Cryo-EM structures of the human PA200 and PA200-20S complex reveal regulation of proteasome gate opening and two PA200 apertures.

Proteasomes are highly abundant and conserved protease complexes that eliminate unwanted proteins in the cells. As a single-chain ATP-independent nuclear proteasome activator, proteasome activator 200 (PA200) associates with 20S core particle to form proteasome complex that catalyzes polyubiquitin-independent degradation of acetylated histones, thus playing a pivotal role in DNA repair and spermatogenesis. Here, we present cryo-electron microscopy (cryo-EM) structures of the human PA200-20S complex and PA200 at 2.72 Å and 3.75 Å, respectively. PA200 exhibits a dome-like architecture that caps 20S and uses its C-terminal YYA (Tyr-Tyr-Ala) to induce the α-ring rearrangements and partial opening of the 20S gate. Our structural data also indicate that PA200 has two openings formed by numerous positively charged residues that respectively bind (5,6)-bisdiphosphoinositol tetrakisphosphate (5,6[PP]2-InsP4) and inositol hexakisphosphate (InsP6) and are likely to be the gates that lead unfolded proteins through PA200 and into the 20S. Besides, our structural analysis of PA200 found that the bromodomain (BRD)-like (BRDL) domain of PA200 shows considerable sequence variation in comparison to other human BRDs, as it contains only 82 residues because of a short ZA loop, and cannot be classified into any of the eight typical human BRD families. Taken together, the results obtained from this study provide important insights into human PA200-induced 20S gate opening for substrate degradation and the opportunities to explore the mechanism for its recognition of H4 histone in acetylation-mediated proteasomal degradation.

A molecularly imprinted electrochemical sensor for specific and ultrasensitive determination of an aminoglycoside drug: the role of copper ions in the determination.

Herein, a molecularly imprinted polymer (MIP) was fabricated for specific sensing of an aminoglycoside e.g. kanamycin (KANA). Carbon paste modified with a MIP specific to Cu2+-KANA was first introduced. Copper (Cu2+) as a metal ion was used as a signal tracer and an amplifier, producing a current response measured by differential pulse voltammetry (DPV). Introducing the aminoglycoside drug into the solution containing Cu2+ did not affect the current response of the NIP/CPE. Under the optimum conditions, the as-fabricated sensor exhibited an increase in the current response in the range of 0.55-550 nM with a good limit of detection (LOD, S/N = 3) of 161 pM. The sensor exhibited many advantages including high sensitivity and selectivity, good stability and reproducibility, and cost-effectiveness. Moreover, it was successfully applied for the determination of KANA in milk and honey samples with RSD % not more than 3.3%, suggesting the reliability of the as-designed sensor.

Use of anti-viral therapies in hospitalised COVID-19 patients in the United Arab Emirates: a cost-effectiveness and health-care resource use analysis.

BACKGROUND: This study attempts to estimate the cost-effectiveness of the antiviral remdesivir, as recommended in the 2021 COVID treatment guidelines for the United Arab Emirates, compared to standard of care (SOC), but also favipiravir (FAVI), which was also recommended for the treatment of hospitalized COVID patients. METHODS: A cost-effectiveness model was built using published efficacy data for RDV, FAVI and SOC as well as local epidemiology data. The outcomes measured included hospital bed days averted, mortality, costs and cost per outcome over one year. One-way, probabilistic and scenario analyses were undertaken to reflect uncertainty in the estimates. RESULTS: When modelled over one year, the results indicated that treatment of adults in need of supplemental oxygen with RDV + SOC could result in 11,338 fewer general ward bed days, 7,003 fewer ICU days and 5,451 fewer ICU + MIV bed days compared to SOC alone and similar results when compared with FAVI + SOC. The model results also showed that there were 374 fewer deaths associated with the use of RDV + SOC compared to SOC alone. The model also estimates substantial potential cost-savings associated with RDV + SOC treatment compared with SOC alone (USD 3,454 per patient). The results of the one-way sensitivity analysis showed that the model was sensitive to estimates of length of stay and the cost of hospitalization. Despite this, the model predicted cost-savings in all scenarios versus all comparators. CONCLUSIONS: The model estimated that using RDV + SOC could result in substantial reductions in HCRU and cost savings regardless of the comparator. However, it should be noted that reliable clinical information on FAVI was limited therefore it is challenging to interpret these results. All the potential benefits modelled here for RDV + SOC can have implications not only for the health of the UAE population but for improving hospital capacity to deal with other conditions.

Role of doppler ultrasound in detecting vascular complications in recipients of living donor liver transplant (LDLT).

OBJECTIVE: To determine the role of Doppler ultrasound in the detection of vascular complications in recipients of living donor liver transplant, keeping contrast-enhanced computerised tomography of abdomen as the gold standard. METHODS: The retrospective study was conducted from February 16 to April 1, 2022, at the Pakistan Kidney and Liver Institute and Research Centre, Lahore, Pakistan, and comprised data of living donor liver transplant recipients who had undergone contrast-enhanced computerised tomography of abdomen within 24 hours of Doppler ultrasound between January 2021 and January 2022. For the diagnosis of hepatic vascular complications, the diagnostic values of Doppler ultrasound parameters were derived by correlating Doppler ultrasound findings with contrast-enhanced computerised tomography results. Data was analysed using SPSS 20. RESULTS: Of the 35 patients, 24(68.6%) were men and 11(31.4%) were women. The overall mean age was 45.86±13.8 years. For hepatic artery thrombosis, the use of Doppler ultrasound criteria yielded a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 100%, 96.6%, 83.3%, 100%, and 97.1% respectively. For hepatic artery stenosis, overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy of Doppler ultrasound was 100%, 96.8%, 75%, 100% and 97.1% respectively. Doppler ultrasound parameters resulted in a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 100% each in detecting portal vein and hepatic venous outflow tract thrombosis. Overall, Doppler ultrasound sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy was found to be 100%, 88.8%, 89.4%, 100% and 94.2% respectively. CONCLUSIONS: Doppler ultrasound was adequate to document vascular complications after living donor liver transplant in majority of the cases with high accuracy and sensitivity.

Telomere length and telomere repeat-binding protein in children with sickle cell disease.

BACKGROUND: This study aimed to assess the telomere length and plasma telomere repeat-binding factor 2 (TRF2) levels in addition to other inflammatory markers in children with sickle cell disease (SCD). METHODS: We enrolled 106 children (90 SCD and 26 controls) aged 1-15 years from the Hematology unit of King Fahad Medical City (KFMC), Saudi Arabia. Genomic DNA extracted from blood and leukocyte TL was determined using quantitative reverse transcription PCR, whereas TRF2, C-reactive protein, interleukin-6, and DNA oxidative damage were determined by using respective commercially available assays. RESULTS: Leukocyte TL was inversely correlated with age in the SCD patients (r = -0.24, P = 0.02) and the controls (r = -0.68, P < 0.0001). In addition, SCD patients had significantly shorter TL (7.74 ± 0.81 kb) (P = 0.003) than controls (8.28 ± 0.73 kb). In contrast, no significant difference in TL among the SCD genotypes (HbSS and HbSß0) has been observed. A modest, positive correlation was seen between TL and reticulocyte % (r = 0.21; P = 0.06). There were no significant differences in the TL and TRF2 concentrations between subjects with HbSS and HbSß0 genotypes. CONCLUSIONS: Short leukocyte TL was significantly associated with SCD. An inverse association was observed between TL and hemoglobin. Hydroxyurea treatment revealed no impact on TL. IMPACT: This study explored the TL and plasma TRF2 in Saudi children with SCD. This is the first documentation that SCD children have shorter TL than their healthy counterparts, and no association between TL and TRF2 has been observed. Hydroxyurea treatment showed no impact on TL in children with SCD. This study is the first of its kind in children with SCD. It will pave the way for another study with a larger sample size in a diverse population to scrutinize these findings better.

Structural Insights into gp16 ATPase in the Bacteriophage ϕ29 DNA Packaging Motor.

Biological motors, ubiquitous in living systems, convert chemical energy into different kinds of mechanical motions critical to cellular functions. Gene product 16 (gp16) in bacteriophage ϕ29 is among the most powerful biomotors known, which adopts a multisubunit ring-shaped structure and hydrolyzes ATP to package double-stranded DNA (dsDNA) into a preformed procapsid. Here we report the crystal structure of the C-terminal domain of gp16 (gp16-CTD). Structure-based alignment and molecular dynamics simulations revealed an essential binding surface of gp16-CTD for prohead RNA, a unique component of the motor complex. Furthermore, our simulations highlighted a dynamic interplay between the N-terminal domain and the CTD of gp16, which may play a role in driving movement of DNA into the procapsid. Lastly, we assembled an atomic structural model of the complete ϕ29 dsDNA packaging motor complex by integrating structural and experimental data from multiple sources. Collectively, our findings provided a refined inchworm-revolution model for dsDNA translocation in bacteriophage ϕ29 and suggested how the individual domains of gp16 work together to power such translocation.

Cryo-electron Microscopy Structure of the Swine Acute Diarrhea Syndrome Coronavirus Spike Glycoprotein Provides Insights into Evolution of Unique Coronavirus Spike Proteins.

Coronaviruses (CoV) have caused a number of major epidemics in humans and animals, including the current pandemic of coronavirus disease 2019 (COVID-19), which has brought a renewed focus on the evolution and interspecies transmission of coronaviruses. Swine acute diarrhea syndrome coronavirus (SADS-CoV), which was recently identified in piglets in southern China, is an alphacoronavirus that originates from the same genus of horseshoe bats as severe acute respiratory syndrome CoV (SARS-CoV) and that was reported to be capable of infecting cells from a broad range of species, suggesting a considerable potential for interspecies transmission. Given the importance of the coronavirus spike (S) glycoprotein in host range determination and viral entry, we report a cryo-electron microscopy (cryo-EM) structure of the SADS-CoV S trimer in the prefusion conformation at a 3.55-Å resolution. Our structure reveals that the SADS-CoV S trimer assumes an intrasubunit quaternary packing mode in which the S1 subunit N-terminal domain (S1-NTD) and the S1 subunit C-terminal domain (S1-CTD) of the same protomer pack together by facing each other in the lying-down state. SADS-CoV S has several distinctive structural features that may facilitate immune escape, such as a relatively compact architecture of the S trimer and epitope masking by glycan shielding. Comparison of SADS-CoV S with the spike proteins of the other coronavirus genera suggested that the structural features of SADS-CoV S are evolutionarily related to those of the spike proteins of the other genera rather than to the spike protein of a typical alphacoronavirus. These data provide new insights into the evolutionary relationship between spike glycoproteins of SADS-CoV and those of other coronaviruses and extend our understanding of their structural and functional diversity.IMPORTANCE In this article, we report the atomic-resolution prefusion structure of the spike protein from swine acute diarrhea syndrome coronavirus (SADS-CoV). SADS-CoV is a pathogenic alphacoronavirus that was responsible for a large-scale outbreak of fatal disease in pigs and that was reported to be capable of interspecies transmission. We describe the overall structure of the SADS-CoV spike protein and conducted a detailed analysis of its main structural elements. Our results and analyses are consistent with those of previous phylogenetic studies and suggest that the SADS-CoV spike protein is evolutionarily related to the spike proteins of betacoronaviruses, with a strong similarity in S1-NTDs and a marked divergence in S1-CTDs. Moreover, we discuss the possible immune evasion strategies used by the SADS-CoV spike protein. Our study provides insights into the structure and immune evasion strategies of the SADS-CoV spike protein and broadens the understanding of the evolutionary relationships between coronavirus spike proteins of different genera.

Factors affecting functional outcome after lower extremity amputation.

BACKGROUND: More than 100,000 major lower extremity amputations -- amputations at the metatarsal, below-knee or above-knee level -- are performed yearly in the United States. Despite improvements in long-term outcome, operative mortality following such amputations has remained stable at 9% to 10% over the last 20 years. Several predictors for functional outcome of amputee patients are mentioned in the literature. OBJECTIVES: The current study was planned to assess the impact of comorbidities on functional status after lower extremity amputations. MATERIALS AND METHODS: It was a prospective comparative study held at the Department of Orthopaedics and Traumatology, Punjab Medical College, Faisalabad, and affiliated hospitals. The study included 104 patients regardless of age and gender. Patients were allocated into trans-metatarsal (TM) group, below-knee (BK) amputation group and above-knee (AK) amputation group. Comorbidities before amputation included diabetes mellitus (70.7%), coronary heart disease (57.1%), chronic kidney disease (53.6%), and/or congestive heart failure (52.1%). RESULTS: Mortality within 30 days of hospital discharge was 9%, and hospital readmission was 27.7%. Stroke, end-stage renal disease (ESRD) and poor baseline cognitive function were associated with the poorest functional outcome after amputation. Patients undergoing BK or AK amputation failed to return to their functional baseline within 6 months. CONCLUSIONS: Higher amputation level, history of stroke, ESRD, poor baseline cognitive scores, and female gender are factors associated with inferior functional status after amputation.

Percutaneous Transhepatic Sphincterotome-Guided Management of Post-Living Donor Liver Transplant Biliary Anastomotic Stricture: An Innovative Approach.

Post-liver transplantation biliary complications remain a serious concern and are associated with reduced patient and graft survival. Among various biliary complications, anastomotic stricture (AS) is the most frequent and challenging one. The frequency of AS after living donor liver transplantation (LDLT) is higher as compared to deceased donor liver transplantation. The management involves endoscopic retrograde cholangiopancreatography and/or percutaneous transhepatic biliary drainage, but refractory cases necessitate surgical revision. We present a case of complex biliary AS in a 63-year-old man after LDLT. The conventional approaches including endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, and cholangioscope-guided interventions remained unsuccessful. An innovative approach using a wire-guided sphincterotome through percutaneous transhepatic route successfully managed the complex post-LDLT AS. This is perhaps the first reported case of novel utilization of sphincterotome through transhepatic route for the management of AS in LDLT, averting major surgical interventions with related morbidity and mortality.

Hexavalent chromium exposure activates the non-canonical nuclear factor kappa B pathway to promote immune checkpoint protein programmed death-ligand 1 expression and lung carcinogenesis.

Lung cancer is the leading cause of cancer-related death worldwide; however, the mechanism of lung carcinogenesis has not been clearly defined. Chronic exposure to hexavalent chromium [Cr(VI)], a common environmental and occupational pollutant, causes lung cancer, representing an important lung cancer etiology factor. The mechanism of how chronic Cr(VI) exposure causes lung cancer remains largely unknown. By using cell culture and mouse models and bioinformatics analyses of human lung cancer gene expression profiles, this study investigated the mechanism of Cr(VI)-induced lung carcinogenesis. A new mouse model of Cr(VI)-induced lung carcinogenesis was developed as evidenced by the findings showing that a 16-week Cr(VI) exposure (CaCrO4, 100 µg per mouse once per week) via oropharyngeal aspiration induced lung adenocarcinomas in male and female A/J mice, whereas none of the sham-exposed control mice had lung tumors. Mechanistic studies revealed that chronic Cr(VI) exposure activated the non-canonical NFκB pathway through the long non-coding RNA (lncRNA) ABHD11-AS1/deubiquitinase USP15-mediated tumor necrosis factor receptor-associated factor 3 (TRAF3) down-regulation. The non-canonical NFκB pathway activation increased the interleukin 6 (IL-6)/Janus kinase (Jak)/signal transducer and activator of transcription 3 (Stat3) signaling. The activation of the IL-6/Jak signaling axis by Cr(VI) exposure not only promoted inflammation but also stabilized the immune checkpoint molecule programmed death-ligand 1 (PD-L1) protein in the lungs, reducing T lymphocyte infiltration to the lungs. Given the well-recognized critical role of PD-L1 in inhibiting anti-tumor immunity, these findings suggested that the lncRNA ABHD11-AS1-mediated non-canonical NFκB pathway activation and PD-L1 up-regulation may play important roles in Cr(VI)-induced lung carcinogenesis.

Pharmacist insights into antimicrobial stewardship: A social marketing approach.

BACKGROUND: Antimicrobial resistance is a worldwide public health problem. Antimicrobial stewardship programs (ASPs) optimize antimicrobial use within hospitals. The social marketing framework has been used in analyzing systems and devising best practices. OBJECTIVE: (s): To use the social marketing framework to explore pharmacist experiences and perceptions of structural, behavioral and interventional strategies that support ASPs. METHODS: A qualitative approach utilizing semi-structured individual interviews was utilized. A purposive sample of hospital pharmacists was invited to participate. An interview guide was constructed to describe participant experience and perceptions regarding ASPs in their institutions based on elements of social marketing: Behavioral goals; Customer Insight; Segmentation and Targeting; Competition; Exchange; and Marketing and Interventional mix. Interviews were recorded digitally and transcribed verbatim. Thematic analysis was conducted using deductive methods. A combination of case-based and code-based approaches allowed individual and holistic analyses respectively. Codes were collated into themes and subthemes. RESULTS: Saturation of themes occurred with 25 interviews from 17 hospitals. ASP metrics included: consumption of antibiotics using days of therapy and defined daily dose, rates of C. difficile and multidrug resistant organisms, resistance patterns, and provider adherence to the ASP. Active stewardship tools such as preauthorization, and prospective feedback/audit were preferred over passive tools such as order sets and automatic stop orders. A physician champion and a clinical pharmacist with infectious disease training were core elements in the multidisciplinary team. Despite certain areas being considered key for stewardship, participants emphasized a hospital-wide approach including outpatient departments; discharge stewardship emerged as a primary theme. Leadership supported ASPs with finances, rapid and novel diagnostics, Clinical Decision Support Systems, mobile technology, and continuous staff training. CONCLUSIONS: The social marketing framework has been used to explore pharmacist perceptions that inform successful qualities including metrics, restriction methods, personnel, benefits, barriers, training needs/modes, and promotional avenues that support ASPs in hospitals.

National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma.

A consensus meeting of national experts from all major national hepatobiliary centres in the country was held on May 26, 2023, at the Pakistan Kidney and Liver Institute & Research Centre (PKLI & RC) after initial consultations with the experts. The Pakistan Society for the Study of Liver Diseases (PSSLD) and PKLI & RC jointly organised this meeting. This effort was based on a comprehensive literature review to establish national practice guidelines for hilar cholangiocarcinoma (hCCA). The consensus was that hCCA is a complex disease and requires a multidisciplinary team approach to best manage these patients. This coordinated effort can minimise delays and give patients a chance for curative treatment and effective palliation. The diagnostic and staging workup includes high-quality computed tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography. Brush cytology or biopsy utilizing endoscopic retrograde cholangiopancreatography is a mainstay for diagnosis. However, histopathologic confirmation is not always required before resection. Endoscopic ultrasound with fine needle aspiration of regional lymph nodes and positron emission tomography scan are valuable adjuncts for staging. The only curative treatment is the surgical resection of the biliary tree based on the Bismuth-Corlette classification. Selected patients with unresectable hCCA can be considered for liver transplantation. Adjuvant chemotherapy should be offered to patients with a high risk of recurrence. The use of preoperative biliary drainage and the need for portal vein embolisation should be based on local multidisciplinary discussions. Patients with acute cholangitis can be drained with endoscopic or percutaneous biliary drainage. Palliative chemotherapy with cisplatin and gemcitabine has shown improved survival in patients with irresectable and recurrent hCCA.

Pacemaker Malfunction in a Patient With Congestive Heart Failure and Hypertension.

A pacemaker is a medical device commonly used to regulate a patient's heartbeat in cases where the heart's natural electrical impulses may be erratic or compromised. Failure of a pacemaker, or pacemaker malfunction, can be life-threatening and requires immediate action to prevent serious complications. This case report describes a 75-year-old male patient with a history of ventricular tachycardia, congestive heart failure, hypertension, and smoking who was admitted to the hospital with symptoms of palpitations, dizziness, lightheadedness, and decreased level of alertness. The patient had a single-chamber pacemaker implanted two years prior to the current admission. Upon physical examination, the patient's pacemaker had failed, and he was diagnosed with pacemaker failure. Differential diagnoses were ranked from most likely to least likely, based on the patient's history and physical examination, and included pacemaker failure, arrhythmia, myocardial infarction, and pulmonary embolism. Treatment included the replacement of the pacemaker, and the patient was discharged in stable condition.

Saudi Arabia Health Systems: Challenging and Future Transformations With Artificial Intelligence.

The healthcare system in Saudi Arabia is facing several challenges, including an aging population, an increase in chronic diseases, and a shortage of healthcare professionals. To address these challenges, the government is taking proactive steps, including expanding healthcare infrastructure, promoting the use of technology, improving the quality of healthcare services, and emphasizing the importance of preventive healthcare. In addition, the adoption of artificial intelligence (AI) solutions can play a crucial role in transforming the healthcare system by improving efficiency, reducing costs, and enhancing the quality of care. However, the adoption of AI solutions comes with challenges such as the need for high-quality data and the development of regulations and guidelines. The government needs to continue to invest in healthcare and AI solutions to build a more efficient and effective healthcare system that benefits all citizens.

Patients' Opinions Toward Healthcare Quality and Improvement in Aseer Health: A Cross-Sectional Study.

Introduction Population health is crucial to government planning. The 2030 national vision is transforming all Saudi sectors. The health sector revolution intends to boost life expectancy by reducing mortality due to road traffic accidents and morbidity due to chronic illness. Health services will change from treatment-based to person-centered and preventive care, empower the population, increase access to healthcare and improve service quality by offering high customer satisfaction. This study establishes a baseline assessment for public awareness, behavior, healthcare access, and quality. Method A cross-sectional study was conducted in the Aseer region in southwestern Saudi Arabia in 2022, September and October. Using the Aseer region's 2.1 million people to calculate the sample needed, the minimal sample size was 664. The study used cluster random sampling and a structured self-administered questionnaire to meet health transformation strategy requirements. All study variables underwent descriptive and bivariate analysis. Result The survey received 1,381 responses, with 97.2% of participants being Saudi and 84.4% being male. 312 (22.6%) of participants self-reported their health status as weak; 615 (44.5%) self-reported as having a good health status; and 667 (48.3%) reported having high knowledge. 740 people (53.6%) said that health was very important in their daily lives. The evaluation rate for Ministry of Health services in primary healthcare centers was 585 (42.4%) medium and 398 (28.8%) media for inpatient services. Evaluation for surgical procedure availability was 388 (28.1%) media. The results showed there is a statistically significant relationship (p-value < 0.05) between health status and age, gender, knowledge, and the importance of a healthy lifestyle. And there is a statistically significant relationship between the availability and quality of the health service profile, including inpatient, outpatient, and virtual care. Nationality appears to be statistically insignificant. Conclusion Health promotion is effective because people are health conscious. The importance of health and lifestyle presents a tremendous opportunity to incorporate health into all policies and improve the availability of healthy lifestyle options and surroundings to support healthy behaviors that will reduce preventable disease and risk mortality and morbidity. Health status was also linked to healthcare availability and quality.

Robotics and Artificial Intelligence and Their Impact on the Diagnosis and Treatment of Cardiovascular Diseases.

A new era has begun in the treatment of cardiovascular disorders as a direct result of the significant developments that have been made in robotics and artificial intelligence (AI). This abstract investigates the potential and impact that AI algorithms and robotic systems may have in the diagnosis and treatment of cardiovascular problems. The field of cardiovascular treatments has been completely transformed by robotically assisted surgeries, which have enabled minimally invasive procedures with increased patient safety and decreased recovery time. The incorporation of AI algorithms into cardiovascular care has made early abnormality identification, risk classification, and tailored treatment planning significantly easier. However, problems including patient safety, data privacy, and smooth integration into existing healthcare systems need to be solved. This abstract places an emphasis on the necessity of collaboration and responsible implementation in order to fully harness the promise of robotics and AI in cardiovascular care, which will ultimately lead to improved patient outcomes and an enhanced quality of life.

Future of Using Robotic and Artificial Intelligence in Implant Dentistry.

The integration of robotic technology and artificial intelligence (AI) in implant dentistry has ushered in a new era of precision and efficiency. This abstract aims to understand the integration, implications, potential, and challenges of robotic technology and AI in implant dentistry. Robotic systems offer unparalleled accuracy in implant placement, reducing human error and improving treatment outcomes. AI algorithms analyze extensive patient data to assist in diagnosis, treatment planning, and implant design, optimizing the overall process. Successful case studies demonstrate improved implant survival rates and patient satisfaction. However, ethical considerations and the balance between human expertise and reliance on technology must be addressed. Ongoing research aims to enhance these technologies and integrate them with digital workflows. Collaboration and knowledge sharing among practitioners, researchers, and industry experts are essential to drive progress and ensure responsible implementation. The future of implant dentistry lies in harnessing the potential of robotics and AI while upholding the highest standards of patient care and ethical practice.

Estimate a patient's 10 years cardiovascular risk using the Arteriosclerotic cardiovascular disease tool in a cross-sectional study in Al-Harja, Asser, Saudi Arabia, 2021.

Introduction: Recently, the cases of arteriosclerotic cardiovascular disease (ASCVD) have been increasing in the rural areas of southwest Saudi Arabia. Therefore, this study sought to consider the relevant contributing factors, such as traditional dietary habits and a diet rich in cholesterol and fat, few opportunities for disease screening, false beliefs about chronic disease management medications, delays in diagnosis, and the great distances required for travel to cardiac specialist centers. Methods: A cross-sectional study was conducted at 12 primary health care (PHC) centers, using the ASCVD tool. The total required sample was determined to be 440 participants after calculating based on the total population of Al-Harja. Systematic random sampling was performed using a list of PHC centers and fixed intervals. The study's outcome is ASCVD risk score divided into four categories: low risk <5%, borderline risk 5%-7.5%, intermediate risk >7.5%-20%, and high risk >20%. Data were collected through interview questionnaires, measurements, and laboratory sample investigations. Result: It was revealed that 16.59% of the participants were classified in the high-risk category for having ASCVD in the next 10 years. There was a significant association between the ASCVD risk score and obesity (P = 0.03). Prior diagnoses for either hypertension or diabetes mellitus (P = 0.00) were significantly associated with an increased ASCVD risk score. Conclusion: An alarmingly high prevalence of high-risk ASCVD scores was seen among male participants, with 54 (22.78%) in the high-risk category, while 19 female participants (9.36%) were in the same category. Therefore, we can conclude that male participants are two times as likely to have a high ASCVD risk than female participants.

Spinopelvic In Situ Fixation and Early Mobilization: A Case Report and Literature Review.

Pelvic fractures with sacroiliac extension are significant and complicated orthopedic injuries that pose a challenge in management and favorable outcomes. A 50-year-old obese female presented after a motor vehicle accident with pelvic fracture lateral compression. The patient underwent anterior external fixation with a left sacroiliac screw (SIS) on the next day of admission and was kept in a non-weight-bearing state. During her hospital stay, she developed deep vein thrombosis (DVT) and was treated. During the follow-up on the sixth week, the patient was not complying with her immobilization instructions and was exposing the left lower limb to weight bearing. The radiologic evaluation demonstrated a pulled-out SIS with a stable fracture. Considering that the patient was obese, had a history of DVT and COVID-19 infection, and the fracture was minimally displaced, it was decided to perform a spinopelvic in-situ fixation from L4 to S2 and augment it with a left SIS. The patient tolerated the surgery well and was referred to physiotherapy for early mobilization with full weight bearing. During her six-month and two-year follow-ups, she was well mobilized with no active complaints, and radiographic studies showed good healing, no displacement, no signs of instability, and a stable construct. Our case report presents a very rare and difficult but successful management of a fracture displacement in a non-compliant patient with one pulled-out screw through fast-tracked in situ spinopelvic fixation with early mobilization and full weight bearing. To our knowledge, this is one of the rare reports detailing a patient undergoing in situ spinopelvic fixation due to minimally displaced fracture with comorbidities such as obesity and DVT. Our report demonstrates the viability of accepting pulled-out screws, with respect to the patient's health, the fracture's geometry, a quick follow-up in situ spinopelvic fixation, early mobilization, full weight-bearing outcomes, and a lower risk for complications.

Short Tandem Repeat (STR) DNA Analysis for Using Coffee Cups As Forensic Medicine Evidence.

Introduction Forensic science has continually evolved, with innovations in DNA analysis techniques playing a pivotal role in improving the accuracy and reliability of criminal investigations. Short tandem repeats (STRs) have been a game-changer in forensic science, offering unique genetic markers to pinpoint individual identities. This study explores the application of STR DNA analysis to an unconventional source: coffee cups. Materials and methods In a study involving 16 unrelated, healthy individuals aged 26 to 32, DNA was investigated from coffee cups and mouth cavities, comparing the results to a previous coffee cup DNA study. Buccal swabs provided reference samples, air-dried for 10 minutes, and stored at 20°C. DNA quantification revealed a significant decrease in coffee cup samples (0.015 to 0.049 ng/µL) compared to the reference, with no DNA in negative controls. Some STR loci displayed inhibition and lower heterozygosity in the research samples. Ethical approval (REC 53-592) and adherence to the Declaration of Helsinki ensured ethical standards. This research highlights potential challenges in obtaining efficient DNA profiles from various sources. Results There was a significant variation in DNA concentrations among the different cup types, with ceramic cups yielding the highest concentrations. Moreover, the DNA profiling outcomes ranged from full profiles, which allow for precise individual identification, to partial profiles, which pose challenges for conclusive matches. These findings have profound implications for forensic science. The study demonstrates the potential of coffee cups as sources of DNA evidence in criminal investigations, even if partial profiles are obtained. Such evidence can assist in suspect identification, victim profiling, and corroborating witness statements. Conclusion This study highlights the application of STR DNA analysis for coffee cups, opening new avenues for forensic investigations and highlighting the need for continued research and development in this exciting field. This observation aligns with existing research on DNA recovery from various surfaces, and further research is warranted to refine the methodology, consider usage patterns, and address ethical and legal concerns regarding the collection and use of DNA evidence from common objects.