There is a need to reduce the proportion of animal-derived food products in the human diet for sustainability and environmental reasons. However, it is also important that a transition away from animal-derived foods does not lead to any adverse nutritional effects. In this study, the potential of blending whey protein isolate (WPI) with either shiitake mushroom (SM) or oyster mushroom (OM) to create hybrid foods with enhanced nutritional and physicochemical properties was investigated. The impact of OM or SM addition on the formation, microstructure, and physicochemical attributes of heat-set whey protein gels was therefore examined. The mushroom powders were used because they have relatively high levels of vitamins, minerals, phytochemicals, and dietary fibers, which may provide nutritional benefits, whereas the WPI was used to provide protein and good thermal gelation properties. A variety of analytical methods were used to characterize the structural and physicochemical properties of the WPI-mushroom hybrids, including confocal microscopy, particle electrophoresis, light scattering, proximate analysis, differential scanning calorimetry, thermogravimetric analysis, dynamic shear rheology, textural profile analysis, and colorimetry. The charge on whey proteins and mushroom particles went from positive to negative when the pH was raised from 3 to 9, but whey protein had a higher isoelectric point and charge magnitude. OM slightly increased the thermal stability of WPI, but SM had little effect. Both mushroom types decreased the lightness and increased the brownness of the whey protein gels. The addition of the mushroom powders also decreased the hardness and Young's modulus of the whey protein gels, which may be because the mushroom particles acted as soft fillers. This study provides valuable insights into the formation of hybrid whey protein-mushroom products that have desirable physiochemical and nutritional attributes.

Sulforaphane (SFN) has shown potential as an antioxidant and anti-inflammatory agent. To improve its druggability, we developed new analgesic formulations with sulforaphane-loaded hyaluronic acid (HA)-poloxamer (PL) hydrogel. This study evaluated the pre-clinical safety and effectiveness of these formulations. Effectiveness was tested on Wistar rats divided into groups (n = 15) receiving (IM, 10 mg/kg) SFN formulations or control groups (without SFN). This study used a hind paw incision postoperative pain model to evaluate mechanical hypersensitivity with von Frey filaments. TNF-α, IL-1β, substance P, and CGRP levels verified anti-inflammatory activity in the hind paw tissue. Histopathology of tissues surrounding the injection site was assessed after 2 and 7 days post-treatment. To corroborate drug safety, cell viability of 3T3 and RAW 264.7 cultures was assessed. Additionally, RAW 264.7 cultures primed with carrageenan evaluated nitric oxide (NO) levels. All animals exhibited post-incisional hypersensitivity, and F2 (PL 407/338 (18/2%) + HA 1% + SFN 0.1%) showed a longer analgesic effect (p < 0.05). F2 reduced TNF-α, IL-1β, and CGRP levels (p < 0.05). Histopathological evaluation showed mild to moderate inflammatory reactions after the formulations' injections. F2 produced no significant difference in cell viability (p > 0.05) but reduced NO production (p < 0.05). Thus, our results highlight the biocompatibility and effectiveness of F2.

Biomechanical tests typically involve bending, compression, or shear stress, while fall tests are less common. The main challenge in performing fall tests is the non-reproducible directionality of bone when tested with soft tissue. Upon removal of the soft tissue, the explanted bone's resistance to impact diminishes. Therefore, ballistic gels can fix specimens in reproducible directions and simulate periosteal soft tissue. However, the use of ballistic gels in biomechanical studies is neither standardized nor widespread. This study aimed to optimize a ballistic gel consistency that mimics the upper thigh muscle in sheep. Our results suggest a standardized and flexible evaluation method by embedding samples in ballistic gel. Compression tests were conducted using cylindrical pieces of gluteal muscle from sheep. Various compositions of agarose and gelatin mixtures were tested to achieve a muscle-like consistency. The muscle-equivalent ballistic gel was found to consist of 29.5% gelatin and 0.35% agarose. Bones remained stable within the ballistic gel setup after freeze-thaw cycles between -20 °C and +20 °C. This method reduces the variability caused by muscle and improves storage quality, allowing for tests to be conducted under consistent conditionsBallistic gels of agarose and gelatin are suitable for bone fracture models. They have muscle-like strength, fix fractures simultaneously, are inexpensive to produce, and can be stored to allow repeated measurements of the same object with changing questions.

The present study aimed to investigate the properties of calcium-rich soy protein isolate (SPI) gels (14% SPI; 100 mM CaCl2), the effects of incorporating different concentrations locust bean gum (LBG) (0.1-0.3%, w/v) to the systems and the stability of the obtained gels. Also, the incorporation of solid lipid microparticles (SLMs) was tested as an alternative strategy to improve the system's stability and, therefore, potential to be applied as a product prototype. The gels were evaluated regarding their visual aspect, rheological properties, water-holding capacities (WHCs) and microstructural organizations. The CaCl2-induced gels were self-supported but presented low WHC (40.0% ± 2.2) which was improved by LBG incorporation. The obtained mixed system, however, presented low stability, with high syneresis after 10 days of storage, due to microstructural compaction. The gels' stability was improved by SLM incorporation, which decreased the gelled matrices' compaction and syneresis for more than 20 days. Even though the rheological properties of the emulsion-filled gels (EFGs) were very altered due to the ageing process (which may affect the sensory perception of a future food originated from this EFG), the incorporation of SLMs increased the systems potential to be applied as a calcium-rich product prototype.

Determining the safety of a newly developed experimental product is a crucial condition for its medical use, especially for clinical trials. In this regard, four hydrogel-type formulations were manufactured, all of which were based on carbomer (Blank-CP940) and encapsulated with caffeine (CAF-CP940), phosphorus derivatives (phenyl phosphinic (CAF-S1-CP940) and 2-carboxyethyl phenyl phosphinic acids (CAF-S2-CP940)). The main aim of this research was to provide a comprehensive outline of the biosafety profile of the above-mentioned hydrogels. The complex in vitro screening (cell viability, cytotoxicity, morphological changes in response to exposure, and changes in nuclei morphology) on two types of healthy skin cell lines (HaCaT-human keratinocytes and JB6 Cl 41-5a-murine epidermal cells) exhibited a good biosafety profile when both cell lines were treated for 24 h with 150 μg/mL of each hydrogel. A comprehensive analysis of the hydrogel's impact on the genetic profile of HaCaT cells sustains the in vitro experiments. The biosafety profile was completed with the in vivo and in ovo assays. The outcome revealed that the developed hydrogels exerted good biocompatibility after topical application on BALB/c nude mice's skin. It also revealed a lack of toxicity after exposure to the hen's chicken embryo. Further investigations are needed, regarding the in vitro and in vivo therapeutic efficacy and safety for long-term use and potential clinical translatability.

The image of a nurse is a source of concern due to its impact on recruitment into the profession, political decisions about the profession, and how the image affects nursing practice. For these reasons, one of the long-term challenges is to assess and maintain a favorable public image that respects the utility and value of the nursing profession.

Maintenance strategies after center-based pulmonary rehabilitation (CBPR) are currently needed. This study aimed to evaluate the feasibility and effect on the quality of life of a home-based pulmonary rehabilitation (HBPR) program delivered by a digital app. As secondary objectives, the patients' adherence, symptoms, effort tolerance changes, and safety were evaluated. This was a single-arm prospective observational monocentric study on 30 patients referred for chronic respiratory diseases. The prescription and evaluations of the HBPR programs performed at the pulmonary facility and delivery of structured exercise and counselling by the digital health tool were achieved under the supervision of a respiratory therapist. Digital capabilities included aerobic, strength, and respiratory exercises, which were monitored with a fitness tracker. The engagement rate of the HBPR after the CBPR was 1:10. The EuroQoL VAS score increased from 66.2 ± 16.28 to 75.60 ± 16.07 (p < 0.001), mainly in younger subjects. No patient was lost during the HBPR program. The global adherence session rate was 94%. The Medical Research Council dyspnea scale (MRC), COPD Assessment Test (CAT) score, and six-minute walking test (6MWT) improved from admission into the pulmonary unit to the end of the HBPR program. Between the beginning and end of the CBPR, the CAT score decreased from 14.4 ± 6.39 to 8.50 ± 5.39 (p < 0.001), the MRC decreased from 1.87 ± 0.9 to 1.17 ± 0.83 (p < 0.001), and the 6MWT increased from 451 ± 93 to 473 ± 115 m (p < 0.05). The average Technology Acceptance Model score for usability was high (145 ± 12.1) and no adverse events occurred during the HBPR program. This HBPR model seemed to be feasible and well-accepted by patients, leading to improvements in quality of life, symptoms, and functional capacity.

Eating disorders are complex psychiatric disorders characterized by compensatory and restrictive behavior and a preoccupation with one's body. Eating and purging behaviors are considered dysfunctional emotional regulation strategies. Therefore, psychological treatment is essential. The most common psychological interventions are dialectical behavior therapy (DBT), cognitive-behavioral therapy (CBT), family therapy (FBT), multi-family group therapy (MFTG) and mentalization-based treatment (MBT). The aim of this study was to summarize the current evidence on the impact of psychological treatments on emotional regulation difficulties and psychological symptoms in patients with eating disorders, especially anorexia nervosa. A search was conducted on PubMed and Web of Science using the terms "anorexia nervosa" and "emotion dysregulation". Of the 278 initial articles, we included 15 publications. The results indicate that the acquisition of coping strategies, through DBT, leads to an improvement in anxiety and alexithymia. DBT, CBT and MBT lead to a reduction in the use of dysfunctional emotional regulation strategies too. Eating disorders involve both physical and mental health; therefore, it is desirable for future research to focus on the mutual synergy between the mental and physical components by evaluating various factors, such as biomarkers and the most appropriate therapeutic approach, with respect to the treatment setting.

Quality indicators (QIs) play a vital role in enhancing the care of older adults. This study aimed to identify existing QIs relevant to the health and care of older adults in community-care, continuing-care, and acute-care settings, along with available information such as definitions and calculation methods. A systematic review of published review studies, grey literature, and guidelines was undertaken, utilizing six electronic databases searched for materials dated from 2010 to 2 June 2023. To be included in this study, the literature had to provide data on QIs in a setting involving older adults. This study included 27 reviews and 44 grey literature sources, identifying a total of 6391 QIs. The highest number of indicators (37%) were relevant to continuing care; 32% and 28% were pertinent to community- and acute-care settings, respectively. The process domain had the highest number of QIs (3932), while the structure domain had the fewest indicators (521). A total of 39 focus areas were identified, with the five most common areas being, in descending order, orthopedics/hip fractures, end-of-life/palliative care, appropriate prescribing, neurocognitive conditions, and cardiovascular conditions; these areas ranged between 10% and 6%. When mapped against the Quadruple Aim framework, most QIs (85%) were linked to improving health outcomes. This inclusive compilation of QIs serves as a resource for addressing various focus areas pertinent to the Quadruple Aims. However, few quality indicators have been designed to provide a comprehensive and thorough evaluation of a specific aspect, taking into account all three key domains: structure, process, and outcomes. Addressing the description and psychometric properties of QIs is foundational for ensuring their trustworthiness and effective application.

Interventions within preschool settings have gained prominence due to the need to increase physical activity (PA) in early childhood. We first developed a 10-week preschool-based behaviour change intervention, guided by the UK Medical Research Council's framework for complex interventions. We then conducted a cluster feasibility randomised controlled trial (RCT) among young children.

During the COVID-19 pandemic, clinical nurses in hospitals in South Korea were exposed to extreme stress, and many continue to suffer from post-traumatic stress disorder (PTSD). This study explores the factors influencing PTSD among hospital clinical nurses during COVID-19. In total, 121 hospital clinical nurses participated in 2022, providing demographic information and completing surveys designed to measure PTSD, resilience, social support, professional pride in nursing (PPN), and variables related to COVID-19. We observed statistically significantly higher levels of resilience (91.48 vs. 70.00), social support (47.37 vs. 35.41), and PPN (88.36 vs. 68.06) in the low-risk PTSD group compared with the high-risk PTSD group. Resilience was associated with a reduced risk of PTSD (OR, 0.91; 95% CI = 0.84-0.98). The subfactors of control (OR = 0.60; 95% CI = 0.43-0.86) and sociability (OR = 0.68; 95% CI = 0.44-0.97) decreased PTSD risk. Among the social support subfactors, family support had an OR of 0.47 (95% CI = 0.26-0.86) for reducing PTSD risk. Programs involving family participation that enhance resilience and provide psychological support can help hospital nurses affected by the COVID-19 pandemic manage their PTSD. Our findings serve as foundational data to develop interventions on psychological well-being for nurses dealing with new infectious diseases.

Background: This study aimed to: (1) assess healthcare providers' opinions on e-cigarette safety and compare them across professions; (2) evaluate providers' recommendations for e-cigarettes as a tobacco product cessation tool and identify any associations with their safety perceptions. Methods: A self-administered questionnaire was completed by 760 healthcare professionals (January-March 2020). The survey included eight opinions on e-cigarette safety with five Likert-scale answers and a question on recommending them for tobacco product cessation. Results: Among 760 healthcare providers (173 physicians/dentists, 69 pharmacists, and 518 nurses), only 20% reported prior experience with tobacco product cessation counseling. Providers expressed uncertainty regarding e-cigarette safety (mean ± SD: 2.5 ± 0.7 on a 5-point Likert scale), with no significant differences between professions (p = 0.836). Similarly, e-cigarette recommendations for tobacco product cessation remained low across professions (13%, 85/637), with no significant differences found (p = 0.072). The recommendation of e-cigarettes for tobacco cessation is associated with perceived safety, lower respiratory irritation, lower coughing, a lower risk of cancer, and a lower risk for secondhand smokers when compared to traditional cigarettes (p < 0.05). Conclusions: Most healthcare providers were unsure about the safety of e-cigarettes; about 13% of providers suggested using them for tobacco product cessation, with safety perceptions influencing recommendations.

The increasing prevalence of chronic diseases in Saudi Arabia has heightened the need for organ transplantation; however, the donor pool remains insufficient. This study explored awareness and willingness towards organ donation among Riyadh residents and examined the sociodemographic factors influencing these attitudes.

Previous studies reported that digital psychotherapy was a clinically beneficial intervention for suicide ideation. However, the effects of digital psychotherapy on other aspects of suicide beyond ideation remain unclear. Therefore, this study investigated the effects of digital psychotherapy on suicide and depression. Articles were identified by searching Cochrane, Google Scholar, Medline, PubMed, Web of Science, and PsycINFO in line with the PRISMA statement, yielding nine randomized controlled trials. The difference between conditions regarding suicide and depression in the effect size of the individual article was calculated using Hedges' g. Most digital psychotherapy interventions were based on cognitive behavioral therapy and delivered via apps or the web for at least six weeks. Suicide outcomes primarily focused on suicide ideation. The findings showed digital psychotherapy achieved a significantly larger effect size for suicide (g = 0.488, p < 0.001) and depression (g = 0.316, p < 0.001), compared to controls. Specifically, digital psychotherapy showed a significant effect on both suicide ideation (g = 0.478, p < 0.001) and other suicidal variables (g = 0.330, p < 0.001). These results suggest the effectiveness of digital psychotherapy in reducing suicide and depression compared to traditional face-to-face therapy. Future research should consider a wider range of outcomes and examine the long-term effectiveness of digital psychotherapy to better understand its effects on suicide prevention.

Providing patients with accurate and organized information about colonoscopy, while reducing anxiety, is critical to the procedure's success. This study evaluated the impact of an immersive 360° virtual reality (VR)-based educational intervention for first-time adult colonoscopy patients regarding anxiety, attitudes, knowledge, compliance with bowel preparation, and bowel cleanliness. A quasi-experimental design with a non-equivalent control group and non-synchronized pretest-post-test clinical trial was conducted with 40 patients in the experimental group and 40 in the control group. The 360° VR intervention included two sessions: precautions before colonoscopy and the colonoscopy process. The control group received education through individual verbal explanations with written materials. The findings indicated that the VR intervention significantly improved patients' colonoscopy-related anxiety, attitudes, adherence to bowel preparation instructions, and bowel cleanliness. Utilizing 360° VR as an educational tool has the potential to enhance the effectiveness of educational programs by providing realistic information and engaging patients. These findings suggest that 360° VR has the capacity to enhance screening rates and clinical outcomes by reducing negative perceptions associated with colonoscopy. Furthermore, the application of this method can extend to diverse diagnostic testing-related nursing situations in clinical settings.

Background: Coronary artery calcium (CAC) is a marker of subclinical atherosclerosis and is a complex heritable trait with both genetic and environmental risk factors, including sex and smoking. Methods: We performed genome-wide association (GWA) analyses for CAC among all participants and stratified by sex in the COPDGene study (n = 6144 participants of European ancestry and n = 2589 participants of African ancestry) with replication in the Diabetes Heart Study (DHS). We adjusted for age, sex, current smoking status, BMI, diabetes, self-reported high blood pressure, self-reported high cholesterol, and genetic ancestry (as summarized by principal components computed within each racial group). For the significant signals from the GWA analyses, we examined the single nucleotide polymorphism (SNP) by sex interactions, stratified by smoking status (current vs. former), and tested for a SNP by smoking status interaction on CAC. Results: We identified genome-wide significant associations for CAC in the chromosome 9p21 region [CDKN2B-AS1] among all COPDGene participants (p = 7.1 × 10-14) and among males (p = 1.0 × 10-9), but the signal was not genome-wide significant among females (p = 6.4 × 10-6). For the sex stratified GWA analyses among females, the chromosome 6p24 region [PHACTR1] had a genome-wide significant association (p = 4.4 × 10-8) with CAC, but this signal was not genome-wide significant among all COPDGene participants (p = 1.7 × 10-7) or males (p = 0.03). There was a significant interaction for the SNP rs9349379 in PHACTR1 with sex (p = 0.02), but the interaction was not significant for the SNP rs10757272 in CDKN2B-AS1 with sex (p = 0.21). In addition, PHACTR1 had a stronger association with CAC among current smokers (p = 6.2 × 10-7) than former smokers (p = 7.5 × 10-3) and the SNP by smoking status interaction was marginally significant (p = 0.03). CDKN2B-AS1 had a strong association with CAC among both former (p = 7.7 × 10-8) and current smokers (p = 1.7 × 10-7) and the SNP by smoking status interaction was not significant (p = 0.40). Conclusions: Among current and former smokers of European ancestry in the COPDGene study, we identified a genome-wide significant association in the chromosome 6p24 region [PHACTR1] with CAC among females, but not among males. This region had a significant SNP by sex and SNP by smoking interaction on CAC.

Hypoxia can induce pulmonary edema (PE) and inflammation. Furthermore, hypoxia depresses left ventricular (LV) inotropy despite sympathetic activation. To study the role of hypoxic sympathetic activation, we investigated the effects of hypoxia with and without adrenergic blockade (AB) on cardiovascular dysfunction and lung injury, i.e., pulmonary edema, congestion, inflammation, and nitrosative stress. Eighty-six female rats were exposed for 72 h to normoxia or normobaric hypoxia and received infusions with NaCl, prazosin, propranolol, or prazosin-propranolol combination. We evaluated hemodynamic function and performed histological and immunohistochemical analyses of the lung. Hypoxia significantly depressed LV but not right ventricular (RV) inotropic and lusitropic functions. AB significantly decreased LV function in both normoxia and hypoxia. AB effects on RV were weaker. Hypoxic rats showed signs of moderate PE and inflammation. This was accompanied by elevated levels of tumor necrosis factor α (TNFα) and nitrotyrosine, a marker of nitrosative stress in the lungs. In hypoxia, all types of AB markedly reduced both TNFα and nitrotyrosine. However, AB did not attenuate PE. The results suggest that hypoxia-induced sympathetic activation contributes to inflammation and nitrosative stress in the lungs but not to PE. We suggest that AB in hypoxia aggravates hypoxia-induced inotropic LV dysfunction and backlog into the pulmonary circulation, thus promoting PE.

Cardiovascular diseases (CVDs) are a leading cause of global morbidity and mortality, significantly driven by chronic inflammation. Interleukin-6 (IL-6) and interleukin-1β (IL-1β) are critical inflammatory cytokines implicated in CVD progression. This systematic review evaluates the roles of IL-6 and IL-1β in CVDs by synthesizing data from relevant studies to understand their impact on cardiovascular outcomes and identify potential therapeutic interventions. A comprehensive literature search was conducted using PubMed and Embase, covering studies from January 2014 to December 2024. Inclusion criteria encompassed studies investigating IL-6 and/or IL-1β in CVDs, including human and relevant animal models, and reporting clinical outcomes, molecular mechanisms, or therapeutic interventions. Data extraction and quality assessment were performed independently by two reviewers. Our review included 12 studies focusing on the roles of IL-6 and IL-1β in various CVDs. Elevated IL-6 levels were significantly associated with peripheral artery disease, myocardial infarction, and heart failure, while IL-1β levels were linked to worse outcomes in coronary artery disease and heart failure. Meta-analyses indicated a significant association between higher IL-6 and IL-1β levels and increased risk of adverse cardiovascular events. These findings suggest that targeting IL-6 and IL-1β could offer promising therapeutic strategies for reducing inflammation and improving cardiovascular outcomes.

The choice of prosthesis for aortic valve replacement (AVR) remains challenging. The risk of anticoagulation complications vs. the risk of aortic valve reintervention should be weighed. This study compared the outcomes of bioprosthetic vs. mechanical AVR in patients older and younger than 50.

Sulfur mustard (SM) is a highly potent alkylating vesicant agent and remains a relevant threat to both civilians and military personnel. The eyes are the most sensitive organ after airborne SM exposure, causing ocular injuries with no antidote or specific therapeutics available. In order to identify relevant biomarkers and to obtain a deeper understanding of the underlying biochemical events, we performed an untargeted metabolomics analysis using liquid chromatography coupled to high-resolution mass spectrometry of plasma samples from New Zealand white rabbits ocularly exposed to vapors of SM. Metabolic profiles (332 unique metabolites) from SM-exposed (n = 16) and unexposed rabbits (n = 8) were compared at different time intervals from 1 to 28 days. The observed time-dependent changes in metabolic profiles highlighted the profound dysregulation of the sulfur amino acids, the phenylalanine, the tyrosine and tryptophan pathway, and the polyamine and purine biosynthesis, which could reflect antioxidant and anti-inflammatory activities. Taurine and 3,4-dihydroxy-phenylalanine (Dopa) seem to be specifically related to SM exposure and correspond well with the different phases of ocular damage, while the dysregulation of adenosine, polyamines, and acylcarnitines might be related to ocular neovascularization. Additionally, neither cysteine, N-acetylcysteine, or guanine SM adducts were detected in the plasma of exposed rabbits at any time point. Overall, our study provides an unprecedented view of the plasma metabolic changes post-SM ocular exposure, which may open up the development of potential new treatment strategies.