Acute coronary thrombosis is a known, but rare, contributor to morbidity and mortality in patients with thermal and electrical injuries. The overall incidence of myocardial infarction among burn patients is 1%, with an in-hospital post-infarction mortality of approximately 67%, whereas the overall mortality rate of the general burn patient population is from 1.4% to 18%. As such, early detection and effective peri-operative management are essential to optimize patient outcomes. Here, we report the details of the management of an adult male patient with a 65% total body surface area severe thermal injury, who developed an ST-elevation myocardial infarction (STEMI) in the resuscitation period. The patient was found to have 100% occlusion of his left anterior descending coronary artery, for which prompt coronary artery stent placement with a drug-eluting stent (DES) was performed. Following stent placement, the patient required dual antiplatelet therapy. The ongoing dual antiplatelet therapy required the development of a detailed peri-operative protocol involving pooled platelets, packed red blood cells, desmopressin (DDAVP™) and intraoperative monitoring of the patient’s coagulation parameters with thromboelastography for three staged operative interventions to achieve complete debridement and skin grafting of his burn wounds. Full article

Long-term storage is an important component of insect mass-rearing systems, prolonging the shelf life of biocontrol agents during a low-demand period or a temporary lack of suitable food. Macrolophus pygmaeus is a predatory heteropteran, mass-reared and widely used for the biological control of arthropod pests in greenhouses. With the aim to determine the optimal conditions and acceptable duration of cold storage, we evaluated the impact of different periods of storage of fed and starved third instar nymphs of M. pygmaeus at different temperatures on nymphal survival, adult emergence, and female fecundity. Four storage temperatures (3, 6, 9, and 12 °C) were tested. The longevity of starved nymphs decreased with an increase in the storage temperature, with a maximum of about 40 days at 3 °C, whereas the longest lifetime of nymphs fed on eggs of the grain moth Sitotroga cerealella (about 150 days) was observed at 9 °C. Further experiments demonstrated that the third instar nymphs of M. pygmaeus fed with eggs of the grain moth can be stored at 9 °C for 30 days, with a moderate (10–20%) decrease in survival and fecundity, whereas the survival of starved nymphs decreased by half after 10 days of storage at 3 °C. Full article

Escherichia coli, a member of the commensal intestinal microbiota, is a significant aetiology of urinary tract infections (UTIs) and has a propensity for acquiring multidrug resistance characteristics, such as extended-spectrum beta-lactamases (ESBLs). Despite the increase in the incidence of ESBL-producing E. coli infections in sub-Saharan Africa, routine ESBL detection in Ghana is often absent, and molecular data on ESBL genotypes is scarce. Eleven ESBL-producing E. coli recovered from mid-stream urine samples were subjected to antimicrobial susceptibility testing and whole-genome sequence analyses. All isolates exhibited multidrug resistance, demonstrating phenotypic resistance to third-generation cephalosporins, such as cefotaxime, ceftazidime, and cefpodoxime. Three isolates demonstrated resistance to norfloxacin (a fluoroquinolone), and one isolate demonstrated intermediate resistance to ertapenem (a carbapenem). Analysis of the draft genomes identified multiple antimicrobial resistance genes including ESBL genotypes bla_{TEM-1B/TEM-190} (6/11 and 1/11, respectively), bla_{CTX-M-15/CTX-M-3} (7/11 and 1/11) and bla_{OXA-1/OXA-181} (3/11 and 1/11). The strains belong to 10 different serotypes and 10 different multilocus sequence types. This study provides information on phenotypic resistance in 11 ESBL E. coli from Ghana and AMR genotypes within their genomes. Full article

Background and Objectives: The healthcare system in Saudi Arabia is growing rapidly with the utilization of advanced technologies. Therefore, this study aimed to assess the Saudi public perceptions and opinions towards artificial intelligence (AI) in health care. Materials and Methods: This cross-sectional web-based questionnaire study was conducted between January and April 2024. Data were analyzed from 830 participants. The perceptions of the public towards AI were assessed using 21-item questionnaires. Results: Among the respondents, 69.4% were males and 46% of them were aged above 41 years old. A total of 84.1% of the participants knew about AI, while 61.1% of them believed that AI is a tool that helps healthcare professionals, and 12.5% of them thought that AI may replace the physician, pharmacist, or nurse in the healthcare system. With regard to opinion on the widespread use of AI, 45.8% of the study population believed that healthcare professionals will be improved with the widespread use of artificial intelligence. The mean perception score of AI among males was 38.4 (SD = 6.1) and this was found to be higher than for females at 37.7 (SD = 5.3); however, no significant difference was observed (p = 0.072). Similarly, the mean perception score was higher among young adults aged between 20 and 25 years at 38.9 (SD = 6.1) compared to other age groups, but indicating no significant association between them (p = 0.198). Conclusions: The results showed that the Saudi public had a favorable opinion and perceptions of AI in health care. This suggests that health management recommendations should be made regarding how to successfully integrate and use medical AI while maintaining patient safety. Full article

This paper demonstrates, for the first time, the stability of synthetic diamond as a passive layer within neural implants. Leveraging the exceptional biocompatibility of intrinsic nanocrystalline diamond, a comprehensive review of material aging analysis in the context of in-vivo implants is provided. This work is based on electric impedance monitoring through the formulation of an analytical model that scrutinizes essential parameters such as the deposited metal resistivity, insulation between conductors, changes in electrode geometry, and leakage currents. The evolution of these parameters takes place over an equivalent period of approximately 10 years. The analytical model, focusing on a fractional capacitor, provides nuanced insights into the surface conductivity variation. A comparative study is performed between a classical polymer material (SU8) and synthetic diamond. Samples subjected to dynamic impedance analysis reveal distinctive patterns over time, characterized by their physical degradation. The results highlight the very high stability of diamond, suggesting promise for the electrode’s enduring viability. To support this analysis, microscopic and optical measurements conclude the paper and confirm the high stability of diamond and its strong potential as a material for neural implants with long-life use. Full article

Introduction: With the passage of the Physician Payment Sunshine Act, there has been increased transparency regarding the industrial financial relations that physicians have. Orthopedic surgeons have been highly studied in this domain with approximately 50% of all orthopedic surgeons engaging in industrial financial relationships. Furthermore, an increasing number of orthopedic surgeons are seeking fellowship training with pediatric fellowship programs gaining popularity in recent years. The purpose of this study is to evaluate the impact various pediatric orthopedic fellowship programs have on industry earnings and academic productivity. Methods: Pediatric orthopedic fellowship programs were identified via the Orthopedic Society of North America (POSNA) website. Information on individual fellowship programs was obtained from their respective websites. Academic productivity was measured via an aggregate of all employed physicians’ H-index at a specific fellowship as found on the Scopus website. The Open Payments Database (OPD) website was used to assess lifetime industry earnings. Other variables such as Newsweek or Doximity ranking were taken directly from relevant websites. Statistical analysis was performed using a Kruskal–Wallis test with Bonferroni correction and Mann–Whitney U-test. Results: A total of 43 pediatric orthopedic surgery fellowships in the United States were identified with a total of 392 physicians as fellowship faculty. Complete OPD and H-index information were available for 336 of those physicians (85.7%). On average, there were 7.81 ± 5.18 physicians and 1.56 ± 0.93 fellows per program. The mean combined physician H-index was 117.23 ± 122.51, and the mean combined physician lifetime supplemental earnings in dollars was $646,684.37 ± $1,159,507.17. There was no significant relationship between region of pediatric orthopedic fellowship, Newsweek ranking of affiliated hospital, Doximity ranking of affiliated hospital, presence of MBA program, type of program (public, private, mixed), and the lifetime industry earnings or academic productivity of program graduates. Conclusions: Despite the observed lack of statistical significance, there were clear trends observed with fellowship programs in the northeast and west coast regions being the highest earning and fellowship programs with top 10 Newsweek ranking of affiliated hospital having by far the greatest industry earnings. Sample size limitations likely prevented the detection of statistical significance. Future studies should examine if any relation exists when accounting for type of industry payment received and case volume per fellowship program. Full article

Obese patients with asthma present with aggravated symptoms that are also harder to treat. Here, we used a mouse model of allergic asthma sensitised and challenged to house dust mite (HDM) extracts to determine whether high-fat-diet consumption would exacerbate the key features of allergic airway inflammation. C57BL/6 mice were intranasally sensitised and challenged with HDM extracts over a duration of 3 weeks. The impact of high-fat-diet (HFD) vs. normal diet (ND) chow was studied on HDM-induced lung inflammation and inflammatory cell infiltration as well as cytokine production. HFD-fed mice had greater inflammatory cell infiltration around airways and blood vessels, and an overall more severe degree of inflammation than in the ND-fed mice (semiquantitative blinded evaluation). Quantitative assessment of HDM-associated Th2 responses (numbers of lung CD4⁺ T cells, eosinophils, serum levels of allergen-specific IgE as well as the expression of Th2 cytokines (Il5 and Il13)) did not show significant changes between the HFD and ND groups. Interestingly, the HFD group exhibited a more pronounced neutrophilic infiltration within their lung tissues and an increase in non-Th2 cytokines (Il17, Tnfa, Tgf-b, Il-1b). These findings provide additional evidence that obesity triggered by a high-fat-diet regimen may exacerbate asthma by involving non-Th2 and neutrophilic pathways. Full article

Lipedema and lymphedema are physically similar yet distinct diseases that are commonly misdiagnosed. We previously reported that lipedema and lymphedema are associated with increased risk for venous thromboembolism (VTE). The underlying etiology of the prothrombotic profile observed in lipedema and lymphedema is unclear, but may be related to alterations in platelets. Our objective was to analyze the platelet transcriptome to identify biological pathways that may provide insight into platelet activation and thrombosis. The platelet transcriptome was evaluated in patients with lymphedema and lipedema, then compared to control subjects with obesity. Patients with lipedema were found to have a divergent transcriptome from patients with lymphedema. The platelet transcriptome and impacted biological pathways in lipedema were surprisingly similar to weight-matched comparators, yet different when compared to overweight individuals with a lower body mass index (BMI). Differences in the platelet transcriptome for patients with lipedema and lymphedema were found in biological pathways required for protein synthesis and degradation, as well as metabolism. Key differences in the platelet transcriptome for patients with lipedema compared to BMI-matched subjects involved metabolism and glycosaminoglycan processing. These inherent differences in the platelet transcriptome warrant further investigation, and may contribute to the increased risk of thrombosis in patients with lipedema and lymphedema. Full article

Background/Objectives: Adenomyosis is a benign condition characterized by the presence of endometrial tissue within the myometrium. Despite surgery being a valuable approach, medical options are considered as the first-line approach and have been investigated in the treatment of adenomyosis, although strong evidence in favor of these is still lacking. This study aims to gather all available data and determine the effectiveness of the aforementioned medical options in patients with associated pain and not currently seeking pregnancy, both in comparison to placebo and to one another. Methods: For this study, PubMed and EMBASE were used as data sources, searched up to January 2024. A systematic review and meta-analysis were performed in accordance to guidelines from the Cochrane Collaboration. The primary outcomes investigated were changes in dysmenorrhea, quantified by means of VAS scores, HMB in terms of number of bleeding days, and changes in uterine volume determined at ultrasound. Twelve eligible studies were selected. Results: The results highlighted that dienogest yields a reduction in dysmenorrhea that is significantly superior to that of the rest of the medical treatments investigated (p-value of <0.0002). On the other hand, GnRH agonists seem to play a more prominent role in reducing uterine volume (p-value of 0.003). While it was not possible to determine which medical treatment better decreased the number of bleeding days, it was observed that COC performed significantly worse than the other treatments studied (p-value of 0.02). Conclusions: While this meta-analysis provides valuable insights in the comparative efficacy of different treatments, the paucity of relevant studies on the topic might impact the reliability of some of the conclusions drawn. Full article

Dengue is an endemic disease in tropical countries, mainly in South America, Southwest Asia, and Africa, which, despite having a low lethality rate, can overwhelm health systems. Strengthening the immune system through regular physical activity can be an important tool to prevent contagion, worsening, hospitalizations, and deaths caused by the disease, as seen in the COVID-19 pandemic. Therefore, this point of view aims to analyze the possible association between physical activity and dengue and its repercussions on public health. Comments were made on the main characteristics of dengue as well as on the main vaccines available to date. It was also discussed the impacts of dengue on health systems, in addition to the main repercussions for public health when a very large number of people are infected. It was also commented on the main factors that contribute to the worsening of the clinical stage of dengue, in addition to discussions and reflections on physical activity, strengthening the immune system, and dengue. There are assumptions that regular physical activity can be an important public health strategy to prevent contagion, severity, and hospitalizations caused by dengue and that it needs to be promoted by governments around the world as a tool for preventing and treating not only chronic communicable diseases but also infectious diseases. Full article

This review was written with the aim of examining the effects that cause an insult, such as a wound, to an organ, such as the skin. Before examining the cellular mechanisms relating to wound healing, the reader is invited to read about the structure of the skin as a necessary basis for understanding the final aim of this review. The structure of the skin as a basis for understanding the phenomena relating to wound healing is addressed, taking into account the updated literature that addresses the numerous problems of the skin microenvironment. Starting from this awareness, the paragraphs dedicated to wound healing become complicated when this phenomenon is not implemented and therefore while the problems of chronic wounds, keloids, and hypertrophic scars are addressed, these are pathologies that are still difficult to understand and treat today. Full article

The Modular Multilevel Converter (MMC) is a promising converter for medium-/high voltage applications due to its various features. The waveform quality could be enhanced further by expanding the number of generated voltage levels, which increases the number of submodules (SMs); however, this improvement enlarges the size and cost of the converter, posing a persistent challenge. Hence, there exists a trade-off between power quality and the size and complexity of the converter. To verify the performance of such a complex converter and to validate the effectiveness of the control system, especially in the absence of a physical system, Real-Time (RT) simulation becomes crucial. However, the large number of components of a MMC creates important numerical challenges and computational difficulties in RT simulation. This paper proposes a grid-connected MMC employing a Z Packed U-Cell converter as a SM to generate a higher number of voltage levels while minimizing the required number of SMs. The ZPUC-MMC is implemented on an FPGA-based RT simulation platform using Electric Hardware Solver to reduce computational burden and simulation time, while improving the accuracy of the obtained results. Conventional controllers of MMCs are applied to assess the effectiveness and robustness of the proposed system during steady-state and dynamic operations. Full article

(1) Problem Statement: The development of clustering algorithms for neural recordings has significantly evolved, reaching a mature stage with predominant approaches including partitional, hierarchical, probabilistic, fuzzy logic, density-based, and learning-based clustering. Despite this evolution, there remains a need for innovative clustering algorithms that can efficiently analyze neural spike data, particularly in handling diverse and noise-contaminated neural recordings. (2) Methodology: This paper introduces a novel clustering algorithm named Gershgorin—nonmaximum suppression (G–NMS), which incorporates the principles of the Gershgorin circle theorem, and a deep learning post-processing method known as nonmaximum suppression. The performance of G–NMS was thoroughly evaluated through extensive testing on two publicly available, synthetic neural datasets. The evaluation involved five distinct groups of experiments, totaling eleven individual experiments, to compare G–NMS against six established clustering algorithms. (3) Results: The results highlight the superior performance of G–NMS in three out of five group experiments, achieving high average accuracy with minimal standard deviation (SD). Specifically, in Dataset 1, experiment S1 (various SNRs) recorded an accuracy of 99.94 $\pm$ 0.01, while Dataset 2 showed accuracies of 99.68 $\pm$ 0.15 in experiment E1 (Easy 1) and 99.27 $\pm$ 0.35 in experiment E2 (Easy 2). Despite a slight decrease in average accuracy in the remaining two experiments, D1 (Difficult 1) and D2 (Difficult 2) from Dataset 2, compared to the top-performing clustering algorithms in these categories, G–NMS maintained lower SD, indicating consistent performance. Additionally, G–NMS demonstrated robustness and efficiency across various noise-contaminated neural recordings, ranging from low to high signal-to-noise ratios. (4) Conclusions: G–NMS’s integration of deep learning techniques and eigenvalue inclusion theorems has proven highly effective, marking a significant advancement in the clustering domain. Its superior performance, characterized by high accuracy and low variability, opens new avenues for the development of high-performing clustering algorithms, contributing significantly to the body of research in this field. Full article

A fitness landscape analysis of the loss surfaces produced by product unit neural networks is performed in order to gain a better understanding of the impact of product units on the characteristics of the loss surfaces. The loss surface characteristics of product unit neural networks are then compared to the characteristics of loss surfaces produced by neural networks that make use of summation units. The failure of certain optimization algorithms in training product neural networks is explained through trends observed between loss surface characteristics and optimization algorithm performance. The paper shows that the loss surfaces of product unit neural networks have extremely large gradients with many deep ravines and valleys, which explains why gradient-based optimization algorithms fail at training these neural networks. Full article

The replication of species A rotaviruses (RVAs) involves the recruitment of and interaction with cellular organelles’ lipid droplets (LDs), both physically and functionally. The inhibition of enzymes involved in the cellular fatty acid biosynthesis pathway or the inhibition of cellular lipases that degrade LDs was found to reduce the functions of ‘viral factories’ (viroplasms for rotaviruses or replication compartments of other RNA viruses) and decrease the production of infectious progeny viruses. While many other RNA viruses utilize cellular lipids for their replication, their detailed analysis is far beyond this review; only a few annotations are made relating to hepatitis C virus (HCV), enteroviruses, SARS-CoV-2, and HIV-1. Full article

This essay examines a little-known but important installation entitled Insure the Life of an Ant, conceived by artist Mike Malloy and displayed at the O.K. Harris Gallery in New York in April of 1972. This provocative and idiosyncratic piece confronted gallery-goers, who became viewer–participants, with the option of killing or saving a live ant displayed like a sculpture on a pedestal, either by pushing a button or not. The artist made the piece, which can function almost like a psychology experiment, to engender a “moral dilemma”. I explore the particular role of affect in a participatory art installation, distinct from response to inanimate art. I investigate the roles of emotion and reason in dealing with the work; whether ratiocination can be considered an “anti-affect”; and how the tension between competing thoughts and feelings helped create a psychological drama. The essay looks at how an art space can operate as a zone of moral exceptionalism to encourage questionable actions. It also locates the piece in relation to the emergence of a more behaviorist art in the early 1970s, as discussed by critic Gregory Battcock, and the larger notion of postmodernism. Other contexts investigated include art and animal rights and issues of sentience and speciesism; social and military violence, including capital punishment and the Vietnam War; the 1961 Milgram experiment; Hannah Arendt’s concept of the “banality of evil” as a Nazi war criminal defense; and other works of art involving maltreatment or violence toward both human and non-human animals, including those by Marina Abramović, Marco Evaristti, and Edward and Nancy Reddin Kienholz. Full article

The mouse Harderian gland (HG) is a secretory gland that covers the posterior portion of the eyeball, opening at the base of the nictitating membrane. The HG serves to protect the eye surface from infection with its secretions. Mice open their eyelids at about 2 weeks of age, and the development of the HG primordium mechanically opens the eye by pushing the eyeball from its rear. Therefore, when HG formation is disturbed, the eye exhibits enophthalmos (the slit-eye phenotype), and a line of Fgf10^+/− heterozygous loss-of-function mice exhibits slit-eye due to the HG atrophy. However, it has not been clarified how and when HGs degenerate and atrophy in Fgf10^+/− mice. In this study, we observed the HGs in embryonic (E13.5 to E19), postnatal (P0.5 to P18) and 74-week-old Fgf10^+/− mice. We found that more than half of the Fgf10^+/− mice had markedly degenerated HGs, often unilaterally. The degenerated HG tissue had a melanized appearance and was replaced by connective tissue, which was observed by P10. The development of HGs was delayed or disrupted in the similar proportion of Fgf10^+/− embryos, as revealed via histology and the loss of HG-marker expression. In situ hybridization showed Fgf10 expression was observed in the Harderian mesenchyme in wild-type as well as in the HG-lacking heterozygote at E19. These results show that the Fgf10 haploinsufficiency causes delayed or defective HG development, often unilaterally from the unexpectedly early neonatal period. Full article

The International System of Units (SI), the current form of the metric system and the world’s most used system of units, has been continuously updated and refined since the Metre Convention of 1875 to ensure that it remains up to date with the latest scientific and technological advances. The General Conference on Weights and Measures, at its 26th meeting in 2018, decided to adopt stipulated values of seven physical constants linked to seven measurement units (the second, meter, kilogram, ampere, kelvin, mole, and candela). This paper reviews the technologies developed, in intense and long-standing work, to determine the Avogadro and Planck constants, which are now integral to realising the kilogram. Full article

Patients with long COVID syndrome present with various symptoms affecting multiple organs. Vaccination before or after SARS-CoV-2 infection appears to reduce the incidence of long COVID or at least limit symptom deterioration. However, the impact of vaccination on the severity and extent of multi-organ long COVID symptoms and the relationship between the circulating anti-spike protein antibody levels and the severity and extent of multi-organ symptoms are unclear. This prospective cohort study included 198 patients with previous PCR-verified SARS-CoV-2 infection who met the criteria for long COVID syndrome. Patients were divided into vaccinated (n = 138, 69.7%) or unvaccinated (n = 60, 30.3%) groups. Anti-spike protein antibody levels were determined at initial clinical presentation and compared between the groups. Long COVID symptoms were quantified on the basis of the number of affected organs: Class I (mild) with symptoms in three organs, Class II (moderate) with symptoms in four to five organs, and Class III (severe) with symptoms in six or more organ systems. Associations between time to infection and vaccination with anti-spike protein antibody levels were assessed. The anti-spike protein antibody levels were 1925 ± 938 vs. 481 ± 768 BAU/mL (p < 0.001) in the vaccinated vs. unvaccinated patients. The circulating anti-spike antibody cutoff of 665.5 BAU/mL allowed us to differentiate the vaccinated from the unvaccinated patients. Vaccinated patients had fewer class II and class III multi-organ symptoms (Class II 39.9% vs. 45.0%; Class III 10.1% vs. 23.3%, p-value 0.014). Anti-spike antibody level correlated negatively with multi-organ symptom classes (p = 0.016; 95% CI −1.229 to −0.126). Anti-spike antibody levels in unvaccinated patients declined markedly with time, in contrast to the persistence of high anti-spike antibody levels in the vaccinated patients. Multi-organ symptoms were lower in vaccinated long-COVID patients, especially in those with higher anti-spike antibody levels (≥665.5 BAU/mL). Classifying the symptoms on the basis of the number of affected organs enables a more objective symptom quantification. Full article

Rett syndrome (RTT) is a rare neurodevelopmental disorder caused by mutation in the X-linked gene methyl-CpG-binding protein 2 (Mecp2), a ubiquitously expressed transcriptional regulator. RTT results in mental retardation and developmental regression that affects approximately 1 in 10,000 females. Currently, there is no curative treatment for RTT. Thus, it is crucial to develop new therapeutic approaches for children suffering from RTT. Several studies suggested that RTT is linked with defects in cholesterol homeostasis, but for the first time, therapeutic evaluation is carried out by modulating this pathway. Moreover, AAV-based CYP46A1 overexpression, the enzyme involved in cholesterol pathway, has been demonstrated to be efficient in several neurodegenerative diseases. Based on these data, we strongly believe that CYP46A1 could be a relevant therapeutic target for RTT. Herein, we evaluated the effects of intravenous AAVPHP.eB-hCYP46A1-HA delivery in male and female Mecp2-deficient mice. The applied AAVPHP.eB-hCYP46A1 transduced essential neurons of the central nervous system (CNS). CYP46A1 overexpression alleviates behavioral alterations in both male and female Mecp2 knockout mice and extends the lifespan in Mecp2-deficient males. Several parameters related to cholesterol pathway are improved and correction of mitochondrial activity is demonstrated in treated mice, which highlighted the clear therapeutic benefit of CYP46A1 through the neuroprotection effect. IV delivery of AAVPHP.eB-CYP46A1 is perfectly well tolerated with no inflammation observed in the CNS of the treated mice. Altogether, our results strongly suggest that CYP46A1 is a relevant target and overexpression could alleviate the phenotype of Rett patients. Full article

The present study deals with the reuse of agro-industrial waste with a specific focus on biochar (processed plant biomass or biochar) consisting of organic and inorganic waste biomass subjected to thermochemical processes. The objective of this work is to carry out a systematic review of the literature according to the Methodi Ordinatio methodology and select a bibliographic portfolio of high relevance to this study that makes it possible to present the concepts, applications and interest on the part of companies in including biochar in their processes, as well as addressing the environmental impacts linked to incorrect waste disposal. In this sense, biochar presents an interesting potential solution from both a waste management and environmental point of view. The current challenge is studies that prove economic viability. Full article