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Introduction: The complex health, social, and economic consequences of tobacco smoking underscore the importance of incorporating reliable and scalable data collection on smoking status and habits into research across various disciplines. Given that smoking impacts voice production, we aimed to develop a gender and language-specific vocal biomarker of smoking status. Methods: Leveraging data from the Colive Voice study, we used statistical analysis methods to quantify the effects of smoking on voice characteristics. Various voice feature extraction methods combined with machine learning algorithms were then used to produce a gender and language-specific (English and French) digital vocal biomarker to differentiate smokers from never-smokers. Results: A total of 1,332‬ participants were included after propensity score matching (mean age = 43.6 [13.65], 64.41% are female, 56.68% are English speakers, 50% are smokers and 50% are never-smokers). We observed differences in voice features distribution: for women, the fundamental frequency F0, the formants F1, F2, and F3 frequencies and the harmonics-to-noise ratio were lower in smokers compared to never-smokers (p < 0.05) while for men no significant disparities were noted between the two groups. The accuracy and AUC of smoking status prediction reached 0.71 and 0.76, respectively, for the female participants, and 0.65 and 0.68, respectively, for the male participants. Conclusion: We have shown that voice features are impacted by smoking. We have developed a novel digital vocal biomarker that can be used in clinical and epidemiological research to assess smoking status in a rapid, scalable, and accurate manner using ecological audio recordings.

Objective To investigate the sex-related differences in single-task performance through motor torque, cognitive tasks and walking speed, and the combined dual-task costs (DTCs) considering both motor and cognitive performance in young adults. Methods Sixty-seven non-athletic subjects 37 females and 30 males were enrolled. The study measured their knee extension muscle torque using an isokinetic strength dynamometer and their walking speed using the one step app. these assessments were performed both with and without a cognitive task, and the DTCs were calculated. Results The females exhibited significantly larger motor performance dual task effect through (torque-DTC, speed-DTC) compared with males while exhibiting smaller cognitive dual task effect with muscle torque and speed. Conclusion Deterioration in motor performance during muscle force production and speed during dual tasks was large in females compared to males, whereas males experience a decline in cognitive ability when performing dual tasks compared with females.

Introduction Unplanned hospital returns are frequent and may be preventable.

Background: Neuroblastoma is the most common extracranial pediatric solid malignancy with high-risk patients showing survival rates less than 50 %. These tumors frequently escape apoptosis through upregulation of the anti-apoptotic protein BCL-2. Unfortunately, monotherapy with the BCL-2 inhibitor venetoclax leads to therapy-induced resistance mediated by upregulation of MCL-1, thereby indicating that tumors could be responsive to dual inhibition of BCL-2 and MCL-1. Methods: In vitro efficacy of venetoclax and multiple MCL-1 inhibitors (MIK665, S63845, AMG-176, AZD-5991) was studied in neuroblastoma cell lines with BCL-2 and/or MCL-1 dependency. Synergy assays were performed to identify the MCL-1 inhibitor with best performance in combination with venetoclax, followed by examining if dual BCL-2 and MCL-1 inhibition protects against resistance. Lastly, the combination was analyzed in two patient-derived xenograft (PDX) models. Results: Venetoclax showed highest efficacy in neuroblastoma cell lines with high BCL-2 mRNA expression, BCL-2 protein levels or BIM:BCL-2 complex formation, while MCL-1 inhibitor efficacy was best correlated with BIM:MCL-1 complex levels. Most promising anti-tumor effects were observed following combination therapy with venetoclax and MIK665. Targeting BCL-2 and MCL-1 led to strong synergy and efficacy at low concentrations, induced apoptosis and prevented resistance. PDX validation studies combining venetoclax with MIK665 showed improved responses compared to monotherapies. Conclusion: Dual inhibition of BCL-2 and MCL-1 in neuroblastoma cells showed highly efficacious and synergistic responses in vitro, but only led to mild additive effects in vivo. Hence, better understanding of in vivo efficacy and side effects of this combination treatment are warranted prior to clinical translation.

In a Low-power and Lossy Network (LLN), owing to its unique characteristics, such as lossy channels, dynamically changing network topology and resource-constrained nodes, finding a global optimum path to deliver packets efficiently and reliably is a challenging task. Current path-finding solutions in LLNs often fall short in addressing the issue of finding a global optimum path based on a comprehensive set of factors that impact network performance. To address these challenges, there is a critical need for a new approach that can dynamically and intelligently optimise routing paths in real-time, considering the most important factors. This paper investigates how to obtain a global optimum path in real-time in LLNs. It critically analyses existing path-finding solutions designed for LLNs and identifies two aspects for improvement. The first one is to capture all the factors that may impact packet delivery reliability by using a greater set of routing metrics. The set of metrics not only measures packet delivery reliability, the level of control overhead and packet delivery delays, but also energy preservation for prolonging network lifetime. The second one is a novel Swarm Intelligence-based Path Selection (SIPaS) framework for finding a global optimum path based on the real-time values of the routing metrics. We have coded the framework into an Ant Colony Objective Function (ACOF) equipped with multiple routing metrics seamlessly integrated into the Routing Protocol for LLNs (RPL). Simulation results indicate that the SIPaS framework outperforms related solutions significantly in terms of packet delivery ratio, energy preservation, network lifetime extension, and reduction of both delay and control overhead.

Low-Power and Lossy Networks (LLNs) have grown rapidly in recent years owing to the increased adoption of Internet of Things (IoT) and Machine-to-Machine (M2M) applications across various industries, including smart homes, industrial automation, healthcare, and smart cities. Owing to the characteristics of LLNs, such as Lossy channels and limited power, generic routing solutions designed for non-LLNs may not be adequate in terms of delivery reliability and routing efficiency. Consequently, a routing protocol for LLNs (RPL) was designed. Several RPL objective functions have been proposed to enhance the routing reliability in LLNs. This paper analyses these solutions against performance and security requirements to identify their limitations. Firstly, it discusses the characteristics and security issues of LLN and their impact on packet delivery reliability and routing efficiency. Secondly, it provides a comprehensive analysis of routing solutions and identifies existing limitations. Thirdly, based on these limitations, this paper highlights the need for a reliable and efficient path-finding solution for LLNs.

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder associated with kidney complications. This study aims to investigate the effects of weekly subcutaneous semaglutide, a GLP-1 agonist, on kidney outcomes. Methods: This retrospective cohort study was conducted in nephrology and endocrinology clinics at KFAFH from March 2022 to February 2023. The sample size was determined based on hospital records, and randomly selected patients who met the inclusion criteria were included. The inclusion criteria included adults with T2DM who were on weekly subcutaneous semaglutide for 6 months or longer. Patients with type 1 diabetes mellitus, pregnant or gestational diabetes patients, individuals who added other antidiabetic medications during the study period, and participants who refused to be involved were excluded from the study. Results: The study included participants aged between 42 and 85 years, with a mean age of 65.38 years, and the majority (58.7%) were males. There was a significant weight and BMI reduction observed in all patients, with P values

Background:. Plastic and reconstructive surgery services need to be improved in developing African countries. Research and article publications from those countries are limited. This review was conducted to identify published articles from Sudan in the area of plastic and reconstructive surgery. Methods:. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were used for the preparation of this systematic review. A comprehensive systematic search was performed using PubMed, ScienceDirect, and Web of Science databases. Articles published in Sudan, specifically in the area of plastic and reconstructive surgery, and written in English were included in this review. Results:. The total number of articles that fulfilled the inclusion criteria was 23. The articles were written from 1969 to 2023. Only two articles were published in the 20th century. The most common study type was a retrospective study of eight articles, and the most common study area was Khartoum Teaching Hospital. Regarding the publishing journals, the number of subscription journals was six (30%), whereas open access was 17 (70%). Conclusion:. This review demonstrates the lack of articles published on plastic surgery in Sudan. Further investigation is needed to determine the challenges and problems associated with possible clarifications.

Abstract Layered thio- and seleno-phosphate ferroelectrics, such as CuInP2S6, are promising building blocks for next-generation nonvolatile memory devices. However, because of the low Curie point, the CuInP2S6-based memory devices suffer from poor thermal stability (

Community Empowerment through Digital Marketing Training in Agricultural Product SMEs in Bodag Village, Madiun, East Java. Micro, Small and Medium Enterprises (MSMEs) are often faced with problems related to the limited range of product marketing because they only use conventional marketing. One of the solutions is through digital marketing to expand the reach of product marketing and increase product sales. This community service aims to provide knowledge and increase the interest of MSMEs in Bodag Village in developing technology-based businesses through digital marketing, as well as assisting MSMEs in Bodag Village in implementing digital marketing. Digital marketing training and assistance for MSMEs in Bodag Village have been carried out. The training was attended by SMEs Rumah Coklat Bodag, Kopi Laksana SMEs, Kopi Selo Gedong SMEs, Keripik Selo Gedong SMEs, Keripik Pop Krip, and Keripik Kiya. The training begins with increasing MSME knowledge and continues with hands-on practice. From the training results, MSMEs' knowledge of digital marketing has increased from a score of 45.79 to 76.84. Regarding skills, it also showed positive results with indicators of the ability of MSME members in Bodag Village to make catalogues of food products, as well as Instagram and website content for. Both of these are indicators of the successful implementation of this program. In addition, the interest in implementing digital marketing in the marketing process by MSMEs in Bodag Village also indicates that the implementation of the program has succeeded in fulfilling the purpose of doing community service.

Abstract Human epidermal growth factor receptor 2 (HER2/ERBB2) factor is known to be implicated in many malignancies and the potential of it as a prognostic biomarker was reported years ago. Molecular subtypes of HER2/ERBB2 negative and positive with distinct clinical outcomes have been identified in recent years; however, it is still under investigation for bladder cancer. This study evaluates the biological and prognostic significance of RAD21, RAD50 and BARD1 (homologous recombination biomarkers) mRNA levels with ERBB2 low and high expression to explore their impact on bladder cancer patient survival and cancer aggressiveness. The expression of ERBB2, RAD21, RAD50 and BARD1 mRNA levels was assessed in The Cancer Genome Atlas (TCGA) bladder cancer dataset along with four validation cohorts. Outcome analysis was evaluated using disease-free survival (DFS) and overall survival (OS). Univariate and multivariate analysis were used to evaluate the relationship between RAD21, RAD50, BARD1 and ERBB2 expression and clinicopathological variables. A significant increase in mRNA expression levels of RAD21, RAD50 and BARD1 was noticed in ERBB2-low patients compared to ERBB2-high patients. This overexpression of the homologous recombination repair transcripts was associated with poor outcome in ERBB2-low tumors, not in ERBB2-high tumors. Furthermore, the combined expression of high RAD21/RAD50, high RAD21/BARD1 or high RAD50/BARD1 were significantly associated with worse DFS and a better outcome for those with low co-expression in the ERBB2-low cohort. High expression of either RAD21/RAD50 or RAD21/BARD1 in ERBB2-low cohort associated with higher chance of metastasis. In addition, gene expression of BARD1 alone or in combination with RAD50 acted as an independent prognostic factor for worst survival. The data presented in this study reveal a connection between RAD21, RAD50, BARD1 and ERBB2 and patient survival. Importantly, it provided novel findings and potential prognostic markers, particularly in ERBB2-low bladder cancer.

Fe3GaTe2 is a promising van der Waals material for future spintronic applications because of its intrinsic above-room-temperature ferromagnetism. Herein, high quality Fe3GaTe2 single crystals were successfully grown by the chemical vapor transport method. Its magnetic critical behavior in the vicinity of paramagnetic to ferromagnetic phase transition region was systematically investigated. The critical exponents β = 0.350(1) and γ = 1.385(5) were obtained by using the Kouvel–Fisher method, and δ = 4.92(1) was obtained by a critical isotherm analysis at critical temperature TC = 358 K, which is consistent with the Widom scaling relation δ = 1 + γ/β. The critical exponents determined using different methods are self-consistent and obey the scaling equations predicted by the scaling theory. The renormalization group theory analysis based on the extracted critical exponents further reveals that the magnetic interaction in Fe3GaTe2 is of the 3D Heisenberg type with long-range magnetic coupling.

Introduction: Twins conjoined at the sacrum present a complex anatomy that requires the highest levels of medical and surgical care. We present the successful management and separation of pygopagus babies in a tertiary care center. Case presentation: The conjoined female twins were diagnosed by routine prenatal ultrasonography (US) and magnetic resonance (MR) imaging and were delivered uneventfully at 37 weeks of gestation. Postnatal imaging included US of the brain and urinary system, contrast enema, intravenous (IV) contrast-enhanced computed tomography (CT), and MR of the pelvis, which confirmed the sacral and pelvic-perineal organ fusion as well as brain abnormalities in twin B. For the separation, appropriate allocation of the intrapelvic muscles was guided by preoperative and intraoperative sphincter muscle mapping. Baby A received a repaired sphincter with a natural anus, while a functional neo-anus was created for the other baby. Mild superficial wound dehiscence occurred in both twins, which resolved conservatively in twin B and by temporary colostomy diversion in twin A A. Twin B underwent placement of a gastrostomy and a tracheostomy and remains hospitalized. Conclusion: Careful preoperative planning can lead to the successful separation of pygopagus conjoined twins, even in places with limited resources.

Thomas et al. test 6 ELISAs detecting IgA and IgG antibodies to whole SARS-CoV-2 spike protein, to its receptor binding domain region and to nucleocapsid protein in saliva. Across 20 household outbreaks, antibody responses are heterogeneous, but a reliable indicator of recent infection.

Animal-based tests are used for the control of vaccine quality. However, because highly purified and safe vaccines are now available, alternative approaches that can replace or reduce animal use for the assessment of vaccine outcomes must be established. In vitro tests for vaccine quality control exist and have already been implemented. However, these tests are specifically designed for some next-generation vaccines, and this makes them not readily available for testing other vaccines. Therefore, universal non-animal tests are still needed. Specific signatures of the innate immune response could represent a promising approach to predict the outcome of vaccines by non-animal methods. Type I interferons (IFNs) have multiple immunomodulatory activities, which are exerted through effectors called interferon stimulated genes (ISGs), and are one of the most important immune signatures that might provide potential candidate molecular biomarkers for this purpose. This paper will mainly examine if this idea might be feasible by analyzing all relevant published studies that have provided type I IFN-related biomarkers for evaluating the safety and efficacy profiles of vaccines using an advanced transcriptomic approach as an alternative to the animal methods. Results revealed that such an approach could potentially provide biomarkers predictive of vaccine outcomes after addressing some limitations.

Aim: This study describes Jordanian intensive care unit nurses' satisfaction with their physical environment and investigates the association between workplace physical environment and nurses' safety compliance. Additionally, the study offers serial mediation analyses of psychological and behavioral factors between satisfaction with the workplace physical environment and nurses’ safety compliance. Introduction: Compliance with safety measures is a vital indicator of safety performance, as less compliance directly reflects undesirable safety outcomes among nurses, like occupational accidents, injuries, and fatalities. Social cognitive theory and the safety triad model contribute to understanding safety compliance behaviors to safety procedures. Thus, enhancing safety compliance in healthcare organizations remains a challenge and concern. Methods: A quantitative research method was used based on cross-sectional and descriptive data from eight governmental hospitals in Jordan. The population included all intensive care unit nurses in the Ministry of Health's hospitals (n = 1104). A cluster sampling technique selected 285 nurses to participate. Empirical results were obtained through structural equation modeling (i.e., Smart PLS-SEM), which has become popular in this kind of research. Results: The mean of Jordanian ICU nurses' satisfaction with the workplace physical environment was 3.36, which is moderate. Although the Smart PLS findings did not support the direct association between the workplace physical environment and nurses' safety compliance, serial mediation of safety participation in the workplace physical environment and nurses’ safety compliance and perceived safety management commitment confirm the indirect association in the study model. Conclusion: This study fills a gap in available safety and nursing literature, especially when considering the scarce studies that investigated the physical elements in the workplace and both safety compliance and safety participation. The findings are valuable for academicians, health providers, and policymakers and may trigger creative ideas and interventional solutions to improve nurses’ safety compliance in healthcare organizations.

Background The issue of burnout syndrome among health discipline students is gaining heightened attention due to its serious effects, which causes them to have the intention to quit. Despite this, limited studies are available on the extent of burnout and its association with resilience and intention to drop out among clinical-level nursing students. Objective To explore the relationship between burnout, resilience, and intention to quit among nursing students. Methods An online questionnaire was used to conduct a cross-sectional study, targeting nursing students at the clinical level through a nonprobability sample. The participants were required to provide their sociodemographic, Maslach Burnout Inventory, and Connor-Davidson Resilience Scale. Data was analyzed using descriptive, inferential, and correlation tests. Results The study included a group of 564 nursing students and interns, the majority of whom were female at a percentage of 78.9%. Among this group, 65% experienced a high level of burnout, with 42% experiencing emotional exhaustion, 54% experiencing depersonalization (DP), and 77% reporting low personal achievement. A total of 48% of clinical-level students were considering quitting the nursing program. Moreover, the students reported low scores of resilience, with negative correlations observed with DP ( r = −.12, p = .04) and positive correlation with low personal achievement ( r = .43, p

Summary:. Resection of advanced rectal cancer might result in significant tissue loss, including pelvic floor and parts of the vaginal wall. Pelvic floor reconstruction using a musculocutaneous flap offers optimized healing abilities and the possibility of vaginal reconstruction. In Skåne University Hospital, two different flap techniques are used to reconstruct the perineum: the vertical rectus abdominis musculocutaneous flap and the gluteus maximus (GM) flap. A combination of a GM flap and a fasciocutanous flap, referred to locally as a GM special (GMS) flap, is used for posterior vaginal wall reconstruction in women undergoing abdominoperineal resections including parts of or the total posterior vaginal wall. The GMS flap was introduced through a national collaboration in Sweden in 2013. The aim of this article is to offer a detailed description and illustrations of the surgical technique used to construct the GMS flap, focusing on the posterior vaginal wall reconstruction. In our experience, the GMS flap is a resilient and cosmetically appealing choice that is technically easily harvested. The flap has acceptable morbidity and long-term results with adequate neovaginal measurements. Collaborative work is further encouraged.

Abstract The van der Waals (vdW) ferromagnet Fe3‐δGeTe2 has garnered significant research interest as a platform for skyrmionic spin configurations, that is, skyrmions and skyrmionic bubbles. However, despite extensive efforts, the origin of the Dzyaloshinskii–Moriya interaction (DMI) in Fe3‐δGeTe2 remains elusive, making it challenging to acquire these skyrmionic phases in a controlled manner. In this study, it is demonstrated that the Fe content in Fe3‐δGeTe2 has a profound effect on the crystal structure, DMI, and skyrmionic phase. For the first time, a marked increase in Fe atom displacement with decreasing Fe content is observed, transforming the original centrosymmetric crystal structure into a non‐centrosymmetric symmetry, leading to a considerable DMI. Additionally, by varying the Fe content and sample thickness, a controllable transition between Néel‐type skyrmions and Bloch‐type skyrmionic bubbles is achieved, governed by a delicate interplay between dipole–dipole interaction and the DMI. The findings offer novel insights into the variable skyrmionic phases in Fe3‐δGeTe2 and provide the impetus for developing vdW ferromagnet‐based spintronic devices.

Abstract Background Maintaining good oral hygiene is key to preventing dental caries and periodontal disease. Children and adolescents with good oral hygiene behaviours are likely to grow into adults with the same behaviours. This study assessed the frequency of using various oral hygiene methods among children and adolescents from different countries and individual, familial and country-level factors associated with the use of these methods. Methods A multi-country online survey collected data from caregivers of children in 2020–21 about children’s use of oral hygiene methods including toothbrush, fluoridated toothpaste, mouthwash, dental floss and miswak using self-administered, close-ended questions. Adjusted multilevel logistic regression models were used to assess the relationship between each of the five oral hygiene methods (dependent variables) and the independent factors: sex, age, and history of dental visits (individual factors), mother's education and area of residence (familial factors) as well as country income and region (country-level factors). Results A total of 4766 parents/caregivers were included from 20 countries (77.4% Eastern Mediterranean-region and 41.6% lower middle income countries). The most frequent oral hygiene methods were using toothbrush and toothpaste (90% and 60.3%). The use of oral hygiene methods differed by age, sex and history of dental visits as well as mother’s education and area of residence (P

ObjectiveThis work aims to study the profiles of Long COVID from the perspective of the patients spontaneously sharing their experiences and symptoms on Reddit.MethodsWe collected 27,216 posts shared between July 2020 and July 2022 on Long COVID-related Reddit forums. Natural language processing, clustering techniques and a Long COVID symptoms lexicon were used to extract the different symptoms and categories of symptoms and to study the co-occurrences and correlation between them.ResultsMore than 78% of the posts mentioned at least one Long COVID symptom. Fatigue (29.4%), pain (22%), clouded consciousness (19.1%), anxiety (17.7%) and headaches (15.6%) were the most prevalent symptoms. They also highly co-occurred with a variety of other symptoms (e.g., fever, sinonasal congestion). Different categories of symptoms were found: general (45.5%), neurological/ocular (42.9%), mental health/psychological/behavioral (35.2%), body pain/mobility (35.1%) and cardiorespiratory (31.2%). Posts focusing on other concerns of the community such as vaccine, recovery and relapse and, symptom triggers were detected.ConclusionsWe demonstrated the benefits of leveraging large volumes of data from Reddit to characterize the heterogeneity of Long COVID profiles. General symptoms, particularly fatigue, have been reported to be the most prevalent and frequently co-occurred with other symptoms. Other concerns, such as vaccination and relapse following recovery, were also addressed by the Long COVID community.

This is the fourth part of a study presenting a miniature, combustion-type gas sensor (dubbed GMOS) based on a novel thermal sensor (dubbed TMOS). The TMOS is a micromachined CMOS-SOI transistor, which acts as the sensing element and is integrated with a catalytic reaction plate, where ignition of the gas takes place. The GMOS measures the temperature change due to a combustion exothermic reaction. The controlling parameters of the sensor are the ignition temperature applied to the catalytic layer and the increased temperature of the hotplate due to the released power of the combustion reaction. The solid-state device applies electrical parameters, which are related to the thermal parameters. The heating is applied by Joule heating with a resistor underneath the catalytic layer while the signal is monitored by the change in voltage of the TMOS sensor. Voltage, like temperature, is an intensive parameter, and one always measures changes in such parameters relative to a reference point. The reference point for both parameters (temperature and voltage) is the blind sensor, without any catalytic layer and hence where no reaction takes place. The present paper focuses on the study of the effect of humidity upon performance. In real life, the sensors are exposed to environmental parameters, where humidity plays a significant role. Humidity is high in storage rooms of fruits and vegetables, in refrigerators, in silos, in fields as well as in homes and cars. This study is significant and innovative since it extends our understanding of the performance of the GMOS, as well as pellistor sensors in general, in the presence of humidity. The three main challenges in simulating the performance are (i) how to define the operating temperature based on the input parameters of the heater voltage in the presence of humidity; (ii) how to measure the dynamics of the temperature increase during cyclic operation at a given duty cycle; and (iii) how to model the correlation between the operating temperature and the sensing response in the presence of humidity. Due to the complexity of the 3D analysis of packaged GMOS, and the many aspects of humidity simultanoesuly affecting performane, advanced simulation software is applied, incorporating computational fluid dynamics (CFD). The simulation and experimental data of this study show that the GMOS sensor can operate in the presence of high humidity.

Despite the small number of reported cases of venous aneurysms, popliteal venous aneurysms (PVAs) are a potential source of venous thromboembolism (VTE) that carries significant morbidity and mortality. Recurrent VTE is a potential complication in cases of undiagnosed PVA. The knowledge of diagnosis and management of PVAs is limited among health professionals. The goal of this case report was to present the symptoms, diagnosis, and surgical management of PVA.

Disasters not only bring bad impacts and cause problems to the victims, but they can also bring a positive impact, i.e., posttraumatic growth (PTG), that appears after the disaster. Investigating the posttraumatic growth of disaster survivors is important as it helps to identify the needs of survivors and develop intervention programs. Currently, there is no research in Indonesia about the PTG of flash flood disaster victims. This study aims to determine the posttraumatic growth of flash flood disaster victims in Indonesia. This was an analytical correlation analysis study which observed 95 flood victims in Magelang and employed the Posttraumatic Growth Inventory-Expanded (PTGI-X) instrument. The data were analyzed by using the Mann-Whitney, Pearson, independent t-test, and multiple linear regression tests. The average PTG of flood victims was 72.31 ± 15.91. The male disaster victims with high PTSD scores, with high school and university education levels, had a higher level of PTG. This model described that the factors investigated in this study had a 23.2% contribution to PTG.The factors that influence the PTG of flood victims were PTSD, gender, educational level, and severity of disasters.

Abstract Background Angiography and embolization (AE) is a lifesaving, high radiation dose procedure for treatment of abdominal arterial hemorrhage (AAH). Interventional radiologists have utilized pre-procedure CT angiography (CTA) and newer fluoroscopic systems in an attempt to reduce radiation dose and procedure time. Purpose To study the factors contributing to the radiation dose of AE for AAH and to compare to the reference standard. Materials and methods This retrospective single-centre observational cohort study identified 154 consecutive AE procedures in 138 patients (median age 65 years; interquartile range 54–77; 103 men) performed with a C-arm fluoroscopic system (Axiom Artis DTA or Axiom Artis Q (Siemens Healthineers)), between January 2010 and December 2017. Parameters analysed included: demographics, fluoroscopy system, bleeding location, body mass index (BMI), preprocedural CT, air kerma-area product (PKA), reference air kerma (Ka,r), fluoroscopy time (FT) and the number of digital subtraction angiography (DSA) runs. Factors affecting dose were assessed using Mann–Whitney U, Kruskal–Wallis one-way ANOVA and linear regression. Results Patients treated with the new angiographic system (NS) had a median PKA, median Ka,r, Q3 PKA and Q3 Ka,r that were 74% (p

Objectives: Our study aimed to investigate the pre-operative neutrophils-lymphocytes ratio (NLR) in patients who underwent cholecystectomy and to identify whether it discriminates between chances of developing pain or not and at what interval. Materials and Methods: A cross-sectional study was conducted in a single center in Saudi Arabia over a period of 2 months. Analysis was conducted using SPSS 22nd edition; numeric variables were presented in mean ± standard deviation and compared using the Mann–Whitney U-test after normality testing. Results: The study included 69 patients diagnosed with acute cholecystitis and underwent cholecystectomy. The minimum identified NLR in our study was 0.3 and the maximum identified variable was 15.0. Highest sensitivity and specificity were found to be 93.8% and 24.5% after 36 h of performing the procedure, respectively. Conclusion: NLR utilization as a pain marker post-operatively has promising outcomes which will highly impact the reduction of disease burden on patients.

Introduction: Dental caries is the most common chronic infectious disease involving children and toddlers. Carious invasion of anterior teeth causes infection, pain, compromised speech, mastication, and impacts the esthetics and appearance of the child. Dental caries' immediate and long-term effects affect the child's quality of life and his family, leading to significant social, economic, and psychological consequences. Aim: The present study was conducted to evaluate the effect of anterior dental caries on Saudi pediatric patients' psychological behavior and quality of life. Materials and Methods: A self-administered, structured questionnaire was used to assess the demographic variables, the prevalence of dental caries (anterior teeth), and their psychological effects on children. The data obtained were subjected to statistical analysis using IBM SPSS version 20.0 software. Results and Discussion: Five hundred and twenty-two children were included in the study, out of which 67.62% were affected with anterior carious lesions, with a mean age of 4.90 ± 1.981 years. Most parents reported that their child has anterior carious lesions, with 50% of children having toothache and 49% difficulty in eating food, especially sweets. Affected children showed psychological issues as they avoided playing, hesitated to smile, were introverted, and covered their faces while smiling. Conclusion: A high anterior dental caries prevalence and the resultant effect on psychological behavior and quality of life were observed among young children in Saudi Arabia. Enhanced educational, counseling, and preventive programs among parents and children will reduce dental caries incidence and ensure young children have a good quality of life.

Edmunds et al. examine how the adenosine receptor A2AR and the checkpoint molecule TIM3 suppress the killing of Renca tumors expressing hemagglutinin (HA) as a model neo-antigen by CL4 TCR transgenic T cells, which recognize an HA peptide presented by H-2Kd. The authors report that TIM3, which is upregulated on tumor-infiltrating CD8+ T cells after inhibition of A2AR, and A2AR impair the cytoskeletal polarization of the CL4 T cells.

Background: Coronavirus disease-2019 (COVID-19) pandemic continues to storm internationally. Various essential services in the health systems have failed to meet the standardized health needs for those non-COVID-19 patients. In this single academic center study, we describe the epidemiological profiles and clinical outcomes on non-COVID-19 patients during COVID-19 pandemic to guide decision-makers in maintaining essential health services and building a structured recovery plan by the end of this pandemic. Materials and Methods: This retrospective cross-sectional single academic center study included 718 non-COVID-19 patients in King Saud University Medical City between March and June 2020. Demographic, clinical, laboratory, treatment, and disposition data were extracted from the Hospital Electronic Records, Electronic System for Integrated Health Information database. Results: The highest age group was 26–35 years, representing 28.6% (n = 205), and 56% (n = 402) were females. The most common comorbidity was hypertension by 25.5% (n = 183), and the main route of admission was through Emergency Medicine Department, 76.7% (n = 551), and 87% (n = 624) of the admissions were to wards, 13% (n = 92) were to Intensive Care Unit, and 7% (n = 51) were deceased. Based on International Classification of Diseases, Revision 10 classifications, 33.6% (n = 241) had diseases of the respiratory system, 14.5% (n = 104) were obstetrics, and 10.4% (n = 75) were cardiac cases. Conclusion: In this single-center study, maintaining essential health-care services is critical during COVID-19 pandemics. Attention should be addressed to extreme ages and to those with pulmonary, obstetric, and cardiac diseases. Mapping decisions taken to curb COVID-19 is critical to structure a solid recovery plan.

Introduction:Klebsiella pneumoniae (K. pneumoniae) and Pseudomonas aeruginosa (P. aeruginosa) are the most common Gram-negative bacteria associated with pneumonia and coinfecting the same patient. Despite their high virulence, there is no effective vaccine against them.Methods: In the current study, the screening of several proteins from both pathogens highlighted FepA and OmpK35 for K. pneumonia in addition to HasR and OprF from P. aeruginosa as promising candidates for epitope mapping. Those four proteins were linked to form a multitope vaccine, that was formulated with a suitable adjuvant, and PADRE peptides to finalize the multitope vaccine construct. The final vaccine’s physicochemical features, antigenicity, toxicity, allergenicity, and solubility were evaluated for use in humans.Results: The output of the computational analysis revealed that the designed multitope construct has passed these assessments with satisfactory scores where, as the last stage, we performed a molecular docking study between the potential vaccine construct and K. pneumonia associated immune receptors, TLR4 and TLR2, showing affinitive to both targets with preferentiality for the TLR4 receptor protein. Validation of the docking studies has proceeded through molecular dynamics simulation, which estimated a strong binding and supported the nomination of the designed vaccine as a putative solution for K. pneumoniae and P. aeruginosa coinfection. Here, we describe the approach for the design and assessment of our potential vaccine.

Abstract Background Prior research studies have found that dental students’ educational environment has an impact on their academic achievement. Therefore, the aim of this cross-sectional study was to assess dental students’ perceptions of the educational environment at King Abdulaziz University Faculty of Dentistry (KAUFD) in Saudi Arabia. Methods Second-, third-, and fourth-year dental students at KAUFD, responded to the Dundee Ready Education Environment Measure (DREEM) in October 2017. It consists of five subscales: students’ perceptions of learning, students’ perceptions of teachers, students’ academic self-perceptions, students’ perceptions of the atmosphere, and students’ social self-perceptions. The overall mean value was calculated. Results A total of 217 dental students responded to the questionnaire (92 males, 125 females); the response rate was 43.40%. The overall mean DREEM score was 125, which is considered “more positive than negative.” The mean DREEM score was higher for females (128.73) than for males (120.13). Third-year students (137.99) obtained higher mean scores compared to fourth-year (121.42) and fifth-year students (115.94). Conclusions Dental students’ perceptions of the educational environment at KAUFD support the findings of national and international studies. Students in the preclinical dental academic year (third year) obtained the highest DREEM score, when compared to those who belonged to the clinical academic years. Therefore, a personal development program and good support systems must be emphasized for clinical-year students.

Individuals with Netherton syndrome (NTS) have increased serine protease activity, which strongly impacts the barrier function of the skin epidermis and leads to skin inflammation. Here, we investigated how serine protease activity in NTS correlates with changes in the stratum corneum (SC) ceramides, which are crucial components of the skin barrier. We examined two key enzymes involved in epidermal ceramide biosynthesis, β-glucocerebrosidase (GBA) and acid-sphingomyelinase (ASM). We compared in situ expression levels and activities of GBA and ASM between NTS patients and controls and correlated the expression and activities with i) SC ceramide profiles, ii) in situ serine protease activity, and iii) clinical presentation of patients. Using activity-based probe labeling, we visualized and localized active epidermal GBA, and a newly developed in situ zymography method enabled us to visualize and localize active ASM. Reduction in active GBA in NTS patients coincided with increased ASM activity, particularly in areas with increased serine protease activity. NTS patients with scaly erythroderma exhibited more pronounced anomalies in GBA and ASM activities than patients with ichthyosis linearis circumflexa. They also displayed a stronger increase in SC ceramides processed via ASM. We conclude that changes in the localization of active GBA and ASM correlate with i) altered SC ceramide composition in NTS patients, ii) local serine protease activity, and iii) the clinical manifestation of NTS.

Background: Coronavirus disease 2019 (COVID-19) has spread to over 150 countries worldwide. Since the first case of COVID-19 was confirmed in Saudi Arabia, cases have continued to escalate exponentially. The COVID-19 outbreak has had a negative effect on mental health and well-being. The study aimed to investigate the effects of the strict national regulations associated with the COVID-19 pandemic on mental health.Methods: This was a cross-sectional study of a convenience sample of Saudi residents. Saudi residents aged 18 years or older were invited to complete an online questionnaire after one month of a nationwide 24-h curfew between May 6, 2020 and May 13, 2020. We measured psychological distress using the Depression, Anxiety, and Stress Scale-21 (DASS-21). We ran binary logistic regression analyses to detect variables that significantly predicted DASS-21 scores.Results: A sample of 2252 participants was recruited from the general population of Saudi Arabia. The DASS-21 score means and standard deviations for depression and anxiety for the whole sample (10.73 ± 10.29 and 6.98 ± 8.30, respectively) were in the range of mild depression and anxiety. In contrast, the mean DASS-21 stress score was within the normal range (11.97 ± 10.80). The mean stress score for healthcare workers was within the normal range (13.70 ± 10.68) but was significantly higher than the mean score for the public (11.56 ± 10.89; P = 0.0006). Several variables (e.g., age, gender, and history of contact with confirmed COVID-19 cases) were significantly associated with higher DASS-21 scores.Conclusions: The COVID-19 pandemic has created a psychological burden. Therefore, there is an urgent need to implement emergency public health interventions that ameliorate the risk perception of COVID-19 through the dissemination of adequate and targeted health information that could be a successful measure to mitigate the psychological impact of the Covid-19 pandemic.

Corrosive substance ingestion is a very serious home accident, mostly common in developing countries. It frequently causes esophageal burns in the acute stage and esophageal stricture, stenosis, and even cancer in the chronic stage. Severe cases of caustic esophagitis may require esophageal replacement. We describe a case of balloon endoscopy dilation in a two-year-old girl with a severe stricture of the esophagus resulting from accidental ingestion of a corrosive substance (strong alkaline liquid) which helped the patient preserve the esophagus and prevent esophageal replacement. We describe the clinical complication and development during the treatment.

Cancer is the leading cause of death globally, with an increasing number of cases being annually reported. Nature-derived metabolites have been widely studied for their potential programmed necrosis, cytotoxicity, and anti-proliferation leading to enrichment for the modern medicine, particularly within the last couple of decades. At a more rapid pace, the concept of multi-target agents has evolved from being an innovative approach into a regular drug development procedure for hampering the multi-fashioned pathophysiology and high-resistance nature of cancer cells. With the advent of the Red Sea Penicillium chrysogenum strain S003-isolated indole-based alkaloids, we thoroughly investigated the molecular aspects for three major metabolites: meleagrin (MEL), roquefortine C (ROC), and isoroquefortine C (ISO) against three cancer-associated biological targets Cdc-25A, PTP-1B, and c-Met kinase. The study presented, for the first time, the detailed molecular insights and near-physiological affinity for these marine indole alkaloids against the assign targets through molecular docking-coupled all-atom dynamic simulation analysis. Findings highlighted the superiority of MEL’s binding affinity/stability being quite in concordance with the in vitro anticancer activity profile conducted via sulforhodamine B bioassay on different cancerous cell lines reaching down to low micromolar or even nanomolar potencies. The advent of lengthy structural topologies via the metabolites’ extended tetracyclic cores and aromatic imidazole arm permitted multi-pocket accommodation addressing the selectivity concerns. Additionally, the presence decorating polar functionalities on the core hydrophobic tetracyclic ring contributed compound’s pharmacodynamic preferentiality. Introducing ionizable functionality with more lipophilic characters was highlighted to improve binding affinities which was also in concordance with the conducted drug-likeness/pharmacokinetic profiling for obtaining a balanced pharmacokinetic/dynamic profile. Our study adds to the knowledge regarding drug development and optimization of marine-isolated indole-based alkaloids for future iterative synthesis and pre-clinical investigations as multi-target anticancer agents.

The aim of this study was to evaluate the antiangiogenic and immunomodulatory potential of sulfated polysaccharides from the marine algae Macrocystis integrifolia characterized by FTIR. The cytotoxicity of sulfated polysaccharides was evaluated using the 3-(4,5-dimethylthiazol-2-yl) -2,5-diphenyltetrazolium bromide (MTT) assay. Antiangiogenic activity was evaluated using the chicken chorioallantoic membrane (CAM) assay. Immunomodulatory activity was determined on macrophage functionality and allergic response. The results showed that sulfated polysaccharides significantly decreased angiogenesis in chicken chorioallantoic membranes (p < 0.05). Likewise, they inhibited in vivo chemotaxis and in vitro phagocytosis, the transcription process of genes that code the enzymes cyclooxygenase-1 (COX-1), cyclooxygenase-2 (COX-2) and nitric oxide synthase-2 (NOS-2) and the nuclear factor kappa-light chain enhancer of activated B cells (NF-κB), showing immunomodulatory properties on the allergic response, as well as an in vivo inhibitory effect in the ovalbumin-induced inflammatory allergy model (OVA) and inhibited lymphocyte proliferation specific to the OVA antigen in immunized mice. Finally, these compounds inhibited the histamine-induced skin reaction in rats, the production of immunoglobulin E (IgE) in mice, and the passive response to skin anaphylaxis in rats. Therefore, the results of this research showed the potential of these compounds to be a promising source for the development of antiangiogenic and immunomodulatory drugs.

Euclea divinorum Hiern is a medicinal plant widely distributed in the northeast parts of South Africa. This plant has been used to treat miscarriage and to alleviate gastrointestinal problems. It can also be used externally for the treatment of ulcers and gonorrhea. In this study, we investigated the phytochemical composition of E. divinorum leaf extract using LC-MS and explored its antioxidant properties in vitro and in vivo. The total polyphenolic content of the extract was determined by the Folin–Ciocalteu method. DPPH and FRAP assays were employed to confirm the plant’s antioxidant potential in vitro. A survival assay in the Caenorhabditis elegans model was used to evaluate the extract’s ability to counteract juglone-induced oxidative stress. Moreover, a docking study was performed for the extract’s metabolites, in order to predict possible molecular targets that could explain the antioxidant effect of the plant on a molecular level. This in silico approach was accomplished on three different proteins; xanthine oxidase enzyme, heat shock protein 90 (Hsp90), and induced nitric oxide synthase (iNOS). Docking scores of the resulting poses and their interactions with binding sites’ residues were explored for each protein and were compared to those of simultaneously docked respective co-crystallized and reference substrates. The extract furnished promising antioxidant activities in vitro and in vivo in the C. elegans model that might be attributed to the presence of 46 compounds, which showed several interactions and low binding scores with the tested enzymes. In conclusion, E. divinorum is a promising, safe, and effective antioxidant candidate that could be used to ameliorate oxidative stress-related disorders.

Phragmanthera austroarabica (Loranthaceae), a semi-parasitic plant, is well known for its high content of polyphenols that are responsible for its antioxidant and anti-inflammatory activities. Gallic acid, catechin, and methyl gallate are bioactive metabolites of common occurrence in the family of Loranthaceae. Herein, the concentrations of these bioactive metabolites were assessed using high-performance thin layer chromatography (HPTLC). Methyl gallate, catechin, and gallic acid were scanned at 280 nm. Their concentrations were assessed as 14.5, 6.5 and 43.6 mg/g of plant dry extract, respectively. Phragmanthera austroarabica extract as well as the three pure compounds were evaluated regarding the cytotoxic activity. The plant extract exhibited promising cytotoxic activity against MDA-MB-231 breast cells with the IC50 value of 19.8 μg/mL while the tested pure compounds displayed IC50 values in the range of 21.26–29.6 μg/mL. For apoptosis investigation, P. austroarabica induced apoptotic cell death by 111-fold change and necrosis by 9.31-fold change. It also activated the proapoptotic genes markers and inhibited the antiapoptotic gene, validating the apoptosis mechanism. Moreover, in vivo studies revealed a significant reduction in the breast tumor volume and weight in solid Ehrlich carcinoma (SEC) mice. The treatment of SEC mice with P. austroarabica extract improved both hematological and biochemical parameters with amelioration in the liver and kidney histopathology to near normal. Taken together, P. austroarabica extract exhibited promising anti-cancer activity through an apoptosis-induction.

Abstract Background Multidisciplinary tumor board meetings (MDTs) have shown a positive effect on patient care and play a role in the planning of care. However, there is limited evidence of the association between MDTs and patient mortality and in‐hospital morbidity for mixed cases of gastrointestinal (GI) cancer. Aim To evaluate the influence of optional MDTs on care of patients with cancer to determine potential associations between MDTs and patient mortality and morbidity. Methods and results This was a retrospective observational study at the referral center of King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. Among all adult patients diagnosed with GI cancer from January 2017 to June 2019, 130 patients were included. We categorized patients into two groups: 66 in the control group (non‐MDT) and 64 in the MDT group. The main outcome measure was overall mortality, measured by survival analysis. The follow‐up was 100% complete. Four patients in the MDT group and 13 in the non‐MDT group died (P = .04). The median follow‐up duration was 294 days (interquartile range [IQR], 140‐434) in the non‐MDT group compared with 176 days (IQR, 103‐466) in the MDT group (P = .20). There were no differences in intensive care unit or hospital length‐of‐stay or admission rates. The overall mortality at 2 years was 13% (95% confidence interval [CI], 0.06‐0.66) in the MDT group and 38% (95% CI, 0.10‐0.39) in the non‐MDT group (P = .08). The MDT group showed a 72% (adjusted hazard ratio [HR], 0.28; 95% CI, 0.08‐0.90; P = .03) decrease in mortality over time compared with the non‐MDT group. Conclusions MDTs were associated with decreased mortality over time. Thus, MDTs have a positive influence on patient care by improving survival and should be incorporated into care.

Curcumin, a natural chemical compound found in Curcuma longa that has been used in antitumor and anti-inflammation applications, exhibits very limited water solubility and rapid in vivo degradation, which limits its clinical application. To overcome these limitations, niosome nanoparticles were prepared by microfluidic mixing for curcumin encapsulation. Niosome nanoparticles are lipid-based, and composed of non-ionic surfactants with cholesterol orientated into a membrane bilayer structure. Two different non-ionic surfactants were used and the mixing parameters were varied to optimize the characteristics of the prepared niosomes. The prepared niosomes had an average particle size of 70–230 nm depending on the type of non-ionic surfactant used and the mixing parameter. Moreover, all prepared niosomes were monodisperse with an average polydispersity index ranging from 0.07 to 0.3. All prepared niosomes were spherical as demonstrated by transmission electron microscopy. Curcumin was encapsulated with a maximum encapsulation efficiency of around 60% using Tween 85 as the non-ionic surfactant. Niosomes prepared by microfluidic mixing provided a controlled release of curcumin, as indicated by the release profile of curcumin, improving its therapeutic capability. These results demonstrate that niosomes prepared by microfluidic mixing to encapsulate curcumin are a promising delivery system to reach target cells.

Accurate, timely air quality index (AQI) forecasting helps industries in selecting the most suitable air pollution control measures and the public in reducing harmful exposure to pollution. This article proposes a comprehensive method to forecast AQIs. Initially, the work focused on predicting hourly ambient concentrations of PM2.5 and PM10 using artificial neural networks. Once the method was developed, the work was extended to the prediction of other criteria pollutants, i.e., O3, SO2, NO2, and CO, which fed into the process of estimating AQI. The prediction of the AQI not only requires the selection of a robust forecasting model, it also heavily relies on a sequence of pre-processing steps to select predictors and handle different issues in data, including gaps. The presented method dealt with this by imputing missing entries using missForest, a machine learning-based imputation technique which employed the random forest (RF) algorithm. Unlike the usual practice of using RF at the final forecasting stage, we utilized RF at the data pre-processing stage, i.e., missing data imputation and feature selection, and we obtained promising results. The effectiveness of this imputation method was examined against a linear imputation method for the six criteria pollutants and the AQI. The proposed approach was validated against ambient air quality observations for Al-Jahra, a major city in Kuwait. Results obtained showed that models trained using missForest-imputed data could generalize AQI forecasting and with a prediction accuracy of 92.41% when tested on new unseen data, which is better than earlier findings.