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Non-toxic, biocompatible, biodegradable, and bioadhesive, characteristics, of natural polysaccharides, are widely recognized and well accepted. Their usage in dietary, medicinal, biomedical, and cosmetic, applications is due to their unique and fascinating attributes. Xanthan gum, a microbial polysaccharide possesses diverse-wonderful features. It is a naturally occurring heteropolysaccharide, with large molecular weight, derived from the Gram-negative bacteria, Xanthomonas Campestris. This biopolymer has been studied extensively as a matrix for tablets, nanoparticles, microparticles, hydrogels, and various other formulation types. However, indigenous xanthan gum has its own set of restrictions, which may be overcome by chemical modification, to fine-tune the characteristics of the native gum, for attaining unmet demands. This approach has huge potential in the drug delivery and numerous other promising applications. The objective of this review is to provide a consolidated source of information on xanthan gum-based gastroretentive systems. Several approaches of floating techniques, with recent research avenues and patents, utilizing the natural polysaccharide xanthan gum is also discussed., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Abstract: Children's Oncology Group study AALL1931 investigated the efficacy and safety of recombinant Erwinia asparaginase (JZP458) in patients with acute lymphoblastic leukemia/lymphoblastic lymphoma and hypersensitivity reactions/silent inactivation to Escherichia coli-derived asparaginases. Each pegylated Escherichia coli asparaginase dose remaining in a patient's treatment plan was replaced by intramuscular (IM) or IV JZP458 (6 doses) administered Monday/Wednesday/Friday (MWF). Three IM cohorts (1a [25 mg/m2 MWF], n = 33; 1b [37.5 mg/m2 MWF], n = 83; 1c [25/25/50 mg/m2 MWF], n = 51) and 1 IV cohort (25/25/50 mg/m2 MWF, n = 62) were evaluated. The proportion (95% confidence interval [CI]) of patients maintaining nadir serum asparaginase activity (NSAA) levels of ≥0.1 IU/mL at the last 72 (primary end point) and 48 hours during course 1 was 90% (95% CI, 81-98) and 96% (95% CI, 90-100) in IM cohort 1c, respectively, and 40% (95% CI, 26-54) and 90% (95% CI, 82-98) in the IV cohort. Population pharmacokinetic modeling results were comparable with observed data, predicting the vast majority of patients would maintain therapeutic NSAA levels when JZP458 is administered IM or IV 25 mg/m2 every 48 hours, or IM 25/25/50 mg/m2 MWF, or with mixed IM and IV administration (IV/IV/IM 25/25/50 mg/m2 MWF). Drug discontinuation occurred in 23% and 56% of patients in the IM and IV cohorts, respectively; 13% and 33% because of treatment-related adverse events (mainly allergic reactions and pancreatitis). JZP458 achieves therapeutic NSAA levels via multiple IM and IV dosing schedules based on combined observed and modeled data with a safety profile consistent with other asparaginases. This trial was registered at www.ClinicalTrials.gov as #NCT04145531., (© 2024 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.)

Introduction: Malnutrition among older adults continues to be a prevalent health concern. While literature has highlighted an increased risk of malnutrition mortality for adults older than 65 y, the age threshold at which malnutrition effects survival and mortality remains unexplored., Methods: Annual crude and age-adjusted malnutrition-related mortality data from 2009 to 2018 was extracted from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. We compared crude rates by year, 10-y age groups (15 to 85+ y), and disposition among age groups 65+ y using analysis of variance. We examined crude rates, year, and 10-y age groups (15 to 85+ y) using multiple linear regression. A Welch two sample t-test was used to compare the 10-y age groups 55-64 and 65-74 by crude rate., Results: From 2009 to 2018, there were 275,282 older adult malnutrition-related mortalities. The differences in crude rates by year from 2009 to 2018 (P < 0.001) and all 10-y age groups were significant (P = 0.028). Differences in crude rates by disposition among age groups 65+ were not significant (P = 0.062). A multiple linear regression between crude rates between years 2009 and 2018 by all 10-y age groups showed a significant association (β = 0.06, 95% CI: 0.03, 0.09, P < 0.001). The difference between the annual crude rate for 10-y age groups 55-64 y and 65-74 y was significant (95% CI = 7.49, 13.41, P value <0.001)., Conclusions: Increasing age correlates with higher rates of malnutrition mortality. While nourishment should be a priority for all patients, preventing malnutrition must be a priority for all care with the goal of survival and future research., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Isocitrate dehydrogenase (IDH) wild-type (IDH wt ) glioblastomas (GB) are more aggressive and have a poorer prognosis than IDH mutant (IDH mt ) tumors, emphasizing the need for accurate preoperative differentiation. However, a distinct imaging biomarker for differentiation mostly lacking. Intratumoral thrombosis has been reported as a histopathological biomarker for GB., Purpose: To evaluate the fragmented intratumoral thrombosed microvasculature (FTV) signs on susceptibility-weighted imaging (SWI) for distinguishing IDH wt and IDH mt tumors., Study Type: Retrospective., Subjects: Ninety-seven treatment-naïve patients with histopathologically confirmed IDH wt GB (54 males, 26 females) and IDH mt grade 4 astrocytoma (13 males, 4 females)., Field Strength/sequence: 3-T, SWI, fluid-attenuated-inversion-recovery (FLAIR), T 1 -weighted, T 2 -weighted, PD-weighted, post-contrast T 1 -weighted and dynamic-contrast-enhanced (DCE)-MRI., Assessment: SWI data were evaluated by three experienced neuroradiologists (S.S., 11 years; J.S., 15 years; R.K.G., 40 years of experience), who assessed FTV presence in necrotic and peri-necrotic regions. FTV was identified as intratumoral susceptibility signal having minimal or no interslice connections. Quantitative DCE-MRI parameters were derived using first-pass-analysis and extended Tofts model. FLAIR abnormal, contrast-enhancing, and necrotic regions were segmented using in-house developed U-Net architecture., Statistical Tests: Fleiss' Kappa, Cohen's Kappa, Shapiro-Wilk test, t tests or Mann-Whitney U test, receiver-operating characteristic (ROC) analysis, confusion matrix. A P-value <0.05 was considered statistically significant., Results: Fleiss' kappa test provided 91% inter-rater agreement, and Cohen's kappa provided intrarater agreement ranged from 81% to 97%. The raters' accuracy in distinguishing IDH wt from IDH mt ranged from 92% to 94%. Some of the quantitative DCE-MRI parameters (CBV, Ve, and K trans ) provided statistically significant differences in differentiating IDH wt and IDH mt . K trans demonstrated 80.3% sensitivity and 81.2% specificity, with ROC analysis showing an AUC of 0.77., Data Conclusion: FTV signs in necrotic and peri-necrotic regions on SWI demonstrated a high accuracy in distinguishing IDH wt from IDH mt . Qualitative assessment of FTV signs showed almost perfect inter-rater and intrarater agreement. Quantitative DCE-MRI metrics also showed statistically significant differentiation of IDH wt and IDH mt ., Plain Language Summary: This study demonstrates that preoperative imaging, particularly the visualization of the fragmented thrombosed vasculature (FTV) sign on susceptibility-weighted imaging (SWI), effectively differentiates isocitrate dehydrogenase (IDH) wild-type (IDH wt ) glioblastoma (GB) from IDH mutant (IDH mt ) grade 4 astrocytomas. Over 90% of IDH wt GB patients displayed the FTV sign, a specific imaging biomarker absent in IDH mt cases. Perfusion parameters such as cerebral blood volume, Ve, and K trans were elevated in IDH wt gliomas, reflecting distinct vascular profiles. SWI offers a noninvasive and accurate diagnostic method, overcoming limitations of histopathology. Despite limitations like unequal sample sizes and retrospective analysis, this study underscores the clinical potential of SWI in improving glioma characterization and aiding treatment planning., Level of Evidence: 4 TECHNICAL EFFICACY: Stage 2., (© 2025 International Society for Magnetic Resonance in Medicine.)

Background: The administration of blood components and their alternatives can be lifesaving. Anaemia, bleeding and transfusion are all associated with poor peri-operative outcomes. Considerable changes in the approaches to optimal use of blood components and their alternatives, driven by the findings of large randomised controlled trials and improved haemovigilance, have become apparent over the past decade. The aim of these updated guidelines is to provide an evidence-based set of recommendations so that anaesthetists and peri-operative physicians might provide high-quality care., Methods: An expert multidisciplinary, multi-society working party conducted targeted literature reviews, followed by a three-round Delphi process to produce these guidelines., Results: We agreed on 12 key recommendations. Overall, these highlight the importance of organisational factors for safe transfusion and timely provision of blood components; the need for protocols that are targeted to different clinical contexts of major bleeding; and strategies to avoid the need for transfusion, minimise bleeding and manage anticoagulant therapy., Conclusions: All anaesthetists involved in the care of patients at risk of major bleeding and peri-operative transfusion should be aware of the treatment options and approaches that are available to them. These contemporary guidelines aim to provide recommendations across a range of clinical situations., (Anaesthesia© 2024 The Author(s). Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.)

Severe mental illness (SMI) encompasses depression, bipolar disorder, and schizophrenia which affect the daily quality of life. While it has a significant impact on their social life, it is also supposedly linked with various comorbidities, of which, cardiovascular disease (CVD) is the most frequently reported. Various biological, behavioral, and genetic mechanisms are thought to play a role: hypothalamic-pituitary-adrenal axis, autonomic nervous system dysregulation, inflammation, and psychotropic medications. Lack of exercise, low-fiber diet, smoking, substance abuse, and failure of medicine compliance also strongly contribute to the increased risk for CVD-related death. The understanding of the complex relationship between CVD and SMI would thus play a significant role in decreasing the incidence of CVD-related morbidity and mortality. This article aims to review and explain the hypothesized increased risk of CVD events in patients with SMI., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

As India's population grows and urbanization accelerates, energy demand is increasing sharply while conventional sources fall behind. To tackle energy shortages and climate change, India must prioritize renewable energy sources (RES), which offer sustainable solutions. The country is rich in RES, which can enhance fuel mix for electricity generation. This study analyzes various RES in India-solar, geothermal, hydro, biomass, wave, onshore, and offshore wind energy -using an integrated data envelopment analysis (DEA) and fuzzy analytic hierarchy process (Fuzzy AHP) methodology. Four main parameters-technical, economic, environmental, and socio-political -are identified and supported by 19 criteria, with environmental parameters including both desirable and undesirable criteria. In first phase, undesirable criteria are transformed into desirable criteria using Modified Ratio model. DEA is then applied to calculate initial efficiency score of RES under each parameter category. Fuzzy AHP determines weights for each parameter. The weights and initial efficiency scores are then combined to calculate overall efficiency score and ranking of RES. Sensitivity analysis shows that results obtained from proposed methodology are significant, and robust. Offshore wind ranks highest in efficiency, followed by hydro and onshore wind, while geothermal scores lowest. This methodology could benefit developing nations and guide policymakers in adopting RES., Competing Interests: Declarations. Ethical declaration: The authors affirm adherence to ethical and professional conduct principles within the manuscript. The author confirms that all methods were carried out in accordance with relevant guidelines and regulations and confirming that informed consent was obtained from all subjects and/or their legal guardian(s). Experimental protocol were approved by institutional and/or licensing committee. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Purpose: Determine the rate of incidence, risk factors, and management for developing venous thromboembolism (VTE) in patients undergoing radiofrequency ablation (RFA) and ultrasound-guided foam sclerotherapy (UGFS) for varicose veins., Methods: All charts of patients undergoing venous ablation from 2016 to 2023 were reviewed at a rural vein treatment clinic. The incidence of VTE was noted and a chart review was completed to identify risk factors for VTE, EHIT score, EFIT score, and management., Results: Patients underwent 14,172 UGFS procedures and 4865 RFAs. VTE was noted in 45 patients (0.24%), with no pulmonary embolisms and no fatal outcomes among the patient population. Patients diagnosed with VTE had a median CEAP score of 3 and a modified Caprini risk score of 7.2. Increased risk of VTE was noted in patients with prior history of DVT, patients undergoing UGFS, patients with higher Caprini scores. 90% of patients diagnosed with VTE had a prior history of DVT ( p < 0.05). Patients who received UGFS treatments had a higher modified Caprini Risk Score than patients who received an RFA and UGFS, 8.7 and 6.8 respectively ( p < 0.05). Increased risk of VTE was noted in patients with swollen legs prior to treatment (0.92%), visible varicose veins (0.92%), obesity (0.49%), and surgery within the prior 3 months to vein treatment (0.41%)., Conclusion: The modified Caprini score is a useful tool for risk stratification for VTE and its incidence is low for patients undergoing RFA and UGFS. Prior history of VTE represents a significant risk for recurrence in patients undergoing RFA and UGFS., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background and Aims: Although beneficial in reducing the risk of bacterial infections in patients with advanced decompensated cirrhosis after upper gastrointestinal (GI) bleed, the utility of prophylactic antibiotics in those with Child-Pugh A cirrhosis is not known. We studied if prophylactic antibiotics can be withheld in this cohort., Methods: This was a single-centre, open-label randomised-controlled-trial with non-inferiority design. Patients of Child-Pugh A cirrhosis with upper-GI bleed and hemodynamic stability were randomised to receive either no prophylactic antibiotics (test-group) or ceftriaxone [standard of care (SOC)] for 72 h alongside standard medical management. The primary outcome was infection at day-5 in both arms. Secondary outcomes included failure to control bleed, mortality at day-5, and at 6 weeks., Results: Eligible patients (n = 180; mean age 45.1 ± 13.1 years, 76.9% males; median MELDNa 9 [interquartile-range: 7-12]) of predominant non-viral etiology (alcohol: 43.4%; non-alcoholic steatohepatitis: 21.7%) were randomised, of whom outcomes could be reliably assessed for 172 and 140 patients at 5-day and 6-week follow-up, respectively. Rate of day-5 infections in test-group [7.0% (95% CI 2.8-15.1%)] was non-inferior to SOC arm [11.6% (95% CI 6.02-20.8%); absolute risk difference: -4.7% (95% CI -13.3% to 4.0%; non-inferior at 10% margin)]. Spontaneous bacterial peritonitis following post-bleed ascites was the most common site of infection in both groups (10/16; 66.7%). Rates of failure to control bleed [0% vs 4.9; absolute-risk-difference: -4.6% (95% CI -9.1% to 0.2%)], day-5 mortality [0% vs 2.5%; absolute-risk-difference: -2.3% (-5.5% to 0.9%)], and 6-week mortality [1.4% vs 2.5%; absolute-risk-difference: -1.6% (-6.5% to 3.2%)] were comparable in both arms., Conclusion: Among patients with Child-Pugh A cirrhosis with hemodynamic stability, withholding prophylactic antibiotics after upper GI bleed was not associated with increased risk of post-bleed infections., Competing Interests: Declarations. Conflict of interest: The authors have not disclosed any competing interests., (© 2025. Asian Pacific Association for the Study of the Liver.)

Objective: To evaluate patient preferences when utilizing telemedicine., Methods: A 5-point Likert scale questionnaire was completed by 153 patients at a rural clinic via a convenience sampling method. The survey contained 21 statements encompassing provider confidence, patient-physician rapport, and accessibility variables. Patient responses for those who attended (n = 120) or canceled/rescheduled (n = 33) telemedicine encounters were analyzed using paired difference t-tests and t-tests of correlations between different groups of variables. An ad-hoc method patterned after the least significant differences was applied to the analysis of variance results to evaluate patient-valued variables., Results: Patients surveyed included 82.4% female (n = 127) and 17.6% male (n = 26); 69.3% of them were Hispanic/Latino (n = 106). When reviewing the patient opinion statements, our data suggested a belief that telemedicine encounters were as good as in-person visits (n = 118, x̄ = 4.932) and that such encounters provided them with the confidence to proceed with future, in-person vein treatments (n = 117, x̄ = 4.744). Additionally, patients expressed feeling as though their personal information was safe (n = 117, x̄ = 4.897)., Conclusion: Rural patients indicated a preference for flexible encounters and for providers who strive to build trust and rapport when utilizing telemedicine., Competing Interests: Declarations. Ethics approval and consent to participate: All experimental protocols were approved by Valley Vein Health Center Ethics and Institutional Review Board (IRB) Committees and confirmed that all surveys were performed per relevant guidelines and regulations. Voluntary, opt-in consent-by-completion approach was used for all subjects. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Competing Interests: Dr. Agarwal received support for article research from the National Institutes of Health; he received support from the National Heart, Lung, and Blood Institute (R01HL153311) and the National Institute of Neurological Disorders and Stroke (R01NS127959). Dr. Kaur has disclosed that she does not have any potential conflicts of interest.

Background: Atherosclerotic cardiovascular disease is the leading cause of death in people with type 2 diabetes (T2D) and chronic kidney disease (CKD) or end-stage kidney disease (ESKD). Glucagon-Like Peptide-1 receptor agonists (GLP-1RA) reduce cardiovascular events, improve glycemic control, promote weight loss, and slow progression of nephropathy. Despite these benefits and professional society treatment guidelines recommendations, GLP-1RAs remain under-utilized in people with advanced CKD and ESKD due to tolerability and safety concerns., Methods: We conducted a retrospective cohort study comparing clinical outcomes and medication use details after initiating GLP-1RA or dipeptidyl-peptidase 4 inhibitor (DPP-4i) in people with T2D and advanced CKD or ESKD. Eligible patients were identified via electronic health record query with extraction of baseline demographics, vital signs, and laboratory values. A manual chart review was undertaken to confirm eligibility, medication use, and extract a detailed account of all side effects., Results: A total of 236 eligible patients (149 in the GLP-1RA group and 87 in the DPP-4i group) were identified. The average duration of treatment was 1036 (±909.9) and 1109 (±1090.9) days for GLP-1RA and DPP-4i, respectively. The average percentage weight loss from baseline to 36 months of treatment in the GLP-1RA group was -9.6 % (95 % CI, -11.3 to -7.8) versus -2.4 % (95 % CI, -5.4 to 0.5) in the DPP-4i group (estimated treatment difference (ETD) -7.1 (95 % CI, -10.6 to -3.7) percentage-points, p < 0.001). The change in HbA1c from baseline to 36 months of treatment was significantly greater in the GLP-1RA (-1.0 %) compared with the DPP-4i group (0.2 %) (ETD -1.2 (95 % CI, -2.1 to -0.3) percentage-points, p = 0.04)., Conclusion: In patients with T2D and advanced CKD or ESKD, treatment with GLP-1RAs in a real-world setting had long treatment persistence, and compared to DPP-4is, was associated with greater weight loss and glycemic improvement., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Donglu Xie reports financial support was provided by National Center for Advancing Translational Sciences. Ildiko Lingvay reports a relationship with Novo Nordisk that includes: consulting or advisory and funding grants. Ildiko Lingvay reports a relationship with Sanofi that includes: consulting or advisory and funding grants. Ildiko Lingvay reports a relationship with Merck that includes: consulting or advisory and funding grants. Ildiko Lingvay reports a relationship with Pfizer that includes: consulting or advisory and funding grants. Ildiko Lingvay reports a relationship with Mylan that includes: consulting or advisory and funding grants. Ildiko Lingvay reports a relationship with Boehringer Ingelheim that includes: consulting or advisory and funding grants. Ildiko Lingvay reports a relationship with Eli Lilly that includes: consulting or advisory. Ildiko Lingvay reports a relationship with AstraZeneca that includes: consulting or advisory. Ildiko Lingvay reports a relationship with Janssen that includes: consulting or advisory. Ildiko Lingvay reports a relationship with Intercept that includes: consulting or advisory. Ildiko Lingvay reports a relationship with Intarcia that includes: consulting or advisory. Ildiko Lingvay reports a relationship with TargetPharma that includes: consulting or advisory. Ildiko Lingvay reports a relationship with Novartis that includes: consulting or advisory. Ildiko Lingvay reports a relationship with GI Dynamics that includes: consulting or advisory. Ildiko Lingvay reports a relationship with MannKind that includes: consulting or advisory. Ildiko Lingvay reports a relationship with Valeritas that includes: consulting or advisory. Ildiko Lingvay reports a relationship with Carmot that includes: consulting or advisory. Ildiko Lingvay reports a relationship with Zealand Pharma that includes: consulting or advisory. Ildiko Lingvay reports a relationship with Shionogi that includes: consulting or advisory. Ildiko Lingvay reports a relationship with Mediflix that includes: consulting or advisory. Ildiko Lingvay reports a relationship with Bayer that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Inc.)

Holoprosencephaly (HPE) is one of the most common malformations in embryonic development. HPE represents a continuum spectrum that involves the midline cleavage of forebrain structures. Facial malformations of varying degrees of severity are also observed. It is probable that HPE results from a combination of genetic mutations and environmental influences during the initial weeks of pregnancy. Some patients with HPE experience early death, whereas others go on to experience neurodevelopmental impairment. Accurate fetal imaging can facilitate diagnosis and prenatal counseling, although more subtle brain abnormalities can be difficult to diagnose prenatally. Fetal counseling can be complex, given that the etiopathogenesis remains unclear and variable penetrance is prevalent in inherited genetic mutations. The aim of this narrative review is to examine the literature on HPE and to offer recommendations for pediatric neurologists for fetal counseling and postnatal care., Competing Interests: Declaration of competing interest The authors report no conflict of interest or competing financial interests in relation to the work., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Bladder cancer (BCa) diagnosis relies on distinguishing muscle-invasive bladder cancer (MIBC) from non-muscle-invasive bladder cancer (NMIBC) forms. Transurethral resection of the bladder tumor (TURBT) is a standard procedure for initial staging and treatment. The Vesical Imaging-Reporting and Data System (VI-RADS) enhances diagnostic accuracy for muscle invasiveness through advanced imaging techniques, potentially reducing reliance on repeat TURBT and improving patient management., Objective: We aimed to evaluate the role of VI-RADS in predicting muscle invasiveness in BCa and its potential to predict adverse pathology in high-risk NMIBC to avoid unnecessary repeat TURBT procedures., Methods: In this prospective study, we included 62 patients over the age of 18 years who underwent TURBT. In a secondary phase, patients selected for restaging TURBT (re-TURBT) were included, but those with T2 tumors or low-risk NMIBC were excluded. Multiparametric magnetic resonance imaging (MRI) examinations were scored by a radiologist using the VI-RADS 5 method, while a pathologist analyzed TURBT and re-TURBT samples for accurate staging. Statistical analysis evaluated the role of VI-RADS in BCa staging., Results: The VI-RADS score was the only predictive factor for muscle invasion in multivariate analysis. Setting the VI-RADS score at >3 resulted in the highest sensitivity, specificity, and diagnostic accuracy, with values of 67.0%, 89.0%, and 78%, respectively. The receiver operating characteristic area under the curve score for VI-RADS for muscle invasion was 85% for stage Ta, 61% for stage T1, and 88% for stage T2, which shows the utility of VI-RADS in the predictiveness of MIBC/NMIBC., Conclusion: VI-RADS is effective in stratifying BCa patients by predicting muscle invasiveness and identifying NMIBC cases that may not need repeat TURBT., Competing Interests: Disclosure: The authors have no conflicts of interest to declare. Informed consent: All participants in this study provided informed consent prior to their involvement in the research., (© 2024. Society of Surgical Oncology.)

Cardiac hemangiomas are rare tumors of the heart which account for less than one-twentieth of all primary cardiac tumors. They can be seen in all age groups but are mostly diagnosed in neonates and children. Although cardiac hemangiomas are benign in nature they can present with features of congestive heart failure and occasionally be life-threatening. We present such a case in a two-month-old child who underwent successful surgical excision of the mass., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Summary: Obesity is one of the greatest public health concerns in the United States and has reached an epidemic scope over the past few decades. Plastic surgery in patients with obesity has been linked to higher complication rates both before and after weight loss. This article discusses the evolution and landscape of antiobesity medications as they apply to plastic surgery. Although bariatric surgery has been effective in long-term treatment, new pharmacologic advances in glucagon-like peptide-1 agonists, such as semaglutide, have demonstrated promising effectiveness. These medications pose several unique challenges, particularly with regard to perioperative management and risk of weight regain after discontinuation. An understanding of these new pharmacologic agents is crucial for plastic surgeons, who treat patients with obesity., (Copyright © 2024 by the American Society of Plastic Surgeons.)

People treated with peritoneal dialysis (PD) often have complicating conditions that require careful management. Three such conditions are reviewed in this article-diabetes mellitus, polycystic kidney disease, and chronic liver disease. Each of these conditions requires an understanding of both its effect on the delivery of the PD and the effect of the PD on the condition itself. In diabetes, glucose absorption from the dialysate complicates metabolic control and affects salt and water management and patient outcome. There is particular benefit in clinical care being delivered through a multidisciplinary team that involves both kidney and diabetes experts. In relation to polycystic kidney disease, a key issue is the potential for increased intraperitoneal pressure due to the combined effect of the enlarged polycystic organs and the presence of the dialysis solution, and therefore, the PD prescription requires to be managed with a particular focus on limiting that pressure. For patients with liver disease, key issues include nutritional support because PD can add to protein losses already consequent on the liver disease itself. Considered approaches are required to manage ascites and reduce infection risk and the potential for hernias and leaks to develop. Mortality in this group is unfortunately high-however, PD may present a better management option than hemodialysis in many patients-particularly in those where the liver disease is complicated by low BP, clotting abnormalities, or troublesome ascites. Overall, the choice to use PD in patients with these complicating conditions should be based on shared decision making with the patient and their family members informed by high-quality information in which risks, benefits, and management strategies are clearly presented., (Copyright © 2024 by the American Society of Nephrology.)

Background: The indications for pediatric airway endoscopy are expanding and a variety of therapeutic interventions are feasible for central airway obstruction (CAO) and other central airway pathologies, apart from foreign body removal., Methods: In this retrospective chart review from four centers, we describe the indications, procedures, outcomes, and complications of therapeutic bronchoscopic interventions in children for non foreign-body removal indications., Results: A total of 72 children (mean age:140 [60.4] months) underwent 143 therapeutic bronchoscopic airway interventions under general anesthesia, via a rigid or flexible bronchoscope or both, between January 2015 and November 2023. 67 (93%) had CAO. The most common diagnoses were posttubercular tracheobronchial stenosis (29%) followed by central airway tumor (26%) and postintubation/posttracheostomy tracheal stenosis (26%). Airway stenosis (subglottic/tracheal/bronchial) was the commonest bronchoscopic finding (43 [59.7%]) followed by endoluminal growth/mass (21 [29.2%]). The most frequently performed procedure was airway dilatation (38, 52.7%), using balloon dilators (89.5%) or rigid bronchoscope (10.5%). Endoluminal tumor debulking was performed in 21 (29%). Assistive modalities included electrocautery (44%), mechanical debulking (10%), cryotherapy (10%), or laser (4%). Airway stent insertion alone or in combination with airway dilatation or debulking was performed in 24 (33.3%) children. The airway conduit used was supraglottic airway in 19 (26%) and rigid bronchoscope in 53 (74%) children. Immediate procedural success was observed in 66 (92%) patients. Fourteen (19.4%) patients had minor procedural complications. Thirty-three (46%) children required a repeat bronchoscopic procedure., Conclusion: Like adults, multimodality therapeutic bronchoscopic airway interventions are feasible and safe in children for CAO and other central airway indications., (© 2024 Wiley Periodicals LLC.)

Pregnancy and lactation-associated osteoporosis (PLO) is a rare presentation of early-onset osteoporosis characterized by low trauma and spontaneous fractures during late pregnancy/lactation. Herein, we report areal BMD (aBMD) by DXA and volumetric BMD (vBMD), microarchitecture, and strength at the distal radius and tibia by HR-pQCT in 59 women with PLO-in comparison to both healthy premenopausal controls (n = 28) and premenopausal women with idiopathic osteoporotic fractures not associated with pregnancy/lactation (non-PLO IOP; n = 50). Women with PLO (aged 34 ± 6 yr) had a more severe clinical presentation than non-PLO IOP: 80% had vertebral and 92% had multiple fractures (p<.001). They had lower DXA aBMD at all sites vs Controls (all p<.001) and non-PLO IOP (all p<.05). By HR-pQCT, PLO had deficits in all radial/tibial density and most microarchitecture parameters and lower bone strength than controls (all p<.001). Compared to non-PLO IOP, PLO had lower total and trabecular density at radius and tibia (all p ≤ .01) and significant deficits in trabecular microstructure and cortical thickness at the radius only. We studied PLO subgroups with clinical factors potentially related to bone physiology: Within PLO, women with vertebral fractures had lower spine aBMD and higher tibial cortical porosity but were otherwise structurally similar to the nonvertebral group. Those with prior heparin exposure had larger bone size and trabecular area, and those with renal stones had smaller bone size and lower 1/3 radius aBMD. We also compared groups based on postpartum timing: Recent PLO (n = 25) evaluated ≤12 M postpartum, before expected recovery of pregnancy/lactation bone loss, had significantly lower aBMD than distant PLO (n = 34) evaluated >12 M postpartum. However, radial/tibial HR-pQCT measures did not differ, suggesting pre-existing and/or persistent structural deficits. This structural study increases our mechanistic understanding of the severe bone fragility presentation that characterizes PLO and also highlights areas of potential mechanistic heterogeneity that require additional investigation., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Society for Bone and Mineral Research. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Oral cancer is responsible for increased mortality, especially in the Indian subcontinent. Habits like smoking and tobacco chewing are among the most common causes of oral cancer. Previously, these habits were seen mainly in the elderly; however, the trends have seemed to increase in the younger generation. Awareness regarding oral cancer is essential during the early years of a healthcare expert for effective diagnosis. This study aimed to investigate oral cancer awareness among medical and dental students. A cross-sectional study including 144 medical and 112 dental undergraduate students was designed. A validated 12-question questionnaire on oral cancer awareness was distributed to medical and dental undergraduate students. The collated data were analyzed statistically using tests of proportion. Dental students were more likely to examine oral mucosa routinely ( χ 2  = 9.585, p =0.002) and observe oral lesions like proliferative growth ( χ 2  = 71.763, p < 0.001), while medical students reported higher incidences of poor oral hygiene ( χ 2  = 7.667, p =0.006) and tobacco usage ( χ 2  = 6.337, p =0.012). Both groups expressed a need for more education on oral cancer, with dental students showing a stronger preference ( χ 2  = 7.526, p =0.006). Referral to an oral surgeon was preferred among both groups. The dental students felt a lack of sufficient knowledge on oral cancer. It was observed that the knowledge and information regarding cancer-related symptoms was more among medical students. However, overall awareness regarding oral cancer was higher in dental students compared to medical students. It was concluded that medical students exhibited more knowledge about oral cancer causes, while dental students were more aware of its signs and symptoms. Educational interventions should be introduced early to reduce diagnostic delays and prevent cancer progression., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Shubham Agarwal et al.)

Background: The efficacy of catheter ablation as a treatment approach for patients with concurrent atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) has been inadequately investigated., Objective: This study's objective was to assess the effectiveness of atrial fibrillation ablation (AFA) in patients with heart failure with preserved ejection fraction., Methods: Utilizing the TriNetX research network, we identified individuals aged 18 and older with atrial fibrillation (AF) and concurrent heart failure with preserved ejection fraction (HFpEF) from January 1, 2010, to June 1, 2021. Patients were further classified based on their catheter ablation procedure, using Current Procedural Terminology codes. Following propensity-score matching, each cohort consisted of 9440 patients. The primary endpoint was all-cause mortality at two years and secondary outcomes during the 2-year follow-up encompassing readmissions for heart failure, AF, and stroke., Results: In propensity-matched cohort, patients with AF and HFpEF who underwent AFA plus medical therapy had significantly lower all-cause mortality at two years than those who did not undergo AFA (hazard ratio (HR): 0.37, 95% CI: 0.34-0.40; P < 0.001) even after matching antiarrhythmic medications. At two years, secondary outcomes including HF readmissions (HR: 0.86 95% CI: 0.84-0.89; P < 0.001) and stroke readmissions (HR: 0.66 95% CI: 0.59-0.73; P < 0.001) were lower in the AFA group., Conclusion: AFA amongst AF patients with concomitant HFpEF showed a significant reduction in all-cause mortality. It also leads to significant reductions in readmissions due to HF and ischemic stroke at two years., Competing Interests: Declarations. Conflict of interest: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Endovascular radiofrequency ablation (RFA) and Endovascular Laser Ablation (EVLA) are minimally invasive methods to safely treat symptomatic varicose veins in pediatric patients. This research aimed to review the management of pediatric patients with venous insufficiency, evaluate the outcome, and determine the efficacy, convenience, and safety of ablation procedures in an outpatient setting., Methods: A retrospective chart review of all patients seen at six locations from 2013 to 2024 was completed. Statistical analysis was done using QuickCalcs by GraphPad., Results: Subjects identified were 34 adolescents with an average age at onset of symptoms of 16.7 years. Ultrasound evaluation was performed on 30 patients (88 %), and among them, 16 met the criteria for treatment. Of those, 13 patients (81 %) received the recommended intervention. RFA or EVLA was done for eight limbs, sclerotherapy for three limbs, and phlebectomy for one limb. No major complications were noted. Females were more likely to have disease in both legs than males (P = 0.04). Male patients were more likely to receive treatments regarding their diagnosis (p < 0.05). Of the 6 patients undergoing EVLA or VNUS, all 8 limbs (100 %) demonstrated total occlusion. There were no DVTs, pulmonary emboli (PEs), or any major complications noted post procedures in this population. No relationship was identified between; sex and vein size; obesity and disease severity or vein size; age and disease severity, vein size, or reflux time., Conclusion: Out-patient ablation procedures (RFA or EVLA) proved to be a safe and effective method for the treatment of venous insufficiency in pediatric patients. Female pediatric patients with venous insufficiency symptoms should have a careful evaluation of both extremities for venous disease. Further research with larger cohorts is warranted., Type of Study: Retrospective Chart Review Study., Evidence: Level 3., Competing Interests: Conflicts of interest All authors declare that they have no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

This article aims to highlight high-quality observational and intervention studies focused on promoting psychological well-being among cardiac arrest (CA) survivors and their families. Following CA, many patients experience significant psychological distress, including depression, generalized anxiety, and post-traumatic stress. Recent studies indicate that this distress can narrow patients' focus, resulting in heightened awareness of cardiac signals-such as fluctuations in heart rate or blood pressure-that lead to constant monitoring and increased anxiety. This anxiety, compounded by behavioral avoidance toward cardioprotective behaviors and physiological hyperarousal, may elevate the risk of secondary cardiovascular diseases and adversely affect the quality of life. Current research is exploring behavioral interventions aimed at reducing this psychological distress, strategies to enhance coping mechanisms, and improving overall health in the survivor-family dyad. Unlike other cardiovascular conditions, no clinical practice guidelines exist for assessing or treating the psychological consequences of CA. Future research should prioritize identifying and treating modifiable psychological factors using targeted therapies and behavioral interventions., Competing Interests: Declaration of competing interest Authors have nothing to declare and have no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Aims: We aimed to perform a retrospective cohort study using the Centers for Disease Control and Prevention's (CDC's) Wide-Ranging Online Data for Epidemiologic Research (WONDER) database to analyse the trends in cardiovascular disease (CVD)-related mortality in patients with myeloproliferative neoplasms (MPNs) from 1999 to 2020., Methods and Results: We analysed the death certificate data from the CDC WONDER database from 1999 to 2020 for CVD with co-morbid myeloproliferative disorders in the US population. Age-adjusted mortality rates (AAMRs) and 95% confidence intervals (CIs) were computed per 1 million population by standardizing crude mortality rates to the 2000 US census population. To assess annual national mortality trends, we employed the Joinpoint regression model, calculating the annual per cent change in AAMR and corresponding 95% CIs. A total of 15 269 deaths related to CVD occurred in patients with co-morbid MPNs from 1999 to 2020. Overall, there was a decreasing trend in CVD-related AAMRs throughout these years. Males contributed to 51% of total deaths, and their AAMR was persistently higher than women throughout the study. Non-Hispanic (NH) Whites had the highest overall AAMR, followed by NH Blacks, NH American Indians or Alaska Natives, Hispanics or Latinos, and NH Asian or Pacific Islanders., Conclusion: Our findings indicate a significant decline with notable gender, racial/ethnic, and regional differences in CVD-related mortality among patients with MPN over the past two decades. We emphasize the importance of a collaborative approach between oncologists and cardiologists in managing these patients, highlighting the potential benefits of integrating cardio-oncology services to enhance patient outcomes., Competing Interests: Conflict of interest: E.H.Y.: research funding from CSL Behring, Boehringer Ingelheim, Eli and Lilly Company, Amgen, and Bristol Myers Squibb; consulting fees from Pfizer and Xencor. A.G. is supported by the American Heart Association-Strategically Focused Research Network Grant in Disparities in Cardio-Oncology (#847740 and #863620) and the Department of Defense Prostate Cancer Research Program’s Physician Research Award (#HT94252310158). None of the other authors have other disclosures or conflicts of interest related to this manuscript., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background: Cerebral amyloid angiopathy (CAA) is a common cause of intracerebral haemorrhage (ICH) with a high recurrence risk. Left atrial appendage occlusion (LAAO) is a method for ischaemic stroke prevention in patients with atrial fibrillation (AF), potentially reducing the risk of intracranial bleeding in CAA-associated ICH. We aimed to determine the outcomes of patients with AF with CAA-associated ICH undergoing LAAO., Methods: We conducted a multicentre study of patients with CAA-associated ICH who underwent LAAO for stroke prevention. We pooled our findings with data from a systematic review of relevant published studies of LAAO for AF in ICH survivors reporting CAA diagnosis., Results: We included data from two published studies (n=65) with CAA-specific data and our cohort study (n=37), providing a total of 102 participants (mean age 76.2±8.0 years, 74.6% male) with CAA-related symptomatic ICH and AF treated with LAAO. The median follow-up period was 9.4 months (IQR 4.2-20.6). Postprocedural antithrombotic regimens varied between single (73.0%) or dual antiplatelet therapy (16.2%), or direct oral anticoagulant (DOAC) (10.8%), with a median duration of 42 days (IQR 35-74). Postprocedural complications were uncommon, but included transient arrhythmias (2.1%) and non-life-threatening tamponade (2.1%). Pooled incidence rates of ischaemic stroke and ICH during follow-up were 5.16 (95% CI 1.36 to 17.48) and 2.73 (95% CI 0.41 to 13.94) per 100 patient years, respectively., Conclusions: LAAO followed by short-term antithrombotic therapy might be a safe and effective ischaemic stroke preventive strategy in people with CAA-associated ICH and AF. However, randomised controlled trials are needed to determine how LAAO compares with long-term DOAC in this population., Prospero Registration Number: CRD42023415354., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Context: Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was introduced as a new entity replacing the diagnosis of noninvasive encapsulated follicular variant of papillary thyroid carcinoma (PTC). Significant variability in the incidence of NIFTP diagnosed in different world regions has been reported., Objective: To investigate the rate of adoption of NIFTP, change in practice patterns, and uniformity in applying diagnostic criteria among pathologists practicing in different regions., Methods: Two surveys distributed to pathologists of the International Endocrine Pathology Discussion Group with multiple-choice questions on NIFTP adoption into pathology practice and whole slide images of 5 tumors to collect information on nuclear score and diagnosis. Forty-eight endocrine pathologists, including 24 from North America, 8 from Europe, and 16 from Asia/Oceania completed the first survey and 38 the second survey., Results: A 94% adoption rate of NIFTP by the pathologists was found. Yet, the frequency of rendering NIFTP diagnosis was significantly higher in North America than in other regions (P = .009). While the highest concordance was found in diagnosing lesions with mildly or well-developed PTC-like nuclei, there was significant variability in nuclear scoring and diagnosing NIFTP for tumors with moderate nuclear changes (nuclear score 2) (case 2, P < .05). Pathologists practicing in North America and Europe showed a tendency for lower thresholds for PTC-like nuclei and NIFTP than those practicing in Asia/Oceania., Conclusion: Despite a high adoption rate of NIFTP across geographic regions, NIFTP is diagnosed more often by pathologists in North America. Significant differences remain in diagnosing intermediate PTC-like nuclei and respectively NIFTP, with more conservative nuclear scoring in Asia/Oceania, which may explain the geographic differences in NIFTP incidence., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Influenza A viruses (IAVs) must navigate through a dense extracellular mucus to infect airway epithelial cells. The mucous layer, composed of glycosylated biopolymers (mucins), presents sialic acid that binds to ligands on the viral envelope and can be irreversibly cleaved by viral enzymes. It was recently discovered that filamentous IAVs exhibit directed persistent motion along their long axis on sialic acid-coated surfaces. This Letter demonstrates through stochastic simulations and mean-field theory, how IAVs harness a "burnt-bridge" Brownian ratchet mechanism for directed persistent translational motion. Importantly, our analysis reveals that equilibrium features of the system primarily control the dynamics, even out of equilibrium, and that asymmetric distribution of ligands on the virus allows for more robust directed transport. We show viruses occupy the optimal parameter range ("Goldilocks zone") for efficient mucous transport, possibly due to the evolutionary adaptation of enzyme kinetics. Our findings suggest novel therapeutic targets and provide insight into possible mechanisms of zoonotic transmission.

Recently, chalcogenide perovskites, of the form ABX 3 , where typically A = alkaline earth metals Ca, Sr, or Ba; B = group IV transition metals Zr or Hf; and X = chalcogens S or Se, have become of interest for their potential optoelectronic properties. In this work, we build upon recent studies and show a general synthesis protocol, involving the use of carbon disulfide insertion chemistry, to generate highly reactive precursors that can be used towards the colloidal synthesis of numerous ABS 3 nanomaterials, including BaTiS 3 , BaZrS 3 , BaHfS 3 , α-SrZrS 3 and α-SrHfS 3 . We overcome the shortcomings in the current literature where BaZrS 3 nanoparticles are synthesized in separate phases via colloidal methods and lack a reproducible protocol for orthorhombic perovskite nanoparticles. We present a high-temperature, hot-injection method that reliably controls the formation of the colloidal BaZrS 3 nanoparticles with the Pnma orthorhombic distorted perovskite structure. We show that the alternate phase, most notably denoted by its extra peaks in the pXRD pattern, is distinct from the distorted perovskite phase as it has a different bandgap value obtained via UV-vis measurements. We also show that the reaction byproducts, resulting from the use of oleylamine and CS 2 , have their own photoluminescence (PL) and their residual presence on the surface of the nanoparticles complicates the interpretation of PL from the nanoparticles. The utility of these nanomaterials is also assessed via the measurement of their absorption properties and in the form of highly stable colloidal inks for the fabrication of homogeneous, crack-free thin films of BaZrS 3 nanoparticles., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Background: In 2021, a spike in Asian American hate crimes resurged discussion on Asian health disparities. This study describes the association between education and assault among Asian Americans and their subgroups., Methods: This cross-sectional study used individual-level data from the mortality multiple cause-of-death data from the National Center for Health Statistics from 2009 to 2021. Non-Hispanic Asians or Pacific Islanders age>25 years who died from assault (X85-Y09) were disaggregated into Chinese, Japanese, Filipino, Indian, Korean and Vietnamese. The gross proportion of decedents who attained at least bachelor's degrees was calculated for Asians or Pacific Islanders and each subgroup and compared with data from the National Center for Education Statistics reported in 2016., Results: Based on US Census estimates in 2016, 55% Chinese, 52% Japanese, 50% Filipino, 56% Korean, 75% Indian and 29% Vietnamese>25 years held at least bachelor's degrees. Between 2009 and 2021, there were 3495 assault mortalities involving Asians or Pacific Islanders, 22.3% of whom had at least attained bachelor's degrees. On disaggregating the data, 35.6% Chinese, 27.7% Japanese, 33.2% Filipino, 43.0% Indian, 36.3% Korean and 15% Vietnamese decedents attained at least a bachelor's degree., Conclusions: Higher educational attainment is correlated with fewer assault deaths across all Asians. Variation in the proportion of Indian and Vietnamese victims with at least bachelor's degrees may be explained by significantly different rates of bachelor's degrees. However, the variation in proportion of Chinese, Japanese, Filipino and Korean victims with at least bachelor's degrees requires further investigation into underlying factors that contribute to assault disparities., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

We investigate the driven-dissipative dynamics of multilevel atomic arrays interacting via dipolar interactions at subwavelength spacings. Unlike two-level atoms in the weakly excited regime, multilevel atoms can become strongly entangled. The entanglement manifests as the growth of spin waves in the ground-state manifold and survives after turning off the drive. We propose the 2.9  μm transition between ^{3}P&#95;{2}↔^{3}D&#95;{3} in ^{88}Sr with 389 nm trapping light as a platform to test our predictions and explore many-body physics with light-matter interactions.

Raman spectroscopy has been proven to be a fast, convenient, and nondestructive technique for advancing our understanding of biological systems. The Raman effect originates from the inelastic scattering of light which directly probe vibration/rotational states in biological molecules and materials. Despite numerous advantages over infrared spectroscopy and continuous technical as well as operational improvement in Raman spectroscopy, an advanced development of the device and more applications have become possible. In this review, we explore the principles, techniques, and myriad applications of Raman spectroscopy in the realm of biology. We begin by providing an overview of Raman spectroscopy, highlighting its significance in unraveling the complexities of biological research. The focus of this review is on Raman spectroscopy concepts and methods, clarifying the fundamentals of Raman scattering and spectral interpretation. The review also highlights the key experimental considerations for productive biological applications. We explore the broad range of Raman applications including molecular structure, biomolecular composition, disease detection, and medication discovery. The Raman imaging and mapping can also be used to visualize biological samples at the molecular level. Raman spectroscopy is still developing, giving fresh insights and remedies, from biosensing to its use in tissue engineering and regenerative medicine. This review sheds light on the past, present, and future of Raman spectroscopy; it also highlights promising directions of future research developments and serves as a thorough resource for all researchers., Competing Interests: The authors declare no competing financial interest., (© 2024 The Authors. Published by American Chemical Society.)

A 62-year-old lady was referred with the diagnosis of hypertensive encephalopathy. She had episodes of paroxysms of hypertension while on the ventilator with normal saturations. She underwent a battery of tests to identify the cause of the paroxysms. Eventually, a very unusual cause was found that should have been identified if the label of hypertensive encephalopathy had not been put at the beginning. A diligent history and examination remain important even in the modern day with high-technology care., (© Journal of The Association of Physicians of India 2024.)

HLA-B*13:01:01:12 differs from HLA-B*13:01:01:01 by a single nucleotide., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The objective was to determine if whole milk intake or total milk intake behaviors are associated with body weight (weight) and related parameters in adults. We hypothesize that whole milk intake would be inversely associated with body weight measures. Whole milk (including flavored whole milk) intake was assessed using 24-hour dietary recall data of the National Health and Nutrition Examination Survey 2001-2018 for adults age 20+ years (N = 43,038). Weight and related parameters were measured, and history of self-reported weights and total milk intake were obtained from questionnaire data. The association of whole milk intake with weight was assessed via regression after adjusting for demographic and lifestyle-related covariates. The average body mass index (BMI) was about 29 kg/m 2 and weight was 76 to 89 kg. About 66% of the population were overweight or obese. Average whole milk intake among consumers was 1.0 to 1.4 cups eq/d. Whole milk intake was inversely associated (P < .05) with weight, BMI, waist circumference, and the prevalence of obesity. Whole milk intake was also inversely associated (P < .01) with trying to lose weight in the past year. In most cases, milk intake behavior at ages 5 to 12, 13 to 17, or 18 to 35 years was not associated with BMI. The results indicate that whole milk intake was inversely associated with weight, BMI, and prevalence of obesity, and these findings may provide additional evidence to support dietary recommendations for whole milk., Competing Interests: Author Declarations MTG, MAP, KRJ, CJC are employees of the National Dairy Council; KF and VLF at Nutrition Impact LLC perform consulting and database analyses for various food and beverage companies and related entities; and SA at NutriScience LLC performs consulting for various food and beverage companies and related entities., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

The prevalence and nature of somatic copy number alterations (CNAs) in breast epithelium and their role in tumor initiation and evolution remain poorly understood. Using single-cell DNA sequencing (49,238 cells) of epithelium from BRCA1 and BRCA2 carriers or wild-type individuals, we identified recurrent CNAs (for example, 1q-gain and 7q, 10q, 16q and 22q-loss) that are present in a rare population of cells across almost all samples (n = 28). In BRCA1/BRCA2 carriers, these occur before loss of heterozygosity (LOH) of wild-type alleles. These CNAs, common in malignant tumors, are enriched in luminal cells but absent in basal myoepithelial cells. Allele-specific analysis of prevalent CNAs reveals that they arose by independent mutational events, consistent with convergent evolution. BRCA1/BRCA2 carriers contained a small percentage of cells with extreme aneuploidy, featuring loss of TP53, BRCA1/BRCA2 LOH and multiple breast cancer-associated CNAs. Our findings suggest that CNAs arising in normal luminal breast epithelium are precursors to clonally expanded tumor genomes., Competing Interests: Competing interests: J.S.B. is a scientific advisory board (SAB) member of Frontier Medicines. D.A.D. is on the SAB for Oncology Analytics, has consulted for Novartis and receives research support from Canon. J.E.G. is a paid consultant for Helix and an uncompensated consultant for Konica Minolta and Earli. S.P.S. has consulted for AstraZeneca and has received funding from Bristol Meyers Squibb. S. Aparicio is cofounder and shareholder of Genome Therapeutics, uncompensated advisor to Chordia Therapeutics and advisor to Sangamo Therapeutics. The other authors declare no competing interests., (© 2024. The Author(s).)

Pilomatrixoma is a rare, benign tumor arising from hair follicle matrix cells, commonly seen in children and young adults. This case report discusses an 8-year-old male with a progressively enlarging posterior neck swelling over three months. Clinical examination revealed a mobile, subcutaneous mass. Fine-needle aspiration cytology (FNAC) suggested an adnexal tumor, characterized by cohesive clusters of basaloid cells, nucleated and anucleated squamous cells, and ghost cells. The patient underwent surgical excision of the mass, and histopathological examination confirmed a diagnosis of pilomatrixoma. Postoperative recovery was uneventful, with no signs of recurrence at the three-month follow-up. This case highlights the importance of combining clinical, cytological, and histopathological findings to accurately diagnose and manage pilomatrixoma, emphasizing the role of complete surgical excision in achieving favourable outcomes. The report adds valuable insights to the literature, aiding clinicians in recognizing and differentiating this rare tumour in paediatric patients., Competing Interests: Conflict of InterestThere is no conflict of interest., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Hearing impairment after treated by radio/chemotherapy for head and neck malignancies may compromise patients' communication and make them socially handicap. Thus, early detection of hearing loss may provide early access to hearing rehabilitation facilities and improve their quality of life. The present study was a 1-year prospective observational study conducted at tertiary care center, Jaipur, India. Total 90 patients treated with radio/chemo or combined therapy for head and neck malignancies were included in our study. Evaluation of type and degree of hearing loss with pure tone audiometry was done Pretreatment and Posttreatment at 1- and 6-months interval and data analyzed. Most common type of modality received by study population was chemoradiotherapy (41.1%) followed with radiotherapy (36.7%) and least common modality was chemotherapy (22.2%). We observed in our study that 50% of patients who received chemotherapy, 48.5% with radiotherapy and 81.1% patients who received concurrent chemoradiotherapy develops sensorineural hearing loss (SNHL) of various grade. Patients who were exposed with high dose of cisplatin developed more severe SNHL (44.44% grade 2, 44.44% grade 3 and 11.1% grade 0) when compared with low dose group of patients (81.8% grade 0 and 18.18% grade 2) and results were found significant (P value less than 0.05). Chemotherapy, with or without radiotherapy can cause hearing loss and it should be monitored to avoid permanent impairment Additionally, it can also guide the dosage to be delivered based on the patient's conditions, and if necessary, a more toxic drug can be replaced with a less toxic drug that is similarly efficient., Competing Interests: Conflict of InterestNone., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Rhinolith, commonly addressed as nasal stone is quite unusual and rare entity. It is actually a calcified mass that form within the nasal cavity, typically as a result of mineral deposits accumulating around a core of foreign material (which can be exogenous or endogenous in origin). Although often small and asymptomatic, rhinolith can occasionally grow to significant size, causing severe clinical symptoms. Case description: We report a case of this clinical entity, a tribal woman from interior Himalayan regions, where the lack of medical facilities and expertise led to missed diagnosis, years of suffering and a rhinolith of humongous proportions., Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-024-04990-4., Competing Interests: Conflicts of InterestWe wish to confirm that there are no known conflicts of interests associated with this manuscript., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Introduction: Racial and ethnic disparities in malnutrition are well-known, but it is unknown if there are disparities in early nutrition delivery for intensive care unit (ICU) patients, which is associated with better outcomes. We investigated the timing of enteral nutrition (EN) and parenteral nutrition (PN) initiation in the ICU, examining for racial differences., Methods: Using the eICU-Collaborative Research Database (eICU-CRD) from 2014 to 2015, we analyzed patients eligible for EN and PN from 208 hospitals. EN and PN delivery was captured through intake/output entries. Exclusions included pre-existing EN/PN and short (<4 d) mechanical ventilation. Severity-of-illness was assessed using the sequential organ failure assessment (SOFA) score. Self-identified race was defined as the primary exposure, and Cox proportional hazards models were used to examine the association between race and time to EN and PN initiation, adjusting for patient, ICU, and hospital characteristics., Results: Of 1914 patients from 14 hospitals with EN data (5.3% Black, 42.4% female, median age 65 y), 888 received EN. Among Black and White patients, the median [Q1, Q3] time from mechanical ventilation to EN was 1.5 [1.0, 2.8] d. Race was not associated with time until EN initiation (hazard ratio = 0.961, 95% confidence interval 0.693, 1.333). Rather, other variables including sex, SOFA score, hospital characteristics and ICU unit type appeared to account for variation in EN initiation. Among 31,551 patients from 59 hospitals with PN data (11.3% Black, 45.1% female, median age 67 y), 1140 received PN, with a median [Q1, Q3] time to PN initiation of 7.4 [4.2, 12.4] d amongst Black and White patients. Race was not associated with time until PN initiation (hazard ratio = 1.095, 95% confidence interval = 0.901, 1.331). Instead, sex, body mass index, SOFA score, hospital characteristics and ICU unit type appeared to account for variation in PN initiation., Conclusions: Disparities in EN and PN delivery in the eICU-CRD dataset from 2014 to 2015 were not associated with race, but rather with sex, body mass index, SOFA, hospital characteristics and ICU unit type. Further investigations using more current data are needed., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Trauma patients with comorbid conditions are known to have poorer outcomes. We hypothesize that these outcomes are further influenced by race or ethnicity and socioeconomic status., Methods: We queried patient records in the Trauma Quality Improvement Program database from 2017 to 2019 and assessed those with selected comorbidities: chronic kidney disease (CKD), diabetes, cardiac comorbidities (angina pectoris, congestive heart failure, myocardial infarct, and hypertension), and chronic obstructive pulmonary disease (COPD). We used multivariate logistic and linear regression models to investigate the interaction of race or ethnicity and insurance status in trauma patients with the above comorbidities, adjusting for injury severity, demographic factors, and other comorbidities., Results: We identified 44,388 patients with CKD, 357,008 with diabetes, 947,980 with cardiac comorbidities, and 205,525 with COPD from a total of 2,493,327 records. Patients were mostly White and non-Hispanic, with Medicare as a payor; patients with diabetes and CKD were male, while patients with cardiac comorbidities and COPD were female. Minority patients had increased hospital mortality and longer hospital stays; length of stay was associated with differences in payor and with increases or decreases observed across different payor-comorbidity interactions. Discharge dispositions were also associated with differences in race or ethnicity and payor., Conclusions: In an analysis of trauma patients with specific comorbidities, racial or ethnic background and socioeconomic status were associated with differences in outcomes, even after adjusting for injury severity and other factors. These results indicate that comorbidity indices alone are insufficient for optimal patient care, necessitating the inclusion of social determinants in treatment and discharge planning., (Published by Elsevier Inc.)

Inhibiting the immune checkpoint (ICP) PD-1 based on PD-L1 expression status has revolutionized the treatment of various cancers, yet its efficacy in anaplastic thyroid carcinoma (ATC) remains limited. The therapeutic response depends upon multiple factors, particularly the conduciveness of the tumor's immune milieu. This study comprehensively evaluated and classified ATC's immune microenvironment (IME) to elucidate the factors behind suboptimal response to anti-PD therapy. Utilizing multiplex-immunofluorescence and immunohistochemistry, we retrospectively analyzed 26 cases of ATC for expression of ICPs PD-L1, PD-1, CTLA4, TIM3, and Galectin-9 and tumor-infiltrating cytotoxic T lymphocytes (CTL)-the effector cells, the anti-tumor NK cells, the immune-inhibitory myeloid-derived suppressor (MDSC) and regulatory T (Treg) cells, and B lymphocytes. Most ATCs (65%) exhibited PD-L1 positivity, but only 31%, in addition, had abundant CTL (type I IME), a combination associated with a better response to ICP inhibition. Additionally, PD-1 expression levels on CTL were low/absent in most cases-a "target-missing" situation-unfavorable for an adequate therapeutic response. All but one ATC showed nuclear Galectin-9 expression. The documentation of nuclear expression of Galectin-9 akin to benign thyroid is a first, and its role in ATC pathobiology needs further elucidation. In addition to less abundant PD-1 expression on CTL, the presence of MDSC, Treg, and exhausted cytotoxic T lymphocytes in the immune milieu of ATC can contribute to anti-PD resistance. TIM3, the most frequently expressed ICP on CTL, followed by CTLA4, provides alternate therapeutic targets in ATC. The co-expression of multiple immune checkpoints is of great interest for ATC since these data also open the avenue for combination therapies., Competing Interests: Declarations. Conflict of Interest: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose of Review: Racial disparities in sleep health as well as the diagnosis and treatment of sleep disorders have emerged as a key driver of cardiovascular outcomes. Obstructive sleep apnea (OSA), is characterized by repeated airway obstructions during sleep and is associated with an increased risk of cardiovascular disease. While racial and ethnic minorities have disproportionately high OSA prevalence rates, diagnosis rates remain low. One explanation behind this phenomenon are structural environmental and lifestyle barriers that prevent access to OSA care. Additionally, there remains significantly limited understanding of OSA and its causes and symptoms within communities., Recent Findings: In general, minorities have poorer sleep health due to systemic and environmental racism, which also causes an increased in conditions such as obesity that increases OSA risk. Disparities also persist within various types of OSA treatment. The most common form of treatment, continuous positive airway pressure (CPAP) has lower adherence among African Americans, as well as those living in areas with low socioeconomic status (SES), primarily minorities. There have been a small number of studies that have shown some initial success of educational campaigns about OSA within minority communities in increasing screenings and diagnoses. Peer based education has been an effective technique, and there is a need for such programs to be expanded., Summary: Disparities persist, with minority groups having worse sleep health and lower rates of adherence to OSA treatment. Some grassroots, peer-led educational campaigns show promise in increasing adherence. In light of these disparities, there remains a need for the field of sleep medicine to continue addressing the systemic barriers that hinder the timely evaluation and treatment in racial minorities., Competing Interests: Competing interests: The authors declare no competing interests. Conflict of Interest: None.

Exploration of the incidence and outcomes of Acute Kidney Injury (AKI) broadly, and sepsis associated AKI specifically, in Aboriginal and Torres Strait Islander (First Nations) people has been limited. We compared a nested cohort of First Nations people drawn from a multinational randomised controlled trial of hydrocortisone in septic shock, to a cohort matched for age, sex and severity of illness. Acute Kidney Injury was defined using the Kidney Disease Improving Global Outcomes (KDIGO) criteria, as well as incident use of kidney replacement therapy (KRT). Major Adverse Kidney Events (MAKE) were described as the composite of death, new dialysis requirement or persisting kidney dysfunction at hospital discharge. A cohort of 57 Aboriginal and/or Torres Strait Islander patients with septic shock was identified. 91.2% (52) of the First Nations cohort met KDIGO criteria for Stage 1 AKI or greater and 63% (36) met Stage 3 criteria. 59.6% (34) of the First Nations required dialysis as compared to 45.6% (26) in the matched cohort. 60.7% (34) of First Nations participants met criteria for MAKE at hospital discharge. The proportions requiring dialysis at 6, 12 and 24 months were 8.3%, 9.1% and 6.9% respectively. The incidences of AKI and MAKE reported in this First Nations cohort are substantially higher than in previously published cohorts of patients with sepsis, even those that use sensitive definitions of AKI. Measures to promote better management of infectious diseases in First Nations communities are required., (© 2024 Asian Pacific Society of Nephrology.)

Introduction: The popularity of nonoperative management for acute appendicitis is based on the untested assumption that it offers a lower risk alternative to surgery in patients who are at high risk for morbidity and mortality with appendectomy. We hypothesized that patients who were at a high risk with appendectomy would also be at a high risk for complications following nonoperative management., Methods: This is a retrospective cohort study of patients with acute, uncomplicated appendicitis in the 2004-2017 National Inpatient Sample. We used a logistic regression model to predict the risk of morbidity or mortality following appendectomy and applied this model to predict the risk of patients managed nonoperatively. High risk was defined as ≥2 standard deviations above the mean predicted risk of morbidity or mortality. We used inverse probability weighting of the propensity score to compare outcomes of nonoperative versus operative management for high-risk patients., Results: The sample included 21,242 high-risk patients with a median age of 68 years (interquartile range 57-78), and 31% were managed nonoperatively. Compared to surgery, nonoperative management was associated with a 9% decrease in complications (95% confidence interval [CI] 7%-10%), 2% increase in mortality (95% CI 2%-3%), $10,202 increase in hospital costs (95% CI $9,065-$11,339), 3-day increase in length of stay (95% CI 2-3), and 9% greater likelihood of discharge to skilled nursing facilities (95% CI 8%-10%)., Conclusion: Nonoperative management of acute appendicitis in high-risk patients may reduce morbidity but increase mortality, duration of hospitalization, discharge to skilled facility, and costs. Surgeons should exercise caution when considering nonoperative management in these vulnerable patients., Competing Interests: Conflict of Interest/Disclosure We have no conflicts of interest to report., (Published by Elsevier Inc.)

Background: The Milan System for Reporting Salivary Gland Cytopathology is an effective reporting system for salivary gland fine needle aspirations with well-established risks of malignancy. Salivary gland neoplasm of uncertain malignant potential (SUMP) comprises a heterogenous group of lesions which have features that can be recognized as at least neoplastic but preclude further classification into benign or malignant. In this study, we reviewed the cytomorphologic features of salivary gland fine needle aspirations diagnosed as SUMP at our institution (over the past 6 years) and correlated those with the final diagnosis on surgical follow up., Design: A retrospective search was performed to identify cases classified as SUMP at our institution from January 2018 to February 2024. Cytology slides were reviewed, and cases were subclassified based on key cytomorphologic features into the following categories: (1) basaloid, (2) oncocytic, (3) with clear cell features and (4) mixed features (myoepithelial/oncocytoid/squamoid features). Histologic diagnosis was recorded if available., Results: A total of 36 cases of SUMP were identified; 31/36 had surgical follow up; final diagnosis included 22 benign lesions (2 non-neoplastic and 20 benign neoplasms), and nine malignant lesions. The overall risk of neoplasm and risk of malignancy were 93.5% and 29% respectively, with the oncocytic sub-category recording the highest ROM (42.8%). Mucoepidermoid carcinoma was the most common malignant diagnosis and pleomorphic adenoma the most common benign diagnoses., Conclusions: Our study supports the subclassification of SUMP lesions based on key cytomorphologic features, thereby aiding in refining this ambiguous entity and providing a precise risk assessment., (© 2024 Wiley Periodicals LLC.)

Despite the benefits of continuous glucose monitoring (CGM), there is lower use of this technology among non-Hispanic Black and Hispanic people with type 1 diabetes compared with their non-Hispanic White counterparts. The T1D Exchange Quality Improvement Collaborative recruited five endocrinology centers to pilot an equity-focused quality improvement (QI) study to reduce racial inequities in CGM use. The centers used rapid QI cycles to test and expand interventions such as provider bias training, translation of CGM materials, provision of CGM education in multiple languages, screening for social determinants of health, and shared decision-making. After implementation of these interventions, median CGM use increased by 7% in non-Hispanic White, 12% in non-Hispanic Black, and 15% in Hispanic people with type 1 diabetes. The gap between non-Hispanic White and non-Hispanic Black patients decreased by 5%, and the gap between non-Hispanic White and Hispanic patients decreased by 8%., Competing Interests: O.E. is a compensated Health Equity Advisory Board member for Medtronic Diabetes and serves as principal investigator for investigator-led projects sponsored by Abbott, Eli Lilly, Insulet, and Medtronic. He is compensated through his organization, the T1D Exchange. No other potential conflicts of interest relevant to this article were reported., (© 2024 by the American Diabetes Association.)

Competing Interests: Declarations Conflict of Interest None.