GIBPS technique-a novel sequential technique of performing shoulder corticosteroid injections.

The introduction of the xxxxxxxx (GIBPS) technique represents a patient-centric novel and innovative method of ultrasound guided corticosteroid injection targeting the Glenohumeral joint (GHJ) and the Subacromial-Subdeltoid (SASD) bursa in a sequential manner, in the same setting. By integrating the two different sites of injection into a single technique, the procedure has the potential of transforming musculoskeletal interventional radiology and maximising patient care in shoulder pathologies. This procedure aims to reduce patient discomfort, optimise procedural efficiency, and enhance treatment precision through ultrasound guidance and improve the overall patient experience.

Changes in pituitary adenoma patient presentation and outcomes during the COVID pandemic at a Pituitary Center of Excellence.

PURPOSE: The COVID-19 pandemic caused significant disruption to the surgical care of patients. The aim of this study was to analyze the impact of the pandemic on endoscopic endonasal surgery (EES) for patients with a pituitary adenoma. METHODS: Patients from 2015 to 2022 that had EES for a pituitary adenoma were included in this study. Patients were separated into pre-COVID (January 2015-March 2020) and COVID (March 2020-September 2022) groups. Univariate analysis was done using chi-square, fisher exact tests, and t-tests to compare groups. RESULTS: This study included 492 patients that had EES for their pituitary adenoma. There were 314 patients in the pre-COVID group and 178 patients in the COVID group. Patients in the COVID group had a higher risk analysis index (RAI) frailty score (15 ± 10 pre-COVID vs. 20 ± 9 COVID, P < 0.001) and a higher American Society of Anesthesiology (ASA) physical status score (3 or 4) (72.0% pre-COVID vs. 81.9% COVID, P = 0.02). There were significantly more macroadenoma cases (87.6% pre-COVID vs. 94.4% COVID, P = 0.02) and extrasellar surgical approaches (45.2% pre-COVID vs. 61.2% COVID, P < 0.001) during COVID. There was no significant difference in length of stay (LOS) and readmission rates between groups. CONCLUSIONS: Patients that presented during the pandemic tended to be more frail, have more comorbidities, and require additional extrasellar surgical approaches. Despite changes in clinical presentation and operative management, the LOS and readmission rate remained stable during COVID, supporting the safety of this procedure during the recent pandemic.

Cytotoxicity and antibacterial susceptibility assessment of a newly developed pectin-chitosan polyelectrolyte composite for dental implants.

Biopolymers such as chitosan and pectin are currently attracting significant attention because of their unique properties, which are valuable in the food industry and pharmaceutical applications. These properties include non-toxicity, compatibility with biological systems, natural decomposition ability, and structural adaptability. The objective of this study was to assess the performance of two different ratios of pectin-chitosan polyelectrolyte composite (PCPC) after applying them as a coating to commercially pure titanium (CpTi) substrates using electrospraying. The PCPC was studied in ratios of 1:2 and 1:3, while the control group consisted of CpTi substrates without any coating. The pull-off adhesion strength, cytotoxicity, and antibacterial susceptibility tests were utilized to evaluate the PCPC coatings. In order to determine whether the composite coating was the result of physical blending or chemical bonding, the topographic surface parameters were studied using Fourier transform infrared spectroscopy (FTIR) and atomic force microscopy (AFM). PCPC (1:3) had the highest average cell viability of 93.42, 89.88, and 86.85% after 24, 48, and 72 h, respectively, as determined by the cytotoxicity assay, when compared to the other groups. According to the Kirby-Bauer disk diffusion method for testing antibacterial susceptibility, PCPC (1:3) showed the highest average diameter of the zone of inhibition, measuring 14.88, 14.43, and 11.03 mm after 24, 48, and 72 h of incubation, respectively. This difference was highly significant compared to Group 3 at all three time periods. PCPC (1:3) exhibited a significantly higher mean pull-off adhesion strength (521.6 psi) compared to PCPC (1:2), which revealed 419.5 psi. PCPC (1:3) coated substrates exhibited better surface roughness parameters compared to other groups based on the findings of the AFM. The FTIR measurement indicated that both PCPC groups exhibited a purely physical blending in the composite coating. Based on the extent of these successful in vitro experiments, PCPC (1:3) demonstrates its potential as an effective coating layer. Therefore, the findings of this study pave the way for using newly developed PCPC after electrospraying coating on CpTi for dental implants.

Molecular and agro-morphological characterization of new barley genotypes in arid environments.

BACKGROUND: Genetic diversity, population structure, agro-morphological traits, and molecular characteristics, are crucial for either preserving genetic resources or developing new cultivars. Due to climate change, water availability for agricultural use is progressively diminishing. This study used 100 molecular markers (25 TRAP, 22 SRAP, 23 ISTR, and 30 SSR). Additionally, 15 morphological characteristics were utilized to evaluate the optimal agronomic traits of 12 different barley genotypes under arid conditions. RESULTS: Substantial variations, ranging from significant to highly significant, were observed in the 15 agromorphological parameters evaluated among the 12 genotypes. The KSU-B101 barley genotype demonstrated superior performance in five specific traits: spike number per plant, 100-grain weight, spike number per square meter, harvest index, and grain yield. These results indicate its potential for achieving high yields in arid regions. The Sahrawy barley genotype exhibited the highest values across five parameters, namely leaf area, spike weight per plant, spike length, spike weight per square meter, and biological yield, making it a promising candidate for animal feed. The KSU-B105 genotype exhibited early maturity and a high grain count per spike, which reflects its early maturity and ability to produce a high number of grains per spike. This suggests its suitability for both animal feed and human food in arid areas. Based on marker data, the molecular study found that the similarity coefficients between the barley genotypes ranged from 0.48 to 0.80, with an average of 0.64. The dendrogram constructed from these data revealed three distinct clusters with a similarity coefficient of 0.80. Notably, the correlation between the dendrogram and its similarity matrix was high (0.903), indicating its accuracy in depicting the genetic relationships. The combined analysis revealed a moderate correlation between the morphological and molecular analysis, suggesting alignment between the two characterization methods. CONCLUSIONS: The morphological and molecular analyses of the 12 barley genotypes in this study effectively revealed the varied genetic characteristics of their agro-performance in arid conditions. KSU-B101, Sahrawy, and KSU-B105 have emerged as promising candidates for different agricultural applications in arid regions. Further research on these genotypes could reveal their full potential for breeding programs.

Correction: Fin whales of the Great Bear Rainforest: Balaenoptera physalus velifera in a Canadian Pacific fjord system.

[This corrects the article DOI: 10.1371/journal.pone.0256815.].

Comparison Flattening Filter and Flattening Filter-Free Techniques in Small-Fields Dosimetry with Various Types of Detectors.

PURPOSE: The aim of this study was to investigate the detector size effect on small-field dosimetry and compare the performance of 6MV WFF/FFF techniques. METHODS: We investigated the detector size effect on small-field dosimetry and compared the performance of 6MV WFF/FFF techniques. PDD, profile curves, and absorbed dose were measured in water under reference conditions with 6MV (WFF/FFF) techniques. We employed Farmer FC65-P, CC13, CC01, and IBA Razor diode, with Versa Lineac. Subsequently, we replicated this assessment for small-fields under 5cmx5cm dimensions. RESULTS: For both 6MV WFF/FFF, significant dose differences (Dmax=1.47cm), were ±4.55%, ±6.7, ±12.75% and ±33.3% for 4cmx4cm, 3cmx3cm, 2cmx2cm, and 1cmx1cm, respectively. The average difference relative to D10 was observed to be ±4.66%, ±5.73%, ±6.58%, and ±8.75% for the previous field sizes. Differences between WFF/FFF are neglected values at all field sizes>2.3%, also, the output of the largest detector FC65-P is lower at 55% in the smallest field size. Variation in the profile doesn't exceed a difference of >5% in flatness between WFF/FFF at depth10cm, across all fields, while symmetry is >1%, but radiation output is considerably lower at 55% for FC65-P chamber in 2cmx2cm, 1cmx1cm compared to the CC01 chamber and Razor diode. Significant differences in 1cmx1cm, where FC65-P chamber exhibits around 49% difference compared to Razor diode with 6MV (WFF/FFF).  Conclusions: Significant differences were observed in doses with various detectors. Detector-size influences the dose. WFF/FFF techniques show no major differences in small-fields dosimetry. Utilize some situations the advantage of FFF boasting a higher dose rate, consequently reducing treatment time to half.

The utility of inflammatory biomarkers in predicting overall survival and recurrence in skull base chordoma.

OBJECTIVE: Numerous studies have investigated the impact of inflammatory factors in cancer, yet few attempts have been made to investigate these markers in skull base chordoma (SBC). Inflammatory values including neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), systemic immune inflammation index (SII), and systemic inflammation response index (SIRI) can serve as prognostic markers in various cancers. This study aimed to determine whether these inflammatory factors influence overall survival (OS) or progression-free survival (PFS) in patients with primary SBC. METHODS: The electronic medical records of patients with primary SBC who underwent resection from 2001 to 2020 were retrospectively reviewed for the associations of sex, age at diagnosis, preoperative steroid use, tumor volume, extent of resection, adjuvant radiation after surgery, tumor metastasis, Ki-67 index, percent homozygous deletion of 9p23 and percent 1p36 loss, and potential prognostic inflammatory markers of NLR, PLR, LMR, SII, and SIRI with the primary outcome measures of OS and PFS. Maximum log-rank statistical tests were used to determine inflammatory marker thresholds for grouping prior to Kaplan-Meier and Cox proportional hazards analysis for OS and PFS of the elucidated groups. RESULTS: The cohort included 115 primary SBC patients. The mean ± SD tumor volume was 23.0 ± 28.0 cm3, 73% of patients received gross-total resection, 40% received postoperative radiation, 25% had local recurrence, and 6% had subsequent metastatic disease (mean follow-up 47.2 months). Univariable Cox analysis revealed that NLR (p < 0.01), PLR (p = 0.04), LMR (p = 0.04), SII (p < 0.01), and SIRI (p < 0.01) were independently associated with PFS. Additionally, NLR (p = 0.05) and SII (p = 0.03) were significant in multivariable Cox analysis of PFS. However, both univariable and multivariable Cox analysis revealed no correlations with OS. CONCLUSIONS: The routine assessment of inflammatory biomarkers such as NLR and SIRI could have prognostic value in postresection SBC patients.

The Enterococcus secretome inhibits the growth of vancomycin-resistant Enterococcus faecalis V853 with their antiproliferative properties and nanoencapsulation effects.

In our study, the secretome of the clinical isolate Enterococcus faecalis HY7 displayed antibacterial activity against the vancomycin-resistant Enterococcus faecalis V853. These bacteriocin-like substances showed thermal stability at a wide range of temperatures up to 121 °C, while proteinase K treatment resulted in a total loss of their activity. PCR-based screening for bacteriocin biosynthetic genes revealed that Enterococcus faecalis HY7 harbored multiple enterocin-producing genes, including ent A, avc A, and as-48. The production kinetics demonstrated the highest levels of bacteriocins production at 16 h, whereas the activity was diminished after 32 h of microbial growth. Notably, the partially purified bacteriocins exhibited anti-proliferative activity on the colon cancer cells, Caco2, with an IC50 value of 172.8 µg/mL. Remarkably, the nanoencapsulation of our bacteriocins in liposome showed a fourfold increase in its anti-vancomycin-resistant Enterococcus activity, which is the first report of liposome encapsulation with anti-vancomycin resistant Enterococcus bacteriocin.

Relationship between the components of mare breast milk and foal gut microbiome: shaping gut microbiome development after birth.

The gut microbiota (GM) is essential for mammalian health. Although the association between infant GM and breast milk (BM) composition has been well established in humans, such a relationship has not been investigated in horses. Hence, this study was conducted to analyze the GM formation of foals during lactation and determine the presence of low-molecular-weight metabolites in mares' BM and their role in shaping foals' GM. The fecal and BM samples from six pairs of foals and mares were subjected to 16S ribosomal RNA metagenomic and metabolomic analyses, respectively. The composition of foal GM changed during lactation time; hierarchical cluster analysis divided the fetal GM into three groups corresponding to different time points in foal development. The level of most metabolites in milk decreased over time with increasing milk yield, while threonic acid and ascorbic acid increased. Further analyses revealed gut bacteria that correlated with changes in milk metabolites; for instance, there was a positive correlation between Bacteroidaceae in the foal's gut microbiota and serine/glycine in the mother's milk. These findings help improve the rearing environment of lactating horses and establish artificial feeding methods for foals.

Assessment of psychological alarms and coping strategies of medical students with irritable bowel syndrome at Zagazig University: A cross-sectional study.

BACKGROUND: Irritable bowel syndrome (IBS) is one of the most prevalent functional gastrointestinal disorders. Medical students tend to report a higher prevalence of IBS since they are under constant stress. Many psychological difficulties are associated with IBS. To cope with IBS, individuals use various strategies which can impact the intensification or alleviation of IBS symptoms. The objective of this study was to assess the prevalence of IBS in medical students as well as psychological alarms and coping strategie employed by IBS sufferers. MATERIALS AND METHODS: We conducted a cross-sectional study from December 2022 to February 2023. Study participants were first to fifth year medical school students at Zagazig University, Egypt. Data were collected using a structured questionnaire comprising four sections: sociodemographic and clinical data; Rome IV criteria for the diagnosis of IBS; the alarm questionnaire for functional gastrointestinal disorders; and the Coping Strategies Questionnaire (CSQ24). Chi-square test or Fischer's exact test, as appropriate, were used to test for association. Binary logistic regression with a backward stepwise method was used to determine significant risk factors of negative coping with IBS. RESULTS: Of the studied 221 medical students, 38% had IBS. A statistically significant association was observed between IBS and the feeling of tension, anxiety, nervousness, depression, and frustration in the previous week, severe pain in the past 4 weeks, and the feeling that the bad situation would not get any better. Most of the students in the IBS group coped positively with stress, while 19.0% were negative in coping. Pain affecting the daily activities and the feelings of depression and frustration to the point of self-harm or suicide were the most significant correlates of IBS group's inability to cope. CONCLUSION: The prevalence of IBS in medical students at Zagazig University was 38%. We recommend psychological intervention and stress management programs to help medical students cope with IBS.

Consensus Guideline on the Management of Epilepsy in Egypt: A National Delphi Consensus Study.

OBJECTIVE: In epilepsy, early diagnosis, accurate determination of epilepsy type, proper selection of antiseizure medication, and monitoring are all essential. However, despite recent therapeutic advances and conceptual reconsiderations in the classification and management of epilepsy, serious gaps are still encountered in day-to-day practice in Egypt as well as several other resource-limited countries. Premature mortality, poor quality of life, socio-economic burden, cognitive problems, poor treatment outcomes, and comorbidities are major challenges that require urgent actions to be implemented at all levels. In recognition of this, a group of Egyptian epilepsy experts met through a series of consecutive meetings to specify the main concepts concerning the diagnosis and management of epilepsy, with the ultimate goal of establishing a nationwide Egyptian consensus. METHODS: The consensus was developed through a modified Delphi methodology. A thorough review of the most recent relevant literature and international guidelines was performed to evaluate their applicability to the Egyptian situation. Afterward, several remote and live rounds were scheduled to reach a final agreement for all listed statements. RESULTS: Of 278 statements reviewed in the first round, 256 achieved ≥80% agreement. Live discussion and refinement of the 22 statements that did not reach consensus during the first round took place, followed by final live voting then consensus was achieved for all remaining statements. SIGNIFICANCE: With the implementation of these unified recommendations, we believe this will bring about substantial improvements in both the quality of care and treatment outcomes for persons with epilepsy in Egypt. PLAIN LANGUAGE SUMMARY: This work represents the efforts of a group of medical experts to reach an agreement on the best medical practice related to people with epilepsy based on previously published recommendations while taking into consideration applicable options in resource-limited countries. The publication of this document is expected to minimize many malpractice issues and pave the way for better healthcare services on both individual and governmental levels.

Correlation between TCF7L2 gene expression and certain biochemical parameters in type 2 diabetes mellitus.

Objectives: The transcription factor 7-like 2 gene (TCF7L2) is associated with a predisposition to type 2 diabetes mellitus (T2DM) in different ethnic populations. This article investigated the relationship between TCF7L2 gene expression and several biochemical indexes among different age categories of T2DM in a sample of the Iraqi population. Methods: One hundred and fifty blood samples were collected from three groups: young T2DM (10-35 years), old T2DM (40-80 years), and healthy control (10-65 years) groups. Both sexes were enrolled. qPCR was performed to explore the expression of the TCF7L2 gene. Biochemical tests were performed to assess hemoglobin A1C (HbA1c), triglyceride (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) levels. The body mass index (BMI) was calculated. The results were statistically analyzed. Results: Patients with T2DM had higher BMI, TG, and LDL, and lower HDL than the control group. There was a strong positive correlation between hemoglobin A1C (HbA1c) and BMI, TG, and LDL and a negative correlation between HbA1c and HDL. Expression of the TCF7L2 gene showed a significant difference between old and young patients by 1.68 and 0.207 fold, respectively. These results showed that old patients had higher gene expression than young patients. Conclusion: TCF7L2 gene expression was affected by age, with higher expression in old T2DM patients. This may influence beta cell functions and insulin secretion.

Passive frequency comb generation at radiofrequency for ranging applications.

Optical frequency combs, featuring evenly spaced spectral lines, have been extensively studied and applied to metrology, signal processing, and sensing. Recently, frequency comb generation has been also extended to MHz frequencies by harnessing nonlinearities in microelectromechanical membranes. However, the generation of frequency combs at radio frequencies (RF) has been less explored, together with their potential application in wireless technologies. In this work, we demonstrate an RF system able to wirelessly and passively generate frequency combs. This circuit, which we name quasi-harmonic tag (qHT), offers a battery-free solution for far-field ranging of unmanned vehicles (UVs) in GPS-denied settings, and it enables a strong immunity to multipath interference, providing better accuracy than other RF approaches to far-field ranging. Here, we discuss the principle of operation, design, implementation, and performance of qHTs used to remotely measure the azimuthal distance of a UV flying in an uncontrolled electromagnetic environment. We show that qHTs can wirelessly generate frequency combs with µWatt-levels of incident power by leveraging the nonlinear interaction between an RF parametric oscillator and a high quality factor piezoelectric microacoustic resonator. Our technique for frequency comb generation opens new avenues for a wide range of RF applications beyond ranging, including timing, computing and sensing.

Does Parkinson's disease affect sleep quality?

BACKGROUND: Parkinson's disease (PD) is a common neurodegenerative disease that is linked to several motor and nonmotor symptoms, including sleep disturbances. Patient quality of life has been shown to be disproportionally impacted by disease. OBJECTIVES: To investigate sleep quality among individuals with PD, and to assess the severity of sleep disturbances and their impact on daytime activities. SUBJECTS AND METHODS: A case‒control with 44 patients with Parkinson's disease and 80 apparently healthy control participants was recruited from several hospitals and clinics. Each participant provided a thorough medical history and underwent a physical examination, and a questionnaire comprising the standard PSQI was used to assess sleep quality. Independent samples t test and Spearman's correlation analysis were used with a p value equal to or less than 0.05 which was considered significant. RESULTS: The mean global PSQI score was 11.55 ± 4.412 for PD patients and 5.73 ± 3.22 for the control group with significant p value, Sleep latency onset was 75.57 min for PD patients and 22.81 min for the control group with significant p value. There was no significant correlation between age and other sleep-related variables. A total of 86.4% of patients with Parkinson's disease suffered from varying degrees of daytime dysfunction compared to 61.25% of the controls. CONCLUSION: Parkinson's disease patients had poorer sleep quality than the controls. Age and sex were not found to be expected as a factor for sleep quality in patients with Parkinson's disease. Daytime dysfunction rates are high in patients with Parkinson's disease.

Aripiprazole-induced quasi-neuroleptic malignant syndrome: two case reports.

BACKGROUND: Significant elevation of creatine kinase levels (above three digits) and leucocytosis in the absence of muscle rigidity, tremors, or autonomic dysfunction can pose a real challenge in the context of antipsychotic treatment as an early herald of neuroleptic malignant syndrome. CASE PRESENTATION: We present here two cases of adult male patients of Black British heritage, ages 51 years and 28 years, respectively. Both received a diagnosis of schizoaffective disorder and presented with massive increase of creatine kinase blood level after aripiprazole depot administration, one with pernicious increase associated with silent neuroleptic malignant syndrome, and the second with asymptomatic benign enzyme elevation. CONCLUSION: Though aripiprazole use is less likely to cause neuroleptic malignant syndrome, on rare occasions it can produce massive symptomatic or asymptomatic increase in serum creatine kinase enzyme levels, raising the need for close monitoring, especially at the initial doses of the drug.

Tracking the therapeutic efficacy of a ketone mono ester and ß-hydroxybutyrate for ulcerative colitis in rats: New perspectives.

Ulcerative colitis (UC) is an inflammatory condition that affects the colon's lining and increases the risk of colon cancer. Despite ongoing research, there is no identified cure for UC. The recognition of NLRP3 inflammasome activation in the pathogenesis of UC has gained widespread acceptance. Notably, the ketone body ß-hydroxybutyrate inhibits NLRP3 demonstrating its anti-inflammatory properties. Additionally, BD-AcAc 2 is ketone mono ester that increases ß-hydroxybutyrate blood levels. It has the potential to address the constraints associated with exogenous ß-hydroxybutyrate as a therapeutic agent, including issues related to stability and short duration of action. However, the effects of ß-hydroxybutyrate and BD-AcAc 2 on colitis have not been fully investigated. This study found that while both exogenous ß-hydroxybutyrate and BD-AcAc 2 produced the same levels of plasma ß-hydroxybutyrate, BD-AcAc 2 demonstrated superior effectiveness in mitigating dextran sodium sulfate-induced UC in rats. The mechanism of action involves modulating the NF-κB signaling, inhibiting the NLRP3 inflammasome, regulating antioxidant capacity, controlling tight junction protein expression and a potential to inhibit apoptosis and pyroptosis. Certainly, BD-AcAc 2's anti-inflammatory effects require more than just increasing plasma ß-hydroxybutyrate levels and other factors contribute to its efficacy. Local ketone concentrations in the gastrointestinal tract, as well as the combined effect of specific ketone bodies, are likely to have contributed to the stronger protective effect observed with ketone mono ester ingestion in our experiment. As a result, further investigations are necessary to fully understand the mechanisms of BD-AcAc 2 and optimize its use.