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A systematic review of literature, in order to investigate an association between Major depressive disorder (MDD) and Oral health was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered on PROSPERO (registration number: CRD42023470383). The search and screening according to previously established protocol were conducted by two authors. Electronic databases such as PubMed, Scopus, and DOAJ were searched from January 2000 until October 2022 for studies reporting data on oral health status and MDD. Quality assessment of included studies was evaluated using NIH tool developed by NHLBI for retrospective and prospective studies and Cochrane risk of bias 2 (RoB 2) tool for interventional studies through its domains. The RoB summary graph and RoB summary applicability concern were plotted using RevMan software version 5.3. All the studies tried to understand the association and impact of major depressive impact on oral health and hygiene. The collective result demonstrates a mixed relationship of depression and oral health. Recognizing the oral health status of individuals with depressive symptoms can serve as valuable information for both dental and mental health professionals. This awareness enables the development of customized treatment plans to assist patients in achieving comprehensive wellness. There is an opportunity for further research of similar nature in developing countries such as India, Indonesia, and China, which have substantial population sizes.

Juvenile systemic sclerosis (JSSc) is a highly uncommon, chronic connective tissue disorder that affects multiple systems, marked by progressive deposition of collagen under the dermis, and various deep organs. Delay in diagnosis can cause irreversible vital organ damage, leading to severe morbidities and seriously affecting quality of life. We report a clinical case of a 9-year-old boy with extensive and diffuse skin manifestations with vascular, pulmonary, and gastrointestinal involvement. The sero-immunological test revealed positive ANA results and high titers of anti-topoisomerase (Scl-70) antibodies, indicative of severe manifestation of the disease. He was managed with systemic immunosuppression and other pharmacological and rehabilitative measures to prevent ongoing organ damage and alleviate the patient’s symptoms.

Aim: The purpose of this in vitro study was the evaluation of the tensile bond strength of two different cements used for luting zirconia coping to one-piece zirconia implant. Settings and Design: The study was designed in an in vitro study setting. Materials and Methods: A one-piece zirconia implant was scanned on laboratory scanner, and thirty zirconia implants were milled by computer aided manufacturing (CAM). Subsequently, the abutment surface of each zirconia implants were scanned in laboratory scanner and coping with a hole was designed by computer-aided designing software, which was used for milling by computer-aided manufacturing (CAM). After various surface treatments of abutment and intaglio surface of coping, fifteen sets were cemented by glass ionomer cement (Group I) and the other fifteen sets by adhesive resin cement (Group II). All thirty samples after thermocycling were dried and pulled out in a universal testing machine, and tensile retention force is noted in pounds per square inch (psi). Statistical Analysis Used: Values for tensile retention force were tabulated for both the groups. Mean and standard deviation are calculated. Independent t-value and P value were calculated. Results: The least tensile retention force was reported in Group I (165.86 ± 25.74 psi). Maximum tensile retention force was received for Group II (396.81 ± 78.32 psi). Independent t-test was applied from which t-value calculated was 10.85 and P value obtained was 0.001, which means that there exists a very high difference in tensile bond strength of cement in Group I and Group II. Conclusions: Better tensile retention forces were observed in samples cemented with adhesive resin cement when compared to samples cemented with glass ionomer cement.

Uncommon spontaneous haematomas of the iliacus muscle are observed in patients on anticoagulant medication or in those with blood dyscrasias like haemophilia. Femoral neuropathy, which may involve pain and paralysis, can arise as a result of these haematomas. Delays in the evacuation of haematomas can lead to protracted or irreversible impairment, as therapeutic options for femoral nerve involvement are not well established. The case discussed in this report is an unusual instance of a spontaneous haematoma of the iliacus muscle in a 67-year-old female patient, who presented with left lower limb pain, swelling, and weakness. She had a history of long-term Warfarin use for cardiac prosthetic valve replacement. An ultrasonography and doppler study of the affected region quickly revealed the concerning presence of an iliacus haematoma causing femoral nerve compression. Further Computed Tomography (CT) imaging illustrated the extent of the haematoma, which ultimately required drainage. Following the drainage of the haematoma and relief of compression on the femoral nerve, the patient showed dramatic improvement in her presenting complaints. This report highlights the need for a high level of clinical acumen and suspicion for spontaneous bleeding episodes with atypical or unusual presentations in patients on Warfarin therapy. Furthermore, the case underscores the importance of rapid ultrasonographical evaluation of the involved region and subsequent non surgical intervention for drainage.

Background: Schizophrenia is a serious mental illness that causes major functional impairments, raises the risk of disability, and reduces life expectancy. It affects around 7 in 1000 people b/w the age of 15 and 35 years. Schizophrenia poses a great challenge not only for the patient but also for the people and the society around the patient. Family members who serve as informal primary carers may suffer personal expenses as a result of providing care for those who have major mental illnesses. One outcome that is regularly studied is the caregiver burden or the challenges encountered in providing care. AIMS: Burden of care in caregivers of patients with schizophrenia in Greater Noida, U.P, India. Methods: This cross-sectional study was carried out at the School of medical sciences and Research, Sharda University. We enrolled 100 caregivers and it is assessed through the burden assessment scale. Results: Caregivers ranged in age from 20 to 85, with a mean age of 47 (SD=14.1). The male-to-female ratio was 1.7, with 63 men and 37 women present. The majority of the caregivers were parents (n=54), siblings (n=9), spouses (n=10), or their children (n=5). On the burden assessment scale, the severity of the burden was found on the basis of mild, moderate, severe, and very severe. Conclusion: It is important to understand the mental health of caregivers in order to develop an appropriate intervention to deal with their mental health problems. Therefore, this study highlighted the need for psychological interventions not only for the patients but also for caregivers.

Background: Homosexuality and bisexuality have long been prevalent in all parts of the world including India. Many efforts have been put to destigmatize and to make the lives of these people better, and it is no longer considered pathological in the diagnostic systems. Still, they experience higher stigma, discrimination, marginalization, violence, and trauma throughout their lives. Thus, research is needed to evaluate the level of stress and how they cope with it. Objectives: The objectives were to study the sociodemographic profiles of the participants and to explore the stress-coping skills among lesbians, gays, and bisexuals. Methods: It was a cross-sectional descriptive study with a sample size of 50, including 18-year and older homosexual and bisexual participants, with the employment of a snowball sampling technique. A semi-structured sociodemographic pro forma, Klein Sexual Orientation Grid, Perceived Stress Scale (PSS), and Brief Coping with Problem Experienced scales were applied. Results: The mean age of participants was 23.620 ± 3.630. There were 36 (72%) gay, 8 (16%) lesbian, and 6 (12%) bisexual participants. On estimation of stress, 15 (30%) participants had low stress, 27 (54%) had moderate stress, and 8 (16%) participants had high levels of stress. Among coping strategies, the highest mean was for self-distraction (5.70 ± 1.51), followed by acceptance (5.32 ± 1.20). A significant positive correlation between the PSS scores was found with self-blame and avoidant coping strategies. Conclusion: People with homosexual and bisexual orientation are likely to experience higher levels of stress, so it becomes vital to have more research in this field.

Salmonella infection in Poultry birds may lead to food poisoning in human beings. Salmonellae are pathogenic, causing enteritis in birds, and others. This study aims to determine the presence of Salmonella spp. isolates with detailed characterization, in ducks and associated environments from a few districts of South Bengal (India). A total of 236 samples (cloacal swabs of ducks, samples from the environment, and duck eggs) were collected, and Salmonella spp. was isolated following standard methodology with molecular confirmation of the isolates done by PCR. Standard methods were followed in all steps of the study. An in vitro antibiogram of the isolates positive for ESBL and biofilm formation was done against 12 antibiotics commonly used in veterinary medicine. Twenty-seven (11.44%) Salmonella enterica strains were detected with environmental samples to show the highest prevalence (13.9%) among other sources. Out of 27, 18 (66.67%) Salmonella spp. isolates were positive for either ESBL or ACBL production in vitro in a double-disc diffusion assay. Twelve (44.44%) isolates showed the presence of two major ESBL genes (blaCTX-Mand blaTEM) but no blaSHV whereas the blaAmpC was found in 11 (40.74%) isolates. The virulence gene (invA) was noticed in 12 (44.44%) isolates, whereas 16 (59.25%) isolates were revealed to have at least one of the biofilm-associated protein-encoding genes. All 12 selected Salmonella enterica isolates were identified with 100% resistance to ampicillin, followed by ertapenem and cefotaxime (both 83%), ceftazidime (75%), etc. In contrast, drugs like chloramphenicol (67%), cotrimoxazole (50%), gentamicin (33%) etc. were sensitive against these isolates.

Objective: This prospective study aimed to evaluate the analgesic effects of acetaminophen and Transcutaneous Electric Nerve Stimulation (TENS) therapy for pain control. Methods: Forty orthodontic patients who underwent fixed orthodontic treatment were randomly assigned to one of 3 groups: (1) acetaminophen, (2) TENS therapy, or (3) control. Pain was evaluated at 12, 24, 36, and 48 hours after the placement of both 0.014" NiTi and 0.016" NiTi archwires using a 10 cm visual analogue scale (VAS). Because the data were found to be non-normal, Kruskal-Wallis test was employed for both stage I and stage II intra-group comparisons. Results: For both stage I and stage II, evaluation of the VAS scores for all 3 groups at different time intervals showed that the difference between groups A and B was statistically insignificant (p>0.05). The scores of Group A compared to Group C were significant, and Group B compared to Group C showed significant values. Conclusion: Both TENS and acetaminophen reduced the pain experienced by patients compared with the placebo group. The acetaminophen group showed VAS results similar to those of the TENS group.

Telecommunication provides the infrastructure to deliver core services but contributes to extensive CO2 emissions. To address the problem, this paper introduces environmental sustainability index for the telecom sector to reduce carbon emissions. The present work identifies the most critical factors that reduce carbon emission in a multiple-stage telecom supply chain through an extensive literature review, followed by developing an environmental sustainability index to measure carbon reduction efforts. A detailed survey was conducted among the personnel of the Indian telecom sector to understand the initiatives for carbon emission reduction. The study employed factor analysis and multiple regression to achieve its objectives.

Primary Central Nervous System Vasculitis (PCNSV) is a rare inflammatory condition affecting the blood vessels in the brain and spinal cord, without signs of systemic vasculitis. The symptoms of PCNSV are typically non-specific and varied. This case involves a 16-year-old female who arrived at the emergency department with tingling and numbness in her left upper and lower extremities since waking up that morning. Within hours, she developed significant weakness in her left arm and leg. She had no significant medical history, comorbidities, or history of substance use. On examination, her vitals were stable, and she was fully conscious and oriented. Neurological examination revealed right-sided mouth deviation and decreased muscle power in her left limbs, while sensory function remained normal. Routine blood tests were normal, except for mildly elevated Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP). Autoimmune markers and complement levels were within normal limits. Cerebrospinal Fluid (CSF) analysis showed lymphocytic pleocytosis and mildly elevated protein levels. Magnetic Resonance Imaging (MRI) brain imaging revealed multiple small, acute, non-haemorrhagic infarcts in the right frontoparietal and temporo-occipital regions. MR angiography indicated thrombosis in the right internal carotid artery, with extensive thickening and constriction in various segments, consistent with PCNSV. She was treated with dual antiplatelet therapy, antiepileptics, methylprednisolone pulse therapy, and intravenous cyclophosphamide, followed by maintenance therapy with methotrexate and oral steroids. This case underscores the importance of early recognition and aggressive treatment of PCNSV to prevent long-term neurological deficits. Reporting this case is crucial as it highlights an atypical presentation in a young female, emphasising the need for awareness and comprehensive diagnostic approaches.

Abstract Background Myocardial bridging is a cardiac anomaly where a segment of epicardial coronary arteries runs through the myocardium and can rarely cause MI. Takotsubo syndrome is a stress-induced cardiomyopathy that can mimic MI. Catecholamine surge during stress can contribute to Takotsubo syndrome, but whether this surge can trigger an inconspicuous myocardial bridging to manifest symptomatically remains unclear, and alternately, whether a myocardial bridge might cause worsening of Takotsubo syndrome is also a matter that needs further research. Case presentation We report the case of a patient who initially presented with features of acute exacerbation of bronchiectasis and subsequently developed symptoms and ECG features suggestive of acute myocardial infarction. Echocardiography revealed features of takotsubo syndrome, and complete myocardial bridging was revealed via coronary angiography. The patient was managed conservatively with pharmacological treatment, and after a few days, echocardiographic features were reversed. As such, the diagnosis shifted toward Takotsubo syndrome with myocardial stunning due to co-existent myocardial bridging. Conclusion We report a rare case of a patient with acute bronchiectasis exacerbation with features suggestive of acute myocardial infarction who had findings of Takotsubo syndrome and complete myocardial bridging. In the beginning, it was difficult to determine whether the symptoms arose due to acute MI resulting from myocardial bridging or were solely due to takotsubo syndrome because of stress from bronchiectasis. Although myocardial bridging is often overlooked as an etiology for acute MI, this case highlights the importance of expanding the differential diagnosis to myocardial bridging in the work-up for the cause of acute MI and how Takotsubo syndrome can mimic acute MI and pose a diagnostic challenge.

Abstract Coagulation factor XII (FXII) conveys various functions as an active protease that promotes thrombosis and inflammation, and as a zymogen via surface receptors like urokinase-type plasminogen activator receptor (uPAR). While plasma levels of FXII are increased in diabetes mellitus and diabetic kidney disease (DKD), a pathogenic role of FXII in DKD remains unknown. Here we show that FXII is locally expressed in kidney tubular cells and that urinary FXII correlates with kidney dysfunction in DKD patients. F12-deficient mice (F12 -/- ) are protected from hyperglycemia-induced kidney injury. Mechanistically, FXII interacts with uPAR on tubular cells promoting integrin β1-dependent signaling. This signaling axis induces oxidative stress, persistent DNA damage and senescence. Blocking uPAR or integrin β1 ameliorates FXII-induced tubular cell injury. Our findings demonstrate that FXII-uPAR-integrin β1 signaling on tubular cells drives senescence. These findings imply previously undescribed diagnostic and therapeutic approaches to detect or treat DKD and possibly other senescence-associated diseases.

Exploring shape memory alloys (SMAs) is like diving into a world of material magic, especially when combined with additive manufacturing techniques. This detailed assessment delves into the fascinating realm of additive manufactured SMAs, examining their complex fabrication processes, captivating internal structures, wide-ranging applications, and unique properties. It is remarkable to observe how the combination of metals, particularly nickel and titanium, creates the very essence of SMA's capabilities and various other material combination for novel SMAs. Additional insights are provided regarding how additive manufacturing parameters and appropriate post-treatments can enable these materials to accomplish extraordinary functionalities. These SMAs also possess the ability to recollect and move, demonstrating superelasticity and the capacity to regain their original shape in various capacities. However, there are promising prospects for the development of novel SMA mixtures, enhanced post-treatments methods, and even more intelligent and responsive products with dimensional accuracy and uniformity. This work presents insights on opportunities in industries for resilient materials, ranging from everyday devices to the immense expanse of space and the human body. Even with the advancements, there is still work to be done in continuously improving their design and pocket comfort. This review not only presents information but also envisions a future in which additive manufactured SMAs are central to advancements in engineering and other fields.

Abstract With the exponential progress in the field of cheminformatics, the conventional modeling approaches have so far been to employ supervised and unsupervised machine learning (ML) and deep learning models, utilizing the standard molecular descriptors, which represent the structural, physicochemical, and electronic properties of a particular compound. Deviating from the conventional approach, in this investigation, we have employed the classification Read-Across Structure-Activity Relationship (c-RASAR), which involves the amalgamation of the concepts of classification-based quantitative structure-activity relationship (QSAR) and Read-Across to incorporate Read-Across-derived similarity and error-based descriptors into a statistical and machine learning modeling framework. ML models developed from these RASAR descriptors use similarity-based information from the close source neighbors of a particular query compound. We have employed different classification modeling algorithms on the selected QSAR and RASAR descriptors to develop predictive models for efficient prediction of query compounds’ hepatotoxicity. The predictivity of each of these models was evaluated on a large number of test set compounds. The best-performing model was also used to screen a true external data set. The concepts of explainable AI (XAI) coupled with Read-Across were used to interpret the contributions of the RASAR descriptors in the best c-RASAR model and to explain the chemical diversity in the dataset. The application of various unsupervised dimensionality reduction techniques like t-SNE and UMAP and the supervised ARKA framework showed the usefulness of the RASAR descriptors over the selected QSAR descriptors in their ability to group similar compounds, enhancing the modelability of the dataset and efficiently identifying activity cliffs. Furthermore, the activity cliffs were also identified from Read-Across by observing the nature of compounds constituting the nearest neighbors for a particular query compound. On comparing our simple linear c-RASAR model with the previously reported models developed using the same dataset derived from the US FDA Orange Book ( https://www.accessdata.fda.gov/scripts/cder/ob/index.cfm ), it was observed that our model is simple, reproducible, transferable, and highly predictive. The performance of the LDA c-RASAR model on the true external set supersedes that of the previously reported work. Therefore, the present simple LDA c-RASAR model can efficiently be used to predict the hepatotoxicity of query chemicals.

Reaching beyond the commonly used spherical atomic electron density model allows one to greatly improve the accuracy of hydrogen atom structural parameters derived from X-ray data. However, the effects of atomic asphericity are less explored for electron diffraction data. In this work, Hirshfeld atom refinement (HAR), a method that uses an accurate description of electron density by quantum mechanical calculation for a system of interest, was applied for the first time to the kinematical refinement of electron diffraction data. This approach was applied here to derive the structure of ordinary hexagonal ice (Ih). The effect of introducing HAR is much less noticeable than in the case of X-ray refinement and it is largely overshadowed by dynamical scattering effects. It led to only a slight change in the O—H bond lengths (shortening by 0.01 Å) compared with the independent atom model (IAM). The average absolute differences in O—H bond lengths between the kinematical refinements and the reference neutron structure were much larger: 0.044 for IAM and 0.046 Å for HAR. The refinement results changed considerably when dynamical scattering effects were modelled – with extinction correction or with dynamical refinement. The latter led to an improvement of the O—H bond length accuracy to 0.021 Å on average (with IAM refinement). Though there is a potential for deriving more accurate structures using HAR for electron diffraction, modelling of dynamical scattering effects seems to be a necessary step to achieve this. However, at present there is no software to support both HAR and dynamical refinement.

Chromosomal disorders manifest with multiple congenital anomalies, which is associated with high morbidity as well as mortality. Trisomy 18 also known as Edward’s syndrome is a rare chromosomal disorder. We report a case of Edwards’ syndrome in a 15-day-old female neonate, with typical syndromic features. Infant’s clinical condition was superimposed by respiratory distress, necessitating a comprehensive, multidisciplinary management involving neonatologist, anesthesiologists, and orthopedic specialists. Considering the intricacies of Edwards’ syndrome and hence contributing to refining protocol for enhanced care and meticulous support. Furthermore, emphasizes the requirement for further research to advance understanding of the clinical condition and propagate future management.

ABSTRACTBackground A bivalent human papillomavirus vaccine (2vHPV) is currently used in the Netherlands; a nonavalent vaccine (9vHPV) is also licensed.Research design and methods We compared the public health and economic benefits of 2vHPV- and 9vHPV-based vaccination strategies in the Netherlands over 100 years using a validated deterministic dynamic transmission metapopulation model.Results Compared to 2vHPV, the 9vHPV strategy averted an additional 3,245 cases of and 825 deaths from 9vHPV-strain-attributable cancers, 4,247 cases of and 190 deaths from recurrent respiratory papillomatosis (RRP), and 1,009,637 cases of anogenital warts (AGWs), with an incremental cost-effectiveness ratio (ICER) of €4,975 per quality-adjusted life year (QALY) gained. The ICER increased in a scenario with increased HPV vaccination coverage rates and was relatively robust to one-way deterministic sensitivity analyses, with variation in the disease utility parameter having the most impact. When catch-up vaccination for individuals ≤26 years of age was added to the model, vaccinating with 9vHPV averted additional cancers and AGWs compared to 2vHPV vaccination.Conclusion Our analyses predict that transitioning from a 2vHPV- to a 9vHPV-based vaccination strategy would be cost-effective in the Netherlands.

The Firefly Funhouse Match is a professional wrestling match between WWE wrestlers John Cena and (the late) “The Fiend” Bray Wyatt at WWE’s Wrestlemania 36 (2020). The present paper attempts to critically analyze the “Firefly Funhouse Match” from a variety of theoretical angles. The match is in essence a dive into the unconscious. Mikhail Bakhtin used the term “carnivalesque” to characterize writing that aims to destabilize the hierarchical status quo. In this sense the Firefly Funhouse Match is carnivalesque because it mocks the dominant/traditional forms of professional wrestling. In a conventional wrestling match, there will be a fixed ring, a referee, a dedicated time-slot, a certain geographical location, and so on. But all these notions are subverted in the Firefly Funhouse match: there is no referee, no linear temporal progression, no fixed ring, no concrete geographical location, and we have frequent changes of time-space. The match turns the hierarchical scale on its head. We also find interconnected chronotopes in the match. The wrestling match explores the differences between grandiose epic heroism and the fragmented postmodern man. The match parodies established character archetypes in professional wrestling, urging us to question the face value of scripted roles. It also contains many postmodern elements, such as intertextuality, magic realism, unpredictability, nonlinear storytelling, deconstruction of a fixed identity, fragmentation and irony.

Background: Blood loss is often a major complication of neurosurgery; and adversely impacts postoperative outcomes. Primary objective of our study was to assess the effect of tranexamic acid (TXA) on total perioperative blood loss and the need for packed red blood cell (PRBC) transfusion in patients. Secondary objective was to assess and compare the effect of TXA on haemoglobin (Hb) , packed cell volume (PCV), coagulation profile, crystalloid and PRBC requirement, neurological outcomes; and the quality of surgical field peri-operatively. Materials and Methods: 60 adult patients, undergoing elective craniotomy for tumor resection were recruited. 30 patients each, received either a bolus of TXA , followed by an infusion (TXA group); or normal saline in the same dose (Placebo group). Crystalloid and PRBC transfusion, blood loss, Hb, PCV, platelet count, fibrinogen levels, international normalized ratio were recorded. Mean intensive care unit (ICU) stay and Glasgow Outcome Extended (GOSE) score were also measured. Results: There was no significant difference in blood loss, PRBC requirement, Hb, PCV, fibrinogen levels , INR, duration of ICU stay or the quality of the operative field; between the TXA and placebo groups. GOSE scores were better and platelet count decrease was significantly higher in the TXA group. Conclusion: Low-dose TXA did not significantly reduce blood loss or improve outcomes in patients undergoing intracranial tumor resection. GOSE score was better; and the platelet decrease post- operatively was significantly higher in the TXA group. Keywords: Intracranial Tumours, Tranexamic Acid ( TXA), Glasgow Outcome Extended (GOSE) Score

Background: India is a vast and diverse country with existing variations in the frequency and distribution of cancers across its various parts. In regions lacking population-based cancer registries (PBCRs) in a vast country like India, hospital-based cancer registry (HBCR) data become an important source of information on the trends and patterns of a region. To determine the numerical trends of cases of the top ten cancer sites reporting to HBCR of a tertiary care cancer center in Bihar from 2014 to 2021. Materials and Methods: The details of all histopathologically confirmed cancer cases registered in the HBCR department of radiation oncology, State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna, India between January 2014 and December 2021 were included in this retrospective observational study. All these cases were grouped site-wise and listed in descending order of the total number of cases reported in each group. Cross-tabulation with age and sex distribution was done. The frequency distribution of the top ten leading cancers for every consecutive calendar year was plotted in line diagrams for time trend analysis. Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.). was used for analysis. Annual percent change (APC) was determined for the number of cases of all ten cancer sites using joinpoint regression analysis (Joinpoint Regression Software, Version 4.0.4—May 2013; Statistical Methodology and Applications Branch, Surveillance Research Program of the US National Cancer Institute; Bethesda, MD, USA). Results: Out of 32,057 total cancer cases registered between Jan 2014 and Dec 2021, 21,848 patients (68.2%) cases constituted the top ten cancers. The top ten cancers among both sexes were cancer gallbladder (n = 4204, 13.1%), head and neck (n = 3395, 10.6%), breast (n = 3392, 10.6%), lung (n = 2069, 6.5%), cervix (n = 2039, 6.4%), hematolymphoid (n = 1930, 6.0%), liver (n = 1572, 4.9%), stomach (n = 1116, 3.5%), ovary (n = 1103, 3.4%), and colon-rectum (n = 1028, 3.2%). Except for cervical and hematolymphoid cancers, the rest all showed a rising trend over consecutive years. Conclusion: Cancer of the gallbladder continues to be among the most common cancers in the region. Focused research in all aspects of this deadly disease is needed. Strengthening of prevention and screening programs for common cancers and upliftment of the existing infrastructure for diagnosis and treatment of cancer in the region are necessitated.

Purpose: To assess the sensitivity and specificity of retinal imaging captured by portable non-mydriatic ‘fundus on phone’ camera as a screening tool against the conventional seven field digital fundus photography. Design: Prospective comparative study design. Methods: Study was performed over 300 diabetic patients (600 eyes). First fundus pictures were taken with non-mydriatic ‘fundus-on-phone’ camera and then with Zeiss seven field fundus camera after pupillary dilation. Images were analysed and compared by two observers. Results: Out of all the 600 undilated fundus images, 15.5% were ungradable, 76% were graded as poor and average quality by both observers. From the dilated fundus images taken using Zeiss camera, only 0.8% images were found ungradable by both observers. The sensitivity and specificity for detecting any diabetic retinopathy changes and its severity by using ‘fundus-on-phone’ camera against Zeiss fundus camera were found to be 54.92% and 85.5%, respectively, by observer one and 56.48% and 85.5%, respectively, by observer two. Conclusion: Non-mydriatic retinal imaging using fundus-on-phone camera is not a feasible method for screening diabetic retinopathy due to low sensitivity and high number of poor-quality images.

Abstract Background Wilson’s disease is an inherited disease characterized by impaired copper metabolism that causes damage to many organs, including the brain. Patients having neurological involvement usually present with varied neuropsychiatric symptoms. Magnetic resonance imaging (MRI) Brain plays an indispensable role in identifying the structural involvement in these patients, aiding in early accurate diagnosis and timely management. Typically, basal ganglia, thalami and brainstem are involved, with bright claustrum sign, face of giant panda sign and miniature panda signs on MRI. Conclusions Having knowledge about the commonly encountered and known MRI brain findings in Wilson’s disease are essential in aiding accurate diagnosis and initiating early management. However, identifying the Atypical MRI brain characteristics is all the more imperative and should be considered in patients with prolonged or severe disease or in patients with rapid clinical progression and in patients showing poor response to treatment.

Abstract Globoid cell leukodystrophy is a severe rare disorder characterized by white matter degradation, resulting in a progressive loss of physical and mental abilities and has extremely limited therapeutic interventions. Therefore, this study aimed to delve into the Globoid cell leukodystrophy associated intricate network of differentially expressed genes (p 1) to identify potential druggable targets and possible therapeutic interventions using small molecules. The disease-associated neuronal protein circuit was constructed and analyzed, identifying 53 nodes (minimum edge cutoff 1), among which five (FOS, FOSB, GDNF, GFRA1, and JUN) were discerned as potential core protein nodes. Although our research enumerates the potential small molecules to target various protein nodes in the proposed disease network, we particularly underscore T-5224 to inhibit c-Jun activity as JUN was identified as one of the pivotal elements within the disease-associated neuronal protein circuit. The evaluation of T-5224 binding energy (− 11.0 kcal/mol) from docking study revealed that the compound to exhibit a notable affinity towards Jun/CRE complex. Moreover, the structural integrity of complex was affirmed through comprehensive molecular dynamics simulations, indicating a stable hydrophilic interaction between T-5224 and the Jun/CRE complex, thereby enhancing protein compactness and reducing solvent accessibility. This binding energy was further substantiated by free binding analysis, revealing a substantial thermodynamics complex state (− 448.00 ± 41.73 kJ/mol). Given that this investigation is confined to a computational framework, we additionally propose a hypothetical framework to ascertain the feasibility of inhibiting the Jun/CRE complex with T-5224 against Globoid cell leukodystrophy, employing a combination of in vitro and in vivo methodologies as a prospective avenue of this study.

The emergence and subsequent advancement of nanotechnology in recent years have greatly benefited the healthcare sector, particularly in the treatment of cancer. As per study, major fatalities are related to the lung cancer. For many years, oral tyrosine kinase inhibitors (TKIs) against the epidermal growth factor receptor (EGFR) family of receptors have been used in the clinic to treat human malignancies, although they observed some very serious adverse effects in the treatment of lung cancer, especially in non-small cell lung cancer (NSCLC). Despite EGFR-TKIs’ exceptional qualities as small-molecule targeted medications, their applicability is nevertheless limited by their poor solubility, inconsistent oral bioavailability, high daily dose needs, high plasma albumin binding propensity, and initial/acquired drug resistance. Article’s purpose is to investigate EGFR-TKI’s effects on lung cancer and get around some of its drawbacks, nanotechnology will be an innovative strategy. An effective tool to increase the effectiveness of these pharmaceuticals is nanotechnology by methods other than oral. This article signifies that a range of nanomedicine delivery systems have been developed to effectively distribute EGFR-TKIs with improved drug release kinetics and tissue-targeting capacity. This review article intends to present information regarding lung cancer and EGFR relation, mechanism of recently approved EGFR-TKI’s targeted therapy, an updated landscape of EGFR-TKIs and their clinical status over lung cancer, advantages and disadvantages of nanotechnology, and new breakthroughs in nano-delivery which mentioned as a significantly better over traditional drug chemotherapy and delivery.

Revolutionary changes in how people interact while travelling at a distance have given rise to several mobile communication tactics. Numerous generations of Mobile telecommunications/telephony have progressed as 1G, 2G, 3G, 4G, 5G, and 6G (now under research). However, in the context of India, mobile telephony can be realized from 2G. The sector has directly or indirectly been impacted by political, social, economic, technological, legal, and environmental (PESTLE) aspects. Therefore, the study objectives are first to discuss the (mobile) telecom sector evolution outline and, second, the factors that contributed to sectoral development by the PESTLE framework. The conceptual foundation of the work is secondary sources.

Among the many biotic factors with adverse effects on Solanum lycopersicum (tomato), diseases caused by fungi, viruses and nematodes are notable. Since the genome of S. lycopersicum became available, efforts have continued to identify the genes and proteins associated with the plant defence activity. One such gene family belongs to TIR-NBS-LRR (TNL), a subfamily of larger NBS-LRR genes. In total, 27 full-length TNLs were identified via genome wide analysis. Four pairs of segmental duplication events were observed involving different pairs of chromosomes, except the pairing of Solyc02g082050-Solyc02g032650, which were both present on chromosome 2. More than twenty nine percent (29.63%) of the genes were localised on chromosome 1 alone. Hormone-mediated biotic stress-responsive cis-regulatory elements were detected for methyl-jasmonate, salicylic acid (TCA motif) and ethylene (ERE motif). Differential gene expression was observed for many genes under different plant tissues and biotic stresses. The upregulation of many genes including SlBS4 was observed against Alternaria solani attacks in the disease tolerant varieties. Altogether, the results suggested that TNLs play a significant role in plant defence under biotic stress.

Background: The relationship between gastroesophageal reflux disease (GERD) and Helicobacter pylori infection is a complicated topic. This study aimed to evaluate the association between H. pylori infection and GERD and identify the associated risk factors in North India. Methods: All individuals who were referred for an endoscopy because they had dyspepsia were included in a cross-sectional study. Using endoscopic assessment, GERD was diagnosed. As a comparison group, patients with normal esophageal function were chosen. H. pylori was cultured and genotyped to assess the virulent genes such as cagA, vacA, and iceA. The relationship of H. pylori infection with GERD and its associated risk factors were estimated with Chi-square analysis, odds ratios, and 95% confidence intervals using multiple logistic regression analysis. Results: In total, 420 patients were included in this study, of whom 335 (79.8%) had GERD. The mean age was 44.01 ± 16.52 years. Overall, 143 (34%) patients were positive for H. pylori infection. cagA-negative H. pylori isolates were significantly associated with the GERD group. Variables such as gender, age, alcohol, smoking, body mass index (BMI), smoking, and hiatus hernia in patients had no significant association with H. pylori infection. However, increased age, gender, Frequency Scale for the Symptoms of GERD (FSSG) score, BMI, and presence of hiatus hernia were significantly associated with the GERD group. Conclusion: In our results, there was no association between H. pylori infection and GERD. The risk factors for GERD were age, gender, FSSG score, BMI, and hiatus hernia. Further studies are recommended.

Abstract Agriculture in Maharashtra has immense importance in India, acting as the back-bone of the economy and a primary livelihood source for a significant population. Being the third largest state in India, Maharashtra has a high scale crop production in the country which also has an important impact on the economy. Initially the study focus on developing predictive models that guide farmers in selecting suitable crops for the divisions in the state of Maharashtra. This study presents a Crop Recommendation System (CRS) designed to support Maharashtra’s agricultural sector by utilizing a comprehensive dataset from 2001 to 2022 provided by the India Meteorological Department. This study helps in improvising technical efficiency and productivity of the farmers. Harvesting crops in optimal condition can help to produce efficient harvest hence the research concentrates on providing best crop recommendation system (CRS) with the help of Machine Learning and Deep Learning techniques. The data, enhanced for accuracy using expectation-maximization optimization, underpins predictive models that guide crop selection. EM contributes to a more robust and reliable dataset for subsequent analyses and modeling by iterative estimating and updating missing values based on probabilistic expectations. Key findings show that the Random Forest algorithm excels in predicting suitable crops with 92% accuracy. Further precision is achieved through a Long Short-Term Memory network forecasting weather patterns three months ahead, accommodating temporal data variations. Subsequently, the proposed system leverages these forecasts to recommend five ideal crops per division within Maharashtra, aiding farmers’ decision-making and adapting to regional climatic conditions. A supplementary crop calendar offers monthly district-specific planting guidance. An intuitive Graphical User Interface delivers this information effectively, ensuring practical and informed agricultural choices across the state. In essence, the study provides an innovative tool for enhancing economic stability and sustenance in Maharashtra through technology-driven agriculture recommendations aligned with future weather expectations.

Abstract While biallelic POLR3A loss‐of‐function variants are traditionally linked to hypomyelinating leukodystrophy, patients with a specific splice variant c.1909+22G>A manifest as adolescent‐onset spastic ataxia without overt leukodystrophy. In this study, we reported eight new cases, POLR3A‐related disorder with c.1909+22 variant. One of these patients showed expanded phenotypic spectrum of generalised dystonia and her sister remained asymptomatic except for hypodontia. Two patients with dystonic arm tremor responded to deep brain stimulation. In our systemic literature review, we found that POLR3A‐related disorder with c.1909+22 variant has attenuated disease severity but frequency of dystonia and upper limb tremor did not differ among genotypes.

Introduction: Dental trauma sustained while participating in sports is the main element that connects dentistry and sports. Sports involving frequent physical contact with other athletes increase the risk of dentofacial injuries. This association underscores the importance of preventive measures, with well-fitted athletic mouthguards identified as a key intervention to mitigate the risk of dentofacial injuries. Aim: To assess awareness about sports-related dental injuries and mouthguard use among young trainees in three contact sports-khokho, kabaddi, and football. Materials and Methods: A cross-sectional study was conducted from May 2023 to July 2023, which included 226 young trainees from the Government College of Physical Education, Bhubaneswar, engaged in football, kabaddi, and khokho. Data was collected using a self-structured questionnaire and were subjected to analysis employing the Chi-square test. Sports-related dental injury was assessed using the Traumatic Dental Injury codes of the World Health Organisation (WHO) Oral Health Assessment Form for Adults, 2013. Results: Eight (8.3%) football players had the highest incidence of upper left central incisor enamel fracture, as determined by the dental injury codes. The majority of the trainees, 206 (91.2%), were aware of what a mouthguard is. However, 135 (59.7%) agreed that mouthguard use should be mandatory during sports practice. A p-value

Background End‐stage kidney disease (ESKD) is commonly associated with critical limb‐threatening ischemia (CLTI) and frailty. Yet there are no specific tools to predict outcomes of CLTI in ESKD, particularly those that incorporate frailty. We aimed to assess the utility of the medical record–based Hospital Frailty Risk (HFR) score in predicting outcomes of CLTI in ESKD. Methods and Results We identified patients with ESKD diagnosed with CLTI from the US Renal Data System from 2015 to 2018. These patients were categorized into 3 frailty risk groups on the basis of their HFR scores: low (10), and on the basis of whether they underwent revascularization (endovascular revascularization [ER]/surgical revascularization [SR]) or not (no revascularization). Primary outcomes of interest included in‐hospital composite of death or major amputation and in‐hospital death. We included 49 454 eligible patients, with ER/SR cohort including 19.8% (n=9777). A total of 88.4% (ER/SR) and 90.0% (no revascularization) were frail on the HFR scale. We found a nonlinear association between HFR score and in‐hospital adverse outcomes. In both cohorts, intermediate and high‐risk HFR scores were associated with greater risk of in‐hospital death (high‐risk, ER/SR: odds ratio, 2.7 [95% CI, 1.6–4.8]; P

Dear Editor, We are impressed by the article titled “Latent tuberculosis diagnostics: current scenario and review” by Gupta et al. published in your journal. The authors have reviewed the tests used for diagnosis of latent tuberculosis infection and have given a detailed overview of the purified protein derivative-based tuberculin skin test and interferon γ release assays. We would like to draw attention to the fact that in 2022, the World Health Organization has also recommended the use of Mycobacterium tuberculosis antigen-based skin tests for the diagnosis of latent tuberculosis (conditional recommendation, very low certainty of evidence).

Spider silk is known for its excellent strength and fracture resistance properties due to its molecular design structure, characterized by sacrificial bonds and hidden lengths. These structures have inspired reinforcements of synthetic polymer materials to enhance toughness. In this study, we mimic these natural toughening mechanisms by designing and manufacturing 3D-printed polymeric structures incorporating overlapping curls consisting of coiling fiber with sacrificial bonds and hidden lengths. Utilizing the liquid rope coiling effect, we manufactured overlapping curls using three polymers: polylactic acid (PLA), liquid crystal polymer (LCP), and polyamide 6 (PA6). Uniaxial tensile tests were performed to characterize the mechanical properties of overlapping curl as a function of geometries, post-treatments, and material constitutive parameters. Our results show that single-sided overlapping curls can fully unfold while double-sided curls are prone to premature failure. Heat-pressure post-treatment was found to significantly increase the load-capacity of the sacrificial bonds by up to Image 1 due to increased contact area. However, the defects introduced in the fibre after the break of the sacrificial bonds, make the structure more susceptible to premature failure, limit the complete unfolding of the hidden length, and lead to a decrease up to Image 2 of the toughness. To guarantee the complete unfolding of the hidden lengths and improve the toughness, we demonstrate that selecting a polymer material with either high fracture strength (e.g., LCP, Image 3) or high fracture strain (e.g., PA6, >2) is crucial, and increase toughness up to Image 4 and Image 5, respectively.

This study explores the application of machine learning algorithms—gene expression programming (GEP), adaptive neuro-fuzzy inference system (ANFIS), and artificial neural networks (ANN)—to predict machining responses during the milling of Inconel 690, a superalloy known for its exceptional mechanical properties and oxidation resistance. Machining Inconel 690 presents significant challenges due to its toughness and work-hardening tendencies, which can lead to rapid tool wear and poor surface finish. Traditional optimization methods often rely on empirical models and trial-and-error approaches, which are time-consuming and costly. In contrast, machine learning techniques can effectively model complex, nonlinear relationships between machining parameters and performance outcomes, such as surface roughness, cutting force, and cutting temperature. This study employs statistical metrics, including Root mean square error (RMSE), coefficient of determination (R2), and mean absolute percentage error (MAPE), to determine the predictive performance of the models. The results show that the GEP model achieved an R2 ranging from 0.944 572 to 0.992 999, with an RMSE between 0.015 527% and 0.694 523% and a MAPE ranging from 1.452 397% to 4.947 892%. ANFIS and ANN also demonstrated strong predictive capabilities, although GEP outperformed them. The importance of this study lies in its demonstration of advanced AI techniques as effective tools for optimizing machining processes, ultimately contributing to improved efficiency and quality in manufacturing superalloys.

IntroductionPlasma cell-free DNA (cfDNA) estimation offers a non-invasive method to potentially diagnose, monitor, and prognosticate patients with malignancy. This prospective study aimed to assess plasma cfDNA levels in patients with differentiated thyroid cancer (DTC) to determine its role in predicting disease status in the post-operative setting.Materials and methodsThis was a single-center prospective observational study conducted at a public medical research university and hospital in New Delhi, India. 254 patients with DTC in the post-operative setting were included: 95 in Group 1 (active structural disease) and 159 in Group 2 (disease-free). Blood samples were collected for plasma separation and cfDNA extraction. The cfDNA concentrations were quantified and compared across various disease states.ResultsMedian values of plasma cfDNA (ng/µL) in groups 1 and 2 were found to be 0.272 (IQR: 0.137-0.442) and 0.222 (IQR: 0.123-0.398), respectively with no significant difference (p=0.122). cfDNA levels were significantly higher in patients in the age group ≥55 years (p=0.016). However, the cfDNA levels were not significantly associated with any of the other known prognostic markers of DTC.DiscussionBased on the results of this study, plasma cfDNA levels did not significantly predict disease status in patients with DTC in the post-operative setting.

Cancer exhibits substantial heterogeneity, manifesting as distinct morphological and molecular variations across tumors, which frequently undermines the efficacy of conventional oncological treatments. Developments in multiomics and sequencing technologies have paved the way for unraveling this heterogeneity. Nevertheless, the complexity of the data gathered from these methods cannot be fully interpreted through multimodal data analysis alone. Mathematical modeling plays a crucial role in delineating the underlying mechanisms to explain sources of heterogeneity using patient-specific data. Intra-tumoral diversity necessitates the development of precision oncology therapies utilizing multiphysics, multiscale mathematical models for cancer. This review discusses recent advancements in computational methodologies for precision oncology, highlighting the potential of cancer digital twins to enhance patient-specific decision-making in clinical settings. We review computational efforts in building patient-informed cellular and tissue-level models for cancer and propose a computational framework that utilizes agent-based modeling as an effective conduit to integrate cancer systems models that encode signaling at the cellular scale with digital twin models that predict tissue-level response in a tumor microenvironment customized to patient information. Furthermore, we discuss machine learning approaches to building surrogates for these complex mathematical models. These surrogates can potentially be used to conduct sensitivity analysis, verification, validation, and uncertainty quantification, which is especially important for tumor studies due to their dynamic nature.

Background: White matter (WM) fiber tracts in the brainstem communicate with various regions in the cerebrum, cerebellum, and spinal cord. Clinically, small lesions, malformations, or histopathological changes in the brainstem can cause severe neurological disorders. A direct and non-invasive assessment approach could bring valuable information about the intricate anatomical variations of the white matter fiber tracts and nuclei. Although tractography from diffusion tensor imaging has been commonly used to map the WM fiber tracts connectivity, it is difficult to differentiate the complex WM tracts anatomically. Both high field MRI methods and ultrahigh-field MRI methods at 7T and 11.7 T have been used to enhance the contrast of WM fiber tracts. Despite their promising results, it is still challenging to achieve wide clinical adoption at 3T. In this study, we explored a clinically feasible method using a proton density weighted (PDW) 3D gradient echo (GRE) sequence to directly image the WM fiber tracts in the brainstem at 3T in vivo. Methods: We optimized a 3D high resolution, double echo, short TR, PDW GRE sequence on 5 healthy volunteers using a clinical 3T scanner to visualize the complicated anatomy of WM fiber tracts in the brain stem. Tissue properties including T1, proton density and T2* from in vivo quantitative MRI data were used for simulations to determine the optimal flip angle for the sequence. The visualization of multiple WM fiber tracts in the brainstem was assessed qualitatively and quantitatively using relative contrast and contrast-to-noise ratio (CNR). To improve the CNR, the final images were created by averaging over all echoes from two consecutive scans at the optimal flip angle. The results were compared to anatomical atlases and histology sections to identify the major fiber tracts. All the identified major fiber tracts were labeled on axial, sagittal and coronal slices. Results: The WM fiber tracts were found to have distinct hypointense signal throughout the brainstem and most of the major WM fiber tracts, such as the corticospinal tract, medial lemniscus, medial longitudinal fasciculus, and central tegmental tract, in the brainstem up to and including the thalamus were identified in all subjects. Both qualitative and quantitative evaluations showed that the 3° scan offered the best contrast for WM fiber tracts for a TR of 20 ms. The average over the first two echo times and two consecutive 3° scans gave a CNR of 47.8 ± 6.2 for the pyramidal tracts in particular and CNRs values greater than 6.5 ± 2.4 for the rest of the fiber tracts. Conclusions: All the major fiber tracts in the brainstem could be visualized. Given the reasonably short scan time of 10 min at 3T, double echo PDW GRE sequence is a very practical approach for clinical adoption.

Several infectious pulmonary diseases affect the eye. An understanding of the association between infectious pulmonary and ocular diseases is pivotal to their successful management. We aimed to review the infections affecting both the lungs and the eye. The electronic database PubMed and the search engine Google Scholar were searched for relevant articles. Ocular tuberculosis (TB), usually not associated with clinical evidence of pulmonary TB, can affect almost all the ocular structures. Confirmation of the diagnosis of ocular TB requires demonstration of Mycobacterium tuberculosis in ocular fluids/tissues. Among the drugs used to treat TB, ethambutol, isoniazid, and linezolid may cause toxic optic neuropathy. Elderly, those with renal disease, diabetes mellitus, malnourished, alcoholics, and those who will receive ethambutol at doses greater than 15 mg/kg/day and for prolonged periods are at high risk of developing toxic optic neuropathy. These individuals should be referred to an ophthalmologist before initiating ATT for a baseline ophthalmic evaluation. Linezolid may also cause toxic retinal neuropathy. Rifampicin may cause yellowish-orange discoloration of tears and contact lenses. Adenovirus, coronavirus, influenza virus, respiratory syncytial virus, and rhinovirus exhibit both pulmonary and ocular tropism. Pneumocystis jirovecii choroiditis is rare and mainly seen when aerosolized pentamidine is used for pneumocystis pneumonia prophylaxis. Further research is needed to develop non-interventional strategies to diagnose ocular TB. Biomarkers for early detection of toxic optic neuropathy are a need of the hour. Genetic factors and mechanisms behind the development of ethambutol, isoniazid, and linezolid-induced toxic optic neuropathy need further study.

Introduction: Saikosaponin A (SSA), a triterpenoid saponin derived from Radix Bupleuri, is a prominent bioactive compound known for its therapeutic potential. Importantly, SSA is recognized for its widespread use in contemporary Chinese medicinal formulations. The current review highlights SSA's promising role in developing pharmaceuticals and dietary supplements for diverse medical applications, supported by extensive empirical evidence (2001–2024). Methodology: Literature search across Google Scholar, Scopus, PubMed, and Web of Science, covering publications from 2001 to 2024, aimed to gather extensive information on the pharmacological properties of Saikosaponin A. Using keywords such as “Saikosaponin A,” “Oxidative stress,” “Cancer,” “Inflammation,” “Neuroprotection,” and “Apoptosis,” this review consolidates existing knowledge and offers potential avenues for future research. Results: This study incorporates findings from various in vitro and in vivo investigations to evaluate SSA's efficacy across multiple health conditions, including cancer, inflammatory diseases, viral infections, cardiac ailments, and neurological disorders. The results demonstrate that SSA exhibits significant therapeutic effects in treating various cancers, mitigating inflammation, providing neuroprotection in conditions such as Parkinson's disease, epilepsy, and depression, combating influenza A virus, and aiding in obesity management. Discussion: Conclusively, this review highlights the therapeutic potential of SSA, underscoring its importance in treating chronic diseases related to the central nervous system, neoplasms, and inflammatory pathways. Continued research into SSA could yield significant advancements in managing these conditions, reinforcing its value in both traditional and modern medical practices.

BackgroundMycobacterium tuberculosis (Mtb) carbonic anhydrases (CAs) are critical enzymes that regulate pH by converting CO2 to HCO3−, essential for Mtb’s survival in acidic environments. Inhibiting γ-CAs presents a potential target for novel antituberculosis drugs with unique mechanisms of action.ObjectiveThis study aimed to explore the biological connections underlying Mtb pathogenesis and investigate the mechanistic actions of antituberculosis compounds targeting the Cas9 protein.MethodsWe employed homology modeling and virtual screening to identify compounds with high binding affinities for Cas9 protein. This study used the homology modeling approach employing high-quality AlphaFold DB models for γ-CA. Furthermore, the systems biology approach was used for analyzing the integrated modelling of compounds, integrating data on genes, pathways, phenotypes, and molecular descriptors. Single-cell RNA sequencing was also conducted to profile gene expression.ResultsThree compounds, F10921405, F08060425, and F14437079, potentially binding to Cas9 protein, have been identified. F10921405 and F08060425 showed significant overlap in their effects on pathways related to the immune response, while F14437079 displayed distinct mechanistic pathways. Expression profiling revealed high levels of genes such as PDE4D, ROCK2, ITK, MAPK10, and SYK in response to F1092–1405 and F0806-0425, and MMP2 and CALCRL in response to F1443-7079. These genes, which play a role in immune modulation and lung tissue integrity, are essential to fight against Mtb.ConclusionThe molecular relationship and pathways linked to the mentioned compounds give the study a holistic perspective of targeting Mtb, which is essential in designing specific therapeutic approaches. Subsequent research will involve experimental validation to demonstrate the efficacy of the promising candidates in Mtb infections.

Pulmonary rehabilitation through invasive ventilation involves the insertion of an endotracheal tube into the trachea of a sedated patient to control breathing via a ventilating machine. Invasive ventilation offers benefits such as greater control over oxygen supply, higher efficiency in supporting patient respiration, and the ability to manage airway secretions. However, this method also poses treatment challenges like ventilator-induced pneumonia, airway injury, long recovery times, and ventilator dependence. Here, we explore an alternative invasive ventilation technique using soft robotic actuators to mimic the biological function of the diaphragm for augmenting and assisting ventilation. We investigated two actuator geometries, each at two locations superior to the diaphragm. These actuators were tested on a bespoke ex vivo testbed that accurately simulated key diaphragmatic characteristics throughout the respiratory cycle. From this, we have been able to drive intrathoracic pressures greater than the 5 cmH2O required for ventilation in a human male. Additionally, by optimising the placement and geometry of these soft robotic actuators we have been able to generate maximum intrathoracic pressures of (6.81 ± 0.39) cmH2O.

This study investigates ceramic fused filament fabrication (CF3) 3D printing of alumina with an emphasis on the impact of particle morphology on feedstock preparation and printability. Spherical powder displayed superior flow with higher apparent density, tap density, and powder packing fraction compared to irregular powder. A 55 vol % powder loading was chosen to ensure good flowability during printing. Irregular powder-based feedstocks had 40X higher viscosity than spherical powder feedstocks at 400 s−1 shear rate, posing potential printing challenges. Slow printing speed maintained low feed-rates for consistent material flow. The debinding and sintering process produced macroscopically defect-free alumina components with relative densities above 89 % for both powder morphologies. The focus of the work is on comparing two different powder particle morphologies influencing feedstock behavior, printing fidelity, and sintered part properties.

Objective: To study the impact of body mass index (BMI) on the outcomes of total knee arthroplasty (TKA) in primary osteoarthritis (OA) patients with CR/PS TKS. Methods: We conducted a retrospective analysis of data from the ongoing, prospective Freedom 400 study, involving 259 patients. Patients were grouped based on the BMI (WHO categorization): Cohort 1 (normal weight, BMI 18.5 kg/m2 to 25.00 kg/m2), Cohort 2 (overweight patients, BMI 25.00 kg/m2 to 29.99 kg/m2), and Cohort 3 (class 1 and 2 obese patients, BMI 30.00 kg/m2 to 39.99 kg/m2). The primary endpoint was implant survivorship and cumulative revision rates. Secondary endpoints included Knee Society score (KSS), Range of Motion (ROM), Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores, SF-36 questionnaire for assessing quality of life (QoL), and radiographic analysis up to a 3-year follow-up period. Results were considered significant at p

An acute neurological disease known as Wernicke Encephalopathy (WE) is characterised by the clinical triad of symptoms: ophthalmoparesis with nystagmus, ataxia, and disorientation. Thiamine deficiency is the underlying cause of this potentially fatal condition, which mainly affects the central and peripheral nervous systems. Hereby, the authors present a case of a 47-year-old male who presented with multiple episodes of loose stools and altered consciousness to the emergency ward. He had hyperchloremic metabolic acidosis suspected to be due to acute gastroenteritis, which may have caused his altered consciousness. Despite correction of his metabolic acidosis, his sensorium did not improve. Later, he was diagnosed with WE using Magnetic Resonance Imaging (MRI) brain findings, which showed symmetrical subtle hyperintensities in the medial part of the thalami and periaqueductal grey matter, suggestive of WE; his consciousness improved after thiamine supplementation. There should be a high suspicion of WE for timely diagnosis and treatment. Prompt treatment would be rewarding as WE is reversible, if treated in time.

Moyamoya disease (MMD) is a chronic progressive steno-occlusive disease of the intracranial arterial vessels and their branches characterized by puff smoke appearance on angiography. Multifocal neurological insults and deficits are commonly observed in children with MMD. A 7-year-old boy presented with multiple episodes of transient hemiparesis preceded by headache, vomiting, and visual auras was initially labeled as sporadic hemiplegic migraine according to the International Headache Society criteria. However, the rare association of hemiplegic migraine with MMD compelled us to perform magnetic resonance imaging and digital subtraction angiography, which revealed MMD as the underlying cause for the alternating hemiplegia and headaches in the child.

Although chronic lymphocytic leukemia (CLL) is the most common leukemia in the Western world, neurologic complications arising from direct leukemic involvement of the nervous system are reported in only 1% of patients with CLL. Ocular involvement in CLL, direct or indirect, is less known and exceptionally rare. This case involves a 63-year-old female with CLL undergoing chemotherapy for a year, who recently presented with unusual eye movements in the horizontal plane (ocular flutter), resting and intentional tremors in the right upper and lower limbs, and intermittent jaw movements. With no established protocol for CLL with central nervous system involvement, collecting case data becomes crucial for determining optimal treatment and diagnostic approaches early on.

Background and Aims: Postoperative neurocognitive dysfunction (PNCD) commonly occurs after surgery and prolongs hospital stays. Both direct noxious stimuli to the central nervous system and systemic inflammation have been implicated. Due to their potent anti-inflammatory effects, corticosteroids have been utilised to attenuate the incidence and severity of PNCD. This systematic review and meta-analysis strived to evaluate the prophylactic role of perioperative corticosteroids for PNCD. Methods: A search was run in pre-defined databases for randomised controlled trials (RCTs) assessing the role of corticosteroids in preventing PNCD. The incidence of PNCD within 1 month was the primary outcome. Secondary outcomes included the use of antipsychotic medications for the treatment, postoperative infection, and hospital length of stay. The results are exhibited as odds ratio (OR) and the mean difference (MD) with 95% confidence interval (CI). Results: Fifteen RCTs comprising 15,398 patients were included. The incidence of PNCD was significantly lower in the corticosteroid group than in the control group, with a pooled OR of 0.75 (95% CI 0.58, 0.96; P = 0.02; I2 = 66%). Trial sequential analysis showed the clinical benefit of corticosteroids in preventing PNCD; however, the requisite information size is still inadequate. The sub-group analysis supported the prophylactic effect of corticosteroids on delirium prevention but not on delayed neurocognitive recovery. Conclusions: Our meta-analysis revealed statistically significant protective effects of corticosteroids on the incidence of PNCD. However, further studies are still needed to confirm the protective role of this commonly used and relatively safe strategy for preventing PNCD.

Abstract Silica-based glasses can be shaped into complex geometries using a variety of additive manufacturing technologies. While the three-dimensional printing of glasses opens unprecedented design opportunities, the development of up-scaled, reliable manufacturing processes is crucial for the broader dissemination of this technology. Here, we design and study phase-separating resins that enable light-based 3D printing of oxide glasses with high-aspect-ratio features and enhanced manufacturing yields. The effect of the resin composition on the microstructure, mechanical properties and delamination resistance of parts printed by digital light processing is investigated with the help of printing experiments, compression tests and electron microscopy analysis. The chemical composition and microstructure of the cured resins were found to strongly affect the stiffness, delamination resistance, and calcination behavior of printed parts. These findings provide useful guidelines to enhance the reliability and yield of the DLP printing process of multicomponent silica-based glasses.