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Objective The present study aimed to evaluate the accuracy of previous equations for estimating gross energy (GE) in feed ingredients and to develop the novel equations. Methods A total of 2,279 ingredient samples consisted of barley (n = 58), corn (n = 319), corn distillers dried grains with solubles (n = 13), corn gluten feed (n = 583), copra expellers (n = 156), copra meal (n = 234), cottonseed meal (n = 12), palm kernel expellers (n = 504), rapeseed meal (n = 114), soybean meal (n = 138), wheat (n = 70), and wheat bran (n = 78) were analyzed for dry matter (DM), crude protein (CP), ether extract (EE), crude fiber, ash, and GE. The 2,279 ingredient samples were used for evaluating the previous equations and developing novel equations. Using data from 62 ingredients in the swine NRC publication in 2012, the old equations and the novel equations were evaluated. Results Based on the evaluation using 2,279 samples, the equation developed by Ewan in 1989 underestimates GE by 218 kcal/kg DM (standard error = 4 and p

Abstract Background The long-term relationship between body composition and lung function has not yet been fully demonstrated. We investigated the longitudinal association between muscle-to-fat (MF) ratio and lung function among middle-aged general population. Methods Participants were enrolled from a community-based prospective cohort between 2005 and 2014. Lung function parameters (forced vital capacity [FVC], forced expiratory volume in 1 s [FEV1], and FEV1/FVC) and the MF ratio (total body muscle mass [kg]/fat mass [kg]) were assessed biannually via spirometry and bioelectrical impedance analysis, respectively. Results We followed up 4,712 participants (age 53.9 ± 7.9 years, men 45.8%) for 8 years. With an increase in MF ratio of 1, in men, the FVC increased by 43.9 mL, FEV1 by 37.6 mL, and FEV1/FVC by 0.320%, while in non-smoking women, the FVC increased by 55.8 mL, FEV1 by 44.3 mL, and FEV1/FVC by 0.265% (all P

Abstract Background Intraoperative hypotension is very common during surgery and is linked to major organ dysfunction and mortality. Current perioperative blood pressure management is largely based on universal blood pressure thresholds ranging from a mean arterial pressure of 60–70 mmHg. However, the effectiveness of this conventional management remains unproven in prospective randomized trials. Therefore, we will conduct this study to test if individualized perioperative blood pressure management decreases the incidence of postoperative major adverse outcomes. Methods This multicenter, randomized controlled superiority trial will enroll 1896 high-risk patients undergoing major noncardiac surgery from five tertiary university hospitals in South Korea. In the control group, mean arterial pressure will be maintained at ≥ 65 mmHg and systolic blood pressure ≥ 90 mmHg during surgery. In the intervention group, mean arterial pressure and systolic blood pressure will be maintained at no less than 20% of their baseline values. The baseline values are calculated as the average of all values measured from the day before surgery until the morning of surgery. These targets will be maintained until the patient is discharged from the post-anesthesia care unit or, for those who are transferred to the intensive care unit after surgery, until the end of the surgery. No specific restrictions, except for these blood pressure targets, will be applied to perioperative management. The primary composite outcome consists of all-cause death, stroke, myocardial infarction, new or worsening congestive heart failure, unplanned coronary revascularization, and acute kidney injury within 7 days after noncardiac surgery or until hospital discharge, whichever occurs first. Discussion This study will reveal if individualized perioperative blood pressure management decreases the risk of major adverse outcomes in patients at high-risk undergoing noncardiac surgery. Trial registration ClinicalTrials.gov NCT06225453. Registered on January 26, 2024.

In July 2023, cases of highly pathogenic avian influenza (HPAI) were reported at 2 shelters for stray cats in Seoul, South Korea. The cause of infection was suspected to be improperly sterilized raw food made from domestic duck meat, which was manufactured in South Korea. All viruses isolated from cats at the shelters and from the raw food belonged to HPAI A(H5N1) clade 2.3.4.4b. The gene constellation of all viruses was most similar to that of viruses isolated in Korea in November 2022. Of note, the viruses isolated from infected cats harbored mutations E627K or D701N in polymerase basic 2, which are indicative of adaptation to mammals. Postmortem examination revealed systemic pathologic lesions and the presence of widespread virus in different tissues. Thus, consumption of raw duck meat contaminated with HPAI virus likely caused systemic symptoms and death in cats, indicating the introduction of mammal-adapted mutations of the virus.

Hepatitis B virus (HBV) is a sex-specific pathogen that is more severe in males than in females. Sex disparities in HBV infection have been attributed to hormonal differences between males and females. However, whether HBV infection affects the metabolic signatures of steroid hormones and how these influences viral replication remains unclear. In this study, we investigated whether HBV infection alters steroid metabolism and its effects on HBV replication. Serum samples from male and female mice obtained after the hydrodynamic injection of replication-competent HBV plasmids were subjected to quantitative steroid profiling. Serum steroid levels in mice were analyzed using an in vitro metabolism assay with the mouse liver S9 fraction. The alteration of steroids by HBV infection was observed only in male mice, particularly with significant changes in androgens, whereas no significant hormonal changes were observed in female mice. Among the altered steroids, dehydroepiandrosterone (DHEA) levels increased the most in male mice after HBV infection. An in vitro metabolism assay revealed that androgen levels were significantly reduced in HBV-infected male mice. Furthermore, the genes involved in DHEA biosynthesis were significantly upregulated in HBV-infected male mice. Interestingly, reduced dihydrotestosterone in male mice significantly inhibits viral replication by suppressing HBV promoter activity, suggesting a viral strategy to overcome the antiviral effects of steroid hormones in males. Our data demonstrated that HBV infection can cause sex-specific changes in steroid metabolism.

Background/Aims The corona virus disease 2019 posed a major risk for end-stage kidney disease (ESKD) cases. Our study aimed to assess changes in kidney replacement therapy (KRT) trends and healthcare access for these patients during the pandemic. Methods We retrospectively analyzed nationwide data from July 2017 to June 2022 to assess changes in KRT and ESKD incidence. KRT modalities included peritoneal dialysis (PD), hemodialysis (HD), and kidney transplantation (KT). We utilized the interrupted time series (ITS) method to compare changes in KRT modality before and after the incidence of the COVID-19 pandemic. Results ESKD incidence remained stable from 2018 to April 2022. The ITS analysis confirmed that the pandemic did not significant impact overall KRT incidence. PD cases decreased (5.7% to 1.3%), while HD cases increased (81.6% to 85%), and KT recipient remained relatively stable (12.7% to 17.3%). The hospitalization and hospital stay decreased in nursing hospital (165.01 days to 147.77 days) and general hospital (61.34 days to 55.58 days) during the pandemic, however, remained unchanged for PD and KT. Conclusions Our findings indicate no significant changes in ESKD incidence in South Korea during the pandemic. However, there were shifts in modality distribution, with decreased PD and increased HD cases. Notably, HD cases showed a significant reduction in hospital admissions and length of stay. The healthcare system demonstrated stability during the pandemic, with minimal disruptions in ESKD care.

Background & aim: Psychosocial factors are crucial for patients with coronary artery disease (CAD), but the type and outcome of anxiety disorders in these patients have not been studied as much as other risk factors. Therefore, the aim of the present study was to determine and investigate psychometric indicators of generalized anxiety disorder (GAD) in CAD patients. Methods: The present research applied a descriptive-cross-sectional method. The statistical population included all patients with CAD referred to Golestan Hospital in Ahvaz, Iran,in 2022. Two-hundred and nine participants were selected using available sampling method and completed the 7-item scale of generalized anxiety disorder (GAD-7). The collected data were analyzed using Cronbach's alpha, Pearson's correlation coefficient, independent t test, one-way analysis of variance, exploratory factor analysis and Imus. Results: The mean and standard deviation of age for men was 58.47±10.45 and for women it was 62.40±9.47. 152 people (72.73%) were men, Cronbach's alpha was equal to 0.936 and a one-factor model was obtained using exploratory factor analysis (EFA). Confirmatory factor analysis (CFA) indicated that the modified one-factor model of GAD-7 (this factor is named GAD-7) had a good fit. Conclusion: since CAD patients experience high anxiety, it is important to use a short and valid tool to determine their anxiety. Therefore, GAD-7 has worthy psychometric properties for use in patients with CAD.

Introduction: The goal of this study was to evaluate the efficacy and safety of high-dose stereotactic body radiation therapy (SBRT) with an extended (48 hours or more) interfraction interval for hepatocellular carcinoma (HCC) ≤5 cm in size after incomplete response to transarterial chemoembolization (TACE). Methods: This multicenter prospective study included 54 patients with inoperable HCC of ≤5 cm size between July 2012 and June 2015. A total SBRT dose of 60 Gy in 3 fractions was administered within 14 days with ≥48 hours interfraction interval to patients who showed an incomplete response after 1–5 sessions of TACE. Treatment responses were defined according to the modified Response Evaluation Criteria for Solid Tumors. Toxicities were evaluated using the Common Terminology Criteria for Adverse Events version 4.0. Results: Forty-eight patients were evaluated with a median follow-up period of 66 months (range, 2–126 months). The median tumor size was 2.0 cm (range, 1.0–4.5 cm), and most patients (87.5%) had a single lesion. The 1-, 2-, and 5-year local control (LC) rates were 100%, 94.8%, and 90.7%, respectively. The 1-, 2-, and 5-year progression-free survival (PFS) rates were 63.4%, 56.9%, and 24.9%, respectively. The 1-, 2-, and 5-year overall survival (OS) rates were 95.6%, 90.9%, and 76.5%, respectively. None of the patients experienced grade 3+ gastrointestinal toxicity, while one patient developed non-classic radiation-induced liver disease 2 months after SBRT. Conclusion: High-dose SBRT with a ≥48-hour interfraction interval after incomplete response to TACE is effective for HCC ≤5 cm in size as evidenced by the high rates of LC and OS and acceptable treatment-related toxicity.

Objective The present study aimed to study effects of a chronic feeding of deoxynivalenol (DON) on growth performance, organ weight, organ DON accumulation, and blood parameters in pigs. Methods Forty-eight castrated male pigs with a body weight of 10.4 kg (standard deviation = 1.7) were assigned to one of 2 diet groups in a randomized complete block design with 6 blocks of pens per diet and 4 pigs per pen. A corn-soybean meal-based control diet was prepared to contain a low DON concentration of 0.28 mg/kg. Corn distillers dried grains with solubles naturally contaminated with DON were used at 30.0% to prepare a contaminated diet with a high DON concentration of 1.8 mg/kg. During the 56-day experimental period, body weight and feed intake were recorded every 14 days. A pig from each pen was euthanized for the collection of organs and muscle every 14 days. Results Gain:feed in pigs fed the contaminated diet during days 14 to 28 and days 28 to 42 were less (p

Abstract Background Phlegm is prevalent symptom in patients with chronic obstructive pulmonary disease (COPD). Few studies have investigated the effectiveness of N-acetylcysteine (NAC) nebulizer therapy in COPD patients. We evaluated the effect of nebulized NAC on the improvement of phlegm symptom in COPD patients. Methods This was a 12-week, prospective, single-arm, open-label, phase IV multi-center trial (NCT05102305, Registration Date: 20-October-2021). We enrolled patients aged ≥ 40 years with post bronchodilator forced expiratory volume in one second/forced vital capacity (FEV1/FVC)

Abstract Post-transplantation diabetes mellitus (PTDM) negatively affects graft and patient survival after kidney transplantation (KT). This prospective study used continuous glucose monitoring (CGM) to evaluate perioperative blood glucose dynamics, identify PTDM risk factors, and compare predictive accuracy with capillary blood glucose monitoring (CBGM) in 60 non-diabetic living-donor KT recipients. Patients underwent 2-week pre- and postoperative CGM, including routine CBGM during their in-hospital stays. PTDM-related risk factors and glucose profiles were analyzed with postoperative CGM and CBG. PTDM developed in 14 (23.3%) patients and was associated with older age, male sex, higher baseline HbA1c, high-density lipoprotein cholesterol, and 3-month cumulative tacrolimus exposure levels. Male sex and postoperative time above the range (TAR) of 180 mg/dL by CGM were PTDM-related risk factors in the multivariate analysis. For predictive power, the CGM model with postoperative glucose profiles exhibited higher accuracy compared with the CBGM model (areas under the curves of 0.916, and 0.865, respectively). Therefore, we found that male patients with a higher postoperative TAR of 180 mg/dL have an increased risk of PTDM. Postoperative CGM provides detailed glucose dynamics and demonstrates superior predictive potential for PTDM than CBGM.

Abstract Background Tranexamic acid (TXA) effectively attenuates hyperfibrinolysis and preemptive administration has been employed to reduce bleeding and blood transfusions in various surgical settings. However, TXA administration could be associated with adverse effects, such as seizures and thromboembolic risks. While patients with fibrinolysis shutdown showed greater thromboembolic complications and mortality, TXA administration may aggravate the degree of shutdown in these patients. Selective TXA administration based on the results of rotational thromboelastometry (ROTEM) would be non-inferior to preemptive TXA administration in reducing postoperative bleeding and beneficial in reducing its risks in patients undergoing cardiovascular surgery. Methods This non-inferiority, randomized, double-blind, placebo-controlled, multicenter trial will be performed in 3 tertiary university hospitals from August 2023 to March 2025. Seven hundred sixty-four patients undergoing cardiovascular surgery will be randomly allocated to get TXA as a preemptive (Group-P) or goal-directed strategy (Group-GDT) in each institution (with a 1:1 allocation ratio). After anesthesia induction, TXA (10 mg/kg and 2 mg/kg/h) and a placebo are administered after anesthesia induction in Group-P and Group-GDT, respectively. ROTEM tests are performed immediately before weaning from CPB and at the considerable bleeding post-CPB period. After getting the test results, a placebo is administered in Group-P (regardless of the test results). In Group-GDT, placebo or TXA is administered according to the results: placebo is administered if the amplitude at 10 min (A10-EXTEM) is ≥ 40 mm and lysis within 60 min (LI60-EXTEM) of EXTEM assay is ≥ 85%, or TXA (20 mg/kg) is administered if A10-EXTEM is

Erwinia pyrifoliae is a gram-negative bacterial pathogen that commonly causes black shoot blight in pear and apple tree. Although the pathogenicity of this bacterial species is very similar to E. amylovora, there is no specific explanation of its pathogenic genes and mechanisms. In this study, our investigation into E. pyrifoliae pathogenicity involved generating seven YKB12327 mutant strains using Tn5 transposon mutagenesis. Observations revealed weakened growth rate and loss of pathogenicity in these mutants. Whole-genome sequencing and alignment analysis identified transposon insertions within the coding sequences of five strains and in the intergenic region of two strains. Annotation analysis elucidated genes directly or indirectly associated with pathogenicity. Notably, mutant strain MT16 displayed a transposon insertion mutation in the cyclic-di-GMP phosphodiesterase (pdeF) gene, a key player in bacterial signaling, governing microbial behavior and adaptation to environmental changes. Our findings provide insights into the genetic regulation of E. pyrifoliae pathogenicity, suggesting potential avenues for further research aimed at understanding and controlling this bacterial pathogen by targeting pdeF to mitigate apple black shoot blight disease.

Depression occurs among the elderly, leading to increased use of medical facilities, adversely affecting quality of life (QoL), and increasing mortality. Fewer studies have been conducted to explore the factors that contribute to depression among the elderly. The purpose of this study was to identify the factors that trigger depression in this population. This research used descriptive analysis with a cross-sectional design. A total of 247 participants completed a questionnaire containing socio-demographic information and the geriatric depression scale-15 (GDS-15). The data were analyzed for correlation using the chi-square test. There was a significant relationship between insurance and occupation and depression in rural communities in Central Java, Indonesia. Insurance and occupation influence elderly individuals’ preparation for old age, ensuring they have sufficient finances through old age savings, which enables them to be financially secure. The population needs to prepare for old age by calculating their retirement fund requirements, saving and investing, and obtaining insurance for pension and health fund protection.

Introduction: : Families of schizophrenia patients need to obtain information from health services about how to care for them. Limited information and understanding of responsibilities in caring are still obstacles to becoming an empowered family in caring for patients with schizophrenia. The study aimed to explore family needs regarding information from health services and family responsibilities when caring for patients with schizophrenia. Methods: This study used a descriptive qualitative design. The study involved families who cared for patients with schizophrenia in Surabaya, Indonesia. Twenty participants were obtained using purposive sampling techniques and the sample size was determined by data saturation. Data were collected using in-depth interviews, field notes and interview question guides. The data were processed with content analysis. Results: The results showed eight themes. Families need information about patient conditions, medication, routine control, and counseling for patient conditions as well as for families. The family describes the responsibilities carried out for the patient as providing support for patient treatment, fulfilling daily needs, helping with social skills, and providing activities in spare time. Conclusions: Adequate information from health services regarding both the patient's condition and family counseling can help to meet the demands of care, which stimulates families to be more empowered to carry out care responsibilities and has an impact on the ability to care better Keywords: counseling, empowerment, family, mental disorder, responsibility, schizophrenia

BackgroundStress is a significant risk factor for psychiatric disorders such as major depressive disorder (MDD) and panic disorder (PD). This highlights the need for advanced stress-monitoring technologies to improve treatment. Stress affects the autonomic nervous system, which can be evaluated via heart rate variability (HRV). While machine learning has enabled automated stress detection via HRV in healthy individuals, its application in psychiatric patients remains underexplored. This study evaluated the feasibility of using machine-learning algorithms to detect stress automatically in MDD and PD patients, as well as healthy controls (HCs), based on HRV features.MethodsThe study included 147 participants (MDD: 41, PD: 47, HC: 59) who visited the laboratory up to five times over 12 weeks. HRV data were collected during stress and relaxation tasks, with 20 HRV features extracted. Random forest and multilayer perceptron classifiers were applied to distinguish between the stress and relaxation tasks. Feature importance was analyzed using SHapley Additive exPlanations, and differences in HRV between the tasks (ΔHRV) were compared across groups. The impact of personalized longitudinal scaling on classification accuracy was also assessed.ResultsRandom forest classification accuracies were 0.67 for MDD, 0.69 for PD, and 0.73 for HCs, indicating higher accuracy in the HC group. Longitudinal scaling improved accuracies to 0.94 for MDD, 0.90 for PD, and 0.96 for HCs, suggesting its potential in monitoring patients’ conditions using HRV. The HC group demonstrated greater ΔHRV fluctuation in a larger number of and more significant features than the patient groups, potentially contributing to higher accuracy. Multilayer perceptron models provided consistent results with random forest, confirming the robustness of the findings.ConclusionThis study demonstrated that differentiating between stress and relaxation was more challenging in the PD and MDD groups than in the HC group, underscoring the potential of HRV metrics as stress biomarkers. Psychiatric patients exhibited altered autonomic responses, which may influence their stress reactivity. This indicates the need for a tailored approach to stress monitoring in these patient groups. Additionally, we emphasized the significance of longitudinal scaling in enhancing classification accuracy, which can be utilized to develop personalized monitoring technologies for psychiatric patients.

Older adults with hypertension often experience a low quality of life. Family support plays a critical role in maintaining and improving their well-being. This study aimed to analyze the effectiveness of a family-centered empowerment model on the quality of life of hypertensive patients. This quasi-experimental study included 70 participants with hypertension, who were divided into an intervention group and a control group. Participants were selected through a consecutive sampling technique. The study utilized the Family Empowerment Instrument and the European Quality of Life questionnaire (EQ-5D-5L) for data collection. The data analysis was performed using Levene's, Wilcoxon Signed Rank, and Mann-Whitney U tests. There were no significant differences in the participants’ characteristics between the control and intervention groups (Levene's test p-value >0.05). After the family-centered empowerment intervention, the quality of life in the intervention group was significantly higher than that of the control group (Mann-Whitney U test p-value=0.000 < 0.05). This suggests that nurses can effectively involve patients with chronic diseases, particularly hypertension, and their families in the treatment process to enhance their quality of life.

Alternative splicing products of AIMP2 and AIMP2-DX2 (DX2) have been reported to be associated with human lung cancer. In fact, DX2 expression is elevated in human lung cancers, and DX2 transgenic mice also develop lung cancer, in particular small cell lung cancer (SCLC). However, the mechanism by which DX2 is induced during cancer progression has not been clearly elucidated. Here, we show that DX2 is induced by nicotine, the main component of smoking-related chemicals, which can stabilize the human epidermal growth factor receptor 2 (HER2) protein and transcriptionally increase sonic hedgehog (Shh). Indeed, nicotine showed tumorigenicity via DX2 by promoting spheroid formation and in vivo lung and kidney cancer progression. Moreover, the elimination of DX2 using small interfering RNA (siRNA) or an optimized inhibitor (SNU-14) blocked the induction of HER2 and Shh and completely suppressed tumor sphere formation in response to nicotine. These results indicate that DX2 is critical for lung cancer progression, and a specific DX2 inhibitor would be useful for the treatment of human cancers, including SCLC and non-SCLC (NSCLC).

Introduction: This systematic review explores the differential impacts of high and low-intensity physical exercise on brain wave activity and functional connectivity in professional athletes. The study aims to elucidate how varying exercise intensities influence cognitive and emotional responses, brain connectivity, and overall mental health. Additionally, it examines the potential synergistic effects of integrating neurofeedback training with physical exercise. Method: A comprehensive literature search was conducted using databases such as PubMed, Scopus, and Google Scholar. Keywords included "high-intensity exercise," "low-intensity exercise," "brain wave activity," "functional connectivity," "professional athletes," and "cognitive performance." Inclusion criteria were studies published in peer-reviewed journals involving professional athletes and examining the impact of exercise intensity on brain wave activity and functional connectivity. Data extraction focused on study design, sample size, exercise intensity, neuroimaging techniques, brain wave activity, and functional connectivity outcomes. Results: High-intensity physical exercise was found to induce significant changes in functional connectivity within affect and reward networks, enhance mood, and improve cognitive performance through increased brain wave coherence and synchronization. Low-intensity exercise primarily enhanced cognitive and attentional processing by increasing resting-state functional connectivity in the fronto-parietal network. Neurofeedback training was shown to enhance brain wave activity, reduce stress levels, and increase self-control over physiological factors. The combined approach of neurofeedback and physical exercise demonstrated potential for optimizing both mental and physical performance in athletes. Conclusion: The findings indicate that high-intensity exercise leads to significant and prolonged changes in brain connectivity and cognitive performance, while low-intensity exercise benefits cognitive and attentional processing. The discussion introduces the Neurofeedback and Physical Fitness Synergy Theory, which posits that integrating neurofeedback with physical exercise can lead to optimal improvements in both physical fitness and mental health. This combined approach suggests a promising strategy for enhancing overall athletic performance and mental well-being. Future research should focus on standardized measures and long-term studies to further validate these findings and explore the underlying neurophysiological mechanisms. Keywords: Brain, Emotions, Physical Fitness, Cognition, Athletes, Self-Control

Introduction: Community-based exercise programs have been shown to significantly improve physical health, cognitive function, and emotional well-being in older adults. However, the factors influencing varying levels of benefit among participants and the challenges they face in maintaining participation remain underexplored. Aim: This study aimed to explore the multifaceted impacts of a community-based exercise program on older adults, focusing on their physical, psychological, and social experiences. Method: A qualitative study design was employed, utilizing thematic analysis to identify themes and sub-themes from participant experiences. Data were collected through semi-structured interviews, focus groups, and participant observations. Participants in-cluded 45 older adults aged 60 years and above who had been in the program for at least three months. Result: The analysis revealed several key themes: Improvement in Physical Function (increased mobility, strength, balance, and endurance), Enhanced Exercise Self-Efficacy (confidence in physical abilities, positive attitude toward exercise, self-management of health), Social and Emotional Benefits (social connections, emotional support, motivation from group dynamics, reduced loneliness), Psychological and Cognitive Benefits (increased mental alertness, stress reduction, improved mood), Overcoming Initial Challenges (physical barriers, psycholog-ical hesitations, adapting to new routines), Long-Term Commitment and Behavior Change (continued participation, development of healthy habits, increased awareness of health), and Program Design and Facilitators' Role (tailored exercises, positive influence of instructors, accessibility of the program). Conclusion: Community-based exercise programs offer multifaceted benefits for older adults, including physical, psychological, and social improvements. These findings underscore the need for personalized approaches and enhanced support systems to maximize benefits and ensure sustained engagement. Keywords: Older Adults, Community-Based Exercise, Physical Health, Psychological Well-Being, Social Interaction

Abstract Impaired ion channels regulating Golgi pH lead to structural alterations in the Golgi apparatus, such as fragmentation, which is found, along with cognitive impairment, in Alzheimer’s disease. However, the causal relationship between altered Golgi structure and cognitive impairment remains elusive due to the lack of understanding of ion channels in the Golgi apparatus of brain cells. Here, we identify that a transmembrane protein TMEM87A, renamed Golgi-pH-regulating cation channel (GolpHCat), expressed in astrocytes and neurons that contributes to hippocampus-dependent memory. We find that GolpHCat displays unique voltage-dependent currents, which is potently inhibited by gluconate. Additionally, we gain structural insights into the ion conduction through GolpHCat at the molecular level by determining three high-resolution cryogenic-electron microscopy structures of human GolpHCat. GolpHCat-knockout mice show fragmented Golgi morphology and altered protein glycosylation and functions in the hippocampus, leading to impaired spatial memory. These findings suggest a molecular target for Golgi-related diseases and cognitive impairment.

Background/Aims Intensive care unit (ICU) quality is largely determined by the mortality rate. Therefore, we aimed to develop and validate a novel prognostic model for predicting mortality in Korean ICUs, using national insurance claims data. Methods Data were obtained from the health insurance claims database maintained by the Health Insurance Review and Assessment Service of South Korea. From patients who underwent the third ICU adequacy evaluation, 42,489 cases were enrolled and randomly divided into the derivation and validation cohorts. Using the models derived from the derivation cohort, we analyzed whether they accurately predicted death in the validation cohort. The models were verified using data from one general and two tertiary hospitals. Results Two severity correction models were created from the derivation cohort data, by applying variables selected through statistical analysis, through clinical consensus, and from performing multiple logistic regression analysis. Model 1 included six categorical variables (age, sex, Charlson comorbidity index, ventilator use, hemodialysis or continuous renal replacement therapy, and vasopressor use). Model 2 additionally included presence/absence of ICU specialists and nursing grades. In external validation, the performance of models 1 and 2 for predicting in-hospital and ICU mortality was not inferior to that of pre-existing scoring systems. Conclusions The novel and simple models could predict in-hospital and ICU mortality and were not inferior compared to the pre-existing scoring systems.

Background/Aims The major histocompatibility class II (MHC II) transactivator, known as CIITA, is induced by Interferon gamma (IFN-γ) and plays a well-established role in regulating the expression of class II MHC molecules in antigen-presenting cells. Methods Primary human hepatocytes (PHH) were isolated via therapeutic hepatectomy from two donors. The hepatocellular carcinoma (HCC) cell lines HepG2 and Huh7 were used for the mechanistic study, and HBV infection was performed in HepG2-NTCP cells. HBV DNA replication intermediates and secreted antigen levels were measured using Southern blotting and ELISA, respectively. Results We identified a non-canonical function of CIITA in the inhibition of hepatitis B virus (HBV) replication in both HCC cells and patient-derived PHH. Notably, in vivo experiments demonstrated that HBV DNA and secreted antigen levels were significantly decreased in mice injected with the CIITA construct. Mechanistically, CIITA inhibited HBV transcription and replication by suppressing the activity of HBV-specific enhancers/promoters. Indeed, CIITA exerts antiviral activity in hepatocytes through ERK1/2-mediated down-regulation of the expression of hepatocyte nuclear factor 1α (HNF1α) and HNF4α, which are essential factors for virus replication. In addition, silencing of CIITA significantly abolished the IFN-γ-mediated anti-HBV activity, suggesting that CIITA mediates the anti-HBV activity of IFN-γ to some extent. HBV X protein (HBx) counteracts the antiviral activity of CIITA via direct binding and impairing its function. Conclusions Our findings reveal a novel antiviral mechanism of CIITA that involves the modulation of the ERK pathway to restrict HBV transcription. Additionally, our results suggest the possibility of a new immune avoidance mechanism involving HBx.

Sodium–glucose cotransporter 2 (SGLT2) inhibitors regulate plasma glucose levels in patients with type 2 diabetes mellitus (T2DM) by inhibiting renal glucose reabsorption. This study investigated the impact of empagliflozin (EMPA), an SGLT2 inhibitor, on hypothalamic energy regulation. To directly investigate the role of SGLT2 inhibitors in the hypothalamus, we administered EMPA through intracerebroventricular (i.c.v.) injections into the murine ventricles. After dental cementing the i.c.v. cannula onto the skull, the mice were given 5 days to recover before receiving vehicle or EMPA (50 nM/2 μL) injections. In a high-fat diet (HFD)-induced obesity model, we determined the gene expression levels of agouti-related peptide (AgRP) and pro-opiomelanocortin (POMC) in the hypothalamus. Additionally, we assessed FoxO1 expression, which regulates AgRP and POMC gene transcription in hypothalamic cell lines. We found that EMPA directly influenced the expression of endogenous mRNA of POMC and AgRP, which are critical for energy homeostasis, and modulated their transcription in high-fat diet-induced obese mice. Additionally, EMPA affected the expression of FoxO1, a key transcriptional regulator of glucose homeostasis, thereby regulating the transcriptional activity of POMC and AgRP. These results indicate that EMPA significantly influences hypothalamic energy homeostasis, highlighting its potential as a regulator in obesity and T2DM management.

Background: Interest in the oligometastatic prostate cancer (OMPC) is increasing, and various clinical studies have reported the benefits of metastasis-directed radiation therapy (MDRT) in OMPC. However, the recognition regarding the adopted definitions, methodologies of assessment, and therapeutic approaches is diverse among radiation oncologists. This study aims to evaluate the level of agreement for issues in OMPC among radiation oncologists. Methods: We generated 15 key questions (KQs) for OMPC relevant to definition, diagnosis, local therapies, and endpoints. Additionally, three clinical scenarios representing synchronous metastatic prostate cancer (mPC) (case 1), metachronous mPC with visceral metastasis (case 2), and metachronous mPC with castration-resistance and history of polymetastasis (case 3) were developed. The 15 KQs were adapted according to each scenario and transformed into 23 questions with 6–9 per scenario. The survey was distributed to 80 radiation oncologists throughout the Republic of Korea. Answer options with 0.0–29.9%, 30–49.9%, 50–69.9%, 70–79.9%, 80–89.9%, and 90–100% agreements were considered as no, minimal, weak, moderate, strong, and near perfect agreement, respectively. Results: Forty-five candidates voluntarily participated in this study. Among 23 questions, near perfect (n = 4), strong (n = 3), or moderate (n = 2) agreements were shown in nine. For the case recognized as OMPC with agreements of 93% (case 1), near perfect agreements on the application of definitive radiation therapy (RT) for whole metastatic lesions were achieved. While ≥70% agreements regarding optimal dose-fractionation for metastasis-directed RT (MDRT) has not been achieved, stereotactic body RT (SBRT) is favored by clinicians with higher clinical volume. Conclusion: For the case recognized as OMPC, near perfect agreement for the application of definitive RT for whole metastatic lesions was reached. SBRT was more favored as a MDRT by clinicians with a higher clinical volume.

Mohamed M Ahmed,1,2,&ast; Mohammad Zaino,1,&ast; Mahmoud Moustafa,3,&ast; Ramzi Abdu Alajam,1,&ast; Abdulaziz H Alameer,1,&ast; Walaa E Morsy,1,4,&ast; Esraa Mohammed Fayed,1,4,&ast; Shazia Malik,1,&ast; Wafaa Mahmoud Amin1,5,&ast; 1Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 2Basic Science Department, Faculty of Physical Therapy, Beni-Suef University, Beni-Suef, Egypt; 3Diagnostic Radiography Technology Department, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 4Department of Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt; 5Basic Science for Physical Therapy Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt&ast;These authors contributed equally to this workCorrespondence: Wafaa Mahmoud Amin, Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan, 82722, Saudi Arabia, Tel +966596211342, Email wafaa_770@yahoo.comPurpose: This study was conducted to release the debate and examine the short-term impact of KT on the quadriceps muscle following arthroscopic surgery for partial meniscectomy.Patients and Methods: As part of a double-blind, randomized controlled trial, 40 people who had an arthroscopic partial meniscectomy (APM) were randomly put into two groups, A and B. Group A received Kinesio tape (KT) for the superficial heads of the quadriceps muscle, while group B received placebo KTk. After 10 minutes of KT application, the peak torque of both groups was measured using a Biodex isokinetic dynamometer.Results: Peak torque showed a significant increase in group A in comparison with group B during angular velocity 60◦/Sec. (F (1, 130) = 58.9, p < 0.001, ƞ2 =0.31) and during angular velocity 180◦/Sec. (F (1, 38) = 25.0, p < 0.001, ƞ2 =0.40).Conclusion: After APM, individuals experienced an immediate and significant improvement in the quadriceps’ peak torque following KT application to the Rectus femoris, Vastus medialis, and Vastus lateralis muscles from origin to insertion.Keywords: quadriceps, kinesio tape, peak torque, arthroscopic partial meniscectomy

Background Reactive oxygen species (ROS) and inflammation are reported to have a fundamental role in the pathogenesis of ischemia-reperfusion (IR) injury, a leading cause of acute kidney injury. The present study investigated the role of pyruvate dehydrogenase kinase 4 (PDK4) in ROS production and inflammation following IR injury. Methods We used a streptozotocin-induced diabetic C57BL6/J mouse model, which was subjected to IR by clamping both renal pedicles. Cellular apoptosis and inflammatory markers were evaluated in NRK-52E cells and mouse primary tubular cells after hypoxia and reoxygenation using a hypoxia work station. Results Following IR injury in diabetic mice, the expression of PDK4, rather than the other PDK isoforms, was induced with a marked increase in pyruvate dehydrogenase E1α (PDHE1α) phosphorylation. This was accompanied by a pronounced ROS activation, as well as tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-1β (IL-1β), and monocyte chemoattractant protein-1 (MCP-1) production. Notably, sodium dichloroacetate (DCA) attenuated renal IR injury-induced apoptosis which can be attributed to reducing PDK4 expression and PDHE1α phosphorylation levels. DCA or shPdk4 treatment reduced oxidative stress and decreased TNF-α, IL-6, IL-1β, and MCP-1 production after IR or hypoxia-reoxygenation injury. Conclusion PDK4 inhibition alleviated renal injury with decreased ROS production and inflammation, supporting a critical role for PDK4 in IR mediated damage. This result indicates another potential target for reno-protection during IR injury; accordingly, the role of PDK4 inhibition needs to be comprehensively elucidated in terms of mitochondrial function during renal IR injury.

Summary: Purpose: Providing continuous self-care support to the growing diabetes population is challenging. Strategies are needed to enhance engagement in self-care, utilizing innovative technologies for personalized feedback. This study aimed to assess the feasibility of the Automated Personalized Self-Care program among type 2 diabetes patients and evaluate its preliminary effectiveness. Methods: A parallel randomized pilot trial with qualitative interviews occurred from May 3, 2022, to September 27, 2022. Participants aged 40–69 years with type 2 diabetes and HbA1c ≥ 7.0% were recruited. The three-month program involved automated personalized goal setting, education, monitoring, and feedback. Feasibility was measured by participants' engagement and intervention usability. Preliminary effectiveness was examined through self-care self-efficacy, self-care behaviors, and health outcomes. Qualitative interviews were conducted with the intervention group. Results: A total of 404 patients were screened. Out of the 61 eligible patients, 32 were enrolled, resulting in a recruitment rate of 52.5%. Retention rates at three months were 84.2% and 84.6% in the intervention and control groups, respectively. Among the intervention group, 81.3% satisfied adherence criteria. Mobile application's usability scored 66.25, and participants' satisfaction was 8.06. Intention-to-treat analysis showed improvements in self-measured blood glucose testing, grain intake, and HbA1c in the intervention group. Qualitative content analysis identified nine themes. Conclusion: Feasibility of the program was verified. A larger randomized controlled trial is needed to determine its effectiveness in self-care self-efficacy, self-care behaviors, and health outcomes among type 2 diabetes patients. This study offers insights for optimizing future trials assessing clinical effectiveness. Trial registration: Clinical Research Information Service, KCT0008202 (registration date: 17 February 2023).

Introduction: Laryngeal cancer (LC) presents a significant health challenge globally, with smoking being a major risk factor. Interestingly, LC incidence in females is significantly lower than in males; however, female smokers are more likely to develop Reinke edema (RE) than LC. This study sought to investigate whether autophagy, a major mechanism for RE development, acts as a defense mechanism in laryngeal tissue against cigarette exposure and suppresses LC development in females who smoke. Methods: This study analyzed the National Health Insurance Service (NHIS) data of South Korea to explore sex differences in LC incidence and clinical outcomes. Protein expression was compared between tissues from LC and RE patients. The changes in autophagy-related markers were analyzed after exposure to human vocal fold fibroblast (hVFF) and cigarette smoke extract (CSE). In addition, to explore the relationship between the level of autophagy-related gene expression and clinical features, female LC patients were compared with male patients through an analysis of data from The Cancer Genome Atlas (TCGA). Results: In the NHIS data analyses, male LC patients had an 11 times higher incidence than female patients, even after adjusting for smoking and age. Additionally, female LC patients had significantly better survival rates. RE tissues exhibited increased autophagy-related protein expression compared with LC tissues. hVFFs after CSE exposure demonstrated elevated autophagy markers along with protein expression similar to RE tissue, suggesting autophagy's role in RE development over LC. The TCGA data analysis did not find a significant difference in autophagy-related gene expression, which would explain the favorable female clinical outcomes, between male and female LC patients. Conclusions: This study implies autophagy activation by cigarette smoke is a crucial mechanism for lower LC incidence and better outcomes in females, highlighting the potential for autophagy-targeted LC prevention and treatment strategies.

Background: Urgent need lies in the development of more effective and holistic interventions that encompass both the physical and psychological dimensions of diabetes. The aim of this study was to investigate the effectiveness of integrating mindfulness and physical activity in the prevention and management of diabetes. Method: The systematic review of existing literature aims to highlight the importance of a deeper understanding of the relationship between mindfulness and physically active activities in the context of diabetes prevention and managing. Result: The results of this systematic review highlight multiple beneficial outcomes, including improvements in psychological well-being and diabetes management, holistic care, parasympathetic activity, insulin resistance, stress reduction, self-management, and mindful eating. Conclusion: The findings advocate for the adjunctive use of mindfulness-based interventions like mindfulness based stress reduction (MBSR), MBCT, and MB-EAT in diabetes care, offering avenues to mitigate stress, bolster self management, and potentially augment diabetes care through enhanced self-efficacy, knowledge, and communication. Keywords: Self-Management, Mindfulness, Insulin Resistance, Psychological Well-Being, Self Efficacy, Exercise, Aging

IntroductionEnd-stage lung disease causes cardiac remodeling and induces electrocardiogram (ECG) changes. On the other way, whether lung transplantation (LTx) in end-stage lung disease patients are associated with ECG change is unknown. The object of this study was to investigate ECG changes before and after LTx in end-stage lung disease patients and whether these changes had clinical significance.MethodThis was a single-center retrospective cohort study of 280 end-stage lung disease patients who consecutively underwent LTx at a tertiary referral hospital. ECG findings before LTx and within 1 week and 1, 3, and 6 months after LTx were obtained and analyzed. To find clinical meaning, the ECG at 1 month after LTx was analyzed according to 1-year survival (survivor vs non-survivor groups). Survival data were estimated using the Kaplan–Meier method.ResultsSignificant differences were observed in the PR interval, QRS duration, QT interval, QTc interval, and heart rate before LTx and 1 month after LTx; the PR interval, QRS duration, QTc interval, and heart rate were decreased. Particularly, the QTc interval was significantly decreased 1 month after LTx, whereas there was no significant change in the QTc interval from 1 to 6 months thereafter. The PR interval, QT interval, QTc interval, and heart rate were significantly different between the survivor and non-survivor groups. The serial changes in QTc interval before LTx and 1 and 3 months after LTx were also significantly different between the survivor and non-survivor groups (p = 0.040 after adjusting for age and body mass index). Upon dividing the patients based on the range of QTc interval change ≤ -8 ms, >-8–10 ms, >10–35 ms, >35 ms), the survival rate was significantly lower in the group whose QTc interval at 1 month after LTx decreased by > 35 m (p = 0.019).ConclusionLTx in patients with end-stage lung disease may induce ECG changes. Patients whose QTc interval at 1 month after LTx decreased by > 35 ms have a significantly higher 1-year mortality rate. Hence, these ECG changes may have clinical and prognostic significance.

This study explores the influence of social identity and team dynamics on the mental health help-seeking behaviors of collegiate athletes. The research aims to understand how factors such as gender, ethnicity, and social status shape athletes' attitudes and actions regarding mental health assistance. Method: Using a mixed-method approach that included focus group discussions (FGDs) and in-depth interviews, data were collected from 30 athletes representing various sports disciplines, ensuring balanced representation in terms of gender, ethnicity, and social status.Result: Thematic analysis revealed significant themes: male athletes faced substantial stigma in seeking mental health assistance, viewing it as a sign of weakness, while female athletes were more open and supported by a culture of emotional expression. Minority athletes encountered additional barriers due to cultural stigma and a lack of culturally competent services, whereas majority athletes had better access to mental health resources. High-status athletes experienced pressure to maintain their image, leading to reluctance in seeking help, while low-status athletes faced challenges in accessing resources despite their willingness to seek help. Positive team dynamics, characterized by support and open communication, facilitated help-seeking behavior, while negative dynamics, such as bullying and lack of trust, created barriers. Conclusion: The study highlights the need for targeted interventions that address specific needs based on gender, ethnicity, and social status, promote mental health literacy, and foster supportive team environments. Future research should focus on the long-term effects of stigma-reduction interventions, culturally tailored mental health services, and the impact of team dynamics over time. These findings provide valuable insights for developing effective mental health support systems for collegiate athletes. Keywords: Cultural Competency, Ethnicity, Health Literacy, Social Identification, Athletes, Bullying

The elderly commonly struggle with mental health issues, especially depression. Spiritual coping is one of the factors that might prevent depression. The aim of this study is to investigate cultural involvement in spiritual coping to depression prevention among the Balinese elderly. From January to March 2021, this study was carried out on 273 elderly members of the Integrated Primary Public Health service in seven districts in Gianyar, Bali. The study used a cluster random sampling method to collect data and focused on quantitative measurements related to participant characteristics, depression prevention, and spiritual coping. The investigation into spiritual coping was based on the tri hita karana, a concept from Balinese philosophy. Bivariate analysis was used to assess the relationship between spiritual coping and depression prevention behaviour. The study comprised 146 male and 127 female participants aged between 65 and 79 years old. Among all participants, 190 (69,6%) were diagnosed with mild to moderate depression, while 83 (30,4%) with moderate to severe depression. However, for the majority, depression prevention was good 163 (59,7%), the rest was moderate 103 (37,7%), and poor 7 (2,6%). Tri hita karana spiritual coping for the majority was good 17 (53,8%). Spiritual coping has a strong correlation with depression prevention (r=0.230). Thus, spiritual coping has a strong correlation with depression prevention among the Balinese elderly. It can be concluded that the implementation of tri hita karana becomes a potent spiritual coping enhance depression prevention. Indigenous philosophy embedded in daily life supports social capital in dealing with stress.

Since the onset of COVID-19, concerns have risen regarding the environmental impact of increased waste generation. Of particular concern is the surge in plastic usage, prompting a call for enhanced recycling practices. This study investigates the impact of the COVID-19 pandemic on recycling discourse in South Korea by analyzing news media coverage on recycling and reuse based on framing theory. Employing Python and R , a total of 24,928 news articles containing keywords (i.e., recycling and reuse) both pre- and during the COVID-19 pandemic were collected and analyzed. The results of computational analyses, such as topic modeling, semantic network analysis, and framing analysis, show that while an initial spike in COVID-19 cases correlated with heightened recycling-related coverage, this trend gradually waned as the pandemic persisted. The results also revealed shifts in keywords, frames, and framing functions over time. Notably, major frames expanded during the pandemic to incorporate COVID-19-related topics and concrete recycling efforts. Throughout, the primary framing function remained prognostic. This research provides valuable insights into the evolving environmental discourse amidst a global pandemic.

Background: In the realm of sports nursing, emergent and innovative educational models are built upon the foundation of stakeholder engagement. Despite the fact that numerous studies have examined the stakeholder perspective in nursing, a greater number of studies have examined stakeholder perspectives in curricula that emphasize athletic nursing. Therefore, the objective of this study is to examine the viewpoints and concerns of relevant parties regarding the creation of a baccalaureate nursing program with a specific emphasis on sports nursing. Methods: A phenomenological study was conducted. This method combines descriptive features (Husserlian) and interpretive phenomenology (Gadamerian). Nineteen stakeholders participated in this study. The interview was ended when data saturation was reached, especially theme redundancy. Results: Three major themes were identified: (1) “Bridges” Which Combines Education And Work Context; (2) Stakeholder Engagement, Controversial Issues (3) Stakeholder Engagement, Structuring A Methodology. This finding shows that. Conclusion: The obligation of nursing education to align with current and future practice needs is emphasized, suggesting strategies such as curriculum mapping to bridge theoretical knowledge with clinical practice. Stakeholder engagement is crucial for successful education and professional development. Keyword: Humans, Models, Educational, Stakeholder Participation, Curriculum, Education, Nursing, Health and Well-being, Quality Education

Introduction To improve the capacity of diabetic foot ulcer (DFU) patients for self-management of wound care, there is a renewed need for self-care on their part, as well as an increase in their readiness to deal with issues and heal their wounds. Therefore, this review empirically assessed contemporary evidence on how patients with DFU can perform self-treat wound care. Methods This integrative literature review assessed how patients with DFU could perform self-treat wound care. Whittemore and Knafl integrative information literature review involved searching four databases (Scopus, PubMed, Web of Science, and Google Scholar), which resulted in 2,595 published articles, between 2010 and 2023. Nineteen articles satisfied the requirements for inclusion and quality assessment, and the PRISMA review checklist was followed. Results No research has addressed DFU patients’ self-treatment of wound care. The integration of evidence from quantitative and qualitative studies was achieved in three categories: (1) motivation, (2) self-wound care strategy, and (3) self-wound care performance by DFU patients. Conclusion To equip themselves to perform wound care independently, patients with DFU must receive training to clean wounds, apply wound medication, and perform dressings. There is a need for research that develops a self-treat wound care intervention model in patients with DFU.

Abstract The small mammalian fauna plays pivotal roles in ecosystem dynamics and as crucial biodiversity indicators. However, recent research has raised concerns about the decline of mammalian species due to climate change. Consequently, significant attention is directed toward studying various big flagship mammalian species for conservation. However, small mammals such as the hog badgers (Mustelidae: Arctonyx) remain understudied regarding the impacts of climate change in Asia. The present study offers a comprehensive analysis of climate change effects on two mainland hog badger species, utilizing ensemble species distribution modeling. Findings reveal concerning outcomes, as only 52% of the IUCN extent is deemed suitable for the Great Hog Badger (Arctonyx collaris) and a mere 17% is ideal for the Northern Hog Badger (Arctonyx albogularis). Notably, projections suggest a potential reduction of over 26% in suitable areas for both species under future climate scenarios, with the most severe decline anticipated in the high‐emission scenario of SSP585. These declines translate into evident habitat fragmentation, particularly impacting A. collaris, whose patches shrink substantially, contrasting with the relatively stable patches of A. albogularis. However, despite their differences, niche overlap analysis reveals an intriguing increase in overlap between the two species, indicating potential ecological shifts. The study underscores the importance of integrating climate change and habitat fragmentation considerations into conservation strategies, urging a reassessment of the IUCN status of A. albogularis. The insights gained from this research are crucial for improving protection measures by ensuring adequate legal safeguards and maintaining ecological corridors between viable habitat patches, which are essential for the conservation of hog badgers across mainland Asia. Furthermore, emphasizing the urgency of proactive efforts, particularly in countries with suitable habitats can help safeguard these small mammalian species and their ecosystems from the detrimental impacts of climate change.

Background Hyperglycemia has shown a negative association with cognitive dysfunction. We analyzed patients with high preoperative blood glucose level and hemoglobin A1c (HbA1c) level to determine the prevalence of postoperative delirium. Methods We reviewed a database of 23,532 patients with diabetes who underwent non-cardiac surgery. Acute hyperglycemia was defined as fasting blood glucose > 140 mg/dl or random glucose > 180 mg/dl within 24 h before surgery. Chronic hyperglycemia was defined as HbA1c level above 6.5% within three months before surgery. The incidence of delirium was compared according to the presence of acute and chronic hyperglycemia. Results Of the 23,532 diabetic patients, 21,585 had available preoperative blood glucose level within 24 h before surgery, and 18,452 patients reported levels indicating acute hyperglycemia. Of the 8,927 patients with available HbA1c level within three months before surgery, 5,522 had levels indicating chronic hyperglycemia. After adjustment with inverse probability weighting, acute hyperglycemia was related to higher incidence of delirium (hazard ratio: 1.33, 95% CI [1.10,1.62], P = 0.004 for delirium) compared with controls without acute hyperglycemia. On the other hand, chronic hyperglycemia did not correlate with postoperative delirium. Conclusions Preoperative acute hyperglycemia was associated with postoperative delirium, whereas chronic hyperglycemia was not significantly associated with postoperative delirium. Irrespective of chronic hyperglycemia, acute glycemic control in surgical patients could be crucial for preventing postoperative delirium.

Background Few studies have evaluated the use of automated artificial intelligence (AI)-based pain recognition in postoperative settings or the correlation with pain intensity. In this study, various machine learning (ML)-based models using facial expressions, the analgesia nociception index (ANI), and vital signs were developed to predict postoperative pain intensity, and their performances for predicting severe postoperative pain were compared. Methods In total, 155 facial expressions from patients who underwent gastrectomy were recorded postoperatively; one blinded anesthesiologist simultaneously recorded the ANI score, vital signs, and patient self-assessed pain intensity based on the 11-point numerical rating scale (NRS). The ML models’ area under the receiver operating characteristic curves (AUROCs) were calculated and compared using DeLong’s test. Results ML models were constructed using facial expressions, ANI, vital signs, and different combinations of the three datasets. The ML model constructed using facial expressions best predicted an NRS ≥ 7 (AUROC 0.93) followed by the ML model combining facial expressions and vital signs (AUROC 0.84) in the test-set. ML models constructed using combined physiological signals (vital signs, ANI) performed better than models based on individual parameters for predicting NRS ≥ 7, although the AUROCs were inferior to those of the ML model based on facial expressions (all P < 0.05). Among these parameters, absolute and relative ANI had the worst AUROCs (0.69 and 0.68, respectively) for predicting NRS ≥ 7. Conclusions The ML model constructed using facial expressions best predicted severe postoperative pain (NRS ≥ 7) and outperformed models constructed from physiological signals.

Abstract Background Bone-modifying agents (BMA) are key components in the management of cancer patients with bone metastasis. Despite their clinical benefits, the use of BMA is associated with dental adverse events (AEs) including medication-related osteonecrosis of the jaw (MRONJ). This study investigated the frequency of dental surveillance before BMA treatment and the prevalence of dental AEs including MRONJ, after BMA treatment in patients with bone metastasis from breast and prostate cancer using data from the national health insurance system. Methods Data, including age, cancer diagnosis, administered BMA, and dental AEs during cancer treatment, of patients with bone metastasis from breast and prostate cancer who received at least one infusion of BMA between 2007 and 2019 were extracted from the Korean National Health Insurance Service (KNHIS) dataset. Results Of the 15,357 patients who received BMA, 1,706 patients (11.1%) underwent dental check-ups before BMA treatment. The proportion of patients receiving dental check-up increased from 4.4% in 2007 to 16.7% in 2019. Referral to dentists for a dental check-up was more active in clinics/primary hospitals than general/tertiary hospitals, and medical doctors and urologists actively consulted to dentists than general surgeons, regardless of the patient’s health insurance status. After BMA treatment, 508 patients (3.8%) developed dental AEs, including abscess (42.9%), acute periodontitis (29.7%), acute pericoronitis (14.9%), and MRONJ (12.5% of dental AEs cases, 0.5% of total BMA treated patients). Conclusions Considering the long treatment period in patients with metastatic cancer, coordination between dentists and oncologists is necessary to ensure appropriate dental management before the initiation of BMA.

Bader B Alsulays, Alhussain H Aodah, Mohammad Muqtader Ahmed, Md Khalid Anwer Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi ArabiaCorrespondence: Bader B Alsulays, Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, P.O. Box 173, Al-Kharj, Saudi Arabia, Tel +966-554112830, Email b.alsulays@psau.edu.saPurpose: Ivosidenib (IVO), an isocitrate dehydrogenase-1 (IDH1) used for treatment of acute myeloid leukemia (AML) and cholangiocarcinoma. However, poor solubility, low bioavailability, high dose and side effects limit clinical application of IVO.Methods: Ivosidenib-loaded PLGA nanoparticles (IVO-PLGA-NPs) and Ivosidenib-loaded chitosan coated PLGA nanoparticles (IVO-CS-PLGA-NPs) were prepared using emulsification and solvent evaporation method for the treatment of liver cancer.Results: The developed IVO-PLGA-NPs were evaluated for their particle size (171.7± 4.9 nm), PDI (0.333), ZP (− 23.0± 5.8 mV), EE (96.3± 4.3%), and DL (9.66± 1.1%); similarly, the IVO-CS-PLGA-NPs were evaluated for their particle size (177.3± 5.2 nm), PDI (0.311), ZP +25.9± 5.7 mV, EE (90.8± 5.7%), and DL (9.42± 0.7%). The chitosan coating of IVO-PLGA-NPs was evidenced by an increase in mean particle size and positive ZP value. Because of the chitosan coating, the IVO-CS-PLGA-NPs showed a more stable and prolonged release of IVO than IVO-PLGA-NPs. In comparison to pure-IVO, the IVO-PLGA-NPs and IVO-CS-PLGA-NPs were found to be more effective against HepG2 cells, with IC50 values for the MTT assay being approximately half of those of pure-IVO. In HepG2 cells, the expressions of caspase-3, caspase-9, and p53 were significantly (p < 0.05) elevated.Conclusion: Overall, these findings suggest that chitosan coating of IVO-PLGA-NPs improves the delivery and efficacy of ivosidenib in liver cancer treatment.Keywords: polymers, characterization, bioavailability, sustained release, caspase

Abstract Purpose Chemotherapy-induced nausea and vomiting (CINV) is a common adverse events in cancer patients and can negatively affect their quality of life (QoL). This study aimed to evaluate the clinical efficacy of an electric massage chair (EMC) for the treatment of CINV. Methods A randomized phase II cross-over trial was conducted on solid cancer patients who received moderate (MEC) to high emetogenic chemotherapy (HEC). The participants were randomly assigned to receive their first chemotherapy either on a standard bed (Group A) or in an EMC (Group B) during the infusion. The patients were then crossed over to the next cycle. CINV and QoL questionnaires were collected from the participants. Results A total of 59 patients completed the trial protocol and were included in the analysis, with 29 and 30 patients in Groups A and B, respectively. The mean INVR (Index of Nausea, Vomiting, and Retching) score in the 2nd day of the first cycle was higher in Group B (3.63 ± 5.35) than Group A (2.76 ± 4.78), but the difference was not statistically significant (p = 0.5367). The complete response rate showed little difference between the groups. Among the high-emetic risk subgroups, patients who received HEC (p = 0.04595), younger patients (p = 0.0108), and non-colorectal cancer patients (p = 0.0495) presented significantly lower CINV scores when EMC was applied. Conclusion Overall, there was no significant difference in INVR scores between standard care and EMC. Applying EMC at the first chemotherapy infusion may help preserve QoL and reduce CINV in high-risk patients. Trial registration KCT0008200, 17/02/2023, Retrospectively registered.

Abstract Nicotiana benthamiana is a fundamental model organism in plant research. Recent advancements in genomic sequencing have revealed significant intraspecific genetic variations. This study addresses the pressing need for a precise genome sequence specific to its geographic origin by presenting a comprehensive genome assembly of the N. benthamiana LAB strain from the Republic of Korea (NbKLAB). We compare this assembly with the widely used NbLAB360 strain, shedding light on essential genomic differences between them. The outcome is a high-quality, chromosome-level genome assembly comprising 19 chromosomes, spanning 2,762 Mb, with an N50 of 142.6 Mb. Comparative analyses revealed notable variations, including 46,215 protein-coding genes, with an impressive 99.5% BUSCO completeness score. Furthermore, the NbKLAB assembly substantially improved the QV from 33% for NbLAB360 to 49%. This refined chromosomal genome assembly for N. benthamiana, in conjunction with comparative insights, provides a valuable resource for genomics research and molecular biology. This accomplishment forms a strong foundation for in-depth exploration into the intricacies of plant genetics and genomics, improved precision, and a comparative framework.

Abstract We aimed to evaluate the association between inflammation-based prognostic markers and mortality after hip replacement. From March 2010 to June 2020, we identified 5,369 consecutive adult patients undergoing hip replacement with C-reactive protein (CRP), albumin, and complete blood count measured within six months before surgery. Receiver operating characteristic (ROC) curves were generated to evaluate predictabilities and estimate thresholds of CRP-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR). Patients were divided according to threshold, and mortality risk was compared. The primary outcome was one-year mortality, and overall mortality was also analyzed. One-year mortality was 2.9%. Receiver operating characteristics analysis revealed areas under the curve of 0.838, 0.832, 0.701, and 0.732 for CAR, NLR, PLR, and modified Glasgow Prognostic Score, respectively. The estimated thresholds were 2.10, 3.16, and 11.77 for CAR, NLR, and PLR, respectively. According to the estimated threshold, high CAR and NLR were associated with higher one-year mortality after adjustment (1.0% vs. 11.7%; HR = 2.16; 95% CI 1.32–3.52; p = 0.002 for CAR and 0.8% vs. 9.6%; HR = 2.05; 95% CI 1.24–3.39; p = 0.01 for NLR), but PLR did not show a significant mortality increase (1.4% vs. 7.4%; HR = 1.12; 95% CI 0.77–1.63; p = 0.57). Our study demonstrated associations of preoperative levels of CAR and NLR with postoperative mortality in patients undergoing hip replacement. Our findings may be helpful in predicting mortality in patients undergoing hip replacement.

Abstract Background Whether COVID-19-induced acute respiratory distress syndrome (ARDS) should be approached differently in terms of mechanical ventilation therapy compared to other virus-induced ARDS is debatable. Therefore, we aimed to ascertain whether the respiratory mechanical characteristics of COVID-19-induced ARDS differ from those of influenza A induced ARDS, in order to establish a rationale for mechanical ventilation therapy in COVID-19-induced ARDS. Methods This was a retrospective cohort study comparing patients with COVID-19-induced ARDS and influenza A induced ARDS. We included intensive care unit (ICU) patients with COVID-19 or Influenza A aged ≥ 19, who were diagnosed with ARDS according to the Berlin definition between January 2015 and July 2021. Ventilation parameters for respiratory mechanics were collected at specific times on days one, three, and seven after intubation. Results The median age of the 87 participants was 71.0 (62.0–78.0) years old, and 63.2% were male. The ratio of partial pressure of oxygen in arterial blood to the fractional of inspiratory oxygen concentration in COVID-19-induced ARDS was lower than that in influenza A induced ARDS during the initial stages of mechanical ventilation (influenza A induced ARDS 216.1 vs. COVID-19-induced ARDS 167.9, p = 0.009, day 1). The positive end expiratory pressure remained consistently higher in the COVID-19 group throughout the follow-up period (7.0 vs. 10.0, p

Background Perioperative adverse cardiac events (PACE), a composite of myocardial infarction, coronary revascularization, congestive heart failure, arrhythmic attack, acute pulmonary embolism, cardiac arrest, and stroke during 30-day postoperative period, is associated with long-term mortality, but with limited clinical evidence. We compared long-term mortality with PACE using data from nationwide multicenter electronic health records. Methods Data from 7 hospitals, converted to Observational Medical Outcomes Partnership Common Data Model, were used. We extracted records of 277,787 adult patients over 18 years old undergoing non-cardiac surgery for the first time at the hospital and had medical records for more than 180 days before surgery. We performed propensity score matching and then an aggregated meta‑analysis. Results After 1:4 propensity score matching, 7,970 patients with PACE and 28,807 patients without PACE were matched. The meta‑analysis showed that PACE was associated with higher one-year mortality risk (hazard ratio [HR]: 1.33, 95% CI [1.10, 1.60], P = 0.005) and higher three-year mortality (HR: 1.18, 95% CI [1.01, 1.38], P = 0.038). In subgroup analysis, the risk of one-year mortality by PACE became greater with higher-risk surgical procedures (HR: 1.20, 95% CI [1.04, 1.39], P = 0.020 for low-risk surgery; HR: 1.69, 95% CI [1.45, 1.96], P < 0.001 for intermediate-risk; and HR: 2.38, 95% CI [1.47, 3.86], P = 0.034 for high-risk). Conclusions A nationwide multicenter study showed that PACE was significantly associated with increased one-year mortality. This association was stronger in high-risk surgery, older, male, and chronic kidney disease subgroups. Further studies to improve mortality associated with PACE are needed.

Ahmed Albushtra,1 Abdulsalam Hadi Mohsen,2 Khaled Ali Alnozaili,3 Faisal Ahmed,4 Younes Mohsen Ali Abdu Aljobahi,1 Fawaz Mohammed,1 Mohamed Badheeb5 1Department of Orthopedic, School of Medicine, Ibb University, Ibb, Yemen; 2Department of Orthopedic, School of Medicine, Aden University, Aden, Yemen; 3Department of Orthopedic, School of Medicine, 21 September University, Sana’a, Yemen; 4Department of Urology, School of Medicine, Ibb University, Ibb, Yemen; 5Department of Internal Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT, USACorrespondence: Faisal Ahmed, Department of Urology, School of Medicine, Ibb University, Ibb, Yemen, Tel/Fax +967 4428950, Email fmaaa2006@yahoo.comBackground: External fixation is one of the most often utilized treatment options for complicated tibial diaphyseal fractures (TDF). The purpose of this study was to assess the efficacy of unilateral external fixators as primary and definitive therapy for complex TDF in a resource-limited setting.Materials and Methods: A retrospective study between June 2016 and March 2021 included 110 subjects with TDF who were treated with an external fixator as definitive fixation in hospitals affiliated with Ibb University. The patient’s demographic characteristics, complications, and outcomes were gathered and analyzed. Factors associated with pin site infection were also investigated.Results: The mean age was 42.1 ± 10.1 years, with 92.7% being male. Rural residents accounted for 22.7%. Smoking and diabetes mellitus were present in 27.3% and 30.0%, respectively. General complications occurred in 12.0%, with pulmonary embolism being the most common at 4.5%. Orthopedic complications included pin-track infections in 27.3% (30) and osteomyelitis in 1.8% (2). Pin site infections required medical treatment in 21 cases and external fixator changes in five. Two cases each needed several debridements for osteomyelitis and soft tissue. Full union occurred in 79.1% (87) over 23.1 ± 3.2 weeks and final alignment in 97.3% (107) over 34.8 ± 4.8 weeks. Malunions occurred in 1.8% (2), and one case had hypertrophic nonunion. Factors like rural residency, smoking, diabetes, open fractures, worst fracture grade (Gustilo and Anderson type C), and general complications occurrence significantly correlated with pin site infection (all p-values < 0.05).Conclusion: A unilateral external fixator as a primary and definitive treatment is a viable, simple, and effective option for TDF with a high success rate even in a resource-limited setting. In this study, residents in rural areas, smoking, diabetes, open fracture, worst fracture grade, and general complication occurrence were associated with pin site infection occurrence.Keywords: external fixation, definitive treatment, tibial fractures, pin tract infection

Abstract Rehabilitation improves symptoms, quality of life, and survival in patients with chronic respiratory or cardiovascular disease. We evaluated smartphone application-based rehabilitation programs for patients with chronic respiratory or cardiovascular diseases. This was a single-center prospective single arm study. Participants underwent smartphone application-based pulmonary or cardiac rehabilitation for 12 weeks. A total of 93 participants were recruited, and 75 visited after rehabilitation. Their median age was 67.0 (interquartile range, 60.0–70.8) years, and 60 (80.0%) were men. For patients with chronic respiratory disease (n = 41), VO2peak (median 13.7 to 15.4 ml/kg/min, P = 0.049), chronic obstructive pulmonary disease assessment test (median 14 to 6, P

Background Studies on the association between pleural effusion (PE) and left ventricular assist devices (LVADs) are limited. This study aimed to examine the characteristics and the clinical impact of PE following LVAD implantation. Methods This study is a prospective analysis of patients who underwent LVAD implantation from June 2015 to December 2022. We investigated the prognostic impact of therapeutic drainage (TD) on clinical outcomes. We also compared the characteristics and clinical outcomes between early and late PE and examined the factors related to the development of late PE. Results A total of 71 patients was analyzed. The TD group (n=45) had a longer ward stay (days; median [interquartile range]: 31.0 [23.0–46.0] vs. 21.0 [16.0–34.0], P=0.006) and total hospital stay (47.0 [36.0–82.0] vs. 31.0 [22.0–48.0], P=0.002) compared to the no TD group (n=26). Early PE was mostly exudate, left-sided, and neutrophil-dominant even though predominance of lymphocytes was the most common finding in late PE. Patients with late PE had a higher rate of reintubation within 14 days (31.8% vs. 4.1%, P=0.004) and longer hospital stays than those without late PE (67.0 [43.0–104.0] vs. 36.0 [28.0–48.0], P