Background: Methamphetamine use disorders (MAUD) can substantially jeopardize public security due to their high-risk social psychology and behavior. Given that the dopamine reward system is intimately associated with MAUD, we investigated the association of single nucleotide polymorphisms (SNPs), as well as methylation status of DRD4, COMT genes and paranoid, motor impulsive symptoms in MAUD patients. Methods: A total of 189 MAUD patients participated in our study. Samples of peripheral blood were used to detecte for 3 SNPs and levels of 35 CpG units of methylation in the DRD4 gene’s promoter region, 5 SNPs and 39 CpG units in the COMT gene. Results: MAUD patients with rs1800955 C allele have a lower percentage of paranoid symptom than those with rs1800955 TT. Individuals with paranoid symptom exhibited reduced methylation degree at particular DRD4 CpG2.3 unit. The interaction of the DRD4 rs1800955 C allele and the reduced DRD4 CpG2.3 methylation degree resulted in the lower occurrence of the paranoid symptom. Meanwhile, those with COMT rs4818 CC allele have lower motor impulsivity scores in MAUD patients, but greater COMT methylation levels in the promotor region and methylation degree at COMT CpG 51.52 unit. Therefore, based only on COMT rs4818 CC polymorphism, there was a negative correlation between COMT methylation and motor impulsivity scores in the MAUD patients. Conclusions: Our results found that the combination of SNP genotyping and methylation status of the DRD4 and COMT genes may serve as biological indicators to evaluate the prevalence of relatively high-risk psychotic symptoms in MAUD patients.

Purpose: This study aimed to evaluate the influence of DRG-based hospital payment system approach on implementation of inpatient treatment. Methods: This study was largely based on retrospective analysis of DRG-based hospital payment data from third-class hospital for the period of October 2021 to February 2022 including determination of diagnosis groups with most significant balance of payment loss and corresponding departments, development of pathways to DRG-based inpatient treatment, pre-checking of prescriptions, in process education of clinical pharmacists and case follow up, comments and penalty measures. The rational drug use, drug income proportion and DRG-related medical services capability assessment (manageable number of DRGs, CMI, average hospital stay, time consumption index and resource consumption index) of departments with loss were compared before and after intervention. Results: Data analysis revealed that BR23 (cerebral ischemic stroke with accompanying diseases or complications) balance of payments loss was most significant with higher average drug income proportion than such in groups of balance of payments surplus. The Neurology Department BR23 demonstrated significant balance of payment deficit. Therefore, the ischemic stroke drug clinical treatment pathway was successfully developed and after intervention, prescription errors counted 14.14, therefore demonstrated 6.89% decrease and at the same time medicines consumption rate was 27.17% with 9.43% decrease. The number of manageable number of DRGs increased by 3, CMI increased by 0.14, average length of stay decreased by 0.8 days, time consumption index and resource consumption index decreased by 0.11 and 0.18 respectively. Conclusion: DRG-based hospital payment management of inpatient treatment provided theoretical support for DRG code-based reimbursement cost control and scientific cost control and has improved quality management of hospital service.

Introduction United Kingdom medical graduates can apply for speciality training after completing a two-year internship (Foundation Training). Post-foundation training application requirements vary depending on speciality but fundamentally require key skills such as teaching, research, and leadership. We investigated whether medical student demographics impact their familiarity with post-graduate training pathways and application process. Methods This was a cross-sectional study using a Bristol Online Survey. All UK medical students were invited to answer a range of questions on their demographics and perceived familiarity with Post-Foundation Training Pathways (PFTPs) and Post-Foundation Application Process (PFAP). The data was collected between March 2022 and April 2022 and exported for further analysis. Statistical analysis was conducted in Stata v.17.1 using Chi-square tests. Results 850 students from 31 medical schools took part. Male students were found to be more familiar with PFTPs and PFAP compared to female students (p<0.001). Similarly, students from Black, Asian, Mixed Ethnic (BAME) backgrounds expressed significantly lower familiarity (p<0.001) with PFAP compared to their white counterparts. Younger participants reported lower familiarity with PFAP (p<0.001). Students from a medical background expressed a significantly higher familiarity with PFTPs and PFAP (p<0.001). Conclusion The impact of gender, ethnicity, age group and medical background on medical students’ self-reported familiarity with PFTP and PFAP are significant. Further studies are required to evaluate the impact of demographics on tested knowledge of PFTPs and PFAP and whether this impacts success rate at post-foundation applications.

A document by Jinfeng Huang. Click on the document to view its contents.

HBV remains a public health concern. Blood donors screened for HBsAg along with AST/ALT could play a key in providing safe blood products. We investigated the features related to HBV infection among rejected blood donors in Luanda, Angola. This was a cross-sectional study conducted with 164 rejected donors. Donors were screened for HBsAg from March to May 2022. Overall, 63.4% tested positive for HBV. Mean age of the HBV-positive (29.2±8.02) was lower than the HBV-negative (33.9±10.0) (p<0.001). Donors between 20–40 years (OR:2.34, p=0.045), females (OR:1.40, p=0.516), residents in urbanized areas (OR:1.23, p=0.530), low educational (OR:1.54, p=0.458), unemployed (OR:1.65, p=0.271), and unmarried (OR:1.41, p=0.616), might be likely to contract HBV. AST/ALT ratio was higher in HBV-infected (2.07±1.42) than in HBV-uninfected (1.90±1.14). About 20% of HBV-positive were classified as having acute liver disease, while 80% with chronic liver disease, based on AST/ALT ratio. Age ranged from 20-40 years (OR:1.97, p=0.305), females (OR:1.61, p=0.557), donors from non-urbanized (OR:1.69, p=0.557), a low educational (OR:1.64, p=0.571), and unemployed donors (OR:1.81, p=0.289) were likely to develop chronic liver disease. Our findings indicated the failure of viral hepatitis control measures. Authorities should consider including HBV nucleic acid testing to ensure early identification of HBV in Angola.

Commentary:Herpes simplex virus and SLE: though uncommon yet with significant implicationsNaim Mahroum1, Abdulrahman Elsalti1, Yehuda Shoenfeld21International School of Medicine, Istanbul Medipol University, Istanbul, Turkey.2Zabludowicz Center for autoimmune diseases, Sheba Medical Center, Ramat-Gan, Israel.Running title : Commentary: Herpes simplex virus and SLE: though uncommon yet with significant implicationsKeywords – Autoimmunity, infection and autoimmunity, systemic lupus erythematosus, human herpes viruses, herpes simplex virus

Autonomic nervous system dysfunction has been reported in up to 76% of stroke patients 7 days after an acute stroke. Heart rate variability (HRV) is one of the important indicators reflecting the balance of sympathetic and parasympathetic nerves. Therefore, we performed a systematic literature review of existing literature on the association between heart rate variability and the different types of stroke. We included studies published in the last 32 years (1990–2022). The electronic databases MEDLINE and Pubmed were searched. We selected the research which met the inclusion or exclusion criteria. A narrative synthesis was performed. This review aimed to summarize evidence regarding the potential mechanism of heart rate variability among patients after stroke. In addition, the association of clinical characteristics of heart rate variability and stroke has been depicted. The review further discussed the relationship between post-stroke infection and heart rate variability, which could assist in curbing clinical infection in patients with stroke. HRV as a non-invasive clinical monitoring tool can quantitatively assess the changes in autonomic nervous system activity, and further predict the outcome of stroke. HRV could play an important role in guiding clinical practice for autonomic nervous system disorder after stroke.

This paper investigates the finite-time preview saturated control problem for linear parameter-varying systems with input saturation. The external disturbances and input saturation, previewable reference signals, and parameter variations are considered simultaneously. First, using the error system method, we construct an augmented error system with previewed information. This transforms the finite-time preview saturated control problem into a finite-time stabilization problem. Next, static output-feedback controllers are used to guarantee the finite-time boundedness of the closed-loop system. Sufficient conditions guarantee the existence of the desired controllers are obtained using linear matrix inequalities. At last, we use a numerical simulation to show the proposed design method's effectiveness.

Next-Generation sequencing technology has enabled accurate insights into the diet of wildlife species. The protocols for faecal sample collection and extraction of DNA for diet analysis have been different from those focusing on focal species DNA, even in studies combining questions on a focal species and its diet. We designed an experiment to evaluate two protocols and select a single one that will generate both focal species (Asiatic wild ass, Equus hemionus, in Israel) and diet DNA, as an effective strategy to minimize time, efforts, and cost without hampering efficiency. In Protocol A, we swabbed the outer surface of faecal boluses and extracted DNA using a Stool Kit, while for Protocol B, we homogenised faecal matter from inside the bolus followed by extraction using a Powersoil Kit. Protocol A performed significantly better for most of the measures, which included, for the focal species, microsatellite amplification success and the quantity of the GAPDH gene; and for its diet, amplification success of a chloroplast barcoding marker, trnL, number of reads, and plant genus richness and diversity. However, there was no significant difference for the amplification success of a sex-linked marker and plant genus composition. Both protocols yielded results for the focal species and its diet, demonstrating that one single protocol can be used for both purposes; although, a pilot study is recommended to optimise the protocol for specific systems. This strategy may also be useful for studies combining focal species and their gut microbiome and parasitic load.

Title pageTitle: Rust-colored patches of the lower extremity in a COVID-19 patientAuthrors: Jacem Rouatbi1, Mouna Korbi1*, Nouha Ben Abdeljalil2, Hichem Belhadjali1*, Jameleddine Zili1*

Root hemiparasitic Pedicularis kansuensis is an invasive native species in China and has been expanding in the Bayanbulak Grassland of Xinjiang Uygur Autonomous Region over the past decade, threatening the local livestock industry. To understand why this damaging species expands in some areas but not in others, we compared soil water content, soil nutrient status, and plant community structures between heavily infected and non-infected sites. We hypothesized that soil nutrient levels and plant species composition would be more beneficial to the spatial expansion of P. kansuensis in heavily infected areas than in non-infected ones. Quadrat (1 m × 1 m) surveys were carried out in the Bayanbulak Grassland. Species number, percent vegetation cover, aboveground plant biomass, plant height, and relative frequency were recorded. Three topsoil samples were taken at 0–10 cm depth from each quadrat and their nutrient statuses were determined. The results showed that (1) P. kansuensis invasion reduces the species richness of the community compared to the uninvaded area (3.07%), but increases the canopy cover overall (16.99%); (2) soil water content (SW) and soil nutrient content are the main factors that determine invasion by P. kansuensis, and SW plays the more important role; (3) SW controls P. kansuensis leaf stoichiometry, decreases the Ratio of leaf nitrogen (LN) to leaf phosphorus (LP), and affects LP (P < 0.005). Finally, after combining the results, we found that the soil factor accounted for 46.50% and plants accounted for 22.50% of P. kansuensis invasions in the Bayanbulak Grassland.

Leishmania is the causative agent of the tropical neglected disease leishmaniasis and infects macrophages as its definitive host cell . In order to sustain and propagate infections, Leishmania parasites have to complete cycles of exit and re-infection. Yet, the mechanism driving the parasite spread to other cells remains unclear. Recent studies reported pro-inflammatory monocytes as replicative niche of L. major and showed prolonged expression of IL-1β at the site of infection, indicating an activation of the NLRP3 inflammasome and pointing towards pyroptosis as a possible mechanism of parasite spread. To address the species-specific inflammasome activation of human cells we characterized the BLaER1 macrophages as a model for L. major infection. We found that Leishmania can infect, activate and develop in BLaER1 macrophages similar as they can do in primary human macrophages. Harnessing the possibilities of this infection model, we first showed that BLaER1 GSDMD-/- cells, which carry a deletion of the pore-forming protein gasdermin D, are more resistant to pyroptotic cell death and, concomitantly, display a strongly delayed release of intracellular parasite. Using that knockout in a co-incubation assay in comparison with wild type BLaER1 cells, we demonstrate that impairment of the pyroptosis pathway leads to lower rates of parasite spread to new host cells, thus, implicating pyroptotic cell death as a possible exit mechanism of L. major in pro-inflammatory microenvironments.

One of the most serious problems worldwide is heavy metal (HM) pollution. HMs can have a toxic effect on human health and thus cause serious diseases. To date, several methods have been used to clean environments contaminated by HMs, but most of them are expensive, and it is difficult to achieve the desired result. Phytoremediation is currently an effective and affordable processing solution used to clean and remove HMs from the environment. This review article discusses in detail the technology of phytoremediation and mechanisms of HM absorption. In addition, methods are described using genetic engineering of various plants to enhance the resistance and accumulation of HMs. Thus, phytoremediation technology can become an additional aid to traditional methods of purification.

As self-driving cars perform more tasks, new challenges arise. One of these challenging tasks is autonomous driving decision-making due to the uncertainty of the vehicle’s complex environment. This paper provides an overview of decision-making technology and trajectory control for autonomous vehicles. The main common goal in decision-making is to consider uncertainties, unpredictable situations, and driving tasks to propose a global and robust solution adapted to each situation. The main concern is safety. Decision-making falls into three categories. The first is the traditional approach, which often consists of building a rule system and deriving optimal operations. The advantages of such an approach are well known for being easy to understand and applicable to small problems. The second category of decision-making is based on a probabilistic process and, due to its efficiency, has several applications in this area. The third category is learning-based approaches. Once a decision has been made, manipulate the steering angle or accelerator/brake pedals to perform the appropriate action. Two approaches are existing to designing autonomous driving controllers. Either based on imitating human drivers that includes approaches based on the use of driver models such as AI, or the use of approach-based models

Electronic bio-implanted medical devices are essential due to their effectiveness in monitoring, disease diagnosis, patient comfort, and safety. Recently, significant efforts have been undertaken to develop implantable and wireless telemetric biomedical systems. Topics such as appropriate near-field wireless communication design, power use, monitoring devices, high-efficiency energy transfer from external to internal parts (implanted), high communication rates, and the need for low energy consumption all significantly influence the advancement of implantable systems. This study reviews various topics related to near-field wireless power transfer (WPT)-based biomedical applications, including WPT types, comparison of WPT types and methods for medical devices, data transmission for WPT-based modulation techniques, and biomedical implantable systems-based WPT. In addition, it extracts research on WPT topologies with related mathematical models—such as power transfer, transfer efficiency, mutual inductance, quality factor, and coupling coefficient—from the literature. The article discusses the effect of specific absorption rate on patient tissue and highlights challenges and solutions for WPT in biomedical implants. Finally, it presents current issues and future developments.

A Case of TAFRO syndrome after COVID-19 vaccinationHitomi Hirosea, Hitoshi Suzukia,c*, Yukako Umezawaa, Masako Iwasakia, Hiromitsu Fukudaa, Hisatsugu Takaharaa, Shigeki Tomitab, Yusuke Suzukica. Department of Nephrology, b. Department of Pathology, Juntendo University Urayasu Hospital, Chiba, Japan. c. Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan.Correspondence to:Hitoshi Suzuki, M.D., Ph.DDepartment of Nephrology, Juntendo University Urayasu Hospital2-1-1 Tomioka, Urayasu-shi, Chiba 279-0021, JapanEmail: shitoshi@juntendo.ac.jpKey words: COVID-19, mRNA vaccine, TAFRO syndrome, renal dysfunction

A document by Chloé Tilliette. Click on the document to view its contents.

Mechanical properties of living cells play an important role in helping to understand cell physiology and pathology. However, to ensure reliability, it is important to precisely define the experimental conditions of these mechanical test. In this study, viscoelastic properties of the outer layer (cytoplasm and membrane) were extracted using standard linear solid model. Finite element modeling of the two-layer cell was performed and the model was validated by experimental data. In the two-layer model, the effect of the radius of the nucleus and the location of the nucleus on the whole cell behavior were investigated. By increasing nucleus size, the whole cell properties follow the nucleus properties and the role of the nucleus becomes more dominant. By dislocating nucleus inside the cytoplasm, the cell behavior changes significantly and becomes more similar to that of nucleus properties. Similarly, changing the aspiration pressure and rate, impacts the observed behavior drastically. The results demonstrate that the location of the nucleus and the ratio of the radius of the cytoplasm to the radius of the nucleus can effectively influence the viscoelastic properties and mechanical behavior of the cell.

Purpose: With the expansion of research utilizing electronic healthcare data to identify transgender (TG) population health trends, the validity of computational phenotype algorithms to identify TG patients is not well understood. We aim to identify the current state of the literature that has utilized CPs to identify TG people within electronic healthcare data and their validity, potential gaps, and a synthesis of future recommendations based on past studies. Methods: Authors searched the National Library of Medicine’s PubMed, Scopus, and the American Psychological Association Psyc Info’s databases to identify studies published in the United States that applied CPs to identify TG people within electronic health care data. Results: Twelve studies were able to validate or enhance the positive predictive value (PPV) of their CP through manual chart reviews (n=5), hierarchy of code mechanisms (n=4), key text-strings (n=2), or self-surveys (n=1). CPs with the highest PPV to identify TG patients within their study population contained diagnosis codes and other components such as key text-strings. However, if key text-strings were not available, researchers have been able to find most TG patients within their electronic healthcare databases through diagnosis codes alone. Conclusion: CPs with the highest accuracy to identify TG patients contained diagnosis codes along with components such as procedural codes or key text-strings. CPs with high validity are essential to identifying TG patients when self-reported gender identity is not available. Still, self-reported gender identity information should be collected within electronic healthcare data as it is the gold standard method to better understand TG population health patterns.

Evaluating Serum HE4: Some Serious ConsiderationsAimen Waqar Khana, Hussain Haider Shahba: Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan.b: Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.Dear Dr Papageorghiou,We have perused with great interest the scholarly article ”Serum HE4 predicts progestin treatment response in endometrial cancer and atypical hyperplasia: A prognostic study” by Chloe Barr et al. [1]. We applaud the authors’ diligent efforts in investigating a biomarker that could independently predict the response to conservative therapy. However, we wish to draw attention to certain noteworthy aspects upon a comprehensive evaluation.Firstly, it is noteworthy that all the women who participated in the study underwent a preliminary endometrial biopsy before the initiation of progestin. However, there is no mention of whether women with relative contraindications such as cervical stenosis, coagulopathy or obstructive cervical lesions were sampled if they were included in the study. It is essential to consider these factors as they can significantly affect the accuracy and reliability of the biopsy results. Furthermore, it is necessary to note that insufficient tissue sampling is a common complication of endometrial biopsy, with an average of 31% of tissues obtained requiring improvement [2]. Considering that this is typically more prevalent in postmenopausal women, and 61% of the participants were 50 years or older, it is crucial to standardize the volume of tissue obtained to ensure fair and precise results. As outlined in the study, the primary form of progestin therapy was levonorgestrel-releasing intrauterine system (LNG-IUS). Still, for women whose devices had been misplaced more than once, an alternative treatment of oral medroxyprogesterone acetate 500mg was administered twice daily. This raises a concern regarding whether these women were closely monitored for compliance with the prescribed treatment regimen. This is particularly important as non-compliance, particularly with extended oral therapies, is a common issue that, if present, could skew the study’s findings. The prognostic potential of pretreatment serum HE4 in predicting therapeutic response has been extensively researched; however, studies have also reported elevated serum HE4 levels in various other cancers, including ovarian, pancreatic, breast, lung, and stomach [3]. Therefore, it is crucial to exclude such patients thoroughly, as their inclusion could lead to inaccurate results by falsely accounting for the non-responder count.Moreover, serum HE4 levels are also known to be influenced by renal function and status, necessitating adjustment [4]. It is, therefore, essential to consider and standardize these factors when analyzing the serum HE4 levels to obtain reliable and valid results. Lastly, it should be noted that a CLEIA technique was employed for analysis, which has been reported to significantly overestimate serum HE4 as compared to EIA [5]. This may raise concerns regarding the validity of the reported findings, and hence, caution must be exercised when interpreting the results.The study focused on endometrial biopsy in women receiving progestin therapy, but potential complications such as insufficient tissue sampling and the inclusion of women with contraindications were not addressed. The study primarily used LNG-IUS but also administered oral medroxyprogesterone acetate, and compliance monitoring was not discussed. Serum HE4 levels were examined, but patients with other cancers or renal issues were not excluded, and the CLEIA technique used for analysis may have overestimated results. Therefore, caution is necessary when interpreting the findings of this study.

A fast ventricular tachycardia was apparently induced in a patient with a CRT-D device by the delivery of a pacemaker stimulus whose timing corresponded with the timing of the QRS complex in the far-field electrogram. Appropriate programming of the device might have prevented this complication.

A 78-year-old male patient was brought via the Primary percutaneous coronary intervention (PPCI) service to our hospital for urgent angiography. He had been discharged a week ago, after presenting with chest pain and undergoing Primary Percutaneous intervention (PCI) to the Left Circumflex artery, followed by Permanent pacemaker insertion for treatment of Sick Sinus Syndrome. CT Coronary angiography/CT Chest demonstrated a right ventricular lead perforation, alongside an occlusion in the mid-distal segment of the recently inserted stent in the circumflex artery. The diagnosis required careful interpretation of the pacing check, and a high clinical suspicion of lead perforation. The perforated lead was removed, and a new lead positioned in the Right ventricular septum the following day. There was also an attempt to open the occluded circumflex artery, but this was unsuccessful.

We present a 35-year-old male who sustained a right hip GSI. Delayed THA with a two-step sequential approach is feasible management in this situation in order to manage soft tissue and decrease infection rate. At one-year follow-up visit the pain was relieved and function improved significantly and had no complaints.

Background: Chronic rhinosinusitis (CRS) is a heterogeneous disease characterized by persistent sinonasal inflammation and sinus microbiome dysbiosis. Nasal polyps (NPs) is one of the main manifestations which cause diverse clinical symptoms of CRS. We conducted a bibliometric and visual analysis of CRS and NPs articles published between 2003 and 2022 to provide researchers with the current state of research and potential directions. Method: We used a systematic search strategy to search relevant articles in the databases of the Web of Science from 2003 to 2022. VOSviewers, Bibliometrix R package, and CiteSpace were used to perform the bibliometric analysis. Results: 3,907 publications, including 3,266 “articles” and 641 “reviews” were retrieved. The USA made the highest contributions to global research, followed by China; furthermore, Northwestern University, Capital Medical University, and Sun Yat-Sen University had the highest number of publications. A total of 12,894 authors participated in this research, with the most published author being Bachert C., followed by Schleimer Robert P. and Schlosser Rodney J.. And the authors with the most co-citations were Bachert C., Fokkens W.J., and Gevaert P. 428 journals had published the articles of this research. Moreover, the journal with the most publications was the International Forum Of Allergy & Rhinology and the Journal Of Allergy And Clinical Immunology received the most citations. “Covid-19”, “biologic”, and “type 2 inflammation” were the top current research hotspots. Conclusion: The United States and Northwestern University were the leading country and institution in researching CRS and NPs. And Bachert C. is the most influential expert. The International Forum Of Allergy & Rhinology published the most articles, and the Journal Of Allergy And Clinical Immunology got the highest number of citations. Moreover, “Covid-19”, “biologic”, and “type 2 inflammation” were the trending topics.