A full-factorial test of motivational and volitional intervention strategies for promoting exercise habit formation and exercise maintenance among new users of an online exercise class platform.

Interventions often fail to achieve long-term behavioral maintenance. Utilizing motivational and volitional strategies to promote behavioral maintenance factors may improve this. Using a full-factorial experiment, we tested the effects of three intervention components (focused on intrinsic motivation and identity, exercise preparation habit, and exercise instigation habit) on exercise participation over a year, among new users (N = 751; 91% identifying as female, 54% identifying as White race) of a global, online exercise class platform, run by Les Mills International Ltd, called LM+. We also tested the intervention components' theoretical mechanisms of action-habit formation, intrinsic motivation, identity, and self-efficacy. Multi-level models found some support for a main effect of the exercise preparation habit intervention component in promoting self-reported and objective exercise participation (behavioral outcomes measured via monthly surveys and the LM+ platform; mechanisms measured via monthly surveys)-in particular online exercise class frequency (fixed effect estimate = 0.84, p < 0.05, and = 0.12, p < 0.05, respectively). The preparation habit component also significantly increased preparation habit strength (0.30, p < 0.05) and instigation habit strength (0.33, p < 0.05). Other expected effects were nonsignificant. Helping individuals form an exercise preparation habit may facilitate initiating and maintaining exercise over time, in particular for attending online exercise classes, potentially through promoting greater preparation and exercise instigation habit strength.

ALOG/LSHs, a novel class of transcription factors: Evolutionarily conserved regulators of plant growth and development.

The ALOG/LSH group of proteins is highly conserved across plant lineage, starting from moss to higher flowering plants, suggesting their crucial role in the evolution and adaptation of land plants. The role of ALOG proteins is highly conserved in various developmental responses, such as vegetative and reproductive developmental programs. Their role in meristem identity, cotyledon development, seedling photomorphogenesis and leaf and shoot development has been relatively well established. Moreover, several key pieces of evidence suggest their role in inflorescence architecture and flower development, including male and female reproductive organs and flower colouration. Recent research has started to explore their role in stress response. Functionally, ALOG proteins have been demonstrated to act as transcriptional regulators and are considered a newly emerging class of transcription factors in plants that regulate diverse developmental and physiological processes. This review aims to stimulate discussion about their role in plant development and their role as transcription factors. It also aims to further unravel the underlying molecular mechanism by which they regulate growth and development throughout the plant lineage.

N-803, an IL-15 superagonist complex as maintenance therapy after allogeneic donor stem cell transplant for acute myeloid leukemia or myelodysplastic syndrome; a Phase 2 trial.

Maintenance therapy may improve natural killer (NK) cell surveillance after allogeneic donor hematopoietic cell transplant (HCT) for myeloid malignancies and represents a potential approach to improve cure rates. Interleukin-15 (IL-15) enhances lymphocyte proliferation and anti-tumor activity. In a prior Phase 1 study of an IL-15 superagonist (N-803) in patients with AML who relapsed after HCT, we observed in vivo expansion of NK cells and anti-tumor responses. The primary objective of this Phase 2 trial was to determine if post-transplant N-803 could reduce relapse. We administered N-803 (n=20) (dosed 6 mcg/kg subcutaneously (SQ) at day 60 after HCT to patients with myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) who were in complete remission (CR). N-803 treatment was planned weekly, bi-weekly or every 4 weeks in 2 sequential cohorts. The most common adverse events after administration were self-limited injection sites skin rashes (n=20). One week after an N-803 dose, we observed enhanced NK cell proliferation and improved anti-tumor cytotoxicity without inducing immune exhaustion. Five patients who developed acute graft versus host disease (aGVHD) after N-803 responded promptly to steroids and 4 patients developed chronic GVHD. Patients receiving >4 doses of N-803 had a 3-fold decrease in relapse at two years (p=0.06). These findings support the safety, immune activation, and potential efficacy of N-803 to prevent relapse of AML/MDS after HSCT.

Agrypnia excitata: a clinical biomarker of acute relapse in anti-NMDAr encephalitis.

Sleep disorders have been described in anti-NMDAr encephalitis including insomnia, hypersomnia, narcolepsy, and sleep-disordered breathing. A patient presented with typical features of anti-NMDAr encephalitis associated with a right ovarian teratoma. After two months of clinical improvement with immunotherapy, the patient deteriorated. A 24-hour video EEG-polysomnography revealed a severe sleep quantity deficit, a total destruction of sleep architecture consisting of short clusters of N1 and rapid eye movement sleep stages, associated with motor and autonomic hyperactivity. These features were consistent with agrypnia excitata and were associated with disease reactivation due to a left ovarian teratoma. A new course of immunotherapy and surgery improved clinical symptoms and normalized sleep patterns. Agrypnia excitata, the most severe form of status dissociatus, was a sleep biomarker of disease relapse in this patient. Polysomnographic studies in the acute phase of anti-NMDAr encephalitis are lacking and are needed to better understand the evolution of sleep patterns.

The efficacy and safety of isotonic and hypotonic fluids in intravenous maintenance fluid therapy in term newborns: national multicenter observational "neofluid" study.

Objective: The objective of this study was to evaluate the efficacy and safety of isotonic and hypotonic intravenous fluids in maintenance fluid therapy for term infants. Methods: This was a multi-centre, prospective, observational study conducted in 21 participating centres from December 30, 2020, to June 30, 2023. The study included term newborns requiring parenteral fluid therapy for maintenance (NCT04781361). The fluid treatment was divided into two groups based on the concentration of sodium in the parenteral fluid, designated as hypotonic (NaCl <130 mmol/L) and isotonic (NaCl = 130-154 mmol/L). The primary outcomes were the change in mean plasma sodium (pNa) levels per hour (∆pNa mmol/L/h), the incidence of hyponatremia (pNa <135 mmol/L) and hypernatremia (pNa >145 mmol/L), and the occurrence of clinically significant changes in sodium levels (∆pNa >0.5 mmol/L/h). Results: A total of 420 patients from 21 centers were included. The ∆pNa was negative in the hypotonic fluid group and positive in the isotonic fluid group, with a significant difference between the groups [respectively -0.07 ± 0.03 (95% CI: -0.13 to -0.02); 0.04 ± 0.03 (95%CI: -0.02 to 0.09), p = 0.04]. There was no difference between the groups in terms of the development of hypernatremia or a clinically meaningful pNa increase. The hypotonic fluid group had a higher incidence of hyponatremia and a clinically meaningful sodium decrease compared to the isotonic fluid group [7.9% vs. 1.2% (OR:6.5, p:0.03)] and [12.2% vs.4.2% (OR:2.9, p = 0.03)]. Conclusion: Contrary to current understanding, this large-scale study is the first to demonstrate that the use of hypotonic fluids in maintenance fluid therapy for newborns poses a risk of hyponatremia development, whereas isotonic fluid therapy appears safe.

Dynamic modeling of human error in industrial maintenance through structural analysis and system dynamics.

Human error constitutes a significant cause of accidents across diverse industries, leading to adverse consequences and heightened disruptions in maintenance operations. Organizations can enhance their decision-making process by quantifying human errors and identifying the underlying influencing factors, thereby mitigating their repercussions. Consequently, it becomes crucial to examine the value of human error probability (HEP) during these activities. The objective of this paper is to determine and simulate HEP in maintenance tasks at a cement factory, utilizing performance shaping factors (PSFs). The research employs the cross-impact matrix multiplication applied to classification (MICMAC) analysis method to evaluate the dependencies, impacts, and relationships among the factors influencing human error. This approach classifies and assesses the dependencies and impacts of different factors on HEP, occupational accidents, and related costs. The study also underscores that PSFs can dynamically change under the influence of other variables, emphasizing the necessity to forecast the behavior of human error over time. Therefore, this paper utilizes the MICMAC method to analyze the interdependencies, relationships, and impact levels among different variables. These relationships are then utilized to optimize the implementation of the system dynamics (SD) method. An SD model is employed to forecast the system's behavior, and multiple scenarios are presented. By considering the HEP value, managers can adjust organizational conditions and personnel to ensure acceptability. The paper also presents various scenarios related to HEP to assist managers in making informed decisions.

Circulating Levels of Vitamins A, C, and E-Alpha in Organ Donors After the Neurologic Determination of Death.

INTRODUCTION: The antioxidant effects of vitamins may attenuate the oxidative stress on organs imposed by ischemia-reperfusion injury during the process of organ transplantation from brain-dead donors. Circulating levels of vitamins A, C, and E-α in donors after brain death and their relationships to donor demographics, management, organ utilization, and recipient outcomes are largely unknown. METHODS: An observational, prospective, cohort study of 84 consecutive brain-dead organ donors managed at a single organ procurement recovery center was conducted. Vitamin levels were drawn immediately prior to procurement. RESULTS: Levels of serum vitamins A and E-α and plasma vitamin C were below normal in 80%, 85%, and 92% of donors and deficient in 40%, 62%, and 63%, respectively. Vitamin C deficiency was associated with a longer time between death and specimen collection (P = .004). Death from head trauma and stroke were associated with lower levels of vitamin A than from anoxic causes (P = .003) and smokers had greater vitamin C deficiency (P = .03). During donor management, vitamin C deficiency was associated with longer vasopressor support (P = .03) and normal levels of vitamin E-α were associated with reaching a lower alanine transferase compared to those with subnormal levels (P < .05). Donors deficient in vitamin E-α were less likely to have a liver recovered for transplantation (P = .005). Vitamin levels were not associated with the recipient outcomes examined. CONCLUSION: Circulating vitamins A, C, and E-α is profoundly low in brain-dead organ donors, associated with relevant demographic features of the donor, and may influence donor management and organ utilization.

The role of hemodialysis access in intradialysis and interdialysis vital sign variabilities and the development of dialysis headache.

To determine the relationship of hemodialysis access with vital sign variability and hemodialysis-related headache (HRH). Adult outpatients receiving maintenance hemodialysis (MHD) were prospectively recruited, and 12 consecutive dialysis sessions were monitored. Intradialysis (hour-to-hour) and interdialysis (dialysis day-to-day) vital sign variabilities were assessed via three metrics: the difference between the maximum and minimum values, average real variability (ARV), and residuals. Multivariate logistic regression analysis was used to explore the factors triggering HRH. A total of 91 Chinese MHD patients (60.4% male) aged 58.5 ± 17.2 years were included, with 59 patients using radiocephalic arteriovenous fistulas (RCAVFs) and 32 patients using tunneled cuffed catheters (TCCs) for dialysis. The median dialysis vintage was 26.8 (12.0-44.7) months. Compared with the RCAVF group, the TCC group had significantly greater urea reduction (71.1 ± 9.3% vs. 61.7 ± 10.5%, p < 0.001) and clearance (1.5 (1.2-1.8) vs. 1.1 (1.0-1.4), p < 0.001) rates, higher intradialysis pulse variability and lower intradialysis diastolic blood pressure variability. Some of interdialysis variability indexes in pulse, systolic blood pressure (SBP), and SpO2 were significantly greater in the TCC group than that in the RCAVF group. Age (OR = 0.880, 95% CI = 0.785-0.986, p = 0.028), TCC use (OR = 22.257, 95% CI = 1.190-416.399, p = 0.038), intradialysis SBP-ARV (OR = 2.768, 95% CI = 1.069-7.171, p = 0.036), and blood sodium level (OR = 0.400, 95% CI = 0.192-0.832, p = 0.014) were shown to be independent risk factors for HRH. In conclusion, the use of TCCs has multifaceted effects on intradialysis and interdialysis vital sign variabilities and is independently associated with an increased risk of HRH.

Quality of life and social reinsertion of patients on maintenance haemodialysis in four government funded hospitals in Cameroon.

BACKGROUND: Reduced quality of life is associated with shorter survival in chronic illnesses. However, the health-related quality of life (HRQOL) and social reinsertion of patients on maintenance haemodialysis is much more underappreciated in resource-limited countries such as Cameroon. METHOD: A hospital-based cross-sectional study was carried out from February 22nd to May 20th, 2022, in 4 government-funded haemodialysis centres in three randomly selected regions of Cameroon. Patients received twice-weekly dialysis sessions. Social reinsertion and HRQOL were assessed using a structured questionnaire and the kidney disease quality of life instrument (KDQOL-36™). HRQOL scores < 50 were categorized as low, while scores > 50 reflected better HRQOL. Data were analysed using the software statistical package for Social Sciences version 25.0. Statistical significance was set at a p value < 0.05. RESULTS: The study included 434 patients. The mean age was 48.33 (13.55) years, 65.7% (285/434) were male, 62.3% (269/434) had no monthly income, and the mean dialysis vintage was 3.74 (3.83) years. The mean HRQOL score was 44.34 (9.77), and 76.2% (325/434) had HRQOL scores < 50). Overall HRQOL was associated with older age (aOR: 2.344, CI 1.089-5.04). After the initiation of maintenance haemodialysis, 67.1% (49/73) of students dropped out of school. The main reason for school absenteeism and unemployment was physical insufficiency, with 82.4% (19/24) and 52.4% (75/144), respectively. There were no promotions or marriages after initiation; 51% (221/434) of relationships with relatives and friends were affected negatively, while 83.3% (66/79) of those of marriageable ages could not find suitors. The social participation score was poor in 61.5% (267/434) of participants. There was an association between low QOL and social participation (p = 0.009). CONCLUSION: The HRQOL of patients on maintenance haemodialysis is greatly reduced, especially their physical health status. Older age was a determinant of low QOL. Additionally, social reinsertion remains poor due to adverse changes that occur to these patients and their families after dialysis initiation. CLINICAL TRIAL NUMBER: Not applicable.

Liberal Fluid Resuscitation is Associated with Improved Outcomes in Pediatric Acute Pancreatitis.

OBJECTIVE: To evaluate outcomes of children from an observational cohort registry of index acute pancreatitis (AP) admissions managed with different types and rates of intravenous fluid therapy. STUDY DESIGN: Patients with index admission of AP between 2013 and 2023 were included. Those who received >1.5x the maintenance intravenous fluid rate were assigned to the liberal fluid group, and patients who received <1.5x maintenance fluids were assigned to the conservative group. Outcomes including intensive care unit admission rate, organ dysfunction, local pancreatic complications, and AP severity were evaluated. Influence of early enteral feeding and fluid composition on outcomes and clinical course were also analyzed. RESULTS: Patients who received liberal fluids were less likely to be admitted or transferred to the intensive care unit compared with those receiving conservative management (OR, 0.32; 95% CI, 0.12-0.80; P = .015). The liberal fluid group with early feeding had the lowest rate of moderate/severe manifestations of AP compared with other combinations of diet and fluid orders. Patients within the liberal fluid group who received the highest fluid rates (>2x maintenance) did not have higher rates of organ dysfunction or severe disease. CONCLUSIONS: Children with AP may stand to benefit from liberal fluid therapy and continued diet compared with more conservative fluid resuscitation and nothing by mouth status.

Sorafenib maintenance after allogeneic stem cell transplantation in patients with FLT3+ AML receiving midostaurin during induction and consolidation: a retrospective analysis.

Introduction: Acute myeloid leukemia (AML) relapse is the main cause of death after allogeneic stem cell transplant (allo-SCT). In AML FLT3+, it was shown that Sorafenib used as maintenance therapy after allo-SCT, significantly reduces the risk of relapse and death. Methods: We analyzed 29 adult patients with FLT3m AML and underwent allogeneic stem cell transplant from 2019 to 2023. All patients received midostaurin plus conventional CT during induction and consolidation. After transplantation, Sorafenib maintenance was administered in all patients independently from MRD status at transplantation. Results: Sorafenib maintenance was applied in 18 patients out 29 patients (62%). Median time to start sorafenib was 100 days (range 37-225) and median duration of treatment was 775 days (range 140-1064). For the whole population (n=29), 2-year OS, LFS, and CIR was 76%, 68% and 28%, respectively. The median time to relapse was 137 days (range 49-246). For patients treated with sorafenib (n=18), the 2-year OS, LFS, and CIR were 94%, 84% and 11%, respectively. For the whole population, the 100-day NRM was 0% and 1-year NRM was 3%. Death was caused by transplant-associated thrombotic microangiopathy in 1 patient. For patients who were administered with Sorafenib, the 1-y NRM was 5%. Death was caused by transplant associated transplant-associated thrombotic microangiopathy. Discussion: This retrospective study suggests that sorafenib maintenance seem to be effective even in patients pre-treated with midostaurin.

A case-control study investigating cardiovascular health in maintenance hemodialysis patients through oxidative stress biomarkers and carotid artery intima-media thickness.

INTRODUCTION: Chronic kidney disease (CKD) is a major risk factor for the development of cardiovascular disease (CVD), and it is the leading cause of morbidity and mortality in end-stage renal disease (ESRD) patients receiving maintenance hemodialysis (MHD).

Systematic Review on Mortality in the Elderly on Methadone Maintenance Treatment.

Opioid dependence is a serious public health concern, particularly for older individuals who have a high prevalence of comorbid conditions. To effectively manage opioid use disorder (OUD), methadone maintenance treatment (MMT) is crucial; however, the MMT poses certain challenges for the aging population. The purpose of this review is to evaluate the impact of MMT on health outcomes, identify predictive factors for mortality, and assess mortality rates among older individuals receiving MMT. A systematic search was performed across databases, including PubMed, Scopus, Web of Science, and Google Scholar, adhering to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies included were published between January 2000 and December 2023, focused on elderly patients (60 years of age and older) receiving MMT and provided information on death rates. A total of 15 studies were examined. The main causes of death for older MMT patients were overdose, respiratory issues, and cardiovascular diseases. The annual mortality rates for these patients ranged from 2% to 10%. Treatment outcomes and mortality were significantly impacted by comorbid conditions. Greater treatment adherence and longer care periods were observed in older individuals, which correlated with better health outcomes and lower mortality. This review makes clear how elderly MMT patients with addiction and chronic health issues require integrated care models. Treatment effectiveness may be further increased by gender-specific interventions. For this aging population, policy reforms and enhanced healthcare support are essential. To enhance clinical results and lower mortality rates among older individuals enrolled in MMT programs, comprehensive age-appropriate care models are crucial. Long-term health outcomes should be investigated further and evidence-based treatments for older individuals with OUD should be developed.

Sustainable Development in Rural Underserved Communities through Improved Responsible Management of Decentralized Wastewater Infrastructure: A Focus on the Alabama Black Belt.

Despite global efforts on meeting sustainable development goals by 2030, persistent and widespread sanitation deficits in rural, underserved communities in high-income countries─including the United States (US)─challenge achieving this target. The recent US federal infrastructure funding, coupled with research efforts to explore innovative, alternative decentralized wastewater systems, are unprecedented opportunities for addressing basic sanitation gaps in these communities. Yet, understanding how to best manage these systems for sustainable operations and maintenance (O&M) is still a national need. Here, we develop an integrated management approach for achieving such sustainable systems, taking into account the utility structure, operational aspects, and possible barriers impeding effective management of decentralized wastewater infrastructure. We demonstrate this approach through a binomial logistic regression of survey responses from 114 public and private management entities (e.g., water and sewer utilities) operating in 27 states in the US, targeting the rural Alabama Black Belt wastewater issues. Our assessment introduces policy areas that support sustainable decentralized wastewater systems management and operations, including privatizing water-wastewater infrastructure systems, incentivizing/mandating the consolidation of utility management of these systems, federally funding the O&M, and developing and retaining water-wastewater workforce in rural, underserved communities. Our discussions give rise to a holistic empirical understanding of effective management of decentralized wastewater infrastructure for rural, underserved communities in the US, thereby contributing to global conversations on sustainable development.

Empowering the circular economy practices: Lifecycle assessment and machine learning-driven residual value prediction in IoT-enabled microwave oven.

In an era of resource scarcity and environmental concerns, integrating Internet of Things (IoT) technology into the circular economy (CE), particularly for household appliances like microwaves, is crucial. The lack of systematic assessment of their post-use residual values often reduces utilization and shortens lifespans. Inadequate disposal and management contribute to electronic waste and environmental pollution. Addressing these challenges is vital for efficient appliance management within resource constraints, ensuring meaningful contributions to sustainable resource management. Thus, this study addresses these concerns by integrating IoT technology into microwave ovens, enabling real-time monitoring of key parameters such as voltage, current, door closures, and motor/blade rotations. Data from integrated sensors enables performance analysis and trend tracking, offering potential for advancing CE practices and sustainable product management. Subsequently, utilizing the insights stored from IoT data analysis and tailored surveys, a predictive maintenance model is developed, aiming to predict the life cycles of microwave oven components and categorize them within the CE principles, including reuse, repair, remanufacturing, and cascade. Finally, to mitigate the challenges of lower effective utilization and shortened operating lifespans observed in household appliances, this research employs machine learning models such as Random Forest, Gradient Boosting, and Decision Tree to accurately predict the residual values of IoT-enabled microwaves. Notably, Random Forest demonstrates superior accuracy compared to the other models. Therefore, these technological advancements allow household appliances to be utilized more effectively, thereby enhancing resource utilization.

A Retrospective Analysis of Medical Management Strategies for Trigeminal Neuralgia: An Institutional Review.

Background Neuropathic pain results from nervous system damage, and trigeminal neuralgia (TN), also called tic douloureux, is a chronic disorder affecting the trigeminal nerve. TN causes sudden, severe, recurring facial pain that can be highly disabling. Treatment usually involves medications like carbamazepine, oxcarbazepine, gabapentin, or baclofen to manage nerve pain. If medications are ineffective, surgical interventions like microvascular decompression or gamma knife radiosurgery may be explored for symptom relief. Aim and objectives This study aims to assess the demographic characteristics and clinical features of patients with TN treated at a private institution. The objective was to assess key demographic factors, including age, gender, and the affected trigeminal nerve divisions, with a focus on identifying the most frequently involved nerve divisions in TN cases. Methodology This five-year retrospective study (January 2019-April 2023) in the Oral Medicine and Radiology Department analyzed 483 TN cases, including 300 patients with confirmed primary TN and complete records. Dental Information Archive System (DIAS) data covered demographics, clinical features, treatments, and outcomes. Pain levels were assessed using the visual analog scale (VAS). LFTs monitor the long-term effects of medications like carbamazepine. Statistical analysis employed descriptive statistics, chi-square tests, and t-tests, with p < 0.05 considered significant. Results Of 7,500 outpatients in the Oral Medicine Department, 483 were diagnosed with TN, and 300 met the diagnostic criteria for inclusion in a five-year study (January 2019-April 2023). The average age was 60 years for men and 58.5 years for women. TN primarily affected the right side in 158 patients (56%), while the left side was involved in 114 (43%) of the cases (p = 0.04) and most commonly involved the maxillary nerve (V2) in 159 patients (53%) and the mandibular nerve (V3) in 141 patients (47%), with a slight female predominance (p = 0.02). One hundred thirty-five patients (45%) used carbamazepine alone, while 84 were treated with carbamazepine and gabapentin, and 81 were treated with carbamazepine and baclofen. The combination of carbamazepine and gabapentin was the most effective, achieving pain control in 123 patients (75%) compared to 94 patients (70%) with carbamazepine alone and 119 patients (72%) with carbamazepine and baclofen (p = 0.06). VAS scores showed better pain relief with carbamazepine and gabapentin (VAS: 3.8 ± 1.0), carbamazepine alone (mean VAS: 4.5 ± 1.2) and carbamazepine with baclofen (mean VAS: 4.2 ± 1.1). In long-term management, 45 patients (15%) discontinued due to side effects, while 105 patients (35%) continued on carbamazepine alone, 90 patients (30%) on carbamazepine with gabapentin, and 60 patients (20%) on carbamazepine with baclofen (p = 0.04). LFTs were performed on 240 patients (80%), while 60 patients (20%) did not undergo LFTs. Conclusions This study underscores the treatment of TN, with anticonvulsants as the primary therapy and alternative options available for refractory cases. However, limitations like small sample size and lack of long-term follow-up affect the findings' generalizability. The results highlight the importance of treatment plans and the potential advantages of combination therapies in clinical practice.

Burden of Pulmonary Hypertension in End-Stage Renal Disease Patients Receiving Maintenance Hemodialysis: Evaluation Factors and Treatment Strategies.

Background Chronic kidney disease (CKD) is an emerging public health problem in India. Pulmonary hypertension (PH) is an overlooked cardiovascular complication of CKD. This study aimed to estimate the burden of PH among CKD patients undergoing hemodialysis in a selected tertiary care hospital. In addition, it aimed to determine the various factors associated with PH and response to various treatment modalities. Methodology This hospital-based, analytical, cross-sectional study was conducted in the nephrology department of a medical college hospital in Tamil Nadu from March 2023 to March 2024. The study included 150 adults diagnosed with stage 5 CKD and registered for hemodialysis. Results Of the 150 participants, 96 (64%) had PH. Of these, 81 (84%) were males and 15 (16%) were females. In the PH group, 58 (60.4%) had type 2 diabetes mellitus, 52 (54%) had been on dialysis for 6-12 months, 67 (69.8%) had chronic glomerulonephritis, 25 (26.04%) had chronic tubular interstitial nephritis, and 72 (75%) had microcytic anemia. PH patients had significantly higher rates of protein-energy malnutrition (26 (48.2%) vs. 67 (80.7%), p < 0.009) and more frequent hospitalizations (19 (35%) vs. 69 (71.9%)) compared to those without PH. Additionally, PH patients exhibited higher incidences of left ventricular hypertrophy (72% vs. 92%), pericardial effusion (0% vs. 65%), and tricuspid regurgitation (16% vs. 100%). Patients treated with a combination of isosorbide dinitrate (ISDN) and hydralazine; extended hemodialysis; and ISDN, hydralazine, and sildenafil showed significant improvement compared to other treatment modalities. Conclusions The high prevalence of PH among CKD patients undergoing hemodialysis underscores the importance of vigilant monitoring and targeted interventions.

Exploring prognostic implications of miRNA signatures and telomere maintenance genes in kidney cancer.

Kidney cancer, particularly clear cell renal cell carcinoma (KIRC), presents significant challenges in disease-specific survival. This study investigates the prognostic potential of microRNAs (miRNAs) in kidney cancers, including KIRC and kidney papillary cell carcinoma (KIRP), focusing on their interplay with telomere maintenance genes. Utilizing data from The Cancer Genome Atlas, miRNA expression profiles of 166 KIRC and 168 KIRP patients were analyzed. An evolutionary learning-based kidney survival estimator identified robust miRNA signatures predictive of 5-year survival for both cancer types. For KIRC, a 37-miRNA signature showed a correlation coefficient (R) of 0.82 and mean absolute error (MAE) of 0.65 years. Similarly, for KIRP, a 23-miRNA signature exhibited an R of 0.82 and MAE of 0.64 years, demonstrating comparable predictive accuracy. These signatures also displayed diagnostic potential with receiver operating characteristic curve values between 0.70 and 0.94. Bioinformatics analysis revealed targeting of key telomere-associated genes such as TERT, DKC1, CTC1, and RTEL1 by these miRNAs, implicating crucial pathways such as cellular senescence and proteoglycans in cancer. This study highlights the significant link between miRNAs and telomere genes in kidney cancer survival, offering insights for therapeutic targets and improved prognostic markers.

Genomic instability in ovarian cancer: Through the lens of single nucleotide polymorphisms.

Ovarian cancer (OC) is the deadliest gynecological malignancy among all female reproductive cancers. It is characterized by high mortality rate and poor prognosis. Genomic instability caused by mutations, single nucleotide polymorphisms (SNPs), copy number variations (CNVs), microsatellite instability (MSI), and chromosomal instability (CIN) are associated with OC predisposition. SNPs, which are highly prevalent in the general population, show a greater relative risk contribution, particularly in sporadic cancers. Understanding OC etiology in terms of genetic basis can increase the use of molecular diagnostics and provide promising approaches for designing novel treatment modalities. This will help deliver personalized medicine to OC patients, which may soon be within reach. Given the pivotal impact of SNPs in cancers, the primary emphasis of this review is to shed light on their prevalence in key caretaker genes that closely monitor genomic integrity, viz., DNA damage response, repair, cell cycle checkpoints, telomerase maintenance, and apoptosis and their clinical implications in OC. We highlight the current challenges faced in different SNP-based studies. Various computational methods and bioinformatic tools employed to predict the functional impact of SNPs have also been comprehensively reviewed concerning OC research. Overall, this review identifies that variants in the DDR and HRR pathways are the most studied, implying their critical role in the disease. Conversely, variants in other pathways, such as NHEJ, MMR, cell cycle, apoptosis, telomere maintenance, and PARP genes, have been explored the least.

The PHEM-B toolbox of methods for incorporating the influences on Behaviour into Public Health Economic Models.

BACKGROUND: It is challenging to predict long-term outcomes of interventions without understanding how they work. Health economic models of public health interventions often do not incorporate the many determinants of individual and population behaviours that influence long term effectiveness. The aim of this paper is to draw on psychology, sociology, behavioural economics, complexity science and health economics to: (a) develop a toolbox of methods for incorporating the influences on behaviour into public health economic models (PHEM-B); and (b) set out a research agenda for health economic modellers and behavioural/ social scientists to further advance methods to better inform public health policy decisions. METHODS: A core multidisciplinary group developed a preliminary toolbox from a published review of the literature and tested this conceptually using a case study of a diabetes prevention simulation. The core group was augmented by a much wider group that covered a broader range of multidisciplinary expertise. We used a consensus method to gain agreement of the PHEM-B toolbox. This included a one-day workshop and subsequent reviews of the toolbox. RESULTS: The PHEM-B toolbox sets out 12 methods which can be used in different combinations to incorporate influences on behaviours into public health economic models: collaborations between modellers and behavioural scientists, literature reviewing, application of the Behaviour Change Intervention Ontology, systems mapping, agent-based modelling, differential equation modelling, social network analysis, geographical information systems, discrete event simulation, theory-informed statistical and econometric analyses, expert elicitation, and qualitative research/process tracing. For each method, we provide a description with key references, an expert consensus on the circumstances when they could be used, and the resources required. CONCLUSIONS: This is the first attempt to rigorously and coherently propose methods to incorporate the influences on behaviour into health economic models of public health interventions. It may not always be feasible or necessary to model the influences on behaviour explicitly, but it is essential to develop an understanding of the key influences. Changing behaviour and maintaining that behaviour change could have different influences; thus, there could be benefits in modelling these separately. Future research is needed to develop, collaboratively with behavioural scientists, a suite of more robust health economic models of health-related behaviours, reported transparently, including coding, which would allow model reuse and adaptation.