UNASSIGNED: Pediatric autoimmune hepatitis has an incidence of 0.23/100.000 children in North America, with a bleak prognosis if left untreated. Steroids are the therapy of choice but are not always effective. B cell depletion is a safe and effective therapy that allows for a steroid-sparing protocol, especially in patients who do not tolerate side effects.
UNASSIGNED: We retrospectively reviewed rituximab-treated patients between 2017 and 2022. Demographics, previous treatments, reasons for B cell depletion, response, and adverse effects were noted.
UNASSIGNED: Six patients with a mean age of 10.2 years were included. All patients had comorbidities that rendered treatment with steroids unsuccessful or undesirable. Rituximab was started at a mean follow-up of 8 months. After 6 months, the mean alanine transaminase and aspartate transaminase levels decreased from 575 IU/L and 342 IU/L, respectively, to 28 IU/L (p = 0.02) and 36 IU/L (p = 0.008), respectively. Mean γ-glutamyl transpeptidase decreased from 105 to 25 IU/L (p = 0.01). Immunoglobulin G levels were normalized in all patients (p = 0.01). No severe adverse events were observed. One patient had persistent hypogammaglobulinemia, and another had lymphopenia.
UNASSIGNED: B-cell depletion is an effective and safe treatment for autoimmune liver diseases and should be included as an option, particularly for relapsing patients in whom steroids are undesirable or have shown nonadherence.

We examine the impact of climate risk on discouraged borrowers among small and medium-sized enterprises (SMEs) in the eurozone, using a unique European Central Bank dataset focusing on the demand side of credit markets. We argue that two opposing channels may exist in this relationship: Either climate risk has a negative effect stemming from increased demand for sustainable or climate-resilient projects that enhance creditworthiness, or climate risk has a positive effect arising from heightened climate uncertainty and risk aversion, leading to credit self-rationing among SMEs. Our findings reveal that heightened climate risk prompts SMEs to self-ration credit, leading to higher probabilities of discouraged borrowers. Our research deepens the understanding of the impact of climate risk on credit-related decisions, stressing the need for proactive measures to integrate climate risk assessments into regulatory frameworks and lending practices. The findings underscore the vulnerability of SMEs to climate risk, emphasizing emphasizing the importance of tailored support mechanisms for economic resilience.

UNASSIGNED: The oncological safety of transanal total mesorectal excision (taTME) remains uncertain, and its special surgical approach may contribute to tumor cell dissemination. Thus, we conducted a study to investigate the impact of surgical approach on circulating tumor cell (CTC) counts and phenotypes in rectal cancer.
UNASSIGNED: This is a prospective randomized controlled study (ClinicalTrials: NCT05109130). The patients were randomized to either the taTME (n = 49) or laparoscopic TME (laTME) (n = 48) groups. Blood samples were collected from the central vein to measure CTC counts and phenotypes at three time points: preoperative (t1), immediately post-tumor removal (t2), and one week post-surgery (t3). The effect of surgical procedure on CTCs at each time point was analyzed, with the primary endpoint being the change in CTC counts from t1 to t3 for each surgical approach. This study adheres to Consolidated Standards of Reporting Trials Guidelines.
UNASSIGNED: The baseline clinicopathologic characteristics of the laTME and taTME groups were balanced. The change in CTC count from t1 to t3 was 1.81 ± 5.66 in the laTME group and 2.18 ± 5.53 in the taTME group. The taTME surgery was non-inferior to laTME in terms of changing CTC counts (mean difference [MD]: -0.371; 95% confidence interval [CI]: -2.626 to 1.883, upper-sided 95% CI of 1.883 < 2, non-inferiority boundary value). Compared with that at t1, the CTC count at t2 did not change significantly. However, higher CTC counts were detected at t3 than at t2 in the taTME (P = 0.032) and laTME (P = 0.003) groups. From t1 to t3, CTC counts significantly increased in both the taTME (P = 0.008) and laTME (P = 0.031) groups. There were no significant differences in CTC phenotype changes between the two groups from t1 to t3.
UNASSIGNED: Compared with laTME, taTME did not affect CTC counts and phenotypes. Our findings indicate that taTME is not inferior to laTME in terms of CTC changes from an oncological perspective.

UNASSIGNED: Pesticides play a crucial role in enhancing agricultural productivity by controlling pests. However, inadequate pesticide handling practices have a considerable adverse impact on human health. Nevertheless, there is limited knowledge regarding the extent of safe pesticide handling practices, particularly in low-income settings like Ethiopia. Hence, this study seeks to evaluate the implementation of safe pesticide handling practices and identify the factors associated with the status of the handling practices in low-income settings in Ethiopia.
UNASSIGNED: A cross-sectional study was undertaken, involving 468 farmers randomly selected for participation. Data collection was carried out through structured questionnaires and face-to-face interviews. The analysis aimed to assess the proportion of safe pesticide handling practices (SPHP) and investigate the factors associated with SPHP was done using binary logistic regression. Explanatory variables with a P-value <0.25 were included in the final analysis. The factors were determined based on adjusted odds ratios and 95% confidence intervals, P-value <.05. Model fit was evaluated using the Hosmer and Lemeshow tests.
UNASSIGNED: From the findings of our study, only 45.7% of farmers practiced SPHP, with factors such as education, experience, pesticide usage, and attitude toward safe practices influencing their practices. Farmers with education status primary and above were two times more likely to practice good handling of pesticides than those who didn\'t attend formal education. Farmers with a maximum of 5 years of experience in vegetable farming were 2.4 times more likely to exhibit good handling practices compared to their counterparts. Furthermore, farmers with favorable attitudes toward pesticide handling were 4.2 times more likely to engage in good pesticide handling practices than those with unfavorable attitudes. Therefore, the agricultural sectors, health sectors, and farmer associations should focus on these factors in order to mitigate the health risks associated with poor pesticide handling.

Li-ion batteries with superior interior thermal management are crucial to prevent thermal runaway and ensure safe, long-lasting operation at high temperatures or during rapid discharging and charging. Typically, such thermal management is achieved by focusing on the separator and electrolyte. Here, the study introduces a Se-terminated MXene free-standing electrode with exceptional electrical conductivity and low infrared emissivity, synergistically combining high-rate capacity with reduced heat radiation for safe, large, and fast Li+ storage. This is achieved through a one-step organic Lewis acid-assisted gas-phase reaction and vacuum filtration. The Se-terminated Nb2Se2C outperformed conventional disordered O/OH/F-terminated materials, enhancing Li+-storage capacity by ≈1.5 times in the fifth cycle (221 mAh·g-1 at 1 A·g-1) and improving mid-infrared adsorption with low thermal radiation. These benefits result from its superior electrical conductivity, excellent structural stability, and high permittivity in the infrared region. Calculations further reveal that increased permittivity and conductivity along the z-direction can reduce heat radiation from electrodes. This work highlights the potential of surface groups-terminated layered material-based free-standing flexible electrodes with self-thermal management ability for safe, fast energy storage.

A 22-year-old male patient presented to the clinic with severe pain in the preauricular area with an inability to completely occlude the jaw. Facial computed tomography and magnetic resonance imaging revealed a well-defined lesion that was tentatively diagnosed as a benign tumor or cystic mass. Surgical approach of a lesion in the condyle is delicate and problematic as many vulnerable anatomical structures are present. There are several methods for surgery in this area. Typically, an extraoral approach is dangerous because of potential injuries to nerves and arteries. The intraoral approach also presents difficulties due to the lack of visibility and accessibility. On occasion, coronoidectomy may be performed. The goal here was to determine an easier and safer new surgical approach to the condyle. We reached the anterior part of the pterygoid plate in the same method as in Le Fort I surgery. From this point, through the external pterygoid muscle, approaching the anterior aspect of the condyle is relatively easy and safe, with minimal damage to the surrounding tissues. Pus was drained at the site, and the lesion was diagnosed as an abscess. Pain and inability to close the mouth resolved without recurrence.

OBJECTIVE: Precautions taken before an earthquake are of vital importance. When buildings collapse, the weight of the ceiling crushes objects such as furniture, leaving a space or void within the rubble. This area is called the \"triangle of life.\" The larger and stronger the object, the more it will maintain its volume; the more the object maintains its volume, the larger the void will be, and the less likely it is that the person who uses this void will be injured.
METHODS: Durable, solid furniture such as beds and tables that can be tipped over during an earthquake in appropriate areas in the building can form a living triangle. Creating and using the triangle of life is the method of protection in an earthquake that produces the highest probability of survival.
RESULTS: Two earthquakes with magnitudes of 7.8 and 7.5 occurred in Kahramanmaraş, Turkey, on February 6, 2023. This report presents the case of a 43-y-old female victim of these earthquakes who used the triangle of life to survive; she was removed from the rubble 164 h after the earthquake.
CONCLUSIONS: The case provides evidence that predetermining areas in which the triangle of life can be formed and storing supplies necessary for survival can decrease morbidity and mortality in an earthquake.

Digital therapeutics (DTx) are a promising way to provide safe, effective, accessible, sustainable, scalable, and equitable approaches to advance individual and population health. However, developing and deploying DTx is inherently complex in that DTx includes multiple interacting components, such as tools to support activities like medication adherence, health behavior goal-setting or self-monitoring, and algorithms that adapt the provision of these according to individual needs that may change over time. While myriad frameworks exist for different phases of DTx development, no single framework exists to guide evidence production for DTx across its full life cycle, from initial DTx development to long-term use. To fill this gap, we propose the DTx real-world evidence (RWE) framework as a pragmatic, iterative, milestone-driven approach for developing DTx. The DTx RWE framework is derived from the 4-phase development model used for behavioral interventions, but it includes key adaptations that are specific to the unique characteristics of DTx. To ensure the highest level of fidelity to the needs of users, the framework also incorporates real-world data (RWD) across the entire life cycle of DTx development and use. The DTx RWE framework is intended for any group interested in developing and deploying DTx in real-world contexts, including those in industry, health care, public health, and academia. Moreover, entities that fund research that supports the development of DTx and agencies that regulate DTx might find the DTx RWE framework useful as they endeavor to improve how DTxcan advance individual and population health.

Aroma compounds in the roasted breasts, thighs and skins of chicken were isolated by solvent-assisted flavor evaporation (SAFE), quantitated by gas chromatography-olfactometry-mass (GC-O-MS), analyzed by aroma extract dilution analysis (AEDA), and determined by recombination-omission tests and sensory evaluation. Forty-seven aroma compounds in total, including aldehydes, ketones, furans, pyrazines, and furanones, were selected by AEDA. Twenty-five compounds were selected as pivotal odorants (Odor Activity Value, OAV ≥ 1). Twenty aroma compounds significantly were identified by recombination and omission experiments. Anethole (fennel odor) was the highest OAV (＞ 1843). Hexanal (grassy) and (E, E)-2,4-decadienal (meaty) were the most abundant aldehydes identified in roasted chicken. 1-octen-3-ol (mushroom), methanethiol (cabbage) and dimethyl trisulfide (areca, sulfur) were considered the key compounds of the breast and thighs of roasted chicken. Notably, furanone and pyrazines, 4-hydroxy-5-methyl-3(2H)-furanone (caramel, sweet and burning odor), 3-ethyl-2,5-dimethylpyrazine (nutty, toasty) and 2,3-dimethyl-5-ethylpyrazine (nutty, toasty) had the most significant effect on roasted chicken odor, especially in the skin.

In Japan, many pregnant women and mothers suffer from anxiety, depression, and other postnatal issues that can be exacerbated by their birth experiences. While benefiting from advanced medical care, these women\'s mental and psychological health may be disregarded in their maternity care. Midwives have the potential to play a significant role in improving women\'s birth experiences. Hence, this study aimed to explore the meaning of the woman-midwife relationship, with a specific focus on sensing peace of mind and trust to improve women\'s birth experiences. Using a hermeneutic phenomenological approach, 14 Japanese women were interviewed. Sensing peace of mind and trust was one of the significant meanings of the woman-midwife relationship and is articulated across five themes: (1) attuning to the world, (2) different kinds of safety and trust, (3) relying on and entrusting midwives, (4) making a mother, and (5) an emotional bridge. The positive relationship with midwives enhanced the women\'s mental well-being through allowing the women to attune to the peaceful mind which directed their future perspectives and sustained them in motherhood. They became confident mothers by trusting their midwives. The maternity care system in Japan needs to shift to more relationship-based care to ensure continuity of midwifery care that will improve women\'s birth experiences and their long-term well-being.