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Abstract Background The use of a tourniquet is common during anterior cruciate ligament (ACL) reconstruction, offering convenience for the surgical procedure. However, the potential adverse effects of tourniquet use have gained increasing attention from clinical researchers. We conducted this systematic review and meta-analysis to compare the clinical outcomes of tourniquet application versus non-tourniquet approach during arthroscopic ACL reconstruction. Methods A comprehensive search of PubMed, Web of Science, Embase, and Cochrane Library databases, was performed through March 2023 to identify controlled clinical trials. The main outcomes assessed included post-operative drain output, post-operative pain using a visual analogue scale (VAS), operation time, calf girth, and thigh girth. A random-effects meta-analysis was performed to account for heterogeneity, with weighted mean difference (WMD) and 95% confidence intervals (CI) used as pooled estimates for clinical outcomes. Results Of the nine potentially related studies, seven eligible studies (sufficient quantitative data) were included in the meta-analysis. Postoperative drain output in the tourniquet group was on average 100 ml higher than in the non-tourniquet group (95% CI: 36 to 168). Pain, measured by the VAS at 24 h postoperatively, was 0.42 points higher in the tourniquet group (95% CI: 0.08 to 0.76), with the increase persisting at 48 h, averaging 0.40 points (95% CI: 0.12 to 0.69). Thigh girth in the tourniquet group was reduced by 1.8 cm (95% CI: -2.7 to -0.94). No significant differences were observed for calf girth and the operation time. Conclusion Our meta-analysis indicates that tourniquet use during arthroscopic ACL reconstruction is associated with higher pain levels, increased postoperative drain output, and reduced thigh girth. However, performing the surgery without a tourniquet does not significantly extend the operation time. Trial registration The protocol was registered in the International Prospective Register of Systematic Reviews, PROSPERO (CRD42023417604).

Intracytoplasmic sperm injection (ICSI) is a cornerstone in managing male infertility, especially in obstructive azoospermia (OA) and non-obstructive azoospermia (NOA), necessitating sperm retrieval via testicular sperm extraction (TESE) or microdissection TESE (mTESE). However, the varied post-sperm extraction processing methods pose uncertainty regarding optimal approaches. To address this, a systematic review following preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) guidelines was conducted, identifying 16 relevant studies. These studies exhibited significant heterogeneity in methodologies and outcomes, with mechanical preparation and enzymatic digestion being the primary techniques investigated. Mechanical methods, including shredding, mincing, vortexing and crushing, yielded varying sperm counts per 100 mg of tissue, with mincing showing promise in NOA cases. Enzymatic digestion, particularly with collagenase type IV, also showed effectiveness, though inconsistently. Additionally, techniques such as microfluidics and magnetic levitation showed potential for improving sperm retrieval efficiency. However, the lack of standardization in outcomes and reporting impedes the establishment of best practice protocols. While collagenase type IV with elastase seemed promising for OA samples and microfluidics for NOA cases, further studies with standardized methodologies and outcomes are necessary. Assessment of DNA damage and comparisons of ICSI success rates between processing methods are crucial for informed clinical practice. In conclusion, optimizing sperm quantity and quality for ICSI necessitates standardized methodologies and outcomes, with microfluidics and collagenase type IV with elastase showing promise pending further validation through well-designed studies.

In the past ten years, chatbot development has matured to become one of the most well-distinguished outcomes of artificial intelligence. Despite some criticism, Bing AI, ChatGPT and other natural language processing (NLP) products of similar nature are becoming more popular. The creation of chatbots can close several gaps in geographic information retrieval as well. This research introduces and successfully implements, for the first time, a model for integrating task-oriented chatbots into geoportals, with the goal of easing user requests, improving access to geospatial services, and fostering human-computer interactions (HCI). Additionally, it presents a novel recommendation solution for matching the most appropriate volunteer to the user’s geospatial needs based on expertise similarity, semantic similarity, and community feedback. The three categories of finding map services, discovering geoprocessing services, and volunteer expert recommendations were shown to be the most significant geoportal bot intents. Depending on the requirement, each intent additionally includes various entities such as time, place, description, skill, etc. The notion of deep transfer learning (DTL) was then put into practice by customizing a pre-trained BERT (Bidirectional Encoder Representations from Transformers) model for our particular aim and creating a task-oriented conversational agent. According to the results, effective intent classification and entity recognition in the geospatial domain could arise from this approach. We performed the training process with 200 sample data, 20% of which were utilized in a stratified manner for testing, and we obtained f1-scores of at least 0.75. Finally, a pilot Geoportal Chabot that combines crowdsourcing and conversational agents’ approaches was put into use and tested with success. In keeping with SDI technical purposes, the system might direct users to common geospatial web services, namely WMS and WPS, in addition to including natural language understanding (NLU) and natural language generation (NLG) capabilities. Result of user-centered evaluation indicated that the integration of a chatbot significantly reduces the average time required to access geospatial data and processing services by more than 50%. Notably, this effect is even more pronounced when locating an expert, with a fivefold decrease in the time required. Finally, overall user satisfaction rose from 86% to 94%.

Pulmonary tumor thrombi are rare but challenging to treat given the generally poor health of the patients in whom they occur and the low likelihood of the embolism to respond to anticoagulation. Management options include therapeutic anticoagulation and surgery, but the mortality rate is high in either case. Thus, in patients who are symptomatic, the decision about whether to intervene may be challenging. Here the authors present an alternative minimally invasive approach, illustrated in the case of a patient with hepatocellular carcinoma who developed intermediate-risk pulmonary tumor embolism that was successfully managed via suction embolectomy. Such treatment should be considered not just as a life-saving intervention but as a palliative one as well.

Abstract Today’s wireless environments, soft robotics, and space applications demand delicate design of devices with tunable performances and simple fabrication processes. Here we show strain-based adjustability of RF/microwave performance by applying frequency-selective patterns of conductive Ti3C2T x MXene coatings on low-cost acetate substrates under ambient conditions. The tailored performances were achieved by applying frequency-selective patterns of thin Ti3C2Tx MXene coatings with high electrical conductivity as a replacement to metal on low-cost flexible acetate substrates under ambient conditions. Under quasi-axial stress, the Kirigami design enables displacements of individual resonant cells, changing the overall electromagnetic performance of a surface (i.e., array) within a simulated wireless channel. Two flexible Kirigami-inspired prototypes were implemented and tested within the S, C, and X (2-4 GHz, 4-8 GHz, and 8-12 GHz) microwave frequency bands. The resonant surface, having ~1/4 of the size of a standard A4 paper, was able to steer a beam of scattered waves from each resonator by ~25°. Under a strain of 22%, the resonant frequency of the wired co-planar resonator was shifted by 400 MHz, while the reflection coefficient changed by 158%. Deforming the geometry impacted the spectral response of the components across three arbitrary frequencies in the 4-10 GHz frequency range. With this proof of concept, we anticipate implementing thin films of MXenes on technologically relevant substrates, achieving multi-functionality through cost-effective and straightforward manufacturing.

ABSTRACT: Objectives: The emergence of antimicrobial-resistant and mastitis-associated Enterococcus faecalis and Enterococcus faecium is of great concern due to the huge economic losses associated with enterococcal infections. Here we report the draft genome sequences of E. faecalis and E. faecium strains that were isolated from raw milk samples obtained from mastitis-infected cows in Bangladesh. Methods: The two strains were isolated, identified, and genomic DNA was sequenced using the Illumina NextSeq 550 platform. The assembled contigs were analysed for virulence, antimicrobial resistance genes, and multilocus sequence type. The genomes were compared to previously reported E. faecalis and E. faecium genomes to generate core genome phylogenetic trees. Results: E. faecalis strain BR-MHR218Efa and E. faecium strain BR-MHR268Efe belonged to multilocus sequence types ST-190 and ST-22, respectively, both of which appear to represent relatively rare sequence types. BR-MHR268Efe harboured only one antibiotic resistance gene encoding resistance towards macrolides (lsa(A)), while BR-MHR218Efa harboured ten different antibiotic resistance genes encoding resistance to aminoglycosides (ant[6]-Ia, aph(3′)-III), sulphonamides (aac(6′)-II), lincosamides (lnu(B)), macrolides (erm(B)), MLSB antibiotics (msr(C)), tetracyclines (tet(M), tet(L)), trimethoprim (dfrG), and pleuromutilin-lincosamide-streptogramin A (lsa(E)). Virulence gene composition was different between the two isolates. BR-MHR218Efa harboured only two virulence genes involved in adherence (acm and scm). BR-MHR268Efe harboured eight complete virulence operons including three operons involved in adherence (Ace, Ebp pili, and EfaA), two operons involved in biofilm formation (BopD and Fsr), and three exoenzymes (gelatinase, hyaluronidase, SprE). Conclusions: The genome sequences of the strains BR-MHR268Efe and BR-MHR218Efa will serve as a reference point for molecular epidemiological studies of mastitis-associated E. faecalis and E. faecium. Additionally, the findings will help understand the complex antimicrobial-resistance in livestock-assoiated Enterococci.

Diabetes mellitus (DM) induces the production of reactive oxygen species, which may lead to cell injury and death. This study aimed to assess the effects of rosmarinic acid (RA) on testicular damage, oxidative stress, and apoptosis in streptozotocin (STZ)-induced diabetic albino mice. DM in four- to six-week-old BALB/c male albino mice was induced via 50 mg/kg STZ, IP for 5 days. Twelve mice were randomly assigned into each of following groups: a control group, a diabetic (DM) group, RA5 mg/kg and RA15 mg/kg groups, and DM + RA5 mg/kg and DM + RA15 mg/kg groups. RA doses were intraperitoneally injected six times a week for seven weeks. Diabetes increased blood sugar and HbA1c levels and decreased all assessed sperm parameters. Testicular tissues of the diabetic mice showed increased lipid peroxidation, decreased reduced glutathione levels and catalase and superoxide dismutase activities, and increased apoptosis associated with histological abnormalities. Both RA doses had no effects on final body weight, blood sugar, and HbA1c in the diabetic mice. It is concluded that the administration of the potent antioxidant RA to diabetic mice improved the redox status in testicular tissues, protected them from diabetes-induced oxidative damage, and improved the quality of spermatozoa, mostly in a dose-dependent manner, which suggests a potential application value of RA in treating DM-related testicular injury and perhaps other complications.

Objective: To report a rare case of otogenic tension pneumocephalus as a complication of a diffuse leptomeningeal glioneuronal tumor in a patient with a ventriculoperitoneal (V. P.) shunt. Patients: Twenty-three- year-old man with a confirmed diffuse leptomeningeal glioneuronal tumor diagnosis was treated for temporal bone defect and considerable pneumocephalus one year after V. P. shunt. Intervention(s): The patient underwent a Transmastoid, retrolabyrinthine approach. The defect was closed with temporalis facia graft and conchal cartilage as a double-layer closure, and then DuraSeal® was placed over the repaired area. Main outcome measure(s): Resolution of the pneumocephalus. Results: There was a significant reduction in the pneumocephalus on the first day post-operatively. Conclusions: Spontaneous or secondary pneumocephalus development should be considered in patients with brain tumors, hydrocephalus, and patients who undergo V.P. shunt insertion.

This paper presents a novel leader-follower consensus control for a particular class of nonlinear multi-agent mechanical systems in the presence of control input constraints and external disturbances which includes robot system dynamics with a wide range of potential applications in industry. In this case, one of the agents is selected as the leader to direct the other agents in such a way that the whole system can reach consensus within certain prescribed performance transient bounds. Due to the presence of disturbances in most practical systems, the effect of limited disturbance in the consensus control method has been investigated, and actuator saturation is included in the design process. A terminal sliding mode control method has been adapted to ensure the stability of the overall system and fast finite-time leader-follower consensus control. The simulation results of the multi-agent nonlinear robot system in MATLAB environment, in different scenarios with simultaneous consideration of actuator saturation and external disturbance, will show the efficiency of the proposed control method.

ABSTRACT Background and Aim Multiparametric magnetic resonance imaging (mpMRI) is recognized as the most indicative method for diagnosing prostate cancer. The purpose of this narrative review is to provide a comprehensive evaluation aligned with the Prostate Imaging and Reporting Data System (PI‐RADS) guidelines, offering an in‐depth insight into the various MRI sequences used in a standard mpMRI protocol. Additionally, it outlines the critical technical requirements necessary to perform a standard mpMRI examination of the prostate, as defined by the PI‐RADS specifications. Methods European Society of Urogenital Radiology has released PI‐RADS guideline detailing its suggestions aimed at improving the standards of the procedure. The purpose of this guideline is to establish a standard strategy for MRI protocols and image interpretation, aiming to prevent variability in each of the imaging and interpretation stages. Results A standard mpMRI protocol comprises morphological sequences and functional sequences. Morphological sequences which encompass T1‐ and T2‐weighted images, and various functional sequences include diffusion‐weighted imaging, and dynamic contrast‐enhanced MRI. The PI‐RADS recommendations assert that having a standard and uniform protocol for all MRI centers is imperative. Furthermore, the existence of a standardized checklist for interpreting MRI images can foster greater consensus in the process of diagnosing and treating patients. Conclusion Standardized protocols and checklists for mpMRI interpretation are essential for achieving greater consensus among radiologists, ultimately leading to improved diagnostic outcomes in prostate cancer.

IntroductionThe jaw with severe bone atrophy is a difficult challenge when rehabilitating with dental implants. To be able to place dental implants in the most severe cases and to achieve an increase in bone volume by means of the tension transmitted by the load is a novelty. This work provides data on the alveolar bone changes in a severely atrophic mandible that has been treated with implant supported prosthesis under progressive loading protocol.Material and methodsThis study reported on 3 patients with completely edentulous mandible. In all cases, implants were inserted in the anterior region of the mandible and progressive loading was carried out with an increase in the distal cantilever. The length of the cantilever extension was adapted to growth of the residual alveolar bone at the mandible body. The increase in bone height was controlled in the area of implant placement as well as in the area distal to the implants (1 cm behind the last implant).ResultsThis case series described 3 patients where 13 implants were placed. The patients were followed for 17, 19 and 20 years after implants insertion. The mean mandibular residual height of the alveolar bone was 7.8 ± 2.7 mm at the implant site. The mean mandibular body height at 1.0 cm distal to the last implant was 7.0 ± 3.9 mm in the third quadrant and 8.1 ± 4.4 mm in the fourth quadrant. The mean height at the last follow-up was 11.0 ± 3.2 mm (±3.2) in the third quadrant and 11.20 ± 4.4 mm in the fourth quadrant.ConclusionsImplant-supported prosthesis and progressive loading have resulted in vertical bone growth in a series of patients with extreme atrophy of the mandible. The long-term follow-up indicated that bone growth is confined to the dental implants but has been extended to distant regions resulting in the thickening of the mandibular body and the creation of the absent mandibular canal.

The motor imagery (MI) electroencephalographic (EEG) signals are leveraged as control commands to numerus engineering applications, such as operating a wheelchair through thought alone. EEG signals are characterized by their non-stationary nature and high dimensionality, posing noteworthy challenges for building robust identification models with limited data samples. The renewed deep convolutional neural network (CNN) has been harnessed in various fields due to its ability to autonomously extract and select latent features addressing problems across various types of EEG signals. However, CNN architectures comprise a vast parameter and hyperparameter space. Normally, parameters are optimized via the back-propagation algorithm, while hyperparameters are adjusted through a lengthy trial-and-error process. This work mitigates the aforementioned problems by employing the genetic algorithm (GA) as an artificial intelligence optimization tool for optimizing crucial architectural hyperparameters including the number of convolution filters, size of filters, and dropout probability. Furthermore, the two parameters of cropping augmentation, used for boosting the EEG training samples, are also optimized by the GA. The proposed model in this paper (GACNN) that includes dual optimization, achieved both by the back-propagation algorithm and GA, has attained promising results in the analysis of MI EEG signals. Experiments are performed on the known brain-computer interface competition IV 2a dataset (BCIC IV 2a). GACNN has recorded an increment of about 17% in Cohen’s kappa coefficient and a decrement of about 30% in standard deviation (SD) in comparison to state-of-the-art studies.

This study addresses a gap in research by aiming to investigate the efficacy of augmented reality technology on vocabulary development for early EFL childhood pupils diagnosed with learning disabilities—a demographic known for significant learning challenges. A quasi-experimental design involving 30 pupils split into experimental and control groups was employed. The experimental group was taught using AR technology, while the control group received conventional instruction. Over a three-month period, both groups were assessed using a pre and post-test designed to measure vocabulary skills: recognition, recall, guessing, and production. Results revealed that the experimental group, exposed to augmented reality, outperformed the control group in all four vocabulary learning skills. This enhancement can be attributed to augmented reality's ability to engage the pupils' visual, aural, and kinesthetic senses, making learning more immersive and interactive.

Despite both/p/and/b/being bilabial sounds, the subtle yet significant mispronunciation of/p/by Saudi Arabian learners of English can lead to unintended meanings, highlighting the critical role of precise pronunciation in mastering a new language. Mispronunciation of English phonemes by non-native speakers has long been a focus of scholarly research, with the consonantal bilabial plosive/p/offering a particular issue for Saudi EFL learners. This study aims to quantify the extent of this mispronunciation, identify prevailing patterns, examine contributing factors, and assess the impact of university and proficiency levels on pronunciation accuracy. Employing a descriptive quantitative methodology, this research engaged 112 male Saudi EFL learners aged 19 to 25, from diverse academic backgrounds, using an oral test comprising 30 words with the/p/sound in various positions to gather data. The findings reveal pronounced difficulties with the/p/sound, particularly in medial positions, without significant variation across university and proficiency levels, suggesting a pervasive issue. Interlingual interference, notably the frequent substitution of/p/with/b/by native Arabic speakers, emerges as a critical factor, with the potential for drastically altering meanings. Fossilization, cognitive, social, educational and psychological factors also contribute to these mispronunciations. This study accentuates the necessity of targeted pronunciation training to tackle this multifaceted challenge effectively, irrespective of learners’ university or proficiency levels. Based on these findings, implications, limitations, and recommendations were provided.

ABSTRACTIn small series, third-party fecal microbiota transplantation (FMT) has been successful in decolonizing the gut from clinically relevant antibiotic resistance genes (ARGs). Less is known about the short- and long-term effects of FMT on larger panels of ARGs. We analyzed 226 pre- and post-treatment stool samples from a randomized placebo-controlled trial of FMT in 100 patients undergoing allogeneic hematopoietic cell transplantation or receiving anti-leukemia induction chemotherapy for 47 ARGs. These patients have heavy antibiotic exposure and a high incidence of colonization with multidrug-resistant organisms. Samples from each patient spanned a period of up to 9 months, allowing us to describe both short- and long-term effects of FMT on ARGs, while the randomized design allowed us to distinguish between spontaneous changes vs. FMT effect. We find an overall bimodal pattern. In the first phase (days to weeks after FMT), low-level transfer of ARGs largely associated with commensal healthy donor microbiota occurs. This phase is followed by long-term resistance to new ARGs as stable communities with colonization resistance are formed after FMT. The clinical implications of these findings are likely context-dependent and require further research. In the setting of cancer and intensive therapy, long-term ARG decolonization could translate into fewer downstream infections.

AbstractThis quantitative study explores metacognitive listening comprehension strategies among Saudi EFL students, aiming to identify the most and least utilized strategies and examine potential gender differences. Employing a descriptive research design, data were collected randomly from 204 Saudi male and female university students across various academic levels using the “Metacognitive Awareness Listening Questionnaire”. Descriptive statistical analysis, conducted via SPSS, revealed that problem-solving and mental translation were the most frequently employed strategies, indicating proactive identification and resolution of listening challenges and significant reliance on language conversion for comprehension. Planning, evaluation, directed attention, and person knowledge were also utilized, albeit to a lesser extent. Gender analysis indicated no significant differences in strategy utilization, except for problem-solving, where females exhibited a higher propensity. These findings offer insights into the metacognitive strategies prevalent among Saudi EFL students and highlight the need for gender-sensitive pedagogical approaches in EFL instruction.

Glioblastoma (GBM) stands as the most common primary malignant brain tumor. Despite the best standard therapies, GBM survivors have a brief survival time, about 24 months on average. The treatment is troublesome because the cancer cells may not respond well to specific therapies as they grow within an extensive network of blood vessels. Our study aims to evaluate the impact of paclitaxel 5.3 μg/mL and topotecan 0.26 μM solely and in pairwise combination on the resultant metabolic and proteomic signatures of the U87 cell line while using the precise ultra-high-performance liquid chromatography quadrupole time-of-flight mass spectrometry (UHPLC-Q-TOF) analytical technology. The U87 cells wear treated with DMSO, paclitaxel 5.3 μM, topotecan 0.26 μM, and their combinations. Using One-way ANOVA, we observed 14 significantly altered metabolites compared to those cells treated with DMSO. For combination treatment (paclitaxel and topotecan), 11 metabolites were significantly dysregulated. Sparse partial least squares-discriminant analysis (sPLS-DA) revealed minimal overlap, highlighting distinctions among the four groups. While for proteomics, a total of 79 proteins were significantly dysregulated among the groups. These findings can aid in identifying new biomarkers associated with the utilized drugs and creating a map for targeted therapy. EIF3F, GNB2L1, HINT2, and RPA3 were shown to be significantly upregulated in the combination group relative to the control. Moreover, ribosome, apoptosis, HIF-1 signaling, arginine and proline, glutathione, purine metabolism, apelin signaling pathway, and glycolysis were significantly altered in the combination group. Overall, this study underscores the effectiveness of multi-omics approaches in revealing the molecular mechanisms driving chemotherapy responses in cancer cells. Additionally, this work generates a comprehensive list of molecular alterations that can serve as a foundation for further investigations and inform personalized healthcare strategies to enhance patient outcomes.

The exponential growth of digital information, particularly user-generated content on social media and blogging platforms, has underscored the importance of sentiment analysis (SA). Arabic language sentiment analysis (ASA) involves identifying the orientation of ideas, feelings, emotions, and attitudes within Arabic text to determine whether they convey a positive, negative, or neutral sentiment. This paper presents a comprehensive review of the past decade, focusing on the utilization of SA in the Arabic language. It examines various applications, methodologies, and challenges associated with ASA, highlighting gaps and limitations in existing approaches, lexicons, and annotated datasets. The primary objective of this review is to assist researchers in identifying these gaps and limitations while offering accessible annotated datasets, preprocessing techniques, and procedures. We defined specific criteria for selecting research publications from the last 10 years, including 150 papers in our review process, while excluding earlier publications. The review utilized multiple databases, including Google Scholar, Scopus, and Web of Science. The inherent complexity of the Arabic language, due to its unique traits and diverse dialects, presents significant challenges in ASA. Moreover, the lack of annotated datasets, lexicon resources, and programming tools further complicates sentiment analysis in Arabic. The morphological variations within Arabic make it linguistically challenging. To address these issues, it is crucial to develop additional resources and construct new Arabic sentiment lexicons that account for the various dialects within Modern Standard Arabic (MSA). Our findings reveal that there is no standard public lexicon that adequately enhances the calculation of ASA across different domains, such as e-commerce, politics, public health, and marketing.

Abstract This paper presents a high‐gain wearable circularly polarized bow‐tie antenna (WCPBTA) with metamaterial unit‐cells and 5 pins (5Ps) technique for telemedicine applications such as telemonitoring the elderly or the patients especially for emergency conditions of contagious diseases. The frequency range of the proposed antenna is 5.725–5.850 GHz, which belongs to the unlicensed‐national information infrastructure (U‐NII‐3) for the industrial, scientific, and medical (ISM) sub‐channels. A light‐weight and flexible felt with dielectric constant εr = 3, thickness 1.27 mm, and tan (δ) = 0.0095 is used as the substrate for patient comfort and wearability. The overall dimensions of the proposed antenna are 64 × 62 × 1.27 mm3 or 0.102 λg3 at 5.8 GHz. The maximum simulated gain at 5.8 GHz is 8.25 dB, which is more than 4 dB compared to that of the original bow‐tie antenna. Besides, the axial ratio (AR) and the specific absorption rate (SAR) are also analyzed, which meet the perfect requirement for medical applications. The fabricated prototype of the antenna shows good compatibility between simulation and measurement results. These characteristics make the proposed WCPBTA a good choice for wireless body area networks (WBANs) in telemonitoring applications especially with the aim of preventing the spread of contagious diseases.

Urbanization has caused severe negative impacts on intra-urban river water worldwide. In this study, the WHO drinking water standards (2024) were used as reference to assess the physicochemical properties, heavy metals (HMs) content and microbial load in water and sediment samples collected from 25 locations along Rachiine River, located in Northern Lebanon, during wet and dry periods. Multivariate statistical analysis was applied to evaluate the seasonal variations in water and sediment quality, and determine the pollution sources. The microbial load assessment indicated high pollution levels by Escherichia coli, fecal enterococci, total coliform and fecal coliform, which generally increased as the river progressed downstream. Cluster analysis (CA) provided three major clusters in the study region, representing the northern, central, and southern sectors of the river. Principal components analysis (PCA) of water samples generated four principal components (PCs) accounting for 64.3, 11.4, 7.6 and 4.1 % of the total variance, whereas PCA of sediment samples explained 59.1, 16.9 and 11.1 % of the data set variance. These PCs revealed that the quality of water and sediments is significantly impacted by point and diffuse sources, including geological and anthropogenic factors. These findings call for urgent management strategies to limit future deterioration of the aquatic bodies.

Aim: Impact of final root canal disinfectants diode laser (DL), Rose Bengal photosensitizer (RBP), Chitosan Nanoparticles (CNPs), and CNPs modified RBP on Enterococcus faecalis (E.faecalis) survival rate, smear layer (SL) removal efficacy and push out bond strength (PBS) of resin sealer to the radicular dentin. Material and method: Single rooted seventy-five human mandibular premolar teeth were sectioned at a level of cementoenamel (CEJ) and root canal treatment was performed using a ProTaper rotary instrument. To assess the antibacterial efficiency E.faecalis inoculation was performed using a pour plate method. The samples were arbitrarily allocated into five groups based on the final disinfectant received (n = 15) Group-1 (NaOCl+17 % EDTA), Group-2 (NaOCl+DL), Group-3 (NaOCl+CNPs), Group-4 (NaOCl+RBP activated by DL) and Group-5 (NaOCl+CNPs-RBP activated by DL). SEM analysis for SL removal was performed on five specimens from each group. Root canal obturation and sectioning were performed at cervical, middle, and apical levels. PBS and failure mode were analyzed using a universal testing machine (UTM) and stereomicroscope respectively. The data was subjected to analysis using one-way analysis of variance (ANOVA) and Tukey's post hoc test. Result: Group 1 (NaOCl+17 % EDTA) (0.36 ± 0.01 CFU/mL) unveiled the maximum survival rate of tested bacteria. However, Group 5 (NaOCl+CNPs-RBP activated by DL) (0.11 ± 0.01 CFU/mL) displayed minimum survival of E.faecalis. The highest SL removal (1.44 ± 0.11) and bond integrity scores (12.23 ± 0.24 MPa) were recorded in the coronal section of Group 5 (NaOCl+ CNPs-RBP activated by DL) treated roots. However, the lowest removal of SL (3.15 ± 1.09) and PBS (7.24 ± 0.09 MPa) were recorded in Group 4 (NaOCl+RBP activated by DL) treated canals. CONCLUSION: CNPs-RBP activated by DL as the final irrigant provided satisfactory antibacterial activity, SL removal, and bond strength outcomes compared to other tested groups.

Herlyn-Werner-Wunderlich (HWW) syndrome is a rare congenital condition characterized by renal agenesis, uterine didelphys, and obstructed hemivagina. This report presents the case of a 19-year-old woman who reported lower abdominal pain and offensive vaginal discharge. Imaging revealed a didelphys uterus, two vaginas, two cervixes, hematocolpos, and an absent right kidney. Surgical intervention involved draining the hematocolpos and excising the uterine septum. After surgery, the patient successfully conceived and had a full-term pregnancy, delivering via cesarean section without complications. This case highlights the importance of early diagnosis and surgical management in preventing complications such as endometriosis and infertility. Prompt recognition and treatment are crucial for preserving fertility in patients with HWW syndrome.

Aim: Dentin conditioned with phosphoric acid (PA) Nd: YAP laser, and photoactivated-Ery(Erythrosine) on microleakage, shear bond strength (SBS) degree of conversion (DC), and rheological assessment of adhesive-infused with carbon nanotubes (CNTs). Material and method: Carious ninety-six human mandibular molars were included. Specimens were disinfected and allocated into three groups based on surface pretreatment (n = 32) Group 1 (PA), Group 2 (Nd: YAP) laser, and Group 3 (Photoactivated-Ery). Conditioned groups were further divided into two 2 subgroups based on the application of unmodified ERA and CNTs-modified ERA. Composite restorations were placed on the CAD surface and thermal aging of the samples was performed. The microleakage assessment was conducted using a dye penetration test. Universal testing machine (UTM) assessed SBS bond failure was evaluated using a stereomicroscope. Scanning electron microscopy (SEM), energy-dispersive X-ray (EDX) analyses of CNT, and Fourier Transform Infrared FTIR of adhesives were performed. One-way ANOVA and Tukey post hoc analyzed the outcomes. Results: Group 1B samples (PA+ CNTs modified adhesive) presented the minimum marginal leakage and highest bond integrity. Group 2A (Nd:YAP laser+Unmodified adhesive) displayed the maximum scores of microleakage and lowest bond strength. Conclusion: Photoactivated Ery-PS can serve as an alternative to phosphoric acid for conditioning CAD. Incorporating CNT in adhesive significantly enhanced bond integrity and marginal seal with no significant difference in DC.

Introduction: Noise exposure may cause a kind of sensorineural hearing loss. Noise-induced hearing loss is known as an occupational disease, but the effect of exposure to recreational noise is not completely understood. This study aimed to assess the impact of exposure to recreational noise on hearing status. Materials and Methods: This was a cross-sectional study of 304 medical students. The participants were randomly selected from medical students in years 4 to 6 and were divided into two groups regarding their exposure to recreational noise. Conventional audiometry was done for all participants, and hearing thresholds at different frequencies were compared between two groups. Data were analyzed using SPSS (ver. 20) using Kolmogorov-Smirnov, Mann-Whitney U, and chi-square tests. Results: The mean age of the participants was 23.18±3.14 years. In total, 74.7% of participants were exposed to recreational noise. The mean duration of noise exposure was 4.67±2.91 years. The most frequent exposure was to music via a headphone or hands-free (27.3%). All hearing thresholds in both groups were within the normal range and there was no significant difference between the two groups regarding hearing thresholds. Conclusion: The results of the present study showed that any exposure type of recreational noise (music, eulogy, or lecture) in the young population did not affect hearing thresholds.

Abstract Background Along the southern shoreline of Lake Malawi, the incidence of schistosomiasis is increasing with snails of the genera Bulinus and Biomphalaria transmitting urogenital and intestinal schistosomiasis, respectively. Since the underlying distribution of snails is partially known, often being focal, developing pragmatic spatial models that interpolate snail information across under-sampled regions is required to understand and assess current and future risk of schistosomiasis. Methods A secondary geospatial analysis of recently collected malacological and environmental survey data was undertaken. Using a Bayesian Poisson latent Gaussian process model, abundance data were fitted for Bulinus and Biomphalaria. Interpolating the abundance of snails along the shoreline (given their relative distance along the shoreline) was achieved by smoothing, using extracted environmental rainfall, land surface temperature (LST), evapotranspiration, normalised difference vegetation index (NDVI) and soil type covariate data for all predicted locations. Our adopted model used a combination of two-dimensional (2D) and one dimensional (1D) mapping. Results A significant association between normalised difference vegetation index (NDVI) and abundance of Bulinus spp. was detected (log risk ratio − 0.83, 95% CrI − 1.57, − 0.09). A qualitatively similar association was found between NDVI and Biomphalaria sp. but was not statistically significant (log risk ratio − 1.42, 95% CrI − 3.09, 0.10). Analyses of all other environmental data were considered non-significant. Conclusions The spatial range in which interpolation of snail distributions is possible appears < 10km owing to fine-scale biotic and abiotic heterogeneities. The forthcoming challenge is to refine geospatial sampling frameworks with future opportunities to map schistosomiasis within actual or predicted snail distributions. In so doing, this would better reveal local environmental transmission possibilities. Graphical Abstract

Background Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae including Escherichia coli (E. coli), are recognized as a global public health threat due to their multidrug-resistant (MDR) phenotypes and their rapid dissemination in aquatic environments. Nevertheless, studies investigating the prevalence and antimicrobial resistance (AMR) profile of ESBL-producing E. coli in Lebanese surface water are limited. Objective This study aimed to assess the physicochemical properties and microbial contamination load and to determine the distribution of AMR patterns of ESBL-producing E. coli in surface water samples from different sites in the North Governorate of Lebanon. Methods Water samples were collected from 25 major sites in North Lebanon. These samples were analyzed for the presence of total coliforms, E. coli, and fecal enterococci. Phenotypic and genetic characterizations were then performed for E. coli isolates to determine their resistance patterns and phylogenetic groups. Results Fifty-six samples out of 100 samples were positive for ESBL-producing E. coli, mostly harboring blaCTX-M (40/56, 71%) including blaCTX-M-15 (33/40, 82%), blaTEM gene (36/56, 64%), blaSHV (20/56, 36%), and blaOXA (16/56, 29%) including blaOXA-48 gene (11/16, 69%). Most ESBL-producing E. coli isolates belonged to the extra-intestinal pathogenic phylogroup B2 (40/56, 71.4%) while 10/56 (17.9%) belonged to the commensal phylogroup A. Conclusion Our results highlight the need to implement effective water monitoring strategies to control transmission of ESBL-producing E. coli in surface water and thus reduce the burden on human and animal health.

Abstract Adolescence is a key period for neurocognitive maturation where deviation from normal developmental trajectories may be tied to adverse mental health outcomes. Cognitive disruptions have been noted in populations at risk for psychosis and are known to accompany periods of sleep deprivation. This study aims to assess the role of cognition as a mediator between sleep disruptions and psychosis risk. A cohort of 3801 high school students (51% female, mean age = 12.8, SD = 0.45 years) was recruited from 31 Montreal high schools. Measures of sleep, psychotic-like experiences, inhibition, working memory, perceptual reasoning, and delayed recall were collected from participants on a yearly basis over the five years of their high school education. A multi-level model mediation analysis was performed controlling for sex and time squared. Response inhibition was shown to be associated with, and to mediate (B = −0.005, SD = 0.003, p = 0.005*) the relationship between sleep disruptions (B = −0.011, SD = 0.004, p

Background: This study aimed to determine the prevalence of Antimicrobial Resistance Genes (ARGs), with a focus on colistin resistance in clinical A. baumannii, as well as the risk factors associated with A. baumannii infection in Jordanian patients. Methods: In total, 150 A. baumannii isolates were obtained from patients at a teaching hospital. The isolates were tested for antimicrobial susceptibility using disc diffusion and microdilution methods. PCR amplification was used to detect ARGs, and statistical analysis was conducted to evaluate the influence of identified risk factors on the ARGs acquisition. Results: More than 90% of A. baumannii isolates were resistant to monobactam, carbapenem, cephalosporins, Fluoroquinolones, penicillin, and β-lactam agents. Moreover, 20.6% of the isolates (n = 31) were colistin-resistant. Several ARGs were also detected in A. baumannii isolates. Univariate analysis indicated that risk factors and the carriage of ARGs were significantly associated P ≤ (0.05) with gender, invasive devices, immunodeficiency, systemic diseases, tumors, and covid-19. Logistic regression analysis indicated seven risk factors, and three protective factors were associated with the ARGs (armA, strA, and strB) P ≤ (0.05). In contrast, tetB and TEM were associated with 2 risk factors each P ≤ (0.05). Conclusion: Our study indicates a high prevalence of MDR A. baumannii infections in ICU patients, as well as describing the case of colistin-resistant A. baumannii for the first time in Jordan. Additionally, the risk factors associated with ARGs-producing A. baumannii infections among ICU patients suggest a rapid emergence and spread of MDR A. baumannii without adequate surveillance and control measures.

Abdominal aortic aneurysm (AAA) is the focal dilation of the terminal aorta, which can lead to rupture if left untreated. Traditional endovascular aneurysm repair techniques are minimally invasive and pose low mortality rates compared with open surgical repair; however, endovascular aneurysm repair procedures face challenges in accommodating variations in the patient's anatomy. Complex aneurysms are defined when the sac extends past the renal arteries or has an insufficient neck landing zone to deploy a traditional endograft. Fenestrated endografts were introduced to enable the repair of complex aneurysms by the creation of fenestrations to enable blood flow into the visceral arteries. This study investigates proof of concept for creating antegrade in situ fenestrations of off-the-shelf endografts using a novel endovascular orifice detection device. Our technique enables the precise location of the visceral artery orifices using fiber optic cables and an infrared light source. The endovascular orifice detection device was tested rigorously in precisely locating an artery opening in blood and a custom AAA phantom model. The study also explored the safest means of creating a fenestration using mechanical puncture and a laser. This innovative approach offers a viable alternative for patients with complex AAAs.

Background: Patients with multiple myeloma (MM) are at risk of venous thromboembolism (VTE), worsened by immunomodulatory drugs. Although antithrombotics are recommended for prophylaxis, existing guidelines are suboptimal and treatment outcomes remain unclear. Objectives: This study aimed to investigate adverse events, antithrombotic utilization, and their associations with survival outcomes in patients with MM initiating multi-drug immunomodulatory combinations. Design: A posthoc analysis of individual-participant level data (IPD). Methods: IPD from three daratumumab clinical trials (MAIA, POLLUX, and CASTOR) were pooled. Adverse events incidence and antithrombotic utilization were assessed. Logistic and Cox regression were utilized to examine associations between antithrombotics use with adverse events and survival outcomes at the baseline and 6-month landmark. Results: Among 1804 patients, VTE occurred in 10%, bleeding in 14%, ischemic heart disease in 4%, and stroke in 2%. Patients with these adverse events demonstrated elevated rates of any grade ⩾3 events. Antiplatelet (primarily aspirin) and anticoagulant (primarily LMWH and direct oral anticoagulants) prescriptions have seen an increase from baseline (25% and 14%, respectively) to 6 months (35% and 31%). The primary indication for their use was prophylaxis. Anticoagulant use within 6 months was associated with reduced VTE (OR (95% CI) = 0.45 (0.26–0.77), p = 0.004), while antiplatelet use showed no associations with any evaluated adverse events. Antithrombotics and survival outcomes had no significant associations. Conclusion: This study underscores the complexities of antithrombotic therapy and adverse events in MM and highlights the need for vigilant and proactive management due to increased grade ⩾3 adverse events. While anticoagulant use was associated with reduced VTE risk, further research is needed to optimize thromboprophylaxis guidelines and explore antithrombotic efficacy and safety in patients with MM. Trial registration: MAIA (NCT02252172), POLLUX (NCT02076009), CASTOR (NCT02136134).

Summary: Resident memory T cells (TRMs) play a vital role in regional immune defense. Although laboratory rodents have been extensively used to study fundamental TRM biology, poor isolation efficiency and low cell survival rates have limited the implementation of TRM-focused high-throughput assays. Here, we engineer a murine vaginal epithelial organoid (VEO)-CD8 T cell co-culture system that supports CD8 TRM differentiation. These in-vitro-generated TRMs are phenotypically and transcriptionally similar to in vivo TRMs. Pharmacological and genetic approaches showed that transforming growth factor β (TGF-β) signaling plays a crucial role in their differentiation. The VEOs in our model are susceptible to viral infections and the CD8 T cells are amenable to genetic manipulation, both of which will allow a detailed interrogation of antiviral CD8 T cell biology. Altogether we have established a robust in vitro TRM differentiation system that is scalable and can be subjected to high-throughput assays that will rapidly add to our understanding of TRMs.

COVID-19 is a highly contagious infectious disease that has posed a global threat, leading to a widespread pandemic characterized by multi-organ complications and failures. Aims: The present study was conducted to evaluate the impact of Pfizer and Sinopharm vaccines on metabolomic changes and their correlations with immune pathways. Main methods: The study used a cross-sectional design and implemented an untargeted metabolomics-based approach. Plasma samples were obtained from three groups: non-vaccinated participants, Sinopharm-vaccinated participants, and Pfizer-vaccinated participants. Comparative metabolomic analysis was conducted using TIMS-QTOF, and multiple t-tests with a 5 % false discovery rate (FDR) were performed using MetaboAnalyst software. Key findings: Out of the 105 metabolites detected, 72 showed statistically significant changes (p-value < 0.05) across the different groups. Notably, several metabolites such as neopterin, pyridoxal, and syringic acid were markedly altered in individuals vaccinated with Pfizer. Conversely, in the Sinopharm-vaccinated group, significant alterations were observed in sphinganine, neopterin, and sphingosine. These metabolites hold potential as biomarkers for evaluating vaccine efficacy. Additionally, both Pfizer and Sinopharm vaccinations were found to influence sphingolipid and histidine metabolisms compared to the control group. The Sinopharm group also displayed changes in lysine degradation relative to the control group. When comparing the enriched pathways between the Pfizer and Sinopharm-vaccinated groups, differences were observed in purine metabolism. Furthermore, alterations in tryptophan and vitamin B6 metabolism were noted when comparing the Pfizer-vaccinated group with both the control and Sinopharm-vaccinated groups. Significance: These findings highlight the importance of metabolomics in assessing vaccine effectiveness and identifying potential biomarkers for monitoring the efficacy of newly developed vaccines in a shorter timeframe.

BACKGROUND: Composite Autonomic Symptom Score-31 (COMPASS-31) is an easy-to-use screening tool for the evaluation of autonomic dysfunction in various diseases affecting neural function but has rarely been used in the assessment of long coronavirus disease 2019 (COVID-19). This study aimed to evaluate the diagnostic accuracy of the COMPASS-31 score in detecting dysfunction of the autonomic nervous system in patients 3 months after COVID-19 infection. MATERIALS AND METHODS: Fifty-nine subjects were recruited and grouped into 2: (a) controls (n = 31) who had never had positive polymerase chain reaction results for COVID-19 before and (b) the post-COVID-19 patients (n = 28) who had confirmed COVID-19 infection 3–6 months before recruitment. COMPASS-31 questionnaire was utilized to evaluate subjective symptoms or evidence of autonomic dysfunction. Autonomic dysfunction was assessed objectively by cardiovascular autonomic reflex tests (CARTs) and heart rate variability (HRV). For comparison of quantitative variables between two groups, t-test or Mann-Whitney U test, as appropriate, were used. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), negative likelihood ratio (LR), and positive LR were used as measures of diagnostic accuracy. Receiver operating characteristic (ROC) curve analysis determined the overall accuracy of COMPASS-31. RESULTS: The median COMPASS score was found to be significantly higher in post-COVID-19 participants than controls (15.5 vs. 10, P = 0.021). The median total CART score was also significantly higher in post-COVID-19 participants (0 vs. 1, P < 0.001). Out of 6 domains of the COMPASS score, the median value for orthostatic dysfunction was found to be significantly higher in post-COVID-19 participants than controls (12 vs. 0, P = 0.008). There was significantly fair accuracy of the COMPASS score with an area under the receiver operating curve 0.68 (0.54–0.82) following the total CART score ≥2 as the gold standard in the diagnosis of autonomic dysfunction (P = 0.021). The best cutoff point of the total COMPASS score was 12.5, where the optimal values of sensitivity, specificity, and positive and negative predictive values were achieved. Nonsignificant and weak correlations between CARTs, HRV parameters, and COMPASS score were found. CONCLUSION: COMPASS-31 could be used as a user-friendly screening tool to detect autonomic dysfunction in post-COVID-19 cases with acceptable sensitivity and specificity.

Background: Systemic Lupus Erythematosus (SLE) may affect one or more organ systems; as time goes on, other manifestations may start to appear. Musculoskeletal, cutaneous, renal, and endocrine systems are all involved in SLE. The nervous system, hematological, vascular, pulmonary, gastrointestinal, and ocular imbalance of the immune response and the production of autoantibodies such as anti-oxidized Low-Density Lipoprotein LDL antibodies have a clear impact on the body’s organs and the development of complications of the disease. Objectives: To assess the levels of anti-oxLDL (IgM-Abs) and anti-oxLDL (IgG-Abs) as biomarkers for disease activity in SLE patients and their relationship to demographic characteristics. Patients and Methods: The study comprised 100 of SLE patients admitted to the Rheumatology Unit at Baghdad Teaching Hospital, age range (33.4 to 9.95) years, including 7 males and 93 females. An enzyme-linked immunosorbent Assay ELISA was used to measure the levels of serum oxLDL (IgM-Abs) and oxLDL (IgG-Abs). Results: The results of the present study showed that there was a significant difference between the levels of anti-oxLDL IgM antibodies(Abs) in SLE patients in obese and non-obese groups since the levels of anti-oxLDL-IgM Abs in obese patients were (3.14 µg/L) and non-obese patients were (5.13 µg/L) (P=0.005), while in SLE patients with Diabetes Mellitus (D.M.), the levels of anti-ox LDL-IgM Abs were (3.80 µg/L) and in SLE patients with no DM were (5.13 µg/L). Also, the results showed that there were no significant differences between levels of anti-oxLDL IgG Abs in obese patients with SLE (6.28 µg/L) and non-obese patients with SLE (10.25µg/L) P > 0.05. Conclusion: There was found a significant difference between levels of anti-oxLDL IgM Abs in obese and non-obese in patients with SLE, and no significant differences between the levels of anti-oxLDL IgG Abs in the same groups of patients.

Objective In 2012, the Commission on Human Medicines mandated lowering the acetaminophen toxicity nomogram treatment threshold in the UK to 100 µg/ml at 4 h post-ingestion. The present study aim was to evaluate biochemical and liver toxicity patterns in patients who presented with acetaminophen overdose and had low serum acetaminophen concentrations (150 µg/ml or an unknown ingestion time were excluded. Data were extracted from electronic medical records and are presented as mean ± SD or median (interquartile range). Results A total of 103 patients were included (median age, 17 [4–21] years) and 80 (78%) were female. The median ingested acetaminophen dose was 5000 (2850–7650) mg. At baseline, the median serum acetaminophen concentration was 42 (4.5–64.8) µg/ml, and median alanine aminotransferase and aspartate aminotransferase levels were 22 (17–28) and 27 (16–45) IU/L, respectively. Twenty patients were treated with acetylcysteine, with none developing adverse reactions. No patient developed hepatotoxicity, including patients with initial multiple product ingestion or other risk factors. Conclusions Patients presenting with an acute acetaminophen overdose with acetaminophen level

Objectives: Infective endocarditis (IE) caused by Abiotrophia spp. and Granulicatella spp. share an increased risk of extracardiac vascular complications (EVC). The current work aims to assess the prevalence of EVC in IE due to these microorganisms. Methods: This was a study with mixed design, consisting in a single center experience combined with a systematic review of multiple databases. We included studies enrolling adults >18 years old with a diagnosis of Abiotrophia spp. and Granulicatella spp. IE. We collected data regarding the presence and the description of EVC in IE along with clinical and microbiological details. Risk of bias assessment was performed using the Newcastle-Ottawa Scale for comparative observational studies, and a dedicated tool for single-arm non-comparative studies. The review was registered in PROSPERO (CRD42023433130). Results: The cohort study identified 2 patients. The systematic review included 83 studies, involving 228 cases of Abiotrophia spp. (n = 103), Granulicatella spp. (n = 94), and unspecified nutritionally variant streptococci (n = 31) IE. EVC occurred in 101/230 (44 %) patients, central nervous system involvement occurred in 66/101 (66 % of total embolisms), and pseudoaneurysm or peripheral vascular embolization occurred in 11/101 (11 %). Conclusions: Considering the observed prevalence of EVC a proactive approach in the diagnosis of such a complication is warranted.

Objective Early detection of cancer is crucial for reducing the global burden of cancer, but effective screening tests for many cancers do not exist. This study aimed to develop a novel proteome-based multi-cancer screening test that can detect early-stage cancers with high accuracy.Methods and analysis We collected plasma samples from 440 individuals, healthy and diagnosed with 18 early-stage solid tumours. Using proximity extension assay, we measured more than 3000 high-abundance and low-abundance proteins in each sample. Then, using a multi-step statistical approach, we identified a limited set of sex-specific proteins that could detect early-stage cancers and their tissue of origin with high accuracy.Results Our sex-specific cancer detection panels consisting of 10 proteins showed high accuracy for both males (area under the curve (AUC): 0.98, 95% CI 0.96, 1) and females (AUC: 0.983, 95% CI 0.95, 1.00). At stage I and at the specificity of 99%, our panels were able to identify 93% (95% CI 79%, 100%) of cancers among males and 84% (95% CI 68%, 100%) of cancers among females. Our sex-specific localisation panels consisted of 150 proteins and were able to identify the tissue of origin of most cancers in more than 80% of cases. The analysis of the plasma concentrations of proteins selected showed that almost all the proteins were in the low-concentration part of the human plasma proteome.Conclusion The proteome-based screening test showed promising performance compared with other technologies and could be a starting point for developing a new generation of screening tests for the early detection of cancer.

Abstract Background Machine learning (ML) algorithms can accurately estimate left ventricular ejection fraction (LVEF) from echocardiography, but their performance on cardiac point-of-care ultrasound (POCUS) is not well understood. Objectives We evaluate the performance of an ML model for estimation of LVEF on cardiac POCUS compared with Level III echocardiographers’ interpretation and formal echo reported LVEF. Methods Clinicians at a tertiary care heart failure clinic prospectively scanned 138 participants using hand-carried devices. Video data were analyzed offline by an ML model for LVEF. We compared the ML model's performance with Level III echocardiographers' interpretation and echo reported LVEF. Results There were 138 participants scanned, yielding 1257 videos. The ML model generated LVEF predictions on 341 videos. We observed a good intraclass correlation (ICC) between the ML model's predictions and the reference standards (ICC = 0.77–0.84). When comparing LVEF estimates for randomized single POCUS videos, the ICC between the ML model and Level III echocardiographers' estimates was 0.772, and it was 0.778 for videos where quantitative LVEF was feasible. When the Level III echocardiographer reviewed all POCUS videos for a participant, the ICC improved to 0.794 and 0.843 when only accounting for studies that could be segmented. The ML model's LVEF estimates also correlated well with LVEF derived from formal echocardiogram reports (ICC = 0.798). Conclusion Our results suggest that clinician-driven cardiac POCUS produces ML model LVEF estimates that correlate well with expert interpretation and echo reported LVEF.

Abstract Rotary-wing aerial vehicles offer manoeuvrability and vertical take-off and landing (VTOL) advantages over fixed-wing systems. Rotary-wing systems do however have comparatively higher energy demands and consequently shorter flight times and therefore a greater energy dependence over their fixed-wing counterparts. Advances in photovoltaic technologies have resulted in significant increases in the specific power (power-to-weight-ratio) of solar cells enabling the design of solar-powered rotary-wing aircraft, and now micro-sized variants. The micro aerial vehicle (MAV) presented, the Micro Solarcopter, is a 0.15 m $$\times$$ × 0.15 m $$\times$$ × 0.02 m solar-rechargeable radio-controlled aircraft. The 0.071 kg aircraft can fly for an average time of 3.5 min, recharge in approximately 68 min under 1000 W/m2 irradiance at 25 °C and can hibernate for 38 days without sunlight. The paper explores the use of commercially available photovoltaic cells for the purpose of increasing the energy autonomy of multi-rotor MAVs, by enabling them to stay out in the field without returning to base for charging. A working prototype has been presented which incorporates a battery management system, automatic power on and off, low-power sleep mode, and first-person-view (FPV) camera.

Abstract The emergence of supermassive black holes (SMBHs) in the early universe remains a topic of profound interest and debate. In this paper, we investigate the formation and growth of the first SMBHs within the framework of Modified Gravity (MOG), where gravity exhibits increased strength. We explore how MOG, as an alternative to the standard model, may offer novel insights into the emergence of SMBHs and potentially reconcile the discrepancies observed in the accretion and growth processes. We examine the dynamics of gas and matter in this modified gravitational framework, shedding light on the unique interplay between gravity and the formation of SMBHs.

ABSTRACT: Objectives: The purpose of this study was to determine the prevalence of colistin-resistant Escherichia coli carrying mcr-1, and to identify risk factors associated with mcr gene-mediated resistance. Methods: In total, 385 cloacal samples were collected from 125 broiler farms and a questionnaire containing information about each farm was designed and filled. Results: Most of the antibiotics used in the disk diffusion method were highly resistant in all samples, with tetracycline and penicillin showing 100% and 99.7% resistance, respectively. Additionally, avian pathogenic E. coli (APEC) virulence genes frequency and percentage of APEC were identified, including sitA, iucC, and astA at 77%, 70.5%, and 62% respectively. In total, 214 of 360 isolates were positive for APEC (59.4%). Based on the minimum inhibitory (MIC) test, 58% of the isolates (n = 209 of 360) were resistant to colistin, with 39.7% displaying the mcr-1 gene. The statistical analysis of risk factors that influence colistin resistance prevalence revealed several significant factors, including commercial feed, farm management, sanitization, and antibiotic use. Irregular health checks for workers, non-dipping of feet before entering poultry houses, and the use of commercial poultry feeds all contributed to higher levels of colistin resistance as measured by MIC. On the other hand, doxycycline and commercial feed was 4 and 3.2 times more likely to occur based on the final logistic model of the mcr-1 gene, respectively. Conclusion: Our results suggest that better biosecurity protocols should be implemented in poultry farms to reduce antibiotic-resistant bacteria. Additionally, antibiotics should be carefully monitored and used only when necessary.

ABSTRACTIn recent years, decision support systems (DSSs) have successfully deployed ontologies in their architecture. The result of such a use is information systems that assist users and organizations in semi-structured decision-making activities. Visitors from throughout Iran travel to different cities and regions every year, and they need help making their choices. Some of these tourists are unable to visit the beautiful areas of the destination city due to a lack of awareness. In this study, we design an ontology-based spatial DSS to find entertainment and tourism centers in Arak, Iran. The objective is to provide users with recommendations appropriate for the location, time, age group, type of activity, and other factors. In this model, the demands and concerns of tourists have been managed by creating a domain Web Ontology Language (OWL) for entertainment centers as a knowledge base in the Protégé environment. The developed web-based DSS operates on a client-server architecture using technologies such as Werkzeug and Flask. As a result, it makes it possible to ontology reasoning based on the HermiT engine to choose the right center and conduct a semantic search on classes related to the appropriate point of interest. The main distinction between the proposed methodology and the previous studies on spatial DSS is that criteria are object properties in an ontology. Therefore, decision support relies on real-time reasoning rather than transforming criteria into geospatial layers. The evaluation results confirmed efficient interaction with this system, purposeful information retrieval, and rapid decision-making process. The results also indicated that searching for a POI (point of interest) in the study area using the developed system is at least 30% more successful than a search engine or social media. Moreover, to overcome the cold start problem, the proposed technique might be utilized in conjunction with the POI recommender systems.

RAS mutations are prevalent in indeterminate thyroid nodules, but their association with malignancy risk and utility for diagnosis remains unclear. We performed a systematic review and meta-analysis to establish the clinical value of RAS mutation testing for cytologically indeterminate thyroid nodules. PubMed and Embase were systematically searched for relevant studies. Thirty studies comprising 13,328 nodules met the inclusion criteria. Random effects meta-analysis synthesized pooled estimates of RAS mutation rates, risk of malignancy with RAS positivity, and histologic subtype outcomes. The pooled mutation rate was 31 % (95 % CI 19-44 %) among 5,307 indeterminate nodules. NRAS mutations predominated at 67 % compared to HRAS (24 %) and KRAS (12 %). The malignancy rate with RAS mutations was 58 % (95 %CI=48-68 %). RAS positivity increased malignancy risk 1.7-fold (RR 1.68, 95 %CI=1.21-2.34, p=0.002), with significant between-study heterogeneity (I2=89 %). Excluding one outlier study increased the relative risk to 1.75 (95 %CI=1.54-1.98) and I2 to 14 %. Funnel plot asymmetry and Egger's test (p=0.03) indicated potential publication bias. Among RAS-positive malignant nodules, 38.6 % were follicular variant papillary carcinoma, 34.1 % classical variant, and 23.2 % follicular carcinoma. No statistically significant difference in the odds of harboring RAS mutation was found between subtypes. In conclusion, RAS mutation testing demonstrates clinical utility for refining the diagnosis of cytologically indeterminate thyroid nodules. Positivity confers a 1.7-fold increased malignancy risk, supporting use for personalized decision-making regarding surgery vs. monitoring. Follicular variant papillary carcinoma constitutes the most common RAS-positive malignant histological subtype.

Abstract The proliferation of technology in educational settings and its impact on learning outcomes has become a focal point in educational research. In language education, the interplay among technological tools, learner self-efficacy, and language proficiency is critical for academic success. This study aims to shed light on these dynamics by presenting a comprehensive structural model that elucidates the relationships and causal effects among students’ academic achievement, English proficiency, self-efficacy, and the utilization of instructional technology while focusing on the Blackboard learning management system. Employing a quantitative correlational design, this study used three questionnaires to measure the primary variables. The study sample included 590 university students from two universities purposively selected using random stratified sampling to ensure representativeness. Statistical analyses—including descriptive statistics, correlation coefficients, and structural equation modeling (path analysis)—were employed to investigate the data. The emergent model demonstrated a perfect fit to the sample data, exhibiting robust goodness-of-fit indicators. The findings highlight the direct positive influence of self-efficacy on academic achievement and the beneficial effects of Blackboard integration on English proficiency and academic success. These insights emphasize the importance of self-efficacy in educational achievement and the pivotal role of e-learning platforms in enhancing students’ motivation and linguistic skills. The implications of these results are profound, suggesting avenues for future research to examine the applicability of the structural model across diverse educational contexts and incorporate additional variables for a more granular understanding of the factors driving academic achievement in technology-enhanced learning environments.

Antennas are shifting with the Internet of Everything (IoE), 6G Joint Sensing and Communication (JSAC), and Wireless Power Transfer (WPT) paradigms into multifunctional devices, that provide more functionality than simply transmitting and receiving communication signals. Thus, antennas or RF-enabled devices [1], emerged as a class of IoE systems which use antennas as sensors, power supplies, or multi-functional JSAC interfaces. This editorial highlights the accepted contributions across 11 papers, presenting contributions from leading researchers on innovative antenna applications beyond telecommunication, spanning RFID, sensing applications in agriculture, food, healthcare, computational imaging, and wireless power transfer.

This paper introduces a novel design methodology for a dual-band branch-line coupler (DBBLC) that, for the first time, facilitates practically unlimited band ratio, enhanced flexibility in power division, and arbitrary port termination impedance concurrently. This approach ensures precise power distribution, matching, and isolation requirements by utilizing a generalized coupler core paired with an L-section impedance-matching network. This paper details an innovative and comprehensive analytical strategy for DBBLC design, which overcomes the limitations noted in prior research by deriving a generalized formula for the power division ratio (k) and simplifying the design equations to decrease complexity. This method enables the simultaneous realization of varied power division ratios, frequency ratios (r), and port impedances ( $Z_{p}$ ), thus offering remarkable design versatility. The effectiveness of this new analytical design methodology is corroborated through several design examples. Moreover, two prototype models operating at 1 GHz/2.5 GHz ( $r=2.5, k=0$ dB) and 1 GHz/2 GHz ( $r=2, k=4.77$ dB) frequencies, constructed on Rogers’ RO4003C substrate, exhibit >22 dB return loss, 25 dB isolation at all the targeted frequencies. Therefore, the development and validation of this new DBBLC structure, as demonstrated by the strong correlation between our simulated and experimental findings, not only surpasses the capabilities of existing models, but also broadens the applicability of dual-band couplers in modern wireless communication systems.

Abstract Breast cancer is one of the leading causes of death in females, mainly because of metastasis. Oncometabolites, produced via metabolic reprogramming, can influence metastatic signaling cascades. Accordingly, and based on our previous results, we propose that metabolites from highly metastatic breast cancer cells behave differently from less-metastatic cells and may play a significant role in metastasis. For instance, we aim to identify these metabolites and their role in breast cancer metastasis. Less metastatic cells (MCF-7) were treated with metabolites secreted from highly metastatic cells (MDA-MB-231) and the gene expression of three epithelial-to-mesenchymal transition (EMT) markers including E-cadherin, N-cadherin and vimentin were examined. Some metabolites secreted from MDA-MB-231 cells significantly induced EMT activity. Specifically, hypoxanthine demonstrated a significant EMT effect and increased the migration and invasion effects of MCF-7 cells through a hypoxia-associated mechanism. Hypoxanthine exhibited pro-angiogenic effects via increasing the VEGF and PDGF gene expression and affected lipid metabolism by increasing the gene expression of PCSK-9. Notably, knockdown of purine nucleoside phosphorylase, a gene encoding for an important enzyme in the biosynthesis of hypoxanthine, and inhibition of hypoxanthine uptake caused a significant decrease in hypoxanthine-associated EMT effects. Collectively for the first time, hypoxanthine was identified as a novel metastasis-associated metabolite in breast cancer cells and represents a promising target for diagnosis and therapy.

Abstract Proton pump inhibitors (PPIs) are commonly used in cancer patients, but their impact on treatment outcomes in multiple myeloma (MM) patients remains unclear. This study investigated the association of PPI use with survival and adverse effects in MM patients across three randomized-control trials initiating daratumumab, lenalidomide, or bortezomib combination treatments. Cox proportional hazard analysis and logistic regression were employed to assess the associations with treatment outcomes, while adjusting for age, sex, weight, MM international staging system stage, ECOG-performance status, comorbidity count, and presence of gastrointestinal disorders. Pooled data involving 1804 patients revealed that 557 (32%) used PPIs at baseline. PPI use was independently associated with worse overall survival (adjusted HR [95% CI] 1.32 [1.08–1.62], P = 0.007) and grade ≥ 3 adverse events (adjusted OR [95% CI] 1.39 [1.03–1.88], P = 0.030). However, the association with progression-free survival did not reach statistical significance (adjusted HR [95% CI] 1.14 [0.97–1.33], P = 0.112). Findings were consistent across trials and treatment arms. PPI use was identified as a negative prognostic factor in MM patients, potentially enhancing clinical decisions regarding its use. Further research is needed to fully comprehend the impacts and safety of PPI use in MM patients.