Objective To investigate the impact of counseling interventions, using face-to-face training vs. mobile app for choosing mode of delivery. Design A four-armed, randomized, controlled parallel-design trial. Setting Ebnesina Private Hospital in Tehran, Iran. Population Pregnant women, between 24 and 32 weeks of gestation (n=120). Methods: Pregnant women were randomly assigend in three psycho-educational intervention groups; 1) motivational interviewing via face-to-face training, 2) information, motivation, and behavioral skills model via face-to-face training, 3) the same model via a mobile application, and 4) usual antenatal care (control group). To assess the face-to-face and mobile app method training method on women’s self-efficacy and intention in choosing a mode of delivery. Main outcome measures Mode of delivery (Cesarean section) Results: While all three intervention groups showed significant increases in women’s self-efficacy and intentions to choose vaginal delivery, the increase was particularly noticeable among those using mobile applications: Before the intervention, self-efficacy and intention Mean ± SD were 77.1±38.6 (CI-95%: [62.72, 91.60]) and 1.10±0.305 (CI-95%: [0.99, 1.21]), respectively. After the intervention, these scores increased to 99.7±30.7 (CI-95%: [88.27, 111.20]) for self-efficacy and 1.70±0.466 (CI-95%: [1.53, 1.87]) for intention. Although 56.7% of women in the intervention groups expressed a preference for vaginal delivery, only 37.5% ultimately pursued this birthing method Conclusions: Brief psycho-educational interventions, particularly technology-deriven interventions (mobile apps) can increase the likelihood of women choosing vaginal delivery. To enhance the effectiveness of such interventions, they can be conducted in conjunction with interventions for doctors and healthcare providers.

Spindle Cell Lipoma: A Case Report and Literature Review on Japanese PatientsKeigo Hirafuku, MD, Mayumi Ota, MD, Yoshimasa Nobeyama, MD, and Akihiko Asahina, MDDepartment of Dermatology, The Jikei University School of Medicine, Tokyo, JapanCorrespondence: Yoshimasa NobeyamaDepartment of Dermatology, The Jikei University School of Medicine25-8 Nishi-Shimbashi 3-chome, Minato-ku, Tokyo 105-8461, JapanTel.: +81-3-3433-1111 ext. 3341; Fax: +81-3-5401-0125E-mail: [email protected] words, 2 tables, 3 figuresKeywords: atypical lipomatous tumor, lipoma, spindle cell lipoma, well-differentiated liposarcoma

Climate change significantly impacted on the survival, development, distribution, and abundance of living organisms. The Chinese serow Capricornis milneedwardsii, known as the ‘four unlike’, is a Class II nationally protected species in China. In this study, we predicted the geographical suitability of C. milneedwardsii under current and future climatic conditions using MaxEnt. The model simulations resulted in area under the receiver operating characteristic curve (AUC) values above 0.9 for both current and future climate scenarios, indicating the excellent performance, high accuracy, and credibility of the MaxEnt model. The results also showed that annual precipitation (Bio12), slope, elevation, and mean temperature of wettest quarter (Bio8) were the key environmental variables affecting the distribution of C. milneedwardsii, with contributions of 31.2%, 26.4%, 11%, and 10.3%, respectively. The moderately and highly suitable habitats were mainly located in the moist area of China, with a total area of 34.56×104 and 16.61×104 km2, respectively. Under future climate change scenarios, the areas of suitability of C. milneedwardsii showed an increasing trend. The geometric center of the total suitable habitats of C. milneedwardsii would show the trend of northwest expansion and southeast contraction. These findings could provide a theoretical reference for the protection of C. milneedwardsii in the future.

Management of Post-Partum Pulmonary edema in an Intensive Care Unit (ICU) of a peripheral district hospital: A Case ReportP Bidari1, IK Silwal1, S Bijukchhe1, R Subedi1, P Sapkota1, S Adhikari2Department of Anesthesia and Critical CareDepartment of Clinical PharmacologyHetauda Hospital, Madan Bhandari Academy of Health Sciences

Although pediatric cancer is often considered a traumatic event, there is significant variability in youth psychosocial outcomes. Many children report coping well and they do not differ from their peers on indices of psychopathology. Understanding what makes children with cancer resilient is vital to supporting those at risk. Therefore, the goal of this systematic review was to identify factors associated with increased resilience following a pediatric cancer diagnosis. A systematic search of four databases (PubMed, PsycINFO, ProQuest, and Academic Search Complete) resulted in 1356 unique records, of which 40 met inclusion criteria. Resilience-enhancing factors included family cohesion, strong parent-child relationships, and social support as well as youths’ coping strategies, positive attitudes toward illness, optimism, hope, and ego-resilience. The factors identified are potentially malleable and thus could contribute to the development of strengths-based psychosocial interventions. Future studies would benefit from person-based or multilevel analyses and prospective designs.

Identity disturbance (ID) has been identified as a transdiagnostic contributor to psychiatric symptoms and seems to be comprised of both interpersonal and self-oriented mechanisms. This study developed the identity self-focus experimental task, incorporating personalized adjectives, reflection, and varying conditions by source (Self or Other) of identity adjectives, to better understand the relation between ID and affectivity. University students ( N=97) completed a positive mood induction followed by the experimental manipulation— during which they continuously rated their positive affect. Results implicated specific facets of ID in higher negative and lower positive affect, and ID predicted difficulty regulating positive emotions. Higher ID was also associated with difficulty maintaining consistent positive affect for those in the Self condition and was associated with poorer emotion regulation for those in the Other condition. Findings suggests that ID is implicated in an unhelpful cognitive and affective style, especially for those with high levels of ID. While evidence-based treatments either do not or only indirectly address identity functioning issues, results suggest that measurement of ID and targeted intervention to strengthen identity may support emotional health outcomes of therapeutic treatments.

Background: Adverse drug events (ADEs) are a frequent cause of injury in patients. Our aim was to assess pharmacist interventions and their association with ADEs and potential adverse drug events (PADE). Methods: The search criteria: a published RCT, evidence of a pharmacist intervention, a comparison control group, and measurement of ADEs or PADEs. The information sources included MEDLINE, Embase, and two other databases through September 19, 2022. The risk of bias was assessed using the Cochrane tool for RCTs. A random-effects model for pooled studies was employed Results: Fifteen references meeting inclusion criteria were discovered. For ADEs, the pooled results showed a statistically significant benefit of pharmacist intervention in comparison to the control group (RR = 0.86; [95% CI 0.80-0.94); P = 0.0005. The heterogeneity was insignificant (P = 0.72; I 2 = 0%). Patients receiving a pharmacist intervention were 14% less likely for ADE than those who did not receive a pharmacist intervention. The estimated number of patients needed to prevent one ADE across all patient locations was 33. For PADEs, the pooled results did not show a statistically significant benefit for pharmacist intervention in comparison to the control group (RR = 0.79; [95% CI 0.47 – 1.32]; P =0.37.There was substantial heterogeneity in the pooled studies (P = 0.01; I 2 = 77%). However, there was a statistically significant subgroup difference (P = 0.005) for the intervention type. Conclusions: To our knowledge, this is the first systematic review and meta-analysis of RCTs seeking to understand the association of pharmacist interventions with ADEs and PADEs. The risk of having an ADE is reduced by a seventh for patients receiving a pharmacist care intervention versus no such intervention. This fraction could be higher for certain high-risk patients. The estimated number of patients needed to be followed across all patient locations to prevent one preventable ADE across all patient locations is 33. Also, a subgroup analysis of pharmacist intervention focus suggests that further research is necessary to fully understand the impact of TOC pharmacist intervention on PADEs. If validated, these findings have potential to significantly reduce drug-related morbidity and related healthcare costs.

Given the potential of natural products (NPs) for various aspects of human well-being, it is important to involve a variety of stakeholders and disciplines in the investigation of their health-related properties. For this reason, IUPHAR has initiated a project aimed at establishing a science-based registry of NPs and their pharmacological activities, with a view to providing a better understanding of their potential influences on human health. From a pharmacological perspective, it is important to evaluate the effects of selected NPs on important determinants of health such as, e.g. immune response and inflammation (among others). IUPHAR calls for a concerted effort and asks stakeholders to contribute to this project.

Distributed sensing for gearbox operation and anomaly detection is essential to improve gearbox design and fault detection to reduce the operation and maintenance cost for wind energy. In this study, we demonstrate the feasibility of real-time distributed strain monitoring of gearbox operation using Distributed Fiber Optic Sensing (DFOS) with Optical Frequency Domain Reflectometry (OFDR). Leveraging the millimeter scale spatial resolution and high strain accuracy of DFOS, we performed an experimental test involving a gearbox with multiple planetary gears under varying load conditions. In this test, a single optical fiber was attached to the outer surface of the gearbox continuously, providing a comprehensive strain profile as the inside gears rotated. The operation status of the gearbox, including the locations of the planet gears can be clearly observed in real-time, and the rotation speed can also be calculated based on the measurements. The results also revealed a linear relationship between the load torque and the strain measurements at all locations, underlining DFOS’s capability to accurately quantify torque load and detect potential faults at an early stage.

Glanzmann Thrombasthenia (GT) is an inherited bleeding disorder of poor platelet function secondary to a defect in platelet membrane glycoprotein IIb/IIIa (GPIIb/IIIa). Patients with GT may develop anti-platelet antibodies including anti-GPIIb/IIIa which can lead to severe refractory thrombocytopenia and life-threatening bleeding, management of which is challenging. We report successful use of imlifidase, a novel IgG protease enzyme, as part of a multimodal approach for management of severe platelet refractoriness and alloimmunization in a child with GT and primary graft failure following hematopoietic stem cell transplant (HSCT). The patient had no detectable anti-platelet alloantibodies following imlifidase, and underwent a second HSCT.

There is controversy about a causal role of serotonin (5-HT) in depression, some arguing that there is no proof for impaired brain 5-HT function in depressed patients. Major depressive disorder comes with multiple endophenotypes; not surprisingly classical antidepressants (tricyclics, MAO inhibitors, SSRIs, SNRIs) are not universally effective. Most antidepressants target the 5-HT system, partially if not exclusively, but treatment-resistant depression (TRD) remains a major issue. The most recent and heavily investigated class of potential rapid acting antidepressant, anxiolytic, and/or anti PTSD drugs, namely psychedelics (psilocybin, LSD, DMT, ayahuasca, etc..) or entactogens (MDMA, ibogaine), all target the 5-HT system, at least in part. Phase II / III clinical trials support psychedelics- and/or MDMA-assisted psychotherapy as a new class of rapid acting treatments for GAD, MDD, TRD, PTSD, and other disorders. Psilocybin and MDMA have FDA breakthrough status for TRD/MDD and PTSD, respectively, whereas LSD just received FDA breakthrough status for GAD. All psychedelics act as 5-HT2A receptor agonists, although LSD, DMT, psilocybin may also target other 5-HT and/or dopamine receptors. Psychedelics produce rapid onset and long-lasting antidepressant effects after one or two administrations. They all promote synaptogenesis and synaptic plasticity. Neuroinflammation plays a major role in anxiety, depression, PTSD. Interestingly, psychedelic-induced 5-HT2A receptor agonism has profound anti-(neuro)inflammatory effects. Altogether, the 5-HT system plays an essential, but not unique role in MDD and related disorders. MDD, TRD and PTSD may be considered as biochemical, neurological and immune conditions, given the emerging role of neuroplasticity and neuroinflammation, which until recently, have been overlooked.

The present study mainly focused on the diversity, distribution and morphology of some ornamental ferns and fern allies (pteridophytes) that have been widely used for ornamental purposes, medicine and food since the ancient period. Ferns and fern- allies belong to filicales. They are homosporous leptosporangiate flowerless, seedless and vascular plants found mostly in humid areas. Ferns are selected for foliage colour, leaves texture, shape of fronds, upright habit delicate beauty and excellent for decorative prospects and are cultivated as an ornamental plant. These species are distributed all over the world. In India, various types of ferns and fern allies are found in the Himalayan mountain range, Eastern Ghat and Western Ghat. They are most times neglected, less cultivated, underutilized, unrecognized plants and there is a lack of awareness of the importance of ferns. The present paper provides a comprehensive review of studies on ornamental ferns for decorative prospects, carried out by many researchers to provide detailed information on the position and morphology of ferns and prospects, values and significance of using ornamental ferns in the florist and landscape industry.

Anxiety is one of the most common and debilitating mental health disorders, and is related to changes in interoception (perception of bodily states). While anxiety is more prevalent in women than men, gender differences in interoception-anxiety associations are often overlooked. Here we examined gender-specific relationships between anxiety and interoception in the breathing domain, utilising multicentre data pooled from four study sites (N=175; 51% female). State anxiety scores were quantified via the Spielberger State-Trait Anxiety Inventory, and interoceptive measurements via an inspiratory load detection task. From this task, breathing-related interoceptive dimensions of sensitivity, decision bias, metacognitive bias (confidence in interoceptive decisions), and metacognitive insight (congruency between performance and confidence) were quantified. Regression analyses revealed a significant negative relationship between state anxiety and metacognitive bias (=-0.28; p=0.01) and insight (=-0.09; 95% Highest Density Interval [HDI] in a hierarchical Bayesian regression=[-0.18,-0.004]) across the whole sample, while anxiety did not relate to interoceptive sensitivity nor decision bias. No mean effects of gender were observed for any interoceptive variables, however, the relationship between anxiety and metacognitive insight into breathing perception was driven by women (women: =-0.18; HDI=[-0.31,-0.05]; men: =0.02; HDI=[-0.12,0.15]) with a significant interaction effect ( difference=-0.20; HDI=[-0.37, -0.01]). In summary, anxiety was associated with decreased metacognitive bias across all participants, while decreased interoceptive insight was only associated with anxiety in women but not men. Therefore, treatment programs focusing on interoceptive metacognitive bias may be useful for all anxiety patients, while interoceptive insight might represent a specific treatment target for women with anxiety.

Primulina magnifica F. Wen & W.C. Chou, a new species of Gesneriaceae from the limestone areas of Yizhou District, Hechi City, Guangxi, China, is described and illustrated here. It morphologically resembles P. mollifolia (D.Fang & W.T.Wang), J.M.Li & Yin Z.Wang in leaf blades. Still, it can be easily distinguished from the latter by noting a combination of characteristics, especially in its tube infundibuliform, and obviously broader bracts. We found only one population, about 300 mature individuals, at the type locality. According to the IUCN Red List Categories and Criteria (Version 3.1), the new species is tentatively designated as Critically Endangered (CR).

Urbanization modifies ecosystem conditions and evolutionary processes. This includes air pollution, mostly as tropospheric ozone (O3), which contributes to the decline of urban and peri-urban forests. A notable case are fir(Abies religiosa) forests in the peripheral mountains southwest of Mexico City, which have been severely affected by O3 pollution since the 1970s. Interestingly, some young individuals exhibiting minimal O3—related damage have been observed within a zone of significant O3 exposure. Using this setting as a natural experiment, we compared asymptomatic and symptomatic individuals of similar age (≤15 years old; n = 10) using histological, metabolomic and transcriptomic approaches. Plants were sampled during days of high (170 ppb) and moderate (87 ppb) O3 concentration. Given that there have been reforestation efforts in the region, with plants from different source populations, we first confirmed that all analysed individuals clustered within the local genetic group when compared to a species-wide panel (Admixture analysis with ~1.5K SNPs). We observed thicker epidermis and more collapsed cells in the palisade parenchyma of needles from symptomatic individuals than from their asymptomatic counterparts, with differences increasing with needle age. Furthermore, symptomatic individuals exhibited lower concentrations of various terpenes (ß-pinene, ß-caryophylene oxide, α-caryophylene and ß-α-cubebene) than asymptomatic trees, as evidenced through GC-MS. Finally, transcriptomic analyses revealed differential expression for thirteen genes related to carbohydrate metabolism, plant defense, and gene regulation. Our results indicate a rapid and contrasting phenotypic response among trees, likely influenced by standing genetic variation and/or plastic mechanisms. They open the door to future evolutionary studies for understanding how O3 tolerance develops in urban environments, and how this knowledge could contribute to forest restoration.

Amplicon sequencing is an effective and increasingly applied method for studying viral communities in the environment. Here, we present vAMPirus, a user-friendly, comprehensive, and versatile DNA and RNA virus amplicon sequence analysis program, designed to support investigators in exploring virus amplicon sequencing data and running informed, reproducible analyses. vAMPirus intakes raw virus amplicon libraries and, by default, performs nucleotide- and amino acid-based analyses to produce results such as sequence abundance information, taxonomic classifications, phylogenies, and community diversity metrics. The vAMPirus analytical framework leverages 16 different opensource tools and provides optional approaches that can increase the ratio of biological signal-to-noise and thereby reveal patterns that would have otherwise been masked. Here, we validate the vAMPirus analytical framework and illustrate its implementation as a general virus amplicon sequencing workflow by recapitulating findings from two previously published double-stranded DNA virus datasets. As a case study, we also apply the program to explore the diversity and distribution of a coral reef-associated RNA virus. vAMPirus is streamlined within Nextflow, offering straightforward scalability, standardization, and communication of virus lineage-specific analyses. The vAMPirus framework is designed to be adaptable; community-driven analytical standards will continue to be incorporated as the field advances. vAMPirus supports researchers in revealing patterns of virus diversity and population dynamics in nature, while promoting study reproducibility and comparability.

INTRODUCTIONThe diagnosis of UTUC has always presented challenges due to the limitations of available diagnostic tools. Cytology, CTU, and URS with biopsies can all yield inadequate results, leading to false negatives. To minimize the risk of biased diagnosis, a combination of these examinations is essential. The European Association of Urology (EAU) recommends the use of diagnostic ureteroscopy and biopsy when imaging and cytology alone are insufficient for accurate diagnosis and risk stratification of the tumor (1). Similarly, according to the guidelines provided by the American Urological Association (AUA), patients with suspected UTUC should undergo evaluation using diagnostic ureteroscopy. During this procedure, any identified lesion should be biopsied, and cytologic washing from the inspected upper tract system should be performed (2).Regrettably, despite the recommendations and guidelines in place, UTUC is frequently underestimated during pre-operative diagnosis. This underestimation can have serious consequences, leading to delayed or inadequate treatment and contributing to significant mortality rates.

A document by Maria Memon. Click on the document to view its contents.

Title: Remarkable improvement of symptoms and signs of severe dry eye treated by ocular immersion hydrotherapy Yong Tao*, M.D., Haoran Cui, M.D., Shuang Zhang, M.D., Tao Zhang, M.D.Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, P. R. ChinaCorresponding author: Prof. Yong Tao, Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University; No. 8, South Road of Worker’s Stadium, Chaoyang District, Beijing 100020, China. Phone: +86-10-85231405. Fax: +86-10-85231405. E-mail: [email protected] Words: Dry eye disease; Ocular immersion hydrotherapy; Ocular graft-versus-host disease; Corneal epithelial cell damage; Ocular surface inflammation

Commentary:

Habitat suitability assessment is crucial for the conservation of endangered species in the context of dramatic global climate change. To investigate changes in the distribution pattern of forest musk in China, the present study used the optimized MaxEnt model of the ENMeval language package to simulate changes in potential suitable areas and potential suitable areas for four shared socio-economic pathways of the endangered species, forest musk (Moschus berezovskii), in both the current and the future periods, and the migration trends of the four shared socioeconomic paths in the current and future periods are analyzed. The results showed that: the MaxEnt model reached the optimal solution when RM=3.4 and FC was LQH; the dominant environmental factors for the distribution of Linnaeus musculus in China were annual precipitation, slope, and cold-season average air temperature; the current suitable habitat accounted for 23.02% of the total area of the study area, which was mainly distributed around the Hengduan Mountain Range, the area around the Longmenshan to Daliangshan Mountains, and the Qinling Mountain System; Under the future climate change, the expansion area of the suitable area is larger than the loss area, and the center of mass of the suitable area has a tendency to migrate to the northeast, in which the fluctuation area of the suitable area is smaller under the SSP370 climate scenario. Critical habitat accounts for 20.04% of the current potential suitable area, which is mainly distributed in the mountain range at the junction of Yunnan-Tibet, the junction of the Zhongshan vein and Sichuan Basin, and the Qinling mountain system. This study suggests focusing on the Yarlung Tsangpo Grand Canyon and Tsatsum Tsibagou in Tibet and the fragmented habitat of forest musk in Cangshan Erhai, Yunnan, to improve the information construction and increase the protection efforts.

In fermentation of filamentous fungi, selecting suitable impellers and controlling fungal morphology are crucial for product yield. Previously, we revealed the AGΔ-GAGΔ strain of Aspergillus oryzae, lacking both α-1,3-glucan (AG) and galactosaminogalactan (GAG), showed improved hyphal dispersion, reduced culture viscosity, and increased recombinant protein production. Here, we used computational fluid dynamics (CFD) to explore the importance of impeller selection. High-performance impellers (HS100/HR100) were compared with the conventional flat-blade turbine and flat-blade paddle combination (6FT/4FP). CFD analysis using viscosity data of the wild-type strain showed gas cavities formed behind the 6FT/4FP blades, with flow velocities and shear stresses concentrated around the impellers; in contrast, HS100/HR100 displayed a broader and more evenly spread range of flow velocities and shear stress values. CFD analysis comparing the mixing properties of AGΔ-GAGΔ and wild-type strain cultures agitated by HS100/HR100 demonstrated that slipping occurred at the impeller periphery–wall boundary in the wild-type culture, while AGΔ-GAGΔ exhibited a wide shear stress distribution and reduced gas cavity formation. The simulation results agreed well with measured volumetric oxygen mass transfer coefficient ( KLa) and mixing time. These findings suggest that an appropriate stirring system, combined with the AGΔ-GAGΔ strain, can drastically improve the mixing characteristics in filamentous fungal fermentation.

Purpose: This scoping review contributes to understanding the utilization of end-of-life anticancer drugs in gastrointestinal cancer patients, a topic posing significant public health challenges due to its prevalence, impact on morbidity and mortality, and associated healthcare costs. Insight into unique treatment patterns at the end of life is vital for enhancing the appropriateness of cancer care for these patients. Methods: Extensive searches were conducted in Medline and Embase to locate articles on the use of anticancer drugs in the end-of-life phase of gastrointestinal cancer patients. Results: We identified 30 publications and described treatment frequencies alongside methodological characteristics. On average, 7.0% and 13.2% of patients received anticancer drugs in the last two and four weeks of life, respectively, with 3.3% commencing new anticancer regimens in the final four weeks. Conclusion: This review offers a comprehensive overview of primary studies reporting end-of-life treatments in gastrointestinal cancer patients. However, methodological inconsistencies present significant challenges, highlighting a notable proportion of patients potentially experiencing overtreatment. Therefore, there is a pressing need for more standardized research methods to ensure robust evaluations and enhance the quality of care for these patients.

This study presents a novel framework This study proposes a new framework for evaluating the performance of distribution networks using a comprehensive approach. This method combines Principal Component Analysis (PCA) for extracting key performance indicators, Improved Analytic Hierarchy Process (IAHP) for determining objective weights of these indicators, and CRITIC method for determining subjective weights. Then, aggregate weights are used to calculate the comprehensive performance score of each part of the distribution network. On the premise of reducing computing resources, K-means clustering analysis is applied to classify the status of distribution network projects, providing data reference for project maintenance and repair. Finally, a case study and corresponding analysis of the evaluation results were presented, providing detailed insights into the practical application of the proposed framework. The limitations of current research and future research approaches were also discussed. The results indicate that the designed strategy performs well in terms of accuracy and computational convenience, and has potential application prospects