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Public-Private Partnership (PPP) road projects are being promoted worldwide to encourage road investments; however, research on the appropriate rate of return for these projects is insufficient. This is likely because the return on investment for PPP road projects is determined through negotiations between the government and the private sector, a process that remains confidential. The rate of return for PPP road projects is not only a key indicator for evaluating project performance but also a potential driver for future government financial subsidies. Therefore, research on the appropriate rate of return for PPP road projects is necessary for the sustainability of these projects.This study, based on the concept that both the government and the private sector share the anticipated risks of the project, quantifies six types of risks and proposes a model for predicting the appropriate rate of return. The model is able to explain approximately 68% of the cases in South Korea’s PPP road projects. The risk with the greatest influence on the rate of return was found to be an economic risk, while the least influential was regulation change risk.Due to the confidentiality of data related to PPP road projects, this study only utilized 54 cases from South Korea. It is hoped that a wider range of data will be collected and further research on the appropriate rate of return will continue to enhance the sustainability of PPP road projects.

Pure Red Cell Aplasia (PRCA) is a well-recognized complication of Major ABO-incompatible allogeneic stem cell transplantation. It is featured by anemia, Reticulocytopenia, and the absence of erythroblasts in a normal-appearing bone marrow biopsy. The mechanism for PRCA is presumed to be the persistence of recipient isoagglutinins, produced by residual host B lymphocytes or plasma cells, which probably interfere with the engraftment of donor erythroid cells. Several risk factors for PRCA have been reported, such as the presence of Anti-A Isoagglutininsbefore transplantation, reduced intensity conditioning, absence of Graft Versus Host Disease (GVHD), sibling donor and Cyclosporin A(CsA) as GVHD prophylaxis. PRCA is not a barrier to going ahead with Hematopoietic Stem Cell Transplantation (HSCT). There are many therapeutic options however few recover spontaneously, among the available options include high-dose steroids, Erythropoietin(EPO), Plasma exchange, Donor lymphocyte Infusion (DLI), treatment with Rituximab, Bortezomib, Daratumumab and tapering or discontinuation of immunosuppression. All these options have variable success in the literature ranging from 30% - 70%, Non-responders become red cell transfusion dependent and their quality of life is impaired. We are reporting a novel therapeutic option, Ibrutinib as an armamentarium in treating the PRCA post-HSCT, which works by blocking the Bruton Tyrosine Kinase (BTK) pathway thereby inhibiting the host B cell isoagglutinins production and good clinical response.

Citrus sinensis is a rich source of bioactive compounds  and has attracted attention due to its medicinal benefits. Historically regarded as agricultural waste, orange peel is rich in flavonoids, polyphenols, tannins, and essential oils with antibacterial, anti-inflammatory, and antioxidant qualities. The phytochemicals in Citrus sinensis peel were used as natural reducing and stabilizing agents in the green synthesis method used in this work to create silver nanoparticles (AgNPs). This method is an environmentally friendly alternative to conventional nanoparticle production, eliminating the need for hazardous chemicals. Based on the study’s results, green-synthesized silver nanoparticles derived from Citrus sinensis peel extract offer a sustainable and biocompatible substitute for biomedical applications. The pharmaceutical and healthcare industries may find therapeutic uses for them due to their exceptional antibacterial, antioxidant, and anticancer properties.

Left ventricular thrombus (LVT) is a life threatening complication following acute coronary syndromes but in modern era its incidence has reduced since the introduction of primary percutaneous intervention. LVT is associated with higher morbidity and mortality due to its thromboembolic events and major adverse cardiac events (MACE). This is a case report of 30-year-old male  who presented with acute abdomen and left ventricular thrombus. CECT abdomen revealed superior mesenteric artery (SMA) thrombosis and echocardiography revealed severe ventricular dysfunction (ejection fraction, EF<30%) with global hypokinesia and LVT. SMA thrombosis is fatal and if left unattended can lead to intestinal ischemia and gangrene, hence immediate intervention is warranted. This patient had undergone emergency laparotomy under general anesthesia for the resection of gangrenous jejunal segment with mucous fistula . This case report discusses perioperative management considerations in such cases.

Background: The proposal that MALDI-ToF mass spectrometry could be used as a direct, rapid and affordable diagnostic tool in clinical laboratory medicine has moved from a theoretical possibility to a reality for Microbiology. Several studies have proposed the application of this technology in obstetric and gynaecological evaluation of patients. In particular, we have proposed that the adoption of MALDI-ToF mass spectrometry in examination of maternal pregnancy urine samples for the detection of Downs syndrome. Methods: A retrospective collection of 20 Down Syndrome and 100 non-aneuploid pregnancy urines at 12 to 14 weeks gestation, collected in 2007-2008 from high risk pregnancy cohorts, were examined by MALDI-ToF mass spectrometry in the mass/charge range between 1000 and 100000 m/z. Normalisation of spectral data was defined using mass bins of 100 m/z expressed as a percentage of the total ion count of the mass spectra from 2000 to 11000 m/z. Of the ninety 100 m/z bins, forty-six were identified as m/z bins at which statistically significant differences in spectra occurred between Downs and control/non-aneuploid samples. Based on the differences and variance, for values at these bins, weighted scores of the probability of being Downs were assigned. Comparative algorithms consisting of various mass bins were tested for ability to distinguish Down syndrome from non-aneuploid pregnancy. Results: Although various algorithms could distinguish Downs from non-aneuploid controls, it was found that gestational age was a confounding factor and that if separated into gestational age matched cohorts the ability to distinguish the groups improved dramatically e.g. whilst a 19 bins algorithm separated 100% of Downs from non-aneuploid pregnancies for a 9% false positive rate in the mixed gestational ages group; a two bin algorithm distinguished 100% of Downs for a 6% false positive rate for the 12 weeks gestational age pregnancies. Conclusion: Normalised MALDI-ToF mass spectra, at 2000 to 11000 m/z, of maternal urine gives rise to gestational age specific screening tests algorithms for Downs’s syndrome.

A specialized installation has been developed for microscopic study of the Reactive Oxygen Species (ROS) formation during microwave irradiation of biological samples with automated control / mechanized tube and real-time data acquisition. The above installation can be used in biomedical practice for: standardization or certification of the microwave sources; testing of the potential antioxidants that protect tissues from ROS-induced effects; testing fluorescent sensors for ROS; analysis of ROS localization and distribution in various tissues in order to establish specific pharmaco-physiotherapeutic and toxicological localizations of ROS in different topographic-anatomical zones. The paper pays special attention to the singlet oxygen produced by the samples upon microwave treatment, as a physiologically active and highly reactive agent.

Background: Endometrial Thickness (EMT) is considered an important prognostic factor in assisted reproductive technology (ART), particularly in frozen embryo transfer (FET) cycles. Thin endometrium (< 7 mm) is often associated with implantation failure and reduced pregnancy rates, although its precise impact remains controversial.Objective: This thesis summary evaluates the role of thin endometrium in FET cycles, discusses etiologies, diagnostic modalities, treatment approaches, and reviews available patient data.Methods: We retrospectively analyzed 69 patients who underwent FET at Saveetha Medical College. Endometrial thickness was assessed via transvaginal ultrasound. Various treatment strategies including hormonal therapies (estradiol, progesterone), vasoactive agents, granulocyte colony-stimulating factor (G-CSF), platelet-rich plasma (PRP), L-arginine, sildenafil citrate, vitamin E, pentoxifylline, and stem cell therapy were reviewed for their efficacy in improving endometrial receptivity.Results: Endometrial thickness < 7 mm correlated with lower pregnancy rates compared to patients with thickness ≥ 7 mm. Hormonal and adjuvant therapies reported varying degrees of success in improving EMT and subsequent pregnancy outcomes. Vascularity, angiogenesis, and Doppler studies also demonstrated a significant association with endometrial receptivity.Conclusion: Thin endometrium remains a critical challenge in ART cycles. Multimodal therapeutic approaches may improve outcomes; however, larger prospective studies are required to establish standardized protocols. Our patient data support that even minimal increases in EMT can enhance implantation success.

Background: Human 30kb coronaviruses entered through the ACE-2 receptors causing fibrosis of the lungs and causing six million deaths worldwide. Here, we have investigated the mutations, deletions and insertions of the recent JN.1 omicron coronaviruses to demonstrate that coronaviruses have reached the pre-elimination stage. Methods: We multi-aligned the genomes of recent JN.1 variants using NCBI Virus Portal and CLUSTAL-Omega. The spike proteins are multi-aligned using MultAlin software and CLUSTAL-Omega.Results: The 17MPLF spike insertion was confirmed to compensate 24LPP, 31S, 69HV, 145Y, 211N and 483V deletions. The 49nt deletions in the 3’-UTR were found in 4997 JN.1 sequences although 26nt deletion was initiated previously in JN.1 as well as BA.5, BF.7, BQ.1 and XBB.1.5 omicron viruses. We first compare 3-D structures of spike proteins with or without 17MPLF four amino acids insertion and nine amino acids deletions using SWISS MODELLING. The JN.1 viruses caused a more stable trimeric spike involving Thr342, Lys436, Lys440, His441, Ser442, Gly443, Tyr445, Lys479, Ser489, Tyr490, Arg493, Pro494, Thr495, and Gln501 amino acids to interact with ACE-2 receptors. The FLiRT spike mutations were found in most KP.2 variants and other changes occurred at the NH2 terminus.Conclusion: We claimed that pre-death changes were initiated in JN.1 COVID-19 lineages and computer simulation showed that the Howard spike with 17MPLF spike insertion appeared more stable than the Oppentrons-spike without 17MPLF insertion. Surely, conflicts of COVID-19 spike sequences must be resolved.

Custard apple is a tropical fruit that is cultivated all over India. The seeds of this fruit are found to have medicinal properties as they contain active compounds such as alkaloids, cyclohexapeptides, and acetogenins. It has been used in powdered form for the treatment of scalp lice and dandruff in our part of the world as a native medicine for a long time. We report a case of bilateral severe toxic keratoconjunctivitis following accidental exposure to custard apple seed powder.