A rare case of Heme oxygenase deficiency: A case report & literature review

Introduction: Despite a reported understanding of basic radiation physics principles, students face barriers that hinder effective translation of this knowledge into clinical practice, potentially leading to suboptimal outcomes.The objectives of this cross-sectional descriptive research are to assess the level of radiation physics knowledge among clinical radiography students, evaluate their ability to apply this knowledge in clinical settings, identify barriers hindering successful application, and provide recommendations for improved integration. Material and method: The study was conducted among clinical students (4 th year and 5 th year) of the department of radiography and radiological sciences, University of Nigeria, Enugu campus, Enugu state. The study design was a cross-sectional descriptive study which enables to collect data at a specific point in time. The study population comprised of students who are currently in 4 th and 5 th year in the department of medical radiography and radiological sciences. The population has a total number of 500 students. All clinical radiography students who are willing to participate in this research were included in this research Results: Among 220 participants from the University of Nigeria’s Department of Radiography and Radiological Sciences, 81.4% expressed thorough teaching of radiation physics during pre-clinical training, while 68.3% reported an excellent understanding. However, 64.3% cited disinterest due to perceived complexity, 42.0% noted a gap between theoretical teaching and practical application, and 84.6% mentioned a lack of fear of radiation’s biological effects. Suggestions for improvement included a dedicated curriculum (90.0%), increased teaching duration (69.7%), expert involvement (95.10%), hands-on training (95.5%), interactive learning methods (93.2%), and collaborative training approaches (95.0%). Conclusion: This research underscores the importance of refining radiation physics education to bridge theory and practice effectively.

India's environmental policy framework has undergone significant transformation since independence, but effective implementation remains a challenge. This research examines the evolution of environmental policy in India, focusing on key challenges and promising sustainable development initiatives. The study adopts a comprehensive approach, analyzing relevant legal documents, policy reports, scientific literature, and data from government agencies. It also incorporates stakeholder perspectives and insights from civil society organizations. The research identifies air and water pollution, land degradation, deforestation, and climate change as major environmental challenges facing India. Promising sustainable development initiatives include renewable energy, energy efficiency, waste management, and sustainable agriculture. However, these initiatives face challenges related to implementation, enforcement, and long-term effectiveness evaluation. The research proposes a series of recommendations, including policy reforms, institutional capacity building, innovation and technological advancements, green financing mechanisms, and international cooperation. It emphasizes the importance of public participation, inter-agency collaboration, and leveraging technology for effective environmental governance. The research concludes that India needs to prioritize effective implementation of existing policies and explore innovative approaches to address emerging environmental challenges. By adopting a holistic strategy that integrates environmental considerations into all policy domains, empowers communities, leverages technology, and fosters international collaboration, India can achieve a cleaner, greener, and more sustainable future.

A document by Oluwatosin Agbaakin. Click on the document to view its contents.

A document by Lu Zhang. Click on the document to view its contents.

CRISPR/Cas9 technology in conjunction with somatic cell nuclear transplantation (SCNT) provides the primary approach to producing gene-edited pigs, and targeting nuclear donors with CRISPR/Cas9 is crucial. Gene-edited nuclear donors are inefficient due to poor editing efficiency and low delivery efficiency, which are highly associated with CRISPR/Cas9 form selection. Nevertheless, there is not a straightforward method to evaluate CRISPR/Cas9 editing efficiency on the porcine genome. In this study, a fluorescence report signal and micropattern arrays-based platform was developed to visually assess the efficiency of CRISPR/Cas9 editing. Based on the quantity and state of cells grown on micropattern arrays, 200 μm in diameter and 150 μm in spacing were optimal specifications for culturing porcine cells. The editing efficiency of three different CRISPR/Cas9 system forms: DNA, mRNA, and Ribonucleoprotein (RNP) were rapidly evaluated using this platform, with mRNA proving the most effective. Subsequently, four homozygotes with β4GalNT2 gene knockout were quickly obtained by mRNA-based form, which lays the groundwork for the subsequent generation of gene-edited pigs. This platform makes gene knockout efficiency evaluation rapid, intuitive, and efficient. It also holds great promise for customizing evaluation platforms for different cell types, evaluating delivery techniques, and swiftly testing innovative gene editing tools.

Over the past decade, our research group has found that plant responses to combined abiotic stresses are unique and cannot be inferred from studying plants exposed to individual stresses. Adaptive mechanisms involve changes in gene expression, ion regulation, hormonal balance, and metabolite biosynthesis or degradation. Understanding how these mechanisms integrate from stress perception to biochemical and physiological adjustments is a major challenge in abiotic stress signaling studies. Today, vast amounts of -omics data (genomics, transcriptomics, proteomics, metabolomics, phenomics) are readily available. Additonally, each –omic level is regulated and influenced by the others, highlighting the complexity of plant metabolism’s response to stress. Considering abscisic acid (ABA) as a key regulator in plant abiotic stress responses, in our study, ABA-deficient plants (flc) underwent single or combined salinity and heat stresses were evaluated and different -omics analyses were conducted. Significant changes in biomass, photosynthesis, ions, transcripts, and metabolites occurred in mutant plants under single or combined stresses. Exogenous ABA application in flc mutants did not fully recover plant phenotypes or metabolic levels but induced cellular reprogramming with changes in specific markers. Multi-omic analysis aimed to identify ABA-dependent, ABA-independent, or stress-dependent markers in plant responses to single or combined stresses. We demonstrated that studying different -omics together identifies specific markers for each stress condition not detectable individually. Our findings provide insight into specific metabolic markers in plant responses to single and combined stresses, highlighting specific regulation of metabolic pathways, ion absorption, and physiological responses crucial for plant tolerance to climate change.

Background: Although there are several health facilities with infrastructure to cater to healthcare services, there are still healthcare facilities with inadequate infrastructure in eThekwini Municipality, KwaZulu-Natal Province, South Africa to provide comprehensive healthcare services. This study investigated the perceptions of healthcare workers and patients about the impact of health facility infrastructure on the provision of healthcare services in this province. Objectives: This study aimed to determine the perception of healthcare workers and patients about the impact of health facility infrastructure on healthcare services at Goodwins Clinic in eThekwini Municipality, KwaZulu-Natal, South Africa. Method: This qualitative study applied phenomenological design by conducting an individual in-depth interview with patients (n= 20) and healthcare workers (n= 10) purposively selected in 2022. Data were analysed using Colaizzi’s phenomenological analysis framework. Results: Participants reported that health facility infrastructure affects healthcare services. Furthermore, old facility structures, scattered structures, and limited working spaces were found to be the leading factors affecting healthcare services in the facility. Conclusion: The facility’s structural design factors need to be considered to ensure that the health facility structure is adequate to deliver healthcare services and motivate radical transformation to take place in measuring and managing healthcare facilities. Contribution: The results will assist in improving health facility structure and healthcare services, help health facilities prepare for National Health Insurance and easily reach SDG 3, motivate future research, and provide information that will assist in implementing programs to reduce poor healthcare services. Highlights: Patients and healthcare workers perception was investigated whereby their views stipulated that health facility infrastructure affects healthcare services. Poor infrastructure was noted as well and inappropriate healthcare services.

Achieving the building’s sustainability requires the assessment of its life-cycle, involving the selection of sustainable materials during the construction stage and adopting rooftop PV system in the exploitation stage, with the objective to lower its carbon footprint. This paper reports a case study for the design of a sustainable office building, located out of town, integrating PV panels for autonomous electricity production. For this purpose, the multi criteria decision making analysis was carried out to select the optimum sustainable materials, and the energetic balance of the building was evaluated. Accordingly, the required rooftop PV panels and the associated area were then estimated, while a storage battery was included for the building’s continuous electrical supply. Using the Weighting Sum Method, and considering the technical/environmental and financial constraints, double wall in hollow brick and expanded polystyrene floor were selected, while expanded polystyrene was used as the insulating material. The energetic analysis of the building performances indicated an average annual heating and air cooling requirement of 0.57 kWh/m 2 and 36.87 kWh/ m 2, respectively. Finally, the on-roof PV panels required a nominal peak power of 400kWp with 1218m 2 area, while a 82kAh storage battery capacity was evaluated for a continuous electricity production.

RATIONALE: Glutamate carboxypeptidase II (GCPII) catalyzes the hydrolysis of N-acetyl-aspartyl-glutamate (NAAG) to yield glutamate (Glu) and N-acetyl-aspartate (NAA). Inhibition of GCPII has been shown to remediate the neurotoxicity of excess glutamate in a variety of cell and animal disease models. A robust high-throughput LC/MS/MS method was needed to quantify GCPII enzymatic activity in a biochemical high-throughput screening assay. METHODS: A dual-stream LC/MS/MS method was developed. Two parallel eluent streams ran identical HILIC gradient methods on BEH-Amide (2x30mm) columns. Each LC Channel was run independently, the cycle time was 2 min per channel. Overall throughput was 1-minute per sample for the dual-channel integrated system. Multiply injected acquisition files were split during data review, batch metadata was automatically paired with raw data during the review process. RESULTS: Two LC sorbents, BEH-Amide and Penta- HILIC, were tested to separate the NAAG cleavage product Glu from isobaric interference and ion suppressants in the bioassay matrix. Early elution of NAAG and NAA on BEH-Amide allowed interfering species to be diverted to waste. The limit of quantification was 0.1 picomoles for Glu. The Z-factor of this assay averaged 0.85. Over 36,000 compounds were screened using this method. CONCLUSIONS: A fast gradient dual-stream LC/MS/MS method for Glu quantification in GCPII biochemical screening assay samples was developed and validated. HILIC separation chemistry offers robust performance and unique selectivity for targeted positive mode quantification of Glu, NAA and NAAG.

Natural ecosystems typically sustain their functions despite moderate changes in one or more of their components.  The adaptability to change is referred to as Nature’s Allostasis. Functional sustainability of ecosystems is not intrinsically possible, however, if the alterations within the ecosystem exceed certain thresholds, referred to as tipping points. The resulting failure of Nature’s Allostasis is attributed to an insufficiency of the required energy. KELEA, an acronym for Kinetic Energy Limiting Electrostatic Attraction, is proposed as a fundamental force of Nature. Its primary role may be to prevent the fusion and annihilation of electrostatically attracted opposing electrical charges. It also functions as a life force energy that is distinct from photosynthesis and food metabolism. Various compounds and devices can create elevated localized levels of KELEA. One such compound, marketed as Kiko Technology, comprises volcanic materials that have been pulverized, heated, and subsequently cooled before being made into small cylindrical pellets. Water that is close to heightened levels of KELEA responds by a loosening of its intermolecular hydrogen bonding. The energy in KELEA activated water can assist in restoring Nature’s Allostasis in polluted inland waterways. This was shown by treating several bodies of water, which were heavily contaminated with toxic blue-green algae (cyanobacteria). Relatively few Kiko pellets in conjunction with small amounts of biochar and a mineral water conditioner were required for long-lasting remedial benefits. Moreover, there was the progressive return of wildlife to the treated regions of water.  This relatively simple approach should find widespread application to many of the world’s polluted waterways.

Aim: This study aimed to assess the feasibility and safety of administering cyclosporin A (CsA) as a 2-hour, twice-daily intravenous infusion versus continuous 24-hour infusion in allogeneic hematopoietic stem cell transplant (HSCT) patients. Methods: A prospective randomized study was conducted, dividing adult HSCT patients into two groups based on the CsA administration method. The primary outcomes assessed the incidence of acute graft-versus-host disease (aGVHD) and CsA-related adverse events. Secondary outcomes included the correlation between time concentrations and area under concentration-time curves (AUCs) and performing a cost-effectiveness analysis. Results: 31 allogeneic HSCT patients were enrolled, with 38.7% initially diagnosed with acute myeloid leukemia (AML). There was no significant difference between the two study groups in developing aGVHD, distribution of different aGVHD types, transplantation outcomes, and mortality. The obtained AUCs showed no significant difference between the two infusion methods at all time points. Regarding the cost-effectiveness, the 2-hour infusion group had a higher total of quality-adjusted life-years (QALYs) per patient (1.77) and lower total costs per patient (3802.15 USD) compared to the 24-hour infusion group (QALYs: 0.74, costs: 13239.22 USD). The incremental cost-effectiveness ratio (ICER) for the intervention group was -9158.53. Conclusion: Administering CsA as a 2-hour twice-daily infusion is both feasible and safe for allogeneic HSCT patients. The study demonstrates that the 2-hour infusion regimen is non-inferior to the conventional 24-hour infusion in terms of aGVHD incidence and adverse events. Moreover, 2-hour infusion strategy proves to be more cost-effective. Further research is necessary to validate these findings and guide clinical practice.

Background: Small cell lung cancer (SCLC) harbours the most aggressive phenotype of all lung cancers to correlate with its bleak prognosis. The aggression of SCLC is partially attributable to its strong metastatic tendencies. The biological processes facilitating the metastasis in SCLC are still poorly understood and garnering a deeper understanding of these processes may enable the exploration of additional targets against this cancer hallmark in the treatment of SCLC. Recent findings: This narrative review will discuss the proposed molecular mechanisms by which the cancer hallmark of activating invasion and metastasis is featured in SCLC through important steps of the metastatic pathway. The review will discuss SCLC VEGF family expression and vascular mimicry as a means of vasculogenesis, and the role of tumour heterogeneity, DLL3, NFIB, selectin, and B1 integrin in enabling epithelial to mesenchymal transition and subsequent invasion, and the molecular markers expressed by SCLC to assist organ-specific homing during metastasis. The review will also discuss a recent article observing mir-1 mrna upregulation as a potential therapeutic option in targeting the metastatic activity of SCLC. Conclusion: Treatment of SCLC remains a clinical challenge due to its recalcitrant and aggressive nature. Amongst the many hallmarks used by SCLC to enable its aggressive behaviour, that of its ability to invade surrounding tissue and metastasise is particularly notable and understanding the molecular mechanisms in SCLC metastasis can identify therapeutic targets to attenuate SCLC aggression and improve mortality.

The prognosis of high-risk neuroblastomas (NB) that are resistant to first-line induction chemotherapy is relatively poor. This study explored the mechanism of resistance to first-line chemotherapeutics mediated by TXNDC17 and its potential solutions in NB. The genetic and clinical data of patients with NB were obtained from the Therapeutically Applicable Research to Generate Effective Treatments dataset. TXNDC17 and BECN1 expressions in NB cells were up- and downregulated by transfection with plasmids and shRNA, respectively. Autophagy-related proteins were detected by western blot. Cell viability was determined using cell proliferation and toxicity experiments. Apoptotic cells were detected using flow cytometry. Overall, 1076 pediatric and adolescent patients with NB were enrolled in this study. The 10-year overall survival (OS) rates and event-free survival (EFS) rates for the patients with mutation of BECN1 were 37.4% ± 9.1% and 34.5% ± 8.8%, respectively. For patients with mutation of TXNDC17, the 10-year OS and EFS were 41.4% ± 5.9% and 24.3% ± 5.1%, respectively, which were significantly lower than those in the unaltered group. The overexpression of BECN1 and TXNDC17 reduced NB sensitivity to cisplatin (DDP), etoposide (VP16), and cyclophosphamide (CTX). Autophagy mediated by BECN1 was regulated by TXNDC17, and this process was involved in the resistance to DDP, VP16, and CTX in NB. Suberoylanilide hydroxamic acid (SAHA) can enhance the sensitivity of NB cells to chemotherapeutics by inhibiting TXNDC17, ultimately decreasing autophagy-mediated chemoresistance. Acquired resistance to first-line chemotherapeutics was associated with autophagy mediated by BECN1 and regulated by TXNDC17, which can be reversed by SAHA.

Urbanization is one the main threats to biodiversity and its effects are projected to increase in magnitude, hence stressing the importance to better understand how urbanization may affect vital ecosystem services, such as pollination. Studies on the impact of urbanization have largely focused on only one aspect of the pollination process (e.g. pollinator visitation, pollen deposition), potentially misrepresenting the full complexity of urbanization effects on pollination services. Evaluating impacts across multiple components of pollination can also help pinpoint the underlying mechanisms driving urbanization effects. This study evaluates how urbanization affects multiple aspects of the pollination process in common milkweed populations, including pollinator community composition and visitation rate, pollen removal and deposition on stigmas. Urbanization altered floral visitor composition, with small bees having a larger presence in urbanized areas. Insect visitation rate and pollen removal were also higher in more urbanized areas, perhaps suggesting a positive impact of urbanization as predicted by the intermediate disturbance hypothesis. However, pollen deposition on stigmas, which is a key component of fertilization success, was not different between natural and urbanized sites. Our findings highlight the complexity evaluating urbanization effects on pollination, as these likely depend on the specific aspect of pollination evaluated and on the of the intensity of disturbance. Our study thus stresses the importance of evaluating multiple components of the pollination process in order to fully understand overall effects and the mechanisms underlying urbanization effects on this vital ecosystem service

Background: The recovery of acid-base and hydro electrolytic balance at medical discharge after Raid races and its association with comfort index is unknown. Objetives: To determine hydroelectrolytic and acid base variations before, after and at the time of clinical discharge in 276 horses that completed 90 km Raid competitions. Study design: Cross sectional study Methods: Hematocrit, total protein, sodium, potassium, chloride, calcium, and serum pH were determined in samples before and after the race and after hydration and analyzed using a mixed procedure, including the moment regarding the race, comfort index, and their interaction. Results: Comfort index did not affect any variable; An interaction with comfort index and blood sample was only found in potassium concentrations, as concentrations were lower after hydration than before the race only in worse climate conditions (p<0.05). The pH values after the race were greater (p<0.01) than before the race and after hydration. The hematocrit and total protein values after hydration showed a correction to normal values, however, for total protein no differences were observed between this sample and before the race, while the hematocrit at medical discharge was still greater than the sample before the race (p<0.05). Sodium concentrations before and after the race were greater than those after hydration (p<0.05), for chloride, the concentrations before the race were greater than those after the race and hydration (p<0.05). Calcium concentrations after the race and hydration were lower than before the race (p<0.05). Main limitations: The medical treatment after races (hydration therapy) in each horse is not known. Conclusion: Most hydroelectrolytic and acid-base variables at the medical discharge did not reach the values before the race, but they were within the normal values. The comfort indicator was not explanatory in most of the variables.

Drug discovery and testing is a lengthy process that is essential before human clinical trials. Animal models are vital in preclinical drug assessment, yet ethical concerns and species variations persist. Although cell-based models are used, they struggle to precisely predict drug efficacy, toxicity, and organ interactions due to cultured cells’ inability to maintain original functions and structures in typical in vitro systems. To overcome these limitations, the emerging technology of organ-on-a-chip is being developed as an alternative to traditional preclinical drug testing models. The implementation of organ-on-a-chip technology holds great potential in significantly enhancing the accuracy and efficacy of preclinical testing, thereby enabling more precise prediction of a drug’s performance in clinical trials. Moreover, the development of multi-organ-on-a-chip (MOC) systems enables the replication of various organs in vitro, making the study of drug-body interactions possible. In this review, we first introduce the design of organ-on-a-chip devices. Subsequently, we describe the applications of different tissue co-culture configurations in organ-on-a-chip for drug testing. Finally, we summarize the challenges and prospects associated with organ-on-a-chip technology. In conclusion, this review provides a comprehensive overview of organ-on-a-chip technology, multi-organ-on-a-chip for drug testing, and the challenges and prospects for the future.

Regularity for strongly elliptic equations with ϵ-periodic highly oscillatory coefficients in two-dimensional space is concerned. In each ϵ-cell, the diffusion coefficients of the elliptic equations are ω 2 ∈ ( 1 , ∞ ) in a small disk with radius ϵµ 4 ( < 1 4 ) and 1 outside the disk of the cell. Two cases are considered. Case one is that ϵ,µ,ω are independent in the elliptic equations. So the diffusion coefficients of the elliptic equations are ϵ-periodic and discontinuous. L p -gradient estimate uniform in ϵ,µ,ω for the elliptic solutions is derived. However, the integrability p ( >2) of the solutions is not a large number. Case two is that ϵ , µ ( = ω − 1 ) are independent in the elliptic equations. The diffusion coefficients of the elliptic equations are ϵ-periodic, discontinuous, and L 1 -bounded. Lipschitz estimate uniform in ϵ , µ ( = ω − 1 ) for the elliptic solutions is obtained.

Objective: To evaluate respiratory functions in children with cat sensitization using impulse oscillometry (IOS) and spirometry and to compare these with those of healthy controls. Methods: This prospective case-control study included 130 children aged 3-17 years with cat sensitization (CS group) accompanying respiratory allergic diseases (Group I: asthma, Group II: allergic rhinitis, and Group III: co-existent asthma and allergic rhinitis), and 70 age- and sex-matched healthy controls (HC group). The cases’ demographic parameters were recorded, and respiratory functions were analyzed using IOS and spirometry. The association between IOS and spirometric parameters was also evaluated. Results: At IOS evaluation, zR5, R5-20, Fres, and AX values were higher in children in the CS group compared to the HC group (p=0.029, p=0.008, p=0.001, and p<0.001, respectively), while zX5 and zX20 values were lower (p=0.001 and p<0.001). R5-20 and AX were higher in asthma compared to allergic rhinitis (p=0.008, 0=0.015), but were insignificant compared to both together. R5-20, Fres, and AX were higher, and zX20 was lower in the pre-school age group (p<0.001). No correlation was found between zFEV1, zFVC, zFEV1/FVC, zFEF25-75 and zR5 values in the CS group (p>0.05). Conclusions: Pulmonary resistance was higher and reactance was lower in the entire and peripheral airways in children with cat sensitization accompanying respiratory allergic diseases compared to the healthy controls. Peripheral airway resistance and reactance were more impared in asthma group compared to allergic rhinitis. However, peripheral airway resistance and main airway reactance were more impaired in the pre-school age group than in the older age group.

Cold-water corals form vast reefs that are highly valuable habitats for diverse deep-sea communities. The deep ocean is, however, getting warmer, and models predict that the temperature of the Atlantic Ocean will further increase by up to 3°C by the end of the century. Understanding the response of cold-water corals to ocean warming is therefore essential to assess their resilience to future water temperatures. Here, we investigate at the holobiont level, the coral host and its associated microbiome, the effects of elevated temperatures on the reef-forming cold-water coral Lophelia pertusa (now named Desmophyllum pertusum) from the north east Atlantic Ocean. We show that at temperature increases of +3 and +5°C, L. pertusa exhibits significant mortality concomitant with changes in its microbiome. A metagenomic approach revealed the presence of genes markers for bacterial virulence factors suggesting that coral death was due to infection by pathogenic bacteria. Differences in survival were observed between L. pertusa colonies, as well as colony-specific microbiome signatures, indicating strong colony variability between colonies in response to warming waters. We hypothesize that L. pertusa, regardless of their ocean of origin, can only survive a temperature increase of < 3°C over a long period of time. Regional variations in deep-sea temperature increase should therefore be taken into account in future estimates of the global distribution of cold-water corals.

Objectives: Nearly 80% of children within the U.S. live with a sibling, and siblings exert a unique and typically lifelong influence on one another. Past research supports an influence between psychopathology of one individual and the psychological functioning of their siblings. Recently this relationship has been examined in the context of borderline personality disorder (BPD), such that siblings of individuals with BPD are at heightened risk of developing psychiatric disorders and engaging in problematic behaviors. Beyond the influence siblings have on one another, there is growing work demonstrating that many siblings of individuals with mental health difficulties face unique challenges in terms of balancing care for themselves and care for their siblings, and yet don’t have resources available for these specific challenges. Methods: The current study utilizes written statements from applications submitted to the Family Connections TM program by siblings of those with emotion regulation (ER) difficulties or BPD. A qualitative analysis is utilized to examine statements written by these sibling applicants, and salient themes are discussed. Results/Conclusion: We hope to clarify the experiences of siblings within these dyads and make a case for increased opportunities for these siblings to access care and support, in order to improve outcomes and support for both siblings.

The regulation of the central metabolism and fermentation pathways and its effect on antimicrobial susceptibility in the anaerobic pathogen Bacteroides fragilis is not completely understood. In this study, we show that B. fragilis encodes for two iron-dependent redox-sensitive regulatory pirin protein genes, pir1 and pir2, whose mRNA expression is upregulated following oxygen exposure and growth in iron-limiting conditions. Pir1 and Pir2 modulate short-chain fatty acids production and alter susceptibility to metronidazole (MTZ), and to amixicile (AMIX), a novel inhibitor of pyruvate:ferredoxin oxidoreductase (PFOR) in anaerobes. Consistent with this, we showed that Pir1 forms direct protein-protein interactions with PFOR as determined by two-hybrid system assays. In addition, AlphaFold2-based structural analysis predicts that Pir1 and Pir2 form stable interactions with several enzymes of the central metabolism including the 2-ketoglutarate:ferredoxin oxidoreductases Kor1AB and Kor2CDAEBG. A series of metabolic mutants and electron transport chain inhibitors were used to show a wide-ranging effect of bacterial metabolism on MTZ and AMIX susceptibility. Furthermore, we show that AMIX is an effective antimicrobial against B. fragilis in an experimental model of intra-abdominal infection. This investigation led to the discovery that the kor2AEBG genes are essential for growth, and we present evidence that kor2AEBG genes have dual functions including the reductive synthesis of 2-ketoglutarate via reverse TCA cycle. However, the metabolic activity that bypasses KorAEBG function remains to be defined. Collectively our investigation reveals new information on B. fragilis central metabolism and its modulatory control by pirin proteins which may be leveraged for the future development of new narrow-spectrum antimicrobials

Non-conventional renewable energy sources integration into distribution systems, data science, and enabling technological infrastructures present formidable challenges in transforming distribution systems, particularly in accommodating active demand. With escalating energy demand emphasizing the need for dependable tracking and predictive methodologies. These methodologies are essential for managing Distributed Energy Resources (DERs) and digital infrastructure. Effectively monitoring active demand requires a comprehensive understanding of the transactional system concept, encompassing digital infrastructure, and decentralized demand. Despite the increasing prominence of metaheuristic techniques in demand response integration, existing literature predominantly focuses on specific techniques rather than providing a characterization of dynamic transaction integration for active demand. Technological advancements, such as smart meters and communication systems, propel the evolution of the demand concept from rudimentary consumption measurement to active consumer involvement. This paper reviews the evolutionary trajectories of essential concepts in the energy sector, namely active demand, DERs, and transactive systems. Through in-depth analysis, Simultaneously, the paper systematically examines prevalent metaheuristic techniques in the literature, specifically focusing on their role in integrating and predicting the behaviors of active demand and DERs. The paper presents a methodology that, if utilized as a roadmap, would facilitate the evidence of stages required for the integration of DERs .

Custom-made 3D printed subperiosteal implant for restoration ofsevere atrophic jaw: a case reportIn the last decades, considerable progress has been made in the field of oral implantology, regarding endosseous implants, especially through the changes brought by the digital revolution. Although their versatility and predictability has been proven over time through clinical studies and follow-ups, endosseous implants have certain limitations, mainly given by the patients’ perspectives: the general state of health, bone supply, long osseointegration time, etc. Well-designed subperiosteal implants have been reported to function successfully for many years and came as an alternative to endoseous implants. The analog method of inserting subperiosteal implants has been widely discussed and used over time, and represents a well-defined protocol. However, the first surgical time, that of taking impression of the residual bone field, caused problems for the clinicians as follows: the trauma inflicted to the patient was greater as he was subjected to two surgical interventions instead of one(first for the impression of the bone and second for the insertion of the implant), the grip contraction of the impression material creates the possibility that the implant doesn’t fit to the bone. Digital technology comes into our hands in order to solve this unpleasant situations, offering the possibility to design the future implant on the CBCT scan of the patient long before the surgery itself.This case report reviews the design characteristics of 3D printed superiosteal implants, step by step procedure and its particularities compared with the analog method, the anatomy of the areas upon which the implants rest in the maxillae, based on recent research perfomed in Romania, in collaboration with AB Dental International (1).IntroductionThe use of endosseous dental implants to replace missing teeth has been a very predictable solution for many years and is now one of the most common techniques in dental rehabilitation. However, sufficient bone quantity and quality is required for implantation. In cases of severe bone resorption, bone regeneration techniques, zygomathic implants, nerve lateralization and sinus lift surgeries were proposed, but unfortunatelly these methods require more advanced surgical procedures, which may result in higher complication rates, morbidity, and longer treatment times.Subperiosteal implants were first developed in Sweden at the beginning of 1940’s and have been used ever since, with a decrease in popularity with the invention of the first endoseous implants by Branemark. Subperiosteal implants were custom-made based on an impression obtained in the stage I surgery and inserted below the periosteum and stabilised to the bone with mini-screws, then covered by the mucosa in the stage II surgery. Thus, the pacient was subject to two surgeries at an interval of 21 days. The subperiosteal implants were made of cobalt-chrome or titanium alloys and were connected to the prosthesis using transmucosal abutments that emerged into the oral cavity. Their replacement or decrease in use was due to the complexity of the production process, the imperfect fit of the implant caused by relative instability of the impression material, the wide range of complications (2).Different protocols have been proposed lately for subperiosteal implants, especially the ones 3D printed, but infortunately romanian clinicians need to collaborate with abroad factories or laboratories in order to treat these cases. Here, the authors present their experience with an innovative design of a customized subperiosteal implant manufactured by AB Dental International based on the CBCT scan of the patient.Case history/examinationA 58 years old male patient with severe maxillary athrophy was referred to the clinic due to complaints of inappropriate masticatory and aesthetic function. He reported a mixed tooth-implant supported maxillary rehabilitation with five implants and two teeth which failed 3 years ago after more that 15 years of use due to peri-implantitis and mobility. Ever since, our patient has been wearing a removable acrylic denture. The pacient denied smoking habits or relevant systemic diseases. In order to decide whether he is a valid candidate for a subperiosteal implant or not, the patient was passed through the entire selection process which included: general examination, clinical local examination of the oral mouth, laboratory analysis and radiographs. The pre-operative laboratory analysis were slightly modified with a high value of the PDW (Platelet Distribution Width) which can indicate anemia or an infection in the body. Clinical examination [Fig. 1(a)](12) and orthopatomography [Fig. 1(b)](12) indicated a combined horizontal and vertical severe osseous atrophy, confirmed through cone-beam computed tomography (CBCT) [Fig. 2](12).Note : In some areas, due to the severe bone atrophy, oro-sinusal communications covered only by the mucosa were evident on the CBCT scan, in which case the patient’s removable denture functioned as a protective „shield”.The cone-beam computed tomography has confirmed an inflamtion of the sinus mucosa due to odontal causes (infections associated with the previous teeth) and the severe lack of alveolar bone in all the maxillary regions that could be seen in the preliminary radiographs. The highest points of the residual bone were found, firstly, as it can be observed on the CBCT, in the third molars region both sides [Fig. 2(a) and 2(b)](12) with dimensions ranging between 2.4 and 7.2 mm in height and 6.6 and 10.2 mm in width in the first quadran and between 4.8 and 10.2 mm in height and 5.4 and 9.6 mm in width in the second quadran.Implant placement in the posterior region of the maxilla, the distal area of the maxillary alveolar process, which corresponds most frequently to the position of the third molar, has been suggested by many authors as an alternative to bone grafting. The posterior maxillary region typically has type III or IV bone quality, consisting of thin cortical bone and low-density trabecular bone. Primary stability is adversely affected by this. Due to inadequate primary locking, as well as short implants having unfavourable biomechanics, this region tends to have low success rates. Therefore, clinicians face a challenge in rehabilitating this area (3).The second area where we could measure some significant alveolar bone is the second molars region both sides [Fig. 3(a) and 3(b)](12) with dimensions ranging between 2.1 and 2.7 mm in height and 10.8 mm width in the first quadran and between 3.0 and 3.9 mm in height and 9.3 and 9.9 mm in width in the second quadran.As it can be observed in the CBCT scan, in the first molars region both sides, the residual alveolar bone height is either less that 3.0 mm or unsignificant [Fig. 3(a), Fig. 4(a)](12), making implant placement without lateral window sinus lift impossible. In the first quadran, it is important to notice the abcence of the cortical vestibular bone and the oral comunication with the maxillary sinus, closed only by the mucosa (an where we previously mentioned that patient’s removable denture functioned as a protective “shield”).As it can be observed in the figures above [Fig 4, Fig. 5 and Fig. 6](12), the other areas of alveolar bone have no significant dimensions that could be useful for a complete implant-prosthetic rehabilitation. Thus, the possible initial treatment plan proposed was bilateral window sinus lifting with delayed implant placement after 8 – 10 months from the initial surgery and guided bone regeneration for vertical and horizontal deficiency in the frontal area. During these 8 – 10 months of healing, the patient was to be only aesthetically rehabilitated with a removable prosthesis and the prognosis was reserved. Because he has high functional and aesthetic requests, and due to the fact that he has already been edentulous for 3 years by now, we had to find a more appropriate treatment solution.