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Ahmed Hassan Assaf,1,2 Hams Samy,2 Noha Fawky,2 Menna Ahmed Kamel1 1Department of Ophthalmology, Ain Shams University, Cairo, Egypt; 2Watany Eye Hospital, Cairo, EgyptCorrespondence: Ahmed Hassan Assaf, Ain Shams University, Abbassia, Cairo, Egypt, Email assaf.ahmed@gmail.comPurpose: To evaluate the effect of angles kappa and alpha on the visual outcomes after implantation of isofocal intraocular lens (IOL) during cataract surgery.Methods: This prospective study involved 66 eyes undergoing cataract surgery with Isopure IOLs. Exclusion criteria comprised irregular corneal astigmatism exceeding 1.0D, and ocular co-morbidities affecting visual outcomes post-surgery. Evaluation parameters included postoperative refraction, uncorrected and corrected-distance visual acuity (UDVA, CDVA), uncorrected intermediate visual acuity (UIVA), and distance-corrected intermediate visual acuity (DCIVA) at 80 cm. Additionally, postoperative angles alpha, kappa, and wavefront aberrations at a 3-mm pupil using ray tracing were assessed post-surgery at least 60 days later.Results: Patients had a mean age of 64.48 ± 9.92 years. Mean postoperative manifest refraction spherical equivalent (MRSE) was − 0.21 ± 0.27 D. Mean UDVA and CDVA were LogMAR 0.06 ± 0.04 and 0.02 ± 0.06, respectively. Mean UIVA LogMAR 0.32 ± 0.08 while mean DCIVA was LogMAR 0.29 ± 0.08. Postoperative angles kappa and alpha were 0.39 ± 0.14 mm and 0.45 ± 0.15 mm, respectively. Mean postoperative ocular RMS higher-order aberrations (HOAs) 0.23 ± 0.08. Spherical aberration, coma, and trefoil averaged 0.05 ± 0.07, 0.12 ± 0.03, and 0.07 ± 0.03, respectively. No significant correlations were observed between postoperative angle kappa and alpha with UDVA, CDVA, or HOAs. A non-significant weak positive correlation was noted between angle kappa and UIVA/DCIVA, while no correlation was found between angle alpha and UIVA/DCIVA.Conclusion: No substantial correlations were found between various postoperative angles kappa and alpha values and postoperative visual acuity metrics (UDVA, CDVA, UIVA, and DCIVA) or higher order ocular aberrations (including, spherical aberration, coma, and trefoil with a 3.0 mm diameter) in pseudophakic eyes implanted with isofocal intraocular lenses (IOLs).Keywords: intraocular lens, cataract, optical quality, angle alpha, angle kappa

Abstract Inflammasome activation results in the cleavage of gasdermin D (GSDMD) by pro-inflammatory caspases. The N-terminal domains (GSDMDNT) oligomerize and assemble pores penetrating the target membrane. As methods to study pore formation in living cells are insufficient, the order of conformational changes, oligomerization, and membrane insertion remained unclear. We have raised nanobodies (VHHs) against human GSDMD and find that cytosolic expression of VHHGSDMD-1 and VHHGSDMD-2 prevents oligomerization of GSDMDNT and pyroptosis. The nanobody-stabilized GSDMDNT monomers partition into the plasma membrane, suggesting that membrane insertion precedes oligomerization. Inhibition of GSDMD pore formation switches cell death from pyroptosis to apoptosis, likely driven by the enhanced caspase-1 activity required to activate caspase-3. Recombinant antagonistic nanobodies added to the extracellular space prevent pyroptosis and exhibit unexpected therapeutic potential. They may thus be suitable to treat the ever-growing list of diseases caused by activation of (non-) canonical inflammasomes.

Numerous techniques, including problem-solving, seeking clarification, and creating questions, have been employed to utilize generative Artificial Intelligence (AI) in education. This study investigates the possibility of using Generate AI (GenAI) to grade Structured Query Language (SQL) queries automatically. Three models were used which are ChatGPT, Gemini, and Copilot. The study uses an experimental approach to assess how well the models perform in evaluating student responses by comparing the models’ accuracy with those of human experts. The results showed that despite some inconsistencies, GenAI holds great promise for streamlining. Thus, further research is required in light of inconsistent GenAI performance. If these issues were resolved, GenAI can be utilized in education. However, human oversight and ethical issues must always come first.

The ability to modulate specific neural circuits and simultaneously visualize and measure brain activity with MRI would greatly impact our understanding of brain function in health and disease. The combination of neurostimulation methods and functional MRI in animal models have already shown promise in elucidating fundamental mechanisms associated with brain activity. We developed an innovative magnetogenetics neurostimulation technology that can trigger neural activity through magnetic fields. Similar to other genetic-based neuromodulation methods, magnetogenetics offers cell-, area-, and temporal-specific control of neural activity. The magnetogenetic protein—Electromagnetic Perceptive Gene (EPG)—is activated by non-invasive magnetic fields, providing a unique way to target neural circuits by the MRI static and gradient fields while simultaneously measuring their effect on brain activity. EPG was expressed in rat's visual cortex and the amplitude of low-frequency fluctuation, resting-state functional connectivity (FC), and sensory activation was measured using a 7T MRI. The results demonstrate that EPG-expressing rats had significantly higher signal fluctuations in the visual areas and stronger FC in sensory areas consistent with known anatomical visuosensory and visuomotor connections. This new technology complements the existing neurostimulation toolbox and provides a means to study brain function in a minimally-invasive way which was not possible previously.

The gene regulatory network (GRN) of biological cells governs a number of key functionalities that enable them to adapt and survive through different environmental conditions. Close observation of the GRN shows that the structure and operational principles resemble an artificial neural network (ANN), which can pave the way for the development of wet-neuromorphic computing systems. Genes are integrated into gene-perceptrons with transcription factors (TFs) as input, where the TF concentration relative to half-maximal RNA concentration and gene product copy number influences transcription and translation via weighted multiplication before undergoing a nonlinear activation function. This process yields protein concentration as the output, effectively turning the entire GRN into a gene regulatory neural network (GRNN). In this paper, we establish nonlinear classifiers for molecular machine learning using the inherent sigmoidal nonlinear behavior of gene expression. The eigenvalue-based stability analysis, tailored to system parameters, confirms maximum-stable concentration levels, minimizing concentration fluctuations and computational errors. Given the significance of the stabilization phase in GRNN computing and the dynamic nature of the GRN, alongside potential changes in system parameters, we utilize the Lyapunov stability theorem for temporal stability analysis. Based on this GRN-to-GRNN mapping and stability analysis, three classifiers are developed utilizing two generic multilayer sub-GRNNs and a sub-GRNN extracted from the Escherichia coli GRN. Our findings also reveal the adaptability of different sub-GRNNs to suit different application requirements.

Objective: Arthrodesis of the first metatarsophalangeal joint (MTPJ) is a reliable procedure for treating various pathologies related to this joint. However, non-union is a common and debilitating complication of the procedure. The purpose of this study was to assess whether the use of a mechanical reamer to prepare the joint surface increases the risk of non-union compared to traditional manual osteotomy. Methods: A retrospective study of all patients who underwent their first MTPJ arthrodesis surgery in our medical center between 2010 and 2015. The articular surface preparation of the MTPJ was either manually performed (Group 1) or mechanically conducted with reamers (Group 2). Data regarding demographic characteristics, indications for surgery, osteosynthesis methods, and post-operative complications, including non-union, infection, and revision rates, were collected for all patients. Results: A total of 83 patients with 92 primary first MTPJ arthrodesis (44 cases in Group 1 and 48 cases in Group 2) were included with a mean follow-up time of 45.3 months (SD 16.8). The two groups were comparable in terms of age, gender, comorbidities, indication for surgery, and follow-up time. The non-union rate was 15.9% in Group 1 and 25% in Group 2 (p = 0.28). Group 2 showed a significantly higher rate of revision surgery compared to Group 1 (43.7% vs. 22.7%, p = 0.03). Conclusions: The mechanical reamer group had a higher non-union rate and a significantly higher rate of revision surgery compared to low-energy manual joint preparation. In light of these findings, the use of mechanical reamers for joint preparation in the first MTPJ arthrodesis was discontinued at our medical center.

Magnetoreceptive biology as a field remains relatively obscure; compared with the breadth of species believed to sense magnetic fields, it remains under-studied. Here, we present grounds for the expansion of magnetoreception studies among teleosts. We begin with the electromagnetic perceptive gene (EPG) from Kryptopterus vitreolus and expand to identify 72 teleosts with homologous proteins containing a conserved three-phenylalanine (3F) motif. Phylogenetic analysis provides insight as to how EPG may have evolved over time and indicates that certain clades may have experienced a loss of function driven by different fitness pressures. One potential factor is water type with freshwater fish significantly more likely to possess the functional motif version (FFF), and saltwater fish to have the non-functional variant (FXF). It was also revealed that when the 3F motif from the homologue of Brachyhypopomus gauderio (B.g.) is inserted into EPG—EPG(B.g.)—the response (as indicated by increased intracellular calcium) is faster. This indicates that EPG has the potential to be engineered to improve upon its response and increase its utility to be used as a controller for specific outcomes.

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Abstract Background Precision surgery is becoming increasingly important in the field of Orthopaedic Oncology. Image-guided percutaneous cryosurgery (CRA) has emerged as a valid treatment modality for extra-abdominal desmoid tumors (EDTs). To date, most CRA procedures use CT-based guidance which fails to properly characterize tumor segments. Computer-guided MRI navigation can address this issue however, the lack of a fixed landmark for registration remains a challenge. Successful CRA correlates directly with precision approaches facilitated by intraoperative imaging guidance. This is the first study that attempts to assess the feasibility and efficacy of a novel approach of using skin fiducial markers to overcome the challenge of a MRI-based navigation CRA for symptomatic or progressive EDTs. Methods In this retrospective study conducted between 2018 and 2020, 11 patients at a single center with symptomatic or progressive EDTs were treated with CRA using intraoperative MRI navigation. Fifteen cryosurgery procedures were performed, each adhering to a personalized pre-operative plan. Total tumor size, viable and non-viable portions pre- and post-operation, and SF-36 questionnaire evaluating subjective health were recorded. Results All CRAs demonstrated 100% adherence to the predetermined plan. Overall, tumor size decreased Median= -56.9% [-25.6, -72.4]) with a reduction in viable tissue, (Median= -80.4% [-53.3, -95.2]). Four patients required additional CRAs. Only one patient’s tumor did not reduce in size. One patient suffered from local muscle necrosis. Pre-operation, the average physical and mental scores 41.6 [29.4, 43] and 26.3 [17.6, 40.9] respectively. Post-operation, the average physical and mental scores were 53.4[38, 59.7] and 38 [31.2, 52.7] respectively. Conclusion These findings provide an early indication of the feasibility and efficacy of performing percutaneous cryosurgery using skin fiducial marker registration for MRI-computed navigation to treat EDTs safely. Larger cohorts and multicenter evaluations are needed to determine the efficacy of this technique.

The ability to manipulate cellular function using an external stimulus is a powerful strategy for studying complex biological phenomena. One approach to modulate the function of the cellular environment is split proteins. In this method, a biologically active protein or an enzyme is fragmented so that it reassembles only upon a specific stimulus. Although many tools are available to induce these systems, nature has provided other mechanisms to expand the split protein toolbox. Here, we show a novel method for reconstituting split proteins using magnetic stimulation. We found that the electromagnetic perceptive gene (EPG) changes conformation due to magnetic field stimulation. By fusing split fragments of a certain protein to both termini of the EPG, the fragments can be reassembled into a functional protein under magnetic stimulation due to conformational change. We show this effect with three separate split proteins: NanoLuc, APEX2, and herpes simplex virus type-1 thymidine kinase. Our results show, for the first time, that reconstitution of split proteins can be achieved only with magnetic fields. We anticipate that this study will be a starting point for future magnetically inducible split protein designs for cellular perturbation and manipulation. With this technology, we can help expand the toolbox of the split protein platform and allow better elucidation of complex biological systems.

Abstract Mayaro Virus (MAYV) is an emerging health threat in the Americas that can cause febrile illness as well as debilitating arthralgia or arthritis. To better understand the geographic distribution of MAYV risk, we developed a georeferenced database of MAYV occurrence based on peer-reviewed literature and unpublished reports. Here we present this compendium, which includes both point and polygon locations linked to occurrence data documented from its discovery in 1954 until 2022. We describe all methods used to develop the database including data collection, georeferencing, management and quality-control. We also describe a customized grading system used to assess the quality of each study included in our review. The result is a comprehensive, evidence-graded database of confirmed MAYV occurrence in humans, non-human animals, and arthropods to-date, containing 262 geo-positioned occurrences in total. This database - which can be updated over time - may be useful for local spill-over risk assessment, epidemiological modelling to understand key transmission dynamics and drivers of MAYV spread, as well as identification of major surveillance gaps.

Studies at the cellular and molecular level of magnetoreception—sensing and responding to magnetic fields—are a relatively new research area. It appears that different mechanisms of magnetoreception in animals evolved from different origins, and, therefore, many questions about its mechanisms remain left open. Here we present new information regarding the Electromagnetic Perceptive Gene (EPG) from Kryptopterus vitreolus that may serve as part of the foundation to understanding and applying magnetoreception. Using HaloTag coupled with fluorescent ligands and phosphatidylinositol specific phospholipase C we show that EPG is associated with the membrane via glycosylphosphatidylinositol anchor. EPG's function of increasing intracellular calcium was also used to generate an assay using GCaMP6m to observe the function of EPG and to compare its function with that of homologous proteins. It was also revealed that EPG relies on a motif of three phenylalanine residues to function—stably swapping these residues using site directed mutagenesis resulted in a loss of function in EPG. This information not only expands upon our current understanding of magnetoreception but may provide a foundation and template to continue characterizing and discovering more within the emerging field.

Jakarta Kini (JAKI) is a super-app developed by Jakarta Smart City that offers a one-stop service to help citizens connect and communicate with the Government. It is undeniable that the use of mobile applications can indeed facilitate people's activities, but on the other hand, it also poses risks and raises concerns in terms of privacy. The purpose of this study is to assess the impact of users' privacy concerns on their tendency to use the JAKI mobile application. To measure the privacy concern, we conduct an online survey of the users of JAKI. The hypothesis and research model were formulated to assess the users' privacy concerns based on the Mobile Users' Information Privacy Concerns (MUIPC) theory, with additional factors, namely prior privacy experience and awareness, as the antecedents. As a result, we found that MUIPC had a significant effect on negatively influencing the intention to use the JAKI application. Our study contributes as a starting point in exploring privacy research in the context of a smart city in Indonesia. Additionally, this study proved that the IPC scales that were originally designed for English-based countries could also be adapted to Bahasa Indonesia and utilized in the Indonesian context.

Abstract In motor learning tasks, there is mixed evidence for whether increased task-relevant variability in early learning stages leads to improved outcomes. One problem is that there may be a connection between skill level and motor variability, such that participants who initially have more variability may also perform worse on the task, so will have more room to improve. To avoid this confound, we experimentally manipulated the amount of movement timing variability (MTV) during training to test whether it improves performance. Based on previous studies showing that most of the improvement in finger-opposition tasks comes from optimizing the relative onset time of the finger movements, we used auditory cues (beeps) to guide the onset times of sequential movements during a training session, and then assessed motor performance after the intervention. Participants were assigned to three groups that either: (a) followed a prescribed random rhythm for their finger touches (Variable MTV), (b) followed a fixed rhythm (Fixed control MTV), or (c) produced the entire sequence following a single beep (Unsupervised control MTV). While the intervention was successful in increasing MTV during training for the Variable group, it did not lead to improved outcomes post-training compared to either control group, and the use of fixed timing led to significantly worse performance compared to the Unsupervised control group. These results suggest that manipulating MTV through auditory cues does not produce greater learning than unconstrained training in motor sequence tasks.

Objectives Palliative treatment options for bone metastasis are limited, especially in cases where standard protocols have already failed. The purpose of this study was to evaluate the efficacy and safety of percutaneous ablation, either by cryoablation or radiofrequency, combined with percutaneous cementoplasty using cone-beam guided navigation. The objective was to relieve symptoms and improve functionality in patients suffering from pain secondary to bone metastases, as well as evaluate local disease progression post ablation. Methods We conducted a retrospective study of 13 patients (average age 63.6 ± 9.8, nine females) with symptomatic skeletal metastases treated using 3D imaging with navigation and followed for at least 12 months. The treatment protocol was implemented either after failure of first line treatment, or as first line when mechanical instability was present. Percutaneous lesion ablation was performed along with percutaneous cementation. Results In this study, we observed a statistically significant decrease in pain. The mean Visual Analog Scale pain score decreased from 7.1 ± 0.4 prior to CRA/RFA to 2.2 ± 0.3 after the procedure ( p < 0.001). At the 12-months follow-up, all patients were able to ambulate with no assistance (Eastern Cooperative Oncology Group

Smart cities are faced with the challenges of systematically initiating the strategies needed to implement predetermined goals according to their plan. Therefore, this study aims to identify smart cities components and build an initial model that can be used for smart cities initiatives in Indonesia. The systematic review methods were used to overview research trends, architecture, components, and challenges to build an initial model for Indonesia. The systematic review results show popular topics, such as the standardization of a smart city and the strategies used to determine relevant models in each city's uniqueness and context. The results also identified thirteen smart city components and their challenges. Furthermore, this study's novelty is proposed the smart city's initial models with the smart government as a key component and to be a centre of other smart city components. The triangulation method determined the research validation using systematic review finding, expert judgment, and a questionnaire for collecting random data from 66 respondents from various cities in Indonesia. The collected survey data and initial models were validated by expert judgment, which showed that the proposed smart city's initial model component's agreement is 90%. In future, these results may be used to develop an assessment in smart cities implementation.

Abstract Background The coronavirus disease 2019 (COVID-19) has spread worldwide, and the vaccine remains the ultimate cornerstone to overcoming its long-term impact. Vaccine hesitancy might obstruct the effort to achieve herd immunity and eradicate the virus. We assessed Saudi Arabian individuals’ willingness, beliefs, and barriers regarding the COVID-19 vaccine and their adherence to preventive measures during and after the pandemic. Methods A self-administered electronic validated questionnaire was distributed among the five major regions in Saudi Arabia between November and December 2020. The questionnaire addressed the sociodemographic data, beliefs, potential barriers, parents’ acceptance of COVID-19 vaccination for their children, and adherence to protective measures during and after the pandemic. Results Of 8,056 participants, 4,218 (52.4%) of a non-representative sample were willing to be vaccinated against COVID-19. Being a young adult, male, having less than a high school degree, being a smoker, having a chronic disease, and having a history of seasonal influenza vaccine uptake were positive predictors of COVID-19 vaccine acceptance. Hesitant participants reported concerns about vaccine side effects and safety as the main barriers to accepting the COVID-19 vaccine. Some refusers (26.1%) declared that they would reconsider vaccination only if the safety and effectiveness of the vaccine were reported by more studies. Conclusions Our study revealed a promising willingness to accept the vaccine among the population, with positive beliefs and attitudes toward COVID-19 vaccination. However, a considerable proportion of the population was reluctant to accept the vaccine. Thus, publicly providing information about vaccine safety and implementing health education programs is crucial for increasing the public’s confidence in the vaccine.

Penelitian ini bertujuan untuk mengevaluasi salah satu aplikasi e-government pada instansi Badan Kepegawaian Negara (BKN) yaitu aplikasi SSCASN (Sistem Seleksi Calon Aparatur Sipil Negara) yang digunakan pada proses pendaftaran seleksi Aparatur Sipil Negara (ASN). Berdasarkan ulasan dari media sosial masih terdapat permasalahan pada penggunaan SSCASN sehingga aplikasi perlu dievaluasi. Dalam penelitian ini, kuesioner dibagikan kepada 205 responden dengan kriteria pernah mengikuti pendaftaran CASN dan menggunakan aplikasi SSCASN. Dalam menyusun indikator pernyataan penelitian ini menggunakan model e-GovQual dan untuk mengolah data menggunakan pendekatan PLS-SEM. Hasil penelitian memperlihatkan bahwa semua variabel yang diusulkan yaitu Reliability, Efficiency, Trust, dan Citizen Support memiliki hubungan positif dan signifikan terhadap kualitas layanan e-government pada aplikasi SSCASN. Hasil dengan pengaruh yang paling tinggi diperoleh oleh variabel Efficiency yang mendapatkan persentase dengan nilai 42,3%, disusul dengan Reliability dengan nilai 32,2%, Trust dengan nilai 25%, dan Citizen Support dengan nilai 7%. Adapun rekomendasi yang kami berikan berdasarkan hasil evaluasi adalah BKN sebagai instansi yang bertanggungjawab dalam pengembangan aplikasi SSCASN harus memprioritaskan semua indikator yang ada pada variabel Efficiency dan Reliability karena mendapatkan nilai tertinggi dan paling berpengaruh pada kualitas layanan SSCASN. Sedangkan dalam aspek Trust dan Citizen Support, BKN harus mulai melakukan beberapa perbaikan seperti meningkatkan tingkat keamanan aplikasi dan meningkatkan kualitas layanan helpdesk support pada aplikasi SSCASN. Abstract The goal of this research is to assess one of the e-government applications at National Civil Service Agency (BKN), namely SSCASN (Sistem Seleksi Calon ASN) which is used in the registration process for selection of State Civil Apparatus (ASN) candidate. Based on reviews from social media and helpdesk data report on SSCASN 2021, there are still problems in using SSCASN so the application needs to be evaluated. In this study questionnaires were distributed to 205 respondents who had registered for CASN and used the SSCASN application. In compiling indicators, this research statement uses the E-GovQual model and to process data using the PLS-SEM approach. The results showed that all the proposed variabels, Reliability, Efficiency, Trust, and Citizen Support, had a positive and significant relationship with the quality of e-Government services in SSCASN application. The variable with the highest influence is obtained by Efficiency received a score of 42.3 %, followed by Reliability with 32.2 %, Trust with 25%, and Citizen Support received a score of 7%. The recommendation that we provide is that BKN as the responsible institution for developing SSCASN must prioritize all indicators in the Efficiency and Reliability variabels because they get the highest score and have the most influence on the quality of SSCASN services. In terms of Trust and Citizen Support, BKN must start to make some improvements, such as increasing the level of application security and improving the quality of helpdesk support services for SSCASN application.

Germination of Bacillus subtilis spores in response to L-alanine requires a putative membrane receptor consisting of three proteins. Here, Artzi et al. use evolutionary co-variation analysis and functional assays of mutants to provide evidence that one of the proteins, GerAB, likely acts as the L-alanine sensor.

Protein engineers conventionally use tools such as Directed Evolution to find new proteins with better functionalities and traits. More recently, computational techniques and especially machine learning approaches have been recruited to assist Directed Evolution, showing promising results. In this article, we propose POET, a computational Genetic Programming tool based on evolutionary computation methods to enhance screening and mutagenesis in Directed Evolution and help protein engineers to find proteins that have better functionality. As a proof-of-concept, we use peptides that generate MRI contrast detected by the Chemical Exchange Saturation Transfer contrast mechanism. The evolutionary methods used in POET are described, and the performance of POET in different epochs of our experiments with Chemical Exchange Saturation Transfer contrast are studied. Our results indicate that a computational modeling tool like POET can help to find peptides with 400% better functionality than used before.

Hemophilia A (HA), a rare recessive X-linked bleeding disorder, is caused by either deficiency or dysfunction of coagulation factor VIII (FVIII) resulting from deleterious mutations in the F8 gene encoding FVIII. Over the last 4 decades, the methods aimed at determining the HA carrier status in female relatives of HA patients have evolved from phenotypic studies based on coagulation tests providing merely probabilistic results, via genetic linkage studies based on polymorphic markers providing more accurate results, to next generation sequencing studies enabling highly precise identification of the causative F8 mutation. In parallel, the options for prenatal diagnosis of HA have progressed from examination of FVIII levels in fetal blood samples at weeks 20–22 of pregnancy to genetic analysis of fetal DNA extracted from chorionic villus tissue at weeks 11–14 of pregnancy. In some countries, in vitro fertilization (IVF) combined with preimplantation genetic diagnosis (PGD) has gradually become the procedure of choice for HA carriers who wish to prevent further transmission of HA without the need to undergo termination of pregnancies diagnosed with affected fetuses. In rare cases, genetic analysis of a HA carrier might be complicated by skewed X chromosome inactivation (XCI) of her non-hemophilic X chromosome, thus leading to the phenotypic manifestation of moderate to severe HA. Such skewed XCI may be associated with deleterious mutations in X-linked genes located on the non-hemophilic X chromosome, which should be considered in the process of genetic counseling and PGD planning for the symptomatic HA carrier. Therefore, whole exome sequencing, combined with X-chromosome targeted bioinformatic analysis, is highly recommended for symptomatic HA carriers diagnosed with skewed XCI in order to identify additional deleterious mutations potentially involved in XCI skewing. Identification of such mutations, which may profoundly impact the reproductive choices of HA carriers with skewed XCI, is extremely important.

Background: Lateral epicondylitis (LE) is one of the most diagnosed elbow pathologies. The purpose of this study was to determine the diagnostic test accuracy of a new test (selfie test) for the diagnosis of LE. Methods: Medical data were collected from adult patients who presented with LE symptoms and ultrasound findings that supported the diagnosis. Patients underwent a physical examination, including provocative tests for diagnosis as well as the selfie test, and were asked to fill out the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire and subjectively rate the activity of their affected elbow. Results: Thirty patients were included in this study (seventeen females, 57%). The mean age was 50.1 years old (range of 35 to 68 years). The average duration of symptoms was 7 ± 3.1 months (range of 2 to 14 months). The mean PRTEE score was 61.5 ± 16.1 (range of 35 to 98), and the mean subjective elbow score was 63 ± 14.2 (range of 30 to 80). Mill’s, Maudsley’s, Cozen’s, and the selfie tests had sensitivities of 0.867, 0.833, 0.967, and 0.933, respectively, with corresponding positive predictive values of 0.867, 0.833, 0.967, and 0.933. Conclusions: The selfie test’s active nature, which allows patients to perform the assessment themselves, could be a valuable addition to the diagnostic process, potentially improving the accuracy of the diagnosis of LE (levels of evidence: IV).

Background: Early postoperative graft detachment remains one of the most common complications of DSAEK. Objectives: To describe a modification of a simple method to facilitate a firm AC, without a leak, during DSAEK. Method: Ten consecutive DSAEK surgeries were reviewed. Surgery was performed by a single surgeon (HA). At the beginning of surgery, a trapezoid paracentesis was made at the limbus using a 20G MVR blade. The trapezoid incision was made by inserting the blade halfway, creating a cut with an internal opening half the width of its external opening. After inserting the corneal disc and suturing the main incision, air was injected with a 25G tapered hydrodelineation cannula. The tip was engaged at the trapezoid paracentesis and did not enter the anterior chamber. A firm, full air bubble was formed in the anterior chamber, and no leaking occurred at the paracentesis site, which acted as a one-way valve. Results: All grafts were adhered from the first day after surgery, and no dislocations were observed. All corneas were clear at the one-month postoperative visit. Conclusions: Wound-assisted air injection is a safe, effective, simple method for achieving a firm air bubble during DSAEK, potentially reducing dislocation rates.

Electronic-based Governance System (SPBE) or known as e-government is an effort to utilize information and communication technology to support government systems and improve the effectiveness and efficiency of government institutions' performance. The implementation of e-government is expected to improve the quality of public services. E-government in the country will usually face many obstacles that can be thwarted in its application. Previous research has discussed more about the constraints of e-government implementation in developing countries. This study aims to identify the obstacles faced in the application of SPBE/e-government in developing and developed countries. This research uses systematic literature review method by Kitchenham. The literature used in this study was taken from several digital Library, namely ACM Digital Library, IEEE Xplore, Science Direct, and Scopus. The results of the study found that constraints in its application in developing and developed countries can be categorized into seven constraints / aspects, namely IT Infrastructure, Human Resources, Policy / Legislation, Politics, Economy, Geography and Culture. These constraints can be a reference for the government to make improvements in the implementation of SPBE so that the quality of services can be better

Ahmed H Assaf,1,2 Mohamed G Aly,1 Rania G Zaki,1 Yasmine M Shaaban,1 Bassem F Aziz1,2 1Ain Shams University, Faculty of Medicine, Ophthalmology Department, Cairo, Egypt; 2Al Watany Eye Hospital, Cataract and Refractive Department, Cairo, EgyptCorrespondence: Ahmed H AssafAin Shams University, Cairo, Egypt Email assaf.ahmed@gmail.comPurpose: To compare effective phacoemulsification time (EFX) in femtosecond laser-assisted cataract surgery (FLACS) versus traditional quick chop phacoemulsification (QCP) in senile nuclear cataracts with different densities focusing on soft and hard ones.Patients and Methods: A prospective non-randomized comparative study was carried out in Al Watany Eye Hospital and Ain Shams University Hospital, Cairo, Egypt; 250 eyes with senile nuclear cataract (NC) were included and classified into two main groups, FLACS and QCP groups. Each of them was stratified according to nuclear density into three subgroups, subgroups I (Soft NC), II (Medium NC), and III (Hard NC). Sextans-softened fragmentation pattern was performed in the FLACS group. Total EFX utilized for nucleus disassembly and removal was recorded by the completion of each surgery.Results: A total of 117 eyes were included in the FLACS group and 133 eyes in the QCP group. No significant difference in EFX was observed between the two groups (P = 0.228). Regarding subgroups, EFX showed no statistically significant difference between FLACS and QCP (P = 0.283) in soft NC. For hard NC, a trend to lower values of EFX in FLACS compared with QCP was found, but without statistically significant difference (P = 0.122). Only in medium NC were significantly lower values obtained in FLACS compared with QCP (P < 0.0001).Conclusion: When compared with QCP technique, FLACS can be used for advantages aside from EFX reduction, including astigmatic keratotomies, accurate sizing, and centration of capsulotomies especially in hard and soft nuclear cataracts. Significant reduction of total EFX with FLACS is most prominent only in medium-density nuclear cataracts.Keywords: phacoemulsification, EFX, FLACS, quick chop, femtosecond laser, cataract surgery

The effects of climate on vector-borne disease systems are highly context-dependent. Here, the authors incorporate laboratory-measured physiological traits of the mosquito Aedes aegypti into climate-driven mechanistic models to predict number, timing, and duration of outbreaks in Ecuador and Kenya.

OBJECTIVE: We aimed to understand family preferences around reporting and receiving health-related social needs (HRSN) information by assessment modality during pediatric emergency department (PED) visits. METHODS: Families were randomized into paper (control), cell phone, or tablet modality groups by their childs exam room. Nurses alerted families to complete a single HRSN assessment during routine workflow. We used logistic regression and McNemars test to assess discordance in modality preference. RESULTS: Forty-seven percent of families disclosed at least one HRSN across a total 611 assessments. Disclosure of HRSN was similar by modality. Twenty-three percent of those assigned tablet preferred cell phone (p

Background: Transtibial amputation (TTA) due to complications of diabetic foot infection (DFI) or peripheral vascular disease (PVD) is a high-risk procedure in fragile patients. The risks of reoperation, blood loss requiring blood transfusion, and mortality are high. The use of a tourniquet in this procedure is controversial and scarcely reported. Objective: this study aimed to compare the outcomes of TTAs with or without a tourniquet in a single tertiary medical center. Methods: We retrospectively identified all patients who had undergone TTA in our institution (1/2019-1/2020) and included only those who underwent the procedure due to complications of DFI or PVD ( n = 69). The retrieved data included demographics, comorbidities, ASA score, the use of a tourniquet, operation duration, pre- and postoperative hemoglobin levels, administration of blood transfusions, hospitalization length, surgical site infection and 60-days reoperation and mortality rates. Results: TTA with a tourniquet was superior to TTA without a tourniquet in reducing the average operation length by 11 min ( p = 0.05), the median postoperative hospitalization by 6 days ( p = 0.04), and the use of blood transfusions (odds ratio [OR] = 0.176, 95% confidence interval [CI]: 0.031–0.996). Conclusions: Our findings demonstrated advantages in operative time, hospitalization length, and blood transfusion requirement for TTA with a tourniquet compared to TTA without a tourniquet.

Hemostasis is a dynamic process that starts in utero. Neonates, especially those who are born preterm, are at high risk of bleeding. The perinatal period is also associated with increased thrombosis risk as compared to older children. The coagulation system evolves with age, and the decreased levels of coagulation factors along with hypo-reactive platelets are counterbalanced by the increased activity of von Willebrand factor, high hematocrit and MCV as well as low levels of coagulation inhibitors that promote hemostasis. This review will address the concept and manifestations of developmental hemostasis with respect to the pathogenesis of severe bleeding or thrombosis in neonates. A special focus will be shared regarding intracerebral hemorrhages and perinatal arterial ischemic stroke. Hemostatic challenges associated with pathogenesis, diagnosis and treatment will be discussed.

Lanthanides (Ln) are a new group of life metals, and many questions remain regarding how they are acquired and used in biology. Methylotrophic bacteria can acquire, transport, biomineralize, and use Ln as part of a cofactor complex with pyrroloquinoline quinone (PQQ) in alcohol dehydrogenases. For most methylotrophic bacteria use is restricted to the light Ln, which range from lanthanum to samarium (atomic numbers 57–62). Understanding how the cell differentiates between light and heavy Ln, and the impacts of these metals on the metabolic network, will advance the field of Ln biochemistry and give insights into enzyme catalysis, stress homeostasis, and metal biomineralization and compartmentalization. We report robust methanol growth with the heavy Ln gadolinium by a genetic variant of the model methylotrophic bacterium Methylorubrum extorquens AM1, named evo-HLn, for “evolved for Heavy Lanthanides.” A non-synonymous single nucleotide polymorphism in a cytosolic hybrid histidine kinase/response regulator allowed for sweeping transcriptional alterations to heavy metal stress response, methanol oxidation, and central metabolism. Increased expression of genes for Ln acquisition and uptake, production of the Ln-chelating lanthanophore, PQQ biosynthesis, and phosphate transport and metabolism resulted in gadolinium hyperaccumulation of 36-fold with a trade-off for light Ln accumulation. Gadolinium was hyperaccumulated in an enlarged acidocalcisome-like compartment. This is the first evidence of a bacterial intracellular Ln-containing compartment that we name the “lanthasome.” Carotenoid and toblerol biosynthesis were also upregulated. Due to its unique capabilities, evo-HLn can be used to further magnetic resonance imaging (MRI) and bioremediation technologies. In this regard, we show that gadolinium hyperaccumulation was sufficient to produce MRI contrast in whole cells, and that evo-HLn was able to readily acquire the metal from the MRI contrast agent gadopentetic acid. Finally, hyperaccumulation of gadolinium, differential uptake of light and heavy Ln, increased PQQ levels, and phosphate transport provide new insights into strategies for Ln recovery.

Long COVID is a chronic and often disabling illness with long-term consequences. Although progress has been made in the clinical characterization of long COVID, no approved treatments exist and disconnects between patients and researchers threaten to hinder future progress. Incorporating patients as active collaborators in long COVID research can bridge the gap and accelerate progress toward treatments and cures.