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Nurdan Kokturk,1 Mehmet Polatli,2 I Kivilcim Oguzulgen,1 Sarfraz Saleemi,3 Mohammed Al Ghobain,4 Javed Khan,5 Adam Doble,6 Luqman Tariq,7 Fayaz Aziz,7 Abdelkader El Hasnaoui7 1Department of Pulmonary Medicine, School of Medicine, Gazi University, Besevler, Turkey; 2Department of Pulmonary Medicine, School of Medicine, Adnan Menderes University, Aydin, Turkey; 3Section of Pulmonary Medicine, Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; 4Department of Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 5Department of Medicine, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia; 6Foxymed, Paris, France; 7GlaxoSmithKline, Dubai, UAE Background: COPD affects millions of people worldwide. Poor treatment adherence contributes to increased symptom severity, morbidity and mortality. This study was designed to investigate adherence to COPD treatment in Turkey and Saudi Arabia. Methods: An observational, cross-sectional study in adult COPD patients in Turkey and Saudi Arabia. Through physician-led interviews, data were collected on sociodemographics and disease history, including the impact of COPD on health status using the COPD Assessment Test (CAT); quality of life, using the EuroQol Five-Dimension questionnaire (EQ-5D); and anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Treatment adherence was measured using the 8-item Morisky Medication Adherence Scale (MMAS-8). Multivariate logistic regression analysis examined the predictors of non-adherence and the impact of adherence on symptom severity. Results: Four hundred and five COPD patients participated: 199 in Turkey and 206 in Saudi Arabia. Overall, 49.2% reported low adherence (MMAS-8 15) compared to 58.4% reporting medium/high adherence (p=0.0008). Patients with low adherence reported a lower mean 3-level EQ-5D utility value (0.54±0.35) compared to those with medium/high adherence (0.64±0.30; p10 was associated with lower adherence (OR 2.50 [95% CI: 1.43–4.39] and 2.43 [95% CI: 1.39–4.25], respectively; p=0.0008). Being a high school/college graduate was associated with better adherence compared with no high school (OR 0.57 [95% CI: 0.33–0.98] and 0.38 [95% CI: 0.15–1.00], respectively; p=0.0310). After adjusting for age, gender, and country, a significant association between treatment adherence (MMAS-8 score ≥6) and lower disease impact (CAT ≤15) was observed (OR 0.56 [95% CI: 0.33–0.95]; p=0.0314). Conclusion: Adherence to COPD treatment is poor in Turkey and Saudi Arabia. Non-adherence to treatment is associated with higher disease impact and reduced quality of life. Depression, age, and level of education were independent determinants of adherence. Keywords: COPD, non-adherence, 8-item Morisky Medication Adherence Scale, MMAS-8, EuroQol Five-Dimension questionnaire, EQ-5D, COPD Assessment Test, CAT, Turkey, Saudi Arabia

Bassam Mahboub,1 Ashraf Alzaabi,2 Mohammed Nizam Iqbal,3 Hocine Salhi,4 Aïcha Lahlou,5 Luqman Tariq,6 Abdelkader El Hasnaoui6 1Department of Pulmonary Medicine and Allergy, University of Sharjah, Sharjah, 2Respirology Division, Zayed Military Hospital, Abu Dhabi, 3Department of Pulmonary Medicine, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates; 4Foxymed, Paris, France; 5MS Health, Rabat, Morocco, 6GlaxoSmithKline, Dubai, United Arab Emirates Objective: To assess the frequency of comorbidities in subjects with COPD and their association with respiratory symptom severity and COPD exacerbations.Materials and methods: This was an analysis of the BREATHE study, a cross-sectional survey of COPD conducted in the general population of eleven countries in the Middle East and North Africa, including Pakistan. The study population consisted of a sample of subjects with COPD for whom the presence of comorbidities was documented. Three questionnaires were used. The screening questionnaire identified subjects who fulfilled an epidemiological case definition of COPD and documented any potential comorbidities; the detailed COPD questionnaire collected data on respiratory symptoms, COPD exacerbations, and comorbidities associated with COPD; the COPD Assessment Test collected data on the impact of respiratory symptoms on well-being and daily life.Results: A total of 2,187 subjects were positively screened for COPD, of whom 1,392 completed the detailed COPD questionnaire. COPD subjects were more likely to report comorbidities (55.2%) than subjects without COPD (39.1%, P

Managing the vast quantities of waste constantly generated by mining activities is one of the major environmental and economic problems facing mankind today. Fluorapatite is separated from the associated gangue minerals by a series of crushing and screening, washing, and flotation processes. These processes produce a significant amount of phosphate sludge, which is stored on the mine site in drift rock and large surface ponds. One possible environmental option is to reuse it as an alternative raw material in ceramics and building materials. Consequently, two phosphate sludges from two different Moroccan towns, Youssoufia and Khouribga, were studied. Due to the complexity of these raw materials resulting from long geological processes, in-depth physical, chemical, mineralogical, and thermal characterization is required. Dry compressed powder pellets were sintered at 900 °C, 1000 °C, and 1100 °C for 2 h. The study focuses on the effect of sintering temperature on mineralogical transformations and ceramic properties such as apparent porosity, water absorption, and mechanical strength. At 1100 °C, a slight increase in density was observed for both phosphate sludges. Water absorption was reduced by 2.51 % in both sludges for pellets sintered at 1100 °C compared to those sintered at 900 °C. Mechanical strength improved significantly, with an increase of about 60 % for samples sintered at 1100 °C, recording 227 N for Youssoufia sludge and 247 N for Khouribga sludge. This work has provided new data on the physical, chemical, mineralogical, and thermal changes in ceramics as the sintering temperature increases. These data will be useful for the manufacture of high-value ceramics.

Introduction: Renal artery embolization has been used in a palliative fashion for symptomatic relief of hematuria or flank pain in unresectable renal cell carcinoma in adults. There is limited data on using embolization for actively bleeding and unresectable tumours in the oncological pediatric population. Case description: A previously healthy, five-year-old boy with no significant past medical or surgical history presented to the clinic with gradually worsening abdominal distension associated with occasional abdominal pain, gross hematuria, and lethargy for four months. Diagnostic investigations showed an 18 cm left-sided metastatic (pulmonary) renal tumour (Wilms), which was deemed unresectable on imaging. Treatment was planned on SIOP-RTSG protocol. However, he became hemodynamically and vitally unstable with acute sudden distension of the abdomen on the left side after the first cycle of chemotherapy. Imaging showed active bleeding from an inferior branch of the left renal artery. Selective angioembolization was done, and chemotherapy was reinitiated with a patent left main renal artery. Following the fourth cycle of chemotherapy, he developed hemodynamic instability and abdominal pain; imaging revealed the resolution of pulmonary nodules and bleeding from the left renal artery (main); this was again embolized, and the patient was stabilized. The patient was operated on after optimization and complete resection of the mass was done with negative margins. On six months follow up, he is well. Practical implications: To the best of our knowledge, this is the first case where angioembolization has been done in conjunction with neoadjuvant chemotherapy to downsize a Wilms Tumor to achieve favourable outcomes. Continued research efforts are necessary to optimize strategies and improve the prognosis for pediatric patients, and this case is one of the prime examples.

Introduction: Wilms tumor is the most common renal malignancy in children. The occurrence of Wilms tumor with various congenital genitourinary anomalies has been reported, particularly in horseshoe kidneys, hypospadias, disorder of sexual development, and double collecting system. However, Wilms tumor with crossed renal ectopia is a rare finding. Case Description: We are reporting a case report of Wilms tumor in a 3-year-old girl who presented with a huge left flank mass with cross-fused renal ectopia. After the initial workup and triphasic computed tomography (CT) scan of the chest, abdomen, and pelvis for confirmation of diagnosis and metastasis, the patient underwent image-guided tissue biopsy followed by neo-adjuvant chemotherapy, left radical nephrectomy with separation of fused right ectopic renal moiety and adjuvant chemoradiation. Practical Implication: This report shows an association of Wilms tumor with cross-fused renal ectopia, a rare combination. Unusual findings on imaging with unilateral flank mass should be considered as part of the differential diagnosis for this rare finding. Adjuvant chemotherapy and modern imaging helped delineate the anatomy and ease the surgery for safe resection, improving the overall outcome.

Introduction: Renal Ewing sarcoma is an aggressive and rare malignancy affecting children and adolescents. Limited data on its management contributes to uncertainties in treatment Case description: We present two pediatric cases of Renal Ewing Sarcoma. Both cases emphasize the significance of accurate diagnosis, multimodal treatment, and long-term follow-up in achieving favourable outcomes. Accurate diagnosis of renal Ewing sarcoma is crucial for effective management. Multimodal treatment involving neoadjuvant chemotherapy, surgical resection and staging with lymph node sampling, and chemotherapy continuation has shown promising results in our cases. Long-term follow-up is essential for monitoring disease progression and ensuring optimal outcomes. Practical Implications: There is limited data published about these renal tumors, especially in the pediatric population, and most studies lack long-term follow-up (6,7,20), with uncertain management due to limited data. This data will add to the newer and multimodal approach and form the basis for future meta-analysis to help formulate guidelines in upcoming international meetings. Continued research efforts are necessary to optimize strategies and improve the prognosis for pediatric patients with renal Ewing sarcoma.

Vaccine hesitancy has, for a considerable time, been a significant risk to global health. As an integral part of disease prevention, vaccines have become a public health matter which is often debated among the community in spite of proven scientific evidence of their efficiency. A questionnaire was designed to evaluate the perception and knowledge of a population and compare it with behavior in order to assess a demographic within a sample population of 245 individuals selected at random within the United States, Here, we aim to clarify the difference between vaccine opinion among the general public as compared to vaccination status. Chi-squared analysis was done with the categorical data showing a statistically significant result when comparing parents versus non-parents, and Asian/Asian Americans against other ethnicities. All other comparisons were statistically insignificant. When looking at participant responses, PCPs did not discuss vaccines at all with 32% of the sample. The need for PCPs to provide educational information to certain ethnicities may play an important role in public health.

The energy demand is increasing due to population growth and economic development. To satisfy this energy demand, the use of renewable energy is essential to face global warming and the depletion of fossil fuels. Photovoltaic energy is one of the renewable energy sources, widely used by several countries over the world. The integration of PV energy into the grid brings significant benefits to the economy and environment, however, high penetration of this energy also brings some challenges to the stability of the electrical grid, due to the intermittency of solar energy. To overcome this issue, the use of a forecasting system is one of the solutions to guarantee an effective integration of PV plants in the electrical grid. In this paper, a PV power ultra short term forecasting has been done by using univariate and multivariate LSTM models. Different combinations of input variables of the models and different timesteps forecasting were tested and compared. The main aim of this work is to study the influence of the different combinations of variables on the accuracy of the LSTM models for one-step forecasting and multistep forecasting and comparing the univariate and multivariate LSTM models with MLP and CNN models . The results show that for one step forecasting, the use of a univariate model based on historical data of PV output power is sufficient to get accurate forecasting with 28.98W in MAE compared to multivariate models that can reach 35.39W. Meanwhile, for multistep forecasting, it is mandatory to use a multivariate model that has historical data of meteorological variables and PV output power in the input of LSTM model. Moreover, The LSTM model shows great accuracy compared to MLP and CNN especially in multistep PV power forecasting.

Introduction: Anal fissure is a common problem in children, the exact etiology of which is unknown and it mostly presents with painful defecation and bleeding per rectum. The standard treatment of anal fissure is lateral internal sphincterotomy but due to risk of fecal incontinence chemical sphincterotomy is used as alternative to surgical sphincterotomy. Aims & Objectives: To compare the effectiveness of topical diltiazem and lignocaine with glyceryl trinitrate and lignocaine in relieving of symptoms and healing of acute anal fissure in children. Place and duration of study: This study was conducted in the Department of Paediatric Surgery, Shaikh Zayed Hospital, Lahore & Department of Paediatric Surgery, Fatima Memorial Hospital, Lahore from September 2017 to September 2018. Material & Methods: Total 228 children were enrolled in the study and randomly divided in group A and B, 114 children in each group. Group A received topical 2% diltiazem cream and 2% lignocaine gel, while group B received topical 0.2% glyceryl trinitrate and 2% lignocaine gel, applied locally, twice daily. Results: There were 78(68.4%) male children in group A and 66(57.9%) in group B. All patients completed 6 week treatment course. The symptoms and condition of the anal fissure were evaluated before start of treatment and at subsequent follow up periods. In group A 55 (48.2%) cases completely healed by second week, while in group B, 33 (28.9%) cases healed. The number of completely healed cases at 4 weeks follow up in group A and group B were 91 (79.8%) and 69(60.5%) respectively, while at week 6 follow up this rate was 95 (83.3%) and 73 (64.0%) respectively. Symptomatic relief in painful defecation observed in group A and group B was 74(64.9%) and 55(48.2%) at week 2, 95(83.3%) and 74(64.9%) at week 4 while 95(83.3%) and 77(67.5%) at week 6 in two groups respectively. Conclusion: Use of combination of topical diltiazem and lignocaine for the treatment of acute anal fissure in paediatric population is preferred over combination of glyceryl trinitrate and lignocaine.

General anesthesia (GA) or monitored anesthesia care (MAC) is increasingly used to perform ERCP. The definitive choice between the 2 sedative types remains to be established. This study compared outcomes of GA with MAC in ERCP performed in patients at average risk for sedation-related adverse events (SRAEs). At a tertiary referral center, patients with American Society of Anesthesiologists (ASA) class ≤III were randomly assigned to undergo ERCP with MAC or GA. The main outcome was a composite of hypotension, arrhythmia, hypoxia, hypercapnia, apnea, and procedural interruption or termination defined as SRAEs. In addition, ERCP procedural time, success, adverse events, and endoscopist and patient satisfaction were compared. Of 204 randomized, 203 patients were evaluated for SRAEs (MAC, n = 96; GA, n = 107). SRAEs developed in 35% of the MAC cohort (34/96) versus 9% in the GA cohort (10/107), which was statistically significant (P <.001). Mean induction time for GA was significantly longer than that for MAC (10.3 ± 10 minutes vs 6.5 ± 10.8 minutes, respectively; P <.001). ERCP procedure time, recovery time, cannulation time and success, and procedure-related adverse events were not statistically different between the 2 sedative groups. The use of GA improved endoscopist and patient satisfaction (P <.001). GA is safe with fewer SRAEs than MAC in patients with ASA scores ≤III undergoing ERCP. Apart from prolonging induction time, use of GA does not change the procedural success or ERCP-related adverse events and offers greater endoscopist and patient satisfaction. Hence, GA is a consideration in patients undergoing ERCP in this population group. (Clinical trial registration number: NCT04099693.) [Display omitted] [ABSTRACT FROM AUTHOR]

Introduction: Conventional radiation therapy has been progressively replaced by fractionated stereotactic radiotherapy (FSRT) and single fraction radiosurgery for dealing with benign intracranial lesions. Purpose of our study is to investigate the safety and efficacy of FSRT in a series of patients with benign intracranial tumors. Methods: 31 patients with benign intracranial lesions treated with FSRT between 2006 and 2014 were retrospectively reviewed. Indications for treatment included post-operative residual tumor growth or symptomatic exacerbation in patients in whom surgery was not indicated. A clinical and radiological outcome evaluation was performed. Univariate analysis was executed to identify predictors for post-treatment neurological function and radiological tumor control. Results: Median age was 62 years (range 22–82). The lesions treated included 20 meningiomas, 2 vestibular schwannomas, 7 pituitary adenomas, 1 craniopharyngioma, 1 jugular-tympanic paraganglioma. Median clinical target volume was 14.59 cm3 (range 0.43–159.06) and median planning treatment volume was 18.16 cm3 (range 0.81–217.24). Median total dose was 45 Gy (range 25–54), and median daily fraction 4 Gy (range 1.8–9). At a median follow-up of 78 and 50 months, respectively clinical and neuroradiological, no tumor had larger dimensions, and only one lesion changed in a way other than size determining a concomitant clinical worsening. Other three patients deteriorated without evidence of radiological progression. Conversely, 12 patients improved clinically. No significant predictor for post-treatment neurological function or radiological tumor control was found. Conclusion: FSRT may represent, when indicated, a safe and effective treatment modality for benign intracranial tumors, especially for large/irregular lesions. Keywords: Clinical outcome, Fractionated stereotactic radiotherapy, Intensity-modulated radiotherapy, Intracranial benign lesions, Tumor progression, Radiotherapy

Bismuth vanadate (BiVO4) has recently been under focus for its potential use in photocatalysis thanks to its well-suited absorption edge in the visible light range. Here, we characterize the optical absorption of a BiVO4 single crystal as a function of temperature and polarization direction by reflectance and transmittance spectroscopy. The optical bandgap is found to be very sensitive to the temperature, and to the tetragonal-to-monoclinic ferroelastic transition at 523 K. The anisotropy, as measured by the difference in the absorption edge for the light polarized parallel and perpendicular to the principal axis, is reduced from 0.2 eV in the high-temperature tetragonal phase to 0.1 eV at ambient temperature. We show that this evolution is dominantly controlled by the ferroelastic shear strain. These findings provide a route for further optimization of bismuth vanadate-based light absorbers in photocatalytic devices.

We present a new method for multi-source semi-supervised domain adaptation in remote sensing scene classification. The method consists of a pre-trained convolutional neural network (CNN) model, namely EfficientNet-B3, for the extraction of highly discriminative features, followed by a classification module that learns feature prototypes for each class. Then, the classification module computes a cosine distance between feature vectors of target data samples and the feature prototypes. Finally, the proposed method ends with a Softmax activation function that converts the distances into class probabilities. The feature prototypes are also divided by a temperature parameter to normalize and control the classification module. The whole model is trained on both the unlabeled and labeled target samples. It is trained to predict the correct classes utilizing the standard cross-entropy loss computed over the labeled source and target samples. At the same time, the model is trained to learn domain invariant features using another loss function based on entropy computed over the unlabeled target samples. Unlike the standard cross-entropy loss, the new entropy loss function is computed on the model’s predicted probabilities and does not need the true labels. This entropy loss, called minimax loss, needs to be maximized with respect to the classification module to learn features that are domain-invariant (hence removing the data shift), and at the same time, it should be minimized with respect to the CNN feature extractor to learn discriminative features that are clustered around the class prototypes (in other words reducing intra-class variance). To accomplish these maximization and minimization processes at the same time, we use an adversarial training approach, where we alternate between the two processes. The model combines the standard cross-entropy loss and the new minimax entropy loss and optimizes them jointly. The proposed method is tested on four RS scene datasets, namely UC Merced, AID, RESISC45, and PatternNet, using two-source and three-source domain adaptation scenarios. The experimental results demonstrate the strong capability of the proposed method to achieve impressive performance despite using only a few (six in our case) labeled target samples per class. Its performance is already better than several state-of-the-art methods, including RevGrad, ADDA, Siamese-GAN, and MSCN.

Three phosphate glass compositions, VF1, VF2, and VF3, containing macro and micronutrients with different [K2O/(CaO+MgO)] ratio, were formulated to be used as controlled release fertilizers for tomato crop, depending on their chemical durability in water and their propriety with respect to the standards of controlled-release fertilizers. This study investigated the influence of [K2O/(CaO+MgO)] ratio variation on glass properties. For this, the elaborated glasses have undergone a chemical characterization using inductively coupled plasma atomic emission spectroscopy, a thermal characterization using differential thermal analysis, a physicochemical characterization based on density and molar volume measurements, and a structural characterization using Raman spectroscopy, Fourier-transform infrared spectroscopy, and X-ray diffraction. In addition, the chemical durability was determined by measuring the percentage of weight loss and the pH. Results revealed that the glass structure and composition have the mean role in controlling the release of nutrients in water. By increasing [K2O/(CaO+MgO)] ratio, the dissolution rates of the glasses increased due to the shrinking in the rate of crosslinking between phosphate chains, accompanied with a diminution in transition and crystallization temperatures, and an increase in the molar volume. An agronomic valorization of VF1 and VF2 glass fertilizers, which showed dissolution profiles adequate to the criteria of controlled-release fertilizers, was carried out to evaluate their efficiency on tomato crops. These glass fertilizers improved soil mineral content and tomato performances in comparison to the control and NPK treatments with the distinction of VF2. The results highlight the effectiveness of these smart fertilizers toward their potential large-scale application to improve crop production and quality for high nutritional value foods.

Four different phosphate glass formulations (F0, F1, F2, and F3) were developed according o wheat nutrient requirements to be used as controlled-release fertilizers. These glasses contain macro-elements (P2O5-K2O-CaO-MgO), with the addition of microelements (Fe-Mn-Zn-B-Cu-Mo) in each formulation. The effects of these elements’ addition on thermal properties, glass structure, and dissolution behaviors were investigated. Results showed that these glasses are composed essentially of metaphosphate chains and that the addition of micronutrients could change the chemical durability of phosphate glasses. A greenhouse experiment was performed using wheat (Triticum durum L.) to evaluate the efficiency of the four glasses, with or without application of chemical nitrogen (N) (N + VF and VF, respectively). The different formulas were tested using two rates of 0.3 and 1 g per plant. In addition to the vitreous fertilizer formulations, two other treatments were applied: control treatment with no amendment and Nitrogen-Phosphorus-Potassium treatment with the application of the conventional fertilizers on the base of optimal rates. After four months of cultivation, vitreous fertilizers application significantly improved growth (7% to 88%), photosynthetic (8% to 49%) parameters, and yield (29% to 33%) compared to NPK treatment and to the control. It has been found that formulas F1, F2, and F3 may constitute a potential alternative to conventional fertilization due to their positive impact on wheat production and can be used in practice as an environmentally controlled-release fertilizer.

Primary sternal osteomyelitis (PSO) in the pediatric population is a rare infection with potentially catastrophic ramifications. We describe a case in a seven-month-old male patient who presented without evidence of trauma or a source of infection. Open sternal biopsies and cultures revealed Methicillin Sensitive Staphylococcus Aureus (MSSA) as the organism. We discuss the preoperative and surgical management of this patient as well as the antibiotic treatment strategy.

Phosphate glasses have potentially interesting properties that can be used in various applications. Recently, different studies are focusing on their dissolution behaviours that can be modified to suit some environmental applications, such as controlled-release fertilisers. In this work, magnesium had been suggested to improve the glass durability of 3P2O5-2K2O-(1 − x)CaO-xMgO glasses (0 ≤ x ≤ 1). Indeed, its effect on glass structure, thermal properties and most important dissolution behaviours were studied, in order to evaluate their suitability of being used as controlled-release fertilisers. Various compositions in which calcium was partially replaced by magnesium were prepared by melting at 800 °C. The samples were characterised by differential scanning calorimetry, density measurements, X-Ray diffraction, FTIR spectroscopy and Raman spectroscopy. The dissolution behaviours were investigated using inductively coupled plasma optical emission spectrometry ICP-OES, pH measurements and SEM. Substitution of calcium by magnesium reduced the glass density, owing to the lower atomic weight of magnesium compared to calcium, and caused an increase in glass transition and crystallisation temperatures. Magnesium substitution significantly improved the chemical durability of the glasses due to more covalent Mg–O bond than the Ca–O bond. This study demonstrated that 3P2O5-2K2O-0.3CaO-0.7MgO (x = 0.7) had a dissolution profile adequate to the criteria of controlled-release fertilisers and could be used to nourish the plants with phosphorus, potassium, calcium and magnesium.

Quantifying the magnitude and timing of groundwater returns to streams from irrigation is important for the management of natural resources in irrigation districts where the quantity or quality of surface water can be affected. Deep vadose zones and perched water tables can complicate the modelling of these fluxes, and model outputs may be biased if these factors are misrepresented or ignored. This study was undertaken in the Murray Basin in southern Australia to develop and test an integrated modelling method that links irrigation activity to surface water impacts by accounting for all key hydrological processes, including perching and vadose zone transmission. The method incorporates an agronomic water balance to simulate root zone processes, semi-analytical transfer functions to simulate the deeper vadose zone, and an existing numerical groundwater model to simulate irrigation returns to the Murray River and inform the management of river salinity. The integrated modelling can be calibrated by various means, depending on context, and has been shown to be beneficial for management purposes without introducing an unnecessary level of complexity to traditional modelling workflows. Its applicability to other irrigation settings is discussed.

Background: Enteric duplication (ED) cysts include a wide variety of cystic lesions, which can involve any part of the gastrointestinal tract (GIT). They can be referred to foregut, midgut, hindgut derived, depending upon the portion of GIT involved. The main purpose of this study was to document the variety of presentation, investigations, and treatment options employed. Patients and Methods: This was a retrospective study at Paediatric Surgery Department of Services Hospital, Lahore from August, 2011 to August, 2013. The details of all the patients, including gender, and age, presenting complaint, abdominal examination findings, diagnostic modality, site, type, associated malformations, surgical option, and outcome were analysed. Results: A total of eight patients with histopathological diagnosis of EDs managed were included in the study. Of these eight patients, six were males and two were females, with an average age of 2.4 years. The main diagnostic tool used was ultrasound in almost all patients. The most commonly involved site was ileum in 5 of 8 (62.5%) patients. Two cases had gastric involvement, while one patient had involvement of the descending colon. Six of eight were of tubular type (75%), while remaining 2 (25%) were of cystic type. Excision was possible in all these patients. Conclusion: ED can present with a wide spectrum of symptomatology. It can present as mass abdomen, intestinal obstruction or even can mimic as hydrocoele. High index of suspicion is therefore required. Ultimate aim of treatment is excision of cyst with preservation of vascularity of native gut.

We present the only case in English medical literature of a spinal neurofibroma misdiagnosed as a herniated disc using magnetic resonance imaging (MRI). This case presented with typical symptoms and radiological findings of a herniated disc. Intraoperatively, an abnormality was noted at the S1 nerve root sleeve. Further exploration revealed a spinal neurofibroma which was completely resected, resulting in an improvement in the patient’s symptoms. Currently, there is heavy reliance on MRI as a highly sensitive and specific tool used in the diagnosis of herniated lumbar discs. Although there have been occasional reports of misdiagnoses using MRI, there are no reported cases of a spinal neurofibroma being misdiagnosed as a herniated lumbar disc. Despite great advances in radiological diagnostic imaging, surgical surprises do still occur. Ultimately, instinct is still essential in intraoperative surgical decisions.

We present a case of heteropagus twins attached to the epigastric region. The neonate also had ruptured giant omphalocoele with most of gut and liver lying outside the abdominal cavity. Patient had uneventful surgery for separation of twins and repair of ruptured omphalocoele.

Abstract Background Counseling in combination with pedometer use has proven to be effective in increasing physical activity and improving health outcomes. We investigated the cost-effectiveness of this intervention targeted at one million insufficiently active adults who visit their general practitioner in the Netherlands. Methods We used the RIVM chronic disease model to estimate the long-term effects of increased physical activity on the future health care costs and quality adjusted life years (QALY) gained, from a health care perspective. Results The intervention resulted in almost 6000 people shifting to more favorable physical-activity levels, and in 5100 life years and 6100 QALYs gained, at an additional total cost of EUR 67.6 million. The incremental cost-effectiveness ratio (ICER) was EUR 13,200 per life year gained and EUR 11,100 per QALY gained. The intervention has a probability of 0.66 to be cost-effective if a QALY gained is valued at the Dutch informal threshold for cost-effectiveness of preventive intervention of EUR 20,000. A sensitivity analysis showed substantial uncertainty of ICER values. Conclusion Counseling in combination with pedometer use aiming to increase physical activity may be a cost-effective intervention. However, the intervention only yields relatively small health benefits in the Netherlands.

Abstract Background Alcohol abuse results in problems on various levels in society. In terms of health, alcohol abuse is not only an important risk factor for chronic disease, but it is also related to injuries. Social harms which can be related to drinking include interpersonal problems, work problems, violent and other crimes. The scope of societal costs related to alcohol abuse in principle should be the same for both economic evaluations and cost-of-illness studies. In general, economic evaluations report a small part of all societal costs. To determine the cost- effectiveness of an intervention it is necessary that all costs and benefits are included. The purpose of this study is to describe and quantify the difference in societal costs incorporated in economic evaluations and cost-of-illness studies on alcohol abuse. Method To investigate the economic costs attributable to alcohol in cost-of-illness studies we used the results of a recent systematic review (June 2009). We performed a PubMed search to identify economic evaluations on alcohol interventions. Only economic evaluations in which two or more interventions were compared from a societal perspective were included. The proportion of health care costs and the proportion of societal costs were estimated in both type of studies. Results The proportion of healthcare costs in cost-of-illness studies was 17% and the proportion of societal costs 83%. In economic evaluations, the proportion of healthcare costs was 57%, and the proportion of societal costs was 43%. Conclusions The costs included in economic evaluations performed from a societal perspective do not correspond with those included in cost-of-illness studies. Economic evaluations on alcohol abuse underreport true societal cost of alcohol abuse. When considering implementation of alcohol abuse interventions, policy makers should take into account that economic evaluations from the societal perspective might underestimate the total effects and costs of interventions.

Abstract Background Excessive alcohol use increases risks of chronic diseases such as coronary heart disease and several types of cancer, with associated losses of quality of life and life-years. Alcohol taxes can be considered as a public health instrument as they are known to be able to decrease alcohol consumption. In this paper, we estimate the cost-effectiveness of an alcohol tax increase for the entire Dutch population from a health-care perspective focusing on health benefits and health-care costs in alcohol users. Methods The chronic disease model of the National Institute for Public Health and the Environment was used to extrapolate from decreased alcohol consumption due to tax increases to effects on health-care costs, life-years gained and quality-adjusted life-years gained, A Dutch scenario in which tax increases for beer are planned, and a Swedish scenario representing one of the highest alcohol taxes in Europe, were compared with current practice in the Netherlands. To estimate cost-effectiveness ratios, yearly differences in model outcomes between intervention and current practice scenarios were discounted and added over the time horizon of 100 years to find net present values for incremental life-years gained, quality-adjusted life-years gained, and health-care costs. Results In the Swedish scenario, many more quality-adjusted life-years were gained than in the Dutch scenario, but both scenarios had almost equal incremental cost-effectiveness ratios: €5100 per quality-adjusted life-year and €5300 per quality-adjusted life-year, respectively. Conclusion Focusing on health-care costs and health consequences for drinkers, an alcohol tax increase is a cost-effective policy instrument.

Background: Excessive alcohol use increases risks of chronic diseases such as coronary heart disease and several types of cancer, with associated losses of quality of life and life-years. Alcohol taxes can be considered as a public health instrument as they are known to be able to decrease alcohol consumption. In this paper, we estimate the cost-effectiveness of an alcohol tax increase for the entire Dutch population from a health-care perspective focusing on health benefits and health-care costs in alcohol users.Methods: The chronic disease model of the National Institute for Public Health and the Environment was used to extrapolate from decreased alcohol consumption due to tax increases to effects on health-care costs, life-years gained and quality-adjusted life-years gained, A Dutch scenario in which tax increases for beer are planned, and a Swedish scenario representing one of the highest alcohol taxes in Europe, were compared with current practice in the Netherlands. To estimate cost-effectiveness ratios, yearly differences in model outcomes between intervention and current practice scenarios were discounted and added over the time horizon of 100 years to find net present values for incremental life-years gained, quality-adjusted life-years gained, and health-care costs.Results: In the Swedish scenario, many more quality-adjusted life-years were gained than in the Dutch scenario, but both scenarios had almost equal incremental cost-effectiveness ratios: 5100 euros per quality-adjusted life-year and 5300 euros per quality-adjusted life-year, respectively.Conclusion: Focusing on health-care costs and health consequences for drinkers, an alcohol tax increase is a cost-effective policy instrument. [ABSTRACT FROM AUTHOR]

Phytohormones are vital for developmental processes, from organ initiation to senescence, and are key regulators of growth, development, and photosynthesis. In natural environments, plants often experience high light (HL) intensities coupled with elevated temperatures, which pose significant threats to agricultural production. However, the response of phytohormone-related genes to long-term HL exposure remains unclear. Here, we examined the expression levels of genes involved in the biosynthesis of ten phytohormones, including gibberellins, cytokinins, salicylic acid, jasmonic acid, abscisic acid, brassinosteroids, indole-3-acetic acid, strigolactones, nitric oxide, and ethylene, in two winter wheat cultivars, Xiaoyan 54 (XY54, HL tolerant) and Jing 411 (J411, HL sensitive), when transferred from low light to HL for 2-8 days. Under HL, most genes were markedly inhibited, while a few, such as TaGA2ox , TaAAO3 , TaLOG1 , and TaPAL2 , were induced in both varieties. Interestingly, TaGA2ox2 and TaAAO3 expression positively correlated with sugar content but negatively with chlorophyll content and TaAGP expression. In addition, we observed that both varieties experienced a sharp decline in chlorophyll content and photosynthesis performance after prolonged HL exposure, with J411 showing significantly more sensitivity than XY54. Hierarchical clustering analysis classified the phytohormone genes into the following three groups: Group 1 included six genes highly expressed in J411; Group 2 contained 25 genes drastically suppressed by HL in both varieties; and Group 3 contained three genes highly expressed in XY54. Notably, abscisic acid (ABA), and jasmonic acid (JA) biosynthesis genes and their content were significantly higher, while gibberellins (GA) content was lower in XY54 than J411. Together, these results suggest that the differential expression and content of GA, ABA, and JA play crucial roles in the contrasting responses of tolerant and sensitive wheat cultivars to leaf senescence induced by long-term HL. This study enhances our understanding of the mechanisms underlying HL tolerance in wheat and can guide the development of more resilient wheat varieties.

Long non-coding RNAs (lncRNAs) have emerged as integral gene-expression regulators underlying plant growth, development, and adaptation. To adapt to the heterogeneous and dynamic rhizosphere, plants use interconnected regulatory mechanisms to optimally fine-tune gene-expression-governing interactions with soil biota, as well as nutrient acquisition and heavy metal tolerance. Recently, high-throughput sequencing has enabled the identification of plant lncRNAs responsive to rhizosphere biotic and abiotic cues. Here, we examine lncRNA biogenesis, classification, and mode of action, highlighting the functions of lncRNAs in mediating plant adaptation to diverse rhizosphere factors. We then discuss studies that reveal the significance and target genes of lncRNAs during developmental plasticity and stress responses at the rhizobium interface. A comprehensive understanding of specific lncRNAs, their regulatory targets, and the intricacies of their functional interaction networks will provide crucial insights into how these transcriptomic switches fine-tune responses to shifting rhizosphere signals. Looking ahead, we foresee that single-cell dissection of cell-type-specific lncRNA regulatory dynamics will enhance our understanding of the precise developmental modulation mechanisms that enable plant rhizosphere adaptation. Overcoming future challenges through multi-omics and genetic approaches will more fully reveal the integral roles of lncRNAs in governing plant adaptation to the belowground environment., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Most lung cancer patients with metastatic cancer eventually relapse with drug-resistant disease following treatment and EGFR mutant lung cancer is no exception. Genome-wide CRISPR screens, to either knock out or overexpress all protein-coding genes in cancer cell lines, revealed the landscape of pathways that cause resistance to the EGFR inhibitors osimertinib or gefitinib in EGFR mutant lung cancer. Among the most recurrent resistance genes were those that regulate the Hippo pathway. Following osimertinib treatment a subpopulation of cancer cells are able to survive and over time develop stable resistance. These 'persister' cells can exploit non-genetic (transcriptional) programs that enable cancer cells to survive drug treatment. Using genetic and pharmacologic tools we identified Hippo signalling as an important non-genetic mechanism of cell survival following osimertinib treatment. Further, we show that combinatorial targeting of the Hippo pathway and EGFR is highly effective in EGFR mutant lung cancer cells and patient-derived organoids, suggesting a new therapeutic strategy for EGFR mutant lung cancer patients., (© 2024. The Author(s).)

RCI2/PMP3s are involved in biotic and abiotic stresses and have an influence on the regulation of many genes. RCI2/PMP3 genes, which particularly encode small membrane proteins of the PMP3 family, are involved in abiotic stress responses in plants. In this work, in silico studies were used to investigate RCI2's potential function in stress tolerance and organogenesis. We conducted an extensive study of the RCI2 gene family and revealed 36 RCI2 genes from cotton species that were distributed over 36 chromosomes of the cotton genome. Functional and phylogenetic examination of the RCI2/PMP3 gene family has been studied in Arabidopsis, but in cotton, the RCI2/PMP3 genes have not yet been studied. Phylogenetic and sequencing studies revealed that cotton RCI2s are conserved, with most of them categorized into six distinct clades. A chromosome distribution and localization study indicated that cotton RCI2 genes were distributed unevenly on 36 chromosomes with segmental duplications, suggesting that the cotton RCI2 family is evolutionarily conserved. Many cis-elements related to stress responsiveness, development, and hormone responsiveness were detected in the promoter regions of the cotton RCI2. Moreover, the 36 cotton RCI2s revealed tissue-specific expression patterns in the development of cotton performed by transcriptome analysis. Gene structure analysis indicated that nearly all RCI2 genes have two exons and one intron. All of the cotton RCI2 genes were highly sensitive to drought, abscisic acid, salt, and cold treatments, demonstrating that they may be employed as genetic objects to produce stress-resistant plants., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)