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Of potential prognostic variables for COPD to use in a multi-dimensional staging tool, BMI, severity of airflow obstruction (FEV1% predicted) and the MRC Dyspnoea Score (BOD) have been shown to be useful for a more complete assessment of the impact of the disease. In 1999-2002 we identified 431 patients (208 women) with COPD in primary care surgeries and recorded their BOD scores (maximum 7). For men and women (mean±SD): age was 66±10 and 64±10; pack/years 34±19 and 34±18; BMI 27±5 and 25±6; FEV1% predicted 55±15 and 57±16; and MRC Dyspnoea Score 2.6±1.0 and 2.6±1.0; with BOD scores 1.9±1.5 and 2.0±1.6 respectively. The low mean BOD scores indicate the mainly moderate severity for this primary care cohort (only one subject had an MRC score of 5). Because of the similarities in these variables for men and women further analysis is of the whole cohort. Mortality was assessed in October 2010 and a Kaplan-Meier analysis for those with BOD scores 0 and 1 shows 80% and 75% probability of survival, whereas for a BOD score of >4 the 10-year survival was <20%. By way of contrast GOLD stages 1 and 2 had a 75% and 60% survival with Stage 4 showing a 60% survival. The Cox regression model (Abstract P219 table 1) demonstrated that BOD was a better predictor of survival than age and that smoking history was a significant covariate. Ten year survival was <10% when smoking history (with age and co-morbidity score) was added to a BOD score of >4 in a Kaplan-Meier plot. [ABSTRACT FROM AUTHOR]

Hydrolysis of poly(ethylene terephthalate) (PET) during processing in the presence of Fe2O3(ferrite) nanoparticles (IO) was investigated. Three nanocomposites, filled with 2.5, 5, and 10 wt.% of IO nanoparticles, were processed in the melt state at 260°C. A nanocomposite containing 5 wt% of nano-silica was also prepared similarly as the blank sample. Dynamic mechanical thermal properties of the nanocomposites showed that, while the introduction of SiO2nanoparticles increased the glass transition temperature (Tg) of PET, incorporation of IO nanoparticles led to a decrease in Tg. There was an increase in rheological storage modulus (G′) of PET with incorporation of SiO2nanoparticles in the low-frequency region. Conversely, the incorporation of IO nanoparticles led to a decrease in G′ in this frequency region. The decrease of G′ was attributed to hydrolysis of PET due to the presence of impurities in the IO. The zero-shear rate viscosity (η0) increased with incorporation of SiO2nanoparticles. Conversely, this value decreased with incorporation of IO nanoparticles. While rheological studies showed a significant decrease in molecular weight of the PET due to hydrolysis, the IR spectroscopy did not have sufficient ability for assessment of the hydrolysis phenomenon. However, the viscosity-average molecular weight () measurements showed that the molecular weight decrease found via rheological studies was in good accordance with thevalues. [ABSTRACT FROM PUBLISHER]

Abstract: Proton beam writing (PBW) has been proven to be a powerful tool for fabricating micro and nanostructures with high aspect ratio. However, being a direct-write technique, and therefore, a serial process, PBW is not economic for low cost multiple component production. Techniques for replicating PBW structures with low cost are necessary for applications in for example nanofluidics, tissue engineering and optical devices. We have investigated casting poly (dimethyl siloxane) (PDMS Sylgard 184, Dow Corning Corp.) with PBW structures as masters. First, a 2MeV focused beam was written into a 2μm thick PMMA layer spin coated onto 50μm thick Kapton film substrate. Next, these PMMA structures, with details down to 700nm, were replicated with PDMS. Without any release coating treatment, PDMS circular pillars, 700nm in diameter were successfully replicated. We also fabricated a nickel master with nanofeature dimensions and 2μm depth using proton beam writing and sulfamate electroplating. The nickel master was used to successfully replicate a prototype DNA separation chip using PDMS. [Copyright &y& Elsevier]

Purpose: The abdominal wall and musculoskeletal tendons share many anatomic, physiologic, and functional characteristics. This review aims to highlight these similar characteristics and to present a rationale why the treatment principles of successful musculoskeletal tendon reconstruction, including principles of surgical technique and physical therapy, can be used in the treatment of complex abdominal wall reconstruction or ventral hernia repair. Methods: The MEDLINE/PubMed database was used to identify published literature relevant to the purpose of this review. Conclusions: There are several anatomical and functional similarities between the linea alba and musculoskeletal tendons. Because of this reason, many of the surgical principles for musculoskeletal tendon repair and ventral hernia repair overlap. Distribution of tension is the main driving principle for both procedures. Suture material and configuration are chosen to maximize tension distribution among the tissue edges, as seen in the standard of care multistrand repairs for musculoskeletal tendons, as well as in the small bites for laparotomy technique described in the STITCH trial. Physical therapy is also one of the mainstays of tendon repair, but surprisingly, is not routine in ventral hernia repair. The evidence surrounding physical therapy prehabilitation and rehabilitation protocols in other disciplines is significant. This review challenges the fact that these protocols are not routinely implemented for ventral hernia repair, and presents the rationale and feasibility for the routine practice of physical therapy in ventral hernia repair. [ABSTRACT FROM AUTHOR]

Three quinoline derivatives as corrosion inhibitors for N80 steel 15% HCl solutions. Influence of the –H, –OCH3 groups and the introduction of π bonding are reported in the present report. Experimental studies were performed using gravimetric tests, electroanalytical methods, and surface analysis. The cinnamaldehyde derivative displayed the maximum inhibition efficiency of 95% at 300 mg L–1, followed by the –OCH3 and the –H derivatives. The inhibitor adsorption on the metal surface obeyed the Langmuir isotherm with a mixed mode of physical and chemical adsorption. Impedance measurements revealed an increase in the charge transfer resistance with the addition of increasing inhibitor dosage, which supported the inhibitor adsorption. Frequency modulations displayed a lowering in the corrosion current density upon the addition of the corrosion inhibitors. Polarization studies revealed that all the three inhibitors showed a mixed-type inhibition behavior with cathodic prevalence. SEM and FTIR of the inhibitor-adsorbed steel surface affirmed the adsorption of inhibitor and improvement in the surface smoothness of the N80 steel. The pKa analysis revealed that all the three inhibitors undergo protonation at the pyridine Nitrogen at the experimental pH. The DFT studies showed that the protonated form of the inhibitors is more active compared to the neutral form. [ABSTRACT FROM AUTHOR]

Ideally, healthcare systematic reviews ( SRs) should be beneficial to practicing professionals in making evidence-based clinical decisions. However, the conclusions drawn from SRs are directly related to the quality of the SR and of the included studies. The aim was to investigate the methodological quality and key descriptive characteristics of SRs published in prosthodontics. Methodological quality was analysed using the Assessment of Multiple Reviews ( AMSTAR) tool. Several electronic resources ( MEDLINE, EMBASE, Web of Science and American Dental Association's Evidence-based Dentistry website) were searched. In total 106 SRs were located. Key descriptive characteristics and methodological quality features were gathered and assessed, and descriptive and inferential statistical testing performed. Most SRs in this sample originated from the European continent followed by North America. Two to five authors conducted most SRs; the majority was affiliated with academic institutions and had prior experience publishing SRs. The majority of SRs were published in specialty dentistry journals, with implant or implant-related topics, the primary topics of interest for most. According to AMSTAR, most quality aspects were adequately fulfilled by less than half of the reviews. Publication bias and grey literature searches were the most poorly adhered components. Overall, the methodological quality of the prosthodontic-related systematic was deemed limited. Future recommendations would include authors to have prior training in conducting SRs and for journals to include a universal checklist that should be adhered to address all key characteristics of an unbiased SR process. [ABSTRACT FROM AUTHOR]

Abstract: The fabrication of polymer lab-on-a-chip systems for applications in Chemistry and Biology is one of the envisaged niche areas for the Proton Beam Writing (PBW) technique developed at the Centre for Ion Beam Applications (CIBA). Utilizing a highly focused beam of MeV protons, well-defined nanostructures with smooth and straight side walls have been directly written in a 500nm to 10μm thick PMMA layer spin coated onto a Kapton substrate. By subsequently thermally bonding the fabricated structures to bulk PMMA and carefully peeling off the Kapton, nanostructures can be attached to bulk PMMA. Finally, by bonding a PMMA sheet to the bottom side of the structure, an integrated PMMA device with enclosed multiple high aspect ratio nanochannels can be realized. Preliminary experiments conducted in order to test this polymeric device indicate good fluidic properties. The nanochannels can be easily filled with dye solution using both pressure and capillary action in the case of hydrophilic solutions. [Copyright &y& Elsevier]

Abstract: A technique has been developed for the rapid prototyping of enclosed micro/nano polymethyl methacrylate (PMMA) fluidic systems using proton beam writing (PBW) and thermal bonding. Micro/nano structures consisting of channels and reservoirs were fabricated in a PMMA resist layer coated on to a Kapton substrate using a focused MeV proton beam. By thermal bonding these structures are fixed to a top bulk housing of PMMA, peeling off the Kapton substrate, and bonding the remaining exposed side to PMMA, enclosed high-aspect-ratio nano/microchannels can be fabricated. The key to the process is bonding the PMMA housing to the patterned resist under suitable conditions, to ensure that the bond strength is higher than the adhesion between the resist to the Kapton substrate, while ensuring that the deformation of the patterned structures caused by bonding temperature and pressure is minimised. Experiments showed that the optimum bonding condition is at 105°C with a pressure of 1.2Bar for 2h. [Copyright &y& Elsevier]

Abstract: The proton beam writing technique is a direct write lithographic technique that is being actively developed at the Centre for Ion Beam Applications, National University of Singapore for microphotonic applications. The technique utilizes a highly focused beam of MeV protons to pattern or modify the refractive index of various materials including polymers, glasses and other inorganic crystals. The technique has been applied to the fabrication of several different types of microoptical components including waveguides, gratings, microlens arrays and colloidal crystal templates. In this paper we give a review of the progress made thus far by our group and other workers in the field of microphotonics using proton beam writing. [Copyright &y& Elsevier]

The major threat to public health due to the outbreak of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection has been recognised as a global issue. The increase in morbidity is primarily due to the lack of SARS-CoV-2 specific drugs. One of the major strategies to combat this threat is to deactivate the enzymes responsible for the replication of corona virus. To this end, 3-arylidene/3-hydroxycoumarin induced deactivation of 3-chymotrypsin like protease (3CLpro) enzyme, which takes the pivotal role in the replication and maturation, was investigated. For ready availability of the compounds for the above investigation, we have developed a user-friendly protocol for the synthesis 3-hydroxycoumarin derivatives from cheap and readily available starting materials in two steps; i) Bronsted acid catalysed Friedel-Crafts alkylation of phenols with Morita-Baylis-Hillman adducts followed by intramolecular lactonization to trans-3-arylidenechroman-2-ones in one-pot and ii) ozonolysis in reasonably good yields. Pharmacokinetic assessments of coumarin derivatives revealed drug-like characteristics with moderate or low toxicity values. Notably, these hydroxycoumarins exhibited enhanced binding affinity against the 3CL protease of SARS-CoV-2, fitting well into the binding pocket akin to the previously studied inhibitor N3. Furthermore, a molecular dynamics study elucidated the dynamic behaviour of these small molecules when bound to the protein, showcasing intriguing complexities within the active site. Despite backbone variations and residual fluctuations, compounds 3 d-f and 6 a exhibited a consistent behaviour, instilling confidence in the therapeutic potential of these coumarins for combating SARS-CoV-2., (© 2024 The Authors. ChemistryOpen published by Wiley-VCH GmbH.)

Rhabdomyolysis (RML), characterized by the breakdown of skeletal muscle fibers and the release of muscle contents into the bloodstream, has emerged as a notable complication associated with Coronavirus disease 2019 (COVID-19) infection and vaccination. Studies have reported an increased incidence of RML in individuals with severe COVID-19 infection. However, the exact mechanisms remain unclear and are believed to involve the host's immune response to the virus. Furthermore, RML has been documented as a rare adverse event following COVID-19 vaccination, particularly with mRNA vaccines. Proposed mechanisms include immune responses triggered by the vaccine and T-cell activation against viral spike proteins. This study aims to review the current literature on the incidence, pathophysiology, clinical presentation, and outcomes of RML secondary to COVID-19 infection and vaccination. We identify common risk factors and mechanisms underlying this condition by analyzing case reports, clinical studies, and pharmacovigilance data. Our findings suggest that while RML is a relatively rare adverse event, it warrants attention due to its potential severity and the widespread prevalence of COVID-19 and its vaccines. This review underscores the need for heightened clinical awareness and further research to optimize management strategies and improve patient outcomes in this context., 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 © 2024 Karimi, Faal Hamedanchi, Ansari, Nahavandi, Mazdak, Javaherchian, Koochaki, Asadi Anar, Shirforoush Sattari and Mohamaditabar.)

Introduction: Maxillofacial fracture severely affects the diet of the patients leading to reduction of body weight. Facial trauma affects the muscles of mastication and the bones of face leading to reduction in bite force. The purpose of our study was to investigate the effect of whey protein supplement in the postoperative period of maxillofacial trauma patients with respect to body weight, bite force and callus formation., Methodology: Patients were divided into control group and study group having 20 patients each. The control group received usual modified diet for maxillofacial fracture and study group received same diet along with whey protein for 6 weeks., Results: There was mean weight loss of 3.15 kg in control group whereas there was no weight loss of in the study group. There was statistically significant increase in bite force in the study group compared to the control group with p value < 0.05. Early callus formation was seen in study group compared to control group., Conclusion: Our results showed that patients who were supplemented with whey protein had no loss of body weight, better masticatory efficiency, better healing of the fracture sites and overall early recovery., Competing Interests: Conflict of interestAll authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or nonfinancial interest in the subject matter or materials discussed in this manuscript. No funds, grants or other support was received for this manuscript., (© The Association of Oral and Maxillofacial Surgeons of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Water scarcity and pollution has increased the need for innovative and effective waste water treatment methods. The presented study aims to tackle this difficulty by synthesizing zinc oxide (ZnO) and nickel (Ni) doped ZnO to improve their photo catalytic capacity. This study examines wastewater treatment and organic pollutant breakdown using nanotechnology. The annealing increases photo catalytic activity by 65%, thereby enhancing efficiency. XRD shows that annealing decreased the average crystal size of pure ZnO and nickel doped ZnO (Ni:ZnO) i.e., for pure ZnO average crystal size is decreased from 23.90 to 20.90 nm and for Ni:ZnO, 34.39-28.65 nm. SEM shows that un annealed samples have agglomerates, while annealed samples are quasi-spherical. Using diffuse reflectance spectroscopy (DRS), the study examines how annealing affects optical band gap. Annealed Ni:ZnO has a band gap of 3.09 eV, which is smaller as compared to un annealed Ni:ZnO (3.18 e V). Similarly, the decline in energy band gap is observed for pure ZnO too. This study highlights the significant capacity of Ni:ZnO, for un annealed and annealed synthesis, to effectively meet the urgent requirements for waste water treatment. The extensive research conducted in this work enhances our comprehension of photo catalytic materials and underscores its potential for practical implementation in addressing waste water-related environmental issues., (© 2024. The Author(s).)

Pediatric patients with osteomyelitis, a serious bone infection, have several difficulties. A 12-year-old child with an acute osteomyelitis diagnosis is the subject of this case study. The child had decreased limb function, a fever, and localized pain. Laboratory testing and diagnostic imaging procedures verified that Staphylococcus aureus was the culprit for the infection. Surgical debridement and intravenous antibiotics were used in combination for treatment. Therapy responses were constantly examined, and modifications were made in response to clinical and radiological findings. Prompt intensive treatment and early detection were essential for controlling the infection and averting long-term consequences. This example emphasizes the value of a multidisciplinary approach to treating pediatric osteomyelitis, pointing out possible directions for future study and presenting best practices., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Saifi et al.)

Background and Objectives: Following the outbreak of COVID-19, a set of restrictions, health advice, and limitations were put in place to reduce the spread of the virus. These restrictions, together with fear and anxiety of the population, limited people's access to public services such as health care services. Cancer patients during this era are a significant concern due to being at high risk for COVID-19 infection and also being exposed to delays in their diagnosis, treatment, and follow-ups. Delays in the treatment of cancer could lead to a poorer prognosis. In this study, we attempted to determine the magnitude of delays in chemotherapy and factors associated with delays during the COVID-19 pandemic., Method: All patients diagnosed with colorectal, lung, gastric cancer, and lymphoma who had chemotherapy at teaching hospitals of Iran University of Medical Sciences (IUMS) between February 20, 2020, and March 20, 2022, were included. Age, gender, cancer type, having metastatic cancer, and date of each chemotherapy session were included for each patient individually. Every session with delays longer than two days was recorded. A three to six-day delay was considered a moderate delay, and a seven-day or longer delay was considered a severe delay in receiving each chemotherapy session. Additionally, each patient's total number of delays in the entire course was calculated. Logistic regression was used to examine the impact of pandemic waves on delays. On the other hand, Poisson regression was used to evaluate the number of delays in the entire course of chemotherapy., Results: The research findings indicated an association between the male gender and having metastasis with a higher likelihood of a moderate delay in the treatment regimen. Regarding cancer type, colorectal cancer was associated with higher rates of moderate delays (IRR = 1.88, P < 0.001), but gastric (IRR = 0.75, P = 0.001) and lung cancer (IRR = 0.59, P = 0.002) were associated with reduced rates of severe and moderate delays, respectively. Compared to the COVID-19 pandemic plateau periods, the first (OR = 2.08, P < 0.001), third, and fifth waves of the pandemic were associated with increased delays., Conclusion: We found an association between the male gender, colorectal cancer, metastatic disease and higher rates of moderate delays. The initial COVID-19 pandemic wave was associated with increased severe delays in the chemotherapy course. According to the findings of this study, male cancer patients and those with metastatic cancer are at risk of poorer prognosis due to lower adherence to treatment. These findings can assist policymakers in developing targeted strategies to lessen the delay rates in the more vulnerable population., (© 2024. The Author(s).)

This case report highlights the understanding of the swelling feature of the right knee in a young adult and gives an overview of bone tumors. We are presenting a case of right knee swelling in a 13-year-old boy who was anxious before the investigations. Additionally, this report provides an approach for an accurate diagnosis of swelling. It highlights the approach to bone swelling and provides an overview of how to classify bone tumors. With the help of advanced technology such as magnetic resonance imaging (MRI), it gives detailed information about the nature of bone tumors, especially in the case of sessile osteochondroma. This case report also gives us information about the classification of bone tumors and their progression and guides us toward management with the help of an MRI., Competing Interests: Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Saifi et al.)

The majority of children's brain cancers are posterior fossa tumours, which include brainstem gliomas, medulloblastomas (MBs), juvenile pilocytic astrocytomas, and ependymomas. This report details a 13-year-old female presenting with headache, nausea, and ataxia. With typical magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) results, the MRI indicated a solid lesion in the fourth ventricle, producing obstructive hydrocephalus. Pilocytic astrocytoma, ependymoma, MB, and other conditions are examples of differential diagnoses. In addition to underscoring the need for early intervention to enhance prognosis and outcomes for paediatric patients with posterior fossa tumours, the case highlights the vital role that sophisticated imaging plays in early detection and therapy., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ansari et al.)

Aim : To develop paliperidone mucoadhesive-nanoemulsion (PLP-NE) to enhance brain bioavailability. To evaluate comparative effects of PLP-NE and CS-PLP-NE in the treatment of schizophrenia, followed by a toxicity study of opt-NE. Material and methods : Oil: oleic acid, surfactant: Tween-80, and co-surfactant: Labrasol were chosen based on the solubility and maximum nanoemulsion area. The ultrasonication technique was applied with the aqueous micro titration method for the development of PLP-NE. The optimization of the method for the excellent PLP-NE was performed using a central composite design based on a five-factor and four-level. Oil (% v/v), S mix (v/v%), ultrasonication intensity in percentage, ultrasonication time in minutes, and temperature (°C) were optimized and used to the independent variables. Results : The parameters i.e. , oil (5%), S mix (10%), ultrasonication time (5.0 min), ultrasonication intensity (25%), and temperature (38 °C) were optimized and used as independent and dependent variables for the development of novel PLP-NE. Based on experimental data, the dependent variables, i.e. , globule size (53.90 ± 4.01 nm), % transmittance (92.56% ± 1.06%), PDI (0.218 ± 0.007), and zeta potential (-11.60 ± 0.031 mV), were determined. The smooth near about spherical shaped of PLP-NE globules with, refractive index i.e. , 1.62 ± 0.021, viscosity: 39 ± 6 cp with the pH: 7.40 ± 0.089, and content of drug (97.98 ± 0.39%) for optimized-PLP-NE. The optimized PLP-NE with oleic acid, Tween-80, and Labrasol was used to improve brain bioavailability with good permeation via the intranasal route. CS-PLP-NE yielded good mucoadhesive property results compared to paliperidone-nanoemulsion, and PLP-S containing a 0.751 minutes retention time with their deuterated-IS (0.806 min) and m / z of 427.2/207.2 with IS ( m / z : 431.2/211.2) for PLP and PLP-IS. A calibration curve was plotted with a linear range of 1-2000 ng mL -1 with inter- and intraday accuracy (97.03-99.31%) and precision (1.69-50.05%). The results of AUC (0-24) and C max for PLP were found to be highly significant ( p < 0.001) as an improvement of brain bioavailability in rats via intranasal delivery of CS-PLP-NE. Furthermore, the locomotion test, social interaction, and forced swimming test (forced swimming, climbing, and immobility) of a mucoadhesive CS-PLP-NE (intranasally) provided highly significant results with the improvement of behavioral analysis when compared to the PLP-NE and PLP-S studies. Conclusion : CS-PLP-NE (i.n.) showed highly significant results, i.e. , p < 0.001 for the improvement of bioavailability of the brain in the treatment of schizophrenia. Optimized-mucoadhesive-CS-based-PLP-NE is safe and shows no toxicity., Competing Interests: There is no conflict between the authors exists., (This journal is © The Royal Society of Chemistry.)

Introduction: Iliac artery aneurysms are rare, with isolated iliac artery aneurysms responsible for only 2 % of all aneurysmal diseases. External iliac artery (EIA) aneurysms are extremely rare, and the exact cause is unknown. In this case, we report a giant aneurysm without any risk factor presented with rupture and managed by open repair., Presentation of Case: An 85-year-old man presented to the emergency department with sudden onset right lower quadrant abdominal pain and vague right lower limb pain. After a complete physical examination, an abdominopelvic CT scan revealed an 80 mm EIA aneurysm containing thrombosis and active leakage. The patient underwent open repair of an aneurysm using a graft between the Aorta and EIA. The surgery was uneventful. Later in the ICU, the patient experienced a cardiac arrest and unfortunately could not recover from it., Discussion: In this case, a patient with a relatively large aneurysm presented with abdominal pain and lower limb discomfort. Although endovascular surgery is recommended for the repair of iliac aneurysms, open repair is common for ruptured aneurysms. Endovascular repair is less invasive but may lead to contrast-induced renal dysfunction. Open repair may induce complications such as sexual dysfunctions, graft infection, and pelvic ischemic conditions., Conclusion: EIA aneurysms are exceedingly rare. They may present with a Rupture that puts the patient in critical condition, such as in this case. Due to the hemodynamic instability, open repair is considered one of the main approaches for repairing the aneurysm., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest. The authors are responsible for the content and writing of the article., (Copyright © 2024. Published by Elsevier Ltd.)

Hydrogels appear to be an attractive class of biomaterial for cartilage tissue engineering due to their high water content, excellent biocompatibility, tunable stiffness, etc. The crosslinking density of the hydrogel can affect their viscoelastic property, and therefore potentially impact the chondrogenic phenotype of re-differentiated chondrocytes in a 3D microenvironment through physical cues. To understand the effect of crosslinking densities on chondrocytes phenotype and cellular interaction with the hydrogel, this study utilized a clinical grade thiolate hyaluronic acid and thiolate gelatin (HA-Gel) hydrogel, crosslinked with poly(ethylene glycol) diacrylate to create various crosslinking densities. The HA-Gel hydrogels were then mixed with human nasal chondrocytes to generate neocartilage in vitro. The influence of the hydrogel crosslinking density and the viscoelastic property on the cell behaviours on the gene and matrix levels were evaluated using biochemistry assays, histology, quantitative polymerase chain reaction (qPCR) and next-generation sequencing (RNA seq). In general, the differences in the storage modulus of the HA-Gel hydrogel are not enough to alter the cartilaginous gene expression of chondrocytes. However, a positively correlated trend of PPAR-γ gene expression to the crosslinking density was measured by qPCR. The RNA-seq results have shown that 178 genes are significantly negatively correlated and 225 genes are positively correlated to the crosslinking density, which is worth investigating in the future studies., (© 2023. The Author(s) under exclusive licence to Biomedical Engineering Society.)

In this research, a novel nano-biocomposite material, namely, tungsten trioxide-Butea monosperma leaf powder (WO 3 @BLP), is an effective and eco-friendly adsorbent used for the mitigation of congo red (CR) and crystal violet (CV) dyes from its aqueous phase. The as-prepared WO 3 @BLP was characterized using Fourier transform infrared spectroscopy (FT-IR), X-ray diffraction (XRD), field emission scanning electron microscopy (FE-SEM), transmission electron microscopy (TEM), DLS analysis, and TGA. Many factors such as solution pH, WO 3 @BLP dose, temperature, contact time, and initial CR/CV dye concentrations were exploited to monitor the adsorption efficiency of WO 3 @BLP composites. The biosorption of both CR and CV dyes followed the Langmuir isotherm, with maximum adsorption capacities (q max ) reaching 84.91 mg g -1 for CR at pH 2.3 and 162.75 mg g -1 for CV at pH 8, fitting of kinetics data to the PSO model with closed values of q e exp (mg g -1 ) and q e cal (mg g -1 ), i.e., 25.69 to 25.38 mg g -1 for CR dye and 29.06 to 29.08 mg g -1 for CV dye. The interaction mechanism behind the adsorption of CR and CV dyes onto the WO 3 @BLP bionanocomposite includes electrostatic interaction and surface complexation. The synthesized materials were tested for antifungal activity against three different Candida cells, i.e., C. albicans ATCC 90028, C. glabrata ATCC 90030, and C. tropicalis ATCC 750, by using broth dilution method on the minimum inhibiting concentration (MIC). Furthermore, the cytotoxicity of nano-formulated WO 3 @BLP was studied by in vitro hemolytic assay on a human host. Overall, this research presents a pioneering nano-biocomposite, WO 3 @BLP, as a sustainable adsorbent for CR and CV dye removal, adhering to Langmuir isotherm and pseudo-second-order kinetics. Its multifaceted approach includes elucidating interaction mechanisms, demonstrating antifungal activity, and assessing cytotoxicity, marking a significant advancement in environmental remediation., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The avascular nature of hyaline cartilage results in limited spontaneous self-repair and regenerative capabilities when damaged. Recent advances in three-dimensional bioprinting have enabled the precise dispensing of cell-laden biomaterials, commonly referred to as 'bioinks', which are emerging as promising solutions for tissue regeneration. An effective bioink for cartilage tissue engineering needs to create a micro-environment that promotes cell differentiation and supports neocartilage tissue formation. In this study, we introduced an innovative bioink composed of photocurable acrylated type I collagen (COLMA), thiol-modified hyaluronic acid (THA), and poly(ethylene glycol) diacrylate (PEGDA) for 3D bioprinting cartilage grafts using human nasal chondrocytes. Both collagen and hyaluronic acid, being key components of the extracellular matrix (ECM) in the human body, provide essential biological cues for tissue regeneration. We evaluated three formulations - COLMA, COLMA+THA, and COLMA+THA+PEGDA - for their printability, cell viability, structural integrity, and capabilities in forming cartilage-like ECM. The addition of THA and PEGDA significantly enhanced these properties, showcasing the potential of this bioink in advancing applications in cartilage repair and reconstructive surgery., 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 B.V. All rights reserved.)

Adolescent idiopathic scoliosis (AIS) is an abnormal coronal curvature of the spine that most commonly presents in adolescence. While it may be asymptomatic, AIS can cause pain, cosmetic deformity, and physical and psychological disability with curve progression. As adolescents with AIS enter adulthood, condition outcomes vary with some experiencing curve stabilization and others noting further curve progression, chronic pain, osteoporosis/fractures, declines in pulmonary and functional capacity, among others. Regular monitoring and individualized management by healthcare professionals are crucial to address the diverse challenges and provide appropriate support for a fulfilling adult life with AIS. This review examines the prevalence, risk factors, presenting symptoms, diagnosis, management, and complications of AIS in the adult population, informing targeted interventions by clinicians caring for adult patients with AIS.

Importance: Restoration of dental occlusion and oral rehabilitation is the ultimate goal of functional jaw reconstruction., Objective: To evaluate the prefabricated fibula flap (PFF) technique in occlusion-driven jaw reconstruction for benign or previously treated malignant disease., Design, Setting, and Participants: This cohort study was conducted from January 2000 to December 2019 at the University of Alberta Hospital and Institute of Reconstructive Sciences in Medicine in Edmonton, Alberta, Canada, among patients who underwent PFF or bone-driven and delayed osseointegrated implant installation (BDD). Patients were followed up for a minimum of 1 year after occlusal rehabilitation. Data were analyzed from July 2021 to June 2022., Exposures: Patients underwent BDD or PFF, which consists of osseointegrated dental implant installation and skin grafting of the fibular bone 3 to 6 months before jaw tumor resection or defect reconstruction. The implant osseointegration is completed at the time of jaw reconstruction, allowing for full reconstruction, loading, and restoration of the dental occlusion in the immediate postoperative period., Main Outcomes and Measure: Safety, effectiveness, accuracy, timeliness of occlusal reconstruction, and aesthetic appeal were compared between PFF and BDD. Groups were compared for the following variables: postoperative complications, number of bony segments used, number of procedures needed, total operative time, time to occlusal rehabilitation, and number of implants installed, exposed, lost, and used (ie, exposed implants - lost implants). Aesthetic appeal was assessed using standardized full-face and profile digital photographs taken before and 6 to 12 months after the operation and analyzed by 3 naive raters., Results: Among 9 patients receiving PFF (mean [SD] age, 43.3 [13.0] years; 7 men [77.8%]) and 12 patients receiving BDD (mean [SD] age, 41.9 [18.0] years; 8 men [66.7%]), the overall complication rate was similar (4 patients [44.4%] vs 3 patients [25.0%], respectively; relative risk, 1.78 [95% CI, 0.52 to 6.04]). The number of patients with implant loss was similar between PFF and BDD groups (0 patients vs 3 patients [25.0%], respectively; difference, -25.0 percentage points [95% CI, -48.4 to 9.7 percentage points]). PFF had a clinically meaningful faster mean (SD) occlusal rehabilitation compared with BDD (12.1 [1.9] months vs 60.4 [23.1] months; difference, -48.3 months [95% CI, -64.5 to -32.0 months]). The mean (SD) difference in preoperative to postoperative aesthetic score was similar between PFF and BDD groups (-0.8 [1.5] vs -0.2 [0.8]; difference, -0.6 [95% CI, -1.6 to 0.4])., Conclusions and Relevance: This study found that PFF compared with BDD was a safe, effective, and aesthetic reconstructive option for patients with benign or previously treated jaw malignant tumors. This technique may provide rapid occlusal reconstruction and oral rehabilitation.

Systematic review/meta-analysis of cumulative incidences of venous thromboembolic events (VTE) after metabolic and bariatric surgery (MBS). Electronic databases were searched for original studies. Proportional meta-analysis assessed cumulative VTE incidences. (PROSPERO ID:CRD42020184529). A total of 3066 records, and 87 studies were included (N patients = 4,991,683). Pooled in-hospital VTE of mainly laparoscopic studies = 0.15% (95% CI = 0.13-0.18%); pooled cumulative incidence increased to 0.50% (95% CI = 0.33-0.70%); 0.51% (95% CI = 0.38-0.65%); 0.72% (95% CI = 0.13-1.52%); 0.78% (95% CI = 0-3.49%) at 30 days and 3, 6, and 12 months, respectively. Studies using predominantly open approach exhibited higher incidence than laparoscopic studies. Within the first month, 60% of VTE occurred after discharge. North American and earlier studies had higher incidence than non-North American and more recent studies. This study is the first to generate detailed estimates of the incidence and patterns of VTE after MBS over time. The incidence of VTE after MBS is low. Improved estimates and time variations of VTE require longer-term designs, non-aggregated reporting of characteristics, and must consider many factors and the use of data registries. Extended surveillance of VTE after MBS is required., (© 2024. The Author(s).)

The growing concern of pediatric mortality demands heightened preparedness in clinical settings, especially within intensive care units (ICUs). As respiratory-related admissions account for a substantial portion of pediatric illnesses, there is a pressing need to predict ICU mortality in these cases. This study based on data from 1188 patients, addresses this imperative using machine learning techniques and investigating different class balancing methods for pediatric ICU mortality prediction. This study employs the publicly accessible "Paediatric Intensive Care database" to train, validate, and test a machine learning model for predicting pediatric patient mortality. Features were ranked using three machine learning feature selection techniques, namely Random Forest, Extra Trees, and XGBoost, resulting in the selection of 16 critical features from a total of 105 features. Ten machine learning models and ensemble techniques are used to make accurate mortality predictions. To tackle the inherent class imbalance in the dataset, we applied a unique data partitioning technique to enhance the model's alignment with the data distribution. The CatBoost machine learning model achieved an area under the curve (AUC) of 72.22%, while the stacking ensemble model yielded an AUC of 60.59% for mortality prediction. The proposed subdivision technique, on the other hand, provides a significant improvement in performance metrics, with an AUC of 85.2% and an accuracy of 89.32%. These findings emphasize the potential of machine learning in enhancing pediatric mortality prediction and inform strategies for improved ICU readiness., (© 2024. The Author(s).)

The crystalization of the components of bile within the gallbladder can lead to the formation of gallstones (cholelithiasis), which may often require surgical removal of the gallbladder, a procedure known as cholecystectomy, in symptomatic cases. Robotic single-site cholecystectomy (RSSC) is a recently introduced groundbreaking minimally invasive procedure for gallbladder removal. RSSC utilizes robotic technology, offering enhanced dexterity through a single-incision approach, promising improved outcomes such as reduced postoperative pain and superior cosmesis. However, certain limitations, such as restricted instrument movement and heightened hernia risk, necessitate a critical evaluation of this modality. Furthermore, as the widespread adoption of RSSC remains undecided due to concerns over its costs, efficiency, and overall superiority over prior models, this paper assesses future possibilities for RSSC's evolution. In vivo robotics, improved digital imaging, and re-engineering of the surgical instruments themselves are all potential avenues to augment the current RSSC design, although it is currently unclear as to what extent they could impact the procedure's viability. This review critically examines the available literature on the effectiveness and potency of RSSC compared to its predecessors in the modern healthcare setting and proposes future directions through which innovation could more firmly establish the procedure as the standard of care for cholecystectomy., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Ansari et al.)

Extracellular vesicles (EVs), including exosomes, have significant potential for diagnostic and therapeutic applications. The lack of standardized methods for efficient and high-throughput isolation and analysis of EVs, however, has limited their widespread use in clinical practice. Surface epitope immunoaffinity (SEI) isolation utilizes affinity ligands, including antibodies, aptamers, or lectins, that target specific surface proteins present on EVs. Paramagnetic bead-SEI isolation represents a fit-for-purpose solution for the reproducible, high-throughput isolation of EVs from biofluids and downstream analysis of RNA, protein, and lipid biomarkers that is compatible with clinical laboratory workflows. This study evaluates a new SEI isolation method for enriching subpopulations of EVs. EVs were isolated from human plasma using a bead-based SEI method designed for on-bead and downstream analysis of EV-associated RNA and protein biomarkers. Western blot analysis confirmed the presence of EV markers in the captured nanoparticles. Mass spectrometry analysis of the SEI lysate identified over 1500 proteins, with the top 100 including known EV-associated proteins. microRNA (miRNA) sequencing followed by RT-qPCR analysis identified EV-associated miRNA transcripts. Using SEI, EVs were isolated using automated high-throughput particle moving instruments, demonstrating equal or higher protein and miRNA yield and recovery compared to manual processing. SEI is a rapid, efficient, and high-throughput method for isolating enriched populations of EVs; effectively reducing contamination and enabling the isolation of a specific subpopulation of EVs. In this study, high-throughput EV isolation and RNA extraction have been successfully implemented. This technology holds great promise for advancing the field of EV research and facilitating their application for biomarker discovery and clinical research., (© The Author(s) 2024. Published by Oxford University Press.)

Background: No previous research of university students in Finland assessed lifestyle behavioral risk factors (BRFs), grouped students into clusters, appraised the relationships of the clusters with their mental well-being, whilst controlling for confounders. The current study undertook this task., Methods: Students at the University of Turku (n = 1177, aged 22.96 ± 5.2 years) completed an online questionnaire that tapped information on sociodemographic variables (age, sex, income sufficiency, accommodation during the semester), four BRFs [problematic alcohol consumption, smoking, food consumption habits, moderate-to-vigorous physical activity (MVPA)], as well as depressive symptoms and stress. Two-step cluster analysis of the BRFs using log-likelihood distance measure categorized students into well-defined clusters. Two regression models appraised the associations between cluster membership and depressive symptoms and stress, controlling for sex, income sufficiency and accommodation during the semester., Results: Slightly more than half the study participants (56.8%) had always/mostly sufficient income and 33% lived with parents/partner. Cluster analysis of BRFs identified three distinct student clusters, namely Cluster 1 (Healthy Group), Cluster 2 (Smokers), and Cluster 3 (Nonsmokers but Problematic Drinkers). Age, sex and MVPA were not different across the clusters, but Clusters 1 and 3 comprised significantly more respondents with always/mostly sufficient income and lived with their parents/partner during the semester. All members in Clusters 1 and 3 were non-smokers, while all Cluster 2 members comprised occasional/daily smokers. Problematic drinking was significantly different between clusters (Cluster 1 = 0%, Cluster 2 = 54%, Cluster 3 = 100%). Cluster 3 exhibited significantly healthier nutrition habits than both other clusters. Regression analysis showed: (1) males and those with sufficient income were significantly less likely to report depressive symptoms or stress; (2) those living with parents/partner were significantly less likely to experience depressive symptoms; (3) compared to Cluster 1, students in the two other clusters were significantly more likely to report higher depressive symptoms; and (4) only students in Cluster 2 were more likely to report higher stress., Conclusions: BRFs cluster together, however, such clustering is not a clear-cut, all-or-none phenomenon. Students with BRFs consistently exhibited higher levels of depressive symptoms and stress. Educational and motivational interventions should target at-risk individuals including those with insufficient income or living with roommates or alone., (© 2024. The Author(s).)

Objective: To assess the effects of COVID-19 vaccines in women before or during pregnancy on SARS-CoV-2 infection-related, pregnancy, offspring and reactogenicity outcomes., Design: Systematic review and meta-analysis., Data Sources: Major databases between December 2019 and January 2023., Study Selection: Nine pairs of reviewers contributed to study selection. We included test-negative designs, comparative cohorts and randomised trials on effects of COVID-19 vaccines on infection-related and pregnancy outcomes. Non-comparative cohort studies reporting reactogenicity outcomes were also included., Quality Assessment, Data Extraction and Analysis: Two reviewers independently assessed study quality and extracted data. We undertook random-effects meta-analysis and reported findings as HRs, risk ratios (RRs), ORs or rates with 95% CIs., Results: Sixty-seven studies (1 813 947 women) were included. Overall, in test-negative design studies, pregnant women fully vaccinated with any COVID-19 vaccine had 61% reduced odds of SARS-CoV-2 infection during pregnancy (OR 0.39, 95% CI 0.21 to 0.75; 4 studies, 23 927 women; I 2 =87.2%) and 94% reduced odds of hospital admission (OR 0.06, 95% CI 0.01 to 0.71; 2 studies, 868 women; I 2 =92%). In adjusted cohort studies, the risk of hypertensive disorders in pregnancy was reduced by 12% (RR 0.88, 95% CI 0.82 to 0.92; 2 studies; 115 085 women), while caesarean section was reduced by 9% (OR 0.91, 95% CI 0.85 to 0.98; 6 studies; 30 192 women). We observed an 8% reduction in the risk of neonatal intensive care unit admission (RR 0.92, 95% CI 0.87 to 0.97; 2 studies; 54 569 women) in babies born to vaccinated versus not vaccinated women. In general, vaccination during pregnancy was not associated with increased risk of adverse pregnancy or perinatal outcomes. Pain at the injection site was the most common side effect reported (77%, 95% CI 52% to 94%; 11 studies; 27 195 women)., Conclusion: COVID-19 vaccines are effective in preventing SARS-CoV-2 infection and related complications in pregnant women., Prospero Registration Number: CRD42020178076., Competing Interests: Competing interests: None declared., (© World Health Organization 2024. Licensee BMJ.)

Introduction:  Hydrocele of the canal of Nuck is a condition that arises due to incomplete obliteration of the processus vaginalis or an abnormal outpouching from the round ligament during fetal development. It usually presents as a painless, rarely painful, groin swelling. The definitive diagnosis for this condition is magnetic resonance imaging. Various management options have been proposed for this condition, including open surgery, transabdominal preperitoneal approach, totally extraperitoneal approach, and a combination of laparoscopic and open surgery. The present study highlights the benefits of the transabdominal preperitoneal approach when compared with the open anterior approach and addresses the intraoperative challenges faced during laparoscopic surgery., Materials and Methods:  The study is a retrospective study inclusive of 20 patients who underwent surgery for the hydrocele of the canal of Nuck from June 2019 to December 2023. Case records of patients were studied for information such as demographic features, type of pathology, the surgery performed, intraoperative challenges encountered, operative time, duration of hospital stay, scores from the visual analog scale pain assessment chart at various intervals, and time taken to return to work. The variables were documented and statistically analyzed., Results:  The average age group of the study population was 27.8 ± 8.34 years. Of the 20 patients, 10 had undergone a transabdominal preperitoneal approach (Group A), and 10 had undergone an open anterior approach (Group B). Eleven out of 20 patients had an associated inguinal hernia, of which three were identified preoperatively and eight were identified incidentally during surgery. The mean operative time of Group A cases was 97.95 ± 7.54 minutes, while it was 66.3 ± 6.20 minutes for Group B cases. The Mann-Whitney U test showed a statistically significantly lesser operative time for Group B than for Group A (p-value < 0.001). The duration of hospital stays was comparable for the two groups with no significant difference (two days versus 3.8 ± 3.08 days, respectively). When the difference in the means of time taken to return to normal work was compared using the Mann-Whitney U test between Group A and B (6.1 ± 0.87 days and 11.2 ± 1.81 days, respectively), a statistically significant early return to normal work in the former group (p-value = 0.001) was revealed. Similarly, the Mann-Whitney U test when used to compare the median postoperative pain score of both groups at 12-24 hours, 48-72 hours, seven days, and three months showed a significantly lesser pain score among patients of Group A at all intervals (p-value < 0.001, p-value = 0.005, p-value = 0.005, p-value < 0.001, respectively). The incidence of intraoperative challenges, sero-hematoma, and surgical site infection were insignificant in comparison., Conclusion: The transabdominal preperitoneal approach for the hydrocele of the canal of Nuck is ideal as it offers excellent intraoperative delineation of pathology and postoperative outcomes. Prophylactic placement of a mesh in all cases can help prevent a future occurrence of inguinal hernia in these cases., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Venkateswaran et al.)

Background: After the outbreak of COVID-19, a huge part of the health care services was dedicated to preventing and treating this disease. In case of COVID-19 infection, severe COVID-19 is reported more in pregnant individuals. Afterward, Vaccination against SARS-CoV-2 became a hot topic due to known effects in preventing severe COVID-19 during pregnancy. Vaccination of pregnant individuals started in August 2021 with the Sinopharm vaccine in Iran. The aim of current study was to determine the incidence of perinatal outcomes in women who were vaccinated during pregnancy., Method: This retrospective cohort study included 129,488 singleton births from March 21, 2021, until March 21, 2022, in Tehran, Iran. The data was obtained from the Iranian Maternal and Neonatal (IMaN) Network and the Maternal Vaccination Registry. Adverse perinatal outcomes investigated in this study include preterm birth, extremely preterm birth, low birth weight, very low birth weight, intrauterine growth restriction, stillbirth, neonatal intensive care unit admission, congenital anomaly, neonatal death and low 5-minute Apgar score. The risk of all perinatal outcomes was evaluated using multiple logistic regression. The analysis was done using STATA version 14., Results: Of all 129,488 singleton births included in this study, 17,485 (13.5%) were vaccinated against SARS-CoV-2 (all with Sinopharm (BBIBP-CorV)). The exposure to the Sinopharm vaccine during pregnancy caused a significant decrease in the incidence of preterm birth (P =0.006, OR=0.91 [95% CI, 0.85 to 0.97]), extremely preterm birth (P =<0.001,OR=0.55 [95% CI, 0.45 to 0.66]), and stillbirth (P =<0.001, OR=0.60 [95% CI, 0.47 to 0.76]). Exposure to vaccination during the first trimester was associated with an increased risk of preterm birth (P =0.01, OR=1.27 [95% CI, 1.04 to 1.55]) Maternal vaccination during pregnancy was not associated with an increased risk of other adverse perinatal outcomes included in this study., Conclusion: The finding of this population-based study indicated no adverse pregnancy outcome due to vaccination with the Sinopharm vaccine during the second and third trimesters of pregnancy. Overall risk of adverse pregnancy outcomes were lower in the vaccinated individuals compared to the unvaccinated group. Also, vaccination during the first trimester was associated with an increased risk of preterm birth., (© 2024. The Author(s).)

In this technology era, sustainable construction practices have become quite imperative. The exploration of alternative materials to reduce the environmental footprint is of paramount importance. This research paper delves into an exhaustive investigation concerning the utilization of recycled coarse aggregates (RCA) and rubber particles (RP) in concrete. It contributes to the growing body of knowledge aimed at fostering sustainable development in the construction industry by reducing waste, promoting recycling, and mitigating the environmental footprint of building materials. The objective of the study is to evaluate the potential benefits and limitations associated with incorporating these materials, thereby providing a sustainable alternative to conventional concrete. In this research, construction and demolition waste were recycled and used as RCA as a fractional switch of natural coarse aggregate (NCA) from 0% to 100%, with an increment of 20% replacement of NCA in concrete. The RP received from discarded tires generated as automobile industry waste were used as a volumetric fractional substitution of sand in concrete from 0% to 20%, with a 5% increment. No pre-treatment for RCA and RP was carried out before their utilization in concrete. A total of 26 mixes, including control concrete without NCA and RP, with a design strength of 40 MPa, were prepared and tested. Concrete mixes were examined for workability, density, mechanical, and durability properties. It was found that the concrete with 60% RCA and 10% RP showed satisfactory results in evaluation with the strength parameters of control concrete, as the compressive strength obtained for this concrete mix is 40.18 MPa, similar to the control mix. The optimization for RCA and RP was conducted using Response Surface Methodology (RSM). The major concern observed was a rise in water absorption with an increase in the percentage replacement of NCA and natural sand by RCA and RP. Findings from the investigation illustrate a promising prospect for the use of RCA and RP in concrete applications, displaying competent mechanical properties and enhanced durability under certain conditions, offering a viable option for environmentally friendly construction practices. However, the research also sheds light on some constraints and challenges, such as the variability in the quality of RCA and the necessity for meticulous quality control to ensure the reliability and consistency of the end product. It is discerned that further refinement in processing techniques and quality assurance measures is pivotal for mainstream adoption of RCA and RP in concrete construction., Competing Interests: 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., (© 2024 The Author(s).)

Introduction: A well-developed procedural sedation programme in the paediatric emergency department can minimise adverse events. We examined how adherence to current best evidence ensures safe delivery of paediatric sedation in a newly established tertiary paediatric hospital., Methods: Our sedation service uses a robust provider training and privileging system, standardised policy and procedures and rigorous data collection all within an evidence-based clinical governance process. We examined sedation data from the first 3 years of operation., Results: From July 2018 to May 2022, ketamine was used in 3388 of the 3405 sedations. The mean age of sedated children was 5.5 years (range 6 months to 17.8 years) and common indications were closed reduction of fractures and laceration repairs. A total of 148 (4.37%, 95% CI 3.68% to 5.06%) adverse events were documented, including 88 (2.59%, 95% CI 2.06% to 3.13%) cases of vomiting, 50 (1.48%, 95% CI 1.07% to 1.88%) cases related to airway and breathing with 40 (1.18%, 95% CI 0.82% to 1.54%) cases of oxygen desaturation, 6 (0.18%, 95% CI 0.04% to 0.32%) cases of laryngospasm, 4 (0.12%, 95% CI 0% to 0.23%) cases of apnoea., Conclusion: This study presents a large single-centre dataset on the use of intravenous ketamine in paediatric procedural sedation. Adhering to international standards and benchmarks for provider skills and training, drug administration and monitoring facilities, with a strict clinical governance process, optimizes patient safety., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: The aim of this study, a retrospective database analysis, was to assess the impact of baseline cannabis use disorder (CUD) on perioperative complication outcomes in patients undergoing primary 1- to 2-level anterior cervical diskectomy and fusion (ACDF) surgery., Methods: The PearlDiver Database was queried from January 2010 to December 2021 for patients who underwent primary 1- to 2-level ACDF surgery for degenerative spine disease. Patients with CUD diagnosis 6 months before the index ACDF surgery (i.e., CUD) were propensity matched with patients without CUD (i.e., control in a ratio of 1:1, employing age, gender, and Charlson Comorbidity Index as matching covariates). Univariate and multivariable analysis models with adjustment of confounding variables were used to evaluate the risk of CUD on perioperative complications between the propensity-matched cohorts., Results: The 1:1 matched cohort included 838 patients in each group. Following multivariate analysis, CUD was demonstrated to be associated with an increased incidence of hospital readmission at 90 days (odds ratio [OR] = 2.64, 95% confidence interval: [1.19 to 6.78], [P = 0.027]) and revision surgery at 1 year postoperative (OR = 3.36, 95% confidence interval: [1.17 to 14.18], [P = 0.049]). CUD was additionally associated with reduced risk of overall medical complications at both 6 months and 1 year postoperative (OR = 0.55, [P = 0.021], and OR = 0.54, [P = 0.015], respectively)., Conclusions: These findings indicate that isolated baseline CUD is associated with an increased risk of hospital readmission at 90 days postoperative and cervical spine reoperation at 1 year after primary 1- to 2-level ACDF surgery with a decrease in overall medical complications, cardiac arrhythmias, and acute renal failure., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Diaphragmatic eventration is one of the rarest conditions characterized by elevation of the hemidiaphragm while maintaining its normal attachments. In recent years, video-assisted thoracoscopic surgery (VATS) has gained popularity for diaphragmatic surgery. In this study, we share our experience over six years with VATS plication of diaphragmatic eventration. We conducted a prospective study at our institute for six years from April 2016 to March 2021, which included 37 symptomatic patients with diaphragmatic eventration. The sample size reported in this study is one of the largest to date for VATS diaphragmatic plication. Of these, 18 patients underwent combined stapler and suture plication, and 19 patients underwent single modality approach (10-stapled resection, 9-suture alone plication). All patients were followed-up for a minimum of 2 years. Comparative analysis of the combined approach and the single modality approach was performed. The mean operative time was significantly longer with the combined approach (p value < 0.01). However, there was no difference in postoperative pain (p value = 0.50), analgesia requirement (p value = 0.72), or pleural drainage (p value = 0.32) between the two approaches. Although not statistically significant, the combined approach had fewer post-operative complications (p value = 0.32). Besides, the Single modality approach resulted in one recurrence (p value = 0.32) and one mortality (p value = 0.32). VATS diaphragmatic plication using staplers and/or sutures is safe and efficacious in the management of diaphragmatic eventration. Surgeons should consider using both staplers and sutures whenever possible, rather than selecting one over the other., (© 2023. Italian Society of Surgery (SIC).)

Organic acids are employed as scale dissolvers in the oil & gas industry during production to stimulate oil recovery by pumping in the formations. Corrosion of metallic surfaces in organic acid solutions poses a significant issue in the oil and gas sector. In recent years, considering the stringent environmental regulations, there has been a growing research interest in environmentally safe inhibitors. This paper explores the synthesis of 2-(3-(carboxymethyl)-1H-imidazol-3-ium-1-yl) acetate (IZ) and its first-time application for corrosion mitigation of N80 steel in 20% formic acid. A detailed experimental study involving gravimetric, electrochemical, and surface analytical techniques is reported herein. The electrochemical impedance spectroscopy (EIS) and potentiodynamic polarization (PDP) analyses suggest a rise of impedance with IZ and a mixed-type inhibition behavior, respectively. The inhibition efficiency (IE) is 99.54% at 200 mg/L at 308 K, reaching 99.4% at 363 K with the introduction of KI as a synergistic agent. Computational studies revealed that the inhibitor IZ gets protonated in the experimental environment. The protonated form shows a tendency to receive electrons from the metal surface and shows a greater energy of adsorption compared to that of the neutral form., 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 © 2023 Elsevier Inc. All rights reserved.)

This literature review explores the pivotal roles of the Uncoordinated-13 (UNC13) protein family, encompassing UNC13A, UNC13B, UNC13C, and UNC13D, in the pathogenesis of various human diseases. These proteins, which are evolutionarily conserved and crucial for synaptic vesicle priming and exocytosis, have been implicated in a range of disorders, spanning from neurodegenerative diseases like amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) to immune-related conditions such as familial hemophagocytic lymphohistiocytosis (FHL). The involvement of UNC13A in neurotransmitter release and synaptic plasticity is linked to ALS and FTD, with genetic variations affecting disease progression. UNC13B, which is closely related to UNC13A, plays a role in autism spectrum disorders (ASD), epilepsy, and schizophrenia. UNC13C is implicated in oral squamous cell carcinoma (OSCC) and hepatocellular carcinoma (HCC), and has a neuroprotective role in Alzheimer's disease (AD). UNC13D has an essential role in immune cell function, making it a key player in FHL. This review highlights the distinct molecular functions of each UNC13 family member and their implications in disease contexts, shedding light on potential therapeutic strategies and avenues for future research. Understanding these proteins' roles offers new insights into the management and treatment of neurological and immunological disorders., Competing Interests: Conflict of interest: The authors declare no conflict of interest., (© 2023 the Author(s), licensee AIMS Press.)

Patients with cirrhosis undergoing liver transplant (LT) are at high risk of postoperative cardiopulmonary complications. It is known that patients with coronary artery disease (CAD) have greater rates of post-LT morbidity and mortality than patients without CAD. Thus, identifying significant CAD in LT candidates is of the utmost importance to optimize survival posttransplant. Consensus is lacking on the ideal screening test for CAD in LT candidates. Traditional exercise and many pharmacologic stress tests are impractical and inaccurate in patients with cirrhosis due to their unique physiology. The purpose of this review is to describe different screening modalities for CAD among LT candidates. The background, diagnostic accuracy, and limitations of each screening modality are described to achieve this goal., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objectives: No previous research of university students in Finland assessed lifestyle behavioural risk factors (BRFs) and categorized students into clusters, explored the associations of the clusters with self-reported health complaints (HCs), whilst controlling for potential confounders. The current study undertook this task., Methods: Students at the University of Turku (1,177) completed an online well-being questionnaire that assessed socio-demographic variables, 5 BRFs - problematic alcohol consumption, smoking, illicit drug use, food consumption habits, moderate-to-vigorous physical activity (MVPA), and 22 HCs. A food frequency questionnaire assessed students' consumption of a range of foods, and a dietary guideline adherence score was computed based on WHO dietary recommendations for Europe. Three separate regression models appraised the associations between the cluster membership and HCs factors, adjusting for sex, income sufficiency and self-rated health., Results: Mean age was 23 ± 5.2 years, 77% had never smoked and 79% never used illicit drug/s. Factor analysis of HCs resulted in four-factors (psychological, circulatory/breathing, gastro-intestinal, pains/aches); cluster analysis of BRFs identified two distinctive student clusters. Cluster 1 represented more healthy students who never smoked/used illicit drugs, had no problematic drinking, and undertook MVPA on 4.42 ± 3.36 days/week. As for cluster 2 students, half the cluster smoked occasionally/daily, used illicit drug/s, and > 50% had problematic drinking and students undertook MVPA on 4.02 ± 3.12 days/week. More cluster 2 students adhered to healthy eating recommendations, but the difference was not significant between clusters. Regression analysis revealed that females, those with sufficient income, and with excellent/very good self-rated general health were significantly less likely to report all four HCs. Cluster 2 students were significantly more likely to report psychological complaints, circulatory/breathing and gastro-intestinal complaints. There was no significant association between BRFs clusters and pains/aches factor., Conclusions: Risk taking students with less healthy lifestyles and behaviour were consistently associated with poorer psychological and somatic health.