bluuebunny/crossref_metadata_2025 huggingface dataset:
Managing the Lesion and Counseling Patient Post–Breast Biopsy
Authors: Raghavan Bagyam , Gautham M. V. , Monushree R. , Kurian Ann , Geethapriya Sivaramalingam , Sathyashree V.
Published: September 2023

Breast cancer is the leading cause of cancer deaths worldwide among women. Early diagnosis and prompt treatment offers a chance for cure and long-term survival among afflicted women. Triple assessment which includes clinical examination, radiological imaging and histopathological evaluation has become a standard of care in the evaluation of breast cancer. Radiological imaging involves mammography, ultrasound, and magnetic resonance imaging while pathological evaluation can be done on fine needle, core-needle, and surgical excision biopsy specimens with core needle biopsy being the workhorse for diagnosis. While triple assessment has increased the diagnostic yield and helps in the identification of early lesions, an increasing subset of patients present with a situation where the imaging and pathological characteristics of a lesion do not correlate with each other thereby causing diagnostic and therapeutic dilemma. Imaging and pathology concordance and discordance present distinctly under differing circumstances in the care of the patient. While those with concordant findings proceed to treatment or follow up directly and hence benefit from the early treatment, those with discordant findings are beset with a delay in the diagnosis and should be subjected to further evaluations for confirming or refuting a diagnosis. This article reviews the salient features of image-guided breast biopsy and the outcomes and management options in imaging and pathology concordance and discordance. We also discuss the role of a radiologist in the counselling of the patient before and after receiving the pathological report after biopsy.
Sedation and General Anesthesia in Diagnostic Pediatric Imaging
Authors: Choudhary Prakash , Boski Neha
Published: September 2023

Objective In this article we will try and provide a comprehensive literature review on the use of sedation and general anesthesia (SAGA) in pediatric population for diagnostic studies and the salient differences in practices worldwide particularly with regards to the practice differences in developed versus developing countries.

Methods The key articles we obtained were primarily from Indian Journal of Anesthesia, Local NHS Trust protocols, PubMed, MEDLINE, NICE Evidence, UptoDate (Wolters Kluwer), and The Cochrane Library.

Results In the last two decades pediatric radiology has seen a huge increase in volume of procedures with a proportional increase in SAGA. The duration being dependent on the modality (for example, few minutes for computed tomography scan and up to an hour for magnetic resonance imaging particularly if there are multiple studies). SAGA has an extensive list of adverse effects that could be due to the underlying drug or due to wrong patient selection. The principles for safe use of the drugs remain the same just like any other medical or surgical procedure and include meticulous assessments of children and ruling out the contraindications, obtaining parental consent, deciding the drugs which can be given, ascertain the duration of procedure after communication with the radiologist, monitor closely before, during, and after the procedure, discharge, and after the discharge criteria are met. All the above criteria depend on the local guidelines and therefore vary from not only one country to the other but also from one institution to the other within the same country.

Conclusion As expected, the SAGA techniques, drugs, and personnel involved in delivering the care vary from country to country. However, the final and desired outcome remains the same that is to deliver safe care with acquisition of optimal images that serve the purpose of arriving at the correct diagnosis.
Unveiling the Enigma of Sellar and Parasellar Pathologies: A Pictorial Essay
Authors: Gulati Anshika
Published: September 2023

Sellar and parasellar pathologies often present with nonspecific symptoms. Clinical examination and endocrine studies are useful but cross-sectional imaging is indispensable to characterize and accurately localize the lesion. Magnetic resonance imaging with its multiplanar capability and excellent soft tissue contrast resolution is workhorse in evaluation of sellar and parasellar pathologies. Imaging findings of a broad spectrum of lesions is presented in this article along with anatomy and literature review.
Chest X-Ray as the First Pointer in Various Skeletal Dysplasia and Related Disorders
Authors: Jain Rupali , Naranje Priyanka , Gupta Neerja , Sinha Pallavi , Kabra Madhulika , Gupta Arun Kumar , Jana Manisha
Published: September 2023

Chest X-ray (CXR) is the most commonly used imaging modality. It is commonly used for respiratory or cardiac ailments; however, it is also used routinely as a part of skeletal surveys. In the case of suspected skeletal dysplasia, the viewer is alerted regarding the presence of some skeletal abnormality. But in case of a routine CXR performed for some other reason, it is not uncommon to miss subtle pointers of skeletal dysplasia. Sometimes routine CXR is the first pointer to alert a radiologist toward some generalized skeletal anomaly and therefore, initiate its proper evaluation by the skeletal survey.
Contrast Enhanced Mammography Descriptors using Breast Imaging and Reporting and Data System
Authors: Subramaniam Prema , Renganathan Rupa , Rajalakshmi Parameswaran Prathiba , Thakur Vinita
Published: September 2023

Contrast-enhanced mammography (CEM) is an emerging breast imaging technique with a potential to develop into a one-stop imaging solution for several conditions which require imaging, especially its role in cancer detection and local staging when combined with ultrasound. In 2022, CEM lexicon was published as a supplement to the American College of Radiology Breast Imaging Reporting and Data System (ACR BIRADS) fifth edition. This pictorial review illustrates the findings that are seen on CEM using ACR BIRADS CEM lexicon to make the reader familiar with the terminologies. In our experience, interpretation and description of findings in CEM using ACR-BIRADS CEM lexicon had a short learning curve and it was easy to implement in practice as most of the terminologies were already in use for interpreting magnetic resonance imaging.
Advancements in cell assembly for tissue reconstruction and the impacts of vitro tumor models
Authors: Liebendorfer Adam
Published: September 2023

Challenges and advancements in magnetophoresis for cell assembly in tissue engineering creates opportunities for improved personalized medicine in tumor model engineering.
A new twist on PIFE: photoisomerisation-related fluorescence enhancement
Authors: Ploetz Evelyn , Ambrose Benjamin , Barth Anders , Börner Richard , Erichson Felix , Kapanidis Achillefs N , Kim Harold D , Levitus Marcia , Lohman Timothy M , Mazumder Abhishek , Rueda David S , Steffen Fabio D , Cordes Thorben , Magennis Steven W , Lerner Eitan
Published: September 2023

PIFE was first used as an acronym for protein-induced fluorescence enhancement, which refers to the increase in fluorescence observed upon the interaction of a fluorophore, such as a cyanine, with a protein. This fluorescence enhancement is due to changes in the rate of cis/trans photoisomerisation. It is clear now that this mechanism is generally applicable to interactions with any biomolecule. In this review, we propose that PIFE is thereby renamed according to its fundamental working principle as photoisomerisation-related fluorescence enhancement, keeping the PIFE acronym intact. We discuss the photochemistry of cyanine fluorophores, the mechanism of PIFE, its advantages and limitations, and recent approaches to turning PIFE into a quantitative assay. We provide an overview of its current applications to different biomolecules and discuss potential future uses, including the study of protein-protein interactions, protein-ligand interactions and conformational changes in biomolecules.
Photo-physical characterization of high triplet yield brominated fluoresceins by transient state (TRAST) spectroscopy
Authors: Demirbay Baris , Baryshnikov Glib , Haraldsson Martin , Piguet Joachim , Ågren Hans , Widengren Jerker
Published: September 2023

Photo-induced dark transient states of fluorophores can pose a problem in fluorescence spectroscopy. However, their typically long lifetimes also make them highly environment sensitive, suggesting fluorophores with prominent dark-state formation yields to be used as microenvironmental sensors in bio-molecular spectroscopy and imaging. In this work, we analyzed the singlet–triplet transitions of fluorescein and three synthesized carboxy-fluorescein derivatives, with one, two or four bromines linked to the anthracence backbone. Using transient state (TRAST) spectroscopy, we found a prominent internal heavy atom (IHA) enhancement of the intersystem crossing (ISC) rates upon bromination, inferred by density functional theory calculations to take place via a higher triplet state, followed by relaxation to the lowest triplet state. A corresponding external heavy atom (EHA) enhancement was found upon adding potassium iodide (KI). Notably, increased KI concentrations still resulted in lowered triplet state buildup in the brominated fluorophores, due to relatively lower enhancements in ISC, than in the triplet decay. Together with an antioxidative effect on the fluorophores, adding KI thus generated a fluorescence enhancement of the brominated fluorophores. By TRAST measurements, analyzing the average fluorescence intensity of fluorescent molecules subject to a systematically varied excitation modulation, dark state transitions within very high triplet yield (>90%) fluorophores can be directly analyzed under biologically relevant conditions. These measurements, not possible by other techniques such as fluorescence correlation spectroscopy, opens for bio-sensing applications based on high triplet yield fluorophores, and for characterization of high triplet yield photodynamic therapy agents, and how they are influenced by IHA and EHA effects.
Lower jaw modularity in the African clawed frog (Xenopus laevis) and fire salamander (Salamandra salamandra gigliolii)
Authors: Stevens Maddison , Fabre Anne-Claire , Felice Ryan N
Published: September 2023

Modularity describes the degree to which the components of complex phenotypes vary semi-autonomously due to developmental, genetic and functional correlations. This is a key feature underlying the potential for evolvability, as it can allow individual components to respond to different selective pressures semi-independently. The vertebrate lower jaw has become a model anatomical system for understanding modularity, but to date most of this work has focused on the mandible of mammals and other amniotes. In contrast, modularity in the mandible of lissamphibians has been less well studied. Here, we used geometric morphometrics to quantify the static (intraspecific) modularity patterns in Xenopus laevis and Salamandra salamandra gigliolii. We tested developmental and functional hypotheses of modularity and demonstrate that both species exhibit significant modularity. Functional modularity was supported in both Xenopus and Salamandra. Allometry has a small yet significant impact on lower jaw shape in both taxa and sex has a significant effect on shape in Xenopus. The high lower jaw modularity in both species observed here, combined with the well-established modularity of the amphibian cranium, suggests that modularity is a ubiquitous feature of the tetrapod head.
Brain–gut axis mechanism of subthreshold nonsuicidal self-injury addictive features in adolescents
Authors: Niu Zhiang , Luo Huiting , Zhang Xun , Wu Xiaohui , Tang Qiao , Chen Chen , Li Jing
Published: September 2023

Nonsuicidal self-injury (NSSI) is associated with an increased risk of suicide. As the diagnostic criteria outlined in DSM-5 and other related clinical studies, a patient must have engaged in self-injurious behavior at least 5 times within the past year. However, patients with fewer than 5 self-injury behaviors should not be ignored. Our study included 46 adolescents aged 10–19 years with subthreshold NSSI (sNSSI), along with a control group of 50 healthy adolescents matched for age and other factors. We collected resting-state functional magnetic resonance imaging data and stool samples. The Ottawa Self-Injury Inventory and Deliberate Self-Harm Inventory were used to evaluate self-harm behaviors and addictive features. Local brain activity was assessed using fractional amplitude of low-frequency fluctuations (fALFF), and brain regions with abnormal fALFF were selected as seeds for whole-brain functional connectivity analysis. Stool samples were identified using 16S rDNA amplicon sequencing, and the LDA Effect Size method was used to explore significant differences between grouped samples. Mediation analysis was performed to investigate the brain–gut axis mechanisms of addictive features in sNSSI. We found that compared with healthy controls, sNSSI patients have abnormal fALFF in left thalamus and posterior cingulate cortex, dysconnectivities of left thalamus, and decreased Prevotellaceae. Our results suggested that addictive features of sNSSI may have a brain–gut mechanism. Furtherly, patients with 1–4 NSSI behaviors in the past year should have separate name for identification, such as “subthreshold NSSI”.
Association between subclinical atherosclerosis and cardiac structure and function—results from the UK Biobank Study
Authors: Simon Judit , Fung Kenneth , Raisi-Estabragh Zahra , Aung Nay , Khanji Mohammed Y , Zsarnóczay Emese , Merkely Béla , Munroe Patricia B , Harvey Nicholas C , Piechnik Stefan K , Neubauer Stefan , Leeson Paul , Petersen Steffen E , Maurovich-Horvat Pál
Published: September 2023

Aims

Heart failure (HF) is a major health problem and early diagnosis is important. Atherosclerosis is the main cause of HF and carotid intima-media thickness (IMT) is a recognized early measure of atherosclerosis. This study aimed to investigate whether increased carotid IMT is associated with changes in cardiac structure and function in middle-aged participants of the UK Biobank Study without overt cardiovascular disease.

Methods and results

Participants of the UK Biobank who underwent CMR and carotid ultrasound examinations were included in this study. Patients with heart failure, angina, atrial fibrillation, and history of myocardial infarction or stroke were excluded. We used multivariable linear regression models adjusted for age, sex, physical activity, body mass index, body surface area, hypertension, diabetes, smoking, ethnicity, socioeconomic status, alcohol intake, and laboratory parameters. In total, 4301 individuals (61.6 ± 7.5 years, 45.9% male) were included. Multivariable linear regression analyses showed that increasing quartiles of IMT was associated with increased left and right ventricular (LV and RV) and left atrial volumes and greater LV mass. Moreover, increased IMT was related to lower LV end-systolic circumferential strain, torsion, and both left and right atrial ejection fractions (all P < 0.05).

Conclusion

Increased IMT showed an independent association over traditional risk factors with enlargement of all four cardiac chambers, decreased function in both atria, greater LV mass, and subclinical LV dysfunction. There may be additional risk stratification that can be derived from the IMT to identify those most likely to have early cardiac structural/functional changes.
Unemployment and Development
Authors: Feng Ying , Lagakos David , Rauch James E
Published: September 2023

We draw on household survey data from countries of all income levels and document that average unemployment rates increase with gross domestic product per capita. This is accounted for almost entirely by low—rather than high—educated workers. We interpret these facts in a model with frictional labour markets, a traditional self-employment sector, skill-biased productivity differences across countries, and unemployment benefits that become more generous with development. A calibrated version of the model does well in explaining the cross-country patterns that we document. Counterfactual exercises point to skill-biased productivity differences as the most important factor in explaining the cross-country unemployment patterns.
Transcriptomic landscape of Atlantic salmon (Salmo salar L.) skin
Authors: Sveen Lene R , Robinson Nicholas , Krasnov Aleksei , Daniels Rose Ruiz , Vaadal Marianne , Karlsen Christian , Ytteborg Elisabeth , Robledo Diego , Salisbury Sarah , Dagnachew Binyam , Lazado Carlo C , Tengs Torstein
Published: September 2023

In this study, we present the first spatial transcriptomic atlas of Atlantic salmon skin using the Visium Spatial Gene Expression protocol. We utilized frozen skin tissue from 4 distinct sites, namely the operculum, pectoral and caudal fins, and scaly skin at the flank of the fish close to the lateral line, obtained from 2 Atlantic salmon (150 g). High-quality frozen tissue sections were obtained by embedding tissue in optimal cutting temperature media prior to freezing and sectioning. Further, we generated libraries and spatial transcriptomic maps, achieving a minimum of 80 million reads per sample with mapping efficiencies ranging from 79.3 to 89.4%. Our analysis revealed the detection of over 80,000 transcripts and nearly 30,000 genes in each sample. Among the tissue types observed in the skin, the epithelial tissues exhibited the highest number of transcripts (unique molecular identifier counts), followed by muscle tissue, loose and fibrous connective tissue, and bone. Notably, the widest nodes in the transcriptome network were shared among the epithelial clusters, while dermal tissues showed less consistency, which is likely attributable to the presence of multiple cell types at different body locations. Additionally, we identified collagen type 1 as the most prominent gene family in the skin, while keratins were found to be abundant in the epithelial tissue. Furthermore, we successfully identified gene markers specific to epithelial tissue, bone, and mesenchyme. To validate their expression patterns, we conducted a meta-analysis of the microarray database, which confirmed high expression levels of these markers in mucosal organs, skin, gills, and the olfactory rosette.
Human Resource Management
Authors: Gilmore Sarah , Williams Steve
Published: September 2023

Human Resource Management is made up of five parts. Part One looks at the nature of human resource management (HRM). Part Two is about the external and internal contexts of HRM. It looks atexamines the business environment of HRM. Part Three is about concerned with the essence of HRM. Topics covered include recruiting and selecting staff, developing human resources, rewarding people at work, utilizing human resources in organizations, and redundancy. The fourth part looks atPart Four discusses the challenges and controversies of HRM. This includesThese include equality, diversity, dignity, managing performance and absence, employment relations, and managing grievances and conflict. The final part is aboutconsiders ethics and international HRM.
Bayesian denoising of structured sources and its implications on learning-based denoising
Authors: Zhou Wenda , Wabnig Joachim , Jalali Shirin
Published: September 2023

Denoising a stationary process $(X_{i})_{i \in \mathbb{Z}}$ corrupted by additive white Gaussian noise $(Z_{i})_{i \in \mathbb{Z}}$ is a classic, well-studied and fundamental problem in information theory and statistical signal processing. However, finding theoretically founded computationally efficient denoising methods applicable to general sources is still an open problem. In the Bayesian set-up where the source distribution is known, a minimum mean square error (MMSE) denoiser estimates $X^{n}$ from noisy measurements $Y^{n}$ as $\hat{X}^{n}=\mathrm{E}[X^{n}|Y^{n}]$. However, for general sources, computing $\mathrm{E}[X^{n}|Y^{n}]$ is computationally very challenging, if not infeasible. In this paper, starting from a Bayesian set-up, a novel denoising method, namely, quantized maximum a posteriori (Q-MAP) denoiser is proposed and its asymptotic performance is analysed. Both for memoryless sources, and for structured first-order Markov sources, it is shown that, asymptotically, as $\sigma _{z}^{2} $ (noise variance) converges to zero, ${1\over \sigma _{z}^{2}} \mathrm{E}[(X_{i}-\hat{X}^{\mathrm{QMAP}}_{i})^{2}]$ converges to the information dimension of the source. For the studied memoryless sources, this limit is known to be optimal. A key advantage of the Q-MAP denoiser, unlike an MMSE denoiser, is that it highlights the key properties of the source distribution that are to be used in its denoising. This key property leads to a new learning-based denoising approach that is applicable to generic structured sources. Using ImageNet database for training, initial simulation results exploring the performance of such a learning-based denoiser in image denoising are presented.
Near-optimal estimation of linear functionals with log-concave observation errors
Authors: Foucart Simon , Paouris Grigoris
Published: September 2023

This note addresses the question of optimally estimating a linear functional of an object acquired through linear observations corrupted by random noise, where optimality pertains to a worst-case setting tied to a symmetric, convex and closed model set containing the object. It complements the article ‘Statistical Estimation and Optimal Recovery’ published in the Annals of Statistics in 1994. There, Donoho showed (among other things) that, for Gaussian noise, linear maps provide near-optimal estimation schemes relatively to a performance measure relevant in Statistical Estimation. Here, we advocate for a different performance measure arguably more relevant in Optimal Recovery. We show that, relatively to this new measure, linear maps still provide near-optimal estimation schemes even if the noise is merely log-concave. Our arguments, which make a connection to the deterministic noise situation and bypass properties specific to the Gaussian case, offer an alternative to parts of Donoho’s proof.
‘Unorthodox’ Usages of the Term xabar in the Early Arabic Grammatical Tradition
Authors: Kasher Almog
Published: September 2023

This paper examines the term xabar. It focuses on cases where xabar, or the dyad ism-xabar, is used at variance with canonical theory. These cases suggest that the triad X + X's ism + X's xabar (familiar when X = ʾinna, kāna and their ‘sisters’) was used to accommodate tripartite configurations whose so-called xabar is not a predicate, or whose ism and xabar are generally taken to be mubtadaʾ and xabar. This syntactic model, which differs significantly from the canonical theory of sentence types in the Arabic grammatical tradition, was most probably designed for pedagogical aims. This alternative model analyzes sentences according to their surface structure, with focus on initial constituents, whereas canonical syntactic model's point of departure is a distinction between sentence types, based on the concept of predication and taking into consideration word order variation. An appendix on the little-known grammarian al-Quhunduzī examines the history of the figure, who has in modern scholarship been confused with another author. Pinning down his identity and the period in which he lived dispels confusion about the figure, allowing us to better place his work in the scholarly record.
Several Genizah Fragments of Saadya Gaon's Translation of the Pentateuch Copied by Yedutun ben Levi
Authors: Zewi Tamar , Ashur Amir
Published: September 2023

This article presents several Genizah fragments containing passages of Saadya Gaon's translation of the Pentateuch in the handwriting of a copyist identified as Yedutun Ha-Levi ben Levi He-Ḥaver, who was active in the first half of the thirteenth century. These passages are transcribed in full in the article, together with a critical apparatus which compares them with early important manuscripts of Saadya Gaon's translation of the Pentateuch and the popular critical Derenbourg edition. The textual and grammatical analysis following these passages shows that their language should be regarded as post-Classical, and that both text and language broadly correspond with the early version of this translation, represented in MS St. Petersburg, RNL, MS Yevr. II C 1—the earliest inclusive manuscript of Saadya Gaon's translation of the Pentateuch copied by Samuel ben Jacob at the beginning of the eleventh century.
Monte Carlo Regression for Evaluating Children’s Role in the Pandemic Spread on the Example of Delta COVID-19 Wave
Authors: Mańdziuk Joanna , Okarska-Napierała Magdalena , Woźniak Weronika , Hryniewicka Ada , Radziński Piotr , Gambin Anna , Podsiadły Edyta , Demkow Urszula , Kuchar Ernest
Published: September 2023

Background:

The children’s role in transmitting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the familial settings is uncertain. We aimed to assess how often children were the index cases transmitting SARS-CoV-2 into their households during the Delta wave, and to identify risk factors of children being the index case.

Methods:

In this prospective survey study, we collected information regarding household members of SARS-CoV-2-positive children tested in a single tertiary hospital. Some patients were tested with polymerase chain reaction and those samples were typed and classified as Delta or non-Delta variant. We have used the Monte Carlo approach to assess predictors of children being the index case in the household.

Results:

We surveyed 629 families and 515 of them fulfilled inclusion criteria. The child was the index case in 359 (69.71%) households. Attending childcare facilities in all age groups was positively associated with being the index case in the household [nursery, estimate = 1.456, 95% confidence interval (CI): 1.456–1.457, P < 0.001; kindergarten, estimate = 0.899, 95% CI: 0.898–0.900, P = 0.003; school, estimate = 1.23, 95% CI: 1.229–1.231, P = 0.001]. The same association was present in the subgroup of the families with the predominant Delta variant, but not in the subgroup with the predominant non-Delta variant.

Conclusions:

Attending childcare and educational facilities might be a significant predictor of a child being the SARS-CoV-2 index case in their household. Children’s role in driving the SARS-CoV-2 pandemic changes in consecutive waves. The Monte Carlo approach can be applied to assess risk factors of infectious agents’ spread in future epidemics.
Epidemiology and Burden of Influenza in Children 0–14 Years Over Ten Consecutive Seasons in Italy
Authors: Barbieri Elisa , Porcu Gloria , Donà Daniele , Cavagnis Sara , Cantarutti Luigi , Scamarcia Antonio , McGovern Ian , Haag Mendel , Giaquinto Carlo , Cantarutti Anna
Published: September 2023

Background:

In Europe, influenza vaccination coverage in the pediatric population is low. This study describes the influenza incidence and associated healthcare utilization in the pediatric population in Italy.

Methods:

Deidentified data from electronic medical records for children 0–14 years old seen by >150 family pediatricians in the Pedianet network in Italy were evaluated for 10 influenza seasons spanning 2010–2020. Incidence of influenza (cases per 1000 person-months), related sequelae and associated healthcare resource use were determined using diagnostic, prescription and medical examination data.

Results:

Over 10 seasons, an average of 8892 influenza cases (range, 4700–12,419; total 88,921) were diagnosed in a cohort of 1,432,384 children 0–14 years of age. Influenza vaccination coverage was 3.6% among children with an influenza diagnosis and 6.8% among children without. Influenza-related healthcare resource utilization included 1.58 family pediatrician visits per influenza episode and 220 ED and 111 hospital admissions, with the highest resource usage among children 1–4 years and lowest among children <6 months old. The most common influenza complications were acute otitis media (2.9% of influenza cases) and pneumonia (0.5%). Antibiotics were prescribed in 38.7% of influenza cases; no antiviral agents were prescribed. One intensive care unit admission and 2 cases requiring ventilatory support were documented. No influenza-related deaths were reported.

Conclusion:

Pediatric influenza vaccination was low despite the burden and healthcare use related to seasonal influenza in the pediatric population during a 10-year period in Italy.
Carbapenem-resistant Klebsiella pneumoniae Osteoarthritis in Two Preterm Infants Treated With Ceftazidime-avibactam
Authors: Pu Weicong , Fan Lili , Zhang Yudong , You Dianping , Li Mei , Ma Li
Published: September 2023

Background:

The emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) poses a major threat to global public health. CRKP infections are challenging to treat owing to the limited number of antibiotic species, especially in preterm infants. Ceftazidime-avibactam (CAZ-AVI) is a novel antibiotic with activity against CRKP. At present, there have been no reports of using CAZ-AVI to treat osteoarthritis in premature infants.

Methods:

We describe 2 preterm infants with CRKP osteoarthritis treated with CAZ-AVI in a tertiary children’s hospital in China. Clinical characteristics, laboratory and microbiologic data, treatment and follow-up information were retrospectively collected and analyzed.

Results:

The 2 cases were both premature infants who contracted sepsis and CRKP osteoarthritis. Meropenem and polymyxin B were initially chosen for the first infant. CAZ-AVI was then used due to persistent infection. The second infant was commenced immediately on CAZ-AVI after receipt of antimicrobial susceptibility on the 4th day after admission. Both recovered with CAZ-AVI (50 mg/kg q8h) and surgical incision and drainage. Neither had a joint deformity or limb length discrepancy at 36 and 34 months, respectively.

Conclusions:

This is the first report on the use of CAZ-AVI to treat CRKP osteoarthritis in premature infants. Successful treatment depends on prompt recognition of the pathogen and treatment with a combination of antibiotics with or without surgery. Further study is needed to determine the pharmacokinetics and pharmacodynamics of CAZ-AVI for treating preterm infants with serious CRKP osteoarthritis.
Respiratory Syncytial Virus in Outpatient Children with Bronchiolitis: Continuous Virus Circulation During the Nonepidemic Period
Authors: Rybak Alexis , Cohen Robert , Kramer Rolf , Béchet Stéphane , Delobbe Jean-François , Dagrenat Véronique , Vié Le Sage François , Deberdt Patrice , Wollner Alain , Bangert Mathieu , Levy Corinne
Published: September 2023

We aimed to estimate the respiratory syncytial virus positivity rate among ambulatory children with bronchiolitis according to the bronchiolitis epidemic period as defined by the French Public Health Institute. The positivity rate was 28.9% during the nonepidemic period and 50.6% during the epidemic period, which suggests continuous virus circulation between bronchiolitis annual peaks.
Spontaneous Clostridium perfringens Meningitis and Brain Abscess in a Neonate
Authors: Shillitoe Ben , Cowie Christopher J. A. , Misgar Hilal , Pareja-Cebrian Lucia , Williams Eleri
Published: September 2023

This case describes a neonate who presented with spontaneous Clostridium perfringens meningitis and brain abscess. The abscess was drained, and the infant completed a 6-week course of antibiotics. Throughout this time the infant remained well with no need for intensive care. C. perfringens central nervous system infections are associated with trauma and poor outcomes. This case highlights that the spectrum of disease can include spontaneous infection with a relatively mildly clinical course demonstrating the importance of 16s polymerase chain reaction in culture-negative cases and its role in detecting rare causes of central nervous system infections such as C. perfringens.
Novel echocardiographic markers for left ventricular filling pressure prediction in heart failure with preserved ejection fraction (ECHO-PREDICT): a prospective cross-sectional study
Authors: Suleman Muhammad , Saqib Muhammad , Mumtaz Hassan , Iftikhar Muhammad , Raza Ali , Rauf Butt Samia , Talha Kenza Manahal
Published: September 2023

Heart failure with preserved ejection fraction is a complex clinical syndrome associated with a high level of morbidity and mortality, constituting 56% of heart failure cases and showing an increasing prevalence. The E/Ea ratio, used for echocardiographic assessment of left ventricular (LV) filling pressure, has been commonly recommended as a noninvasive measure. However, its validity lacks robust prospective validation in patients with preserved LV ejection fraction, and its accuracy has been questioned in comparison to patients with reduced LV ejection fraction. The objective of this study was to evaluate the accuracy of novel echocardiographic markers incorporating peak E velocity, left atrial volume index (LAVi), and pulmonary artery systolic pressure (PAP) for noninvasive estimation of LV end-diastolic pressure (LVEDP) against invasive measurement. In this cross-sectional study conducted at a tertiary care hospital, a sample size of 122 participants was utilized. Statistical analyses including independent samples t-test, χ2 test, and linear regression analysis were employed to explore correlations and predict outcomes. The results indicated that Group 1 (LVEDP <20 mmHg) had a mean age of 59.25 years, while Group 2 (LVEDP >20 mmHg) had a mean age of 56.93 years. Mitral E velocity positively predicted LVEDP, while Mitral E/A ratio showed a negative association. Notably, (E+PAP)/2, (E+LAVi)/2, and Mitral E exhibited good discriminative ability, with respective area under the curve values of 0.840, 0.900, and 0.854. (E+LAVi)/2 demonstrated the highest discriminatory power, with a threshold of 40.100, yielding high sensitivity (0.971) but relatively low specificity (0.302) in predicting LVEDP greater than 20. These findings emphasize the accuracy and utility of combining diastolic variables and peak E velocity as markers for left ventricular filling pressure in patients with a high burden of cardiac disease. Additionally, the study highlights the importance of these parameters in assessing cardiac abnormalities and supports the potential of novel echocardiographic parameters, particularly (E+LAVi)/2, in predicting LVEDP greater than 20. Further research is warranted to validate and explore the prognostic implications of these parameters in larger patient populations, ultimately improving the diagnosis and management of cardiac disease and enhancing clinical outcomes.
Propensity score-matched comparison of safety outcomes between high-risk and low-risk patients towards early hospital discharge after laparoscopic cholecystectomy
Authors: Cheewatanakornkul Siripong , Yolsuriyanwong Kamthorn , Wangkulangkul Piyanun , Bualoy Praisuda , Sakolprakaikit Kanittha
Published: September 2023

Background:

Laparoscopic cholecystectomy (LC), a common treatment for symptomatic gallstones, has demonstrated safety in low-risk patients. However, existing data are scarce regarding the safety of LC in high-risk patients and the feasibility of early hospital discharge.

Materials and methods:

This retrospective study included 2296 patients diagnosed with symptomatic gallstones who underwent LC at a tertiary care centre from January 2009 through December 2019. The authors employed propensity score matching to mitigate bias between groups. Statistical significance was set at P less than 0.05.

Results:

The median age of the patients was 56 years (range 46–67), with a mean BMI of 25.2±4.3 kg/m2. Patients were classified as: American Society of Anesthesiologists (ASA) I (19.7%), II (68.3%), III (12.0%), and IV (0%). ASA I–II included low surgical risk patients (88%) and ASA III–IV comprised high-risk patients (12%). The LC-related 30-day reoperative rate was 0.2% and the readmission rate was 0.87%. Nine patients (0.4%) sustained major bile duct injuries, resulting in a conversion rate of 2.4%. The postoperative mortality rate was 0.04%, and the mean hospitalization time was 3.5 days. Patients in the high-risk group with a history of acute cholecystitis exhibited greater estimated blood loss, longer operative times, and were significantly more likely to be in the longer-stay group.

Conclusion:

These findings suggest that LC can be conducted safely on high-risk patients, and early hospital discharge is achievable. However, specific factors, such as a history of acute cholecystitis, may result in prolonged hospitalization owing to increased blood loss and longer operative times.
Coexistence of choroidal melanoma and rhegmatogenous retinal detachment: a case report and literature review
Authors: Pokawattana Nattapol , Prasert Wiwat , Silpa-archa Sukhum
Published: September 2023

Introduction and importance:

The simultaneous occurrence of rhegmatogenous retinal detachment (RRD) and choroidal melanoma is extremely rare, and diagnosis of choroidal melanoma in RRD patients is challenging. As a result, choroidal masses in RRD patients tend to be overlooked, resulting in delayed treatment. The authors report a rare case presenting with simultaneous choroidal melanoma and RRD, and the authors review the related literature.

Case presentation:

A 45-year-old Thai man who presented with inferior RRD and choroidal elevation in the left eye was examined using fundoscopy and ultrasonography. The presumptive diagnosis was simultaneous RRD and haemorrhagic choroidal detachment (CD). Vitrectomy and external drainage were attempted but were unsuccessful in draining fluid from the presumed haemorrhagic CD. Although the retina was reattached, the choroidal elevation remained unchanged. After being lost to follow-up, the patient returned later with severe proptosis in the left eye. MRI findings suggested a presumptive diagnosis including choroidal melanoma and choroidal metastasis, which choroidal melanoma was later confirmed through histopathological examination after exenteration.

Clinical discussion:

Important clinical clues were provided for distinguishing between choroidal melanoma and haemorrhagic CD in cases of coexisting RRD.

Conclusions:

In the differential diagnosis of RRD with suspicious choroidal elevation, the possibility of the presence of choroidal melanoma should be considered. In particular, in cases where haemorrhagic CD fails to drain during surgery, the possibility of underlying choroidal melanoma should be investigated.
Jejunal duplication cyst in a female neonate: a case report
Authors: Sah Rajesh Prasad , Bhusal Amrit , Pokhrel Sagar , Yogi Tek Nath , Labh Sujal , Acharya Kshitiz , Pokharel Sushan , Bhattarai Madhur
Published: September 2023

Introduction and importance:

Duplications are the abnormal portion of the intestine, either externally attached to the intestine or intrinsically placed within the bowel lumen. Their prevalence is noted to be around one in 25 000 deliveries. The rare gastrointestinal tract duplication may be located in any part of the gastrointestinal system from the oral cavity to the anus. The most common site of enteric duplication cyst (DC) is the terminal part of the ileum. Hence, duplications in jejunum are rare.

Case presentation:

Hereby, the authors report a case of jejunal DC in a female neonate which was managed successfully via surgery and adequate post-operative care without any complications.

Clinical discussion:

Duplications are more frequently single. They are usually located in the mesenteric border of the associated native bowel and may vary in shape and size. Most of them are cystic, followed by tubular and mixed type, with or without other congenital anomalies. More than 80% of the cases present before the age of 2 years as an acute abdomen or bowel obstruction, but many duplications remain silent unless complications occur, and therefore may not be diagnosed until adulthood. Complications of enteric DC include volvulus, bleeding, and, rarely, malignant degeneration.

Conclusion:

It is important for paediatric surgeons to include DC in the differential diagnosis if a neonate presents with features of intestinal obstruction.
Artificial intelligence (AI) in personalized medicine: AI-generated personalized therapy regimens based on genetic and medical history: short communication
Authors: Parekh Ad-Duhaa E. , Shaikh Omer A. , Simran  , Manan Sadia , Hasibuzzaman Md. Al
Published: September 2023

Personalized medicine entails tailoring medical care to an individual's unique genomic and molecular characteristics. AI holds significant promise in advancing the field of personalized medicine. The challenge lies in effectively analyzing vast amounts of data to create tailored treatment approaches. The incorporation of AI into personalized treatment will require healthcare infrastructure adjustments. Upon patients' arrival, their personal data and clinical information (including images, electrophysiology findings, genetic data, blood pressure, medical notes, etc.) are gathered into the AI system with their consent. Subsequently, the AI system utilizes this patient-specific data to offer healthcare recommendations, aiding healthcare professionals in their clinical decision-making. Results and insights from these recommendations, whether accurate or not, are logged and fed back into the AI system to enhance its precision.
Rare giant renal artery aneurysm in neurofibromatosis type 1 patient: a case report
Authors: Jawad Ali , Hannouneh Zein Alabdin , Soqia Jameel , Al Nahhas Zaher , Ahmed Adnan , Nahas Mohamad Ali
Published: September 2023

Introduction and importance:

Neurofibromatosis type 1 (NF1) is a genetic disorder characterised by multiple neurofibromas, café-au-lait spots, and iris hamartomas. The variety of vasculopathies that can occur in NF1 make it difficult for clinicians to accurately follow-up patients. Most cases of vasculopathies are stenotic, and, in few cases, aneurysms may form.

Case presentation:

A 35-year-old male presented with extreme left flank pain for the past 2 days. His physical examination revealed whole-body several café-au-lait skin macules, a subcutaneous lesion, and a palpable abdominal mass in the left flank. His laboratory workup was within normal ranges. A multi-slice computed tomography and computed tomography angiogram with contrast outlined a giant left renal artery aneurysm (RAA). A kidney salvage surgery was planned. However, due to ectatic dilatation and large extension of the aneurysm, the affected renal artery branches and renal vein were found unfit for auto-transplantation during the surgical procedure and a total nephrectomy was necessary. Symptoms improved significantly postoperatively and no complications developed.

Clinical discussion:

RAA is an uncommon finding in NF1 patients. Diagnosis is often dependent on computed tomography angiogram. Management techniques are conservative, endovascular, or surgical. In few surgical cases, a total nephrectomy may be necessary if auto-transplantation is not feasible.

Conclusion:

Despite its rarity, the diagnosis of RAA should be considered in patients with NF1 presenting with flank pain. Moreover, early screening for renal vasculopathies can evade critical surgical outcomes including a total nephrectomy. Hence, the authors recommend a total vascular workup for these patients, consisting of doppler ultrasound and, if necessary, a multi-slice computed tomography with contrast.
Effect of CHIKV capsid protein nucleolar localisation on host gene modulation
Authors: Rao Shambhavi , West Nicholas P. , Zaid Ali , Mahalingam Suresh , Taylor Adam
Published: September 2023

Host cell nuclear localisation of alphaviral proteins has been shown to be important for host transcriptional shut off, antagonising type I interferon induction and inhibiting the antiviral response. Our previous studies demonstrate that mutation of the nucleolar localisation sequence (NoLS) of chikungunya virus (CHIKV) capsid protein significantly attenuates CHIKV replication. However, the reason for this attenuation remains unclear. In this study we investigated the impact of CHIKV capsid protein on host gene expression using Nanostring analysis and determined whether nucleolar localisation of capsid protein is required for host gene modulation. Little significant change in differential gene expression (adjusted p value <0.05) was observed in Capsid-WT-EGFP and mutant Capsid-NoLS-EGFP transfected HEK293T cells compared to mock EGFP transfected cells. To explore minor changes to host gene modulation in response to capsid protein, differential gene expression analysis was performed under a reduced arbitrary threshold (unadjusted P value < 0.01). Results suggest that, expressed as a recombinant protein, CHIKV capsid has limited impact on host gene expression, regardless of its ability to localise to the nucleolus. Results further suggest that attenuation of CHIKV resulting from mutation of the capsid protein NoLS is largely dependent on viral rather than host factors.
Quality characteristics of distilled soju using
Dae-hong peaches
Authors: Kang Ji-Eun , Kim Young-Mi , Lee Ju-Eun , Im Bo-Ra , Choi Ji-Ho , Han Gui-Jeong , Jeong Haet-Nim
Published: September 2023

The study was conducted to confirm the possibility of producing alcohol beverages
from Dae-hong peaches. Upon examining the quality
characteristics of distilled soju using
Dae-hong peaches, the alcohol content was 1.12 to 1.16
times higher than that from the atmospheric distillation method.
Soju with 20 % peach extract content had the highest
alcohol content and the lowest volatile acid content, indicating a low
possibility of causing irritating odors. Acetaldehyde was 1.3-1.94 times lower
in vacuum-distilled soju, and methanol was not detected in all
samples. The absorbance value of furfural, a burnt component generated during
distillation is high in atmospheric distillation, which can cause irritating
odors. Upon examining the volatile fragrance components, isoamylalcohol and
1-propanol were found to be the main components, both of which were the highest
in the treatment group with 20 % peach extract content. The electronic
nose analysis revealed that this group showed the most opposing flavor patterns
to the control group, and when distilled under reduced pressure with 20 %
addition of Dae-hong peaches can produce high-quality
soju.