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In this article, we have examined the three-dimensional flow of heat and mass transport of carbon nanotube–based nanoliquid over a rotating stretchable disk. A uniform magnetic field B 0 is applied in a transverse direction to the flow of nanofluid. Moreover, we have considered carbon nanotube nanoparticles termed as single-walled carbon nanotubes within the base liquid (water). In addition, at the boundaries of current problem, the effect of velocity slip and thermal convection is deliberated. The heat transport mechanism is also incorporated thermal radiation. The pertinent strong nonlinear ordinary differential system after utilizing the appropriate variables is intended. Homotopy analysis method technique is employed to estimate the analytical results for velocities and thermal fields. For the sake of comparison, the numerical method ND-Solve solution is also obtained. The results are found to be in an excellent agreement. Various graphs have been plotted in order to study the effect of different model variables on the velocities and thermal fields. The main features of physical quantities of flow like C F Re α 0 . 5 , C G Re α 0 . 5 (local skin friction coefficient), and Nu Re α − 0 . 5 (heat transfer rate) have been formulated and deliberated graphically. It is found that velocity is reduced under the influence of the exterior magnetic field. Concluding remarks are pinched under the analysis of complete investigation.

This article analyzes the Darcy Forchheimer 2D thin film fluid of nanoliquid. Flow of nanoliquid is made due to a flat unsteady stretchable sheet. In nanoliquids, nanomaterial is in form of CNTs (carbon nanotubes). Also, in present analysis, single walled carbon nanotubes (SWCNTs) are accounted as nanoparticles. The classical liquid ‘water’ is treated as based liquid. The flow in permeable region is characterized by Darcy–Forchheimer relation. Heat transport phenomena are studied from convective point of view. The transformation of partial differential set of equations into strong ordinary differential frame is formed through appropriate variables. Homotopy Analysis Method (HAM) scheme is executed for solving the simplified set of equations. In addition, a numerical analysis (ND-Solve) is utilized for the convergence of the applied technique. The influence of some flow model quantities like Pr (Prandtl number), λ (unsteadiness factor), k (porous medium factor), F (Darcy-porous medium factor) on liquid velocity and thermal field are scrutinized and studied through sketches. Certain physical factors like f″(0) (friction factor coefficient) and −θ′(0) (rate of heat transport) are first derived and then presented through tables.

This article studies the unsteady thin film flow of a fourth grade fluid over a moving and oscillating vertical belt. The problem is modeled in terms of non-nonlinear partial differential equations with some physical conditions. Both problems of lift and drainage are studied. Two different techniques namely the adomian decomposition method (ADM) and the optimal homotopy asymptotic method (OHAM) are used for finding the analytical solutions. These solutions are compared and found in excellent agreement. For the physical analysis of the problem, graphical results are provided and discussed for various embedded flow parameters.

Highlights differences between the North American and European cable television network architectures and outlines the European network management scenario. Management of networks and network elements; Radio frequency spectrum usage; Standards for network element management.

In this research work, a 3D rotating flow of carbon nanotubes (CNTs) over a porous stretchable sheet for heat and mass transfer is investigated. Kerosene oil is considered as a base liquid and two types of CNTs, (Single & Multi) WCNTs are added as the additives to the base liquid. The present analysis further comprises the combined effect of the Hall, ion-slip, and thermal radiation, along with heat generation/absorption. The appropriate ordinary differential system of equations after applying appropriate transformation is calculated. The resulting nonlinear system of equations (conservation of mass, momentum, temperature) is explained by HAM (Homotopy Analysis Method). Solution of velocities and thermal fields are obtained and discussed graphically. Expression of C f and N u are intended for both type of nanoliquids. The influences of prominent physical factors are plotted for velocities and thermal profiles using Methematica. These graphical results are qualitatively in excellent agreement with the previous published results. Also, single wall nanoparticles are found to have higher temperatures than multi wall CNTs nanoparticles.

Highlights from the article: Application of linear programming model to assess the optimum cropping pattern for mixed cropping zone of semi-arid area The experimental results manifested that the cotton, maize and wheat acreage was enhanced by about 5-10%, while Basmati rice, IRRI rice, sugarcane and potato depicted decline in acreage. Moreover, income, crop acreage and production of wheat, cotton, basmati rice, IRRI rice and sugar cane was estimated using linear programming model. Whereas, proposed areas through linear programming model for wheat, cotton and maize was 13, 7.1 and 4.8 ha to gain 1.07% higher profit than existing profit.

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ABSTRACT Background: Obturator Nerve Block (ONB) in Transurethral Resection of Bladder Tumor (TURBT) can prevent adductor reflex to avoid complications like bleeding, bladder perforation or incomplete tumor resection. ONB using anatomical land marks, use of nerve stimulator or ultrasound are various techniques of nerve block. Study Design: Prospective observational study. Material & Methods: Prospective study was conducted using ONB with anatomical land marks from 15-10-2011 to 15-07-2013. All patients of bladder tumor having mass on lateral & infero-lateral wall of bladder were included in the study. Results: Total number of patients was 53 with male to female ratio of 5:1. Average age was 55.72 years. Twenty two (41.5%), patients had two masses with size range of 1-6 cm. Duration of surgery (TURBT) was 15-30 minutes in majority (62%) of patients. Eleven patients (20.75%) required blood transfusion. Forty two (79.24%) patients were administered bilateral and 20.76% unilateral nerve block. ONB was completely successful in 90.56% cases and 9.44% has partial or incomplete block. No bladder perforation, haematoma or bruising at site of injection occurred. Conclusion: ONB with spinal anesthesia using anatomical land marks is a safe procedure with comparable success rate to the usage of nerve stimulator or ultrasonography in ONB but less time consuming. We recommend ONB in all patients of bladder tumor undergoing TURBT.

ABSTRACT Background: I-gel is a new supraglottic device, which is comparable with classical LMA for its seal and ease of insertion. It has an additional port for insertion of gastric tube. We studied whether insertion of a gastric tube has any effect on the seal pressure of I-gel. The present study was conducted in 30 ASA I and II patients undergoing general anesthesia. The aim was to study the difference in the seal pressure of I-gel before and after insertion of gastric tube. Methods: Water lubricated I-gel was inserted in 30 patients 1 minute after induction of general anaesthesia with Propofol 2.5 mg/kg and rocuronium 0.6mg/kg I/V for muscle relaxation, according to the technique described in the manual. Seal pressure was measured using manometer before and after gastric tube insertion. Results: The subjects were 86.7% females and 13.3% males. 43.3% weighed

Competing Interests: The authors declare no conflicts of interest.

Competing Interests: The authors declare no conflicts of interest.

This study highlighted the nutritional importance of Catostylus perezi (an edible jellyfish) in Pakistan; a society where a large proportion of the population suffers from malnutrition, while C. perezi , a blessing of the sea, is wasted or exported. In the present study, the amino acid and fatty acid profiles of the oral arms and umbrella of C. perezi were determined by HPLC. The total amino acid concentration (ΣAA) in the oral arms was 151.19 mg/100g, while in the umbrella it was 100.17 mg/100g. The ratio of total essential amino acids to total non-essential amino acids (TEAA/TNEAA) was 0.72 in the oral arms, while it was 0.70 in the umbrella. Higher amount of ω-3 with lower ratio of ω-6/ω-3 in oral arms (0.52), rather umbrella (ω-6/ω-3 ratio; 0.62). The antimicrobial activity, MIC, MBC, and MFC of the whole body of the edible jellyfish were determined. On the basis of polarity, different solvents were used, e.g. water, methanol, dichloromethane, chloroform, and n-hexane. Among all the extracts, the water extract gave the highest ZOI against C. xerosis (29 mm), while the n-hexane extract gave the lowest ZOI against S. aureus (MRSA) ATCC 33591 (8.20 mm). The water extract of C. perezi had high potential against C. xerosis with the highest AMI and PAI (1.53 and 153, respectively), while the same extract had the highest TAI against E. coli (81.43 mL/g). For fungi/yeast, the methanolic extract had the highest ZOI (29.70 mm) against S. cerevisiae and the lowest MIC/MFC (2.40 µg/mL) against the same pathogen. The n-Hexane extract gave the lowest ZOI (11.10 mm) against P. variotii and the highest MIC/MFC (31.60 µg/mL) against Penicillium sp. Atomic force microscopy (AFM) was used to analyse the disintegrating effect of the extracts (with the highest antimicrobial effect) on the cells of selected Gram-positive, Gram-negative and yeast species. The amino acid and fatty acid profiles and antimicrobial assessment showed that C. perezi has great nutritional importance, so the use of C. perezi as food is highly recommended for the Pakistani community.

Social media use is ubiquitous to the lives of children and adolescents. The body of research investigating its potential impact on mental health has risen exponentially. We systematically reviewed the present literature exploring potential linkages between social media use and symptoms of depression and anxiety in this vulnerable group. Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses framework, articles were searched across Medline, EMBASE, CINAHL, and PsycINFO databases from inception to February 2024. Quantitative studies with social media as exposure and anxiety/depressive symptoms as outcomes in children and adolescents 5-18 years of age were included. Of the 4850 studies retrieved, 67 fulfilled the inclusion criteria. The most frequent measures of social media were "time spent on social media" and "frequency of use." Depressive symptoms were the outcome of 61 studies, whereas anxiety was measured in 27 studies. Most studies were of fair quality ( n = 53). A meta-analysis was not possible due to study heterogeneity. Our review shows that (1) problematic social media use is associated with depressive and anxiety symptoms among children and adolescents, (2) duration of social media use was more consistently linked with anxiety and depression in girls compared with boys, and (3) mediating and moderating mechanisms were sleep deprivation, social comparison, and feedback-seeking behaviors, exercise, social support, and type of social media use. Qualitative work and robust large-scale longitudinal observations using a person-specific approach are needed to further our understanding of the impact of social media use on depression and anxiety in children and adolescents.

Background and Aims: Co-axial plastic double pigtail stents (DPSs) are commonly placed through lumen apposing metal stents (LAMS) in patients with pancreatic fluid collections (PFCs) to decrease the risk of adverse events. In this meta-analysis, we have compared the outcomes of LAMS plus co-axial DPS versus LAMS alone in patients with PFCs., Methods: We reviewed several databases to identify the studies that compared outcomes of LAMS with DPS to LAMS without DPS in the treatment of PFCs. Our outcomes of interest were overall adverse events, clinical success and individual adverse events such as stent (LAMS) migration, stent occlusion, bleeding, and infection. We calculated pooled risk ratios (RR) with 95% confidence intervals (CIs) for the analysis of outcomes. We used a random effects model to analyze the data. Heterogeneity was assessed using the I2 statistic., Results: We included 10 studies with 685 patients. Rate of overall adverse events was significantly lower in the LAMS+DPS group compared with LAMS alone, RR (95% CI) 0.58 (0.40, 0.87). There was no significant difference in the rate of clinical success between groups, RR (95% CI) 1.03 (0.94, 1.13). We found no significant difference in rate of stent occlusion between groups. Rate of infection was significantly lower in LAMS+DPS group, RR (95% CI) 0.46 (0.24, 0.85). There was no significant difference in rate of bleeding and stent (LAMS) migration between groups., Conclusions: Addition of co-axial DPS to LAMS decreases the risk of adverse events in patients with PFCs and should be considered in all patients with PFCs., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

The increasing prevalence of multidrug-resistant microorganisms in poultry has led to a rise in bacterial infections, causing significant economic loss. Green nanotechnology, such as silver nanoparticles (AgNPs), has the potential to address this issue by providing potent antifungal, antiviral, and antibacterial properties. This study explored the combined potential of AgNPs and the local herb Swertia chirayita against established poultry pathogens, employing a non-factorial Central Composite Design (CCD) to evaluate the factors affecting the production of nanoparticles induced by silver nitrate from the selected herb. The optimal values for temperature, wavelength, silver nitrate concentration, incubation duration, and pH were found to produce the highest nanoparticles. The functional groups in Swertia chirayita stimulated nanoparticles were confirmed using FTIR spectroscopy, and the stability of ScNPs was elucidated using zeta potential. The crystalline structure of ScNPs was confirmed using diffraction intensity patterns. Silver nanoparticles demonstrated antibacterial activity against Salmonella spp. and Escherichia coli (E.coli), both known as significant poultry pathogens, using the agar well diffusion method, with inhibition zones of 25.0 mm and 35.0 mm, respectively.This study explored the green manufacturing of silver nanoparticles by using plants and microorganisms, focusing on their antibacterial properties. The exact mechanism of synthesis and action in AgNPs is still poorly understood. Researchers should prioritize the use of accessible, easy-to-extract plants or bacteria, especially non-pathogenic and fast-growing microorganisms for safe handling. Analyzing biomolecules in plant extract, microbial biomass, or culture supernatants, including probiotic bacteria, is crucial for creating and stabilizing AgNPs, which could be effective synthetic agents. It is crucial to optimize conditions for rapid, stable, and large-scale synthesis. Based on this research, Sc-NPs may be proposed as nanomedicine for treating infections in poultry caused by E. coli and Salmonella spp., Competing Interests: Declaration of competing interest We declare no conflicts of interest regarding the research conducted and presented in the manuscript entitled “Biosynthesis of antimicrobial nanoparticles from Swertia spp. (Chirayita) against bacterial pathogens of Poultry - A way forward to Green Nanotechnology and Nanomedicines”, submitted for publication in the Journal of “Microbial Pathogens”. All authors listed have no financial or personal relationships that could influence the content of this work. This research was conducted with integrity and following ethical standards., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Calcimimetics, including intravenous etelcalcetide and oral cinacalcet, are often prescribed to hemodialysis patients to prevent complications of elevated parathyroid hormone (PTH) levels. In January 2021, US dialysis reimbursement policy switched from the transitional drug add-on payment adjustment (TDAPA) to an increased bundled payment, with $10.09 per session added for all hemodialysis patients to cover the expense for calcimimetics, whether or not patients are administered etelcalcetide. We leveraged this natural experiment to investigate the impact of this policy change., Methods: This analysis included 713 US in-center hemodialysis patients enrolled in the United States Dialysis Outcomes and Practice Patterns Study (US-DOPPS) who discontinued etelcalcetide during the TDAPA transition period (December 2020 - April 2021). Within a self-matched longitudinal design, within-patient changes in mean PTH, calcium, and phosphorus were assessed in the six months pre- vs. post- etelcalcetide discontinuation, using linear regression adjusted for potential confounders., Results: Etelcalcetide use in US-DOPPS decreased 58%, from 12% to 5% from July 2020 to July 2021; 73% of etelcalcetide discontinuers switched to cinacalcet within six months. Comparing the six months pre- vs. post- etelcalcetide discontinuation, mean PTH levels increased by 107 (95% CI: 80, 133) pg/mL, and the prevalence of PTH >600 pg/mL increased by 15% (95% CI: 11%, 19%), from 28% to 43% overall, and increased from 26% to 49% among Black patients. Mean serum calcium and phosphorus levels increased by 0.42 and 0.16 mg/dL, respectively., Conclusion: Etelcalcetide use decreased substantially after TDAPA ended in January 2021, with most patients switching to cinacalcet. The subsequent increase in PTH levels was swift and sustained, and especially pronounced among Black patients, raising concerns about disparities and potential downstream impact on clinical outcomes. Despite the spirit of the policy change, the flat per-treatment increased payment may have inadvertently created a financial incentive to restrict patient access to a more effective therapy, and potentially stifle drug innovation., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Nephrology.)

Background Breakfast consumption and sleep habits are known to affect cognitive performance, yet their specific impact on health professional students' morning attention is underresearched. Objective The study's objective was to assess the influence of sleeping habits and breakfast eating habits on health professional students' morning attention span. Methodology A cross-sectional study was conducted with 323 undergraduate health professional students from medical colleges in Lahore, Pakistan. Participants completed an online questionnaire that gathered data on demographic characteristics, breakfast consumption patterns, sleep habits, and morning attention levels. Morning attention was measured using a self-reported scale where students rated their ability to concentrate during morning lectures on a five-point Likert scale ranging from "very poor" to "very good." Additional questions assessed the frequency and quality of breakfast consumption, sleep duration, sleep quality (using the Pittsburgh Sleep Quality Index), and daytime napping habits. Statistical analyses, including descriptive statistics and multiple regression analysis, were conducted using the IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York, United States) to explore the relationships between breakfast and sleep habits and their effects on self-reported attention during morning lectures. Results Of the 323 participants, 78 (24.14%) never skipped breakfast, while 71 (22.93%) skipped breakfast regularly. Breakfast skippers exhibited poorer attention, with a coefficient of -0.45 (p = 0.0002). Students consuming a more nutritious breakfast demonstrated improved attention, with a coefficient of 0.32 (p < 0.0001). Regarding sleep, 196 students (60.68%) slept four to six hours; those with longer sleep durations had better attention (coefficient = 0.21, p = 0.020). Conversely, 271 participants (83.90%) reported that frequent daytime napping and poor sleep quality, including frequent nighttime awakenings, had a negative impact on attention, with coefficients of -0.30 (p = 0.007) and -0.28 (p = 0.005), respectively. Additionally, 161 students (49.84%) reported difficulty concentrating during morning lectures. Conclusion Regular consumption of a nutritious breakfast and sufficient sleep are crucial for maintaining optimal morning attention and cognitive performance among health professional students., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. 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, Abdullah et al.)

Biomimetic artificial olfactory cilia have demonstrated potential in identifying specific volatile organic compounds linked to various diseases, including certain cancers, metabolic disorders, and respiratory conditions. These sensors may facilitate non-invasive disease diagnosis and monitoring. Cilia Motility is the coordinated movement of cilia, which are hair-like projections present on the surface of particular cells in different species. Cilia serve an important part in several biological functions, including motility, fluid movement, and sensory reception. Cilia motility is a complicated process that requires the coordinated interaction of structural components and molecular pathways. Cilia are made up of a highly structured structure known as the axoneme, which is made up of microtubules grouped in a unique pattern. The axoneme is made up of nine outer doublet microtubules and a core pair of singlet microtubules. This arrangement offers structural support and serves as a scaffold for the proteins involved in ciliary movement. Our latest endeavors investigate these Multiphysics phenomena in ciliary beating flows that are inspired by biology, utilizing copper, gold, and titania nanoparticles. We examine their functions in biological systems such as peristaltic transport computationally. Our models give precise two- and three-dimensional velocity, temperature, and concentration solutions by integrating transverse magnetohydrodynamics with laser heating. Furthermore, at the channel wall expressions, the skin friction coefficient, Sherwood number, Nusselt number and optimization of entropy generation are acquired and analyzed. Important properties of the velocity and scalar profiles are revealed by a thorough analysis of dimensionless parameters. The simplified examination provides more insight into the trapping patterns that result from the complex interaction between nanofluid rheology and optics. These findings greatly contribute to our knowledge and improvement of nanofluidic transport technologies in a variety of fields supporting industry, sustainability, and medicine. Our combined computational and experimental methodology clarifies the complex dynamics in these systems and provides design guidance for the engineering of improved fluidic devices that make use of multifunctional nanomaterial interfaces and peristaltic motion., (© 2024 IOP Publishing Ltd. All rights, including for text and data mining, AI training, and similar technologies, are reserved.)

Bacterial meningitis is a serious central nervous system (CNS) infection, claiming millions of human lives annually around the globe. The deadly infection involves severe inflammation of the protective sheath of the brain, i.e., meninges, and sometimes also consists of the brain tissue, called meningoencephalitis. Several inflammatory pathways involved in the pathogenesis of meningitis caused by Streptococcus pneumoniae, Neisseria meningitidis, Escherichia coli, Haemophilus influenzae, Mycobacterium tuberculosis, Streptococcus suis, etc. are mentioned in the scientific literature. Many in-vitro and in-vivo analyses have shown that after the disruption of the blood-brain barrier (BBB), these pathogens trigger several inflammatory pathways including Toll-Like Receptor (TLR) signaling in response to Pathogen-Associated Molecular Patterns (PAMPs), Nucleotide oligomerization domain (NOD)-like receptor-mediated signaling, pneumolysin related signaling, NF-κB signaling and many other pathways that lead to pro-inflammatory cascade and subsequent cytokine release including interleukine (IL)-1β, tumor necrosis factor(TNF)-α, IL-6, IL-8, chemokine (C-X-C motif) ligand 1 (CXCL1) along with other mediators, leading to neuroinflammation. The activation of another protein complex, nucleotide-binding domain, leucine-rich-containing family, pyrin domain-containing-3 (NLRP3) inflammasome, also takes place resulting in the maturation and release of IL-1β and IL-18, hence potentiating neuroinflammation. This review aims to outline the inflammatory signaling pathways associated with the pathogenesis of bacterial meningitis leading to extensive pathological changes in neurons, astrocytes, oligodendrocytes, and other central nervous system cells., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Alzheimer's disease (AD) is a neurodegenerative disorder and the most prevailing cause of dementia. AD critically disturbs the daily routine, which usually needs to be detected at its early stage. Unfortunately, AD detection using magnetic resonance imaging is challenging because of the subtle physiological variations between normal and AD patients visible on magnetic resonance imaging., Methods: To cope with this challenge, we propose a deep convolutional generative adversarial network (DeepCGAN) for detecting early-stage AD in this article. The DeepCGAN is an unsupervised generative model that expands the dataset size in addition to its diversity by utilizing the generative adversarial network (GAN). The Generator of GAN follows the encoder-decoder framework and takes cognitive data as inputs, whereas the Discriminator follows a structure similar to the Generator's encoder. The last dense layer uses a softmax classifier to detect the labels indicating the AD., Results: The proposed model attains an accuracy rate of 97.32%, significantly surpassing recent state-of-the-art models' performance, including Adaptive Voting, ResNet, AlexNet, GoogleNet, Deep Neural Networks, and Support Vector Machines., Discussion: The DeepCGAN significantly improves early AD detection accuracy and robustness by enhancing the dataset diversity and leveraging advanced GAN techniques, leading to better generalization and higher performance in comparison to traditional and contemporary methods. These results demonstrate the ecacy of DeepCGAN in enhancing early AD detection, thereby potentially improving patient outcomes through timely intervention., 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 Ali, Saleem, Alhussein, Zohra, Aurangzeb and Haq.)

Malaria, transmitted through the bite of a Plasmodium -infected Anopheles mosquito, remains a significant global health concern. This review examines the complex life cycle of Plasmodium , emphasizing the role of humans and mosquitoes in its transmission and proliferation. Malarial parasites are transmitted as sporozoites to the human body by biting an infected female Anopheles mosquito. These sporozoites then invade liver cells, multiply, and release merozoites, which infect red blood cells, perpetuating the cycle. As this cycle continues, the affected person starts experiencing the clinical symptoms of the disease. The current treatments for malaria, including chloroquine, artemisinin-based combination therapy, and quinine, are discussed alongside the challenges of drug resistance and misdiagnosis. Although efforts have been made to develop a malarial vaccine, they have so far been unsuccessful. Additionally, the review explores the potential of medicinal plants as remedies for malaria, highlighting the efficacy of compounds derived from Artemisia annua , Cinchona species, and Helianthus annuus L., as well as exploration of plants and phytocompounds like cryptolepine, and isoliquiritigenin against drug-resistant Plasmodium species. Moreover, studies from Pakistan further highlight the diverse vegetal resources utilized in malaria treatment, emphasizing the need for further research into natural remedies. Despite the advantages of herbal medicines, including cost-effectiveness, and fewer side effects; their limitations must be taken into account, including variations in potency and potential drug interactions. The review concludes by advocating for a balanced approach to malaria treatment and prevention, emphasizing the importance of early detection, accurate diagnosis, and integrated efforts to combat the disease in the endemic regions., 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 Ain, Saleem, Munawar, Nawaz, Naseer and Ahmed.)

Background: Basidiobolomycosis is a rare fungal infection caused by Basidiobolus ranarum., Case Presentation: A 53-year-old man from Saudi Arabia with a known history of diverticulosis presented with severe abdominal pain and diarrhea. A CT scan revealed circumferential wall thickening of the descending and sigmoid colon with surrounding fat stranding, suggesting a diagnosis of complicated diverticulitis. Additional thick fluid was observed around the affected area. Surgical excision was pursued. A gross examination of two received large bowel segments disclosed marked ulcerated mucosa and wall thickening with exudate-covered serosal surfaces and adhesions. Microscopic examination unveiled significant infiltration by eosinophils, polymorphonuclear leukocytes, and granulomatous inflammation. Thin-walled, broad fungal hyphae of Basidiobolus, surrounded by eosinophilic material, were identified. Granulomas displayed abundant multinucleated giant cells and palisading histiocytes around central necrosis or abscess formation. Thin-walled, broad fungal hyphae of Basidiobolus, with sparse septations, are surrounded by a radiating, intensely eosinophilic cuff (Splendore-Hoeppli phenomenon). These hyphae, visible with hematoxylin and eosin staining, were further highlighted with periodic acid-Schiff and Gomori methenamine silver staining., Discussion: Basidiobolomycosis may mimic neoplastic lesions. Histologically, the characteristic features include broad, thin-walled septate hyphae surrounded by eosinophilic material, a finding that is accentuated by the Splendore-Hoeppli phenomenon. Microscopic examination, along with special stains such as periodic acid-Schiff (PAS) and Gomori methenamine silver, is essential for accurate diagnosis., Conclusion: Prompt recognition and appropriate antifungal therapy are vital for favorable patient outcomes. This report highlights the distinctive features of Basidiobolomycosis to raise awareness and understanding of this infrequent yet clinically significant fungal infection., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background and Aims: In response to documented duodenoscope-related infectious outbreaks of multidrug-resistant organisms, the Food and Drug Administration has recommended a transition to duodenoscopes with innovative designs, including duodenoscopes with disposable components or fully disposable duodenoscopes. We aim to characterize the learning curve (LC) for a single-use disposable duodenoscope., Methods: We performed a retrospective analysis of a prospectively collected database from 31 patients who underwent ERCP by a single, experienced operator using the EXALT Model D® (Boston Scientific, Marlborough) disposable duodenoscope at a single tertiary referral center. The LC for this device was described by the number of cases needed to achieve proficiency using cumulative sum (CUSUM) analysis. Number of attempts to cannulate and time to cannulate the desired duct were assessed as separate endpoints. The overall mean number of attempts and overall mean time to cannulation were used as the target values in the respective CUSUM analyses. Proficiency was defined as the number of procedures where an inflection point was reached in the CUSUM graph. This observation indicates improving operator performance as shown by a decrease in the number of attempts and shortening of cannulation time after the defined number of procedures., Results: Overall, 31 patients underwent ERCP using the EXALT Model D disposable duodenoscope by a single experienced endoscopist. 6 (19%) patients had a native papilla and the majority of these procedures were classified as ASGE complexity level 2 or above. The procedure was completed using solely the disposable duodenoscope in 27 patients (87%), while a reusable duodenoscope was required for procedure completion in 4 patients (13%). The cross-overs were distributed evenly across the performance period. Procedure-related adverse events included: post-ERCP pancreatitis (3%), bleeding (3%) and no perforations. In the analyses of both endpoints, an inflection of the CUSUM curves is achieved at 10 cases, indicating sustained reduction of cannulation attempts and time to cannulation., Conclusion: Among experienced pancreaticobiliary endoscopists, approximately 10 ERCPs is the threshold whereby procedure-related factors including cannulation success and procedural time improves. Procedure-related adverse events are consistent with those expected with reusable duodenoscopes. The need to cross-over from single-use duodenoscope to reusable duodenoscope did not appear to be related to the learning curve, as they were evenly distributed across the study period. These results can be used to guide adoption of single-use duodenoscopes into clinical practice., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background and Purpose: Endovascular treatment of wide-neck bifurcation aneurysms has historically proved difficult with variable outcomes. Different endovascular techniques such as balloon-assisted coiling, stent-assisted coiling, or intrasaccular devices provide a varied range of efficacy and safety. Neqstent-assisted coiling is a new device and technique that aim to provide a maximum of both. We analyzed the early clinical and radiologic outcomes after the use of this new technique and device in our practice., Materials and Methods: This study was a retrospective analysis of ruptured and unruptured intracranial aneurysms treated with the Neqstent. The primary radiologic outcomes were quantified on DSA, CTA, or MRA using the modified Raymond-Roy criteria. The outcomes were defined as immediate complete occlusion (modified Raymond-Roy criteria 1) and complete (modified Raymond-Roy criteria 1) and adequate occlusion (modified Raymond-Roy criteria 1 and modified Raymond-Roy criteria 2) at 6 months posttreatment. The primary safety outcome was the rate of device-related adverse events. Secondary safety outcomes included time to discharge and change in the mRS score at 6-month follow-up., Results: Twenty patients were treated with the Neqstent from November 2020 to January 2023. Nine had unruptured aneurysms, and 11 were patients with subarachnoid haemorrhage due to ruptured aneurysms. Eighteen of 20 aneurysms (90%) treated demonstrated complete occlusion (modified Raymond-Roy criteria 1) on immediate postembolization angiograms. Sixteen of 17 aneurysms treated (94.1%) remained adequately occluded on 6-month follow-up (modified Raymond-Roy criteria 1 and modified Raymond-Roy criteria 2). Immediate postoperative complications occurred in 2 patients; only 1 patient had residual neurologic deficits at 6 months (mRS = 2)., Conclusions: Management of large, wide-neck aneurysms remains difficult, with high rates of recurrence and complications. The use of the Neqstent shows promising short-term results for the treatment of complex wide-neck aneurysms. Initial complication rates for our cohort were relatively high. However, this result is likely related to the initial learning experience of device deployment and the use of antiplatelets., (© 2024 by American Journal of Neuroradiology.)

Overlapping autoimmune disorders are used to describe the coexistence of more than one autoimmune disease in the same patient. Mixed connective tissue disease (MCTD) and anti-synthetase syndrome (ASS) are autoimmune diseases that manifest with pulmonary involvement, presenting as persistent dyspnea. The coexistence of both conditions in the same patient is extremely rare. We herein report a case of a 44-year-old female who was diagnosed with MCTD with features of ASS (anti-Jo-1 antibody) in the setting of rheumatoid arthritis (anti-cyclic citrullinated peptide (anti-CCP) antibody), which shows temporary breathing improvement following treatment with corticosteroid and mycophenolate mofetil. However, after the completion of mycophenolate mofetil, she was found to be anti-Jo-1 antibody negative and anti-CCP antibody positive. Our case emphasizes the need to recognize overlapping autoimmune conditions in patients with complex clinical features and presentations with the immediate application of a comprehensive diagnostic approach and tailored treatment strategies. Early diagnosis and aggressive treatment are crucial for achieving remission and preventing organ damage., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Evbuomwan et al.)

Adolescent refugees confront a complex interplay of trauma arising from forced displacement, resettlement, and the challenges of transitioning from childhood to adulthood. Using photovoice methodology, this study engaged 14 Iraqi and Syrian adolescent refugees now residing in the United States with the aim to illuminate their well-being experiences. Our findings show that temporal continuities and discontinuities in adolescent refugees' lives contributed to their sense of well-being by helping satisfy their basic psychological needs for autonomy, competence, relatedness, and safety. Temporal continuities involved drawing upon past resources and formulating future career aspirations based on present experiences. Temporal discontinuities encompassed contrasting past and present and processing adversities endured. This study underscores that, beyond current circumstances, the interpretation of life experiences over extended timeframes influences the well-being of adolescent refugees., (© 2024 The Authors. Journal of Community Psychology published by Wiley Periodicals LLC.)

Introduction: Endovascular treatment of wide neck aneurysms remains complicated with a determined and continuous technological effort towards treatment options that can offer safer and efficacious outcomes. The Woven Endobridge device was introduced in 2010 and has become a mainstay endovascular treatment for wide neck and large intracranial aneurysms. A recent review of the Woven Endobridge Clinical Assessment of Intrasaccular Aneurysm Therapy (WEBCAST) and WEBCAST2 trials and the five-year follow-up of patients was published. Our aim is to demonstrate real-life experience of aneurysms and patients treated with Woven Endobridge from a large high-volume specialist centre., Methods: A retrospective review was performed of patients treated with Woven Endobridge from March 2013 to March 2018. Primary efficacy outcomes were defined as per Raymond-Roy Occlusion Criteria (RROC) resulting in long-term complete occlusion (RROC1) and adequate occlusion (RROC1 and RROC2). Primary Safety outcomes were defined as procedure-related morbidity, rate of re-bleeding and rate of re-treatment., Results: Seventy-nine aneurysms were treated during the five-year period. Adequate aneurysm occlusion (RROC1 and RROC2) achieved was 81%. Retreatment was required in 18% of patients (14/79). Greater retreatment rate was demonstrated in partially thrombosed aneurysms, aneurysms with larger neck and dome diameter and dome heights., Conclusion: Woven Endobridge treatment of wide-neck intracranial aneurysms offers a safe and efficacious outcome. This large UK single-centre experience demonstrates congruity with recent five-year outcomes of WEBCAST and WEBCAST2 trials., Competing Interests: Declaration of conflicting interestsProfessor Tufail Patankar is a consultant and proctor for Medtronic, Stryker, Phenox and Microvention. The remaining authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Post-operative infections are a common cause of morbidity following major surgery. Little is understood about how major surgery perturbs immune function leading to heightened risk of subsequent infection. Through analysis of paired blood samples obtained immediately before and 24 h following surgery, we evaluated changes in circulating immune cell phenotype and function across the first 24 h, to identify early immune changes associated with subsequent infection., Methods: We conducted a prospective observational study of adult patients undergoing major elective gastrointestinal, gynecological, or maxillofacial surgery requiring planned admission to the post-anesthetic care unit. Patients were followed up to hospital discharge or death. Outcome data collected included mortality, length of stay, unplanned intensive care unit admission, and post-operative infections (using the standardized endpoints in perioperative medicine-core outcome measures for perioperative and anesthetic care criteria). Peripheral blood mononuclear cells were isolated prior to and 24 h following surgery from which cellular immune traits including activation and functional status were assessed by multi-parameter flow cytometry and serum immune analytes compared by enzyme-linked immunosorbent assay (ELISA)., Results: Forty-eight patients were recruited, 26 (54%) of whom developed a post-operative infection. We observed reduced baseline pre- and post-operative monocyte CXCR4 and CD80 expression (chemokine receptors and co-stimulation markers, respectively) in patients who subsequently developed an infection as well as a profound and selective post-operative increase in CD4 + lymphocyte IL-7 receptor expression in the infection group only. Higher post-operative monocyte count was significantly associated with the development of post-operative infection (false discovery rate < 1%; adjusted p-value = 0.001) with an area under the receiver operating characteristic curve of 0.84 (p < 0.0001)., Conclusion: Lower monocyte chemotaxis markers, higher post-operative circulating monocyte counts, and reduced co-stimulatory signals are associated with subsequent post-operative infections. Identifying the underlying mechanisms and therapeutics to reverse defects in immune cell function requires further exploration., 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 Snow, Waller, Loye, Ryckaert, Cesar, Saleem, Roy, Whittle, Al-Hindawi, Das, Singer, Brealey, Arulkumaran and the University College London Hospitals Critical Care Research Team.)

Background: Pantoea agglomerans is an environmental pathogen known to cause infection in immunocompromised individuals, particularly after thorn injuries. However, previous data showed few cases of human disease caused by contaminated medical products such as parenteral nutrition, anesthetic agents, blood, and peritoneal dialysis solutions. Infection in hemodialysis patients is rare. In this study, we presented a detailed account of several hemodialysis patients infected with this contagious pathogen and compared them with noninfected dialysis patients., Methods: We retrospectively reviewed the hospital records of 105 hemodialysis patients. Seventeen of 105 patients were diagnosed with P. agglomerans infection. We carefully analyzed their entire in-hospital course., Results: Among infected patients, 52.9% were male with a median age of 49 (IQR: 32-66) years. Compared to the noninfected patients, age below 50 years, prior kidney transplantation, prior immunosuppression and antibiotics use, and dialysis via a tunneled vascular catheter were the significant epidemiological features. Despite negative microbiological investigations, we suspect the possible infectious spread via infected central venous catheter was the likely infectious source. Most importantly, all patients responded well to intravenous antibiotics. Only two patients required the removal of the tunneled catheter. Their mortality rate was 0%., Conclusion: P. agglomerans infection, although considered rare, is becoming increasingly prevalent among dialysis patients. Its occurrence must be appraised as an infectious outbreak rather than mere contamination. Prompt treatment, source identification, and early implementation of preventive strategies should always be the goal to curtail this infection at an early stage., (© 2023 Wiley Periodicals LLC.)

Background: Ovarian cancer ranks 12th in cancer incidence among women in the United States and 5th among causes of cancer-related death. The typical treatment of ovarian cancer focuses on disease management, with little attention given to the survivorship needs of the patient. Qualitative work alludes to a gap in survivorship care; yet, evidence is lacking to support the delivery of survivorship care for individuals living with ovarian cancer. We developed the POSTCare survivorship platform with input from survivors of ovarian cancer and care partners as a means of delivering patient-centered survivorship care. This process is framed by the chronic care model and relevant behavioral theory., Objective: The overall goal of this study is to test processes of care that support quality of life (QOL) in survivorship. The specific aims are threefold: first, to test the efficacy of the POSTCare platform in supporting QOL, reducing depressive symptom burden, and reducing recurrence worry. In our second aim, we will examine factors that mediate the effect of the intervention. Our final aim focuses on understanding aspects of care platform design and delivery that may affect the potential for dissemination., Methods: We will enroll 120 survivors of ovarian cancer in a randomized controlled trial and collect data at 12 and 24 weeks. Each participant will be randomized to either the POSTCare platform or the standard of care process for survivorship. Our population will be derived from 3 clinics in Texas; each participant will have received some combination of treatment modalities; continued maintenance therapy is not exclusionary., Results: We will examine the impact of the POSTCare-O platform on QOL at 12 weeks after intervention as the primary end point. We will look at secondary outcomes, including depressive symptom burden, recurrence anxiety, and physical symptom burden. We will identify mediators important to the impact of the intervention to inform revisions of the intervention for subsequent studies. Data collection was initiated in November 2023 and will continue for approximately 2 years. We expect results from this study to be published in early 2026., Conclusions: This study will contribute to the body of survivorship science by testing a flexible platform for survivorship care delivery adapted for the specific survivorship needs of patients with ovarian cancer. The completion of this project will contribute to the growing body of science to guide survivorship care for persons living with cancer., Trial Registration: ClinicalTrials.gov NCT05752448; https://clinicaltrials.gov/study/NCT05752448., International Registered Report Identifier (irrid): PRR1-10.2196/48069., (©Elizabeth Kvale, Farya Phillips, Samiran Ghosh, Jayanthi Lea, Claire Hoppenot, Anthony Costales, Jan Sunde, Hoda Badr, Eberechi Nwogu-Onyemkpa, Nimrah Saleem, Rikki Ward, Bijal Balasubramanian. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 09.02.2024.)

Introduction: Acute necrotizing pancreatitis (ANP) complicates 15 % of acute pancreatitis cases and is associated with prolonged length of stay (LOS). There are limited studies exploring potential predictors., Methods: We carried out a retrospective study of all consecutive patients presenting to a large referral healthcare system with ANP. Patients younger than 18 years of age, without confirmed glandular necrosis and with in-hospital mortality were excluded. Poisson regression was carried out to identify potential predictors of prolonged hospital stay., Results: One hundred and sixty-two patients hospitalized between December 2016 and June 2020 were included. The median LOS was 12 days (range: 1-155 days). On multivariate analysis, organ dysfunction at presentation (Incidence rate ratio (IRR) 1.21, p = 0.01) or during admission (IRR 1.32, p = 0.001), Charlson Comorbidity Index scores (IRR 1.1 per CCI point, p < 0.001), known chronic pancreatitis (IRR 1.19, p = 0.03), concurrent (non-pancreas related) infections (IRR 1.13, p = 0.04), need for enteral tube placement (IRR 3.42, p < 0.001) and in-hospital interventions (IRR 1.48-2.85 depending on intervention, p < 0.001) were associated with increased LOS. For patients in the cohort to whom this applied, delayed hospital transfers (IRR 1.02, p < 0.001) and delayed start of enteral feeds (IRR 1.01, p = 0.017) contributed to increased overall LOS., Conclusion: We demonstrate that multiple factors including delayed transfers to hospitals with pancreaticobiliary expertise lead to increased length of hospitalization. We suggest various strategies that can be considered to target those gaps and may have a favorable effect on LOS., Competing Interests: Declaration of competing interest None of the contributing authors have any conflict of interest, including specific financial interests or relationships and affiliations relevant to the subject matter or materials discussed in the manuscript., (Copyright © 2023 IAP and EPC. Published by Elsevier B.V. All rights reserved.)

Introduction: Acute heart failure (HF) is a major cause of unplanned hospitalisation characterised by excess body water. A restriction in oral fluid intake is commonly imposed on patients as an adjunct to pharmacological therapy with loop diuretics, but there is a lack of evidence from traditional randomised controlled trials (RCTs) to support the safety and effectiveness of this intervention in the acute setting.This study aims to explore the feasibility of using computer alerts within the electronic health record (EHR) system to invite clinical care teams to enrol patients into a pragmatic RCT at the time of clinical decision-making. It will additionally assess the effectiveness of using an alert to help address the clinical research question of whether oral fluid restriction is a safe and effective adjunct to pharmacological therapy for patients admitted with fluid overload., Methods and Analysis: THIRST (Randomised Controlled T rial within the electronic H ealth record of an I nterruptive alert displaying a fluid R estriction S uggestion in patients with the treatable T rait of congestion) Alert is a single-centre, parallel-group, open-label pragmatic RCT embedded in the EHR system that will be conducted as a feasibility study at an National Health Service (NHS) hospital in London. The clinical care team will be invited to enrol suitable patients in the study using a point-of-care alert with a target sample size of 50 patients. Enrolled patients will then be randomised to either restricted or unrestricted oral fluid intake. Two primary outcomes will be explored (1) the proportion of eligible patients enrolled in the study and (2) the mean difference in oral fluid intake between randomised groups. A series of secondary outcomes are specified to evaluate the effectiveness of the alert, adherence to the randomised treatment allocation and the quality of data generated from routine care, relevant to the outcomes of interest., Ethics and Dissemination: This study was approved by Riverside Research Ethics Committee (Ref: 22/LO/0889) and will be published on completion., Trial Registration Number: NCT05869656., Competing Interests: Competing interests: RTL has received funding from Pfizer for unrelated research, under the Innovative Target Exploration Network programme., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: Immunoglobulin A Nephropathy (IgAN) is a heterogeneous disorder. Multiple ethnicities conducted studies to assess the effectiveness of the Oxford classification of IgAN in prognostication. However, there is no study on the Pakistani population. We aim to identify its prognostic effectivity in our patients., Methods: We retrospectively reviewed the medical records of 93 biopsy-proven cases of primary IgAN. We collected the clinical and pathological data at baseline and on follow-ups. The median follow-up period was 12 months. We defined the renal outcome as a ≥ 50% decline in eGFR or end-stage renal disease (ESRD)., Results: Of 93 cases, 67.7% were males with a median age of 29. Glomerulosclerosis was the most prevalent lesion (71%). The median MEST-C was 3. On follow-up, median serum creatinine worsened from 1.92 to 2.2 mg/dL, and median proteinuria reduced from 2.3 g/g to 1.072 g/g. The reported renal outcome was 29%. T and C scores and MEST-C scores above 2 were significantly associated with pre-biopsy eGFR. On Kaplan-Meier analysis, the T and C scores' association was significant with the renal outcome (p-value 0.000 and 0.002). In univariate and multivariate analyses, the association of T-score (p-value 0.000, HR 4.691), total MEST-C score (p-value 0.019), and baseline serum creatinine (p-value 0.036, HR 1.188) were significant with the outcome., Conclusion: We validate the prognostic significance of the Oxford classification. T and C scores, baseline serum creatinine, and total MEST-C score significantly affect the renal outcome. Furthermore, we recommend the inclusion of the total MEST-C score in determining the IgAN prognosis., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

Background and Aims: Extracorporeal shock wave lithotripsy (ESWL) is performed to fragment large main pancreatic duct (MPD) stones in symptomatic patients. Subsequent endoscopic retrograde cholangiopancreatography (ERCP) is often performed to clear the stone fragments. Edema of surrounding tissue after ESWL theoretically affects the ability to perform ERCP. However, the optimal timing of ERCP after ESWL is not clearly defined. The aim of this study is to determine the efficacy and safety of same-day ERCP after ESWL and to determine if the timing of ERCP after ESWL affects outcomes., Methods: This is a retrospective study of consecutive patients from January, 2013 to September, 2019 who received ESWL for MPD stones at our center. Included patients received subsequent same-day ERCP under the same general anesthesia session or later session ERCP (1-30 days after ESWL). Demographics, anatomical findings, history, and outcomes were collected. Success was defined as complete or near complete (> 80%) stone fragmentation with clearance., Results: 218 patients were treated with ESWL and subsequent ERCP. 133 (61.0%) received ERCP on the same day immediately after ESWL, while 85 (39.0%) returned for ERCP at a later day (median 3.0 days after ESWL). Baseline characteristics demonstrated patients who received same-day ERCP had a higher rate of pain at baseline (94.7% vs 87.1%, p = 0.045). Main outcomes demonstrated an overall successful MPD stone clearance rate of 90.4%, with similar rates between same-day ERCP and later session ERCP (91.7% vs 88.2%, p = 0.394). Additionally, successful cannulation at ERCP, adverse events, and post-procedure admission rates were similar., Conclusions: Delaying ERCP to allow peripancreatic tissue recovery after ESWL does not affect outcomes. Same-day ERCP after ESWL is safe and effective., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction Obesity, a complex and multifactorial disease, is defined by a body mass index (BMI) greater than 30 kg/m². When the BMI exceeds 40 kg/m², it is classified as morbid obesity. This condition leads to excessive fat accumulation, which impairs normal body function and metabolism. For individuals grappling with morbid obesity and those who have faced significant hurdles in their quest for substantial weight loss, bariatric surgery emerges as a vital option. Purpose The study aims to explore the dynamics of bariatric surgical tourism in Pakistan, shedding light on factors influencing the choice of Pakistan as a destination for bariatric tourism. Materials and methods A retrospective cross-sectional study design was adopted. Data were gathered from the medical records database, including all patients who had undergone bariatric surgery from 2018 until 2022. The data collection process involved comprehensive patient outreach, where investigators conducted phone interviews and collected patient satisfaction assessments. During these phone interviews, valuable information was gathered by posing questions. These inquiries encompassed various aspects, including the patient's overall satisfaction with the surgical experience, their countries of origin, the specific bariatric procedures they underwent, the motivating factors behind their decision to travel abroad for surgery, their postoperative follow-up routines, and any complications they may have encountered. Results One hundred and nine patients traveled to Pakistan for bariatric surgery from 2018 to 2022. Out of 109 patients, 78 responded to the questionnaire by phone or email. The proforma was filled by 41 (52.5%) males and 37 (47.5%) females. Forty-seven (60.2%) of these patients underwent Roux-en-Y gastric bypass and 31 (39.8%) patients underwent sleeve gastrectomy. Out of 78 bariatric patients, 72 (92.3%) were satisfied with their surgery, five patients (6.4%) were neutral in their response and one patient (1.3%) was dissatisfied with the surgery. Most of the patients (26, 33.3%) declared money as the main driving force for traveling, with long waiting times being the close second reason (19, 24.36%) patients. Conclusion At least 2% of worldwide bariatric procedures are provided for medical tourists. Countries such as Mexico, India, Lebanon, and Romania dominate as providers for patients mainly from the USA, UK, and Germany. The lack of affordable bariatric healthcare and long waiting lists are some of the reasons for patients choosing bariatric tourism. The 92.3% satisfaction rate of patients with the surgery and its outcomes is a significant finding, as it suggests that bariatric surgery services provided in Pakistan are meeting or exceeding the expectations of international patients. The exceptionally high level of patient satisfaction speaks to the quality of care provided by the medical institutions in Pakistan. The data and analysis presented in this study shed light on the motivations and experiences of international patients traveling to Pakistan for bariatric surgery. These insights are invaluable for healthcare providers, policymakers, and the medical tourism industry as they seek to enhance the accessibility, affordability, and quality of healthcare services for domestic and international patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Bashir et al.)

Objective: To report clinical and radiological follow-up outcomes of stent-assisted coiling of wide-necked basilar tip aneurysms and to evaluate the safety and efficacy of this treatment choice., Methods: A retrospective review was carried out of 19 patients with wide-necked basilar tip aneurysms in our institution between 2010 and 2020. The rates of perioperative complication, morbidity, mortality, imaging follow-up and re-treatment were analysed., Results: Our technical complication rate was 11% but did not result in treatment failure. The combined procedure related morbidity and mortality rate of the 19 patients who underwent stent assisted coiling was also 11%. 16 of 19 patients had undergone angiographic follow-up with a mean period of 32 months. 81% of patients with angiographic follow-up had a satisfactory occlusion (RROI or II) with 11% requiring re-treatment. Those requiring re-treatment were both treated with laser-cut stents; this is in contrast with no re-treatments required in the patients treated with braided stents., Conclusion: Our report provides acceptable outcomes in wide-necked basilar termination aneurysms which are very challenging to treat. Aneurysms treated with braided stents had better efficacy outcomes than those with laser-cut stents., Advances in Knowledge: Given the emergent and increasing utility of alternative endovascular techniques such as intrasaccular devices and flow diverters, real-world data are lacking on more conventional approaches such stent-assisted coiling, especially so in the posterior circulation. The associated relatively higher aneurysmal haemorrhagic risk in this location warrants further additional safety and efficacy data for this treatment approach, which this paper provides.

FUSCA 3 (FUS3), a seed master regulator, plays critical role in seed dormancy and oil accumulation. However, its downstream regulation mechanisms remain poorly understood. Here, we explored the roles of AINTEGUMENTA-like 6 (AIL6), a seed transcription factor, in these processes. The activation of AIL6 by FUS3 was demonstrated by dual-LUC assay. Seeds of ail6 mutants showed alterations in fatty acid compositions, and both AtAIL6 (AIL6 from Arabidopsis thaliana) and BnaAIL6 (AIL6 from Brassica napus) rescued the phenotype. Over-expression (OE) of AIL6s reversed changes in seed fatty acid composition. Notably, OE lines showed low seed germination rates down to 12% compared to 100% of wild-type Col-0. Transcriptome analysis of the mutant and an OE line indicated widespread expression changes of genes involved in lipid metabolism and phytohormone pathways. In OE mature seeds, GA4 content decreased more than 15-fold, while abscisic acid and indole-3-acetic acid (IAA) contents clearly increased. Exogenous GA3 treatments did not effectively rescue the low germination rate. Nicking seed coats increased germination rates from 25% to nearly 80% while the wild-type rdr6-11 is 100% and 98% respectively, and elongation of storage time also improved seed germination. Furthermore, dormancy imposed by AIL6 was fully released in the della quintuple mutant. Together, our results indicate AIL6 acts as a manager downstream of FUS3 in seed dormancy and lipid metabolism., Competing Interests: Conflict of interest statement. The authors declare that there is no conflict of interest., (© American Society of Plant Biologists 2023. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)