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A 16-year-old male presented to OPD with right-sided flank pain associated with lower urinary tract symptoms. CT scan and ultrasound findings demonstrated a 12.9 mm renal stone in the lower calyx and moderate hydronephrosis, respectively. The diagnosis of pelvic ureteric junction obstruction was confirmed by a diethylenetriamine pentaacetate (DTPA) scan. Laparoscopic pyeloplasty was planned but to remove the stone from a hard-to-reach location i.e. minor calyx, ureterorenoscope was introduced from one of the laparoscopic ports. The stone was retrieved successfully. This case represents the implementation of laparoscopic-assisted ureteroscopy instead of conventional retrograde ureteroscopy. This technique warrants further study as it makes the overall procedure more efficient and time-saving., Competing Interests: None declared., (Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2024.)

Background Obstructive sleep apnea (OSA) is a common sleep disorder that's characterized by episodes of a complete or partial collapse of the upper airway with an associated decrease in oxygen saturation or arousal from sleep. According to the American Academy of Sleep Medicine (AASM), OSA is categorized based on polysomnography findings into mild, moderate, and severe. Objectives This study aims at determining the prevalence of the severities of OSA in Erbil, Kurdistan Region of Iraq, as well as discovering the predictors for severe OSA. Methods This was a cross-sectional study that was carried out from December 2021 to July 2023 on patients displaying OSA symptoms in a sleep study section of a private clinic in Erbil, Kurdistan Region of Iraq. A detailed questionnaire was designed to collect the data, and IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States) was used to analyze it. The polysomnography device used for the diagnosis of OSA was a Philips Respironics Alice NightOne home device, and Philips Respironics Sleepware G3 (Koninklijke Philips N.V., Amsterdam, Netherlands) was used to analyze the sleep data. Results A sample size of 328 OSA cases was analyzed. The results revealed a prevalence of 47% (155) for severe OSA. Apnea-hypopnea index (AHI) was negatively correlated with lowest and average oxygen saturation, while it was positively correlated with time spent with oxygen saturation under 89%, body mass index (BMI), and weight of the participants. Furthermore, stepwise multiple regression tests revealed BMI, age, gender, and heart failure as independent predictors for AHI. Conclusion This study highlights the links between OSA and various chronic health conditions. Furthermore, it underscores the importance of factors like age, obesity, and gender in influencing OSA severity. The identification of predictors for OSA severity can assist in risk assessment and personalized interventions., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Dr Shwan's Cardiology Clinic's Ethics Committee issued approval 1105. Animal subjects: All authors have confirmed that this study did not involve animal subjects 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, Amen et al.)

We present a new integrated experimental and modeling effort that assesses the intrinsic sensitivity of energetic materials based on their reaction rates. The High Explosive Initiation Time (HEIT) experiment has been developed to provide a rapid assessment of the high-temperature reaction kinetics for the chemical decomposition of explosive materials. This effort is supported theoretically by quantum molecular dynamics (QMD) simulations that depict how different explosives can have vastly different adiabatic induction times at the same temperature. In this work, the ranking of explosive initiation properties between the HEIT experiment and QMD simulations is identical for six different energetic materials, even though they contain a variety of functional groups. We have also determined that the Arrhenius kinetics obtained by QMD simulations for homogeneous explosions connect remarkably well with those obtained from much longer duration one-dimensional time-to-explosion (ODTX) measurements. Kinetic Monte Carlo simulations have been developed to model the coupled heat transport and chemistry of the HEIT experiment to explicitly connect the experimental results with the Arrhenius rates for homogeneous explosions. These results confirm that ignition in the HEIT experiment is heterogeneous, where reactions start at the needle wall and propagate inward at a rate controlled by the thermal diffusivity and energy release. Overall, this work provides the first cohesive experimental and first-principles modeling effort to assess reaction kinetics of explosive chemical decomposition in the subshock regime and will be useful in predictive models needed for safety assessments.

Circadian clocks are composed of transcription-translation negative feedback loops that pace rhythms of gene expression to the diurnal cycle. In the filamentous fungus Neurospora crassa, the proteins F requency ( F RQ), the F RQ-interacting RNA helicase (FRH), and C asein-Kinase I (CK1) form the FFC complex that represses expression of genes activated by the white-collar complex (WCC). FRQ orchestrates key molecular interactions of the clock despite containing little predicted tertiary structure. Spin labeling and pulse-dipolar electron spin resonance spectroscopy provide domain-specific structural insights into the 989-residue intrinsically disordered FRQ and the FFC. FRQ contains a compact core that associates and organizes FRH and CK1 to coordinate their roles in WCC repression. FRQ phosphorylation increases conformational flexibility and alters oligomeric state, but the changes in structure and dynamics are non-uniform. Full-length FRQ undergoes liquid-liquid phase separation (LLPS) to sequester FRH and CK1 and influence CK1 enzymatic activity. Although FRQ phosphorylation favors LLPS, LLPS feeds back to reduce FRQ phosphorylation by CK1 at higher temperatures. Live imaging of Neurospora hyphae reveals FRQ foci characteristic of condensates near the nuclear periphery. Analogous clock repressor proteins in higher organisms share little position-specific sequence identity with FRQ; yet, they contain amino acid compositions that promote LLPS. Hence, condensate formation may be a conserved feature of eukaryotic clocks., Competing Interests: DT, NM, BB, SC, JD, AB, BC No competing interests declared, (© 2023, Tariq, Maurici et al.)

Background Hypertension is a major public health problem, and it remains the major preventable cause of cardiovascular and all-cause mortality worldwide. Most cases are asymptomatic and discovered incidentally. Objectives The objective of this study is to identify (i) the proportion of hypertensive patients diagnosed incidentally and those diagnosed due to symptoms, (ii) the most common symptoms among patients that present with symptoms, (iii) the presentation of acute elevations of blood pressure in hypertensive patients, and (iv) hypertension-related symptoms affect compliance with medications. Patients and methods A cross-sectional study was carried out on 386 hypertensive patients in two public health care centres and public places in Erbil, the capital of the Kurdistan Region of Iraq, from December 20, 2021, to February 7, 2022. Data was collected through interviews with the patients using a questionnaire designed by the researchers. A p-value ≤ 0.05 was considered to be statistically significant. Results The majority (76.5%) of patients were diagnosed because they got their blood pressure measured due to symptoms. The likelihood of being diagnosed incidentally was not significantly different with age, gender, age at diagnosis, socioeconomic status, or having one or more risk factors. The most common symptoms were headache followed by lightheadedness. Since diagnosis, 87.7% of subjects reported feeling symptoms with elevations in blood pressure, most commonly headaches followed by lightheadedness. Women and individuals belonging to a low socioeconomic status were more likely to report feeling symptoms. Whether or not patients felt symptoms with elevations of blood pressure, it didn't significantly affect compliance with medications. Conclusion The majority of hypertensive patients are diagnosed once they develop symptoms or complications, and a small percentage are diagnosed incidentally. Screening for hypertension in our region may be inadequate. Treatment rates were high. Hypertension-related symptoms didn't seem to affect compliance with medications., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Tariq et al.)

Background: Gout is a chronic noncommunicable disease that might lead to multiple systemic complications if it is left untreated. The knowledge, attitudes, and perceptives among patients toward the diagnosis and management of gout are important indicators in determining the prognosis and predicting sequelae of the disease. This cross-sectional survey aimed to assess the knowledge, attitudes, and perspectives of patients diagnosed with gout toward the disease diagnosis and treatment., Methodology: An observational cross-sectional study was conducted at university clinics and local health facilities in central Riyadh, Saudi Arabia, for the duration between April and August 2022. Pearson χ 2 test was used to determine the difference in the proportion of patients who adapt different attitudes and perspectives in terms of their demographic variables. Statistical significance was defined as a p value less than .05., Results: Two-hundred thirteen patients were involved in this study. The majority of the patients (84.0%) were diagnosed for more than 1 year. The majority of the patients (76.5%) were aged 25-60 years when they were diagnosed with gout. The most common complaint at the time of the diagnosis was joint pain (73.7%). The most commonly reported gout medication treatment being used was allopurinol accounting for 23.0%. The majority of the patients (83.6%) were satisfied regarding the effects of gout management on their job performance, work life, and careers. The vast majority (97.5%) reported that they are satisfied with the health service provided., Conclusion: The patients diagnosed with gout in Saudi Arabia exhibited a satisfactory level of information, attitude, and perspectives regarding their condition. The participants expressed a significant degree of satisfaction with the impact of gout management on their occupational performance, work-life balance, and professional plans. Additional research is necessary to ascertain the risk factors associated with gout and provide suitable preventative interventions., (© 2023 The Authors. Immunity, Inflammation and Disease published by John Wiley & Sons Ltd.)

Purpose: Postoperative morbidity in glioblastoma (GBM) patients can be due to the disease course but can also come from postoperative complications. Our objective was to study the association of dexamethasone use and perioperative hyperglycemia with postoperative complications in GBM patients., Methods: A single-center, retrospective cohort study was conducted in patients who underwent surgery for primary GBM from 2014-2018. Patients with perioperative fasting blood glucose (FBG) measurements and adequate follow-up to assess for complications were included., Results: A total of 199 patients were included. More than half (53%) had poor perioperative glycemic control (FBG ≥ 7 mM for ≥ 20% perioperative days). Higher dexamethasone dose (≥ 8 mg) was associated with higher FBG on postoperative days 2-4 and 5 (p = 0.02,0.05,0.004,0.02, respectively). Poor glycemic control was associated with increased odds of 30-day any complication and 30-day infection on univariate analysis (UVA), and 30-day any complication and increased length of stay (LOS) on multivariate analysis (MVA). Higher average perioperative daily dexamethasone dose was associated with increased odds of 30-day any complication and 30-day infection on MVA. Elevated hemoglobin A1c (HgbA1c, ≥ 6.5%) was associated with increased odds of 30-day any complication, 30-day infection, and LOS on UVA. In a multivariate linear regression model, only the diagnosis of diabetes mellitus predicted perioperative hyperglycemia., Conclusions: Perioperative hyperglycemia, higher average dexamethasone use and elevated preoperative HgbA1c are associated with increased risk of postoperative complications in GBM patients. Avoiding hyperglycemia and limiting dexamethasone use in postoperative period may decrease the risk of complications. Select HgbA1c screening may allow the identification of a group of patients at higher risk of complications., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

We present our discovery of switchable high explosives (HEs) as a new class of energetic material that cannot detonate unless filled with a fluid. The performance of fluid-filled additive-manufactured HE lattices is herein evaluated by analysis of detonation velocity and Gurney energy. The Gurney energy of the unfilled lattice was 98% lower than that of the equivalent water-filled lattice and changing the fluid mechanical properties allowed tuning of the Gurney energy and detonation velocity by 8.5% and 13.4%, respectively. These results provide, for the first time since the development of HEs, a method to completely remove the hazard of unplanned detonations during storage and transport.

Pannexin1 (Panx1) is a hemichannel-forming protein that participates in the communication of cells with the extracellular space. To characterize the role of osteoclastic Panx1 on bone, Panx1 fl/fl ;TRAP-Cre (Panx1 ΔOc ) mice were generated, and compared to Panx1 fl/fl littermates at 6 weeks of age. Total and femoral BMD was ~20% lower in females and males whereas spinal BMD was lower only in female Panx1 ΔOc mice. μCT analyses showed that cortical bone of the femoral mid-diaphysis was not altered in Panx1 ΔOc mice. In contrast, cancellous bone in the distal femur and lumbar vertebra was significantly decreased in both female and male Panx1 ΔOc mice compared to Panx1 fl/fl controls and was associated with higher osteoclast activity in female Panx1 ΔOc mice, with no changes in the males. On the other hand, vertebral bone formation was decreased for both sexes, resulting from lower mineral apposition rate in the females and lower mineralizing surface in the males. Consistent with an osteoclastic effect in female Panx1 ΔOc mice, osteoclast differentiation with RANKL/M-CSF and osteoclast bone resorbing activity in vitro were higher in female, but not male, Panx1 ΔOc mice, compared to Panx1 fl/fl littermates. Surprisingly, although Panx1 expression was normal in bone marrow stromal-derived osteoblasts from male and female Panx1 ΔOc mice, mineral deposition by male (but not female) Panx1 ΔOc osteoblasts was lower than controls, and it was reduced in male Panx1 fl/fl osteoblasts when conditioned media prepared from male Panx1 ΔOc osteoclast cultures was added to the cell culture media. Thus, deletion of Panx1 in TRAP-expressing cells in female mice leads to low bone mass primarily through a cell autonomous effect in osteoclast activity. In contrast, our evidence suggests that changes in the osteoclast secretome drive reduced osteoblast function in male Panx1 ΔOc mice, resulting in low bone mass., 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., (© 2022 The Authors.)

A series of experiments involving the detonation of PBX 9501 encased in a copper cylinder are modeled with the objective of evaluating a proposed set of phenomenological parameters for the Wescott-Stewart-Davis reactive burn model. The numerical analysis is conducted using the Los Alamos continuum mechanics code FLAG. Numerical considerations pertaining to various aspects of modeling the experiments using FLAG are discussed. It is shown that use of the proposed set of phenomenological parameters results in predictions of free-surface velocity that match empirically measured velocities reasonably well.

The vibrational reporter unnatural amino acid (UAA) 4-cyano-l-phenylalanine (pCNF) was genetically incorporated individually at three sites (5, 36, and 78) in the heme protein Caldanaerobacter subterraneus H-NOX to probe local hydration environments. The UAA pCNF was incorporated site-specifically using an engineered, orthogonal tRNA synthetase in E. coli . The ability of all of the pCNF-containing H-NOX proteins to form the ferrous CO, NO, or O 2 ligated and unligated states was confirmed with UV-Vis spectroscopy. The solvation state at each site of the three sites of pCNF incorporation was assessed using temperature-dependent infrared spectroscopy. Specifically, the frequency-temperature line slope (FTLS) method was utilized to show that the nitrile group at site 36 was fully solvated and the nitrile group at site 78 was de-solvated (buried) in the heme pocket. The nitrile group at site 5 was found to be partially solvated suggesting that the nitrile group was involved in moderate strength hydrogen bonds. These results were confirmed by the determination of the X-ray crystal structure of the H-NOX protein construct containing pCNF at site 5.

Ganciclovir is synthetic nucleoside analog of guanine closely related to acyclovir but has greater activity against cytomegalovirus. This comprehensive profile on ganciclovir starts with a description of the drug: nomenclature, formulae, chemical structure, elemental composition, and appearance. The uses and application of the drug are explained. The methods that were used for the preparation of ganciclovir are described and their respective schemes are outlined. The methods which were used for the physical characterization of the dug are: ionization constant, solubility, X-ray powder diffraction pattern, crystal structure, melting point, and differential scanning calorimetry. The chapter contains the spectra of the drug: ultraviolet spectrum, vibrational spectrum, nuclear magnetic resonance spectra, and the mass spectrum. The compendial methods of analysis of ganciclovir include the United States Pharmacopeia methods. Other methods of analysis that were reported in the literature include: high-performance liquid chromatography alone or with mass spectrometry, electrophoresis, spectrophotometry, voltammetry, chemiluminescence, and radioimmunoassay. Biological investigation on the drug includes: pharmacokinetics, metabolism, bioavailability, and biological analysis. Reviews on the methods used for preparation or for analysis of the drug are provided. The stability of the drug in various media and storage conditions is reported. More than 240 references are listed at the end of the chapter., (© 2018 Elsevier Inc. All rights reserved.)