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Aberration of the "gut-liver axis" contributes to the development and progression of metabolic dysfunction-associated steatotic liver disease (MASLD). Here, we use multi-omics to analyze the gut microbiota composition and metabolic profile of patients with type-2 diabetes mellitus (T2DM). T2DM patients were screened for liver disease by blood tests, ultrasound, and liver stiffness measurements. Stool microbiota was analyzed by 16S rRNA gene sequencing; metabolomic profiling by Nuclear Magnetic Resonance spectroscopy and Ultra-High Performance-Mass Spectrometry. Microbiome and metabolic signatures were analyzed in the whole cohort and in matched subsets to identify signatures specific for steatosis (MASLD±) or fibrosis (Fibrosis±). Gut permeability was assessed in-vitro using monolayers of MDCK cells and trans-epithelial electric resistance (TEER). Cytokine profile was assessed in serum and stools.Overall, 285 patients were enrolled: 255 serum, 252 urine and 97 stool samples were analyzed. Anaeroplasma and Escherichia/Shigella ASVs were higher, while Butyricicoccus ASVs were lower in those with normal liver. In MASLD±, Butyricicoccus ASV was significantly higher in those with steatosis. In the Fibrosis±, Butyricicoccus ASV was significantly lower in those with fibrosis. Glycochenodeoxycholic acid-3-sulfate (G-UDCA-3S) appeared to be higher in MASLD with fibrosis. Fecal water from patients with MASLD and fibrosis caused the greatest drop in the TEER vs those with normal liver; this was reversed with protease inhibitors. Finally, fecal IL-13 was lower in MASLD with fibrosis. We identified microbiome signatures which were specific for steatosis and fibrosis and independent of other metabolic risk factors. Moreover, we conclude that protease-related gut permeability plays a role in those MASLD patients with fibrosis, and that disease progression is linked to a gut-liver axis which is at least partially independent of T2DM.

A fully probabilistic earthquake risk model was developed for five countries in Central Asia, providing updated earthquake loss estimates with a higher level of detail on all components with respect to previous studies in the region. Additionally, a regionally consistent approach that, on the one hand, allows for direct comparisons at different disaggregation levels (e.g., country and oblast) was used. On the other hand, this updated earthquake risk assessment aims to facilitate initiating a policy dialogue regarding national and regional disaster risk financing and insurance applications. This earthquake risk model made use of a regional probabilistic seismic hazard analysis and a comprehensive exposure database on which different types of assets and sectors were included and for which two scenarios (the years 2020 and 2080) were modeled. For each type of asset, a unique vulnerability function was derived and later used for convolution with the hazard data, which allowed for the estimation of the loss exceedance curve, at different disaggregation levels, from where other risk metrics such as the average annual loss (AAL) and specific return period losses were obtained. The regional earthquake AAL for the five countries and for the 2020 exposure scenario has been estimated to be around USD 2 billion, with the Kyrgyz Republic and Tajikistan being the countries with the highest earthquake risk levels in the region. Besides the probabilistic earthquake risk results, as-if scenarios were modeled using a pseudo-deterministic approach to assess the human and economic losses for realistic and representative earthquakes for the main cities within earthquake-prone regions in the five countries of the study area.

Abstract Background People who use drugs (PWUD) often face restricted healthcare access despite their heightened healthcare needs. Factors such as stigma, mistrust of the healthcare system, competing priorities, and geographical barriers pose significant healthcare access challenges. Telehealth offers an innovative solution to expand healthcare access for better inclusion of underserved populations in healthcare. We aimed to explore PWUDs’ perceptions of telehealth as a healthcare delivery modality. Methods We utilized purposive sampling to recruit participants (N = 57) for nine focus group discussions (FGDs) in Athens, Greece. Eligibility criteria required participants to be at least 18 years, with current or prior injection drug use, and current internet access. The FGDs followed a semi-structured interview guide, were audio recorded, transcribed verbatim, translated into English, and de-identified. We applied thematic analysis to analyze FGD transcripts. Results Participants’ mean (standard deviation) age was 47.9 (8.9) years, 89.5% (51/57) were male, 91.2% (52/57) were of Greek origin, and 61.4% (35/57) had attended at least 10 years of school. Three main themes emerged from the FGDs: (1) high internet utilization for healthcare-related purposes among PWUD, (2) highlighting telehealth benefits despite access obstacles and PWUDs’ concerns about diagnostic accuracy, and (3) approaches to overcome access obstacles and build digital trust. Participants extensively used the internet for healthcare-related processes, such as accessing healthcare information and scheduling provider appointments. Despite being telehealth-inexperienced, most participants expressed a strong willingness to embrace telehealth due to its perceived convenience, time-saving nature, and trusted digital environment. Some participants recognized that the inability to conduct physical examinations through telehealth reduces its diagnostic accuracy, while others expressed concerns about digital literacy and technological infrastructure accessibility. Most participants expressed a preference for video-based telehealth encounters over audio-only encounters. To build trust in telehealth and promote patient-centeredness, participants recommended an initial in-person visit, virtual eye contact during telehealth encounters, patient education, and partnerships with PWUD-supportive community organizations equipped with appropriate infrastructure. Conclusions PWUD frequently use the internet for health-related purposes and suggested several approaches to enhance virtual trust. Their insights and suggestions are practical guidance for policymakers seeking to enhance healthcare access for underserved populations through telehealth. Trial registration NCT05794984.

In the present work, we study the number of working units of a consecutive-type structure at a specific time point under the condition that the system’s failure has not been observed yet. The main results of this paper offer some closed formulae for determining the distribution of the number of working components under the aforementioned condition. Several alternatives are considered for identifying the structure of the underlying system. The numerical investigation which is carried out takes into account different distributional assumptions for the lifetime of the components of the reliability system. Some concluding remarks and comments are provided for the performance of the resulting consecutive-type design.

In this article, we improve the behavior of nonparametric Shewhart-type control charts, which employ order statistics and multiple runs-type rules. The proposed class of monitoring schemes includes some existing control charts. In addition, new distribution-free monitoring schemes that pertain to the class, are set up and examined extensively. Explicit expressions for determining the variability and the mean of the run length distribution for the enhanced control charts are additionally delivered. As an example, a real-life managerial application is considered, where the proposed framework is implemented in order to enhance the provided services of a company under a supply chain management environment. Based on numerical comparisons, we draw the conclusion that the new charts outperform their competitors in identifying potential changes in the fundamental distribution in almost all cases considered.

Gastric cancer remains a disease with an ominous prognosis, while early gastric cancer has a good-to-excellent prognosis, with 5-year survival rates of up to 92.6% after successful endoscopic resection. In this context, the accurate identification of patients with established gastric precancerous lesions, namely chronic atrophic gastritis and intestinal metaplasia, is the first step in a stepwise approach to minimize cancer risk. Although current guidelines advocate for the execution of random biopsies to stage the extent and severity of gastritis/intestinal metaplasia, modern biopsy protocols are still imperfect as they have limited reproducibility and are susceptible to sampling error. The advent of novel imaging-enhancing modalities, i.e., high-definition with virtual chromoendoscopy (CE), has revolutionized the inspection of gastric mucosa, leading to an endoscopy-based staging strategy for the management of these premalignant changes in the stomach. Nowadays, the incorporation of CE-targeted biopsies in everyday clinical practice offers not only the robust detection of premalignant lesions but also an improvement in quality, by reducing missed diagnoses along with mean biopsies and, thus, the procedural costs and the environmental footprint. In this review, we summarize the recent evidence regarding the endoscopic grading and sampling of gastric precancerous lesions.

Abstract In this study, optical photothermal infrared (O-PTIR) spectroscopy combined with machine learning algorithms were used to evaluate 46 tissue cores of surgically resected cervical lymph nodes, some of which harboured oral squamous cell carcinoma nodal metastasis. The ratios obtained between O-PTIR chemical images at 1252 cm−1 and 1285 cm−1 were able to reveal morphological details from tissue samples that are comparable to the information achieved by a pathologist’s interpretation of optical microscopy of haematoxylin and eosin (H&E) stained samples. Additionally, when used as input data for a hybrid convolutional neural network (CNN) and random forest (RF) analyses, these yielded sensitivities, specificities and precision of 98.6 ± 0.3%, 92 ± 4% and 94 ± 5%, respectively, and an area under receiver operator characteristic (AUC) of 94 ± 2%. Our findings show the potential of O-PTIR technology as a tool to study cancer on tissue samples.

In this paper we explore the difficulties undergraduates from Greek Higher Educational Institutions faced during the transition to online learning due to the COVID-19 pandemic. By analyzing qualitative data from an online survey (N = 2093), we were able to identify the barriers undergraduates encountered during this transition and make inferences about the quality of the way online learning was implemented. The most frequently reported barriers include problems that undergraduates perceived as being caused by their lecturers, internet connection issues during an online lecture and the perceived limited social interactions that synchronous environments can afford. The paper argues that the way online learning was implemented by Greek Higher Educational Institutions did not result a meaningful learning experience for undergraduates. Our results are relevant to universities that are either forced in implementing emergency online protocols or wish to support their undergraduates' learning experience.

The rapid development of technology in today's times make business' survival a rather complex task. It is therefore necessary for the specialized organization and administration of each company to differentiate and strengthen its competitive advantages. Gamification is an established practice in many business domains and can enforce employees to engage in business processes and change aspects of their behavior. Even though numerous gamification patterns that are described in literature have been used so far by businesses to various working environments, the outcomes were not the best possible that we would expect in terms of their right utilization to business non-game contexts. Thus, there is need for concise gamification patterns that can offer right guidance to game designers in business. Gamification design patterns can provide a distilled knowledge of techniques of how to design object-oriented software. This paper aims to address this gap in existing literature by describing new gamification design patterns, classifying them according to specific criteria and providing new information to this research domain. Our study is a descriptive literature review and is based on review of previous works. This descriptive literature review tries to give a better understanding by proposing new gamification design patterns in the continuously evolving research domain of gamification design patterns.

Introduction: The current imaging report describes a unique coexistence of the neck venous system morphological variants. Methods: The imaging study of a 75-year-old male patient was isolated due to its unique venous system. Results: An internal jugular vein (IJV) duplication (main-typical and accessory IJVs) was identified on the right side, coexisting with a facial vein (FV) drainage into the accessory IJV. On the left side, the external jugular vein (EJV) was draining into the IJV and the FV into the EJV. A transverse anastomosis of the EJV and anterior jugular vein (AJV) was identified. Conclusions: The IJV duplication is a rare morphological variant, and its coexistence with other co-variants complicates the area's anatomy. Understanding these morphological variants is crucial for anesthesiologists and surgeons, as it can help prevent iatrogenic injury.

Summary: Background: Immune dysfunction contributes to a high rate of infection in patients with acute decompensation of cirrhosis. CD52 is a glycoprotein prominently expressed in lymphocytes. Immune regulation by CD52 may be involved in adaptive immune dysfunction in cirrhosis. This study aimed to investigate the function of CD52 on CD4+ T cells on the blood of patients with acute decompensation of cirrhosis. Methods: The expression of CD52 in the peripheral blood lymphocytes of 49 patients with cirrhosis was investigated using flow cytometry and transcriptomics. Potential cis-membrane ligands of CD52 were discovered via proximity labelling followed by proteomics. The function of CD52 on antigen-specific activation of CD4+ T cells was examined using flow cytometry in CD52 CRISPR-Cas9 knockout primary T cells. Findings: CD52 expression was elevated in CD4+ T cells in acute decompensation of cirrhosis, and this elevation was correlated with increased disease severity and mortality. Components of the T cell receptor complex including TCRβ, CD3γ and CD3ε were identified and validated as cis-membrane ligands of CD52. Knockout of CD52 promoted antigen-specific activation, proliferation, and pro-inflammatory cytokine secretion. Interpretation: Membrane bound CD52 demonstrated cis-interaction with the T cell receptor and served as a dynamic regulator of antigen-specific activation of CD4+ T cells. The upregulation of CD52 in the periphery of acute decompensation of cirrhosis hinders the recognition of the T cell receptor by MHC, contributing to impaired T cell function. The development of an alternative anti-CD52 antibody is required to restore T cell function and prevent infections in cirrhosis. Funding: This study was supported by the NIHR Imperial Biomedical Research Centre, Institute for Translational Medicine and Therapeutics (P74713), Wellcome Trust (218304/Z/19/Z), and Medical Research Council (MR/X009904/1 and MR/R014019/1).

The aim of this research was to investigate the influence of a foliar fertilization program, consisted of the BUD 14 nitrogen-calcium commercial formulation (N: 14% w/w, CaO: 5.5% w/w) as a biostimulant, on bud development percentage, flowering rate, classification of flowers into open, closed and triple, flower and pollen quality traits, fruit quality attributes, and leaf nutritional status of the ‘Hayward’ kiwifruit cultivar. The study was realized during a two-year experimental period in Naoussa, Central Macedonia, Greece. The results showed that BUD 14 induced synchronization in bud development relative to different vegetative stages including initiation of bud expansion, appearance of leaf apices covered by hair and deployment of 2-8 leaves and increased the flowering rate of open flowers. Pedicel length, ovary fresh weight, and dry weight, dry matter and length in female flowers as well as maximum pollen grain diameter and area in polar view in male flowers were significantly enhanced in the BUD 14 treatment. Fruit quality characteristics like average weight and dry mass were significantly augmented, and a 1.5-fold and 2-fold increase was recorded in canes length and number of kiwifruits per cane. In addition, leaf nutrient Ca and Mg concentrations were significantly enhanced, compared to the control. The efficacy of BUD 14 as a more target-oriented and environmentally friendly alternative method of supplying plants with smaller and controlled amounts of nutrients for breaking bud dormancy and improving their development was demonstrated, enhancing flower and fruit quality, leaf nutrition, kiwifruit developmental characteristics, and finally the total production per fruit per tree.