[Working conditions in surgery and their impact : Results of a national survey]. / Arbeitsbedingungen in der Chirurgie und deren Auswirkungen : Ergebnisse einer nationalen Umfrage.

BACKGROUND: In surgical disciplines poor working conditions and a high level of dissatisfaction among surgeons in the various disciplines have been reported. The psychological consequences of these conditions on the surgeons themselves and the effects on their families have so far been inadequately considered. OBJECTIVE: The objective of this national survey of the Professional Association of German Surgery (Berufsverband der Deutschen Chirurgie e. V.) was to determine the current status of working conditions in surgical departments of German hospitals and to demonstrate their psychological and familial effects. MATERIAL AND METHODS: In the period January-February 2024 a questionnaire with 26 questions focusing on psychological stress, work-related partnership and family problems as well as addictive behavior was sent to all members of the Berufsverband der Deutschen Chirurgie e. V. and to all German surgical societies. RESULTS: A total of 2221 questionnaires could be analyzed. Among the survey participants, bureaucracy (84.4%) and inadequate compensation for overtime (68.1%) were seen as the main stress factors. Alcohol (20.3%), nicotine (8.9%) and medication (8.3%) were cited as ways of managing the workload. Of the surgeons 60% reported a negative impact on their relationship with their partner and 40% on their relationship with their children. DISCUSSION: The surgeons reported poor working conditions. These have a massive impact on the mental health of surgeons and on their family relationships. Consequently, many surgeons consider leaving the surgical profession. To improve this situation and to make the surgical profession attractive again, a drastic rethinking is needed.

Interaction between the oxidative balance score and serum per- and poly-fluoroalkyl substances (PFASs) on liver health: analysis of the NHANES 2007-2018 dataset.

BACKGROUND: Per- and poly-fluoroalkyl substances (PFASs) are pervasive synthetic compounds, prompting investigations into their intricate interactions with lifestyle factors and health indicators because of their enduring environmental presence and bioaccumulation. This study aimed to explore the effects of the oxidative balance score (OBS) and PFAS on liver-related indices. METHODS: Twenty dietary and lifestyle factors were used to calculate the OBS. The serum concentrations of PFASs were measured, and their sum was calculated for analysis. The levels of liver markers were also evaluated. Linear regression models and interaction analyses were used to assess the associations between OBS, PFAS concentrations, and liver indices. RESULTS: The results revealed an inverse association between high OBS and perfluorooctane sulfonic acid concentration, as well as the sum of PFAS concentrations. OBS was positively associated with liver markers. The PFAS concentrations were positively associated with total bilirubin, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels. Interaction analyses revealed significant interactions between OBS and specific PFASs for alkaline phosphatase (interaction P < 0.05). Possible interactions were also found between OBS and specific PFASs for ALT, and AST levels (interaction P < 0.10). CONCLUSIONS: This study clarified the association between total PFAS and OBS. This association was significant mainly for diet-related OBS. PFAS and OBS are associated with liver-related indicators in the blood.

The effects of cognitive-motor interference on walking performance in adolescents with low balance.

BACKGROUND: Children with reduced motor competence (MC) have reported differences in their walking performance when compared to their typically developed peers, albeit, with inconsistent results. RESEARCH QUESTIONS: What is the effect of reduced balance on walking performance in adolescent boys and girls under cognitive-motor interference conditions? METHODS: This cross-sectional study assessed motor competence, in adolescents aged 13-14 years, using the Movement Assessment Battery for Children 2nd edition and walking performance from gait parameters derived from an inertial measurement unit placed over the estimated centre of mass. Each participant performed two 10 m straight-line walks at their self-selected speed. These consisted of a walk with no distractions and a cognitive-motor interference walk (reciting the alternate letters of the alphabet out loud). A two-way mixed ANOVA was used to assess for significant interactions. RESULTS: 365 adolescents, (low balance = 58, typical balance = 307) participated in this study (boys = 204, girls = 161). Significant interactions were reported between MC groups and walking condition for walking speed in boys (F(1,195) = 5.23, p= 0.02, ηp2 = 0.03) and girls (F(1,154) = 4.05, p= 0.046, ηp2 = 0.03). Both sexes with low balance reduced their walking speed to a greater extent than their typically developed peers under cognitive-motor interference conditions compared to the single-task walk. In addition, boys with low balance reported increased stride length variability (F(1,198)= 4.40, p= 0.037, ηp2= 0.02) compared to typically developed peers. SIGNIFICANCE: Adolescents with low balance report altered walking. Our data could support a better understanding of the relationship between balance and gait and may help the development of interventions to support those with difficulties.

Stilbene glycosides alleviate atherosclerosis partly by promoting lipophagy of dendritic cells.

Atherosclerosis (AS) is a chronic inflammatory disease resulting from lipid metabolism disorders and immune imbalances. Dendritic cells (DCs) are key cells that regulate adaptive and adaptive immunity. When DCs engulf excessive amounts lipids, their function is altered, thereby, accelerating the inflammatory process of AS. Cellular lipophagy serves to reduce lipid accumulation and maintain cellular lipid metabolism balance. In this study, we investigated the effectiveness of 2,3,5,4'-tetrahydroxystilbene 2-O-ß-D-glucoside (TSG) in intervening in the promotion of DCs lipid accumulation by ox-LDL, as well as its role in downregulating lipophagy. Our findings indicate that TSG reduces the maturity of DCs and promotes the differentiation of T cells towards Treg, thereby correcting the imbalanced Treg/Th17. These effects of TSG are closely associated with its inhibition of the PI3K-AKT-mTOR signaling pathway. After administering TSG to ApoE-/- mice that were fed a high-fat diet, there was a noticeable decrease in harmful blood lipids found in the serum. Additionally, the imbalanced Treg/Th17 levels in the spleen were restored, and the levels of pro-inflammatory factor IL-6 and IL-17A in the serum decreased, while the level of anti-inflammatory factor IL-10 increased. Furthermore, the arterial DCs showed a decrease in P62 content. Ultimately, these changes resulted in a reduction in plaque area. It is worth noting that the autophagy inhibitor chloroquine significantly altered the effects of TSG on ApoE-/- mice. In conclusion, this study reveals that TSG can alleviate AS. This is partly achieved through the activation of autophagy in DCs. By intervening in the lipophagy of DCs, it is possible to regulate the immune function of these cells, which in turn helps control the inflammation associated with AS. This presents a potential method for intervening in AS.

How work engagement and workaholism relate to individuals' and their intimate partners' mental well-being: a test of the spillover-crossover model among Indonesian dual-earner couples.

This study investigated the relationship between work engagement, workaholism, and mental well-being of individuals and their intimate partners. This association was explored in the context of Indonesian dual-earner couples, using the Spillover-Crossover Model (SCM). The study examined how work-to-family spillover (i.e. work-to-family conflict and facilitation) and recovery experiences (i.e. psychological detachment, relaxation, mastery, and control) mediate these relationships. A cross-sectional survey was conducted among 186 Indonesian dual-earner couples with preschool children. Structural equation modeling was used to test the hypothesized model and bootstrap method was conducted to evaluate the indirect relationships. As hypothesized, among male and female workers, work engagement was positively related to individual's mental well-being through work-to-family facilitation and recovery experiences. In contrast, workaholism was negatively related to individual's mental well-being through work-to-family conflict and recovery experiences excluding psychological detachment. Individual's mental well-being, in turn, was positively related to intimate partner's mental well-being. These findings suggested that work engagement and workaholism were related to intimate partner's mental well-being differently. These results further supported the SCM, suggesting that higher work engagement could increase workers' and their intimate partners' mental well-being through work-to-family facilitation and their recovery experiences, while workaholism acts oppositely.

Unraveling the stride: exploring the influence of neurogenic orthostatic hypotension on gait and balance in Parkinson's disease.

PURPOSE: Neurogenic orthostatic hypotension (nOH) and gait impairment are frequent sources of disability in Parkinson's disease (PD). However, the impact of nOH on balance and gait features remains unclear. This cross-sectional study aimed to assess the influence of nOH on postural and gait parameters in a cohort of patients with PD by means of wearable inertial sensors. METHODS: Gait and balance were assessed using Opal inertial sensors. nOH was defined as sustained systolic blood pressure (BP) drop ≥ 20 mmHg or diastolic BP drop ≥ 10 mmHg within 3 min of standing, with a ΔHR/ΔSBP ratio ≤ 0.5 bpm/mmHg. Analysis of covariance was performed to evaluate differences in gait/balance features between patients with and without nOH, adjusting for age, cognitive status, and motor disability. Moreover, we performed the same analysis considering the presence of hemodynamically relevant nOH (orthostatic mean BP ≤ 75 mmHg). RESULTS: A total of 82 patients were enrolled, 26 with nOH (31.7%), of which 13 presented with hemodynamically relevant nOH. After correcting for confounders, nOH was independently associated with lower gait speed (p = 0.027), shorter stride length (p = 0.033), longer time for postural transitions (p = 0.004), and increased postural sway (p = 0.019). These differences were even more pronounced in patients with hemodynamically relevant nOH. Higher postural sway was associated with a 7.9-fold higher odds of falls (p = 0.040). CONCLUSIONS: Our study presents an objective demonstration of the independent negative impact of nOH on gait and balance in PD, emphasizing the need for careful detection and management of nOH to mitigate gait and balance disturbances in PD.

A Non-Weight Bearing Method for Measuring Hip Abduction Strength Overestimates Hip Abductor Muscle Fatigue During One-Leg Stance.

OCCUPATIONAL APPLICATIONSAssessing workers' strength capacities is a common practice prior to return to work following injury or illness, or assessing capabilities for strenuous jobs. Because it requires 50% or more of maximum strength capacity, hip abductor muscle strength is a strong predictor of both middle- and older-aged individuals' ability to reliably balance on one leg and of their risk of falls. Our results suggest subjects were able to augment their hip abductor moment during unipedal weight stance via gluteus maximus activity. Weight-bearing hip abduction strength measures are important for assessing worker capacity for jobs requiring reliable unipedal balance whether during lateral loading, while walking in gusty winds, on slippery footing or resisting lateral deck movements on board ship or train. Measurements of hip abductor strength should be made in a full unipedal weight bearing posture; non-weight-bearing measurements significantly underpredicted hip abductor strength as well as endurance.

Background: Unipedal stance time is a significant predictor of fall risk in middle- and older-aged individuals. Because muscle fatigue reduces muscle strength over a sustained contraction, muscle endurance time could limit maximum unipedal stance time. Purpose: We tested the hypothesis that hip abduction muscle endurance time, which depends on muscle strength, limits maximum unipedal stance time. Methods: We recruited 18 healthy young (10 females) and 17 older (10 females) adults who could stand on one leg for at least 10 s. Using a non-weight bearing test, we measured the left hip isometric maximum abduction strength and endurance time at 50% of that strength. We also measured subjects' maximum unipedal stance time, while force plate and full-body 3D motion capture signals were recorded. Subject-specific inverse dynamics biomechanical models were used to calculate the hip abduction moment required to stand on one leg. Results: Unipedal balance required a mean (SD) of 59 (19) % and 118 (53) % of the young and old adult hip abduction muscle strengths, respectively, which were consistent with published values. Mean (SD) hip muscle endurance times at 50% of abduction MVC were 63 (62) sec. and 147 (107) sec. for young and older adults, respectively. However, contrary to our hypothesis (above), the endurance time at 50% MVC failed to predict an upper limit for the maximum unipedal stance time. Conclusions: Our results show that standing on one leg requires over 50% of non-weight bearing hip abductor strength when young, and full strength when older. Because all younger individuals and four (out of 17) older individuals could balance on one leg longer than predicted during weight-bearing the gluteus maximus, a hip extensor, likely tensioned the iliotibial band to counteract abductor muscle fatigue with time. So, measurements of hip abduction strength should be made in the weight-bearing posture when middle- and older-aged workers' balance capacity is being assessed whether in a return-to-work assessment setting or evaluating workers for jobs requiring significant lateral loading, walking in gusty winds or on slippery surfaces, or on boat or train decks prone to sudden movements.

A New, Zero-Iteration Analytic Implementation of Wet-Bulb Globe Temperature: Development, Validation, and Comparison With Other Methods.

Wet-bulb globe temperature (WBGT)-a standard measure for workplace heat stress regulation-incorporates the complex, nonlinear interaction among temperature, humidity, wind and radiation. This complexity requires WBGT to be calculated iteratively following the recommended approach developed by Liljegren and colleagues. The need for iteration has limited the wide application of Liljegren's approach, and stimulated various simplified WBGT approximations that do not require iteration but are potentially seriously biased. By carefully examining the self-nonlinearities in Liljegren's model, we develop a zero-iteration analytic approximation of WBGT while maintaining sufficient accuracy and the physical basis of the original model. The new approximation slightly deviates from Liljegren's full model-by less than 1°C in 99% cases over 93% of global land area. The annual mean and 75%-99% percentiles of WBGT are also well represented with biases within ± 0.5 °C globally. This approximation is clearly more accurate than other commonly used WBGT approximations. Physical intuition can be developed on the processes controlling WBGT variations from an energy balance perspective. This may provide a basis for applying WBGT to understanding the physical control of heat stress.

Post-mechanotherapy differences in postural control in patients with Achilles tendinopathy - A randomized controlled trial.

BACKGROUND: Neuromuscular deficits affecting functional ability can occur in patients with Achilles tendinopathy during difficult balance activities. This study aimed to assess postural control in patients with Achilles tendinopathy after shockwave and sonotherapy, using advanced analytical methods, including rambling-trembling signal decomposition and sample entropy. RESEARCH QUESTION: What are the differences in postural control between patients with Achilles tendinopathy after shockwave therapy, ultrasound therapy, and placebo ultrasound? METHODS: Thirty-nine patients were included in the study, and randomly assigned to 3 groups, i.e., shockwave therapy, ultrasound therapy and placebo ultrasound. Postural sway was assessed during quiet standing with eyes open and closed, with two force platforms, one for the affected and the other for the non-affected limb, at baseline and at weeks 1 and 6 after treatment. Rambling-trembling trajectories and sample entropy were calculated for the antero-posterior and medio-lateral directions. RESULTS: The parameters of trembling trajectory in both directions were significantly smaller for the affected compared to non-affected limb. The ultrasound group had significantly larger rambling-trembling trajectories in the antero-posterior and medio-lateral sway directions than the shockwave therapy group. Also, all patients had more difficulty controlling their postural sway while standing with eyes closed compared to eyes open. Sample entropy was not significantly affected by the therapy type, timepoint and limb condition. SIGNIFICANCE: As opposed to sample entropy, rambling-trembling decomposition can complement or replace traditional linear measures of COP time series in functional assessment of the Achilles tendon.

Lower-limb inter-joint coordination during balance recovery after trips.

BACKGROUND: Trips are one of the most common external perturbations that can lead to accidental falls. Knowledge about postural control attributes of balance recovery after trips could help reveal the biomechanical causes for trip-induced falls and provide implications for fall prevention interventions. RESEARCH QUESTION: The objective of the present study was to examine coordinated lower-limb movements during balance recovery after trips. METHODS: One hundred and twenty-three volunteers participated in an experimental study. They were tripped unexpectedly by a metal pole when walking on a linear walkway at their self-selected speed. Lower-limb inter-joint coordination quantified by continuous relative phase measures, including the mean of the absolute relative phases (MARP) and the deviation phase (DP), was analyzed during the execution of the first recovery step after unexpected trips. RESULTS: Compared to unsuccessful balance recovery, smaller MARPknee-ankle and DPknee-ankle of successful recovery were observed with distal inter-joint coordination on the swing side. Inter-joint coordination of the stance limb did not significantly differ between successful and unsuccessful recovery conditions. These findings indicate that the control of the swing limb's distal joints is crucial for regaining balance after trips. SIGNIFICANCE: An implication derived from this study is that greater in-phase coordination and smaller coordination variability in distal joints of the swing limb could be considered as potential targets for interventions aimed at preventing trip-induced accidental.

Understanding the intricate impacts and mechanism of actions of adaptogens on reproductive function.

Adaptogens, comprising plants and mushrooms, modulate the immune system, energy balance, and various physiological processes, including reproduction. Despite their potential benefits, the impact of adaptogens on reproductive function remains understudied. This review examines the effects of common adaptogens on male and female reproductive functions, highlighting their regulation of neuro-endocrine-immune interactions crucial for reproduction. While existing literature reveals varying impacts on reproductive function, most adaptogens exhibit beneficial effects, modulating neuroimmunology and promoting gonadal steroidogenesis, spermatogenesis, and folliculogenesis through direct mechanisms or suppression of oxidative stress and inflammation. Further experimental research is necessary to elucidate the mechanisms of action of adaptogens, which would significantly advance the management of reproductive disorders and other diseases. Validating these findings in clinical trials is also essential.

Differences in the Impact of Intensive Rehabilitation on Hereditary Ataxias and the Cerebellar Subtype of Multiple System Atrophy.

Multiple system atrophy-cerebellar type (MSA-C) exhibits faster disease progression than does hereditary spinocerebellar degeneration (hSCD). In this study, we aimed to investigate the differences in the treatment effects and sustainability of intensive rehabilitation between patients with hSCD and those with MSA-C. Forty-nine patients (hSCD = 30, MSA-C = 19) underwent a 2- or 4-week intensive rehabilitation program. Balance function was evaluated using the scale for the assessment and rating of ataxia (SARA) and the balance evaluation systems test (BESTest) at pre-intervention, post-intervention, and 6-month follow-up. Notably, both groups demonstrated beneficial effects from the rehabilitation intervention. However, differences were observed in the magnitude and duration of these effects. In the hSCD group, the SARA scores at follow-up remained similar to those at baseline, indicating sustained benefits. However, the MSA-C group showed some deterioration in SARA scores compared with baseline scores but maintained improvements on the BESTest, demonstrating partial sustainability. Differences, mainly in sustainability, were observed between the hSCD and MSA-C groups. This may be due to varying rates of symptom progression. The findings of this study are significant when considering the frequency of follow-ups based on disease type.

Impact of whole-body vibration training on ankle joint proprioception and balance in stroke patients: a prospective cohort study.

BACKGROUND: Although whole-body vibration (WBV) training is acknowledged for its benefits in enhancing motor functions across several neurological disorders, its precise influence on ankle joint proprioception and balance in stroke patients is still not well understood. This research seeks to assess the impact of WBV training on ankle joint proprioception and balance in stroke patients, thereby filling this important research void. METHODS: In this prospective cohort study, thirty-five stroke patients were randomly assigned to either the WBV group (n = 17) or a control group (n = 18) using a random number table method. The control group received daily general rehabilitation for four weeks, while the WBV group received an additional 30 min of WBV training each day with the Trunsan S110 Vibration Training System. Blinded outcome assessments were conducted at baseline and post-treatment, utilizing the Berg balance scale (BBS), Functional reach test (FRT), Romberg test length (RTL) and area (RTA), and completion rates of ankle joint dorsiflexion-plantar flexion (DP) and inversion-eversion (IE) tests. Follow-up assessments were performed after four weeks of intervention, focusing on RTL, RTA, DP, and IE as primary outcomes. RESULTS: Analysis of intra-group changes from baseline to post-treatment revealed significant improvements across the BBS, FRT, RTL, RTA, and DP and IE assessments (p < 0.001). Notably, the WBV group showed significant enhancements compared to the control group in DP and IE (p < 0.001 and p < 0.05, respectively), with mean values increasing from 13.556 to 16.765 (23.7%) and from 5.944 to 8.118 (36.6%), respectively. However, WBV did not provide additional benefits over the control treatment for balance recovery parameters such as BBS, FRT, RTL, and RTA (p > 0.05). CONCLUSIONS: This study demonstrates that WBV therapy is equally effective as conventional methods in enhancing proprioception and balance in stroke patients, but it does not provide additional benefits for balance recovery. WBV significantly improves proprioceptive functions, particularly in DP and IE parameters. However, it does not surpass traditional rehabilitation methods in terms of balance recovery. These findings indicate that WBV should be incorporated into stroke rehabilitation primarily to enhance proprioception rather than to optimize balance recovery. TRIAL REGISTRATION: This study was retrospectively registered in the ISRCTN Registry on 29/07/2024 ( https://www.isrctn.com/ , ISRCTN64602845).

Efficacy and safety of using a unilateral lower limb exoskeleton combined with conventional treatment in post-stroke rehabilitation: a randomized controlled trial.

Introduction: The incidence of hemiplegia caused by stroke is high. In particular, lower limb dysfunction affects the daily activities of patients, and lower limb robotic devices have been proposed to provide rehabilitation therapy to improve balance function in this patient population. Objective: To assess the effectiveness of the LiteStepper® unilateral lower limb exoskeleton (ULLE) combined with conventional treatment for balance function training in patients with post-stroke hemiplegia. Methods: This multicenter randomized controlled trial, conducted in the convalescent rehabilitation ward of four hospitals, involved 92 patients in their post-stroke phase. Participants were randomized into an experimental group (EG) or a conventional group (CG). The EG adopted the LiteStepper® ULLE combined with conventional treatment for 21 days. The CG underwent a standard daily rehabilitation routine for 21 days. The Berg Balance Scale (BBS), Functional Ambulation Category scale (FAC), 6-min walk test (6MWT), and Barthel Index (Barthel) were used for evaluations before and after 21 days of rehabilitative training. Results: The BBS scores in EG was significantly elevated compared to CG, exhibiting a profound statistical difference (P< 0.0001). Notably, these disparities persisted at both day 21 (P < 0.0001) and day 14 (P < 0.0047) post-intervention, underscoring the efficacy of the treatment in the EG. The EG demonstrated a markedly greater improvement in BBS scores from pre-rehabilitation to 21 days post-training, significantly outperforming the CG. Furthermore, at both day 14 and day 21, functional assessments including the FAC, 6MWT, and Barthel revealed improvements in both groups. However, the improvements in the EG were statistically significant compared to the CG at both time points: day 14 (FAC, P = 0.0377; 6MWT, P = 0.0494; Barthel, P = 0.0225) and day 21 (FAC, P = 0.0015; 6MWT, P = 0.0005; Barthel, P = 0.0004). These findings highlight the superiority of the intervention in the EG in enhancing functional outcomes. Regarding safety, the analysis revealed a solitary adverse event (AEs) related to the LiteStepper®ULLE device during the study period, affirming the combination therapy's safety profile when administered alongside conventional balance training in post-stroke hemiplegic patients. This underscores the feasibility and potential of incorporating LiteStepper®ULLE into rehabilitation protocols for this patient population. Discussion and significance: The LiteStepper® ULLE combined with conventional treatment is effective and safe for balance function training in patients with post-stroke hemiplegia.

Lower extremity muscle activity during reactive balance differs between adults with chronic traumatic brain injury and controls.

Background: Control of reactive balance is key to achieving safe independent walking and engagement in life activities. After traumatic brain injury (TBI), motor impairments and mobility challenges are persistent sequelae. To date, no studies have explored muscle activity of individuals with chronic TBI during a task that requires reactive control of balance. Objective: To investigate lower extremity muscle activity during a reactive balance test performed by adults with chronic severe TBI and matched controls. We hypothesized that abnormal activity of lower extremity muscles would be related with poorer reactive balance performance. Also, we performed an exploratory analysis for those with TBI investigating the impact of unilateral versus bilateral lower extremity involvement in the control of reactive balance. Methods: Ten adults with chronic severe TBI who were independent community ambulators and ten matched controls performed the computerized reactive balance test (Propriotest®) while lower extremity muscle activity was recorded. Electromyographic (EMG) activity was contrasted (Mann-Whitney U Test) between groups across each 10 s epoch of the 120 s test. Additionally, test scores were correlated (Spearman) with lower extremity composite EMG activity to distinguish muscle activity patterns related with reactive balance performance. Lastly, reactive balance test scores were correlated with reactive balance test scores and clinical functional measures only for the TBI group. Results: Although the TBI group exhibited greater EMG activity across the entire test compared with the control group, significant differences were not observed. Greater composite EMG activity correlated significantly with poorer reactive balance performance across most of the 10 s windows of the test. Conclusion: Greater muscle activity exhibited during the reactive balance test by individuals with chronic severe TBI compared to those without disabilities, particularly at small unexpected perturbations, highlights the greater physiologic effort required to control reactive balance even after independent ambulation is achieved.

Nitrate removal by a novel aerobic denitrifying Pelomonas puraquae WJ1 in oligotrophic condition: Performance and carbon source metabolism.

Reducing nitrate contamination in drinking water has become a critical issue in urban water resource management. Here a novel oligotrophic aerobic denitrifying bacterium, Pelomonas puraquae WJ1, was isolated and purified from artificial lake sediments. For the first time, excellent aerobic denitrification capabilities were demonstrated. At a carbon-to­nitrogen ratio of 5.0, strain WJ1 achieved 100.0 % nitrate removal and 84.92 % total nitrogen removal within 24 h, with no nitrite accumulation. PCR amplification and sequencing confirmed the presence of the denitrification genes napA, nirS, and nosZ in the strain. The nitrogen balance demonstrated that approximately 74.95 % of the initial nitrogen was eliminated as gaseous products under aerobic conditions. Furthermore, carbon balance analysis showed that most electron donors from strain WJ1 were directed towards oxygen, with limited availability for nitrate reduction. A combination of bio-ECO analysis and network modeling indicated that strain WJ1 has robust metabolic capabilities for diverse carbon sources and exhibits high adaptability to complex carbon environments. Overall, Pelomonas puraquae WJ1 removed approximately 45.89 % of the nitrates in raw water, demonstrating significant potential for practical applications in oligotrophic denitrification.

SARS-CoV-2 Spike Protein Exacerbates Thromboembolic Cerebrovascular Complications in Humanized ACE2 Mouse Model.

COVID-19 increases the risk for acute ischemic stroke, yet the molecular mechanisms are unclear and remain unresolved medical challenges. We hypothesize that the SARS-CoV-2 spike protein exacerbates stroke and cerebrovascular complications by increasing coagulation and decreasing fibrinolysis by disrupting the renin-angiotensin-aldosterone system (RAAS). A thromboembolic model was induced in humanized ACE2 knock-in mice after one week of SARS-CoV-2 spike protein injection. hACE2 mice were treated with Losartan, an angiotensin receptor (AT1R) blocker, immediately after spike protein injection. Cerebral blood flow and infarct size were compared between groups. Vascular-contributes to cognitive impairments and dementia was assessed using a Novel object recognition test. Tissue factor-III and plasminogen activator inhibitor-1 were measured using immunoblotting to assess coagulation and fibrinolysis. Human brain microvascular endothelial cells (HBMEC) were exposed to hypoxia with/without SARS-CoV-2 spike protein to mimic ischemic conditions and assessed for inflammation, RAAS balance, coagulation, and fibrinolysis. Our results showed that the SARS-CoV-2 spike protein caused an imbalance in the RAAS that increased the inflammatory signal and decreased the RAAS protective arm. SARS-CoV-2 spike protein increased coagulation and decreased fibrinolysis when coincident with ischemic insult, which was accompanied by a decrease in cerebral blood flow, an increase in neuronal death, and a decline in cognitive function. Losartan treatment restored RAAS balance and reduced spike protein-induced effects. SARS-CoV-2 spike protein exacerbates inflammation and hypercoagulation, leading to increased neurovascular damage and cognitive dysfunction. However, the AT1R blocker, Losartan, restored the RAAS balance and reduced COVID-19-induced thromboembolic cerebrovascular complications.

Perturbation Training in Anterior Cruciate Ligament Graft Tear and Posterolateral Corner Injury: A Case Report of a Combined Injury.

This case study illustrates how rehabilitation for combination injuries necessitates a thorough, customized strategy that includes perturbation training to address complicated biomechanical impairments because of the complex relationship between the anterior cruciate ligament (ACL) and the posterolateral corner (PCL). An 18-year-old female basketball player visited the Sports Rehab Outpatient Department with a complaint of pain in the posterior aspect of her knee, difficulty fully flexing her right knee joint, and intermittent instability one month after an injury. Her grade 2 ACL tear was accompanied by thinning of the lateral collateral ligament and strain of the popliteofibular ligament as per the MRI findings before the ACL reconstruction surgery. She underwent a knee graft sprain and ACL re-injury. The decision was made to manage the injury conservatively by implementing a rehabilitation program focused on perturbations to improve neuromuscular control and functional stability of the knee. This case report highlights the significance of a multidisciplinary approach, evidence-based interventions (such as the Lysholm score, International Knee Documentation Committee-Subjective Knee Form, and Tempa Scale of Kinesiophobia as outcome measures), and patient-centered care. This study intends to make a significant contribution to sports medicine and orthopedic rehabilitation by clarifying the complexities of rehabilitation in such complicated circumstances.

Effect of Whole-body Vibration on Changing Foot Position and Postural Stability in Young Adults - Comparative Study.

BACKGROUND: Whole-body vibration is commonly used in physiotherapy. The vibration platform generates mechanical stimuli that primarily influence the neuromuscular system. Vibration can improve proprioception and balance. The aim of the study was to assess the impact of whole-body vibration on foot position and postural stability. MATERIAL AND METHODS: A group of 31 participants took part in 6 vibration sessions at 15Hz and 30Hz over 2 weeks. Foot position parameters (angle and distance) and postural stability indicators before and after vibration were assessed on the Biodex Balance System. Vibration was performed on the Galileo Med35 platform (3x3 min). A control group consisted of 26 people who were only assessed on the Biodex platform. RESULTS: There was no change in the angle of both feet (p>0.05) after vibration at the frequency of 15 Hz. The angle of the right foot increased (p=0.013) after vibration at 30 Hz. Vibration increased the distance between the feet for both 15Hz (p=0.000) and 30Hz (p=0.000) sessions. There was no correlation between the change in feet spacing and the change in the overall stability index, anteroposterior stability index and mediolateral stability index (p>0.05). In the control group, no changes (p>0.05) in the angle and foot spacing were noted between consecutive measurements. CONCLUSIONS: 1. Whole body vibration can increase the width of quadrilateral of support in static conditions but has a minimal effect on changing the angle of the feet. 2. The width of the quadrilateral of support after whole-body vibration does not appear to affect postural stability under static conditions. 3. It is recommended that postural stability is assessed before and after whole body vibration while the initial position of the feet is maintained.

Estimating Air Change Rate in Mechanically Ventilated Classrooms Using a Single CO2 Sensor and Automated Data Segmentation.

With a growing emphasis on indoor air quality (IAQ) in educational environments, CO2 monitoring in classrooms has become commonplace. CO2 data can be used to estimate outdoor air change rate (ACH) based on the mass balance principle, which can be further linked to human health, performance, and building energy consumption. This study used a novel machine learning method to automatically segment CO2 concentration time series data into build-up, equilibrium, and decay periods, and then estimated classroom ACH using the corresponding CO2 mass balance equations. This method, applied to 40 classrooms in two mechanically ventilated K-6 schools, generated up to ten ACH estimates per day per classroom. A comparison with ACH calculated using the mechanical ventilation rates with 100% outdoor air reported by the building automation system during the study period reveals a slight underestimation by the decay and build-up methods, while the equilibrium method produced closer estimates. These differences may be attributed to uncertainties in occupancy, activity, CO2 emission rates, and air mixing. This research underscores the potential of leveraging CO2 data for more comprehensive IAQ assessments and highlights the challenges associated with accurately estimating ACH in real-world settings.