Iran. Leaves of the fully grown vines were sprayed with each of the 1.5 and 3 g L -1 K 2 SO 4 solutions once (1 month after petal senescence) and twice (15 days after first spraying). The control plants were sprayed with distilled water. Various biochemical contents and enzyme activities on the ripe berries were analyzed., Results: Significant increases in anthocyanin, total protein content, and antioxidant enzyme activities were observed in the berries treated twice with 3 g L -1 K 2 SO 4 . Concentrations of total carbohydrate, phenol, and antioxidant activity in berries sprayed with K 2 SO 4 were higher than in the controls. We observed a strong correlation between antioxidant activity and different phenolic compounds., Conclusion: These findings suggest that K 2 SO 4 treatment influences biosynthesis of phenolic compounds and antioxidant enzymes. Thus, treatment by K 2 SO 4 could improve nutritional and qualitative attributes of grape. © 2018 Society of Chemical Industry., (© 2018 Society of Chemical Industry.)

Keeping the sources of pollution such as chromium (Cr) under a safe limit is a daunting challenge due to the negative impact of heavy metal bioaccumulation in vegetation and the concomitant human health exposure. We took a closer look at Sonchus asper by cultivating in the green house. It resulted in 80% germination when cultivated over nine different soils collected from the tannery dump site. The biochemical analytical techniques such as mass spectrometry indicated significant bioaccumulation of Cr in the plant tissue. As per the ICP-MS analysis, this annual herb resulted in the accumulation of 601 mg kg -1 of total Cr with 212 mg kg -1 in its shoot from soil samples containing up to 41 mg kg -1 of hexavalent Cr. The energy dispersive X-ray (EDX) spectroscopy of S. asper revealed a higher level of S element indicating a sulfate-Cr binding relation. Elevated content of Cr in soil (73,721 ± 65 mg kg -1 ) caused biochemical changes in the shoot of S. asper as indicated by the disappearance of Fourier transform infrared spectroscopy (FTIR) bands at 935 and 872 cm -1 and further revealing aliphatic -CH 2 appearing as anti-symmetry ν a (CH 2 ) and symmetric vibration ν s (CH 2 ) at the band of 2920 and 2850 cm -1 , respectively.

Papaya is trioecious and an excellent system for studying sex determination and differentiation in plants. An ortholog of HUA1, CpHUA1, a gene controlling stamen and carpel development in Arabidopsis, was cloned and characterized in papaya. CpHUA1 consists of 12 exons with full genomic length of 19,313 bp in male AU9 and 19,312 bp in hermaphrodite SunUp, whereas the Arabidopsis HUA1 consists of 12 exons with full genomic length of 4300 bp. All the 324 SNPs between male and hermaphrodite varieties are in the 11th intron, which spans 8.5 kb. Quantitative RT-PCR revealed that CpHUA1 expression is highly elevated in carpels, suggesting that CpHUA1 may be involved in sex differentiation gene network. Southern blot analysis revealed a distinct restriction pattern in male AU9 compared to hermaphrodite Kapoho and SunUp, despite high DNA sequence identity and sharing of all but two EcoR I restriction sites in genomic CpHUA1 sequences of AU9 and SunUp. The methylation of cytosine at one restriction site in male but not in other two sex types may result in distinct restriction pattern of EcoR I in southern blot result. Bisulfite sequencing showed differential methylation of CpHUA1 among sex types, particularly the enrichment of sex-specific methylation in 9th and 11th intron. The methylation difference in cold stress induced male to hermaphrodite mutant mostly observed in the CHH context of CpHUA1, but no methylation difference detected in CHH context in other sex types, which may indicate the role of methylation in CHH context of CpHUA1 in temperature-related stress response and sex reversal., (Copyright © 2018 Elsevier B.V. All rights reserved.)