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There are several problems in physics, such as kinetic energy equation, wave equation, anomalous diffusion process, and viscoelasticity that are described well in the fractional differential equation form. Therefore, the solutions with elementary solution method cannot be solved and described deliberately with detailed physics of the problems, so these problems are solved with the help of special operators such as Mittag–Leffler (M–L) functions equipped with Riemann–Liouville (R–L) fractional operators. Hence, keeping in view the above-mentioned problems in physics in the current study, the generalized properties are derived M–L functions connected with R–L fractional operators that are investigated in the generalized form. These extended special operators will be used for the solutions of generalized kinetic energy equation. The M–L function is a fundamental special function with a wide range of applications in mathematics, physics, engineering, and various scientific disciplines. Ayub et al. gave the definition of newly extended M–L (p,s,k)\left(p,s,k) function. Also, they gave its convergence condition and found several results relevant to that. The purpose of this study is to investigate newly extended M–L function and study its elementary properties and integral transforms such as Whittaker transform and fractional Fourier transform. The R–L fractional operator is a fundamental concept in fractional calculus, a branch of mathematics that generalizes differentiation and integration to non-integer orders. In this study, we discuss the relation of M–L (p,s,k)\left(p,s,k)-function and R–L fractional operators. In some cases, fractional calculus is used to describe kinetic energy equations, particularly in systems where fractional derivatives are more appropriate than classical integer-order derivatives. The M–L function can appear as a solution or as a part of the solution to these fractional kinetic energy equations. Also, we gave the generalization of kinetic energy equation and its solution in terms of newly extended M–L function.

Serious consequences including septicemia and amputations can result from complex wounds, which is a serious healthcare concern. In addition, there are currently only a few choices for management, which justifies the search for novel, highly effective wound-healing medications. This research work was aimed at fabricating chitosan-based Alkanna tinctoria and Mupirocin nanoparticles by ionic gelation technique for burn wound management. Preliminary studies were conducted, and the prepared nanoparticles were characterized by various techniques that involve, high-performance liquid chromatography for the detection of components in A. tinctoria root extract, ATR-FTIR, particle size, zeta potential, percent drug content (DC%), percent entrapment efficiency (EE%), scanning electron microscopy, and transmission electron microscopy (TEM) for surface morphology. The optimized formulation CS-AT-MU-NPs3 shows a particle size of 340.8 ± 34.46 nm and positive zeta potential 27.3 ± 3.10 mV. In vitro drug release study was also performed, which demonstrated improved and controlled release of the drug from the nanoparticles. The CS-AT-MU-NPs3 exhibited a maximum release up to 92.61% (AT) and 88.35% (MU). Antibacterial and antifungal activities of the formulation were also accessed by utilizing the agar well diffusion technique. The combination of AT and MU in chitosan-based nanoparticles was significantly effective against bacterial and fungal strains like Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans as compared to other formulations. The skin irritation study was also conducted, which shows that the prepared formulation did not cause any observable changes to the skin in terms of inflammation, erythema, edema, or any other symptoms associated with skin irritation. All the chitosan-based nanoparticles showed almost 75% reduction in wound contraction, while the optimized formulation CS-AT-MU-NPs3 showed complete wound healing on the 15th day. Based on the results, it can be assumed that chitosan-based nanoparticles containing A. tinctoria and Mupirocin demonstrated good wound healing and could be used to effectively manage burn wounds of any description.

The current study aimed to assess the neuroprotective effect of Zn and Fe oxide nanoparticles biofabricated by Taverniera glabra in alloxan-induced diabetic rats. The experimental animals (160–200 g) were divided into nine groups (n = 9). The blood glucose, body weight, glucose-6-phosphate dehydrogenase (G6PD), superoxide dismutase (SOD), catalase test (CAT), lipid peroxidation (TBARS), glutathione (GSH), and acetylcholinesterase (AChE) activities were determined. Oral administration of nanoparticles and T. glabra methanol extract (TGME; 10 and 15 mg/kg b.w) significantly decreased the glucose level, increased the body weight, controlled the quantitative level of G6PD, and significantly decreased the levels of ALT, ALP, cholesterol, and creatinine. Moreover, TGME and their Zn and Fe oxide nanoparticles significantly restored the antioxidant enzymes (SOD, CAT, GPx, and GSH) that decreased during induced diabetes. In the diabetic group, a significant increase in TBARS was noted and recovered in diabetic animals (p < 0.05) as compared to glibenclamide. The AChE activity was significantly recovered by nanoparticles and TGME both in the blood and brain of the diabetic group (p < 0.05). Taken together, it can be suggested that TGME and Zn and Fe oxide nanoparticles significantly improved memory and could be considered as an effective biogenic nanomaterial for diabetes, Alzheimer’s disease, and oxidative stress.

The ubiquity of Internet of Things (IoT) devices has prompted security concerns, particularly in the face of evolving botnet attacks. This paper investigates the impact of botnet attacks on IoT devices and proposes a network-based detection and prevention system employing signature and anomaly-based mechanisms. Notably, our methodology extends beyond traditional detection, focusing on proactively impeding bot creation. Leveraging a Linux-based distributed system, Security Information and Event Management (SIEM) tools, and custom rules, our approach encompasses distinct phases Preprocessing, Network Security Monitoring, Rule-based IDS System, and Analysis. Experimental results with diverse PCAP files demonstrate the efficacy of custom rules, significantly enhancing alert counts for various security aspects, including network trojan detection and privacy violations. The significant finding is the substantial increase in alert counts after the integration of custom rules, exemplified in the 1.1 GB PCAP file scenario. Network trojan detection surged from 585 to 988, emphasizing the heightened efficacy of rule-based measures. Privacy breaches and bad traffic alerts also experienced significant increments, showcasing the system’s improved sensitivity and responsiveness. This finding reinforces the pivotal role of custom rules in fortifying IoT network security comprehensively.

The cost-effective and environmental friendly biosynthesis of metal nanoparticles is becoming increasingly important in biomedical science. This study biosynthesized zinc oxide nanoparticles (ZnO NPs) from pumpkin seed extract and assessed its anticancer activity by using different molecular biology experiments in human breast cancer (MDA-MB-231) cell lines. The well-known analytical techniques, such as UV-visible spectrophotometry, energy-dispersive X-ray spectroscopy, field emission scanning electron microscopy, and transmission electron microscopy (TEM), were used to confirm the synthesis and characterize the morphological and structural features of biogenic ZnO NPs. The formation of spherical nanoparticles with an average size of 50–60 nm was recorded using scanning electron microscopy and TEM. We observed the dose-dependent increase in cytotoxicity of ZnO NPs in the MDA-MB-231 cell line with a 50% inhibitory concentration of 10 µg/mL. Moreover, the ZnO NPs also showed significant cell morphology changes, apoptosis induction, and reactive oxygen species production at the highest tested concentration. The cellular adhesion and migration assay indicated cell death and inhibition in the migration of breast cancer cells in response to ZnO NPs’ treatment. These results clearly demonstrated the significant anticancer potential of ZnO NPs against the studied breast cancer cell line. However, an extension of this study is recommended in different cancer models and, based on the results, in vivo validation should be done.

Nanoparticles (NPs) have a critical function in mitigating the disease of fruits and vegetables. In the present investigation, the effects of three levels of concentrations (0.05, 0.10, and 0.20 mg/mL) of titanium dioxide NPs (TiO2-NPs) and silicon dioxide NPs (SiO2-NPs) were investigated against fungus Phomopsis vexans, bacterium Ralstonia solanacearum, and Meloidogyne incognita (root-knot nematode). The present investigation’s findings found that the application of SiO2-NPs was more efficient against test pathogens in comparison to TiO2-NPs. The best result produced by SiO2-NPs against pathogenic strain was used in the molecular docking investigation with the protein of R. solanacearum to better understand the interaction of active amino acids with SiO2-NPs. The obtained results revealed that the administration of 0.20 mg/mL foliar spray of SiO2-NPs in plants with M. incognita improves up to 37.92% of shoot dry weight and increases 70.42% of chlorophyll content. P. vexans growth was suppressed by 41.2% with 0.62 mm of inhibition zone when SiO2-NPs were given at a dosage of 0.20 mg/mL. The reductions in egg hatching and M. incognita (J2) mortality were greater in SiO2-NPs than in TiO2-NPs. The results of scanning electron microscopy confirmed that the application of both NPs harmed test pathogens. The confocal study also showed the penetration of NPs among test pathogens.

N-Substituted phenyl/cyclohexyl-2-(pyridine-4-carbonyl) hydrazine-1-carbothioamides (2a–r) were synthesized, characterized by spectral and analytical data. The compounds were evaluated for antibacterial activity by the disc diffusion method. Most of the compounds showed activity against Gram-positive bacteria. Compound 2h with 4-Sulfapyrimidine phenyl substitution was found to be the most promising candidate, active against Gram-positive and methicillin-resistant Staphylococcus aureus (MRSA) strains with minimum inhibitory concentration (MIC) of (2–7 μg/mL). From the docking study, we predicted that compounds (2r, 2g, 2h, 2o, 2p and 2e) possess better antibacterial activity by having a good binding affinity with target protein and they could be used as potential drugs as antimicrobials. Amongst all the docked compounds, the compound 2h presented near binding affinity & interaction docking score with DNA gyrase enzymes with reference to ciprofloxacin.

In the present study, pumpkin seed extract was used to synthesize copper oxide nanoparticles (CuO NPs) along with evaluating its anticancer activity using different molecular biology tools in the human colorectal cancer cell line (HCT-116). Morphological and structural properties of the biogenically synthesized CuO NPs were characterized by UV-visible spectrophotometry (UV-vis), energy-dispersive X-ray spectroscopy (EDS), scanning electron microscopy (SEM), and transmission electron microscopy (TEM). For estimating the anticancer efficacy, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide cytotoxicity, morphological alteration, reactive oxygen species (ROS) formation, and alterations in the mitochondrial membrane potential (MMP) were determined. SEM and TEM data revealed the formation of spherical nanoparticles possessing an average size of 20 nm. The CuO NPs showed 50% inhibitory concentration (IC50) at 25 µg/mL against the HCT-116 cell line. The treatment with IC50 concentration of CuO NPs showed significant shrinking, detachment, membrane blebbing, and shape distortion of cancer cells. Similarly, the IC50 dose of CuO NPs showed significantly early apoptosis in cancer cells compared to late apoptosis. The cancer cell line also showed a dose-dependent increase and decrease in ROS formation and MMP, respectively. The results obtained through various assays indicated significant anticancer efficacy of biogenically synthesized CuO NPs. Thus, further studies are recommended to validate our results using ex vivo and in vivo models.

The goal of this work was to assess the cytotoxicity, chemical characteristics, thermal stability, and antioxidant activity of green-synthesized MgO nanoparticles (MgO NPs) produced from pumpkin seed extract for their potential therapeutic implications in cancer treatment. The shape, chemical properties, and thermal stability of MgO NPs made with green synthesis were looked at with Fourier-transform infrared spectroscopic analysis, scanning electron microscopy (SEM) and transmission electron microscopic (TEM) imaging, energy-dispersive X-ray spectroscopy (EDX), ultraviolet-visible, X-ray diffraction (XRD), and thermogravimetric analysis. Three cell lines, HCT-116, HT29, and Vero, were used to test the cytotoxicity of MgO NPs. The AlamarBlue® assay was used for HCT-116 and Vero cells, and the Neutral Red (NR) Uptake Assay was used for HT29 cells. A molecular docking study was done to find out how MgO nanoparticles and cyclin-dependent kinase 2 (CDK2), a protein linked to cancerous cells growing out of control, interact. The morphological properties, size, aggregation, shapeless pores, and high surface-to-area volume ratio of biosynthesized MgO NPs were shown using SEM and TEM imagings. The elemental composition of Mg and O in green-synthesized MgO NPs was validated using EDX. The AlamarBlue® assay did not yield IC50 values for HCT-116 and Vero cells, suggesting minimal cytotoxicity in these cell lines. However, the NR Uptake Assay showed an IC50 of 164.1 µg/mL for HT29 cells, indicating a significant impact. The DPPH experiment revealed that MgO nanoparticles had high antioxidant activity, with a scavenging capacity of 61% and an IC50 of 170 μg/mL. In conclusion, MgO nanoparticles produced utilizing green chemistry demonstrated a wide range of biological features, including antioxidant activity and cytotoxicity against three cell lines. According to molecular docking studies, these nanoparticles may interact with CDK2, a protein implicated in cancer cell growth. These findings emphasize MgO nanoparticles’ potential for cancer treatment. However, further study is needed to understand the underlying processes and investigate therapeutic applications.

The present study deals with the molecular modeling studies of the endothelins (ETs), a multi-functional 21 amino acid (AA) peptides, with sub-types ET-I, II, and III to find the structure property relationship (SPR) of different fragments naturally derived from the cyclic body part of the ETs’ structures together with the structurally similar and common tail sequence (AA 16–21) utilization of the ETs and the dissimilar sarafotoxin-6b (SRT-6b) hexapeptide chain tail, as well as their SPR comparisons to find peptide-based leads as comparable to the ETs, especially ET-I. Approach to plausible vesiculation of the ETs and the involved process as a suggested mechanism is also discussed.

This article reports a simple, cost-effective, and eco-friendly biosynthesis of ZnO/Fe3O4 nanocomposites using Callistemon viminalis leaves’ water extract. For the first time, we used a green synthetic route via C. viminalis leaves’ extract to prepare ZnO/Fe3O4 nanocomposites (NCs) using zinc acetate and ferric chloride as precursor materials. Fourier transform infrared (FTIR) spectroscopic results revealed polyphenolic compounds mainly phenolic acids present in the plant extract acted as both reducing and stabilizing agents to synthesize ZnO/Fe3O4 NCs. Outcomes of XRD and X-ray photoelectron spectroscopy confirmed the formation of ZnO–Fe3O4 heterojunction in ZnO/Fe3O4 NCs, with crystallite sizes of 45, 35, and 60 nm, respectively, according to Debye–Scherrer’s formula. EDX confirmed Zn, Fe, and O in the ZnO/Fe3O4 nanocomposite. Scanning electron microscopy and transmission electron microscopy (TEM) analyses revealed the existence of both ZnO and Fe3O4 in the NCs with some agglomeration. The thermal stability of NCs was evaluated using thermogravimetric analysis (TGA) and differential thermal analysis (DTA) in a nitrogen atmosphere. In addition, as-prepared ZnO/Fe3O4 NCs along with biosynthesized ZnO and Fe3O4 (prepared by C. viminalis extract) nanoparticles were examined for photodegradation of methylene blue under visible light irradiation for 150 min. The result reveals that the photodegradation efficiency of ZnO/Fe3O4 NCs (99.09%) was higher compared to that of monometallic ZnO (84.7%) and Fe3O4 (37.1%) nanoparticles.

Herein, the synthesis of silver nanoparticles using extracts of pistachio seed coat waste is investigated. The surface plasmon resonance peak at 443 nm was observed in the nanoparticles by using ultraviolet-visible spectroscopy (UV-Vis). To identify potential biomolecules involved in the bio-reduction of silver ions, Fourier-transform infrared spectroscopy (FTIR) was used. Scanning and transmission electron microscopy (SEM and TEM) show irregular shapes with an average size of ∼20 nm. The active surface determined by Brunauer, Emmett, and Teller analysis was 22 m2/g. The effect of silver nanoparticles on eggplants sprayed with a nanoparticle suspension of 75 mg/L led to increased plant growth and chlorophyll and carotenoid contents. The fly ash addition to the soil promoted plant growth. The highest increase in plant growth occurs when plants were sprayed with 75 ppm AgNPs in 20% fly ash amended soil.

In this study, steroidal sitosteryl hydrogen phthalate (stigmast-5-en-3b-yl hydrogen phthalate) was synthesized by the reaction of 3b-sitosterol and phthalic anhydride using silica gel as a solid support under microwave irradiation (MWI). The comparative study of microwave assisted synthesis and conventional synthesis of the steroidal compound in a hazardous solvent revealed that the former method provided shortened reaction times at increased yields. The compounds obtained by the two procedures were characterized by infrared spectroscopy, proton, carbon-13 nuclear magnetic resonance (1H and 13C NMR) and high-resolution mass spectrometry. The synthesized compound was screened for in vitro antifungal activity against Aspergillus niger and Candida albicans by the Kirby-Bauer Well Diffusion method. The synthesized compound was subjected to the molecular docking simulation with a receptor (CYP51). The findings of the antifungal and docking studies revealed that the synthesized sitosteryl hydrogen phthalate could be considered as a suitable inhibitor of Lanosterol 14a-demethylase (CYP51). In addition, the molecular docking approach was applied to design hypothetical derivatives of sitosteryl hydrogen phthalate inhibitors against the antifungal target and to compare findings with the binding score of the molecular synthesized 3b-sitosteryl hydrogen phthalate.

Nutrient management is a key component of best agronomic practices for optimal crop production. The continuous use of high yielding genotypes and exhaustive cropping systems has resulted in potassium deficiency. Furthermore, the imbalanced use of nutrients, particularly potassium (K), has resulted in persistent depletion from agricultural soils. To address this issue, a field experiment was conducted to determine the influence of different potassium levels under a split application on yield and yield attributes of wheat crops. The experiment was laid out in a randomized complete block design replicated four times. Five K levels (0, 60, 80, 100 and 120 kg ha−1) and different K application timings (whole dose (Basal) at sowing, equal doses at sowing+ 30 DAS, half dose at sowing+ equal doses at 30 +60 DAS and equal doses at sowing+30+60+ 90 DAS). The findings of the study revealed that potassium levels and their application times substantially influenced yield and yield components of wheat. The application of K at 120 kg ha−1 delayed anthesis and maturity and enhanced chlorophyll content (53), tillers m−2 (293.4 m−2) and increased plant height (97.1cm). The application of K 80 kg ha−1 significantly increased grain protein, nitrogen, phosphorus and potassium content which resulted in a higher (4227 kg ha−1) grain yield. In the case of K timings application, the higher grain yield (3758 kg ha−1) was achieved when K was applied one time at sowing time. It is concluded that K at the rate of 80 kg ha−1 should be applied in full at sowing for achieving higher wheat production.

Phonological and orthographic processing are important cognitive skills required in reading. The present study attempts to investigate the role of phonological processing and orthographic knowledge, in reading alphasyllabic Hindi orthography. The sample constituted 65 children from Grade 4. The result of hierarchical multiple regression indicated that the variance in reading fluency was significantly explained by phonological processing and orthographic knowledge measured through the tasks of rapid automatized naming, syllable deletion and dictation. The variance in reading accuracy was significantly explained only by orthographic knowledge measured through a dictation task. Phonological short-term memory showed significant correlations with all the reading measures but was non-significant in explaining the unique variance in reading. The limitation of the study and suggestions for future research is discussed.

Spontaneous oesophageal perforation, or Boerhaave's syndrome, represents barogenic oesophageal injury. Patients don't always present with classical features and treatment may be delayed. Various approaches and strategies have been described but, despite advances in surgery and critical care, the condition continues to carry a high morbidity and mortality. Primary repair may be undertaken in patients who present within 24 hours of perforation and remains the gold standard. Increasingly, this strategy is being adopted for patients who present later with similar mortality rates. Diversion with exclusion and resectional procedures may be undertaken when repair is not possible. [ABSTRACT FROM AUTHOR]

'Claudication' refers to pain experienced in the legs that is brought on by exertion, caused by relative ischaemia of the muscle. Exercise is effective in improving vascular claudication pain and walking distance. Despite this, community-based exercise rehabilitation programmes that are directly available to GPs are almost unknown in the UK. In this pilot study, the authors assess the practicalities of setting up such a programme and evaluate its efficacy.Patients with stable claudication for whom exercise was not contraindicated were enrolled into a twice-weekly exercise programme for up to 8 months (n =20). This was supervised by one of the authors with experience in exercise rehabilitation. Outcome measures included the Six-Minute Walk Test (6MWT) and the Short-Form-36 (SF-36) questionnaire. The average walking distance as measured by the 6MWT increased by 16.3% (P=0.001). There was also a 23.5% increase in the average score of the physical functioning domain of the SF-36 (P=0.007).Community-based exercise rehabilitation for lower limb claudication is safe and effective, with high compliance and attendance rates. Walking distances increase both objectively and subjectively. Patients also become more able to cope with claudication pain and show improvements in their physical function. If these programmes are available to primary care groups, the majority of patients can be managed in the community, reducing the workload of consultant-based hospital services. [ABSTRACT FROM AUTHOR]

A simple, sensitive and accurate HPLC method with high throughput has been developed and validated for the simultaneous determination of irbesartan (IRB) and hydrochlorothiazide (HCT) in combined pharmaceutical dosage forms. The proposed method employed, for the first time, a monolithic column in the analysis. Optimal chromatographic separation of the analytes was achieved on Chromolith® Performance RP-18e column using a mobile phase consisting of phosphate buffer (pH 4)/acetonitrile (50:50, V/V) pumped isocratically at a flow rate of 1.0 mL min-1. The eluted analytes were monitored with a UV detector set at 270 nm. Under the optimum chromatographic conditions, linear relationship with a good correlation coefficient (R ≥ 0.9997) was found between the peak area and the corresponding concentrations of both IRB and HCT in the ranges of 10-200 and 1-20 ng mL-1. The limits of detection were 2.34 and 0.03 ng mL-1 for IRB and HCT, respectively. The intra- and inter-assay precisions were satisfactory as the RSD values did not exceed 3 %. The accuracy of the proposed method was > 97 %. The proposed method had high throughput as the analysis involved a simple procedure and a very short run- -time of < 3 min. The results demonstrated that the method is applicable in the quality control of combined pharmaceutical tablets containing IRB and HCT

Curing is essential if concrete is to perform the intended function over the design life of the structure while excessive curing time may lead to the escalation of the construction cost of the project and unnecessary delays. Where there is a scarcity of water and on sloping surfaces where curing with water is difficult and in cases where large areas like pavements have to be cured, the use of curing compound may be resorted to. The parameters of the study include the curing period [1, 3, 7, 14 and 28 day], curing method [conventional wet curing, membrane forming compound curing and accelerated curing] and the type of cement [Ordinary Portland Cement(OPC) 43 grade, Portland Pozzolana Cement(PPC) 43 grade and Ordinary Portland Cement(OPC) 43 grade +10% Silica Fume(SF) replacement for cement]. In all a total of 99 cube specimens were cast and cured under different conditions before testing. Test results indicate a drop in strength at all ages for concretes with PPC and the one in which 10% OPC is replaced by silica Fume(SF) in comparison with the concrete with OPC. Curing by membrane forming curing compound yielded nearly the same results as that of conventional wet curing for concrete with OPC and there was a marginal decrement in concrete with PPC. Predicted 28-day strength of concrete from the accelerated curing test was found to be on a conservative side compared to control concrete.

Traditionally 'lateral aberrant thyroid' tissue present in cervical lymph nodes in the face of a clinically normal thyroid gland is held to be a metastasis from an occult primary thyroid carcinoma. A patient in whom follicular thyroid tissue was found in a lymph node lateral to the carotid sheath in the presence of a thyroid gland which was histologically free of cancer is herewith presented. [ABSTRACT FROM AUTHOR]

Abstract Introduction The emotional burden associated with the diagnosis of cancer is sometimes overshadowed by financial burden sustained by patient and the family. This is especially relevant for a developing country as there is limited state support for cancer treatment. We conducted this study to estimate the cost of cancer care for two major types of cancer and to assess the perception of patients and families regarding the burden of the cost for undergoing cancer treatment at a private tertiary care hospital. Methods This cross-sectional study was conducted at day care and radiotherapy unit of Aga Khan University, Hospital (AKUH) Karachi, Pakistan. All adult patients with breast and head & neck cancers diagnosed for 3 months or more were included. Data was collected using a structured questionnaire and analysed using SPSS. Results Sixty seven patients were interviewed during the study period. The mean and median monthly income of these patients was 996.4 USD and 562.5 USD respectively. Comparatively the mean and median monthly cost of cancer care was 1093.13 USD and 946.42 USD respectively. The cost of the treatment either fully or partially was borne by the family in most cases (94%). The financial burden of cancer was perceived as significant by 28 (42%) patients and unmanageable by 18 (27%) patients. This perceived level of burden was associated significantly with average monthly income (p = Conclusion Our study indicates that the financial burden of cancer care is substantial and can be overwhelming. There is a desperate need for treatment support programs either by the government or other welfare organisations to support individuals and families who are already facing a difficult and challenging situation.

Abstract Background The use of percutaneous needle biopsy in the evaluation of indeterminate renal masses is controversial and its role in management remains largely unclear. We set to establish current practice on this issue in UK urology departments. Methods We conducted a national questionnaire survey of all consultant urologists in the UK, to establish current practice and attitudes towards percutaneous needle biopsy in the management of indeterminate renal masses. Results 139 (43%) consultant urologists never use biopsy, whereas 111 (34%) always employ it for the diagnosis of indeterminate renal masses. 75 (23%) urologists use biopsy only for a selected patient group. Mass in a solitary kidney, bilateral renal masses and a past history of non-renal cancer were the main indications for use of percutaneous biopsy. The risk of false negative results and biopsy not changing the eventual management of their patients were the commonest reasons not to perform biopsy. Conclusion There is a wide and varied practice amongst UK Consultant Urologists in the use of percutaneous biopsy as part of the management of indeterminate renal masses. The majority of urologists believe biopsy confers no benefit. However there is a need to clarify this issue in the wake of recent published evidence as biopsy results may provide critical information for patients with renal masses in a significant majority. It not only differentiates benign from malignant tissue but can also help in deciding the management option for patients undergoing minimally invasive treatments.

Purpose: To examine the effectiveness and identify clinical response predictors of a short corticosteroid-based regimen consisting of topical preservative-free 0.1% dexamethasone (Monopex®, Théa Laboratories) in conjunction with artificial tears (AT) for dry eyes in a real-life clinical setting., Methods: Patients were recruited from the Norwegian Dry Eye Clinic and were allowed to use ATs of their own choice in addition to the prescribed 14-day topical dexamethasone course. Ocular Surface Disease Index (OSDI), Dry Eye Questionnaire (DEQ-5), Schirmer test (ST), fluorescein tear film break-up time (FBUT), ocular surface staining (OSS), meibum expressibility (ME), meibum quality (MQ), number of expressible meibomian glands among the central eight glands in the lower lids (N MG ) and intraocular pressure (IOP) were measured at baseline and at 1-month follow-up. The average values of clinical parameters from both eyes were used for analyses. A paired t-test and a significance value of p < 0.05 were used for statistical analyses. Associations between sex, age, baseline values and the changes after the intervention (Δ) were explored using linear regression., Results: A total of 167 patients (124 women, mean age 54 years ±17 (standard deviation)) were included. One month after initiation of intervention, OSDI and DEQ5 scores improved from 39.5 ± 22.1 to 31.4 ± 21.3 (p < 0.001) and from 12.6 ± 4.2 to 11.0 ± 4.6 (p < 0.001), respectively. OSS improved from 2.2 ± 1.4 to 1.8 ± 1.5 (p < 0.001), N MG increased from 4.8 ± 2.2 to 5.1 ± 2.2 (p < 0.05), while IOP decreased from 12.9 ± 3.3 to 12.4 ± 3.5 mmHg (p < 0.05). Significant associations were found between the change in symptoms and objective measures of DED (Δ OSDI , Δ DEQ5 , Δ OSS , Δ FBUT , ΔN MG , Δ MQ ) and their respective baseline values (OSDI, DEQ5, OSS, FBUT, N MG , MQ). The remaining tests did not show statistically significant changes., Conclusion: Improvement in dry eye symptoms and signs were observed following a short course of topical, preservative-free 0.1% dexamethasone treatment in combination with AT. Individuals exhibiting more pronounced symptoms and signs witnessed the most profound improvements with the treatment regimen, suggesting that poor baseline parameters may serve as response predictors of the treatment regimen. While the real-life data presented herein are valuable, the conclusions are limited by the inherent biases of a non-controlled study., (© 2024 The Author(s). Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Canine appendicular osteosarcoma (OSCA) is a highly aggressive cancer, constituting 85% of all bone tumors in dogs, predominantly affecting larger breeds and exhibiting a high metastatic rate. This disease also shares many genomic similarities with human osteosarcomas, making it an ideal comparative model for treatment discovery. In this study, we characterized the radiobiological properties of several OSCA cell lines when subjected to spatially fractionated radiation therapy (SFRT) and chemotherapy. Specifically, we focused on lower (peak) doses from SFRT ranging from 1 to 10 Gy. These canine OSCA cell lines serve as useful models for osteosarcoma research that can be utilized to find translational treatments for both canine and human patients. This study reaffirms established clinical wisdom regarding the notoriously radioresistant profile of osteosarcomas but additionally offers compelling evidence supporting SFRT as a promising treatment option that could be used in conjunction with other cytotoxic agents., (© 2024 by Radiation Research Society. All rights of reproduction in any form reserved.)

Introduction: Significant discrepancy and variance exist in the United States health care system with regards to patient access to medical care based on a patient's insurance type, whether that be government-assisted or a private insurer. There are currently three major government-assisted insurance programs: Medicare, Medicare Advantage, and Medicaid, each of which have their own patient mix and regulatory processes that govern care delivery. The purpose of this study was to evaluate the current perceptions of shoulder and elbow surgeons surrounding practice patterns and barriers to access for patients whose primary insurance is a government-assisted payor., Methods: This was a national, observational study that surveyed the American Shoulder and Elbow Surgeons (ASES) society membership. This 15-question survey assessed surgeon demographics, practice types, reimbursement models, as well as rates and trends of their access to patients with government-assisted insurance. Subgroup analysis between practice type and barriers to access for patients with one of these three government-assisted insurance were also analyzed and compared. Pearson's Chi-squared test or Fisher's exact test was used to test association between categorical responses and categorical/binary respondent characteristics. A P value < .05 was deemed statistically significant., Results: A total of 257 ASES members completed the survey. Mean years in practice for respondents was 14. For Medicare patients, the most common perceived barriers were reimbursement (49%) followed by administrative burden (33%) and then implant reimbursement at the surgeon's primary surgical facility (32%). For Medicare Advantage patients the most common barrier to access was administrative burden (52%), reimbursement (50%), and the patient's ability to access peri-operative services such as physical therapy, home health etc. (40%). The most common barriers for Medicaid patients were relatively evenly distributed between reimbursement (62%), low patient engagement in their care (61%), and patient's ability to access peri-operative services (60%)., Conclusion: Amongst members of the ASES, barriers to patient access varied by government-assisted payor. For Medicare advantage, administrative burden was largest barrier to access. Whereas for Medicare and Medicaid, reimbursement was the most significant barrier. Further investigation and understanding of these barriers to patient access are necessary to improve availability of shoulder and elbow subspecialized care to a broader population of patients insured by government-assisted payors., (Copyright © 2024. Published by Elsevier Inc.)

Background: Revision shoulder arthroplasty continues to add an increasing burden on patients and the healthcare system. This study aimed to delineate long-term shoulder arthroplasty revision incidence, quantify associated Medicare spending, and identify relevant predictors of both revision and spending., Methods: The complete 2016-2022(Q3) Medicare fee-for-service inpatient and outpatient claims data was analyzed. Patients receiving a primary total shoulder arthroplasty for osteoarthritis, rotator cuff pathology, or inflammatory arthropathy were included and subsequent ipsilateral revision surgeries were identified. The time to revision was modeled using the Prentice, Williams, and Peterson Gap Time Model. Medicare spending within 90 days post-discharge was modeled using a generalized linear model. The analysis was subdivided by index procedure type: anatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA)., Results: A total of 82,949 primary TSAs and 172,524 RSAs were identified. Compared to index TSA cases, index RSA cases had a lower first revision rate in an observation window of nearly 7 years (1.9% vs. 3.5%, p<0.001), but a higher rate of second (11.4% vs. 4.9%, p<0.001) as well as third revision (13.8% vs. 13.8%, p=0.449). TSA spending was significantly lower than RSA spending for the index procedure ($21,531 vs. $23,267, p<0.001), first ($23,096 vs. $26,414, p<0.001), and second ($25,060 vs. $29,983, p<0.001) revision. There was no statistically significant difference in third revision between TSA and RSA groups ($31,313 vs. $30,829, p=0.860). Age, sex, race, and rheumatoid arthritis were among the top predictors of revisions. Top predictors of Medicare spending included having a non-osteoarthritis surgical indication, a hospital stay of three or more days, a discharge to a setting other than home, malnutrition, dementia, stroke, major kidney diseases, and being operated on in a teaching hospital., Conclusion: Compared with TSA, RSA was associated with a lower first revision rate, but a higher subsequent revision rate. An index RSA procedure was also associated with higher initial Medicare spending as well as subsequent revision surgery spending compared with an index TSA procedure. Demographics and comorbid medical conditions were among the top predictors of revisions, while procedure-related factors predicted Medicare spending., (Copyright © 2024. Published by Elsevier Inc.)

Our aim in this study was to understand how we perform visuospatial comparison tasks by analyzing ocular behavior and to examine how restrictions in macular or peripheral vision disturb ocular behavior and task performance. Two groups of 18 healthy participants with normal or corrected visual acuity performed visuospatial comparison tasks (computerized version of the elementary visuospatial perception [EVSP] test) (Pisella et al., 2013) with a gaze-contingent mask simulating either tubular vision (first group) or macular scotoma (second group). After these simulations of pathological conditions, all participants also performed the EVSP test in full view, enabling direct comparison of their oculomotor behavior and performance. In terms of oculomotor behavior, compared with the full view condition, alternation saccades between the two objects to compare were less numerous in the absence of peripheral vision, whereas the number of within-object exploration saccades decreased in the absence of macular vision. The absence of peripheral vision did not affect accuracy except for midline judgments, but the absence of central vision impaired accuracy across all visuospatial subtests. Besides confirming the crucial role of the macula for visuospatial comparison tasks, these experiments provided important insights into how sensory disorder modifies oculomotor behavior with or without consequences on performance accuracy.

Background: Total shoulder arthroplasty (TSA) in patients with rheumatoid arthritis (RA) can present unique challenges. The aim of this study was to compare both systemic and joint-related postoperative complications in patients undergoing primary TSA with RA versus those with primary osteoarthritis (OA)., Methods: Using the TriNetX database, Current Procedural Terminology and International Classification of Diseases, 10th edition codes were used to identify patients who underwent primary TSA. Patients were categorized into two cohorts: RA and OA. After 1:1 propensity score matching, postoperative systemic complications within 90 days following primary TSA and joint-related complications within 5 years following anatomic TSA (aTSA) and reverse shoulder arthroplasty (RSA) were compared., Results: After propensity score matching, the RA and OA cohorts each consisted of 8,523 patients. Within 90 days postoperation, RA patients had a significantly higher risk of total complications, deep surgical site infection, wound dehiscence, pneumonia, myocardial infarction, acute renal failure, urinary tract infection, mortality, and readmission compared to the OA cohort. RA patients had a significantly greater risk of periprosthetic joint infection and prosthetic dislocation within 5 years following aTSA and RSA, and a greater risk of scapular fractures following RSA. Among RA patients, RSA had a significantly higher risk of prosthetic dislocation, scapular fractures, and revision compared to aTSA., Conclusions: Following TSA, RA patients should be considered at higher risk of systemic and joint-related complications compared to patients with primary OA. Knowledge of the risk profile of RA patients undergoing TSA is essential for appropriate patient counseling and education. Level of evidence: III.

Background: Numerous applications and strategies have been utilized to help assess the trends and patterns of readmissions after orthopaedic surgery in an attempt to extrapolate possible risk factors and causative agents. The aim of this work is to systematically summarize the available literature on the extent to which natural language processing, machine learning, and artificial intelligence (AI) can help improve the predictability of hospital readmissions after orthopaedic and spine surgeries., Methods: This is a systematic review and meta-analysis. PubMed, Embase and Google Scholar were searched, up until August 30, 2023, for studies that explore the use of AI, natural language processing, and machine learning tools for the prediction of readmission rates after orthopedic procedures. Data regarding surgery type, patient population, readmission outcomes, advanced models utilized, comparison methods, predictor sets, the inclusion of perioperative predictors, validation method, size of training and testing sample, accuracy, and receiver operating characteristics (C-statistic), among other factors, were extracted and assessed., Results: A total of 26 studies were included in our final dataset. The overall summary C-statistic showed a mean of 0.71 across all models, indicating a reasonable level of predictiveness. A total of 15 articles (57%) were attributed to the spine, making it the most commonly explored orthopaedic field in our study. When comparing accuracy of prediction models between different fields, models predicting readmissions after hip/knee arthroplasty procedures had a higher prediction accuracy (mean C-statistic = 0.79) than spine (mean C-statistic = 0.7) and shoulder (mean C-statistic = 0.67). In addition, models that used single institution data, and those that included intraoperative and/or postoperative outcomes, had a higher mean C-statistic than those utilizing other data sources, and that include only preoperative predictors. According to the Prediction model Risk of Bias Assessment Tool, the majority of the articles in our study had a high risk of bias., Conclusion: AI tools perform reasonably well in predicting readmissions after orthopaedic procedures. Future work should focus on standardizing study methodologies and designs, and improving the data analysis process, in an attempt to produce more reliable and tangible results., Level of Evidence: Level III. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/B118)., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)

Background: Anatomic and reverse total shoulder arthroplasty (RSA) (total shoulder arthroplasty [TSA]) have surged in popularity in recent years. While RSA is Food and Drug Administration approved for cases of rotator cuff tear arthropathy, indications have expanded to include, among others, primary glenohumeral osteoarthritis (GHOA)., Methods: PubMed, Cochrane, and Google Scholar (pages 1-20) were queried through November 2023. Inclusion criteria consisted of studies that compared the utility of TSA to that of RSA for the treatment of GHOA with intact rotator cuff with respect to adverse events, patient-reported outcomes, and range of motion (ROM). The Risk Of Bias In Non-randomised Studies - of Interventions tool was used to assess the risk of bias in the included nonrandomized studies, and Review Manager 5.4 was used for statistical analysis. P values <.05 were deemed significant., Results: Fourteen studies met the above inclusion criteria. Twelve studies reported adverse outcomes, with the RSA group having a lower rate of complications (odds ratio = 0.54, P = .004) and reoperations (odds ratio = 0.31, P < .001) relative to TSA at an average follow-up of 3.4 years. Four studies reported Shoulder Pain and Disability Index and University of California Los Angeles scores, while 5 reported Simple Shoulder Test scores. These studies showed superior Shoulder Pain and Disability Index (P = .040), University of California Los Angeles (P = .006), and Simple Shoulder Test (P = .040) scores among the RSA group. No significant differences were seen with regards to other patient-reported outcomes. Ten studies reported on ROM, and the RSA group had a significantly lower external rotation relative to the TSA group (P < .001) while other ROM parameters did not show statistically significant differences., Conclusion: The present study provides support for RSA as a reasonable surgical option for patients with GHOA and an intact rotator cuff, with lower rates of adverse events and better outcomes relative to TSA, although at the expense of decreased external rotation. Patient education and counseling is key in order to decide optimal treatment as part of a shared decision-making process, as well as setting appropriate expectations., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Introduction: Total joint arthroplasties (TJAs) have recently been shifting toward outpatient arthroplasty. This study aims to explore recent trends in outpatient total joint arthroplasty (TJA) procedures and examine whether patients with a higher comorbidity burden are undergoing outpatient arthroplasty., Methods: Medicare fee-for-service claims were screened for patients who underwent total hip, knee, or shoulder arthroplasty procedures between January 2019 and December 2022. The procedure was considered to be outpatient if the patient was discharged on the same date of the procedure. The Hierarchical Condition Category Score (HCC) and the Charlson Comorbidity Index (CCI) scores were used to assess patient comorbidity burden. Patient adverse outcomes included all-cause hospital readmission, mortality, and postoperative complications. Logistic regression analyses were used to evaluate if higher HCC/CCI scores were associated with adverse patient outcomes., Results: A total of 69,520, 116,411, and 41,922 respective total knee, hip, and shoulder arthroplasties were identified, respectively. Despite earlier removal from the inpatient-only list, outpatient knee and hip surgical volume did not markedly increase until the pandemic started. By 2022Q4, 16%, 23%, and 36% of hip, knee, and shoulder arthroplasties were discharged on the same day of surgery, respectively. Both HCC and CCI risk scores in outpatients increased over time ( P < 0.001)., Discussion: TJA procedures are shifting toward outpatient surgery over time, largely driven by the COVID-19 pandemic. TJA outpatients' HCC and CCI risk scores increased over this same period, and additional research to determine the effects of this should be pursued., Level of Evidence: Level III, therapeutic retrospective cohort study., (Copyright © 2024 by the American Academy of Orthopaedic Surgeons.)

Peri-urban environments are significant reservoirs of wastewater, and releasing this untreated wastewater from these resources poses severe environmental and ecological threats. Wastewater mitigation through sustainable approaches is an emerging area of interest. Algae offers a promising strategy for carbon-neutral valorization and recycling of urban wastewater. Aiming to provide a proof-of-concept for complete valorization and recycling of urban wastewater in a peri-urban environment in a closed loop system, a newly isolated biocrust-forming cyanobacterium Desertifilum tharense BERC-3 was evaluated. Here, the highest growth and lipids productivity were achieved in urban wastewater compared to BG11 and synthetic wastewater. D. tharense BERC-3 showed 60-95% resource recovery efficiency and decreased total dissolved solids, chemical oxygen demand, biological oxygen demand, nitrate nitrogen, ammonia nitrogen and total phosphorus contents of the water by 60.37%, 81.11%, 82.75%, 87.91%, 85.13%, 85.41%, 95.87%, respectively, making it fit for agriculture as per WHO's safety limits. Soil supplementation with 2% wastewater-cultivated algae as a soil amender, along with its irrigation with post-treated wastewater, improved the nitrogen content and microbial activity of the soil by 0.3-2.0-fold and 0.5-fold, respectively. Besides, the availability of phosphorus was also improved by 1.66-fold. The complete bioprocessing pipeline offered a complete biomass utilization. This study demonstrated the first proof-of-concept of integrating resource recovery and resource recycling using cyanobacteria to develop a peri-urban algae farming system. This can lead to establishing wastewater-driven algae cultivation systems as novel enterprises for rural migrants moving to urban areas., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)