Introduction: Heart failure (HF) is a complex condition often accompanied by comorbidities such as renal dysfunction, diabetes mellitus (DM), chronic respiratory diseases, frailty, and anaemia, necessitating intricate management involving multiple therapeutics. Objectives: This retrospective cohort study aims to characterize prescribing patterns and identify potentially inappropriate polypharmacy in individuals with HF and multimorbidity. Methods: Data was collected from 234 HF adults with multimorbidity under the care of the HF multidisciplinary team at Liverpool University Hospital Foundation Trust (LUHFT) from January 2020 -February 2021. Results: The mean age was 71.5±13.9 and 44% were female. ACCI was 6.9±3.3, CFS was 5.5±3.2, polypharmacy burden was high at 10.2±3.9, and ACB was 1.45±0.9. ACB was higher in those with CFS≥6 vs. those with CFS<6 (1.5±1.1 vs. 1.1±0.9; p=0.02). The proportion of adults with HF on treatment for depression was 19.7%, chronic pain 35%, and chronic constipation 19.7%. Fifteen percent received oral iron instead of the appropriate intravenous iron replacement, while 17.9% of the cohort were observed to be nearing the end of their lives. Regarding PIM use, 9% were on either DAPT/anticoagulant plus anti-platelet therapy beyond 12 months of an acute coronary event. One in five patients received PPIs without clear justification. Conclusion: Adults with frailty and HF have a higher ACB. This study identifies targets for de-prescribing interventions in HF, including inappropriate PPI and DAPT/anticoagulant plus anti-platelet therapy, which are seeing in 1:5 and 1:10 adults with HF in the clinic, respectively. Tailored guidelines can aid shared decision-making, reducing drug-related complications in this group.

Myocardial injury and cardiovascular dysfunction are the most common complications in patients with sepsis, and effective therapeutic candidate is still lacking. This study aims to investigate the protective effect of oxycodone in the myocardial injury in lipopolysaccharide-induced sepsis and its related signaling pathways. Wildtype and Nrf2-knockout mice, as well as H9c2 cardiomyocytes culture treated with LPS were used as models of septic myocardial injury. In vitro model showed that oxycodone protected the cells from pyroptosis induced by LPS. In vivo model showed oxycodone pretreatment significantly attenuated myocardial pathological damage and improved cardiac function with increased ejection fraction (EF) and fractional shortening (FS) as well as decreased cardiac troponin I (cTnI), creatine kinase isoenzymes MB (CK-MB). Oxycodone also reduced the levels of inflammatory factors and oxidative stress damage induced by LPS, which involves pyroptosis-related proteins including the NLRP3, Caspase-1, ASC, and GSDMD. These changes were mediated by Nrf2 and HO-1 because Nrf2-knockout mice or Nrf2 knockdown in H9c2 cells significantly reversed the beneficial effect of oxycodone on oxidative stress, inflammatory responses and NLRP3-mediated pyroptosis. Our findings proved that oxycodone therapy reduces LPS -induced myocardial injury by suppressing NLRP3-mediated pyroptosis via the Nrf2/HO-1 signaling pathway in vivo and in vitro.

：Objective To explore the role of p53 in the replication of enterovirus 71 (EV71) and the anti-EV71 replication mechanism of isochlorogenic acid B in extract of honeysuckle. Methods EV71 strain was isolated and inoculated with RD cells to detect virus titer, CCK-8 to detect cell survival rate and LDH to detect cell damage rate. RD cells were treated with RITA (p53 activator), Pifithin-α (p53 inhibitor) and isochlorogenic acid B, and the expressions of autophagy related proteins p62, LC3, p53 and viral VP1 were detected by Western Blot. Cell survival rate and cell damage rate were detected by CCK-8 and LDH. Results EV71 strain was isolated and infected with RD cells, the intracellular p53 content decreased, p62 and LC3II content increased. In the RITA treatment group, p53 content increased, p62, LC3II content decreased, virus titer decreased, cell survival rate decreased, and damage rate increased. In Pifithin-α treatment group, intracellular p53 content decreased, p62, LC3II content increased, virus titer increased, cell survival rate decreased, and damage rate increased. In isochlorogenic acid B treatment group, p53 content increased, p62, LC3II content decreased, virus titer decreased, cell survival rate increased, and damage rate decreased. Conclusion EV71 can affect autophagy and promote self-replication by regulating p53. Isochlorogenic acid B up-regulates p53 to promote autophagy, inhibits EV71 replication in RD cells, and weakens its cytotoxicity, which has a good anti-EV71 effect.

The Battery Management System’s (BMS) precision in estimating battery state depends on the accuracy of the Equivalent Circuit Model (ECM) parameters, which is affected by the sampling interval. This study investigates the impact of sampling interval on Lithium-ion parameter estimation and modelling using interpolation techniques. Five simple interpolation methods (Linear, S-Linear, Quadratic, Cubic, and Akima) are applied to interpolate Hybrid Pulse Power Characterization (HPPC) data from 1s interval to 0.5s and 0.25s intervals and down sampled to 2s. The interpolated and down sampled data is used to estimate ECM parameters, which are then used to fit battery aging data from the Electric Vehicle Urban Dynamometer Driving Schedule (UDDS) for 1RC and 2RC models. Statistical analysis is employed to compare the results. The findings demonstrate that not all interpolation techniques perform equally. Quadratic interpolation exhibits poor performance, particularly in the 1RC model with a 0.5s interval, resulting in significant errors. Linear and S-Linear interpolation show comparable performance to non-interpolated data with R2 score difference in the range of 0.000361 for 1RC model and 0.000061 for 2RC model closely followed by Akima. The error distribution of Quadratic and Cubic interpolation is right skewed, indicating a higher frequency of negative errors. Overall, Linear and S-Linear interpolation perform well especially for smaller interpolated intervals, providing accurate results with minimal processing time effectively capturing slow-changing charge cycle and fast-changing variations in the UDDS cycle for both models. Hence, low size acquired data can be transferred to cloud efficiently to be interpolated with proper interpolation technique at a suitable sampling period, complex and novel parameter estimation algorithms to give accurate internal parameter estimation reducing unit hardware cost in vehicles.

To investigate the impact of the COVID-19 pandemic on vitamin D status among adults. A total of 1525 adults from Henan Provincial People’s Hospital were included. The results revealed a significant difference in overall 25-hydroxyvitamin D (25(OH)D) levels between 2022 (18.14, 13.78, 23.68) and 2023 (19.15, 14.88, 25.01, p=0.004). Notably, males exhibited a substantial difference in 25(OH)D levels, with 18.01 (14.10, 23.53) in 2022 and 20.49 (16.11, 26.01) in 2023 (p<0.001). The prevalence of vitamin D deficiency was significantly higher in 2022 (62%) compared to 2023 (54.9%, p=0.009), with males having higher rates of deficiency (64.1% in 2022 and 47.2% in 2023). These findings were supported by an independent cohort of 168 individuals tested in both years, showing overall 25(OH)D levels of 20.73 ± 9.37 in 2022 and 22.28 ± 8.59 in 2023 (p=0.012), and vitamin D deficiency rates of 58.3% in 2022 and 47.0% in 2023 (p=0.038). In the 40-49 age group, 25(OH)D levels were significantly lower in 2022 (16.10, 12.41, 21.18) compared to 2023 (18.28, 13.91, 23.86, p=0.005), with a higher vitamin D deficiency rate in 2022 (72.8%) compared to 2023 (59.9%, p=0.02). Furthermore, in April, May, and June, 2022, 25(OH)D levels were significantly lower compared to 2023 (p<0.001, p<0.002, p<0.001, respectively), accompanied by a higher prevalence of vitamin D deficiency (p<0.001, p<0.002, p<0.001, respectively). In conclusion, our study findings indicate a substantial decline in vitamin D levels and an elevated prevalence of vitamin D deficiency among the adult population, with a particular emphasis on adult males, during the course of the COVID-19 pandemic.

Retinoblastoma, the most common intraocular tumor in childhood, still faces challenges in diagnosis and treatment, particularly in low- and middle-income countries. Identifying strategies to improve the time to diagnosis and access to treatment is crucial to enhance survival rates and preserve ocular health. We conducted a systematic review to identify interventions that have demonstrated potential in addressing these challenges. We performed a comprehensive search across databases until March 2023. Out of the studies reviewed, twenty-one met the inclusion criteria and were categorized into five main areas: surveillance strategies, genetic counseling, education, public assistance and international partnership. Despite the obstacles faced, the initiatives identified in this review present acts towards improving the time to diagnosis and access to treatment for retinoblastoma. Based on the extracted data, we propose a comprehensive chain of initiatives. We firmly believe that implementing this chain of initiatives can lead to improved clinical outcomes for retinoblastoma patients.

Full Title:A corneal stroma circular ring captured by smartphone adaptor slit lamp camera after small incision lenticule extractionShort Title: A corneal stroma ring captured by smartphone slit lamp camera after smileAbbreviations: small incision lenticule extraction = smile.Keywords: corneal stroma, circular ring, smartphone, slit lamp, small incision lenticule extraction

Microbial communities colonizing Pandalus borealis (the northern shrimp) plays an important role in their ecosystem. Although Pandalus borealis attracts extensive attention worldwide for a long time, the microbial community and composition remain unclear. Therefore, the microbial diversity and community composition were studied by high-throughput sequencing technology and traditional cultured method. Whole shrimp were dissected into components including eyes, shrimp eggs, viscera, muscles, and shrimp tails to evaluate the diversity of culture-independent microorganisms. The results showed that the microbial composition of different body parts were similar, although fungal and bacterial community diversity of the viscera were highest. The most predominant bacterial phylum was the Proteobacteria that accounted for 13.47–89.82% of all reads from different body parts, except for shrimp eggs. Only the CXQ1 whole-shrimp and viscera of CXQ25 yielded fungal community results, of which the predominant phylum and genus were Acomycota (48.02% and 71.21% in CXQ1 and CXQ25, respectively) and Aspergillus (4.52% and 4.18%), respectively. Moreover, bacterial functional predictions and fungal guild were also investigated on the basis of OTUs results. Meanwhile, the traditional cultivable method showed that total 22 Acomycota phylum fungal colonies were identified by 18S rRNA sequencing technology. These findings provide new insights for culturable and inculturable microbial community composition of Pandalus borealis for the first time.

Behavioural research over several decades has found that concrete words are processed more quickly and accurately than abstract words (concreteness effect). This advantage is also reflected in their different processing and representation in the human brain. In this electrophysiological study, we explored the interplay of concreteness as a continuous measure and task effects on word processing. Electrophysiological responses of 58 participants were recorded during semantic, affective, and grammatical decision tasks on words parametrically varied in concreteness. Our findings uncovered a fine-grained concreteness effect within four distinct spatiotemporal windows when a coding of semantic information is required. In the semantic decision task, we detected a higher parietal positivity within the P300 time range and an increased left temporo-lateral negative-going amplitude for less concrete concepts. We also identified a concreteness effect characterised by greater negativity in the N400 component. In the affective task, we observed a more pronounced parietal P600-like component for more abstract concepts. Interestingly, we found that the neural representational similarity (starting from 450 ms with a widespread scalp distribution) conformed to the concreteness similarity among concepts (regardless of the task), implying that their semantic representations may be characterised along the concreteness dimension in the brain. Our study transcends the conventional dichotomy of abstract versus concrete words, unearthing not only varied processing dynamics along the concreteness dimension but also distinct fine-grained neural representations. This novel insight positions concreteness as a structural dimension, enriching our comprehension of how the brain organises and processes semantic information.

Nigeria is among the highest contributor to global prevalence of obstetrics fistula (OF) and weak health care policies and services have left the victims reeling in untold psycho-social and physical morbidities. This study was aimed at assessing the psychometric properties of a globally used Patients’ Health Questionnaire (PHQ-9) among these patients. A descriptive cross-sectional study design was employed to study the fertility desires, mental health and patients’ quality of life among women with obstetric fistula in three selected OF centers in Northwestern region of Nigeria. Using two-stage sampling technique four hundred twenty (420) OF patients were recruited into the study. Maximum likelihood (ML) factor analysis was deployed to produce latent factors from the responses to the PHQ-9 scale, internal reliability and construct validity were determined by Cronbach alpha values while comparative mean analysis was used to validate standardized scores of the derived PHQ-9 scale factors against socio-demographic and obstetric characteristics. Mean age and standard deviation of respondents were 26.4±8.4 years as 60% aged between 20-25 years. The married, divorced and those in polygamous were 45%, 47.1% and 73.6% respectively. More than half (55.5%) were traders while majority (89.8%) earned NGN4500 or less monthly. Three factors of somatic (r= 0.72-0.82; α=0.86), non-somatic (r= 0.64-0.76; α=0.77) and affective (r= 0.64-0.96; α=0.74) constructs emerged from the ML factor analysis. Patients of ages 20-25 years, divorced/single and widows, the formally educated and farmers significantly differed with high scores of the affective construct of the PHQ-9 scale. Those who had more than four pregnancies and greater than a single stillbirths significantly differed with affective symptoms (0.29±0.90; 0.69±0.9 The 15-17 year olds at first birth and those who waited more than ten years for OF surgical repairs differed with non-somatic symptoms’ construct of the PHQ-9 scale (0.21±1.04; 0.31±0.87) significantly differed with affective factors. The PHQ-9 instrument exhibited possibility of being used to assess the quality of OF patients’ mental health. Future studies could expand the sample size to accommodate advanced inferential psychometric methods.

A rare case of femoral vein stenosisLifan Shao1, Naixia Wang2, Guangxin Cao21Master student,Weifang Medical University,Weifang City,Shandong,China 2610002Department of Vascular Surgery, Weifang People’s Hospital, No.151 Guangwen Street,Kuiwen District,Weifang City,Shandong,China26100011Lead Author:Lifan Shao; Master student, Weifang Medical University, Weifang City, Shandong, China, email: 1163786632@qq.com Correspondence should be addressed to Guangxin Cao; No.151 Guangwen Street, Kuiwen District, Weifang City, Shandong, China, email:caoguangxinvip1234@163.comThe patient provided written informed consent for the report of his case details and imaging studies. The authors have no competing interests.Abstract: A 61-year-old male patient with post-thrombotic syndrome came to our hospital for treatment. Imaging showed stenosis of the left iliac vein, and post-symptoms of iliac vein stenosis improved significantly after iliac vein stent implantation. A year later, the patient returned with a ruptured left foot, and imaging revealed stenosis of the left common femoral vein. This case has certain reference value for the study of complications after iliac vein stent implantation.Keyword: Chronic iliofemoral venous obstruction; Iliac vein stenting; Post-thrombotic syndromeCase report: A 61-year-old male. Over 20 years ago, there was no obvious cause of local pigmentation of his left inner leg, which was mild at the beginning and gradually aggravated. The pigmentation area gradually expanded with local ulcers accompanied by leg swelling and discomfort. He was previously treated in another hospital, and his ulcer healed after conservative treatments. Four months ago, the patient was injured by heavy objects falling on his left leg that caused local ulcers. He came to our hospital in April 2022 and was diagnosed with varicose veins of the lower limb accompanied by ulcers and infection of the skin tissue of the lower limb. Anterograde deep vein angiography of the lower limb was performed in our hospital. Imaging revealed stenosis of the left iliac vein and sequelae of thrombosis in the right superficial femoral vein. Balloon dilation of the left superficial femoral vein + iliac vein stent implantation was performed. Intraoperative angiography showed that the left common iliac vein stenosis(IVS) was greater than 70%, and the common femoral vein was well developed without significant stenosis (FIG. A). Through left popliteal vein puncture, WALLSTENT (16 mm*90 mm) was placed through a guide wire. and the left superficial femoral vein balloon was dilated. The stent position was satisfactory after surgery. IVS was significantly relieved, blood flow was restored, and no significant abnormality was observed in the common femoral vein (FIG. B). The ulcer healed gradually after the operation. In August 2023, the patient returned to our hospital due to non-healing of his left foot. Anterograde imaging of the deep vein of the lower limb was performed. Imaging showed that the length of the stent was slightly shortened, the patient’s left iliac vein was well developed, and the left common femoral vein was obviously narrow at the lower end of the stent (FIG. C). Left iliofemoral venography + stent implantation was performed. Through left popliteal vein puncture, WALLSTENT (14 mm*90 mm, 12 mm*90 mm) was implanted through a guide wire, Post-operative angiography showed satisfactory stent position, good shape, disappearance of stenosis, and satisfactory blood flow velocity (FIG. D).Discussion:IVS is clinically considered the anatomic basis of the deep vein thrombosis of the lower limbs and the cause of post-thrombotic syndrome(PTS) in most patients[1]. IVS is very common in clinical practice, with an incidence as high as 22%–50%[2]. In recent years, with the improvement of diagnostic technology, the incidence of IVS has gradually increased. IVS is mostly related to the dissected structure around the common iliac vein, and the left iliac vein is mostly narrowed by the compression of the right iliac artery and the fifth lumbar vertebrae. The incidence of left side deep vein thrombosis (DVT) is significantly higher than that of right side DVT. IVS can affect blood flow and cause deep vein thrombosis DVT of the lower extremities, which may increase the mortality of patients[3]. After stent implantation for IVS, displacement and blockage may occur, and the stenosis of the lesion site is often recurrent. However, one year after the common iliac vein stent implantation, common femoral vein stenosis occurrs below the stent, which is a rare complicationthat has been documented in only a few reports at home and abroad.After consulting relevant data and discussion, the reasons for the formation of common femoral vein stenosis after stent implantation in this case are speculated as follows. The common femoral vein is also oppressed by the hip joint and its surrounding muscles, ligaments and other tissues. Chen previously reported a case of deep vein thrombosis caused by femoral vein compression by the medial femoral muscle[5]. Relevant studies showed that WALLSTENT venous stenting in the treatment of post-iliofemoral thrombosis or compression obstruction is safe and effective with a good primary and secondary patency rates of 87% and 95% at 72 months[5], However some shortcomings are worth mentioning. For example, the radial force at the end of the stent is small and the stent is significantly shortened after implantation[5], as reflected in angiography (FIG. C). In addition, due to the small radial force at the end of the stent, the uneven support force inside the lumen may also lead to the common femoral vein stenosis.The pressure and wear caused by the surrounding tissues also generate internal shear stress, which causes irreversible damage to the tube wall and promotes the occurrence of inflammatory reaction, thus further affecting the normal function of the tube wall elastin, resulting in the thinning of the wall of the common femoral vein, reducing its resistance to pressure from the surrounding tissues, and eventually leading to stenosis.Reference:[1]S. Vedantham, et al., Quality improvement guidelines for the treatment of lower-extremity deep vein thrombosis with use of endovascular thrombus removal, Vasc. Intervent. Radiol. 25 (9) (2014) 1317–1325.[2]Kutsenko O, McColgan Y, Salazar G. Iliac Vein Stenosis: Is the Data Strong Enough for Stenting in the Young Pelvic Venous Disorders (PeVD) Population? Tech Vasc Interv Radiol. 2021 Mar;24(1):100733. doi: 10.1016/j.tvir.2021.100733. Epub 2021 Apr 15. PMID: 34147201.[3]Wang H, Jia W, Xi Y, Li Y, Fan Y, Deng X, Chen Z. Morphometric and Hemodynamic Analysis of the Compressed Iliac Vein. J Endovasc Ther. 2022 Nov 20:15266028221134895. doi: 10.1177/15266028221134895. Epub ahead of print. PMID: 36408873.[4]Chen YT. The Medial and Posterior Compression of the Distal Femoral Vein: An Underused Approach to Detect Venous Thrombosis. J Coll Physicians Surg Pak. 2021 Nov;31(11):1389-1390. doi: 10.29271/jcpsp.2021.11.1389. PMID: 34689511.[5]Gagne PJ, Gagne N, Kucher T, Thompson M, Bentley D. Long-term clinical outcomes and technical factors with the Wallstent for treatment of chronic iliofemoral venous obstruction. J Vasc Surg Venous Lymphat Disord. 2019 Jan;7(1):45-55. doi: 10.1016/j.jvsv.2018.07.016. Epub 2018 Oct 24. PMID: 30558730.

Photoelectrochemical (PEC) systems harness light absorption to initiate chemical reactions, while electrochemical reactions facilitate the conversion of reactants into desired products, ensuring more efficient and sustainable energy conversion in PECs. Central to optimizing the performance of PECs was the pivotal role played by interface engineering. This intricate process involved manipulating material interfaces at the atomic or nanoscale to enhance charge transfer, improve catalytic activity, and address limitations associated with bulk materials. The careful tuning of factors such as band gap, surface energy, crystallinity, defect characteristics, and structural attributes through interface engineering led to superior catalytic efficiency. Specifically, interface engineering significantly enhanced the efficiency of semiconductor-based PECs. Engineers strategically designed heterojunctions and manipulated catalyst surface properties to optimize the separation and migration of photogenerated charge carriers, minimizing recombination losses and improving performance overall. In this review, we categorized our discussion into five sections focusing on PECs and interface engineering, providing valuable insights into recent research trends. Overall, the synergy between PECs and interface engineering holds tremendous promise for advancing renewable energy technologies and addressing environmental challenges by offering innovative solutions for sustainable energy conversion and storage.

Multi-needle electrospinning is a simple and general method for mass preparation of nanofiber membranes, which has great industrial potential. However, due to the bending instability produced in the process of electrospinning, the deposition uniformity of the nanofibers has been very worrying, resulting in uneven nanofiber films, which seriously affects the batch application of electrospinning films in environmental filtration, new energy and medical fields. In order to improve the uniformity of nanofiber deposition in multi-needle electrospinning, we propose an auxiliary flow field system (AFF), which can effectively improve the non-uniformity of nanofiber deposition. After image processing of electrospun nanofiber films, we quantified the uniformity of fiber deposition with the index of gray distribution, and verified the effectiveness of this method. Combined with the multi-physical field analysis of the experimental model, the influence mechanism of cross-wind field on the uniformity of fiber deposition was revealed. By optimizing the experimental parameters, the non-uniformity of nanofiber deposition was reduced by 49. 19%.

Commentary: Calcium supplementation for the prevention of pre-eclampsia:

Understanding animal movement and behaviour can aid spatial planning and inform conservation management. However, it is difficult to directly observe behaviours in remote and hostile terrain such as the marine environment. Behaviours can be inferred from telemetry data using hidden Markov models (HMMs), but model predictions are not typically validated due to difficulty obtaining ‘ground truth’ behavioural information. We investigate the accuracy of HMM-inferred behaviours by considering a unique dataset provided by Joint Nature Conservation Committee. The data consist of simultaneous proxy movement tracks of the boat (defined as visual tracks as birds are followed by eye) and seabird behaviour obtained at the same time-frequency by observers on the boat. We use these data to assess whether (i) visual track is a good proxy for true bird locations in relation to HMM-inferred behaviours, and (ii) inferred behaviours from HMMs fitted to visual tracking data accurately represent true behaviours as identified by behavioural observations taken from the boat. We demonstrate that visual tracking data can be regarded as a good proxy for true movement data of birds in terms of similarity in inferred behaviours. Accuracy of HMMs ranging from 71% to 87% during chick-rearing and 54% to 70% during incubation was generally insensitive to model choice, even when AIC values varied substantially across different models. Finally, we show that for foraging, a state of primary interest for conservation purposes, identified missed foraging bouts lasted for only a few seconds. We conclude that HMMs fitted to tracking data can accurately identify important conservation-relevant behaviours, demonstrated using visual tracking data. Therefore, confidence in using HMMs for behavioural inference should increase even when validation data are unavailable. This has important implications for animal conservation, where the size and location of protected areas are often informed by behaviours identified using HMMs fitted to movement data.

The evolution of animals and their gut symbionts is a complex phenomenon, obscured by lability and diversity. In social organisms, transmission of symbionts among relatives may yield systems with more stable associations. Here we study the history of a social insect symbiosis involving cephalotine ants and their extracellular gut bacteria, which come predominantly from host-specialized lineages. We perform multi-locus phylogenetics for symbionts from nine bacterial orders, and map prior amplicon sequence data to lineage-assigned symbiont genomes, studying distributions of rigorously defined symbionts across 20 host species. Based on monophyly and additional hypothesis testing, we estimate that these specialized gut bacteria belong to 18 distinct lineages, of which 15 have been successfully isolated and cultured. Several symbiont lineages showed evidence for domestication events that occurred later in cephalotine evolutionary history, and only one lineage was ubiquitously detected in all 20 host species and 48 colonies sampled with amplicon 16S rRNA sequencing. We found evidence for phylogenetically constrained distributions in four symbionts, suggesting historical or genetic impacts on community composition. Two lineages showed evidence for frequent intra-lineage co-infections, highlighting the potential for niche divergence after initial domestication. Nearly all symbionts showed evidence for occasional host switching, but four may, more often, co-diversify with their hosts. Through our further assessment of symbiont localization and genomic functional profiles, we demonstrate distinct niches for symbionts with shared evolutionary histories, prompting further questions on the forces underlying the evolution of hosts and their gut microbiomes.

Background: Over-the-counter (OTC) medications are widely available in the market without a prescription. Pain, coughs and colds, diarrhoea, constipation, acne, and other ailments are all treated with over-the-counter medications. The implications of such actions should always be made clear to the community, along with efforts to prevent them. Objective: This assessment aims to evaluate AJK medical students’ knowledge, attitudes, and behaviours around self-medication using over-the-counter (OTC) medications. Methods: A study was carried out with AJK medical students. Through WhatsApp, an online survey was sent to the students of the first year to fifth year of each of the four medical colleges in AJK. The information was gathered in 2023 between June 25 and July 31,. Applying SPSS-25, data analysis was done. Results: 372 individuals reported their responses. Last year, 65.3% of people practiced self-medication. Analgesics and antipyretics were the most often used medications (55.9%). Fever, discomfort, and toothache were the symptoms that medical students self-medicated for the most (58.1%). Conclusion: In a nutshell self-medication with OTC medications is a contemporary issue. Medical students who lack the necessary clinical expertise and understanding to self-medicate. They alter the course of therapy frequently in order to suit their schedules, which lowers the effectiveness of the medications.

Rapid environmental change and human activity has dramatically facilitated the spread of invasive species, expanding their impacts beyond the original recipient communities. Predicting the potential spread of invasive species and ways to stop it remain challenging, as several abiotic, biotic, and management factors may alter outcomes. Among the most problematic invasive species globally, Burmese pythons (Python bivittatus) have established throughout much of south Florida (USA) and pose substantial ecological, economic, and societal threats to the region. To understand the invasion process, we use a new spatiotemporal modeling framework, the spatial absorbing Markov chain (SAMC), to model future spread of pythons while accounting for propagule pressure and mortality risk from three hypothesized sources: (i) cold exposure, (ii) vehicle strikes on roads, and (iii) removal management programs. To parameterize this model, we integrated empirical and model-derived data of python occurrence, movement, and behavior, and physiology using coupled correlative-mechanistic models. In a simulated invasion scenario, we found that removal management programs may have the greatest potential for limiting future spread through long-term mortality—accounting for 93.6% of all expected mortality and exceeding both cold exposure (<0.1%) and road mortality (6.3%). Furthermore, we demonstrate that circuit theory, a model which does not account for demographic processes, likely overestimates spatial patterns of connectivity. By examining invasions in a spatiotemporal framework, SAMC can provide novel information—including spatial patterns of survival, time-specific movements, and evaluation of different types of removal management strategies—to guide the management of invasive species.

Key Clinical MessageSturge–Weber syndrome (SWS) is a neurocutaneous syndrome characterized by angiomas. This report presents airway management using submental intubation in sagittal split ramus osteotomy under general anesthesia and aimed to explore better anesthetic management for avoiding the rupture of angiomas in a patient with SWS.

TITLE PAGETitle: Primary liver cancer misdiagnosis of gastrointestinal stromal tumor liver metastasis： A case report

A document by Pouya Ebrahimi. Click on the document to view its contents.

This paper studies how an edge recurrent neural network can improve a Battery Monitoring System (BMS). The proposed monitoring measures current, voltage, and temperature and infers the State of Charge (SoC) and State of Health (SoH) values through machine learning in an embedded system. The study relies on two test cases: a theoretical one using NASA’s battery dataset, where the high volume of data is best suited for a study, and a second one with a system built in the University of São Paulo where this paper can analyze more profound the practical results of its use. This system of the second test case consists of peripheral sensors integrated into an Internet of Things (IoT) platform, sending the data collected from a VRLA battery to a Single Board Computer (SBC) via Bluetooth Low Energy (BLE). The edge SBC concentrates this received data - from one or more IoT nodes - generating new data for supervision and enabling control. The SBC communicates with a Web server in a one-way route to send the battery data without any data request. The algorithm developed for the SoC uses a dense recursive network with Mean Absolute Error (MAE) up to 0.2, and for SoC above 10%, the Mean Absolute Percentage Error (MAPE) can reach 0.16%. As an SoH calculation method, the battery replacement performs the methodology when the capacity reaches 80% of its nominal capacity. It is essential to highlight that these results are from a devices with limited hardware availability without cloud communication.

Minimum surgeon volumes have been introduced in multiple specialties in the UK with the aim of improving patient outcomes. This includes endocrine surgery, pertinent to ENT surgeons performing thyroid and parathyroid surgery, where a minimum annual workload of 20 cases is recommended. Further implementation of minimum surgeon volumes could lead to substantial changes to service provision, including centralisation of procedures, turf wars between specialties, an accelerated shift of elective surgery to the private sector and a disproportionate impact on female surgeons.

Objectives This study explores how nasal structure and mucosal contractility in CRSsNP patients relate to and potentially affect their olfactory function.. Design and Setting The subjective olfactory function of the patients was assessed using the Sniffin’ Stick test. Patients with an olfactory total score of ≤27 were classified into the olfactory disorder group, while those with an olfactory total score of >27 were classified into the normal olfactory function group. Participants Patients diagnosed with Chronic Rhinosinusitis without Nasal Polyps (CRSsNP) at our hospital’s Department of Otorhinolaryngology-Head and Neck Surgery. Main outcome measures Acoustic Rhinometry (AR) was employed to assess the patients’ nasal cavity structure and nasal mucosal contractility. Results No significant differences were found in gender, age, smoking history, and nasal function indicators between the normal olfaction and olfactory disorder groups (P > 0.05). After controlling for age, olfaction was negatively correlated with nasal mucosal contractility (ΔNV2-5). In the normal olfaction group, olfactory threshold was positively correlated with ΔNV2-5 (P < 0.01), while no significant correlation was observed in the olfactory disorder group. Multiple linear regression analysis revealed that age and NV2-5 were negatively correlated with total olfactory score. Conclusions The reduction of olfaction in CRSsNP patients does not affect the contractility and relaxation functions of the nasal mucosa.As the nasal cavity volume increases, the sensitivity of olfaction in CRSsNP patients actually decreases.The relative stability of the nasal mucosa in CRSsNP patients allows their olfactory cognitive ability to reach its optimal state.