Dilemma of seronegative lupus nephritis: A case report of diffuse proliferative glomerulonephritis with thrombotic microangiopathyYuxuan Wu1, Qiaoyu Wang1, Haiyan Zhang2, Jianhua Qin1*, Weihua Wu1*1Department of Nephrology,Affiliated Hospital of Southwest Medical University; Sichuan Clinical Research Center for Nephropathy; Metabolic Vascular Disease Key Laboratory, Luzhou, Sichuan, China

Case ReportChairside and Labside CAD/CAM Workflow for Esthetic and Functional Smile Design RehabilitationDragoș Andrei Adam 1, Andrei B. Faur1,2, and Anca Jivănescu 1,21 Department of Prosthodontics, University of Medicine and Pharmacy “Victor Babes”, B-dul Revolutiei 1989, No. 9, 300580 Timisoara, Romania; adam.deagos@umft.ro (D.A.); andrei.faur@umft.ro (A.B.F.); jivanescu.anca@umft.ro (A.J.)2 TADERP Research Center, Department of Prosthodontics, University of Medicine and Pharmacy “Victor Babes”, B-dul Revolutiei 1989, No. 9, 300580 Timisoara, Romania* Correspondence: adam.dragos.andrei@gmail.com; Tel.: +40-744765857Abstract: Esthetic restorations that mimic the patient’s individual naturalness must be shaped and guided by the patient’s complex facial features and physiognomy. CAD/CAM protocols allow us to communicate treatment options with the patient, enabling us to understand the patient’s aesthetic preferences and to convey to the dental technician a viable, functional, physiognomic, and yet patient-accepted treatment option.This case report presents a case of aesthetic frontal rehabilitation based on a fully digital workflow on a young female patient with Kennedy class IV frontal edentulousness. The workflow consisted in a digital smile design protocol, 3D-printed diagnostic wax-up, multiple 3D-printed provisional restorations and a CAD/CAM zirconia fixed dental prostheses.Complex cases of frontal rehabilitation can be functional and aesthetically solved using digital methods and predictable CAD/CAM protocols, by establishing a good communication of the whole team, accurately and thoroughly transmitting all the details related to the aesthetics and natural anatomy of the patient and performing several stages of provisional treatment before the final restoration.Keywords: CAD/CAM, zirconia fixed dental prostheses, 3D-printed provisional restorations, 3D-printed diagnostic wax-up, frontal rehabilitation, digital workflow.1. IntroductionA person s smile is influenced by the size, shape, and color of the teeth, the position, texture, color and lines of the lips and gingiva, as well as the shape of the jaws. The most appealing, fulfilling, and fascinating component of dentistry is creating aesthetically pleasing smile design [1,2]Fulfill the patient’s expectation is a key goal of the aesthetic treatments, and the result be improving the appearance of his or her face and smile. By achieving a simulation and previsualization of the outcome of the suggested therapy, Digital Smile Design (DSD) is a digital tool that aids in the creation and projection of the new smile. A digital mockup of the patient’s new smile is created and presented to them before the actual treatment process begins. This allows for careful examination of the patient’s facial and dental characteristics that play a crucial role in determining the treatment plan [3–5].The development of simplified and predictable protocols in the field of restorative dentistry has been made possible by the advancement of digital technology in dentistry. CAD software can be used to create the temporary and permanent prosthesis as well as the master die model, which can then be produced using 3D printing or milling.Additive procedures have recently been used in restorative dentistry in order to give the dental professional more restorative alternatives. As printing methods are becoming more accurate, the doctor can use digital design (CAD) to create initial diagnostic models, full removable dentures, surgical guides, and temporary restorations. Due to its reproducibility, low cost, and speed of treatment, utilizing a three-dimensional (3D) printed coping to assess the marginal adaptation of the final prosthetic restoration is a solid option. Fixed dental prosthesis using printed materials and techniques may become quite popular in the near future [6,7].Zirconia was initially employed in dentistry at the beginning of the 1990s and has since become widely accessible through the use of CAD/CAM technology. According to recent surveys, dentists frequently propose ceramics, particularly lithium disilicate and zirconia, for both front and back single crowns [8].In the present dental industry, there are several different zirconia materials, and the level of yttrium oxide significantly affects the mechanical and optical capabilities of the restoration. High biological stability and biocompatibility, as well as excellent mechanical qualities, are all characteristics of zirconia. The main drawback of this material is its opacity, which makes it less aesthetically pleasing than other ceramic materials, but can be overcome by stabilizing it with yttrium. While zirconia with 3 mol% yttrium oxide (3 Y-TZP) exhibit high flexural strength, it is not the same for case zirconia with 5 mol% yttrium oxide (5 Y-TZP). Although it is not advised to fabricate fixed dental prostheses larger than three units from 5 Y-TZP, greater translucency may also result in superior aesthetics [9–12].This case report presents a smile design rehabilitation for a young female patient with Kennedy class IV frontal edentulousness, based on a fully digital workflow. The workflow consisted in a digital smile design protocol, 3D-printed diagnostic wax-up, multiple 3D-printed provisional restorations and a CAD/CAM zirconia fixed dental prostheses, in order to restore the smile design considering the facial characteristics, in an accurate and predictable way.2. Case PresentationThe patient was a 26-year-old Asian woman who came to the Department of Prosthodontics Clinic at the University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania, in February 2023, with a chief complaint regarding her old prosthetic. The patient presented a Kennedy class IV frontal edentulousness, restored with an eleven years old removable partial denture (Figure 1).

Background: Indian Kathiawari horses are well-known as an endurance breed in the Indian subcontinent, yet not much research has been undertaken on their exercise physiology. An evaluation of the exercise physiology of Kathiawari horses could significantly contribute to the further development of the breed and for the improvement of its healthcare. Objectives: This study aimed to investigate the changes in cardiac biomarkers and echocardiographic indices before and after exercise in Indian Kathiawari horses. Methods: Eighteen working Kathiawari horses age ranging from 2 years to 12 years, consisting of 8 mares and 10 stallions were selected for this study. Horses were subjected to exercise for a period of ± 40 mins. Serum samples were collected before and after exercise for evaluation of changes in cardiac biomarkers concentration. Electrocardiographic and echocardiographic evaluations were also done for same horses before and after exercise. Results: CTnI, CTnT, CK-MB and NT-proBNP after exercise showed highly significant increase when compared to before exercise. Significant increase in left ventricular dimensions and systolic function such as LVIDd, LVIDs, EDV, ESV, SV, Ao, LA, EF and FS after exercise when compared to before exercise. Post exercise doppler echocardiographic showed increase in number of aortic regurgitation compared to pre exercise. Significant changes were seen in P and T wave morphology and significant decrease in the duration of P wave, P-Q interval, QT interval and R-R intervals immediately after the exercise. Significant elevation was noticed in P wave amplitude immediately after the exercise. Conclusion: In Indian Kathiawari horses the concentration of cardiac biomarkers are increased after 3 hour of exercise. Increased left ventricular dimensions and systolic function was observed in horses after exercise. This study contributes to establishing the reference ranges of cardiac biomarkers in Kathiawari horses after exercise.

Understanding community assembly of living organisms has been a prominent ecological question since the early days of the discipline. The impact of habitat filtering and limiting similarity on plant community structures is well-known, as both processes are influenced by individual responses to environmental changes. However, identifying and quantifying potential abiotic and biotic factors that ultimately influence community structures at a fine scale remains a challenge. Here, we employed different species pool null models to assess the importance of habitat filtering and limiting similarity at two spatial scales. We used 63 natural vegetation plots, each measuring 5m x 5m, with 3 nested subplots measuring 1m x 1m, from the 2021 field survey, to examine the alpha diversity of plots and subplots as well as Beta diversity. We also used linear mixed-effects models (LMEs) to assess how environmental factors affect the assembly process. Our findings indicate that habitat filtering was the dominant assembly process at both the plot and subplot levels, while limiting similarity was stronger at the subplot level. Plot-level limiting similarity was positively correlated with fine-scale partitioning, suggesting that trait divergence resulted from a combination of limiting similarity species and spatial partitioning. Our results also suggest that the assembly process varies more strongly along the mean annual temperature (MAT) gradient than the mean annual precipitation (MAP). Additionally, the community assembly process of different traits varied with these environmental factors, indicating the importance of multi-dimensional traits. This study provides a valuable example of non-random assembly rules from spatial scale and environmental factors in grassland communities in the loess hilly region. These results highlight the essential role of additional constraints with spatial scales and environmental factors for understanding the process of grassland community assembly.

The fertile Anatolian lands in Turkey, supporting about 80 million people, rely on abundant water resources. The Kızılırmak River basin in Anatolia is vulnerable to global warming, mainly due to snowmelt in its headwaters. Quantifying the upper watershed’s climate sensitivity is crucial for assessing water availability. Instead of using Global Climate Model (GCM)-driven projections, a sensitivity-based approach was employed with the Variable Infiltration Capacity (VIC) hydrologic model to assess the region’s hydrological vulnerability to potential future climatic changes. Considering the consistent projections of increasing temperature (T) over this region in GCMs, the system was perturbed to examine gradients of a more challenging climate, characterized by warming and drying conditions. The sensitivity of streamflow, snowpack water equivalence, and evapotranspiration to T and Precipitation (P) variations under each perturbation or “reference” climates was quantified. Results indicate that streamflow responds to T negatively under all warming scenarios. Streamflow responding to P increases nonlinearly as P decreases in the reference climates. These results suggest that there will be heightened difficulty in managing water resources in the region if it undergoes both warming and drying due to the following setbacks: 1) water availability will shift away from the summer season of peak water demand due to the warming effects on the snowpack, 2) annual water availability will likely decrease due to a combination of warming and lower precipitation, and 3) streamflow sensitivity to hydroclimatic variability will increase, meaning that water managers will likely need to plan for a system that is more sensitive to weather variations.

The present study deals with the role of pre-disposing environmental factors in agricultural land conversion. A quantitative research design with structured questionnaire was adopted to gather information from a sample of 375 households through simple random sampling technique. Further the data was analyzed in terms of descriptive and inferential statistics through SPSS. At descriptive analysis simple frequencies and percentages distributions was carried out, where at bivariate and multivariate analysis Chi-square and Tau-c is a directional test was adopted to found the association between the study variables. The results disclosed that due to low agricultural productivity farmers enforce to convert their land for other purpose (P = 0.000; T c = 0.259), growth in population creates immense pressure on land conversion (P = 0.000; T c = 0.091), growth in population creates immense pressure on land conversion (P = 0.000; T c = 0.091), infertility of agricultural land is responsible for low productivity (P = 0.000; T c = 0.140) with relation to agricultural land conversion. Additionally, at multivariate analysis the association between free-disposing environmental factors and agricultural land conversion while controlling gender of the respondents was found highly significant (P = 0.000) and positive (T c = 0.292). Lastly, the association between free-disposing environmental factors with agricultural land conversion while controlling gender of the respondent was found significant (P = 0.000) and positive (T c = 0.292). Implementation of agricultural land policies and laws in their true spirit, empowerment and equipping agricultural staff, community empowerment and involvement in agricultural land governance, government interventions in land policies is needed to preserve agricultural lands, a strong system of monitoring and apprehension and punishment of illegitimate practices were some of the recommendations in light of the study.

Maximizing the recombinant protein yield necessitates optimizing the production medium. This can be done using a variety of methods, including the conventional “one-factor-at-a-time” approach and more recent statistical and mathematical methods like the artificial neural network ANN (artificial neural network), GA (genetic algorithm), etc. Every approach has advantages and disadvantages of its own, yet even when a technique has flaws, it is nevertheless used to get the best results. Here, one categorical variable and four numerical parameters including post-induction time, inducer concentration, post-induction temperature, and cell density of induction time were optimized using the 232 experimental assays of the CCD (central composite design). The direct and indirect effects of factors on the yield of anti-EpEx (anti-EpCAM extracellular domain) fragment antibody were examined using statistical methods. Induction at the cell density of 0.7 and an IPTG (Isopropyl β-D-1-thiogalactopyranoside) concentration of 0.6 mM for 32 hours at 30 °C in BW25113 was the ideal culture condition leading to the protein yield of 259.51 mg/L. Under the optimum condition, the output values predicted by the ANN model (259.83 mg/L) was more in line with the experimental data (259.51 mg/L) than the RSM (response surface methodology) (276.13 mg/L) expected value. This outcome demonstrated that the ANN model outperforms the RSM in terms of prediction accuracy.

Background: Sanghuangporus vaninii has antioxidant, anti-inflammatory, anti-tumor and other effects. However, the antitumor effects and mechanisms of S.vaninii gainst pancreatic cancer remain unclear. Methods: The antitumor activity of compounds isolated from S. vaninii was evaluated, and cell function experiments, such as wound healing, transwell and 3D culture assays, were conducted after the target cancer species was determined. Transcriptome analysis, Micro-Scale Thermophoresis and western blot were used to verify the targets and signaling pathways. Results: 13 compounds were isolated and identified from S.vanini. Among them, compound 1, the phenylpentane derivative compound, has the strongest inhibitory activity on the pancreatic cancer cells. In vitro, compound 1 inhibited the proliferation, migration, invasion, tube formation and colony formation of PANC-1 cells in a dose-dependent manner. Through transcriptome analysis, the signaling pathways compound 1 targeted were identified as MAPK/PI3K and HIPPO pathways. Western blot and immunofluorescence assay also showed that compound 1 can inhibit the EMT through inactivated HIPPO signaling pathway. By molecular docking and MST assay, we confirmed that compound 1 interacted with EGFR by binding with LYS745/PHE856 of EGFR. After knocking down EGFR, the effect of compound 1 on downstream signaling pathways was weakened, and the functions such as migration and invasion of cancer cells were also decreased. Conclusion: Compound 1, the phenylpentane derivative isolated from S. vaninii, inhibited the malignant process and EMT in PANC-1 cells via MAPK/PI3K and HIPPO signaling pathways by targeting EGFR. These data indicated that compound 1 might be a potential drug candidate for pancreatic cancer treatment.

Human respiratory syncytial virus (RSV) is a common cause of respiratory infections in infants, young children, and elderly people. However, there are no effective treatments or vaccines available in most countries. In this study, we explored the anti-RSV potential of 2, 4-Di-tert-butylphenol (2, 4-DTBP), a compound derived from Houttuynia cordata Thunb. To overcome the poor solubility of 2, 4-DTBP, we encapsulated it in polymeric micelles and delivered it by inhalation. We found that 2, 4-DTBP-loaded micelles inhibited RSV infection in vitro and improved survival, lung pathology, and viral clearance in RSV-infected mice. Our results suggest that 2, 4-DTBP-loaded micelles are a promising novel therapeutic agent for RSV infection and that micellar delivery can enhance the efficacy of lipophilic drugs.

Abstract Objective: To examine the validity and reliability of the Birth Satisfaction Scale – Revised Indicator (BSS-RI) and to adapt it to Hausa language. Design: Cross-sectional research design Setting: Murtala Muhammad Specialist Hospital, Kano, Nigeria Population or Sample: The population of the study were women at postnatal wards of Murtala Muhammad Specialist Hospital. Methods: The sample size was 422 respondents, selected using a simple random sampling technique. The BSS-RI, comprising 6 items, was translated into Hausa and validated. Data were analyzed using SPSS version 25. Results: The study revealed that the Hausa version of the BSS-RI had good face and content validity, with a content validity index (CVI) of 1.0. Construct validity was established through exploratory factor analysis, revealing a 2-factor structure, explaining 51.40% of total variance. The Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO) was calculated to be 0.683. Convergent validity was demonstrated by a strong, positive correlation (r = 0.901, p = .005). Divergent validity was demonstrated by the very weak positive correlation (r = 0.059, p = .725). The internal consistency reliability of the Hausa BSS-RI was high, with a Cronbach’s Alpha value of 0.763. Conclusions: The study established that the Hausa version of the BSS-RI is a valid and reliable tool for measuring birth satisfaction among postpartum women in Kano, Nigeria. This instrument can contribute to improving maternal care and ultimately reduce maternal mortality in low- and middle-income settings like Nigeria. Keywords: Birth Satisfaction Scale-Revised Indicator, BSS-RI, intrapartum care, psychometric properties, validity, reliability, Nigeria.

Title: Continuous wound infiltration can become one effective choice to control postoperative pain: a response to F.S. Xue et. al.List of authors: Mayu Kuriyama, MD1); Hirotaka Nakamura, MD1); Serabi Tanabe, PhD2); Yoshihiko Morikawa, MD3); Tetsuji Kaneko, MD3)

Background The introduction of multiple avian influenza virus (AIV) subtypes into Nigeria has resulted in several poultry outbreaks purportedly linked to trade and wild birds. The role of wild birds in perpetuating AIV in Nigeria was, therefore, elucidated. Methods A cross-sectional study was conducted among wild aquatic bird species at the Hadejia-Nguru wetlands in northeastern Nigeria between March and April 2022. A total of 452 swabs (226 cloacae and 226 oropharyngeal swabs) were collected using a mist net to capture the birds. These samples were tested by RT-qPCR, followed by sequencing. Results Highly pathogenic AIV of the H5N1 subtype was identified in clinically healthy wild bird species, namely African jacana, ruff, spur-winged goose, squared-tailed nightjar, white-faced whistling ducks, and white stork. A prevalence of 11.1% (25/226) was recorded. Phylogenetic analysis of the complete HA gene segment indicated the presence of clade 2.3.4.4b. However, these H5N1 viruses characterized from these wild birds cluster separately from the H5N1 viruses characterized in Nigerian poultry since early 2021. Specifically, the viruses form two distinct genetic groups both linked with the Eurasian H5N1 gene pool but likely resulting from two distinct introductions of the virus in the region. Whole genome characterization of the viruses reveals the presence of the mammalian adaptive marker E627K in two Afro-tropical resident aquatic ducks. This has zoonotic potential. Conclusion Our findings highlight the key role of surveillance in wild birds to monitor the diversity of viruses in this area, provide the foundations of epidemiological understanding, and facilitate risk assessment.

Infection with influenza A virus (IAV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses a significant risk to human life, health, and the global economy. Vaccination is one of the most effective strategies in the fight against infectious viruses. In this study, we, for the first time, have evaluated the immunogenicity and protective effect of an influenza/SARS-CoV-2 Omicron subunit combined vaccine adjuvanted with MF59 and administered to BALB/c mice. Results showed that the combined vaccine induced high levels of IgG, IgG 1, and IgG 2a antibodies, as well as influenza A H1N1/California/2009 virus-specific hemagglutination-inhibiting antibodies in BALB/c mice. Moreover, this subunit combined vaccine induced high titers of neutralization antibodies against SARS-CoV-2 Omicron BA.5 pseudovirus and effectively reduced the viral load of authentic SARS-CoV-2 Omicron BA.5.2 variant in the cell culture supernatants. These results suggested that this subunit combined vaccine achieved protective effect against both H1N1 A/California/07/2009 strain and SARS-CoV-2 Omicron BA.5.2 variant. It is therefore expected that this study will establish the scientific foundation for the next-step development of combined vaccines against other strains or variants of IAV and SARS-CoV-2.

Sentiment analysis plays an essential role in identifying user preferences for recommender system. However, existing recommendation systems mainly focus on the relationships between items and the user’s purchasing behavior while ignoring the user’s sentiment information. To improve the accuracy of recommender system, in this paper, a multi-feature fusion recommendation model based on sentiment analysis (MFF-SA) is proposed. Firstly, rather than sentiment values, sentiment vectors are obtained by a new quantify sentiment method that based on natural language processing, which to gain more valuable insights about uses’ preferences. Secondly, to explicitly model the features interactions, a multi-head self-attention mechanism is introduced, which can capture multiple different aspects of the feature relationship simultaneously. Finally, experimental results on three datasets demonstrate that the proposed methods outperform the state-of-the-art methods in terms of effectiveness and feasibility with a 3.9% relative improvement.

Objectives. To investigate the accuracy of intraoperative frozen section (FS) diagnosis for predicting the permanent section (PS) diagnosis of mucinous ovarian tumors and evaluate the factors affecting the diagnostic discordance. Methods. This retrospective cohort study was performed in Tianjin Medical University General Hospital. All women who underwent mucinous ovarian tumor (MOT) surgery with FS between January 2011 and December 2022 were identified. Clinical and pathologic data were extracted. Results. A total of 180 women were included, of which 141 (78.33%) had diagnostic concordance between FS and PS, yielding a sensitivity of 83.43% and a positive predictive value (PPV) of 92.76%. Under-diagnosis and over-diagnosis occurred in 28 cases (15.56%) and 11 cases (6.11%). Tumor size > 13cm (OR 3.79, 95% CI 1.12-12.73) was an independent risk factor for under-diagnosis, and tumor size ≤ 13cm (OR 16.78, 95% CI 0.01-0.49), laparoscopic surgery (OR 0.14, 95% CI 0.02-0.92), the combination of other tumor components (including serous, Brenner tumor, and chocolate cyst; OR 7.00, 95% CI 1.19-41.12) were independently associated with over-diagnosis. The Kaplan-Meier survival curves and the log-rank test showed no significant difference between misdiagnosed and accurately diagnosed patients (all P > 0.05). Conclusion. Intraoperative frozen pathology of MOT is problematic for under- and overdiagnosis. The incorrect diagnosis of FS was related to determining the extent of surgery but had no impact on the patients’ long-term recurrence and survival outcomes. Surgeons need to obtain material accurately and enhance communication with pathologists during the operation to improve the accuracy of FS diagnosis.

Background. Non-invasive prenatal testing (NIPT) analyses the cell-free fetal DNA (cffDNA) present in maternal plasma. It is used for the screening of autosomal trisomies and sex chromosome aneuploidies (SCAs). Objectives. Compare the positive predictive value (PPV) of a high-risk cffDNA test result for SCAs (Monosomy X, 47,XXX, 47,XXY and 47,XYY) and autosomal trisomies (T21, T18 and T13) with confirmatory diagnostic tests in singleton pregnancies. Identify the main reason for discordant and inconclusive results. Search strategy. PubMed, Web of Science and Scopus from 2017. Selection criteria. Primary research articles on cffDNA testing of autosomal trisomies and SCAs in singleton pregnancies. Data collection and analysis. The methodological characteristics of the studies and the statistical results of each aneuploidy were collected. The risk of bias was assessed using the CASP tool. Main results. A total of 14 studies were included. Amongst the autosomal trisomies, T21 had the highest PPVs, whereas T13 showed the lowest PPVs. As for the SCAs, the lowest PPVs were found with Monosomy X. Although discordant and inconclusive results were not rigorously reported, mosaicism was the main cause of false positives and an insufficient cffDNA fraction was the main reason for inconclusive results. Conclusions. CffDNA is a reliable screening tool for the common autosomal trisomies, and it is also useful for prenatal screening of SCAs, although the PPVs are lower. A positive NIPT result should be followed with a confirmatory test. Funding. The review was carried out with no funding. Keywords. Cell-free fetal DNA, non-invasive prenatal testing, aneuploidy, trisomy.

Aim: To develop evidence-based clinical algorithms for the assessment and management of spontaneous, uncomplicated labour and vaginal birth. Population: Pregnant women at any stage of labour, with singleton, term pregnancies considered to be at low risk of developing complications. Setting: Health facilities in low- and middle-income countries. Search Strategy: We searched for relevant published algorithms, guidelines, systematic reviews and primary research studies on Cochrane Library, PubMed, and Google on terms related to spontaneous, uncomplicated labour and childbirth up to 01 June 2023. Case scenarios: Three case scenarios were developed to cover assessments and management for spontaneous, uncomplicated first, second and third stage of labour. The algorithms provide pathways for definition, assessments, diagnosis, and links to other algorithms in this series for management of complications. Conclusions: We have developed three clinical algorithms to support evidence-based decision making during spontaneous, uncomplicated labour and vaginal birth. These algorithms might help guide health care staff to institute respectful care, appropriate interventions where needed, and potentially reduce the unnecessary use of interventions during labour and childbirth.

Aim: Since the efficacy of some tricyclic antidepressants (TCAs) in reducing pain has been reported, several studies have evaluated the analgesic potency of other drugs in this category. This study aims to accumulate all the data evaluating the efficacy of nortriptyline in reducing pain. Methods: In accordance with the PRISMA guideline, clinical trials were imported from PubMed, Web of Science, and Scopus (until February 2023). Screening stages (based on pre-defined eligibility criteria) and data extraction were conducted by two independent researchers. Random- and fixed-effect meta-analysis was performed to pool the data. Publication bias and study heterogeneity were assessed. The Cochrane Collaboration tool was utilized to determine the risk of bias, and the certainty of outcomes was evaluated by the Grade criteria. Results: Of the initial 648 studies, 14 were finally imported. Except for one study, all other studies reported that nortriptyline significantly reduces various types of pain. The pooled standardized mean difference (95% CI) of reducing pain score as pre- and post-treatment, compared with placebo, and compared with other alternative analgesics were -1.20 [-1.48, -0.93], 0.43 [0.23, 0.64], and -0.18 [-0.39, 0.03], respectively. While the most reported side effects were dry mouth and constipation, all studies reported that side effects were not serious and were well tolerated. Outcomes for the effectiveness of nortriptyline and its tolerability got high certainties. Some studies reported the equality of nortriptyline with amitriptyline and gabapentin in terms of their analgesic effects. Conclusion: Using nortriptyline as an analgesic is effective while being safe and well-tolerated.

Background: Crimean-Congo hemorrhagic fever (CCHF) is a severe viral illness with high mortality rates. Nosocomial transmission poses a significant risk to healthcare workers (HCWs). Materials/methods: In this study, we evaluated the effectiveness of ribavirin in post-exposure prophylaxis (PEP) among HCWs with high-risk contacts. Exposures are grouped into 3 categories. The high-risk group consisted of HCWs who were directly exposed to blood or bodily fluids. We also included HCWs who participated in CPR without wearing appropriate PPE to the high-risk group. The moderate-risk group consisted of HCWs without a visible exposure to blood or bodily fluids but handled patient without appropriate PPE. Results: At least 38 HCWs had contact with the index fatal patient. None of the HCWs who had contact with the patient had appropriate PPE. Patient’s PCR and IgM were positive for CCHF. Among all known contacts, all HCWs in high and moderate risk groups (n:24) received PEP with ribavirin. No moderate or severe side effects were observed due to ribavirin. None of the HCWs developed nosocomial CCHF. Conclusions: There are still life-threatening gaps in the compliance of the HCWs to standard precautions. Ribavirin seems an effective and well tolerated agent for PEP of nosocomial CCHF.

Adolescents are the primary cohort for routine human papillomavirus (HPV) vaccination, but unvaccinated adults may also benefit. A lack of consensus on which adults to target and the presence of reimbursement barriers likely contribute to the lag in adult vaccinations, highlighting missed prevention opportunities. Understanding factors contributing to risk of HPV infection and disease could help in decision making on vaccination at an individual level. This review summarizes existing literature on risk factors for HPV infection and disease and includes 153 studies reporting relative risks or odds ratios for factors associated with HPV infection or disease in adults, published between 2009 and 2020. Despite inconsistent design and reporting of risk factors across studies, this review confirmed several risk factors associated with adult infection, including HIV positivity, number of sex partners, and smoking. These findings can support policymaking, guideline development, and clinical decision making for HPV vaccination and screening of high-risk adult groups.

Over the last two decades, lipid nanoparticles (LNPs) have evolved as an effective biocompatible and biodegradable RNA delivery platform in the field of nanomedicine, biotechnology and drug delivery, with the current successes as COVID-19 mRNA vaccines. Therefore, it is important to provide a general workflow of studying RNA-based LNP performance, which further offers useful guidance for researchers who want to work in the RNA-based LNP field. In this perspective, we first summarized the approaches for the preparation of LNPs, followed by the introduction of the key characterization parameters. Then, the in vitro evaluation of LNP performance including cell selection, cell viability, cellular association/uptake, endosomal escape and their efficacy was summarized. Finally, the in vivo assessment in the aspects of animal selection, administration, dosing and safety, and their therapeutic efficacy was discussed. We hope this perspective can offer valuable guidance to researchers who enter the field of RNA-based LNPs and help them understand the crucial parameters that RNA-based LNP demands.

The river morphology of a braided-type river is rather complex. High sediment transport rates and frequently changing discharges are the cause of dynamic planform evolution. Over the past few decades, scientific attention has been directed toward understanding the coexistence of alternating bars and the consequent emergence of confluences and divergences, all of which interact intricately with the process of bank erosion. It is still rather challenging to estimate or predict the total sediment transport rate in such type of rivers, especially by considering various hydrologic data and climate effects. This study is focused on a reach of the Devoll River in Albania, located upstream of the Banja dam. Understanding the morphodynamic of this river reach holds significance due to the expanding delta upstream of the dam reservoir. The objectives of the two-dimensional (2D) depth-averaged approach of the present study are to investigate the temporal variation of braided intensity of Devoll River due to using a discharge hydrograph from hydrologic data compared to the regulated one from the upstream dam on the morphodynamic of the river, and estimate the sediment transport rate of this complex braided river. After evaluating various parameters such as 11 different sediment transport functions, the best results were reached for a cell size of 5×5 m 2, Manning roughness coefficient of 0.03, Meyer-Peter and Müller’s sediment function, Hayashi et al. (1980) hiding function, and Van Rijn bed roughness predictor in this study. In addition, the results of comparing satellite images and modeling the river from 2019 to 2023 show that the braided index (BI) decreased, and this can be due to the fact that the real scenario of the river has a regulated discharge (scenario A) compared to the non-regulated discharge of hydrologic data (scenario B), in the mentioned period. Moreover, the study also estimates sediment transport rates, with scenario A showing higher values for total bed load rate (35.93 kg/s/m) and suspended load concentration (652.48 mg/l) compared to scenario B (16.32 kg/s/m and 152.39 mg/l). This research highlights the impact of regulated discharge on sediment transport in a complex braided river.

With the gradual development of the restoration and protection of the water ecosystem, the research and safegard of ecological flow have received much attention. However, there is a lack of systematization of the literature in the field of “ecological flow” and a lack of in-depth understanding of the main and topical contents of the research in this field. In order to gain an in-depth understanding of the progress and current status of research on ecological flows, this paper searched Web of Science core databases for scientific papers published from 1999 to 2021 on the topic of “ecological flow”. The retrieved 18,128 research papers on ecological flows were also visualized and analyzed by using CiteSpace software for documents per year, category, country and institution distribution, co-citation, and clustering. The results show that research papers on ecological flows have shown an increasing trend since 1999. The categories of disciplines involved cover a wide range of disciplines such as environmental science and ecology, water resources, and so on. The United States ranks first in the number of publications and has a high influence. A total of five clusters were obtained through keywords clustering, with more overlapping areas, hydrological modeling, and aquatic ecosystems are the mainstream of research in the field of ecological flow. “Ecological flow” is still in a phase of rapid development, with the depth of research gradually increasing and the breadth of research expanding. In a long time, the keywords “r package”, “ecological flow”, “loess plateau”, “yellow river” and “emission” will be the center of the field of “ecological flow”.

We quantified temporal dynamics of wood storage, input, and transport in a third-order stream over a 23-year period in adjacent old-growth and second-growth forested reaches in the Cascade Mountains of Oregon. Numbers and volumes of large wood (i.e., standing stock) in the old growth reach were more than double and triple, respectively, than those in the second growth. Annual inputs of large wood were highly variable. Wood numbers delivered into the old-growth reach were 3X higher and wood volume 10X greater than that of the second growth. Movement of number and volume of logs did not differ significantly between the two reaches. Less than 3% of the logs moved in most years, and the highest proportion moved in the year of the 1996 flood (9% in old growth and 17% in second growth). The majority of wood occurred in accumulations (i.e., jams) in both reaches. The second-growth reach lacked major jams, but 29% of the logs in the old growth were in full-channel spanning jams. Long-term observations of annual storage, input, and movement best reveal the dynamics of wood rather than static representations of the characteristics of wood. Input events and transport of wood in Mack Creek were episodic and varied greatly over the 23-yr study, which illustrates one of the major challenges and opportunities for understanding the cumulative dynamics of wood in streams.